• Users Online: 503
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Contacts Login 


 
 Table of Contents  
RESEARCH ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 3  |  Page : 81-87

Changes in insulin resistance and inflammatory factors in cataract patients with glaucoma after phacoemulsification and trabeculectomy: a self-controlled trial


Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China

Date of Submission20-Mar-2019
Date of Decision23-Mar-2019
Date of Acceptance28-May-2019
Date of Web Publication3-Oct-2019

Correspondence Address:
Yan Li
Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2542-3975.267998

Rights and Permissions
  Abstract 


Background and objective: Cataract with glaucoma can adversely affect visual acuity and corneal endothelial cells. Studies have shown that after phacoemulsification combined with trabeculectomy in patients with cataract and glaucoma, blood lipid ratio and insulin sensitivity are associated with intraocular pressure, visual acuity and corneal endothelial cells, which may be used for the evaluation of efficacy. Interleukins are the main mediators of the inflammatory response and are involved in the pathogenesis of cataract. In this trial, we will examine the postoperative changes in interleukin-10, interleukin-2 and interleukin-1β levels in patients with cataract with glaucoma, and analyze the correlation between insulin sensitivity and corneal endothelial cell density to assess whether inflammatory factors can be used to evaluate efficacy.
Participants and methods: This prospective, single-center, open-label, self-controlled clinical trial will include 160 patients with cataract combined with glaucoma, 35–65 years of age, from the Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, China. All patients will receive phacoemulsification and trabeculectomy, and will be followed up at 5 days, and at 1 and 3 months. Patient recruitment will begin on December 30, 2019 and end on December 30, 2020. Analysis of the results will be performed from May 1, 2021 to May 30, 2021. This study is scheduled to end on June 30, 2021. This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Kunming Medical University, China, on December 15, 2013 (approval No. 20131215085), and will be performed in accordance with the principles of the Declaration of Helsinki, adopted by the World Medical Association. Study protocol version is 1.0. Written informed consent to participate will be obtained from each participant.
Results: The primary outcome measure will be serum interleukin-2 level, as an index of the inflammatory response, 3 months after surgery. Secondary outcome measures will include serum interleukin-2 level before and 5 days and 1 month after surgery, serum levels of interleukin-1β, interleukin-10, C-reactive protein and tumor necrosis factor-α, best corrected visual acuity, endothelial cell density, mean cell area, coefficient of variation, insulin sensitivity index and intraocular pressure before and 5 days and 1 and 3 months after surgery, and incidence of adverse reactions at 5 days and 1 and 3 months after surgery. From January 2014 to June 2017, our team undertook and completed a small-sample study of 80 cataract patients (95 eyes) with glaucoma. The best corrected visual acuity was significantly improved, endothelial cell density and intraocular pressure were significantly reduced, interleukin-1β, interleukin-2, interleukin-10, C-reactive protein and tumor necrosis factor-α levels were significantly decreased (P < 0.05), and mean cell area, coefficient of variation and insulin sensitivity index were significantly increased (P < 0.05) after phacoemulsification and trabeculectomy. None of the patients had adverse reactions during the treatment.
Conclusion: The trial will confirm whether phacoemulsification combined with trabeculectomy has a good therapeutic effect in patients with cataract combined with glaucoma, and clarify whether the effect is associated with the regulation of insulin sensitivity index, corneal endothelial cells and inflammatory factors.
Trial registration: This study was registered with the Chinese Clinical Trial Registry on September 10, 2019 (registration number: ChiCTR1900025837).

Keywords: cataract; cinterleukin; C-reactive protein; glaucoma; insulin resistance; insulin sensitivity index; orneal endothelial cells; phacoemulsification; trabeculectomy; tumor necrosis factor-α


How to cite this article:
Zhao JF, Geng Y, Chen QB, Yang JH, Li Y. Changes in insulin resistance and inflammatory factors in cataract patients with glaucoma after phacoemulsification and trabeculectomy: a self-controlled trial. Clin Trials Degener Dis 2019;4:81-7

