Clinical and epidemiological study in patients with primary open-angle glaucoma / Estudo clínico-epidemiológico em indivíduos com glaucoma primário de ângulo aberto

Abstract Objective: To evaluate the clinical and epidemiological profile of patients with primary open-angle glaucoma. Methods: This is a quantitative study with cross-sectional and analytical design, which sample consisted of 425 patients treated in an unit of Specialized Care in Ophthalmology, located in the northern state of Minas Gerais, from 2004 to 2015. We collected the data using formularies that addressed demographic and clinical aspects, risk factors and the presence of undercurrent diseases. We conducted an ophthalmological examination to evaluate anatomical and functional changes. We used statistical analysis, and the results are presented by mean, standard deviation and percentiles 25, 50 and 75. Results: Females predominate (56.8%), the age group of 60 years or older (44%) and mixed skin (81.7%). A minority of participants present risk factors such as high myopia (6.3%) and diabetes mellitus (17.9%). Regarding the clinical examination, there is a prevalence of increased optic nerve excavation (≥ 0.8) and low thickness of the corneas (≤ 535 microns). Conclusion: Most people develop advanced glaucoma, with increased optic nerve excavation and changed visual fields. Other common risk factors are: family history of glaucoma, decreased thickness of the cornea and hypertension. Early diagnosis and treatment can prevent vision loss. Primary care physicians should consider referring patients who have glaucoma risk factors, for an ophthalmologic examination.

Resumo Objetivo: Avaliar o perfil clínico-epidemiológico dos indivíduos com glaucoma primário de ângulo aberto. Métodos: Trata-se de estudo quantitativo com desenho transversal e analítico, mediante amostra constituída de 425 pacientes atendidos em uma Unidade de Atenção Especializada em Oftalmologia localizada no norte do estado de Minas Gerais, Brasil, cadastrados no período de 2004 a 2015. As variáveis analisadas foram: características demográficas e clínicas, fatores de risco e presença de doenças associadas. Foi realizado exame oftalmológico para avaliar alterações anatômicas e funcionais. Para as análises estatísticas foram utilizados os programas Statistical Package for the Social Sciences (SPSS), versão 19.0. Considerou-se nível de significância p<0,05 para as variáveis categóricas. As variáveis descritivas foram apresentadas pela média, desvio-padrão e percentis 25, 50 e 75. Resultados: Predominou o gênero feminino (56,8%), a faixa etária de 60 anos ou mais (44%), e a cor da pele parda (81,7%). Fatores de risco como alta miopia (6,3%) e diabetes mellitus (17,9%) foram relatados pela minoria dos participantes. Em relação ao exame clínico, houve prevalência de escavação do nervo óptico aumentada (≥ 0,8 mm2) e baixa espessura central das córneas (≤ 535 micras). Conclusão: A maioria dos indivíduos apresenta glaucoma avançado, com escavações do nervo óptico aumentadas e campos visuais alterados. Outros fatores de risco frequentes foram: história familiar positiva para glaucoma, espessura central da córnea diminuída e hipertensão arterial sistêmica. Diagnóstico e tratamento precoces podem prevenir contra a perda de visão no glaucoma. Médicos da atenção primária à saúde devem encaminhar os pacientes que tenham fatores de risco para glaucoma, para a consulta especializada e exames oftalmológicos.

Advances in genetic study of primary open angle glaucoma / 中华实验眼科杂志

Primary open angle glaucoma (POAG) is a complex and heterogeneous neurodegenerative disease caused by genetic and environmental factors,and it is also one of the leading causes of irreversible blindness worldwide.Recent molecular genetic studies revealed that numbers of susceptible gene variants are associated with POAG,and the researching technology includes genome wide association study and whole exon sequence.Studies of POAG families discovered 16 loci linked to the disease.To date,three genes were reported to be the causative genes of POAG,they are these studies MYOC,OPTN and WDR36.Other causative or presumably causative genes are thought to contribute to POAG,such as NTF4 and TBK1.Genetic factor for the path ogenesis POAG is being widely concerned,and provides a solid foundation for genetic research and gene therapy of this disease.In this paper,we reviewed a comprehensive discussion of the genetics and research strategies of POAG.

Therapeutic effects of induced pluripotent stem cells on primary open angle glaucoma / 中华实验眼科杂志

Glaucoma is an group of ocular disease associated with the degeneration of retinal ganglion cells and it finally causes vision loss.Primary open angle glaucoma (POAG) is a main type of glaucoma worldwide.The primary reason of POAG is elevated intraocular pressure (lOP) caused by the degeneration or dysfunction of the trabecular meshwork (TM).Recent studies showed that stem cell-based therapy becomes a promising approach to treat the degenerative diseases,including POAG.Among multiple types of stem cells,induced pluripotent stem cell (iPSC) is the one with the most clinical potential due to its autologous derivation and non-ethical issue.In this paper,we summarized the encouraging therapeutic effects of iPSCs on POAG from different species,different etiological factors and different pathological stages.Although these encouraging studies suggest that iPSC is a fabulous stem cell type to regenerate the damaged tissue,more efforts are required for clinical application.In addition,we discussed several solutions to improve the safety of iPSCs and provided potential approaches to improve the therapeutic efficiency and specific targeting.Answering these questions will help us to better understand the characteristics of iPSCs and promote the development of bench to bedside research.

