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PubMed1999

[Morphology of the optic papilla in glaucoma. I. Primary open-angle glaucoma].

BACKGROUND: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. RESULTS: Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. CONCLUSIONS: These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.

Adult↗
PubMed1982

[Surgical method for the treatment of irreversible angle-closure glaucoma and aphakic glaucoma. Direct ciliary body coagulation with partial cyclodialysis].

Among 16 patients aged from 31 to 86 there were 13 cases of hemorrhagic glaucoma, three cases of secondary glaucoma from iritis and one case of secondary angle-closure glaucoma after trauma. Reduction in intraocular pressure was achieved by a surgical method which primarily aims to improve the outflow of aqueous humor. The ciliary body is laid bare by preparation of a scleral flap, a partial cyclodialysis is attached on both sides and the ciliary body is induced to stricture by coagulation, so that a large enough cleft is created. Before the operation, pressure ranged from 34 to 64 mm Hg; after the operation, during postoperative periods of observation lasting from two to 32 months, there were 14 cases in which the pressure was below 25 mm Hg and two cases with 30-40 mm Hg respectively. In view of the good results and the few complications, this method of operation can be recommended for treatment of both irreversible angle-closure glaucoma and aphakic glaucoma.

Adult↗
PubMed1998

Conjunctival changes associated with glaucoma therapy: implications for the external disease consultant and the treatment of glaucoma.

PURPOSE: Enhance recognition by the external disease specialist of the conjunctival changes associated with glaucoma therapy and the reported association with glaucoma filtration surgery. METHODS: Literature search with emphasis on the cellular and subcellular changes induced by antiglaucoma medications, the definition and diagnosis of drug-induced cicatricial conjunctivitis (DICC), and the implications for future glaucoma therapy or surgery. RESULTS: Significant conjunctival and subconjunctival changes occur associated with the use of antiglaucoma medications that affect the success of glaucoma filtration surgery. The extreme form of change is the DICC, which is clinically and pathologically identical to ocular cicatricial pemphigoid. The autoantigen in the basement membrane probably differs in these two disease processes. CONCLUSIONS: There is a movement toward an earlier approach to glaucoma filtration surgery, in large part based on the literature reviewed here. The external disease specialist needs to be cognizant of these conjunctival changes to best consult on patients receiving antiglaucoma medications.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Glaucoma and glaucoma medications.

Unrecognized and untreated glaucoma (ocular hypertension) results in loss of visual field and blindness for millions of people. While no cure exists for glaucoma, early detection and maintaining recommended treatment regimens can be major factors in reducing irreparable damage--damage that has a devastating effect on the quality of life of glaucoma sufferers. Nurses who understand and teach about the importance of glaucoma testing and treatment can be significant agents in the fight against glaucoma related blindness.

Adrenergic beta-Antagonists↗
PubMed2007

Optic disc tomography and perimetry in controls, glaucoma suspects, and early and established glaucomas.

