Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c.

PURPOSE: To compare the outcome of deep sclerectomy (DS) with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG). METHODS: We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; mean ± SD; 64 ± 7 years) who underwent DS with a collagen implant. Patients were randomized to the MMC and non-MMC groups. Subconjunctival MMC (0.4 mg/ml for 3 min) was used intraoperatively in 15 of 37 eyes. We defined total success as 25% reduction in intraocular pressure (IOP) without medication. Follow-up time was 12 months. RESULTS: The mean preoperative IOP was significantly reduced from 15.2 ± 2.8 mmHg to 9.3 ± 2.7 (p < 0.001) in the MMC group after 12-month follow-up and from 15.1 ± 2.9 mmHg to 11.8 ± 2.0 (p < 0.001) in the non-MMC group. At 12 months, the mean IOP was significantly lower in the MMC group (p = 0.003) compared with the non-MMC group. Total success was achieved in 10 of 15 eyes (67%) in MMC group and in nine of 22 eyes (41%) in non-MMC group (p = 0.12). The number of glaucoma medications was decreased from 2.2 ± 0.8 to 0.5 ± 1.2 in MMC group (p = 0.001) and from 2.6 ± 1.0 to 0.5 ± 0.7 in non-MMC group (p < 0.001). Goniopuncture was performed in seven eyes (47%) in the MMC group, compared with 16 eyes (73%) in the non-MMC group (p = 0.13). IOP < 10 mmHg was achieved in seven of 15 eyes in the MMC group and in two of 22 in the non-MMC group (p = 0.009). Complication rate was low, and no difference between groups was evident. CONCLUSION: Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG. Intraoperative use of MMC results in lower postoperative IOP 12-month postoperatively without increased rate of complications.

Change in retinal blood flow and retinal arterial diameter after intraocular pressure reduction in glaucomatous eyes.

PURPOSE: To study retinal blood flow and vessel diameter after intra-ocular pressure (IOP) reduction in high- and low-pressure glaucomas, that is, exfoliation glaucoma (ExG) and normal-tension glaucoma (NTG). METHODS: The study included 17 eyes with ExG and 20 with NTG. A minimum of 25% IOP reduction was achieved by deep sclerectomy. Blood flow in the temporal peripapillary retina was measured with scanning laser Doppler flowmetry (Heidelberg Retina Flowmeter, HRF), and retinal vessel diameters were evaluated with the retinal vessel analyser (RVA). Examinations were carried out before and 3 months after the operation. RESULTS: Pre-operative IOP was significantly higher in ExG than in NTG (median 26 mmHg, range 20-33 mmHg versus 15 mmHg, 12-20; p < 0.001). Surgery reduced IOP significantly both in ExG eyes (postoperative IOP 13 mmHg, 5-17; p < 0.001) and NTG eyes (9 mmHg, 3-13; p < 0.001). After the operation, systolic retinal flow was significantly reduced in ExG eyes, whereas in NTG, HRF parameters remained unchanged. Pre-operatively, the central retinal artery equivalent (CRAE) and arteriovenous ratio (AVR) were higher in ExG than in NTG eyes. After IOP reduction, both CRAE and AVR were reduced in ExG eyes, but remained unchanged in NTG. CONCLUSION: The study showed that before IOP reduction, arterial diameter was larger in ExG eyes than in NTG eyes. IOP reduction resulted in vasoconstriction and reduction of flow in ExG, whereas in NTG, both vessel diameter and retinal flow remained unchanged.

Change in optic nerve head topography in healthy volunteers: an 11-year follow-up.

AIM: To study longitudinal changes in optic nerve head (ONH) topography in healthy volunteers. METHODS: One eye each of 36 healthy volunteers was prospectively followed for 11 (7-13) years with the Heidelberg Retina Tomograph I (HRT I). All eyes had normal visual fields, non-glaucomatous ONHs, no defects on red-free nerve fibre layer photographs and intraocular pressure (IOP) <22 mm Hg. During the follow-up, no eye developed glaucoma; visual fields remained normal, and no longitudinal changes appeared in nerve fibre layers assessed from red-free photographs or ONHs assessed from stereophotographs. The median baseline and follow-up IOPs were comparable (15 mm Hg, range 10-20 mm Hg; and 16 mm Hg; range 10 to 22 mm Hg, respectively; p=0.38). Images were re-evaluated with HRT III and ONHs graded as normal, borderline or glaucomatous with the Moorfield Regression Analysis (MRA). RESULTS Significant changes in HRT parameters indicating increased ONH cupping were detected in cup area (p=0.013), cup-to disc area ratio (p=0.015), rim area (p=0.015), mean cup depth (p=0.006) and cup shape measure (p<0.001). With the MRA classification, nine eyes (9/31, 29%) had changed for the worse in the global or any of the sector classifications. CONCLUSION: Age-dependent changes occur in ONH topography detectable with the HRT.

Altered temporal peripapillary retinal flow in patients with disc hemorrhages.

BACKGROUND: To investigate whether any peripapillary retinal blood flow changes are related to disc hemorrhage (DH). METHODS: The study included 21 eyes of 21 patients, of which 14 eyes had glaucoma. All eyes were examined at the time of detection of DH and again 6 months later. Blood flow in the peripapillary retina was measured by scanning laser Doppler flowmetry (Heidelberg Retina Flowmeter), with four adjacent images focused on the peripapillary nerve fiber layer obtained. Retinal perfusion was calculated in arbitrary units by automatic full-field perfusion image analysis. The mean of all four rectangles representing the whole temporal peripapillary retina plus the rectangle representing the area of DH served for analysis. RESULTS: The mean of measurements in all four areas revealed a statistically significant increase in mean flow (MF), systolic flow (SF), and diastolic flow (DF), and a decrease in pulsation index (PI). The rectangle representing the area of DH showed a significant increase in MF, but the SF increase was of borderline significance. Changes in DF and PI did not reach statistical significance. CONCLUSIONS: Results indicate reduced flow at the time of DH and increased flow after resorption.

Blood flow in the peripapillary retina in exfoliation glaucoma.

PURPOSE: The aim of this article is to study peripapillary retinal blood flow in patients with progressive and stable exfoliation glaucoma (ExG). METHODS: Fifty-eight eyes with ExG were included; 25 of them had progressive and 33 stable glaucoma. Retinal blood flow in the peripapillary retina was measured with scanning laser Doppler flowmetry. Acquired flow maps were analysed with the automatic full-field perfusion image analyser. Multiple logistic regression was used to model progression of glaucoma. RESULTS: Mean retinal flow (MF; correlation coefficient, P-value; R = 0.36, P = 0.006) and retinal minimum diastolic flow (R = 0.33, P = 0.011) were positively correlated with visual field mean defect (MD). Factors associated with progressive glaucoma were mean intraocular pressure (OR = 1.198 for each mmHg; P = 0.050) and visual field MD (OR = 1.134 for each dB; P = 0.013). Age (P = 0.35), MF (P = 0.58), or presence of cardiovascular disease (P = 0.17) were not associated with glaucoma progression. CONCLUSION: No difference in peripapillary retinal blood flow between progressive and stable ExG could be found.