Prolidase activity in aqueous and serum samples of cataract cases with Pseudoexfoliation syndrome.

Pseudoexfoliation syndrome (PEX) represents an age-related systemic disease that is characterized by the accumulation of extracellular matrix material in ocular tissues and visceral organs. Abnormal matrix remodeling is thought to be one of the important factors in the etiopathogenesis of the disease. Prolidase represents an enzyme, which takes a significant part in collagen biosynthesis and remodeling of the extracellular matrix. The purpose of the current research was to assess the prolidase enzyme activity in the aqueous and serum samples of subjects with PEX. The study population consisted of 66 subjects, involving 33 subjects with age-related cataract among patients with PEX and 33 subjects with age-related cataract without PEX. The prolidase activity measurement was performed using the modified Chinard's method. Significantly increased aqueous prolidase activity was detected in the group with PEX (p < 0.01). Despite about a three times higher increase in the serum prolidase activity of the group with PEX in comparison with the control group, the two groups did not differ statistically significantly (p > 0.05). The high prolidase enzyme activity in the aqueous samples of subjects with PEX suggests that the collagen cycle and the remodeling of the extracellular matrix are accelerated. These results can be a guide for understanding the formation mechanisms of PEX.

[Determination of cytokines in the blood serum and in the aqueous humor of the anterior camera during pseudoexfoliative syndrome and cataract.]

There have been studied changes of proinflammatory cytokines, IL-1ß and TNF-α, in anterior chamber aqueous humor and in blood serum before cataract surgery in 81 patients with cataract. Of these, 46 patients had verified diagnosis of pseudoexfoliative syndrome (PEÐ¥) of varying degree of manifestation of dystrophic changes and deposits of pseudoexfoliative material (main group). In 35 patients, PES (comparison group) has not been detected. 2-stage biomicroscopy (with a narrow pupil, after tonometry with mydriasis) and ultrasound biomicroscopy (UBM) have been conducted. According to the results of biomicroscopy and UBM structures of the eye, 3 stages of development of PEX have been identified: I - 11 (23,91%), II - 20 (43,48%), III - 15 (32,61%). Inflammatory complications after cataract surgery have been in 17,39% of eyes with PEÐ¥, of which PEX Stage II in 13,04% and PEÐ¥ Stage III in 4,35%. There have been no complications in the eyes with PEX Stage I and without PEX. In comparison with patients without PEX, significant differences in the indicators of IL-1ß and TNF-α both in the blood serum and in the aqueous humor of the anterior chamber of patients with PEX have been found. In particular, there have been confirmed significant differences of indicators depending on the stage of development of changes during PEX. At the same time, higher concentrations of IL-1ß and TNF-α during PEX, as well as somatic pathologies in patients with PES occurring 2 times more often, confirm the opinion that PEX should be considered as pathology of the organ of vision. Thus, decrease in the compensatory abilities of the body with age and a set of chronic age-related pathology form the pathogenetic mechanisms of PEX, including age-related changes in structures and surgery background in older patients, to a certain extent predetermining the nature and features of the postoperative period and possible complications.

Evaluation of thiol-disulfide homeostasis in pseudoexfoliation glaucoma and primary open-angle glaucoma.

AIMS: This study aimed to compare the serum thiol-disulfide homeostasis, total antioxidant status (TAS), and total oxidant status (TOS) in patients with pseudoexfoliation glaucoma (PEG) patients, primary open-angle glaucoma (POAG) patients, and healthy individuals (control). METHODS: Ninety subjects were included in this study. Three groups were separated as PEG, POAG, and control. All groups were chosen to be similar in terms of age and gender. Blood samples were obtained following an overnight fasting state and were collected on the ice at 4°C. The serum samples were separated from the cells by centrifugation at 3000 rpm for 15 min and were stored at -80°C. Serum samples analyzed for TAS and TOS, native thiol, total thiol, disulfide, and native thiol/disulfide ratio. RESULTS: TAS and TOS levels of PEG patients were 1.2892 ± 0.0905 mmol/L; 5.0191 ± 2.7722 µmol/L, respectively. TAS and TOS levels of POAG patients were 1.2741 ± 0.1252 mmol/L; 4.1674 ± 1.7723 µmol/L, respectively. TAS and TOS levels of the control group were 2.3414 ± 0.1409 mmol/L; 4.0931 ± 0.1107 µmol/L, respectively. The TAS level was significantly lower in PEG and POAG groups compared to control. TOS level showed no significant differ ¬ ence between PEG, POAG, and control groups (P > 0.05). The mean serum total thiol and native thiol levels were significantly lower in patients with PEG compared to POAG and control group; there was no significant difference between the POAG and control group (P > 0.05). The mean serum disulfide level was significantly lower in patients with PEG compared to POAG (P = 0.018). CONCLUSION: Low levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients. While total thiol and native thiol levels were higher in the PEG group, the disulfide level was higher in the POAG group. TAS and TOS levels showed no significant difference between POAG and PEG groups.

