[In Press] Diabetes and risk of glaucoma: systematic review and a Meta-analysis of prospective cohort studies

AIM: To quantify the association between diabetes and glaucoma using meta-analysis. METHODS: PubMed and Embase were searched using medical subject headings and key words related to diabetes and glaucoma. The inclusion criteria were: 1) the study design was a prospective cohort study; 2) the exposure of interest was diabetes; 3) the outcome of interest was primary open-angle glaucoma (POAG); 4) Risk ratios (RR) and the corresponding 95% confidence interval. Data were pooled using fixed effects models to take into account heterogeneity between studies. Seven prospective studies were selected. Diabetes increased the incidence of glaucoma by 36% (OR=1.36, 95% CI=1.25-1.50). There was no evidence of statistical heterogeneity (I2= 0.0%, P=0.53) or publication bias (the funnel plot did not identify obvious asymmetry). RESULTS: Seven prospective cohort studies were incorporated in this meta-analysis. The pooled RR of the association between POAG and diabetes based on the risk estimates of the seven cohort studies was 1.36 (95% CI=1.25-1.50), with no significant heterogeneity across studies (I2=0%; P=0.526>0.1). The sensitivity analysis yielded a range of RRs from 1.34 (CI=1.22-1.48) to1.40 (CI=1.18-1.67). CONCLUSION: Diabetes was associated with a significantly increased risk of glaucoma.     

Genome-wide association studies in the hunt for genes causing primary open-angle glaucoma: a review

Genome-wide association studies are a powerful tool for the identification of genetic risk factors for complex disease. This methodology has been successfully applied to primary open-angle glaucoma through the analysis of primary open-angle glaucoma (POAG) as well as specific subgroups of patients including those with normal tension glaucoma and advanced glaucoma. In addition, the analysis of quantitative traits important in POAG, including optic disc area and vertical cup-to-disc ratio has also identified genes important in POAG development. This review explores findings of genome-wide association studies for POAG and related traits.     

正常眼压青光眼与原发性开角型青光眼的比较

正常眼压青光眼（ＮＴＧ）的发病率逐渐增加,日益受到眼科工作者的重视。ＮＴＧ发病隐蔽,早期诊断较其它青光眼显得更为困难和复杂,其发病机制、诊断标准及其与原发性开角型青光眼（ＰＯＡＧ）的异同等一系列问题仍无统一意见。就ＮＴＧ与ＰＯＡＧ的诊断标准,发病机制,临床表现,治疗原则以及相互关系等问题的研究进展等进行综述。     

High myopia as a risk factor in primary open angle glaucoma

Glaucoma, one of the leading causes of irreversible blindness in the adult population worldwide, is a progressive optic neuropathy. Primary open angle glaucoma (POAG) is the most commonly reported type of glaucoma in population based prevalence studies worldwide. Elevated intraocular pressure is a well-known major risk factor for POAG. In addition, there is growing evidence that other risk factors like age, gender, race, refractive error, heredity and systemic factors may play a role in glaucoma pathogenesis. Many studies found that high myopia has been associated with POAG, however, direct and convincing evidences are still lacking. The aim of this review is to summarize the evidences implicating high myopia as a risk factor in the pathogenesis of POAG.     

Daunorubicin versus 5-Fluoro-Uracil in surgical treatment of primary open angle glaucoma: a prospective study

In a prospective randomized study, we compare the results at 20 months of 5 Fluoro-Uracil and Daunorubicin filtering surgery in two groups of 25 patients with primary open-angle glaucoma. For the first group of 14 eyes, 10 injections of 5FU are done and only one subconjunctival preoperative injection of Daunorubicin in the second group of 13 eyes. 5FU group consists of 13 patients: 9 males, 4 females. The mean age is 52.3±18.4 years. The mean follow-up is 6.9 7 months. Daunorubicin group consists of 12 patients: 9 males, 3 females. The mean age is 50.2± 21.4 years. The mean follow-up is 7.3±7 months. By Kaplan-Meier method, the probability success rate is 79 per 100 with 5FU and 68 per 100 with Daunorubicin. After 5FU procedure, the most disturbing complication is related to the decrease in IOP during the first postoperative days: flat anterior chamber (9 eyes) (7 eyes after Daunorubicin), choroïdal detachment (6 eyes) (2 eyes after Daunorubicin), cataract (3 eyes in the two groups). After Daunorubicin, corneal complications are less frequent: corneal ulcer (2 eyes) (3 eyes after 5FU), corneal dystrophy (1 eye in the two groups). Transient chemosis and local palpebral oedema are constant after Daunorubicin. We compared the IOP reduction rate and visual function loss in the two groups.     

