Publications by authors named "Francesco Oddone"

119 Publications

A new look at the safety and tolerability of prostaglandin analogue eyedrops in glaucoma and ocular hypertension.

Expert Opin Drug Saf 2021 Oct 19. Epub 2021 Oct 19.

1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Introduction: In the last 25 years, topical prostaglandin analogues (PGAs) have emerged to become first line and first choice therapeutic options in the management of glaucoma and ocular hypertension (OHT). Although the short-term efficacy and safety of PGAs has been extensively investigated, less is known about their long term safety and tolerability. This gap in current knowledge is clinically relevant, because treatment-related adverse events and long-term tolerability issues are key determinants of the overall success of long-term therapy and the final outcome of a lifelong, symptomless disease like glaucoma.

Areas Covered: We include selected evidence pertaining to the safety and tolerability of available and emerging PGA formulations. We also outline PGA formulations with different concentrations of the active ingredient, different preservatives, and preservative-free (PF) options.

Expert Opinion: Undoubtedly PGAs will continue to play a major role in the medical therapy of glaucoma and OHT. Despite extensive literature and prolonged clinical experience with these agents worldwide, a number of areas that warrant further research have been identified in the present review. Recently launched novel PGAs, or those still in development offer new opportunities and future challenges.
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http://dx.doi.org/10.1080/14740338.2022.1996560DOI Listing
October 2021

At the Cutting Edge against Cancer: A Perspective on Immunoproteasome and Immune Checkpoints Modulation as a Potential Therapeutic Intervention.

Cancers (Basel) 2021 Sep 28;13(19). Epub 2021 Sep 28.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.

Immunoproteasome is a noncanonical form of proteasome with enzymological properties optimized for the generation of antigenic peptides presented in complex with class I MHC molecules. This enzymatic property makes the modulation of its activity a promising area of research. Nevertheless, immunotherapy has emerged as a front-line treatment of advanced/metastatic tumors providing outstanding improvement of life expectancy, even though not all patients achieve a long-lasting clinical benefit. To enhance the efficacy of the currently available immunotherapies and enable the development of new strategies, a broader knowledge of the dynamics of antigen repertoire processing by cancer cells is needed. Therefore, a better understanding of the role of immunoproteasome in antigen processing and of the therapeutic implication of its modulation is mandatory. Studies on the potential crosstalk between proteasome modulators and immune checkpoint inhibitors could provide novel perspectives and an unexplored treatment option for a variety of cancers.
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http://dx.doi.org/10.3390/cancers13194852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507813PMC
September 2021

Glaucoma Heritability: Molecular Mechanisms of Disease.

Genes (Basel) 2021 Jul 27;12(8). Epub 2021 Jul 27.

Midwest Eye Institute, Indianapolis, IN 46290, USA.

Glaucoma is one of the world's leading causes of irreversible blindness. A complex, multifactorial disease, the underlying pathogenesis and reasons for disease progression are not fully understood. The most common form of glaucoma, primary open-angle glaucoma (POAG), was traditionally understood to be the result of elevated intraocular pressure (IOP), leading to optic nerve damage and functional vision loss. Recently, researchers have suggested that POAG may have an underlying genetic component. In fact, studies of genetic association and heritability have yielded encouraging results showing that glaucoma may be influenced by genetic factors, and estimates for the heritability of POAG and disease-related endophenotypes show encouraging results. However, the vast majority of the underlying genetic variants and their molecular mechanisms have not been elucidated. Several genes have been suggested to have molecular mechanisms contributing to alterations in key endophenotypes such as IOP (, , , and , and VCDR (, , , and ). Still, genetic studies about glaucoma and its molecular mechanisms are limited by the multifactorial nature of the disease and the large number of genes that have been identified to have an association with glaucoma. Therefore, further study into the molecular mechanisms of the disease itself are required for the future development of therapies targeted at genes leading to POAG endophenotypes and, therefore, increased risk of disease.
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http://dx.doi.org/10.3390/genes12081135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391305PMC
July 2021

Topical carbonic anhydrase inhibitors and glaucoma in 2021: where do we stand?

Br J Ophthalmol 2021 Aug 25. Epub 2021 Aug 25.

Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour production; however, frequent side effects including polyuria and paresthesia contributed to the eventual development of topical CAIs. As topical drug development evolved over time, prostaglandin analogues and beta-blockers have become the gold standard of glaucoma therapies. Although prescribed less often than other classes of topical glaucoma therapies, topical CAIs continue to be used in combination therapies with beta-blockers and alpha agonists. Topical CAIs have also been demonstrated to alter biomarkers of ocular haemodynamics, which have relevance in glaucoma. The purpose of this review is to review and summarise the current state of topical CAI prescribing trends, known efficacy and suggested mechanisms and potential influence on ocular haemodynamics for the future of glaucoma management.
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http://dx.doi.org/10.1136/bjophthalmol-2021-319530DOI Listing
August 2021

Neural Conduction Along Postretinal Visual Pathways in Glaucoma.

Front Aging Neurosci 2021 2;13:697425. Epub 2021 Aug 2.

IRCCS-Fondazione Bietti, Rome, Italy.

