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Purpose The aim of the study was to compare the frequency and the level of expression of selected miRNAs in the aqueous humor of patients with various types of glaucoma. Methods The studied group consisted of 42 patients with glaucoma: 19 with primary open-angle glaucoma (POAG), 14 with pseudoexfoliation glaucoma (PEXG), 9 with primary angle closure glaucoma (PACG), and the control group of 36 patients with senile cataract without glaucoma. The real-time polymerase chain reaction method was used to analyze the expression of miRNAs. Results There were no significant differences in the frequency and the level of miRNA expression between various types of glaucoma. There was a tendency for hsa-miR-6722-3p and hsa-miR-184 to be expressed more frequently in PEXG and hsa-miR-1260b in POAG. The expression levels of hsa-miR-1260b and hsa-miR-6515-3p were correlated with age in POAG. Target annotation and functional analyses showed that genes targeted by the most frequently expressed miRNAs (hsa-miR-1202, -1260b, -184, -187-5p, -6515-3p, -6722-3p, and hsa-mir-4634) are involved mainly in response to hypoxia, cardiovascular system development, and apoptosis. Conclusion Hsa-miR-1260b was the most abundantly expressed among studied miRNAs and may be a potential biomarker of clinical status in PEXG and PACG.

Small nucleolar RNAs (snoRNAs) are small non-coding regulatory RNAs that have been investigated extensively in recent years. However, the relationship between snoRNA and glaucoma is still unknown. This study aims to analyze the levels of snoRNA expression in the aqueous humor (AH) of patients with pseudoexfoliation glaucoma (PEXG) compared to a control group and identify hypothetical snoRNA-dependent mechanisms contributing to PEXG. The AH was obtained from eighteen Caucasian patients, comprising nine PEXG and nine age-matched control patients. RNA was isolated, and a microarray system was used to determine the snoRNA expression profiles. Functional and enrichment analyses were performed. We identified seven snoRNAs, SNORD73B, SNORD58A, SNORD56, SNORA77, SNORA72, SNORA64, and SNORA32, in the AH of the PEXG and control group patients. Five snoRNAs showed statistically significantly lower expression in the PEXG group, and two snoRNAs had statistically significantly higher expression in the PEXG group compared to the control group. In addition, we identified two factors—CACNB3 for SNORA64 and TMEM63C for SNORA32, similar to PEX-related genes (CACNA1A and TMEM136). The enrichment analysis for four genes targeted by snoRNAs revealed possible mechanisms associated with glaucoma and/or PEX, but the direct role of snoRNAs in these biological processes was not proven.

Aim. The aim of the study was to determine the frequency of pathologies which can mimic normal-tension glaucoma (NTG), observed in neuroimaging of NTG patients, and to evaluate the frequency of pathologies in determined additional indications for neuroimaging. Material and Methods. The studied group consisted of 126 NTG patients who met at least one of the following criteria: unilateral NTG, damage in the visual field (VF) inconsistent with optic disc appearance, fast VF progression, worsening of visual acuity, predominant optic disc pallor rather than optic disc excavation, diagnosis under the age of 50, and scotoma in VF restricted by a vertical line. The patients included in the research underwent MRI scans of the brain and both orbits. Results. After neuroimaging, the results of 29 (23%) patients were qualified as positive; 18 (14.2%) of the identified pathologies were found to clinically affect the visual pathway. The most frequent brain pathology was intracranial meningiomas, observed in 4 patients (3.1%), followed by optic nerve sheath meningiomas diagnosed in 3 cases (2.4%), and brain glioma in 1 patient (0.8%). Pituitary gland adenomas were described in 6 patients (4.5%); 3 of the tumours were in contact with the optic chiasm. 53 (40%) patients had minimal ischemic changes in different regions of the brain. In the case of worsening BCVA or fast VF progression, the frequency of positive results was the highest (50% and 40%), whereas in the case of diagnosis at a young age and unilateral involvement, neuropathology was the rarest (0% and 6.9%). Conclusions. In the case of NTG, the decision to perform neuroimaging should be made after a detailed assessment of clinical status, rather in the event of finding the signs of possible compressive optic neuropathy than as an obligatory procedure for every patient.

