Mechanism and Etiology of Primary Chronic Angle Closure Glaucoma

The ocular anatomic features, pupil-blocking force, status of angle synechiae closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary a-cute angle closure glaucoma (PAACG) by using ultrasonic biometry, computerized anterior ocular segment image processing technique, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG was shallower than that of PCACG; the pupil-blocking force of PAACG was st...

Surgical treatment for primary angle closure-glaucoma: a Meta analysis

AIM To evaluate the efficacy and safety of trabeculectomy, phacotrabeculectomy plus intraocular lens implantation (phacotrab+IOL group) and phacoemulsification with IOL (phaco+IOL) in primary angle-closure glaucoma(PACG). METHODS: It was a systematic review and meta-analysis, randomized controlled trials(RCT) and clinical controlled trials (CCT) were collected through electronic searches of the Cochrane Library, PubMed, EMbase, Wanfang Database online, Chinese journal Full-text Database, Chinese Scientific Journals Full-text Database (from the date of building the database to October 2010) We also checked the bibliographies of retrieved articles. M the related data that matched our standards were abstracted. The quality of included trials was evaluated according to the Dutch Cochrane Centre. Rev Man 5.0 software was used for Meta-analysis. RESULTS: A total of 5 RCT and 11 CCT involving 1495 eyes were included. The results of meta-analysis showed that phacotrab+IOL group was superior than trabeculectomy(trab group) (MD -3.93,95% CI [-7.31, -0.54]) which was also superior than phaco+IOL group(MD 0.52,95%CI [0.10, 0.95]) in decreasing Intraocular Pressure(IOP). Phacotrab group(MD -1.45,95%CI [-1.68, -1.22])and phaco group (MD-1.12,95% CI [-1.87, -0.37])are both deeper than trab group in the anterior chamber depth. In increasing the coefficient of outflow facility of aqueous humor (C values) there was no statistical difference in the three groups. And there was no statistical difference between phacotrab groups and phaco groups in visual acuity but phacotrab group was superior than phaco group (MD 1.07, 95% CI [0.73, 1.40])in the use of IOP-lowering drugs. There was no statistical difference among three groups. CONCLUSION: Current evidence suggests that phacotrab+IOL group was superior than tab group which was also superior than phaco+IOL group in decreasing IOP. Phacotrab group and phaco group are both deeper than trab group in the anterior chamber depth. Phacotrab group was superior than phaco group in the use of IOP-lowering drugs.

Clear lens extraction as the first line treatment of primary angle closure/primary angle closure glaucoma

Angle closure glaucoma(ACG)is one of the major causes of blindness.Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris,which results in increased intraocular pressure(IOP)through impaired aqueous flow.Considering pupillary block by crystalline lens is the most frequent mechanism,lens extraction is regarded as an effective therapy.Recently,to validate the effect of lens extraction,the EAGLE study was reported.In this study,subjects were 50 years or older,did not have cataracts,and had newly diagnosed primary angle closure(PAC)with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma(PACG),and were divided into clear-lens extraction group and standard care group(laser peripheral iridotomy and topical glaucoma medication).This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy.Initial clear lens extraction showed better clinical course and patient-reported outcomes.This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.

AB025.One-year outcomes of trabecular micro-bypass stents with concomitant cataract surgery in primary angle closure glaucoma

Background:Trabecular microbypass stents have allowed improved multidirectional flow with good efficacy and safety profile in primary open-angle glaucoma(OAG).The efficacy of these devices in primary angle closure glaucoma has been understudied.We aimed to assess the one-year postoperative outcomes following implantation of trabecular micro-bypass stents with concomitant cataract surgery in angle-closure glaucoma patients.Methods:We evaluated the baseline clinical characteristics and the 12-month outcomes of patients with mild to severe primary angle-closure glaucoma who underwent cataract surgery with implantation of either a first generation trabecular microbypass stent(iStent group)or two second generation trabecular microbypass stents(iStent-inject group).The primary outcomes included intraocular pressure(IOP)and anti-glaucoma medication use.The secondary outcomes were success rate(defined by IOP between 5-18 mmHg with IOP reduction of at least 20%)and visual acuity.Results:A total of 83 eyes(58 from the iStent and 25 from the iStent-inject group)were included with an average age of 68.9±8.6 and 67.6±8.3 years,respectively.All eyes had mild to severe angle-closure glaucoma.At one-year follow-up,the IOP decreased by 21%(from 18.8±4.5 mmHg)and 25%(from 18.7±3.6 mmHg),in each group respectively(P<0.001).Additionally,the medication burden dropped by 52%and 50%at one-year follow-up(P<0.001).The 12-month success rate was 45%in the iStent group compared to 64%in the iStent-inject group(P=0.086)and visual acuity remained stable.Conclusions:The present study provides clinically relevant,real-world data on the utility of iStent and iStent inject with cataract surgery in angle-closure glaucoma-a population that has been understudied in the world of trabecular micro-bypass stents.Our data demonstrated efficacy of these stents in reducing intraocular pressure and medication burden among patients with primary angle closure glaucoma.

