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.     

开角型与闭角型青光眼色觉异常的对比研究

采用FM100－色彩有试验，对开角型与闭角型青光眼色觉损害的情况进行了对比观察，结果发现，两类青光眼色彩分辨力的损害，无论在波长区域或程度上，均无明显差异，认为眼压升高是引起色觉异常的始发因素，据此可以对两类青光眼色觉损害的相似性作出较为满意的解释。     

Glaucoma management trends in Australia and New Zealand

BACKGROUND: To describe self-reported patterns of care for glaucoma of ophthalmologists in Australia and New Zealand and summarize current practice styles and patterns associated with glaucoma management. METHODS: A questionnaire of glaucoma management practices was mailed to all ophthalmologists registered with the Royal Australian and New Zealand College of Ophthalmologists in June 2003. The questionnaire assessed practice preferences for medical management, examination techniques and indications for surgery. The results were cross-tabulated by age, country and subspecialty training in glaucoma. RESULTS: Fifty-one per cent of 761 surveys were returned, 14% being from glaucoma specialists. New Zealand ophthalmologists proceeded to surgical management of glaucoma earlier than did their Australian colleagues. Australian ophthalmologists tended to use argon laser trabeculoplasty more frequently. Ninety-six per cent of ophthalmologists routinely use gonioscopy in diagnosing glaucoma. Disc drawings and recording cup:disc ratios were the most commonly used methods of documenting disc morphology; glaucoma specialists were more likely to use imaging technologies. SITA-Standard 24-2 was the most commonly used modality of perimetry, and was favoured by glaucoma specialists. CONCLUSIONS: This survey represents the first Australian and New Zealand effort to identify glaucoma management practices. Although a substantial consensus was found in most areas of treatment, a few areas showed diversity. The information gathered will enable ophthalmologists to compare their own practices with those of their colleagues. In addition, this survey provides a baseline allowing future trends in management to be determined.     

Glaucoma prescribing trends in Australia and New Zealand

PURPOSE: To summarize current practice styles and patterns associated with glaucoma management in ophthalmologists of Australia and New Zealand as derived from a survey. METHOD: A questionnaire was sent to all Australian and New Zealand ophthalmologists, which anonymously assessed demographic characteristics and prescribing patterns for each major class of glaucoma medication. RESULTS: A total of 761 questionnaires were sent with a response rate of 51%. Of respondents 14% were glaucoma subspecialists. In 69%, the first-line drug-class of choice was a prostaglandin analogue. New Zealand ophthalmologists favoured beta-blockers as their first-line agent because of cost, government restrictions and familiarity. Most respondents stated "hypotensive efficacy" as the most important factor in class choice. Alpha-2-agonists, carbonic anhydrase inhibitors and miotics were considered second-line agents, because of side-effects and lack of hypotensive potency. CONCLUSIONS: The choice of first-line agent for the treatment of glaucoma differed between Australian and New Zealand ophthalmologists, in part as the result of government restriction of prostaglandin-class drugs. Practice patterns seen in Australasia parallel the current evidence base reported in peer-reviewed literature.     

Ocular Dominance in Open-angle Glaucoma: The Shifting Trend Depending on Stage of the Disease

PurposeTo investigate the characteristics and distribution of ocular dominance in primary open-angle glaucoma eyes. In addition, we tried to catch any trend of ocular dominance according to the stage of disease.MethodsTwo hundred participants with bilateral open-angle glaucoma underwent ocular dominant testing by “the hole-in-a-card” test. Using optical coherence tomography, macular ganglion cell-inner plexiform layer, as well as circumpapillary retinal nerve fiber layer thickness were measured and compared according to ocular dominance. Of the two eyes of one subject, the eye with less glaucomatous damage based on mean deviation was considered to be the “better eye” in our study.ResultsOcular dominance was in the right eye in 66% of the population and ocular dominance was positioned in the better eye in 70% of the population (p = 0.001 and p = 0.002, respectively). In conditional logistic regression analyses, right eye and better mean deviation were significantly associated with ocular dominance (p = 0.001 and p = 0.002, respectively). Ocular dominance tends to be present in the better eye and this trend was more apparent as the severity of glaucoma increased. Intereye comparison of visual field indices and retinal nerve fiber layer thickness between dominant versus nondominant eye become apparent in moderate and advanced glaucoma whereas it was not as apparent in early glaucoma.ConclusionsIn glaucomatous eyes, laterality and severity of glaucoma determined ocular dominance. Intereye difference between nondominant and dominant eyes increased with the severity of glaucoma. Our findings suggest the existence of potential reciprocal interactions between ocular dominance and glaucoma.     

