Novel method for endovascular fenestration using radiofrequency transseptal needle for aortic dissection with malperfusion syndrome.

Malperfusion syndrome is considered one of the most significant adverse events in aortic dissection disease and often requires invasive strategies to improve ischemia. We report the case of a patient who was presented with worsening claudication and leg rest pain due to malperfusion syndrome of type B aortic dissection. We successfully performed endovascular fenestration therapy to relieve the symptom by using a NRG radiofrequency transseptal needle (Baylis Medical, Montreal, Canada). We suggest that this novel method would be available for the patients with malperfusion syndrome of aortic dissection.

Effect of fat supplementation on the maintenance of gut integrity in elemental diet-fed rats.

AIMS: The aims of this study were to investigate the mechanism of atrophic change in ileal mucosa supplied with an elemental diet (ED) and to assess the value of supplemented fat emulsion in the prevention of atrophic change. MATERIALS AND METHODS: In experiment 1, 25 male Wistar rats with a body weight of 160-180 g were divided into 3 groups. The first group was fed regular rat chow (Control group, n=5). The second group was given ED containing 0.6% long-chain triglycerides (ED group, n=10). The third group was provided with fat-enriched ED (FED) containing 3.5% long-chain triglycerides (FED group, n=10). Each group received an isocaloric diet (300 kcal/kg/day). 4 weeks later, after euthanization, ileal samples were taken for light and electron microscopic examinations. The morphological changes of the intestinal mucosa and the crypt cell proliferation rate (CCPR) were determined. In experiment 2, to determine the site of fat absorption, 9 rats were fed ED for 1 week. After 24 h of food deprivation, all rats were given 2 ml of FED through a gastric tube. Then 1, 2, and 3 h(s) later, groups of 3 rats each were euthanized, and the total small intestine was obtained from each rat. The proximal and distal jejunum and distal ileum were stained with oil red O. RESULTS: In experiment 1, the samples had almost the same morphological appearance irrespective of the type of feeding. The CCPR was significantly diminished in the ED group compared with the Control group, while there was no statistical difference between the FED and Control groups. In experiment 2, the oil red O stain was positive in the proximal and distal jejunum, but was completely negative in the distal ileum. CONCLUSIONS: The introduction of ED does not soon result in an atrophic morphological change of the ileum but will decrease the CCPR. An additive fat emulsion which was rapidly absorbed by the distal jejunum could play a role in maintaining ileal mucosa integrity through some mechanism independent of absorption.

Intake of n-3 polyunsaturated fatty acids and non-alcoholic fatty liver disease: a cross-sectional study in Japanese men and women.

BACKGROUND/OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a common condition, in which abnormal amounts of triglycerides accumulate in hepatocytes and is closely related to cardiovascular diseases and diabetes. Dietary fats contribute 15% of fat accumulation in the liver and regulate hepatic lipid metabolism. The supplementation of n-3 polyunsaturated fatty acids (n-3 PUFAs) improves NAFLD. The aim of this study is to assess the cross-sectional association between dietary n-3 PUFAs and NAFLD in Japanese men and women. SUBJECTS/METHODS: Participants were middle-aged, apparently healthy, 296 men and 496 women, who did not drink alcohol and who participated in a general health check-up program. Dietary information from the previous month was obtained by the brief-type self-administered diet history questionnaire. NAFLD was diagnosed if abdominal ultrasonography revealed the presence of fatty liver. RESULTS: The prevalence of NAFLD was 45.3% in men and 17.5% in women. In comparison with the first tertile, multivariate adjusted odds ratios (95% confidence intervals) for the presence of NAFLD in the second and third tertiles for men taking eicosapentaenoic acid (EPA) were 0.59 (0.31-1.14) and 0.45 (0.23-0.90), respectively, (P for linear trend=0.024), and the multivariate adjusted odds ratios (95% confidence intervals) for the presence of NAFLD in the second and third tertiles for men taking EPA+docosahexaenoic acid (DHA) were 0.44 (0.23-0.86) and 0.48 (0.24-0.95), respectively, (P for linear trend=0.035). However, there was no significant relation between NAFLD and each of these nutrients in women. CONCLUSIONS: Dietary EPA and EPA+DHA may be independent and preventive nutrients for NAFLD in Japanese men.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND: Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study. METHODS: This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study. RESULTS: In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT. CONCLUSIONS: The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

Clinical response to risperidone in relation to plasma drug concentrations in acutely exacerbated schizophrenic patients.

