Surgical management of secondary glaucoma in Fuchs’ heterochromic iridocyclitis

Purpose

To access surgical effects in patients with secondary glaucoma in Fuchs’ heterochromic iridocyclitis.

Methods

We had employed medical or surgical treatment for 22 patients who had been diagnosed as secondary glaucoma and Fuchs’ heterochromic iridocyclitis. Thirteen patients had undergone trabeculectomy with intraoperative applications of mitomycin C (MMC), of whom 11 patients had been followed up postoperatively for 25.09?±?14.4 months (range 6–48 months).

Results

Intraocular pressure (IOP) were controlled medically in 17 of 22 (77.3 %) patients. In 11 patients who had surgical therapy, mean IOP fell from a preoperative initial value of 38.05?±?7.26 mmHg to 20.63?±?6.15 mmHg (P?=?0.000), and mean number of lowering IOP medications fell from preoperative value of 2.27?±?0.78 to 1.09?±?1.22 at postoperative final follow-up time (P?=?0.014). The result of Kaplan–Meier analysis showed a total success of 90.9 % was achieved at 1 year, 62.3 % success at 4 years and 63.6 % complete success was achieved at 1 year and 31.8 % at 4 years. Exacerbations of intraocular inflammation with transient IOP rise at the early postoperative period occurred in six patients (23 %), and were controlled with topical corticosteroid. No frequent postoperative uveitic relapses were observed.

Conclusion

Fuchs’ heterochromic iridocyclitis has high morbidity of secondary glaucoma. Regular follow-up and close observation should be carried out. Trabeculectomy with MMC is a moderately effective procedure for patients with secondary glaucoma.     

Trabekulektomie bei juveniler idiopathischer Arthritis-assoziierter Uveitis

Background

Secondary uveitic glaucoma in children can only be controlled in many cases by surgery. The aim of this study was to evaluate the outcome of trabeculectomy (TE) with administration of mitomycin C in children with secondary uveitis associated with juvenile idiopathic arthritis (JIA).

Materials and methods

This study was a retrospective chart review of 21 children with uveitic glaucoma who underwent TE with administration of mitomycin C including analysis of complications, further interventions, additional surgical procedures to control intraocular pressure (IOP) and of the success rates after a mean follow-up of 5 years.

Results

Defining success as an IOP ≤?15 mmHg, the surgical success rate after TE was 55?% after 1 year and 38?% after 5 years but 43?% of the children required further IOP controlling operations in the long-term follow-up. An IOP ≤?15 mmHg was observed in 70?% of the children after 1 year and in 62?% after 5 years. In regard to the overall success (with topical antiglaucomatous medication) the success rate increased to 71.4?% after 5 years.

Conclusions

The results show that TE is a suitable surgical procedure to control IOP in secondary uveitic glaucoma of JIA patients. In the long-term follow up additional postoperative adjustments are necessary to control the IOP.     

Effects of trabeculectomy on posture-induced intraocular pressure changes over time

Introduction

To determine whether trabeculectomy affects postural-induced changes in intraocular pressure (IOP), and whether it is maintained.

Methods

Thirty-six eyes of 36 patients with open-angle glaucoma who were scheduled for their initial trabeculectomy with adjunctive mitomycin C were prospectively examined. The IOP was measured in the sitting and the lateral decubitus position with an ICare rebound tonometer before, and 1, 3, and 12?months after trabeculectomy.

Results

Twenty-nine eyes of 29 patients completed this study. The mean baseline IOP measured with the ICare tonometer was 17.4?±?4.9?mmHg in the sitting position and 21.3?±?5.6?mmHg in the lateral decubitus position (p?p?p?=?0.004 respectively). This decrease in the degree of posture-dependent IOP change was maintained at +1.7?±?2.2?mmHg at 1 year postoperatively (p?Conclusions Our results indicate that trabeculectomy not only reduces the IOP but also reduces the degree of posture-induced changes in the IOP. Our findings also speculate that measuring the postural IOP changes after trabeculectomy might provide a clue on the functioning of a filtering bleb.     