Purpose The aim of this study was to describe clinical characteristics of glaucomatous optic neuropathy in treated Polish patients with pseudoexfoliative glaucoma. Methods In the course of the study, 348 eyes of 231 patients with pseudoexfoliative glaucoma. The patients involved in the study were treated in the Department of Diagnostic and Microsurgery of Glaucoma in Lublin between 2012 and 2019. The following parameters were assessed in the examination: visual acuity, slit-lamp biomicroscopy with evaluation of anterior segment of the eye, gonioscopic examination, stereoscopic fundus examination of the eye, intraocular pressure, visual field, and pachymetry. Results The mean age of all the patients was 73.16 years (SD±8.03). The mean age of women was 74.06 (SD±6.97), and the mean age of men was 71.8 (SD±8.51, p=0.006265). Women represented 37.93% (n=132) of the studied group, while men 62.07% (n=216). In the group of patients younger than 65 years of age, 27.9% were male and 15% female (p=0.0021). In the whole studied group, mean peak IOP was 29.25 mmHg with higher mean values in male patients (M vs F: 33.24 mmHg vs 26.86 mmHg; p=0.000). Peak values exceeding 30 mmHg were significantly more frequent in males (M vs F: 56.5% vs 31.9%; p=0.0000). Peak IOP never exceeding 21 mmHg was observed in 18.6% of the patients. The mean value of MD (Mean Deviation) was -12.85 dB in the whole group. The men were more likely to have more advanced glaucoma, according to MD (M vs F: -16.35 dB vs -11.13 dB; p=0.0000). Conclusion Pseudoexfoliative glaucoma was more frequently observed in men with younger age, higher IOP, and more advanced glaucoma. Normotensive glaucoma was observed in 18.6% of the patients with pseudoexfoliative glaucoma.

The aim of the study was to evaluate changes in the central visual pathways during the early and advanced stages of bilateral normal-tension glaucoma (NTG). Methods: The studied groups constituted patients with bilateral normal-tension glaucoma of the same stage (n = 45) and age-matched healthy volunteers (n = 17). All patients underwent ophthalmic examination and examination on a 1.5 Tesla Magnetic Resonance Scanner (Optima 360, GE Healthcare). Volume and cortical thickness analyses were performed using the open-source automated software package FreeSurfer. Results: There was a significant difference in lateral geniculate nuclei volume between the control and advanced glaucoma groups in the right hemisphere (p = 0.03) and in the left hemisphere between the early and advanced glaucoma patients (p = 0.026). The optic chiasm volume differed significantly between the control and advanced NTG groups (p = 0.0003) and between early and advanced glaucoma patients (p = 0.004). Mean cortical thickness analysis revealed a significant increase in values in the advanced glaucoma group in the right Brodmann area 17 (BA17) (p = 0.007) and right BA18 (p = 0.049) as compared to early NTG. In the left BA18 area, the mean thickness of the cortex in the early glaucoma group was significantly lower than in the control group (p = 0.03). Conclusions: The increase in the grey matter thickness in the V1 region with more-advanced glaucoma stages may reflect compensatory hypertrophy. Additionally, the regions of the brain early affected during glaucoma with reduced thickness were the right lateral occipital gyrus and left lingual gyrus. The most prominent change during the course of glaucoma was the increase in grey matter thickness in the right cuneus.

Glaucomatous optic nerve damage is caused by selective death of retinal ganglion cells (RGCs). Another condition with underlying loss of RGCs is autosomal dominant optic atrophy (ADOA). Majority of ADOA patients have mutations inFourThere was a significant difference in genotype frequencies of rs9851685 and rs2111534 polymorphisms between glaucoma patients and control subjects. Several genotype combinations comprising SNPs atIn studied population, genotype CC and allele C of rs9851685

