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Sample records for primary angle closure

  1. Why does acute primary angle closure happen? Potential risk factors for acute primary angle closure.

    PubMed

    Zhang, Xiulan; Liu, Yaoming; Wang, Wei; Chen, Shida; Li, Fei; Huang, Wenbin; Aung, Tin; Wang, Ningli

    Acute primary angle closure is an ocular emergency and requires immediate management to avoid blindness. Narrow anterior chamber angle, advanced age, female gender, and Asian ethnic background are considered risk factors for acute primary angle closure. The predictive power of these factors is, however, relatively poor, and many questions remain unanswered because acute primary angle closure eventually develops in only a relatively small proportion of anatomically predisposed eyes. We summarize the potential roles of various factors in the pathogenesis of acute primary angle closure. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Management of Primary Angle-Closure Glaucoma.

    PubMed

    Lai, Jimmy; Choy, Bonnie N K; Shum, Jennifer W H

    2016-01-01

    Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed.

  3. Residual angle closure one year after laser peripheral iridotomy in primary angle closure suspects.

    PubMed

    Baskaran, Mani; Yang, Elizabeth; Trikha, Sameer; Kumar, Rajesh S; Wong, Hon Tym; He, Mingguang; Chew, Paul Tk; Foster, Paul J; Friedman, David; Aung, Tin

    2017-09-05

    To determine the incidence and baseline clinical and anterior segment optical coherence tomography (AS-OCT) predictors associated with residual angle closure as assessed by gonioscopy 1 year after laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS). Sub-analysis of randomized controlled trial data METHODS: AS-OCT images (Visante, Carl Zeiss Meditec, Dublin, CA) from 181 PACS subjects ≥ 50 years of age, were analyzed using customized software, prior to, and 1 year after LPI. Other parameters assessed were intraocular pressure (IOP) and axial length (Axl). Residual angle closure was defined as the inability to see the posterior trabecular meshwork for at least 2 quadrants on gonioscopy after LPI. Multivariate regression analysis determined the baseline predictors of residual angle closure 1 year after LPI. The mean age of participants was 62.4 (SD 9.9) years. The majority were female (137, 75.7%) and Chinese 174, 96.1%). At 1 year post LPI, 148 (81.8%) subjects had gonioscopic residual angle closure. Univariate analysis showed that baseline Axl, anterior chamber area, anterior chamber volume, angle opening distance at 750 microns from the scleral spur and angle recess area were smaller while baseline lens vault and iris curvature were larger in residual angle closure subjects (all p<0.05). Multivariate analysis revealed that baseline iris volume (B=-0.08, P=0.035) and baseline IOP (B=0.23, p=0.032) were predictors for residual angle closure. One year after LPI, >80% of PACS had gonioscopic residual angle closure. Greater baseline iris volume and higher IOP at baseline are independent risk factors for residual gonioscopic angle closure. Copyright © 2017. Published by Elsevier Inc.

  4. The visual evoked potential in acute primary angle closure glaucoma.

    PubMed Central

    Mitchell, K. W.; Wood, C. M.; Howe, J. W.; Church, W. H.; Smith, G. T.; Spencer, S. R.

    1989-01-01

    Visual evoked potentials (VEPs) were elicited from 29 patients who had experienced a previous attack of acute primary angle closure glaucoma. The VEPs were shown to be abnormal in at least one of the measures (latency, amplitude, contrast threshold, or slope) in 72.4% of affected eyes, whereas only 41.4% indicated obvious optic nerve damage. It is notable that 48.1% of fellow eyes with no (known) history of acute pressure rise also showed some form of VEP abnormality. The possible pathophysiological mechanisms operating in both affected and fellow eyes are discussed. It is concluded that, despite the presence of possible artefactual influences, the results probably reflect the presence of primary angle closure glaucoma. PMID:2751978

  5. [Comments on classification of primary angle-closure glaucoma].

    PubMed

    Zhang, Xiulan; Zhou, Minwen

    2014-05-01

    The new criteria to classify and diagnose primary angle-closure glaucoma (PACG) proposed by International Society Geographical & Epidemiological Ophthalmology (ISGEO) brought about not only new concept but also huge impact on Chinese traditional classification established in 1987. The controversy between these two systems has baffled Chinese ophthalmologists in years of clinical practice. The new criteria obviously has some concepts not suitable and not practical for Chinese PACG patients. However, domestic studies based on traditional classification are not internationally valued or accepted. Chinese own evidence-based clinical trials are urgently needed to elucidate the pros and cons of two classification systems.

  6. Phenotypic features of Chinese family members with primary angle closure.

    PubMed

    Tu, Yun Shu; Damji, Karim F; Chen, Zai Hong; Arora, Sourabh; Yin, Zheng Qin

    2013-06-01

    To describe ocular phenotypic features in Chinese families with primary angle closure (PAC). Prospective cohort study. 428 individuals of 103 eligible families. Probands identified in clinic and their relatives were examined. Measurements included intraocular pressure, anterior chamber depth, lens thickness, axial length, and gonioscopic features related to the anterior chamber angle. Electroretinogram (ERG) testing for dark and light adaptation on both eyes of each individual examined was also obtained. There were 144 PAC affected patients (33.7%), 60 suspects (14%), and 224 unaffected individuals (52.3%). There were more than 2 affected members in 51 families (49.5%). Compared with unaffected individuals, affected individuals were more likely to be female, have shallower peripheral and central anterior chamber depths, narrower angles, thicker lenses, and shorter axial lengths (p<0.001). Affected patients and suspects had similar axial lengths (p>0.05). Compared with unaffected individuals, affected and suspect individuals showed ERG adaptation abnormalities (p<0.05). Of 45 unaffected individuals with mean axial length ≤ 22.00 mm (10.51%), 20 individuals (4.67%) showed ERG adaptation abnormalities similar to affected patients and suspects (p> 0.05). Patients with PAC were significantly more likely to be female, have shorter axial length, and have thicker lenses compared with unaffected individuals. PAC suspects showed similar axial lengths to affected individuals. ERG abnormalities mainly occurred in affected patients and suspects, but also occurred in unaffected individuals with short axial length. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  7. Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

    PubMed Central

    Li, Shi-Wei; Chen, Yan; Wu, Qiang; Lu, Bin; Wang, Wen-Qing; Fang, Jian

    2015-01-01

    AIM To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure (APAC) using ultrasound biomicroscopy (UBM). METHODS Patients (n=23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy (n=24, 31 eyes). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively. RESULTS The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group (P<0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up (P<0.05), whereas there was no significant difference between the two groups at the latter follow-up (P>0.05). Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery (P<0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group. CONCLUSION Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However, phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery. PMID:26309873

  8. Monsoon and primary acute angle closure in malaysia.

    PubMed

    Ch'ng, T W; Mosavi, S A A; Noor Azimah, A A; Azlan, N Z; Azhany, Y; Liza-Sharmini, A T

    2013-10-01

    Acute angle closure (AAC) without prompt treatment may lead to optic neuropathy. Environmental factor such as climate change may precipitate pupillary block, the possible mechanism of AAC. To determine the association of northeast monsoon and incidence of AAC in Malaysia. A retrospective study was conducted on AAC patients admitted to two main tertiary hospitals in Kelantan, Malaysia between January 2001 and December 2011. The cumulative number of rainy day, amount of rain, mean cloud cover and 24 hours mean humidity at the estimated day of attack were obtained from the Department of Meteorology, Malaysia. A total 73 cases of AAC were admitted with mean duration of 4.1SD 2.0 days. More than half have previous history of possibility of AAC. There was higher incidence of AAC during the northeast monsoon (October to March). There was also significant correlation of number of rainy day (r=0.718, p<0.001), amount of rain (r=0.587, p<0.001), cloud cover (r=0.637, p<0.001), mean daily global radiation (r=- 0.596, P<0.001), 24 hours mean temperature (r=-0.298, p=0.015) and 24 hours mean humidity (r=0.508, p<0.001) with cumulative number of admission for AAC for 12 calendar months. Higher incidence of AAC during northeast monsoon suggested the effect of climate as the potential risk factor. Prompt treatment to arrest pupillary block and reduction of the intraocular pressure is important to prevent potential glaucomatous damage. Public awareness of AAC and accessibility to treatment should be part of preparation to face the effect of northeast monsoon.

  9. Primary angle closure glaucoma: What we know and what we don't know.

    PubMed

    Sun, Xinghuai; Dai, Yi; Chen, Yuhong; Yu, Dao-Yi; Cringle, Stephen J; Chen, Junyi; Kong, Xiangmei; Wang, Xiaolei; Jiang, Chunhui

    2017-03-01

    Primary angle-closure glaucoma (PACG) is a common cause of blindness. Angle closure is a fundamental pathologic process in PAGC. With the development of imaging devices for the anterior segment of the eye, a better understanding of the pathogenesis of angle closure has been reached. Aside from pupillary block and plateau iris, multiple-mechanisms are more common contributors for closure of the angle such as choroidal thickness and uveal expansion, which may be responsible for the presenting features of PACG. Recent Genome Wide Association Studies identified several new PACG loci and genes, which may shed light on the molecular mechanisms of PACG. The current classification systems of PACG remain controversial. Focusing the anterior chamber angle is a principal management strategy for PACG. Treatments to open the angle or halt the angle closure process such as laser peripheral iridotomy and/or iridoplasty, as well as cataract extraction, are proving their effectiveness. PACG may be preventable in the early stages if future research can identify which kind of angles and/or persons are more likely to benefit from prophylactic treatment. New treatment strategies like adjusting the psychological status and balancing the sympathetic-parasympathetic nerve activity, and innovative medicines are needed to improve the prognosis of PACG. In this review, we intend to describe current understanding and unknown aspects of PACG, and to share the clinical experience and viewpoints of the authors.

  10. Central Corneal Thickness in Primary Angle Closure and Open Angle Glaucoma

    PubMed Central

    Moghimi, Sasan; Torabi, Hamidreza; Hashemian, Hesam; Amini, Heydar; Lin, Shan

    2014-01-01

    Purpose: To quantitatively analyze central corneal thickness (CCT) in patients with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG), and to evaluate its correlation with severity of glaucoma. Methods: In this retrospective study, records of patients with previously diagnosed POAG or PACG at a tertiary glaucoma service were reviewed. CCT was measured by ultrasound pachymetry. Mean deviation (MD) on visual field (VF) testing was recorded for glaucoma severity determination. CCT and age- and sex-adjusted CCT were compared among the study groups using Student's t-test and analysis of covariance (ANCOVA), respectively. Univariate and multivariate regression models were used for correlation of age, MD and CCT. Results: A total of 115 patients with PACG, 215 with POAG, and 100 normal controls were included with mean age of 64.1 ± 10.4, 59.9 ± 10.5, and 62.04 ± 10.80 years, respectively. CCT was thicker in PACG eyes (545.5 ± 46.1 μm) as compared to POAG eyes (531.7 ± 37.3 μm) and controls (531.0 ± 38.3 μm) even after age and gender adjustment (ANCOVA, P = 0.05). CCT was found to decrease with increasing age only in the POAG group (β = -0.57, P = 0.01). Disease severity (MD of VF) was significantly and inversely correlated with CCT in both POAG and PACG eyes (β = 1.89, P = 0.02; and β = 1.38, P = 0.04, respectively) after age and sex correction. Conclusion: PACG eyes had thicker CCT as compared to POAG and normal healthy eyes in Iranian subjects. Severity of the disease was inversely correlated with CCT in eyes with both POAG and PACG. PMID:25709768

  11. Peripheral anterior synechia reduce extent of angle widening after laser peripheral iridotomy in eyes with primary angle closure.

    PubMed

    Lin, Zhong; Liang, Yuanbo; Wang, Ningli; Li, Sizhen; Mou, Dapeng; Fan, Sujie; Sun, Sucijanti; Tang, Xin; Thomas, Ravi

    2013-01-01

    To quantify the effect of laser peripheral iridotomy (LPI) on angle widening in primary angle closure with and without peripheral anterior synechia (PAS). Prospective hospital-based study of 44 consecutive patients (69 eyes) with primary angle closure. Comprehensive ophthalmic examination and ultrasound biomicroscopy were performed at enrollment and 2 weeks following LPI. The following angle parameters: angle opening distance, trabecular-iris angle, and angle recess area were obtained. On the basis of the presence of PAS, angle quadrants were divided into 3 groups: group A comprised quadrants in PAS-negative eyes; group B, the unaffected quadrants in PAS-positive eyes; and group C, the quadrants with PAS in PAS-positive eyes. Correlation between PAS and angle width was determined and changes in angle parameters following LPI were compared between groups. Sixty-six eyes of 42 patients (31 eyes with PAS) were available for analysis. Groups A, B, and C provided 140, 66, and 58 quadrants, respectively, for analysis. There was a moderate negative correlation between angle width changes (angle opening distance, trabecular-iris angle, angle recess area) after LPI and PAS extent at baseline (r=-0.46 to -0.39; P<0.01). The change in angle width was significantly different between groups A and B compared to group C (P<0.01); there was no difference between groups A and B. Changes in anterior chamber angle following LPI were inversely correlated with presence of PAS. Quadrants unaffected by PAS can be expected to widen as much as in eyes with only appositional closure. In quadrants with PAS the ultrasound biomicroscopy parameters did not change following LPI.

  12. Clinical outcomes of peripheral iridotomy in patients with the spectrum of chronic primary angle closure.

    PubMed

    Cumba, Ricardo J; Nagi, Kundandeep S; Bell, Nicholas P; Blieden, Lauren S; Chuang, Alice Z; Mankiewicz, Kimberly A; Feldman, Robert M

    2013-01-01

    Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was 57.1 ± 29.0 months (range 13.8-150.6 months). Sixty-eight eyes (86.1%) underwent additional medical, laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10× logMAR visual acuity score for all patients significantly declined from 0.94 ± 1.12 at baseline to 1.83 ± 3.49 (N = 79, P = 0.0261) at the last followup. Conclusions. Most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted.

  13. Evaluation of Ocular Surface Disease in Asian Patients with Primary Angle Closure

    PubMed Central

    Ling, Tan Ee; Othman, Khairuddin; Yan, Ong Poh; Rashid, Rasdi Abdul; Tet, Cheong Min; Yaakob, Azhany; Tajudin, Liza-Sharmini Ahmad

    2017-01-01

    Objective: To evaluate the incidence of ocular surface disease (OSD) and to determine the effects of topical pressure-lowering drugs on ocular surface disease in primary angle closure patients. Methods: This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer’s test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses. Results: Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer’s test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer’s test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer’s test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference. Conclusion: Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients. PMID:28400889

  14. Evaluation of Ocular Surface Disease in Asian Patients with Primary Angle Closure.

    PubMed

    Ling, Tan Ee; Othman, Khairuddin; Yan, Ong Poh; Rashid, Rasdi Abdul; Tet, Cheong Min; Yaakob, Azhany; Tajudin, Liza-Sharmini Ahmad

    2017-01-01

    To evaluate the incidence of ocular surface disease (OSD) and to determine the effects of topical pressure-lowering drugs on ocular surface disease in primary angle closure patients. This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer's test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses. Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer's test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer's test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer's test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference. Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients.

  15. Primary Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure

    PubMed Central

    Su, Wei-Wen; Chen, Phil Yeong-Fung; Hsiao, Ching-Hsi; Chen, Henry Shen-Lih

    2011-01-01

    Background To investigate the effect of primary phacoemulsification on intraocular pressure (IOP) in patients with acute primary angle-closure (PAC) and coexisting cataract. Methodology Sixteen eyes of 14 patients with acute PAC received phacoemulsification and intraocular lens implantation as initial management for medically uncontrolled IOP in a retrospective chart review. The effects on IOP, vision, anterior chamber depth (ACD), and number of antiglaucoma medications were evaluated. Principal Findings The postoperative IOP was reduced in 16 eyes (100%). The mean ± standard deviation preoperative IOP was 48.81±16.83 mm Hg, which decreased postoperatively to 16.46±10.67 mm Hg at 1 day, 9.43±3.03 mm Hg at 1 week, 9.49±2.14 mm Hg at 2 weeks, 10.78±3.56 mm Hg at 1 month, and 10.70±2.80 mm Hg at 3 months (p<0.001). The mean number of antiglaucoma medications decreased from 3.56±1.14 to 0.13±0.34 (p<0.001). The average preoperative ACD was 2.08±0.35 mm, which increased to 3.59±0.33 mm after surgery (p<0.001). Visual acuity (converted into logarithm of the minimum angle of resolution [logMAR]) improved from 1.14±0.71 to 0.73±0.53 (p = 0.001). Conclusions Primary phacoemulsification plus intraocular lens implantation lowered IOP, reduced the use of antiglaucoma medications, and improved vision in patients with acute PAC. This is a safe and effective method of IOP control and can be considered a first treatment option in managing patients with acute PAC and coexisting cataract. PMID:21629644

  16. Conventional and emerging treatments in the management of acute primary angle closure

    PubMed Central

    Boey, Pui Yi; Singhal, Shweta; Perera, Shamira A; Aung, Tin

    2012-01-01

    The management of acute primary angle closure is directed at lowering the intraocular pressure and relieving pupil block. Conventional treatment involves the use of medical treatment and laser peripheral iridotomy, respectively, as a means for achieving these aims. Newer therapeutic strategies have been described that are potentially useful adjuncts or alternatives to conventional treatment. Emerging strategies that lower intraocular pressure include anterior chamber paracentesis, as well as laser procedures such as iridoplasty and pupilloplasty. A possible alternative to relieving pupil block is lens extraction, and may be combined with adjunctive measures such as goniosynechiolysis and viscogoniosynechiolysis. Trabeculectomy has a limited role in the acute setting. This review paper reviews the current evidence regarding conventional and newer treatment modalities for acute primary angle closure. PMID:22536030

  17. Management of Secondary Angle Closure Glaucoma.

    PubMed

    Parivadhini, Annadurai; Lingam, Vijaya

    2014-01-01

    Secondary angle closure glaucomas are a distinct entity from primary angle closure glaucoma (PACG). Unlike PACG, secondary angle closure glaucoma's have an identifable contributory factor/s for angle closure and obstruction of aqueous fow which is usually unrelieved by iridotomy. The treatment of each type of secondary angle closure glaucoma is varied, so identification of the primary cause aids in its effective management. How to cite this article: Annadurai P, Vijaya L. Management of Secondary Angle Closure Glaucoma. J Current Glau Prac 2014;8(1):25-32.

  18. Structure-function correlations using scanning laser polarimetry in primary angle-closure glaucoma and primary open-angle glaucoma.

    PubMed

    Lee, Pei-Jung; Liu, Catherine Jui-Ling; Wojciechowski, Robert; Bailey-Wilson, Joan E; Cheng, Ching-Yu

    2010-05-01

    To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry and visual field (VF) sensitivity in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Prospective, comparative, observational cases series. Fifty patients with POAG and 56 patients with PACG were examined using scanning laser polarimetry with variable corneal compensation (GDx VCC; Laser Diagnostic Technologies, Inc.) and Humphrey VF analyzer (Carl Zeiss Meditec, Inc.) between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity in both decibel and 1/Lambert scales, were estimated by the Spearman rank correlation coefficient (r(s)) and multivariate median regression models (pseudo R(2)). The correlations were determined globally and for 6 RNFL sectors and their corresponding VF regions. The correlation between RNFL thickness and mean sensitivity (in decibels) was weaker in the PACG group (r(s) = 0.38; P = .004; pseudo R(2) = 0.17) than in the POAG group (r(s) = 0.51; P < .001; pseudo R(2) = .31), but the difference in the magnitude of correlation was not significant (P = .42). With Bonferroni correction, the structure-function correlation was significant in the superotemporal (r(s) = 0.62), superonasal (r(s) = 0.56), inferonasal (r(s) = 0.53), and inferotemporal (r(s) = 0.50) sectors in the POAG group (all P < .001), whereas it was significant only in the superotemporal (r(s) = 0.53) and inferotemporal (r(s) = 0.48) sectors in the PACG group (both P < .001). The results were similar when mean sensitivity was expressed as 1/Lambert scale. Both POAG and PACG eyes had moderate structure-function correlations using scanning laser polarimetry. Compared with eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Structure-Function Correlations using Scanning Laser Polarimetry in Primary Angle-Closure Glaucoma and Primary Open Angle Glaucoma

    PubMed Central

    Lee, Pei-Jung; Liu, Catherine Jui-Ling.; Wojciechowski, Robert; Bailey-Wilson, Joan E.; Cheng, Ching-Yu

    2010-01-01

    Purpose To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry (SLP) and visual field (VF) sensitivity in primary open angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Design Prospective, comparative, observational cases series Methods Fifty patients with POAG and 56 with PACG were examined using SLP with variable corneal compensation (GDx VCC) and Humphrey VF analyzer between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity (MS) in both decibel (dB) and 1/Lambert (L) scales, were estimated by Spearman's rank correlation coefficient (rs) and multivariate median regression models (pseudo R2). The correlations were determined globally and for six RNFL sectors and their corresponding VF regions. Results The correlation between RNFL thickness and MS (in dB) was weaker in the PACG group (rs = 0.38, P = 0.004, pseudo R2 = 0.17) than in the POAG group (rs = 0.51, P <0.001, pseudo R2 = 0.31), but the difference in the magnitude of correlation was not significant (P = 0.42).With Bonferroni correction, the structure-function correlation was significant in the superotemporal (rs = 0.62), superonasal (rs = 0.56), inferonasal (rs = 0.53), and inferotemporal (rs = 0.50) sectors in the POAG group (all P <0.001), while it was significant only in the superotemporal (rs = 0.53) and inferotemporal (rs = 0.48) sectors in the PACG group (both P <0.001). The results were similar when MS was expressed as 1/L scale. Conclusions Both POAG and PACG eyes had moderate structure-function correlations using SLP. Compared to eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG. PMID:20202618

  20. Intraocular pressure fluctuation after water drinking test in primary angle-closure glaucoma and primary open-angle glaucoma.

    PubMed

    Poon, Yi-Chieh; Teng, Mei-Ching; Lin, Pei-Wen; Tsai, Jen-Chia; Lai, Ing-Chou

    2016-12-01

    Only a few studies have assessed intraocular pressure (IOP) changes during the water drinking test (WDT) in patients with primary angle-closure glaucoma (PACG). The aim of this study is to investigate IOP changes during WDT in patients with PACG versus primary open-angle glaucoma (POAG). This was a prospective and single tertiary center study. PACG and POAG patients (n = 15 each) without prior glaucoma surgery were enrolled and subjected to WDT, wherein they consumed an amount of water proportional to their body weight within 10 min. IOP was measured at baseline and every 15 min for 1 h after water intake. Intergroup comparisons were performed using Mann-Whitney U-test for continuous variables and Chi-square test for categorical variables. Wilcoxon signed-ranks test was used for comparisons of IOP before and after water intake in the two groups. Regression analysis was used to determine factors associated with IOP fluctuations during WDT. IOP changes over 1 h after water intake showed no significant differences between groups. The mean maximum fluctuation from baseline was 3.61 ± 2.49 and 3.79 ± 1.91 mmHg, respectively, in the PACG and POAG groups. The mean peak IOP was 19.17 ± 4.32 and 19.87 ± 3.44 mmHg in the PACG and PAOG groups, respectively. The axial length and anterior chamber depth showed no correlations with IOP fluctuations. We found similar IOP fluctuation curves and peak IOP values in both PACG and POAG patients subjected to WDT. These findings suggest that WDT is a useful test to induce IOP peaks in both POAG and PACG patients.

  1. Intraocular pressure fluctuation after water drinking test in primary angle-closure glaucoma and primary open-angle glaucoma

    PubMed Central

    Poon, Yi-Chieh; Teng, Mei-Ching; Lin, Pei-Wen; Tsai, Jen-Chia; Lai, Ing-Chou

    2016-01-01

    Context: Only a few studies have assessed intraocular pressure (IOP) changes during the water drinking test (WDT) in patients with primary angle-closure glaucoma (PACG). Aims: The aim of this study is to investigate IOP changes during WDT in patients with PACG versus primary open-angle glaucoma (POAG). Settings and Design: This was a prospective and single tertiary center study. Materials and Methods: PACG and POAG patients (n = 15 each) without prior glaucoma surgery were enrolled and subjected to WDT, wherein they consumed an amount of water proportional to their body weight within 10 min. IOP was measured at baseline and every 15 min for 1 h after water intake. Statistical Analysis Used: Intergroup comparisons were performed using Mann–Whitney U-test for continuous variables and Chi-square test for categorical variables. Wilcoxon signed-ranks test was used for comparisons of IOP before and after water intake in the two groups. Regression analysis was used to determine factors associated with IOP fluctuations during WDT. Results: IOP changes over 1 h after water intake showed no significant differences between groups. The mean maximum fluctuation from baseline was 3.61 ± 2.49 and 3.79 ± 1.91 mmHg, respectively, in the PACG and POAG groups. The mean peak IOP was 19.17 ± 4.32 and 19.87 ± 3.44 mmHg in the PACG and PAOG groups, respectively. The axial length and anterior chamber depth showed no correlations with IOP fluctuations. Conclusions: We found similar IOP fluctuation curves and peak IOP values in both PACG and POAG patients subjected to WDT. These findings suggest that WDT is a useful test to induce IOP peaks in both POAG and PACG patients. PMID:28112134

  2. Angle closure in younger patients.

    PubMed Central

    Chang, Brian M; Liebmann, Jeffrey M; Ritch, Robert

    2002-01-01

    PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention. PMID:12545694

  3. The incidence of primary angle-closure glaucoma in Olmsted County, Minnesota.

    PubMed

    Erie, J C; Hodge, D O; Gray, D T

    1997-02-01

    To determine the incidence of primary angle-closure glaucoma (PACG) and to assess the visual outcomes of patients treated for PACG. Population-based retrospective incidence study. Residents of Olmsted County, Minnesota, aged 40 years and older and diagnosed with PACG in the 13-year period between January 1, 1980, and December 31, 1992. Incident cases of PACG identified through the Medical Diagnostic Index of Mayo Clinic, Rochester, Minn, and the Rochester Epidemiology Project. Thirty-six incident cases were identified. The mean annual age-and sex-adjusted incidence per 100000 people aged 40 years and older was 8.3 (95% confidence interval, 5.6-11.0). The probability of monocular blindness associated with PACG at the time of diagnosis was 14%. Among patients not monocularly blind at diagnosis, the 5-year probability of developing monocular blindness associated with PACG was 4%. Primary angle-closure glaucoma is an uncommon disease in our community. Most of the patients blinded by PACG were blind at the time the condition was diagnosed.

  4. Peripheral yttrium aluminium garnet (YAG) iridotomy versus phacoemulsification in primary angle closure: prospective comparative study.

    PubMed

    Jarrín, E; Cabarga-Nozal, C; Almendral, A; Muñoz-Negrete, F J

    2014-09-01

    A study was designed to determine and describe the changes induced in the anterior segment of the eye and the intraocular pressure (IOP) after laser peripheral iridotomy (LPI) versus phacoemulsification in primary angle closure suspects (PACS) and primary angle closure (PAC). Forty-seven eyes (47 patients) with Shaffer gonioscopy 0-II were included and split into 2 groups: cataract surgery (n=29) or LPI (n=18), depending on the lens sclerosis and visual acuity. Tonometry, gonioscopy, funduscopy, and automated measurements of the anterior chamber by Pentacam were performed before the intervention, and one and 3 months after the technique. Phacoemulsification reduces IOP after one and 3 months (P<.01). LPI reduces IOP after 3 months (P<.04), and after one month (P<.38). IOP was 16.2mmHg (SD: 3.59) in the phacoemulsification group vs. 16.83mmHg (SD: 2.36) in the LPI group after one month (P=.4), and 15.52 (SD: 2.95) vs. 16.05 (SD: 2.46) in the third month (P=.5). There were no significant differences in the antiglaucoma drugs. Shaffer gonioscopy grading was greater in the phacoemulsification group vs. in the LPI group one and 3 months after the intervention (P=.01). The highest difference between both techniques was found in the superior quadrant. The anterior chamber depth, angle and volume by Pentacam were wider in the phacoemulsification group after one and 3 months (P<.01). Although phacoemulsification and LPI could both be effective techniques in the prevention of pupillary block in PAC, faster and greater amplitude of the angle and the anterior chamber can be obtained after phacoemulsification than after LPI. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  5. Appositional Closure Identified by Ultrasound Biomicroscopy in Population-Based Primary Angle-Closure Glaucoma Suspects: The Liwan Eye Study

    PubMed Central

    Kong, Xiangbin; Foster, Paul J.; Huang, Qunxiao; Zheng, Yingfeng; Huang, Wenyong; Cai, Xiaoyu

    2011-01-01

    Purpose. To describe the characteristics of the iridocorneal angle using ultrasound biomicroscopy (UBM) in Chinese people classified gonioscopically as having suspected primary angle-closure (PACS) glaucoma. Methods. PACS were defined as not having visible posterior (usually pigmented) trabecular meshwork in two or more quadrants examined by static gonioscopy. The PACS and 1 of 10 those who did not meet this criterion were identified from a population-based survey. Iridotrabecular meshwork contact (ITC) was identified and further classified into low and high, according to standard UBM images. Those with high ITC were further classified according the configuration of ITC: B-type, with contiguous ITC from the base of the angle, and S-type, with ITC localized to the region of Schwalbe's line. Results. ITC was identified in 78.6% of the superior, 40.2% of the nasal, 59.8% of the inferior, and 25.6% of the temporal quadrants in the PACS (n = 117). These proportions were 43.9%, 15.8%, 29.8%, and 14.0% in the controls (n = 57), respectively. About two thirds of the eyes with ITC were classified as high. In those with high ITC, the number with B- and S-type ITC was very similar. The proportions of any high ITCs increased substantially from 15.4% in those with Shaffer angle grade 4 and 45.0% in grade 3, to 71.0% in grade 2, 70.2% in grade 1, and 86.4% in grade 0. Conclusions. More ITC is identified on UBM imaging than by gonioscopy. Careful consideration should be given to the assessment modality regarded as the reference standard in defining anatomic risk factors for glaucomatous visual loss and the need for treatment. PMID:21357394

  6. Genome-wide association analyses identify three new susceptibility loci for primary angle closure glaucoma

    PubMed Central

    Nongpiur, Monisha E; George, Ronnie; Chen, Li-Jia; Do, Tan; Abu-Amero, Khaled; Huang, Chor Kai; Low, Sancy; Tajudin, Liza-Sharmini A; Perera, Shamira A; Cheng, Ching-Yu; Xu, Liang; Jia, Hongyan; Ho, Ching-Lin; Sim, Kar Seng; Wu, Ren-Yi; Tham, Clement C Y; Chew, Paul T K; Su, Daniel H; Oen, Francis T; Sarangapani, Sripriya; Soumittra, Nagaswamy; Osman, Essam A; Wong, Hon-Tym; Tang, Guangxian; Fan, Sujie; Meng, Hailin; Huong, Dao T L; Wang, Hua; Feng, Bo; Baskaran, Mani; Shantha, Balekudaru; Ramprasad, Vedam L; Kumaramanickavel, Govindasamy; Iyengar, Sudha K; How, Alicia C; Lee, Kelvin Y; Sivakumaran, Theru A; Yong, Victor H K; Ting, Serena M L; Li, Yang; Wang, Ya-Xing; Tay, Wan-Ting; Sim, Xueling; Lavanya, Raghavan; Cornes, Belinda K; Zheng, Ying-Feng; Wong, Tina T; Loon, Seng-Chee; Yong, Vernon K Y; Waseem, Naushin; Yaakub, Azhany; Chia, Kee-Seng; Allingham, R Rand; Hauser, Michael A; Lam, Dennis S C; Hibberd, Martin L; Bhattacharya, Shomi S; Zhang, Mingzhi; Teo, Yik Ying; Tan, Donald T; Jonas, Jost B; Tai, E-Shyong; Saw, Seang-Mei; Hon, Do Nhu; Al-Obeidan, Saleh A; Liu, Jianjun; Chau, Tran Nguyen Bich; Simmons, Cameron P; Bei, Jin-Xin; Zeng, Yi-Xin; Foster, Paul J; Vijaya, Lingam; Wong, Tien-Yin; Pang, Chi-Pui

    2014-01-01

    Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study including 1,854 PACG cases and 9,608 controls across 5 sample collections in Asia. Replication experiments were conducted in 1,917 PACG cases and 8,943 controls collected from a further 6 sample collections. We report significant associations at three new loci: rs11024102 in PLEKHA7 (per-allele odds ratio (OR) = 1.22; P = 5.33 × 10−12), rs3753841 in COL11A1 (per-allele OR = 1.20; P = 9.22 × 10−10) and rs1015213 located between PCMTD1 and ST18 on chromosome 8q (per-allele OR = 1.50; P = 3.29 × 10−9). Our findings, accumulated across these independent worldwide collections, suggest possible mechanisms explaining the pathogenesis of PACG. PMID:22922875

  7. Genome-wide association analyses identify three new susceptibility loci for primary angle closure glaucoma.

    PubMed

    Vithana, Eranga N; Khor, Chiea-Chuen; Qiao, Chunyan; Nongpiur, Monisha E; George, Ronnie; Chen, Li-Jia; Do, Tan; Abu-Amero, Khaled; Huang, Chor Kai; Low, Sancy; Tajudin, Liza-Sharmini A; Perera, Shamira A; Cheng, Ching-Yu; Xu, Liang; Jia, Hongyan; Ho, Ching-Lin; Sim, Kar Seng; Wu, Ren-Yi; Tham, Clement C Y; Chew, Paul T K; Su, Daniel H; Oen, Francis T; Sarangapani, Sripriya; Soumittra, Nagaswamy; Osman, Essam A; Wong, Hon-Tym; Tang, Guangxian; Fan, Sujie; Meng, Hailin; Huong, Dao T L; Wang, Hua; Feng, Bo; Baskaran, Mani; Shantha, Balekudaru; Ramprasad, Vedam L; Kumaramanickavel, Govindasamy; Iyengar, Sudha K; How, Alicia C; Lee, Kelvin Y; Sivakumaran, Theru A; Yong, Victor H K; Ting, Serena M L; Li, Yang; Wang, Ya-Xing; Tay, Wan-Ting; Sim, Xueling; Lavanya, Raghavan; Cornes, Belinda K; Zheng, Ying-Feng; Wong, Tina T; Loon, Seng-Chee; Yong, Vernon K Y; Waseem, Naushin; Yaakub, Azhany; Chia, Kee-Seng; Allingham, R Rand; Hauser, Michael A; Lam, Dennis S C; Hibberd, Martin L; Bhattacharya, Shomi S; Zhang, Mingzhi; Teo, Yik Ying; Tan, Donald T; Jonas, Jost B; Tai, E-Shyong; Saw, Seang-Mei; Hon, Do Nhu; Al-Obeidan, Saleh A; Liu, Jianjun; Chau, Tran Nguyen Bich; Simmons, Cameron P; Bei, Jin-Xin; Zeng, Yi-Xin; Foster, Paul J; Vijaya, Lingam; Wong, Tien-Yin; Pang, Chi-Pui; Wang, Ningli; Aung, Tin

    2012-10-01

    Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study including 1,854 PACG cases and 9,608 controls across 5 sample collections in Asia. Replication experiments were conducted in 1,917 PACG cases and 8,943 controls collected from a further 6 sample collections. We report significant associations at three new loci: rs11024102 in PLEKHA7 (per-allele odds ratio (OR)=1.22; P=5.33×10(-12)), rs3753841 in COL11A1 (per-allele OR=1.20; P=9.22×10(-10)) and rs1015213 located between PCMTD1 and ST18 on chromosome 8q (per-allele OR=1.50; P=3.29×10(-9)). Our findings, accumulated across these independent worldwide collections, suggest possible mechanisms explaining the pathogenesis of PACG.

  8. Does acute primary angle-closure cause an increased choroidal thickness?

    PubMed

    Wang, Wei; Zhou, Minwen; Huang, Wenbin; Chen, Shida; Ding, Xiaoyan; Zhang, Xiulan

    2013-05-01

    We compared the choroidal thickness of the eyes of patients with acute primary angle-closure (APAC) with fellow eyes in the same patients. The analysis included 21 participants with unilateral APAC affected eyes and 21 fellow eyes with a diagnosis of primary angle-closure suspect (PACS). Enhanced depth imaging-optical coherence tomography (EDI-OCT) was used to measure the macular and peripapillary retinal and choroidal thickness in both eyes. The average choroidal thickness of the APAC eyes at each location or segment was compared to that of the fellow eyes. At all macular locations, the choroidal thickness was greatest at the subfovea for both groups. Comparison of the choroidal thickness between the groups showed that the thickness in the APAC eyes was significantly greater than in the PACS eyes at all locations except at 1 mm, 3 mm superior, 3 mm inferior, and 3 mm temporal from the fovea (P < 0.005). The mean subfoveal choroidal thickness was 349.0 ± 78.1 μm in the APAC eyes and 308.1 ± 70.5 μm in the PACS eyes, with a statistically significant difference (P < 0.005). Multivariable linear regression analysis showed that the subfoveal choroidal thickness was significantly greater in association with the APAC diagnosis and diastolic blood pressure and thinner in association with older subjects. APAC eyes have a higher level of macular choroidal thickness than PACS eyes when the IOP is reduced. However, the source of this difference is unclear and must be investigated further.

  9. Vascular Endothelial Growth Factor is Increased in Aqueous Humor of Acute Primary Angle-Closure Eyes.

    PubMed

    Huang, Wenbin; Gao, Xinbo; Chen, Shida; Li, Xingyi; Zhang, Xinyu; Zhang, Xiulan

    2016-07-01

    To measure and compare the levels of vascular endothelial growth factor (VEGF) in the aqueous humor of patients with acute primary angle closure (APAC), primary angle-closure glaucoma (PACG), and normal cataract (controls). Aqueous humor samples were prospectively collected from 38 APAC eyes, 36 PACG eyes, and 25 nonglaucomatous cataract control eyes. The levels of aqueous humor VEGF were measured using enzyme-linked immunoassays. The clinical characteristics of participants were also collected for correlation analysis. VEGF was detected in aqueous humor samples of 35 of 38 APAC patients (mean±SE of the mean, 935±258 pg/mL), 30 of 36 PACG patients (165±37.5 pg/mL), and 16 of 25 cataract controls (69.5±13.5 pg/mL). The mean concentration of VEGF in APAC eyes was 13.5 and 5.7 times higher than that in controls and PACG eyes, respectively, and these differences were statistically significant (both P<0.0167). In the correlation analysis that included all participants, the aqueous humor VEGF level was found to correlate negatively with axial length (ρ=-0.342, P=0.001), and positively with intraocular pressure (ρ=0.434, P<0.001). VEGF was significantly increased in aqueous humor of APAC eyes. An increase in aqueous humor VEGF may be the result of the characteristic ocular ischemia and hypoxia observed in APAC eyes as a consequence of sudden excessive increases in intraocular pressure during the acute episode.

  10. Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore

    PubMed Central

    Wong, T. Y.; Foster, P.; Seah, S.; Chew, P.

    2000-01-01

    AIM—To estimate the rates of hospital admissions for primary angle closure glaucoma (PACG) in Chinese, Malays, and Indians in Singapore
METHODS—A population-wide hospital discharge database in Singapore was used to identify all hospital admissions with a primary discharge diagnosis of PACG (International Classification of Disease—CM code: 365.2). The Singapore census was used for denominator data.
RESULTS—Between 1993 and 1997 there were 894 hospital admissions for PACG. The mean annual rate of PACG admissions was 11.1 per 100 000 (95% confidence interval (CI), 10.4, 11.8) among people aged 30 years and over. The annual rate was highest for Chinese (age and sex adjusted rate: 12.2 per 100 000), which was twice that of Malays (6.0 per 100 000) and Indians (6.3 per 100 000). Females had two times higher rates than males in all three races (age adjusted relative risk: 2.0, 95% CI: 1.7, 2.3).
CONCLUSION—Malay and Indian people had identical rates of hospital admissions for PACG, which were only half the rates compared with Chinese.

 PMID:10966951

  11. Uveal effusion following acute primary angle-closure: a retrospective case series

    PubMed Central

    Yang, Jian-Gang; Li, Jian-Jun; Tian, Hua; Li, Yan-Hong; Gong, Yu-Jing; Su, An-Le; He, Na

    2017-01-01

    AIM To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion (UE) after the attack of acute primary angle-closure (APAC) using ultrasound biomicroscopy (UBM), and to assess the clinical course and prognosis of the disease. METHODS In a retrospective case series, 26 eyes in 26 consecutive patients diagnosed with UE after the treatment of intraocular pressure (IOP)-lowering medication for the attack of APAC were enrolled. The unaffected fellow eyes served as controls. The morphological changes were observed by ultrasonography, slit lamp microscopy and gonioscopy. UBM was used to assess the degree and extent of effusion based on the analysis of parameters associated with UE. RESULTS The mean IOP was 9.2 (SD 2.1) mm Hg at the diagnosis of UE after IOP-lowering medication, while 14.1 (SD, 2.6) mm Hg in the fellow eyes (P=0.000). The anterior chamber depth (ACD) (P=0.000), angle opening distance at 500 µm (AOD500) (P<0.01) and anterior chamber angle (ACA) (P<0.05) were decreased significantly, while ciliary body thickness (CBT) (P<0.05) increased significantly in UE eyes. UE grade analysis showed 7 eyes in grade 1, 9 eyes in grade 2, and 10 eyes in grade 3. Quadrant scores were performed of 4 eyes in 1 quadrant, 3 eyes in 3 quadrants, and 19 eyes in 4 quadrants. There was the positive correlation between grade and quadrant score (r=0.644, P=0.000). The effusion on all eyes were recovered after medication, which mean IOP was 13.9 (SD, 2.8) mm Hg. CONCLUSION UE is a frequent complication in Chinese patients after the attack of APAC, partially associated with hypotony. The severity of UE is correlation with height of effusion, extent of detachment, and shallower ACD. PMID:28393032

  12. The biometric study in different stages of primary angle-closure glaucoma

    PubMed Central

    Chen, Y-Y; Chen, Y-Y; Sheu, S-J; Chou, P

    2013-01-01

    Purpose This study compared the general and ocular biometric characteristics of normal, primary angle closure (PAC), and primary angle-closure glaucoma (PACG) patients to better understand the possible relationship between differences in ocular parameters that might predict risk for PACG in PAC patients. Methods One hundred normal, 90 PAC, and 90 PACG eyes were retrospectively reviewed. General characteristics such as age, gender, body height, body weight, blood pressure, pulse, systemic diseases, and education level were recorded. Ocular findings included visual acuity, intraocular pressure, refraction, cup to disc ratio, and ocular biometry. Ocular biometry was obtained by A-scan ultrasonography (Digital A/B scan 5500; Sonomed Inc., Lake Success, NY, USA). The parameters recorded were anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens/axial length factor (LAF), and relative lens position (RLP). Results Although the controls, PAC group, and PACG group were found to be significantly different in age (62.7±9.8; 65.3±7.5; and 66.0±7.4, respectively), there were no gender differences. With regard to ocular parameters, the ACD tended to decrease and the LT and LAF tended to increase from normal to PAC to PACG. The eyes of the PACG group had significantly shallower ACD (P<0.001) and thicker lens (P<0.001) than those of the PAC group. While PAC had similar lens position to the control group, PACG had more anteriorly positioned lens than the PAC group (P<0.001). Logistic regression analysis found a significant association between a decrease in ACD and increased risk of PACG (odds ratio (OR)=3.59 for 0.2 mm decrease in ACD) as well as a significant association between an increase in LT and increased risk of PACG (OR=1.30). Conclusions In addition to LT, a shallower ACD owing to a change in RLP may have a role in the progression from PAC to PACG. Owing to the differences of certain biometric characteristics between PAC and PACG, A

  13. The biometric study in different stages of primary angle-closure glaucoma.

    PubMed

    Chen, Y-Y; Chen, Y-Y; Sheu, S-J; Chou, P

    2013-09-01

    This study compared the general and ocular biometric characteristics of normal, primary angle closure (PAC), and primary angle-closure glaucoma (PACG) patients to better understand the possible relationship between differences in ocular parameters that might predict risk for PACG in PAC patients. One hundred normal, 90 PAC, and 90 PACG eyes were retrospectively reviewed. General characteristics such as age, gender, body height, body weight, blood pressure, pulse, systemic diseases, and education level were recorded. Ocular findings included visual acuity, intraocular pressure, refraction, cup to disc ratio, and ocular biometry. Ocular biometry was obtained by A-scan ultrasonography (Digital A/B scan 5500; Sonomed Inc., Lake Success, NY, USA). The parameters recorded were anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens/axial length factor (LAF), and relative lens position (RLP). Although the controls, PAC group, and PACG group were found to be significantly different in age (62.7±9.8; 65.3±7.5; and 66.0±7.4, respectively), there were no gender differences. With regard to ocular parameters, the ACD tended to decrease and the LT and LAF tended to increase from normal to PAC to PACG. The eyes of the PACG group had significantly shallower ACD (P<0.001) and thicker lens (P<0.001) than those of the PAC group. While PAC had similar lens position to the control group, PACG had more anteriorly positioned lens than the PAC group (P<0.001). Logistic regression analysis found a significant association between a decrease in ACD and increased risk of PACG (odds ratio (OR)=3.59 for 0.2 mm decrease in ACD) as well as a significant association between an increase in LT and increased risk of PACG (OR=1.30). In addition to LT, a shallower ACD owing to a change in RLP may have a role in the progression from PAC to PACG. Owing to the differences of certain biometric characteristics between PAC and PACG, A-scan ultrasonography might potentially be used

  14. Scanning electron microscopy of the trabecular meshwork: understanding the pathogenesis of primary angle closure glaucoma.

    PubMed

    Sihota, Ramanjit; Goyal, Amita; Kaur, Jasbir; Gupta, Viney; Nag, Tapas C

    2012-01-01

    To study ultrastructural changes of the trabecular meshwork in acute and chronic primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG) eyes by scanning electron microscopy. Twenty-one trabecular meshwork surgical specimens from consecutive glaucomatous eyes after a trabeculectomy and five postmortem corneoscleral specimens were fixed immediately in Karnovsky solution. The tissues were washed in 0.1 M phosphate buffer saline, post-fixed in 1% osmium tetraoxide, dehydrated in acetone series (30-100%), dried and mounted. Normal trabecular tissue showed well-defined, thin, cylindrical uveal trabecular beams with many large spaces, overlying flatter corneoscleral beams and numerous smaller spaces. In acute PACG eyes, the trabecular meshwork showed grossly swollen, irregular trabecular endothelial cells with intercellular and occasional basal separation with few spaces. Numerous activated macrophages, leucocytes and amorphous debris were present. Chronic PACG eyes had a few, thickened posterior uveal trabecular beams visible. A homogenous deposit covered the anterior uveal trabeculae and spaces. Converging, fan-shaped trabecular beam configuration corresponded to gonioscopic areas of peripheral anterior synechiae. In POAG eyes, anterior uveal trabecular beams were thin and strap-like, while those posteriorly were wide, with a homogenous deposit covering and bridging intertrabecular spaces, especially posteriorly. Underlying corneoscleral trabecular layers and spaces were visualized in some areas. In acute PACG a marked edema of the endothelium probably contributes for the acute and marked intraocular pressure (IOP) elevation. Chronically raised IOP in chronic PACG and POAG probably results, at least in part, from decreased aqueous outflow secondary to widening and fusion of adjacent trabecular beams, together with the homogenous deposit enmeshing trabecular beams and spaces.

  15. Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma.

    PubMed

    Khor, Chiea Chuen; Do, Tan; Jia, Hongyan; Nakano, Masakazu; George, Ronnie; Abu-Amero, Khaled; Duvesh, Roopam; Chen, Li Jia; Li, Zheng; Nongpiur, Monisha E; Perera, Shamira A; Qiao, Chunyan; Wong, Hon-Tym; Sakai, Hiroshi; Barbosa de Melo, Mônica; Lee, Mei-Chin; Chan, Anita S; Azhany, Yaakub; Dao, Thi Lam Huong; Ikeda, Yoko; Perez-Grossmann, Rodolfo A; Zarnowski, Tomasz; Day, Alexander C; Jonas, Jost B; Tam, Pancy O S; Tran, Tuan Anh; Ayub, Humaira; Akhtar, Farah; Micheal, Shazia; Chew, Paul T K; Aljasim, Leyla A; Dada, Tanuj; Luu, Tam Thi; Awadalla, Mona S; Kitnarong, Naris; Wanichwecharungruang, Boonsong; Aung, Yee Yee; Mohamed-Noor, Jelinar; Vijayan, Saravanan; Sarangapani, Sripriya; Husain, Rahat; Jap, Aliza; Baskaran, Mani; Goh, David; Su, Daniel H; Wang, Huaizhou; Yong, Vernon K; Yip, Leonard W; Trinh, Tuyet Bach; Makornwattana, Manchima; Nguyen, Thanh Thu; Leuenberger, Edgar U; Park, Ki-Ho; Wiyogo, Widya Artini; Kumar, Rajesh S; Tello, Celso; Kurimoto, Yasuo; Thapa, Suman S; Pathanapitoon, Kessara; Salmon, John F; Sohn, Yong Ho; Fea, Antonio; Ozaki, Mineo; Lai, Jimmy S M; Tantisevi, Visanee; Khaing, Chaw Chaw; Mizoguchi, Takanori; Nakano, Satoko; Kim, Chan-Yun; Tang, Guangxian; Fan, Sujie; Wu, Renyi; Meng, Hailin; Nguyen, Thi Thuy Giang; Tran, Tien Dat; Ueno, Morio; Martinez, Jose Maria; Ramli, Norlina; Aung, Yin Mon; Reyes, Rigo Daniel; Vernon, Stephen A; Fang, Seng Kheong; Xie, Zhicheng; Chen, Xiao Yin; Foo, Jia Nee; Sim, Kar Seng; Wong, Tina T; Quek, Desmond T; Venkatesh, Rengaraj; Kavitha, Srinivasan; Krishnadas, Subbiah R; Soumittra, Nagaswamy; Shantha, Balekudaru; Lim, Boon-Ang; Ogle, Jeanne; de Vasconcellos, José P C; Costa, Vital P; Abe, Ricardo Y; de Souza, Bruno B; Sng, Chelvin C; Aquino, Maria C; Kosior-Jarecka, Ewa; Fong, Guillermo Barreto; Tamanaja, Vania Castro; Fujita, Ricardo; Jiang, Yuzhen; Waseem, Naushin; Low, Sancy; Pham, Huan Nguyen; Al-Shahwan, Sami; Craven, E Randy; Khan, Muhammad Imran; Dada, Rrima; Mohanty, Kuldeep; Faiq, Muneeb A; Hewitt, Alex W; Burdon, Kathryn P; Gan, Eng Hui; Prutthipongsit, Anuwat; Patthanathamrongkasem, Thipnapa; Catacutan, Mary Ann T; Felarca, Irene R; Liao, Chona S; Rusmayani, Emma; Istiantoro, Vira Wardhana; Consolandi, Giulia; Pignata, Giulia; Lavia, Carlo; Rojanapongpun, Prin; Mangkornkanokpong, Lerprat; Chansangpetch, Sunee; Chan, Jonathan C H; Choy, Bonnie N K; Shum, Jennifer W H; Than, Hlaing May; Oo, Khin Thida; Han, Aye Thi; Yong, Victor H; Ng, Xiao-Yu; Goh, Shuang Ru; Chong, Yaan Fun; Hibberd, Martin L; Seielstad, Mark; Png, Eileen; Dunstan, Sarah J; Chau, Nguyen Van Vinh; Bei, Jinxin; Zeng, Yi Xin; Karkey, Abhilasha; Basnyat, Buddha; Pasutto, Francesca; Paoli, Daniela; Frezzotti, Paolo; Wang, Jie Jin; Mitchell, Paul; Fingert, John H; Allingham, R Rand; Hauser, Michael A; Lim, Soon Thye; Chew, Soo Hong; Ebstein, Richard P; Sakuntabhai, Anavaj; Park, Kyu Hyung; Ahn, Jeeyun; Boland, Greet; Snippe, Harm; Stead, Richard; Quino, Raquel; Zaw, Su Nyunt; Lukasik, Urszula; Shetty, Rohit; Zahari, Mimiwati; Bae, Hyoung Won; Oo, Nay Lin; Kubota, Toshiaki; Manassakorn, Anita; Ho, Wing Lau; Dallorto, Laura; Hwang, Young Hoon; Kiire, Christine A; Kuroda, Masako; Djamal, Zeiras Eka; Peregrino, Jovell Ian M; Ghosh, Arkasubhra; Jeoung, Jin Wook; Hoan, Tung S; Srisamran, Nuttamon; Sandragasu, Thayanithi; Set, Saw Htoo; Doan, Vi Huyen; Bhattacharya, Shomi S; Ho, Ching-Lin; Tan, Donald T; Sihota, Ramanjit; Loon, Seng-Chee; Mori, Kazuhiko; Kinoshita, Shigeru; Hollander, Anneke I den; Qamar, Raheel; Wang, Ya-Xing; Teo, Yik Y; Tai, E-Shyong; Hartleben-Matkin, Curt; Lozano-Giral, David; Saw, Seang Mei; Cheng, Ching-Yu; Zenteno, Juan C; Pang, Chi Pui; Bui, Huong T T; Hee, Owen; Craig, Jamie E; Edward, Deepak P; Yonahara, Michiko; Neto, Jamil Miguel; Guevara-Fujita, Maria L; Xu, Liang; Ritch, Robert; Liza-Sharmini, Ahmad Tajudin; Wong, Tien Y; Al-Obeidan, Saleh; Do, Nhu Hon; Sundaresan, Periasamy; Tham, Clement C; Foster, Paul J; Vijaya, Lingam; Tashiro, Kei; Vithana, Eranga N; Wang, Ningli; Aung, Tin

    2016-05-01

    Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

  16. Primary angle closure glaucoma in East Asia: educational attainment as a protective factor.

    PubMed

    Yip, Jennifer L Y; Nolan, Winifred P; Davaatseren, Uranchimeg; Baasankhuu, Jamyanjav; Lee, Pak S; Khaw, Peng T; Johnson, Gordon J; Foster, Paul J; Gilbert, Clare E

    2011-10-01

    To examine the relationship between education, other risk factors and incident primary angle closure glaucoma (PACG). Glaucoma was excluded in a group of 4597 Mongolian volunteers in 1999. After 6 years, 1892 traced participants had full ophthalmic examination, dilated disc photographs and agreed to complete a questionnaire on socio-economic status. PACG was diagnosed using both structural and functional evidence from objective grading of paired disc photographs, follow up visual fields and clinical examination. Ophthalmic examination included van Herick grading, Goldmann intraocular pressure (IOP), gonioscopy, lens opacity grading and dilated disc examination. Central anterior chamber depth, lens thickness and axial length were recorded using ultrasound A scan mounted on a slitlamp. Education level was assessed using national census categories. PACG was diagnosed in 29 participants (6 year incidence = 1.53%, 95% confidence interval (CI) = 1.03-2.19%). In univariate analysis, risk factors for incident PACG included presence of refractive error, narrow van Herick grading of ≤15%, narrower average Shaffer grading, higher IOP, larger cup disc ratio and lower levels of education. In multivariate analysis, adjusted for age, sex, Shaffer grading, refractive error and IOP, those with no formal education were approximately 7 times more likely to develop PACG compared to those with >8 years of formal schooling (OR = 7.27, 95% CI = 2.73-19.38). People with lower levels of education have a higher risk of incident PACG, independent of age, sex, IOP and axial length.

  17. Decision-making Impairments in Primary Angle-closure Glaucoma Patients

    PubMed Central

    Pu, Hui; Wang, Yong; Wei, Qiang; Ma, Hui-Juan; Hu, Pan-Pan; Li, Shou-Ling; Pang, Hong-Bo; Tian, Yang-Hua; Wang, Kai

    2017-01-01

    Background: Primary angle-closure glaucoma (PACG) is a common eye disease and a common cause of blindness. Inappropriate medical decisions severely affect the prognosis. This study investigated decision-making under risk in PACG patients. Methods: Thirty patients with first acute attack of PACG before surgery and thirty healthy controls were included in the study. Decision-making under risk was evaluated with the game of dice task (GDT). The results of Eysenck Personality Questionnaire (EPQ) and GDT between PACG patients and healthy controls were compared. Results: Risky decisions in PACG patients were more than those in healthy controls as measured by mean score of GDT (12.47 ± 5.72 vs. 4.33 ± 3.30, P < 0.001). Higher neuroticism score in EPQ was found in PACG patients compared to healthy controls (14.97 ± 3.93 vs. 9.90 ± 4.49, P < 0.001). Neuroticism scores in EPQ were associated with decision-making performance (r = 0.417, P = 0.001). Conclusions: Neuroticism positively correlated with risky decisions. Decision-making might be influenced by neuroticism. Future studies will show whether therapy compliance will be improved by emotional management and psychological intervention in PACG patients. PMID:28584204

  18. A comparison of two approaches to managing acute primary angle closure in Asian eyes

    PubMed Central

    Ho, Henrietta; Chew, Paul T; Sng, Chelvin; Huang, Huiqi; Aung, Tin; Perera, Shamira A

    2013-01-01

    Purpose To review the management regimes of acute primary angle closure (APAC) in two hospitals in Singapore, and to identify the incidence of and risk factors for progression to glaucomatous optic neuropathy. Methods We conducted a retrospective review of 40 patients from National University Hospital (NUH) and 52 patients from Singapore National Eye Centre (SNEC) who were diagnosed with APAC. Patients were treated with similar protocols of intensive medical therapy until laser peripheral iridotomy could be performed. In the event of failed medical treatment, patients at NUH only underwent laser iridoplasty. The 1-year outcomes were reviewed. Results The demographic features of patients and presenting intraocular pressures (IOP) were similar in both centers. More patients from NUH presented within 3 days of symptom onset, compared to those from SNEC (90.0% versus 71.2%, respectively) (P = 0.037). The mean ± standard deviation time to break the attack was 18.2 ± 32.9 hours at SNEC and 9.80 ± 10.6 hours at NUH (P = 0.11). The mean follow up duration was 18.8 ± 14.0 months. Nineteen patients (36.5%) from SNEC and six patients (22.5%) from NUH developed raised IOP (P = 0.032) within 1-year of the attack. Of these, glaucomatous optic neuropathy developed in thirteen patients (68.4%) from SNEC and all six patients (100%) from NUH. At final review, the mean IOP of the APAC eye was 14.8 ± 4.3 mmHg from SNEC and 13.4 ± 3.0 mmHg from NUH. There was no significant difference in final visual acuity or IOP between both groups. Conclusion Treatment strategies in both centers were effective in aborting an APAC attack. The development of raised IOP appears to be associated with a longer period of attack suggesting that greater urgency in aborting APAC attacks may entail better long term outcomes. PMID:23818755

  19. Topographic profile of choroid in eyes after acute primary angle-closure.

    PubMed

    Gao, Xinbo; Huang, Wenbin; Wang, Wei; Zhou, Minwen; Wang, Jiawei; Du, Shaolin; Chen, Shida; Zhang, Xiulan

    2016-10-01

    To characterize and compare the topographic profile of choroid in eyes after acute primary angle-closure (APAC) and in normal controls. A prospective observational study was conducted. Forty-four consecutive patients who had experienced unilateral APAC that was resolved by treatment were recruited. Seventy age- and sex-matched normal individuals were recruited as controls. Enhanced depth imaging-optical coherence tomography was used to measure choroidal thickness (CT) in 9 diffuse locations of macular region. The average CT was compared among each location in the APAC and control groups and between the same locations in the 2 groups. Variants of CT at different macular locations were found in both groups; it was greatest at subfoveal locations and spread thinner around them, to reach a significant decrease (all p ≤ 0.05) 3 mm away in all directions from the fovea except for the superior direction in normal controls (p = 0.472). Among the 4 directions, the superior had the thickest CT in both groups, followed by the temporal, inferior, and nasal directions in both groups, whereas the APAC had a thicker choroid profile at each location (all p < 0.05). Univariate analysis showed that age, sex, anterior chamber depth, axial length, and spherical equivalent were all associated with the subfoveal choroidal thickness (SFCT) (all p < 0.1). Multivariable linear regression analysis showed that the SFCT was significantly thicker in association with an APAC diagnosis, shorter axial length, greater spherical equivalent refractive error, and younger female subjects (all p ≤ 0.05). APAC eyes have a thicker choroid than normal eyes in the macular region, and the increase in CT in APAC eyes follows topographic distribution as in normal control eyes. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  20. [A study on the association of apolipoprotein E genotypes with primary open-angle glaucoma and primary angle-closure glaucoma in northeast of China].

    PubMed

    Yuan, Hui-ping; Xiao, Zheng; Yang, Bin-bin

    2007-05-01

    To analysis the association of apolipoprotein E (APOE) genotype with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in northeast of China. The polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) technique were used to detect the distribution of genotype and gene frequency of APOE alleles in 36 patients with POAG, 69 with PACG and 57 healthy subjects as control. The frequency of APOE epsilon 3/epsilon 4 genotype in POAG group (41.7%)and epsilon 2/epsilon 4 in PACG group (43.5%) was significantly (P < 0.05) higher than that in control group (14.0% and 21.1%, respectively). The frequency of APOE epsilon 4 allele in both of POAG (37.5%) and PACG group (39.2%) was significantly (P < 0.05) higher than that in control group (17.5%), whereas the frequency of APOE epsilon 2 allele in POAG group (8.3%) was significantly (P < 0.05) lower than that in control group (15.8%). APOE epsilon 4 allele may be a latent risk factor in the development of primary glaucoma, but APOE epsilon 2 allele may play a protective role in POAG and warrant further investigation.

  1. Characterization of ocular biometrics and aqueous humor dynamics in primary angle closure suspects.

    PubMed

    Guo, Li; Deng, Yuan; Fang, Li; Liu, Chaoqi; Guo, Tao

    2017-02-01

    Detailed characterizations of ocular biometrics and parameters of aqueous humor dynamics are lacking in primary angle closure suspect (PACS) patients. This study aims to characterize these parameters and compare them with age-matched healthy volunteers.Elderly healthy volunteers (60.6 ± 7.2 years of age, mean ± SD, n = 28) and PACS patients (64.1 ± 11.6 years, n = 30) completed the study. Parameters investigated were axial length (AXL), anterior chamber depth (ACD), anterior chamber volume (ACV), central cornea thickness (CCT), intraocular pressure (IOP), aqueous flow (Fa), outflow facility (C), episcleral venous pressure (EVP), and uveoscleral outflow (Fu). Comparisons and correlations were made between and within groups.In healthy volunteers, ocular biometric parameters, IOP, and EVP correlated very well between the 2 eyes of each individual, but Fa, C, and Fu were not significantly correlated. Biometric parameters of the PACS group significantly (P < 0.001) differed from those of the healthy controls: AXL (23.31 ± 1.03 mm [PACS] vs 22.39 ± 1.04 mm [Control]; mean ± SD), ACD (2.44 ± 0.33 mm [PACS] vs 1.86 ± 0.25 mm [Control]), ACV (136.0 ± 36.1 μL [PACS] vs 81.4 ± 21.8 μL [Control]), CCT (526.9 ± 37.0 μm [PACS] vs 556.1 ± 28.4 μm [Control]). There was no significant change in IOP, Fa, C, EVP, or Fu between Control and PACS. Furthermore, IOP showed no significant correlations with AXL, ACD, ACV, CCT, or C in both groups.The PACS eyes had a shorter AXL, a shallower ACD, and a smaller ACV, but a thicker CCT. Despite these morphological changes, the PACS eyes did not have any significant changes in IOP, and aqueous humor dynamics parameters. This is consistent with the findings that IOP did not show significant correlations with biometrics, or C.

