Impact of peripheral anterior synechiae on the outcome of combined phacoemulsification, goniosynechialysis and goniotomy for primary angle-closure glaucoma and cataract: a multicenter observational study.

PURPOSE: To evaluate the impact of the extent of peripheral anterior synechiae (PAS) on the effectiveness and safety of combined phacoemulsification (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes with primary angle-closure glaucoma (PACG) and cataract. PATIENTS AND METHODS: This study included patients diagnosed with PACG and cataract who underwent combined PEI and 120 degrees GSL plus GT (PEI+GSL+GT) between April 2020 and October 2022 at 10 ophthalmic institutes. Eligible patients were divided into three groups based on the extent of PAS: 180°≤PAS<270°, 270°≤PAS<360°, and PAS=360°. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. The study defined complete success as postoperative IOP within the 6-18 mmHg range and a 20% reduction from baseline without the use of topical medications. Qualified success was defined in the same way as complete success, but it allowed for the use of ocular hypotensive medications. RESULTS: Three hundred and four eyes of 283 patients were included. The mean follow-up was 12.50±1.24 months. All groups experienced a significant reduction in IOP after the surgery (P <0.05). There were no significant differences in final IOP, number of medications, and cumulative complete and qualified success rates among the three groups (P >0.05). The groups with 270°≤PAS<360°had a higher frequency of hyphema compared to 180°≤PAS<270° (P = 0.044). CONCLUSIONS: PEI+GSL+GT has proven to be an effective treatment for PACG with cataract over one year period. However, the outcome was not correlated with preoperative extent of PAS. PRCIS: The combination of phacoemulsification, goniosynechialysis and goniotomy is an effective treatment for primary angle-closure glaucoma patients with cataract, and this is not linked to the extent of preoperative peripheral anterior synechiae.

Phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma with cataract: A randomized non-inferiority trial.

PURPOSE: To investigate the effectiveness and safety of phacogoniotomy versus phacotrabeculectomy (PVP) among patients with advanced primary angle-closure glaucoma (PACG) and cataracts. DESIGN: Multicenter, randomized controlled, non-inferiority trial. METHODS: A total of 124 patients (124 eyes) with advanced PACG and cataracts were enrolled, with 65 in the phacogoniotomy group and 59 in the phacotrabeculectomy group. Patients were followed up for 12 months with standardized evaluations. The primary outcome was the reduction in intraocular pressure (IOP) from baseline to 12 months postoperatively, of which a non-inferiority margin of 4 mmHg was evaluated. Secondary outcomes included the cumulative surgical success rate, postoperative complications, and changes in the number of glaucoma medications. RESULTS: After 12 months, phacogoniotomy demonstrated non-inferiority to phacotrabeculectomy in terms of IOP reduction, with mean IOP reductions of - 26.1 mmHg and - 25.7 mmHg (P = 0.383), respectively, from baseline values of around 40 mmHg. Both groups experienced a significant reduction in the mean number of medications used postoperatively (P < 0.001). The cumulative success rate was comparable between the groups (P = 0.890). However, phacogoniotomy had a lower rate of postoperative complications and interventions (12.3% and 4.6%) compared to phacotrabeculectomy (23.7% and 20.3% respectively). The phacogoniotomy group reported shorter surgery time (22.1 ± 6.5 vs. 38.8 ± 11.1 min; P = 0.030) and higher quality of life (EQ-5D-5 L) improvement at 12 months (7.0 ± 11.5 vs. 3.0 ± 12.9, P = 0.010) than the phacotrabeculectomy group. CONCLUSIONS: Phacogoniotomy was non-inferior to phacotrabeculectomy in terms of IOP reduction for advanced PACG and cataracts. Additionally, phacogoniotomy provided a shorter surgical time, lower postoperative complication rate, fewer postoperative interventions, and better postoperative quality of life.

One-Year Results of a Multicenter Study: Intraocular Pressure-Lowering Effect of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Cases of Advanced Primary Angle-Closure Glaucoma With Cataract.

