Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 7 Articles
Background: To compare corneal hysteresis (CH) measurements between patients with glaucoma, ocular hypertension\n(OHT) and glaucoma-like optic discs (GLD)- defined as a cup to disc ratio greater than or equal to 0.6 with normal\nintraocular pressure (IOP) and visual fields. The secondary aim was to investigate whether corneal resistance factor (CRF)\nand central corneal thickness (CCT) differ between patient groups.\nMethods: In this cross sectional study a total of 123 patients (one eye each) were recruited from a glaucoma outpatient\ndepartment to undergo ocular response analyser (ORA) testing and ultrasound pachymetry as well as clinical\nexamination. A One-way Analysis of Covariance (ANCOVA) was conducted to evaluate the mean difference in CH\nbetween the three diagnostic groups (glaucoma, OHT and GLD) correcting for potential confounding factors, IOP\nand age. Analysis was repeated for CRF and CCT.\nResults: There was a significant difference in mean CH across the three diagnosis groups; F(2, 115) = 96.95;\np < 0.001. Mean CH significantly higher for GLD compared to glaucoma (mean difference 1.83, p < 0.001), and\nsignificantly higher for OHT compared to glaucoma (mean difference 2.35, p < 0.001). Mean CH was slightly\nlower in patients with GLD than those with OHT but this difference was not statistically significant. A similar\npattern was seen when the analysis was repeated for CRF and CCT.\nConclusions: Higher CH in GLD and OHT compared to glaucoma suggests increased viscoelasticity of ocular\ntissues may have a protective role against glaucoma....
Background: Oxidative stress contributes to both intraocular pressure regulation and glaucomatous neuropathy.\nThe systemic redox status (solitary determination) was examined in primary open-angle glaucoma (POAG) patients\nwith cataract and nonglaucomatous cataract patients. Cataract-matched group comparisons appear more precise in\nthe context of oxidative stress evaluation. The aim of this study was to establish if systemic oxidative status in\nPOAG patients was elevated compared with the cataract only subjects.\nMethods: The study included patients with primary open angle glaucoma (POAG group, n = 30) and controls (non\nPOAG group, n = 25). Serum concentration of lipofuscine (LPS), malondialdehyde (MDA) and activity of total\nsuperoxide dismutase (SOD), and its mitochondrial (Mn-SOD) and cystolic (Cu,Zn-SOD) isoform were measured.\nTotal oxidant state (TOS) and total antioxidant capacity (TAC) in blood were also evaluated.\nResults: Significant increase of LPS (p = 0.0002) and MDA (p = 0.005) concentration was observed in glaucomatous\npatients as compared with controls. Total SOD activity was significantly lowered in the glaucoma group (p = 0.003);\nserum level of Mn-SOD was significantly lower in glaucoma patients (p = 0.048) however, Cu,Zn-SOD was not.\nGlaucoma patients presented elevated mean TOS (p = 0.016). Both groups presented with comparable TAC.\nConclusion: Systemic redox balance of cataract patients was significantly altered in the course of glaucoma....
Objective. To evaluate the efficacy and tolerability of travoprost 0.004%/timolol 0.5% fixed-dose combination (TTFC) in patients\nwith open-angle glaucoma (OAG) or ocular hypertension (OHT) inadequately controlled on beta-blocker monotherapy. Methods.\nIn this phase IV, open-label study, 156 patients on beta-blocker monotherapy with mean intraocular pressure (IOP) between 18\nand 32mmHg were randomized (no washout period) to receive TTFC for 8 weeks (TTFC group) or to continue beta-blocker\nmonotherapy for 4 weeks followed by TTFC for the remaining 4 weeks (beta-blocker group). Results. The mean IOP (Ã?±standard\ndeviation) at baseline in the TTFC and beta-blocker groups was 22.5 Ã?± 2.5mmHg and 22.2 Ã?± 2.3mmHg, respectively, and at weeks\n4 and 8, was 16.7 Ã?± 3.1mmHg and 16.1 Ã?± 3.1mmHg, respectively, in TTFC group and 21.1 Ã?± 3.1mmHg and 16.1 Ã?± 2.8mmHg,\nrespectively, in the beta-blocker group. There was a significant least squares mean difference between TTFC and beta-blocker in 8\na.m. IOP at week 4 (âË?â??4.6mmHg; one-sided 95% confidence interval [âË?â??inf, âË?â??3.9]; ...
Purpose. To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients without retinopathy with\nprimary angle-closure glaucoma (PACG). Design. This is a retrospective case series comparison. Participants. This retrospective\ntrial compared outcomes of 88 eyes that underwent trabeculectomy in patients with diabetes mellitus (DM) without retinopathy\nand in 97 patients without DM. Methods. In this study, the intraocular pressure (IOP), visual acuity, visual field, and\npostoperative complications were compared between the two groups. Qualified surgical success is defined as an IOP between 6\nand 18mmHg with or without topical antiglaucoma medication. Results. After a follow-up of 5 years, the IOP decreased from\na mean basal IOP of 27 8 �± 7 3mmHg to 15 0 �± 5 6mmHg in the DM group and from 27 3 �± 6 0mmHg to 12 4 �± 5 3mmHg\nin the control group. The mean number of antiglaucoma medications was 3 4 �± 1 3 and 3 3 �± 1 2 preoperatively (P = 0 587)\nwhereas it was 1 7 �± 1 5 and 1 1 �± 1 4 at the 5-year follow-up (P = 0 049). The 5-year qualified surgical success rates were\n42.9% and 65.4% for both groups (P = 0 046; log-rank test). Encysted blebs were seen in 21 (23.9%) patients in the DM group\nand in 12 (12.4%) patients in the control group (P = 0 041). Conclusion. PACG patients with DM without retinopathy\nundergoing primary trabeculectomy with MMC may have a lower long-term surgical survival rate compared with patients\nwithout DM....
