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Top-Eight of the Third Asia Pacific Glaucoma Congress 2016
Chiang Mai, Thailand, July 14-16, 2016

Prin Rojanapongpun, Visanee Tantisevi, Anita Manassakorn, Rath Itthipanichpong

1. New findings and pathogenesis in true exfoliation syndrome
   True exfoliation is characterized by peeling of the translucent membrane of the anterior lens capsule. A new classification, based on a prospective observational case series of 259 Thai patients (424 eyes) on the anterior lens capsule, was proposed. Initial capsular splits occur along the insertions of disrupted anterior zonules. It is believed that the mechanical peeling is with iris movement and aqueous flow. (Chaiwat Teekhasaenee )
2. Genetics of exfoliation syndrome LOXL1 gene was found to be associated with exfoliation syndrome.
   The new identifying gene, CACNA1A rs4926244 on chromosome 6p was recently discovered in Genome wide association analysis (GWAS) that was performed in 9,700 exfoliation syndrome and 98,000 controls. (Mineo Ozaki)
3. The role of neurotrophic factors in axonal regeneration of the optic nerve
   The new neurotrophic factors are: glial cell line-derived neurotrophic factor (GDNF) and its genes, neuturin (NRTN) and artemin (ARTN), and their receptors (GFRα1, 2, and 3). The most effective agent against axonal injury is ARTN and GFRα3 that will be an important factor for gene therapy in the future. (Toru Nakazawa)
4. Gene therapy in glaucoma
   Cell culture and monkey studies showed success of gene therapy in glaucoma, in either at enhancing aqueous humor outflow by targeting the outflow pathways or at reducing the aqueous production by targeting the non-pigmented epithelium. A number of viral vectors, delivered via transcorneal injection or via micro-invasive glaucoma surgical approach through Schlemm’s canal, have been shown to be superior to non-viral techniques with a longer duration and high transduction efficiency. Viral vectors carrying cytoskeleton active genes can modify the outflow pathway resulting in IOP reduction for several months in monkey models. (Paul Kaufman)
5. Retinal ganglion cell imaging
   Retinal ganglion cell death is associated with the disturbance of axonal transport and mitochondrial dysfunction. The intravital multiphoton imaging device provides sequential time lapse of mitochondria transport in a single axon in mouse. The axonal transport is more vulnerable in older than younger mice. This imaging will be benefit to predict glaucoma progression. (Masaru Inatani)
6. Dendrites of the retinal ganglion cell in glaucoma
   Decreases in soma size, dendritic shrinkage and loss of dendritic branches of RGC were found prior to RGC apoptosis. RGC dendrites are responsive element, unlike axons which were shown unable to regenerate after injury, modulating the RGC dendrites may be the new possibility in glaucoma treatment. (Hae-Young Lopilly Park)
7. Wound healing modulator in glaucoma filtering surgery
   Wound healing modulation has been extensively discussed in the APGC 2016 meeting. Newer wound modulating agents based on protein such as CAT-152 (Leredelimumab), a human monoclonal antibody to Transforming Growth Factor ß2 (TGF-ß2), was described. This antibody works by decreasing TGF- ß2 induced collagen production and myofibroblast-mediated contraction. Sustain-released pharmacological agents and mechanical barrier (biodegradable collagen matrix) have been under experiment to help wound modulation in glaucoma filtering surgery and in Ahmed glaucoma implant surgery. The one-year complete success rate of Ahmed valve implantation plus collagen matrix is increased to 57% in comparison to 14% in conventional Ahmed implantation. The qualified success rate is 71% and 33% in Ahmed plus collagen matrix and Ahmed alone, respectively. (Seungsoo Rho)
8. Rho kinase inhibitors for glaucoma treatment
   IOP lowering effect of Rho-kinase inhibitor was initially reported in 2001. Up until now, ten agents are under clinical trials. Ripasudil is one that proved effective based on phase-1-3 trials. An open label study also showed its effects on secondary glaucoma besides POAG and OHT. (Hidenobu Tanihara.)