Serum insulin-like growth factor-1 levels in patients with pseudoexfoliation syndrome and glaucoma.

Insulin-like growth factor-1 (IGF-1) is altered in several neurodegenerative diseases, the association between serum IGF-1 levels and glaucoma has not been evaluated. This study was designed to evaluate whether serum IGF-1 levels are different in patients with Pseudoexfoliation (PEX) with or without glaucoma. The study was conducted with 110 participants aged 65 years or older who were divided into three groups: group 1, patients with PEX syndrome; group 2, patients with PEX glaucoma; and group 3, participants without PEX or glaucoma. All participants underwent full ophthalmological examination and a detailed medical history was recorded. Patients with known neurodegenerative diseases other than PEX glaucoma were excluded. Serum IGF-1 levels were measured by automated chemiluminescent assay. Groups 1, 2, and 3 included 35, 34, and 41 patients, respectively; there were no differences regarding age, gender, or systemic disease status. There were also no statistically significant differences between the groups in terms of IGF-1 levels, which were 91.7 ± 39.1, 101.1 ± 40.2, and 107.2 ± 43.8 ng/ml for groups 1, 2, and 3, respectively (p = 0.276). Serum IGF-1 levels were similar by gender, the presence of systemic disease, status of diabetes mellitus, and laterality of the PEX material. There was no correlation between the cup-to-disk ratios and IGF-1 levels (r = -0.214, p = 0.223). IGF-1 levels in the circulation did not differ in the presence of PEX syndrome with or without glaucoma. This may indicate that the neurodegenerative process is local rather than systemic.

Bone Mineral Density and 25-Hydroxyvitamin D Levels in Patients With Ocular Pseudoexfoliation Syndrome: A Case-Control Study.

The objective of this study was to evaluate bone mineral density (BMD) and 25-hydroxyvitamin D (25(OH)D) levels in patients with ocular pseudoexfoliation (PEX) syndrome. Subjects with ocular PEX syndrome were included in the PEX group and subjects without PEX syndrome were defined as the control group. 25(OH)D levels were measured by chemiluminescence microparticle immunoassay method. BMD measurements were obtained from the femoral neck and lumbar spine by using dual-energy X-ray absorptiometry. The results were expressed as gram per square centimeter, T-scores (standard deviation compared to a healthy 30-yr-old male), and Z-scores (standard deviation compared to the subject's age). Independent t-test was used to compare the mean and medians of the groups. The PEX group consisted of 23 subjects with a mean age of 71.09 ± 2.02 yr and the control group consisted 46 subjects with a mean age of 67.04 ± 1.34 yr. There was no significant difference between the groups as regards the BMD measurements (gram per square meter), T-scores, and Z-scores. Both groups have low 25(OH)D, yet vitamin 25(OH)D levels were similar in the groups (p > 0.05). In the light of our results, although patients with ocular PEX have low BMD and 25(OH)D, BMD and 25(OH)D do not appear to be linked to ocular PEX syndrome in our study population.

Plateletcrit in Ocular Pseudoexfoliation Syndrome.

