Oxygen venular saturation correlates with a functional loss in primary open-angle glaucoma and normal-tension glaucoma patients

Posted Posted in glaucoma

Oxygen, saturation, open-angle glaucoma, normal-tension glaucoma

2017 Nov 1. doi: 10.1111/aos.13575. [Epub ahead of print]

Oxygen venular saturation correlates with a functional loss in primary open-angle glaucoma and normal-tension glaucoma patients.

Abstract

PURPOSE:

To investigate whether there are differences in retinal oxygen saturation in upper and lower visual field hemispheres in primary open-angle glaucoma (POAG) and in normal-tension glaucoma (NTG).

METHODS:

This study enrolled POAG and NTG patients exhibiting differences between the upper and lower total deviation (TD) that were either more than 10 or <5 dB. Retinal oxygen saturation measurements in these patients with glaucoma were performed by a non-invasive spectrophotometric retinal oximeter. The Student’s t-test was used for statistical analysis.

RESULTS:

Evaluations of the worse and better hemifields in the patients with POAG who exhibited differences in the upper and lower hemifield TD that was <5 dB (n = 25) showed that there were no statistically significant differences for the retinal venous saturation of oxygen (SaO2 ). However, there was a higher mean SaO2 in the worse (57.0 ± 7.5%) versus the better (54.3 ± 7.0%) hemifield in the patients with NTG (n = 22; p = 0.007). Evaluations of the patients with more than a 10-dB difference in the upper and lower hemifield TD showed statistically significant differences for the retinal venous SaO2 in the venous vessels between the POAG (n = 19) and the NTG (n = 26) patients.

CONCLUSION:

Although there was no significant difference in retinal SaO2 in the venules between the better and worse hemifield when the difference between the better and worse hemifield in the patients with POAG was <5 dB, there was a higher SaO2 in the venous vessels in the worse hemifield in the patients with NTG.

 

Oxygen, saturation, open-angle glaucoma, normal-tension glaucoma

 

KEYWORDS:

normal-tension glaucoma; oxygen saturation; primary open-angle glaucoma; visual field defect

Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

Posted Posted in glaucoma

Outcomes, Ahmed Glaucoma Valve, Revision, Pediatric, Glaucoma

2017 Sep 13. pii: S0002-9394(17)30392-6. doi: 10.1016/j.ajo.2017.09.015. [Epub ahead of print]

Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

Abstract

PURPOSE:

Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children.

DESIGN:

Retrospective cross sectional study METHODS: A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of six months was conducted. Outcome measures included: reduction in intraocular pressure from baseline, survival analysis and reduction in the number of anti-glaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21 mmHg or less without medications, while qualified success was defined as having an IOP of 21 mmHg or less with medications.

RESULTS:

A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range 1.9 – 13 years) with a median follow up of 12 months (range; 6 to 24 months). The IOP was reduced from a preoperative mean of 30.4 (±10.3) to 24.9 (±10.6) mmHg at 6 months postoperatively. Kaplan-Meier analysis showed that the complete success at 1 month was 100% followed by a rapid decline at 6 months to 38.6%, 27.7% at one year and 5.5% at 2 years. Qualified success was 100% at 1 month followed by a six-month and 1 year survival rate of approximately 50%, and a two-year survival rate of approximately 16%. The median survival time was 14 months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other complications included hyphema (n=3; 6.8%), endophthalmitis (n=1; 2.3%) wound leak (n=1; 2.3%) and choroidal detachment (n=2; 4.5%).

CONCLUSION:

Although the short-term success rate of AGV revision in children is high, with longer follow-up the success rate decreases significantly.

Outcomes, Ahmed Glaucoma Valve, Revision, Pediatric, Glaucoma

PMID:
28918060
DOI:
10.1016/j.ajo.2017.09.015

Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal

Posted Posted in glaucoma

iPad, Application, Visual Field Loss

2017 Aug 24. pii: S0002-9394(17)30341-0. doi: 10.1016/j.ajo.2017.08.007. [Epub ahead of print]

Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal.

Abstract

PURPOSE:

To evaluate the accuracy and efficiency of Visual Fields Easy (VFE), a free iPad app, for performing suprathreshold perimetric screening.

