Cases of Pseudophakic Pseudoexfoliation in Glaucoma Patients

We present cases of primary open angle glaucoma patients without previous history of pseudoexfoliation who developed pseudoexfoliative materials on the anterior surface of the intraocular lens after cataract surgery. Among 5 unilateral pseudophakic pseudoexfoliation cases, 3 showed a more advanced state of glaucoma in the affected eye. The other 2 cases showed progression of glaucoma in the affected eye after the development of pseudophakic pseudoexfoliation, while the unaffected eyes remained stable. In the latter 2 cases, control of intraocular pressure was difficult, and more glaucoma medication was needed in the affected eye. Pseudophakic pseudoexfoliation in glaucoma patients with no history of pseudoexfoliation syndrome or pseudoexfoliative glaucoma has not been reported. In our cases, the eyes which developed pseudophakic pseudoexfoliation showed a more advanced state of glaucoma, more difficulty controlling intraocular pressure, and faster progression of glaucoma. More observation is needed, but we cautiously postulate that pseudophakic pseudoexfoliation may have a role as a clinical risk factor in the prediction of glaucoma progression.     

Refractive Outcomes of Uneventful Cataract Surgery in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

PurposeTo compare the refractive outcomes after cataract surgery between patients with and without pseudoexfoliation, and to evaluate the risk factors of refractive error.MethodsRetrospective review of 210 eyes with pseudoexfoliation (study group) and 510 normal eyes (control group) that underwent uneventful phacoemulsification with intraocular lens implantation. The study group included pseudoexfoliation syndrome and pseudoexfoliation glaucoma (PXG) subgroups. The main outcome measure was refractive error, defined as the difference between the target refraction and postoperative refraction in diopter (D). A refractive error >±1.0 D was identified as a large-magnitude refractive error. The frequency of the large-magnitude refractive error was compared between study and control groups, and also between each subgroup and normal eyes. The factors influencing refractive error were analyzed by logistic regression.ResultsThere was a significantly higher frequency of a refractive error >± 1.0 D and hyperopic error >1.0 D in the study group than in the control group (p = 0.001 and p = 0.003, respectively). In the multivariate logistic regression analysis, PXG and poor preoperative visual acuity were related with a large-magnitude refractive error (p = 0.001 and p = 0.02, respectively) Refractive error >± 1.0 D and hyperopic error >1.0 D were noted more often in PXG eyes that had an intraocular pressure spike >25 mmHg at postoperative first 24 hours (p = 0.01 and p=0.03, respectively).ConclusionsThe eyes with pseudoexfoliation were at a high risk for refractive error, especially in the presence of glaucoma. In PXG, the only significant risk factor for refractive error was observed to be the presence of an intraocular pressure spike.     

Argon Laser Trabeculoplasty in the Presurgical Glaucoma Patient

The trabecular meshwork in 334 eyes of 260 patients with medically uncontrolled primary and secondary open-angle glaucoma was treated with the argon laser. The average intraocular pressure reduction obtained was 7.1 mm Hg. Tonographic data showed significant increase in the facility of outflow. Glaucoma surgical intervention was avoided in 87.5% of phakic eyes and in 62.1% of aphakic eyes. Laser trabeculoplasty was found to be effective in primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, angle recession glaucoma, glaucoma secondary to uveitis, and in eyes with failed glaucoma surgical procedures. The length of follow-up in this series ranged from one week to 21 months, with an average of five months. The major complication noted was a rise in intraocular pressure following treatment. In one eye, a small central island of vision was lost due to this intraocular pressure elevation. Treating one-half of the angle in each of two treatment sessions separated by a few weeks reduces the degree of this pressure elevation. The glaucoma status of 3% eyes was made worse after treatment with trabeculoplasty.     

