[Prone position ultrasound biomicroscopy for two plateau iris configuration cases with decreased corneal endothelial cells after laser iridotomy].

BACKGROUND: To report a possibility of mechanical injury following laser iridotomy (LI) via the iris surface to the corneal endothelium possibly causing bullous keratopathy. CASE: Subjects were two patients with plateau iris configuration who had been given LI bilaterally. One eye of each patient showed serious decrease in cellular density of the corneal endothelium. Cataract surgery was carried out in these two eyes. We performed ultrasound biomicroscopy in supine and prone positions for eight directions and specular microscopy for nine directions. Data were compared before and after the surgery. Significant endothelial loss was observed in the lower part of cornea in the two eyes. In the same area, the angular part of the plateau iris was attached to the cornea above the Schwalbe line was also shown in prone position. After the cataract surgery, the attachment was relieved, and the cellular density value of endothelium was increased in the lower area while the value was decreased in other areas. Thereafter, the endothelial decrease stopped. CONCLUSION: The contact between the iris root and the corneal endothelium might be one cause of bullous keratopathy in eyes with plateau iris following LI.

Evaluation of the relationship between quality of vision and the visual function index in Japanese glaucoma patients.

BACKGROUND: We compared two types of visual field index including mean deviation (MD) and the visual field index (VFI) for assessing the relationship between quality of life (QOL) and the loss of visual field in open-angle glaucoma patients. METHODS: We examined 336 eyes of 168 consecutive glaucoma patients. All participants completed the Japanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Visual field testing using the Humphrey Field Analyzer (HFA) was performed to obtain both MD and VFI in the bilateral eyes of each patient. We defined eyes of better MD or VFI as the better eye and the fellow eyes as the worse eye. Visual field data and scores of NEI VFQ-25 were compared between patients with normal tension glaucoma (NTG) and patients with primary open-angle glaucoma (POAG). A single linear regression analysis was applied to assess the significance of the relationship between QOL and visual field, and to compare the strength of correlations between MD and the VFI. An unpaired t test was used for the comparison the data between NTG and POAG. RESULTS: A significant relationship was observed between QOL and visual field in nine subscales and the composite in both the better eye and the worse eye. The relationship was stronger in the better eye than in the worse eye. The correlation coefficients of the VFI were slightly higher than those of MD overall. The highest correlation coefficients were demonstrated in ten subscales and the composite in the better eye of the VFI. Only the score for general vision was significantly higher in NTG patients than POAG patients. CONCLUSIONS: A significant relationship was found between QOL and both the VFI and MD, but the VFI had a marginally better correlation than that of MD. While QOL was better related with visual field loss in the better eye than in the worse eye, the difference was not large. Not much of a difference was found in the status of QOL between NTG patients and POAG patients.

Iridocorneal contact as a potential cause of corneal decompensation following laser peripheral iridotomy.

PURPOSE: This study aimed to investigate the relationship between corneal decompensation following laser peripheral iridotomy (LPI) and iridocorneal endothelial contact. STUDY DESIGN: Retrospective observational case series. METHODS: Specular microscopy images of LPI recipients with narrow angles were taken at the central cornea and the 8 midperipheral corneal regions at approximately 3 mm from the center. Eleven eyes of 11 patients had a minimum of ≤ 1600 cells/mm2 among 8 midperipheral corneal endothelial cell densities (ECDs). Radial scans of the angles in the 8 directions were taken with ultrasound biomicroscopy (UBM) in the supine and face-down positions. The minimum and maximum angle opening distance at 750 µm from the scleral spur of the 8 directions were defined as the narrowest and widest angles, respectively. The ECD of the narrowest angle direction was compared with the ECD of the widest angle direction. RESULTS: When UBM was performed with the subject in the supine position, the iris and cornea at the narrowest angle were in contact in only 4 of 11 eyes, while in the face-down position, the iris and the cornea at the narrowest angle were in contact in 10 of the 11 eyes. In the face-down UBM, the midperipheral ECD of the narrowest angle direction was significantly smaller than the midperipheral ECD of the widest angle direction (P = 0.006). CONCLUSION: The ECD of the narrow angle direction can decrease after LPI. This suggests that corneal endothelial cell damage following LPI may be due to mechanical damage from iridocorneal endothelial contact.

[Visual course for proliferative diabetic retinopathy after pars plana vitrectomy].

