Treated Glaucoma Patients Research Articles

Aspects of Tertiary Prevention in Patients with Primary Open Angle Glaucoma.

The purpose of the study is to assess the health of patients in the activity of tertiary prevention dedicated to preventing blindness caused by POAG (primary glaucoma with open angle and high tension) and NTG (primary glaucoma with open-angle and statistically normal tension—particular form of glaucoma with open angle) and preservation of the remaining visual function. The design of the study is epidemiological, observational, descriptive and retrospective, and uses only the data recorded in the existing records in the archives of the Ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea (IOCECHO) during the years 1999–2019 (anamnestic data; objective examination and paraclinical examination: intraocular pressure—IOP and visual field—VF). The methods of the study included the standardized protocol: anamnesis, physical ophthalmological examination, IOP determination, and computerized perimetry with the “Fast Threshold” strategy performed with the “Opto AP-300” perimeter. The obtained results were statistically processed with a specialized software (S.P.S.S.—I.B.M. Statistics version 22). The study examined the available data of 522 patients of which 140 were men (26.8%) and 382 were women (73.2%). The gender ratio was 0.37. In the period 1999–2019, 150,844 people with ophthalmic pathology were consulted in the Ophthalmology office of IOCECHO out of which 522 patients (0.35%) were diagnosed with primitive open-angle glaucoma, 184 people (35.2%) presented high IOP (POAG), and 338 people (64.8%) had statistically normal IOP (NTG). The annual proportion of cases diagnosed with glaucoma in the total number of patients examined was between 0.1% (2005; 2008; 2010) and 2.4% in 2012, when 101 people were detected. In the studied records, no cases of uni- and/or bilateral blindness were mentioned. The mean age of glaucoma patients at the first consultation was 60.81 ± 12.14 years with high frequencies in the 55–69 age groups and at the last consultation it was 66.10 ± 12.47 years with high frequencies in the age groups between 60–74 years. Monitoring and treatment of glaucoma patients was beneficial; IOP decreased statistically significantly: in patients with POAG by 46.16%, from 30.50 ± 7.98 mmHg to 16.42 ± 3.01 mmHg (p = 0.000) and in those with NTG by 17.44%, at 16.39 ± 3.66 mmHg at 13.53 ± 1.92 mmHG (p = 0.000). The duration of treatment and monitoring was on average 5.1 ± 3.4 years, for 184 patients (35.2%) with POAG and 5.1 ± 3.8 years for 338 patients (64.8%) with NTG. Tertiary prevention of glaucoma, by providing specialized care, ensures effective control of IOP and implicitly of the long-term evolution of the disease. IOP is the only modifiable risk factor in patients with POAG and NTG and its decrease prevents the progression of the disease and emphasizes the importance of early diagnosis and treatment. The management of the glaucoma patient consisted of: complete ophthalmological examination (subjective and objective), paraclinical examination with IOP, and VF measurement (valuable ophthalmological diagnostic tool) for disease detection and effective assessment of disease progression in order to improve the process of therapeutic decision making.

Discrepancy between NTG and POAG with corneal nerves in CCM.

To investigate the morphological features of corneal subbasal nerve plexus (CSNP) in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG). Thirty-four eyes with NTG (16 untreated), 23 eyes with POAG (11 untreated) and 31 eyes of healthy subjects were recruited. CSNP were assessed by corneal confocal microscopy (CCM) and peripapillary retinal nerve fibre layer (RNFL) was measured with optical coherence tomography (OCT). CCM parameters including corneal subbasal nerve fibre length (FL), corneal subbasal nerve branch number (BN), corneal subbasal nerve width (NW), corneal subbasal nerve reflectivity (NR), total and local corneal subbasal nerve tortuosity (NT) was compared across all groups, as well as between the topical medication treated and the nontreated patients. The newly diagnosed NTG patients had the longest FL (3619.15 ± 501.55), most BN (21.02 ± 5.90), thinnest corneal subbasal nerve width (3.04 ± 0.82), corneal subbasal nerve lowest reflectivity (140.43 ± 10.24) and the corneal subbasal nerves were most bending (1.09 ± 0.06) and tortuous (123.36 ± 7.82) compared with untreated POAG patients and controls. Untreated POAG had similar CSNP to controls. The treated glaucoma patients had longer FL and more BN than the nontreated but with no significant difference. FL and BN had correlations with RNFL thickness in untreated NTG patients, and NR and NW had correlations with RNFL thickness in untreated POAG patients. NT had no correlations with RNFL thickness. The NTG group had different CSNP characteristics from the POAG group and controls, while the latter two shared more morphological features. The CCM parameters except NT had associations with the RNFL thickness in glaucoma patients.

