Clinical features and correlation analysis of the 24h intraocular pressure and water drinking test in patients with primary open angle glaucoma and ocular hypertension / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To summarize the clinical features of the 24h intraocular pressure data and the water drinking test(WDT)results in patients with primary open angle glaucoma(POAG)and ocular hypertension(OHT), and analyze the correlation.METHODS: To collect the data of 87 cases(174 eyes)with POAG and OHT, who had completed 24h intraocular pressure(IOP)(measured every 2h)and WDT(drink 1 000mL water off within 5min and then measure every 15min within 1h)in the ophthalmology department of Shenzhen University General Hospital from December 2019 to March 2022. They were divided into three groups, with 33 cases(66 eyes)in high tension glaucoma(HTG)group, 28 cases(56 eyes)in normal tension glaucoma(NTG)group and 26 cases(52 eyes)in OHT group. The clinical features of 24h IOP and WDT among the patients in three groups were summarized, and Spearman correlation was used to analyze the peak and fluctuation values of IOP.RESULTS: Clinical features among the patients in three groups:(1)the proportion of peak IOP of HTG, NTG and OHT group:(2:00-6:00 a.m.): 40.9%, 23.2% and 26.9%;(8:00-12:00 a.m.): 34.8%, 46.4% and 55.8%;(14:00-18:00 p.m.): 18.2%, 21.4% and 11.5%;(20:00-24:00 p.m.): 6.1%, 8.9% and 5.8%. Valley proportion among groups: early morning: 21.2%, 25.0% and 30.8%; morning: 22.7%, 10.7% and 13.5%; afternoon: 19.7%, 17.9% and 17.3%; evening: 36.4%, 46.4% and 38.5%. The proportion of 24h IOP fluctuation <6mmHg: 9.1%, 62.5% and 17.3%; 6-<8mmHg: 24.2%, 32.1% and 40.4%; ≥8mmHg: 66.7%, 5.4% and 42.3%.(2)WDT: The proportion of the three groups that could reach peak IOP within 30min was 81.8%, 76.8% and 80.8%, respectively. The proportion of IOP fluctuations in the three groups <6mmHg: 10.6%, 78.6% and 38.5%; 6-<8mmHg: 22.7%, 16.1% and 28.8%; ≥8mmHg: 66.7%, 5.4% and 32.7%.(3)the proportions of WDT peak higher than 24h peak IOP in the three groups were 80.3%, 80.4% and 80.8%. Correlation: the peak values of 24h IOP were positively correlated with the peak values of WDT(all P<0.01), the fluctuation of 24h IOP was positively correlated with the fluctuation of WDT in HTG and OHT group(P<0.01, P<0.05), while it showed no significant correlation in NTG group(P>0.05).CONCLUSION: Diurnal measurements of IOP during office hours(08:00 a.m.-18:00 p.m.)may fail to capture the peak values and underestimate IOP fluctuations. The 24h IOP fluctuation ≥HTG group of 8mmHg>OHT group>NTG group. The peak WDT in over 75% patients could be achieved within 30min, and it was higher than 24h peak IOP of over 80% patients. There was a positive correlation between the 24h IOP fluctuations and the WDT fluctuations in HTG and OHT patients. Therefore, WDT has clinical significance in assessing fluctuations in patients' IOP.

Comparison of Contrast Sensitivity and Central Corneal Thickness in Primary Open Angle Glaucoma Suspects and Visually Normal Participants

