Myopia and advanced-stage open-angle glaucoma

OBJECTIVE: To investigate the effect of myopic refraction on the central visual field in patients with advanced open-angle glaucoma (OAG). DESIGN: Multicenter cross-sectional study. PARTICIPANTS: Three hundred thirteen OAG eyes (176 eyes of 176 primary open-angle glaucoma [POAG] patients and 137 eyes of 137 normal-tension glaucoma [NTG] patients) with clear ocular media and a mean deviation (MD) <-15 dB. Patients with a recorded maximum intraocular pressure (IOP) of 22 mmHg or greater were classified as POAG, and those with an IOP of 21 mmHg or less were classified as NTG. METHODS: Multiple regression analysis was used to study the influence of refraction on 12 central test points of the C30-2 Humphrey program, and the differences in visual field defects between POAG and NTG eyes were examined using logistic discriminant analysis. In the multiple regression analysis, total deviation (TD) of the 12 test points was graded and used as the dependent variable, and MD and the spherical equivalent refraction were the explanatory variables. In the logistic discrimination analysis, TD, MD, and refraction were covariants that determined the OAG subtypes. MAIN OUTCOME MEASURES: TD values of the 12 central test points (C30-2 program). RESULTS: Higher myopic refraction was significantly associated with more damage at a point just temporal and inferior to the fixation point in POAG eyes, whereas it was significantly associated with less damage at test points just temporal and superior to the fixation point in NTG eyes. After correcting for the influence of refraction, POAG eyes had significantly more damage at a test point just temporal and inferior to the fixation point, whereas NTG eyes had significantly more damage at those test points nasal and inferior to the fixation point. CONCLUSIONS: High myopia constitutes a threat to the remaining lower cecocentral visual field and is one of the factors that interfere with the quality of vision in advanced OAG with high IOP but not low IOP.     

Intraocular pressure and central visual field of normal tension glaucoma

AIM—To study whether damage in the central 30° field of normal tension glaucoma (NTG) is relatively heterogeneous or homogeneous with respect to intraocular pressure (IOP) related damage.
METHODS—Using the results of Humphrey perimeter examinations, the central 30° field was divided into four subfields; superior and inferior hemifields excluding the caecocentral field (30-2 program) and superior and inferior 10° hemifields (10-2 program). In 103 NTG cases, the intraindividual bilateral difference in the mean of total deviations (mean TD) in the four subfields was analysed by multiple linear regression to correct the effects of factors other than IOP. Explanatory variables were the intraindividual bilateral difference in the mean of clinic IOP (IOP_mean), that in the ratio of area of peripapillary atrophy corresponding to each subfield to disc area, and that in myopic refraction.
RESULTS—The intraindividual bilateral difference in the mean TD was significantly and negatively correlated with that in IOP_mean in three of the above four subfields (p<0.005) and correlation tended to be negative (p=0.07) in the superior 10° hemifield.
CONCLUSIONS—Diffuse IOP related damage was suggested in the central 30° field of NTG; greater extent of the damage in the above four subfields was correlated with higher mean IOP. The present findings may have clinical implications.

     

垂体瘤术后视野改善的时程特征及改善程度的影响因素

目的：通过对垂体瘤患者进行术前及术后不同时间点中心静态视野的定量分析,来探讨经鼻蝶垂体瘤切除术后患者视野改善时程的特征,以及术后视野改善程度的影响因素。方法：回顾性系列病例研究。收集2013 年1 月至2016 年2 月在复旦大学附属上海市第五人民医院行经鼻蝶垂体瘤切除术且术前有视野缺损的垂体瘤患者110 例（212 眼）,对其中在术后1 周复查视野有改善且术后3、6、12 个月时随访资料完整的30 例患者（45 眼）视野改善的时程特征进行分析。采用平均缺损（MD）定量分析视野。对各影响因素先进行单因素分析,再进行多因素Logistic回归分析。结果：随访资料完整的30例患者视野在术后1周时改善最为明显,而后随时间推移视野改善程度逐渐趋于平缓,其中有1例患者在术后12个月时出现垂体瘤复发。110例患者手术后1周视野正常、改善、无改善者最佳矫正视力（BCVA）、视野MD绝对值、全颞上象限视野缺损、视交叉压迫以及肿瘤最大径的差异有统计学意义（F=17.025,P <0.001;F=37.580,P < 0.001;χ2=17.459,P < 0.001;χ2=11.296,P=0.004;F=13.197,P < 0.001）;多因素Logistic回归分析显示术前BCVA（β=2.241,P=0.011,OR=9.406）、术前视野MD绝对值（β=0.195,P < 0.001,OR=1.215）、术前全颞上象限视野缺损（β=1.614,P=0.002,OR=5.024）、肿瘤最大径（β=0.512,P=0.023,OR=1.668）为影响术后视野改善程度的相对独立的影响因素。结论：经鼻蝶垂体瘤切除术后患者视野在术后1 周时改善最为迅速。术前BCVA、术前视野MD绝对值、术前全颞上象限视野缺损和肿瘤最大径为影响垂体瘤患者术后视野改善程度的相对独立影响因素。     

