Anterior Chamber Depth Changes in Narrow Iridocorneal Angles after Phacoemulsification

Background: The burden of cataract and glaucoma has been increasing. Primary angle closure occurs as a result of crowded anterior segment anatomy causing appositional contact between peripheral iris and trabecular meshwork. Lens extraction has been proposed as a method of deepening anterior chamber and managing intraocular pressure. Purpose: To assess changes in anterior chamber depth after phacoemulsification with intraocular lens implantation in narrow angle eyes. Design: Prospective controlled trial (before-after) study. Method: The study was conducted from March 2015 to August 2017 among the patients of department of Ophthalmology of BSMMU who were diagnosed as cataract with narrow angles. Anterior chamber angle grading of 2 or less (Shaffer grading) in 3 or more quadrants was considered narrow angle (NA). The purposive type sampling technique was applied to collect sample from the study population, as per inclusion and exclusion criteria. Complete clinical evaluation including history, physical examination, relevant ocular examinations and systemic examinations were performed. In this prospective study, subjects underwent phacoemulsification with foldable lens implantation. A scan ultrasonography was performed preoperatively and 10th and 30th postoperative days of surgery. Results: Thirty eyes of 29 patients included in the study, male: female ratio was 1:1, with an overall mean age of 62.03 ± 8.95 years. The mean preoperative central ACD was 2.95 ± 0.35 mm. At 10th and 30th POD mean central ACD were 3.94 ± 0.32, and 3.92 ± 0.28 mm respectively. Mean of increase in central ACD at final follow-up was 0.96 mm (p Conclusion: Phacoemulsification with posterior chamber in bag lens implantation can deepen the anterior chamber depth in patients with narrow angles. Based on these findings, it is concluded that phacoemulsification with foldable intraocular lens implantation is an effective tool in deepening the anterior chamber.

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.

Suicide risk in juvenile open angle glaucoma patients

AIM:To investigate the association between juvenile open angle glaucoma(JOAG)and mental health among Koreans.METHODS:This study used nationally representative data from the 8th Korea National Health and Nutrition Examination Survey(KNHANES)2021.Glaucoma diagnosis followed the International Society of Geographical and Epidemiological Ophthalmology criteria based on glaucomatous structural defects,visual field defects,corrected vision,and intraocular pressure.As outcomes,suicidal behaviors,psychiatric counseling,and depression were evaluated through mental health questionnaires.Odds ratios(ORs)with 95%confidence intervals(CIs)were estimated using logistic regression models,adjusting for covariates.RESULTS:Among 7090 participants,3446 met the inclusion criteria for analysis,and 88(2.6%)were diagnosed with open angle glaucoma(OAG).After adjusting for age,sex,and best-corrected visual acuity(VA),participants with OAG were revealed to have significantly higher odds of suicidal behaviors(i.e.,ideation,planning,or attempts)compared with those without OAG(OR:2.70;95%CI:1.12-6.54;P=0.028).This association remained significant after further adjustments for socioeconomic status,lifestyle factors,and presence of chronic conditions(P=0.031 and 0.035,respectively).However,there was no significant difference for the other two outcomes,psychiatric counseling and depression.An age-stratified analysis revealed a stronger association between OAG and suicidal behaviors in younger JOAG participants(<40y)than in older OAG participants(≥40y;OR:3.80 vs 2.22;95%CI:0.79-18.22 vs 0.56-8.80,respectively).CONCLUSION:OAG patients show a higher risk of suicidal behaviors than those without glaucoma particularly in JOAG patients.

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.

Efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy

AIM:To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy(MAT).METHODS:Totally 10 eyes of 10 patients with primary open angle glaucoma(POAG)who underwent MAT facilitated by Usights UC100(5 eyes)or iTrack(5 eyes)were reviewed.The success of this surgery was defined as intraocular pressure(IOP)<22 mm Hg with>30%reduction,without oral glaucoma medications,or additional glaucoma surgery.RESULTS:The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group.MAT was achieved in all eyes in both groups.The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes,respectively.Both microcatheters produced a statistically significant reduction in IOP,and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo followup(12.58±1.52 and 14.84±1.89 mm Hg,respectively),but no statistical significance was there.No severe side effects were observed in either group.CONCLUSION:MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG,and Usights UC100 is as safe as iTrack.

