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Open-angle Glaucoma (open-angle + glaucoma)
Kinds of Open-angle Glaucoma Terms modified by Open-angle Glaucoma Selected AbstractsIncidence of open-angle glaucoma in central SwedenACTA OPHTHALMOLOGICA, Issue 7 2008Curt Ekström Abstract. Purpose:, To estimate the incidence rate of open-angle glaucoma (OAG) in a population in which pseudoexfoliation is a common finding. Methods:, A population-based survey of 760 people aged 65,74 years was conducted in the municipality of Tierp, in central Sweden, during 1984,86. Visual fields (VFs) were tested with the Competer 350 automated perimeter. The present report concerns 711 people, all of whom participated in the survey and were not diagnosed with glaucoma. Since 1988, a follow-up study of the 530 individuals in this cohort with normal and reliable VFs has been in progress. Incident cases of OAG were identified among study participants and patients seeking medical attention at the Eye Department in Tierp. Records of prescriptions for anti-glaucoma drugs were used to search for unidentified patients. A time-weighted mean intraocular pressure (IOP) for all visits was calculated. Results:, By the end of the study in May 2006, 51 new cases of definite OAG had been identified, 31 with capsular and 20 with chronic simple glaucoma. Of these, 46 cases were detected in the follow-up study, corresponding to an incidence of 7.11 (95% confidence interval 5.06,9.17) per 1000 person-years. Twelve of the 51 cases were classified as normal-tension glaucoma, all of which were found in the follow-up study. Open-angle glaucoma with a mean IOP , 23 mmHg tended to emerge closer to the baseline examination than OAG with a mean IOP < 23 mmHg. Conclusions:, The incidence of OAG was high compared with that reported for other studies conducted in White populations. [source] Seed-based systematic discovery of specific transcription factor target genesFEBS JOURNAL, Issue 12 2008Ralf Mrowka Reliable prediction of specific transcription factor target genes is a major challenge in systems biology and functional genomics. Current sequence-based methods yield many false predictions, due to the short and degenerated DNA-binding motifs. Here, we describe a new systematic genome-wide approach, the seed-distribution-distance method, that searches large-scale genome-wide expression data for genes that are similarly expressed as known targets. This method is used to identify genes that are likely targets, allowing sequence-based methods to focus on a subset of genes, giving rise to fewer false-positive predictions. We show by cross-validation that this method is robust in recovering specific target genes. Furthermore, this method identifies genes with typical functions and binding motifs of the seed. The method is illustrated by predicting novel targets of the transcription factor nuclear factor kappaB (NF-,B). Among the new targets is optineurin, which plays a key role in the pathogenesis of acquired blindness caused by adult-onset primary open-angle glaucoma. We show experimentally that the optineurin gene and other predicted genes are targets of NF-,B. Thus, our data provide a missing link in the signalling of NF-,B and the damping function of optineurin in signalling feedback of NF-,B. We present a robust and reliable method to enhance the genome-wide prediction of specific transcription factor target genes that exploits the vast amount of expression information available in public databases today. [source] Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic RetinopathyHEALTH SERVICES RESEARCH, Issue 4 2003José 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 2008Alex 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] Fluorescein leakage of the optic disc: time course in primary open-angle glaucomaOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2010Niklas Plange Abstract Purpose:, To identify and quantify the time course of fluorescein leakage of the optic nerve head in primary open-angle glaucoma (POAG) and controls. Methods:, Twenty patients with POAG (aged 58 ± 10 years) and 14 controls (aged 51 ± 12 years, p = 0.07) were included in a prospective study. Fluorescein leakage of the optic disc was quantified using digital image analysis. A new leakage ratio (fluorescence of the optic disc divided by fluorescence of the surrounding retina) was defined and fluorescein leakage was quantified at 7,8, 9,10, 11,12, and 13,14 min after injection of 2.5 cc sodium fluorescein (10%). Results:, The fluorescein leakage exhibited a significantly different time course with higher leakage ratio values in POAG compared to controls (7,8 min: 1.24 ± 0.32 vs 1.16 ± 0.12; 9,10 min: 1.37 ± 0.37 vs 1.19 ± 0.1; 11,12 min: 1.38 ± 0.36 vs 1.24 ± 0.13; 13,14 min: 1.44 ± 0.36 vs 1.27 ± 0.13; p = 0.004). The change in optic disc fluorescence from 7,8 min to 9,10 min was significantly higher in POAG compared to controls (0.13 ± 0.09 vs 0.03 ± 0.07; p = 0.002). Conclusion:, The time course of fluorescein leakage is significantly different in POAG compared to controls. This might reflect damage of the optic disc vasculature related to increased vascular permeability. [source] Managing patients with an overactive bladder and glaucoma: a questionnaire survey of Japanese urologists on the