Comparison of intraocular pressure fluctuation and glaucoma progression rate between phakic and pseudophakic eyes in pseudoexfoliation glaucoma.

The management of patients with concurrent pseudoexfoliation glaucoma (PXG) and cataract is challenging given its worse prognosis compared to other glaucoma types and the increased risk associated with cataract surgery. In this retrospective study, we investigated the long-term outcomes of cataract surgery in patients with PXG. We enrolled patients with PXG who had undergone cataract surgery at least 2 years previously and compared them with mean deviation (MD) matched patients with phakic eyes. The results showed that both groups experienced a decrease in MD, with the group of pseudophakic eyes exhibiting a significantly higher rate of decline (-2.15 ± 2.66 dB/year vs. -0.86 ± 0.95 dB/year; P = 0.040). Similarly, there was a trend towards more rapid thinning of the retinal nerve fiber layer in the pseudophakic group (-2.92 ± 2.34 µm/year vs. -1.79 ± 1.71 µm/year; P = 0.074). No significant differences in the intraocular pressure parameters were observed between the two groups. Multivariate analysis revealed that pseudophakic lens status was significantly associated with a faster rate of MD decline in patients with PXG (regression coefficient, -1.391; P = 0.022). These findings underscore the importance of close monitoring of patients with pseudophakic PXG to effectively manage glaucoma progression.

Comparison of RCI001 and corticosteroid on the effects on intraocular pressure in mice.

Purpose: RCI001, a novel therapeutic candidate for the treatment of ocular inflammatory diseases, have demonstrated remarkable anti-inflammatory and antioxidant effects in various ocular experimental models. This study was to evaluate the effects of RCI001 on intraocular pressure (IOP) and compare them with those of corticosteroids in experimental mouse models. Methods: Experimental mice were randomly divided into naïve, phosphate-buffered saline (PBS), 0.1% dexamethasone (DEX-1), and 1% RCI001 (RCI) groups, and each reagent was pipetted into the right eye of the mouse at 10 µL thrice daily for 5 weeks. In addition, 20 µL of 0.1% dexamethasone was injected subconjunctivally into the right eye once weekly for 5 weeks in the DEX-2 group. The IOP was measured under anesthesia at baseline and twice weekly for 5 weeks. The △IOP (%) was defined as the change in IOP from baseline [△IOP (%) = (IOPweek5-IOPbaseline)/IOPbaseline × 100%]. The anterior segments were clinically and histologically examined. Results: There was no significant increase in IOP and △IOP (%) [values by week 3 (day 21) in any of the groups]. However, IOP and △IOP (%) in the DEX-2 group tended to increase slightly after day 10 compared with baseline. Compared with baseline IOP values, the DEX-1 group showed a statistically significant increase in IOP at weeks 4 and 5, and the DEX-2 group at week 5. The △IOP (%) of the DEX-1 and DEX-2 groups (%) at week 5 were 38.2% ± 5.8% and 38.4 ± 4.6%, respectively. However, the IOP in the RCI group did not increase significantly until week 5. The RCI group did not show notable corneal changes, such as epithelial defects or stromal opacities, at week 5. In addition, hematoxylin and eosin (H&E) staining of corneas in the RCI group revealed healthy corneal epithelial, stromal, and endothelial integrity. Conclusion: Long-term use of RCI001 did not induce significant IOP elevation or ocular surface changes, whereas topical corticosteroids significantly increased the IOP. Therefore, RCI001 may be an effective anti-inflammatory agent with a low risk of drug-induced IOP elevation.

Longitudinal Changes in Peripapillary and Macular Vessel Densities in Glaucomatous Eyes With a Single-Hemifield Retinal Nerve Fiber Layer Defect.

