Combined Phacoemulsification, Intraocular Lens Implantation and Trabeculectomy for Chronic Angle Closure Glaucoma

Purpose: To investigate the results of combined phacoemulsification, intraocular lens implantation and trabeculectomy in Asian patients with chronic angle closure glaucoma (CACG). Methods: This was a retrospective non-comparative case series of 55 consecutive patients (57 eyes) who underwent phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy for CACG at the Singapore National Eye Centre between 1997–1998. The surgical outcome was assessed in terms of intraocular pressure (IOP), the incidence of complications and the visual acuity at last follow-up. Success was defined as final IOP 21 mmHg without medication and qualified success as final IOP 21 mmHg with medication. Patients with final IOP > 21 mmHg who required further glaucoma surgery, lost light perception or became pthisical, were classified as failures. The eyes were further categorized into two groups according to whether single-site or separate-sitesurgery was performed. The outcome was also compared among eyes in which per-operative antimetabolites were applied to the trabeculectomy site and those without antimetabolites. Results: The mean follow up was 22.0 ± 5.6 months (mean ± SD). Success was achieved in 46 (81%) eyes, qualified success in 10 (17%) eyes, and failure in 1 (2%) eye. In terms of IOP outcome, the success rate was similar in the two surgical groups (single-site or separate-site).There was no significant difference in IOP outcome among eyes in which per-operative antimetabolites were used and eyes with no per-operativeantimetabolites use. Forty-one eyes (72%) had 6/12 or better vision. There were no cases of intraoperative complications and the incidence of postoperative complications was low. Conclusions: Combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with good intraocular pressure control and visual outcome in patients with CACG.     

A Study of Motion Perception in Primary Open Angle Glaucoma

Purpose: To study the features of the motion perception (MP) and explore the worth of the clinical application of MP test in primary open angle glaucoma (POAG).Methods: MPs were recorded from 41 patients (67 eyes) with POAG ang 56 normal subjects (112 eyes) by the MP software in PC compatible computer. Meanwhile , the MP ways and MP sites were analyzed and MP abnormal rate was compared to the clinical parameters and the visual function indices related to glaucoma. . Results: The results showed that the total abnormal rate of MP was 89. 5% in POAG, and the abnormal rate was 81. 6% in early stage of POAG, and MP abnormal degree had positive correlation with C/D, ocular tension and corrected loss variance (CLV), and negative correlation with visual acuity and mean sensitivity (MS), and no correlation with age and short-term fluctuation (SF) in the patients with POAG.Concusion: These results suggest that the MP test provides a newly effctive examination method in diagnosing the early POAG. Eye Science 1996;     

原发性开角型青光眼相关基因及发病机制研究进展

青光眼是一种视神经病变,是全球不可逆性失明的主要原因,其发病机制目前尚不完全清楚。近年 来,随着全基因组关联研究（GWAS）、家系研究和功能学研究的深入,人们对青光眼的分子基础和 复杂性的认识也有了较大的进展。原发性开角型青光眼（POAG）占全世界青光眼病例的70%左右, 且患病率一直在增加。POAG具有明显的遗传特征,但因其遗传方式复杂,仅有约10%的病例表现 为典型的孟德尔单基因遗传模式,其他的则可能是多个遗传因素的相互影响,或者是遗传因素和环 境因素共同作用的结果。目前已明确与青光眼直接相关基因达30余个,其编码蛋白参与了广泛的细 胞进程和生物系统,包括细胞外基质、细胞因子信号转导、脂质代谢、膜生物学、细胞分化、自噬和 眼发育的调节等生物学进程。本综述拟从内质网应激反应、肿瘤坏死因子-α信号通路与自噬调节、 TGF-β信号通路等几个重要的生物学角度来深入认识青光眼与基因之间的内在关联,进一步明确其 可能的发病机制。     