Comparison of canaloplasty and trabeculectomy for open angle glaucoma: a Meta-analysis

AIM: To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma. METHODS: Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction (IOPR), postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse events. RESULTS: We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference (WMD) of IOPR between canaloplasty and trabeculectomy from baseline to 12mo was -2.33 (95%CI: -4.00, -0.66). There was not significant improvement in the complete or qualified success rate (OR: 0.58, 95%CI: 0.26, 1.31; OR: 0.50, 95%CI: 0.10, 2.44, respectively). Similarly, no statistically significance was observed in anti-glaucoma mediations reduction (WMD: -0.54, 95%CI: -1.18, 0.09). Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis result. CONCLUSION: Trabeculectomy seems to be more effective in lowering IOP up to 12mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications.     

Normal tension glaucoma: diagnostic features and comparisons with primary open angle glaucoma

Background : A significant proportion of patients diagnosed under the broad classification of open angle glaucoma actually has normal tension glaucoma (NTG). It has many clinical features that overlap with primary open angle glaucoma (POAG), yet there is a question of whether it has a different aetiology in which intraocular pressure plays less of a role. Methods : The epidemiology and clinical features of normal tension glaucoma are reviewed with particular reference to possible differences from primary open angle glaucoma, which might permit differentiation. The pathophysiology is discussed, outlining recent research in cell death (apoptosis), axonal damage and neuroprotection. Discussion and Conclusion : There is considerable evidence that NTG develops with little contribution from the effect of intraocular pressure. However, the clinical diagnosis of NTG is often one of exclusion and the differentiation of NTG from POAG remains difficult because many clinical signs are suggestive but not definitive of NTG. More accurate diagnosis may be possible when individual patients exhibit a greater number of signs. Some evidence suggests that NTG with relatively high pressures (greater than 15 mmHg) is more likely to progress than NTG with relatively low pressures. Clinicians must be particularly alert to the possibility of NTG because IOP, a clinical marker for some glaucomas, is absent.     

Inflammatory model in patients with primary open angle glaucoma and diabetes

AIM: To assess the inflammatory cytokines expression in aqueous humor in diabetic primary open angle glaucoma (POAG) patients. METHODS: A cross-sectional study on 87 eyes, distributed as following: 26 eyes from diabetic patients, 16 eyes with POAG and 21 eyes from diabetic POAG patients; healthy controls (24 eyes) were recruited from patients undergoing conventional cataract surgery. A volume of 100 μL of aqueous humor (AH) was collected during phacoemulsification and 21 inflammatory markers were quantified using a Luminex® cytometric bead assay: IL-1Ra, IL-1α, IL-1β, IL-5, IL-6, IL-10, IL-17, GM-CSF, IFNγ, CCL2, CCL3, CCL4, CXCL5, CXCL8, bFGF, VEGF, TNFα. Main changes in cytokine profile were analyzed and compared between groups. Data on demographics, duration of glaucoma, intraocular pressure (IOP), number of anti-glaucoma substances were recorded for correlation analysis and prediction models. RESULTS: Significant differences in cytokine expression between groups were detected for CXCL5 (P<0.001), CXCL8 (P=0.004), IL-1α (P<0.001), IL-2 (P<0.001), CCL4 (P=0.003), CCL5 (P<0.001) and TNFα (P=0.05). Post-hoc analysis identified IL-2 (P=0.009) and CXCL5 (P<0.001) as “separation markers” between POAG and diabetic POAG eyes. In POAG patients, the “separation markers” could highly predict the TNFα levels F(1, 16)=14.639, P<0.001, whereas in diabetic patients F(1, 24)=4.844, P=0.006 and diabetic POAG patients F(1, 19)=2.358, P=0.05 the level of prediction was inferior. CONCLUSION: Our results reveal an inflammatory model based on increased TNFα levels in POAG eyes. Simultaneous co-stimulatory molecules and additional inflammatory pathways need to be further explored in diabetic POAG cases, since the prediction model could only partially explain the increased TNFα level in this category of patients.     

Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma vs primary open angle glaucoma: a one-year comparative study

AIM: To compare the efficacy of single-session 360-degree selective laser trabeculoplasty (SLT) for reduction of intraocular pressure (IOP) in patients with pseudoexfoliative glaucoma (PXFG) and primary open angle glaucoma (POAG). METHODS: This is a single-center, prospective, nonrandomized comparative study. Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included. The primary outcome measure changed in IOP from baseline. Success was defined as IOP reduction ≥20% from baseline without any additional IOP-lowering medication. All patients were examined at 1d, 1wk, 1, 3, 6, 9, 12mo after SLT. RESULTS: Nineteen patients (20 eyes) with PXFG and 27 patients (28 eyes) with POAG were included in the study. In the visual fields mean deviation was -2.88 (±1.67) in the POAG and -3.1 (±1.69) in the PXFG groups (P=0.3). The mean (±SD) IOP was 22.9 (±3.7) mm Hg in the POAG group and 25.7 (±4.4)?mm Hg in the PXFG group at baseline and decreased to 18.4 (±3.2) and 18.0 (±3.9) mm Hg in the POAG group (P<0.001 and P=0.02), and to 17.9 (±4.0) and 21.0 (±6.6) mm Hg in the PXFG group (P<0.001 and P=0.47) at 6 and 12mo, respectively. The number of medications was 2.6 (±0.8) in the POAG group and 2.5 (±0.8) in the PXFG group at baseline, and did not change at all follow-up visits in both groups (P=0.16 in POAG and 0.57 in PXFG). Based on Kaplan-Meier survival analysis, the success rate was 75% in the POAG group compared to 94.1% in the PXFG group (P=0.08; log rank test) at 6mo, and 29.1% and 25.0% at 12mo, respectively (P=0.9; log rank). CONCLUSION: The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications. The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12-month follow-up.     

外路微导管辅助的360度小梁切开术治疗青少年性开角型青光眼和原发性开角型青光眼的临床对照研究

目的 评估微导管辅助小梁切开术治疗青少年性开角型青光眼（JOAG）和原发性开角型青光眼（POAG)的临床效果和安全性。设计 回顾性病例系列。研究对象2017年11月至2018年12月北京同仁医院接受微导管辅助的小梁切开术治疗的JOAG患者22例（26眼）,平均年龄（25.2±4.5）岁;POAG患者11例（14眼）,平均年龄（46.3±5.1）岁。方法 回顾患者的病历资料,记录眼压、抗青光眼药物使用数量、术中及术后并发症等。术后1、3、6、12个月随访。术后不使用降眼压药物眼压≤21 mmHg且眼压下降幅度≥20%为成功。主要指标 眼压、抗青光眼药物使用数量、术中及术后并发症。结果 所有患者均完成了12个月的随访。JOAG组术前平均眼压（30.6±7.5） mmHg,平均应用（3.5±1.0）种药物;术后12个月平均眼压（15.8±3.3 ) mmHg,平均应用（0.5±1.0）种药物,眼压降幅为44.9%±18.0%。POAG组术前平均眼压（25.4±6.2） mmHg,平均应用（3.4±0.9）种药物;术后12个月平均眼压（15.9±3.2） mmHg,平均应用（0.3±0.6）种药物,眼压降幅为35.8%±15.6%。JOAG组、POAG手术成功率分别为76.0%、78.6%。两组降眼压幅度和成功率均无显著性统计学差异（P=0.122、0.855)。均无严重手术并发症发生。结论 微导管辅助小梁切开术治疗JOAG和POAG均具有较好的短期降眼压效果及安全性。（眼科,2021, 30： 20-24）     

