Hemorrhage of the optic disc and neurosensorial dysacousia

Forty-one high-tension glaucoma patients. 16 normotensive glaucoma patients, and 30 normals were studied in relationship to neurosensorial dysacousia. Although frequency of dysacousia was higher in normotensive glaucoma (87.5%) in comparison with high-tension glaucoma (75.69%) and normals (76.6%). this was not statistically significant (p = 0.53). When we compared glaucoma patients with and without hemorrhages of disc. 100% of the former had neurosensorial dysacousia and 71.4% of the latter had it (p = 0.047). The association of vascular disease in neurosensorial dysacousia and its association with hemorrhages of the optic disc suggest that there could be a common vascular denominator in both diseases.     

Retinal nerve fiber loss in high- and normal-tension glaucoma by optical coherence tomography.

PURPOSE: To compare the pattern of retinal nerve fiber layer (RNFL) damages in high-tension and normal-tension primary chronic open-angle glaucoma using optical coherence tomography (OCT). METHODS: Age- and refractive error-matched patients with normal-tension glaucoma (NTG) (n = 38) and high-tension glaucoma (HTG) (n = 48) and normal subjects (n = 48) were recruited. All subjects underwent complete eye examinations and OCT RNFL assessments. RESULTS: No statistically significant difference was found between eyes with HTG and NTG for any OCT RNFL thickness parameters (p > 0.05). Inferotemporal thickness values were significantly lower than the superotemporal thickness values in both glaucoma groups (p < 0.001), but no difference was observed in the normal group. Compared with the results from normal subjects, several OCT parameters, including average, superior, inferior, inferotemporal, and superotemporal values, were significantly lower in patients with HTG and NTG (p < 0.01). CONCLUSIONS: A mixture of diffuse RNFL damage (superotemporal and inferotemporal regions) and local damage in inferotemporal region was observed in patients with HTG and NTG, suggesting that HTG and NTG may undergo same pathological process.     

Comparative study of retinal nerve fiber layer damage in Japanese patients with normal- and high-tension glaucoma

PURPOSE: To look for possible differences in the pattern of retinal nerve fiber layer (RNFL) damage induced by normal- and high-tension glaucoma. METHODS: The study included randomly selected eyes from 27 patients with open-angle, high-tension glaucoma (mean age, 54.7 +/- 15.0 years; range 21-74 years) and from 19 age-matched patients with normal-tension glaucoma (mean age, 55.7 +/- 11.9 years; range 35-83 years). Eyes were examined using scanning laser polarimetry. RESULTS: The ratio between the superior and inferior quadrant thickness, or symmetry, was significantly lower in patients with high-tension glaucoma (1.00 +/- 0.22) than in patients with normal-tension glaucoma (1.18 +/- 0.32). Similarly, the ratio of the superior to the nasal quadrant thickness was significantly lower in patients with high-tension glaucoma (1.56 +/- 0.38) than in patients with normal-tension glaucoma (1.80 +/- 0.29). No statistically significant differences in the other parameters were detected between the two groups. CONCLUSION: These results show that the pattern of RNFL change is different in patients with high- and low-tension glaucoma. The thickness of the RNFL is reduced symmetrically in the superior and inferior quadrants in high-tension glaucoma, whereas a more localized defect on the inferior RNFL occurs in normal-tension glaucoma.     

Retinal nerve fiber layer measures in high- and normal-tension glaucoma.

