Effect of Different Postures on Intraocular Pressure in Open-Angle Glaucoma.

INTRODUCTION: This study aims to investigate the pattern of intraocular pressure (IOP) changes in different postures among patients with open-angle glaucoma (OAG). METHODS: A observational study was conducted on a total of 74 patients with OAG (148 eyes). IOP measurements were taken in a variety of positions, including supine, left lateral decubitus, right lateral decubitus, head tilted downwards position with immediate head-up (transient head tilted downwards), seated, seated with head tilted downwards, standing, and walking. Each position was held for 5 min before measurement. In all positions, the patient maintains both eyes looking forward and remains alert. In the head tilted downwards position, the angle of head tilt with respect to the sagittal plane was 30°. RESULTS: The overall trend of IOP changes showed a significant decrease with an increase in the position height (r = 0.037, p < 0.001). The IOP was significantly higher in the supine, left lateral decubitus, right lateral decubitus, and head tilted downwards positions than in the seated position (p < 0.001). Compared with the seated position with eyes at primary gaze, IOP decreased significantly when standing (p = 0.008) or walking (p < 0.001). The IOP in the left lateral decubitus and right lateral decubitus was significantly higher than in the supine position (p = 0.008, p = 0.001, respectively). The IOP decreased significantly during walking compared with standing (p < 0.001). CONCLUSIONS: The magnitude of IOP strongly correlates with the body position during IOP measurement. The head tilted downwards, supine, left lateral decubitus, and right lateral decubitus positions result in a higher IOP than IOP at the seated position. Patients with OAG can potentially reduce IOP fluctuations by adjusting their daily postures.

Factors associated with blindness three months following treatment for acute primary angle glaucoma.

AIMS: To study the risk factors associated with blindness after treatment of acute primary angle closure (APAC), and to identify the critical time window to decrease rate of blindness. METHODS: In this multicentre retrospective case series, 1030 consecutive subjects (1164 eyes) with APAC in China were recruited. The rates of blindness were analysed up to 3 months after treatment of APAC. A logistic regression was used to identify the risk factors associated with blindness, including age, gender, distance to hospital, rural or urban settings, treatment method, education level, time from symptom to treatment (TST, hours) and presenting intraocular pressure (IOP). The critical time window associated with a blindness rate of ≤1% was calculated based on a cubic function by fitting TST to the rate of blindness at each time point. RESULTS: The rate of blindness after APAC was 12.54% after treatment. In multivariate regression, education level, TST and presenting IOP were risk factors for blindness (p=0.022, 0.004 and 0.001, respectively). The critical time window associated with a blindness rate of ≤1% was 4.6 hours. CONCLUSIONS AND RELEVANCE: Education level, TST and presenting IOP were risk factors for blindness after APAC. Timely medical treatment is key in reducing blindness after APAC.

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.

Correlation between pupil diameter and angle configuration in the dark room provocative test.

PURPOSE: To study the associations between changes in pupil diameter and in the anterior chamber angle configuration during the dark room provocative test. METHODS: The study included 70 suspects of primary angle closure (study group) and 40 normal participants (control group). Using anterior-segment optical coherence tomography (AS-OCT), we measured the anterior chamber angle configuration and pupil diameter at 3 minutes and at 1.5 hours of dark adaptation. RESULTS: In the study group, the mean number of closed angle segments was significantly (P<0.001) higher at 3 minutes of dark adaptation (3.9 ± 2.3) than at room light conditions (2.6 ± 2.2) or at 1.5 hours of dark adaptation (3.1 ± 2.1), with no statistically significant (P>0.05) difference between the 2 latter values. In the study group, the pupil diameter was significantly associated with the number of closed angle segments at 3 minutes of dark adaptation (P<0.01), but not at 1.5 hours of dark adaptation (P=0.13). Defined as an increased number of closed angle segments, the dark room test was positive in a significantly higher number of participants at 3 minutes than at 1.5 hours of dark adaptation [44 (63%) eyes vs. 31 (44%) eyes; P<0.05]. Final interocular pressure was statistically better correlated with the angle configuration segments assessed at 3 minutes (correlation coefficient r2=0.33) than at 1.5 hours of dark adaptation (r2=0.21). CONCLUSIONS: After short-term dark adaptation of 3 minutes, the assessment of the anterior chamber angle configuration by AS-OCT is more reliable than as if carried out after a long-term dark adaptation and may be used to identify suspects of primary angle closure.

Comparative study of retinal nerve fibre layer measurement by RTVue OCT and GDx VCC.

