PITX2 deficiency and associated human disease: insights from the zebrafish model.

The PITX2 (paired-like homeodomain 2) gene encodes a bicoid-like homeodomain transcription factor linked with several human disorders. The main associated congenital phenotype is Axenfeld-Rieger syndrome, type 1, an autosomal dominant condition characterized by variable defects in the anterior segment of the eye, an increased risk of glaucoma, craniofacial dysmorphism and dental and umbilical anomalies; in addition to this, one report implicated PITX2 in ring dermoid of the cornea and a few others described cardiac phenotypes. We report three novel PITX2 mutations-c.271C > T, p.(Arg91Trp); c.259T > C, p.(Phe87Leu); and c.356delA, p.(Gln119Argfs*36)-identified in independent families with typical Axenfeld-Rieger syndrome characteristics and some unusual features such as corneal guttata, Wolf-Parkinson-White syndrome, and hyperextensibility. To gain further insight into the diverse roles of PITX2/pitx2 in vertebrate development, we generated various genetic lesions in the pitx2 gene via TALEN-mediated genome editing. Affected homozygous zebrafish demonstrated congenital defects consistent with the range of PITX2-associated human phenotypes: abnormal development of the cornea, iris and iridocorneal angle; corneal dermoids; and craniofacial dysmorphism. In addition, via comparison of pitx2M64* and wild-type embryonic ocular transcriptomes we defined molecular changes associated with pitx2 deficiency, thereby implicating processes potentially underlying disease pathology. This analysis identified numerous affected factors including several members of the Wnt pathway and collagen types I and V gene families. These data further support the link between PITX2 and the WNT pathway and suggest a new role in regulation of collagen gene expression during development.

Acquired ectropion uveae and secondary glaucoma due to trauma: report of 3 cases.

PURPOSE: To investigate the possible association between acquired ectropion uveae and blunt trauma to the eye. We present 3 cases of acquired ectropion uveae that occurred after blunt trauma to the eye. There are no previously published data on possible association of these conditions. METHODS:: A retrospective review was conducted of patients with ectropion uveae and eye injury at University Eye Hospital over a 10-year period (2006-2016). We analyzed medical records and clinical findings. RESULTS:: Three eyes of 3 male patients with ocular trauma and ectropion uveae, ages 71, 68, and 5 years, were reviewed. The period between the eye injury and the diagnosis of ectropion uveae ranged from 10 to 36 months. All 3 eyes developed clinical evidence of secondary glaucoma with moderately to severely elevated intraocular pressure (IOP) (ranging from 29 to 48 mm Hg). Surgical treatment (trabeculectomy) was needed in 2 cases in order to control secondary glaucoma and conservative treatment was sufficient in 1 case. Mean patient follow-up was 19.3 ± 4.6 months. CONCLUSIONS:: Trauma can be considered as a cause of acquired ectropion uveae. Acquired ectropion uveae following eye trauma may be associated with significant increase in IOP. All patients in our series had secondary glaucoma and 2 of 3 required surgical treatment for IOP control.

Relationship between blood pressure and retrobulbar blood flow in dipper and nondipper primary open-angle glaucoma patients.

PURPOSE: To evaluate the relationship between retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery, and short posterior ciliary artery and 24-hour blood pressure (BP) measurements in dipper and nondipper patients with primary open-angle glaucoma (POAG). METHODS: A prospective, cross-sectional, and observational study was conducted on consecutive patients, referred or recruited, attending the outpatient service of our ophthalmology department. Ambulatory BP monitoring, Doppler imaging, and ocular pulse amplitude measurements were performed on the same day. Patients with nocturnal BP decrease up to 10% of the diurnal BP were defined as dippers and those with BP decrease less than 10% were defined as nondippers. RESULTS: A total of 114 patients (36 nondippers and 78 dippers) were included in the study. The end-diastolic velocity was significantly lower and the resistivity index (RI) was significantly higher in the dippers than in the nondippers (p<0.0001 and p<0.0001, respectively). The RI in the OA was significantly correlated with daytime and nighttime systolic BP and with the daytime mean arterial pressure in the dippers. CONCLUSIONS: The RI in the OA significantly correlates with BP in patients with POAG with nocturnal BP dips. Additionally, retrobulbar blood flow parameters are reduced in dippers as compared with nondippers with POAG.