Study on the Progression of Visual Field Defect and Clinical Factors in Normal-Tension Glaucoma

Purpose: We investigated the relationship between the progression of visual field defect and clinical factors in patients with normal-tension glaucoma (NTG).Subjects and Methods: Forty-eight eyes of 48 NTG patients undergoing more than 5-year follow-up were enrolled in this study. Their visual field defects ranged between Aulhorn's classification stage 2 and 4, and mean deviation (MD) more than -10 dB measured by Humphrey Field Analyzer (HFA). End points of this follow-up study were defined as follows: in HFA STATPAC 2 glaucoma change probability analysis, more than 5 points which significantly deteriorated at P <.05 were found at 2 consecutive examinations (Criterion 1) or a significant decrease in MD value at P <.025 was encountered at one examination or in MD value at P <.05 at consecutive examinations (Criterion 2).Results: During the follow-up period, 18 eyes of 48 patients satisfied Criterion 1 and 21 eyes Criterion 2. There were no significant differences in clinical factors between patients with progression and without progression. By multiple logistic regression analysis, minimum flow velocity of central retinal artery (CRA) showed significant relation (odds ratio for a 1 cm/sec rise = 0.2215; 95% confidence interval: 0.0530-0.9253) to progression of visual field defect in Criterion 1, and minimum flow velocity of CRA (odds ratio for a 1 cm/sec rise = 0.2099; 95% confidence interval: 0.0506-0.8712) and cholesterol (odds ratio for a 1 cm/dl rise = 1.0332; 95% confidence interval: 0.4096-2.6064) showed significant relation in Criterion 2.Conclusion: These results suggests that vascular risk factors of ocular blood flow may play a role in the progression of visual field defects in NTG patients.     

Interocular asymmetry of visual field defects in primary open angle glaucoma and primary angle-closure glaucoma

AIM: To compare the interocular asymmetry in visual field loss of patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG). METHODS: Subjects entering a prospective, randomised, controlled trial of intraoperative 5-fluorouracil in glaucoma surgery in Singapore were included. Preoperative visual field testing was performed using automated white-on-white perimetry (24-2 test pattern, threshold program, Mk II, Model 750, Zeiss-Humphrey, San Leandro, CA, USA). A minimum of two tests were required with mean deviation within 2 dB on two tests, fixation losses <20%, false positives <33%, and false negatives <33%. The second field was scored using AGIS II criteria and the 'mean asymmetry score' defined as the mean difference between eyes for both AGIS scores and global indices. RESULTS: In 230 subjects assessed (128 POAG, 102 PACG), mean interocular asymmetry of visual field loss was greater for the PACG group. The mean AGIS asymmetry scores for total (PACG=9.21+/-6.87 vs POAG=6.48+/-5.58, P=0.001), superior (PACG=4.31+/-3.39 vs POAG=3.35+/-3.13, P=0.035), and inferior (PACG=4.43+/-3.31 vs POAG=2.64+/-2.77, P<0.0001) areas and mean deviation (MD) asymmetry scores (PACG=6.89+/-13.22 vs POAG=1.66+/-16.97, P=0.012) were all significantly different. Interocular correlation of visual field loss for POAG was significant; total AGIS, r=0.27 (P=0.003), superior field AGIS, r=0.24 (P=0.008), inferior field AGIS, r=0.34 (P=0.0001), and MD, r=0.27 (P=0.003). In PACG, there was no significant correlation between eyes; total AGIS, r=-0.02 (P=0.85), superior field AGIS, r=-0.02 (P=0.82), inferior field AGIS, r=-0.17 (P=0.87), and MD, r=0.015 (P=0.89). CONCLUSION: There was a greater asymmetry of visual field loss between eyes, as measured by AGIS scores and MD, in PACG than that in POAG.     

Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study

AIM: To investigate the influencing factors of visual field improvement after trans-sphenoidal resection of pituitary macroadenomas. METHODS: This retrospective cohort study included 201 patients (366 eyes) with visual field defect induced by pituitary macroadenomas. All of them were treated with trans-sphenoidal surgery. Ophthalmologic evaluation, best-corrected visual acuity (BCVA), and visual field examination were performed before and 3mo after surgery. BCVA, visual field defect index mean deviation (MD), duration of symptoms, age, sex, and volume of tumors were compared. Expression of vascular endothelial growth factor (VEGF) and Ki-67 of tumor tissue were detected by immunohistochemical technique. RESULTS: The mean age of patients was 44.23±1.29y. Ninety-three patients were female and 108 were male. The mean tumor volume was 14.36±6.23 cm3. The mean duration of preoperative symptoms was 11.50±0.88mo. Mean preoperative MD was -17.50±0.82 dB. Mean Preoperative visual acuity was 0.64±0.04. Postoperative visual field improved in 270 (73.77%) eyes, unchanged in 96 (26.23%) eyes. Multivariate logistic regression displayed that the factors independently influencing visual field improvement were young age (OR=1.71, 95%CI: 1.325-2.387, P=0.013), low preoperative MD absolute value (OR=1.277, 95%CI: 1.205-1.355, P<0.001), small volume of tumor (OR=1.458, 95%CI: 1.060-4.289, P<0.001), low expression of VEGF in tumor tissue (OR=1.554, 95%CI: 1.089-2.457, P=0.022), and low expression of Ki-67 in tumor tissue (OR=1.552, 95%CI: 1.161-2.847, P=0.026). CONCLUSION: After pituitary macroadenomas trans-sphenoidal resection, the independent influencing factors of the visual fields recovery were low preoperative MD absolute value, young age, small volume of tumor, and expression levels of VEGF/ Ki-67.     

Circadian fluctuation of mean ocular perfusion pressure is a consistent risk factor for normal-tension glaucoma

PURPOSE: To investigate systemic and ocular hemodynamic risk factors for glaucomatous damage in eyes with normal tension glaucoma (NTG). METHODS: Each patient with diagnosed NTG underwent 24-hour monitoring of intraocular pressure (IOP) and blood pressure (BP), scanning laser polarimetry (GDx-VCC), and a Humphrey visual field (HVF) examination. Multivariate regression models were used to evaluate potential risk factors: age, spherical equivalent, central corneal thickness (CCT), mean/peak in-hospital IOP, circadian IOP fluctuation, average mean arterial pressure (MAP), circadian MAP fluctuation, and circadian fluctuation of mean ocular perfusion pressure (MOPP). Functional outcome variables for glaucomatous damage were mean deviation (MD), pattern SD (PSD), and Advanced Glaucoma Intervention Study (AGIS) score. Anatomic outcome variables were TSNIT (temporal, superior, nasal, inferior, and temporal) average, superior average, inferior average, and nerve fiber indicator (NFI) on GDx-VCC. RESULTS: One hundred thirteen eyes of 113 patients met the inclusion criteria. In the multivariate regression models, larger circadian MOPP fluctuation was significantly associated with decreased MD, increased PSD, and increased AGIS score among functional outcome variables and with reduced TSNIT average, reduced inferior average, and increased NFI among anatomic outcome variables. Larger MAP fluctuation was associated with decreased MD, increased PSD, reduced TSNIT average, reduced inferior average, and increased NFI. CCT was not associated with any outcome variable. CONCLUSIONS: Of the functional and anatomic outcome variables, circadian MOPP fluctuation was the most consistent clinical risk factor for glaucoma severity in eyes with NTG. This finding may suggest an etiology of NTG as a chronic ischemic end organ disease.     