PURPOSE: To investigate retrospectively the visual course for proliferative diabetic retinopathy after pars plana vitrectomy. CASES AND METHODS: From January 2002 to December 2004, we operated 209 eyes with proliferative diabetic retinopathy. For this study, we selected 28 eyes in which the visual acuity could be followed for 6 months or longer after the vitrectomy. RESULT: The mean time period for reaching the best visual acuity after vitrectomy was 14.7 +/- 12.0 months. Depending on the type of diabetic maculopathy, the ischemic type, deposit type, and cystoid macular edema type required a mean time of 16 approximately 19 months. For the diffuse edema type, the mean was 9 months. It is significant that vitrectomy with triamcinolone acetonide (TA) resulted in visual improvement earlier than vitrectmy without TA (p value = 0.03).

[A case of acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery].

BACKGROUND: We report a patient with acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery. CASE: An 82-year-old man was diagnosed with bilateral shallow central anterior chamber depth, flat peripheral anterior chamber, and elevated intraocular pressure. One day previously he had undergone uncomplicated unsutured cataract surgery in the right eye and eight days previously, in the left eye. Ultrasound biomicroscopy revealed annular ciliochoroidal detachment in both eyes. Treatment with intravenous methyl prednisolone deepened the anterior chamber and reduced intraocular pressure. CONCLUSION: Annular ciliochoroidal detachment may lead to anterior rotation of the ciliary body and angle-closure. This clinical entity is indistinguishable from malignant glaucoma when the fundus cannot be visualized.

Assessment of the vision-specific quality of life using clustered visual field in glaucoma patients.

PURPOSE: To investigate the significance of vision-specific quality of life (QOL) in glaucoma patients based on the location of visual field defects. PATIENTS AND METHODS: We examined 336 eyes of 168 patients. The 25-item National Eye Institute Visual Function Questionnaire was used to evaluate patients' QOL. Visual field testing was performed using the Humphrey Field Analyzer; the visual field was divided into 10 clusters. We defined the eye with better mean deviation as the better eye and the fellow eye as the worse eye. A single linear regression analysis was applied to assess the significance of the relationship between QOL and the clustered visual field. RESULTS: The strongest correlation was observed in the lower paracentral visual field in the better eye. The lower peripheral visual field in the better eye also showed a good correlation. Correlation coefficients in the better eye were generally higher than those in the worse eye. For driving, the upper temporal visual field in the better eye was the most strongly correlated (r=0.509). For role limitation and peripheral vision, the lower peripheral visual field in the better eye had the highest correlation coefficients at 0.459 and 0.425, respectively. CONCLUSIONS: Overall, clusters in the lower hemifield in the better eye were more strongly correlated with QOL than those in the worse eye. In particular, the lower paracentral visual field in the better eye was correlated most strongly of all. Driving, however, strongly correlated with the upper hemifield in the better eye.

The relationship between the mean deviation slope and follow-up intraocular pressure in open-angle glaucoma patients.

PURPOSE: The purpose of this study was to analyze the relationship between the mean deviation (MD) slope as the progressive rate of visual field defects and the follow-up intraocular pressure (IOP) in open-angle glaucoma (OAG) patients. METHODS: This study was a retrospective, nonrandomized comparative study. A total of 287 eyes from 287 Japanese OAG patients were examined. The MD slope of the Humphrey Field Analyzer was calculated and compared with the follow-up IOP. OAG was classified into the high-tension group (>21 mm Hg) and the normal-tension group (≤ 21 mm Hg) on the basis of the highest recorded IOP without treatment, and then the 2 groups were compared. After setting a threshold for the progression rate at -0.3 dB/y, related factors were compared between the fast-progression and slow-progression eyes in each group. RESULTS: The correlation line between the follow-up IOP and the MD slope was statistically significant in the high-tension group but not in the normal-tension group. Compared with eyes with slow progression, eyes with fast progression in the high-tension group were older and had a higher mean IOP, greater highest and lowest IOPs, and a smaller mean IOP reduction ratio, whereas eyes with fast progression in the normal-tension group had a greater SD of the mean IOP, a larger IOP range, and a greater highest IOP. CONCLUSIONS: Eyes with a faster visual field progression tended to have a higher follow-up IOP in the high-tension group and larger IOP fluctuations in the normal-tension group of OAG patients. We should monitor both the follow-up IOP and fluctuations in IOP to provide a safer and more reliable visual field prognosis for OAG.

Evaluation of the relationship between quality of vision and visual function in Japanese glaucoma patients.

PURPOSE: To evaluate the correlation between quality of vision (QOV) and visual function in glaucoma patients. PATIENTS AND METHODS: The relationship between QOV and visual function was investigated in 200 Japanese glaucoma patients. QOV was assessed using the Japanese version of the 25-item National Eye Institute Visual Function Questionnaire. The better eye and the worse eye were defined based on the mean deviation (MD) value of the Humphrey Field Analyzer program 30-2. A single linear regression analysis was applied to assess the relationship. RESULTS: The lowest subscale score was observed in general health followed by general vision and driving. Visual acuity and the central 10° MD value in the better eye and the central 30° MD value in the worse eye were highly correlated with QOV. Threshold MD values at which patients began to have lower QOV ranged from -2 to -12 dB in the better eye and from -7 to -16 dB in the worse eye. CONCLUSION: Loss of visual function in both the better and the worse eye is significantly correlated to QOV. QOV of glaucoma patients begins to decrease in the early stages of visual field defects.