Clinical Application of Cataract Ultrasonic Emulsification Combined with Atrial Angle Segmentation in the Treatment of Primary Angle-Closure Glaucoma

Objective:To evaluate the therapeutic effect of cataract ultrasonic emulsification(PE)combined with atrial angle separation(CSS)for primary angle-closure glaucoma(PACG).Methods:78 patients with PACG admitted to the hospital between October 2021 and October 2023 were selected and grouped by randomized numerical table;39 cases were counted in the observation group and selected PE combined with CSS surgery;39 cases were counted in the reference group and selected PE combined with trabeculectomy and the total effective rate,the state of the atrial angle,the clinical indexes,the degree of ocular symptoms,and the complication rate were compared.Results:The total effective rate of the observation group was higher than that of the reference group,and the percentage of the wide atrial angle of the atrial angle status was higher than that of the reference group;3 months after the operation,the logarithm of the minimum angle of resolution(Log MAR)and intraocular pressure of the observation group was lower than that of the reference group,and the central anterior chamber depth(ACD)was greater than that of the reference group;the scores of the degree of ocular symptoms of the observation group were lower than that of the reference group,and the rate of complication was lower than that of the reference group(P<0.05).Conclusion:PE combined with CSS surgical treatment for PACG patients can improve the efficacy of treatment,improve the state of the patients’atrial angles,and restore the ocular function indexes.It can alleviate the ocular symptoms as soon as possible and has a high surgical safety.

Genome-wide association study in primary angle closure glaucoma

Before the Human Genome Project,family-based mapping,positional cloning and mutation screening of candidate genes were largely used to ascertain the etiology of a given genetic disease.While this method proved to be very effective for most Mendelian single-gene disorders,it was not efficient for multigenic disorders with unknown genetic etiology.Subsequent advancement in molecular genetics techniques provided an opportunity to screen millions of biological markers in thousands of patients in a relatively short period of time.One rapid technique that is already used in a large number of clinical disorders is genome-wide association study(GWAS).Other screening methods include next-generation exome sequencing,whole-genome sequencing and targeted regional sequencing.

Analysis of SMOC2 gene variants in familial and nonfamilial primary open angle glaucoma Pakistani patients

AIM:To find out the association of secreted protein acidic and rich in cysteine(SPARC)-related modular calcium binding 2(SMOC2)gene variants rs2255680 and rs13208776 with genotypic and phenotypic characteristics in both familial and non-familial primary open angle glaucoma(POAG)patients.METHODS:A total of 212 POAG patients,comprising 124 familial and 88 non-familial,were enrolled.For genotyping the SMOC2 variant rs2255680,amplification refractory mutation system(ARMS)-polymerase chain reaction(PCR)method and PCR-restriction fragment length polymorphism(PCR-RFLP)were utilized for analyzing rs13208776 variant.RESULTS:The mean age of familial POAG patients was 50.92±9.12y,with 78 males and 46 females.The mean age of non-familial POAG patients was 53.14±13.44y,with 52 males and 36 females.The SMOC2 gene variant rs13208776 showed the significant association with POAG between familial and non-familial groups.The homozygous G/G variant was frequent among non-familial(60.2%)whereas the heterozygous G/A variant was more frequent in familial POAG patients(46%).There were significant differences in G/A variant between familial and non-familial glaucoma patients,and the risk was decreased to 0.53-fold in non-familial glaucoma patients[odds ratio(OR):0.53;95%confidence interval(CI):0.29-0.94;P=0.033]in codominant model.The risk was further reduced to 0.49-fold(95%CI:0.28-0.86;P=0.012)in dominant model for non-familial patients.No significant association of SMOC2 gene variant rs2255680 between familial and non-familial glaucoma patients was found in our population.The haplotype analysis showed the decreased risk for TA[OR:0.48(95%CI:0.29-0.79);P=0.004]and an increased risk for TG[OR=2.28(95%CI:1.22-4.25);P=0.01]haplotypes.CONCLUSION:Current findings show significant association of SMOC2 gene variant rs13208776 with POAG between familial and non-familial Pakistani patients.

