Posture-induced changes in intraocular pressure: comparison of pseudoexfoliation glaucoma and primary open-angle glaucoma

Purpose

The objective of this study was to evaluate and compare the IOP values in the sitting and supine positions in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) patients. We also investigated possible relationships between the level of visual field damage and postural IOP change.

Methods

Twenty-nine patients with POAG and 32 patients with PXG were recruited to the study. An Icare PRO tonometer was used to measure IOP in the sitting and supine positions. Intraocular pressure in the sitting position was also measured with a Goldmann applanation tonometer (GAT). Humphrey field analyzer 750 data taken within the previous 3 months were obtained and analyzed.

Results

The mean difference between the GAT and the Icare PRO tonometer readings was 0.12 ± 0.8 mmHg, and the tonometers were in close agreement (r = 0.964; P < 0.0001). The mean Icare PRO IOP in the sitting position was 16.6 ± 3.3 mmHg in the POAG group and 14.9 ± 2.7 mmHg in the PXG group. The average rise was 1.7 ± 1.2 mmHg in the POAG group and 2.9 ± 1.9 mmHg in the PXG group. The difference in IOP between the sitting and supine positions was significant between the groups (P = 0.001). The ?IOP was negatively correlated with both the mean deviation and the visual field index (P < 0.0001 for both). The ?IOP and pattern standard deviation were positively correlated (P < 0.0001).

Conclusions

A higher increase in IOP was observed in PXG patients from the sitting to the supine position than in POAG patients. Postural variation in IOP was found to be associated with the severity of visual field damage.     

Evaluation of relationship between retinal nerve fiber layer thickness progression and visual field progression in patients with glaucoma

Purpose

To evaluate the capability of optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, and visual field (VF) measurements in glaucoma progression detection.

Methods

The study examined 62 eyes of 37 glaucoma patients observed over a 3-year period. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least 3 years. VF testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer (HFA) on the same day as the RNFL imaging. Both serial RNFL thicknesses and VF progression were assessed by the guided progression analysis (GPA) software program. RNFL thickness progression was evaluated by event analysis. Total deviation (TD) in the superior or inferior hemifield was also examined.

Results

A total of 295 OCT scans and 295 VFs were analyzed. Five eyes exhibited progression by OCT only and 8 eyes exhibited progression by VF GPA only. When the analysis was based on the combined measurement findings, progression was noted in 6 eyes. The average of the progressive hemifield TD at baseline for combined RNFL and VF progression was ?3.21 ± 1.38 dB, while it was ?2.17 ± 1.14 dB for RNFL progression and ?9.12 ± 3.75 dB for VF progression. The average of the progressive hemifield TD indicated a significant advancement of VF progression as compared to RNFL progression (P = 0.002).

Conclusions

When a mild VF defect is present, OCT RNFL thickness measurements are important in helping discern glaucoma progression.     

Retinal neurovascular coupling in patients with glaucoma and ocular hypertension and its association with the level of glaucomatous damage

Purpose

To analyze neurovascular coupling in the retina of untreated primary open-angle glaucoma (POAG) and ocular hypertension (OHT) patients.

Patients and methods

Maximal vessel dilation in response to flicker light was analyzed with Retinal Vessel Analyzer (RVA) in temporal superior/inferior arterioles and veins in 51 POAG patients, 46 OHT and 59 control subjects. RVA parameters were compared between groups, between contralateral POAG eyes, and correlated to intraocular pressure, visual field mean defect and retinal nerve fiber layer thickness.

Results

POAG eyes demonstrated generally smaller response of all vessels to flicker light than the other two groups (ANOVA p?=?0.026; mean arterial flicker response in percent of baseline, averaged superior and inferior was 3.48?±?2.22 % for controls , 2.35?±?2.06 % for POAG patients , and 2.97?±?2.35 % for OHT patients; corresponding values for venules were 3.88?±?1.98 %, 2.89?±?1.72 %, 3.45?±?2.77 %). There was no difference in flicker response between the eye with more and less advanced damage in each patient of the POAG group (ANOVA p?=?0.79). Correlation of flicker response to intraocular pressure (IOP) was borderline at best, correlations to the level of glaucomatous damage were not significant. Correlation of flicker response of superior and inferior vessels of the same eye was significant for the arteries (Pearson r?=?0.23, p?=?0.004), as well as venules (r?=?0.52, p?<?0.001).

