C-reactive Protein and Lipid Profiles in Korean Patients With Normal Tension Glaucoma

Purpose

To compare high-sensitivity C-reactive protein (hsCRP) levels and lipid profiles between Korean normal tension glaucoma (NTG) patients and healthy controls.

Methods

This cross-sectional study included 38 Korean patients with NTG and 38 age- and sex-matched healthy control subjects. We excluded the patients with cardiovascular risk factors and other systemic diseases that might affect CRP levels and lipid profiles. Each patient underwent a Humphrey visual field examination and blood sampling for hsCRP and lipid profile analyses. Subsequently, the NTG patients were classified into two groups based on their untreated intraocular pressure (IOP) level: low NTG (LNTG) with IOP≤13 mmHg (13 subjects) and high NTG (HNTG) with relatively high IOP (>13 and ≤21 mmHg, 25 subjects). The hsCRP levels and lipid profiles were compared between NTG patients and healthy controls, and between LNTG, HNTG, and healthy controls.

Results

There were no significant differences in hsCRP and lipid profiles between either the NTG patients and healthy controls, or between the LNTG, HNTG, and controls (p>0.05) after exclusion of Korean patients with cardiovascular risk factors. There was no significant association between hsCRP and visual field indices (p>0.05).

Conclusions

High-sensitivity C-reactive protein-related vascular inflammatory conditions may not be directly associated with the development of NTG, regardless of the untreated IOP level.     

Abnormal flow-mediated vasodilation in normal-tension glaucoma using a noninvasive determination for peripheral endothelial dysfunction

PURPOSE: To assess peripheral vascular endothelial function in patients with normal-tension glaucoma (NTG) by using a noninvasive method: endothelium-dependent flow-mediated vasodilation (FMD). METHODS: Forty patients with NTG and 40 healthy age- and sex-matched normal control subjects underwent measurement of FMD and endothelium-independent nitroglycerin-mediated vasodilation (NMD) via high-resolution, two-dimensional (2D) ultrasonographic imaging of the brachial artery. The patients also underwent blood sampling for biochemistry, lipid profile, and high-sensitivity C-reactive protein (hsCRP) analysis. RESULTS: The NTG group exhibited significant impairment of FMD compared with the control group (NTG: 2.64% +/- 2.22%, control: 5.96% +/- 2.50%, P < 0.001). Multivariate analysis demonstrated that the presence of NTG was the strongest independent predictor of FMD. The lipid profile and hsCRP did not differ significantly between the two groups. CONCLUSIONS: This study demonstrated impaired FMD in patients with NTG and the results provide evidence of a generalized peripheral vascular endothelial dysfunction in patients with NTG.     

Prevalence of normal-tension glaucoma and primary open-angle glaucoma in patients with collagen diseases

PURPOSE: To investigate the prevalence of normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) in patients with collagen diseases and determine whether an immunocompromised condition is present in a subset of glaucoma patients. METHODS: Three glaucoma specialists prospectively examined patients with collagen diseases. The diagnostic process included applanation tonometry, slit-lamp examination, gonioscopy, direct ophthalmoscopy, and automated static perimetry. Twenty-four-hour intraocular pressure monitoring was done when necessary. Using the results of a population-based survey conducted in Japan, we calculated an expected number of cases of NTG and POAG, and compared these with the actual number of cases. RESULTS: Of the 153 patients with collagen diseases examined, we found 6 patients with NTG and 2 patients with POAG. Of these 8 patients, 2 with progressive systemic sclerosis (PSS), one with NTG, and the other, POAG, had a history of being on systemic steroidal therapy. The prevalence of NTG and POAG was significantly higher in women patients having collagen diseases as compared with normal women (P = .027). CONCLUSION: Women patients with collagen diseases are highly susceptible to NTG and POAG.     

