Ocular Hypertension (ocular + hypertension)

Distribution by Scientific Domains

Selected Abstracts

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

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

Neurotrophic rationale in glaucoma: A TrkA agonist, but not NGF or a p75 antagonist, protects retinal ganglion cells in vivo

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

Bimatoprost, a novel efficacious ocular hypotensive drug now recognized as a member of a new class of agents called prostamides

Robert M. Burk
Pursuit of a new FP-agonist prodrug led to the identification of an interesting series of neutral C1-substituted prostaglandin F2, analogues. Although these initial analogues were devoid of any inherent pharmacological activity at the FP-receptor, two compounds AGN-190910 and AGN-191129, were found to have pronounced effects in lowering intraocular pressure (IOP) in normotensive dogs and monkeys. The cat iris sphincter assay was quickly developed as a primary screen for these analogues, leading to rapid identification of AGN-192024 (17-phenyl PGF2, ethyl amide, bimatoprost). While bimatoprost is structurally similar to naturally occurring mammalian hormones of the prostanoid family, surprisingly it demonstrates no significant activity at any of the known prostanoid receptors. Furthermore, results of considerable additional pharmacological studies provide evidence that it may indeed act through a unique receptor yet to be identified. The effect of Bimatoprost on lowering IOP has also been found to be unique in comparison to prostanoids. Bimatoprost reduces human IOP by increasing aqueous humor outflow through a dual mechanism of action where it improves both pressure-dependent and pressure-independent outflow pathways. First introduced to the market in 2002, bimatoprost is currently the most potent single therapy available for control of ocular hypertension. Drug Dev Res 68:147,155, 2007. ©2007 Wiley-Liss, Inc. [source]

Novel mutations in the MYOC/GLC1A gene in a large group of glaucoma patients,,

HUMAN MUTATION, Issue 6 2002
Karin Michels-Rautenstrauss
Abstract Mutations at the myocilin (MYOC) gene within the GLC1A locus have been revealed in 2-4% of patients suffering primary open angle glaucoma (POAG) worldwide. In our ongoing glaucoma study sixhundred eighty two persons have been screend for MYOC mutations. The first group consisted of 453 patients from a long-term clinical study diagnosed either with juvenile OAG (JOAG), POAG, ocular hypertension (OHT) or normal tension glaucoma (NTG) plus 22 cases of secondary glaucoma. This group, and additional 83 healthy controls, is part of a long term study with repeated clinical examinations at the University of Erlangen-Nurnberg. An additional sample of 124 glaucoma patients or at risk persons referred from other sources were included in the mutation screening. Five novel mutations, namely Gly434Ser, Asn450Asp, Val251Ala, Ile345Met and Ser393Asn, could be identified as cause of preperimetric POAG, JOAG, normal tension POAG and POAG. Myocilin mutations were identified similar with previous reports with other ethnic populations at the rate of 11/341 (3.2%) probands. © 2002 Wiley-Liss, Inc. [source]

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

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

Bimatoprost: Mechanism of Ocular Surface Hyperemia Associated with Topical Therapy

June Chen
ABSTRACT Bimatoprost is a safe and well-tolerated intraocular pressure (IOP) lowering drug that was approved in the United States in 2001 for the treatment of glaucoma and ocular hypertension. It is highly efficacious and produces greater mean reductions in IOP than other currently available antiglaucoma drugs. Conjunctival hyperemia is a common side effect of bimatoprost, but the hyperemia is typically mild and transient. No association has been found between signs of inflammation and the presence of hyperemia in bimatoprost-treated patients. Preclinical studies have elucidated the pharmacological mechanism of bimatoprost-related hyperemia and have examined the possible involvement of inflammation. Bimatoprost, as well as the free acid of latanoprost, elicited endothelium-de-pendent vasorelaxation in the rabbit jugular vein preparation, a quantitative in vitro model for ocular surface hyperemia (OSH). The vasorelaxant responses to either bimatoprost or latanoprost free acid were significantly inhibited by L-NAME, a nitric oxide synthase inhibitor. Similarly, the in vivo OSH responses to topically applied bimatoprost or latanoprost in dog eyes were significantly inhibited by L-NAME. As predicted, prostaglandin E2 (PGE2)-induced conjunctival hyperemia was not inhibited by L-NAME, since PGE2 has a direct relaxant effect on the vascular smooth muscle. In-life observations and histopatho-logical assessment of ocular surface tissues following bimatoprost treatment were performed for multiple-dose one month, 6 month, or 12 month safety studies in rabbits, dogs, and non-human primates. Results of these studies showed no evidence of bimatoprost-re-lated inflammation in the ocular surface tissues. In summary, OSH related to bimatoprost treatment in laboratory animals occurs by endothelial-derived nitric oxide-mediated vasodilatation and is not associated with inflammation. These studies suggest that conjunctival hyperemia, a side effect of bimatoprost treatment, results from non-inflammatory, pharmacologically based vasodilatation. [source]

