Nuevos horizontes para el tratamiento del glaucoma. I: neuroinflamación e inflamasomas / New horizons for the treatment of glaucoma. I: Neuroinflammation and inflammasomes

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Biomarcadores de peroxidación lipídica en el humor acuoso de pacientes con glaucoma primario de ángulo abierto / Biomarkers of lipid peroxidation in the aqueous humor of primary open-angle glaucoma patients

OBJETIVO: Investigamos la peroxidación lipídica (PEROX) en el glaucoma primario de ángulo abierto (GPAA) y si este mecanismo puede relacionarse con su progresión. MATERIAL Y MÉTODOS: Estudio prospectivo observacional, transversal, analítico no experimental de casos y grupo comparativo, con selección de 175 pacientes quirúrgicos, distribuidos en: 1) grupo diagnosticado de GPAA (GG; n=88) y 2) grupo comparativo de pacientes con cataratas (GC; n=87). Se han obtenido datos demográficos, características de los participantes y estilo de vida. Se realizó un examen oftalmológico centrado en GPAA. Se obtuvieron muestras de humor acuoso al principio de la cirugía programada, que fueron procesadas para determinar el malonildialdehído mediante la técnica del ácido tiobarbitúrico y sustancias reactivas (MDA/TBARS) así como la actividad antioxidante total (AAO) por métodos enzimático-colorimétricos. El estudio estadístico se realizó mediante el programa SPSS 15.0. RESULTADOS: El nivel de MDA/TBARS fue significativamente mayor (p < 0,001) y la AAO significativamente menor (p < 0,001) en el GG que en el GC. El MDA/TBARS correlacionaba directamente con la presión intraocular (PIO) y relación vertical excavación/papilla (CDR). La disminución de la AAO correlacionaba inversamente con la PIO y el CDR. Las diferencias fueron notablemente mayores en el GG para obesidad, hábito alcohólico, ansiedad, depresión y sedentarismo. En el análisis multivariante las variables que presentaron una mejor capacidad predictiva fueron MDA, PIO, AAO, CDR y la presencia de depresión. CONCLUSIONES: Los pacientes con GPAA están tratados mediante procesos de PEROX que se reflejan en el humor acuoso mediante variaciones en MDA/TBARS y AAO que, además, correlacionan con la PIO y el CDR en el curso del glaucoma. Proponemos que la determinación de MDA/TBARS y AAO en el humor acuoso de los pacientes con GPAA puede utilizarse como biomarcadores predictivos, junto con los cambios en el estilo de vida y otros factores de riesgo relacionados, para mejorar el seguimiento de los glaucomatosos

OBJECTIVE: To investigate the lipid peroxidation (PEROX) processes in primary open-angle glaucoma (POAG) patients, and whether this mechanism may be related to disease progression. MATERIAL AND METHODS: A prospective, observational, cross-sectional, non-experimental, and analytical study was conducted on a case and a comparison group, consisting of 175 surgical patients divided into: 1) POAG group (GG; n=88) and 2) comparison group of patients with cataracts (CG; n=87). Demographic data, patient characteristics, lifestyle data, as well as ophthalmological examination were registered in an Excel spreadsheet. Biochemical data were obtained by processing the aqueous humor collected at the beginning of surgery. Determination of malondialdehyde/thiobarbituric acid reactive substances (MDA/TBARS) and total antioxidant activity (AAO) was assayed using enzymatic-colorimetric methods in the aqueous humor samples. Statistical analysis was performed using SPSS 15.0 software. RESULTS: Aqueous humor MDA/TBARS levels were significantly higher (P<.001) and the AAO significantly lower (P<.001) in the GG than in the GC. The MDA/TBARS directly correlated with intraocular pressure (IOP) values and the cup-to-disc ratio (CDR). Decreased AAO activity correlated inversely with IOP and CDR. Differences between groups were noticeably higher in the GG as regards obesity, alcohol consumption, anxiety, depression, and sedentary lifestyle. In the multivariate analysis, the variables that showed a better predictive ability were: MDA/TBARS, PIO, AAO, CDR, and depression. CONCLUSIONS: The POAG patients have a PEROX background that is reflected in the aqueous humor by variations in MDA/TBARS and AAO. Moreover, both the MDA/TBARS and AAO correlated with IOP values and the CDR. We propose that determination of MDA/TBARS and AAO in the aqueous humor of POAG patients can be used as biomarkers for monitoring the disease, as well the changes in lifestyle and other related risk factors

Antonio Vena fue el primero / Antonio Vena was the first

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Biomarkers of lipid peroxidation in the aqueous humor of primary open-angle glaucoma patients. / Biomarcadores de peroxidación lipídica en el humor acuoso de pacientes con glaucoma primario de ángulo abierto.

