ABSTRACT
Purpose: Pseudoexfoliation glaucoma (XFG) is often associated with a higher rate of intraoperative complications and failure. This study aims to compare the long?term clinical and surgical outcomes of cataract surgery alone versus combined surgery in XFG. This was a retrospective comparative case series. Methods: All patients with XFG who underwent either cataract surgery alone [group 1: either phacoemulsification, PHACO/small?incision cataract surgery (SICS), n = 35] or combined surgery (group 2: phacotrabeculectomy, PHACOT or SICS + trabeculectomy, n = 46) from 2013 to 2018 by a single trained surgeon were screened and recalled for a detailed clinical examination, including Humphrey visual field analysis at 3?monthly intervals for a minimum of 3 years. Surgical success (intraocular pressure, IOP, <21 mm Hg and >6 mm Hg with (qualified success) or without medicines, complete success, survival rates, visual field changes, and need for additional procedures/medicines for IOP control were compared between groups. Results: A total of 81 eyes of 68 patients with XFG were included in this study (groups 1–35 eyes and groups 2–46 eyes each). Both groups achieved 27–40% IOP reduction from preoperative IOP levels, P < 0.001. Surgical success rates were similar in both groups (complete success 66% vs 55%, P = 0.4), qualified success 17% vs 24%, P = 0.8, in groups 1 and 2). Kaplan–Meier analysis showed a marginally better survival rate for group 1, 75% (55–87%), than group 2, 66% (50–78%), at 3 and 5 years which was not significantly different. The number of eyes that progressed at 5 years after surgery (5–6%) was similar in both groups. Conclusion: Cataract surgery can be as effective as combined surgery in XFG eyes with regards to final visual acuity, long?term IOP profile, and visual field progression, and complications/survival rates are comparable between the two procedures.
ABSTRACT
AIM: To compare the retinal nerve fiber layer(RNFL)thickness in Uyghur patients with pseudoexfoliation syndrome(PEX)or pseudoexfoliative glaucoma(PEXG)and to provide a theoretical basis for the early diagnosis of PEXG.METHODS: A retrospective case-control study was conducted. A total of 70 cases(70 eyes)of Uyghur PEX patients, 80 cases(80 eyes)of PEXG patients, and 60 cases(60 eyes)of age-related cataract patients who were admitted to our hospital from April 2018 to June 2020 were selected as the PEX group, PEXG group, and CON group, respectively. The PEXG group was further divided into mild-to-moderate stage(56 eyes)and severe stage(24 eyes)based on the stage of visual field defect, and the RNFL thickness at different locations of the optic disc was analyzed.RESULTS: The mean defect(MD)gradually increased in the CON group, PEX group, and PEXG group, and it was significantly higher in PEXG group than that in the PEX group(P<0.01). The RNFL thickness at different locations of the optic disc in the PEX group, mild-to-moderate stage PEXG group, and severe-stage PEXG group was thinner than that in the CON group(all P<0.01). The mean RNFL thickness, as well as the RNFL thickness below and above the optic disc, were lower in the PEX group than in the CON group(all P<0.01). The RNFL thickness at all locations of the optic disc in the severe-stage PEXG group was significantly lower than that in the mild-to-moderate stage PEXG group(all P<0.01).CONCLUSION: The RNFL thickness in Uyghur patients with PEX begins to be thinner than those without pseudoexfoliation syndrome, and early detection of RNFL thickness in PEX patients is helpful for the diagnosis and early treatment of PEXG.
ABSTRACT
Purpose: Angle?based surgeries for the treatment of open?angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open?angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN). Methods: In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early?to?moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan–Meier graph was used to demonstrate the survival status of the eyes. Results: Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post?operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%). Conclusion: Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS)
ABSTRACT
Purpose: The purpose of this study was to genotype two previously identified SNPs (rs1048661:R141L, and rs3825942:G153D) in the lysyl oxidase?like 1 (LOXL1) gene and determine their association with pseudoexfoliation glaucoma (XFG) in patients from Pune, India. Methods: All subjects underwent detailed phenotyping, and DNA extraction was performed on blood samples by using standardized techniques. Exon 1 of the LOXL1 gene containing the SNPs (rs3825942:G153D; rs1048661:R141L) were Sanger sequenced, and the results were analyzed using sequence analysis software SeqScape 2.1.1. Results: Data were analyzed from 71 patients with XFG and 81 disease?negative, age?matched controls. There was a strong association between the G allele of rs3825942 and XFG with an odds ratio of 10.2 (CI: 3.92–26.6; P < 0.001). The G allele of rs1048661 also showed an increase in risk relative to the T allele (OR = 1.49; CI: 0.88–2.51; P = 0.13), but this was not significant. Haplotype combination frequencies were estimated for rs1048661 and rs3825942; the GG haplotype was associated with a significant increase in risk (OR = 3.91; CI: 2.27–6.73; P < 0.001). Both the GA and TG haplotypes were associated with decreased XFG risk, although the latter was not significant (GA: OR = 0.08; CI: 0.03–0.21; P < 0.001; TG: OR = 0.67; CI: 0.40–1.13; P = 0.13). Conclusion: The risk G allele in rs3852942 (G153D) is strongly associated with the development of XFG in the Western Indian population. Genetic screening strategies to identify LOXL1 risk alleles in the population can assist in case definition and early diagnosis, targeting precious resources to high?risk patients.