There are no data indicating a clear relationship between the clinical effect of risperidone and plasma drug concentration. In this study, 51 patients with acutely exacerbated schizophrenia received 6 mg risperidone/day for 4 weeks. A clinical evaluation using the Brief Psychiatric Rating Scale (BPRS) and Udvalg for Klinicke Undersøgelser (UKU) side effect rating scale were performed at baseline and each week. Significant (P < 0.05) correlations were found between plasma concentrations of risperidone and improved total BPRS scores, positive and cognitive symptoms. Plasma concentrations of the active moiety were significantly (P < 0.05) correlated with improved total BPRS scores. Improved score and percent improvement in anxiety-depression subscale were significantly (P < 0.01) correlated with plasma concentrations of the active moiety. The sum of total UKU side effect scores from 1 to 4 weeks was significantly correlated with plasma concentration of both risperidone (rs = 0.319, P < 0.05) and active moiety (rs = 0.373, P < 0.01). The sum of the psychic subgroup scores was significantly correlated with plasma concentrations of active moiety (rs = 0.318, P < 0.05). Results suggest that plasma drug concentrations are, to some extent, associated with improved scores in some psychopathological schizophrenic symptoms and sedative side effects. These findings should be replicated with a larger patient sample.

BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians.

OBJECTIVE: To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in association with diabetes or hypertension. METHODS AND PROCEDURES: Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35-74 years, of different ethnicities were included in this meta-analysis. RESULTS: Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P=0.001) in men but with WC and WSR than BMI (both P<0.05) in women. Hypertension had stronger association with BMI than WHR in men (P<0.001) and had the strongest with BMI than the others (WHR P<0.001; WSR P<0.01; and WC P<0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped. DISCUSSION: WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.

Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults.

AIMS: To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with impaired glucose metabolism in Japanese subjects. METHODS: One thousand, nine hundred and fifty subjects enrolled in a general health examination programme from September 2002 to February 2003 were recruited. NAFLD was diagnosed if a person showed 'fatty liver' on ultrasonography, and his/her alcohol consumption, estimated by questionnaire, was < 40 gram/week. A general linear model was used for the comparison of estimated means of metabolic variables adjusted for age and body mass index (BMI) between subjects with NAFLD and those without fatty liver. Multivariate regression with fasting plasma glucose (FPG) as the dependent variable was performed in 1547 non-diabetic individuals after adjusting for age, gender, BMI and NAFLD. RESULTS: NAFLD was found in 566 of the 1950 health-check examinees (29%). Its prevalence increased with increasing FPG levels: 27% in the subgroup with normal fasting glucose, 43% in impaired fasting glucose and 62% in newly diagnosed diabetes. Adjusted means of FPG, HbA1c, triglyceride, total protein, albumin, AST and ALT were all significantly higher, while adjusted means of HDL cholesterol and AST/ALT ratio were significantly lower in subjects with NAFLD than those without fatty liver. Multivariate regression analysis showed that NAFLD was independently associated with increasing FPG in non-diabetic individuals. CONCLUSIONS: The prevalence of NAFLD was 29% in apparently healthy middle-aged Japanese adults and NAFLD was independently associated with impaired glucose metabolism.

Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin.

AIMS/HYPOTHESIS: The study was done to assess how well fasting and 2-h plasma glucose (FPG, 2-h PG) after a 75-g OGTT predict cardiovascular disease (CVD) and all-cause mortality in Asian subjects. METHODS: People ( n=6817) of Japanese and Asian Indian origin from five prospective studies in five countries were monitored for 5 to 10 years. Hazard ratios for death from all causes and CVD were estimated using Cox proportional hazard models, adjusting for FPG, 2-h PG and established risk factors. RESULTS: Multivariate Cox regression analysis showed that an increase in FPG from 7.0 to 8.0 mmol/l (increase of 0.76 SD) increased relative risk (95% CI) by 1.14 (1.05-1.25) for all-cause and 1.24 (1.10-1.39) for CVD mortality. An increase in 2-h PG from 9.0 to 11.9 mmol/l (0.76 SD) increased relative risks by 1.29 (1.18-1.41) and 1.35 (1.19-1.54). Inclusion of 2-h PG in the FPG model improved the predictive value ( p<0.001), whereas FPG did not influence the predictive value of 2-h PG ( p>10). In a model containing FPG and 2-h PG, hazards ratios for 2-h PG in subjects with IGT or diabetes were 1.35 (1.03-1.77) or 3.03 (2.18-4.21) for all-cause and 1.27 (0.86-1.88) or 3.39 (2.14-5.37) for CVD mortality, compared with normal subjects. The respective hazards ratio for FPG in subjects with IFG or diabetes were 0.94 (0.68-1.31) or 0.88 (0.59-1.32) for all-cause and 1.05 (0.67-1.65) or 0.88 (0.51-1.51) for CVD mortality, compared with normal subjects. CONCLUSIONS/INTERPRETATION: For prediction of premature death, 2-h PG was superior to FPG in several Asian populations.