The course of primary open angle glaucoma in a patient with subcompensated non-insulin dependent diabetes type 2

Оphthalmic manifestations of diabetes mellitus include changes in the circulation of aqueous humor, increase or decrease in the level of intraocular tension, abnormal permeability of the blood-aqueous barrier, and anomalies of the retinal vessels. A balanced approach to the choice of treatment tactics is a basis for treatment of Primary Open Angle Glaucoma. The criterion for the effectiveness of glaucoma surgery is sustained normalization of intraocular tension and preservation of visual functions. Surgical treatment of glaucoma in patients with severe somatic pathology is accompanied by a high risk of postoperative complications: hyphema, ciliochoroidal detachment, hemophthalmos, repeated increase in intraocular tension, etc. Diabetes mellitus as a systemic disease causes widespread vascular autonomic and endothelial dysfunction. The reasons for the decrease in the hypotensive effect of glaucoma surgery in such patients is excessive cicatrization of the newly created fluid outflow tracts with the formation of adhesions between the conjunctiva and the sclera, the scleral flap and underlying tissues. It leads to a repeated increase in intraocular tension in the late postoperative period. Therefore, the choice of tactics for the management and treatment of patients with glaucoma and with severe comorbidity requires an individual and measured approach.

Diode laser transscleral cyclophotocoagulation causes intraocular collamer lens displacement in pseudophakic eye: a case report

BackgroundWith the rapid development of intraocular collamer lens (ICL) operation, it is foreseeable that we will encounter a large number of glaucoma patients with ICL implantation history. However, our current understanding of the treatment of glaucoma patients with ICL is limited. Hence we report a rare case of refractory glaucoma after intraocular collamer lens and intraocular lens implantation in a patient who underwent unsuccessful transscleral cyclophotocoagulation, which led to intraocular collamer lens displacement, angle closure and uncontrolled intraocular pressure.Case presentationA 39-year-old woman presented with intractably elevated intraocular pressure in the right eye. Since her intraocular collamer lens implantation surgery in 2017, her intraocular pressure had remained over 40 mmHg while using 3 types of anti-glaucoma medications. The patient had a history of phacoemulsification and posterior chamber phakic intraocular lens implantation for complicated cataracts secondary to uveitis in 2006. On gonioscope examination, there were signs of pigment dispersion, and the anterior chamber angle was open. Ultrasound biomicroscopy examination showed contact and rubbing between the intraocular collamer lens and posterior surface of the iris. And typical advanced glaucomatous optic neuropathy and visual field defects were observed. Transscleral cyclophotocoagulation was performed to control the intraocular pressure and prevent further visual field loss. However, the intraocular collamer lens was displaced after transscleral cyclophotocoagulation, which resulted in formation of a shallow anterior chamber 1 week later, angle closure and loss of intraocular pressure control 1 month later, even though the maximum dose of anti-glaucoma medication was used. Finally, an Ahmed glaucoma valve was successfully implanted in her anterior chamber, and the glaucoma was controlled, as observed at the 10-month follow-up.ConclusionsPigment dispersion is a common phenomenon after intraocular collamer lens implantation and may accelerate the progression of glaucoma. Transscleral cyclophotocoagulation should be carefully considered in glaucoma patients with elevated intraocular pressure after intraocular collamer lens implantation, given that transscleral cyclophotocoagulation may cause intraocular collamer lens displacement.

