1: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Review of the Influence of Pigment Dispersion and Exfoliation Glaucoma Diagnosis
on Intraocular Pressure in Clinical Trials Evaluating Primary Open-angle
Glaucoma and Ocular Hypertension.

Stewart WC, Demill DL, Wirostko BM, Nelson LA, Stewart JA.

*PRN Pharmaceutical Research Network, Cheyenne, WY daggerDepartment of
Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT.

PURPOSE:: To evaluate published, randomized, prospective, parallel clinical
trials utilizing currently approved glaucoma medications to determine what
influence, if any, pigment dispersion (PD) or exfoliation glaucoma (XFG)
patients had on the intraocular pressure. METHODS:: A review of clinical trial
articles evaluating currently used topical glaucoma medicines. Articles were
published between January 1995 and April 2011. If the articles met the
inclusion/exclusion criteria, they were analyzed for PD and XFG. RESULTS::
Twenty-four articles were included, containing 49 treatment arms that included
PD or XFG patients. The range of PD patients was 0% to 4.5%, with a mean of
1.5+/-0.9%, and for XFG patients 0% to 6.3%, with a mean of 2.2+/-2.1%. The
treatment arms with PD showed a difference in the intraocular pressures (IOPs),
for all studies analyzed together, for the baseline IOPs between clinical trials
that did and did not include PD patients (8 AM IOPs: with PD 26.5+/-0.9 mm Hg
and without PD 25.8+/-1.3 mm Hg, P=0.024; and diurnal curve mean IOPs: with PD
25.3+/-1.1 mm Hg and without PD 24.5+/-1.3 mm Hg, P=0.024). The XFG treatment
arms showed that there was a difference in the IOPs for all studies analyzed
together for diurnal baseline IOPs between clinical trials that did and did not
include XFG patients (with XFG 25.2+/-1.2 mm Hg and without XFG 24.3+/-1.0 mm
Hg, P=0.016). CONCLUSIONS:: Trial designs for prospective, parallel, glaucoma
clinical studies that are performed in the United States generally can include
PD and XFG patients with only a small impact on the IOP and a low number of such
subjects enrolled.

PMID: 22274674  [PubMed - as supplied by publisher]

2: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Comparison of Sensitivities for Detecting Diffuse and Localized Retinal Nerve
Fiber Layer Defects With Time-domain Optical Coherence Tomography in Patients
With Glaucoma.

Yoo YC, Park KH.

*Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University
College of Medicine daggerDepartment of Ophthalmology, Seoul National University
College of Medicine, Seoul, Korea.

PURPOSE:: To compare the ability of time-domain optical coherence tomography
(OCT) to detect diffuse and localized retinal nerve fiber layer (RNFL) defects
using a built-in normative database in patients with early to moderate glaucoma.
METHODS:: Subjects with localized visual field defects confined to either
hemifield were consecutively recruited. Only 1 eye per subject was considered.
Among the 91 eyes with localized RNFL defects, 46 eyes with mean deviations
matched to those of the 46 eyes with diffuse RNFL defects were selected for
statistical analysis. This case-control study included 46 eyes with diffuse RNFL
defects and 46 eyes with localized RNFL defects. The fast RNFL thickness
protocol of Stratus OCT was used. The clock-hour and quadrant sector parameters
corresponding to the hemifield with the visual field defect were evaluated at
P<0.05 with regard to the built-in normative database. The sensitivities of
these parameters were compared between diffuse and localized RNFL defects.
RESULTS:: The sensitivity of the clock-hour sector parameter for diffuse RNFL
defects (84.8%) was not significantly different than that for localized RNFL
defects (80.4%) (P=0.78). The sensitivity of the quadrant sector parameter for
diffuse RNFL defects (74.9%) was significantly higher than that for localized
RNFL defects (52.3%) (P=0.04). CONCLUSIONS:: The clock-hour parameter of
time-domain OCT detected RNFL defects without significant difference in
sensitivities between diffuse and localized patterns of RNFL loss in
glaucomatous eyes. However, the quadrant parameter of OCT showed better
sensitivity for diffuse RNFL defects than for localized RNFL defects.

