Chronic Primary Open-angle Glaucoma Research Articles

Netarsudil: A new ophthalmic drug in the treatment of chronic primary open angle glaucoma and ocular hypertension.

Vision impairment remains a major health problem worldwide. Elevated intraocular pressure is a prime risk factor for blindness in the elderly. Netarsudil is a Rho-associated protein kinase (ROCK) inhibitor, which also inhibits norepinephrine transport. This narrative review summarizes the properties and clinical significance of netarsudil, a promising drug in topical glaucoma therapy. We searched PubMed, Medline and Scopus databases using relevant keywords to retrieve information on the physicochemical properties, formulation, mechanism of action, clinical pharmacokinetics, dose and toxicity of netarsudil. Netarsudil showed promising effects in lowering the elevated intraocular pressure by two mechanisms. The US FDA approved netarsudil for clinical use in 2017 under the trademark of Rhopressa® while European Medicines Agency approved Rhokiinsa® in 2019. This drug is available as a 0.02% ophthalmic solution for once-daily topical application. The discovery of netarsudil is a breakthrough in the therapy of glaucoma with proven efficacy in a wide range of eye pressures and is well tolerated in cases with ocular hypertension and chronic glaucoma.

The effect of trabeculectomy and deep sclerectomy on the choroidal thickness: a comparative study

Purpose The aim of this study was to compare the changes in subfoveal choroidal thickness (SFCT) following trabeculectomy and nonpenetrating deep sclerectomy (NPDS) in cases with primary open-angle glaucoma (POAG).Patients and methods This is a prospective interventional comparative randomized study that was carried out on 42 eyes of 32 patients with chronic POAG who were divided into two groups: group A included 22 eyes that underwent trabeculectomy, and group B included 20 eyes that underwent NPDS. SFCT was measured preoperatively and was repeated on the third day and at 1 month postoperatively using spectral domain optical coherence tomography.Results In group A, there was a statistically significant increase in the SFCT on the third postoperative day and after 1 month, with a mean value of 42.86±38.08 and 28.5±27.91 μm, respectively, when compared with the preoperative SFCT (P<0.05). In group B, the increase in SFCT was statistically significant on the third postoperative day, with a mean value of 38.45±24.33 μm when compared with the preoperative SFCT (P=0.0001). However, after 1 month, the increase in SFCT became nonsignificant, with a mean value of 13.25±6.55 μm when compared with the preoperative SFCT (P=0.19). There was a positive correlation between the amplitude of intraocular pressure reduction and the change in the SFCT in both groups.Conclusion Both trabeculectomy and NPDS caused a significant increase in SFCT in the early postoperative period, which might be related to postoperative hypotony maculopathy. SFCT went back near to normal values after NPDS earlier than after trabeculectomy in cases with POAG.

Low-cost, smartphone-based frequency doubling technology visual field testing using a head-mounted display

BackgroundCurrent visual field screening machines are bulky and expensive, limiting their accessibility, affordability and use. We report the design and evaluation of a novel, portable, cost-effective system for glaucoma screening...

A comparative study of central corneal thickness measurement in four different groups by specular microscope

Background: A prospective, randomized, single-site clinical trial conducted on patients attending our eye outpatient department. Objective: To compare central corneal thickness (CCT) measurements by noncontact specular microscope in young, elder, cataract, and chronic primary open-angle glaucoma (POAG) patients. Materials and Methods: Total 120 patients were selected which were divided into four groups of 30 patients in each group, i.e., Group A, B, C, and D. CCT was measured by noncontact specular microscopy. Group A was considered control group for rest of the groups while Group B was considered as a control for Group C and D. The P value was calculated using student paired t-test and P < 0.005 was considered significant. Results: In our study, out of 120 patients 74 (61.66%) were male while 46 (38.33%) were female. Male predominance is seen in all groups. In Group A the mean CCT was 545.17 ± 31.43 μm, in Group B it was 547.67 ± 21.16 μm, in Group C CCT was 524.03 ± 27.48 μm while in Group D it was 467.53 ± 31.21 μm. POAG patients have significantly lesser CCT as compared to other three groups. Conclusion: In this study, no significant difference in CCT of male and female was seen. Aging and cataract had no significant effect on CCT. Glaucoma patients had significantly lower CCT than young patients (P < 0.001) and elder patients (P < 0.001). It concludes that POAG patients have thinner cornea.

