Pattern electroretinogram in glaucoma and ocular hypertension

We recorded the pattern electroretinogram (PERG) to small (0.8°) and very large (15°) check sizes in normal subjects, in patients with early-stage glaucoma, and in patients with ocular hypertension. In glaucoma, the PERG amplitude was reduced. This reduction was more prominent for a check size of 0.8° as compared with 15° stimuli and for high (16/s) as compared with low (7.8/s) reversal rates. Using a discriminant analysis of the amplitudes for two different check sizes, we could distinguish the normal and the glaucoma groups with a specificity of 96% and a sensitivity of 91%. Of the ocular hypertension patients, 43% were classified as pathologic by the discriminant analysis. Thus multivariate analysis of the PERG may increase its diagnostic value.     

Pattern electroretinogram as a function of spatial frequency in ocular hypertension and early glaucoma

Pattern electroretinograms (PERGs) in response to 8.3 Hz alternating gratings (16.6 rev/sec) of different spatial frequencies were recorded in normal subjects as well as in patients affected by early glaucoma and ocular hypertension. In normal subjects the PERG response is spatially tuned, with a maximum at about 1.5 cycles/deg and attenuation at higher and lower spatial frequencies. In all cases of early glaucoma and in the great majority of cases of ocular hypertension the PERG was reduced, as compared with that of normal subjects, mainly in the medium range of spatial frequencies (at which the PERG has its maximal amplitude).     

Pattern electroretinograms in ocular hypertension

The authors recorded pattern electroretinograms at different spatial frequencies in 16 patients affected with ocular hypertension. In 12 of these subjects the electroretinograms dropped in amplitude around 2 cycles/degree. The authors attributed this finding to ocular hypertension, hypothesizing ischemic damage at the head of the optic nerve with consequent fiber atrophy and degeneration of ganglion cells.     

Pattern reversal retinal potentials in ocular hypertensives at high and low risk of developing glaucoma

The human pattern-reversal retinal potential (PRRP) is a bioelectrical response which reflects neural activity generated in the proximal retina. Visual diseases which affect the retinal ganglion cells and the optic nerve often produce significant reductions in the amplitude of the PRRP. PRRP amplitude reductions are frequently observed in patients with primary open-angle glaucoma. This investigation was designed to determine whether patients with ocular hypertension who are at risk of developing glaucoma also exhibit PRRP amplitude reductions. The results indicate that PRRP amplitude reductions do occur in some ocular hyptertensives, but many other ocular hypertensives do not exhibit PRRP abnormalities.Supported in part by Research Grant EY 04464 from the National Eye Institute.     

Observations on color vision testing in ocular hypertension and glaucoma

Forty-eight patients aged from 60 to 69 years (58 eyes) with ocular hypertension (OHT) or primary open angle glaucoma (POAG) and a control group of 16 persons (31 eyes) were studied with six color vision tests: Standard Pseudoisochromatic Plates Part 2, Farnsworth Panel D 15, Farnsworth-Munsell 100-hue (FM 100) test, Lanthony Desaturated Panel, Nagel (red-green) anomaloscope, and Besançon (blue) anomalometer. In the color vision tests, the newly diagnosed OHT eyes without treatment differed significantly from the control group in the blue anomalometer. The long-term OHT eyes with treatment had no significant difference from the normals in any of the tests. The newly diagnosed POAG eyes without treatment were significantly different from the normals in the FM 100 test as well as in the boxes I, II, III and IV of the test, in the Lanthony Desaturated Panel and in the blue anomalometer. The long-term POAG eyes with treatment only differed significantly from the normal eyes in the blue anomalometer. The box IV of the FM 100 test and blue anomalometer were observed to be the most useful of these six tests in finding the possible early beginning of the blue color vision defect in the group of newly diagnosed OHT.Abbreviations AQ anomalous quotient - FM 100 Farnsworth-Munsell 100 hue test - IOP intraocular pressure - MR matching range - OHT ocular hypertension - POAG primary open angle glaucoma - SD standard deviation - SPP2 Standard Pseudoisochromatic Plates part 2     