use of anticholinergicsBJU INTERNATIONAL, Issue 1 2005Kumiko Kato OBJECTIVES To establish the views of urologists on the use of anticholinergic drugs for treating the overactive bladder (OAB) in patients with glaucoma. SUBJECTS AND METHODS In February 2004 a self-description questionnaire was mailed to all 417 urologists who were members of the Tokai Society of Voiding Dysfunction, to determine current practice in Japan for patients with an OAB and glaucoma. Subgroups were analysed between the types of practice and the duration since the urologists had graduated from medical school. RESULTS Of the 155 respondents, 76 (49%) routinely enquired about a history of glaucoma before prescribing anticholinergics, and 45 (29%) routinely referred patients with such a history to ophthalmologists. To treat patients with OAB and glaucoma, 102 (66%) would prescribe anticholinergics if permission were available from the ophthalmologist, 33 (21%) chose other treatments and 17 (11%) abandoned treatment. Forty-nine urologists (32%) were currently prescribing anticholinergics to patients with glaucoma. As to knowledge about glaucoma, 132 (85%) urologists knew that there were two types of glaucoma and 98 (63%) knew about laser iridotomy. The proportion of urologists who knew of the two types of glaucoma and asked patients for this information was significantly higher in university than in general hospitals (P < 0.05). CONCLUSIONS Although anticholinergic drugs can precipitate angle-closure glaucoma by pupillary block, they are not contraindicated in open-angle glaucoma or in angle-closure glaucoma that has already been treated by laser iridotomy. Not all urologists are aware of this difference, at least in Japan. Some urologists avoid anticholinergics in all patients with glaucoma, while others pay little attention to glaucoma. Routine history taking and referral to ophthalmologists allows many patients with OAB and glaucoma to benefit safely from anticholinergics. Moreover, clinicians should be aware of patients with OAB who have not been evaluated by ophthalmologists but who are at risk of angle-closure glaucoma. [source] 2423: Compartment syndrome in glaucoma damage, a new hypothesis?ACTA OPHTHALMOLOGICA, Issue 2010S ORGUL Purpose To evaluate the potential similarities in pathophysiology between non-arteritic anterior ischemic optic neuropathy (AION) and primary open-angle glaucoma (POAG). Methods The currently accepted views of the pathophysiology of AION and general understanding of the clinical picture of this ischemic condition were reviewed. Based on the hypothesis of the group in Wisconsin, who postulated a compartment syndrome of the anterior optic nerve within the tight anatomical structures of the lamina cribrosa, parallels were drawn for glaucomatous optic neuropathy, and a new hypothesis for the pathogenesis of the latter condition was suggested. Results The tight structures around, but also within the "disk at risk" observed in a majority of patients with AION are well compatible with the hypothesis of a compartment syndrome. Similar conditions may result from the restructuring process within the lamina cribrosa in POAG and lead to locally limited, but repeated "AION-like" processes, explaining why some patients progress despite reduced intraocular pressure. Conclusion The pathophysiology of POAG, especially in advanced cases, and AION seem to present similarities, which need to be better understood. [source] 2127: Ghrelin concentration in the aqueous humour and plasma in open angle glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2010A KATSANOS Purpose Ghrelin is a peptide hormone that exerts metabolic and smooth muscle-relaxant effects in ocular tissues. The aim of this study was to compare aqueous humor and plasma levels of ghrelin in patients with open angle glaucoma (OAG) and controls. Methods Twenty four OAG, including 7 pseudoexfoliation (PXG) and 17 primary open-angle glaucoma (POAG) patients, and 30 controls were included. All participants were patients scheduled for cataract or glaucoma surgery. Patients with other concomitant ocular disease, previous ocular surgery or diabetes were excluded. Blood samples were collected before cataract surgery. Aqueous humor was aspirated from the anterior chamber through a paracentesis with a 27 G needle under sterile conditions. Ghrelin levels in both samples were measured quantitatively with commercially available Radioimmunoassay (RIA) kits. Results Mean±SD age was 71.0±9.3 and 69.6±6.6 years in the OAG and control groups, respectively (p=0.6). Plasma levels of ghrelin were 495.6±157.7 pg/ml in the OAG and 482.2±125.4 pg/ml in the control group, respectively (Mann-Whitney test, p=0.9). Aqueous humor levels of ghrelin were 85.5±15.4 pg/ml and 123.4 ±25.5 pg/ml in the OAG and control groups, respectively (Mann-Whitney test, p<0.01). The ratio of plasma/aqueous concentration in ghrelin was higher in the OAG versus the control group (5.82± 1.94 versus 4.00±1.04, Mann-Whitney test, p<0.01). There was no difference neither in plasma nor in aqueous humor levels of ghrelin between POAG and PXG patients (p>0.5). Conclusion Aqueous humor levels of ghrelin were significantly lower in OAG patients. This difference may manifest a role of ghrelin in the disease process or a consequence of antiglaucoma