Comparison of success rate and intraocular pressure spikes between selective laser trabeculoplasty and micropulse laser trabeculoplasty in African American and Hispanic patients

AIM:To examine the efficacy and safety of micropulse laser trabeculoplasty(MLT)versus selective laser trabeculoplasty(SLT)in a large cohort of primarily African American and Hispanic patients.METHODS:A single center retrospective comparative cohort review conducted at Cook County Health facilities that included patients with a diagnosis of open angle glaucoma or ocular hypertension who received an SLT or MLT procedure between January 2017 and May 2021.RESULTS:Totally 131 eyes of 99 patients were analyzed.The 77 eyes received SLT and 54 received MLT.Seven out of 77 eyes in the SLT group(9.1%)and 1 out of 54 eyes in the MLT group(1.9%)had an IOP spike(defined as>5 mm Hg)at either 1h or 1wk after procedure(P=0.05,Chisquared test with Haldane-Anscombe correction).The procedure failure rate at one year was 50%for SLT and 48%for MLT(P=0.31).CONCLUSION:MLT has a significantly lower incidence of pressure spikes and a similar treatment failure rate at 1-year post-procedure,demonstrating that it is a reasonable alternative compared to SLT.

Efficacy and safety of latanoprost/timolol fixed combination dosed twice daily compared to once daily in patients with primary open angle glaucoma

AIM:To evaluate whether latanoprost/timolol fixed combination(LTFC)dosed twice daily may provide further intraocular pressure(IOP)reduction and evaluate the safety profile at this dose.METHODS:This is an open-labeled,randomized,prospective crossover study on fourty primary open angle glaucoma patients.Two weeks of washout period were followed by randomization to either once daily(OD,group A)or twice daily dosing(BD,group B)of LTFC for 4wk.After another 2-week washout period,the patients’treatment dose was crossed-over for another 4wk.IOP reduction alongside ocular and systemic side effects were evaluated.RESULTS:Mean baseline IOP was 18.57±2.93 and 17.8±3.01 mm Hg before OD and BD dose respectively,(P=0.27).Mean IOP after BD dose was statistically lower(12.49±1.59 mm Hg)compared to OD(13.48±1.81 mm Hg,P=0.017).Although IOP reduction after BD dose was more(5.32±3.24 mm Hg,29.89%)than after OD dosing(5.04 mm Hg,27.14%),it did not reach statistical significance(P=0.68).Patients switched from OD to BD(group A)showed mean IOP reduction by 0.69 mm Hg[95%confidence interval(CI):-0.09 to 1.48 mm Hg,P=0.078];but patients switched from BD to OD(group B)had significantly higher mean IOP by 1.25 mm Hg(95%CI:-2.04 to-0.46 mm Hg,P=0.006).BD dose had more ocular side effects albeit mild.CONCLUSION:Mean IOP after LTFC dosed twice daily is statistically lower,with additional mild side effects.

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.

Prevalence of Myocilin Gene Mutation in Adult-Onset Primary Open Angle Glaucoma and Non-Glaucoma Subjects Who Are Indigenes of Rivers State, Nigeria

Background: Glaucoma is the leading cause of irreversible blindness incapacitating over 80 million people worldwide. Several pathogenetic mechanisms have been postulated to explain the optic nerve damage that occur in POAG among which genetic predisposition is prominent. Gene-Linkage-based studies have identified genes associated with POAG: Myocilin, Optineurin, WDR36, Tank-Binding Kinase (TBK1) and APbb-2. Objective: To investigate the prevalence of myocilin gene mutation in adult-onset POAG patients and non-glaucoma subjects who are indigenes of Rivers State. Methodology: In this comparative cross-sectional study, 393 POAG patients attending the Glaucoma Clinic of UPTH were compared with 393 age and sex-matched phenotypically normal participants. Clinical assessment combined with findings from clinical records was used. Venous blood was obtained for genomic analyses. Extracted DNA was sequenced with specific primers for myocilin and polymerase chain reaction. Zymo-Bead Genomic DNA kit protocol was used to detect allelic differences. Results: Total of 786 participants participated in the study. The mean age was 59.8 ± 11.8 years. The prevalence of myocilin gene mutation (MYOC) in the study population was 5.3%, in the POAG group was 8.4%, and 2.3% in the non-glaucoma group. This observed difference was statistically significant (p = 0.001). Location of the mutant myocilin gene was in GLC1A 171638779, 171638703, 171638610 and 171638608. Conclusion: Mutations in myocilin gene are associated with adult-onset POAG in Rivers State. Its relevance as a biomarker for diagnosis of adult-onset POAG needs further investigations.

