Identification of biomarker candidates for exfoliative glaucoma from autoimmunity profiling.

BACKGROUND: Exfoliative glaucoma (XFG) is a subtype of open-angle glaucoma characterized by distinctive extracellular fibrils and a yet unknown pathogenesis potentially involving immune-related factors. The aim of this exploratory study was to identify biomarkers for XFG using data from autoimmunity profiling performed on blood samples from a Scandinavian cohort of patients. METHODS: Autoantibody screening was analyzed against 258 different protein fragments in blood samples taken from 30 patients diagnosed with XFG and 30 healthy donors. The 258 protein fragments were selected based on a preliminary study performed on 3072 randomly selected antigens and antigens associated with the eye. The "limma" package was used to perform moderated t-tests on the proteomic data to identify differentially expressed reactivity between the groups. RESULTS: Multiple associated genes were highlighted as possible biomarker candidates including FUT2, CDH5, and the LOX family genes. Using seven variables, our binary logistic regression model was able to classify the cases from the controls with an AUC of 0.85, and our reduced model using only one variable corresponding to the FUT2 gene provided an AUC of 0.75, based on LOOCV. Furthermore, over-representation gene analysis was performed to identify pathways that were associated with antigens differentially bound to self-antibodies. This highlighted the enrichment of pathways related to collagen fibril formation and the regulatory molecules mir-3176 and mir-876-5p. CONCLUSIONS: This study suggests several potential biomarkers that may be useful in developing further models of the pathology of XFG. In particular, CDH5, FUT2, and the LOX family seem to have a relationship which merits additional exploration.

Comparison of visual field progression in new-diagnosed primary open-angle and exfoliation glaucoma patients in Sweden.

BACKGROUND: The present study aimed to compare visual field progression in new-diagnosed exfoliation versus open-angle glaucoma patients. METHODS: Retrospective study. The study included patients with new-diagnosed primary open-angle and exfoliation glaucoma. All patients were followed for 3 years with reliable visual fields. At least five reliable fields were needed for inclusion. Exfoliation and open-angle glaucoma were defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the software threshold 24-2 of the Humphrey Field Analysis. OUTCOMES: Visual field progression. For visual field progression, three different strategies were used: mean deviation (MD), visual field index (VFI), and the guided progression analysis (GPA). RESULTS: The study included 128 subjects, of the 54 in the open-angle and 74 in the exfoliation glaucoma group. The MD difference values were higher in the exfoliation (- 3.17 dB) than in the primary open-angle (- 1.25 dB) glaucoma group in the three-year follow-up period. The difference between groups was significant (t-test, p = < 0.001). The difference in VFI was calculated for the 3 years follow-up period. The difference was higher in the exfoliation (- 7.65%) than in the primary open (- 1.90%) glaucoma group (t-test, p = < 0.001). The GPA showed progression in 58% of cases in exfoliation, and 13% in primary open glaucoma group (Chi-square, p = < 0.001). CONCLUSION: The present study found a more frequent and faster visual field progression in exfoliation than in primary open-angle glaucoma patients. New-diagnosed exfoliation glaucoma patients must be controlled and treated more strictly than primary open-angle glaucoma patients to avoid visual field deterioration.

Accuracy of optical coherence tomography (OCT) in pachymetry for glaucoma patients.

BACKGROUND: Central corneal thickness (CCT) measurement has become an important test in the diagnosis and management of glaucoma. Currently, ultrasound corneal thickness measurement (pachymetry) is the most frequently used clinical technique and the gold standard to assess CCT. Newer instruments are currently available including the optical coherence tomography (OCT) instrument. The aim of the present study was therefore to evaluate the accuracy of the CCT measurements performed by three different observers, both with the OCT and ultrasound pachymetry (USP), in patients suffering from glaucoma. METHODS: Patients who had been previously diagnosed with glaucoma participated in this cross-sectional study. Glaucoma was defined as patients who had at least two repeatable Humphrey visual fields showing glaucoma damage using the software 24-2, and with the optic nerve showing typical glaucoma damage. The patients CCTs were measured with OCT and USP by three different examiners. RESULTS: Seventy eyes of 35 patients were included. The average age was 74 ± standard deviation (SD) 10.88, the average pachymetry value with OCT was 536 ± 29 µm, and the average pachymetry with USP was 532 ± 32 µm. The differences between OCT and USP were not significant (t-test, p = 0.32). The intraclass correlation coefficients were, for OCT, 0.99 [confidence interval (CI): 0.98-0.996], and for USP, 0.97 (CI: 0.95-0.98). CONCLUSIONS: Agreement among the three observers using OCT or USP for pachymetry measurements was good. OCT might be used as an alternative method for pachymetry in glaucoma patients.

