Testing the eligibility of glaucoma patients for potential gene therapy among a clinic population.

PURPOSE: Glaucoma patients who deteriorate despite standard treatment may benefit from novel gene therapies. Key inclusion criteria for a glaucoma gene therapy trial were devised. A retrospective chart review in a glaucoma clinic population was conducted. Feasibility of gene therapy inclusion criteria and factors associated with progression and fast progression < -1 decibels/year (dB/y) were evaluated. METHODS: Three hundred and seventy-four primary open-angle glaucoma patients all of whom had performed at least five Swedish interactive threshold algorithm standard visual fields within a 58-month period. Two definitions were applied to characterize visual field progression rate using Guided Progression Analysis for an individual patient based on A, the eye with the greatest visual field loss, or B, the eye with the most rapid progression rate. RESULTS: Mean rate of visual field progression was -0.50 dB/y (Definition A) and -0.64 dB/y (Definition B). 19.0% (A) and 21.9% (B) of eyes, 71 (A) and 82 (B) eyes, were 'fast progressors' (< -1 dB/y). 37 (A) and 43 (B) eyes met the putative gene therapy inclusion criteria (≥ 50 years; mean deviation ≤ -4 to ≥ -12 or ≤ -20 dB, progression rate between -1 and -4 dB/y). Beta blockers (Odds ratio (OR) with 95% Confidence Intervals (CI): 2.84 (1.39-5.80); p = 0.004) (A), (OR (95%CI): 2.48 (1.30-4.75); p = 0.006) (B) and alpha agonists (OR (95%CI): 2.18 (1.14-4.17); p = 0.02) (A), (OR (95%CI) 2.00 (1.08-3.73); p = 0.028) (B) were significantly associated with fast progression. CONCLUSION: A substantial proportion (10%) of patients in this clinic population would meet recommended gene therapy inclusion criteria.

Anterior segment optical coherence tomography imaging and ocular biometry in cataract patients with open angle glaucoma comorbidity.

BACKGROUND: Anterior chamber angle anatomy in perspective of ocular biometry may be the key element to intraocular pressure (IOP) reduction, especially in glaucoma patients. We aim to investigate anterior chamber angle and biometrical data prior to cataract surgery in patients with and without glaucoma comorbidity. MATERIALS AND METHODS: This prospective comparative case-control study included 62 subjects (38 with cataract only and 24 with cataract and glaucoma). A full ophthalmic examination including, Goldmann applanation tonometry, anterior chamber swept source optical coherence tomography (DRI OCT Triton plus (Ver.10.13)) and swept source optical biometry (IOL Master 700 v1.7) was performed on all participants. RESULTS: We found that ocular biometry parameters and anterior chamber parameters were not significantly different among groups. However, when we added cut-off values for narrow angles, we found that glaucoma group tended to have more narrow angles than control group. IOP was higher in glaucoma group despite all glaucoma patients having medically controlled IOP. In all subjects, anterior chamber parameters correlated well with lens position (LP), but less with relative lens position, while LP cut-off value of 5.1 mm could be used for predicting narrow anterior chamber angle parameters. CONCLUSIONS: Cataract patients tend to develop narrow anterior chamber angles. Anterior chamber angle parameters have a positive moderate to strong relationship with lens position. LP may be used predicting narrow angles.

[Lamina cribrosa defect and progress of glaucoma].

Lamina cribrosa (LC) is considered as the original site of glaucomatous damage of axons of retinal ganglion cells, and therefore understanding the morphological changes in the LC will help to uncover the pathogenesis of glaucoma. Previous studies have indicated that the progress of glaucomatous optic neuropathy may be associated with the LC defects. Based on imaging by swept source optical coherence tomography B-Scan of the optic discs of patients with glaucoma, for the first time the spontaneous local LC defects have been found to balance the gradient between intraocular and cerebrospinal fluid pressures, which in turn can slow down the progress of glaucomatous optic neuropathy. This article provides the direct evidence supporting the role of intraocular and cerebrospinal fluid pressure gradient in the pathogenesis of glaucoma. This finding will increase our understanding of the mechanisms underlying glaucoma and help to develop novel strategies for its treatment and prognosis analysis. (Chin J Ophthalmol, 2020, 56: 17-20).

[Spontaneous focal lamina cribrosa defect in glaucoma and its relationship with nonprogressive glaucomatous neuropathy].

Objective: To investigate the relationship between the spontaneous focal lamina cribrosa (LC) defect and the progression of visual field defect (VFD) in primary open-angle glaucoma (POAG). Methods: Case-control study. The patients who were diagnosed as POAG with at least 5 visual field results had been collected from June 2018 to January 2019 at Beijing Tongren Hospital Affiliated to Capital Medical University. Serial imaging by swept source optical coherence tomography B-Scan of the optic discs were acquired at the end of the follow-up and LC defects status were reviewed. Intraocular pressure, mean defects of visual field, central corneal thickness and axis length were recorded in the follow-up duration. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated by χ(2) or Fisher's test, mixed-effect model analysis and multivariate Logistical regression analysis. Results: A total of 32 subjects (64 eyes) were enrolled in the study with mean age of (47±14) years, the group consisted of 17 males and 15 females. Fourty-five eyes showed nonprogressive VFD. LC defects were more common in eyes without (28/45) rather than with progressive VFD (5/19) (χ(2)=6.896, P=0.009). Eyes with nonprogressive VFD showed longer axis length[(26.82±1.34) mm vs. (25.79±1.44) mm; t=6.589, P=0.013] and wider LC defects diameter[211 (165-326) µm vs. 114 (106-156) µm; Z=4.797, P=0.042]. Multivariate Logistic regression analysis revealed that the presence of LC defect was significantly associated with nonprogressive VFD (odds ratio=0.217, P=0.012). There were 7 subjects with asymmetry VFD and the incedence of LC defects without progression (7/7) is higher than fellow eye with progression (1/7, P=0.002). There was only one patient with progressive VFD showed one LC defect with an smaller diameter (169 µm) than that in the contralateral eyes with stable VFD (269 µm). Conclusions: LC defects are more common in eyes with nonprogressive VFD. Spontaneous LC defects are associated with nonprogressive glaucomatous defects and could be a protective factor for POAG. (Chin J Ophthalmol, 2019, 55:338-346).

