Optic Disc Characteristics and Visual Field Progression in Normal Tension Glaucoma Patients With Tilted Optic Discs.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the optic disc characteristics associated with visual field (VF) progression in normal tension glaucoma (NTG) eyes with tilted optic discs. METHODS: Sixty-six eyes of 66 NTG patients with tilted optic disc were included in this cross-sectional study, who were examined by at least 5 Humphrey 30-2 VFs. Glaucomatous VF progression was evaluated using pointwise linear regression. Optic nerve heads were scanned with enhanced-depth imaging optical coherence tomography (EDI-OCT), and evaluated for the focal lamina cribrosa (LC) defects and LC thicknesses. Optic disc torsion degrees and tilt ratios were measured from disc photographs. Logistic regression analyses were used to identify the risk factors for VF progression and focal LC defects. RESULTS: Multivariate analysis showed that VF progression was associated with the presence of focal LC defects and greater number of VFs. The eyes with focal LC defects were associated with greater torsion degree and tilt ratio in multivariate analysis. The VF mean deviation slopes and localized VF progression rates in eyes with focal LC defects were greater than those without defects. CONCLUSIONS: The greater optic disc tilt and torsion in NTG eyes with tilted optic disc were associated with focal LC defects, but not with VF progression. The focal LC defects were associated with VF progression. This study suggests that the focal LC defects in NTG patients with tilted optic disc may be an independent risk factor for glaucomatous VF progression, and the development of focal LC defects could be influenced by optic disc torsion or tilt.

Changes of gene expression of Gal3, Hsp27, Lcn2, and Timp1 in rat substantia nigra following medial forebrain bundle transection using a candidate gene microarray.

Neuroinflammation is an early event and important contributor to the pathobiology of neurodegenerative diseases. Neuroglia, especially microglia, are a major central nervous system population that can modulate neuroinflammation. To determine potential key molecules in this process, we employed microarray analysis in the substantia nigra (SN) following medial forebrain bundle (MFB) transection and analyzed the temporal expression profiles of candidate genes implicated in neuroglial activation and functional maturation. The DNA microarray analyzed, 8913 probes. Sixty nine genes were up-regulated and 11 genes were down-regulated at least twofold compared to normal control. Of the 80 genes, 23 were related to cell metabolism, 3 related to apoptosis, 27 related to immunity. Among them, 4 genes (Galectin 3, Heat shock protein 27, Lipocalin 2, Tissue inhibitory metalloproteinase 1) seemed to be related to the neuroglial function. The candidate genes were subjected to quantitative real-time PCR, Western blotting, and immunohistochemical approaches. Expression changes similar to the microarray were evident. In a double immunofluorescence assay, Galectin 3 almost completely co-localized with OX6-positive activated microglia, and Heat shock protein 27 mainly co-localized with glial fibrillary acidic protein (GFAP) positive astrocytes. Lipocalin 2, except for a few matches of GFAP positive astrocytes, did not co-localized with any of neuroglial markers. This is the first study to evaluate gene expression changes in the SN following MFB transection, which has been used as a parkinsonian animal model. Several candidate genes with potential roles in neuroglial activation and functional maturation were identified. The molecular significance of the candidate genes in neuroglial activation and neuroinflammation remains unclear.

Surgical outcomes of different Ahmed Glaucoma Valve implantation methods between scleral graft and scleral flap.

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 ± 10.1 months in the graft group versus 50.9 ± 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Comparison of OVD and BSS for maintaining the anterior chamber during IOL implantation.

PURPOSE: To compare surgical results between conventional intraocular lens (IOL) implantation using an ophthalmic viscosurgical device (OVD) and IOL implantation using a balanced salt solution (BSS) after irrigation/aspiration (I/A) of the lens cortex. METHODS: A randomized prospective study was conducted on 62 patients who underwent cataract surgery. Following completion of conventional I/A of the lens cortex, we divided patients into two groups according to whether or not BSS was used. In group A (n = 31), the anterior chamber and the capsular bag were completely filled with an OVD before IOL implantation. On the other hand, in group B (n = 31), BSS was irrigated into the anterior chamber through a previous side port during IOL implantation. Surgical results were compared between the two groups. RESULTS: In both groups, IOP peaked six hours after surgery. The occurrence of an IOP spike by postoperative day one was observed in six cases (6 / 31) in group A and in no cases (0 / 31) in group B, a difference that was statistically significant (p = 0.024). The values of endothelial cell density, central corneal thickness, anterior chamber inflammation, myopic shift, and posterior capsule opacification were not significantly different between the two groups. CONCLUSIONS: Compared with the use of OVD for IOL implantation, use of BSS during IOL implantation resulted in reductions in postoperative IOP spike and OVD removal time.