@#Introduction: Glaucoma causes a reduction of contrast sensitivity (CS) while thinner central corneal thickness is (CCT) associated with the risk of glaucoma. Thus, in glaucoma suspect patients, CS and CCT measurements may better evaluate and monitor the disease. The purpose of this study was to compare CS and CCT between a Primary Open Angle Glaucoma (POAG) suspect group and a normal group of similar age. Methods: CS was measured with the Pelli-Robson CS chart, while CCT was measured with a hand-held pachymeter. In total, 115 glaucoma suspects and 102 normal participants were included. Results: There was a significant effect of the clinical condition on CS [F(1,209)=5.409, p=0.02]. The effect of age on CS was also significant [F(3,209)=20.419, p<0.001]. The interaction between age and clinical condition was not statistically significant [F(3,209)=0.815, p=0.49]. CS of POAG suspects was significantly lower than that of the normal group for the younger age groups (40 to 59 years old) but not for the older age groups (50 to 80 years old). There was no significant effect of clinical condition on CCT [F(3,209)=0.754, p=0.39]. However, there was a significant effect of age on CCT [F(3,209)=3.789, p=0.01]. Conclusion: Contrast sensitivity measurement is potentially useful to be integrated with routine investigations for POAG suspect patients, especially those who are younger than 60 years old. Measurements of central corneal thickness alone may not be able to differentiate between POAG suspects and visually normal individuals.

Assessment of optic disk by disk damage likelihood scale staging using slit-lamp biomicroscopy and optical coherence tomography in diagnosing primary open-angle glaucoma

Purpose: The current study was aimed at assessment of optic disk by disk damage likelihood scale (DDLS) staging using slit?lamp biomicroscopy and optical coherence tomography (OCT) in diagnosing primary open?angle glaucoma (POAG) patients. Methods: This was a cross?sectional observational study of 106 POAG patients, which was conducted from April 2017 to April 2018. All patients underwent slit?lamp fundoscopy with a +78 D lens and high?definition (HD)?OCT, and the vertical cup disk ratios (VCDRs) were recorded. Disk size and neuroretinal rim assessment were done, and the disk was then staged using the recent version, which stages the optic nerve head (ONH) from 1 to 10 as read from the DDLS nomogram table. DDLS scores >5 indicate glaucomatous damage. Pearson coefficient was used to correlate the DDLS staging by slit?lamp biomicroscopy with best?corrected visual acuity (BCVA), intraocular pressure (IOP), disk size, and VCDR and VCDR, mean deviation, and DDLS staging by HD?OCT. Results: The mean age of the patients was 59.54 ± 6.61 years. The male: female ratio was 2:1. The mean IOP was 16.04 ± 1.97 mmHg, and BCVA was 0.72 ± 0.13 LogMAR units. The mean VCDR on 78 D slit?lamp biomicroscopy was 0.76 ± 0.09 (standard deviation [SD]) (range 0.1–0.77), whereas on HD?OCT, the mean VCDR was 0.81 ± 0.09 (SD) (range 0.07–0.81). The mean deviation on visual field testing in decibels was ?14.43 ± 3.31 (SD). The correlation coefficient between DDLS staging by slit?lamp biomicroscopy and DDLS staging by HD?OCT parameters was r = 0.96. Conclusion: There is a positive correlation between the DDLS system of optic disk evaluation on slit?lamp biomicroscopy and most of the HD?OCT evaluation parameters

Diagnostic ability of superficial vascular density measured by optical coherence tomography angiography to differentiate high myopic eyes from eyes with primary open angle glaucoma

Purpose: To determine if high myopia and glaucoma can be differentiated based on the measurement of superficial vascular density in the peripapillary and macular areas by using Optical Coherence Tomography Angiography (OCTA). Methods: This prospective, observational, cross?sectional, comparative study was conducted on patients between 40 and 60 years of age diagnosed as primary open?angle glaucoma (POAG) or high myopia and compared with age?matched controls. The main outcome measures were the difference in SVD% in peripapillary and macular areas in POAG and high myopic eyes. Detailed ophthalmic examination and OCTA of the disc and peripapillary area and macula were performed. The SVD in each zone was calculated using ImageJ software and their difference were analyzed. Results: In total, 128 eyes of 70 patients were enrolled. Peripapillary SVD% in controls was 45.07 ± 3.44, 40.36 ± 8.27 in high myopia, and 31.80 ± 9.008 in POAG. The mean difference in peripapillary SVD% of POAG to control was ? 13.479, of POAG to high myopia was ?8.777 (both P < 0.001), and of high myopia to controls was ?4.701 (P = 0.012). Macular SVD% in controls was 27.30 ± 3.438, 22.33 ± 6.011 in high myopia, and 21.21 ± 5.598 in POAG. The mean difference in macular SVD% of POAG to controls was ?6.088, of high myopia to controls was ?4.965 (both P < 0.001), and of POAG to high myopia was ?1.122 (P = 0.984; not statistically significant). Conclusion: OCTA is a useful diagnostic tool in distinguishing glaucomatous and myopic eyes. The measurement of peripapillary SVD has a greater discriminatory ability than that of the macular area.

