Peripapillary vessel density in healthy people, primary open-angle glaucoma, and normal-tension glaucoma.

OBJECTIVE: To compare peripapillary vessel density using optical coherence tomography angiography (OCT-A) in eyes of healthy people, primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG). METHODS: Thirty patients with POAG, 27 patients with NTG, and 29 healthy individuals in the control group were assessed. Capillary vessels in peripapillary retinal nerve fiber layer (RNFL) represented by whole image RPC (radial peripapillary capillary) density in an AngioDisc scan 4.5 × 4.5 mm centered on the optic disc, and ONH morphological variables (disc area, rim area, cup to disc area ratio (CDR)), and average peripapillary RNFL thickness were measured. RESULTS: Differences in mean RPC, RNFL, disc area, rim area, and CDR between the groups were statistically significant (P < 0.05). The difference in RNFL thickness and rim area was not significant between NTG and healthy groups, while RPC and CDR showed a statistically significant difference between all pairs. The vessel density in the POAG group was 8.25% and 11.7% lower compared to the NTG and healthy groups, respectively; while the mean difference was less (2.97%) for the NTG and healthy group. In the POAG group, 67.2% of the variation in RPC can be explained by a model containing CDR and RNFL thickness, and in normal eyes 38.8% of the changes using a model containing RNFL. CONCLUSION: The peripapillary vessel density is reduced in both types of glaucoma. The vessel density in NTG was significantly lower than in the healthy eyes, despite the lack of significant difference in RNFL thickness and neuroretinal rim area between them.

Long-term effects of intraoperative topical bevacizumab in sutureless scleral tunnel trabeculectomy: a prospective clinical trial.

PURPOSE: To investigate the long-term efficacy and safety of the novel method sutureless trabeculectomy with topical administration of bevacizumab. MATERIALS/METHODS: Primary open-angle glaucoma patients with intraocular pressure (IOP) > 21 mmHg despite maximum tolerated medication were included in a single-blind prospective interventional clinical trial. Group 1 underwent sutureless scleral tunnel trabeculectomy with intraoperative topical administration of bevacizumab (1.25 mg) applied on the scleral incision for 1 min. Group 2 underwent sutureless trabeculectomy alone and group 3 (control group) underwent conventional trabeculectomy with mitomycin C (MMC). Outcome measures were surgical success, IOP, number of needed anti-glaucoma medications, and complications. Patients were followed for two years. RESULTS: Finally, 50 eyes from group 1, 46 from group 2, and 47 from group 3 were analyzed. At the end of 24 months, 52% (n = 26) of group 1, 34.8% (n = 16) of group 2, and 57.4% (n = 27) of group 3 had complete success (IOP < 18 mmHg without medication). The difference was only significant between groups 2 and 3 (p = 0.003). 94% (n = 47) of group 1, 89.1% (n = 41) of group 2, and 91.5% (n = 43) of group 3 had qualified success (IOP < 18 mmHg with ≤ 2 anti-glaucoma medications) (p = 0.69). There was a significant difference in the overall IOP mean between the three groups (p < 0.0001). There was no significant difference between the three groups in complication rates and the number of needed anti-glaucoma medications for IOP control. CONCLUSION: Sutureless trabeculectomy with topical application of bevacizumab showed comparable surgical success rates with conventional trabeculectomy and MMC in long-term follow-up. Additionally, adjuvant use of topical bevacizumab had a significant positive impact on long-term IOP control.

Short-Term Results of Sutureless Scleral Tunnel Trabeculectomy Using Adjunctive Topical Bevacizumab.

This study was performed to assess the short-term effect of sutureless scleral tunnel trabeculectomy procedure with and without topical bevacizumab. Thirty patients with Primary Open-Angle Glaucoma (POAG) were enrolled and randomly divided to two groups. Patients in the first group (15 patients) underwent sutureless trabeculectomy without topical bevacizumab and patients in the second group (15 patients) underwent sutureless trabeculectomy with 1.25 mg of topical bevacizumab. Intraocular Pressure (IOP) of both groups was measured by an expert ophthalmologist, without awareness of the patient's study group before the operation and six months post-operatively. Out of 30 patients in this study, six females (40%) and nine males (60%) underwent the sutureless trabeculectomy procedure (group A) as well as seven females (46.7%) and eight males (53.3%) underwent sutureless trabeculectomy with topical bevacizumab (group B). The mean age of the patients was not significantly different between the two groups (P = 0.91). A statistically significant difference in time variation of IOP was found between the two groups (P < 0.001). Mean IOP was 18.4 ± 4.35 mmHg in the sutureless group without bevacizumab and 11.73 ± 2.12 mmHg in the sutureless group with bevacizumab, six months post-surgically. No statistical significant differences were found in the baseline IOP between the two groups (P = 0.28). However, IOP changed significantly in group A and B from baseline to six months post-operatively (P = 0.004 and P < 0.001 respectively). According to the current findings, the sutureless trabeculectomy procedure is an effective surgical method for reduction of IOP. Addition of a single dose of 1.25 mg topical bevacizumab was more effective in reduction of IOP compared to sutureless trabeculectomy alone.