Conclusion

General vessel response to flicker light was decreased in POAG patients, compared to normal controls and OHT patients. In contrast to significant correlation between the two contralateral eyes of the flicker response itself, only its borderline correlation to IOP was seen. There was no correlation to the level of damage, altogether indicating a systemic dysregulation phenomenon.

Grants

Swiss National Foundation Grant 3200B0-113685, Velux Stiftung Grant, Freie Akademische Gesellschaft (FAG) Grant, Pfizer Inc. Grant

Clinical trial registration reference number

ClinicalTrials.gov NCT00430209     

Influence of Selective Laser Trabeculoplasty (SLT) on combined clear cornea phacoemulsification and Trabectome outcomes

Background

In this retrospective comparative cohort outcome study, the influence of Selective Laser Trabeculoplasty (SLT) on combined clear cornea phacoemulsification and ab interno trabeculectomy (Trabectome) outcomes in Primary Open Angle Glaucoma (POAG), Pseudoexfoliation Glaucoma (PEX), and Pigmentary Glaucoma (PG) was examined.

Methods

Combined clear cornea phacoemulsification and Trabectome were performed in 27 consecutive patients with POAG, in 27 patients with PEX, and in 20 patients with PG. Each group was divided into two subgroups including patients without SLT treatment prior to surgery and patients who had insufficient response to 360° SLT treatment three months prior to surgery.

Results

In the SLT group, mean IOP at six months measured 13.33?±?2.08 mmHg with an average decrease of 30 % from preoperative IOP in the POAG group, 12.10?±?1.40 mmHg with an average decrease of 46 % in the PEX group, and 11.83?±?2.21 mmHg with an average decrease of 38 % in the PG group. In eyes without previous SLT, mean IOP sixt 6 months measured 11.00?±?1.73 mmHg with an average decrease of 38 % from preoperative IOP in the POAG group, 15.50?±?1.41 mmHg with an average decrease of 35 % in the PEX group, and 15.67?±?2.91 mmHg with an average decrease of 36 % in the PG group, respectively.

Conclusions

Prior SLT treatment seems not to negatively influence combined clear cornea phacoemulsification and Trabectome outcomes in glaucoma patients. However, SLT treatment may even have an additive effect on following combined Trabectome outcomes in patients with PEX and PG.     

Relationship of change in central corneal thickness to visual field progression in eyes with glaucoma

Background

To assess the relationship between baseline central corneal thickness (CCT) and/or ongoing CCT change over time with subsequent visual field progression.

Methods

One hundred sixty three eyes of 163 patients with medically treated glaucoma were followed up for 6.8?±?1.8 years. Exclusion criteria was laser or intraocular surgery. Baseline and follow up CCT, confocal scanning laser tomography and visual fields were performed. CCT and CCT change related to visual field progression using Glaucoma Progress Analysis were assessed. Multivariate logistic regression analysis for predictive factors of glaucoma progression was used to analyze data.

Results

Thinner baseline CCT was associated with more advanced damage at presentation, mean deviation (MD) (r?=?0.17, p?=?0.02) and neuroretinal rim area (NRR) (r?=?0.20, p?=?0.02). Progressing eyes had significantly thinner (p?=?0.01) baseline CCT compared to non-progressing eyes. The slope of visual field change was significantly greater (p?=?0.05) for thinner (<540 μm) as compared to thicker eyes. A small but significant CCT reduction (12.78?±?13.35 μm, p?<?0.0001) was noted in all eyes; however, there was no significant difference (p?=?0.95) in the amount of change between progressing and non-progressing eyes. CCT change did not correlate with MD or NRR change. A thinner CCT (Odds ratio?=?1.80, p?=?0.02), but not CCT change (Odds ratio?=?1.07, p?=?0.69), was a significant risk factor for glaucoma progression.

Conclusions

CCT correlates significantly with the amount of glaucomatous damage at presentation. Thinner corneas may be associated with increased risk of visual field progression. CCT reduced slightly over time in eyes with glaucoma; but the magnitude of this change was not related to visual field progression.     

Intraocular pressure alterations after visual field testing

Purpose

To determine whether intraocular pressure (IOP) is significantly altered after visual field (VF) testing in eyes with open-angle glaucoma (OAG).

Methods

A prospective clinical trial of 106 OAG patients who had not had any previous surgical interventions. IOP was measured with a non-contact tonometer and refractive error with an auto refractometer. The measurements were made before and immediately after the VF test of the first eye (OD) and the second eye (OS).

