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.     

早期开角型青光眼的视网膜神经纤维层缺损及相关临床特点

目的观察早期原发性开角型青光眼（primary open-angle glaucoma,POAG）及正常眼压性青光眼（normal tension glaucoma,NTG）的弥漫性及局限性视网膜神经纤维层缺损（retinal never fiber layer defect,RNFLD）的分布及相关的临床特点。方法通过对立体眼底像的观察,明确81例POAG及70例NTG的RNFLD类型,分析弥漫性及局限性RNFLD在两型青光眼中的分布,比较两型RNFLD患者未治疗的最高眼压及视盘出血发生比例的不同。结果81例POAG中,78例出现RNFLD,其中弥漫性RNFLD50例,局限性RNFLD28例。70例NTG中,弥漫性RNFLD27例,局限性RNFLD43例,两型青光眼的RNFLD的分布相比较,差异有显著性（χ     

角膜厚度与高眼压症及青光眼的眼压

目的 探讨高眼压症、正常眼压性青光眼、原发性开角型青光眼患者及正常人的角膜厚度差异,分析角膜厚度与眼压间的关系,以及角膜厚度的测定对各型青光眼的诊断意见。方法 用超声波角膜测厚仪检测７３例（７３只眼）高眼压症、７９例（７９只眼）正常人的中央角膜厚度,并将其测定结果进行比较。回顾性分析每只青光眼治疗前的最高眼压（Ｇｏｌｄｍａｎｎ）,包括２４ｈ眼压曲线,用Ｅｈｌｅｒ法通过中央角膜厚度对眼压进行校正。结     

Incidence of disc hemorrhages in open-angle glaucoma before and after trabeculectomy

PURPOSE: To investigate the effects of reduction of intraocular pressure (IOP) by surgical intervention on the frequency of disc hemorrhages in eyes with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). DESIGN: Retrospective study. METHODS: We studied 99 eyes of 99 patients with POAG and 50 eyes of 50 patients with NTG, who underwent trabeculectomy with adjunctive mitomycin C (MMC) and were followed regularly at 1 to 3-month intervals at the Glaucoma Service of Gifu University Hospital. We applied Kaplan-Meier life-table analysis for the detection of disc hemorrhages before and after trabeculectomy. RESULTS: Trabeculectomy significantly reduced IOP (in POAG: 19.6 +/- 4.4 down to 11.1 +/- 4.2 mm Hg; in NTG: 15.3 +/- 1.5 down to 11.3 +/- 4.5 mm Hg; mean +/- SD). Life-table analysis revealed that the final cumulative probability of detecting a disc hemorrhage after surgery in POAG was 5.5 +/- 2.2% (calculated probability +/- SE) and was significantly lower than that (33.4 +/- 7.8%) before surgery (P < 0.0001, log-rank test). Likewise, the final probability after surgery in NTG was 23.1 +/- 6.3% and was significantly lower than that (42.1 +/- 8.8%) before surgery (P = 0.0063, log-rank test). CONCLUSIONS: IOP reduction via surgical intervention significantly decreases the frequency of disc hemorrhages in open-angle glaucoma patients.     

Pulsatile ocular blood flow in primary open-angle glaucoma and ocular hypertension

PURPOSE: To compare pulsatile ocular blood flow measurements in untreated ocular hypertensive (OHT) subjects and primary open-angle glaucoma (POAG) patients. DESIGN: A prospective observational study in an institutional setting. METHODS: A total of 97 subjects were recruited to the study (50 ocular hypertensives, 24 glaucoma patients, and 23 normal subjects). "High-risk" OHT had intraocular pressure (IOP) > 25 mm Hg; "low-risk" OHT had IOP 相似文献   

Corneal biomechanical properties in primary open angle glaucoma and normal tension glaucoma