PMID: 22274673  [PubMed - as supplied by publisher]

3: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Association Between Risk Factors and Glaucomatous Damage in Untreated Primary
Open-angle Glaucoma.

Gugleta K, Polunina A, Kochkorov A, Waldmann N, Portmann N, Katamay R, Flammer
J, Orgul S.

Ophthalmology Department, University Hospital Basel, University of Basel, Basel,
Switzerland.

PURPOSE:: To analyze an association between the presumed risk factors for
glaucoma and the actual extent of glaucomatous damage in untreated primary
open-angle glaucoma. PATIENTS AND METHODS:: In 50 untreated open-angle glaucoma
patients, we analyzed an association between the level of glaucomatous damage
and presumed glaucoma risk factors: mean untreated intraocular pressure (IOP)
and short-term IOP variability, ocular pulse amplitude, corneal thickness, acral
and corneal temperature, retinal arterial diameter and retinal venous diameter,
choroidal blood flow (laser Doppler flowmetry flow, velocity, volume), heart
rate, and ocular perfusion pressure. Morphologic damage (mean retinal nerve
fiber layer thickness, measured by ocular coherence tomography) and functional
damage (visual field mean defect) were evaluated separately in 2
forward-stepwise multiple regression models. RESULTS:: The mean retinal nerve
fiber layer thickness was significantly (P<0.05) associated with IOP (r=-0.35),
retinal arterial diameter (r=0.36), and choroidal blood flow (r=0.30); mean
defect was associated with ocular perfusion pressure (r=-0.30), laser Doppler
flowmetry volume (r=-0.33), and IOP variability (0.36). CONCLUSIONS:: Despite
small differences between the morphologic and functional glaucomatous damage,
IOP and perfusion parameters seem to contribute, at least in part, independently
to both.

PMID: 22274672  [PubMed - as supplied by publisher]

4: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Glaucoma Detection Using Optic Disc Images From the English National Screening
Programme for Diabetic Retinopathy.

Ong HS, Levin S, Vafidis G.

Central Eye Services, Central Middlesex Hospital, North West London Hospitals
NHS Trust, London, UK.

PURPOSE:: We performed this study to determine the positive predictive value of
a Diabetic Retinopathy Screening Program (DRSP) in detecting early glaucoma
using diabetic retinopathy screening images. PATIENTS AND METHODS:: The study
was carried out on patients referred to the glaucoma clinic from the local DRSP.
Retinal images considered by DRSP graders to show possible glaucomatous optic
discs were referred to the final referral grader, a medical retina specialist
(MR). The same images were independently graded by a glaucoma specialist (GS).
GS-positive patients were referred to the glaucoma clinic. Possible outcomes at
1 year were true cases (patients found to have glaucoma or glaucoma suspects) or
false cases (patients for whom a diagnosis of glaucoma was excluded). RESULTS::
Of 11,565 diabetic patients screened, 216 were suspected to have glaucoma after
DRSP grading (1.87%). A total of 170 were graded glaucoma positive and referred
to a clinic. At 1 year, 113 were true cases (98 per 10,000 screened with
previously undiagnosed glaucoma or glaucoma suspect) and 22 were false cases and
discharged from clinic (19 false positives per 10,000 screened). Of the 113 true
cases, 89 were given a positive grade by the MR and 24 were given a negative
grade, giving the DRSP a positive predictive value of 78.8% in detecting
glaucoma in the population. Comparison of the MR and GS grading showed an
agreement of 76.4%. The kappa-coefficient was 0.404 (95% confidence interval,
0.272-0.536). CONCLUSIONS:: We conclude that optic discs imaging in DRSP can be
useful as part of a glaucoma screening strategy to identify new disease within a
diabetic population.

PMID: 22274671  [PubMed - as supplied by publisher]

5: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Surgical Outcomes of the Baerveldt Glaucoma Implant:  Differences Between
Surgical Techniques in the Rotterdam Eye Hospital.