OCT测量正常人与原发性开角型青光眼视网膜神经纤维层厚度的研究

目的：采用光学相干断层成像术(optical coherence tomography,OCT)测量正常人与原发性开角型青光眼(primary open angle glaucoma,POAG)视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度,为POAG的诊断提供理论依据。

方法：本组观察对象为2014-11/2017-11于我院就诊的POAG患者100例123眼,设为观察组,选择年龄、性别配对的正常体检人群50例100眼,设为对照组,根据视野平均缺损(mean defect,MD)将POAG患者分为早期组36例44眼、进展期组40例50眼与晚期组24例29眼; 采用OCT测量视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度,各象限MD采用全自动视野计测量,并进行相关性分析。

结果：观察组视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度均显著低于对照组,差异具有统计学意义(P<0.001); 观察组视盘全周、颞侧、鼻侧、下方、上方MD均显著高于对照组,差异具有统计学意义(P<0.001); 早期组、进展期组与晚期组平均RNFL厚度依次变薄,两两比较差异具有统计学意义(P<0.001),早期组、进展期组与晚期组MD依次变增加,两两比较差异具有统计学意义(P<0.001); 视盘全周、颞侧、鼻侧、下方、上方平均RNFL厚度与MD均呈负相关(r=-0.675、-0.667、-0.560、-0.711、-0.660,均P<0.001)。

结论：OCT检查显示POAG患者RNFL厚度较正常人群明显变薄,且随着病情进展RNFL厚度越薄,且与患眼MD有密切联系。     

Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery.

OBJECTIVE: To assess the effect of blepharoptosis on patients' visual function and health-related quality of life and to determine what measures are associated with postsurgical change in functional status. DESIGN: Prospective, observational case series. PARTICIPANTS: One hundred patients with unilateral or bilateral blepharoptosis. INTERVENTION/MAIN OUTCOME MEASURES: Preoperative and postoperative upper eyelid position (i.e., margin reflex distance [MRD]) and superior visual field (SVF) height, as well as subjective visual function and health-related quality-of-life functional status before and after ptosis surgery. RESULTS: There was a mean 30-point increase in functional index score after ptosis repair (P < 0.001). Lower (more ptotic) preoperative upper eyelid position and SVF (combined eye) were associated with greater change in functional index after surgery (r = -0.290, P = 0.007 and r = -0.39, P = 0.003, respectively). Preoperative visual field testing with manual lid elevation was not significantly correlated to the postoperative change in functional index (P > 0.100). The strongest correlation of postoperative functional index change was with the preoperative functional status (r = -0.79, P < 0.001). CONCLUSIONS: Patients' functional status is reduced by blepharoptosis, and surgical repair results in measurable increase in health-related quality of life. Patients' self-reported preoperative functional impairment is most strongly associated with the degree of postsurgical functional improvement.     

Relationship between optic nerve head microcirculation and visual field loss in glaucoma

PURPOSE: To study the relationship between optic nerve head blood flow velocity and visual field loss in patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS: This study included 44 eyes of 44 patients with POAG and 44 eyes of 44 patients with NTG. To evaluate optic nerve head blood flow velocity, the square blur rate (SBR) was measured by means of laser speckle flowgraphy. The correlation between SBR and Humphrey visual field indices was evaluated with linear regression analysis. RESULTS: In the NTG group, the average SBR at the superior and inferior temporal neuroretinal rim was positively correlated with mean deviation (MD) (r = 0.349, p = 0.020). The SBR at the superior or inferior temporal neuroretinal rim was positively correlated with the sum of the total deviations in the corresponding hemifields (r = 0.299, p = 0.049; r = 0.354, p = 0.019, respectively). The correlations between SBR and MD did not differ statistically between the NTG and POAG groups; however, no significant correlation between SBR and visual field indices was observed in the POAG group. CONCLUSION: These results suggested that the change in the circulation of the optic nerve head may be related to visual field damage in the NTG group but may be less involved in visual field damage in the POAG group.     