动态轮廓眼压计在正常眼压性青光眼及原发性开角型青光眼的应用研究

目的:应用动态轮廓眼压计(dynamic contour tonometer,DCT)测量正常眼压性青光眼(normal tension glaucoma,NTG)及原发性开角型青光眼(primary open angle glaucoma,POAG)患者的眼压(intraocular pressure,IOP)及眼脉动幅度值(ocular pulse amplitude,OPA),并探讨影响OPA测量值的相关因素。方法:选取NTG患者20例,POAG患者21例及正常对照组各20例,应用Goldmann压平眼压(Goldmann applanation tonometer,GAT)及DCT测量IOP,同时测量了中央角膜厚度(central corneal thickness,CCT)、眼轴(axial length,AL)、心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)等指标,并探讨GAT,DCT两种眼压计测量的相关性,进而分析OPA测量值的影响因素。结果:三组被检者的IOP,OPA,SBP及DBP差异均有统计学意义(P<0.05),而CCT,AL及HR差异无统计学意义(P>0.05)。其中OPA值NTG组为(1.7±0.9)mmHg,POAG组为(2.8±0.7)mmHg,正常对照组为(2.4±0.6)mmHg;NTG组与POAG组比较(P=0.001),与正常对照组比较(P=0.005)差异均有统计学意义,POAG组与正常对照组比较(P=0.502)差异无统计学意义;OPA值与IOP,HR及CCT无相关性(P>0.05),与AL,SBP及DBP具有一定的相关性(P<0.05)。结论:NTG患者与POAG患者及正常人的OPA值存在差异,同时OPA值受AL及SBP及DBP影响。     

Assessment of the retinal blood flow by DRG retina Doppler in primary open angle glaucoma and normal tension glaucoma

PURPOSE: The aim of the study was to evaluate the blood flow in central retinal artery (CRA) in primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). MATERIAL AND METHODS: Two groups of patients were examined: I group consisted of 15 patients (19 eyes) with POAG, II group of 16 patients (32 eyes) with NTG. The controls were age-matched healthy persons. Blood flow velocities and resistance index in central retinal artery were measured by DRG Retina-Doppler. RESULTS: We found decreased blood flow velocity in CRA in most of the patients with NTG and in part of the patients with POAG. Significant increase of resistance index was found only in NTG group. CONCLUSION: Our study confirmed that assessment of the blood flow in central retinal artery appears to be a valuable method in diagnosis of neuropathy mechanism in glaucoma.     

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.     

Comparative study of brain magnetic resonance imagings in normal tension glaucoma,primary open-angle glaucoma,and normal subjects

Purpose : To evaluate and compare the presence and extent of ischemic findings in brain magnetic resonance images (MRI) of patients with normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control subjects. Method : Seventeen patients with NTG underwent MRI. Cortical atrophy and cerebral infarcts were graded in a masked fashion by a neuroradiologist and findings were compared with age- and sex-matched POAG patients and controls. Results : In terms of CNS ischemia, patients with NTG showed more pathological findings compared to POAG and controls. The latter two were found to be statistically similar. Also, these findings were not related to age.     

Systemic arterial stiffness in glaucoma patients

PURPOSE: To investigate systemic arterial stiffness in glaucoma patients. SUBJECTS AND METHODS: One hundred and forty glaucoma patients and 121 control subjects were enrolled in the study. Among these subjects, 51 glaucoma patients [normal-tension glaucoma (NTG), 31; primary open angle glaucoma or ocular hypertension (POAG/OH): 20] and 61 control subjects without glaucoma, who presented with no risk factors for arteriosclerosis, were extracted for further analysis of systemic arterial stiffness by glaucoma type. Subjects presenting with risk factors for arteriosclerosis were classified into group A, and those presenting with no risk factors were classified into group B. Brachial-ankle pulse wave velocity (baPWV), a marker of systemic arterial stiffness, was determined with a volume-plethysmographic apparatus. The correlation between baPWV and mean deviation obtained from Humphrey Field Analyzer program 30-2 test was compared between 13 each of age-matched and sex-matched NTG and POAG/OH patients. RESULTS: There was a significant difference in baPWV between groups A and B [P<0.0001; 1748+/-393 cm/s (group A) and 1467+/-282 cm/s (group B)]. The baPWVs of control, NTG patients, and POAG/OH patients with no risk factors showed no significant difference. baPWV was positively correlated with age in all the 3 groups, but there were no significant differences among the 3 groups. baPWV tended to be negatively correlated with mean deviation in NTG patients (r2=0.25, P=0.08); in contrast, no correlation was observed in POAG/OH patients. CONCLUSION: Systemic arterial stiffness seems not to be strongly associated with glaucoma.     