Combined clear cornea phacoemulsification in the treatment of pseudoexfoliative glaucoma associated with cataract: significance of trabecular aspiration and ab interno trabeculectomy

Background

In the present study, the effectiveness of combined cataract surgery and ab interno trabeculectomy (Trabectome) in exfoliation glaucoma (PEX) was compared with combined cataract surgery and trabecular aspiration.

Methods

In this retrospective comparative cohort outcome study, 27 consecutive patients (mean age 73.41 years?±?10.78) in group 1 suffering from visually significant cataract and PEX glaucoma (mean preoperative IOP 23.41 mmHg?±?5.86) were treated with phacoemulsification combined with Trabectome; and 28 consecutive patients (73.83 years?±?8.94) were treated with phacoemulsification combined with trabecular aspiration (mean preoperative IOP 22.22 mmHg?±?6.33). The intraocular pressure (IOP) and the number of antiglaucoma eyedrops before and after surgery were evaluated.

Results

Examinations were performed prior to surgery, 1 day, 6 weeks, 3 months, 6 months, and 1 year after surgery. In both groups there was a statistically significant decrease in postoperative IOP during the whole follow-up period. Comparing the two groups, there was a statistically significant lower IOP in the Trabectome group 1 day (p?=?0.019), 6 months (p?=?0.025), and 1 year (p?=?0.019) after surgery. Between the two groups, there was no statistically significant difference in the number of antiglaucoma eyedrops at any time.

Conclusions

Both procedures have the ability to significantly lower the postoperative IOP during the first year. However, clear cornea phacoemulsification combined with Trabectome seems to be more effective in IOP reduction in cases of PEX glaucoma associated with cataract.     

Late Needling mit 5-Fluorouracil bei drohender Sickerkissenvernarbung

Background

Evaluation of needling and 5-fluorouracil (5-FU) injections more than 4 months after preceding filtration surgery.

Patients and Method

Retrospective analysis of 17 eyes in 14 patients who underwent needling of the filtering bleb and administration of 5-FU by injection at least 4 months after trabeculectomy (TE) with mitomycin C (MMC; same surgeon throughout). Complete success was defined as a reduction of intraocular pressure (IOP) by >30% from the baseline value without further medication and, in cases of primary open-angle glaucoma, IOP of 18 mmHg. The mean period of follow-up was 8.1 months (3–24 months).

Results

One to four needlings (Ø 1.6) with one to five injections (Ø 3.1) of 5-FU were performed as required according to clinical need an average of 31.3 months (4–108 m) after TE. The mean baseline IOP was 25 mmHg (±SD 6.02; median 25 mmHg). After needling and 5-FU injection the mean IOD at the last hospital visit was 13.64 mmHg (±SD 5.2, median 13 mmHg; p<0,001). Complete success was achieved in 82.4% of these cases. The mean reduction in IOP was 11.2 mmHg (0–22 mmHg). In the cases with successful outcome (14 of 17 eyes) the mean IOP reduction from baseline was 55%. Three eyes required further treatment. Complications encountered were hyphaema (2 cases), subconjunctival bleeding (1 case) and corneal erosion (3 cases).

Conclusion

Late needling and injections of 5-FU can restore filtering bleb function even over 4 months after initial surgery. The high success rate and low incidence of complications together with the simple procedure justify regarding this approach as an alternative that can be used before passing on to more invasive interventions.     

Nonpenetrating very deep sclerectomy with hyaluronic acid implant vs trabeculectomy — a 2-year follow-up

Objective

To study and compare the efficacy and safety of nonpenetrating very deep sclerectomy (NPVDS) with the use of hyaluronic acid implant (SKGEL) to trabeculectomy (TB) in patients with with medically uncontrolled glaucoma.