METHODS:

We performed screening visual fields using a calibrated iPad 2 with the VFE application on 206 subjects (411 eyes): 210 normal (NL), 183 glaucoma (GL) and 18 diabetic retinopathy (DR) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. We correlated the results with a Humphrey Field Analyzer using 24-2 SITA Standard tests on 273 of these eyes (198 NL, 160 GL, 15 DR) RESULTS: The number of missed locations on the VFE correlated with Mean Deviation (MD, r=0.79), Pattern Standard Deviation (PSD, r = 0.60), and number of locations that were worse than the 95% confidence limits for Total Deviation (r=0.51) and Pattern Deviation (r=0.68) using SITA Standard. iPad suprathreshold perimetry was able to detect most visual field deficits with moderate (MD of -6 to -12 dB) and advanced (MD worse than -12 dB) loss, but had greater difficulty in detecting early (MD better than -6 dB) loss, primarily due to an elevated false positive response rate. The average time to perform the Visual Fields Easy test was 3 minutes 18 seconds (s.d = 16.88 seconds).

iPad, Application, Visual Field Loss

DISCUSSION:

The Visual Fields Easy test procedure is a portable, fast, effective procedure for detecting moderate and advanced visual field loss. Improvements are currently underway to monitor eye and head tracking during testing, reduce testing time, improve performance and eliminate the need to touch the video screen surface.

KEYWORDS:

Abstract: 249; Design: Prospective; Word Count: Manuscript: 2928; cross sectional; diabetic retinopathy; glaucoma; iPad; tablet display; validation study; visual field screening; visual impairment

PMID:
28844641
DOI:
10.1016/j.ajo.2017.08.007

 

Microcatheter Circumferential Trabeculotomy versus Conventional Trabeculotomy in Congenital Glaucoma

Posted Posted in glaucoma

Microcatheter, Trabeculotomy, Congenital Glaucoma

2017 Jun 14. pii: S0002-9394(17)30242-8. doi: 10.1016/j.ajo.2017.06.004. [Epub ahead of print]

Randomized Trial on Illuminated Microcatheter Circumferential Trabeculotomy versus Conventional Trabeculotomy in Congenital Glaucoma.

Abstract

PURPOSE:

To compare one year outcomes of illuminated microcatheter-assisted circumferential trabeculotomy(IMCT) vs conventional partial trabeculotomy(CPT) for Primary Congenital Glaucom (PCG).

DESIGN:

Randomized clinical trial METHODS: Forty eyes of 31 patients with unilateral or bilateral primary congenital glaucoma aged less than two years were randomized to undergo IMCT (20 eyes) or CPT (20 eyes). Primary outcome measure was IOP reduction. The success criterion was defined as intraocular pressure (IOP) ≤ 12 mm Hg without and with anti-glaucoma medications (absolute success and qualified success respectively).

RESULTS:

The mean age of our study population was 8.35 ± 1.2 months. The mean pre-operative IOP was 24.70± 3.90 mm Hg in the IMCT group and 24.60± 3.31 mm Hg in the CPT group. Both groups were comparable with respect to pre-operative IOP, corneal clarity, corneal diameter, vertical cup-disc ratio and refractive error. In IMCT group, 360 degree cannulation was achieved in 80% (16/20) eyes. For the IMCT group and CPT groups respectively, the absolute success rates were 80%(16/20) and 60%(12/20) (p< 0.001); and qualified success rates were 90% (18/20) and 70% (14/20) (p< 0.001). Both procedures produced a statistically significant reduction in IOP, and eyes undergoing IMCT achieved a lower IOP than CPT group at 12 months follow-up (9.5 + 2.4 mm and 11.7 + 2.1 mm Hg respectively, p< 0.001).

CONCLUSION:

In primary congential glaucoma, illuminated microcatheter assisted 360 degree circumferential trabeculotomy performed better than conventional partial trabeculotomy at one year follow-up, and resulted in significantly lower IOP measurements.

PMID:
28624326
DOI:
10.1016/j.ajo.2017.06.004
Microcatheter, Trabeculotomy, Congenital Glaucoma
Baerveldt glaucoma implant

Risk factors for Rapid Glaucoma Disease Progression

Posted Posted in glaucoma

Risk Factor, Glaucoma, Progression

2017 Jun 14. pii: S0002-9394(17)30241-6. doi: 10.1016/j.ajo.2017.06.003. [Epub ahead of print]

Risk factors for Rapid Glaucoma Disease Progression.

