A meta-analysis of the association between high-sensitivity c-reactive protein level and glaucoma

Abstract

Objective

Glaucoma is the second-leading cause of blindness in the US for people over the age of 40; the most common form is primary open-angle glaucoma (POAG). It has been suggested that inflammatory markers have a role in the development and the progression of glaucoma (GL). High-sensitivity C reactive protein (HsCRP) is an inflammatory marker that has been linked to cardiovascular disease and a possible link to GL. Although a number of studies have found a link between CRP and GL; POAG, normal tension glaucoma (NTG), exfoliation glaucoma (XFG), Exfoliation syndrome (XFS), other research has shown the opposite.

Purpose

This systematic review is to determine the association between HsCRP and GL.

Methodology

A literature search was conducted using the MEDLINE database. We identified thirty-six peer-reviewed studies.

Results

Five retrospective studies were included and summed up to 164305 study participants, 161759 POAG patients, and 2546 controls. The pooled result of all studies revealed that HsCRP (SMD: 0.44 mg/dl; [95% confidence interval −0.10 to 0.99]; P = 0.11, I² 89%) concentration was not significantly higher in POAG patients compared to the healthy controls. The SMD for NTG, XFG and XFS; 0.64 mg/dl; 0.03 mg/dl, 0.03 mg/dl respectively. The pooled result revealed that HsCRP concentration was not significantly higher in POAG, NTG, XFG, and XFS. No publication bias was found using the funnel plot.

Conclusion

The meta-analysis concluded that there is no correlation between the elevated plasma levels of HsCRP and GL. Future studies should be conducted.

Keywords

hsCRP POAG glaucoma inflammation

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References

Pepys

Berger

. The renaissance of C reactive protein. Br Med J 2001; 322(7277): 4–5.

Pepys

Hirschfield

. C-reactive protein: a critical update. J Clin Invest 2003; 111(12): 1805–1812.

Flammer

Orgül

Costa

, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res 2002; 21(4): 359–393.

Nakamura

Yoshida

Arakawa

, et al. Endothelium-dependent vasodilator response is augmented in peripheral resistance vessels of patients with vasospastic angina. Cardiology 1999; 92(2): 85–92.

Ritch

Schlötzer-Schrehardt

. Exfoliation syndrome. Surv Ophthalmol 2001; 45: 265–315.

Schlötzer-Schrehardt

. Genetics and genomics of pseudoexfoliation syndrome/glaucoma. Middle East Afr J Ophthalmol 2011; 18(1): 30–36.

Cheng

Hsu

, et al. Abnormal flow-mediated vasodilation in normal-tension glaucoma using a noninvasive determination for peripheral endothelial dysfunction. Invest Ophthalmol Vis Sci 2006; 47(8): 3390–3394.

Cheng

, et al. Glaucoma is associated with peripheral vascular endothelial dysfunction. Ophthalmology 2008; 115(7): 1173–1178.e1171.

Jeon

Hwang

Lee

. Evaluation of systemic renin and angiotensin II levels in normal tension glaucoma. J Clin Med 2020; 9(12).

10.

Leibovitch

Kurtz

Kesler

, et al. C-reactive protein levels in normal tension glaucoma. J Glaucoma 2005; 14(5): 384–386.

11.

Lee

Park

H-YL

Park

, et al. Analysis of systemic endothelin-1, matrix metalloproteinase-9, macrophage chemoattractant protein-1, and high-sensitivity C-reactive protein in normal-tension glaucoma. Curr Eye Res 2012; 37(12): 1121–1126.

12.

Cheng

, et al. Systemic high-sensitivity C-reactive protein levels in normal-tension glaucoma and primary open-angle glaucoma. J Glaucoma 2007; 16(3): 320–323.

13.

Wells

Shea

O'Connell

, et al. The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. 2000.

14.

Gye

Kim

Yoo

, et al. Relationship between high serum ferritin level and glaucoma in a south Korean population: the Kangbuk Samsung health study. Br J Ophthalmol 2016; 100(12): 1703–1707.

15.

Atalay

Savur

Kirgiz

, et al. Serum levels of thyroid hormone, vitamin D, vitamin B12, folic acid, C-reactive protein, and hemoglobin in pseudoexfoliation and primary open angle glaucoma. J Fr Ophtalmol 2019; 42(7): 730–738.

16.

Mocan

Dikmetaş

Irkeç

. Serum C-reactive protein levels in exfoliation syndrome and exfoliative glaucoma. Eye (London, England) 2011; 25: 1383–1384.

17.

Yüksel

Pirhan

Altıntaş

, et al. Systemic high-sensitivity C-reactive protein level in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. J Glaucoma 2009; 19: 373–376.

18.

Henry

Newby

Webb

, et al. Peripheral endothelial dysfunction in normal pressure glaucoma. Invest Ophthalmol Vis Sci 1999; 40(8): 1710–1714.

19.

Buckley

Hadoke

Henry

, et al. Systemic vascular endothelial cell dysfunction in normal pressure glaucoma. Br J Ophthalmol 2002; 86(2): 227–232.

20.

W-W

Cheng

S-T

Hsu

, et al. Abnormal flow-mediated vasodilation in normal-tension glaucoma using a noninvasive determination for peripheral endothelial dysfunction. Invest Ophthalmol Visual Sci 2006; 47: 3390–3394.

21.

Hackam

Anand

. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. Jama 2003; 290(7): 932–940.

22.

Resch

Garhofer

Fuchsjäger-Mayrl

, et al. Endothelial dysfunction in glaucoma. Acta Ophthalmol 2009; 87(1): 4–12.

23.

Sorkhabi

Ghorbanihaghjo

Ahoor

, et al. High-sensitivity C-reactive protein and tumor necrosis factor alpha in pseudoexfoliation syndrome. Oman Med J 2013; 28(1): 16–19.

24.

Lesiewska

Malukiewicz

Mańkowska-Cyl

, et al. Lipids and C-reactive protein as vascular risk markers in pseudoexfoliation syndrome. Acta Ophthalmol 2016; 94(5): e380–e381.

25.

Pearson

Bazzarre

Daniels

, et al. American Heart association guide for improving cardiovascular health at the community level: a statement for public health practitioners, healthcare providers, and health policy makers from the American heart association expert panel on population and prevention science. Circulation 2003; 107(4): 645–651.