Methods

Prospective, controlled study of patients with open-angle glaucoma was designed. Seventy-eight eyes of 68 patients with medically uncontrolled glaucoma were assigned either to the NPVDS or to the TB group of trial. Examinations were applied before and 7?days, 1, 3, 6, 12, 18, and 24?months after surgery.

Main outcome measure

Best-corrected logMAR visual acuity, intraocular pressure, number of additional procedures, antiglaucoma medications, number of complications.

Results

At 24?months, success rate defined as IOP?≤?21?mmHg with medication and additional procedures in NPVDS group was 92.31?%, and 94.88?% in control group (p?=?0.64). There was no statistically significant difference between intraocular pressure in NPVDS (14.56?±?4.07?mmHg ) and control (TB) (15.38?±?3.38?mmHg) group (p?=?0.34). Number of glaucoma mediations decreased from 2.18?±?0.56 to 0.54?±?0.56 in NPVDS and from 2.28?±?1.41 to 0.61?±?0.03 in TB group (p?=?0.71). Early and late postoperative complications included two cases of hyphema, two of choroidal detachment, two of filtering bleb fibrosis, four of cataract progression in the NPVDS group; and five cases of hyphema, four of choroidal detachment, one of filtering bleb fibrosis, one of blebitis, and 12 of cataract progression in the control group.

Conclusions

NPVDS is an effective surgical option for patients with medically uncontrolled glaucoma. NPVDS is associated with a lower risk of complications, and in particular cataract progression, compared to TB.

Application to clinical practice

NPVDS is a modification of NPDS devised for patients with medically uncontrolled open-angle glaucoma.     

Clinical results of selective laser trabeculoplasty in silicone oil-induced secondary glaucoma

Background

To analyze the efficacy of selective laser trabeculoplasty (SLT) on silicone oil-induced secondary glaucoma in terms of intraocular pressure (IOP).

Patients and Methods

42 patients (42 eyes) with silicone oil-induced secondary glaucoma were selected, and SLT was performed with 360° of the trabecular meshwork. During the 12-month follow-up, the complications, IOP, and antiglaucoma medication usage were observed.

Results

The mean IOP decreased from 23.1?±?1.9 mmHg before treatment to 18.4?±?3.7 mmHg after treatment (p?<?0.05). Mean number of antiglaucoma medications used for IOP control also decreased from 2.17?±?1.21 to 1.25?±?0.89 (p?<?0.05). The 12-month success rate in the total sample was 59.5 %. The success rate was 60.7 % (17 eyes) and 57.1 % (eight eyes) for phakic and aphakic eyes, respectively (p?>?0.05)

Conclusions

SLT is a safe and effective option for the treatment of patients with silicone oil-induced secondary glaucoma.     

Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma

Background

Cataract and glaucoma are both common comorbidities among older patients. Combining glaucoma surgery with minimal invasive phacoemulsification (phaco) is a considerable option to treat both conditions at the same time, although the combination with filtration surgery can produce a strong inflammatory response. Combined non-penetrating procedures like canaloplasty have shown to reduce intraocular pressure (IOP) comparable to trabeculectomy without the risk of serious bleb-related complications. The purpose of this retrospective study was to compare the outcomes of phacotrabeculectomy and phacocanaloplasty.

Methods

Thirty-nine eyes with concomitant cataract and glaucoma who underwent phacotrabeculectomy (n?=?20; 51.3%) or phacocanaloplasty (n?=?19; 48.7%) were included into this trial on reduction of IOP, use of medication, success rate, incidence of complications and postsurgical interventions. Complete success was defined as IOP reduction by 30% or more and to 21 mmHg or less (definition 1a) or IOP to less than 18 mmHg (definition 2a) without glaucoma medication.