曲伏前列素与噻吗洛尔治疗原发性开角型青光眼疗效的Meta分析

目的:系统评价曲伏前列素滴眼液与噻吗洛尔滴眼液治疗中国成人原发性开角型青光眼(POAG)的血流动力学、散光度及细胞因子的变化。方法:检索PubMed, EMbase, Cochrane Library, Web of Science,中国期刊全文数据库(CNKI),中国生物医学文献数据库(CBM),维普数据库及万方数据库2015-01-01/2020-12-31收录的有关曲伏前列素与噻吗洛尔治疗中国成人POAG的随机对照试验(RCTs)和回顾性队列研究。按照纳入与排除标准筛选文献,用Cochrane风险评估工具对RCTs进行质量评价,用NOS量表对回顾性队列研究进行质量评价。采用Review Manager 5.4软件进行Meta分析并生成加权均数差(WMD)为效应量对比曲伏前列素与噻吗洛尔在视网膜中央动脉(CRA)和睫状后短动脉(PCA)的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)及血管阻力指数(RI)、散光度、血浆内皮素-1(ET-1)、血清基质金属蛋白酶(MMP)、房水基质金属蛋白酶抑制因子-2(TIMP-2)、血清TIMP-2中的差异。结果:共纳入8项RCTs, ...     

Optical coherence tomography evaluation of retinal nerve fiber layer thickness in non-arteritic anterior ischemic optic neuropathy and primary open angle glaucoma: a systematic review and Meta-analysis

AIM: To assess the differences in average and sectoral peripapillary retinal nerve fiber layer (pRNFL) thickness using spectral domain optical coherence tomography (SD-OCT) in patients with non-arteritic anterior ischemic neuropathy (NAION) compared with those with primary open angle glaucoma (POAG).METHODS: A comprehensive literature search of the PubMed, Cochrane Library, and Embase databases were performed prior to October, 2021. Studies that compared the pRNFL thickness in NAION eyes with that in POAG eyes with matched mean deviation of the visual fields were included. The weighted mean difference (WMD) with 95% confidence interval (CI) was used to pool continuous outcomes.RESULTS: Ten cross-sectional studies (11 datasets) comprising a total of 625 eyes (278 NAION eyes, 347 POAG eyes) were included in the qualitative and quantitative analyses. The pooled results demonstrated that the superior pRNFL was significantly thinner in NAION eyes than in POAG eyes (WMD=-6.40, 95%CI: -12.22 to -0.58, P=0.031), whereas the inferior pRNFL was significant thinner in POAG eyes than in NAION eyes (WMD=11.10, 95%CI: 7.06 to 15.14, P≤0.001). No difference was noted concerning the average, nasal, and temporal pRNFL thickness (average: WMD=1.45, 95%CI: -0.75 to 3.66, P=0.196; nasal: WMD= -2.12, 95%CI: -4.43 to 0.19, P=0.072; temporal: WMD= -1.24, 95%CI: -3.96 to 1.47, P=0.370).CONCLUSION: SD-OCT based evaluation of inferior and superior pRNFL thickness can be potentially utilized to differentiate NAION from POAG, and help to understand the different pathophysiological mechanisms between these two diseases. Further longitudinal studies and studies using eight-quadrant or clock-hour classification method are required to validate the obtained findings.     

老年原发性开角型青光眼数据库的建立

目的:针对临床老年原发性开角型青光眼(primary open angle glaucoma,POAG)治疗中目标眼压控制的难题,结合我院医疗设备条件,开发老年POAG数据库,便于资料管理和科研。方法:复习文献制定老年POAG观察资料登记表,应用Microsoft Access2003数据库软件建立老年POAG患者临床资料数据库,并联网测试使用。结果:我院老年POAG数据库初步建立,相关网络通道运行良好。结论:医院老年POAG数据库的建立有利于科学和系统地收集老年POAG相关临床数据,为老年POAG治疗研究提供依据。     

Association between interleukin-10 genetic polymorphisms and risk of primary open angle glaucoma in a Chinese Han population: a case-control study

AIM: To investigate the association between interleukin-10 (IL-10) genetic polymorphisms and risk of POAG through a case-control study in a Han population of China. METHODS: A total of 210 patients with POAG and 420 normal subjects were recruited during the period from Dec. 2013 to Dec. 2016. The IL-10 -1082A>G (rs1800870), -819T>C (rs1800871) and -592C>A (rs1800872) polymorphisms were determined using iPlex GOLD SNP genotyping analysis (the SequenomMassARRAY® System, Sequenom, San Diego, USA). The association between IL-10 -1082A>G (rs1800870), -819T>C (rs1800871), and -592C>A (rs1800872) polymorphisms and risk of POAG was assessed by singlelogistic regression analysis. RESULTS: We observed that those carrying the CC genotype of rs1800871 was associated with an increased risk of POAG when compared with those harboring the TT genotype (OR=1.84, 95%CI=1.01-3.38). Those with AA genotype of rs1800872 had a 10.62 fold risk of POAG in comparison to the CC genotype (OR=10.62, 95%CI, 3.41-33.09). A completely linkage disequilibrium was found between IL-10 rs1800871-rs1800872 (D’=1.00, r2=0.16). The A-C-A (OR=2.60, 95%CI, 1.48-4.58) and G-T-A (OR=2.34, 95%CI, 1.42-3.86) haplotypes were associated with an increased risk of POAG, while the A-T-C haplotype showed a decreased risk of POAG (OR=0.63, 95%CI, 0.49-0.81). CONCLUSION: Our data suggest that IL-10 rs1800871 and rs1800872 can be predictive factors for the pathogenesis of POAG in the Chinese population.     