Leishmania donovani infection differentially regulates small G-proteins.

Leishmania is a protozoan parasite that resides and replicates in macrophages and causes leishmaniasis. The parasite alters the signaling cascade in host macrophages and evades the host machinery. Small G-proteins are GTPases, grouped in 5 different families that play a crucial role in the regulation of cell proliferation, cell survival, apoptosis, intracellular trafficking, and transport. In particular, the Ras family of small G-proteins has been identified to play a significant role in the cellular functions mentioned before. Here, we studied the differential expression of the most important small G-proteins during Leishmania infection. We found major changes in the expression of different isoforms of Ras, mainly in N-Ras. We observed that Leishmania donovani infection led to enhanced N-Ras expression, whereas it inhibited K-Ras and H-Ras expression. Furthermore, an active N-Ras pull-down assay showed enhanced N-Ras activity. L donovani infection also increased extracellular signal-regulated kinase 1/2 phosphorylation and simultaneously decreased p38 phosphorylation. In contrast, pharmacological inhibition of Ras led to reduction in the phosphorylation of extracellular signal-regulated kinase 1/2 and enhanced the phosphorylation of p38 in Leishmania-infected cells, which could lead to increased interleukin-12 expression and decreased interleukin-10 expression. Indeed, farnesylthiosalicyclic acid (a Ras inhibitor), when used at the effective level in L donovani-infected macrophages, reduced amastigotes in the host macrophages. Thus, upregulated N-Ras expression during L donovani infection could be a novel immune evasion strategy of Leishmania and would be a potential target for antileishmanial immunotherapy.

Evaluation of LATS1 and LATS2 Promoter Methylation with the Risk of Pterygium Formation.

Purpose. Pterygium is a serious eye problem in countries with high exposure to UV. However, despite numerous studies, the molecular etiology of pterygium is unclear. Recent studies have indicated that LATS1 and LATS2 genes are involved in DDR signaling pathways against continuous UV exposure. Our aim was to evaluate the LATS1 and LATS2 promoter methylation with the risk of pterygium formation. Methods. We evaluated the promoter methylation status of LATS1 and LATS2 using methylation-specific PCR technique. Also, mRNA expression of LATS1 and LATS2 was assessed in 14 cases of pterygium and 14 normal specimens by real-time PCR. Results. Promoter methylation of LATS1 and LATS2 was detected significantly between pterygium tissues and normal tissues [LATS1; OR = 4.9; 95% CI: 1.54 to 15.48, P = 0.003; LATS2; OR = 7.1; 95% CI: 1.53 to 33.19, P = 0.004]. The gene expression analysis showed a statistically significant difference between pterygium tissues and healthy controls for both LATS1 and LATS2 (P < 0.05). Conclusions. The data of this study is the first report regarding the effect of promoter methylation of the LATS1 and LATS2 in the pterygium. To confirm these data, doing further studies in various genetic populations with large sample sizes using advanced molecular techniques is proposed.

Assessment of Promoter Hypermethylation and Expression Profile of P14ARF and MDM2 Genes in Patients With Pterygium.

BACKGROUND: Pterygium is a fairly general condition in many regions of the world. The cause of this abnormality is still ambiguous. However, recent findings suggest that pterygium is a benign progressive tissue and not a degenerative disorder. The main goal of our study was to investigate the effects of P14 and MDM2 promoter methylation on the risk of pterygium. MATERIALS AND METHODS: In this study, the DNA of 81 primary pterygium and 75 normal conjunctiva tissues was extracted and modified for the assessment of methylation of P14 and MDM2 promoters by methylation-specific polymerase chain reaction (MSP). We also estimated the mRNA expression levels of these genes in 23 pterygium and 18 normal conjunctiva tissue samples using real-time quantitative reverse transcriptase polymerase chain reaction. RESULTS: The frequency of methylation for P14 was 92.6% for cases and 97.3% for controls. MDM2 gene methylation at the promoter site was 39.5% and 72.0% for pterygium and normal conjunctiva tissues, respectively. So statistically, a significant relationship between MDM2 gene promoter methylation and the risk of disease was found (odds ratio=5.3; 95% confidence limit, 2.6-10.8; P<0.0001). In addition, the expression of MDM2 gene has increased in pterygium (1.371548±0.6727) in comparison with conjunctiva tissues as control (1.20621±1.0) (P<0.05), but it was not significant for P14 gene. CONCLUSION: Our results have indicated that hypomethyaltion and overexpression of MDM2 gene take place in patients with the pterygium. To confirm the presented data, suggesting further studies with a larger sample size in various genetic populations.

Intravitreal autologous plasmin prepared by urokinase for vitreolysis: a pilot study.

