Prevalence of pseudoexfoliation syndrome and its association with ocular and systemic diseases in Eskisehir,Turkey

AIM： To investigate the prevalence of pseudoexfoliation syndrome （PEX） and its associations with ocular and systemic diseases in a population sample aged over 40y. METHODS： A total of 2356 subjects were randomly chosen for the sample population based on the database of the Turkish Statistical Agency in Eskisehir. Of the invited 2356 subjects, 2017 subjects participated, out of which 2009 were eligible for the study. Systemic diseases, drug use, smoking and body mass index were assessed using questionnaires. Measurements of central corneal thickness （CCT）, anterior chamber depth （ACD） and intraocular pressure （IOP） were performed during June to December, 2015. After pupillary dilation, the anterior segment and lenses were evaluated using a slit lamp.RESULTS： Prevalence of PEX in this sample was 5.0% （n=100）. Of patients with PEX, 26% also had glaucoma. Incidence of cataracts, and using drugs for hypertension, cardiac and psychiatric conditions was higher in patients with PEX compared to normal cases （P〈0.05）. Hearing loss was more common in PEX cases （34.0% vs 5.4%; P〈0.001）. The mean CCT, ACD and IOP were not significantly different between PEX and non-PEX cases.CONCLUSION： This study is the first population-based, randomized trial in Turkey. Prevalence of PEX in patients over 40 years old was found to be 5.0%. Besides glaucoma and cataract, hypertension, hearing loss, using drugs for cardiac and psychiatric diseases were associated with PEX.

Comparison of total/active ghrelin levels in primary open angle glaucoma,pseudoexfoliation glaucoma and pseudoexfoliation syndrome

AIM：To investigate the levels of ghrelin（Gh）,acylated ghrelin（AGh） and AGh/Gh ratio in the humor aqueous（HA） of cases with pseudoexfoliation syndrome（PXS）,pseudoexfoliation glaucoma（PXG）,primary open angle glaucoma（POAG） and to compare these with control subjects.METHODS：A prospective examination was made of the total Gh,and AGh levels in HA of 67 patients undergoing cataract surgery.Patients were divided into 4 groups.HA samples were aspirated at the beginning of the surgery,stored at -70℃.Gh and AGh quantification was performed with ELISA kits and the AGh/total-Gh ratios were calculated.ANOVA,Kruskal-Wallis,Chi-square and post-hoc tests were used for statistical analysis.RESULTS：Total Gh levels in HA were 189.2±45.6 pg/mL in the control group,199.2±32.9 pg/mL in PXS,180.6±20.9 pg/mL in PXG and 176.8±21.4 pg/mL in POAG groups（P〉0.05）.AGh levels in HA were 23.09±5.01 pg/mL in the control group,24.13±5.22 pg/mL in PXS,22.29±1.55 pg/m L in PXG and 19.69±2.93 pg/mL in POAG groups（P〉0.05）.The ratio of AGh/Gh was 10.3%±2.34% in the control group,13.03%±2.58% in PXS,12.3%±1.54% in PXG and 11.79%±1.41% in POAG groups（P=0.044）.The difference between the PXS and control groups was significant（P=0.03）.CONCLUSION：In spite of statistically insignificant results,the HA total Gh levels were lower than those of the control subjects but not parallel with the AGh levels in glaucoma patients.The relative increase in the AGh/Gh ratio in glaucoma cases supports the view that proportional increases of AGh might play a role in the pathogenesis of glaucoma.

Prevalence and Associations of Pseudoexfoliation Glaucoma in a Group of Tertiary Eye Care Facilities in Southwest Nigeria

