Visual field loss morphology in high- and normal-tension glaucoma.

Purpose. To determine whether the patterns of visual field damage between high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) are equivalent. Methods. In this retrospective cross-sectional study, fifty-one NTG and 57 HTG patients were recruited. For each recruited patient only the left eye was chosen. Glaucomatous patients had abnormal visual fields and/or glaucomatous changes at the optic nerve head. They were classified as HTG or NTG on the basis of intraocular pressure (IOP) measurements. Patients' visual fields were analyzed by using Humphrey Field Analyzer (HFA), program 30-2, full threshold. The visual field sensitivity values and the pattern deviation map values of the 72 tested points were considered. Then a pointwise analysis and an area analysis, based on the Glaucoma Hemifield test criteria, were performed, and a comparison between the two subgroups was made by Student's t test. Results. Between NTG and HTG, no significant difference was found pointwise for almost all the visual field points, except for two locations. One was under the blind spot, and the other was in the inferior hemifield around the twenty-degree position. When area analysis was considered, three areas showed a significantly different sensitivity between HTG and NTG. Conclusions. These data suggested that there was no relevant difference in the pointwise analysis between NTG and HTG; however, when visual field areas were compared, no difference in paracentral areas was found between NTG and HTG, but superior nasal step and inferior and superior scotomata showed to be deeper in HTG than in NTG.

Efficacy and safety of a steel drainage device implanted under a scleral flap.

OBJECTIVE: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS X200) implanted under a scleral flap for the surgical treatment of primary open-angle glaucoma (POAG). STUDY DESIGN: Clinical, prospective, noncomparative, nonrandomized study. The efficacy and safety were evaluated on the full sample, with a minimum follow-up of 12 months (maximum 24, mean 18). PARTICIPANTS: Thirty-seven eyes of 35 patients. METHODS: The Ex-PRESS device was implanted under a scleral flap in patients with POAG. RESULTS: Preoperative intraocular pressure (IOP) was 27.6 (SD 8.7) mm Hg; at last follow-up, IOP was 12.4 (SD 3.4) mm Hg (55.1% reduction). The success rates (IOP < 18 mm Hg and < 15 mm Hg at last visit without medications) were 78.4% (29/37) and 70.3% (26/37), respectively. Kaplan-Meier analyses (probability of IOP < 18 mm Hg and < 15 mm Hg without medications) at last follow-up were 72.6% and 47.9%, respectively. Early postoperative complications were clinically mild and included postoperative IOP < 5 mm Hg: 12 cases at 1 day, 8 cases at 1 week, 3 cases at 1 month, 1 case at 3 months; serous choroidal detachment: 9 cases, of which 3 spontaneously resolved, whereas in 6 cases, hypotony and flat chamber were treated with viscoelastic injection in the anterior chamber. At last follow-up, 6 patients were treated with 2 IOP-lowering medications. No sight-threatening consequences of surgery were observed. There were 8 cases (21.6%, n = 37) of bleb needling. CONCLUSIONS: Our data support the efficacy and safety of the implantation of this device under a scleral flap. The IOP reduction obtained was significant and long standing and complications were mild.

Histological biocompatibility of a stainless steel miniature glaucoma drainage device in humans: a case report.

The purpose of this study was to evaluate the histological biocompatibility of a stainless steel miniature glaucoma drainage device. Twenty-four months before death due to heart failure, this seventy-three-year-old female patient underwent filtration surgery for primary open-angle glaucoma uncontrolled in the right eye. The device was implanted at the limbus under a scleral flap. For histopathological evaluation, two corneoscleral specimens were embedded in methacrylate blocks sectioned to a thickness of 50 microns, polished and stained with periodic acid schiff. Some sections included a longitudinal cross-section of the implant. At the interface between the spur and the flange of the device and the cornea, there was a small shoulder of fibrous tissue. A thin, fibrous capsule covered the remainder of the body of the device up to the distal tip. No inflammatory cells occurred within the fibrous capsule. No material or blockage was noted within the lumen. Our results support the biological inertness of the device.

Magnetic resonance imaging in patients implanted with Ex-PRESS stainless steel glaucoma drainage microdevice.