Efficacy of Combined Phacoemulsification and Goniosynechialysis in the Treatment of Patients with Primary Angle Closure Disease and Concomitant Cataract at Preah Ang Duong Hospital in Cambodia

Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.

Safety and Efficacy of Combined Trabeculectomy for Primary Angle Closure Glaucoma with Persistent Ocular Hypertension

Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients.(40 eyes).with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group(≥ 40 mm Hg) or control group(< 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure,filtering bleb,anterior chamber depth,and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups(P>0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group(P<0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications(P>0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.

A highly sensitive fluorescent probe RN-NA reveals peroxynitrite as a novel biomarker for primary open angle glaucoma

AIM:To directly quantify peroxynitrite(ONOO-)using a highly sensitive fluorescence resonance energy transfer probe RN-NA,investigate the association between ONOOand primary open angle glaucoma(POAG),and clarify whether RN-NA could be used as a potential tool for POAG diagnosis.METHODS:Plasma and aqueous humor(AH)samples were collected from POAG patients(n=100,age:59.70±6.87y)and age-related cataract(ARC)patients(n=100,age:61.15±4.60y)admitted to our hospital.Next,RN-NA was used to detect ONOO-in plasma and AH samples,and the relationship between ONOO-level and POAG was analyzed using binary logistic regression.Besides,Pearson correlation analysis was applied to characterize the correlation of the levels of ONOO-with the patients’age,intraocular pressure(IOP),and mean deviation of visual field testing.The ONOO-scavenger MnTMPyP was employed to treat the 3-morpholinosyndnomine(SIN-1)-induced ocular hypertension in mice(n=7,6-8wk).Finally,the IOP and ONOO-in both eyes were measured 30min after the last drug treatment.RESULTS:ONOO-levels of AH and plasma were significantly higher in the POAG group than in the ARC group(P<0.01).Additionally,ONOO-levels were closely correlated with POAG in a binary logistic regression analysis[odds ratio(OR)=1.008,95%confidence interval(CI):1.002-1.013,P<0.01 for AH;OR=1.004,95%CI:1.002-1.006,P<0.001 for plasma].Pearson correlation analysis showed that ONOO-levels in AH or plasma were positively associated with visual field defects(R=0.51,P<0.01 for AH;R=0.45,P<0.001 for plasma),and ONOO-levels in plasma and AH were correlated in the POAG group(R=0.69,P<0.001).However,administering MnTMPyP to mouse eyes reversed the elevated IOP caused by SIN-1(P<0.05).CONCLUSION:ONOO-levels in AH and plasma,detected by RN-NA,are significantly related to POAG and positively correlated with visual field defects in POAG patients.Hence,ONOO-is a potential biomarker of POAG,especially advanced POAG.Besides,anti-nitration compounds may be novel ocular hypotensive agents based on the animal study.

Acute primary angle closure during the Omicron outbreak

AIM:To investigate Omicron’s impact on clinical presentation of acute primary angle closure(APAC)in China.METHODS:A consecutive case series with historical controls was conducted at Shenzhen Eye Hospital,the largest specialized hospital in Shenzhen,China.Medical records from a two-month period during the Omicron pandemic(December 1,2022,to January 31,2023)were compared with records from two control groups(12/2018–1/2019 and 12/2021–1/2022)before pandemic.Patients with APAC were included,and the prevalence of APAC and demographic characteristics in Omicron-infected and noninfected patients were compared.RESULTS:Seventy-one(23.43%)out of 303 patients were diagnosed with APAC in the pandemic cohort,which was 2.98 and 2.61 times higher than that in control cohorts(7.87%in 2019,8.96%in 2022,P<0.001).The pandemic cohort has significantly higher Omicron-infected rate(78.87%vs 0 vs 0;P<0.001),lower proportion of glaucoma history(16.90%vs 42.86%vs 41.67%,P=0.005),higher surgical rate(95.77%vs 83.33%vs 78.57%,P=0.024),higher total medical costs and larger pupil diameter(5.63±0.15 vs 4.68±0.15 vs 4.69±0.22 mm,P<0.01).In 83%Omicron-infected patients,ocular symptoms appeared within 3d after systemic symptoms onset.In multivariate analysis,Omicron infection(P<0.001)was the only independent predictor of pupil diameter.CONCLUSION:In the Omicron epidemic in China,there is an increase of prevalence and severity of APAC,particularly focusing on the first 3d following infection.