Abstract

PURPOSE:

To determine the intraocular and systemic risk factor differences between a cohort of rapid glaucoma disease progressors and non-rapid disease progressors.

DESIGN:

Retrospective case control study Methods SETTING: Five private ophthalmology clinics STUDY POPULATION: 48 rapidly progressing eyes (progression ≥1dB mean deviation (MD)/year) and 486 non-rapidly progressing eyes (progression <1dB MD/year). Patients were eligible if they had a diagnosis of glaucoma from their ophthalmologist and if they had greater than or equal to 5 Humphrey visual fields (24-2) conducted. Patients were excluded if their sequential visual fields showed an improvement in MD or if they had greater than 5dB MD variation in between visits. Patients with obvious neurological fields were excluded.

OBSERVATION PROCEDURE:

Clinical and demographic data (age, gender, CCT, IOP, refraction, medications) as well as medical, surgical and ocular histories were collected.

MAIN OUTCOME MEASURES:

Risk factor differences between the cohorts were measured using the independent t-test, Wald chi-squared and binomial regression analysis.

RESULTS:

Rapid progressors were older, had significantly lower CCT and baseline IOPs and were more likely to have pseudoexfoliation, disc haemorrhages, ocular medication changes and IOP lowering surgery. They also had significantly higher rates of cardiovascular disease and hypotension. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressive glaucoma disease despite significantly lower mean and baseline IOPs.

CONCLUSION:

Cardiovascular disease is an important risk factor for rapid glaucoma disease progression irrespective of IOP control.

PMID:
28624324
DOI:
10.1016/j.ajo.2017.06.003
Risk Factor, Glaucoma, Progression
Optic nerves damaged by glaucoma. Not from article

Rates of Local Retinal Nerve Fiber Layer Thinning before and after Disc Hemorrhage in Glaucoma

Posted Posted in glaucoma
Retina, Nerve fiber layer, Thinning, Disc hemorrhage, glaucoma
Ophthalmology. 2017 May 9. pii: S0161-6420(16)32367-3. doi: 10.1016/j.ophtha.2017.03.059. [Epub ahead of print]

Rates of Local Retinal Nerve Fiber Layer Thinning before and after Disc Hemorrhage in Glaucoma.

Abstract

Retina, Nerve fiber layer, Thinning, Disc hemorrhage, glaucoma

PURPOSE:

To investigate longitudinal temporal and spatial associations between disc hemorrhage (DH) and rates of local retinal nerve fiber layer (RNFL) thinning before and after DHs.

DESIGN:

Longitudinal, observational cohort study.

PARTICIPANTS:

Forty eyes of 37 participants (23 with glaucoma and 17 with suspect glaucoma at baseline) with DH episodes during follow-up from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.

METHODS:

All subjects underwent optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were calculated using multivariate linear mixed-effects models before and after DH.

MAIN OUTCOME MEASURES:

Rates of global and local RNFL thinning.

RESULTS:

Thirty-six eyes of 33 participants with inferior or superior DHs were analyzed. The rates of RNFL thinning were significantly faster in DH quadrants than in non-DH quadrants after DH (-2.25 and -0.69 μm/year; P < 0.001). In the 18 eyes with intensified treatment after DH, the mean rate of RNFL thinning significantly slowed after treatment compared with before treatment in the non-DH quadrants (-2.89 and -0.31 μm/year; P < 0.001), but not in the DH quadrants (-2.64 and -2.12 μm/year; P = 0.19). In 18 eyes with unchanged treatment, the rate of RNFL thinning in the DH quadrant was faster after DH than before DH (P = 0.008). Moreover, compared with eyes without a treatment change, intensification of glaucoma treatment after DH significantly reduced the global, non-DH quadrants, and DH quadrant rates of RNFL thinning after DH compared with before DH (global, P = 0.004; non-DH quadrant, P < 0.001; DH quadrant, P = 0.005). In the multiple linear regression analysis, treatment intensification (β, 1.007; P = 0.005), visual field mean deviation (β, 0.066; P = 0.049), and difference in intraocular pressure before and after DH (β, -0.176; P = 0.034) were associated significantly with the difference of global RNFL slope values before and after DH.