Age, body mass index and Type 2 diabetes-associations modified by ethnicity.

AIMS/HYPOTHESIS: The aim of this study was to assess the effect of ethnicity on the association between age and body mass index as well as the prevalence of diabetes. METHODS: We selected population-based studies carried out after 1980 in the DECODE/A studies representing different ethnic groups: 11 European, 1 Maltese, 3 Indian, 2 Chinese and 3 Japanese surveys. The total numbers of subjects were 14,240 men and 15,129 women who were 30 to 89 years of age. Diabetes was diagnosed according to the 1999 World Health Organization criteria based on a standard 75 g OGTT. Sex-specific prevalence of diabetes by age and BMI was stratified by ethnic group, in particular the interaction of ethnicity on the associations between age/BMI and the prevalence of diabetes. RESULTS: The prevalence of diabetes was higher in studies from India and Malta compared to Japan, China, and the rest of Europe. The association between BMI and diabetes, adjusted for age, showed noticeable differences between the ethnic groups with an increase in prevalence starting at a BMI between 15 and 20 kg/m(2) in the Maltese and Indian populations compared to 25 kg/m(2 )in Europeans. CONCLUSION/INTERPRETATION: The effect of BMI on the age-adjusted prevalence of Type 2 diabetes was modified by ethnicity with considerably lower thresholds in Indian and Maltese subjects compared to those from the rest of Europe. This difference should be reflected in national and international recommendations regarding "optimal" BMI.

Local ocular immunotherapy for experimental allergic conjunctivitis.

PURPOSE: We studied the efficacy of eyedrops as local ocular immunotherapy against experimental allergic conjunctivitis. METHODS: Guinea pigs were sensitized with an intraperitoneal injection of ovalbumin (OA). Three weeks after the sensitization, a low concentration (10 microg/mL) of OA eyedrops was administered once a day for 3 weeks. Six weeks after the sensitization, an allergic inflammation was provoked with 20 mg/mL of OA eyedrops. RESULTS: In conjunctival clinical scores 30 minutes after the allergen challenge, there was no significant difference between the controls and the treated group. The total number of inflammatory cells in the conjunctiva 8 hours after the allergen challenge was significantly decreased in the treated group (60.8 +/- 23.2 cells/field) compared with the control group (199.1 +/- 83.4 cells/field). Eosinophils in the conjunctiva 24 hours after the allergen challenge were also significantly decreased in the treated group (22.1 +/- 15.5 cells/field) compared with the control group (50.3 +/- 15.0 cells/field). CONCLUSIONS: In this study, local ocular immunotherapy mainly suppressed the late phase reaction of allergic inflammation. These results coincide with previous studies of immunotherapy in which a subcutaneous injection was used. Local ocular immunotherapy is effective against experimental allergic conjunctivitis.

The Contribution of Inflammatory Cell Infiltration to Conjunctival Inclusion Cyst Formation.

Purpose: The incidence of inclusion cysts was examined histopathologically in conjunctival disorders where inflammatory cell infiltration was seen in the subepithelial connective tissue.Method: The incidence of inclusion cysts was examined histopathologically in pterygium, vernal conjunctivitis, pyogenic granuloma and pingueculitis. The specimens of pinguecula were used as control.Results: Inclusion cysts were recognized in 5/(55) cases of pterygium, 2/(12) cases of vernal conjunctivitis, 1/(4) cases of pyogenic granuloma, and 1/(2) cases of pingueculitis. On the other hand no inclusion cyst was recognized in 20 cases of pinguecula in which no inflammatory cell infiltration was seen.Conclusions: Inflammatory cell infiltration may contribute to the formation of conjunctival inclusion cysts in pterygium, pingueculitis, vernal conjunctivitis and pyogenic granuloma.

Expression of stem cell factor in pterygium.

PURPOSE: To investigate the possible role of stem cell factor (SCF) in the pathogenesis of pterygium. METHODS: The localization of SCF was examined immunohistochemically in excised tissue from 4 primary pterygia and 5 normal conjunctival specimens. RESULTS: Three of the four pterygia showed strong immunoreactivity of SCF in the subepithelial connective tissue at the cap area. This immunoreactivity was completely blocked by using a primary antibody preincubated with recombinant SCF. The SCF-positive cells were identified as a population of fibroblasts by immunostaining for vimentin and prolyl 4-hydroxylase in adjacent sections. No apparent immunoreactivity of SCF was observed in the subepithelial connective tissues in the head and body of the pterygia and in the normal conjunctiva. CONCLUSION: Stem cell factor is overexpressed in fibroblasts at the cap area of most pterygia.

