Home About us Contact
|
Home About us Contact | ||
|
|
||
Primary Open-angle Glaucoma (primary + open-angle_glaucoma)
Terms modified by Primary Open-angle Glaucoma Selected AbstractsAssociation of a single nucleotide polymorphism in the TIGR/MYOCILIN gene promoter with the severity of primary open-angle glaucomaCLINICAL GENETICS, Issue 3 2001E Colomb Primary open-angle glaucoma (POAG) is a highly prevalent optic neuropathy and a major cause of irreversible blindness, with elevation of intraocular pressure (IOP) being a primary risk factor. The trabecular meshwork-inducible glucocorticoid response (TIGR)/MYOCILIN (MYOC) gene coding region is mutated in 3,4% of POAG patients. Here, in a retrospective study of 142 POAG patients, we evaluated the influence on glaucoma phenotype of a novel biallelic polymorphism (,1000C/G) located in the upstream region of the MYOC gene. Allele frequencies were similar among patients and controls. However, the G allele (frequency 17.6%), also designated as MYOC.mt1, was associated with an increased IOP (+4.9 mmHg, p=0.0004) and a more damaged visual field (p=0.02). Both effects were predominant in females. Moreover, whereas IOP in MYOC.mt1 noncarriers decreased very markedly to the normal range between diagnosis and inclusion in the study (p=3×10,5 in both males and females), reflecting successful therapy, it decreased less noticeably in MYOC.mt1+ male patients (p=0.005) and not at all in MYOC.mt1+ female patients. MYOC.mt1 appears therefore to be an indicator of poor IOP control and greater visual field damage in diagnosed POAG patients, potentially due to a lack of response to therapeutic intervention. Its typing might help in the selection of treatment paradigms for the management of POAG patients. [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] 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] 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 Martķnez 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] 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] 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] 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] 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] Comparisons between Pascal dynamic contour tonometry, the TonoPen, and Goldmann applanation tonometry in patients with glaucomaACTA OPHTHALMOLOGICA, Issue 3 2007Maria L. Salvetat Abstract. Purpose:, To compare intraocular pressure (IOP) measurements taken with Pascal dynamic contour tonometry (DCT), the TonoPen and the Goldmann applanation tonometry (GAT). The influence of central corneal thickness (CCT) on IOP measurements taken with Pascal DCT and the TonoPen was evaluated. Methods:, One eye in each of 101 consecutive patients with primary open-angle glaucoma (POAG) underwent ultrasonic CCT measurement and IOP evaluation with GAT, Pascal DCT and the TonoPen in random order. The agreement between results from Pascal DCT and the TonoPen and those of GAT was assessed using the Bland,Altman method. The deviation of Pascal DCT and TonoPen readings from GAT values, corrected for CCT, was calculated and correlated to CCT using a linear regression model. Results:, The mean of the differences in IOP measurements was 3.2 ± 2.4 mmHg for Pascal DCT minus GAT readings and 0.5 ± 4.5 mmHg for TonoPen minus GAT readings. The 95% confidence interval of differences in IOP measurements was higher between TonoPen and GAT readings (, 6 to 7 mmHg) than between Pascal and GAT readings (0.1,6.8 mmHg). Pascal DCT significantly overestimated IOP compared with GAT, especially for higher IOP readings. Bland,Altman scatterplots showed reasonable inter-method agreement between Pascal DCT and GAT measurements, and poor agreement between TonoPen and GAT measurements. The deviations of Pascal DCT and TonoPen readings from the corrected GAT values were both highly correlated with CCT values (linear regression analysis, p < 0.0001). The mean change in measured IOP for a 10-µm increase in CCT was 0.48 mmHg for Pascal DCT and 0.74 mmHg for the TonoPen. Conclusions:, Agreement with GAT measurements was higher for Pascal DCT than for TonoPen readings; however, Pascal DCT significantly overestimated IOP values compared with GAT. Measurements of IOP obtained with both Pascal DCT and the TonoPen appeared to be influenced by CCT, and this influence appeared to be greater for the latter. [source] Phacoemulsification in trabeculectomized eyesACTA OPHTHALMOLOGICA, Issue 5 2005Pia Ehrnrooth Abstract. Purpose:,To evaluate retrospectively risk indicators for cataract surgery and the effect of phacoemulsification on intraocular pressure (IOP) control in eyes that have