Search Results (17)

Background: This case–control study evaluated the concentrations of zinc (Zn), iron (Fe), and copper (Cu) in the aqueous humor (AH) of patients with primary glaucoma, and their relationships with clinical factors. Methods: This study enrolled 100 patients with primary glaucoma and categorized them into subtypes: acute angle-closure crisis (AACC), primary angle-closure glaucoma (PACG), and primary open-angle glaucoma (POAG). A total of 67 patients with senile cataract were enrolled as controls. Their AH samples and clinical information were obtained. Results: In primary glaucoma, Zn, Fe, and Cu concentrations increased, especially in AACC group; Zn, Fe, and Cu were positively correlated mutually; and decreased Zn/Fe and increased Fe/Cu were observed. The number of quadrants with closed anterior chamber angle on gonioscopy was positively associated with Fe and Cu levels in AACC and with Zn and Cu levels in PACG. In POAG, we found negative associations between Zn and the number of quadrants with retinal nerve fiber layer thinning on optical coherence tomography, Fe and age, and Cu and the cup-to-disc ratio. Trace metals showed high efficiency in discriminating primary glaucoma from controls. Conclusions: Zn, Fe, and Cu concentrations in patients with primary glaucoma increased and were associated with clinical factors, acting as potential biomarkers. Full article

Background/Objectives: Black and Afro-Latinx communities have a higher propensity for more-severe glaucoma at a younger age. This study aimed to use the Kahook Dual Blade (KDB) to treat all glaucoma subtypes and severity levels in this historically underserved community. Materials and Methods: This study involved a retrospective analysis of surgical case records, with follow-up through 20 months. The subjects were glaucoma patients at Hospital Elias Santana in Santo Domingo, Dominican Republic. Inclusion criteria were age >18 years and a minimum follow-up of 1 year after surgery. All glaucoma subtypes and disease severities were included, including previous glaucoma procedures. Sequential patients undergoing KDB goniotomy alone or in combination with phacoemulsification cataract surgery were assessed. IOP data and number of medications were collected at specific time points: baseline, postoperative day 1, postoperative week 1, and postoperative months 1, 3, 6, 12, 16, and 20. Surgical outcome was determined using IOP and number of medications. Success was defined as either a 20% or more reduction in IOP or a decrease in at least one topical therapy. Recorded postoperative complications were hyphema, ocular hypertension, and need for additional glaucoma surgery. Results: A total of 90 eyes from 90 patients were included. A total of 100% of the patient population was Black or Afro-Latinx. The most common glaucoma subtype was primary open-angle (76.7%). Most of the eyes had severe glaucoma (53.3%). The mean preoperative baseline IOP was 20.5 mmHg. The mean postoperative IOP from all time points ranged from 12.9 to 13.5 mmHg (all time points were significantly lower than baseline IOP, p < 0.0001). A mean reduction in IOP percent of at least 31.5% was seen at every time point. There was a mean reduction of two medications by postoperative month 20. Surgical success was achieved in 95.6% of patients at postoperative month 1 and remained high throughout the study period (95.4% at month 20). Conclusions: KDB goniotomy achieved successful IOP and medication reduction across all levels of glaucoma severity. Surgical success rates were maintained to 20 months. While MIGS has historically been used as an intervention in mild-to-moderate glaucoma, our study results show that the KDB can play a significant role in all stages of glaucoma, including severe. MIGS should be considered as a favorable intervention in all disease severities in Black and Afro-Latinx communities around the world. Full article

Background and Objectives: Diabetes has become a global epidemic, contributing to significant health challenges due to its complications. Among these, diabetes can affect sight through various mechanisms, emphasizing the importance of early identification and management of vision-threatening conditions in diabetic patients. Changes in the crystalline lens caused by diabetes may lead to temporary and permanent visual impairment. Since individuals with diabetes are at an increased risk of developing cataracts, which significantly affects their quality of life, this study aims to identify the most common cataract subtypes in diabetic patients, highlighting the need for proactive screening and early intervention. Materials and Methods: This study included 201 participants with cataracts (47.6% women and 52.4% men), of whom 105 also had diabetes. With the use of machine learning, the patients were assessed and categorized as having one of the three main types of cataracts: cortical (CC), nuclear (NS), and posterior subcapsular (PSC). A Random Forest Classification algorithm was employed to predict the incidence of different associations of cataracts (1, 2, or 3 types). Results: Cataracts have been encountered more frequently and at a younger age in patients with diabetes. CC was significantly more frequent among patients with diabetes (p < 0.0001), while the NS and PSC were only marginally, without statistical significance. Machine learning could also contribute to an early diagnosis of cataracts, with the presence of diabetes, duration of diabetes, or diabetic polyneuropathy (PND) having the highest importance for a successful classification. Conclusions: These findings suggest that diabetes may impact the type of cataract that develops, with CC being notably more prevalent in diabetic patients. This has important implications for screening and management strategies for cataract formation in diabetic populations. Full article