How to cite this URL:
Zhao JF, Geng Y, Chen QB, Yang JH, Li Y. Changes in insulin resistance and inflammatory factors in cataract patients with glaucoma after phacoemulsification and trabeculectomy: a self-controlled trial. Clin Trials Degener Dis [serial online] 2019 [cited 2019 Dec 9];4:81-7. Available from: http://www.clinicaltdd.com/text.asp?2019/4/3/81/267998


  Introduction Top


Background

Cataract is an ophthalmic disease characterized by opacity of the lens as the main pathological change, and is an important cause of blindness.[1],[2],[3],[4] Glaucoma is characterized by atrophy of the optic papilla, depression, and decreased vision, and can cause blindness in humans.[5],[6] The concurrent occurrence of glaucoma and cataract can adversely affect visual acuity and corneal endothelial cells in patients, and severely reduce their quality of life.[7],[8],[9],[10] Therefore, effective early diagnosis of glaucoma with cataract is needed.

Phacoemulsification plays an increasingly important role in the treatment of cataract.[11],[12],[13],[14] Trabeculectomy allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed.[15] Insulin resistance is a decrease in the body’s sensitivity to insulin, and contributes to the pathological progression of various ophthalmic diseases.[16],[17] Inflammatory factors such as interleukin and C-reactive protein are the main mediators of the inflammatory response and are strongly associated with the pathogenesis of ocular diseases such as cataract.[18],[19] However, there are few reports on the changes in inflammatory factors and insulin resistance in patients with cataract and glaucoma treated with phacoemulsification combined with trabeculectomy.

The first author retrieved PubMed papers published from 2017 to 2018 using the search terms “cataract,” “glaucoma” and “interleukin.” The three latest clinical studies on inflammatory factor changes in cataract and/or glaucoma patients in China were screened [Table 1].[20],[21],[22]
Table 1: Three Chinese most representative clinical trials addressing inflammatory factor changes in cataract and/or glaucoma patients from 2017 to 2018

Click here to view


Objective

In this planned trial, we will examine insulin resistance and the efficacy of phacoemulsification combined with trabeculectomy in cataract patients with glaucoma to provide a rational basis for clinical treatment.


  Participants/Methods Top


Design

Prospective, single-center, open-label, self-controlled clinical trial.

Setting

Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, China.

Investigator qualification

All physicians performing phacoemulsification and trabeculectomy in this study will receive professional medical training and will be skilled surgeons. They will be associate chief physician, and have more than 10 years of clinical experience in the Department of Ophthalmology.

Participants

Recruitment

Before publishing the recruitment information, the protocol and the content of the recruitment announcement will be approved by the First Affiliated Hospital of Kunming Medical University.

A research recruitment notice will be sent to patients and their family members in the First Affiliated Hospital of Kunming Medical University to recruit patients who are interested in participating in the trial.

Patients and their family members who receive the leaflet will read the leaflet carefully. If they decide to participate in the trial, they can contact the investigator by telephone. After undergoing screening procedures and providing written informed consent, eligible individuals will be included in the trial.

Patients will be given the latest treatment information in information sessions before beginning the clinical trial, and will receive close follow-up from the professional medical team of our hospital for free. The laboratory examination and registration fees will be waived during follow-up.

Inclusion criteria

- Diagnosis of glaucoma combined with cataract in accordance with the criteria formulated by the Ophthalmological Branch of the Chinese Medical Association[23]

- Effective drug treatment cannot be carried out, confirmed by ophthalmologists in the First Affiliated Hospital of Kunming Medical University (no significant improvement in the best corrected visual acuity after treatment)

- Age range, 35–65 years, irrespective of sex

- Irrespective of disease in the left or right eye

- Provision of written informed consent

- Primary angle-closure glaucoma

Exclusion criteria

- Concurrently participating in other ophthalmic treatments

- High myopia

- Keratitis

- Diabetes

- Nervous system diseases

- Cardiac or renal dysfunction

Provision of insurance

Participants who participate in this clinical trial will be required to have inpatient medical insurance, and the majority of medical expenses during hospitalization will be paid by the insurance company in proportion to the medical insurance contract.

