Author Response: Helicobacter pylori–Related Impact on Glaucoma Pathophysiology

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 PXFG^3–6; 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.^3–5 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 colleagues^1,6 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.