Results

Over a 12-month follow-up, baseline IOP significantly decreased from 30.0 ± 5.3 mmHg with a mean of 2.5 ± 1.2 glaucoma medications to 11.7 ± 3.5 mmHg with a mean of 0.2 ± 0.4 medications in eyes with phacotrabeculectomy (P?<?.0001). Eyes with phacocanaloplasty had a preoperative IOP of 28.3 ± 4.1 mmHg and were on 2.8 ± 1.1 IOP-lowering drugs. At 12 months, IOP significantly decreased to 12.6 ± 2.1 mmHg and less glaucoma medications were necessary (mean 1.0 ± 1.5 topical medications; P?<?.05). 15 patients (78.9%) with phacotrabeculectomy and 9 patients (60.0%) in the phacocanaloplasty group showed complete success according to definition 1 and 2 after 1 year (P?=?.276). Postsurgical complications were seen in 7 patients (36.8%) of the phacocanaloplasty group which included intraoperative macroperforation of the trabeculo-Descemet membrane (5.3%), hyphema (21.1%) and bleb formation (10.5%). Although more complications were observed in the phacotrabeculectomy group, no statistically significant difference was found.

Conclusions

Phacocanaloplasty offers a new alternative to phacotrabeculectomy for treatment of concomitant glaucoma and cataract, although phacotrabeculectomy yielded in better results in terms of IOP maintained without glaucoma medications.     

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.     

Pattern-Laser-Trabekuloplastik und Argon-Laser-Trabekuloplastik zur Glaukombehandlung

Introduction

Argon laser trabeculoplasty (ALT) and pattern laser trabeculoplasty (PLT) are two laser surgery methods for treatment of open angle glaucoma and the effect in reducing intraocular pressure (IOP) of these methods was compared in a retrospective study.

Methods

The IOP, the best corrected visual acuity (BCVA) and the eye drop glaucoma medication used by patients who were treated by ALT or PLT in this clinic between January 2011 and December 2012 were compiled and evaluated.

Results

An ALT was carried out on 22 eyes from 22 patients (13 right and 9 left eyes in patients with an average age of 71.1?±?1.5 years, 7 men and 15 women) and a significant average reduction of IOP from 18.6?±?0.9 to 15.3?±?0.7 mmHg (p?Conclusion Both PLT and ALT are effective methods for treatment of open angle glaucoma and lead to similar significant reductions in IOP.     

Prognostic factors in trabeculectomy with mitomycin C having history of previous glaucoma surgery

Purpose

To evaluate the prognostic factors for surgical outcomes of subsequent trabeculectomy with mitomycin C (MMC) after prior incisional glaucoma surgery.

Methods

We reviewed medical records of a total cohort of 781 trabeculectomies with MMC, and selected 125 patients (125 eyes). The primary endpoints included persistent intraocular pressure (IOP) of ≥21 or <5 mmHg, the need for additional glaucoma surgery and deterioration of visual acuity to no light perception. Univariate and Multivariate analyses were performed by using the Cox proportional hazards model.

Results

The mean follow-up period was 26.8 months. The probabilities of success at 1, 2, and 3 years were 80.6, 72.2, and 70.6 %, respectively. Multivariate analysis showed that a shorter time interval between prior glaucoma surgery and subsequent trabeculectomy [relative risk (RR), 0.8867/year; P = 0.0090] and the number of prior trabeculectomies (RR, 2.2645; P = 0.0029) were significant prognostic factors for subsequent failure of trabeculectomy with MMC.

Conclusion

A short time period between prior glaucoma surgery and subsequent trabeculectomy and the number of prior trabeculectomies are associated with surgical failure of subsequent trabeculectomy with MMC.     

Pneumatic trabecular bypass versus trabeculotomy in the management of primary congenital glaucoma

Background

The optimal surgical management in primary congenital glaucoma (PCG) remains a subject of debate. The aim of this study was to assess efficacy of pneumatic trabecular bypass (PTB) in comparison to conventional trabeculotomy (T) in the treatment of PCG.

Methods

In a prospective comparative experimental study, one eye per child suffering from PCG underwent either PTB or T. Complete examinations were performed before surgery, postoperatively at one and seven days, then monthly for a minimum of six months. The main outcome measures were the IOP, number of IOP-lowering medications, change in cup/disc ratio, and corneal clarity.