Normal tension glaucoma: diagnostic features and comparisons with primary open angle glaucoma

Background : A significant proportion of patients diagnosed under the broad classification of open angle glaucoma actually has normal tension glaucoma (NTG). It has many clinical features that overlap with primary open angle glaucoma (POAG), yet there is a question of whether it has a different aetiology in which intraocular pressure plays less of a role. Methods : The epidemiology and clinical features of normal tension glaucoma are reviewed with particular reference to possible differences from primary open angle glaucoma, which might permit differentiation. The pathophysiology is discussed, outlining recent research in cell death (apoptosis), axonal damage and neuroprotection. Discussion and Conclusion : There is considerable evidence that NTG develops with little contribution from the effect of intraocular pressure. However, the clinical diagnosis of NTG is often one of exclusion and the differentiation of NTG from POAG remains difficult because many clinical signs are suggestive but not definitive of NTG. More accurate diagnosis may be possible when individual patients exhibit a greater number of signs. Some evidence suggests that NTG with relatively high pressures (greater than 15 mmHg) is more likely to progress than NTG with relatively low pressures. Clinicians must be particularly alert to the possibility of NTG because IOP, a clinical marker for some glaucomas, is absent.     

Open-angle glaucoma clinical presentation and management]

Both primary open-angle and normal-tension glaucoma belong to an identical spectrum of diseases. Clinical presentations of primary open-angle or high-tension glaucoma (POAG) and normal-tension glaucoma (NTG) were studied in an attempt to determine prognostic, clinical factors and define the appropriate management. Clinical data obtained from 826 primary open-angle and normal-tension glaucoma patients were analyzed. In addition, the results of laboratory studies, including the immunological assay of heat shock protein (hsp) and gene analyses which were undertaken to identify risk factors at the molecular level, are discussed. 1. The identified prognostic factors were disk hemorrhage, peripapillary chorioretinal atrophy (PPA), maximum intraocular pressure (IOP), the recovery rate of skin temperature after exposure to cold, family history of glaucoma, systemic systolic channel blood pressure, and oral administration of Ca(2+)-channel antagonists. 2. Disk hemorrhage was observed in 30.5% of NTG patients and 15.4% of POAG patients. Cumulative probability of hemorrhagic events was 16.9% in POAG and 38.4% in NTG patients at the end of a 14.8-year follow-up. 3. The hazard ratio of disk hemorrhage decreased with the increase of IOP(26%/5 mmHg) and was 1.46 times higher in females than in males. Disk hemorrhage was closely associated with PPA: PPA becomes greater in association with the progression of glaucomatous optic neuropathy in both POAG and NTG. No such correlation was noted in primary angle-closure glaucoma. 4. Color Doppler imaging analyses and the hourly determination of ocular perfusion pressure (OPP) indicated a difference in retrobulbar hemodynamics between OPP-mean deviation concordant and OPP-mean deviation discordant patients: a circulatory disturbance causally unrelated to OPP seems to be involved in the OPP-mean deviation discordant patients. 5. The oral administration of Ca(2+)-channel antagonists was shown to favorably influence retrobulbar hemodynamics in NTG patients. 6. Serum antigen titer to hsps(hsp 27, alpha B crystallin, human & bacterial hsp 60) was higher in both POAG and NTG patients than in normal subjects. None of the hsp-antigens was correlated to any morphometric parameters of the optic disk or any global indices of the visual field. 7. Myocilin mutation was noted in only 0.5% of POAG patients and 2.37% of NTG patients. The very low rate of occurrence precludes the value of mutation of the gene as a prognostic factor in open-angle glaucoma(OAG). 8. IOP reduction achieved by mitomycin-C trabeculectomy is effective in maintaining visual function in OAG eyes. 9. Brovincamine fumarate is effective in inhibiting the progression of glaucomatous field loss in NTG.     