The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients.

In treated eyes with mild/suspect glaucoma, intraocular pressure (IOP) increments are associated with worsening mean deviation (MD) once IOP reaches the 20s. In moderate/advanced eyes, IOP increments are associated with worse visual field (VF) performance across the entire IOP range. The purpose of this study was to describe the relationship between mean treated IOP and VF worsening and understand how this relationship is affected by glaucoma severity and IOP range. A total of 1446 eyes of 869 treated glaucoma patients with at least 5 longitudinal reliable VF tests and IOP measures were included. Mixed-effects linear models were employed to understand the effect of eye-specific mean treated IOP on MD slope. Models included interaction terms to assess the differing relationships between MD slope and mean IOP by glaucoma severity (suspect/mild vs. moderate/advanced) and splines to account for the differing effects of mean IOP on MD slope at different IOP ranges (above or below 21 mm Hg). In suspect/mild glaucoma, when treated IOP values were <21 mm Hg, a 1 mm Hg increment in IOP was not associated with an increase in the rate of VF worsening (P>0.05) but when treated IOP values rose >21 mm Hg, a 1 mm Hg increment in IOP was associated with faster VF worsening (-0.09 dB/y per 1 mm Hg increment, P<0.05). In moderate/advanced disease, a 1 mm Hg increment in treated IOP was associated with faster VF worsening both below and above 21 mm Hg, but the effect was much more pronounced in the higher range (-0.02 dB/y per mm Hg increment <21 mm Hg vs. -0.74 dB/y per mm Hg increment >21 mm Hg, P<0.05 for both). IOP remained associated with VF worsening in eyes with more advanced glaucoma throughout the IOP range but was only associated with VF worsening in eyes with less severe glaucoma at higher IOP.

Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review.

Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.

Comparison of Corneal Wave Speed and Ocular Rigidity in Normal and Glaucomatous Eyes.

Ocular biomechanics were compared between treated glaucoma patients and healthy subjects matched for age, intraocular pressure (IOP), and axial length. There was no difference in corneal wave propagation speed, but ocular rigidity was lower in glaucomatous eyes. Ocular biomechanical properties are important in understanding glaucoma pathogenesis but the affected tissues are unclear. In this study, we compared corneal wave speed (a measure of corneal elasticity) and ocular rigidity coefficient between glaucomatous and normal eyes. Twenty glaucomatous eyes from 10 patients and 20 normal eyes from 13 controls, matched for age, IOP, and axial length were included. Ocular rigidity was calculated based on the difference in supine IOP by pneumatonometry with and without a 10-g weight. Corneal wave speed was determined by ultrasound surface wave elastography. A small, 0.1-second harmonic vibration at 100 Hz was generated through the closed eyelids. Wave propagation was captured by an ultrasound transducer, and wave speed was determined from the phase change with distance. Comparisons were performed using generalized estimating equation models. There were no significant differences in corneal wave speed between glaucomatous and normal eyes (2.16±0.25 vs. 2.07±0.16 m/s, P=0.17). However, ocular rigidity was significantly lower in glaucomatous eyes (0.0218±0.0033 vs. 0.0252±0.0050/μL, P=0.01). Corneal wave speed was not correlated with age and IOP in either group (P≥0.23) but was correlated with ocular rigidity (R=0.48, P=0.02) and inversely correlated with axial length (R=-0.53, P=0.01) in glaucomatous eyes. Glaucomatous eyes tend to have lower ocular rigidity than healthy eyes with similar age, IOP, and axial length. However, the lack of a difference in corneal wave speed suggests that corneal tissue may not be significantly affected, and scleral changes likely play a more important role in glaucoma.

