Intraobserver and interobserver agreement of computer software-assisted optic nerve head photoplanimetry.

PURPOSE: To report the reproducibility profile of optic nerve head parameters obtained by computer software-assisted fundus photoplanimetry. METHODS: Fundus photographs obtained during a population-based health survey (Sakurae Study) were planimetrically analyzed using newly developed computer software, CDSketch. The parameters assessed included vertical and horizontal cup-to-disc (C/D) ratios, superior and inferior rim-to-disc (R/D) ratios, disc and cup vertical-to-horizontal (V/H) ratios, and disc-macular distance-to-disc diameter (DM/DD) ratio. For intraobserver and interobserver agreement assessments, we calculated the coefficients of variation (CVs) and intraclass correlation coefficients (ICCs) of the mean of three measurements obtained by one observer and a one-time measurement by three observers, respectively. RESULTS: The intraobserver CVs were between 2.4 % (DM/DD ratio) and 11.0 % (inferior R/D ratio), and the ICCs were between 0.868 (cup V/H ratio) and 0.976 (DM/DD ratio); all intraobserver ICCs had almost perfect agreement (>0.81). The interobserver CVs were between 2.6 % (disc V/H ratio) and 18.0 % (inferior R/D ratio), and the ICCs were between 0.762 (cup V/H ratio) and 0.930 (DM/DD ratio); the interobserver ICCs were categorized as substantial (0.61-0.80) for the inferior R/D and cup V/H ratios and as almost perfect for the other five parameters. CONCLUSIONS: The consistent profiles of the planimetric parameters suggest the suitability of software-assisted photoplanimetry for assessing optic disc characteristics in glaucoma clinical study and practice.

Glaucoma in atomic bomb survivors.

Radiation has been associated with increases in noncancerous diseases. An effect of low-dose radiation on the prevalence of clinically detected glaucoma has not been previously reported. We therefore investigated the prevalence of glaucoma in A-bomb survivors and its possible association with radiation dose. A total of 1,589 people who participated in the clinical examination program for A-bomb survivors at the Radiation Effects Research Foundation (RERF) between October 2006 and September 2008 and who had reconstructed radiation doses, were recruited into this cross-sectional screening study. The prevalence of glaucoma and its dose-response relationship to A-bomb radiation were measured. Each subject underwent an initial screening consisting of an interview and ophthalmological examination. Questionable cases with any indication of ocular disease, including glaucoma, were referred to local hospitals for more comprehensive evaluation. A diagnosis of glaucoma was made based on specific optic disc appearance, perimetric results and other ocular findings. Of 1,589 eligible people, we detected 284 (17.9%) cases of glaucoma overall, including 36 (2.3%) cases of primary open-angle glaucoma with intraocular pressure levels greater than 21 mmHg, 226 (14.2%) cases of normal-tension glaucoma and 25 (1.6%) cases of primary angle-closure glaucoma. Seven glaucoma risk factors were examined as potential confounders but only two needed to be included in the final model. Binary regression using a generalized estimating equation method, with adjustment for gender, age, city, cataract surgery or diabetes mellitus, revealed an odds ratio at 1 Gy of 1.31 (95% confidence interval 1.11-1.53, P = 0.001) in the case of normal-tension glaucoma, but no association for other types of glaucoma. The prevalence of normal-tension glaucoma may increase with A-bomb radiation dose, but uncertainties associated with nonparticipation (59% participation) suggest caution in the interpretation of these results until they are confirmed by other studies.

[Fundus photoplanimetry of the optic nerve head in the Sakurae Study].

