Minwen Zhou

Choroidal thickness in fellow eyes of patients with acute primary angle-closure measured by enhanced depth imaging spectral-domain optical coherence tomography.

PURPOSE We evaluated choroidal thickness in the fellow eyes of patients with acute primary angle-closure (APAC) and compared findings to those of normal controls. METHODS The study group comprised 44 fellow eyes defined as primary angle-closure suspect (PACS) of 44 subjects who had experienced APAC and 43 eyes of 43 healthy volunteers. Using enhanced depth imaging optical coherence tomography (EDI-OCT), the peripapillary and macular choroidal thickness of the PACS eyes and the control eyes were measured and compared at each location or segment. Pearson correlation analysis and a multivariable regression model were used to evaluate the relationships between choroidal thickness and related factors. RESULTS At all the macular locations, the choroidal thickness was thickest at the subfovea. The PACS eyes had a thicker choroid than the control eyes at all macular locations (all P < 0.05), and it still was significantly thicker after controlling for age, axial length, and sex, except at 3 mm superior from the fovea (P = 0.124). Multivariable linear regression analysis showed that the subfoveal choroidal thickness was significantly thicker in association with the PACS diagnosis, and thinner in association with older subjects and longer axial length eyes. There were no statistically significant differences in the choroidal thickness between the groups at any peripapillary location or segment (P > 0.05). CONCLUSIONS PACS eyes that had a fellow eye experience of APAC had a thicker macular choroid than the control eyes. The potential role of a thicker choroid as a risk factor for APAC must be investigated further.

Peripapillary choroidal thickness in healthy Chinese subjects

BackgroundTo evaluate the peripapillary choroidal thickness of a healthy Chinese population, and to determine its influencing factors.MethodsA total of 76 healthy volunteers (76 eyes) without ophthalmic or systemic symptoms were enrolled. Choroidal scans (360-degree 3.4 mm diameter peripapillary circle scans) were obtained for all eyes using enhanced depth imaging spectral-domain optical coherence tomography. Choroid thickness was measured at the temporal, superotemporal, superior, superonasal, nasal, inferonasal, inferior, and inferotemporal segments.ResultsThe average peripapillary choroidal thicknesses were 165.03 ± 40.37 μm. Inferonasal, inferior, and inferotemporal thicknesses were significantly thinner than temporal, superotemporal, superior, superonasal, nasal thicknesses (p < 0.05). No statistically significant difference was found among inferonasal, inferior, and inferotemporal thicknesses. The average peripapillary choroidal thickness decreased linearly with age (β = −1.33, 95% CI −1.98, -0.68, P < 0.001). No correlation was noted between average choroidal thickness and other factors (gender, refractive error, axial length, average retinal nerve fiber layer thickness, intraocular pressure, diastolic blood pressure, systolic blood pressure, mean blood pressure, diastolic ocular perfusion pressure, systolic ocular perfusion pressure, and mean ocular perfusion pressure).ConclusionsThe inferonasal, inferior, inferotemporal peripapillary choroidal thicknesses were significantly thinner than temporal, superotemporal, superior, superonasal, and nasal thicknesses. A thinner peripapillary choroid is associated with increasing age.

Ocular Pseudoexfoliation Syndrome and Vascular Disease: A Systematic Review and Meta-Analysis

Objective Many studies have assessed the association between ocular pseudoexfoliation syndrome (PEX) and vascular disease and produced controversial results. We performed a meta-analysis of epidemiologic studies to evaluate this relationship. Methods Eligible studies that reported the incidence of vascular disease among PEX and control groups were identified via computer searches and reviewing the reference lists of the key articles. The summary odds ratio (OR) and 95% confidence interval (CI) were pooled using a random-effects model. Meta-regression to assess heterogeneity by several covariates and a subgroup analysis on study design and population were performed. Publication bias was tested by Beggs funnel plot and Eggers regression test. Results Sixteen eligible studies involving 8,533 PEX patients and 135,720 control patients were included in the meta-analysis. All studies were performed primarily in whites with a mean age between 54.7 and 77.1 years. The overall combined ORs for patients with PEX compared with the reference group were 1.72 (95% CI: 1.31 to 2.26) for any vascular disease, 1.61 (95% CI: 1.22 to 2.14) for coronary heart disease, 1.59 (95% CI: 1.12 to 2.23) for cerebrovascular disease, and 2.48 (95% CI: 1.30 to 4.72) for aortic aneurysm. There was evidence of statistical heterogeneity; however, subgroup and sensitivity analyses showed this result to be robust. No evidence of publication bias was observed. Conclusions The overall current literature suggests that PEX was associated with increased risk of vascular disease. Because of the limitations of the included studies and meta-analysis, the findings need to be confirmed in future research via well-designed cohort studies.

Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a meta-analysis.

Objective To evaluate the efficacy and tolerability of Ex-PRESS implantation (Ex-Press) compared with trabeculectomy (Trab) in the treatment of patients with uncontrolled glaucoma. Methods A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing Ex-Press with Trab. Efficacy estimates were measured by weight mean difference (WMD) for the percentage intraocular pressure (IOP) reduction from baseline to end-point, odds ratio (OR) for complete success, and qualified success rates. Tolerability estimates were measured by OR for adverse events. All outcomes were reported with a 95% confidence interval (CI). Data were synthesized by Stata 11.0 SE for Windows. Results Eight controlled clinical trials meeting the predefined criteria were included in the meta-analysis. A total of 605 eyes from 559 patients with medically uncontrolled glaucoma were included. The weighted mean difference of the percentage IOP reduction from baseline was 2.33 (95% confidence interval: −2.59–7.24) when comparing Ex-Press with Trab. Ex-Press was associated with numerically greater, but nonsignificant, IOP lowering efficacy than Trab. The pooled odds ratio comparing Ex-Press with Trab were 0.93 (0.39, 2.23) for the complete success rate and 1.00 (0.39, 2.56) for the qualified success rate. Ex-Press was associated with a significantly lower frequency of hypotony and hyphema than Trab, with pooled ORs of 0.29 (0.13, 0.65) and 0.36 (0.13, 0.97), respectively. Conclusion Ex-Press was associated with equivalent efficacy to Trab in lowering IOP. Comparable proportions of patients reached the IOP target with Ex-Press and Trab. Ex-Press was better tolerated than Trab.

Choroidal Thickness in the Subtypes of Angle Closure: An EDI-OCT Study

PURPOSE To evaluate choroidal thickness (CT) in the subtypes of angle-closure (AC) disease compared with CT in a healthy control. METHODS A total of 297 subjects (eyes) were enrolled in the study: 87 were nonglaucoma controls and 210 were AC subtype eyes (primary AC suspect [PACS], 73 eyes; acute primary AC [APAC], 46 eyes; primary AC [PAC], 35 eyes; and primary AC glaucoma [PACG], 56 eyes). Enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) was used to measure the macular CT in the subtypes of AC disease and in healthy control subjects. The average CT was compared among the five groups. RESULTS Thinner CT was associated with older age and longer axial length (AL) (all P < 0.001). All AC groups had thicker subfoveal CT (SFCT) compared with the control eyes (all P < 0.05), even after controlling for age and the AL factor. Acute primary angle-closure eyes had the thickest SFCT and were 61.9-μm thicker than healthy eyes, while PACS, PAC, and PACG eyes were 32.9-, 30.9-, and 25.4-μm thicker than healthy eyes, respectively. No significant difference was observed among the PACS, PAC, and PACG groups. CONCLUSIONS Increased CT might be another anatomic characteristic of AC eyes. These findings may support the hypotheses that choroidal expansion is a contributing factor to the development of AC disease.

Changes in Choroidal Thickness After Trabeculectomy in Primary Angle Closure Glaucoma

PURPOSE The purpose of this study was to evaluate changes in choroidal thickness (CT) in advanced or late-stage primary angle closure glaucoma (PACG) patients who had undergone trabeculectomy. METHODS This study included 23 eyes with PACG that required trabeculectomy. Enhanced depth imaging optical coherence tomography was used to measure CT before and 7 days after trabeculectomy. The relationships between changes in CT and changes in IOP and axial length were explored. RESULTS At all nine macular locations, CT was significantly higher after trabeculectomy, with the exception of two sites. CT at locations close to the macula exhibited a greater increase after surgery (except for the inferior location), although there were no significant differences compared to locations farther from the macula. The mean CTs (± SD) under the fovea before and after the surgery were 282.3 (± 42.4) μm and 311.6 (± 59.9) μm, respectively. The mean IOP (± SD) decreased from 25.9 (± 11.0) mm Hg to 11.8 (± 3.2) mm Hg (without antiglaucoma medications), which positively related to the shortened axial length after surgery (P = 0.019). However, the changes in CT were not correlated with either IOP or axial length. CONCLUSIONS Short-term CT increased following trabeculectomy in PACG, but it was not related to decreased IOP or shortened axial length. The potential role for and significance of CT increase after trabeculectomy remains to be interpreted.

