Experience and challenges in the treatment of neovascular glaucoma / 中华眼底病杂志

Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.

Glaucoma secundário a fístula carótido-cavernosa / Secondary glaucoma following carotid cavernous fistula

RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.

ABSTRACT Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clínicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270º, which was controlled satisfactorily with medication.

Oxygen saturation in the retinal vessels of glaucoma and normal eyes / 中华眼底病杂志

Objective To observe the difference of retinal vessel oxygen saturation in glaucoma and normal eyes.Methods A cross sectional study design was performed.Fifty eyes of 30 glaucoma patients (glaucoma group) and 41 eyes of 27 age-and sex-matched healthy subjects (control group) were included.Retinal vessel oxygen saturation was measured with a spectrophotometric retinal oximeter in darkness and visual fields were obtained by Humphrey filed analyzer.The glaucoma eyes were divided into two groups:mean defect (MD) ＜6 dB (28 eyes) and MD≥6 dB (22 eyes) according to mean defect of visual field.Results Retinal arteriolar oxygen saturation values in glaucoma group and control group were (94.52 ±6.51) ％ and (93.47±6.30) ％ respectively.No statistical difference was found in retinal oxygen saturation in arterioles (H =-0.949,P =0.343).Retinal venous oxygen saturation values in glaucoma group and control group were (57.57 ± 7.96)％ and (52.60 ± 7.70) ％ respectively.The retinal venous oxygen saturation values in glaucoma group was higher than that in control group (H=-3.318,P=0.001).The retinal arteriovenous difference in glaucoma group and control group were (36.59± 4.69)％ and (42.41 ±6.73) ％ respectively.The retinal arteriovenous difference in glaucoma group was lower than that in control group (H=-4.148,P＜0.01).The retinal arteriolar oxygen saturation values in glaucoma eyes with MD＜6 dB and MD≥6 dB were (93.38 ± 6.33)％ and (95.71 ± 6.54)％ respectively,with no statistical difference (H=-1.857,P=0.063).Retinal venous oxygen saturation values in glaucoma eyes with MD＜6 dB and MD≥6 dB were (54.83 ± 6.10) ％ and (6 1.07 ± 8.79) ％ respectively.The retinal venous oxygen saturation values in MD≥ 6 dB glaucoma eyes was higher than that in MD＜ 6 dB glaucoma eyes (H =-2.599,P=0.009).The retinal arteriovenous difference in glaucoma eyes with MD＜6 dB and MD≥6 dB were (38.12± 4.34) ％ and (34.64 ± 4.49) ％ respectively.The retinal arteriovenous difference in MD≥6 dB glaucoma eyes was lower than that in MD＜6 dB glaucoma eyes (H=-2.463,P＜0.05).Conclusions Compared with healthy eyes,there is no change in the retinal arteriolar oxygen saturation,but the retinal venous oxygen saturation is higher and the retinal arteriovenous difference is lower.This feature is more obvious in MD≥6 dB glaucoma eyes.

The association between obstructive sleep apneahypopnea syndrome and glaucoma:a Meta analysis / 中华实验眼科杂志

Background Studies have showed an increasing prevalence of glaucoma in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).However,this view remains controversial.Objective This Meta analysis was to assess whether there is an association between glaucoma and OSAHS.Methods A systematic search in PubMed database was carried out with the subject headingssleeping apnea andglaucoma.The literature type was limited to cases-controlled studies and prospective cohort studies with the publishing duration from January 1,1982 to January 30,2015 in English.The risk of glaucoma among OSAHS patients was analyzed,and Review Manager 5.2 was applicated for Meta analysis.The pooled odds ratio (OR) and 95％ confidence interval (CI) was calculated to assess the strength of the association.Results Twelve independent retrospective casescontrolled studies were included in this review,including 11 592 subjects in the OSAHS group and 25 931 subjects in the control group.The study quality was scored 6-8 by Newcastle-Ottawa Scale which was acceptable.The random effects model was accepted because of the heterogeneity among the studies (x2=34.20,P＜0.05,I2 =68％).The prevalence of glaucoma was higher in the OSAHS group than that in the control group (OR =1.87,95％ CI:1.21-2.90,Z=2.82,P＜0.05).The subgroup analysis of OSAHS showed that the OR (95％ CI) of mild,moderate and severe OSAHS groups versus control group was 3.61 (0.56-23.43),4.17 (0.47-36.91) and 6.95 (1.14-42.26),respectively.Sensitivity analysis confirmed that the OR value fluctuated in 1.74-2.16 and closed to 1.87.Funnel graphy exhibited a asymmetry appearance among the literatures,which suggested a possible publication bias.Conclusions OSAHS is one of the risk factors of glaucoma.The serious OSAHS is associated with an increased risk of glaucoma.

