The clinical features in patients with newly diagnosed pseudoexfoliative glaucoma in Serbia.

PURPOSE: To evaluate the clinical characteristics of newly diagnosed pseudoexfoliative glaucoma and compare them with those pertaining to newly diagnosed primary open-angle glaucoma as well as pseudoexfoliation syndrome. METHODS: This case-control study involved 306 participants, including patients with newly diagnosed pseudoexfoliative glaucoma, age- and sex-matched normal controls, patients with newly diagnosed primary open-angle glaucoma, and subjects with pseudoexfoliation syndrome. The study was conducted at the Glaucoma Department of Clinic for Eye Diseases, Clinical Center of Serbia, as the referral center for glaucoma in Serbia. RESULTS: The mean age in the pseudoexfoliative glaucoma, primary open-angle glaucoma, pseudoexfoliation syndrome, and normal control groups was 73.61 ± 8.46, 65.50 ± 8.97, 74.81 ± 6.80, and 73.58 ± 9.34 years, respectively (pseudoexfoliative glaucoma vs primary open-angle glaucoma, p < 0.001). Unilateral pseudoexfoliative glaucoma was diagnosed in 35 patients (42.2%). The intraocular pressure was higher in the eyes affected by pseudoexfoliative glaucoma (32.0 ± 9.5 mmHg) than that in the primary open-angle glaucoma eyes (28.8 ± 5.9 mmHg) (p < 0.001). In pseudoexfoliative glaucoma and primary open-angle glaucoma eyes, glaucoma severity was determined via the vertical cup-to-disk ratio (C/D) 0.65 (0.45-1.0) versus 0.60 (0.45-1.0), p = 0.048 and visual field mean deviation -5.68 (-1.58 to -30.9) versus -4.70 (-1.39 to -31.0), p = 0.045. Alzheimer's was the only systemic disease associated with pseudoexfoliative glaucoma in the study sample, with an odds ratio of 0.021 (95% confidence interval = 0.00-21.52, p = 0.022). CONCLUSION: At the time of diagnosis, pseudoexfoliative glaucoma exhibits different clinical features compared with primary open-angle glaucoma. Higher intraocular pressure, narrow or occludable angle, increased trabecular pigmentation, phacodonesis, and poorer pupillary dilatation emerged as the factors associated with pseudoexfoliative glaucoma.

Serum heparan sulfate and chondroitin sulfate concentrations in patients with newly diagnosed exfoliative glaucoma.

BACKGROUND: Exfoliative glaucoma (XFG) is typically classified as a high-pressure type of secondary open-angle glaucoma that develops as a consequence of exfoliation syndrome (XFS). Exfoliation syndrome is an age-related, generalized disorder of the extracellular matrix characterized by production and progressive accumulation of a fibrillar exfoliation material (XFM) in intra- and extraocular tissues. Exfoliation material represents complex glycoprotein/proteoglycan structure composed of a protein core surrounded by glycosaminoglycans such as heparan sulfate (HS) and chondroitin sulfate (CS). The purpose of the present study was to investigate HS and CS concentrations in serum samples of patients with newly diagnosed XFG and compare the obtained values with those pertaining to newly diagnosed primary open-angle glaucoma (POAG), normal controls (NC) and subjects with XFS. METHODS: This case-control study involved 165 subjects, including patients with newly diagnosed XFG, patients with newly diagnosed POAG, subjects with XFS and age- and sex-matched NC. The study was conducted at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia. RESULTS: The mean age in the XFG, POAG, XFS and NC groups was 73.3 ± 9.0, 66.3 ± 7.8, 75.5 ± 7.0 and 73.5 ± 9.5 years, respectively, XFG vs. POAG, p < 0.001. Mean serum HS concentrations in the XFG, POAG, NC and XFS groups were 3,189.0 ± 1,473.8 ng/mL, 2,091.5 ± 940.9 ng/mL, 2,543.1 ± 1,397.3 ng/mL and 2,658.2 ± 1,426.8 ng/mL respectively, XFG vs. POAG, p = 0.001 and XFG vs. NC, p = 0.032. Mean serum CS concentrations in the XFG, POAG, NC and XFS group were 43.9 ± 20.7 ng/mL, 38.5 ± 22.0 ng/mL, 35.8 ± 16.4 ng/mL and 43.3 ± 21.8 ng/mL, respectively, XFG vs. NC, p = 0.041. CONCLUSIONS: Our findings revealed greater HS and CS concentrations in XFG patients and XFS subjects compared to those without XFM. Implications of HS and CS in the pathophysiology of XFS and glaucoma should be studied further. Serum is easily accessible and should thus be explored as rich sources of potential biomarkers. Further research should aim to identify XFG biomarkers that could be utilized in routine blood analysis tests, aiding in timely disease diagnosis.

Ocular pulse amplitude after panretinal photocoagulation in normotensive eyes with proliferative diabetic retinopathy.

PURPOSE: To assess the effect of panretinal laser photocoagulation on ocular pulse amplitude (OPA) in normotensive eyes with proliferative diabetic retinopathy. METHODS: Prospectively, we performed unilateral argon laser panretinal photocoagulation (PRP) in 30 patients with diabetes mellitus type II and previously untreated bilateral proliferative diabetic retinopathy. Before and 7 and 30 days after the treatment, OPA was measured using dynamic contour tonometer. RESULTS: Compared with the untreated contralateral eyes, laser photocoagulation led to a reduction of OPA. Ocular pulse amplitude did not significantly differ in photocoagulated eyes 7 days after the treatment, but there was a significant difference in OPA 30 days after the treatment. The decrease in OPA values was 15% 7 days after PRP and 40% 30 days after PRP. CONCLUSIONS: Ocular pulse amplitude reduction after PRP indirectly informs us about choriocapillary closure, already reported in previous studies.

