Zonular instability-associated morphologic features in eyes with primary angle closure disease using the swept-source anterior segment - optical coherence tomography system.

BACKGROUND: This study aims to investigate the morphologic features of the crystalline lens in Primary Angle Closure Disease (PACD) patients with zonular instability during cataract surgery using the swept-source CASIA 2 Anterior Segment-Optical Coherence Tomography (AS-OCT) system. METHODS: A total of 398 eyes (125 PACD eyes with zonular instability, 133 PACD eyes with zonular stability, and 140 cataract patient controls) of 398 patients who underwent cataract surgery combined or not glaucoma surgery between January 2021 and January 2023 were enrolled. The crystalline lens parameters were measured by CASIA2 AS-OCT. Then, logistic regression was performed to evaluate the risk factors associated with zonular instability. RESULTS: The results revealed that PACD eyes had a more anterior lens equator position, a steeper anterior curvature of lens, shorter Axial Length (AL), shallower Anterior Chamber Distance (ACD), higher Lens Vault (LV) and thicker Lens Thickness (LT), when compared to eyes in the cataract control group. Furthermore, PACD eyes in the zonular instability group had steeper front R, front Rs and Front Rf, flatter back Rf, thicker lens anterior part thickness, higher lens anterior-to-posterior part thickness ratios, shallower ACD, and greater LV, when compared to PACD eyes with zonular stability. The logistic regression analysis, which was adjusted for age and gender, revealed that zonular instability was positively correlated with anterior part thickness, lens anterior-to-posterior part thickness ratio, and LV, but was negatively correlated with lens anterior radius and ACD. CONCLUSION: Steeper anterior curvature, increased lens anterior part thickness, higher anterior-to-posterior part thickness ratio, shallower ACD, and greater LV are the anatomic features of PACD eyes associated with zonular instability.

Targeting Necroptosis: A Novel Therapeutic Option for Retinal Degenerative Diseases.

The discovery of the necroptosis, a form of regulated necrosis that is mediated by receptor-interacting protein kinase 1 (RIPK1), RIPK3, and mixed-lineage kinase domain-like pseudokinase (MLKL), represents a major breakthrough that has dramatically altered the conception of necrosis - traditionally thought of as uncontrolled cell death - in various human diseases. Retinal cell death is a leading cause of blindness and has been identified in most retinal diseases, e.g., age-related macular degeneration, glaucoma, retinal detachment, retinitis pigmentosa, etc. Increasing evidence demonstrates that retinal degenerative diseases also share a common mechanism in necroptosis. Exacerbated necroptotic cell death hinders the treatment for retinal degenerative diseases. In this review, we highlight recent advances in identifying retinal necroptosis, summarize the underlying mechanisms of necroptosis in retinal degenerative diseases, and discuss potential anti-necroptosis strategies, such as selective inhibitors and chemical agents, for treating retinal degenerative diseases.

Distribution of Pigment Particles in Aqueous Drainage Structures in a DBA/2J Mouse Model of Pigmentary Glaucoma.

Purpose: To characterize the distribution of pigment particles in aqueous drainage structures of DBA/2J mice with different intraocular pressure (IOP) levels. Methods: DBA/2J mice were monitored from 9 to 44 weeks of age. IOP measurements were performed periodically. At 12, 20, 28, and 36 weeks, three mice were randomly selected for each time point and divided into three IOP groups. The morphology, size, and quantity of pigment particles in aqueous drainage structures were determined via transmission electron microscopy combined with ImageJ-based analysis. Between-group differences were evaluated with a one-way analysis of variance and Fisher's least significant difference test. Results: In the anterior chamber, 74.2% (187/252) of pigment particles were round (diameter range, 0.20-0.73 µm), and 25.8% (65/252) were oval (length range, 0.35-1.20 µm ). In the high-IOP group (IOP≥15 mmHg), pigment particles in the trabecular meshwork (TM) were more abundant and larger in size than those in the normal-IOP group (P<0.001). All separate pigment particles in the TM of the high-IOP group were >0.4  µm in size. The diameters of round (IOP≤10 mmHg, 0.44±0.13 µm; IOP between 10 and 15 mmHg, 0.57±0.13 µm; IOP≥15 mmHg, 0.61±0.12 µm) and the lengths of oval (0.65±0.14 µm vs. 0.77±0.12 µm vs. 0.88±0.15 µm, respectively) pigment particles in the TM differed among groups (F=27.258 and F=27.295, respectively; both P<0.001). No such differences were discovered in the iris and around Schlemm's canal (P>0.05). Conclusions: In DBA/2J mice, large and medium pigment particles (>0.4 µm) seem to play an important role in causing aqueous outflow obstruction and IOP elevation.

