Incidence Of Glaucoma Research Articles

Novel intravitreal fluocinolone acetonide implant in the treatment of chronic noninfectious posterior uveitis

Noninfectious posterior uveitis is a group of heterogeneous intraocular inflammatory diseases with high visual morbidity and devastating socioeconomic impact. Corticosteroids, currently used for the first-line treatment of uveitis, are limited by systemic toxicity. Other immunosuppressants used as steroid-sparing agents have their own systemic side effects. Retisert™ is a fluocinolone acetonide sustained-release intravitreal implant designed to release drug locally for up to 30 months in the posterior segment of the eye for the treatment of uveitis. Two large randomized trials have shown that Retisert reduces the rate of uveitis recurrence in implanted eyes compared with the fellow eye. Retisert also significantly improved visual acuity in implanted eyes. However, there is a significant incidence of glaucoma and cataract in eyes treated with the Retisert implant. Retisert offers a new potent treatment option for patients with sight-threatening uveitis.

Carbon-ion radiotherapy for locally advanced or unfavorably located choroidal melanoma: A Phase I/II dose-escalation study

To evaluate the applicability of carbon ion beams for the treatment of choroidal melanoma with regard to normal tissue morbidity and local tumor control. Between January 2001 and February 2006, 59 patients with locally advanced or unfavorably located choroidal melanoma were enrolled in a Phase I/II clinical trial of carbon-ion radiotherapy at the National Institute of Radiologic Sciences. The primary endpoint of this study was normal tissue morbidity, and secondary endpoints were local tumor control and patient survival. Of the 59 subjects enrolled, 57 were followed >6 months and analyzed. Twenty-three patients (40%) developed neovascular glaucoma, and three underwent enucleation for eye pain due to elevated intraocular pressure. Incidence of neovascular glaucoma was dependent on tumor size and site. Five patients had died at analysis, three of distant metastasis and two of concurrent disease. All but one patient, who developed marginal recurrence, were controlled locally. Six patients developed distant metastasis, five in the liver and one in the lung. Three-year overall survival, disease-free survival, and local control rates were 88.2%, 84.8%, and 97.4%, respectively. No apparent dose-response relationship was observed in either tumor control or normal tissue morbidity at the dose range applied. Carbon-ion radiotherapy can be applied to choroidal melanoma with an acceptable morbidity and sufficient antitumor effect, even with tumors of unfavorable size or site.

Nine-Year Changes in Intraocular Pressure

To describe temporal changes in intraocular pressure (IOP) and associated risk factors after 9 years of follow-up in a population of African descent. Changes in IOP were evaluated in 2298 participants without glaucoma or IOP-lowering treatment at baseline. Risk factor analyses used a multiple regression approach with mixed effects, which accounted for intereye correlation. The mean 9-year change in IOP was small, with relatively large dispersion (mean +/- SD, 0.4 +/- 4.0 mm Hg). Only 6.5% of persons with IOP of 21 mm Hg or less at baseline had elevated IOP greater than 21 mm Hg after 9 years. Mean IOP increases were largest in persons aged 50 to 59 years at baseline (mean +/- SD, 0.9 +/- 4.3 mm Hg), whereas IOP decreased in persons 70 years or older (mean +/- SD, -0.6 +/- 4.2 mm Hg). In multivariate analyses, IOP changes were positively associated with male sex, hypertension, diabetes history, and higher systolic and diastolic blood pressure at baseline, as well as with increases in blood pressure throughout 9 years (P<.05). After long-term follow-up, minimal changes in IOP were observed in this African-origin population. The consistent relationships of hypertension and diabetes to IOP, a major glaucoma risk factor, underscore the public health importance of controlling these systemic conditions in black populations, where glaucoma incidence is high.

Primary intraocular lens implantation in infants: Complications and visual results

To evaluate the complications and visual results in a consecutive series of patients having cataract extraction with intraocular lens (IOL) implantation in the first year of life. St. Erik's Eye Hospital, Stockholm, Sweden. This retrospective study comprised 28 children (31 eyes) who had cataract surgery with primary IOL implantation. The median age at surgery was 2.5 months (range 8 days to 10 months). The median follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV) who had surgery at 8 days and 17 days, respectively, developed intraoperative vitreous hemorrhage; a retinal detachment developed in 1 of the eyes. Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of eyes developed opacification of the visual axis that required additional surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye. Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100). In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1 achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of 20/200 and the rest achieved CF or worse. After-cataract with membrane formation was the main complication in infants with primary IOL implantation. The glaucoma incidence was low at the last follow-up.

Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation

A retrospective study of 313 pediatric cataract surgical cases with (266 eyes) and without (47 eyes) intraocular lens implantation (IOL) was performed in order to determine the incidence and risk factors for developing glaucoma. Exclusion criteria included traumatic cataract, aniridia, Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than one month of follow-up. Glaucoma was diagnosed in 10 eyes (3.8%) after pediatric cataract with surgery with IOL and in eight eyes (17.0%) without IOL. All cases occurred in children who underwent cataract surgery before the age of 4.5 months. Among patients who underwent surgery before the age of 4.5 months, the incidence of glaucoma was 24.4% in pseudophakic eyes and 19.0% in age-matched children with aphakic eyes. Glaucoma was diagnosed in the pseudophakic eyes after a mean interval of 8.6 months and in aphakic eyes after a mean interval of 93.3 months. The authors conclude patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without intraocular lens implant.—Michael D. Wagoner

Paediatric aphakic glaucoma

Aphakic glaucoma is a serious, sight-threatening complication in children who remain aphakic following congenital cataract surgery. The reported incidence varies from 15% to 45% and it has a higher incidence in small eyes and in babies who undergo surgery before 4 weeks of age. Most cases take the form of open-angle glaucoma. Despite careful monitoring, diagnostic difficulties in children may lead to delayed treatment. Aphakic children require ongoing monitoring, including examinations carried out under general anaesthesia. Contrary to earlier optimism, it is unlikely, according to current clinical information, that intraocular lenses provide protection against the development of glaucoma. It is likely that the lower incidence of glaucoma in pseudophakic eyes results from selection bias for lens insertion. Both medical and surgical treatments have a role in glaucoma management. Trabeculectomy with mitomycin C or Seton implantation (glaucoma drainage device) form the mainstay of surgical treatment. The success rate with Seton implants is better in the short term and more promising in the longer term than that of trabeculectomy. Cyclodestructive procedures play a role in refractory glaucoma. Success rates for surgery range from 14% to 44% and many children require additional medical treatment. Children with aphakic glaucoma need lifelong care. Despite our best efforts, many have poor vision, poor glaucoma control and ultimately become blind.

Intravitreal steroids in the management of macular oedema

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.

Secondary Glaucoma Associated With Advanced Acanthamoeba Keratitis

To describe the association of acanthamoeba keratitis and glaucoma, to establish an incidence of glaucoma in patients with acanthamoeba keratitis, to discuss treatment options and outcomes in these patients, and to describe the histopathologic findings and pathogenesis of glaucoma secondary to acanthamoeba keratitis. After Institutional Review Board approval, the charts of all patients suspected of having acanthamoeba keratitis at Aston Ambulatory Center at The University of Texas Southwestern Medical Center were reviewed. Inclusion criteria were as follows: diagnosis of acanthamoeba keratitis by positive confocal microscopy or culture, diagnosis of glaucoma or ocular hypertension secondary to acanthamoeba keratitis, and at least 6 months of follow-up. Exclusion criteria included a previous diagnosis of glaucoma or ocular hypertension and any history of intraocular surgery before the development of glaucoma. The date of keratitis development, pneumotonometry on initial and follow-up examinations, glaucoma medications used, and surgical procedures performed were tabulated. Twenty patients (20 eyes) were included. Six (30%) eyes developed secondary glaucoma during the review period. Of the patients treated for glaucoma with medication alone, the visual acuity of three (75%) of four became light perception or no light perception. Three of six patients required glaucoma drainage device implantation for intraocular pressure control. Of these, the vision of one eye became no light perception, and the other two eyes maintained better than 20/100 vision. Histopathologic examination showed chronic inflammation of the trabecular meshwork and angle closure. No acanthamoeba organisms were found in the angle structures. The development of secondary glaucoma is not uncommon in acanthamoeba keratitis and is a poor prognostic sign in patients with acanthamoeba keratitis, because most progress to light perception or no light perception vision. Histopathologic findings suggest an inflammatory angle-closure mechanism, apparently without direct infiltration of the organism. The glaucoma associated with acanthamoeba keratitis is often severe and frequently requires surgical intervention for intraocular pressure control and vision preservation.

