PubMed · 14349439
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P A CHANDLER, R R TROTTER. 1955. Angle-closure glaucoma; subacute types.. https://doi.org/10.1001/archopht.1955.00930010307001
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AIM: To compare the effect on intraocular pressure (IOP) of large vs small scleral flap size during trabeculectomy using adjustable sutures. METHODS: Trabeculectomy operations were performed on nine donor human eyes connected to a constant flow infusion with real-time IOP monitoring. Large scleral flaps (4 x 4 mm, 16 mm(2), n=12) or small scleral flaps (3 x 2 mm, 6 mm(2), n=9) were constructed over 0.76 mm(2) sclerostomies. For each procedure, equilibrium IOP was measured following tight closure with two four-throw adjustable 10-0 nylon sutures. RESULTS: Five scleral flaps were thin or poorly constructed; four of these were in the initial seven procedures, implying learning effect. These had a mean absolute IOP of 7.6 mmHg (range 2.7-12.4 mmHg) and mean relative IOP of 28.3% of baseline (range 10-45.8%) after closure. In the remaining 16 good quality procedures, mean IOP was 1.3 mmHg (range 0-3.4 mmHg) after sclerostomy, confirming minimal outflow resistance before closure. Following flap closure mean IOP was 20 mmHg (SD 4.4, range 15.5-29.3 mmHg) for large (n=8), and 18.7 mmHg (SD 3.6, 15.9-25.8 mmHg) for small (n=8) flaps (unpaired t-test, P=0.26). Mean IOP (% baseline) was 71.6% (SD 8.4, range 60.6-86.6%) and 66% (SD=12.7, 46.8-86.6%) for large and small flap groups, respectively (unpaired t-test, P=0.2). CONCLUSIONS: Well-constructed scleral flaps of both sizes were able to support an average IOP at least two-thirds of baseline, and both had similar absolute IOP levels. Errors in flap construction resulted in loss of IOP control. Smaller flap size does not appear to compromise control of early postoperative IOP using adjustable sutures.
DNA damage is related to a variety of degenerative diseases such as cancer, atherosclerosis and neurodegenerative diseases, depending on the tissue affected. Increasing evidence indicates that reactive oxygen species (ROS) play a key role in the pathogenesis of primary open angle glaucoma (POAG), the main cause of irreversible blindness worldwide. Oxidative DNA damage is significantly increased in the ocular epithelium regulating aqueous humor outflow, i.e., the trabecular meshwork (TM), of glaucomatous patients compared to controls. The pathogenic role of ROS in glaucoma is supported by various experimental findings, including (a) resistance to aqueous humor outflow is increased by hydrogen peroxide by inducing TM degeneration; (b) TM possesses remarkable antioxidant activities, mainly related to superoxide dismutase-catalase and glutathione pathways that are altered in glaucoma patients; and (c) intraocular-pressure increase and severity of visual-field defects in glaucoma patients parallel the amount of oxidative DNA damage affecting TM. Vascular alterations, which are often associated with glaucoma, could contribute to the generation of oxidative damage. Oxidative stress, occurring not only in TM but also in retinal cells, appears to be involved in the neuronal cell death affecting the optic nerve in POAG. The highlighting of the pathogenic role of ROS in POAG has implications for the prevention of this disease as indicated by the growing number of studies using genetic analyses to identify susceptible individuals and of clinical trials testing the efficacy of antioxidant drugs for POAG management.
PURPOSE: To understand the impact of glaucoma on ability to function and on quality of life to guide therapeutic choices and strategies for improved adherence to therapeutic regimens and to suggest alterations to environments to help the patient to cope better with the effects of the disease. DESIGN: Review of the published literature on quality-of-life assessments of patients with glaucoma. METHODS: The published literature on quality-of-life impacts of glaucoma was reviewed with a focus on the design and evolution of quality-of-life instruments, correlations of responses with objective measures of disease progression, and insights that were gained from the analyses of results. RESULTS: Information about the impact of glaucoma has been derived from responses to general health-related questionnaires, vision-specific questionnaires, and questionnaires that were designed to be glaucoma specific. Responses to glaucoma-specific instruments tend to correlate best with visual field measurements and other objective measures of disease progression, which suggests that such responses reflect the effects of glaucoma rather than the effects of other health-related issues in this patient population. Recent advances in the design of glaucoma-specific instruments and in analysis of the responses to them have provided some interesting insights. For example, patients who have experienced significant (peripheral) visual field loss attach greater importance to their central vision than do patients with less-advanced disease, but these patients seem to have accepted or adapted to their difficulties with outdoor mobility. CONCLUSION: Continued improvements in the collection and analysis of quality-of-life data should assist health care providers with the effective delivery of therapies to patients with glaucoma.