PURPOSE: To analyze the priority of morphological and functional defects in glaucoma. METHODS: Nine-hundred seventy-three eyes of 973 subjects were examined with Heidelberg retinal tomograph (HRT II) and Octopus 311 perimeter (TOP strategy). These included 72 controls (C), 659 early and suspect open angle glaucoma (ESG) with perimetric mean defect (MD) lower than 6 dB, and 242 confirmed moderate and advanced glaucomas (AG) with perimetric MD>or=6 dB. RESULTS: I. (Control group): Age was significantly correlated with mean sensitivity (MS) (r=0.50, p<0.00001) and nasal cup shape measure (r=0.33, p=0.005). II. (C and ESG groups): For 95.8% specificity, the best sensitivity was obtained with square root of loss variance (sLV) (ROC area=69.7%, sensitivity=33.7%) and maximum contour elevation (ROC area=69.6%, sensitivity=29.0%). Maximum contour elevation and sLV coincided in diagnosis in 12.4% of cases. An equation using 64 HRT II indices predicted MS with a standard error of estimate (SEE) of 1.87 dB (r=0.67, p<0.00001) and MD (SEE=1.88 dB, r=0.47, p<0.00001). III. (All cases): RB discriminant function value was the best HRT II index to estimate MS values (SEE=5.4 dB, r=0.52, p<0.0001), MD (SEE=5.2 dB, r=0.50, p<0.0001), sLV (SEE=1.9 dB, r=0.41, p<0.0001) and Number of Pathological Points (NPP; SEE=21.3 dB, r=0.49, p<0.0001). Sector correlation of the optic nerve and visual field was high (maximum r=0.66) in cases with superior visual field defects and low in the rest of cases. More than 95% of cases with established glaucoma had abnormal sLV, but <60% had abnormal optic disc indices. DISCUSSION: Perimetry reveals age-related defects slightly more than HRT II. HRT II indices correlated better with MS than with MD, probably because none of them was age corrected. Good correlation between anatomical and functional data in C and ESG, and sensitivity results indicated small differences in early development between both methods. Perimetry identifies defects more clearly than structural measures in established glaucoma.

Adolescent↗
PubMed2004

How prostaglandins have changed the medical approach to glaucoma and its costs: an observational study of 2228 patients treated with glaucoma medications.

PURPOSE: The aim of the present study was to investigate how the medical treatment of glaucoma changed between 1997 and 2002, since the advent of prostaglandin derivatives, with regard to drug prescriptions and pharmaceutical costs. METHODS: A study was made of medical prescriptions for 2228 patients with glaucoma and/or ocular hypertension, in order to investigate the following: (i) the antiglaucoma drugs most commonly prescribed in 1997 and 2002, and any differences between the drugs prescribed in these 2 years; (ii) the number of drugs used per patient in 1997 and 2002, respectively, and (iii) any increase in the prescribing of antiglaucoma drugs and their relative costs from 1997 to 2002. RESULTS: From 1997 to 2002 there was a sharp drop in the prescribing of beta-blockers (79% in 1997 and 55% in 2002). A marked increase in the use of prostaglandin derivatives (0% in 1997 and 18% in 2002) was registered and a marked increase in the prescribing of carbonic anhydrase inhibitors (5% in 1997 and 14% in 2002) was also noted. From 1997 to 2002 there was a trend towards drug addition rather than substitution, so that the number of drugs used per patient increased. The number of patients treated increased enormously (by 98%) from 1997 to 2002. The cost of medical therapy from 1997 to 2002 rose dramatically, with an increase of 148.9% per patient. CONCLUSION: The availability of prostaglandin derivatives has strongly influenced the medical approach to glaucoma. This class of drugs will soon become the type most commonly prescribed for patients with glaucoma and/or ocular hypertension. The increased number of treatments also suggests that the approach of ophthalmologists towards these diseases has changed. Ocular hypertension, as well as glaucoma, is now treated more aggressively. Given the increase in the prescription of prostaglandin derivatives, the pharmaceutical cost of treatment has risen dramatically.

Antihypertensive Agents↗
PubMed1976

The cyclopentolate provocative test in suspected or untreated open-angle glaucoma. IV. Fluorescein angiography of the vessels of the iris in open-angle glaucoma eyes with a positive cyclopentolate response.

Fluorescein angiography of the iris (IFAG) was performed on 15 patients with a positive cyclopentolate response (IOP elevation greater than or equal to 8 mmHg) in 17 eyes to the cyclopentolate provocative test. The chamber angles were open in all the eyes. Seven of the responder eyes had capsular glaucoma undergoing treatment, six had simple glaucoma, two had pigmentary glaucoma and two suspicion of open-angle glaucoma. The object was to study with IFAG whether vascular changes can be established in the iris of the responder eyes such as could have a role in the elevation of IOP. All the eyes with capsular glaucoma displayed vascular changes, vasoproliferation and fluorescein leakage from the iris vessles. No other vascular changes were seen in the irises of the responder eyes. IFAG revealed no differences in the iris vasculature between responder and non-responder eyes. A vascular aetiology for the IOP elevation in responders is improbable.