Peripapillary and fovea avascular zone optical coherence tomography angiography parameters in exfoliation glaucoma versus primary open-angle glaucoma versus healthy eyes

Purpose : To examine the differences in the peripapillary vascular parameters and foveal?avascular?zone (FAZ) vascularity parameters between primary open?angle?glaucoma (POAG) patients versus exfoliation?glaucoma (XFG) patients versus healthy subjects. Methods: This is cross?sectional study and a comparative clinical study. POAG and XFG patients and healthy subjects underwent a comprehensive ophthalmic examination, including visual field optical coherence tomography (OCT) and OCT angiography (OCTA) of the optic disc and FAZ. Differences in peripapillary vessel density (VD), perfusion density (PD), and FAZ area and circularity were examined between all groups, as well as correlations between clinical parameters and vascularity parameters for each glaucoma group. Results: A total of 109 subjects (one eye for each patient) were analyzed, including 45 with POAG, 30 with XFG, and 34 controls. The average peripapillary VDs were the lowest among the XFG patients and the highest among the controls (P < 0.05, ANOVA). The average peripapillary PD of the central ring was the lowest in the XFG group and the highest in the control group (P = 0.02, ANOVA). A significant negative correlation was found between the average peripapillary VDs and PDs of the inner ring and full ring and disease severity of the POAG patients. There was a significant positive correlation between the average peripapillary PDs of the central rings and full ring and the central macular thickness of the XFG patients (P < 0.01 and P < 0.04, respectively, Pearson correlation). Conclusion: The peripapillary vascular parameters of the POAG and XFG patients were lower compared to those of normal participants. A correlation between clinical characteristics of POAG and XFG patients and PD was found. This may hint to a vascular mechanism in glaucoma either primary or secondary to intra?ocular pressure/OAG damage.

Familial Primary Open Angle Glaucoma

Primary open-angle glaucoma (POAG), also known as chronic simple glaucoma, is usually an inherited disease. Inheritance is considered multifunctional and polygenic. Glaucoma is the second leading cause of irreversible blindness worldwide, of which POAG is the most common. First-degree relatives of POAG patients are at increased risk. A reasonable risk for siblings is four and twice the risk of the normal population for the offspring, although the number of surveys varies. This case series of eight family members with POAG illustrates the stealth nature of POAG and the devastating vision loss it can cause as it progresses; emphasizing regular and comprehensive eye examinations during its early stage.

Research on diagnostic value of OCT measurement of optic disc and macular parameters in early primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To analyze the diagnostic value of optical coherence tomography(OCT)for early primary open angle glaucoma(POAG)by measuring the thickness of macular ganglion cell complex(mGCC), peripapillary retinal nerve fiber layer(pRNFL), macular retinal nerve fiber layer(mRNFL)and retinal ganglion cell layer+inner plexiform layer(GCIP)in the macular region.METHODS:A case-control study design was used to collect 82 patients(82 eyes)with early POAG who admitted to our hospital from January 2019 to January 2020. There were 40 healthy volunteers(40 eyes)in the same period selected as the control group(20 eyes for left and right eyes, respectively). All subjects underwent tests of uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and equivalent spherical power. The upper, lower, nasal, temporal and average pRNFL thickness, the upper, lower and average mGCC, mRNFL and GCIP thickness in the macular region were analyzed. Spearman was used to analyze the correlation among the average thickness of eachindices, and ROC curve was used to analyze the value of mGCC, pRNFL, mRNF and GCIP thickness parameters in diagnosing early POAG.RESULTS:In the early POAG group, the thickness of upper, nasal, lower, temporal, average pRNFL and the thickness of upper, lower and average mGCC, mRNFL and GCIP were lower than those in the control group(all P&#x003C;0.05). Average thickness of pRNFL was positively correlated with average thickness of mGCC, average mRNFL and average GCIP(rs=0.582, 0.632, 0.456, all P&#x003C;0.05); average thickness of mGCC was positively correlated with average thickness of mRNFL and average GCIP(rs=0.583, 0.851, all P&#x003C;0.05); Average thickness of mRNFL was positively correlated with average thickness of GCIP(rs=0.528, all P&#x003C;0.01). ROC curve analysis shows that the AUC value of mGCC thickness and average value in early diagnosis of POAG were all above 0.8, and the diagnostic efficiency was the highest.CONCLUSION: OCT measurement of mGCC has certain value in diagnosing early POAG.