视网膜振荡电位对原发性开角型青光眼早期诊断的意义

目的:评价振荡电位(OPs)在原发性开角型青光眼早期诊断的作用。方法:比较33例(66眼)正常人和30例(58眼)原发性开角型青光眼患者OPs的变化特点,分析不同时期原发性开角型青光眼患者OPs的异常率,同时计算其敏感性和特异性,并与眼压、视力和C/D进行相关分析。结果:原发性开角型青光眼患者与正常人相比OPs总值下降,OPs子波个数减少;原发性开角型青光眼患者OPs总值总的异常率为67.24％,其中较早期为42.86％,早期为65.38％,中晚期为76.00％;OPs总值的敏感性和特异性为67.24％和92.42％;OPs与C/D具有相关性。结论:OPs可以作为原发性开角型青光眼视野改变出现前较早期或早期诊断的指标。眼科学报1996;12:88—92。     

原发性开角型青光眼和正常眼压性青光眼危险因素的研究

目的：探讨原发开角型青光眼（POAG）和正常眼压性青光眼（NTG）发病相关的危险因素。方法：对592例（1156眼）原发开角型青光眼和53例（100眼）正常眼压青光眼患者进行眼科常规检查,视野检查,屈光,血糖,血压检测,家庭史及药物史和全身病调查,结果：NTG组与POAG组相比较,在患病年龄的分布上有差异：POAG组以20－40岁年龄最常见,而NTG组以50－60岁年龄最常见;两组患者均有较高的近视患病率（POAG组为42．1％,NTG组为66．04％）,NTG组低血压患病率67．92％）,阳性家族史为20．75％,两者均明显高于POAG组,差异有显著性,结论：年龄,近视,低血压,青光眼家族史可能是POAG和NTG发病的重要因素。     

The Objective Measure of Color Vision in Primary Open Angle Glaucoma

Purpose: To objectively evaluate the clinical application of color pattern reversal visual e-voked potential (CPR-VEP) on primary open angle glaucoma (POAG). Methods: CPR-VEP and FM 100-hue test were performed in 31 eyes with POAG and 33 normal eyes. Color pattern stimulation was presented by color monitor controlled by computer program. The reversal rate of the stimulating pattern was 2 Hz and the spatial frequency of the stimulating was 0.53 cycle/degree. The color stimulating pattern include White /Black , Red/Black , Green/Black , Blue/Black , Yellow /Black , Red/Green and Blue /Yellow . Results : CPR-VEP P1 latencies were obviously prolonged in POAG group in comparison with normal control group in equiluminance. All CPR-VEP P1 amplitudes, except Blue/Black P1 amplitude, show no differences between POAG group and normal control group . Conclusion: P1 latencies of all CPR-VEP and P1 amplitude of Blue/Black CPR-VEP were parameters for identifing acquired dyschromatopsia caused by POAG. The results sho     

Efficacy of Combined Administration of 0.2% Brimonidine and 0.5% Betaxolol in Treatment of Primary Open Angle Glaucoma and Ocular Hypertension

Purpose： To observe the efficacy of combined use of bri- monidine and betaxolol in treatment of primary open angle glaucoma （POAG） and ocular hypertension. Methods- A total of 54 patients （90 eyes） with POAG and ocular hypertension were randomly divided into three groups （receiving betaxolol, brimonidine and combined administra- tion of betaxolol and brimonidine respectively）. The adminis- tration was given twice daily in all groups （0.5% betaxolol, 0.2% brimonidine and 0.5% betaxolol combined with 0.2% brimonidine）. The changes in intraocular pressure （IOP） were observed before, and 2, 4, 6, and 8 weeks after treatment. In addition, the adverse reactions were also recorded post-treat- ment. Results： The mean lOPs at all the time points after treatment were significantly reduced compared with pre-treatment levels （P〈0.05）. Patients receiving brimonidine had a greater reduc- tion in lOP compared with their counterparts in the betaxolol group but the difference was not statistically significant. The lOP decline was significantly higher in the combined therapy group than in the other two groups （P〈0.01）. Few cases presented with slight discomfort, such as sensation of foreign bodies, ocular irritation, dizziness, headache, fatigue, and dryness of mouth and nose. No severe adverse reactions were noted following administration.Conclusion： Combined use of brimonidine and betaxolol is an efficacious treatment of reducing IOP without severe side effects.     