Intraocular pressure reduction after initial failure of selective laser trabeculoplasty (SLT).

PURPOSE: The aim of this work was to study the reduction in intraocular pressure (IOP) after two selective laser trabeculoplasty (SLT) treatments in the same area of the trabecular meshwork (TM) compared to two SLT treatments in two different areas of the TM when the initial SLT treatment has failed. METHODS: This was a prospective randomized clinical trial for testing the effect of repeated SLT treatments in reducing IOP. The patients in the study all suffered from primary open-angle or pseudoexfoliation glaucoma. All patients were treated initially with SLT (SLT 1) over 180° in the lower half of the TM. Patients who were chosen for retreatment with SLT (SLT 2) were asked to participate in the study. The patients in the study were randomized to either SLT 2 in the same, already-treated TM area or to SLT 2 in the upper untreated TM area. The IOP was measured before and 2 h, 1 month, 3 months, and 6 months after the SLT 2 treatment. Patients who changed medical therapy regimens during this time were excluded. RESULTS: A total of 40 patients were included in both groups. At baseline, there were no significant differences between the groups in regards to age (t-test, p = 0.44), gender (χ(2), p = 0.14), pseudoexfoliation glaucoma (χ(2), p = 0.07), time between SLT 1 and SLT 2 (t-test, p = 0.78), IOP before SLT 1 (t-test, p = 0.78), or IOP before SLT 2 (t-test, p = 0.32). At the conclusion of the study, there were no significant differences in IOP between the groups 2 h (t-test, p = 0.65), 1 month (t-test, p = 0.60), 3 months (t-test, p = 0.42), or 6 months (t-test, p = 0.66) after the SLT 2 treatment. CONCLUSIONS: Two SLT treatments of the same TM area do not have a significant effect on IOP compared to two SLT treatments in two different areas.

Risk Factors and Frequency of Examinations for Detecting Visual Field Deterioration in Patients with Newly Diagnosed Exfoliation Glaucoma in Sweden.

PRCIS: The study identified risk factors for exfoliation glaucoma and recommended re-evaluating target intraocular pressure (IOP) after 5 visual fields to slow disease progression. PURPOSE: This study aimed to establish risk factors for exfoliation glaucoma and determine the earliest time points for estimating disease progression. PATIENTS: A total of 96 patients with newly diagnosed exfoliation glaucoma were included. Included patients were required to perform at least 7 visual field tests within a 3-year period (±3 months). All patients were treated at inclusion. METHODS: This was a nonrandomized, prospective cohort study. The predictors measured included IOP, mean deviation (MD), and visual field index (VFI). Progression was assessed using the rate of progression based on MD, VFI, and "Guided Progression Analysis." Linear or logistic regression models were developed based on the variables studied. An analysis of variance was used to establish the earliest time point. At the earliest time point, the models were retested. The area under the receiver operating characteristic curve was calculated. RESULTS: The general rate of progression of the cohort was -3.84 (±2.61) dB for the MD values and 9.66 (±6.25) % for the VFI values over 3 years. The IOP, MD, and VFI values at diagnosis were predictors of progression for both linear and logistic regression. Analysis of variance and post hoc Tukey test showed significant values at 24 months for MD and VFI. The area under the curve at 24 months showed significant values for MD and VFI. CONCLUSIONS: The predictors studied (IOP, MD, and VFI) showed moderate accuracy at baseline but excellent predictive capacity at 24 months postdiagnosis. Re-evaluating the target IOP at 24 months can effectively slow down disease progression.

Former smoking as a risk factor for visual field progression in exfoliation glaucoma patients in Sweden.

