Comparison of combined phacotrabeculectomy with trabeculectomy only in the treatment of primary angle-closure glaucoma.

BACKGROUND: Trabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract. METHODS: This is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication. RESULTS: After 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group. CONCLUSION: Phacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

[Gene screening as the forewarning measure to predict glaucoma].

OBJECTIVE: To investigate the effect of gene screening on forewarning and monitoring of familial open-angle glaucoma pedigree. METHODS: Comprehensive ophthalmic examinations were performed in all available family members. The genomic DNA was extracted from peripheral blood. The myocilin gene was amplified and screened for mutations using direct sequencing. All family members were followed up. RESULTS: Among 12 family members, 5 individuals carry a C to T transition in exon 3 resulting in the substitution of proline to leucine (Pro370Leu), and the other 7 individuals did not carry this mutation. Ophthalmic examinations did not show any abnormality in the optic disc, the thickness of RNFL, and visual field parameters in mutation-carriers. During the follow-up, all carriers were diagnosed as open-angle glaucoma. The mean time of presentation of the defect of visual field was 21.6 months and 14.4 months after the changes in RNFL thickness. CONCLUSION: Genetic diagnosis was proven to be a method with high specificity and sensitivity; and can be used for presymptom diagnosis and forewarning in familial open-angle glaucoma pedigree.

[Clinical observation of trabeculectomy for primary angle closure glaucoma].

OBJECTIVE: To evaluate the effect of trabeculectomy on intraocular pressure (IOP) and complications in eyes with primary angle closure glaucoma (PACG). METHODS: It was retrospective clinical study. PACG was classified as acute primary angle closure glaucoma (APACG) group and chronic primary angle closure glaucoma (CPACG) group. APACG was then divided into acute attack phase and chronic phase, and CPACG was divided into chronic phase and late phase. IOP, best corrected visual acuity were compared before and after trabeculectomy in different subgroup of PACG. In addition, the incidence of complications of trabeculectomy was assessed. Statistical analyses were performed using SPSS 12.0 statistics software. Categorical variables such as best corrected visual acuity were compared using nonparametric test, continuous variables such as age and IOP were compared between the two groups using independent two-sample t-tests. Pre- and postoperative IOP were compared using one-way analysis of variance of repeated measures. RESULTS: 40 eyes (37 cases) of APACG and 56 eyes (45 cases) of CPACG were enrolled in this study. The median follow-up period was 24 and 25 months, respectively. IOP was significantly decreased from (53.6 +/- 17.9) mm Hg (1 mm Hg = 0.133 kPa, preoperation) to (10.5 +/- 4.9) mm Hg (postoperation) at time of discharging from hospital and (14.0 +/- 10.3) mm Hg at time of final follow up in APACG (F = 100.783, P < 0.01), respectively, and from (36.8 +/- 13.8) mm Hg to (11.7 +/- 4.2) mm Hg at time of discharging from hospital and (13.8 +/- 4.5) mm Hg at time of final follow up in CPACG (F = 54.383, P < 0.01), respectively. The IOP remained controlled (< or = 21 mm Hg) without antiglaucomatous medication in 38 eyes (95.0%) of APACG and in 50 eyes (89.3%) of CPACG. Visual acuity was significantly (H = 12.316, P < 0.01) decreased after trabeculectomy in all sub-types of PACG by Kruskal-wallis analysis. Shallow anterior chamber was commonly occurred after trabeculectomy. CONCLUSIONS: Trabeculectomy is an effective method to control IOP in APACG and CPACG. However, the high proportion of impaired vision was found following trabeculectomy in this study and warranted further clinical investigation.

[The measurement of central corneal thickness of normal subjects and glaucomatous patients with optical coherence tomography].

