MARKERS OF APOPTOSIS IN INTRAOCULAR FLUID IN PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA

Abstract

Abstract. Primary open-angle glaucoma (POAG) is the second leading cause of blindness in the world. The prevalence of glaucoma in adults aged 18 and older in Ukraine in 2016 was 452.7, in 2017 - 458.0 per hundred thousand population, respectively. The issues of timely diagnosis of glaucoma, determination of the rate of disease progression and improvement of surgical treatment methods remain relevant. The search for new informative markers and methods for predicting the progression of glaucoma optic neuropathy (GON) in POAG is an urgent task. Earlier we found that the progression of GON after various types of surgical treatment of POAG is observed in 10-15% of patients. It is known that the main mechanism of GON is apoptotic death of retinal ganglion cells. Aim: to study markers of apoptosis in intraocular fluid in patients with primary open-angle glaucoma. Materials and methods. We observed 69 patients (69 eyes) with stage I-III POAG who underwent trabeculectomy with Ex-Press shunt implantation.. In intraocular fluid (IOF) were studied markers of apoptosis — tumor necrosis factor-α (TNFα), Fas-ligand (FasL) and soluble form of Fas-receptor (sFas / APO-1) by enzyme-linked immunosorbent assay. The control group consisted of 25 patients who underwent phacoemulsification for age-related cataracts. Statistical analysis of the results was performed using the software package SPSS 11.0, MedStat. The mean (M) and its standard deviation (SD) were calculated. Tukey HSD for unequal sample sizes and Student's t-test for paired independent intergroup comparisons were used to perform pairwise comparisons. Fisher's test (F; analysis of variance) was used for multiple comparisons. In all cases of analysis, the critical significance level was assumed to be 0.05. Results. As a result of the study it was found that the level of TNFα in stage I POAG was 1.55 ±0.97 pg / ml, in stage II - 2.16 ±0.88 pg / ml, in stage III - 2.52 ± 0, 45 pg / ml, in the control group - 1.11 ±0.76 pg / ml. The level of FasL in stage I POAG was 29.5 ±11.5 pg / ml, in stage II - 38.2 ±13.4 pg / ml, in stage III - 41.5 ± 6.7 pg / ml, in the control group - 22.4 ±3.8 pg / ml (F = 22.36; p <0.001). The level of sFas / Apo-1 in stage I POAG was 1.02 ±0.37 ng / ml, in stage II - 0.83 ±0.31 ng / ml, in stage III - 0.66 ±0.16 ng / ml , in the control group - 1.05 ±0.12 ng / ml (F = 14.65; p <0.001). It should be noted that the content of TNFα in IOF was significantly increased in patients with stage II and III POAG compared with controls (p <0,001). There was no statistically significant difference between control and stage I and between stages I and II (p = 0.473 and p = 0.191, respectively). The content of TNFα was highest in IOF of patients with stage III POAG and exceeded the values in the control (2.3 times; p <0.001) and in stage I (1.6 times; p = 0.011). The difference between stages II and III was statistically insignificant (p = 0.350). Similar differences between stages of POAG were observed in the content of FasL in IOF, which was maximum in IOF of patients with stage III and exceeded that in the control (1.9 times; p <0.001) and in stage I (1.4 times; p = 0.010). The difference between stages II and III was statistically insignificant (p = 0.584). It was also found that in contrast to TNFα and FasL, the content of sFas / Apo-1 in IOF according to the POAG stage was lower. Statistically significant content of sFas / Apo-1 did not differ between IOF of patients in the control group and in stage I POAG (p = 0,983), and it was minimal in patients with stage III POAG (was lower than the control 1.6 times; p <0,001 ). Multiple comparisons established the statistical significance of trends in changes in the content of all studied markers of apoptosis by stages of POAG (p <0,001). Conclusions. As a result of the study, it was found that according to the stage of POAG, the content of TNFα and FasL in the intraocular fluid increased, and sFas / Apo-1 decreased (p <0.001). 2. The largest absolute increase in intraocular fluid was observed for TNFα.