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[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 factors 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 factors are (1) family history of glaucoma. (2) increase in age, (3) diabetes mellitus, (4) cardiovascular conditions like central retinal vein occlusion etc. (5) the endocrine disorders with increased thyroid and increased corticosteroids responsiveness in patients with glaucoma will be discussed.

Adult↗

[Glaucoma parameters of the papilla. Comparison of clinical and stereophotography methods with laser scanning tomography].

The observations recorded by laser tomographic scanner (LTS) and with clinical and stereophotographic evaluation of 40 optic discs in the same glaucomatous patients were compared. Quantitative parameters (vertical and horizontal cup-to-disc ratio) and qualitative parameters (nasal excavation, notch, pseudo-pit, overpass, bayonetting) were evaluated. The correlation coefficients for the quantitative parameter ranged from 0.59 to 0.73. The definition of excavation used meant that the values found with the LTS were consistently higher. The qualitative parameter did not differ significantly with the method. Therefore, the LTS can be considered equivalent to the standard methods.

Adult↗

[An analysis of the causes of glaucomatous visual function damage by computed multifactorial stepwise regression].

Computed multifactorial stepwise regression analysis of quantitative visual field deterioration in relation to 28 factors showed that only the hemorheological indices entered the multiplex regression equations, especially accurately for POAG patients with severe visual damages. Besides, the patients might also have lower antioxidant capability in the red cell membrane protein. Based on the present results and data abroad, POAG might pertain to the blood hyperviscosity syndrome, and with elevated intraocular pressure and decreased ocular arterial pressure, the visual function damage would be aggravated.

Blood Viscosity↗

[Computerized image analysis for retinal nerve fiber layer: a preliminary report].

The principle and method for analysing the white-black photographs of retinal nerve fiber layer (RNFL) by using the technique of computerized image analysis were introduced. An objective and quantitative result of RNFL on the white-black photograph was initially obtained, and using the technique of fulse colour, each of the RNFL could be showed, which seem to have more advantages than observing RNFL on a white-black photograph.

Anthropometry↗

Effects of timolol and acetazolamide on intraocular pressure elevation following argon laser iridotomy.

To study the effect of hypotensive agents on intraocular pressure elevation following argon laser iridotomy, 0.5% timolol maleate topically and acetazolamide 125 mg orally were given in 39 eyes, one hour prior to laser iridotomy, with 29 eyes serving as the control. The mean pressure two hours after laser iridotomy was 18.9 +/- 7.2 mmHg in the control group and 12.8 +/- 3.9 mmHg in the pretreated group. Ocular pressure was elevated from the baseline pressure of the prelaser status in two eyes (5%) only in the timolol-acetazolamide treated group and in 16 eyes (55%) in the control group. The pressure elevation two hours after laser iridotomy was significantly less in the timolol-acetazolamide pretreated group.

Acetazolamide↗

Recent developments in medical therapy of POAG with beta blocking agents.

Since 1987, an entirely computerized open study has been developed in Pr Sole's Ophthalmology Department: the CLERTORE project (Clermont-Tonus-Research). It is a data bank including all the ophthalmic data of hypertensive patients, whether treated or untreated. Every six months, the patients included in the CLERTORE project undergo a clinical ophthalmic examination as well as an automated visual field examination (OCTOPUS 500), an examination of the optic disc (ONHA) and fluorophotometry (FLUOROTRON MASTER). To date, 92 patients have been included in the project. One hundred and eighty-three eyes are examined every six months with a maximal follow-up of 42 months. Because of the numerous criteria of the data base, it is too early to give any statistical results. With a close look at the evolution of the examinations of some of our cases, this preliminary work however allows us to make the three following remarks: In the hypertensive patients, a modification of the papillary pallor is observed without any change in the visual field, C/D ratio and fluorophotometry. The pallor is clearly modified when adrenaline eye drops are given to glaucomatous patients. There is a break of the iridic blood barrier in some hypertensive patients, whether treated or untreated.

