Analysis of the correlation between mental status and ocular and systemic indicators in patients with primary angle-closure glaucoma

Analysis of the correlation between mental status and ocular and systemic indicators in patients with primary angle-closure glaucoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the correlation between mental status and ocular and systemic indicators in patients with primary angle-closure glaucoma Shizhou Cheng, Pan Deng, Lijun Du, Kangning Wang, Xue He, Yi Xiang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6376257/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 12 You are reading this latest preprint version Abstract Background To analyze the poor mental status of patients with primary closed-angle glaucoma(PACG), and to explore the correlation between mental status and ocular and systemic indices in patients with PACG. Methods We collected patients' axial length (AL), anterior chamber depth (ACD), nerve fiber layer thickness (RNFL), cup-to-disc ratio (C/D), antinuclear antibody (ANA), toxoplasmosis antibody (anti-Toxoplasma gondii IgM), and anxiety and depression scores (HAMA and HAMD scales). Statistical analysis was utilized to analyze the data for each of the patients in the PACG and cataract patient groups. Results The results showed that there was a statistically significant difference between the glaucoma group and the cataract group in terms of anxiety and depression scores, AL, ACD, RNFL, C/D, ANA, and Anti-Toxo IgM (P < 0.05). Anxiety scores of glaucoma patients were positively correlated with AL and C/D (P < 0.05), negatively correlated with RNFL (P 0.16). Depression scores in glaucoma patients were positively correlated with C/D (P < 0.05), negatively correlated with AL and RNFL (P 0.16). RNFL, C/D, and ANA can be considered significant predictors of anxiety status.AL and C/D can be considered significant predictors of depression status. Conclusion Patients with primary angle-closure glaucoma have higher anxiety and depression scores than the general population, and clinically we can predict the patient's mental status by their ocular and systemic indicators so that appropriate treatment can be taken in time. primary angle-closure glaucoma anxiety and depression eye exam ANA toxoplasma antibodies Figures Figure 1 Figure 2 Figure 3 1. Background Glaucoma is the leading global cause of irreversible vision loss. It is characterized by the degeneration of retinal ganglion cells and resulting changes in the optic nerve papillae, with the loss of ganglion cells being primarily related to IOP[ 1 ].Glaucoma is considered a chronic disease that requires lifelong management, with treatment focused on preventing progression.[ 2 ]Mental disorders such as depression and anxiety are often associated with chronic illnesses[ 3 ].Numerous studies show a high prevalence of anxiety or depression in glaucoma patients[ 4 – 6 ].Glaucoma patients are hospitalized much more frequently due to chronic pain, progressive vision loss, and many other reasons, which puts a serious psychological burden on the patient and the patient is constantly worried about the possibility of blindness[ 7 ].This leads to poor mental health in the long run. An observational study showed that glaucoma patients were 10.6 and 12.3 times more likely to experience depression and anxiety, respectively[ 5 ].It is therefore crucial to prevent and promptly diagnose and treat poor mental health in patients with glaucoma. Antinuclear antibodies (ANA) in somatic cells are autoantibodies produced by the nucleus and associated genetic molecules and are a hallmark of autoimmunity[ 8 ].It has been shown that patients with acute cerebral infarction (ACI) have a high rate of ANA antibody positivity, which is closely related to the degree of cerebrovascular stenosis and neurological deficit.[ 9 ]Toxoplasma gondii is an intracellular apicomplexan protozoan parasite that attaches to the cell membrane via its apical complex and invades all nucleated cells of vertebrates by gliding motility.[ 10 ]Invasion by Toxoplasma gondii triggers a series of immune responses in the host (Fig. 1 ), with a common complication being increased intraocular pressure[ 11 ].Many studies have now shown that Toxoplasma infection is a risk factor for the development of schizophrenia and depression in humans[ 12 – 14 ],Interestingly, we found ANA antibody positivity and toxoplasma antibody positivity in a subset of patients with high intraocular pressure in primary angle-closure glaucoma (PACG)compared to normal subjects.PACG is a common form of blinding glaucoma. Atrial angle closure is the basic pathologic process in PAGC[ 15 ].Could this finding indicate neurological impairment in glaucoma patients, leading to psychiatric disorders such as anxiety and depression? The role of psychiatric disorders in glaucoma is still complex, which makes it difficult to identify psychiatric abnormalities in glaucoma patients on time. Here we collected and analyzed the ocular and systemic indicators of PACG patients to explore the degree of anxiety and depression in PACG patients under various indicators, and to provide clinical references for the prevention and timely diagnosis and treatment of adverse mental states in glaucoma patients. 2. Materials and methods 2.1 Study patients This is a retrospective study to analyze whether patients with primary closed-angle glaucoma are more likely to suffer from psychiatric system disorders (anxiety and depression). And to explore the correlation between anxiety and depression scores and various indicators in patients with closed-angle glaucoma. Clinical information of 101 (63 right eyes, 38 left eyes) patients with primary closed-angle glaucoma (mean intraocular pressure 46.86, mean age 67.92) and 110 (56 right eyes, 54 left eyes) with simple cataract (mean age 68.57) from the Department of Ophthalmology of the First Affiliated Hospital of Yangtze University from September 2023 to September 2024 were selected for this study.We obtained written informed consent from all patients. 2.2 Data collection Each patient underwent a comprehensive ophthalmologic examination, including evaluation of best-corrected visual acuity (BCVA), measurement of intraocular pressure (IOP) using an iCare rebound tonometer (ta01i), and measurement of axial length (AL) and anterior chamber depth (ACD) by an ophthalmic optical biometer (Zeiss IOLMaster 500). Retinal nerve fiber layer thickness (RNFL) and cup-to-disc ratio (C/D) were measured by optical coherence tomography (OCT) (Zeiss CIRRUS HD-OCT 5000).Fasting blood was drawn from each patient, and the patients were tested for antinuclear antibodies (ANA) and Anti-Toxo IgM. Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess each patient. Patients with significant refractive media clouding, ophthalmic surgery, other ophthalmic diseases, and previous psychiatric disorders were excluded. Patients with systemic diseases such as diabetes or hypertension were also excluded. All ophthalmologic examinations and psychiatric evaluations were performed by a single ophthalmologist who was skilled in psychiatric evaluation methods. The HAMA scale is a commonly used clinical anxiety assessment tool, which measures anxiety through a series of quantitative ratings of symptoms, including mental and physical aspects, with a total of 14 items; clinically, a total score of ≥ 29 is likely to be severe anxiety, ≥ 21 is definitely significant anxiety, ≥ 14 is definitely anxiety, ≥ 7 is probably anxiety, and < 7 is no anxiety symptoms. The HAMD scale, developed by Hamilton in 1960, is the most commonly used scale for assessing depressive states in clinical settings, and there are three versions of this scale: 17-item, 21-item, and 24-item, and the 24-item version was used in this study. According to Davis JM's delineation score, a total score of ≥ 35 is likely to be severely depressed; ≥20 is likely to be mildly or moderately depressed; and < 8, the patient would have no depressive symptoms. We set patients with primary angle-closure glaucoma as the experimental group and patients with cataract as the control group. Between the groups we designated age 51–60 years as group I, 61–70 years as group II, 71–80 years as group III, and 81–90 years as group IV. (Fig. 2 ) 3. Results 3.1 Comparison of the general conditions of the two groups