PURPOSE: The aim of this study was to compare all platelet markers, especially plateletcrit (PCT, total platelet mass), in patients with and without ocular pseudoexfoliation (PEX) syndrome. METHODS: One hundred six patients with ocular PEX syndrome (study group) and 106 individuals without ocular PEX syndrome (control group) were enrolled in this retrospective case-control study. The biochemical/hematological laboratory results of both the study and control groups were analyzed by a clinician blinded to the group assignments. The main outcome measures were the PCT, platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW). RESULTS: The mean PCT in the study and control groups were 0.206%±0.520% and 0.171%±0.410%, respectively (P<0.001), and the mean PDW in the study and control groups were 16.12%±1.21% and 14.68%±1.40%, respectively (P<0.001). There were no differences in the MPV or mean PLT (P=0.138 and P=0.055, respectively). The PCT cutoff value was 0.180 (area under the receiver operating characteristics curve, 0.706; P<0.001; 65% sensitivity; 74% specificity). CONCLUSIONS: The PCT and PDW were significantly higher in patients with than without ocular PEX syndrome. These increased parameters may cause microvascular blood flow resistance and the heightened inflammatory response caused by excessive platelet activity, as with other cardiovascular diseases, and may also decrease aqueous humor outflow in ocular PEX syndrome.

Plasma adropin level in patients with pseudoexfoliation.

The aim of this study was to evaluate plasma adropin levels in patients with pseudoexfoliation (PEX). This retrospective case-control study included 35 patients with PEX and 35 individuals without PEX who served as controls. Plasma adropin levels with triglycerides, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and haemoglobin A1c (HGBA1C) concentrations were measured in both groups. The mean serum adropin levels were 3.24 ± 0.95 ng/mL (range, 1.90-7.88 ng/mL) in patients with PEX syndrome and 5.78 ± 2.85 ng/mL (range, 2.08-5.41 ng/mL) in PEX glaucoma patients. There was no statistically significant difference in mean adropin levels between PEX syndrome and PEX glaucoma patients. However, similar adropin levels were found in the PEX glaucoma patients and the control group (P > 0.05). The mean serum adropin levels were 3.34 ± 0.89 ng/mL (range, 1.90-5.39 ng/mL) in the PEX group and 5.78 ± 2.85 ng/mL (range, 3.08-11.06 ng/mL) in the control group. The mean serum adropin level of the PEX group was significantly lower than that of the control group (P < 0.001). There were no significant differences between the two groups in terms of serum glucose, total cholesterol, LDL, HDL, HGBA1C, triglycerides levels, or body mass index (all P > 0.05). Adropin level is lower in patients with PEX.

Plasma homocysteine, folic acid, and vitamin B12 levels in patients with pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and normotensive glaucoma.

OBJECTIVE: The aim of this study was to evaluate the levels of plasma homocysteine (Hcy), vitamin B12, and folic acid in patients with pseudoexfoliation glaucoma (PEXG), pseudoexfoliation syndrome (PEXS), PEXS plus normotensive glaucoma (NTG). MATERIAL AND METHODS: In total, 24 patients with PEXG, 35 patients with PEXS, 18 patients with PEXS plus NTG, and 35 control subjects were enrolled into study. Their Hcy levels were measured by high performance liquid chromatography (HPLC); the levels of vitamin B12 and folic acid were measured by a competitive electrochemiluminescence immunoassay. RESULTS: Higher plasma Hcy levels and lower folic acid and vitamin B12 levels were found in all 3 patients' groups compared with the control group (all P<0.001, expect for folic acid in the PEXG group, P=0.03). Although plasma Hcy levels in the PEXG and PEXS groups were similar, the PEXS plus NTG group had significantly higher Hcy levels compared with these groups (P=0.019 and P=0.032, respectively). CONCLUSIONS: Our study showed that there was an association between hyperhomocysteinemia and PEXS either with or without glaucoma. The patients with PEXS plus NTG had higher plasma Hcy levels than the patients with PEXS or PEXG and the healthy controls. The treatment of hyperhomocysteinemia by taking low-cost vitamin B12 and folic acid preparations may prevent additional vascular problems.

Rapid inexpensive genome-wide association using pooled whole blood.

Genome-wide association studies (GWAS) have now successfully identified important genetic variants associated with many human traits and diseases. The high cost of genotyping arrays in large data sets remains the major barrier to wider utilization of GWAS. We have developed a novel method in which whole blood from cases and controls, respectively, is pooled prior to DNA extraction for genotyping. We demonstrate proof of principle by clearly identifying the associated variants for eye color, age-related macular degeneration, and pseudoexfoliation syndrome in cohorts not previously studied. Blood pooling has the potential to reduce GWAS cost by several orders of magnitude and dramatically shorten gene discovery time. This method has profound implications for translation of modern genetic approaches to a multitude of diseases and traits yet to be analyzed by GWAS, and will enable developing nations to participate in GWAS.

