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PubMed1978

Prognosis of glaucoma simplex and glaucoma capsulare. A comparative study.

To study the prognosis of capsular glaucoma (102 eyes) as compared to simplex glaucoma (58 eyes), a retrospective comparison of the functional status of these diseases when first diagnosed and five years afterwards was made. At the first examination the capsular glaucoma eyes were on average more seriously damaged. After five years this tendency was more marked with several amaurotic eyes, 17% as compared to 10% of the simplex glaucoma group. Severe visual field loss in the eyes with advanced glaucoma after five years was present in 48% of the capsular glaucoma group but only 19% of the simplex glaucoma group.

Adult↗

PubMed2000

Glaucoma incidence in an unselected cohort of diabetic patients: is diabetes mellitus a risk factor for glaucoma? DARTS/MEMO collaboration. Diabetes Audit and Research in Tayside Study. Medicines Monitoring Unit.

AIMS: To evaluate whether diabetes mellitus is a risk factor for the development of primary open angle glaucoma or ocular hypertension (OHT). METHODS: A historical cohort study of an unselected population comprising all residents of the Tayside region of Scotland was performed using record linkage techniques followed by case note review. Ascertainment of prevalent diabetes was achieved using the Diabetes Audit and Research in Tayside Study (DARTS) validated regional diabetes register. Glaucoma and treated OHT were defined by encashment of community prescriptions and the statutory surgical procedure coding database. RESULTS: The study population comprised 6631 diabetic subjects and 166 144 non-diabetic subjects aged >40 years without glaucoma or OHT at study entry. 65 patients with diabetes and 958 without diabetes were identified as new cases of glaucoma or treated OHT during the 24 month study period, yielding a standardised morbidity ratio of 127 (95% CI, 96-158). Case note review demonstrated non-differential misclassification of prevalent glaucoma and OHT as incident disease (diabetic cohort 20%, non-diabetic cohort 24%; p=0.56) primarily as a result of non-compliance in medically treated disease. Removing misclassified cases and adjusting for age yielded an incidence of primary open angle glaucoma in diabetes of 1.1/1000 patient years (95% CI, 0.89-1. 31) compared to 0.7/1000 patient years (95% CI, 0.54-0.86) in the non-diabetic cohort; RR 1.57 (95% CI, 0.99-2.48). CONCLUSIONS: This study failed to confirm an association between diabetes mellitus and primary open angle glaucoma and ocular hypertension. A non-significant increase in diagnosed and treated disease in the diabetic population was observed, but evidence was also found that detection bias contributes to this association.

Adult↗

PubMed2000

Molecular characterisation of congenital glaucoma in a consanguineous Canadian community: a step towards preventing glaucoma related blindness.

Glaucoma is a leading cause of irreversible blindness in Canada. Congenital glaucoma usually manifests during the first years of life and is characterised by severe visual loss and autosomal recessive inheritance. Two disease loci, on chromosomes 1p36 and 2p21, have been associated with various forms of congenital glaucoma. A branch of a large six generation family from a consanguineous Amish community in south western Ontario was affected with congenital glaucoma and was studied by linkage and mutational analysis to identify the glaucoma related genetic defects. Linkage analysis using the MLINK component of the LINKAGE package (v 5.1) showed evidence of linkage to the 2p21 region (Zmax=3.34, theta=0, D2S1348 and D2S1346). Mutational analysis of the primary candidate gene, CYP1B1, was done by direct cycle sequencing, dideoxy fingerprinting analysis, and fragment analysis. Two different disease causing mutations in exon 3, 1410del13 and 1505G-->A, both segregated with the disease phenotype. The two different combinations of these alleles appeared to result in a variable expressivity of the phenotype. The compound heterozygote appeared to have a milder phenotype when compared to the homozygotes for the 13 bp deletion. The congenital glaucoma phenotype for this large inbred Amish family is the result of mutations in CYP1B1 (2p21). The molecular information derived from this study will be used to help identify carriers of the CYP1B1 mutation in this community and optimise the management of those at risk of developing glaucoma.