OBJECTIVE: To investigate the lipid peroxidation (PEROX) processes in primary open-angle glaucoma (POAG) patients, and whether this mechanism may be related to disease progression. MATERIAL AND METHODS: A prospective, observational, cross-sectional, non-experimental, and analytical study was conducted on a case and a comparison group, consisting of 175 surgical patients divided into: 1) POAG group (GG; n=88) and 2) comparison group of patients with cataracts (CG; n=87). Demographic data, patient characteristics, lifestyle data, as well as ophthalmological examination were registered in an Excel spreadsheet. Biochemical data were obtained by processing the aqueous humor collected at the beginning of surgery. Determination of malondialdehyde/thiobarbituric acid reactive substances (MDA/TBARS) and total antioxidant activity (AAO) was assayed using enzymatic-colorimetric methods in the aqueous humor samples. Statistical analysis was performed using SPSS 15.0 software. RESULTS: Aqueous humor MDA/TBARS levels were significantly higher (P<.001) and the AAO significantly lower (P<.001) in the GG than in the GC. The MDA/TBARS directly correlated with intraocular pressure (IOP) values and the cup-to-disc ratio (CDR). Decreased AAO activity correlated inversely with IOP and CDR. Differences between groups were noticeably higher in the GG as regards obesity, alcohol consumption, anxiety, depression, and sedentary lifestyle. In the multivariate analysis, the variables that showed a better predictive ability were: MDA/TBARS, PIO, AAO, CDR, and depression. CONCLUSIONS: The POAG patients have a PEROX background that is reflected in the aqueous humor by variations in MDA/TBARS and AAO. Moreover, both the MDA/TBARS and AAO correlated with IOP values and the CDR. We propose that determination of MDA/TBARS and AAO in the aqueous humor of POAG patients can be used as biomarkers for monitoring the disease, as well the changes in lifestyle and other related risk factors.

Los miRNAs como potenciales biomarcadores de las enfermedades oculares / MicroRNAs as potential biomarkers of eye diseases

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Causes of childhood blindness in a developing country and an underdeveloped country.

INTRODUCTION: The causes of childhood blindness depend on factors such as geographic location or the human development index of the populations under study. The main causes in developed countries are genetic and hereditary diseases, while infectious and contagious diseases, together with nutritional and vitamin deficiencies, are the main causes in underdeveloped countries (UDCs). METHODS: Study of the causes of blindness among children admitted to a regional centre in Nador, Morocco, and among children in Mekele, Ethiopia. The study was carried out in collaboration with two non-governmental organizations based in Madrid, Spain. First, we worked with Fudación Adelias in June 2010, and with Proyecto Visión in October 2012. RESULTS: The study comprised a total of 27 children in Morocco and 85 in Ethiopia. The average age of the children was 10.92 and 6.94 years, respectively. The main causes of blindness in Morocco were hereditary pathologies (25.92%) and refractive errors (14.82%), although trauma (7.40%) and corneal disease (7.40%) are relevant. Among the children from Ethiopia, corneal disease (27.05%) and trauma (20%) were the main causes of blindness, while congenital and hereditary diseases had a lower prevalence (4.70%). CONCLUSIONS: The causes of blindness depend on the human development index of the populations under study. While corneal disease and trauma are the main causes observed in UDCs like Ethiopia, hereditary pathologies and refractive errors are the main causes within the Moroccan population studied. A mixed form can be observed in this country, as the cause of blindness found in developed countries, such as congenital and hereditary pathologies which are present alongside the causes normally found in LDCs.