糖皮质类固醇相关的高眼压症或青光眼——对定义及分类的初步认识

本文对１９例用糖皮质类固醇（激素）后眼压升高的患者进行了全面检查和追踪观察。综合分析患者用药前、后特别是停药后的眼压、房角、眼底、视野等资料后,分为以下４组：①３例药前各项检查正常,药后眼压升高,停药后观察２～４月,眼压尚需用降眼压药维持;但眼底、视野正常。②９例药前各项检查正常,药后眼压短期内升高,停药后各项检查正常。③５例药前或药后追查证实药前已有眼压、房角等异常;药后眼压显著升高,停药后不能恢复正常。④２例药前各项检查正常,药后眼压升高并已造成视盘、视野损害。根据以上结果,对糖皮质类固醇相关的高眼压症或青光眼之定义及分类提出了初步认识。     

小儿糖皮质激素性高眼压和青光眼46例临床分析

目的:分析小儿糖皮质激素性高眼压和青光眼的病因、临床特点及治疗效果.方法:回顾分析46例84眼糖皮质激素性高眼压和青光眼患者病史,并给予相应的治疗.结果:患儿46例经停用激素、局部或联合全身应用降眼压药物后,眼压均能控制正常.结论:小儿糖皮质激素性高眼压和青光眼中,用药剂量、持续时间、药物种类对其发生都有影响,治疗后均可得到满意的疗效.     

Efficacy and safety of bimatoprost in glaucoma and ocular hypertension in non-responder patients

AIM: To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension (OHT) patients with inadequate intraocular pressure (IOP)on current therapy. METHODS: Pre- and post-switch IOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in IOP post-pre switch was analyzed using a 2-sided Student''s paired t-test at the 5% significance level. RESULTS: There was a statistically significant mean reduction in IOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment (P<0.001). Subgroup analysis also demonstrated a statistically significant mean reduction in IOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy (P<0.001). CONCLUSION: This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.     

Management of ocular hypertension and primary open angle glaucoma

Background : Glaucoma and pcular hypertension are among the most common pathologies encountered in clinical practice. Within the next 20 years, patients with these two problems will increase threefold as the population ages. The growing burden of glaucoma worldwide will also become a significant public health problem. The effective management of glaucoma will require the introduction of new screening strategies and better therapeutic approaches to these disorders. Methods : Our current understanding of the epidemiology of primary open angle glaucoma and ocular hypertension is reviewed. Diagnosis and treatment strategies are discussed in the context of the current best available clinical trial and laboratory data. Results : While few patients with ocular hypertension will require therapy, it is the conventional practice to lower the intraocular pressure by at least one‐third once glaucomatous optic neuropathy is detected. Topical beta‐adrenergic antagonists have been the preferred first‐line therapy for primary open angle glaucoma for the past 20 years, but with the advent of topical prostaglandin analogues and alpha‐2 agonists, the effectiveness of medical therapy has improved significantly. The decision to perform glaucoma filtering surgery or laser trabeculoplasty must be carefully considered and based on the past response to medication, the extent and rate of progression of any visual field loss, and on the life expectancy and wishes of the patient. Conclusion : The treatment of chronic glaucoma is directed at preserving vision and interfering with the quality of life of the patient as little as possible. Many older patients who develop primary open angle glaucoma may have a limited life expectancy and do not require aggressive medical therapy or surgery. Many new medications have become available that permit less frequent dosing with fewer local and systemic side‐effects. In the near future, therapies that address the underlying molecular basis of glaucomatous optic neuropathy might become available and further reduce the risk of glaucoma blindness.     