The Role of 24-hour Ambulatory Blood Pressure Monitoring in Hypertensive Patients with Normal-tension Glaucoma.

INTRODUCTION: Extreme dippers are patients with a nocturnal fall of blood pressure (BP) of more than 20%, dippers have normal diurnal rhythm and decrease of BP of 10-15%, while patients with a nocturnal BP fall of less than 10% are considered to be non-dippers. OBJECTIVE: The aim of this study was to compare 24-hour ambulatory BP monitoring results of normal-tension glaucoma (NTG) patients with NTG suspects, as well as to determine whether NTG patients are more prone to daytime/nighttime systemic arterial BP and heart rate oscillations in comparison to NTG suspects. METHODS: This was a prospective, cross-sectional and observational study of 57 hypertensive patients (39 female and 18 male), all examined at the Eye and the Cardiology Clinic, Clinical Center of Serbia in Belgrade, between November 2011 and March 2012. Before 24-hour ambulatory BP monitoring, complete ophthalmological examination was performed (intraocular pressure was measured with both Goldmann applanation and dynamic contour tonometer, as well as with computerized perimetry and Heidelberg retinal tomography). RESULTS: There was no statistically significant difference between NTG patients and NTG suspects both in systolic daytime (131.86-141.81 mmHg, SD=±l 4.92 vs. 129.67-141.83 mmHg, SD=±l3; p=0.53) and nighttime measurements (117.1-129.7 mmHg, SD=±l 8.96 vs. 112.11-127.59 mmHg, SD=±16.53; p=0.53) as well as diastolic daytime (74.55-80.37 mmHg, SD=±8.72 vs. 75.19-82.41 mmHg, SD=±7.72; p=0.58) and nighttime measurements (65.66-71.48 mmHg, SD=±8.73 vs. 67.12-73.78 mmHg, SD=±7.1 1; p=0.34). There was no statistically significant difference between NTG patients and NTG suspects in heart rate during the day (72.73-76.36 beats per minute [bpm], SD=±5.44 vs. 72.15-76.45 bpm, SD=±4.59; p=0.43) nor during the night (64.4-71.9 bpm, SD=±6.74 vs. 68.02-72.48 bpm, SD=±4.76; p=0.11). CONCLUSION: No statistically significant difference was found between NTG patients and NTG suspects in regard to their systolic and diastolic BP measured both during daytime and nighttime. NTG patients had fall (both systolic and diastolic) than NTG suspects.

Changes in the retrobulbar hemodynamic parameters after decreasing the elevated intraocular pressure in primary open-angle glaucoma patients.

INTRODUCTION: Ocular blood flow (OBF) disturbances could be involved both in the pathogenesis and in progression of glaucomatous damage. OBJECTIVE: The aim of the study was to compare the retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior cilliary arteries (SPCA) after decreasing the elevated intraocular pressure (IOP) in primary open-angle glaucoma (POAG) patients by using color Doppler imaging (CDI). METHODS: We examined 60 patients (21 male and 39 female) with diagnosed and treated POAG. Thirty-nine patients had increased IOP (> 25 mm Hg). Peak-systolic velocity (PSV), end-diastolic velocity (EDV), Pourcelot resistance index (RI), and pulsatility index (PI) were assessed in the OA, CRA, and SPCA. IOP was measured both with the Goldmann Applanation tonometer (GAT) and with the Dynamic Contour tonometer (DCT), three times respectively. Ocular pulse amplitude (OPA) was measured using DCT. RESULTS: The retrobulbar parameters between the baseline and after IOP reduction showed no difference in measurements. After Bonferroni correction (p < or = 0.0056, alpha/9) statistical significance was recorded only in the following retrobulbar hemodynamic parameters; DCT (29.8 +/- 6.2 vs. 15.5 +/- 5.0), GAT (33.8 +/- 9.0 vs. 15.0 +/- 6.6) and OPA measurements (4.3 +/- 1.0 vs. 3.0 +/- 1.6), as compared to the baseline. There was no correlation between the changes in IOP measured with either DCT or GAT and changes in the hemodynamic parameters (p > 0.05 for all). Pearson correlation coefficient (95% CI) showed very good correlation for IOP measurements between DCT and GAT: at baseline 0.83 (0.71 to 0.90) and at the end 0.71 (0.55 to 0.83); p < 0.0001 for both measurements, but without any difference between them (p > 0.05). CONCLUSION: There was a lack of correlation between the changes in IOP measured with either DCT or GAT and the changes in the hemodynamic parameters.

