Intraocular pressure reduction in normal-tension glaucoma patients in South Korea.

To evaluate the potential benefit of intraocular pressure (IOP) reduction in normal-tension glaucoma (NTG) patients in South Korea. A retrospective, multi-center analysis of Korean NTG patients with 5-years follow-up, typical glaucomatous optic disc and/or visual field changes and no recorded IOP >21 mmHg. Progression was identified by Advanced Glaucoma Intervention Study visual field scoring. There were 90 (42%) progressed patients and 127 (58%) stable patients included in the study. Mean IOP measured higher in the progressed (14.3 ± 2.2 mmHg) than stable patients (14.0 ± 1.9 mmHg), but was not statistically different between the groups (P = 0.29). The mean IOP that best discriminated stable patients was ≤15 mmHg, but no statistical difference existed in the numbers of progressed versus stable patients at ≤15 mmHg compared to >15 mmHg (P = 0.07). Multivariate regression analysis showed that the baseline number of glaucoma medicines and visual field as well as mean, peak and fluctuation of IOP were significant risk factors for glaucomatous progression (P < 0.01). This study suggests that in Korean NTG patients, despite relatively similar IOPs between progressed and stable patients, and based on multivariate regression analysis, IOP may be a risk factor for glaucomatous progression.

Comparison of the Safety and Efficacy between Preserved and Preservative-Free Latanoprost and Preservative-Free Tafluprost.

In this study, we investigated the effect of preservative-free (PF) 0.0015% tafluprost (TA), to the preservative containing (PC) and the PF 0.005% latanoprost (LA) in Korean subjects. This study was conducted as a multi-center, randomized, investigator-blind, active controlled, parallel-group, clinical trial in adult patients (≥19 years) with open-angle glaucoma (OAG) and ocular hypertension (OHT). After a washout period, patients with an IOP between 15 and 35 mmHg were enrolled and evaluated the efficacy, safety, and compliance at 4, 8 and 12 weeks after the first administration. A total of 137 OAG and OHT patients were randomized. Statistically significant reductions in IOP were observed in all groups. Twelve weeks after each eye drop instillation, the mean IOP reduction was -4.59 ± 2.70 mmHg (-24.57 ± 13.49%) in the PC-LA group, -4.52 ± 2.17 mmHg (-24.41 ± 11.38%) in the PF-LA, and -3.14 ± 2.83 mmHg (-17.22 ± 14.57%) in the PF-TA group. The PF-LA showed significantly better responsiveness than did PF-TA. PF-LA was better tolerated than was PC-LA. There were no adverse events that led to cessation of eye drop use in any of the groups. In conclusion, IOP decreased similarly across the groups. PF-LA may provide a good choice for OAG patients with ocular surface diseases.

Central corneal thickness of Korean patients with glaucoma.

OBJECTIVE: To characterize the central corneal thickness (CCT) in Koreans and assess CCT variation in different types of glaucoma. DESIGN: Observational cross-sectional study. PARTICIPANTS: Patients previously diagnosed as primary open-angle glaucoma (POAG, n = 343), normal-tension glaucoma (NTG, n = 192), and ocular hypertension (OHT, n = 44), as well as nonglaucomatous patients (n = 224) examined in a glaucoma clinic in Korea. METHODS: Participants' CCT was measured by ultrasound pachymetry. MAIN OUTCOME MEASURES: Mean CCT and its correlations with glaucoma diagnosis, age, spherical equivalent, gender, diabetes, and hypertension. RESULTS: Mean CCT was highest in eyes with OHT (582.1 microm, P<0.0001), lowest in NTG (537.5 microm, P<0.0001), and intermediate and similar in eyes with POAG and healthy eyes (550.7 and 553.6 microm, respectively, P = 0.289). Central corneal thickness was inversely correlated with age (r = -0.12; P<0.0001). There was no statistically significant difference in mean CCT between eyes with different gender or presence of diabetes and hypertension. Mean CCT in normal and OHT eyes was weakly correlated with refractive error (P<0.05). CONCLUSIONS: In Korean subjects, CCT is greatest in eyes with OHT and least in eyes with NTG.

Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography.

