Association between ActiveHelicobacter pyloriInfection and Glaucoma: A Systematic Review and Meta-Analysis

Background: Glaucoma is the second most common cause of blindness worldwide affecting almost 70 million individuals.Helicobacter pylori (H. pylori)is a widespread pathogen with systematic pathogenicity. This meta-analysis aimed to estimate the contradictory data regarding a potential association between activeH. pyloriinfection and glaucoma. Materials and Methods: A research in MEDLINE/PubMed and Google Scholar was conducted and original studies investigating the relationship betweenH. pyloriinfection and glaucoma were included. Analysis was performed with random effects model. The main outcome was the odds ratio (OR) with 95% confidence intervals (CI) ofH. pyloriinfection as a risk factor for glaucoma. A parallel analysis studied the role of active infection as indicated by histology and the titer of anti-H. pyloriantibodies. For the anti-H. pyloriantibody titers, weighted mean differences (WMD) were estimated between patients and controls. Results: Fifteen studies were included, with 2664 participants (872 patients with glaucoma and 1792 controls), divided into primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudo-exfoliation glaucoma (PEG). The association betweenH. pyloriinfection and overall glaucoma was significant (OR = 2.08, CI 95% 1.48-2.93) with moderate heterogeneity (I-2= 61.54%). After stratification by glaucoma subtype, heterogeneity was eliminated in the NTG subgroup. Studies with healthy controls, and controls with anemia yielded very low or no heterogeneity, respectively. Gastric biopsy to document activeH. pyloriinfection yielded the highest OR (5.4, CI: 3.17-9.2,p< 0.001) and null heterogeneity. For anti-H. pyloriantibody titers, there was a significant difference in WMD between patients and controls (WMD 15.98 IU/mL; 95% CI: 4.09-27.87;p= 0.008); values were greater in glaucoma patients, with high heterogeneity (I-2: 93.8%). Meta-regression analysis showed that mean age had a significant impact on glaucoma (p= 0.037). Conclusions: ActiveH. pyloriinfection may be associated with glaucoma with null heterogeneity, as, beyond histology, quantified by anti-H. pylorititers and increases with age.