  2. Characterization of ocular biometrics and aqueous humor dynamics in primary angle closure suspects

    PubMed Central

    Guo, Li; Deng, Yuan; Fang, Li; Liu, Chaoqi; Guo, Tao

    2017-01-01

    Abstract Detailed characterizations of ocular biometrics and parameters of aqueous humor dynamics are lacking in primary angle closure suspect (PACS) patients. This study aims to characterize these parameters and compare them with age-matched healthy volunteers. Elderly healthy volunteers (60.6 ± 7.2 years of age, mean ± SD, n = 28) and PACS patients (64.1 ± 11.6 years, n = 30) completed the study. Parameters investigated were axial length (AXL), anterior chamber depth (ACD), anterior chamber volume (ACV), central cornea thickness (CCT), intraocular pressure (IOP), aqueous flow (Fa), outflow facility (C), episcleral venous pressure (EVP), and uveoscleral outflow (Fu). Comparisons and correlations were made between and within groups. In healthy volunteers, ocular biometric parameters, IOP, and EVP correlated very well between the 2 eyes of each individual, but Fa, C, and Fu were not significantly correlated. Biometric parameters of the PACS group significantly (P < 0.001) differed from those of the healthy controls: AXL (23.31 ± 1.03 mm [PACS] vs 22.39 ± 1.04 mm [Control]; mean ± SD), ACD (2.44 ± 0.33 mm [PACS] vs 1.86 ± 0.25 mm [Control]), ACV (136.0 ± 36.1 μL [PACS] vs 81.4 ± 21.8 μL [Control]), CCT (526.9 ± 37.0 μm [PACS] vs 556.1 ± 28.4 μm [Control]). There was no significant change in IOP, Fa, C, EVP, or Fu between Control and PACS. Furthermore, IOP showed no significant correlations with AXL, ACD, ACV, CCT, or C in both groups. The PACS eyes had a shorter AXL, a shallower ACD, and a smaller ACV, but a thicker CCT. Despite these morphological changes, the PACS eyes did not have any significant changes in IOP, and aqueous humor dynamics parameters. This is consistent with the findings that IOP did not show significant correlations with biometrics, or C. PMID:28207520

  3. Multiplex Cytokine Analysis of Aqueous Humor from the Patients with Chronic Primary Angle Closure Glaucoma.

    PubMed

    Duvesh, Roopam; Puthuran, George; Srinivasan, Kavitha; Rengaraj, Venkatesh; Krishnadas, S R; Rajendrababu, Sharmila; Balakrishnan, Vijayakumar; Ramulu, Pradeep; Sundaresan, Periasamy

    2017-09-22

    To compare the levels of cytokines and growth factor in aqueous humor of the patients with chronic primary angle closure glaucoma (PACG) and cataract. Aqueous humor samples were collected from 19 chronic PACG patients and compared with 14 nonglaucomatous controls presenting for cataract surgery. The levels of 27 cytokines and growth factors were measured in the aqueous samples using multiplex bead immunoassay and compared across groups. Significantly higher levels of interleukin (IL)-8 (p < 0.001), eotaxin (p < 0.001), interferon gamma-induced protein (IP)-10 (p < 0.001) and macrophage inflammatory protein-1-beta (MIP-1β; p < 0.001) were observed in aqueous of chronic PACG patients compared to controls. In comparison to controls, significantly lower levels of IL-9 (p = 0.001), IL-17 (p < 0.001), tumor necrosis factor-alpha (TNF-α; p < 0.001), granulocyte-macrophage colony-stimulating factor (GM-CSF; p < 0.001), and IL-5 (p = 0.001) were observed in chronic PACG eyes. All other assayed cytokines-IL-1β, interleukin-1 receptor antagonist (IL-1rα), IL-6, IL-7, IL-10, IL-12, IL-13, IL-15, fibroblast growth factor-basic (FGF-basic), granulocyte colony-stimulating factor (G-CSF), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1-alpha (MIP-1α), and vascular endothelial growth factor (VEGF) -showed no significant difference between the groups. These results suggest that the aqueous cytokine levels of chronic PACG eyes differ significantly from nonglaucomatous eyes. This is the first study reporting significantly increased levels of eotaxin, MIP-1β, and IP-10 and lower levels of TNF-α, IL-5, IL-9, IL-17, and GM-CSF in chronic PACG patients, suggesting a plausible role of these inflammatory cytokines in its pathogenesis.

  4. Long-Term Outcomes of Primary Trabeculectomy in Diabetic Patients without Retinopathy with Primary Angle-Closure Glaucoma

    PubMed Central

    Liu, Jian; Li, Bin; Wang, Jianrong

    2017-01-01

    Purpose. To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients without retinopathy with primary angle-closure glaucoma (PACG). Design. This is a retrospective case series comparison. Participants. This retrospective trial compared outcomes of 88 eyes that underwent trabeculectomy in patients with diabetes mellitus (DM) without retinopathy and in 97 patients without DM. Methods. In this study, the intraocular pressure (IOP), visual acuity, visual field, and postoperative complications were compared between the two groups. Qualified surgical success is defined as an IOP between 6 and 18 mmHg with or without topical antiglaucoma medication. Results. After a follow-up of 5 years, the IOP decreased from a mean basal IOP of 27.8 ± 7.3 mmHg to 15.0 ± 5.6 mmHg in the DM group and from 27.3 ± 6.0 mmHg to 12.4 ± 5.3 mmHg in the control group. The mean number of antiglaucoma medications was 3.4 ± 1.3 and 3.3 ± 1.2 preoperatively (P = 0.587) whereas it was 1.7 ± 1.5 and 1.1 ± 1.4 at the 5-year follow-up (P = 0.049). The 5-year qualified surgical success rates were 42.9% and 65.4% for both groups (P = 0.046; log-rank test). Encysted blebs were seen in 21 (23.9%) patients in the DM group and in 12 (12.4%) patients in the control group (P = 0.041). Conclusion. PACG patients with DM without retinopathy undergoing primary trabeculectomy with MMC may have a lower long-term surgical survival rate compared with patients without DM. PMID:28337343

  5. Comparison of relation between visual function index and retinal nerve fiber layer structure by optical coherence tomography among primary open angle glaucoma and primary angle closure glaucoma eyes.

    PubMed

    Rao, Aparna

    2014-01-01

    To compare the visual field index (VFI) in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) eyes, and to study the correlation with disc variables on optical coherence tomography (OCT) in all stages of severity. Thirty POAG and PACG underwent Humphrey visual field 24-2 along with detailed examination. They also underwent stratus OCT imaging of the optic nerve and retinal nerve fiber layer (RNFL). The correlation of VFI with RNFL thickness was compared in POAG and PACG. The VFI significantly differed between POAG and PACG, with POAG eyes apparently having a better VFI at all severities of glaucoma. There were statistically significant differences in the superior max (Smax) and inferior max (Imax) in early and moderate POAG and PACG eyes. In early and moderate glaucoma, multivariate regression showed that maximum correlation of the VFI was seen with the mean deviation (b = 1.7, P < 0.001), average and superior RNFL thickness (b = 2.1, P < 0.001 and b = 1.8, P = 0.03, respectively), and age (b = 0.7, P = 0.04); while no correlation was seen with intraocular pressure (IOP), axial length, sex, or other clinical variables. VFI did not correlate well with RNFL thickness or other disc variables on OCT in severe glaucoma. VFI may not serve as a useful indicator of visual function in severe glaucoma. More useful indicators are required to monitor glaucoma patients with severe damage.

  6. Changes in ocular biometry and anterior chamber parameters after pharmacologic mydriasis and peripheral iridotomy in primary angle closure suspects.

    PubMed

    Razeghinejad, Mohammad Reza; Lashkarizadeh, Hamid; Nowroozzadeh, Mohammad Hossein; Yazdanmehr, Mohammad

    2016-01-01

    The aim of this study was to evaluate the effects of pharmacologic mydriasis and Peripheral Iridotomy (PI) on ocular biometry and anterior chamber parameters in primary angle closure suspects. In this prospective interventional case series, 21 primary angle closure suspects were enrolled. Intraocular pressure, refraction, ocular biometry (Lenstar, LS900), and anterior chamber parameters (Pentacam HR) were measured at four occasions: before PI (before and after mydriasis with phenylephrine) and two weeks after PI (before and after mydriasis). The study was conducted on both eyes and only one eye per patient, in random, was included in the analysis. The mean age of the participants was 60±7 years and 17 (81%) were female. There were no significant differences in intraocular pressure, refraction, keratometry, biometric and anterior chamber parameters between groups, except for anterior chamber volume, which showed increments with PI and mydriasis. The corresponding values for anterior chamber volume were as follows: 88.2±13.7mm(3) before PI, undilated; 106.3±18.8 before PI, dilated; 99.0±14.6 after PI, undilated, and 107.4±16.5 after PI, dilated (P<0.001). This study showed no change in the ocular biometric and anterior chamber parameters including iridocorneal angle after PI and/or pharmacologic mydriasis except for increments in anterior chamber volume. This factor has the potential to be used as a numerical proxy for iris position in evaluating and monitoring patients with primary angle closure suspects after PI. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  7. Comparison of self-measured diurnal intraocular pressure profiles using rebound tonometry between primary angle closure glaucoma and primary open angle glaucoma patients

    PubMed Central

    Tan, Shaoying; Baig, Nafees; Hansapinyo, Linda; Jhanji, Vishal; Wei, Shihui; Tham, Clement C.

    2017-01-01

    Purpose To document the diurnal intraocular pressure (IOP) profile with rebound tonometry performed by primary glaucoma patients in non-clinic environment. Patients and methods Fifty-three medically-treated eyes of 31 primary angle closure glaucoma (PACG) and 22 primary open angle glaucoma (POAG) patients with no previous eye surgery were recruited. Diurnal IOP was measured 5 times per day at four-hourly intervals from 08:00 to 24:00 for 1 week in patients’ study eye using rebound tonometry in a non-clinic environment. The diurnal IOP profiles were compared between PACG and POAG eyes. Results For both PACG and POAG eyes, mean patient-measured IOP was highest in the morning, gradually decreased over the course of a day, and was lowest by midnight (p < 0.001). The diurnal IOP fluctuation ± 1 standard deviation (SD), as documented by SD in daily IOP values, was lower in PACG group (1.6 ± 1.1 mmHg) than in POAG group (2.0 ± 1.2 mmHg; p = 0.049). The mean trough IOP ± 1 SD was higher in PACG group (12.9 ± 2.8 mmHg), compared to POAG group (11.5 ± 3.8 mmHg; p = 0.041). The mean IOP level at midnight ± 1 SD in PACG group (14.0 ± 3.2 mmHg) was higher than that in POAG group (12.1 ± 3.7 mmHg; p = 0.013). Conclusions IOP in primary glaucoma patients was highest in the morning, and decreased over the course of a day in non-clinic environment. Treated diurnal IOP fluctuation seemed to be greater in POAG than PACG eyes. PMID:28333942

  8. Patient-Reported Vision-Related Quality-of-Life Differences between Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

    PubMed Central

    Guo, Chao-Yu; Chen, Yu-Jing; Chen, Mei-Ju; Ko, Yu-Chieh; Huang, Nicole; Liu, Catherine Jui-ling

    2016-01-01

    Purpose To investigate the different impacts on patient-reported vision-related quality of life (pVRQOL) outcomes in patients with primary angle-closure glaucoma(PACG) and primary open-angle glaucoma(POAG). Methods Prospective cross-sectional study. PACG and POAG patients who had a best-corrected visual acuity(BCVA) in the better eye equal to or better than 20/60, intraocular pressure controlled at or below 25 mmHg and reliable visual field test were invited to participate. The control group included patients with BCVA in the better eye equal to or better than 20/60 and who did not have major eye disease. A validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25(T)) was performed to assess pVRQOL. The association between each domain of NEI VFQ-25(T) among 3 groups was determined using multivariable linear regression analysis. Results A total of 106 PACG, 186 POAG, and 95 controls were enrolled. In multivariable regression analysis of all three groups(PACG/POAG/controls), compared to POAG, PACG showed a weakly positive association with social functioning (R2 = 0.13, β = 0.22, P = 0.04). PACG showed no significantly negative impact on pVRQOL compared to controls. Taking only glaucoma patients into consideration, PACG patients had a higher score on social functioning compared to POAG (R2 = 0.16, β = 0.27, P = 0.01). The results of other domains of NEI VFQ-25(T) between the two groups did not differ significantly(p>0.05). Conclusions In patients with controlled disease, the impact of PACG and POAG on most domains of NEI VFQ-25(T) were similar, except for better social functioning in PACG compared to POAG. PMID:27690232

  9. Clinical and Anterior Segment Anatomical Features in Primary Angle Closure Subgroups Based on Configurations of Iris Root Insertion

    PubMed Central

    Hong, Ji Wook; Yun, Sung-Cheol; Lee, Jong Eun

    2016-01-01

    Purpose To compare the clinical and anterior segment anatomical features in primary angle closure sub-groups based on configurations of iris root insertion. Methods Primary angle closure patients were imaged using anterior segment optical coherence tomography. Anterior chamber depth, iris curvature, iris thickness (IT) at the scleral spur and 500, 750, and 1,500 µm from the scleral spur (IT0, IT500, IT750, and IT1500), lens vault, iris area, angle opening distance (AOD500), angle recess area (ARA750), and trabecular iris space area (TISA750) were measured. Iris root insertion was categorized into a non-basal insertion group (NBG) and basal insertion group (BG). Results In total, 43 eyes of 39 participants belonged to the NBG and 89 eyes of 53 participants to the BG. The mean age of participants was greater in the NBG than the BG (62.7 ± 5.7 vs. 59.8 ± 7.3 years, p = 0.043), and the baseline intraocular pressure was higher in the BG than the NBG (16.4 ± 4.4 vs. 14.9 ± 3.3 mmHg, p = 0.037). The BG showed a greater IT0 (0.265 ± 0.04 vs. 0.214 ± 0.03 mm, p < 0.001) and iris area (1.59 ± 0.24 vs. 1.52 ± 0.27 mm2, p = 0.045), lower ARA750 (0.112 ± 0.08 vs. 0.154 ± 0.08 mm2, p = 0.017) and AOD500 (0.165 ± 0.07 vs. 0.202 ± 0.08 mm, p = 0.014) compared to the NBG. Conclusions The BG had a narrower anterior chamber angle, thicker peripheral iris, and higher pretreatment intraocular pressure. PMID:27247520

  10. Evaluation of potential risk factors for development of primary angle-closure glaucoma in Bouviers des Flandres.

    PubMed

    Dubin, Alexis J; Bentley, Ellison; Buhr, Kevin A; Miller, Paul E

    2017-01-01

    OBJECTIVE To evaluate potential risk factors for development of primary angle-closure glaucoma (PACG) in Bouviers des Flandres. DESIGN Prospective, observational study. ANIMALS 98 Bouviers des Flandres. PROCEDURES All dogs underwent slit-lamp biomicroscopy, indirect ophthalmoscopy, gonioscopy, applanation tonometry, streak retinoscopy, and A-scan, B-scan, and high-resolution ultrasonography. Iridocorneal angles and degree of pectinate ligament dysplasia sheeting were graded, and an angle index was mathematically derived for each eye on the basis of these values. Ciliary clefts evaluated by high-resolution ultrasonography were classified as open, narrow, or closed. Owners were contacted by telephone 7 to 9 years after the initial examination to determine whether dogs had a subsequent diagnosis of PACG. Relationships between previously recorded variables and the development of PACG were evaluated by logistic regression methods. Available pedigrees were reviewed to assess genetic relationships among affected dogs. RESULTS 9 of 92 (9.8%) dogs with follow-up information available developed PACG. An angle index < 1 and presence of a narrow or closed ciliary cleft in 1 or both eyes were each significantly associated with development of PACG. Odds of developing PACG for dogs with an angle index < 1 (indicating marked reduction in outflow capacity through the iridocorneal angle), a narrow or closed ciliary cleft in > 1 eye, or both findings were 13, 20, and 28 times those for dogs that did not have these findings, respectively. All dogs that developed PACG shared 1 common male sire or grandsire. CONCLUSIONS AND CLINICAL RELEVANCE Several anatomic factors were significant risk factors for development of PACG in this population of dogs. Results also suggested a genetic component for the disease.

  11. Primary Angle Closure and Sequence Variants within MicroRNA Binding Sites of Genes Involved in Eye Development

    PubMed Central

    Shi, Haihong; Zhang, Junfang; Zhu, Rongrong; Hu, Nan; Lu, Hong; Yang, Mei; Qin, Bai; Shi, Jian; Guan, Huaijin

    2016-01-01

    Purpose The formation of primary angle closure (PAC) and primary angle closure glaucoma (PACG) is regulated by a tissue remodeling pathway that plays a critical role in eye development. MicroRNAs (miRNAs) are powerful gene expression regulators and may exert their effects on tissue remodeling genes. This study investigated the associations between gene variants (single-nucleotide polymorphism, SNP) in miRNA binding sites in the 3’-UTR region of genes involved in eye development and PAC. Methods The sample consisted of 232 PAC subjects and 306 controls obtained from a population-based cohort in the Funing District of Jiangsu, China. The markers include 9 SNPs in the COL11A1, PCMTD1, ZNRF3, MTHFR, and ALPPL2 genes respectively. SNP genotyping was performed with a TaqMan-MGB probe using an RT-PCR system. Results Of the 9 SNPs studied, the frequency of the minor A allele of COL11A1 rs1031820 was higher in the PAC group than in the control group in allele analysis (p = 0.047). The genotype analysis indicated that MTHFR rs1537514 is marginally associated with PAC (p = 0.014). The CC genotype of rs1537514 was present solely in the PAC group. However, the differences lost significance after Bonferroni correction. Conclusion Our study reveals a possible association of COL11A1 and MTHFR with PAC in the Han Chinese population. These results will contribute to an improved understanding of the genetic basis of PACG. PMID:27824919

  12. ABCC5, a gene that influences the anterior chamber depth, is associated with primary angle closure glaucoma.

    PubMed

    Nongpiur, Monisha E; Khor, Chiea Chuen; Jia, Hongyan; Cornes, Belinda K; Chen, Li-Jia; Qiao, Chunyan; Nair, K Saidas; Cheng, Ching-Yu; Xu, Liang; George, Ronnie; Tan, Do; Abu-Amero, Khaled; Perera, Shamira A; Ozaki, Mineo; Mizoguchi, Takanori; Kurimoto, Yasuo; Low, Sancy; Tajudin, Liza-Sharmini A; Ho, Ching-Lin; Tham, Clement C Y; Soto, Ileana; Chew, Paul T K; Wong, Hon-Tym; Shantha, Balekudaru; Kuroda, Masako; Osman, Essam A; Tang, Guangxian; Fan, Sujie; Meng, Hailin; Wang, Hua; Feng, Bo; Yong, Victor H K; Ting, Serena M L; Li, Yang; Wang, Ya-Xing; Li, Zheng; Lavanya, Raghavan; Wu, Ren-Yi; Zheng, Ying-Feng; Su, Daniel H; Loon, Seng-Chee; Yong, Vernon K Y; Allingham, R Rand; Hauser, Michael A; Soumittra, Nagaswamy; Ramprasad, Vedam L; Waseem, Naushin; Yaakub, Azhany; Chia, Kee-Seng; Kumaramanickavel, Govindasamy; Wong, Tina T; How, Alicia C; Chau, Tran Nguyen Bich; Simmons, Cameron P; Bei, Jin-Xin; Zeng, Yi-Xin; Bhattacharya, Shomi S; Zhang, Mingzhi; Tan, Donald T; Teo, Yik-Ying; Al-Obeidan, Saleh A; Hon, Do Nhu; Tai, E-Shyong; Saw, Seang-Mei; Foster, Paul J; Vijaya, Lingam; Jonas, Jost B; Wong, Tien-Yin; John, Simon W M; Pang, Chi-Pui; Vithana, Eranga N; Wang, Ningli; Aung, Tin

    2014-03-01

    Anterior chamber depth (ACD) is a key anatomical risk factor for primary angle closure glaucoma (PACG). We conducted a genome-wide association study (GWAS) on ACD to discover novel genes for PACG on a total of 5,308 population-based individuals of Asian descent. Genome-wide significant association was observed at a sequence variant within ABCC5 (rs1401999; per-allele effect size =  -0.045 mm, P = 8.17 × 10(-9)). This locus was associated with an increase in risk of PACG in a separate case-control study of 4,276 PACG cases and 18,801 controls (per-allele OR = 1.13 [95% CI: 1.06-1.22], P = 0.00046). The association was strengthened when a sub-group of controls with open angles were included in the analysis (per-allele OR = 1.30, P = 7.45 × 10(-9); 3,458 cases vs. 3,831 controls). Our findings suggest that the increase in PACG risk could in part be mediated by genetic sequence variants influencing anterior chamber dimensions.

  13. ABCC5, a Gene That Influences the Anterior Chamber Depth, Is Associated with Primary Angle Closure Glaucoma

    PubMed Central

    Cornes, Belinda K.; Chen, Li-Jia; Qiao, Chunyan; Nair, K. Saidas; Cheng, Ching-Yu; Xu, Liang; George, Ronnie; Tan, Do; Abu-Amero, Khaled; Perera, Shamira A.; Ozaki, Mineo; Mizoguchi, Takanori; Kurimoto, Yasuo; Low, Sancy; Tajudin, Liza-Sharmini A.; Ho, Ching-Lin; Tham, Clement C. Y.; Soto, Ileana; Chew, Paul T. K.; Wong, Hon-Tym; Shantha, Balekudaru; Kuroda, Masako; Osman, Essam A.; Tang, Guangxian; Fan, Sujie; Meng, Hailin; Wang, Hua; Feng, Bo; Yong, Victor H. K.; Ting, Serena M. L.; Li, Yang; Wang, Ya-Xing; Li, Zheng; Lavanya, Raghavan; Wu, Ren-Yi; Zheng, Ying-Feng; Su, Daniel H.; Loon, Seng-Chee; Allingham, R. Rand; Hauser, Michael A.; Soumittra, Nagaswamy; Ramprasad, Vedam L.; Waseem, Naushin; Yaakub, Azhany; Chia, Kee-Seng; Kumaramanickavel, Govindasamy; Wong, Tina T.; How, Alicia C.; Chau, Tran Nguyen Bich; Simmons, Cameron P.; Bei, Jin-Xin; Zeng, Yi-Xin; Bhattacharya, Shomi S.; Zhang, Mingzhi; Tan, Donald T.; Teo, Yik-Ying; Al-Obeidan, Saleh A.; Hon, Do Nhu; Tai, E-Shyong; Saw, Seang-Mei; Foster, Paul J.; Vijaya, Lingam; Jonas, Jost B.; Wong, Tien-Yin; John, Simon W. M.; Pang, Chi-Pui; Vithana, Eranga N.; Wang, Ningli; Aung, Tin

    2014-01-01

    Anterior chamber depth (ACD) is a key anatomical risk factor for primary angle closure glaucoma (PACG). We conducted a genome-wide association study (GWAS) on ACD to discover novel genes for PACG on a total of 5,308 population-based individuals of Asian descent. Genome-wide significant association was observed at a sequence variant within ABCC5 (rs1401999; per-allele effect size = −0.045 mm, P = 8.17×10−9). This locus was associated with an increase in risk of PACG in a separate case-control study of 4,276 PACG cases and 18,801 controls (per-allele OR = 1.13 [95% CI: 1.06–1.22], P = 0.00046). The association was strengthened when a sub-group of controls with open angles were included in the analysis (per-allele OR = 1.30, P = 7.45×10−9; 3,458 cases vs. 3,831 controls). Our findings suggest that the increase in PACG risk could in part be mediated by genetic sequence variants influencing anterior chamber dimensions. PMID:24603532

  14. Peripapillary retinal vessel density in eyes with acute primary angle closure: an optical coherence tomography angiography study.

    PubMed

    Wang, Xiaolei; Jiang, Chunhui; Kong, Xiangmei; Yu, Xiaobo; Sun, Xinghuai

    2017-05-01

    The purpose was to investigate peripapillary retinal vessel density in resolved acute primary angle closure (APAC) eyes. This was a prospective, cross-sectional observational study. Thirty-four eyes of 34 patients with unilateral APAC were included, together with the fellow eyes with primary angle closure suspect (PACS) as controls. Peripapillary retinal vessel density was measured using optical coherence tomography (OCT) angiography. Peripapillary retinal vessel density was compared in both eyes and the potential relationship with visual field (VF) test results was evaluated. After an acute attack, the peripapillary retinal vessel density was lower in the APAC than in the PACS eyes (79.3 ± 8.2 versus 85.6 ± 4.9, respectively; P = 0.001). The VF mean deviation (MD) (-7.7 ± 6.7 versus -3.3 ± 1.8 dB, P = 0.002), and the pattern standard deviation (PSD) (4.6 ± 3.3 versus 2.4 ± 0.9 dB, P = 0.001) were worse for the APAC than the PACS eyes, but both had similar thicknesses of the retinal nerve fiber layer (RNFL) (111.8 ± 9.6 versus 114.1 ± 29.1 μm, P = 0.880) and ganglion cell complex (GCC) (94.7 ± 7.5 versus 91.8 ± 9.3 μm, P = 0.328). The peripapillary retinal vessel density was significantly correlated with the VF MD (vessel density: r = 0.455, P = 0.008) and PSD (vessel density: r = -0.592, P < 0.001) in the APAC eyes. Even when IOP was normalized after the acute attack, the APAC eyes had a lower peripapillary retinal vessel density, which was correlated with the VF values. OCT angiography is a reliable method for detecting vascular changes in glaucomatous eyes that show no thinning of the RNFL and GCC.

  15. Optic nerve head changes after short-term intraocular pressure elevation in acute primary angle-closure suspects.

    PubMed

    Jiang, Ran; Xu, Liang; Liu, Xue; Chen, Jian Dong; Jonas, Jost B; Wang, Ya Xing

    2015-04-01

    To investigate changes in the optic nerve head morphology after acute intraocular pressure (IOP) elevation during a dark room prone provocative test (DRPPT). Prospective cohort study. Acute primary angle-closure (APAC) suspects underwent DRPPT. Study participants stayed in a dark room for 2 hours with the forehead placed on a desk. At baseline and within 5 minutes after DRPPT, tonometry and enhanced depth imaging by spectral-domain optical coherence tomography (SD OCT) were performed. Changes in 3-dimensional optic nerve head topography. The study included 114 eyes of 65 participants with a mean age of 58.3±8.7 years and a mean IOP elevation of 10.1±10.9 mmHg during DRPPT. When all eyes were included, the mean value of most optic disc parameters did not change significantly, except for a decrease in the temporal minimal rim width (P = 0.005). By including only eyes with an IOP increase greater than 15 mmHg, the mean value of cup width (P = 0.001) and cup depth (P = 0.002) increased, whereas the lamina cribrosa (LC) thickness (P = 0.035), temporal minimal rim width (P = 0.001), and nasal minimal rim width (P < 0.001) decreased. The LC depth and Bruch's membrane opening (BMO) did not differ between the baseline and the end of DRPPT. An IOP increase was significantly associated with widening (P < 0.001; r = 0.46) and deepening (P < 0.001; r = 0.52) of the optic cup, thinning of the LC (P = 0.003; r = -0.35), temporal minimal rim width (P < 0.001; r = -0.34), and nasal minimal rim width (P < 0.001; r = -0.35). Angle-closure suspect eyes showed a widening and deepening of the optic cup, decrease in neuroretinal rim width, and thinning of the LC after a darkness-induced IOP increase of >15 mmHg. The diameter of the BMO and position of the anterior LC surface remained unchanged. This suggests that a short-term IOP increase leads to a condensation of neuroretinal rim, prelaminar tissue, and LC, without major changes in the optic disc size and position of the anterior LC

  16. An evaluation of the darkroom prone provocative test in family members of primary angle closure glaucoma patients.

    PubMed

    Sihota, R; Mohan, S; Dada, T; Gupta, V; Pandey, R M; Ghate, D

    2007-07-01

    To compare ocular biometric parameters with darkroom prone provocative test (DRPPT) in family members of primary angle closure glaucoma (PACG) patients. One hundred and forty-nine family members of 46 PACG patients underwent ocular examination included slit lamp biomicroscopy, gonioscopy, fundus examination using +90 D lens, Goldmann applanation tonometry, darkroom prone provocative test, perimetry on Humphrey's field analyzer II and optic disc evaluation using HRT II. Ultrasonic ocular biometry and the DRPPT were then performed. IOP>or=8 mmHg rise from baseline with iridocorneal touch was considered as a positive test. Of the 149 family members examined, 55 (36.9%) were found to have PACG. Forty (72.7%) of these had subacute PACG and 15 (27.3%) were found to have chronic PACG. Thirty-nine (70.3%) of the affected members showed a positive DRPPT. Mean anterior chamber depth (ACD) was 2.03+/-0.3, 2.3+/-0.4, 2.7+/-0.3 mm (P=0.0001) and mean lens thickness was 4.41+/-0.39, 3.99+/-0.5, 3.93+/-0.4 mm (P=0.0001) in DRPPT positives, borderlines and negatives respectively. ROC curve (ACD) plotted showed cutoff value of 2.07 mm (sensitivity 88.57%) for screening. Anterior chamber is shallowest, lens is thickest and axial length is shortest in affected and DRPPT positive, family members of PACG patients.

  17. Risk Factors for Progressive Visual Field Loss in Primary Angle-Closure Glaucoma: A Retrospective Cohort Study

    PubMed Central

    Fan, Nai-Wen; Hwang, De-Kuang; Ko, Yu-Chieh; Tseng, Fan-Chen; Hung, Kuo-Hsuan; Liu, Catherine Jui-Ling

    2013-01-01

    Purpose To investigate risk factors associated with progressive visual field (VF) loss in primary angle closure glaucoma (PACG). Methods We retrospectively reviewed medical record of PACG patients who had ≥5 reliable VF examinations (central 24-2 threshold test, Humphrey Field Analyzer) and ≥2 years of follow-up. Each VF was scored using Collaborative Initial Glaucoma Treatment Study system. Progression was defined if 3 consecutive follow-up VF tests had an increased score of ≥3 above the mean of the first 2 VF scores. Factors associated with VF progression were evaluated by Cox proportional hazards models. Results A total of 89 eyes from 89 patients (mean age, 69.8 ± 7.9 years), who received a mean of 6.9 ± 2.3 VF tests (mean deviation at initial, -8.1 ± 4.4 dB) with a mean follow-up of 63.9 ± 23.9 months were included. VF progression was detected in 9 eyes (10%). The axial length (AL), anterior chamber depth, and intraocular pressure (IOP) in patients with and without progression were 22.5 ± 0.6 and 23.1 ± 0.9 mm, 2.5 ± 0.3 and 2.5 ± 0.3 mm, 14.8 ± 2.4 and 14.3 ± 2.3 mm Hg, respectively. AL was the only factor associated with progression in both Cox proportional hazards univariate (p = 0.031) and multivariate models (p = 0.023). Conclusion When taking into account age, IOP, follow-up period, and number of VF tests, a shorter AL is the only factor associated with VF progression in this cohort of Chinese patients with PACG. Further studies are warranted to verify the role of AL in progressive VF loss in PACG. PMID:23861982

  18. Diurnal intraocular pressure changes in eyes affected with acute primary angle closure and fellow eyes after laser peripheral iridotomy.

    PubMed

    Park, Han Seok; Kim, Joon Mo; Shim, Seong Hee; Kim, Hyun Tae; Bae, Jeong Hun; Choi, Chul Young; Park, Ki Ho

    2015-09-01

    To evaluate diurnal curves of intraocular pressure (IOP) in eyes affected with unilateral acute primary angle closure (APAC) after laser peripheral iridotomy (LPI), and fellow eyes. The medical records of 22 female patients (44 eyes) with unilateral APAC and LPI performed OU were reviewed along with those of 48 normal control subjects (48 eyes). None of the subjects used glaucoma medications after LPI. IOP was measured with a Goldman applanation tonometer during waking hours and in a sitting position every 2 h between 09:00 and 23:00. IOP profiles were compared including the means, peaks, trough IOPs, and IOP fluctuations of the affected, fellow, and normal eyes. The IOPs of the affected eyes were significantly higher than those of normal eyes at every time point measured, including peak and trough IOPs. The diurnal IOPs of fellow eyes were higher than those of normal eyes, though not significantly. There were no significant differences in IOP fluctuation between the affected, fellow, and normal eyes. IOP diurnal curves for APAC affected, fellow, and normal eyes were not statistically different (repeated measures ANOVA, p = 0.865). The mean coefficient of IOP in affected and fellow eyes ranged from 0.486 to 0.604. There were no clinically significant differences among the three groups in terms of IOP diurnal curves, and thus LPI did not have a significant effect on diurnal patterns of IOP. Though the diurnal IOPs of affected eyes after LPI was significantly higher than those of normal eyes, the IOP range was not acute.

  19. Changes in choroidal thickness after prophylactic iridectomy in primary angle closure suspect eyes using enhanced depth imaging optical coherence tomography.

    PubMed

    Wang, Wei; Zhou, Minwen; Huang, Wenbin; Gao, Xinbo; Zhang, Xiulan

    2015-10-01

    The aim of the present study was to evaluate the effect of surgical peripheral iridectomy (SPI) on choroidal thickness in primary angle-closure suspect (PACS) eyes. This was a prospective observational case series of 30 subjects with PACS. Ocular biometry was performed before SPI (baseline) and then 1 week later. Choroid was imaged by enhanced depth imaging optical coherence tomography (EDI-OCT). The choroidal thickness of the subfoveal area at 1 and 3 mm diameter around the fovea was determined. Central anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and axial length (AL) were measured by A-scan ultrasound. Parameters were compared before SPI (baseline) and 1 week later. Thirty eyes of 30 patients with mean age of 61.53 ± 7.98 years were studied. There was no significant difference in the choroidal thickness at all macular locations before and after SPI (all P > 0.05). Mean subfoveal choroidal thickness was 279.61 μm ± 65.50 μm before and 274.54 μm ± 63.36 μm after SPI (P = 0.308). There was also no significant change in central ACD, LT, VCD, and LT after SPI (all P > 0.05). SPI does not appear to alter choroidal thickness in PACS eyes, as assessed using EDI-OCT. Long-term follow-up of PACS eyes treated with SPI may provide further insight into the effects of this treatment modality on the choroid.

  20. Changes in choroidal thickness after prophylactic iridectomy in primary angle closure suspect eyes using enhanced depth imaging optical coherence tomography

    PubMed Central

    Wang, Wei; Zhou, Minwen; Huang, Wenbin; Gao, Xinbo; Zhang, Xiulan

    2015-01-01

    Purpose: The aim of the present study was to evaluate the effect of surgical peripheral iridectomy (SPI) on choroidal thickness in primary angle-closure suspect (PACS) eyes. Materials and Methods: This was a prospective observational case series of 30 subjects with PACS. Ocular biometry was performed before SPI (baseline) and then 1 week later. Choroid was imaged by enhanced depth imaging optical coherence tomography (EDI-OCT). The choroidal thickness of the subfoveal area at 1 and 3 mm diameter around the fovea was determined. Central anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and axial length (AL) were measured by A-scan ultrasound. Parameters were compared before SPI (baseline) and 1 week later. Results: Thirty eyes of 30 patients with mean age of 61.53 ± 7.98 years were studied. There was no significant difference in the choroidal thickness at all macular locations before and after SPI (all P > 0.05). Mean subfoveal choroidal thickness was 279.61 μm ± 65.50 μm before and 274.54 μm ± 63.36 μm after SPI (P = 0.308). There was also no significant change in central ACD, LT, VCD, and LT after SPI (all P > 0.05). Conclusions: SPI does not appear to alter choroidal thickness in PACS eyes, as assessed using EDI-OCT. Long-term follow-up of PACS eyes treated with SPI may provide further insight into the effects of this treatment modality on the choroid. PMID:26654999

  1. Factors Associated with the Retinal Nerve Fiber Layer Loss after Acute Primary Angle Closure: A Prospective EDI-OCT Study

    PubMed Central

    Lee, Kyoung Min; Lee, Seung Hyen; Kim, Hyunjoong

    2017-01-01

    Purpose To determine the factors associated with retinal nerve fiber layer (RNFL) loss in eyes with acute primary angle-closure (APAC), particularly focusing on the influence of the change in the anterior lamina cribrosa surface depth (LCD). Methods After the initial presentation, 30 eyes with unilateral APAC were followed up at the following specific time points over a 12-month period: 1 week, 1~2 months, 2~3 months, 5~6 months, and 11~12 months. These follow-ups involved intraocular pressure measurements, enhanced depth-imaging spectral-domain optical coherence tomography (SD-OCT) scanning of the optic disc, and measurements of the circumpapillary RNFL thickness. The prelaminar tissue thickness (PLT) and LCD were determined in the SD-OCT images obtained at each follow-up visit. Results Repeated measures analysis of variance revealed a significant pattern of decrease in the global RNFL thickness, PLT, and LCD (all p<0.001). The global RNFL thickness decreased continuously throughout the follow-up period, while the PLT decreased until 5~6 months and did not change thereafter. The LCD reduced until 2~3 months and then also remained steady. Multivariable regression analysis revealed that symptoms with a longer duration before receiving laser peripheral iridotomy (LI) (p = 0.049) and a larger LCD reduction (p = 0.034) were significant factors associated with the conversion to an abnormal RNFL thickness defined using OCT normative data. Conclusion Early short-term decreases in the PLT and LCD and overall long-term decrease in the peripapillary RNFL were observed during a 12-month follow-up after an APAC episode. A longer duration of symptoms before receiving LI treatment and larger LCD reduction during follow-up were associated with the progressive RNFL loss. The LCD reduction may indicate a prior presence of significant pressure-induced stress that had been imposed on the optic nerve head at the time of APAC episode. Glaucomatous progression should be suspected in

  2. Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease

    PubMed Central

    Rao, Aparna; Padhy, Debananda; Sarangi, Sarada; Das, Gopinath

    2016-01-01

    Purpose To evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease. Methods This observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1–4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt). Result There were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7–5.9) and PACG (Odds ratio = 1.6(95%CI-1.19–2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently. Conclusion The ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately. PMID:27788183

  3. Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease.

    PubMed

    Rao, Aparna; Padhy, Debananda; Sarangi, Sarada; Das, Gopinath

    2016-01-01

    To evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease. This observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1-4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt). There were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7-5.9) and PACG (Odds ratio = 1.6(95%CI-1.19-2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently. The ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately.

  4. Bilateral angle closure glaucoma following general anaesthesia.

    PubMed

    Raj, K Mohan; Reddy, P Arun Subhash; Kumar, Vikram Chella

    2015-04-01

    Angle closure glaucoma is one of the ophthalmic emergencies and treatment has to be given at the earliest. It is a rare complication of general anesthesia. A female patient underwent Hysterectomy under general anesthesia. Following this, patient developed bilateral angle closure glaucoma. This patient was treated with antiglaucoma medications followed by YAG laser iridotomy and patient regained vision.

  5. Prevalence of primary angle-closure disease in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study.

    PubMed

    Vijaya, Lingam; George, Ronnie; Arvind, Hemamalini; Baskaran, M; Ve Ramesh, S; Raju, Prema; Kumaramanickavel, Govindasamy; McCarty, Catherine

    2008-04-01

    To determine the prevalence of primary angle-closure glaucoma (PACG), primary angle closure (PAC), and PAC suspect (PACS) in an urban population, and to compare prevalence and associated risk factors with a rural population. Population-based cross-sectional study. Four thousand eight hundred subjects 40 years or older were selected from Chennai city using multistage random cluster sampling. All subjects had a complete ophthalmic examination that included logarithm of the minimum angle of resolution visual acuity, applanation tonometry, gonioscopy, grading of lens opacities, dilated fundus examination, optic disc photography, and visual fields. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology classification. Three thousand eight hundred fifty (80.2%) responded; 34 subjects (17 female, 17 male) had PACG (0.88%; 95% confidence interval [CI], 0.60-1.16). The mean intraocular pressure (IOP) was 26.0+/-14.9 mmHg. Five subjects (14.7%) had been previously diagnosed to have glaucoma, 1 of whom had undergone glaucoma surgery and 2 of whom had been diagnosed to have open-angle glaucoma. Two subjects (5.9%) were bilaterally and 3 subjects (8.8%) were unilaterally blind. One hundred six subjects (2.75%; 95% CI, 2.01-3.49) were diagnosed to have PAC (62 female, 44 male). Thirty-nine subjects (36.8%) had presenting IOP > 24 mmHg, 83 (78.3%) had peripheral anterior synechiae, and 16 (15.1%) had both. Two hundred seventy-eight subjects (7.24%; 95% CI, 6.38-8.02) had PACS (183 female, 95 male). Prevalences of PACG and PACS were similar in the urban and rural populations. Primary angle closure prevalence was higher in the urban population (P<0.0001). Primary angle closure and PACG were positively associated with increasing age and IOP in both populations and were more common in rural women (odds ratio [OR], 4.3; 95% CI, 2.2-8.3). Association with hyperopia was seen only in the urban population (OR, 2.0; 95% CI, 1

  6. Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma.

    PubMed

    Kaushik, Sushmita; Ichhpujani, Parul; Kaur, Savleen; Singh Pandav, Surinder

    2014-01-01

    Primary angle closure glaucoma is usually a bilateral disease, though it may be asymmetrical. However, it is unusual to see advanced glaucoma in one eye and no disk damage in the other. We present a case of unilateral angle closure glaucoma complicated by an optic disk pit and iridociliary cysts. How to cite this article: Kaushik S, Ichhpujani P, Kaur S, Pandav SS. Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma. J Current Glau Prac 2014;8(1): 33-35.

  7. Associations of polymorphisms of rs1015213 with primary angle closure glaucoma-recent evidence and a meta-analysis

    PubMed Central

    Liao, Liang; Gong, Xiaohong; Lu, Ming; Yan, Xiaoling; Xia, Yanting; Wei, Qiping

    2015-01-01

    Background: Primary angle closure glaucoma (PACG) has been thought to have a significantly genetic basis for a long time, and genome-wide association studies (GWAS) have identified various candidate genes including PCMTD1-ST18 rs1015213 as susceptibility loci. However, different results produced inconsistent results and make the conclusions controversial in some extent. Thus, we carried out a systematic review, attempting to summarize the recent evidence and determine the association of rs1015213 with PACG risk. Methods: A systematic literature search was conducted to identify all published studies on associations of rs1015213 (PCMTD1-ST18) polymorphism and PACG risk up to April 30, 2015. Selection of eligible studies was undertaken by two investigators according to inclusion criteria. Summary odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as the pooled ocular biometric measures in different genotype or allele groups, were collected and analyzed. Heterogeneity was measured using the chi-square-based Q statistic test and I2 metric. Publication bias of the included articles was evaluated using funnel plots. Results: 21 eligible studies were included, among them 15 studies with enough data to estimate OR were included for meta-analysis, with a total of 24764 subjects (4737 PACG patients and 20027 controls), including 19416 Asian subjects (4378 PACG patients and 15038 controls) and 5348 Caucasian subjects (359 PACG patients and 4989 controls). Low heterogeneity was detected among studies (for Asian subgroups P=0.80, I2=0%, for Caucasian subgroups P=0.78, I2=0%, for all groups, P=0.89, I2=0%), thus, only fixed-effects model was used in the meta-analysis. The results showed that the frequencies of the TT genotype of rs1015213 were significant higher in PACG group than the controls in Asians (OR=1.51, 95% CI 1.27-1.79, P<0.01) but not in Caucasians (OR=1.54, 95% CI 0.94-2.54, P=0.09). In sensitivity analysis the significance of the pooled OR remained

  8. [The prevalence of blindness caused by primary angle closure glaucoma in middle-aged Chinese population: a systematic review and meta-analysis].

    PubMed

    Liu, M L; Wang, Y X

    2017-05-11

    Objective: To evaluate the rate of blindness caused by primary angle closure glaucoma (PACG) in Chinese population of more than 40 years old, and to explore the effectiveness of a prevention and treatment system on PACG. Methods: We searched the databases of Pubmed, ScienceDirect, Springer Link, CNKI and Wanfang Data and collected all the original studies of the prevalence and blindness of angle closure glaucoma in China. The population was limited to over 40 years old. The research site was limited to the community-based, while the published time was not limited. Two researchers completed the literature search, data extraction and methodological quality assessment independently, with same criteria. Meta analysis was performed using R software. Results: Five papers were included in this study finally. A total of 26 437 cases of natural population over the age of 40 were observed, and 306 cases of angle closure glaucoma were found, of which 113 cases had binocular or monocular blindness caused by PACG. The random effect model meta-analysis results showed that the overall blindness rate was 38.3% [95%CI (28.1%, 49.6%)]. In Beijing, where the prevention and treatment system was well established, the blindness rate was far lower than that in the areas where the system was poorly established. Compared with the past, the blindness rate caused by PACG in Beijing decreased sharply. Conclusions: The rate of blindness caused by PACG is still high in the mainland of China. The prevention and treatment system is effective and worth promoting. (Chin J Ophthalmol, 2017, 53: 373-377).

  9. Intrinsic Functional Connectivity Alterations of the Primary Visual Cortex in Primary Angle-Closure Glaucoma Patients before and after Surgery: A Resting-State fMRI Study

    PubMed Central

    Gong, Honghan; Jiang, Fei; Liu, Dan; Cai, Fengqin; Pei, Chonggang; Zhou, Fuqing; Zeng, Xianjun

    2017-01-01

    Purpose To investigate the altered intrinsic functional connectivity (iFC) of the primary visual cortex (V1) in primary angle-closure glaucoma (PACG) patients before and after surgery using resting-state functional MRI. Materials and Methods Twenty-five preoperative PACG (pre-PACG) patients and 25 well-matched healthy controls (HCs) were included in this study, and 9 PACG patients were assessed again at least 3 months after treatment (post-PACG). We generated the iFC maps of the seed regions in the centers of the left and right V1 and conducted group comparisons. Then, the relationships between the altered iFC coefficients and clinical variables were investigated in the pre-PACG patients. Results Compared with the HCs, the pre-PACG patients showed decreased iFC between the left V1 and right V2 (covering the cuneus, calcarine and lingual gyrus) and increased iFC between the left V1 and left temporal-parietal region, left frontal opercula-insula-basal ganglia region, right insula-basal ganglia region, and right inferior parietal lobule (P < 0.01, corrected). Compared with the pre-PACG patients, the post-PACG patients showed increased iFC between the left V1 and bilateral V2, and between the left V1 and left or right postcentral gyrus; in addition, they showed decreased iFC between the left V1 and the dorsal-attention and frontoparietal-control networks. In the pre-PACG patients, visual activity (VA) was positively correlated with increased iFC between the left V1 and the left temporal-parietal region or the right inferior parietal lobule. Similar patterns of alterations were observed in the right V1-iFC in both the pre- and post-PACG patients. Conclusions The primary findings have demonstrated a gradual decrease in visual information integration in the left V1-V2 pathway and VA-related functional compensation in the pre-PACG patients, generating further evidence of functional restoration in post-PACG patients. PMID:28122025

  10. Fish allergy causing angioedema and secondary angle-closure glaucoma.

    PubMed

    Calder, Donovan; Calder, Jennifer

    2013-03-06

    A 56-year-old woman with a history of primary angle-closure glaucoma presented with acute generalised swelling, and facial angioedema following a fish meal. She complained of nausea, vomiting, headache, pain in both eyes and acute loss of vision. Her visual acuity was reduced and intraocular pressures (IOP) were elevated. Gonioscopy revealed complete angle closure in the left eye and complete to partial closure in the right eye. Through existing peripheral iridotomies the anterior capsules were seen pressed up against the iris of both eyes. A diagnosis of angle-closure glaucoma was made, medications were started to reduce the elevated intraocular pressure and systemic antihistamine to counter the allergic reaction. She was hospitalised for further management. A follow-up at 2 years revealed her visual acuities and IOP had remained normal.

  11. Dynamic changes of anterior segment in patients with different stages of primary angle-closure in both eyes and normal subjects.

    PubMed

    Lin, Jialiu; Wang, Zhonghao; Chung, Chuchen; Xu, Jianan; Dai, Miaomiao; Huang, Jingjing

    2017-01-01

    To compare changes in anterior segment parameters under light and dark (light-to-dark) conditions among eyes with chronic primary angle-closure glaucoma (CPACG), fellow eyes with confirmed or suspect primary angle-closure (PAC or PACS), and age-matched healthy eyes. Consecutive patients with CPACG in one eye and PAC/PACS in the fellow eye, as well as age-matched healthy subjects were recruited. Anterior segment optical coherence tomography measurements were conducted under light and dark conditions, and anterior chamber, lens, and iris parameters compared. Demographic and biometric factors associated with light-to-dark change in iris area were analyzed by linear regression. Fifty-seven patients (mean age 59.6±8.9 years) and 30 normal subjects matched for age (60.6±9.3 years) and sex ratio were recruited. In regards to differences under light-to-dark conditions, angle opening distance at 500 μm (AOD500μm) and iris area during light-to-dark transition were smaller in CPACG eyes than fellow PACS/PAC eyes and normal eyes (P<0.017). Pupil diameter change was largest in normal eyes, and larger in PACS/PAC eyes than CPACG eyes (P<0.017). There was an average reduction of 0.145 mm2 in iris area for each millimeter of pupil diameter increase in CPACG eyes, 0.161 mm2 in fellow PAC/PACS eyes, and 0.165 mm2 in normal eyes. Larger iris curvature in the dark and diagnosis of PACG were significantly associated with less light-to-dark iris area changes. Dynamic changes in iris parameters with light-to-dark transition differed significantly among CPACG eyes, fellow PAC/PACS eyes, and normal eyes. Greater iris curvature under dark conditions was correlated with reduced light-to-dark change in iris area and pupil diameter, which may contribute to disease progression.

  12. The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): study protocol for a randomized controlled trial

    PubMed Central

    2011-01-01

    Background Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care. EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care. Methods/Design EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible. The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events. A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean

  13. The Dimensions of Eyes with Chronic Angle-closure Glaucoma.

    PubMed

    Salmon, J F; Swanevelder, S A; Donald, M A

    1994-01-01

    The measurement of eyes with primary angle-closure glaucoma has been comprehensively documented in people of European ethnic origin. In comparison, few biometric studies have examined the relationship of one intraocular structure to another in people of Oriental or African ethnic background with primary angle-closure glaucoma. To determine the ocular characteristics of people with this ethnic background suffering from chronic angleclosure glacoma, both eyes of 46 patients with chronic angle-closure glaucoma were measured by contact A-scan ultrasonography, and the measurements were compared with those found in two groups of 23 matched normals. The correlation between the measurements obtained in the right and left eyes in each group was statistically significant (p < 0.001). Although the mean axial length was less (22.43 mm vs. 23.17 and 23.25 mm, p = 0.0001), the mean anterior chamber depth shallower (2.48 mm vs. 2.80 and 2.81 mm, p < 0.001). and the mean "relative lens position'' more anterior in eyes with chronic angle-closure glaucoma compared with normal, the mean lens thickness in all three groups was similar (4.73 mm). These measurements are significantly different from those reported in other ethnic groups. In comparison with the previously reported findings in Europeans, an anterior lens position without significant lens enlargement is responsible for the crowded anterior segment in our patients with chronic angle-closure glaucoma.

  14. Is prophylactic laser peripheral iridotomy for primary angle closure suspects a risk factor for cataract progression? The Chennai Eye Disease Incidence Study.

    PubMed

    Vijaya, Lingam; Asokan, Rashima; Panday, Manish; George, Ronnie

    2017-05-01

    To report the risk of cataract progression among primary angle closure suspects (PACS) 6 years after they underwent laser peripheral iridotomy (LPI). In the Chennai Eye Disease Incidence Study, 6 years after their baseline evaluation, 4421 subjects were examined again. As part of a detailed evaluation cataract was graded using the Lens Opacities Classification System II; progression was defined as change of cataract by two or more grades or history of cataract surgery in the 6-year period. Only bilaterally phakic subjects with less than N2 or C2 or P2 cataract at baseline with no history of any form of glaucoma, primary angle closure and pseudoexfoliation were included. There were 3205 eligible subjects. Of these, 190 had undergone LPI for PACS. In comparison to the study population, they were significantly older (p<0.001), female (p=0.008), urban residents (p=0.001) and patients with hypertension (p<0.001). During the intervening period, 53 subjects had undergone cataract surgery. The cataract progression rate was significantly greater (OR 1.7, 95% CI 1.3 to 2.4, p<0.001) in those who had undergone LPI. For the study population the baseline risk factors for progression of cataract were age (p<0.001), female gender (p=0.01), diabetes (p<0.001) and LPI (p<0.001). Diabetes and female gender were significant risk factors for nuclear and cortical cataract progression; LPI was a risk factor only for cortical cataract (OR 1.6, 95% CI 1.1 to 2.3, p=0.007). There was significant cataract progression in 6 years following LPI for PACS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

    PubMed Central

    Javanbakht, Mehdi; Azuara-Blanco, Augusto; Burr, Jennifer M; Ramsay, Craig; Cooper, David; Cochran, Claire; Norrie, John; Scotland, Graham

    2017-01-01

    Objective To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon. Setting 22 hospital eye services in the UK. Population Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC). Interventions Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery). Outcome measures Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care. Results The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years. Trial registration number ISRCTN44464607; Results. PMID:28087548

  16. Drug-induced Angle-Closure Glaucoma

    PubMed Central

    Khurana, Aruj K; Khurana, Bhawna

    2012-01-01

    Drug-induced angle-closure glaucoma is an important entity for the ophthalmologist as well as the general physician as it represents a preventable cause of potential blindness. This brief review highlights the fact that a high index of suspicion, in a susceptible individual followed by confirmation on appropriate imaging modality (UBM, ultrasound or anterior segment OCT) can alleviate the threat to sight and also help to institute appropriate therapy. PMID:27990064

  17. Spectrum of Angle Closure, Uveal Effusion Syndrome, and Nanophthalmos

    PubMed Central

    Neale, Matthew; Johnson, Sandra M

    2016-01-01

    Nanophthalmos, uveal effusion syndrome, and acute angle closure glaucoma (ACG) can present as a continuum in a patient, as is described here. This patient's angle closure was thought to be caused by idiopathic uveal effusion syndrome, and while there are no generally accepted diagnosis criteria for nanophthalmos, our patient fulfilled the criteria as defined by Wu.10 To prevent development of further angle closure, the decision was made to do cataract extraction as opposed to medical management. How to cite this article Areiter E, Neale M, Johnson SM. Spectrum of Angle Closure, Uveal Effusion Syndrome, and Nanophthalmos. J Curr Glaucoma Pract 2016;10(3):113-117. PMID:27857491

  18. Mirtazapine-induced acute angle closure

    PubMed Central

    Kahraman, Nilay; Durmaz, Onur; Durna, Mehmet Murat

    2015-01-01

    Acute angle closure (AAC) is an ocular emergency with symptoms including blurred vision, eye pain, headache, nausea, vomiting and reddening of the eye those results from increased intraocular pressure. This clinical condition can lead to permanent damage in vision, thus causing blindness by generating progressive and irreversible optic neuropathy if left untreated. There are several reasons of AAC, including several types of local and systemic medications; mainly sympathomimetics, cholinergics, anti-cholinergics, mydriatics, anti-histamines, antiepileptics like topiramate, tricyclic and tetracyclic antidepressants, serotonin reuptake inhibitors, antipsychotics, sulfa-based drugs and anticoagulants. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, is an atypical antidepressant with a complex pharmacological profile. This case report describes a patient with major depressive disorder, who experienced AAC after the first dosage of mirtazapine treatment, and highlights the importance of close monitoring of individuals under antidepressant treatment particularly immediately after initiation of the drug. PMID:26265648

  19. Cross-sectional study of the retinal nerve fiber layer thickness at 7 years after an acute episode of unilateral primary acute angle closure.

    PubMed

    Lee, Jacky W Y; Woo, Tiffany T Y; Yau, Gordon S K; Yip, Stan; Yick, Doris W F; Wong, Jasper; Wong, Raymond L M; Wong, Ian Y H

    2015-01-01

    The purpose of this article is to investigate the long-term retinal nerve fiber layer (RNFL) status and determinants of RNFL thinning after an episode of unilateral primary acute angle closure (AAC). This cross-sectional study analyzed the medical records of consecutive patients with a single episode of unilateral AAC from 1999 to 2009 in Hong Kong. The peripapillary RNFL thickness was correlated with age, gender, presenting intraocular pressure (IOP), time to laser iridotomy, time to cataract extraction, follow-up duration, as well as the last IOP, vertical cup-to-disc ratio (CDR), and vision. The fellow uninvolved eye was used as a proxy comparison of RNFL loss in the attack eye. In 40 eligible patients, the mean age was 68.3 ± 8.7 years with a male-to-female ratio of 1:7. The mean presenting IOP was 49.2 ± 14.0 mm Hg and the time from presentation to laser iridotomy was 6.7 ± 6.9 days. Forty percent of subjects received a cataract extraction at 3.2 ± 2.9 years after the attack. The last IOP, CDR, and LogMAR vision were 16.0 ± 3.8 mm Hg, 0.6 ± 0.2, and 0.6 ± 0.6 LogMAR units, respectively, at 7.9 ± 2.4 years. The RNFL thickness in the attack eye (69.2 ± 19.1 μm) was 25.2 ± 17.9% thinner than the fellow eye (93.0 ± 17.8 μm) at 7.5 ± 2.9 years post-AAC. Using univariate analysis, the last vertical CDR (odds ratio [OR] = 17.2, P = 0.049) and LogMAR visual acuity (VA) (OR = 6.6, P = 0.03) were the only significant predictors for RNFL thinning whereas none of the other covariates showed significant associations (P > 0.1). At 7.5 years following unilateral AAC, the RNFL thickness was 25% thinner than the fellow eye. CDR enlargement and poor VA were the only significant predictors for RNFL loss.

  20. Profile of the subtypes of angle closure glaucoma in a tertiary hospital in north India.

    PubMed

    Sihota, R; Agarwal, H C

    1998-03-01

    A prospective study of 500 consecutive patients of primary angle closure glaucoma was undertaken to study the clinical profile of the three subtypes: acute, subacute, and chronic. A record of age and sex distributions, symptomatology, the best corrected visual acuity, gonioscopy, visual fields, methods of control of intraocular pressure, and status of the second eye was maintained. Statistical analysis of these parameters and the subtypes of angle closure glaucoma was carried out using the chi-square test. Angle closure glaucoma constituted 45.9% of all primary adult glaucomas seen. 24.8% of these had acute angle closure glaucoma, 31.2% subacute, and 44% chronic glaucoma. Angle closure glaucoma occurred maximally in the sixth decade and females constituted 51.4% of those affected. The difference in symptoms among the subtypes was significant (p < 0.001). More than 80% of the chronic eyes had no significant symptoms. Visual field defects specific for glaucoma were seen in only 15.1% of chronic glaucoma eyes. Bilaterality was commonest in subacute angle closure glaucoma (95.5%) and least in acute angle closure 35.5%. Nd YAG iridotomy alone or with topical medication controlled the intraocular pressure in 48.3% of acute angle closure glaucoma, 78.8% of subacutes, and 30% of chronic eyes. Statistically, each parameter reviewed was significantly different among the subtypes. There are considerable differences as well as an overlap of clinical features in the subtypes of angle closure glaucoma, which suggest some anatomical differences or dissimilar pathogenic mechanisms in these eyes.

  1. Prevalence of angle-closure disease in a rural southern Indian population.

    PubMed

    Vijaya, Lingam; George, Ronnie; Arvind, Hemamalini; Baskaran, M; Paul, Pradeep G; Ramesh, S Ve; Raju, Prema; Kumaramanickavel, Govindasamy; McCarty, Catherine

    2006-03-01

    To estimate the prevalence of primary angle-closure glaucoma, primary angle closure (PAC), and primary angle-closure suspect (PACS) and its associated risk factors in a rural population in southern India. Three thousand and nine hundred thirty-four (81.95%) of 4800 enumerated subjects aged 40 years or older underwent a complete ophthalmic examination, including compression gonioscopy. Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology classification. Data were analyzed for 3924 subjects (81.75%). Primary angle-closure glaucoma was diagnosed in 34 subjects (0.87%; 95% confidence interval [CI], 0.58 to 1.16) (27 women, 7 men). The mean intraocular pressure was 20.71 +/- 9.24 mm Hg. One subject (2.94%) was blind. Twenty-eight subjects (0.71%; 95% CI, 0.45 to 0.98) were diagnosed to have PAC (21 women, 7 men). Eleven subjects (39.3%) had an intraocular pressure greater than 21 mm Hg, 13 subjects (46.43%) had peripheral anterior synechiae, and 4 subjects (14.29%) had both. Two hundred forty-six subjects (6.27%; 95% CI, 5.51 to 7.03) had PACS (168 women, 78 men). Primary angle closure and primary angle-closure glaucoma were more common in women (age-adjusted odds ratio, 3.02; 95% CI, 1.66 to 5.51) with an increasing prevalence with age. Increasing intraocular pressure was associated with the disease (odds ratio, 1.14; 95% CI, 1.09 to 1.19). There was no association with hypertension and hyperopia. Axial length and anterior chamber depth were longer in the normal group than in the 3 groups with angle closure (P<.05). Women had shorter axial lengths than men (P<.001) in the angle closure groups. The overall prevalence of primary angle closures (PAC and primary angle-closure glaucoma) in a rural population of southern India was 1.58%. There was a female preponderance, and the disease tends to be asymptomatic.

  2. Changing trends of imaging in angle closure evaluation.

    PubMed

    Dorairaj, Syril; Tsai, James C; Grippo, Tomas M

    2012-01-01

    Primary angle closure glaucoma (PACG) is a significant cause of visual disability worldwide. It predominantly affects the Eastern and South Asian population of the world. Early detection of anatomically narrow angles is important, and the subsequent prevention of visual loss from PACG depends on an accurate assessment of the anterior chamber angle (ACA). Gonioscopy has given way to modern day imaging technologies such as ultrasound biomicroscopy (UBM) and more recently, anterior segment optical coherence tomography (AS-OCT). Ultrasound biomicroscopy provides objective, high-resolution images of anterior segment anatomy, including the cornea, iris, anterior chamber, anterior chamber angle, and ciliary body. Optical coherence tomography (OCT) is a noncontact optical signal acquisition and processing device that provides magnified, high-resolution cross-sectional images of ocular tissues. Recent technological advances towards three-dimensional visualization broadened the scope of AS-OCT in ophthalmologic evaluation. Optical coherence tomography systems use low-coherence, near-infrared light to provide detailed images of anterior segment structures at resolutions exceeding that of UBM. This paper summarizes the clinical application of UBM and OCT for assessment of anterior segment in glaucoma.

  3. Primary closure for postoperative mediastinitis in children.

    PubMed

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L

    2004-09-01

    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  4. Angle closure glaucoma following a combined blepharoplasty and ectropion repair.

    PubMed

    Gayton, J L; Ledford, J K

    1992-01-01

    This paper reports an occurrence of angle closure glaucoma following a combined blepharoplasty and ectropion repair. We are unaware of any previous reports of such an incident. Specific to this case was the coexistence of a cataract that contributed to the narrowing of the anterior chamber. This condition, along with pupil dilation secondary to the anesthetic, precipitated a phacomorphic angle closure glaucoma attack, necessitating emergency cataract surgery. Because other procedures involve pupillary dilation as a potential side effect, we recommend an increased awareness of this potential postoperative complication.

  5. Risk of angle-closure glaucoma with bupropion and topiramate.

    PubMed

    Symes, Richard J; Etminan, Mahyar; Mikelberg, Frederick S

    2015-10-01

    Epidemiologic studies have shown that antidepressants may increase the risk of angle-closure glaucoma. We examined the risk of angle-closure glaucoma with bupropion hydrochloride, a unique, popular antidepressant also marketed as a smoking cessation aid. A nested case-control study was conducted using a large health claims database in the United States from January 1, 2006, to March 31, 2014. The database contained deidentified information pertaining to a cohort of 6 110 723 patients. Cases were defined according to the first coding for angle-closure glaucoma. For each case, 10 control participants were selected and matched to the cases using density-based sampling. Adjusted rate ratios were computed for bupropion, topiramate (positive control group drug), and esomeprazole (negative control group drug). The adjusted rate ratio was 1.09 (95% CI, 0.75-1.59) for bupropion and 2.59 (95% CI, 1.56-4.30) for topiramate. In a prespecified analysis of patients younger than 50 years, the adjusted rate ratio was 1.98 (95% CI, 1.02-3.84) for bupropion and 5.30 (95% CI, 2.54-11.04) for topiramate. Both bupropion and topiramate are widely prescribed drugs. The risk of angle-closure glaucoma in patients younger than 50 years was twice as high in patients taking bupropion and more than 5 times higher in patients taking topiramate.

  6. Isolated Microspherophakia Presenting with Angle-Closure Glaucoma

    PubMed Central

    Şimşek, Tülay; Beyazyıldız, Emrullah; Şimşek, Enver; Öztürk, Faruk

    2016-01-01

    We report a case of 13-year-old girl presenting to our clinic with blurred vision in both eyes. Ophthalmic examination revealed high myopia and angle-closure glaucoma due to pupillary block caused by small, spherical crystalline lenses. Treatment approaches to glaucoma in patients with microspherophakia are discussed in this case report. PMID:28058167

  7. Combined phacoemulsification with ExPRESS shunt in angle closure glaucoma.

    PubMed

    Rao, Aparna

    2015-01-01

    A 60-year-old woman diagnosed with primary angle closure glaucoma with extensive peripheral anterior synechiae (PAS) and advanced glaucomatous optic neuropathy unresponsive to maximal medical treatment, underwent clear corneal phacoemulsification and ExPRESS (Alcon Inc, Fort Worth, TX) shunt surgery in the right eye with intraoperative placement tailored to avoid areas of PAS. Postoperatively her visual acuity in the right eye was 20/20 and intraocular pressure was 13 mm Hg with the shunt in place and functioning bleb at final follow-up. The ExPRESS shunt can be used in angle closure eyes with good outcomes after proper placement of the shunt.

  8. Combined phacoemulsification with ExPRESS shunt in angle closure glaucoma

    PubMed Central

    Rao, Aparna

    2015-01-01

    Summary A 60-year-old woman diagnosed with primary angle closure glaucoma with extensive peripheral anterior synechiae (PAS) and advanced glaucomatous optic neuropathy unresponsive to maximal medical treatment, underwent clear corneal phacoemulsification and ExPRESS (Alcon Inc, Fort Worth, TX) shunt surgery in the right eye with intraoperative placement tailored to avoid areas of PAS. Postoperatively her visual acuity in the right eye was 20/20 and intraocular pressure was 13 mm Hg with the shunt in place and functioning bleb at final follow-up. The ExPRESS shunt can be used in angle closure eyes with good outcomes after proper placement of the shunt. PMID:27330457

  9. Ocular biometry in occludable angles and angle closure glaucoma: a population based survey.

    PubMed

    George, R; Paul, P G; Baskaran, M; Ramesh, S Ve; Raju, P; Arvind, H; McCarty, C; Vijaya, L

    2003-04-01

    To compare ocular biometric values in a population based sample of eyes with occludable angles, angle closure glaucoma, and normal subjects. 2850 subjects from a population based glaucoma prevalence study underwent complete ocular examination including indentation gonioscopy. Ocular biometry was performed in all subjects classified to have occludable angles (n = 143); angle closure glaucoma (n = 22), and a random subgroup of 419 normal subjects. Ocular biometry readings between the groups were compared and statistically analysed using "t," "z," and Mann-Whitney U tests. The mean age among subjects with occludable angles (54.43 (SD 9.53) years) and angle closure glaucoma (57.45 (8.5) years) was significantly higher (p<0.001) than normal subjects (49.95 (9.95) years). Axial length was shorter (p<0.001) in the occludable angle group (22.07 (0.69) mm) compared to the normal group (22.76 (0.78) mm). Anterior chamber depth (ACD) was shallower (p<0.001) among subjects with occludable angles (2.53 (0.26) mm) than normal subjects (3.00 (0.30) mm). Lens thickness (LT) was greater (p<0.001) in people with occludable angles (4.40 (0.53) mm) compared to normal subjects (4.31 (0.31) mm). No significant difference was noted in axial length, ACD (p = 0.451), and LT (p = 0.302) between angle closure glaucoma and occludable eyes. South Indian eyes with angle closure glaucoma and occludable angles seem to have significantly shorter axial lengths, shallower anterior chambers and greater lens thickness compared to the normal group.

