Effects of Deep Optic Nerve Head Structures on Bruch's Membrane Opening- Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer.

PURPOSE: To explore the effects of deep optic nerve head (ONH) structures on Bruch's membrane opening (BMO)-minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in healthy eyes. DESIGN: Prospective cross-sectional study. METHODS: Two hundred five healthy eyes of 141 subjects (mean ± standard deviation of age and axial length (AXL): 46.9 ± 10.0 years and 24.79 ± 1.15 mm) were enrolled. Best fit multivariable linear mixed models identified factors associated with BMO-MRW and pRNFLT. Explanatory variables included age, gender, AXL, BMO and anterior scleral canal opening (ASCO) area and ovality, magnitude of BMO and ASCO shift, peripapillary choroidal thickness, lamina cribrosa (LC) parameters, prelaminar thickness, and peripapillary scleral (PPS) angle. RESULTS: Thinner BMO-MRW was associated with older age, smaller ASCO/BMO offset magnitude, larger BMO area, thinner prelaminar thickness, deeper LC, and thinner pRNFLT (P = .011, <.001, .004, <.001, <.001, <.001 respectively). Thinner pRNFLT was associated with shorter AXL, smaller ASCO area, a more posteriorly bowed PPS, shallower LC and thinner BMO-MRW. (P = .030, .002, .035, .012, <.001 respectively) CONCLUSIONS: BMO-MRW and pRNFLT were influenced by several deep ONH structures such as BMO and ASCO position shift, BMO or ASCO area, prelaminar thickness, PPS bowing and LC depth in addition to patient characteristics such as age and AXL. The degree and/or direction of associations varied between deep ONH structures and BMO-MRW or pRNFLT. Despite both BMO-MRW and pRNFLT being surrogate parameters for RGC loss, a complex relationship with ONH deep-layer morphology was indicated.

Deep Optic Nerve Head Structures Associated With Increasing Axial Length in Healthy Myopic Eyes of Moderate Axial Length.

PURPOSE: To elucidate which swept-source optical coherence tomography (OCT)-derived optic nerve head (ONH) parameters are associated with longer axial length (AXL) in healthy myopic eyes. DESIGN: Prospective cross-sectional observational study. METHODS: Two hundred eleven healthy eyes of 140 participants (96 emmetropic-mild myopic [AXL: 22.2-24.5 mm], 83 moderately myopic [24.5-26.0 mm], and 32 highly myopic [26.0-27.4 mm] eyes) were enrolled. Bruch membrane opening (BMO), anterior scleral canal opening (ASCO) area and ovality, minimum rim width, parameters defining misalignment between the BMO and ASCO planes, OCT-defined region of perineural canal retinal epithelium atrophy and externally oblique choroidal border tissue, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), circumpapillary choroidal thickness (cpChT), lamina cribrosa parameters, and peripapillary scleral (PPS) angle were calculated from BMO-centered radial scans reconstructed from 3D raster scans. Multivariate linear mixed models were used to elucidate ONH parameters that are independently associated with AXL. RESULTS: Longer AXL was associated with a greater misalignment between ASCO and BMO planes, larger region of externally oblique choroidal border tissue, thinner cpChT, larger PPS angle, larger ASCO area, and thicker cpRNFLT (all P < .040 after Bonferroni's correction for number of included explanatory variables). CONCLUSIONS: A greater misalignment between BMO and ASCO planes, thinner choroid, a more posteriorly bowed PPS, an enlargement of ASCO, and thicker cpRNFLT were each associated with longer AXL. An enhanced understanding of these AXL-associated configurations should provide essential information to improve our ability to detect glaucoma-induced ONH morphology in myopic eyes.

Characterization of laser speckle flowgraphy pulse waveform parameters for the evaluation of the optic nerve head and retinal circulation.