Morning glory syndrome associated with primary open angle glaucoma--case report.

INTRODUCTION: Morning glory syndrome (MGS) is a rare congenital optic disc anomaly, first reported in 1970. MGS is a nonprogressive and untreatable condition, which usually occurs as an isolated ocular anomaly, and can be associated with the increased incidence of nonrhegmatogenous retinal detachment, and also with strabismus, afferent pupillary defect, visual field defects, presence of hyaloids artery remnants, ciliary body cyst, congenital cataract, lid hemangioma and preretinal gliosis. CASE OUTLINE: We report a clinical case of MGS associated with primary open angle glaucoma. The use of sophisticated diagnostic tools, such as retinal tomography and visual field testing is limited if multiple eye conditions are present, since optic disc does not have "usual" appearance that can be analyzed according to standard statistical databases. CONCLUSION: In treating and follow up of glaucoma cases associated with other diseases and conditions that affect the appearance and function of the optic nerve head, sometimes the use of modern technological methods is limited due to difficult interpretation of the obtained results.

Changes in the retrobulbar arterial circulation after decrease of the elevated intraocular pressure in men and women with primary open angle glaucoma.

INTRODUCTION: An altered perfusion of the optic nerve head has been proposed as a pathogenic factor of glaucoma. OBJECTIVE: The aim of this study was to evaluate the changes of the hemodynamic parameters in the retrobulbar arterial circulation after decrease of the elevated intraocular pressure (IOP) in women and men with primary open angle glaucoma. METHODS: The study included 60 patients (33 males and 27 females) older than 50 years, with diagnosed and treated primary open angle glaucoma (77 eyes of 39 patients had increased IOP, > 25 mm Hg).They were examined at the Clinic of Eye Diseases (complete ophthalmologic exam) and Clinic of Neurology, Clinical Center of Serbia, Belgrade, from December 2009 to December 2010. Imaging of hemodynamic parameters of three retrobulbar arterial vessels: ophthalmic, central retinal and posterior ciliary arteries with color Doppler was performed. RESULTS: Among women, hemodynamic arterial parameter of the peak-systolic velocity was increased in the central retinal artery and decreased in the ophthalmic artery and posterior ciliary arteries; end-diastolic velocity was increased in all three retrobulbar vascular levels; Pourcelot resistivity index was increased, but pulsatility index was decreased in all three vessels. Among men, peak-systolic velocity, end-diastolic velocity and pulsatility index were decreased in all three vessels; resistivity index was increased in the ophthalmic artery, but decreased in the central retinal artery and posterior ciliary arteries. There was a significant change of the ophthalmic artery pulsatility index in women, and the end-diastolic velocity of the ophthalmic artery in men. CONCLUSION: There was a difference of the retrobulbar arterial circulation between women and men with primary open angle glaucoma after decrease of the elevated intraocular pressure.The role of vascular factors in the supply of the optic disc neuroretinal rim is important.

Two cases of uveitis masquerade syndrome caused by bilateral intraocular large B-cell lymphoma.

INTRODUCTION: Sometimes it is not easy to clinically recognize subtle differences between intraocular lymphoma and noninfectious uveitis. The most common lymphoma subtype involving the eye is B-cell lymphoma. CASE REPORT: We presented two patients aged 59 and 58 years with infiltration of the subretinal space with a large B-cell non-Hodgkin intraocular lymphoma. The patients originally had clinically masked syndrome in the form of intermediate uveitis. As it was a corticosteroid-resistant uveitis, we focused on the possible diagnosis of neoplastic causes of this syndrome. During hospitalization, the neurological symptoms emerged and multiple subretinal changes accompanied by yellowish white patches of retinal pigment epithelium with signs of vitritis, which made us suspect the intraocular lymphoma. Endocranial magnetic resonance imaging established tumorous infiltration in the region of the left hemisphere of the cerebellum. The histopathological finding confirmed the diagnosis of large B-cell non-Hodgkin lymphoma of risk moderate degree, immunoblast--centroblast cytological type. The other patient had clinical chronic uveitis accompanied by yellowish shaped white echographic changes of the retina and localized changes in the level of the subretina. The diagnosis of lymphoma was made by brain biopsy. CONCLUSION: Uveitis masquerade syndrome should be considered in all patients over 40 years with idiopathic steroid-resistant uveitis. Treatment begun on time can affect the course and improve the prognosis of uveitis masquerade syndrome (UMS) and systemic disease.