Оптимизация хирургического лечения вторичной закрытоугольной глаукомы у пациентов с органическим блоком угла передней камеры

Purpose. Optimization of surgical treatment of secondary closed-angle glaucoma in patients with organic block of the anterior chamber angle. Material and methods. The analysis of the results of 6 AGO using autologous scleral drains treated with MMC is presented in children with an organic block of the anterior chamber angle without the phenomena of neovascularization is privided. Five children had uveal glaucoma; one child had an essential mesodermal iris dystrophy with secondary glaucoma. In all cases before the formation of autologous scleral drains, intraoperative applications of MMC were performed, followed by a plentiful washing of the operating field with normal saline solution. The duration of follow-up was from 1.5 to 7 years. Results. The operations proceeded without complications. There was a long choroidal edema on one eye in the early postoperative, stopped with the help of conservative treatment for 10 days. In the long term, on one eye in the period of exacerbation of uveitis, dislocation of autodrainages arose, which was facilitated by the appearance of exudative effusion in the anterior chamber. Later on this eye the failure of the AGO developed. On the other eyes, the intraocular pressure remained compensated, and the functions were stable. Conclusion. Treatment of drainages from the autosclera with MMC before implanting them into the anterior chamber of the eye, in patients with organic block of the anterior chamber angle, is effective against the hypotensive effect of the operation and is safe for intraocular structures while observing the processing technique. Key words: secondary closed-angle glaucoma, anterior chamber, autologous

Effect of Glaucoma on Corneal Endothelium

Background: Glaucoma is a group of diseases characterized by a specific pattern of optic nerve neuropathy and retinopathy which is permenant. There is increasing evidence of glaucoma-associated corneal endothelial changes. Decrease ECD has been reported in various types of glaucoma such as primary angle-closure glaucoma, primary open-angle glaucoma (POAG) and some types of secondary glaucoma. Objectives: The purpose of this study is to evaluate the status of corneal endothelium in different type of open angle glaucoma patients by using Specular microscope comparing with the normal ones. Patients and Methods: We included (120) subjects in this study of normal and open angle glaucoma patients. This present study was a case control study; conducted on 60 open angel glaucoma patients (22 male, 38 female) with age ranged from (28) to (60) and an average 53.56 ±7.6years, compared with 60 healthy control individuals matched in age and sex. Results: There is pоsitive relationship between ECD and glaucoma which is significant in open angle than normal pоpulation. This may be of value during оur daily clinic practice especially when dealing with refractive surgery and glaucоma suspects. Quantitative analysis of CEC morphology of glaucoma patient is necessary by specular microscopy. We should measure CCT and cоnsequently we can adjust IOP to judge the real IOP of the patient and take a good reasonable decision in the treatment of glaucoma patients. High IOP should be controlled as soon as possible to prevent optic neuropathy and corneal endothelial damage. Conclusion: Glaucoma and its management may have deleterious effects on the corneal endothelium. There is still much more to learn about how increased IOP, mechanical forces, and the aqueous environment contribute to corneal endothelial cell loss broadly observed in the milieu of glaucoma treatment. A history of glaucoma surgery poses a particularly significant risk to corneal endothelial cell health and cornea transplant graft survival.

The Effect of Glaucoma on the Quality of Patient’s Life

Abstract Glaucoma is a chronic, progressive opticopathy with morphological optic disc changes and visual field disturbances. Visual field disturbances change the patient’s life habits. Medical as well as surgical treatments also disturb patients` activities of daily living. According to this, glaucoma is the disease which affects quality of patient’s life (QQL). Visual field (VF) evaluation is very important in glaucoma disease diagnostic process. Location of the VF defects also have an impact on the QOL. Patient`s daily activities, such as walking, low light condition adaptation, peripheral seeing of the objects, can be affected by glaucoma progression and with VF defects. All social, religious, cultural and traveling events are more difficult for the severe glaucomatous patients (MD&lt;-12dB) in comparison with mild glaucomatous, defined as patients with MD &gt; −6 dB. Every day usage of the local antuglaucomatous therapy disturbs patients’ QOL. The side effects of the eye drops can produce burning sensation, bronchospasm, bradycardia, increased iris pigmentation, increased eyelash length. Also, locally applied therapy provokes ocular surface disease. Benzalkonium chloride provokes destruction of the epithelial cells junction with development of the epitheliopathy and ocular surface disease. Surgically treated glaucoma patients can have disturbed QOL due to ocular surface disease symptoms (foreign body sensation, eye pain, redness, and increased tearing). These symptoms are caused by trabeculectomy and they are correlated with filtering bleb existence.To achieve QOL of the glaucomatous patients, different founded instruments are used. They are classified in: general health, vision specific, and glaucoma specific.