Study of retinal nerve fiber layer thickness within normal hemivisual field in primary open-angle glaucoma and normal-tension glaucoma

PURPOSE: To determine if nerve fiber layer thickness (NFLT) in glaucoma patients decreases before the development of visual field loss, and if there is a difference in the thinning of NFLT between primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) eyes. METHODS: Thirty patients (33 eyes) with POAG and 31 patients (31eyes) with NTG, who had visual field defects localized in either the upper or the lower hemifield verified by Humphrey Field Analyzer (HFA), were measured for NFLT by scanning laser polarimetry (Nerve Fiber Analyzer). Twenty-three normal subjects (23 eyes) matched in refraction and age with the glaucoma patients were recruited as the control group. The total deviation (TD) in each hemifield obtained by HFA and the 180 degrees NFLT of each corresponding hemifield was calculated. Relationships between the TD of the normal or abnormal visual hemifield and the NFLT of the corresponding hemifield were compared among the POAG, NTG, and control groups. RESULTS: The NFLT of the corresponding normal hemifield was decreased both in the POAG group and in the NTG group when compared with the corresponding measurements in control subjects. In POAG eyes, thinning of the NFLT in the corresponding normal hemifield was more remarkable if the TD of the abnormal hemifield was greater, but this tendency was not observed in NTG eyes. CONCLUSION: NFLT is already decreased when the visual field is still normal both in POAG eyes and in NTG eyes. However, the pattern of retinal nerve fiber layer damage in POAG may differ from that in NTG.     

Fluorescein filling defects of the optic nerve head in normal tension glaucoma, primary open-angle glaucoma, ocular hypertension and healthy controls

BACKGROUND: To evaluate fluorescein filling defects of the optic nerve head in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), ocular hypertension (OHT) and controls. METHODS: Forty patients with NTG (mean age 55 +/- 10 years), 40 patients with POAG (mean age 55 +/- 11 years), 40 patients with OHT (mean age 53 +/- 13 years), and 40 age-matched controls (mean age 54 +/- 11 years) were included in a prospective study. Video fluorescein angiograms were performed by means of a scanning laser ophthalmoscope. The extent of absolute filling defects of the optic nerve head was assessed (as a percentage of the disc area) using digital image analysis. Visual fields were tested by automatic static perimetry (Humphrey Field Analyzer, programme 24-2). RESULTS: Absolute filling defects were significantly larger in patients with NTG (12.2 +/- 15.5%) and POAG (12.9 +/- 13.1%) compared to patients with OHT (1.2 +/- 3.6%) and healthy controls (0.1 +/- 0.5%) (p < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.806 for NTG vs healthy controls, and 0.812 for POAG vs OHT. Absolute filling defects are significantly correlated to the global indices mean deviation (r = -0.63, p < 0.0001), pattern standard deviation (r = 0.61, p < 0.0001), and corrected pattern standard deviation (r = 0.62, p < 0.0001) and significantly correlated to horizontal (r = 0.50, p < 0.0001) and vertical (r = 0.53, p < 0.0001) cup-to-disc-ratios. CONCLUSIONS: Fluorescein filling defects of the optic disc representing capillary dropout are present in NTG and POAG. The extent of these filling defects is correlated to visual field loss and morphological damage. Fluorescein angiography may be useful in the diagnosis and management of NTG and POAG.     