An Overview of SR121463, a Selective Non-Peptide Vasopressin V2 Receptor Antagonist

C. Serradeil-Le Gal
ABSTRACT SR121463 is a selective, orally active, non-peptide antagonist of vasopressin (AVP) V2 receptors with powerful aquaretic properties in various animal species and humans. SR121463 belongs to a new class of drugs, called aquaretics, which are capable of inducing free-water excretion without affecting electrolyte balance. SR121463 displays high affinity for animal and human V2 receptors and exhibits a remarkably selective V2 receptor profile. SR121463 and [3H]SR121463 are used, therefore, as selective probes for characterization and labeling of V2 receptors. In various functional studies in vitro, SR121463 behaves as a potent antagonist. It inhibits AVP-stimulated human renal adenylyl cyclase and dDAVP (1-desamino, 8-D arginine-vasopressin)-induced relaxation of rat aorta. SR121463 also behaves as an inverse agonist in cells expressing a constitutively activated human V2 receptor mutant. In vitro, SR1 21463 rescued misfolded V2 AVP receptor mutants by increasing cell surface expression and restoring V2 function. In normally hydrated conscious rats, dogs and monkeys, SR121463, by either i.v. or p.o. administration, induced a dose-dependent aquaresis with no major changes in urinary Na+ and K+ excretion (unlike classical diuretics). In cirrhotic rats with ascites and impaired renal function, a 10-day treatment with SR121463 totally corrected hyponatremia and restored normal urine excretion. In a model of diabetic nephropathy in rats, SR121463 strongly reduced albumin excretion. SR121463 was also effective at extrarenal V2 (or V2 -like) receptors involved in vascular relaxation or clotting factor release in vitro and in vivo. In the rabbit model of ocular hypertension, SR121463 by either single or repeated instillation, decreased intraocular pressure. After acute and chronic administration to rats, dogs or healthy human volunteers, SR121463 was well absorbed and well tolerated. In all species studied the drug produced pronounced aquaresis without any agonist effect. Thus, SR121463 is a potent, orally active and selective antagonist at V2 receptors with powerful aquaretic properties. It is a useful tool for further exploration of function of renal or extrarenal V2 receptors. Pure V2 receptor antagonists are likely to be therapeutically useful in several water-retaining diseases such as hyponatremia, Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH), congestive heart failure, liver cirrhosis, and other disorders possibly mediated by V2 receptors (e.g., glaucoma). [source]

2223: Carbon monoxide as a mediator in the retina

Purpose Carbonic monoxide (CO) is organic gas ubiquitously synthesized in mammalian tissues by enzyme that has constitutive and inducible forms. This gas is produced as metabolic end-product in specific cell life phases, and may acts as atypical neuronal messenger. Evidence has recently accumulated suggesting that CO may be cytoprotective because its bioactions, including inhibition of apoptosis, platelet aggregation, complement activation, and inflammatory cytokine production. CO appears to be important to counteract the cytotoxicity caused by excessive production of reactive oxygen (ROS) and nitrogen (RNS) species. Methods In vitro and in vivo models. Results Induction of heme oxygenase (HO)-1 by hemin has been found to prevent retinal cell death after ischemia provoked by ocular hypertension in rats. The LPS-induced expression of pro-inflammatory cytokines, in rat eye, is also inhibited by CO. Interestingly, drugs active as inhibitors of iNOS block CO-induced increases in cGMP in the retina.Drugs inhibiting NO formation by acting on iNOS activity have been found to potently reduce intraocular pressure. Studies from our lab showed that an increase of CO availability by hemin or carbon monoxide-releasing molecules lower the intraocular pressure, suggesting a suppress action of iNOS-derived NO production. Conclusion A better understanding of CO regulation may lead to new therapeutic options that are safer and more efficacious than currently available treatments for various sight-threatening eye diseases, such as retinal degenerations. [source]