Effects of oral brovincamine on visual field damage in patients with normal-tension glaucoma with low-normal intraocular pressure

PURPOSE: To prospectively study the effect of oral brovincamine, a relatively selective cerebral vasodilator, on further deterioration of visual field in patients with normal-tension glaucoma (NTG) with low-normal intraocular pressure (IOP). METHODS: Fifty-two patients with NTG (average age 57.7 years) with an IOP that was consistently less than 15 mmHg were randomly assigned to receive oral brovincamine (20 mg three times daily) or to an untreated control group. The groups were prospectively followed for 2 years with visual field examinations every 4 months, using the 30-2 Humphrey perimeter program. Changes in mean deviation (MD), corrected pattern standard deviation (CPSD), and total deviation (TD) at 74 test points were analyzed using regression analysis with linear mixed model. Data from one eye without media opacity of each subject were analyzed. RESULTS: There were no differences between groups in age; sex distribution; refraction; blood pressure; baseline IOP; MD, CPSD, or TD at each point. Changes in MD (standard error [SE]) during the study period were -0.778 (0.178) and -0.071 (0.195) dB/year in the control and brovincamine groups, respectively; change in the control group was significantly more negative than in the brovincamine group. Change in CPSD (SE) was 0.032 (0.015) and 0.004 (0.016) dB/year in the control and brovincamine groups, respectively. Change in the control group was significantly positive, but the intergroup difference was not significant. Change in TD was significantly negative at six test points in the control group, whereas no points showed a significant trend in the brovincamine group; the intergroup difference was significant. The average IOP was 13.2 mmHg and 13.1 mmHg in the control and brovincamine groups, respectively, and there was no significant intergroup difference. CONCLUSION: Oral brovincamine may retard further visual field deterioration in patients with NTG who have low-normal IOP.     

Study on the progression of visual field defect and clinical factors in normal-tension glaucoma

PURPOSE: We investigated the relationship between the progression of visual field defect and clinical factors in patients with normal-tension glaucoma (NTG). SUBJECTS AND METHODS: Forty-eight eyes of 48 NTG patients undergoing more than 5-year follow-up were enrolled in this study. Their visual field defects ranged between Aulhorn's classification stage 2 and 4, and mean deviation (MD) more than -10 dB measured by Humphrey Field Analyzer (HFA). End points of this follow-up study were defined as follows: in HFA STATPAC 2 glaucoma change probability analysis, more than 5 points which significantly deteriorated at p < 0.05 were found at 2 consecutive examinations (Criterion 1) or a significant decrease in MD value at p < 0.025 was encountered at one examination or in MD value at p < 0.05 at consecutive examinations (Criterion 2). RESULTS: During the follow-up period, 18 eyes of 48 patients satisfied Criterion 1 and 21 eyes Criterion 2. There were no significant differences in clinical factors between patients with progression and without progression. By multiple logistic regression analysis, minimum flow velocity of central retinal artery (CRA) showed significant relation (odds ratio for a 1 cm/sec rise = 0.2215; 95% confidence interval: 0.0530-0.9253) to progression of visual field defect in Criterion 1, and minimum flow velocity of CRA (odds ratio for a 1 cm/sec rise = 0.2099; 95% confidence interval: 0.0506-0.8712) and cholesterol (odds ratio for a 1 cm/dl rise = 1.0332; 95% confidence interval: 0.4096-2.6064) showed significant relation in Criterion 2. CONCLUSION: These results suggests that vascular risk factors of ocular blood flow may play a role in the progression of visual field defects in NTG patients.     

