Effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma: A protocol for systematic review and network meta-analysis.

BACKGROUND: Glaucoma is the second most-common blinding ophthalmic disease in the world, and its incidence has been rising year by year in recent years. Currently, the main treatment of glaucoma still relies on surgery. Glaucoma patients often suffer from various psychological problems like anxiety and depression not only because of the lack of understanding of the surgical treatment of glaucoma, but also the long-term stress and the poor prognosis. As alternative therapies, non-pharmacological interventions can greatly alleviate psychological burdens and improve sleep quality in surgically treated glaucoma patients. Randomized controlled trials of non-pharmacologic interventions for glaucoma have been reported, although the results remain conflicting. Evidences for determining the efficacy of non-pharmacologic interventions for glaucoma are scant. This study aims to assess the effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma through a network meta-analysis. METHODS: A systematic search of relevant literatures published before August 2021 about the effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma will be performed in Wanfang, VP Information Chinese Journal Service Platform, China National Knowledge Infrastructure, Chinese BioMedicine Literature Database, Pubmed, Embase, Cochrane, and Web of science. Two reviewers will be independently responsible for literature screening and selection, quality assessment, and data extraction. WinBUGS 1.4 will be used for the network meta-analysis. RESULTS: This meta-analysis will provide additional and stronger evidences for non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma, which will help clinicians and decision makers to make an optimal therapeutic strategy. CONCLUSION: This study will provide a reliable evidence-based basis for the clinical application of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma. ETHICS AND DISSEMINATION: Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/TYJPK.

High MMP-9 Expression May Contribute to Retroprosthetic Membrane Formation after KPro Implantation in Rabbit Corneal Alkali Burn Model.

Purpose. To evaluate aqueous humor MMP-9 levels in alkali-burned rabbit cornea following KPr implantation and their roles in RPMs formation. Methods. Left eyes of 36 rabbits received a deep corneal alkali wound. 12 corneas were implanted with KPro and the other 24 control corneas were either penetrating keratoplasty or left without keratoplasty. Aqueous humor MMP-9 and TIMP-1 levels were determined and RPMs were obtained for histopathological and ultrastructural examination. Results. Alkali exposure induced significant increase in aqueous humor MMP-9 level and the data were further enhanced by KPro implantation. By contrast, TMIP-1 levels in aqueous humor showed a decreased trend following corneal alkali burn and KPro surgery. RPMs were developed in 5 out of 10 cases of KPro successfully implanted eyes. Histopathology showed the presence of a large number of fibroblasts and collagen fibers arranged irregularly with inflammatory cells infiltration, and an ingrowth of new blood vessels in this retrokeratoprosthesis fibrous tissue. Immunohistochemical analysis showed positive stain of RPMs for both MMP-9 and TIMP-1. Aqueous humor MMP-9 levels were significantly higher in RPM group postoperatively, while TIMP-1 levels were comparatively lower than that of No-RPM group. Conclusions. Our study evidenced the potential pathophysiological role of MMP-9 expression in RPM formation following KPro implantation.

Role of extracellular signal-regulated kinase in glutamate-stimulated apoptosis of rat retinal ganglion cells.

PURPOSE: To investigate the involvement of the extracellular signal-regulated kinase (ERK) signaling pathway after intravitrevous injection of glutamate in rat retina. METHODS: Three groups of five Sprague-Dawley rats each were studied. Group I was a normal control group, intravitreal saline injections. In Group II, one eye received an intravitreal glutamate injection (375 nmol, dissolved in saline) while the contralateral eye served as control. In Group III, intravitreal PD98059 (100 micro mol, an inhibitor of ERK) injections were administered 1 hr before glutamate injections. Seven days after injections, phosphorylated (activated) ERK in retina was localized by immunohistochemistry and fluorescent double labeling of retinal cryosections. Specific ERK blockade was documented to assess the functional significance of activated ERK. TUNEL staining was performed to assess apoptotic cell death. RESULTS: Expression of phosphorylated ERK in rat retina was observed in the inner nuclear layer, the outer nuclear layer, and the nerve fiber layer after 3 days intravitreous injection of glutamate, increasing significantly after 7 days. Double immunofluorescence labling demonstrated that the increased retinal immunostaining for phospho-ERK was predominantly localized to the retinal Müller cells after 7 days intravitreous injection of glutamate. Moreover, blocking activation of ERK significantly improved the number of TUNEL-positive cells in the eyes receiving intravitreal PD98059 injections compared with the eyes receiving glutamate injections. CONCLUSIONS: The ERK pathway is involved in signal transduction in the retina after excessive stimulation by glutamate, which may contribute to the antiapoptotic role in retinal ganglion cell death induced by glutamate.