Results

Seventeen eyes (patients) were operated on for PTB compared to 25 eyes (patients) in the T group. The mean (±SD, range) preoperative IOP in the PTB and T groups was 34.7 (6.4, 26–48) mmHg and 26.4 (6.6, 18–44) mmHg, respectively, and these dropped at six months of follow-up to 14.9 (3.6, 11–24) mmHg and 18.8 (8.0, 6–34) mmHg, respectively. The mean reductions of IOP were 55.87 %(±11) and 28.4 %(±28.8), (p?=?0.001), where those for cup/disc ratio were 39.0 %(±29) and 17.5 %(±39.7) (p?=?0.088) in the PTB and T groups, respectively. The number of IOP-lowering medications had dropped from 1.7?±?0.5 to 0.7?±?1.0 in PTB patients, compared to an insignificant change in the T group (0.64?±?0.9 & 0.62?±?0.9 pre- and post-operatively respectively). Corneal clarity improved in 13 eyes (76.5 %) in the PTB group, while three eyes (12 %) had worsened in the T group. Total cumulative chances for success were 88.2 % (15 out of 17 eyes), compared to 56 % (14 out of 25 eyes), in the PTB and T groups, respectively (p?=?0.027).

Conclusions

PTB is a promising surgical technique for the control of primary congenital glaucoma. A randomized controlled trial with a longer follow-up is recommended.     

Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application

Purpose

To examine the influence of different intravitreous injection techniques on the short-term intraocular pressure (IOP) in patients with exudative age-related macular degeneration (AMD) receiving 0.05 ml ranibizumab (Lucentis®) in the supine position.

Methods

Forty-five eyes (45 patients, 16 male, 29 female, mean age: 78 years) received intravitreal ranibizumab injections for treatment of exudative AMD (0.05 ml?=?0.5 mg). A total of 31 patients received a standard straight scleral incision, and 14 were injected using the tunneled sclera technique. IOP was measured by Schiøtz tonometry immediately pre-and postoperatively, and the amount of subconjunctival reflux was documented using a semi-quantitative scale. Twenty-three eyes were phakic, and the remaining 22 were pseudophakic. No history of glaucoma was present. The Wilcoxon matched-pairs test was used for comparisons.

Results

The mean preoperative IOP was 22.4?±?5.5 mmHg in the supine position. Immediately after the injection, the IOP increased to 47.9?±?15.1 (range 23–82). The mean difference between preoperative IOP and immediately after the injection was 25.5?±?13.6 mmHg. The mean IOP increase in eyes receiving a standard straight scleral incision was 21.9?±?14.2 mmHg (median 22.3) versus 33.5?±?7.2 mmHg (median 34.7) in the tunneled scleral incision group (p?=?0.001).

Conclusions

IOP increased significantly in a considerable number of patients after receiving 0.05-ml intravitreal ranibizumab injections. This increase was dependent on the intravitreal injection technique and was significantly higher if a tunneled scleral injection was performed.     

Long-term efficacy of goniosynechialysis combined with phacoemulsification for primary angle closure

Aims

To evaluate long-term efficacy of goniosynechialysis (GSL) combined with phacoemulsification and intraocular lens implantation (phaco-GSL) for primary angle closure or primary angle-closure glaucoma (PAC/PACG) and to analyze risk factors for surgical outcomes.

Methods

We reviewed medical records of 109 eyes of 109 patients (mean [± SD] age 70?±?9.4 years) who underwent phaco-GSL as primary treatment of PAC/PACG at five institutions. All eyes had a preoperative intraocular pressure (IOP) of ≥21 mmHg with or without medications. Surgical failure was defined as: (1) condition A: persistent IOP values of ≥21 mmHg, or (2) condition B: IOP values of ≥18 mmHg, with or without topical ocular medication, at two consecutive follow-up visits, or additional operations needed. Risk factors for surgical failure were analyzed via Cox proportional hazards model.