PURPOSE: To determine and compare the corneal biomechanical properties between eyes with primary open angle glaucoma (POAG) and eyes with normal tension glaucoma (NTG). PATIENTS AND METHODS: Prospective cross-sectional study. Consecutive eligible POAG and NTG patients attending the Glaucoma Clinic had assessment of their corneal biomechanical properties-corneal hysteresis (CH) and corneal resistance factor (CRF)-using the Ocular Response Analyzer by an observer masked to the diagnosis. Exclusion criteria included previous intraocular surgery, corneal pathology, inflammatory connective tissue disease, and refraction of 5-dimensional or over. If both eyes were eligible, then the right eye was used for analysis. The main outcome measures were corneal hysteresis and CRF measurements. Data analysis was performed using the t test and general linear model. RESULTS: Eighty-one patients (80 whites) were analyzed. Forty had NTG, whereas 41 had POAG. Thirty-five were females. There was a statistically significant difference in mean CH (NTG 9.6+/-1.3 mm Hg; POAG 9.0+/-1.4 mm Hg; P=0.01), but not in mean CRF (NTG 9.9+/-1.4; POAG 10.8+/-1.7; P=0.06). The highest recorded Goldmann applanation intraocular pressure (IOP) was statistically significantly associated with lower CH (P=0.01) and higher CRF (P=0.02). CONCLUSIONS: There was a small but statistically significant difference in the mean CH between POAG and NTG (CH was higher in NTG). The highest recorded Goldmann applanation IOP was also statistically significantly correlated with lower CH and higher CRF, suggesting that alterations to the corneal biomechanical properties may occur as a result of chronic raised IOP in POAG.     

动态轮廓眼压计的临床应用

目的 探讨动态轮廓眼压计(OCT)在原发性开角型青光眼(POAG)、高眼压症(OHT)、正常眼压性青光眼(NTG)及正常对照人群眼压和眼压脉动振幅(OPA)测量中的临床应用价值及影响因素.方法 选取POAG、OHT、NTG及正常对照组各30例,分别采用Goldmann压平眼压计(GAT)测量眼压,DCT测量眼压及OPA,并测量中央角膜厚度(CCT)、中央角膜曲率(CCV)以及心率、收缩压、舒张压等指标,以了解这些指标对OPA的影响.各组统计量两两比较采用q检验.各统计量之间的相关分析采用Pearson相关分析,对于多个变量之间的线性关系采用多重线性回归分析.结果 DCT测量POAG、OHT、NTG及对照组的眼压值分别为(21.68±2.02)、(23.37±2.65)、(18.43±3.08)、(17.04±2.07)lnln Hg(1 mm Hg=0.133 kPa);GAT测最的眼压值分别为(21.18±2.95)、(23.28±5.95)、(16.39±3.60)、(14.66±2.27)mm Hg.两者测量结果的差异无统计学意义(t=1.338,1.445,1.682,1.803;P=0.197,0.151,0.136,0.081).POAG、OHT、NTG及对照组的OPA值分别为3.03±1.13,3.53±1.43,2.21±0.55,2.87±0.60,组间比较差异有统计学意义(F=21.311,P=0.000);OPA值与心率、收缩压、舒张压、GAT测量值、CCT均相关,与年龄无明显相关性.结论 DCT测量结果与GAT有良好的一致性,受干扰因素少,可信度高;POAG、NTG、OHT患者和正常人的OPA存在差异,其中NCT患者OPA值明显较低,提示各组间眼内血液动力学状况的差异,OPA可能对青光眼的诊断及治疗具有一定的潜在价值.     

Relationship between postural change of the intraocular pressure and visual field loss in primary open-angle glaucoma

PURPOSE: To determine the relationship between the postural changes of the intraocular pressure and the visual field loss in patients with primary open-angle glaucoma. METHODS: Eleven normal subjects and 11 patients with primary open-angle glaucoma were studied. Intraocular pressure was measured in both the sitting and the supine positions. Visual fields were measured with automated perimetry. RESULTS: When patients moved from a sitting to supine position, the intraocular pressure increased by an average of 3.1 +/- 0.4 mm Hg (mean +/- SEM) in normal subjects and 4.0 +/- 0.2 mm Hg in patients with primary open-angle glaucoma. There was a significant difference between the normal subjects and patients with primary open-angle glaucoma (P = 0.049). Intraocular pressure increased by 4.4 +/- 0.3 mm Hg (P = 0.02) in the worse eye for mean deviation and 3.6 +/- 0.3 mm Hg (P = 0.38) in the better eye for mean deviation. There was no significant difference in intraocular pressure in the sitting position between both groups. CONCLUSIONS: The greatest difference in intraocular pressure between the sitting and supine positions was observed in the worse eye of patients with primary open-angle glaucoma. This result suggests that damage to the optic nerve in primary open-angle glaucoma might occur when patients are asleep in the supine position.     