拉坦前列腺素与噻吗心安治疗原发性开角型青光眼和高眼压症对照研究

目的　以噻吗心安为对照,评估新型异丙酯前列腺素Ｆ２α的苯基替代衍生物拉坦前列腺素（ＰｈＸＡ４１）对于眼压升高病人的降眼压疗效和副作用。方法　３４ 例（６６ 只眼） 原发性开角型青光眼或高眼压症患者入选,随机分组,１７ 例（３２ 只眼）滴用０．０５ｇ·Ｌ－１ 拉坦前列腺素每天１ 次,１７ 例（３４ 只眼）滴用５ｇ·Ｌ－１ 噻吗心安每天２ 次,共治疗１２ｗｋ。结果　１２ｗｋ治疗期间,两种药物均能有效降低眼压（Ｐ＜ ０－０１） ,且效应持续。各次随访均显示,拉坦前腺素的降眼压效果显著优于噻吗心安（Ｐ＜ ０－０５）。１２ｍｏ 时,拉坦前列腺素组的眼压降低了９－５±３－１ｍ ｍＨｇ（３６－８ ％）（１ｍ ｍＨｇ＝ ０．１３３ｋＰａ） ,噻吗心安组降低了７－４±２－６ｍ ｍＨｇ（２９－６％ ）（ Ｐ＜ ０－０１）。拉坦前列腺素治疗后,少数病例发现角膜上皮点状脱落。噻吗心安组的平均心率减少４ 次·ｍｉｎ－１（Ｐ＜ ０－０５） 。结论　０ ．０５ｇ·Ｌ－１ 拉坦前列腺素每天１ 次与５ｇ·Ｌ－１ 噻吗心安每天２ 次相比,具有更强的降眼压作用,而且耐受性良好。因此,拉坦前列腺素将成为青光眼药物治疗的有效选择。     

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Purpose:Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN).Methods:In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan–Meier graph was used to demonstrate the survival status of the eyes.Results:Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%).Conclusion:Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).     

真空小梁成形术对原发性开角型青光眼及高眼压症的降眼压作用的初步研究

目的观察真空小梁成形术（PNT）对国人原发性开角型青光眼（POAG）及高眼压症患者的降眼压效果。设计前瞻性病例系列。研究对象北京同仁医院2008年11月至2009年2月就诊的POAG及高眼压症患者30例（30眼）。方法人选患者进行眼科一般检查、前房角镜及Humphrey视野检查,测量眼压（压平眼压计）。患者单眼或双眼进行PNT1000型治疗仪（Ophthalmic International公司产）治疗。治疗后1小时、1天、1周、2周、1个月、2个月复查。首次治疗后第7天重复治疗一次。单眼治疗者选治疗眼,双眼者随机选1眼,进行重复测量的方差分析。主要指标眼压。结果30例患者治疗前眼压（23．2±5．3）mmHg,平均应用局部降眼压药物1．47种（0—5种）,治疗后1天、1周、2周、1个月、2个月各时间点眼压分别为（20．0±5．0）mmHg、（19．8±3．8）mmHg、（19．7±4．0）mmHg、（19．3±3．9）mmHg、（19．8±4．0）mmHg,眼压下降幅度分别为3．2mmHg、3．4mmHg、3．5mmHg、3．9mmHg、3．4mmHg,各时间点较治疗前眼压差异有统计学意义（P均〈0．001）.23例（83％）治疗后眼压下降≥15％。结论本文的短期小样本研究显示,真空小梁成形术可安全有效地降低POAG及高眼压症患者的眼压。     

Retinal vascular accidents in glaucoma and ocular hypertension

The incidence of primary open angle glaucoma in patients with central retinal vein occulusion is reported to be between 5.7 and 66%, while that of primary angle closure glaucoma is from 0 to 9%. (Corrected for the relative incidence of these two types of glaucoma in the general population, these rates are comparable.) There appears to be a causal relationship between elevated intraocular pressure and central retinal vein occlusion, which does not correlate with the height to which the pressure is elevated. Other etiologic factors may be important, particularly arteriosclerosis. The association between elevated pressure and branch vein occlusion is less clear. Central vein occlusions occur in 3.5 to 5% of patients with primary open angle glaucoma. Similarly, central vein occlusions occur in approximately 3% of patients with ocular hypertension. It is recommended that ocular hypertensive patients over the age of 65 be treated to lower their pressure below 25 mm Hg.     

曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症

目的：研究曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症的降眼压效果及安全性。方法：随机选取2013-03/2016-03我院收治的原发性开角型青光眼和高眼压症患者80例80眼,依据不同治疗方法分为两组：曲伏前列素滴眼液组( n=40)和拉坦前列素滴眼液组(n=40),对两组患者的临床疗效、视力、散光度、眼压及不良反应发生情况进行统计分析。结果：曲伏前列素滴眼液组患者治疗的总有效率95%(38/40)显著高于拉坦前列素滴眼液组80%(32/40),差异有统计学意义(P<0.05)。曲伏前列素滴眼液组患者治疗后视力显著高于拉坦前列素滴眼液组,差异有统计学意义(P<0.05),散光度、眼压均显著低于拉坦前列素滴眼液组,差异有统计学意义(P<0.05),不良反应发生率25%(10/40)显著低于拉坦前列素滴眼液组53%(21/40),差异有统计学意义(P<0.05)。结论：曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症比拉坦前列素滴眼液具有较好的降眼压效果及较高的安全性。     