Spectral analysis of intraocular pressure pulse wave in ocular hypertensive and primary open angle glaucoma patients.

CONTEXT: In attempt to find an alternative way to determine conversion from ocular hypertension to primary open angle glaucoma (POAG) (besides visual field and optic disc changes), we analyzed intraocular pressure (IOP) pulse wave in spectral domain. AIMS: The aim of this study was to test the potential differences in spectral content of IOP pulse wave between ocular hypertension and POAG patients, which could indicate conversion. SETTINGS AND DESIGN: Cross-sectional study designed to test the differences in the spectral content of pressure pulse wave between nontreated ocular hypertensive and nontreated, freshly diagnosed POAG patients. METHODS: The total of 40 eyes of 40 subjects was included: 20 previously untreated ocular hypertensive patients, and 20 previously untreated POAG patients. Continuous IOP measuring gained by dynamic contour tonometry was submitted to fast Fourier transform signal analysis and further statistical data processing. Statistics Analysis Used: Ocular and systemic characteristics of the tested subjects were compared by analysis of variance appropriate for this study design. A P < 0.05 was considered to be statistically significant. RESULTS: Higher spectral components of the IOP pulse wave was discerned up to the fifth harmonic in both of the tested groups. No statistically significant differences were found in any of the tested harmonic amplitudes. CONCLUSIONS: There are no differences in the spectral content of IOP pulse wave between ocular hypertensive and primary open angle glaucoma patients which could be indicative for conversion.

Ocular pulse amplitude in patients with thyroid-associated ophthalmopathy.

PURPOSE: To determine ocular pulse volume values in patients with thyroid-associated ophthalmopathy with normal intraocular pressure, and to test the hypothesis that changes in orbital tissue that accompany thyroid-associated ophthalmopathy can in turn give changes in choroidal perfusion.
 METHODS: In a prospective study, we evaluated 30 eyes of 30 consecutive patients with TAO, and 30 eyes of 30 healthy subjects. Complete ophthalmologic examination including dynamic contour tonometry was done. Possible differences in ocular parameters between the tested groups were assessed.
 RESULTS: . No significant difference was found in ocular pulse volume values between the tested subjects (paired test p=0.23).
 CONCLUSIONS: . The orbit tissue changes that are involved in thyroid-associated ophthalmopathy do not have much implication on choroidal perfusion, at least when intraocular pressure values remain within the normal range.

The effect of intraocular pressure on visual field after trabeculectomy in patients with primary open angle glaucoma.

PURPOSE: To compare the mean intraocular pressure (IOP), peak IOP and percentage reduction in IOP in the first five years following trabeculectomy between the patients with progressed visual field loss and the patients with stable visual fields. MATERIAL AND METHODS: Thirty-six eyes of 36 patients were followed for five years after their first trabeculectomy with tonometry and automated perimetry (Octopus 500EZ, program G1). The rate of change of the visual field was measured by linear regression analysis of the mean sensitivity value (dB) of each field test versus time (month). Based on the statistical significance of the slope of the regression line (Spearman p value of the correlation coefficient less than 0.05), patients were divided into two groups: with significant negative slope of the regression line (group with progressed visual field loss) and with non-significant slope of the regression line (group with stable visual field). The mean IOP values and percentage of IOP reduction at the end of each of the first five years after surgery were compared between the group with progressed field loss and group with stable fields by using Mann-Whitney U test. RESULTS: Patients with progressed visual field loss had higher mean IOP, higher peak IOP and less reduction in pressure after the operation than patients with stable visual field. The mean IOP at end of the two year postoperative period was significantly higher in patients with progressed visual field loss (21.98 +/- 3.38 mmHg) than in those with stable fields (17.48 +/- 4.80 mmHg). The mean percentage reduction in IOP at the end of two year postoperative period was significantly less in patients that showed progression of field loss (21.84%) than in those with stable fields (41.0%). CONCLUSION: Prognosis for further field loss seems to be better if postoperative pressure is at lower levels and greater percent reduction of IOP is obtained after surgery. The data that predict better prognosis is the mean postoperative IOP value of approximately 18 mmHg or less resulting from at least 35% of IOP reduction.

Comparison of postoperative pain and satisfaction after dacryocystorhinostomy in patients operated on under local and general anesthesia.

BACKGROUND: There has been only 1 study on postoperative pain after external dacryocystorhinostomy (DCR) that compared pain between 2 groups of patients; 1 group received local anesthesia and the other received general anesthesia. To further characterize the relationship between these 2 types of anesthesia and postoperative pain, we designed a study in which a single patient received these 2 different anesthesia modalities for a short interval on 2 different sides. MATERIAL/METHODS: There were 50 participants in this study. External DCR was performed on the same participant on both sides using local anesthesia on 1 side and general anesthesia on the other. Postoperative pain was measured using the visual analogue scale (VAS), and localization and timing of pain were reported by the participants. Postoperative nausea and vomiting (PONV) were documented if present. RESULTS: Pain levels were significantly higher with general anesthesia 3 hours post-surgery, and 6 hours post-surgery the pain remains higher following general anesthesia but is borderline insignificant (p=0.051). However, 12 hours post-surgery, there is no significant difference in the pain level (p=0.240). There was no significant difference in the localization of pain with local and general anesthesia. Postoperative nausea is significantly more frequent after general anesthesia, and vomiting only occurs with general anesthesia. Local anesthesia was preferred by 94% of the participants (47 out of 50). CONCLUSIONS: The vast majority of patients in our study who have undergone both GA and LA DCR would choose LA again, providing a compelling case for use of the LA technique.