[The contribution of inflammatory cell infiltration to conjunctival inclusion cyst formation].

PURPOSE: The incidence of inclusion cysts was examined histopathologically in conjunctival disorders where inflammatory cell infiltration was seen in the subepithelial connective tissue. METHOD: The incidence of inclusion cysts was examined histopathologically in pterygium, vernal conjunctivitis, pyogenic granuloma and pingueculitis. The specimens of pinguecula were used as control. RESULTS: Inclusion cysts were recognized in 5/55 cases of pterygium, 2/12 cases of vernal conjunctivitis, 1/4 cases of pyogenic granuloma, and 1/2 cases of pingueculitis. On the other hand no inclusion cyst was recognized in 20 cases of pinguecula in which no inflammatory cell infiltration was seen. CONCLUSIONS: Inflammatory cell infiltration may contribute to the formation of conjunctival inclusion cysts in pterygium, pingueculitis, vernal conjunctivitis and pyogenic granuloma.

Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts.

AIMS/HYPOTHESIS: The American Diabetes Association recommended that only a single fasting plasma glucose of greater than or equal to 7.0 mmol/l should be used for diagnosing diabetes in epidemiological studies and did not recommend using a 2-h oral glucose tolerance test. We evaluated the effect of diagnostic changes on the prevalence of diabetes and on the choice of subjects diagnosed with diabetes. METHODS: Existing epidemiological data collected from Asian people between 30 and 89 years of age, was re-analysed separately in 11 population-based studies (n = 17,666), 6 pre-selected hyperglycaemic cohorts (n = 12,221) and one suspected diabetic cohort (n = 8382). RESULTS: Among the 11 population-based studies, the new fasting glucose criteria resulted in an overall reduction of 1.8% in the prevalence of diabetes, which ranged from a reduction of 4.8% to an increase of 1.7% in the different studies. Of 1215 subjects diagnosed with diabetes by either criteria, only 449 met both criteria, a concordance of 37%. More than half of the diabetic subjects had isolated post-challenge hyperglycaemia and three quarters of the subjects with impaired glucose tolerance, according to the 2-h glucose criteria, were normal according to the fasting glucose criteria. Subjects diagnosed as diabetic based only on the 2-h glucose criteria were, on average, older than those with diabetes according to the fasting criteria. CONCLUSION/INTERPRETATION: The fasting and the 2-h glucose criteria diagnose different groups of subjects. It would therefore be inappropriate to use the fasting glucose criteria alone for screening diabetes in Asian populations.

Mast cells in pterygium: number and phenotype.

PURPOSE: To investigate the pathogenesis of pterygium. METHODS: The number and phenotype of mast cells were examined in excised tissue from 35 pterygia patients and compared with those in normal conjunctival specimens obtained during cataract or other intraocular surgery. RESULTS: Toluidine blue staining showed that the mean number of mast cells in the pterygia specimens was twice as high as that in the normal conjunctival tissues. Immunohistochemistry with a primary antibody to tryptase, specific for mast cells, also revealed a twofold increase in the mast cell number in the pterygia specimens compared with the normal conjunctival tissues. In the pterygia, more than 94% of the tryptase-positive mast cells were found to express chymase and c-kit. Almost all mast cells in the pterygia were tryptase-positive, chymase-positive mast cells (MC(TC)S). There was no phenotypic difference between the mast cells in the pterygia and those in the normal conjunctival tissues. CONCLUSIONS: The MC(TC)S appear not to be immune system-related and to have functions in angiogenesis and tissue remodeling. The increase in the number of mast cells caused by nonallergic stimulation may contribute to the pathogenesis of pterygium.

Adenosine triphosphate-sensitive potassium channels are involved in insulin-mediated glucose transport in humans.