  10. Rural Primary School Closures in England.

    ERIC Educational Resources Information Center

    Whitfield, Richard C.

    A three-phase interdisciplinary effort between educators and environmental planners is focusing on the social effects of rural primary school reorganization now occuring in England as a result of a declining birth rate and the resulting need for school closure. A questionnaire mailed nationally to rural Local Education Authorities, cross-community…

  11. Angle-closure glaucoma after piggyback intraocular lens implantation.

    PubMed

    García-Feijo, J; Saenz-Frances, F; Martinez-De-La-Casa, J M; Mendez-Hernandez, C; Fernandez-Vidal, A; Elias-de-Tejada, M; Reche-Frutos, J; Garcia-Sanchez, J

    2008-01-01

    To report a case of angle closure glaucoma after piggyback intraocular lens implantation and its treatment. The authors present the case of a 75-year-old woman who was seen in the emergency department with angle closure glaucoma. Two years before she had undergone piggyback intraocular lens (IOL) implantation in order to correct a refractive error after cataract surgery. Ultrasound biomicroscopy revealed a closed angle with synechiae in 360 degrees as well as the presence of two IOLs: one in the capsular bag and the other in the ciliary sulcus. Extraction of the anterior IOL was precluded due to the poor endothelial count. Peripheral iridotomy and trabeculectomy were ineffective to lower the intraocular pressure (IOP); the authors decided to implant with an Ahmed valve and to place the valve's tube between the two IOLs to protect the endothelium. After Ahmed valve implantation, IOP maintains stable around 10-12 mmHg without medical treatment. Ahmed valve implantation is a good option in angle closure glaucoma due to piggyback. The placement of the valve's tube between the two IOLs is a good option to protect corneal endothelium.

  12. Feasibility of laser trabeculoplasty in angle closure glaucoma: a review of favourable histopathological findings in narrow angles.

    PubMed

    Matos, Alexis Galeno; Asrani, Sanjay G; Paula, Jayter Silva

    2017-02-28

    Selective laser trabeculoplasty (SLT) has been indicated as a safe and efficient treatment for primary open-angle glaucoma; however, recent studies have also shown positive results with the use of SLT in some clinical conditions related to primary angle-closure glaucoma (PACG). Despite the potential benefits of SLT in selected cases of PACG, the mechanisms underlying the modifications in the trabecular meshwork tissue of patients with PACG are poorly understood. This narrative review approached both the current, limited knowledge about the histological changes observed in different forms of PACG and the clinical results of SLT treatment for PACG. Favourable outcomes of SLT in patients with PACG, specifically in areas of non-occluded angle, need further substantiation through large controlled clinical trials. A deeper understanding of the biomolecular changes of those areas is essential to improve both laser technical details and the clinical efficacy of SLT therapy.

  13. Dermabond wound closure in primary hip arthroplasty.

    PubMed

    Khurana, Ashish; Parker, Salim; Goel, Vivek; Alderman, Phillip M

    2008-06-01

    Cyanoacrylate glues have been used in various surgical specialties for primary wound closure or as a supplement to other methods. We assessed the overall results and safety of this technique following primary hip arthroplasty. Ninety-three patients undergoing primary total hip replacement were studied. The surgical wound had been closed with subcuticular vicryl followed by the application of topical dermabond adhesive, without any additional dressings. The mean follow-up was 7.2 months. One patient suffered wound dehiscence on the third post operative day. Two patients had serous oozing from the wound for the initial 3-4 days. This technique provides an immediate water tight seal in a sterile operative environment and provides a barrier to micro organisms. It has good tensile strength, aesthetic value and patient satisfaction.

  14. Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury.

    PubMed

    Eliya, Martha C; Banda, Grace W

    2011-09-07

    Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds. To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury. We searched the Cochrane Wounds Group Specialised Register (searched 14 July 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to July Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 13, 2011); Ovid EMBASE (1980 to 2011 Week 27); and EBSCO CINAHL (1982 to 14 July 2011). There were no restrictions with respect to language, date of publication or study setting. Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds. Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review. Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible. There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non

  15. Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury.

    PubMed

    Eliya-Masamba, Martha C; Banda, Grace W

    2013-10-22

    Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds. To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury. In May 2013, for this first update we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds. Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review. Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible. There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours of injury.

  16. Primary Cerebellopontine Angle Melanocytoma: Review

    PubMed Central

    Phang, Isaac; Elashaal, Rahim; Ironside, James; Eljamel, Sam

    2012-01-01

    Introduction Primary cerebellopontine angle melanocytomas (PCPAMs) are very rare. Their natural history and prognosis are not fully understood. We reviewed the literature and add a new case to analyze PCPAM's presentation, radiological features, and outcome of treatment. Methods We performed a literature review using Medline, Embase, PubMed, and Cochrane databases. We searched for melanocytoma, melanoma, and pigmented tumors in the posterior cranial fossa and CPA to identify PCPAM. We have also searched our institution's neuro-oncology database. Results We identified 23 PCPAM from the literature and one case of our own. The mean age at presentation was 44.4 years with slight male preponderance. PCPAM presented with cerebellopontine angle (CPA) syndrome with or without hydrocephalus. Preoperative diagnosis was difficult; they appeared hyperintense on T1 and isointense on T2 magnetic resonance imaging (MRI) and enhanced with gadolinium. However, the final diagnosis was only made by immunohistochemical examination. Total surgical resection of PCPAM was associated with prolonged survival while subtotal excision was associated with frequent recurrence. Conclusion PCPAM are very rare and should be considered in the differential diagnosis of all CPA lesions that appear hyperintense on T1 and isointense on T2 MRI images. Patients with PCPAM should undergo total surgical resection to avoid fatal recurrences. PMID:23946922

  17. Primary open-angle glaucoma.

    PubMed

    Weinreb, Robert N; Khaw, Peng Tee

    2004-05-22

    Primary open-angle glaucoma is a progressive optic neuropathy and, perhaps, the most common form of glaucoma. Because the disease is treatable, and because the visual impairment caused by glaucoma is irreversible, early detection is essential. Early diagnosis depends on examination of the optic disc, retinal nerve fibre layer, and visual field. New imaging and psychophysical tests can improve both detection and monitoring of the progression of the disease. Recently completed long-term clinical trials provide convincing evidence that lowering intraocular pressure prevents progression at both the early and late stages of the disease. The degree of protection is related to the degree to which intraocular pressure is lowered. Improvements in therapy consist of more effective and better-tolerated drugs to lower intraocular pressure, and more effective surgical procedures. New treatments to directly treat and protect the retinal ganglion cells that are damaged in glaucoma are also in development.

  18. Circumscribed Ciliochoroidal Effusion Presenting as an Acute Angle Closure Attack

    PubMed Central

    Lipa, Roslyn Kathryn Manrique; Sánchez, María Eugenia González; Ordovas, Carlos Antonio Hijar; Aragües, Abel Rojo; Borque, Carmen Garcia

    2017-01-01

    Purpose: To report a case of choroidal effusion probably caused by angiotensin receptor II blocker. Case Report: A 52-year-old man with aplastic anemia and high blood pressure who developed unilateral acute angle closure glaucoma after receiving oral cyclosporine and angiotensin II receptor blocker (losartan). Ophthalmic examination revealed visual acuity of 20/30 in the left eye, mild mydriasis, iris bombe, no anterior chamber reaction, mild conjunctival hyperemia, and the intraocular pressure of 30 mmHg. After laser YAG iridotomy, funduscopy was performed showing a choroidal circumscribed lesion at the inferotemporal quadrant. Diagnostic tests ruled out any inflammatory or malignancy process, and the choroidal lesion spontaneously disappeared. After 20 months of follow-up, patient's ocular remained stable. Conclusion: This is the third case of choroidal effusion associated with angiotensin II receptor blockers. Since idiosyncratic ciliochoroidal effusion is a diagnosis of exclusion, it is mandatory to rule out more frequent causes, such as inflammatory or malignant processes. PMID:28299016

  19. Glycopyrrolate Induced Bilateral Angle Closure Glaucoma after Cervical Spine Surgery

    PubMed Central

    Jaroudi, Mahmoud; Fadi, Maalouf; Farah, Fadi; El Mollayess, Georges M.

    2013-01-01

    To report a case of bilateral acute angle closure glaucoma (AACG) that occurred after cervical spine surgery with the use of glycopyrolate. A 59-year-old male who presented with severe bilateral bifrontal headache and eye pain that started 12 h postextubation from a cervical spine surgery. Neostigmine 0.05 mg/kg (4.5 mg) and glycopyrrolate 0.01 mg/kg (0.9 mg) were used as muscle relaxant reversals at the end of the surgery. Ophthalmic examination revealed he had bilateral AACG with plateau iris syndrome that was treated medically along with laser iridotomies. Thorough examination of anterior chamber should be performed preoperatively on all patients undergoing surgeries in the prone position and receiving mydriatic agents under general anesthesia. PMID:23741140

  20. Effect of phacoemulsification on drainage angle status in angle closure eyes with or without extensive peripheral anterior synechiae.

    PubMed

    Latifi, Golshan; Moghimi, Sasan; Eslami, Yadollah; Fakhraie, Ghasem; Zarei, Reza; Lin, Shan

    2013-01-21

    Purpose. To evaluate the anatomic effects of phacoemulsification on drainage angle status in primary angle closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). Methods. A total of 62 eyes of 58 patients underwent cataract surgery in Farabi Rye Hospital, Tehran, Iran. Patients were examined postoperatively on day 1, week 1, and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. Main outcome measures were angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. Thirty-five eyes had PAS =180 degrees (group 1) and 27 eyes had >180-degree synechial closure (group 2). Results. Mean age of the patients was 64.3±9.0 years. The mean extent of PAS was significantly reduced from 45.9 to 32.2 degrees (p<0.03) in group 1, and from 277.4 to 159.0 degrees (p<0.001) in group 2. Group 2 showed significantly greater reduction in PAS extent (p<0.001). Angle opening distance and trabecular-iris space area at 500 µm from the scleral spur measured by AS-OCT increased significantly in both groups (p<0.001 for both). Anterior chamber depth (ACD) increased and lens vault (LV) decreased after both procedures. However, the amount of change in ACD and LV and angle parameters were not significant between the 2 groups. Conclusions. Phacoemulsification resulted in opening of the drainage angle, deepening of the anterior chamber, and reduction of PAS extent in PACG eyes with or without extensive PAS. Greater reduction of PAS could be considered in eyes with PAS >180 degrees.

  1. Note: A gel based imaging technique of the iridocorneal angle for evaluation of angle-closure glaucoma

    NASA Astrophysics Data System (ADS)

    Shinoj, V. K.; Murukeshan, V. M.; Baskaran, M.; Aung, T.

    2014-06-01

    Noninvasive medical imaging techniques have high potential in the field of ocular imaging research. Angle closure glaucoma is a major disease causing blindness and a possible way of detection is the examination of the anterior chamber angle in eyes. Here, a simple optical method for the evaluation of angle-closure glaucoma is proposed and illustrated. The light propagation from the region associated with the iridocorneal angle to the exterior of eye is considered analytically. The design of the gel assisted probe prototype is carried out and the imaging of iridocorneal angle is performed on an eye model.

  2. Acute Angle Closure Glaucoma with Capilllary Leak Syndrome Following Snake Bite

    PubMed Central

    George, Twinkle Ann; AV, Asha; Ravindran, Risha

    2014-01-01

    Introduction: Acute angle closure glaucoma is rarely seen as complication of snake bite.We report three cases of bilateral acute angle closure glaucoma with capillary leak syndrome and acute renal failure secondary to hematotoxic snake bites. We are also briefly discussing the association of capillary leak syndrome and angle closure glaucoma in hematotoxic snake bite. This is the first time an association between angle closure and capillary leak syndrome following snake bite is reported. Study type: Descriptive case series. Materials and Methods: Records of all patients admitted to ICU with snake bite were reviewed to identify cases developing acute angle closure glaucoma. These cases with acute angle closure glaucoma are analysed in detail for systemic condition. Diagnosis, management and outcome of cases are described Results: Of the 119 snake bites admitted, 47 patients had confirmed hematotoxic snake bite. Fifteen of these patients underwent hemodialysis for acute renal failure. Seven of them were diagnosed to have capillary leak syndrome and all of them complained of decreased vision. Three of the 7 cases had acute angle closure glaucoma on the second day of bite. One of the patients expired and other two recovered fully, both of them had normal IOP and good vision at one month follow-up. Conclusion: Acute angle closure glaucoma seems to be associated with systemic capillary leak syndrome in hematotoxic snake bite. High suspicion, early recognition, timely and appropriate treatment can prevent visual loss in this rare complication. PMID:25478432

  3. Bilateral acute angle closure glaucoma following a snake bite: Are we missing it?

    PubMed Central

    Kumar, K. V. Praveen; Kumar, S. Praveen

    2016-01-01

    Introduction: We report a case series of acute angle closure following snake bite, their clinical features, treatment, and the outcomes. Materials and Methods: Ocular examination was done in all the snake bite victims admitted over 1-year period. The systemic status, presenting intraocular pressure (IOP), treatment instituted, and outcomes were recorded for all cases of acute angle closure. Results: Six patients developed angle closure following snake bite. Average IOP was in the range of 32–56 mmHg. Treatment was initiated as for cases of acute angle closure. Two patients succumbed and the other four recovered, had normal IOP at follow-up. Conclusion: Acute angle closure glaucoma is a rare complication of snake bite. Timely detection and management will result in good visual prognosis. Treating physicians should be aware of this rare sight-threatening complication so that a preliminary ophthalmic examination can be sought and the visual morbidity be prevented. PMID:26955216

  4. Evolution of Staged Versus Primary Closure of Gastroschisis

    PubMed Central

    Kidd, Joseph N.; Jackson, Richard J.; Smith, Samuel D.; Wagner, Charles W.

    2003-01-01

    Objective Since the introduction of a preformed silo to the authors’ practice in 1997, there has been a decrease in primary closure of gastroschisis. To clarify the impact of this change, the authors reviewed their results over the past 10 years. Methods From patient records, the authors abstracted the closure method, mechanical ventilation days, time to full feeds, mechanical and infectious complications, and length of stay. The authors compared groups using the Student t test and the Mann-Whitney test, as appropriate. Results Between 1993 and the present, 124 patients were identified. Between 1993 and 1997, 38 children presented with gastro-schisis. Thirty-two (84.2%) closures were primary and six (18.8%) were staged. After 1997, the authors treated 80 children with gastroschisis. There were 27 (33.8%) primary and 53 (66.2%) staged closures. Six patients with other lethal anomalies were excluded. Length of stay and ventilator days were higher for the staged closure group, but infection and mechanical complications were less common in the staged closure group. The time to full feeds did not differ. Conclusions A lower incidence of infection and complications related to abdominal compartment syndrome has made staged closure of gastroschisis more common in the authors’ practice. While it has resulted in a longer hospital stay, staged closure decreases the risk of long-term bowel dysfunction and need for reoperation. PMID:12796571

  5. Anterior segment optical coherence tomography parameters in phacomorphic angle closure and mature cataracts.

    PubMed

    Mansouri, Mohammadreza; Ramezani, Farshid; Moghimi, Sasan; Tabatabaie, Ali; Abdi, Fatemeh; He, Mingguang; Lin, Shan C

    2014-10-21

    To describe anterior segment optical coherence tomography (AS-OCT) parameters in phacomorphic angle closure eyes, mature cataract eyes, and their fellow eyes, and identify those parameters that could be used to differentiate phacomorphic angle closure eyes from those with mature cataract and no phacomorphic angle closure. In this cross-sectional study, a total of 33 phacomorphic angle closure subjects and 34 control patients with unilateral mature cataracts were enrolled. All patients underwent AS-OCT imaging and A-scan biometry of both eyes. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris curvature, lens vault (LV), and angle parameters, including angle opening distance (AOD750) and trabecular-iris space area (TISA750), were measured in qualified images using customized software and compared among eyes with phacomorphic angle closure, mature cataract eyes, and their fellow eyes. There was no significant difference in axial length among the four groups. Phacomorphic angle closure had the smallest angle (AOD750, TISA750) and anterior chamber parameters (ACD, ACA, anterior chamber width) and the greatest LV among the groups. This pattern was similar when comparing fellow eyes of mature cataract patients and fellow eyes of phacomorphic angle closure. Anterior chamber area less than 18.62 mm(2), ACD less than 2.60 mm, LV greater than 532.0 μm, and AOD750 less than 0.218 mm had the highest odds ratios (ORs) for distinguishing fellow eyes of phacomorphic angle closure versus fellow eyes of mature cataracts, with OR values of 9.90, 8.31, 7.91, and 7.91, respectively. Logistic regression showed that ACA less than 18.62 was the major parameter associated with fellow eyes of phacomorphic angle closure (OR = 10.96, P < 0.001). Anterior chamber depth, ACA, AOD750, and LV are powerful indicators in differentiating phacomorphic angle closure eyes from those with mature cataract and their fellow eyes. Copyright 2014 The Association for Research in

  6. Bilateral acute angle closure glaucoma associated with hydrochlorothiazide-induced hyponatraemia.

    PubMed

    Chen, Sylvia H; Karanjia, Rustum; Chevrier, Robert L; Marshall, David H

    2014-12-04

    We report a case of a 67-year-old woman presenting with bilateral acute angle closure. On investigation, she was found to have bilateral ciliary effusions and profound hyponatraemia. Her effusions resolved with the cessation of hydrochlorothiazide and normalisation of her blood sodium levels by fluid restriction. This case displays a novel association of hyponatraemia as a possible mechanism for the development of bilateral acute angle closure.

  7. Six-year incidence of angle-closure disease in a South Indian population: the Chennai Eye Disease Incidence Study.

    PubMed

    Vijaya, Lingam; Asokan, Rashima; Panday, Manish; Choudhari, Nikhil S; Ramesh, Sathyamangalam Ve; Velumuri, Lokapavani; Boddupalli, Sachi Devi; Sunil, Govindan T; George, Ronnie

    2013-12-01

    To estimate the 6-year incidence of primary angle-closure (PAC) disease among adult population aged 40 years and older from rural and urban south India. Population-based longitudinal study. A complete ophthalmologic examination, including applanation tonometry, gonioscopy, biometry, stereoscopic fundus examination, and automated perimetry was performed at both baseline and at the 6-year follow up at base hospital. Incident PAC disease was defined as the development of PAC disease during the 6-year follow-up in phakic subjects without PAC disease at baseline. Diagnosis was made using the International Society Geographical and Epidemiological Ophthalmology classification. The data were analyzed for 3350 subjects (mean age, 56.4 ± 8.9 years; 1547 males, 1803 females) for a diagnosis of PAC disease at baseline and at follow-up examinations. The incidence of PAC disease was identified in 134 subjects (6-year incidence rate, 4.0%; 95% confidence interval (CI), 3.3-4.7). Among the 134 subjects, 88 subjects (2.6%, 95% CI, 2.1-3.2) were primary angle-closure suspects; 37 subjects (1.1%, 95% CI, 0.7-1.5) had primary angle closure, and 9 subjects (0.3%, 95% CI, 0.1-0.4) had primary angle-closure glaucoma. There was an inverse relationship between the incidence of PAC disease and the cataract surgery rates. Significant risk factors for PAC disease on logistic regressions were higher intraocular pressure, increased lens thickness, shorter axial length, shallow anterior chamber depth, anteriorly positioned lens, and hyperopia. The average incidence of PAC disease per year was 0.7%. All biometric parameters were found to be strong predictors for the incidence of PAC disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Primary closure after carotid endarterectomy is not inferior to other closure techniques.

    PubMed

    Avgerinos, Efthymios D; Chaer, Rabih A; Naddaf, Abdallah; El-Shazly, Omar M; Marone, Luke; Makaroun, Michel S

    2016-09-01

    Primary closure after carotid endarterectomy (CEA) has been much maligned as an inferior technique with worse outcomes than in patch closure. Our purpose was to compare perioperative and long-term results of different CEA closure techniques in a large institutional experience. A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. Closure technique was used to divide patients into three groups: primary longitudinal arteriotomy closure (PRC), patch closure (PAC), and eversion closure (EVC). End points were perioperative events, long-term strokes, and restenosis ≥70%. Multivariate regression models were used to assess the effect of baseline predictors. There were 1737 CEA cases (bilateral, 143; mean age, 71.4 ± 9.3 years; 56.2% men; 35.3% symptomatic) performed during the study period with a mean clinical follow-up of 49.8 ± 36.4 months (range, 0-155 months). More men had primary closure, but other demographic and baseline symptoms were similar between groups. Half the patients had PAC, with the rest evenly distributed between PRC and EVC. The rate of nerve injury was 2.7%, the rate of reintervention for hematoma was 1.5%, and the length of hospital stay was 2.4 ± 3.0 days, with no significant differences among groups. The combined stroke and death rate was 2.5% overall and 3.9% and 1.7% in the symptomatic and asymptomatic cohort, respectively. Stroke and death rates were similar between groups: PRC, 11 (2.7%); PAC, 19 (2.2%); EVC, 13 (2.9%). Multivariate analysis showed baseline symptomatic disease (odds ratio, 2.4; P = .007) and heart failure (odds ratio, 3.1; P = .003) as predictors of perioperative stroke and death, but not the type of closure. Cox regression analysis demonstrated, among other risk factors, no statin use (hazard ratio, 2.1; P = .008) as a predictor of ipsilateral stroke and severe (glomerular filtration rate <30 mL/min/1.73 m(2)) renal insufficiency (hazard ratio, 2.6; P

  9. Primary fascial closure with laparoscopic ventral hernia repair: systematic review.

    PubMed

    Nguyen, Duyen H; Nguyen, Mylan T; Askenasy, Erik P; Kao, Lillian S; Liang, Mike K

    2014-12-01

    Laparoscopic ventral hernia repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic ventral incisional hernia repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0-5.7 vs. 4.8-16.7 %) and seroma formation rates (5.6-11.4 vs. 4.3-27.8 %). Follow-up periods for both groups were similar (1-108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted.

  10. Angle closure glaucoma detection using fractal dimension index on SS-OCT images.

    PubMed

    Ni, Soe Ni; Marzilianol, Pina; Wong, Hon-Tym

    2014-01-01

    Optical coherence tomography (OCT) is a high resolution, rapid and non-invasive screening tool for angle closure glaucoma. In this paper, we propose a new strategy for automatic and landmark invariant quantification of the anterior chamber angle of the eye using swept source optical coherence tomography (SS-OCT) images. Seven hundred and eight swept source optical coherence tomography SS-OCT images from 148 patients with average age of (59.48 ± 8.97) were analyzed in this study. The angle structure is measured by fractal dimension (FD) analysis to quantify the complexity or changes of angle recess. We evaluated the FD index with biometric parameters for classification of open angle and angle closure glaucoma. The proposed fractal dimension index gives a better representation of the angle configuration for capturing the nature of the angle dynamics involved in different forms of open and closed angle glaucoma (average FD (standard deviation): 1.944 (0.045) for open and 1.894 (0.043) for closed angle). It showed that the proposed approach has promising potential to become a computer aided diagnostic tool for angle closure glaucoma (ACG) disease.

  11. Choroidal thickness change after water drinking is greater in angle closure than in open angle eyes.

    PubMed

    Arora, Karun S; Jefferys, Joan L; Maul, Eugenio A; Quigley, Harry A

    2012-09-21

    To study change in choroidal thickness (CT) after water drinking test (WDT), comparing angle closure (AC) to open angle (OA) eyes. Before and 30 minutes after drinking 1 L of water, 88 glaucoma subjects underwent measurements of CT by spectral domain-optical coherence tomography, IOP, blood pressure (BP), axial length (AL), and anterior chamber depth (ACD). Baseline CT was significantly greater in AC than in OA eyes (P = 0.002). After WDT, BP, IOP, and AL increased significantly (all P ≤ 0.0001). Mean CT increased significantly in the AC group (5.6 μm, P = 0.04, n = 40) and among 80 subjects whose IOP rose > 2 mm Hg (responders; 3.2 μm, P = 0.048), but not in the OA group or among all subjects (2.5 μm increase overall, <1% of baseline CT, P = 0.10). ACD decreased in AC (-18 μm, P = 0.07), but not in OA eyes (+3 μm, P = 0.74). AC eyes had a significantly greater IOP increase after WDT than OA eyes (P = 0.002, multivariate regression). Among responders, CT increased more in those with larger diastolic perfusion pressure increase and in AC compared to OA eyes (P = 0.04 and P = 0.053, respectively, multivariate regression). A significant increase in CT and a decrease in ACD after WDT were observed in AC but not in OA eyes, and IOP increased significantly more in AC than in OA eyes, suggesting that the dynamic behavior of the choroid may play a role in the AC process. IOP increase after the WDT was not fully explained by CT increase.

  12. Bilateral acute angle closure developing due to use of ipratropium bromide and salbutamol.

    PubMed

    Kola, Mehmet; Hacıoğlu, Dilek; Erdöl, Hidayet; Türk, Adem

    2017-02-06

    Acute angle closure can be seen as a side effect of some medications that can be used systemically. In this article, clinical characteristics of 54-year-old female patient who applied to our clinic with bilateral acute angle closure and has been received nebulized form of salbutamol and ipratropium bromide due to asthma for 4 days was evaluated. Right and left eye IOP were measured as 50 and 48 mmHg. IOP was reduced with anti-glaucomatous treatment. and peripheral iridectomy was done, and then the patient was discharged. It is necessary to be careful to prevent contact with the eye of nebulized form of these drugs which may result in angle closure glaucoma when used systemically.

  13. Classification algorithms based on anterior segment optical coherence tomography measurements for detection of angle closure.

    PubMed

    Nongpiur, Monisha E; Haaland, Benjamin A; Friedman, David S; Perera, Shamira A; He, Mingguang; Foo, Li-Lian; Baskaran, Mani; Sakata, Lisandro M; Wong, Tien Y; Aung, Tin

    2013-01-01

    A recent study found that a combination of 6 anterior segment optical coherence tomography (ASOCT) parameters (anterior chamber area, volume, and width [ACA, ACV, ACW], lens vault [LV], iris thickness at 750 μm from the scleral spur, and iris cross-sectional area) explain >80% of the variability in angle width. The aim of this study was to evaluate classification algorithms based on ASOCT measurements for the detection of gonioscopic angle closure. Cross-sectional study. We included 2047 subjects aged ≥50 years. Participants underwent gonioscopy and ASOCT (Carl Zeiss Meditec, Dublin, CA). Customized software (Zhongshan Angle Assessment Program, Guangzhou, China) was used to measure ASOCT parameters in horizontal ASOCT scans. Six classification algorithms were considered (stepwise logistic regression with Akaike information criterion, Random Forest, multivariate adaptive regression splines, support vector machine, naïve Bayes' classification, and recursive partitioning). The ASOCT-derived parameters were incorporated to generate point and interval estimates of the area under the receiver operating characteristic (AUC) curves for these algorithms using 10-fold cross-validation as well as 50:50 training and validation. We assessed ASOCT measurements and angle closure. Data on 1368 subjects, including 295 (21.6%) subjects with gonioscopic angle closure were available for analysis. The mean (±standard deviation) age was 62.4±7.5 years and 54.8% were females. Angle closure subjects were older and had smaller ACW, ACA, and ACV; greater LV; and thicker irides (P<0.001 for all). For both, the 10-fold cross-validation and the 50:50 training and validation methods, stepwise logistic regression was the best algorithm for detecting eyes with gonioscopic angle closure with testing set AUC of 0.954 (95% confidence interval [CI], 0.942-0.966) and 0.962 (95% CI, 0.948-0.975) respectively, whereas recursive partitioning had relatively the poorest performance with testing set

  14. Bilateral Angle-Closure Glaucoma in a Young Female Receiving Cabergoline: A Case Report

    PubMed Central

    Razmjoo, Hasan; Rezaei, Leila; Dehghani, Alireza; Peyman, Alireza; Akhlaghi, Mohammadreza

    2011-01-01

    Purpose To report a case of bilateral acute angle-closure glaucoma after oral administration of cabergoline for the treatment of galactorrhea. Methods A diagnosis of secondary drug-induced angle-closure glaucoma was made in a patient with elevated intraocular pressure (IOP) and myopic refractive shift, which was confirmed by ultrasound biomicroscopy (UBM) of the ciliary body and anterior segment, sonography, and optical coherence tomography. The treatment included the discontinuation of the culprit drug and the administration of topical anti-glaucoma drops. The treatment course was followed with serial measurements of the IOP and refraction, and with performing UBM. Results Five hours after he received a single 0.5-mg oral cabergoline tablet, the patient suffered from acute secondary angle-closure glaucoma and myopic refractive error. UBM demonstrated both effusion of the ciliary body and an anterior rotation of the iris-ciliary body. IOP was reduced 8 h after cessation of the causative agent and administration of anti-glaucoma drops. Refractive errors returned to normal levels after 8 days. Conclusion Secondary acute angle-closure glaucoma has been reported to occur after the administration of some drugs. In this report, an attempt has been made to describe this adverse reaction after oral cabergoline intake. PMID:21347189

  15. Effect of gender and Frankfort mandibular plane angle on orthodontic space closure: a randomized controlled trial.

    PubMed

    Ireland, A J; Songra, G; Clover, M; Atack, N E; Sherriff, M; Sandy, J R

    2016-05-01

    To determine the effect of gender and Frankfort mandibular plane angle (FMPA) on extraction space closure. A single district general hospital. The sample population were 11- to 18-year-olds undergoing upper and lower fixed appliance therapy following the loss of a premolar in each quadrant. A total of 100 patients undergoing upper and lower fixed appliance therapy following the loss of four premolars were randomized with stratification on two age ranges (11-14 years and 15-18 years) and three FMPAs (high, medium and low). Allocation was to one of three treatment groups: conventional, active or passive self-ligating brackets, with an allocation ratio of 1:2:2. All subjects were treated using the same archwire sequence and space closing mechanics. Space closure was measured on models taken every 12 weeks throughout treatment. All measurements were taken by one operator, blinded to bracket type. A total of 98 patients were followed to completion. Data were analysed using linear mixed models and demonstrated no statistically significant difference between bracket types with respect to space closure. Therefore, the data were pooled to determine the effect of gender and FMPA on space closure. At all stages of space closure, there was a significant effect of gender (results are presented as effect size, lower and upper 95% confidence intervals and probability), that is passive [1.064, 0.521, 1.607, 0.001], active [0.825, 0.312, 1.339, 0.002] and total space closure [1.029, 0.527, 1.531, 0.001]. There was no statistically significant effect of FMPA on space closure. Space closure during fixed appliance therapy is affected by gender but is unaffected by FMPA. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Linkage studies in primary open angle glaucoma

    SciTech Connect

    Avramopoulos, D.; Grigoriadu, M.; Kitsos, G.

    1994-09-01

    Glaucoma is a leading cause of blindness worldwide. The majority of glaucoma is associated with an open, normal appearing anterior chamber angle and is termed primary open angle glaucoma (POAG, MIM 137760). It is characterized by elevated intraocular pressure and onset in middle age or later. A subset of POAG with juvenile onset has recently been linked to chromosome 1q in two families with autosomal dominant inheritance. Eleven pedigrees with autosomal dominant POG (non-juvenile-onset) have been identified in Epirus, Greece. In the present study DNA samples have been collected from 50 individuals from one large pedigree, including 12 affected individuals. Preliminary results of linkage analysis with chromosome 1 microsatellites using the computer program package LINKAGE Version 5.1 showed no linkage with the markers previously linked to juvenile-onset POAG. Further linkage analysis is being pursued, and the results will be presented.

  17. The cost of failure: The economic impact of failed primary closure in classic bladder exstrophy.

    PubMed

    Hesh, Christopher A; Young, Ezekiel; Intihar, Paul; Gearhart, John P

    2016-08-01

    Failure of primary closure in classic bladder exstrophy (CBE) is a significant cause of morbidity, and yet its relative economic impact has not been well characterized. The authors aim to determine whether CBE patients who underwent failed primary closure incur greater economic burden in the year following their successful closure than those patients who underwent a successful primary closure. After institutional review board approval CBE patients who were successfully closed between 1993 and 2013 were identified in an institutional exstrophy-epispadias database. Patients who were never closed at the study institution and those who had no documented successful closure were excluded. Inpatient hospital charges, hospital costs, and professional fees were collected for the year following successful closure. 162 patients met the inclusion and exclusion criteria and accounted for 312 inpatient admissions in the year following and including their respective successful bladder closures. 62 of the patients failed their primary closure and the remaining 100 succeeded. Adjusting for covariates, patients who underwent successful primary closure experienced a reduction in inpatient hospital charges of $8497, hospital costs of $9046 and professional fees of $11,180 in the year following their successful closure compared to those patients who failed their primary closure. Apart from the self-evident financial advantages of a successful primary closure, namely the avoidance of reclosure, there appears to be a lasting negative financial impact of failed primary closure even after these patients undergo successful reclosure at the study institution. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Modified Primary Closure Method for the Treatment of Pilonidal Sinus.

    PubMed

    Arslan, Sukru; Karadeniz, Erdem; Ozturk, Gurkan; Aydinli, Bulent; Bayraktutan, Muhammed Cagri; Atamanalp, Sabri Selcuk

    2016-06-01

    Pilonidal sinus (PS) is considered to be the acquired disease of especially in the sacrococcygeal region. Various primary or secondary or flap methods, accompanied by one of local curettage, phenol application, electro-cauterization and total sinus excision methods, are used for the treatment of pilonidal sinus. However, currently there is not a single widely accepted treatment method. Ninety-eight patients who had operation for PS in Atatürk University, Department of General Surgery between January 2012 and August 2014 were included in this study. The patients were categorized into two groups: first, the patients undergone total sinus excision with primary closure (Group 1), and second, patients undergone total sinus excision with modified primary closure (MPC) (Group 2). Among all 98 patients participated in this study, age, sex, type of operation, duration of operation, amount of excised skin, duration of postoperative stay at hospital and complications were evaluated. Forty-four patients (44.9%) underwent primary closure method, while 54 patients (55.1%) underwent MPC method. Mean duration of operation was 39.1 (30-60) minutes, mean diameter of excised material was 9.3 (8-11) cm(2) and mean duration of stay at hospital was 1.4 (1-3) days for the patients in the first group. Meanwhile, duration of operation was 52.2 (35-70) minutes, mean diameter of excised material was 2.6 (2-4) cm(2) and mean duration of stay at hospital was 1.6 (1-3) days for the patients in the second group. There was statistically significant difference between the two groups by means of duration of operation, dehiscence of surgical wound, recurrence and development of general complications (p<0.001, p<0.05, p<0.05 and p<0.005, respectively). According to the multivariate analysis, during surgical treatment of pilonidal sinus, primary closure method increases the rate of complication 6.65 times and MPC method increases the duration of operation 1.2 times. We hereby suggest that MPC method

  19. Modified Primary Closure Method for the Treatment of Pilonidal Sinus

    PubMed Central

    Arslan, Sukru; Karadeniz, Erdem; Ozturk, Gurkan; Aydinli, Bulent; Bayraktutan, Muhammed Cagri; Atamanalp, Sabri Selcuk

    2016-01-01

    Objective: Pilonidal sinus (PS) is considered to be the acquired disease of especially in the sacrococcygeal region. Various primary or secondary or flap methods, accompanied by one of local curettage, phenol application, electro-cauterization and total sinus excision methods, are used for the treatment of pilonidal sinus. However, currently there is not a single widely accepted treatment method. Materials and Methods: Ninety-eight patients who had operation for PS in Atatürk University, Department of General Surgery between January 2012 and August 2014 were included in this study. The patients were categorized into two groups: first, the patients undergone total sinus excision with primary closure (Group 1), and second, patients undergone total sinus excision with modified primary closure (MPC) (Group 2). Among all 98 patients participated in this study, age, sex, type of operation, duration of operation, amount of excised skin, duration of postoperative stay at hospital and complications were evaluated. Results: Forty-four patients (44.9%) underwent primary closure method, while 54 patients (55.1%) underwent MPC method. Mean duration of operation was 39.1 (30–60) minutes, mean diameter of excised material was 9.3 (8–11) cm2 and mean duration of stay at hospital was 1.4 (1–3) days for the patients in the first group. Meanwhile, duration of operation was 52.2 (35–70) minutes, mean diameter of excised material was 2.6 (2–4) cm2 and mean duration of stay at hospital was 1.6 (1–3) days for the patients in the second group. There was statistically significant difference between the two groups by means of duration of operation, dehiscence of surgical wound, recurrence and development of general complications (p<0.001, p<0.05, p<0.05 and p<0.005, respectively). According to the multivariate analysis, during surgical treatment of pilonidal sinus, primary closure method increases the rate of complication 6.65 times and MPC method increases the duration of

  20. Acute angle closure glaucoma secondary to polypoidal choroidal vasculopathy – a devastating complication

    PubMed Central

    Baskaran, Prabu; Sindal, Manavi D.; Dhoble, Pankaja; Ramakrishnan, Seema; Rengaraj, Venkatesh; Ramulu, Pradeep

    2017-01-01

    Acute angle closure glaucoma (ACG) in the setting of polypoidal choroidal vasculopathy (PCV) is a catastrophic complication that has been documented infrequently in literature. Ours is the second only report that describes hemorrhagic choroidal detachment as an event leading to acute angle closure glaucoma in PCV patients and the first one to describe the use of diode cyclophotocoagulation (CPC) for this condition. The purpose of this article is to familiarize readers with this entity that has an extremely dismal visual prognosis. Ours is a descriptive case report of two patients with PCV complicated by sudden onset hemorrhagic choroidal detachment (CD) and acute ACG. Both patients had severe pain with no perception of light at presentation with an acute angle closure attack. Both underwent diode CPC for pain relief and control of intraocular pressure (IOP). Both our patients did not regain any vision, but their pain was relieved by diode CPC. Both eyes eventually became phthisical. Acute ACG following massive hemorrhagic CD is a rare but grave complication of PCV, not amenable to treatment. Diode CPC is an effective palliative modality of management to achieve pain relief in such cases. PMID:28154791

  1. Skin stretching for primary closure of acute burn wounds.

    PubMed

    Verhaegen, Pauline D H M; Bloemen, Monica C T; van der Wal, Martijn B A; Vloemans, Adrianus F P M; Tempelman, Fenike R H; Beerthuizen, Gerard I J M; van Zuijlen, Paul P M

    2014-12-01

    In burn care, a well-acknowledged problem is the suboptimal scar outcome from skin grafted burn wounds. With the aim of improving this, we focused on a new technique: excision of the burn wound followed by primary closure, thereby using a skin-stretching device to stretch the adjacent healthy skin. The short- and long-term effect of Skin Stretch was compared to split skin grafting (SSG) in a randomized controlled trial. Patients with burn wounds were randomized for SSG or primary wound closure using Skin Stretch. Follow-up was performed at 3 and 12 months postoperatively. The scar surface area was calculated and the scar quality was assessed, using subjective and objective measurement methods. No significant differences between the SSG and the Skin Stretch group were found for scar surface area. In the Skin Stretch group, a significant reduction of the surface area from 65.4cm(2) (13.6-129.1) to 13.4cm(2) (3.0-36.6) was found at 3 months (p=0.028) and at 12 months postoperatively (65.4cm(2) (13.6-129.1) to 33.0cm(2) (8.9-63.7), p=0.046, Wilcoxon signed ranks test). Skin Stretch for primary closure of acute burn wounds is a suitable technique and can be considered for specific circumscript full-thickness burn wounds. However, future research should be performed to provide additional scientific evidence. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  2. The association of membrane frizzled-related protein (MFRP) gene with acute angle-closure glaucoma – a pilot study

    PubMed Central

    Wang, I-Jong; Lin, Shan; Chiang, Ting-Hsuan; Chen, Zoe Tzu-Yi; Lin, Luke L.K.; Hung, Por-Tying

    2008-01-01

    Purpose The membrane frizzled-related protein (MFRP) has been proposed as a probable candidate gene for extreme hyperopia and nanophthalmos, which are factors for angle-closure glaucoma. The purpose of our study was to investigate whether there are significant associations between angle-closure glaucoma and sequence variants in the MFRP gene reported previously in Taiwanese subjects. Methods Genomic DNA was collected from 63 subjects with angle-closure glaucoma and 66 age-matched and gender-matched controls without angle-closure glaucoma. Three sequence variants were detected by polymerase chain reaction (PCR) and direct sequencing in all of the cases and controls. Results None of the three sequence variants showed a significant result in terms of association with disease. The pairwise linkage disequilibrium (LD) mapping confirmed that these alleles have a comparatively strong LD index greater than 0.7 for D' and greater than 0.4 for r2 at these polymorphisms. However, we found there were no statistical associations between any of the three sequence variants located on MFRP and angle-closure glaucoma. Conclusions In our pilot study, variations that we tested in MFRP were not associated with the development of acute angle-closure glaucoma in Taiwanese subjects. PMID:18781223

  3. Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT.

    PubMed

    Fu, Huazhu; Xu, Yanwu; Lin, Stephen; Zhang, Xiaoqin; Wong, Damon Wing Kee; Liu, Jiang; Frangi, Alejandro F; Baskaran, Mani; Aung, Tin

    2017-09-01

    Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.

  4. Development of a score and probability estimate for detecting angle closure based on anterior segment optical coherence tomography.

    PubMed

    Nongpiur, Monisha E; Haaland, Benjamin A; Perera, Shamira A; Friedman, David S; He, Mingguang; Sakata, Lisandro M; Baskaran, Mani; Aung, Tin

    2014-01-01

    To develop a score along with an estimated probability of disease for detecting angle closure based on anterior segment optical coherence tomography (AS OCT) imaging. Cross-sectional study. A total of 2047 subjects 50 years of age and older were recruited from a community polyclinic in Singapore. All subjects underwent standardized ocular examination including gonioscopy and imaging by AS OCT (Carl Zeiss Meditec). Customized software (Zhongshan Angle Assessment Program) was used to measure AS OCT parameters. Complete data were available for 1368 subjects. Data from the right eyes were used for analysis. A stepwise logistic regression model with Akaike information criterion was used to generate a score that then was converted to an estimated probability of the presence of gonioscopic angle closure, defined as the inability to visualize the posterior trabecular meshwork for at least 180 degrees on nonindentation gonioscopy. Of the 1368 subjects, 295 (21.6%) had gonioscopic angle closure. The angle closure score was calculated from the shifted linear combination of the AS OCT parameters. The score can be converted to an estimated probability of having angle closure using the relationship: estimated probability = e(score)/(1 + e(score)), where e is the natural exponential. The score performed well in a second independent sample of 178 angle-closure subjects and 301 normal controls, with an area under the receiver operating characteristic curve of 0.94. A score derived from a single AS OCT image, coupled with an estimated probability, provides an objective platform for detection of angle closure. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography

    PubMed Central

    Tay, Elton Lik Tong; Yong, Vernon Khet Yau; Lim, Boon Ang; Sia, Stelson; Wong, Elizabeth Poh Ying; Yip, Leonard Wei Leon

    2015-01-01

    AIM To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography (AS-OCT), as well as gonioscopy and spectral domain OCT (SD-OCT). A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments. METHODS Seventeen consecutive subjects (33 eyes) were recruited from the study hospital's Glaucoma clinic. Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 other glaucomatologists masked to gonioscopy findings as well as each other's analyses of OCT images. RESULTS Totally 84.8% and 45.5% of scleral spurs were visualized in AS-OCT and SD-OCT images respectively (P<0.01). The agreement for angle closure between AS-OCT and gonioscopy was fair at k=0.31 (95% confidence interval, CI: 0.03-0.59) and k=0.35 (95% CI: 0.07-0.63) for reader 1 and 2 respectively. The agreement for angle closure between SD-OCT and gonioscopy was fair at k=0.21 (95% CI: 0.07-0.49) and slight at k=0.17 (95% CI: 0.08-0.42) for reader 1 and 2 respectively. The inter-reader agreement for angle closure in AS-OCT images was moderate at 0.51 (95% CI: 0.13-0.88). The inter-reader agreement for angle closure in SD-OCT images was slight at 0.18 (95% CI: 0.08-0.45). CONCLUSION Significant proportion of scleral spurs were not visualised with SD-OCT imaging resulting in weaker inter-reader agreements. Identifying other angle landmarks in SD-OCT images will allow more consistent angle closure assessments. Gonioscopy and OCT imaging do not always agree in angle closure assessments but have their own advantages, and should be used together and not exclusively. PMID:25938053

  6. Neodymium-YAG laser iridotomy in angle closure glaucoma: preliminary study.

    PubMed Central

    Naveh, N; Zborowsky-Gutman, L; Blumenthal, M

    1987-01-01

    A prospective short-term preliminary clinical study to evaluate the efficacy and immediate complications of Q-switched Nd-YAG laser iridotomy in the treatment of acute and chronic angle closure glaucoma is described. The follow-up period ranged from four to 10 months. Of 40 eyes treated 36 (90%) required a single lasing session for patency (19, one application; 17, two applications), and four eyes (10%) required two sessions. Closure of the iridotomy site following Nd-YAG lasing due to pigment epithelium proliferation occurred in 10% of eyes, an incidence remarkably lower than that of argon laser iridotomy. Transitory closure or diminution of a prior patent iridotomy during the first hour after lasing was observed in 6.7% of eyes. Patency was again noted up to three weeks later and remained unchanged. Immediate postoperative complications included a marked increase in ocular pressure (42% of eyes), minimal transitory bleeding, and transitory localised corneal oedema at the lasing site. Persistent iridocorneal adhesion at the lasing site was noted in three eyes, and localised lenticular opacities, of non-progressive type, were observed in one eye. PMID:3580337

  7. 12. ANGLED VIEW OF THE SCOTT FURNACE WITH PRIMARY CONDENSER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. ANGLED VIEW OF THE SCOTT FURNACE WITH PRIMARY CONDENSER AND SOUTH SECONDARY CONDENSER IN BACKGROUND, LOOKING SOUTHWEST. - Mariscal Quicksilver Mine & Reduction Works, Terlingua, Brewster County, TX

  8. A double blind randomized controlled trial comparing primary suture closure with mesh augmented closure to reduce incisional hernia incidence

    PubMed Central

    2013-01-01

    Background Incisional hernia is the most frequently seen long term complication after laparotomy causing much morbidity and even mortality. The overall incidence remains 11-20%, despite studies attempting to optimize closing techniques. Two patient groups, patients with abdominal aortic aneurysm and obese patients, have a risk for incisional hernia after laparotomy of more than 30%. These patients might benefit from mesh augmented midline closure as a means to reduce incisional hernia incidence. Methods/design The PRImary Mesh Closure of Abdominal Midline Wound (PRIMA) trial is a double-blinded international multicenter randomized controlled trial comparing running slowly absorbable suture closure with the same closure augmented with a sublay or onlay mesh. Primary endpoint will be incisional hernia incidence 2 years postoperatively. Secondary outcomes will be postoperative complications, pain, quality of life and cost effectiveness. A total of 460 patients will be included in three arms of the study and randomized between running suture closure, onlay mesh closure or sublay mesh closure. Follow-up will be at 1, 3, 12 and 24 months with ultrasound imaging performed at 6 and 24 months to objectify the presence of incisional hernia. Patients, investigators and radiologists will be blinded throughout the whole follow up. Disccusion The use of prosthetic mesh has proven effective and safe in incisional hernia surgery however its use in a prophylactic manner has yet to be properly investigated. The PRIMA trial will provide level 1b evidence whether mesh augmented midline abdominal closure reduces incisional hernia incidence in high risk groups. Trial registration Clinical trial.gov NCT00761475. PMID:24499111

  9. Components separation technique is feasible for assisting delayed primary fascial closure of open abdomen.

    PubMed

    Rasilainen, S K; Mentula, P J; Leppäniemi, A K

    2016-03-01

    The goal after open abdomen treatment is to reach primary fascial closure. Modern negative pressure wound therapy systems are sometimes inefficient for this purpose. This retrospective chart analysis describes the use of the 'components separation' method in facilitating primary fascial closure after open abdomen. A total of 16 consecutive critically ill surgical patients treated with components separation during open abdomen management were analyzed. No patients were excluded. Primary fascial closure was achieved in 75% (12/16). Components separation was performed during ongoing open abdomen treatment in 7 patients and at the time of delayed primary fascial closure in 9 patients. Of the former, 3/7 (43%) patients reached primary fascial closure, whereas all 9 patients in the latter group had successful fascial closure without major complications (p = 0.019). Components separation is a useful method in contributing to successful primary fascial closure in patients treated for open abdomen. Best results were obtained when components separation was performed simultaneously with primary fascial closure at the end of the open abdomen treatment. © The Finnish Surgical Society 2015.

  10. Primary closure of contaminated wounds in perforated appendicitis.

    PubMed

    Burnweit, C; Bilik, R; Shandling, B

    1991-12-01

    We studied the clinical course of 506 children consecutively admitted with appendicitis at The Hospital for Sick Children from 1985 to 1989. One hundred eighty-one children (35%), ranging in age from 1 to 17 years, presented with perforation verified by histological examination. Ninety-six of them (53%) had generalized peritonitis, 47 (26%) had localized peritonitis, and 38 (21%) had abscess formation. Usually, triple antibiotics were begun preoperatively if perforation was suspected; otherwise, cefoxitin was started. Triple antibiotics were used postoperatively for 5 to 7 days in almost all children in the perforated group. Neither abdominal nor subcutaneous drainage was routinely used even in cases of intraabdominal abscess. The skin was closed primarily with steri-strips (63%), staples (20%), subcutaneous Dexon (11%), or silk (4%). Postoperative wound infection arose in 20 children (11%). Wound infections were noted from 1 to 14 days postoperatively (mean, 5.9 days). Whereas 9 of these were treated with local therapy only, 11 delayed the child's discharge or necessitated readmission. No patient suffered major complications from wound infection in that there were no cases of necrotizing fasciitis, reoperation for debridement, sepsis, or death. The intraabdominal abscess rate in this group of 181 children was 6% (n = 11). The low rate of infective complications fully justifies the policy of primary closure in contaminated wounds. This policy eliminates the necessity for painful and time-consuming dressing changes, shortens hospitalization, and obviates the trauma of delayed suturing of wounds in children.

  11. Oseltamivir (Tamiflu)-induced bilateral acute angle closure glaucoma and transient myopia

    PubMed Central

    Lee, Ji Woong; Lee, Ji Eun; Choi, Hee Young; Lee, Jong Soo

    2014-01-01

    A 27-year-old woman developed bilateral acute angle closure glaucoma (AACG) and transient myopia after taking oseltamivir for four days. On the fourth day, she received systemic and topical intraocular pressure (IOP)-lowering agents, and IOP decreased in both eyes. However, her visual acuity was unchanged. A myopic shift of -5.25 D OD and -5.0 D OS was estimated to have occurred in the acute phase. A-scan ultrasonography and Pentacam showed markedly shallow anterior chambers and increased lens thickness. Ultrasound biomicroscopy revealed an annular ciliochoroidal effusion with forward displacement of the lens-iris diaphragm. Ciliochoroidal effusion and transient myopia were resolved after discontinuation of oseltamivir. PMID:23571265

  12. Outpatient argon laser iridectomy for angle closure glaucoma: a two-year study.

    PubMed

    Abraham, R K; Miller, G L

    1975-01-01

    A technique for iridectomy in the the treatment of angle-closure glaucoma utilizing laser beams has been developed. The operation is performed in two steps. In step 1 a partially penetrating burn of the iris is made to produce an iris hump. In step 2 a penetrating burn is used to pierce the crown of the previously produced hump. Tables 1, 2, and 3 summarize current recommendations and the detailed steps that must be followed (without exception) to achieve success with this technique. Of 22 phakic eyes, fellow eyes, or eyes with narrow-angle glaucoma, instantaneous, permanent iris perforation was produced in all except two. In these two, a second treatment on the following day produced a permanent perforation. Serious complications were encountered in only one patient who received treatment at a greater energy level than we now recommend. In that patient striate keratopathy became apparent, as well as a decrease in vision which has lasted five months. No significant complication was encountered in any eye treated with the currently recommended procedure.

  13. A comparison of 0.1% timolol eye gel and 0.5% timolol eye drop in patients with chronic angle-closure glaucoma.

    PubMed

    Metheetrairut, Ankana; Leumsamran, Panitee; Rojananin, Supamas; Kitnarong, Naris

    2012-04-01

    Primary angle-closure glaucoma has been reported with higher prevalence in Asian populations. There is no significant data of different response of topical medication between angle- closure and open angle eyes. The present study investigates ocular hypotensive effect and systemic side effects of 0.1% timolol eye gel once daily compared with 0.5% timolol eye drop twice daily in patients with chronic angle-closure glaucoma. The present study was a prospective, randomized, investigator-masked, two-period crossover study in chronic angle-closure glaucoma patients with each drug tested for a six-week period. Twenty five eyes were included. Timolol 0.1% eye gel and 0.5% timolol eye drop significantly reduced IOP at 9 am, 11 am and 3 pm compared with baseline (P < 0.001). At week 6, the mean IOP reduction from baseline of 0.5% timolol eye drop group was higher than that of 0.1% timolol eye gel group at 9 am (3.68 mmHg, 2.51 mmHg respectively) and at 11 am (4.21 mmHg, 2.51 mmHg respectively). These differences were not statistically significant (p = 0.421, p = 0.157 respectively). At 3 pm of week 6, the mean IOP change from baseline of 0.1% timolol eye gel group (3.03 mmHg) was more than that of 0.5% timolol eye drop group (2.84 mmHg). There was also statistically insignificant difference (p = 0.873). The highest IOP reduction of 0.5% timolol eye drop was 4.21 mmHg (19.82%) at 11 am of week 6 and that of 0.1% timolol eye gel was 3.03 mmHg (14.38%) at 3 pm of the same week. There was no significant ocular side effect. Systolic blood pressure after treatment with 0.1% timolol eye gel and diastolic blood pressure after treatment with 0.5% timolol eye drop were significantly decreased from baseline (P = 0.006 and P = 0.026 respectively). But there was no clinical significance. Timolol 0.5% eye drop and 0.1% timolol eye gel effectively reduced IOP in chronic angle-closure glaucoma patients. There was no statistically significant difference in the ocular hypotensive effect of

  14. Postoperative neuromuscular blocker use is associated with higher primary fascial closure rates after damage control laparotomy.

    PubMed

    Abouassaly, Chadi T; Dutton, William D; Zaydfudim, Victor; Dossett, Lesly A; Nunez, Timothy C; Fleming, Sloan B; Cotton, Bryan A

    2010-09-01

    Failure to achieve fascial primary closure after damage control laparotomy (DCL) is associated with increased morbidity, higher healthcare expenditures, and a reduction in quality of life. The use of neuromuscular blocking agents (NMBA) to facilitate closure remains controversial and poorly studied. The purpose of this study was to determine whether exposure to NMBA is associated a higher likelihood of primary fascial closure. All adult trauma patients admitted between January 2002 and May 2008 who (1) went directly to the operating room, (2) were managed initially by DCL, and (3) survived to undergo a second laparotomy. Study group (NMBA+): those receiving NMBA in the first 24 hours after DCL. Comparison group (NMBA-): those not receiving NMBA in the first 24 hours after DCL. Primary fascial closure defined as fascia-to-fascia approximation by hospital day 7. One hundred ninety-one patients met inclusion (92 in NMBA+ group, 99 in NMBA- group). Although the NMB+ patients were younger (31 years vs. 37 years, p = 0.009), there were no other differences in demographics, severity of injury, or lengths of stay between the groups. However, NMBA+ patients achieved primary closure faster (5.1 days vs. 3.5 days, p = 0.046) and were more likely to achieve closure by day 7 (93% vs. 83%, p = 0.023). After controlling for age, gender, race, mechanism, and severity of injury, logistic regression identified NMBA use as an independent predictor of achieving primary fascial closure by day 7 (OR, 3.24, CI: 1.15-9.16; p = 0.026). Early NMBA use is associated with faster and more frequent achievement of primary fascial closure in patients initially managed with DCL. Patients exposed to NMBA had a three times higher likelihood of achieving primary fascial closure by hospital day 7.

  15. Automatic screening of narrow anterior chamber angle and angle-closure glaucoma based on slit-lamp image analysis by using support vector machine.

    PubMed

    Theeraworn, C; Kongprawechnon, W; Kondo, T; Bunnun, P; Nishihara, A; Manassakorn, A

    2013-01-01

    At present, Van Herick's method is a standard technique used to screen a Narrow Anterior Chamber Angle (NACA) and Angle-Closure Glaucoma (ACG). It can identify a patient who suffers from NACA and ACG by considering the width of peripheral anterior chamber depth (PACD) and corneal thickness. However, the screening result of this method often varies among ophthalmologists. So, an automatic screening of NACA and ACG based on slit-lamp image analysis by using Support Vector Machine (SVM) is proposed. SVM can automatically generate the classification model, which is used to classify the result as an angle-closure likely or an angle-closure unlikely. It shows that it can improve the accuracy of the screening result. To develop the classification model, the width of PACD and corneal thickness from many positions are measured and selected to be features. A statistic analysis is also used in the PACD and corneal thickness estimation in order to reduce the error from reflection on the cornea. In this study, it is found that the generated models are evaluated by using 5-fold cross validation and give a better result than the result classified by Van Herick's method.

  16. Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate: A Meta-analysis of Randomized Controlled Trials.

    PubMed

    Hsieh, Meng-Chiao; Kuo, Liang-Tseng; Chi, Ching-Chi; Huang, Wen-Shih; Chin, Chih-Chien

    2015-08-01

    Stoma reversal is a surgical procedure commonly used following temporary defunctioning stoma surgery. Surgical site infection is one of the most common postoperative morbidities. A few skin closure methods have been developed to decrease surgical site infection. However, the optimal skin closure method is still in debate. The aim of this study was to compare the surgical site infection rate and other postoperative outcomes between the pursestring closure and conventional primary closure techniques. We searched the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant trials. We conducted a meta-analysis of randomized controlled trials that compared the surgical outcomes following pursestring closure and conventional primary closure techniques. We conducted the meta-analysis by using the random-effects model. The primary outcome of interest was surgical site infection following stoma reversal within 30 days after operation. This meta-analysis included 4 randomized controlled trials with a total of 319 participants (162 in the pursestring closure group and 157 in the conventional primary closure group). Compared with the conventional primary closure group, the pursestring closure group had a significant decrease in surgical site infection (risk difference, -0.25; 95% CI, -0.36 to -0.15; p < 0.00001; number needed to treat = 4) and higher satisfaction with cosmetic outcomes (standard mean difference, 0.7; 95% CI, 0.13-1.27; p = 0.02). No other significant differences in operative time, length of hospital stay, and wound healing time were found between the 2 groups. This study was limited to the lack of double blinding and long-term follow-up in the included trials. Pursestring closure has significantly fewer surgical site infections and achieves better cosmetic outcomes following stoma reversal than conventional primary closure.

  17. Primary closure of the abdominal wall after "open abdomen" situation.

    PubMed

    Kääriäinen, M; Kuokkanen, H

    2013-01-01

    "Open abdomen" is a strategy used to avoid or treat abdominal compartment syndrome. It has reduced mortality both in trauma and non-trauma abdominal catastrophes but also has created a challenging clinical problem. Traditionally, open abdomen is closed in two phases; primarily with a free skin graft and later with a flap reconstruction. A modern trend is to close the abdomen within the initial hospitalization. This requires multi-professional co-operation. Temporary abdominal closure methods, e.g. negative pressure wound therapy alone or combined with mesh-mediated traction, have been developed to facilitate direct fascial closure. Components separation technique, mesh reinforcement or bridging of the fascial defect with mesh and perforator saving skin undermining can be utilized in the final closure if needed. These techniques can be combined. Choice of the treatment depends on the condition of the patient and size of the fascia and skin defect, and the state of the abdominal contents. In this paper we review the literature on the closure of an open abdomen and present the policy used in our institution in the open abdomen situations.

  18. Autosomal dominant nanophthalmos (NNO1) with high hyperopia and angle-closure glaucoma maps to chromosome 11.

    PubMed Central

    Othman, M I; Sullivan, S A; Skuta, G L; Cockrell, D A; Stringham, H M; Downs, C A; Fornés, A; Mick, A; Boehnke, M; Vollrath, D; Richards, J E

    1998-01-01

    Nanophthalmos is an uncommon developmental ocular disorder characterized by a small eye, as indicated by short axial length, high hyperopia (severe farsightedness), high lens/eye volume ratio, and a high incidence of angle-closure glaucoma. We performed clinical and genetic evaluations of members of a large family in which nanophthalmos is transmitted in an autosomal dominant manner. Ocular examinations of 22 affected family members revealed high hyperopia (range +7.25-+13.00 diopters; mean +9.88 diopters) and short axial length (range 17.55-19.28 mm; mean 18.13 mm). Twelve affected family members had angle-closure glaucoma or occludable anterior-chamber angles. Linkage analysis of a genome scan demonstrated highly significant evidence that nanophthalmos in this family is the result of a defect in a previously unidentified locus (NNO1) on chromosome 11. The gene was localized to a 14.7-cM interval between D11S905 and D11S987, with a maximum LOD score of 5. 92 at a recombination fraction of .00 for marker D11S903 and a multipoint maximum LOD score of 6.31 for marker D11S1313. NNO1 is the first human locus associated with nanophthalmos or with an angle-closure glaucoma phenotype, and the identification of the NNO1 locus is the first step toward the cloning of the gene. A cloned copy of the gene will enable examination of the relationship, if any, between nanophthalmos and less severe forms of hyperopia and between nanophthalmos and other conditions in which angle-closure glaucoma is a feature. PMID:9792868

  19. Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis

    PubMed Central

    García-Morales, Esther; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; Cecilia-Matilla, Almudena; García-Álvarez, Yolanda; Beneit-Montesinos, Juan Vicente

    2012-01-01

    Background The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot. PMID:23050062

  20. T-cell primary leptomeningeal lymphoma in cerebellopontine angle

    PubMed Central

    Briongos-Figuero, Laisa Socorro; Gómez-Traveso, Tamara; Pérez-Castrillon, José Luis

    2015-01-01

    Primary meningeal lymphomas are very rare and those derived from T cells are even more infrequent (less than 5% of primary central nervous system lymphomas). Cerebellopontine angle involvement in the primary T-cell lymphoma is exceptional. Clinical presentation depends on the type of lesions, and histological diagnosis is needed. We present a rare case of a 50-year-old woman who presented with clinical cerebellar syndrome with posterior opsoclonus-myoclonus syndrome. Necropsy evaluation revealed primary diffuse leptomeningeal non-Hodgkin's T-cell lymphoma. PMID:25750225

  1. Delayed primary closure of bladder exstrophy: immediate postoperative management leading to successful outcomes.

    PubMed

    Baradaran, Nima; Stec, Andrew A; Schaeffer, Anthony J; Gearhart, John P; Mathews, Ranjiv I

    2012-02-01

    To present the critical features of our postoperative plan for children undergoing delayed primary bladder closure because appropriate postoperative management is crucial to successful exstrophy repair. Using an institutionally approved database, patients with bladder exstrophy whose primary bladder closure was performed at least 1 month after birth were identified. All aspects of the postoperative management were reviewed. A total of 20 patients (18 boys) were identified: 19 with classic bladder extrosphy and 1 with an exstrophy variant. The patients underwent closure at a mean age of 9.9 months. All patients underwent pelvic osteotomy and immobilization for an average of 34.8 days. Analgesia was administered by way of a tunneled epidural catheter in 90% of patients for an average of 18.8 days, and 12 patients (60%) required adjunct intravenous analgesia. Bilateral ureteral catheters and suprapubic tubes were used in all patients. Total parenteral nutrition was administered to 10 (83%) of 12 patients who underwent closure after 2000. All patients received preoperative antibiotics and 2 weeks of postoperative intravenous antibiotics that was followed by oral prophylaxis. The mean hospital stay was 6.3 weeks. With an average follow-up of 7.4 years, delayed closure was 100% successful. Successful delayed primary closure of bladder exstrophy requires a multidisciplinary approach. The keys to success include osteotomy, pelvic immobilization, analgesia, nutritional support, maximal bladder drainage, and infection prophylaxis. Copyright © 2012. Published by Elsevier Inc.