SPECIFIC CHARACTERISTICS OF OCULAR BIOMETRIC FACTORS IN GLAUCOMATOUS PATIENTS WITH PSEUDOEXFOLIATIVE SYNDROME AS MEASURED BY OPTICAL LOW-COHERENCE REFLECTOMETRY.

The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with cataract and pseudoexfoliative syndrome, cataract and pseudoexfoliative glaucoma, and cataract and primary open-angle glaucoma (POAG), and to determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low-coherence reflectometry. This retrospective study included 72 patients, and the study sample of 102 eyes was divided into the following three groups according to diagnosis: 29 eyes with pseudoexfoliative syndrome and cataract; 36 eyes with POAG and cataract; and 37 eyes with pseudoexfoliative glaucoma and cataract. Data on biometric measurements (central corneal thickness, pupillary diameter, anterior chamber depth, lens thickness, axial length, retinal thickness, astigmatism and white-to-white) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International) were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Department of Ophthalmology, Sveti Duh University Hospital in Zagreb, Croatia. Comparative analysis of the groups yielded statistically significant differences in central corneal thickness (F2/99=7.066; p=0.001) and lens thickness (F2/96=5.133; p=0.008). The group of eyes diagnosed with pseudoexfoliative glaucoma and cataract had a significantly thinner cornea as compared with the other two groups and a significantly thicker lens as compared with the group of eyes with POAG and cataract. In conclusion, optical low-coherence reflectometry revealed differences in biometric factors among the three groups of eyes, with a statistically significantly thinner cornea and thicker lens in the group of glaucomatous patients with pseudoexfoliative syndrome.

SUBCONJUNCTIVAL FRAGMENTATION OF A PREVIOUSLY EFFICIENT XEN GEL STENT IMPLANTATION AND SUCCESSFUL BLEB FORMATION: A CASE REPORT.

The XEN gel stent is one of the available minimally invasive glaucoma surgery devices, a new generation implant, which is designed to reduce intraocular pressure in patients with primary open angle glaucoma if past medical treatments have failed. This report presents a case of subconjunctival fragmentation of the XEN gel stent after a three-month follow-up of successful XEN gel implantation. A 70-year-old male patient was treated for primary open angle glaucoma. He underwent successful phacoemulsification and intraocular lens implantation two years before. Due to medical therapy failure in controlling glaucoma, XEN gel stent implantation was suggested to the patient. The implant was successfully placed in both eyes, and extended bleb and drainage aqueous humor from the anterior chamber to the subconjunctival space was obtained. Three months after the surgery, at a regular follow-up visit, three fragments of the subconjunctival part of the XEN gel implant were found in his left eye. Neither serious complications nor intraocular pressure increase were detected. A new potential complication of the XEN gel implant is described.

[The function-structure impairment pattern of optic nerves in primary open-angle glaucoma and normal-tension glaucoma].