Background: Diabetes mellitus (DM) is one of the most impactful health problems worldwide. It affects ocular health in multiple ways and is one of the leading causes of vision loss. Our study aimed to evaluate the most important systemic risk factors related to the occurrence of cataracts in patients with DM. Method: This study evaluated a final number of 319 participants who were previously diagnosed with DM. For all patients, we retrieved data regarding DM status, metabolic control, demographic and anthropometric indices, and generally associated comorbidities from their medical charts. A comprehensive eye examination was performed on all patients. Results: The main studied risk factors were hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), diabetic polyneuropathy (DPN), dyslipidemia, and hepatic steatosis, which were present among the entire population. Hypertension (67.6%), DPN (53.3%), and dyslipidemia (46.6%) were highly prevalent in the cataract subgroup, and CKD (p < 0.001) and DPN (p = 0.019) were found to be predictive factors for the probability of cataract occurrence. Ophthalmologic evaluation was used to assess the presence of ocular complications, such as diabetic retinopathy (DR) and diabetic maculopathy. DR reached statistically significant values in the occurence of cataracts. Patients’ age and DM-related factors, such as disease duration (p < 0.001) and HbA1c values (p = 0.029), significantly increased the risk of cataracts. Smoking was self-reported by 24.8% of the patients, with a significant impact on the occurrence of cataracts (p = 0.04). Conclusions: Patients with DM who exhibit a longer disease duration and poor glycemic control in conjunction with systemic comorbidities present a higher risk of developing cataracts; consequently, a strict therapeutic approach regarding these risk factors is needed. Full article

Background and Objectives: This study aimed to evaluate the effect of cataract extraction on intraocular pressure at 6, 12, and 24 months and their difference compared to the baseline in diverse glaucoma subtypes. Materials and Methods: We carried out research in the MEDLINE, Cochrane Library and EMBASE databases, as of April 2022 for relevant papers, filtered according to established inclusion and exclusion criteria. The meta-analysis evaluated the Mean Reduction and relative Standard Error in these subpopulations at predetermined times. A total of 41 groups (2302 eyes) were included in the systematic review. Due to the significant heterogeneity, they were analysed through a Random Effects Model. Results: We obtained these differences from baseline: (1) Open Angle Glaucoma at 6, 12 and 24 months, respectively: −2.44 mmHg, −2.71 mmHg and −3.13 mmHg; (2) Angle Closure Glaucoma at 6, 12 and 24 months, respectively: −6.81 mmHg, −7.03 mmHg and −6.52 mmHg; (3) Pseudoexfoliation Glaucoma at 12 months: −5.30 mmHg; (4) Ocular Hypertension at 24 months: −2.27 mmHg. Conclusions: Despite a certain variability, the reduction in ocular pressure was statistically significant at 6, 12 and 24 months in both Open Angle Glaucoma and Angle Closure Glaucoma, the latter being superior. Data for Pseudoexfoliation Glaucoma and for Ocular Hypertension are available, respectively, only at 12 months and at 24 months, both being significant. Full article

The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments. Full article

Hypoxic environments are known to trigger pathological damage in multiple cellular subtypes. Interestingly, the lens is a naturally hypoxic tissue, with glycolysis serving as its main source of energy. Hypoxia is essential for maintaining the long-term transparency of the lens in addition to avoiding nuclear cataracts. Herein, we explore the complex mechanisms by which lens epithelial cells adapt to hypoxic conditions while maintaining their normal growth and metabolic activity. Our data show that the glycolysis pathway is significantly upregulated during human lens epithelial (HLE) cells exposure to hypoxia. The inhibition of glycolysis under hypoxic conditions incited endoplasmic reticulum (ER) stress and reactive oxygen species (ROS) production in HLE cells, leading to cellular apoptosis. After ATP was replenished, the damage to the cells was not completely recovered, and ER stress, ROS production, and cell apoptosis still occurred. These results suggest that glycolysis not only performs energy metabolism in the process of HLE cells adapting to hypoxia, but also helps them continuously resist cell apoptosis caused by ER stress and ROS production. Furthermore, our proteomic atlas provides possible rescue mechanisms for cellular damage caused by hypoxia. Full article