  2. Combined Acute Haemolytic and Secondary Angle Closure Glaucoma following Spontaneous Intraocular Haemorrhages in a Patient on Warfarin

    PubMed Central

    Andreatta, Walter; Boukouvala, Stavroula; Bansal, Atul

    2016-01-01

    Background To report the first described case of combined haemolytic and acute angle closure glaucoma secondary to spontaneous intraocular haemorrhages in a patient on excessive anticoagulation. To the best of our knowledge, this is the first case reported in the literature presenting with raised intraocular pressure due to both mechanisms. Case Description A 90-year-old woman presented with acute pain and reduction in vision in the left eye. Her intraocular pressure (IOP) was 55 mm Hg. There were red tinted blood cells in the anterior chamber giving it a reddish hue. The patient was known to have advanced wet macular degeneration. She was taking oral warfarin for atrial fibrillation. Her international normalised ratio (INR) was 7.7. B-scan ultrasound of posterior segment showed vitreous and suprachoroidal haemorrhages. An ultrabiomicroscopic examination confirmed open angles. A diagnosis of haemolytic glaucoma secondary to intraocular haemorrhages was made. The IOP was controlled medically. Warfarin was withdrawn and oral vitamin K therapy was initiated leading to a rapid INR reduction. Three days later, her anterior chamber became progressively shallower causing a secondary acute angle closure which was managed medically. After 2 months, the left IOP was well-controlled without any medications and the eye was not inflamed. Her vision in that eye remained perception of light. Conclusion Patients with suprachoroidal haemorrhages should be closely monitored as they might subsequently develop acute angle closure despite an initially open angle and well-controlled INR and IOP. Excessive anticoagulation needs to be prevented to minimise the risk of sight-threatening complications. PMID:27990116

  3. Retroauricular skin flap and primary Z-plasty for donor site closure in partial ear reconstruction.

    PubMed

    Horch, Raymund E; Schipper, Joerg; Laszig, Roland

    2003-06-01

    Helical rim defects are noticeable and may well need reconstruction, especially in men. A method for reconstructing this type of defect together with primary donor site closure by Z-plasty is described. To close partial helical rim defects, a retroauricular caudally based rotational skin flap is performed to cover a conchal cartilage graft from the same ear that is harvested first and sutured into place to remodel the helical rim. To primarily close the donor site defect a retroauricular Z-plasty was developed which easily allowed primary closure of the donor site. The technique described here is straightforward, safe and reproducible. The Z-plasty approach for closing the donor site is useful, since the slight disturbance of the hairline is well hidden retroauricularly. This technique can be considered as a single-stage repair modality for the reconstruction of helical rim defects within primary donor site closure.

  4. Disorientation angle distribution of primary particles in potash alum aggregates

    NASA Astrophysics Data System (ADS)

    Kovačević, Tijana; Wiedmeyer, Viktoria; Schock, Jonathan; Voigt, Andreas; Pfeiffer, Franz; Sundmacher, Kai; Briesen, Heiko

    2017-06-01

    In order to fully characterize crystal aggregates, the orientation of primary particles has to be analyzed. A procedure for extracting this information from three-dimensional microcomputed tomography (μ CT) images was recently published by our group. We here extend this method for asymmetrical crystals and apply it for studying the disorientation angle distribution of four potash alum crystal samples that were obtained under various experimental conditions. The results show that for all considered supersaturation profiles, primary particle pairs tend to have the same orientation significantly more often than in theoretical considerations, in which the orientations of primary particles are assumed to be distributed randomly.

  5. Schlemm's Canal Expands After Trabeculectomy in Patients With Primary Angle–Closure Glaucoma

    PubMed Central

    Hong, Jiaxu; Yang, Yujing; Wei, Anji; Deng, Sophie X.; Kong, Xiangmei; Chen, Junyi; Girard, Michaël J. A.; Mari, Jean Martial; Xu, Jianjiang; Sun, Xinghuai

    2014-01-01

    Purpose. To evaluate the in vivo changes in the Schlemm's canal (SC) in patients with primary angle-closure glaucoma (PACG) after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT). Methods. Forty eyes of 40 patients with PACG who underwent trabeculectomy were included. All participants underwent SD-OCT. The diameter and area of SC were examined and measured before and within 1 month after trabeculectomy. All SD-OCT images were processed using adaptive compensation algorithm to improve contrast and image quality. Multivariate linear regression analysis was performed for predictors of percentage change in the mean SC diameter and area. Results. The mean age of participants was 60.5 ± 14.6 years. Adaptive compensation significantly increased the percentage of sections in which SC was observable in the subjects studied from 52.5% (21/40) to 75.0% (30/40), which has acceptable intraobserver and interobserver repeatability. There was a significant increase in the SC diameter and area at the follow-up examination compared with the baseline value (SC diameter: 34.2 ± 6.2 μm vs. 28.4 ± 6.1 μm; SC area: 8117 ± 1942 μm2 vs. 5200 ± 996 μm2; all P < 0.001). After multivariate analysis, the only variable related to changes in SC was percentage change in IOP (SC diameter, P = 0.002; SC area, P < 0.001). In addition, the magnitude of the change in the SC area also correlated with angle opening distance at 750 μm from the scleral spur at baseline. Conclusions. Expansion of SC was observed after trabeculectomy in PACG patients. The degree of SC expansion was related to the extent of the IOP decrease. PMID:25118266

  6. Canaloplasty versus Viscocanalostomy in Primary Open Angle Glaucoma

    PubMed Central

    Wagdy, Faried Mohammed

    2017-01-01

    Introduction The purpose of this study was to compare the efficacy and safety of canaloplasty versus viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication. Methods Canaloplasty surgery was applied for thirty eyes of thirty patients (45–55 years) with a mean age of 48 years (Group A) and viscocanalostomy surgery was applied also for thirty eyes of thirty patients (43–54 years) with a mean age of 46 years (group B). All patients were with uncontrolled primary open angle glaucoma by maximally tolerated medical therapy. Results Intraocular pressure (IOP) in both surgeries was significantly reduced through follow up period (p < 0.0.001). Complete success was 86.6% in group A and 80% in group B. Visual field deterioration was in 2 cases (6%) in group A and in 4 cases (13%) in group B. Low incidence of postoperative complications was reported as Descemet’s membrane detachment (3% in group A and 8% in group B), ocular hypotony (2% in group A and 4% in group B) and hyphema (3% in group A and 5% in group B). Conclusion Canaloplasty was more effective and safer than viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication. PMID:28243422

  7. Experience With Wound VAC and Delayed Primary Closure of Contaminated Soft Tissue Injuries in Iraq

    DTIC Science & Technology

    2006-11-01

    Experience With Wound VAC and Delayed Primary Closure of Contaminated Soft Tissue Injuries in Iraq Brian E. Leininger , MD, FACS, Todd E. Rasmussen...Annual Meeting, January 2006, Orlando FL (Poster). Address for reprints: Brian Leininger , MD, FACS, 2200 Bergquist Drive, Suite 1, Wilford Hall Medical

  8. Elastic bandaging facilitates primary closure of large ventral hernias due to giant omphaloceles.

    PubMed

    Sander, S; Eliçevik, M; Unal, M

    2001-11-01

    Large ventral hernias (VH) following conservative treatment of a giant omphalocele are a major challenge for pediatric surgeons. Although primary closure is accepted as the ideal procedure, these defects often require multi-staged operations, prosthetic support, and postoperative mechanical ventilation. Between 1990 and 2000, 34 patients with omphaloceles were admitted to our unit and 6 of them (17.6%) who had giant omphaloceles were treated conservatively. In the same period, a 5-year-old girl was admitted with a huge VH following application of subcutaneous tissue expanders in another center. In these 7 patients (6 girls, 1 boy, average age 20 months) we used preoperative elastic bandaging for facilitating primary closure. In all cases primary closure was successful following 3 to 6 weeks of bandaging. We did not use prosthetic material or postoperative mechanical ventilation in any case. Follow-up periods ranged from 2 to 10 years, and there were no recurrences or other problems. Out limited experience reveals that preoperative elastic bandaging is a safe and effective procedure for facilitating primary closure of the large VHs.

  9. A new approach: oblique excision and primary closure in the management of acute pilonidal disease

    PubMed Central

    Ciftci, Fatih; Abdurrahman, Ibrahim; Tosun, Mirhan; Bas, Gurhan

    2014-01-01

    Aim: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses. Materials and methods: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student’s t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients. Results: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001). Conclusion: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development. PMID:25664095

  10. Effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract

    PubMed Central

    Li, Bo; Wang, Feng-Yun; Lv, Tai-Liang; Zhu, Yu

    2016-01-01

    The aim of the present study was to examine the effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly. A total of 68 patients were consecutively selected and divided into the control group with 33 cases (48 eyes) and the observation group with 35 cases (53 eyes). Cataract surgery combined with trabeculectomy was performed on the patients in the control group and phacoemulsification cataract extraction combined with ciliarotomy was performed on the subjects in the observation group, to compare postoperative effects and complications. Following surgery, the visual acuity of patients in the two groups significantly improved, intraocular pressure decreased, and improvement of the observation group was more evident (P<0.05). Following surgery, the depth of central anterior chamber and width of chamber angle of patients in two groups was increased, and improvement of the observation group was significantly more evident (P<0.05). Additionally, the incidence of complications, including corneal swelling, shallow of anterior chamber, fibrinous exudate in iris, and filtering bleb leaking and following cataract removal, of patients in the observation group was significantly reduced compared to the control group (P<0.05). In summary, the results of the present study show that, phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly is a safe and effective method and should be applied in the clinic. PMID:27698750

  11. Resection and Primary Closure of Edematous Glossoepiglottic Mucosa in a Dog Causing Laryngeal Obstruction.

    PubMed

    Schabbing, Kevin J; Seaman, Jeffrey A

    An approximately 22 mo old male neutered English bulldog was evaluated for acute onset of dyspnea with suspected brachycephalic obstructive airway syndrome (BOAS). Laryngoscopic exam revealed diffuse, severe edema and static displacement of redundant glossoepiglottic (GE) mucosa causing complete obstruction of the larynx and epiglottic entrapment. Static displacement of the GE mucosa was observed and determined to be the overriding component of dyspnea in this patient with BOAS. Resection and primary closure with two separate, simple continuous sutures of the GE mucosa were performed. Resection and primary closure of the GE mucosa resolved the acute onset of dyspnea in this patient. Surgical correction of the stenotic nares, elongated soft palate, and everted laryngeal saccules were performed under the same anesthetic procedure. Static displacement of the GE mucosa may occur in patients with BOAS. Surgical resection and closure of the GE mucosa resolved this patient's dyspnea and is recommended in airway obstruction. It remains to be determined if primary closure and subsequent tensioning or scar tissue of the GE mucosa results in further complications related to restricted epiglottic movement.

  12. Recurrent acute angle-closure attack due to plateau iris syndrome after cataract extraction with or without argon laser peripheral iridoplasty: a case report.

    PubMed

    Choy, Bonnie Nga Kwan; Chan, Jonathan Cheuk Hung; Chien, Carol Pui Yang; Lai, Jimmy Shiu Ming

    2016-05-26

    We describe two cases of recurrent acute angle-closure attack in patients with plateau iris syndrome after cataract extraction. Argon laser peripheral iridoplasty and cataract extraction have been used to reduce the occurrence of acute angle-closure attack in plateau iris syndrome although the risk cannot be completely eliminated. There is no consensus on the long term management of plateau iris syndrome. This is, as far as we know, the first case report of recurrent acute angle-closure attack in plateau iris syndrome after cataract extraction. We report two cases of recurrent acute angle-closure attack in 2 Chinese patients with plateau iris syndrome. The first patient was a 69 year-old woman who received bilateral argon laser peripheral iridoplasty and cataract extraction 2 years prior to the latest acute angle-closure with right eye intraocular pressure 48 mmHg. The attack was aborted medically. Peripheral iridotomy was patent and argon laser peripheral iridoplasty marks were mostly at peripheral 2/3 of the iris. Anterior segment optical coherence tomography confirmed bilateral plateau iris configuration. Use of long term pilocarpine or repeated argon laser peripheral iridoplasty to prevent recurrent angle-closure attack was discussed but she opted for observation. The second patient was a 64 year-old man presented with acute angle-closure after cataract extraction despite placement of laser peripheral iridotomy. Plateau iris syndrome was confirmed by anterior segment optical coherence tomography and he received argon laser peripheral iridoplasty. Acute angle-closure due to plateau iris syndrome can still occur despite previous cataract extraction and argon laser peripheral iridoplasty. These are the first reported cases of recurrent acute angle-closure attack due to plateau iris syndrome following cataract extraction, with or without previous argon laser peripheral iridoplasty. Repeated treatment with argon laser peripheral iridoplasty or pilocarpine could

  13. Outcome of limited forefoot amputation with primary closure in patients with diabetes.

    PubMed

    Shaikh, N; Vaughan, P; Varty, K; Coll, A P; Robinson, A H N

    2013-08-01

    Limited forefoot amputation in diabetic patients with osteomyelitis is frequently required. We retrospectively reviewed diabetic patients with osteomyelitis, an unhealed ulcer and blood pressure in the toe of > 45 mmHg who underwent limited amputation of the foot with primary wound closure. Between 2006 and 2012, 74 consecutive patients with a mean age of 67 years (29 to 93), and a median follow-up of 31 months, were included. All the wounds healed primarily at a median of 37 days (13 to 210; mean 48). At a median of 6 months (1.5 to 18; mean 353 days), 23 patients (31%) suffered a further ulceration. Of these, 12 patients (16% of the total) required a further amputation. We conclude that primary wound closure following limited amputation of the foot in patients with diabetes is a safe and effective technique when associated with appropriate antibiotic treatment.

  14. Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech.

    PubMed

    Hsiao, Hung-Tao; Leu, Yi-Shing; Lin, Chang-Ching

    2002-12-01

    The authors compared the postoperative speech and swallowing function of six patients who underwent free radial forearm flap reconstruction after hemiglossectomy with that of six control patients who underwent primary closure of the defect. Clinical speech pathologic evaluations included the Fletcher time-to-time maximum repetition rate of syllables, multiple rhyme test, and overall quality and intelligibility of the patients' speech. Evaluation of swallowing included the duration of deglutition, bolus volume, and ingestion rate. Speech quality, including intelligibility and articulation, was better in patients with primary closure. However, the bolus volume and ingestion rate in deglutition were better in those with flap reconstruction. These results suggest that the flap adds bulk, thus improving pharyngeal clearance by maintaining the tongue-to-mouth roof contact that is necessary in the swallowing process. The nonfunctional flap, however, hinders articulation by restricting the mobility of the remaining portion of the normal tongue.

  15. Divided and Sliding Superficial Temporal Artery Flap for Primary Donor-site Closure

    PubMed Central

    Sugio, Yuta; Seike, Shien; Hosokawa, Ko

    2016-01-01

    Summary: Superficial temporal artery (STA) flaps are often used for reconstruction of hair-bearing areas. However, primary closure of the donor site is not easy when the size of the necessary skin island is relatively large. In such cases, skin grafts are needed at the donor site, resulting in baldness. We have solved this issue by applying the divided and sliding flap technique, which was first reported for primary donor-site closure of a latissimus dorsi musculocutaneous flap. We applied this technique to the hair-bearing STA flap, where primary donor-site closure is extremely beneficial for preventing baldness consequent to skin grafting. The STA flap was divided into 3, and creation of large flap was possible. Therefore, we concluded that the divided and sliding STA flap could at least partially solve the donor-site problem. Although further investigation is necessary to validate the maximum possible flap size, this technique may be applicable to at least small defects that are common after skin cancer ablation or trauma. PMID:27975020

  16. Persistent histological changes in the exstrophic bladder after primary closure-a cause for concern?

    PubMed

    Rubenwolf, Peter C; Eder, Fabian; Ebert, Anne-Karoline; Hofstaedter, Ferdinand; Woodhouse, Christopher R J; Roesch, Wolfgang H

    2013-02-01

    We investigated bladder biopsies from patients with classic bladder exstrophy for the histological features and discuss the potential clinical significance of the findings. Bladder tissues were collected from patients with bladder exstrophy between 2004 and 2011. These specimens were obtained at primary bladder closure (group 1, 29 patients), during secondary reconstructive procedures (group 2, 27) or during cystectomy for failed reconstruction (group 3, 15). All tissue specimens were investigated for inflammatory, proliferative, metaplastic and dysplastic changes. Expression of urothelial differentiation markers CK13 and CK20 was determined by immunohistochemical analysis. Inflammatory, proliferative and metaplastic changes were found in bladder specimens of all subgroups. Neither dysplasia nor neoplasia was present. Severe epithelial changes such as cystitis glandularis and intestinal metaplasia were observed in up to 62% of bladders several years after primary closure. Aberrant expression patterns of CK13 and CK20 suggesting abnormal urothelial differentiation were shown to be present in the urothelium of all subgroups. Our findings provide prima facie evidence that the epithelial changes observed in the unclosed bladder template persist or even progress in a subset of bladders after primary closure. Although the malignant potential of cystitis glandularis and intestinal metaplasia is controversial, some patients may be at increased risk for dysplasia/neoplasia in the long term. Since the natural history of these lesions in the exstrophic bladder is unknown, these patients require lifelong surveillance. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  17. Comparison of voice outcomes after radial forearm free flap reconstruction versus primary closure after laryngectomy.

    PubMed

    Alam, Daniel S; Vivek, Prashant P; Kmiecik, Joann

    2008-08-01

    Laryngectomy with primary closure and tracheoesophageal prosthesis (TEP) voice rehabilitation has been the mainstay of the management of patients with advanced laryngeal malignancy. When adequate mucosal tissue is not available, pharyngeal reconstruction with free flaps can be utilized. The speech outcomes of these patients have been traditionally considered inferior based on the findings of a limited number of studies. We report the results of a review of our experience with radial forearm free flap (RFFF) reconstruction of extensive laryngopharyngectomy defects vs our institutional outcomes seen with primary closure. Retrospective review. All patients treated with laryngectomy procedures with either primary closure (28 patients) or RFFF (20 patients) reconstructions at the Cleveland Clinic from 2002 through 2007 were included. Blinded evaluation with statistical analysis of standard speech outcomes measures (maximal sustained phonation, fluent count) as well as qualitative variables are reported. Based on our data collection, the two groups are statistically indistinguishable. These findings support the utility and effectiveness of the RFFF in pharyngeal reconstruction in achieving good voice outcomes.

  18. Outcome of Trabeculectomy Surgery in Primary Open Angle Glaucoma

    PubMed Central

    Bhatia, Jagdish

    2008-01-01

    Objectives Retrospective study to evaluate the short term outcome and contributing prognostic factors of trabeculectomy in terms of intraocular pressure in Omani patients of South Batinah region with primary open-angle glaucoma. Methods This study involved retrospective evaluation of 18 patients (22 eyes) with primary open angle glaucoma who underwent primary trabeculectomy between February 2005 and February 2008. All patients were aged over 40 years and were Omani. Follow-up for all subjects lasted at least 6 months or more [Average follow up 388 days with standard deviation of 182]. Successful control of Intraocular pressure (IOP) was defined as achieving IOP of 21 mmHg or less without medication (complete success). Results The results are presented with particular emphasis being placed only on intraocular pressure (IOP) control. The tonometric success rate of trabeculectomy in controlling the IOP at 21mmHg or less without any medication was 46% [complete successes], 18% had qualified success [Post operative IOP 21 mm Hg or less with one topical medication], while 36% trabeculectomies failed to show desired results. Conclusion The results of this retrospective study underline that the procedure of trabeculectomy has moderate success in controlling the intra ocular pressure in the study population. The procedure failed to show the desired result in almost one third of the patients (36%) and topical medical treatment was reinstated in these patients with either two or three drugs. However these results lead to the following question: Should trabeculectomy be the therapy of first choice in the early stage of glaucoma? PMID:22379543

  19. [Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect].

    PubMed

    Zhengyang, Gao; Canhua, Jiang; Jie, Chen; Limeng, Wu; Hui, Ren; Fuqiang, Long; Chunrui, He; Xinchun, Jian

    2016-10-01

    This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps. The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radial-based fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t-
test to perform statistical analysis with SPSS 19.0 statistical software package. Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation. Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.

  20. Outcomes of primary fascial closure after open abdomen for nontrauma emergency general surgery patients.

    PubMed

    O'Meara, Lindsay; Ahmad, Sarwat B; Glaser, Jacob; Diaz, Jose J; Bruns, Brandon R

    2015-12-01

    Emergency general surgery patients are increasingly being managed with an open abdomen (OA). Factors associated with complications after primary fascial closure (PFC) are unknown. Demographic and operative variables for all emergency general surgery patients managed with OA at an academic medical center were prospectively examined from June to December 2013. Primary outcome was complication requiring reoperation. Of 58 patients, 37 managed with OA achieved PFC. Of these, 14 needed re-exploration for dehiscence, compartment syndrome, infection, or other. Complications after PFC were not associated with age, type of operative intervention, time to closure, re-explorations, comorbidities, or mortality. Complications correlated with higher body mass index (P = .02), skin closure (P = .04), plasma infusion (P = .01), and less intraoperative bleeding (P = .05). Deep surgical site infection correlated with fascial dehiscence (P = .02). Reoperation after PFC was more likely in obese and nonhemorrhagic patients. Recognition of these factors and strategies to reduce surgical site infection may improve outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. The modern staged repair of classic bladder exstrophy: a detailed postoperative management strategy for primary bladder closure.

    PubMed

    Stec, Andrew A; Baradaran, Nima; Schaeffer, Anthony; Gearhart, John P; Matthews, Ranjiv I

    2012-10-01

    Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed. Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway. Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%. A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy. Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  2. Acute angle closure attack after an intravitreal bevacizumab injection for branch retinal vein occlusion: a case report.

    PubMed

    Jeong, Seongyong; Sagong, Min; Chang, Woohyok

    2017-03-14

    Intravitreal injection is widely used to treat retinal vein occlusion, and acute angle closure (AAC) is an exceptional complication of intravitreal injection. The authors report a case of AAC that occurred immediately after administering intravitreal bevacizumab to treat branch retinal vein occlusion (BRVO). A 65-year-old woman was referred to the retina clinic of a tertiary referral center for the treatment of macular edema secondary to BRVO. On slit lamp examination, anterior chamber (AC) depth was shallow (3 corneal thicknesses centrally, 1/4 corneal thicknesses peripherally) in both eyes. Intraocular pressure (IOP) was 19 mmHg in both eyes, and refractive error was +1.00 diopter sphere in both eyes. A gonioscopy exam demonstrated narrow angle of over 180° in both eyes. To treat the macular edema, bevacizumab was injected into her right eye intravitreally. After two bevacizumab injections, the macular edema regressed but recurred 5 months later, and thus, a third injection was performed. The next day, she visited our emergency department complaining of persistent ocular pain in her right eye. The right pupil had dilated to 6 mm diameter and was fixed. Slit lamp exam revealed diffuse corneal edema in her right eye, which had an IOP of 56 mmHg. After administration of intravenous mannitol, the IOP fell to 14 mmHg and the corneal edema disappeared. Subsequently, a glaucoma specialist performed laser iridotomy on the right eye. Although AAC is a rare complication of intravitreal injection, it can occur in a patient with risk factors such as hyperopic eye or narrow angle.

  3. Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq.

    PubMed

    Leininger, Brian E; Rasmussen, Todd E; Smith, David L; Jenkins, Donald H; Coppola, Christopher

    2006-11-01

    Wartime missile injuries are frequently high-energy wounds that devitalize and contaminate tissue, with high risk for infection and wound complications. Debridement, irrigation, and closure by secondary intention are fundamental principles for the management of these injuries. However, closure by secondary intention was impractical in Iraqi patients. Therefore, wounds were closed definitively before discharge in all Iraqi patients treated for such injures at our hospital. A novel wound management protocol was developed to facilitate this practice, and patient outcomes were tracked. This article describes that protocol and discusses the outcomes in a series of 88 wounds managed with it. High-energy injuries were treated with rapid aggressive debridement and pulsatile lavage, then covered with negative pressure (vacuum-assisted closure [VAC]) dressings. Patients underwent serial operative irrigation and debridement until wounds appeared clean to gross inspection, at which time they were closed primarily. Patient treatment and outcome data were recorded in a prospectively updated database. Treatment and outcomes data from September 2004 through May 2005 were analyzed retrospectively. There were 88 high-energy soft tissue wounds identified in 77 patients. Surprisingly, for this cohort of patients the wound infection rate was 0% and the overall wound complication rate was 0%. This series of 88 cases is the first report of the use of a negative pressure dressing (wound VAC) as part of the definitive management of high-energy soft tissue wounds in a deployed wartime environment. Our experience with these patients suggests that conventional wound management doctrine may be improved with the wound VAC, resulting in earlier more reliable primary closure of wartime injuries.

  4. Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure.

    PubMed

    Lambrecht, J R; Vaktskjold, A; Trondsen, E; Øyen, O M; Reiertsen, O

    2015-06-01

    Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p < 0.01) larger hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).

  5. Commentary on Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen

    DTIC Science & Technology

    2013-05-01

    initial TAC after index laparotomy, nutrition sup- port in patients with an open abdomen , methods for ongoing TAC to include fascial-based and negative...trauma patient with an open abdomen " 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Lundy J. B., 5d. PROJECT NUMBER...Z39-18 Commentary on ‘‘Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen ’’ Jonathan B. Lundy, MD Damage

  6. Oxidative stress in primary open-angle glaucoma.

    PubMed

    Zanon-Moreno, Vicente; Marco-Ventura, Pilar; Lleo-Perez, Antonio; Pons-Vazquez, Sheila; Garcia-Medina, Jose J; Vinuesa-Silva, Ignacio; Moreno-Nadal, Maria A; Pinazo-Duran, Maria Dolores

    2008-01-01

    To analyze oxidative stress in primary open-angle glaucoma (POAG). A case-control study including 90 eyes of 90 patients who needed antiglaucomatous surgery in the course of POAG (glaucoma group, n=50) and from patients who were operated of nonpathologic cataracts (cataract group, n=40). Free radical formation via lipid peroxidation by malondialdehyde-thiobarbituric acid reactive substances (MDA-TBARS) test and total antioxidant status in the aqueous humor samples of both groups were determined. Statistical analyses were carried out in relation to MDA-TBARS and total antioxidant status and their correlations with glaucoma risk factors. Significantly higher MDA-TBARS were detected in the POAG with respect to the comparative group of cataract subjects (P<0.001). Antioxidant activity was significantly lower in the POAG than in the cataract group (P<0.001). Aqueous humor samples may be used for determining oxidative and antioxidant status in pathologic processes. Glaucomatous eyes had a significant increase in oxidative status and decreased antioxidant activity in the aqueous humor than the cataract eyes. Oxidative stress may play a pathogenical role in the POAG.

  7. Mediterranean diet adherence by patients with primary open angle glaucoma.

    PubMed

    Abreu-Reyes, J A; Álvarez-Luis, D; Arteaga-Hernández, V; Sánchez-Mendez, M; Abreu-González, R

    2017-08-01

    To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG). An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone. A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases. Patients who are affected by POAG have moderate adherence to the Mediterranean diet. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Current primary open-angle glaucoma treatments and future directions

    PubMed Central

    Beidoe, Gabriel; Mousa, Shaker A

    2012-01-01

    Primary open-angle glaucoma (POAG) is a leading cause of blindness with no known cure. Management of the disease focuses on lowering intraocular pressure (IOP) with current classes of drugs like prostaglandin analogs, beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors. These treatments have not helped all patients. Some patients continue to experience deterioration in the optic nerve even though their IOPs are within the normal range. New views have surfaced about other pathophysiological processes (such as oxidative stress, vascular dysfunction, and retinal cell apoptosis) being involved in POAG progression, and adjunctive treatments with drugs like memantine, bis(7)-tacrine, nimodipine, and mirtogenol are advocated. This review examines the current and proposed treatments for POAG. Some of the proposed drugs (bis(7)-tacrine, nimodipine, vitamin E, and others) have shown good promise, mostly as monotherapy in various clinical trials. It is recommended that both the current and proposed drugs be put through further robust trials in concurrent administration and evaluated. PMID:23118520

  9. Primary glioblastoma of the cerebellopontine angle in adults.

    PubMed

    Wu, Bo; Liu, Weidong; Zhu, Hong; Feng, Hailong; Liu, Jinping

    2011-05-01

    Gliomas are rare entities in the cerebellopontine angle (CPA) in adults. The authors present clinical, neuroradiological, serological, and neuropathological findings in a 60-year-old man with an extraaxial CPA glioblastoma arising from the proximal portion of cranial nerve VIII. The patient presented with progressive left-sided deafness and left-sided facial palsy lasting less than 2 months and progressive dysarthria and dysphagia lasting 2 weeks. Preoperative neuroimaging suggested the diagnosis of CPA meningioma with "dural-tail" sign and involvement of the internal auditory canal. Serological examination showed an increase in the malignant markers of ferritin and neuron-specific enolase, which suggested underlying malignancy. The tumor was subtotally removed, and it was confirmed to be completely separated from the brainstem and cerebellum. Cranial nerves VII and VIII were destroyed and sacrificed. Transient severe bradycardia occurred during surgery due to entrapment of the caudal cranial nerve complex by the tumor in such an infiltrative way. The neuropathological examination revealed a glioblastoma. The patient underwent no further treatment and died of cachexia 2 months postoperatively. To the authors' knowledge, this represents the first case of a primary glioblastoma in the CPA in an adult. A high index of suspicion along with reliance on clinical assessment, radiological findings, and serum detection of specific malignant markers is essential to diagnose such uncommon CPA lesions.

  10. Race, ethnicity and prevalence of primary open-angle glaucoma.

    PubMed Central

    Kosoko-Lasaki, Omofolasade; Gong, Gordon; Haynatzki, Gleb; Wilson, M. Roy

    2006-01-01

    BACKGROUND: Recently, some authors pooled data from studies on the Dutch, Australians and Americans of European origin in an attempt to predict the prevalence of primary open-angle glaucoma (POAG) in the United States. PURPOSE: To examine potential ethnic diversity in the prevalence of POAG among populations of the "same race." Methods: Medical literature was searched, and 11 population-based studies on populations of African origin and five on populations of European origin were identified. RESULTS: The prevalence of POAG was significantly higher in white Australians than in the Dutch (p<0.001) and was significantly lower (p<0.001) among black populations in South Africa, Nigeria, Tanzania and the United States than in Ghana, St. Lucia or Barbados. Notably, the prevalence was significantly lower in Afro Caribbeans living in London than in St. Lucia or Barbados (p<0.001). There was, however, inconsistency in the definition of POAG among the different studies. CONCLUSIONS: There is a wide range in the prevalence of POAG among populations of the same "race," which might be attributed to the different methodology and definition of POAG; potential difference in social, behavioral and environmental factors; and/or genetic predisposition. Scrutiny is warranted when pooling data from different ethnic groups of the "same race" in meta-analyses. PMID:17052053

  11. Metabolome-Wide Association Study of Primary Open Angle Glaucoma

    PubMed Central

    Burgess, L. Goodwin; Uppal, Karan; Walker, Douglas I.; Roberson, Rachel M.; Tran, ViLinh; Parks, Megan B.; Wade, Emily A.; May, Alexandra T.; Umfress, Allison C.; Jarrell, Kelli L.; Stanley, Brooklyn O. C.; Kuchtey, John; Kuchtey, Rachel W.; Jones, Dean P.; Brantley, Milam A.

    2015-01-01

    Purpose To determine if primary open-angle glaucoma (POAG) patients can be differentiated from controls based on metabolic characteristics. Methods We used ultra-high resolution mass spectrometry with C18 liquid chromatography for metabolomic analysis on frozen plasma samples from 72 POAG patients and 72 controls. Metabolome-wide Spearman correlation was performed to select differentially expressed metabolites (DEM) correlated with POAG. We corrected P values for multiple testing using Benjamini and Hochberg false discovery rate (FDR). Hierarchical cluster analysis (HCA) was used to depict the relationship between participants and DEM. Differentially expressed metabolites were matched to the METLIN metabolomics database; both DEM and metabolites significantly correlating with DEM were analyzed using MetaboAnalyst to identify metabolic pathways altered in POAG. Results Of the 2440 m/z (mass/charge) features recovered after filtering, 41 differed between POAG cases and controls at FDR = 0.05. Hierarchical cluster analysis revealed these DEM to associate into eight clusters; three of these clusters contained the majority of the DEM and included palmitoylcarnitine, hydroxyergocalciferol, and high-resolution METLIN matches to sphingolipids, other vitamin D-related metabolites, and terpenes. MetaboAnalyst also indicated likely alteration in steroid biosynthesis pathways. Conclusions Global ultrahigh resolution metabolomics emphasized the importance of altered lipid metabolism in POAG. The results suggest specific metabolic processes, such as those involving palmitoylcarnitine, sphingolipids, vitamin D-related compounds, and steroid precursors, may contribute to POAG status and merit more detailed study with targeted methods. PMID:26230767

  12. Vascular and Autonomic Dysregulation in Primary Open-Angle Glaucoma

    PubMed Central

    Pasquale, Louis R.

    2015-01-01

    Purpose of the review To discuss whether vascular dysfunction and autonomic dysfunction are related to primary open-angle glaucoma stratified by the intraocular pressure (IOP) level (the high tension glaucoma and normal tension glaucoma subtypes). Recent findings Patients with POAG across the spectrum of IOP exhibit a variety of ocular and non-ocular vascular abnormalities. Interestingly common genetic variation in NOS3 and the CAV1/CAV2 genomic regions, which code for proteins involved in setting vascular tone, are associated with POAG. These markers seem to stratify with POAG subtypes by sex or pattern of initial visual field loss. Overall it is clear that there is also cardiovascular autonomic dysfunction in HTG and NTG but it is unclear if this dysfunction is more common in NTG compared to HTG. Summary Overall POAG is likely a heterogeneous disease but stratifying cases by IOP level associated with initial optic nerve damage may be less useful than using other endophenotype approaches. Embracing the evidence suggesting systemic endothelial and autonomic dysfunction are operative in POAG will help move beyond an IOP-centric view of the disease and facilitate “tearing down the wall” that divides treating physicians and a better understanding of POAG pathogenesis. PMID:26720776

  13. Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept: new concept for direct closure of large defects.

    PubMed

    Topaz, Moris; Carmel, Narin Nard; Topaz, Guy; Li, Mingsen; Li, Yong Zhong

    2014-12-01

    Stress-relaxation is a well-established mechanism for laboratory skin stretching, with limited clinical application in conventional suturing techniques due to the inherent, concomitant induction of ischemia, necrosis and subsequent suture failure. Skin defects that cannot be primarily closed are a common difficulty during reconstructive surgery. The TopClosure tension-relief system (TRS) is a novel device for wound closure closure, providing secured attachment to the skin through a wide area of attachment, in an adjustable manner, enabling primary closure of medium to large skin defects. The aim of this study was to evaluate the efficiency of the TopClosure TRS as a substitute for skin grafting and flaps for primary closure of large soft tissue defects by stress-relaxation. We present three demonstrative cases requiring resection of large to huge tumors customarily requiring closure by skin graft or flaps. TRS was applied during surgery serving as a tension-relief platform for tension sutures, to enable primary skin-defect closure by cycling of stress-relaxation, and following surgery as skin-secure system until complete wound closure. All skin defects ranging from 7 to 26 cm in width were manipulated by the TRS through stress-relaxation, without undermining of skin, enabling primary skin closure and eliminating the need for skin grafts and flaps. Immediate wound closure ranged 26 to 135 min. TRS was applied for 3 to 4 weeks. Complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced and wound aesthetics were improved. In this case series we present a novel technology that enables the utilization of the viscoelastic properties of the skin to an extreme level, extending the limits of primary wound closure by the stress-relaxation principle. This is achieved via a simple device application that may aid immediate primary wound closure and downgrade the complexity of surgical procedures for a wide range

  14. [The primary closure approach of dog bite injuries of the nose].

    PubMed

    Zieliński, Tomasz

    2010-01-01

    Biting of humans by domestic animals, especially by dogs, is common injury which causes suffering and pain, might be a cause of disability or even death. It is associated with high risk of bacterial infection of the wounds or even transfection of rabies virus. Bites are usually to the upper and lower limbs, while the face is third in a raw localization of bites. Within the face, the nose and lips are injured the most often. The goal of this paper is presentation selected methods and obtained results of primary closure of dog bite injures of the nose. There were 16 patients with dog bites injures of the nose treated in the Department of Plastic, Reconstructive and Aesthetic Surgery of the Medical University of Łódź in the years 2003-2008. The patients were 11 to 46 years old. Bites caused either superficial laceration of the skin, tearing of the nostril wing or even major defects of the tissues. In 7 patients superficial wounds a direct closure was done and antibiotic ointment was applied. In 7 patients a defect of the skin was covered with a skin graft taken from retroauricular area, but in 2 of the patients of this group repair of mucosa and alar cartilage was done. In two persons with full thickness defects of the nose reconstruction was performed with the use of a pedicled nosolabial flap. Complications occurred only in 1 patient who developed infection in the wound. In all other patients there were no complications. Good aesthetic results were obtained. Primary closure approach of bite injures with tissue defect is not associated with larger risk than in the case in secondary such approach, and should be implemented always whenever it is possible in order to avoid risk of wound and scars which require further reconstructive procedures in future.

  15. Evaluation of primary open-angle glaucoma clinical practice guidelines.

    PubMed

    Wu, Annie M; Wu, Connie M; Young, Benjamin K; Wu, Dominic J; Chen, Allison; Margo, Curtis E; Greenberg, Paul B

    2015-06-01

    To evaluate the methodologic quality of 3 primary open-angle glaucoma (POAG) clinical practice guidelines (CPGs). The CPGs were assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four authors (A.M.W., C.M.W., B.K.Y., D.J.W.) performed independent assessments of POAG CPGs. POAG CPGs published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS), and National Institute for Health and Care Excellence (NICE) were appraised using the AGREE II instrument's 6 domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence) and Overall Assessment score summarizing guideline quality across all domains. Scores ranged from 28% to 85% for the AAO CPG, 51% to 96% for the COS CPG, and 55% to 97% for the NICE CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO, COS, and NICE CPGs were 0.89, 0.86, and 0.74; 95% CIs were 0.80 to 0.95, 0.74 to 0.93, and 0.51 to 0.87, respectively. The strongest domains were Scope and Purpose (AAO, COS, NICE) and Clarity of Presentation (COS, NICE). The weakest domains were Stakeholder Involvement (AAO, COS) and Editorial Independence (AAO, COS, NICE). Future POAG CPGs can be improved by addressing potential conflicts of interest within the development group, ensuring transparency of guideline development methodology, and involving all relevant stakeholders in guideline development and review. Published by Elsevier Inc.

  16. Screening of candidate genes for primary open angle glaucoma

    PubMed Central

    Liu, Ting; Xie, Lin; Ye, Jian; Liu, Yuewuyang

    2012-01-01

    Purpose Primary open-angle glaucoma (POAG) is one of the leading causes of irreversible blindness in the world. To make progress in understanding POAG, it is necessary to identify more POAG-causing genes. Methods Using haplotype analysis, we found that mutational region is located on chromosome 2 in two families. Furthermore, we screened 11 candidate genes on chromosome 2 by protein–protein interaction (PPI) analysis, including mutS homolog 6 (MSH6), mutS homolog 2 (MSH2), v-rel reticuloendotheliosis viral oncogene homolog (REL), endothelial PAS domain protein 1 (EPAS1), vaccinia related kinase 2 (VRK2), F-box protein 11 (FBXO11), EGF containing fibulin-like extracellular matrix protein 1 (EFEMP1), reticulon 4 (RTN4), RAB1A, member RAS oncogene family (RAB1A), ARP2 actin-related protein 2 homolog (ACTR2), and calmodulin 2 (phosphorylase kinase, delta; CALM2). These 11 genes are all predicted to be related to trabecular meshwork changes and progressive loss of retinal ganglion cells in POAG patients. Results According to our study, FBXO11 and VRK2 may interact with tumor protein p53 to regulate mitochondrial membrane permeability, mitochondrial membrane organization, and apoptosis. MSH2 is responsible for repairing DNA mismatches and RTN4 is for neuronal regeneration. Therefore, they are supposed to play a negative role in cellular process in POAG. CALM2 may be involved in retinal ganglion cell death and oxidative damage to cell communication. Conclusions The results demonstrate that the genes above may be associated with pathogenesis of POAG. PMID:22876139

  17. Retinal oximetry in primary open-angle glaucoma.

    PubMed

    Olafsdottir, Olof Birna; Hardarson, Sveinn Hakon; Gottfredsdottir, Maria Soffia; Harris, Alon; Stefánsson, Einar

    2011-08-16

    PURPOSE. To determine whether retinal vessel oxygen saturation is affected in primary open-angle glaucoma (POAG) patients. METHODS. Retinal oxygen saturation in patients with POAG was measured in retinal vessels with a spectrophotometric retinal oximeter in darkness, and visual fields were obtained. Oxygen tension (Po(2)) was calculated from oxygen saturation values. Statistical analysis was performed using Pearson's correlation and Student's t-test. RESULTS. Mean oxygen saturation in venules was higher in persons with poor visual fields (68% ± 4%, mean ± SD) than in those with good visual fields (62% ± 3%; P = 0.0018). The mean arteriovenous difference in oxygen saturation was lower in persons with poor visual fields (30% ± 4%, n = 9) than in those with good visual fields (37% ± 4%; P = 0.0003; n = 12). No correlation was found between saturation in retinal arterioles and visual field mean defect (n = 31; r = -0.16; P = 0.38). Oxygen saturation in retinal venules correlated positively with worsening visual field mean defect (r = 0.43; P = 0.015). Arteriovenous difference in oxygen saturation decreased significantly as the visual field mean defect worsened (r = -0.55; P = 0.0013). Mean Po(2) in venules was 38 ± 3 mm Hg. It was significantly higher in persons with poor visual field fields (40 ± 3 mm Hg) than in those with good visual fields (36 ± 2 mm Hg; P = 0.0016). CONCLUSIONS. Deeper glaucomatous visual field defects are associated with increased oxygen saturation in venules and decreased arteriovenous difference in retinal oxygen saturation. The data suggest that oxygen metabolism is affected in the glaucomatous retina, possibly related to tissue atrophy.

  18. Comparison of phacotrabeculectomy and sequential surgery in the treatment of chronic angle-closure glaucoma coexisted with cataract

    PubMed Central

    Li, Hai-Jun; Xuan, Jie; Zhu, Xiao-Min; Xie, Lin

    2016-01-01

    AIM To compare the safety and effectiveness of phacotrabeculectomy versus sequential surgery in chronic angle-closure glaucoma (CACG) with coexisting cataract. METHODS One hundred and sixty-two CACG patients (162 eyes) were retrospectively analyzed. Of them, 87 patients (87 eyes) in group A had underwent phacotrabeculectomy with intraocular lens (IOL) implantation, and 75 patients (75 eyes) in group B had underwent sequential surgery with IOL implanted. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), complications and anterior chamber angle (ACA) were measured. RESULTS Demographic characteristics of the two groups were similar. A mean follow-up period was 15±6mo (range 13 to 24mo), a mean IOP of 16.61±6.43 mm Hg in group A and 15.80±5.35 mm Hg in group B (P=0.84) at the last follow up. The Kaplan-Meier analysis revealed that the cumulative probability of success in both groups was similar (P=0.61). Anterior uveitis and hypotony were the most common complications in group A, whereas group B experienced shallow anterior chamber with trabeculectomy. With the exception of anterior uveitis, no complications occurred to 11 trabeculectomized eyes. All postoperative measurements of anterior chamber showed statistically significant differences in each group according to the preoperative data (P<0.05). However, fewer changes occurred in group B than in group A. CONCLUSION Phacotrabeculectomy and sequential surgery exhibit similar IOP reduction, visual recovery, and complications when treating CACG patients with cataract. However, for a wider ACA, phacotrabeculectomy has demonstrated higher effectiveness than sequential surgery. PMID:27275422

  19. Clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture: use of one-stage skin closure.

    PubMed

    Uemura, Takuya; Kazuki, Kenichi; Egi, Takeshi; Yoneda, Masahiro; Takamatsu, Kiyohito; Nakamura, Hiroaki

    2010-12-01

    Y-V or Z-plasties are a useful one-stage technique for skin closure after aponeurotomy. However, we know no details about postoperative improvement, particularly at each joint. The purpose of this study was to evaluate the clinical outcomes of primary skin closure with Y-V and Z-plasties for Dupuytren's contracture. We retrospectively reviewed the postoperative results of 23 patients (25 hands, 29 fingers). The preoperative severity of the contracture evaluated by the Meyerding classification was grade I in 11 fingers, II in two fingers, and III in 16 fingers. In total, 26 metacarpophalangeal (MP) joints and 27 proximal interphalangeal (PIP) joints were treated. In each finger we assessed clinical outcomes according to the percentage improvement in extension and a modified version of Tubiana's classification. Primary wound closure was possible in all cases. The mean contracture values were improved from 46.5° preoperatively to 4.2° postoperatively for the MP joint and from 43.9° to 22.4° for the PIP joint. The mean percentage improvement in extension for the MP joint was 92% and for the PIP joint 56%. The rate for the PIP joint of the little finger was 40% and for the other fingers 78%. In total, 83% of the fingers had satisfactory results. For Dupuytren's contracture, primary skin closure with Y-V and Z-plasties gives satisfactory results, more so with involvement of the MP than the PIP joint and less so with involvement of the little finger.

  20. An Inexpensive Modified Primary Closure Technique for Class IV (Dirty) Wounds Significantly Decreases Superficial and Deep Surgical Site Infection.

    PubMed

    Kim, Bradford J; Aloia, Thomas A

    2016-11-01

    Despite the creation of several programs to decrease the incidence of surgical site infection, it remains a common complication that has a significant impact on patient recovery and medical costs. The following is a description and brief outcome report of a modified primary closure technique used for dirty (Class IV) wounds. There were 14 consecutive patients who had a laparotomy with Class IV wounds treated by a single surgeon (TAA) from 2011 to 2015. All patients had a history of cancer and either showed signs suggestive for an acute abdomen and required an emergent exploratory laparotomy or were found to have purulent intraabdominal infection at the time of elective surgery. The operation and "modified primary closure" technique (subcutaneous wound wicks with stapled skin closure) were performed in every case. The modified primary closure technique was utilized in 14 patients with a Class IV wound. There were no 30-day mortalities or readmissions. Wound wicks were slowly advanced out over a 7-day period, and only one patient required subsequent wound packing of a single-wicked area. There were no superficial or deep surgical site infections, or wound dehiscence during the hospital course, or 30-day postoperative period. The modified primary closure technique is efficient and inexpensive and was effective in a series of 14 patients with wounds classified as dirty.

  1. Medical interventions for primary open angle glaucoma and ocular hypertension.

    PubMed

    Vass, C; Hirn, C; Sycha, T; Findl, O; Bauer, P; Schmetterer, L

    2007-10-17

    Primary open angle glaucoma (POAG) is a progressive optic neuropathy with an elevated intraocular pressure (IOP), where the optic nerve head becomes pathologically excavated and the visual field (VF) is characteristically altered. Ocular hypertension (OHT) is a condition with elevated IOP but without discernible pathology of the optic nerve head or the VF. It is a major risk factor for development of POAG. To assess and compare the effectiveness of topical pharmacological treatment for POAG or OHT to prevent progression or onset of glaucomatous optic neuropathy. We searched CENTRAL, MEDLINE and EMBASE in May 2007. We searched the bibliographies of identified articles and contacted experts, investigators and pharmaceutical companies for additional published and unpublished studies. Randomised controlled trials comparing topical pharmacological treatment to placebo, no treatment or other treatment for specified endpoints which included people with POAG or OHT, and with duration of treatment of at least one year. Two authors independently extracted data and assessed trial quality. Where appropriate, we summarised data using Peto odds ratio and mean difference after testing for heterogeneity between studies. We included 26 trials, which randomised 4979 participants, in this review. Meta-analysis of 10 trials clearly demonstrated reduction of onset of VF defects in treated OHT (OR 0.62, 95% CI 0.47 to 0.81). No single drug showed a significant VF protection compared to placebo or untreated controls. We did identify some border line evidence for a positive influence of treatment on VF prognosis (OR 0.67, 95% CI 0.45 to 1.00) for the beta-blockers . The results of this review support the current practice of IOP lowering treatment of OHT. A visual field protective effect has been clearly demonstrated for medical IOP lowering treatment. Positive but weak evidence for a beneficial effect of the class of beta-blockers has been shown. Direct comparisons of prostaglandins or

  2. Dog-bite lacerations: a controlled trial of primary wound closure.

    PubMed Central

    Maimaris, C; Quinton, D N

    1988-01-01

    Dog-bite wounds are often left open because of their reputation for infection if primarily closed. A prospective randomized trial comparing primary closure with leaving the wound open was performed to assess infection and cosmesis. Ninety-six patients with 169 lacerations had thorough surgical debridement and irrigation of their wounds. Ninety-two wounds were sutured and 77 left open. No prophylactic antibiotics were given. A total of 13 wounds developed infection: seven sutured and six unsutured wounds (not statistically significant), giving an overall infection rate of 7.7%. Significantly (P less than 0.01), more wound infections occurred in the hand in both groups compared to the rest of the body, indicating that particular attention should be paid to management of such wounds. It was concluded that dog-bite wounds should receive thorough surgical treatment and can be safely sutured at presentation. Special care should be given to hand wounds. PMID:3178974

  3. Outcome of primary closure of abdominal wounds following laparotomy for peritonitis in children

    PubMed Central

    Kache, Stephen Akau; Mshelbwala, Philip M.; Ameh, Emmanuel A.

    2016-01-01

    Background: Primary wound closure following laparotomy for peritonitis is generally believed to be associated with wound complications and long hospital stay. Open wound management has long been the most common practice after laparotomy for peritonitis. Primary closure (PC), however, has recently been advocated to reduce cost and morbidity. This study determined the incidence and severity of wound complications and their impact on hospital stay and overall outcome when PC of abdominal wounds is done following laparotomy for peritonitis. Patients and Methods: A prospective review of patients who had PC of abdominal wounds following laparotomy for peritonitis over a 6-year period. Results: Fifty-six children were analysed (35 boys and 21 girls), aged 11 months to 13 years (median: 8 years). The indication for laparotomy was typhoid intestinal perforation 47 (83.9%), perforated appendicitis 4 (7.1%), complicated cholecystitis 3 (5.3%) and penetrating abdominal injury with bowel perforation and intestinal obstruction with bowel perforation, 1 (1.8%) each, respectively. Postoperatively, 34 patients had wound complications. Nine patients (16.1%) had superficial wound infection alone, 12 (21.4%) had superficial wound infection with partial wound dehiscence, 6 (10.7%) had deep wound infection, 7 (12.5%) had deep wound infection with complete wound dehiscence, whereas 22 (39.3%) had no wound complication. Overall, wound complications in 13 (23.2%) patients were considered to be severe, but none resulted in mortality. Hospital stay in patients who developed wound complications was 8–37 days (median: 25 days) and 6–22 days (median: 10 days) in patients who had no wound complications (P = 0.02). Conclusion: The rate of wound complications following PC of dirty abdominal wounds remain but PC is safe and gives good healing outcomes. PMID:28051048

  4. Measuring the distribution of cellulose microfibril angles in primary cell walls by small angle X-ray scattering

    PubMed Central

    2014-01-01

    Background X-ray scattering is a well-established method for measuring cellulose microfibril angles in secondary cell walls. However, little data is available on the much thinner primary cell walls. Here, we show that microfibril orientation distributions can be determined by small angle X-ray scattering (SAXS) even in primary cell walls. The technique offers a number of advantages: samples can be analyzed in the native hydrated state without any preparation which minimizes the risk of artifacts and allows for fast data acquisition. The method provides data averaged over a specimen region, determined by the size of the used X-ray beam and, thus, yields the microfibril orientation distribution within this region. Results Cellulose microfibril orientation distributions were obtained for single cells of the alga Chara corallina, as well as for the multicellular hypocotyl of Arabidopsis thaliana. In both, Chara and Arabidopsis, distributions with a broad scattering around mean microfibril angles of approximately 0° and 90° towards the longitudinal axis of the cells were found. Conclusions With SAXS, the structure of primary cell walls can be analysed in their native state and new insights into the cellulose microfibril orientation of primary cell walls can be gained. The data shows that SAXS can serve as a valuable tool for the analysis of cellulose microfibril orientation in primary cell walls and, in consequence, add to the understanding of its mechanical behaviour and the intriguing mechanisms behind cell growth. PMID:25170343

  5. A Study of the Outcome of Primary Excision and Closure Technique in the Management of Lip Leukoderma in 30 Patients

    PubMed Central

    Shilpa, Kanathur; Sacchidanand, S.; Savitha, Somaiah; Ranjitha, Ramamurthy; Lakshmi, DV; Divya, Gorur

    2016-01-01

    Context: Lips being one of the graceful cosmetic units of the face, any disfigurement, including depigmentation, can be embarrassing, psychologically distressing, and socially stigmatizing. Even with the evolution of various surgical modalities, none of the techniques ensure 100% pigmentation with a good cosmetic appearance. With this background, this study was undertaken to study the efficacy of the technique—primary excision and closure in treatment of lip leukoderma (LL). Aims: To study the efficacy, cosmetic outcome, and recurrence following primary excision and closure technique in the management of LL. Settings and Design: A prospective single-center open-label uncontrolled study. Materials and Methods: Thirty patients with LL involving inner margin of the lower lip and those who fulfilled inclusion and exclusion criteria were included in the study. After obtaining consent and physician fitness, patients were posted for primary excision and closure of the vitiliginous area of the lip. Patients were followed up at the immediate postoperative period and 6 months later. Patient satisfaction scale was done by asking the patient to grade the response between one and ten. Statistical Analysis Used: Mean and percentiles. Results: Out of 30 patients, 29 patients achieved complete clearance that was cosmetically acceptable. Only one patient showed recurrence at the end of 6 months. Average patient satisfaction scale showed an average of 9.66. Conclusions: Primary excision and closure technique is one of the safe, inexpensive modality in the management of LL involving the inner margin of the lip with immediate result. PMID:27081245

  6. Flat Anterior Chamber after Trabeculectomy in Secondary Angle-Closure Glaucoma with BEST1 Gene Mutation: Case Series

    PubMed Central

    Xiao, Hui; Luo, Jingyi; Zuo, Chengguo; Huang, Xiaobo; Huang, Jingjing; Mi, Lan; Zhang, Qingjiong; Liu, Xing

    2017-01-01

    Purpose Trabeculectomy has been regarded as a mainstay of initial treatment in eyes of angle closure glaucoma (ACG) with peripheral anterior synechia > 180° in the Chinese population while its efficacy in secondary ACG with BEST1 gene mutation remains unclear. We set out to investigate the treatment outcome of trabeculectomy for secondary ACG in a group of patients with autosomal recessive bestrophinopathy (ARB). Methods In this retrospective case series study, 8 secondary ACG patients with ARB and their 4 recruited family members underwent a thorough ophthalmic examination including best-corrected visual acuity, Goldmann applanation tonometry, gonioscopy, and fundus examinations. Ultrasound biomicroscopy, optical coherence tomography (OCT), ultrasound A-scan, B-scan, electro-oculography (EOG), Humphrey perimetry, fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were also performed. Blood samples were obtained in the patients and their available family members to analyze the variants of the BEST1 gene. Trabeculectomy was performed in the 8 patients (15 eyes). Results The age of onset varied from 13 to 38 years. The average axial length (AL) of the affected eyes was 21.82 ± 0.92 mm and the average anterior chamber depth (ACD) was 2.19 ± 0.29 mm. There was marked axial shallowing of the anterior chamber in all 15 eyes after trabeculectomy, and was not improved with potent mydriatics. The IOP was elevated in 3 eyes. Variable degree of yellowish subretinal deposits was observed in the posterior retina. The FFA showed punctuate or patched hyperfluorescence suggesting retinal pigment epithelium impairment. The ICGA demonstrated dilatation of choroidal vessels. The OCT revealed diffused neuroretinal detachment in the posterior and midperipheral retina, with intraretinal fluid collections, and hyperreflective subretinal accumulations. The average subfoveal choroidal thickness of the patients was 382.36 ± 80.09 μm. All

  7. The inheritance of juvenile onset primary open angle glaucoma.

    PubMed

    Gupta, V; Somarajan, B I; Gupta, S; Chaurasia, A K; Kumar, S; Dutta, P; Gupta, V; Sharma, A; Tayo, B O; Nischal, K

    2016-10-25

    Juvenile onset open angle glaucoma (JOAG) affects patients before 40 years of age, who present with high intraocular pressure and deep steep cupping of the optic nerve head. While it was considered to be inherited in an autosomal dominant fashion, recent studies have shown an autosomal recessive pattern as well as sporadic occurrence of the disease in several families. In this review, we analyze the genetic basis of the disease along with common mutations and their association with JOAG. We also analyzed the inheritance patterns in a large group of unrelated JOAG patients (n = 336) from Northern India wherein the prevalence of familial occurrence was assessed and segregation analysis performed, to determine the mode of inheritance.

  8. Maxillary Midline diastema closure after replacement of primary teeth with implant prosthesis

    PubMed Central

    Al-Saqabi, Farah Y; Fenlon, Michael R; Bavisha, Kalpesh A

    2015-01-01

    Key Clinical Message This case shows an excellent esthetic treatment outcome using implant-retained crowns replacing maxillary laterals and canines in hypodontia patient with unusual incidence of spontaneous diastema closure after the placement of implants. To our knowledge, this is the first case report showing maxillary midline diastema closure after implant placement. PMID:25984308

  9. VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen

    PubMed Central

    Ji, Zhenling; Liu, Shengli; Wang, Baochai; Zheng, Yu; Gu, Guosheng; Wang, Xinbo; Li, Jieshou

    2014-01-01

    Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222–4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen. PMID:25548553

  10. VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen.

    PubMed

    Tao, Qingsong; Ren, Jianan; Ji, Zhenling; Liu, Shengli; Wang, Baochai; Zheng, Yu; Gu, Guosheng; Wang, Xinbo; Li, Jieshou

    2014-01-01

    Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222-4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen.

  11. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study

    PubMed Central

    2013-01-01

    Background To investigate the emergency treatment on facial laceration of dog bite wounds and identify whether immediate primary closure is feasible. Methods Six hundred cases with facial laceration attacked by dog were divided into two groups randomly and evenly. After thorough debridement, the facial lacerations of group A were left open, while the lacerations of group B were undertaken immediate primary closure. Antibiotics use was administrated only after wound infected, not prophylactically given. The infection rate, infection time and healing time were analyzed. Results The infection rate of group A and B was 8.3% and 6.3% respectively (P>0.05); the infection time was 26.3±11.6h and 24.9±13.8h respectively (P>0.05), the healing time was 9.12±1.30d and 6.57±0.49d respectively (P<0.05) in taintless cases, 14.24±2.63d and 10.65±1.69d respectively (P<0.05) in infected cases. Compared with group A, there was no evident tendency in increasing infection rate (8.3% in group A and 6.3% in group B respectively) and infection period (26.3±11.6h in group A and 24.9±13.8h in group B respectively) in group B. Meanwhile, in group B, the wound healing time was shorter than group A statistically in both taintless cases (9.12±1.30d in group A and 6.57±0.49d in group B respectively) and infected cases (14.24±2.63d in group A and 10.65±1.69d in group B respectively). Conclusion The facial laceration of dog bite wounds should be primary closed immediately after formal and thoroughly debridement. And the primary closure would shorten the healing time of the dog bite wounds without increasing the rate and period of infection. There is no potentiality of increasing infection incidence and infection speed, compared immediate primary closure with the wounds left open. On the contrary, primary closure the wounds can promote its primary healing. Prophylactic antibiotics administration was not recommended. and the important facial organ or tissue injuries should be secondary

  12. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study.

    PubMed

    Rui-feng, Chen; Li-song, Huang; Ji-bo, Zheng; Li-qiu, Wang

    2013-01-01

    To investigate the emergency treatment on facial laceration of dog bite wounds and identify whether immediate primary closure is feasible. Six hundred cases with facial laceration attacked by dog were divided into two groups randomly and evenly. After thorough debridement, the facial lacerations of group A were left open, while the lacerations of group B were undertaken immediate primary closure. Antibiotics use was administrated only after wound infected, not prophylactically given. The infection rate, infection time and healing time were analyzed. The infection rate of group A and B was 8.3% and 6.3% respectively (P>0.05); the infection time was 26.3 ± 11.6h and 24.9 ± 13.8h respectively (P>0.05), the healing time was 9.12 ± 1.30 d and 6.57 ± 0.49 d respectively (P<0.05) in taintless cases, 14.24 ± 2.63 d and 10.65 ± 1.69 d respectively (P<0.05) in infected cases.Compared with group A, there was no evident tendency in increasing infection rate (8.3% in group A and 6.3% in group B respectively) and infection period (26.3 ± 11.6h in group A and 24.9 ± 13.8h in group B respectively) in group B. Meanwhile, in group B, the wound healing time was shorter than group A statistically in both taintless cases (9.12 ± 1.30 d in group A and 6.57 ± 0.49 d in group B respectively) and infected cases (14.24 ± 2.63 d in group A and 10.65 ± 1.69 d in group B respectively). The facial laceration of dog bite wounds should be primary closed immediately after formal and thoroughly debridement. And the primary closure would shorten the healing time of the dog bite wounds without increasing the rate and period of infection. There is no potentiality of increasing infection incidence and infection speed, compared immediate primary closure with the wounds left open. On the contrary, primary closure the wounds can promote its primary healing. Prophylactic antibiotics administration was not recommended. and the important facial organ or tissue injuries should be secondary

  13. Septic necrosis of the midline wound in postoperative peritonitis. Successful management by debridement, myocutaneous advancement, and primary skin closure.

    PubMed Central

    Lévy, E; Palmer, D L; Frileux, P; Hannoun, L; Nordlinger, B; Tiret, E; Honiger, J; Parc, R

    1988-01-01

    Wound management following laparotomy for postoperative peritonitis and varying degrees of parietal necrosis remains a challenging and controversial problem. Because maintained peritoneal integrity and primary wound closure offer the best opportunity for survival, an original technique involving bilateral incisions to relax skin and rectus fascia is proposed. This technique permits medial myocutaneous advancement and primary tension-free skin closure of midline laparotomy incisions. Sixty-nine patients with severe postoperative peritonitis were treated according from 1980 through 1985. Nine of these patients died of advanced multiple organ failure soon after referral, and eight more died after prolonged treatment. Fourteen patients had one or more reoperations for complications. Only nine wound failures resulted, including five eviscerations and four wound infections followed by progressive dehiscence. The bilateral relaxing incisions healed secondarily without complication. Survivors developed midline wound hernia; ten of the 52 surviving patients have had these repaired. This method of primary closure is safe when performed in conjunction with rigorous surgical care of intraperitoneal infection and may enhance survival. We recommend the technique to surgeons who treat severe postoperative peritonitis and septic necrosis of midline laparotomy wounds. Images Fig. 1. Fig. 4. Fig. 7. Figs. 8A and B. Fig. 9. PMID:3281613

  14. Quality of life in patients after resection of pT3 lateral tongue carcinoma: Microvascular reconstruction versus primary closure.

    PubMed

    Canis, Martin; Weiss, Bernhard G; Ihler, Friedrich; Hummers-Pradier, Eva; Matthias, Christoph; Wolff, Hendrik A

    2016-01-01

    Controversy exists regarding the functional advantages of free flap reconstruction after partial glossectomy as compared to primary closure. Forty patients were included in this retrospective analysis after resection of pT3 lateral tongue carcinomas. Twenty patients received a free forearm flap and 20 patients had a primary closure. All patients had adjuvant chemoradiation, were free of disease at least 1 year after therapy, and completed the German versions of the European Organization for Research and Treatment of Cancer (EORTC) questionnaires Quality of Life Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (QLQ-H&N35). Mean time between surgery and quality of life (QOL) assessment was 16.2 ± 3.4 months. The average resection was 41.60% (reconstruction) of the oral tongue, and 39.1% (primary closure). After reconstruction, patients had significantly (p > .05) fewer problems with the swallowing, speech, and social eating subdomains of the EORTC QLQ-H&N35. All other items showed no significant differences. Our preliminary results suggest that free flaps might be useful when treating pT3 tongue cancer. © 2015 Wiley Periodicals, Inc.

  15. Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen.

    PubMed

    Zielinski, M D; Goussous, N; Schiller, H J; Jenkins, D

    2013-02-01

    Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the "chemical components separation," which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral abdominal wall musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009-June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-abdominal abscess (44 %) and deep surgical site infection (33 %). The "chemical components separation" technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.

  16. Comparison of primary repair and patch plasty procedure on the P wave in adult atrial septal defect closure

    PubMed Central

    Ucak, Alper; Temizkan, Veysel; Ugur, Murat; Selcuk, Arif; Yilmaz, Ahmet Turan; Yedekci, Ahmet Erturk; Uz, Omer

    2016-01-01

    Summary Introduction: In this study we compared the effects of two different surgical procedures for closure of adult atrial septal defect (ASD) on postoperative P-wave changes. Methods: Patients who underwent cardiac surgery for secundum type ASD closure were evaluated retrospectively. Seventy-two patients with primary repair of ASD and 29 patients with pericardial patch plasty repair were compared according to Pmax, Pmin and P-wave dispersions (Pd). Results: In each group, the increases in postoperative maximum P-wave duration (Pmax) and minimum P-wave duration (Pmin) were statistically significant. There was no statistically significant difference between post- and pre-operative Pd values. In the comparison between group 1 and group 2 in terms of postoperative P-wave changes (Pmax, Pmin, Pd) there was no statistically significant difference. Conclusion: Comparing patch plasty and primary repair for the surgical closure of ASD in the early to mid-postoperative period, no difference was found and both surgical procedures can be performed in adult ASDs. PMID:27149297

  17. [Morphological alterations of the trabecular meshwork in primary open angle glaucoma].

    PubMed

    Potau, J M; Canals, M; Costa, J; Merindano, M D; Ruano, D

    2000-03-01

    In the present essay we have compared the morphology and structure of normal trabecular meshworks and glaucomatous trabecular meshworks with the purpose of obtaining information about the etiopathogeny of primary open angle glaucoma. We have observed by conventional light microscopy and scanning electron microscopy a total amount of 20 trabecular meshworks from non-glaucomatous patients and 35 trabecular meshworks from surgical pieces of trabeculectomy performed in patients diagnosed of primary open angle glaucoma. We have observed that glaucomatous trabecular meshworks show morphological and structural alterations of their trabecular beams, as their enlarging, collapse, the partial loss of endothelial cells and the existence of plenty of material accumulated on them, like pigment granules and calcium precipitates. Glaucomatous trabecular meshworks present morphological and structural alterations which can be related to etiopathogeny of primary open angle glaucoma since they modify the normal conditions of drainage of aqueous humour to Schlemm's channel.

