Comparison of the vessel density measurements of the macula, optical disc, and peri-papillary region between ocular hypertension patients and healthy controls.

OBJECTIVE: To evaluate Optical Coherence Tomography Angiography (OCT-A) findings in patients with Ocular Hypertension (OHT) and compare them with healthy individuals. METHODS: Thirty-four patients with ocular hypertension (OHT) and 22 healthy individuals were included in the study. Foveal thickness, retinal vascular density in superficial and deep capillary plexus and choriocapillaris, foveal avascular zone (FAZ), acircularity index (AI), foveal vessel density (FD), non-flow area, capillary and all vessel densities in the peripapillary area and the disc were automatically measured using the Angiovue software of OCT-A and compared between groups. RESULTS: The comparison of the macular OCT-A findings did not reveal a significant difference between the two groups in terms of central macular thickness, superficial and deep capillary plexus vessel density (p>0.05). The foveal avascular zone width was significantly higher in OHT subjects compared to the control group (0.30±0.08 µ and 0.25±0.11 µ, respectively; p = 0.04). The comparison of optic nerve OCT-A findings revealed that the whole-field vessel density (wVD) (p = 0.007), peripapillary vessel density (pVD) (p = 0.001), inferior, superior and temporal radial peripapillary capillary plexus vessel density (p = 0.006, p = 0.008, p = 0.02) and the mean retinal nerve fiber layer thickness (p = 0.02) were significantly lower in the OHT group. CONCLUSIONS: Our findings suggest that the decrement in the optic disc vascular density and foveal avascular zone width was significantly higher in OHT subjects. The possible effect or role of these microvascular changes in terms of glaucoma development should be examined through further studies.

Macular Choroidal Thickness in Patients with Ocular Hypertension as Assessed Using Enhanced Depth Imaging Optical Coherence Tomography.

OBJECTIVES: The aim of this study was to evaluate the macular choroidal thickness (CT) in patients with ocular hypertension (OHT) using spectral domain optical coherence tomography (SD-OCT) and compare the results with healthy individuals. METHODS: Thirty eyes of 30 patients newly diagnosed with OHT and 24 eyes of 24 healthy controls were included in this cross-sectional study. After a detailed ophthalmological examination, macular CT was measured with enhanced depth imaging optical coherence tomography (EDI-OCT) (Cirrus HD-OCT, Carl Zeiss Meditec AG, Jena, Germany) at the fovea and at positions 500 µ, 1000 µ, 1500 µ nasal and temporal to the fovea. The Mann-Whitney U test was used to compare the CT measurements between groups. The correlation between the mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness (RNFL) and CT was evaluated with the Spearman correlation coefficient. Statistical significance was accepted as p<0.05. RESULTS: The mean CT in the OHT group was significantly thinner than that of the controls at locations 1000 µ (250.13±69.53µ vs 275.92±47.34µ; p=0.02) and 1500µ (236.03±65.44µ vs 265.46±47.56µ; p=0.009) temporal to the fovea. The CT at the other measurement points was also thinner in eyes with OHT, but the difference failed to reach statistical significance. A moderately negative correlation was detected between the mean deviation and CT at locations 1000µ (r=-0.42; p=0.03) and 1500µ (r=-0.44; p=0.02) temporal to the fovea There was a moderate correlation between the average RNFL thickness and CT at locations 500µ (r=0.44; p=0.03), 1000µ (r=0.42; p=0.04) and 1500µ (r=0.56; p=0.005) temporal to the fovea. CONCLUSION: In the present study, the macular CT was thinner in patients with OHT and this thinning was statistically significant at the temporal macula. A longitudinal, prospective study involving multiple EDI-OCT measurements is required to further understand the relationship.

Evaluation of Carotid Intima Media Thickness and Renal Artery Resistive Index in Patients With Pseudoexfoliation Syndrome: A Prospective Case-Control Study.