The aim of the study was to assess the volume of the lateral geniculate nucleus (LGN) in patients with open-angle glaucoma in 7Tesla MRI and to evaluate its relation to RNFL thickness and VF indices. Material and methods. The studied group consisted of 20 open-angle glaucoma patients with bilaterally the same stage of glaucoma (11 with early glaucoma and nine with advanced glaucoma) and nine healthy volunteers from the Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Poland. Circumpapillary RNFL-thickness measurements were performed using OCT in all patients and visual fields were performed in the glaucoma group. A 7Tesla MRI was performed to assess the volume of both lateral geniculate bodies. Results. The LGN volume varied significantly between groups from 122.1 &plusmn, 14.4 mm3 (right LGN) and 101.6 &plusmn, 13.3 mm3 (left LGN) in the control group to 80.2 &plusmn, 17.7 mm3 (right LGN) and 71.8 &plusmn, 14.2 mm3 (left LGN) in the advanced glaucoma group (right LGN p = 0.003, left LGN p = 0.018). However, volume values from early glaucoma: right LGN = 120.2 &plusmn, 26.5 mm3 and left LGN = 103.2 &plusmn, 28.0 mm3 differed significantly only from values from the advanced group (right LGN p = 0.006, left LGN p = 0.012), but not from controls (right LGN p = 0.998, left LGN p = 0.986). There were no significant correlations between visual field indices (MD (mean deviation) and VFI (visual field index)) and LGN volumes in both glaucoma groups. Significant correlations between mean RNFL (retinal nerve fiber layers) thickness and corresponding and contralateral LGN were observed for the control group (corresponding LGN: p = 0.064, contralateral LGN: p = 0.031) and early glaucoma (corresponding LGN: p = 0.017, contralateral LGN: p = 0.008), but not advanced glaucoma (corresponding LGN: p = 0.496, contralateral LGN: p = 0.258). Conclusions. The LGN volume decreases in the course of glaucoma. These changes are correlated with RNFL thickness in early stages of glaucoma and are not correlated with visual field indices.

The aim of this paper is to report clinically various cases of intracranial tumors in patients referred to glaucoma clinic for consultation. The secondary aim was to increase the awareness of intracranial tumors in atypical cases of glaucoma. We present the retrospective analysis of five patients referred to glaucoma clinic for consultation. Due to atypical course of the disease, in addition to standard glaucoma examinations, all patients had a neurologic full visual field, color vision, and MRI done. In all patients, intracranial malignancies were found, some patients underwent surgery of the lesions with consecutive clinical improvements. Interestingly, in some patients, coexisting glaucoma was diagnosed. Patients were selected deliberately to present a wide spectrum of possible clinical scenarios when glaucoma may be complicated by intracranial tumors. Sometimes, the relevance of intracranial tumors with respect to their influence on the clinical picture of the optic nerve cannot be established. To conclude, in the “atypical cases of glaucoma” the assessment of the optic nerve may indicate the necessity of neuroimaging in differential diagnostics.

International audience; Exfoliation syndrome (XFS) is the commonest known risk factor for secondary glaucoma and a significant cause of blindness worldwide. Variants in two genes, LOXL1 and CACNA1A have been previously associated with XFS. To further elucidate the genetic basis of XFS, we collected a global sample of XFS cases to refine the association at LOXL1, which previously showed inconsistent results between populations,and to identify new variants associated with XFS. We identified a rare, protective allele at LOXL1 (p.407Phe, OR= 25, P=2.9 x 10-14) through deep resequencing of XFS cases and controls from 9 countries. This variant results in increased cellular adhesion strength compared to the wild-type (p.407Tyr) allele. A genome-wide association study (GWAS) of XFS cases and controls from 24 countries followed by replication in 18 countries identified seven genome-wide significant loci (P < 5 x 10-8). Index variants at the new loci map to chromosomes 13q12 (POMP), 11q23.3 (TMEM136), 6p21 (AGPAT1), 3p24 (RBMS3) and 5q23 (near SEMA6A). These findings provide biological insights into the pathology of XFS, and highlight a potential role for naturally occurring rare LOXL1 variants in disease biology.

Purpose The aim of this study was to describe clinical characteristics of glaucomatous optic neuropathy in treated Polish patients with pseudoexfoliative glaucoma. Methods In the course of the study, 348 eyes of 231 patients with pseudoexfoliative glaucoma. The patients involved in the study were treated in the Department of Diagnostic and Microsurgery of Glaucoma in Lublin between 2012 and 2019. The following parameters were assessed in the examination: visual acuity, slit-lamp biomicroscopy with evaluation of anterior segment of the eye, gonioscopic examination, stereoscopic fundus examination of the eye, intraocular pressure, visual field, and pachymetry. Results The mean age of all the patients was 73.16 years (SD±8.03). The mean age of women was 74.06 (SD±6.97), and the mean age of men was 71.8 (SD±8.51, p=0.006265). Women represented 37.93% (n=132) of the studied group, while men 62.07% (n=216). In the group of patients younger than 65 years of age, 27.9% were male and 15% female (p=0.0021). In the whole studied group, mean peak IOP was 29.25 mmHg with higher mean values in male patients (M vs F: 33.24 mmHg vs 26.86 mmHg; p=0.000). Peak values exceeding 30 mmHg were significantly more frequent in males (M vs F: 56.5% vs 31.9%; p=0.0000). Peak IOP never exceeding 21 mmHg was observed in 18.6% of the patients. The mean value of MD (Mean Deviation) was −12.85 dB in the whole group. The men were more likely to have more advanced glaucoma, according to MD (M vs F: −16.35 dB vs −11.13 dB; p=0.0000). Conclusion Pseudoexfoliative glaucoma was more frequently observed in men with younger age, higher IOP, and more advanced glaucoma. Normotensive glaucoma was observed in 18.6% of the patients with pseudoexfoliative glaucoma.