重庆忠县原发性开角型青光眼家系的临床表型和遗传学分析

目的:对重庆POAG家系进行调查,分析遗传特点和临床表型。方法:追踪家系成员,收集病史资料,进行眼科常规检查。总结家系POAG患者发病的临床特点,根据孟德尔法则对本家系遗传方式进行分析。结果:该家系可追踪到的有5代共54例,男29例,女25例。已确诊的POAG患者17例,男11例,女6例,6例死亡。确诊年龄28~64(平均38.6)岁。发病眼眼压25~39mmHg,平均31.63±5.14mmHg。治疗后视野视力仍进行性恶化的7例。结论:该家系患者符合青年性POAG,常规治疗效果差,应存在除机械压迫以外的其他致病因素。家系中POAG发病者为突变等位基因常染色体显性遗传的结果,在本家系中存在导致POAG发病的突变的等位基因。     

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.     

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;     

How significant is a family history of glaucoma? Experience from the Glaucoma Inheritance Study in Tasmania

Purpose: To determine what proportion of primary open angle glaucoma (POAG) in Tasmania, Australia is familial. Methods: Between 1994 and 1996 an audit of Tasmanian patients diagnosed with glaucoma was performed. Identified probands along with their family members were invited to participate. Family history of POAG was noted and pedigrees constructed. Each participant underwent a detailed examination, including visual acuity, intraocular pressure measurement, gonioscopy, optic disc assessment and visual field testing. Participants were classified as normal, suspect or POAG. Data from 467 participants in the Twins Eye Study in Tasmania (TEST) were used as a reference for the general population. Results: Of 2062 participants examined, 1700 were classified as POAG. A total of 1014 participants (59.6%) belonged to families in which other members were affected (familial glaucoma). Six hundred and fifty‐six of these 1014 familial cases (64.8%) had a first‐degree relative affected. The number of affected members in the family groups varied from two to 29. Six hundred and eighty‐eight participants had no known family history of POAG (sporadic glaucoma). There were significantly more POAG patients with a family history of POAG compared to the TEST population (χ² = 161.81, P < 0.0001), and for a person with POAG the odds ratio of having a positive family history was 4.1 (95% confidence interval: 3.2–5.2). Conclusion: Approximately 60% of POAG in Tasmania is familial. This percentage is higher than most previous reports of familial glaucoma and emphasizes the importance of genetics in POAG, with major implications for screening and future research.     

Screening glaucoma genes in adult glaucoma suggests a multiallelic contribution of CYP1B1 to open-angle glaucoma phenotypes

Background: Despite increasing knowledge of the genetic pathophysiology of glaucoma, mutations in known genes account for less than 15% of disease. Gene screening predominantly remains a research tool rather than an essential part of the clinical work‐up. We aimed to determine the mutational spectrum and frequency in the genes implicated in glaucoma, in a range of glaucoma and ‘glaucoma suspect’ (GS) participants, with a positive family history. Methods: Observational large case series. One hundred fifteen patients recruited from public hospital and private clinics had diagnoses of GS, ocular hypertension, pseudoexfoliative glaucoma (PXG) or primary open‐angle glaucoma (POAG), and at least one affected family member. In a university laboratory, DNA samples were screened for mutations in all coding exons of MYOC and CYP1B1, and OPTN (exons 4, 5 and 16). WDR36 (exons 1, 4, 5, 8, 11, 13 and 17) was screened in those with CYP1B1 changes. LOXL1 risk variants were screened in PXG pedigrees. Cascade screening of family members was undertaken. Results: Seven out of one hundred fifteen (6.1%) individuals had at least one pathogenic or hypomorphic CYP1B1 allele associated with GS, POAG (5) and PXG phenotypes, including two novel sequence variations (p.Ser6Gly, p.Val243Leu). No pathogenic MYOC change was detected. Five individuals (4.3%) carried an OPTN sequence variation. Three of the seven with CYP1B1 changes had polygenic changes. Conclusions: Mutational analysis of known glaucoma genes in a mixed glaucoma population replicates the reported frequency of pathogenic CYP1B1 changes. Heterozygous CYP1B1 changes occurred at a greater frequency than other genes. Glaucoma pathogenesis in the clinic setting is genetically heterogeneous and may be polygenic.     