Plasma homocysteine, serum folic acid, serum vitamin B12, serum vitamin B6, MTHFR and risk of pseudoexfoliation glaucoma: a meta-analysis.

BACKGROUND: The aim of this meta-analysis is to explore the relationship between plasma total homocysteine (tHcy) levels, serum folic acid, vitamin B12 and vitamin B6 levels, methylenetetrahydrofolate reductase (MTHFR) C677T genotype and risk of pseudoexfoliation glaucoma (PEXG). METHODS: A systematic search of EMBASE and PubMed of relevant articles was carried out for all published articles. Main outcome measures included the calculation of plasma tHcy levels, serum folic acid, vitamin B12, and vitamin B6 levels mean difference and odds ratios (OR) of MTHFR C677T genotype between cases and controls. RESULTS: There were 14 studies for tHcy (485 cases and 456 controls), five studies for folic acid (188 cases and 189 controls), six studies for vitamin B12 (199 cases and 225 controls), three studies for vitamin B6 (128 cases and 130 controls) and eight studies for MTHFR (479 cases and 661 controls). Overall, the mean plasma tHcy levels in cases was 3.38 umol/l (95% confidence intervals (CI): 2.35-4.42) higher than in controls. Serum folic acids, but not vitamin B12 and vitamin B6 levels, was significantly lower in cases than in controls; the weighted mean differences with 95% CI were -1.50 umol/l (-2.53, -0.46), -36.29 umol/l (-81.27, 8.68) and -0.60 umol/l (-2.55, 1.35) respectively. There was no evidence of association between the MTHFR C677T genotype and PEXG (OR = 1.28, 95% CI: 0.85, 1.93). CONCLUSIONS: PEXG is associated with elevated plasma tHcy and low serum folic acid levels, but not serum vitamin B12, vitamin B6 levels, and MTHFR C677T genotype.

Endothelial cell markers in patients with pseudoexfoliation syndrome.

The aim of the study was the assessment of the von Willebrand antigen (vWF Ag), E-selectin, and P-selectin concentration in blood plasma of patients with pseudoexfoliation syndrome (PEX). The group studied comprised 30 patients with PEX, aged from 50 to 86 years (mean 73, SD ± 8 years). Patients with cardiovascular and cerebrovascular diseases, diabetes mellitus, infectious disease, cancer, renal or liver insufficiency, connective tissue disease, current smoking, and hormone, antiplatelet, hypolipidemic, antioxidant, or antihypertensive drug therapy were excluded from the study. Each subject underwent a complete ophthalmological examination. Venous blood samples from the cubital vein were taken into sodium citrate solution. VWF Ag, sP-selectin, and sE-selectin concentration were determined by a commercially available enzyme-linked immunosorbent assay (MedSystems, Diagnostica Stago/Roche, R&D). Concentrations of vWF Ag, soluble E-selectin, and soluble P-selectin in blood plasma in the study group were compared with the levels in blood plasma in the control group. No significant differences were found between the groups. Our results indicate that there might be no correlation between PEX and such endothelial cell markers as vWF Ag, sP-selectin, and sE-selectin concentrations. Since the study size is limited, further investigations to confirm that there is no association between endothelial dysfunction in PEX and risk of future cardiovascular disease are necessary.

Decreased total antioxidants status in the plasma of patients with pseudoexfoliation glaucoma.