The prevalence between the two groups was 45.6% (31/68) in males and 49.0% (70/143) in females, with no statistically significant difference between the two groups ( χ 2 = 0.21, P > 0.05). The prevalence was 56.1% (23/41) in the age group 51–60, 44.8% (39/87) in the age group 61–70, 48.0% (36/75) in the age group 71–80, and 44.4% (4/9) in the age group 81–90. There was no statistical significance in the prevalence of the four age groups ( χ 2 = 1.52, P > 0.05),The two groups are comparable. (Table 1 ) Table 1 Basic information about the patients in both groups Group Total Disease rate(%) Non-disease rate(%) Difference and 95%- Cl(%) P value Male 68 31(45.6%) 37(54.4%) 3.40[-10.08-16.88] 0.66 * Female 143 70(49.0%) 73(51.0%) Age - 0.68 # Group I 40 23(55.0%) 18(45.0%) Group II 87 39(44.8%) 48(55.2%) Group III 75 36(48.0%) 39(52.0%) Group Ⅳ 9 4(44.4%) 5(55.6%) * Chi-Square # Fisher exact test 3.2 Comparative analysis of ocular/systemic indicators between groups The median of ocular axial length in the glaucoma group was 22.23 (21.60, 22.75), and in the cataract group was 23.26 (22.66, 23.85), and there was a statistical difference in the ocular axial length in the two groups ( z =-7.87, P < 0.001). The median of anterior chamber depth was 2.41 (2.25, 2.56) in the glaucoma group and 3.00 (2.72, 3.24) in the cataract group, and there was a statistical difference between the anterior chamber depths of the two groups (z=-10.22, P < 0.001).(Table 2 ) The positivity rate of ANA was 66.3% (67/101) in the glaucoma group and 12.7% (14/110) in the cataract group, and there was a statistically significant difference in the positivity rate of ANA between the two groups ( χ 2 = 63.95, P < 0.001). The positivity rate of Anti-Toxo IgM was 28.7% (29/101) in the glaucoma group and 10.9% (12/110) in the cataract Anti-Toxo IgM, and there was a statistically significant difference in Anti-Toxo IgM positivity between the two groups ( χ 2 = 10.66, P = 0.001). (Table 3 ) Table 2 Comparison of ocular conditions between the two groups Group M(P 25 ,P 75 ) Difference and 95%- Cl(%) P value Ocular axial length -1.08[-1.34- -0.84] < 0.001 Glaucoma 22.23(21.60,22.75) Cataract 23.26(22.66,23.85) Anterior chamber depth -0.57[-0.66 - -0.48] < 0.001 Glaucoma 2.41(2.25,2.56) Cataract 3.00(2.72,3.24) two-sample rank-sum test. Table 3 Comparison of systemic indicators between the two groups Group Total Positive rate(%) Negative rate(%) Difference and 95%- Cl(%) P value Antinuclear antibodies 53.60[42.48–64.72] < 0.001 Glaucoma 101 67(66.3) 34(33.7) Cataract 110 14(12.7) 96(87.3) Anti-Toxo IgM 17.80[7.23–28.37] 0.001 Glaucoma 101 29(28.7) 72(71.3) Cataract 110 12(10.9) 98(89.1) Chi-Square test. 3.3 Comparative analysis of anxiety and depression scores between groups Anxiety scores in the glaucoma group were (15.51 ± 4.89) and in the cataract group were (4.77 ± 2.12), and there was a statistically significant difference in the overall mean of the overall anxiety scores between the two groups ( t = 21.01, p < 0.001). The median depression score in the glaucoma group was 19.0(14.50, 28.00), and in the cataract group was 4.0 (2.75, 6.90), and there was a statistically significant difference in the depression scores between the two groups ( z =-12.46, P < 0.001).(Table 4 ) Table 4 Comparison of anxiety and depression scores between the two groups. Group Scores Difference and 95%- Cl(%) P value Anxiety 10.74[9.73–11.75] < 0.001 * Glaucoma 15.51 ± 4.89 Cataract 4.77 ± 2.12 Depression 15.00[14.00–17.00] < 0.001 # Glaucoma 19.0(14.50,28.00) Cataract 4.0(2.75,6.90) * two-sample t-test # two-sample rank-sum test 3.4 Comparison of anxiety and depression scores between gender and age within the glaucoma group. Anxiety scores by age group were as follows: 51–60: 16.27 ± 4.93; 61–70: 15.59 ± 4.64; 71–80: 15.17 ± 5.32; 81–90: 13.75 ± 3.40 .Overall means of anxiety scores were not statistically different between age groups ( F = 0.407, P > 0.05). Depression scores by age group were as follows:51–60: 21.55 ± 6.22; 61–70: 19.33 ± 6.03; 71–80: 18.31 ± 6.06; 81–90: 19.25 ± 7.09 .There was no statistical difference in the overall mean of depression scores between age groups ( F = 1.286, P > 0.05). (Table 5 ) In the glaucoma group, the anxiety score was 14.42 ± 4.60 in males and 16.00 ± 4.96 in females and there was no statistically significant difference between the total mean anxiety scores of males and females ( t =-1.51, P > 0.05). Depression score was 17.71 ± 6.11 for males and 20.21 ± 6.04 for females. There was no statistically significant difference between the total mean depression scores of males and females ( t =-1.915, P > 0.05). (Table 6 ) Table 5 Comparison of anxiety and depression scores by age in the glaucoma group. Group Mean ± SD P value Age(anxiety) 0.75 Group I 16.27 ± 4.93 Group II 15.59 ± 4.64 Group III 15.17 ± 5.32 Group Ⅳ 13.75 ± 3.40 Age(depression) 0.28 Group I 21.55 ± 6.22 Group II 19.33 ± 6.03 Group III 18.31 ± 6.06 Group Ⅳ 19.25 ± 7.09 ANOVA Table 6 Comparison of anxiety and depression scores by gender in the glaucoma group Group Mean ± SD Difference and 95%- Cl(%) P value Anxiety group -1.58[-3.66-0.50] 0.13 Male 14.42 ± 4.60 Female 16.00 ± 4.96 Depression group -2.51[-5.10-0.09] 0.058 Male 17.71 ± 6.11 Female 20.21 ± 6.04 two-sample t-tests 3.5 Correlation analysis of anxiety and depression scores within the glaucoma group According to the correlation analysis, the anxiety scores of glaucoma patients were positively correlated with AL and C/D ( P < 0.05), negatively correlated with RNFL ( P 0.16), and no correlation with ACD ( P > 0.05). Depression scores in glaucoma patients were positively correlated with C/D ( P < 0.05), negatively correlated with AL and RNFL ( P 0.16), and not correlated with ACD ( P > 0.05). (Fig. 3 ) 3.6 Multiple linear regression of indicators and anxiety/depression scores within the glaucoma group There was a statistically significant difference in the effect of RNFL ( b =-0.01, t =-0.19, P < 0.001), C/D ( b = 18.83, t = 7.14, P < 0.001), and ANA on anxiety scores ( b = 0.76, t = 0.2.39, P < 0.05). RNFL, C/D, and ANA can be considered significant predictors of anxiety status. (Table 8) There was a statistically significant difference in the effect of AL ( b =-1.58, t =-3.76, P < 0.001) and C/D ( b = 31.96, t = 2.18, P < 0.05)on depression scores. AL and C/D can be considered significant predictors of depression status. (Table 7 ) Table 7 multiple linear regression for each indicator Variable B value Standard error of B-value P value Anxiety group axial length -0.01 0.08 0.849 anterior chamber depth -0.01 0.42 0.986 retinal nerve fiber layer -0.07 0.02 < 0.001 cup-to-disc ratio 18.83 2.64 < 0.001 antinuclear antibodies 0.76 0.32 0.019 Anti-Toxo IgM -0.14 0.29 0.638 Depression group axial length -1.58 0.42 < 0.001 anterior chamber depth -2.14 2.33 0.360 retinal nerve fiber layer 0.04 1.00 0.719 cup-to-disc ratio 31.96 14.64 0.032 antinuclear antibodies 2.38 1.78 0.184 Anti-Toxo IgM -0.25 1.63 0.877 4. Discussion The role of psychiatric disorders in glaucoma is still complex, and the purpose of this study is to compare whether there are differences in indicators and anxiety and depression between patients with primary angle-closure glaucoma and patients with normal cataracts, and also the focus of this study is that we compare the correlation between these indicators and anxiety and depression scores. The aim is to construct a predictive model to prevent and timely diagnose and treat poor mental status in glaucoma patients. A special “retinal melanopsin-expressing ganglion cells—dorsal perihabenular nucleus—nucleus accumbens” neural circuit in the brain has been identified by neural tracing tools[ 16 ].They hypothesized that this loop of emotion regulation may be the reason why blue light depresses mice at night, and therefore we suspect that the development of mood disorders in glaucoma patients may be due to the damage of intrinsically photosensitive retinal ganglion cells (ipRGCs), and the specific mechanism needs to be further investigated in the future. The exact mechanism needs to be further investigated in the future. Another study revealed the existence of a shared lymphatic circuit between the eye and the brain that is capable of generating a unified immune response between the posterior eye and the brain[ 17 ],which strengthens the