Full Project – MAJOR IONS VARIABILITY IN SERUM AND TEAR AS A BIOMARKER IN PRIMARY GLAUCOMA

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TABLE OF CONTENTS

Dedication

Certification

Acknowledgement

Abstract

Table of contents

List of table

List of graph

CHAPTER ONE: GENERAL INTRODUCTION

1.1       Background

1.2 Definition

1.3 Classification

1.4 Epidemiology

1.5 Pathophysiology

1.5.1 Mechanical Theory

1.5.2 Vascular Theory

1.5.3 The Role of Oxidative Stress

1.5.4    Paracrine Effects

1.5.6 Ions

1.6 Diagnosis

1.7 Treatment

1.8   Statement of Purpose

1.9 Aim and Objectives

CHAPTER TWO: LITERATURE REVIEW

2.1 Gaucoma Screening

2.2 Human Tear Composition and Function

2.3 Serum Electroly Test

2.4 Role of Ions in Apoptosis

2.5 Biomarkers in Systemic Disease

CHAPTER THREE: MATERIALS AND METHODS

3.1 Study Design

3.2 Study Area

3.4 Subjects

3.5 Sample Collection

3.6 Data Management

CHAPTER FOUR: RESULTS

4.1 Statistical Analysis

4.2 Sensitivity and Specificity of the Study

CHAPTER FIVE: DISCUSSION

5.1 Limitations of the Study

5.2 Conclusion

References

Appendix I (ethical approval)

Appendix II (data form and questionnaire)

ABSTRACT

Glaucoma is the leading cause of irreversible blindness globally and more so in individuals of African descent. All age groups are affected but common with increasing age. About 0.3% of Nigerians are blind from glaucoma. Variations in extracellular ion concentrations have been implicated in the pathogenesis of chronic neurodegenerative diseases including glaucoma. The aim of the study was to measure the serum and tear concentration of potassium, sodium and chloride in glaucoma patients and normal subjects and analysis of the variability of the results in the two groups. All together one hundred (100) consecutive consenting subjects aged 30 years above attending eye clinic at Enugu State University Teaching Hospital were recruited for the study between the months of November and December 2015. Fifty (50) subjects were glaucoma patients while the remaining 50 served as control. The mean serum concentrations (mMol/L) of sodium, potassium and chloride were 135.42, 4.07 and 101.50 respectively while tear concentrations were 133.74, 17.14 and 125.34 respectively in the glaucoma subjects (test group) while the mean serum concentration (Mm0l/L) of sodium, potassium and chloride for control subjects were 135.56, 4.14, and 101.58 respectively and tear concentrations were 130.96, 21.40 and 122.86 respectively. Forty seven (47) out of the fifty glaucoma subject had a potassium concentration lower than 20mMol/L while forty eight (48) out of the fifty normal subjects had potassium concentration of 20mMol/L or above. This difference was statically significant (p= 0.012). Using 20mMol/L as the reference value for tear potassium concentration, the study gave a sensitivity of 94% and specificity of 92%. Tear potassium estimation may be a useful parameter in glaucoma screening and diagnoses. However, further studies are suggested to validate these finding.

CHAPTER ONE

INTRODUCTION

1.1               Background.

The word glaucoma is thought to be a derivative of the Greek word ‘glaucosis’ which literarily translates to bluish -green. This was thought to be the colour of a swollen eye surface resulting from a yet to be understood eye disease. In 1662, the English Oculist Dr Richard Bannister published the first attempt at characterizing the disease. He described the condition as being a tetrad comprising of eye tension, long duration of the disease, inability to perceive light and a fixed dilated pupil (this description in present-day concept only applies to the final stages of glaucoma, often referred to as absolute glaucoma). However, two centuries after this epochal publication, other workers in the field failed to recognize the role of raised eye pressure until 1818 when the French Physician Dr Antoine-Pierre Demours brought back the concept of raised eye as a cardinal feature of the disease. Carl Heinrich Weller, a German Ophthlmologist, was the first to use the word ‘glaucoma’ to describe the eye condition characterized by ocular pain, dilated pupil and loss of vision (Weller and Monteah, 1821).

As soon as the commonality of raised eye pressure was agreed as an important feature of the disease, several conflicting theories were espoused by as many investigators in explaining the elevation. The cause of the increased intra-ocular pressure was seen by Albreicht von Graefe to result from inflammation of the inner coat of the eye giving rise to choroiditis with associated lens swelling (von Graefe and Windsor, 1859). Dr Donders.

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