: This study was conducted in order to evaluate retinal ganglion cell (RCG) function and the neural conduction along the postretinal large and small axons and its correlation with retinal nerve fiber layer thickness (RNFL-T) in open-angle glaucoma (OAG) eyes. : Thirty-seven OAG patients (mean age: 51.68 ± 9.83 years) with 24-2 Humphrey mean deviation (MD) between -2.5 and -20 dB and IOP <21 mmHg on pharmacological treatment (OAG group) and 20 age-matched controls (control group) were enrolled. In both groups, simultaneous pattern electroretinograms (PERG) and visual evoked potentials (VEP), in response to checks stimulating macular or extramacular areas (the check edge subtended 15' and 60' of visual arc, respectively), and RNFL-T (measured in superior, inferior, nasal, and temporal quadrants) were assessed. : In the OAG group, a significant (ANOVA, < 0.01) reduction of 60' and 15' PERG P50-N95 and VEP N75-P100 amplitudes and of RNFL-T [overall (average of all quadrants) or temporal] with respect to controls was found; the values of 60' and 15' PERG P50 and VEP P100 implicit times and of retinocortical time (RCT; difference between VEP P100 and PERG P50 implicit times) were significantly ( < 0.01) increased with respect to control ones. The observed increased RCTs were significantly linearly correlated (Pearson's test, < 0.01) with the reduced PERG amplitude and MD values, whereas no significant linear correlation ( < 0.01) with RNFL-T (overall or temporal) values was detected. : In OAG, there is an impaired postretinal neural conduction along both large and small axons (increased 60' and 15' RCTs) that is related to RGC dysfunction, but independent from the RNFL morphology. This implies that, in OAG, the impairment of postretinal neural structures can be electrophysiologically identified and may contribute to the visual field defects, as suggested by the linear correlation between the increase of RCT and MD reduction.
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http://dx.doi.org/10.3389/fnagi.2021.697425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365149PMC
August 2021

Improving event-based progression analysis in glaucomatous visual fields.

Sci Rep 2021 08 11;11(1):16353. Epub 2021 Aug 11.

Fondazione Bietti IRCCS, Rome, Italy.

Glaucoma is a progressive optic neuropathy with characteristic changes to the optic nerve head and the visual field (VF). Detecting progression of VF damage with Standard Automated Perimetry (SAP) is of paramount importance for clinical care. One common approach to detecting progression is to compare each new VF test to a baseline SAP test (event analysis). This comparison is made difficult by the test-retest variability of SAP, which increases with the level of VF damage, and the limited range of measurement, meaning that damage cannot be assessed below a certain level. We performed a prospective international multi-centre data collection of SAP data on 90 eyes from 90 people with glaucoma and different levels of VF damage over a short period of time (6 tests in 60 days). Data were collected using a fundus tracked perimeter (Compass, CenterVue). We used these data (minus the first test) to develop an improved event analysis that accounts for both the change in variability with damage and the lower bound on the measurement imposed by SAP. Using simulations, we show that our approach is more sensitive compared to previously developed methods, especially in the case of advanced glaucoma, while retaining similar specificity.
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http://dx.doi.org/10.1038/s41598-021-95877-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8357820PMC
August 2021

Vascular biomarkers from optical coherence tomography angiography and glaucoma: where do we stand in 2021?

Acta Ophthalmol 2021 Aug 6. Epub 2021 Aug 6.

IRCCS -Fondazione Bietti, Rome, Italy.

Biomarkers of ocular blood flow originating from a wide variety of imaging modalities have been associated with glaucoma onset and progression for many decades. Advancements in imaging platforms including optical coherence tomography angiography (OCTA) have provided the ability to quantify vascular changes in glaucoma patients, alongside traditional measures such as retinal nerve fibre layer thickness and optic nerve head structure. Current literature on vascular biomarkers, as measured by OCTA, indicates significant relationships between glaucoma and blood flow and capillary density in the retina and ONH. The data currently available, however, are highly diverse and lack robust longitudinal data on OCTA vascular outcomes and glaucoma progression. Herein we discuss and summarize the relevant current literature on OCTA vascular biomarkers and glaucoma reviewed through March 1, 2021. Associations between OCTA vascular biomarkers and clinical structural and functional glaucoma outcomes as well as differences between glaucoma patients and healthy controls are reviewed and summarized. The available data identify significantly decreased flow density, flow index and vessel density in the ONH, peripapillary vascular layer and macula of glaucoma patients compared with controls. Whole image vessel density is also significantly decreased in glaucoma patients compared with controls, and this outcome has been found to correspond to severity of visual field loss. OCTA vascular biomarkers alongside clinical structural outcomes may aid in assessing overall risk for glaucoma in patients.
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http://dx.doi.org/10.1111/aos.14982DOI Listing
August 2021

Risk Factors for Retinal Ganglion Cell Distress in Glaucoma and Neuroprotective Potential Intervention.

Int J Mol Sci 2021 Jul 27;22(15). Epub 2021 Jul 27.

Department of Experimental Medicine (DIMES), University of Genoa, 16126 Genoa, Italy.

Retinal ganglion cells (RGCs) are a population of neurons of the central nervous system (CNS) extending with their soma to the inner retina and with their axons to the optic nerve. Glaucoma represents a group of neurodegenerative diseases where the slow progressive death of RGCs results in a permanent loss of vision. To date, although Intra Ocular Pressure (IOP) is considered the main therapeutic target, the precise mechanisms by which RGCs die in glaucoma have not yet been clarified. In fact, Primary Open Angle Glaucoma (POAG), which is the most common glaucoma form, also occurs without elevated IOP. This present review provides a summary of some pathological conditions, i.e., axonal transport blockade, glutamate excitotoxicity and changes in pro-inflammatory cytokines along the RGC projection, all involved in the glaucoma cascade. Moreover, neuro-protective therapeutic approaches, which aim to improve RGC degeneration, have also been taken into consideration.
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http://dx.doi.org/10.3390/ijms22157994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346985PMC
July 2021

Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review.

Pharmaceuticals (Basel) 2021 Jun 18;14(6). Epub 2021 Jun 18.

IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy.

Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.
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http://dx.doi.org/10.3390/ph14060581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234834PMC
June 2021

Do Additional Testing Locations Improve the Detection of Macular Perimetric Defects in Glaucoma?