AIM: To evaluate the diagnostic performances and correlations of retinal nerve fibre layer (RNFL) thickness measured by RTVue OCT and GDx variable corneal compensation (VCC). METHODS: The total and regional RNFL thickness were measured by RTVue OCT and GDx VCC in 62 normal eyes and 72 glaucomatous eyes of Chinese subjects. The RNFL thickness profiles of normal and glaucomatous eyes by RTVue OCT are plotted. Correlations of RNFL thickness measured by RTVue OCT and GDx VCC were assessed using the Pearson correlation. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC). RESULTS: RTVue OCT demonstrated double hump patterns in the RNFL profiles. In both normal and glaucomatous subjects, the peaks were located in the superotemporal (ST) and inferotemporal (IT) regions, and the troughs were located at the nasal (NU+NL) and temporal (TU+TL) regions. Despite poor agreement, a high correlation (r=0.821) was found between the mean RNFL measurements by RTVue OCT and GDx VCC. For RTVue OCT, the highest AUCs were mean RNFL (AUC=0.914) and inferior mean RNFL (AUC=0.909). The nerve fibre indicator (AUC=0.856) and inferior RNFL (AUC=0.852) achieved the highest AUCs among all the GDx VCC measurements. The mean RNFL in RTVue OCT had the greatest AUC in the two devices. There was a significant difference in comparing the AUCs of the mean RNFL thickness obtained by RTVue OCT and GDx VCC (p=0.009). CONCLUSIONS: Although there were absolute value differences in RNFL thickness, a high correlation was observed between RTVue OCT and GDx VCC. RTVue OCT shows a reasonable ability to distinguish normal from glaucomatous eyes.

[Alteration of anterior chamber and angle structure in eyes with primary angle closure after laser peripheral iridotomy].

OBJECTIVE: To quantitatively evaluate the long-term changes in anterior segment morphology by using ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with primary angle closure (PAC). METHODS: This was a clinical case series study. A total of 54 eyes with PAC of 31 consecutive patients were enrolled. Routine ophthalmic and UBM examination were performed at visit one (before LPI), 2 weeks, 6, and 12 months after LPI. The parameters of anterior chamber were measured by UBM and calculated. Results of each follow-up time were analyzed using repeated measures analysis of variance. Parameters of UBM measurement at 750 µm anterior to the sclera spur and at 500 µm counterpart were compared using paired student t-test. RESULTS: Compared to before LPI, anterior chamber depth (ACD) was deepened by approximate 0.10 mm after LPI, however, it was not statistically significant (F = 3.50, P > 0.05). Angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) and trabecular-ciliary process distance (TCPD) were significantly increased at 2 weeks, 6 and 12 months after LPI compared with respective baseline [AOD750: (165.0 ± 70.3), (185.8 ± 68.5), (196.1 ± 77.7) µm vs (66.2 ± 51.6) µm, F = 92.60; TIA750: 14.1° ± 6.3°, 15.5° ± 6.2°, 16.4° ± 5.9° vs 6.4° ± 4.9°, F = 92.60; ARA: (0.058 ± 0.024), (0.065 ± 0.023), (0.068 ± 0.026) mm(2) vs (0.025 ± 0.017) mm(2), F = 92.60; TCPD: (647.1 ± 113.0), (701.8 ± 93.4), (670.1 ± 95.4) µm vs (571.0 ± 97.2) µm, F = 34.00; P < 0.05]. The parameters of UMB measurement at 750 µm were significantly increased more than that at 500 µm anterior to the sclera spur (AOD: t = 5.90, TIA750: t = 2.70, P < 0.05; ARA: t = 2.00, P = 0.05). CONCLUSIONS: LPI can significantly widen the peripheral anterior angle in eyes with PAC lasting for at least 1 year after LPI. Parameters detected by UBM at 750 µm anterior to the sclera spur appear to be more sensitive in evaluating the alternation of peripheral angle structure.

[Significance of optic disc topography and retinal nerve fiber layer thickness measurement by spectral-domain OCT in diagnosis of glaucoma].