MP-3 microperimeter in early primary open angle glaucoma with a new pattern

AIM:To investigate macular microperimetry in patients with early primary open angle glaucoma(POAG)using a new custom-made pattern,and analyze the characteristics of macular sensitivity.METHODS:This case-control study included 38 patients with POAG,who were divided into pre-perimetric glaucoma(18 eyes of 18 patients),early-stage(20 eyes of 20 patients),and control(20 eyes of 20 patients)groups.All subjects underwent standard 24-2 humphrey visual field test.An MP-3 microperimeter with a new custom-made pattern(28 testing points distributed in four quadrants,covering the central 10°of the retina)was used to evaluate macular sensitivity.Ganglion cell complex(GCC)thicknesses were examined using an RS-3000 Advance OCT system.The features of structure and function were analysed per quadrant.RESULTS:The pre-perimetric glaucoma group had significantly lower inferior hemifield macular sensitivity compared to controls(P<0.05).The early-stage POAG group had significantly lower average,inferior hemifield,inferonasal,and inferotemporal mean sensitivities compared to the pre-perimetric glaucoma group(P<0.05),and lower macular sensitivity in all sectors compared to controls(P<0.05).Regarding GCC thickness,all sectors in the early-stage POAG group became thinner compared to those in controls(P<0.05);whereas all sectors in the early-stage POAG group,except the superonasal quadrant,became thinner compared to those in the pre-perimetric glaucoma group(P<0.05).Macular sensitivity and GCC thickness were significantly associated in each sector.The inferotemporal quadrant had the highest correlation coefficients(0.840).The structure-function relationship for the inferonasal and inferotemporal sectors was stronger compared to the corresponding superior sectors.CONCLUSION:Microperimetry reveals variations in macular sensitivity in patients with early glaucoma earlier than conventional perimetry,particularly in pre-perimetric glaucoma cases in which it might be undetectable by conventional methods.The new custom-made pattern may improve the accuracy of microperimetry by enhancing point arrangement and reducing fatigue effects.Macular sensitivity measured by MP-3 with this pattern shows statistically significant structural and functional associations with the thicknesses of the GCC.

Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation to manage primary angle-closure glaucoma

AIM: To describe and evaluate a new ophthalmic endoscope surgical technique combined with phacoe-mulsification and intraocular lens (IOL) implantation to treat goniosynechialysis and manage primary angle-closure glaucoma (PACG). ·METHODS: Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation was performed in 32 eyes of 29 patients with PACG. Regular follow-up was performed 1 week and 1 month, 3, and 6 months after surgery to assess complications, intraocular pressure (IOP), anterior chamber depth, visual acuity, and anterior chamber angle. ·RESULTS: Preoperative mean IOP was 24.88±7.22mmHg with pharmacological treatment, and was 13.70 ±4.02, 13.06 ±3.74, 14.29 ±4.70, and 14.33 ±5.01mmHg 1 week, 1 month, 3 months, and 6 months after surgery, respectively. The postoperative decrease in IOP was significant (P 【 0.05). The rate for all eyes with IOP of 21mmHg or less was 93.8% (30 eyes) at the final visit without ocular hypotensive agents. The average preoperative anterior chamber depth was 1.60 ±0.64mm, and this value significantly increased to 2.72±0.62, 2.76±0.70, 2.73±0.68, and 2.74 ±0.71mm at 1 week, 1 month, 3 months, and 6 months, respectively. Visual acuity was improved in 28 eyes (87.5% ) at 6 months postoperatively. The anterior chamber angle had increased in 25 eyes (78.1% ) at the final visit; it was adhesive 90°-180° in 6 eyes, 180°-270° in only 1 eye. Two eyes exhibited minimal hyphema in the early postoperative period, but it could gradually be absorbed. Fibrinous reaction was observed in five eyes and spontaneously disappeared within 7 days. No shallow anterior chamber, iridodialysis, choroidal deta-chment, or malignant glaucoma was found in any eyes.CONCLUSION:Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation to manage PACG has several advantages, including optimized visualization, greater accuracy, and improved safety. Our results suggest that it has certain curative effects and clinical application value.