Ophthalmology 2021 Jun 18. Epub 2021 Jun 18.

Optometry and Visual Sciences, City, University of London, London, United Kingdom. Electronic address:

Purpose: To evaluate the ability of additional central testing locations to improve detection of macular visual field (VF) defects in glaucoma.

Design: Prospective cross-sectional study.

Participants: Four hundred forty healthy people and 499 patients with glaucomatous optic neuropathy (GON) were tested with a fundus tracked perimeter (CMP; CenterVue) using a 24-2 grid with 12 additional macular locations (24-2+).

Methods: Glaucomatous optic neuropathy was identified based on expert evaluation of optic nerve head photographs and OCT scans, independently of the VF. We defined macular defects as locations with measurements outside the 5% and 2% normative limits on total deviation (TD) and pattern deviation (PD) maps within the VF central 10°. Classification was based on the total number of affected macular locations (overall detection) or the largest number of affected macular locations connected in a contiguous cluster (cluster detection). Criteria based on the number of locations and cluster size were used to obtain equivalent specificity between the 24-2 grid and the 24-2+ grids, calculated using false detections in the healthy cohort. Partial areas under the receiver operating characteristic curve (pAUCs) were also compared at specificities of 95% or more.

Main Outcome Measures: Matched specificity comparison of the ability to detect glaucomatous macular defects between the 24-2 and 24-2+ grids.

Results: At matched specificity, cluster detection identified more macular defects with the 24-2+ grid compared with the 24-2 grid. For example, the mean increase in percentage of detection was 8% (95% confidence interval, 5%-11%) and 10% (95% confidence interval [CI], 7%-13%) for 5% TD and PD maps, respectively, and 5% (95% CI, 2%-7%) and 6% (95% CI, 4%-8%) for the 2% TD and PD maps, respectively. Good agreement was found between the 2 grids. The improvement measured by pAUCs was also significant but generally small. The percentage of eyes with macular defects ranged from about 30% to 50%. Test time for the 24-2+ grid was longer (21% increase) for both cohorts. Between 74% and 98% of defects missed by the 24-2 grid had at least 1 location with sensitivity of < 20 dB.

Conclusions: Visual field examinations with additional macular locations can improve the detection of macular defects in GON modestly without loss of specificity when appropriate criteria are selected.
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http://dx.doi.org/10.1016/j.ophtha.2021.06.012DOI Listing
June 2021

Dexamethasone Downregulates Autophagy through Accelerated Turn-Over of the Ulk-1 Complex in a Trabecular Meshwork Cells Strain: Insights on Steroid-Induced Glaucoma Pathogenesis.

Int J Mol Sci 2021 May 31;22(11). Epub 2021 May 31.

IRCCS-Fondazione Bietti, 00198 Rome, Italy.

Steroid-induced glaucoma is a severe pathological condition, sustained by a rapidly progressive increase in intraocular pressure (IOP), which is diagnosed in a subset of subjects who adhere to a glucocorticoid (GC)-based therapy. Molecular and clinical studies suggest that either natural or synthetic GCs induce a severe metabolic dysregulation of Trabecular Meshwork Cells (TMCs), an endothelial-derived histotype with phagocytic and secretive functions which lay at the iridocorneal angle in the anterior segment of the eye. Since TMCs physiologically regulate the composition and architecture of trabecular meshwork (TM), which is the main outflow pathway of aqueous humor, a fluid which shapes the eye globe and nourishes the lining cell types, GCs are supposed to trigger a pathological remodeling of the TM, inducing an IOP increase and retina mechanical compression. The metabolic dysregulation of TMCs induced by GCs exposure has never been characterized at the molecular detail. Herein, we report that, upon dexamethasone exposure, a TMCs strain develops a marked inhibition of the autophagosome biogenesis pathway through an enhanced turnover of two members of the Ulk-1 complex, the main platform for autophagy induction, through the Ubiquitin Proteasome System (UPS).
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http://dx.doi.org/10.3390/ijms22115891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198647PMC
May 2021

Visual Field Endpoints Based on Subgroups of Points May Be Useful in Glaucoma Clinical Trials: A Study With the Humphrey Field Analyzer and Compass Perimeter.

J Glaucoma 2021 08;30(8):661-665

Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Precis: Visual field (VF) endpoints based on average deviation of specific subsets of points rather than all points may offer a more homogeneous data set without necessarily worsening test-retest variability and so may be useful in clinical trials.

Purpose: The purpose of this study was to characterize the outcome measures encompassing particular subsets of VF points and compare them as obtained with Humphrey [Humphrey visual field analyser (HVF)] and Compass perimeters.

Methods: Thirty patients with imaging-based glaucomatous neuropathy performed a pair of 24-2 tests with each of 2 perimeters. Nonweighted mean deviation (MD) was calculated for the whole field and separate vertical hemifields, and again after censoring of points with low sensitivity (MDc) and subsequently including only "abnormal" points with a total deviation probability of <5% (MDc5%) or <2% (MDc2%). Test-retest variability was assessed using Bland-Altman 95% limits of agreement (95%LoA).

Results: For the whole field, using HVF, MD was -7.5±6.9 dB, MDc -3.6±2.8 dB, MDc5% -6.4±1.7 dB, and MDc2% -7.3±1.5 dB. With Compass the MD was -7.5±6.6, MDc -2.9±1.7 dB, MDc5% -6.3±1.5, and MDC2% -7.9±1.6. The respective 95%LoA were 5.5, 5.3, 4.6, and 5.6 with HVF, and 4.8, 3.7, 7.1, and 7.1 with Compass. The respective number of eligible points were 52, 42±12, 20±11, and 15±9 with HVF, and 52, 41.2±12.6, 10±7, and 7±5 with Compass. With both machines, SD and 95%LoA increased in hemifields compared with the total field, but this increase was mitigated after censoring.