PURPOSE: The present study aimed to identify whether former smoking was a risk factor for visual field progression in exfoliation glaucoma patients. METHODS: Prospective nonrandomised cohort study. The study included patients diagnosed with exfoliation glaucoma. All included patients were followed for three years (± three months) with reliable visual fields. At least five reliable visual fields needed to be included in the study. Exfoliation glaucoma was defined using the European Glaucoma Society Guidelines. The visual fields were tested using the 24-2 test strategy of the Humphrey Field Analyzer. Smoking was assessed through questionnaires. Outcomes: Visual field progression. Three different approaches were used: difference in mean deviation (MD), rate of progression (ROP), and guided progression analysis (GPA). RESULTS: In total, n = 113 patients were included; among them, n = 57 were smokers. Smoking was a significant predictor for visual field progression in the three models (MD/ROP/GPA) studied (p = 0.01/p = 0.001/p ≤ 0.001), even adjusting for intraocular pressure (IOP). Other predictors were included in the MD model: IOP at diagnosis (p = 0.04) and selective laser trabeculoplasty (SLT) treatment (p = 0.01). Other predictors were in the ROP model: Visual field index (p = 0.005), number of medications (p = 0.001) and SLT treatment (p = 0.001). The number of medications was another predictor in the GPA model (p = 0.002). CONCLUSIONS: Former smoking induced visual field deterioration in all models studied. Smoking status should be considered when establishing the glaucoma diagnosis. Increased glaucoma care should be provided to former smokers to slow the progression of the disease.

Adding Genetics to the Risk Factors Model Improved Accuracy for Detecting Visual Field Progression in Newly Diagnosed Exfoliation Glaucoma Patients.

BACKGROUND: This study aims to determine whether including genetics as a risk factor for progression will improve the accuracy of the models used in newly diagnosed exfoliation glaucoma patients. METHODS: This was a prospective cohort study. This study included only patients who were newly diagnosed with exfoliation glaucoma and received treatment upon inclusion. Blood samples were taken from all patients at inclusion to test for the single nucleotide polymorphisms (SNPs) LOXL-1 rs2165241 and rs1048661. RESULTS: This study found that the frequency of SNPs, as well as intraocular pressure (IOP), mean deviation (MD), and visual field index (VFI) values at diagnosis, were significant predictors of visual field deterioration (p ≤ 0.001). This study showed that interaction terms, including SNPs, were highly significant (p ≤ 0.001). Furthermore, logistic regression analysis also showed highly significant results for interaction terms when SNPs were included (p ≤ 0.001). Finally, the area under the curve (AUC) analysis showed an increased value of around 10-20% when SNPs were included. CONCLUSIONS: Adding genetic factors to the well-known clinical risk factors can increase the accuracy of models for predicting visual field deterioration in exfoliation glaucoma patients. However, further studies are needed to investigate the role of other genes in this process.

Optimal Performance of Selective Laser Trabeculoplasty: Results from the Swedish Optimal SLT Multicenter Randomized Controlled Trial.

PURPOSE: Selective laser trabeculoplasty (SLT) is a first-line treatment for glaucoma and ocular hypertension. However, due to insufficient comparative evidence in efficacy and safety, several SLT treatment protocols are currently used in practice. The objective of this trial was to compare the clinical outcomes of the 4 most significant SLT variants. DESIGN: Prospective, multicenter, masked, randomized controlled trial (RCT). PARTICIPANTS: Four hundred patients with glaucoma or ocular hypertension. The cohort consisted of both treatment-naive patients and patients undergoing glaucoma treatment, at different stages of disease. METHODS: Selective laser trabeculoplasty was performed with 50 ± 5 laser spots in 180 degrees or with 100 ± 10 spots in 360 degrees. The laser power was titrated to either just below the cavitation bubble level ("standard energy") or to a level producing cavitation bubbles at 50% to 75% of laser applications ("high energy"). Thus, 4 different treatment protocols were included - 180/standard, 180/high, 360/standard, and 360/high. The study adhered as close as possible to regular clinical management, but within a scientific framework. MAIN OUTCOME MEASURES: Reduction of intraocular pressure (IOP) 1 to 6 months after SLT. The proportion of patients achieving a 20% IOP reduction without any further intervention. Time to glaucoma treatment escalation in a Kaplan-Meier survival analysis. RESULTS: SLT performed with the 360/high protocol was shown to be superior regarding all primary endpoints. The IOP reduction 1 to 6 months after SLT was 5.4 mmHg in the 360/high group, compared to 3.4, 3.2, and 4.2 mmHg with the 180/standard, 180/high, and 360/standard protocols, respectively (P < 0.001). Furthermore, the success rate after 6 months was significantly higher -58.3%, compared with 30.2%, 29.3%, and 41.7% (P < 0.001). The median time to glaucoma treatment escalation was more than twice as long with 360/high SLT -1323 days, compared to 437 days, 549 days, and 620 days (P < 0.001). Although postoperative discomfort was more frequent with the 360/high protocol, symptoms were generally mild and transient. Adverse events were rare in all groups. CONCLUSIONS: The magnitude and longevity of SLT results increases substantially if SLT is performed according to the 360/high protocol, without compromising safety. Therefore, we recommend that 360/high SLT be considered as standard treatment. FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.

