Aqueous Humor and Serum Levels of Ischemia Modified Albumin (IMA): A Novel Biomarker in Primary Glaucoma
Glaucoma is a worldwide health-care problem of irreversible blindness. Glaucoma consists of neurodegenerative disorders marked by chronic progressive degeneration and apoptosis of anatomical structure resulting in marked visual field defect.
The increase of intraocular pressure (IOP) is one of the risk factors, which is also the only factor that able to be controlled by medications or surgery. Therefore, the target of glaucoma treatments is to lower the IOP to delay the disease progression. High IOP is the result of aqueous humor (AQH) build-up. Pathogenesis of glaucoma also associated with oxidative stress process. Moreover, vasoconstriction of vessels as the result of peroxynitrite (ONOO-) is also causing the reduction optic nerve blood flow, which further resulting in RGC death. Oxidative stress also leads to increase endothelin-1, responsible to vasoconstriction of vessels and reduction of the optic nerve blood flow, resulting in RGC death. Neuronal transport in the optic nerve head is also disrupted by increasing activation of endothelin. Therefore, ischemia, apoptosis of RGC and further damage in glaucoma.
Early diagnosis, prompt treatment, and progression monitoring in glaucoma have been challenging. Patient evaluation needs to be thorough with the complete clinical examination, IOP measurements, structural, and functional imaging modalities. Screening examination based only on IOP measurements is no longer considered precise, especially in early stage patients with normal IOP range.
A novel parameter for early diagnosis, monitoring treatment response, and disease progression may contribute to improve disease prognosis in glaucoma. Molecular biomarkers are now thought to be able to diagnose glaucoma in its early stages or patients with high-risk developing glaucoma, also in glaucoma treatments. Oxidation induces albumin structure modifications. The binding of the oxidative stress to one of the albumin's chains causes the formation of IMA, which is considered a novel biomarker of ischemia-related events and oxidative stress. IMA levels were higher in serum and aqueous humor in diabetic retinopathy (DR). The changes in glaucoma progression have been considered able to depict by systemic antioxidant levels, and oxidative stress biomarkers. This study by Rusmayani et al aimed to analyze IMA levels in the serum and aqueous humor as an early diagnostic parameter and their correlation to RNFL thinning in primary glaucoma.
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