Background: Globally, glaucoma is the leading cause of irreversible blindness. Pseudoexfoliation glaucoma is the most common form of secondary open angle glaucoma. Purpose: To determine the prevalence and characteristics of pseudoexfoliation glaucoma (PXG) among newly diagnosed glaucoma patients in Eye Foundation Hospital Ikeja, Guinness Eye Center, Lagos University Teaching Hospital and Deseret Community Vision Institute, Ijebu Imushin. Methods: This hospital-based, descriptive cross-sectional study included newly diagnosed adult glaucoma patients at the glaucoma clinics of three tertiary eye care centers. A study proforma was used to obtain socio-demographic information, medical history, ocular history and relevant findings on ocular and systemic examination. Descriptive and comparative statistical analyses were performed. Values were considered statistically significant where P Results: One hundred and forty adult glaucoma patients aged 60.5 ± 11.9 SD years and male to female ratio of 2:1 were examined. The prevalence of PXG among the glaucoma patients was 16.9%. The pseudoexfoliative material (PXM) was most commonly found on the pupil (39%). Common ocular features seen among PXG patients were poor pupillary dilation with mydriatic agents (44%) and Sampaolesi’s line in the anterior chamber angle (41%). A higher proportion of PXG patients than primary open angle glaucoma (POAG) patients showed signs of severe glaucoma, including severe optic disc cupping (P = 0.019) and visual field defects (P = 0.014). Hearing defects were the only significantly associated non-ocular feature (P = 0.0005). Conclusion: The prevalence of PXG was 16.9%. This implies that it is relatively common in Nigeria. Hearing loss is an important non-ocular association. Careful ocular examination of glaucoma patients is recommended to identify PXG, which runs a more severe clinical course than POAG.

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.

Optical coherence tomography angiography of the peripapillary region and macula in normal,primary open angle glaucoma,pseudoexfoliation glaucoma and ocular hypertension eyes

AIM:To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma(POAG),pseudoexfoliation glaucoma(PXG),ocular hypertension(OHT)and normal eyes using optical coherence tomography angiography(OCTA).METHODS:A total of 114 POAG,PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included.The PXG,POAG,OHT,and control groups(aged 68.17±6.30 y,61.11±10.26 y,58.1±8.9 y,and 56.9±4.6 y,respectively)contained of 46,36,32,and 46 eyes,respectively.Measurements of vessel density(VD)in the peripapillary region and macula,average retinal inner thickness,and retinal nerve fiber layer thickness(RNFLT)were compared among groups.In order to test the accuracy of differentiation between eyes with and without glaucoma,the area was calculated under the receiver operating characteristic(ROC)curves.RESULTS:The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors(44.35%±6.78%vs 50.47%±1.83%,P<0.001),the superficial(44.08%±5.46%vs 51.28%±2.85%,P<0.001)and the deep(45.13%±8.55%vs 54.20%±5.44%,P<0.001)vascular plexus.There was a significant difference in peripapillary VD between glaucomatous and OHT eyes(44.35%±6.78%vs 49.86%±2.45%,P<0.001).The OHT group featured a lower superficial(48.06%±4.32%vs 51.28%±2.85%,P=0.027)and deep plexus(48.70%±5.99%vs 54.20%±5.44%,P=0.013)whole image vessel density(wiVD)than did the control group.The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG(42.22%±5.36%vs 46.54%±5.56%,P=0.046).CONCLUSION:OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT,and these results are correlated to functional and structural glaucomatous alterations.Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG.Furthermore,the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.

The role of the cytokines in the pathogenesis of pseudoexfoliation syndrome

AIM:To examine the mechanism of the development of pseudoexfoliation (PSX) syndrome via both cytokine formation and endothelial vasorelaxing and growth factors that will provide us new therapeutic insights for the treatment. METHODS:This is a cross sectional study included two groups; Group 1:control patients with nuclear cataract(n =20, aged 51-80 years). Group 2:PSX patients with nuclear cataract (n=18, aged 50-90 years). Patients with other ophthalmic problems and systemic diseases were excluded. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and interleukin-1β (IL-1β) and nitrotyrosine levels were determined through serum samples by Enzyme-linked immunosorbent assay (ELISA) method. Nitrite-nitrate levels were measured with photometric endpoint determination. RESULTS:There were no significant differences between the groups in terms of age, VEGF, IL-1β, nitrite-nitrate and nitrotyrosine. The significant results were the mean IL-6 levels that were higher in PSX group 2 (37.68± 29.52 pg/mL) compared to that in control group 1 (15.32± 10.08 pg/mL) (P 【0.001). CONCLUSION:Several interacting and extending biochemical pathways may lead to the promotion of VEGF and IL-6 expressions. IL-6 which is the only altered marker in our study may indirectly cause an increase of vascular permeability and neovascularization. We suggest inflammation as a factor that can be involved in etiopathogenesis of PSX.