Comparison of central and peripheral corneal thicknesses between normal subjects and patients with primary open angle glaucoma, normal tension glaucoma and pseudoexfoliation glaucoma

BACKGROUND: While many comparative data are available about central corneal thickness in different types of open angle glaucoma, peripheral corneal thickness has been much less investigated up to now. Thus, the aim of this study was to compare the central and peripheral corneal thicknesses in patients with primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudoexfoliation glaucoma (PEXG) to values of normal subjects. PATIENTS: 104 patients with POAG, 20 patients with NTG, 23 patients with PEXG and 127 normal subjects were investigated with the Orbscan II. The central corneal thickness and the peripheral corneal thickness at 3 mm distance from the centre were determined in 4 quadrants. The acoustic equivalent factor of 0.92 was not used. Patients with eye diseases, patients who had undergone eye surgery or wearers of contact lenses were excluded. Differences were analysed with the Bonferroni-adjusted Mann-Whitney U Test for statistical significance. RESULTS: The median central corneal thickness in POAG was 600 +/- 35 microm, in NTG 577 +/- 31 microm, in PEXG 603 +/- 25 microm and in the control group 606 +/- 38 microm. The difference between NTG and the control group was statistically significant (p = 0.01). Superiorly the peripheral corneal thickness was lower in POAG (670 +/- 47 microm) and NTG (639 +/- 37 microm) compared to the control group (686 +/- 46 microm). Nasally the peripheral corneal thickness was lower in POAG (656 +/- 48 microm), NTG (658 +/- 55 microm) and PEXG (642 +/- 47 microm) compared to the control group (677 +/- 46 microm). Temporally and inferiorly there were only small differences compared to the control group. The differences in peripheral corneal thickness were not statistically significant. DISCUSSION: In accord with literature data the central corneal thickness was lower in patients with normal tension glaucoma compared to normal subjects. Superiorly and nasally the peripheral corneal thickness was lower in patients with open angle glaucoma than in normal subjects which was, however, not statistically significant. To what extent these characteristics of the corneal architecture are relevant for the pathogenesis of open angle glaucomas has to be clarified in further larger trials.     

Episcleral venous pressure in untreated primary open-angle and normal-tension glaucoma

The aim of this prospective study was to investigate episcleral venous pressure (EVP) in different forms of glaucoma in comparison with age-matched controls. EVP was measured by means of a venomanometer in 32 eyes with untreated primary open-angle glaucoma (POAG), 36 eyes with untreated normal-tension glaucoma (NTG) as well as 56 control eyes without ophthalmological disease other than cataract. In addition to ophthalmological standard examination, cardiovascular parameters such as systolic and diastolic blood pressure and heart rate were recorded. In the POAG group, EVP was 12.1 +/-0.5 mm Hg and in the NTG group 11.6 +/- 0.4 mm Hg. This was significantly different from EVP of the controls (9.5 +/- 0.2 mm Hg). The EVP/intraocular pressure (IOP) ratio was significantly different in NTG patients (80.0% +/- 3.2) in comparison with both POAG patients (67.1% +/- 2.8) and controls (69.2% +/- 2.4). The difference between IOP and EVP (IOP - EVP) was 6.2 +/- 0.6 in the POAG, 3.1 +/- 0.45 in the NTG and 4.5 +/- 0.4 in the control group. All these values were significantly different from each other. Regression analysis revealed a significant linear correlation between EVP and IOP in both the NTG and the POAG group. In the control group, however, the correlation was weak. This study is the first to demonstrate differences in EVP between untreated NTG and POAG and an age-matched healthy control group.     

原发性开角型青光眼视乳头旁脉络膜萎缩区的双眼对照研究

目的研究单眼视野缺损的原发性开角型青光眼患者双眼间视乳头旁脉络膜萎缩区（PPA）的出现频率和面积大小差异。方法利用计算机图像分析系统对视乳头立体照相进行测量,比较40例单眼视野缺损的原发性开角型青光眼患者双眼间PPA的发生率及大小差异。所有入选患者的屈光度（等效球镜）均在-3．00-＋3．00D之间。结果视野缺损眼的视杯面积、杯盘面积比均大于视野正常眼,差异有统计学意义（视杯面积：t=5．332,P〈0．01;杯盘面积比：t=5．126,P〈0．01）。视野缺损眼的α区面积略大于视野正常眼,差异有统计学意义（t=3．02,P=0．0045）;双眼间β区面积差异无统计学意义（S：13．5,P=0．426）;双眼α区与β区的发生率均存在一致性（α区：Х^2=0．00,P=1．000;β区：Х^2=1．2857,P=0．2568）。结论在排除了-3．00D以上的中高度近视眼人群后,单眼视野缺损的原发性开角型青光眼α区、β区的有无和13区的大小均不能很好地反映双眼间视野缺损的差异。     