link between glaucoma and central nervous system disease. This study also opens up the potential for new therapeutic strategies for both eye and CNS diseases Patients with short ocular axis and shallow anterior chamber tend to have a higher risk of glaucoma than normal people. High intraocular pressure in glaucoma can harm the retina and optic nerve[ 18 ],resulting in decreased RNFL and increased C/D. We confirmed that the ocular axis, anterior chamber depth, RNFL and C/D in glaucoma patients are statistically different from those in common cataract patients. All of them were correlated with anxiety and depression scores. ANA is a general term for a group of autoantibodies directed against different components of the nucleus of one's own cells, which can be produced against DNA and RNA proteins and their molecular complexes in the nucleus. Our finding that a large proportion of patients with primary angle-closure glaucoma are ANA positive during the course of our clinic has given us pause for thought. We proposed that primary angle-closure glaucoma may an autoimmune attack on the SC and optic nerve as an endpoint, and many studies have shown that the SC bears a striking structural and functional resemblance to lymphatic vessels[ 19 ],and that the optic nerve sheath contains lymphoid gene signatures, therefore autoimmune occurrences may be present in all of these structures. Our study found statistically significant differences in the differences between glaucoma and normal cataracts and a correlation with anxiety scores. Toxoplasma infections often result in elevated IOP[ 11 ],and glaucomatous Toxoplasma antibody serum IgM and IgG antibodies are produced within 1–2 weeks after infection, and similar to most infections, the first anti-Toxoplasma antibody to appear is IgM, which peaks at 1–3 months[ 20 ].We found that toxoplasma antibody IgM was statistically different from the normal cataract group in these patients with primary angle-closure glaucoma and correlated with anxiety scores as did ANA. Overall, glaucoma can cause not only a dramatic loss of vision, but also headaches, dizziness, nausea, and other symptoms that may even lead to blindness. At the same time, glaucoma can adversely affects patients' mental status, which is often overlooked by ophthalmologists. Therefore, the focus of our study is to correlate the poor mental status of glaucoma patients with their ocular and systemic indices to recognize the patients' mental status in time for rational pharmacological and surgical treatments. Conclusion Patients with PACG have higher anxiety and depression scores than the general population. Through our study, we found that there is a correlation between ocular and systemic indicators and poor mental status in PACG patients. Clinically, we can predict patients' mental status in advance based on their examination results so that appropriate treatment measures can be taken. Declarations -Ethics approval and consent to participate 1)Our study adheres to the Declaration of Helsinki by stating this in the manuscript. 2)Our study has been approved by the Ethics Committee of the First People's Hospital of Jingzhou. 3)Informed consent was obtained from all patients for our study. -Consent for publication Not Applicable -Availability of data and materials The data that support the findings of this study are available from the corresponding author, [ZJC], upon reasonable request. -Competing interests The authors declare no competing interests. -Funding No relevant funding was received for this study. -Authors' contributions Shizhou-Cheng:Formal analysis,Writing–original draft,Writing–review & editing. Pan-Deng:Software,Writing–review & editing. Lijun-Du:Methodology,Writing–review & editing. Kangning-Wang:Formal analysis,Investigation,Methodology. Xue-He:Formal analysis,Investigation. Yi-Xiang:Formal analysis,Investigation. Guojin Zuo:Resources,Software,Supervision,Validation. Zijian-Chen:Writing–original draft,Supervision,Validation,Visualization. -Acknowledgements Not Applicable -Authors' information Shizhou Cheng, M.D. Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] ORCID Number: 0000-0003-4418-4844 Pan Deng, M.D. Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] Lijun Du, M.D. Medical Department of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] Kangning,Wang, M.D. Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] Xue He, M.D. Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China Email: [email protected] Yi Xiang, M.D. Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] *Correspondence Guojin Zuo, M.D. Professor, Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] Zijian Chen, M.D. Professor,Department of Ophthalmology The First Affiliated Hospital of Yangtze University Jingzhou City, Hubei Province,434000,China E-mail: [email protected] References Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901–11. Khatib TZ, Martin KR. Protecting retinal ganglion cells. Eye (Lond). 2017;31(2):218–24. Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust. 2009;190(S7):S54–60. Zhang X, Liang Y, Huang Y, Liu S, Li Q, Wang S, Wu G, Du Z, Wang Y, Wang J, et al. Evaluation of the Observational Associations and Shared Genetics Between Glaucoma With Depression and Anxiety. Invest Ophthalmol Vis Sci. 2024;65(3):12. Zhang X, Olson DJ, Le P, Lin FC, Fleischman D, Davis RM. The Association Between Glaucoma, Anxiety, and Depression in a Large Population. Am J Ophthalmol. 2017;183:37–41. Shin DY, Jung KI, Park HYL, Park CK. The effect of anxiety and depression on progression of glaucoma. Sci Rep. 2021;11(1):1769. Berchuck S, Jammal A, Mukherjee S, Somers T, Medeiros FA. Impact of anxiety and depression on progression to glaucoma among glaucoma suspects. Br J Ophthalmol. 2021;105(9):1244–9. Irure-Ventura J, López-Hoyos M. The Past, Present, and Future in Antinuclear Antibodies (ANA). Diagnostics (Basel) 2022, 12(3). Meng H, Xing X, Zhang C, Zhao J, Ren C, Liu Y. Relations between antinuclear, antineutrophil cytoplasmic, anticardiolipin antibodies and degree of neurological deficit, cerebrovascular stenosis in cerebral infarction patients. Pak J Med Sci. 2023;39(3):677–81. Dobrowolski JM, Sibley LD. Toxoplasma invasion of mammalian cells is powered by the actin cytoskeleton of the parasite. Cell. 1996;84(6):933–9. Chen Z, Cheng S, Chen X, Zhang Z, Du Y. New advances in immune mechanism and treatment during ocular toxoplasmosis. Front Immunol. 2024;15:1403025. Hinze-Selch D, Däubener W, Eggert L, Erdag S, Stoltenberg R, Wilms S. A controlled prospective study of toxoplasma gondii infection in individuals with schizophrenia: beyond seroprevalence. Schizophr Bull. 2007;33(3):782–8. Chaudhury A, Ramana BV. Schizophrenia and bipolar disorders: The Toxoplasma connection. Trop Parasitol. 2019;9(2):71–6. Alvarado-Esquivel C, Martínez-Martínez AL, Sánchez-Anguiano LF, Hernández-Tinoco J, Castillo-Orona JM, Salas-Martínez C, Sifuentes-Álvarez A, Sandoval-Carrillo AA, Salas-Pacheco JM, Liesenfeld O, et al. Lack of association between Toxoplasma gondii exposure and depression in pregnant women: a case-control study. BMC Infect Dis. 2017;17(1):190. Sun X, Dai Y, Chen Y, Yu DY, Cringle SJ, Chen J, Kong X, Wang X, Jiang C. Primary angle closure glaucoma: What we know and what we don't know. Prog Retin Eye Res. 2017;57:26–45. An K, Zhao H, Miao Y, Xu Q, Li YF, Ma YQ, Shi YM, Shen JW, Meng JJ, Yao YG, et al. A circadian rhythm-gated subcortical pathway for nighttime-light-induced depressive-like behaviors in mice. Nat Neurosci. 2020;23(7):869–80. Yin X, Zhang S, Lee JH, Dong H, Mourgkos G, Terwilliger G, Kraus A, Geraldo LH, Poulet M, Fischer S, et al. Compartmentalized ocular lymphatic system mediates eye-brain immunity. Nature. 2024;628(8006):204–11. Lafuente MP, Villegas-Pérez MP, Sellés-Navarro I, Mayor-Torroglosa S, Miralles de Imperial J, Vidal-Sanz M. Retinal ganglion cell death after acute retinal ischemia is an ongoing process whose severity and duration depends on the duration of the insult. Neuroscience. 2002;109(1):157–68. Aspelund A, Tammela T, Antila S, Nurmi H, Leppänen VM, Zarkada G, Stanczuk L, Francois M, Mäkinen T, Saharinen P, et al. The Schlemm's canal is a VEGF-C/VEGFR-3-responsive lymphatic-like vessel. J Clin Invest. 