Attention and Its Relationship with Anxiety in Primary Open Angle Glaucoma Patients / 中山大学学报(医学科学版)

@#【Objective】 To explore the attention and its relationship with anxiety in patients with glaucoma.【Methods】A prospective case-control study was done on 20 primary open angle glaucoma（POAG）patients and 28 normal subjects. Response time with and without disturbance was examined by using Matlab software. Anxiety was assessed with State Anxiety Inventory（S- AI）and Trait Anxiety Inventory（T- AI）. Response time and inhibiting effects between two groups were compared by t test and Mann- Whitney U test ，respectively. Spearman correlation analysis was applied to determine the relationship between inhibiting effect and anxiety.【Results】The scores of S-AI and T-AI in POAG group were significantly higher than those in normal subjects（t = -3.912，P = 0.001；t = -2.127，P = 0.042）. There were statistically significant differences in the scores between groups even after gender was adjusted by using line regression model（β = 9.449，P = 0.000；β = 7.089，P = 0.018）. The average response time in POAG group（0.84±0.15）s was significantly longer than that in normal participants（0.75±0.14）s（t = -2.127，P = 0.039）. The difference was statistically insignificant when gender was adjusted by using line regression model（β = 0.063，P = 0.210）. The inhibiting effect in POAG group（0.126±0.089）s was longer than that in normal subjects（0.085±0.066）s（Z = -1.715，P = 0.086）. The inhabiting effect wasn′ t statistically significantly correlated with scores of S- AI and T- AI（P＞0.05）.【Conclusions】Patients with POAG showed severer anxiety than normal subjects but attention was comparable. There was no significant correlation between attention and anxiety.

Central visual function and inner retinal structure in primary open-angle glaucoma / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma (POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential (icVEP) testing, 24–2 standard automated perimetry (SAP), and Cirrus optical coherence tomography (OCT) examinations. Signal-to-noise ratio (SNR) measures obtained from icVEP responses to isolated checks presented at four depths of modulation (DOMs; 8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity (mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness (GCL+IPLT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls (P<0.001). A significant positive association was found between SNR at 14% DOM and GCL+IPLT at the inferior sector in early glaucoma (r=0.465, P=0.004). In moderate to advanced glaucoma, significant correlations were found between SNR at 32% DOM and mean GCL+IPLT (r=0.364, P=0.023), superior GCL+IPLT (r=0.358, P=0.025), and mean pRNFLT (r=0.396, P=0.025). In addition, in moderate to advanced glaucoma, there were significant correlations between mMS and all relevant measures of retinal thickness (r=0.330−0.663, P<0.010). In early glaucoma, significant correlations were found between mean mMS and minimum GCL+IPLT (r=0.373, P=0.023), and between inferior mMS and superior GCL+IPLT (r=0.470, P=0.003). Linear models provided a good explanation for the relationship between SNR and inner retinal thickness (IRT), whereas nonlinear models better explained the relationship between mMS and IRT. In early glaucoma, both SNR and mMS were related moderately and significantly to IRT, whereas in moderate to advanced glaucoma, mMS was more strongly correlated with IRT than SNR.