Unilateral amelanotic conjunctival malignant melanoma: a case report.

INTRODUCTION: Cutaneous malignant melanomas rarely occur in the eye, usually in the eyelids or the conjunctiva. Conjunctival malignant melanomas are even rarer. Most melanomas are dark in color as they are pigmented. However, amelanotic conjunctival malignant melanomas, a scarce variant of the cancer, can be challenging to diagnose accurately. CASE PRESENTATION: We present two cases of white Caucasian Swedish-born women who were diagnosed with unilateral amelanotic malignant melanoma in the conjunctiva of the eye. In the first case, the patient was an 81-year-old woman who was suffering from redness and foreign body sensation in the left eye. The initial diagnosis was blepharitis. Three biopsies were taken, which showed malignant melanoma in the eyelid and the conjunctiva. Unfortunately, the eye and the rest of the orbit could not be saved, and the patient had to undergo an orbital exenteration. In the second case, the patient was a 50-year-old woman, and the tumor was localized in the temporal conjunctiva of the left eye. The initial diagnosis was pinguecula, but at the time of surgery, the physician suspected conjunctival intraepithelial neoplasia. The tumor was not completely removed, so adjuvant brachytherapy and local chemotherapy were used. The eye was preserved. No neck and/or lung metastasis was detected in either case at the time of diagnosis. CONCLUSIONS: Conjunctival amelanotic malignant melanomas should be suspected when tumors are present in the eye and/or the eyelids. By suspecting amelanotic malignant melanoma, the delay in treatment can be shortened. Treating them as soon as possible is essential to minimize the risk of metastasis.

Estimating functions for visual field progression in newly diagnosed exfoliation glaucoma patients in Sweden.

This study aimed to determine whether glaucoma progression was linear or not in newly diagnosed exfoliation glaucoma patients. A total of 96 patients with newly diagnosed exfoliation glaucoma were included. These patients were required to undergo at least seven visual field tests within 3 years (± 1 month), and all were treated at the time of inclusion. The study was a non-randomized, prospective cohort study. The outcome of the study was visual field progression. Progression was assessed based on mean deviation (MD), visual field index (VFI), and "Guided Progression Analysis". The MD and VFI values were plotted against time, and distribution and curve fit were calculated. The results showed that the general rate of progression of the cohort was - 3.84 (± 2.61) dB for the MD values and 9.66 (± 6.25)% for the VFI values over 3 years. The best-fitted curve for MD and VFI values in the 36 months period was significant for both linear and exponential curves (p ≤ 0.001; p ≤ 0.001). However, in the MD group, the F and the R2 values were higher for exponential than for linear function (linear: F = 42.60, R2 = 0.059; exponential: F = 53.26, R2 = 0.073). The opposite results were found among VFI values. The F and the R2 values were slightly better for linear than for exponential (linear: F = 37.22, R2 = 0.052; exponential: F = 35.55, R2 = 0.050). In conclusion, the study found that visual field progression between diagnosis and 18 months seemed to be exponential. However, after 18 months, the IOP reduction effects probably ameliorated progression, making the curve linear.

Single nucleotide polymorphisms in LOXL1 as biomarkers for progression of exfoliation glaucoma in Sweden.