Effect of torsional mode phacoemulsification on cornea in eyes with/without pseudoexfoliation

AIM: To evaluate the effect of torsional mode phacoemulsification on central corneal thickness, corneal endothelial cell density, and morphology in eyes with/without pseudoexfoliation(PEX) syndrome.METHODS: Fourty-two consecutive patients with and42 patients without PEX as a control group scheduled for cataract surgery was studied. Phacoemulsification, using OZi L IP system, was performed with quick chop technique. Using noncontact specular microscopy, the central endothelial cell density(ECD), coefficient of variation, percentage of hexagonal cells, and the central corneal thickness(CCT) were evaluated preoperatively and postoperatively at 1, 7 and 30 d.RESULTS: The ECD in PEX syndrome was statistically significantly lower than that in the control group preoperatively and postoperatively(P ≤0.001).Percentage change in ECD was statistically significantly higher in PEX than that in control group after surgery follow up(P ≤0.04).There was no statistically significant difference between both groups comparing percentage of hexagonal cells and coefficient of variation in the cell size before and after the surgery. At 1 and 7d after surgery, percentage change in CCT was statistically significantly higher in PEX group than that in the control group(P ≤0.041).CONCLUSION: Although torsional mode phacoemulsification and intraocular lens(IOL) implantation provided a safe and favorable surgical outcome in patients with/without PEX, torsional phacoemulsification led to significantly higher ECD loss in the PEX group than that in the control group during the whole follow up period.In addition, more corneal swelling in the PEX group than that in the control group during the early postoperative period has indicated that the corneal endothelium, in presence of PEX endotheliopathy, seems to be more susceptible to the effects of phacoemulsification surgeryin eyes with PEX. The increased risk of anterior chamber manipulations in patients with PEX should be taken into account for an increased risk of bullous keratopathy.

Safety of hydroimplantation in cataract surgery in patients with pseudoexfoliation syndrome

AIM：To evaluate the safety of hydroimplantation in cataract surgery in patients with pseudoexfoliation syndrome.METHODS：This prospective randomized study comprised 100 eyes of 100 consecutive patients who underwent cataract surgery and implantation of foldable intraocular lens（IOL）. Each eye was assigned to group 1 or group 2. Hydroimplantation without using viscoelastic agent as group 1（n=50）, and hydroxypropylmethylcellulose（Eyevisc, Biotech, India） was used in group 2（n=50）. RESULTS：There were no statistically significant differences in central corneal thickness（CCT） and corneal endothelial cell count（ECC） between both groups at each visit and percentage change in CCT and ECC（P〉0.05）. The mean intraocular pressure（IOP） at postoperative 5h increased statistically significantly in group 2（P〈0.001）. There was no statistically significant difference in IOP between two groups, before and after surgery excluding the 24 h postoperative IOP, but patients in group 2 had higher IOP than that in the group 1 at 24 h after surgery（P=0.035）. No case in either group experienced posterior capsular rupture, or zonular dialysis. Fixation of the globe during IOL implantation was better in group 1 than that in group 2.CONCLUSION：Hydroimplantation has advantages in terms of IOP changes and duration of the surgery and seems to be safe in patients with pseudoexfoliation syndrome.

Corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome

AIM: To evaluate the corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome (PEX). METHODS: Medical records of 16 patients (20 eyes) with PEX who presented to our institution between July 2008 and June 2010 were retrospectively reviewed. Thirteen eyes had combined glaucoma. The information of five apparently normal fellow eyes in these patients was also recorded. Left eyes of 20 patients with bilateral senile cataracts but no other eye disease were included as controls. Specular microscopy was performed in all eyes to analyze for corneal endothelial cell density and morphology. Cell density, coefficient of variation in cell size, and percentage of hexagonal cells in corneal endothelium were evaluated. RESULTS: The mean corneal endothelial cell density in the PEX eyes was 2298+/- 239 cells/mm(2), significantly lower than that in the cataract eyes (2652+/- 18 cells/mm(2), P=0.026), but there were no significant differences in coefficient of variation of cell size and frequency of hexagonality between these two groups. No significant differences in the three parameters were found between the apparently normal fellow eyes and the PEX eyes or the cataract eyes, or between the PEX eyes with and without glaucoma. CONCLUSION: Corneal endothelial cell density may decrease in Chinese patients with PEX. The development of glaucoma in PEX eyes does not seem to be related with the change in corneal endothelial cell density or morphology.