treatment. [source] Predictors for visual field progression and the effects of treatment with dorzolamide 2% or brinzolamide 1% each added to timolol 0.5% in primary open-angle glaucomaACTA OPHTHALMOLOGICA, Issue 5 2010Antonio Martínez Abstract. Purpose:, This study aims to identify progression factors in patients with primary open-angle glaucoma (POAG), including the effects of treatment with dorzolamide 2% or brinzolamide 1%, each added to timolol 0.5%. Methods:, A sample of 161 POAG patients were prospectively randomized to receive either dorzolamide 2% (DT) or brinzolamide 1% (BT) b.i.d., each added to timolol 0.5%, during a 60-month, evaluator-masked study. Progression was determined by perimetric criteria. Factors associated with visual field progression were estimated using a conditional Cox hazard model with patient intraclass correlation and were expressed as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results:, Predictive baseline factors were lower diastolic blood pressure (DBP), lower mean arterial pressure (MAP), antihypertensive treatment, lower end-diastolic velocity (EDV) in the ophthalmic artery (OA) and short posterior ciliary artery (SPCA), and a higher resistivity index (RI) in the OA and SPCA. Progression risk decreased by approximately 30% and 20% with each centimetre per second increase of EDV in the OA and SPCA, respectively, from baseline to the last follow-up visit. Each RI decrease (or increase) of 0.01 unit in the OA or SPCA was associated with an approximate 20% decrease (or increase) in risk for progression. In a multivariate analysis, progression risk was significantly lower in eyes treated with DT (HR = 0.65, 95% CI 0.41,0.90) compared with those treated with BT. Conclusions:, Progression increased with lower DBP, lower MAP, antihypertensive medication, lower EDV in the OA and SPCA, and higher RI in the OA and SPCA. The risk for progression in patients treated with DT was half that in patients treated with BT. [source] Reply on Lee et al., Tight orbit syndrome: a previously unrecognized cause of open-angle glaucomaACTA OPHTHALMOLOGICA, Issue 5 2010Sung B. Lee No abstract is available for this article. [source] Tight orbit syndrome: a previously unrecognized cause of open-angle glaucoma: authors replyACTA OPHTHALMOLOGICA, Issue 5 2010Graham A. Lee No abstract is available for this article. [source] Quantifying the effect of intraocular pressure reduction on the occurrence of glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Andrea Peeters Abstract. Purpose:, To estimate the effect of reducing intraocular pressure (IOP) on: (i) the incidence of primary open-angle glaucoma (POAG) in patients with ocular hypertension (OH), and (ii) the progression of glaucoma. Methods:, A meta-analysis of relevant randomized controlled trials was conducted. A literature search was performed to identify trials with: a randomized comparison of IOP-lowering intervention versus placebo or no treatment; visual field loss or optic disc changes as outcome; and follow-up >6 months. A pooled relative risk (RR) was calculated by a random effects model. Risk reduction of glaucoma conversion per mmHg of IOP reduction was quantified in a meta-regression model. Results:, We identified nine OH and one POAG trials. A meta-analysis of OH trials gives a pooled RR of 0.61 [95% confidence interval (CI) 0.45,0.83]. A meta-regression shows a decrease of the RR of glaucoma conversion by 14% with each mmHg extra IOP reduction (P = 0.045). No meta-analysis of POAG trials was performed because only one study has been identified. Conclusion:, There is sufficient evidence that OH therapy reduces the risk of conversion to glaucoma. This risk reduction increases with greater IOP reduction. [source] Efficacy and safety of tafluprost 0.0015% versus latanoprost 0.005% eye drops in open-angle glaucoma and ocular hypertension: 24-month results of a randomized, double-masked phase III studyACTA OPHTHALMOLOGICA, Issue 1 2010Hannu Uusitalo Abstract. Purpose:, The objective of the study was to compare the long-term efficacy and safety of tafluprost 0.0015% with latanoprost 0.005% eye drops in patients with open-angle glaucoma or ocular hypertension. Methods:, This double-masked, active-controlled, parallel-group, multinational, multicentre, phase III study was conducted at 49 centres in 8 countries. Eligible patients were assigned to treatment administered once daily at 20:00 hrs for up to 24 months. Change from baseline intraocular pressure (IOP) was the primary efficacy variable. Adverse events were recorded and ocular safety was evaluated. Both tafluprost and latanoprost were preserved with benzalkonium chloride. Results:, From 533 patients randomized, 402 patients completed 24 months of therapy. Both treatments had a substantial IOP-lowering effect which persisted throughout the study (,7.1 mmHg for tafluprost and ,7.7 mmHg for latanoprost at 24 months). Although the IOP-lowering effect during the study was slightly larger with latanoprost, this difference was clinically small and the noninferiority of tafluprost to latanoprost over all diurnal IOP measurements was shown with anova and almost reached with ancova (upper limits of the 95% confidence intervals 1.38 and 1.52 for the overall period, respectively). The noninferiority limit was 