Central visual function and inner retinal structure in primary open-angle glaucoma / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma (POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential (icVEP) testing, 24-2 standard automated perimetry (SAP), and Cirrus optical coherence tomography (OCT) examinations. Signal-to-noise ratio (SNR) measures obtained from icVEP responses to isolated checks presented at four depths of modulation (DOMs; 8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity (mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness (GCL+IPLT) and peripapillary retinal nerve fiber layer thickness (pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls (P<0.001). A significant positive association was found between SNR at 14% DOM and GCL+IPLT at the inferior sector in early glaucoma (r=0.465, P=0.004). In moderate to advanced glaucoma, significant correlations were found between SNR at 32% DOM and mean GCL+IPLT (r=0.364, P=0.023), superior GCL+IPLT (r=0.358, P=0.025), and mean pRNFLT (r=0.396, P=0.025). In addition, in moderate to advanced glaucoma, there were significant correlations between mMS and all relevant measures of retinal thickness (r=0.330-0.663, P< 0.010). In early glaucoma, significant correlations were found between mean mMS and minimum GCL+IPLT (r=0.373, P=0.023), and between inferior mMS and superior GCL+IPLT (r=0.470, P=0.003). Linear models provided a good explanation for the relationship between SNR and inner retinal thickness (IRT), whereas nonlinear models better explained the relationship between mMS and IRT. In early glaucoma, both SNR and mMS were related moderately and significantly to IRT, whereas in moderate to advanced glaucoma, mMS was more strongly correlated with IRT than SNR.

A Pharmacoeconomic Analysis to Determine the Relative Cost-effectiveness of Timolol 0.5%, Brinzolamide 1% and Brimonidine 0.2% Eye Drops in Treatment of Primary Open Angle Glaucoma/Ocular Hypertension

Aim: A pharmacoeconomic analysis to determine the relative cost-effectiveness of timolol 0.5%, brinzolamide 1% and brimonidine 0.2% eye drops in treatment of Primary Open Angle Glaucoma (POAG)/ocular hypertension (OHT). Settings and Design: Comparative, open, randomized, parallel group prospective study. Materials and Methods: 60 patients of POAG or ocular hypertension were included in this study. Time period of study was 6 weeks. 60 eyes of 60 patients were included in the study. Patients were divided randomly into 3 groups of 20 each. Patients in group A, B and C received timolol, brinzolamide and brimonidine respectively. One drop of each medication was instilled twice a day at 9 am and 9 pm daily for 6 weeks. IOP was measured on day 0 at 9 am (before administration of drugs) and then at 11 am, to get baseline IOP. IOP was again measured on subsequent visits at 9 am and 11 am. Treatment outcome was number of mm Hg fall in IOP induced by the study drug. The daily cost of each drug was calculated by maximum retail price and the average number of drops per bottle. The cost‑effectiveness was then calculated as the cost of drug/mm Hg fall in IOP. Statistics: Paired ‘t’ test was used to analyze the parameters within the group. Independent samples t‑test was used to compare the efficacy of drugs with each other. Results: The % reduction of brimonidine, timolol and brinzolamide at end of 6 weeks was 21.43 ± 3.06%, 24.87 ± 2.46% and 18.78 ± 1.73% respectively. Timolol was superior in efficacy to other two drugs. The difference was statistically significant between the efficacy of timolol and brinzolamide (p < 0.001) as well as timolol and brimonidine (p = 0.003). There was no statistical significant difference in the efficacy of brimonidine when compared to brinzolamide (p=0.26). Timolol (5.87 ± 0.83 Rs/mm lowering after 6 weeks) was found to be most cost-effective followed by brimonidine (46.83 ± 7.37) and then brinzolamide (60.49 ± 6.77) in lowering IOP. Conclusion: All three drugs under the present study are useful in the treatment of POAG/OHT, but timolol is a better choice than other two drugs because of greater reduction in IOP and greater cost-effectiveness.

