Current Status and Future Perspectives of Optic Nerve Imaging in Glaucoma

Lommatzsch, Claudia; van Oterendorp, Christian

doi:10.3390/jcm13071966

Cited by 3 publications

References 75 publications

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Intraocular pressure and optical coherence tomography concerning visual field outcomes in “green” patients: An observational study

Chou,

Tseng,

et al. 2024

Medicine

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This study investigates the relationship between intraocular pressure (IOP), optical coherence tomography (OCT) parameters, and visual field (VF) outcomes in ‘Green’ patients—those with normal OCT findings but potential VF abnormalities. Understanding this relationship is crucial for improving early detection and management strategies for glaucoma, especially in patients who show functional loss despite normal structural findings on OCT. A cross-sectional study was conducted at Taipei City Hospital, Renai Branch, Taiwan, from July 1, 2015, to July 1, 2023. Participants were referred for suspected glaucoma and included based on normal OCT parameters (‘green’ coding) and completed VF tests. Patients with any ocular disease that could confound results were excluded. Logistic regression models were used to assess relationships between IOP, OCT parameters (rim area, disc area, retinal nerve fiber layer thickness, cup-to-disc ratios, and cup volume), and VF outcomes. Age, sex, and IOP status (normal or ocular hypertension) were also included in the analysis. All data were analyzed using Statistical Package for the Social Sciences version 23.0. Larger disc area was a significant predictor of VF abnormalities, with an adjusted OR of 3.72 (95% confidence interval [CI], 1.14–12.15). Neither normal IOP nor ocular hypertension significantly predicted VF loss (adjusted OR = 0.89; 95% CI, 0.27–2.96). Female sex was associated with a higher likelihood of VF abnormalities (adjusted OR = 5.68; 95% CI, 1.03–31.25). Other OCT parameters, including retinal nerve fiber layer thickness and cup-to-disc ratios, were not significantly associated with VF outcomes. Disc area plays a critical role in predicting VF abnormalities in “green” patients, suggesting the importance of integrating disc size into screening and monitoring protocols. These findings challenge the reliance on IOP alone for predicting VF loss and support the need for more comprehensive assessments. Future research should explore longitudinal studies to further assess the predictive value of disc area and investigate additional factors, such as vascular and biomechanical influences, that may contribute to VF deterioration in this population.

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Intraocular pressure and optical coherence tomography concerning visual field outcomes in “green” patients: An observational study

Chou,

Tseng,

et al. 2024

Medicine

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Microglia respond to elevated intraocular pressure and synapse loss in the visual thalamus in a mouse model of glaucoma

Thompson,

McCool,

Smith

et al. 2024

Preprint

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Microglia are resident immune cells of the central nervous system and mediate a broad array of adaptations and responses during disease, injury, and development. Typically, microglia morphology is understood to provide a window into their functional state. However, it is apparent that they have the capacity to adopt a broad spectrum of functional phenotypes characterized by numerous morphological profiles and associated gene expression profiles. Glaucoma, which leads to blindness from retinal ganglion cell (RGC) degeneration, is commonly associated with elevated intraocular pressure and has been shown to trigger microglia responses within the retinal layers, at the optic nerve head, and in retinal projection targets in the brain. The goal of this study was to determine the relationship of microglia morphology to intraocular pressure and the loss of retinal ganglion cell output synapses in the dorsolateral geniculate nucleus (dLGN), a RGC projection target in the thalamus that conveys information to the primary visual cortex. We accomplished this by analyzing dLGN microglia morphologies in histological sections from DBA/2J mice, which develop a form of inherited glaucoma. Microglia morphology was analyzed using skeletonized Iba1-fluorescence images and fractal analyses of individually reconstructed microglia cells. We found that microglia adopted more simplified morphologies, characterized by fewer endpoints and less total process length per microglia cell. There was an age-dependent shift in microglia morphology in tissue from control mice (DBA/2JGpnmb+) that was accelerated in DBA/2J mice. Microglia morphological measurements correlated with cumulative intraocular pressure, immunofluorescence labeling for the complement protein C1q, and density of vGlut2-labeled RGC axon terminals. Additionally, fractal analysis revealed a clear distinction between control and glaucoma dLGN, with microglia from ocular hypertensive DBA/2J dLGN tissue showing an elongated rod-like morphology. RNA-sequencing of dLGN tissue samples showed an upregulation of immune system-related gene expression and several specific genes associated with microglia activation and potential neuroprotective functions. These results suggest that microglia in the dLGN alter their physiology to respond to RGC degeneration in glaucoma, potentially contributing to CNS adaptations to neurodegenerative vision loss.

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Secondary Glaucoma Following Corneal Transplantation: A Comprehensive Review of Pathophysiology and Therapeutic Approaches

Donthula,

Daigavane

2024

Cureus

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Corneal transplantation is a critical surgical procedure aimed at restoring vision in patients with corneal blindness or severe damage. This review focuses on secondary glaucoma, a significant postoperative complication, with the primary objective of providing a comprehensive analysis of its pathophysiology, risk factors, diagnostic challenges, and therapeutic approaches. Unlike other reviews, this work emphasizes the interplay between inflammatory responses, corticosteroid use, and structural changes in the eye that lead to elevated intraocular pressure (IOP) after transplantation. A comprehensive review of the literature was conducted, including studies on postcorneal transplantation glaucoma, to highlight both clinical outcomes and the efficacy of current management strategies. Key findings indicate that medical treatments, such as prostaglandin analogs and beta-blockers, are effective for IOP control in the early stages, while surgical interventions, like trabeculectomy, are often necessary for more advanced cases. Diagnostic challenges, such as the difficulty of accurate IOP measurement posttransplant, are underscored, along with the importance of advanced imaging techniques for the early detection of optic nerve damage. The pathophysiology of secondary glaucoma involves a complex interaction of postsurgical inflammation, steroid-induced complications, and anatomical changes that hinder aqueous humor outflow. Diagnosis requires a combination of tonometry, gonioscopy, and imaging technologies. Management strategies range from pharmacological treatments to surgical options, with a critical focus on balancing IOP control and minimizing risks to graft survival. Clinically, these findings highlight the need for proactive and tailored management of IOP in corneal transplant patients to preserve both graft function and long-term visual outcomes. Future research should focus on improving diagnostic accuracy, developing less invasive surgical techniques, and exploring personalized medicine approaches, including genetic profiling and targeted therapies.

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Current Status and Future Perspectives of Optic Nerve Imaging in Glaucoma

Cited by 3 publications

References 75 publications

Intraocular pressure and optical coherence tomography concerning visual field outcomes in “green” patients: An observational study

Intraocular pressure and optical coherence tomography concerning visual field outcomes in “green” patients: An observational study

Microglia respond to elevated intraocular pressure and synapse loss in the visual thalamus in a mouse model of glaucoma

Secondary Glaucoma Following Corneal Transplantation: A Comprehensive Review of Pathophysiology and Therapeutic Approaches

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