Incidence and Prevalence of Glaucoma in Severe Ocular Surface Disease

To describe the incidence and prevalence of glaucoma in a patient population with severe ocular surface disease (OSD). A retrospective case series was compiled from all charts of patients in the Cincinnati Eye Institute/University of Cincinnati and University of Minnesota population with a diagnosis of severe OSD from 1991 to 2003. The incidence and prevalence of glaucoma in the overall patient population were identified, and stratified into disease subgroups. Of the 108 eyes evaluated in this study, 71 were diagnosed with glaucoma. The overall prevalence of glaucoma in patients with severe OSD is 65.7%, with a range from 42.9% to 88.4%. Analysis by subgroup shows the highest percentage of patients with concurrent glaucoma fall into the categories of aniridia and chemical injury, and the lowest was noted in those patients with autoimmune or iatrogenic OSD. Overall, the incidence of glaucoma was 20.4%, with a range of 13.6% to 60%. Compared with previous studies, our results show a significantly higher prevalence of glaucoma in patients with severe OSD. This information warrants increased attention to treatment and management of OSD and concurrent glaucoma.

Incidence and Risk Factors for Glaucoma After Pediatric Cataract Surgery With and Without Intraocular Lens Implantation

We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma. We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up. After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio=1.1, CI=0.7-1.9; P=.555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months+/-1.4 vs. 1.9 months+/-1.0, P=.700) or aphakic eyes (2.6 months+/-1.5 vs. 1.4 months+/-0.9, P=.070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes (P=.860) or aphakic eyes (P=.254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively. Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.

Incidence of Canine Glaucoma with Goniodysplasia in Japan: A Retrospective Study

The incidence of primary and secondary glaucoma in dogs was investigated. A total of 1244 dogs received ophthalmologic examinations, including tonometry and gonioscopy. Goniophotographs were taken using a goniolens to evaluate the iridocorneal angle (ICA) as well as pectinate ligament (PL). The anterior width of the ciliary cleft and the total distance from the origin of the PL to the anterior corneal surface were measured from the goniophotographs. Glaucoma was diagnosed based on the cupping of the optic nerve head, clinical signs, ocular changes, and high IOP, and it was synchronized with gonioscopic grades to differentiate between primary and secondary glaucoma. We investigated 1244 dogs of 29 breeds, including the mixed breed; among these, glaucoma was diagnosed in 127 dogs (162 eyes). Of 162 eyes, primary glaucoma was diagnosed in 129 eyes and secondary glaucoma in 33 eyes. Shiba Inu dogs (42 dogs, 33%) showed the highest incidence of glaucoma, followed by Shih-Tzu (21 dogs, 16.5%). Furthermore, all the glaucomatous Shiba Inu dogs had primary glaucoma with abnormal ICA grades and dysplastic PLs. The findings of our study reveal that the Shiba Inu breed in Japan may have a hereditary predisposition to glaucoma.

Expression of the homeobox gene Pitx2 in neural crest is required for optic stalk and ocular anterior segment development

Heterozygous mutations in the homeobox gene, PITX2, result in ocular anterior segment defects and a high incidence of early-onset glaucoma. Pitx2 is expressed in both the neural crest and the mesoderm-derived precursors of the periocular mesenchyme. Complete loss of function in mice results in agenesis or severe disruption of periocular mesenchyme structures and extrinsic defects in early optic nerve development. However, the specific requirements for Pitx2 in neural crest versus mesoderm could not be determined using these mice, and only roles in the initial stages of eye development could be assessed due to early embryonic lethality. To determine the specific roles of Pitx2 in the neural crest precursor pool, we generated neural crest-specific Pitx2 knockout mice (Pitx2-ncko). Because Pitx2-nkco mice are viable, we also analyzed gene function in later eye development. Pitx2 is intrinsically required in neural crest for specification of corneal endothelium, corneal stroma and the sclera. Pitx2 function in neural crest is also required for normal development of ocular blood vessels. Pitx2-ncko mice exhibit a unique optic nerve phenotype in which the eyes are progressively displaced towards the midline until they are directly attached to the ventral hypothalamus. As Pitx2 is not expressed in the optic stalk, an essential function of PITX2 protein in neural crest is to regulate an extrinsic factor(s) required for development of the optic nerve. We propose a revised model of optic nerve development and new mechanisms that may underlie the etiology of glaucoma in Axenfeld-Rieger patients.