PURPOSE: To compare the effectiveness of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and retinal nerve fiber layer (RNFL) photography using the Heidelberg Retina Angiograph 1 (HRA1) for early glaucoma detection. DESIGN: Cross-sectional comparative study. PARTICIPANTS: Seventy-two primary open-angle glaucoma patients with early-stage visual field defects and 48 healthy controls were included. METHODS: Measurements using Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1, as well as standard automated perimetry, were obtained. We constructed receiver operating characteristic (ROC) curves for all available parameters and calculated the area under the ROC curves (AUC) to seek the best discriminating parameter of each test. Subsequently, the ROC curves were calculated for the combinations of the best discriminating parameters of each test to seek the most effective combination for early glaucoma detection. MAIN OUTCOME MEASURE: The AUC for various parameters of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1. RESULTS: The AUCs of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1 with the best discriminating parameter were 0.990, 0.906, 0.794, and 0.751, respectively. The AUC of the following best combination was 0.972, more than 5 points depressed below the level of 5% on the pattern deviation plot from Humphrey Matrix perimetry, and the nerve fiber indicator was larger than 20 from GDx VCC. CONCLUSIONS: The AUC of the Humphrey Matrix perimetry was greater than that of the GDx VCC, Stratus OCT, and RNFL photography using HRA1.

Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma.

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.

Evaluation of a new scoring system for retinal nerve fiber layer photography using HRA1 in 964 eyes.

PURPOSE: To evaluate retinal nerve fiber layer (RNFL) defect by a new scoring system for RNFL photography using the Heidelberg Retina Angiograph 1 (HRA1). METHODS: This retrospective study included 128 healthy eyes and 836 primary open-angle glaucoma eyes. The RNFL photography using HRA1 was interpreted using a new scoring system, and correlated with visual field indices of standard automated perimetry (SAP). Using the presence of RNFL defect, darkness, width, and location, we established the new scoring system of RNFL photos. RESULTS: The mean RNFL defect score I in the early, moderate, severe, and control groups were 7.3, 9.2, 10.4, and 3.6, respectively. The mean RNFL defect score II in the early, moderate, severe, and control groups were 14.5, 28.5, 43.4, and 3.4, respectively. Correlations between the RNFL defect score II and the mean deviation of SAP was the strongest of the various combinations (r=-0.675, P<.001). CONCLUSIONS: Using a new scoring system, we propose a method for semi-quantitative interpretation of RNFL photographs. This scoring system may be helpful to distinguish between normal and glaucomatous eyes, and the score is associated with the severity of visual field loss.

Recurrent intraocular pressure elevation during hemodialysis in a patient with neovascular glaucoma.

PURPOSE: To report a patient with symptomatic intraocular pressure (lOP) elevation in an eye with neovascular glaucoma (NVG) during hemodialysis. METHODS: Case report. RESULTS: Recurrent episodes of severe ocular pain and elevated IOP in the NVG eye were noted during hemodialysis in a 29-year-old man. The patient was recently diagnosed at our ophthalmology clinic with NVG due to central retinal vein occlusion. IOP was temporarily controlled after the Ahmed valve implantation. However, after the fibrous membrane developed and occluded the tip of the Ahmed valve, IOP elevation during hemodialysis recurred. Further treatments with intravenous mannitol, oral carbonic anhydrase inhibitor, topical antiglaumatic agents and subconjunctival 5-fluorouracil (5-FU) injections all failed to control relapsing pain and IOP elevation. Eventually, evisceration and hydroxyappatite implantation were performed. CONCLUSIONS: Physicians must be alert to the possibility of IOP elevation in glaucomatous eyes during hemodialysis.

Comparison of Ocular Pulse Amplitude Lowering Effects of Preservative-Free Tafluprost and Preservative-Free Dorzolamide-Timolol Fixed Combination Eyedrops.