PURPOSE: To investigate the significance of renal artery resistance and carotid intima media thickness (CIMT) parameters in patients with pseudoexfoliation syndrome (PES). MATERIALS AND METHODS: In this prospective case-control study, 37 patients were involved and grouped as PES (n=19) and control groups (n=18). Ophthalmological evaluation included visual acuity, intraocular pressure, central corneal thickness measurement, and optic disc evaluation. In addition, renal artery resistive index and CIMT measurements were taken for all patients and compared between the groups. RESULTS: The 2 groups were similar with respect to age, sex, and family history of glaucoma. The mean CIMT in the PES group was found to be significantly higher compared with the control group (0.73±0.02 vs. 0.59±0.06 mm, P=0.003). Renal artery resistive indices were found to be higher in the PES group than in the control group, however, the difference was not significant (P=0.46). A moderate positive correlation between CIMT and renal artery resistive indices was detected (r=0.447, P=0.01). However, a higher correlation rate was detected when the analysis was made in the PES group only (r=0.603, P=0.01). CONCLUSIONS: CIMT increases in PES patients and also the renal artery resistance index has a tendency to increase. Patients with PES should be informed about potential systemic consequences of this syndrome.

The evaluation of the retrobulbar orbital fat tissue and optic nerve with strain ratio elastography.

AIM: The aim of this study was to evaluate the diagnostic performance of strain ratio elastography in the assessment of retrobulbar orbital fat tissue. MATERIALS AND METHODS: The retrobulbar fat tissue of 14 eyes in 14 participants was scanned by sonoelastography. All the participants had permanent vision loss secondary to glaucoma in at least one eye. The elasticity scores were determined and the strain ratio was based on the comparison of the average strain measured in the retrobulbar fat tissue around the optic nerve at the same depth. RESULTS: The mean strain values for the optic nerve (B) and the retrobulbar fat tissue (A) were 0.78+/-0.61 and 1.43+/-0.99, respectively (p=0.005). The mean strain ratio (B/A) was 0.56+/-0.24. CONCLUSION: This preliminary study showed that by providing strain values and ratios of different orbital tissues sonoelastography may have a potential use in the diagnosis and follow-up of orbital inflammatory and infiltrative diseases.

Plasma homocysteine, folic acid, and vitamin B12 levels in patients with pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and normotensive glaucoma.

OBJECTIVE: The aim of this study was to evaluate the levels of plasma homocysteine (Hcy), vitamin B12, and folic acid in patients with pseudoexfoliation glaucoma (PEXG), pseudoexfoliation syndrome (PEXS), PEXS plus normotensive glaucoma (NTG). MATERIAL AND METHODS: In total, 24 patients with PEXG, 35 patients with PEXS, 18 patients with PEXS plus NTG, and 35 control subjects were enrolled into study. Their Hcy levels were measured by high performance liquid chromatography (HPLC); the levels of vitamin B12 and folic acid were measured by a competitive electrochemiluminescence immunoassay. RESULTS: Higher plasma Hcy levels and lower folic acid and vitamin B12 levels were found in all 3 patients' groups compared with the control group (all P<0.001, expect for folic acid in the PEXG group, P=0.03). Although plasma Hcy levels in the PEXG and PEXS groups were similar, the PEXS plus NTG group had significantly higher Hcy levels compared with these groups (P=0.019 and P=0.032, respectively). CONCLUSIONS: Our study showed that there was an association between hyperhomocysteinemia and PEXS either with or without glaucoma. The patients with PEXS plus NTG had higher plasma Hcy levels than the patients with PEXS or PEXG and the healthy controls. The treatment of hyperhomocysteinemia by taking low-cost vitamin B12 and folic acid preparations may prevent additional vascular problems.

Nd:YAG laser goniopuncture in viscocanalostomy: penetration in non-penetrating glaucoma surgery.