PURPOSE: To explore the fundus photoplanimetric distribution of the optic nerve head in a population-based health survey conducted in Sakurae area, in Shimane, Japan(the Sakurae Study). METHODS: After the exclusion of poor quality images from the 1660 right eye-fundus photos obtained from the Sakurae Study in 1991, 1583 photos were digitized, and then were planimetrically analyzed using a newly developed computer software, CDSketch. The parameters calculated included vertical and horizontal cup-to-disc (C/D) ratios, superior and inferior rim-to-disc (R/D) ratios, disc and cup vertical-to-horizontal (V/H) ratios, and disc-macular distance-to-disc diameter (DM/DD) ratio. RESULTS: For the vertical and horizontal C/D, superior and inferior R/D, disc and cup V/H, and DM/DD ratios, mean values were calculated to be 0.58, 0.59, 0.20, 0.18, 1.11, 1.09, 2.60, respectively, and median values were calculated to be 0.58, 0.59, 0.19, 0.18, 1.11, 1.09, 2.57, respectively; no parameter showed any remarkably skewed distribution. The vertical C/D ratio was positively correlated with the cup V/H ratio, but was not correlated with the disc V/ H ratio. The vertical and horizontal C/D, and the disc and cup V/H ratios were negatively correlated with the DM/DD ratio. CONCLUSIONS: The distributions of the various optic nerve head parameters and their correlations in the Sakurae Study are reported. Both mean and median values of the vertical C/D ratio were approximately 0.6 in this study population. These values were larger than the previously reported C/D ratios obtained by direct ophthalmoscopic observations and/or by subjective methods.

Systemic steroid-pulse therapy in a patient with idiopathic choroidal detachment: a case report.

AIM: To report on the effectiveness of systemic steroid-pulse therapy in treating idiopathic choroidal detachment. CASE PRESENTATION: Our patient developed idiopathic choroidal detachment after cataract surgery for pseudoexfoliation glaucoma and glaucoma filtration surgery. Systemic steroid-pulse therapy was performed, and the choroidal detachment resolved completely. CONCLUSION: We suggest systemic steroid-pulse therapy as a treatment option for idiopathic choroidal detachment with low intraocular pressure.

Comparison of the prevalence of plateau iris configurations between angle-closure glaucoma and open-angle glaucoma using ultrasound biomicroscopy.

PURPOSE: To determine the prevalence of plateau iris configurations in acute primary angle-closure (APAC), chronic angle-closure glaucoma (CACG), and open-angle glaucoma (OAG) eyes using ultrasound biomicroscopy. MATERIALS AND METHODS: The study included fellow eyes of 27 APAC patients, 26 OAG patients, and 26 CACG patients with no history of APAC. Patients with a history of earlier intraocular surgery or argon laser peripheral iridoplasty were excluded from the study. Eyes that had not undergone laser peripheral iridotomy were excluded from APAC and CACG groups. Radial scans were carried out using ultrasound biomicroscopy in all 4 quadrants. A plateau iris configuration within a quadrant was defined by the presence of an anteriorly positioned ciliary process, a narrow ciliary sulcus, a steeply rising peripheral iris, followed by a downward angulation from the corneoscleral wall and the presence of a flat iris plane. Eyes with plateau iris configurations were defined as those having at least 2 quadrants fulfilling these criteria. RESULTS: Plateau iris configurations were found in fellow eyes of 10 of 27 patients with (37.0%) APAC, 9 of 26 (34.6%) patients with CACG, and 5 of 26 (19.2%) patients with OAG. No significant difference in the prevalence of plateau iris configurations was observed among the 3 groups (P=0.314, χ2 test). CONCLUSIONS: Eyes with OAG had a higher rate of plateau iris configurations than expected. Longitudinal studies to evaluate plateau iris height are required to determine its significance in the pathogenesis of angle-closure glaucoma.

Twenty-four-hour ocular hypotensive effects of 0.0015% tafluprost and 0.005% latanoprost in healthy subjects.

PURPOSE: To compare the intraocular pressure (IOP) reduction over 24 h achieved with tafluprost (0.0015%) with that achieved with latanoprost (0.005%). METHODS: Twenty-seven healthy volunteers were studied. After a 24-h IOP baseline measurement was taken, one ophthalmic solution was applied to the right eye daily for 7 days. The drug was then withdrawn for 2 weeks. The other agent was then applied to the left eye in the same manner. IOP was measured every 3 h for 24 h on the seventh day of treatment. RESULTS: The 24-h IOP after 7 days' treatment with latanoprost decreased from 11.5 mmHg at baseline to 9.7 mmHg (-1.8 mmHg) and that with tafluprost from 11.8 to 9.8 mmHg (-1.9 mmHg). Tafluprost was statistically more effective after 24 h (P = 0.007; paired t test). The number of subjects with a 24-h mean IOP reduction of <10% was 8/27 (29.6%) with latanoprost versus 4/27 (14.8%) with tafluprost. The incidence of conjunctival hyperemia with latanoprost was 4/27 (14.8%) and that with tafluprost was 8/27 (29.6%). CONCLUSION: The overall efficacies of the two agents were not different, but tafluprost was associated with a greater reduction in IOP at 24 h after administration. Tafluprost showed a higher rate of conjunctival hyperemia.