Retinal nerve fibre layer analysis in primary open angle glaucoma

Background: POAG occurs in elderly, rarely seen earlier than 40 years of age and tends to run in families. Glaucoma is a neurodegenerative disease characterized by the slow, progressive degeneration of retinal ganglion cells. Aim: To study the changes, in retinal nerve fibre layer thickness in primary open angle glaucoma (POAG). Materials and methods: The present cross sectional study was carried out at a tertiary care hospital in North India. 100 patients of primary open angle glaucoma were matched with 100 controls and evaluated with the aim to assess their RNFL thickness and compare with each other. Results: The data distribution analysis of retinal nerve fibre layer thickness in different optic nerve head quadrants in POAG group in relation to overall severity of glaucoma shows that in superior quadrant maximum number of patients in preperimetric group 6 (50%) cases, in mild 9 (45%) cases and in moderate group 25 (44.6%) were in the range 100±10μm. But in severe glaucoma cases majority 7 (58.3%) cases had the RNFL thickness in the range of 60±10 μm. The temporal quadrant RNFL thickness was least in all grades of severity of glaucoma i.e. preperimetric 6 (50%), in mild cases 9 (45%), in moderate 25 (44.6%) cases and in severe 8 (66.7%) cases. Conclusion: Overall RNFL thickness variation, regardless of severity of glaucoma, follow the normal pattern of thickness being thicker in superior and inferior quadrant compared to nasal and temporal quadrant. It was interesting to note that the RNFL thickness in all the quadrants of optic nerve head area continues to become thinner as the severity of glaucoma increases.

Clinical effectiveness and safety of brimonidine (0.2%) versus Dorzolamide (2.0%) in primary open angle.

A Comparison of efficacy & tolerability of brimonidine (0.2%) versus dorzolamide (2.0%) in primary open angle glaucoma or ocular hypertension. In this open, randomized, cross over comparative study, 30 subjects of primary open angle glaucoma with IOP > 22 mmHg were taken. The patients fulfilling the inclusion criteria and after verifying the exclusion criteria were included in the study after a written informed consent. These subjects were randomized to receive brimonidine (0.2%) TDS or dorzolamide (2.0%) TDS for 4 weeks. After a wash out period of 4 weeks the subjects were crossed over to other therapy .The IOP was measured at 8.00 am before dosing and at 10.00 am i.e. 2 hours after dosing at each baseline and at the end of each treatment period. Monotherapy with brimonidine (0.2%) TDS and dorzolamide (2.0%) TDS given for 4 weeks had caused overall reduction in IOP of 5.833+2.102mmHg (23.48%) and 5.433+ 2.582mmHg (22.42%) respectively at peak levels. The difference is statistically insignificant (p>0.05). Overall monotherapy with brimonidine and dorzolamide appear to produce equivalent IOP lowering efficacy and have well tolerated adverse effect profile, although a trend was observed at 10.00 a.m. of greater brimonidine efficacy compared with dorzolamide.

Differences in the Histopathology and Matrix Metalloproteinase Expression in Tenon's Tissue of Primary Open-Angle Glaucoma and Primary Angle-Closure Glaucoma

PURPOSE: To investigate the differences in the histopathology and matrix metalloproteinase (MMP) expression in the Tenon's tissue of primary open-angle glaucoma (POAG) patients, primary angle-closure glaucoma (PACG) patients, and non-glaucomatous patients. METHODS: POAG and PACG patients, who underwent a trabeculectomy and had no history of ocular disease except glaucoma, were enrolled. The number and instillation period of topical eye drops were reviewed. For the controls, which were patients without glaucoma or a history of ocular surgery, the Tenon's tissue was obtained in the course of retinal detachment surgery. For glaucoma patients, the Tenon's tissue was obtained during the trabeculectomy. H&E and Masson's trichrome staining and immunohistochemistry for MMP-1, MMP-2, and MMP-9 were performed. A total of six eyes of POAG, six eyes of PACG, and four control eyes were evaluated. RESULTS: The duration of topical anti-glaucoma medication and the mean number of anti-glaucoma medications were similar in the POAG and PACG groups. The levels of MMP-1 and 2 were elevated in the POAG and PACG groups compared to the control group (p=0.03, 0.01, respectively). Compared with the control group, the MMP-2 level was higher in the POAG patients (p=0.01), whereas the MMP-1 was higher in the PACG patients (p=0.04). The levels of MMP-9 in the POAG and PACG patients were not significantly different from that of the control patients (p=0.48, 0.26). The levels of MMP-2 were significantly lower in the PACG patients than in the POAG patients (p=0.02). CONCLUSIONS: The MMP expression was altered in the Tenon's tissue of glaucoma patients compared to the control group. The levels of MMP-2 were lower in the PACG patients than in the POAG patients. These results suggest that there may be histopathological differences in the Tenon's tissue of POAG and PACG patients.