The objective was to evaluate the results of Nd:YAG laser goniopuncture after viscocanalostomy and to investigate the rate of penetration in non-penetrating surgery. Results of viscocanalostomy and incidence of goniopuncture were retrospectively investigated in 33 eyes of 33 patients. Success was defined as an intraocular pressure (IOP) below 19 mmHg with an at least 30% decrease compared to the last preoperative measurement. General success rates after a mean follow-up of 33.5 +/- 11.3 months were 79 and 46%, with and without medications, respectively. Mean IOP levels, which were 37.7 +/- 9.9 mmHg at the diagnosis without treatment and 27.7 +/- 11.3 mmHg at the last preoperative measurement with medical treatment, significantly decreased to 12.7 +/- 4.8 mmHg at the last follow-up visit (P < 0.001 for both comparisons). Twelve eyes (36%) with IOPs higher than 18 mmHg during follow-up underwent laser goniopuncture. Mean IOP, which was 26.0 +/- 4.6 mmHg before goniopuncture, decreased to 11.5 +/- 4.0 mmHg immediately after the procedure (P = 0.002). Early goniopunctures (before month 3) were performed in six eyes, and late goniopunctures (after month 10) were performed in the remaining six eyes. Success rates of laser-applied eyes at the last visit were 75 and 33%, with and without medications, respectively (P = 0.568). No significant difference was found between eyes with and without goniopunctures in terms of success rates, IOP levels, and IOP reduction rates. According to the results of this study, laser goniopuncture is indicated in a significant proportion of patients following viscocanalostomy and may substantially improve the outcome of surgery.

Normotensive glaucoma and risk factors in normotensive eyes with pseudoexfoliation syndrome.

PURPOSE: To evaluate the prevalence of normotensive glaucoma (NTG) in patients with pseudoexfoliation (PEX) syndrome. METHODS: In this prospective study, 178 eyes of 178 patients with PEX syndrome who had no previous history of antiglaucomatous treatment were evaluated in terms of NTG prevalence. NTG diagnosis was based on the presence of glaucomatous optic nerve head damage with glaucomatous visual field defects, open angles, and intraocular pressure (IOP) levels less than 22 mm Hg. Two groups of normotensive pseudoexfoliative eyes with or without glaucomatous findings were compared in terms of age, sex, the presence of systemic diseases and mean IOP, maximum IOP, and IOP fluctuation levels. RESULTS: The IOP levels were below 22 mm Hg in 109 of the 178 eyes, and 24% (n=27) of those eyes were diagnosed as NTG. There were no significant differences between the eyes with or without glaucoma in terms of age, sex, and the presence of systemic diseases (P>0.05). The mean IOP, maximum IOP, and IOP fluctuation levels were significantly higher in eyes with NTG when compared with eyes without glaucoma (P<0.05). Univariate analysis revealed that significant risk factors associated with NTG in patients with PEX syndrome were higher mean IOP (> or =14 mm Hg), higher maximum IOP (> or =18 mm Hg), and greater IOP fluctuation (> or =4 mm Hg). In multivariate analysis, these factors were higher maximum IOP and greater IOP fluctuation range (P=0.003, P<0.001, respectively). CONCLUSIONS: There are glaucomatous findings in a significant proportion of normotensive patients with PEX syndrome. The high maximum IOP levels and greater IOP fluctuation range may be contributory factors in the pathogenesis of NTG in patients with PEX syndrome.

The effect of paclitaxel on conjunctival wound healing: a pilot study.