Interventions

Preoperative preparation

All patients will be treated with intraocular pressure control before phacoemulsification combined with trabeculectomy. Pilocarpine (Anhui Shuangke Pharmaceutical Co., Ltd., China; GYZZ H20058062, 5 mL:25 mg, one drop every 5–10 minutes for 3–6 times, then every 1–3 hours, until the intraocular pressure is reduced) will be used to ensure intraocular pressure of no more than 30 mmHg.

Phacoemulsification

Phacoemulsification will be performed after mydriasis and anesthesia, and ensuring that the angle of the ocular chamber is below 180°. Appropriate intraocular lens implantation will be selected for trabeculectomy. Intraocular lens (Alcon Laboratories Incorporated; GXZJ20153221306; three-piece/posterior chamber, foldable, modified C-shaped loop) will be used. The optical part is made of acrylate and methacrylate materials containing ultraviolet absorbent, and the loops are made of PMMA materials; spherical, single focal; ethylene oxide sterilization, disposable. It is suitable for the replacement of human lens and the implantation of lens after extracapsular cataract surgery or phacoemulsification in adults. The brief procedure of trabeculectomy is as follows: (1) Eyelid opening and eyeball fixation; (2) conjunctival flaps: fornix is the basal conjunctival flap; corneal limbus as the basal conjunctival flaps; (3) scleral flaps: scleral plate separation; (4) trabecular removal; (5) iris removal; (6) stratified suture of sclerae and conjunctival flaps; and (7) anterior chamber forming.

Postoperative treatment

The patients will be treated with routine Tobradex eye ointment (S.A. Alcon Couvreur N.V., Puurs, Belgium; approval No. H20160337; three or four times a day, applying 1.0–1.5 cm long ointment to conjunctival sac each time) and routine anti-infective therapy using tobramycin-dexamethasone eye drops (Shanghai Xinyi Jinzhu Pharmaceutical Co., Ltd., Shanghai, China; GYZZ H20067439; 1–2 drops every 5 hours; for serious cases, every 3 hours). Antihypertensive drugs (pilocarpine; Anhui Shuangke Pharmaceutical Co., Ltd.; GYZZ H20058062, 5 mL:25 mg, one drop every 5–10 minutes for 3–6 times, then every 1–3 hours) will be used to control intraocular pressure below 21 mmHg.

Follow-up

All patients will be followed up at 5 days, and at 1 and 3 months by telephone by the outpatient department. Detailed data of laboratory tests will be recorded during follow-up, and the occurrence of adverse events during follow-up will be carefully observed.

Outcome measures

Primary outcome measure

Serum interleukin-2 levels, used to assess the inflammatory response, 3 months after surgery. Enzyme-linked immunosorbent assay (ELISA) will be used to measure serum interleukin-2 levels using the RT-6000 microplate reader (Rayto Ltd., Shenzhen, China) and reagents purchased from R&D Systems, Oxon, UK.

Secondary outcome measures

- Interleukin-2 level before and 5 days and 1 month after surgery, measured by ELISA, as described above.

- Levels of interleukin-1β, interleukin-10, C-reactive protein, tumor necrosis factor-α before and 5 days, and 1 and 3 months after surgery, measured by ELISA, as described above.

- Best corrected visual acuity, endothelial cell density, mean cell area, coefficient of variation before and 5 days, and 1 and 3 months after surgery: The best corrected visual acuity is the corrected naked vision. Corneal endothelial cells will be photographed using a corneal endothelial microscope. The corneal endothelial cell density, mean cell area and coefficient of variation of cell area will be measured with the non-contact corneal endothelial microscope. Corneal endothelial cells are generally responsible for the nutrient metabolism and material transport of the cornea. The decrease in the number of corneal endothelial cells indicates the improvement of corneal function.

- Insulin sensitivity index before and 5 days, and 1 and 3 months after surgery. Insulin sensitivity index = 1/(fasting insulin × fasting blood glucose). Insulin sensitivity index describes the degree of insulin resistance. The lower the insulin sensitivity, the weaker the effect of insulin per unit, and the lower the degree of sugar decomposition.

- Intraocular pressure before and 5 days, and 1 and 3 months after surgery. Intraocular pressure refers to the pressure of the intraocular fluid in the eyeball, measured with a manometer (Huaian Antel Instrument Factory, Huaian, China).