Ocular hypotensive effects and safety over 3 months of switching from an unfixed combination to latanoprost 0.005%/timolol maleate 0.5% fixed combination.

PURPOSE: Latanoprost 0.005%/timolol maleate 0.5% combination eye drops are now available in Japan. The aim of the present study was to investigate the prospective intraocular pressure (IOP) reduction effects and adherence with the combination eye drops in Japanese patients. METHODS: The subjects were 162 patients (162 eyes) with glaucoma or ocular hypertension concomitantly using latanoprost 0.005% and timolol maleate 0.5% eye drops. Concomitant use of the 2 eye drops was stopped, and patients were switched to the latanoprost 0.005%/timolol maleate 0.5% combination eye drops without any washout period. IOP was measured before the switch, and at 1 and 3 months after the switch, and then compared. A questionnaire survey on adherence was also conducted 1 month after the switch. RESULTS: IOP was the same before and after the switch: 15.2±3.3 mmHg before the switch, 14.9±3.0 mmHg 1 month after the switch, and 15.1±3.2 mmHg 3 months after the switch. According to the questionnaire survey, the frequency of forgetting to administer eye drops decreased with the switch, but 45.1% of the patients experienced irritation. About 82.1% replied that they preferred the latanoprost 0.005%/timolol maleate 0.5% combination eye drops. By the third month after the switch, 13 patients (8.0%) had discontinued the eye drops due to side effects or insufficient IOP reduction. CONCLUSION: The switch from the concomitant use of latanoprost 0.005% and timolol maleate 0.5% eye drops to latanoprost 0.005%/timolol maleate 0.5% combination eye drops improved adherence and helped maintain IOP.

Tumor necrosis factor-alpha concentrations in the aqueous humor of patients with glaucoma.

PURPOSE: To investigate the concentration of tumor necrosis factor (TNF)-alpha in the aqueous humor of patients with glaucoma, including correlations with glaucoma subtypes and intraocular pressure. METHODS: The study population comprised 84 patients with open-angle glaucoma who were scheduled for filtration or cataract surgery. Glaucoma subgroups included 29 cases of primary open-angle glaucoma (POAG), 28 cases of normal-tension glaucoma (NTG), and 27 cases of exfoliation glaucoma (ExG). Seventy-nine patients with senile cataract were recruited as control subjects. The concentrations of TNF-alpha in the aqueous humor were measured with an enzyme-linked immunosorbent assay. The percentages of samples positive for TNF-alpha and the measured concentrations in the glaucoma and cataract groups were compared. In addition, the relationships with the glaucoma subtypes, intraocular pressure, and glaucoma severity were analyzed. RESULTS: A significantly higher percentage of subjects in the glaucoma group were positive for TNF-alpha compared with the cataract group (P = 0.011). The mean TNF-alpha concentrations among the positive cases were not different between the groups (P = 0.689). TNF-alpha-positive samples were higher in the POAG (13.7%) and NTG (10.7%) subgroups than in the cataract group without significance, but higher in ExG subgroup (29.6%) with significance (P = 0.001). Relationships between the TNF-alpha concentration and the intraocular pressure or the clinical stage of glaucoma were not observed. CONCLUSIONS: TNF-alpha levels were significantly higher in the glaucoma group than in the cataract group, with a particularly large difference observed in those with ExG. The results suggest that TNF-alpha plays a key role in the progression of glaucoma.

Progression rate of total, and upper and lower visual field defects in open-angle glaucoma patients.

PURPOSE: We evaluated the progression rate of total, and upper and lower visual field defects in treated open-angle glaucoma patients. PATIENTS AND METHODS: This study was a retrospective, nonrandomized, comparative study. Five-hundred forty-four eyes from 315 Japanese open-angle glaucoma patients were examined. The mean deviation (MD) and total deviation (TD) for both the upper and lower slopes on the Humphrey Field Analyzer were calculated and compared in high-tension glaucoma (>21 mmHg) and normal-tension glaucoma (≤21 mmHg). RESULTS: Patients with over -20 dB of MD and over -23 dB of upper or lower TD were enrolled into each analysis. Patients with -7.75 ± 5.30 (mean ± standard deviation) dB of MD, -9.16 ± 10.80 dB of upper TD, or -7.11 ± 6.02 dB of lower TD were followed up for 4-19 years. The mean MD slope was -0.41 ± 0.50 dB/year, the upper TD slope was -0.46 ± 0.65 dB/year, and the lower TD slope was -0.32 ± 0.53 dB/year. Comparing high-tension glaucoma and normal-tension glaucoma, the upper TD slope was similar for both types of glaucoma, but the MD and lower TD slopes in high-tension glaucoma were significantly lower than those in normal-tension glaucoma. CONCLUSIONS: The progression rates in lower visual field defects in high-tension glaucoma might be faster than those in normal-tension glaucoma. The results of this study might be used to predict the prognosis of visual field defects, as well as the quality of vision in patients with open-angle glaucoma.