Phacoemulsification combined with deep sclerectomy augmented with mitomycin and amniotic membrane implantation in chronic primary open angle glaucoma with cataract.

ObjectiveThe aim of this study was to determine the safety and efficacy of combined phacoemulsification plus Intraocular lens (IOL) implantation with deep sclerectomy augmented with mitomycin C (MMC) and sub-flap implantation of amniotic membrane for the management of uncontrolled, chronic, primary open-angle glaucoma patients.MethodsThis prospective study included 41 patients with chronic, primary, open-angle glaucoma and cataract uncontrolled with medical treatment who underwent combined phacoemulsification augmented with mitomycin C (MMC) application and amniotic membrane implantation under the scleral flap. Intraocular pressure (IOP), visual acuity, glaucoma medications, stabilization of visual field, complications, and viability of the success rate were assessed a 36-month follow-up period.ResultsThe mean age of cases was 54.8 ± 5.3 years. Sixty-one percent of cases were males, and 39% were females. The mean IOP decreased from 23.8 ± 1.8 mmHg preoperatively to 16.8 ± 2.3 mmHg postoperatively. The overall success rate was 97.5, 95, and 92.7% in the first, second, and third year, respectively. The overall success rate was 90% in the first year, but that decreased to 85.3 and 78% in the second and third year, respectively. Qualified success was 7.5, 10, and 14.7% in the first, second, and third year, respectively. Failure was recorded as 2.5, 5, and 7.3% in the first, second, and third year, respectively. IOP reduction was sustained through the follow-up period. Visual acuity improved from 0.13 ± 0.06 to 0.9 ± 0.07 (p < 0.001). The visual field improved significantly in the first assessment, from 14.0 ± 2.7 preoperatively to 12.6 ± 2.6 at three months postoperatively (p < 0.001), after which it became stable for the remainder of the follow-up period. One hundred percent of cases were on three anti-glaucoma drugs preoperatively, while postoperatively, 12.2% were on three drugs, 4.2% were on two drugs, and 82.9% were controlled without anti-glaucoma treatment. There were minor postoperative complications all of which were minor, such as a spike in the post-operative IOP and the formation of fibrinous material in the anterior chamber, both of which were treated medically without any adverse effects on the final results.ConclusionAmniotic membrane implantation in conjunction with MMC application may be an effective alternative to expensive implants in deep sclerectomy combined with phacoemulsification, and this approach can be used safely in advanced cases.

Glaucoma in Costa Rica. Initial approaches

Glaucoma is the second most frequent cause of irreversible blindness worldwide. Genetic factors have been implicated in the development of the disease. So far six loci (GLC1A-GLC1F) and two genes (TIGR/MYOC and OPTN) are involved in the development of juvenile (JOAG) and adult onset or chronic primary open angle glaucoma (COAG), while two loci (GLC3A,GLC3B) and one gene (CYP1B1) are known for primary congenital glaucoma (PCG). Here we summarize the results of the first genetic studies of glaucoma in Costa Rica. Nine families: 1 with JOAG, 1 with PCG and 7 with COAG were screened for mutations at the known genes. A 10 bp duplication, 1546-1555dupTCATGCCACC, at the CYP1B1 gene, causes, in homozygous state, glaucoma in the consanguineous PCG family. This mutation has been found in different countries and generates an early stop codon that termitates protein synthesis 140 amino acids earlier than the normal allele. In exon 1 of the T1GR/MYOC the innocuous Arg76Lys variant was found in two of the COAG families. In the OPTN gene two variants in the coding region (Thr34Thr, Met 98Lys) and 7 intronic changes were found in other Costa Rican glaucoma patients. One of the COAG families was chosen for a genome scan with 379 microsatellite markers and linkage analysis. LOD scores "suggestive" of linkage were obtained for several chromosomal regions. Evidence indicates that hereditary glaucoma in Costa Rica is highly heterogeneous and that further studies in the country will probably disclose some up to now unknown genes responsible for the disease.