1.5 mmHg. Conclusions:, Tafluprost is a new effective and well-tolerated treatment for glaucoma and ocular hypertension. [source] Mitomycin-C-augmented deep sclerectomy in patients with primary open-angle glaucoma and exfoliation glaucoma: a 1-year prospective studyACTA OPHTHALMOLOGICA, Issue 1 2010Minna Ollikainen ABSTRACT. Purpose:, To investigate the efficacy and safety of mitomycin C (MMC)-augmented deep sclerectomy with implant (DSCI) in patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG). Methods:, A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Results:, Preoperatively, the mean IOPs were 23.1 ± 5.8 and 25.4 ± 8.3 mmHg, and 13.8 ± 6.1 and 11.2 ± 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. Conclusion:, DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications. [source] Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open-angle glaucoma and neovascular glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Elisabeth 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] Tight orbit syndrome: a previously unrecognized cause of open-angle glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Graham A. Lee ABSTRACT. Purpose:, To describe a new syndrome of tight orbit and intractable glaucoma with a poor visual prognosis. Methods:, A retrospective observational case series of six patients seen at two centres between 2001 and 2007 assessing intraocular pressure (IOP), best-corrected visual acuity and visual field. Results:, Three men and three women, ranging in age at diagnosis from 14 to 53 years, demonstrated similar orbital features and progressive visual field loss despite intensive management with medication and laser and operative surgery. Highest IOPs ranged from 30 to 50 mmHg. Trabeculectomy and/or glaucoma drainage devices were attempted in five patients but all failed. One patient underwent orbital decompression with achievement of IOP control. Final IOP at last follow-up was variable; only two patients achieved IOP in the normal range, with the rest ranging from 25 to 40 mmHg. All patients had advanced visual field loss. Conclusion:, Tight orbit syndrome presents a serious clinical challenge. Despite maximum medical therapy and surgical intervention IOP is difficult to control, resulting in progressive visual field loss. [source] Diagnostic accuracy of Heidelberg Retina Tomograph III classifications in a Turkish primary open-angle glaucoma populationACTA OPHTHALMOLOGICA, Issue 1 2010Banu Bozkurt Abstract. Purpose:, This study aimed to evaluate the diagnostic accuracy of Moorfields regression analysis (MRA) and the glaucoma probability score (GPS) in primary open-angle glaucoma (POAG) and to measure the level of agreement between the two algorithms in classifying eyes as normal or abnormal in a Turkish population. Methods:, We prospectively selected 184 healthy subjects and 158 subjects with POAG, who underwent an ophthalmological examination, visual field analysis and imaging with the Heidelberg Retina Tomograph II, using HRT III software, Version 3.0. The diagnostic accuracies of the two classifications were measured when the borderline was taken as either normal (highest specificity criteria) or abnormal (highest sensitivity criteria). The agreement between them was calculated using the unweighted kappa (,) coefficient. Results:, Optic nerve head topographic parameters showed statistically significant differences between the control and POAG groups (p < 0.001). The parameters with the highest area under the receiver operating characteristic curves were global GPS (0.86), cup : disc area (0.85), rim : disc area (0.85) and vertical cup : disc (0.85). According to the highest specificity criteria, MRA had a sensitivity of 67.7% and a specificity of 95.1%, whereas the GPS had a sensitivity of 70.9% and a specificity of 88.0%. According to the highest sensitivity criteria, MRA had a sensitivity of 81.0% and a specificity of 75.0%, whereas the GPS had a sensitivity of 89.2% and a specificity of 57.6%. A moderate agreement of 68% (233 eyes) with a , coefficient of 0.51 was found between MRA and the GPS. Conclusions:, The GPS automated classification showed similar sensitivity to MRA, but considerably lower specificity, when applied in a Turkish population. [source] Reduced endothelial progenitor cells and brachial artery flow-mediated dilation as evidence of endothelial dysfunction in ocular hypertension and primary open-angle glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Gian Paolo Fadini Abstract. Purpose:, This study aimed to assess vascular endothelial function in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) by measuring: (a) endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery, and (b) circulating endothelial progenitor cells, which are believed to support the integrity of the vascular endothelium. Methods:, We enrolled 25 patients with OHT, 23 with POAG and 26 control subjects, all of whom were aged < 65 years and had no medical history of cardiovascular disease or cardiovascular risk factors. All subjects underwent a complete ophthalmological examination, biochemistry study, assessment of cardiovascular parameters, brachial artery ultrasound assessment of endothelium-dependent FMD, generic circulating progenitor cell (CPC) and circulating endothelial progenitor cell (EPC) count with the use of flow cytometry. Results:, Flow-mediated vasodilation values differed significantly in OHT (4.5 ± 1.1%; p = 0.021) and POAG (4.0 ± 0.9%; p = 0.003) patients compared with controls (7.7 ± 0.8%). The CD34+ KDR+ EPC count was markedly lower in OHT (28.0 ± 5.0; p < 0.001) and POAG (24.3 ± 3.4; p < 0.001) patients compared with controls (73.1 ± 8.1). Neither FMD not EPCs differed significantly between OHT and POAG patients. No significant differences in CPC count or cardiovascular parameters were found among OHT or POAG patients and controls. The levels of CD34+ KDR+ EPCs were directly correlated (p = 0.043) with FMD, and inversely correlated (p = 0.032) with baseline intraocular pressure in OHT and POAG patients. Conclusions:, Both OHT and POAG patients without cardiovascular risk factors have previously unreported severely reduced circulating EPCs and reduced FMD, both of which are indicators of endothelial dysfunction and increased risk of cardiovascular events. [source] Ocular blood flow and oxygen delivery to the retina in primary open-angle glaucoma patients: the addition of dorzolamide to timolol monotherapyACTA OPHTHALMOLOGICA, Issue 1 2010Brent Siesky Abstract Purpose:, To assess the effects of adding dorzolamide to timolol monotherapy on ocular haemodynamics and retinal oxygen saturation in patients with primary open-angle glaucoma (POAG). Methods:, Twenty-four patients (12 healthy, 12 with POAG) were treated with dorzolamide/timolol combination (DT) versus timolol maleate 0.5% twice daily in a randomized, crossover, double-blind study conducted over a period of 18 months. Patients received each treatment for 8 months then crossed over to the other treatment after a 1-month washout and second baseline. Goldmann applanation tonometry, Heidelberg retinal flowmetry (HRF), colour Doppler imaging (CDI) and retinal photographic oximetry were performed at each visit. Results:, DT significantly reduced intraocular pressure (IOP) in both glaucomatous [right eye (OD) ,13.15%, left eye (OS) ,14.43%; p < 0.036] and non-glaucomatous (OD ,12.4%, OS ,13.88%; p < 0.039) patients compared to timolol after 8 months of treatment. DT significantly reduced the number of zero blood flow pixels in the superior (,39.72%; p < 0.014) and inferior (,51.44%; p < 0.008) retina in the non-glaucomatous group and inferior retina in the glaucomatous group (,55.38%, p < 0.006). The continuation of timolol monotherapy from baseline did not change (p < 0.05) any measured parameter and neither treatment had a significant effect (p < 0.05) on retinal oximetry or CDI parameters. Conclusion:, The addition of dorzolamide to timolol monotherapy decreases IOP and increases retinal blood flow in the superficial retinal vasculature in both glaucomatous and healthy patients following 8 months of treatment. The combination of increased retinal blood flow with consistent oxygen saturation may potentially increase oxygen delivery to the retina. [source] Association between corneal hysteresis and central corneal thickness in glaucomatous and non-glaucomatous eyesACTA OPHTHALMOLOGICA, Issue 8 2009George Mangouritsas Abstract. Purpose:, We aimed to determine corneal hysteresis values (CH) using the ocular response analyser (ORA) in non-glaucomatous and glaucomatous eyes and their relationship with central corneal thickness (CCT). Methods:, Corneal hysteresis, intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) and CCT were prospectively evaluated in 74 non-glaucoma subjects with IOP < 21 mmHg and in 108 patients with treated primary open-angle glaucoma (POAG). One eye in each subject was randomly selected for inclusion in the analysis. Results:, Mean (± standard deviation [SD]) age was 59.2 ± 14.2 years in the non-glaucoma group and 62.4 ± 9.8 years in the glaucoma group. Mean (± SD) GAT IOP was 15.7 ± 2.65 mmHg and 16.38 ± 2.73 mmHg in the non-glaucoma and glaucoma groups, respectively. There was no statistically significant difference between the two groups in mean age (p = 0.396) or mean GAT IOP (p = 0.098). Mean (± SD) CH was 10.97 ± 1.59 mmHg in the non-glaucoma and 8.95 ± 1.27 mmHg in the glaucoma groups, respectively. The difference in mean CH between the two groups was statistically significant (p < 0.0001). There was a strong positive correlation between CH and CCT in the non-glaucoma group (r = 0.743) and a significantly (p = 0.001) weaker correlation (r = 0.426) in the glaucoma group. Conclusions:, Corneal hysteresis was significantly lower in eyes with treated POAG than in non-glaucomatous eyes. The corneal biomechanical response was strongly associated with CCT in non-glaucoma subjects, but only moderately so in glaucoma patients. It can be assumed that diverse structural factors, in addition to thickness, determine the differences in the corneal biomechanical profile between non-glaucomatous and glaucomatous eyes. Corneal hysteresis could be a useful tool in the diagnosis of glaucoma. [source] Disease mechanisms leading to impaired blood flow in glaucomaACTA OPHTHALMOLOGICA, Issue 2009D GHERGHEL Purpose SIS lecture Methods Literature search Results Although primary open-angle glaucoma (POAG), is associated more closely with elevated intraocular pressure (IOP), other risk factors already implicated in the aetiology of this disease