IMPORTANCE Exfoliation syndrome is a systemic disorder characterized by progressive accumulation of abnormal fibrillar protein aggregates manifesting clinically in the anterior chamber of the eye. This disorder is the most commonly known cause of glaucoma and a major cause of irreversible blindness. OBJECTIVE To determine if exfoliation syndrome is associated with rare, protein-changing variants predicted to impair protein function. DESIGN, SETTING, AND PARTICIPANTS A 2-stage, case-control, whole-exome sequencing association study with a discovery cohort and 2 independently ascertained validation cohorts. Study participants from 14 countries were enrolled between February 1999 and December 2019. The date of last clinical follow-up was December 2019. Affected individuals had exfoliation material on anterior segment structures of at least 1 eye as visualized by slit lamp examination. Unaffected individuals had no signs of exfoliation syndrome. EXPOSURES Rare, coding-sequence genetic variants predicted to be damaging by bioinformatic algorithms trained to recognize alterations that impair protein function. MAIN OUTCOMES AND MEASURES The primary outcome was the presence of exfoliation syndrome. Exome-wide significance for detected variants was defined as P < 2.5 x 10(-6). The secondary outcomes included biochemical enzymatic assays and gene expression analyses. RESULTS The discovery cohort included 4028 participants with exfoliation syndrome (median age, 78 years [interquartile range, 73-83 years]; 2377 [59.0%] women) and 5638 participants without exfoliation syndrome (median age, 72 years [interquartile range, 65-78 years]; 3159 [56.0%] women). In the discovery cohort, persons with exfoliation syndrome, compared with those without exfoliation syndrome, were significantly more likely to carry damaging CYP39A1 variants (1.3% vs 0.30%, respectively; odds ratio, 3.55 [95% CI, 2.07-6.10]; P = 6.1 x 10(-7). This outcome was validated in 2 independent cohorts. The first validation cohort included 2337 individuals with exfoliation syndrome (median age, 74 years; 1132 women; n = 1934 with demographic data) and 2813 individuals without exfoliation syndrome (median age, 72 years; 1287 women; n = 2421 with demographic data). The second validation cohort included 1663 individuals with exfoliation syndrome (median age, 75 years; 587 women; n = 1064 with demographic data) and 3962 individuals without exfoliation syndrome (median age, 74 years; 951 women; n = 1555 with demographic data). Of the individuals from both validation cohorts, 5.2% with exfoliation syndrome carried CYP39A1 damaging alleles vs 3.1% without exfoliation syndrome (odds ratio, 1.82 [95% CI, 1.47-2.26]; P < .001). Biochemical assays classified 34 of 42 damaging CYP39A1 alleles as functionally deficient (median reduction in enzymatic activity compared with wild-type CYP39A1, 94.4%[interquartile range, 78.7%-98.2%] for the 34 deficient variants). CYP39A1 transcript expression was 47% lower (95% CI, 30%-64% lower; P < .001) in ciliary body tissues from individuals with exfoliation syndrome compared with individuals without exfoliation syndrome. CONCLUSIONS AND RELEVANCE In this whole-exome sequencing case-control study, presence of exfoliation syndrome was significantly associated with carriage of functionally deficient CYP39A1 sequence variants. Further research is needed to understand the clinical implications of these findings. National Research Foundation of SingaporeNational Research Foundation, Singapore [NRF-NRFI2018-01]; US National Eye Institute of the National Institutes of Health [R01 EY020928, P30 EY014104, UM1 CA186107, U01 CA167552, EY015473]; Glaucoma Research Foundation of Canada [X052, CIRG17may053]; National Medical Research Council of SingaporeNational Medical Research Council, Singapore The study was funded by grant NRF-NRFI2018-01 from the National Research Foundation of Singapore. Additional support was provided by grants R01 EY020928, P30 EY014104, UM1 CA186107, U01 CA167552, and EY015473 from the US National Eye Institute of the National Institutes of Health, funding from the Glaucoma Research Foundation of Canada, and grants X052 and CIRG17may053 from the National Medical Research Council of Singapore.