Assessment of Corneal Biomechanical Properties in Normal Tension Glaucoma and Comparison With Open-angle Glaucoma, Ocular Hypertension, and Normal Eyes

To assess the biomechanical properties of corneas in patients with normal tension glaucoma (NTG) and to compare them with those of patients with primary open-angle glaucoma (POAG), ocular hypertension (OHT), and normal controls (N). Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) were obtained using an ocular response analyzer for 28 eyes in 14 patients with NTG, 75 eyes in 38 patients with chronic POAG, 53 eyes of 27 patients with OHT, and 44 eyes of 22 N controls. IOP using Goldmann applanation tonometry (IOPGA) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Analysis of variance test was used for statistical analysis. CH was significantly lower in the NTG group (9.88±2.02 mm Hg) compared with the N group (11.05±1.53 mm Hg; P<0.01). CRF was significantly lower in the NTG group (9.5±1.89 mm Hg) compared with the POAG group (11.15±2.35 mm Hg; P<0.01) and to the N group (11.00±1.75 mm Hg; P<0.01). CCT was not considered significantly different between the 4 groups. However, IOPcc was found to be significantly lower in NTG group compared with the POAG group and OHT group (P<0.001). NTG was associated with significantly lower CRF than chronic POAG and N patients. CH and CRF could be a useful tool in early diagnosis of NTG.

Qualitative morphologic characteristics of normal and glaucomatous optic papillae

Using optic disk photographs, qualitative morphologic characteristics of the optic nerve head were determined in 251 nonselected normal eyes and 308 eyes with chronic primary open-angle glaucoma. These characteristics were correlated to morphometric (both intra- and parapapillary) and perimetric data. The highest degree of accuracy in distinguishing normal from glaucomatous optic disks was found with the characteristics "localization of narrowest point of neuroretinal rim outside the temporal horizontal optic disk sector" (85.5%) and "changes in the parapapillary retinal nerve fiber layer" (87.9%). The signs "baring of circumlinear vessels," "baring of cilioretinal arteries," "epipapillary flame-shaped hemorrhages," and "bridging of the vessel trunk" were highly specific for glaucomatous optic nerve damage (94.4%-100%) and less sensitive (5.8%-25.3%). Bayonetlike vessel kinking," "prevalence of cupping nasal to the main vessel trunk," "baring of the lamina cribrosa pores," and "undermining of the cup border" were less useful in qualitative evaluation of the optic disk. The location of the central artery in relation to the central vein (nasal in 98.4%), prevalence of the cilioretinal arteries, and the total number of circumlinear vessels were not significantly correlated to changes associated with glaucoma and are therefore of no importance for optic disk evaluation in glaucoma.