Effect of epigallocatechin-gallate on inner retinal function in ocular hypertension and glaucoma: A short-term study by pattern electroretinogram

Background  Epigallocatechin-gallate (EGCG) is a powerful antioxidant with suggested neuroprotective action. The aim of this study was to evaluate the effect of short-term supplementation of EGCG on inner retinal function in ocular hypertension (OHT) and open-angle glaucoma (OAG). Methods  Eighteen OHT and 18 OAG patients (perimetric mean deviation: >−10 dB) were randomly assigned to assume oral placebo or EGCG over a 3-month period in a randomized, placebo-controlled, double-blind, cross-over design clinical trial (clinicaltrials.gov identifier: NCT00476138). Pattern-evoked electroretinograms (PERGs) to 1.6 cycles/degree square-wave gratings, counterphased at 16 reversals/second, and standard automated perimetry (Humphrey 30–2) were assessed at the study entry (baseline), and after 3 months of placebo or EGCG. Results  After EGCG, PERGs of OAG, but not OHT patients were increased in amplitude, compared either to baseline values (mean amplitude change: 0.06 log μV, p < 0.05) or to PERG amplitude values found in the same patients after placebo administration (mean change: −0.02 log μV, p not significant; difference between EGCG and placebo: 0.08 log μV, p < 0.05). In both OHT and OAG patients, standard automated perimetry did not show significant changes after either EGCG or placebo. In individual OAG patients, the magnitude of PERG amplitude increment after EGCG was inversely related (r = −0.8, p < 0.01) to corresponding baseline amplitudes. Conclusions  Although this study cannot provide evidence for long-term benefit of EGCG supplementation in OAG, and the observed effect is small, the results suggest that EGCG might favourably influence inner retinal function in eyes with early to moderately advanced glaucomatous damage. Drs Falsini and Marangoni contributed equally to this article     

The assessment of structural changes on optic nerve head and macula in primary open angle glaucoma and ocular hypertension

AIM: To assess morphological changes in macula, retinal nerve fiber layer (RNFL) and optic nevre head (ONH) of cases with primary open angle glaucoma (POAG) and ocular hypertension (OH) with spectral domain optic coherence tomography (OCT). METHODS: This study included 109 eyes from 62 POAG patients, 50 eyes from 30 OH patients, and 101 eyes from 53 healthy volunteers. Data gained by OCT were compared with perimetry indexes. ONH, RNFL and macula analysis were performed for all subjects. Rim area, disc area, average cup/disc (C/D) ratio, vertical C/D ratio, cup volume data were recorded during ONH analysis. Average RNFL thickness and the thickness of four quadrants (superior, inferior, nasal and temporal) was established in microns. In total, nine macular quadrants involving the foveal region mentioned in the Early Treatment Diabetic Treatment Study (ETDRS) template were measured, and average macular thickness and macular volume data were recorded during macula analysis. Differences between groups were evaluated with the one-way ANOVA test. Tukey’s multiple comparison test was performed to detect difference between groups. Receiver-operating characteristic (ROC) analysis was done for early stage POAG patients to establish sensitivity and specificity of chosen parameters in early stage POAG. Area under the receiver operating characteristic (AUROC) values were calculated to compare ROC areas. RESULTS: Statistically significant differences were found in all ONH parameters, except optic disc area. Neuroretinal rim area was identified as the parameter with the highest difference between groups (F=21.72, P<0.05). The highest correlation between ONH parameters and perimetry was observed at neuroretinal rim region (r=0.487). Inferior RNFL thickness was established as the parameter with the highest difference between groups among RNFL parameters. In the mean of all glaucoma patients, the highest correlation between data handled with OCT and mean deviation was observed in RNFL thickness. Average macular thickness was detected as the parameter with the highest difference between groups among macular parameters. The highest correlation between macula parameters and perimetry indexes was observed between average macular thickness and perimetry indexes (r=0.514). CONCLUSION: Although the assessment of ONH and the analysis of macular thickness are important in diagnosis and treatment, RNFL assessment is the most valuable parameter.     