Poels MM, Niessen AG, de Waard PW, Lemij HG.

Glaucoma Service, The Rotterdam Eye Hospital, Rotterdam, The Netherlands.

PURPOSE:: During the last decades, the Baerveldt Glaucoma Implant (BGI) has
proven effective in the surgical treatment of glaucoma. Various surgical
procedures have been used for its implantation and these may yield different
clinical outcomes and different intraoperative and postoperative complications.
We evaluated the success rate of BGI and compared complications between 2
different surgical implantation techniques. METHODS:: Retrospective analyses of
medical records of consecutive adult patients who underwent a BGI implantation
at the Rotterdam Eye Hospital between September 2007 and August 2008. Patients
were divided by the surgical implantation technique. Success was defined as an
intraocular pressure >/=6 mm Hg and /=20%
from preoperative values. Other outcome measures were intraoperative and
postoperative complications and surgical revisions of the BGI. RESULTS:: A total
of 173 BGI procedures were performed during the study period. Only first-ever
BGI implantations in adult patients were analyzed, yielding 141 implants for the
analyses. The length of follow-up averaged 11.5 months (range, 0.3 to 24.7 mo)
and the mean (SD) preoperative intraocular pressure was 25.6 (8.6). Overall
success rates were 75% and 83%, respectively, for the 2 different groups (P=0.40
for differences between groups). Nine patients (6%) needed a reoperation,
whereas complications were documented in another 9 patients without significant
differences between groups. CONCLUSIONS:: Overall complication rates of the BGI
were low and they combined with high success rates. Outcomes did not differ
between the various surgical techniques. The choice of a certain technique might
therefore be based on differences in costs and length of surgery between these
techniques.

PMID: 22274670  [PubMed - as supplied by publisher]

6: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Corneal Biomechanics, Optic Disc Morphology, and Macular Ganglion Cell Complex
in Myopia.

Chang PY, Chang SW.

*Departments of Ophthalmology double daggerMedical Research, Far Eastern
Memorial Hospital, Ban-Chiao daggerDepartment of Ophthalmology, National Taiwan
University Hospital, Taipei, Taiwan.

PURPOSE:: To determine the association between corneal biomechanical properties
and optic disc morphology, to verify the relationship between corneal
biomechanical properties and peripapillary retinal nerve fiber layer (pRNFL)
thickness in myopia, and to investigate the association between axial length
(AL) and pRNFL and macular inner retinal layer (MIRL) thickness in myopia.
METHODS:: An observational cohort study was conducted. Corneal hysteresis (CH),
corneal resistance factor, central corneal thickness (CCT), AL, MIRL thickness,
and pRNFL thicknesses were measured. RESULTS:: This study examined 100 eyes from
50 patients, age 33.48+/-8.32 years (mean+/-SD), with spherical equivalent PMID: 22274669  [PubMed - as supplied by publisher]

7: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Reproducibility of the Mean, Fluctuation, and IOP Peak in the Diurnal Tension
Curve.

Hatanaka M, Babic M, Susanna R Jr.

University of Sao Paulo School of Medicine, Sao Paulo, SP Brazil.

PURPOSE:: To verify the reproducibility of the mean, peak, and fluctuation of
intraocular pressure (IOP) observed during modified diurnal tension curves
(mDTC) performed on ocular hypertensive and primary open-angle glaucoma
patients. METHODS:: Prospective analysis of 88 eyes from 88 ocular hypertensive
and primary open-angle glaucoma patients subjected to 2 consecutive mDTCs (IOP
measurements obtained at 8:00 AM, 11:00 AM, 2:00 PM, and 4:00 PM) on 2
consecutive days. Mean IOP was calculated as the average of all IOP measurements
obtained during each mDTC. Peak and minimum IOP levels were considered as the
highest and lowest IOP level during each mDTC, respectively. IOP fluctuation was
calculated using 2 different approaches: the difference between IOP peak and
minimum IOP detected during each mDTC and as the SD of all mDTC measurements.
Reproducibility was assessed using the intraclass correlation coefficient (ICC).
RESULTS:: IOP fluctuation between 2 days in the modified diurnal curve,
calculated as the difference between peak IOP and minimum IOP and as the SD of
all mDTC measurements, was less reproducible than the mean IOP and peak IOP (ICC
values 0.60, 0.62, 0.91, and 0.85, respectively; all ICC values, P<0.001).
CONCLUSIONS:: Mean IOP and peak IOP observed during the mDTC had good
reproducibility, whereas the reproducibility of IOP fluctuation was only fair.