选择性激光小梁成形术治疗青光眼的研究进展

青光眼是世界第二位不可逆的致盲性眼病,一旦确诊,需要长期治疗。激光治疗已经成为青光眼治疗的3个主要手段之一,其中选择性激光小梁成形术（SLT）可选择性地作用于色素性小梁组织,使靶组织收缩,房水外流通畅,从而降低青光眼患者的眼压,但其具体作用机制复杂,目前尚不完全明确。由于其对小梁网组织破坏程度轻微,术后反应较轻,且对邻近组织无损伤,因此是一种安全且可重复治疗的手段,并且不会影响青光眼的下一步治疗。就SLT的原理及SLT临床应用的背景、临床疗效、治疗的安全性等进行综述。     

Descemet stripping with automated endothelial keratoplasty: A comparative study of outcome in patients with preexisting glaucoma

PurposeTo compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma.MethodsFor this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication (55) or with previous glaucoma surgeries (64) with a time-matched group of all other DSAEK cases (179, control).ResultsWith a mean follow-up of 1.85 ± 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure (odds ratio OR = 12.35, 95% confidence interval CI [5.46–27.90], P < 0.001). Graft detachment was not associated with either history of glaucoma or glaucoma surgery (P > 0.05). Glaucoma on medication had no increased risks of graft failure compared to normal eyes (P = 0.38). However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries (OR = 4.26, 95% CI [1.87–9.71], P < 0.001). Medically managed glaucoma has increased risks of postoperative IOP elevation (OR = 2.39, 95% CI [1.25–4.57], P = 0.013), whereas surgically managed glaucoma has no significant elevation (P = 0.23). Elevation of IOP was not significantly correlated with graft failure (P = 0.21).ConclusionDSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival.     

三种眼压计在准分子激光原位角膜磨镶术后的应用比较

目的评价三种不同眼压计在近视准分子激光原位角膜磨镶术后的应用。方法对近视33例66眼和LASIK术后43例86眼分别用非接触眼压计(non—contact tonometer NCT)，Goldmann压平眼压计(Godmann applanalion tonometer，GAT)和Tono-Pen压平眼压计测量眼压(Tono—Pen眼压计测量角膜中央和颞下距角膜缘1．5～2mm处的眼压)，同时测角膜中央及颞下方的厚度。结果用三种方法测得的近视眼LASIK术后的眼压测量值均明显低于正常近视眼。两组均为Tono—Pen和NCT、与GAT测量值呈正相关，LASIK术后中央Tbno—Pen眼压测量值与术前GAT呈正相关。眼压与角膜厚度的关系：近视眼组，NCT与角膜中央厚度呈正相关；GAT和Tono—Pen与角膜厚度无相关性。LASIK术后组，GAT和NCT与角膜厚度呈正相关；Tono-Pen与角膜中央厚度无相关性。结论LASIK术后眼压测量值下降。Tono—Pen测量IOP不受角膜厚度的影响，可应用于LASIK术后等角膜表面不平者。     

Circadian Blood Pressure and Intraocular Pressure Patterns in Normal Tension Glaucoma Patients with Undisturbed Sleep

Purpose

To investigate and compare the circadian pattern of blood pressure (BP), intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) while experiencing undisturbed sleep in normal-tension glaucoma (NTG) and non-glaucoma control patient groups.

Methods

Twenty-four eyes from 24 patients diagnosed with NTG and 22 eyes from 22 control group patients were enrolled. Systolic BP, diastolic BP and IOP were measured every two hours except for the period of time from 1 AM to 7 AM in the NTG group and from 11 PM to 7 AM in the control group over a one-day period. IOP and hemodynamic parameters were then compared between the two groups. NTG patients were subdivided according to the degree of morning BP dip and IOP, and hemodynamic parameters and visual field indices (mean deviation and pattern standard deviation) were also compared among these subgroups.

Results

There were no significant differences in mean systolic BP, mean diastolic BP and mean arterial pressure (MAP) between the NTG and the control groups. The NTG group showed a significantly large morning BP dip compared to the control group (7.1±4.2% vs. 3.8±3.4%, p=0.022). However, there were no significant differences in mean or fluctuation of MOPP between the two groups. Morning over-dippers showed significantly large MAP and MOPP fluctuations compared to non-dippers and dippers, while there were no significant differences in visual field indices among the three subgroups.