Results of viscocanalostomy for primary open-angle glaucoma

PURPOSE: Viscocanalostomy is a nonperforating filtering surgical procedure that may avoid postoperative complications common with standard trabeculectomy. This study was conducted to determine the surgical outcome of this procedure after a postoperative observation period of 12 to 36 months. METHODS: Interventional consecutive case series. In a prospective study, a consecutive series of 67 eyes of 67 patients with chronic primary open-angle glaucoma underwent VCS. Excluded were patients with angle closure glaucoma, post-traumatic, uveitic, neovascular, or dysgenetic glaucoma, as well as patients who needed combined cataract-glaucoma procedures. The patients were examined postoperatively on the first day, first week, at 1 month, and then at 3-month intervals through 36 months. At each visit, best-corrected visual acuity, intraocular pressure (IOP), and the appearance of the surgical wound, anterior chamber, and indirect funduscopy were recorded. RESULTS: Complete success was defined as IOP less than or equal to 20 mm Hg and greater than or equal to 30% IOP reduction without medical or additional surgical treatment compared with the IOP from a preoperative level with maximum tolerated medical therapy; qualified success IOP less than or equal to 20 mm Hg with treatment or an IOP reduction less than 30% from preoperative level with maximum tolerated medical therapy; and qualified failure of an IOP greater than 20 mm Hg with glaucoma medication, but no optic nerve or visual field deterioration and complete failure as an eye requiring further glaucoma surgery or lost visual function. The overall success rate was 88% at 1 year, 90% at 2 years, and 88% at 3 years, with a complete success of 68% at 1 year, 60% at 2 and 59% at 3 years. Four eyes had a perforation of the Descemet membrane, three of those needed peripheral iridectomy; six eyes had a microperforation not needing a peripheral iridectomy. Five eyes presented hyphema. Eight eyes presented deterioration of visual function after surgery: three eyes because of corneal astigmatism, one eye because of cataract, and four presented glaucomatous deterioration of the visual field despite pressures under 20 mm Hg. Four eyes had progressive cataract formation judged as independent from surgery. CONCLUSION: VCS provides an overall success rate of 88% and a complete success of 59% 3 years after surgery. The major immediate complication is perforation of the Descemet membrane with a need for peripheral iridectomy. No serious long-term complications were noted in our small series. Visual function remained stable in 55 eyes (82%).

Mutations in the third exon of the MYOC gene in Spanish patients with primary open angle glaucoma

Primary open angle glaucoma (POAG) is the second most common cause of blindness in developed countries. It is an optic neuropathy in which a degeneration of the retinal ganglion cells causes a characteristic excavation in the optic disc. Several loci have been identified to be responsible for different types of glaucoma, including the MYOC gene located on chromosome 1. In this work, six mutations have been identified in the third exon of the MYOC gene in patients with POAG. We studied 79 Galician patients with chronic POAG glaucoma and 90 control individuals from the same general population. We identified six mutations, including three novel ones. Two of the six mutations were considered to be polymorphisms, while the other four met the criteria for pathogenicity in this disease as they altered the amino acid sequence and were found in one or more patients with glaucoma and in less of 1% of the control population. These mutations were detected in eight patients suffering from POAG (7.5%) and in two people from the control population (2.2%). POAG can be due to mutations in the myocilin gene (MYOC) on chromosome 1. The glaucoma phenotype associated with this gene may vary from a juvenile severe form to a late-onset chronic open angle glaucoma.

The spatial distribution of ERG losses across the posterior pole of glaucomatous eyes in multifocal recordings.