  18. Comparison of W-Plasty vs Traditional Straight-Line Techniques for Primary Paramedian Forehead Flap Donor Site Closure.

    PubMed

    Jáuregui, Emmanuel J; Tummala, Neelima; Seth, Rahul; Arron, Sarah; Neuhaus, Isaac; Yu, Siegrid; Grekin, Roy; Knott, P Daniel

    2016-07-01

    The paramedian forehead flap (PMFF) donor site scar is hard to disguise and may be a source of patient dissatisfaction. To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) closure techniques of the PMFF donor site. A retrospective cohort study was conducted at the University of California, San Francisco Medical Center. Clinical history and operative reports were reviewed for 31 patients who underwent a PMFF procedure performed between November 1, 2011, and May 29, 2014. Blinded photographic analysis of postoperative photographs was performed. The pedicled component of the PMFF was raised primarily with either a W-plasty or traditional SL design. Standard photographs of the donor site, obtained at least 90 days after surgery, were reviewed and scored in a blinded fashion by 4 dermatologic surgeons using a 100-point visual analog scale (from 0 [worst possible outcome] to 100 [best possible outcome]) and a 5-point Likert scale (from very poor to excellent). Interrater reliability was assessed via Cronbach α testing. All 31 forehead flaps survived during this study period; 16 PMFFs were raised with the W-plasty technique and 15 were raised with the SL technique. The W-plasty and SL groups were similar in terms of age, sex, and race/ethnicity (mean [SD] age, 68.4 [12.4] vs 61.8 [11.6] years; 13 [84%] vs 9 [60%] men; and 15 [94%] vs 13 [87%] white). Patients undergoing W-plasty closure had significantly higher mean visual analog scale scores compared with those undergoing SL closure (72.8 [18.3] vs 65.6 [18.1]; P = .03). Mean Likert scale scores for W-plasty were higher than those for SL closure, but the difference was not significant (3.77 [1.02] vs 3.43 [0.98]; P = .08). Overall interrater reliability for the visual analog scale and Likert scale scores were 0.67 and 0.58, respectively. Patients undergoing PMFF donor site closure using a primary W-plasty technique demonstrated better mean scar appearance of the forehead donor site

  19. Combination medical treatment for primary open angle glaucoma and ocular hypertension: a network meta-analysis

    PubMed Central

    Michelessi, Manuele; Lindsley, Kristina; Yu, Tsung; Li, Tianjing

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: The objectives of this review are to examine the comparative effectiveness and safety of different glaucoma fixed combination therapies and monotherapies in eyes with primary open angle glaucoma or ocular hypertension and to provide relative rankings of these treatments. PMID:25774087

  20. Changing Concepts of Primary Open-Angle Glaucoma and Early Detection

    PubMed Central

    Battista, Renaldo N.; Huston, Patricia; Davis, M. William L.

    1986-01-01

    The understanding of primary open-angle glaucoma has changed over the past 20 years and recommendations on early detection are being revised. In this paper the use of Shiotz tonometry is critically examined, and the problems encountered in instituting alternative screening techniques are reviewed. ImagesFigure 3c PMID:21267099

  1. Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration.

    PubMed

    Muzaffar, Iqbal; Zula, Pai; Yimit, Yusp; Jaan, Ajim Tuergan; Wen, Hao

    2014-11-01

    To compare the postoperative short-term and mid-term complications in patients who underwent CBD exploration and closure by using T-tube or primary closure. Prospective randomized clinical trial. Hepatobiliary Department of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, from August 2009 to March 2013. A total of 148 consecutive patients with Common Bile Duct Stones (CBDS) and CBD dilation were enrolled in this randomized study to undergo open cholecystectomy with CBD exploration. Pre-operative findings, postoperative short-term complications, postoperative follow-up (mid-term), and hospital stay were recorded and analyzed. A T-tube was inserted in 76 (51.35%) patients and the primary closure was done in 72 (48.64%) patients. There were no differences in the demographic characteristics and clinical presentations between the two groups. Compared with the T-tube group 8.97 ± 1.629 days, the postoperative stay in primary closure 5.34 ± 1.25 days was significantly shorter (p < 0.01). The incidence of overall postoperative short-term complications and mid-term complications were statistically but not significantly lower in the primary closure group (9.7%) than that in T-tube group (17.10%, p=0.189). Complications in the primary closure group were lower than that in T-tube group but there was no significant statistical difference. So during open surgery for CBD stones, primary closure of CBD appeared safe and effective with shorter hospital stays and less complications.

  2. Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma

    PubMed Central

    Dusak, Abdurrahim; Baykara, Mehmet; Ozkaya, Guven; Erdogan, Cuneyt; Ozcetin, Hikmet; Tuncel, Ercan

    2013-01-01

    AIM To investigate the relationship between the ultrasound biomicroscopic (UBM) features of anterior-segment cysts (ASCs) and increased intraocular pressure (IOP) as a risk factor for closed-angle glaucoma (CAG). METHODS Totally 24 eyes with recently diagnosed ASCs were divided into two groups. First group with ASC and ocular normotension (n=13), second group with ASC and ocular hypertension (n=11). An ophthalmologic examination, including tonometry, slit-lamp biomicroscopy (SLBM), gonioscopy, fundoscopy, pentacam, and UBM, was performed. The features of the ASCs were compared with the IOP. RESULTS ASCs were accurately diagnosed and delineated in 24 eyes using UBM. IOP was elevated in those ASCs with a secondary aetiology (P=0.027), iridociliary location (P=0.006), deformed shape (P=0.013), increased size (P=0.001) and elongated pupillary aperture (P=0.009). However, the count (P=0.343) of ASCs, anterior chamber depth (ACD; P=0.22) and axial lenght (AL; P=0.31) were not associated with ocular hypertension. Correlations were found between the IOP and ASC size (r=-0.712; P=0.003), anterior chamber angle (ACA; r=-0.985; P<0.001), angle opening area (AOA; r=0.885; P<0.001), angulation of iris (r=-0.776, P<0.001), and affected iris quadrant (r =-0.655, P=0.002). CONCLUSION Ocular hypertension in some eyes with ASC might be associated with various mechanisms, including secondary aetiology, iridociliary location, deformed shape, increased size and elongated pupill, which can be determined by UBM. PMID:23991389

  3. The distinction between juvenile and adult-onset primary open-angle glaucoma

    SciTech Connect

    Wiggs, J.L.; Haines, J.L.; Damji, K.F.

    1996-01-01

    Because of the significant differences between the juvenile and adult forms of open-angle glaucoma, especially with regard to inheritance, prevalence, severity, and age of onset, we read with interest the recent publication by Morissette et al., describing a pedigree with a phenotype that overlaps the distinctive features of juvenile-onset open-angle glaucoma (JOAG) and adult-onset primary open-angle glaucoma (usually abbreviated as POAG or COAG). These authors conclude that a gene mapped to human chromosome 1q21-q31 (GLC1A) can be responsible for both juvenile and adult forms of open-angle glaucoma. The implications of such a result could be extremely important, in light of the high prevalence of the adult form of the disease. However, while the data presented in this report suggest that variable expressivity of the GLC1A gene may lead to a broader range of onset for this form of juvenile glaucoma, these data do not identify the GLC1A gene as an important cause of POAG. To prevent misleading interpretations of this and similar studies, we wish to clarify the distinction between the juvenile and adult forms of open-angle glaucoma. 8 refs.

  4. Macular Thickness Variability in Primary Open Angle Glaucoma Patients using Optical Coherence Tomography.

    PubMed

    Sharma, Anjali; Agarwal, Prakashchand; Sathyan, P; Saini, V K

    2014-01-01

    To compare the difference of retinal macular thickness and macular volume using optical coherence tomography (OCT) in primary open angle glaucoma (POAG) patients with the normal subjects. This observational case control study included primary open angle glaucoma (POAG) patients (n = 124 eyes) and healthy subjects in the control group (n = 124 eyes). All subjects underwent detailed history, general and systemic exami -nation. Complete ocular examination included best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), central corneal thickness, gonioscopy, dilated fundus biomicroscopy. Field analysis was done by white on white Humphrey Field Analyzer (Carl Zeiss). Optical coherence tomography imaging of macular area was performed using Stratus OCT (OCT 3, Version 4, Carl Zeiss Inc, Dublin, California, USA). In both these groups, parameters analyzed were macular thickness, inner macular thicknesses (IMT), outer macular thicknesses (OMT), central macular thick ness (CMT) and total macular volume (TMV). The POAG group had significantly decreased values of TMV, OMT and IMT, compared to control group, while there was no difference in CMT, presumably due to absence of ganglion cells in the central part. Thus, macular thickness and volume parameters may be used for making the diagnosis of glaucoma especially in patients with abnormalities of disc. Macular thickness parameters correlated well with the diagnosis of glaucoma. How to cite this article: Sharma A, Agarwal P, Sathyan P, Saini VK. Macular Thickness Variability in Primary Open Angle Glaucoma Patients using Optical Coherence Tomography. J Current Glau Prac 2014;8(1):10-14.

  5. Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study.

    PubMed

    Wennergren, John Emil; Askenasy, Erik P; Greenberg, Jacob A; Holihan, Julie; Keith, Jerrod; Liang, Mike K; Martindale, Robert G; Trott, Skylar; Plymale, Margaret; Roth, John Scott

    2016-08-01

    Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates. A multicenter, retrospective database of all ventral hernia repairs performed from 2010-2012 was accessed. Patients who underwent LVHR with mesh were reviewed. Patients who had PFC were compared to bridged repair. Primary outcome was hernia recurrence determined by clinical examination or CT scan. Secondary outcomes included SSI and seroma formation. A total of 1594 patients were identified. Following exclusion, a total of 196 patients were left who underwent LVHR with a mean follow-up period of 17.5 months. Ninety-seven patients underwent PFC, while 99 underwent bridged repairs. Initial comparisons between both groups was negative for any significant statistical difference in terms of recurrence, seroma formation, SSI, deep/organ space SSI, reoperation, and readmission. The same initial findings held true during subgroup analysis. Propensity score analysis was then performed for recurrence, seroma, and SSI controlling for age, gender, immune status, ASA class, BMI, smoking status, and acute repair. No statistically significant differences were identified in either group. Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on

  6. Diagnostic value of nasal nitric oxide measured with non-velum closure techniques for children with primary ciliary dyskinesia.

    PubMed

    Mateos-Corral, Dimas; Coombs, Robin; Grasemann, Hartmut; Ratjen, Felix; Dell, Sharon D

    2011-09-01

    Nasal nitric oxide (nNO) is a reliable non-invasive screening test for primary ciliary dyskinesia (PCD), but the recommended technique, exhalation against resistance (ER), requires cooperation limiting its use in young children. Our objectives were to determine whether easier non-velum closure techniques have the ability to discriminate PCD and longitudinal reproducibility. We conducted a case-control study evaluating 5 breathing techniques (ER, breath hold, tidal breathing mouth open, tidal breathing mouth closed, and humming) for measuring nNO in patients with PCD compared with control subjects (cystic fibrosis [CF], non-PCD non-CF bronchiectasis, and healthy). A subgroup repeated measurements 1 month later. Sensitivity, specificity, and intraclass correlation coefficient of each nNO technique were determined. We tested 85 children (20 PCD, 32 CF, 14 broncheoctasis, and 19 healthy), aged 5 to 18 years (mean age, 11.5 years); 52% of children were male. All breathing techniques discriminated patients with PCD from control subjects with high specificity (>90%), 100% sensitivity, and intraclass correlation coefficient >0.8. nNO output cutoff values for diagnosing PCD varied with techniques (ER, 59 nL/min; breath hold, 61 nL/min; tidal breathing mouth open, 37 nL/min; tidal breathing mouth closed, 30 nL/min; humming, 41 nL/min). Non-velum closure techniques are reproducible and valid to discriminate PCD; however, they generally yield lower values than ER. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. Ring closure in actin polymers

    NASA Astrophysics Data System (ADS)

    Sinha, Supurna; Chattopadhyay, Sebanti

    2017-03-01

    We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers.

  8. Pediatric primary pilocytic astrocytoma of the cerebellopontine angle: a case report.

    PubMed

    Mirone, G; Schiabello, L; Chibbaro, S; Bouazza, S; George, B

    2009-02-01

    We describe a rare case of pediatric pilocytic astrocytoma presented as a right cerebellopontine angle (CPA) mass, completely separated from the brain stem and arising from the proximal VIII nerve portion. A 12-year-old boy, with no evidence of neurofibromatosis type 2, presented with progressive hearing loss at the right ear and headache. An initial enhanced magnetic resonance examination suggested the diagnosis of schwannoma. The tumor was resected by a suboccipital retrosigmoid approach. Our case seems to be the first report of a primary pediatric CPA pylocitic astrocytoma arising from the VIII nerve complex and presenting internal auditory canal enlargement. It represents the third reported case of a primary CPA pilocytic astrocytoma (the second pediatric case with the first arising from V nerve) and the eighth report of primary CPA glioma, overall. We discuss the clinical, neuroradiological, and intraoperative findings, and we review the different hypothesis about the origin of these rare tumors.

  9. Novel Pharmacologic Candidates for Treatment of Primary Open-Angle Glaucoma

    PubMed Central

    Lu, Louise J.; Tsai, James C.; Liu, Ji

    2017-01-01

    Primary open-angle glaucoma (OAG) affects approximately 45 million people worldwide and more than 2.5 million people aged 40 years or older in the United States. Pharmacologic treatment for glaucoma is directed towards lowering intraocular pressure (IOP) to slow disease progression and delay visual field loss. Current medical treatment options for the lowering of IOP include the following classes of topical medications: beta-adrenergic antagonists, alpha-adrenergic agonists, cholinergic agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. Issues with existing drugs include failure to achieve target IOP with monotherapy, drug-related side effects, and low patient compliance with multiple daily administration of eye drops. In recent years, the scientific and medical community has seen encouraging development of novel classes of drugs for primary OAG, the majority of which lower IOP by targeting the trabecular meshwork outflow pathway to increase aqueous humor outflow. Among the most promising new pharmacologic candidates are rho kinase inhibitors including ripasudil (K-115), netarsudil (AR-13324), and AMA0076; adenosine receptor agonists including trabodenoson (INO-8875); and modified prostaglandin analogs including latanoprostene bunod (LBN, BOL-303259-X) and ONO-9054. This study aims to systematically review and summarize the most recent developments in clinical trials for new pharmacologic options for the treatment of primary open-angle glaucoma. PMID:28356898

  10. Depth resolution, angle dependence, and the sputtering yield of Irganox 1010 by coronene primary ions.

    PubMed

    Seah, Martin P; Spencer, Steve J; Shard, Alex G

    2013-10-03

    A study is reported of the depth resolution and angle dependence of sputtering yields using the reference organic material, Irganox 1010, for a new coronene(+) depth profiling ion source at 8 and 16 keV beam energies. This source provides excellent depth profiles as shown by 8.5 nm marker layers of Irganox 3114. Damage occurs but may be ignored for angles of incidence above 70° from the surface normal, as shown by X-ray photoelectron spectroscopy (XPS) of the C 1s peak structure. Above 70°, XPS profiles of excellent depth resolution are obtained. The depth resolution, after removal of the thickness of the delta layers, shows a basic contribution of 5.7 nm together with a contribution of 0.043 times the depth sputtered. This is lower than generally reported for cluster sources. The coronene(+) source is thus found to be a useful and practical source for depth profiling organic materials. The angle dependencies of both the undamaged and damaged materials are described by a simple equation. The sputtering yields for the undamaged material are described by a universal equation and are consistent with those obtained for C60(+) sputtering. Comparison with the sputtering yields using an argon gas cluster ion source shows great similarities, but the yields for both the coronene(+) and C60(+) primary ion sources are slightly lower.

  11. System for closure of a physical anomaly

    SciTech Connect

    Bearinger, Jane P; Maitland, Duncan J; Schumann, Daniel L; Wilson, Thomas S

    2014-11-11

    Systems for closure of a physical anomaly. Closure is accomplished by a closure body with an exterior surface. The exterior surface contacts the opening of the anomaly and closes the anomaly. The closure body has a primary shape for closing the anomaly and a secondary shape for being positioned in the physical anomaly. The closure body preferably comprises a shape memory polymer.

  12. [The effect of crystalline lens extraction on intraocular pressure in patients with primary open-angle glaucoma].

    PubMed

    Macarie, S; Macarie, Daniela

    2013-01-01

    This issue presents the results of a study on patients with cataract and primary open angle glaucoma who suffered lens extraction for cataract. We analise the effects of the lens extraction on the level of intraocular pressure at this patients.

  13. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study.

    PubMed

    Pasqualini, D; Cocero, N; Castella, A; Mela, L; Bracco, P

    2005-01-01

    Primary and secondary closure techniques after removal of impacted third molars were compared in terms of post-operative pain and swelling. Two hundred patients with impacted third molars were randomly divided into two groups of 100. Panoramic radiographs were taken to assess degree of eruption and angulation of third molars. Teeth were extracted, and in Group 1 the socket was closed by hermetically suturing the flap. In Group 2 a 5-6 mm wedge of mucosa adjacent to the second molar was removed to obtain secondary healing. Swelling and pain were evaluated for 7 days after surgery with the VAS scale. The statistical analysis (*analysis of variance for repeated measures, P < 0.05) showed that pain was greater in Group 1, although it decreased over time similarly in the two groups (P = 0.081, F(6,198) = 3.073*). Swelling was significantly worse in Group 1 (P < 0.001, F(6,198) = 44.30*). In Group 1, dehiscence of the mucosa was present in 33% of patients at day 7, and 2% showed signs of re-infection with suppurative alveolitis at 30 days. Pain and swelling were less severe with secondary healing than with primary healing.

  14. Abnormal interhemispheric resting-state functional connectivity in primary open-angle glaucoma.

    PubMed

    Peng Zhou; Jieqiong Wang; Ting Li; Ningli Wang; Junfang Xian; Huiguang He

    2016-08-01

    Glaucoma is the second leading cause of blindness and it has been the topic of massive studies to explore the underlying mechanisms of the disease. Resting-state neuroimaging studies have been widely applied to investigate the functional damage of the brain, but little is known about the alterations of the interhemispheric resting-state functional connectivity (RSFC) in patients with primary open-angle glaucoma (POAG). In the present study, we used a newly developed voxel-mirrored homotopic connectivity (VMHC) method to explore the interhemispheric RSFC of the brain in POAG patients. The result showed decreased VMHC in the precuneus and the occipital lobe including calcarine and cuneus, as well as increased VMHC in the lingual gyrus, insula, supramarginal gyrus, and frontal gyrus. Meanwhile, we found the mean VMHC in precuneus was negatively correlated (r=-0.551, P=0.041) with Cup-to-disk Ratio. Significant differences between POAG patients and normal controls reveal the altered brain regions and the functional damage, strengthening the understanding of the primary open-angle glaucoma.

  15. Is nail fold capillaroscopy useful in normotensive and primary open angle glaucoma? A pilot study.

    PubMed

    Božić, Marija; Senćanić, Paraskeva-Hentova; Spahić, Goran; Kontić, Dorđe; Marković, Vujica; Marjanović, Ivan; Stojkovic, Milenko; Dorđević-Jocić, Jasmina

    2010-12-01

    Vascular dysregulation is deemed a significant risk factor in glaucoma occurrence and progression. Capillaroscopy of the blood vessels on the finger nail-fold is a method that can provide information regarding the state of the vascular system at the capillary level. The aim of this pilot study was to determine whether there are significant differences in the morphological characteristics of the peripheral blood vessels in normotensive glaucoma and primary open angle glaucoma. An ophthalmological and capillaroscopic examination was conducted on 30 normotensive glaucoma patients and 30 primary open angle glaucoma patients. The capillaroscopic characteristics described were as follows: capillary row density, capillary diameter, number of spirally formed capillaries, permeability of the loop, and loop resistance. Statistically, significantly more intensively spiraled capillaries were found in normotensive glaucoma patients (χ(2) test, p < 0.05). Results confirm the thesis that vascular factors play a significant role in the pathogenesis of the glaucoma, especially in cases where the level of intraocular pressure cannot be deemed responsible for the present damage of the optical nerve. Despite the newer, technologically more developed methods for diagnostics and monitoring glaucoma, it is often not easy to establish the right diagnosis and determine further the course of the illness, since the role the intraocular pressure (IOP) plays compared to the role of vascular factors is unknown; hence, capillaroscopy as a complementary diagnostic procedure can be of help.

  16. Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease: results of 200 military service members.

    PubMed

    Can, Mehmet Fatih; Sevinc, Mert Mahsuni; Yilmaz, Mehmet

    2009-01-01

    There is a high incidence of sacrococcygeal pilonidal disease (SPD) among young males. Despite increasing data on the treatment of SPD, no standard treatment has yet been established. The goal of this study was to compare the Karydakis flap reconstruction with a primary midline closure (PMC) in the treatment of patients with SPD. The study included 200 patients treated over a period of 30 months. After a power analysis, the study was run on a two-directional basis (both retrospective reviews of patient charts and a telephone interview for prospective evaluation). The surgical findings, complications, recurrence rates, and degree of satisfaction based on a questionnaire were assessed. The duration of the surgery was longer in the Karydakis group. Complications were more frequently seen in the PMC group. The recurrence rate was 4.6% for the Karydakis group and 18.4% for the PMC group. Of patients who underwent the Karydakis operation, 70.8% were completely satisfied with the procedure, while only 32.6% of patients who underwent the PMC reported excellent satisfaction. A significantly higher number of patients in the Karydakis group recommended the same procedure to other patients with SPD. The Karydakis method may be a preferable option in the treatment of SPD, due to the low rate of recurrence and the promising satisfaction rates.

  17. Mapping a gene for adult-onset primary open-angle glaucoma to chromosome 3q

    SciTech Connect

    Wirtz, M.K.; Samples, J.R.; Kramer, P.L.

    1997-02-01

    Glaucoma is the third-leading cause of blindness in the world, affecting >13.5 million people. Adult-on-set primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States. We present a family in which adult-onset POAG is inherited as an autosomal dominant trait. Twelve affected family members were identified from 44 at-risk individuals. The disease-causing gene was mapped to chromosome 3q21-24, with analysis of recombinant haplotypes suggesting a total inclusion region of 11.1 cM between markers D3S3637 and D3S1744. This is the first report of mapping of an adult-onset POAG gene to chromosome 3q, gene symbol GLC1C. 57 refs., 3 figs., 3 tabs.

  18. Effect of betaxolol on primary open-angle glaucoma and normal-tension glaucoma patients.

    PubMed

    Saccà, S C; Macrì, A; Rolando, M; Ciurlo, G

    1998-06-01

    This study is aimed at establishing the efficacy of the therapeutic agent, betaxolol, in diurnal control of IOP (intraocular pressure). Therapy was performed on 32 eyes affected by POAG (primary open-angle glaucoma) and 16 eyes affected by NTG (normal-tension glaucoma). Two preparations of betaxolol were utilized: betaxolol hydrochloride 0.50% (Betoptic) was administered to 15 POAG and 7 NTG eyes; betaxolol hydrochloride 0.25% ophthalmic suspension (Betoptic S) was administered to 17 POAG and 9 NTG eyes. IOP measurements were taken every two hours from 8 a.m. to 8 p.m. IOP was measured before therapy and at 12 hours, 30 days, and 3 months of therapy. Betaxolol hydrochloride 0.50% was more effective at lowering IOP during the day. Diurnal pressure peaks, which are a risk factor concerning the maintenance of visual field in glaucoma patients, were also reduced using 0.50% betaxolol hydrochloride.

  19. Mapping a gene for adult-onset primary open-angle glaucoma to chromosome 3q.

    PubMed Central

    Wirtz, M K; Samples, J R; Kramer, P L; Rust, K; Topinka, J R; Yount, J; Koler, R D; Acott, T S

    1997-01-01

    Glaucoma is the third-leading cause of blindness in the world, affecting >13.5 million people. Adult-onset primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States. We present a family in which adult-onset POAG is inherited as an autosomal dominant trait. Twelve affected family members were identified from 44 at-risk individuals. The disease-causing gene was mapped to chromosome 3q21-24, with analysis of recombinant haplotypes suggesting a total inclusion region of 11.1 cM between markers D3S3637 and D3S1744. This is the first report of mapping of an adult-onset POAG gene to chromosome 3q, gene symbol GLC1C. PMID:9012402

  20. Molecular biomarkers in primary open-angle glaucoma: from noninvasive to invasive.

    PubMed

    Agnifili, Luca; Pieragostino, Damiana; Mastropasqua, Alessandra; Fasanella, Vincenzo; Brescia, Lorenza; Tosi, Gian Marco; Sacchetta, Paolo; Mastropasqua, Leonardo

    2015-01-01

    Glaucoma, the first cause of irreversible blindness worldwide, is a neurodegenerative disease characterized by the progressive loss of retinal ganglion cells. There are different subtypes of glaucoma, all expression of a common optic neuropathy; primary open-angle glaucoma (POAG) is the most diffuse subtype in western countries. To date, unfortunately, several questions still remain unsolved in the glaucoma management, such as the availability of powerful methods for screening high-risk populations, early diagnosis, timely detection of damage progression, and prediction of response to therapy. Over the last years, biomarkers have gained immense scientific and clinical interest to solve these issues, with countless molecules that have been candidate as potential biomarkers. In the present review, we summarize the current knowledge about the most robust molecular biomarkers proposed in POAG, distinguishing noninvasive from minimally invasive, and invasive biomarkers, according to the procedure adopted to collect fluid samples.

  1. Visual impairment in an optineurin mouse model of primary open-angle glaucoma.

    PubMed

    Tseng, Henry C; Riday, Thorfinn T; McKee, Celia; Braine, Catherine E; Bomze, Howard; Barak, Ian; Marean-Reardon, Carrie; John, Simon W M; Philpot, Benjamin D; Ehlers, Michael D

    2015-06-01

    Primary open-angle glaucoma (POAG) is characterized by progressive neurodegeneration of retinal ganglion cells (RGCs). Why RGCs degenerate in low-pressure POAG remains poorly understood. To gain mechanistic insights, we developed a novel mouse model based on a mutation in human optineurin associated with hereditary, low-pressure POAG. This mouse improves the design and phenotype of currently available optineurin mice, which showed high global overexpression. Although both 18-month-old optineurin and nontransgenic control mice showed an age-related decrease in healthy axons and RGCs, the expression of mutant optineurin enhanced axonal degeneration and decreased RGC survival. Mouse visual function was determined using visual evoked potentials, which revealed specific visual impairment in contrast sensitivity. The E50K optineurin transgenic mouse described here exhibited clinical features of POAG and may be useful for mechanistic dissection of POAG and therapeutic development. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Genes, pathways, and animal models in primary open-angle glaucoma

    PubMed Central

    Iglesias, A I; Springelkamp, H; Ramdas, W D; Klaver, C C W; Willemsen, R; van Duijn, C M

    2015-01-01

    Glaucoma is an optic neuropathy characterized by loss of retinal ganglion cells (RGCs) and consequently visual field loss. It is a complex and heterogeneous disease in which both environmental and genetic factors play a role. With the advent of genome-wide association studies (GWASs), the number of loci associated with primary open-angle glaucoma (POAG) have increased greatly. There has also been major progress in understanding the genes determining the vertical cup–disc ratio (VCDR), disc area (DA), cup area (CA), intraocular pressure (IOP), and central corneal thickness (CCT). In this review, we will update and summarize the genetic loci associated so far with POAG, VCDR, DA, CA, IOP, and CCT. We will describe the pathways revealed and supported by genetic association studies, integrating current knowledge from human and experimental data. Finally, we will discuss approaches for functional genomics and clinical translation. PMID:26315706

  3. MYOCILIN LEVELS IN PRIMARY OPEN-ANGLE GLAUCOMA AND PSEUDOEXFOLIATION GLAUCOMA HUMAN AQUEOUS HUMOR

    PubMed Central

    Howell, Kyle G.; Vrabel, Anne M.; Chowdhury, Uttio Roy; Stamer, W. Daniel; Fautsch, Michael P.

    2010-01-01

    Purpose To determine the concentration of myocilin in primary open-angle and pseudoexfoliation glaucoma aqueous humor. Methods Aqueous humor was collected during surgery from patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and elective cataract removal (control). Volume-equivalent aqueous samples were separated on SDS-PAGE gradient gels. Quantification of myocilin levels was performed using Western blots probed with two independent N-terminal polyclonal anti-myocilin antibodies (AB1 and AB2) followed by densitometry. Myocilin levels in aqueous humor were quantified by plotting the densitometry readings of the aqueous samples against a recombinant myocilin standard curve. Total protein concentration was determined by Bradford protein assay. Transforming growth factor beta 2 (TGFβ2) levels were assessed by ELISA. Results Myocilin levels are significantly elevated in human POAG aqueous humor when compared to control aqueous humor (AB1: 0.66 ± 0.53 ng/μl vs. 0.23 ± 0.20 ng/μl, p<0.001; AB2: 0.98 ± 0.59 ng/μl vs. 0.65 ± 0.5 ng/μl, p<0.03; mean ± SD). Myocilin makes up a larger percent of the total protein in POAG aqueous humor compared to control aqueous (AB1: 0.26 ± 0.20% vs. 0.10 ± 0.20%, p<0.001; AB2: 0.43 ± 0.32% vs. 0.28 ± 0.18%, p<0.05). In contrast to POAG, myocilin levels were not elevated in PEXG aqueous humor when compared to control aqueous humor. No correlation between myocilin and TGFβ2 levels was observed. Conclusions Myocilin is elevated in POAG, but not PEXG aqueous humor. PMID:20179615

  4. Single nucleotide polymorphisms of metabolic syndrome-related genes in primary open angle glaucoma

    PubMed Central

    Zhou, Gang; Liu, Bin

    2010-01-01

    AIM To analyze single nucleotide polymorphisms (SNP) of primary open angle glaucoma- and metabolic syndrome-related genes in primary open angle glaucoma (POAG), in order to elucidate the roles of metabolic syndrome as a risk factor in POAG progress. METHODS SNP genotypes and alleles of interleukin-6 (IL-6), IL-6 receptor (IL-6R), dopamine D2 receptor (DRD2), beta-fibrinogen (FGB), peroxisome proliferator-activated receptor-γ2 (PPARG), transforming growth factor-β1 (TGF-β1), E-selectin (E-Sel), apolipoprotein A-5 (APOA5), C-reactive protein (CRP), ectonueleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), hepatic lipase (LIPC), adiponectin (ADIPOQ), paraoxonase 1 (PON1) and serine protease inhibitor E (SERPINE1) genes in POAG (n=37) and normal control (n=100) groups were measured with ABI Prism 7900HT Fluorescence Quantitative PCR and TaqMan SNP Genotyping fluorescence probe kit. RESULTS Genotypes and allele frequencies of IL-6R, IL-6, FGB, CRP, ENPP1, LIPC, ADIPOQ, PON1, and SERPINE1 in total POAG group were significantly different compared to the control group. CONCLUSION Metabolic syndrome as a risk factor for POAG may be associated with genotypes and allele frequencies of the related genes. The corresponding gene expression and function can affect POAG progress, including roles of SERPINE1 in extracellular matrix, ENPP1 in insulin inhibition, IL-6 in endogenous neuroprotection, IL-6, IL-6R and E-Sel in autoimmune response, LIPC and FGB in blood hyperviscosity syndrome, ADIPOQ in NOS/NO production, PON1 in vascular endothelial protection. PMID:22553514

  5. Effect of topical Beta blocker (Timolol maleate 0.5%) in primary open angle glaucoma.

    PubMed

    Khan, N; Khaleque, M A; Islam, M S; Begum, R A; Uddin, M S; Hossain, M M; Ali, M

    2012-10-01

    The study was undertaken to measure the effects of Beta blocker (Timolol maleate 0.5%) in moderate and advanced stage of primary open angle glaucoma by controlling intra-ocular pressure (IOP) and assessing the visual acuity (VA) and mean sensitivity (MS) of visual field. Study was done in the department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from January 2002 to December 2005. It was a Prospective and interventional study. Thirty patients of bilateral primary open angle glaucoma were treated medically by B-blocker (Timolol maleate 0.5%) two times daily. Follow up were done after 7 days, 1 month, 3 months and 6 months. Before treatment Intra ocular pressure (IOP) range was 22-30 mm of Hg (mean 23.40 ± 2.04). After beta-blockers IOP reduced to the range of 10-20mm of Hg (mean 13.12 ± 2.01) which was statistically significant (p>0.02) in moderate stage & 8-18 mm Hg (mean 13.50 ± 2.0) in advance stage which was also statistically significant (p<0.02). VA and MS also improved in 15 eyes (50%), remained unchanged in 9 eyes (30%) and deteriorated in 6 eyes (20%) in moderate stage and also improved in 15 eyes (50%), remained unchanged in 6 eyes (20%) and deteriorated in 9 eyes (30%) in advanced stage. Success rate was 80% in moderate (p>0.02) & 70% in advanced stage (p<0.02) and which was statistically significant.

  6. The Association Between Primary Open Angle Glaucoma and Clustered Components of Metabolic Syndrome

    PubMed Central

    Rasoulinejad, Seyed Ahmad; Kasiri, Ali; Montazeri, Mahdi; Rashidi, Negin; Montazeri, Maryam; Montazeri, Mohammad; Hedayati, Hesam

    2015-01-01

    Purpose : There is conflicting evidence whether components of metabolic syndrome (MetS) increase or decrease the risk of primary open-angle glaucoma (POAG). The aim of the present study was to determine the association between metabolic syndrome and primary open-angle glaucoma. Methods : A total of 200 participants comprising 100 controls and 100 patients with POAG documented by clinical tests and examined by an experienced ophthalmologist using standard ophthalmologic equipment were included in the study. MetS was defined and based on ATP III criteria and POAG was defined by the criteria of the International Society of Geographic and Epidemiological Ophthalmology (ISGEO). The data were entered into the SPSS software and analyzed. Results : The prevalence of MetS in the glaucoma group was 53% in comparison to 38% in the control group (p=0.037). MetS was associated with an increased odds ratio for an IOP higher than 21 mmHg (OR: 1.72; 95% CI 1.03-2.79; p=0.034). The mean IOP was 24.91±4.29 mmHg in the patients without MetS, and 27.23±4.81 mmHg in those with MetS (p=0.027). The mean values of CCT were 603.64±63.16 µm in MetS patients and 579.27±72.87 µm in controls (p=0.018). Conclusion : Data showed an increased prevalence of components of metabolic syndrome in patients with glaucoma. The mechanisms underlying these associations need to be established in future studies. Our results support the recommendation that patients with metabolic syndrome undergo regular ophthalmological exams to monitor for the onset or progression of glaucoma. PMID:26535072

  7. A cohort study of duplex Doppler examinations of the carotid artery in primary open angle glaucoma

    PubMed Central

    Marmion, Vincent J; Aldoori, Munther I; Woodcock, John P

    2014-01-01

    Objectives To explore the possibility of pathological change in the common carotid artery at the bifurcation and in the internal carotid artery beyond the bifurcation which could contribute to a reduced diastolic pressure as observed in primary open angle glaucoma. Design Duplex ultrasonic examinations of carotid bifurcations were conducted on 80 patients. Carotid artery defects were allocated into three types: no demonstrable flow defects, internal carotid artery abnormalities and disease in the carotid bulb. Setting Bristol Royal Infirmary Vascular Laboratory. Participants Eighty patients (mean age 69.6 years) providing a total of 160 sides to the analysis. Main outcome measures An estimated central retinal artery pressure, intraocular pressure and field loss were recorded for each side measured. Results Doppler investigations revealed significant levels of pathological change in the internal carotid distinct from changes at the carotid bulb. The disease revealed in the internal carotid artery was significantly associated with intraocular pressure (p = 0.032), with an effect small to medium in magnitude. The Q2 measure, derived from mean arterial pressure and intraocular pressure, was also substantively associated with disease in the internal carotid artery. Both intraocular pressure and the Q2 measure effectively discriminated between groups, with field loss providing rather less discriminating capability. There was a strong trend towards a higher intraocular pressures and a greater visual field loss with internal carotid artery disease. Conclusions Pathological changes in the extra cranial carotid artery in primary open angle glaucoma exceed those in the arteries classified as normal. The presence of disease specifically in the internal carotid artery emphasised the need for a mechanism for the evaluation of the internal carotid apart from the carotid bulb. A basis for clarifying the presence of an ischaemic zone is proposed. PMID:25289141

  8. Tag SNPs detect association of the CYP1B1 gene with primary open angle glaucoma.

    PubMed

    Burdon, Kathryn P; Hewitt, Alex W; Mackey, David A; Mitchell, Paul; Craig, Jamie E

    2010-11-04

    The cytochrome p450 family 1 subfamily B (CYP1B1) gene is a well known cause of autosomal recessive primary congenital glaucoma. It has also been postulated as a modifier of disease severity in primary open angle glaucoma (POAG), particularly in juvenile onset families. However, the role of common variation in the gene in relation to POAG has not been thoroughly explored. Seven tag single nucleotide polymorphisms (SNPs), including two coding variants (L432V and N543S), were genotyped in 860 POAG cases and 898 examined normal controls. Each SNP and haplotype was assessed for association with disease. In addition, a subset of 396 severe cases and 452 elderly controls were analyzed separately. There was no association of any individual SNP in the full data set. Two SNPs (rs162562 and rs10916) were nominally associated under a dominant model in the severe cases (p<0.05). A common haplotype (AGCAGCC) was also found to be nominally associated in both the full data set (p=0.048, OR [95%CI]=0.83 [0.69-0.90]) and more significantly in the severe cases (p=0.004, OR [95%CI]=0.68 [0.52-0.89]) which survives correction for multiple testing. Although no major effect of common variation at the CYP1B1 locus on POAG was found, there could be an effect of SNPs tagged by rs162562 and represented on the AGCAGCC haplotype.

  9. Applying the recent clinical trials on primary open angle glaucoma: the developing world perspective.

    PubMed

    Thomas, Ravi; Kumar, Rajesh S; Chandrasekhar, G; Parikh, Rajul

    2005-08-01

    Recent clinical trials have provided scientific guidelines for the treatment of ocular hypertension and primary open angle glaucoma. The developing world need to apply these trials in a sensible and cost effective manner. The number needed to treat (NNT) attempts to tailor treatment to the individual patient. The NNT for the average ocular hypertensive is 20. Those with intraocular pressure > or =26 mm Hg have an NNT of 6. Restricting treatment to those with lower central corneal thickness and or high cup disc ratios can further lower NNT and make treatment more cost effective. The NNT for the average patient with early POAG is 5. Targeting those at higher risk for progression, (bilateral POAG, higher IOP and or pseudo-exfoliation) can further reduce NNT. As far as the modality of treatment is concerned, provided quality can be ensured, collaborative initial glaucoma treatment study (CIGTS) could be interpreted to justify primary surgery in the developing world context. Population attributable risk percentage (PAR), a measure that reflects the public health importance of a disease was used to extrapolate results to the overall population. Ocular hypertension has an "effective" PAR of 8.5%, a value not considered high enough to warrant public health intervention. POAG had an "effective" PAR of 16%, perhaps high enough to be considered a public health problem and justify inclusion as a target disease in the Vision 2020 program. However the logistics and opportunity costs of diagnosis and treatment would probably prevent inclusion of POAG in public health budgets of most developing countries.

  10. Delayed primary closure of contaminated abdominal wall defects with non-crosslinked porcine acellular dermal matrix compared with conventional staged repair: a retrospective study

    PubMed Central

    2014-01-01

    Introduction Synthetic mesh has been used traditionally to repair abdominal wall defects, but its use is limited in the case of bacterial contamination. New biological materials are now being used successfully for delayed primary closure of contaminated abdominal wall defects. The costs of biological materials may prevent surgeons from using them. We compared the conventional staged repair of contaminated abdominal wall defects with a single-stage procedure using a non-crosslinked porcine acellular dermal matrix. Methods A total of 14 cases with Grade 3 contaminated abdominal wall defects underwent delayed primary closure of the abdomen using a non-crosslinked porcine acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA). The results were compared with a group of 14 patients who had received conventional treatment for the repair of contaminated abdominal wall defects comprising a staged repair during two separate hospital admissions employing synthetic mesh. Treatment modalities, outcomes, and costs were compared. Results In all cases treated with delayed primary closure employing non-crosslinked porcine acellular dermal matrix, there were no complications related to its use. Two patients died due to unrelated events. Although treatment costs were estimated to be similar in the two groups, the patients treated with porcine acellular dermal matrix spent less time as an inpatient than those receiving conventional two-stage repair. Conclusions Delayed primary closure of contaminated abdominal wall defects using a non-crosslinked porcine acellular dermal matrix may be a suitable alternative to conventional staged repair. In our patients, it resulted in early restoration of abdominal wall function and shorter hospitalization. The costs for treating contaminated abdominal wall defects using porcine acellular dermal matrix during a single hospital admission were not higher than costs for conventional two-stage repair

  11. Utilization of a continuous external tissue expansion system to assist in primary closure of a large anterolateral thigh donor site defect.

    PubMed

    Silver, Andrew G; Baynosa, Richard C

    2014-01-01

    Primary closure of a large anterolateral thigh (ALT) flap donor site defect with the assistance of an external tissue expansion system is presented. The dimensions of this donor site (12 cm × 40 cm) and its percentage of leg circumference (34%) would make this site likely to require skin grafting or further flap coverage based on the results of previously published literature.

  12. [Study of novel mutation of OPTN gene in two primary open angle glaucoma families in northeast China].

    PubMed

    Yuan, Hui-Ping; Xiao, Zheng; Xu, Na; Yang, Bin-Bin; Meng, Qing-Feng; Li, Yuan-Yuan

    2008-02-01

    To identify the mutation gene of two Chinese families with primary open angle glaucoma. It was a case control study. Clinical observation and pedigree analysis were undertaken in two families with primary open angle glaucoma. Venous blood were drawn from 6 affected and 6 unaffected subjects in family L, and from 4 affected and 4 unaffected subjects in family C. Genomic DNA was extracted. Linkage to OPTN gene locus was determined. Mutation of this gene was screened by PCR of OPTN gene exons and direct sequencing. A missense mutation A1274G in exon 10 of OPTN gene was identified in affected members of family L. The corresponding amino acid change was Lys322Glu. This mutation was not found in unaffected family members of family L, all members of family C and 87 unrelated normal controls. A novel mutation of OPTN gene with Lys322Glu change is responsible for the occurrence of primary open angle glaucoma in a Chinese family.

  13. Effect of closure of a local safety-net hospital on primary care physicians' perceptions of their role in patient care.

    PubMed

    Walker, Kara Odom; Clarke, Robin; Ryan, Gery; Brown, Arleen F

    2011-01-01

    PURPOSE We examined how the closure of a large safety-net hospital in Los Angeles County, California, affected local primary care physicians. METHODS We conducted semistructured interviews with 42 primary care physicians who practiced in both underserved and nonunderserved settings in Los Angeles County. Two investigators independently reviewed and coded transcripts. Three investigators used pile-sorting to sort the codes into themes. RESULTS Overall, 28 of 42 physicians (67%) described some effect of the hospital closure on their practices. Three major themes emerged regarding the impact of the closure on the affected physicians: (1) reduced local access to specialist consultations, direct hospital admissions, and timely emergency department evaluation; (2) more patient delays in care and worse health outcomes because of poor patient understanding of the health care system changes; and (3) loss of colleagues and opportunities to teach residents and medical students. CONCLUSIONS Physicians in close proximity to the closed hospital-even those practicing in nonunderserved settings-reported difficulty getting their patients needed care that extended beyond the anticipated loss of inpatient services. There is a need for greater recognition of and support for the role primary care physicians play in coordinating care; promoting continuity of care; and informing patients, clinic administrators and policy makers about system changes during such transitions.

  14. Effect of Closure of a Local Safety-Net Hospital on Primary Care Physicians’ Perceptions of Their Role in Patient Care

    PubMed Central

    Walker, Kara Odom; Clarke, Robin; Ryan, Gery; Brown, Arleen F.

    2011-01-01

    PURPOSE We examined how the closure of a large safety-net hospital in Los Angeles County, California, affected local primary care physicians. METHODS We conducted semistructured interviews with 42 primary care physicians who practiced in both underserved and nonunderserved settings in Los Angeles County. Two investigators independently reviewed and coded transcripts. Three investigators used pile-sorting to sort the codes into themes. RESULTS Overall, 28 of 42 physicians (67%) described some effect of the hospital closure on their practices. Three major themes emerged regarding the impact of the closure on the affected physicians: (1) reduced local access to specialist consultations, direct hospital admissions, and timely emergency department evaluation; (2) more patient delays in care and worse health outcomes because of poor patient understanding of the health care system changes; and (3) loss of colleagues and opportunities to teach residents and medical students. CONCLUSIONS Physicians in close proximity to the closed hospital—even those practicing in nonunderserved settings—reported difficulty getting their patients needed care that extended beyond the anticipated loss of inpatient services. There is a need for greater recognition of and support for the role primary care physicians play in coordinating care; promoting continuity of care; and informing patients, clinic administrators and policy makers about system changes during such transitions. PMID:22084260

  15. Primary Closure Following Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Choledochoscopy and D-J Tube Drainage for Treating Choledocholithiasis.

    PubMed

    Yu, Miao; Xue, Huanzhou; Shen, Quan; Zhang, Xiao; Li, Ke; Jia, Meng; Jia, Jiangkun; Xu, Jian

    2017-09-19

    BACKGROUND This study aimed to assess the clinical short-term results of a primary closure following laparoscopic common bile duct exploration (LCBDE) combined with intraoperative choledochoscopy and D-J tube drainage for choledocholithiasis treatment. MATERIAL AND METHODS Twenty-five patients (14 women and 11 men) who underwent LCBDE with primary duct closure and D-J tube drainage for choledocholithiasis were retrospectively enrolled. The D-J tube (4.7F×14 cm) was removed using a duodenoscope if there was no bile leakage. Before discharge, patients were examined for blood amylase. After discharge or D-J tube removal, all patients were routinely assessed for complications. RESULTS Mean operating time was 135±46 min (range, 78-195 min). Mean intraoperative blood loss was 71±24 mL (range, 25-110 mL). Total hospital stay was 6-9 days (mean, 8.04±1.37 days). Two patients experienced intraoperative bile leakage, which was stopped with re-suturing. None of these patients experienced postoperative bile leaks. Three patients had slight elevation of serum amylase before discharge but without pancreatitis signs. The successful clearance rate of stones was 100%. During 1-year follow-up, no recurrence or severe complications occurred. CONCLUSIONS A primary closure following LCBDE combined with intraoperative choledochoscopy and D-J tube drainage is safe and feasible for choledocholithiasis treatment.

  16. Analysis of the qualitative dermatoglyphics of the digito-palmar complex in patients with primary open angle glaucoma.

    PubMed

    Novak-Laus, Katia; Milicić, Jasna; Tedeschi-Reiner, Eugenia; Iveković, Renata; Korsić, Jadranka; Zrinsćak, Ognjen; Mandić, Zdravko

    2006-03-01

    The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.

  17. The Primary Open-Angle African-American Glaucoma Genetics (POAAGG) Study: Baseline Demographics

    PubMed Central

    Charlson, Emily S.; Sankar, Prithvi S.; Miller-Ellis, Eydie; Regina, Meredith; Fertig, Raymond; Salinas, Julia; Pistilli, Maxwell; Salowe, Rebecca J.; Rhodes, Allison L.; Merritt, William T.; Chua, Michael; Trachtman, Benjamin T.; Gudiseva, Harini V.; Collins, David W.; Chavali, Venkata Ramana Murthy; Nichols, Charles; Henderer, Jeffrey; Ying, Gui-shuang; Varma, Rohit; Jorgenson, Eric

    2014-01-01

    Objective To describe the baseline characteristics of the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study cohort, the largest African-American primary open-angle glaucoma (POAG) population recruited at a single institution (University of Pennsylvania, Department of Ophthalmology, Scheie Eye Institute) to date. Design Population-based, cross-sectional, case-control study. Participants 2,520 African-American subjects 35 years and older, recruited from the greater Philadelphia, Pennsylvania area. Methods Each subject underwent a detailed interview and eye examination. The interview assessed demographic, behavioral, medical, and ocular risk factors. Current zip codes surrounding the University of Pennsylvania were recorded and United States census data were queried to infer socioeconomic status. The eye exam included measurement of visual acuity and intraocular pressure, a detailed anterior and posterior segment examination including gonioscopy, dilated fundus and optic disc examination, visual fields, stereo disc photography, optical coherence tomography imaging, and measurement of central corneal thickness. Main Outcome Measures The baseline characteristics of gender, age, and glaucoma diagnosis were collected. Body mass index (BMI), hypertension, diabetes, and alcohol and tobacco use, as well as ocular conditions including blindness, cataract, non-proliferative diabetic retinopathy, age-related macular degeneration, and use of ocular medication and surgery, were examined. Median population density, income, education level, and other socioeconomic measures were determined for the study cohort. Results Of the 2,520 African-Americans recruited to the POAAGG study to date, 2,067 (82.0%) including 807 controls and 1,260 POAG cases met all inclusion criteria and completed the detailed clinical ocular exam. Cases were more likely to have a lower BMI (p<0.01) and report a history of blindness (visual acuity of 20/200 or worse, p<0.001), while controls

  18. [Magnetotherapy designed to affect cervical sympathetic ganglia for the treatment of patients with primary open-angle glaucoma].

    PubMed

    Veselova, E V; Kamenskikh, T G; Raĭgorodkiĭ, Iu M; Kolbenev, I O; Myshkina, E S

    2010-01-01

    The traveling magnetic field was used to treat primary open-angle glaucoma. The field was applied to the projection of cervical sympathetic ganglia of the patients. Hemodynamic parameters of posterior short ciliary arteries and central retinal artery were analysed along with visual evoked potentials, visual field limits, and visual acuity. It was shown that magnetotherapy with the use of an AMO-ATOS apparatus produces better clinical results in patients with stage I and II primary open-angle glaucoma compared with medicamentous therapy (intake of trental tablets).

  19. Tag SNPs detect association of the CYP1B1 gene with primary open angle glaucoma

    PubMed Central

    Hewitt, Alex W.; Mackey, David A.; Mitchell, Paul; Craig, Jamie E.

    2010-01-01

    Purpose The cytochrome p450 family 1 subfamily B (CYP1B1) gene is a well known cause of autosomal recessive primary congenital glaucoma. It has also been postulated as a modifier of disease severity in primary open angle glaucoma (POAG), particularly in juvenile onset families. However, the role of common variation in the gene in relation to POAG has not been thoroughly explored. Methods Seven tag single nucleotide polymorphisms (SNPs), including two coding variants (L432V and N543S), were genotyped in 860 POAG cases and 898 examined normal controls. Each SNP and haplotype was assessed for association with disease. In addition, a subset of 396 severe cases and 452 elderly controls were analyzed separately. Results There was no association of any individual SNP in the full data set. Two SNPs (rs162562 and rs10916) were nominally associated under a dominant model in the severe cases (p<0.05). A common haplotype (AGCAGCC) was also found to be nominally associated in both the full data set (p=0.048, OR [95%CI]=0.83 [0.69–0.90]) and more significantly in the severe cases (p=0.004, OR [95%CI]=0.68 [0.52–0.89]) which survives correction for multiple testing. Conclusions Although no major effect of common variation at the CYP1B1 locus on POAG was found, there could be an effect of SNPs tagged by rs162562 and represented on the AGCAGCC haplotype. PMID:21139974

  20. Differential protein expression in tears of patients with primary open angle and pseudoexfoliative glaucoma.

    PubMed

    Pieragostino, Damiana; Bucci, Sonia; Agnifili, Luca; Fasanella, Vincenzo; D'Aguanno, Simona; Mastropasqua, Alessandra; Ciancaglini, Marco; Mastropasqua, Leonardo; Di Ilio, Carmine; Sacchetta, Paolo; Urbani, Andrea; Del Boccio, Piero

    2012-04-01

    Primary open angle (POAG) and pseudoexfoliative glaucoma (PXG) are the most common primary and secondary forms of glaucoma, respectively. Even though the patho-physiology, aqueous humor composition, risk factors, clinical features, therapy and drug induced ocular surface changes in POAG and PXG have been widely studied, to date information concerning tear protein characterization is lacking. Tears are a source of nourishment for ocular surface tissues and a vehicle to remove local waste products, metabolized drugs and inflammatory mediators produced in several ophthalmic diseases. In glaucoma, the proteomic definition of tears may provide insights concerning patho-physiology of the disease and ocular surface modifications induced by topical therapy. Our study aimed at characterizing protein patterns in tears of patients with medically controlled POAG and PXG. A comparative tears proteomic analysis by label-free LC-MS(E) highlighted differences in the expression of several proteins in the two glaucoma sub-types and control subjects, highlighting inflammation pathways expressed in both diseases. Results were independently reconfirmed by SDS-PAGE and linear MALDI-TOF MS, validating altered levels of Lysozyme C, Lipocalin-1, Protein S100, Immunoglobulins and Prolactin Inducible Protein. Moreover, we found a differential pattern of phosphorylated Cystatin-S that distinguishes the two pathologies. The most relevant results suggest that in both pathologies there may be active inflammation pathways related to the disease and/or induced by therapy. We show, for the first time, tear protein patterns expressed under controlled intraocular pressure conditions in POAG and PXG subjects. These findings could help in the understanding of molecular machinery underlying these ophthalmologic diseases, resulting in early diagnosis and more specific therapy.

  1. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis.

    PubMed

    Podda, Mauro; Polignano, Francesco Maria; Luhmann, Andreas; Wilson, Michael Samuel James; Kulli, Christoph; Tait, Iain Stephen

    2016-03-01

    With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills, laparoscopic common bile duct exploration (LCBDE) is technically feasible and increasingly practiced by surgeons worldwide. Traditional practice of suturing the dochotomy with T-tube drainage may be associated with T-tube-related complications. Primary duct closure (PDC) without a T-tube has been proposed as an alternative to T-tube placement (TTD) after LCBDE. The aim of this meta-analysis was to evaluate the safety and effectiveness of PDC when compared to TTD after LCBDE for choledocholithiasis. A systematic literature search was performed using PubMed, EMBASE, MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases for studies comparing primary duct closure and T-tube drainage. Studies were reviewed for the primary outcome measures: overall postoperative complications, postoperative biliary-specific complications, re-interventions, and postoperative hospital stay. Secondary outcomes assessed were: operating time, median hospital expenses, and general complications. Sixteen studies comparing PDC and TTD qualified for inclusion in our meta-analysis, with a total of 1770 patients. PDC showed significantly better results when compared to TTD in terms of postoperative biliary peritonitis (OR 0.22, 95% CI 0.06-0.76, P = 0.02), operating time (WMD, -22.27, 95% CI -33.26 to -11.28, P < 0.00001), postoperative hospital stay (WMD, -3.22; 95% CI -4.52 to -1.92, P < 0.00001), and median hospital expenses (SMD, -1.37, 95% CI -1.96 to -0.77, P < 0.00001). Postoperative hospital stay was significantly decreased in the primary duct closure with internal biliary drainage (PDC + BD) group when compared to TTD group (WMD, -2.68; 95% CI -3.23 to -2.13, P < 0.00001). This comprehensive meta-analysis demonstrates that PDC after LCBDE is feasible and associated with fewer complications than TTD. Based on these results, primary duct closure may be considered

  2. Extracting Primary Open-Angle Glaucoma from Electronic Medical Records for Genetic Association Studies

    PubMed Central

    Restrepo, Nicole A.; Farber-Eger, Eric; Goodloe, Robert; Haines, Jonathan L.; Crawford, Dana C.

    2015-01-01

    Electronic medical records (EMRs) are being widely implemented for use in genetic and genomic studies. As a phenotypic rich resource, EMRs provide researchers with the opportunity to identify disease cohorts and perform genotype-phenotype association studies. The Epidemiologic Architecture for Genes Linked to Environment (EAGLE) study, as part of the Population Architecture using Genomics and Epidemiology (PAGE) I study, has genotyped more than 15,000 individuals of diverse genetic ancestry in BioVU, the Vanderbilt University Medical Center’s biorepository linked to a de-identified version of the EMR (EAGLE BioVU). Here we develop and deploy an algorithm utilizing data mining techniques to identify primary open-angle glaucoma (POAG) in African Americans from EAGLE BioVU for genetic association studies. The algorithm described here was designed using a combination of diagnostic codes, current procedural terminology billing codes, and free text searches to identify POAG status in situations where gold-standard digital photography cannot be accessed. The case algorithm identified 267 potential POAG subjects but underperformed after manual review with a positive predictive value of 51.6% and an accuracy of 76.3%. The control algorithm identified controls with a negative predictive value of 98.3%. Although the case algorithm requires more downstream manual review for use in large-scale studies, it provides a basis by which to extract a specific clinical subtype of glaucoma from EMRs in the absence of digital photographs. PMID:26061293

  3. Structural brain alterations in primary open angle glaucoma: a 3T MRI study

    PubMed Central

    Wang, Jieqiong; Li, Ting; Sabel, Bernhard A.; Chen, Zhiqiang; Wen, Hongwei; Li, Jianhong; Xie, Xiaobin; Yang, Diya; Chen, Weiwei; Wang, Ningli; Xian, Junfang; He, Huiguang

    2016-01-01

    Glaucoma is not only an eye disease but is also associated with degeneration of brain structures. We now investigated the pattern of visual and non-visual brain structural changes in 25 primary open angle glaucoma (POAG) patients and 25 age-gender-matched normal controls using T1-weighted imaging. MRI images were subjected to volume-based analysis (VBA) and surface-based analysis (SBA) in the whole brain as well as ROI-based analysis of the lateral geniculate nucleus (LGN), visual cortex (V1/2), amygdala and hippocampus. While VBA showed no significant differences in the gray matter volumes of patients, SBA revealed significantly reduced cortical thickness in the right frontal pole and ROI-based analysis volume shrinkage in LGN bilaterally, right V1 and left amygdala. Structural abnormalities were correlated with clinical parameters in a subset of the patients revealing that the left LGN volume was negatively correlated with bilateral cup-to-disk ratio (CDR), the right LGN volume was positively correlated with the mean deviation of the right visual hemifield, and the right V1 cortical thickness was negatively correlated with the right CDR in glaucoma. These results demonstrate that POAG affects both vision-related structures and non-visual cortical regions. Moreover, alterations of the brain visual structures reflect the clinical severity of glaucoma. PMID:26743811

  4. Structural brain alterations in primary open angle glaucoma: a 3T MRI study.

    PubMed

    Wang, Jieqiong; Li, Ting; Sabel, Bernhard A; Chen, Zhiqiang; Wen, Hongwei; Li, Jianhong; Xie, Xiaobin; Yang, Diya; Chen, Weiwei; Wang, Ningli; Xian, Junfang; He, Huiguang

    2016-01-08

    Glaucoma is not only an eye disease but is also associated with degeneration of brain structures. We now investigated the pattern of visual and non-visual brain structural changes in 25 primary open angle glaucoma (POAG) patients and 25 age-gender-matched normal controls using T1-weighted imaging. MRI images were subjected to volume-based analysis (VBA) and surface-based analysis (SBA) in the whole brain as well as ROI-based analysis of the lateral geniculate nucleus (LGN), visual cortex (V1/2), amygdala and hippocampus. While VBA showed no significant differences in the gray matter volumes of patients, SBA revealed significantly reduced cortical thickness in the right frontal pole and ROI-based analysis volume shrinkage in LGN bilaterally, right V1 and left amygdala. Structural abnormalities were correlated with clinical parameters in a subset of the patients revealing that the left LGN volume was negatively correlated with bilateral cup-to-disk ratio (CDR), the right LGN volume was positively correlated with the mean deviation of the right visual hemifield, and the right V1 cortical thickness was negatively correlated with the right CDR in glaucoma. These results demonstrate that POAG affects both vision-related structures and non-visual cortical regions. Moreover, alterations of the brain visual structures reflect the clinical severity of glaucoma.

  5. An Updated Review on the Genetics of Primary Open Angle Glaucoma

    PubMed Central

    Abu-Amero, Khaled; Kondkar, Altaf A.; Chalam, Kakarla V.

    2015-01-01

    Epidemiological studies suggest that by 2020 the prevalence of primary open angle glaucoma (POAG) is estimated to increase to 76.0 million, and to 111.8 million by 2040 globally due to the population aging. The prevalence of POAG is the highest among those of African descent, followed by Asians, and the lowest in Europeans. POAG is a genetically complex trait with a substantial fraction exhibiting a significant heritability. Less than 10% of POAG cases in the general population are caused by specific gene mutations and the remaining cases are polygenic. Quantitative traits related to POAG pathogenesis such as intra-ocular pressure (IOP), vertical cup/disc ratio (VCDR), optic disc area, and central corneal thickness (CCT) are highly heritable, and likely to be influenced at least in part by genes and show substantial variation in human populations. Recent genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) at different loci including CAV1/CAV2, TMCO1, CDKN2B-AS1, CDC7-TGFBR3, SIX1/SIX6, GAS7 and ATOH7 to be associated with POAG and its related quantitative traits (endophenotypes). The chapter provides a brief overview on the different GWAS and SNP association studies and their correlation with various clinical parameters important for POAG in the population worldwide, including the Middle East. PMID:26690118

  6. Genetic screening in a large family with juvenile onset primary open angle glaucoma

    PubMed Central

    Booth, A.; Anwar, R.; Chen, H.; Churchill, A.; Jay, J.; Polansky, J.; Nguyen, T.; Markham, A.

    2000-01-01

    AIMS—A number of genetic loci have been implicated in the pathogenesis of primary open angle glaucoma (POAG). The aim of this study was to identify the genetic cause of POAG in a large Scottish family and, if possible, offer genetic screening and advice to family members.
METHODS—Family members were examined to determine their disease status. Base excision sequence scanning was carried out in order to test for the presence of a POAG causing mutation at known genetic loci. Direct DNA sequencing was performed in order to determine the mutation sequence.
RESULTS—All family members of known affected disease status and two family members of unknown disease status were found to have a mutation in the TIGR gene. The mutation resulted in the substitution of a glycine residue with an arginine residue at codon 252 (Gly252Arg). No other sequence variations were present in any members of the family.
CONCLUSION—The Gly252Arg mutation in the TIGR gene results in the development of POAG in this family. It was possible to identify younger, currently unaffected, members of the family who carry the mutation and who are therefore at a very high risk of developing POAG themselves. This is the first demonstration that Gly252Arg can be a disease causing mutation rather than a benign polymorphism. The possible pathogenic mechanisms and wider implications of the mutation are considered.

 PMID:10873982

  7. A common variant near TGFBR3 is associated with primary open angle glaucoma

    PubMed Central

    Li, Zheng; Allingham, R. Rand; Nakano, Masakazu; Jia, Liyun; Chen, Yuhong; Ikeda, Yoko; Mani, Baskaran; Chen, Li-Jia; Kee, Changwon; Garway-Heath, David F.; Sripriya, Sarangapani; Fuse, Nobuo; Abu-Amero, Khaled K.; Huang, Chukai; Namburi, Prasanthi; Burdon, Kathryn; Perera, Shamira A.; Gharahkhani, Puya; Lin, Ying; Ueno, Morio; Ozaki, Mineo; Mizoguchi, Takanori; Krishnadas, Subbiah Ramasamy; Osman, Essam A.; Lee, Mei Chin; Chan, Anita S.Y.; Tajudin, Liza-Sharmini A.; Do, Tan; Goncalves, Aurelien; Reynier, Pascal; Zhang, Hong; Bourne, Rupert; Goh, David; Broadway, David; Husain, Rahat; Negi, Anil K.; Su, Daniel H; Ho, Ching-Lin; Blanco, Augusto Azuara; Leung, Christopher K.S.; Wong, Tina T.; Yakub, Azhany; Liu, Yutao; Nongpiur, Monisha E.; Han, Jong Chul; Hon, Do Nhu; Shantha, Balekudaru; Zhao, Bowen; Sang, Jinghong; Zhang, NiHong; Sato, Ryuichi; Yoshii, Kengo; Panda-Jonas, Songhomita; Ashley Koch, Allison E.; Herndon, Leon W.; Moroi, Sayoko E.; Challa, Pratap; Foo, Jia Nee; Bei, Jin-Xin; Zeng, Yi-Xin; Simmons, Cameron P.; Bich Chau, Tran Nguyen; Sharmila, Philomenadin Ferdinamarie; Chew, Merwyn; Lim, Blanche; Tam, Pansy O.S.; Chua, Elaine; Ng, Xiao Yu; Yong, Victor H.K.; Chong, Yaan Fun; Meah, Wee Yang; Vijayan, Saravanan; Seongsoo, Sohn; Xu, Wang; Teo, Yik Ying; Cooke Bailey, Jessica N.; Kang, Jae H.; Haines, Jonathan L.; Cheng, Ching Yu; Saw, Seang-Mei; Tai, E-Shyong; Richards, Julia E.; Ritch, Robert; Gaasterland, Douglas E.; Pasquale, Louis R.; Liu, Jianjun; Jonas, Jost B.; Milea, Dan; George, Ronnie; Al-Obeidan, Saleh A.; Mori, Kazuhiko; Macgregor, Stuart; Hewitt, Alex W.; Girkin, Christopher A.; Zhang, Mingzhi; Sundaresan, Periasamy; Vijaya, Lingam; Mackey, David A.; Wong, Tien Yin; Craig, Jamie E.; Sun, Xinghuai; Kinoshita, Shigeru; Wiggs, Janey L.; Khor, Chiea-Chuen; Yang, Zhenglin; Pang, Chi Pui; Wang, Ningli; Hauser, Michael A.; Tashiro, Kei; Aung, Tin; Vithana, Eranga N.