Conclusions

NTG patients showed significant morning BP dips compared to the control group. The marked morning BP dip was associated with significantly large MAP or MOPP fluctuations but was not associated with visual field indices.     

EX-PRESS青光眼引流钉植入术和小梁切除术治疗原发性开角型青光眼的临床观察

目的与小梁切除术对比,观察EX-PRESS青光眼引流钉植入术治疗原发性开角型青光眼的有效性和安全性。方法对药物不能控制的原发性开角型青光眼患者进行手术,随机分为EX-PRESS青光眼引流钉植入术组和小梁切除术组,每组术中均联合使用丝裂霉素。收集术前,术后1 d,2周,1,3,6,12个月的视力、眼压等基本数据。结果评价主要为平均眼压和术后并发症的发生率。手术完全成功的标准为:在不使用任何降眼压药物的情况下,眼压控制在5~18 mm Hg或比基线眼压下降20%。结果 28例原发性开角型青光眼患者共32只眼纳入研究,每组各14例。EX-PRESS青光眼引流钉植入组术前平均眼压(34.5±5.6)mm Hg,小梁切除术组术前平均眼压(33.8±6.8)mm Hg。两组比较无差异(P>0.05)。术后1年两组平均眼压分别为(12.6±4.5)mm Hg和(11.5±4.6)mm Hg。两组比较无差异(P>0.05)。术后随访1年,完全成功者EX-PRESS青光眼引流钉植入组占69%,小梁切除术组占56%。相对成功者两组分别占87%和81%。两组比较无差异(P>0.05)。在手术时间和并发症发生率上两组比较无明显统计学差异。结论对于原发性开角型青光眼患者,巩膜瓣下植入EX-PRESS青光眼引流钉装置安全、有效。     

选择性激光小梁成形术作为初始疗法治疗原发性开角型青光眼的疗效评价

背景选择性激光小梁成形术（SLT）是治疗早期原发性开角型青光眼（POAG）常用的方法之一,但其在中国多被用于抗青光眼药物控制眼压效果欠佳的开角型青光眼患者,目前中国尚无SLT作为POAG初始疗法的效果评价。目的比较SLT对未经过任何治疗和经过局部抗青光眼药物治疗而眼压未得到控制的早期POAG患者的疗效和安全性。方法本研究为前瞻性临床试验,采用非随机病例对照的研究：疗法。按照患者行SLT前是否局部使用抗青光眼药物将纳入的早期POAG患者37例65眼分为未预治疗组16例30眼和预治疗组21例35眼,患者年龄为12—57岁,所有患眼均采用Selectaduet532nm倍频Q开关Nd：YAG激光器行SLT,激光脉冲时间为3ns,光斑直径为400Ixm,初始能量为0．6mJ,之后以0．1mJ为单位逐步递减,至刚好出现气泡时为治疗能量,治疗范围为下方180。小梁网。所有患者随访6个月,主要疗效指标包括眼压的变化及术后6个月的治疗成功率,次要结局指标为视功能和视杯改变。SLT的安全性评价指标为术后术眼的刺激症状发生率。结果治疗后1d～6个月,所有患眼眼压均较术前明显下降,差异均有统计学意义（P〈0．05）。未预治疗组SLT术前和术后1个月眼压分别为（24．03＋3．76）mmHg（1mmHg=0．133kPa）和（19．18±3．86）mmHg,眼压平均下降了（4．854_4．31）mmHg,预治疗组患眼SLT术前和术后1个月眼压分别为（23．63±4．29）mmHg和（17．074_4．15）mmHg,眼压平均下降了（6．284-3．57）mmHg,两组间眼压下降幅度比较差异有统计学意义（P=0．045）,但两组间在术后1h、1d、1周、3个月和6个月眼压下降值的差异均无统计学意义（P〉0．05）。术后6个月未预治疗组和预治疗组的治疗成功率分别为75．00％和76．67％,差异无统计学意义（P=0．882）。术后各时间点术眼视野损害及视神经检查与术前比较均无明显进展。2个组术眼术后各时间点均未发现严重并发症。结论SLT对早期POAG患者具有较好的疗效和安全性,术前是否局部应用抗青光眼药物对SLT的短期降眼压效果无明显影响,但SLT的长期疗效有待进一步观察。     