2327: Preservative free tafluprost 0.0015% in the treatment of patients with ocular hypertension and glaucoma: results of a multi-center open-label observational study

Purpose Efficacy, tolerability and safety of the novel preservative-free prostaglandin tafluprost 0.0015% were investigated. Methods Data were collected in a non-interventional prospective multi-center observational open label study. IOP readings were recorded for each eye at baseline (prior therapy or untreated) and 12 weeks after changing or initiating treatment with preservative-free tafluprost. Change in IOP was evaluated over the study period for all patients and for specific pre-treatment subgroups. Local comfort was measured using a 5 step scale. All adverse events were recorded. Results Data from 2123 patients with glaucoma or ocular hypertension were eligible for the final evaluation. In all patients preservative-free tafluprost lowered IOP from 19.5+4.4 mmHg at baseline to 16.4+2.9 mmHg after 12 weeks. Preservative-free tafluprost also lowered IOP significantly in all monotherapy-subgroups: Na,ve patients (N=440): 22.6+3.9 mmHg to 16.7+2.7mmHg; betablockers (N=307): 20.3+3.5 mmHg (baseline) to 16.7+2.6 mmHg (week 12); CAI's (N=158): 19.0+3.6 mmHg to 16.0+2.6 mmHg; PG's (N=447): 16.8+2.9 mmHg to 15.8+2.6 mmHg. Local comfort was rated as 'very good' or 'good' by 85.6% of patients at the final visit. Only few adverse events occurred during the treatment period. Conclusion Preservative-free tafluprost was effective, well tolerated and safe in a broad patient population. Local comfort and patient satisfaction improved after change of medical treatment in the vast majority of patients. Commercial interest [source]

Ocular findings among young men: a 12-year prevalence study of military service in Poland

Michal S. Nowak
Abstract. Purpose:, To determine the prevalence of ocular diseases among young men and to assess the main ocular causes reflecting discharge from military service in Poland. Methods:, A retrospective review of the medical records of 105 017 men undergoing a preliminary examination for military service during the period 1993,2004. Sample size for the study was calculated with 99% confidence within an error margin of 5%. All of the study participants were White men of European origin, most of whom live or lived in Poland. Data regarding the vision status were assessed in 1938 eyes of 969 participants. Two groups were distinguished based on the age of the participants: group I aged 18,24 years, and group II aged 25,34 years. Results:, Presented visual impairment [visual acuity (VA) < 20/40)] followed by colour vision defects were the most common ocular disorders, accounting for 13.2%. There were statistically significant differences in uncorrected VA as well as in the rates of particular refractive errors in between the age groups (p < 0.05). The prevalence of glaucoma and ocular hypertension was significantly higher in older participants. Six hundred and sixty-seven (68.8%) participants examined medically in the study period were accepted for military service. However, 302 (31.2%) failed their examination and were temporarily or permanently discharged from duty. Fifty-two of them (17.2%) were discharged because of various ocular disorders. The most common causes were high refractive errors, which accounted for 38.5% of all the ocular discharges, followed by chronic and recurrent diseases of the posterior segment of the eye, which accounted for 19.2%. Conclusion:, The prevalence of ocular disorders among young men in an unselected military population was closer to the results obtained in other population-based studies comprising both men and women in the same age group. High refractive errors followed by chronic and recurrent diseases of the posterior segment of the eye are important causes of medical discharges from military service in Poland. [source]

Quantifying the effect of intraocular pressure reduction on the occurrence of glaucoma

Andrea 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 study

Hannu 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]

A randomized, 36-month, post-marketing efficacy and tolerability study in Sweden and Finland of latanoprost versus non-prostaglandin therapy in patients with glaucoma or ocular hypertension