Adolescent↗

PubMed2005

Progress in glaucoma treatment research: a nonrandomized prospective study of 102 patients with advanced refractory glaucoma treated by Leksell gamma knife irradiation.

OBJECT: The authors performed a study to characterize the effects of ciliary body gamma knife surgery (GKS) for advanced glaucoma. METHODS: In addition to a pilot project involving 14 patients, 88 other patients were treated. Four 8-mm isocenters were used. Blind eyes received 20 Gy to the 50% isodose. If there was preserved vision the dose was 15 Gy. The median follow up was 20 months (range 2-54 months). Severe pain was present in 93% of patients with secondary glaucoma; after GKS it was substantially improved in 89% of cases. In primary open angle glaucoma, the pain was less frequent and severe. In more than half the patients it disappeared during a median latency of 6 weeks. The median intraocular pressure value was lowered in patients with secondary glaucoma (from 51.3-27 mm Hg). The same values for primary glaucoma were 25.3 and 16.1 mm Hg, respectively, after a median latency of 12 weeks. Twenty-seven of 40 patients with neovascular glaucoma showed a marked reduction of neovascularization after a median latency of 18 weeks. Treatment complications were slight. There was postoperative lacrimation in 61%. Two patients underwent postirradiation cataract extraction. Noninfectious keratitis was observed in two patients. Pharmacotherapy could be reduced in all patients and ceased in approximately one third. There has been no recurrence of the initial symptoms and no worsening of visual acuity. CONCLUSIONS: Gamma knife surgery ameliorates the main symptoms in advanced glaucomas and precludes the need for eventual ocular enucleation.

Adolescent↗

PubMed1999

[Valve implants of glaucoma pressure regulator for refractory glaucoma: own experience].

PURPOSE: To present our experiences in valve implantation for refractory glaucoma. MATERIAL AND METHODS: From October 1993 to December 1996 implantations of Glaucoma Pressure Regulator Optimed were performed in 7 eyes of 7 patients. There were 4 men and 3 women aged from 32 to 65 years. There were 3 eyes with neovascular glaucoma due to diabetes mellitus, 2 eyes with posttraumatic glaucoma, including 1 case after keratoplasty, 1 eye with postkeratoplasty glaucoma and 1 eye with aphakic glaucoma. Preoperative IOPs ranged from 33 to 61 mm Hg (mean 37.6 +/- 7.2 mm Hg). RESULTS: Success was considered an IOP of less than 22 mm Hg without medication (complete success) or with medication (qualified success) without additional filtering surgery. Postoperative success was obtained in 4 out of 7 eyes after follow-up period of 37.4 +/- 17.08 months (range 16-39 months). Early complications were hyphema (1 patient, 14.3%), blockage of intracameral portion of the tube (1 patient, 14.3%), hypertony (1 patient, 14.3%). Late complications were: external conjunctival bleb failure (2 patients, 28.6%), blockage of intracameral portion of tube by fibrovascular tissue (1 patient, 14.3%). CONCLUSION: Our experiences confirm that the valve implant is still today an alternative surgical procedure for controlling IOP in eyes with refractory glaucoma that have visual potential.

Adult↗

PubMed2000

Accuracy and implications of a reported family history of glaucoma: experience from the Glaucoma Inheritance Study in Tasmania.