Comparison of long-term results of trabeculectomy to treat pseudoexfoliative glaucoma and primary open angle glaucoma

AIM: To compare the long term outcome of trabeculectomy in patients with pseudoexfoliative glaucoma (PEG) and primary open angle glaucoma (POAG) in terms of surgical success. METHODS: The success of the trabeculectomy was evaluated by three criteria. Criterion A: intraocular pressure (IOP) ≤21 mm Hg and decrease in IOP ≥20%; Criterion B: IOP ≤18 mm Hg and decrease in IOP ≥30%; Criterion C: IOP ≤15 mm Hg and decrease in IOP ≥50%. Patients that met these criteria without medical treatment were considered to be completely successful, while those that met these criteria with medical treatment were considered partially successful. Significance levels of differences between the POAG and PEG groups in the Kaplan-Meier survival curves were calculated with the log-rank test. RESULTS: Sixty-four eyes from 64 patients with PEG and 51 eyes from 51 patients with POAG were evaluated. No significant differences were detected between the PEG and POAG groups according to full or partial success relative to each of the three criteria (A: P=0.73, 0.32; B: P=0.73, 0.31; C:P=0.90, 0.27). CONCLUSION: There is no difference in the long-term success of trabeculectomy between PEG and POAG patients whose clinical characteristics are otherwise the same.     

原发性开角型青光眼全身危险因素及眼体同治的系统回顾和Meta分析

目的系统回顾原发性开角型青光眼(POAG)存在的全身危险因素,分析眼体同治对POAG的治疗效果。 方法对Embase、Medline、Pubmed、Google Scholarship、ISI Web of Knowledge及the Cochrane Central Register of Controlled Trials等英文文献数据库和维普、万方、中国知网及生物医学文献数据库等中文文献数据库进行检索。在检索结果中,选取以POAG患者作为研究对象,以身体质量指数(BMI)、雌激素相关情况、甲皱襞微循环情况、传统降眼压治疗联合口服硝苯地平以及中西医结合治疗效果为主要分析因素的研究。用Meta分析评估POAG患者BMI情况;并对雌激素及微循环异常在POAG发病中的作用、传统降眼压联合口服硝苯地平及中西医结合对POAG的治疗效果进行系统回顾。 结果BMI相关文献中共6篇文章符合纳入标准进行Meta分析。总样本量26 835例,包括POAG患者3058例,正常对照23 777例。POAG患者BMI (MD＝-0.64,95% CI：-1.06,-0.21)较正常人明显降低,差异有统计学意义( I²＝99%,P<0.05)。共分析雌激素相关文献7篇,其中2项研究结果表明女性停经时间相对较迟可以降低POAG的发病风险,3项研究结果表明停经后雌激素替代治疗降低POAG发病的风险。分析微循环相关文献5篇,研究结果表明POAG患者存在甲皱襞毛细血管出血、扩张、无血管区、血管形态异常、血流流速减慢、流量降低情况。分析传统降眼压治疗联合口服硝苯地平治疗青光眼相关文献10篇,其中4项研究结果表明口服硝苯地平后视野无明显进展或较传统治疗方法视野进展缓慢,5项研究针对口服硝苯地平后青光眼患者眼部血流情况进行研究,其中2项证明眼部血流有改善并且差异有统计学意义(P<0.05),3项无统计学意义( P>0.05)。分析5篇中西医结合治疗POAG相关研究,其中4项研究结果表明中西医结合治疗效果更好,1项研究结果表明组间差异无统计学意义(t＝-0.510,0.140; P>0.05)。 结论POAG患者BMI较正常人低,低雌激素、微循环异常可能增加POAG发病风险。联合硝苯地平及中西医结合的眼体同治方法对POAG治疗效果较传统降眼压治疗效果好。     