Björn Friström
Abstract. Purpose:, To compare the effect of time on therapy, efficacy, tolerability and resource utilization of latanoprost or non-prostaglandin analogues (non-PGs) in patients who required a change in intraocular pressure (IOP)-lowering monotherapy. Methods:, This open-label, multicentre study (Sweden, 19 sites; Finland, seven sites) included adults with glaucoma or ocular hypertension with mean diurnal IOP , 21 mmHg on ocular hypotensive monotherapy. Patients were randomized to latanoprost monotherapy or non-PG therapy (commercially available therapy other than a PG) and followed for 36 months. End-points included: time to treatment failure (baseline to visit with a change in/addition to treatment); diurnal IOP (mean of 08.00, 12.00 and 16:00 hr measurements) at months 6, 12, 24 and 36; tolerability; and resource utilization, where analyses used Swedish and Finnish 2006 unit costs. Results:, Three hundred and twenty-six patients received , 1 dose of latanoprost (n = 162) or non-PGs (n = 164). Median time to treatment failure was longer for latanoprost (36 months) than for non-PGs (12 months; p < 0.001); 51% and 24% of patients remained on randomized therapy after 36 months, respectively (p < 0.001). Decreases in mean diurnal IOP from baseline were significantly greater for latanoprost than for non-PGs at months 6 and 12 (p < 0.01). No serious adverse events were judged to be treatment-related. Mean total 36-month direct costs were similar in patients initiated with latanoprost and non-PGs. Conclusion:, Patients who failed previous monotherapy remained on therapy longer when switched to latanoprost. Latanoprost's IOP-reducing effect and tolerability were sustained over the long term. Resource utilization and costs were generally similar in those initiating latanoprost or non-PG therapy. [source]

Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysis

Robert Ritch
Abstract. Purpose:, To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. Methods:, Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. Results:, A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45,75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. Conclusion:, In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS. [source]

Reduced endothelial progenitor cells and brachial artery flow-mediated dilation as evidence of endothelial dysfunction in ocular hypertension and primary open-angle glaucoma

Gian 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]

The present role of corticosteroids in uveitis

Corticosteroids are the most widely used anti-inflammatory and immunosuppressant drugs in ophthalmology in general, and remain the mainstay of therapy for patients with uveitis. An infectious etiology for intraocular inflammation should be adequately excluded or appropriately covered with anti-infectious therapy before administration of corticosteroid therapy. Topical corticosteroids alone are usually effective in the management of anterior uveitis and have little activity against intermediate or posterior uveitis. Ocular adverse effects of topical steroid therapy mainly include ocular hypertension and cataract. The use of periocular steroid injections (subconjunctival, anterior or posterior subtenon, orbital floor) are important modalities in the management of anterior uveitis refractory to topical treatment and intermediate or posterior uveitis, particularly unilateral cases. Systemic corticosteroids remain the initial drug of choice for most patients with severe bilateral intermediate or posterior uveitis. Therapy is initiated with 1.0 to 2.0 mg/Kg of oral prednisone or prednisolone as a single morning dose, followed by a slow taper. Use of intravenous pulse steroid therapy is an important option in acute, severe, bilateral posterior segment inflammation. In several cases, the level of systemic steroid required to control the inflammation is too high and unacceptable. Immunosuppressive drugs as steroid-sparing agents are indicated is such cases. Intravitreal injection of triamcinolone acetonide and slow-release intraocular devices are therapeutic options that can be used in selected uveitis cases refractory to conventional therapy and biologic agents. [source]

Evaluation of cerebrospinal fluid pressure in patients with Alzheimer's disease as a possible cause of glaucoma

Purpose To investigate whether cerebrospinal fluid (CSF) pressure and trans-lamina cribrosa pressure gradient play a role in the pathogenesis of glaucoma. Our hypothesis is that a low cerebrospinal fluid (CSF) pressure may be correlated with the presence of glaucoma. The first objective is to investigate whether the CSF pressure in Alzheimer's disease (AD) patients with glaucoma is lower than in AD patients without glaucoma. The second goal is to evaluate an animal model with AD for the incidence and prevalence of glaucoma. If glaucoma is present histopathological analysis will be performed on retina and optic nerve, to search for Alzheimer-type changes. Methods Newly diagnosed AD suspects will undergo a lumbar puncture with CSF manometry, during neurological work-up. Ophthalmological evaluation consists of best corrected visual acuity, slit lamp biomicroscopy, gonioscopy, fundoscopy and pachymetry. Diagnosis of glaucoma or ocular hypertension will be made on the basis of visual field examination, optic disc evaluation and IOP measurement. Correlation between CSF pressure, trans lamina cribrosa pressure gradient and the presence of glaucoma will be calculated. The prevalence of low tension glaucoma will be compared to the prevalence of chronic open angle glaucoma with elevated IOP. In the second part of the project a genetically modified strain of mice with AD will be examined and screened for the development of glaucoma. Opthalmological examination will consist of IOP measurement, corneal pachymetry, optic disc evaluation and visual evoked potentials with flash. Histopathological analysis will be performed by the team of Prof De Deyn PP. Results will follow Conclusion will follow [source]

