DEVELOPMENTAL NEUROBIOLOGY, Issue 7 2007
ZhiHua Shi
Abstract Glaucoma is a major cause of vision impairment, which arises from the sustained and progressive apoptosis of retinal ganglion cells (RGC), with ocular hypertension being a major risk or co-morbidity factor. Because RGC death often continues after normalization of ocular hypertension, growth factor-mediated protection of compromised neurons may be useful. However, the therapeutic use of nerve growth factor (NGF) has not proven effective at delaying RGC death in glaucoma. We postulated that one cause for the failure of NGF may be related to its binding to two receptors, TrkA and p75. These receptors have distinct cellular distribution in the retina and in neurons they induce complex and sometimes opposing activities. Here, we show in an in vivo therapeutic model of glaucoma that a selective agonist of the pro-survival TrkA receptor was effective at preventing RGC death. RGC loss was fully prevented by combining the selective agonist of TrkA with intraocular pressure-lowering drugs. In contrast, neither NGF nor an antagonist of the pro-apoptotic p75 receptor protected RGCs. These results further a neurotrophic rationale for glaucoma. © 2007 Wiley Periodicals, Inc. Develop Neurobiol, 2007. [source]

Glaucomatous optic nerve injury involves early astrocyte reactivity and late oligodendrocyte loss

GLIA, Issue 7 2010
Janice L. Son
Abstract Glaucoma, a neurodegenerative disease affecting retinal ganglion cells (RGC), is a leading cause of blindness. Since gliosis is common in neurodegenerative disorders, it is important to describe the changes occurring in various glial populations in glaucoma animal models in relation to axon loss, as only changes that occur early are likely to be useful therapeutic targets. Here, we describe changes occurring in glia within the myelinated portion of the optic nerve (ON) in both DBA/2J mice and in a rat ocular hypertension model. In both glaucoma animal models, we found only a modest loss of oligodendrocytes that occurred after axons had already degenerated. In DBA/2J mice there was proliferation of oligodendrocyte precursor cells (OPCs) and new oligodendrocyte generation. Activation of microglia was detected only in highly degenerated DBA/2J ONs. In contrast, a large increase in astrocyte reactivity occurred early in both animal models. These results are consistent with astrocytes playing a prominent role in regulating axon loss in glaucoma. © 2010 Wiley-Liss, Inc. [source]

Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy

HEALTH SERVICES RESEARCH, Issue 4 2003
José J. Escarce
Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction. [source]

Myocilin allele-specific glaucoma phenotype database,

HUMAN MUTATION, Issue 2 2008
Alex W. Hewitt
Abstract Glaucoma, a complex heterogenous disease, is the leading cause for optic nerve,related blindness worldwide. Since 1997, when mutations in the myocilin (MYOC) gene were identified as causing juvenile onset as well as a proportion of primary open-angle glaucoma (POAG), more than 180 variants have been documented. Approximately one in 30 unselected patients with POAG have a disease-causing myocilin mutation and it has been shown that firm genotype,phenotype correlations exist. We have compiled an online catalog of myocilin variants and their associated phenotypes. This locus-specific resource, to which future submissions can be made, is available online (www.myocilin.com; last accessed 28 August 2007). The database, constructed using MySQL, contains three related sheets that contain data pertaining to the information source, variant identified, and relevant study data, respectively. The website contains a list of all identified variants and summary statistics as well as background genomic information, such as the annotated sequence and cross-protein/species homology. Phenotypic data such as the mean±standard deviation (SD) age at POAG diagnosis, mean±SD maximum recorded intraocular pressure, proportion of patients requiring surgical intervention, and age-related penetrance can be viewed by selecting a particular mutation. Approximately 40% of the identified sequence variants have been characterized as disease causing, with the majority (,85%) of these being missense mutations. Preliminary data generated from this online resource highlight the strong genotype,phenotype correlations associated with specific myocilin mutations. The large-scale assimilation of relevant data allows for accurate comprehensive genetic counseling and the translation of genomic information into the clinic. Hum Mutat 29(2), 207,211, 2008. © 2007 Wiley-Liss, Inc. [source]