开角型青光眼与正常大陷凹眼中视乳头旁萎缩区的比较研究

目的研究原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)与正常大陷凹眼的视乳头旁脉络膜萎缩区(PPA)的差异及其与视野的关系。方法利用计算机图像分析系统对拍摄的视乳头立体图像进行测量,比较42例(42只眼)POAG、40例(40只眼)NTG与45例(45只眼)正常大陷凹眼之间PPA的发生率及大小差异,分析PPA的有关参数与视乳头结构指标、视野分级之间的相关性。所有入选患者的屈光度(等效球镜度数)均在+3.00~-3.00D之间。结果正常大陷凹组、POAG组及NTG组α区的出现率分别为85.4%、100.0%、95.0%,β区的出现率分别为19.1%、48.9%、37.5%,POAG组和NTG组的α区和β区的出现率均大于正常大陷凹组,差异均有统计学意义(P<0.05)。正常大陷凹组、POAG组及NTG组β区面积分别为(0.08±0.25)、(0.24±0.36)、(0.14±0.21)mm2,POAG组的β区面积大于正常大陷凹组,差异有统计学意义(P<0.05)。三组的α区面积差异无统计学意义(Chi-Square=4.534,P=0.104)。而POAG组与NTG组间上述各指标及α区和β区出现率的差异均无统计学意义(P>0.05)。青光眼患者视乳头结构指标与视野相关分析结果表明,杯/盘比值与视野受损分级之间有较强相关性(r=0.5624,P<0.01)。而α区面积、β区面积与视野受损分级之间均为低相关性(α区:r=0.246,P<0.01;β区:r=0.2302,P<0.01)。有无青光眼性视野缺损相关因素的Logistic回归分析结果显示,在包括年龄、性别、屈光度、杯/盘比值分级指标及α区面积和β区有无的多个因素中,仅年龄和杯/盘比值分级指标被证实为两个可能的影响因素。结论排除了-3.00D以上的中高度近视人群后,POAG和NTG患者的α区和β区出现率及β区面积虽与正常大陷凹者有所不同,但其与视野缺损程度的相关性较传统的视乳头结构指标低,在两组青光眼患者间也未见明显差异。由此认为PPA不能作为诊断POAG的独立指标,也不能作为POAG与NTG的鉴别诊断指标。     

Plasma vascular endothelial growth factor,soluble VEGF receptor FLT-1, and von Willebrand factor in glaucoma

Aim: To investigate plasma indices of vascular permeability (vascular endothelial growth factor, VEGF-also an index of angiogenesis, as well as the soluble receptor for VEGF, sFlt-1) and endothelial damage/dysfunction (von Willebrand factor, vWf) in glaucoma. METHODS: Citrated plasma was assayed for VEGF, sFlt-1, and vWf (all ELISA) in a cross sectional study of 50 patients (20 male; mean age 63.9 years, SD 10.5) with glaucoma: 26 had normal tension glaucoma (NTG) and 24 had primary open angle glaucoma (POAG), who were compared with 26 healthy controls (mean age 73.4 years, SD 9.2). RESULTS: Median (interquartile range, IQR) levels of VEGF were significantly elevated in patients with NTG and POAG compared to healthy controls (Kruskal-Wallis test, p<0.001). Similarly, mean (SD) vWF levels were abnormal in NTG and POAG compared to healthy controls (one way ANOVA, p<0.001). Median levels of sFlt-1 were significantly lower in patients with NTG and POAG, when compared to healthy controls (Kruskal-Wallis test, p<0.001; p<0.05 with Tukey's post hoc test for controls v POAG). There were no significant differences in VEGF, sFlt-1 or vWf levels between the NTG and POAG groups (Tukey's test, all p=NS). In both NTG and POAG groups, there was a significant correlation between VEGF and sFlt-1 (Spearman, NTG: r=0.6517, p=0.001; POAG: r=0.6017, p=0.008). There were no significant correlations between VEGF and sFlt-1, or with vWf among the controls. CONCLUSIONS: The pathogenesis of optic nerve damage in both NTG and POAG may be associated with abnormal vascular permeability and endothelial damage/dysfunction, as indicated by abnormal plasma VEGF and vWf levels in these patients.     