OBJECTIVE: To study the significance of optic disc tomography and retinal nerve fiber layer (RNFL) thickness measurement by spectral-domain optical coherence tomography (OCT) in the diagnosis of glaucoma. METHODS: It was a noninterventional, observational study. The optic disc topographic parameters and total and regional RNFL thickness were measured by RTVue OCT in 60 normal eyes and 97 glaucomatous eyes. One-way analysis of variance was used to compare the parameters above mentioned between normal and glaucomatous groups. The area under the receiver operating characteristic curve (AUC) and the sensitivity at 80% specificity were used to assess the ability of each testing parameter in the differentiation between normal and glaucoma eyes. RESULTS: There were statistically significant differences in all RTVue OCT measurement parameters (F = 1.024, P = 0.596;F = 36.519, 54.464, 27.659, 36.176, 20.562, 63.833, 30.031, 54.652, 98.146, 78.705, 99.839, 43.728, 75.720, 45.709, 39.380, 33.590, 66.887, 78.335, 45.485;P = 0.000) except disc area. The average RNFL thickness in normal, early, moderate and advanced glaucomatous eyes was 109.950, 93.313, 80.374 and 65.570 µm, respectively. Among the eight regions around the optic disc, the thickest RNFL was located at the inferotemporal (150.066 µm) and superotemporal (146.285 µm) regions in normal eyes, and the superotemporal (108.569, 103.420 and 88.708 µm in early, moderate and advanced glaucomatous eyes, respectively) and inferotemporal (108.201, 102.830 and 86.369 µm in early, moderate and advanced glaucomatous eyes, respectively) regions in glaucomatous eyes. Both in normal and glaucomatous eyes, the thinnest RNFL was located at the nasal and temporal regions, respectively. For optic disc topographic parameters, the highest AUC was vertical cup/disc ratio (AUC = 0.762, 0.946 and 0.988 in early, moderate and advanced glaucomatous eyes, respectively), and the sensitivity at 80% specificity was 62.2%, 76.5% and 99.2% in early, moderate and advanced glaucomatous eyes, respectively. For RNFL thickness, the highest AUC was superotemporal region RNFL thickness (AUC = 0.915) and the sensitivity at 80% specificity was 89.5% in early glaucomatous eyes. The highest AUC was inferior average RNFL thickness (AUC = 0.967) and the sensitivity at 80% specificity was 94.1% in moderate glaucomatous eyes. The highest AUC was average RNFL thickness (AUC = 0.985) and the sensitivity at 80% specificity was 99.2% in advanced glaucomatous eyes. Among the eight regions around the optic disc, RNFL thickness of region ST (AUC = 0.915, 0.926 and 0.966 in early, moderate and advanced glaucomatous eyes, respectively) achieved the highest AUC. RNFL thicknesses of the nasal and temporal regions showed the lowest AUCs. CONCLUSIONS: RTVue OCT shows fair discriminating ability in distinguishing normal from glaucomatous eyes. RTVue OCT is a useful equipment for the diagnosis of glaucoma.

Prospective evaluation of changes in anterior segment morphology after laser iridotomy in Chinese eyes by rotating Scheimpflug camera imaging.

BACKGROUND: To investigate the 3-D morphology changes of anterior segment in primary angle-closure suspect and primary angle-closure after laser peripheral iridotomy (LPI) using rotating Scheimpflug camera. METHODS: A total of 37 eyes of 25 patients were enrolled in the study. Just before and after LPI, rotating Scheimpflug camera was performed on each selected eye by one skilled ophthalmologist. Comparison of anterior segment parameters before and after LPI such as central corneal thickness, central anterior chamber depth, peripheral anterior chamber depth, anterior chamber volume, pupil diameter and anterior chamber angle of cross-section photographs from 0 degrees to 180 degrees (ACA) were analysed. RESULTS: Before and after LPI, central corneal thickness increased from 537.92 +/- 27.92 microm to 541.49 +/- 27.85 microm (P = 0.074); no statistic changes of central anterior chamber depth were found before LPI (1.72 +/- 0.27 mm) and after LPI (1.70 +/- 0.24 mm) (P = 0.337); peripheral anterior chamber depth deepen from 0.89 +/- 0.26 to 1.14 +/- 0.26 mm (P = 0.000); anterior chamber volume increased from 55.54 +/- 14.25 to 82.65 +/- 17.63 mm(3) (P = 0.000); average pupil diameter of all patients are 1.72 +/- 0.42 and 1.63 +/- 0.46 mm, respectively, showed no statistic difference (P = 0.228). ACA widen from 25.51 +/- 5.66 degrees to 28.11 +/- 5.67 degrees in 9 o'clock direction(P = 0.005), and from 25.77 +/- 5.15 degrees to 27.91 +/- 4.87 degrees in 3 o'clock direction after LPI (P = 0.020). CONCLUSION: LPI induce dramatic changes of 3-D anterior segment morphology in primary angle-closure suspect and primary angle-closure.

Measurement of anterior chamber volume with rotating scheimpflug camera and anterior segment optical coherence tomography.