PURPOSE: To evaluate whether artifacts caused by a stainless steel glaucoma drainage device can alter the interpretation of magnetic resonance imaging (MRI) scans of the optic nerve and brain. DESIGN: Consecutive case series. METHODS: Five patients (7 eyes) with Ex-PRESS devices (Optonol Ltd, Neve Ilan, Israel) positioned at the limbus were studied. For each subject, an axial T1-weighted, axial and coronal T2-weighted with fat saturation, and whole brain proton density (PD)/T2-weighted MRI scan was obtained. Standard MRI protocol was not optimized for the imaging of patients harboring Ex-PRESS implants. The effects of the device on PD/T2 pulse sequence imaging of the optic nerve and brain were rated from 1 (optic nerve margins unidentifiable or brain details altered) to 5 (excellent visualization of the optic nerve and brain). RESULTS: For optic nerve visualization, 1 optic nerve scored 2, 3 optic nerves scored 3, and 3 optic nerves scored 4 (mean, 3.3 +/- 0.8 standard deviation). For whole brain imaging, 4 patients scored 4 and 1 patient scored 5 (mean, 4.2 +/- 0.4 standard deviation). CONCLUSIONS: Our data demonstrate that interpretation of MRI scans of the orbit and brain is unaffected by the artifacts caused by the Ex-PRESS shunt, whereas optic nerve imaging may be affected. We are unaware of previous reports of this finding and could find no reference to it in a computerized search using PubMed.

Comparison between GDx VCC parameter and achromatic perimetry in glaucoma patients.

PURPOSE: To evaluate the correlation between polarimetry parameters and standard threshold perimetry indices. PATIENT AND METHODS: One hundred and eight consecutive glaucomatous patients were recruited in this study. Glaucomatous patients were classified when an abnormal visual field and/or an abnormal optic nerve head were present. One eye was chosen randomly from all the subjects. All optic nerve heads were examined with the GDx variable corneal compensator (VCC) (Laser Diagnostic Technologies, Inc, San Diego, CA) and visual fields were assessed by Humphrey Perimeter, program 24-2, SITA standard (Humphrey Instrument, Inc, San Leandro, CA). GDx VCC parameters and visual field indices were considered. Correlation coefficient was used to compare the 2 sets of data. A linear regression model was also used to calculate the independent contribution of each GDx VCC parameter and to determine which parameter was the most predictive of visual field damage. RESULTS: The mean age (+/-standard deviation) was 61+/-10.3, the average of the mean deviation (MD) was -2.31+/-3.2 dB and the mean pattern standard deviation (PSD) was 3.32+/-2.83 dB. Significant (P<0.05) correlation was found between MD and the nerve fiber indicator (NFI) (r=-0.35), the superior average (r=0.28), the Temporal-Superior Nasal-Inferior Temporal average (r=0.24) and the inferior average (r=0.21). The linear regression model found NFI to be the predictor variable of MD. Significant (P<0.05) correlation was found between PSD and the NFI (r=0.39), the superior and the inferior average (r=0.30), and the Temporal-Superior Nasal-Inferior Temporal average (r=0.29). The linear regression model found NFI to be the predictor variable of PSD. CONCLUSIONS: Some of the GDx VCC indices were significantly correlated to visual field indices in glaucomatous patients, but NFI was the best indicator of visual field damage.

Correlation between frequency doubling technology and heidelberg retina tomograph.

PURPOSE: To evaluate the association between Heidelberg Retina Tomograph (HRT) parameters and the Frequency Doubling Technology (FDT) indices in ocular hypertension or primary open angle glaucoma patients. METHODS: One eye was randomly chosen from 85 patients with primary open angle glaucoma (abnormal visual field and/or abnormal optic nerve and untreated IOP > 21 mm Hg) and ocular hypertension (normal visual field and normal optic nerve and untreated IOP > 21 mm Hg). All the patients were examined with Humphrey Perimeter program 30-2 full threshold, FDT program C 20-5, and HRT. Findings were analyzed using Pearson's correlation coefficient and linear regression. RESULTS: Within the entire sample of studied subjects we found a statistically significant correlation (Pearson's r) (P < 0.05) between FDT mean deviation and RA, CA, RV, CSM, RNFLt, and RNFLc of HRT, and between FDT pattern standard deviation and RA, CA, VOLC, CV, RV, CSM, RNFLt, and RNFLc of HRT. Linear regression analysis showed that cup shape measure was the most predictive parameter for FDT MD. No correlation was found between HRT parameters and FDT PSD indices in the glaucoma subgroup; in the ocular hypertensive subgroup some correlation was found between FDT PSD and some of the HRT parameters. CONCLUSION: In the entire group, cup shape measure showed to be the most significant factor correlating functional and morphologic changes. The presence of significant correlations between some HRT parameters and visual field indices in the ocular hypertensive and glaucoma subgroup suggested that HRT parameters and FDT indices could detect glaucoma damage differently.