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

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

Diurnal variation of intraocular pressure in primary open-angle glaucoma.

Intraocular pressure was measured with a Goldmann applanation tonometer in 12 normal individuals (24 eyes), 14 ocular hypertensives (28 eyes), and 14 patients (27 eyes) with primary open-angle glaucoma every hour for 24 hours. In most subjects, pressure was highest sometime during the day and pressure elevation before rising was not demonstrated. The lowest intraocular pressure was most frequently observed early in the morning, whether the patient was normotensive or hypertensive. Fourteen of 27 glaucomatous eyes had intraocular pressure below 20 mm Hg early in the morning.     

Posture-induced changes in intraocular pressure: comparison of pseudoexfoliation glaucoma and primary open-angle glaucoma

Purpose

The objective of this study was to evaluate and compare the IOP values in the sitting and supine positions in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) patients. We also investigated possible relationships between the level of visual field damage and postural IOP change.

Methods

Twenty-nine patients with POAG and 32 patients with PXG were recruited to the study. An Icare PRO tonometer was used to measure IOP in the sitting and supine positions. Intraocular pressure in the sitting position was also measured with a Goldmann applanation tonometer (GAT). Humphrey field analyzer 750 data taken within the previous 3 months were obtained and analyzed.

Results

The mean difference between the GAT and the Icare PRO tonometer readings was 0.12 ± 0.8 mmHg, and the tonometers were in close agreement (r = 0.964; P < 0.0001). The mean Icare PRO IOP in the sitting position was 16.6 ± 3.3 mmHg in the POAG group and 14.9 ± 2.7 mmHg in the PXG group. The average rise was 1.7 ± 1.2 mmHg in the POAG group and 2.9 ± 1.9 mmHg in the PXG group. The difference in IOP between the sitting and supine positions was significant between the groups (P = 0.001). The ?IOP was negatively correlated with both the mean deviation and the visual field index (P < 0.0001 for both). The ?IOP and pattern standard deviation were positively correlated (P < 0.0001).

Conclusions

A higher increase in IOP was observed in PXG patients from the sitting to the supine position than in POAG patients. Postural variation in IOP was found to be associated with the severity of visual field damage.     

Long-term effect of ophthalmic beta-adrenoceptor antagonists on intraocular pressure and retinal sensitivity in primary open-angle glaucoma.

Timolol (TIM) and betaxolol (BET) were evaluated for their effects on both intraocular pressure and retinal sensitivity as determined from visual fields in a randomized two-year parallel study in 20 patients with primary open-angle glaucoma. All treatments were twice-daily in both eyes. TIM was more effective than BET as an ocular hypotensive agent throughout the two year period. With regard to retinal sensitivity as measured by automated visual fields, there was a decrease in retinal sensitivity in the first six months in the TIM and BET treatment groups by 0.5-0.6 dB, and 0.2-0.3 dB, respectively. However, at the one and two year visits, retinal sensitivity increased 0.8-0.9 dB in the BET treatment group only. It appears that ocular hypotensive efficacy may not relate to retinal sensitivity within a period of two years or less in patients with mildly to moderately elevated intraocular pressure. Further work may reveal the reliability of this observation, and its clinical relevance.     

Diurnal intraocular pressure in juvenile open-angle glaucoma

Outpatient diurnal intraocular pressures were obtained on 10 patients with juvenile open-angle glaucoma at approximately 6 hour intervals. There were 8 males and 2 females with an age range of 19 to 38 years. All glaucomatous medications were stopped 24 hours before recording the tensions. The peak intraocular pressure was recorded at the 6 PM interval in 6 of the 10 patients. Three patients recorded their highest pressures at the 12 AM (midnight) interval. Extraordinarily wide angles were observed in all cases and myopia was a common refractive error. Although the family history was not known in 3 patients, there was a positive family history of glaucoma in 7 of the 10 patients, which suggests an autosomal dominant mode of inheritance.     

Relationships among systemic blood pressure, intraocular pressure, and open-angle glaucoma

Several vascular factors, including systemic hypertension (or high blood pressure [HBP]), ocular perfusion pressure, and nocturnal hypotension, have been identified as risk factors for the development and progression of glaucoma. The results of epidemiologic studies of these factors and their relationships to intraocular pressure (IOP) and open-angle glaucoma (OAG) have been contradictory. Inconsistent definitions of HBP and OAG, inconsistent design, and differing population characteristics within these studies have obfuscated definitive conclusions. Here, we review the relationships among blood pressure, IOP, and OAG.     