ABSTRACT
Objective:To explore the differences of anterior segment parameters in Uyghur patients with pseudoexfoliation syndrome (PEX), pseudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG) and age-related cataracts in Xinjiang.Methods:A retrospective study was conducted, Uyghur patients included 114 eyes of 84 cases with PEX, 96 eyes of 70 cases with PEXG, 88 eyes of 72 cases with POAG and 80 eyes of 80 cases with age-related cataracts (control, CON) who had received treatment in Ophthalmology Center of Xinjiang Military Region General Hospital of Chinese People's Liberation Army from April 2019 to July 2020 were selected to obtained central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL) and corneal curvature (horizontal curvature K1 and vertical curvature K2).Results:There was no significant difference in gender ratio and age of patients between CON, PEX, PEXG and POAG groups ( P > 0.05). The CCT of patients in CON, PEX, PEXG and POAG groups were (545.52 ± 34.22), (536.81 ± 42.64), (516.74 ± 32.39) and (530.38 ± 28.72) μm, respectively, the CCT in CON, PEX and POAG groups were all higher than those in PEXG group ( P < 0.05), and the CCT in PEXG group became thinner. The ACD of patients in CON, PEX, PEXG and POAG groups were (3.05 ± 0.38), (2.87 ± 0.36), (2.77 ± 0.41), (2.81 ± 0.32) mm, respectively, compared with CON group, the ACD in PEX, PEXG and POAG groups were all lower ( P < 0.05). There was no significant difference in LT, AL, K1 and K2 of patients between each group ( P > 0.05). Conclusion:This study has showed that the ACD of Uyghur patients with PEX in Xinjiang is shallower than that of CON group, but the CCT of PEXG patients is thinner than that of PEX patients.
ABSTRACT
@#AIM: To compare effects of combined glaucoma-cataract surgery on pseudoexfoliation glaucoma(PXG)and primary open angle glaucoma(POAG).<p>METHODS: This was a retrospective case-control study conducted the hospitalized patients at department of glaucoma from January 2015 to January 2018. The PXG group included 40 eyes of 38 cases, with 46 eyes of 36 cases on POAG group, which were matched for baseline data. Visual acuity, intraocular pressure(IOP), number of anti-glaucoma medications used and occurrence of complications were observed in both groups after trabeculectomy + phacoemulsification + IOL implantation. Surgical success was defined according to the following 2 criteria: criterion A: IOP≤21mmHg, criterion B: IOP≤18mmHg. Complete success, and qualified success is defined as patients met these criteria with medical treatment(≤3 medications). <p>RESULTS: The visual acuity was improved, with IOP and the number of anti-glaucoma medications used both reduced in both group after surgery. There was no statistically significant difference in complete and qualified success rates between the two groups at 1 and 3mo after surgery(<i>P</i>>0.05). Postoperative 6mo, 1 and 2a, for criterion A: the qualified success rates in PXG group(90%, 80%, 74%)were slightly lower than that of POAG group(91%, 86%, 82%, <i>P</i>>0.05). The complete success rates in PXG group(50%, 40%, 29%)were significantly lower than that of POAG group(85%, 64%, 61%, <i>P</i><0.05). For criterion B: the qualified success rates in PXG group(70%, 70%, 59%)were slightly lower than that of POAG group(80%, 80%, 75%, <i>P</i>>0.05). The complete success rates in PXG group(45%, 30%, 18%)were significantly lower than that of POAG group(78%, 61%, 54%, <i>P</i><0.05).<p>CONCLUSION: The combined glaucoma-cataract surgery in PXG and POAG patients can significantly improve visual acuity and reduce intraocular pressure. The short-term success rates of both types of glaucoma were similar, however the long-term success rates of PXG patients was significantly lower, and it was difficult to achieve a low level IOP.