- Incidence of adverse reactions at 5 days and 1 and 3 months after surgery: Adverse reactions will be monitored after surgery in the two groups. Incidence of adverse reactions = (number of patients with adverse reactions during follow-up/total number of patients) × 100%.

The schedule for primary and secondary outcome measures is given in [Table 2].
Table 2: Timing of primary and secondary outcome measures

Click here to view


Sample size

Based on the number of hospitalized patients with cataract and glaucoma in recent years in the Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University (approximately 180 cases per year), we anticipate recruiting at least 150 patients during the recruitment period (2019-12-30 to 2020-12-30). Assuming a patient loss rate of 5%, an initial sample size of n = 160 will be used, approximately twice the size of the small sample test.

Randomization

Randomized grouping will not be used in this trial.

Blinding method

The assessors will be unaware of the test plan, and the blind method will be used.

Ethical approval

This study was approved by the Medical Ethics Com-mittee, First Affiliated Hospital of Kunming Medical University, China on December 15, 2013 (approval No. 20131215085; [Additional file 1] [Additional file 1]). This study will be performed in accordance with the principles of the Declaration of Helsinki. Study protocol version is 1.0. The writing and editing of the article will be performed in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) [Additional file 2] [Additional file 2].

Informed consent

Patients and their family members will participate in the trial voluntarily. All patients will sign the informed consent on the premise of fully understanding the treatment plan [Additional file 3] [Additional file 3].

Statistical analysis

All data will be statistically analyzed using SPSS 24.0 software (IBM Corp., Armonk, NY, USA). Measurement data will be expressed as mean; standard deviation; median, minimum, and maximum values; and upper and lower quartiles. Count data will be expressed as number and percentage.

Serum levels of interleukin-2, interleukin-1β, interleukin-10, C-reactive protein and tumor necrosis factor-α, best corrected visual acuity, endothelial cell density, mean cell area, coefficient of variation, insulin sensitivity index and intraocular pressure at various time points will be compared using repeated-measures analysis of variance and least significant difference test. Incidence of adverse reactions will be compared using Pearson’s chi-square test in both groups. Pearson linear correlation analysis will be used to analyze the correlation between inflammatory factors and insulin sensitivity index. The significance level (two-sided) will be α = 0.05.

All included patients will be assigned to the per-protocol set.


  Results Top


Flow chart

The study flow chart is shown in [Figure 1].
Figure 1: Trial flow chart.

Click here to view


Patients intended to be recruited into the trial

We anticipate that 160 patients will be recruited from December 30, 2019 to December 30, 2020.

Baseline requirements for prospective recruits

The patient baseline data, including age, sex, side of the affected eye and duration of illness, will be recorded in detail before surgery.

Expected outcome measures

Serum levels of interleukin-2, interleukin-1β, interleukin-10, C-reactive protein and tumor necrosis factor-α, best corrected visual acuity, endothelial cell density, mean cell area, coefficient of variation, insulin sensitivity index, intraocular pressure and incidence of adverse reactions during follow-up will be recorded in detail.

Expected possible adverse reactions

The main adverse reactions expected to be observed during the trial are intraocular and corneal edema, anterior chamber hemorrhage, conjunctival superficial dehiscence and anterior chamber exudation.

Adverse event report stipulates that if adverse events occur after phacoemulsification combined with trabeculectomy, the report time limit is 24 hours. Irrespective of the treatment a subject receives, any adverse events that occur will be treated immediately.

If serious adverse events such as bleeding, coma or shock, prolonged hospitalization, continuous functional loss and life-threatening caused by unforeseen factors occur, the clinician will report the serious adverse event(s) to the project manager within 1 hour and take corresponding emergency treatment measures.

Small-sample-size study results

Baseline data

The small sample included 80 patients (95 eyes) with cataract combined with glaucoma undergoing phacoemulsification combined with trabeculectomy in the First Affiliated Hospital of Kunming Medical University from January 2014 to June 2017. The patients included 43 males (24 affected in the left eye and 28 affected in the right eye) and 37 females (20 affected in the left eye and 23 affected in the right eye), with a mean age of 47.5 ± 11.4 years.