CONCLUSIONS:

Although the rate of RNFL thinning worsened in a DH quadrant after DH, glaucoma treatment intensification may have a beneficial effect in reducing this rate of thinning.

Contribution of Mutations in Known Mendelian Glaucoma Genes to Advanced Early-Onset Primary Open-Angle Glaucoma

Posted Posted in glaucoma

Glaucoma, Genes, Mutations

Invest Ophthalmol Vis Sci. 2017 Mar 1;58(3):1537-1544. doi: 10.1167/iovs.16-21049.
Contribution of Mutations in Known Mendelian Glaucoma Genes to Advanced Early-Onset Primary Open-Angle Glaucoma.

Zhou T1, Souzeau E1, Siggs OM1, Landers J1, Mills R1, Goldberg I2, Healey PR3, Graham S4, Hewitt AW5, Mackey DA6, Galanopoulos A7, Casson RJ7, Ruddle JB8, Ellis J9, Leo P9, Brown MA9, MacGregor S10, Sharma S1, Burdon KP11, Craig JE1.
Author information
Abstract
PURPOSE:
Primary open-angle glaucoma (POAG) and primary congenital glaucoma (PCG) with Mendelian inheritance are caused by mutations in at least nine genes. Utilizing whole-exome sequencing, we examined the disease burden accounted for by these known Mendelian glaucoma genes in a cohort of individuals with advanced early-onset POAG.
METHODS:
The cases exhibited advanced POAG with young age of diagnosis. Cases and examined local controls were subjected to whole-exome sequencing. Nine hundred ninety-three previously sequenced exomes of Australian controls were called jointly with our dataset. Qualifying variants were selected based on predicted pathogenicity and rarity in public domain gene variant databases. Case-control mutational burdens were calculated for glaucoma-linked genes.
RESULTS:
Two hundred eighteen unrelated POAG participants and 103 nonglaucomatous controls were included in addition to 993 unexamined controls. Fifty-eight participants (26.6%) harbored rare potentially pathogenic variants in known glaucoma genes. Enrichment of qualifying variants toward glaucoma was present in all genes except WDR36, in which controls harbored more variants, and TBK1, in which no qualifying variants were detected in cases or controls. After multiple testing correction, only MYOC showed statistically significant enrichment of qualifying variants (odds ratio [OR] = 16.62, P = 6.31×10-16).
CONCLUSIONS:
Rare, potentially disease-causing variants in Mendelian POAG genes that showed enrichment in our dataset were found in 22.9% of advanced early-onset POAG cases. MYOC variants represented the largest monogenic cause in POAG. The association between WDR36 and POAG was not supported, and the majority of POAG cases did not harbor a potentially disease-causing variant in the remaining Mendelian genes.

Long-term efficacy of combined phacoemulsification plus trabeculectomy versus phacoemulsification plus excimer laser trabeculotomy.

