Genistein: A promising phytoconstituent with reference to its bioactivities.

Genistein, a potent phytoconstituent, has garnered significant attention for its diverse bioactivities, making it a subject of extensive research and exploration. This review delves into the multifaceted properties of genistein, encompassing its antioxidant and anticancer potential. Its ability to modulate various cellular pathways and interact with diverse molecular targets has positioned it as a promising candidate in the prevention and treatment of various diseases. This review provides a comprehensive examination of Genistein, covering its chemical properties, methods of isolation, synthesis, therapeutic attributes with regard to cancer management, and the proposed mechanisms of action as put forth by researchers.

Evaluation of visual field changes with retinal nerve fiber layer thickness in primary congenital glaucoma.

Purpose: To evaluate visual field changes in primary congenital glaucoma (PCG) with retinal nerve fiber layer thickness on optical coherence tomography. Methods: In this cross-sectional, observational study, consecutive PCG children who underwent combined trabeculotomy with trabeculectomy and on regular follow-up were enrolled. All patients were aged over four years and co-operative for RNFL OCT and visual field examination. Perimetry was done on Humphrey visual field (HVF) analyzer using 30-2 and 10-2 SITA standard algorithms as appropriate. If a reliable automated perimetry was not feasible, kinetic perimetry was done. The following were noted at baseline and every follow-up: age, sex, visual acuity, intraocular pressure (IOP), cup-disc ratio (CDR), corneal diameters, refraction, any topical antiglaucoma medications, surgeries underwent, age at surgery and duration between surgery and final examination. Results: Forty-eight eyes of 34 children operated for PCG and 19 eyes of 17 controls were analyzed. A statistically significant thinner average RNFL thickness of 87.2 ± 28 µm was noted in PCG eyes as compared to controls with 100.6 ± 7.2 µm (P = 0.04). The mean cup-disc area ratio on OCT in PCG eyes was 0.43 ± 0.2 (0.02-0.93) and in control eyes was 0.23 ± 0.07 (0.1-0.4) (P < 0.001). On RNFL OCT, there was significant focal RNFL loss in temporal superior (P = 0.003), nasal inferior (P = 0.037) and temporal inferior (P < 0.001) quadrants compared to controls. Among PCG eyes, 20/48 eyes (41.7%), had definitive, reproducible glaucomatous VF defects. Mean baseline IOP in PCG eyes with VF defect was 28.7 ± 5.7 mmHg and in eyes with normal VF was 24.6 ± 5.9 mmHg (P = 0.03). On univariate regression analysis, higher baseline IOP was significantly associated with both RNFL loss (odds ratio (OR): -2.17) and VF defects (OR: 3.35). Fluctuation in follow-up IOP (OR: 3.33) was also significantly associated with the presence of VF defects. On multivariable regression analysis maximum, IOP was significantly associated with RNFL loss and VF defects. Conclusion: Peripapillary RNFL thickness could be used to identify PCG eyes having visual field loss and possibly poor visual function from PCG eyes without visual field defects. Baseline and follow-up IOP, significantly correlated with RNFL thickness in PCG eyes.

Consanguinity and severity of primary congenital glaucoma.

PURPOSE: To evaluate the severity of primary congenital glaucoma (PCG) among children born of consanguineous marriage. METHODS: In this case-control study, the medical records of unrelated consanguineous patients and unrelated nonconsanguineous (control) PCG patients seen at a single tertiary eye care facility were retrospectively reviewed. Those with a minimum of 5 years' follow-up were included. Data collected included age at presentation, corneal diameter, axial length, corneal haze at presentation and its persistence after surgery, need for repeat surgery, and final visual acuity. RESULTS: A total of 130 PCG patients were included: 30 patients born of consanguineous marriage and 100 nonconsanguineous control patients. The median age of presentation for consanguineous cases was 3 months (range, 1-36) compared with 10 months (range, 2-24) for nonconsanguineous cases (P < 0.001). Mean corneal diameter for consanguineous cases was 13 ± 0.82 mm and for nonconsanguineous cases was 12.41mm ± 1.18 mm (P = 0.002). Consanguineous cases also had a significantly higher prevalence of corneal haze persisting after surgery (P < 0.001) and need for repeat IOP-lowering surgery (P = 0.039). The consanguineous group had 44 eyes (73%) with severe PCG compared with 69 (34.5%) in the nonconsanguineous group (P < 0.001). CONCLUSIONS: In this study cohort, children with PCG born of consanguineous parents were more severely affected at presentation compared with children born of nonconsanguineous parents; they also had poorer outcomes with IOP-lowering surgery independent of severity at presentation. It is however possible that a founder effect with consanguinity over multiple generations could account for our observations.