Glaucoma is one of the leading causes of visual impairment and blindness worldwide. However, the cause of retinal ganglion cell loss and damage of the optic nerve in its pathogenesis is largely unknown. The high energy demands of these cells may reflect their strong dependence on mitochondrial function and thus sensitivity to mitochondrial defects. To address this issue, we studied whole mitochondrial genome variation in normal tension glaucoma patients and control individuals from the Polish population using next generation sequencing. Our findings indicate that few features of mitochondrial DNA variation are different for glaucoma patients and control subjects. New insights into normal tension glaucoma development are discussed. We provide also a comprehensive approach for mitochondrial DNA analysis and variant evaluation.

Aim: The aim of the study is to assess the outcomes of transconjunctival mitomycin C (MMC)-augmented revision in eyes with failed trabeculectomy. Materials and Methods: This is a retrospective, noncomparative case series. One hundred and twenty-one eyes of 113 consecutive glaucoma patients with previously failed trabeculectomy who underwent transconjunctival revision with at least 12 months of follow-up were initially included in the study. The success was determined on the basis of intraocular pressure (IOP) alone. The main outcome measures were IOP, best-corrected distance visual acuity, complications, bleb appearance, lens status, visual field progression, and time between primary trabeculectomy and MMC revision. The main purpose of the study was to determine the efficacy of a single MMC-augmented needle revision. Results: Mean follow-up was 2.3 years. Twelve months after revision, IOP had declined from 26.1 ± 8.4 mmHg to 14.1 ± 4.8 mmHg (P < 0.05) and remained 16.0 ± 5.6 mmHg at 24 months, 15.7 ± 5.8 mmHg at 48 months, and 15.2 ± 4.0 mmHg at 60 months. Complete success was achieved in 53% of cases, 84% achieved qualified success, and 16% were classified as failures 12 months after revision. Early complications developed in 45 of the initial 121 eyes (37.2%). Conclusions: Transconjunctival MMC-augmented revision appears to be a safe and useful tool in reducing IOP and re-establishing filtration after trabeculectomy failure. This simple procedure has a high rate of success and helps avoid other surgical interventions which are more destructive for the conjunctiva.

The aim of the study was to evaluate the results of nailfold videocapillaroscopic examination in patients with normal-tension glaucoma (NTG) in comparison to age-matched individuals without glaucoma and young healthy volunteers and to assess the relation between the results of this examination with clinical status in NTG group. Material and methods The studied group consisted of 188 patients: 80 patients with NTG and 2 control groups (58 young healthy and 50 age-matched volunteers). The nailfold videocapillaroscopy (NVC) was performed in all participants. The results of every NVC were qualified as a normal or abnormal pattern. In the NTG group, ophthalmic examination was performed and medical history regarding glaucoma, chronic general disorders, and vascular risk factors was recorded. Results In the NTG group, an abnormal NVC pattern was more common than in young controls (p = 0.0008). Microbleedings were present more frequently in NTG patients (p = 0.0365). Enlargement of capillaries (p = 0.0006) and branching capillaries (p = 0.0221) were more frequent in the NTG group compared to age-matched controls. Maximal intraocular pressure was higher in NTG patients with abnormal NVC pattern than with normal NVC (p = 0.0000). Disc hemorrhages were more frequently observed in patients with abnormal NVC pattern (p = 0.0313). Presence of paracentral scotoma was associated with abnormal NVC pattern (p = 0.0054). Conclusions Abnormalities in nailfold capillaroscopy are more frequent in NTG patients. The results of capillaroscopic examination differ in NTG patients according to the profile of ocular and general risk factor.

