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Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years

Paula, Jayter Silva; Furtado, Joao Marcello; Santos, Arles Silva; Coelho, Roberto de Mattos; Rocha, Eduardo Melani; Veronese Rodrigues, Maria de Lourdes
Fonte: CONSEL BRASIL OFTALMOLOGIA; SAO PAULO Publicador: CONSEL BRASIL OFTALMOLOGIA; SAO PAULO
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
35.94%
Purpose: To determine the proportion of blindness and investigate the relationships between risk factors based on clinical characteristics and development of blindness in patients with primary open-angle glaucoma (POAG) treated for at least 15 years. Methods: A retrospective observational chart review was performed with 403 patients referred to a tertiary level hospital, each with a diagnosis of primary open-angle glaucoma, treated for at least 15 years. Blindness attributable to glaucoma was defined based on visual acuity and/or visual field tests. Variables considered to be possible risk factors for blindness were evaluated using odds ratio (OR), confidence interval (95% CI), and univariate and multivariate analyses. Results: Thirty-one patients became blind [13/53 (24.5%) - unilaterally and 18/53 (34%) - bilaterally] during the follow-up period of treatment (19.5 +/- 4.6 years, range 15-31 years). Multivariate statistics with regression analysis revealed that persistency on initial therapy <= 6 months was significantly associated with blindness, both unilateral (OR: 8.4; 95% CI: 1.3-56.4) and bilateral (OR: 7.2; 95% CI: 1.3-39.6). Other potential factors such as race, age, gender or number of medications were not associated with blindness. Conclusion: Blindness from primary open-angle glaucoma was not uncommon in this population of treated patients after the long follow-up period proposed. Persistence rates with the first therapy...

Bilateral acute angle closure glaucoma caused by fluoxetine: a case report

Pina, S; Silva, F; Alves, S; Azevedo, A; Santos, MJ; Vaz, F; Kaku, P; Esperancinha, F
Fonte: World Glaucoma Association Publicador: World Glaucoma Association
Tipo: Conferência ou Objeto de Conferência
Publicado em //2011 ENG
Relevância na Pesquisa
45.87%
Background: Acute angle closure glaucoma (ACG) occurs in patients with narrow iridocorneal angle, being more prevalent in elderly, hyperopic and asian. Mydriasis, induced by factors such as darkness, stress or drugs, may be a triggering factor of this disease. Methods: Case report of a 55 years old patient, female, black, with history of depressive mood that one month after initiation of oral fluoxetine therapy, appears in the emergency department with bilateral condition of intense eye pain, tearing, photophobia, decreased vision, nausea and vomiting. Ophthalmological exam showed corneal edema, conjunctival injection, mid mydriasis, narrow anterior chamber (AC) and IOP of 58 mmHg OD and 47 mmHg in OS. After systemic therapy with intravenous mannitol, oral acetazolamide and topical pilocarpine, the transparency of the cornea improved, allowing us to perform bilateral iridotomy. Later, the patient underwent Pentacam exam, OCT RNFL and Computerized Perimetry Results: After therapy, there was complete recovery of the symptoms, with stabilization of IOP at 10-12 mmHg OU. Gonioscopy revealed a narrow iridocorneal angle, grade II in Shaffer’s classification, corroborated by the Pentacam exam. The OCT showed a pathological decrease of the nerve fiber layer in the upper OD and suspicion in the upper OS. Perimetry also revealed changes in threshold sensitivity...

Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years

Paula,Jayter Silva; Furtado,João Marcello; Santos,Arles Silva; Coelho,Roberto de Mattos; Rocha,Eduardo Melani; Rodrigues,Maria de Lourdes Veronese
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2012 EN
Relevância na Pesquisa
35.94%
PURPOSE: To determine the proportion of blindness and investigate the relationships between risk factors based on clinical characteristics and development of blindness in patients with primary open-angle glaucoma (POAG) treated for at least 15 years. METHODS: A retrospective observational chart review was performed with 403 patients referred to a tertiary level hospital, each with a diagnosis of primary open-angle glaucoma, treated for at least 15 years. Blindness attributable to glaucoma was defined based on visual acuity and/or visual field tests. Variables considered to be possible risk factors for blindness were evaluated using odds ratio (OR), confidence interval (95% CI), and univariate and multivariate analyses. RESULTS: Thirty-one patients became blind [13/53 (24.5%) - unilaterally and 18/53 (34%) - bilaterally] during the follow-up period of treatment (19.5 ± 4.6 years, range 15-31 years). Multivariate statistics with regression analysis revealed that persistency on initial therapy ≤6 months was significantly associated with blindness, both unilateral (OR: 8.4; 95% CI: 1.3-56.4) and bilateral (OR: 7.2; 95% CI: 1.3-39.6). Other potential factors such as race, age, gender or number of medications were not associated with blindness. CONCLUSION: Blindness from primary open-angle glaucoma was not uncommon in this population of treated patients after the long follow-up period proposed. Persistence rates with the first therapy...