Clinical Characteristics of Juvenile-onset Open Angle Glaucoma

PurposeTo demonstrate the clinical characteristics of juvenile-onset open angle glaucoma (JOAG) and to evaluate the prognostic factors for visual field (VF) progression in eyes with JOAG.MethodsThe medical records of 125 eyes of 72 patients with JOAG were analyzed retrospectively. At least four reliable VF tests were required to determine the VF progression, and the progression was defined using the modified Anderson criteria. Comparisons in clinical manifestations among groups were performed using independent t-test, and generalized estimating equations were also conducted.ResultsThe mean follow-up duration was 94.4 ± 50.5 months. Patients with JOAG showed a male preponderance (64 %), myopia (−4.99 ± 4.01 diopters) and a severe elevation of intraocular pressure (35.6 ± 10.8 mmHg). Forty-two JOAG patients (58 %) had complained of symptoms associated with vision and pain; however, one-third presented with no definite symptoms. Fifty-seven patients were diagnosed with JOAG in both eyes, and they were significantly older (p = 0.039) and had a greater family history (p = 0.035) than patients with unilateral JOAG. The progression group exhibited a significantly higher intraocular pressure at the last visit (p = 0.023) than the non-progression group.ConclusionsBecause patients with considerable JOAG had no definite symptoms, periodic eye examinations are needed. To prevent the VF''s progression, JOAG patients may require more careful management of intraocular pressure.     

剥脱性开角型青光眼与原发性开角型青光眼眼前节结构参数的比较

目的：比较剥脱性开角型青光眼（PXOAG）与原发性开角型青光眼（POAG）眼前节结构参数的差异。方法：病例对照研究。选取2012 年12 月至2016 年12 月住院治疗的连续PXOAG病例54 例（54 眼）作为PXOAG组,平均眼压为（28.8±7.9）mmHg（1 mmHg=0.133 kPa）。选取性别、年龄及眼压相匹配的POAG病例53 例（53 眼）作为POAG组,平均眼压为（26.3±7.4）mmHg。测定2 组患者角膜厚度、角膜内皮细胞密度、六角型细胞比例、前房深度及晶状体厚度等眼前节参数,并采用独立样本t 检验进行数据分析。结果：POAG组角膜厚度、角膜内皮细胞密度、六角型细胞比例、前房深度及晶状体厚度分别为（535±36）μm、 （2 538±356）/mm2、 （52±12）%、 （2.89±0.36）mm和（4.96±0.41）mm;PXOAG组相应参数分别为（523±41）μm、 （2 323±451）/mm2、 （52±14）%、 （2.79±0.60）mm和（4.98±0.42）mm。2 组患者角膜厚度、六角型细胞比例、前房深度及晶状体厚度比较差异无统计学意义（t =1.57、0.18、1.11、0.26,P ＞0.05）,而角膜内皮细胞密度比较差异有统计学意义（t =2.78,P =0.01）。结论：PXOAG与POAG相比,角膜内皮细胞密度较低,提示在临床治疗过程中应更加注意对角膜内皮的保护。     

荧光素浓度曲线法用于青光眼房水动力学

对原发性开角青光眼（POAG）51眼及对照组60眼作了房水荧光素浓度曲线（FCC）的测定，结果显示对照组房水FCC的荧光素下降率为82．61％，而POAG组的下降率为39．585，二者相比，P＜0．001，差别非常显著。POAG组早期（21眼）与中晚期（30眼）的荧光素下降率，分别为65．66％及28．96％，与对照组相比，P＜0．01，差别非常显著，对房水FCC测定作为POAG早期诊断的指标作出建议。     

Reduced Pulsatile Trabecular Meshwork Motion in Eyes With Primary Open Angle Glaucoma Using Phase-Sensitive Optical Coherence Tomography