PURPOSE: To evaluate total antioxidant status (TAS) in the plasma of pseudoexfoliation glaucoma (PEG) patients and to compare this level with a matching control group. Additionally, we aim to investigate the effect of the combined action of the lysyl oxidase-like 1 (LOXL1) mutation status with TAS level on the development of PEG. METHODS: Plasma samples were obtained from 54 PEG patients and 54 controls of matching age, sex, and ethnicity. TAS in all samples was determined by spectrophotometric and enzyme-linked immunosorbent assay methods. The coding region of LOXL1, where it encompasses both single nucleotide polymorphisms (SNPs; rs1048661 and rs3825942), was sequenced. RESULTS: The mean (±SD) total antioxidant (TAS) value was lower among patients: 0.87 (0.24), range 0.9-1.41 than controls: 1.07 (0.23), range 0.72-1.94, and this difference was statistically significant (p<0.0001: 95%CI: -0.295-0.114). Evaluating the impact of age, sex, and the mutation in addition to the mean TAS value in patients with PEG, a logistic regression analysis was conducted using diseased/not diseased as the outcome of interest (the dependent variable). Results show that, controlling for all other variables, mean TAS value (p<0.0001) and the mutation G/G in rs3825942 (p=0.041) are significant risk factors for PEG. CONCLUSIONS: Our findings provide evidence that TAS decreases in the plasma of PEG patients, suggesting that TAS may have an important role in the pathogenesis of PEG. The combined effect of the "G" allele and the decreased TAS may contribute to the overall pathogenesis of PEG.

Levels of plasma homocysteine in pseudoexfoliation glaucoma.

BACKGROUND: To examine levels of serum homocysteine (Hcy), vitamin B12 and folic acid in patients with pseudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG), and healthy control subjects. METHODS: This study included 36 patients with PEXG, 40 with POAG, and 40 age-matched healthy subjects. Fasting plasma Hcy concentrations and levels of serum vitamin B12 and folic acid were measured using competitive chemiluminescent enzyme immunoassay; values exceeding 14 µm/l were considered elevated. RESULTS: Mean plasma Hcy was significantly higher in PEXG (16.55 ± 7.23 µm/l) compared with POAG (13.91 ± 3.61 µm/l) and controls (13.12 ± 5.13 µm/l) (p = 0.03 and p = 0.0007 respectively). There were no statistical differences in serum vitamin B12 and folic acid levels among PEXG, POAG and control subjects (p > 0.05). A moderate, although statistically significant, relationship between Hcy and folic acid levels was found in the PEXG group (R(2) = 0.23, p = 0.003). Hcy levels were found not to be related with folic acid or vitamin B12 in either POAG or control subjects. CONCLUSIONS: In this study, plasma Hcy is significantly higher in PEXG group than the POAG and control groups. Hyper-Hcy might play a role in the pathogenesis of PEXG. Hyper-Hcy may be an independent factor stressing vasculopathy in addition to pseudoexfoliation, so might be a modifiable risk factor for PEXG.

Plasma and aqueous humour levels of ghrelin in open-angle glaucoma patients.

BACKGROUND: To compare aqueous humour and plasma levels of ghrelin, a peptide recently identified in human eyes, in patients with open-angle glaucoma and controls. DESIGN: Cross-sectional, controlled, hospital-based study. PARTICIPANTS: Twenty-four open-angle glaucoma (17 primary open-angle and 7 pseudo-exfoliation glaucoma) patients and 30 controls were included. All participants were patients scheduled for cataract or glaucoma surgery. Patients with other ocular pathology, previous ocular surgery or diabetes were excluded. METHODS: Blood samples were collected before elective surgery. Aqueous humour was aspirated from the anterior chamber through a paracentesis with a 27-G needle under sterile conditions before any tissue manipulation. Ghrelin quantification was performed with commercially available Radioimmunoassay kits. MAIN OUTCOME MEASURE: Ghrelin levels in aqueous humour and plasma. RESULTS: Plasma levels of ghrelin were 490.5 ± 156.0 pg/mL in the open-angle glaucoma and 482.2 ± 125.4 pg/mL in the control group (Mann-Whitney test, P = 0.897). Aqueous humour levels of ghrelin were 85.5 ± 15.4 and 123.4 ± 25.5 pg/mL in the respective groups (P < 0.001). The ratio of plasma/aqueous humour ghrelin concentration was higher in the open-angle glaucoma versus the control group (5.75 ± 1.92 vs. 4.00 ± 1.04, P < 0.001). There was no difference in aqueous humour levels of ghrelin between primary open-angle glaucoma and pseudo-exfoliation glaucoma patients (P = 0.494). CONCLUSIONS: Aqueous humour levels of ghrelin were significantly lower in open-angle glaucoma patients, compared with controls. This difference may manifest a role of ghrelin in the disease process or a consequence of antiglaucoma treatment.

