Alterations of locomotor activity rhythm and sleep parameters in patients with advanced glaucoma.

The aim of this study was to evaluate the effect of advanced glaucoma on locomotor activity rhythms and related sleep parameters. Nine normal subjects and nine age-matched patients with bilateral advanced primary open-angle glaucoma, >10 yrs since diagnosis, were included in this observational, prospective, case-control study. Patients were required to record the timing and duration of their sleep and daily activities, and wore an actigraph on the wrist of the nondominant arm for 20 d. Activity rhythm period, MESOR (24-h time-series mean), amplitude (one-half peak-to-trough variation), and acrophase (peak time), plus long sleep episodes during the wake state, sleep duration, efficiency, and latency, as well as mean activity score, wake minutes, and mean wake episodes during the sleep interval were assessed in controls and glaucomatous patients. Glaucomatous patients exhibited significant decrease in nighttime sleep efficiency, and significant increase in the mean activity score, wake minutes, and mean wake episode during the night. These results suggest that alterations of circadian physiology could be a risk to the quality of life of patients with glaucoma.

Frequency-doubling perimetry: comparison with standard automated perimetry to detect glaucoma.

PURPOSE: To compare second generation frequency-doubling perimetry (FDP) with standard automated perimetry (SAP) to detect glaucomatous visual field abnormalities. DESIGN: Prospective, cross-sectional, controlled observational study. METHODS: Fifty eyes of 50 patients with glaucoma with confirmed SAP visual field abnormalities and 42 eyes from 42 normal control subjects were studied. Swedish Interactive Thresholding Algorithm (SITA) standard 24-2 SAP and FDP visual fields were performed. The correlation of global indices and the number of defects on total deviation (TD) and pattern deviation (PD) plots were compared. The spatial concordance of FDP and SAP defect locations was determined. RESULTS: In patients with glaucoma, significant correlations of mean deviation (MD) and pattern standard deviation (PSD) were found between SAP and FDP (P < .001 for MD and P < .001 for PSD), but not in the normal group. FDP had significantly greater defect scores than SAP on total deviation and PD plots in the glaucoma group (P = .028 and P = .01, respectively). In comparison with SAP, sensitivity and specificity of FDP were 92% and 98% with glaucoma hemifield test criteria and 98% and 93% with PSD <5% criteria, respectively. Similarly high diagnostic precision was found with MD and PSD (at 95% specificity; MD and PSD sensitivity was 82% and 90%, respectively). The location of defects within 12 hemifield clusters found with FDP agreed moderately well with those detected with SAP (kappa = .48). CONCLUSIONS: FDP and SAP perform similarly in their ability to detect visual field defects in early to moderate glaucoma. Larger and deeper defects detected with FDP suggests the possibility of earlier detection at high specificity.

Trabeculectomy with mitomycin C: outcomes and risk factors for failure in phakic open-angle glaucoma.

PURPOSE: To evaluate long-term tonometric outcomes of trabeculectomy with adjunctive mitomycin C (MMC) and its efficacy in achieving a range of intraocular pressures (IOP) in phakic patients with open-angle glaucoma. DESIGN: Retrospective cohort study. METHODS: Three levels of success were defined by these criteria: (A) IOP < or =18 mmHg and IOP reduction of 20%; (B) IOP < or =15 mmHg and IOP reduction of 25%; and (C) IOP < or =12 and IOP reduction of 30%. Kaplan-Meier survival analyses were used to assess outcomes. Cox's proportional hazard regression analysis was used to identify risk factors for failure. PARTICIPANTS: Two hundred twenty-five phakic patients (292 eyes) with open-angle glaucoma, > or =40 years of age at time of trabeculectomy. MAIN OUTCOME MEASURES: The primary outcome was qualified success rate (with or without medications) according to the defined criteria. Secondary outcomes include IOP level and number of medications at 1 and 3 years after surgery, postoperative complications, and need for further glaucoma surgery. RESULTS: Mean IOP (+/-standard deviation) decreased from 18.8 mmHg (+/-6.1 mmHg) before surgery to 11.3 mmHg (+/-4.5 mmHg) at 1 year and 11.1 mmHg (+/-4.2 mmHg) at 3 years (P<0.001 for both). The mean number of medications decreased from 2.8 (+/-1.0) to 0.4 (+/-0.7) at 1 year and 0.7 (+/-1.0) at 3 years (P<0.001 for both). The success rates were 85%, 84%, and 79% at 1 year for criteria A, B, and C, respectively; and 62%, 56%, and 46% for these criteria, respectively, at 3 years. Postoperative laser suture lysis was associated with a higher rate of failure for criteria B and C (P<0.001 for both), the hazard ratio (HR) was 1.7 for criteria B and 2.0 for criteria C. Prior argon laser trabeculoplasty was associated with higher risk of failure for criteria C (HR = 1.6; P = 0.05). CONCLUSIONS: Trabeculectomy with MMC effectively reduces IOP in phakic open-angle glaucoma, but long-term low IOPs are achieved in only half of the cases. Laser suture lysis after trabeculectomy and prior argon laser trabeculoplasty are associated with a higher risk of failure when low IOPs are required.

Trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma: outcomes and risk factors for failure.

PURPOSE: To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. DESIGN: Retrospective cohort study. METHODS: Seventy-three pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) < or = 18 mm Hg and IOP reduction > or = 20%; (B) IOP < or = 15 mm Hg and IOP reduction > or = 25%; and (C) IOP < or = 12 mm Hg and IOP reduction > or = 30%. IOP, visual acuity, complications, and additional interventions were documented after surgery. Cox's proportional hazard regression analysis was used to identify risk factors for failure. RESULTS: Mean IOP (+/-SD) decreased from a preoperative value of 18.8 +/- 6.6 mm Hg to 10.2 +/- 5.1 mm Hg at one year and to 10.0 +/- 4.2 at two years (P < .001 for both). Average number of preoperative medications decreased from 3.0 +/- 1.1 to 0.5 +/- 1.0 at one year and to 0.5 +/- 0.9 at two years (P < .001 for both). For criteria A, B, and C, success rates (+/-SE) were 87% +/- 4%, 83% +/- 5%, and 76% +/- 5% at 1 year and 67% +/- 4%, 58% +/- 8%, and 50% +/- 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure. CONCLUSION: Increasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.