Evaluation analysis of blood flow of peripapillary area in glaucoma patients using scanning laser Doppler flowmetry

PURPOSE: To evaluate capillary blood flow and velocity in retinal peripapillary area in primary open angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PEXG) and age matched control group (C) using scanning laser Doppler flowmetry (Heildelberg Retina Flowmeter). MATERIAL AND METHOD: One randomly selected eye of 17 POAG patients (mean age 59.3 +/- 2.6), 18 NTG patients (mean age 56.4 +/- 2.4), 17 PEXG patients (63.3 +/- 2.8) and 15 healthy subjects (mean age 55.8 +/- 3.8) underwent examination with scanning laser Doppler flowmetry. The measurements were performed at the superior and inferior temporal peripapillary retinal area. The measured parameters were capillary blood flow and velocity of the moving erythrocytes. Each image was analysed using the program AFFPIA. This software calculates the hemodynamic parameter flow of each pixel. Comparison of value obtained from patients and control participants were made using Student's t test. RESULTS: Scanning laser Doppler flowmetry results showed a significant reduction in blood flow at the superior and inferior temporal peripapillary area in POAG and NTG patients compared to control group (p < 0.04). The POAG and NTG patients had also significantly decreased velocity at the inferior temporal peripapillary retinal area compared to control group. No statistical difference was found between blood flow and velocity in POAG compared with NTG. When compared with the control participants, patients with PEXG showed significant decreases in the mean blood flow at the inferior temporal quadrant (p < 0.05), while the differences in the mean flow and velocity at the superior quadrant between those groups were not statistically significant. CONCLUSIONS: Our findings indicate a reduction in ocular blood flow at the temporal peripapillary retinal area in patients with POAG and NTG compared to age matched control participants. The peripapillary retinal microcirculation is not significantly altered in patients with PEXG compare with POAG and JNC. The blood flow parameters in the capillaries are lower in JNC retinas, the difference however is not significant. Further clinical investigation is required having groups homogeneous with respect to stage of glaucoma and controlled for factors known to effect perfusion pressure.     

相干光断层扫描仪检测正常人及青光眼患者中央角膜厚度

目的探讨相干光断层扫描仪(OCT)测量正常人、原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)、高眼压症(OHT)患者的中央角膜厚度(CCT)。方法采用OCT3测量正常人143例(143只眼)、POAG患者36例(36只眼)、NTG患者39例(39只眼)及OHT患者40例(40只眼)的CCT,并进行单因素4水平设计定量资料的方差分析;用线性回归方法分析正常人CCT与Goldmann压平眼压测量值的相关关系;对OCT测量CCT观察者间和观察者内的一致性进行类内相关系数(ICC)分析。结果正常组、POAG组、NTG组及OHT组的平均CCT值分别为(523.66±32.13)μm、(530.92±27.32)μm、(506.92±21.49)μm及(573.13±27.39)μm。POAG组与正常人组的平均CCT值差异无统计学意义(P=0.099);OHT组的平均CCT值大于其他各组,均P<0.01;NTG组的平均CCT值小于其他各组,均P<0.01。正常组CCT与眼压值呈正相关(r=0.318,R2=0.101,P<0.01)。OCT测量CCT的测量者间和测量者内的ICC值分别为0.995和0.996。结论OCT可以准确地测量CCT;NTG患者平均CCT比正常人薄,而OHT患者比正常人厚;CCT可以影响Goldmann压平眼压计的测量值,但贡献率较小。(中华眼科杂志,2006,42:199-203)     