Cyclopentolate↗
PubMed1986

The follow-up in patients with pseudoexfoliation of the lens capsule with and without glaucoma. 2. The development of glaucoma in persons with pseudoexfoliation.

102 persons with pseudoexfoliation without glaucoma, not attending follow-up controls, underwent re-examination. The time elapsed since last control was greater than or equal to 5 years in 39%. In those with monocular pseudoexfoliation, 30% became binocularly affected. Only 3 persons had developed glaucoma (2.9%). Probable explanations for this low figure are discussed. IOP measurements of the total group and the subgroup of persons remaining monocularly affected during the observation period, revealed similar or lowered values at re-examination compared with the last control. A retrospective analysis of a capsular glaucoma group (208 eyes), disclosed that 84% had glaucoma at their initial visit, 38% of the remaining patients developing glaucoma during 1.5 years.

Aged↗
PubMed2006

Trefoil factor family 1, MUC5AC and human leucocyte antigen-DR expression by conjunctival cells in patients with glaucoma treated with chronic drugs: could these markers predict the success of glaucoma surgery?

AIMS: To evaluate conjunctival expression of trefoil factor family (TFF)1, MUC5AC and human leucocyte antigen (HLA)-DR in patients with glaucoma treated with topical drugs, and to determine whether these parameters can predict the outcome of glaucoma surgery. METHODS: 77 conjunctival impression cytology specimens were collected from 77 patients with glaucoma (66 receiving drops with preservative and 11 treated with preservative-free drops) and 43 controls. TFF1, MUC5AC and HLA-DR expression was analysed using flow cytometry. Trabeculectomy was performed in 56 patients; success was defined as an intraocular pressure (IOP) < or =15 mm Hg without any IOP-lowering drug at 6 months. RESULTS: The expression of TFF1, MUC5AC and HLA-DR was significantly higher in patients than in controls (p = 0.01, 0.05 and 0.004, respectively). A higher expression of MUC5AC was found in patients treated with preserved drops than in those receiving unpreserved drops (p = 0.04). A higher MUC5AC expression and a lower HLA-DR expression was observed in successful glaucoma surgeries than in failures. CONCLUSIONS: TFF1 and MUC5AC secretions are probably a response to mild ocular surface changes caused by long-term use of topical treatment. Their increased expression could be a predicting factor of further successful glaucoma surgery.

Adrenergic beta-Antagonists↗
PubMed1996

The 'GIST' score: ranking glaucoma for genetic studies. Glaucoma Inheritance Study of Tasmania.

The 'GIST' score was developed to facilitate linkage analysis of adult-onset primary open angle glaucoma (POAG) pedigrees in the Glaucoma Inheritance Study of Tasmania (GIST). Previous genetic linkage studies on juvenile open angle glaucoma pedigrees have relied upon an analysis of definitely affected individuals using the 'single best diagnosis' convention. Studies of adult-onset POAG have been complicated by limited numbers of unequivocally affected members identified even in very large pedigrees due to the later onset of the disease. Many members of the pedigree may have equivocal clinical features or are too young to show signs of the disease. The 'GIST score' is a numeric value between zero and one where zero is clinical certainty of absence of the disease and one is the definitive diagnosis of POAG. The score is developed by assigning relative weighting to key clinical features which results in a 'pedigee probability' of the diagnosis being present or absent in a member of a pedigree. Ranking of borderline and unaffected glaucoma subjects allows the laboratory more flexibility in the use of the members of the pedigree for linkage analysis. The score is not intended to have clinical usefulness in management of glaucoma.

Adult↗
PubMed1996

The problem of overlapping glaucoma families in the Glaucoma Inheritance Study in Tasmania (GIST).