Australian and New Zealand Journal of OphthalmologyVolume 24, Issue S2 p. 28-31 Free Access The spatial distribution of ERG losses across the posterior pole of glaucomatous eyes in multifocal recordings , Corresponding Author *The Eye and Vision Research Institute, Electrophysiology Department.Visiontest Australia, Suite 5, Level 5, 187 Macquarie Street, Sydney 2000, New South Wales.Search for more papers by this authorL. Buckland BSc, Corresponding Author L. Buckland BSc †Eye Clinic, Prince of Wales Hospital.Visiontest Australia, Suite 5, Level 5, 187 Macquarie Street, Sydney 2000, New South Wales.Search for more papers by this author , Corresponding Author *The Eye and Vision Research Institute, Electrophysiology Department.Visiontest Australia, Suite 5, Level 5, 187 Macquarie Street, Sydney 2000, New South Wales.Search for more papers by this authorL. Buckland BSc, Corresponding Author L. Buckland BSc †Eye Clinic, Prince of Wales Hospital.Visiontest Australia, Suite 5, Level 5, 187 Macquarie Street, Sydney 2000, New South Wales.Search for more papers by this author First published: May 1996 https://doi.org/10.1111/j.1442-9071.1996.tb00987.xCitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Vaegan, Graham SL, Goldberg I., Millar TJ. Selective reduction of oscillatory potentials and patterr electroretinograms after retinal ganglion cell damage 05 disease in humans or by kainic acid toxicity in cat. Doc Ophthalmologica 1991; 77: 237– 53. 2 Vaegan, Graham SL, Goldberg I., Buckland L., Hollows FC Flash and pattern electroretinogram changes with optk atrophy and glaucoma. Exp Eye Res 1995; 60: 697– 706. 3 Yin ZQ, Vaegan, Millar TJ, Sarks J., Sarks SH. Choroida atrophy in chronic primary open angle glaucoma. [Abstrac 2714] Invest Ophthalmol Vis Sci 1994; 35(Suppl.): 1842. 4 Yin ZQ, Vaegan, Millar TJ, Sarks J., Sarks SH. The locui of choroidal blood vessel loss in chronic primary oper angle glaucoma. [Abstract 4446] Invest Ophthalmol Vi: Sci 1995; 36(Suppl.): S964. 5 Vaegan, Yin ZQ, Beaumont P. Delayed choroidal filling across the posterior pole of glaucomatous eyes shown by fluorescein angiography. [Abstract 4452] Inves Ophthalmol Vis Sci 1995; 36(Suppl.): S965. 6 Nork TM, Poulsen GL, Vaegan, Sarks SH. Photoreceptoi damage and loss in human eyes with primary open angl> glaucoma. [Abstract 1546] Invest Ophthalmol Vis Sc 1995; 36(Suppl.): S331. 7 Yin ZQ, Vaegan, Millar TJ, Beaumont P., Sarks J., Sarks SH. The locus of choroidal blood vessel loss in chronic primary open angle glaucoma. [Abstract 4446] Invest Ophthalmol Vis Sci 1995; 36(Suppl.): S964. 8 Sutter EE, Tran D. The field topography of ERG components in man | I. The photopic luminance response. Vision Res 1992; 32: 433– 46. 9 Sutter EE, Vaegan. Lateral interaction component and local luminance nonlinearities in the human pattern reversal ERG. Vision Res 1990; 30: 659– 71. 10 Vaegan, Sutter EE. Fundamental differences between the nonlinearities of pattern and focal electroretinograms. Doc Ophthalmologica 1990; 76: 13– 25. 11 Sutter EE, Bearse MA. Extraction of a ganglion cell component from the corneal response. Vision Science and its Applications. 1995 OSATechnical Digest Series, Vol 1. Optical Society of America, Washington DC. 1995; 310– 13. 12 Vaegan, Buckland L. Outer retinal changes in early glaucoma detected with the Sutter local luminance ERG field test. Proceedings of the 33rd ISCEV Symposium, Athens, Greece. 16–20 June 1995. 13 Hennessy MP, Vaegan. Amplitude scaling relationships of Burian-Allen, gold foil, and Dawson Trick and Iitzkow electrodes. Doc Ophthalmologica 1995; 89: 235– 48. 14 Vaegan, Buckland L. Relationship between means and variances of ERGs obtained with gold foil and DTL electrodes across the full range of recordable amplitudes. Proceedings of the 33rd ISCEV Symposium, Athens, Greece. 16–20 June 1995. 15 Holder GL. Pattern electroretinography in the evaluation of glaucoma and in optic nerve function. In JR Heckenlively, GB. Arden Principles and Practice Of Clinical Electrophysiology Of Vision. St Louis : Mosby Year Book, 1991; 549– 56. 16 James AC, Maddess T., Wine S., Goldberg I. A novel multiple region PERG for glaucoma. [Abstract 4317] Invest Ophthalmol Vis Sci 1994; 35(Suppl.): 2187. Citing Literature Volume24, IssueS2May 1996Pages 28-31 ReferencesRelatedInformation