Central corneal thickness of normal tension glaucoma patients in Japan

PURPOSE: To compare central corneal thickness (CCT) of patients with normal tension glaucoma (NTG) with that of age-matched normal subjects, patients with open-angle glaucoma (POAG) and ocular hypertension (OH) subjects in Japan. METHODS: Central corneal thickness was measured in 79 NTG, 61 POAG, 73 OH, and 50 normal subjects with an ultrasonic pachymeter. One eye for 1 subject randomly selected in each group was used for inter-group comparison. The relationship between CCT and the maximum intraocular pressure (IOP) measured by Goldmann applanation tonometer with no ocular hypotensive medication (NTG, OH, and normal subjects) or under medication (POAG patients) was analyzed. RESULTS: The CCT of OH subjects (582 +/- 32 microm; mean +/- SD) was significantly greater than that of the other groups (P <.001), while no difference was seen in CCT among normal (552 +/- 36 microm), NTG (548 +/- 33 microm) and POAG (550 +/- 33 microm) subjects. In normal subjects, CCT and the maximum IOP were significantly correlated but the correlation coefficient was small (r = 0.420, P <.05). CONCLUSIONS: Central corneal thickness shows no significant difference among NTG, POAG, and normal subjects in Japan, while it is significantly greater in OH subjects. The CCT has little influence on the diagnosis of NTG in Japan.     

Systemic high-sensitivity C-reactive protein levels in normal-tension glaucoma and primary open-angle glaucoma

PURPOSE: To determine the systemic high-sensitivity C-reactive protein (hsCRP) level in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). MATERIALS AND METHODS: With the exclusion of patients with cardiovascular and other systemic diseases, 40 patients with NTG, 40 with POAG, and 40 normal controls were enrolled in this study. Each patient underwent blood sampling for hsCRP, biochemistry, and lipid profile analysis. RESULTS: Each group had similar demographic parameters including the age, sex, body mass index, heart rate, and blood pressure. There was no statistically significant difference in the hsCRP and biochemistry results between the 3 groups. The lipid profile exhibited a mild elevation in the patients with POAG. CONCLUSIONS: Our data revealed no difference in the hsCRP level between NTG, POAG, and normal controls after exclusion of patients with cardiovascular and other systemic diseases. Systemic vascular inflammation may not be a major cause in the pathogenesis of glaucoma in those without histories of cardiovascular diseases.     

Sequential office pressure measurements in the management of glaucoma

PURPOSE: To evaluate the usefulness of day-long sequential office measurements of intraocular pressure (IOP) to make therapeutic decisions in patients with progressive glaucomatous damage despite apparently 'controlled' IOP. METHODS: We reviewed the records of 93 consecutive glaucoma patients (185 eyes) who underwent sequential office IOP measurements (every hour from 7 AM to 5 PM on a single day). These included 53 patients with normal-tension glaucoma (NTG), 12 glaucoma suspects (GS), and 28 patients with primary open-angle glaucoma (POAG) whose visual field deteriorated despite apparently 'controlled' IOP. Only one eye per patient was included in the study. RESULTS: The pattern of the day-long IOP curve was similar in the 3 groups of patients. IOPs were highest in the early morning hours in all groups. The mean +/- SD of the IOP range was 5 +/- 2 mm Hg. An IOP > 21 mm Hg was found in 3 eyes (3%), whereas a range of IOPs > 5 mm Hg was detected in 33 eyes (35%). In the NTG group, there was a significant correlation between visual field deterioration and the peak and range of IOP (P = 0.0002 and P = 0.05, respectively). CONCLUSIONS: Day-long sequential office IOP measurements are useful in selected patients who demonstrate progressive glaucomatous damage. Early morning measurements are most frequently highest. The range of IOP may be as important, or more important than, the peak IOP level.     

Augeninnendruckmessungen im Tages- und Nachtverlauf bei Glaukompatienten und Normalprobanden mittels Goldmann- und Perkins-Applanationstonometrie

