The Effects of Nocturnal Dip and Blood Pressure Variability on Paracentral Scotoma in Early Open-Angle Glaucoma.

PURPOSE: To evaluate the effect of nocturnal dip and blood pressure (BP) variability on paracentral scotoma in early open-angle glaucoma. METHODS: The present study included 72 early normal-tension glaucoma (NTG) patients and 34 early primary open-angle glaucoma (POAG) patients. Nocturnal dip and weighted standard deviation (wSD) were determined by 24-hour ambulatory BP monitoring (24-hr ABPM). The mean deviation (MD) and pattern deviation (PD) were measured with visual field. Correlations between nocturnal dip and/or BP variability and paracentral scotoma were assessed using Student's t-test, Pearson's correlation test, and linear logistic regression analysis. RESULTS: The systolic and diastolic nocturnal dip and paracentral scotoma occurrence demonstrated a statistically significant correlation in the early NTG group (systolic nocturnal dip: p=0.047, diastolic nocturnal dip: p=0.011). In the early NTG group, the subgroup with paracentral scotoma had a greater nocturnal dip than those patients without paracentral scotoma (systolic nocturnal dip: p=0.000; diastolic nocturnal dip: p=0.000). In the early NTG group, the subgroup with paracentral scotoma had higher wSD of SBP than the patients without paracentral scotoma (p=0.003). In the logistic regression analysis of the factors that can affect paracentral scotoma SBP dip and SBP, wSD appeared to significantly affect the occurrence of paracentral scotoma in the early NTG group. CONCLUSIONS: Early NTG patients with paracentral scotoma have nocturnal dip and large BP variability. Therefore, in early glaucoma patients, particularly in early NTG with paracentral scotoma, nocturnal dip and BP variability should be assessed with 24-hr ABPM.

Risk Factors of Disease Progression After Cataract Surgery in Chronic Angle-closure Glaucoma Patients.

PURPOSE: To evaluate clinical risk factors of disease progression after cataract surgery using phacoemulsification with posterior chamber intraocular lens implantation, in eyes with chronic angle-closure glaucoma (CACG) and coexisting cataract. DESIGN: Retrospective study. METHODS: The data of 56 eyes of 45 CACG patients who had undergone uncomplicated phacoemulsification with posterior chamber intraocular lens implantation were retrospectively analyzed. Disease progression was defined as glaucomatous optic nerve change or visual field (VF) deterioration according to the European Glaucoma Society guideline. Correlations between VF progression and various preoperative and postoperative factors were determined by χ and independent t tests. Linear regression analysis [(odds ratio (OR)] was used to determine predictive risk factors for disease progression using univariate and multivariate analyses. RESULTS: The mean postoperative follow-up period was 45.13 ± 17.54 (24 to 84) months. Fourteen eyes (25%) with cataracts diagnosed with CACG progressed after phacoemulsification, but the remaining 42 eyes (75%) did not. According to univariate analysis, disease progression was significantly associated with older age, more number of preoperative/postoperative antiglaucoma drugs, higher scores of preoperative pattern standard deviation, and lower scores of preoperative and postoperative visual field index (VFI) (P<0.05). Using multivariate analysis, a lower score of preoperative VFI (OR: 0.86, P=0.044) and lower postoperative intraocular pressure (IOP) reduction, which was not sustained below 20% less than the preoperative mean IOP, were significantly correlated with disease progression after cataract surgery (OR: 8.44, P=0.048). CONCLUSIONS: CACG patients with low preoperative VFI and high postoperative IOP are at risk for disease progression even after uncomplicated cataract surgery.

Effect of Goniosynechialysis During Phacoemulsification on IOP in Patients With Medically Well-controlled Chronic Angle-Closure Glaucoma.