Real-World Study on Patient Satisfaction and Tolerability After Switching to Preservative-Free Latanoprost.

PurposePatient satisfaction is important in the treatment of glaucoma. Suboptimal compliance and impaired long-term outcome are a likely result of poor tolerability. The present multicentre, international, transverse, epidemiological survey was conducted to assess the satisfaction of patients who had received preservative-free latanoprost (PFL) for at least 3 months.Patients and MethodsA total of 1872 patients from 6 European countries, treated with PFL for at least 3 months, were included in this survey. Prior to PFL treatment, patients were to be treatment naïve or currently treated for their glaucoma. During a single routine consultation, patients completed a questionnaire concerning global satisfaction and satisfaction based on tolerability.ResultsIn total, 76.2% had been previously treated; 69.4% had received preserved and 6.8% preservative-free (PF) topical treatment. After 3 months of PFL treatment, a large majority of patients (95.3%) were satisfied or very satisfied with their PFL treatment and were, overall, significantly (p<0.0001) more satisfied with PFL than with their previous treatment; 4.2% were either unsatisfied or very unsatisfied. Overall, 97.3% of originally treatment-naïve patients were satisfied (50.1%) or very satisfied (47.2%) with their PFL. Ocular surface disease was diagnosed in 9.2% of patients (n=173) and was mainly mild (76.9%). Patient satisfaction with PFL was very high. ConclusionPFL may be considered a valuable first-choice treatment in glaucoma patients.

Adherence to drop treatment in glaucoma patients and its relationship with progression

Adherence to drop treatment in glaucoma patients and its relationship with progression

Cannabinoids in Glaucoma Patients: The Never-Ending Story.

Glaucoma is one of the principal causes of irreversible blindness worldwide. Yet, intraocular pressure (IOP) is the main modifiable risk factor for disease progression. In the never-ending challenge to develop new and effective drugs, several molecules have been tested as anti-glaucoma agents thanks to their pressure-lowering capabilities. Among these molecules, the cannabinoids have been investigated as possible anti-glaucoma drugs since the early 1970s. Cannabinoids are a large class of chemical compounds that exploit their effects by interaction with cannabinoid receptors 1 and 2. These receptors are widely expressed in the human retina where they may influence important functions such as photo-transduction, amacrine cell network maintenance, and IOP regulation. Therefore, in past years several studies have been conducted in order to assess the IOP lowering effects of cannabinoids. PRISMA guidelines have been used to perform a literature search on Pubmed and Scopus aiming to investigate the mechanism of IOP lowering effects and the potential benefits of orally administered, inhaled, topical, and intravenous cannabinoids in the treatment of glaucoma patients.

Surgery for glaucoma in patients with facial port wine mark

To report the results of surgical treatment of glaucoma in patients with facial port wine mark at a single institution over a 10-year period. The study was conducted on 21 eyes (10 right eyes) of 17 children (8 males) with glaucoma associated with facial port wine mark presenting to the pediatric ophthalmology practice at a single institution between January 2008 and December 2017. All study eyes underwent combined angle and filtering surgery with antimetabolite (mitomycin C) and were followed for 2years. Eyes were randomized for the angle component of the procedure to conventional trabeculotomy-trabeculectomy (CTT) or viscotrabeculotomy-trabeculectomy (VTT). Success was defined as intraocular pressure (IOP) of 5-16mm Hg with no vision-threatening complications. Mean patient age was 17.4±7.5months. Mean IOP was 30.4±3.7mm Hg; mean corneal diameter, 12.4±0.5mm; mean axial length, 21.17±1.63mm; mean cup:disk ratio, 0.5±0.2; and mean number of IOP-lowering drugs at presentation, 2.6±0.5. At the end of the 2-year follow-up period, corresponding values were 12.9±0.9mm Hg, 12.6±0.4mm, 21.6±1.7mm, 0.6±0.2, and 0.1±0.3, respectively, in VTT patients and 14.3±0.7mm Hg, 12.9±0.5mm, 21.8±1.7mm, 0.6±0.2, and 0.1±0.4, respectively, in CTT groups. The most notable complication was a minimal self-limiting hyphema, more prevalent in the CTT group. In our study cohort, there were few postoperative complications associated with combined angle and filtering surgery with antimetabolites, which effectively treated elevated IOP, especially when medical treatment showed a modest response. The addition of viscoelastic to the procedure may provide additional benefits and slightly limit intra- and postoperative complications.