Changes of trabecular meshwork pigmentation in patients with pigment dispersion syndrome: A 15-year study.

ABSTRACT: To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block.Twenty one eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6 months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline.Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 ±â€Š6.93 years (range, 31-55 years) at initial diagnosis. The mean IOP level was 33.1 ±â€Š9.8 mmHg (range, 22-56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15-16) on admission, which changed to 14 (IQR, 13-15), 13 (IQR, 12-14), 12(IQR, 10.5-12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1 ±â€Š3.4 mmHg.TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants.

Modified Cortex Mori Capsules improving the successful rate of functional filtering blebs after reclinical glaucoma filtering surgery.

BACKGROUND: The major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic. Traditional Chinese medicine has preeminence in the prevention of fibrosis formation through the regulation of systemic circulation and improvement of the properties of the inflammatory cells in the blood. AIM: To examine the clinical efficacy of using the Modified Cortex Mori Capsules (MCMC; Chinese name: Jiawei Sangbaipi Capsules) in the success rate of functional filtering blebs after glaucoma filtering surgery in clinical patients. METHODS: Sixty resurgery glaucoma patients were randomly divided into two groups: 30 patients in surgery with the placebo group and 30 patients in surgery with the MCMC group. Patients took either the placebo or the MCMC 2 wk before and after surgery. Postoperative morphology and function filtering bleb, visual acuity, intraocular pressure, postoperative complications, the success rate of filtration surgery and clinical efficacy were observed. RESULTS: Fifty patients completed the study. The percentage of functional filtering blebs in the surgery plus MCMC group was 84% at 6 mo after surgery, which was higher than surgery plus placebo group (64%, P < 0.05). The surgical success rate in the MCMC and placebo groups were 79% ± 8.3% and 57% ± 10.6% respectively (P < 0.05). The visual acuity, intraocular pressure and the postoperative complications in the two groups had no significant differences. CONCLUSION: Glaucoma filtering surgery while taking MCMC not only reduced excessive scar formation and increased the success rate of functional filtering blebs but also improved the success of glaucoma filtration operations.

Controlled synthesis of cyclosiloxanes by NHC-catalyzed hydrolytic oxidation of dihydrosilanes.

Hydrolytic oxidation of various hydrosilanes in acetonitrile and in the absence of organic solvents catalyzed by an N-heterocyclic carbene organocatalysis is described. The NHC organocatalyst exhibited a very high activity with only 0.1 mol% loading of the catalyst in acetonitrile for aryl-substituted dihydrosilanes to produce hydrogen gas and cyclosiloxanes almost quantitatively in several minutes. The calculated TOF (15 000 h-1) of this organocatalyst is comparable to those of precious metal-based heterogeneous catalysts and much superior to those of the existing homogeneous metal catalysts. The catalytic reaction selectively yielded cyclosiloxanes in high yield without the contamination of silanols. Furthermore, the catalytic reaction can also be furnished under solvent-free conditions at elevated temperatures with 2.5 mol% loading of the NHC in 5-12 hours.

Long-term Efficacy of Trabeculectomy on Chinese Patients with Pigmentary Glaucoma: A Prospective Case Series Observational Study.

BACKGROUND: Though trabeculectomy is often performed on patients with medically refractive pigmentary glaucoma (PG), the clinical outcomes of surgical treatment on PG remain unknown. The aim of this study was to summarize the long-term efficacy and safety of trabeculectomy on PG. METHODS: This was a prospective case series observational study. Eighteen consecutive PG patients were followed up for 8 years after trabeculectomy from May 2006 to April 2007. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, intraocular pressure (IOP) measurement, Humphrey visual field analysis (VFA), and stereoscopic funduscopy were performed on admission and every 6 months after the surgery. Postoperative IOP, VA, BCVA, VFA, adjunctive anti-glaucoma medication, treatment-related side-effects, changes in blebs, and main clinical findings in the anterior segment of PG were recorded and compared with the baseline. RESULTS: Eighteen PG eyes from 18 patients, with average preoperative IOP of 34.5 ± 4.7 mmHg (range: 21-47 mmHg, 1 mmHg=0.133 kPa) were enrolled in this study. All enrolled patients completed the follow-up visits and required examinations. Eight years after trabeculectomy, all surgical eyes (18/18) had satisfactory IOP control with an average of 13.7 ± 2.5 mmHg (range: 9-19 mmHg), which was significantly lower than baseline (P = 0.001). Majority (15/18) of the PG eyes had stable VA, BCVA, VFA, and optic disc cupping parameters. Functional blebs still existed in 12/18 of the PG eyes at the last follow-up visit. Unanimously, pigmentation in the anterior segment attenuated with time after surgical treatment. No severe side-effects were recorded in any of the surgical eyes. CONCLUSIONS: All surgical PG eyes in this study had satisfactory IOP control 8 years after the surgery with well-preserved visual function. The long-term efficacy and safety of trabeculectomy are promising in PG patients.