PurposeThe purpose of this study was to investigate the difference in pulsatile trabecular meshwork (TM) motion between normal and eyes with POAG using phase-sensitive optical coherence tomography (PhS-OCT).MethodsIn this cross-sectional study, eight healthy subjects (16 eyes) and nine patients with POAG (18 eyes) were enrolled. A laboratory-based prototype PhS-OCT system was used to measure pulsatile TM motion. PhS-OCT images were analyzed to obtain parameters of pulsatile TM motion (i.e. maximum velocity [MV] and cumulative displacement [CDisp]). Outflow facility and ocular pulse amplitude were measured using pneumotonography. Detection sensitivity was compared among various parameters by calculating the area under the receiver operating characteristic curves (AUCs).ResultsA pulsatile TM motion waveform synchronous with digital pulse was observed using PhS-OCT in both healthy and POAG eyes. The mean MV in eyes with glaucoma was significantly lower than healthy eyes (P < 0.001). The mean CDisp in POAG eyes was also significantly lower than healthy eyes (P < 0.001). CDisp showed a significant correlation (r = 0.46; P = 0.0088) with ocular pulse amplitude in the study. Compared with the outflow facility, both the MV and CDisp were found to have a better discrimination of glaucoma (P < 0.001 and P = 0.0074, respectively).ConclusionsPulsatile TM motion was reduced in patients with POAG compared to healthy subjects. The underlying mechanism may be due to the altered tissue stiffness or other biomechanical properties of the TM in POAG eyes. Our evidence suggests that the measurement of pulsatile TM motion with PhS-OCT may help in characterizing outflow pathway abnormalities.     

Influence of Family History as a Risk Factor on Primary Angle Closure and Primary Open Angle Glaucoma in a Chinese population

Purpose: To identify the likelihood of family history as a risk factor for the presence and severity of primary angle closure (PAC) and primary open angle glaucoma (POAG) in a Chinese population.

Methods: All participants were asked to complete a questionnaire and undergo a comprehensive eye examination. Past history of hypertension, diabetes mellitus, hyperopia, high myopia, and family history of glaucoma were recorded. For those patients with a family history of glaucoma, the relationship between the patient and the affected relatives has been specified.

Results: A total of 332 PAC patients, 228 POAG patients and 193 controls were included. Of the 332 PAC patients, 83 (25.00%) had glaucoma family history. Characteristic-adjusted odds ratio (OR) of family history for PAC was 4.82 [95% confidence interval (CI): 2.08–11.19] and for severity of PAC was 1.61 (95% CI: 1.05–2.49). Among first-relatives only parents account for the family history rate of PAC [OR 8.76 (95% CI: 2.00–38.32)]. Of the 228 POAG patients, 49 (21.49%) had a family history of glaucoma. Odds ratio for POAG was 8.38 (95% CI: 3.33–21.07) and for severity of POAG was 1.81 (95% CI: 1.05–3.14). Unlike patients with PAC, only siblings and offspring account for the family history rate of POAG [OR 8.99 (95% CI: 2.38–33.99) and OR 19.23 (95% CI: 1.53–241.24) respectively].

Conclusion: Our study showed that a family history of glaucoma is associated with the presence and severity of PAC and POAG. This supports the finding that screening first-degree relatives will be an effective way to detect glaucoma in a population.     

Mechanism and Etiology of Primary Chronic Angle Closure Glaucoma

The ocular anatomic features, pupil-blocking force, status of angle synechiae closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary a-cute angle closure glaucoma (PAACG) by using ultrasonic biometry, computerized anterior ocular segment image processing technique, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG was shallower than that of PCACG; the pupil-blocking force of PAACG was stronger than that of PCACG; the status of angle synechiae closure of PCACG were mainly creeping synechiae closure; the positivity of mydriasis test was much higher (46. 01%) in PCACG than that (6. 8%) in PAACG after iridectomy. These facts suggest approximately half of the PCACG cases may be multi-mechanism to contribute to the angle closure besides the mechanism of pupillary block. Therefore, the authors emphasis that the pupillary block must be eliminated as well as the other mechanism for the treatment     

Studies of Primary Angle Qosure Glaucoma in China

The resent researches on primary angle closure glaucoma (PACG) in China were reviewed. The prevalence of PACG (0.41%) in chinese is between the Caucasian and Eskimos, and chronic type is the dominant type in PACG. However, with the economic development and medical care improvements, the prevalence condition of PACG may change; several researches discovered that the mechanism of PACG, especially the chronic type, is not only because of pupil-blocking but also closely related to the mechanism of crowding of peripheral iris and the anterior location of the ciliary body. We supposed that PACG can be divided into several subtypes based on this machnism. Also, we believe that the use of ultrasound biomicroscopy (UBM) and ophthalmic laser in China has promoted the research of PACG and improved the level of prevention and treatment of PACG. Eye Science 1997; 13 : 120- 124.     

