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PubMed1977

Clinical comparison of pilocarpine preparations in heavily pigmented eyes: an evaluation of the influence of polymer vehicles on corneal penetration, drug availability, and duration of hypotensive activity.

Heavily pigmented eyes have been shown to be relatively resistant to pilocarpine, and present special problems in management of open-angle glaucoma. Studies have suggested that the hypotensive effect of pilocarpine may be influenced by the vehicle; therefore, 13 relatively resistant black patients (26 eyes) were selected for a clinical comparison of pilocarpine as delivered in two different polymer vehicles. One vehicle was composed of 1.67% polyvinylpyrrolidone and BP water-soluble polymers (Adsorbobase); the other of hydroxypropyl methylcellulose 0.5%. All patients had been under treatment with the pilocarpine/methylcellulose preparation; 20 of the 26 eyes were judged to be uncontrolled (IOP above 21 mm Hg). Control of intraocular pressure was promptly obtained with the pilocarpine/Adsorbobase solution, and maintained at lower pilocarpine concentrations than with the previous therapy. Often, frequency of instillation could be decreased. This clinical comparison suggests that the Adsorbobase vehicle appreciably enhances corneal penetration and availability of pilocarpine. Three cases are discussed demonstrating the need for titration when instituting a new therapy with as little as one fourth the concentration of the previous pilocarpine therapy.

Aged↗
PubMed1977

Clinical manifestations of inherited glaucoma in the beagle.

Inherited glaucoma was exhibited in 55 beagles. The glaucomatous process was divided into early (6 to 12 months of age), moderate (13 to 30 months of age), and advanced (31 months of age). In early glaucoma the tridocorneal angles, as judged by gonioscopy, were open and without anomalies, intraocular pressure was elevated, and the tonographic facility of aqueous outflow was decreased. With moderate glaucoma, the tridocorneal angles were typically open; intraocular pressure was elevated, facility of aqueous outflow was decreased; and variable optic disc cupping and focal disinsertion of the zonules from the lens were seen. Advanced glaucoma exhibited narrow to closed tridocorneal angles, decreased facility of aqueous outflow, elevated intraocular pressure, lens dislocation, optic disc atrophy, and finally phthisis bulbi. The beagle in the early and moderate stages of glaucoma, before angle closure and lens dislocation, is an animal model for studies in open-angle glaucoma.

Animals↗
PubMed1976

Results of the carotid and the differential jugular compression tests in normal and glaucomatous patients.

A carotid compression tonographic test was performed in 53 normal persons and 40 patients with primary open-angle glaucoma. Fifty normal and 58 glaucomatous patients were investigated by a differential jugular compression test. In the glaucomatous eyes as compared to the normal eyes the volume changes in the eyeball were found to be significantly greater during compression of the common carotid artery and significantly less under the influence of the jugular compression test.

Adolescent↗
PubMed2023

The Use of ChatGPT to Assist in Diagnosing Glaucoma Based on Clinical Case Reports.

INTRODUCTION: The purpose of this study was to evaluate the capabilities of large language models such as Chat Generative Pretrained Transformer (ChatGPT) to diagnose glaucoma based on specific clinical case descriptions with comparison to the performance of senior ophthalmology resident trainees. METHODS: We selected 11 cases with primary and secondary glaucoma from a publicly accessible online database of case reports. A total of four cases had primary glaucoma including open-angle, juvenile, normal-tension, and angle-closure glaucoma, while seven cases had secondary glaucoma including pseudo-exfoliation, pigment dispersion glaucoma, glaucomatocyclitic crisis, aphakic, neovascular, aqueous misdirection, and inflammatory glaucoma. We input the text of each case detail into ChatGPT and asked for provisional and differential diagnoses. We then presented the details of 11 cases to three senior ophthalmology residents and recorded their provisional and differential diagnoses. We finally evaluated the responses based on the correct diagnoses and evaluated agreements. RESULTS: The provisional diagnosis based on ChatGPT was correct in eight out of 11 (72.7%) cases and three ophthalmology residents were correct in six (54.5%), eight (72.7%), and eight (72.7%) cases, respectively. The agreement between ChatGPT and the first, second, and third ophthalmology residents were 9, 7, and 7, respectively. CONCLUSIONS: The accuracy of ChatGPT in diagnosing patients with primary and secondary glaucoma, using specific case examples, was similar or better than senior ophthalmology residents. With further development, ChatGPT may have the potential to be used in clinical care settings, such as primary care offices, for triaging and in eye care clinical practices to provide objective and quick diagnoses of patients with glaucoma.

Artificial intelligence (AI)↗
PubMed1979

Clinical experiences with the use of an automated perimeter (Octopus) in the diagnosis and management of patients with glaucoma and neurologic diseases.

This is a study of 59 patients, 42 with glaucoma and 17 with neurological disease, to compare the Octopus automated perimeter with the conventional Goldmann and Tubinger perimeters for detection and assessment of visual field defects. We believe the Octopus automated perimeter is an excellent method for screening patients suspected of glaucoma and can be expected to identify over 90% of the patients actually having visual field loss due to glaucoma. In patients with neurological disease, the Goldmann perimeter was superior to either the Octopus or Tubinger perimeters in providing clinically useful information.