Retinotopic Changes in the Gray Matter Volume and Cerebral Blood Flow in the Primary Visual Cortex of Patients With Primary Open-Angle Glaucoma.

PURPOSE: To assess the cortical structure and cerebral blood flow changes in the brain of patients with primary open-angle glaucoma (POAG). METHODS: High-resolution anatomical magnetic resonance imaging (MRI) and arterial spin labeling (ASL)-MRI were performed in 23 POAG patients and 29 controls. Patients were further divided into early-moderate and advanced groups based on mean deviation (MD) cutoff of 12 dB. A baseline scan was obtained and repeated during visual stimulation to the central preserved visual field in the more affected eye of POAG patients and a randomly selected eye of controls. Gray matter volume (GMV) and cerebral blood flow (CBF) throughout the whole brain were compared between patients and controls. RESULTS: Compared to controls, a region with significant reduction of GMV was detected in the anterior calcarine fissure of advanced POAG patients (P < 0.001, voxels = 503, 1698 mm3). Patients with early-moderate POAG had resting CBF similar to that of controls. However, a region with marked CBF decrease was detected in the anterior calcarine fissure of advanced POAG patients (P < 0.001, voxels = 1687, 13,496 mm3). The region with CBF reduction in advanced POAG showed good colocalization with the region with GMV decrease in this group. Following visual stimulation, patients with advanced POAG showed significantly lower increase in CBF in the occipital lobes (P < 0.001, voxels = 112, 896 mm3) as compared to controls (P < 0.001, voxels = 1880, 15,040 mm3) and early-moderate POAG (P < 0.001, voxels = 2233, 17,864 mm3). CONCLUSIONS: Primary open-angle glaucoma patients demonstrate a disease severity-dependent retinotopic pattern of cortical atrophy and CBF abnormalities in the visual cortex. Cerebral blood flow may be a potential biomarker for the brain involvement in glaucoma.

[Long-term efficacy of laser peripheral iridotomy in preventing progression in eyes with pigment dispersion syndrome].

OBJECTIVE: To evaluate the long-term efficacy of laser peripheral iridotomy (LPI) in preventing deterioration in eyes with pigment dispersion syndrome (PDS). METHODS: A cohort study. Nineteen patients with PDS were treated with LPI and followed up periodically in Beijing Tongren Eye Center from May 2006 to April 2007. One eye of each patient was chosen randomly for the study. Main investigating items included iris configuration, intraocular pressure (IOP), anterior chamber pigmentation, and visual field analysis. The average follow-up period was (6.5 ± 0.3) years. A paired sample t test was used to determine whether there is a significant difference between average values of pre- and post-LPI IOP and mean deviation of Humphrey visual field analysis in these PDS eyes. RESULTS: The average age of the 19 patients were (35.8 ± 7.1) years on admission. The initial IOP of the 19 eyes was (24.7 ± 2.2) mmHg (1 mmHg = 0.133 kPa) before LPI. The mean deviation (MD) of Humphrey visual field analysis (VFA) were (-1.82 ± 1.26) dB (-4.34--0.28 dB) . All 19 eyes had concave iris and heavy trabecular pigmentation. The iris became flat in all PDS eyes after the laser treatment. At the last follow-up visit, the average IOP was 14.8 ± 2.0 (12-20) mmHg, which was statistically lower than that of baseline (t = 11.49, P < 0.01) . Extent of trabecular pigmentation reduced obviously in 16 eyes. No deterioration or new visual field defect was detected in any of the PDS eyes. MD of the last VFA was -1.79 ± 1.21 (-4.39--0.21 dB) . There was no statistical difference between MD of the last VFA and baseline (t = -0.26, P = 0.798). CONCLUSION: The long-term follow-up results showed that LPI prevents progression effectively in eyes with PDS.