PURPOSE: To compare the effects of mitomycin C (MMC) and paclitaxel entrapped within Carbopol 980 hydrogel (CH) on conjunctival wound healing. METHODS: Twenty rabbits were randomized into 2 groups. In group 1, limbal-based conjunctival flaps were created in both eyes. In this stage, eyes were randomized for 4 different processes. In process 1, a dry cellulose sponge soaked with 0.2 mg/mL of MMC was applied to the scleral surface. A cellulose sponge soaked with balanced saline solution was applied in the same manner in process 2. In process 3, paclitaxel 1 mg/mL entrapped within CH was placed between the conjunctiva and sclera. In process 4, CH without paclitaxel was applied in the same manner. The conjunctiva was then sutured. All procedures were applied in the same manner in both eyes of animals in group 2. Eyes from group 1 were sampled at the seventh day, and the sampling was also carried out in group 2 on day 14. The inflammatory response and fibrosis were evaluated with light microscopy. RESULTS: Among 4 different processes, lower cell counts and fibrosis scores were found in eyes treated with MMC and paclitaxel compared with balanced saline solution and CH groups (P<0.05). There was no difference between eyes treated with MMC and paclitaxel in terms of these histopathologic parameters (P>0.05). CONCLUSIONS: Paclitaxel was shown to provide MMC-like antifibrotic effects during conjunctival wound healing, particularly when delivered with CH and might be a promising alternative as an adjunctive antimetabolite in glaucoma filtration surgery.

Comparison of the effects of travoprost, latanoprost and bimatoprost on ocular circulation: a 6-month clinical trial.

PURPOSE: To study the effect of three prostaglandin F(2)-alpha (PG) analogues on retrobulbar blood flow velocity in previously untreated patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT), using colour Doppler ultrasound. METHODS: Sixty newly diagnosed patients with POAG or OHT were randomly assigned to travoprost 0.004% (n = 12 with POAG, n = 8 with OHT), latanoprost 0.005% (n = 11 with POAG, n = 9 with OHT) and bimatoprost 0.03% (n = 13 with POAG, n = 7 with OHT) treatment groups in a double-masked fashion. At baseline examination, blood pressure, heart rate and intraocular pressure (IOP) were recorded. Peak-systolic and end-diastolic velocities were measured in the ophthalmic (OA), central retinal (CRA) and temporal short posterior ciliary arteries (PCA). The resistive index (RI) and ocular perfusion pressure (OPP) were determined for each treatment group. After a treatment period of 6-months, all procedures were repeated. RESULTS: There were no significant differences in age (53 +/- 14 years in the travoprost group, 51 +/- 14 years in the latanoprost group, 53 +/- 11 years in the bimatoprost group), gender (11 men, nine women; 11 men, nine women; 13 men, seven women, by group, respectively), or clinical diagnosis (POAG or OHT) among treatment groups (p > 0.05). A significant decrease in IOP (baseline: 26.4 +/- 3.3 mmHg, 26.8 +/- 1.3 mmHg, 25.8 +/- 1.8 mmHg, respectively; month 6: 20.9 +/- 1.9 mmHg, 20.8 +/- 2.4 mmHg, 18.3 +/- 1.2 mmHg, respectively; p < 0.0001) and an increase in OPP (baseline: 33.7 +/- 3.8 mmHg, 33.5 +/- 3.2 mmHg, 33.9 +/- 2.6 mmHg, respectively; month 6: 40.2 +/- 3.5 mmHg, 39.9 +/- 3.1 mmHg, 41.7 +/- 2.6 mmHg, respectively; p < 0.0001) were verified in all three groups during the study period. Mean baseline RI values for the CRA in the travoprost group and the OA in the latanoprost group were both 0.7 +/- 0.1 mmHg and both values were statistically significantly lower at 6 months (0.6 +/- 0.1 mmHg in both groups; p = 0.002, p < 0.0001, respectively). In the bimatoprost group there was no statistically significant difference in haemodynamic parameters over the study period (p > 0.05). CONCLUSIONS: Our results suggest that the three PG analogues significantly reduce IOP and increase OPP in patients with POAG or OHT. Topical travoprost and latanoprost significantly reduce the RI of the CRA and OA, respectively. We were unable to determine any effect of topical bimatoprost on ocular haemodynamics.

Encapsulated blebs following primary standard trabeculectomy: course and treatment.