Lack of Association Between LOXL1 Gene Polymorphisms and Primary Open Angle Glaucoma in the Saudi Arabian Population

Purpose: To investigate whether major single nucleotide polymorphisms (SNPs) in the LOXL1 gene associated with pseudoexfoliation glaucoma are associated with primary open angle glaucoma (POAG) in the Saudi Arabian population.

Methods: The regions of the LOXL1 gene associated with pseudoexfoliation glaucoma, encompassing the three common SNPs, (rs1048661, rs3825942 and rs2165241), were sequenced in a Saudi Arabian dataset consisting of 96 POAG cases and 101 healthy controls.

Results: The allele frequency of the G exfoliation risk allele for SNP rs1048661 in POAG cases and controls was 0.75 and 0.76 (p?=?0.886), respectively and the allele frequency difference was not statistically significant (p?=?0.866). There was no statistically significant difference in the genotypes between patients and controls (p?=?0.261 and 0.156 for genotypes G/G and G/T respectively). As for SNP rs3825942, the frequency of the “G” allele in the POAG patients was comparable to that in the controls (p?=?0.477) and there was no statistically significant difference in genotype G/G and A/G frequency in the study groups. As for SNP rs2165241, the “T” allele frequency in the POAG patients (0.46) was slightly higher than the frequency in controls (0.39), but this difference was not statistically significant (p?=?0.176).

Conclusion: The Saudi Arabian POAG population, similar to all other populations studied to date, demonstrates no association with SNPs associated with pseudoexfoliation glaucoma.     

Otago Glaucoma Surgery Outcome Study: long‐term results of 841 trabeculectomies

Background: To describe the long‐term outcomes of trabeculectomies performed at Dunedin Hospital and followed in the Otago Glaucoma Surgery Outcome Study. Methods: Prospective non‐comparative case series of 841 eyes of 607 patients who had first trabeculectomies for primary open‐ or closed‐angle glaucoma at Dunedin Hospital between 1976 and 2005 and followed for a mean of 7.5 years (standard deviation 6.0). Results: The probability of a trabeculectomy controlling the intraocular pressure at 21 mmHg or less at 1, 10 and 20 years was 0.96 (95% confidence interval [CI] 0.95, 0.97), 0.86 (95% CI 0.83, 0.89) and 0.79 (95% CI 0.74, 0.83), respectively. Visual acuity was maintained or improved between preoperative assessment and final follow up in 68% of cases. The probability of not being blind following trabeculectomy at 1, 10 and 20 years was 0.98 (95% CI 0.96, 0.98), 0.83 (95% CI 0.80, 0.87) and 0.70 (95% CI 0.64, 0.76), respectively. The proportion of those with glaucomatous field loss increased during follow up from 16% (44/283) at 0–5 years to 50% (10/20) for those with 21 or more years of follow up. A repeat drainage procedure was required in 65 eyes (8%) (56 Molteno implant insertions and 9 repeat trabeculectomies). Conclusions: Intraocular pressure was well controlled by trabeculectomy; however, a steady decline in intraocular pressure control, visual acuity and visual field occurred during follow up.     

Hemodynamics of Ophthalmic Artery and Central Retinal Artery and Correlation with Other Factors in Patients with Primary Open Angle Glaucoma

Objective : To investigate the hemodynamics of ophthalmic artery (OA) and central retinal artery (CRA) in patients with primary open angle glaucoma(POAG) and analyse the correlation between hemodynamics of OA and CRA and other factors.Methods:The hemodynamics of OA and CRA in normal persons (102 eyes) and glaucoma-tous patients (102 eyes) were measured by Colour Doppler Image (GDI). The linear correlation analysis was made between OA and CRA about each of the following parameters: the peak systolic flow velocity (Vmax), the end diastolic velocity (Vmin). The multiple step-wise regression analysis was taken to investigate the correlation between each of the following hemodynamics of OA and CRA; Vmax and Vmin in 74 eyes with POAG and each of the following related factors in hemorrheology; whole blood apparent viscosity at low, medium and high shear rate, plasma viscosity and hematocrit. The multiple linear regression was applied to investigate the correlation between each of the following hemodynamics of