PURPOSE: Exfoliation glaucoma is a common and aggressive type of glaucoma with high prevalence in Scandinavia. The aim of this study was to elucidate whether the allele frequencies of two single nucleotide polymorphisms (SNPs) located in LOXL1 were associated with the progression of exfoliation glaucoma in Swedish patients. METHODS: In this non-randomised cohort study, we enrolled patients with exfoliation glaucoma, and they performed at least five reliable visual field tests. Blood samples were collected, and genotyping was performed using competitive allele-specific PCR genotyping. Glaucoma progression was evaluated using the guided glaucoma progression analysis (GPA), mean deviation (MD) difference and rate of progression (ROP). In addition, associations between allele frequencies and glaucoma progression were tested using logistic regression for GPA and linear regression for MD and ROP. RESULTS: We enrolled a total of 130 patients in the study. The general genetic model showed statistical significance for LOXL1_rs2165241 (p = 8 × 10-7 , Fisher's exact test) and LOXL1_rs1048661 (p = 2 × 10-6 , Fisher's exact test). Regression analyses using an additive genetic model showed significant values for LOXL1_rs2165241SNP in relation to GPA, MD and ROP as outcomes (p = 1.8 × 10-4 , 4 × 10-2 , 6 × 10-4 ) and for LOXL1_rs1048661 SNP in relation to GPA, MD and ROP (p = 7 × 10-5 , 8 × 10-3 , 2 × 10-4 ). CONCLUSIONS: This was the first study to show an association of the SNPs LOXL1_rs2165241 and LOXL1_rs1048661 with the progression of exfoliation glaucoma. Further large-scale studies are required to verify these findings.

The impact of topical NSAID treatment on selective laser trabeculoplasty efficacy.

PURPOSE: Selective laser trabeculoplasty (SLT) is a first-line intervention for glaucoma, with the aim to reduce the intraocular pressure (IOP). Topical non-steroidal anti-inflammatory drugs (NSAIDs) are sometimes prescribed after SLT. However, it has been proposed that such treatment may either increase or reduce SLT efficacy. The purpose of this study was to investigate this further. METHODS: The study was a retrospective chart review, including 192 eyes of 192 patients, half of which received a course of NSAID eyedrops after SLT. Absolute and relative IOP reduction 3-12 weeks after SLT was compared. Furthermore, subgroup analyses, a multiple linear regression analysis, and a Kaplan-Meier survival analysis regarding time to treatment escalation were performed. RESULTS: The mean absolute IOP reduction was 4.3 ± 3.4 mmHg in the NSAID group and 5.4 ± 4.1 mmHg in the control group (p = 0.049). Relative IOP reduction was 17.5% ± 13.0% and 21.8% ± 14.8% in the NSAID and control groups, respectively (p = 0.033). The same tendency of superior results in control eyes compared with NSAID eyes was seen in an extensive subgroup analysis. A multiple linear regression analysis confirmed NSAID treatment as a negative predictor of IOP reduction after adjustment for covariates (p = 0.023). Survival analysis showed a longer median time to treatment escalation in the control group, though not statistically significant. CONCLUSION: Topical NSAID treatment was not associated with an increased SLT efficacy. On the contrary, the present study is the first to demonstrate that SLT effectiveness may even be reduced by NSAIDs.

Measuring corneal hysteresis: threshold estimation of the waveform score from the Ocular Response Analyzer.

BACKGROUND: The aim of this study was to determine a threshold waveform score (WS) for the best score value (BSV) in the Ocular Response Analyzer (ORA). METHODS: Retrospective study. One hundred and thirty-three healthy adults were recruited. Measurements were done with the ORA 2.04. RESULTS: Two hundred and sixty-six eyes were analyzed. Mean age was 56.49 ± 15.97 years. The mean waveform score of the BSV was 7.39 ± 1.32. The waveform scores ranged from 2.8 to 9.7. Kolmogorov-Smirnov test for normality was significant (p ≤ 0.0001). Linear regression showed a significant positive correlation between IOPg (measured with the ORA) and IOP measured with Goldmann applanation tonometry (p ≤ 0.0001), as well as significant negative correlation between the difference IOPg-IOP Goldmann and waveform score of the BSV values. Threshold estimation considering 95 % confidence interval was 7.23. Meanwhile, threshold estimation considering the difference IOPg-IOP Goldmann, for 3 mmHg, was 6.7. CONCLUSIONS: When using the ORA device, we recommend that clinicians try to obtain several waveform score measurements of 7 or above. Waveform scores lower than 7 may render less reliable results.

Comparison of the monocular Humphrey Visual Field and the binocular Humphrey Esterman Visual Field test for driver licensing in glaucoma subjects in Sweden.