OBJECTIVE: To evaluate central corneal thickness (CCT) of normal subjects, patients with primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and ocular hypertension (OHT) using optical coherence tomography (OCT). METHODS: One hundred and forty-three eyes of 143 normal subjects, 36 eyes of 36 patients with POAG, 39 eyes of 39 patients with NTG and 40 eyes of 40 patients with OHT were enrolled. CCT were measured by OCT3 and analyzed using ANOVA. The relationship of CCT and intraocular pressure (IOP) measured by Goldmann applanation tonometry were analyzed by linear regression. The inter-observer and intra-observer agreement of CCT measurement by OCT were analyzed by interclass correlation coefficient (ICC). RESULTS: The average CCT of normal subjects, patients with POAG, NTG and OHT were (525.31 +/- 32.18) microm, (531.87 +/- 31.58) microm, (507.61 +/- 21.56) microm and (574.09 +/- 27.84) microm, respectively. There was no significant difference between normal subjects and patients with POAG (P = 0.099). The average CCT of OHT patients was larger than those of other groups (P < 0.001). The average CCT of patients with NTG was less than those of other groups (P < 0.001). There was positive relationship between CCT and IOP in normal subjects (r = 0.318, R2 = 0.101, P < 0.001). The ICC of inter-observer and intra-observer agreement of CCT measurement by OCT were 0.995 and 0.996 respectively. CONCLUSIONS: Central corneal thickness could be measured by OCT accurately. The average CCT in the patients with NTG was thinner, but the average CCT in the patients with OHT was thicker than that of normal subjects. CCT could affect IOP measurement in the application of Goldmann applanation tonometry but with little significant.

[The action of dexamethasone on trans epithelial electrical resistance and the expression of aquaporin-1 in immortalized trabecular cells].

OBJECTIVE: To study the effect of dexamethasone on trans epithelial electrical resistance (TEER) and the expression of AQP-1 in immortalized trabecular cells. METHODS: Immortalized human trabecular cells were cultured on PET membrane in 24 wells plate. The cells were treated with Dexamethasone in concentration of 10(-7) mol/L. After the cultured cell became confluence, TEER of the cells was detected to evaluate the resistance of outflow pathway at different time points. Western blot was used to analyze the expression of AQP-1 in the trabecular cells. RESULTS: The TEER and the expression of AQP-1 were much higher in the cells treated by Dexamethasone in comparison to control without dexamethasone exposure. CONCLUSIONS: The TEER and expression of AQP-1 in immortalized trabecular cells can be enhanced by Dexamethasone. AQP-1 upregulation induced by Glucocorticoid may relate with the increased resistance of outflow pathway in glaucoma.

[A preliminary study on gene mutation and its function in a large family (GZ.1 pedigree) with open-angle glaucoma].

OBJECTIVE: To determine the causative mutation of myocilin gene and to investigate its pathogenic function in a large Chinese pedigree (GZ.1) with familial open-angle glaucoma. METHODS: Genome-wide scanning was performed and the Lod scores were calculated. Candidate gene was amplified and screened for mutations using direct sequencing. To elucidate its expression, distribution and cytotoxicity of mutant myocilin, human trabecular cells (HTM) cells were transfected with pcDNA-wild-type and mutant myocilin vectors using liposomes. RESULTS: Mutation analysis of the myocilin gene showed a C-to-T transition at the 1, 109 th nucleotide in exon 3 resulting in a change of amino acid from proline to leucine (Pro370Leu). This mutation cosegregated with all affected individuals (16/16) and never presented in unaffected individuals (0/8). In transfected HTM cells, the mutant myocilin protein was not correctly processed in ER and accumulated as aggresome-like structures in the cytoplasma instead of being secreted. In addition, the expression of mutant protein also led to apoptosis of trabecular cells and the occurrence of. CONCLUSION: The mutation of Pro370Leu in myocilin gene could cause the accumulation of misfolding myocilin protein in HTM cells, which might lead to glaucoma in GZ.1 pedigree.

[Analysis of topograph and relevant factors of optic nerve head in normal subjects].