Epidemiological, Clinical, Therapeutic and Evolutive Profile of Primary Open-Angle Glaucoma in a Cameroonian Population

Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. However, in sub-Saharan Africa, its effectiveness has many challenges, due to multiple factors, including cost and access to care. Thus, the present study aimed to determine the epidemiological, clinical, therapeutic and evolutive profile of primary open-angle glaucoma patients. Methodology: A descriptive cross-sectional study was carried out in two hospitals in western Cameroon. Epidemiological, clinical, therapeutic, and evolutionary data on intraocular pressure at one year after medical treatment were analyzed. SPSS version 23 software was used for statistical analysis, with a significant p-value set at 5%. Results: A total of 201 patients with POAG were included in the study. The population comprised 100 men and 101 women, with a mean age of 54 ± 12 years. At diagnosis, the mean intraocular pressure was 23.9 ± 8.70 mmHg for the right eye and 25.5 ± 9.57 mmHg for the left eye. The mean cup/disc ratio was 0.64 ± 0.2 [0.2-1] and 0.67 ± 0.19 [02-1] in the right and left eyes, respectively. Monotherapy was the most prescribed treatment [59.2%]. After one year of treatment, intraocular pressure was reduced by 15.5% with beta-blockers, 23.66% with prostaglandins, 19.11% with carbonic anhydrase inhibitors, 35, 92% with beta-blockers and carbonic anhydrase inhibitors, 25.92% with beta-blockers and prostaglandins, 48.03% with carbonic anhydrase inhibitors and prostaglandin agonists, and 38.77% with triple therapy. Taking glaucoma severity into account, a significant reduction in intraocular pressure at one year was observed in all participants [p 0.05]. However, the target pressure was obtained in 47%, 20% and 14% of eyes suffering of mild, moderate, and severe grade of POAG respectively. Conclusion: In the present study, there was a significant reduction in intraocular pressure after one year of medical treatment. However, the reduction in intraocular pressure does not allow the target pressure to be reached in severe forms. Thus, alternatives to the medical treatment of POAG should be discussed early in the present context. .

Diffusion tensor imaging of optic nerve and optic radiation in primary chronic angle-closure glaucoma using 3T magnetic resonance imaging

AIM: To evaluate the value of quantitative diffusion tensor imaging (DTI) in assessing the axonal and myelin damage of the optic nerves and optic radiations in patients with chronic primary angle -closure glaucoma (PACG) by using high -field magnetic resonance (MR) imaging (3T). METHODS: Twenty patients with bilateral chronic PACG and twenty age - and sex matched disease -free control subjects were enrolled. Conventional MRI and DTI were performed on all subjects using 3T MR scanner. Mean diffusivity (MD), fractional anisotropy (FA), axial diffusivities (AD) and radial diffusivities (RD) of each optic nerve and each optic radiation were measured by using post -processing software of DTI studio 2.3, and then compared between left eyes and right eyes and between patients group and control group. The pairedsample t- test were used. RESULTS: There was no abnormality in the shape and signal intensity of the optic nerves and optic radiations in patients group and control group on the conventional MRI. No significant differences were observed in the FA, MD, AD and RD between the right and left optic nerves and optic radiations within patients group and control group (P>0.05). The optic nerves and optic radiations of patients with chronic PACG, as compared with control subjects, had significantly higher MD, AD, RD and significantly lower FA (P<0.05). CONCLUSION: The diffusivity of optic nerves and optic radiations in chronic PACG group showed abnormal and diffusivity parameters could be used markers of axonal and myelin injury in glaucoma.