AIM The aim of this observational study was to evaluate the epidemiology of disc haemorrhages (DH) in Polish patients with normal tension glaucoma (NTG) and their association with some risk factors. MATERIAL AND METHODS The group studied consisted of 274 Caucasian patients with NTG (410 eyes) divided into those with disk haemorrhages (DH+, = 94 eyes in 81 patients) and those without disc haemorrhages (DH-, = 316 eyes in 193 patients). Ophthalmic examinations with visual field (VF) testing were carried out in these patients every 3 months for at least 18 months. The medical history was recorded taking glaucoma, other ophthalmic diseases, chronic general disorders and vascular risk factors into account. RESULTS Unilateral and bilateral DH were observed more frequently in women (p = 0.0010). Maximum IOP was significantly higher in the DH+ group (p = 0.000026). Notches and peripapillary atrophy were found with similar frequency in DH+ and DH- patients (p = 0.4631). The mean defect (MD) in the VF at the time of diagnosis was lower in the DH+ group (-6.27 dB) than in the DH group (-10.14 dB), (p = 0.000055). The initial MD in the DH+ group had a positive correlation with maximum initial IOP. A progressive loss of VF was observed in 206 eyes with NTG (50.2%), with a mean of 0.72 dB/year. The progression was more frequent in DH+ patients (78.4% versus 41.1%), but there were no statistically significant differences in the rate of progression between DH+ and DH- patients (p = 0.46). The morphology of early scotoma depended on the presence of DH (p

The Aim. The aim of this study was to assess general and ocular profiles of patients with single-localisation changes in visual field. Material and Methods. The study group consisted of 215 Caucasian patients with normal-tension glaucoma with scotoma on single localisation or with preperimetric glaucoma. During regular follow-up visits, ophthalmic examination was carried out and medical history was recorded. The results of the visual field were allocated as paracentral scotomas, arcuate scotomas, peripheral defects, or hemispheric defects. Statistical analysis was conducted with Statistica 12, and p<0.05 was considered statistically significant. Results. Risk factors such as notch, disc hemorrhage, general hypertension, migraine, and diabetes were strongly associated with specific visual field defects. Paracentral defect was significantly more frequent for women (p=0.05) and patients with disc hemorrhage (p<0.001). Arcuate scotoma occurred frequently in patients without disc hemorrhage (p=0.046) or migraines (p=0.048) but was observed in coexistence with general hypertension (p<0.001). The hemispheric defect corresponded with notch (p=0.0036) and migraine (p=0.081). Initial IOP was highest in patients with arcuate scotoma and lowest in patients with preperimetric glaucoma (p=0.0120). Conclusions. The specific morphology of scotoma in patients with normal-tension glaucoma is connected with definite general and ocular risk factors.

International audience; Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

Background: The present study compared the effects of adjuvant bevacizumab and 5-fluorouracil on the efficacy and safety of trabeculectomy. Design: A nonrandomized, prospective, interventional case study. Participants: A total of 62 patients in two groups undergoing primary trabeculectomy. Methods: In Group 1 (21 primary open-angle glaucoma, nine pseudoexfoliative glaucoma), trabeculectomy was performed with an adjuvant 5% solution of 5-fluorouracil administered for 4 min, intraoperatively. In Group 2 (21 primary open-angle glaucoma, 11 pseudoexfoliative glaucoma), trabeculectomy was enhanced with 1.25 mg of bevacizumab applied subconjunctivally immediately before and after surgery and again 1 and 7 days after surgery. Main Outcome Measures: Intraocular pressure, best corrected visual acuity, visual field index, bleb morphology, cornel endothelial cell count. Results: Mean intraocular pressure was 28.0 ± 8.0 mmHg before 5-fluorouracil-augmented trabeculectomy and 27.8 ± 9.5 mmHg before bevacizumab-augmented trabeculectomy. After 12 months, mean intraocular pressure was 13.6 ± 4.4 mmHg in the 5-fluorouracil group and 14.7 ± 4.7 mmHg in the bevacizumab group. A 30% reduction of initial intraocular pressure was attained in 86.7% of patients in the 5-fluorouracil group and 78.1% of patients in the bevacizumab group at the end of follow up. No significant differences were noted between the two studied groups with respect to corneal endothelial density, visual field indices and postoperative complications. Conclusions: The 12-month intraocular pressure results showed no significant differences between the two groups of patients after bevacizumab or 5-fluorouracil to augment trabeculectomy. However, to obtain successful intraocular pressure control more patients in bevacizumab group needed medical therapy.