The retinal nerve fiber layer in normal and glaucomatous eyes. II. Correlations

The retinal nerve fiber layer is different in normal and glaucomatous eyes. We correlated semi-quantitative data of the retinal nerve fiber layer of 398 eyes with chronic primary open-angle glaucoma and of 234 normal eyes with the intra- and parapapillary morphometric signs and with the perimetric indices. The three parameters "sequence of the fundus sectors concerning the best visibility of the retinal nerve fiber bundles", "visibility of the nerve fiber bundles", and "localized defects" were significantly (p less than 0.001) correlated to 1) area of the neuroretinal rim as a whole and in four different optic disc sectors, 2) neuroretinal rim width determined every 30 degrees, 3) optic cup area, diameters and form, 4) horizontal and vertical cup/disc ratios and the quotient of the horizontal to vertical cup/disc ratio, 5) area and width of zone "Alpha", zone "Beta", and the total parapapillary chorio-retinal atrophy, 6) diameter of the retinal vessels, 7) grade of a "tesselated fundus", and 8) the visual field loss. If only the inferior temporal and the superior temporal sectors were considered, the retinal nerve fiber bundles were less visible in that sector with the largest notch in the neuroretinal rim, the smaller neuroretinal rim area and width, the thinner retinal vessels, and the larger zone "Alpha", zone "Beta", and total parapapillary chorio-retinal atrophy. The glaucomatous changes in the retinal nerve fiber layer are correlated in time and location with the intra- and parapapillary and the perimetric alterations. Evaluation of the retinal nerve fiber layer is a useful method to detect a glaucomatous optic nerve damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-quantitative morphologic features in normal and glaucomatous optic discs.

Glaucoma is associated with changes of the optic disc topography. Using color stereo photographs we examined non-quantitative signs in 584 optic discs of 308 patients with chronic primary open-angle glaucoma and in 383 optic discs of 236 age and refraction matched normal subjects. Only one eye per patient and normal subject was chosen for statistical analysis. Highest predictive value to differentiate between normal and glaucoma eyes had the parameters 'changes in the juxtapapillary retinal nerve fiber layers' (86.7%), 'abnormal size (79.8%) and abnormal location (68.6%) of the parapapillary chorio-retinal atrophy', 'smallest neuroretinal rim part outside of the temporal horizontal disc sector' (78.5%), and area with cupping larger than area with pallor' (68.2%). Characteristics with high specificity and low sensitivity were 'optic disc haemorrhages', 'bared cilioretinal arteries', and 'bared circumlinear vessels'. With their evaluation being independent of sophisticated techniques the non-quantitative parameters are helpful for the ad hoc diagnosis of glaucomatous optic nerve damage.

Die retinale Nervenfaserschicht in Normal-und Glaukomaugen - Teil 1: Semiquantitative Daten von 398 Glaukomaugen

Atrophy of the optic nerve is associated with changes of the retinal fiber layer (RNFL). Using red-free photographs the authors examined the RNFL of 398 eyes with chronic primary open-angle glaucoma and compared it with the RNFL of 234 normal eyes. The glaucoma group was divided into five stages and the fundus into four sectors. Differences between the normal and glaucoma eyes were: (1) The sequence of the sectors, with regard to the best visibility of the retinal nerve fiber bundles, was changed. In the normal eyes the nerve fiber bundles were most often best visible in the inferior temporal sector, followed by the superior temporal sector, the temporal horizontal area and finally the nasal region. In the glaucoma group the nerve fiber bundles were significantly more often best detectable in the superior temporal sector and the temporal horizontal area. (2) The degree of visibility of the retinal nerve fibers decreased significantly with increasing glaucoma stage. (3) Localized defects were seen in 15% of the eyes with glaucoma and none of the normal eyes. The specificity of this qualitative parameter was, therefore, 100%. The defects were found most often in the superior and inferior temporal regions. These differences between normal and glaucomatous eyes were also significant for the first glaucoma stage of this study. The localization of the foveola below the optic disk center (0.53 +/- 0.34 mm in the glaucoma group and 0.55 +/- 0.29 mm in the normal eyes) was not significantly different.