Is increased choroidal thickness association with primary angle closure

To investigate whether increased choroidal thickness is a risk factor for primary angle closure.

Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Patients with Open-Angle Glaucoma: A Systematic Review and Meta-Analysis

Objective To examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in open-angle glaucoma at different times post-treatment. Methods Randomized controlled trials (RCTs) comparing SLT versus ALT were searched through August 2013. The main outcome measure was IOP, and secondary outcomes included the number of glaucoma medications, the success rate, and adverse events. Results Six RCTs, involving 482 eyes treated with laser trabeculoplasty, were included in the meta-analysis. For all patients (including first and previous laser trabeculoplasy), no significant difference in IOP lowering was observed between SLT and ALT at one hour (P = 0.40), one week (P = 0.72), one month (P = 0.37), six months (P = 0.08), one year (P = 0.34), two years (P = 0.58), three years (P = 0.34), four years (P = 0.47), and five years (P = 0.50). A statistically significant difference in favor of SLT was found when comparing the IOP reduction at three months after intervention (weighted mean difference (WMD): 1.19 mmHg [0.41; 1.97]; I2=0%; P = 0.003). For patients who were naive to laser, there was no significant difference of reduction in IOP comparing SLT with ALT at any time point. In patients’ previous LT, no statistically significant difference in IOP reduction was found at six months (WMD: 1.92 mmHg [-0.91; 4.74]; I2 = 77.3%; P = 0.18). There was no significant difference in the reduction in the number of glaucoma medications, the success rate, or adverse event rates between the two treatments. Conclusions SLT has equivalent efficacy to ALT with a similar constellation of side effects. In the case of retreatment, SLT appears to be similar to ALT in IOP lowering at six months.

Trabeculectomy with versus without releasable sutures for glaucoma: a meta-analysis of randomized controlled trials

BackgroundThe aim of this study was to compare the efficacy and tolerability of trabeculectomies performed with and without releasable sutures in the treatment of patients with uncontrolled glaucoma.MethodsA comprehensive literature meta-analysis was performed, comparing trabeculectomies performed with and without releasable sutures. The primary efficacy measure was the weighted mean difference (WMD) in percentage intraocular pressure reduction (IOPR%) at the follow-up end point. The secondary efficacy measure was the risk ratio (RR) for complete and qualified success rates of trabeculectomy at the follow-up end point. Trabeculectomy tolerability estimates were measured by the RR for adverse events. All the outcomes were reported with a 95% confidence interval (CI).ResultsThe WMD of the IOPR% from baseline was −4.56 (range −9.24–0.12) when trabeculectomies without releasable sutures were compared with trabeculectomies with releasable sutures. Trabeculectomies with releasable sutures were associated with numerically greater, but nonsignificant, efficacy in terms of lowered IOP compared with trabeculectomies without releasable sutures. The complete and qualified success rate of the two surgical procedures were comparable, with RRs of 0.92 (range 0.80–1.04) and 0.99 (range 0.89–1.11), respectively, at the follow-up endpoints. Trabeculectomies without releasable sutures were associated with a significantly higher frequency of hypotony and flat anterior chambers than trabeculectomies with releasable sutures, with pooled RRs of 4.04 (range 1.88–8.68) and 2.57 (range 1.25–5.30), respectively.ConclusionAlthough the two surgical procedures resulted in equivalent efficacy in IOP control, the trabeculectomies performed with releasable sutures were better tolerated than those without releasable sutures.

Collagen: A potential factor involved in the pathogenesis of glaucoma

Numerous studies have been completed on glaucoma pathogenesis. However, the potential and controversial interaction between ocular biomechanical properties and the glaucomatous diseases process has received much more attention recently. Previous studies have found that collagen tissues gain mutation change in glaucoma patients. This study was conducted to determine the role of collagen in the biomechanics of glaucoma in humans. Its changes may be the result of mechanical modifications brought on by intraocular pressure (IOP) fluctuations. More importantly, biomechanics and genetic evidence indicate that the mutation of collagen may play a role in the process of glaucoma. Alteration of collagen in the outflow pathway may alter mechanical tissue characteristics and a concomitant increase of aqueous humor outflow resistance and elevation of IOP. The variations of collagen, leading to inter-individual differences in scleral and lamina cribrosa properties, result in different susceptibility of individuals to elevated IOP. Therefore, this study hypothesized that collagen mutations may be an original cause of glaucoma.