Plasma levels of sirtuin and adiponectin in patients with primary open-angle glaucoma, exfoliative glaucoma, and healthy controls

Purpose To compare plasma levels of sirtuin 1 (SIRT1) and adiponectin (APN) in patients with primary open-angle glaucoma (POAG), exfoliative glaucoma (XFG), and healthy control subjects. Methods This prospective case-control study collected plasma samples from 118 participants. All subjects underwent a comprehensive ophthalmologic examination before the acquisition of a plasma sample. Plasma samples were obtained from 40 POAG, 38 XFG, and 40 healthy control subjects without any evidence of systemic or ocular disease. Serum SIRT1 and APN levels were estimated by an enzyme-linked immunosorbent assay, ELISA (Elabscience, Houston, USA) method. Statistical analysis of results relied on Kolmogorov-Smirnov, Kruskal-Wallis, Chi-square, analysis of variance (ANOVA) tests, and linear regression analysis, where appropriate. Results A significant decrease in SIRT1 levels was observed in POAG patients compared to healthy controls (p = 0.004, Dunn's test). In contrast, no difference was detected between XFG and POAG patients or healthy controls (p = 0.32 and p = 0.34, respectively, Dunn's test). There was no significant difference in plasma APN levels between the three groups under investigation (p = 0.59, ANOVA). Conclusion Alterations in serum level of SIRT1 may suggest a possible role in POAG via potential effects in neuroprotection and oxidative stress.

Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

Glaucoma Profile at the Tertiary Ophthalmic Centers in Ankara, Turkey

Purpose: This study aimed to investigate the demographic and clinical characteristics of the patients with glaucoma, who presented at the tertiary ophthalmology clinics in Ankara, Turkey.Patients and Methods: This cross-sectional study included all of the consecutive glaucoma patients or glaucoma suspects who presented at ten different tertiary ophthalmology clinics in Ankara between March 2015 and May 2015. The demographic characteristics and clinical findings of the patients were evaluated. Glaucoma was diagnosed according to the International Society for Geographical and Epidemiological Ophthalmology Classification. In the patients with binocular glaucoma, only the data of the worse eye was included for statistical analyses. Results: A total of 4604 eyes of 2541 patients fulfilled the inclusion criteria and were classified as having glaucoma. Binocular involvement was present in 2063 (81.2%) patients. Primary open angle glaucoma (POAG) was the most common glaucoma type (38.8%), followed by exfoliative glaucoma (XFG; 26.2%), and primary angle-closure glaucoma (PACG; 7.7%). The distribution of the sexes was significantly different among the diagnosis groups (P < 0.001). The cup/disk ratio was the highest among the patients with secondary angle-closure glaucoma (SACG; P < 0.001). The visual field MD parameter was significantly higher in the patients with SACG and XFG (P < 0.001). Monocular and binocular blindness ratios were 21% and 2.8%, respectively.Conclusions: The predominant type of glaucoma in Turkish clinic patients was found to be POAG, followed by XFG and PACG.

Efficacy of corneal shape index in the evaluation of ocular hypertension, primary open-angle glaucoma and exfoliative glaucoma

Purpose: The aim of the present study is to calculate Concavity Shape Index (CSI) in patients with POAG and exfoliative glaucoma (XFG) and correlate CSI with the severity of glaucoma, comparing to control and ocular hypertension (OHT) patients. Methods: This was a cross‑sectional study with 146 eyes/146 subjects: 37 healthy eyes, 23 eyes with OHT and 86 glaucoma eyes (70 with POAG, 16 with XFG). The severity of glaucoma was scored with the Glaucoma Staging System 2 (GSS2). Corvis ST® was used to calculate CSI. Results: Central corneal thickness (CCT) was significantly thinner in POAG (526 ± 40.0 µm) and XFG (520 ± 38.2 µm) than control group (553 ± 28.8 µm). CSI had no significant differences between the groups. XFG had a higher mean of GSS 2 (2.42 ± 1.38) than POAG (1.87 ± 1.55) and OHT (1.87 ± 1.55). OHT had a significantly less deformable cornea than: control (higher A1 length, lower A1 velocity, higher A2 velocity), POAG (higher A1 length, lower A1 velocity, lower deflection amplitude at highest concavity), and XFG group (lower A1 velocity, lower deflection amplitude at highest concavity), which was independent of age and CCT. No significant correlation was found between GSS 2 and CSI. Discussion: OHT patients had stiffer corneas (less deformed by the air puff) when compared to control, POAG or XFG patients. A less deformable cornea could potentially be related to a more resistant LC/peripapillary sclera. As such, this would result in a lesser optic nerve susceptibility to IOP damage.

Association of LOXL1 Gene Polymorphisms in Exfoliation Glaucoma Patients

Background: Pseudoexfoliation syndrome (XFS) is pathogenetically related to exfoliative glaucoma (XFG), which is the most common type of secondary glaucoma. We aimed to investigate the relationship between LOXL1 SNPs (rs1048661, rs3825942) and XFS and/or XFG in a cohort of Iranian subjects. Methods: This cross-sectional study investigated possible association between LOXL1 gene polymorphisms and exfoliative glaucoma in Northeastern part of Iran between May 2014 and May 2015. Sixty unrelated XFS/XFG patients, as well as 40 control subjects, were studied by direct sequencing. In fifteen senile cataract patients without glaucoma and fifteen patients with coexisting XFG and cataract, capsulorhexis specimen of the anterior lens capsule was used to evaluate LOXL1 gene transcripts by Real-Time PCR technique. We analyzed the results for allele frequencies and haplotype association and investigated the relative gene expression. Results: Significant associations between the rs382594 SNP and XFG and between rs1048661 SNP and XFG were observed (P<0.05 for both). The frequency of the G allele in the exonic SNP (rs1048661) appeared to be higher in XFS or XFG patients compared to control subjects (P= 0.0497). Moreover, in the rs3825942 SNP, the G allele was more frequent in XFS/XFG patients compared to control subjects (P=0.0016). The highest cumulative frequency was for the GG haplotype. GG haplotype was associated with increased risk of XFG compared to the rs1048661 G/T and rs3825942 G/A haplotypes. LOXL1 mRNA expression was not statistically significantly different between XFS/XFG and control subjects. Conclusion: We reported the LOXL1 gene polymorphism in an Iranian XFS/XFG cohort. Similar to many other ethnic groups and geographic regions, our results confirmed an association between LOXL1 gene variants and XFG in Iran.