Presente y futuro de la interferencia por ácido ribonucleico / Present and future of ribonucleic acid interference

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Esclerectomía profunda no perforante enla anomalía de rieger. A propóstito de unc aso / Non-penetrating Deep sclerectomy in axenfeld-rieger's anomaly

Introducción. La anomalía de Axenfeld-Rieger es una enfermedad congénita autosómica dominante de penetrancia completa del desarrollo ocular, que afecta al segmento anterior del ojo y que pertenece al grupo de las llamadas disgenesias iridocorneales. Caso Clínico. Se describe el caso clínico de una paciente de 11 años, que es diagnosticada de glaucoma de presentación juvenil tras acudir a consulta por molestias inespecíficas en su ojo izquierdo (OI). Tras una adecuada exploración, se aprecian cambios en cámara anterior como embriotoxon posterior, ectropión uveal, atrofia de iris y tensión ocular (TO) OI de 40 mmHg, compatibles con anomalía de Axenfeld-Rieger. Se inicia tratamiento médico con latanoprost colirio 0,005%, planteando posterior tratamiento quirúrgico con esclerectomía profunda no perforante (EPNP) con implante Esnoper plus® por daño inicial glaucomatoso en el campo visual. Resultados. A las 24 horas tras la cirugía, la TO del OI es de 15 mmHg, con buen aspecto de la ampolla de filtración. Tras 2 años de seguimiento con controles trimestrales, la paciente continúa estable. Conclusión. La EPNP puede plantearse como primera opción quirúrgica en glaucomas congénitos de presentación juvenil sin cambios estructurales en ángulo (AU)

Introduction. Axenfeld-Rieger anomaly is an autosomal dominant congenital complete penetrance of ocular development, affecting the anterior segment of the eye that belongs to iridocorneal dysgenesis. Abstract. An 11 year old girl comes for nonspecific pain in her left eye (LE), being diagnosed with juvenile glaucoma. The examination suggested changes in anterior chamber as posterior embryotoxon, uveal ectropion and iris atrophy. Intraocular pressure (IOP) was 40 mmHg LE. These findings were compatible with Axenfeld-Rieger anomaly. Treatment was started with latanoprost 0.005% eye drops, later it was decided to perform non-penetrating deep esclerectomy (NPDS) with Esnoper plus®implant Results. At 24 hours after surgery, IOP LE is 15 mmHg, with good appearance of the filtering bleb. After 2 years of quarterly monitoring controls, the patient remained stable. Conclusion. NPDS may be the first option in congenital juvenil glaucoma without angle changes (AU)

Oftalmología, historia y humanidades / Ophthalmology, history and humanities

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¿Qué comer y qué beber en el glaucoma? Evidencias a partir de estudios en humanos / What to eat and drink in glaucoma? Evidence from human studies

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[Development of conjunctival hyperemia with the use of a fixed combination of latanoprost/timolol: systematic review and meta-analysis of clinical trials]. / Desarrollo de hiperemia conjuntival tras el empleo de la combinación fija de latanoprost/timolol: revisión sistemática y metaanálisis de ensayos clínicos publicados.

PURPOSE: To asses the association of conjunctival hyperemia with the use of a fixed combination of latanoprost/timolol, through a systematic review and meta-analysis of clinical trials in patients with glaucoma. METHODS: A systematic review of published clinical trials of latanoprost/timolol and other competitors was conducted in Medline, Embasse and Cochrane Controlled Clinical Trials Register, between 2000 and 2007. Statistical analysis included calculation of the odds ratio (OR) with its 95% confidence interval (CI) using the fixed effects model of Mantel-Haenszel and the random effects model of Der Simonian and Laird. To assess the heterogeneity between trials the Cochrane Q test and the I(2) rate were calculated. The conjunctival hyperemia rates obtained were compared with the Chi-square test. RESULTS: A total of 8 clinical trials comparing latanoprost/timolol fixed combination with different therapeutic options were found. As trial heterogeneity was moderate (Q: 14.64; df=7; p=0.041; I(2)= 52.2%) a random effects model was used. The final OR was 0.47 (CI 95%: 0.24-0.90); p = 0.024. The total conjunctival hyperemia incidence was 2.9% in the latanoprost/timolol group and 7.0% for the competitors (p<0.0001). CONCLUSIONS: The use of a fixed combination of latanoprost/timolol is associated with a significant reduction (53%; CI 95%: 10%-76%) in the development of conjunctival hyperemia against the other compared options for the treatment of glaucoma.