Objective: To investigate the characteristics of impairment of the visual field (VF) and retinal nerve fiber layer (RNFL) and the differences of progression pattern of early, middle and late stages of primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) , and to analyze the correspondence of structure and function. Methods: Cross-sectional study. POAG patients, NTG patients and healthy volunteers who were enrolled from February 2008 to May 2017 at Department of Ophthalmology, Eye & ENT Hospital of Fudan University, underwent basic ophthalmic examination, Humphrey central 24-2 threshold test and optical coherence tomography. Patients were divided into early, middle and late stages according to the mean defect (MD) index of the VF test. According to the RNFL distributional characteristics, the pattern deviation map and RNFL were divided into 6 sectors. The differences of each sector's MD and RNFL thickness in the healthy group and groups of patients at 3 stages were analyzed using the Kruskal-Wallis test, and the correlation of MD and RNFL thickness of each sector was analyzed using the Pearson coefficient. Results: In the POAG group, there were 84 cases (84 eyes) including 35 eyes of early stage, 20 eyes of middle stage and 29 eyes of late stage, with a male/female ratio of 43∶41, aged (45±15) years. In the NTG group, 69 cases (69 eyes) included 30 eyes of early stage, 20 eyes of middle stage and 19 eyes of late stage, with a male/female ratio of 33∶36, aged (49±13) years. The control group had 23 cases (23 eyes), with a male/female ratio of 16∶17 and an age of (44±10) years. There was no significant difference in male/female ratio, age or best corrected visual acuity among the three groups. (1) In the middle stage of POAG, the VF defects of inferior hemi-fields were more severe than the superior (t=21.62, P=0.000), which was opposite to the late stage of POAG (t=-3.28, P=0.003). In each stage of NTG, there was no significant difference between two hemi-fields. In the control group, the MD values(antilog) of VF in the superior peripheral arch (PEA), superior paracentral arch (PAA), inferior PEA and PAA, temporal and central regions were 0.87 (0.63-1.11)/L, 0.74 (0.61-0.83)/L, 0.72 (0.55-0.97)/L, 0.65 (0.51-0.87)/L, 0.69 (0.57-0.97)/L, and 0.82 (0.54-0.93)/L, respectively. The sectoral MD values in the VF sectors of POAG were significant compared with the control group (P<0.05): superior PAA for early stage [0.61 (0.18-0.92)/L, H=21.58], superior PEA and PAA for middle stage [0.61 (0.15-0.87)/L, 0.21 (0.00-0.78)/L, H=25.99, 34.91], superior PEA and PAA, inferior PEA and PAA for late stage [0.01 (0.00-1.13)/L, 0.00 (0.00-0.76)/L, 0.41 (0.00-1.07)/L, 0.21 (0.00-0.95)/L, H=46.27, 54.19, 25.64, 28.10]. With the aggravation of POAG, superior PAA had the largest reduction percentage of sectoral MD. The sectoral MD values in the VF sectors of NTG were significant compared with the control group (P<0.05): superior PAA for early stage [0.54 (0.19-0.80)/L, H=20.93], superior PAA for middle stage [0.60 (0.02-1.01)/L, H=22.13], superior PEA and PAA, inferior PEA and PAA for late stage [0.33 (0.00-0.90)/L, 0.05 (0.00-0.92)/L, 0.16 (0.01-0.87)/L, 0.64 (0.02-1.10)/L, H=37.66, 42.78, 35.15, 37.15]. With the aggravation of NTG, the largest reduction percentage of sectoral MD was found in superior PAA at the beginning but in inferior PAA at last. (2) The RNFL thickness of the control group in Region 1NI, 2TI, 3NS, 4TS, 5N, and 6T was 112.76 (63.54-150.99) µm, 134.89 (89.44-198.55) µm, 96.52 (57.32-158.79) µm, 120.96 (69.25-148.48) µm, 71.85 (65.03-95.47) µm, and 66.24 (55.44-90.97) µm, respectively. The sectoral thickness in the RNFL sectors of POAG were significant compared with the control group (P<0.05): 2TI for early stage [109.17 (43.77-173.86) µm, H=31.50], 1NI, 2TI and 4TS for middle stage [71.54 (49.92-94.98) µm, 62.92 (42.33-102.73) µm, 84.20 (45.98-120.13) µm, H=38.91, 49.89, 30.60], 1NI, 2TI, 3NS, 4TS, 5N and 6T for late stage [61.76 (39.32-97.99) µm, 59.59 (42.80-108.69) µm, 67.28 (42.56-117.96) µm, 65.16 (41.96-138.02) µm, 59.45 (21.04-78.48) µm, 53.74 (27.88-92.71) µm, H=52.76, 55.06, 35.76, 41.72, 41.32, 29.93]. With the aggravation of POAG, at the beginning 2TI had the largest reduction percentage of RNFL thickness but 4TS had it at last. The sectoral thickness in the RNFL sectors of NTG were significantly different from the control group (P<0.05): 2TI for early stage [78.97 (47.77-131.45) µm, H=28.86], 1NI, 2TI, 3NS and 4TS for middle stage [61.46 (49.69-97.38) µm, 74.51 (40.25-135.16) µm, 86.36 (42.70-105.06) µm, 83.60 (54.75-117.35) µm, H=38.76, 35.64, 22.47, 24.14], 1NI, 2TI, 3NS, 4TS and 6T for late stage [61.45 (49.09-92.64) µm, 54.35 (37.40-102.62) µm, 63.72 (28.68-105.55) µm, 61.00 (44.92-108.49) µm, 50.33 (35.62-82.09) µm, H=42.56, 51.50, 36.11, 47.44, 25.50]. With the aggravation of NTG, the sector with the largest reduction percentage of thickness changed from 2TI to NI and 4TS. (3) The VF superior PAA-RNFL 2TI had the highest Pearson correlation coefficient in POAG (r=0.630, P<0.001), while it was the inferior PAA-4TS in NTG (r=0.645, P<0.001). Conclusions: The impairment patterns of VF and RNFL in each stage of POAG and NTG are distinctly different from certain rules of aggravation. The sector with the strongest correlation of function-structure is the VF superior PAA-RNFL inferior temporal sector in POAG and inferior PAA-superior temporal sector in NTG. (Chin J Ophthalmol, 2018, 54: 811-819).

[Preliminary study on the measurement of optic nerve subarachnoid space in patients with normal tension glaucoma].