Incidence of Open-Angle Glaucoma in a General Elderly Population: The Rotterdam Study

To determine the incidence of open-angle glaucoma (OAG) in a general elderly white population. Population-based cohort study. Participants 55 years and older from the Rotterdam Study, The Netherlands. Participants at risk for incident OAG underwent at baseline (1990-1993) and follow-up (1997-1999) the same ophthalmic examination, including measurement of intraocular pressure, visual field testing, and stereo optic disc photography. The diagnosis of probable or definite OAG was made with an algorithm based on optic disc parameters and on visual field testing, independent of the intraocular pressure. Five-year risk and incidence rates of OAG. In total, 3842 participants were examined (participation rate at follow-up, 78%). After a mean follow-up time of 6.5 years, probable (n = 58) or definite OAG (n = 29) developed in 87 persons. The 5-year risk of probable OAG was 1.2% and that of definite OAG 0.6%, and the rate rose for both together from 1% at age 60 years to approximately 3% at age 80 years. Bilateral OAG occurred 5 times more often after than before age 75 years. In participants with prevalent OAG in 1 eye, the 5-year risk of OAG in the fellow eye was 5 times higher than in fellow eyes of non-OAG eyes. Only 37% of the incident cases received treatment for OAG at the time of the reexamination. The incidence of OAG rose significantly with age. Most of the patients with incident OAG were unaware of having OAG.

Das Fuchs’sche Uveitis Syndrom — die Heterochromie ist keine Conditio sine qua non

Fuchs uveitis syndrome (FUS) is typically a unilateral, chronic, low-grade inflammation of the anterior segment which manifests in young adulthood. It is underdiagnosed because of its variable clinical spectrum. Although it can mimic various forms of anterior uveitis, it is important to make the correct diagnosis, based on clinical grounds, because both the management and prognosis differ from those of other uveitides. While its etiology remains unknown, it is possible that the disease has multiple causes that lead through different pathogenic mechanisms to the same clinical entity. Although many patients do not require treatment, it is not a benign condition, as often perceived. The high incidence of glaucoma makes it mandatory that all patients with FUS should be screened at regular intervals, even if they are not being actively treated and are relatively asymptomatic.

Incidence of secondary glaucoma in Behcet’s disease

The authors performed a retrospective and prospective study to determine the incidence of secondary glaucoma in 230 eyes of 129 patients (90 male, 39 female) with Behcet’s disease. The mean patient age was 34.2 ± 7.4 years (range, 18 to 55 years). Episodes of acute recurrent iridocyclitis only were present in 122 eyes (53%), while 108 eyes (47%) developed chronic posterior uveitis, including vitreitis, retinitis, vasculitis, or optic nerve involvement. Secondary glaucoma was present in 25 eyes (10.9%) eyes, including 11 eyes (44%) with steroid or inflammation induced open angle glaucoma, 6 eyes (24%) with partial angle-closure glaucoma and/or peripheral anterior synecchia, 5 eyes (20%) with angle closure glaucoma, peripheral anterior synecchia, and/or pupillary block, and 3 eyes (12%) with neovascular glaucoma.

Incidence of Glaucoma in Patients with Uveitis

To evaluate the incidence of glaucoma and elevation of intraocular pressure (IOP) in patients with inflammatory eye disease. Retrospective review of medical records of 391 consecutive patients with uveitis attending a uveitis clinic of an academic Department of Ophthalmology from January 1999 to August 2002. Demographic, ocular and systemic variables were recorded. The diagnosis and treatment of uveitis were recorded. Uveitis was classified according to standard anatomic, etiological and clinical criteria. "Glaucoma" was defined as elevated IOP (>21 mm Hg) or glaucomatous optic nerve damage requiring medical and/or surgical anti-glaucoma treatment. Kaplan-Maier analysis and log-rank tests were used to evaluate and compare the incidence of glaucoma. The incidence of glaucoma as defined above at 3 and 12 months after acute uveitis was 7.6%. In patients with chronic uveitis (n = 337), the incidence of glaucoma at 1 and 5 years was 6.5% and 11.1%, respectively. There was no statistically significant difference in the incidence of glaucoma between different types of uveitis, idiopathic versus non-idiopathic, and among anterior, intermediate, posterior and panuveitis. Visual loss occurred more frequently in patients with glaucoma than in patients without glaucoma. In patients with chronic inflammatory eye disease, the presence of glaucoma was associated with an increasing risk of visual loss. The incidence of glaucoma increased with time and was similar among the different types of uveitis.