OBJECTIVES: To ascertain the prevalence of previously undiagnosed primary open-angle glaucoma (POAG) within 5 large POAG pedigrees and to evaluate the reliability of a reported family history of glaucoma within these pedigrees. METHODS: The Glaucoma Inheritance Study in Tasmania (GIST) identified several large adult POAG pedigrees. Intraocular pressure (IOP), optic disc stereophotography, and automated perimetry were performed on all adult pedigree members. Participants were classified as normal (IOP <22 mm Hg and normal optic disc and field); glaucoma suspect (normal field, but an IOP >/=22 mm Hg and/or suspicious optic disc); or POAG (field defect and glaucomatous optic disc). Some individuals with POAG had been previously diagnosed by their local ophthalmologist; others were diagnosed as a result of the GIST project. Family members with a prior diagnosis of POAG were asked to report if they were aware of any relatives with POAG. This reported family history was then directly compared with the actual pedigree (before the diagnosis of new cases) to calculate agreement. MAIN OUTCOME MEASURE: The rate of glaucoma in pedigrees and percentage of previously diagnosed glaucoma cases who were aware of the positive family history of POAG. RESULTS: Four hundred forty-two subjects (mean age, 54 years [range, 13-97 years]) from 5 pedigrees were examined: 316 subjects (71%) were normal, 47 (11%) were previously diagnosed with POAG, and 8 (2%) were previously diagnosed glaucoma suspects; 30 cases (7%) of POAG and 41 suspects (9%) were newly diagnosed as a direct result of the GIST examination. Of the 47 previously diagnosed POAG cases, 41 were questioned about their prior knowledge of any family history and 11 (27%) were unaware of their family history of POAG. CONCLUSIONS: Examination of all adult subjects from POAG families yields new cases. Even in large POAG pedigrees, 27% of previously diagnosed POAG patients were unaware of their positive family history. These findings suggest that a higher percentage of adult POAG may be inherited than hitherto reported. Arch Ophthalmol. 2000;118:900-904

Adolescent↗

PubMed2002

[A study of experimental carbomer glaucoma and other experimental glaucoma in rabbits].

OBJECTIVE: To establish models of experimental glaucoma in rabbits to investigate the treatment of glaucoma. METHODS: Twenty-one normal albino rabbits weighing 2.5 - 3.0 kg were studied. The rabbits were divided randomly into 4 groups: I, II, III and IV. Anterior chamber injection of 0.1 ml of 0.3% carbomer (I), 0.2 ml of methylcellulose (II), 0.2 ml of compound methylcellulose (III) and subconjunctival injection of 5 mg of dexamethasone (IV) were performed respectively on them to induce glaucoma. The intraocular pressure (IOP) was monitored with a Tono-pen XL tonometer several times prior to injection and 2 times per week after injection. The basic IOP in every group served as control. RESULTS: Experimental glaucoma occurred in eleven of twelve eyes in group I and IOP lasted from 20 to 50 days. The mean IOP levels were 29 - 35 mmHg (1 mm Hg = 0.133 kPa) and the peak IOP levels were 37 - 45 mm Hg. The IOP in 2 out of 10 eyes in group II increased to 22 - 50 mm Hg and lasted for 3 days. The IOP of 1 out of 10 eyes in group III increased to 25 - 40 mm Hg and lasted for 4 days. The IOP in eyes of group IV increased only 3 mmHg in the mean and lasted for one week. According to the standard, IOP above 22 mmHg for one week as the successful experimental glaucoma, group II and III were not the ideal ones and group IV was a failure. CONCLUSION: Experimental glaucoma model induced by carbomer has the advantages of producing moderate and sustained IOP elevation. The model is easy to be carried out. It is simple, reliable, and useful for investigating optic nerve and retinal damage in glaucoma and testing the toxicity and efficacy of various therapies.

Acrylic Resins↗

PubMed1998

Glaucoma medications, glaucoma therapy, and the evolving paradigm.

BACKGROUND: Therapy for the glaucomas is dynamic, with changes evolving as new medications or modalities are discovered. In comparing the method(s) of treating open-angle glaucoma today, as compared to treatment in the 1980s, clear differences emerge. While topical beta-blockers remain the mainstay for treatment of open-angle glaucoma, other medications and modalities have recently become available that supplement their use. Topical carbonic anhydrase inhibitors (CAIs), introduced in 1995, have become an important addition to the glaucoma armamentarium. They are more useful than their oral counterparts, since they cause fewer systemic side effects, with similar efficacy. Brimonidine, a topical alpha2-adrenergic agonist, and latanoprost, a topical prostaglandin, have become important additions to the glaucoma regimen because of their ability to reduce the intraocular pressure (i.o.p.) with an improved therapeutic index, as compared to older medications. Finally, argon laser trabeculoplasty (ALT) appears to be a safe technique and useful in reduction of IOP. CONCLUSION: The scheme for how the anti-glaucoma medications and modalities are used for the therapy of open-angle glaucoma will change over time. The evolution will occur as we continue to learn more about the drugs presently being used.