and especially in the aetiology of normal-tension glaucoma are: abnormal ocular circulation, ocular and systemic vascular dysregulation, as well as systemic blood pressure (BP) alterations. Oxidative stress, which occurs as a result of an imbalance between generation of reactive oxygen species (ROS) and antioxidant defence mechanisms and is implicated in the pathogenesis of disorders ranging from atherosclerosis to neurodegenerative disorders, diabetes and aging, may also contribute to the general vascular disturbances observed in glaucoma. Moreover, increasing evidence shoes that oxidative stress plays a role in promoting endothelial dysfunction, which is a key factor in progression of vascular diseases. Indeed, glaucomatous optic nerve damage has been related to endothelial damage/dysfunction. This presentation explores the role of various ocular and systemic circulatory factors in the pathogenesis of glaucomatous neuropathy. [source] Ocular rigidity and ocular response analyzerACTA OPHTHALMOLOGICA, Issue 2009E IOMDINA Purpose To study ocular rigidity and sclera crosslinking level at diferent stages of primary open angle glaucoma (POAG). Methods Biomechanical parameters of the eye especially corneal hysteresis (CH, mm Hg) were measured in 238 patients (311 eyes) aged 40-84 (median age 67.4 yrs) at various stages of compensated primary open-angle glaucoma using Reichert Ocular Response Analyzer (ORA). Besides, scleral samples obtained during sinus trabeculectomy combined with sclera trephination in the inferio-exterior quadrant of 28 patients (28 eyes) with various stages of POAG were studied using differential scanning calorimetry (Mettler TA 4000 with DSC20 cell). Results Average value (median) of CH gradually decreased from 10.1 mm Hg in the initial glaucoma stage (I) to 9.1 mm Hg in the developed (II) and 8.6 mm Hg in the advanced (III) glaucoma stage. The decrease of this clinical parameter is caused by structural and biochemical damage of the corneoscleral coat. In stage I, endothermic scleral collagen transition occurred at the median thermal peak Tm=60.3 grad.C, while in stages II and III the median peaks of scleral collagen melting emerge at higher temperatures: Tm=62.0 grad.C and Tm=64.5 grad.C, respectively (p<0,05). This testifies to a significant increase of scleral cross-linking and ocular rigidity during glaucoma development. Conclusion Biomechanical and biochemical disorders of glaucomatous sclera may cause clinical changes of ocular rigidity of eyes with POAG. This may be an important link of POAG pathogenesis requiring special therapy. [source] Relationship between standard automated perimetry and high-resolution optical coherence tomography in glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2009P CALVO PEREZ Purpose To determine the relationship between the main indices of standard automated perimetry (SAP) and the peripapillary retinal nerve fiber layer (RNFL) thickness measured with spectral-domain optical coherence tomography (OCT) in patients with glaucomatous visual field defects. Methods 47 consecutive patients with open-angle glaucoma were included in the study. Only one eye per subject was randomly selected. SAPs were performed with a Humphrey perimeter and the 24-2 SITA standard algorithm. All of them underwent imaging with the Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). Left eye data were converted to a right eye format. The Kolmogorov Smirnov test was applied to check that the data were normally distributed. Pearson correlations were calculated between SAP indices (mean deviation, pattern standard deviation, and visual field index) and OCT parameters Results The average visual field mean deviation was -6.50 dB. Mild to moderate correlations were observed between SAP indices and most OCT parameters. The strongest correlations were found between the inferior quadrant thickness and pattern standard deviation (-0.544). Conclusion The RNFL thicknesses measured with high-resolution OCT showed moderate correlations with SAP indices in glaucoma patients. These results may help to understand the relationship between structural and functional changes in open-angle glaucoma. [source] The retinal nerve fiber layer and the optic nerve head morphology after glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 2009T GRACNER Purpose To detect and quantify changes in the retinal nerve fiber layer (RNFL) and the optic nerve head (ONH) morphology after glaucoma surgery. Methods 13 eyes of 13 patients with open-angle glaucoma in which goniotrephining with scleral flap without intraoperative antimetabolites for progressive glaucoma damage was done were included in this prospective study. Before and 6 months after the surgery: the intraocular pressure (IOP) was measured, the thicknes of the RNFL was measured with a scanning laser polarimeter (GDx VCC), the confocal scanning laser ophthalmoscopy measurements of ONH with Heidelberg retina tomograph (HRT 3) were performed and the visual field was tested with Humphrey Field Analyser. Results The mean IOP before surgery was 24.5 ? 2.3 mmHg decreasing 6 months after to a mean of 13.9 ? 