To characterize laser speckle flowgraphy (LSFG) pulse waveform parameters for ocular circulation evaluation, a multicenter, prospective, cross-sectional study was conducted in 111 eyes of 86 healthy Japanese individuals. Optic nerve head (ONH) tissue-area, vessel-area mean blur rate (MT and MV, respectively), and MT and MV pulse waveform parameters were obtained using LSFG and ONH structural parameters using planimetry. Multivariate linear mixed-effects modeled regression analysis identified factors contributing to MT- or MV-waveforms using age, gender, smoking history, body mass index, systolic and diastolic blood pressure, heart rate, intraocular pressure, axial length, disc, rim, and ß-peripapillary atrophy areas, MT or MV, central retinal artery, and vein equivalents (CRAE and CRVE) as explanatory variables. MT- and MV-waveforms significantly correlated with one or more systemic factors, consistent with previous studies. Following confounding factor adjustment, MT-Skew significantly negatively correlated with ß-PPA area (P = 0.026); MT- and MV-flow acceleration index positively correlated with CRAE, MT, and MV (P = 0.041-< 0.001), compatible with these parameters' observed correlations to systemic factors. Significantly negative correlations of the blowout score and acceleration time index to CRAE partly conflicted with their correlations to systemic factors, and other waveform parameters showed little correlation to ocular factors. Thus, Skew and flow acceleration index assisted the in vivo ocular circulation characterization.

Ocular and Systemic Factors Affecting Laser Speckle Flowgraphy Measurements in the Optic Nerve Head.

Purpose: To investigate the ocular and systemic factors related to glaucoma and to be adjusted for interindividual comparison of ocular blood flow measurement results by laser speckle flowgraphy (LSFG) obtained from the optic nerve head (ONH) in normal Japanese individuals. Methods: A multicenter, prospective cross-sectional study was conducted. The ONH tissue-area and vessel-area mean blur rate (MT and MV) were evaluated using LSFG and ONH structural parameters using planimetric methods. Multivariate linear mixed-effects modeled regression analysis was used to identify the contributing factors to the MT and MV. The explanatory variables were age; gender; smoking history; body mass index; mean arterial pressure (MAP); heart rate; intraocular pressure; axial length (AL); disc, rim, cup, and ß-peripapillary atrophy (ß-PPA) areas; and central retinal artery and vein equivalents. Results: In total, 195 eyes of 126 healthy individuals with an average age of 48.1 years were included. Multivariate analysis showed that MAP and disc area had a negative (P < 0.001) correlation, whereas ß-PPA area had a positive correlation with MT (P = 0.010). Age and AL had a negative correlation (P = 0.001 and P = 0.011, respectively), whereas cup area had a positive correlation (P = 0.012) with MV. Conclusions: Interindividual comparison of MT or MV must be adjusted for both systemic factors (blood pressure or age) and local ocular factors (AL and disc, cup, or ß-PPA area). Translational Relevance: Our results provided reference data on the LSFG measurement and are important in comparing ocular blood flow between individuals using LSFG.

Incidence and Risk Factors of Iatrogenic Retinal Breaks: 20-Gauge versus 25-Gauge Vitrectomy for Idiopathic Macular Hole Repair.

PURPOSE: We compared the incidences of iatrogenic retinal breaks and postoperative retinal detachment between eyes that underwent 20-gauge vitrectomy and those that underwent 25-gauge vitrectomy for idiopathic macular hole repair. METHODS: This retrospective nonrandomized consecutive observational case series included 185 eyes of 183 patients (130 eyes of 129 patients and 55 eyes of 54 patients in the 20- and 25-gauge groups, respectively). We assessed the relationship between the incidence of retinal breaks and postoperative retinal detachment and related this to posterior vitreous detachment and lattice degeneration. RESULTS: The incidences of iatrogenic retinal breaks were 36.9% and 12.7% in the 20-gauge and 25-gauge groups, respectively. These groups did not differ in their respective frequencies of posterior vitreous detachment (the 20-gauge group: 31.5% and the 25-gauge group: 27.3%) and lattice degeneration (the 20-gauge group: 14.6% and the 25-gauge group: 7.3%). Among eyes without lattice degeneration, the 20-gauge group showed a higher incidence of iatrogenic retinal breaks than the 25-gauge group. However, among the eyes with lattice degeneration, the frequency of retinal breaks did not differ between the two surgery types, and four cases of postoperative retinal detachment were reported in both groups. CONCLUSIONS: The incidence of retinal breaks related to idiopathic macular hole surgery is higher among patients undergoing 20-gauge vitrectomy than among those undergoing 25-gauge vitrectomy. Posterior vitreous detachment and lattice degeneration are associated with considerably increased incidences of retinal break.