Impact of cataract on the results of frequency-doubling technology perimetry

PURPOSE: To determine the effect of cataract on the results of frequency-doubling technology (FDT) perimetry. DESIGN: Consecutive cohort study. PARTICIPANTS: Forty-four patients with normal ophthalmic examinations, with the exception of cataract, scheduled to undergo phacoemulsification and posterior chamber lens implantation were prospectively identified and completed the study. METHODS: All subjects underwent FDT perimetry using the full-threshold C-20 strategy. Both eyes were tested within 1 month before cataract surgery and up to 3 months after surgery. The unoperated fellow eyes served as controls. MAIN OUTCOME MEASURES: Changes in visual acuity (VA), mean deviation (MD), and pattern standard deviation (PSD) were evaluated. For each subject, the change in MD and PSD in the eye that underwent cataract surgery was adjusted for change in the control eye that is thought to occur due to a learning effect. RESULTS: Among the eyes that underwent cataract surgery, the median preoperative VA was 20/60 (range, 20/30-20/800) and the mean preoperative MD was -4.00+/-3.72 decibels (dB). Postoperatively, the median VA improved to 20/30 (range, 20/20-20/70) and the mean postoperative MD was -0.26+/-3.09 dB (P<0.001). Among the control eyes, MDs were -1.74+/-3.71 dB preoperatively and -0.94+/-3.85 dB postoperatively (P = 0.019). The adjusted improvement in MD among eyes that underwent cataract surgery was 2.94+/-3.44 dB (P<0.001). There was no significant change in PSD. Preoperative VA correlated significantly with preoperative MD (r = 0.39, P = 0.01). The improvement in VA correlated significantly with the adjusted improvement in MD (r = 0.38, P = 0.01). CONCLUSIONS: Cataract has an adverse effect on the MD but not the PSD in FDT perimetry. Among eyes with visually significant cataract, the MD correlates significantly with VA. After cataract surgery, the change in VA correlates significantly with the adjusted change in MD.     

Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 2 Visual field progression

BACKGROUND: Reduction of intraocular pressure by 20-30% with glaucoma drainage surgery slows disease progression in normal tension glaucoma (NTG). It is not clear whether adjunctive antiproliferative agents are necessary or safe in eyes at low risk for scarring. METHOD: 61 eyes of 61 white patients with NTG who had undergone a primary guarded fistulising procedure were reviewed. 20 eyes had no antiproliferatives (nil), 29 had peroperative 5-fluorouracil (5-FU), and 12 had peroperative mitomycin C (MMC). Pointwise linear regression analysis (PROGRESSOR for Windows software) was applied to their visual field series starting with the first visual field following surgery and adding subsequent visual fields one at a time. Progression of visual field loss was defined as the appearance of a regression slope 1 dB per year or more with a significance of p<0.01 at one or more visual field locations which remained consistent with the addition of two of three successive visual fields. Time updated covariate analysis was used to determine the relation between variables that changed with time, such as IOP, and the risk of progression. RESULTS: The median percentage IOP reduction was 24.4 for the nil group, 38.0 for the 5-FU group, and 47.5 for the MMC group (p=0.001). There was a statistically significant relation between percentage change in IOP and risk of visual field progression in the subsequent 6 month period for all patients analysed as one group, hazard ratio = -0.021 (p=0.002). There was a statistically significantly increase in the risk of visual field progression for the MMC group compared with the 5-FU group, hazard ratio = 1.51 (p=0.02). CONCLUSION: In NTG patients, the IOP reduction produced by drainage surgery reduces the risk that visual field progression may be reduced after drainage surgery; this is related to the level of IOP reduction. The percentage drop in IOP during a given time is related to the risk of subsequent visual field progression. However, the use of MMC is associated with a greater risk of visual field progression despite a greater fall in IOP. This visual field deterioration may be related to the functional loss produced by late postoperative complications which have been reported at a higher rate in this group. The use of adjunctive perioperative 5-FU should maintain a suitable target IOP with preservation of visual function without the additional complications and associated visual deterioration seen with adjunctive MMC.     

Morphological and functional differences between normal‐tension and high‐tension glaucoma