Results

The baseline refractive error (spherical equivalent) was ?4.13 ± 3.61 diopters (D) OD and ?4.05 ± 3.63 D OS. The average VF testing time was 7.5 ± 1.4 min OU. The average baseline IOP was 12.8 ± 2.9 mmHg OD and 12.6 ± 2.8 mmHg OS. After the VF testing OD, the average IOP decreased significantly to 12.3 ± 2.6 mmHg (P = 0.001), but the IOP (12.5 ± 2.6 mmHg) OS was not significantly unchanged (P = 0.190). Following the VF testing OS, the IOP OD was 12.2 ± 2.6 mmHg (P = 0.252) and OS was 12.4 ± 2.7 mmHg (P = 0.487). An elevation of ≥2 mmHg in the IOP after the VF testing was found in 2.8 % of the right eyes and 0.9 % of the left eyes. The refractive error was not significantly changed after the VF testing. Multivariate analysis showed statistically significant correlations between the IOP decrease after the VF testing and the baseline IOP (P = 0.000) and the central corneal thickness (P = 0.034).

Conclusions

In the majority of eyes with OAG, VF testing did not lead to an increase in the IOP. The amount of IOP reduction after VF testing is significantly correlated with the baseline IOP and central corneal thickness.     

The natural history of lamellar macular holes: a spectral domain optical coherence tomography study

Background

To study the evolution of lamellar macular holes (LMHs) using spectral domain-optical coherence tomography (SD-OCT).

Methods

Thirty-four consecutive patients diagnosed with a LMH were followed prospectively at Sacco University Hospital from October 2008 to January 2011. Inclusion criteria were a foveal defect on SD-OCT with residual foveal tissue above the retinal pigment epithelium and corresponding hyperautofluorescence on fundus autofluorescence imaging. Epiretinal membranes (ERMs) were categorized by SD-OCT at baseline as two different types: normal and thicker than normal. Best corrected visual acuity (BCVA) and SD-OCT findings were collected and compared at baseline and every 6 months thereafter. Active eye tracking technology ensured that the same scanning location was identified on follow-up visits. Main outcome measures were visual acuity changes (Early Treatment Diabetic Retinopathy charts) and progression of the lamellar macular defect. The influence of ERM type on disease progression was also evaluated.

Results

The patients included 15 males and 19 females with a mean age of 73 years and mean refraction of ?0.25 diopters. The mean follow-up period was 18 months (range 6 to 24 months). BCVA at baseline (±standard deviation) was 63?±?6 letters and did not change significantly during the follow-up period (P?=?0.256). Foveal thickness at baseline, 180?±?29 μm, was also stable (P?=?0.592). All eyes had an ERM at baseline. Both thicker and normal ERMs showed similar functional and morphological evolution during follow-up with no significant changes. Two LMHs (5.8 %) developed a full thickness macular hole after 6 and 15 months follow-up respectively.

Conclusions

Lamellar macular holes seem to be a stable macular condition. Vitrectomy should be considered only in the presence of progressive thinning of foveal thickness and/or decrease of visual acuity during the follow-up of the disease.     

Pattern ERG and RNFL thickness in hypertensive eyes with normal blue-yellow visual field

Purpose

To evaluate the transient pattern electroretinogram (t-PERG) and the retinal nerve fiber layer (RNFL) thickness in eyes with ocular hypertension (OH) and normal short-wavelength automated perimetry (SWAP).

Methods

In 26 patients with bilateral OH with normal SWAP, and in 26 age and sex matched healthy controls, t-PERG recording and RNFL thickness measurement were performed. Mean deviation (MD) and pattern standard deviation (PSD) of a reliable full threshold 24-2 SWAP were considered. RNFL thickness was determined by OCT3. Monocular PERG were recorded by using a black and white checkerboard pattern (check size 0.9°, contrast 100 %, mean luminance 80 cd/m2) generated on a monitor and reversed in contrast (four reversals per second, 2 Hz) at a distance of 70 cm. Patients had optimal correction at viewing distance; no mydriatic or miotic eye drops were used. Silver/silver chloride skin electrodes were placed over the lower eyelids in the stimulated eye (active electrode) and in the patched eye (reference electrode); ground electrode was in the Fpz scalp. Peak-to peak amplitude of P50 (N35-P50) and N95 (P50-N95) waves, and implicit time of P50, were considered.