BACKGROUND: Measurement of anterior segment parameters plays an important role in diagnosis and treatment of glaucoma. The objective of this study was to evaluate the repeatability and reproducibility of anterior chamber volume (ACV) measurements with rotating scheimpflug camera (RSC) and to examine agreement with anterior segment optical coherence tomography (AS-OCT). METHODS: Thirty nine healthy normal subjects were recruited from the Eye Center of Tongren Hospital. ACV was measured using RSC and AS-OCT in a randomly selected eye for each subject. For RSC measurements, both automatic and manual ACV measurements and 2 independent operators' ACV measurements were obtained. All subjects were invited for 3 visits within a week to evaluate repeatability and reproducibility of ACV measurement by RSC. Agreement was evaluated between RSC and AS-OCT. RESULTS: Good repeatability and reproducibility were found for both automatic and manual ACV measurements obtained by RSC. For intrasession repeatability, coefficient of variation (CVw) and intraclass correlation coefficient (ICC) values for automatic were 3.52% and 0.98; the values for manual were 3.44% and 0.97, respectively. For intersession reproducibility, the respective CVw and ICC values were 3.96% and 0.96. Good agreement was also found in 2 operators for both automatic and manual ACV measurements; nevertheless, poor agreement was found between RSC and AS-OCT (95% confidence interval (CI) for agreement of automatic RSC measurement versus AS-OCT were -96.3 to 72.8 microl and 95% CI for agreement of manual RSC measurement versus AS-OCT were between -41.7 to 10.1 microl). CONCLUSIONS: Both RSC automatic and manual ACV measurements showed good repeatability and reproducibility, and showed comparable agreement between 2 independent operators, but poor agreement was found between RSC and AS-OCT.

Accuracy and repeatability of direct ciliary sulcus diameter measurements by full-scale 50-megahertz ultrasound biomicroscopy.

BACKGROUND: Phakic intraocular lens (pIOL) implantation has been a popular means for the treatment of high ametropia. Measurements of ciliary sulcus diameter is important for pIOL size determining. But till now, no perfect system can directly measure it. The present study was to evaluate the accuracy, repeatability and reproducibility of direct sulcus diameter measurements obtained by a full-scale 50-megahertz (MHz) ultrasound biomicroscopy (UBM). METHODS: A fresh cadaver human eye with a scale marker inserted through the posterior chamber plane from 3 o'clock to 9 o'clock meridian and 30 randomly selected eyes from 30 normal subjects were scanned by full-scale 50-MHz UBM in horizontal meridional scan plane. The distance between the scales and the whole length of the marker inside the cadaver eye were measured by the same observer using the "built-in" measurement tools and the indicating error of instrument was calculated. Reproducibility of the measurement was evaluated in 30 eyes by 2 operators using Blander and Altman plot test. Repeatability was evaluated from 10 successive eyes randomly selected from the 30 eyes by one operator. RESULTS: On a scale of 1 mm, the greatest indicating error was 40 microm; the mean largest indicating error of 1 mm scale from the 10 images was (26 +/- 14) microm; on a scale of 11 mm, the greatest indicating error was 70 microm; the error rate was 0.64%. The mean length of the needle inside the eye of the 10 images was 11.05 mm, with the mean indicating error of 47 microm, the average error rate was 0.43%. For ciliary sulcus diameter measurements in vivo, the coefficient of variation was 0.38%; the coefficients of repeatability for intra-observer and inter-observer measurements were 1.99% and 2.55%, respectively. The limits of agreement for intra-observer and inter-observer measurement were -0.41 mm to 0.48 mm and -0.59 mm to 0.58 mm, respectively. CONCLUSION: The full-scale 50-MHz UBM can be a high accuracy and good repeatability means for direct measuring the ciliary sulcus diameter and useful for size determining of posterior chamber pIOL.

Inhibitory effect of activin A on activation of lipopolysaccharide-stimulated mouse macrophage RAW264.7 cells.

Activin A is a member of transforming growth factor beta (TGF-beta) superfamily, which is also named restrictin-P, and can inhibit the secretion of nitric oxide (NO) and interleukin-1beta (IL-1beta) from LPS-activated mouse macrophages. In this study, the regulation effect and possible mechanism of activin A as an anti-inflammatory factor on lipopolysaccharide (LPS)-activated macrophages were investigated in vitro. It was observed that activin A could not only decrease the secretion of IL-1beta and NO, as well as the mRNA expressions of IL-1beta and iNOS, but also suppress the pinocytosis of mouse macrophage cell line RAW264.7 cells induced by LPS. In addition, activin A could obviously reduce the expressions of CD68 and CD14, as well as Toll-like receptor 4 (TLR4) on RAW264.7 cells induced by LPS, but could not influence the proliferation of RAW264.7 cells. These findings suggest that activin A may play an important down-regulation role in inflammatory factor production and phagocytosis of the activated macrophages via suppressing the maturation of LPS-induced macrophages or LPS-TLR4 signal transduction.