The Glaucoma Inheritance Study in Tasmania (GIST) is a population survey of Australia's island state, Tasmania (population 450,000). Its aim is to find families with autosomal dominant, adult-onset, primary open angle glaucoma (POAG) suitable for genetic linkage analysis. POAG is relatively common, affecting around 3% of the Australian population. By finding the large families with POAG and identifying all the descendants in a captive population, it is possible that there may be overlap of different glaucoma pedigrees. Three of the first thirteen families in the study were composed of overlapping pedigrees. In one GIST family, GTas3, there has been intermarriage with other pedigrees with glaucoma on five occasions. The possibility of multiple genotypes was also reinforced by the inability to determine a single glaucoma phenotype in this family. When finding large families of POAG for linkage analysis, researchers must be aware of the risk of affected individuals inheriting their gene from the alternate parent. Thus, the alternate parents or their families must be examined, especially if the phenotype is atypical for the rest of the family.

Adult↗
PubMed2005

The effectiveness of the Heidelberg Retina Tomograph and laser diagnostic glaucoma scanning system (GDx) in detecting and monitoring glaucoma.

OBJECTIVES: To determine the potential of optic nerve head tomography [Heidelberg Retina Tomograph (HRT)] and scanning laser polarimetry (GDx) for identifying patients with glaucomatous visual field loss. DESIGN: Examinations were performed with the HRT, GDx and Humphrey Field Analyzer (HFA). Glaucoma was defined by the presence of a field defect. Patients within the cross-sectional groups underwent a single examination, whereas patients in the longitudinal groups were examined 6 monthly, for an average of 3.5 years. SETTING: Manchester Royal Eye Hospital, UK. PARTICIPANTS: Patients with primary open angle glaucoma (POAG) or who were at risk of developing glaucoma. INTERVENTIONS: The diagnostic accuracies of the HRT and GDx were compared; specificity was set at 95%. The rate of change was determined by linear regression. To estimate the clinical application of the instruments, the proportion of an unselected group of patients on whom the examinations could be performed was calculated. Additionally, the time taken to perform and process each examination was measured. MAIN OUTCOME MEASURES: The ability of the techniques to identify cases showing deterioration. The level of agreement and applicability of the techniques. Time taken to perform and process each examination. RESULTS: From the cross-sectional group, the maximum sensitivities of the HRT and GDx were 59% and 45%, respectively (at 95% specificity). From the two longitudinal cohorts, the level of agreement between the three instruments for identification of the development and deterioration of POAG was low. The applicability of the techniques was 80% (HRT), 88% (GDx) and 98% (HFA). The length of time to perform a full examination with each instrument was 12.3, 11.8 and 28.3 minutes, respectively. Agreement of HRT and GDx parameters between and within observers was largely good. CONCLUSIONS: There is poor agreement for detection of glaucoma between the HFA, HRT and GDx. The techniques are amenable to use in the clinical environment, but no single examination has sufficient diagnostic precision to be used in isolation; also, the imaging techniques were not universally applicable. Neither the HRT nor GDx should be viewed as a replacement for visual field examination. Further research is needed into why most patients within the longitudinal arms of the study showed very little deterioration and into determining aspects of the structure versus function relationship in glaucoma that may explain why any one technique fails to detect a proportion of cases.

Adult↗
PubMed2000

[A case report of neovascular glaucoma due to carotid artery occlusive disease--diagnosis of neovascular glaucoma and histological characteristics].