undergone trabeculectomy. Methods:,We undertook a retrospective analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes (35%) undergoing a cataract operation during the follow-up period of 2,5 years, 46 were included in this analysis. Their IOP, glaucoma medication and best corrected visual acuity (BCVA) before cataract surgery and at the last follow-up were compared. Risk indicators for cataract surgery were analysed. Results:,Cataract operations were performed 5.1,58.1 months (median 14.4 months) after trabeculectomy. The mean length of follow-up after cataract surgery was 25.3 months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was 16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD 1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in which treatment had been categorized as completely successful (IOP ,,21 mmHg without other therapy) before cataract surgery, 13 (59%) had remained so. The number of failures (IOP >,21 mmHg, or more than one medication needed or further surgery performed) increased from 14 (30%) before surgery to 28 (61%) afterwards. The proportion of failures in the cataract surgery group was twice that in the no cataract surgery group (61% versus 31%). In a proportional hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in patients with and without cataract surgery, respectively) proved to be a significant (p = 0.001) indicator for surgery. Conclusion:,The results of this retrospective study on consecutive clinical cases of trabeculectomy indicate that cataract progression after trabeculectomy is mainly an age-related process. In more than half the eyes with good preoperative IOP control, this good control was maintained after cataract surgery. On the other hand, in some eyes cataract surgery may compromise IOP control even when surgery avoids the area of the bleb. [source] A comparison of the effects of dorzolamide/timolol fixed combination versus latanoprost on intraocular pressure and pulsatile ocular blood flow in primary open-angle glaucoma patientsACTA OPHTHALMOLOGICA, Issue 6 2004I. Janulevicienė Abstract. Purpose:,To evaluate the effects of dorzolamide/timolol fixed combination (D/T) compared to latanoprost on intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) in primary open-angle glaucoma (POAG) patients. Methods:,Thirty patients with POAG were randomized in an open-label, cross-over study. Intraocular pressure reduction was achieved by 4 weeks medical therapy with D/T twice daily or latanoprost 0.005% dosed once in the evening. During a 4-week run,in and a 4-week wash-out period between study arms, patients ceased use of all other glaucoma medications and used timolol maleate 0.5% twice daily. Primary efficacy variables were IOP and POBF. Results:,There was no difference in baseline IOP and POBF parameters between the two study arms. Both D/T and latanoprost statistically significantly reduced IOP by 4.6 mmHg (p < 0.0001) and 3.75 mmHg (p < 0.0001) and increased POBF by 2.048 µl/second (p = 0.0030) and 2.147 µl/second (p = 0.0009), respectively. Repeated measures anova detected significant changes in POBF with treatment (p = 0.0361). Dorzolamide/timolol fixed combination statistically significantly increased pulse volume by 0.767 µl (p = 0.0087), while latanoprost therapy had no significant effect (p = 0.2407). Conclusions:,Both drugs had similar effects in terms of IOP reduction. Dorzolamide/timolol significantly increased pulse volume while latanoprost had no effect. Further studies are necessary to establish whether the enhancement of choroidal blood flow can prevent glaucoma progression. [source] Efficacy and safety of timolol maleate/latanoprost fixed combination versus timolol maleate and brimonidine given twice dailyACTA OPHTHALMOLOGICA, Issue 3 2003William C. Stewart Abstract. Purpose:, To evaluate the efficacy and safety of the timolol maleate/latanoprost fixed combination (TLFC) given once each evening versus brimonidine and timolol solution given twice daily as concomitant therapy in primary open-angle glaucoma or ocular hypertension patients. Methods:, Qualified subjects were begun on timolol alone twice daily for 1 month and then randomized to either TLFC or brimonidine and timolol concomitant therapy for 6 weeks. Patients were then switched to the other treatment regimen. Intraocular pressures (IOPs) were measured every 2 hours between 08 : 00 and 20 : 00 hours at baseline and at the end of periods 1 and 2. Results:, This study found that in 32 subjects the IOP diurnal curve on timolol alone (20.9 ± 2.8 mmHg) decreased to 17.9 ± 3.2 mmHg when patients were treated with TLFC and to 19.0 ± 2.4 mmHg when patients were treated