Conclusion: Restricting analysis to particular subsets of points of interest in the VF after censoring points with low sensitivity, as compared with using the familiar total field MD, can provide outcome measures with a broader range of MD, a markedly reduced SD and therefore more homogeneous data set, without necessarily worsening test-retest variability.
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http://dx.doi.org/10.1097/IJG.0000000000001856DOI Listing
August 2021

Comparison of preserved bimatoprost 0.01% with preservative-free tafluprost: A randomised, investigator-masked, 3-month crossover, multicentre trial, SPORT II.

Eur J Ophthalmol 2021 Apr 5:11206721211006573. Epub 2021 Apr 5.

Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium.

Importance: This study compares the efficacy and tolerability of a preservative-free prostaglandin analogue (tafluprost 15 mg/ml) to a prostaglandin analogue that uses 0.02% of benzalkonium chloride (bimatoprost 0.1 mg/ml).

Background: Different prostaglandin analogues have been commercially approved, with differences in tolerability.

Design: Prospective, randomised, investigator-masked, 3-month crossover, multicentre trial.

Participants: Sixty-four patients with ocular hypertension or open-angle glaucoma were randomised to two groups, after a 4-week washout period from their current topical drop regimen.

Methods: Participants were randomised to tafluprost (Group 1;  = 33) or bimatoprost (Group 2;  = 31). At month 3, each group switched to the opposite treatment. IOP was evaluated at multiple timepoints.

Main Outcome Measures: The primary outcome was difference in mean IOP between the two groups at the final visit. Secondary outcomes included change from baseline IOP at month 3 and month 6, difference in mean IOP at month 3 and difference in IOP at all timepoints. Safety outcomes included best-corrected visual acuity (BCVA), adverse events, ocular tolerability, optic nerve assessment and slit lamp biomicroscopy.

Results: Both medications significantly lowered IOP at month 6 compared to baseline: 5.4 mmHg (27%) for tafluprost and 6.8 mmHg (33%) for bimatoprost ( < 0.0001). No significant differences in any of the safety measures (including conjunctival hypearemia) were detected.

Conclusions And Relevance: Bimatoprost produced a statistically significant greater IOP reduction compared to tafluprost with minimal to no difference in side effects. This should be borne in mind when weighing up the pros and cons of preserved versus preservative-free prostaglandin analogue therapy.

Clinicaltrials.gov Identifier: NCT02471105.
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http://dx.doi.org/10.1177/11206721211006573DOI Listing
April 2021

Endothelial Cell Density After XEN Implant Surgery: Short-term Data From the Italian XEN Glaucoma Treatment Registry (XEN-GTR).

J Glaucoma 2021 07;30(7):559-565

Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa.

Precis: XEN implant was associated with low endothelial cell density (ECD) reduction. In fact, when combined with phacoemulsification, the reduction in ECD was similar to that expected after phacoemulsification alone.

Purpose: The purpose of this study was to assess the impact of XEN implant, either alone or in combination with phacoemulsification, on ECD.

Methods: Multicenter, prospective, observational study conducted on consecutive open-angle glaucoma patients, who were enrolled in the Italian XEN Glaucoma Treatment Registry and have complete endothelial cell count data at baseline and at 6 months after implantation. The primary endpoint was the mean percentage change in ECD between baseline and month 6.

Results: The study included 108 open-angle glaucoma eyes (68 in the XEN-solo and 40 eyes in the XEN+phaco groups) and 60 control eyes (phaco-solo group). As compared with baseline, mean (95% confidence interval, CI) ECD reduction was -5.6% (-7.0% to -4.9%), -11.3% (-13.8% to -10.9%), and -13.0% (14.8% to -11.8%) in the XEN-solo, XEN+phaco, and phaco-solo groups, respectively (P=0.0004, <0.0001, and <0.0001, respectively). As compared with the XEN-solo group, the ECD reduction was significantly greater in the XEN+phaco group (mean difference=5.7%; 95% CI: 4.1%-7.3%, P<0.0001) and in the phaco-solo group (mean difference=7.4%; 95% CI: 5.7%-9.1%, P<0.0001). ECD reduction was similar in XEN+phaco and phaco-solo groups (P=0.9). In absolute terms, ECD reduction was significantly greater in the XEN+phaco (mean difference=169±306, P=0.021) and in the phaco-solo (mean difference=192±302, P=0.0022) groups than in the XEN-solo group.

Conclusions: The mean ECD reduction 6 months after XEN implantation was low. The ECD reduction in the XEN+phaco group was larger than in the XEN-solo group but was similar to that observed in the phaco-solo group.
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http://dx.doi.org/10.1097/IJG.0000000000001840DOI Listing
July 2021

Citicoline in Ophthalmological Neurodegenerative Disease: A Comprehensive Review.

Pharmaceuticals (Basel) 2021 Mar 20;14(3). Epub 2021 Mar 20.

IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy.

Cytidine 5'-diphosphocholine has been widely studied in systemic neurodegenerative diseases, like Alzheimer's disease, Parkinson's disease, and brain ischemia. The rationale for the use of citicoline in ophthalmological neurodegenerative diseases, including glaucoma, anterior ischemic optic neuropathy, and diabetic retinopathy, is founded on its multifactorial mechanism of action and the involvement in several metabolic pathways, including phospholipid homeostasis, mitochondrial dynamics, as well as cholinergic and dopaminergic transmission, all being involved in the complexity of the visual transmission. This narrative review is aimed at reporting both pre-clinical data regarding the involvement of citicoline in such metabolic pathways (including new insights about its role in the intracellular proteostasis through an interaction with the proteasome) and its effects on clinical psychophysical, electrophysiological, and morphological outcomes following its use in ophthalmological neurodegenerative diseases (including the results of the most recent prospective randomized clinical trials).
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http://dx.doi.org/10.3390/ph14030281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003774PMC
March 2021

Glaucoma and neuroinflammation: An overview.