Changes in anterior chamber depth following vitrectomy.

BACKGROUND: Anterior segment morphometry is crucial for ophthalmologists to understand the visual outcomes of cataract surgery, keratorefractive surgery, as well as some other anterior segment disorders. Previous reports in literature have shown that anterior chamber depth (ACD) may shift slightly after vitrectomy. This study aimed to characterize the shortterm changes in ACD in eyes after vitrectomy by means of A-scan ultrasound. METHODS: A prospective case series study was carried out on 29 eyes of 29 patients who underwent vitrectomy as the sole procedure. ACD was measured using A-scan ultrasound biometry shortly before vitrectomy and 1 week, 1 month, and 3 months after the surgery. Postoperative ACDs were compared with baseline. RESULTS: Twenty-nine patients (16 males and 13 females) were enrolled in the study, with mean age of (50 ± 11) (25-65) years. Twenty-three eyes of 23 patients were vitrectomized for vitreous hemorrhage (VH) and the other six were operated for idiopathic epiretinal membrane (ERM). The mean preoperative ACD of the VH eyes was (2.98 ± 0.38) mm. No significant difference was found between the ACD of the VH eyes and their fellow eyes (P = 0.058). The average preoperative ACD in the ERM eyes was (2.94 ± 0.31) mm, which was statistically deeper than that of their fellow eyes ((2.85 ± 0.28) mm, P = 0.008). No statistical difference was found in the postoperative average ACD of the VH eyes compared with baseline. In the ERM group, the postoperative ACD in the surgical eyes was still statistically deeper than the fellow eyes 1 week after surgery (P = 0.034). However, such statistical difference disappeared at 1 or 3 months postoperative (P = 0.186 and 0.682). CONCLUSIONS: ERM may induce deepening of the ACD, which can be recovered by uneventful vitrectomy. VH does not cause shift of ACD, neither does vitrectomy.

Efficacy of laser peripheral iridoplasty and iridotomy on medically refractory patients with acute primary angle closure: a three year outcome.

BACKGROUND: Argon laser peripheral iridoplasty (ALPI) is proved to be effective in lowering intraocular pressure (IOP) of patients with mild acute primary angle closure (APAC). It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed to evaluate the IOP-lowering efficacy of ALPI and laser peripheral iridotomy (LPI) on patients with refractory APAC, who have previously responded poorly to intensive medical therapy. METHODS: Thirty-six patients (8 men and 28 women) were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber (AC) angle, and IOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity (VA), best corrected VA (BCVA), IOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes. RESULTS: All patients were affected unilaterally, with average age of (54.6 ± 11.7) (range, 37.0 - 75.0) years old. The mean IOP value of the affected eyes dropped from (31.6 ± 7.7) (range, 21.0 - 39.0) mmHg at enrollment to (18.4 ± 8.7) (range, 10.0 - 27.0) mmHg 2 hours after ALPI. At follow-up day 7, the mean IOP value maintained at (14.8 ± 4.2) (range, 9.0 - 21.0) mmHg, which was significantly different (P = 0.000) compared with baseline. The average decrease of IOP in the APAC eyes was (16.8 ± 7.4) (range, 12.0 - 21.0) mmHg. At follow-up three years later, the mean IOP of the APAC eyes stabilized at (16.3 ± 3.2) (range, 9.0 - 20.0) mmHg with at least 180° of AC angle opened. CONCLUSION: ALPI and LPI lower the IOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.

Efficacy of goniosynechialysis for advanced chronic angle-closure glaucoma.