Late recurrent iris synechia following laser goniopuncture for deep sclerectomy enhancement: case report

Hilgert,Christiana Rebello; Hilgert,Guilherme Luz; Hardoim,Vinicius Andrighetto; Omi,Carlos Akira
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2012 EN
Relevância na Pesquisa
35.65%
We report a case of recurrent iris synechiae one year after Nd:YAG laser goniopuncture for deep sclerectomy enhancement in the only functional eye of a patient with end-stage glaucoma. The possible pathophysiology of this uncommon complication and laser treatment aspects are discussed.

Perioperative management of anticoagulant users scheduled for glaucoma surgery: a survey among the Brazilian Glaucoma Society members

Balbino,Marcos; Boin,Plinio; Prata,Tiago Santos
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2013 EN
Relevância na Pesquisa
35.85%
PURPOSE: To investigate and describe, among the members of the Brazilian Glaucoma Society (BGS), the practices regarding the perioperative management of anticoagulants (warfarin and aspirin) use in patients scheduled for glaucoma surgery. METHODS: The active members of the Brazilian Glaucoma Society answered a questionnaire evaluating different aspects of their current perioperative management of glaucomatous patients taking warfarin or aspirin. RESULTS: A total of 52 participants returned a complete questionnaire. Warfarin or aspirin was routinely interrupted prior to glaucoma surgery by 82.7% of the respondents. The majority of the surgeons who discontinued these medications reported doing so 7 days prior to surgery and resumed their use the day after the procedure. Almost half of our interviewees reported hemorrhagic complications that could be related to anticoagulant therapy. A large number of the surgeons (86.5%) preferred a particular surgical technique for anticoagulated patients; however, most of them (88.5%) do not change the anesthetic planning in such patients. Finally, the majority of the participants (90.4%) refer their anticoagulated patients to a preoperative appointment with a cardiologist or a general practitioner before the surgery. CONCLUSIONS: The majority of Brazilian Glaucoma Society members participating in this study interrupt either warfarin or aspirin prior to glaucoma surgery. Although there is scant information available in the literature to offer definitive guidance...

Malignant glaucoma

Cronemberger,Sebastião; Calixto,Nassim; Diniz Filho,Alberto
Fonte: Sociedade Brasileira de Oftalmologia Publicador: Sociedade Brasileira de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2012 EN
Relevância na Pesquisa
35.86%
The aim of this review is to discuss current knowledge about pathophysiology and clinical, therapeutic and prophylactic approaches for malignant glaucoma. This type of glaucoma can occur after different surgical procedures. It can also occur in aphakic, phakic and pseudophakic eyes and develop spontaneously in individuals with no ocular surgical history, or associated with topical miotics. Currently, the ultrasound biomicroscopy has provided many interesting and useful findings for diagnosis and monitoring the treatment of malignant glaucoma. It occurs more often in short eyes in which pre operative measurements of the anterior chamber depth and axial length are extremely important for its prophylaxis and diagnosis.

Long term results of glaucoma surgery among participants in an east African population survey

Quigley, H.; Buhrmann, R.; West, S.; Isseme, I; Scudder, M.; Oliva, M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/2000 EN
Relevância na Pesquisa
35.88%
AIM—To evaluate the long term results of glaucoma surgery among people in East Africa.
METHODS—Participants in a population based survey of eye disease prevalence were offered glaucoma surgery using standardised criteria. Either surgical iridectomy or trabeculectomy was carried out as indicated by a medical officer or by one of two ophthalmologists. Trabeculectomy methods included releasable sutures and mitomycin C in the majority of eyes. Subjects were examined during the first week and 2 months after surgery. Nearly 3 years later, re-examination was carried out in those who were still resident in the region.
RESULTS—Among 46 people who were offered iridectomy, trabeculectomy, or combined cataract extraction/lens implant/trabeculectomy, 21 people underwent surgery (46%). Of the 21, 19 were re-examined at 3 years (90%), including 16/18 eyes after trabeculectomy. Among these, intraocular pressure (IOP) declined from 29.9 (SD 9.4) mm Hg to 14.7 (5.9) mm Hg, with 16 of 18 eyes (89%) achieving a reduction > 25%. Hypotony maculopathy, late bleb leak, and late endophthalmitis were not detected. Visually significant cataract developed in 5/15 re-examined eyes that underwent trabeculectomy alone (33%), possibly associated with pre-existing cataract and diagnosis of angle closure glaucoma...