Surv Ophthalmol 2021 Sep-Oct;66(5):693-713. Epub 2021 Feb 11.

IRCCS - Fondazione Bietti, Rome, Italy.

Glaucoma is an optic neuropathy characterized by well-defined optic disc morphological changes (i.e., cup enlargement, neuroretinal border thinning, and notching, papillary vessel modifications) consequent to retinal ganglion cell loss, axonal degeneration, and lamina cribrosa remodeling. These modifications tend to be progressive and are the main cause of functional damage in glaucoma. Despite the latest findings about the pathophysiology of the disease, the exact trigger mechanisms and the mechanism of degeneration of retinal ganglion cells and their axons have not been completely elucidated. Neuroinflammation may play a role in both the development and the progression of the disease as a result of its effects on retinal environment and retinal ganglion cells. We summarize the latest findings about neuroinflammation in glaucoma and examine the connection between risk factors, neuroinflammation, and retinal ganglion cell degeneration.
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http://dx.doi.org/10.1016/j.survophthal.2021.02.003DOI Listing
February 2021

Anterior Chamber Angle Assessment Techniques: A Review.

J Clin Med 2020 Nov 25;9(12). Epub 2020 Nov 25.

Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy.

Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment's structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.
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http://dx.doi.org/10.3390/jcm9123814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759936PMC
November 2020

Conjunctival thickness as a predictive imaging biomarker for the glaucoma filtration surgery outcome: An optical coherence tomography study.

Clin Exp Ophthalmol 2020 12 17;48(9):1192-1200. Epub 2020 Sep 17.

Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.

Importance: To analyse the preoperative conjunctival thickness in glaucomatous patients undergoing filtration surgery (FS), using optical coherence tomography (OCT).

Background: The conjunctival status represents one of the most critical determinants of the FS outcome.

Design: Retrospective study.

Participants: Sixty-seven patients candidate to FS for uncontrolled glaucoma were enrolled.

Methods: OCT was performed at the superior bulbar conjunctiva before FS, and at bleb site at the last follow-up (LF-up) after surgery.

Main Outcome Measures: Preoperative full, epithelial, and stromal conjunctival thickness (FCT, CET, CST) and reflectivity (CR), and LF-up bleb-wall thickness (BT), reflectivity (BR) and intraocular pressure (IOP), were the major outcomes. The relations between preoperative parameters and LF-up-IOP, BT and BR were calculated.

Results: FS was completely successful in 23 patients (group 1), successful with medications in 22 (group 2), and failed in 22 (group 3). FCT, CET and CST were lower, whereas CR higher, in group 3 compared to groups 1 and 2 (P < .05); BT was lower (P < .001), whereas BR higher (P < .05) in group 3 compared to group 1. FCT and CST were predictors of FS outcome with lower thickness associated with increased odds of failure (odds ratio 0.922, P = .08; 0.941, P = .025). LF-up-IOP inversely correlated with FCT and CST (r = -0.447, P = .003; r = -0.408, P = .007), whereas positively correlated with CR (r = 0.789, P < .001).

Conclusions And Relevance: Preoperative conjunctival thickness and reflectivity show significant correlations with the FS outcome, both in terms of IOP and bleb-wall features. Therefore, they may be proposed as predictive imaging biomarkers to estimate the risk of filtration failure.
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http://dx.doi.org/10.1111/ceo.13857DOI Listing
December 2020

A case report of pediatric neurotrophic keratopathy in pontine tegmental cap dysplasia treated with cenegermin eye drops.

Medicine (Baltimore) 2020 Jul;99(30):e20816

Department of Surgical, Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo.

Rationale: To report the management of recalcitrant neurotrophic keratopathy in a pediatric patient affected by pontine tegmental cap dysplasia (PTCD) using topical human recombinant nerve growth factor (hrNGF, Cenegermin 20 μg/ml). To the best of our knowledge the present case is one of the few described in patients with congenital NK treated with Cenegermin, and the first in a patient affected by PTCD.

Patient Concerns: A 9-year-old patient, affected by PTCD with bilateral cranial nerve V1 and VIII palsies, was referred to our hospital for visual disturbances and redness of the right eye due to persistent neurotrophic epithelial defect. The patient presented marked developmental delay, ataxia, bilateral hypoacusia, and bilateral corneal severe hypoaesthesia. Ocular history revealed multiple treatments in order to treat neurotrophic ulcer in the left eye. Four years later, he developed a persistent epithelial defect with corneal anesthesia in the right eye.

Diagnoses: The impaired trigeminal nerve function, due to the underlying congenital disease, led to the development of moderate NK (stage II) in the right eye and a mild NK (stage I) in the left eye.

Interventions: Cenegermin 20 μg/ml eye-drop was administered in both eyes. Treatment was continued for 8 weeks. The patient was assessed after 4 and 8 week of treatment. At each follow-up visit, treatment efficacy and adverse events were evaluated.

Outcomes: The use of Cenegermin eye drops facilitated the remarkable resolution of the neurotrophic keratopathy and the improvement of corneal sensitivity in both eyes. No local or systemic adverse events were observed.