PURPOSE: To evaluate the intraocular pressure (IOP)-lowering efficacy of goniosynechialysis (GSL) for advanced chronic angle-closure glaucoma (CACG) using a simplified slit-lamp technique. PATIENTS AND METHODS: Patients with CACG with one severely affected eye with best-corrected visual acuity below 20/200 and a mildly or functionally unaffected fellow eye were enrolled in this study. All patients underwent ophthalmologic examinations including measurement of visual acuity, best-corrected visual acuity, and IOP; biomicroscopy; specular microscopy; fundus examination; and gonioscopy followed by anterior chamber paracentesis and GSL for nasal peripheral anterior synechiae in the eye with severe CACG. RESULTS: Thirty patients (18 men, 12 women) were identified as having CACG with an initial mean IOP of 47.1 ± 6.7 mmHg (range 39-61 mmHg) in the severely affected eye. One week after GSL, the mean IOP of the treated eyes decreased to 19.3 ± 2.8 mmHg (range 14-26 mmHg) without antiglaucoma medication (average decrease 27.7 ± 6.5 mmHg; range 16-41 mmHg), which was significant (P < 0.00001) compared with baseline. After an average follow-up period of 36.6 ± 1.0 months (range 35-38 months), the mean IOP stabilized at 17.4 ± 2.2 mmHg (range 12-21 mmHg). The nasal angle recess did not close again in any one of the patients during the follow-up period. The average significant (P < 0.00001) decrease in corneal endothelial cell density in the treated eyes was 260 ± 183 cells/mm(2) (range 191-328 cells/mm(2)). CONCLUSIONS: Anterior chamber paracentesis and GSL lowers IOP in advanced CACG, though it may lead to mild corneal endothelial cell loss.

Different transillumination property in Chinese and White irides.

PURPOSE: To compare the least light density (LLD) required to elicit iris transillumination defects in donor Chinese and White irides with radial posterior iris pigment epithelium (IPE) scratches. MATERIALS AND METHODS: Seven Chinese and 7 White irides were used in this study, in which 10 to 11 radial posterior IPE scratches were made under biomicroscopy. LLD for at least 3 and 6 IPE scratches was determined with a digital light meter. Histologic studies and transmission electron microscopy were carried out on each iris specimen after LLD measurement. RESULTS: Six Chinese and all 7 White irides had qualified IPE scratch model verified by the histologic study. The average LLD required to elicit at least 3 and 6 IPE scratches in these Chinese irides were 476.5±135.7 and 855.9±290.2 Lux, respectively. In the White irides, they were 5.3±2.3 and 69.3±25.4 Lux, respectively. In histologic and transmission electron microscopy study, moderate to heavy pigmentation was seen uniformly in the Chinese irides in the IPE layer, iris stroma, and anterior surface; whereas minimal pigmentation was visualized in their White counterparts. CONCLUSIONS: LLD in IPE scratched Chinese irides were considerably higher than that of the White irides. Dense pigmentation in iris stroma and anterior surface may be the mechanism for the greater LLD in the Chinese irides and lack of iris transillumination defects in Chinese pigment dispersion syndrome patients.

Narrow- and open-angle measurements with anterior-segment optical coherence tomography and Pentacam™.

BACKGROUND AND OBJECTIVE: To assess the agreement of the Pentacam (Oculus, Wetzlar, Germany) and anterior-segment optical coherence tomography (AS-OCT) in measuring open and narrow angles. PATIENTS AND METHODS: Prospective observational case series in which 39 healthy normal subjects (39 eyes) and 25 patients with narrow angles (37 eyes) were enrolled between May and September 2008. The anterior chamber measurements were performed by AS-OCT and the Pentacam. RESULTS: There was no significant difference in the open-angle measurements between the Pentacam and AS-OCT (P > .05). However, in patients with narrow angles, the average values of nasal and temporal anterior chamber angles taken by the Pentacam were larger than those of AS-OCT (25.5° ± 5.66° and 25.77° ± 5.15° vs 13.40° ± 6.81° and 12.13° ± 6.47°; P < .001). CONCLUSION: Both AS-OCT and the Pentacam can reliably measure anterior chamber angles in healthy normal subjects. The difference in measuring narrow angles by the two instruments was due to inability to view the angle recess or the scleral spur with the Pentacam.

Functional MRI signal changes in primary visual cortex corresponding to the central normal visual field of patients with primary open-angle glaucoma.