    2015-01-01

    Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10−33), we observed one SNP showing significant association to POAG (CDC7–TGFBR3 rs1192415, ORG-allele = 1.13, Pmeta = 1.60 × 10−8). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis. PMID:25861811

  8. RAND-like appropriateness methodology consensus for primary open-angle glaucoma in Latin America.

    PubMed

    Lerner, S Fabian; Singh, Kuldev; Susanna, Remo; Wilson, M Roy; Lee, Brian L; Maul, Eugenio

    2012-09-01

    To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States. A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America. The 148 polling statements created for the RAND- like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND- like methodology before and after the panel meeting. Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making. This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Shorter Scleral Spur in Eyes With Primary Open-Angle Glaucoma

    PubMed Central

    Swain, David L.; Ho, Joseph; Lai, Julia; Gong, Haiyan

    2015-01-01

    Purpose. We determined whether the scleral spur is shorter in primary open-angle glaucoma (POAG) eyes compared to age-matched normal eyes and whether the collapse of Schlemm's canal (SC) is more prevalent in eyes with a shorter scleral spur. Methods. The anterior segments of normal (n = 20) and POAG eyes (n = 20) were fixed and processed for light microscopy. The scleral spur length, ratio of posterior trabecular meshwork (TM) insertion into the scleral spur to the posterior TM height, and the percentage of SC collapse were measured. Analysis using an existing mathematical model was conducted to estimate the distances that the scleral spur theoretically would move in vivo and to determine if these distances would be sufficient to keep SC open in POAG compared to normal eyes. Results. The mean scleral spur length was significantly shorter in POAG eyes compared to normal eyes (P < 0.0001). A higher mean percentage of SC collapse was found in POAG eyes than in normal eyes (P < 0.0001). Estimated posterior movement of scleral spur in POAG eyes was less than sufficient to prevent the collapse of SC. A significant negative correlation was found between the posterior scleral spur movement and percent collapse of SC (P < 0.0001). Conclusions. A shorter scleral spur found in POAG eyes was associated with a higher percent of SC collapse. Our data suggest that a shorter scleral spur may be a risk factor in the development of POAG by being insufficient to hold SC open. PMID:25670488

  10. Primary Open Angle Glaucoma is Associated with MR Biomarkers of Cerebral Small Vessel Disease.

    PubMed

    Mercieca, Karl; Cain, John; Hansen, Thomas; Steeples, Laura; Watkins, Amy; Spencer, Fiona; Jackson, Alan

    2016-02-29

    This prospective study tests the hypotheses that: 1) glaucoma is associated with evidence of cerebral small vessel disease; 2) that imaging biomarkers of cerebral small vessel disease in POAG and NTG will show different characteristics. 12 normal controls, 7 patients with primary open angle glaucoma (POAG) and 9 patients with normal tension glaucoma (NTG) were recruited. Ophthalmological clinical assessment and MR imaging of the brain were performed. MR imaging was used to quantify white matter lesion load, frequency of dilated perivascular spaces (PVS) and abnormalities in cerebral hydrodynamics. Patients with POAG had significantly greater white matter lesion load (p < 0.05), more PVS in the centrum semiovale (p < 0.05) and had higher overall PVS scores than controls (p < 0.05). In the POAG group, optic cup-to-disc ratio (CDR) was positively correlated with deep white matter hyperintensities (R(2) = 0.928, p < 0.01). Mean deviation on the Humphrey visual field assessment was negatively correlated with deep white matter lesion load (R(2) = -0.840, p < 0.01), total white matter lesion load (R(2) = -0.928, p < 0.01) and total PVS (R(2) = -0.820, p < 0.01). MR evidence of cerebral small vessel disease is strongly associated with a diagnosis of POAG and with the severity of abnormalities in CDR and visual field.

  11. Electrophysiological and psychophysical flicker sensitivity in patients with primary open-angle glaucoma and ocular hypertension.

    PubMed

    Holopigian, K; Seiple, W; Mayron, C; Koty, R; Lorenzo, M

    1990-09-01

    Temporal sensitivity was assessed in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Three measures of flicker sensitivity were obtained: psychophysical modulation thresholds, visual-evoked potentials (VEPs), and focal electroretinograms (FERGs). We found elevated psychophysical thresholds at higher temporal frequencies (30-50 Hz) in patients with POAG, relative to thresholds for age-matched controls. The OHT patients had elevated psychophysical thresholds only at 50 Hz. On the other hand, VEP amplitudes in POAG patients were reduced at all temporal frequencies, with the magnitude of the loss increasing with temporal frequency. The OHT patients, however, showed no reductions in VEP amplitude at any temporal frequency. Finally, POAG patients' FERG amplitudes were reduced at 30-50 Hz; whereas FERG amplitudes in the OHT patients were normal at all temporal frequencies. These results indicate that OHT patients can exhibit psychophysical threshold losses at high temporal frequencies which are not observed in the suprathreshold electrophysiological amplitude measures. On the other hand, patients with POAG show both psychophysical and VEP losses across a range of temporal frequencies. In addition, the decreases in FERG amplitudes in POAG patients suggest changes in the functioning of the outer retina in this disease.

  12. Lack of association between polymorphism rs540782 and primary open angle glaucoma in Saudi patients.

    PubMed

    Kondkar, Altaf A; Edward, Nikhil B; Kalantan, Hatem; Al-Kharashi, Abdullah S; Altuwaijri, Saleh; Mohamed, Gamal; Sultan, Tahira; Azad, Taif A; Abu-Amero, Khaled K

    2017-02-02

    To investigate whether polymorphism rs540782 on chromsome 1, in close proximity to the Zona Pellucida Glycoprotein 4 (ZP4) gene, is a risk factor for primary open angle glaucoma (POAG). The study genotyped 92 unrelated POAG cases and 95 control subjects from Saudi Arabia using Taq-Man® assay. The genotype frequency distribution did not deviate significantly from the Hardy-Weinberg equilibrium (p > 0.05). Overall, both the genotype and allele frequencies were not significantly different between cases and controls. The minor 'C' allele frequency was 49.4%, which was comparable to the Japanese population and higher than the Indian and Afro-Caribbean populations. Similarly, no significant association was found between genotypes and systemic diseases and health awareness/behavior domain variables. Importantly, glaucoma specific indices, such as intraocular pressure, cup/disc ratio and number of anti-glaucoma medication, also showed no statistically significant effect of genotypes within POAG cases. Polymorphism rs540782 is not a risk factor for POAG in the Saudi cohort.

  13. Vessel Caliber in Normal Tension and Primary Open Angle Glaucoma Eyes With Hemifield Damage.

    PubMed

    Rao, Aparna; Agarwal, Komal; Mudunuri, Harika; Padhy, Debananda; Roy, Avik K; Mukherjee, Sujoy

    2017-01-01

    The purpose of the study was to evaluate retinal vessel diameter in age-matched normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) eyes with hemifield involvement. Fundus photographs of patients with hemifield defect, good visibility of retinal nerve fiber layer defect, and vessels were compared with 30 controls. One eye of each patient (28 NTG and 30 POAG) was randomly chosen for analysis using Image J software by different clinicians at 2 levels. The structural parameters analyzed included retinal nerve fiber layer defect width, diameter of vessels (superotemporal or inferotemporal artery and superotemporal or inferotemporal vein). The average superotemporal artery diameter was similar in NTG (71±16.8 µm), POAG (79±26.6 µm), and controls (82±14.1 µm), P=0.2 with similar pattern seen for other vessels. The affected quadrant in all eyes and those with disc hemorrhage (n=8) did not have significantly different arteries and veins diameter as compared with the unaffected quadrant in that eye. No relation of artery or vein diameter with retinal nerve fiber layer defect width or clinical variables in NTG or POAG eyes was seen on multivariate regression analysis. The vessel diameter was not significantly different in the affected and unaffected quadrants of age and severity-matched NTG and POAG eyes with hemifield structural and functional defect as reported in earlier studies. These results point toward the possibility that vascular diameter changes may not be the cause for glaucomatous changes.

  14. Cytokine biomarkers in tear film for primary open-angle glaucoma

    PubMed Central

    Gupta, Divakar; Wen, Joanne C; Huebner, Janet L; Stinnett, Sandra; Kraus, Virginia B; Tseng, Henry C; Walsh, Molly

    2017-01-01

    Purpose To determine the utility of tear film cytokines as biomarkers for early primary open-angle glaucoma (POAG). Methods Patients without POAG and eye drop-naïve patients with newly diagnosed POAG were recruited from an academic hospital-based glaucoma practice. Tear films of recruited patients were obtained and analyzed using a multiplex, high-sensitivity electrochemiluminescent enzyme-linked immunosorbent assay for proinflammatory cytokines (IFNγ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8, and TNFα). Results Mean concentrations of tear film cytokines were lower in the glaucoma group for 8 of 10 cytokines tested. IL-12p70 (3.94±2.19 pg/mL in control vs 2.31±1.156 pg/mL in POAG; P=0.035) was significantly lower in the tear film of patients with newly diagnosed POAG. Conclusion Proinflammatory cytokines were lower in eye drop-naïve newly diagnosed glaucoma patients. Tear film cytokine profiles may be used as biomarkers of early POAG. PMID:28260854

  15. Clinical profiles of primary open angle glaucoma versus normal tension glaucoma patients: a pilot study.

    PubMed

    Asrani, Sanjay; Samuels, Brian; Thakur, Mugdha; Santiago, Cecilia; Kuchibhatla, Maragatha

    2011-05-01

    To study the health profiles and behavioral differences between primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. Confidential mail survey of ICD-9 defined POAG (n = 277) and NTG (n = 116) patients was carried out to collect information regarding age, gender, height, weight, waist circumference, blood pressure (BP), medications [prescription (Rx) and over the counter (OTC)], education, and the Short Health Anxiety Inventory (SHAI). NTG patients (59/116) were significantly more likely to respond to the survey than POAG patients (43/277), p = 0.0001, and to have obtained college level education (70% vs. 42%), p = 0.003. Body weight, waist circumference, body mass index, systolic BP, pulse pressure, and ratio of prescription medications to OTC medications were significantly lower in the NTG group (p < 0.0001). The SHAI score, mean age, and diastolic BP were not different between the two groups. A subgroup analysis of college-educated patients in both groups revealed persisting significant differences in waist circumference, systolic BP, and ratio of Rx to OTC medications. NTG patients do not have significantly greater health anxiety than POAG patients. NTG patients are more likely to have lower BMI, systolic BP, and ratio of Rx to OTC medications than POAG patients. The pilot nature of this study limits generalizability of these findings. Larger studies confirming these findings and elucidating the role of refractive error and medical history on such differences are needed.

  16. [Effect of physical and psychological stress on the course of primary open angle glaucoma].

    PubMed

    Marc, Alexandra; Stan, Cristina

    2013-01-01

    Analyzing how mutch mental or physical stress influences the elevation of intraocular pressure (lOP) and therefore the influence of stress over the progress of primary open angle glaucoma (POAG), monitoring the changes of the glaucoma parameters that occur either under stress or under normal life conditions. Observational analytical prospective nonexposed-exposed study that took place over a period of 18 months and reviewed 151 patients. Of the 64 patients that had mental stress before presenting to the doctor, in 47 (73%) of them, were foud increased lOP and visual field changes at regular consultation and 17 (27%) have experienced mental stress without increasing lOP values or any visual field change. Of the 69 patients that reported insomnia, 47 (68%) had elevated lOP, while 22 (32%) had unchanged IOP values. Of the 42 patients that had an increased stress score due to physical fatigue, 22 (52%) had increased lOP and visual field changes (CV) and 20 (48%) had no change in lOP or visual field. The presence of mental stress in a glaucomatous patient increases lOP values and leads to the worsening of the disease, while insomnia represents only a potential risk factor for POAG and physical exercise might even have a beneficial effect.

  17. Short-term effects of relaxation music on patients suffering from primary open-angle glaucoma

    PubMed Central

    Bertelmann, Thomas; Strempel, Ilse

    2015-01-01

    Purpose To evaluate whether additive relaxation music (RM) has an adjuvant short-term effect on physiological and psychological parameters in patients with primary open-angle glaucoma. Methods Prospective, randomized clinical trial. Patients in the therapy group (TG) received a 30-minute RM via headphones, whereas members of the control group (CG) did not. Best corrected visual acuity, intraocular pressure, visual field testing, short- and long-term mental states, and blood levels of different stress hormones were analyzed and compared. Results A total of 25 (61%)/16 (39%) patients were assigned to the TG/CG. Best corrected visual acuity, daily intraocular pressure, and short-term mental state (KAB) development were significantly better in the TG in comparison to controls. Visual field testing, long-term mental well-being (profile of mood states), and adrenalin, cortisol, and endothelin-I blood levels did not differ significantly between both groups. Conclusion Additive RM applied on a daily basis can positively impact various physiological and psychological parameters in the short term. PMID:26543350

  18. A common variant near TGFBR3 is associated with primary open angle glaucoma.

    PubMed

    Li, Zheng; Allingham, R Rand; Nakano, Masakazu; Jia, Liyun; Chen, Yuhong; Ikeda, Yoko; Mani, Baskaran; Chen, Li-Jia; Kee, Changwon; Garway-Heath, David F; Sripriya, Sarangapani; Fuse, Nobuo; Abu-Amero, Khaled K; Huang, Chukai; Namburi, Prasanthi; Burdon, Kathryn; Perera, Shamira A; Gharahkhani, Puya; Lin, Ying; Ueno, Morio; Ozaki, Mineo; Mizoguchi, Takanori; Krishnadas, Subbiah Ramasamy; Osman, Essam A; Lee, Mei Chin; Chan, Anita S Y; Tajudin, Liza-Sharmini A; Do, Tan; Goncalves, Aurelien; Reynier, Pascal; Zhang, Hong; Bourne, Rupert; Goh, David; Broadway, David; Husain, Rahat; Negi, Anil K; Su, Daniel H; Ho, Ching-Lin; Blanco, Augusto Azuara; Leung, Christopher K S; Wong, Tina T; Yakub, Azhany; Liu, Yutao; Nongpiur, Monisha E; Han, Jong Chul; Hon, Do Nhu; Shantha, Balekudaru; Zhao, Bowen; Sang, Jinghong; Zhang, NiHong; Sato, Ryuichi; Yoshii, Kengo; Panda-Jonas, Songhomita; Ashley Koch, Allison E; Herndon, Leon W; Moroi, Sayoko E; Challa, Pratap; Foo, Jia Nee; Bei, Jin-Xin; Zeng, Yi-Xin; Simmons, Cameron P; Bich Chau, Tran Nguyen; Sharmila, Philomenadin Ferdinamarie; Chew, Merwyn; Lim, Blanche; Tam, Pansy O S; Chua, Elaine; Ng, Xiao Yu; Yong, Victor H K; Chong, Yaan Fun; Meah, Wee Yang; Vijayan, Saravanan; Seongsoo, Sohn; Xu, Wang; Teo, Yik Ying; Cooke Bailey, Jessica N; Kang, Jae H; Haines, Jonathan L; Cheng, Ching Yu; Saw, Seang-Mei; Tai, E-Shyong; Richards, Julia E; Ritch, Robert; Gaasterland, Douglas E; Pasquale, Louis R; Liu, Jianjun; Jonas, Jost B; Milea, Dan; George, Ronnie; Al-Obeidan, Saleh A; Mori, Kazuhiko; Macgregor, Stuart; Hewitt, Alex W; Girkin, Christopher A; Zhang, Mingzhi; Sundaresan, Periasamy; Vijaya, Lingam; Mackey, David A; Wong, Tien Yin; Craig, Jamie E; Sun, Xinghuai; Kinoshita, Shigeru; Wiggs, Janey L; Khor, Chiea-Chuen; Yang, Zhenglin; Pang, Chi Pui; Wang, Ningli; Hauser, Michael A; Tashiro, Kei; Aung, Tin; Vithana, Eranga N

    2015-07-01

    Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10(-33)), we observed one SNP showing significant association to POAG (CDC7-TGFBR3 rs1192415, ORG-allele = 1.13, Pmeta = 1.60 × 10(-8)). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis. © The Author 2015. Published by Oxford University Press.

  19. Evaluation of brimonidine-timolol fixed combination in patients of primary open-angle glaucoma.

    PubMed

    Joshi, Sachin R; Akat, Pramod B; Ramanand, Jaiprakash B; Ramanand, Sunita J; Karande, Vitthal B; Jain, Suyog S

    2013-12-01

    The aim of present study was to compare the efficacy and safety of fixed combination of brimonidine and timolol with individual components used as monotherapy in patients of primary open angle glaucoma. Patients were randomly assigned to receive brimonidine or timolol or brimonidine-timolol fixed combination, with 30 patients in each group. The mean reduction in intraocular pressure in brimonidine, timolol, and brimonidine-timolol group were 4.29 ± 1.97 mm Hg, 4.34 ± 1.21 mm Hg, and 5.54 ± 1.87 mm Hg respectively at 2 weeks and 4.86 ± 1.16 mm Hg, 5.42 ± 1.50 mm Hg, and 7.36 ± 2.58 mm Hg respectively at 6 weeks. When values of mean reduction in intraocular pressure were compared between brimonidine-timolol fixed combination with brimonidine and timolol, it was found to be statistically significant ( P < 0.05) at 2 weeks and highly significant (0.001) at 6 weeks. The overall frequency of adverse effects was similar in all three groups.

  20. Corneal biomechanical properties affect Goldmann applanation tonometry in primary open-angle glaucoma.

    PubMed

    Costin, Bryan R; Fleming, Gloria P; Weber, Paul A; Mahmoud, Ashraf M; Roberts, Cynthia J

    2014-02-01

    To study differences in corneal biomechanical properties between primary open-angle glaucoma (POAG) and central corneal thickness (CCT)-matched control subjects and their effect on intraocular pressure (IOP) measurement. Thirteen eyes of 13 POAG subjects and 15 eyes of 15 normal subjects underwent corneal topography; IOP using Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), and corneal compensated IOP (IOPcc) using the Reichert ocular response analyzer (ORA); corneal hysteresis; and CCT. Results from POAG and control eyes were then compared using t tests. Ages in the POAG group were slightly greater than that in the control group. CCT was closely matched between groups. Significant differences were found between GAT versus DCT and GAT versus IOPcc within both groups: Mean GAT IOP was not significantly different between POAG and controls, whereas mean DCT IOP did show a significant difference between groups as did mean IOPcc. The delta differences, GATΔDCT and GATΔIOPcc, were of greater magnitude in POAG subjects when compared with controls. Corneal hysteresis was significantly lower in POAG subjects. The delta differences between GAT and newer measures of IOP are greater in magnitude in patients with POAG than in the normal controls, independent of CCT. This is likely due to differences in the corneal biomechanical properties with POAG corneas being softer than healthy corneas, which causes greater underestimation of IOP by GAT in POAG than controls. Underestimation of IOP could affect treatment decisions and outcomes in POAG.

  1. Role of cholesterol 24S-hydroxylase gene polymorphism (rs754203) in primary open angle glaucoma

    PubMed Central

    Weger, Martin; Faschinger, Christoph; Schmut, Otto; Renner, Wilfried; Wedrich, Andreas; Zimmermann, Christina; El-Shabrawi, Yosuf

    2011-01-01

    Purpose The enzyme cholesterol 24S-hydroxylase (Cyp46A1) is responsible for the conversion of cholesterol to its more polar metabolite 24S-hydroxycholesterol, thereby enabling the intracerebral elimination of cholesterol. An intronic single nucleotide polymorphism in the gene CYP46A1 (IVS2 −150 T>C; rs754203) has recently been associated with primary open angle glaucoma (POAG). This association, however, lacks confirmation in other studies. The purpose of the present study was to investigate a hypothesized association between rs754203 and the presence of POAG in a Central European population of Caucasian descent. Methods The present institutional study comprised a total of 581 unrelated subjects: 330 patients with POAG, and 251 control subjects. Main outcome measures are genotype distributions and allelic frequencies determined by polymerase chain reaction. Results No significant differences in either genotype distribution or allelic frequencies were found between patients with POAG and control subjects (p>0.05). The presence of the rs754203 T-allele was associated with a nonsignificant odds ratio of 0.81 (95% CI: 0.63–1.04; p=0.11) for POAG. Conclusions Our data suggest that the rs754203 polymorphism itself is unlikely a genetic risk factor for POAG in Caucasian individuals. PMID:21386929

  2. Optineurin coding variants in Ghanaian patients with primary open-angle glaucoma

    PubMed Central

    Liu, Yutao; Akafo, Stephen; Santiago-Turla, Cecile; Cohen, Claudia S.; LaRocque-Abramson, Karen R.; Qin, Xuejun; Herndon, Leon W.; Challa, Pratap; Schmidt, Silke; Hauser, Michael A.

    2008-01-01

    Purpose Coding variants in the optineurin gene (OPTN, GLC1E) have been reported to play a role in primary open-angle glaucoma (POAG) in various populations. This study investigated the role of OPTN sequence variants in patients with POAG in Ghana (West Africa). Methods This is a case-control study of unrelated Ghanaian POAG cases and non-glaucomatous controls. Ascertainment criteria for POAG included the presence of glaucomatous optic nerve neuropathy, associated visual field loss, and elevated intraocular pressure (IOP) in both eyes, all in the absence of secondary causes of glaucoma. Controls had normal optic nerves, visual fields, and IOP. All the coding exons of OPTN were polymerase chain reaction (PCR) amplified and sequenced in all 140 cases and 130 controls using an ABI 3730 DNA analyzer. Results All the coding exons of OPTN were sequenced in 140 POAG patients and 130 controls. Several coding variants were identified including M98K, A134A, V147L, P292P, A301G, S321S, and E322K. Three coding variants (V147L, P292P, and A301G) have not been reported previously. There were no significant differences on the frequencies of all the identified variants between POAG cases and controls in this population. Conclusions This is the first comprehensive study of OPTN in a single West African population. Our results suggest that coding variants in OPTN may not contribute to the risk for POAG in persons of West African descent. PMID:19096531

  3. Assessment of polygenic effects links primary open-angle glaucoma and age-related macular degeneration.

    PubMed

    Cuellar-Partida, Gabriel; Craig, Jamie E; Burdon, Kathryn P; Wang, Jie Jin; Vote, Brendan J; Souzeau, Emmanuelle; McAllister, Ian L; Isaacs, Timothy; Lake, Stewart; Mackey, David A; Constable, Ian J; Mitchell, Paul; Hewitt, Alex W; MacGregor, Stuart

    2016-05-31

    Primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD) are leading causes of irreversible blindness. Several loci have been mapped using genome-wide association studies. Until very recently, there was no recognized overlap in the genetic contribution to AMD and POAG. At genome-wide significance level, only ABCA1 harbors associations to both diseases. Here, we investigated the genetic architecture of POAG and AMD using genome-wide array data. We estimated the heritability for POAG (h(2)g = 0.42 ± 0.09) and AMD (h(2)g = 0.71 ± 0.08). Removing known loci for POAG and AMD decreased the h(2)g estimates to 0.36 and 0.24, respectively. There was evidence for a positive genetic correlation between POAG and AMD (rg = 0.47 ± 0.25) which remained after removing known loci (rg = 0.64 ± 0.31). We also found that the genetic correlation between sexes for POAG was likely to be less than 1 (rg = 0.33 ± 0.24), suggesting that differences of prevalence among genders may be partly due to heritable factors.

  4. Common Genetic Determinants of Intraocular Pressure and Primary Open-Angle Glaucoma

    PubMed Central

    Ikram, M. Kamran; Jansonius, Nomdo M.; Pasutto, Francesca; Hysi, Pirro G.; Macgregor, Stuart; Janssen, Sarah F.; Hewitt, Alex W.; Viswanathan, Ananth C.; ten Brink, Jacoline B.; Hosseini, S. Mohsen; Amin, Najaf; Despriet, Dominiek D. G.; Willemse-Assink, Jacqueline J. M.; Kramer, Rogier; Rivadeneira, Fernando; Struchalin, Maksim; Aulchenko, Yurii S.; Weisschuh, Nicole; Zenkel, Matthias; Mardin, Christian Y.; Gramer, Eugen; Welge-Lüssen, Ulrich; Montgomery, Grant W.; Carbonaro, Francis; Young, Terri L.; Bellenguez, Céline; McGuffin, Peter; Foster, Paul J.; Topouzis, Fotis; Mitchell, Paul; Wang, Jie Jin; Wong, Tien Y.; Czudowska, Monika A.; Hofman, Albert; Uitterlinden, Andre G.; Wolfs, Roger C. W.; de Jong, Paulus T. V. M.; Oostra, Ben A.; Paterson, Andrew D.; Mackey, David A.; Bergen, Arthur A. B.; Reis, André; Hammond, Christopher J.; Vingerling, Johannes R.; Lemij, Hans G.; Klaver, Caroline C. W.; van Duijn, Cornelia M.

    2012-01-01

    Intraocular pressure (IOP) is a highly heritable risk factor for primary open-angle glaucoma and is the only target for current glaucoma therapy. The genetic factors which determine IOP are largely unknown. We performed a genome-wide association study for IOP in 11,972 participants from 4 independent population-based studies in The Netherlands. We replicated our findings in 7,482 participants from 4 additional cohorts from the UK, Australia, Canada, and the Wellcome Trust Case-Control Consortium 2/Blue Mountains Eye Study. IOP was significantly associated with rs11656696, located in GAS7 at 17p13.1 (p = 1.4×10−8), and with rs7555523, located in TMCO1 at 1q24.1 (p = 1.6×10−8). In a meta-analysis of 4 case-control studies (total N = 1,432 glaucoma cases), both variants also showed evidence for association with glaucoma (p = 2.4×10−2 for rs11656696 and p = 9.1×10−4 for rs7555523). GAS7 and TMCO1 are highly expressed in the ciliary body and trabecular meshwork as well as in the lamina cribrosa, optic nerve, and retina. Both genes functionally interact with known glaucoma disease genes. These data suggest that we have identified two clinically relevant genes involved in IOP regulation. PMID:22570627

  5. Red blood cell plasmalogens and docosahexaenoic acid are independently reduced in primary open-angle glaucoma.

    PubMed

    Acar, Niyazi; Berdeaux, Olivier; Juaneda, Pierre; Grégoire, Stéphane; Cabaret, Stéphanie; Joffre, Corinne; Creuzot-Garcher, Catherine P; Bretillon, Lionel; Bron, Alain M

    2009-12-01

    Among several theories involved in the pathogenesis of primary open-angle glaucoma (POAG), the vascular theory considers the disease to be a consequence of reduced ocular blood flow associated with red blood cell abnormalities. Red blood cell membrane structure and function are influenced by their phospholipid composition. We investigated whether specific lipid entities that may affect the membrane physiology, namely, polyunsaturated fatty acids (PUFAs) and plasmalogens, are modified in POAG and whether these potential variations are related to the stage of glaucoma. Blood samples were collected from 31 POAG patients and 10 healthy individuals. The stage of glaucoma was determined according to the Hodapp and Parrish classification. Lipids were extracted from red blood cell membranes and individual phospholipid species were quantified by liquid chromatography combined with mass spectrometry using triple quadrupole technology. POAG patients had reduced erythrocyte levels of phosphatidyl-choline (PC) carrying docosahexaenoic acid (DHA). POAG patients also displayed lower levels of choline plasmalogens (PlsC) carrying PUFAs other than DHA. These differences were greater as the severity of the disease increased. Linear regressions predicted that red blood cell PlsC levels would decrease years before clinical symptoms, whereas the levels of PC carrying DHA were linearly correlated to visual field loss. Our data demonstrate the selective loss of some individual phospholipid species in red blood cell membranes, which may partly explain their loss of flexibility in POAG.

  6. Assessment of polygenic effects links primary open-angle glaucoma and age-related macular degeneration

    PubMed Central

    Cuellar-Partida, Gabriel; Craig, Jamie E.; Burdon, Kathryn P.; Wang, Jie Jin; Vote, Brendan J.; Souzeau, Emmanuelle; McAllister, Ian L.; Isaacs, Timothy; Lake, Stewart; Mackey, David A.; Constable, Ian J.; Mitchell, Paul; Hewitt, Alex W.; MacGregor, Stuart

    2016-01-01

    Primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD) are leading causes of irreversible blindness. Several loci have been mapped using genome-wide association studies. Until very recently, there was no recognized overlap in the genetic contribution to AMD and POAG. At genome-wide significance level, only ABCA1 harbors associations to both diseases. Here, we investigated the genetic architecture of POAG and AMD using genome-wide array data. We estimated the heritability for POAG (h2g = 0.42 ± 0.09) and AMD (h2g = 0.71 ± 0.08). Removing known loci for POAG and AMD decreased the h2g estimates to 0.36 and 0.24, respectively. There was evidence for a positive genetic correlation between POAG and AMD (rg = 0.47 ± 0.25) which remained after removing known loci (rg = 0.64 ± 0.31). We also found that the genetic correlation between sexes for POAG was likely to be less than 1 (rg = 0.33 ± 0.24), suggesting that differences of prevalence among genders may be partly due to heritable factors. PMID:27241461

  7. Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases.

    PubMed

    Hammarfjord, O; Ekanayake, K; Norton, J; Stassen, L F A

    2015-03-01

    Tracheostomy is an efficient and widely used method to secure a patent airway in patients undergoing major oral and maxillofacial oncology operations. The inferiorly based Björk flap technique, through a limited incision, followed by early primary skin closure, has been the preferred method in our unit. Patients who underwent tracheostomy for major oral and maxillofacial oncology operations during the period June 2005 to December 2012 were reviewed. Age, gender, preoperative diagnosis, duration the tracheostomy tube was in situ, tracheostomy-associated complications, and long-term sequelae were evaluated. A total 158 tracheostomies were performed using the same surgical approach in patients aged 18-84 years (median 59, mean 58.2, standard deviation 14.24 years). The time the tracheostomy tube was in situ ranged from 3 to 40 days (median 7, mean 9.0, standard deviation 6.52 days). The complication rate was 5.06% (8/158 patients). A major concern highlighted in previous publications is the risk of surgical emphysema with early closure. In this study, no patients developed surgical emphysema, tracheal fistula, clinical tracheal stenosis, or cosmetically unacceptable scarring of the neck. No patient died of a tracheostomy-related cause. In summary, the Björk flap with early primary closure of the skin by simple sutures provides a safe and easily managed approach, causing minimal postoperative morbidity.

  8. Anti-Neurotrophic Effects from Autoantibodies in Adult Diabetes Having Primary Open Angle Glaucoma or Dementia

    PubMed Central

    Zimering, Mark B.; Moritz, Thomas E.; Donnelly, Robert J.

    2013-01-01

    Aim: To test for anti-endothelial and anti-neurotrophic effects from autoantibodies in subsets of diabetes having open-angle glaucoma, dementia, or control subjects. Methods: Protein-A eluates from plasma of 20 diabetic subjects having glaucoma or suspects and 34 age-matched controls were tested for effects on neurite outgrowth in rat pheochromocytoma PC12 cells or endothelial cell survival. The mechanism of the diabetic glaucoma autoantibodies’ neurite-inhibitory effect was investigated in co-incubations with the selective Rho kinase inhibitor Y27632 or the sulfated proteoglycan synthesis inhibitor sodium chlorate. Stored protein-A eluates from certain diabetic glaucoma or dementia subjects which contained long-lasting, highly stable cell inhibitory substances were characterized using mass spectrometry and amino acid sequencing. Results: Diabetic primary open angle glaucoma (POAG) or suspects (n = 20) or diabetic dementia (n = 3) autoantibodies caused significantly greater mean inhibition of neurite outgrowth in PC12 cells (p < 0.0001) compared to autoantibodies in control diabetic (n = 24) or non-diabetic (n = 10) subjects without glaucoma (p < 0.01). Neurite inhibition by the diabetic glaucoma autoantibodies was completely abolished by 10 μM concentrations of Y27632 (n = 4). It was substantially reduced by 30 mM concentrations of sodium chlorate (n = 4). Peak, long-lasting activity survived storage ×5 years at 0–4°C and was associated with a restricted subtype of Ig kappa light chain. Diabetic glaucoma or dementia autoantibodies (n = 5) caused contraction and process retraction in quiescent cerebral cortical astrocytes effects which were blocked by 5 μM concentrations of Y27632. Conclusion: These data suggest that autoantibodies in subsets of adult diabetes having POAG (glaucoma suspects) and/or dementia inhibit neurite outgrowth and promote a reactive astrocyte morphology by a mechanism which may involve

  9. [Effects of nootropic agents on visual functions and lacrimal antioxidative activity in patients with primary open-angle glaucoma].

    PubMed

    Davydova, N G; Kuznetsova, T P; Borisova, S A; Abdulkadyrova, M Zh

    2006-01-01

    The paper presents the results of an investigation of the effect of the nootropic agents pantogam and nooclerine on visual functions in patients with primary open-angle glaucoma. These agents have been found to have a beneficial effect on the functional activity of the retina and optic nerve, light sensitivity, hemo- and hydrodynamics of the eye.

  10. Failed exstrophy closure.

    PubMed

    Novak, Thomas E

    2011-05-01

    Children with bladder exstrophy present a formidable surgical challenge. Like all major reconstructive surgeries, the best hope for a favorable outcome lies in achieving success in the first operative attempt. Regardless of the surgical approach, however, complications do occur. A failed exstrophy closure is a major complication with significant implications on the long-term surgical outcome and ultimate fate of the urinary tract. Successful repeat exstrophy closure can be accomplished in most cases when performed in conjunction with pelvic osteotomy and proper postoperative immobilization. Modern staged repair of exstrophy, complete primary repair of exstrophy, and immediate continent urinary diversion have been advocated by different groups in the management of a failed exstrophy closure. It is apparent that compared with children who undergo successful primary closure, a failed closure with subsequent successful repeat closure makes the child much less likely to achieve sufficient bladder growth to be considered for bladder neck reconstruction, and furthermore, makes them less likely to have a successful bladder neck reconstruction even when they are an acceptable candidate. Although acceptable dryness rates after repeat closure can ultimately be obtained, they are typically at the expense of a commitment to intermittent catheterization and continent diversion. Published by Elsevier Inc.

  11. Longitudinal Analysis of Serum Autoantibody-Reactivities in Patients with Primary Open Angle Glaucoma and Optic Disc Hemorrhage

    PubMed Central

    Keilani, Munir M.; Wasielica-Poslednik, Joanna; Pfeiffer, Norbert; Grus, Franz H.

    2016-01-01

    Background The aim of our current investigation was to analyze the autoantibody-reactivities of primary open angle glaucoma patients with optic disc hemorrhage as possibly correlated to disease progression by means of a protein microarray approach. Methods Sera of patients with primary open angle glaucoma and optic disc hemorrhage (n = 16) were collected directly after study inclusion (0 weeks) and after 2 weeks, 4 weeks and 12 weeks. As a control group patients with primary open angle glaucoma (n = 18) were used (0 weeks and 12 weeks). Microarrays were incubated and occurring antibody-antigen-reactions were visualized with fluorescence labeled anti-human-IgG secondary antibodies. To detect changes in autoantibodies spot intensities were digitized and compared. Results With respect to the immunoreactivity at 0 weeks level increment of anti-adaptor protein 1 complex subunit mu-1 antibodies and anti-SPRY domain-containing SOCS box protein 3 antibodies in sera of primary open angle patients with optic disc hemorrhage was detected. Linear trend analysis revealed a positive correlation with r ≥ 0.8 between antibody-level and time course. Control group show no relevant changes in the same period. Significant changes were found in time point 4 comparison between patient groups in anti-adaptor protein 1 complex subunit mu-1-level (p = 0.01). No significant changes in visual acuity were found. Conclusion With this approach we were able to detect autoimmune reactivities in sera of patients with primary open angle glaucoma and optic disc hemorrhage compared to patients without optic disc hemorrhage. These antibodies could give further insights into the pathogenesis and the autoimmune component of glaucomatous optic neuropathy. PMID:28030545

  12. Association of primary open-angle glaucoma with mitochondrial variants and haplogroups common in African Americans

    PubMed Central

    Gudiseva, Harini V.; Trachtman, Benjamin; Bowman, Anita S.; Sagaser, Anna; Sankar, Prithvi; Miller-Ellis, Eydie; Lehman, Amanda; Addis, Victoria; O'Brien, Joan M.

    2016-01-01

    Purpose To estimate the population frequencies of all common mitochondrial variants and ancestral haplogroups among 1,999 subjects recruited for the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study, including 1,217 primary open-angle glaucoma (POAG) cases and 782 controls, and to identify ancestral subpopulations and mitochondrial mutations as potential risk factors for POAG susceptibility. Methods Subject classification by characteristic glaucomatous optic nerve findings and corresponding visual field defects, as defined by enrolling glaucoma specialists, stereo disc photography, phlebotomy, extraction of total DNA from peripheral blood or saliva, DNA quantification and normalization, PCR amplification of whole mitochondrial genomes, Ion Torrent deep semiconductor DNA sequencing on DNA pools (“Pool-seq”), Sanger sequencing of 3,479 individual mitochondrial DNAs, and bioinformatic analysis. Results The distribution of common African haplogroups within the POAAGG study population was broadly similar to prior surveys of African Americans. However, the POAG case population was found to be enriched in L1c2 haplogroups, which are defined in part by missense mutations m.6150G>A (Val83Ile, odds ratio [OR] 1.8, p=0.01), m.6253C>T (Met117Thr, rs200165736, OR 1.6, p=0.04), and m.6480G>A (Val193Ile, rs199476128, OR 4.6, p=0.04) in the cytochrome c oxidase subunit 1 (MT-CO1) gene and by a variant, m.2220A>G (OR 2.0, p=0.01), in MT-RNR2, which encodes the mitochondrial ribosomal 16s RNA gene. L2 haplogroups were predicted to be overrepresented in the POAG case population by Pool-seq, and the difference was confirmed to be significant with Sanger sequencing, that targeted the L2-associated variants m.2416T>C (rs28358580, OR 1.2, p=0.02) and m.2332C>T (OR 1.2, p=.02) in MT-RNR2. Another variant within MT-RNR2, m.3010G>A (rs3928306), previously implicated in sensitivity to the optic neuropathy-associated antibiotic linezolid, and arising on D4 and J1

  13. Using the Utah Population Database to assess familial risk of primary open angle glaucoma.

    PubMed

    Wang, Xiaolei; Harmon, Jennifer; Zabrieskie, Norman; Chen, Yuhong; Grob, Seanna; Williams, Brice; Lee, Clara; Kasuga, Daniel; Shaw, Peter X; Buehler, Jeanette; Wang, Ningli; Zhang, Kang

    2010-11-23

    Primary open angle glaucoma (POAG) is a leading cause of irreversible blindness in the elderly. Previous epidemiological studies have identified family history, ethnic origin, age, high intraocular pressure and diabetes mellitus as risk factors. However, it is difficult to assess the extent family history plays in this disease process. The Utah Population Database (UPDB), created by the University of Utah, has recently become a resource for which greater than 9 million records are available for use. The UPDB is divided into two major data sets from which family members can be identified, namely 1.6 million genealogy records and 2 million Utah birth certificates. This study utilizes these resources to assess the familial risk of POAG within the Utah Population. The University of Utah's hospital and clinic records were searched for patients with primary and chronic open angle glaucoma (ICD9 codes 365.04 and 365.11) between the years 1995 and 2005. A case-control analysis was then performed with specialized UPDB software that was modified to constrain the control and pedigree populations to over 1 million University of Utah-UPDB linked records. Controls were matched to cases by gender and birth year (±2.5years) with only one control being used per case. Population-attributable risk (PAR) to familial factors and relative risk (RR) were computed using conditional logistic regression (CLR). From the original 1.5 million medical records, 6198 patients with glaucoma were identified. Of these, 3391 met the inclusion criteria, which required patients to have at least one parent or one child in the UPDB. The PAR in this population was found to be 0.20, indicating 20% of the risk for glaucoma is attributable to genetic factors. CLR computations also showed a significantly increased relative risk (p<0.05) in first cousins (RR=1.45 (95% confidence interval (CI) 1.16-1.8)), second cousins (RR=1.19 (95% CI 1.08-1.32)), siblings (RR=3.76 (95% CI 2.66-5.31)), parents (RR=6.25 (95

  14. Comparison of Prelaminar Thickness between Primary Open Angle Glaucoma and Normal Tension Glaucoma Patients

    PubMed Central

    Jung, Youn Hea; Park, Hae-Young L.; Jung, Kyoung In; Park, Chan Kee

    2015-01-01

    Main Objective The thinning of prelaminar tissue and prelamina cupping is known to occur by ischemia, as we see in anterior ischemic optic neuropathy. Since normal tension glaucoma (NTG) is thought to be more related to vascular factor than in primary open-angle glaucoma (POAG), we hypothesized that prelamina thinning may occur prominently in NTG patients. This study investigated the difference in prelaminar tissue thickness between patients with POAG and NTG and verified the factors related to prelaminar thinning. Methods Complete ophthalmic examination including standard automatic perimetry was performed in all patients. The prelaminar tissue thickness was measured in all patients by performing enhanced depth imaging with a Heidelberg Spectralis Optical Coherence Tomography. The retinal nerve fiber layer and optic nerve head parameters were obtained using the Heidelberg Retina Tomography II and Cirrus Optical Coherence Tomography. Various ocular factors and their relationships with prelaminar thickness were analyzed. Results The mean prelaminar tissue thickness was significantly thinner in patients with POAG than in those with NTG. The difference in the prelaminar thickness between patients with POAG and those with NTG was greater in the early field defect group than in the moderate and severe field groups. In multivariate analysis, the mean prelaminar thickness was related to the intraocular pressure, mean deviation, cup-disc ratio, and cup volume. Conclusions The prelaminar tissue was thinner in patients with POAG than in patients with NTG, and intraocular pressure had a strong influence on the prelaminar thickness in both POAG and NTG. This may indicate that mechanical compression is the main pathogenic factor in both POAG and NTG. PMID:25793734

  15. Nailfold Capillary Abnormalities in Primary Open-Angle Glaucoma: A Multisite Study

    PubMed Central

    Pasquale, Louis R.; Hanyuda, Akiko; Ren, Ai; Giovingo, Michael; Greenstein, Scott H.; Cousins, Clara; Patrianakos, Thomas; Tanna, Angelo P.; Wanderling, Christopher; Norkett, William; Wiggs, Janey L.; Green, Kelsey; Kang, Jae H.; Knepper, Paul A.

    2015-01-01

    Purpose There is considerable evidence for systemic vascular dysfunction in primary open-angle glaucoma (POAG). We performed nailfold capillary video microscopy to observe directly the nature of nonocular microvasculature abnormalities in POAG. Methods We enrolled 199 POAG patients and 124 control subjects from four sites. We used JH-1004 capillaroscopes to perform nailfold capillary video microscopy on the fourth and fifth digits of each subject's nondominant hand. Videos were evaluated for hemorrhages, dilated capillary loops > 50 μm, and avascular zones > 100 μm by graders masked to case status. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) for POAG were obtained by means of logistic regression analyses that were applied to data from all cases and controls. Corresponding estimates of moderate or severe POAG versus mild POAG (based on the Hodapp-Anderson-Parrish scale) were obtained among cases only. Results After controlling for demographic factors, family history of glaucoma, systemic diseases, and use of anticoagulation and antiplatelet therapy, for each 100 nailfold capillaries assessed, all types of microvascular abnormalities were significantly associated with POAG. Specifically, the presence of any dilated capillaries (OR = 2.9; 95% CI, 1.6–5.6), avascular zones (OR = 4.4; 95% CI, 1.7–11.3) and hemorrhages (OR = 12.2; 95% CI, 5.9–25.1) were associated with POAG. Among cases, the frequency of microvascular abnormalities was not associated with glaucoma severity (P ≥ 0.43). Conclusions These data provided support for nonocular capillary bed abnormalities in POAG. Comparable vascular abnormalities in the optic nerve may render it susceptible to glaucomatous damage. PMID:26523386

  16. DNA copy number variants of known glaucoma genes in relation to primary open-angle glaucoma.

    PubMed

    Liu, Yutao; Garrett, Melanie E; Yaspan, Brian L; Bailey, Jessica Cooke; Loomis, Stephanie J; Brilliant, Murray; Budenz, Donald L; Christen, William G; Fingert, John H; Gaasterland, Douglas; Gaasterland, Terry; Kang, Jae H; Lee, Richard K; Lichter, Paul; Moroi, Sayoko E; Realini, Anthony; Richards, Julia E; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Vollrath, Douglas; Weinreb, Robert; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret A; Haines, Jonathan L; Pasquale, Louis R; Wiggs, Janey L; Allingham, R Rand; Ashley-Koch, Allison E; Hauser, Michael A

    2014-11-20

    We examined the role of DNA copy number variants (CNVs) of known glaucoma genes in relation to primary open angle glaucoma (POAG). Our study included DNA samples from two studies (NEIGHBOR and GLAUGEN). All the samples were genotyped with the Illumina Human660W_Quad_v1 BeadChip. After removing non-blood-derived and amplified DNA samples, we applied quality control steps based on the mean Log R Ratio and the mean B allele frequency. Subsequently, data from 3057 DNA samples (1599 cases and 1458 controls) were analyzed with PennCNV software. We defined CNVs as those ≥5 kilobases (kb) in size and interrogated by ≥5 consecutive probes. We further limited our investigation to CNVs in known POAG-related genes, including CDKN2B-AS1, TMCO1, SIX1/SIX6, CAV1/CAV2, the LRP12-ZFPM2 region, GAS7, ATOH7, FNDC3B, CYP1B1, MYOC, OPTN, WDR36, SRBD1, TBK1, and GALC. Genomic duplications of CDKN2B-AS1 and TMCO1 were each found in a single case. Two cases carried duplications in the GAS7 region. Genomic deletions of SIX6 and ATOH7 were each identified in one case. One case carried a TBK1 deletion and another case carried a TBK1 duplication. No controls had duplications or deletions in these six genes. A single control had a duplication in the MYOC region. Deletions of GALC were observed in five cases and two controls. The CNV analysis of a large set of cases and controls revealed the presence of rare CNVs in known POAG susceptibility genes. Our data suggest that these rare CNVs may contribute to POAG pathogenesis and merit functional evaluation. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  17. DNA Copy Number Variants of Known Glaucoma Genes in Relation to Primary Open-Angle Glaucoma

    PubMed Central

    Liu, Yutao; Garrett, Melanie E.; Yaspan, Brian L.; Bailey, Jessica Cooke; Loomis, Stephanie J.; Brilliant, Murray; Budenz, Donald L.; Christen, William G.; Fingert, John H.; Gaasterland, Douglas; Gaasterland, Terry; Kang, Jae H.; Lee, Richard K.; Lichter, Paul; Moroi, Sayoko E.; Realini, Anthony; Richards, Julia E.; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Vollrath, Douglas; Weinreb, Robert; Wollstein, Gadi; Zack, Donald J.; Zhang, Kang; Pericak-Vance, Margaret A.; Haines, Jonathan L.; Pasquale, Louis R.; Wiggs, Janey L.; Allingham, R. Rand; Ashley-Koch, Allison E.; Hauser, Michael A.

    2014-01-01

    Purpose. We examined the role of DNA copy number variants (CNVs) of known glaucoma genes in relation to primary open angle glaucoma (POAG). Methods. Our study included DNA samples from two studies (NEIGHBOR and GLAUGEN). All the samples were genotyped with the Illumina Human660W_Quad_v1 BeadChip. After removing non–blood-derived and amplified DNA samples, we applied quality control steps based on the mean Log R Ratio and the mean B allele frequency. Subsequently, data from 3057 DNA samples (1599 cases and 1458 controls) were analyzed with PennCNV software. We defined CNVs as those ≥5 kilobases (kb) in size and interrogated by ≥5 consecutive probes. We further limited our investigation to CNVs in known POAG-related genes, including CDKN2B-AS1, TMCO1, SIX1/SIX6, CAV1/CAV2, the LRP12-ZFPM2 region, GAS7, ATOH7, FNDC3B, CYP1B1, MYOC, OPTN, WDR36, SRBD1, TBK1, and GALC. Results. Genomic duplications of CDKN2B-AS1 and TMCO1 were each found in a single case. Two cases carried duplications in the GAS7 region. Genomic deletions of SIX6 and ATOH7 were each identified in one case. One case carried a TBK1 deletion and another case carried a TBK1 duplication. No controls had duplications or deletions in these six genes. A single control had a duplication in the MYOC region. Deletions of GALC were observed in five cases and two controls. Conclusions. The CNV analysis of a large set of cases and controls revealed the presence of rare CNVs in known POAG susceptibility genes. Our data suggest that these rare CNVs may contribute to POAG pathogenesis and merit functional evaluation. PMID:25414181

  18. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

    PubMed Central

    Jimenez-Roman, Jesus; Lazcano-Gomez, Gabriel; Martínez-Baez, Karina; Turati, Mauricio; Gulías-Cañizo, Rosario; Hernández-Zimbrón, Luis F.; Ochoa-De la Paz, Lenin; Zamora, Rubén; Gonzalez-Salinas, Roberto

    2017-01-01

    AIM To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group. PMID:28944195

  19. Discovery and Functional Annotation of SIX6 Variants in Primary Open-Angle Glaucoma

    PubMed Central

    Allingham, R. Rand; Whigham, Benjamin T.; Havens, Shane; Garrett, Melanie E.; Qiao, Chunyan; Katsanis, Nicholas; Wiggs, Janey L.; Pasquale, Louis R.; Ashley-Koch, Allison; Oh, Edwin C.; Hauser, Michael A.

    2014-01-01

    Glaucoma is a leading cause of blindness worldwide. Primary open-angle glaucoma (POAG) is the most common subtype and is a complex trait with multigenic inheritance. Genome-wide association studies have previously identified a significant association between POAG and the SIX6 locus (rs10483727, odds ratio (OR) = 1.32, p = 3.87×10−11). SIX6 plays a role in ocular development and has been associated with the morphology of the optic nerve. We sequenced the SIX6 coding and regulatory regions in 262 POAG cases and 256 controls and identified six nonsynonymous coding variants, including five rare and one common variant, Asn141His (rs33912345), which was associated significantly with POAG (OR = 1.27, p = 4.2×10−10) in the NEIGHBOR/GLAUGEN datasets. These variants were tested in an in vivo Danio rerio (zebrafish) complementation assay to evaluate ocular metrics such as eye size and optic nerve structure. Five variants, found primarily in POAG cases, were hypomorphic or null, while the sixth variant, found only in controls, was benign. One variant in the SIX6 enhancer increased expression of SIX6 and disrupted its regulation. Finally, to our knowledge for the first time, we have identified a clinical feature in POAG patients that appears to be dependent upon SIX6 genotype: patients who are homozygous for the SIX6 risk allele (His141) have a statistically thinner retinal nerve fiber layer than patients homozygous for the SIX6 non-risk allele (Asn141). Our results, in combination with previous SIX6 work, lead us to hypothesize that SIX6 risk variants disrupt the development of the neural retina, leading to a reduced number of retinal ganglion cells, thereby increasing the risk of glaucoma-associated vision loss. PMID:24875647

  20. Primary Open Angle Glaucoma is Associated with MR Biomarkers of Cerebral Small Vessel Disease

    PubMed Central

    Mercieca, Karl; Cain, John; Hansen, Thomas; Steeples, Laura; Watkins, Amy; Spencer, Fiona; Jackson, Alan

    2016-01-01

    This prospective study tests the hypotheses that: 1) glaucoma is associated with evidence of cerebral small vessel disease; 2) that imaging biomarkers of cerebral small vessel disease in POAG and NTG will show different characteristics. 12 normal controls, 7 patients with primary open angle glaucoma (POAG) and 9 patients with normal tension glaucoma (NTG) were recruited. Ophthalmological clinical assessment and MR imaging of the brain were performed. MR imaging was used to quantify white matter lesion load, frequency of dilated perivascular spaces (PVS) and abnormalities in cerebral hydrodynamics. Patients with POAG had significantly greater white matter lesion load (p < 0.05), more PVS in the centrum semiovale (p < 0.05) and had higher overall PVS scores than controls (p < 0.05). In the POAG group, optic cup-to-disc ratio (CDR) was positively correlated with deep white matter hyperintensities (R2 = 0.928, p < 0.01). Mean deviation on the Humphrey visual field assessment was negatively correlated with deep white matter lesion load (R2 = −0.840, p < 0.01), total white matter lesion load (R2 = −0.928, p < 0.01) and total PVS (R2 = −0.820, p < 0.01). MR evidence of cerebral small vessel disease is strongly associated with a diagnosis of POAG and with the severity of abnormalities in CDR and visual field. PMID:26923106

  1. Vascular tone pathway polymorphisms in relation to primary open-angle glaucoma

    PubMed Central

    Kang, J H; Loomis, S J; Yaspan, B L; Bailey, J C; Weinreb, R N; Lee, R K; Lichter, P R; Budenz, D L; Liu, Y; Realini, T; Gaasterland, D; Gaasterland, T; Friedman, D S; McCarty, C A; Moroi, S E; Olson, L; Schuman, J S; Singh, K; Vollrath, D; Wollstein, G; Zack, D J; Brilliant, M; Sit, A J; Christen, W G; Fingert, J; Forman, J P; Buys, E S; Kraft, P; Zhang, K; Allingham, R R; Pericak-Vance, M A; Richards, J E; Hauser, M A; Haines, J L; Wiggs, J L; Pasquale, L R

    2014-01-01

    Aims Vascular perfusion may be impaired in primary open-angle glaucoma (POAG); thus, we evaluated a panel of markers in vascular tone-regulating genes in relation to POAG. Methods We used Illumina 660W-Quad array genotype data and pooled P-values from 3108 POAG cases and 3430 controls from the combined National Eye Institute Glaucoma Human Genetics Collaboration consortium and Glaucoma Genes and Environment studies. Using information from previous literature and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, we compiled single-nucleotide polymorphisms (SNPs) in 186 vascular tone-regulating genes. We used the ‘Pathway Analysis by Randomization Incorporating Structure' analysis software, which performed 1000 permutations to compare the overall pathway and selected genes with comparable randomly generated pathways and genes in their association with POAG. Results The vascular tone pathway was not associated with POAG overall or POAG subtypes, defined by the type of visual field loss (early paracentral loss (n=224 cases) or only peripheral loss (n=993 cases)) (permuted P≥0.20). In gene-based analyses, eight were associated with POAG overall at permuted P<0.001: PRKAA1, CAV1, ITPR3, EDNRB, GNB2, DNM2, HFE, and MYL9. Notably, six of these eight (the first six listed) code for factors involved in the endothelial nitric oxide synthase activity, and three of these six (CAV1, ITPR3, and EDNRB) were also associated with early paracentral loss at P<0.001, whereas none of the six genes reached P<0.001 for peripheral loss only. Discussion Although the assembled vascular tone SNP set was not associated with POAG, genes that code for local factors involved in setting vascular tone were associated with POAG. PMID:24603425

  2. Axial Myopia Is Associated with Visual Field Prognosis of Primary Open-Angle Glaucoma

    PubMed Central

    Qiu, Chen; Qian, Shaohong; Sun, Xinghuai; Zhou, Chuandi; Meng, Fanrong

    2015-01-01

    Purpose To identify whether myopia was associated with the visual field (VF) progression of primary open-angle glaucoma (POAG). Methods A total of 270 eyes of 270 POAG followed up for more than 3 years with ≥9 reliable VFs by Octopus perimetry were retrospectively reviewed. Myopia was divided into: mild myopia (-2.99 diopter [D], 0), moderate myopia (-5.99, 3.00 D), marked myopia (-9.00, -6.00 D) and non-myopia (0 D or more). An annual change in the mean defect (MD) slope >0.22 dB/y and 0.30 dB/y was defined as fast progression, respectively. Logistic regression was performed to determine prognostic factors for VF progression. Results For the cutoff threshold at 0.22 dB/y, logistic regression showed that vertical cup-to-disk ratio (VCDR; p = 0.004) and the extent of myopia (p = 0.002) were statistically significant. When logistic regression was repeated after excluding the extent of myopia, axial length (AL; p = 0.008, odds ratio [OR] = 0.796) reached significance, as did VCDR (p = 0.001). Compared to eyes with AL≤23 mm, the OR values were 0.334 (p = 0.059), 0.309 (p = 0.044), 0.266 (p = 0.019), 0.260 (p = 0.018), respectively, for 23 26 mm. The significance of vertical cup-to-disk ratio of (p = 0.004) and the extent of myopia (p = 0.008) did not change for the cutoff threshold at 0.30dB/y. Conclusions VCDR and myopia were associated with VF prognosis of POAG. Axial myopia may be a protective factor against VF progression. PMID:26214313

  3. Axial Myopia Is Associated with Visual Field Prognosis of Primary Open-Angle Glaucoma.

    PubMed

    Qiu, Chen; Qian, Shaohong; Sun, Xinghuai; Zhou, Chuandi; Meng, Fanrong

    2015-01-01

    To identify whether myopia was associated with the visual field (VF) progression of primary open-angle glaucoma (POAG). A total of 270 eyes of 270 POAG followed up for more than 3 years with ≥9 reliable VFs by Octopus perimetry were retrospectively reviewed. Myopia was divided into: mild myopia (-2.99 diopter [D], 0), moderate myopia (-5.99, 3.00 D), marked myopia (-9.00, -6.00 D) and non-myopia (0 D or more). An annual change in the mean defect (MD) slope >0.22 dB/y and 0.30 dB/y was defined as fast progression, respectively. Logistic regression was performed to determine prognostic factors for VF progression. For the cutoff threshold at 0.22 dB/y, logistic regression showed that vertical cup-to-disk ratio (VCDR; p = 0.004) and the extent of myopia (p = 0.002) were statistically significant. When logistic regression was repeated after excluding the extent of myopia, axial length (AL; p = 0.008, odds ratio [OR] = 0.796) reached significance, as did VCDR (p = 0.001). Compared to eyes with AL≤23 mm, the OR values were 0.334 (p = 0.059), 0.309 (p = 0.044), 0.266 (p = 0.019), 0.260 (p = 0.018), respectively, for 23 26 mm. The significance of vertical cup-to-disk ratio of (p = 0.004) and the extent of myopia (p = 0.008) did not change for the cutoff threshold at 0.30dB/y. VCDR and myopia were associated with VF prognosis of POAG. Axial myopia may be a protective factor against VF progression.

  4. The association between primary open-angle glaucoma and fall: an observational study.

    PubMed

    Tanabe, Sachiko; Yuki, Kenya; Ozeki, Naoki; Shiba, Daisuke; Tsubota, Kazuo

    2012-01-01

    Falls are among the most serious public health concerns for the elderly. Information conveyed via the visual sense is relevant to postural balance and movement, and proper visual function is essential to avoid falls. Here we investigated the prevalence of injurious falls among patients with primary open-angle glaucoma (POAG) who were more than 45 years old, compared with comparably aged healthy subjects. This is a cross-sectional study. Consecutive patients who visited the Tanabe Eye Clinic, Yamanashi, Japan between January 1 and March 30, 2009 were screened for eligibility by ophthalmic examination. A total of 117 control subjects (77 men, 40 women; aged 60.2 ± 7.5 years) who were free of ocular disease and 101 POAG patients (58 men, 43 women; aged 62.3 ± 8.7 years) were consecutively enrolled. Participants answered a questionnaire on injurious fall experience during the previous 10 years. The prevalence of injurious fall in subjects with POAG versus healthy controls was examined with Fisher's exact test. Adjusted odds ratios and 95% confidence intervals were estimated with logistic regression models for the subjects with POAG (factors: age, gender, mean deviation in the better eye or worse eye). The self-reported prevalence of injurious fall was 0.9% (1/117) in the control group and 6.9% (7/101) in the POAG group. The association between injurious fall and POAG was statistically significant (P = 0.026, Fisher's exact test). Within the POAG patients, the group reporting falls was significantly older and had a lower BMI, worse BCVA, and worse mean deviation in both the better and worse eye than the group reporting no falls. Worse mean deviation in the eye with the better visual field (odds ratios 0.75; 95% confidence intervals: 0.57 to 0.99; P = 0.036) was a significant risk factor for injurious falls in subjects with POAG. POAG was significantly associated with injurious falls.

  5. Role of MYOC and OPTN sequence variations in Spanish patients with Primary Open-Angle Glaucoma

    PubMed Central

    López-Martínez, Francisco; López-Garrido, María-Pilar; Sánchez-Sánchez, Francisco; Campos-Mollo, Ezequiel; Coca-Prados, Miguel

    2007-01-01

    Purpose To retrospectively investigate the contribution of myocilin (MYOC) and optineurin (OPTN) sequence variations to adult-onset ocular hypertension (OHT) and primary open-angle glaucoma (POAG) in Spanish patients. Methods The promoter region and the three exons of MYOC were analyzed by direct PCR DNA sequencing in 40 OHT and 110 POAG unrelated patients. We used 98 subjects in whom OHT or glaucoma had been ruled out as controls. We also screened the complete coding region of the OPTN gene (exons 4-16) in all subjects by single-stranded conformational polymorphisms (SSCPs). Results We identified six common single nucleotide polymorphisms (SNPs) in the promoter region of MYOC (-1000C>G, -387C>T, -306G>A, -224T>C, -126T>C and -83G>A) and a polymorphic GT microsatellite (-339(GT)11-19). In addition, we detected four novel, rare DNA polymorphisms. None of these DNA sequence variations were associated with either OHT or POAG. We also found three (2.7%) POAG patients with MYOC pathogenic mutations. Two of these pathogenic mutations (Gln368Stop and Ala445Val) were previously described whereas the third (Tyr479His) was novel. Transient expression of the novel mutation in 293T cells supported its pathogenicity. Only two OPTN polymorphisms, which are not associated with the disease, were detected. Conclusions Overall, our data show that in Spain a minority of adult-onset high-pressure POAG patients carry heterozygous disease-causing mutations in the MYOC gene and that OPTN is not involved in either OHT or POAG. PMID:17615537

  6. A history of metal shaft/portal closures in Utah

    SciTech Connect

    Amodt, L.A.

    1996-12-31

    Over the last twelve years the Utah Abandoned Mine Reclamation Program has utilized metal shaft and portal closures when physical constraints required an alternative method of closure to backfill or masonry seals. Eight types of metal closures have been installed with varying degrees of success. Relative advantages/disadvantages of these closures are discussed. The eight closure types are (1) A-frame {open_quotes}bird cages{close_quotes}, (2) large diameter cyclone fence-type grid, (3) bar grates, (4) rebar grates, (5) cable nets, (6) steel doors, (7) angle iron bat grates, and (8) {open_quotes}jail bar{close_quotes} steel bat grates. The primary application of the fabricated metal closures has been in non-coal mines. Only the angle iron bat grate has been installed in abandoned coal mines to date. Bird cages placed in avalanche zones failed and the shafts were later backfilled. Large cyclone fence-type grids were placed in the Wasatch and Tintic mountains in 1985. Rebar grates have been used in the Wasatch and Tintic mountains as an alternative to backfill. Bar grating was used in the Tintic mountains when the aesthetics of an historical headframe dictated a less visible closure. Cable nets have been installed in Canyonlands National Park utilizing a design pioneered in Death Valley National Monument. Steel doors have been utilized where the landowner requests access or a need to access the adit exists. Two types of bat grates have been utilized in both coal and non-coal mines where sensitive or endangered bat species have been identified. The bird cage design has not been as effective as the others. Indications are the rebar grates, angle iron bar grates, and steel doors excel in giving long term protection to the public, with the second generation bat grate giving the maximum protection to the public.

  7. Anthropometric measures and their relation to incident primary open-angle glaucoma.

    PubMed

    Pasquale, Louis R; Willett, Walter C; Rosner, Bernard A; Kang, Jae Hee

    2010-08-01

    To assess the relation between anthropometric measures and incident primary open-angle glaucoma (POAG). Prospective cohort study. Included were 78,777 women in the Nurses' Health Study and 41,352 men in the Health Professionals Follow-up Study. Females and male health professionals were followed prospectively from 1980 through 2004 and 1986 through 2004, respectively. Eligible participants were 40 years of age or older, did not have POAG at baseline, and reported undergoing eye examinations during follow-up. Information regarding anthropometric measures, potential confounders, and ophthalmic status was updated using biennial questionnaires. During follow-up, 980 POAG cases were identified. Multivariate rate ratios (MVRR) of POAG and their 95% confidence intervals (CIs). There was no significant relation between cumulatively averaged body mass index (BMI) in kilograms per meter squared and POAG overall (P = 0.06, for trend). However, in relation to POAG with intraocular pressure (IOP) of 22 mmHg or less at diagnosis, each unit increase in BMI was associated with a 6% reduced risk in women (MVRR, 0.94; 95% CI, 0.91-0.98; P = 0.01), but not for men (MVRR, 1.02; 95% CI, 0.96-1.09; P = 0.57); this gender difference was significant (P = 0.03, for heterogeneity). In multivariate analyses to explore the independent effects of height and weight, weight (as height-adjusted weight residuals; P = 0.002, for trend), but not height (P = 0.10, for trend) seemed to account for most of the inverse association between BMI and POAG with IOP of 21 mmHg or less at diagnosis in women. There was no association between BMI and POAG with IOP of more than 21 mmHg at diagnosis for either gender (P> or =0.26, for trend). Among women, analyses found that the relations between anthropometric parameters and both POAG subtypes (POAG with IOP< or =21 mmHg vs. POAG with IOP >21 mmHg when diagnosed) were significantly different (P< or =0.0001). Among women, higher BMI was associated with a lower

  8. [Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"].

    PubMed

    Dick, V B; Zenz, H; Eisenmann, D; Tekaat, C J; Wagner, R; Jacobi, K W

    1996-05-01

    Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection

  9. [Morphological changes of cerebral cortex in primary open-angle glaucoma patients under magnetic resonance imaging].