PURPOSE: To use optical coherence tomography (OCT) to investigate the qualitative and quantitative differences in the defects of the retinal nerve fiber layer (RNFL) in subjects with high tension primary open angle glaucoma and subjects with normal tension glaucoma. METHODS: RNFL was assessed with OCT in 21 eyes with high-tension glaucoma (HTG) and 20 eyes with normal-tension glaucoma (NTG). Regression analyses were performed to investigate the interaction of disease group and location for localized RNFL loss, and to predict diffuse and localized RNFL loss as a function of age, mean defect, spherical equivalent, disease group, and location. Local RNFL thicknesses for superior clock-hour regions were estimated after adjustment for the thicknesses of symmetrically opposed locations. RESULTS: There were no differences in mean age, visual field defect mean deviation, and refractive error between subjects in HTG and NTG groups. Diffuse RNFL thickness was not significantly different between the two groups [mean RNFL for NTG > HTG by 3.48 mum, 95% confidence interval (CI) -3.9 to 10.9 microm, p = 0.092]. There was no significant interaction of group and location for localized RNFL loss (p = 0.916). Local RNFL thickness at superior regions was not significantly different in the two groups, after adjustment for RNFL thickness at corresponding inferior locations (mean RNFL for NTG > HTG by 6.30 microm, 95% CI -1.08 to 13.7 microm, p = 0.34). RNFL thickness decreased, on average (1.88 microm/dB mean deviation, 95% CI 1.21 to 2.55 microm, p < 0.0001) and locally (1.37 microm/dB mean deviation, 95% CI 0.79 to 1.96 microm, p < 0.0001), with increasing severity of glaucoma. CONCLUSION: There is no difference in the spatial pattern of RNFL defects, as assessed by the OCT, between HTG and NTG.     

Visual field defects in patients with normal-tension glaucoma and patients with high-tension glaucoma.

We compared the automated visual field test results of 24 patients with normal-tension glaucoma and 24 patients with high-tension glaucoma who were closely matched for the amount of visual field loss to determine any differences in the characteristics of visual field defects between the two groups. Patients were matched with a maximum allowable difference in mean deviation of 0.3 dB. Although the normal-tension group had a greater amount of focal visual field loss (pattern standard deviation), the difference was not statistically significant (P = .628). Additionally, there was no statistically significant difference in the amount of diffuse or focal visual field damage in the superior hemifields between the two groups; however, the patients with normal-tension glaucoma had a significantly greater amount of localized visual field loss in the inferior hemifield than the patients with high-tension glaucoma (P = .015). Our data support the hypothesis that a vascular mechanism may have a greater role in the pathogenesis of optic nerve damage and visual field loss in patients with normal-tension glaucoma than in patients with high-tension glaucoma.     

Difference of optic disc topography between a low-tension group and a high-tension group in normal-tension glaucoma patients

PURPOSE: Glaucomatous visual field loss and optic disc damage differ by intraocular pressure (IOP) levels. In this study, we compared the optic disc topography in the high-tension group and the low-tension group in normal-tension glaucoma (NTG). METHOD: We selected NTG patients with mean deviation (MD) > or = -10.00 dB and the highest recorded IOP of < 14 mmHg or > or = 17 mmHg without glaucoma treatment. We classified NTG eyes into the following two groups: 1) a low-tension group with the highest recorded IOP of < 14 mmHg, 2) a high-tension group with the highest recorded IOP of > or = 17 mmHg. The optic disc parameters in the low-tension group eyes were compared with those in the high-tension group eyes using a Heidelberg Retina Tomograph. RESULTS: Nineteen eyes of nineteen patients were selected for each group. The cup/disc area ratio in the global sector, and the rim volume in the nasal sector of the low-tension group had deteriorated more than in the high-tension group. CONCLUSIONS: The disc topography is different between the low-tension group and the high-tension group in the nasal sector, suggesting that different pathogenetic mechanisms exist in the optic disc damage in NTG.     

Comparison of visual field defects in normal-tension glaucoma and high-tension glaucoma

In a prospective comparison of visual defects in 23 patients with normal-tension glaucoma and 23 with high-tension glaucoma, the groups were matched for equal involvement of the optic disk. F profiles on the Octopus 201 Perimeter were used to quantify thresholds at 1-degree intervals from fixation to define eccentricity, depth, and slope of the scotoma. The mean eccentricity of scotomas in the normal-tension group was 4.86 degrees from fixation; in the high-tension group it was 2.96 degrees. These differences were statistically significant (P less than .01). No statistically significant differences were found between the slopes of the scotomas or depths of the scotomas in the two groups.     

Biostatistical evidence for two distinct chronic open angle glaucoma populations.