PRCIS: The peripapillary vessel density decreased significantly in the affected hemiretina compared with that in the intact hemiretina in glaucomatous eyes with a single-hemifield retinal nerve fiber layer defect. PURPOSE: To evaluate the difference in the change rates of peripapillary vessel density (pVD) and macular vessel density (mVD) measured using optical coherence tomography angiography (OCTA) in glaucomatous eyes with a single-hemifield retinal nerve fiber layer (RNFL) defect. MATERIALS AND METHODS: We performed a retrospective, longitudinal study of 25 patients with glaucoma who were followed up for at least 3 years, with a minimum of 4 visits after baseline OCTA. At each visit, all participants underwent OCTA examination, and the pVD, mVD were measured by removing the large vessels. Changes in the pVD, mVD, peripapillary RNFL thickness (pRNFLT), and macular ganglion cell inner plexiform layer thickness were investigated in the affected and intact hemispheres, and the differences between the 2 hemispheres were compared. RESULTS: In the affected hemiretina, the pVD, mVD, pRNFLT, and mCGIPLT were reduced than that in the intact hemiretina (all, P < 0.001). The changes in pVD and mVD were statistically significant at the 2-year and 3-year follow-ups in the affected hemifield (all, P <0.05). However, pVD and mVD did not show statistically significant changes in the intact hemiretina throughout the follow-up visits. Although the pRNFLT decreased significantly at the 3-year follow-up, the macular ganglion cell inner plexiform layer thickness showed no statistical change at any follow-up visit. Compared with the intact hemisphere, pVD was the only parameter that showed significant changes throughout the follow-up period. CONCLUSION: Although pVD and mVD decreased in the affected hemiretina, the reduction in pVD was significant compared with that in the intact hemiretina.

Comparison of Vision-related Quality of Life Between Normal Tension Glaucoma and Primary Open-angle Glaucoma.

PRCIS: Although there was little difference in overall vision-related quality of life (VRQOL) between patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) after controlling for confounding factors, POAG tended to have poorer VRQOL, especially in social functioning and dependency, than NTG. PURPOSE: The fundamental goal of treatment of patients with glaucoma is to preserve their VRQOL. The aim of this study was to compare VRQOL between patients with NTG and those with POAG. MATERIALS AND METHODS: The self-reported National Eye Institute Visual Function Questionnaire (NEI VFQ-25) survey was performed, including clinical, demographic, and socioeconomic data from 506 Korean patients with NTG and 287 with POAG. The mean deviation of the integrated binocular visual field was calculated using the best location method. The NEI VFQ-25 results were evaluated by Rasch analysis to control item difficulty and variation in individual response ability. Propensity score matching was used to control for various confounding factors affecting VRQOL. RESULTS: Although patients with POAG tended to have worse VRQOL than those with NTG, there was no statistically significant between-group difference in ocular pain, near and distance activities, mental health, role difficulties, ability to drive, and the overall composite score. However, the social functioning (P=0.016) and dependency (P=0.026) were significantly poorer in POAG patients. CONCLUSIONS: Overall VRQOL in patients with NTG and POAG was found to be similar. However, social functioning and dependency were significantly worse in those with POAG. These findings are relevant to supporting glaucoma patients.

Bleb-related Porcine Lymphatic Outflow is Greater from Subconjunctival compared to Subtenon Blebs.

Aim: Understanding the mechanism of fluid outflow by comparing the subconjunctival and subtenon spaces can lead to improved ocular therapeutics. The purpose of the current study is to evaluate subconjunctival vs subtenon lymphatic outflow by creating tracer-filled blebs in each location. Methods: Porcine (n = 20) eyes received subconjunctival or subtenon injection(s) of fixable and fluorescent dextrans. Blebs were angiographically imaged using a Heidelberg Spectralis ([Heidelberg Retina Angiograph] HRA + OCT; Heidelberg Engineering) and bleb-related lymphatic outflow pathways were counted. Optical coherence tomography (OCT) imaging of these pathways was used to assess structural lumens and the presence of valve-like structures. Furthermore, a comparison between tracer injection locations (superior/inferior/temporal/nasal) was made. Histologic analyses for subconjunctival and subtenon outflow pathways were performed, to confirm tracer co-localization with molecular lymphatic markers. Results: Subconjunctival blebs demonstrated a greater number of lymphatic outflow pathways compared to subtenon blebs in every quadrant [superior: 6.10 ± 1.18 (subconjunctival) vs 0.50 ± 0.27 (subtenon); temporal: 2.30 ± 0.40 vs 0.10 ± 0.10; nasal: 5.30 ± 0.60 vs 0.30 ± 0.21; inferior: 6.00 ±1.29 vs 0.1 ± 0.1; all comparisons p < 0.001]. For subconjunctival blebs, the temporal quadrant showed fewer lymphatic outflow pathways compared to the nasal side (p = 0.005). Discussion: Subconjunctival blebs accessed greater lymphatic outflow compared to subtenon blebs. Furthermore, regional differences existed, with fewer lymphatic vessels temporal than at the other locations. Clinical significance: Aqueous humor drainage after glaucoma surgery is incompletely understood. The present manuscript adds to our understanding of how lymphatics might influence filtration bleb function. How to cite this article: Lee JY, Strohmaier CA, Akiyama G, et al. Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs. J Curr Glaucoma Pract 2022;16(3):144-151.