Importance of circulating platelet aggregates and haemodynamic changes in ophthalmic artery and progression of visual field loss at pseudoexfoliation glaucoma.

The aim of this work is to examine the role of circulating platelet aggregates (CPA) at pseudoexfoliation glaucoma (PXG), haemodynamic changes in the ophthalmic artery by ultrasonic color Doppler, searching for visual field progression. Vascular component at PXG and its role in VF progression dynamics has not been sufficiently explained, as well as CPA influence to ischaemic events related to optic nerve damage and VF progression. The examination included 80 patients, where of 35 (44%) men average age 68.3 +/- 7.0 and 45 (56%) women average age 65.7 +/- 7.0 (t = 1.66; p = 0.101). Forthy of them suffered from primary open angle glaucoma (POAG) as a control group (healthy), and 40 from pseudoexfoliative glaucoma (PXG) as an experimental group. All the examinees underwent complete ophthalmological examination: visual acuity, ocular fundus, intraocular pressure measured, anterior eye segment biomicroscopy with gonioscopy performed. Also VF examination was performed three times at 6 months intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method and ultrasonic measurement of blood perfusion in the carotid tree, particularly concerning ophthalmic artery by means of color Doppler. Obtained decreased values of CPA proportion resulted in hypercoagulability of blood in PXG group. At PXG were also found increased blood flow resistivity indexes in ophthalmic artery (RI AO) and internal carotid artery (RI ACI), resulting with ischemia and hypoxia and finally progression of the visual filed damage. In conclusion, our study shows that examining CPA and ultrasonic monitoring of vascular parameters in ophthalmic artery with color Doppler may be the way of better understanding the vascular role in PXG prognosis.

Serological Levels of Anti-clathrin Antibodies Are Decreased in Patients With Pseudoexfoliation Glaucoma.

Evidence for immunologic contribution to glaucoma pathophysiology is steadily increasing in ophthalmic research. Particularly, an altered abundance of circulating autoantibodies to ocular antigens is frequently observed. Here, we report an analysis of autoantibody abundancies to selected antigens in sera of open-angle glaucoma patients, subdivided into normal-tension glaucoma (N = 31), primary open-angle glaucoma (N = 43) and pseudoexfoliation glaucoma (N = 45), vs. a non-glaucomatous control group (N = 46). Serum samples were analyzed by protein microarray, including 38 antigens. Differences in antibody levels were assessed by ANOVA. Five serological antibodies showed significantly altered levels among the four groups (P < 0.05), which can be used to cluster the subjects in groups consisting mainly of PEXG or POAG/NTG samples. Among the altered autoantibodies, anti-Clathrin antibodies were identified as most important subgroup predictors, enhancing prospective glaucoma subtype prediction. As a second aim, we wanted to gain further insights into the characteristics of previously identified glaucoma-related antigens and their role in glaucoma pathogenesis. To this end, we used the bioinformatics toolset of Metascape to construct protein-protein interaction networks and GO enrichment analysis. Glaucoma-related antigens were significantly enriched in 13 biological processes, including mRNA metabolism, protein folding, blood coagulation and apoptosis, proposing a link of glaucoma-associated pathways to changes in the autoantibody repertoire. In conclusion, our study provides new aspects of the involvement of natural autoimmunity in glaucoma pathomechanisms and promotes advanced opportunities toward new diagnostic approaches.

Increased oxidative stress in patients with pseudoexfoliation syndrome.

PURPOSE: The objective of this study was to investigate the antioxidant/oxidant status of serum in patients with pseudoexfoliation syndrome (PEX). METHODS: Forty-seven patients with PEX and 32 healthy controls were included in the study. Serum total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using a novel automated method. RESULTS: A significant increase in serum TOS (p < 0.001) and a significant decrease in serum TAC (p < 0.0001) were observed in PEX patients compared to control subjects. CONCLUSION: TAC decreases while the oxidative stress increases in PEX.

Role of haematological testing: ratio values of circulating platelet aggregates in visual field loss associated with pseudoexfoliation glaucoma.