Incidence of Secondary Glaucoma in Beh??et Disease

To determine the incidence of secondary glaucoma in Behcet disease. A total of 230 eyes of 129 patients with Behcet disease, were examined in uveitis and glaucoma clinics of Ankara Social Security Eye Hospital between January 1997 and September 2002. The data from all patients were investigated both retrospectively and prospectively. The mean age of 129 patients was 34.2 +/- 7.4 years (range, 18 to 55 years). In 22 patients (17%), the disease was diagnosed on the basis of the ocular findings, while in the remaining 107 patients (83%), the period between the diagnosis of Behcet disease and the onset of the ocular symptoms was 23.3 +/- 17 months (range, 1 month to 5.3 years); 122 eyes (53%) had the episodes of acute recurrent iridocyclitis, while 108 eyes (47%) developed chronic posterior uveitis, including vitreitis, retinitis, vasculitis, or optic nerve involvement. Secondary glaucoma was diagnosed in 25 eyes (10.9%); 11 eyes (44%) with steroid or inflammation induced open angle glaucoma, 6 eyes (24%) with partial angle-closure glaucoma and peripheral anterior synechiae, 5 eyes (20%) with angle closure glaucoma, peripheral anterior synechiae, and pupil block and 3 eyes (12%) with neovascular glaucoma. The treatments included YAG-laser iridotomy in 5 eyes, diode-laser cyclodestruction in 3 eyes, primary trabeculectomies with mitomycin-c in 4 eyes, secondary trabeculectomies with mitomycin-c in 2 eyes, Ahmed valve implantations in 2 eyes, and cyclocryotherapy in 3 eyes. We suggest that secondary glaucoma is a common and serious complication of Behcet disease. It develops as a result of multiple factors, generally triggered by recurrent intraocular inflammation. Early recognition and treatment of these factors have vital importance to avoid the visual morbidity.

Familial pseudoexfoliation in Gozo

To describe the occurrence of pseudoexfoliation in three Gozitan families. Three families with a high incidence of pseudoexfoliation were identified. All members of the three families who agreed to participate were interviewed and underwent a full ophthalmologic examination. The pseudoexfoliation status was classified as present, absent, or unknown. A total of 55 individuals from three separate family probands and with a male : female sex ratio of 5 : 4 were examined. In all, 18 had definite evidence of pseudoexfoliation, 17 of them bilaterally and one showing only unilateral signs. Age was the main risk factor, with 18 out of the 20 individuals who were over the age of 60 years having pseudoexfoliation, while none of the 35 who were below the age of 60 years had pseudoexfoliation. The ophthalmological findings varied in different families. Family I had a high incidence of both cataract and glaucoma, family II had mainly glaucoma, while in family III all individuals had cataract but none had evidence of glaucoma. The first generation of these three families were deceased but their hospital and clinical records revealed that in all three families the father was affected and there was no evidence of maternal involvement. In all three families, pseudoexfoliation appeared to be genetically transmitted as a late onset autosomal dominant trait of variable expression. Maternal transmission could not be confirmed in these families.

Decreased incidence of neovascular glaucoma by sparing anterior structures of the eye for proton beam therapy of ocular melanoma

We previously hypothesized that sparing the anterior segment of the eye would reduce the incidence of neovascular glaucoma (NVG) (Daftari, I. K., et al., IJROBP 1997, 39:997–1010; Meecham, W.J., et al., Arch Ophthalmol 1994, 112:197–203). To test this hypothesis, we examined the incidence and contributing factors of NVG in patients treated with proton beam therapy at the Crocker Nuclear Lavoratory faculty in Davis, California using techniques for sparing anterior structures of the eye.

Decreased incidence of neovascular glaucoma by sparing anterior structures of the eye for proton beam therapy of ocular melanoma

We previously hypothesized that sparing the anterior segment of the eye would reduce the incidence of neovascular glaucoma (NVG) (Daftari, I. K., et al., IJROBP 1997, 39:997–1010; Meecham, W.J., et al., Arch Ophthalmol 1994, 112:197–203). To test this hypothesis, we examined the incidence and contributing factors of NVG in patients treated with proton beam therapy at the Crocker Nuclear Lavoratory faculty in Davis, California using techniques for sparing anterior structures of the eye.