Purpose: To compare visual field (VF) and nerve fibre loss in patients with normal‐tension (NTG) and high‐tension glaucoma (HTG) at an equal level of glaucomatous structural damage of the optic nerve head (ONH). Methods: In a retrospective, pair‐matched, comparative study, 126 eyes with NTG and 126 eyes with HTG were matched according to the same glaucomatous ONH damage based on rim volume, rim area and disc size measured by the Heidelberg Retina Tomograph (HRT III). Visual field by Humphrey perimetry and nerve fibre layer thickness measured by scanning laser polarimetry (GdxVCC) were compared between both groups. Results: Based on the HRT, NTG and HTG displayed comparable structural damage of the ONH without a statistically significant difference between both groups (mean, NTG/HTG: disc area 2.32/2.32 mm², p =0.342; rim area 1.03/1.00 mm², p = 0.279; rim volume 0.2/0.19 mm³; p = 0.274). Eyes with NTG had significantly less VF damage than eyes with HTG (mean, NTG/HTG: mean deviation (MD) ?3.69/?9.77 dB, p = 0.0001; pattern standard deviation (PSD) 4.80/7.17 dB, p = 0.0001). The nerve fibre layer of NTG patients was thicker than that of HTG patients (mean, NTG/HTG: GDx total: 46.9/44.0 μm, p = 0.073; GDx superior: 57.2/49.9 μm, p = 0.0001; GDx inferior: 54.9/49.7 μm, p = 0.001). Conclusions: At an equal level of glaucomatous structural damage of the ONH indicated by cupping, rim area and rim volume, NTG patients seem to have a less affected visual field and a better preserved nerve fibre layer than HTG patients.     

Regional variability in visual field sensitivity during hypercapnia

PURPOSE: Previous investigations have demonstrated a relative vascular autoregulatory inefficiency of the inferior compared to the superior retina in healthy subjects breathing increased CO(2). The purpose of this study was to determine whether the superior and inferior visual field sensitivities of healthy eyes are similarly affected during mild hypercapnia. DESIGN: Experimental study. METHODS: Visual field analysis (Humphrey Field Analyser; SITA standard 24-2 program) was carried out on one randomly selected eye of 22 subjects (mean age, 27.7 +/- 5 years) during normal room air breathing and isoxic hypercapnia. The Student paired t-tests were used to compare the visual field indices mean deviation (MD) and pattern standard deviation (PSD) for each breathing condition. A secondary, sectoral analysis of mean pointwise sensitivity was performed for each condition. In each case a P value of <.01 was considered statistically significant (Bonferroni corrected). RESULTS: Visual field MD was -0.23 +/- 0.95dB during room air breathing and -0.49 +/- 1.04dB during hypercapnia (P =.034). Sectoral pointwise mean sensitivity deteriorated by 0.46dB (P =.006) in the upper visual hemifield during hypercapnia, whereas no significant difference was observed for the lower hemifield (P =.331). CONCLUSIONS: The upper visual hemifield exhibited a significantly greater degree of deterioration in pointwise visual field mean sensitivity compared to the lower hemifield during hypercapnic conditions. This suggests that the upper visual hemifield and hence inferior retina is more susceptible to insult during hypercapnia than the superior retina in healthy individuals. A regional susceptibility of inferior retinal function to altered vascular or metabolic effects may account for the earlier and more frequent inferior nerve fibre damage associated with glaucomatous optic neuropathy.     

In vivo retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after surgery for parachiasmal tumors

PURPOSE: Restoration of visual function after neurosurgery for parachiasmal tumors is variable and unpredictable. The current study was conducted to determine whether in vivo retinal nerve fiber layer (RNFL) thickness measurements predict the visual recovery of such patients. METHODS: Forty patients undergoing surgical resection of parachiasmal lesions were prospectively assessed before surgery with a neuro-ophthalmic examination, involving standard automated visual field (VF) testing and optical coherence tomography (OCT) measurements of RNFL thickness, which was the prespecified marker for axonal loss. Tests were repeated within 6 weeks after surgery. RESULTS: Thinner preoperative RNFL thickness was associated with worse visual acuity (VA) and VF mean deviation (MD). Patients with normal preoperative RNFL had significant improvement in mean VA after surgery, from 20/40 to 20/25 (P = 0.028), whereas patients with thin RNFL did not improve (20/80 to 20/60, P = 0.177). Eyes with normal RNFL showed improvement in MD (-7.0 dB before surgery, -3.5 dB after surgery, P = 0.0007) unlike eyes with thin RNFLs, which had no significant improvement after surgery (-15.3 dB before and -13.3 dB after surgery, P = 0.191). RNFL thickness increased by 1% after surgery among all eyes (P = 0.04). Eyes with severe VF defects (MD 相似文献   