OBJECTIVE: Our aim was to evaluate intraocular pressure (IOP) levels in primary open angle glaucoma (POAG) patients and healthy controls during both the day and night while measuring in an upright as well as in a supine position. METHODS: In a prospective clinical trial, 30 glaucoma patients on topical treatment and 50 healthy controls received IOP measurements every 4 h for a 24 h period starting at 8 am. Additionally, blood pressure and heart rate were measured and perfusion pressures were calculated. At 12 am IOP was initially measured in a sitting position and then, after 20 min, in a supine position. At midnight this was carried out conversely. At 4 am IOP was measured in a supine position; all other measurements were performed in a sitting position. Measurements in the sitting position were performed by Goldmann and Perkins tonometry and in a supine position by Perkins tonometry. RESULTS: IOP was 1 mmHg lower in Perkins tonometry measurements compared to Goldmann tonometry. There was no difference between the two patient groups. In a supine position, IOP measured by Perkins tonometry was higher than in an upright position. At 12 am the difference was 1.8 mmHg+/-2.7 mmHg (p=0.001) in healthy subjects and 1.3+/-2.7 mmHg (p=0.013) in the POAG patients. At 12 pm the increase of IOP in the supine position was even more pronounced with 2.4+/-3.4 mmHg in healthy subjects and 5.6+/-3.2 mmHg in the POAG patients (p=0.001). The blood pressure and the perfusion pressure were lowest during night measurements. CONCLUSIONS: During diurnal IOP measurements in an upright position there were no statistically significant differences in IOP changes between groups. However, in a supine position IOP was significantly higher than in a sitting position and increased more in the glaucoma patients than in healthy controls. This observation might be due to a faulty regulation of the fluid shift in glaucoma patients and could cause progression of glaucomatous damage.     

Attempted eyelid closure affects intraocular pressure measurement in open-angle glaucoma patients

PURPOSE: To evaluate the effect of attempted eyelid closure on intraocular pressure (IOP) measurements in normal-tension (NTG) and high-tension (HTG) open-angle glaucoma patients. DESIGN: Prospective clinical trial. METHODS: Forty randomly selected eyes of 40 patients underwent corneal pachymetry and IOP measurements using both Goldmann applanation tonometry and Tono-pen XL (Mentor, Inc., Norwell, Massachusetts, USA). Intraocular pressure was measured by the same examiner holding the eyelids open, both with and without the subject simultaneously attempting forced eyelid closure. Subjects were seated during all measurements and waited 5 minutes between measurements with each instrument; the order of measurement was randomized. RESULTS: Twenty NTG and 20 HTG eyes were enrolled. The mean age was 63.0 +/- 13.0 years (range, 31-80 years). The average corneal thickness was 540 +/- 32 microm (range, 480-608 microm) in NTG patients and 552 +/- 40 microm (range, 449-610 microm) in HTG patients (P =.07, analysis of variance [ANOVA]). Using Goldmann applanation tonometry, IOP measurement in eyes with NTG increased by 3.9 +/- 2.0 mm Hg with attempted eyelid closure (P <.0001, paired t test; range, 2-11 mm Hg). With the Tono-pen XL, IOP measurements increased 4.2 +/- 2.7 mm Hg (P <.0001, paired t test; range, 1-14 mm Hg). With attempted forced eyelid closure, the Goldmann applanation measurement in eyes with HTG increased 4.1 +/- 2.1 mm Hg (P <.0001, paired t test; range, 1-9 mm Hg). Using the Tono-pen XL, measurements increased 4.5 +/- 2.0 mm Hg (P <.0001, paired t test; range, 2-11 mm Hg). CONCLUSION: Attempted eyelid closure during tonometry is a significant and common source of error in eyes with glaucoma and may influence the clinical management and decision-making in the treatment of NTG and HTG.     