Choroidal thickness and intraocular pressure after 25-gauge and 23-gauge vitrectomy for idiopathic epiretinal membrane.

PURPOSE: To determine the relationship between the subfoveal choroidal thickness (SCT) and intraocular pressure (IOP) following 25-gauge (25G) and 23-gauge (23G) vitrectomy for idiopathic epiretinal membrane (ERM). STUDY DESIGN: Retrospective, consecutive, interventional case series. METHODS: Sixty-two patients undergoing 25G vitrectomy and 56 patients undergoing 23G vitrectomy for ERM participated. SCT was measured using enhanced depth imaging optical coherence tomography and IOP were measured both at baseline and postoperatively. RESULTS: In both groups, the IOPs on day one and one week after surgery were significantly lower than at baseline (P < 0.001 for both). The rates of changes of IOP were significantly greater in 23G compared to 25G on day one (P = 0.026). In 23G the SCTs on day one and one week after surgery were significantly thicker (P < 0.001) than baseline. The rates of changes in SCT between baseline and day one negatively correlated with those of IOP in 23G (r = -0.559, P < 0.001) but no correlation was observed with 25G (r = -0.129, P = 0.316). CONCLUSION: Choroidal thickness increases soon after 23G vitrectomy for ERM which is probably due to the transient hypotony, however, early SCT change does not appear in 25G vitrectomy. Twenty-five-gauge vitrectomy may have an advantage in minimizing postoperative choroidal changes.

Efficacy and safety of adding ripasudil to existing treatment regimens for reducing intraocular pressure.

PURPOSE: Ripasudil accelerates aqueous humour drainage along the trabecular meshwork-Schlemm's canal route and has been approved for clinical use in Japan. We retrospectively investigated the efficacy and safety of adding ripasudil to existing treatment regimens to reduce intraocular pressure (IOP) in patients with glaucoma. METHODS: A total of 119 eyes from 119 subjects (61 men, 58 women) with primary open-angle glaucoma or ocular hypertension who had ripasudil added to their treatment regimens between December 2014 and June 2015 were included. An average of 3.8 ± 1.0 anti-glaucoma medications was in use before adding ripasudil. Subjects were divided into four groups based on the number of medications included in the original treatment regimen: ≤2, 3, 4, or ≥5 medications. The IOP was compared before and after 1 and 3 months of treatment with ripasudil for all subjects and between groups. Patients for whom ripasudil use was discontinued within 3 months were also examined. RESULTS: The IOP was significantly lower in all patients after 1 month (17.5 ± 4.5 mmHg) and 3 months (16.8 ± 4.2 mmHg) of treatment than it was before (19.8 ± 5.3 mmHg, p < 0.0001). All groups were equivalent in the rate and magnitude of IOP change. Ripasudil administration was discontinued in five patients (4.2%) prior to the end of the study: three were lost to follow-up and two underwent glaucoma surgery. CONCLUSION: Adding ripasudil to existing glaucoma treatment regimens is effective and safe in reducing IOP, regardless of the number of medications in use.

Incidence of outer retinal tubulation in eyes with choroidal neovascularization under intravitreal anti-vascular endothelial growth factor therapy in a Japanese population.

PURPOSE: The purpose of this study was to investigate the occurrence of outer retinal tubulation (ORT) among patients with different types of choroidal neovascularization (CNV) over time. MATERIALS AND METHODS: In this retrospective chart review, disease type was classified as typical age-related macular degeneration (t-AMD), polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), or myopic CNV (mCNV). Spectral domain-optical coherence tomography (SD-OCT) images were evaluated for the appearance of ORT and subretinal fibrosis and fluid. Furthermore, the association of the presence of ORT with clinical data and OCT findings was investigated. RESULTS: Among the 136 eyes studied, the overall rates of occurrence of ORT were 7.8%, 18.8%, and 31.6% after 12, 24, and 36 months from baseline, respectively. Among patients with t-AMD, RAP, and mCNV, the occurrence of ORT increased soon after the initial visit. In contrast, among patients with PCV, the occurrence of ORT increased slowly over time. Patients with and without ORT - ORT(+) and ORT(-) groups, respectively - differed significantly in terms of sex ratio and presence of intraretinal fluid at the initial visit and presence of subretinal fibrosis at 3 years from baseline. The ORT(+) group exhibited lower visual acuity (VA; 0.67±0.43) than that of the ORT(-) group (0.41±0.36; P<0.001). CONCLUSION: The occurrence of ORT tended to increase more slowly among eyes diagnosed with PCV than among eyes with other types of CNV.