Postoperative follow-up results analysis

After phacoemulsification combined with trabeculectomy, the best corrected visual acuity was significantly improved, endothelial cell density was significantly decreased (P < 0.05), while mean cell area and coefficient of variation were significantly increased (P < 0.05; [Table 3]).
Table 3: Analysis of best corrected visual acuity and changes of corneal endothelial cells after phacoemulsification combined with trabeculectomy

Click here to view


After phacoemulsification combined with trabeculectomy, insulin sensitivity index was significantly increased and intraocular pressure was significantly decreased (P < 0.05; [Table 4]).
Table 4: Changes of insulin sensitivity index and intraocular pressure after phacoemulsification combined with trabeculectomy

Click here to view


After phacoemulsification combined with trabeculectomy, the levels of interleukin-1β, interleukin-2, interleukin-10, C-reactive protein and tumor necrosis factor-α were significantly decreased (P < 0.05; [Table 5]).
Table 5: Changes in inflammatory factors (ng/mL) after phacoemulsification combined with trabeculectomy

Click here to view


Analysis of adverse reactions

No significant adverse reactions occurred during the treatment in any subject.


  Discussion Top


Study limitations

The study does not include a control group, or randomized or blind grouping. The long-term efficacy (beyond 1 year) will not be explored. It is a self-controlled trial. The limitations might affect the reliability of the test results. The team will use multi-center, large-sample, randomized controlled trials in future studies to more rigorously verify the effectiveness of the treatment method.

Generalizability

The findings should confirm whether phacoemulsification and trabeculectomy is an effective method for the treatment of cataract combined with glaucoma. The results should also clarify whether the therapeutic effect is associated with the regulation of insulin sensitivity index, corneal endothelial cells and inflammatory factors. This trial will provide a rational basis for the clinical treatment of cataract combined with glaucoma using phacoemulsification and trabeculectomy.

Explanation

The completed small-sample trial showed that the best corrected visual acuity was significantly improved, endothelial cell density, intraocular pressure and interleukin-2 and interleukin-10 levels were significantly decreased, and the mean cell area, coefficient of variation and insulin sensitivity index were significantly increased after surgery. These results suggest that phacoemulsification combined with trabeculectomy is an effective therapeutic strategy for cataract combined with glaucoma.

Interleukin is strongly associated with the pathogenesis and treatment of cataract and glaucoma. However, many other inflammatory factors may contribute to disease. Therefore, in future studies, numerous additional inflammatory factors will be analyzed to provide a more comprehensive evaluation of the inflammatory response in the pathogenesis and treatment of cataract and glaucoma.


  Data Authenticity Management Top


Data collection

All data from patients with cataract combined with glaucoma will be collected and recorded in case report forms, signed and dated, and finally entered into an electronic version of the document saved on the computer.

Data management

After collecting the experimental data, they will be input by an investigator using Epi-Data 3.0 software using the double entry method. The accuracy of the data will be checked item by item to ensure the authenticity and credibility of the data.

Data quality control

The data monitoring committee will include ophthalmologists, and clinical trial management, statistics and ethics experts. The research will be carried out under the supervision of the responsible representative with corresponding qualifications. The data will be checked regularly.

Modification of the research plan

Participating researchers may not modify the content of the protocol during the trial without the permission of the research leader (such as enrollment criteria for cataract patients with glaucoma and postoperative follow-up outcome data).

Audits

Clinical monitors will check the trial records and case report forms of all cataract patients with glaucoma after phacoemulsification combined with trabeculectomy during and after the study. The data monitoring committee will report the progress of the trial to the Ethics Committee of the hospital every other month.

Confidentiality

Personal information of all cataract patients with glaucoma after phacoemulsification combined with trabeculectomy will be kept strictly confidential by our hospital, and a confidentiality agreement will be signed before the trial.

Declaration of interest

None declared.

Data sharing statement

Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices). Data will be available immediately following publication, with no end date. Anonymized trial data will be available indefinitely at www.figshare.com.

Result release

Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal.