Lessons: Topical Cenegermin 20 μg/ml was well-tolerated and may represent a valuable therapeutic option in the management of pediatric neurotrophic keratopathy.
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http://dx.doi.org/10.1097/MD.0000000000020816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387065PMC
July 2020

The Mont Blanc Study: The effect of altitude on intra ocular pressure and central corneal thickness.

PLoS One 2020 7;15(8):e0237343. Epub 2020 Aug 7.

University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

The aim of the Mont Blanc Study was to investigate the relationship between intraocular pressure (IOP), central corneal thickness (CCT), and altitude in healthy subjects. Thirty-three eyes of 33 healthy volunteers (mean age: 24.8 years, 17 females) had their IOP measured with Perkins and I-Care tonometers and their CCT using ultrasound pachymetry at three locations in Italy with different altitudes: Pavia, (PV), 77 meters above sea level (a.s.l); Courmayeur (CM), 1300 meters a.s.l; Pointe Helbronner (PH), 3466 meters a.s.l.). The measurements were performed at 9 am, 11 am, 1 pm and 3 pm (±30') in indoor settings (mean temperature of 19°C) in PV and PH. At 9 am, CCT and IOP were measured outdoor (mean temperature of -1.4°C) at PH. The mean values of the IOP curve decreased from PV to PH with the Perkins (p = 0.02) and I-Care tonometers (p = 0.001). Instead, CCT increased upon ascension from PV to PH (p = 0.01), and from CM to PH (p = 0.002). When exposed to sub-zero temperature, the IOP increased (p<0.001), while the CCT did not change (p = 0.30). The results suggest that IOP significantly decreased and CCT significantly increased upon ascension from the sea level to higher altitudes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237343PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413504PMC
October 2020

Corrigendum to An advanced in vitro model to assess glaucoma onset.

ALTEX 2020 ;37(3):492

Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy.

In this manuscript, which appeared in ALTEX 37, 265-274 (doi: 10.14573/altex.1909262), the affiliation of Stefania Vernazza should read: Stefania Vernazza 5# 5 IRCCS-Fondazione Bietti, Rome, Italy and the address for correspondence should read: Stefania Vernazza, PhD, IRCCS, Fondazione Bietti via Livenza 3, 00198 Rome, Italy ([email protected]).
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http://dx.doi.org/10.14573/altex.1909262eDOI Listing
January 2020

Correction to: Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: The VISIONARY Study.

Adv Ther 2020 08;37(8):3643-3644

Department of Ophthalmology, Semmelweis University, Budapest, Hungary.

In the original article, the The VISIONARY Study Group Principal Investigator Jose Javier Garcia-Medina.
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http://dx.doi.org/10.1007/s12325-020-01407-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370974PMC
August 2020

Structural imaging of conjunctival filtering blebs in XEN gel implantation and trabeculectomy: a confocal and anterior segment optical coherence tomography study.

Graefes Arch Clin Exp Ophthalmol 2020 Aug 15;258(8):1763-1770. Epub 2020 May 15.

Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 66100, Chieti, CH, Italy.

Purpose: To describe and compare the conjunctival filtering bleb features after XEN gel implantation and trabeculectomy using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM).

Methods: Fifty-two patients who underwent completely successful trabeculectomy (24 eyes) or completely successful XEN gel implantation (28 eyes) were consecutively enrolled. At the sixth-month follow-up, filtering blebs were analyzed with AS-OCT and IVCM. The main outcomes were the following: (i) bleb-wall epithelium cyst-like structure density and area (BECSD, BSCSA), (ii) bleb-wall sub-epithelium cyst-like structure density and area (BSCSD, BSCSA,), (iii) bleb-wall thickness (BT), (iv) bleb-wall epithelial thickness (BET), (v) bleb-wall reflectivity (BR), and (vi) bleb height (BH), for AS-OCT. Mean microcyst density (MMD) and area (MMA) and stromal meshwork reflectivity (SMR) were the IVCM outcomes.

Results: Six-month intraocular pressure was 11.46 ± 3.09 and 10.06 ± 3.39 mmHg in the XEN gel implantation and trabeculectomy, respectively (p > 0.05). At AS-OCT, XEN gel blebs showed lower BH, BT, BET, BR, (p < 0.001), and BECSA values (p < 0.005), and a higher BECSD (p < 0.05) compared with trabeculectomy blebs. At IVCM, MMA and SMR values were lower in the XEN gel implantation, compared with trabeculectomy (p < 0.05). BECSD and BSCSD negatively correlated with BR (p < 0.01; r = - 0.110; p < 0.01; r = - 0.249), whereas BR strongly correlated with SMR (p < 0.001; r = 0.819).

Conclusion: Successful filtering blebs after XEN gel implantation appeared flatter and thinner, with a higher number of epithelial cysts and a hypo-reflective bleb wall compared with trabeculectomy. These aspects may depend on the different intra-operative tissue manipulation and/or on different aqueous humor dynamics in the sub-conjunctiva between surgeries.
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http://dx.doi.org/10.1007/s00417-020-04671-2DOI Listing
August 2020

Structural and functional evidence for citicoline binding and modulation of 20S proteasome activity: Novel insights into its pro-proteostatic effect.

Biochem Pharmacol 2020 07 13;177:113977. Epub 2020 Apr 13.