New Glaucoma Medications in the Geriatric Population: Efficacy and Safety

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2002
Gary D. Novack PhD
Glaucoma can be considered a disease of the aging eye. Most medications used to treat glaucoma are in topical eyedrop form and may cause numerous untoward systemic effects in older persons. In recent years, several new ocular hypotensive medications have become available. These medications are being used more commonly because there is a growing trend by ophthalmologists to aggressively lower intraocular pressure. Therefore, geriatricians require a comprehensive knowledge of medications used to treat glaucoma, in addition to an understanding of their mechanism of action profiles of untoward effects and possible interactions with other diseases or medications. Therefore, we performed a review of the medications recently introduced into clinical practice. We selected drugs approved by the U.S. Food and Drug Administration between 1996 and September 2001. The safety profiles of these agents and their untoward side effects were reviewed by class: topical carbonic anhydrase inhibitors (brinzolamide: ocular tolerance, taste perversion), ,-adrenoceptor antagonists (timolol: bradycardia and bronchospasm), ,-adrenergic agonists (brimonidine: oral dryness, headache, and fatigue), and prostaglandin analogs (latanoprost, bimatoprost, travoprost, and unoprostone isopropyl: ocular hyperemia, iris color changes). The function of this review is to make geriatricians more aware of the efficacy and untoward effects of medications recently introduced into clinical practice. We recommend that geriatricians perform a medication review on all medications their patients use, including eye drops. [source]

Subunits of the epithelial sodium channel family are differentially expressed in the retina of mice with ocular hypertension

JOURNAL OF NEUROCHEMISTRY, Issue 1 2005
Frank M. Dyka
Abstract Glaucoma is a prevalent cause of blindness, resulting in the apoptotic death of retinal ganglion cells and optic nerve degeneration. The disease is often associated with elevated intraocular pressure, however, molecular mechanisms involved in ganglion cell death are poorly understood. To identify proteins contributing to this pathological process, we analysed the retinal gene expression of DBA/2J mice that develop an elevated intraocular pressure by the age of 6 months with subsequent ganglion cell loss. In this study, we identified subunits of the epithelial sodium channel (ENaC) family that are specifically expressed under elevated intraocular pressure. Using reverse transcriptase polymerase chain reaction we observed a significant increase of ,-ENaC in the neuronal retina of DBA/2J mice when compared with control animals, while ,-ENaC and ,-ENaC were not detectable in this tissue. Specific immune sera to ENaC subunits showed up-regulation of ,-ENaC in synaptic and nuclear layers of the retina, and in the retinal pigment epithelium. Consistent with our polymerase chain reaction data, ,-ENaC was not detected by specific antibodies in the retina, while ,-ENaC was only present in the retinal pigment epithelium under ocular hypertension. Finally, the increase of ,-ENaC gene expression in the neuronal retina and the retinal pigment epithelium was not observed in other tissues of DBA/2J mice. Since the intraocular pressure is regulated by the transport of aqueous humour across epithelial structures of the eye that in turn is associated with ion flux, the specific up-regulation of ENaC proteins could serve as a protecting mechanism against elevated intraocular pressure. [source]

Eye Drops Delay Glaucoma

NURSING FOR WOMENS HEALTH, Issue 5 2002
Carolyn Davis Cockey
No abstract is available for this article. [source]

Glaucoma: target intraocular pressures and current treatments

PRESCRIBER, Issue 7 2009
FRCOphth, James McAllister FRCS
Our Drug review of glaucoma management describes the use of target intraocular pressures in directing treatment, and the medical, laser and surgical management options. This is followed by an analysis of prescription data and sources of further information. Copyright © 2009 Wiley Interface Ltd [source]

Effects of optic nerve injury, glaucoma, and neuroprotection on the survival, structure, and function of ganglion cells in the mammalian retina

THE JOURNAL OF PHYSIOLOGY, Issue 18 2008
A. J. Weber
Glaucoma is an optic neuropathy that originates with pressure-induced damage to the optic nerve. This results in the retrograde degeneration of ganglion cells in the retina, and a progressive loss of vision. Over the past several years, a number of studies have described the structural and functional changes that characterize ganglion cell degeneration in the glaucomatous eye, and following optic nerve injury. In addition, a variety of different strategies for providing neuroprotection to the injured retina have been proposed. Many of these are based on the use of brain-derived neurotrophic factor (BDNF), a particularly potent neuroprotectant in the mammalian eye and the basis of our research in this area. Of particular importance is the fact that BDNF not only promotes ganglion cell survival following damage to the optic nerve, but also helps to preserve the structural integrity of the surviving neurons, which in turn results in enhanced visual function. The studies presented here describe these attributes, and serve as the foundation for ongoing work that suggests a need to think beyond the eye in the development of future treatment strategies. [source]