Effect of capsular tension ring implantation on predicted refractive error after cataract surgery in patients with pseudoexfoliation syndrome

AIM: To investigate the effect of capsular tension ring(CTR) implantation on predicted refractive error after cataract surgery in patients with pseudoexfoliation(PEX) syndrome.METHODS: This double-blind randomized clinical trial was conducted on 60 patients with PEX syndrome referring to Imam Khomeini Hospital affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, for undergoing cataract surgery. The study population was divided into two groups, namely CTR group(n=30) and non-CTR group(control group;n=30). The refractive error and anterior chamber depth(ACD) were measured 1 wk, 1 mo, and 3 mo after phacoemulsification(PE) surgery.RESULTS: The results indicated no statistically significant difference between the two groups in terms of predicted refractive error(obtained by subtracting preoperative predicted refractive error from actual postoperative refractive error) 1 wk(P=0.47), 1 mo(P=0.30), and 3 mo(P=0.06) after the PE surgery. Regarding the CTR group, the changes of ACD was statistically significant 1 and 3 mo after the PE surgery, compared to those obtained 1 wk post-surgery(P=0.005).CONCLUSION: The CTR implantation in PEX cataractous patients without zonulysis has no statistically significant effect on the predicted refraction and ACD changes after PE. The predicted refraction error has a hyperopic shift in both groups. The results reveal the unnecessary of calculating modified IOL in CTR implantation.

Retinal vessel diameters and their correlation with retinal nerve fiber layer thickness in patients with pseudoexfoliation syndrome

AIM: To compare retinal artery-vein diameters(RAVDs)of patients with pseudoexfoliation(PSX) syndrome with healthy controls and investigate the correlations between retinal nerve fiber layer(RNFL) thickness parameters and RAVDs.METHODS: Seventeen eyes with PSX and 17 eyes of age-matched controls were included in the study. All participants underwent routine ophthalmological examination, Humphrey visual field and RNFL examination by using Stratus OCT. Retinal images were obtained by using a retinal camera(Topcon 501X).RAVDs were measured from inferior nasal, inferior temporal, superior nasal and superior temporal arcuates by using IMAGEnet software. Superior, inferior, nasal,temporal and average RNFL thicknesses were recorded.RAVDs and RNFL parameters in groups and correlations were analyzed by Mann-Whitney U and Spearmann correlation tests.RESULTS: Only inferior quadrant and average RNFL thickness were detected thinner in the PSX group compared with control group(P =0.009, P =0.038,respectively). No statistically significant difference regarding RAVDs was found between two groups.CONCLUSION: RAVDs seems to be comparable in the PSX and control group. RNFL is thinner in the inferior quadrant in the PSX group. RNFL thickness and RAVDs show significant correlations in both groups. This correlation doesn’t seem to be specific to PSX.

Total oxidative stress, paraoxonase and arylesterase levels at patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma

AIMTo investigate the oxidative stress status of the aqueous humor and serum of patients with pseudoexfoliation (PEX) syndrome and pseudoexfoliative glaucoma (PEG) and to measure paraoxonase (PON) and arylesterase (ARE) levels.METHODSA total of 78 patients were enrolled in the study, with 26 patients in each separate group. The patients were divided into three groups: the first group entailed PEX syndrome patients, while the second group consisted of patients with PEG and the third group involved patients with no additional systemic diseases, other than the diagnosis of cataract as control. Total oxidative stress (TOS), total antioxidant capacity (TAC), PON, and ARE levels in aqueous humor and serum were measured.RESULTSTAC, PON and arylesterase levels in aqueous humor and serum of the PEX syndrome and PEG patients were significantly decreased compared with control group (P&#x0003c;0.05). TOS values were higher in patients with PEX syndrome and PEG than controls (P&#x0003c;0.05). TAC, PON and ARE levels of aqueous humor did not differ significantly between the PEX syndrome and PEG groupsCONCLUSIONThese findings are potentially of significance and add to the growing body of evidence for oxidative stress in PEX syndrome and PEG. Decreased antioxidant defense and increased oxidative stress system may play an important role in the pathogenesis of PEX syndrome and PEG.