Effect of glaucoma and glaucoma risk factors on choroidal hemodynamics

Purpose a) to determine subfoveal choroidal hemodynamics in patients with primary open angle glaucoma (POAG) and patients with ocular hypertension (OH); b) to assess the effects of diabetes (DM), systemic hypertension (SHT) and myopia on subfoveal choroidal hemodynamics Methods Laser Doppler flowmetry (LDF) was used to determine the subfoveal choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBF) in 1) patients with POAG (n=85) and patients with OHT (n=25); 2) patients with glaucoma risk factors which were further subdivided into three subgroups; DM (n=93), SHT (n=57) and myopia (n=29) respectively. Subjects with each risk factor were further subdivided into two subgroups (without and with POAG), 3) age matched healthy controls (n=100). Results All LDF parameters were significantly reduced in all groups of patients compared with age matched controls. No statistically significant differences in the LDF parameters among HTG, NTG and OHT subgroups were detected. No significant difference in the LDF parameters between the two subgroup of each risk factor (without and with POAG) was noted. The LDF data of glaucomatous patients with risk factors demonstrated a significant reduction of ChBF and an increase in resistance in comparison to glaucomatous patients without risk factors Conclusion Subfoveal choroidal LDF parameters are reduced in subjects with POAG, OHT and patients with glaucoma risk factors, such as DM, SHT (under antihypertensive therapy) and myopia when compared with age matched healthy controls. However, the role of these choroidal circulatory alterations in the development or progression of the glaucomatous optic neuropathy remains to be clarified. [source]

Association between optic nerve head blood flow as assessed with Laser Doppler Flowmetry and mean arterial blood pressure in glaucoma, ocular hypertension and healthy control subjects

Purpose It has been implicated that vascular dysregulation plays a role in the pathogenesis of primary open angle glaucoma (POAG). In the present study the association between optic nerve head blood flow as measured with laser Doppler flowmetry and ocular perfusion pressure in patients with treated and untreated POAG, patients with ocular hypertension and healthy control subjects was compared. Methods 136 patients with treated POAG, 116 patients with untreated POAG, 138 patients with ocular hypertension and 160 control subjects were included in the study. Optic nerve head blood flow was assessed using laser Doppler flowmetry. Ocular perfusion pressure was calculated based on measurement of IOP and systemic hemodynamics. Results Optic nerve head blood flow was significantly reduced in patients with glaucoma compared to patients with ocular hypertension and healthy subjects (p<0.01). However, no difference in optic nerve head blood flow between treated and untreated glaucoma patients was detected. The highest association between ocular perfusion pressure and optic nerve head blood flow was found in untreated glaucoma patients followed by ocular hypertensives and treated glaucoma patients. Conclusion The present study confirms evidence that optic nerve head blood flow is reduced in patients with POAG and patients with ocular hypertension. Correlation coefficients in the glaucoma groups and in the ocular hypertensives indicate a vascular dysregulation in these patients compared to healthy control subjects. [source]

Comparison of dynamic contour tonometry with Goldmann applanation tonometry in glaucoma practice

Ioannis Halkiadakis
Abstract. Purpose:, To compare intraocular pressure (IOP) readings taken using dynamic contour tonometry (DCT) with IOP readings taken with Goldmann applanation tonometry (GAT) in eyes with glaucoma or ocular hypertension. Methods:, The present study included 100 eyes in 100 patients with glaucoma or ocular hypertension. After pachymetry DCT and GAT were performed. Intraocular pressures as measured with DCT and GAT were compared with one another and with central corneal thickness (CCT). Results:, Mean DCT IOP measurements (20.1 ± 4.3 mmHg) were significantly (p < 0.001) higher than GAT IOP values (17.9 ± 4.7 mmHg). The mean difference between DCT and GAT measurements was 2.1 mmHg (range , 3.4 to 9.7 mmHg). The difference followed a normal distribution. Measurements made with DCT and GAT correlated significantly with one another (Spearman's rho = 0.761, p < 0.001). Neither GAT nor DCT measurements showed a significant correlation with CCT (537 ± 39 ,m, range 458,656 ,m). Multivariate regression analysis has shown that the difference between DCT and GAT is influenced significantly by ocular pulse amplitude (r = , 0.334, p = 0.001) and it is not influenced by CCT (r = , 0.106, p = 0.292). Conclusions:, In eyes with glaucoma or ocular hypertension, DCT facilitates suitable and reliable IOP measurements which are in good concordance with GAT readings. Variation in CCT cannot by itself explain the differences in measurements taken with DCT and GAT in a number of eyes. [source]