Aim The purpose of this study was to evaluate the influence of polymorphisms of the eNOS gene on the clinical status of patients with normal and high tension glaucoma. Methods 266 Polish Caucasian patients with primary open angle glaucoma were studied. Of the 266, 156 had normal tension glaucoma (NTG) and 110 high tension glaucoma (HTG). DNA material was isolated from peripheral venous blood using commercial kits. Real-time PCR reaction was used to amplify the promoter site of the endothelial nitric oxide synthase (eNOS) gene, including the single nucleotide polymorphism (SNP) site T-786C and part of the 7th exon of eNOS, including G894T SNP. Genotypes were determined with TaqMan SNP Genotyping Assays. Results There were no significant differences in frequencies of the allelic variants of both polymorphisms. In G894T SNP, however, the wild GG form was more common in the HTG group. The SNP of the eNOS gene did not significantly influence the progression rate in either of the groups studied. There were no differences in variants of the eNOS gene regarding the necessity for and success of surgery and the progression of the disease. In the NTG group, no statistical correlation was observed between G894T, T786C polymorphism variants, and risk factors such as optic disc haemorrhages, optic disc notches, and peripapillary atrophy. Mean diastolic and systolic pressure during the day and night were lowest in NTG patients with the CC variant of the T786C polymorphism. No statistical correlation was observed between the G894T and T786C polymorphisms and capillaroscopic examination results. Conclusions Genotype frequencies are similar for both the eNOS G894T and T-786C polymorphisms in NTG and HTG patients. These polymorphisms do not correlate with risk factors and do not influence the state of the capillary system in NTG patients. Systolic blood pressure is lower in NTG patients with mutated alleles of both polymorphisms.

The aimof the research is to analyse the influence of polymorphisms of endothelin-1 gene and endothelin-1 receptor type A gene on the clinical condition of patients with primary open angle glaucoma.Methods. 285 Polish patients took part in the research (160 normal-tension glaucoma and 125 high-tension glaucoma). DNA was isolated by standard methods and genotype distributions of four polymorphisms in genes encoding endothelin-1 (K198N) and endothelin-1 receptor type A polymorphisms (C1222T, C70G, and G231A) were determined. Genotype distributions were compared between NTG and HTG groups. The clinical condition of participants was examined for association with polymorphisms.Results. A similar frequency of occurrence of the polymorphic varieties of the studied genes was observed in patients with NTG and HTG. There is no relation between NTG risk factors and examined polymorphisms. NTG patients with TT genotype of K198N polymorphism presented with the lowest intraocular pressure in comparison to GG + GT genotype (p=0.03). In NTG patients with CC genotype of C1222T polymorphism (p=0.028) and GG of C70G polymorphism (p=0.03) the lowest values of mean blood pressure were observed.Conclusions. The studied polymorphic varieties (K198N, C1222T) do have an influence on intraocular pressure as well as arterial blood pressure in NTG patients.

To determine the efficacy and safety of mitomycin C-augmented revision in eyes after failed primary trabeculectomy failure.Retrospective review of 40 eyes after a single MMC-augmented revision due to primary trabeculectomy failure.intraocular pressure, best corrected visual acuity, number of antiglaucoma medications, complications.Twelve months after revision the mean intraocular pressure declined from 24.5 +/- 6.7 mmHg to 15.4 +/- 4.4 mmHg (p0.05) and remained decreased at 24 months (16.33 +/- 4.2 mmHg) and at 84 months (16.75 +/- 2.8 mmHg). The therapeutic success, defined as intraocular pressureor = 18 mmHg without medication at 12 months after revision, was achieved in seventeen eyes (42.5%). Fourteen eyes (35.0%) achieved qualified success, defined as intraocular pressureor = 18 mmHg with antiglaucoma medication, and 9 of 40 eyes (22.5%) were classified as failures. Mean best corrected visual acuity did not change significantly after the surgery (12 month: p = 0.76, 36-48 months: p = 0.25, 72-84 months: p = 0.15). The mean number of medications was reduced from 1.2 +/- 0.8 preoperatively to 0.68 +/- 0.8 postoperatively at 12 months, to 0.78 +/- 0.49 at 24 months and the drop was statistically significantly. Early complications developed in 7 (17.5%) eyes but they resolved spontaneously.MMC-augmented revision appears to be a safe and useful tool in reducing intraocular pressure after trabeculectomy failure. This simple-technique procedure is successful in 42.5% of eyes for up to 24-36 months and helps protect the eye from other surgical intervention, more destructive for the conjunctiva.