Therapeutically effective covalent spike protein inhibitors in treatment of SARS-CoV-2.

COVID-19 [coronavirus disease 2019] has resulted in over 204,644,849 confirmed cases and over 4,323,139 deaths throughout the world as of 12 August 2021, a total of 4,428,168,759 vaccine doses have been administered. The lack of potentially effective drugs against the virus is making the situation worse and dangerous. Numerous forces are working on finding an effective treatment against the virus but it is believed that a de novo drug would take several months even if huge financial support is provided. The only solution left with is drug repurposing that would not only provide effective therapy with the already used clinical drugs, but also save time and cost of the de novo drug discovery. The initiation of the COVID-19 infection starts with the attachment of spike glycoprotein of SARS-CoV-2 to the host receptor. Hence, the inhibition of the binding of the virus to the host membrane and the entry of the viral particle into the host cell are one of the main therapeutic targets. This paper not only summarizes the structure and the mechanism of spike protein, but the main focus is on the potential covalent spike protein inhibitors.

Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma.

PURPOSE: To evaluate long-term perimetric stabilization at set Target (IOPs) in primary angle-closure glaucoma with visual field defects. METHODS: Two hundred forty-eight eyes, of 124 primary angle-closure glaucoma (PACG) patients on medical treatment, and 124 eyes, of 95 patients after trabeculectomy performed at least 5 years prior were evaluated. One hundred eighty-five eyes had a follow-up of ≥10 years. Target IOPs for mild, moderate, and severe glaucomatous optic neuropathy were set at ≤18, ≤15, and ≤12 mmHg, respectively. Progression was evaluated by event-based changes on guided progression analysis. Primary outcome measure was therapy required to achieve individualized Target IOP. Secondary outcome measure was assessment of perimetric change over time. RESULTS: Mean baseline IOP was 23.34 ± 6.16 mmHg in medically treated and 36.08 ± 9.73 mmHg in surgically treated eyes (P = 0.0001). All eyes with a baseline IOP of <25 mmHg were on medications alone, 65.33%, of those with a baseline IOP of 25-30 mmHg were on medications, while 34.67% required trabeculectomy. In total, 91.4% of eyes with a baseline IOP of >30 mmHg underwent a trabeculectomy for achieving Target IOP. Perimetric stabilization was achieved in 98.17% of PACG eyes. "Target" IOP was achieved for mild, moderate, and severe glaucomatous optic neuropathy, medically in 90.2, 73.9, and 29.7%, and surgery was required in 9.8, 26.1, and 70.3%, respectively. Overall analysis found that percentage reduction in IOP was significantly more after trabeculectomy than medical treatment, 64.16 ± 14.91 and 43.61 ± 13.73%, P = 0.0001. Decrease in IOP was significantly greater 5-9 years after trabeculectomy, in comparison to ≥10 years, P = 0.001. CONCLUSION: Medications controlled IOP to "Target" in PACG eyes with mild and moderate glaucoma for over ≥10 years, when the baseline IOP off treatment was <30 mmHg. Trabeculectomy was necessary in PACG eyes having severe glaucomatous optic neuropathy, or with a baseline IOP of >30 mmHg to achieve Target IOP. These appropriate initial therapeutic interventions and Target IOPs are therefore suggested as a clinically validated algorithm of care for different severities of PACG.

Improving long-term intraocular pressure and visual outcomes in eyes with aniridic glaucoma.