Morphological changes in the trabecular meshwork and Schlemm's canal after treatment with topical intraocular pressure-lowering agents.

Glaucoma treatment is usually initiated with topical medication that lowers the intraocular pressure (IOP) by reducing the aqueous production, enhancing the aqueous outflow, or both. However, the effect of topical IOP-lowering medications on the microstructures of the aqueous outflow pathway are relatively unknown. In this retrospective, observational study, 56 treatment-naïve patients with primary open-angle glaucoma were enrolled. Images of the nasal and temporal corneoscleral limbus were obtained using anterior segment optical coherence tomography (AS-OCT). The conjunctival vessels and iris anatomy were used as landmarks to select the same limbal area scan, and the trabecular meshwork (TM) width, TM thickness, and Schlemm's canal (SC) area were measured before and after using the IOP-lowering agents for 3 months. Among the 56 patients enrolled, 33 patients used prostaglandin (PG) analogues, and 23 patients used dorzolamide/timolol fixed combination (DTFC). After 3 months of DTFC usage, the TM width, TM thickness, and SC area did not show significant changes in either the nasal or temporal sectors. Conversely, after prostaglandin analog usage, the TM thickness significantly increased, and the SC area significantly decreased (all P < 0.01). These findings warrant a deeper investigation into their relationship to aqueous outflow through the conventional and unconventional outflow pathways after treatment with PG analogues.

Long-Term Effectiveness and Safety of Tafluprost, Travoprost, and Latanoprost in Korean Patients with Primary Open-Angle Glaucoma or Normal-Tension Glaucoma: A Multicenter Retrospective Cohort Study (LOTUS Study).

This multicenter retrospective cohort study compared the effectiveness and safety of long-term tafluprost, travoprost, or latanoprost in patients with primary open-angle glaucoma (POAG) or normal-tension glaucoma (NTG). Data were extracted from electronic medical records of 300 patients treated with tafluprost, travoprost, or latanoprost for >6 months. Propensity matching for age and sex was used for effectiveness and safety comparisons. The primary endpoint was visual field (VF) progression via mean deviation (MD) slope. Secondary endpoints were change of MD, intraocular pressure, pattern standard deviation, VF index, and advanced glaucoma intervention study score. Treatment-related adverse events (AEs) were also compared between groups. Overall, 216 POAG or NTG patients were matched into Match Set 1 (72 patients/group), and 177 NTG-only patients in Match Set 2 (59 patients/group) according to: age (mean: 61, 62 years) and sex (male: 53, 56%). There were no statistically significant between-group differences regarding MD slope (p = 0.413, p = 0.374 in Match Sets 1 and 2, respectively). There were no significant between-group differences/tendencies regarding secondary endpoints. No AEs were serious, and there were no significant between-group differences regarding reported AEs. In patients with POAG or NTG, long-term tafluprost, travoprost, or latanoprost showed similar effects. All three prostaglandin analogs had good long-term safety profiles.

Effects of Trabecular Meshwork Width and Schlemm's Canal Area on Intraocular Pressure Reduction in Glaucoma Patients.

PURPOSE: To evaluate the effects of baseline trabecular meshwork (TM) and Schlemm's canal (SC) microstructures on intraocular pressure (IOP) reduction amount in treatment-naïve patients with primary open-angle glaucoma (POAG). METHODS: A total 69 eyes of POAG patients who had not been treated with IOP-lowering agent were enrolled in this retrospective study. The patients had been prescribed topical IOP-lowering agent and used it for 1 year. The morphologic features of the TM and SC were collected using anterior segment module of spectral-domain optical coherence tomography with enhanced depth imaging at baseline. Images of the nasal and temporal corneoscleral limbus were obtained with serial horizontal enhanced depth imaging B-scans and TM width and SC area were measured in each scan. We investigated the effects of baseline TM and SC microstructures on IOP reduction amount. RESULTS: The baseline IOP of 69 glaucomatous eyes was 17.9 ± 3.8 mmHg, and the mean amount of IOP reduction was 3.5 ± 2.1 mmHg after 1 year. Mean TM widths of nasal and temporal sector were 470.33 ± 80.05 and 479.74 ± 79.59 µm, respectively. SC area was measured as 4,818.50 ± 1,464.28, 4,604.23 ± 1,567.73 µm2 at nasal sector and temporal sector, respectively. The correlation analysis revealed a positive correlation between SC area and average amount of IOP reduction, indicating that the larger baseline SC area, the greater the IOP drop with topical IOP-lowering agents. However, no correlation was found between TM width and IOP lowering amount in patients with POAG. CONCLUSIONS: The baseline SC area showed positive correlation with the IOP reduction amount in patients with POAG. This finding suggests that the SC area can be a clinical parameter to predict the IOP reduction amount before using IOP-lowering agents in POAG patient.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017-2021).