Plasma endothelin-1 level in Japanese normal tension glaucoma patients

PURPOSE: To compare the plasma concentration of endothelin-1 (ET-1) among patients < 60 years of age with normal-tension glaucoma (NTG), primary open-angle glaucoma (POAG), and in age-matched normal participants. METHODS: Plasma concentration of ET-1 was determined in 30 NTG 18 POAG patients, and 19 age-matched normal participants using an enzyme immunoassay. RESULTS: The ET-1 level was 1.49 +/- 0.51 pg/ml in the NTG patients (49.4 +/- 8.8 years), 1.58 +/- 0.64 pg/ml in the POAG patients (44.7 +/- 10.7 years), and 1.33 +/- 0.50 pg/ml in the normal participants (49.9 +/- 5.6 years). The ET-1 levels were not significantly different among the three groups, and no significant correlation with the extent of visual field damage, intraocular pressure (IOP), refraction, or age was seen in the glaucoma patients. CONCLUSIONS: The plasma ET-1 level showed no difference among NTG patients, POAG patients, and normal participants < 60 years of age in the Japanese population.     

Retinal blood flow measurements and neuroretinal rim damage in glaucoma

AIM: To assess retinal blood flow characteristics in subjects with normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and a group of controls using the Heidelberg retina flowmeter (HRF). The vascular parameters were correlated against structural damage of the optic nerve head, assessed using the Heidelberg retina tomograph (HRT). METHODS: HRF images were obtained in 76 subjects with NTG, 58 with POAG, and 38 controls. Optic nerve head images, acquired using the HRT, were analysed with Moorfields Regression Analysis software. The HRF variables, measured adjacent to a rim segment identified as "abnormal," were compared with the vascular parameters of the "normal" rim segments. The HRF parameters of the segments identified as normal in glaucoma subjects were compared with matched control segments. RESULTS: The glaucoma subjects had significantly lower retinal haemodynamics than the control subjects. There were no significant differences in the HRF parameters between the NTG and POAG subjects. The discs that had been identified as having abnormal segments had lower HRF values than those with a corresponding normal segment. The glaucoma subjects with normal rim segments had statistically significant lower velocity, flow, and volume measurements than the controls for each location sampled. CONCLUSION: This study shows a relation between structural damage of the optic nerve head and the level of retinal blood flow. The changes in the circulation could indicate that it may be an early marker of the pathological process.     

Specificity and sensitivity of glaucoma detection in the Japanese population using scanning laser polarimetry.

AIMS: To investigate the usefulness of the scanning laser polarimeter (GDx; GDx Nerve Fiber Analyzer) for glaucoma detection in the Japanese population, and to investigate the difference in the thickness of retinal nerve fibre layer (RNFL) between normal tension glaucoma (NTG) and primary open angle glaucoma (POAG). METHODS: 69 eyes of 69 normal subjects and 115 eyes of 115 chronic open angle glaucoma patients (60 NTG and 55 POAG patients) were studied. The thickness of RNFL was measured with GDx. An eye was diagnosed as glaucomatous, if at least one original GDx variable showed p <5%. The difference in thickness of RNFL between the NTG and POAG groups was then investigated. RESULTS: 46 normal eyes (66.7%) were diagnosed as not glaucomatous (no variables showing p <5%), and 93 glaucomatous eyes (46 NTG and 47 POAG eyes) (80.9%) were diagnosed as glaucomatous. Actual values of average thickness, ellipse average, superior average, and superior integral were significantly lower in the POAG group than those in the NTG group. CONCLUSIONS: New variables which elucidate focal RNFL defects or early changes are needed to improve the moderate detection ability found in this present study. The pattern of the change in RNFL may differ in NTG and POAG groups.