The effect of intraocular pressure on visual field after trabeculectomy in patients with primary open angle glaucoma.

PURPOSE: To compare the mean intraocular pressure (IOP), peak IOP and percentage reduction in IOP in the first five years following trabeculectomy between the patients with progressed visual field loss and the patients with stable visual fields. MATERIAL AND METHODS: Thirty-six eyes of 36 patients were followed for five years after their first trabeculectomy with tonometry and automated perimetry (Octopus 500EZ, program G1). The rate of change of the visual field was measured by linear regression analysis of the mean sensitivity value (dB) of each field test versus time (month). Based on the statistical significance of the slope of the regression line (Spearman p value of the correlation coefficient less than 0.05), patients were divided into two groups: with significant negative slope of the regression line (group with progressed visual field loss) and with non-significant slope of the regression line (group with stable visual field). The mean IOP values and percentage of IOP reduction at the end of each of the first five years after surgery were compared between the group with progressed field loss and group with stable fields by using Mann-Whitney U test. RESULTS: Patients with progressed visual field loss had higher mean IOP, higher peak IOP and less reduction in pressure after the operation than patients with stable visual field. The mean IOP at end of the two year postoperative period was significantly higher in patients with progressed visual field loss (21.98 +/- 3.38 mmHg) than in those with stable fields (17.48 +/- 4.80 mmHg). The mean percentage reduction in IOP at the end of two year postoperative period was significantly less in patients that showed progression of field loss (21.84%) than in those with stable fields (41.0%). CONCLUSION: Prognosis for further field loss seems to be better if postoperative pressure is at lower levels and greater percent reduction of IOP is obtained after surgery. The data that predict better prognosis is the mean postoperative IOP value of approximately 18 mmHg or less resulting from at least 35% of IOP reduction.

Unusual eye injuries.

PURPOSE: The analysis of ten unusual eye injuries, and the discussion of appropriate preventive measures. CASE OUTLINE: Ten patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, in the period from January 2000. to December 2009. were presented. Following data were taken in account: sex and age of the patient, injured eye, the mechanism of injury, type of the injury, applied treatment and final visual acuity. The circumstances of the eye injuring of ten patients were described. The eye injuries in all cases occurred in a bizarre way and they were severe enough to require hospital admission. The surgery was necessary in seven patients. Three injured eyes resulted in blindness, and two additional had subnormal vision. CONCLUSION: In three quarters of discussed cases injuries can be avoided. It is necessary to implement protective measures constantly and consistently and to think about the possible consequences of certain activities. Particular attention should be paid on safety of children. The iatrogenic injuries require special consideration.

[Influence of initial visual field sensitivity on visual field loss progression in open angle glaucoma].

INTRODUCTION: It is important to know the risk factors for visual field defect progression in order to predict the future development of glaucoma. OBJECTIVE: To investigate the influence of visual field initial sensitivity on the rate of visual field progression. METHODS: A minimum of five visual fields were performed using computerized perimetry (Octopus) over a mean followup 4-year period (48.85 +/- 17.84 months) in 64 persons (114 eyes) with primary open angle glaucoma. The rate of change of the whole central visual field and each of the seven regions of the field were measured by linear regression analysis of the mean sensitivity value versus time. Based on the slope of the regression line of visual field mean sensitivity over time the eyes were divided into two groups: the group with stable and the group with progressive visual field.The comparison of the mean sensitivity of the whole central visual field between the groups was performed using the Mann-Whitney U-test. The Spearman rang correlation coefficient and the Spearman probability p values were calculated to assess the mean sensitivity of the whole central visual field and of each visual field regions determined at the beginning of the study. RESULTS: The initial mean sensitivity of the whole central visual field was lower in the group with progressive visual field (16.62 +/- 6.35 dB). Correlation between the initial mean sensitivity and the slope of the regression line was negative. The lowest mean sensitivity was in the group with progressive visual field in the upper temporal (13.73 +/- 7.35 dB), nasal (14.74 +/- 7.23 dB) and upper nasal (15.03 +/- 7.75 dB) regions. CONCLUSION: The lower mean sensitivity value of the visual field, especially in the nasal and upper nasal visual field regions, carries a greater risk for delayed progressive loss of the visual field in persons with glaucoma.