PURPOSE: To evaluate the intraocular pressure (IOP)-lowering effect of the combination of phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL), and goniotomy (GT) in eyes of advanced primary angle-closure glaucoma (PACG) with cataract. DESIGN: Multicenter observational study. METHODS: We enrolled 83 eyes of 83 patients with advanced PACG who received combined PEI+GSL+GT at 8 ophthalmic institutes. Each patient was assessed before treatment and at 1, 7 days, 1, 3, 6, and 12 months postsurgery. The criteria for complete success were IOP within 6 to 18 mm Hg and at least 20% of reduction in IOP from baseline without ocular hypotensive medications or reoperation. The definition of qualified success was similar to that of complete success, except for the need for ocular hypotensive medications. The potential prognostic factors for surgical success were investigated using a multivariate logistic model. RESULTS: All participants completed 1 year of follow-up. Complete and qualified success were achieved in 74 (89.1%) and 79 (95.2%) of 83 eyes, respectively. The mean preoperative and postsurgical IOPs were 27.4±7.3 and 14.2±2.6 mm Hg, respectively. Participants used an average of 2.0 and 0.3 types of ocular hypotensive medications before and after surgery, respectively. The chief complications included hyphema (n=9), IOP spike (n=9), and corneal edema (n=8). None of the eyes required reoperation or developed vision-threatening complications. Multivariate analysis showed that older age was associated with a higher probability of complete success (odds ratio=1.13; 95% CI: 1.02-1.25; P=0.020). CONCLUSIONS: The 1-year results of combination of PEI+GSL+GT in treating advanced PACG cases with cataract appear to be safe and effective. Further large-scale multination and multicenter studies are warranted.

Efficacy and safety of trabeculectomy versus peripheral iridectomy plus goniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre, non-inferiority, randomised controlled trial (the TVG study).

INTRODUCTION: Primary angle-closure glaucoma (PACG) is a major subtype of glaucoma that accounts for most bilateral glaucoma-related blindness globally. Filtering surgery is a conventional strategy for PACG, yet it has a long learning curve and undesirable disastrous complications. Minimally invasive glaucoma surgery (MIGS) plays an increasing role in the management of glaucoma due to its safer and faster recovery profile; cataract surgery-based MIGS is the most commonly performed such procedure in PACG. However, for patients with a transparent lens or no indications for cataract extraction, incorporation of MIGS into PACG treatment has not yet been reported. Therefore, this multicentre, non-inferiority, randomised controlled clinical trial aims to compare the efficacy and safety of trabeculectomy versus peripheral iridectomy plus an ab interno goniotomy in advanced PACG with no or mild cataracts. METHODS AND ANALYSIS: This non-inferiority, multicentre, randomised controlled trial will be conducted at seven ophthalmic departments and institutes across China. Eighty-eight patients with no or mild cataracts and advanced PACG will be enrolled and randomised to undergo trabeculectomy or peripheral iridectomy plus ab interno goniotomy. Enrolled patients will undergo comprehensive ophthalmic examinations before and after surgery. The primary outcome is intraocular pressure (IOP) at 12 months postoperatively. The secondary outcomes are cumulative success rate of surgery, surgery-related complications and number of IOP-lowering medications. Participants will be followed up for 36 months postoperatively. ETHICS AND DISSEMINATION: The study protocol was approved by the ethical committees of the Zhongshan Ophthalmic Center, Sun Yat-sen University, China (ID: 2021KYPJ191) and of all subcentres. All participants will be required to provide written informed consent. The results will be published in peer-reviewed journals and disseminated in international academic meetings. TRIAL REGISTRATION NUMBER: NCT05163951.

Efficacy and safety of phacotrabeculectomy versus phacogoniotomy in advanced primary angle-closure glaucoma: study protocol for a multicentre non-inferiority randomised controlled trial (PVP Study).

INTRODUCTION: Primary angle-closure glaucoma (PACG) has a high prevalence and blinding rate across Asia. The first-line treatment of PACG is surgery, and phacotrabeculectomy remains the mainstream surgery for advanced PACG. However, it may cause vision-threatening complications with long learning curve. Minimally invasive glaucoma surgery has been gradually used in PACG combined with cataract surgery and achieved efficacy without excessive injury, of which goniotomy is the most commonly performed. Therefore, this study aimed to conduct a multicentre, non-inferiority randomised controlled clinical trial to compare the efficacy and safety of phacotrabeculectomy versus phacogoniotomy in advanced PACG. METHODS AND ANALYSIS: This is a non-inferiority multicentre randomised controlled trial and will be conducted at eight ophthalmic departments and institutes in China. 124 patients with advanced PACG will be enrolled and randomised to undergo phacotrabeculectomy or phacogoniotomy. Comprehensive ophthalmic examinations will be performed before and after the surgery. The primary outcome is the change of intraocular pressure at 12 months after surgery compared with the baseline intraocular pressure. An extended follow-up period of 36 months will be required. Cumulative success rate of surgery, intraoperative and postoperative complications, and number of anti-glaucomatous medications will also be compared between the groups as secondary outcomes. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the ethical committee of Zhongshan Ophthalmic Center, Sun Yat-sen University, China (ID: 2021KYPJ090) and all subcentres. All the participants will be required to provide written informed consent. The results will be disseminated through scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04878458.