BACKGROUND: The purpose of this study was to compare the monocular Humphrey Visual Field (HVF) with the binocular Humphrey Esterman Visual Field (HEVF) for determining whether subjects suffering from glaucoma fulfilled the new medical requirements for possession of a Swedish driver's license. METHODS: HVF SITA Fast 24-2 full threshold (monocularly) and HEVF (binocularly) were performed consecutively on the same day on 40 subjects with glaucomatous damage of varying degrees in both eyes. Assessment of results was constituted as either "pass" or "fail", according to the new medical requirements put into effect September 1, 2010 by the Swedish Transport Agency. RESULTS: Forty subjects were recruited and participated in the study. Sixteen subjects passed both tests, and sixteen subjects failed both tests. Eight subjects passed the HEFV but failed the HVF. There was a significant difference between HEVF and HVF (χ(2), p = 0.004). There were no subjects who passed the HVF, but failed the HEVF. CONCLUSIONS: The monocular visual field test (HVF) gave more specific information about the location and depth of the defects, and therefore is the overwhelming method of choice for use in diagnostics. The binocular visual field test (HEVF) seems not be as efficient as the HVF in finding visual field defects in glaucoma subjects, and is therefore doubtful in evaluating visual capabilities in traffic situations.

Risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients in Sweden.

The present study aimed to identify risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients. Prospective nonrandomized cohort study. The study included patients with newly diagnosed exfoliation glaucoma. All patients were followed for at least 3 years with reliable visual fields. Both risk factors at inclusion and during the 3-year follow-up were considered. For inclusion, five reliable visual fields were needed. Exfoliation glaucoma was defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the 24-2 strategy of Humphrey field analysis. Outcomes: Visual field progression. Three different approaches were used: mean deviation, visual field index, and guided progression analysis. Independent variables were tested first in a univariate linear or regression model. The significant variables were retested in a multivariate linear or logistic regression model. The results were different for the MD, VFI and GPA models. The only variable that showed a significant association in the three models was age (p = 0.004; p = 0.006; p = 0.04). Significant variables in the two models were IOP at diagnosis (p = 0.02; p = 0.04), IOP reduction in absolute terms (p = 0.006; p = 0.003), IOP reduction in relative terms (%) (p = 0.04; p = 0.009) and number of medicines (p = 0.02; p = 0.002). Significant variables in one model were family history (p = 0.04), smoking (p = 0.03), cataract surgery (p = 0.04) and SLT treatment (p ≤ 0.001). Exfoliation glaucoma is a fast progressive glaucoma. Age at diagnosis must be considered. Significant IOP reduction must be achieved to slow down progress in exfoliation glaucoma. The use of SLT treatment should be advised in exfoliation glaucoma patients.

Corneal hysteresis in normal subjects and in patients with primary open-angle glaucoma and pseudoexfoliation glaucoma.

PURPOSE: To identify differences in corneal hysteresis (CH) between primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma patients (PXSG) and a healthy control group. METHODS: In this retrospective study, CH was measured with the Ocular Response Analyzer. 90 subjects were evaluated, 30 subjects in each group. One eye per subject was analyzed. RESULTS: In normal eyes, POAG and PXSG, CH was 9.8±1.6, 9.0±1.9 and 8.0±1.5 mm Hg, respectively. CH was significantly lower in PXSG patients than in POAG (p=0.042) and normal patients (p=0.0001), but no significance was found between the POAG and the normal group (p=0.23). CONCLUSION: CH differs in the different groups and might be considered in glaucoma evaluation. Further studies with larger sample sizes are needed.

Lower Success in Trabeculectomies in Exfoliation Compared With Primary Open-angle Glaucoma Patients in Sweden.

