April 2016
Volume 57, Issue 4
Open Access
Letters to the Editor  |   April 2016
Author Response: Helicobacter pylori–Related Impact on Glaucoma Pathophysiology
Author Affiliations & Notes
  • Chun Ding
    Department of Ophthalmology of the Second Xiangya Hospital Central South University, Changsha, China
Investigative Ophthalmology & Visual Science April 2016, Vol.57, 2261. doi:10.1167/iovs.16-19278
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      Chun Ding, Jun Zeng; Author Response: Helicobacter pylori–Related Impact on Glaucoma Pathophysiology. Invest. Ophthalmol. Vis. Sci. 2016;57(4):2261. doi: 10.1167/iovs.16-19278.

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      © ARVO (1962-2015); The Authors (2016-present)

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We appreciate the opportunity to respond to Kountouras and colleagues,1 whom we thank for their interest in our article.2 Their comments focused on the association between Helicobacter pylori infection and pseudoexfoliation glaucoma (PXFG) incidence and how the possible mechanisms of H. pylori increase the risk of open-angle glaucoma (OAG). We entirely agree with the authors about how the possible mechanisms of H. pylori increase the risk of OAG (as explained by Kountouras et al.1); however, we have some questions for the authors regarding the association between H. pylori and PXFG. 
Four studies have investigated the relationship between H. pylori infection and PXFG36; however, the existence of this relationship remains a controversial topic. Kountouras et al.1,6 reported a strong association between H. pylori and PXFG; however, the other three studies mentioned above found no significant association between the occurrence of PXFG and H. pylori infection.35 Considering the inconsistent reports on H. pylori infection as a risk factor for PXFG, conducting a subgroup analysis within our meta-analysis,2 in which the results of all relative studies would be combined to assess the correlation of H. pylori infection with PXFG, would be informative. It is important to note that the pooled results did not detect any correlation between H. pylori infection and PXFG. 
Kountouras and colleagues1,6 also claimed that there were significantly higher levels of anti–H. pylori IgG in the aqueous humor of PXFG patients as compared with the cataract control group. Similarly, Razeghinejad et al.7 found significantly higher levels of anti–H. pylori IgG in the aqueous humor of PXFG patients as compared with the cataract control group. Deshpande and colleagues,5 however, found similar concentrations of anti–H. pylori specific for IgG in the aqueous humor samples from patients with PXFG as compared with the cataract control group. Thus, the literature we reviewed does not provide conclusive evidence that H. pylori infection is associated with PXFG. It is worth noting that because of the small number of studies eligible for the subgroup analysis and the fact that the studies with small sample sizes made it difficult to acquire enough data to provide meaningful results, the conclusion from our meta-analysis should be interpreted with caution. Future large-volume, well-designed studies to confirm the association between H. pylori infection and PXFG occurrence and to confirm the exact mechanism of their association are needed. 
Supported by the National Natural Science Foundation of China (81300758). The authors alone are responsible for the content and the writing of the paper. 
References
Kountouras J, Zavos C, Zeglinas C, Polyzos SA, Katsinelos P. Helicobacter pylori–related impact on glaucoma pathophysiology. Invest Ophthalmol Vis Sci. 2015; 56: 8029–8030.
Zeng J, Liu H, Liu X, Ding C. The relationship between Helicobacter pylori infection and open-angle glaucoma: a meta-analysis. Invest Ophthalmol Vis Sci. 2015; 56: 5238–5245.
Kurtz S, Regenbogen M, Goldiner I, Horowitz N, Moshkowitz M. No association between Helicobacter pylori infection or CagA-bearing strains and glaucoma. J Glaucoma. 2008; 17: 223–226.
Galloway PH, Warner SJ, Morshed MG, Mikelberg FS. Helicobacter pylori infection and the risk for open-angle glaucoma. Ophthalmology. 2003; 110: 922–925.
Deshpande N, Lalitha P, Krishna DS, et al. Helicobacter pylori IgG antibodies in aqueous humor and serum of subjects with primary open angle and pseudo-exfoliation glaucoma in a South Indian population. J Glaucoma. 2008; 17: 605–610.
Kountouras J, Mylopoulos N, Konstas AG, Zavos C, Chatzopoulos D, Boukla A. Increased levels of Helicobacter pylori IgG antibodies in aqueous humor of patients with primary open-angle and exfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol. 2003; 241: 884–890.
Razeghinejad MR, Kamali-Sarvestani E, Farvardin M, Pourhabibi A. Aqueous levels of anti-Helicobacter pylori IgG antibody in patients with primary open angle and pseudoexfoliation glaucoma. Iran J Immunol. 2006; 3: 86–90.
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