PMID: 22274668  [PubMed - as supplied by publisher]

8: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Dampening of Diurnal Intraocular Pressure Fluctuation by Combined Trabeculotomy
and Sinusotomy in Eyes With Open-angle Glaucoma.

Matsuoka M, Ando A, Minamino K, Matsuyama K, Shima C, Matsumura M, Nishimura T.

*Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka
daggerNagata Eye Clinic, Nara, Japan.

PURPOSE:: Large diurnal intraocular pressure (IOP) fluctuation (triangle upIOP)
is believed to be one of the causes of progression in glaucomatous changes. Some
fully medicated glaucoma patients whose IOPs are controlled during the regular
office hours (10:00 to 16:00 h) still have progression in glaucomatous changes
and IOP elevation during off-office hours. The purpose of this study was to
determine whether triangle upIOP is dampened after combined trabeculotomy and
sinusotomy (LOT+SIN) in glaucoma patients with low IOPs during the regular
office hours. PATIENTS AND METHODS:: Fourteen eyes of 8 open-angle glaucoma
patients who had large triangle upIOP despite low IOPs during the office hours
were studied. The IOP was measured every 3 hours for 24 hours before and >3
months after the operation. The IOPs were measured in the sitting position with
a Goldmann applanation tonometer. All patients underwent LOT+SIN. RESULTS:: All
patients had IOP elevations >20 mm Hg between 0:00 and 3:00 hours before the
operation, and none had an IOP peak after the operation. The postoperative mean
IOP (16.5+/-1.7 to 13.9+/-2.0 mm Hg, P=0.00064), the maximum IOP (21.9+/-2.4 to
16.1+/-2.5 mm Hg, P=0.0020), and triangle upIOP (8.9+/-2.7 to 4.3+/-1.2 mm Hg,
P=0.0032) were significantly lower than the preoperative values. However, the
minimum IOP was not reduced significantly (13.0+/-1.9 to 11.7+/-1.7 mm Hg).
CONCLUSIONS:: The diurnal triangle upIOPs are dampened by LOT+SIN in glaucoma
patients with controlled IOPs during regular office hours. These results
indicate that these surgical procedures can be used for the treatment of
open-angle glaucoma patients.

PMID: 22274667  [PubMed - as supplied by publisher]

9: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Comparative In Vitro Flow Study of 3 Different Ex-PRESS Miniature Glaucoma
Device Models.

Estermann S, Yuttitham K, Chen JA, Lee OT, Stamper RL.

*Department of Ophthalmology, University of California San Francisco (UCSF), San
Francisco, CA daggerAugenklinik Stadtspital Triemli, Zurich, Switzerland.

PURPOSE:: To determine the flow characteristics of the 3 different models of the
Ex-PRESS miniature glaucoma device in a controlled laboratory study. MATERIALS
AND METHODS:: The 3 different Ex-PRESS models (P-50, R-50, and P-200; Optonol
Ltd; now Alcon Lab) were tested using a gravity-driven flow test. Three samples
of each of the 3 Ex-PRESS models were subjected to a constant gravitational
force of fluid at 5 different pressure levels (5 to 25 mm Hg). Four measurements
per sample were taken at each pressure level. The main outcome measure was flow
rate (Q) (microL/min). Resistance (R) was calculated by dividing pressure (P) by
the measured flow (Q). RESULTS:: The flow rate was primarily pressure dependent.
The P-200 model (internal diameter 200 microm) showed a statistically
significant higher flow rate and lower resistance compared with both the P-50
and R-50 models (internal diameter 50 microm) (P<0.0001). The P-50 and R-50
models demonstrated similar flow rates (P=0.08) despite their difference in tube
length (2.64 vs. 2.94 mm). CONCLUSIONS:: The 3 models of the Ex-PRESS mini shunt
behaved in vitro as simple flow resistors by creating a relatively constant
resistance to flow. Tube diameter was the only parameter with significant impact
on flow and resistance. All models demonstrated flow rates per unit of pressure
much higher than the outflow facility of a healthy human eye.