Nitric oxide and tumour necrosis factor alpha in the process of pseudoexfoliation glaucoma

AIMTo establish the role of nitric oxide (NO), ascorbic acid and tumour necrosis factor-&#x003b1; (TNF-&#x003b1;) in the pathogenesis of pseudoexfoliation glaucoma (XFG).METHODSOur study included 120 patients who were referred for cataract surgery. All patients were divided into four groups according to clinical findings: XFG, early and late pseudoexfoliation syndrome (XFS), and cataract (without pseudoexfoliation). Serum and aqueous humour levels of the ascorbic acid, NO and TNF-&#x003b1; were measured. The concentrations of the ascorbic acid and NO were measured by an appropriate spectrophotometric method. Enzyme-linked immunosorbent assay (ELISA) was used to determine TNF-&#x003b1; level.RESULTSAqueous humour concentration of ascorbic acid was significantly lower in patients with late XFS (0.61&#x000b1;0.11 mmol/L) and XFG (0.48&#x000b1;0.15 mmol/L) compared to patients with early XFS (0.9&#x000b1;0.15 mmol/L) and cataract (1.16&#x000b1;0.22 mmol/L), while there was no difference in serum concentration in all examined groups. Aqueous humour concentration of NO was significantly higher in patients with XFG (77.7&#x000b1;11.4 &#x000b5;mol/L) compared to patients with early XFS (50.27&#x000b1;9.34 &#x000b5;mol/L) and cataract (49.77&#x000b1;7.1 &#x000b5;mol/L), while serum concentration was increased in the early stage of XFS (73.26&#x000b1;8.29 &#x000b5;mol/L). Aqueous humour level of proinflammatory cytokine TNF-&#x003b1; was increased in patients with XFS (early 460.04&#x000b1;18.32 pg/mL; late 502.42&#x000b1;53.23 pg/mL) and XFG (510.34&#x000b1;43.07 pg/mL), while there was no difference in serum level in all examined groups of patients.CONCLUSIONReduced ascorbic acid and elevated NO and inflammation related cytokine TNF-&#x003b1; level in aqueous humour of the patients with developed XFG suggest that oxidative stress induces local inflammation.

Ultrasound biomicroscopy in patients with unilateral pseudoexfoliation

·AIM: To compare the anterior segment morphology evaluated using ultrasound biomicroscopy(UBM) in patients with clinical pseudoexfoliation syndrome(XFS)in one eye and no clinical XFS in the fellow eye.·METHODS: Thirty patients with unilateral XFS were included in the study. All patients underwent evaluation of their anterior segment using UBM with and without dilatation with 1% cyclopentolate. The anterior chamber depth(ACD), lens thickness(LT), anterior chamber angle(ACA), ciliary body thickness(CBT), scleral thickness(ST), trabeculae-ciliary processes distance(T-CPD), and iris-ciliary processes distance(I-CPD) were measured using UBM scans. All results between the eyes with clinical XFS and their fellow eyes without clinical XFS were then compared.·RESULTS: Before dilatation the eyes with XFS(4.350±0.531 mm) were found to have a significantly thicker lens(P =0.002) than the eyes without XFS(4.238 ±0.540 mm).In addition after dilatation, the eyes with XFS(4.310 ±0.500 mm) were found to have a significantly thicker lens than the eyes without XFS(4.160±0.480 mm)(P=0.019).The average ACD, for the group with XFS, comparing pre-dilatation(2.616 ±0.349 mm) and post-dilatation measurements(2.714±0.413) was found to be statistically increased(P =0.014). The average ACD, comparing pre-dilatation to post-dilatation measurements in patients without XFS(2.680±0.360),(2.720±0.500) was found to be statistically unchanged(P =0.450).·CONCLUSION: Crystalline lenses tended to be thicker in the eyes with clinical pseudoexfoliation than their fellow eyes without pseudoexfoliation.