The aim of the work is to examine the role of circulating platelet aggregates (CPAs) in association with pseudoexfoliation glaucoma (PXG) and searching for visual field (VF) progression. The impact of CPAs in association with PXG and ischaemic events related to optic nerve damage and VF progression has not been so far sufficiently explained. The examination included 80 patients, of whom 35 (44 %) were men with average age of 68.3 +/- 7.0 and 45 (56 %) were women with average age of 65.7 +/- 7.0 (t = 1.66; p = 0.101). Forty of them suffered from primary open-angle glaucoma (POAG) and were included into a control (healthy) group, and 40 patients suffered from pseudoexfoliative glaucoma (PXG) and were included into the experimental group. All the examinees underwent complete ophthalmologic examination of visual acuity, ocular fundus, intraocular pressure and anterior eye segment by biomicroscopy and gonioscopy. In addition, VF examination was performed three times in six-month intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method. The obtained decreased values of CPA proportion were caused by hypercoagulability of blood in PXG group resulting finally in ischaemia and hypoxia helping the progression of visual field. In conclusion, our study shows that CPA examination improves the assessment of the vascular role and PXG prognosis (Tab. 3, Ref. 30).

Is Netrin-1 Deficiency Responsible for Inflammation and Systemic Diseases Related to Pseudoexfoliation?

PRECIS: Serum netrin-1 levels are significantly lower in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliative glaucoma (PEG) compared with the control group. PURPOSE: To investigate serum netrin-1 levels in PES and PEG patients and to determine the relevance of this molecule in the etiopathogenesis of PES-related and PEG-related diseases. MATERIALS AND METHODS: This prospective study included 29 PES and 17 PEG patients in the study groups and age-sex matched 47 cataract patients without pseudoexfoliative accumulation as a control group. Serum netrin-1 levels were measured by enzyme-linked immunosorbent assay. RESULTS: Serum netrin-1 level was significantly lower in the PES and PEG groups compared with the control group (P=0.007). Multinominal logistic regression analysis was performed in terms of netrin-1 levels ≤712.9 pg/mL, >712.9 pg/mL and sex which may affect PES and PEG. It were found that netrin-1 was a significant negative predictor for PES (odds ratio, 3.45; 95% confidence interval, 1.230-9.716; P=0.019) and PEG (odds ratio, 3.57; 95% confidence interval, 1.008-12.669; P=0.049), respectively. CONCLUSIONS: Decreased serum netrin-1 levels were detected in PES and PEG patients, similar to atherosclerosis and Alzheimer disease. Inflammation lays behind in the common pathogenesis of these diseases. Therefore, netrin-1 promises a potential anti-inflammatory role.

Serum Apelin and Asymmetric Dimethylarginine Levels in Patients With Exfoliation Syndrome or Exfoliative Glaucoma.

PRéCIS:: Apelin and asymmetric dimethylarginine (ADMA) concentrations, affecting the nitric oxide pathway, were different in the patient group compared with the control subjects. These 2 molecules may have potential effects in vascular pathologies and their possible role in predisposition to vascular comorbidities in exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). PURPOSE: To evaluate apelin and ADMA levels in serum samples from patients with XFS or XFG compared with healthy control subjects. METHODS: Serum ADMA and apelin concentrations were evaluated from 36 and 32 XFS patients; 27 and 24 XFG patients; and 34 and 30 healthy controls, respectively. Subjects without systemic disease (including diabetes mellitus, hypertension, coronary artery disease, obesity) were included in the study and body mass index was calculated in all participants. An enzyme-linked immunosorbent assay and high-performance liquid chromatography were used to determine serum apelin and ADMA concentrations. Independent sample t test, χ test, analysis of variance test, and Pearson test were used for statistical analysis. RESULTS: Mean serum apelin levels of XFG, XFS, and control group were 1063.3±373.4, 1196.7±433.7, and 1343.3±405.1 ng/mL, respectively. Patients with XFG demonstrated significantly lower level of apelin versus controls (P=0.034). Mean serum ADMA concentration was significantly greater in XFS subjects (2.05±0.98 µmol/L) compared with normal controls (1.57±0.58 µmol/L) (P=0.042). No association was detected between ADMA and apelin concentrations and age, sex, and body mass index for both XFS and XFG groups. CONCLUSIONS: Significant alterations in serum levels of apelin and ADMA may suggest potential effects in vascular pathologies and a possible role in predisposition to vascular comorbidities in XFS/XFG.