Changes in the thickness of the macular ganglion cell complex and retinal nerve fiber layer over time after surgery in a case of juvenile glaucoma.

PURPOSE: To report longitudinal changes over time after surgery in the topography of the optic disc, thickness of the circum papillary retinal nerve fiber layer (c-RNFL), and thickness of the macular ganglion cell complex (m-GCC) in a case of juvenile open angle glaucoma. OBSERVATIONS: Case report based on one patient. After significant edema of the optic disc for 2 months, the cup depth and cup volume measured by Heidelberg retina tomograph images showed reversal, which lasted for 3 years. The c-RNFL thickness and m-GCC thickness measured by spectral domain optical coherence tomography first increased for a week and then continued to decrease until 6 months after operation. These two parameters reached a plateau after 3 years. The mean deviation of global visual field indices of the Humphrey visual field revealed a very mild reduction for this 3 year period. CONCLUSIONS AND IMPORTANCE: In juvenile onset glaucoma, changes in c-RNFL thickness and m-GCC thickness after operation were not consistent with changes in optic disc cupping. Changes in the thicknesses of the c-RNFL or m-GCC, rather than changes in the optic disc changes, may be good surrogate measures to confirm the effectiveness of glaucoma surgery.

Idiopathic Macular Hole Vitrectomy Without Postoperative Face-Down Positioning Performed by Different Surgeons.

PURPOSE: To evaluate the efficacy of vitrectomy with internal limiting membrane peeling and sulfur hexafluoride gas tamponade without postoperative face-down positioning for macular holes (MHs) when performed by 3 surgeons at 2 centers. DESIGN: A retrospective, consecutive, observational case series. METHODS: Fifty-seven eyes operated on by 1 of 3 surgeons and followed for 12 months after surgery were studied. Exclusion criteria included cases with MH duration longer than 6 months, secondary MH, and clear lenses. The surgical procedure involved cataract extraction and intraocular lens implantation in all phakic eyes before vitrectomy. Internal limiting membrane removal and 20% sulfur hexafluoride gas tamponade without postoperative face-down positioning were performed in all cases. Preoperative factors [age at surgery, sex, symptom duration, visual acuity (VA), MH size, and MH stage], initial and final hole-closure rates and VA at 1, 3, 6, and 12 months after surgery, were evaluated. RESULTS: Mean patient age was 65.3 years. Of the 57 eyes, 40 were in women, and 17 were in men. Macular hole (mean size, 0.30 disc diameter) was present for a mean of 2.37 months. Eight eyes had stage 2, 37 had stage 3, and 12 had stage 4 MH. Fifty-four holes (94.7%) initially closed. Final closure rate was 100%. Mean VA significantly improved from 0.65 to 0.41 at 1 month, 0.35 at 3 months, 0.28 at 6 months, and 0.21 at 12 months after surgery. CONCLUSIONS: Vitrectomy without face-down positioning for MHs produced favorable anatomic and functional results, regardless of which surgeon performed the procedure.

Idiopathic macular hole vitrectomy without postoperative face-down positioning.

PURPOSE: To evaluate the efficacy of vitrectomy with internal limiting membrane (ILM) peeling and SF(6) gas tamponade for macular holes without face-down positioning. METHODS: Twenty-one eyes of 21 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and 20% SF(6) gas tamponade without face-down positioning were included in this study. Biomicroscopy and optical coherence tomography were used to assess macular hole closure. Pre- and postoperative visual acuities (VAs) were compared. RESULTS: Among the 21 eyes, five (23.8%) had stage 2, 11 (52.4%) stage 3, and five (23.8%) stage 4 macular holes. Mean macular hole size was 0.35 disc diameters. The macular holes had been present for an average of 2.3 months. Twenty eyes (95.2%) were phakic, and one (4.8%) was pseudophakic. Nineteen of the 21 holes (90.5%) initially closed. The final closure rate was 100%, and no eyes showed reopening. Preoperative mean VA (logMAR) was 0.65, and mean VA had significantly improved to 0.46 at 1 month and to 0.42 at 3 months after surgery (P < 0.0001, repeated measures analysis of variance). CONCLUSION: Vitrectomy with ILM peeling and SF(6) gas tamponade for macular holes without face-down positioning achieved favorable anatomical and functional results.

