Stratus OCT, SWAP, Matrix FDT in Preperimetric Glaucoma

PURPOSE: To evaluate the peripapillary retinal nerve fiber layer (RNFL) thickness with optical coherence tomography (OCT) in normal subjects and preperimetric glaucoma patients, as well as compare the results of OCT, short wavelength automated perimetry (SWAP), frequency doubling technology perimetry (FDT) in preperimetric glaucoma patients. METHODS: Thirty-six eyes of 36 preperimetric glaucoma patients who have definitive localized RNFL defects in disc photograph and normal standard visual field, as well as 35 eyes of 35 normal subjects, were enrolled in this study. We compared the peripapillary RNFL thickness between the two groups using Stratus OCT. Stratus OCT, FDT, and SWAP results in preperimetric glaucoma group were also compared. RESULTS: Compared with normal controls, peripapillary RNFL thickness, including the average, superior, and inferior quadrant, was significantly low (P<0.05) in the preperimetric glaucoma group, 93.40+/-11.16 micrometer, 118.33+/-21.17 micrometer, and 108.72+/-16.76 micrometer respectively. In preperimetric glaucoma group, functional and structural abnormalities were found in 55.6% with Stratus OCT, 31.4% with SWAP, and 79.4% with Matrix FDT. CONCLUSIONS: Statistically significant reduction of RNFL thickness was revealed in the preperimetric glaucoma group, and Matrix FDT was the most sensitive test for detecting early glaucomatous change, followed by Stratus OCT, and SWAP.

Transforming Growth Factor-beta Levels in Human Aqueous Humor of Glaucomatous, Diabetic and Uveitic Eyes

PURPOSE: Transforming growth factor-beta2 is known to be present at elevated levels in the aqueous humor of patients with primary open angle glaucoma (POAG) and diabetes but not in uveitis-related secondary glaucoma. We investigated total TGF-beta2 levels and levels of the active form of TGF-beta2 in the aqueous humor of eyes with different types of glaucoma. METHODS: The concentration of the total and active form of TGF-beta2 was measured in 63 patients with primary open angle glaucoma, neovascular glaucoma complicated with diabetes (NVG), and secondary open angle glaucoma complicated with uveitis (SOAG) using a double antibody 'sandwich-indirect' ELISA method. RESULTS: The levels of total TGF-beta2 in the aqueous samples of POAG, NVG, and SOAG were elevated. The levels of active TGF-beta2 in the aqueous samples of POAG, and NVG were also elevated, whereas the level of active TGF-beta2 was within the normal range in the aqueous samples of SOAG. CONCLUSIONS: These results suggest that the level of TGF-beta2 may play a role in the pathology of various types of glaucoma.

Neovascular Glaucoma: Diode Laser Trans-Scleral Cyclophotocoaculation Versus Ahmed Glaucoma Valve Implant

PURPOSE: To retrospectively study the clinical outcomes of diode laser trans-scleral cyclophotocoagulation and Ahmed glaucoma valve implant in eyes with neovascular glaucoma. METHODS: We reviewed the medical records of patients who had undergone diode laser trans-scleral cyclophotocoagulation (group 1) and Ahmed glaucoma valve implant (group 2) with a follow-up period of 6 months or longer. The treatments were carried out to control high intraocular pressure (IOP) and ocular pain in the patients with visual acuity less than hand motions. RESULTS: Group 2 had a significantly lower IOP during the first postoperative month. The cumulative probability of success was higher in group 2 than group 1 throughout the follow-up period. The postoperative complications in most cases were transient and improved with conservative management in both groups. However, 3 cases in group 1 required evisceration secondary to phthisis. Subjective relief of ocular pain was higher in group 2. CONCLUSIONS: The Ahmed glaucoma valve implant group showed a higher success rate and fewer serious complications than the diode laser trans-scleral cyclophotocoagulation group in patients with high IOP and ocular pain with poor visual acuity. Diode laser trans-scleral cyclophotocoagulation may be considered in patients with poor general health.