ABSTRACT
Objective To compare and analyze differences in macular thickness and to discuss the correlation between macular thickness and visual field mean defect (MD) in early and moderate,late pseudoexfoliation glaucoma (PXG) patients and normal control subjects.Methods A series of cases-observation study was adopted.Thirty-three early and moderate PXG patients (33 eyes) and 24 late PXG patients (24 eyes) were collected in the First Hospital of Shijiazhuang from May 2013 to May 2018.Meanwhile,34 age,gender and diopermatched healthy subjects (34 eyes) were included as normal control group.Spectral domain optical coherence tomography (SD-OCT) was used to measure macular thickness and volume in every quadrant.The correlation between the macular thickness and visual field MD were analyzed.This study followed the Helsinki declaration and was approved by the ethics committee of the First Hospital of Shijiazhuang.Written informed consent was obtained from each subject prior to any medical examination.Results The average macular thickness in normal control group,early and moderate PXG group and late PXG group were (305 ± 15),(297 ± 15) and (287 ± 17) μm,respectively;the average macular volume were (0.94 ± 0.05),(0.91 ± 0.05) and (0.89 ± 0.05) μm3,respectively.The macular thickness and volume differences between the 3 groups were statistically significant in nasal inner macula,superior inner macula,temporal inner macula,inferior inner macula,superior outer macula,temporal outer macula,inferior outer macula quadrants (Fthickness =4.226,9.335,12.133,10.115,11.298,8.243,12.142;all at P＜0.05.Fvolume =3.812,9.152,12.774,8.889,11.284,7.937,11.652;all at P＜0.05).The macular thickness of early and moderate PXG group in superior inner macula,temporal inner macula,inferior inner macula,superior outer macula and temporal outer macula quadrants were statistically thinner than those in the normal control group (all at P＜0.05);the macular thickness of late PXG group in inferior inner macula,temporal inner macula,superior outer macula and inferior outer macula quadrants were statistically thinner than those in the early and moderate PXG group (all at P＜0.05);the macular thickness of late PXG group in inner and outer rings were statistically thinner than those in the normal control group (all at P＜0.05).The macular thickness was not correlated with visual field MD in normal control group and the early and moderate PXG group in every quadrants (all at P＞0.05),but it was positively correlated with visual field MD in the late PXG group in nasal inner macula,superior outer macula and temporal inner macula quadrants (r =0.527,0.544,0.417;all at P＜0.05).Conclusions SD-0CT can quantify the macular thickness,and can be used an important reference index for the staging and follow-up of PXG combined with perimetry.
ABSTRACT
PURPOSE: To compare the levels of serum homocysteine, vitamin B12, vitamin B6 and folate in patients with normal-tension glaucoma, pseudoexfoliation glaucoma and high-tension glaucoma. METHODS: Thirty-two healthy subjects, 35 patients with normal-tension glaucoma, 22 patients with pseudoexfoliation glaucoma and 31 patients with high-tension glaucoma were included in the present study. Fasting venous samples were collected from all the participants. The levels of serum homocysteine, vitamin B12, vitamin B6 and folate were measured. One-way analysis of variance was used for the comparison of homocysteine, vitamin B12, vitamin B6 and folate levels among the 4 groups. RESULTS: The mean homocysteine levels in the pseudoexfoliation glaucoma and high-tension glaucoma group were 17.91 +/- 5.11 and 17.60 +/- 3.89 micromol/l, respectively, which were significantly higher than that of the control group (p = 0.014, p = 0.013, respectively). The mean vitamin B6 levels in the pseudoexfoliation glaucoma and high-tension glaucoma group were 17.67 +/- 14.32 and 17.00 +/- 10.58 nmol/l, respectively, which were significantly lower than that of the control group (p = 0.026, p = 0.008, respectively). CONCLUSIONS: Hyperhomocysteinemia may play a role as a risk factor in the development or progression of pseudoexfoliation glaucoma and high-tension glaucoma.
Subject(s)
Humans , Fasting , Folic Acid , Glaucoma , Homocysteine , Hyperhomocysteinemia , Risk Factors , Vitamin B 12 , Vitamin B 6ABSTRACT
A prospective study undertaken to study the profile the various sub types of glaucoma in the Kashmir Valley to document the prevlance and clinical manifestations of the various type of glaucomas was conducted in the glaucoma clinic of the Post Graduate Department of Ophthalmology, Govt. Medical College ,Srinagar, Kashmir. 200 patients (400 eyes) were included. All patients underwent a comprehensive and exhaustive Glaucoma work up to diagnose classify and treatment modalities were suggested. Pseudoexfoliation glaucoma was the largest group of glaucoma patients in the study (40.25%). 29% had POAG.;7.25% had angle closure glaucoma. This is in contrast to most studies in India where this group forms the largest group of all Glaucomas. Male female ratio was 7:3. Females were more affected by angle closure glaucoma. 60% patients had various degrees of glaucomatous optic atrophy on presentation.Early detection, proper training of medical professionals to do a basic IOP examination and fundus examination, awareness about glaucoma is need of hour.