Acute Glaucoma after Dilated Eye Exam in a Patient With Hyphema, Retinal Detachment, and Vitreous Hemorrhage

ACADEMIC EMERGENCY MEDICINE, Issue 1 2009
Gavin Budhram MD
No abstract is available for this article. [source]

Prostanoids in the Therapy of Glaucoma

CARDIOVASCULAR THERAPEUTICS, Issue 1 2006
Naruhiro Ishida
ABSTRACT Elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma, which is a progressive optic neuropathy. Lowering IOP is currently the only therapeutic approach to the therapy of glaucoma. Since the use of pilocarpine eye drops for glaucoma treatment was reported in the late 1870s, academic researchers and pharmaceutical companies attempted to discover new drugs with more potent, prolonged, and safer IOP-reducing effects. These persistent efforts finally paid off, and prostanoids with FP-receptor agonist activity were found to be very potent IOP-lowering agents. To date, three prostanoids (latanoprost, travoprost and bimatoprost) have been launched in many countries, and now a new FP-receptor agonist, tafluprost, is entering clinical development. All of these prostanoids are superior to the ,-adrenoceptor antagonists in their IOP-lowering efficacy, and no severe side effects have been reported in their long-term clinical use. In addition, tafluprost may be expected to improve ocular blood flow. Hence, prostanoids currently occupy center stage among glaucoma medications. It cannot be denied that in terms of efficacy, safety, patient compliance, and medical economy prostanoids are currently the first-line medicines among ocular antihypertensive drugs. [source]

4234: Glaucoma considerations in OOKP

ACTA OPHTHALMOLOGICA, Issue 2010
N AL RAQQAD
Purpose To study the incidence and prognosis of glaucoma in OOKP eyes and to evaluate methods for detection and treatment of glaucoma following osteo-odonto-keratoprosthesis surgery. Methods Retrospective analysis of 49 consecutive patients treated at the national OOKP referral centre in Brighton, UK between November 1996 and September 2009. Data were collected over a 3 month period from December 2009 giving a minimum of 6 months follow up (range: 6 months to 13 years). Data collected include: age at surgery, primary diagnosis, previous surgical procedures (corneal grafts), family history of glaucoma, serial post-operative cup-disc ratios and visual fields, glaucoma procedures at any stage, and any OOKP complications. Results A total of 49 patients were included in the study with age ranging from 19 to 88 years (mean 53.5). 14 (28.5%) patients had pre-existing glaucoma, 25(51%) patients had glaucoma by the end of the study. 12(24.5%) patients developed de novo increase in intraocular pressure. Of the 49 patients, 5 underwent cyclodialysis ,4 had cyclodiode laser treatment, 4 underwent ECP, 5 had a glaucoma tube inserted and 4 had detachment and reattachment of their recti muscles (VRDR ± MRDR). All patients were treated with oral acetozolamide 250mg once daily (except one who is allergic). Sublingual timolol was used in three patients, one of experienced severe side effects and the treatment had to be stopped. Systemic betablockers were used in 3 patients. Conclusion Glaucoma is one of the major complications of osteo-odonto-keratoprosthesis. It is difficult to monitor and treat in the OOKP eye. Various treatment modalities have been used. Many patients require long term oral medications and many are not adequately controlled and should have surgical treatment the results of which are not satisfactory. VRDR might represent a safer surgical method to control glaucoma in OOKP eyes. [source]

Progress and Lack of Progress in Glaucoma

ACTA OPHTHALMOLOGICA, Issue 1 2010
Anders Heijl
No abstract is available for this article. [source]

Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of life

ACTA OPHTHALMOLOGICA, Issue 1 2010
Caitriona Kirwan
Abstract. Purpose:, To determine the incidence and risk factors for glaucoma in pseudophakic and aphakic eyes following surgery for congenital cataract within the first year of life. Methods:, We conducted a review of all cataract surgery performed at our unit over a 23-year period. Age at surgery, corneal diameter, intraocular lens implantation, presence of persistent foetal vasculature and visual axis opacification (VAO) were documented. Time to development of glaucoma, management and outcome were determined. One eye was selected randomly for analysis in cases of bilateral cataract. Results:, Duration of follow-up was significantly longer (p < 0.001) in the aphakic (113 ± 69 months) compared to the pseudophakic group (56 ± 44 months). Age at surgery was significantly less (p = 0.01) in the aphakic group. The incidence of glaucoma was significantly greater (p = 0.02) in the aphakic (15 eyes, 33%) compared to the pseudophakic (seven eyes, 13%) group. Each eye that developed glaucoma underwent cataract extraction aged , 2.5 months. Analysis of all eyes that underwent surgery aged , 2.5 months revealed no statistical difference (p = 0.08) in the incidence of glaucoma. Smaller corneal diameter and VAO were not associated with increased risk of glaucoma development. Ahmed valves proved effective in controlling intraocular pressure but visual outcome was poor in the majority of cases. Conclusion:, Surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic. Intraocular pressure control with Ahmed valves is frequently required. Glaucomatous damage and dense amblyopia contribute to poor visual outcome in these eyes. [source]

Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open-angle glaucoma and neovascular glaucoma

ACTA OPHTHALMOLOGICA, Issue 1 2010
Elisabeth Wittström
Abstract. Purpose:, To evaluate patients with central retinal vein occlusion (CRVO) and neovascular glaucoma (NVG) using electrophysiology in order to gain better understanding of visual outcome and risk factors, such as previously diagnosed primary open-angle glaucoma (POAG). Methods:, Eighty-three patients (83 eyes) initially presenting with CRVO and examined with full-field electroretinography (ERG) within 3 months of the thrombotic event were analysed retrospectively regarding treatment, risk factors and visual outcome. In addition, 30 patients initially presenting with NVG caused by CRVO were also investigated regarding risk factors using electrophysiology in order to determine the cause of their visual impairment. Results:, Nineteen (23%) of the 83 patients initially presenting with CRVO had been diagnosed previously with POAG. Ninety-five per cent (18/19) of all the patients with previously diagnosed glaucoma developed ischaemic CRVO. Thirty-four per cent of the patients initially presenting with CRVO (28/83) developed NVG. Sixty-eight per cent (13/19) of the patients with previous glaucoma developed NVG, compared to 23% (15/64) of the patients without previous POAG. In the patients who initially presented with NVG, full-field ERG demonstrated a remaining retinal function of both cones and rods, indicating that the main cause of visual impairment is ischaemia of the ganglion cell layer. Conclusion:, Glaucoma is a significant risk factor for developing ischaemic CRVO and subsequent NVG. The presence of POAG in CRVO worsens visual outcome. NVG is associated with preserved photoreceptor function, thus indicating ischaemia of the ganglion cell layer as the primary cause of visual impairment. This emphasizes the importance of prompt treatment of ischaemia and elevated intraocular pressure in these patients. [source]

Tolerance and safety of ocular use of recombinant human erythropoietin (rhEPO).

ACTA OPHTHALMOLOGICA, Issue 2009
Neuroprotective effects in ocular hypertension/glaucoma
Purpose The purpose of this study was to evaluate the long-term effects of monthly intravitreal injections of rhEPO in a rabbit model. Methods Sixteen New Zealand rabbits were divided into 4 groups: control (no injection), saline injection, or rhEPO injections of 500 U and 1000 U (N=4 per group). The right eye of each animal was injected monthly over a period of 7 months. Fundus examination and electroretinography (ERG) were performed at 1 day prior, and 1 week, 1 month, and 6 months after the initial injection. After the final ERG, animals underwent fluorescein angiography and sacrifice one week later. Scotopic and photopic ERG amplitude and implicit times were analyzed by calculating a ratio between the right and the left eyes. Angiograms were graded for the presence of neovascularization or leakage. Statistical analysis was carried out using two-way ANOVA. Results Fifteen animals were used for this experiment (1 developed a traumatic cataract and was excluded). Between all groups and time points, there were no statistically significant differences in the computed right eye:left eye ratios for the scotopic or photopic ERG components (p>0.05). No evidence of neovascularization or fluorescein leakage was seen on angiography. There were no visible differences in retinal architecture or thickness in the rhEPO groups when compared to uninjected controls. Conclusion Monthly 0.1 ml intravitreal injections of rhEPO at a dose of up to 1000 U over 7 months is well-tolerated and does not cause adverse effects on retinal function, architecture, or vasculature in a rabbit model. A review of published data on rhEPO and Glaucoma will also be presented. [source]