Effect of intravitreal bevacizumab on iris vessels in neovascular glaucoma patients.

BACKGROUND: We aimed to investigate the effects of a single 1-mg injection of intravitreal bevacizumab on iris vessels in neovascular glaucoma (NVG) patients. METHODS: Twenty-two surgically resected irises from glaucoma patients were obtained during trabeculectomy. Eight were from patients with NVG who received a 1-mg injection of intravitreal bevacizumab (IVB) before glaucoma surgery, eight were from patients with primary open-angle glaucoma (POAG), and six were from patients with NVG who were not administered IVB. The collected iris specimens were compared after immunohistochemical staining with anti-CD34 monoclonal antibodies and anti-VEGF monoclonal antibody, and the percentage of CD34-positive and VEGF-positive regions in the total area of the specimens from the three groups was compared. RESULTS: The difference in the CD34-positive area between all groups was statistically significant (p = 0.0061, Kruskal-Wallis test). There was no significant difference in the CD34-positive area between the NVG with IVB group and the POAG group (p = 0.3017, Mann-Whitney U test with Bonferroni correction). The POAG group had significantly fewer CD34-positive regions than the NVG without IVB group (p = 0.0019, Mann-Whitney U test with Bonferroni correction). Many vessels remained in the iris stroma, and there was no significant difference in the CD34-positive area between the NVG with IVB and NVG without IVB groups (p = 0.0357, Mann-Whitney U test with Bonferroni correction). The ratio of the length of CD34 expression on the iris surface in the NVG without IVB group was significantly longer than that in the NVG with IVB group (p = 0.0002, Mann-Whitney U test). The difference in VEGF expression between all groups was statistically significant (p = 0.04, Kruskal-Wallis test). There was no significant difference between the NVG with IVB group and the NVG without IVB group (p = 0.7963 Mann-Whitney U test with Bonferroni correction). The frequency of hyphema and fibrin formation in the anterior chamber 1 day after surgery between the two NVG groups was not statistically significant. CONCLUSION: A single intravitreal dose of IVB at 1 mg/0.04 ml to eyes with rubeotic glaucoma reduced the neovascularization in the human iris surface, but could not eliminate completely neovascularization in iris stroma. This finding implies that the prevention of hyphema and fibrin formation based on the slit-lamp examination can not be predicted, even if neovascularization in iris surface seems to be eliminated by a single dose of IVB.

Efficacy of latanoprost when stored at room temperature.

We compared the ocular hypotensive effect for 24 hours and the tolerability of latanoprost stored at 4 degrees C and 30 degrees C. Seventeen healthy volunteers were included in this crossover trial. Latanoprost 0.005% (Xalatan) was stored at 4 degrees C or 30 degrees C for 4 weeks in the dark. The subjects enrolled to the study were randomly assigned to receive either latanoprost stored at 4 degrees C or that stored at 30 degrees C. The eye drop was applied to the right eye of each subject for 3 days. The left eye served as a control without administration. Slit-lamp biomicroscopy and circadian intra ocular pressure (IOP) curve was performed at Day 3, every 3 hours from 6 pm. This procedure was repeated 7 days after changing the drug from 4 degrees C to 30 degrees C or vice versa, and application to the left eye for 3 days. Eyes treated with latanoprost, stored both at 4 degrees C and 30 degrees C, achieved statistically significantly lower mean IOPs than untreated eyes at all time points, except at 21 hours treated by the drug stored at 30 degrees C. We subtracted the IOP of eyes receiving latanoprost from the IOP of untreated eyes for each time point to evaluate the efficacy of the eye drops (delta IOP). There were no statistically significant differences between the delta IOPs with the drug stored at 4 degrees C and 30 degrees C. During the study, no subject developed a serious adverse event. These results suggest that latanoprost stored at 30 degrees C for 4 weeks after opening the bottle remains as effective and safe as latanoprost stored under cold conditions.

Topical latanoprost causes posterior movement of lens in a patient with exfoliation syndrome and subluxated lens: a case report.

