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Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target\" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. \"Target\" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a \"Target\" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.

This study investigated the distinctive features and management outcomes of combined exfoliation syndrome and angle-closure glaucoma (XFS-PACG) through a prospective, multicenter observational cohort study including 350 patients (118 XFS, 127 PACG, 105 combined XFS-PACG). Combined pathology demonstrated unique characteristics including bimodal diurnal IOP fluctuations, asymmetric angle closure correlating with exfoliation material distribution, and accelerated zonular weakness with progressive anterior lens displacement. Disease progression was significantly more aggressive in combined cases (visual field deterioration − 2.9 ± 0.8 dB/year versus − 1.7 ± 0.6 and − 1.4 ± 0.5 dB/year in XFS and PACG respectively). Therapeutic response evaluation revealed that prostaglandin-alpha2agonist combinations were most effective pharmacologically in combined cases, while traditional laser peripheral iridotomy achieved limited sustained control (38.1%). Early phacoemulsification with minimally invasive glaucoma surgery demonstrated superior surgical outcomes (72.4% complete success) compared to filtering procedures (53.3%). These findings support an individualized treatment approach for combined XFS-PACG, with early intervention and condition-specific protocols to optimize outcomes in this challenging clinical entity.

Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have the potential application in evaluating pathological structural change of the optic nerve. We aimed to evaluate the value of the OCT and OCTA parameters of the optic disk and macular in differentiating early chronic primary angle-closure glaucoma (CPACG) and early pituitary adenoma (PA) in case of mild visual field defects (the mean defect (MD) > 6 dB). The results showed that regarding OCTA parameters, CPACG patients had lower retinal blood flow density of most layers of the optic disk and macular than PA patients. Regarding OCT parameters, CPACG patients had thinner circumpapillary retinal nerve fiber layer (CP-RNFL) in all quadrants and average CP-RNFL, ganglion cell layer (GCL) and macular ganglion cell complex (GCC) in each quadrant of macular inner and outer rings, and inner plexus layer (IPL) of macular inner ring, superior-outer ring and temporal-outer ring than PA patients. The Z test indicated that OCTA parameters and OCT parameters had similar value in the diagnosis of disease. In conclusion , in the case of similar visual field damage, early CPACG patients have smaller blood flow density and thinner optic disk and macular than early PA. OCTA has similar performance to OCT in diagnosing CPACG and PA.

Background To analyze the poor mental status of patients with primary closed-angle glaucoma(PACG), and to explore the correlation between mental status and ocular and systemic indices in patients with PACG. Methods We collected patients' axial length (AL), anterior chamber depth (ACD), nerve fiber layer thickness (RNFL), cup-to-disc ratio (C/D), antinuclear antibody (ANA), toxoplasmosis antibody (anti-Toxoplasma gondii IgM), and anxiety and depression scores (HAMA and HAMD scales). Statistical analysis was utilized to analyze the data for each of the patients in the PACG and cataract patient groups. Results The results showed that there was a statistically significant difference between the glaucoma group and the cataract group in terms of anxiety and depression scores, AL, ACD, RNFL, C/D, ANA, and Anti-Toxo IgM ( P  < 0.05). Anxiety scores of glaucoma patients were positively correlated with AL and C/D ( P  < 0.05), negatively correlated with RNFL ( P  < 0.05), and correlation existed with ANA and Anti-Toxo IgM (Eta 2  > 0.16). Depression scores in glaucoma patients were positively correlated with C/D ( P  < 0.05), negatively correlated with AL and RNFL ( P  < 0.05), and correlated with ANA and Anti-Toxo IgM (Eta 2  > 0.16). In addition,RNFL and C/D can be considered significant predictors of anxiety status. AL and C/D can be considered significant predictors of depression status. Conclusion Patients with primary angle-closure glaucoma have higher anxiety and depression scores than the general population, and clinically we can predict the patient's mental status by their ocular and systemic indicators so that appropriate treatment can be taken in time.

Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary open-angle glaucoma and primary angle-closure glaucoma, affect more than 2 million Americans and are increasing in prevalence. Many patients with glaucoma are asymptomatic and do not know they have the disease. Risk factors for primary open-angle glaucoma include older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus. Risk factors for primary angle-closure glaucoma include older age, Asian descent, and female sex. Advanced disease at initial presentation and treatment nonadherence put patients with glaucoma at risk of disease progression to blindness. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting. Regular eye examinations for adults are recommended by the American Academy of Ophthalmology, with the interval depending on patient age and risk factors. Diagnosis of glaucoma requires careful optic nerve evaluation and functional studies assessing a patient's visual field. The goal of treatment with eye drops, laser therapy, or surgery is to slow visual field loss by lowering intraocular pressure. Family physicians can contribute to lowering morbidity from glaucoma through early identification of high-risk patients and by emphasizing treatment adherence in patients with glaucoma.

Glaucoma, the world’s leading cause of irreversible blindness, is a complex disease, with differential presentation as well as ethnic and geographic disparities. The multifactorial nature of glaucoma complicates the study of genetics and genetic involvement in the disease process. This review synthesizes the current literature on glaucoma and genetics, as stratified by glaucoma subtype and ethnicity. Primary open-angle glaucoma (POAG) is the most common cause of glaucoma worldwide, with the only treatable risk factor (RF) being the reduction of intraocular pressure (IOP). Genes associated with elevated IOP or POAG risk include: ABCA1, AFAP1, ARHGEF12, ATXN2, CAV1, CDKN2B-AS1, FOXC1, GAS7, GMDS, SIX1/SIX6, TMCO1, and TXNRD2. However, there are variations in RF and genetic factors based on ethnic and geographic differences; it is clear that unified molecular pathways accounting for POAG pathogenesis remain uncertain, although inflammation and senescence likely play an important role. There are similar ethnic and geographic complexities in primary angle closure glaucoma (PACG), but several genes have been associated with this disorder, including MMP9, HGF, HSP70, MFRP, and eNOS. In exfoliation glaucoma (XFG), genes implicated include LOXL1, CACNA1A, POMP, TMEM136, AGPAT1, RBMS3, and SEMA6A. Despite tremendous progress, major gaps remain in resolving the genetic architecture for the various glaucoma subtypes across ancestries. Large scale carefully designed studies are required to advance understanding of genetic loci as RF in glaucoma pathophysiology and to improve diagnosis and treatment options.

Chronic glaucoma is a multifactorial disease among which oxidative stress may play a major pathophysiological role. We conducted a systematic review and meta-analysis to evaluate the levels of oxidative and antioxidative stress markers in chronic glaucoma compared with a control group. The PubMed, Cochrane Library, Embase and Science Direct databases were searched for studies reporting oxidative and antioxidative stress markers in chronic glaucoma and in healthy controls using the following keywords: \"oxidative stress\" or \"oxidant stress\" or \"nitrative stress\" or \"oxidative damage\" or \"nitrative damage\" or \"antioxidative stress\" or \"antioxidant stress\" or \"antinitrative stress\" and \"glaucoma\". We stratified our meta-analysis on the type of biomarkers, the type of glaucoma, and the origin of the sample (serum or aqueous humor). We included 22 case-control studies with a total of 2913 patients: 1614 with glaucoma and 1319 healthy controls. We included 12 studies in the meta-analysis on oxidative stress markers and 19 on antioxidative stress markers. We demonstrated an overall increase in oxidative stress markers in glaucoma (effect size = 1.64; 95%CI 1.20-2.09), ranging from an effect size of 1.29 in serum (95%CI 0.84-1.74) to 2.62 in aqueous humor (95%CI 1.60-3.65). Despite a decrease in antioxidative stress marker in serum (effect size = -0.41; 95%CI -0.72 to -0.11), some increased in aqueous humor (superoxide dismutase, effect size = 3.53; 95%CI 1.20-5.85 and glutathione peroxidase, effect size = 6.60; 95%CI 3.88-9.31). The differences in the serum levels of oxidative stress markers between glaucoma patients and controls were significantly higher in primary open angle glaucoma vs primary angle closed glaucoma (effect size = 12.7; 95%CI 8.78-16.6, P < 0.001), and higher in pseudo-exfoliative glaucoma vs primary angle closed glaucoma (effect size = 12.2; 95%CI 8.96-15.5, P < 0.001). In conclusion, oxidative stress increased in glaucoma, both in serum and aqueous humor. Malonyldialdehyde seemed the best biomarkers of oxidative stress in serum. The increase of some antioxidant markers could be a protective response of the eye against oxidative stress.