国产拉坦前列腺素治疗开角型青光眼和高眼压症的疗效及安全性

目的:观察国产拉坦前列腺素滴眼液(见康)治疗开角型青光眼和高眼压症的临床疗效及安全性。方法:采用随机、单盲对照研究。原发性开角型青光眼或高眼压症的患者90例随机分三组,试验组:国产0.05g/L拉坦前列腺素(见康);对照组1:进口0.05g/L拉坦前列腺素(适利达);对照组2:0.04g/L曲伏前列素(苏为坦),每组30例患者。三组患者均9:00pm给药1次,疗程4wk。结果:用药2wk后,三组间治疗后眼压差异无统计学意义(P=0.673)。治疗4wk后,三组日眼压曲线各时间点眼压下降值差异无统计学意义。三组病例中均有轻度结膜充血的患者,试验组4例(13%),对照组1:3例(10%),对照组2:8例(27%)。结论:国产拉坦前列素滴眼液(见康)可有效降低眼压,安全性好,为治疗开角型青光眼及高眼压症提供了新的选择。     

Effect of IOP on the visual field in ocular hypertension and glaucoma

The traditional opinion that increased intraocular pressure is the cause of glaucoma is controversial, probably mainly because of the fact that firm evidence for the value of pressure reduction is largely lacking. The present article reviews results from short term studies of visual fields before and after pressure reduction. It also reviews published and unpublished preliminary results from studies addressing the problem of whether the long term visual field prognosis, in glaucoma and inocular hypertension, is affected by pressure lowering therapy.There is no convincing agreement among results from modern studies using computerized perimetry indicating that acute lowering of the ocular tension results in an improvement of the glaucomatous visual field. Long-term result are equally conflicting, and often negative. We have noted from a preliminary analysis of our own masked, prospective study of patients with high risk ocular hypertension, that the same results may be interpreted in quite different ways.The results of available studies certainly indicate that pressure reduction does not automatically lead to clear and positive effects on the visual field. The studies have often been small, however, and have usually not had the power of detecting small effects of treatment. Also, pressure reduction has usually not been dramatic and many treated patients have maintained elevated pressure levels. Patients with very high pressures have not been included, and the effect of pressure reduction in this situation has therefore not been investigated at all. More controlled, prospective therapeutic studies are necessary and ethical. It seems particularly important to study the long-term effects of non-pharmacologically induced pressure reduction in patients with manifest field loss. It is necessary to make every effort to avoid bias not only in the design of such studies, but also in the interpretation of their results.     

Color pattern-reversal visual evoked potential in eyes with ocular hypertension and primary open-angle glaucoma

Color pattern-reversal visual evoked potential testing was performed in 99 normal eyes, 27 eyes with ocular hypertension and 30 eyes with primary open-angle glaucoma with the use of black-white, black-red and black-blue color checkerboard stimuli. The PI wave peak time and amplitude of the eyes with ocular hypertension and glaucoma were significantly different from those of age-similar normal eyes, especially on the black-red and black-blue checkerboards (p < 0.001). The differences between the ocular hypertensive and glaucomatous eyes were of less significance. The P1 peak time difference between black-white and black-red checkerboards may serve as an important parameter in the early diagnosis of glaucoma.Abbreviations OH ocular hypertension - POAG primary open-angle glaucoma - NC normal control - CPRVEP color pattern-reversal visual evoked potential     

小梁切除联合前房穿刺术治疗青光眼持续高眼压

目的探讨小梁切除联合前房穿刺术治疗青光眼持续高眼压的有效性及安全性。方法22例（23眼）经最大剂量降眼压药物治疗后眼压仍≥40mmHg（1kPa=7．5mmHg）的顽固性高眼压患者，在小梁切除术前先行两次前房穿刺，使眼压平稳下降，避免术中眼压骤降。结果手术并发症少，无一例发生暴发性脉络膜出血、眼内出血、恶性青光眼等严重并发症。随访6个月～2年，平均16．5个月，90．0％的患者眼压控制正常。结论小梁切除联合前房穿刺术能有效防止术中眼压骤降的危险，减少手术并发症是安全有效的。