Results

Mean follow-up was 40.0 months (range, 1 to 139 months). Probabilities of treatment success at 1 and 3 years after phaco-GSL were 85.9 % and 85.9 % (condition A) and 66.2 % and 61.0 % (condition B) respectively. Via multivariable analysis, we identified risk factors for surgical failure to be younger age (relative risk [RR]?=?0.93/year, P?=?0.0333) and absence of postoperative laser peripheral iridoplasty (LPI) (P?=?0.0359) for condition A, and younger age (RR?=?0.94/year, P?=?0.0035), lower preoperative IOP (RR?=?0.93/mm Hg, P?=?0.0131), and absence of postoperative LPI (RR?=?2.34, P?=?0.0228) for condition B.

Conclusions

The outcome of phaco-GSL for PAC/PACG may depend on age, preoperative IOP, and postoperative LPI.     

Comparison of Fornix- and Limbus-Based Conjunctival Flaps in Mitomycin C Trabeculectomy with Laser Suture Lysis in Japanese Glaucoma Patients

Purpose

To analyze the results of mitomycin C (MMC) trabeculectomy and laser suture lysis using either fornix-based (FB) or limbus-based (LB) conjunctival flaps.

Methods

Eighty-two Japanese glaucoma patients were treated by MMC trabeculectomy, with 38 eyes receiving an FB conjunctival flap and 44 eyes receiving an LB conjunctival flap. Postoperative intraocular pressure (IOP), the probability of success, and complications were compared between the FB and LB groups.

Results

The IOP of the FB group decreased from 21.6 ± 7.90?mmHg to 9.75 ± 3.23?mmHg at 12 months postoperation, and the IOP of the LB group decreased from 21.3 ± 6.77?mmHg to 9.30 ± 3.16?mmHg. The postoperative IOPs were similar in the two groups at all postoperative time points. A life-table analysis (Kaplan-Meier method) showed that the survival rate was similar in the two groups but tended to be lower in the early postoperative period in the FB group. Complications were similar also, with the exception of increased leakage in the FB group.

Conclusions

MMC trabeculectomy results were similar between FB and LB conjunctival flaps, in agreement with previous reports. However, increased care may be warranted when an FB flap is used in MMC trabeculectomy.?Jpn J Ophthalmol 2006;50:338–344 © Japanese Ophthalmological Society 2006     

Retrospective observation on trabeculectomy of primary congenital glaucoma by applying biological amniotic membranes soaked with 5-fluorouracil

Purpose

To report our experience on treatment of primary congenital glaucoma with trabeculectomy in combination with biological amniotic membranes soaked with 5-fluorouracil.

Methods

This is a retrospective study. Thirty primary congenital glaucoma (PCG) patients (41 eyes) were treated with trabeculectomy in combination with biological amniotic membranes soaked with 5-fluorouracil before operation and followed up for 2.75 ± 1.35 years in average ranging from 1.2 to 5.3 years (Group A). In addition, 22 PCG patients (32 eyes) treated with mitomycin C-trabeculectomy were selected as control and followed up for 2.3 ± 1.25 years in average ranging from 1.4 to 5.1 years (Group B).

Results

Patients in Group A were 4.74 ± 2.13 years old. After treatment, their mean intraocular pressure decreased from preoperative 38.8 ± 11.3–17.6 ± 8.2 mmHg at 12 months of postoperation (P = 0.0000). At 12 months of follow-up, the intraocular pressure was less than 13 mmHg in 8 eyes (19.5%), between 17 and 13 mmHg in 15 eyes (36.6%), between 21 and 17 mmHg in 12 eyes (29.3%) and more than 21 mmHg in 6 eyes (14.6%). The overall success rate was 85.4%, and total complication rate was 17.1%. By comparison, the overall success rate and total complication rate were 87.5 and 34.4%, respectively, at 12 months of follow-up for patients in Group B. Although the overall success rate was not significantly different between Groups A and B (P = 0.1203) at the end of follow-up, the total complication rate was significantly decreased in Group A (P = 0.0419).