2014;124(9):3975–86. Park SW, Kim SH, Kwon HJ, Lee SM, Byon IS, Lee JE. Diagnostic Value of Positive Findings of Toxoplasma gondii-Specific Immunoglobulin M Serum Antibody in Uveitis Patients to Confirm Ocular Toxoplasmosis. Ocul Immunol Inflamm. 2019;27(4):583–90. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 26 May, 2025 Reviews received at journal 17 May, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers invited by journal 06 May, 2025 Editor assigned by journal 06 May, 2025 Editor invited by journal 15 Apr, 2025 Submission checks completed at journal 12 Apr, 2025 First submitted to journal 12 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6376257","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453965797,"identity":"89420888-1b45-4b32-aaad-3a969067b83e","order_by":0,"name":"Shizhou Cheng","email":"","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Shizhou","middleName":"","lastName":"Cheng","suffix":""},{"id":453965798,"identity":"32ad82a7-907f-446e-97c2-91782b6599ff","order_by":1,"name":"Pan Deng","email":"","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Pan","middleName":"","lastName":"Deng","suffix":""},{"id":453965799,"identity":"53887a11-26b5-48e3-915c-6a33cdd36658","order_by":2,"name":"Lijun Du","email":"","orcid":"","institution":"Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Lijun","middleName":"","lastName":"Du","suffix":""},{"id":453965800,"identity":"5d2dbf2c-929d-41b4-ab37-657442bbb48f","order_by":3,"name":"Kangning Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Kangning","middleName":"","lastName":"Wang","suffix":""},{"id":453965801,"identity":"2fe33c54-5f2f-4c15-8e65-92d0e93f3f1b","order_by":4,"name":"Xue He","email":"","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"He","suffix":""},{"id":453965802,"identity":"e3c9c351-f376-42f2-a206-b6ebce3365c3","order_by":5,"name":"Yi Xiang","email":"","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Xiang","suffix":""},{"id":453965803,"identity":"1fbc0198-78c0-43b0-9827-e49916256b08","order_by":6,"name":"Guojin Zuo","email":"","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Guojin","middleName":"","lastName":"Zuo","suffix":""},{"id":453965804,"identity":"aa0bca74-4a49-49ab-9a94-1b10043ef2fc","order_by":7,"name":"Zijian Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIie3QsUoEMRCA4ZFArolem+WOzSvkONjKh8lwsJWCZYorJpwkhdr7GJaWFxZSxX7LE8FauysEtVd2184iXz0/zAxAUfxDXMVwfNPnQs128WDsdjw5k4yqe9vWq9u00YecxpNazmghcreG/qKpnq/ZhMUWjvSpZ+iobS0Sh3m4McPJMpKpPMcAXerxcQkyPz0MJ4C0X3mBzvm2x8xBy8vRxBF6idSJ5go9m5BI3ME+6zUk0cC0RER/QtZ8P5lvpMlJjN6iQnhlH/pTKPUS3492W8/D3XDyg/jbeFEURfGrL/PHTRtb7mYxAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Yangtze University","correspondingAuthor":true,"prefix":"","firstName":"Zijian","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-04-04 12:38:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6376257/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6376257/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-04227-0","type":"published","date":"2025-07-07T15:57:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82584819,"identity":"1bacacfe-9793-42fe-9bfe-deb03cb0e41e","added_by":"auto","created_at":"2025-05-13 06:56:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":378749,"visible":true,"origin":"","legend":"\u003cp\u003eInvasion of the host by Toxoplasma gondii.Slow colonizers (dormant form of Toxoplasma gondii) are transmitted after invasion of the human body and are converted to tachyzoites in thesmall intestine. CD11+ dendritic cells and CD11+ monocytes help to transport the tachyzoites to various tissues of the host.In the eye,after tachyzoites arrive at the retina with blood, MIC2 is first secreted from the tachyzoite tip and forms a MIC2-M2AP hexameric complex with MIC2-associated protein (M2AP) in a ratio of 1:1, recognizing the intercellular adhesion factor ICAM-2 on the host cell membrane. Subsequently, rod protein (rhoptry protein, ROP) is released and interacts with MIC2 to invade retinal endothelial cells and form parasitophorous vacuole (PV). Finally, dense granule protein (GRA) begin to be secreted, modifying the PV and facilitating the worm’s access to nutrients necessary for survival and replication.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6376257/v1/3978fc41b657f77b0e4d9ef2.jpg"},{"id":82583168,"identity":"2fd3f6dd-f506-4118-b11b-aa4fe8576936","added_by":"auto","created_at":"2025-05-13 06:48:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":427774,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of this study\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6376257/v1/bed142706a932c6095c90adb.jpg"},{"id":82583173,"identity":"4e01fd38-4cc9-43e2-a337-0e8e8c9e0ae6","added_by":"auto","created_at":"2025-05-13 06:48:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":531007,"visible":true,"origin":"","legend":"\u003cp\u003eA-D:Correlation analysis between depression scores and ACD, AL, RNFL, and C/D. E-H: Correlation analysis between anxiety scores and ACD, AL, RNFL, and C/D. I: Correlation analysis between depression and anxiety scores and ANA , Anti-Toxo IgM (\u003csup\u003e*\u003c/sup\u003e.anxiety，\u003csup\u003e#\u003c/sup\u003e.depression).\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6376257/v1/f02386c14fd42b17846c965e.jpg"},{"id":86699453,"identity":"a57cdae0-962e-46d7-a599-cee0849b1798","added_by":"auto","created_at":"2025-07-14 16:09:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2384152,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6376257/v1/9a82245f-1af0-45d8-8807-0285d2992069.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the correlation between mental status and ocular and systemic indicators in patients with primary angle-closure glaucoma","fulltext":[{"header":"1. Background","content":"\u003cp\u003eGlaucoma is the leading global cause of irreversible vision loss. It is characterized by the degeneration of retinal ganglion cells and resulting changes in the optic nerve papillae, with the loss of ganglion cells being primarily related to IOP[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].Glaucoma is considered a chronic disease that requires lifelong management, with treatment focused on preventing progression.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]Mental disorders such as depression and anxiety are often associated with chronic illnesses[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Numerous studies show a high prevalence of anxiety or depression in glaucoma patients[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].Glaucoma patients are hospitalized much more frequently due to chronic pain, progressive vision loss, and many other reasons, which puts a serious psychological burden on the patient and the patient is constantly worried about the possibility of blindness[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].This leads to poor mental health in the long run. An observational study showed that glaucoma patients were 10.6 and 12.3 times more likely to experience depression and anxiety, respectively[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].It is therefore crucial to prevent and promptly diagnose and treat poor mental health in patients with glaucoma.\u003c/p\u003e \u003cp\u003eAntinuclear antibodies (ANA) in somatic cells are autoantibodies produced by the nucleus and associated genetic molecules and are a hallmark of autoimmunity[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].It has been shown that patients with acute cerebral infarction (ACI) have a high rate of ANA antibody positivity, which is closely related to the degree of cerebrovascular stenosis and neurological deficit.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]Toxoplasma gondii is an intracellular apicomplexan protozoan parasite that attaches to the cell membrane via its apical complex and invades all nucleated cells of vertebrates by gliding motility.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]Invasion by Toxoplasma gondii triggers a series of immune responses in the host (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with a common complication being increased intraocular pressure[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].Many studies have now shown that Toxoplasma infection is a risk factor for the development of schizophrenia and depression in humans[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e],Interestingly, we found ANA antibody positivity and toxoplasma antibody positivity in a subset of patients with high intraocular pressure in primary angle-closure glaucoma (PACG)compared to normal subjects.PACG is a common form of blinding glaucoma. Atrial angle closure is the basic pathologic process in PAGC[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Could this finding indicate neurological impairment in glaucoma patients, leading to psychiatric disorders such as anxiety and depression?