Adolescent↗
PubMed1992

Sezolamide: additivity to timolol twice daily.

Sezolamide, a potent topical carbonic anhydrase inhibitor previously known as MK-417, was studied to determine its ocular hypotensive activity in patients with elevated intraocular pressure while on continuing therapy with topical timolol. This was a three-centre, double-masked, randomised, placebo-controlled, parallel study in 36 patients with bilateral primary open angle glaucoma or ocular hypertension on therapy receiving 0.5% timolol twice daily, with a morning intraocular pressure greater than or equal to 22 mmHg in both eyes 2-4 hours following an 8 a.m. dose of timolol. Sezolamide 1.8% or placebo twice daily was added to treatment with timolol on the evening of day 1 and continued for 2 weeks. Twelve-hour diurnal curves were performed before the study on day 1 (timolol alone) and on day 15. Intraocular pressure measurements were also taken on days 2 and 8 at 8 a.m. and 9 a.m. Patients who received timolol and sezolamide showed additional intraocular pressure reductions from day 1 (timolol alone) of 8.0 to 15.5%, which were significant at all times. At hours 1, 2, 4 and 8 the reductions in intraocular pressure observed in the group receiving sezolamide and timolol were significantly greater than those in the group receiving timolol and placebo.

Aged↗
PubMed1992

A prospective study examining the changes in factors that affect visual acuity following trabeculectomy.

Many patients report subjective changes in vision following trabeculectomy. In a prospective study of 16 eyes, we have tried to determine the causes of these visual changes. Ninety-four per cent of eyes showed a change in uncorrected Snellen acuity 1 week following surgery. This change was due to a myopic shift in refraction secondary to changes in the anterior chamber depth. A 1 mm change in anterior chamber depth results in approximately a 2 dioptre change in refractive sphere. Visual acuity starts to return to pre-operative levels by the third post-operative week, from which point no eyes showed a deterioration in corrected acuity of more than one line of Snellen. The vertical corneal radius of curvature is reduced in the early post-operative period and there is a with-the-rule change in corneal astigmatism. This resolves over longer follow-up and the possible causes of this are discussed. No changes were noted in corneal thickness and there was no evidence of macular oedema over the follow-up period. Patients should be warned of these possible visual changes pre-operatively as many will have normal acuity prior to surgery.

Aged↗
PubMed2025

Investigating the miRNA-mRNA interactome of human trabecular meshwork cells treated with TGF-β1 provides insights into the pathogenesis of pseudoexfoliation glaucoma.

Pseudoexfoliation glaucoma is a severe form of secondary open angle glaucoma and is associated with activation of the TGF-β pathway by TGF-β1. MicroRNAs (miRNAs) are small non-coding RNA species that are involved in regulation of mRNA expression and translation. To investigate what glaucomatous changes occur in the trabecular meshwork and how these changes may be regulated by miRNAs, we performed a bioinformatics analysis resulting in a miRNA-mRNA interactome. Primary human trabecular meshwork cells originating from normal donors were treated with TGF-β1 at 5 ng/mL for 24h; total RNA was extracted followed by RNA-Seq and miRNA-Seq. For both mRNA and miRNA species, differential expression was determined using a bioinformatics pipeline consisting of FastQC, STAR, FeatureCounts, edgeR (for miRNA) and DESeq2 (for mRNA). Putative mRNA-miRNA interactions between differentially expressed mRNA and miRNA species were determined using interaction databases miRWalk, miRTarBase, TarBase and TargetScan. To classify mRNA species by function and pathway, gene enrichment was performed using Enrichr. The resulting miRNA-mRNA interactome consisted of 1202 interactions. Some highly connected microRNAs were hsa-let-7e-5p, hsa-miR-20a-5p, hsa-miR-122-5p, and hsa-miR-29c-3p. Most differentially expressed genes were indicated to be regulated by miRNAs. The sub-interactomes of genes involved in specific pseudoexfoliation glaucoma related enrichment terms such as oxidative stress, unfolded protein response, signal molecules and ECM remodelling were determined. This is the first study to present a genome-wide microRNA-mRNA regulatory network for human trabecular meshwork cells treated with TGF-β1 and may serve to generate unbiased hypotheses about regulatory functions and mRNA targets of miRNAs in pseudoexfoliation glaucoma and may help to develop miRNA-based therapeutics.

Humans↗
PubMed1992

[The clinical significance of following up the differential light threshold in glaucoma].

The correlation of the differential light threshold changes in the Bjerrum area to the glaucomatous visual field defects that followed was studied prospectively by the Humphrey Field Analyzer. Of 42 early glaucomatous eyes without field defects, 24 developed reproducible glaucomatous field defects in 2.5 years of follow-up. The agreement in location between the field defects and the meridian of highest light threshold elevation was remarkable (87.0%), and a mean 5 dB decline in local light sensitivity predicted ensuing field defect development. Thus, the discovery of glaucomatous field defects with automated Humphrey perimetry could be 1-2 years earlier than with Goldmann perimetry.