Characteristics of Undiagnosed Primary Open-Angle Glaucoma: The Tajimi Study

Purpose: To evaluate the characteristics of patients with previously undiagnosed primary open-angle glaucoma (POAG) in the Tajimi Study.

Methods: Background and ophthalmic examination data from 111 patients previously undiagnosed with POAG from the Tajimi Study, a population-based survey of glaucoma, were analyzed and compared with those of eight patients with previously diagnosed glaucoma.

Results: The mean deviation (MD) and vertical cup-to-disc ratio (vC/D) of the worse eye of each patient averaged ?5.5 decibels (dB) and 0.72 and ?10.4?dB and 0.83, respectively, in undiagnosed and diagnosed POAG. In undiagnosed POAG, arcuate and partial arcuate patterns accounted for 50% of the pattern of the visual field (VF) damage, and 95% of patients presented with intraocular pressure of 21?mmHg or less (normal tension glaucoma). The undiagnosed group had better MD and smaller vC/D values in the worse eye and less involvement of bilateral VFs than the diagnosed group (p?=?0.004–0.050 with Bonferroni correction), while other factors, including mean sensitivity of the binocular VF, showed no intergroup difference.

Conclusion: The characteristics of Japanese patients with previously undiagnosed POAG indicated that bilateral evaluation of the optic disc and VF are important for identifying individuals with glaucoma.     

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。     

急慢性閉角型青光眼小梁切除後淺前房發生率對比觀察

目的比較急性閉角型青光眼、慢性閉角型青光眼小梁切除術後淺前房的發生情况.方法對410祗實施小梁切除術的原發性閉角型青光眼進行回顧性總結.結果 99祗眼發生淺前房,占總數24.1%,其中急性閉角型青光眼69祗眼,發生率爲22.3%;慢性閉角型青光眼爲30祗眼,發生率爲29.7%.結論淺前房在慢性開角型青光眼中的發生率高于急性閉角型青光眼.     

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.     

Sutureless Scleral Tunnel Trabeculectomy: Evaluation of Feasibility and Effectiveness versus Conventional Trabeculectomy for Management of Primary Open Angle Glaucoma

Purpose: To evaluate the intraocular pressure-lowering effect of sutureless scleral tunnel trabeculectomy with Mitomycin-C (MMC) compared to the standard trabeculectomy with MMC in patients with primary open angle glaucoma (POAG). Methods: This was a masked, randomized, controlled comparison trial involving 34 eyes of 34 patients with bilateral POAG. Patients were randomized to receive sutureless sclera flap trabeculectomy with MMC or conventional trabeculectomy with MMC. The main outcome for comparison was the IOP-lowering effect of both procedures. Complete surgical success was considered if the patient’s IOP was <22 mmHg and the IOP were lowered by more than 20% with the use of maximum two anti-glaucoma medications. Results: All surgeries passed uneventfully without intraoperative complications and all patients showed significantly (p<0.05) lower IOP on the first postoperative day compared to their respective preoperative IOP with non-significant (p>0.05) difference between both study groups. All patients, irrespective of operative procedure, maintained significantly (p<0.05) lower IOP compared to their respective preoperative IOP until the end of 12 months’ follow-up. There were no recorded serious postoperative complications in either groups, like wound leaks or endophthalmitis. Conclusion: Sutureless scleral tunnel trabeculectomy exhibits potential as an alternative to conventional trabeculectomy surgery. Over 12 months of follow-up, sutureless sclera flap trabeculectomy was safe and effective with an IOP-lowering effect comparable to that achieved with the conventional technique, but with increased rate of postoperative transient hypotony.     

Motion Perception of Short-Wavelength Sensitive Cones in Glaucoma Using Random Dots Moving

Purpose: To determine whether motion perception of short-wavelength sensitive (SWS) cones is capable of predicting primary open angle glaucoma (POAG) optic neuropathy. Methods: Motion perceptions of SWS cones were isolated by Blue random dot stimulus displayed on the Yellow background, then the detecting displacement threshold of motion perception from SWS cone in POAG was measured, and compared with the age-matched normal group.Results: The detecting displacement thresholds of motion perception from SWS cones in 8 sites of 15 degrees were all elevated in POAG compared with the normal group. Conclusion: These findings suggest that motion perception of SWS cones may reveal preclinical visual nerve damage in early POAG. Eye Science 2001; 17:176 ~ 179.     

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