Pseudoexfoliation syndrome and cardiovascular diseases

Pseudoexfoliation(PEX) syndrome is a well-recognized late-onset disease caused by a generalized fibrillopathy. It is linked to a broad spectrum of ocular complications including glaucoma and perioperative problems during cataract surgery. Apart from the long-known intraocular manifestations, PEX deposits have been found in a variety of extraocular locations and they appear to represent a systemic process associated with increased cardiovascular and cerebrovascular morbidity. However, as published results are inconsistent, the clinical significance of the extraocular PEX deposits remains controversial. Identification of PEX deposits in the heart and the vessel wall, epidemiologic studies, as well as, similarities in pathogenetic mechanisms have led to the hypothesis of a possible relation between fibrillar material and cardiovascular disease. Recent studies suggest that PEX syndrome is frequently linked to impaired heart and blood vessels function. Systemic and ocular blood flow changes, altered parasympathetic vascular control and baroreflex sensitivity, increased vascular resistance and decreased blood flow velocity, arterial endothelial dysfunction, high levels of plasma homocysteine and arterial hypertension have all been demonstrated in PEX subjects. Common features in the pathogenesis of both atherosclerosis and PEX, like oxidative stress and inflammation and a possible higher frequency of abdominal aorta aneurysm in PEX patients, could imply that these grey-white deposits and cardiovascular disorders are related or reflect different manifestations of the same process.

Sensory-neural hearing loss in pseudoexfoliation syndrome

AIM:To evaluate relationship between ocular pseudoex-foliation syndrom(PXF) and sensory-neural hearing loss(SNHL).· METHODS:This prospective case-control study was designed on patients who referred to a general ophthalmic clinic at Imam Khomeini Medical Center,Urmia,Iran(March 2010 through November 2010).On routine ophthalmic examination,patients diagnosed with ocular PXF were referred to the ENT department and,selected cases(after evaluating inclusion and exclusion criteria) were referred to Audiometric Department.Pure tone hearing threshold level(HTL) was measured at 1,2,3 kHz for each ear and was compared with International Standard(ISO 7029) median age associated hearing loss at 1,2,3 kHz(AAHL).· RESULTS:Overall 21 of 50 patients(42.0%) had a higher HTL than the ISO 7029 median AAHL at 1,2 and 3kHz,which included 14 ears of 23 patients in the male group(30.4%) and 21 ears of 27 patients in the female group(38.8%).Approximately 12.0% of patients had glaucoma at the same time,however;no significant correlation was found in SNHL prevalence and severity between PXF patient and patients with simultaneous glaucoma.SNHL was more common in patients with ocular PXF compared to their age-sex matched controls(P <0.05).· CONCLUSION:Most of patients with ocular PXF had SNHL compared to their age-sex matched controls,which could be due to PXF fibrils in the inner ear.These findings suggest PXF could be a systemic disease.·

Association of sensorineural hearing loss and pseudoexfoliation syndrome:a meta-analysis

Background:Previous studies that assessed the association of sensorineural hearing loss(SNHL)and pseudoexfoliation syndrome(PEX)produced contradictory results.We conducted a meta-analysis to further evaluate this relationship.Methods:Eligible studies that evaluated the association between SNHL and PEX were identified.Summary odds ratios(ORs)and 95%confidence intervals(CIs)were calculated employing random-effects models.Subgroup analysis and meta-regression were performed to assess heterogeneity by several covariates.Publication bias was tested by Begg’s funnel plot and Egger’s regression test.Results:A total of 14 eligible studies,involving 1,142 PEX patients and 9,914 controls,were included in this meta-analysis.Overall analysis showed that patients with PEX,when compared with the control group,experienced a significantly increased risk for hearing loss[OR:3.74(95%CI:2.56 to 5.47);P<0.001].Substantial heterogeneity was observed.Subgroup analysis revealed a decrease in this heterogeneity in ageand sex-matched studies and in studies that used the same definition of hearing loss.Meta-regression analysis showed that definition of hearing loss contributed to substantial heterogeneity(P=0.044).No evidence of publication bias was observed.Discussion:We found that PEX is associated with an increased risk of SNHL.The effect of PEX on the prevalence of hearing loss indicates that PEX is clearly a systemic disease with potential otological complications.