Simulations of Tapered Channel in Multilayer Graphene as Reverse Osmosis Membrane for Desalination

Pressure-driven reverse osmosis membrane has important application in seawater desalination.Inspired by the structure of aquaporin,we established and studied the mechanism of the structure of multilayer graphene with tapered channels as reverse osmosis.The water flux of multilayer graphene with tapered channels was about 20%higher than that of parallel graphene channel.The flow resistance model was established,and the relationship between flow resistance and opening angles was clarified.The relationship between flow resistance and outlet size was also described.By means of molecular dynamics simulation,slip coefficients of multilayer graphene with tapered channel were obtained and verified by the contact angle of water.Results show that the permeability of graphene with tapered channel is about three orders of magnitude higher than that of commercial reverse osmosis membrane and the desalination rate is 100%.Temperature difference between the two sides of the tapered channel will promote the water flux positively.

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.

High myopia as a risk factor in primary open angle glaucoma

Glaucoma, one of the leading causes of irreversible blindness in the adult population worldwide, is a progressive optic neuropathy. Primary open angle glaucoma (POAG) is the most commonly reported type of glaucoma in population based prevalence studies worldwide. Elevated intraocular pressure is a well-known major risk factor for POAG. In addition, there is growing evidence that other risk factors like age, gender, race, refractive error, heredity and systemic factors may play a role in glaucoma pathogenesis. Many studies found that high myopia has been associated with POAG, however, direct and convincing evidences are still lacking. The aim of this review is to summarize the evidences implicating high myopia as a risk factor in the pathogenesis of POAG.

Analysis of peripapillary retinal nerve fiber layer and inner macular layers by spectral-domain optical coherence tomography for detection of early glaucoma

AIM： To analyze the diagnostic capabilities of peripapillary retinal nerve fiber layer（p RNFL） thickness and segmented inner macular layer（IML） thickness measured by spectraldomain optical coherence tomography for detection of early glaucoma. METHODS： Fifty-three patients with primary open angle glaucoma（POAG）, 60 patients with normal tension glaucoma（NTG） and 32 normal control subjects were enrolled. Thicknesses of p RNFL, total macular layers（TML）, and the IML, including macular RNFL（m RNFL） and macular ganglion cell layer（m GCL） were assessed. The areas under the receiver operating characteristic curves（AROC） were calculated to compare the diagnostic power of different parameters. RESULTS： There were no differences in the parameters of p RNFL, TML, and IML between POAG and NTG groups. The thicknesses of superior and inferior m GCL showed significant correlation with mean deviation of visual field（R2=0.071, P=0.004; R2=0.08, P=0.002）. The m GCL thickness significantly correlated with the p RNFL thickness in the superior and inferior quadrants（R2=0.156, P〈0.001; R2=0.407, P〈0.001）. The thickness of the inferior-outer sector of macula had greater AROCs than those in the inferior-inner sector of macula. The AROCs for superior（0.894） and inferior（0.879） p RNFL thicknesses were similar with the AROCs for superior（0.839） and inferior m GCL（0.864） thicknesses. Sensitivities at 80% specificity for global p RNFL, inferior-outer m GCL and inferior-outer m RNFL thicknesses were 0.938, 0.867, and 0.725, respectively. CONCLUSION： The diagnostic capability of the m GCL thickness is comparable to that of the p RNFL thickness in patients with early glaucoma. The inferior-outer sector of IML has a better diagnostic capability than the inferiorinner sector of IML for detection of early glaucoma.

Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma： a retrospective multicenter study

AIM： To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma （POAG） patients. METHODS： This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure （IOP） reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as： 1） IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2） no additional glaucoma surgery required. RESULTS： A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y （P=0.05）. The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery （P=0.04）. The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone （100% vs 76%）. In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen. CONCLUSION： Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

Diabetes and risk of glaucoma:systematic review and a Meta-analysis of prospective cohort studies

AIM：To quantify the association between diabetes and glaucoma using Meta-analysis.METHODS：Pub Med and Embase were searched using medical subject headings and key words related to diabetes and glaucoma.The inclusion criteria were：1）the study design was a prospective cohort study;2）the exposure of interest was diabetes;3）the outcome of interest was primary open angle glaucoma（POAG）;4）risk ratios（RR）and the corresponding 95%confidence interval（CI）.Data were pooled using fixed effects models to take into account heterogeneity between studies.Seven prospective studies were selected.Diabetes increased the incidence of glaucoma by 36%（OR=1.36,95%CI=1.25-1.50）.There was no evidence of statistical heterogeneity（I2=0,P=0.53）or publication bias（the funnel plot did not identify obvious asymmetry）.RESULTS：Seven prospective cohort studies were incorporated in this Meta-analysis.The pooled RR of the association between POAG and diabetes based on the risk estimates of the seven cohort studies was 1.36（95%CI=1.24-1.50）,with no significant heterogeneity across studies（I2=0;P=0.526）.The sensitivity analysis yielded a range of RRs from 1.34（95%CI=1.22-1.48）to1.40（95%CI=1.18-1.67）.CONCLUSION：Diabetes is associated with a significantly increased risk of glaucoma.

Inflammatory model in patients with primary open angle glaucoma and diabetes

AIM: To assess the inflammatory cytokines expression in aqueous humor in diabetic primary open angle glaucoma(POAG) patients. METHODS: A cross-sectional study on 87 eyes, distributed as following: 26 eyes from diabetic patients, 16 eyes with POAG and 21 eyes from diabetic POAG patients; healthy controls(24 eyes) were recruited from patients undergoing conventional cataract surgery. A volume of 100 μL of aqueous humor(AH) was collected during phacoemulsification and 21 inflammatory markers were quantified using a Luminex~? cytometric bead assay: IL-1 Ra, IL-1α, IL-1β, IL-5, IL-6, IL-10, IL-17, GM-CSF, IFNγ, CCL2, CCL3, CCL4, CXCL5, CXCL8, bFGF, VEGF, TNFα. Main changes in cytokine profile were analyzed and compared between groups. Data on demographics, duration of glaucoma, intraocular pressure(IOP), number of anti-glaucoma substances were recorded for correlation analysis and prediction models. RESULTS: Significant differences in cytokine expression between groups were detected for CXCL5(P<0.001), CXCL8(P=0.004), IL-1α(P<0.001), IL-2(P<0.001), CCL4(P=0.003), CCL5(P<0.001) and TNFα(P=0.05). Post-hoc analysis identified IL-2(P=0.009) and CXCL5(P<0.001) as "separation markers" between POAG and diabetic POAG eyes. In POAG patients, the "separation markers" could highly predict the TNFα levels F(1, 16)=14.639, P<0.001, whereas in diabetic patients F(1, 24)=4.844, P=0.006 and diabetic POAG patients F(1, 19)=2.358, P=0.05 the level of prediction was inferior.CONCLUSION: Our results reveal an inflammatory model based on increased TNFα levels in POAG eyes.Simultaneous co-stimulatory molecules and additional inflammatory pathways need to be further explored in diabetic POAG cases, since the prediction model could only partially explain the increased TNFα level in this category of patients.

Diagnostic performance of OCT and OCTA in less than 60-year-old patients with early POAG:a cross-sectional study