Cataracts are among the most common causes of childhood vision loss worldwide. This study seeks to identify differentially expressed proteins in the aqueous humor of pediatric cataract patients. Samples of aqueous humor were collected from pediatric and adult cataract patients and subjected to mass spectrometry-based proteomic analysis. Samples of pediatric cataracts were grouped by subtype and compared to adult samples. Differentially expressed proteins in each subtype were identified. Gene ontology analysis was performed using WikiPaths for each cataract subtype. Seven pediatric patients and ten adult patients were included in the study. Of the pediatric samples, all seven (100%) were male, three (43%) had traumatic cataracts, two (29%) had congenital cataracts, and two (29%) had posterior polar cataracts. Of the adult patients, seven (70%) were female and seven (70%) had predominantly nuclear sclerotic cataracts. A total of 128 proteins were upregulated in the pediatric samples, and 127 proteins were upregulated in the adult samples, with 75 proteins shared by both groups. Gene ontology analysis identified inflammatory and oxidative stress pathways as upregulated in pediatric cataracts. Inflammatory and oxidative stress mechanisms may be involved in pediatric cataract formation and warrant further investigation. Full article

Background: To investigate the anterior segment parameters before and after cataract surgery in open-angle eyes and different subtypes of primary angle-closure glaucoma (PACG) eyes and to further explore the potential relationship between the anterior rotation of the ciliary process and crystalline lens. Methods: An observational, prospective study was performed on 66 patients who had cataract surgery including 22 chronic PACG patients, 22 acute PACG patients, and 22 open-angle cataract patients. Anterior segment parameters including the trabecular-ciliary process distance, ciliary process area, trabecular-ciliary angle (TCA), maximum ciliary body thickness (CBTmax), and so on, were measured using ultrasound biomicroscopy preoperatively and 3 months postoperatively. Results: After the surgery, there were significant increases in TCA (p < 0.001) and CBTmax (p < 0.05) in all three groups, while there was no significant change in the trabecular-ciliary process distance (p > 0.05) in all three groups. No significant difference in the changes of ciliary process area, TCA, and CBTmax (p > 0.05) pre- and postoperatively among the three groups were identified. Conclusions: Extractions of crystalline lenses played similar roles in terms of decreasing the anterior rotation of ciliary processes in open-angle eyes and angle-closure eyes. A natural anatomical abnormality may be a more important factor in the anterior rotation of ciliary processes in PACG patients. Full article

Warburg Micro syndrome (WARBM) is an autosomal recessive neuro-ophthalmologic syndrome characterized by microcephaly, microphthalmia, congenital cataracts, cortical dysplasia, corpus callosum hypoplasia, spasticity, and hypogonadism. WARBM is divided into four subtypes according to the causative genes, of which RAB3GAP1 (OMIM# 602536) accounts for the highest proportion. We collected detailed medical records and performed whole-exome sequencing (WES) for a congenital cataract patient. A novel heterozygous frameshift RAB3GAP1 variant was detected in a boy with a rare ocular phenotype of bilateral membranous cataracts accompanied by a persistent papillary membrane. Further copy number variation (CNV) analysis identified a novel deletion on chromosome 2q21.3 that removed 4 of the 24 exons of RAB3GAP1. The patient was diagnosed with WARBM following genetic testing. The present study expands the genotypic and phenotypic spectrum of WARBM. It suggests applying whole exome sequencing (WES) and CNV analysis for the early diagnosis of syndromic diseases in children with congenital cataracts. Full article

The purpose of our work is to describe the actual knowledge concerning etiopathogenesis, clinical manifestations, diagnostic procedures, complications and therapy of ocular sarcoidosis (OS). The study is based on a recent literature review and on the experience of our tertiary referral center. Data were retrospectively analyzed from the electronic medical records of 235 patients (461 eyes) suffering from a biopsy-proven ocular sarcoidosis. Middle-aged females presenting bilateral ocular involvement are mainly affected; eye involvement at onset is present in one-third of subjects. Uveitis subtype presentation ranges widely among different studies: panuveitis and multiple chorioretinal granulomas, retinal segmental vasculitis, intermediate uveitis and vitreitis, anterior uveitis with granulomatous mutton-fat keratic precipitates, iris nodules, and synechiae are the main ocular features. The most important complications are cataract, glaucoma, cystoid macular edema (CME), and epiretinal membrane. Therapy is based on the disease localization and the severity of systemic or ocular involvement. Local, intravitreal, or systemic steroids are the mainstay of treatment; refractory or partially responsive disease has to be treated with conventional and biologic immunosuppressants. In conclusion, we summarize the current knowledge and assessment of ophthalmological inflammatory manifestations (mainly uveitis) of OS, which permit an early diagnostic assay and a prompt treatment. Full article