Posted Posted in glaucoma

cataract surgery, phacoemulsification, excimer laser, trabeculotomy

Klin Monbl Augenheilkd. 2017 Mar 6. doi: 10.1055/s-0043-100291. [Epub ahead of print]
Long-term efficacy of combined phacoemulsification plus trabeculectomy versus phacoemulsification plus excimer laser trabeculotomy.
Töteberg-Harms M1, Wachtl J1, Schweier C2, Funk J1, Kniestedt C1.
Author information
Abstract
Background Combined cataract and glaucoma procedures, and minimally-invasive glaucoma surgery in particular, have gained increasing interest over the past few years. The aim of this study was to compare the long-term efficacy of combined phaco-trabeculectomy (Phaco-Trab) and combined phacoemulsification plus excimer laser trabeculotomy (Phaco-ELT). Patients and Methods Retrospective, non-randomised, comparative, interventional case series of consecutive patients after Phaco-Trab and Phaco-ELT at the University Hospital of Zurich and the Talacker Eye Center Zurich in Switzerland. Inclusion criteria were diagnosis of glaucoma plus vision-impairing coexisting cataract. Primary outcome measures were change in intraocular pressure (IOP), number of anti-glaucoma drugs (AGDs), and best-corrected visual acuity (BCVA) 1 year and 4 years after the procedure. Secondary outcome measures were surgical complications and requirement of postoperative interventions. Success was defined based on the criteria of the Tube-versus-Trabeculectomy study. Results Mean age was 76.1 ± 8.6 years (29.2 % males; 47.8 % right eyes). Phaco-Trab (n = 62) decreased median IOP from 22.8 to 13.0 at 1 year and to 14.0 mmHg at 4 years. AGDs were reduced from 2 drugs to 0 AGDs at 1 year and 4 years. Median BCVA improved from 0.2 logMAR to 0.0 logMAR at 1 year and 4 years. Phaco-ELT (n = 51) lowered median IOP from 19.0 to 15.0 at 1 year and to 14.0 mmHg (p = 0.002) at 4 years. AGDs were reduced from 2 drugs to 1 AGD at 1 year and 4 years (p = 0.002). BCVA improved from 0.4 logMAR to 0.1 logMAR after 1 year and 4 years. If not stated otherwise, all changes compared to baseline were highly significant (p < 0.001). No perioperative complications occurred; postoperative interventions were performed in 74 % of Phaco-Trab patients. Conclusion Both surgical procedures reduced IOP and AGDs and improved BCVA significantly and persistently during the entire follow-up period of 4 years with a good safety profile. This study validates Phaco-ELT as an option when post-operative target pressure in the mid-teens would be adequate, whereas Phaco-Trab would be the treatment of choice when IOP in the low teens is desired.

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

Posted Posted in glaucoma
Ocul Immunol Inflamm. 2016 Aug 5:1-7. [Epub ahead of print]

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

Abstract

PURPOSE:

To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).

METHODS:

Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test.

RESULTS:

At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).

CONCLUSIONS:

Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

KEYWORDS:

Cataract; glaucoma; heterochromia; uveitis

Abstract

PURPOSE:

To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).

METHODS:

Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test.

RESULTS:

At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).

CONCLUSIONS:

Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

KEYWORDS:

Cataract; glaucoma; heterochromia; uveitis

The pressure difference between eye and brain changes with posture

Posted Posted in glaucoma
pressure,eye ,brain, posture
Ann Neurol. 2016 Jun 28. doi: 10.1002/ana.24713. [Epub ahead of print]

The pressure difference between eye and brain changes with posture.

Abstract

OBJECTIVE:

The discovery of a posture-dependent effect on the difference between intraocular pressure (IOP) and intracranial pressure (ICP) at the level of lamina cribrosa could have important implications for understanding glaucoma and idiopathic intracranial hypertension and could help explain visual impairments in astronauts exposed to microgravity. The aim of this study was to determine the postural influence on the difference between simultaneously measured ICP and IOP.

METHODS:

Eleven healthy adult volunteers (age 46±10 years) were investigated with simultaneous ICP, assessed through lumbar puncture, and IOP measurements when supine, sitting, and in 9° head down tilt (HDT). The trans-lamina cribrosa pressure difference (TLCPD) was calculated as the difference between the IOP and ICP. To estimate the pressures at the lamina cribrosa, geometrical distances were estimated from MRI and were used to adjust for hydrostatic effects.

RESULTS:

The TLCPD (mm Hg) between IOP and ICP was 12.3±2.2 for supine, 19.8±4.6 for sitting and 6.6±2.5 for HDT. The expected 24-hour average TLCPD on earth- assuming 8 h supine and 16 h upright-was estimated to be 17.3 mm Hg. By removing the hydrostatic effects on pressure, a corresponding 24 h-average TLCPD in microgravity environment was simulated to be 6.7 mmHg.

INTERPRETATION:

We provide a possible physiological explanation for how microgravity can cause symptoms similar to those seen in patients with elevated ICP. The observed posture dependency of TLCPD also implies that assessment of the difference between IOP and ICP in upright may offer new understanding of the pathophysiology of idiopathic intracranial hypertension and glaucoma.

INTERPRETATION:

We provide a possible physiological explanation for how microgravity can cause symptoms similar to those seen in patients with elevated ICP. The observed posture dependency of TLCPD also implies that assessment of the difference between IOP and ICP in upright may offer new understanding of the pathophysiology of idiopathic intracranial hypertension and glaucoma.