Optic disc morphometry in chronic primary open-angle glaucoma

Four hundred twenty-seven optic discs of 233 unselected patients suffering from chronic primary open-angle glaucoma were morphometrically evaluated and compared with the optic nerve heads of 253 unselected normal subjects. Only one randomly chosen eye per patient was taken into consideration. We found that glaucoma leads to a change in the characteristic configuration of the neuroretinal rim that in normal eyes is significantly (P less than 0.001) largest at the lower disc pole, smaller at the upper and nasal disc side, and smallest in the temporal disc region. Based on this information, significant (P less than 0.001) morphometric differences between "early" glaucomatous and normal discs are: (a) the neuroretinal rim area in the lower temporal disc sector is smaller than in the upper temporal disc sector; the smallest rim width is outside the horizontal temporal disc sector ("pathognomonic"); the quotient of horizontal to vertical c/d ratio is lowered; and (d) the lower temporal, upper temporal, and total rim area are decreased. No significant difference in overall optic disc size and form exists between normal and glaucomatous eyes. Smaller optic nerve heads are not more susceptible to glaucoma.

Optic disc morphometry in chronic primary open-angle glaucoma. II. Correlation of the intrapapillary morphometric data to visual field indices.

The intrapapillary morphometric data of 290 optic nerve heads of 158 patients with chronic primary open-angle glaucoma and of 253 unselected normal subjects were correlated with the visual field indices of Octopus program 32,34-Delta. Only one eye per patient was considered. Significant correlations (P less than 0.001) were revealed for the neuroretinal rim (NRR) area as a whole and in four defined disc sectors, the ratio of lower temporal to upper temporal rim area, the rim width, the optic cup area and diameters, the horizontal and vertical cup/disc (c/d) ratios, and the quotient of horizontal to vertical c/d ratio. Correlation coefficients ranged between 0.30 and 0.77. They were highest for the rim area of the inferior temporal disc sector, followed by the superior temporal, nasal, and temporal sectors. There were no correlations for the optic disc size and form. The topographic morphometry of the intrapapillary optic disc structures was unremarkable in four glaucomatous eyes with small discs.

Parapapillary region in normal and glaucoma eyes. II. Correlation of planimetric findings to intrapapillary, perimetry and general data

The planimetric values of the parapapillary region in 312 unselected eyes with chronic primary open-angle glaucoma and 125 normal eyes of an age-/and refraction-matched control group were correlated to the intrapapillary, perimetric, and general data of these eyes. High myopics (less than -8.00 D) and "ocular hypertensives" were excluded. Zone "Alpha" and "Beta" incipient to advanced or subtotal to total parapapillary chorio-pigmentepithelioretinal atrophy) were significantly correlated (p less than 0.001) to: 1) area and width of the neuroretinal rim as a whole and in four different optic disk sectors; 2) cup area; 3) horizontal and vertical c/d ratios; 4) glaucoma stage; 5) age, and 6) refraction. Zone "Beta" was additionally correlated to the perimetric indices. Its correlation coefficients were generally higher than those of zone "Alpha." Sex and side showed no significant relationships. Divided into four different radial sectors, both zones "Alpha" and "Beta" were significantly larger (p less than 0.001) the smaller the neuroretinal rim area (intrapapillary) in the same sector was. Additionally, zone "Beta" was significantly (p less than 0.001) most often largest in the sector where the rim area was smallest. Thus, besides the temporal there was also a spatial correlation between the intrapapillary and parapapillary glaucomatous alterations. "Conus pigmentosus" and the peripapillary scleral rim showed no significant glaucoma-associated correlations and are thus without importance for quantified optic disk evaluation in glaucoma. Zones "Alpha" and "Beta", as regions of early to advanced of subtotal to total parapapillary, chorio-pigmentepithelioretinal atrophy, are not only chronologically but also spatially correlated to intrapapillary glaucomatous changes and are important in optic disk evaluation in glaucoma.