Results

Compared to controls, in OH eyes, a reduction of N35-P50 amplitude (2.86?±?1.49 vs. 3.77?±?1.08 microvolts, ?24.1 %, t-test p?=?0.015), of average RNFL thickness (88?±?11 vs. 96?±?10 μm, ?9.5 %, t-test p?=?0.002), and of RNFL thickness in superior (p?=?0.015) and inferior quadrant (p?<?0.001), were found. Multivariate analysis showed that in OH eyes, N35-P50 amplitude was inversely related to intraocular pressure (IOP) (p?=?0.001); no correlation was found between N35-P50 amplitude and MD, PSD, CCT or RNFL thickness.

Conclusions

In OH eyes, both PERG and RNFL thickness changes occur in hypertensive eyes with undamaged SWAP; the correlation of PERG amplitude with IOP, but not with RNFL thickness, suggests that such PERG changes are an effect of the IOP on retinal ganglion cells, rather than a sign of their loss.     

Association between ganglion cell complex and axial length

Purpose

We evaluated the association between each layer of macular ganglion cell complex (mGCC) and axial length measured with spectral-domain optical coherence tomography (OCT).

Methods

One hundred and one eyes of 101 healthy younger women were assessed in this prospective study. In one eye, mGCC was measured two times with 3D-OCT 2000 (Topcon). The associations between mGCC and axial length were analyzed using single regression analysis. To support the data of this study, repeatability also was assessed by intraclass correlation coefficient (ICC), coefficient of variance (CoV), and test–retest standard deviation (TRTSD).

Results

In each layer of the mGCC, ICC ranged from 0.980 to 0.997; CoV ranged from 0.8 to 2.4 %; TRTSD ranged from 0.8 to 3.0 μm. For every 1 mm of greater axial length, total macular retinal nerve fiber layer (mRNFL) thickness increased by 1.1 μm (p < 0.01), and total macular ganglion cell layer and inner plexiform layer (mGCL+) and mGCC thickness decreased by 2.5 μm (p < 0.001) and 1.4 μm (p = 0.018), respectively.

Conclusions

In healthy younger participants, mGCC measurement using 3D OCT-2000 showed good repeatability. As axial length increased, total mGCC decreased, whereas total mRNFL and mGCL+ showed an inverse correlation.     

Corneal biomechanics predict the outcome of selective laser trabeculoplasty in medically uncontrolled glaucoma

Purpose

To evaluate the predictive value of clinical parameters, including biomechanical properties on the outcome of selective laser trabeculoplasty (SLT) in medically uncontrolled open angle glaucoma (OAG).

Methods

Sixty-eight eyes from 68 patients with OAG and IOP insufficiently regulated by topical medications were enrolled. Patients’ follow-up occurred 6 and 12 months after the procedure. The recorded parameters intraocular pressure (IOP), angle characteristics, central corneal thickness (CCT) and biomechanical properties of the eyes, including corneal hysteresis CH and corneal resistance factor CRF measured with the Ocular Responses Analyzer (ORA, Reichert Ophthalmic Instruments) were tested on their predictive value of SLT-induced IOP lowering effect using correlation analyses and regression models.

Results

Mean IOP reduction 12 months after SLT was 4.2?±?5.7 mmHg (23.2 %, from baseline 18.1?±?5.2 mmHg). The preoperative IOP correlated significantly with IOP reduction (maximum Spearman’s correlation r?=?0.75, p?<?0.001). In linear regression analysis, the corneal biomechanical properties (CH and CRF) together with the baseline IOP revealed good modelling for the IOP lowering effect of SLT (R²?=?0.64, respectively).

Conclusions

In addition to the baseline IOP biomechanical properties (CH and CRF) are significant predictors of SLT induced IOP lowering effect in medically uncontrolled OAG.     

Long-term intraocular pressure changes after vitrectomy for epiretinal membrane and macular hole

Background

To investigate long-term intraocular pressure (IOP) changes after vitrectomy for epiretinal membrane (ERM) or macular hole (MH).

Methods

We retrospectively reviewed the medical records of 57 eyes with ERM and 61 eyes with MH that underwent vitrectomy. IOP levels and changes at 1, 3, 6, 12 months, and the final visit from baseline were evaluated in vitrectomized eyes and non-vitrectomized fellow eyes.