Ex-PRESS引流钉植入治疗原发性开角型青光眼的临床观察

目的：观察Ex－PRESS引流钉植入联合调整缝线治疗原发性开角型青光眼的临床效果。方法：回顾2013－01／2015－05在我院就诊的确诊为原发性开角型青光眼患者23例29眼。患者年龄23～42岁,术前最佳矫正视力：指数／50cm～0．5,眼压16～52mmHg。给予降眼压药物效果不理想,行Ex－PRESS引流钉植入联合调整缝线手术。术后进行眼压、滤过泡形成观察及超声生物显微镜（ ultrasound biomicroscope,UBM）观察引流钉开口是否通畅。结果：术后视力0．06～0．5;术后1 wk 平均眼压为10±3mmHg,与术前比较明显降低（ P＜0．05）;手术后有1眼出现术后浅前房,1眼术后第2 d出现前房积血;所有患者（29眼）在术后至术后1wk拆除调整缝线期间滤过泡形成好,有1眼术后3mo复查滤过泡包裹,UBM检查巩膜内口有高密度强回声阻塞物,而无巩膜瓣下通道,其他患者（28眼）术后3mo UBM观察滤过通道通畅。结论：Ex－PRESS青光眼引流钉植入术联合调整缝线治疗开角型青光眼是安全有效的,术中及术后风险低、并发症少。     

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Purpose

To assess the efficacy and safety of different regimens, including monotherapy and double therapy, for primary open‐angle glaucoma (POAG) or ocular hypertension.

Methods

We searched PubMed, EMBASE and clinicaltrials.gov for studies that fit our inclusion criteria in this network meta‐analysis. Randomized controlled trials that report data on efficacy and safety of medications for POAG or ocular hypertension are included. Data on intra‐ocular pressure (IOP) lowering effect and incidence of adverse events including hyperaemia and ocular discomfort were extracted and used in mixed‐comparison analysis.

Results

This study includes 72 randomized trials. Data were available on 12 medical treatments of POAG or ocular hypertension. Of 66 possible comparisons of outcome efficacy, 15 treatments were compared directly. Compared to prostaglandin analogues (PGA), beta‐blockers (BB) showed relatively weaker ability to lower IOP, followed by α2‐adrenergic agonists (AA) and carbonic anhydrase inhibitors (CAI). For dual therapy, regimens composed of a combination of PGA with another treatment demonstrated more powerful IOP lowering efficacy, while the combination of two non‐PGA drugs had lower efficacy in controlling IOP than PGA alone. There was no statistical significance in combinations that did not include PGA on efficacy of IOP control. In terms of tolerance, PGA alone leads to more severe hyperaemia than any other monotherapy regimen, while BBs have the lowest effect on the incidence of hyperaemia. Most dual therapy regimens containing PGA also lead to serious hyperaemia, with the exception of PGA + AA. Compared to regimens containing PGA, those with BB are less likely to cause hyperaemia.

Conclusion

Our network meta‐analysis showed that PGAs provide best IOP lowering effect among all the monotherapy regimen. Combination of PGA and other category of drugs leads to better IOP decrease. Combination of BB and another non‐PGA drug may have less ocular side‐effects than PGA alone.     

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population

Purpose: A retrospective cohort study was undertaken to evaluate and compare the long‐term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population. Methods: Yearly diurnal measurements of intraocular pressure (IOP), best‐corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti­mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed. Results: Sixty‐four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to ≤21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two‐line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline. Conclusions: Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.     

原发性开角型青光眼的早期诊断

青光眼是全世界成人致盲的主要眼病。原发性开角型青光眼做为青光眼的一种类型,其特点是病程进展较为缓慢,多数没有明显症状,不易早期发现。许多患者就诊时已经出现了较严重的视功能障碍,且近年来该病患病率在临床上所占的比例有所上升。而对原发性开角型青光眼的早期诊断,是延缓或停止视功能进行性损害的关键。因此,综合国内外近年来相关文献,对原发性开角型青光眼的早期诊断做以下综述。