PURPOSE: To study the long-term intraocular pressure (IOP) and visual outcomes in treated aniridic glaucoma. METHODS: A retrospective chart review of patients with aniridia and glaucoma, with ≥ 2-year follow-up, was performed. Eyes in early glaucomatous stages were medically managed, while moderate-severe stage eyes underwent a trabeculectomy with mitomycin-c (MMC). Success was termed 'complete' when average final IOP was ≤ 18 mmHg without usage of glaucoma medications, and 'qualified' when with/without topical glaucoma therapy. A significant change in vision was defined as > 2-line change on Snellen vision chart or > 0.2 change in logMAR units in in either direction (better or worse). RESULTS: Thirty-five eyes of 20 patients were included. The mean duration of follow-up was 7.29 ± 5.75 years. Associated ocular anomalies were present in 19 eyes (54.29%). Twelve eyes (34.28%) were maintained on medical management, while 23 eyes (65.71%) had undergone a trabeculectomy with MMC. The mean baseline IOP was 31.46 ± 6.34 mmHg, and mean IOP on last follow-up was 13.25 ± 5.82 mmHg, p < 0.001. Seventy-five percent of the medically managed eyes achieved an IOP ≤ 18 mmHg. 52.17% and 95.65% of the surgically treated eyes achieved 'complete' and 'qualified' success respectively. The median best corrected visual acuity (BCVA) at baseline was 1.48(0.6-2) logMAR units and on final follow-up was 1.3 (0.48-5) logMAR units, p = 0.21. Fifty percent of the eyes remained stable, 35.71% showed an improvement and 14.29% a deterioration of > 0.2 logMAR units. Patients with a longer follow-up (> 10 years) and those who had undergone a trabeculectomy with MMC were more likely to show good IOP control (p = 0.003; p = 0.004 respectively). CONCLUSION: Aniridic glaucoma can be managed efficiently by medications in early glaucomatous neuropathy, and with trabeculectomy augmented with mitomycin-C and releasable sutures for more advanced glaucomas, offering favourable long-term IOP control, visual stability and safety.

Evaluating target intraocular pressures in primary congenital glaucoma.

Purpose: The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of glaucomatous neuropathy after surgery in primary congenital glaucoma (PCG). Methods: Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes - Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive error. Results: A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was -0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter. Conclusion: Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary congenital glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia.

Long-term functional outcomes of different subtypes of primary congenital glaucoma.

AIM: To analyse long-term visual outcomes across different subtypes of primary congenital glaucoma (PCG). METHODS: Patients with PCG with a minimum of 5-year follow-up post surgery were included in the study. Snellen visual acuity recordings taken at their last follow-up were analysed. We evaluated the results using Kaplan-Meier curves to predict the probability of maintaining good vision (as defined by a visual acuity of 6/18 or better) in our patients after 30-year follow-up. The results were also analysed to determine whether there were any differences in the long-term visual acuities with time between the neonatal and infantile PCG. We also analysed the reasons for poor visual outcomes. RESULTS: We assessed a cohort of 140 patients with PCG (235 eyes) with an average follow-up of 127±62.8 months (range 60-400 months). Overall, the proportion of eyes with good visual acuity was 89 (37.9%), those with fair visual acuity between 6/60 and 6/18 was 41 (17.4%), and those with poor visual acuity (≤6/60) was 105 (44.7%). We found a significant difference (p=0.047) between neonatal and infantile patients with PCG whereby the neonatal cohort fared worse off in terms of visual morbidity. On Kaplan-Meier analysis, the cumulative probability of survival of a visual acuity of 6/18 or better was more among the infantile PCG in comparison to the neonatal PCG (p=0.039) eyes, and more among the bilateral than the unilateral affected eyes (p=0.029). Amblyopia was the most important cause for poor visual acuity as shown on a Cox proportional-hazards regression model. CONCLUSIONS: Long-term visual outcomes of infantile are better than neonatal PCG. Eyes with unilateral have worse visual outcomes compared with those with bilateral PCG because of the development of dense amblyopia.

Comparison of Rates of Fast and Catastrophic Visual Field Loss in Three Glaucoma Subtypes.