Results

In the ERM group, the mean follow-up period was 29.3 months; the mean preoperative IOP in the operated eyes was 12.9?±?2.5 mmHg and the final IOP was 13.2?±?2.9 mmHg. In the MH group, the mean follow-up period was 25.6 months; the mean preoperative IOP in the operated eyes was 13.3?±?2.5 mmHg and the final IOP was 14.0?±?3.2 mmHg. The mean final IOP of the fellow unoperated eyes was 13.0?±?2.5 mmHg in the ERM group and it was 12.9?±?3.2 mmHg in the MH group. A significant difference was found between the operated eyes and fellow eyes at the final visit in the MH group (P?<?0.01) but not in the ERM group (P?=?0.40). MH group was significantly at high risk of IOP increase after vitrectomy (P?<?0.01).

Conclusions

IOP increase after vitrectomy was found in some eyes with MH during long-term follow-up but it was unlikely in eyes with ERM.     

Comparison of Spectralis-OCT, GDxVCC and GDxECC in assessing retinal nerve fiber layer (RNFL) in glaucomatous patients

Background

Glaucomatous optic neuropathy is characterized by a progressive loss of retinal ganglion cells (RGCs). The defects in the peripapillary retinal nerve fiber layer (RNFL) have been reported to be the earliest sign of glaucoma. We determined the agreement between RNFL thickness assessments from spectral-domain OCT (Spectarlis HRA?+?OCT; Heidelberg Engeneering, Heidelberg, Germany), scanning laser polarimetry (SLP) with variable cornea compensation (GDxVCC; Carl Zeiss Meditec, Dublin, CA, USA), and SLP with enhanced cornea compensation (GDxECC; Carl Zeiss Meditec, Dublin, CA, USA) in glaucomatous patients. Furthermore, we investigate the influence of typical scan score (TSS) on the results of GDx assessments.

Methods

The enrolled subjects were devided into different groups by modified HODAPP visual field criteria. The peripapillary RNFL thickness was assessed with the three devices . ANOVA test, Pearson and Spearman correlation coefficient, and Bland-Altman plots were used to analyse the RNFL thickness assessments.

Results

Ninety-two eyes from 92 glaucomatous subjects were analysed. These were divided into four groups: preperimetric glaucoma (n?=?26), mild glaucoma (n?=?18), moderate glaucoma (n?=?21), and severe glaucoma (n?=?27). For Spectralis-OCT, the average RNFL thickness (mean ± SD) was 99.25?±?26.31 μm, 80.52?±?16.63 μm, 71.59?±?21.15 μm, and 63.85?±?20.86 μm for preperimetric, mild, moderate, and severe glaucoma respectively. For GDxVCC, the corresponding assessments were 52.63?±?8.18 μm, 52.95?±?10.20 μm, 46.77?±?10.62 μm, and 49.70?±?13.34 μm. For GDxECC, the assessments were 49.35?±?6.52 μm, 45.92?±?7.21 μm, 42.19?±?8.00 μm, and 39.53?±?8.45 μm. All Spectralis-GDxVCC and Spectralis-GDxECC differences were statistically significant by ANOVA test. The differences between GDxVCC and GDxECC were statistically significant only for severe glaucoma. There was a highly significant correlation between Spectralis-OCT and GDxECC, as well as Spectralis-OCT and GDxVCC, in assessing the RNFL thickness. The best instrument agreement was found between GDxECC and Spectralis-OCT. The RNFL thickness assessed with Spectralis-OCT and GDxECC showed a better correlation to visual field defects than GDxVCC. Evaluating GDx assessments with typical retardation pattern GDxVCC and GDxECC showed very similar RNFL thickness results.

Conclusions

RNFL thickness assessments between GDxVCC, GDxECC, and Spectralis-OCT cannot be directly compared. The assessments are generally higher with Spectralis-OCT than with GDxVCC and GDxECC, because of differences in method of the devices. The atypical retardation pattern has a major impact on the RNFL thickness results of GDx devices. This must be taken into account when evaluating the assessed RNFL thickness results.     

Anterior chamber paracentesis and pH values in patients with acute primary angle closure

Background

To assess the efficacy and safety of anterior chamber paracentesis (ACP) and the changes in pH values in eyes with acute primary angle closure (APAC).

Methods

This retrospective case-control study involved 22 patients with APAC who underwent ACP (study group) and 21 patients with APAC who did not undergo ACP (control group). Intraocular pressure (IOP) and visual acuity were measured before treatment and 15 min and 24 h after treatment in both groups. The pH of aqueous humor was measured immediately after ACP in the study group.

