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Biochemical Markers in Ophthalmology
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Abdus Samad Ansari, Pirro G. Hysi
Other genes also show a statistically significant enrichment for properties involving angiogenesis and lymphangiogenesis [62]. Traditionally, functional dysfunction of the trabecular meshwork has been postulated as one of the main mechanisms of IOP elevation and increased glaucoma risk. A lymphatic element in the pathogenesis of POAG suggests first-hand involvement of the Schlemm’s canal, which could change the way this disease is understood and managed.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Echothiophate is a potent, long-acting cholinesterase inhibitor with parasympathomimetic activity. Its iodide salt echothiophate iodide (CAS number 513-10-0, EC number 208-152-1, molecular formula C9H23INO3PS) potentiates the action of endogenous acetylcholine by inhibiting acetylcholinesterase that hydrolyzes acetylcholine. When applied topically to the eye, this agent prolongs stimulation of the parasympathetic receptors at the neuromuscular junctions of the longitudinal muscle of the ciliary body. Contraction of longitudinal muscle pulls on the scleral spur, and opens the trabecular meshwork, thereby increasing aqueous humor outflow from the eye and reducing intraocular pressure. Echothiopate iodide is indicated for use in the treatment of subacute or chronic angle-closure glaucoma after iridectomy or where surgery is refused or contraindicated (1).
Management of hyphema, repair of iridodialysis, and repair of corneoscleral lacerations
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Most cases of traumatic hyphema are now managed on an outpatient basis. Findings that support inpatient care include other associated trauma (e.g. a closed head injury), a hyphema filling greater than 50% of the anterior chamber, elevated IOP, blood dyscrasia, or an inability to comply with medical treatment or follow-up. For patients who do not have such findings or issues, daily examinations should be performed for the first 5–7 days. Particular attention is paid to visual acuity, IOP, appearance of the cornea, and status of the hyphema. Indirect ophthalmoscopy should be performed as soon as visualization allows. The clinician should be alert for posterior segment pathology such as retinal tears or detachments, vitreous hemorrhage, macular pathology such as choroidal ruptures or commotion retinae, or optic disc pathology. Several weeks after the injury, gonioscopy can be safely performed to evaluate the trabecular meshwork and angle. The presence of angle recession will necessitate more frequent examinations and pressure checks.
Simvastatin Attenuates Glucocorticoid-Induced Human Trabecular Meshwork Cell Dysfunction via YAP/TAZ Inactivation
Published in Current Eye Research, 2023
Hannah Yoo, Ayushi Singh, Haiyan Li, Ana N. Strat, Tyler Bagué, Preethi S. Ganapathy, Samuel Herberg
The trabecular meshwork (TM) plays a central role in the conventional outflow pathway, which drains the aqueous humor from the anterior chamber to regulate outflow facility and intraocular pressure.1–3 The bidirectional interactions between TM cells4 and their extracellular matrix (ECM) are crucial for maintaining normal tissue function in the healthy eye.5,6 In primary open-angle glaucoma, the most common form of glaucoma,7 disruption of these interactions drive progressive fibrotic-like tissue remodeling. Key characteristics of this postulated process include increased TM contraction, actin stress fiber assembly, ECM deposition/crosslinking, and overall tissue stiffening.8 These pathologic alterations lead to increased outflow resistance driving ocular hypertension, which provides further feed-forward amplification and may ultimately push the TM to irreversibly fail.9,10 Despite substantial scientific efforts over the past several decades devoted to understanding TM pathophysiology, the mechanisms underlying persistent tissue dysfunction in glaucoma remain elusive.
Illuminated Microcatheter Passage Assisted Circumferential Trabeculotomy and Trabeculectomy (IMPACTT): An improved surgical procedure for Primary Congenital Glaucoma
Published in Seminars in Ophthalmology, 2022
The patient was a 4-month-old child, product of a normal pregnancy and his birth weight was 3 kg. The parents noticed gradual enlargement of the eyes with intolerance to light and tearing from the eyes since the second months of birth. They consulted a general ophthalmologist who referred the child to us with the provisional diagnosis of congenital glaucoma. His physical examination was unremarkable. Examination under anesthesia revealed horizontal corneal diameter of 13.5 mm with diffuse corneal edema with multiple Haab’s striae in both eyes. His intraocular pressures were 36 mm Hg in both eyes and the lenses were clear. Gonioscopic view was hazy, but flat insertion of the iris over the poorly developed trabecular meshwork could be appreciated. Indirect ophthalmoscopy revealed asymmetric cupping of the optic of the optic nerves (0.6 OD and 0.4 OS). The posterior pole of both the eyes was otherwise normal with an incomplete view of the fundus. On ultrasound B-scan, both the eyes showed anechoic posterior segment. With this history and clinical findings, a diagnosis of bilateral primary congenital glaucoma was established, and the child underwent surgical intervention.
Diabetic eye: associated diseases, drugs in clinic, and role of self-assembled carriers in topical treatment
Published in Expert Opinion on Drug Delivery, 2021
Axel Kattar, Angel Concheiro, Carmen Alvarez-Lorenzo
Glaucoma is the leading cause of blindness worldwide and is defined by damage of the retinal ganglion cells, leading to irreversible damage of the optic nerve [32]. This is often accompanied by a rise of the intraocular pressure (IOP) triggered through different mechanisms. Open-angle glaucoma is caused by blocking of the trabecular meshwork, which in turn hinders fluid drainage and increases pressure. This is the most common form of glaucoma and happens at slow pace. Angle closure glaucoma is provoked by the iris coming forward and blocking the drainage angle between the iris and the cornea. It can happen over time or suddenly. Secondary angle closure glaucoma, in which the angle can be opened or closed, is caused by a secondary factor that leads to drainage hindrance, for example excessive pigment release blocking the trabecular meshwork (pigmentary glaucoma). Although the role of diabetes is unclear, direct correlations were found between diabetes duration and fasting glucose levels and the increase in IOP [33].