Twenty-six eyes of 26 patients with low-tension glaucoma and 34 eyes of 34 patients with high-tension glaucoma were studied. Fifty-one measurements were available on each patient, including visual field indices, finger blood flow measurements, as well as haematological, coagulation, and biochemical and rheological variables. Multivariate analysis revealed two statistically distinct groups of patients, with low and high tension glaucoma cases equally distributed in both. The smaller group (15 patients) showed a suggestion of vasospastic finger blood flow measurements, and had a high positive correlation between the mean deviation (MD) index of field severity and the highest intraocular pressure (r = 0.715, p = 0.0008). The second, larger group (45 patients) showed disturbed coagulation and biochemical measurements, suggestive of vascular disease, and had no correlation between the MD index and the highest intraocular pressure.     

Increased serum total antioxidant status and decreased urinary 8‐hydroxy‐2′‐deoxyguanosine levels in patients with normal‐tension glaucoma

Acta Ophthalmol. 2010: 88: e259–e264

Abstract.

Purpose: To investigate the amount of systemic oxidative stress‐related DNA damage and serum total antioxidant status of patients with normal‐tension glaucoma compared with healthy controls. Methods: Forty‐three patients with normal‐tension glaucoma selected from 60 consecutive newly diagnosed patients with primary open‐angle glaucoma were enrolled. Each patient’s intraocular pressure (IOP) was measured seven times over a 24‐hour period. Those whose highest IOP was over 21 mmHg were excluded. Forty control subjects were recruited. The serum total antioxidant status was assessed colorimetrically by its ability to reduce the generation of the radical cation ABTS (2,2‐azinobis‐3‐ethylbenzthiazoline sulphonate). The urinary 8‐hydroxy‐2′‐deoxyguanosine was measured as a marker of oxidative DNA damage and normalized to creatinine. The results were compared between healthy subjects and patients with normal‐tension glaucoma. Results: The control and normal‐tension glaucoma groups did now show significant differences for age, gender, serum fructosamine, cholesterol and triglyceride levels; systolic and diastolic blood pressure, body mass index; and prevalence of hypertension. The serum total antioxidant status was significantly higher (p = 0.01) and the urinary 8‐hydroxy‐2′‐deoxyguanosine/creatinine level significantly lower (p = 0.03) in the patients with normal‐tension glaucoma compared with the controls. Even after we adjusted the data for independent variables, the incidence of normal‐tension glaucoma was significantly correlated with high serum total antioxidant levels (p = 0.03; odds ratio, 1.007; 95% confidence interval, 1.001–1.013) and low urinary 8‐hydroxy‐2′‐deoxyguanosine/creatinine (p = 0.02; odds ratio 0.76; 95% confidence interval, 0.61–0.96). Conclusions: Increased serum total antioxidant and decreased 8‐hydroxy‐2′‐deoxyguanosine may reflect compensatory alterations in response to increased systemic oxidative stress in patients with normal‐tension glaucoma.     

The relationship between macular cell layer thickness and visual function in different stages of glaucoma

Purpose

To determine whether there were differences in the structure–function relationship between early and advanced glaucoma, and study the association between thickness of discrete macular cell layers, the thickness of the retinal nerve fiber layer, and visual field sensitivity.

Methods

In all, 71 eyes of 50 subjects (28 glaucoma patients and 22 normal control subjects) were included. Thickness of macular retinal nerve fiber layer (mRNFL), macular inner retinal layer (mIRL), and macular outer retinal layer (mORL) were measured from Stratus optical coherence tomography macular scans, using our previously published segmentation algorithm. Visual sensitivity loss was determined by mean deviation (MD) using Humphrey Visual Field Analyzer. The mean thickness for each layer from the normal control subjects, early, and advanced glaucoma groups was compared. In addition, a mixed model analysis was used to explore the relationship between structure–function, allowing for possible interaction with glaucoma stage.