Ultrasound biomicroscopy in narrow peripheral anterior chamber eyes with or without peripheral anterior synechiae.

AIM: To compare the configurations of the anterior ocular segment including the anterior chamber (AC) angle and ciliary body between eyes with a narrow AC angle (ACA) with and without peripheral anterior synechiae (PAS). PATIENTS AND METHODS: One hundred and one eyes of 101 consecutive patients with a temporal peripheral AC depth one-quarter of the corneal thickness or less were included. Gonioscopy and ultrasound biomicroscopy were performed under light and dark conditions. The existence of PAS was further confirmed with compression gonioscopy with indentation. Eyes with findings suggestive of plateau iris configuration or those with glaucomatous optic neuropathy were carefully excluded. The biometric parameters including the ACA, the angle opening distance at 500 mum, the trabecular-ciliary process distance, the iris-zonule distance, and the scleral-ciliary process angle were determined. RESULTS: PAS were found in 43 (43%) of the 101 eyes. There were no differences in age, refractive error, or intraocular pressure between PAS-positive and PAS-negative eyes (P>0.1). ACA, iris-zonule distance, scleral-ciliary process angle under light and/or dark conditions were significantly smaller in the PAS-positive eyes than in the PAS-negative eyes (P<0.05). CONCLUSIONS: Shallow peripheral AC depth and relatively anteriorly located ciliary body was significantly associated with the presence of PAS in eyes with a narrow ACA.

[Tajimi Study review].

The results of The Tajimi Study (a population-based prevalence survey of glaucoma in Tajimi City performed by the Japan Glaucoma Society) are summarized. The Tajimi Study was carried out from September, 2000 to October, 2001 to investigate the prevalence of glaucoma among residents aged 40 years old or over in Tajimi. Seventy-eight point one % of 3,870 eligible people from 4,000 subjects who had been randomly selected from the 54,165 over 40 years old residents in Tajimi participated in the study. Estimated prevalence of all glaucoma and glaucoma/suspected glaucoma were 5.0 (95% confidence interval [CI], 4.2-5.8)% and 7.5 (95% CI, 6.5-8.4)%. The prevalence of primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG), and secondary glaucoma (SG) were 3.9 (95% CI, 3.2-4.6)%, 0.6 (95% CI, 0.4-0.9)%, and 0.5 (95% CI, 0.2-0.7)%, respectively. Including suspected cases, the prevalence of POAG, PACG, and SG was 6.0 (5.1-6.8)%, 0.8 (0.5-1.2)%, 0.7 (0.4-1.0)%. High intraocular pressure, myopia, and older age were shown to be statistically significant risk factors for POAG. It was suggested that the Frequency Doubling Technology is a good candidate as a screening test for glaucoma. The leading cause of low vision was cataracts. Investigation of refractive status showed that the prevalence of myopia(spherical equivalence [SE] < 0.5 diopters) and high myopia (SE < -5.0 diopters) was 41.8 (40.0-43.6)% and 8.2 (7.2-9.2)%, respectively.

Optic disc and retinal nerve fiber layer analysis with scanning laser tomography after LASIK.

PURPOSE: To examine whether LASIK induces changes in the optic disc and retinal nerve fiber layer using scanning laser tomography. METHODS: Prospective, consecutive study of 53 myopic eyes in 38 patients (mean age: 35.7 +/- 10.4 years; range: 22 to 58 years). Preoperative average refractive error was -6.0 +/- 2.4 diopters (D) (spherical equivalent) (range: -2.0 to -10.0 D). Optic disc morphology and retinal nerve fiber layer thickness were evaluated with scanning laser tomography preoperatively and at 7 and 13 months postoperatively. RESULTS: No statistically significant differences were noted between the pre- and postoperative optic disc and retinal nerve fiber layer measurements. CONCLUSIONS: Our results suggest that transient extreme elevation of intraocular pressure during LASIK does not affect the optic disc morphology or retinal nerve fiber layer thickness in normal myopic eyes for at least 1 year after surgery.