PURPOSE: To evaluate and compare the efficacy and safety of combined phacoemulsification and goniosynechialysis (PEGS) to phacoemulsification alone (PE) in patients with medically well-controlled chronic angle-closure glaucoma (CACG) with cataracts. MATERIALS: Thirty eyes diagnosed with CACG and requiring cataract surgery from January 2008 to October 2010 were prospectively randomized, 15 each to PE and PEGS. Changes in peripheral anterior synechiae (PAS), intraocular pressure (IOP), anterior chamber depth, and number of antiglaucoma drugs from baseline to 2 months after the operation were analyzed, as were the type and number of complications. RESULTS: The PE group showed decreases in PAS (118.67±95.38 degrees) and IOP (2.33±2.38 mm Hg) and a significant reduction in the number of antiglaucoma drugs (0.53±0.83, P<0.05) from before to 2 months after surgery. The PEGS group showed similar decreases in PAS (114.00±90.95 degrees), and IOP (4.53±4.16 mm Hg) and number of antiglaucoma drugs (1.20±1.32) (P<0.05). However, the amount of decline in both the groups did not show any significantly difference in PAS, reduction of IOP, or number of antiglaucoma drugs (P>0.05), The increase in anterior chamber depth from baseline to 2 months after surgery was significantly greater in the PEGS group (P=0.003). CONCLUSIONS: The IOP-lowering effects of PEGS do not differ significantly from those of PE in medically well-controlled CACG patients with cataract. These results suggest that additional goniosynechialysis during phacoemulsification is not necessary in such patients.

Comparison of macular ganglion cell complex thickness by Fourier-domain OCT in normal tension glaucoma and primary open-angle glaucoma.

PURPOSE: To compare perimacular ganglion cell complex (GCC) parameters between patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). METHODS: Participants, consecutively enrolled from January 2009 to June 2009, underwent optical coherence tomographic imaging with RTVue-100 (Optovue Inc, Fremont, CA). Optic nerve head (ONH) parameters, retinal nerve fiber layer (RNFL) parameters, and GCC parameters were acquired. Mean measurements of ONH, RNFL, and GCC parameters among the normal, NTG, and POAG groups were compared using analysis of variance. Area under the receiver operator characteristic curve was used to assess the ability of each parameter to detect glaucomatous changes. RESULTS: Fifty-eight normal controls, 51 patients with NTG, and 52 patients with POAG were included. Mean measurements of ONH parameters were similar between the NTG and POAG groups (all P>0.05). Average RNFL thickness did not differ between the NTG and POAG groups (P=0.053), whereas average GCC thickness significantly differed between the NTG and POAG groups (P=0.001). In terms of pattern-based parameters of GCC, focal loss volume did not differ between the NTG and POAG groups (P=0.165), whereas global loss volume was significantly higher in the POAG group (P<0.001). There were no statistically significant differences between RNFL and GCC measurements with respect to the ability to detect glaucomatous changes. CONCLUSIONS: GCC loss in the NTG group was more localized compared with diffuse GCC loss in the POAG group. Perimacular GCC parameters could be a good alternative or supplement to peripapillary RNFL measurements for diagnosis and research in patients with NTG.

Factors associated with false positives in retinal nerve fiber layer color codes from spectral-domain optical coherence tomography.

PURPOSE: To determine the factors that contribute to false-positive retinal nerve fiber layer (RNFL) color code results from spectral-domain optical coherence tomography (OCT). DESIGN: A prospective, cross-sectional study. PARTICIPANTS: This study included 149 eyes from 77 healthy participants. METHODS: Participants, who were consecutively enrolled from June 2009 to December 2009, underwent Cirrus OCT. Recorded demographic and clinical factors included age, gender, eye side, intraocular pressure, central corneal thickness, spherical equivalent, axial length, anterior chamber depth, disc area, and the extent of retinal vasculature. MAIN OUTCOME MEASURES: An abnormal finding in RNFL color codes was defined as ≥1 yellow or red sectors by quadrant and clock-hour maps and a wedge-shaped color pattern represented by yellow or red in the deviation map. The incidence of false-positive color codes was determined. The influence of clinical and demographic factors on the incidence of false-positive RNFL color codes was assessed using generalized linear mixed model analysis. RESULTS: The false-positive rate for ≥1 of the quadrant, clock-hour, and deviation maps was 26.2%. Longer axial length and smaller disc area were significantly associated with an increased incidence of false-positives when other factors were controlled (odds ratios, 2.422 and 0.165; P = 0.008 and 0.035, respectively). CONCLUSIONS: The factors that significantly affected the false-positive RNFL color code results using spectral-domain OCT were axial length and disc area, which may significantly affect the specificity of spectral-domain OCT. Therefore, axial length and disc area should be considered during RNFL thickness profile analysis.