Probability of global indices in low tension glaucoma

To know the pattern of visual field (VF) defect of low tension glaucoma (LTG), its diffuse and localized VF defects were compared using the significance values (p-value) of mean deviation (MD) and corrected pattern standard deviation (CPSD), which are calculated with STATPAC in Humphrey Visual Field Analyser. Sixteen eyes of LTG were enrolled and 34 eyes of primary open angle glaucoma (POAG) were used as controls. The degree of VF defects in LTG and POAG was relatively mild with the p-value of MD equal to or greater than 1%. Neither mean MD nor mean CPSD of LTG was significantly different from each of POAG (p > 0.8 and p > 0.2, respectively). Comparing the p-values of MD and CPSD, many patients showed more significant p-value of MD in LTG and POAG (62.5% and 61.8%, respectively). However, relatively more severe defect of CPSD tended to occur more frequently in LTG than in POAG (25% and 5.9%, respectively, chi-square = 4.964, p < 0.09). The relation between p-values of MD and CPSD was not significantly influenced by the intraocular pressure, MD or vertical cup to disc ratio in either LTG or POAG.

Effects of Topical Mitomycin C on Glaucoma Filtration Surgery

We studied the efficacy and safety of using topical mitomycin C(MMC) as an adjunct to glaucoma filtration surgery. Trabeculectomy was performed in 23 eyes of 19 patients with poor surgical prognosis. After the preparation of a scleral flap. 0.2mg or 0.4 mg/ml MMC was applied to the exposed tissue for 5 minutes. The wound was then irrigated with 250ml of normal saline. The follow-up period was from 2 to 12 months(mean 7.8 +/- 4.3 months). Preoperative mean intraocular pressure(IOP) was 33.8 +/- 7.1 mmHg, ranged from 25 to 51 mmHg. The mean IOPs after 1, 3, 6 and 12 months were 10.3 +/- 4.4, 12.5 +/- 6.9, 12.4 +/- 6.6 and 12.3 +/- 6.7 mmHg, respectively. Nineteen(82.6%) among 23 eyes were successfully controlled with the IOP below 20 mmHg without any antiglaucomatous therapies, and success rate was 0.747 by Kaplan-Meier method at Postoperative 12 months. There were early postoperative complications of aqueous leaking from conjunctival wound in 3 eyes(13.0%), shallow anterior chamber in 2 eyes, and hyphema in one eye and one eye had long-term hypotony lasting more than 3 months. Although MMC is simple to use and a potent adjunct to glaucoma filtration surgery, more work will be needed to determine the mechanism of action, indications, dosage and optimal exposure time of MMC.

Effects of topical mitomycin C on glaucoma filtration surgery

We studied the efficacy and safety of using topical mitomycin C (MMC) as an adjunct to glaucoma filtration surgery. Trabeculectomy was performed in 23 eyes of 19 patients with poor surgical prognosis. After the preparation of a scleral flap, 0.2 mg or 0.4 mg/ml MMC was applied to the exposed tissue for 5 minutes. The wound was then irrigated with 250ml of normal saline. The mean follow-up period was 7.8 months. Preoperative mean intraocular pressure (IOP) was 33.8mmHg, and the mean IOPs on 1, 3, 6, and 12 months after operation were 10.3, 12.5, 12.4 and 12.3mmHg, respectively. At postoperative 12 months, 74.7% achieved an IOP of less than or equal to 20mmHg without any antiglaucoma medication. There were early postoperative complications of aqueous leaking from conjunctival wounds in 3 eyes (13.0%), shallow anterior chamber in 2 eyes, and hyphema in one eye and one eye had long-term hypotony lasting more than 3 months. Although MMC is simple to use, it is a potent adjunct to glaucoma filtration surgery, more work should follow to determine the mechanism of action, indications, dosage and optimal exposure time of MMC.

Effect of apraclonidine hydrochloride on the attack of Posner-Schlossman syndrome

The intraocular pressure (IOP) of glaucomatocyclitic crisis with the attack fell 50.3%, from 37.8 +/- 8.2 mmHg to 18.8 +/- 4.8 mmHg, 4 hours after instillation of 1% apraclonidine. Glaucomatocyclitic crisis showed a more significant hypotensive response to 1% apraclonidine than primary open-angle glaucoma (24.8%, from 43. 1 +/- 8.1 mmHg to 32.4 +/- 7.5 mmHg after 4 hours). The intraocular pressure decrease percentage was similar regardless of the initial level of intraocular pressure. Clinically significant changes in mean systolic and diastolic blood pressures, were not observed, however, a mild decrease in the pulse rate was noted. And the local mydriatic effect on the pupillary diameter was significant. Apraclonidine, 1% might be newly indicated to control the IOP rise of glaucomatocyclitic crisis. Further studies on the possible mechanism of the prostaglandin mediated hypotensive effect of 1% apraclonidine are suggested.