Advances in molecular genetics of glaucoma / 中华实验眼科杂志

Glaucoma is the most common cause of irreversible blindness worldwide.The major performances of glaucoma optic neuropathy are progressive loss of retinal ganglion cells (RGCs),specific visual field defect and optic atrophy induced by elevated intraocular pressure.Glaucoma primarily includes primary open angle glaucoma (POAG),chronic angle-closure glaucoma (CACG) and exfoliation glaucoma (XFG).Recent studies showed that genetic factor and environmental factor participate in the pathogenesis of glaucoma,and the contributions of genetic factor to glaucoma are widely concerned,and some disease-causing gene and their pathogenic mechanisms are sequentially announced.A comprehensive discussion of the advances in molecular genetics of glaucoma is included in this paper.

Comparison of peripapillary choroidal watershed zones in different types of glaucoma / 中华眼底病杂志

Objective To observe the location of peripapillary choroidal watershed zones relative to the optic disc in the different types of glaucoma.Methods A total of 98 patients (98 eyes) with glaucoma (glaucoma group) were enrolled in this study.The eyes included 34 eyes with primary open-angle glaucoma (POAG group),33 eyes with normal tension glaucoma (NTG group) and 31 eyes with chronic angle closure glaucoma (CACG group).Thirty-seven fellow eyes of 37 patients with monocular blunt trauma were selected in this study as control group.The differences of age (t=1.197),sex (x2=3.548),average diopter (t=-1.644) between glaucoma group and control group were not statistically significant (P＞0.05).The differences of age (F=2.645),sex (F=1.984),average diopter (F=2.621),and visual fields mean defect (MD) (F=0.899) between different types of glaucoma were also not statistically significant (P＞0.05).Simultaneous indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) were performed on all subjects.The watershed zones were classified into three types according to its location relative to the optic disc:in type Ⅰ,the watershed zone did not include the optic disc or could not be observed; in type Ⅱ,the watershed zone partially included the optic disc; in type Ⅲ,the watershed zone completely included the optic disc.The location of watershed zones relative to the optic disc in the different types of glaucoma was comparatively analyzed.The relationship between watershed zones,type and age,and MD were also analyzed by Pearson analysis method.Results The constituent ratio of type Ⅱ and Ⅲ watershed zones were 81.6％ and 56.8％ in glaucoma group and control group,respectively; with a statistically significant difference (x2=8.756,P ＜ 0.003).The constituent ratios of type Ⅱ and Ⅲ watershed zones were 82.4％,90.9％,71.1％ in POAG,NTG and CACG group,respectively.No significant differences were found between POAG and NTG group (x2 =1.039),POAG and CACG group (x2 =1.039,1.166; P＞0.05).But there was significant difference between NTG and CACG group (x2 =4.107,P＜0.05).Significant differences were found between POAG and control group,NTG and control group (x2=5.352,10.141;P＜ 0.05).No significant difference was found between CACG and control group (x2=1.444,P＞0.05).There was no correlation between age and watershed zone type (r=0.114,P＞0.05).The watershed zones type of glaucoma group positively correlated with MD (r=0.354,P=0.000).Conclusion The peripapillary choroidal watershed zones in glaucoma patients include the optic disc more than in healthy eyes.