Correlation between ocular pulse amplitude measured by dynamic contour tonometer and colour Doppler flow imaging of the arteric retrobulbar vessels.

INTRODUCTION: An altered perfusion of the optic nerve head has been proposed as a pathogenic factor in glaucoma. OBJECTIVE: The aim of this study was to evaluate the correlation between ocular pulse amplitude (OPA), measured by Dynamic contour tonometer (DCT) and colour Doppler imaging (CDI) of the arteric retrobulbar vessels. METHODS: Twenty patients older than 50 years were examined, and divided into two equal groups. The first group comprised of patients with normal tension glaucoma treated with topical antiglaucomatous therapy, and the second group included patients with ocular hypertension and glaucoma suspicious without any antiglaucomatous therapy. Ocular pulse amplitude (OPA) was measured with DCT. CDI was also performed. We measured haemodynamic parameters of the internal carotid artery (ICA), ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCA). Peak systolic (PSV), end-diastolic (EDV) velocities were measured, and resistance index (RI) and pulsatility index (PI) were calculated. RESULTS: Correlation with OPA showed indirect servitude in the RI of the ICA, RI and PI of the CRA, in the first group; and in the PSV and EDV of the ICA, in the RI and PI of the OA, EDV and RI of the CRA, and RI of the PCA, in the second group CONCLUSION: Increase of OPA was mostly followed by the increase of the parameters (PSV, EDV, RI, and PI) of the arteric retrobulbar vessels in the first group; in the second group, increase of OPA was in almost 50% of parameters followed by their decrease.

[Prevention of intraocular pressure elevation after argon laser trabeculoplasty in primary open angle glaucoma].

INTRODUCTION: Argon laser trabeculoplasty (ALT) is an intraocular pressure lowering method that is overall safe and powerful, but often complicated by transient postoperative intraocular pressure rises. In prevention of this complication, we frequently use two potent alpha-adrenergic agonists--brimonidine and apraclonidine. OBJECTIVE: The aim of this study was to compare brimonidine 0.2% and apraclonidine 0.5% efficacy and safety in prevention of intraocular pressure elevation after ALT. METHODS: This was a prospective, randomized, double-masked and comparative study. This study included 27 POAG patients, 15 received 0.2% brimonidine, and 12 received 0.5% apraclonidine before laser surgery (22 eyes in both groups). Intraocular pressure readings were taken 1, 2, 3, 24 hours and 7 days after ALT. Student's t-test was used to analyse data between two groups, and chi2 test to compare data within groups. Value p less than 0.05 was considered statistically significant. RESULTS: We found statistically significantly lower IOP in eyes that received 0.2% brimonidine at readings taken 1 hour after ALT (p = 0.001). There were no statistically significant differences in other IOP readings between two groups. CONCLUSION: A single preoperative drop of brimonidine 0.2% had similar efficacy and safety as apraclonidine 0.5% in preventing transient IOP elevations after ALT.

Changes in the retrobulbar arterial circulation after decrease of elevated intraocular pressue in patients with primary open angle glaucoma.

INTRODUCTION: An altered perfusion of the optic nerve head has been proposed as a pathogenic factor in glaucoma. OBJECTIVE: To evaluate changes of haemodynamic parameters in the retrobulbar arterial circulation after a decrease of elevated intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG). METHODS: Twenty-six patients were examined, 14 men and 12 women, 21 up to 50 years old and 5 below, all with previously diagnosed and treated POAG, and all examined at the Eye Clinic, Clinical Centre of Serbia. IOP was measured both with a Goldmann aplanation tonometer and dynamic contour tonometer. Central corneal thickness was measured with ultrasound pachymeter. Imaging of the retrobulbar arterial circulation by colour Doppler was performed at the Neurology Clinic, Clinical Centre of Serbia. It involved measuring of haemodynamic parameters of the ophthalmic artery, central retinal artery, and posterior ciliary arteries. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) and pulsatility index (PI) were calculated. RESULTS: Haemodynamic arterial parameters PSV and EDV in the ophthalmic and central retinal artery after decrease of IOP were lower, while RI and PI were higher. In the posterior ciliary arteries PSV, EDV and PI were lower, and RI was higher. CONCLUSION: Changes of the retrobulbar arterial circulation after elevated LOP in POAG patients are important for approach and treatment, while the role of vascular factors in the supplement of the optic disc neuroretinal rim could be a key for progression backlash of glaucoma and the radix of neuroprotection.