Results

The mean mRNFL thickness in early and advanced glaucoma patients was significantly less than measurements in normal subjects (P<0.01). The mean mIRL thickness in advanced glaucoma was significantly less than normal subjects (P=0.04). The mean mORL thickness in early and advanced glaucoma was not statistically significant different from that of normal subjects (P>0.8). There was no statistically significant difference in macular structure–function relationship between the two glaucoma groups (P>0.05). Mean mIRL thickness was significantly associated with MD (P=0.04).

Conclusion

There was no significant difference in macular structure–function relationship between early and advanced glaucoma groups. Combined data from both glaucoma groups indicated that mIRL thickness was associated with visual sensitivity loss.     

Peripheral vasospasm and nocturnal blood pressure dipping--two distinct risk factors for glaucomatous damage?

PURPOSE: To evaluate the relationship between peripheral vasospasm and circadian blood pressure rhythm in patients with primary open angle glaucoma (POAG). METHODS: Nail-fold capillaroscopy, combined with a cold provocation test, and 24-hour blood pressure monitoring was carried out in 130 patients with POAG (M:F 58:72; mean age 60 +/- 14 years), 99 with high-tension glaucoma (HTG) and 31 with normal-tension glaucoma (NTG). Peripheral blood flow parameters were compared for patients with a nocturnal fall in mean systemic blood pressure (MBP) of less than 10% (non-dippers), patients with a nighttime MBP fall of 10-20% (dippers), and patients with a nighttime MBP fall of more than 20% (over-dippers). RESULTS: Patients with POAG showed a significantly lower blood flow velocity both at baseline (p < 0.01) and after cold provocation (p < 0.02) and a significantly higher percentage of cold-induced blood-flow standstill (p < 0.0001) in the nail-fold capillaroscopy than normal controls. The numbers of non-dippers (50), dippers (66) and over-dippers (14) did not differ between the HTG and NTG group. There were no significant differences between non-dippers, dippers, and over-dippers in peripheral blood flow parameters. CONCLUSIONS: Our findings indicate that vasospasm and low blood pressure may be distinct risk factors for glaucomatous damage. It also appears that screening for vascular dysregulation and systemic hypotension should not be restricted to NTG patients alone.     

Twenty four hour blood pressure monitoring in normal tension glaucoma.

BACKGROUND: The few investigations that used continuous 24 hour blood pressure monitoring to investigate whether blood pressure in patients with normal tension glaucoma is lower than in normal subjects yielded conflicting results. Therefore, a prospective controlled trial was carried out. METHODS: Systemic blood pressure was recorded continuously over a 24 hour period in 20 patients with normal tension glaucoma (IOP < or = 21 mm Hg). Eight of them showed a localised loss of the neuroretinal rim area and, in addition, optic disc haemorrhages-that is, focal ischaemic signs. Twenty healthy patients without glaucoma, who were hospitalised for cataract or retinal surgery, served as controls. Blood pressure was automatically measured every 20 minutes during the day and every 40 minutes at night. RESULTS: Both groups showed a significant (physiological) blood pressure drop at night, which was significantly (p < 0.001, ANOVA) more pronounced in the group with normal tension glaucoma than in the control group. There was a weak trend towards lower blood pressure values in the normal tension glaucoma group. Minima, maxima, and mean values of the systolic, diastolic, and mean arterial pressures did not differ significantly between the group with normal tension glaucoma and the control group. The greatest differences occurred with nocturnal systolic and diurnal diastolic values. There were no significant differences between the subgroup with focal lesions and the other patients with normal tension glaucoma. CONCLUSIONS: Patients with normal tension glaucoma tend to have lower blood pressure values (p > 0.05, ANOVA) than normals; this difference is probably much smaller than formerly assumed. Patients with normal tension glaucoma, however, have significantly greater nocturnal blood pressure drops (p < 0.001, ANOVA) than normal controls. Nocturnal blood pressure drops (relative day-night differences) may play a more important role in the pathogenesis of normal tension glaucoma than the absolute height of the blood pressure.     

