Sunday, 11 January 2015

(Preview) Most Common Diseases of Ages of 50 Plus - Glaucoma: The Causes

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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Glaucoma is a medical condition of an eye disease caused by induced retinal ganglion cell types alterations before detectable dendritic loss. If untreated, the disease can lead to permanently vision impair and blindness.
II. Causes and Risk Factors
A. Causes
1. Genes
a. Certain genes mutation, such as Myocilin(MYOC), Cytochrome P450, family 1, subfamily B, polypeptide 1(CYP1B1), and Forkhead box C1(FOXC1)
In primary Glaucoma, Matrix metalloproteinases (MMPs) play an important role on cell behaviors such as cell proliferation, migration (adhesion/dispersion), differentiation, angiogenesis, apoptosis, and host defense(23), defect of MMPs (MMP1 rs1799750 (-1607 1G/2G) and MMP9 rs17576 polymorphisms(25)) have been shown to associated with gender-dependent risk factors for developing primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG), respectively(24)(26).
According to studies,
a.1. Although it is rare, genetic mutation of genes cytochrome P450, family 1, subfamily B, polypeptide 1(CYP1B1), myocilin (MYOC), optineurin(OPTN), and Opticin(OPTC) is associated to increased risk in Indian population(28).;
a.2. Mutation of  genes myocilin (MYOC) and optineurin (OPTN) sequence variations is associated to  risk factor in Spanish(29) and
a.3. Mutation of myocilin (MYOC),optineurin (OPTN), WD repeat domain 36 (WDR36), and apolipoprotein E (APOE) genes are increased risk of primary open-angle glaucoma (POAG) in northern Chinese(30).
a.4. Although other gene mutations, such as Latent Transforming Growth Factor Beta Binding Protein(LTBP2) has been found in north Indian patients with PCG, it is not involved in the pathogenesis of primary congenital glaucoma(27).

b. Connective tissue growth factor (CTGF)
The most critical risk factor for optic nerve damage in cases of primary open-angle glaucoma (POAG)(31) is an increased intraocular pressure (IOP) due to alternation of tissues in the eye located around the base of the cornea(32). Actin, a critical player in many cellular functions, including cell motility and the maintenance of cell shape, etc.(33), disruption or taken over actin cytoskeleton by numerous pathogens(34), may induce a resistance to aqueous humor outflow in the trabecular meshwork (TM)(36), an area of tissue is responsible for draining the aqueous humor from the eye via the anterior chamber causes of optic nerve damage involved connective tissue growth factor (CTGF), found in higher amounts in the aqueous humor of patients with POAG(35).

c. Alterations of serine protease
Angle-closure glaucoma (ACG) is a subset of glaucoma affecting 16 million people. According to the study by the The Jackson Laboratory, alterations of  serine protease, a family of enzymes that cut certain peptide bonds in other proteins with functions, especially in digestion, blood clotting, and the complement system(37) may induce a wide range of  ocular conditions, including reduced ocular size and ACG(38)(39) and high hyperopia(39).

2. Iactive congenital syphilitic interstitial keratitis
Iterstitial keratitis(IK), a condition of corneal scarring caused by chronic inflammation of corneal stroma(40) has been found to associate to the development of angle-closure glaucoma in the absence of corneal opacity in patinets(41).

3. Anatomical disorder(42)
Chronic angle-closure glaucoma, the commonest form of glaucoma in Sino Mongaloid populations can lead to permanent closure of part of the filtration angle in the anterior segment(42)(43) of the eye, leading to conditions of recurrent pupillary block and “creeping” angle closure(44).

4. Atypical ocular ischaemia
 Low intraocular pressure in untreated glaucoma(45) can lead to ciliary shut down, retinal detachment, post filtering surgery and ocular ischaemia, according to Glaucoma Services, LV Prasad Eye Institute(46).

5. Other causes
According to the examination of post operation patients with glaucoma in the first 275 consecutive eyes, other causes include
a. Exacerbation of a pre-existing glaucoma
b. IOP elevation induced mechanical angle closure, due to impaired ocular blood flow(48)
c. Steroid response(49)(50)
d. Peripheral anterior synechiae(51)(52)
e. Without detectable cause (47).

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