Research progress of Posner-Schlossman syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

Posner-Schlossman syndrome(PSS)is a sporadic and recurrent self-limiting anterior uveitis, and its pathogenesis remains unclear. It was considered to be a prostaglandin-mediated inflammatory response. In recent years, it has been found to be related to viral infection, immune genetics, vascular endothelial dysfunction, and other factors. Clinically, the disease is predominantly unilateral. The patients with PSS suffer from increased intraocular pressure, mild pain in the affected eye, as well as blurred vision, and irisopsia. Seldom damage to the optic nerve and visual field was reported. The commonly treatment of PSS is local medication, such as anti-inflammatory drugs and intraocular pressure lowering drugs; otherwise systemic medication can be employed in severe cases. Surgical treatment can be performed for PSS if uncontrolled intraocular pressure elevation, frequent attacks, and optic nerve damage and visual field defect due to prolonged disease course. Early diagnosis and treatment of PSS can effectively reduce glaucoma-related damages. This review discussed the research progress of PSS from various aspects, aiming to provide references for the etiology, pathogenesis, and clinical diagnosis and treatment of this disease.

The Influence of Demographic Characteristics on the Qualitative Signs of Glaucomatous Optic Disc

PURPOSE: To evaluate the influence of age, gender, and refractive error on the qualitative signs of glaucomatous optic nerve damage in normal eyes. METHODS: We evaluated color optic disc photographs for the presence or absence of 10 qualitative signs: rim shape alteration (alteration of ISN'T rule), thinnest rim width outside the temporal sector, rim notch, optic disc hemorrhage, baring of circumlinear vessel, bayonetting of vessel, nasalization of vessel, abnormally large peripapillary atrophy, abnormal form of peripapillary atrophy, and zone beta in 181 eyes of 181 normal subjects. The influence of age, gender, and refractive error on each qualitative sign was analysed by multiple logistic regression. RESULTS: Refractive error was related to zone beta (odds ratio=2.29, 95% confidence interval [CI]=1.21~4.33, p=0.009) and the frequency of zone beta was higher in myopic eyes. Age was weakly associated with abnormally large peripapillary atrophy (odds ratio=1.03, 95% CI=1.01~1.06, p=0.02). Gender, on the other hand, had no influence on qualitative signs. CONCLUSIONS: Our findings indicate that the qualitative signs of glaucomatous optic nerve damage were not affected by age, gender, and refractive error, except for zone beta and abnormally large peripapillary atrophy. Myopia was related to zone beta, and age was related to abnormally large peripapillary atrophy in normal eyes.

Glaucomatous Optic Nerve Damage in the Fellow Eyes of Acute Angle-Closure Glaucoma

PURPOSE: To determine whether glaucomatous optic nerve damage occurs in the fellow eyes of patients with unilateral acute primary angle-closure glaucoma. METHODS: This study included both eyes of 75 subjects with unilateral acute primary angle-closure glaucoma in one eye, and 92 eyes of age- and refraction-matched normal controls. The presence or absence of qualitative signs for differentiating between normal and glaucoma eyes, vertical cup to disc ratio, and extent of zone beta were recorded. All subjects underwent examination with a Humphrey Field Analyser. RESULTS: Twelve fellow eyes (16%), 28 attacked eyes (37.3%), and no eyes in the control group had a vertical cup to disc ratio of 0.7 or greater (p<0.05). Thinnest rim width outside the temporal sector, rim shape alteration (alteration of ISN'T rule), baring of circumlinear vessel, and abnormal form of peripapillary atrophy were detected more frequently in fellow eyes than in normal controls (P<0.05). After excluding the attacked eyes with vertical cup to disc ratios of 0.69 or less and their fellow eyes, interocular correlation of mean deviation (r=0.31), corrected pattern standard deviation (r=0.32), extent of zone beta (r=0.57), and vertical cup to disc ratio (r=0.38) for attacked and fellow eyes were significant (p<0.05). CONCLUSIONS: Some of the fellow eyes of patients with unilateral acute primary angle-closure glaucoma had glaucomatous optic nerve damage, particularly the fellow eyes with a large cup to disc ratio.

Comparison of Glaucomatous Optic Nerve Damage in Primary Angle-Closure Glaucoma with and without Acute Attack

PURPOSE: To compare the glaucomatous optic nerve damage in primary angle-closure glaucoma (PACG) with acute attack (acute PACG; AACG) and PACG without acute attack (chronic PACG; CACG). METHODS: The study subjects were 84 normal individuals, 130 AACG patients, and 86 CACG patients. Color optic disc photographs were evaluated for the presence or absence of 10 qualitative signs to differentiate between normal and glaucomatous optic discs. RESULTS: Abnormally shaped rim width (alteration of ISN'T rule), bared circumlinear vessel, vessel bayonetting, rim width narrower than the temporal sector, and zone beta (nasal and superotemporal sectors) were detected more frequently in the CACG group than in the AACG group (P< 0.05). The most accurate qualitative sign was abnormally shaped rim width in both groups. The specificity and sensitivity of abnormally shaped rim width were 71.4% and 60.8% for AACG, and 71.4% and 81.4% for CACG, respectively. CONCLUSIONS: The optic disc damage is greater in CACG than in AACG.

Two Cases of Topless Optic Disc Syndrome

Topless optic disc syndrome is considered as congenital optic nerve hypoplasia.The risk factors of this syndrome are female sex, prematurity and history of maternal diabetes.Normal central visual acuity, thinning of superior peripapillary nerve fiber layer and corresponding inferior visual field defects are the characteristic features of this syndrome.Relative superior entrance of central retinal vessels and superior scleral halo can be found in patients with this syndrome. We experienced two cases of topless optic disc syndrome :one was unilateral and the other, bilateral. They had no history of maternal diabetes. Diffuse superior retinal nerve fiber layer atrophy and inferior visual field defects were observed.Pallor of superior optic neural rim, relative superior entrance of central retinal vessels and superior scleral halo were also observed. It will be necessary to differentiate these findings from glaucomatous optic disc damage and visual field defects.

Retinal Vessel Diameter: 1. Comparison of Normal and Glaucoma Eyes

Narrowing of the retinal vessels in chronic glaucoma has been recognized only recently. We performed this study to evaluate the vessel diameter in normal and glaucoma eyes, addressing whether the retinal vessel diameters differ with the degree of glaucomatous optic nerve damage. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The photographic magnification was corrected according to Littmanns method. Only one eye per patient and subject was taken for statistical analysis. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(early; more than 0.61, medium; 0.60~0.41, advanced; 0.40~0.21, far advanced; less than 0.20). In the normal group the diameter of the inferior temporal vein(0.130+/-0.020mm) was the largest, followed by the superior temporal vein(0.117+/-0.017mm), the inferior temporal artery(0.102+/-0.016mm), finally the superior temporal artery(0.093+/-0.012mm). The retinal vessel diameter decreased significantly with decreasing of the neuroretinal rim/disc area ratio. In the glaucomatous eyes as compared to the normal eyes, the diameters of the inferior temporal and superior temporal retinal artery were significantly smaller at the early and medium stages(p<0.03, p<0.02, respectively). Whereas both inferior temporal and superior temporal retinal vein diameters were significantly samller at the far advanced stage(p=0.01, p=0.005, respectively). The results indicate that generalized reduction of the retinal vessel diameter throughout the retina is related to the severity of glaucoma. From a diagnostic point of view, evaluation of artery diameter rather than vein diameter may be helpful for the differentiation between normal and glaucomatous eyes.