Glaucoma associated with KPros

ACTA OPHTHALMOLOGICA, Issue 2009
K HILLE
Purpose Glaucoma is one of the most serious problems in Keratoprostheses. Already glaucoma is very frequent in patients with severe changes of the ocular surface requiring keratoprosthesis surgery. About 50% of those patients have pre-existing secondary glaucoma. Preoperatively all efforts should be done to detect its presence very early on. In KPro detection of glaucoma with traditional aids is difficult. A rough estimation of the tension by digital palpation will be the only available method. All indirect clues such as the medical history of glaucoma, echographic signs of disc cupping and anterior synechiae and examination of the visual field should be considered. Methods The incidence of postoperative secondary glaucoma vary among the different kinds of prostheses according to the surgery affecting the anterior segment and the long term anatomic results. In Osteo-Odonto-Keratoprostheses (OOKP) the most vision threatening complication is a primary or secondary glaucoma, due to the extended interventions required in the anterior segment. In Boston Keratoprostheses the risk seems to be somehow less. Results As the absorption of topical anti-glaucomatous medication will not reach the inner eye because of the anatomic barrier in KPro the only promising possibilities of treatment are systemic carbonic anhydrase inhibitors, different kinds of aqueous shunts and endo-cyclo-laserphotocoagulation. Conclusion Glaucoma is still a mayor problem in KPro. PS: This lession will be presented at the KPro-Meeting!! [source]

Hunter's syndrome and buphthalmos in a girl: an unusual ophthalmic association

ACTA OPHTHALMOLOGICA, Issue 2009
S SETHI
Purpose To report an unusual ophthalmic presentation of a case of Hunter's syndrome/MPS II. Methods A sixteen-year-old girl presented to us with total loss of vision and forward protrusion OU since early childhood. Detailed examination, including slit lamp biomicroscopy, Intra ocular pressure (IOP) and fundoscopy was carried out. Thorough systemic evaluation including Computed Tomography (CT), metabolic and genetic analysis was undertaken in collaboration with internists. Results Characteristic facies, detection of glycosaminoglycan (GAG) variants in urine (chondroitin sulfate B and heparin sulfate) and iduronate-2-sulphatase activity in fibroblasts/leucocytes confirmed the diagnosis of MPS II. Child had severe photophobia but with no perception of light OU. OU buphthalmos with Haab's striae was noted, making a clear view of the fundus difficult. IOP OU was elevated, and 90D slit lamp biomicroscopy revealed a total glaucomatous optic atrophy in both eyes. On CT there was thickening and edema of preseptal and periorbital soft tissue with marked thinning of the optic nerves with prominent perineural CSF sleeves, indicative of marked optic atrophy. Conclusion Glaucoma is a known association of Hurler's, Scheie's and Maroteaux-Lamy syndromes but not Hunter's. In fact, there is only one report of suspected angle closure glaucoma in MPS II. Buphthalmos is not a likely presentation as the sclera in these patients is known to be thickened due to deposition of GAG. To the best of our knowledge, this is the first case report of buphthalmos in association with MPS II. The importance of a meticulous examination in this subset of patients cannot be overemphasised. An appropriate and timely intervention may result in a better quality of life for them. [source]

Inflammation assessment after selective laser trabeculoplasty (SLT) treatment

ACTA OPHTHALMOLOGICA, Issue 2009
M AYALA
Purpose Glaucoma is a progressive neuropathy, reducing intraocular pressure (IOP) seems to be the only treatment to stop progression in glaucoma. There are several methods to reduce IOP: medical treatment, laser and surgery. Selective Laser Trabeculoplasty (SLT) is a new treatment alternative. SLT selectively targets the pigmented cells of the trabecular meshwork without causing thermal or collateral damage to the surroundings structures. The aim of the present study was to assess inflammation after SLT treatment. Methods 40 patients (80 eyes) were included in the study. Inclusion criteria: Glaucoma (POAG, pigmentary and pseudoexfoliative glaucoma)/ OHT patients that will be treated with SLT in just one eye, both with and without eye-drops. Exclusion criteria: patients suffering from ocular or systemic inflammatory diseases or treated with cortisone or immunosuppressive drugs. Inflammation was measured in 2 different ways: 1) clinically with a slit lamp and classified 0-4; 2) with a "Laser flare meter (Kowa FM 500)". Measurements were done before, 2 hours after, 1 week and 1 month after SLT treatement, both eyes were evaluated. IOP was also checked in the same way. SLT treatment was performed in 90° with the SLT Solo Ellex laser. Results inflammation before and after SLT showed no significant difference measured both clinically with slit lamp and objectively with the laser flare meter. No inflammation was found in the untreated eyes. No IOP peaks after SLT treatment were found. Conclusion SLT treatment seems not to induce inflammation in the anterior chamber when 90° were treated. SLT treatment might be considered as a first choice treatment against high intraocular pressure. [source]