Conclusion

Application of trabeculectomy in combination with biological amniotic membranes soaked with 5-fluorouracil can be an effective surgical treatment method for primary congenital glaucoma 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.     

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.     

Electroretinography in streptozotocin diabetic rats following acute intraocular pressure elevation

Background

We consider whether pre-existing streptozotocin induced hyperglycemia in rats affects the ability of the eye to cope with a single episode of acute intraocular pressure (IOP) elevation.

Methods

Electroretinogram (ERG) responses were measured (?6.08 to 1.92 log cd.s.m^?2) in anaesthetized (60:5 mg/kg ketamine:xylazine) dark-adapted (>12 h) adult Sprague–Dawley rats 1 week after a single acute IOP elevation to 70 mmHg for 60 min. This was undertaken in rats treated 11 weeks earlier with streptozotocin (STZ, n?=?12, 50 mg/kg at 6 weeks of age) or citrate buffer (n?=?12). ERG responses were analyzed to derive an index of photoreceptor (a-wave), ON-bipolar (b-wave), amacrine (oscillatory potentials) and inner retinal (positive scotopic threshold response, pSTR) function.

Results

One week following acute IOP elevation there was a significant reduction of the ganglion cell pSTR (?35?±?11 %, P?=?0.0161) in STZ-injected animals. In contrast the pSTR in citrate-injected animals was not significant changed (+16?±?14 %). The negative component of the STR was unaffected by IOP elevation in either citrate or STZ-treated groups. Photoreceptoral (a-wave, citrate-control +4?±?3 %, STZ +4?±?5 %) and ON-bipolar cell (b-wave, control +4?±?3 %, STZ +4?±?5 %) mediated responses were not significantly affected by IOP elevation in either citrate- or STZ-injected rats. Finally, oscillatory potentials (citrate-control +8?±?23 %, STZ +1?±?17 %) were not reduced 1 week after IOP challenge.

Conclusions

The ganglion cell dominated pSTR was reduced following a single episode of IOP elevation in STZ diabetic, but not control rats. These data indicate that hyperglycemia renders the inner retina more susceptible to IOP elevation.     

Corneal biomechanical properties measured by the ocular response analyzer in acromegalic patients

Purpose

To investigate the effect of acromegaly on corneal biomechanical parameters.

Methods

This cross-sectional, comparative clinical study included 34 acromegalic patients and 30 age-matched and sex-matched healthy controls. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated intraocular pressure (IOPg and IOPcc, respectively) were measured using the Ocular Response Analyzer. Central corneal thickness (CCT) was determined with the ultrasonic pachymeter.

Results

The mean duration of disease for the acromegalic patients was 5.3 years. There was no significant difference between the groups regarding mean CH, CRF, IOPg and IOPcc values. The respective mean values in patients with acromegaly and controls were 10.3?±?2.2 and 9.5?±?1.5 mmHg (p?=?0.13) for CH; 10.5?±?2.4 and 9.7?±?1.7 mmHg (p?=?0.16) for CRF, 16.1?±?3.6 and 15.5?±?2.9 mmHg (p?=?0.49) for IOPg, 16.8?±?3.4 and 17.0?±?2.8 mmHg (p?=?0.82) for IOPcc, and 544.8?±?32.2 and 530.7?±?22.9 μm (p?=?0.05) for CCT. A significant moderate correlation was detected between the duration of acromegaly and IOPg OD (r?=?0.430, p?=?0.01). There was no significant correlation between other ocular parameters and levels of GH and IGF-1 at the time of diagnosis, the status of control, adenoma type, radiotherapy treatment, and drug usage.

Conclusions

In acromegalic patients, the duration of disease was correlated with IOPg OD level. Corneal biomechanical parameters and CCT values were not significantly different than those in age-matched and sex-matched healthy individuals.