Retrobulbar haemodynamics in normal and high tension glaucoma patients: the diagnostic importance of tinnitus, migraine and Raynaud-like symptoms

BACKGROUND: In the pathophysiology of open-angle glaucoma altered perfusion of the optic nerve head is of importance. Up to now these disturbances were presumed to be the chief cause of glaucomatous damage in patients with normal tension glaucoma showing other vascular disturbances like migraine or tinnitus. PATIENTS AND METHODS: Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured and the resistive index (RI) was calculated by colour Doppler imaging (CDI) in the ophthalmic artery (OA), central retinal artery (CRA) and in the short and long posterior ciliary arteries (SPCA, LPCA) in 18 patients with normal tension glaucoma (NTG), in 18 patients with high tension glaucoma (HTG) and in 18 normal control subjects. RESULTS: In an upright sitting position both glaucoma groups showed statistically significant decreases in PSV and EDV in CRA and SPCA compared to the control subjects. HTG when compared to NTG and normal subjects showed statistically significant decreases of EDV and statistically significant increases of RI in LPCA. In addition, compared to normal subjects, HTG patients showed statistically significant increases of RI in both OA and SPCA. DISCUSSION: Both glaucoma groups showed decreased blood flow velocities in the small retrobulbar vessels in an upright sitting position. Normal tension glaucoma patients with symptoms of vasospasms compared to patients with high tension glaucoma showed only small differences in ocular haemodynamics.     

Evaluation analysis of blood flow of peripapillary area in glaucoma patients using scanning laser Doppler flowmetry

PURPOSE: To evaluate capillary blood flow and velocity in retinal peripapillary area in primary open angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PEXG) and age matched control group (C) using scanning laser Doppler flowmetry (Heildelberg Retina Flowmeter). MATERIAL AND METHOD: One randomly selected eye of 17 POAG patients (mean age 59.3 +/- 2.6), 18 NTG patients (mean age 56.4 +/- 2.4), 17 PEXG patients (63.3 +/- 2.8) and 15 healthy subjects (mean age 55.8 +/- 3.8) underwent examination with scanning laser Doppler flowmetry. The measurements were performed at the superior and inferior temporal peripapillary retinal area. The measured parameters were capillary blood flow and velocity of the moving erythrocytes. Each image was analysed using the program AFFPIA. This software calculates the hemodynamic parameter flow of each pixel. Comparison of value obtained from patients and control participants were made using Student's t test. RESULTS: Scanning laser Doppler flowmetry results showed a significant reduction in blood flow at the superior and inferior temporal peripapillary area in POAG and NTG patients compared to control group (p < 0.04). The POAG and NTG patients had also significantly decreased velocity at the inferior temporal peripapillary retinal area compared to control group. No statistical difference was found between blood flow and velocity in POAG compared with NTG. When compared with the control participants, patients with PEXG showed significant decreases in the mean blood flow at the inferior temporal quadrant (p < 0.05), while the differences in the mean flow and velocity at the superior quadrant between those groups were not statistically significant. CONCLUSIONS: Our findings indicate a reduction in ocular blood flow at the temporal peripapillary retinal area in patients with POAG and NTG compared to age matched control participants. The peripapillary retinal microcirculation is not significantly altered in patients with PEXG compare with POAG and JNC. The blood flow parameters in the capillaries are lower in JNC retinas, the difference however is not significant. Further clinical investigation is required having groups homogeneous with respect to stage of glaucoma and controlled for factors known to effect perfusion pressure.     

Ocular blood flow in patients with asymmetric glaucoma

BACKGROUND: Hemodynamic factors are gaining increasing importance in the pathogenesis of glaucoma. This study was designed to investigate ocular blood flow in patients with asymmetric glaucoma. METHODS: The more affected and the contra-lateral eyes of 15 glaucoma patients with asymmetric scotomas (difference in mean deviation >/=8 dB) despite equal IOP were compared with reference to IOP, optic nerve head excavation, mean deviation in scotomas and ocular blood flow (OBF). Exclusion criteria were defined as follows: operated eyes, secondary glaucomas, differences in IOP and in antiglaucoma therapy, differences in visual acuity >2 steps and other ophthalmological diseases. For statistical analysis the Wilcoxon test for paired samples was used. RESULTS: A comparison of IOP's of the more affected eyes with the contralateral eyes showed no differences. Vertical and horizontal excavation differed significantly ( p=0.027 and p=0.01, respectively) and also the mean deviation in scotomas showed a statistically significant difference ( p=0.001). The pulse amplitude and the pulse volume showed only a slight tendency, but the pulsatile ocular blood flow was significantly lower in the more affected eyes ( p=0.047). CONCLUSION: The lower pulsatile ocular blood flow in the more affected eye in patients with asymmetric glaucoma could be the lateralizing factor in these patients, and suggests an influence of hemodynamic factors in the pathogenesis of glaucoma.     