Objective: To investigate the ultrasonographic measurements of the optic nerve subarachnoid space (ONSAS) in patients with normal tension glaucoma (NTG). Methods: Cross-sectional study. Patients with NTG or primary open-angle glaucoma (POAG) but without any anti-glaucoma treatment and the control group were collected from June 2016 to March 2017 at Beijing Tongren Hospital affiliated to Capital Medical University. Measurements of 24-h intraocular pressure, central corneal thickness, mean visual field damage, visual axis, blood pressure and body mass index and ocular ultrasound scans were performed. The differences in the ONSAS of the two-dimensional ultrasound images of the three groups of subjects and their correlation with various clinical variables were evaluated. Qualitative data were analyzed by the chi-square test for comparison between groups; quantitative data were analyzed by the one-way ANOVA for comparison between groups, and the LSD-t test was used for comparison between groups; the Pearson correlation analysis was used for correlation analysis of measurement data. The intra-group correlation coefficient was used to evaluate the reproducibility and repeatability of two measurements by different measurers or the same measurer. Results: A total of 35 patients (35 eyes) with NTG were enrolled in the NTG group, including 14 males and 21 females, aged (50±8) years; 32 patients (32 eyes) with POAG were enrolled in the POAG group, including 14 males and 18 females, aged (52±10) years; 37 healthy people (37 eyes) were enrolled in the control group, including 20 males and 17 females, aged (49±9) years. The ONSAS was (5.07±0.83) mm(2) in the retrobulbar 3- to 7-mm range in the NTG group, significantly smaller than the control group (6.57±1.43) mm(2) and the POAG group (6.19±0.90) mm(2) (t=1.17, 1.29; P=0.03, 0.01). There was no significant difference in the statistical results between the control group and the POAG group (t=1.31, P=0.75). Between the ONSAS and mean intraocular pressure and maximum intraocular pressure, there was a statistically positive correlation in the NTG group (r=0.66, 0.48; both P<0.01), but there was no linear correlation; there was no statistical correlation in the control group or the POAG group (all P>0.05). There was no statistically significant association between the ONSAS and age, mean arterial pressure, body mass index, central corneal thickness, visual axis length, and mean visual field loss in any group (all P>0.05). Conclusion: Compared with the POAG group and the control group, the ONSAS is smaller in the NTG group, indicating lower retrobulbar cerebrospinal fluid pressure, and it is positively correlated with the mean intraocular pressure and the highest intraocular pressure. (Chin J Ophthalmol, 2018, 54: 827-832).

[The 8-year follow-up study for clinical diagnostic potentials of frequency-doubling technology perimetry for perimetrically normal eyes of open-angle glaucoma patients with unilateral visual field loss].

Objective: To analyze potentials of frequency-doubling technology perimetry (FDP) for diagnosing open-angle glaucoma (OAG) in perimetrically normal eyes of OAG patients diagnosed with standard automated perimetry (SAP) and relating factors from abnormalities on FDP to visual field loss on SAP. Methods: A prospective cohort study. Sixty-eight eyes of 68 OAG patients visiting the ophthalmic clinic of Peking University Third Hospital during November 2003 and October 2007 [32 primary open-angle glaucoma patients and 36 normal tension glaucoma patients, 32 males and 36 females, with an average age of (59±13) years] with unilateral field loss detected by SAP (Octopus101 tG2 program) were examined with the FDP N-30 threshold program (Humphrey Instruments) at baseline. Two groups, FDP positive group and FDP negative group, were divided based on the FDP results, and visual field examinations were followed by a series of SAP examinations for the perimetrically normal eyes over 8 years. During the follow-up, the difference of the converting rate of SAP tests between the two groups was analyzed. Differences between "convertors" and "non-convertors" of SAP tests in the FDP positive group, such as the cup-to-disk ratio and glaucomatous optic neuropathy rate, were also compared with the independent-sample t test or Wilcoxon two-sample test for continuous variable data and the χ(2) test or Fisher exact test for classified variable data and rates. Results: Forty-eight perimetrically normal eyes of 48 participants had complete data and a qualifying follow-up. Baseline FDP results were positive in 33 eyes and negative in 15 eyes. Of the eyes with positive FDP results, 22 eyes developed abnormal SAP results after 4.0 to 90.0 months (median 14.5 months) , whereas none of the eyes with negative FDP results developed abnormal SAP results. For perimetrically normal eyes in the FDP positive group, "converters" showed a greater cup-to-disk ratio (0.73±0.09 vs. 0.63±0.14, Wilcoxon two-sample test, P=0.011) and more eyes with glaucomatous optic neuropathy (19/22 vs. 4/11, Fisher exact test, P=0.006). Conclusions: In perimetrically normal eyes of OAG patients, FDP could detect visual field loss of these eyes and predict to some extent future visual field loss on SAP. Severity of glaucomatous optic neuropathy at baseline is related to converting from abnormalities on FDP to visual field loss on SAP. (Chin J Ophthalmol, 2018, 54: 177-183).

[Study of optic radiations in patients with primary open-angle glaucoma with diffusion tensor imaging].

Objective: To study the alteration of the optic radiations in patients with primary open-angle glaucoma (POAG) by diffusion tensor imaging (DTI) and tractography, and to reveal the correlation between the DTI derived parameters and the severity of the disease. Methods: A total of 24 patients with POAG and 20 age- and gender-matched healthy controls were enrolled in this study from January 2011 to June 2013.All subjects underwent ophthalmoscopy, standard automatic perimetry, intraocular pressure measurement and MRI scanning.All the eyes of POAG patients were evaluated by Hodapp-Anderson-Parrish (HAP) system.Then the stages of bilateral eyes were added together to evaluate the disease severity.Tractography was used to measure the fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) of the optic radiations of these subjects.The results of the two groups were compared.Partial correlation was then used to reveal the correlation between these derived DTI parameters and the severity of POAG. Results: Compared with health controls, POAG patients showed significant decreased FA (t=-3.299, P=0.002) and AD (t=-2.485, P=0.013), increased RD (t=2.365, P=0.018) in optic radiation .The alteration of MD was not significant (t=0.719, P=0.454). Mean FA values of the optic radiations were negatively correlated with POAG stages (r=-0.643, P= 0.001), while mean RD values (r=0.570, P= 0.004) and mean MD values (r= 0.448, P= 0.028) were positively correlated with POAG stages.No correlation between AD values and severity of POAG was found. Conclusion: In the optic radiations of POAG patients, the FA values and AD values decrease, while RD values increase, indicating the fiber integrity changes.The alterations of FA, RD and MD are correlated with disease severity.