Adrenergic beta-Antagonists↗

PubMed1993

The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, western Cape, South Africa.

OBJECTIVE: To determine the prevalence of primary angle closure glaucoma in the so-called Cape people of mixed ethnic background. DESIGN: A population-based prevalence study. SETTING: Mamre, a village near Cape Town, South Africa. PARTICIPANTS: Individuals aged 40 years or older. Historically, their ancestors were Southeast Asians and indigenous Africans and, to a lesser extent, Europeans. Of a total of 1194 people, 987 (82.7%) were examined. MAIN OUTCOME MEASURE: Primary angle closure glaucoma was diagnosed in individuals with previous acute or intermittent symptoms of angle closure and in individuals with an "occludable" angle and an intraocular pressure of greater than 21 mm Hg or a glaucomatous visual field. MAIN RESULTS: An age-related trend toward hypermetropia was found, which was greatest in women older than age 50 years. Gonioscopy identified Shaffer grade 1 angles in 89 (9%) of 987 subjects. The prevalence of primary angle closure glaucoma was 2.3% (23 subjects) and increased with age in both sexes. Women were affected more than four times as often as men and the sex difference persisted across all age groups. In comparison, the prevalence of primary open angle glaucoma was 1.5% (15 subjects). Primary glaucoma (angle closure plus open angle) was the leading cause of bilateral blindness in the community, with a prevalence rate of 0.5% (five subjects). CONCLUSIONS: This study identified primary angle closure glaucoma as a significant public health problem in the Western Cape Province. Because of the ethnic back-ground of the people studied, these findings may also apply to the populations of Southeast Asia.

Adult↗

PubMed2000

Post-operative 5-fluorouracil for glaucoma surgery.

BACKGROUND: Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intra-ocular pressure. The surgery involves creating a channel through the sclera, through which intra-ocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel intra-ocular pressure rises and the operation fails. Antimetabolites are used to inhibit wound healing to prevent the conjunctiva scarring down on to the sclera. The principal antimetabolites used are 5-Fluorouracil and Mitomycin C. Both may be applied on a sponge between the conjunctiva and sclera at the beginning of surgery. 5-Fluorouracil may also be given as one or more injections under the conjunctiva after the surgery. OBJECTIVES: The objective of this review is to assess the effects of post-operative injections of 5-Fluorouracil in eyes of people undergoing surgery for glaucoma. SEARCH STRATEGY: We searched the Cochrane Eyes and Vision Group specialised register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE and EMBASE. We searched the reference lists of relevant articles for additional trials, and we used the Science Citation Index to search for articles that cited the included studies. We contacted investigators and experts for details of additional relevant trials. SELECTION CRITERIA: We included randomised trials of post-operative 5-Fluorouracil injections compared to placebo injections or no injections in trabeculectomy for glaucoma. DATA COLLECTION AND ANALYSIS: We independently assessed trial quality and extracted data. We contacted trial investigators for missing information. Data were summarised using relative risk, Peto odds ratio and weighted mean difference as appropriate. MAIN RESULTS: Eight trials, which randomised a total of 536 participants, are included in the review. As far as can be determined from the trial reports, the methodological quality of the trials was not high. 5-Fluorouracil when delivered by post-operative injection appears to be effective in reducing the likelihood of surgical failure of trabeculectomy both in eyes at high risk of failure and those undergoing surgery for the first time. Complications are more common after 5-Fluorouracil injections, especially early and late wound leaks and temporary damage to the ocular surface. Whilst no evidence was found of an increased risk of serious sight threatening complications, people undergoing initial trabeculectomy had a substantially increased risk of ocular hypotony. None of the trials reported on the participants' perspective of care. REVIEWER'S CONCLUSIONS: This treatment is now rarely used on the basis of a planned series of post-operative injections.This presumably reflects an aspect of the treatment that is unacceptable to both patients and doctors. None of the trials reported on the participants' perspective of care which constitutes a serious omission for an invasive treatment such as this. Increasingly, injections are used on an ad hoc basis. The effectiveness of this strategy is the subject of a future systematic review.