Detection of Glaucomatous Visual Field Defect by Screening Program of Humphrey Field Analyzer

We have experienced automated and computerized perimetry using a Humphrey Field Analyzer in our Glaucoma Services. To evaluate its clinical efficacy, we report the results of the Armaly central field screening test in comparison with those of central 30-2 threshold test of the Humphrey Field Analyzer. One hundred fortythree eyes of 83 cases of normotensives, ocular hypertensives and glaucoma patients with open-angle or narrow-angle were enrolled in this study. Fiftyfour out of 61 patients (88.5%) and 73 out of 81 eyes (90.1 %) with visual field defect were detected by the screening test of the Humphrey Field Analyzer. Eight out of 81 eyes (9.9%) with visual field defect detected by the screening test were confirmed as false positive. All points of false positive were solitary, which tended to occur more frequently on superior vusual field. False negative of 8 eyes (12.9%) detected by the screening test were confirmed by the threshold test. The point of false negative was more frequent on superior field and showed to locate more peripherally from the fixation point. There was no significant difference in either central sensitivity or age of the false ring.

Effect of Apraclonidine Hydrochloride on the Acute Intraocular Pressure Rise after Argon laser Iridotomy

To determine the effect of apraclonidine hydrochloride on the acute intraocular pressure (IOP) rise after argon laser iridotomy (ALl), a double-masked comparative study was carried out. Twenty-nine eyes (20 patients) with angle-closure glaucoma underwent ALL Eighteen eyes were treated with apraclonidine and the remainder received placebo 1 hour before and immediately after ALl. The mean IOP increase in the apraclonidine group was lower than that in placebo group at each postlaser intervals (p<0.01). Although average value of maximal increases of IOP after ALl in apraclonidine group was 4 mmHg, that in placebo group was 16mmHg. 27.3% (3 out of 11 eyes) in placebo group experienced IOP rise greater than or equal to 10 mmHg, however, that kind of IOP rise was not found in apraclonidine group (0 out of 18 eyes) (p

Effect of apraclonidine hydrochloride on acute introacular pressure rise after argon laser iridotomy

To determine the effect of apraclonidine hydrochloride on the acute intraocular pressure (IOP) rise after argon laser iridotomy (ALI), a double-masked comparative study was carried out. Twenty-nine eyes (20 patients) with angle-closure glaucoma underwent ALI. Eighteen eyes were treated with apraclonidine, and the remainder received a placebo 1 hour before and immediately after ALI. The mean IOP increase in the apraclonidine group was lower than that in the placebo group at each postlaser interval (p or = 10 mmHg. However, that kind of IOP rise was not found in the apraclonidine group (0 out of 18 eyes) (p < 0.01). Ocular or systemic side effects were not found in a series of examinations in both groups. Therefore, apraclonidine proved to be effective in lowering the IOP rise after ALI.

Clinical Efficacy of Laser Flare-Cell Meter

Aqueous flare, the scattering of light by the Tyndall phenomenon, have been applied for the assessment of aqueous protein by the ophthalmologists. Since the intensity of flare ultimately reflects the severity of ocular inflammation. Laser flare-cell meter was developed to determine protein concentration and number of cells in the aqueous with non-invasive technique. The principle of evaluation was similar to that of slit-lamp examination in the viewpoint of scattering of light. The significant linear correlation was observed between the values of concentration for protein and photon counts, in the range from 5mg/100ml to 2,500ml/100ml in boine serum albumin (BSA) and from 5mg/100ml to 1,000mg/100ml in human gamma globulin (HGG), the valuses of HGG was three times higher than those of BSA in the same concentration. In experiments for WBC, RBC and latex particles with diameter of 2.95 micrometer, although somewhat differences was observed according to the sort of cells, significant linear correlation was shown between the number of detected peaks and that of cells.

Detection of glaucomatous visual field defect using a screening program of Humphrey Field Analyzer

To evaluate its clinical efficacy, we report the results of Armaly central field screening test in comparison with those of central 30-2 threshold test of Humphrey Field Analyzer. In 83 cases of normotensives, ocular hypertensives, and glaucoma patients with open-angle or narrow-angle enrolled in this study, a total of 143 eyes were examined. Fifty-four out of 61 patients (88.5%) and 73 out of 81 eyes (90.1%) with visual field defects were detected by the Humphrey Field Analyzer screening test. Eight eyes out of 81(9.9%) with visual field defects detected by the screening test were confirmed as false positive. All points of false positive were solitary, which tended to occur more frequently on superior visual field. A false negative of eight eyes out of 62 (12.9%) detected by the screening test was confirmed by the threshold test, which was more frequent on superior field and shown to be located more peripherally from the fixation point. There was no significant difference in either central sensitivity or age of the false positive and negative.