[Study of retinal microvascular perfusion alteration and structural damage at macular region in primary open-angle glaucoma patients].

Objective: To investigate the alteration of retinal microcirculation and structural damage at macular region and evaluate their associations in primary open angle glaucoma (POAG) eyes. Methods: Cross-sectional study. Fifty-nine POAG patients (male/femal=35/24) were recruited from July 2015 to December 2015 in Eye, Ear, Nose and Throat Hospital of Fudan University. Twenty-eight eyes of early-stage POAG group (EG), 11 eyes of moderate-stage POAG group (MG) and 20 eyes of severe-stage POAG group (SG) were enrolled in this study. All patients underwent complete ophthalmological examinations and the general information was collected. The macular perfusion parameters (flow index & vessel area density) and the global/hemimacular retina thickness were derived from the 3D angio-retina and retina map procedures in the single optic coherence tomography (OCT) system with split-spectrum amplitude decorrelation angiography (SSADA) algorithm, respectively. One-way ANOVA analysis was conducted to compare the macular perfusion parameters, retinal thickness and visual field defects among three groups. Pearson partial regression analysis was used to calculate the correlations between different variables. Results: The mean flow index and vessel area density of MG eyes were 0.05±0.01 and 60.8%±7.9%, which were significantly lower than those indexes (0.06±0.01; 71.9%±4.6%) in EG eyes (t=5.11, P=0.001; t=5.05, P<0.01). The full and inner retinal layer thicknesses of MG eyes were (270.3±24.6) µm and (98.4±13.3) µm, which were obviously thinner than those indexes (293.0±12.0 µm, 113.0±7.4 µm) in EG eyes (t=3.60, P<0.01; t=4.06, P<0.01). However, there was no significant alteration of macular perfusion parameters and retinal thickness between MG and SG eyes. Furthermore, there was a significantly positive correlation between macular perfusion (flow index/vessel area density) and the macular retina thickness (full/inner thickness) (R=0.35-0.71, All P<0.01). Conclusions: The microvascular perfusion and retinal thickness in MG eyes were lower than those in EG eyes. There was significant positive association between the retinal microvascular perfusion and structural damage. Furthermore, the association between microvascular perfusion and inner inferior retinal thickness is the strongest. (Chin J Ophthalmol, 2017, 53: 98-103).

Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma.

OBJECTIVE: To investigate the prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. DESIGN: Case series. SETTING: School of Medicine, Düzce University, Turkey. PATIENTS: Twenty-one consecutive primary open-angle glaucoma patients (12 females and 9 males) who attended the out-patient clinic of the Department of Ophthalmology between July 2007 and February 2008 were included in this study. All patients underwent polysomnographic examination. RESULTS: The prevalence of obstructive sleep apnoea syndrome was 33.3% in patients with primary open-angle glaucoma; the severity of the condition was mild in 14.3% and moderate in 19.0% of the subjects. The age (P=0.047) and neck circumference (P=0.024) in patients with obstructive sleep apnoea syndrome were significantly greater than those without the syndrome. Triceps skinfold thickness in glaucomatous obstructive sleep apnoea syndrome patients reached near significance versus those without the syndrome (P=0.078). Snoring was observed in all glaucoma cases with obstructive sleep apnoea syndrome. The intra-ocular pressure of patients with primary open-angle glaucoma with obstructive sleep apnoea syndrome was significantly lower than those without obstructive sleep apnoea syndrome (P=0.006 and P=0.035 for the right and left eyes, respectively). There was no significant difference in the cup/disc ratio and visual acuity, except visual field defect, between primary open-angle glaucoma patients with and without obstructive sleep apnoea syndrome. CONCLUSIONS: Although it does not provide evidence for a cause-effect relationship, high prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma in this study suggests the need to explore the long-term results of coincidence, relationship, and cross-interaction of these two common disorders.

The association between clinical parameters and glaucoma-specific quality of life in Chinese primary open-angle glaucoma patients.

OBJECTIVE. To investigate the association between clinical measurements and glaucoma-specific quality of life in Chinese glaucoma patients. DESIGN. Cross-sectional study. SETTING. An academic hospital in Hong Kong. PATIENTS. A Chinese translation of the Glaucoma Quality of Life-15 questionnaire was completed by 51 consecutive patients with bilateral primary open-angle glaucoma. The binocular means of several clinical measurements were correlated with Glaucoma Quality of Life-15 findings using Pearson's correlation coefficient and linear regression. The measurements were the visual field index and pattern standard deviation from the Humphrey Field Analyzer, Snellen best-corrected visual acuity, presenting intra-ocular pressure, current intra-ocular pressure, average retinal nerve fibre layer thickness via optical coherence tomography, and the number of topical anti-glaucoma medications being used. RESULTS. In these patients, there was a significant correlation and linear relationship between a poorer Glaucoma Quality of Life-15 score and a lower visual field index (r=0.3, r(2)=0.1, P=0.01) and visual acuity (r=0.3, r(2)=0.1, P=0.03). A thinner retinal nerve fibre layer also correlated with a poorer Glaucoma Quality of Life-15 score, but did not attain statistical significance (r=0.3, P=0.07). There were no statistically significant correlations for the other clinical parameters with the Glaucoma Quality of Life-15 scores (all P values being >0.7). The three most problematic activities affecting quality of life were "adjusting to bright lights", "going from a light to a dark room or vice versa", and "seeing at night". CONCLUSION. For Chinese primary open-angle glaucoma patients, binocular visual field index and visual acuity correlated linearly with glaucoma-specific quality of life, and activities involving dark adaptation were the most problematic.