with brimonidine and timolol (p = 0.02). Intraocular pressures at individual time-points were statistically similar between the groups at the 08 : 00 trough and 2 and 4 hours after dosing. However, beyond 4 hours after dosing, TLFC-treated subjects demonstrated a trend towards lower IOPs at each 2-hour time-point that was not statistically significant after a Bonferroni correction (p , 0.05). The incidence of both solicited and unsolicited side-effects was similar between groups. Conclusion:, This study suggests that TLFC given in the evening reduces the mean daytime diurnal IOP more than brimonidine and timolol given concomitantly twice daily. [source] Frequency doubling technology and high-pass resolution perimetry in glaucoma and ocular hypertensionACTA OPHTHALMOLOGICA, Issue 3 2003Lada Kalaboukhova Abstract. Purpose:, To study the correlation between frequency doubling technology perimetry (FDT) and high-pass resolution perimetry (HRP) in eyes with primary open-angle glaucoma, suspect glaucoma, ocular hypertension, and in normal eyes. Patients and Methods:, Ninety-four patients (162 eyes) were studied. Visual fields were assessed by HRP, FDT screening C-20,5 and FDT threshold C-20 programs. In eyes with a discrepancy between the test results, a comprehensive clinical examination was performed, including optic disc photography and Heidelberg retinal tomography (HRT). Results:, There was a strong correlation between HRP global deviation and the FDT mean deviation (for FDT threshold C-20 test), and between HRP score and FDT score (for FDT screening C-20,5 ). The correlation coefficients were r = ,0.83 and r = 0.77, respectively. In all, 75 eyes (46.3%) had normal HRP and FDT screening results, while 67 eyes (41.4%) showed abnormal results in both tests. In 12 eyes (7.4%) HRP was within normal limits while FDT screening was abnormal. Seven of these eyes were judged to have glaucoma; three of them had converted from ocular hypertension to glaucoma. In eight eyes (4.9%) HRP was abnormal while FDT screening was normal. Three of these were judged to have glaucoma. Thus, the sensitivity and specificity of the FDT screening test for the detection of glaucoma were 91.7% and 87.8%, respectively. Conclusion:, There was a strong correlation between FDT threshold C-20, FDT screening C-20,5 and HRP test results. Frequency doubling technology perimetry C-20,5 represents a good screening test for the detection of optic nerve damage in open-angle glaucoma. [source] Evaluation of central corneal thickness in patients affected by ocular hypertension, primary open-angle glaucoma, normal tension glaucomaACTA OPHTHALMOLOGICA, Issue 2002L. Quaranta No abstract is available for this article. [source] Evaluation of the new Ocuton S tonometerACTA OPHTHALMOLOGICA, Issue 2 2002Giorgio Marchini ABSTRACT. Purpose:, To evaluate the intra- and interobserver variability of the Ocuton S tonometer, its correlation with Goldmann tonometry, the reliability of self-tonometry and the safety of the instrument. Methods:, Thirty-five healthy subjects and 45 patients with primary open-angle glaucoma (POAG), aged from 38 to 80 years (mean age: 64.6 ± 12.2 years), underwent tonometry with the Ocuton S tonometer in one eye chosen at random. The intra- and interobserver variability between two operators (kappa coefficient), the Ocuton S/Goldmann correlation and the reliability of self-tonometry were evaluated by performing two tonometries on each patient in subgroups. Each tonometry was considered as the mean of three consecutive measurements. Central ultrasonic pachymetry, keratometry and corneal biomicroscopy were also evaluated. Results:, The intra- and interobserver variability ranged from 0.38 to 0.66. The difference between the means of intraocular pressure (IOP) with the Ocuton S (24.4 ± 4.7 mmHg) and the Goldmann tonometer (18.1 ± 4.7 mmHg) was statistically significant (p < 0.0001). Linear regression analysis revealed a good Ocuton S/Goldmann correspondence (r = 0.88, p = 0.0001). However, IOP values detected with the Ocuton were consistently overestimated, compared to those detected with the Goldmann tonometer. The correlation between corneal thickness and IOP was statistically significant both for the Goldmann (r = 0.510, p = 0.021) and for the Ocuton S tonometer (r = 0.520, p = 0.019). No correlation was found between keratometry and IOP. The mean measurement obtained by self-tonometry (21.9 ± 3.6 mmHg) showed no statistically significant difference when compared to the mean measurement obtained by an expert operator (21.3 ± 3.4 mmHg). Conclusion:, The Ocuton S tonometer is a safe instrument that can be used easily by the