We investigated the influence of treatment with nicorandil, a K-channel opener currently used for angina, on glucose homeostasis in patients with non-insulin-dependent diabetes mellitus (NIDDM) and coronary artery disease (CAD). Adenosine triphosphate (ATP)-sensitive K (K-ATP) channels are present in various tissues, including pancreatic B cells and skeletal muscle, and are the putative targets of this agent. Nine NIDDM patients with CAD and five healthy subjects participated in the study. Fasting plasma levels (mean+/-SEM) of glucose (144+/-11 to 180+/-22 mg/dL, P<.05) and insulin (5.8+/-1.6 to 7.0+/-1.8 microU/mL, P<.05) and hemoglobin A1c (7.54+/-0.47 to 8.11+/-0.55%, P<.01) increased significantly in nine NIDDM patients after treatment with nicorandil at a dose of 5 mg three times daily for 2 to 8 months. Glucose tolerance as examined by an identical meal test deteriorated (P<.001), but the insulin response did not change significantly. A washout of nicorandil for 1 to 4 months restored glucose tolerance almost to pretreatment levels in four patients. A 5- to 7-day trial of nicorandil (5 mg three times daily) in five healthy subjects resulted in a marginal to twofold increase in fasting plasma insulin, reflecting the progression of insulin resistance. In addition, three healthy subjects showed a substantial reduction in the glucose infusion rate (GIR) required in the euglycemic-hyperinsulinemic clamp study. Since the therapeutic dose of nicorandil did not affect pancreatic B-cell function but caused insulin resistance in both healthy and NIDDM subjects, we conclude that K-ATP channels play a regulatory role in insulin-mediated glucose transport in humans.

[Pterygium and mast cells--expression of basic fibroblast growth factor increase in mast cells of the pterygium].

We examined the expression of basic fibroblast growth factor (bFGF) protein immunohistochemically, and bFGF specific messenger RNA (bFGF-mRNA) by in situ hybridization in the excised tissue of 5 cases of pterygium and 4 cases of normal conjunctiva. Immunohistochemical staining for bFGF showed strong positive staining in metachromatic mast cells stained with toluidine blue in the pterygium and in normal conjunctival specimens. The mean metachromatic mast cell count in pterygium specimens was increased significantly when compared with normal conjunctiva. In mast cells, bFGF positive rate was 84% in pterygium specimens, and 69% in normal conjunctival specimens. In situ hybridization indicated that the bFGFmRNA is located in most mast cells in pterygium specimens, but in only a few mast cells in normal conjunctival specimens. These results suggest that increased bFGF protein produced and stored by mast cells in the pterygium may contribute to its progression.

[Effect of ultraviolet-filtering contact lens on rabbit eyes after exposure to ultraviolet light].

We evaluated the protective effect of a newly designed soft contact lens (SCL) on rabbit eyes. This SCL absorbs the ultraviolet B light of wavelengths between 280 nm and 320 nm. Three weeks after resecting the nictitating membrane, the rabbit corneas were covered either by the new SCL or a conventional SCL. The eyes were exposed to ultraviolet light from two 15 W lamps placed 20 cm anteriorly for 3 hours. Another three hours after the exposure, the cornea was examined first with a slitlamp biomicroscope after staining with fluorescein and then by histopathological means after enucleation. Six eyes wearing the new SCL showed moderate superficial punctate keratopathy. Six eyes wearing conventional SCL showed severe superficial keratopathy or corneal erosion. These findings were in good agreement with the histopathological findings. The new ultraviolet-filtering SCL was thus effective in protecting the rabbit cornea under our experimental conditions.

[Pterygium and mast cells--mast cell number, phenotype, and localization of stem cell factor].

We examined the number and phenotype of mast cells, and the localization of stem cell factor (SCF) as a growth factor of mast cells in the excised tissue of 38 cases of pterygium. In histopathology with toluidine blue stain and immunohistochemistry with a monoclonal antibody to tryptase, the mean mast cell count in pterygium specimens was twice as high as in normal conjunctiva. In pterygium specimens more than 94% of tryptase-positive mast cells were found to express chymase and c-kit. There was no phenotypic difference between mast cells in pterygium and normal conjunctiva. In all immunohistochemical specimens in which we could examine the head of the pterygium, SCF was expressed in subepithelial fibroblasts at the central edge of pterygium. The results suggest that overexpression of SCF was accompanied with the augmentation of mast cells in the pterygium.

Optic disc findings in normal tension glaucoma.

One hundred thirty stereo photographs of optic discs in patients with normal tension glaucoma (NTG) were reviewed in order to identify characteristics of the three following types of NTG: focal ischemic, senile sclerotic, and generalized cup enlargement. Twenty patients in each group were selected. Focal ischemic patients were more frequently women, had a higher incidence of migraine, a relatively smaller disc size, and localized superior scotoma that often threatened fixation. Senile sclerotic patients were generally elderly, had a higher incidence of surgery under general anesthesia, had more ischemic heart disease or systemic hypertension, had a small rim area, and also had extensive peripapillary atrophy as well as combined diffuse and localized visual field defects. Generalized cup enlargement patients were younger, had a relatively larger disc size and a greater incidence of purely diffuse visual field loss. Results of our study suggest that the different characteristics of the groups are related to pathogenic mechanisms specific to each group.