Minimally Invasive Glaucoma Surgery (MIGS) recommendations in Clinical Practice Guidelines for open angle glaucoma and MIGS procedures: A scoping review.

Introduction: To assess the recommendations of open angle glaucoma Clinical Practice Guidelines (CPG) addressing Minimally Invasive Glaucoma Surgery (MIGS) or MIGS procedures CPG. Methods: A scoping review of CPG was conducted, based on an ongoing systematic review (CRD42024510656). A systematic literature search of CPG was carried out in November 2023, with an update in January 2024. CPG published in the last 8 years, full text available and addressing MIGS were selected. CPG details and recommendations concerning MIGS were extracted. Results: 13 CPG addressing MIGS were selected (8 recovered from databases and 5 from registers). Four health Technology Assessments were assessed but recommendations were not considered. Finnish and Swedish guidelines, published in 2024, and Japanese guidelines, published in 2023, are English versions of their native language guidelines, but none of them make specific recommendations about MIGS. The Spanish Glaucoma Society - Advanced Glaucoma guideline (2023) describes the available techniques but does not make recommendations about MIGS. The European Glaucoma Society (2023) guideline only makes recommendations for 4 devices and the National Institute for Health and Care Excellence Interventional procedures guidance makes recommendations both for specific procedures and devices. Conclusion: MIGS is a relevant topic that has not been adequately addressed in terms of updated evidence, available procedures, and recommendations in open angle glaucoma CPG or MIGS procedures CPG.

"Association of APOE gene polymorphisms with primary open angle glaucoma in Brazilian patients".

Background: Primary open-angle glaucoma (POAG) is a multifactorial disease that affects 65.5 million people worldwide. In addition to the genetic variants already established as indicators of greater risk for POAG, the apolipoprotein (APOE) gene has been studied in some populations, with controversial results. The aim of this study is to investigate the frequency of the genetic variants of APOE in the Brazilian population, and to evaluate the association between these polymorphisms and the risk of POAG. Methods: APOE variants (rs429358; rs7412) were genotyped in 402 POAG patients and 401 controls. We evaluated the association between APOE genetic variants and the risk for POAG, as well as the correlation between the requirement of glaucoma surgery and the APOE polymorphisms. Results: Among the three APOE gene isoforms, we found a low frequency of APOE alleles ε2 (7.34%) and ε4 (11.76%), but a high frequency of ε3 (80.88%) in our population. When compared to ε3ε3 reference genotype, ε2 allele-carriers (OR = 1.516; p-value = 0.04) and ε2ε3 genotype (OR = 1.655; p-value = 0.02) were associated with a greater risk for POAG. An additive genetic model confirmed the influence of the ε2 allele in the risk of POAG in this sample of the Brazilian population (OR = 1.502; p-value = 0.04). There was no significant association between the analyzed genotypes and the requirement or number of glaucoma surgeries (p > .05). Conclusion: Brazilian individuals carrying the APOEε2 allele may be at an increased risk for the development of POAG.

Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients.

BACKGROUND: This study sought to investigate the associations between metabolic health status, obesity, and incidence of primary open-angle glaucoma (POAG). METHODS: In this nationwide, population-based, longitudinal prospective cohort study conducted using the Korean National Health Insurance System, we categorized all subjects based on presence and severity of metabolic syndrome and obesity. Insurance claims data were used to identify POAG development. Then, Cox regression was applied to calculate the hazard of developing POAG in people with various components of metabolic syndrome, obesity, or their combination. RESULTS: Of the total 287,553 subjects, 4,970 (1.3%) developed POAG. High fasting glucose, blood pressure, and total cholesterol levels were all associated with increased risk of developing POAG. Regarding obesity level, people with body mass index (BMI) greater than 30 kg/m² were more likely to develop POAG than those with normal BMI. Also, people with greater number of metabolic syndrome components showed a greater POAG incidence. People who are metabolically unhealthy and obese (adjusted hazard ratio [HR], 1.574; 95% confidence interval [CI], 1.449 to 1.711) and those who are metabolically unhealthy nonobese (MUNO: adjusted HR, 1.521; 95% CI, 1.405 to 1.645) but not those who are metabolically healthy obese (MHO: adjusted HR, 1.019; 95% CI, 0.907 to 1.144) had an increased hazard of developing POAG compared with metabolically healthy nonobese (MHNO) subjects. CONCLUSION: Metabolic health status and obesity were significantly associated with increased risk of POAG incidence. MUNO subjects but not MHO subjects showed a higher risk of POAG development than did MHNO subjects, suggesting that metabolic status is more important than obesity in POAG.