Neuroprotective role of phosphoserine in primary open-angle glaucoma patients.

To evaluate the neuroprotective role of phosphoserine (P-Ser) in primary open-angle glaucoma (POAG) patients and to compare its therapeutic effectiveness to placebo treatment. Fifty-one patients (24 males and 27 females) between 35 and 61 years (average 46 years ± 3.8 SD) affected by POAG were enrolled in this study. Patients were divided in two groups: group A included 28 subjects that received an oral P-Ser treatment for 12 months; and group B included 23 subjects that received an oral placebo treatment for 12 months. Complete ophthalmological examination, standard automated perimetric examination, analysis of ON fibers via scanning laser polarimetry and glaucoma staging was performed in all patients at enrolment and 1, 3, 6, and 12 months after. Statistical analysis was performed using STATA 14.0 (Collage Station, TX, USA). Mean deviation (MD) and pattern standard deviation (PSD) analysis by means of 30-2 full threshold of the visual fields (VFs), retinal nerve fiber layer (RNFL) thickness by means of GDx, and IOP were considered to evaluate P-Ser therapy effectiveness in both groups. A statistically significant improvement (p<0.05) in VF, RNFL thickness and IOP compared to pre-treatment was found in patients in group A. Our study shows a significant improvement in several variables in patients with glaucoma treated with P-Ser compared to placebo and suggests a potential neuroprotective effect of P-Ser in treating glaucoma patients in association with the traditional hypotonic topical therapy.

Soft Contact Lens with Embedded Microtubes for Sustained and Self-Adaptive Drug Delivery for Glaucoma Treatment.

Because of the physiological and anatomical constraints of the eye, ophthalmic drug delivery is challenging. When applied topically, less than 1% of administered ophthalmic drugs reach the aqueous humor. The delivery of a drug within an efficient therapeutic concentration, to the required site of action, for an extended period of time, is complicated. Herein, a novel type of contact lens device, with embedded microtubes as drug containers, is reported. This device can provide a simple, noninvasive, extended drug release up to 45 days with higher bioavailability and lower risk for adverse effects. Another unique feature of the device is the release of drug triggered by stretching of the contact lens, indicating the possibility for achieving a self-adaptive drug release device for treating glaucoma patients.

Use of a novel telemetric sensor to study interactions of intraocular pressure and ganglion-cell function in glaucoma

Aims(1) To test the feasibility of simultaneous steady-state pattern electroretinogram (ssPERG) and intraocular pressure (IOP) measurements with an implanted IOP sensor. (2) To explore the scope of this approach for...

Эффективность и безопасность надпороговой селективной лазерной трабекулопластики как первого этапа лечения начальной стадии первичной открытоугольной глаукомы у пациентов с катарактой на фоне псевдоэксфолиативного синдрома

Suprathreshold selective laser trabeculoplasty (SLT) is a modification of the classical subthreshold SLT. Purpose . To study the clinical efficacy and safety of suprathreshold SLT as the first stage of combined surgical treatment of the early primary open-angle glaucoma in patients with cataract against the background of pseudoexfoliation syndrome. Material and methods . The study of 48 suprathreshold SLT cases (48 eyes) was performed in patients with early primary open-angle glaucoma (POAG) with cataract against the background of pseudoexfoliation syndrome. Results . The drug therapy led to IOP decrease from 22.1±3.2 to 16.3±2.6 mm Hg (-26.3%). An additional IOP decrease to 14.3±1.8 mm Hg was determined 1 month after suprathreshold SLT (-34.8%). A significant improvement in the coefficient of intraocular fluid easiness outflow was noted from 0.12±0.03 to 0.16±0.03 mm3 /mm Hg·min. The decrease in IOP was accompanied by a significant improvement in MD and PSD indicators according to static perimetry and a decrease in the area of the optic disc excavation. Colorimetric analysis showed a decrease in pigmentation of the trabecular meshwork. The density of corneal endothelial cells has not changed: PEC – 2204±392 cells/mm2 . There wasn’t any clinical case of reactive hypertension, pain by palpation in the ciliary body projection, precipitates or Tyndall phenomenon during the study. Conclusion . According to the study, suprathreshold SLT is an effective and safe method of the early primary open-angle glaucoma treatment in patients with cataract against the background of pseudoexfoliation syndrome.

Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients

AimTo assess the visual acuity at the end of life in glaucoma suspect patients, ocular hypertension, and patients treated for glaucoma and to find factors contributing to a reduced visual acuity in this cohort of deceased patients.MethodsIn a cohort of 3883 medically treated glaucoma patients, glaucoma suspect, or patients with ocular hypertension assembled in 2001–2004, 1639 were deceased. Patient data were collected from electronic and paper patient files. The files of 1378 patients were studied and the last measured visual acuity and ocular comorbidities influencing the visual acuity were extracted.ResultsOur results show that only 37.2% of patients had no visual impairment in either eye, 30.5% was visually impaired or blind in both eyes and 4.1% was blind in both eyes, all based on VA. The most common contributing factors for severe visual impairment or blindness (prevalence ≥ 1%) were: glaucoma, retinal vein occlusion, dry and exudative age-related macular degeneration, past retinal detachment, amblyopia, diabetic retinopathy, anterior ischemic optic neuropathy, trauma, decompensated cornea, past keratitis, enucleation, corneal transplantation, and macular hole.ConclusionsDespite the current advanced treatment modalities for glaucoma, 30.5% of patients had a VA < 0.5 in both eyes and 4.1% was blind in both eyes. However, this disability cannot be confidently attributed only to glaucoma. Besides glaucoma, most common contributing factors were among others retinal and macular diseases. Patient management in glaucoma should be based on more than lowering the intraocular pressure to prevent blindness at the end of life.

&lt;p&gt;The Pro-Fibrotic Behavior of Human Tenon’s Capsule Fibroblasts in Medically Treated Glaucoma Patients&lt;/p&gt;

PurposeThe aim of this study was to compare human Tenon’s capsule fibroblasts (HTCFs) obtained from patients who received medical therapy for glaucoma (glaucomatous patients) and patients not treated for glaucoma (non-glaucomatous patients) in terms of wound healing and fibrosis.Patients and MethodsBioartificial tissues (BATs) were generated using primary HTCF-populated collagen lattices. Pro-fibrotic gene expression within HTCFs was compared between glaucomatous patients and non-glaucomatous patients after BAT culture. The BATs were also assessed regarding fibroblast–myofibroblast transition, collagen remodeling and collagen contraction using alpha-smooth muscle actin immunohistochemistry, picrosirius red staining and collagen contraction assays, respectively.ResultsPro-fibrotic gene expression in BAT-cultured HTCFs derived from glaucomatous patients was significantly increased compared to non-glaucomatous patients. BATs imbued with HTCFs collected from glaucomatous patients exhibited a greater proportion of myofibroblasts as well as increased collagen contraction/remodeling compared to HTCFs isolated from non-glaucomatous patients.ConclusionHTCFs from glaucomatous and non-glaucomatous patients differ in the expression of genes involved in fibrosis, proportion of fibroblasts undergoing transdifferentiation into myofibroblasts, contractile properties and collagen remodeling. These results suggest that for any number of reasons, at a cellular level, patients who received medical therapy for glaucoma have eyes primed for fibrosis.