Inflammatory Markers in Glaucoma and the Prevalence of Autoimmune Diseases in Primary Open Angle Glaucoma (POAG) Patients Undergoing Ophthalmic Surgeries

Abstract

Purpose: To identify inflammatory markers in glaucoma patients undergoing ophthalmic surgeries prospectively. Concurrently, assess the prevalence of autoimmune diseases in patients with primary open angle glaucoma (POAG) undergoing ophthalmic surgery retrospectively. Methods: A prospective study is being conducted at the Massachusetts Eye and Ear (MEE). Patients with different subtypes of glaucoma were included if undergoing routine cornea, glaucoma, or cataract surgery. Control subjects were scheduled for cataract surgery and excluded if they carried the diagnosis of glaucoma, glaucoma suspect, or have a family history of glaucoma. Patients with any inflammatory or autoimmune disease were excluded from the prospective study but included in the retrospective analysis. Blood and aqueous humor samples were collected at the time of the surgery and sent to collaborators at the Schepens Eye Research Institute (SERI) of MEE for immune analysis. A retrospective study was also performed using the same set of patient demographic and ophthalmic information from the prospective study. Patients with POAG and controls without glaucoma undergoing ophthalmic surgery at MEE were included. Similar to the prospective study, control subjects were scheduled for cataract surgery and excluded if they carried the diagnosis of glaucoma, glaucoma suspect, or have a family history of glaucoma. The presence of autoimmune diseases was determined based on all available medical record information. The difference in prevalence of autoimmune diseases between POAG and controls was assessed with chi-square test and these results were adjusted for covariates including age, body mass index (BMI), gender, ethnicity, and type 2 diabetes using multinomial logistic regression. Results: For the prospective study, patient recruitment and analysis of the peripheral blood and aqueous humor samples are still in process and ongoing. Results will be finalized once patient recruitment is completed. For the retrospective study, 62 POAG patients and 97 controls were included. The overall prevalence of autoimmune diseases was 27% in the POAG group and 9% in the controls (p=0.003). In the fully adjusted multinomial logistic regression analysis, having an autoimmune disease was associated with 4.61-fold increased odds of POAG relative to controls (95% CI: 1.69- 12.5, p=0.003), while age and non-white ethnicity also increased odds of POAG (odds ratio = 1.05, 1.54, respectively, p<0.05 for both). Conclusions: The retrospective study suggests a higher prevalence of autoimmune diseases in POAG patients compared to control patients undergoing surgery. The presence of an autoimmune disease significantly increased the risk for POAG after adjusting for covariates. This provides further support for the prospective study, which will explore the role of autoimmunity in the pathogenesis of POAG.