PURPOSE: To investigate, by functional magnetic resonance imaging (fMRI), the impact of glaucomatous neuropathy of primary open-angle glaucoma (POAG) on neuronal activity in the primary visual cortex, which corresponds to the central normal visual field. METHODS: Six POAG patients with asymmetric visual field damage and spared central vision were enrolled in the study. All patients underwent detailed ophthalmic examinations, including visual acuity, intraocular pressure, refraction, gonioscopy, and fundus examination. Scanning laser polarimetry with variable corneal compensation, confocal scanning laser ophthalmoscopy, posterior segment optical coherence tomography (OCT), and SITA-standard 30-2 and 10-2 visual field perimetry were also performed on each patient. Block-design fMRI was then performed. The stimulus was a hemifield checkerboard contrast, reversing at 8 Hz and viewed by the examined eye monocularly during fMRI scanning, with the fellow eye occluded. RESULTS: The blood oxygen level-dependent (BOLD) fMRI signal change in the primary visual cortex corresponding to central visual input from the more severely affected eye was less than that of the fellow eye. Such a difference in fMRI response did not correlate with interocular differences in measurements of scanning laser polarimetry, OCT, and scanning laser ophthalmoscopy, but showed a negative correlation with interocular pattern SD (PSD) difference of visual field analysis. CONCLUSIONS: Glaucomatous neuropathy from POAG may lead to decreased cortical activity in the primary visual cortex, which corresponds to the central normal visual field. The resultant cortical depression is not related to interocular differences in results of polarimetry, OCT, and ophthalmoscopy, but is negatively correlated with PSD of visual field analysis.

Detection of early neuron degeneration and accompanying glial responses in the visual pathway in a rat model of acute intraocular hypertension.

Transsynaptic degeneration has been implicated in patients with primary open angle glaucoma (POAG) and animal models of chronic intraocular hypertension. Whether the sustained intraocular pressure (IOP) elevation is necessary for the induction of transsynaptic changes in the brain remains unclear. The aim of this study is to characterize the effects of acute and transient intraocular hypertension on the visual pathway of rats. Acute intraocular hypertension was induced in the right eye by anterior chamber perfusion. At 1 day, 3 days, 1 week, 2 weeks and 4 weeks after the operation, neuronal degeneration and glial responses in the retina, dorsal lateral geniculate nucleus (dLGN) and superior colliculus (SC) were assessed using Nissl staining and immunohistochemistry. TUNEL staining was also performed to detect the neuronal apoptosis in the brain. At the first day after the operation, no obvious neuronal changes were detected in the retina or the brain. At 3 days, 46% of the retinal ganglion cells (RGCs) were lost. Atrophy of the contralateral optic tract was also observed. Meanwhile, the cross-sectional area of neurons in the contralateral dLGN and SC was decreased, while cell density in the same regions was increased. Glial activation in the retina occurred much earlier than the RGC loss. Co-expression of glial fibrillary acid protein (GFAP) and glutamine synthetase (GS) was observed in the end-feet and processes of Müller cells at 1 day after the operation. GFAP immunoreactivity was remarkably increased in the contralateral dLGN and SC at 3 days. It also showed a good co-localization with GS. All of aforementioned changes gradually progressed and persisted for the whole observation period. No TUNEL-positive cells were detected in the dLGN and SC at any post-operative time point. Taken together, these results illustrate that acute and transient intraocular hypertension is able to induce early onset and long-lasting neurodegenerative changes and the accompanying glial activation in the visual pathway. Brain changes may occur in parallel with the RGC loss. Reactive glial cells in the brain may participate in the clearance of aberrantly released glutamate and may serve as a sensitive marker of neuronal injury. Neuroprotection of the entire visual pathway and glia-target therapies may bring new insights into the glaucoma treatment.

Clinical signs and characteristics of pigmentary glaucoma in Chinese.

PURPOSE: To report the clinical findings in 21 Chinese patients with pigmentary glaucoma (PG). METHODS: Medical charts of 21 patients diagnosed with PG between 1993 and 2006 at the Beijing Tongren Eye Center were reviewed. RESULTS: From our database, 14 men and seven women were identified as having PG. The mean age of the subjects at the time of the diagnosis was 35.3+/-6.8 years. All but one patient had myopia >-0.5 diopters (D) with a mean spherical equivalent refractive error of -5.38+/-2.56 D. The average intraocular pressure at the initial diagnosis was 34.5+/-10.3 mmHg. All 17 patients with visibility chart documentation of the appearance of the peripheral lens and zonule showed lenticular and/or zonular pigmentation. The irides of all 15 subjects for whom detailed descriptions of the iris configuration were reported were bowed posteriorly. None of the subjects had iris transillumination defects (TIDs) except for trace areas of transillumination in both eyes of one patient. CONCLUSIONS: In these Chinese patients with PG, homogeneous increased trabecular pigmentation, dusting of the peripheral lens or zonule with pigment granules, and posterior bowing of the iris were common. Typical spoke-like radial TIDs were not observed.