Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma

Purpose:To evaluate long-term perimetric stabilization at set Target (IOPs) in primary angle-closure glaucoma with visual field defects.Methods:Two hundred forty-eight eyes, of 124 primary angle-closure glaucoma (PACG) patients on medical treatment, and 124 eyes, of 95 patients after trabeculectomy performed at least 5 years prior were evaluated. One hundred eighty-five eyes had a follow-up of ≥10 years. Target IOPs for mild, moderate, and severe glaucomatous optic neuropathy were set at ≤18, ≤15, and ≤12 mmHg, respectively. Progression was evaluated by event-based changes on guided progression analysis. Primary outcome measure was therapy required to achieve individualized Target IOP. Secondary outcome measure was assessment of perimetric change over time.Results:Mean baseline IOP was 23.34 ± 6.16 mmHg in medically treated and 36.08 ± 9.73 mmHg in surgically treated eyes (P = 0.0001). All eyes with a baseline IOP of <25 mmHg were on medications alone, 65.33%, of those with a baseline IOP of 25–30 mmHg were on medications, while 34.67% required trabeculectomy. In total, 91.4% of eyes with a baseline IOP of >30 mmHg underwent a trabeculectomy for achieving Target IOP. Perimetric stabilization was achieved in 98.17% of PACG eyes. “Target” IOP was achieved for mild, moderate, and severe glaucomatous optic neuropathy, medically in 90.2, 73.9, and 29.7%, and surgery was required in 9.8, 26.1, and 70.3%, respectively. Overall analysis found that percentage reduction in IOP was significantly more after trabeculectomy than medical treatment, 64.16 ± 14.91 and 43.61 ± 13.73%, P = 0.0001. Decrease in IOP was significantly greater 5–9 years after trabeculectomy, in comparison to ≥10 years, P = 0.001.Conclusion:Medications controlled IOP to “Target” in PACG eyes with mild and moderate glaucoma for over ≥10 years, when the baseline IOP off treatment was <30 mmHg. Trabeculectomy was necessary in PACG eyes having severe glaucomatous optic neuropathy, or with a baseline IOP of >30 mmHg to achieve Target IOP. These appropriate initial therapeutic interventions and Target IOPs are therefore suggested as a clinically validated algorithm of care for different severities of PACG.     

针刺对眼压已控制的慢性高眼压兔视网膜保护作用的研究

目的:观察针刺对眼压已控制的慢性高眼压兔的保护作用。方法:以大耳白兔为实验动物,通过前房注射复方卡波姆溶液造成慢性高眼压模型,28天后通过滤过性手术使眼压恢复正常。分层随机分为模型组、针刺组、电针组、神经营养剂组,并设正常组。予针刺和电针治疗4周,观察其对各组兔视网膜形态学和视网膜节细胞(RGCs)计数的影响。结果:实验结束时各组动物出现显著差异,针刺组、电针组兔视网膜病理结构损伤较轻,视网膜节细胞(RGCs)数量明显高于模型组(P0.05)。结论:针刺能保护高眼压损害的视神经,作用主要表现为减轻视网膜结构损伤,减少视网膜神经节细胞的凋亡。     

An alkaloidal extract (ALKS1) from Trophis racemosa lowers intraocular pressure in dogs

A 1.0% solution of ALKS1, an alkaloidal extract obtained from Trophis racemosa, produced a significant fall in intraocular pressure in the dog's eye (p <0.001). The fall was antagonized by atropine (p <0.0025), suggesting ALKS1 is acting through a muscarinic mode of action. Further purifcation of the extract is required to determine the actual compound producing this effect on the eye. © 1997 John Wiley & Sons, Ltd.