Is nail fold capillaroscopy useful in normotensive and primary open angle glaucoma? A pilot study.

PURPOSE: Vascular dysregulation is deemed a significant risk factor in glaucoma occurrence and progression. Capillaroscopy of the blood vessels on the finger nail-fold is a method that can provide information regarding the state of the vascular system at the capillary level. The aim of this pilot study was to determine whether there are significant differences in the morphological characteristics of the peripheral blood vessels in normotensive glaucoma and primary open angle glaucoma. MATERIALS AND METHODS: An ophthalmological and capillaroscopic examination was conducted on 30 normotensive glaucoma patients and 30 primary open angle glaucoma patients. The capillaroscopic characteristics described were as follows: capillary row density, capillary diameter, number of spirally formed capillaries, permeability of the loop, and loop resistance. RESULTS: Statistically, significantly more intensively spiraled capillaries were found in normotensive glaucoma patients (χ(2) test, p < 0.05). CONCLUSIONS: Results confirm the thesis that vascular factors play a significant role in the pathogenesis of the glaucoma, especially in cases where the level of intraocular pressure cannot be deemed responsible for the present damage of the optical nerve. Despite the newer, technologically more developed methods for diagnostics and monitoring glaucoma, it is often not easy to establish the right diagnosis and determine further the course of the illness, since the role the intraocular pressure (IOP) plays compared to the role of vascular factors is unknown; hence, capillaroscopy as a complementary diagnostic procedure can be of help.

Correlation between central corneal thickness and intraocular pressure in various age groups.

INTRODUCTION: The Pascal Dynamic Contour Tonometer (DCT) is an ophthalmic investigational device which directly calculates the dynamic pulsatile fluctuations in intraocular pressure (IOP) using a piezoelectric pressure sensor embedded in the devices tip. OBJECTIVE: The aim of this study was to compare IOP results obtained with Goldmann applanation tonometer (GAT), and their correlation with central corneal thickness (CCT) in patients of various age groups. METHODS: We studied 37 patients (17 male and 20 female), divided into three age groups: younger than 40 years; 40-60 years old, and older than 60 years. In the first and second group there were patients rarely and in the third mostly diagnosed and medicamentously compensated glaucoma. In topical anaesthesia, first we measured CCT, with ultrasound pachimeter, then IOP with DCT and GAT. RESULTS: Statistically significant difference between measurements of IOP with the DCT and GAT appeared in all groups: I mean diff. -1.71 +/- 1.27 mm; p < 0.0001; II mean diff. -1.19 +/- 1.06 mm; p < 0.0001; III mean diff. -1.69 +/- 1.67 mm; p < 0.0001. CCT was in indirect correlation with the values of IOP measured both with the DCT and GAT in the first and third, while it was in the direct correlation with these values in the second group. CONCLUSION: CCT had no influence on IOP measurements both with the DCT and GAT in none of the groups. The DCT cannot replace GAT, but it is a reliable device for the measurement of IOP particularly in corneal deformations (keratoconus, after corneal refractive surgery, corneal scars, etc.).

MTHFR C677T homozygous mutation in a patient with pigmentary glaucoma and central retinal vein occlusion.

PURPOSE: We present the rare case of a young male patient with asymmetric ocular findings: pigmentary ocular hypertension associated with nonischemic central retinal vein occlusion (CRVO) in the right eye and pigmentary glaucoma (PG) with progressive glaucomatous optic damage in the left eye. PATIENTS AND METHODS: A 31-year-old man showed nonischemic CRVO in the right eye and the clinical triad of pigment dispersion syndrome in both eyes, however more marked in the left eye. Best-corrected visual acuity was logMAR 0.3 in the right eye and 1.0 in the left eye at presentation. The single risk for developing PG and CRVO was hyperhomocysteinemia. The patient was a carrier of the methylenetetrahydrofolate reductase C677 homozygous mutation. RESULTS: At 18 months of follow-up, visual acuity remained stable, intraocular pressure was in the normal range, but retinal tomography indicated an increase in glaucomatous optic damage to the nerve fiber layer in almost the complete temporal-inferior sector of the left eye, but without visual field defects in the left eye. Retinal tomography and automated perimetry were normal in the right eye. The patient received topical antiglaucomatous therapy. CONCLUSION: Higher levels of plasma homocysteine, even mildly elevated ones, could be associated with nonischemic CRVO and PG, especially when related to genetic risk factors or C677T mutation.