Purpose: To compare the distribution of visual field progression rates in three subgroups of glaucoma, being primary angle-closure glaucoma (PACG), POAG, and juvenile open-angle glaucoma (JOAG). Methods: We assessed glaucoma patients treated in an Indian tertiary care setting with at least four visual field assessments. We determined rates from a single eye of each of 525 patients using linear regression of the summary index mean deviation (MD) over time. The main outcome measures were the proportions of fast (<-1.0 to -2.0 dB/y) and catastrophic (<-2 dB/y) visual field progression. Bootstrapped 95% CIs allowed comparison with published data from a large clinical cohort in Canada. Results: The combined proportion of fast and catastrophic progressors in our cohort was less than half that in the Canada dataset (2.3% vs. 5.8%), despite median progression rates differing by only 0.03 dB/y. PACG, POAG, and JOAG represented 45%, 32%, and 12% of our cohort, respectively. Baseline MD values were similarly distributed between these subtypes. All subtypes showed a similar shaped distribution for progression rates, with median progression rates of -0.03, -0.05, and 0.02 dB/y for PACG, POAG, and JOAG, respectively. Combined proportions of fast and catastrophic progression rates did not significantly differ between subtypes. Conclusions: Differences in fast and catastrophic visual field progression can exist despite only small changes in median progression rates, highlighting the importance of considering the full shape of the progression rate distribution when comparing the risk of devastating visual field loss.

Long-term evaluation of ocular hypertension with primary angle closure and primary open angles.

PURPOSE: To evaluate the long-term course of primary angle-closure ocular hypertension and primary open-angle ocular hypertension and possible risk factors for progression to glaucoma. METHODS: A total of 109 eyes of 109 ocular hypertension (OHT) patients with a minimum follow-up period of 5 years having complete ocular/medical records were evaluated. They were classified into primary angle closure or primary open angle based on gonioscopy at baseline. Baseline and review data of Humphrey field analyser, HFA, and Heidelberg retinal tomography, HRT, were recorded. Guided progression analysis (GPA) and univariate Cox regression were used for time to event analysis in identifying progression to glaucoma. RESULTS: Over a mean follow-up of 12.18 ± 4.8 years, progression to glaucoma was 17.43% (19 eyes), out of whom 5.5% (6 eyes) showed ≥ 3 loci on GPA. Sub-classifying them, progression to primary angle-closure glaucoma was 19.72%, and that of primary open-angle glaucoma was 13.16%. The mean time to progression was 9.34 ± 3.6 years. Significant risk factors included small disc area (≤ 1.99 sq.mm on HRT), requirement of ≥ 2 drugs to maintain target IOP and those engaged in activities yielding a Valsalva effect in daily life. Coronary artery disease (CAD) and systemic use of steroids were associated with increased severity. CONCLUSION: Overall progression of OHT to glaucoma was 17.43% over a mean of 9 years, with target IOP of ≤ 18 mm Hg. Patients with smaller discs, CAD, exercising Valsalva type activities and using ≥ 2 glaucoma medications or systemic steroids should be closely monitored.

'Van Herick Plus': a modified grading scheme for the assessment of peripheral anterior chamber depth and angle.

AIM: To evaluate the accuracy of a new, modified grading scheme involving a short vertical slit beam, at the inferior angle for peripheral anterior chamber depth (PAC) and angle estimation and its correlation with anterior segment optical coherence tomography (ASOCT). METHODS: A cross-sectional study of consecutive phakic patients, above 40 years of age, was performed. Using a short, vertical slit beam not reaching the pupil, the inferior angle at the sclerolimbal junction was evaluated, photographed and assessed by a ratio of peripheral anterior chamber depth to peripheral corneal thickness (PAC:PCT) and iridocorneal angle (ICA) on ImageJ software. The inferior angle at the same meridian was also recorded on ASOCT. RESULTS: Based on the PAC:PCT ratio, the subjects were divided into four groups: I (<1/4), II (1/4-1/2), III (>1/2-1) and IV (>1). The clinically assessed angle by short vertical slit beam correlated well with ASOCT values, trabecular-iris angle (TIA) (r=0.918; p<0.001) and scleral spur angle (r=0.903, p<0.001). The mean difference between ICA and TIA on ASOCT was 0.7970; 95% limits of agreement:-5.7670 to 7.3610 (±1.96 SD). For angles graded narrow on ASOCT (TIA <200), using a cut-off of peripheral PAC:PCT <1/4, the area under the curve was 0.918 with a sensitivity of 85.2% and a specificity of 88.2%. There was good agreement between ImageJ parameters with those assessed subjectively on photograph of the slit beam examination by a glaucoma fellow (weighted kappa=0.74) as compared with a general ophthalmologist, where there was moderate agreement (weighted kappa=0.57). CONCLUSION: A short, vertical slit lamp beam evaluation at the inferior angle is an easy and relatively accurate method for both peripheral anterior chamber depth and angle assessment. It correlated well with ASOCT and can be used as a more reliable screening tool to identify eyes with possibly occludable angles.