Differences in the Histopathology and Matrix Metalloproteinase Expression in Tenon's Tissue of Primary Open-Angle Glaucoma and Primary Angle-Closure Glaucoma

PURPOSE: To investigate the differences in the histopathology and matrix metalloproteinase (MMP) expression in the Tenon's tissue of primary open-angle glaucoma (POAG) patients, primary angle-closure glaucoma (PACG) patients, and non-glaucomatous patients. METHODS: POAG and PACG patients, who underwent a trabeculectomy and had no history of ocular disease except glaucoma, were enrolled. The number and instillation period of topical eye drops were reviewed. For the controls, which were patients without glaucoma or a history of ocular surgery, the Tenon's tissue was obtained in the course of retinal detachment surgery. For glaucoma patients, the Tenon's tissue was obtained during the trabeculectomy. H&E and Masson's trichrome staining and immunohistochemistry for MMP-1, MMP-2, and MMP-9 were performed. A total of six eyes of POAG, six eyes of PACG, and four control eyes were evaluated. RESULTS: The duration of topical anti-glaucoma medication and the mean number of anti-glaucoma medications were similar in the POAG and PACG groups. The levels of MMP-1 and 2 were elevated in the POAG and PACG groups compared to the control group (p=0.03, 0.01, respectively). Compared with the control group, the MMP-2 level was higher in the POAG patients (p=0.01), whereas the MMP-1 was higher in the PACG patients (p=0.04). The levels of MMP-9 in the POAG and PACG patients were not significantly different from that of the control patients (p=0.48, 0.26). The levels of MMP-2 were significantly lower in the PACG patients than in the POAG patients (p=0.02). CONCLUSIONS: The MMP expression was altered in the Tenon's tissue of glaucoma patients compared to the control group. The levels of MMP-2 were lower in the PACG patients than in the POAG patients. These results suggest that there may be histopathological differences in the Tenon's tissue of POAG and PACG patients.

Dynamic Model of the Aqueous Humor Circulation with Application to Simulation of the Treatment for Primary Open Angle Glaucoma / 대한의료정보학회지

OBJECTIVE: In order to study the mechanism of the aqueous humor circulation and its relationship to the glaucoma macroscopically with engineering methods. METHODS: A dynamistic model was presented, which can be used to simulate the situation and the treatment of the primary open angle glaucoma (POAG). The frame of the model was built based on the ophthalmically accepted feedback mechanism between the aqueous humor circulation and the intraocular pressure (IOP). The transfer functions and the parameters were educed from the analysis of physiological theories, the basic elements of hydrodynamics, and the clinical parameters. The relation between the parameters of the system and the episode mechanism of POAG was discussed. A digital method was used to simulate the Challenge test and some medicines' treatment of POAG, and the results were consistent with clinical observations. RESULTS: The results of simulation illuminate that the model can simulate the mechanism of the aqueous humor circulation and the curative mechanism of some medicines under the physiological condition and the pathological condition of the POAG. CONCLUSION: A few parameters which can hardly be captured with clinical method could be obtained from the model. These parameters can be helpful for the diagnosis and prediction of the curative effect.