Adult↗
PubMed1992

Epidemiology of glaucoma in Asia-Pacific.

Primary open angle glaucoma is the second most important cause of permanent blindness in the Asia Pacific region. Thus it is very important to identify epidemiological and other risk factore which are associated with open angle glaucoma. The risk for glaucoma optic nerve damage increases with the age and with the level of the intraocular pressure. In this paper, I will highlight our study of several risk factors for development of the open angle glaucoma like (1) elevated intraocular pressure, (2) myopia, (3) suspicious large optic disc cup, (4) cupping with disc haemorrhages and (5) nerve fibre defect. The general and systemic conditions which are implicated as risk factore are (1) family history of glaucoma, (2) increase in age, (3) diabetes mellitus, (4) cardio vascular conditions like central retinal vein occlusion etc. (5) the endocrine disorders with increased thyroid and increased cortico steroids responsiveness in patients with glaucoma will be discussed.

Adult↗
PubMed1992

Complications and management of the filtration bleb.

Filtration surgery is the commonest operation performed for closed angle or open angle glaucoma when medical treatment or laser trabeculoplasty has failed to control the intraocular pressure. It is characterized by the formation of an artificial drainage fistula between the anterior chamber and subconjunctival space. The successful operation is evidenced by the appearance of a subconjunctival filtration bleb which in turn depends on the patency of this pathway. Despite numerous modification, the procedure trabeculectomy first described by Sugar in 1961 and later on popularized by Watson and Cairns in 1968 is the most popular filtration surgery performed nowadays. It is a safe, relatively easy operation which carries a success rate of around 76% to 84% with a small complication rate. Repeat filtration surgery, however, is often less successful, making a successful initial surgery critically important. A successful outcome of filtration surgery can be enhanced by preoperative preparation, meticulous technique with modification for individual case, and early identification and prompt treatment of the complications arisen.

Anterior Chamber↗
PubMed1992

Retrospective study of optometric referrals.

We undertook a retrospective study of the referral patterns of optometrists. During the study period 13,107 patients had been seen, of whom 2.86% had been referred. Of the referred patients, 66.67% were referred to an ophthalmologist via the general practitioner, 25.87% to their general practitioner alone, and 7.47% directly to an ophthalmologist. The conditions for which patients were referred are given along with information on any supplementary tests used. The effect of practitioner age and seasonal variations on referrals was also determined. The role of the optometrist in screening for ocular disease is discussed.

Adolescent↗
PubMed1979

Peripheral nasal field defects in glaucoma.

One hundred fifty-one eyes of 101 consecutive patients with chronic open-angle and low tension glaucoma showed typical visual field changes. Sixty of the eyes had a nasal step, either alone or in combination with other defects. In 17 of these eyes, it was possible to demonstrate an isolated scotoma in the nasal periphery. It was concluded that the peripheral nasal step is a nerve fiber bundle defect that in its earliest phase produces a scotoma. In this sense, it behaves similar to the more central defects, rather than simply as a depression of isopters nasally.

Adult↗
PubMed1977

Diathermo-trabeculotomy ab externo: indications and long-term results.

The authors present the results of 2 years' observation of 47 eyes operated with diathermo-trabeculotomy ab externo. This technique, based on a diathermic effect in association with trabeculotomy ab externo, allows an ample opening of Schlemm's canal and of the trabecular meshwork, with normalisation of intraocular pressure and outflow facility, for a period of up to 2 years, in open-angle and congenital glaucoma.

Electrocoagulation↗
PubMed1976

Combined cyclodialysis and cataract extraction.

Combined cyclodialysis and cataract extraction was performed on 78 eyes in a consecutive series of 26 years duration. This operation was performed on eyes with severe glaucoma, inadequately controlled on maximum medical therapy, and with a cataract needing extraction. Glaucoma types included open-angle, angle-closure with peripheral anterior synechias, combined open-angle and angle-closure, and secondary to uveitis. Seventy of the 78 eyes had follow-up of six months or more and the results in these 70 eyes were analyzed. In thirteen percent of the eyes in this study the postoperative intraocular pressure was the same or higher than the preoperative level, or reductions of intraocular pressure were not clinically significant. Eighty-seven percent (61 eyes) had a clinically significant lowering of intraocular pressure following the combined procedure. Thirty-nine percent (27 eyes) of the 70 eyes in this study had a tension of 0-14 mm Hg, and 44% (31 eyes) had a tension of 15-20 mm Hg. Intraocular pressure was improved significantly more often in patients over 60 years of age. Resulting intraocular pressures of 14 mm Hg or less were more likely when the cyclodialysis was performed in the lower quadrant. The results of the combined procedure were not significantly influenced by the type of glaucoma involved or by a history of previous glaucoma surgery. Bleeding was a frequent complication, but was not related to resulting intraocular pressure. Other complications were rare. We conclude that combining cyclodialysis with cataract extraction is safe and effective, and is a suitable procedure when there is need for surgery to relieve severe glaucoma, along with a need for cataract extraction.

Adolescent↗