Refractive outcomes of cataract surgery in primary congenital glaucoma.

AIM: To evaluate refractive outcomes of cataract surgery with intraocular lens (IOL) implantation in operated eyes of primary congenital glaucoma (PCG). DESIGN: A retrospective case-control study. METHODS: Patients of PCG who developed cataract following trabeculectomy with trabeculotomy were recruited. Preoperative biometry was recorded and refractive outcomes of the patients in terms of spherical equivalent (SE) and prediction error were noted at 3 and at 12 months following surgery. The refractive outcomes were compared with non-glaucomatous eyes of children in similar age group who underwent lens aspiration with IOL implantation (controls). RESULTS: The median age of the children with PCG (n = 31) at the time of cataract surgery was 60 months, similar to controls (n = 29); 48 months (p = 0.3). The SE in PCG eyes at 12 months was comparable to controls (p = 0.18). The prediction error (postoperative SE - predicted SE) at 3 months (p = 0.018) and at 12 months (p = 0.03) among PCG eyes was higher and more myopic compared with controls. The range of prediction error at 12 months in PCG eyes was - 8.6 to + 5.8 D (median - 2.0 D), whereas in controls it was - 4.2 to + 6.3 D (median + 0.5 D). For each mmHg intraocular pressure (IOP) increase there was 0.42 mm increase in axial length among PCG eyes and a 0.24 mm increase among controls (p < 0.001). CONCLUSIONS: After IOL implantation there was a greater prediction error and a greater myopic shift among PCG eyes. Eyes of children with PCG are more prone to refractive surprises as their axial length changes are more sensitive to IOP fluctuation.

Implantable miniature telescope (IMT) for vision loss due to end-stage age-related macular degeneration.

BACKGROUND: Age-related macular degeneration (AMD) causes progressive and irreversible damage to the retina, resulting in loss of central vision. AMD is the third leading cause of irreversible visual impairment worldwide and the leading cause of blindness in industrialized countries. Since AMD is more common in older individuals, the number of affected individuals will increase significantly as the population ages. The implantable miniature telescope (IMT) is an ophthalmic device developed to improve vision in individuals who have lost vision due to AMD. Once implanted, the IMT is used to enlarge objects in the central visual field and focus them onto healthy areas of the retina not affected by AMD, allowing individuals to recognize objects that they otherwise could not see. It is unclear whether and how much the IMT can improve vision in individuals with end-stage AMD. OBJECTIVES: To assess the effectiveness and safety of the IMT in improving visual acuity and quality of life in people with late or advanced AMD. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 11); Ovid MEDLINE; Embase.com; PubMed; LILACS; AMED; Web of Science Conference Proceedings Citation Index-Science; OpenSIGLE; the metaRegister of Controlled Trials (mRCT) (last searched 27 June 2014); ClinicalTrials.gov; the ICTRP and the US Food and Drug Administration (FDA) Medical Devices database. The date of the search was 2 November 2017, with the exception of mRCT which is no longer in service. SELECTION CRITERIA: We planned to include randomized controlled trials (RCTs) and quasi-randomized trials that compared the IMT versus no IMT. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all studies for inclusion, using standard methodological procedures expected by Cochrane. MAIN RESULTS: Our search yielded 1042 unique records. We removed irrelevant studies after screening titles and abstracts, and evaluated five full-text reports from four studies; three were non-randomized studies. There was one ongoing RCT that compared the OriLens intraocular telescope with standard low vision training in eyes with end-stage AMD. Results for this study are expected in 2020. AUTHORS' CONCLUSIONS: We found no RCT or quasi-RCT and can draw no conclusion about the effectiveness and safety of the IMT in improving visual acuity in individuals with late or advanced AMD. Since the IMT is typically implanted monocularly based upon which eye has better best-corrected distance visual acuity, randomization between eyes within an individual may not be acceptable. Studies are needed that compare outcomes between individuals randomized to the device versus individuals not implanted, at least during study follow-up, who serve as controls.

