Off the Cuff: Role Models

This study evaluated retinal ganglion cell (RGC) function after intraocular pressure (IOP) reduction measured by pattern electroretinogram (PERG) in patients with newly diagnosed, non-treated preperimetric and early stages of primary open-angle glaucoma (POAG). Twenty-four eyes from 24 patients with POAG were included: 11 eyes with preperimetric glaucoma and 13 eyes with early glaucoma received Ganfort (bimatoprost and timolol) once a day for a period of one month. Before and after the treatment, the following measurements were analyzed: IOP, mean ocular perfusion pressure (MOPP), peak time of P50, and amplitude of P50 and N95 waves in PERG (ISCEV standard 2012). Correlations between PERG P50 and N95 waves, IOP and MOPP were calculated.

After therapy, IOP significantly decreased in all eyes, on average 31%. A significant increase in MOPP in all eyes of on average 14% was detected. PERG amplitude of P50 and N95 waves increased in 75% and 79% eyes, respectively, and on average by 28% for P50 and 38% for N95. There were no significant interactions between the change of PERG parameters in time and stage of glaucoma.

Researchers concluded that significant IOP-lowering therapy could improve RGC function measured by PERG in patients with preperimetric and early stages of POAG.

This study evaluated success rates in controlling intraocular pressure (IOP) after implantation of a second glaucoma drainage device (GDD) with a Baerveldt glaucoma implant in patients with refractory glaucoma, with a secondary aim of reducing the need for postoperative glaucoma medications. This retrospective, noncomparative, interventional study included patients undergoing a second GDD for uncontrolled glaucoma from a tertiary care glaucoma service. Data were obtained from the medical records for the preoperative period and after the first, fifteenth and thirtieth day; after three, six and 12 months, and then yearly until the last postoperative visit. Visual acuity, IOP and number of glaucoma medications (NGM) from the follow-up visits were compared to baseline. Success and failure criteria were analyzed based on IOP level or need of glaucoma medications.

Forty-nine patients were studied, with a mean follow-up time of 25 ± 21 months. The mean preoperative IOP was 23.7mm Hg ± 8.2mm Hg, and decreased to 14.8mm Hg  ± 4.0mm Hg after one year, 14.4mm Hg  ± 3.9mm Hg after two years and 16.6mm Hg  ± 8.5mm Hg after three years. The mean preoperative NGM was 3.4 ± 1.3 and decreased to 2.0 ± 1.8 after one year, 2.5 ± 1.6 after two years and 2.8 ± 2.0 after three years. Absolute success was 9% after one year for a postoperative IOP between 5mm Hg and 18 mmHg, and 76% for a postoperative IOP between 5mm Hg and 21 mmHg. The qualified success was 88% at the first and second years, and 83% at the third year.

With up to three years of follow-up, a second glaucoma drainage device was successful in reducing IOP to below 21 mmHg, but not as successful below 18 mmHg. The success rate was improved with the use of glaucoma medications within three years of follow-up.

This study determined the expression profile of immune response and inflammation (IRI) mediator molecules in tears from patients with dry eye (DE), and those who were suspected of having or who had been diagnosed with primary open-angle glaucoma (POAG) and were receiving treatment, and compared them with healthy controls. This prospective, observational, cohort study included 107 participants, subdivided into: healthy controls (CG; n=30), patients with DE (DEG; n=41), and patients suspected of having or who were diagnosed with POAG and were receiving hypotensive treatment (POAG-G; n=36). Tear samples were collected by capillary to be processed using a multi-immunoassay system based on flow cytometry (Luminex R-200), in order to determine the interleukins (IL): 1β, 2, 4, 5, 6 and 10, and growth factors including tumor necrosis alpha (TNF-α), vascular endothelial (VEGF), and granulocyte macrophage-colony stimulating factor (GM-CSF). Data were processed using the SPSS 20.0 program.

Molecules that significantly increased in tears from DEG vs. POAG-G patients were: IL-1, IL-6 and IL-10, whereas VEGF significantly decreased in the DEG. The POAG-G showed significantly higher IL-6 values compared with the CG. When comparing the DEG and POAG-G, significant differences were observed in tear expression of IL-4, IL-6, TNF-α, GM-CSF and VEGF.

Investigators wrote that the increased expression of IRI mediators in tears from patients with DE or POAG strongly demonstrated the importance of immune response in both pathologies. They added that the different molecules involved also suggested distinct signaling pathways for these processes that required further research.