XEN® Gel Implant for Glaucoma;Prospective Cohort Study in a High-Volume Department

Purpose: To evaluate the 3-year efficiency and safety of XEN® 45 gel stent implantation in a heterogenous group of open angle glaucoma patients. Methods: In this prospective, non-randomized observational study we identified patients who had undergone either stand-alone XEN® implantation (XEN solo) or XEN® implantation in combination with phacoemulsification (XEN combi). All patients who had undergone an implantation during the period 01.04.17-31.10.19 at the Department of Ophthalmology, Drammen Hospital, Norway, were asked to participate. Success was defined as IOP between 5 - 18 mmHg and 20% pressure reduction without medications. Qualified success required the same pressure interval and reduction but allowed medications. The procedure was deemed as failure if pressure requirements were not met, vision was reduced to light perception or worse, or if there was a converion to secondary glaucoma surgery. Results: Out of 115 patients and 133 eyes identified, 87 patients and 99 eyes consented to participate. All patients were Caucasians with a mean age of 73.6 years. The study had a mean (range) follow-up of 38.9 (28 - 54) months. The mean medicated baseline (SD) was reduced from 22.6 (7.9) mmHg on 3.2 (1.1) medications to 14.2 (5.6) mmHg on 1.4 (1.6) medications. Success and qualified success were achieved in 22.2% and 21.2%, respectively. Needling was performed in 34 eyes. Conclusion: XEN® 45 gel stent implantation is a safe procedure, offering a significantly lower IOP and number of medications in a subset of patients with open angle glaucoma.

Optic disc area in different types of glaucoma

AIMTo evaluate the possible relationship of optic disc area with retina nerve fiber layer in different glaucoma subtypes.METHODSOne eye each was chosen from 45 patients with ocular hypertension, 45 patients with primary open angle glaucoma, 45 patients with pseudoexfoliation glaucoma and 45 healthy controls followed in our hospital. The records of the patients were reviewed retrospectively. Optic disc area and circumpapillary retina nerve fiber layer measurements were obtained using optical coherence tomography. Central corneal thickness was measured by ultrasound pachymetry.RESULTSThe median disc area in the patients with primary open angle glaucoma was significantly higher than the patients with ocular hypertension (2.19 vs 1.90 mm2, P=0.030). The median retina nerve fiber layer was thinner in the patients with primary open angle glaucoma and pseudoexfoliation glaucoma than the patients with ocular hypertension for superior, inferior and temporal quadrants. After adjustment for age, no difference in central corneal thickness was found between the groups. Greater disc area was associated with thicker retinal nerve fiber layer for superior, inferior and nasal quadrants in the patients with primary open angle glaucoma. There was no correlation between disc area and central corneal thickness measurements of the groups.CONCLUSIONDisc size affects the retinal nerve fiber layer thickness in eyes with primary open angle glaucoma and is a possible risk factor for glaucomatous optic nerve damage.

Oxidant/antioxidant balance in the aqueous humor of patients with glaucoma

AIM： To evaluate total antioxidant status （TAS）, total oxidant status （TOS）, and the oxidative stress index （OSI） of the aqueous humor （AH） in patients with glaucoma. METHODS： The prospective study was composed of a study group （n-31） and a control group （n=31）. Fifteen patients in the study group were diagnosed with primary open angle glaucoma （POAG）, and 16 patients were diagnosed with pseudoexfoliation glaucoma （PEG）. The control group was composed of non-glaucomatous patients with cataracts. AH samples were collected and analyzed for TAS, TOS, and OSI levels. RESULTS： Mean AH TAS level was significantly higher in patients with glaucoma than that in the control group （P〈0.01）. Mean TOS and OSI levels tended to increase in patients with glaucoma. No significant differences in TAS, TOS, or OSI levels were observed between patients with POAG and PEG. CONCLUSION： High levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients.