Incidence Of Glaucoma Research Articles

Long-term cumulative incidence of glaucoma after congenital cataract surgery

Glaucoma is one of the greatest threats to vision following congenital cataract surgery. The odds of developing glaucoma have been reported to be directly related to the age of surgery after short-term follow-up. We report the long-term cumulative incidence of glaucoma in a consecutive series of children undergoing congenital cataract surgery.

Prevalence, distribution and determinants of myopia in Owerri, Nigeria

Background: Uncorrected myopia is a significant cause of visual impairment and avoidable blindness. Incidence of open-angle glaucoma has been shown to occur more often in myopia. This cross-sectional analytical study determined the prevalence, distribution and determinants of myopia in the adult population of Imo State, Nigeria with a view to establish a reference data for research purposes and future intervention in this locality. Materials and Method: A total of 3451 adults living in Owerri consisting of 2606 persons as test group and 845 persons as controls were randomly selected using standard optometric methods including subjective refraction. Results: Refractive error (ametropia) was found in 79.5% study and 76.8% control. Myopia was found in 23.4% study and 19.6% control. Highest prevalence of myopia was observed in females aged 40-49 years. Fifty percent of study and 68.1% of control group had myopia of -0.50DS to -3.00DS while 4.0% and 2.4% of study and control group respectively had myopic astigmatism. In all, 27.7% study and 16.2% control had myopia > 5.00DS. The highest degree of myopia found in this study was - 24.00DS. Conclusion: This study provided information on the prevalence, distribution and determinants of myopia in Owerri, Nigeria and the data could be a basis for improved visual health care in the south-eastern sub-region of Nigeria.

Systemic Parameters Associated With Cerebrospinal Fluid Pressure

Low cerebrospinal fluid (CSF) pressure has recently been implicated in the pathogenesis of glaucoma. Although little data currently exists, various systemic parameters may affect CSF pressure. CSF pressure increases with increased body mass index (BMI), which corroborates recent studies that have demonstrated elevated BMI may be protective of glaucoma. CSF pressure decreases with age, while the incidence of glaucoma increases with age. Blood pressure has been reported to influence CSF pressure in some studies but not others. Women appear to have a slightly lower CSF pressure than men and CSF pressure shows diurnal fluctuation, as do blood pressure and intraocular pressure. Additionally, postural changes likely alter CSF pressure near the optic nerve. Finally, many factors that may affect CSF pressure (such as medications, genetics, race, and others) have yet to be studied conclusively.

Effect of corneal graft diameter on therapeutic penetrating keratoplasty for fungal keratitis.

To evaluate the effect of corneal graft diameter on therapeutic penetrating keratoplasty (PKP) for fungal keratitis. A total of 116 patients (116 eyes) suffered from fungal keratitis underwent PKP at the Affiliated Hospital of Medical College Qingdao University from May 2006 to May 2010. They were divided into two groups according to the corneal graft diameter. 64 eyes' corneal graft diameter was 8.00mm or larger and 52 eyes' graft diameter was smaller than 8.00mm. The follow-up time was 2 years. The postoperative visual acuity and complications were documented and compared. Sixty-two (96.88%) eyes and fifty (96.15%) eyes preserved eyeballs respectively in two groups. There was no statistical difference in postoperative visual acuity (P=0.961), corneal graft clear rate (P=0.132) or the incidence of recurred fungal infection (P=0.770) between two groups. But there was a higher incidence of graft rejection (P=0.020) and secondary glaucoma (P=0.039) in group with corneal graft diameter 8.00mm or larger. PKP is an effective treatment approach for fungal keratitis. There is a higher incidence of complications in large-diameter PKP for fungal keratitis. Effective, preventive and therapeutic measures can improve the prognosis.

The Glaucoma Guidelines of the Swedish Ophthalmological Society

The Glaucoma Guidelines of the Swedish Ophthalmological Society

Long-term Result of Carbon-ion Radiation Therapy for Locally Advanced or Unfavorably Located Choroidal Melanoma: CT Based 2-port Orthogonal Therapy Can Reduce the Incidence of Neovascular Glaucoma

To evaluate long-term result of carbon ion radiation therapy (C-ion RT) for the patients with choroidal melanoma and to determine the prognostic factors and risk factors of neovascular glaucoma (NVG). Between January 2001 and February 2012, 116 patients with locally advanced or unfavorably located choroidal melanoma received the C-ion RT with CT based treatment planning. Of the 116 patients, 114 patients followed longer than 6 months were analyzed for this study. Of those, 106 patients had T3 tumor and 8 patients had T2 tumor according to UICC 5th edition. Initially the treatment was performed according to a phase I/II dose-escalation protocol, therefore 16 patients treated with 60 GyE, 78 with 70 GyE, 13 with 77 GyE, and 7 with 85 GyE, in 5 fractions. Since October 2005, two-port orthogonal therapy has been started in attempting to reduce the risk of NVG, and 51 patients were already performed. Dose-volume histogram analysis was additionally performed in 106 patients with regard to NVG occurrence. Median follow up duration was 4.6 years (range, 0.5-10.6). Five-year overall survival (OS), cause-specific survival (CSS), local control rate, distant metastasis free survival rate (DMFSR), and eye retention rate of entire group were 80.4%, 82.2%, 92.8%, 72.1%, and 92.8%, respectively. NVG was occurred in 36 patients, and enucleation was undergone in 3 patients because of severe glaucoma. Three-year and 5-year NVG incidence rate was 29.7% and 35.9% for all the analyzed patients. Concerning number of port, NVG incidence rate of two-port group was significantly lower than that of one-port group on univariate analysis (p < 0.001 log-rank test): 3-year NVG incidence rate was 41.6% and 13.9% for one-port group and two-port group. Multivariate analysis identified tumor size, distance from optic disc (0-3mm vs others), and one-port therapy were independent significant risk factors of NVG; distance from optic disc (0 vs others) was independent significant prognostic factor of OS, CSS, and DMFSR. Dose-volume histogram analysis showed the average irradiated volumes of iris ciliary body were significantly lower in non-NVG group at all dose levels than NVG group. Long-term result of C-ion RT for choroidal melanoma at our institute was satisfactory, even with tumors of unfavorable size or site. This study suggests tumor size, distance from optic disc, and number of port are related to NVG occurrence; distance from optic disc is related to survival and distant metastasis. CT based two-port C-ion RT can be useful to reduce irradiated volumes of iris ciliary body and resulting risk of NVG.

Retinal Vessel Caliber Is Associated with the 10-year Incidence of Glaucoma: The Blue Mountains Eye Study

To examine associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG).Population-based cohort study.The Blue Mountains Eye Study examined 3654 persons at baseline and 2461 persons at either 5 years, 10 years, or both times. After excluding 44 subjects with OAG at baseline, 2417 participants at risk of OAG at the 5- or 10-year examinations were included.Retinal vessel calibers of baseline retinal photographs were measured using a computer-based program and summarized as central retinal artery and vein equivalents (CRAE, CRVE). Incident OAG was defined as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the 2 eyes (≥0.3) at either the 5- or 10-year examination. Generalized estimating equation models were used to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP).We assessed the 10-year incidence of OAG.There were 82 persons (104 eyes) who developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction, and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12-2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14-3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11-2.78), and remained significant when analyses were confined to eyes with IOP<20 mmHg and C:D ratio<0.6 at baseline. There were no independent associations between CRVE and incident OAG.Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Vitreous surgery impact in glaucoma development in liver transplanted familial amyloidosis ATTR V30M Portuguese patients

Purpose: Familial amyloidosis with polyneuropathy (FAP) sometimes courses with vitreous amyloid. The aim of this study was to evaluate the incidence of glaucoma after vitrectomy in FAP patients. Methods: A total of 79 eyes of 42 liver transplanted FAP patients and 16 eyes of 16 non-FAP patients with rhegmatogenous retina detachment were collected. The patients were divided in to three groups: Group I – FAP patients with vitreous opacities submitted to vitrectomy, Group II – FAP patients without vitreous opacities and not submitted to vitrectomy and, Group III – non-FAP patients with rhegmatogenous retinal detachment submitted to vitrectomy. The Group I was subdivided into: Ia – “complete” vitrectomy; Ib – “incomplete” vitrectomy. The onset of glaucoma was considered when the intraocular pressure level was higher than 21 mmHg, with concomitant visual field abnormalities and optic nerve cupping. Results: Post vitrectomy glaucoma was more frequent in Group I (56.1%) than in Group III (12.5%) and in Group II (10.5%). We observed a higher incidence of glaucoma in the Ia than in the Ib subgroup (86.4 vs. 21.1%) and earlier appearance in subgroup Ia (7.9 ± 3.6 vs. 39.5 ± 6.6 months). Conclusion: Vitrectomy induced the development of glaucoma in FAP patients.

Evaluation of whether intracameral dexamethasone predisposes to glaucoma after pediatric cataract surgery

To evaluate the effect of intracameral dexamethasone during pediatric cataract surgery on the incidence of postoperative glaucoma. Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom. Retrospective case series. This case-note review comprised all infants who had cataract surgery with intraocular lenses between January 1, 2007, and December 31, 2008, and were given preservative-free intracameral dexamethasone intraoperatively. The definition of glaucoma was an intraocular pressure (IOP) of 21 mm Hg or greater on more than 2 occasions or moderate or firm digital IOP with 1 of the following: myopic shift, increased cup-to-disc ratio, increased horizontal corneal diameter, or corneal edema. Eighteen patients (24 eyes) were included. The median age at surgery was 3 months (mean 4 months ± 3 (SD); range 1 to 11 months). The median follow-up was 38 months (mean 34 ± 10 months; range 20 to 48 months). In 4 eyes, transient postoperative antihypertensive medication was used; however, no eye developed glaucoma during the follow-up period. Fifteen eyes had a second procedure to clear the visual axis due to posterior visual axis opacification a mean of 6.4 ± 3.5 months postoperatively (median 4.8 months; range 3.5 to 14.5 months); however, no eye developed anterior membranes. Intracameral preservative-free dexamethasone in infantile cataract surgery did not seem to cause an increased risk for glaucoma and appeared to protect against anterior membrane formation.

Ocular hypertension and glaucoma incidence in patients with scleritis

Scleritis belongs to the group of chronic inflammatory eye diseases that may cause ocular hypertension (OHT) and secondary glaucoma (SG). Aim of this study was to identify the incidence and risk factors for OHT and SG with regard to the scleritis form. Single-center retrospective analysis of all consecutive patients with scleritis. A total of 271 scleritis patients (161 women, mean age 51.0 ± 16.9 years) were enrolled. The median follow-up was 17.0 ± 21.4 months (range 6-116). Of these patients, 56 (21 %) showed an intraocular pressure (IOP) increase with an open chamber angle at any time during follow-up. Another four patients (7 %) had secondary angle-closure glaucoma. An increase in IOP was found more frequently in patients with necrotizing (42 %) than in those with posterior (30 %), nodular (18 %) or diffuse anterior scleritis (18 %, p = 0.022). Most patients (82 %) developed the pressure increase during acute scleritis episodes. Initially, 72 % of patients with increased IOP were classified as OHT; this figure had decreased to 56 % at the end of follow-up. In the course of disease, the IOP normalized in 13 %. The univariate analysis of risk factors showed an increased risk in the presence of anterior uveitis, peripheral ulcerative keratitis, posterior synechiae, and previous cataract surgery. An increase in IOP occurs in about one-fifth of patients with scleritis. The initial pressure elevation occurs mostly in the acute phase of disease. An increase in pressure is found most often in patients with necrotizing scleritis.

Long‐term risk of intraocular pressure elevation and glaucoma escalation after deep anterior lamellar keratoplasty

To determine the prevalence and severity of intraocular pressure changes after deep anterior lamellar keratoplasty and its effect on visual function. Retrospective cohort study. All patients undergoing deep anterior lamellar keratoplasty procedures at a tertiary referral centre (Leeds University Hospitals, UK) using a manual dissection technique. Case note review of all cases between the 1st of January 2000 and the 31st of December 2005. Raised intraocular pressure, glaucoma incidence or escalation. Data were collected for 69 of eyes of 58 patients. The mean period of follow-up was 54.9 months (median 60, range 6-95 months). The initial diagnosis was keratoconus in 56 cases (81%), corneal scarring in four cases (5.8%), herpes simplex keratitis in four cases (5.8%), lattice dystrophy in four cases (5.8%) and one case of corneal dermoid. Temporarily intraocular pressure was thought to be related to topical steroid use occurred in 12 (17%) cases. Ocular hypertension requiring treatment occurred in three eyes. None of these eyes had progressive disc changes or visual field defects suggestive of glaucoma, and all had well-controlled intraocular pressure on topical, single-drug therapy. Overall, there was a small insignificant rise in intraocular pressure after deep anterior lamellar keratoplasty (P = 0.11). The long-term risk of glaucoma following deep anterior lamellar keratoplasty using the manual dissection technique appears to be low. Ocular hypertension after deep anterior lamellar keratoplasty is infrequent and can be controlled on topical medication alone.

The changing geometry of angle closure

The changing geometry of angle closure

Four-Year Incidence of Open-Angle Glaucoma and Ocular Hypertension: The Los Angeles Latino Eye Study

To estimate the 4-year incidence of open-angle glaucoma (OAG) and ocular hypertension (OHT) among adult Latinos 40 years of age and older. Population-based longitudinal study. Comprehensive ophthalmologic examinations including intraocular pressure, visual field testing, and stereoscopic fundus photography were performed at both baseline and the 4-year follow-up examination. Incident OAG at the 4-year follow-up examination was defined as the presence of an open angle and a glaucomatous visual field abnormality or evidence of glaucomatous optic disc damage, or both when not present at baseline. Incident OHT was defined as intraocular pressure of more than 21 mm Hg and the absence of optic disc damage or abnormal visual field results at the 4 year follow-up examination when not present at baseline. Among the 3939 participants (mean age, 54.7 ± 10.5 years) with complete data for a diagnosis of glaucoma at both baseline and follow-up examination, incident OAG at the 4-year follow-up was identified in 87 persons (4-year incidence rate, 2.3%; 95% confidence interval, 1.8% to 2.8%). Incident OHT at the 4-year follow-up was identified in 124 persons (4-year incidence rate, 3.5%; 95% confidence interval, 2.9% to 4.1%). In participants with OAG in 1 eye, the 4-year risk of OAG developing in the fellow eye was 5 times as high as the risk for those without OAG in either eye at baseline. In participants with OHT in 1 eye, the 4-year risk of OHT developing in the fellow eye was 10 times as high as the risk for those without OHT in either eye at baseline. The incidence rates of OAG and OHT were higher in older Latinos than in younger Latinos. Incidence of OAG in Latinos is higher than in non-Hispanic whites, but lower than in Afro-Caribbeans. The relatively high rate of incident OAG and OHT underscores the need for community screening programs in this fastest growing segment of the United States population.

The times they are a‐changin’: time to change glaucoma management

The times they are a‐changin’: time to change glaucoma management

Iris melanoma: Features and prognosis in 317 children and adults

To evaluate iris melanoma in children versus adults. Retrospective, nonrandomized clinical case series including all patients with a clinical diagnosis of iris melanoma managed at the Ocular Oncology Service at Wills Eye Institute over 40 years. Patients were divided into three age categories based on age at presentation: children (≤ 20 years), mid-adults (21-60 years), and older adults (>60 years). The clinical features, treatments, and outcomes were statistically analyzed based on patient age at presentation. The main outcome measures were melanoma features and related metastasis and death. Of 8,101 eyes with uveal melanoma, there were 317 (4%) with iris melanoma, including 24 (8%) children (≤ 20 years), 187 (59%) mid-adults (21-60 years), and 106 (33%) older adults (>60 years). There was no age-related difference in race, sex, tumor quadrant, thickness, pigmentation, associated corectopia, ectropion uveae, hyphema, or extraocular extension. Significant age-related differences were found with mean tumor basal diameter, tapioca appearance, mean intraocular pressure, secondary glaucoma, tumor seeding in angle, and mean number of clock hours of angle seeding. Multivariate analysis of factors predictive of metastasis included extraocular extension and high intraocular pressure. Factors predictive of death included increased tumor thickness and high intraocular pressure. There was no difference in metastasis or death by age group. Iris melanoma shows significant clinical differences in children versus adults, with smaller tumor size, less tumor seeding in angle, and lower incidence of secondary glaucoma. There was no significant difference in metastasis or death by age group.

Causes of Glaucoma After Descemet Membrane Endothelial Keratoplasty

To describe the incidence and causes of glaucoma after Descemet membrane endothelial keratoplasty (DMEK). Nonrandomized prospective cohort study at a tertiary referral center. The incidence of glaucoma was evaluated in the first 275 consecutive eyes that underwent DMEK for Fuchs endothelial dystrophy (260 eyes) or bullous keratopathy (15 eyes). Glaucoma was defined as a postoperative intraocular pressure (IOP) elevation of ≥24 mm Hg, or ≥10 mm Hg from the preoperative baseline. If possible, the cause of glaucoma was identified, and best-corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative course were documented, with a mean follow-up of 22 (± 13) months. Overall, 18 eyes (6.5%) showed postoperative glaucoma after DMEK. Seven eyes (2.5%) had an exacerbation of a pre-existing glaucoma. Eleven eyes (4%) presented with a de novo IOP elevation, associated with air bubble-induced mechanical angle closure (2%), steroid response (0.7%), or peripheral anterior synechiae (0.4%), or without detectable cause (0.7%). Two eyes (0.7%) required glaucoma surgery after DMEK. At 6 months, all eyes had a BCVA of ≥20/40 (≥0.5), and 81% reached ≥20/25 (≥0.8) (n = 16); mean ECD was 1660 (± 554) cells/mm(2) (n = 15) (P > .1). Glaucoma after DMEK may be a relatively frequent complication that could be avoided by reducing the residual postoperative air bubble to 30% in phakic eyes, applying a population-specific steroid regime, and avoiding decentration of the Descemet graft. Eyes with a history of glaucoma may need close IOP monitoring in the first postoperative months, especially in eyes with an angle-supported phakic intraocular lens.

Survival and complications following Gamma Knife radiosurgery or enucleation for ocular melanoma: a 20-year experience

We present our experience in treating ocular melanoma at the National Centre for Stereotactic Radiosurgery in Sheffield, UK over the last 20 years. We analysed 170 patients treated with Gamma Knife radiosurgery, recorded the evolution of visual acuity and complication rates, and compared their survival with 620 patients treated with eye enucleation. Different peripheral doses (using the 50% therapeutic isodose) were employed: 50-70 Gy for 24 patients, 45 Gy for 71 patients, 35 Gy for 62 patients. There was no significant difference in survival between the 35-Gy, 45-Gy and 50- to 70-Gy groups when compared between themselves (p = 0.168) and with the enucleation group (p = 0.454). The 5-year survival rates were: 64% for 35 Gy, 62.71% for 45 Gy, 63.6% for 50-70 Gy and 65.2% for enucleated patients. Clinical variables influencing survival for radiosurgery patients were tumour volume (p = 0.014) and location (median 66.4 vs 37.36 months for juxtapapillary vs peripheral tumours, respectively; p = 0.001), while age and gender did not prove significant. Regarding complications, using 35 Gy led to more than a 50% decrease, when compared with the 45-Gy dose, in the incidence of cataract, glaucoma and retinal detachment. Retinopathy, optic neuropathy and vitreous haemorrhage were not significantly influenced. Blindness decreased dramatically from 83.7% for 45 Gy to 31.4% for 35 Gy (p = 0.006), as well as post-radiosurgery enucleation: 23.9% for 45 Gy vs 6.45% for 35 Gy (p = 0.018). Visual acuity, recorded up to 5 years post-radiosurgery, was significantly better preserved for 35 Gy than for 45 Gy (p = 0.0003). Using 35 Gy led to a dramatic decrease in complications, vision loss and salvage enucleation, while not compromising patient survival.

Glaucoma and corneal transplant procedures.

Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients.

Role of ECM in the pathogenesis of diabetic retinopathy and POAG

D retinopathy and glaucoma are major ocular diseases that cause significant vision loss and subsequent blindness. However, the precise mechanisms involved in the onset and the progression of these diseases are still not completely understood. While clinical reports have indicated a higher incidence of diabetic retinopathy and glaucoma in the diabetic population compared to the general population, it is unclear whether an association exists between these two disease processes. The extracellular matrix (ECM) is an important determinant of functional properties for retinal blood vessels and trabecular meshwork (TMW). Since retinal blood vessels and TMW are major targets of diabetes, studies have focused on understanding how hyperglycemia affects these tissues. While increased ECM deposition in the outflow pathway may cause resistance to aqueous outflow and contribute to the development of primary open angle glaucoma (POAG), increased ECM can compromise vascular function in the retina. This presentation will focus on understanding a common pathological link between the two ocular diseases, in particular, how overexpression of ECM may contribute to the development of diabetic retinopathy and POAG.

Combined phacovitrectomy with preoperative cyclosporin A in management of resistant panuveitis

PurposeThis paper evaluates the visual outcome and report complications and uveitis control of one-stage combined pars plana vitrectomy, phacoemulsification, and intraocular lens (IOL) implantation in eyes with resistant noninfective uveitis after preoperative control by oral cyclosporin A (CSA).MethodsThis paper uses an interventional case-series study of ten eyes in nine patients with panuveitis, controlled by oral CSA with the least dose of topical and systemic steroids. All eyes underwent standard pars plana vitrectomy, microcoaxial phacoemulsification, and IOL implantation. The data recorded were visual acuity (VA), intraoperative and postoperative complications, and recurrences of activity through a minimum follow-up of 6 months.ResultsThe mean logarithm of the minimum angle of resolution (logMAR) significantly improved from 1.597 at baseline (3/60 Snellen’s equivalent), to 0.819 at the 3-month follow-up meeting (6/45 Snellen’s equivalent), to 0.663 at the 6-month postoperative visit). VA improved in 70% of eyes, worsened in 20%, and stabilized in 10%. There was improvement (>6 lines) in 30% of eyes. The rate of posterior synechia formation and uncontrollable glaucoma decreased from 60% preoperative to 10% postoperative (P = 0.01). There was significant decline in the number of eyes requiring topical steroids from 100% preoperative to 50% postoperative (P = 0.01). The same is true for oral CSA, which decreased from 100% preoperatively to 10% postoperatively.ConclusionA single-stage combination of phacovitrectomy and IOL implantation is able to control noninfective panuveitis with less need for systemic treatment and topical steroids, and results in fewer incidence of glaucoma and posterior synechia. Furthermore, it restores useful postoperative vision.