INTRODUCTION: To report the effect of topical latanoprost on the position of a subluxated lens. CASE PRESENTATION: After 0.005% latanoprost was administered topically to a patient with ocular hypertension due to a pseudoexfoliation syndrome and a subluxated lens, the position of the lens was examined by slit-lamp biomicroscopy, and the ciliary body thickness by ultrasound biomicroscopy. The lens had moved posteriorly, and the thickness of the ciliary body had decreased after the latanoprost. CONCLUSION: We suggest that the decrease in the thickness of the ciliary body resulted in an increase in the tension of the zonule of Zinn fibers, thus pulling the subluxated lens posteriorly.

Additive effect of bunazosin on intraocular pressure when topically added to treatment with latanoprost in patients with glaucoma.

PURPOSE: To investigate whether an alpha-1 blocker, bunazosin, has an additive effect on lowering intraocular pressure (IOP) when topically added to latanoprost treatment in patients with glaucoma. METHODS: Bunazosin twice a day was added topically to the treatment for 12 patients with glaucoma who had been instilling latanoprost once a day for more than 1 month. IOP was measured and adverse events were checked 2, 4 and 8 weeks after the addition of bunazosin to their treatment. RESULTS: One of the 12 patients dropped out in the course of the study. Therefore, 11 patients were included for the analysis of IOP, and 12 for the analysis of adverse events. IOPs were decreased significantly (P=.008, Wilcoxon signed rank test) from 18.2+/-3.4 mm Hg to 16.6+/-3.5 mm Hg 8 weeks after the addition of bunazosin. Adverse events were seen in 5 of the 12 patients. CONCLUSION: Bunazosin has an additive effect on lowering IOP when topically added to latanoprost treatment in glaucoma patients.

The negative correlation between age and intraocular pressures measured nyctohemerally in elderly normal-tension glaucoma patients.

PURPOSE: To evaluate the correlation between age and intraocular pressure (IOP) measured every 3 h for 24 h in older normal-tension glaucoma (NTG) patients. METHODS: Ninety consecutive patients suspected of having NTG on the basis of both visual field defect and disc appearance were hospitalized for measurement of nyctohemeral IOP every 3 h over a 24-h period with a Goldmann tonometer after a 4-week wash-out of any existing medication. Sixty-nine patients (76.7%) were diagnosed as having NTG. Sixty-nine eyes of 69 subjects were enrolled for this prospective, cross-sectional study. They were divided into two groups by age (cut-off between 59 and 60 years: group 1, under 60 years; group 2, over 60 years). The correlations between age and the mean, maximum and minimum IOP and IOP variation of the eight nyctohemeral IOP measurements nyctohemerally were evaluated for each group. The times of day at which the maximum and minimum IOPs were observed were recorded. RESULTS: Groups 1 and 2 consisted of 28 patients (age: 50.2+/-6.1 years) and 42 patients (age: 70.3+/-6.1 years) ( P<0.0001), respectively. Neither mean, maximum or minimum IOP nor the IOP variation was significantly different between the groups (all P values > or =0.115). The mean, maximum and minimum IOP in group 2 were all correlated with age ( n=41; r=-0.516, P=0.0004; r=-0.434, P=0.004; r=-0.522, P=0.0004, respectively), while none of those in group 1 was correlated with age (all P values > or =0.303). CONCLUSION: The IOPs of the elder NTG patients have a negative correlation with age while those of the younger ones have no relation to age.

The effect of latanoprost on circadian intraocular pressure.

The presence of a circadian variation of both intraocular pressure (IOP) and aqueous humor flow has been demonstrated in several studies. It must therefore be considered important to monitor IOP and evaluate the efficacy of ocular hypotensive drugs over the 24 hours of the day. The efficacy of latanoprost on IOP during both day and night has been evaluated and the most important results from four such studies are reviewed. The studies reviewed here clearly demonstrate that topical administration of latanoprost 0.005% once daily provided a steady reduction of the IOP during both day and night. Given as a single dose to healthy volunteers, latanoprost resulted in a sustained effect with a significant IOP reduction over 24 hours, and the reduction was still present, however less pronounced, even after 48 hours. Latanoprost administered once daily for 4 weeks to patients with glaucoma or ocular hypertension was more effective in reducing the IOP over 24 hours than timolol gel solution 0.5% once daily, timolol aqueous solution 0.5% twice daily, or dorzolamide 2% three times daily. Latanoprost applied once daily thus provided a better effect on the IOP together with a stable and sustained IOP reduction during both day and night.