Endothelial dysfunction in glaucoma

ACTA OPHTHALMOLOGICA, Issue 1 2009
Hemma Resch
Abstract. Glaucoma is a group of ocular diseases characterized by optic neuropathy associated with loss of the retinal nerve fibre layer and re-modelling of the optic nerve head, and a subsequent particular pattern of visual field loss. Increased intraocular pressure is the most important risk factor for the disease, but the pathogenesis of glaucoma is not monofactorial. Among other factors, ischaemia and vascular dysregulation have been implicated in the mechanisms underlying glaucoma. The vascular endothelium plays an important role in the regulation of ocular blood flow and pathological alterations of vascular endothelial cells may induce ischaemia and dysregulation. The present review summarizes our current evidence of endothelial dysfunction in glaucoma. This is of interest because endothelial dysfunction is a good prognostic factor for progression in several diseases. Although such data are lacking for glaucoma, endothelial dysfunction may provide an attractive target for therapeutic intervention in open-angle glaucoma and other vascular disorders of the eye. [source]

Unmet needs in the treatment of glaucoma related to compliance, tolerability and concomitant dry eye

ACTA OPHTHALMOLOGICA, Issue 2008
G HOLLO
Purpose Compliance to long-term topical treatment of glaucoma can be less than optimal. This may decrease the efficacy of the treatment. This presentation summarises the unmet needs in the current topical treatment of glaucoma related to compliance, tolerability and concomitant dry eye and discusses the expectations for future therapies. Results Glaucoma is a life long conditions and its management is multifactorial. However, compliance to topical glaucoma treatment can be less than optimal. Forgetfulness and topical side effects have been identified as important reasons for non-compliance. Topical side effects decrease the quality of life of the patient, which impacts on compliance. Dry eye and glaucoma are often concomitant diseases. Therefore, it is advisable to consider the management of both diseases together for the optimal care for these patients. Preservative free preparations may have benefits for the long term treatment of glaucoma patients, especially those with dry/sensitive eyes. Conclusion Compliance remains a key issue in the management of glaucoma. Glaucoma and dry eye as concomitant diseases present specific challenges for the optimal care of the patient. [source]

Trabeculectomy and Mitomycin C (Trab-MMC) for uveitic glaucoma: post surgical interventions

ACTA OPHTHALMOLOGICA, Issue 2007
A LOCKWOOD
Purpose: To examine the outcome of patients at who underwent trabeculectomy and MMC for refractory uveitic glaucoma and determine the post operative interventions required Methods: The Birmingham ReGAE (Research into Glaucoma and Ethinicity) Project is an open, prospective, consecutive series of patients who had undergone trabeculectomy with MMC. The surgery was performed by a single surgical team at the Birmingham and Midland Eye Centre Results: Twenty eyes of 25 patients with uveitic glaucoma underwent Trab-MMC for uncontrolled IOP despite maximally tolerated medical treatment. Mean follow-up was 650 days. Mean pre-op IOP was 26.7 mmHg and post-op was 11.5 mmHg. 92 % of trabeculectomies reached complete success (IOP , 21 mmHg without medication). Subconjunctival injections of 5-fluorouracil were performed on 10 eyes (36 %). Bleb needling revision was performed on 5 eyes (18 %).Visual loss > 2 lines occurred in 1 case (3.8%) due to delayed hypotony maculopathy Conclusions: Trabeculectomy and Mitomycin C is effective in this complex series of patients but do require considerable post surgery manipulation [source]

Long term outcome of bleb needling revisions following mitomycin C trabeculectomy in Afro-Caribbean eyes