PURPOSE: To investigate the incidence and course of encapsulated filtering blebs (EB) following primary standard trabeculectomy in eyes with non-complicated glaucoma. MATERIALS AND METHODS: Records of patients who were being followed-up in Ankara Numune Hospital, 1st Eye Clinic Glaucoma Department were analyzed and 183 eyes of 183 consecutive patients who underwent primary trabeculectomy without antimetabolites were enrolled in the study. RESULTS: Encapsulation developed in 14 (7.6%) of 183 eyes and identification of bleb encapsulation occurred at a mean follow-up time of 5.1 +/- 5.0 weeks (median = 4 weeks). Mean intraocular pressure (IOP) levels before, during, and after the encapsulated bleb phase were 14.1 +/- 3.6, 23.4 +/- 6.9, and 14.4 +/- 3.9 mm Hg respectively. All eyes responded to conservative medical treatment consisting of aqueous suppressants without digital massage, and encapsulation resolved after a mean duration of 8.3 +/- 4.6 weeks (median = 8 weeks). Patient age, gender, glaucoma diagnosis, and preoperative IOP levels were not significantly related with the occurrence of EB formation. There was no significant difference in the use of topical beta-blockers and miotics in patients that developed EB versus those who did not; however, EB developed only in eyes with prior beta-blocker therapy and no encapsulation occurred in the 16 eyes that had not received topical beta-blockers. Mean duration of follow-up was 45.3 +/- 30.7 months (12 to 127 months) in the group without encapsulation and 44.6 +/- 22.7 months (18 to 84 months) in the EB group. Overall success rates of trabeculectomies in eyes with and without EB were not significantly different (100% and 91.7%, respectively). Complete surgical success, however, without antiglaucomatous medications at the last visit was significantly lower in eyes with prior encapsulation (35.7% with EB, 63.9% without EB) (P = 0.014). CONCLUSION: Filtering bleb encapsulation following primary trabeculectomy responds well to conservative medical IOP-lowering therapy in eyes with glaucoma associated with elevated IOP.

Viscocanalostomy versus trabeculectomy in patients with bilateral high-tension glaucoma.

Results of trabeculectomy (TE) and viscocanalostomy (VCO) were compared in a prospective randomised study in two fellow eyes of 22 consecutive patients with bilateral symmetrical high-tension glaucoma. Rates of overall surgical success with intraocular pressures (IOP) < or = 18 mm Hg with or without medications were 91 for the TE, and 95 for the VCO group after a mean follow-up of 18 months. Complete success rates without medications were 64 and 59 for TE and VCO groups, respectively (p = 0.750). Both procedures significantly reduced IOP, however, IOP course following trabeculectomy was significantly lower (p = 0.026). Rates of complications were not found to be different between the two groups of eyes, except for an apparent--though not significant (p = 0.066)--increase in cataract progression with TE. Various types of conjunctival blebs were detected in all eyes with surgical success in both groups, however, diffuse, elevated or multi-cystic functional blebs appeared to be more predominant in eyes with TE, compared to the VCO group in which low-lying, localised blebs had a higher incidence (p = 0.015). Viscocanalostomy was found to be a safe and effective filtration technique in patients with uncomplicated high-tension glaucoma, though IOP decrease was more pronounced with trabeculectomy.

Effects of betaxolol and flunarizine on visual fields and intraocular pressure in patients with migraine.

Fifty-one patients with migraine were divided into four groups to investigate the effects of topical betaxolol and systemic calcium channel blocker flunarizine on visual fields (VF) and intraocular pressure (IOP). The first group (Group 0) was followed with no medications, topical betaxolol (bid) was precribed to the second group (Group B), oral flunarizine (10 mg daily) was prescribed to the third group (Group F), and the last group (Group BF) was assigned for combined betaxolol and flunarizine treatment. After a mean follow-up time of 4.2 +/- 1.2 months (3-6 months), IOP measurements and VF tests were repeated. Group B and Group BF were found to be statistically different from the other groups in terms of IOP reduction and VF improvement according to mean deviation and corrected pattern standard deviation indices in the second examinations. On the other hand, Group F and Group BF differed from the other two groups considering the improvement in migrainous complaints. VF findings which are probably influenced by perfusion problems due to vasospastic mechanisms in migraineurs, improved following topical betaxolol treatment. However, systemic use of flunarizine--a calcium channel blocker--did not seem to be effective on visual fields although it had beneficial effects on migraine.