\u003c/p\u003e \u003cp\u003eThe role of psychiatric disorders in glaucoma is still complex, which makes it difficult to identify psychiatric abnormalities in glaucoma patients on time. Here we collected and analyzed the ocular and systemic indicators of PACG patients to explore the degree of anxiety and depression in PACG patients under various indicators, and to provide clinical references for the prevention and timely diagnosis and treatment of adverse mental states in glaucoma patients.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study patients\u003c/h2\u003e \u003cp\u003eThis is a retrospective study to analyze whether patients with primary closed-angle glaucoma are more likely to suffer from psychiatric system disorders (anxiety and depression). And to explore the correlation between anxiety and depression scores and various indicators in patients with closed-angle glaucoma. Clinical information of 101 (63 right eyes, 38 left eyes) patients with primary closed-angle glaucoma (mean intraocular pressure 46.86, mean age 67.92) and 110 (56 right eyes, 54 left eyes) with simple cataract (mean age 68.57) from the Department of Ophthalmology of the First Affiliated Hospital of Yangtze University from September 2023 to September 2024 were selected for this study.We obtained written informed consent from all patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eEach patient underwent a comprehensive ophthalmologic examination, including evaluation of best-corrected visual acuity (BCVA), measurement of intraocular pressure (IOP) using an iCare rebound tonometer (ta01i), and measurement of axial length (AL) and anterior chamber depth (ACD) by an ophthalmic optical biometer (Zeiss IOLMaster 500). Retinal nerve fiber layer thickness (RNFL) and cup-to-disc ratio (C/D) were measured by optical coherence tomography (OCT) (Zeiss CIRRUS HD-OCT 5000).Fasting blood was drawn from each patient, and the patients were tested for antinuclear antibodies (ANA) and Anti-Toxo IgM. Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to assess each patient. Patients with significant refractive media clouding, ophthalmic surgery, other ophthalmic diseases, and previous psychiatric disorders were excluded. Patients with systemic diseases such as diabetes or hypertension were also excluded. All ophthalmologic examinations and psychiatric evaluations were performed by a single ophthalmologist who was skilled in psychiatric evaluation methods.\u003c/p\u003e \u003cp\u003eThe HAMA scale is a commonly used clinical anxiety assessment tool, which measures anxiety through a series of quantitative ratings of symptoms, including mental and physical aspects, with a total of 14 items; clinically, a total score of \u0026ge;\u0026thinsp;29 is likely to be severe anxiety, \u0026ge;\u0026thinsp;21 is definitely significant anxiety, \u0026ge;\u0026thinsp;14 is definitely anxiety, \u0026ge;\u0026thinsp;7 is probably anxiety, and \u0026lt;\u0026thinsp;7 is no anxiety symptoms.\u003c/p\u003e \u003cp\u003eThe HAMD scale, developed by Hamilton in 1960, is the most commonly used scale for assessing depressive states in clinical settings, and there are three versions of this scale: 17-item, 21-item, and 24-item, and the 24-item version was used in this study. According to Davis JM's delineation score, a total score of \u0026ge;\u0026thinsp;35 is likely to be severely depressed; \u0026ge;20 is likely to be mildly or moderately depressed; and \u0026lt;\u0026thinsp;8, the patient would have no depressive symptoms.\u003c/p\u003e \u003cp\u003eWe set patients with primary angle-closure glaucoma as the experimental group and patients with cataract as the control group. Between the groups we designated age 51\u0026ndash;60 years as group I, 61\u0026ndash;70 years as group II, 71\u0026ndash;80 years as group III, and 81\u0026ndash;90 years as group IV. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of the general conditions of the two groups\u003c/h2\u003e \u003cp\u003eThe prevalence between the two groups was 45.6% (31/68) in males and 49.0% (70/143) in females, with no statistically significant difference between the two groups (\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The prevalence was 56.1% (23/41) in the age group 51\u0026ndash;60, 44.8% (39/87) in the age group 61\u0026ndash;70, 48.0% (36/75) in the age group 71\u0026ndash;80, and 44.4% (4/9) in the age group 81\u0026ndash;90. There was no statistical significance in the prevalence of the four age groups (\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.52, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05),The two groups are comparable. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic information about the patients in both groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDisease rate(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-disease rate(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDifference and 95%- Cl(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31(45.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37(54.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.40[-10.08-16.88]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.66\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70(49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73(51.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.68\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48(55.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(48.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39(52.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(55.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e Chi-Square\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e#\u003c/sup\u003e Fisher exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparative analysis of ocular/systemic indicators between groups\u003c/h2\u003e \u003cp\u003eThe median of ocular axial length in the glaucoma group was 22.23 (21.60, 22.75), and in the cataract group was 23.26 (22.66, 23.85), and there was a statistical difference in the ocular axial length in the two groups (\u003cem\u003ez\u003c/em\u003e=-7.87, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The median of anterior chamber depth was 2.41 (2.25, 2.56) in the glaucoma group and 3.00 (2.72, 3.24) in the cataract group, and there was a statistical difference between the anterior chamber depths of the two groups (z=-10.22, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe positivity rate of ANA was 66.3% (67/101) in the glaucoma group and 12.7% (14/110) in the cataract group, and there was a statistically significant difference in the positivity rate of ANA between the two groups (\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;63.95, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The positivity rate of Anti-Toxo IgM was 28.7% (29/101) in the glaucoma group and 10.9% (12/110) in the cataract Anti-Toxo IgM, and there was a statistically significant difference in Anti-Toxo IgM positivity between the two groups (\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;10.66, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of ocular conditions between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM(P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifference and\u003c/p\u003e \u003cp\u003e95%- Cl(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcular axial length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-1.08[-1.34- -0.84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.23(21.60,22.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.26(22.66,23.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior chamber depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-0.57[-0.66 - -0.48]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.41(2.25,2.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.00(2.72,3.