Selective laser trabeculoplasty for primary open-angle glaucoma patients younger than 40 years.

OBJECTIVE: To evaluate the efficacy of selective laser trabeculoplasty (SLT) among patients with juvenile-onset primary open-angle glaucoma (JOAG). METHODS: Patients diagnosed with JOAG who were not controlled on medical therapy were offered a trial of SLT. The patients were followed up prospectively for 1, 3, 6, and 12 months postlaser to evaluate the efficacy of SLT as second-line therapy. Success was defined as an intraocular pressure (IOP) reduction of ≥20% at 12 months without the need for further medication, laser, or surgery. Factors associated with success/failure, prelaser IOP, age, and angle dysgenesis on gonioscopy were analysed. RESULTS: The average prelaser IOP in these JOAG eyes (n = 30) was 25.3 ± 6.5 mm Hg, which reduced to 17.3 ± 5.8 mm Hg at 12 months (p = 0.01). All patients were of Indian ethnicity. Out of 30 eyes, at 12 months post-SLT, 13 (43%) eyes had at least a 20% reduction in IOP. In the eyes that achieved success, the average reduction of IOP was 37.6%. There was no difference in the prelaser IOP between those with success (25.5 ± 5.6 mm Hg) and those that failed (25.1 ± 8 mm Hg; p = 0.8), nor was there a difference in the mean age between successful cases (34.4 ± 9.4 years) and failures (31.6 ± 8.9 years; p = 0.4). However, those without angle dysgenesis were 4 times (CI 1.1-15.2) more likely to succeed with SLT than those with angle dysgenesis (p = 0.03). CONCLUSIONS: A significant proportion of patients with JOAG can benefit from an IOP reduction after SLT. Those with gonioscopically normal-appearing angles are more likely to respond to SLT.

Phenotypic differences between familial versus non-familial Juvenile onset open angle glaucoma patients.

AIM: To evaluate phenotypic differences among familial and non-familial JOAG patients. METHODS: First degree relatives of unrelated JOAG patients were screened for glaucoma and ocular hypertension. JOAG probands were grouped as familial or non-familial and phenotypic differences in terms of age of onset, gender, baseline untreated IOP, presence angle dysgenesis, and refractive error was compared between the two groups. RESULTS: Out of 368 unrelated JOAG patients, 134 in whom all first degree relatives had been examined were included in the study. The non-familial JOAG (n = 96) had similar age of onset as familial JOAG (n = 38); (p = 0.076) but had greater male preponderance (p = 0.046), and had the higher baseline IOP (p = 0.044) compared to familial JOAG. However, on adjustment using the Bonferroni correction, the observed differences were not found to be significant. Both groups had similar proportion of patients with angle dysgenesis (p = 0.46) and high myopia (p = 0.72). CONCLUSIONS: Non-familial JOAG were not found to be phenotypically different from the familial JOAG patients in this cohort.

In Vivo Analysis of Angle Dysgenesis in Primary Congenital, Juvenile, and Adult-Onset Open Angle Glaucoma.

Purpose: The purpose of this study was to comparatively evaluate angle dysgenesis in vivo, among congenital, juvenile, and adult-onset open angle glaucoma patients. Methods: A cross-sectional evaluation of 96 glaucoma patients, 22 children with primary congenital glaucoma (PCG) old enough to cooperate for optical coherence tomography (OCT), 34 juvenile-onset open angle glaucoma (JOAG) patients, 40 adult-onset primary open angle glaucoma (POAG), and 30 healthy subjects, was carried out using high-resolution anterior segment spectral domain (SD)-OCT. Subgroup analysis was done for presence/ absence of angle dysgenesis as defined by presence of abnormal tissue/hyperreflective membrane within angle recess and/or absence of Schlemm's canal (SC). Results: Morphologic features suggestive of angle dysgenesis such as the presence of abnormal tissue at the angle and a hyperreflective membranous structure covering the meshwork were seen in all PCG eyes (100%), in 14 (40%) JOAG eyes, and none of the POAG eyes in comparison to healthy eyes (P = 0.01, P = 0.03, and P = 0.23 for PCG, JOAG, and POAG, respectively). SC could be seen in 27 (90%) healthy eyes compared with only 7 (30%) in PCG (P = 0.01) 20 (60%) JOAG eyes (P = 0.03), and 26 (65%) adult-onset POAG eyes (P = 0.23; χ2 test). Conclusions: Angle dysgenesis in the form of abnormal tissue at the angle/hyperreflective membrane and/or absence of SC could be identified on anterior segment SD-OCT, which can be used for in vivo evaluation of eyes with developmental glaucoma.