The effect of trabeculectomy on the intraocular pressure of the unoperated fellow eye.

PURPOSE: To investigate the intraocular pressure (IOP) changes in the unoperated fellow eye in patients who underwent trabeculectomy. MATERIALS AND METHODS: IOP changes in the unoperated fellow eyes of 107 patients who underwent trabeculectomy in 1 eye for high-tension glaucoma (48 primary open-angle glaucoma, 43 pseudoexfoliative glaucoma, and 16 narrow-angle glaucoma) were evaluated during the early postoperative period. All IOP measurements were recorded during the postoperative first 3 months and compared with preoperative values. RESULTS: Mean preoperative IOP levels were 37.0 +/- 10.0 mm Hg in the operated eyes and 15.1 +/- 3.1 mm Hg in the fellow eyes. Mean IOPs in the unoperated eyes on the postoperative first-day, first- and second-week, and first- and third-month visits (17.1 +/- 5.7, 17.5 +/- 5.1, 18.5 +/- 5.4, 18.6 +/- 5.1, and 19.0 +/- 5.9 mm Hg, respectively) were significantly different compared with the preoperative levels for each period of time (P < 0.01). Eight fellow eyes underwent operations for uncontrolled glaucoma before month 3. Among the remaining 99 eyes, higher postoperative IOP values were measured in 33 (33%) eyes at all postoperative visits compared with the preoperative IOP levels. A consistent IOP rise equal to or higher than 5 mm Hg was detected in 12 eyes (12%) and a consistent IOP elevation of 30% or more was found in 14 eyes (14%) during the postoperative first 3 months. Contralateral IOP elevation was not correlated with patient age, type of glaucoma, or preoperative antiglaucomatous medications prescribed to the operated or fellow eyes. CONCLUSION: After filtration surgery, IOP of the unoperated fellow eye should also be monitored closely in order not to overlook a possible insidious rise, especially in glaucomatous eyes that were previously under good medical control.

Glaucomatous visual field defects in patients with migraine.

PURPOSE: To investigate the visual fields in patients with migraine in terms of glaucomatous visual field defects. METHOD: Patients who attended our Neurology outpatient clinic complaining of headache and were diagnosed as migraine were enrolled in the study. Each patient was questioned for the frequency, side, localisation and severeness of the pain as well as the onset and the duration of the symptoms, the existence of aura, the description of the aura - if present -, additional systemic problems, and family history of migraine and glaucoma. Detailed ophthalmological examinations and computerised visual field (VF) analysis were then performed on each patient in our Ophthalmology Clinic. The findings of 77 patients (61 female, 16 male) were evaluated and statistical comparisons were carried out between the group of patients with glaucomatous-like VF defects and the group without significant defects. RESULTS: VF tests revealed glaucomatous-like defects in 48 (62.3 %) patients. Intraocular pressure (IOP) levels were within normal limits in all cases. There were no statistically significant differences between the groups with and without VF defects in terms of sex, the localisation and severeness of pain, the existence and the description of aura, and family history of glaucoma, as well as the duration of migraine, IOP and cup/disc ratio. The glaucomatous group was significantly older, with a significantly higher age of onset for migraine. Risk of having glaucomatous-like defects was higher in patients who had migraine attacks once a month or less frequently. A tendency of pain and VF defects to develop ipsilaterally was noticed. DISCUSSION: A possible relationship between the pathophysiology of migraine, visual field defects and glaucomatous optic neuropathy is emphasized and VF screening for normal tension glaucoma is recommended in patients with migraine.