[Contribution and significance of Heidelberg Retinal Tomography II in diagnostics of ocular hypertension and its conversion into primary open-angle glaucoma].

BACKGROUND/AIM: A term "ocular hypertension" is used when IOP is found to be >21 mmHg on two consecutive occasions, in the absence of detectable glaucomatous damage. The aim of this study was to determine the significance and contribution of Heidelberg Retinal Tomography II (HRT II) results that show very early, subtle changes in retinal neurofibre layers (RNFL) in the optic nerve head that are specific for glaucoma itself (the loss of neuroretinal rim area and an increase of Cup/Disc ratio), but are not possible to register by an ophthalmoscope. Also, when the results of the functional tests remain unchanged, that confirms the conversion of ocular hypertension into glaucoma. METHODS: During a 5-year study period (2002-2007), 29 patients with ocular hypertension were examined. The frequency of control examinations, based on the presence of risk factors for glaucoma development, was 3-6 months. The examination also included IOP measurements with Goldmann Applanation Tonometry (GAT), central corneal thickness (CCT) determination by pachymetry, the examination of chamber angle using indirect gonioscopy, visual field tests by computerized perimetry and also papillae nenr optic (PNO) examination by using HRT II. The application of HRT II enables a great number of stereometric parameters of optic disc, the most important being the rim area and Cup/Disc (C/D) ratio, which was followed during the control examination by each segment, as well as PNO in global. RESULTS: In the examination period, three cases of conversion of ocular hypertension into a primary open-angle glaucoma were found. In the group of patients with ocular hypertension, HRT II results after six months did not show a significant increase in C/D ratio. No significant loss of rim area or rim volume was found either. In three cases of conversion, HRT II results after 3 months showed an increase of C/D ratio and also a significant loss in rim volume at first examination (0.413) comparing to the last one. CONCLUSION: In diagnosing ocular hypertension and its conversion to glaucoma, HRT II is used for quantitative evaluation of retinal topography and for quantitative monitoring of topographical changes, especially regarding the increase of C/D ratio and loss of rim volume tissue, which enables to see and register subtle structural changes in optic nerve head and RNFL that are so characteristic for glaucoma, which cannot be seen by an ophthalmoscope. With these results, according to risk factors for glaucoma, one can confirm the diagnosis of ocular hypertension and its conversion to primary open-angle glaucoma. In this study HRT II revealed conversion of ocular hypertension into glaucoma in 10% of the patients.

Topographic changes at the optic disc in 33 patients with primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To show frequency of progression and progres-sion at the optic disc in primary open angle glaucoma (POAG).METHODS: A total of 33 patients (66 eyes), 14 male and 19 female, aged 14 to 79 with POAG were imaged using the Heidelberg Retina Tomography II (HRT II) three or more times during follow-up periods of 6 years (2000-2006). Disc progression was determined by regression analysis of global and segmental changes in optic disc parameters. Every patient was tested by Octopus G1 once a year. Imaged optic disc parameters with scanning laser tomography were: rim area (ra), cup/disc (C/D), rim volume (rv), mean RNFL thickness (mRNFL). Imaged segments of the optic disc were: global (G), temporal (T), temporal superior (TS), temporal inferior (TI), nasal (N), nasal superior (NS) and nasal inferior (NI).RESULTS: Global frequency of progression according to c/d ratio existed in 34 eyes (51%), but 32 eyes (48%) were without frequency of progression. Progression existed in 12 eyes (18%) in temporal, 7 eyes (10.6%) in temporal superior (TS), 14 eyes (21%) in temporal inferior (TI), 8 eyes (12%) in nasal (N), 7 eyes (10.6%) in nasal superior (NS), and 13 eyes (20%) in nasal inferior (NI) segment. Without progression were 5 eyes (8%).CONCLUSION: Disc progression in our study was mostly in nasal (N) and temporal inferior (TI) segments. Most frequently were stricken temporal inferior (TI) and nasal inferior (NI), but most infrequently nasal superior (NS) segment. Most sensitive parameter was c/d ratio. Segmental scanning is of importance in POAG progression analysis.