Evaluating the effect of the new alignment algorithm for longitudinal series of Heidelberg retina tomography images

Ciara Bergin
Abstract. Purpose:, To evaluate the impact of a new image-alignment algorithm on the repeatability of longitudinal measurements obtained from Heidelberg retina tomograph (HRT) images. Methods:, HRTI and HRTII image series from 124 patients with glaucoma or ocular hypertension were made available from previously reported studies and were reprocessed with the old and new image-alignment algorithms. Improvements afforded by the new alignment algorithm were examined by considering statistically significant improvement in repeatability of specific stereometric parameters (SP), namely rim area (RA), rim volume (RV), cup volume (CV) and cup shape measure (CSM). A further comparison was made by examining reduction in the variability of pixel-by-pixel height measures within image series. Results:, In some HRT image series, the new algorithm automatically corrected obvious misalignment events that occurred with the previous algorithm. However, average improvement in repeatability of the SP in HRTI image series was not statistically significant (P = 0.13) and there was no statistically significant reduction in pixel-by-pixel height measurement variability (P =0.73). In HRTII image series, there was evidence of improvement, on average, in the repeatability of some parameters (RA, P = 0.01; RV, P = 0.02; CSM, P = 0.05), but not in CV (P = 0.22). There was a large reduction in pixel-by-pixel variability in HRTII image series (P,<,0.001). Conclusion:, There was no evidence to show that the new algorithm improved repeatability, on average, in HRTI images. However, the application of the new algorithm to HRTII image series marginally improved repeatability in stereometric measures and yielded a significant reduction in pixel-by-pixel variability. [source]

Visualisation of reverse pupillary block using AC-OCT in primary pigment dispersion syndrome

Purpose: To describe morphologic characteristics associated with secondary IOP elevation due to pigment release after pupil dilation in primary melanin dispersion syndrome. Methods: The history of a 49 year old male patient with primary pigment dispersion syndrome and secondary ocular hypertension is described. Besides detailed ophthalmologic examination including slit lamp biomicroscopy, gonioscopy as well as IOP and Laser-Flare measurement (KOWA FC-1000; Kowa, Tokyo, Japan) before and after pupil dilation, anterior segment optical coherence tomography was performed before and after Nd:YAG laser iridotomy and in medical miosis. Results: After pupil dilatation IOP increased up to 46 mmHg at the right eye but no IOP elevation was recognised at the left eye. Measurement by Laser-Flare Cell Meter revealed no cells in undilated state but 13.4 cells/ 0.075 ,l at the right and 4.0 cells/ 0.075 ,l at the left eye after mydriasis. Nd:YAG laser iridotomy was recommended for the right eye to the patient recently. Iris configuration detected by OCT demonstrates a concave shape before iridotomy more pronounced temporal than nasal which resolves after application of pilocarpin as well as after performance of Nd:YAG laser iridotomy. Conclusions: The effect of Nd:YAG laser iridotomy as a prophylactic but potentially causal treatment in pigmentary glaucoma can be easily visualized by OCT as a fast and non-contact procedure. [source]

Cost-effectiveness analysis in glaucoma: what drives utility?