Saccadic movements during an exploratory visual search task in patients with glaucomatous visual field loss

ABSTRACT Purpose: To evaluate the saccadic movements of patients with visual field loss due to primary open-angle glaucoma. Methods: Thirteen patients with good visual acuity (0.2 logMAR or better) (seven patients with primary open-angle glaucoma 65 ± 13 years) and six controls (51 ± 6 years) yielded a comprehensive ophthalmological examination, including Humphrey Visual Field tests (SITA-Standard 24-2), and performed a monocular, exploratory digital visual search task that quantifies the duration for finding the number "4" on a random array of digits distributed on the screen. After individual adjustments of the angle and distance positioning, the screen was spatially matched with the 24-2 visual field, and divided into five areas for analysis. During the task, saccades were simultaneously recorded in the same eye with a video-based eye tracker. Results: The patients with primary open-angle glaucoma showed a significantly higher number of saccades/screen (median ± interquartile range, 59.00 ± 29.00 vs. 32.50 ± 19.75 saccades (p=0.027) and visual search time per screen (38.50 ± 60.14 vs. 23.75 ± 8.90 seconds (p=0.035) than the controls did. Although the univariate analysis indicated a significant correlation with visual field mean deviation (coefficient=26.19 (p=0.02), only the visual search time/screen was significantly associated with the number of saccades/screen in the multivariate regression model (coefficient=0.55 (p<0.001). Overall, no significant correlation was observed between the sectorial number of saccades and the sensitivity of the five visual field areas. Conclusions: The patients with primary open-angle glaucoma show impaired search performance and showed a higher number of saccades needed to find stimuli when performing the exploratory visual task.

Resultados iniciais de mundo real do XEN® 45 Gel Stent na população brasileira / Real-world initial results of the XEN® 45 Gel Stent in the Brazilian population

RESUMO Objetivo Avaliar os resultados preliminares em médio prazo (até 6 meses) do uso isolado ou em combinação com a cirurgia de catarata do dispositivo XEN® Gel Stent na população brasileira. Métodos Realizou-se um estudo longitudinal retrospectivo de olhos portadores de glaucoma primário de ângulo aberto consecutivamente submetidos à cirurgia de implante de XEN® Gel Stent isolada (Grupo XEN®) ou em combinação com a cirurgia de catarata (Grupo Faco-XEN®) no mesmo centro entre abril e dezembro de 2023. Analisou-se a capacidade de redução da pressão intraocular e da quantidade de medicamentos hipotensores oculares, além das intercorrências intra e pós-operatórias. O critério de sucesso foi pressão intraocular < 18 mmHg e pelo menos 20% de redução da pressão intraocular pré-operatória (sucesso absoluto: sem medicação; sucesso relativo: com ou sem medicação). Avaliou-se ainda a duração do procedimento cirúrgico ao longo da curva de aprendizado. Resultados Foram incluídos 37 olhos no estudo (15 no Grupo Faco-XEN® e 22 no Grupo XEN®). A pressão intraocular média reduziu de 19,35 mmHg, no pré-operatório, para 13,05 mmHg, ao fim do acompanhamento (p < 0,001). Já a quantidade de medicamentos caiu de 2,95 para 0,22 por olho, no mesmo período (p < 0,001). A maioria dos pacientes (83%) chegou ao fim do acompanhamento livres de colírios. Não houve diferenças entre os dois grupos em relação à capacidade de redução pressórica e dos colírios. A taxa de sucesso absoluto foi de 81,2 e 86,7% nos Grupos XEN® e Faco-XEN®, respectivamente (p = 0,532). Seis olhos apresentaram falência da bolha e necessitaram de reintervenção cirúrgica. Houve uma redução significativa do tempo de cirurgia ao longo do acompanhamento. Conclusão O dispositivo XEN® Gel Stent foi efetivo, tanto em cirurgia isolada quando combinada, em reduzir a pressão intraocular e a quantidade de medicamentos, com elevado perfil de segurança na população brasileira.

ABSTRACT Objective To evaluate the preliminary medium-term results (up to 6 months) of the stand-alone use of XEN® Gel Stent implantation or in combination with cataract surgery in the Brazilian population. Methods A retrospective longitudinal study was carried out on eyes with primary open-angle glaucoma consecutively submitted to XEN® Gel Stent implantation surgery alone (XEN® Group) or in combination with cataract surgery (Phaco-XEN® Group) in the same center between April and December 2023. The ability to reduce intraocular pressure and the amount of ocular hypotensive medications were analyzed, in addition to intra- and postoperative complications. The success criterion was intraocular pressure < 18 mmHg and at least 20% reduction from the preoperative intraocular pressure (absolute success: without medication; relative success: with or without medication). The duration of the surgical procedure was also evaluated throughout the learning curve. Results Thirty-seven eyes were included in the study (15 in the Phaco-XEN® group and 22 in the XEN® group). The mean intraocular pressure was reduced from 19.35 mmHg preoperatively to 13.05 mmHg at the end of the follow-up (p < 0,001). The amount of medication decreased from 2.95 to 0.22 per eye in the same period (p < 0,001). Of the patients, 83% reached the end of follow-up without no need for eye drops. There were no differences between the two groups in terms of intraocular pressure reduction capacity and eye drops. The absolute success rate was 81.2 and 86.7% in the XEN® and Phaco-XEN® Groups, respectively (p = 0.532). Six eyes presented bleb failure and required surgical reintervention. There was a significant reduction in surgery time throughout follow-up. Conclusion The XEN® gel stent implantation was effective, both in stand-alone and in combined surgery, in reducing intraocular pressure and the medication burden, with a high safety profile in the Brazilian population.

[Assessment of quality of life in patients with primary open-angle glaucoma in urban areas]. / Evaluation de la qualite de vie chez les patients atteints de glaucome primitif a angle ouvert en milieu urbain.