PURPOSE: The methods of diagnosing neovascular glaucoma were evaluated in a case with carotid artery occlusive disease. A trabeculectomy specimen taken from this patient was examined histologically to find the characteristic picture of this slowly progressive neovascular glaucoma. MATERIALS AND METHODS: The left eye of a 48-year old man with neovascular glaucoma due to carotid artery occlusive disease had been previously diagnosed as uveitis with ocular hypertension. His left eye was examined by fluorescein fundus and gonioangiography. Trabeculectomy was performed because of uncontrolled intraocular pressure and the trabeculectomy specimen was examined histologically including immunohistochemistry with antibodies against von Willebrand factor antigen. RESULTS: The characteristic picture of fluorescein fundus angiography was filling delay in the choroid and stained walls of the retinal arteries and veins. Fluorescein gonioangiography using a fundus camera clearly demonstrated new vessels in the pupil and angle with intense fluorescein leak in spite of faint neovascularization in those areas when observed by slit lamp with gonioscopy. Histological examination of the trabeculectomy specimen revealed proliferation of new vessels in the spaces of the trabecular meshwork and focal occlusion of Schlemm's canal. CONCLUSION: Fluorescein fundus angiography and gonioangiography by fundus camera is very useful for diagnosis of neovascular glaucoma due to carotid artery occlusive disease. Neovascular proliferation in the trabecular meshwork with slight of peripheral anterior synechia and focal occlusion of Schlemm's canal may be peculiar to such slowly progressive neovascular glaucoma.

Carotid Stenosis↗
PubMed2001

Long-term fluctuation in short-wavelength automated perimetry in glaucoma suspects and glaucoma patients.

PURPOSE: To determine the magnitude of the homogeneous, LF(Ho), and the heterogeneous, LF(He), components of the long-term fluctuation (LF) in glaucoma suspects and in stable primary open angle glaucoma (POAG) patients undergoing short-wavelength automated perimetry (SWAP) and to compare the magnitude of the SWAP LF components with those elicited by standard white-on-white (W-W) perimetry. METHODS: The sample comprised 33 glaucoma suspects and 17 patients with early-to-moderate stable POAG who underwent W-W perimetry and SWAP at each of six visits over a mean period of 12.75 months (SD, 2.29). The LF(Ho), LF(He), and error components of the long-term fluctuation were determined between the third and seventh visual field examinations. The intervening visual field examinations and the optic nerve head parameters, derived both by stereo observation and by the Heidelberg Retinal Tomograph, were used to confirm stability over the follow-up period. RESULTS: The LF(Ho) and LF(He) components were larger in the POAG patients than in the glaucoma suspects for both W-W perimetry and SWAP; the magnitude was independent of the depth of defect and of the short-term fluctuation. All three components of long-term fluctuation were greater for SWAP than for W-W perimetry, both in the glaucoma suspects and in the POAG patients. CONCLUSIONS: SWAP exhibits greater long-term fluctuation than white-on-white perimetry. The usefulness of SWAP will be limited if the extent of this variability is not overcome in future statistical procedures developed to detect progressive visual field loss.

Adult↗
PubMed1992

Pseudoexfoliation syndrome and glaucoma. Does glaucoma capsulare exist?

Pseudoexfoliation syndrome (PES) is seen in patients with a characteristic deposition of material on the anterior preequatorial region of the lens and on a variety of surfaces throughout the anterior segments of the eye. A high frequency of associated glaucoma has also been reported. In spite of numerous clinical and histological investigations, the mechanisms for the glaucoma are unclear. In a series of 5154 patients referred to our hospital for cataract extraction we found a prevalence of 6.1% (n = 314). In 51 of these patients (16.2%) glaucoma was diagnosed in contrast to 33 patients (10.9%) in an age-matched control group. The prevalence of glaucoma in PES patients and the control group was not statistically different, so our findings in cataract patients do not support the interpretation that there is a clinical entity called "glaucoma capsulare."

Aged↗
PubMed1991

Epidemiology of glaucoma in Japan--a nationwide glaucoma survey.

A population-based, collaborative glaucoma survey was conducted in seven regions throughout Japan, during the years of 1988 and 1989. The total number of subjects examined was 8,126 out of 16,078 residents aged 40 years or older, representing a participation rate of 50.54%. There were no significant differences in background factors between participants and randomly sampled nonparticipants. A mainstay of the screening consisted of tonometry and fundus photography with nonmydriatic camera, followed by automatic perimetry as a recall examination. Overall prevalences obtained were primary open-angle glaucoma (POAG) 0.58%, low-tension glaucoma (LTG) 2.04%, primary angle closure glaucoma (PACG) 0.34%, other types of glaucomas 0.60%, and ocular hypertension (OH) 1.37% at the time of screening. The very high prevalence of LTG and extremely low prevalence of OH in the Japanese might reflect a racial peculiarity in the age-specific trend of the intraocular pressure. The prevalence of PACG was found much higher in Japanese than in Caucasians, with a predilection for women. Racial peculiarities as revealed in this study were discussed, with particular reference to the refractive status in the Japanese that showed progressive decrease in myopia with age.