3.0 mmHg (p<0.05). The RNFL measurements with GDx VCC revealed no differences between the mean TSNIT Avarage (p=0.383), mean Superior Avarage (p=0.756) and mean Inferior Avarage (p=0.269) before and after surgery. The ONH measurements with HRT 3 revealed postoperatively a significant increase in the mean Rim Area, Rim Volume and Cup Shape Measure, whereas Cup Area, Cup Volume and Linear Cup/Disc Ratio decreased (p<0.05). There were no differences between the mean Height Variation Contour (p=0.678) and Mean RNFL Thickness (p=0.064) before and after surgery. Preoperatively the mean value of the Mean Deviation on automated perimetry was ,18.82 ? 8.5 dB improving 6 months postoperatively to a mean of ,16.63 ? 7.9 dB (p<0.05). Conclusion Our study demonstrated the beneficial effect of IOP reduction obtained with glaucoma surgery on visual field indices and ONH parameters evaluated by HRT 3. [source] Major eye diseases and risk factors associated with systemic hypertension in an adult chinese population: the Beijing Eye StudyACTA OPHTHALMOLOGICA, Issue 2009T LIBONDI Purpose To assess the relationship of hypertension with major eye diseases and other ocular parameters. Methods The Beijing Eye Study is a population-based study. Examination at baseline in 2001; follow-up examination in 2006; 3222 subjects had blood pressure measurements. All participants underwent a thourough ophthalmic examination and blood pressure measurement. Hypertension was defined as a systolic blood pressure ,140 mm Hg and/or a diastolic blood pressure ,90 mm Hg, and/or self-reported current treatment for hypertension with antihypertensive medication. Results Mean age of participants in the present study was 60.4±10.0 years. Hypertension was present in 1500 (46.6%) of the 3222 subjects who had their blood pressure measured. In multiple regression analysis, hypertension was associated with higher intraocular pressure (P = 0.005), arterio-venous nicking (P = 0.009),retinal vein occlusions (P = 0.02), and diabetic retinopathy (P = 0.02). Hypertension was not significantly associated with the prevalence of open-angle glaucoma (P = 0.19) or angle-closure glaucoma (P = 0.15), age-related macular degeneration (P = 0.73), nuclear cataract (P = 0.88), posterior subcapsular cataract (P = 0.30), cortical cataract (P = 0.10), or area of alpha zone (P=0.05) or beta zone of parapapillary atrophy (P = 0.95). Conclusion In Chinese persons, while controlling for other systemic parameters, hypertension was associated with increased intraocular pressure, retinal microvascular abnormalities, and prevalence of retinal vein occlusion and diabetic retinopathy. Hypertension was not associated significantly with age-related macular degeneration, age-related cataract, or glaucoma [source] Do patients with normal tension glaucoma have a thinner conjunctiva?ACTA OPHTHALMOLOGICA, Issue 2009R VAN GINDERDEUREN Purpose The central cornea is thinner in patients with normal tension glaucoma (NTG). We had developed the surgical impression of thinner conjunctivas in patients with NTG. The purpose of this study was to determine whether there is a difference between the conjunctival thickness of patients with NTG and those with high tension primary open-angle glaucoma (POAG). Methods In this prospective study, 40 patients scheduled for trabeculectomy were categorized into NTG and POAG based on maximum intraocular pressure (IOP) as measured by Goldmann applanation tonometry. Ten (10) patients with NTG (max. IOP,21mmHg) and 30 patients with high tension POAG (max IOP>21mmHg) were included in the study. Conjunctival biopsies taken from the inferior fornix one month prior to trabeculectomy were fixed in formalin and embedded in Historesin. The conjunctival thickness was measured on a standardised way and compared between the two groups. Non-paired Student T test for two-tailed groups with equal variance was used for statistical analysis. Results The difference in mean conjunctival thickness between patients with NTG (66.4,±21.1) and patients with high tension POAG (104.6,±44.3) was statistically significant (P=0.045). The mean CCT in NTG (537,6±19.6) was lower than in POAG (548.3±38.0), but did not reach significancy in this study. Conclusion Patients with NTG have a thinner conjunctiva than those with high tension POAG [source] From epidemiology to lysyl oxidase like one (LOXL1) polymorphisms discovery: phenotyping and genotyping exfoliation syndrome and exfoliation glaucoma in IcelandACTA OPHTHALMOLOGICA, Issue 5 2009Fridbert Jonasson Abstract. The first Icelandic articles on exfoliation syndrome (XFS) and exfoliation glaucoma (XFG) appeared some 35 years ago in 1974. Articles since then have included epidemiology, pedigree-based and twin-studies as well as investigations into XFG response to medical therapy and XFS/XFG genetics. All studies found XFS/XFG to be common in Iceland and to be age-related. The Reykjavik Eye Study (RES), a population-based epidemiological study, was first conducted in 1996. The RES found that XFS and XFG prevalence in patients aged 50 years and older was 11% and that XFS/XFG was more common in women than in men. These results were confirmed in 5- and 12-year incidence studies that also suggested that detailed characterization of the phenotype is important, including pupil dilation. In the RES, eyes with XFS were found to be clinically unilateral in about half of cases and to have higher mean intraocular pressure (IOP) than non-XFS eyes. However, XFS was