Impact of disorders in blood rheology on progress of glaucoma in patients with stable normalized intraocular pressure

Comparative study of blood rheology in 53 patients (76 eyes) without stabilization of primary glaucoma with normalized intraocular pressure (group 1) and in 43 patients (61 eyes) with stabilized course (group 2) showed significant differences between the two groups. In group 1 erythrocyte aggregation was increased in 79.3% and their deformability decreased in 88.7%; high content of Willebrandt's factor was detected in 83% patients. By contrast, in group 2 these shifts were detected in only 20.9 and 23.3% patients, respectively, while the content of Willebrandt's factor was normal. The detected rheological shifts were in high correlation with an unstable course of glaucoma, and their severity may serve as a prognostic sign for predicting the course of glaucoma in patients with normalized intraocular pressure.     

Oxygen saturation levels in the juxta-papillary retina in eyes with glaucoma

Oxygen saturation (OS) levels in the juxta-papillary retina particularly inferotemporal retina were investigated in open-angle glaucoma (OAG) patients as well as normal subjects. Fifty-six eyes of 56 OAG Japanese patients and 20 eyes of 20 age-matched normal subjects were recruited for the study. OAG eyes (56) were subdivided into two groups: 15 eyes of low-tension (LT) subgroup and 41 eyes of high-tension (HT) subgroup. The average of age of the LT, HT subgroup and normal group were 60.5, 55.9 and 52.6 years, respectively. OS levels in the retina were measured using a Fourier transform-based spectral retinal imaging (SRI) system (Retinal Cube; ASI Co. Migdal Hemak, Israel), with which OS levels in the fundus could be computed at every pixel point of a 35 degrees fundus image. We calculated OS levels at five points in the retina near the optic disc and retinal arteries and veins in all eyes. The OS levels were also compared with the results analyzed using Humphrey visual field Analyzer with the program 30-2 SITA. At the superior and nasal juxta-papillary retinal points, OS level of the LT subgroup showed significant decrease as compared with the HT subgroup and the normal group (p=0.048-0.009). The LT and the HT subgroups were significantly lower than the normal group at the inferotemporal and the average of the retinal points (p=0.047-0.001). There were no statistically significant differences among the three groups in regards to the OS in the retinal artery. There was a statistical significant correlation between the mean of total deviation of the 17 points in the upper arcuate area and OS of the inferotemporal point (p=0.018), and between mean deviation and the average of OS of the inferotemporal and the superotemporal point (p=0.037) in the HT subgroup. However, there was no significant correlation in the LT subgroup. OS levels in the retina were especially decreased in the low-tension glaucoma subtype. There was a correlation between the visual field defect and OS in the HT eyes in the inferotemporal region. OS measurement may be a novel adjunct to study glaucoma patients.     

Relationship between progression of visual field damage and choroidal thickness in eyes with normal-tension glaucoma

