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Glaucoma: Overview01:25

Glaucoma: Overview

Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...

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In Vivo Vascular Injury Readouts in Mouse Retina to Promote Reproducibility
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Inflammatory Stability Index Correlates with Retinal Nerve Fiber Layer Reduction in Glaucoma.

Raluca Neacșa1,2, Daniela Manasia1,2, Cristiana Tănase3,4

  • 1Department of Medico-Surgical Disciplines, Faculty of Medicine, "Titu Maiorescu" University of Bucharest, Bucharest, Romania.

Romanian Journal of Ophthalmology
|May 18, 2026
PubMed
Summary

Inflammatory stability, measured by the Inflammatory Stability Index (ISI), is a better predictor of glaucoma progression than absolute cytokine levels. High inflammatory stability indicates faster retinal nerve fiber layer loss in patients with primary open-angle glaucoma (POAG).

Keywords:
ANOVA = Analysis of VarianceAUC = Area Under the CurveBCa = Bias-Corrected and Accelerated (bootstrap confidence interval)CI = Confidence IntervalCV = Coefficient of VariationHD-OCT = High-Definition Optical Coherence TomographyIFN-γ = Interferon gammaIL-10 = Interleukin-10IL-1β = Interleukin-1 betaIL-4 = Interleukin-4IL-6 = Interleukin-6IOP = Intraocular PressureIQR = Interquartile RangeISI = Inflammatory Stability IndexLR+ = Positive Likelihood RatioLR− = Negative Likelihood RatioMAD = Median Absolute DeviationNPV = Negative Predictive ValueOCT = Optical Coherence TomographyPGA = Prostaglandin AnalogsPOAG = Primary Open-Angle GlaucomaPPV = Positive Predictive ValueQALY = Quality-Adjusted Life YearRGCs = Retinal Ganglion CellsRNFL = Retinal Nerve Fiber LayerROC = Receiver Operating CharacteristicSD Standard = DeviationSTROBE = Strengthening the Reporting of Observational Studies in EpidemiologyTNF-α = Tumor Necrosis Factor alphabiomarkerscytokinesglaucomaneuroinflammationretinal

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Immunology

Background:

  • Neuroinflammation is a known factor in glaucomatous neurodegeneration.
  • The prognostic significance of inflammatory markers in glaucoma remains uncertain.
  • Previous research focused on absolute cytokine levels, potentially missing crucial temporal dynamics.

Purpose of the Study:

  • To investigate the association between inflammatory stability over time and retinal nerve fiber layer (RNFL) reduction in primary open-angle glaucoma (POAG).
  • To introduce and validate the Inflammatory Stability Index (ISI) as a measure of temporal inflammatory patterns.

Main Methods:

  • A prospective longitudinal cohort study involving 57 participants (19 controls, 38 POAG patients) over 24 months.
  • Serum cytokine profiling (IL-1β, TNF-α, IL-6) and RNFL measurements were collected.
  • The Inflammatory Stability Index (ISI) was developed using the formula: ISI = Median[cytokines] / (1 + IQR[cytokines]) to quantify inflammatory stability.

Main Results:

  • The ISI significantly correlated with RNFL progression rate (r = -0.491, p = 0.002).
  • Patients with stable-high inflammation (ISI > 3.5) exhibited 74% faster RNFL progression compared to those with volatile-low inflammation (ISI < 1.6).
  • The ISI demonstrated acceptable accuracy in identifying rapid progressors (AUC = 0.76) and remained significant after multivariable adjustments.

Conclusions:

  • Inflammatory stability patterns, as quantified by the ISI, are more informative for predicting glaucoma progression than absolute cytokine levels.
  • The ISI can identify high-risk inflammatory phenotypes in POAG patients.
  • This index may aid in personalized management strategies and patient stratification for closer monitoring.