Prevalence and risk factor for refractive error in rural Chinese adults in Kailu, Inner Mongolia.

PURPOSE: To investigate the prevalence of refractive error in adults 40 years of age and older in Kailu, Inner Mongolia. METHODS: A population-based, cross-sectional study was conducted in Chinese adults. Spherical equivalent (S.E.) refractive error was determined from the right eye. Myopia and hyperopia were defined as a spherical equivalent (S.E.) < -0.5 dioptres (D) and >0.5 D, respectively. Since the prevalence of high myopia will vary with the precise criterion chosen, the prevalence of this condition was calculated for thresholds of both <-5.0 D and <6.0 D. Astigmatism was defined as cylinder power >0.5 D. Anisometropia was defined as a difference in S.E. between the two eyes >1.0 D. RESULTS: The prevalence of myopia, high myopia (<-5.0 D/<-6.0 D) and hyperopia in Kailu adults was 60.3% (95%CI: 58.95-61.71), 5.5% (95%CI: 4.82-6.10) /4.0% (95%CI: 3.47-4.57) and 12.2% (95%CI: 11.26-13.11), respectively. The age- and gender-standardised prevalence of myopia, high myopia (-5.0 D/-6.0 D) and hyperopia were 62.5% (95%CI: 61.05-63.99), 5.0% (95%CI: 4.34-5.61) /3.5% (95%CI: 2.99-4.04) and 10.6% (95%CI: 9.71-11.49), respectively. 52.9% had refractive astigmatism >0.5 D and 18.8% of subjects had clinically significant anisometropia. Age was significantly associated with hyperopia, high myopia, astigmatism and anisometropia. Myopia was more prevalent in females. Individuals with a higher educational level had a greater and lesser likelihood of myopia and astigmatism, respectively. CONCLUSIONS: Myopia affects around two-thirds of the rural Chinese population over 40 years of age in Kailu. This high prevalence highlights that rural populations should be included in epidemiological studies of refractive error. Further investigations are needed to clarify the role of environmental factors in myopia development.

Distance- and near-visual impairment in rural Chinese adults in Kailu, Inner Mongolia.

PURPOSE: To investigate the prevalence and causes of distance-visual impairment and near-vision impairment in a rural Chinese population in Inner Mongolia. METHODS: A population-based, cross-sectional study design was used to identify visual impairment in the Chinese aged 40 years and older living in Kailu County, Inner Mongolia. Low vision, blindness and near-visual impairment (NVI) were defined according to World Health Organization (WHO) criteria. RESULTS: The overall prevalence of blindness and visual impairment based on the presenting visual acuity (VA) was 2.2% (95% CI: 1.8-2.6) and 9.8% (95% CI: 8.9-10.6), respectively, and was adjusted to 0.9% (95% CI: 0.6-1.2) and 4.7% (95% CI: 4.1-5.3) using best-corrected visual acuity (BCVA), respectively. Taking the presenting VA into consideration, the leading cause of visual impairment and blindness was cataract (40.3%, 40.9%), followed by uncorrected refractive error (26.6%, 28.2%). According to the BCVA, the main cause of visual impairment and blindness was cataract (48.3%, 41.3%) followed by glaucoma (19.0%, 23.9%). Among the examined subjects, 80.3% had NVI, and 51.7% had presbyopia. Major barriers reported by NVI persons without near correction were lack of money to purchase prescription glasses and poor quality of the available ones (43.2%). CONCLUSION: Visual impairment is a serious public health problem, and the main causes leading to visual impairment are treatable and preventable in the rural Chinese population in Inner Mongolia. Presbyopia, together with the low rate of spectacles and lack of appropriate refractive and presbyopia spectacles, is highly prevalent in rural China.

Pregnenolone sulfate decreases intraocular pressure and changes expression of sigma receptor in a model of chronic ocular hypertension.