ACTA OPHTHALMOLOGICA, Issue 2007
TA WILLIAMS
Purpose: To assess the frequency, risk factors and outcome of patients requiring bleb needling revisions (BNR)following Mitomycin-C (MMC) augmented trabeculectomies in Afro-Caribbean eyes in Birmingham, United Kingdom. Methods: ReGAE (Research in Glaucoma and Ethinicity) is a UK based multidisciplinary based research group whose research is aimed at preventing glaucomatous blindness in the diverse ethnic population of the West Midlands. A prospective study of consecutive Afro-Caribbean patients with refractory advanced glaucoma who had undergone Mitomycin C augmented trabeculectomy (modified Cairns type trabeculectomy with fornix based conjunctival flap mitomycin C 0.1-0.4mg/ml) was completed. Bleb needling revisions in the operating theatre with subconjunctival 5 fluro-uracil (5FU) 0.1ml 25mg/ml) were required in a subset of eyes. The frequency, timing, complications and outcome of BNRs was studied. Results: 38 eyes (35 patients) were included in the study; mean age 52 years (range 11-77 years); male:female 21:14. 9 of 38 eyes (24%)required BNR. Aetiology of glaucoma POAG 44%; JOAG 23%; traumatic 11%; fuchs 11%; pseudoexfoliation 11%. Of the patients requring BNR 6 eyes required BNR within 1 month of MMC- trabeculectomy. BNRs were performed 1-48 months postopereratively. Number of BNRs required 1.7 per eye (range 1-4) over a 2 year post operative follow up period. No complications occurred during BNR. Conclusions: Afro-Caribbean patients have a significant risk of requiring BNR following MMC trabeculectomy. Although such bleb manipulations are most commonly required during the early postoperative period, late subtenon's fibrosis may necessitate late BNR in this ethnic group. [source]

The influence of age, sex, race, refractive error and optic disc parameters on the sensitivity and specificity of scanning laser polarimetry

ACTA OPHTHALMOLOGICA, Issue 4 2004
Vital P. Costa
Abstract. Purpose:,To evaluate the influence of age, sex, race, refractive error and optic disc topography on the sensitivity and specificity of scanning laser polarimetry (SLP) in the diagnosis of glaucoma. Methods:,A total of 88 normal individuals and 95 glaucoma patients were included in this study. Glaucoma was defined on the basis of both optic nerve damage and visual field defects. Scanning laser polarimetry, optic disc topography, automated perimetry and refractometry were performed in all subjects. The sensitivity and specificity of SLP were assessed applying a previously calculated cut-off to a previously described linear discriminant function (LDF). Results:,The sensitivity and specificity of SLP in the study population were 82% and 83%, respectively. Sensitivity and specificity were not affected by age, sex, race, average disc diameter or disc area. The sensitivity of SLP tended to be higher in myopes (93%) than in emmetropes (80%) and hyperopes (71%) (p = 0.08). Sensitivities were higher in individuals with cup areas > 0.96 mm2 (89%), rim areas , 1.36 mm2 (92%), and cup area/disc area ratios > 0.45 (89%) (p < 0.05). Stepwise logistic regression analysis indicated that the presence of a cup area > 0.96 mm2 and a rim area < 1.36 mm2 significantly increased the sensitivity of the LDF, whereas a cup area/disc area ratio , 0.45 significantly increased the specificity of the LDF. Conclusion:,The sensitivity and specificity of SLP may be influenced by refractive error and optic disc parameters that are affected by glaucomatous damage (cup area, rim area and cup area/disc area ratio). These parameters must be considered in studies evaluating the sensitivity and specificity of optic nerve/retinal nerve fibre layer imaging technologies. [source]

Outcome after treatment of congenital bilateral cataract

ACTA OPHTHALMOLOGICA, Issue 6 2002
Anna Lundvall
ABSTRACT. Purpose:, To evaluate long-term functional outcome after treatment of dense congenital bilateral cataract. Methods:, The records of 22 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991,96) were reviewed retrospectively. Linear Snellen visual acuity (VA) at last check, presence of stereoacuity, nystagmus, strabismus and other complications are accounted for. Subject age at last check ranged from 4 to 9 years. Results:, Visual acuity could be estimated in 19 children: the median VA of the better eye was 0.4 (range: counting fingers , 0.8) and of the fellow eye 0.15 (range: amaurosis , 0.8). In nine otherwise healthy children who were operated on early (by 1 month of age), VA varied from 0.4 to 0.8 in the better eye. Four of these children achieved stereopsis. Pupillary block glaucoma developed in five eyes (in three children). Chronic glaucoma developed in eight eyes (in five children). Glaucoma occurred predominantly in children who underwent cataract extraction during the first week of life. Two of the latter had marked microphthalmos. Conclusion:, Good postoperative VA was achieved in most healthy children with dense bilateral congenital cataract when surgery was performed early (before 6,8 weeks of age). Chronic glaucoma developed predominantly when cataract extraction was performed during the first week of life. [source]