Antimetabolites↗

PubMed2004

Mutations in the optineurin gene in Japanese patients with primary open-angle glaucoma and normal tension glaucoma.

The optineurin gene (OPTN) was identified as a gene that causes primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). To investigate the frequency of sequence changes in OPTN in Japanese glaucoma patients, single-strand conformation polymorphism analysis and subsequent sequence analysis were performed for genotyping OPTN in 165 unrelated Japanese patients with POAG and 148 patients with NTG, with 196 control subjects without glaucoma as reference subjects. Out of four mutations reported to be associated with risk and to cause disease in Caucasian patients, sequence alterations in 458G > A and 691_692insAG were not detected in any investigated Japanese patients with glaucoma, and alterations in 1944G > A and 603T > A, were present in similar frequencies in glaucoma patients and control subjects. The current results suggest that there may be certain racial differences between Japanese and Caucasians with respect to OPTN genotypes.

Adult↗

PubMed1998

A clinical study of the Ahmed glaucoma valve implant in advanced glaucoma.

OBJECTIVE: To assess clinical outcomes and establish the incidence and management of a hypertensive phase (HP) (defined as intraocular pressure [IOP] > 21 mmHg in the first 6 postoperative months) in patients with Ahmed glaucoma valve implant. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 85 patients were included in the current study, including consecutive patients who had intractable glaucoma and underwent Ahmed valve implant insertion at the University Glaucoma Center, Tampa, Florida (DWR and WEL) and the Massachusetts Eye and Ear Infirmary (PAN) between January 1993 and June 1997. Only patients with a minimum of 6 months' follow-up were included. INTERVENTION: Ahmed glaucoma valve implant insertion to control intractable glaucoma was performed. MAIN OUTCOME MEASURES: Success was defined as IOP less than 22 mmHg and greater than 4 mmHg on the last two visits, a decrease of no more than two lines in the visual acuity and no additional surgical interventions to control IOP. RESULTS: The cumulative probability of success at 12 months was 77%. A total of 26 patients (30.6%) failed during the study period, and 70 patients (82%) exhibited HP. Hypertensive phase peaked at 1 month after the operation and stabilized at 6 months. There were 34 patients (48%) with HP who were controlled with additional medications: 14 (20%) with needling and 5-fluorouracil injections and 20 (28%) who needed secondary surgical intervention. There were 8 patients (9.4%) who exhibited hypotony (< 5 mmHg) on postoperative day 1 and 3 (3.5%) at 3 months. Visual acuity returned to baseline between 3 and 6 months after the operation. The major complications associated with the valve were hyphema in 14 cases (16.5%), suprachoroidal hemorrhage in 4 cases (4.7%), end-plate exposure in 10 cases (11.7%), tube exposure in 6 cases (7%), tube block in 4 cases (4.7%), loss of vision in 5 cases (5.8%), and corneal graft failure in 4 (30%) of 13 cases with clear grafts. CONCLUSIONS: The overall success rate is comparable to that of prior studies using different implants. The majority of the patients exhibit an HP that peaks at 1 month, with gradual stabilization over 6 months. One third of the patients needed secondary surgical intervention to control the HP. The incidence of postoperative hypotony and flat or shallow anterior chambers is very low after Ahmed glaucoma valve insertion.

Female↗

PubMed1989

[Evaluation of glaucomas. Frequently misdiagnosed glaucoma conditions].

On the basis of a number of examples the authors describe specific glaucomas which have often reached their final stages by the time the patients are referred to the clinic. They include sub-acute and chronic angle-closure glaucoma, pseudoexfoliation syndrome, and pigmentary glaucoma. An unpleasant feature of these glaucomas is that, somehow or other, treatment comes too late: complete cupping of the optic disk when the ophthalmologist is first consulted, increased intraocular pressure in exfoliation syndrome detected too late, or a tardy decision to perform an iridotomy or a fistulizing operation. The following are some important points: gonioscopy should be performed not only at the initial examination but also at subsequent ones; subacute and chronic pupillary or angle-closure glaucomas are progressive diseases for which the sensible therapy is not miotics but laser iridotomy; because papillary changes usually precede visual field changes (automated perimetry notwithstanding), particular attention must be paid to the former. This can only be accomplished with exact documentation. Therefore, glaucoma follow-up means pressure measurement and gonioscopy and examination of the optic disk and visual field. In conclusion, aids for decision-making and a follow-up schedule are presented.