patient. However, in comparison to the Goldmann tonometer , it overestimates IOP and requires further technical and methodological refinements in order to ensure greater reliability. [source] The short-term effect of latanoprost on intraocular pressure and pulsatile ocular blood flowACTA OPHTHALMOLOGICA, Issue 1 2002Gerasimos T. Georgopoulos ABSTRACT. Purpose:, There is evidence that ocular blood flow plays a critical role in the clinical course of glaucoma. Any reduction in ocular blood flow due to topical antiglaucoma treatment should therefore be avoided. This study aimed to evaluate the short-term effect of local latanoprost application on ocular hemodynamics. Methods:, Intraocular pressure (IOP), ocular pulse amplitude (OPA), ocular pulse volume (OPV), systemic blood pressure, heart rate and the pulsatile component of ocular blood flow (POBF) were recorded using a pneumotonometer linked to the Langham Ocular Blood Flow System in 24 patients in a prospective, open-label study before and after 1 week of topical latanoprost application in both eyes. Twenty of the subjects had primary open-angle glaucoma and four had ocular hypertension. Results:, After 1 week of latanoprost treatment, IOP decreased significantly 6.2 ± 2.9 mmHg in OD (P < 0.001) and 6.2 ± 3.2 mmHg in OS (P < 0.001). Pulsatile OBF increased significantly by 201.2 ± 167.4 µL/min in OD (P < 0.001) and 203.8 ± 187.3 µL/min in OS (P < 0.001). Ocular pulse amplitude and OPV showed statistically significant increases (P < 0.05 and P < 0.001 respectively). Blood pressure and heart rate did not change significantly. Conclusion:, Our results indicate that 1 week after latanoprost application, POBF, OPA and OPV were significantly increased in the eyes treated. More information on the perfusion of the optic nerve head is needed before the relevance of these findings to optic nerve head blood flow can be interpreted correctly. [source] Corneal thickness in glaucoma: an important parameter?ACTA OPHTHALMOLOGICA, Issue S232 2000P. Brusini Summary Central corneal thickness was measured by pachometry in 49 patients with primary open-angle glaucoma (POAG), 41 with ocular hypertension (OHT), 14 with normal tension glaucoma (NTG) and 48 normal subjects. The mean corneal thickness of the OHT patients was significantly greater than that of the normal control group. The NTG patients, on the other hand, had a cornea on average thinner than the normals. These differences may cause misclassification of normals with a thick cornea as ocular hypertensive eyes or, contrarywise, cause those normals whose IOP is underestimated because of a thin cornea to be classed as NTG patients. [source] Ascorbic acid concentration is reduced in the secondary aqueous humour of glaucomatous patientsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2009Mauro T Leite MD Abstract Background:, We aimed to evaluate the ascorbic acid concentration in secondary aqueous humour (AH) from glaucomatous patients and to compare it with primary AH from primary open-angle glaucoma patients and non-glaucomatous patients. Methods:, Primary AH samples were prospectively obtained from clinically uncontrolled primary open-angle glaucoma patients and senile cataract patients (controls) prior to trabeculectomy and cataract surgery. Secondary AH samples were obtained from eyes with previous intraocular surgery, prior to trabeculectomy or cataract surgery. AH (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber just before surgery and then immediately stored at ,80°C. The ascorbic acid concentration was determined in a masked fashion by high-pressure liquid chromatography. Results:, A total of 18 patients with senile cataract, 16 glaucomatous patients with primary AH (no previous intraocular surgery) and 11 glaucomatous patients with secondary AH (previous intraocular surgery) were included. There was no difference in mean age between groups (P = 0.15). The mean ± standard deviation concentration of ascorbic acid in the secondary AH from glaucomatous patients (504 ± 213 µmol/L [95% confidence interval {CI}, 383,624]) was significantly lower than the concentration of ascorbic acid found in the primary aqueous of primary open-angle glaucoma (919 ± 427 µmol/L [95% CI, 709,1128]) and control patients (1049 ± 433 µmol/L [95% CI, 848,1249]; P < 0.01, Kruskal-Wallis test). Conclusions:, The ascorbic acid concentration in secondary AH of glaucomatous patients was approximately twofold lower in comparison with primary AH of glaucomatous and cataract patients. The implications of a reduced concentration of ascorbic acid in the secondary AH deserve further investigation. [source] | |||||||||||||