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Effect of prostaglandin analogues on anterior scleral thickness and corneal thickness in patients with primary open-angle glaucoma.

Prostaglandin (PG) analogues are usually prescribed as a first-line therapy in patients with glaucoma because of its once-daily dosing benefit and effective intraocular pressure (IOP) reduction. However, the mechanism of PG analogues is not completely understood. In this study, we investigated the effect of PG analogues on the anterior scleral thickness (AST) in treatment-naïve eyes with primary open-angle glaucoma using anterior segment optical coherence tomography. The AST was measured at the location of the scleral spur, 1000 µm, and 2000 µm posterior to the scleral spur and was compared before and after using the medications for 3 months and 1 year. Among 54 patients enrolled in this study, 31 patients used prostaglandin analogues and 23 patients used dorzolamide/timolol fixed combination (DTFC) drugs. There was no significant difference in untreated IOP, glaucoma severity, and baseline AST values between the two groups. While there was no significant changes in AST after using the DTFC drugs, the AST at all 3 locations showed a significant reduction in both the nasal and temporal sectors after using PG analogues for 1 year (all, P < 0.05). These findings suggest that the AST reduction after using PG analogues might be related with the increased uveoscleral outflow.

The effects of peripheral anterior synechiae on refractive outcomes after cataract surgery in eyes with primary angle-closure disease.

ABSTRACT: Objective of the study was to investigate the effects of peripheral anterior synechiae (PAS) on refractive outcomes after cataract surgery in eyes with primary angle-closure disease (PACD).This is a retrospective, cross-sectional study. Seventy eyes of 70 PACD patients who underwent phacoemulsification and intraocular lens implantation. Patients were divided into 2 groups based on the presence of PAS on preoperative gonioscopy. The predictive power of the intraocular lens was calculated by the SRK/T, Hoffer Q, Haigis, and Holladay formulae. The mean absolute error (MAE) and predicted refractive errors were compared between PAS (+) and PAS (-) groups. We also evaluated the refractive errors with regards to the extent of PAS in the subanalyses.The mean MAE was greater in the PAS (+) group with all formulae (0.61-0.70 diopters [D] vs 0.33-0.45 D, all P < .05). The eyes with PAS tended towards myopia (-0.30 D to -0.51 D vs -0.05 D to +0.24 D, all P < .05). However, the MAEs or predicted refractive errors were not different, irrespective of the extent of PAS in the subanalyses (all, P > .05).The presence or absence of PAS may influence the postoperative refractive outcomes in PACD patients.

Effect of Head Position and Tube Entry on Corneal Endothelial Cells in Patients with Glaucoma Drainage Implants: A Cross-sectional Study.