A pilot study of the relationship between retinal structural and functional damage in primary open-angle glaucoma / 中华实验眼科杂志

Background Application of available technology and objective indexes are very important for the early diagnosis,monitoring and therapeutic evaluation of primary open angle glaucoma (POAG).Many studies have determined retinal damage in structure and function in POAG.However,the study on the association of structural damage and functional abnormality in early POAG is still lack.Objective This study was to evaluate the relationship between structural and functional changes of retina in early stage of POAG.Methods A prospectively pilot study was performed under the approval of Ethic Committee of Shenzhen Eye Hospital from January 2011 to June 2013.Based on Helsinki Declaration,written informed consent was obtained from subject prior to entering the cohort.Ninety-five eyes of 95 POAG patients were included as the study group,and 41 eyes of 41 non-glaucoma subjects were enrolled at the same period as controls.The structural parameters of retinas were measured using RTVue-100 OCT and Cirrus HD-OCT respectively,including macular ganglion cell complex (GCC)-Avg thickness and peripapillary retinal neural fibril layer (RNFL)-Avg thickness;and the functional parameters of retinas were obtained by Humphrey visual filed analyzer and RETI scan 3.15 system respectively,including MD of visual field and PhNR of flash electroretinogram (F-ERG).The associations between the GCC or RNFL thickness and M D or amplitude of PhNR were evaluated by linear and curvilinear regression models.Results The MD,GCC-Avg,RNFL-Avg and PhNR amplitude were (-0.68±1.72)dB,(97.17± 4.82)μm,(102.51±8.74) μm and (49.61±11.01)μV respectively in the control subjects,and those in the POAG patients were (-10.82±9.87) dB,(75.07±12.29) μm,(69.09±12.96) μm and (28.38± 11.52) μV,showing significant differences between them (t =6.549,11.118,-15.061,9.956,all at P=0.001).The curvilinear regression model appeared to better describe the relationship between GCC thickness and MD (R2 =0.595,F=97.089,P＜0.001) ;while a linear regression model seemed to be better fit for the relationship between GCC thickness and amplitude of PhNR (R2=0.437,F=103.413,P＜0.001).RNFL thickness analysis showed the similar regression models with MD and amplitude of PhNR as GCC thickness,but R2 values were higher between the RNFL thickness and MD (R2 =0.606,F =101.666,P＜0.001) or amplitude of PhNR (R2 =0.454,F=54.983,P＜0.001).Conclusions Both GCC thickness and RNFL thickness show a curvilinear relationship with MD and a linear relationship with amplitude of PhNR.Goodness-of-fit of RNFL thickness is superior to GCC thickness.

Multicenter clinical study of safety and efficacy of selective laser trabeculoplasty for Chinese primary open angle glaucoma / 中华实验眼科杂志

Background Selective laser trabeculoplasty (SLT) is a safe and effective therapy to the treatment of primary open angle glaucoma (POAG),and the clinical application is approved by American FDA.However,the relevant researching outcomes from several single-center study are in dispute owing to non-uniform approach in China.A muhicenter clinical trial is need to verify the effectiveness of SLT for Chinese POAG.Objective This study was to investigate the safety and efficacy of SLT in Chinese POAG patients.Methods A prospective,multicenter and self-controlled clinical trail was designed.Sixty-two eyes of 62 POAG patients with the age of ≥ 18 years were enrolled.Frequency SLT was performed around 360° angle using Lumenis Selecta DuetTM or Lumenis Selecta Ⅱ laser instrument,with the 100 non-overlapping spots,3 ns preset time,400 μm size of laser spot and 0.6 mJ energy.The operated eyes were followed-up for 6 months.The curative effects were checked including intraocular pressure (IOP),IOP-lowing value,number and percentage of IOP-lowing 20％ and 30％.The therapyrelated complications were recorded including the number of conjunctival congestion and cloudy of the anterior chamber.Results The preoperative IOP was (25.7±2.6) mmHg in the 62 eyes.The IOP was significantly lowed 1 day,2 weeks,4 weeks,3 months and 6 months after SLT in comparison with preoperative IOP (all at P＜0.001) with the lowest value of (16.5±4.5)mmHg in postoperative day 1.IOP was stable from 4 weeks to 6 months after operation.The mean lowing-value of IOP was 5.3-9.2 mmHg from 1 day through 6 months after SLT.The percentage of eyes 20％ drop in lOP was 83.9％,and that of 30％ drop was 58.1％ in postoperative day 1.In 6 months after SLT,percentages of eyes 20％ and 30％ drop in IOP were 56.5％ and 27.4％,respectively.Conclusions SLT is a safe and effective method of lowing IOP for POAG eyes in Chinese population.