INTRODUCTION: Quality of life is defined by the physical, emotional and social well-being of an individual. Primary Open Angle Glaucoma (POAG) is a blinding optic neuropathy, it can change the quality of life by its chronic and irreversible nature. The objective of this study was to evaluate the quality of life in patients with POAG in urban areas. PATIENTS AND METHODS: this was a quantitative cross-sectional study with a descriptive aim over 3 months. Patients followed for POAG at CHU-IOTA with an age ≥ 18 years were included and submitted to the GlauQOL-17 questionnaire for data collection. RESULTS: We collected 100 glaucomatous patients, the mean age of patients was 52 years with a standard deviation of 14.02. The extreme ages are 18 and 81 years old. There was a male predominance; (54%) with a sex ratio (M / F) of 1.7. The good visual acuities were majority (higher or equal to 3/10). Among our patients, 35% were at the stage of glaucoma starting at OD and 30% at the stage of moderate glaucoma at OG. Our patients had a poor quality of life score (score <50%) in the Anxiety and Driving dimensions. In patients younger than 70 years old, we had a poor anxiety score in all progressive stages of the disease. Scores of self-image dimensions, constraints, and management were greater than 60% in patients over 70 years of age. CONCLUSION: Alteration of some of the domains studied was proportional to evolution of POAG. This degradation can have physical, psychological and social impacts on his patients.

INTRODUCTION: La qualité de vie se définit par le bien-être physique, émotionnel et social d'un individu. Le Glaucome Primitif à Angle Ouvert (GPAO) est une neuropathie optique cécitante, il peut modifier la qualité de vie de par son caractère chronique et irréversible. L'objectif de cette étude était d'évaluer la qualité de vie chez les patients atteints de GPAO en milieu urbain. PATIENTS ET MÉTHODES: il s'agissait d'une étude quantitative transversale à visée descriptive sur 3 mois. Les patients suivis pour GPAO au CHU-IOTA avec un âge ≥ 18 ans ont été inclus et soumis au questionnaire GlauQOL-17 pour la collecte des données. RÉSULTATS: Nous avons colligé 100 patients glaucomateux, la moyenne d'âge des patients était de 52 ans avec un écart type de 14,02. Les extrêmes d'âges sont de 18 et 81 ans. Il y avait une prédominance masculine ; (54%) avec un sex-ratio (M/F) de 1.7. Les acuités visuelles bonnes étaient majoritaires (supérieures ou égales à 3/10).Parmi nos patients 35% étaient au stade de glaucome débutant à OD et 30% au stade de glaucome modéré à OG. Nos patients avaient un mauvais score qualité de vie (score < à 50%) dans les dimensions Anxiété et conduite. Chez les patients de moins de 70 ans nous avons noté un mauvais score d'anxiété dans tous les stades évolutifs de la maladie. Les scores des dimensions image de soi, contraintes, et prise en charge étaient supérieurs à 60% chez les patients de plus de 70 ans. CONCLUSION: L'altération de certains domaines étudiés était proportionnelle à l'évolution du GPAO. Cette dégradation peut avoir des impacts physiques, psychologiques et sociaux sur ses patients.

Effect of tobacco smoking on outcomes of trabeculectomy / Efeito do tabagismo nos desfechos da trabeculectomia

ABSTRACT Purpose: To evaluate the effect of tobacco smoking on trabeculectomy outcomes. Methods: Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. Results: A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). Conclusion: Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.

RESUMO Objetivo: Avaliar o efeito do tabagismo nos desfechos da trabeculectomia. Métodos: Uma revisão retrospectiva do gráfico de pacientes com glaucoma submetidos à trabeculectomia foi realizada por um único cirurgião entre 2007 e 2016. Os gráficos foram examinados para uma história documentada de condição de fumante antes da cirurgia. Variáveis pré-operatórias clínicas e demográficas e clínicas foram registradas. Os pacientes foram divididos em dois grupos de acordo com sua história de tabagismo em fumantes e não fumantes. Quaisquer Intervenções relacionadas à bolha, por exemplo, injeções de 5-fluorouracil + lise de sutura com laser, ou revisão da bolha realizada durante o período pós-operatório foram observadas. O sucesso foi definido como pressão intraocular > 5 mmHg e < 21 mm Hg sem (sucesso completo) ou com (sucesso qualificado) medicamentos hipotensores oculares. A falha foi identificada como violação dos critérios mencionados acima. Resultados: O estudo incluiu 98 olhos de 83 pacientes com idade média de 70,7 ± 11,09 anos, sendo 53% (44/83) dos pacientes do sexo feminino. O diagnóstico mais comum foi o glaucoma de ângulo aberto primário com 47 casos (47,9%). O Grupo de fumantes incluiu 30 olhos de 30 pacientes. Os fumantes, quando comparados aos não fumantes, apresentaram uma melhor acuidade visual pré-operatória significativamente pior (p=0,038), maior espessura central da córnea (p=0,047) e maior pressão intraocular pré-operatória (p=0,011). A taxa de sucesso de um ano para a cirurgia de trabeculectomia foi de 56,7% no Grupo de fumantes contra 79,4% no Grupo de não fumantes (p=0,020). O tabagismo apresentou razão de chances para falha de 2,95 95% de IC (1,6-7,84). Conclusão: Os fumantes demonstraram uma taxa de sucesso significativamente menor em um ano após a trabeculectomia em comparação com os não fumantes e uma maior necessidade de intervenções relacionadas à bolha.