not found to be associated with central corneal thickness, corneal curvature, anterior chamber depth, lens thickness, lens opacification or optic disc morphology. About 15% of persons with XFS had XFG, and XFG eyes had higher risk of developing visual impairment and blindness than eyes with primary open-angle glaucoma. The first genetic studies on Icelanders, conducted about 12 years ago, were linkage studies and were unsuccessful in discovering the genetics behind XFS/XFG. However, in 2007 a genome-wide association study in Iceland using more than 300 000 markers [single nucleotide polymorphisms (SNPs)] on a relatively small number of patients did discover that lysyl oxidase like 1 (LOXL1) on chromosome 15q24 is a major gene for XFS/XFG. These results have now largely been replicated world-wide. [source] Trabeculectomy with an active postoperative regimen: results and resource utilizationACTA OPHTHALMOLOGICA, Issue 5 2009Amelie B. Taube Abstract. Purpose:, To evaluate intraocular pressure (IOP) and resource utilization after trabeculectomy, using an active postoperative regimen, in a Swedish population. Methods:, A retrospective analysis was performed on the patient charts of all patients who underwent trabeculectomy in a Swedish university hospital during 1 year (November 2000,December 2001). Trabeculectomy was performed in 34 eyes and trabeculectomy in combination with phacoemulsification in 10 eyes. Intraocular pressure, visual acuity, complications and numbers of injections of 5-fluorouracil, suture removal, needling procedures and visits to ophthalmologists were recorded for 2 years. Results:, Mean IOP before surgery was 30.4 mmHg (standard deviation [SD] 9.5) in eyes with capsular glaucoma and 28.7 mmHg (SD 9.3) in eyes with primary open-angle glaucoma. Mean IOP after 2 years was 15.3 mmHg (SD 3.9) in all eyes. Intraocular pressure of < 18 mmHg was achieved in 65% of the eyes after 2 years, as was IOP , 13 mmHg in 37%. Flap or suture manipulation was performed in 41 of 44 eyes. Needling procedures were carried out a mean of 2.3 times in 31 eyes. The mean number of visits to an ophthalmologist was 14.1 during the first postoperative year and 4.4 during the second. Conclusions:, The results were encouraging, with few complications and modest resource utilization. [source] Recent clinical findings with memantine should not mean that the idea of neuroprotection in glaucoma is abandonedACTA OPHTHALMOLOGICA, Issue 4 2009Neville N. Osborne Abstract. Loss of vision in primary open-angle glaucoma (glaucoma) is caused by retinal ganglion cells dying at a seemingly steady and variable rate in different patients. Present treatments for all glaucoma patients are inadequate and a goal to rectify this is to discover appropriate drugs or chemicals (neuroprotectants) that can be taken orally to slow down retinal ganglion cell death and have negligible side-effects. It was therefore of great disappointment to learn earlier this year that the one clinical trial conducted to test the efficacy of memantine as a neuroprotectant for glaucoma was unsuccessful. In this article, I consider the mechanisms by which retinal ganglion cells may die in glaucoma and suggest that memantine may have benefited patients taking it but to a level that was difficult to detect with present methodologies. Ganglion cells are induced to die by different triggers in glaucoma, suggesting that neuroprotectants with multiple modes of actions are likely to reveal clearer results than was found for memantine. Therefore, the idea of neuroprotection in glaucoma must not be abandoned. [source] The Beijing Eye StudyACTA OPHTHALMOLOGICA, Issue 3 2009Jost B. Jonas Abstract. Purpose:, This review presents and summarizes the findings of the Beijing Eye Study. Methods:, The Beijing Eye Study is a population-based study which included 4439 of 5324 subjects (aged , 40 years) who were initially examined in 2001. The study was repeated in 2006, when 3251 (73.2% of 4439, or 61.1% of 5324) of the original subjects participated. Participants underwent a series of examinations including: refractometry; pneumotonometry; biomicroscopy assisted by slit-lamp; optical coherence tomography of the anterior segment; photography of the cornea, lens, optic disc, macula and fundus; blood sampling for laboratory tests; blood pressure measurements, and determinations of anthropomorphic parameters. They were also asked to complete a questionnaire which included questions on socioeconomic parameters, and awareness and treatment of ocular and general diseases. Results:, We present normative data for refractive error, anterior segment measurements, intraocular pressure and optic disc structures and their associations, frequency and causes of visual impairment, blindness and visual field defects, prevalences of trachoma, pterygia, open-angle glaucoma and angle-closure glaucoma, cortical, nuclear and posterior subcapsular cataract, age-related macular degeneration, retinal vein occlusions, diabetes mellitus and diabetic retinopathy, myelinated nerve fibres, and retinitis pigmentosa, and associated and risk factors. Discussion:, These data may be helpful for dealing with public health issues in China and for assessing associated and risk factors of ocular and general diseases in general. [source] | |||||||||||||