Gene Therapy Targeting Glaucoma: Where Are We?

Liu, Xuyang; Rasmussen, Carol A.; Gabelt, B’Ann T.; Brandt, Curtis R.; Kaufman, Paul L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
35.85%
In a chronic disease such as glaucoma, a therapy that provides a long lasting local effect, with minimal systemic side effects, while circumventing the issue of patient compliance, is very attractive. The field of gene therapy is growing rapidly and ocular applications are expanding. Our understanding of the molecular pathogenesis of glaucoma is leading to greater specificity in ocular tissue targeting. Improvements in gene delivery techniques, refinement of vector construction methods, and development of better animal models combine to bring this potential therapy closer to reality.

The disc as the basis of treatment for glaucoma

Zangalli, Camila; Gupta, Shelly R.; Spaeth, George L.
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
35.79%
The goal of the treatment of patients with glaucoma is to prevent disability or, if disability already exists, to repair the disability or at the least to prevent further disability from developing. To achieve these goals requires knowing what will happen if there is no treatment and what will happen if there is treatment. That is, one must know the possible benefits from the therapy in comparison to the damage caused by the therapy. As we will demonstrate, the classic risk factors do not provide accurate estimates of the development of disability and do not answer these two questions. The most helpful clues are provided by what the patient says, by whether the disc is damaged and by whether the disc is deteriorating.

Noninvasive Glaucoma Procedures: Current Options and Future Innovations

Abdelrahman, Ahmed M.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
Relevância na Pesquisa
35.83%
Noninvasive glaucoma procedures (NIGPs) represent a new dawn in the management of glaucoma. They try to fill the gap between the shortcoming of invasive glaucoma surgeries and antiglaucoma medications. NIGPs were introduced as an adjunct or alternative treatments for glaucoma. Some of these procedures have shown good efficacy with few serious complications. Hence, they are now used as both primary and adjunctive therapy for glaucoma. The most common NIGPS involve laser and ultrasound technologies. Currently, the portfolio of NIGPs includes argon laser trabeculoplasty, selective laser trabeculoplasty, and micropulse diode laser trabeculoplasty. More recent innovations include therapeutic ultrasound for glaucoma, ultrasonic circular cyclocoagulation, and deep wave trabeculoplasty.

A Study of the Safety and Efficacy of Travoprost 0.004%/Timolol 0.5% Ophthalmic Solution Compared to Latanoprost 0.005% and Timolol 0.5% Dosed Concomitantly in Patients with Open-Angle Glaucoma or Ocular Hypertension

Peace, James H; Mallick, Sushanta; Landry, Theresa A; Bergamini, Michael VW; Rhee, Douglas J; Study Group
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
35.79%
Background/Aims: To compare the intraocular pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% in fixed combination with the unfixed combination of latanoprost 0.005% and timolol 0.5% in open-angle glaucoma or ocular hypertension patients with IOP levels below 18 mmHg on the unfixed combination of latanoprost 0.005% and timolol 0.5%. Methods: Following a 30-day open-label run-in with latanoprost QD PM and timolol QD AM, subjects with intraocular pressure below 18 mmHg were randomized to continue concomitant latanoprost QD PM and timolol QD AM or switch to travoprost 0.004%/timolol 0.5% QD AM and vehicle QD PM in masked fashion and were followed for 3 months. The primary efficacy endpoint was mean IOP reduction from baseline. Results: There were no clinically relevant or statistically significant differences in mean IOP, mean IOP change from baseline, or percentage IOP change from baseline between the two treatment groups. Between-group differences in mean IOP were within ±0.3 mmHg at all time points (p ≥ 0.384), and between-group differences in mean IOP change from baseline were within ±0.4 mmHg at all time points. Overall, 88% of patients whose IOP was less than 18 mmHg on the unfixed combination of latanoprost and timolol remained well controlled on the same regimen in the masked portion of the study...