The association between matrix metalloprotease-9 gene polymorphisms and primary angle-closure glaucoma in a Chinese Han population

AIM:To examine the association between the single nucleotide polymorphisms (SNPs)of matrix metalloprotease-9 (MMP-9) gene and primary angleclosure glaucoma(PACG)in a Chinese Han population.METHODS:DNA samples were extracted from peripheral-blood mononuclear cells of 214 PACG patients and 224 healthy controls.Genotyping of rs3918249,rs3918254,rs17577 and rs3787268 in MMP-9was performed using polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP)analysis and the direct sequencing technique.The association between these genetic polymorphisms and risk of PACG was estimated by χ2 test.RESULTS:The distributions of rs3918249,rs3918254,rs17577 and rs3787268 genotypes among cases and healthy controls were compatible with that from HardyWeinberg equilibrium(HWE,P】0.05).The increased frequency of CC and CT genotypes of rs3918254 were observed in PACG patients compared to healthy controls[P=0.006,P corrected(Pcorr)=0.048].The haplotype analysis showed that the CCGG haplotype was nominal associated with PACG(P=0.015),however,the significant was lost when the Bonferroni correction was used(Pcorr=0.105).CONCLUSION:Our results revealed that rs3918254 in MMP-9 may be a susceptible locus to PACG in China,people with the CC and CT genotypes of rs3918254 are more susceptible to PACG.The susceptibility to PACG inChinese Han patients may be not influenced by SNPs rs3918249,rs3787268 and rs17577 in MMP-9.

Phacoemulsification versus combined phacotrabeculectomy in the treatment of primary angle-closure glaucoma with cataract: a Meta-analysis

AIM： To compare the efficacy and safety of phacoemulsification（Phaco） against combined phacotrabeculectomy（Phacotrabe） in primary angle-closure glaucoma（PACG） with coexisting cataract.·METHODS： By searching electronically the Pub Med,EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by Rev Man 5.0.· RESULTS： Five randomized controlled trials were selected and included in Meta-analysis with a total of468 patients（468 eyes） with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure（IOP） lowing effect [preoperative IOP： weighted mean difference（WMD）=0.58, 95% confidence intervals（95% CI,-0.53 to 1.69）, P =0.31; postoperative IOP： WMD =1.37,95% CI（0.45 to 2.28）, P =0.003], a lower number of antiglaucoma medications [risk ratio（RR）=0.05, 95% CI（0.02 to 0.18）, P 〈0.00001] needed postoperatively and less serious damage of optic nerve [RR =0.48, 95% CI（0.21 to 1.07）, P =0.07], but a higher risk of complications[odds ratio（OR）=0.04, 95% CI（0.01 to 0.16）, P 〈0.00001]compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity（BCVA） [WMD =-0.05, 95% CI（-0.14 to 0.05）, P =0.32] and loss of visual field [RR=1.06, 95% CI（0.61 to1.83）, P =0.83].·CONCLUSION： Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the securitydecline. Considering the number of sample size, our results remains to be further studied.

Ultrasonic Evaluation of the Lens Thickness to Axial Length Factor in Primary Closure Angle Glaucoma

Ultrasonic biometry was done in 232 normal eyes and 138 eyes with primary angle closure glaucoma (ACG), using Ultrascan Digital B System IV (10 MHz). The ratio between the lens thickness and the axial length (lens thickness to axial length factor, LAF) was evaluated as a biometric index for assessing the eye with primary ACG in Chinese. LAF of 2.00 was found to be ideal point of demarcation between ACG and normal eyes (i.e., lens thickness equals to 1/5 of axial length). It appears that LAF is helpful i...

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

AIM：To compare the effect of phacoemulsification on intraocular pressure（IOP）in patients with primary open angle glaucoma（POAG）and pseudoexfoliation glaucoma（PXG）.METHODS：A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico.The study enrolled consecutive patients having phacoemulsification with intraocular lens（IOL）implantation and a diagnosis of POAG or PXG.Data about IOP values and number of glaucoma medications used was collected at baseline,1,3,6 and12mo postoperatively.RESULTS：The study enrolled 88 patients（88 eyes）.After phacoemulsification,there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients（P〈0.001）.In the POAG group,a 20%decrease in IOP values was evidenced,and a 56.5%reduction in the number of medications used at the one-year follow-up.The PXG group showed a 20.39%,and a 34.46%decrease in IOP and number of medications used,respectively.A significant difference in the meanΔIOP（postoperative changes in IOP）was evidenced between groups（P=0.005）.The reduction of the postsurgical IOP mean values in both groups,the POAG group showed a greater reduction in IOP values compared to the PXG group.CONCLUSION：In both types of glaucoma,phacoemulsification cataract surgery can result in a significant IOP reduction（20%）over a 12mo follow-up period.The number of medications used is also significantly reduced up to 12mo after surgery,especially in the PXG group.