Results

A total of 43 eyes in 43 patients were reviewed. The IOP 15 min after ACP (23.3?±?9.6 mmHg) and 24 h after ACP (21.6?±?12.0 mmHg) were significantly lower than that before ACP (58.6?±?12.9 mmHg). The IOP 15 min after ACP was significantly lower than the IOP 15 min after conventional treatment (55.4?±?10.3 mmHg). Visual acuity recovery was achieved earlier after ACP than after conventional treatment. Hyphema after ACP was noted in one eye. The mean pH of the aqueous humor in APAC was 6.99?±?0.35. The pH of the aqueous humor significantly correlated with the duration of acute IOP elevation and the IOP before ACP.

Conclusions

ACP is an effective and safe procedure. The pH of aqueous humor is lower in eyes with APAC of longer duration and in eyes with higher IOP at presentation.     

Correlation between early retinal nerve fiber layer loss and visual field loss determined by three different perimetric strategies: white-on-white,frequency-doubling,or flicker-defined form perimetry

Purpose

To compare the significance of white-on-white standard automated perimetry (SAP), matrix frequency doubling technology (FDT), and flicker-defined form perimetry (FDF) for early detection of nerve fiber layer loss in early glaucoma patients.

Methods

Fifty-one healthy controls and 40 patients with early glaucomatous nerve fiber loss were enrolled in this study. Patients had retinal nerve fiber layer (RNFL) imaging and visual field testing by SAP, FDT matrix, and FDF perimetry at the same visit. Visual field defects were confirmed with two or more consecutive examinations by the same types of perimetry. Significant retinal nerve fiber layer loss and thus early glaucoma was defined with the reference to the RNFL thickness deviation map. The sensitivity, specificity, correlation, MD (mean deviation) and PSD (pattern standard deviation) visual field indexes, and area under the receiver operating characteristic curve (AUC) of MD and PSD of the perimetries were compared.

Results

There was a significant difference in nerve fiber layer thickness between healthy patients (97.7 ± 1.34 μm and patients with early glaucoma (84.1 ± 1.58 μm) (p?p?0.6. AUCs of PSD were not reliable in all of the three VF devices.

Conclusions

The sensitivity for detection of RNFL loss in early glaucoma seems to be higher in FDF and FDT matrix than SAP perimetry, while specifity was highest in SAP. Thus, simultaneous performance of FDF/FDT matrix and SAP perimetry seems beneficial for the correct diagnosis of early glaucoma in patients.     

Investigation of blood flow regulation and oxygen saturation of the retinal vessels in primary open-angle glaucoma

Purpose

To examine the supply of oxygen to the retina in primary open-angle glaucoma (POAG).

Methods

Forty-one patients with primary open-angle glaucoma (mean age 64.1?±?12.9 years) and 40 healthy subjects (63.6?±?14.1 years) were included. Fundus images, centered at the optic disc, were taken using the Retinal Vessel Analyzer (RVA). The vessel diameters were calculated as central retinal artery (CRAE) and vein equivalent (CRVE) from diameter measurements in the peripapillary vessels. The oxygen saturation of the arteries and veins was investigated employing a two-wavelengths technique. After the measurement at baseline, the vascular response to flicker light exposure was measured.

Results

In glaucoma patients the mean oxygen saturation of the retinal veins at baseline was higher than in the healthy controls (64.36?±?7.11 vs. 59.78?±?8.47, p?=?0.01), whereas the mean arteriovenous oxygen saturation difference was lower (33.07?±?5.24 vs. 37.53?±?6.95, p?=?0.002). The arterial oxygen saturation as well as the arterial and venous diameters showed no difference between the groups. The increase of the CRVE during flicker light stimulation (3.72?±?3.29 % vs. 5.43?±?4.04, p?=?0.039), as well as the change of the venous oxygen saturation (2.08?±?3.74 % vs. 4.18?±?3.88 %, p?=?0.016) and the arteriovenous saturation difference (?2.1?±?3.31 % vs. ?4.43?±?3.6 %, p?=?0.003) were smaller in POAG patients than in the healthy group.

Conclusions

The reduction in the arteriovenous difference in oxygen saturation in POAG patients might show a decreased oxygen demand of the retina caused by the glaucomatous loss of neuroretinal tissue. The lower extent of the flicker light-induced change of the diameter of retinal veins and the venous oxygen saturation could indicate an impairment of blood flow regulation.     