Role of prostaglandins and specific place in therapy of bimatoprost in the treatment of elevated intraocular pressure and ocular hypertension: A closer look at the agonist properties of bimatoprost and the prostamides

Smid, S.
Fonte: Dove Medical Press Ltd Publicador: Dove Medical Press Ltd
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
35.83%
Bimatoprost is the only representative of a novel class of prostaglandin ethanolamide (prostamide) compounds used therapeutically as an efficacious treatment for glaucoma. The pathways through which bimatoprost works to improve uveoscleral outflow to relieve elevated intraocular pressure are similar to those of the conventional prostaglandins used in glaucoma therapy, with some evidence of a preferential action at the trabecular meshwork. The pharmacology of bimatoprost is however, unclear. Pharmacological evidence supports a specific and distinct receptor-mediated agonist activity of bimatoprost at ‘prostamide’ receptors, which is selective to the prostamides as a class. However, other studies have reported either activity of bimatoprost at additional prostanoid and nonprostanoid receptors, or a conversion of bimatoprost to metabolites with agonist activity at prostaglandin FP receptors in the human eye. The formation of endogenous prostamides has been demonstrated in vivo, by a novel pathway involving the cyclooxygenase-2-mediated conversion of endogenous cannabinoid (endocannabinoid) substrates. Irrespective of the pharmacology of bimatoprost and the prostamides in general, further studies are needed to determine the biological role and biochemical pathology of prostamides in the human eye...

Translational neuroprotection research in glaucoma: a review of definitions and principles

Casson, R.; Chidlow, G.; Ebneter, A.; Wood, J.; Crowston, J.; Goldberg, I.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
45.82%
The maintenance of vision, through prevention and attenuation of neuronal injury in glaucoma, forms the basis of current clinical practice. Currently, the reduction of intraocular pressure is the only proven method to achieve these goals. Although this strategy enjoys considerable success, some patients progress to blindness; hence, additional management options are highly desirable. Several terms describing treatment modalities of neuronal diseases with potential applicability to glaucoma are used in the literature, including neuroprotection, neurorecovery, neurorescue and neuroregeneration. These phenomena have not been defined within a coherent framework. Here, we suggest a set of definitions, postulates and principles to form a foundation for the successful translation of novel glaucoma therapies from the laboratory to the clinic.; Robert J Casson, Glyn Chidlow, Andreas Ebneter, John PM Wood, Jonathan Crowston and Ivan Goldberg

The Rho-kinase Signaling Pathway in Tenon’s Capsule Fibroblasts and Retinal Ganglion Cells: A novel pharmacological target for improving the outcomes of filtration surgery and promoting retinal cell survival in glaucoma; Die Rho-Kinase Signalkette in Tenonfibroblasten und retinalen Ganglienzellen: ein neues pharmakologisches Zielprotein, um den Erfolg der filtrierenden Glaukomchirurgie zu erhöhen und das Überleben retinaler Ganglienzellen in Glaukompatienten zu verbessern.

Tura, Aysegül
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
EN
Relevância na Pesquisa
35.84%
Glaucoma is characterized by the progressive loss of retinal ganglion cells (RGC) and their axons, giving rise to irreversible visual field defects leading to blindness when left untreated. The current methods of glaucoma treatment aim at reducing the intraocular pressure (IOP), the major risk factor arising from an imbalance between the production and outflow of aqueous humor. Glaucoma filtration surgery, which entails the creation of a scleral fistula that enables the drainage of aqueous humor, remains to be the most effective method for lowering the IOP. However, the wound healing activities of the Tenon’s capsule fibroblasts (TCF) result in the occlusion of the drainage channel and account for the surgical failure. The Rho-kinase/ROCK signaling pathway is an intracellular convergence point for signals initiating the cytoskeletal alterations underlying the dynamic events involved in wound healing. The first part of this study therefore focused on the functions of the ROCK-pathway in human TCFs in vitro. With this purpose, the fibroblasts stimulated with serum were treated with H-1152P, a specific ROCK-inhibitor. Incubation of the TCFs with 10 µM H-1152P resulted in an 80-90% reduction in cell proliferation. H-1152P also caused the disassembly of stress fibers in a dose-dependent manner without exerting toxicity and without interfering with the protein kinase A (PKA) pathway. Migration of the fibroblasts and their contractility were also suppressed by H-1152P together with the impairment of fibronectin network assembly. These findings provide further evidence for the role of the ROCK-pathway in the wound healing activities of human TCFs and underline the potential of H-1152P as a safe and specific means to suppress these events. Numerous extracellular signals that induce apoptosis also converge on the activation of ROCK. This places H-1152P mediated ROCK-inhibition as a novel approach for promoting the survival of RGCs in glaucoma...