PURPOSE: To investigate the effect of head tilt on the tube position of the Ahmed glaucoma valve (AGV) implanted in patients with glaucoma and to assess how the head tilt-induced alterations of tube parameters and the level of tube entry influence corneal endothelial cell density (ECD). METHODS: A total of 29 eyes of 26 patients with AGV implantation were included. Tube-cornea distance, tube-cornea angle, and intracameral tube length were measured using anterior segment optical coherence tomography in three different head positions (neutral, 30° temporalward tilt, and 30° nasalward tilt). The tube entry was assessed using static gonioscopy. ECD was measured using specular microscopy before and after surgery. RESULTS: The mean tube-cornea distance, tube-cornea angle, and intracameral tube length (neutral: 0.87 ± 0.39 mm, 30.56 ± 5.89˚, and 3.10 ± 0.82 mm, respectively) decreased with head tilts (temporalward: 0.82 ± 0.39 mm, 29.27 ± 5.82˚, and 3.04 ± 0.82 mm, respectively; nasalward: 0.83 ± 0.40 mm, 29.61 ± 6.04˚, and 3.05 ± 0.81 mm, respectively; all p < 0.01). The multivariate analyses found age and the tube insertion level to be associated with postoperative changes in the central ECD (p = 0.039 and 0.013, respectively), and the postoperative follow-up period and tube insertion level to be associated with the difference between the inferonasal and superotemporal ECDs (p = 0.034 and 0.007, respectively). CONCLUSIONS: Mild alterations of head positions induced changes in the intracameral tube positions of AGV implants; nevertheless, it did not significantly affect ECD loss. However, the eyes with tubes inserted anteriorly to Schwalbe's line may be more susceptible to corneal ECD loss.

Comparison of the Progression of Localized Retinal Nerve Fiber Layer Defects in Red-free Fundus Photograph, En Face Structural Image, and OCT Angiography Image.

PRECIS: This study demonstrated the high topographic correlation between the red-free fundus photographs and en face structural images in eyes with glaucomatous progression. PURPOSE: The purpose of this study was to compare the progression of localized retinal nerve fiber layer (RNFL) defects in red-free fundus photographs, en face structural images, and optical coherence tomography angiography (OCTA) images. METHODS: We performed a retrospective, comparative study on 45 glaucomatous eyes showing RNFL defect widening in red-free photography. The localized RNFL defect in the red-free photographs was termed as red-free defect. The wedge-shaped hyporeflective area radiating from the optic nerve head in the optical coherence tomography (OCT) en face structural images and OCTA images was defined as en face defect and OCTA defect, respectively. The baseline and follow-up angular parameters of each red-free defect were compared with those of en face defect and OCTA defect. RESULTS: When the baseline angular parameters were compared, there were no significant differences between red-free defect and en face defect, and between red-free defect and OCTA defect (all, P>0.017). In addition, the follow-up angular parameters showed no difference between red-free defect and en face defect. However, the OCTA defect showed significantly greater values compared with red-free defect and en face defect with respect to the distal angular location and angular width at follow-up visit (36.78±15.10 vs. 34.10±15.09 vs. 33.40±15.05 degrees, both, P<0.001). CONCLUSIONS: Localized RNFL defects detected in red-free photographs showed high topographic correlation with defects detected in OCT en face structural images, and this correlation was also noted in eyes with progressive glaucoma. The OCT en face structural images may be an alternative to red-free photography for identifying progressive RNFL defects in eyes with glaucoma.

Characteristics of diffuse retinal nerve fiber layer defects in red-free photographs as observed in optical coherence tomography en face images.

BACKGROUD: To determine whether diffuse retinal nerve fiber layer (RNFL) defects, identified on red-free fundus photographs, could be identified on optical coherence tomography (OCT) en face structural images and to evaluate which factors are related to the different recognition patterns on en face images. METHODS: This retrospective, cross-sectional study included open-angle glaucoma eyes with diffuse RNFL defects in the inferior hemifield, identified in red-free photographs. The corresponding OCT en face structural images were divided into 3 groups: (1) no defect, (2) localized defect, and (3) diffuse defect. We compared the demographic and clinical ocular characteristics among the groups. RESULTS: A total of 209 eyes from 157 patients were included. The distribution of OCT en face images was: no defect, 25 eyes (11.96%); localized defect, 106 eyes (50.72%); diffuse defect, 78 eyes (37.32%). Logistic regression analysis revealed that eyes with greater mean deviation (P = 0.004) and thicker inferior RNFL (P = 0.008) would be included in the no defect and localized defect groups based on OCT en face images, rather than in the diffuse defect group. CONCLUSION: Around half of diffuse RNFL defects identified in the red-free photographs appeared as localized defects in OCT en face images. Mild glaucomatous damage was related to no defect and localized defect groups, classified based on the OCT en face images, in eyes with diffuse photographic RNFL defects. OCT en face images may be helpful in further assessing diffuse RNFL defects seen in red-free photographs in eyes with open-angle glaucoma.

Localized Retinal Nerve Fiber Layer Defect Location Among Red-free Fundus Photographs, En Face Structural Images, and Cirrus HD-OCT Maps.