PURPOSE: To compare the ocular pulse amplitude (OPA) lowering effects of preservative-free tafluprost and dorzolamide-timolol fixed combination (DTFC) using dynamic contour tonometry. METHODS: In total, 66 eyes of 66 patients with normal tension glaucoma (NTG) (n = 34) or primary open angle glaucoma (POAG) (n = 32) were included. Patients were divided into two groups: the preservative-free tafluprost-treated group (n = 33) and the preservative-free DTFC-treated group (n = 33). Intraocular pressure (IOP) was measured using Goldmann applanation tonometry (GAT). OPA was measured using dynamic contour tonometry; corrected OPA (cOPA) was calculated at baseline and at 1 week and 1, 3, and 6 months after treatment. RESULTS: After 6 months of treatment, tafluprost significantly reduced IOP (P < 0.001). The OPA lowering effects differed significantly between the two treatment groups (P = 0.003). The cOPA-lowering effect of tafluprost (1.09 mmHg) was significantly greater than that of DTFC (0.36 mmHg) after 6 months of treatment (P = 0.01). CONCLUSIONS: Tafluprost and DTFC glaucoma treatments provided marked OPA and IOP lowering effects. Tafluprost had a greater effect than DTFC; thus, this drug is recommended for patients at risk of glaucoma progression, due to the high OPA caused by large fluctuations in IOP.

Comparison of Ocular Pulse Amplitude-Lowering Effects of Tafluprost and Latanoprost by Dynamic Contour Tonometry.

PURPOSE: A prospective study was performed to compare the ocular pulse amplitude (OPA)-lowering effects of tafluprost and latanoprost, used in the treatment of glaucoma, using dynamic contour tonometry. METHODS: The study population consisted of patients with normal-tension glaucoma (NTG) (n = 27) or primary open-angle glaucoma (POAG) (n = 14) treated with tafluprost and latanoprost. All patients were newly diagnosed with NTG and POAG and had undergone no previous treatment. Intraocular pressure (IOP) was measured by Goldmann applanation tonometry (GAT), OPA was measured by dynamic contour tonometry, and corrected OPA (cOPA) was calculated before and after 1 week, 1-3 months of treatment. RESULTS: Initial IOP and OPA were 17.12 ± 3.75, 2.30 ± 0.56 mmHg and 17.53 ± 2.87, 2.65 ± 0.94 mmHg in the tafluprost and latanoprost groups, respectively. After 3 months of treatment, IOP and OPA were 13.00 ± 2.04 mmHg (24.1%) and 1.51 ± 0.30 mmHg (34.3%), respectively, in the tafluprost group. These values were 15.40 ± 2.32 mmHg (12.2%) and 2.08 ± 0.83 mmHg (21.5%), respectively, in the latanoprost group. Therefore, tafluprost significantly reduced IOP (P = 0.01), but OPA-lowering effects did not differ significantly between the 2 groups (P = 0.17). However, the cOPA-lowering effect of tafluprost (1.27 mmHg, 55.2%) was significantly greater than that of latanoprost (0.84 mmHg, 31.7%) after 3 months of treatment (P < 0.001). CONCLUSIONS: Tafluprost and latanoprost, used to treat glaucoma, have marked OPA-lowering effects as well as IOP-lowering effects. Moreover, tafluprost has a greater effect than latanoprost. Therefore, it can be used for patients in need of IOP reduction and at risk of glaucoma progression.

Intracapsular lens extraction for the treatment of pupillary block glaucoma associated with anterior subluxation of the crystalline lens.

PURPOSE: To report a case of pupillary block glaucoma associated with spontaneous crystalline lens subluxation into the anterior chamber in a 34-year-old man. METHODS: Dry vitrectomy was performed for securing enough retrolental space, and an intracapsular lens extraction was then performed via a corneolimbal incision. Additional endothelial cell damage was avoided with an injection of viscoelastics and gentle extraction of the crystalline lens. After deepening of the anterior chamber, scleral fixation of the intraocular lens was performed with an ab externo technique. RESULTS: Two months after the operation, a well-fixated intraocular lens was observed and intraocular pressure was stable. The postoperative corneal astigmatism was -3.5 dpt, and the patient had a best-corrected visual acuity of 20/25. Postoperative complications included decreased endothelial cell count and sector iris paralysis near the incision site. CONCLUSIONS: An anteriorly subluxated crystalline lens can cause pupillary block glaucoma in healthy young adults. To prevent intraoperative complications, intracapsular lens extraction with dry vitrectomy can be a good surgical option. The endothelial cell density should be closely monitored after surgery.