激光周边虹膜成形术中光凝兔青光眼模型不同部位虹膜的效果比较

背景 激光周边虹膜成形术(LPI)能使虹膜收缩变平,房角增宽,在临床上用于青光眼的治疗.但目前临床上对LPI的最佳作用部位尚无定论. 目的 探讨选择不同部位虹膜行LPI对青光眼疗效的影响.方法 取健康成年雄性灰兔40只,用含质量分数0.3％卡波姆和质量分数0.025％地塞米松的复方卡波姆溶液0.1 ml行兔右眼前房注射建立青光眼动物模型,然后将模型眼按随机数字表法随机分为模型对照组、角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组和距角巩膜缘2个光斑对应部位组,每组各10只.按照分组描述部位应用532 nm激光对角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组和距角巩膜缘2个光斑对应部位组实验眼行LPI,光斑直径为500 μm,能量为300 mW,曝光时间为0.3s,激光击射24个点,模型对照组未行LPI.用Schi(o)tz眼压计记录术前及术后2、4、7、14、30 d各组兔的眼压并计算房水流畅系数(C值),用超声生物显微镜(UBM)测定上述时间点兔眼前房深度(ACD)、房角开放度数(AA)和距巩膜突500 μm半径内的房角开放距离(AOD500).于术后30 d摘取兔眼球,采用苏木精-伊红染色法观察各组兔眼房角的形态学改变.结果UBM检查显示,与模型对照组比较,LPI各组兔眼房角均明显增宽,以距角巩膜缘1个光斑对应部位组最为明显,距角巩膜缘2个光斑对应部位组效果最不明显.与模型对照组比较,角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组、距角巩膜缘2个光斑对应部位组兔眼眼压均明显下降,C值均明显增加,AA和AOD500均明显增加,总体比较差异均有统计学意义(眼压:F分组=16.848,P＜0.01;C值:F分组=9.629,P＜0.01;AA:F分组=62.336,P＜0.01;AOD500:F分组=77.779,P＜0.01).与各自LPI组内术前值比较,兔眼术后2、4、7、14、30 d眼压均明显下降,C值、AA和AOD500值均明显增加,总体比较差异均有统计学意义(眼压:F时间=3.041,P=0.011;C值:F时间 =4.311,P＜0.01;AA:F时间=14.627,P＜0.01;AOD500:F时间=20.378,P＜0.01).与模型对照组比较,角巩膜缘对应部位组、距角巩膜缘1个光斑对应部位组兔眼各时间点ACD值均明显增加,而距角巩膜缘2个光斑对应部位组与其相似,总体比较差异有统计学意义(F分组=18.017,P＜0.01),各组兔眼LPI前后不同时间点ACD的总体比较差异无统计学意义(F帅=0.022,P=1.000).苏木精-伊红染色可见各LPI组术后30 d兔眼房角处小梁网和房角粘连均被拉开,房角不同程度增宽.结论 LPI可使青光眼模型兔眼房角增宽,眼压下降.在距离角巩膜缘1个光斑处虹膜上行LPI效果最佳.     

Incidence and Risk Factors for Developing Glaucoma Among Patients with Uveitis in a University-based Tertiary Referral Center in Riyadh,Saudi Arabia

Purpose: To investigate the incidence and risk factors of secondary glaucoma among uveitis patients.

Methods: Retrospective review of medical records of 642 patients (1220 eyes).

