The Association of Oxidative Stress Status with Open-Angle Glaucoma and Exfoliation Glaucoma: A Systematic Review and Meta-Analysis.

Purpose: To systematically evaluate the associations between oxidative stress status and different types of glaucoma.

Design: Systematic review and meta-analysis.

Methods: We searched PubMed, EMBASE, and the Web of Science for randomized controlled trials written in the English language between January 1, 1990, and November 30, 2016. A random effects model was used to estimate oxidative stress status along with weighted mean differences and 95% confidence intervals (CIs). A funnel plot analysis and Egger's test were performed to assess potential publication bias.

Main outcome measures: Oxidative stress status was abnormal and different in patients with OAG (open-angle glaucoma) and EXG (exfoliation glaucoma).

Results: Blood TAS (total antioxidant status) was lower in the OAG group than in the control group, with a mean difference of 0.580 mmol/L ( p < 0.0001, 95% CI = -0.668 to -0.492). The aqueous humor SOD (superoxide dismutase), GPX (glutathione peroxidase), and CAT (catalase) levels were higher in the OAG group than in the control group, with mean differences of 17.989 U/mL ( p < 0.0001, 95% CI = 14.579-21.298), 12.441 U/mL ( p < 0.0001, 95% CI = 10.423-14.459), and 1.229 fmol/mL ( p =0.042, 95% CI = 0.043-2.414), respectively. Blood TAS was lower in the EXG group than in the control group, with a mean difference of 0.262 mmol/L ( p < 0.0001, 95% CI = -0.393 to -0.132). However, there were no differences in blood TOS and aqueous humor TOS between the EXG group and the control group.

Conclusions: This meta-analysis indicates that OAG patients had a lower TAS in the blood and higher levels of SOD, GPX, and CAT in the aqueous humor, while EXG patients only had a decreased TAS in the blood.