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for ‘glaucoma following cataract surgery’ (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies—presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months—were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases. Full article

Extracellular vesicles (EVs) are secreted by various cells in the body fluid system and have been found to influence vessel formation and inflammatory responses in a variety of diseases. However, which EVs and their subtypes are involved in vascular retinal diseases is still unclear. Therefore, the aim of this study was to explore the particle distribution of EVs in retinal neovascular diseases, including age-related macular degeneration, polypoidal choroidal vasculopathy, and central retinal vein occlusion. The aqueous humor was harvested from 20 patients with different retinal neovascular diseases and six patients with cataracts as the control group. The particle distribution was analyzed using nanoparticle tracking analysis (NTA) and transmitting electron microscopy (TEM). The results revealed that the disease groups had large amounts of EVs and their subtypes compared to the control group. After isolating exosomes, a higher expression of CD81⁺ exosomes was shown in the disease groups using flow cytometry. The exosomes were then further classified into three subtypes of exomeres, small exosomes, and large exosomes, and their amounts were shown to differ depending on the disease type. To the best of our knowledge, this is the first study to elucidate the dynamics of EVs in retinal neovascular diseases using clinical cases. Our findings demonstrated the possible functionality of microvesicles and exosomes, indicating the potential of exosomes in the diagnosis and therapy of retinal neovascular diseases. Full article

Background: the safety and efficacy of cataract surgery in eyes with exudative neovascular age-related macular degeneration (nAMD), receiving active treatment, remain unclear. We evaluated the long-term outcomes and associated predictive factors of cataract surgery in eyes with exudative nAMD. Methods: this retrospective cohort study included 65 eyes (61 patients) treated with anti-vascular endothelial growth factor (VEGF) injections within six months preoperatively. Changes in best-corrected visual acuity (BCVA) and anti-VEGF treatment patterns from before to up to four years after surgery were assessed. Predictive factors were identified in association with one-year surgical outcomes. Results: the BCVA improved at six months (p < 0.001) and was maintained for three years postoperatively. The interval between anti-VEGF injections increased 3.4 times postoperatively (p = 0.001). Risk factors for poor BCVA were low preoperative BCVA (p < 0.001) and prolonged nAMD duration (p = 0.003). Prolonged nAMD duration and short exudation-free period were associated with more frequent postoperative anti-VEGF treatments (p = 0.028 and p = 0.003, respectively). AMD subtypes were not associated with both vision and injection pattern outcomes. Conclusions: patients with cataracts receiving nAMD treatment can safely undergo surgery with favorable long-term visual benefits. The preoperative BCVA, nAMD duration, and exudation-free period are potential predictors of surgery outcomes. Full article

Mevalonate kinase-associated diseases (MKAD) are caused by pathogenic mutations in the mevalonate kinase gene (MVK) and encompass several phenotypically different rare and hereditary autoinflammatory conditions. The most serious is a recessive systemic metabolic disease called mevalonic aciduria, and the most recently recognized is disseminated superficial actinic porokeratosis, a dominant disease limited to the skin. To evaluate a possible correlation between genotypes and (1) the different MKAD clinical subtypes or (2) the occurrence of severe manifestations, data were reviewed for all patients with MVK variants described in the literature (N = 346), as well as those referred to our center (N = 51). The genotypes including p.(Val377Ile) (homozygous or compound heterozygous) were more frequent in mild systemic forms but were also sometimes encountered with severe disease. We confirmed that amyloidosis was more prevalent in patients compound heterozygous for p.(Ile268Thr) and p.(Val377Ile) than in others and revealed new associations. Patients homozygous for p.(Leu264Phe), p.(Ala334Thr) or compound heterozygous for p.(His20Pro) and p.(Ala334Thr) had increased risk of severe neurological or ocular symptoms. All patients homozygous for p.(Leu264Phe) had a cataract. The variants associated with porokeratosis were relatively specific and more frequently caused a frameshift than in patients with other clinical forms (26% vs. 6%). We provide practical recommendations focusing on phenotype–genotype correlation in MKAD that could be helpful for prophylactic management. Full article