Aged↗

PubMedDate not supplied

Cullen frontal sinus valved glaucoma shunt: preliminary findings in dogs with primary glaucoma.

PURPOSE: To evaluate the efficacy of a novel, professionally manufactured, frontal sinus valved glaucoma shunt in maintaining normal intraocular pressure (IOP) and vision in dogs with primary glaucoma. METHODS: Three eyes of three dogs diagnosed with primary glaucoma were included in this prospective clinical study. A Cullen frontal sinus valved glaucoma shunt was implanted into each glaucomatous globe. Dogs were treated postoperatively with topical neomycin/polymyxin B/0.1% dexamethasone and 0.03% flurbiprofen every 6 h tapered over 8-12 weeks, and meloxicam at 0.1 mg/kg orally every 24 h for 7-10 days. IOP, intracameral shunt position and apparent patency, and vision were assessed twice daily for up to 4 (n= 3 eyes) and 10 (n= 2 eyes) days postoperatively, and then at re-examination periods of up to 36 weeks (n= 1 eye). Postoperative complications were recorded and documented photographically. RESULTS: Normal IOP was maintained in all shunted globes (range 10-29 mmHg; mean = 16.7 mmHg at 24 h; IOP = 23 mmHg at 36 weeks) postoperatively for 2 days (3/3 eyes), 8 weeks (2/2 eyes), and 36 weeks (1/1 eye) without additional antiglaucoma therapies. Photopic vision and shunt position and patency were maintained in all shunted globes for all follow-up periods. Postoperative complications included mild aqueous flare and fibrin (n= 3 eyes for 3-10 days postoperatively); intracameral shunt occlusion with fibrin (n= 1 eye at days 2 and 4); partial anterior chamber tube extrusion (n= 1 eye at day 4), and focal corneal edema (n= 1 eye at 18 weeks). Tissue plasminogen activator injected intracamerally through the silicone tube near the frontal sinus effectively resolved the fibrinous shunt occlusion. CONCLUSIONS: The Cullen frontal sinus valved glaucoma shunt shows promise for the management of canine primary glaucoma.

Animals↗

PubMed2000

Efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucoma.

AIMS: To evaluate the efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucomas. METHODS: This retrospective study reviewed the final intraocular pressure, visual outcome, and incidence of complications in all patients with the Ahmed glaucoma valve implant performed at the Prince of Wales Hospital, Hong Kong, between June 1996 and November 1998. RESULTS: A total of 65 eyes from 60 patients were treated with the Ahmed glaucoma implant. At a mean follow up (SD, median) of 21.8 (9.2, 28. 0) months (range 6-37 months), the mean intraocular pressure was reduced from 37.0 (SD 12.1) mm Hg before the implant surgery to 16.1 (12.4) mm Hg at the last follow up after surgery. The success rate of intraocular pressure control of <22 mm Hg was achieved in 73.8% of operated eyes. Transient postoperative hypotony with shallow anterior chamber occurred in 10.8% of cases. The most common postoperative complication was the formation of encapsulated bleb (24.6%). CONCLUSIONS: The Ahmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas in Chinese eyes. The success rate is comparable with those reported in non-Asian eyes. Formation of postoperative encapsulated bleb is, however, more commonly encountered.

Adolescent↗

PubMed1997

TIGR gene in primary open-angle glaucoma and steroid-induced glaucoma.