PURPOSE: To evaluate the effects of intravitreal autologous plasmin injection (IVAP) on vitreoretinal diseases and vitreolysis. METHODS: In this interventional, prospective, case series pilot study, 8 eyes were assigned to IVAP. Plasminogen as centrifuged from the patients' plasma was converted to plasmin by adding urokinase. A total of 0.2 mL extracted plasmin was injected intravitreally. Posterior vitreous detachment (PVD) and potential injection-related complications at week 4 were the primary outcome measures. Secondary outcomes included changes in best-corrected visual acuity (VA) (logMAR) and central macular thickness (CMT). RESULTS: Mean age of the patients was 54.35 years. Two patients had complete PVD and 3 patients had partial PVD. Four patients had decrease in CMT. The VA was not changed in 6 patients, improved in 1 patient, and decreased in 1 patient. No uveitis, endophthalmitis, or postinjection vitreous hemorrhage was observed. CONCLUSIONS: This pilot study demonstrated the efficacy of urokinase-prepared IVAP injection on releasing vitreomacular traction and inducing vitreolysis.

A comparative study of sutureless scleral tunnel trabeculectomy versus conventional trabeculectomy in the management of primary open-angle glaucoma.

The aim of this study was to compare the outcome and complications of sutureless trabeculectomy with conventional trabeculectomy. A total of 52 eyes were randomly assigned to two groups. One group received standard conventional trabeculectomy and the other group received sutureless trabeculectomy. The patients were evaluated at 1, 3, 6 and 12 months after surgery. Patient data such as sex, age, intraocular pressure (IOP), logMAR visual acuity, antiglaucoma medications, and intraoperative and postoperative complications were collected and statistically analyzed. The mean age of the conventional and sutureless groups was 48.5 ± 15.4 and 57.3 ± 13.9 years, respectively. All patients achieved IOP levels <21 mmHg with a mean IOP of 13.4 ± 5.3 mmHg in the conventional group and 12.8 ± 2.6 mmHg in the sutureless group at 6 months and 11.00 ± 1.3 and 12.4 ± 3.2 mmHg at 12 months post surgery, respectively. These results showed a significant decrease compared to preoperative measures but did not show a significant difference between the two groups (p = 0.659). The number of antigalucoma medications used postoperatively showed a significant decline from preoperative status of 0.7 ± 0.58 in the conventional group and 0.4 ± 0.4 in the sutureless trabeculectomy group after 6 months and 0.68 ± 0.8 and 0.78 ± 0.9 after 12 months, respectively; however, there was no significant difference between the two groups (p = 0.112). No intraoperative complications were encountered in any of the groups. One patient in the sutureless trabeculectomy group developed mild hyphema which was managed medically. In the conventional group, two patients had failed trabeculectomy which was successfully revised, two patients showed hypotony 2 days after surgery which was managed medically and normal pressure was achieved within 5 days. Sutureless trabeculectomy appears to be a safe and easy method with results comparable to conventional trabeculectomy.

A Pilot Trial of Jawarish Amla as Adjuvant to Anti-Tubercular Treatment Drugs for Control of Adverse Reactions in DOTS Regime in Pulmonary TB.

BACKGROUND AND OBJECTIVES: One of the greatest challenges of health care systems at the dawn of the 21st century is tuberculosis (TB). Drug resistant strains of TB are becoming a global public health risk. These strains commonly appear due to faulty therapies. Patients frequently stop treatment due to the toxicity of anti-tubercular treatment (ATT) drugs. Amla (Emblica officinalis) is a well-known Unani single drug. Jawarish amla is a Unani compound formulation which is commonly used to administer amla. This study tested the efficacy of Jawarish amla as an adjuvant to ATT drugs in reducing their side effects. METHODOLOGY: Half of forty eligible pulmonary tuberculosis patients were randomly assigned to Test (Group B) and the other half to Control (Group A). Six grams of Jawarish amla twice daily was administered to the test group, and the same dosage of placebo was administered to control group along with directly observed treatment, short course chemotherapy (DOTS) for 60 days. Fisher exact test and paired t-test were applied for efficacy evaluation. Grading of symptoms was done to assess the toxicity of ATT and outcome of the adjuvant. RESULTS AND DISCUSSION: Significant improvements were observed in almost all subjective and objective parameters. The exceptions were serum creatine and serum uric acid, which showed non-significant slight elevations within normal limits. CONCLUSION: Jawarish amla was ascertained to be safe and effective adjuvant of DOTS in combating the adverse effects of ATT drugs.

Prevalence of malaria, dengue, and chikungunya significantly associated with mosquito breeding sites.

OBJECTIVES: To observe the prevalence of malaria, dengue, and chikungunya and their association with mosquito breeding sites. METHODS: The study was observational and analytical. A total of 162 houses and 670 subjects were observed during the study period. One hundred forty-two febrile patients were eligible for the study. After obtaining informed consent from all febrile patients, 140 blood samples were collected to diagnose malaria, dengue, and chikungunya. Larval samples were collected by the standard protocol that follows. Correlation of data was performed by Pearson correlation test. RESULTS: Forty-seven blood samples were found positive: 33 for chikungunya, 3 for dengue, and 11 for malaria. Fifty-one out of 224 larval samples were found positive. Out of the 51 positive samples, 37 were positive for Aedes, 12 were positive for Anopheles, and two were positive for Culex larvae. INTERPRETATION AND CONCLUSION: Mosquito-borne fevers, especially malaria, dengue, and chikungunya, have shown a significant relationship with mosquito breeding sites.