Background: To measure choroidal thickness in normal eyes and in patients with normal‐tension glaucoma using enhanced depth imaging optical coherence tomography and evaluate the association between choroidal thickness and progression of visual field damage. Design: Cross‐sectional comparative study. Participants: A total of 62 eyes of 62 normal subjects and 45 eyes of 45 normal‐tension glaucoma patients were examined. Methods: The choroid was measured at the fovea and 3 mm nasal and temporal from the fovea. In the separate study, both eyes of the patients with normal‐tension glaucoma were included in the analyses. Visual fields were measured with automated perimetry. Changes in mean deviation per year (dB/year), that is, mean deviation slope, were calculated. Main Outcome Measures: Difference in the choroidal thickness between the normal subjects and the patients with normal‐tension glaucoma. The relationship between mean deviation slope and the choroidal thickness in eyes with normal‐tension glaucoma was analysed. Results: Compared with normal subjects, the choroidal thickness was significantly thinner in eyes with normal‐tension glaucoma at 3 mm nasal from the fovea (P = 0.02). There was a significant correlation between the choroidal thickness at 3 mm nasal from the fovea and the mean deviation slope (Pearson's r = 0.413; P < 0.001). Conclusion: The decrease in the thickness of the choroid at 3 mm nasal from the fovea in eyes with normal‐tension glaucoma may be associated with progressive visual field loss. Thus, choroidal abnormalities may play a role in the pathogenesis of normal‐tension glaucoma.     

Clock-hour laminar displacement and age in primary open-angle glaucoma and normal tension glaucoma

Background: To find out the relationship between laminar displacement and age between patients with primary open‐angle glaucoma and normal tension glaucoma. Design: Retrospective study conducted at a tertiary university hospital Participants or Samples: Twenty‐six eyes of 26 primary open‐angle glaucoma patients and 52 eyes of 52 normal tension glaucoma patients. Methods: Patients were scanned with a Stratus optical coherence tomography apparatus to measure the retinal nerve fibre layer thickness and to visualize the cross‐sectional laminar displacement of 12 clock‐hour segments, 30 degrees each. Depth1 was defined as the longest distance between the retinal pigment epithelium and the anterior laminar cribrosa surface, which represents the amount of laminar displacement. Main Outcome Measure: Partial correlation coefficients adjusted by mean deviation and intraocular pressure between (i) retinal nerve fibre layer thickness and age, and (ii) Depth1 and age. Results: In the primary open‐angle glaucoma group, strong negative correlations (approximately ?0.343 ～ ?0.738) were found between Depth1 and age. Eight of 12 clock‐hour segments' correlations were significant after Bonferroni correction (α = 0.0021; 24 comparisons). However, no significant correlations were found between Depth1 and age in the normal tension glaucoma group. When the correlation coefficients were compared between the two groups, eight clock‐hour segments showed significant differences after Bonferroni correction. Conclusions: The significantly different correlation between laminar displacement and age between primary open‐angle glaucoma and normal tension glaucoma patients may suggest a different role of the lamina cribrosa to the disease.     

Analysis of autoantibody repertoires in sera of patients with glaucoma

PURPOSE: Glaucoma is the second cause of blindness worldwide. It is usually considered a neurodegenerative disease. There is evidence that an autoimmune mechanism is involved in the development of glaucoma in some patients. The aim of this study was to analyze the IgG autoantibody repertoires in sera of glaucoma patients and healthy subjects. METHODS: A total of 82 patients were divided into four groups: healthy volunteers without any ocular disorders (CO, n = 30), patients with primary open-angle glaucoma (POAG, n = 19), ocular hypertension (OHT, n = 16), and normal tension glaucoma (NTG, n = 17). All groups were matched for age and gender. The sera of these patients were tested against Western blots of retinal antigens. Immunodetection was done using 4-chloro-1-naphthol staining. The autoantibody patterns were digitized and subsequently analyzed by multivariate statistical techniques. RESULTS: All patients showed different, complex staining patterns of autoantibodies against retinal antigens. There was an increase in the number of peaks in sera of patients with primary open-angle glaucoma (POAG) compared to healthy subjects (CO). Including all peaks the analysis of discriminance revealed a statistically significant difference between the patterns of POAG compared to all other groups (p < 0.01). Sera of normal tension glaucoma (NTG) had no statistically different autoantibody pattern compared to those of control subjects. CONCLUSIONS: In this study, we demonstrated a difference in the IgG autoantibody patterns of primary open-angle glaucoma patients compared to healthy subjects. However, the patterns were not significantly different in normal tension glaucoma compared to control subjects.