Prognosis of different glaucomas seen at a tertiary center: A 10-year overview.

AIM: This study aims to determine treatment patterns, long-term intraocular pressure (IOP) and perimetric control in different glaucomas seen at a tertiary eye center. SETTINGS AND DESIGN: Hospital-based, cross-sectional chart review of patients routinely following up at an outpatient glaucoma service. METHODS: Patients with a follow-up of at least 10 years were evaluated. Their mean IOP, visual field (VF) status, and medications/surgery required at final assessment were noted. STATISTICAL ANALYSIS: Descriptive statistics (mean, standard deviation, and range) were used for all parameters. RESULTS: A total of 230 patients met our inclusion and exclusion criteria, 79 having ocular hypertension with open angles or primary angle closure (PAC), 35 primary open angle glaucoma (POAG), 50 PAC glaucoma (PACG), 20 primary congenital glaucoma (PCG), 46 secondary glaucoma patients. Ocular hypertensives with open angles showed progression to POAG in 3.7%, those with PAC in 5.2%, at a mean IOP of 17.3 ± 3.37 mmHg and 17.13 ± 4.41 mmHg, respectively. A progression on Humphrey Field Analyzer was seen in 11% of POAG and PACG eyes at a mean IOP of 13.50 ± 5.07 and 13.09 ± 3.95 mmHg, respectively. Fifteen percent of primary congenital glaucomas (PCGs) showed a glaucomatous VF defect after 10 years. In secondary glaucoma eyes, the mean IOP at last follow-up visit was 12.38 ± 3.74 mmHg, with progression noted in 7.69% of eyes. CONCLUSION: This study provides evidence that routine delivery of care can provide well controlled IOP in glaucomas, both primary and secondary, and the VF stabilized in about 90% of patients over a period of 10 years, with the currently available glaucoma medications and trabeculectomy.

Prospective evaluation of optic nerve head by confocal scanning laser ophthalmoscopy after intraocular pressure control in adult glaucoma.

PURPOSE: To evaluate and compare changes in scanning laser ophthalmoscopy, HRT II, and perimetry in adult primary open angle and chronic angle closure glaucoma over at least five years. DESIGN: Prospective non-randomized clinical trial. METHODS: 245 eyes of 245 patients, 116 primary open angle glaucoma, POAG eyes and 129 primary angle closure glaucoma, PACG eyes were studied. Standard achromatic perimetry and optic nerve head topography by HRT II were studied serially, at baseline and thereafter every six months. RESULTS: 14 POAG eyes (11.2%) and 20 PACG eyes (15.5%) showed progression on achromatic perimetry. Kaplan-Meier analysis showed a survival rate of 71% at 148 months for PACG and 86% at 144 months in POAG eyes. Eyes that progressed had frequent records (median 3.08 visits, range 2-10 visits) of a rise of IOP of >4 mm, over the target IOP, during follow-up. In stable eyes, PACG required >50% reduction in IOP to achieve stability on HRT, while POAG eyes showed improvement of optic nerve head parameters even with an IOP reduction of 25%. CONCLUSION: Intermittent IOP fluctuations of ≥4 mm Hg over the mean IOP was associated with progression in POAG and CPACG eyes. PACG eyes appeared to progress faster and to a greater extent, and were more resistant to changes in ONH tomography following standard therapy, requiring a larger percentage drop in IOP to manifest improvement in optic nerve head parameters, as compared to POAG eyes.