Aim: To estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020. Methods: A review of published data with use of prevalence models. Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions were used to construct prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study. Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma. Results: There will be 60.5 million people with OAG and ACG in 2010, increasing to 79.6 million by 2020, and of these, 74% will have OAG. Women will comprise 55% of OAG, 70% of ACG, and 59% of all glaucoma in 2010. Asians will represent 47% of those with glaucoma and 87% of those with ACG. Bilateral blindness will be present in 4.5 million people with OAG and 3.9 million people with ACG in 2010, rising to 5.9 and 5.3 million people in 2020, respectively. Conclusions: Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians.

Background Cognitive dysfunction has been reported in patients with glaucoma, but the underlying neural mechanisms remain unclear. This study aimed to explore functional connectivity (FC) alterations in hippocampal subregions in primary angle-closure glaucoma (PACG) patients with cognitive impairment. Method This study included forty-four PACG patients with cognitive dysfunction, and forty-six healthy controls (HCs). Participants underwent 3D high-resolution T1 structural imaging and BOLD fMRI scanning. Seven hippocampal subregions were selected as seed regions to explore changes in FC between the bilateral hippocampal subregions (Cornu Ammonis 1, Cornu Ammonis 2, Cornu Ammonis 3, Dentate gyrus, Entorhinal cortex, HATA, Subiculu) and the whole brain in PACG patients with cognitive dysfunction. Results Compared with the HCs group, the PACG group showed decreased FC between multiple hippocampal subregions and the cerebellum, precentral gyrus, postcentral gyrus, supplementary motor area, supramarginal gyrus, inferior frontal gyrus, opercular part, lenticular nucleus, pallidum, rolandic operculum, inferior parietal, supramarginal, and angular gyri. However, increased FC was found between the bilateral hippocampal subregions and the calcarine fissure and surrounding cortex, lingual gyrus, anterior cingulate, and paracingulate gyri. We also found that FC between hippocampal subregions and some brain regions were associated with visual acuity, average cup-to-disc ratio, and retinal nerve fibre layer thickness. Conclusion These findings reveal widespread hippocampal FC alterations involving the cerebellum, sensorimotor, default mode, and visual network (VN) in PACG patients with cognitive dysfunction, contributing to a better understanding of the underlying neural mechanisms.

Background Phacoemulsification combined with intraocular lens implantation and goniosynechialysis (PEI + GSL) represents a mainstream ​surgical technique​for the treatment of primary angle-closure glaucoma (PACG). As the disease progresses, when the extent of peripheral anterior synechiae (PAS) gradually expands to 360°, whether PEI + GSL remains effective remains uncertain. This study aimed to investigate the long-term clinical efficacy​of PEI + GSL in treating PACG patients with 360° PAS. Methods A case‒control study was conducted on PACG patients with 360° PAS (360° PAS group) and those with PASs ranging from 90° to 180° (90°≤ PAS ≤ 180° group). Patients underwent PEI + GSL and were followed up for 1–3 years. The data collected included intraocular pressure (IOP), glaucoma medications, visual acuity, PAS extent, complications, and other relevant parameters. Kaplan‒Meier curves were used to analyse the cumulative surgical success rates in both groups. Results The 360° PAS group included 31 eyes (31 patients), and the 90°≤ PAS ≤ 180° group included 32 eyes (32 patients). At the final follow-up (36 months), the IOP was 14.8 ± 3.9 mmHg in the 360°PAS group and 15.5 ± 2.9 mmHg in the 90°≤ PAS ≤ 180° group ( P  = 0.507). The degree of IOP reduction was 47.9% in the 360°PAS group and 33.0% in the 90°≤ PAS ≤ 180° group ( P  = 0.272). The mean number of glaucoma medications decreased by 2.5 in the 360°PAS group and 1.1 in the 90°≤ PAS ≤ 180° group ( P  < 0.001). The complete plus qualified success rates at 3 years were 90.3% and 93.8%, respectively, with no significant difference ( P  = 0.970). Conclusions PEI + GSL in PACG patients with 360° PAS resulted in a 47.9% reduction in IOP, a mean reduction of 2.5 glaucoma medications, and a high overall surgical success rate (90.3%), comparable to the 90°≤ PAS ≤ 180° group (93.8%). Trial registration ChiCTR2400086966 The study protocol was approved in the Chinese Clinical Trial Registry at 2024-07-16.