Adult↗
PubMed1998

Penetrating keratoplasty with a valved glaucoma drainage implant for congenital glaucoma and corneal scarring secondary to hydrops.

The simultaneous management of glaucoma and corneal opacification is sometimes required in infants with severe congenital glaucoma if timely visual rehabilitation is to be achieved. A 1-month-old female infant presented with an enlarged, protuberant, opaque cornea in each eye and elevated intraocular pressure. An intrastromal, fluid-filled cleft was noted in both corneas. It resolved over 3 weeks as corneal scarring progressed. Peripheral corneal clearing allowed a view of an essentially normal anterior chamber. Penetrating keratoplasty and Ahmed (New World Medical Inc., Rancho Cucamonga, CA) valve implant surgery with mitomycin-C were performed simultaneously in the two eyes 1 months apart. At 15 months of age, the patient's grafts were clear and the intraocular pressure was well controlled in both eyes. One eye required multiple procedures for eventual glaucoma control. No postoperative overfiltration occurred. The authors conclude that the use of a valved implant should be considered in patients who require urgent simultaneous corneal and glaucoma surgery for severe congenital glaucoma. This combination may improve early postoperative control of aqueous outflow and positively affect long-term graft survival in these difficult cases.

Administration, Topical↗
PubMed2005

Comparison of safety and efficacy between silicone and polypropylene Ahmed glaucoma valves in refractory glaucoma.

OBJECTIVE: To compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs) over 1 year of follow-up. DESIGN: Retrospective comparative study. PARTICIPANTS: Fifty consecutive patients with polypropylene and 49 consecutive patients with silicone AGV implantation. METHODS: Our hospital instituted a formulary conversion of the glaucoma aqueous drainage device from polypropylene to silicone AGVs in January 2003. We reviewed the polypropylene AGVs within 7 months before and the silicone AGVs within 7 months after the date of conversion performed on patients with glaucoma refractory to medical treatment and filtering procedures, without previous drainage devices or cyclodestructive procedures, and with a minimum of 12 months' follow-up. Surgical success was defined as an intraocular pressure (IOP) reduction of > or =20% and a final IOP of >5 and <22 mmHg, without additional surgical intervention for IOP control, loss of light perception, or serious complications. MAIN OUTCOME MEASURES: The 2 groups were compared for IOP control, visual outcome, complication rate, and surgical success rate. RESULTS: Significant IOP reductions occurred after polypropylene AGV implantation (from 32.4+/-11.3 mmHg to 16.5+/-6.9 mmHg, P<0.0001) and silicone AGV implantation (from 32.6+/-12.6 mmHg to 14.7+/-6.9 mmHg, P<0.0001). The silicone group had a lower mean IOP than the polypropylene group at all postoperative visits, but the differences were significant only at 3 months postoperatively (P = 0.014). In addition, the silicone group was associated with a rate of insufficient IOP control as the reason of failure (IOP of > or =22 mmHg or IOP reduction of <20%) lower (4.1%) than that of the polypropylene group (20.0%, P = 0.015), but a rate of non-tube related serious complications (16.3%) higher than that of the polypropylene AGV (4.0%, P = 0.042). CONCLUSION: After 1 year of follow-up, the silicone AGV is at least as effective as the polypropylene AGV in IOP reduction but may be associated with a higher rate of complications. These differences are important for surgeons converting to use of the silicone AGV in patients with glaucoma refractory to other forms of treatment.

Aged↗