AIM:To observe and characterize imaging features of macular and optic disc areas in less than 60-year-old patients with early primary open angle glaucoma(POAG)by optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA),and to evaluate the diagnostic value of OCT and OCTA.METHODS:Totally 15 patients(23 eyes)with early POAG as observation group and 30 health people(30 eyes)as normal control group were enrolled in this cross-sectional study.OCTA-based superficial macula vessel density,superficial macula perfusion density,superficial optic disc vessel density,superficial optic disc perfusion density and spectral domain OCT(SD-OCT)-based macular area thickness,ganglion cell complex(GCC)thickness and retinal nerve fiber layer(RNFL)thickness were measured in the two groups.Independent t-test and receiver operating characteristic curve were used for analysis.Area under the receiver operating characteristic curves(AUROC)were used to measure the diagnostic utility.RESULTS:Among all the parameters,the optimal diagnostic utility parameter was the superficial vessel density in the macular area(except the center of the macula),and the AUROC reached 0.98.The diagnostic utility of macular area perfusion density(except the center of the macula)was similar to that of superficial vessel density in the macular area,and the AUROC was above 0.97.Followed by the diagnostic utility of vessel density in the optic disc area,the best parameter was the inner ring of the vessel density,and its AUROC reached 0.97.The diagnostic utility of perfusion density in the optic disc area was slightly lower than that of vessel density in the optic disc area.The best parameter was the central optic disc perfusion density,and its AUROC was 0.95.The SD-OCT-based diagnostic utility parameters were generally lower than that mentioned above,the top three parameters were the inferior RNFL thickness(AUROC=0.919),the superior(AUROC=0.919)and the inferior GCC thickness(AUROC=0.9077).CONCLUSION:The OCT-based diagnostic utility parameters are generally lower than the OCTA-based diagnostic utility parameters.OCTA has an important clinical application value in diagnosis and evaluation for less than 60-year-old patients with early POAG.

Selective laser trabeculoplasty

The introduction of selective laser trabeculoplasty (SLT) provided a new choice for the reduction of intraocular pressure (IOP) in eyes with open angle glaucoma (OAG) and ocular hypertension (OHT). SLT was demonstrated equally as effective as topical medical therapy and argon laser trabeculoplasty (ALT) to lower IOP. It is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork (TM) and also effect in patients with previously failed ALT. SLT can be used to treat patients with OAG, pseudoexfoliation glaucoma, pigmentary glaucoma, normal-tension glaucoma, OHT, juvenile glaucoma, pseudophakic and aphakic glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with medications, while not interfering with the success of future surgery. Its safety profiles include mild and transient inflammation, ocular pain and a small risk of moderate IOP elevations after the procedure. SLT is a safe and effective means of IOP reduction in eyes with OAG and OHT.

Meta Analysis of Non-penetrating Trabecular Surgery versus Trabeculectomy for the Treatment of Open Angle Glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED （1966 to 2009）, Embase （1980 to 2009） and CMB-disk （1979 to 2009） for the randomized clinical trials （RCT） concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration＇s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure （IOP） between non-penetrating trabecular surgery and trabeculectomy （Z=6.05 P0.00001）. There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures （Z=4.92, P0.00001）. Difference in the success rate was also found between the two surgeries （Z=3.82, P=0.0001）. It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.

Fixed combination of latanoprost and timolol vs the individual components for primary open angle glaucoma and ocular hypertension:a systematic review and meta-analysis

AIM:To assess the effects of the fixed combination of0.005% latanoprost and 0.5% timolol(FCLT) vs their individual components for primary open angle glaucoma(POAG) and ocular hypertension(OHT).· METHODS:After searched PubMed, EMBASE, the Cochrane Library and SCI, all randomized controlled clinical trials(RCTs) and cross-over studies were included. The control groups were the monotherapy or the concomitant therapy of latanoprost and timolol. The outcomes were visual field defect, optic atrophy, mean intraocular pressure(IOP) and IOP fluctuation. The analysis was carried out in RevMan version 5.1 software.RESULTS:Thepost-interventionmeanIOPofFCLTwas significantly lower compared to timolol [mean difference(MD)-2.92, 95%CI-3.28 to-2.55, P 【0.00001] and latanoprost(MD-1.11, 95%CI-1.51 to-0.72, P 【0.00001). The postintervention IOP fluctuation was also significantly lower compared to timolol(MD-0.88, 95%CI-1.23 to-0.53, P 【0. 00001) and latanoprost( MD- 0. 63, 95 % CI- 1. 04to-0.22, P =0.002). The mean IOP was higher in FCLT morning dose group than the one in unfixed combination of 0.005% latanoprost and 0.5% timolol(UFCLT)(MD1.10, 95% CI 0.81 to 1.39, P 【0.00001). Otherwise, there was no difference between FCLT evening dose group and UFCLT(MD 0.34, 95% CI-0.01 to 0.69, P =0.06).There was no statistical difference for the incidence ofvisual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.visual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the monotherapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.