The parapapillary region of normal and glaucoma eyes. I. Planimetric values of 312 glaucoma and 125 normal eyes

Magnification-corrected planimetry of the parapapillary region was performed according to Littmann's method in 312 unselected eyes with chronic primary open-angle glaucoma and in 125 normal eyes of an age- and refraction-matched control group using optic disk photographs. The glaucoma group was divided into five pathomorphologic subgroups. High myopics (less than -8.00 D) and "ocular hypertensives" had been excluded. The coefficient of variation ranged intraindividually from 0.0 to 0.17 and interindividually from 0.0 to 0.16. Two different morphologic variants were defined and examined: 1) Zone "Alpha" with incipient to advanced parapapillary chorio-pigmentepithelio-retinal atrophy - characterized by irregular hypo- and hyperpigmentation - was statistically proven in the control group (0.60 +/- 0.44 mm2; p less than 0.05; Wilcoxon-Mann-Whitney test) to be smaller than in the glaucoma group (0.81 +/- 0.70 mm2). It increased significantly (p = 0.0000) with advancing glaucoma stage. In the glaucoma and normal group it was broadest in the temporal horizontal sector (p less than 0.001; Wilcoxon test), followed by the temporal lower (p less than 0.001), temporal upper (p less than 0.001) and nasal sectors (p less than 0.001). There was no significant difference in prevalence between the two groups. 2) Zone "Beta" with subtotal to total parapapillary chorio-pigment-epithelio-retinal atrophy was also smaller in the normal eyes (0.18 +/- 0.52 mm2, prevalence: 20.0%; p = 0.0000) than in the glaucomatous ones (0.85 +/- 1.42 mm2, prevalence 66.7%) and was also, in both groups, broadest in the temporal horizontal sector, followed by the temporal lower, temporal upper and nasal sectors. In the control group it was smaller than zone "Alpha" (p less than 0.00001), while in the glaucoma group there was no difference. 3) The difference between normal eyes and earliest glaucoma stage I was for zone "Beta" (p = 0.0000); the difference between the normal eyes and those of glaucoma stage II was significant for both zones (p = 0.0000 and p less than 0.05, respectively). In both groups and in all glaucoma stages both zones were larger in the lower half of the optic disk than in the upper half. 4) "Conus pigmentosus" and the peripapillary scleral rim in normal and glaucomatous eyes showed no significant difference as regards their area and frequency. The parapapillary chorio-pigmentepithelio-retinal alterations are precursors of, or are equivalent to the so-called "halo glaucomatosus".(ABSTRACT TRUNCATED AT 400 WORDS)

Parapapillary retinal vessel caliber. II. Caliber reduction in eyes with glaucoma (a papillometric study of 309 eyes with chronic simple glaucoma compared with 264 normal eyes)

The diameter of the temporal superior or inferior artery and vein was measured at the optic disk border and 2 mm from the disk center in 309 nonselected eyes with chronic primary open-angle glaucoma. The values obtained were compared with those of 264 nonselected normal eyes. The calibers of both vessels were significantly larger in the normal eyes than in the glaucomatous ones (p = 0.000 or p less than 0.01; Wilcoxon-Mann-Whitney test). Their diameters diminished significantly (p less than 0.001) with decreasing width and area of the neuroretinal rim as a whole and when divided into different optic disk sectors, and with increasing optic cup area, horizontal and vertical cup/disk ratios, area of the subtotal to total parapapillary choriopigmentepithelioretinal atrophy, perimetric loss, and glaucoma stage. Thus, the caliber of the parapapillary retinal vessels decreases significantly with increasing glaucomatous optic nerve damage.