Glaucoma induced by periorbital topical steroid use , a rare complication

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 6 2004
D. Sahni
Summary Eye complications arising during systemic and ophthalmic steroid use are well known. In contrast, there is little highlighting the similar risks associated with topical steroid use around the eyelids. We now describe a 29-year-old lady who used topical steroids in prolonged fashion throughout most of her life for severe eczema, with the recent application of large quantities of potent steroid continuously for one month, including to the periorbital region. Soon after, she presented to her ophthalmologist with severe bilateral glaucoma and irreversible visual loss attributed to the steroid use. Here we emphasise the possible risks of periorbital topical steroid use, as well as the importance of patient education and ophthalmological follow-up. [source]

Essentials in Ophthalmology: Glaucoma

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2008
Joanna Koppens FRANZCO
No abstract is available for this article. [source]

Glaucoma: time to talk to the family

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 9 2007
Paul R Healey PhD FRANZCO
No abstract is available for this article. [source]

Diadenosine tetraphosphate protects sympathetic terminals from 6-hydroxydopamine-induced degeneration in the eye

ACTA PHYSIOLOGICA, Issue 2 2010
C. H. V. Hoyle
Abstract Aims:, To examine diadenosine tetraphosphate (Ap4A) for its ability to protect the eye from neurodegeneration induced by subconjunctival application of 6-hydroxydopamine (6-OHDA). Methods:, Intraocular neurodegeneration of anterior structures was induced by subconjunctival injections of 6-OHDA. Animals were pre-treated with topical corneal applications of Ap4A or saline. Results:, 6-OHDA caused miosis, abnormal pupillary light reflexes, a precipitous drop in intraocular pressure and loss of VMAT2-labelled (vesicle monoamine transporter-2, a marker for sympathetic neurones) intraocular neurones. Pre-treatment with Ap4A prevented all of these changes from being induced by 6-OHDA, demonstrably preserving the sympathetic innervation of the ciliary processes. This neuroprotective action of Ap4A was not shared with the related compounds adenosine, ATP or diadenosine pentaphosphate. P2-receptor antagonists showed that the effects of Ap4A were mediated via a P2-receptor. Conclusion:, Ap4A is a natural component of tears and aqueous humour, and its neuroprotective effect indicates that one of its physiological roles is to maintain neurones within the eye. Ap4A can prevent the degeneration of intraocular nerves, and it is suggested that this compound may provide the basis for a therapeutic intervention aimed at preventing or ameliorating the development of glaucoma associated with neurodegenerative diseases. Furthermore, subconjunctival application of 6-OHDA provides a useful model for studying diseases that cause ocular sympathetic dysautonomia. [source]

Dexamethasone alters F-actin architecture and promotes cross-linked actin network formation in human trabecular meshwork tissue

CYTOSKELETON, Issue 2 2005
Abbot F. Clark
Abstract Elevated intraocular pressure is an important risk factor for the development of glaucoma, a leading cause of irreversible blindness. This ocular hypertension is due to increased hydrodynamic resistance to the drainage of aqueous humor through specialized outflow tissues, including the trabecular meshwork (TM) and the endothelial lining of Schlemm's canal. We know that glucocorticoid therapy can cause increased outflow resistance and glaucoma in susceptible individuals, that the cytoskeleton helps regulate aqueous outflow resistance, and that glucocorticoid treatment alters the actin cytoskeleton of cultured TM cells. Our purpose was to characterize the actin cytoskeleton of cells in outflow pathway tissues in situ, to characterize changes in the cytoskeleton due to dexamethasone treatment in situ, and to compare these with changes observed in cell culture. Human ocular anterior segments were perfused with or without 10,7 M dexamethasone, and F-actin architecture was investigated by confocal laser scanning microscopy. We found that outflow pathway cells contained stress fibers, peripheral actin staining, and occasional actin "tangles." Dexamethasone treatment caused elevated IOP in several eyes and increased overall actin staining, with more actin tangles and the formation of cross-linked actin networks (CLANs). The actin architecture in TM tissues was remarkably similar to that seen in cultured TM cells. Although CLANs have been reported previously in cultured cells, this is the first report of CLANs in tissue. These cytoskeletal changes may be associated with increased aqueous humor outflow resistance after ocular glucocorticoid treatment. Cell Motil. Cytoskeleton 60:83,95, 2005. © 2004 Wiley-Liss, Inc. [source]