Novel pressure-to-cornea index in glaucoma

BACKGROUND: Several conversion tables and formulas have been suggested to correct applanation intraocular pressure (IOP) for central corneal thickness (CCT). CCT is also thought to represent an independent glaucoma risk factor. In an attempt to integrate IOP and CCT into a unified risk factor and avoid uncertain correction for tonometric inaccuracy, a new pressure-to-cornea index (PCI) is proposed. METHODS: PCI (IOP/CCT(3)) was defined as the ratio between untreated IOP and CCT(3) in mm (ultrasound pachymetry). PCI distribution in 220 normal controls, 53 patients with normal-tension glaucoma (NTG), 76 with ocular hypertension (OHT), and 89 with primary open-angle glaucoma (POAG) was investigated. PCI's ability to discriminate between glaucoma (NTG+POAG) and non-glaucoma (controls+OHT) was compared with that of three published formulae for correcting IOP for CCT. Receiver operating characteristic (ROC) curves were built. RESULTS: Mean PCI values were: Controls 92.0 (SD 24.8), NTG 129.1 (SD 25.8), OHT 134.0 (SD 26.5), POAG 173.6 (SD 40.9). To minimise IOP bias, eyes within the same 2 mm Hg range between 16 and 29 mm Hg (16-17, 18-19, etc) were separately compared: control and NTG eyes as well as OHT and POAG eyes differed significantly. PCI demonstrated a larger area under the ROC curve (AUC) and significantly higher sensitivity at fixed 80% and 90% specificities compared with each of the correction formulas; optimum PCI cut-off value 133.8. CONCLUSIONS: A PCI range of 120-140 is proposed as the upper limit of "normality", 120 being the cut-off value for eyes with untreated pressures or=22 mm Hg. PCI may reflect individual susceptibility to a given IOP level, and thus represent a glaucoma risk factor. Longitudinal studies are needed to prove its prognostic value.     

Comparison of central and peripheral corneal thicknesses between normal subjects and patients with primary open angle glaucoma, normal tension glaucoma and pseudoexfoliation glaucoma

BACKGROUND: While many comparative data are available about central corneal thickness in different types of open angle glaucoma, peripheral corneal thickness has been much less investigated up to now. Thus, the aim of this study was to compare the central and peripheral corneal thicknesses in patients with primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudoexfoliation glaucoma (PEXG) to values of normal subjects. PATIENTS: 104 patients with POAG, 20 patients with NTG, 23 patients with PEXG and 127 normal subjects were investigated with the Orbscan II. The central corneal thickness and the peripheral corneal thickness at 3 mm distance from the centre were determined in 4 quadrants. The acoustic equivalent factor of 0.92 was not used. Patients with eye diseases, patients who had undergone eye surgery or wearers of contact lenses were excluded. Differences were analysed with the Bonferroni-adjusted Mann-Whitney U Test for statistical significance. RESULTS: The median central corneal thickness in POAG was 600 +/- 35 microm, in NTG 577 +/- 31 microm, in PEXG 603 +/- 25 microm and in the control group 606 +/- 38 microm. The difference between NTG and the control group was statistically significant (p = 0.01). Superiorly the peripheral corneal thickness was lower in POAG (670 +/- 47 microm) and NTG (639 +/- 37 microm) compared to the control group (686 +/- 46 microm). Nasally the peripheral corneal thickness was lower in POAG (656 +/- 48 microm), NTG (658 +/- 55 microm) and PEXG (642 +/- 47 microm) compared to the control group (677 +/- 46 microm). Temporally and inferiorly there were only small differences compared to the control group. The differences in peripheral corneal thickness were not statistically significant. DISCUSSION: In accord with literature data the central corneal thickness was lower in patients with normal tension glaucoma compared to normal subjects. Superiorly and nasally the peripheral corneal thickness was lower in patients with open angle glaucoma than in normal subjects which was, however, not statistically significant. To what extent these characteristics of the corneal architecture are relevant for the pathogenesis of open angle glaucomas has to be clarified in further larger trials.     

Prevalence of open-angle glaucoma in a rural south Indian population

PURPOSE: To determine the prevalence of primary open-angle glaucoma (POAG) and the associated risk factors in a rural population in southern India. METHODS: Subjects aged 40 years or more (n = 3934) underwent a complete ophthalmic examination. Glaucoma was diagnosed according to the International Society of Geographical and Epidemiologic Ophthalmology classification. RESULTS: Complete data were available for 3924 subjects (response rate, 81.75%). In eyes with normal suprathreshold visual fields, the mean intraocular pressure was 14.29 +/- 3.32 mm Hg (97.5th and 99.5th percentiles, 21 and 25 mm Hg, respectively). The mean vertical cup-to-disc ratio was 0.39 +/- 0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8, respectively). Sixty-four subjects had definite POAG (1.62%, 9.5% CI 1.42-1.82); 30 were men and 34 were women. Subjects with POAG (59.85 +/- 10.43 years) were older (P < 0.001) than the study population (53.78 +/- 10.71 years). In only one (1.5%) person was POAG diagnosed before the study. Two (3.12%) subjects were blind due to POAG; 21 (32.81%) subjects had a presenting IOP >21 mm Hg, and 43 (67.19%) had an IOP <21 mm Hg. The mean central corneal thickness in subjects with POAG (502.82 +/- 35.29 microm) was not different from that of the normal study population (505.93 +/- 31.11 microm). No association was found with diabetes mellitus, systemic hypertension, gender, and myopia. Increasing IOP (per mm Hg) was associated with the disease (OR 1.12; 95% CI, 1.08-1.16). The odds for POAG increased with advancing age after adjustment for gender. CONCLUSIONS: The prevalence of POAG in this population was 1.62%. The prevalence increased with age, and 98.5% were not aware of the disease.     