Incidence, severity and factors related to drug-induced keratoepitheliopathy with glaucoma medications.

PURPOSE: To evaluate the incidence, severity, and factors related to drug-induced keratoepitheliopathy in eyes using antiglaucoma eye drops. PATIENTS AND METHODS: In a cross-sectional study, 749 eyes from 427 patients who had used one or more antiglaucoma eye drops were examined at Niigata University Medical and Dental Hospital or related facilities. The incidence and severity of superficial punctate keratitis (SPK), patient gender and age, type of glaucoma, and type of eye drops were recorded. SPK was graded according to the AD (A, area; D, density) classification. The severity score (SS) was calculated from A x D. RESULTS: SPK was observed in 382 (51.0%) of 749 eyes that had received any type of antiglaucoma eye drops. While 254 eyes (33.9%) were classified as A1D1 (SS 1), 34 eyes (4.6%) had severe SPK with SS 4 or more. The number of eye drops and the total dosing frequency per day were significantly greater in SPK-positive eyes than in eyes without SPK. The number of eye drops was proportional to the frequency and severity of SPK. Among eyes that were treated with three or more eye drops, SPK was more severe and more frequent in older patients (>/=71 years). In addition, a considerable difference was detected for each type of glaucoma. CONCLUSION: Drug-induced keratoepitheliopathy is often observed in eyes that have received recent antiglaucoma eye drops. The number of eye drops, the total dose frequency per day, patient age, and type of glaucoma may affect this condition. We have to consider not only the effects on intraocular pressure but also the incidence and severity of drug-induced keratoepitheliopathy as a frequent side effect of glaucoma medications.

Oxidative stress markers in aqueous humor of patients with senile cataracts.

PURPOSE: To investigate the levels of oxidative stress markers in human eyes with senile cataracts. METHODS: We conducted a retrospective, case-controlled study of 57 patients with senile cataracts. To assess oxidative stress markers in the eye, we measured the enzymatic activities of superoxide dismutase (SOD) and catalase (CAT) as well as the total protein levels in aqueous humor. RESULTS: In aqueous humor, SOD and CAT activity levels were 0.133 +/- 0.020 and 1.223 +/- 0.081 U/ml, respectively; protein levels were 2.372 +/- 0.166 mg/ml (means +/- SEM). We observed a significant increase in SOD activity and the protein level in progressed nuclear cataracts. No significant age-associated difference in antioxidant enzyme levels was detected. CONCLUSION: Significant increases in the levels of SOD activity and total protein correlated with the severity of the cataract but not with patient age, suggesting that progressed cataract is associated with molecules leaking from the lens capsule.

Changes of scleral sulfated proteoglycans in three cases of nanophthalmos.

PURPOSE: To examine the composition of scleral sulfated proteoglycans in three nanophthalmic eyes by electron microscopic histochemistry. METHODS: Scleral tissues from three cases of nanophthalmos were collected from the Niigata University Hospital for transmission electron microscopic examination. Sulfated proteoglycans were studied using the cuprolinic blue (CB) dye binding method in conjunction with enzymatic digestion. RESULTS: Compared with the controls, the nanophthalmic sclerae were much thicker, and the collagen fibrils showed a less orderly arrangement. Twisting or fraying of collagen fibrils was noted in some areas, and fine fibrous materials surrounded the abnormal fibrils. CB-positive proteoglycan filaments were found around the collagen fibrils and in the fine fibrous materials in the nanophthalmic specimens. The number of proteoglycan filaments was smaller than that in the normal specimens. After enzymatic digestion, the CB-positive filaments were identified as dermatan/chondroitin sulfate proteoglycans. Although the number of dermatan sulfate filaments in nanophthalmos sclerae was similar to that in the controls, there were many fewer chondroitin sulfate filaments. CONCLUSION: A loss of chondroitin sulfate proteoglycan was observed in nanophthalmic sclerae. The alteration may be related to the abnormal organization of collagen fibrils and the onset of uveal effusion.