Results from a pilot study in Sweden
Abstract. Purpose:,To investigate the effect of different levels of visual field defect in glaucoma on utilities and to test if utilities could be assessed using a general questionnaire such as the EQ-5D. Methods:,A cross-sectional study in 199 patients with ocular hypertension or open-angle glaucoma grouped into 5 severity stages according to visual field defects was performed in 4 specialized ophthalmic centres. Descriptive analysis was performed for the sample and by stage, and the effect of vision loss on utility was investigated with multiple step-wise regression analysis. Results:,The mean age of the sample was 70 and the mean MD in the worse eye was ,13.1 dB (SD 10.2). Visual acuity (VA) was 0.63 and 0.87 in the worse and better eye, respectively, and the mean utility was 0.80 (SD 0.23). Utility decreased with increasing glaucomatous damage, ranging from 0.84 for mild disease to 0.72 for severe damage (MD ,2.5 to ,28.1), but the difference between the groups was not statistically significant when controlling for co-morbidity, except for the most severe stage (p < 0.01). In multiple regression analysis, visual field in the better eye was significantly correlated with utility, and there was an indirect correlation between visual field in the worse eye and utility: the effect of total VA on utility was significant, and MD in the worse eye was correlated with total VA. Conclusions:,Utility is strongly correlated with overall vision. Our results suggest a relationship between glaucomatous damage and utility, and patients with severe damage have a significantly lower utility. However, this should be further investigated in larger samples that include more patients with moderate-severe bilateral damage. [source]

Microvascular blood flow of the optic nerve head and peripapillary retina in unilateral exfoliation syndrome

Ozcan Ocakoglu
Abstract. Purpose:, To measure microvascular blood flow in patients with unilateral exfoliation syndrome (XFS) without glaucoma or ocular hypertension and to compare the values in the eyes with clinically detected exfoliation, their nonexfoliative fellow eyes of the same patients and control eyes. Methods:, Twenty-two patients with clinically detected unilateral XFS and 30 age-matched healthy subjects were included in this study. Group 1 consisted of 22 eyes with clinical XFS, and the nonexfoliative fellow eyes of the same patients formed Group 2. The control group (Group 3) comprised the randomly selected eyes of 30 age-matched healthy subjects. Ocular blood flow values (volume, flow and velocity) were recorded from the optic nerve head (ONH) and peripapillary retina (PPR) using the Heidelberg retinal flowmeter (HRF). The differences between the three groups were compared statistically. Results:, The mean values of blood flow obtained from the ONH and PPR in eyes with clinically detected exfoliation (Group 1) and their nonexfoliative fellow eyes (Group 2) were both significantly lower than the values for the control eyes (Group 3). The differences in ocular blood flow between the eyes with exfoliation and the nonexfoliative fellow eyes were not statistically significant [one-way analysis of variance (anova), Dunnett's T3 test, p , 0.05). Conclusion:, These findings suggest that the eyes with clinically detected unilateral XFS were associated with reduced blood flow values in both the ONH and the PPR. The nonexfoliative fellow eyes also have lower blood flow values than the control eyes. [source]

Frequency doubling technology and high-pass resolution perimetry in glaucoma and ocular hypertension

Lada 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 glaucoma

L. Quaranta
No abstract is available for this article. [source]

The short-term effect of latanoprost on intraocular pressure and pulsatile ocular blood flow

Gerasimos 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]

Intraocular pressure and progression in exfoliative eyes with ocular hypertension or glaucoma

Mika Harju
ABSTRACT. Purpose: This retrospective study was conducted in exfoliative eyes in order to study the influence of IOP and other possible factors on the conversion from ocular hypertension (OHT) to glaucoma and progression of glaucoma. Methods: 139 patients with exfoliation OHT or glaucoma with exfoliation syndrome were included (mean follow-up 5.2±3.6 years). The effects of age, gender, weighted mean IOP, maximum IOP, stage of glaucoma at the first visit, refraction, glaucoma medication, and interventions on the hazard of progression were studied by multivariate survival analysis. Results: Conversion from OHT to glaucoma or progression of glaucoma was detected in 63 eyes (45.3%). A significant association with progression was found for age (relative risk 1.042; p-value 0.043), weighted mean IOP (1.076; <0.001), and stage of glaucoma (1.436; <0.001). History of trabeculectomy (0.360; 0.002) related to a decreased risk. Conclusion: The risk of conversion from OHT to glaucoma and progression of glaucoma increased in exfoliative eyes with severity of stage of glaucoma, weighted mean IOP, and the age of the patient. A history of trabeculectomy was related to decreased risk of progression. [source]

Discriminating between early glaucoma and ocular hypertension: diagnostic accuracy of pattern electroretinogram and confocal scanning laser optic disc morphometry

A. Colotto
No abstract is available for this article. [source]

Corneal thickness in glaucoma: an important parameter?

P. 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]