OBJECTIVE: To study the optic nerve head (ONH) parameters and topograph features of normal subjects, and analyze the effect of gender, laterality, age and disc size on the topograph of ONH. METHODS: Heidelberg Retina Tomograph (HRT) was used to obtain the optic nerve head parameters and topograph images in 216 eyes of 116 normal volunteers. The impact of gender, laterality, age and disc size on the topograph was analyzed. The optic disc was divided into three groups by their size, small (less than 1.5 mm2), middle and large disc (equal or larger than 2.5 mm2), to evaluate the differences of parameters. RESULTS: The parameters of ONH in normal eyes were as following: disc area (DA) (2.208 +/- 0.411) mm, cup area (CA) (0.466 +/- 0.355) mm2, cup/disk area ratio (C/DAR) (0.217 +/- 0.137), rim area (RA) (1.563 +/- 0.339) mm2, height variation contour (HVC) (0.404 +/- 0.096) mm, cup volume (CV) 0.127 mm3, rim volume (RV) (0.446 +/- 0.173) mm3, mean cup depth (MCD) (0.196 +/- 0.096) mm, maximum cup depth (MxCD) (0.559 +/- 0.228) mm, cup shape measure (CSM) (-0.213 +/- 0.076), mean retinal nerve fiber layer thickness (mRNFLT) (0.272 +/- 0.076) mm, and retinal nerve fiber layer cross section area (RNFLA) (1.364 +/- 0.375) mm2. There were significant differences between right and left eyes in C/DAR, RA and RV, but no difference between different genders in all parameters. A negative correlation was found between mRNFLT, RNFLA and age. There were significant differences in most parameters among three groups with different disc size, such as CA, C/DAR, CV, RA and CSM, but not in mRNFLT, RNFLA and RV. CONCLUSIONS: Significant variations were found in parameters of ONH in normal subjects. Some parameters of ONH were affected by age and optic disc size. There were differences in some parameters between right and left eyes, but not between different genders. There were differences of parameters between different quadrants of ONH.

[The diagnostic ability of Heidelberg retina tomography to detect glaucomatous optic neuropathy in Chinese].

OBJECTIVE: To evaluate the ability of Heidelberg retina tomography (HRT) in the diagnosis of primary open angle glaucoma (POAG). METHODS: The topography of optic nerve head of 116 normal eyes and 99 eyes with POAG were examined using HRT. The differences of the optic disc parameters between two groups were compared. The topographic parameters of the optic nerve head were undergone stepwised discriminant analysis and the discriminant function was established. The sensitive diagnostic parameters of POAG were screened. RESULTS: The topographic parameters of optic nerve head, including disc area (DA), cup area (CA), cup/disc area ratio (C/DAR), rim area (RA), height variation contour (HVC), cup volume (CV), rim volume (RV), mean cup depth (MCD), maximum cup depth (MxCD), cup shape measure (CSM), mean retinal nerve fiber layer thickness (mRNFLT), retinal nerve fiber layer cross section area (RNFLA), showed significant (P < 0.001) difference between normal subjects and patients with POAG. The sensitive diagnostic parameters of POAG were C/DAR, RA, CSM, CV, MCD. The discriminant function was Y = -2.083-4.833 x C/DAR-20.379 x CSM + 2.035 x RA + 3.955 x CV-3.701 x MxCD. The sensitivity, specificity and diagnostic accuracy were 81.8%, 86.2% and 84.2%, respectively, which were comparable to the automatic analysis program of HRT. CONCLUSIONS: The topographic parameters of optic nerve head in patients with POAG showed significant differences from that in normal people. The power of discriminant function established based on our data was comparable to the HRT automatic analysis program. Our results indicate that HRT automatic analysis program is applicable to Chinese.

[Study of agreement of optic nerve head topography parameters].

OBJECTIVE: To evaluate the interobserver and intraobserver agreement of parameters of optic nerve head by Heidelberg Retina Tomograph (HRT). METHODS: Optic nerve heads from 50 eyes (30 subjects) were imaged with the HRT. Three ophthalmologists majoring in glaucoma traced the disc margin with a contour line. One of these observers, repeatedly traced the disc margin with contour line in triplicate at three different times. Eleven topographic parameters of optic nerve head (including disc area, cup area, cup/disc area ratio, rim area, cup volume, rim volume, mean cup depth, maximum cup depth, cup shape measure, mean retinal nerve fiber layer thickness, sectional area of retinal nerve fiber layer) were analyzed with HRT software (version 2.01). Intraclass coefficients (ICC) and agreement of result estimation (kappa value) were calculated. RESULTS: The ICCs results among three observers on 12 parameters of optic nerve head topography were 0.976 - 0.999, which showed almost perfect agreement; and the kappa value were 0.649 approximately 0.767, which showed substantial agreement. The ICC of the same observer in different times were 0.983 approximately 0.999, which showed almost perfect agreement; and the Kappa values were 0.810 approximately 0.951, which showed substantial agreement. CONCLUSIONS: Tracing the optic nerve head with contour line on HRT image is substantial to almost perfect within both interobserver and intraobserver in experienced ophthalmologist. This procedure is suitable for clinical diagnosis and follow-up observation of glaucoma.