Safety and feasibility of the use of a bevacizumab-methylcellulose mixture as an adjunct to glaucoma surgery: a pilot study

Paula,Jayter Silva; Secches,Danilo José Lopes; Silva,Marcelo Jordão Lopes; Rodrigues,Maria de Lourdes Veronese; Cunha Junior,Armando da Silva
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 EN
Relevância na Pesquisa
35.79%
ABSTRACT Bevacizumab, a monoclonal anti-vascular endothelial growth factor antibody, has been suggested as a potential healing therapeutic following glaucoma surgery. Here, we aimed to improve the bioavailability of bevacizumab when used as an adjunct therapy to non-penetrating deep sclerectomy (DS) by using a bevacizumab-methylcellulose mixture (BMM). Ten previously non-operated eyes in ten patients diagnosed with primary open angle glaucoma underwent DS with a subconjunctival injection of 0.3 ml of BMM (bevacizumab 3.75 mg incorporated into 4% methylcellulose) at the surgical site. Bevacizumab release was evaluated in vitro using size-exclusion high performance liquid chromatography (HPLC). Intraocular pressure (IOP), bleb morphology, corneal endothelial cell count (CECC), and complications were evaluated at 6 months after surgery. Using HPLC, bevacizumab was detected in BMM for up to 72 h. Moreover, all surgical blebs remained expanded with hyaline material during the first week. A significant IOP reduction (mean ± SD= -10.3 ± 5.4 mmHg, P<0.001) and diffuse blebs were observed at the final follow-up period. Although CECC was slightly reduced (-7.4%), no complications were observed. In conclusion, bevacizumab was released from BMM...

Level of agreement among Latin American glaucoma subspecialists on the diagnosis and treatment of glaucoma: results of an online survey

Grigera,Daniel E.; Mello,Paulo Augusto Arruda; Barbosa,Wilma Lelis; Casiraghi,Javier Fernando; Grossmann,Rodolfo Perez; Peyret,Alejo
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2013 EN
Relevância na Pesquisa
35.95%
PURPOSE: The aim of this research was to assess the level of agreement among glaucoma experts in Latin America on key practices related to treatment and diagnosis of glaucoma. METHODS: An online questionnaire was sent to a multinational panel of glaucoma experts. The questionnaire contained 107 statements on the medical treatment (Part 1) and diagnosis (Part 2) of glaucoma, and was developed in Spanish and translated into English. Agreement was defined as >70% of respondents. RESULTS: Fifty participants from 14 countries completed the questionnaire. For the medical treatment of glaucoma, nearly all respondents (98% or greater) confirmed that medical treatment as first-line therapy is preferred to surgery, prostaglandin analogs are the medication of first choice for primary open-angle glaucoma (POAG), longitudinal monitoring of efficacy should include intraocular pressure, structural and functional status, as well as if patients' quality of life is impaired by the high cost of medication. For the diagnosis of glaucoma section, all respondents confirmed that, after initial examination, gonioscopy should be repeated over time, standard automated perimetry is the most important functional examination for diagnosis and monitoring of primary open-angle glaucoma...

Advanced Glaucoma: Management Pearls

Gessesse, Girum W.; Damji, Karim F.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
35.79%
A significant proportion of glaucoma patients present late, particularly in the developing world, and unfortunately, in an advanced stage of the disease. They are at imminent danger of losing remaining vision, and may also be afflicted with various socioeconomic and health challenges. The encounter with such a patient is typically characterized by anxiety/fear and sometimes hopelessness from the patient's perspective. The physician may also feel that they are in a difficult position managing the patient's disease. When dealing with such cases, we suggest a holistic, individualized approach taking into account the ‘biopsychosociospiritual’ (BPSS) profile of each patient. The BPSS model takes into account relevant ocular as well as systemic biology (factors such as the mechanism of glaucoma, level of intraocular pressure [IOP], rate of progression, life expectancy, general health), psychological considerations (e.g., fear, depression), socio-economic factors and spiritual/cultural values and beliefs before being able to decide with the patient and their care partner(s) what treatment goals should be and how they can best be approached. Treatment for advanced glaucoma can be highly effective, and patients and their care partners should be informed that aggressive IOP lowering to the low teens or even single digits offers the best chance of protecting remaining vision. This can be achieved safely and effectively in most cases with trabeculectomy (including an antimetabolite)...