  Trial Status Top


Registration time: September 10, 2019.

Recruitment time: December 30, 2019–December 30, 2020.

Study completed: June 30, 2021.

Trial status: Preparation for recruitment.

Additional files

Additional file 1: Hospital Ethics Approval (Chinese).

Additional file 2: TREND checklist.

Additional file 3: Informed Consent Form (Chinese).

Author contributions

Study design: JJZ; recruitment, data collection and analysis: JJZ, YG, QBC, JHY, and YL. All authors approved the final version of the paper.

Conflicts of interest

We declare that we have no conflict of interest.

Financial support

This study was supported by the National Natural Science Foundation of China, No. 81560159 (to YG); the Health Science and Technology Project of Yunnan Province of China, No. 2016NS063 (to JFZ). The funding sources had no role in study conception and design, data analysis or interpretation, paper writing or deciding to submit this paper for publication.

Institutional review board statement

This study will be performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Kunming Medical University, China on December 15, 2013 (approval No. 20131215085).

Declaration of patient consent

The authors certify that they will obtain all appropriate patient consent forms. In the form, the patients will give their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Reporting statement

The writing and editing of the article was performed in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.

Biostatistics statement

The statistical methods of this study were reviewed by the biostatistician of First Affiliated Hospital of Kunming Medical University, China.

Copyright license agreement

The Copyright License Agreement has been signed by all authors before publication.

Data sharing statement

Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices). Data will be available immediately following publication, with no end date. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. Anonymized trial data will be available indefinitely at www.figshare.com.

Plagiarism check

Checked twice by iThenticate.

Peer review

Externally peer reviewed.

Open access statement

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Funding: This study was supported by the National Natural Science Foundation of China, No. 81560159 (to YG); the Health Science and Technology Project of Yunnan Province of China, No. 2016NS063 (to JFZ).

C-Editor: Zhao M; S-Editors: Wang J, Li CH; L-Editors: Patel B, Qiu Y, Wang L; T-Editor: Jia Y



 
  References Top

1.
Correia M, Das T, Magno J, et al. Prevalence and causes of blindness, visual impairment, and cataract surgery in Timor-Leste. Clin Ophthalmol. 2017;11:2125-2131.  Back to cited text no. 1
    
2.
Thoufeeq U, Das T, Limburg H, et al. First rapid assessment of avoidable blindness survey in the maldives: prevalence and causes of blindness and cataract surgery. Asia Pac J Ophthalmol (Phila). 2018;7:316-320.  Back to cited text no. 2
    
3.
Arieta CE, de Oliveira DF, Lupinacci AP, et al. Cataract remains an important cause of blindness in Campinas, Brazil. Ophthalmic Epidemiol. 2009;16:58-63.  Back to cited text no. 3
    
4.
Fry M, Wilson GA. Scope for improving congenital cataract blindness prevention by screening of infants (red reflex screening) in a New Zealand setting. J Paediatr Child Health. 2005;41:344-346.  Back to cited text no. 4
    
5.
Tan AN, Cornelissen MF, Webers CAB, et al. Outcomes of severe uveitic glaucoma treated with baerveldt implant: can blindness be prevented? Acta Ophthalmol. 2018;96:24-30.   Back to cited text no. 5
    
6.
Stone JS, Muir KW, Stinnett SS, Rosdahl JA. Glaucoma blindness at a tertiary eye care center. N C Med J. 2015;76:211-218.  Back to cited text no. 6
    
7.
Arriola-Villalobos P, Martinez-de-la-Casa JM, Diaz-Valle D, et al. Glaukos istent inject® trabecular micro-bypass implantation associated with cataract surgery in patients with coexisting cataract and open-angle glaucoma or ocular hypertension: a long-term study. J Ophthalmol. 2016;2016:1056573.  Back to cited text no. 7
    
8.
Özyol P, Özyol E, Sül S, Baldemir E, Çavdar S. Intra-ocular pressure fluctuation after cataract surgery in primary angle-closure glaucoma eyes medically controlled after laser iridotomy. Acta Ophthalmol. 2016;94:e528-e533.  Back to cited text no. 8
    