To identify TIGR gene mutation in two Korean pedigrees of primary open-angle glaucoma (POAG), and in 25 steroid-induced glaucoma patients, TIGR gene assay was performed. Genomic DNA was extracted from peripheral blood and the TIGR gene was amplified by polymerase chain reaction (PCR). The PCR amplification products were evaluated by single-stranded conformation polymorphism and direct DNA sequencing. In POAG families, not only those patients clinically diagnosed as glaucoma, but also most of their siblings, in whom glaucoma had not yet been detected, had a proline-to-serine (TCC-to-CCC) mutation in codon 334. However, no steroid-induced glaucoma patients showed TIGR gene mutation. TIGR gene mutation, in familial POAG, was found in a different codon from that previously reported. The TIGR gene does not, however, seem to be related to steroid-induced glaucoma.

Cytoskeletal Proteins↗

PubMed2003

Clinical experience with the Ahmed glaucoma valve implant in complicated glaucoma.

BACKGROUND: To assess clinical outcomes of the Ahmed glaucoma valve implant, an aqueous shunting device with a unidirectional valve mechanism, in eyes with refractory glaucoma. METHODS: Consecutive patients with intractable glaucoma who underwent Ahmed glaucoma valve insertion were retrospectively reviewed. Only patients with a minimum of 6 months of follow-up were included. The presence of intraocular pressure (IOP) > or = 22 mmHg in the first 6 postoperative months was defined as a hypertensive phase (HP). This study included 19 eyes in 19 patients. RESULTS: The mean preoperative IOP was 32.1 +/- 6.9 mmHg, with medication (mean times medication administered, 3.8 +/- 1.0; range, 0-3). The mean postoperative IOP was 7.8 +/- 2.2 mmHg on day 1, 11.3 +/- 4.4 mmHg at 1 week, 19.1 +/- 7.7 mm Hg at 1 month, 16.5 +/- 6.4 mmHg at 3 months, and 17.5 +/- 0.7 mmHg at 6 months, respectively. Twelve patients (63.2%) exhibited the HP. Nine patients (49.3%) experienced the HP at 1 month and 3 patients at 2 months after the operation. At the end of 6 months of follow-up, 11 patients (57.9%) who had exhibited the HP required additional anti-glaucoma medication to control the IOP (mean times medication was administered, 1.0 +/- 1.1; range, 0-2). Complications associated with the valve included hyphema in 1 case, choroidal effusion in 2 cases, iris plugging of the tube in 1 case, bleb encapsulation in 3 cases, and PK graft failure in 1 case. Postoperative hypotony resolved within 1 week. CONCLUSION: The Ahmed glaucoma valve implant was safe and effective in this series. The hypertensive phase peaked in the first to second months after surgery.

Adolescent↗

PubMed1996

A gene for primary congenital glaucoma is not linked to the locus on chromosome 1q for autosomal dominant juvenile-onset open angle glaucoma.

BACKGROUND: Primary congenital glaucoma is an uncommon autosomal recessive condition that results from a developmental defect in the trabecular meshwork and anterior chamber angle, manifesting in the neonatal or infantile period with increased intraocular pressure, corneal enlargement and edema, and optic nerve cupping with consequent loss of vision. Nothing is known about its genetic location. PATIENTS AND METHODS: Linkage analysis was performed in 25 primary congenital glaucoma Saudi Arabian families with six polymorphic DNA markers on chromosome 1q in a region that has shown tight linkage to a locus for autosomal dominant juvenile-onset open angle glaucoma (GLC1A). Twenty-four of these families are highly consanguineous. RESULTS: Each family was shown separately to exclude the 8-centimorgan (cM) interval containing the GLC1A locus. Four families independently demonstrated overlapping regions of exclusion (theta < or = -2) that spanned the entire 8-cM interval. Assignment of a primary congenital glaucoma locus in this region could be excluded by a cadre of 21 families because a primary congenital glaucoma disease locus did not segregate in an autosomal recessive manner on haplotypes constructed with markers in this region. For all families, no affected individuals demonstrated homozygosity of alleles in regions tightly linked to the GLC1A locus. CONCLUSION: These results exclude the 8-cM region on chromosome 1q shown to contain the GLC1A locus from containing a disease locus for primary congenital glaucoma in this population of 25 Saudi Arabian families.

Chromosome Mapping↗