Results: Glaucoma was diagnosed in 169 (13.9%) eyes and was most common in eyes with anterior uveitis (19.1%) (p?p?Conclusions: Incidence of glaucoma differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of glaucoma.     

Evaluation of the Safety and Efficacy of Selective Retina Therapy Laser Treatment in Patients with Central Serous Chorioretinopathy

PurposeTo assess the safety and efficacy of selective retina therapy (SRT) using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback systems in patients with idiopathic central serous chorioretinopathy (CSC).MethodsThis randomized clinical trial enrolled patients having at least 3-month symptom of CSC. From month 3 visit, all subjects in both groups were eligible for SRT retreatment if they showed persistent or recurrent subretinal fluid (SRF). The primary outcome was complete resolution of SRF by optical coherence tomography at 3 months after treatment. The secondary outcomes were changes in SRF, central macular thickness (CMT) and best-corrected visual acuity at the 1-, 3-, and 6-month examinations.ResultsSixty-eight CSC patients were included (SRT, 31; control, 37). After 1 and 3 months, complete resolution of SRF was achieved in 25.8% and 54.8% of SRT group and 17.6% and 35.1% of controls. The differences were not statistically significant (p = 0.424 and p = 0.142, respectively). However, mixed model for repeated measures analyses showed that the reduction of SRF and CMT were observed earlier in SRT group than in the sham group (least squares mean difference, −59.7 μm; 95% confidence interval, −98.2 to −21.2; p = 0.0029; least squares mean difference −67.0 μm; 95% confidence interval, −104.8 to −29.2; p = 0.0007, respectively). Significant reduction of SRF (≥50% reduction from baseline) was more frequently observed in SRT group (80.6%) than the sham group (44.1%) at month 1 (p = 0.007). Early reduction of SRF and CMT was more abundant in SRT group with symptom duration less than 6 months. Treatment related serious adverse events were not observed.ConclusionsSRT using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback system was safe in this trial and effective for early resolution of SRF in the CSC patients. Early intervention with SRT can be a safe alternative for patients with acute symptomatic CSC.     

Prognostic Factors for Progression of Visual Field Damage in Patients with Normal-Tension Glaucoma

Purpose

To evaluate the rate of progression and the prognostic factors of visual field damage in patients with normal-tension glaucoma (NTG).

Methods

Ninety-two NTG patients (92 eyes) were followed up for more than 2 years with topical antiglaucoma medications. All subjects were classified as having early damaged eyes with an initial mean deviation (MD) of ?6?dB or better, moderately damaged eyes with MD between ?6?dB and ?12?dB, and severely damaged eyes with MD of ?12?dB or worse, and survival data were analyzed using regression analysis based on the Cox proportional hazards model.

Results

The probability of visual field stability was significantly higher in patients with moderate damage than in those with severe damage (P = 0.035). The patients with early damage showed no difference in the probability of visual field stability compared with patients with moderate or severe damage. The progression of visual field damage was significantly associated with mean intraocular pressure (IOP) (P = 0.000) or IOP fluctuation (P = 0.002) during follow-up regardless of the severity of the initial visual field damage.

Conclusions

The rate of progression of visual field damage differed according to the severity of the initial visual field damage. IOP reductive medication may be effective in preventing glaucomatous visual field progression in patients with NTG. Jpn J Ophthalmol 2006;50:38–43 © Japanese Ophthalmological Society 2006     

Anterior Segment Imaging and the Intraocular Pressure Lowering Effect of Cataract Surgery for Open and Narrow Angle Glaucoma

Anterior segment imaging modalities including anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) are increasingly widespread, and can quantify several parameters of the anterior segment, such as anterior chamber depth and angle anatomy. These parameters are important to assess, particularly in patients with forms of narrow angle glaucoma. In many cases of open and narrow angle glaucoma, cataract extraction has been shown to result in favorable modification of these parameters, and a lasting decrease in intraocular pressure. Anterior segment imaging has the ability to enable the development of predictive models regarding the potential intraocular pressure lowering effect of cataract extraction in a given individual.