Quantitative Relation between the Glaucomatous Visual Field Defect and Optic Disc Cupping

To evaluate the quantitative relation between the changes of visual field and optic disc in glaucoma, thirty-six patients(58 eyes) with primary glaucoma(P.O.A.G: 29 cases, P.A.C.G.; 7 cases) were enrolled in this study. Visual field defects including the central(25 degrees) and peripheral fields were examined with three different illuminations(2-9, 2-4 and clear filters) by using an automated perimeter(Autofield D, Cavitron, CA, USA) and horizontal and vertical cup/disc(C/D) ratios were traced and calculated with the disc photographs taken with a fundus camera(CF-60Z, Canon Inc, Tokyo, Japan). Each defect by using 2.9, 2.4 and clear filter of Autofield D in either the central or the peripheral visual field has the relationship of arc tangent with either the horizontal or the vertical C/D ratio. The exponential correlation was noted between the summation of the central or the peripheral visual field defect and either horizontal or vertical C/D ratio.

Clinical experience of exfoliation syndrome

Six patients with exfoliation syndrome were seen in our glaucoma clinic. Four patients presented unilateral ocular involvement and the other 2 patients were bilaterally involved. Eight eyes had exfoliation material on the anterior surface of the lens and pupillary border, and 7 eyes exhibited it on the anterior chamber angle. Sampaolesi`s line was detected in 4 eyes. Five patients (6 eyes) of 6 patients (8 eyes) with exfoliation exhbited an elevated intraocular pressure (IOP) exceeding 21 mmHg. Among them, 3 patients (3 eyes) had an extremely high maximum IOP over 47 mmHg, and 2 patients (3 eyes) had a slightly elevated IOP less than 26 mmHg during the follow-up period. Argon laser trabeculoplasty (ALT) was performed twice on each unilateral eye of the 2 patients on whom the inital trabeculectomy failed. However, longterm IOP control after laser treatment was not obtained in either case, which might be due to the extremely high prelaser lOP level, in exoess of 40 mmHg.

Clinical Effects of Topical Betaxolol Hydrochloride(Betoptic(R)) in Glaucoma Patients

To evaluate the clinical usefulness of a newly developed beta-one selective blocker. Betaxolol hydrochloride(Betoptice(R)), seven patients(14 eyes) with primary open-angle glaucoma who were instilled twice a day with a drop of 0.5% Betoptic were enrolled in this study. Intraocular pressure(IOP), systolic and diastolic blood pressure, pulse rate and pupil size were measured with the evaluation on the local adverse reaction before and after the Betoptic treatment of 1, 2, 4, 8 and 12 weeks. The following results were obtained: 1. Significant reduction of IOP was noted at all intervals examined after the treatment of 0.5% Betoptic and it had the additive effect on pilocarpine. 2. The systemic side reaction of Betoptic on either pulse rate or blood pressure was not significant and pupil size was not changed by Betoptic. 3. The local transient and mild stinging sensation with tearing was followed after the instillation of 0.5% Betoptic eye solution.

Clinical study of Korean glaucomatous patients

In order to determine the distribution of each type of glaucoma in Korea, a retrospective clinical study was carried out on 206 glaucomatoils patients (295 eyes) who were followed from July 1982 to December 1985 in theClaucoma Clinic of the Department of Ophthalmology of Hanyang University Hospital. The distribution of glaucomatous patients was as follows; 34.0% primary open-angle glaucoma (POAG),32.5% secondary glaucoma,20.9% primary angle-closure glaucoma (PACG),7.3% ocular hypertension,3.9% congenital glaucoma, and 1.5% low tension glaucoma. In serondary glaucoma, glaucoma associated with uveitis occurred most frequently, and aphakic glaucoma, neovascular glaucoma, steroid-induced glaucoma, pigmentary glaucoma and exfoliative glauroma followed. The acute stage of PACG presented the highest initial IOP, 55.2+/-8.4mmHg, where as the initial IOP of POAG patients was 33.4+/-15.5 mmHg. Sixty-two per percent of POAG and 98% of PACG patients were over 40 years of age, and the mean age of the POAG and PACG patients was 43.1+/-16.3 and 61.6+/-9.5 years, respectively. There was no remarkable sex-difference associated with glaucoma, in PACG which showed an incidence of 79.1% in females. There was no significant difference in laterality between the right and left eyes with either glaucoma or ocular hypertension. Bilateral involvement of POAG and PACG during the follow-up period was 7l.4% and 32.6%, respectively.

Exfoliation Syndrome: Clinical analysis of 6 cases

The first comprehensive clinical description of exfoliation syndrome was published by Vogt. The appearance is described as a deposition of white granular fluffy material on the anterior lens surface, pupil margin, zonule, ciliary body and anterior chamber angle, and floating free in the aqueous. At past, this syndrome was thought to be rare outside of the Scandinavian countries, but the relatively high prevalence has been noted in many other countries outside of Scandinavia. The clinical significance of this syndrome is high frequency of glaucoma. Six cases in this report illustrate some of typical clinical features of exfoliation syndrome. The purpose of this study is to concentrate our attention upon the presence of this syndrome in Korea.