Adrenergic beta-Antagonists↗

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↗

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↗

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↗

[Topical oxpernolol in the treatment of various forms of glaucoma (author's transl)].

Oxprenolol is a new beta-adrenergic blocking drug, whose effectiveness in the treatment of various forms of glaucoma has been evaluated. The drug was administered topically as 0.5% -1%-2% solution. The results of the investigation may be summarized as follows: The instillation of the drug produces a transient and slight conjunctival hyperaemia and a not significant miosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaumiosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaucoma. The concentration of 0.5% Oxprenolol seems to be as effective as topical 1% Propranolol. At the same concentration (0.5%), Oxprenolol produces no significnat change of the systemic blood pressure or of the heart rate. Topical pre-treatment with 1% Oxprenolol inhibits the systemic side-effects (tachycardia) produced by topical Isoproterenol, a wellknown ocular hypotensive drug. The authors conclude the investigation affirming that Oxprenolol may represent a new effective means for the medical treatment of glaucoma.

Chronic Disease↗

Pilocarpine therapy in glaucoma: effects on anterior chamber depth and lens thickness in patients receiving long-term therapy.

The effect of pilocarpine hydrochloride on the anterior chamber depth and lens thickness was measured in 20 eyes of patients with chronic open-angle glucoma who were receiving long-term glaucoma therapy with pilocarpine. Measurements were made with high-resolution ultrasonic biometry. This study demonstrated that regardless of their age (58.4 years, average) and the fact that they had been regularly using pilocarpine from two to four times a day, 85% of these patients demonstrated narrowing of the anterior chamber (AC) depth (average, 0.19 mm) and thickening of the lens (average, 0.21 mm) with each instillation of pilocarpine. In approximately 15% of eyes, a repeatable deepening of the AC depth and flattening of the lens was noted.

Administration, Topical↗

The histopathology of pigmentary dispersion syndrome with glaucoma.

Iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.

Atrophy↗

Glucocorticoid responsiveness associated with HLA-B12.

Primary open-angle galucoma (POAG) patients are more responsive to glucocorticoids, and have increased prevalences of the histocompatibility antigens HLA-B7 and HLA-B12. We report herein a comparison of in vitro cellular responsiveness to glucocorticoids and HLA classification for 25 POAG patients, and 25 individuals who respond to topical dexamethasone with intraocular pressure is greater than 31 mm. HG. (GG responders). Within both the POAG and GG groups, significantly greater responsiveness to prednisolone occurs in patients with HLA-B12 antigen. No such association occurs for patients with HLA-B7.

Aged↗

Diurnal variations in outflow facility.

Tonography was carried out at 8 AM, 2 PM, and 8 PM on 43 normal eyes, 58 open-angle glaucomatous eyes and 10 ocular hypertensive eyes. Diurnal variations in outflow facility and their relation to those in intraocular pressure (IOP) were studied. Diurnal variations in outflow facility were present in almost all eyes, with approximately a 10% exception. The average diurnal variation in true outflow facility (deltaCtrue) was 0.10 microliter/min/mm Hg in normal eyes and 0.07 microliter/min/mm Hg in glaucomatous eyes. The average rate of diurnal variation in true outflow facility: formula: (see text) was 43.6% in normal eyes and 69.1% in glaucomatous eyes. The value was greater in glaucomatous eyes than in normal eyes. The curve of diurnal variations in true outflow facility was divided into 5 types, and in glaucomatous eyes the value of outflow facility was apt to increase in the morning and decrease in the evening. In 42% of the normal and 45% of the glaucomatous eyes, inverse relation was seen between diurnal variations in outflow facility and diurnal rhythm in IOP. It is thought that diurnal variations in outflow facility, along with diurnal fluctuations in the rate of aqueous formation, are one of the factors responsible for the diurnal rhythm found in IOP.

Adult↗