Background: To stratify the outcomes of phacoemulsification combined with trabectome surgery using a new\nglaucoma severity index.\nMethods: This is a retrospective, observational cohort study that included open angle glaucoma patients with\nvisually significant cataract that had phacoemulsification combined with trabectome surgery. Exclusion criteria were\nfollow-up less than 12 months, any other surgeries or diagnosis of neovascular or active uveitic glaucoma. Patients\nwere stratified into four groups according to the Glaucoma Index (GI) that incorporated preoperative intraocular\npressure (IOP), number of medications and visual field status. The primary outcome measures were IOP reduction\nand the success rate at 12 months. We examined the relationship between GI group and IOP and medications at\none year with a linear regression analysis and survival with log-rank testing.\nResults: Of 1374 patients, a total of 498 cases with 12 month follow-up were included in the study after applying\nthe exclusion criteria. At one year, IOP of GI groups 1 through 4 was reduced by 2.9 �± 4.4, 3.6 �± 5.0, 3.9 �± 5.3, and 9.\n2 �± 7.6 mmHg for. Individuals in the next higher GI group had a 1.69 �± 0.2 mmHg larger IOP decrease. The success\nrate was 98%, 93%, 96% and 88% at one year for GI groups 1 to 4 (p < 0.05).\nConclusions: A substantial IOP reduction was seen in subjects with more advanced glaucoma suggesting that the\ntrabecular meshwork is the primary impediment to outflow and its ablation benefits those eyes relatively more than\nin mild glaucoma. A larger IOP reduction can be expected in individuals with a higher GI group that indicates a\nclinically more challenging glaucoma....
Background: To evaluate the torsional and flattening effect of steep meridian incisions and influence of posterior\ncorneal astigmatism (PCA) on total corneal astigmatism (TCA) after cataract surgery.\nMethods: One hundred thirty-two eyes underwent cataract surgery with steep meridian 2.2 mm microcoaxial and\n2.85 mm conventional clear corneal incisions. Eyes were divided into with-the-rule (WTR) astigmatism and againstthe-\nrule (ATR) astigmatism groups depending on the steeper meridian and measured with autokeratorefractor and\nPentacam�® before surgery, at 1 day, 1 week, 1 and 2 months postoperatively. Polar vector analysis was used to\nevaluate torsional effect of steep meridian incisions.\nResults: A decrease in astigmatic polar value (AKP) (+0) was observed in both keratometric and total astigmatism\n(TA) after 1 and 2 months, although the decrease was only statistically significant in TA (p < 0.05). The AKP(+45) was\nmore significant in the conventional group than the microcoaxial group at 2 months postoperatively (p < 0.05,\nrespectively). There was a significant correlation between corneal thickness of the superior quadrant and PCA in the\nWTR group (p = 0.028). In eyes with anterior corneal astigmatism smaller than 0.55D of WTR astigmatism and PCA\ngreater than 0.35D of WTR astigmatism showed greater shifting of steep axis and also increment of refractive\ncylinder powers.\nConclusions: In eyes with superior corneal thickness greater than 714.5 �¼m and PCA greater than 0.35D of WTR\nastigmatism, steep meridian incision may cause a significant torsional effect and off-steep meridian change,\ncontributing to an increment of postoperative residual manifest astigmatism after cataract surgery....
Purpose. To evaluate gel microstent (XEN, Aquesys, Inc) for treatment of primary open angle glaucoma (POAG). Methods. In this\nprospective interventional study, 13 eyes with POAG underwent XEN implantation with subconjunctival mitomycin-C. Of those\neyes, 3 were pseudophakic and 10 underwent simultaneous phacoemulsification and XEN. Patients had uncontrolled IOP, had\nintolerance to therapy, or had maximal therapy but undergoing cataract extraction. Follow-up visits included IOP, number of\nmedications, vision, and complications and lasted for 1 year. Complete success was defined as IOP reduction â�¥20% from\npreoperative baseline at 1 year without any glaucoma medications while partial success as IOP reduction of â�¥20% at 1 year with\nmedications. Results. IOP dropped from 16 �± 4mmHg pre-op to 9 �± 5, 11 �± 6, 12 �± 5, 12 �± 4, and 12 �± 3mmHg at 1 week, 1, 3, 6,\nand 12 months (p = 0 004, 0.026, 0.034, 0.01, and 0.01, Wilcoxon Signed Ranks) consecutively. BCVA (LogMAR) was 0.33 �± 0.34\nand improved to 0.13 �± 0.11 at 1 year. Mean number of medications dropped from 1.9 �± 1 preoperatively to 0.3 �± 0.49 (p = 0 003)\nat 1 year. 42% of eyes achieved complete success and 66% qualified success. Complications included choroidal detachment\nin 2 eyes, and implant extrusion in 1 eye, and 2 eyes underwent trabeculectomy. Conclusion. XEN implant is an effective surgical\ntreatment for POAG, with significant reduction in IOP and glaucoma medications at 1 year follow-up....
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