Problems of intraocular pressure and the early period of primary open-angle glaucoma

The author presents the up-to-date opinions on the problem of "normal" intraocular pressure connecting it with another hydro- and haemodynamic parameters of the eye. Subsequently he discusses the contradictory opinions whether one has to distinguish two clinical conditions: intraocular hypertension and the initial period of open angle glaucoma. According to the author the initiation of the ++anti-glaucoma treatment should be considered individually in each particular case but before the onset of changes at the fundus and before the impairment of the visual field.     

Long-term relationship between intraocular pressure and visual field loss in primary open-angle glaucoma

PURPOSE: To investigate the dependence upon intraocular pressure (IOP) of the progression of visual field defects in eyes with primary open-angle glaucoma (POAG), in which the mean IOP was maintained at < or =21 mm Hg. METHODS: This study involved 100 eyes with POAG, which were followed up for > or =5 years. The mean IOP levels were maintained at < or =21 mm Hg during the follow-up period. The relationship between the IOP and the progression of visual field defects, which was scored using the Advanced Glaucoma Intervention Study criteria, was investigated retrospectively. RESULTS: Compared with the baseline scores, the visual field defect scores had significantly worsened by the end of the follow-up period (P<0.0001, Wilcoxon paired signed rank test). The change in the visual field defect score (2.5+/-0.5) in eyes with average IOP levels of > or =16 mm Hg (n=36) was significantly greater (P=0.031, Mann-Whitney U test) than the change (1.3+/-0.3) in eyes with average IOP levels of <16 mm Hg (n=64). Moreover, IOP of > or =18 mm Hg made a major contribution to the aggravation of visual field defects in eyes with POAG. CONCLUSIONS: Eyes with POAG and with mean IOP levels maintained at < or =21 mm Hg underwent IOP-dependent progression of their visual field defects. Our results suggest that further IOP lowering would be beneficial in such cases.     

Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma

Fifty-five patients with primary open-angle glaucoma and early glaucomatous damage who had medical therapy and laser trabeculoplasty were followed up for four to 11 years or until progressive glaucomatous damage was documented. Factors associated with the stability or progression of glaucoma were evaluated. Eyes with mean intraocular pressure higher than 21 mm Hg during the follow-up period uniformly had progressive glaucomatous changes. Conversely, eyes with mean intraocular pressure less than 17 mm Hg remained stable, and approximately half of the eyes with mean intraocular pressure between 17 and 21 mm Hg had progressive glaucomatous changes. Patients who remained stable were slightly younger than those with progressive glaucomatous changes (P less than .05), but initial optic nerve head appearance, initial visual field findings, number of medicines used, medical history, and patient gender or race were not statistically associated with stability or progression of the glaucoma. These findings reinforce the importance of intraocular pressure control in primary open-angle glaucoma and the need to identify other markers that help determine the proper level of intraocular pressure for individual patients.     

Bilateral retinal venous occlusion in pigmentary glaucoma

Background The association of central retinal vein occlusion with primary open angle glaucoma is well known. This communication reports the occurrence of branch retinal vein occlusion and central retinal vein occlusion in a case of pigmentary glaucoma.Methods A 32-year-old man presented with old branch retinal vein occlusion in one eye and resolving central retinal vein occlusion in the other eye. Examination revealed bilateral Krukenbergs spindle and hyperpigmented trabecular meshwork. Intraocular pressure was 30 mmHg OU. Topical antiglaucoma medication was prescribed.Results Intraocular pressure was controlled with topical antiglaucoma medication.Conclusion The present report suggests that intraocular pressure monitoring is important in eyes even with branch retinal vein occlusion. Pigment dispersion may be the underlying cause for bilateral retinal vein occlusion, especially in young patients.     

Relationship between intraocular pressure,anterior chamber depth and lens thickness in primary open-angle glaucoma patients

Introduction

To investigate the relationship between intraocular pressure (IOP), anterior chamber depth (ACD) and lens thickness (LT) in primary open-angle glaucoma (POAG) patients and compare with age- and sex-matched controls.