    PubMed

    Zhang, Yuyan; Zhao, Jin; Ning, Li; Zhang, Jinling; Tang, Weijun

    2015-09-08

    To observe the morphology changes of cerebral cortex in primary open-angle glaucoma (POAG) patients, and to explore the damage mechanism in the central nerve system. 30 patients, 19 males and 11 females (age ranged from 26 to 82 years old), who were diagnosed with POAG in the department of ophthalmology at Huashan Hospital of Fudan University from February 2011 to December 2012 were enrolled. Meanwhile, additional 30 age- and sex- matched patients were collected as controls. All subjects underwent a complete ophthalmic evaluation. As for magnetic resonance imaging (MRI), we adopted the scans of T1WI, T2WI and fluid attenuated inversion recovery (FLAIR) on a Siemens Magneton Verio 3T MRI machine with a 12-channel head coil. Subjects with space occupying or vascular lesion in brain imaging were excluded from the study. The three-dimensional magnetization prepared rapid acquisition gradient echo sequence (3D-MPRAGE) was used to acquire the volume data of whole brain of all subjects. SPM8 and VBM8 toolbox were used to analyze the image data. Voxel-based analysis was done for whole brain grey matter images. Compared with the control group, the volume of grey matter from several brain regions of the POAG patients decreased. These structures included left lingual gyrus (t=3.207, P=0.002), left medial frontal gyrus (t=2.912, P=0.004), right superior frontal gyrus (t=2.745, P=0.005), left middle temporal gyrus (t=2.958, P=0.003), right precuneus (t=3.291, P=0.001), right postcentral gyrus (t=3.306, P=0.001), left inferior parietal lobule(t=2.716, P=0.006), left parahippocampa gyrus (t=2.815, P=0.005). The results were assessed with comparative t-test to perform statistical analysis. When t>2.479, P<0.01, the difference between the two groups was considered statistically significant. The volume of grey matter in POAG patients' brain decreased in several regions. It is illustrated that POAG is a syndrome, which causes damages in the brain of POAG patients at multi-aspects and

  10. Effect of selective laser trabeculoplasty on ocular haemodynamics in primary open-angle glaucoma.

    PubMed

    Pillunat, Karin R; Spoerl, Eberhard; Terai, Naim; Pillunat, Lutz E

    2017-06-01

    Selective laser trabeculoplasty (SLT) is known to reduce intraocular pressure (IOP) effectively. The aim of this study, however, was to evaluate the effect of SLT on ocular haemodynamics. A total of 69 eyes of 69 patients (age 67.8 ± 9.9 years) with already treated primary open-angle glaucoma who were assigned for SLT for further IOP reduction were consecutively enrolled in this prospective interventional case series. Intraocular pressure, the ocular pulse amplitude (OPA), ocular pulse volume (OPV) and pulsatile ocular blood flow (pOBF) were assessed with the Ocular Blood Flow Analyzer prior to and 3 months after SLT. Intraocular pressure was statistically significantly reduced from 16.0 ± 5.4 mmHg to 12.8 ± 4.0 mmHg (p = 0.001). The OPA did not change (p = 0.783) after IOP reduction following SLT. OPV and pOBF increased statistically significantly. OPV increased from 7.33 ± 3.05 to 8.59 ± 3.35 μl (17.2%; p = 0.001) and pOBF from 17.11 ± 5.42 to 19.74 ± 6.59 μl/s (15.4%; p = 0.002). Selective laser trabeculoplasty probably does not induce any pharmacological changes effecting systemic blood pressure or ocular blood flow as topical IOP-lowering medication might do, nor does it change biomechanical properties of the eye as surgery could. Therefore, an increase in ocular blood flow following SLT can only be explained by the reduction in IOP and might be a sign of dysfunctional autoregulation in glaucoma patients. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  11. Concordance of diurnal intraocular pressure between fellow eyes in primary open-angle glaucoma.

    PubMed

    Dinn, Robert B; Zimmerman, M Bridget; Shuba, Lesya M; Doan, Andrew P; Maley, Michael K; Greenlee, Emily C; Alward, Wallace L M; Kwon, Young H

    2007-05-01

    To study the concordance of diurnal intraocular pressure (IOP) between fellow eyes in primary open-angle glaucoma (POAG). Retrospective chart review. Ninety-three POAG patients. Patients who met the definition of POAG and underwent diurnal curve measurement were included. Subjects were excluded if there was a history of surgery, trauma, ocular vascular disease, incomplete diurnal curve, or asymmetric ocular medication use. Patients on symmetric ocular medication were included and analyzed separately. Goldmann applanation tonometry was performed at 10 am, 1 pm, 4 pm, 7 pm, 10 pm, and 7 am (the next day). The following statistical analyses were performed: (1) average Pearson correlation coefficient (r) from individual correlations of right and left eye IOP over the 6 time points for each subject; (2) linear mixed model analysis for repeated measures, with eye (right and left) and time as the within-subject fixed effects, and (3) absolute difference in change in IOP between fellow eyes over each time interval and probability that the difference was within 2 or 3 mmHg. The concordance of the IOP between fellow eyes as measured by absolute difference in change in IOP between fellow eyes and probability of the difference being within 2 or 3 mmHg. Thirty-seven patients were untreated and 56 were treated on symmetric IOP-lowering medications. The diurnal curves of fellow eyes exhibited parallel profiles according to the linear mixed model. The average difference in the change of IOP between fellow eyes over given time intervals ranged from 1.6 to 2.0 mmHg. The estimated probability that the absolute change in IOP between fellow eyes was within 2 mmHg was 68% to 90%, and within 3 mmHg was 78% to 95% for all time intervals. The diurnal variation of IOP in POAG is largely concordant between fellow eyes. For any given time interval, the fellow eye IOPs may fluctuate asymmetrically a minority of the time. Clinicians who utilize the uniocular trial should be aware of the limit

  12. [A comparison study of pulsitile ocular blood flow in normal eyes and primary open angle glaucoma].

    PubMed

    Zhang, Ming-Zhi; Fu, Zhi-Fu; Liu, Xiao-Rui; Zheng, C

    2004-04-01

    To compare pulsatile ocular blood flow (POBF) and intraocular pressure (IOP) in primary open angle glaucoma (POAG) and normal control group matched for age, sex and refraction error, to investigate the rule of hem-dynamics in POAG and to determine the sensitivity and specificity of POBF measurement as a diagnostic test for glaucoma. Prior to the test a questionnaire was completed to determine age, sex, refractive error, family history of glaucoma, history of eye diseases, ocular medication, medical history and using of systemic beta-blockers. Patients of POAG were determined by following diagnostics standards: (1) Three IOP >25 mm Hg in different times of one day. (2) The fluctuate of IOP > 8 mm Hg during 24 hours. (3) Typical glaucoma changes in the visual field. (4) Typical glaucoma changes in optic disc. There were 100 POAG subjects with single eye observed (50 male and 50 female). We picked up 100 eyes randomly (50 male and 50 female) in 534 normal persons who matched for following conditions: (1) Sex. (2) Discrepancy of age less than 5 years. (3) Discrepancy of the refraction error less than +/- 2.00 DS. as the normal comparison group. The tonometer used was the POBF Tonometry. Pulse amplitude of IOP (PA), pulsatile ocular blood flow (POBF), pulse/heart rate (PR), maximum-IOP (max-IOP), minimum-IOP (min-IOP) and average IOP (aver-IOP) were obtained before the medical therapy and 1 or 2 weeks after the operation. The correlation between the POBF & mean value of the perimeter was analyzed. POBF was analyzed to determine the sensitivity and specificity of POBF measurement as a diagnostic test. The value of POBF in POAG and normal control was (9.72 +/- 3.47) microl/s and (12.04 +/- 4.68) microl/s, respectively. POAG patients' POBF, PV, PA, and AVE-IOP were less than those in the normal control, and the difference was statistically significant. There was no statistically significant correlation between the changes of visual field and POBF (r = 0.224, P = 0

  13. Relationship between visual field progression and baseline refraction in primary open-angle glaucoma.

    PubMed

    Naito, Tomoko; Yoshikawa, Keiji; Mizoue, Shiro; Nanno, Mami; Kimura, Tairo; Suzumura, Hirotaka; Umeda, Yuzo; Shiraga, Fumio

    2016-01-01

    To analyze the relationship between visual field (VF) progression and baseline refraction in Japanese patients with primary open-angle glaucoma (POAG) including normal-tension glaucoma. In this retrospective study, the subjects were patients with POAG who had undergone VF tests at least ten times with a Humphrey Field Analyzer (Swedish interactive thresholding algorithm standard, Central 30-2 program). VF progression was defined as a significantly negative value of mean deviation (MD) slope at the final VF test. Multivariate logistic regression models were applied to detect an association between MD slope deterioration and baseline refraction. A total of 156 eyes of 156 patients were included in this analysis. Significant deterioration of MD slope was observed in 70 eyes of 70 patients (44.9%), whereas no significant deterioration was evident in 86 eyes of 86 patients (55.1%). The eyes with VF progression had significantly higher baseline refraction compared to those without apparent VF progression (-1.9±3.8 diopter [D] vs -3.5±3.4 D, P=0.0048) (mean ± standard deviation). When subject eyes were classified into four groups by the level of baseline refraction applying spherical equivalent (SE): no myopia (SE > -1D), mild myopia (-1D ≥ SE > -3D), moderate myopia (-3D ≥ SE > -6D), and severe myopia (-6D ≥ SE), the Cochran-Armitage trend analysis showed a decreasing trend in the proportion of MD slope deterioration with increasing severity of myopia (P=0.0002). The multivariate analysis revealed that baseline refraction (P=0.0108, odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.25) and intraocular pressure reduction rate (P=0.0150, OR: 0.97, 95% CI: 0.94-0.99) had a significant association with MD slope deterioration. In the current analysis of Japanese patients with POAG, baseline refraction was a factor significantly associated with MD slope deterioration as well as intraocular pressure reduction rate. When baseline refraction was classified into

  14. Does Use of a Variable Distal Femur Resection Angle Improve Radiographic Alignment in Primary Total Knee Arthroplasty?

    PubMed

    Nam, Denis; Vajapey, Sravya; Haynes, Jacob A; Barrack, Robert L; Nunley, Ryan M

    2016-09-01

    The distal femur resection in total knee arthroplasty (TKA) is commonly made using a fixed angle relative to an intramedullary rod. This study's purpose was to assess if a variable distal femur resection angle technique improves femoral component alignment in TKA. This was a review of primary TKAs performed by 2 surgeons. One surgeon used a fixed resection angle of 5° for varus and 3° for valgus knees ("fixed" cohort). The second used hip-knee-ankle (HKA) radiographs to measure the angle between the femoral anatomic axis and a line perpendicular to the femoral mechanical axis, which was used as the resection angle for each patient ("variable" cohort). Femoral component and HKA alignment were measured from standing HKA radiographs by 2, independent, blinded observers. Two hundred ninety patients were needed for power to detect a 15% difference in femoral component "outliers" (target of 0° ± 2°; significance = P < .05). Three hundred twenty consecutive patients were included with no differences in age, body mass index, or preoperative deformity (P = .3-.8). A 5° resection angle was used in 46.3% of the variable and 80.0% of the fixed cohort patients. A total of 80.2% of femoral components in the variable and 63.1% in the fixed cohort were within 0° ± 2° (P = .002; 84.6% of variable and 56.3% of fixed for valgus knees, P < .001). The mean HKA alignment was improved in the variable cohort (-1.4° ± 3.3° vs -2.6° ± 3.3°, P = .001). Use of a variable distal femur resection angle improves femoral component alignment after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. A new control method depending on primary phase angle of transcutaneous energy transmission system for artificial heart.

    PubMed

    Miura, H; Saito, I; Sato, F; Shiraishi, Y; Yambe, T; Matsuki, H

    2013-01-01

    A new control method for stabilizing output voltage of the transcutaneous energy transmission system for artificial heart is proposed. This method is primary side, is outside of the body, which is not depending on a signal transmission system from the implanted device. The impedance observed from primary side changes from inductive to capacitive and the output voltage decreases drastically when the output current is large and the coupling factor is higher than that of the optimal condition. In this case, the driving frequency should be changed to higher so that the phase angle of the primary impedance is zero degree. The preliminary examination showed that this control method can enhance the output voltage limit to twice and the feasibility of the primary side control.

  16. A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry.

    PubMed

    Choe, Yun Seon; Kim, Min-Woo; Jo, Seong Jin

    2015-12-01

    In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim.

  17. A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry

    PubMed Central

    Choe, Yun Seon; Kim, Min-Woo

    2015-01-01

    In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim. PMID:26719646

  18. Mutations in MYOC gene of Indian primary open angle glaucoma patients.

    PubMed

    Mukhopadhyay, Arijit; Acharya, Moulinath; Mukherjee, Saibal; Ray, Jharna; Choudhury, Sumit; Khan, Mita; Ray, Kunal

    2002-11-15

    Glaucoma is the second leading cause of blindness worldwide after cataract. Defects in the myocilin gene (MYOC) have been shown to be associated with Primary Open Angle Glaucoma (POAG), the most common form of the disease, especially in its juvenile form. Most of the reported mutations in MYOC are in POAG patients of Caucasian origin. A few studies have been reported on Asian patients (such as Chinese, Japanese, and Koreans) but none from the Indian subcontinent. The purpose of this study was to investigate the molecular basis of POAG among Indians, using MYOC as the candidate gene, and broaden our understanding on the pathogenesis caused by MYOC. Fifty-six unrelated POAG patients, comprising 39 sporadic cases and 17 patients having familial history for POAG were enrolled in this study. The coding sequence of the gene was amplified by polymerase chain reaction (PCR) using genomic DNA from 30 POAG patients, followed by sequencing of the PCR products. Nucleotide changes were detected by identifying double peaks in the chromatogram due to heterozygosity and pairwise BLAST analysis of the sequence output data against the normal copy of the MYOC cDNA. Alteration of restriction sites due to nucleotide changes was identified. Twenty-six patients (not sequenced) and controls were screened for nucleotide changes by allele specific restriction digestion of the PCR products followed by separation of the digested DNA fragments by polyacrylamide gel electrophoresis. From a pool of 56 unrelated POAG patients two mutations were identified. A putative novel mutation (144 G->T; Gln48His) of a conserved amino acid was detected in the exon 1 of MYOC from three unrelated patients but none in the 51 control samples examined. The other mutation (1109 C->T; Pro370Leu), located in exon 3 and detected in a family affected with POAG, cosegregated with the disease and was not present in control samples. Two single nucleotide polymorphisms (SNPs) were identified; one in the promoter region

  19. Using a Simulation Game to Make Learning about Angles Meaningful. An Exploratory Study in Primary School

    ERIC Educational Resources Information Center

    Piu, Angela; Fregola, Cesare; Santoro, Anna

    2016-01-01

    As indicated in numerous research studies, schoolchildren encounter many difficulties and obstacles in learning the multifaceted concept of the angle. In order to explore the possibility of enhancing schoolchildren's understanding of such a concept, the authors present a study that aims at investigating some structural characteristics of…

  20. [The effect of chronic beta-blocker treatment on the evolution of primary open-angle glaucoma].

    PubMed

    Chiselita, D; Vancea, P P; Poiata, I

    1998-01-01

    Comparative analysis of the results of the trabeculectomy in primary open-angle glaucoma (POAG) when it was chosen as a primary treatment and when was preceded by chronic use of topic beta-blockers. Retrospective study of 59 patients (group A) with primary trabeculectomy and 42 patients (group B) with topic beta-blockers treatment for at least 3 years subsequent to trabeculectomy was performed. The average postoperative follow-up period was 3 years and 5 months. Postoperative IOP lowering was similar in both groups; There are no statistical differences between group A and B concerning stationary cases (76.27% in group A and 75.4% in group B), regressive cases (6.8% and 7.14% respectively) and progressive cases (18.6% and 17.9% respectively); Preoperative and postoperative complication rates were similar in the 2 groups. The chronic beta-blockers use does not influence the evolution of operated POAG.

  1. Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate.

    PubMed

    Bruneel, Laura; Luyten, Anke; Bettens, Kim; D'haeseleer, Evelien; Dhondt, Cleo; Hodges, Andrew; Galiwango, George; Vermeersch, Hubert; Van Lierde, Kristiane

    2017-09-01

    Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (≥8years) primary palatal closure. Fifteen Ugandan participants with cleft (lip and) palate (CP±L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined. Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP±L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed. Delayed palatal repair (≥8years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Reflection color filters of the three primary colors with wide viewing angles using common-thickness silicon subwavelength gratings.

    PubMed

    Kanamori, Yoshiaki; Ozaki, Toshikazu; Hane, Kazuhiro

    2014-10-20

    We fabricated reflection color filters of the three primary colors with wide viewing angles using silicon two-dimensional subwavelength gratings on the same quartz substrate. The grating periods were 400, 340, and 300 nm for red, green, and blue filters, respectively. All of the color filters had the same grating thickness of 100 nm, which enabled simple fabrication of a color filter array. Reflected colors from the red, green, and blue filters under s-polarized white-light irradiation appeared in the respective colors at incident angles from 0 to 50°. By rigorous coupled-wave analysis, the dimensions of each color filter were designed, and the calculated reflectivity was compared with the measured reflectivity.

  3. Bilateral juvenile onset primary open-angle glaucoma among keratoconus patients.

    PubMed

    Goel, Sahil; Ganger, Anita; Gupta, Viney

    2015-01-01

    To report the occurrence of juvenile open-angle glaucoma (JOAG) in patients with keratoconus. In this observational case series we report 6 eyes of 3 patients with keratoconus who had concomitant JOAG. Corneal topography, intraocular pressure, gonioscopic, and fundus findings were recorded for all the eyes. All 3 patients presented with corneal ectasia, high intraocular pressure, and advanced glaucomatous damage and had no family history of glaucoma or keratoconus. Two of the 3 patients needed collagen cross-linking with riboflavin for progression of keratoconus and trabeculectomy for control of intraocular pressure. One of the patients also underwent a lamellar keratoplasty for keratoconus. This is the first case series pointing toward a possible association of JOAG with keratoconus and highlights the importance of a thorough workup of glaucoma in patients with keratoconus.

  4. Isolated cardiophrenic angle node metastasis from ovarian primary. report of two cases

    PubMed Central

    2011-01-01

    Ovarian cancer is the most lethal gynaecologic malignancy. It usually spreads out of the abdomen involving thoraco-abdominal organs and serosal surface. This disease is poorly curable and surgery, at early stage, is supposed to achieve the best survival outcome. In systemic dissemination, chemiotherapy is indicated, sometimes with neoadjuvant aim. The most common clinical expressions of advanced ovarian carcinoma are multiple adenopathy, neoplastic pleuritis, peritoneal seeding and distant metastasis, mainly hepatic and pulmonary. Isolated adenopathy of the mediastinum is rare and isolated bilateral have never been described before. We report two cases of isolated bilateral cardiophrenic angle lymphnode metastasis from ovarian carcinoma, without peritoneal and pleural involvement. Both patients were successfully resected through minimally invasive thoracic surgery. About the role of surgery, few data are available but survival seems to be longer after resection thus, more investigation is required to make the indication to surgery more appropriate in advanced cases. PMID:21208441

  5. Ocular safety of propiverine hydrochloride in elderly patients with primary open- and narrow-angle glaucoma
.

    PubMed

    Gatchev, Emil; Petkova, Natalia; Braeter, Manfred; de Mey, Christian

    2016-12-01

    Propiverine hydrochloride (P4) is an antimuscarinic drug used in overactive bladder syndrome. Two studies were performed: one in 24 patients with open-angle glaucoma (OAG) treated with topical β-blockers, one in 24 patients with narrow-angle glaucoma (NAG) treated with pilocarpine ± topical β-blockers. Patients were treated in randomized, placebo-controlled, double-blind parallel-group fashion (15 : 9 attribution to P4 vs. placebo (PL)). Single-blind PL dose in the morning of day 1 for baseline; double-blind 15 mg P4 or matched placebo t.i.d. from the afternoon of day 1 until the morning of day 7. In the morning of day 7, trough mean serum P4 concentrations were 169.4 ng/mL (CV (coefficient of variation): 0.55) and 140.7 ng/mL (CV: 0.56) in OAG and NAG; at 3:15 hours after dosing: 237.4 ng/mL (CV: 0.47) and 212.4 ng/mL P4 (CV: 0.38), respectively. P4-treatment led to a prompt (OAG) or more gradient (NAG) increase in pupil diameter (PUD), with a maximum difference from PL of 0.97 mm (95% confidence interval (CI): 0.67 - 1.27) and 0.87 mm (95% CI: 0.36 - 1.39) in OAG and NAG, respectively. However, there was no average increase in intraocular pressure (IOP) or increase in noteworthy safety-relevant individual IOP values (or changes thereof). There was no effect on visual acuity or accommodation. 1-week treatment with P4 appeared to be safe 1) in OAG patients treated with topical β-blockers and 2) in NAG patients treated with topical pilocarpine ± β-blockers, irrespective of whether the eyes had previously been treated with glaucoma surgery or laser therapy.
.

  6. Analysis of the quantitative dermatoglyphic traits of the digito-palmar complex in patients with primary open angle glaucoma.

    PubMed

    Novak-Laus, Katia; Milicić, Jasna; Tedeschi-Reiner, Eugenia; Iveković, Renata; Mijić, Vesna; Masnec-Paskvalin, Sanja; Zrinsćak, Ognjen; Mandić, Zdravko

    2005-12-01

    Patient with primary open angle glaucoma (PAOG), which is known to have a genetic predisposition, and their immediate relatives unaffected with PAOG, may have some changes in dermatoglyphic traits of the digito-palmar complex, since the trabecular meshwork develops at the same time and with the same hereditary base like dermatoglyphs, which have high genetic transmission. The objective of this study is to determine whether differences in quantitative dermatoglyphic traits of the digito-palmar complex exist between patients with glaucoma and the phenotipically healthy population and whether their family members have the same dermatoglyphic changes. The quantitative dermatoglyphic traits in patients suffering from glaucoma, first-degree members of their family and the phenotypically healthy population have been screened in this study. Descriptive statistics, univariate analysis of variance (ANOVA) and post hoc (Tukey HSD) method have been used. The results have shown that there is a link between the quantitative dermatoglyphic traits of the digito-palmar complex in patients affected by glaucoma and a first-degree healthy member of their family, as well as the difference between patients with glaucoma and their first-degree relatives, which may discriminate them from the phenotypically healthy population. The results of the study mostly affirm the existence of genetic predisposition for the development of primary open-angle glaucoma, thus emphasizing the relevance of hereditary factors in the etiopathogenesis of this disease.

  7. [Analysis of the effectiveness of beta-blockers for intraocular pressure and visual field in primary open-angle glaucoma].

    PubMed

    Dobre, Xenia

    2008-01-01

    The aim of this study was the evaluation of beta-blockers efficiency (as a monotherapy) in the lowering of IOP and the evolution of the visual field. An observational clinical study was carried out over a determined period of time (January 2005-January 2007) on a number of 73 eyes with primary open-angle glaucoma in which one parameter was observed: IOP; on a number of 77 eyes with primary open-angle glaucoma the evolution of the visual field, while receiving specific treatment, was observed. Pressure release situated at 21.65%, with initial medium IOP at 23.95, and a final value of 17.51; p <0.0001. The aspect of the visual field suffered no negative transformations and no improvements either. The MD and PD parameters were recorded. CONCLUSIONS Beta-blockers can be efficient in monotherapy by offering the reduction and stabilisation of IOP. No problems with regard to tolerability in the eyes observed; no negative side effects emerged because it was not administered to patients which suffered from heart diseases or bronchial asthma. However, patient satisfaction is reduced by an administration of twice a day.

  8. Effect of caffeine on the intraocular pressure in patients with primary open angle glaucoma.

    PubMed

    Chandra, Peeyush; Gaur, Ajit; Varma, Shambhu

    2011-01-01

    Coffee and tea are very common nonalcoholic beverages. However, their intake, particularly that of coffee, has been suggested to increase intraocular pressure (IOP) in patients with open angle glaucoma/ocular hypertension. The causative agent has been suggested to be their caffeine content. The objective of this study was to determine if this represents a direct caffeine effect. This study was therefore done using pure caffeine applied directly to the eyes. The study was conducted with five human volunteers with open angle glaucoma/ ocular hypertension. IOP was measured using a Perkins applanation tonometer. Eye drops of 1% caffeine were prepared in-home. Following the initial (basal) measurement of the IOP, 50 μL of the eye drop preparation was instilled in the eye at 0-, 4-, and 6-hour intervals. IOPs were measured 30 minutes after each instillation. A second study was also undertaken following the first. In this study, the same patients instilled the eye drops three times per day for 1 week at home and then returned to the clinic on day 7. They were then again treated with caffeine eye drops as above and IOPs measured. In the 1-day study, the mean basal IOP was 23.6 ± 2.80 mmHg. Thirty minutes after instillation of the drops as described, the pressures were 23.2 ± 1.93, 22.2 ± 1.99, and 22.6 ± 2.31. The basal reading was taken at 10 am and another reading was then taken at 10.30 am. Additional eye drops were instilled at 2 and 8 pm and readings taken 30 minutes after each instillation. In the 1 week study, the basal value was 22.6 ± 2.32. After instillation of the drops as above the values were 23 ± 2.16, 22.4 ± 2.27, and 23 ± 1.94. Administration of caffeine into the eyes of patients did not have any effect on IOP and it remained relatively unchanged. This was true in the 1-day study as well as in the 1-week study. A cumulative effect was not visible. The results therefore demonstrate that caffeine has no significant effect on IOP in patients with

  9. Spontaneous closure of stoma.

    PubMed

    Pandit, Narendra; Singh, Harjeet; Kumar, Hemanth; Gupta, Rajesh; Verma, G R

    2016-11-01

    Intestinal loop stoma is a common surgical procedure performed for various benign and malignant abdominal problems, but it rarely undergoes spontaneous closure, without surgical intervention. Two male patients presented to our emergency surgical department with acute abdominal pain. One of them was diagnosed as having rectosigmoid perforation and underwent diversion sigmoid loop colostomy after primary closure of the perforation. The other was a known case of carcinoma of the rectum who had already undergone low anterior resection with covering loop ileostomy; the patient underwent second loop ileostomy, this time for complicated intestinal obstruction. To our surprise, both the loop colostomy and ileostomy closed spontaneously at 8 weeks and 6 weeks, respectively, without any consequences. Spontaneous stoma closure is a rare and interesting event. The exact etiology for spontaneous closure remains unknown, but it may be hypothesized to result from slow retraction of the stoma, added to the concept of a tendency towards spontaneous closure of enterocutaneous fistula. © The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

  10. Evaluation of Contrast Sensitivity, Chromatic Vision, and Reading Ability in Patients with Primary Open Angle Glaucoma

    PubMed Central

    Güerri, Noemi; Cameo, Beatriz; Polo, Vicente; Larrosa, Jose M.

    2016-01-01

    Purpose. To compare contrast sensitivity, acquired color vision deficiency, and reading ability in patients with glaucoma at different stages of the disease and to establish correlations between visual field parameters and visual function scores. Methods. This prospective cross-sectional study included 121 glaucoma patients. Subjects with a diagnosis of chronic open angle glaucoma were recruited and classified according to Hodapp-Parrish-Anderson criteria. Patients with severe visual field defects were excluded because they were older, which could bias the interpretation of visual function tests. Contrast sensitivity was measured using the Pelli-Robson Chart and the CSV1000E test. Chromatic vision was evaluated using the Farnsworth-panel D15 and the L'Anthony D15 tests of Vision Color Recorder software. Reading ability was measured using Radner-Vissum test. Results. Contrast sensitivity (with photopic and mesopic luminance with glare) differed significantly between patients with early and moderate visual field defects (p < 0.05). Reading ability scores and results of the chromatic vision tests did not differ significantly between the two groups. Significant and moderate Spearman correlations between visual field indexes and contrast sensitivity tests were detected. Conclusions. Contrast sensitivity was significantly worse in patients with moderate glaucoma compared to those with early-stage glaucoma. Evaluation of visual function in clinical practice provides important information to address a glaucoma patient's vision complaints. PMID:27872754

  11. Targeting relatives of patients with primary open angle glaucoma: the help the family glaucoma project.

    PubMed

    Okeke, Constance Nduaguba; Friedman, David S; Jampel, Henry D; Congdon, Nathan G; Levin, Lisa; Lai, Hong; Quigley, Harry A

    2007-09-01

    To assess the knowledge of patients with open angle glaucoma (OAG) and their family members about OAG risk factors and to study the referral of family members for eye examinations. Cross-sectional survey and prospective cohort study. We interviewed OAG patients (probands) at the Wilmer Eye Institute and their biologically related parents, siblings, and children about their knowledge of OAG risk factors. Qualified family members were offered an eye examination through the EyeCare America program. Three months after initial contact, a follow-up telephone questionnaire determined the outcome of the referral. Among 102 probands and 100 (of 230 eligible) family members who were interviewed, there was high awareness that OAG is related to older age (85% both groups). More probands knew of the association with higher intraocular pressure (95%) compared with family (78%). Yet, 21% of both groups were not aware that OAG is hereditary, and only 53% of probands and 30% of family members knew that OAG is more common in certain ethnic groups. Only two-thirds of probands had suggested that family members have an eye examination. Eighty percent of family members had had an eye examination within the last year; of 21 with no recent examination, 66% (13/21) accepted referral. The Help the Family Glaucoma project developed a novel approach to identify those at high-risk for OAG. Screening of relatives of OAG patients deserves further study in a more representative selection of the general population.

  12. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA.

    PubMed

    Gililland, Jeremy M; Anderson, Lucas A; Sun, Grant; Erickson, Jill A; Peters, Christopher L

    2012-01-01

    The use of barbed suture for surgical closure has been associated with lower operative times, equivalent wound complication rate, and comparable cosmesis scores in the plastic surgery literature. Similar studies would help determine whether this technology is associated with low complication rates and reduced operating times for orthopaedic closures. We compared a running barbed suture with an interrupted standard suture technique for layered closure in primary TKA to determine if the barbed suture would be associated with (1) shorter estimated closure times; (2) lower cost; and (3) similar closure-related perioperative complication rates. We retrospectively compared two-layered closure techniques in primary TKA with either barbed or knotted sutures. The barbed group consisted of 104 primary TKAs closed with running barbed suture. The standard group consisted of 87 primary TKAs closed with interrupted suture. Cost analysis was based on cost of suture and operating room time. Clinical records were assessed for closure-related complications within the 6-week perioperative period. Average estimated closure time was 2.3 minutes shorter with the use of barbed suture. The total closure cost was similar between the groups. The closure-related perioperative complication rates were similar between the groups. Barbed suture is associated with a slightly shorter estimated closure time, although this small difference is of questionable clinical importance. With similar overall cost and no difference in perioperative complications in primary TKA, this closure methodology has led to more widespread use at our institution.

  13. Visual Closure.

    ERIC Educational Resources Information Center

    Groffman, Sidney

    An experimental test of visual closure based on an information-theory concept of perception was devised to test the ability to discriminate visual stimuli with reduced cues. The test is to be administered in a timed individual situation in which the subject is presented with sets of incomplete drawings of simple objects that he is required to name…

  14. A common gene for juvenile and adult-onset primary open-angle glaucomas confined on chromosome 1q

    SciTech Connect

    Morissette, J.; Plante, M.; Raymond, V.

    1995-06-01

    Primary open-angle glaucoma (POAG), which causes progressive loss of the visual fields, was subdivided into two groups according to age at onset: (1) chronic open-angle glaucoma (COAG) diagnosed after 40 years and (2) juvenile open-angle glaucoma (JOAG) diagnosed between 3 years of age and early adulthood. A JOAG gene (GLC1A) was recently mapped to chromosome 1q. We studied 142 members of a huge multigenerational French Canadian family affected with autosomal dominant POAG. Either JOAG or COAG was diagnosed with ocular hypertension (OHT), which may lead to POAG. To localize a common disease gene that might be responsible for both glaucoma subsets, we performed linkage analysis considering JOAG and COAG under the same phenotypic category. JOAG/COAG was tightly linked to seven microsatellite markers on chromosome 1q23-q25; a maximum lod score of 6.62 was obtained with AF-M278ye5. To refine the disease locus, we exploited a recombination mapping strategy based on a unique founder effect. The same characteristic haplotype, composed of 14 markers spanning 12 cM between loci D1S196 and D1S212, was recognized in all persons affected by JOAG, COAG, or OHT, but it did not occur in unaffected spouses and in normal family members >35 years of age, except for three obligatory carriers. Key combination events confined the disease region within a 9-cM interval between loci D1S445 and D1S416/D1S480. These observations demonstrate that the GLC1A gene is responsible for both adult-onset and juvenile glaucomas and suggest that the JOAG and COAG categories within this family may be part of a clinical continuum artificially divided at age 40 years. 49 refs., 4 figs., 2 tabs.

  15. Soluble Guanylate Cyclase α1–Deficient Mice: A Novel Murine Model for Primary Open Angle Glaucoma

    PubMed Central

    Buys, Emmanuel S.; Ko, Yu-Chieh; Alt, Clemens; Hayton, Sarah R.; Jones, Alexander; Tainsh, Laurel T.; Ren, Ruiyi; Giani, Andrea; Clerté, Maeva; Abernathy, Emma; Tainsh, Robert E. T.; Oh, Dong-Jin; Malhotra, Rajeev; Arora, Pankaj; de Waard, Nadine; Yu, Binglan; Turcotte, Raphael; Nathan, Daniel; Scherrer-Crosbie, Marielle; Loomis, Stephanie J.; Kang, Jae H.; Lin, Charles P.; Gong, Haiyan; Rhee, Douglas J.; Brouckaert, Peter; Wiggs, Janey L.; Gregory, Meredith S.; Pasquale, Louis R.; Bloch, Kenneth D.; Ksander, Bruce R.

    2013-01-01

    Primary open angle glaucoma (POAG) is a leading cause of blindness worldwide. The molecular signaling involved in the pathogenesis of POAG remains unknown. Here, we report that mice lacking the α1 subunit of the nitric oxide receptor soluble guanylate cyclase represent a novel and translatable animal model of POAG, characterized by thinning of the retinal nerve fiber layer and loss of optic nerve axons in the context of an open iridocorneal angle. The optic neuropathy associated with soluble guanylate cyclase α1–deficiency was accompanied by modestly increased intraocular pressure and retinal vascular dysfunction. Moreover, data from a candidate gene association study suggests that a variant in the locus containing the genes encoding for the α1 and β1 subunits of soluble guanylate cyclase is associated with POAG in patients presenting with initial paracentral vision loss, a disease subtype thought to be associated with vascular dysregulation. These findings provide new insights into the pathogenesis and genetics of POAG and suggest new therapeutic strategies for POAG. PMID:23527308

  16. The efficacy of topical prophylactic antiglaucoma therapy in primary closed angle glaucoma in dogs: a multicenter clinical trial.

    PubMed

    Miller, P E; Schmidt, G M; Vainisi, S J; Swanson, J F; Herrmann, M K

    2000-01-01

    The ability of either 0.5% betaxolol (1 drop topically, bid; n=31) or a combination of 0.25% demecarium bromide and a topical corticosteroid (gentamicin/betamethasone) (DB/GB; 1 drop of each topically, sid; n=55) to prevent glaucoma in the fellow eye of dogs with unilateral, primary closed angle glaucoma (PCAG) was investigated in a multicenter, open-label, clinical trial. Untreated control dogs (n=20) developed glaucoma significantly sooner (median, eight mos; p less than 0.001) than dogs treated either with DB/GB (median, 31 mos) or betaxolol (median, 30.7 mos). Although DB/GB and betaxolol equally delayed or prevented the onset of glaucoma in the second eye, a less frequent dosing schedule for DB/GB suggests demecarium bromide in combination with a topical corticosteroid may be preferable to betaxolol in preventing PCAG in dogs.

  17. [The effect of parenteral citicoline on visual functions and life quality of patients with primary open-angle glaucoma].

    PubMed

    Frolov, M A; Gonchar, P A; Barashkov, V I; Kumar, V; Morozova, N S; Frolov, A M; Kazakova, K A

    2011-01-01

    The effect of nootropic drug citicoline on visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality of patients with primary open-angle glaucoma (POAG) stage I-III and normalized intraocular pressure (IOP) was studied. 40 patients aged 46-78 years old with POAG stage I-III and normalized IOP were treated with citicoline. Among them there were 24 female and 16 male. The patients were divided into 2 equal groups--experimental and control. Patients of both groups were treated with intravenous citicoline for 10 days. The dose of citicoline in experimental group was 1000 mg/day, in control--500 mg/day. After treatment in both groups visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality showed improvement. Citicoline has significant neuroprotective effect preventing apoptosis.

  18. Recent Developments in Understanding the Role of Aqueous Humor Outflow in Normal and Primary Open Angle Glaucoma

    PubMed Central

    Hann, Cheryl R.; Fautsch, Michael P.

    2015-01-01

    Primary open angle glaucoma (POAG) is the second leading cause of blindness in the world's rapidly aging population. POAG is characterized by progressive degeneration of neural structures in the posterior segment, often associated with a concomitant elevation of intraocular pressure. Changes in IOP are believed to be caused by a disruption in the normal outflow of aqueous humor. This article reviews recent research associated with normal and POAG aqueous humor outflow. Novel findings elucidating biochemical and pathological changes in the ocular tissues affected in POAG are presented. Stem cell research, identification of lymphatic markers, and increased use of mouse models give researchers exciting new tools to understand aqueous humor outflow, changes associated with POAG and identify underlying causes of the disease. PMID:26236568

  19. Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population.

    PubMed

    Pleet, Alexander; Sulewski, Melanie; Salowe, Rebecca J; Fertig, Raymond; Salinas, Julia; Rhodes, Allison; Merritt Iii, William; Natesh, Vikas; Huang, Jiayan; Gudiseva, Harini V; Collins, David W; Chavali, Venkata Ramana Murthy; Tapino, Paul; Lehman, Amanda; Regina-Gigiliotti, Meredith; Miller-Ellis, Eydie; Sankar, Prithvi; Ying, Gui-Shuang; O'Brien, Joan M

    2016-08-01

    To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population. This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors. Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pre-treatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP ≥21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups. Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.

  20. Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities.

    PubMed

    Fondevila, Damián; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Mónica; Dosoretz, Bernardo

    2008-05-01

    Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (alpha(max)) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining alpha(max), which is a function of the thickness of the barrier (t(E)) and the equilibrium tenth-value layer (TVL(e)) of the shielding material for the nominal energy of the beam. It can be seen that alpha(max) increases for increasing TVL(e) (hence, beam energy) and decreases for increasing t(E), with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation.

  1. Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities

    SciTech Connect

    Fondevila, Damian; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Monica; Dosoretz, Bernardo

    2008-05-15

    Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle ({alpha}{sub max}) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining {alpha}{sub max}, which is a function of the thickness of the barrier (t{sub E}) and the equilibrium tenth-value layer (TVL{sub e}) of the shielding material for the nominal energy of the beam. It can be seen that {alpha}{sub max} increases for increasing TVL{sub e} (hence, beam energy) and decreases for increasing t{sub E}, with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation.

  2. Duct closure

    DOEpatents

    Vowell, Kennison L.

    1987-01-01

    A closure for an inclined duct having an open upper end and defining downwardly extending passageway. The closure includes a cap for sealing engagement with the open upper end of the duct. Associated with the cap are an array of vertically aligned plug members, each of which has a cross-sectional area substantially conforming to the cross-sectional area of the passageway at least adjacent the upper end of the passageway. The plug members are interconnected in a manner to provide for free movement only in the plane in which the duct is inclined. The uppermost plug member is attached to the cap means and the cap means is in turn connected to a hoist means which is located directly over the open end of the duct.

  3. Gonioscopy findings and prevalence of occludable angles in a Burmese population: the Meiktila Eye Study

    PubMed Central

    Casson, R J; Newland, H S; Muecke, J; McGovern, S; Abraham, L M; Shein, W K; Selva, D; Aung, T

    2007-01-01

    Aim To determine the prevalence of preglaucomatous angle‐closure disease in central Myanmar. Methods A population‐based survey of inhabitants ⩾40 years in the Meiktila District was carried out; 2481 subjects were identified, 2076 participated and 2060 underwent gonioscopy of at least one eye. Eyes with angles traditionally described as “occludable” were recorded as primary angle‐closure suspects (PACS); eyes with PACS and peripheral anterior synechiae (PAS), or an increased intraocular pressure but without primary angle‐closure glaucoma, were recorded as primary angle closure (PAC). Results The prevalence of PACS in at least one eye was 5.7% (95% CI 4.72 to 6.62); prevalence increased with age and was more common in women (p<0.001). The prevalence of PAC in at least one eye was 1.50% (95% CI 1.47 to 1.53). All participants with PAS had at least 90° of closure (range 90–360°). Conclusion The prevalence of preglaucomatous angle‐closure disease (PACS and PAC) in this population was 5.7% and 1.5%, respectively. PACS was more common in women, and its prevalence increased with age. PMID:17576708

  4. Closure device

    SciTech Connect

    Sable, D. E.

    1985-06-11

    A closure device connectible to a well head through which the polished rod of a rod string extends into a well tubing for operating pump means for moving well fluids to a surface flow conductor, the closure device having a tubular ram provided with a packing or plug for closing an annular passage between the polished rod and a tubular body connected to the well head above a lateral port of the tubular body, the tubular ram and the tubular body having thread means for moving the plug between an operative lower position wherein it closes the annular passage when the rod string is stationary and on inoperative upper position; seal means between the ram and the polished rod spaced above the plug; and a plurality of independent seal means between the ram and the tubular body operative when the plug is in its inoperative position. The plug of the closure device is especially adapted to operate under high temperature and pressure conditions of the well, as during steam injection operations when the rod string is stationary, to protect the seal means from high pressures and temperatures as well as any fluids which may be corrosive or otherwise deleterious to the substance of which the seal means are made.

  5. Assessing the Association of Mitochondrial Genetic Variation With Primary Open-Angle Glaucoma Using Gene-Set Analyses

    PubMed Central

    Khawaja, Anthony P.; Cooke Bailey, Jessica N.; Kang, Jae Hee; Allingham, R. Rand; Hauser, Michael A.; Brilliant, Murray; Budenz, Donald L.; Christen, William G.; Fingert, John; Gaasterland, Douglas; Gaasterland, Terry; Kraft, Peter; Lee, Richard K.; Lichter, Paul R.; Liu, Yutao; Medeiros, Felipe; Moroi, Syoko E.; Richards, Julia E.; Realini, Tony; Ritch, Robert; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J.; Zhang, Kang; Pericak-Vance, Margaret; Weinreb, Robert N.; Haines, Jonathan L.; Pasquale, Louis R.; Wiggs, Janey L.

    2016-01-01

    Purpose Recent studies indicate that mitochondrial proteins may contribute to the pathogenesis of primary open-angle glaucoma (POAG). In this study, we examined the association between POAG and common variations in gene-encoding mitochondrial proteins. Methods We examined genetic data from 3430 POAG cases and 3108 controls derived from the combination of the GLAUGEN and NEIGHBOR studies. We constructed biological-system coherent mitochondrial nuclear-encoded protein gene-sets by intersecting the MitoCarta database with the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. We examined the mitochondrial gene-sets for association with POAG and with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) subsets using Pathway Analysis by Randomization Incorporating Structure. Results We identified 22 KEGG pathways with significant mitochondrial protein-encoding gene enrichment, belonging to six general biological classes. Among the pathway classes, mitochondrial lipid metabolism was associated with POAG overall (P = 0.013) and with NTG (P = 0.0006), and mitochondrial carbohydrate metabolism was associated with NTG (P = 0.030). Examining the individual KEGG pathway mitochondrial gene-sets, fatty acid elongation and synthesis and degradation of ketone bodies, both lipid metabolism pathways, were significantly associated with POAG (P = 0.005 and P = 0.002, respectively) and NTG (P = 0.0004 and P < 0.0001, respectively). Butanoate metabolism, a carbohydrate metabolism pathway, was significantly associated with POAG (P = 0.004), NTG (P = 0.001), and HTG (P = 0.010). Conclusions We present an effective approach for assessing the contributions of mitochondrial genetic variation to open-angle glaucoma. Our findings support a role for mitochondria in POAG pathogenesis and specifically point to lipid and carbohydrate metabolism pathways as being important. PMID:27661856

  6. Assessing the Association of Mitochondrial Genetic Variation With Primary Open-Angle Glaucoma Using Gene-Set Analyses.

    PubMed

    Khawaja, Anthony P; Cooke Bailey, Jessica N; Kang, Jae Hee; Allingham, R Rand; Hauser, Michael A; Brilliant, Murray; Budenz, Donald L; Christen, William G; Fingert, John; Gaasterland, Douglas; Gaasterland, Terry; Kraft, Peter; Lee, Richard K; Lichter, Paul R; Liu, Yutao; Medeiros, Felipe; Moroi, Syoko E; Richards, Julia E; Realini, Tony; Ritch, Robert; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret; Weinreb, Robert N; Haines, Jonathan L; Pasquale, Louis R; Wiggs, Janey L

    2016-09-01

    Recent studies indicate that mitochondrial proteins may contribute to the pathogenesis of primary open-angle glaucoma (POAG). In this study, we examined the association between POAG and common variations in gene-encoding mitochondrial proteins. We examined genetic data from 3430 POAG cases and 3108 controls derived from the combination of the GLAUGEN and NEIGHBOR studies. We constructed biological-system coherent mitochondrial nuclear-encoded protein gene-sets by intersecting the MitoCarta database with the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. We examined the mitochondrial gene-sets for association with POAG and with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) subsets using Pathway Analysis by Randomization Incorporating Structure. We identified 22 KEGG pathways with significant mitochondrial protein-encoding gene enrichment, belonging to six general biological classes. Among the pathway classes, mitochondrial lipid metabolism was associated with POAG overall (P = 0.013) and with NTG (P = 0.0006), and mitochondrial carbohydrate metabolism was associated with NTG (P = 0.030). Examining the individual KEGG pathway mitochondrial gene-sets, fatty acid elongation and synthesis and degradation of ketone bodies, both lipid metabolism pathways, were significantly associated with POAG (P = 0.005 and P = 0.002, respectively) and NTG (P = 0.0004 and P < 0.0001, respectively). Butanoate metabolism, a carbohydrate metabolism pathway, was significantly associated with POAG (P = 0.004), NTG (P = 0.001), and HTG (P = 0.010). We present an effective approach for assessing the contributions of mitochondrial genetic variation to open-angle glaucoma. Our findings support a role for mitochondria in POAG pathogenesis and specifically point to lipid and carbohydrate metabolism pathways as being important.

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

    PubMed Central

    Helmy, Hazem

    2016-01-01

    Objective The 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. Methods This 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. Results The 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

  8. Investigation of blood flow regulation and oxygen saturation of the retinal vessels in primary open-angle glaucoma.

    PubMed

    Ramm, L; Jentsch, S; Peters, S; Augsten, R; Hammer, M

    2014-11-01

    To examine the supply of oxygen to the retina in primary open-angle glaucoma (POAG). Forty-one patients with primary open-angle glaucoma (mean age 64.1 ± 12.9 years) and 40 healthy subjects (63.6 ± 14.1 years) were included. Fundus images, centered at the optic disc, were taken using the Retinal Vessel Analyzer (RVA). The vessel diameters were calculated as central retinal artery (CRAE) and vein equivalent (CRVE) from diameter measurements in the peripapillary vessels. The oxygen saturation of the arteries and veins was investigated employing a two-wavelengths technique. After the measurement at baseline, the vascular response to flicker light exposure was measured. In glaucoma patients the mean oxygen saturation of the retinal veins at baseline was higher than in the healthy controls (64.36 ± 7.11 vs. 59.78 ± 8.47, p = 0.01), whereas the mean arteriovenous oxygen saturation difference was lower (33.07 ± 5.24 vs. 37.53 ± 6.95, p = 0.002). The arterial oxygen saturation as well as the arterial and venous diameters showed no difference between the groups. The increase of the CRVE during flicker light stimulation (3.72 ± 3.29 % vs. 5.43 ± 4.04, p = 0.039), as well as the change of the venous oxygen saturation (2.08 ± 3.74 % vs. 4.18 ± 3.88 %, p = 0.016) and the arteriovenous saturation difference (-2.1 ± 3.31 % vs. -4.43 ± 3.6 %, p = 0.003) were smaller in POAG patients than in the healthy group. The reduction in the arteriovenous difference in oxygen saturation in POAG patients might show a decreased oxygen demand of the retina caused by the glaucomatous loss of neuroretinal tissue. The lower extent of the flicker light-induced change of the diameter of retinal veins and the venous oxygen saturation could indicate an impairment of blood flow regulation.

  9. Bimatoprost/timolol fixed combination (BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece

    PubMed Central

    Rotsos, Tryfon G.; Kliafa, Vasso G.; Asher, Kevin J.; Papaconstantinou, Dimitrios

    2016-01-01

    AIM To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03% and timolol 0.5% (BTFC) in patients in Greece with primary open angle glaucoma (POAG) or ocular hypertension (OHT) whose previous therapy provided insufficient lowering of intraocular pressure (IOP). METHODS A multicenter, prospective, open-label, non-interventional, observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece. The primary endpoint was the reduction in IOP from baseline at study end, approximately 12wk after initiation of BTFC therapy. RESULTS A total of 785 eligible patients were enrolled in the study and 97.6% completed the study. The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg (n=764; P<0.001). In patients (n=680) who replaced their previous IOP-lowering monotherapy (a single drug, or a fixed combination of 2 drugs in a single ophthalmic drop) with once-daily BTFC, the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg (P<0.001). IOP was reduced from baseline in 99.2% of patients, and 58.0% of patients reached or exceeded their target IOP. Substantial mean IOP reductions were observed regardless of the previous therapy. BTFC was well tolerated, with 96.0% of patients who completed the study rating the tolerability of BTFC as “good” or “very good.” Adverse events were reported in 8.3% of patients; only 0.6% of patients discontinued the study due to adverse events. CONCLUSION In clinical practice in Greece, BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy. PMID:26949613

  10. Expression profile of the matricellular protein osteopontin in primary open-angle glaucoma and the normal human eye.

    PubMed

    Chowdhury, Uttio Roy; Jea, Seung-Youn; Oh, Dong-Jin; Rhee, Douglas J; Fautsch, Michael P

    2011-08-16

    PURPOSE. To characterize the role of osteopontin (OPN) in primary open-angle glaucoma (POAG) and normal eyes. METHODS. OPN quantification was performed by enzyme-linked immunosorbent assay in aqueous humor (AH) obtained from human donor eyes (POAG and normal) and surgical samples (POAG and elective cataract removal). OPN expression and localization in whole eye tissue sections and primary normal human trabecular meshwork (NTM) cells were studied by Western blot and immunohistochemistry. Latanoprost-free acid (LFA)-treated NTM cells were analyzed for OPN gene and protein expression. Intraocular pressure was measured by tonometry, and central corneal thickness was measured by optical coherence tomography in young OPN(-/-) and wild-type mice. RESULTS. OPN levels were significantly reduced in donor POAG AH compared with normal AH (0.54 ± 0.18 ng/μg [n = 8] vs. 0.77 ± 0.23 ng/μg [n = 9]; P = 0.039). A similar trend was observed in surgical AH (1.05 ± 0.31 ng/μg [n = 20] vs. 1.43 ± 0.88 ng/μg [n = 20]; P = 0.083). OPN was present in the trabecular meshwork, corneal epithelium and endothelium, iris, ciliary body, retina, vitreous humor, and optic nerve. LFA increased OPN gene expression, but minimal change in OPN protein expression was observed. No difference in intraocular pressure (17.5 ± 2.0 mm Hg [n = 56] vs. 17.3 ± 1.9 mm Hg [n = 68]) but thinner central corneal thickness (91.7 ± 3.6 μm [n = 50] vs. 99.2 ± 5.5 μm [n = 70]) was noted between OPN(-/-) and wild-type mice. CONCLUSIONS. OPN is widely distributed in the human eye and was found in lower concentrations in POAG AH. Reduction of OPN in young mice does not affect IOP.

  11. Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

    PubMed Central

    Fea, Antonio Maria; Consolandi, Giulia; Zola, Marta; Pignata, Giulia; Cannizzo, Paola; Lavia, Carlo; Rolle, Teresa; Grignolo, Federico Maria

    2015-01-01

    Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158. PMID:26587282

  12. Common variants near ABCA1, AFAP1 and GMDS confer risk of primary open-angle glaucoma

    PubMed Central

    Fogarty, Rhys; Sharma, Shiwani; Hewitt, Alex W.; Martin, Sarah; Law, Matthew H.; Cremin, Katie; Bailey, Jessica N. Cooke; Loomis, Stephanie J.; Pasquale, Louis R.; Haines, Jonathan L.; Hauser, Michael A.; Viswanathan, Ananth C.; McGuffin, Peter; Topouzis, Fotis; Foster, Paul J.; Graham, Stuart L; Casson, Robert J; Chehade, Mark; White, Andrew J; Zhou, Tiger; Souzeau, Emmanuelle; Landers, John; Fitzgerald, Jude T; Klebe, Sonja; Ruddle, Jonathan B; Goldberg, Ivan; Healey, Paul R; Mills, Richard A.; Wang, Jie Jin; Montgomery, Grant W.; Martin, Nicholas G.; Radford-Smith, Graham; Whiteman, David C.; Brown, Matthew A.; Wiggs, Janey L.; Mackey, David A; Mitchell, Paul; MacGregor, Stuart; Craig, Jamie E.

    2014-01-01

    Primary open-angle glaucoma (POAG) is a major cause of irreversible blindness worldwide. We performed a genome-wide association study in an Australian discovery cohort comprising 1,155 advanced POAG cases and 1,992 controls. Association of the top SNPs from the discovery stage was investigated in two Australian replication cohorts (total 932 cases, 6,862 controls) and two US replication cohorts (total 2,616 cases, 2,634 controls). Meta-analysis of all cohorts revealed three novel loci associated with development of POAG. These loci are located upstream of ABCA1 (rs2472493 [G] OR=1.31, P= 2.1 × 10−19), within AFAP1 (rs4619890 [G] OR=1.20, P= 7.0 × 10−10) and within GMDS (rs11969985 [G] OR=1.31, and P= 7.7 × 10−10). Using RT-PCR and immunolabelling, we also showed that these genes are expressed within human retina, optic nerve and trabecular meshwork and that ABCA1 and AFAP1 are also expressed in retinal ganglion cells. PMID:25173105

  13. Association of Common Variants in eNOS Gene with Primary Open Angle Glaucoma: A Meta-Analysis

    PubMed Central

    Xiang, Yang; Dong, Yi; Li, Xuan; Tang, Xin

    2016-01-01

    Purpose. To clarify the association of endothelial nitric oxide synthase (eNOS) polymorphisms and primary open angle glaucoma (POAG). Methods. After a systematic literature search in the MEDLINE, EMBASE, and ISI Web of Science databases, all relevant studies evaluating the association between the polymorphisms (rs2070744 and rs1799983) of eNOS gene and POAG were screened and included. The pooled odds ratios (ORs) and the 95% confidence interval (CI) of each single-nucleotide polymorphism (SNP) in five genetic models were estimated using fixed-effect model if I2 < 50% in the test for heterogeneity; otherwise the random-effects model was used. Results. Thirty-one records were obtained, with five being suitable for meta-analysis. The overall results showed that both TT genotype in rs2070744 and GG genotype in rs1799983 are associated with decreased risk of POAG susceptibility. Stratified analysis based on ethnicity showed that the association of rs2070744 with POAG remained only in Caucasians. Results of subgroup analysis by sex indicated association between both polymorphisms and POAG in female group, but not in male group. Conclusions. TT genotype and/or T-allele in rs2070744, as well as GG genotype and/or G-allele in rs1799983, was associated with decreased risk for POAG overall and in female group. PMID:27242919

  14. Primary open-angle glaucoma patients characterized by ocular vasospasm demonstrate a different ocular vascular response to timolol versus betaxolol.

    PubMed

    Evans, D W; Harris, A; Cantor, L B

    1999-12-01

    We evaluated the retrobulbar response to a selective versus nonselective beta blocker in a subgroup of primary open-angle glaucoma patients (POAG) characterized by ocular vasospasm. Eleven patients who exhibited ocular vasospasm (i.e. a significant increase in ophthalmic artery blood flow velocity or a significant decrease in ophthalmic artery resistance index during hypercapnia) underwent medication washout for 4 weeks and were enrolled in a double-masked cross-over study (betaxolol versus timolol). Patients were evaluated for blood flow velocity of the retrobulbar vessels using color Doppler imaging, intraocular pressure, visual field sensitivity and contrast sensitivity at the beginning and end of each 4 week treatment period. Timolol treatment caused a significant reduction in IOP (p = .007), but no change in retrobulbar hemodynamics or visual function. After betaxolol treatment, resistance index fell significantly (p = .040) in the ophthalmic artery and increased significantly in both the central retinal (p = .003) and temporal posterior ciliary arteries (p = .030). Also following betaxolol treatment, contrast sensitivity improved significantly (p = .006), and a significant positive correlation was shown between change in contrast sensitivity and change in resistance index (r = .70; p = .015) of the ciliary arteries. POAG patients characterized by ocular vasospasm display a significant hemodynamic response to betaxolol, but not to timolol.

  15. Predicting Clinical Binary Outcome Using Multivariate Longitudinal Data: Application to Patients with Newly Diagnosed Primary Open-Angle Glaucoma.

    PubMed

    Gao, Feng; Miller, J Philip; Beiser, Julia A; Xiong, Chengjie; Gordon, Mae O

    2015-10-01

    Primary open angle glaucoma (POAG) is a chronic, progressive, irreversible, and potentially blinding optic neuropathy. The risk of blindness due to progressive visual field (VF) loss varies substantially from patient to patient. Early identification of those patients destined to rapid progressive visual loss is crucial to prevent further damage. In this article, a latent class growth model (LCGM) was developed to predict the binary outcome of VF progression using longitudinal mean deviation (MD) and pattern standard deviation (PSD). Specifically, the trajectories of MD and PSD were summarized by a functional principal component (FPC) analysis, and the estimated FPC scores were used to identify subgroups (latent classes) of individuals with distinct patterns of MD and PSD trajectories. Probability of VF progression for an individual was then estimated as weighted average across latent classes, weighted by posterior probability of class membership given baseline covariates and longitudinal MD/PSD series. The model was applied to the participants with newly diagnosed POAG from the Ocular Hypertension Treatment Study (OHTS), and the OHTS data was best fit by a model with 4 latent classes. Using the resultant optimal LCGM, the OHTS participants with and without VF progression could be accurately differentiated by incorporating longitudinal MD and PSD.

  16. Fluctuation in systolic blood pressure is a major systemic risk factor for development of primary open-angle glaucoma

    PubMed Central

    Lee, Na Young; Jung, Younhea; Han, Kyungdo; Park, Chan Kee

    2017-01-01

    We evaluated the risk of development of primary open-angle glaucoma (POAG) in terms of variability in BP using a nationwide, population-based, 11-year longitudinal study using the Korean National Health Insurance Research Database. We included patients who underwent health care examinations more than twice between January 2002 and December 2006. We divided all subjects by the quartiles of variability in systolic blood pressure (SBP), diastolic blood pressure (DBP), and the difference between SBP and DBP. Of the total of 80,021 included subjects, 910 were diagnosed with POAG between January 2007 and December 2013. Both the Kaplan-Meier survival curves and log-rank test data indicated that patients with higher-level BP variability developed POAG significantly more frequently than did patients with lower-level variability (P < 0.001). On multivariate Cox’s regression modeling including gender, age, sex, household income, smoking status, level of alcohol intake, extent of exercise, diabetes mellitus status, dyslipidemia status, SBP, and DBP; the hazard ratios among the highest and lowest quartiles of SD SBP and CV SBP were 1.256 and 1.238, respectively. Our findings suggest that subjects in the highest quartile of SBP variability were significantly more likely to develop POAG in our population-based sample of Korean adults. PMID:28262703

  17. Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

    PubMed Central

    Kulkarni, Sadhana V; Damji, Karim F; Buys, Yvonne M

    2008-01-01

    Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms “compliance, persistence and adherence” with reference to medication use is central not only for monitoring patients’ drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence. PMID:19920977

  18. Elevated Plasma Endothelin-1 Levels in Normal Tension Glaucoma and Primary Open-Angle Glaucoma: A Meta-Analysis

    PubMed Central

    Li, Shengjie; Zhang, Aiping

    2016-01-01

    Purpose. The aim of this meta-analysis was to clarify the association between the plasma endothelin-1 level and the risks of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). Methods. Relevant publications were collected from three databases including PubMed, EMBASE, and the Web of Science through December 31, 2015. In this study, the terms “(endothelin OR ET) AND glaucoma” were searched. Review Manager 5.2 was used to process the data. Results. Seven studies (212 cases, 164 controls) were included for the NTG analysis. The mean plasma endothelin-1 level in the NTG subjects was 0.60 pg/mL (p = 0.02, 95% CI: 0.17–1.04) higher than that of the healthy controls. Six studies (160 cases, 174 controls) were included for the POAG analysis, and the endothelin-1 level was 0.63 pg/mL (p = 0.007, 95% CI: 0.12–1.15) higher in the POAG subjects than in the healthy controls. Additionally, two studies influenced the meta-analysis results regarding the association of plasma endothelin-1 with POAG by sensitivity analysis, and the probability of publication bias was low. Conclusions. The observation that NTG and POAG subjects showed significantly elevated endothelin-1 plasma concentrations suggests that a higher plasma level of endothelin-1 might increase the risk of NTG and POAG development. PMID:27965889

  19. Genome-Wide Linkage Scan for Primary Open Angle Glaucoma: Influences of Ancestry and Age at Diagnosis

    PubMed Central

    Qin, Xuejun; Liu, Yutao; Gibson, Jason R.; Santiago-Turla, Cecilia; Larocque-Abramson, Karen R.; Del Bono, Elizabeth; Challa, Pratap; Herndon, Leon W.; Akafo, Stephen; Wiggs, Janey L.; Schmidt, Silke; Hauser, Michael A.

    2011-01-01

    Primary open-angle glaucoma (POAG) is the most common form of glaucoma and one of the leading causes of vision loss worldwide. The genetic etiology of POAG is complex and poorly understood. The purpose of this work is to identify genomic regions of interest linked to POAG. This study is the largest genetic linkage study of POAG performed to date: genomic DNA samples from 786 subjects (538 Caucasian ancestry, 248 African ancestry) were genotyped using either the Illumina GoldenGate Linkage 4 Panel or the Illumina Infinium Human Linkage-12 Panel. A total of 5233 SNPs was analyzed in 134 multiplex POAG families (89 Caucasian ancestry, 45 African ancestry). Parametric and non-parametric linkage analyses were performed on the overall dataset and within race-specific datasets (Caucasian ancestry and African ancestry). Ordered subset analysis was used to stratify the data on the basis of age of glaucoma diagnosis. Novel linkage regions were identified on chromosomes 1 and 20, and two previously described loci—GLC1D on chromosome 8 and GLC1I on chromosome 15—were replicated. These data will prove valuable in the context of interpreting results from genome-wide association studies for POAG. PMID:21765929

  20. An evaluation of ocular elasticity using real-time ultrasound elastography in primary open-angle glaucoma.

    PubMed

    Agladioglu, Kadir; Pekel, Gökhan; Altintas Kasikci, Seher; Yagci, Ramazan; Kiroglu, Yilmaz

    2016-01-01

    The aim of this study was to compare sonoelastographic findings in the retina-choroid-sclera (RCS) complex and vitreous in glaucomatous and healthy eyes. For this cross-sectional comparative study, 20 patients with primary open-angle glaucoma and 20 healthy volunteers were recruited. Ultrasound elastography measurements were taken with a sonographic scanner of the RCS complex, anterior vitreous (AV), posterior vitreous (PV), retrobulbar fat tissue (RFT), optic disc (OD) and optic nerve (ON) in each eye. The elasticity index of the RCS complex, RFT, OD, ON, AV and PV was similar in both groups (p  >  0.05), although the AV/PV strain ratio in the group of patients with glaucoma was significantly higher (p  =  0.04). Glaucoma increases the AV/PV strain ratio. In providing reproducible and consistent values, the real-time elastography (RTE) technique may be helpful in elucidating the mechanisms of glaucoma in some aspects. This study can help to evaluate the elasticity of the RCS complex and vitreous in glaucomatous eyes with RTE.

  1. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541).

    PubMed

    Seiler, Christoph M; Bruckner, Thomas; Diener, Markus K; Papyan, Armine; Golcher, Henriette; Seidlmayer, Christoph; Franck, Annette; Kieser, Meinhard; Büchler, Markus W; Knaebel, Hanns-Peter

    2009-04-01

    In patients undergoing midline incisions, the abdominal fascia can be closed with a continuous or interrupted suture using various materials. The aim of this study is to compare: (1) interrupted technique with rapidly absorbable sutures and (2) continuous techniques with different slowly absorbable sutures, focusing on the incidence of incisional hernias within 1 year. A meta-analysis suggested that the incidence of incisional hernias can be more effectively reduced with slowly absorbable continuous sutures. Multicenter randomized surgical trial with 3 parallel groups. Patients were scheduled for primary elective midline incisions. All surgeons were trained (4:1 suture wound length in continuous groups) and monitored. Primary end point, measured within 1 year after surgery, was the frequency of incisional hernias diagnosed by clinical examination and confirmed by ultrasound. Complications and safety were used as secondary end points. This study has been registered with the ISRCTN Register (INSECT: ISRCTN24023541). Conducted on 625 randomized patients (210 interrupted Vicryl, 205 continuous polydioxanone suture (PDS), 210 continuous Monoplus), the primary analysis showed an incidence of 28 incisional hernias (15.9%) versus 15 (8.4%) versus 22 (12.5%) for the 3 closure techniques, respectively (P = 0.09). No significant difference was observed between the 3 groups with regard to burst abdomen (4 [2.0%] vs. 6 [3.0%] vs. 8 [4.0%], P = 0.46), wound infection (26 [12.7%] vs. 39 [19.4%] vs. 33 [16.3%], P = 0.19), pulmonary infections (9 [4.4%] vs. 5 [2.5%] vs. 5 [2.5%], P = 0.46), serious adverse events (63 [30.0%] vs. 57 [27.8%] vs. 61 [29.1%], P = 0.89), and 1-year mortality (16 [7.9%] vs. 11 [5.5%] vs. 16 [7.9%], P = 0.54). The incidence of incisional hernias and the frequency of wound infection was higher than expected in all groups. New concepts need to be developed and studied to substantially reduce the frequency of incisional hernias.