Sigma receptors are Ca(2+)-sensitive, ligand-operated receptor chaperones at the mitochondrion-associated endoplasmic reticulum membrane. This study describes the effect of the sigma receptor 1 agonist pregnenolone sulfate on intraocular pressure (IOP) and sigma receptor 1 expression in rat retinas after chronic ocular hypertension. Chronic ocular hypertension was induced by occlusion of episcleral veins. Retinal histological sections were obtained to determine inner plexiform layer thickness and the number of cell bodies in the ganglion cell layer. Sigma receptor expression in rat retinas was analyzed by RT-PCR and Western blotting. Cauterization caused IOP to increase >73%, and the pressure was maintained for 2 months. A time-dependent loss of ganglion cells and retinal thickness occurred at elevated IOP. High IOP decreased sigma receptor 1 expression during the first week, but expression was increased at 8 weeks. Injected pregnenolone significantly decreased IOP, prevented ganglion cell loss, protected inner plexiform layer thickness, and increased sigma receptor 1 expression in episcleral vein-cauterized rats. Sigma receptors appear to be neuroprotective and potential targets for glaucoma therapeutics.

Prevalence and risk factors for angle-closure disease in a rural Northeast China population: a population-based survey in Bin County, Harbin.

PURPOSE: To estimate the prevalence of primary angle-closure glaucoma (PACG), primary angle closure (PAC) and primary angle-closure suspect (PACS) and associated risk factors for PACG in a rural population in Northeast China. METHODS: A population-based survey was conducted in Bin County, Harbin, Northeast China. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. All subjects underwent a complete ophthalmic examination. RESULTS: A total of 4956 (86.01%) of 5762 subjects aged 40 years or older were examined. The mean intraocular pressure (IOP) of the right eyes was 14.0 mmHg. The mean vertical cup-to-disc ratio of the right and the left eyes was 0.31 and 0.31, respectively. The prevalence of PACG, PAC and PACS was 1.57% [95% confidence interval (CI), 1.469-1.671], 1.33% (95% CI, 1.236-1.424), and 4.68% (95% CI, 4.541-4.819), respectively. Among all PACG subjects, 42 (53.84%) had elevated IOP >21 mmHg in either eye and 37 (47.44%) had been treated by laser, surgical iridectomy or trabeculectomy. Sixty-four subjects (82.05%) had vision impairment of varying degrees. Multivariate analysis revealed that old age, family history of PACG, constipation and IOP were significant independent risk factors. CONCLUSIONS: Primary angle-closure glaucoma was a disease of high prevalence in rural Northeast China. Old age, family history of PACG, constipation and IOP were significant independent risk factors for PACG.

Prevalence of glaucoma in a rural northern china adult population: a population-based survey in kailu county, inner mongolia.

PURPOSE: To assess the prevalence and types of glaucoma in a rural population in northern China. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Subjects randomly selected from the population 40 years of age and older in Kailu County, Tongliao, Inner Mongolia. METHODS: Each subject underwent a screening examination consisting of an interview and ophthalmic examinations, including applanation tonometry, central corneal thickness, gonioscopy, slit-lamp examination, dilated fundus evaluation, and a screening visual field test using frequency-doubling technology. MAIN OUTCOME MEASURES: Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria. RESULTS: Of 5949 individuals 40 years of age and older, 5197 (87.36%) were examined. Of these, 169 (3.28%) had diagnosed glaucoma, giving an age- and gender-standardized prevalence of 2.90% (95% confidence interval, 2.02%-3.78%). The age- and gender-standardized prevalence of primary angle-closure glaucoma (PACG) was 1.42% (95% confidence interval, 0.82%-2.02%) and that for primary open-angle glaucoma (POAG) was 1.41% (95% confidence interval, 0.79%-2.02%). Of the 169 subjects with glaucoma, 54 (60%) and 3 (4.1%) had a previous known history of PACG or POAG, respectively. Unilateral blindness resulting from primary glaucoma was observed in 27 subjects (16.56%; 19 PACG/8 POAG), and bilateral blindness was present in 12 subjects (7.36%; 6 PACG/6 POAG). The prevalence of all types of glaucoma was increased with older age. CONCLUSIONS: The adjusted prevalence of glaucoma in this Chinese population was 2.90%, comparable with other data from Asia. The ratio of PACG to POAG was approximately equal. More than 90% of POAG cases previously were undetected, and nearly 30% of subjects with glaucoma were blind in at least 1 eye. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

A 556 kb deletion in the downstream region of the PAX6 gene causes familial aniridia and other eye anomalies in a Chinese family.