PRECIS: Although the localized retinal nerve fiber layer (RNFL) defects in the en face structural images showed excellent topographic correlation with those in red-free photographs, the RNFL defect was frequently misidentified by the optical coherence tomography (OCT) deviation map. PURPOSE: The purpose of this study was to compare the location of localized RNFL defects using red-free fundus photographs, OCT en face structural images, and OCT RNFL deviation and thickness maps. METHODS: We investigated the agreement of angular locations of localized RNFL defects. Seventy localized RNFL defects were selected in red-free photographs (red-free defect). En face images and OCT deviation and thickness maps were overlaid on the corresponding red-free photographs. The proximal/distal angular locations and angular width of the red-free defects were compared with those of en face structural images (en face defect) and OCT RNFL deviation (deviation map defect) and thickness maps (thickness map defect). RESULTS: Among 70 eyes with red-free defects, 13 (18.6%), 1 (1.4%), and 0 (0%) defects were misidentified by the OCT deviation map, thickness map, and en face image, respectively. There were no significant differences among red-free defects, en face defects, and OCT thickness map defects in the angular width and proximal/distal angular locations. The angular widths were significantly greater in OCT RNFL deviation maps compared with those of other imaging modalities. The correlation coefficients of angular width and locations between the red-free defect and en face defect were significantly higher than those between the red-free defect and OCT map defects (all, P<0.001). CONCLUSIONS: Localized RNFL defects detected in red-free photographs showed the highest topographic correlation with defects detected in OCT en face images. En face structural images may aid in identifying the localized RNFL defects in glaucomatous eyes.

Peripapillary Vessel Density in Young Patients with Open-Angle Glaucoma: Comparison between High-Tension and Normal-Tension Glaucoma.

Although primary open-angle glaucoma (OAG) generally occurs in older individuals and manifests in eyes with elevated intraocular pressure (IOP), it may also occur in young patients or in eyes with an IOP that always measures within the statistically normal range. Recent advances in optical coherence tomography angiography have enabled noninvasive visualization of the vasculature around the optic disc. In this study, we investigated the clinical features of young Korean patients with OAG and compared the peripapillary vessel density of patients with normal-tension glaucoma (NTG) to those with high-tension glaucoma (HTG). The peripapillary vessel density was reduced in eyes with HTG compared with that in normal subjects (HTG: 23.18 ± 2.06% vs. normal subjects: 24.74 ± 1.88%, P value = 0.013). In contrast, the peripapillary vessel density of eyes with NTG was comparable with that of normal eyes (NTG: 23.98 ± 2.30% vs. normal subjects: 24.74 ± 1.88%, P value = 0.505). These findings suggest that young patients with HTG show greater peripapillary microvascular attenuation than healthy subjects or young patients with NTG, indicating that different levels of the initial untreated IOP may have different effects on the peripapillary vessel density in young patients with OAG.

Effects of Different Body Postures on the Intraocular Pressure in Patients with Primary Angle-Closure Disease.

SIGNIFICANCE: Eyes with primary angle-closure disease showed higher intraocular pressure (IOP) in the recumbent postures including supine and lateral decubitus (LD) positions compared with the sitting position. PURPOSE: The purpose of this study was to investigate the effects of different body postures on the IOP in eyes with primary angle-closure suspect (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG). METHODS: This is a comparative case series of 31 patients with bilateral PAC disease, such as PACS, PAC, and PACG. The IOP was measured using Tonopen AVIA in sitting, supine, and right or left LD positions. Patients were instructed to rest their heads on the pillows in supine and LD positions. The eye on the lower side in the LD position was called dependent eye. The main outcome was the difference in IOP among different body postures. RESULTS: Among the 62 eyes (31 patients), PACG, PAC, and PACS were noted in 44, 12, and 6 eyes, respectively. The IOP was not significantly different between the two eyes in sitting and supine positions, whereas the IOP was significantly higher in the dependent eye than in the nondependent eye in LD positions. Compared with that measured in the supine position, IOP differences of the dependent eye were higher than those of the nondependent eye when measured in LD position (right LD vs. supine, P = .02; left LD vs. supine, P = .01). In addition, when the study patients were divided into three groups according to their diagnosis, no significant differences were observed in the IOPs and IOP differences among the three groups. CONCLUSIONS: Posture-induced IOP changes were comparable among eyes with PACS, PAC, and PACG.