Morphometric evaluation of changes with time in optic disc structure and thickness of retinal nerve fibre layer in chronic ocular hypertensive monkeys.

We examined the time course of changes in optic disc structure by means of a scanning laser ophthalmoscope (Heidelberg Retina Tomograph, HRT) in ocular hypertensive (experimental glaucoma) monkeys, and clarified the relationships between the histological RNFL thickness and HRT parameters. Further, the time course of changes in retinal nerve fiber layer (RNFL) thickness in individual eyes was measured using a scanning laser polarimeter with fixed corneal polarization compensator (GDx FCC). In the present study, two separate experiments were carried out. A chronic intraocular pressure (IOP) elevation was induced by laser trabeculoplasty in the left eye in 11 cynomolgus monkeys. In Experiment 1, the HRT and GDx parameters were measured 12 weeks after the laser treatment in 10 eyes in five monkeys. In Experiment 2, the time course of changes in the HRT and GDx parameters was examined before and 1, 3, 4, 5, 6, 8, 10, 12, 14, and 16 weeks after the laser treatment in 12 eyes in six monkeys. The retardation values (thickness parameters) obtained from the GDx were used to derive thickness and ratio parameters in the superior, inferior, nasal and temporal quadrants. Ratio parameters were expressed as a ratio of superior and inferior quadrant to nasal quadrant. After the last measurements, each eye was enucleated, and retinal cross sections were prepared for histological analysis. In the left (hypertensive) eyes, IOP was persistently elevated throughout the observation periods in both Experiments 1 and 2. In the HRT measurements in Experiment 1, seven out of eight global topographic parameters (exception, disc area) were statistically different between the hypertensive and control eyes 12 weeks after the laser treatment. In Experiment 2, the HRT parameters changed in a time-dependent manner, but each of them almost plateaued at about 4 weeks after the laser treatment. Significant correlations were seen between the histological mean RNFL thickness at 1.5 disc diameters from the optic disc margin and the HRT parameters in 21 eyes from 11 monkeys in Experiments 1 and 2. Especially good correlations with histological mean RNFL thickness were seen for the rim volume and cup volume. In Experiment 1, good correlations were found between GDx ratio parameters and histological RNFL thickness in individual right control eyes (n=5). In individual left experimental glaucoma eyes of Experiment 2 (n=6), GDx ratio parameters declined in a time-dependent manner alongside the IOP elevation. In conclusion, alongside the IOP elevation, time-related changes in optic disc topography and RNFL thickness were demonstrated in monkey eyes using HRT and GDx. HRT (rim and cup) parameters showed good correlations with histological RNFL thickness, and significant interrelations.

Intraocular metabolites of isopropyl unoprostone.

PURPOSE: It is still unknown which metabolite of isopropyl unoprostone is responsible for reducing intraocular pressure. This study was carried out to measure intraocular metabolites of isopropyl unoprostone in the aqueous humor of primate and human eyes. METHODS: Nine monkeys were randomly divided into three groups, all of which received isopropyl unoprostone. In group I, the drug was scheduled to be instilled at 0 hr, in group II at 1 hr, and in group III at 2 hr, prior to aqueous humor aspiration in order to determine metabolite concentration. Furthermore, 27 patients scheduled for cataract surgery and intraocular lens implantation were divided into five groups that received isopropyl unoprostone. In group A, the drug was scheduled to be instilled at 0 hr, in group B at 1 hr, in group C at 2 hr, in group D at 3 hr, and in group E at 4 hr, prior to surgery. At the beginning of the operation, the aqueous humor was aspirated. Metabolites of isopropyl unoprostone in the aqueous humor were determined by high-performance liquid chromatography. RESULTS: M1 (3-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]propionic acid) (unoprostone free acid) and M2 ((Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]hept-5-enoic acid), an intraocular oxidized metabolite of isopropyl unoprostone, were measured. M1:M2 in monkeys was respectively 0:0 ng/ml in group I, 150.2 +/- 45.1:9.5 +/- 1.7 (p < 0.05) in group II, and 74.6 +/- 31.4:19.2 +/- 5.3 (p < 0.01) in group III. M1:M2 in humans was respectively 0:0 ng/ml in group A, 50.6 +/- 22.3:3.2 +/- 1.3 (p < 0.05) in group B, 125.0 +/- 23.1:12.2 +/- 3.4 (p < 0.001) in group C, 144.9 +/- 33.8:24.5 +/- 6.2 (p < 0.01) in group D, and 56.7 +/- 21.5:18.7 +/- 5.3 (p < 0.05) in group E. CONCLUSIONS: A free acid of isopropyl unoprostone is the major intraocular metabolite of isopropyl unoprostone that is expected to act on target tissues in the eyes of both monkeys and humans.