9.
Shah M, Law G, Ahmed II. Glaucoma and cataract surgery: two roads merging into one. Curr Opin Ophthalmol. 2016;27:51-57.  Back to cited text no. 9
    
10.
Xu X, Ma YY, Zou HD. Cost-utility analysis of cataract surgery in advanced glaucoma patients. J Glaucoma. 2016;25:e657-e662.  Back to cited text no. 10
    
11.
Westermeyer HD, Cook AG, Harms C, Boylan S. Phacoemulsification cataract surgery in the loggerhead turtle (Caretta caretta): surgical technique and outcomes in 10 cases. Vet Ophthalmol. 2019. doi: 10.1111/vop.12635.  Back to cited text no. 11
    
12.
Chen J, Wang D, Zheng J, Gao C. Efficacy of femtosecond laser-assisted phacoemulsification for cataract patients and its influence on serum levels of inflammatory factors. J Coll Physicians Surg Pak. 2019;29:123-127.  Back to cited text no. 12
    
13.
Ma Q, Fan F, Zhao Z, Jia Z. Combined phacoemulsification, 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for patients with coexisting idiopathic macular hole and age-associated cataract. Exp Ther Med. 2019;17:525-530.  Back to cited text no. 13
    
14.
Hsu SL, Lee PY, Chiu LY. A simple method for preventing graft detachment during phacoemulsification cataract surgery after descemet stripping automated endothelial keratoplasty: a case report. Medicine (Baltimore). 2019;98:e13992.  Back to cited text no. 14
    
15.
Lu M, Wu YJ, Li DQ, et al. Phcoemulsification combined with trabeculectomy for treatment of primary angle-closure glaucoma and cataract. Guoji Yiyao Weisheng Daobao. 2008;14:19-21.  Back to cited text no. 15
    
16.
Gorski DJ, Petz A, Reichert C, et al. Cardiac fibroblast activation and hyaluronan synthesis in response to hyperglycemia and diet-induced insulin resistance. Sci Rep. 2019;9:1827.  Back to cited text no. 16
    
17.
Thanikachalam M, Fuller CH, Lane KJ, et al. Urban environment as an independent predictor of insulin resistance in a South Asian population. Int J Health Geogr. 2019;18:5.  Back to cited text no. 17
    
18.
Gao X, Hao L, Wang J, Ma G, Zhang T. Effect of phacoemulsification combined with intraocular lens implantation on inflammatory factors, oxidative stress response and hemorheology in diabetic cataract patients. J Coll Physicians Surg Pak. 2018;28:762-765.  Back to cited text no. 18
    
19.
Sakurada Y, Nakamura Y, Yoneyama S, et al. Aqueous humor cytokine levels in patients with polypoidal choroidal vasculopathy and neovascular age-related macular degeneration. Ophthalmic Res. 2015;53:2-7.  Back to cited text no. 19
    
20.
Xu JC, Chen HB, Liu HS, et al. Perioperative changes of blood lipid ratio, insulin sensitivity, intraocular pressure and corneal endothelial cells in ultrasonic emulsification treating cataract with glaucoma and their mutual relationships. Guangdong Yixue. 2017;38:1515-1518.  Back to cited text no. 20
    
21.
Niu J. Relation of serum and aqueous humor TNF-α and IL-6 with the process of neovascular glaucoma. Guoji Yanke Zazhi. 2018;18:1684-1686.  Back to cited text no. 21
    
22.
Tang J, Abramite B. Changes and significance of serum and aqueous humor IL-34,IL-6 levels in patients with inflammatory glaucoma. Guoji Jianyan Yixue Zazhi. 2018;39:2442-2445.  Back to cited text no. 22
    
23.
Glaucoma Group of Ophthalmology Branch of Chinese Medical Association. Consensus on Diagnosis and Treatment of Primary Glaucoma in China (2014). Zhonghua Yanke Zazhi. 2014;50:382-383.  Back to cited text no. 23
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  Data Authenticit...
  In this article
Abstract
Introduction
Participants/Methods
Results
Discussion
Trial Status
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed200    
    Printed22    
    Emailed0    
    PDF Downloaded36    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]