Neuroprotective therapies in glaucoma: II. Genetic nanotechnology tools

Nafissi, Nafiseh; Foldvari, Marianna
Fonte: Frontiers Media S.A. Publicador: Frontiers Media S.A.
Tipo: Artigo de Revista Científica
Publicado em 14/10/2015 EN
Relevância na Pesquisa
35.89%
Neurotrophic factor genome engineering could have many potential applications not only in the deeper understanding of neurodegenerative disorders but also in improved therapeutics. The fields of nanomedicine, regenerative medicine, and gene/cell-based therapy have been revolutionized by the development of safer and efficient non-viral technologies for gene delivery and genome editing with modern techniques for insertion of the neurotrophic factors into clinically relevant cells for a more sustained pharmaceutical effect. It has been suggested that the long-term expression of neurotrophic factors is the ultimate approach to prevent and/or treat neurodegenerative disorders such as glaucoma in patients who do not respond to available treatments or are at the progressive stage of the disease. Recent preclinical research suggests that novel neuroprotective gene and cell therapeutics could be promising approaches for both non-invasive neuroprotection and regenerative functions in the eye. Several progenitor and retinal cell types have been investigated as potential candidates for glaucoma neurotrophin therapy either as targets for gene therapy, options for cell replacement therapy, or as vehicles for gene delivery. Therefore, in parallel with deeper understanding of the specific protective effects of different neurotrophic factors and the potential therapeutic cell candidates for glaucoma neuroprotection...

A Potential Application of Canaloplasty in Glaucoma Gene Therapy

Tian, Baohe; Kaufman, Paul L.
Fonte: The Association for Research in Vision & Ophthalmology Publicador: The Association for Research in Vision & Ophthalmology
Tipo: Artigo de Revista Científica
Publicado em 31/01/2013 EN
Relevância na Pesquisa
45.83%
Canaloplasty, a recently developed nonpenetrating glaucoma surgical approach, may restore physiological outflow routes in primary open-angle glaucoma with less risk of severe postoperative complications than trabeculectomy. Since the inner wall of Schlemm's canal (SC) is directly in contact with the trabecular meshwork (TM) for 360° and the catheter device used in canaloplasty allows viscoelastic to be injected into the entire length of SC, canaloplasty might also be used to perform SC/TM-targeted delivery of transgene vectors for glaucoma gene therapy. This hypothesized new method for transgene delivery may give the transgene access to the entire inner wall of SC and the whole juxtacanalicular region of the TM and allow the transgene to be expressed in both the TM and SC without affecting the cornea, iris, and ciliary body. This strategy might have a greater trabecular outflow resistance-decreasing effect than either the genetic or surgical approach alone.

Pediatric glaucoma medical therapy: who more accurately reports medication adherence, the caregiver or the child?

Moore, Daniel B; Neustein, Rebecca F; Jones, Sarah K; Robin, Alan L; Muir, Kelly W
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Publicado em 25/11/2015 EN
Relevância na Pesquisa
35.76%
As they grow older, most children with glaucoma must eventually face the transition to self-administering medications. We previously reported factors associated with better or worse medication adherence in children with glaucoma, using an objective, electronic monitor. Utilizing the same data set, the purpose of the current study was to determine whose report (the caregiver’s or the child’s) corresponded better with electronically monitored adherence. Of the 46 participants (22 girls), the mean age of children primarily responsible, and caregiver primarily responsible for medication administration was 15±2 and 10±2 years, respectively. For the children whose caregiver regularly administered the eyedrops, the caregiver’s assessment of drop adherence was associated with measured adherence (P=0.012), but the child’s was not (P=0.476). For the children who self-administered eyedrops, neither the child’s (P=0.218) nor the caregiver’s (P=0.395) assessment was associated with measured percent adherence. This study highlights potential errors when relying on self-reporting of compliance in patients and caregivers with pediatric glaucoma, particularly when the child is responsible for administering their own eyedrops. Frank discussions about the importance of medication adherence and how to improve compliance may help both the child and caregiver better communicate with the treating provider.