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.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Primary open-angle glaucoma (POAG) is a leading cause of blindness, and its primary risk factor is elevated intraocular pressure (IOP) due to pathologic changes in the trabecular meshwork (TM). We ...previously showed that there is a cross-inhibition between TGFβ and Wnt signaling pathways in the TM. In this study, we determined if activation of the Wnt signaling pathway using small-molecule Wnt activators can inhibit TGFβ2-induced TM changes and ocular hypertension (OHT).PurposePrimary open-angle glaucoma (POAG) is a leading cause of blindness, and its primary risk factor is elevated intraocular pressure (IOP) due to pathologic changes in the trabecular meshwork (TM). We previously showed that there is a cross-inhibition between TGFβ and Wnt signaling pathways in the TM. In this study, we determined if activation of the Wnt signaling pathway using small-molecule Wnt activators can inhibit TGFβ2-induced TM changes and ocular hypertension (OHT).Primary human TM (pHTM) cells and transduced SBE-GTM3 cells were treated with or without Wnt and/or TGFβ signaling activators and used for luciferase assays; for the extraction of whole-cell lysate, conditioned medium, cytosolic proteins, and nuclear proteins for Western immunoblotting (WB); or for immunofluorescent staining. Human donor eyes were perfusion cultured to study the effect of Wnt activators on IOP.MethodsPrimary human TM (pHTM) cells and transduced SBE-GTM3 cells were treated with or without Wnt and/or TGFβ signaling activators and used for luciferase assays; for the extraction of whole-cell lysate, conditioned medium, cytosolic proteins, and nuclear proteins for Western immunoblotting (WB); or for immunofluorescent staining. Human donor eyes were perfusion cultured to study the effect of Wnt activators on IOP.We found that the small-molecule Wnt activators (GSK3β inhibitors) (BIO, SB216763, and CHIR99021) activated canonical Wnt signaling in pHTM cells without toxicity at tested concentrations. This activation inhibited TGFβ signaling as well as TGFβ2-induced extracellular matrix deposition and formation of cross-linked actin networks in pHTM cells or SBE-GTM3 cells. We also observed nuclear translocation of both Smad4 and β-catenin in pHTM cells, which suggested that the cross-inhibition between the TGFβ and Wnt signaling pathways may occur in the nucleus. Using our ex vivo model, we found that CHIR99021 inhibited TGFβ2-induced OHT in perfusion-cultured human eyes.ResultsWe found that the small-molecule Wnt activators (GSK3β inhibitors) (BIO, SB216763, and CHIR99021) activated canonical Wnt signaling in pHTM cells without toxicity at tested concentrations. This activation inhibited TGFβ signaling as well as TGFβ2-induced extracellular matrix deposition and formation of cross-linked actin networks in pHTM cells or SBE-GTM3 cells. We also observed nuclear translocation of both Smad4 and β-catenin in pHTM cells, which suggested that the cross-inhibition between the TGFβ and Wnt signaling pathways may occur in the nucleus. Using our ex vivo model, we found that CHIR99021 inhibited TGFβ2-induced OHT in perfusion-cultured human eyes.Our results showed that small-molecule Wnt activators have the potential for treating TGFβ signaling-induced OHT in patients with POAG.ConclusionsOur results showed that small-molecule Wnt activators have the potential for treating TGFβ signaling-induced OHT in patients with POAG.
IMPORTANCE Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of ...the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. OBJECTIVE To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. EVIDENCE REVIEW A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. FINDINGS The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. CONCLUSIONS AND RELEVANCE Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
Transscleral cyclophotocoagulation (TSCPC) is a minimally invasive laser procedure used to reduce intraocular pressure in patients with glaucoma. By selectively coagulating the ciliary body, TSCPC ...reduces the production of aqueous humour and lowers intraocular pressure. TSCPC can be performed using various laser delivery methods, including “pop”‐titrated (PT–CPC), “slow‐burn” (SB‐CPC), and micropulse techniques (MP‐CPC).
MP‐TSCPC has been shown to be effective in lowering IOP in patients with mild to moderate glaucoma, but may be less effective in patients with more advanced glaucoma or those with higher baseline IOP levels. PT/SB‐CPC, on the other hand, has been shown to be effective in lowering IOP in patients with refractory glaucoma who have not responded to other treatment options. Although there is a lot of research on the efficacy and safety of TSCPC, there is still limited data available, particularly comparing different TSCPC techniques.
The present talk will summarize our experience with different TSCPC techniques, including patient selection, potential risks and benefits.
Poem by a Woman With Glaucoma Erickson, Terri Kirby
JAMA : the journal of the American Medical Association,
11/2021, Letnik:
326, Številka:
18
Journal Article
Interpreting the results of standard automated perimetry (SAP) is not difficult but a systematic approach is pivotal. In this part of the course we address the following topics: Which test to choose ...in which situation? Is the test reliable? What are common artefacts and how do you recognize them? What do the various plots mean on the printout? What do the global indices mean? How do you differentiate a normal from an abnormal test? What abnormalities are typical of glaucoma? And what of other pathologies?
Glaucoma is a neurodegenerative disease characterized by the progressive degeneration of retinal ganglion cells. Oxidative stress has been related to the cell death in this disease. Theoretically, ...this deleterious consequence can be reduced by antioxidants substances. This presentation intends to update the knowledge about oxidative stress mechanisms in relation with glaucoma and the effect of antioxidant coadjuvant therapy on this disease.
The French approach Rousseau, Antoine
Acta ophthalmologica (Oxford, England),
December 2022, 2022-12-00, 20221201, Letnik:
100, Številka:
S275
Journal Article
Recenzirano
If one could define one French specificity regarding the medical management of glaucoma, it would certainly be a high propensity to consider the ocular surface when treating a patient. Therefore, the ...first part will focus on why the interactions between ocular surface and glaucoma treatments are so important, and how to manage them.
Regarding the surgical aspect, French ophthalmologists, more than other, have a preference for non‐penetrating deep sclerectomy, which is considered for many as the reference surgical procedure for open angle glaucoma. Thus, in the second part, we'll consider the pros and cons, and some tips to succeed with this technique.
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