Application of retinal tomography in primary open angle glaucoma / 中国康复理论与实践

@#ObjectiveTo study the application of retinal tomography in primary open angle glaucoma diagnosis.MethodsThe differences between POAG, high myopia with suspected glaucoma and normal volunteers on the rim area, rim volume and the thickness of retinal nerve fiber layer (RNFL) thickness in quadrants under Heideberg retinal tomography-Ⅱ(HRT-Ⅱ) were analyzed.ResultsIn the cases of POAG and high myopia with suspected glaucoma, the values of rim area, rim volume and RNFL thickness were significantly lower than that in normal group.ConclusionRetinal tomography can be used in the diagnosis of POAG.

Clinical Types of Glaucoma and Comparison Between Diffuse and Focal Nerve Fiber Layer Defects

PURPOSE: To evaluate and compare the characteristics of patients whose nerve fiber layer (NFL) photographs showing diffuse or focal nerve fiber layer defects. METHODS: Patients with diffuse NFL defect were selected by comparing upper and lower half of a NFL photo, and we included the patients only when one part of it showed NFL defect. Patients with focal NFL defect were selected only when one eye had a wedge-shape NFL defect. RESULTS: There were no significant differences between the two groups in visual field index, nor in the results of glaucoma hemifield test. However, patients with diffuse NFL defect (13 eyes, 13 patients) mostly had primary open-angle glaucoma (POAG) (62%), and patients with focal NFL defect (13 eyes, 13 patients) mostly had normal- tension glaucoma (NTG) (62%) (p=0.048, chi-square test). CONCLUSIONS: We found significant differences in the diagnosis of glaucoma between the diffuse and focal NFL loss groups. Our results suggest that the characteristics of NFL loss in POAG and NTG may be different.

The Additive of Latanoprost 0.005% in Patients with Maximum Tolerated Medical Therapy Regimen

Latanoprost 0.005% which is a currently available ocular hypotensive agent has been known to produce an additional reduction of intraocular pressure when used in combination with beta adrenergic bloker. The aim of this study was to evaluate the additive effect of this drug in patients with maximum tolerated medical therapy regimen. 48 eyes of 32 patients were categorized into 2 groups as to their type of glaucomas(primary open abgle glaucoma(POAG) vs chronic angle closure glauoma(CACG), and pilocarpine use. POAG group showed 22.3, 24.8, 22.7, 21.0, 21.4% and CACG group showed 17.6, 17.1, 15.7, 17.5, 17.8% of ocular hypotensive effect at post treatment 2 weeks, 4 weeks, 3 months, 6 months, 9 to 12 months, respectively and there was no satistically significant difference between two groups. Pilocarpine using group showed 25.5, 30.5, 26.4, 23.4, 17.8% and non-using group showed 20.6, 18.9, 19.0, 18.7, 25.1% of ocular hypotensive effect at each follow up period. Conclusively, latanoprost 0.005% appeared to be a very effective drug in reducing intraocular pressure in patients with maximum tolerated medical therapy regimen without regard to their type of glaucomas, and use of parasympathomimetics.

The Relationship Between the Activity of Matrix Metalloproteinase in the Aqueous Humor and the Development of Primary Open Angle Glaucoma

To investigate whether the abnormal expression of matrix metalloproteinases(MMPs) in the aqueous humor may case the development of glaucoma, the activity of MMP in the aqueous humor of galucoma and cataract patients were measured and compared. Six primary open angle glaucoma(POAG), 2 chronic angle closureglaucoma(CACG), 2 normal tension glaucoma(NTG), and 14 cataract patients were enrolled. Aqueous humor of each patients were collected during surgery, and total protein concentration and activity of gelatinase A in the aqueous humor were measured by protein assay kit and zymography, respectively. Total protein concentration and gelatinase A activity of POAG patients were increased by 2.1 times and 3.9 times, respectively compared to those of cataract patients. However, there were no statistically significant changes in total protein concentration and gelatinase A activity of CACG and NTG patients compared to those of cataract patients. In conclusion, the development of POAG may be associated with the abnormal expression of MMP in the aqueous humor.