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003etwo-sample rank-sum test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of systemic indicators between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive rate(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative rate(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDifference and\u003c/p\u003e \u003cp\u003e95%- Cl(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntinuclear antibodies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53.60[42.48\u0026ndash;64.72]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67(66.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34(33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96(87.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-Toxo IgM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.80[7.23\u0026ndash;28.37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72(71.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98(89.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChi-Square test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparative analysis of anxiety and depression scores between groups\u003c/h2\u003e \u003cp\u003eAnxiety scores in the glaucoma group were (15.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89) and in the cataract group were (4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12), and there was a statistically significant difference in the overall mean of the overall anxiety scores between the two groups (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21.01, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe median depression score in the glaucoma group was 19.0(14.50, 28.00), and in the cataract group was 4.0 (2.75, 6.90), and there was a statistically significant difference in the depression scores between the two groups (\u003cem\u003ez\u003c/em\u003e=-12.46, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of anxiety and depression scores between the two groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScores\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifference and\u003c/p\u003e \u003cp\u003e95%- Cl(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.74[9.73\u0026ndash;11.75]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.00[14.00\u0026ndash;17.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlaucoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.0(14.50,28.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0(2.75,6.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003e two-sample t-test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e#\u003c/sup\u003e two-sample rank-sum test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Comparison of anxiety and depression scores between gender and age within the glaucoma group.\u003c/h2\u003e \u003cp\u003eAnxiety scores by age group were as follows: 51\u0026ndash;60: 16.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93; 61\u0026ndash;70: 15.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64; 71\u0026ndash;80: 15.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32; 81\u0026ndash;90: 13.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40 .Overall means of anxiety scores were not statistically different between age groups (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.407, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Depression scores by age group were as follows:51\u0026ndash;60: 21.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22; 61\u0026ndash;70: 19.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03; 71\u0026ndash;80: 18.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06; 81\u0026ndash;90: 19.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.09 .There was no statistical difference in the overall mean of depression scores between age groups (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.286, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn the glaucoma group, the anxiety score was 14.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60 in males and 16.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96 in females and there was no statistically significant difference between the total mean anxiety scores of males and females (\u003cem\u003et\u003c/em\u003e=-1.51, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Depression score was 17.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11 for males and 20.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.04 for females. There was no statistically significant difference between the total mean depression scores of males and females (\u003cem\u003et\u003c/em\u003e=-1.915, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of anxiety and depression scores by age in the glaucoma group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(anxiety)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(depression)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e18.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eANOVA\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of anxiety and depression scores by gender in the glaucoma group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifference and\u003c/p\u003e \u003cp\u003e95%- Cl(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-1.58[-3.66-0.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-2.51[-5.10-0.09]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003etwo-sample t-tests\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Correlation analysis of anxiety and depression scores within the glaucoma group\u003c/h2\u003e \u003cp\u003eAccording to the correlation analysis, the anxiety scores of glaucoma patients were positively correlated with AL and C/D (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), negatively correlated with RNFL (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), correlation existed with ANA and Anti-Toxo IgM (Eta\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.16), and no correlation with ACD (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Depression scores in glaucoma patients were positively correlated with C/D (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), negatively correlated with AL and RNFL (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), correlated with ANA and Anti-Toxo IgM (Eta\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.16), and not correlated with ACD (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Multiple linear regression of indicators and anxiety/depression scores within the glaucoma group\u003c/h2\u003e \u003cp\u003eThere was a statistically significant difference in the effect of RNFL (\u003cem\u003eb\u003c/em\u003e=-0.01, \u003cem\u003et\u003c/em\u003e=-0.19, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), C/D (\u003cem\u003eb\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18.83, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.14, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ANA on anxiety scores (\u003cem\u003eb\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.76, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.2.39, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). RNFL, C/D, and ANA can be considered significant predictors of anxiety status. (Table\u0026nbsp;8)\u003c/p\u003e \u003cp\u003eThere was a statistically significant difference in the effect of AL (\u003cem\u003eb\u003c/em\u003e=-1.58, \u003cem\u003et\u003c/em\u003e=-3.76, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and C/D (\u003cem\u003eb\u003c/em\u003e\u0026thinsp;=\u0026thinsp;31.96,\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.18, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)on depression scores. AL and C/D can be considered significant predictors of depression status. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003emultiple linear regression for each indicator\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard error of B-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaxial length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanterior chamber depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eretinal nerve fiber layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecup-to-disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eantinuclear antibodies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-Toxo IgM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaxial length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanterior chamber depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eretinal nerve fiber layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecup-to-disc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eantinuclear antibodies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-Toxo IgM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe role of psychiatric disorders in glaucoma is still complex, and the purpose of this study is to compare whether there are differences in indicators and anxiety and depression between patients with primary angle-closure glaucoma and patients with normal cataracts, and also the focus of this study is that we compare the correlation between these indicators and anxiety and depression scores. The aim is to construct a predictive model to prevent and timely diagnose and treat poor mental status in glaucoma patients.\u003c/p\u003e \u003cp\u003eA special “retinal melanopsin-expressing ganglion cells—dorsal perihabenular nucleus—nucleus accumbens” neural circuit in the brain has been identified by neural tracing tools[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].They hypothesized that this loop of emotion regulation may be the reason why blue light depresses mice at night, and therefore we suspect that the development of mood disorders in glaucoma patients may be due to the damage of intrinsically photosensitive retinal ganglion cells (ipRGCs), and the specific mechanism needs to be further investigated in the future. The exact mechanism needs to be further investigated in the future. Another study revealed the existence of a shared lymphatic circuit between the eye and the brain that is capable of generating a unified immune response between the posterior eye and the brain[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e],which strengthens the link between glaucoma and central nervous system disease. This study also opens up the potential for new therapeutic strategies for both eye and CNS diseases\u003c/p\u003e \u003cp\u003ePatients with short ocular axis and shallow anterior chamber tend to have a higher risk of glaucoma than normal people. High intraocular pressure in glaucoma can harm the retina and optic nerve[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e],resulting in decreased RNFL and increased C/D. We confirmed that the ocular axis, anterior chamber depth, RNFL and C/D in glaucoma patients are statistically different from those in common cataract patients. All of them were correlated with anxiety and depression scores.\u003c/p\u003e \u003cp\u003eANA is a general term for a group of autoantibodies directed against different components of the nucleus of one's own cells, which can be produced against DNA and RNA proteins and their molecular complexes in the nucleus. Our finding that a large proportion of patients with primary angle-closure glaucoma are ANA positive during the course of our clinic has given us pause for thought. We proposed that primary angle-closure glaucoma may an autoimmune attack on the SC and optic nerve as an endpoint, and many studies have shown that the SC bears a striking structural and functional resemblance to lymphatic vessels[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e],and that the optic nerve sheath contains lymphoid gene signatures, therefore autoimmune occurrences may be present in all of these structures. Our study found statistically significant differences in the differences between glaucoma and normal cataracts and a correlation with anxiety scores.\u003c/p\u003e \u003cp\u003eToxoplasma infections often result in elevated IOP[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e],and glaucomatous Toxoplasma antibody serum IgM and IgG antibodies are produced within 1–2 weeks after infection, and similar to most infections, the first anti-Toxoplasma antibody to appear is IgM, which peaks at 1–3 months[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].We found that toxoplasma antibody IgM was statistically different from the normal cataract group in these patients with primary angle-closure glaucoma and correlated with anxiety scores as did ANA.\u003c/p\u003e \u003cp\u003eOverall, glaucoma can cause not only a dramatic loss of vision, but also headaches, dizziness, nausea, and other symptoms that may even lead to blindness. At the same time, glaucoma can adversely affects patients' mental status, which is often overlooked by ophthalmologists. Therefore, the focus of our study is to correlate the poor mental status of glaucoma patients with their ocular and systemic indices to recognize the patients' mental status in time for rational pharmacological and surgical treatments.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003ePatients with PACG have higher anxiety and depression scores than the general population. Through our study, we found that there is a correlation between ocular and systemic indicators and poor mental status in PACG patients. Clinically, we can predict patients' mental status in advance based on their examination results so that appropriate treatment measures can be taken.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e-Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1)Our study adheres to the Declaration of Helsinki by stating this in the manuscript.\u003c/p\u003e\n\u003cp\u003e2)Our study has been approved by the Ethics Committee of the First People\u0026apos;s Hospital of Jingzhou. 3)Informed consent was obtained from all patients for our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, [ZJC], upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo relevant funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShizhou-Cheng:Formal analysis,Writing\u0026ndash;original draft,Writing\u0026ndash;review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003ePan-Deng:Software,Writing\u0026ndash;review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eLijun-Du:Methodology,Writing\u0026ndash;review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eKangning-Wang:Formal analysis,Investigation,Methodology.\u003c/p\u003e\n\u003cp\u003eXue-He:Formal analysis,Investigation.\u003c/p\u003e\n\u003cp\u003eYi-Xiang:Formal analysis,Investigation.\u003c/p\u003e\n\u003cp\u003eGuojin Zuo:Resources,Software,Supervision,Validation.\u003c/p\u003e\n\u003cp\u003eZijian-Chen:Writing\u0026ndash;original draft,Supervision,Validation,Visualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Authors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShizhou Cheng, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eORCID Number: 0000-0003-4418-4844\u003c/p\u003e\n\u003cp\u003ePan Deng, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLijun Du, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical Department of Yangtze University\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u003c/p\u003e\n\u003cp\u003eKangning,Wang, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail:[email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXue He, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eYi Xiang, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*Correspondence\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGuojin Zuo, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProfessor, Department of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u003c/p\u003e\n\u003cp\u003eZijian Chen, M.D.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProfessor,Department of Ophthalmology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Yangtze University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJingzhou City, Hubei Province,434000,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWeinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatib TZ, Martin KR. Protecting retinal ganglion cells. Eye (Lond). 2017;31(2):218\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust. 2009;190(S7):S54\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Liang Y, Huang Y, Liu S, Li Q, Wang S, Wu G, Du Z, Wang Y, Wang J, et al. Evaluation of the Observational Associations and Shared Genetics Between Glaucoma With Depression and Anxiety. Invest Ophthalmol Vis Sci. 2024;65(3):12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Olson DJ, Le P, Lin FC, Fleischman D, Davis RM. The Association Between Glaucoma, Anxiety, and Depression in a Large Population. Am J Ophthalmol. 