Department of Clinical Sciences and Translational Medicine, University of Roma Tor Vergata, via Montpellier, 1, 00133, Rome, Italy. Electronic address:

Citicoline or CDP-choline is a drug, made up by a cytidine 5'-diphosphate moiety and choline, which upon adsorption is rapidly hydrolyzed into cytidine 5'-diphosphate and choline, easily bypassing the blood-brain barrier. Once in the brain, these metabolites are used to re-synthesize citicoline in neurons and in the other cell histo-types which uptake them. Citicoline administration finds broad therapeutic application in the treatment of glaucoma as well as other retinal disorders by virtue of its safety profile and neuro-protective and neuroenhancer activity, which significantly improves the visual function. Further, though supported by limited clinical studies, this molecule finds therapeutic application in neurodegenerative disease, delaying the cognitive decline in Alzheimer's Disease (AD) and Parkinson's Disease (PD) subjects. In this work we show that citicoline greatly affects the proteolytic activity of the 20S proteasome on synthetic and natural substrates, functioning as a bimodal allosteric modulator, likely binding at multiple sites. In silico binding simulations identify several potential binding sites for citicoline on 20S proteasome, and their topology envisages the possibility that, by occupying some of these pockets, citicoline may induce a conformational shift of the 20S proteasome, allowing to sketch a working hypothesis for the structural basis of its function as allosteric modulator. In addition, we show that over the same concentration range citicoline affects the distribution of assembled proteasome populations and turn-over of ubiquitinated proteins in SH-SY5Y and SK-N-BE human neuroblastoma cells, suggesting its potential role as a regulator of proteostasis in nervous cells.
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http://dx.doi.org/10.1016/j.bcp.2020.113977DOI Listing
July 2020

Defective proteasome biogenesis into skin fibroblasts isolated from Rett syndrome subjects with MeCP2 non-sense mutations.

Biochim Biophys Acta Mol Basis Dis 2020 07 8;1866(7):165793. Epub 2020 Apr 8.

Dept of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy. Electronic address:

Rett Syndrome (RTT) is a rare X-linked neurodevelopmental disorder which affects about 1: 10000 live births. In >95% of subjects RTT is caused by a mutation in Methyl-CpG binding protein-2 (MECP2) gene, which encodes for a transcription regulator with pleiotropic genetic/epigenetic activities. The molecular mechanisms underscoring the phenotypic alteration of RTT are largely unknown and this has impaired the development of therapeutic approaches to alleviate signs and symptoms during disease progression. A defective proteasome biogenesis into two skin primary fibroblasts isolated from RTT subjects harbouring non-sense (early-truncating) MeCP2 mutations (i.e., R190fs and R255X) is herewith reported. Proteasome is the proteolytic machinery of Ubiquitin Proteasome System (UPS), a pathway of overwhelming relevance for post-mitotic cells metabolism. Molecular, transcription and proteomic analyses indicate that MeCP2 mutations down-regulate the expression of one proteasome subunit, α7, and of two chaperones, PAC1 and PAC2, which bind each other in the earliest step of proteasome biogenesis. Furthermore, this molecular alteration recapitulates in neuron-like SH-SY5Y cells upon silencing of MeCP2 expression, envisaging a general significance of this transcription regulator in proteasome biogenesis.
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http://dx.doi.org/10.1016/j.bbadis.2020.165793DOI Listing
July 2020

Optic nerve head diurnal vessel density variations in glaucoma and ocular hypertension measured by optical coherence tomography angiography.

Graefes Arch Clin Exp Ophthalmol 2020 Jun 27;258(6):1237-1251. Epub 2020 Mar 27.

IRCCS - Fondazione Bietti, Rome, Italy.

Background/aims: To evaluate diurnal variations in optic nerve head (ONH) vessel density assessed by optical coherence tomography angiography (OCT-A) in healthy subjects, ocular hypertension (OHT), and open-angle glaucoma (OAG) patients.

Methods: Forty subjects (OAG, 21; OHT, 6; healthy, 13) were assessed for vessel density percentage (VD%) and flow index in the ONH (NH VD%, NH index), and in the radial peripapillary capillary layer (RPC VD%, RPC index) at 9:00, 11:00, 14:00, 16:00, and 18:00 on a single day. Repeated measures ANOVAs were used to test for changes in the parameters measured at multiple time points.

Results: All OCT-A parameters analyzed at the different time points were statistically lower in the OAG patients compared to both the OHT and healthy groups (p < 0.05). In the OAG group, the NH index, RPC index, NH VD%, and RPC VD% were statistically lower at 18:00 compared to 14:00, and the RPC VD% was statistically lower at 9:00 than 14:00. In the OHT group, the RPC index was statistically lower at 9:00 than 11:00. In the healthy group, the NH VD% and RPC VD% were statistically lower at 16:00 than 18:00, and the RPC index was statistically lower at 9:00 than 11:00. No other statistically significant difference was found in none of the three groups comparing any other time point (p > 0.05).

Conclusion: In healthy subjects, OHT and OAG patients, the variations in the OCT-A derived parameters were relatively small. These results suggest that in the clinical practice the OCT-A assessment can be performed independently of the time of the day, contrasting IOP evaluation.
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http://dx.doi.org/10.1007/s00417-020-04635-6DOI Listing
June 2020

The Glaucoma Italian Pediatric Study (GIPSy): The Long-term Effect of Topical Latanoprost on Central Corneal Thickness.

J Glaucoma 2020 06;29(6):441-447

Section of Ophthalmology, Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy.

Precis: Central corneal thickness (CCT) may increase over time in children affected by primary congenital glaucoma and treated with latanoprost for at least 30 months.

Purpose: The purpose of this study was to investigate CCT modification over time in a population of primary pediatric glaucoma (PPG) patients prescribed a monotherapy of latanoprost.

Materials And Methods: The present paper reports the results of a post hoc analysis on patients enrolled in the Glaucoma Italian Pediatric Study (GIPSy). Children affected by PPG, with a postsurgical intraocular pressure between 22 and 26 mm Hg and treated with latanoprost monotherapy for at least 30 months were eligible for the analysis. CCT variation from baseline was investigated over the follow-up using univariable and multivariable longitudinal linear mixed models. The impact of age, sex, and intraocular pressure on CCT variation were evaluated taking into account the interaction of each variable with time.