Purpose The purpose of this study was assessment of nailfold capillary changes and their possible relation to polymorphism of a gene encoding endothelial nitric oxide synthase (eNOS) in normal tension glaucoma (NTG) patients Methods The study included 35 normal-tension glaucoma (NTG) patients (23 female and 12 male). Capillaroscopic examination of the nailfold capillaries of II to V fingers of both hands was performed (before and after the cold provocation test) by means of a videocapillaroscope. T786C eNOS gene polymorphism was determined by RT- PCR methods. Results 31 (88.6%) patients suffered from cold extremities. In 24 (68.5%) patients nailfold capillaroscopy was within normal limits, in 11 (31.5%) patients the results were abnormal, 4 (11.4%) of them mimicked changes observed in sclerodermia. The cold provocation test was positive in 43.5% of NTG patients. The patients with NTG presented the following nailfold capillaries: megacapilaries or dilatated capillaries (44.4%), ramified/bushy (18.9%), coiled (17.1%). Assessing the T786C polymorphism of eNOS gene in NTG patients, TT genotype was present in 36% patients, TC in 52.6% and CC in 11.3%. There were no correlation between SNP variants and capillaroscopy results nor cold provocation test ( p=0.9 and 0.5, respectively). Conclusion The T786C polymorphism of eNOS gene does not influence the capillaroscopy results. The high incidence of sclerodermia - like changes in capillaroscopy in NTG needs further studies.

Evaluation of the serum and aqueous humor antibodies to beta-2 glycoprotein I in patients with glaucoma.48 persons (38 women and 17 men), aged 30-86 (mean age 70), suffering from glaucoma was examined. There were 19 with POAG, 18 with PACG and 11 with PEXG. All patients have undergone trabeculectomy. The group of 20 operated patients, because of age-related cataracta (7 men and 13 women), aged 47-82 (mean age 65), constituted a control group. All patients agreed with samples collection. In plasma and anterior chamber fluid, the level of antibodies to b-2 glycoprotein I classes IgA and IgG were measured using ELISA method (commercial kits produced by Euroimmun), according to producer's instruction. Statistical analysis was performed using U Mann-Whitney test when both groups were compared and Spearman test to comparisons concerning single group.Significant changes between glaucoma and cataract patients were observed in anti-b-2 glycoprotein I antibodies class IgA in aqueous humour (p=0.04) and in serum (p=0.03).Knowledge of the immunological pathogenesis in the glaucomatous nerve damage can be curtailed or even prevented with the use of proper agents. Indeed, there are many intriguing new therapeutic possibilities on the horizon. To determine the clinical potential of serum antibodies in glaucoma patients, a randomized clinical trial would be necessary. It is the preliminary communication.

The evaluation of the relationships between the antibodies anti beta-2 glycoprotein I in serum and aqueous humor of the glaucoma patients to the visual field defects.48 persons (38 women and 17 men), aged 30-86 (mean age 70), suffering from glaucoma was examined. There were 19 with POAG, 18 with PACG and 11 with PEXG. All patients have undergone trabeculectomy. In plasma and anterior chamber fluid the level of antibodies to beta-2 glycoprotein I classes IgA and IgG were measured using ELISA method (commercial kits produced by Euroimmun), according to producer's instruction. The visual field defects were examined with Humphrey static perimetry. Statistical analysis was performed using Spearman test.There were no significant correlations between antibodies anti beta-2 glycoprotein I, static perimetry, age and duration of the disease.There have not been stated any relationships between the static perimetry to antiphospholipid antibodies level in serum and aqueous humor in patients with glaucoma. It is the preliminary communication.

There is increasing evidence suggesting, that nitric oxide may be implicated in the pathogenesis of glaucoma. The aim of the study was to evaluate nitric oxide level in aqueous humor of glaucoma patients.The examined group was constituted by 26 persons (13 women and 13 men), aged 60-86 (mean age 70) suffering from glaucoma. In 14 patients glaucoma was classified as POAG and in 12 as PACG. All patients have undergone trabeculectomia. The 14 patients was operated because of age-related cataract (8 women and 6 men), aged 47-82 (mean age 65), constituted a control group. All patients agreed to samples collection. Level of nitric oxide in anterior chamber fluid was assessed using commercial kits based on Griess reaction (RD) according to manufacturer's instruction. Statistical analysis was performed using U Mann-Whitney test.The mean level of nitric oxide in aqueous humor was not significantly different between glaucoma and cataract group (p=0.535). The level of NO in humor aqueous was statistically significantly lower in patients with primary open angle glaucoma than in patients with primary angle closure (p=0.022), and than in control group (p=0.053). No statistically significant differences in the level of nitric oxide in humor aqueous between PACG and cataract patients were observed (p=0.365).