Desarrollo de hiperemia conjuntival tras el empleo de la combinación fija de latanoprost/timolol: revisión sistemática y metaanálisis de ensayos clínicos publicados / Conjuntival hyperemia with the use of a fixed combination of latanoprost/timolol: systematic review and meta-analysis of clinical trials

Objetivo: Valorar la asociación de hiperemia conjuntival con el uso de la combinación fija de la tanoprost/timolol en el tratamiento del glaucoma, a través de una revisión sistemática y de un metaanálisis. Métodos: Se efectuó una búsqueda de los ensayos clínicos publicados de la tanoprost/timolol y distintos comparadores en las bases de datos Medline, Embasse y Cochrane Controlled Clinical Trials Register, entre 2000 y 2007. La medida para valorar el tamaño del efecto ha sido la odds ratio (OR) y su intervalo de confianza (IC) del 95 %, habiéndose calculado mediante el modelo de efectos fijos de Mantel-Haenszel y el de efectos aleatorios de DerSimonian and Laird. Para valorar la existencia de heterogeneidad entre los estudios, se llevó a cabo la prueba Q de Cochran así como el cálculo del índiceI2. Los porcentajes de hiperemia hallados se han comparado a través de la prueba de Chi-cuadrado. Resultados: Se encontraron 8 ensayos clínicos que comparaban la tanoprost/timolol con distintas opciones terapéuticas. La heterogeneidad de los estudios fue moderada (Q: 14,64; df = 7; p = 0,041;I2 = 52,2%) por lo que se utilizó el modelo de efectos aleatorios. La OR final fue de 0,47 (IC 95%:0,24-0,90); p = 0,024. La incidencia total de hiperemia fue de 2,9% en el grupo la tanoprost/timolol y de 7,0% para los comparadores (p < 0,0001). Conclusiones: El uso de la tanoprost/timolol se asocia con una disminución significativa de la aparición de hiperemia conjuntival del 53% (IC 95%:10%-76%) frente a otras opciones de tratamiento en el manejo del glaucoma (AU)

Purpose: To asses the association of conjuntival hiperemia with the use of a fixed combination of la tanoprost/timolol, through a systematic review and metaanalysis of clinical trials in patients with glaucoma. Methods: A systematic review of published clinical trials of la tanoprost/timolol and other competitors was conducted in Medline, Embasse and Cochrane Controlled Clinical Trials Register, between 2000 and 2007. Statistical analysis included calculation of the odds ratio (OR) with its 95% confidence interval (CI) using the fixed effects model of Mantel-Haenszel and the random effects model of Der Simonian and Laird. To assess the heterogeneity between trials the Cochran Q test and the I2 ratewere calculated. The conjuntival hyperemia rates obtained were compared with the Chi-square test. Results: A total of 8 clinical trials comparing la tanoprost/timolol fixed combination with different therapeutic options were found. As trial heterogeneity was moderate (Q: 14.64; df = 7; p = 0.041; I2 = 52.2%) a random effects model was used. The fina lOR was 0.47 (CI 95%: 0.24-0.90); p = 0.024. The total conjuntival hyperemia incidence was 2.9% inthe latanoprost/timolol group and 7.0% for the competitors (p< 0.0001). Conclusions: The use of a fixed combination of la tanoprost/timolol is associated with a significant reduction (53%; CI 95%: 10%-76%) in the development of conjuntival hyperemia against the other compared options for the treatment of glaucoma (AU)

Serotonin levels in aqueous humor of patients with primary open-angle glaucoma.

PURPOSE: Glaucoma is an optic neuropathy characterized by a high intraocular pressure (IOP), alterations in optic nerve head, and loss of visual field that could lead to bilateral blindness. Serotonin (5-HT) is a biogenic monoamine that is synthesized from hydroxylation of tryptophan and acts by three ways, dissemination, metabolism, and reuptake in synaptic cleft through specific systems of the membrane. The purpose of this study is to evaluate the 5-HT and 5-HIAA (5-hydroxiindolacetic acid) levels in the aqueous humor of patients with primary open-angle glaucoma (POAG). METHODS: We performed a case-control study, and the patients recruited were classified into two groups, 1) 30 patients with POAG (GG) and 2) 30 patients with cataracts (CG), who acted as the controls. Aqueous humor samples of each patient were obtained by paracentesis at the beginning of the surgical procedures. 5-HT and 5-HIAA levels were determined by high performance liquid chromatography (HPLC) with electrochemical detection. RESULTS: There were no statistical differences between age (71.3 +/- 7.2 years in GG, 73.5 +/- 9.0 years in CG; p=0.2581) or gender (sex ratio 0.765 in GG and 0.667 in CG). 5-HT levels were lower in GG, but this difference was not significant (p=0.820). We observed a statistically significant higher level of 5-HIAA in GG (p=0.001). The 5-HT turnover (5-HIAA/5-HT) were higher in GG than in CG (p<0.05), but the difference was not significant (p=0.598). CONCLUSIONS: The level of 5-HT was lower in GG patients, and the level of 5-HIAA was higher in GG patients than in CG patients.