Results: Twenty-seven eyes (20 patients) were included in the analysis. Mean duration of latanoprost treatment was 36.6 months (SD 2.5) and mean CCT at baseline was 551 μm (SD 37.7). A significant increase of CCT over time was revealed by multivariable analysis, taking into account the impact of age at baseline and its interaction with time (P=0.03). The interaction between age and time was significant (P=0.04), indicating that older age at baseline was associated with lower increase of CCT over time. No variation of CCT was found in univariable analysis (P=0.28).

Conclusion: In this population of PPG patients treated with latanoprost for at least 30 months, CCT significantly increased over time, when the impact of age and its interaction with time were considered.
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http://dx.doi.org/10.1097/IJG.0000000000001495DOI Listing
June 2020

Citicoline and Vitamin B Eye Drops in Type 1 Diabetes: Results of a 3-year Pilot Study Evaluating Morpho-Functional Retinal Changes.

Adv Ther 2020 04 16;37(4):1646-1663. Epub 2020 Mar 16.

IRCCS Fondazione Bietti, Rome, Italy.

Introduction: This study aimed to evaluate the effect of treatment with eye drops containing citicoline and vitamin B on changes in function of the inner retina, morphology of the inner and outer retina, and microvascular condition in patients with type 1 diabetes (DM1) with mild signs of non-proliferative diabetic retinopathy (NPDR) during 3 years of follow-up.

Methods: A pilot study with prospective, randomized, and double-masked design was conducted to address the aims. Twenty patients with DM1 were enrolled and randomly divided into two groups: the DC group comprising patients treated with citicoline and vitamin B eye drops (10 patients; mean age ± standard deviation, 46.86 ± 8.78 years) and the DP group comprising those treated with placebo (10 patients; mean age ± standard deviation, 47.89 ± 7.74 years). In the DC group, one eye of each patient was treated with citicoline and vitamin B eye drops (OMK2, Omikron Italia srl, Italy, 3 drops/day), while in the DP group, it was treated with placebo (eye drops containing hypromellose 0.3%, 3 drops/day) for a 3-year period. In both groups, Humphrey Matrix frequency doubling technology (FDT), spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA), and adaptive optics (AO) were applied at baseline and 12, 24, and 36 months of the follow-up period.

Results: In the results of follow-up evaluation, the DC and DP groups were significantly different: Significant reduction in function in terms of 10-2 FDT mean sensitivity and in morphology reflected by an increase in inner nuclear layer thickness and decrease in other plexiform layer thickness and foveal vessel density were observed in the DP group, while no such significant changes were observed in the DC group in the long term.

Conclusions: This pilot study indicated that patients with DM1 with mild signs of diabetic retinopathy (DR) who underwent treatment with citicoline and vitamin B eye drops for a 3-year duration achieved stabilization or decreased rate of functional impairment, neuroretinal degeneration, and microvascular damage.

Trial Registration: ClinicalTrials.gov identifier, NCT04009980.
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http://dx.doi.org/10.1007/s12325-020-01284-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140741PMC
April 2020

Author Correction: Vision-related quality of life and symptom perception change over time in newly-diagnosed primary open angle glaucoma patients.

Sci Rep 2020 Mar 6;10(1):4517. Epub 2020 Mar 6.

Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico, San Matteo, Pavia, Italy.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-60489-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060282PMC
March 2020

European study of the efficacy of a cross-linked gel stent for the treatment of glaucoma.

J Cataract Refract Surg 2020 03;46(3):441-450

From the Department of Surgical Sciences (Fea), Eye Clinic, University Hospital, Turin, Department of Ophthalmology (Laffi), S. Orsola Hospital, Bologna, Department of Ophthalmology (Martini), Sassuolo Hospital, Sassuolo, Department of Surgical, Medical, Molecular Pathology, and Critical Area (Figus), University of Pisa, Pisa, IRCCS GB Bietti Foundation (Oddone), Rome, Italy; Department of Ophthalmology, University Hospital (Bron), Dijon, France; and St Erik Eye Hospital (Economou), Karolinska Institute, Stockholm, Sweden.

Purpose: To investigate the efficacy and safety of a cross-linked gel stent (XEN45) with or without cataract surgery in the treatment of glaucoma patients.

Setting: Five university hospitals.

Design: Prospective multicenter clinical trial.

Methods: Patients with glaucoma inadequately controlled by treatment or poor compliance or intolerance to topical therapy were included. Patients were divided into those who had an implant only (Solo Group; phakic and pseudophakic patients) and those who had an implant combined with cataract surgery (Combo Group). Differences in mean intraocular pressure (IOP) and number of medications between the baseline preoperative visit and study end (12 months), and the rate of qualified and complete success, were evaluated.

Results: The Solo Group comprised 115 glaucoma patients (43 phakic and 72 pseudophakic) and the Combo Group comprised 56 patients. Compared with baseline, mean IOP (23.9 ± 7.6 to 15.5 ± 3.9) and number of medications (3.0 ± 1.1 to 0.5 ± 1.0) decreased significantly at 12-month follow-up (P < .001 for both). A >20% and >30% reduction in IOP from baseline was achieved by 72.3% and 52.6% of patients, respectively. IOP at 1 week postoperatively was a predictor of success, and the needling rate was inversely correlated with early postoperative IOP. The number of preoperative medications and patient age were not significantly associated with failure.

Conclusions: Insertion of a cross-linked gel stent alone or combined with phacoemulsification might be effective and safe in the treatment of open-angle glaucoma, with a substantial reduction in IOP and number of medications.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000065DOI Listing
March 2020
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