Efficacy and complications after trabeculectomy with mitomycin C in normal-tension glaucoma.

PURPOSE: To evaluate the efficacy of and complications after trabeculectomy using mitomycin C (MMC) in Japanese normal-tension glaucoma (NTG) patients by a retrospective analysis based on the Kaplan-Meier life table method. METHODS: Clinical records of 39 NTG patients who underwent trabeculectomy with 0.04% MMC and had postoperative follow-up periods of 3 years or more (50.5 +/- 8.4 months, mean +/- SD) were reviewed. Postoperative intraocular pressure (IOP) at every 1 or 2 months, complications, visual acuity, and visual field at every 6 months were recorded. RESULTS: IOP significantly decreased from 15.9 +/- 1.9 preoperatively to 8-11 mmHg throughout the postoperative follow-up period (P < 0.0001). The life table analysis, in which failure of IOP control was defined as an IOP above a level either 30% or 20% lower than the preoperative IOP at three consecutive visits, showed a cumulative survival rate of 39.4 +/- 7.8% (mean +/- SEM) or 41.3 +/- 8.9%, respectively, at 4 years after surgery. Mean deviation of the visual field results did not significantly change (P > 0.5). The cumulative survival rate from postoperative late-onset hypotony was 74.7 +/- 6.3% at 4 years after surgery. Postoperative complications observed were shallow anterior chamber (six eyes), choroidal detachment (nine eyes), hypotonous maculopathy (seven eyes), bleb leak (one eye), cataract development (three eyes), and blebitis (two eyes). No eyes developed endophthalmitis. CONCLUSIONS: In NTG patients, trabeculectomy with MMC showed significant efficacy in reducing IOP up to 4 years after surgery. Since risks of postoperative complications are unavoidable, indications for surgery should be carefully considered, and careful follow-up is necessary to avoid severe postoperative complications.

Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients.

PURPOSES: To describe the clinical characteristics of functioning blebs in Japanese glaucoma patients after primary trabeculectomy with adjunctive mitomycin-C (MMC) and to correlate their associations with postoperative bleb leakage. DESIGN: A prospective, observational case series. PARTICIPANTS: One hundred sixty-two glaucoma patients who had undergone primary trabeculectomy with MMC at the University of Tokyo Hospital at least 3 months before were examined between December 1997 and February 1998. METHODS: A predesigned data form was completed at each visit. Ophthalmologic examinations included Goldmann applanation tonometry, slit-lamp examination, and Seidel tests with and without digital ocular pressure (DOP). MAIN OUTCOME MEASURES: Properties of the functioning bleb, including bleb appearance, thickness of bleb wall, dimensions of bleb and avascular area, and leakage status with and without DOP. RESULTS: Of 162 Japanese patients, 162 eyes with functioning blebs were included. There were no differences in bleb characteristics among the different types of primary glaucoma. With a long postoperative duration, blebs tended to be thinner (P = 0.024). With DOP, the leaking rate increased from 3.1% to 5.6%, and the oozing rate increased from 11.1% to 35.8% (P < 0.001). Logistic regression analysis indicated that the larger the avascular area, the more likely the bleb leaked without DOP (P = 0.016). When DOP was applied, leakage was more likely to occur in the blebs with a long postoperative duration (P = 0.002) or with a large avascular area (P < 0.001). CONCLUSIONS: The clinical characteristics of filtering blebs were similar in Japanese patients with different types of primary glaucoma. Blebs with a large avascular area were associated with a higher risk of bleb leakage. Attention to the increased chance of leakage induced by DOP is important, especially for blebs with a long postoperative duration. Ophthalmologists should be aware of late bleb-related complications in addition to bleb function.