Risk of sudden visual loss following filtration surgery in end-stage glaucoma

PURPOSE: To evaluate the effect of filtration surgery on visual acuity and visual fields in patients with end-stage glaucoma during the immediate postoperative period and to assess the risk of sudden visual loss. DESIGN: Prospective interventional, consecutive case-series. METHODS: The study prospectively included consecutive patients with end-stage glaucoma who underwent trabeculectomy with mitomycin-C. The inclusion criterion was a preoperative visual field with Advanced Glaucoma Intervention Study score over 16. Main outcome measures included change in best corrected logMAR visual acuity, in mean deviation (MD) of visual field test, in number of points among the four central visual field points with a sensitivity less than 5 dB and in mean sensitivity of the four central visual field points after surgery. The incidence of intraoperative and postoperative complications was also recorded. RESULTS: Twenty-one patients (21 eyes) were enrolled. Mean age was 64 years (range 31 to 78). Surgery resulted in a reduction of preoperative intraocular pressure (IOP) by 14.1 +/- 9.2 mm Hg (P < .001) and a decrease in postoperative antiglaucoma medication use (P < .001). Preoperatively the mean visual acuity was 0.77 +/- 0.78, and the mean value of the mean deviation at the visual field test was -27.94 +/- 2.7 dB. Three months after surgery, there was no significant difference in visual acuity (0.74 +/- 0.79, P = .73) and mean deviation (-27.50 +/- 2.6 dB, P = .1). Similarly there was no significant change in the visual field parameters tested to assess central visual field sensitivity. There were no intraoperative complications. Transient hypotony occurred in three eyes while one eye presented more extended hypotony. Three of these eyes experienced bleb leak (seidel). CONCLUSIONS: In our case-series of consecutive patients with end-stage glaucoma, followed for 3 months after filtration surgery IOP was reduced effectively and vision was preserved with no occurrences of "wipe-out" phenomenon.     

Prognostic Factors for Progression of Visual Field Damage in Patients with Normal-Tension Glaucoma

Purpose

To evaluate the rate of progression and the prognostic factors of visual field damage in patients with normal-tension glaucoma (NTG).

Methods

Ninety-two NTG patients (92 eyes) were followed up for more than 2 years with topical antiglaucoma medications. All subjects were classified as having early damaged eyes with an initial mean deviation (MD) of ?6?dB or better, moderately damaged eyes with MD between ?6?dB and ?12?dB, and severely damaged eyes with MD of ?12?dB or worse, and survival data were analyzed using regression analysis based on the Cox proportional hazards model.

Results

The probability of visual field stability was significantly higher in patients with moderate damage than in those with severe damage (P = 0.035). The patients with early damage showed no difference in the probability of visual field stability compared with patients with moderate or severe damage. The progression of visual field damage was significantly associated with mean intraocular pressure (IOP) (P = 0.000) or IOP fluctuation (P = 0.002) during follow-up regardless of the severity of the initial visual field damage.

Conclusions

The rate of progression of visual field damage differed according to the severity of the initial visual field damage. IOP reductive medication may be effective in preventing glaucomatous visual field progression in patients with NTG. Jpn J Ophthalmol 2006;50:38–43 © Japanese Ophthalmological Society 2006     

Risk factors for visual field damage progression in normal-tension glaucoma eyes

· Background: This study was carried out to evaluate intraocular or systemic factors associated with the visual field damage progression in eyes with normal-tension glaucoma (NTG). · Patients and methods: Forty-seven NTG eyes with a minimum follow-up of 5 years were enrolled into the retrospective study. A stepwise regression analysis was performed to correlate the visual field damage progression, expressed as the mean deviation (MD) change per year, with several independent clinical factors including age, history of disc hemorrhage, initial MD, mean intraocular pressure (IOP), peak IOP, diurnal fluctuation of IOP, presence of a β zone of peripapillary atrophy, and use of Ca²⁺-channel blockers. · Results: Statistical analysis revealed that non-use of Ca²⁺-channel blockers (P=0.01), peripapillary atrophy (P=0.03) and disc hemorrhage (P=0.04) were associated with visual loss progression. · Conclusions: Risk factors unrelated to IOP were suggested to be associated with progression of visual field loss. Systemic use of Ca²⁺-channel blockers has a favorable effect on visual field prognosis in NTG eyes. Received: 29 July 1997 Revised version received: 17 November 1997 Accepted: 9 December 1997