2017;183:37\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin DY, Jung KI, Park HYL, Park CK. The effect of anxiety and depression on progression of glaucoma. Sci Rep. 2021;11(1):1769.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerchuck S, Jammal A, Mukherjee S, Somers T, Medeiros FA. Impact of anxiety and depression on progression to glaucoma among glaucoma suspects. Br J Ophthalmol. 2021;105(9):1244\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrure-Ventura J, L\u0026oacute;pez-Hoyos M. The Past, Present, and Future in Antinuclear Antibodies (ANA). Diagnostics (Basel) 2022, 12(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeng H, Xing X, Zhang C, Zhao J, Ren C, Liu Y. Relations between antinuclear, antineutrophil cytoplasmic, anticardiolipin antibodies and degree of neurological deficit, cerebrovascular stenosis in cerebral infarction patients. Pak J Med Sci. 2023;39(3):677\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDobrowolski JM, Sibley LD. Toxoplasma invasion of mammalian cells is powered by the actin cytoskeleton of the parasite. Cell. 1996;84(6):933\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Z, Cheng S, Chen X, Zhang Z, Du Y. New advances in immune mechanism and treatment during ocular toxoplasmosis. Front Immunol. 2024;15:1403025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHinze-Selch D, D\u0026auml;ubener W, Eggert L, Erdag S, Stoltenberg R, Wilms S. A controlled prospective study of toxoplasma gondii infection in individuals with schizophrenia: beyond seroprevalence. Schizophr Bull. 2007;33(3):782\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaudhury A, Ramana BV. Schizophrenia and bipolar disorders: The Toxoplasma connection. Trop Parasitol. 2019;9(2):71\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlvarado-Esquivel C, Mart\u0026iacute;nez-Mart\u0026iacute;nez AL, S\u0026aacute;nchez-Anguiano LF, Hern\u0026aacute;ndez-Tinoco J, Castillo-Orona JM, Salas-Mart\u0026iacute;nez C, Sifuentes-\u0026Aacute;lvarez A, Sandoval-Carrillo AA, Salas-Pacheco JM, Liesenfeld O, et al. Lack of association between Toxoplasma gondii exposure and depression in pregnant women: a case-control study. BMC Infect Dis. 2017;17(1):190.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun X, Dai Y, Chen Y, Yu DY, Cringle SJ, Chen J, Kong X, Wang X, Jiang C. Primary angle closure glaucoma: What we know and what we don't know. Prog Retin Eye Res. 2017;57:26\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAn K, Zhao H, Miao Y, Xu Q, Li YF, Ma YQ, Shi YM, Shen JW, Meng JJ, Yao YG, et al. A circadian rhythm-gated subcortical pathway for nighttime-light-induced depressive-like behaviors in mice. Nat Neurosci. 2020;23(7):869\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYin X, Zhang S, Lee JH, Dong H, Mourgkos G, Terwilliger G, Kraus A, Geraldo LH, Poulet M, Fischer S, et al. Compartmentalized ocular lymphatic system mediates eye-brain immunity. Nature. 2024;628(8006):204\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLafuente MP, Villegas-P\u0026eacute;rez MP, Sell\u0026eacute;s-Navarro I, Mayor-Torroglosa S, Miralles de Imperial J, Vidal-Sanz M. Retinal ganglion cell death after acute retinal ischemia is an ongoing process whose severity and duration depends on the duration of the insult. Neuroscience. 2002;109(1):157\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAspelund A, Tammela T, Antila S, Nurmi H, Lepp\u0026auml;nen VM, Zarkada G, Stanczuk L, Francois M, M\u0026auml;kinen T, Saharinen P, et al. The Schlemm's canal is a VEGF-C/VEGFR-3-responsive lymphatic-like vessel. J Clin Invest. 2014;124(9):3975\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SW, Kim SH, Kwon HJ, Lee SM, Byon IS, Lee JE. Diagnostic Value of Positive Findings of Toxoplasma gondii-Specific Immunoglobulin M Serum Antibody in Uveitis Patients to Confirm Ocular Toxoplasmosis. Ocul Immunol Inflamm. 2019;27(4):583\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"primary angle-closure glaucoma, anxiety and depression, eye exam, ANA, toxoplasma antibodies","lastPublishedDoi":"10.21203/rs.3.rs-6376257/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6376257/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo analyze the poor mental status of patients with primary closed-angle glaucoma(PACG), and to explore the correlation between mental status and ocular and systemic indices in patients with PACG.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe collected patients' axial length (AL), anterior chamber depth (ACD), nerve fiber layer thickness (RNFL), cup-to-disc ratio (C/D), antinuclear antibody (ANA), toxoplasmosis antibody (anti-Toxoplasma gondii IgM), and anxiety and depression scores (HAMA and HAMD scales). Statistical analysis was utilized to analyze the data for each of the patients in the PACG and cataract patient groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results showed that there was a statistically significant difference between the glaucoma group and the cataract group in terms of anxiety and depression scores, AL, ACD, RNFL, C/D, ANA, and Anti-Toxo IgM (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Anxiety scores of glaucoma patients were positively correlated with AL and C/D (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), negatively correlated with RNFL (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and correlation existed with ANA and Anti-Toxo IgM (Eta2\u0026thinsp;\u0026gt;\u0026thinsp;0.16). Depression scores in glaucoma patients were positively correlated with C/D (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), negatively correlated with AL and RNFL (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and correlated with ANA and Anti-Toxo IgM (Eta2\u0026thinsp;\u0026gt;\u0026thinsp;0.16). RNFL, C/D, and ANA can be considered significant predictors of anxiety status.AL and C/D can be considered significant predictors of depression status.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatients with primary angle-closure glaucoma have higher anxiety and depression scores than the general population, and clinically we can predict the patient's mental status by their ocular and systemic indicators so that appropriate treatment can be taken in time.\u003c/p\u003e","manuscriptTitle":"Analysis of the correlation between mental status and ocular and systemic indicators in patients with primary angle-closure glaucoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 06:48:42","doi":"10.21203/rs.3.rs-6376257/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-26T06:58:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-17T15:40:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T20:59:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93264039002726773608536723088478953713","date":"2025-05-08T19:33:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39231945862816415049376304137908374164","date":"2025-05-08T08:07:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210985989365339868236175514741780175055","date":"2025-05-07T17:38:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119699482948818105795016596879412465402","date":"2025-05-07T11:22:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-06T19:19:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-06T16:43:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-15T09:46:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-12T14:36:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-04-12T14:35:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"21771d4b-0f9d-4a7d-ab00-0dba09e96077","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T16:04:32+00:00","versionOfRecord":{"articleIdentity":"rs-6376257","link":"https://doi.org/10.1186/s12886-025-04227-0","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-07-07 15:57:09","publishedOnDateReadable":"July 7th, 2025"},"versionCreatedAt":"2025-05-13 06:48:42","video":"","vorDoi":"10.1186/s12886-025-04227-0","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04227-0","workflowStages":[]},"version":"v1","identity":"rs-6376257","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6376257","identity":"rs-6376257","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}