Ranibizumab as adjuvant in the treatment of rubeosis iridis and neovascular glaucoma—results from a prospective interventional case series

Background

To evaluate the capability of adjuvant intraocular ranibizumab (Lucentis®) injections in the treatment of rubeosis and intraocular pressure in patients with rubeosis and neovascular glaucoma.

Methods

Ten eyes with rubeosis (R) and ten eyes with neovascular glaucoma (NVG) received Lucentis® injections (ranibizumab 0.5 mg/0.05 ml) in this prospective, monocenter, 12-months, interventional case series. The primary efficacy outcome measure was the change of degree of iris rubeosis as documented by iris fluorescein angiography measured after 12 months. Secondary outcomes were intraocular pressure (IOP), best-corrected visual acuity (BCVA, logMAR), numbers of additional interventions or antiglaucoma medications administered after injection, the gonioscopic status of the anterior chamber angle, and central retinal thickness.

Results

In the R group, 3.6 injections and in the NVG group 2.3 injections of Lucentis® were administered. Additional treatments were photocoagulation (n?=?19), cyclodestructive procedures (n?=?9), cryopexy (n?=?3), and vitrectomy (n?=?1). The mean stage of rubeosis was 3.4?±?0.7 in the R group and 3.6?±?0.8 in the NVG group at baseline. At month 12, the rubeosis was almost resolved in the R group (0.1?±?0.3, p?<?0.001), and decreased significantly in the NVG group (0.7?±?1.1, p?<?0.001). In the NVG subgroup, mean IOP was 41.4?±?13.4 mmHg at baseline, which decreased rapidly (18.2?±?12.3, day-14, p?=?0.005) and stabilized during the follow-up (15.6?±?2.0 mmHg, p?<?0.05). BCVA improved significantly in both groups (p?<?0.05, at month 12).

Conclusions

Injection of 0.5 mg ranibizumab appears to be beneficial as an adjuvant treatment in neovascular glaucoma and rubeosis due to its anti-angiogenic properties and its ability to prevent establishment or progression of anterior chamber angle obstruction. Conventional therapeutic procedures addressing the retinal ischemia are still required in a stage-wise treatment approach.     

Switching efficacy on intraocular pressure from latanoprost to bimatoprost in eyes with open angle glaucoma: implication to the changes of central corneal thickness

Purpose

Intraocular pressure (IOP)-lowering effects of 0.03 % bimatoprost in eyes with open angle glaucoma (OAG) was compared with that of 0.005 % latanoprost.

Methods

Thirty-one patients with OAG who had received three kinds of ocular hypotensive agents (latanoprost, beta-blocker, and topical carbonic anhydrase inhibitor) were included in this study. In these patients, bimatoprost was administered for 8 weeks after switching from latanoprost. The IOP was measured with a goldmann applanation tonometer (GAT) at the baseline, and Weeks 2, 4 and 8 after switching the treatment. The IOP at the baseline and at the end of treatment period was measured at 10:00, 12:00, and 16:00. The central corneal thickness (CCT) was measured at each visit using an ultrasonic pachymeter.

Results

At the baseline, the mean IOP was 18.8 ± 1.4 mmHg, and the CCT was 530.7 ± 29.5 μm. At Week 8 after switching treatment, bimatoprost significantly reduced the IOP by 2.0 ± 1.6 mmHg from the baseline (p < 0.001). The CCT tended to be reduced (p = 0.009; Repeated ANOVA) and Bonferroni test indicated a statistically significant decrease of the CCT at Week 8 in comparison with that at the baseline (p = 0.013).

Conclusions

Bimatoprost has an IOP-lowering effect superior to that of latanoprost in glaucoma patients after switching from latanoprost. The use of bimatoprost can decrease the CCT for a relatively short period in a linear regression fashion.     

Clinical correlates to the goniodysgensis among juvenile-onset primary open-angle glaucoma patients

Objectives

To evaluate gonioscopic features and relate them to clinical characteristics in eyes with juvenile-onset primary open-angle glaucoma (JOAG).

Methods

Goniophotographs of unrelated JOAG patients, presenting between 10–40 years of age, were evaluated and compared with 60 healthy subjects in the same age group. Age of onset, family history of glaucoma, highest untreated IOP and visual field defect (mean deviation) were analyzed and correlated with the gonioscopic features among JOAG patients.