PMID: 22274666  [PubMed - as supplied by publisher]

10: J Glaucoma. 2012 Jan 20; [Epub ahead of print] 

Klinefelter Syndrome Associated With Goniodysgenesis.

Matlach J, Grehn F, Klink T.

Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany.

OBJECTIVE:: We report a case of a patient with Klinefelter syndrome and
glaucoma. CASE PRESENTATION:: A 30-year-old patient with karyotype 47, XXY,
presented with a known medical history of glaucoma. Besides reduced fertility,
no characteristic physical or behavioral symptoms for Klinefelter syndrome were
found on clinical examination. While both eyes were treated with topical
intraocular pressure-lowering medications, an increased intraocular pressure,
visual field losses, and advanced optic disc damage with a cup-disc ratio of 0.9
were assessed only in the right eye. However, gonioscopy revealed
goniodysgenesis in both eyes. DISCUSSION:: Klinefelter syndrome is the most
common cause of male hypogonadism with a variety of clinical signs and symptoms.
The principal effect is the hypogonadism predisposing to infertility and
requiring testosterone replacement therapy. Several other classical features of
the syndrome including mental retardation, gynecomastia, and breast cancer are
described. However, the association between Klinefelter syndrome and ocular
manifestations is rare. CONCLUSIONS:: Glaucoma or in fact any other ocular
manifestations associated with Klinefelter syndrome are rarely described. Here,
we report a case of glaucoma and its treatment combining trabeculotomy and
trabeculectomy in a patient with Klinefelter syndrome.

PMID: 22274665  [PubMed - as supplied by publisher]

11: J Glaucoma. 2012 Jan 3; [Epub ahead of print] 

Evaluation of Secondary Glaucoma Associated With Subluxated Lens Misdiagnosed as
Acute Primary Angle-closure Glaucoma.

Luo L, Li M, Zhong Y, Cheng B, Liu X.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen
University, Guangzhou, China.

PURPOSE:: To evaluate the causes of misdiagnosis in patients with acute
angle-closure glaucoma secondary to subluxated lens, and postoperative outcomes.
DESIGN:: Retrospective clinical study. METHODS:: Five hundred twenty-six cases
of acute angle-closure glaucoma were consecutively recruited from Zhongshan
Ophthalmic Center between March 2003 and March 2009. Zonular dialysis, anterior
chamber angle, and anterior chamber depth were examined by ultrasound
biomicroscopy. Surgical therapy was performed according to the degree of zonular
dialysis and angle closure. RESULTS:: Thirty-one eyes (5.89%) with acute
angle-closure glaucoma secondary to lens subluxation were misdiagnosed as acute
primary angle-closure glaucoma. In these cases, the anterior chamber depth of
the affected eyes was significantly shallower than the fellow eyes (1.34+/-0.45
vs. 2.27+/-0.44, P<0.05). The best-corrected visual acuity was significantly
improved 3 months after surgery, and intraocular pressure was well controlled in
all eyes. Mean intraocular pressure was 12.09+/-4.41 mm Hg without any
medication at the final visit. CONCLUSIONS:: The causes of misdiagnosis in
patients with acute angle-closure glaucoma secondary to subluxated lens include
neglected history and/or signs of ocular trauma. Lens extraction surgery was an
effective therapy for these cases.

PMID: 22218127  [PubMed - as supplied by publisher]