PRCIS: In a Sweden-based study, a lower success rate in exfoliation than in open-angle glaucoma patients was found in a 5-year follow-up after trabeculectomy. PURPOSE: The present study aimed to compare the success of trabeculectomies in exfoliation versus open-angle glaucoma patients. PATIENTS AND METHODS: Data were gathered through a retrospective chart review. Included patients underwent primary trabeculectomy from January 1 2009 till December 31, 2014 (6 y). All included patients were operated on at the Eye Department, Skaraborg Hospital, Sweden, and followed for at least 5 years after surgery. Included patients had primary open-angle glaucoma (POAG) or exfoliation glaucoma (EXFG). The study followed the recommendations of the World Glaucoma Association (WGA). Successful result: criterion A: eye pressure ≤18 mm Hg and pressure reduction ≥30% without medications (complete success: A1), with or without medications (qualified success: A2). Criterion B: eye pressure ≤15 mm Hg and pressure reduction ≥40% without medications (complete success: B1), with or without medications (qualified success: B2). RESULTS: A total of 147 patients were included in this study, 92 in the EXFG and 55 in the POAG group. At the baseline, only 3 variables (intraocular pressure, number of medications, and the number of laser treatments) showed a significant difference between EXFG and POAG patients. Complete and qualified success for both criterion A (A1 and A2) and B (B1 and B2) were significantly lower in the EXFG compared with the POAG group (Mantel-Cox test, P<0.0001, P=0.01, P<0.001, P=0.008). CONCLUSIONS: Trabeculectomies in EXFG seem to have a lower success rate than in POAG patients. EXFG patients should be checked often after trabeculectomy to detect the failure of the surgery.

Association of Single Nucleotide Polymorphisms Located in LOXL1 with Exfoliation Glaucoma in Southwestern Sweden.

INTRODUCTION: Glaucoma is an optic neuropathy that leads to visual field defects. Genetic mechanisms seem to be involved in glaucoma development. Lysyl Oxidase Like 1 (LOXL1) has been described in previous studies as a predictor factor for exfoliation glaucoma. The present article studied the association between three single nucleotide polymorphisms (SNPs) in the LOXL1 gene and the presence of exfoliation glaucoma in Southwestern Sweden. METHODS: Case-control study for genetic association. In total, 136 patients and 1011 controls were included in the study. Patients with exfoliation glaucoma were recruited at the Eye Department of Sahlgrenska University Hospital and Skaraborgs Hospital, Sweden. Controls were recruited from the Gothenburg H70 Birth Cohort Study. Three different SNPs were genotyped: LOXL1_rs3825942, LOXL1_rs2165241 and LOXL1_rs1048661. RESULTS: The distribution of allele frequencies was significantly different between controls and glaucoma patients; for rs3825942 (p = 2 × 10-12), for rs2165241 (p = 3 × 10-16) and for rs1048661 (p = 2 × 10-6). Logistic regression analyses using an additive genetic model, adjusted for sex and age, also showed associations between the studied SNPs and glaucoma (p = 9 × 10-6; p = 2 × 10-14; p = 1 × 10-4). CONCLUSION: A strong association was found between allele frequencies of three different SNPs (LOXL1_rs3825942, LOXL1_rs2165241, and LOXL1_rs1048661) and the presence of exfoliation glaucoma in a Southwestern Swedish population.

No effects of mitomycin-C in primary trabeculectomies in Sweden.

AIM: To evaluate the results of a long-term follow-up after two different types of surgical techniques: trabeculectomy with or without mitomycin-C. MATERIALS AND METHODS: This study is a retrospective chart review of patients operated on with a primary trabeculectomy at the Eye Department of the Skaraborg Hospital, Skövde, Sweden. Complete success was defined as intraocular pressure ⩽18 mmHg (criterion 1) or intraocular pressure reduction ⩾30% (criterion 2) without eye drops postoperatively. Qualified success was defined using the same criteria (1 and 2), but patients were treated or untreated with eye-drops. RESULTS: A total of 167 patients were included in this retrospective study, 83 patients in the no-mitomycin-C group and 84 patients in the mitomycin-C-treated group. No significant difference was found in intraocular pressure reduction between the mitomycin-C and no-mitomycin-C group (t-test; p = 0.19). Complete success using criterion 1 was 66.2% in no-mitomycin-C and 62.8% in mitomycin-C (p = 0.88); success using criterion 2 was 76.6% in the no-mitomycin-C and 64.2% in the mitomycin-C group (p = 0.21). Qualified success using criterion 1 was 71.4% in the no-mitomycin-C and 74.4% in the mitomycin-C group (p = 0.84); success using criterion 2 was 80.0% in the no-mitomycin-C and 84.4% in the mitomycin-C group. All included patients were born in Sweden. CONCLUSION: Mitomycin-C seems to add no benefits to intraocular pressure reduction after primary trabeculectomies in a Swedish population.