动态轮廓眼压计在正常眼压性青光眼及原发性开角型青光眼的应用研究

目的:应用动态轮廓眼压计(dynamic contour tonometer,DCT)测量正常眼压性青光眼(normal tension glaucoma,NTG)及原发性开角型青光眼(primary open angle glaucoma,POAG)患者的眼压(intraocular pressure,IOP)及眼脉动幅度值(ocular pulse amplitude,OPA),并探讨影响OPA测量值的相关因素。方法:选取NTG患者20例,POAG患者21例及正常对照组各20例,应用Goldmann压平眼压(Goldmann applanation tonometer,GAT)及DCT测量IOP,同时测量了中央角膜厚度(central corneal thickness,CCT)、眼轴(axial length,AL)、心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)等指标,并探讨GAT,DCT两种眼压计测量的相关性,进而分析OPA测量值的影响因素。结果:三组被检者的IOP,OPA,SBP及DBP差异均有统计学意义(P<0.05),而CCT,AL及HR差异无统计学意义(P>0.05)。其中OPA值NTG组为(1.7±0.9)mmHg,POAG组为(2.8±0.7)mmHg,正常对照组为(2.4±0.6)mmHg;NTG组与POAG组比较(P=0.001),与正常对照组比较(P=0.005)差异均有统计学意义,POAG组与正常对照组比较(P=0.502)差异无统计学意义;OPA值与IOP,HR及CCT无相关性(P>0.05),与AL,SBP及DBP具有一定的相关性(P<0.05)。结论:NTG患者与POAG患者及正常人的OPA值存在差异,同时OPA值受AL及SBP及DBP影响。     

Episcleral venous pressure in younger and older subjects in the sitting and supine positions

PURPOSE: Intraocular pressure is higher in older than younger subjects during the day and night. We attempted to determine whether episcleral venous pressure could explain the difference in the sitting and supine positions. PARTICIPANTS AND METHODS: We compared episcleral venous pressure, intraocular pressure, and blood pressure in a group of younger subjects aged 18 to 30 years and in a group of older subjects aged 65 years or older. The above measurements were performed in the sitting position and after 15 minutes in the supine position. RESULTS: The main difference between the groups was their systemic conditions. Comparing both groups, episcleral venous pressure and intraocular pressure were not different in the sitting position. However, in the supine position, episcleral venous pressure (9.6 vs. 8.3 mm Hg) (P < 0.01) and intraocular pressure (17.1 vs. 15.6 mm Hg) (P < 0.05) were higher in the older group. Statistically, a within-group analysis showed a significant increase in intraocular pressure in the supine position for both the younger (+ 0.8 mm Hg) (P < 0.001) and older subjects (+ 1.8 mm Hg) (P < 0.02). This was associated with an increased episcleral venous pressure in younger (+ 0.4 mm Hg) (P < 0.001) and older subjects (+1 mm Hg) (P < 0.02). There was no gender difference in intraocular pressure and episcleral venous pressure. No differences were found for intraocular pressure and episcleral venous pressure in subjects having certain systemic conditions. Blood pressure was higher for older subjects (P < 0.001). It decreased in the supine position for both groups (P < 0.001). CONCLUSION: Intraocular pressure and episcleral venous pressure were not different in the younger and older group in the sitting position. They were higher in the supine position for older subjects. There was no gender difference.