Methods

A cross-sectional analytical study of 62 newly diagnosed POAG patients compared with 62 age- and sex-matched control subjects in a tertiary eye clinic. Socio-demographic data and ocular examinations were documented. IOP was measured using the Goldmann applanation tonometer. LT and ACD were measured using A-scan ultrasonography and the IOLMaster, respectively. Data were analyzed using SPSS version 19.0 and level of significance set at p value <0.05.

Results

In the glaucoma group and control groups, respectively, mean age was 60.3 ± 8.9 and 58.5 ± 8.1 years (p = 0.234), mean IOP was 28.27 ± 7.88 and 14.47 ± 2.60 mmHg (p < 0.001), mean ACD was 3.12 ± 0.27 and 3.15 ± 0.24 mm (p = 0.514), mean LT was 4.24 ± 0.46 and 4.23 ± 0.45 mm (p = 0.903), and mean ACD was shallower in females (p = 0.034) and (p = 0.001). In the glaucoma group, there was a positive correlation between IOP and ACD (r = 0.022, p = 0.864), but a negative correlation between IOP and LT (r = ?0.04, p = 0.758) and ACD and LT (r = ?0.058, p = 0.657). In the control group, there was a positive correlation between IOP and ACD (r = 0.141, p = 0.275), IOP and LT (r = 0.031, p = 0.811) and ACD and LT (r = 0.016, p = 0.901).

Conclusion

ACD is shallower in females. There is no significant correlation between IOP and ACD or between IOP and LT in POAG as well as normal individuals.

     

Mean intraocular pressure and progression based on corneal thickness in primary open-angle glaucoma.

PURPOSE: The aim of this study was to evaluate the association of corneal thickness on the incidence of glaucomatous progression at individual levels of intraocular pressure. METHODS: A retrospective, noninterventional evaluation of patients with primary open-angle glaucoma who were either stable over 5 years or had glaucomatous progression before 5 years of follow-up was performed. Each patient had central thickness corneal measurements documented. RESULTS: We included 310 patients in this study. Patients with thicker (at least 0.571 mm, n = 77) and mid-range corneas (0.511-0.570 mm, n = 177) progressed in 14% (n = 11) and 18% (n = 31) of cases, respectively. The progression rate for patients with a mean pressure of less than 17 mmHg in both groups was 12%-13%. In contrast, the progression rate in patients with 18 mmHg or higher was 23% and 16% in the mid-range and thick corneal groups, respectively. In patients with thinner corneas (equal to or less than 0.510 mm, n = 56), the progression rate was 32% (n = 18). The progression rate was 60% (12 of 20) with mean pressures of at least 18 mmHg or higher, but 18% with mean pressures equal to or less than 17 mmHg. Univariant (P = 0.05), but not multivariant, analysis showed that corneal thickness was a risk factor for progression. CONCLUSIONS: This study suggests that the reduction of intraocular pressure helps to prevent progression in patients with primary open-angle glaucoma. However, for patients with thinner corneas, pressure reduction may potentially be of even greater importance to help avoid glaucomatous progression. Future study should clarify potential variables associated with thin corneas and glaucomatous progression.     

Long-term progression at individual mean intraocular pressure levels in primary open-angle and exfoliative glaucoma

PURPOSE: To describe progression and non-progression rates at individual mean intraocular pressure (IOP) levels for patients with primary open-angle and exfoliative glaucoma. METHODS: A meta-analysis of five previously published retrospective studies describing progression and non-progression rates at individual intraocular pressure levels over 5 or more years of follow-up. All patients had primary open-angle (four studies) or exfoliative glaucoma (one study). RESULTS: This meta-analysis included 822 patients of whom 655 (80%) had primary openangle glaucoma and 167 (20%) had exfoliative glaucoma. In total, 220 patients progressed (27%), while 602 (73%) remained stable over 5 years. The mean IOP was 20.0 for progressed and 17.1 mmHg for stable patients (p=0.0004). The peak IOP was 29.1 for progressed and 23.6 mmHg for stable patients (p=0.0014). At an IOP level >18 mmHg, 49% of patients remained stable; at 18 mmHg, 78%; between 13 and 17 mmHg, 82%; and <13 mmHg, 96%.Additional factors associated with progression were older age (p=0.0004) and exfoliative glaucoma (p=0.0001). However, multivariant regression analysis identified only mean IOP as a risk factor for progression (p=0.039). CONCLUSIONS: This study suggests that maintaining an IOP well within the normal range over 5 years in patients with primary open-angle or exfoliative glaucoma helps to prevent glaucomatousprogression.