PURPOSE: The paired box gene 6 (PAX6) on human chromosome 11p13 is an essential transcription factor for eye formation in animals. Mutations in PAX6 can lead to varieties of autosomal-dominant ocular malformations with aniridia as the major clinical signs. Known genetic alterations causing haplo-insufficiency of PAX6 include nonsense mutations, frame-shift mutations, splicing errors, or genomic deletions. The purpose of this study was to identify genetic defects as the underlying cause of familial aniridia in a large Chinese family. METHODS: All exons of PAX6 in the proband were sequenced by the Sanger sequencing technique. The genome of the proband was evaluated by a microarray-based comparative genomic hybridization (aCGH). Quantitative real-time PCR was applied to verify the abnormal aCGH findings in the proband and to test five other family members. RESULTS: There were no detectable pathogenic mutations in the exons of PAX6 in the proband. The aCGH analysis showed two copies of PAX6 but revealed a 566 kb hemizygous deletion of chromosome 11p13, including four annotated genes doublecortin domain containing 1 (DCDC1), DnaJ homolog subfamily C member 24 (DNAJC24), IMP1 inner mitochondrial membrane(IMMP1L), andelongation factor protein 4 (ELP4) downstream of PAX6. Quantitative real-time PCR verified the deletion in the proband and further identified the deletion in a blind fashion in four affected family members but not in the one with a normal phenotype. CONCLUSIONS: The 566 kb hemizygous deletion of chromosome 11p13 downstream of PAX6 should be the cause of the familial aniridia in this Chinese family, although two copies of PAX6 are intact. aCGH evaluation should be applied if there is a negative result for the mutation detection of PAX6 in patients with aniridia.

Copolymer-1 immunization reduces damage in retinal ganglion cells under high intraocular pressure through altering the expression of retinal neurotrophins.

PURPOSE: To evaluate expression changes in retina neurotrophic factors (NTs) in glaucomatous rats with copolymer-1 (COP-1) immunization. METHODS: Three episcleral veins in rat eyes were cauterized to produce chronic high intraocular pressure (IOP). Qualified rats were divided into 3 groups: glaucoma group, COP-1 immunization group, and PBS control group. Using immunohistochemistry and RT-PCR, we compared the expression of retinal NTs in these 3 groups. RESULTS: NGF, BDNF, and NT-4 expression increased to different degrees and the levels of their RNAs had transient increases under elevated IOP, but there were no statistical differences with respect to the RNAs of interest in the COP-1 immunization group compared with the 2 control groups. Expression of NT-3 appeared earlier and stronger in the rats immunized with COP-1 than in rats with glaucoma. Moreover, the expression of the COP-1 receptor, TrkC, increased accordingly. CONCLUSIONS: COP-1 immunization might increase NT-3 expression by some unknown mechanism in high IOP rats and the change may be related to COP-1 therapeutic intervention.

Prevalence and causes of visual impairment in a rural North-east China adult population: a population-based survey in Bin County, Harbin.

PURPOSE: To investigate the prevalence and causes of visual impairment in a rural population in north-east China. METHODS: A population-based study was conducted within Bin County, Harbin of north-east China. Low vision and blindness were defined using the World Health Organization categories of visual impairment. The prevalence of visual impairment was estimated, and causes were identified based on best-corrected visual acuity (BCVA) as well as presenting visual acuity (VA). RESULTS: Out of 5764 people, 4956 (86.01%) aged older than 40 participated in the study. The prevalence of visual impairment, low vision and blindness based on presenting VA was 9.6% (BCVA, 6.6%), 7.7% (BCVA, 4.9%) and 1.9% (BCVA, 1.7%), respectively. Taking the presenting VA, cataract (44%) was the most common cause for visual impairment followed by uncorrected refractive error (24%), treatable causes of visual impairment accounted for 68% of the total cases. Cataract (59%) and glaucoma (15%) were leading causes for blindness based on presenting VA. According to BCVA, cataract was the leading cause of visual impairment and blindness (58% and 60%, respectively), followed by glaucoma (17% and 15%, respectively). The prevalence of visual impairment was higher among women than men (p<0.0001) and increasing with age (p<0.0001) and decreasing with increasing education level (p=0.0075). CONCLUSION: Visual impairment was a serious public health problem in this rural population, with most of it easily remedied. Results highlighted the need for visual impairment prevention programs to an increasing number of elderly people, with a special emphasis on female and those with little or no education.