Results

Of 126 patients included in the study, 44 (34 %) had a normal open angle (group 1), while 82 (66 %) had developmental anomalies (group 2). Developmental anomalies of the angle were classified as: high iris insertion with or without prominent iris processes (n?=?42), a featureless angle (n?=?30), and those with prominent iris processes alone (n?=?10). There was no difference in age of onset (group 1, 30.5?±?7 years and group 2, 26.3?±?9.6 years) (p?=?0.07) or the untreated IOP at presentation (group 1; 36?±?12.5 mmHg and group 2, 38.8?±?12.3 mmHg; p?=?0.37) between the groups. However, those with angle anomalies presented with a greater visual field defect (MD ?23.5?±?10.5 vs ?14.8?±?13 dB; p?=?0.02) compared to those with normal appearing angle.

Conclusions

While two thirds of JOAG patients present with developmental anomalies of the angle, one third have normal appearing angles. High insertion of the iris is the most common form of gonio dysgenesis observed. Those with angle dysgenesis are more likely to present with severe disease.     

Photoreceptor inner and outer segment layer thickness in multiple evanescent white dot syndrome

Purpose

To evaluate the photoreceptor inner and outer segment layer thickness in eyes with MEWDS.

Design

Prospective, non-comparative, observational case series. The follow-up duration was 4 months.

Methods

Four women were diagnosed with unilateral MEWDS. The ages of the patients were 25, 24, 35, and 40 years. The retinal microstructure was assessed by spectral-domain optical coherence tomography (SD-OCT). The thickness of the photoreceptor inner (IS) and outer (OS) segments and sum of them (IS + OS) at the fovea were analyzed.

Results

The visual acuity was reduced in three of four eyes at the acute phase. SD-OCT showed that the border of IS and OS (IS/OS) line and the cone outer segment tips (COST) line in the macula area were not detected in all four eyes. The IS + OS thickness was 50.3?±?5.6 μm and that of the healthy fellow eyes was 73.5?±?7.0 μm (n?=?4 eyes). The thickness of the IS was 27.8?±?2.6 μm and that of the OS was 45.8?±?7.3 μm. In all eyes, there was a spontaneous improvement of the visual acuity. SD-OCT showed a recovery of only the IS/OS line in the macular area, but the COST line was not visible in three cases. The mean IS + OS thickness increased to 56.0?±?7.9 μm (n?=?4), IS?=?26.0?±?2.0 μm (n?=?3), and OS?=?30.1?±?8.7 μm (n?=?3) in the early recovery phase, and to 64.8?±?9.3 μm (n?=?4), IS?=?28.5?±?1.7 μm (n?=?4), and OS?=?36.3?±?7.9 μm (n?=?4) in the late recovery phase. The mean inner and outer segment thickness remained unchanged in the fellow eyes.

Conclusion

Eyes with MEWDS have changes in the photoreceptor microstructures. The change in the IS + OS thickness during the natural recovery course might be due to an increase in the OS length.     

Retinal vessel diameter in normal-tension glaucoma patients with asymmetric progression

Purpose

To investigate the longitudinal changes in the central retinal vessel diameter in asymmetric progressive normal-tension glaucoma (NTG) patients.

Methods

This study included 27 patients with bilateral NTG without any systemic vascular disease who showed glaucomatous progression in one eye at the mean follow-up of 24.3 months (range, 18–29 months). Progression was determined by the development of new retinal nerve fiber layer (RNFL) defects or widening of pre-existing defects on red-free RNFL photographs. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were measured at baseline and at the mean follow-up of 24.3 months. We classified the eyes of each patient as either progressed or stable eyes, and compared the differences and changes in the CRAE and CRVE.

Results

No significant inter-eye difference was observed at baseline in the mean CRAE (167.5?±?22.2 μm vs. 168.2?±?15.5 μm, p?=?0.809) and in the mean CRVE (276.3?±?18.2 μm vs. 281.6?±?21.9 μm, p?=?0.267) between the progressed and stable eyes. There were significant changes in CRAE in the progressed eyes between baseline and 2 years after baseline (from 167.5?±?22.2 μm to 146.9?±?18.0 μm, p?p?=?0.084).

Conclusions

In our series of NTG patients with asymmetric progression, central retinal artery diameter decreased over time in the progressed eyes, whereas no significant decrease in the central retinal artery diameter was seen in the stable eyes.