  2. The association of platelets with failed patent ductus arteriosus closure after a primary course of indomethacin or ibuprofen: a systematic review and meta-analysis.

    PubMed

    Mitra, Souvik; Chan, Anthony K; Paes, Bosco A

    2017-01-01

    To conduct a meta-analysis of the association of platelet counts and pharmacotherapeutic failure in preterms with a patent ductus arteriosus (PDA). MEDLINE, Embase, Science Citation Index, abstracts and conference proceedings were searched, and principal authors contacted. Included studies reported indomethacin or ibuprofen use for PDA closure, compared a group which failed treatment versus a group which did not and reported the association between platelet counts and indomethacin or ibuprofen failure. Two reviewers independently screened results and assessed methodological quality using the Newcastle-Ottawa Scale. Results are expressed as mean difference in platelet counts and summary odds ratios (OR) using a random effects model. 1105 relevant studies were identified; eight involving 1087 preterms were included. Platelet counts were significantly lower in infants who failed pharmacotherapy (Meandifference:-30.88 × 10(9)/L; 95% CI:-45.69 × 10(9),-16.07 × 10(9)/L; I2 = 24%; pheterogeneity = 0.24). Similar results were obtained based on either pharmacotherapeutic agent. Treatment failure was also significantly associated with pre-treatment thrombocytopenia (summary OR:1.75; 95% CI:1.23-2.49, I2 = 36%, pheterogeneity = 0.20). Platelet counts are significantly lower in preterms who fail primary treatment for PDA. Pre-treatment thrombocytopenia is associated with higher odds of failure. Further cohort studies reporting platelet counts in prostaglandin inhibitor failure are needed for meta-analyses to firmly establish or refute a stronger association.

  3. Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

    PubMed

    Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap

    2013-12-01

    To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. Retrospective chart review. One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of

  4. CLOSURE DEVICE

    DOEpatents

    Linzell, S.M.; Dorcy, D.J.

    1958-08-26

    A quick opening type of stuffing box employing two banks of rotatable shoes, each of which has a caraming action that forces a neoprene sealing surface against a pipe or rod where it passes through a wall is presented. A ring having a handle or wrench attached is placed eccentric to and between the two banks of shoes. Head bolts from the shoes fit into slots in this ring, which are so arranged that when the ring is rotated a quarter turn in one direction the shoes are thrust inwardly to cramp the neopnrene about the pipe, malting a tight seal. Moving the ring in the reverse direction moves the shoes outwardly and frees the pipe which then may be readily removed from the stuffing box. This device has particular application as a closure for the end of a coolant tube of a neutronic reactor.

  5. The Relationship between Central Visual Field Damage and Motor Vehicle Collisions in Primary Open-Angle Glaucoma Patients

    PubMed Central

    Yuki, Kenya; Asaoka, Ryo; Tsubota, Kazuo

    2014-01-01

    Purpose To investigate the relationship between visual field (VF) damage and history of motor vehicle collisions (MVCs) in subjects with primary open-angle glaucoma (POAG). Methods MVC history and driving habits were recorded using patient questionnaires in 247 POAG patients. Patients' driving attitudes (carefulness) were estimated using Rasch analysis. The relationship between MVC outcomes and 52 total deviation (TD) values of integrated binocular VF (IVF), better and worse visual acuities (VAs), age and gender was analyzed using principal component analysis and logistic regression. Results 51 patients had the history of MVCs. Significant difference was observed between patients with and without history of MVCs only for: better VA, a single TD value in the superior-right VF, and the typical distance driven in a week (unpaired t-test, p = 0.002, 0.015 and 0.006, respectively). There was not a significant relationship between MVCs and mean deviation (MD) of IVF (p = 0.41, logistic regression). None of the principal components were significantly correlated with MVC outcome (p>0.05, polynomial logistic regression analysis). There was a significant relationship between IVF MD and Rasch derived Person parameter (R2 = 0.023, p = 0.0095). There was also a significant positive relationship between MVCs and the distance driven in a week (p = 0.005, logistic regression). Conclusions In this study of POAG patients, MVCs were not related to central binocular VF damage. These results suggest the relationship between visual function and driving is not straightforward, and careful consideration should be given when predicting patients' driving ability using their VF. PMID:25545660

  6. Oxygen saturation measurements of the retinal vasculature in treated asymmetrical primary open-angle glaucoma using hyperspectral imaging

    PubMed Central

    Mordant, D J; Al-Abboud, I; Muyo, G; Gorman, A; Harvey, A R; McNaught, A I

    2014-01-01

    Purpose To determine whether there are differences in retinal vascular oxygen saturation measurements, estimated using a hyperspectral fundus camera, between normal eyes and treated eyes of subjects with asymmetrical primary open-angle glaucoma (POAG). Methods A noninvasive hyperspectral fundus camera was used to acquire spectral images of the retina at wavelengths between 556 and 650 nm in 2-nm increments. In total, 14 normal eyes and both eyes of 11 treated POAG subjects were imaged and analyzed using algorithms that use the spectral variation of the optical densities of blood vessels to estimate the oxygen saturation of blood within the retinal vasculature. In the treated POAG group, each of the eyes were categorized, based on the mean deviation of the Humphrey visual-field analyzer result, as either more-advanced or less-advanced, glaucomatous eyes. Unpaired t-tests (two-tailed) with Welch's correction were used to compare the mean oxygen saturation between the normal subjects and the treated POAG subgroups. Results In less-advanced and more-advanced-treated POAG eyes, mean retinal venular oxygen saturations (48.2±21.6% and 42.6±18.8%, respectively) were significantly higher than in normal eyes (27.9±9.9% P=0.03 and 0.01, respectively). Arteriolar oxygen saturation was not significantly different between normal eyes and treated POAG eyes. Conclusions The increased oxygen saturation of the retinal venules in advanced-treated POAG eyes may indicate reduced metabolic consumption of oxygen in the inner retinal tissues. PMID:25060843

  7. Color Doppler Imaging Analysis of Retrobulbar Blood Flow Velocities in Primary Open-Angle Glaucomatous Eyes: A Meta-Analysis

    PubMed Central

    Meng, Nana; Zhang, Ping; Huang, Huadong; Ma, Jinlan; Zhang, Yue; Li, Hao; Qu, Yi

    2013-01-01

    Background To analyze the diagnostic value of color Doppler imaging (CDI) of blood flow in the retrobulbar vessels of eyes with primary open-angle glaucoma (POAG). Methods Pertinent publications were retrieved from the Cochrane Central Register of Controlled Trials, PubMed and the ISI Web of Knowledge up to October 2012. Changes in peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA) of POAG eyes and normal controls were evaluated by CDI. Subgroup analyses were conducted according to whether patients received IOP-lowering drugs treatment and were defined as treated and untreated. Results PSV and EDV were statistically significantly reduced in the OA of POAG eyes (P = 0.0002; P<0.00001; respectively), with significant heterogeneity (Pheterogeneity<0.00001, I2 = 94%; Pheterogeneity<0.00001, I2 = 85%; respectively). Similar results were demonstrated for the CRA (P<0.00001; respectively) and SPCA (P = 0.005; P<0.00001; respectively), with significant heterogeneities for both the CRA (Pheterogeneity<0.00001, I2 = 81%; Pheterogeneity<0.00001, I2 = 98%; respectively) and the SPCA (Pheterogeneity<0.00001, I2 = 96%; Pheterogeneity<0.00001, I2 = 93%; respectively). Significant increases in RI were found in all retrobulbar vessels (P<0.00001; respectively), with significant heterogeneities (Pheterogeneity<0.00001, I2 = 95%; Pheterogeneity<0.00001, I2 = 94%; Pheterogeneity<0.00001, I2 = 97%; respectively). Conclusions This meta-analysis suggests that CDI is a potential diagnostic tool for POAG. PMID:23675419

  8. Correlation of endothelin-1 concentration in aqueous humor with intraocular pressure in primary open angle and pseudoexfoliation glaucoma.

    PubMed

    Choritz, Lars; Machert, Maren; Thieme, Hagen

    2012-10-23

    Endothelin-1 (ET-1) has been found in elevated concentrations in the aqueous humor of glaucoma patients. Indirect evidence from animal studies suggests that ET-1 might directly influence intraocular pressure (IOP). The aim of this study was to determine whether ET-1 concentrations in aqueous humor of cataract and glaucoma patients correlate with IOP. Aqueous humor and blood samples from patients with either cataract (control, n = 38), primary open angle glaucoma (POAG, n = 35), or pseudoexfoliation glaucoma (PEXG, n = 21), without other ocular or systemic disease, were collected during routine cataract surgery or trabeculectomy. ET-1 concentration was determined by an ET-1 ELISA kit. IOP was measured preoperatively by standard Goldmann applanation tonometry. All statistical analysis was performed using commercial predictive analytics software. Both IOP and ET-1 concentration in aqueous humor were significantly increased in POAG (23.4 ± 6.8 mm Hg, 5.9 ± 2.9 pg/mL) and PEXG (24.3 ± 8.8 mm Hg, 7.7 ± 2.1 pg/mL) compared with control (15.0 ± 2.9 mm Hg, 4.3 ± 2.4 pg/mL). No difference was detected for plasma ET-1 concentrations. IOP and ET-1 in the aqueous humor were significantly correlated (R = 0.394, R² = 0.155, P < 0.001), although no correlation was found between IOP and ET-1 in blood plasma or between ET-1 in aqueous humor and ET-1 in plasma. In this study, a small but highly significant correlation between IOP and the ET-1 concentration in the aqueous humor was found. Although no causative relationship can be deduced from this, ocular ET-1 effects on IOP control may merit further investigation.

  9. Preservative-free latanoprost eye drops in patients with primary open-angle glaucoma/ocular hypertension.

    PubMed

    Sanford, Mark

    2014-07-01

    Latanoprost is an ester prodrug prostaglandin F2α analogue that is a selective agonist of endogenous prostanoid FP receptors and that reduces intraocular pressure (IOP) by increasing the uveoscleral outflow of aqueous humour. Preservative-free (PF) latanoprost [Monoprost(®)] is a new formulation of latanoprost that is approved for use in the EU in patients with primary open-angle glaucoma (POAG)/ocular hypertension. This article reviews the clinical pharmacology of this new formulation, focussing on its efficacy and tolerability in this indication. PF latanoprost was efficacious in reducing IOP in a randomized, investigator-masked, multinational trial in patients with POAG/ocular hypertension (n = 404). At days 15, 42 and 84 of follow-up, PF latanoprost was noninferior to benzalkonium chloride-preserved (BAK) latanoprost in terms of reductions in IOP. In this trial, at days 42 and 84 the proportions of patients with conjunctival hyperaemia were significantly lower with PF latanoprost than with BAK latanoprost. Patient subjective ratings of ocular symptoms were also significantly lower with PF latanoprost than with BAK latanoprost. In the absence of head-to-head comparisons with other anti-glaucoma drugs, an adjusted, indirect comparison meta-analysis was performed using data from 21 randomized clinical trials in patients with POAG/ocular hypertension. Based on this analysis, PF latanoprost had similar efficacy to different formulations of three comparator prostaglandin analogues in reducing the patient's IOP and was associated with a significantly lower risk of developing hyperaemia/ocular redness than these comparators. PF latanoprost offers a useful alternative to the available preserved prostaglandin analogues for the treatment of POAG/ocular hypertension.

  10. [Effectiveness of 3-hydroxypyridine and succinic acid derivatives in complex treatment of primary open-angle glaucoma].

    PubMed

    Volchegorskiĭ, I A; Tur, E V; Soliannikova, O V; Rykun, V S; Sumina, M S; Dmitrienko, V N; Berdnikova, E V

    2012-01-01

    Prospective, placebo-controlled, single-blind, randomized clinical investigation of the influence of domestic 3-hydroxypyridine and succinic acid derivatives (emoxipin, reamberin, mexidol) on the effectiveness of a complex treatment of primary open-angle glaucoma (POAG) has been performed in a group of patients. It is established that intravenous infusion of 3-hydroxypyridine derivatives (emoxipin and mexidol) for two weeks, beginning 14 days after the start of POAG treatment, produced a retinoprotective action, with three months postponed changes in the central retinal artery (CRA) blood velocity. The retinoprotective effect of emoxipin (single dose, 150 mg) was manifested by reduction in the horizontal size of blind spot in two weeks, with the subsequent reduction of the CRA end-diastolic blood velocity observed three months after finish of the infusion therapy. The administration of mexidol (single dose, 300 mg) after 14 days of treatment led to widening of the summarized field of vision (test-object square, 16 mm), accompanied by a decrease in the electrosensitivity threshold of the optic nerve and the intensity of POAG-associated hypothymia. All indices of CRA blood velocity increased three months after termination of mexidol infusions. Reamberin (single dose, 400 ml 1,5% solution of reamberine, containing polyelectrolyte and meglumine succinate mixture) did not show retinoprotective action, but caused proatherogenic changes of blood lipids and 3 months postponed CRA end-diastolic blood velocity increase. The effect of mexidol (which is a derivative of both 3- hydroxypyridine and succinic acid) exceeds that of separate 3-hydroxypyridine (emoxipin) and succinic acid (reamberin) derivatives in the degree of retinoprotection and positive effect on the optic nerve condition and mood of POAG patients.

  11. Estrogen pathway polymorphisms in relation to primary open angle glaucoma: An analysis accounting for gender from the United States

    PubMed Central

    Loomis, Stephanie J.; Weinreb, Robert N.; Kang, Jae H.; Yaspan, Brian L.; Bailey, Jessica Cooke; Gaasterland, Douglas; Gaasterland, Terry; Lee, Richard K.; Scott, William K.; Lichter, Paul R.; Budenz, Donald L.; Liu, Yutao; Realini, Tony; Friedman, David S.; McCarty, Catherine A.; Moroi, Sayoko E.; Olson, Lana; Schuman, Joel S.; Singh, Kuldev; Vollrath, Douglas; Wollstein, Gadi; Zack, Donald J.; Brilliant, Murray; Sit, Arthur J.; Christen, William G.; Fingert, John; Kraft, Peter; Zhang, Kang; Allingham, R. Rand; Pericak-Vance, Margaret A.; Richards, Julia E.; Hauser, Michael A.; Haines, Jonathan L.; Wiggs, Janey L.

    2013-01-01

    Purpose Circulating estrogen levels are relevant in glaucoma phenotypic traits. We assessed the association between an estrogen metabolism single nucleotide polymorphism (SNP) panel in relation to primary open angle glaucoma (POAG), accounting for gender. Methods We included 3,108 POAG cases and 3,430 controls of both genders from the Glaucoma Genes and Environment (GLAUGEN) study and the National Eye Institute Glaucoma Human Genetics Collaboration (NEIGHBOR) consortium genotyped on the Illumina 660W-Quad platform. We assessed the relation between the SNP panels representative of estrogen metabolism and POAG using pathway- and gene-based approaches with the Pathway Analysis by Randomization Incorporating Structure (PARIS) software. PARIS executes a permutation algorithm to assess statistical significance relative to the pathways and genes of comparable genetic architecture. These analyses were performed using the meta-analyzed results from the GLAUGEN and NEIGHBOR data sets. We evaluated POAG overall as well as two subtypes of POAG defined as intraocular pressure (IOP) ≥22 mmHg (high-pressure glaucoma [HPG]) or IOP <22 mmHg (normal pressure glaucoma [NPG]) at diagnosis. We conducted these analyses for each gender separately and then jointly in men and women. Results Among women, the estrogen SNP pathway was associated with POAG overall (permuted p=0.006) and HPG (permuted p<0.001) but not NPG (permuted p=0.09). Interestingly, there was no relation between the estrogen SNP pathway and POAG when men were considered alone (permuted p>0.99). Among women, gene-based analyses revealed that the catechol-O-methyltransferase gene showed strong associations with HTG (permuted gene p≤0.001) and NPG (permuted gene p=0.01). Conclusions The estrogen SNP pathway was associated with POAG among women. PMID:23869166

  12. Associations between obstructive sleep apnoea, primary open angle glaucoma and age-related macular degeneration: record linkage study.

    PubMed

    Keenan, Tiarnan D L; Goldacre, Raph; Goldacre, Michael J

    2017-02-01

    Primary open angle glaucoma (POAG) is thought to be associated with obstructive sleep apnoea (OSA) but previous studies are conflicting and have methodological limitations. This potential relationship has implications for investigation and treatment strategies, and may provide insights into disease pathogenesis. The relationship between OSA and age-related macular degeneration (AMD) is unknown. A sleep apnoea cohort of 67 786 people was constructed from linked English hospital episode statistics (1999-2011). We compared this cohort with a reference cohort (2 684 131 people) for rates of subsequent POAG and AMD. A POAG cohort (comprising 87 435 people) and an AMD cohort (248 408 people) were also constructed and compared with the reference cohort for rates of subsequent sleep apnoea. All analyses were restricted to people aged 55 and over and, within this age range, were age standardised using 5-year age groups. Risk of POAG following sleep apnoea was not elevated: the rate ratio for POAG was 1.01 (95% CI 0.85 to 1.19). Similarly, the risk of sleep apnoea following POAG was not elevated: the rate ratio was 1.00 (0.86 to 1.17). These findings held true across subgroup analysis according to sex and age group. By contrast, the risk of AMD following sleep apnoea was significantly elevated, with rate ratio 1.44 (1.32 to 1.57). Although plausible mechanisms exist to consider a link between OSA and POAG, the two conditions are not positively associated. This holds true in either temporal direction. By contrast, OSA is positively associated with AMD. While potential confounding factors may contribute, obesity does not appear sufficient to explain this association. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Age-based analysis of choroidal thickness and choroidal vessel diameter in primary open-angle glaucoma.

    PubMed

    Toprak, Ibrahim; Yaylalı, Volkan; Yildirim, Cem

    2016-04-01

    We aimed to assess choroidal thickness and vessel diameter in patients with primary open-angle glaucoma (POAG) using enhanced depth imaging (EDI) optical coherence tomography (OCT) with age-based analysis. Fifty-four patients with a confirmed diagnosis of POAG and 44 age-sex matched healthy subjects were included into the study. A masked physician performed measurements of largest choroidal vessel diameter and choroidal thicknesses (subfoveal, nasal, and temporal) using EDI OCT. Subgroup analyses were performed to compare choroidal measurements based on age (with a cut point of 70 years). The study cohort comprised 54 patients with POAG (mean age of 63.2 ± 8.8 years) and 44 healthy control subjects (mean age of 62.9 ± 8.5 years) (P = 0.870). We found no significant differences in terms of choroidal measurements (P > 0.05) between the glaucoma and control groups. However, in the glaucoma group, patients with an age ≥70 years had significantly thinner subfoveal and nasal choroid compared to those of the patients with <70 years of age (P = 0.017, 0.002 respectively). In the control group, choroidal thickness and vessel measurements showed no significant difference when the subjects were subgrouped according to the age cut point (P > 0.05). Choroidal thickness and vessel caliber seem not to differ between patients with POAG and healthy controls. However, an age ≥70 years might be associated with thinning in subfoveal and nasal choroid in patients with POAG. Further studies are needed to elucidate whether choroidal thinning is a cause or result in POAG.

  14. Linkage analysis of primary open-angle glaucoma excludes the juvenile glaucoma region on chromosome 1q

    SciTech Connect

    Wirtz, M.K.; Acott, T.S.; Samples, J.R. |

    1994-09-01

    The gene for one form of juvenile glaucoma has been mapped to chromosome 1q21-q31. This raises the possibility of primary open-angle glaucoma (POAG) also mapping to this region if the same defective gene causes both diseases. To ask this question linkage analysis was performed on a large POAG kindred. Blood samples or skin biopsies were obtained from 40 members of this family. Individuals were diagnosed as having POAG if they met two or more of the following criteria: (1) Visual field defects compatible with glaucoma on automated perimetry; (2) Optic nerve head and/or nerve fiber layer analysis compatible with glaucomatous damage; (3) high intraocular pressures (> 20 mm Hg). Patients were considered glaucoma suspects if they only met one criterion. These individuals were excluded from the analysis. Of the 40 members, seven were diagnosed with POAG; four were termed suspects. The earliest age of onset was 38 years old, while the average age of onset was 65 years old. We performed two-point and multipoint linkage analysis, using five markers which encompass the region 1q21-q31; specifically, D1S194, D1S210, D1S212, D1S191 and LAMB2. Two-point lod scores excluded tight linkage with all markers except D1S212 (maximum lod score of 1.07 at theta = 0.0). In the multipoint analysis, including D1S210-D1S212-LAMB2 and POAG, the entire 11 cM region spanned by these markers was excluded for linkage with POAG; that is, lod scores were < -2.0. In conclusion, POAG in this family does not map to chromosome 1q21-q31 and, thus, they carry a gene that is distinct from the juvenile glaucoma gene.

  15. Genetic African Ancestry Is Associated With Central Corneal Thickness and Intraocular Pressure in Primary Open-Angle Glaucoma.

    PubMed

    Bonnemaijer, Pieter W M; Cook, Colin; Nag, Abhishek; Hammond, Christopher J; van Duijn, Cornelia M; Lemij, Hans G; Klaver, Caroline C W; Thiadens, Alberta A H J

    2017-06-01

    To unravel the relationship between African ancestry, central corneal thickness (CCT), and intraocular pressure (IOP) by estimating the genetic African ancestry (GAA) proportion in primary open-angle glaucoma (POAG) patients and controls from an admixed South African Colored (SAC) and a South African Black (SAB) population. In this case-control study, 268 POAG patients and 137 controls were recruited from a university clinic in Cape Town, South Africa. All participants were genotyped on the Illumina HumanOmniExpress beadchip or HumanOmni2.5Exome beadchip. ADMIXTURE was used to infer participant's GAA among 86,632 SNPs. Linear and logistic regression models were used to assess the relation between GAA, POAG, CCT, and IOP. The median proportion of GAA was 60% in the study population. GAA was significantly associated with thinner CCT (P < 0.001) and IOP (P = 0.034) in POAG patients. The effect of GAA on CCT was marginally different among POAG patients versus controls (P = 0.066). In POAG patients, the CCT was significantly thinner compared to controls after adjusting for age and sex (P = 0.016). In a stratified analysis in participants with >60% GAA, CCT was not associated with POAG (P = 0.550). This study demonstrated that a higher proportion of GAA was associated with a thinner CCT and a higher IOP in POAG patients. Remarkably, at higher proportions of GAA, the difference in CCT between POAG and controls was reduced. This suggests that thinner CCT is not associated with POAG in Africans.

  16. Investigation of known genetic risk factors for primary open angle glaucoma in two populations of African ancestry.

    PubMed

    Liu, Yutao; Hauser, Michael A; Akafo, Stephen K; Qin, Xuejun; Miura, Shiroh; Gibson, Jason R; Wheeler, Joshua; Gaasterland, Douglas E; Challa, Pratap; Herndon, Leon W; Ritch, Robert; Moroi, Sayoko E; Pasquale, Louis R; Girkin, Christopher A; Budenz, Donald L; Wiggs, Janey L; Richards, Julia E; Ashley-Koch, Allison E; Allingham, R Rand

    2013-09-17

    Multiple genes have been associated with primary open angle glaucoma (POAG) in Caucasian populations. We now examine the association of these loci in populations of African ancestry, populations at particularly high risk for POAG. We genotyped DNA samples from two populations: African American (1150 cases and 999 controls) and those from Ghana, West Africa (483 cases and 593 controls). Our analysis included 57 single nucleotide polymorphisms (SNPs) in five loci previously associated with POAG at the genome-wide level, including CDKN2B-AS1, TMCO1, CAV1/CAV2, chromosome 8q22 intergenic region, and SIX1/SIX6. We evaluated association in the full datasets, as well as subgroups with normal pressure glaucoma (NPG, maximum IOP ≤21 mm Hg) and high pressure glaucoma (HPG, IOP >21 mm Hg). In African Americans, we identified an association of rs10120688 in the CDNK2B-AS1 region with POAG (P = 0.0020). Several other SNPs were nominally associated, but did not survive correction for multiple testing. In the subgroup analyses, significant associations were identified for rs10965245 (P = 0.0005) in the CDKN2B-AS1 region with HPG and rs11849906 in the SIX1/SIX6 region with NPG (P = 0.006). No significant association was identified with any loci in the Ghanaian samples. POAG genetic susceptibility alleles associated in Caucasians appear to play a greatly reduced role in populations of African ancestry. Thus, the major genetic components of POAG of African origin remain to be identified. This finding underscores the critical need to pursue large-scale genome-wide association studies in this understudied, yet disproportionately affected population.

  17. Estimated Cerebrospina Fluid Pressure and the 5-Year Incidence of Primary Open-Angle Glaucoma in a Chinese Population

    PubMed Central

    Zhong, Hua; Tao, Yijin; Yuan, Yuansheng; Pan, Chen-Wei

    2016-01-01

    Purpose We aim to assess the longitudinal association between baseline estimated cerebrospinal fluid pressure (CSFP) and 5-year incident primary open angle glaucoma (POAG) in a population-based sample of Bai Chinese living in rural China. Methods Among the 2133 Bai Chinese aged 50 years or older who had participated in the baseline examination of the Yunnan Minority Eye Study, 1520 (71.3%) attended the follow-up examination after five years and 1485 were at risk of developing POAG. Participants underwent comprehensive ophthalmic examinations at both baseline and follow-up surveys. CSFP in mmHg was estimated as 0.55 × body mass index (kg/m2) + 0.16 × diastolic blood pressure (mmHg)-0.18 × age (years)-1.91. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification criteria. Multivariate logistic regression models were established to determine the association between baseline CSFP and incident POAG. Results After a mean follow-up time of 5 years, 19 new cases of POAG were detected, with an incidence rate of 1.3% (95% confidence interval, 0.7–1.9%). In multivariate logistic regression analysis, after adjusting for age, gender, education, intraocular pressure, central corneal thickness, hypertension and diabetes, no significant associations, nor any trends, were evident between baseline estimated CSFP and incident POAG. The association between estimated CSFP per mmHg increase in baseline and 5-year incidence of POAG was also non-significant, with adjusted relative risk of 0.96 (P = 0.11) in multivariate analysis. Conclusions This longitudinal cohort study does not support previously observed cross-sectional association between estimated CSFP and POAG in population-based studies. PMID:27611879

  18. Comparison of Pattern Electroretinography and Optical Coherence Tomography Parameters in Patients with Primary Open-Angle Glaucoma and Ocular Hypertension

    PubMed Central

    Tiryaki Demir, Semra; Oba, Mehmet Ersin; Erdoğan, Ezgi Tuna; Odabaşı, Mahmut; Dirim, Ayşe Burcu; Demir, Mehmet; Can, Efe; Kara, Orhan; Yekta Şendül, Selam

    2015-01-01

    Objectives: To investigate the correlation of visual field (VF), pattern electroretinography (PERG) and Fourier domain optical coherence tomography (FD-OCT) results in patients with ocular hypertension (OHT) and early primary open-angle glaucoma (POAG). Materials and Methods: The study included 72 eyes of 37 patients with early POAG, 76 eyes of 38 patients with OHT, and 60 eyes of 30 controls. All subjects underwent full ophthalmologic examination, VF assessment with 24-2 Humphrey standard automated perimetry (Swedish Interactive Thresholding Algorithm (SITA)-Standard), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness measurement with FD-OCT, and PERG P50 and N95 wave latency and amplitude measurements with electroretinography (Nihon Kohden). Results: With the exception of the nasal quadrant, all GCC parameters and RNFL results were significantly lower in the POAG group compared to the OHT and control groups. There was no statistically significant difference between the OHT and control group. PERG amplitudes were lower in the POAG and OHT groups than in the control group. Reduction in N95 amplitude was greater than that of P50 amplitude. No difference was detected in PERG latencies among groups. GCC was significantly correlated with VF and RNFL in the POAG group. Conclusion: Significant thinning of the GCC and RNFL occurs in addition to VF pathologies in patients with early POAG, and these examinations should be concomitantly evaluated. During diagnostic assessment of patients with early POAG, GCC and RNFL analysis by FD-OCT are highly effective. GCC is as reliable as RNLF in the early diagnosis of glaucoma and there is a highly significant correlation between them. Dysfunction of ganglion cells in patients with OHT may be detected earlier using PERG amplitude analysis. PMID:27800239

  19. Early Postoperative Effects of Cataract Surgery on Anterior Segment Parameters in Primary Open-Angle Glaucoma and Pseudoexfoliation Glaucoma

    PubMed Central

    Elgin, Ufuk; Şen, Emine; Şimşek, Tülay; Tekin, Kemal; Yılmazbaş, Pelin

    2016-01-01

    Objectives: To compare the effect of cataract surgery on anterior segment parameters measured by optical biometry in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Materials and Methods: Twenty-five eyes of 25 patients with POAG and 29 eyes of 29 patients with PXG who had uncomplicated phacoemulsification and posterior chamber intraocular lens implantation surgery were included to our prospective study. Central corneal thickness (CCT), anterior chamber depth (ACD) and axial length (AL) were measured with an optical biometer preoperatively and at 1 month postoperatively. The pre- and postoperative values of intraocular pressure (IOP) and the anterior segment parameters and the differences between POAG and PXG were compared statistically by paired t, independent t and chi-square tests. Results: The mean values of preoperative CCT (p=0.042) and ACD (p=0.012) were significantly lower in the PXG than in the POAG group. In the PXG group, IOP decreased (p=0.001) but CCT (p=0.03) and ACD (p=0.001) increased significantly postoperatively; AL did not change significantly. In the POAG group, IOP decreased (p=0.01) and ACD (p=0.004) increased significantly postoperatively, while AL and CCT did not change significantly. There were no significant differences in the pre- to postoperative changes in IOP (p=0.76), AL (p=0.44) and CCT (p=0.52) values between the two groups. However, the postoperative increase in ACD was larger in the PXG group (p=0.03). Conclusion: Cataract surgery may cause some changes in IOP and anterior segment parameters like ACD and CCT postoperatively in eyes with POAG and PXG, and these changes may differ between eyes with PXG and POAG. PMID:27800269

  20. Optic disc topography in Malay patients with normal-tension glaucoma and primary open-angle glaucoma.

    PubMed

    Adlina, Abdul Rahim; Alisa-Victoria, Koh; Shatriah, Ismail; Liza-Sharmini, Ahmad Tajudin; Ahmad, Mt Saad

    2014-01-01

    There are limited data concerning the optic disc topography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients living in Southeast Asian countries. This study aims to compare optic disc parameters in patients with NTG and POAG in Malaysia and to discuss the results in comparison with studies of NTG and POAG in other Asian countries. This prospective cross-sectional study was performed in two hospitals with glaucoma service in Malaysia from 2010 to 2012. Seventy-seven patients of Malay ethnicity were enrolled in this study, including 32 NTG patients and 45 POAG patients. Using the Heidelberg Retinal Tomograph III, we measured optic disc area, cup area, rim area, cup volume, rim volume, cup-to-disc area ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area. The eyes for NTG patients had significantly larger optic disc areas (2.65 [standard deviation, 0.41] vs 2.40 [standard deviation, 0.36] mm(2), respectively; P=0.006) and cup areas (1.54 [standard deviation, 0.43] vs 1.32 [standard deviation, 0.40] mm(2), respectively; P=0.027) compared with the eyes of POAG patients. Comparison of the other parameters between the two groups revealed no significant difference (P>0.050). The moderate and severe NTG patients showed significantly deeper cups and larger disc and cup areas when compared with the moderate and severe POAG patients (P<0.050). The NTG patients in this study have notably larger optic disc and cup areas than the POAG patients. Our observations are consistent with those reported in studies of NTG and POAG patients in Korea. The deeper cups and larger disc and cup areas may serve as indicators of severity when comparing NTG with POAG. However, these findings require verification with IOP and visual field results.

  1. Enhanced depth imaging detects lamina cribrosa thickness differences in normal tension glaucoma and primary open-angle glaucoma.

    PubMed

    Park, Hae-Young Lopilly; Jeon, So Hee; Park, Chan Kee

    2012-01-01

    To confirm the advantages of the enhanced depth imaging (EDI) mode over the standard mode of the Heidelberg Spectralis spectral domain optical coherence tomography (SD-OCT) for imaging of the lamina cribrosa, and to compare laminar thicknesses of various glaucoma types with or without disc hemorrhage in a similar state of visual field loss. Cross-sectional, case-control design. We included 137 glaucoma patients and 49 healthy controls. Optic nerve head B-scans were obtained by both the standard and EDI modes of the Spectralis OCT. Laminar thickness was measured at the center of mid-superior, central, and mid-inferior horizontal B-scans. Laminar thickness in patients with normal tension glaucoma (NTG) was compared with that in patients with primary open-angle glaucoma (POAG). To verify the reproducibility of EDI imaging, intraclass correlation coefficients and test-retest variability were calculated from selected B-scans. Laminar thickness and mean deviation values on standard automatic perimetry. The EDI OCT imaging showed significantly better intraobserver, interobserver, intravisit, and intervisit reproducibility than those by standard imaging. Laminar thickness in mid-superior, central, and mid-inferior regions was thinner in the POAG and NTG groups than in the normal control group (P<0.001). The mid-superior, central, and mid-inferior regions of the lamina were also significantly thinner in patients with NTG and disc hemorrhage than in those with NTG but no disc hemorrhage. The EDI mode of the Heidelberg Spectralis SD-OCT detected differences in the lamina cribrosa by glaucoma type. The lamina cribrosa was thinner in NTG eyes and in NTG eyes with disc hemorrhage. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  2. Conjunctival inflammatory cells and their predictive role for deep sclerectomy in primary open-angle glaucoma and exfoliation glaucoma.

    PubMed

    Helin, Minna; Rönkkö, Seppo; Puustjärvi, Tuomo; Teräsvirta, Markku; Ollikainen, Minna; Uusitalo, Hannu

    2011-03-01

    To investigate the conjunctival inflammatory alterations of patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) and correlate the findings with the success of deep sclerectomy (DS) surgery and with the patients' medical history. Altogether 25 POAG and ExG patients of the prospective DS study were divided, based on the diagnosis and success of the operation, into 4 groups, POAG S (success), POAG F (failure), ExG S, and ExG F. Controls were obtained from other ophthalmologic surgery patients who did not have glaucoma, and their conjunctiva was examined to be normal. Inflammatory cell subtypes in the conjunctiva were identified and quantified by using immunohistochemistry and monoclonal antibodies: CD3 (T-lymphocyte marker), CD4 (T-helper lymphocyte marker), CD8 (T-cytotoxic lymphocyte marker), CD20 (pan-B cell marker), CD38 (plasma cell marker), CD45RA (naïve T-cell marker), and CD68 (macrophage marker). Higher numbers of inflammatory cells were found in the conjunctiva of the glaucoma patients on medical treatment compared with the normal conjunctiva of the controls. Moreover, T-lymphocytes, T-helper lymphocytes, T-cytotoxic lymphocytes, B cells, plasma cells, and macrophages were found in significantly higher numbers in patients in whom DS failed during the follow-up period of 2.5 years than those with surgical success. High numbers of cytotoxic and helper T-lymphocytes, plasma cells, and macrophages indicate a chronic inflammatory reaction in the conjunctiva of glaucoma patients. The chronic inflammation is most probably owing to the chronic topical treatment of the patients and seems to be a significant risk factor for DS surgery failure.

  3. Genetic correlations between intraocular pressure, blood pressure and primary open-angle glaucoma: a multi-cohort analysis.

    PubMed

    Aschard, Hugues; Kang, Jae H; Iglesias, Adriana I; Hysi, Pirro; Cooke Bailey, Jessica N; Khawaja, Anthony P; Allingham, R Rand; Ashley-Koch, Allison; Lee, Richard K; Moroi, Sayoko E; Brilliant, Murray H; Wollstein, Gadi; Schuman, Joel S; Fingert, John H; Budenz, Donald L; Realini, Tony; Gaasterland, Terry; Scott, William K; Singh, Kuldev; Sit, Arthur J; Igo, Robert P; Song, Yeunjoo E; Hark, Lisa; Ritch, Robert; Rhee, Douglas J; Gulati, Vikas; Haven, Shane; Vollrath, Douglas; Zack, Donald J; Medeiros, Felipe; Weinreb, Robert N; Cheng, Ching-Yu; Chasman, Daniel I; Christen, William G; Pericak-Vance, Margaret A; Liu, Yutao; Kraft, Peter; Richards, Julia E; Rosner, Bernard A; Hauser, Michael A; Klaver, Caroline C W; vanDuijn, Cornelia M; Haines, Jonathan; Wiggs, Janey L; Pasquale, Louis R

    2017-08-30

    Primary open-angle glaucoma (POAG) is the most common chronic optic neuropathy worldwide. Epidemiological studies show a robust positive relation between intraocular pressure (IOP) and POAG and modest positive association between IOP and blood pressure (BP), while the relation between BP and POAG is controversial. The International Glaucoma Genetics Consortium (n=27 558), the International Consortium on Blood Pressure (n=69 395), and the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database (n=37 333), represent genome-wide data sets for IOP, BP traits and POAG, respectively. We formed genome-wide significant variant panels for IOP and diastolic BP and found a strong relation with POAG (odds ratio and 95% confidence interval: 1.18 (1.14-1.21), P=1.8 × 10(-27)) for the former trait but no association for the latter (P=0.93). Next, we used linkage disequilibrium (LD) score regression, to provide genome-wide estimates of correlation between traits without the need for additional phenotyping. We also compared our genome-wide estimate of heritability between IOP and BP to an estimate based solely on direct measures of these traits in the Erasmus Rucphen Family (ERF; n=2519) study using Sequential Oligogenic Linkage Analysis Routines (SOLAR). LD score regression revealed high genetic correlation between IOP and POAG (48.5%, P=2.1 × 10(-5)); however, genetic correlation between IOP and diastolic BP (P=0.86) and between diastolic BP and POAG (P=0.42) were negligible. Using SOLAR in the ERF study, we confirmed the minimal heritability between IOP and diastolic BP (P=0.63). Overall, IOP shares genetic basis with POAG, whereas BP has limited shared genetic correlation with IOP or POAG.European Journal of Human Genetics advance online publication, 30 August 2017; doi:10.1038/ejhg.2017.136.

  4. Steroid-induced glaucoma treated with trabecular ablation in a matched comparison with primary open-angle glaucoma.

    PubMed

    Dang, Yalong; Kaplowitz, Kevin; Parikh, Hardik A; Roy, Pritha; Loewen, Ralitsa T; Francis, Brian A; Loewen, Nils A

    2016-12-01

    To evaluate the outcomes of trabectome-mediated ab interno trabeculectomy in patients with steroid-induced glaucoma (SIG). A retrospective, observational cohort study performed in the Department of Ophthalmology, University of Pittsburgh Medical Center. The data of 60 patients with SIG and 484 controls with primary open-angle glaucoma (POAG) matched by age, gender and glaucoma index were collected from the Trabectome Study Group database. Reduction of intraocular pressure (IOP) and medications were compared between POAG and SIG by multivariate regression. Kaplan-Meier was used for survival analysis. Success was defined as IOP ≤21 mmHg and at least 20% IOP reduction from baseline for any two consecutive visits after 3 months without secondary glaucoma surgery. Postoperative IOP and number of medications were compared with baseline in the SIG subgroups by the Wilcoxon test. Intraocular pressure reduction and 1-year success rate. Patients with SIG had a higher baseline IOP (31.4 ± 10.4 vs. 24.1 ± 7.6 mmHg, P < 0.01) and obtained a greater IOP reduction than controls with POAG (48.4% vs. 31.5%, P < 0.01). Multivariate regression showed that patients with SIG had an IOP reduction of 6.7 ± 1.1 mmHg more than those with POAG. Survival rates at 12 months were comparable at 86% in the SIG group and 85% in the POAG group (P = 0.47). Patients with SIG with a high baseline IOP, younger age and advanced glaucoma experienced a larger IOP drop. Trabectome appears to be an effective surgical treatment in reducing IOP for patients with SIG. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  5. Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography

    PubMed Central

    Wen, Joanne C.; Zhang, Qinqin; Xin, Chen; Gupta, Divakar; Mudumbai, Raghu C.; Johnstone, Murray A.; Wang, Ruikang K.; Chen, Philip P.

    2016-01-01

    Purpose To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. Design Cross-sectional, observational study. Subjects Twenty-eight normal, 30 POAG, and 31 NTG subjects. Methods One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. Main Outcome Measures Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. Results Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. Conclusions Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for

  6. A novel MYOC heterozygous mutation identified in a Chinese Uygur pedigree with primary open-angle glaucoma.

    PubMed

    Cai, Su-ping; Muhemaiti, Paerheti; Yin, Yan; Cheng, Hongbo; Di Ya, A; Keyimu, Maliyamu; Cao, Xu; Fan, Ning; Jiang, Liqiong; Yan, Naihong; Zhou, Xiaomin; Wang, Yun; Liu, Xuyang

    2012-01-01

    To characterize the clinical features of a Chinese Uygur pedigree with primary open-angle glaucoma (POAG) and to identify mutations in two candidate genes, trabecular meshwork inducible glucocorticoid response (MYOC/TIGR) and human dioxin-inducible cytochrome P450 (CYP1B1). Twenty one members from a Chinese Uygur family of four generations were included in the study. All participants underwent complete ophthalmologic examinations. Five were diagnosed as POAG, four as glaucoma suspects, and the rest were asymptomatic. Molecular genetic analysis was performed on all subjects included in the study. All exons of CYP1B1 and MYOC were amplified by polymerase chain reaction (PCR), sequenced and compared with a reference database. The variations detected were evaluated in available family members as well as 102 normal controls. Possible changes in structure and function of the protein induced by amino acid variance were predicted by bioinformatics analysis. Elevated intraocular pressure and late-stage glaucomatous cupping of the optic disc were found in five patients of this family. A novel heterozygous missense mutation c.1151 A>G in exon 3 of MYOC was found in all five patients diagnosed as POAG and four glaucoma suspects, but not in the rest of the family members and 102 normal controls. This mutation caused an amino acid substitution of aspartic acid to glycine at position 384 (p. D384G) of the MYOC protein. This substitution may cause structural and functional changes of the protein based on bioinformatics analysis. No mutations were found in CYP1B1. Our study suggests that the novel mutation D384G of MYOC is likely responsible for the pathogenesis of POAG in this pedigree.

  7. Measurement of Systemic Mitochondrial Function in Advanced Primary Open-Angle Glaucoma and Leber Hereditary Optic Neuropathy.

    PubMed

    Van Bergen, Nicole J; Crowston, Jonathan G; Craig, Jamie E; Burdon, Kathryn P; Kearns, Lisa S; Sharma, Shiwani; Hewitt, Alex W; Mackey, David A; Trounce, Ian A

    2015-01-01

    Primary Open Angle Glaucoma (POAG) is a common neurodegenerative disease characterized by the selective and gradual loss of retinal ganglion cells (RGCs). Aging and increased intraocular pressure (IOP) are glaucoma risk factors; nevertheless patients deteriorate at all levels of IOP, implying other causative factors. Recent evidence presents mitochondrial oxidative phosphorylation (OXPHOS) complex-I impairments in POAG. Leber Hereditary Optic Neuropathy (LHON) patients suffer specific and rapid loss of RGCs, predominantly in young adult males, due to complex-I mutations in the mitochondrial genome. This study directly compares the degree of OXPHOS impairment in POAG and LHON patients, testing the hypothesis that the milder clinical disease in POAG is due to a milder complex-I impairment. To assess overall mitochondrial capacity, cells can be forced to produce ATP primarily from mitochondrial OXPHOS by switching the media carbon source to galactose. Under these conditions POAG lymphoblasts grew 1.47 times slower than controls, whilst LHON lymphoblasts demonstrated a greater degree of growth impairment (2.35 times slower). Complex-I enzyme specific activity was reduced by 18% in POAG lymphoblasts and by 29% in LHON lymphoblasts. We also assessed complex-I ATP synthesis, which was 19% decreased in POAG patients and 17% decreased in LHON patients. This study demonstrates both POAG and LHON lymphoblasts have impaired complex-I, and in the majority of aspects the functional defects in POAG were milder than LHON, which could reflect the milder disease development of POAG. This new evidence places POAG in the spectrum of mitochondrial optic neuropathies and raises the possibility for new therapeutic targets aimed at improving mitochondrial function.

  8. Correlations between corneal and optic nerve head variables in healthy subjects and patients with primary open angle glaucoma

    PubMed Central

    Saenz-Frances, Federico; Jañez, Luis; Borrego-Sanz, Lara; Berrozpe-Villabona, Clara; Martinez-de-la-Casa, Jose Maria; Morales-Fernandez, Laura; Garcia-Sanchez, Julian; Santos-Bueso, Enrique; Garcia-Feijoo, Julian

    2015-01-01

    AIM To correlate corneal variables (determined using the Pentacam) with optic nerve head (ONH) variables determined using the Heidelberg retina tomograph (HRT) in healthy subjects and patients diagnosed with primary open angle glaucoma (POAG). METHODS Measurements were made in 75 healthy eyes and 73 eyes with POAG and correlations examined through Pearson correlation coefficients between the two sets of variables in the two subject groups. The corneal variables determined were corneal volume (CVol), central corneal thickness (CCT), overall corneal thickness (OvCT), the mean thickness of a circular zone centered at the corneal apex of 1 mm radius (zone I) and the mean thickness of several concentric rings, also centered at the apex until the limbus, each of 1 mm width (zones II to VI respectively). The ONH variables were determined using the HRT. RESULTS The following pairs of variables were correlated in the control group: CCT-disc area (DAr) (-0.48; P<0.0001), Zone I-DAr (-0.503; P<0.0001) and Zone II-DAr (-0.443; P<0.0001); and in the POAG group: CCT-cup-to-disc area ratio (CDRa) (-0.402; P<0.0001), Zone I-CDRa (-0.418; P<0.0001), Zone II-CDRa (-0.405; P=0.006), Zone I-cup shape measure (CSM) (-0.415; P=0.002), Zone II-CSM (-0.405; P=0.001), Zone IV-height variation contour (HVC) (0.378; P=0.002); Zone V-HVC (0.388, P<0.0001). CONCLUSIONS In the healthy subjects, significant negative correlation was detected between central and paracentral corneal thickness and optic disc area. In contrast, the POAG patients showed significant negative correlation between central and paracentral corneal thickness and the cup-disc ratio and CSM, and positive correlation between peripheral corneal thickness and HVC. PMID:26682165

  9. A Common Variant in MIR182 Is Associated With Primary Open-Angle Glaucoma in the NEIGHBORHOOD Consortium

    PubMed Central

    Liu, Yutao; Bailey, Jessica Cooke; Helwa, Inas; Dismuke, W. Michael; Cai, Jingwen; Drewry, Michelle; Brilliant, Murray H.; Budenz, Donald L.; Christen, William G.; Chasman, Daniel I.; Fingert, John H.; Gaasterland, Douglas; Gaasterland, Terry; Gordon, Mae O.; Igo, Robert P.; Kang, Jae H.; Kass, Michael A.; Kraft, Peter; Lee, Richard K.; Lichter, Paul; Moroi, Sayoko E.; Realini, Anthony; Richards, Julia E.; Ritch, Robert; Schuman, Joel S.; Scott, William K.; Singh, Kuldev; Sit, Arthur J.; Song, Yeunjoo E.; Vollrath, Douglas; Weinreb, Robert; Medeiros, Felipe; Wollstein, Gadi; Zack, Donald J.; Zhang, Kang; Pericak-Vance, Margaret A.; Gonzalez, Pedro; Stamer, W. Daniel; Kuchtey, John; Kuchtey, Rachel W.; Allingham, R. Rand; Hauser, Michael A.; Pasquale, Louis R.; Haines, Jonathan L.; Wiggs, Janey L.

    2016-01-01

    Purpose Noncoding microRNAs (miRNAs) have been implicated in the pathogenesis of glaucoma. We aimed to identify common variants in miRNA coding genes (MIR) associated with primary open-angle glaucoma (POAG). Methods Using the NEIGHBORHOOD data set (3853 cases/33,480 controls with European ancestry), we first assessed the relation between 85 variants in 76 MIR genes and overall POAG. Subtype-specific analyses were performed in high-tension glaucoma (HTG) and normal-tension glaucoma subsets. Second, we examined the expression of miR-182, which was associated with POAG, in postmortem human ocular tissues (ciliary body, cornea, retina, and trabecular meshwork [TM]), using miRNA sequencing (miRNA-Seq) and droplet digital PCR (ddPCR). Third, miR-182 expression was also examined in human aqueous humor (AH) by using miRNA-Seq. Fourth, exosomes secreted from primary human TM cells were examined for miR-182 expression by using miRNA-Seq. Fifth, using ddPCR we compared miR-182 expression in AH between five HTG cases and five controls. Results Only rs76481776 in MIR182 gene was associated with POAG after adjustment for multiple comparisons (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.11–1.42, P = 0.0002). Subtype analysis indicated that the association was primarily in the HTG subset (OR = 1.26, 95% CI: 1.08–1.47, P = 0.004). The risk allele T has been associated with elevated miR-182 expression in vitro. Data from ddPCR and miRNA-Seq confirmed miR-182 expression in all examined ocular tissues and TM-derived exosomes. Interestingly, miR-182 expression in AH was 2-fold higher in HTG patients than nonglaucoma controls (P = 0.03) without controlling for medication treatment. Conclusions Our integrative study is the first to associate rs76481776 with POAG via elevated miR-182 expression. PMID:27537254

  10. A Common Variant in MIR182 Is Associated With Primary Open-Angle Glaucoma in the NEIGHBORHOOD Consortium.

    PubMed

    Liu, Yutao; Bailey, Jessica Cooke; Helwa, Inas; Dismuke, W Michael; Cai, Jingwen; Drewry, Michelle; Brilliant, Murray H; Budenz, Donald L; Christen, William G; Chasman, Daniel I; Fingert, John H; Gaasterland, Douglas; Gaasterland, Terry; Gordon, Mae O; Igo, Robert P; Kang, Jae H; Kass, Michael A; Kraft, Peter; Lee, Richard K; Lichter, Paul; Moroi, Sayoko E; Realini, Anthony; Richards, Julia E; Ritch, Robert; Schuman, Joel S; Scott, William K; Singh, Kuldev; Sit, Arthur J; Song, Yeunjoo E; Vollrath, Douglas; Weinreb, Robert; Medeiros, Felipe; Wollstein, Gadi; Zack, Donald J; Zhang, Kang; Pericak-Vance, Margaret A; Gonzalez, Pedro; Stamer, W Daniel; Kuchtey, John; Kuchtey, Rachel W; Allingham, R Rand; Hauser, Michael A; Pasquale, Louis R; Haines, Jonathan L; Wiggs, Janey L

    2016-08-01

    Noncoding microRNAs (miRNAs) have been implicated in the pathogenesis of glaucoma. We aimed to identify common variants in miRNA coding genes (MIR) associated with primary open-angle glaucoma (POAG). Using the NEIGHBORHOOD data set (3853 cases/33,480 controls with European ancestry), we first assessed the relation between 85 variants in 76 MIR genes and overall POAG. Subtype-specific analyses were performed in high-tension glaucoma (HTG) and normal-tension glaucoma subsets. Second, we examined the expression of miR-182, which was associated with POAG, in postmortem human ocular tissues (ciliary body, cornea, retina, and trabecular meshwork [TM]), using miRNA sequencing (miRNA-Seq) and droplet digital PCR (ddPCR). Third, miR-182 expression was also examined in human aqueous humor (AH) by using miRNA-Seq. Fourth, exosomes secreted from primary human TM cells were examined for miR-182 expression by using miRNA-Seq. Fifth, using ddPCR we compared miR-182 expression in AH between five HTG cases and five controls. Only rs76481776 in MIR182 gene was associated with POAG after adjustment for multiple comparisons (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 1.11-1.42, P = 0.0002). Subtype analysis indicated that the association was primarily in the HTG subset (OR = 1.26, 95% CI: 1.08-1.47, P = 0.004). The risk allele T has been associated with elevated miR-182 expression in vitro. Data from ddPCR and miRNA-Seq confirmed miR-182 expression in all examined ocular tissues and TM-derived exosomes. Interestingly, miR-182 expression in AH was 2-fold higher in HTG patients than nonglaucoma controls (P = 0.03) without controlling for medication treatment. Our integrative study is the first to associate rs76481776 with POAG via elevated miR-182 expression.

  11. [Genetic variants of CYP1B1 and WDR36 in the patients with primary congenital glaucoma and primary open angle glaucoma from Saint-Petersburg].

    PubMed

    Motushchuk, A E; Komarova, T Iu; Grudinina, N A; Rakhmanov, V V; Mandel'shtam, M Iu; Astakhov, Iu S; Vasil'ev, V B

    2009-12-01

    In 32 patients with primary congenital glaucoma (PCG), a search for mutations in the myocilin (MYOC), cytochrome P450B1 (CYP1B1), and WDR36 genes was performed. The Q368X mutation in myocilin gene, typical of the patients with adult-onset primary open-angle glaucoma (POAG), was not detected in the PCG patients. Screening of the CYP1B1 introns 2 and 3 for the presence of mutations in PCG patients revealed only six DNA polymorphisms, including IVS1-12ntT>C (g.3793 T>C), A119S (g.4160 G>T; GCC>TCC), G188G (g.4369 C>A; GGC>GGA), L432V (G.8131 C>G; CTG>GTG), D449D (g.8184 C>T; GAC>GAT), and N453S (g.8195 A>G; AAC>AGC) (nucleotide numbering is given in accordance with the GenBank sequence U56438). In the groups of PCG patients and donors without eye diseases, the frequencies of these variants were not statistically significantly different, pointing to the neutrality of these polymorphisms. Furthermore, the CYP1B1 polymorphism L432V, considered to be associated with POAG in some world populations, was not associated with this disease in the patients from St. Petersburg. DNA collections obtained from the POAG and PCG patients and from the control group were tested for the carriage of the worldwide distributed mutations of the WRD36 gene, D658G, R529Q, A449T, and N355S. D658G variant was found with equally low frequencies in the groups of POAG and PCG patients, as well as in the control group. Mutations A449T and R529Q were found only once each, while mutation N355S was not detected in any of the groups examined. Our results indicate that the WDR36 variants make no substantial contribution to the development of POAG and PCG in the patients from St. Petersburg and represent normal DNA polymorphism. It is likely that in most of the PCG patients from the population examined the disease is not associated with the CYP1B1 gene defects.

  12. Anterior Segment Optical Coherence Tomography Changes to the Anterior Chamber Angle in the Short-term following Laser Peripheral Iridoplasty.

    PubMed

    Yoong Leong, James Chiung; O'Connor, Jeremy; Soon Ang, Ghee; Wells, Anthony P

    2014-01-01

    To evaluate, by anterior segment optical coherence tomography (AS-OCT), the changes in the anterior chamber angle during the short-term postoperative period after diode laser peripheral iridoplasty (LPI). Retrospective, observational study of consecutive primary angle closure suspect, primary angle closure, or primary angle closure glaucoma patients who underwent LPI. These patients had persistent iridotrabecular contact despite the presence of a patent peripheral iridotomy. The AS-OCT images of the temporal and nasal anterior chamber angles in dark conditions before and after LPI were ana lyzed. The main outcome measures were changed in AS-OCT parameters such as trabecular-iris angle (TIA), angle opening distance (AOD), trabecular-iris space area (TISA), trabecular-iris contact length (TICL), iris thickness (IT), and maximum iris bow height (MIBH). Secondary outcome para meters included intraocular pressure (IOP) and postlaser complications. Images of 14 eyes of 14 patients were assessed. The mean time from LPI to the follow-up AS-OCT scan was 6 ± 3 weeks. The IT did not alter significantly after LPI, but there were significant increases in the TIA, AOD and TISA, as well as a significant decrease in TICL and MIBH. There were no significant postlaser complications. There was a small decrease in mean IOP from 17.1 ± 4.0 mm Hg to 14.8 ± 4.6 mm Hg (p = 0.014). Based on AS-OCT imaging, LPI resulted in significant angle widening and iris profile fattening during the short-term postoperative period in eyes with persistent angle closure despite the presence of a patent peripheral iridotomy. How to cite this article: Leong JCY, O'Connor J, Ang GS, Wells AP. Anterior Segment Optical Coherence Tomography Changes to the Anterior Chamber Angle in the Short-term following Laser Peripheral Iridoplasty. J Current Glau Prac 2014;8(1):1-6.

  13. TANGLE: Two-Level Support Vector Regression Approach for Protein Backbone Torsion Angle Prediction from Primary Sequences

    PubMed Central

    Song, Jiangning; Tan, Hao; Wang, Mingjun; Webb, Geoffrey I.; Akutsu, Tatsuya

    2012-01-01

    Protein backbone torsion angles (Phi) and (Psi) involve two rotation angles rotating around the Cα-N bond (Phi) and the Cα-C bond (Psi). Due to the planarity of the linked rigid peptide bonds, these two angles can essentially determine the backbone geometry of proteins. Accordingly, the accurate prediction of protein backbone torsion angle from sequence information can assist the prediction of protein structures. In this study, we develop a new approach called TANGLE (Torsion ANGLE predictor) to predict the protein backbone torsion angles from amino acid sequences. TANGLE uses a two-level support vector regression approach to perform real-value torsion angle prediction using a variety of features derived from amino acid sequences, including the evolutionary profiles in the form of position-specific scoring matrices, predicted secondary structure, solvent accessibility and natively disordered region as well as other global sequence features. When evaluated based on a large benchmark dataset of 1,526 non-homologous proteins, the mean absolute errors (MAEs) of the Phi and Psi angle prediction are 27.8° and 44.6°, respectively, which are 1% and 3% respectively lower than that using one of the state-of-the-art prediction tools ANGLOR. Moreover, the prediction of TANGLE is significantly better than a random predictor that was built on the amino acid-specific basis, with the p-value<1.46e-147 and 7.97e-150, respectively by the Wilcoxon signed rank test. As a complementary approach to the current torsion angle prediction algorithms, TANGLE should prove useful in predicting protein structural properties and assisting protein fold recognition by applying the predicted torsion angles as useful restraints. TANGLE is freely accessible at http://sunflower.kuicr.kyoto-u.ac.jp/~sjn/TANGLE/. PMID:22319565

  14. Question on clinical efficiency and principles of diode laser radiation activity at a primary open-angle glaucoma

    NASA Astrophysics Data System (ADS)

    Bolshunov, A. V.; Litvinova, G. G.; Ilyina, O. S.; Easakiva, A. L.; Fyodorov, A. A.; Poleva, R. P.

    1999-07-01

    The efficiency of a diode laser with a wavelength 0,81 microns in treatment of an open-angle glaucoma is investigated. The diode LTP is a pathogenesis oriented method of treatment of an open angle glaucoma: it gives in improvement of outflow of an intraocular fluid, stabilization and improvement of visual functions for patients with initial and developed stages of disease at term of observation up to 12 months.

  15. Magnetic Resonance Imaging of Optic Nerve Traction During Adduction in Primary Open-Angle Glaucoma With Normal Intraocular Pressure

    PubMed Central

    Demer, Joseph L.; Clark, Robert A.; Suh, Soh Youn; Giaconi, JoAnn A.; Nouri-Mahdavi, Kouros; Law, Simon K.; Bonelli, Laura; Coleman, Anne L.; Caprioli, Joseph

    2017-01-01

    Purpose We used magnetic resonance imaging (MRI) to ascertain effects of optic nerve (ON) traction in adduction, a phenomenon proposed as neuropathic in primary open-angle glaucoma (POAG). Methods Seventeen patients with POAG and maximal IOP ≤ 20 mm Hg, and 31 controls underwent MRI in central gaze and 20° to 30° abduction and adduction. Optic nerve and sheath area centroids permitted computation of midorbital lengths versus minimum paths. Results Average mean deviation (±SEM) was −8.2 ± 1.2 dB in the 15 patients with POAG having interpretable perimetry. In central gaze, ON path length in POAG was significantly more redundant (104.5 ± 0.4% of geometric minimum) than in controls (102.9 ± 0.4%, P = 2.96 × 10−4). In both groups the ON became significantly straighter in adduction (28.6 ± 0.8° in POAG, 26.8 ± 1.1° in controls) than central gaze and abduction. In adduction, the ON in POAG straightened to 102.0% ± 0.2% of minimum path length versus 104.5% ± 0.4% in central gaze (P = 5.7 × 10−7), compared with controls who straightened to 101.6% ± 0.1% from 102.9% ± 0.3% in central gaze (P = 8.7 × 10−6); and globes retracted 0.73 ± 0.09 mm in POAG, but only 0.07 ± 0.08 mm in controls (P = 8.8 × 10−7). Both effects were confirmed in age-matched controls, and remained significant after correction for significant effects of age and axial globe length (P = 0.005). Conclusions Although tethering and elongation of ON and sheath are normal in adduction, adduction is associated with abnormally great globe retraction in POAG without elevated IOP. Traction in adduction may cause mechanical overloading of the ON head and peripapillary sclera, thus contributing to or resulting from the optic neuropathy of glaucoma independent of IOP. PMID:28829843

  16. The Accuracy and Clinical Application of Predictive Models for Primary Open-Angle Glaucoma in Ocular Hypertensive Individuals

    PubMed Central

    2011-01-01

    Objective This report compares the accuracy of three prediction models for the development of primary open-angle glaucoma (POAG). The models differ primarily in their handling of these eye-specific variables: intraocular pressure (IOP), central corneal thickness (CCT), vertical cup-to-disc ratio (VCD) and visual field pattern standard deviation (PSD). 1). The “means” model includes age and the means of right and left eyes, 2). The “means plus asymmetry” model includes age, the means of right and left eyes as well as the absolute difference between eyes for eye-specific variables, 3). The “worse” eye model includes age and values from the eye at higher risk for developing POAG. Design This report uses data from the observation group of the Ocular Hypertension Treatment Study (OHTS) and the placebo group of the European Glaucoma Prevention Study (EGPS) who have complete data on both eyes at baseline. Performance of the prediction models is assessed using the c-statistic, calibration chi-square and Pearson correlation coefficient. Participants The OHTS observation group (n=717, 6.7 years median follow-up) and the EGPS placebo group (n=324, 4.9 years median follow-up). Testing Baseline data included demographic characteristics, medical history, ocular examination, visual fields and optic disc photographs. Main Outcome Measures Development of reproducible visual field abnormality or optic disc deterioration as determined by masked readers and attributed to POAG by a masked endpoint committee. Results Baseline factors that were statistically significant in all predictive models were-age, IOP, CCT, VCD and PSD. Also, statistically significant were baseline asymmetry in IOP and asymmetry in VCD. The c-statistics for the “means” model, “means plus asymmetry” model and “worse” eye model were 0.74, 0.77 and 0.75 respectively. The calibration chi-squares were 7.32, 11.19 and 1.81 respectively. Correlation coefficients between risk estimates calculated

  17. A Validated Prediction Model for the Development of Primary Open Angle Glaucoma in Individuals with Ocular Hypertension

    PubMed Central

    2007-01-01

    Objective To test the validity and generalizability of the Ocular Hypertension Treatment Study (OHTS) prediction model for the development of primary open angle glaucoma (POAG) in a large independent sample of untreated ocular hypertensive individuals. To develop a quantitative calculator to estimate the 5-year risk that an individual with ocular hypertension will develop POAG. Design A prediction model was developed from the observation group of the OHTS and then tested on the placebo group of the European Glaucoma Prevention Study (EGPS) using a z-statistic to compare hazard ratios, a c-statistic for discrimination and a calibration chi-square for systematic over/under estimation of predicted risk. The two study samples were pooled to increase precision and generalizability of a 5-year predictive model for developing POAG. Participants The OHTS observation group (n=819, 6.6 years median follow-up) and the EGPS placebo group (n=500, 4.8 years median follow-up). Testing Data were collected on demographic characteristics, medical history, ocular examination visual fields and optic disc photographs. Main Outcome Measures Development of reproducible visual field abnormality or optic disc progression as determined by masked readers and attributed to POAG by a masked endpoint committee. Results The same predictors for the development of POAG were independently identified in both the OHTS observation group and the EGPS placebo group - baseline age, intraocular pressure (IOP), central corneal thickness, vertical cup/disc ratio, and Humphrey visual field pattern standard deviation. The pooled multivariate model for the development of POAG had good discrimination (c-statistic 0.74) and accurate estimation of POAG risk (calibration chi-square 7.05). Conclusions The OHTS prediction model was validated in the EGPS placebo group. A calculator to estimate the 5-year risk of developing POAG, based on the pooled OHTS-EGPS predictive model, has high precision and will be useful to

  18. Effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma.

    PubMed

    Erkin, E F; Tarhan, S; Kayikçioğlu, O R; Deveci, H; Güler, C; Göktan, C

    2004-01-01

    To evaluate the effects of betaxolol and latanoprost on ocular blood flow and visual fields in patients with primary open-angle glaucoma (POAG) by means of an observer-masked, prospective clinical study. Thirty-two patients with newly diagnosed POAG were included in the study. The patients were randomized into two groups. The first group was treated with betaxolol 0.50% twice daily and the second group with latanoprost 0.005% once daily. Baseline and posttreatment examinations on the first and third months of treatment included intraocular pressure (IOP) measurement, automated visual field testing, and ocular blood flow assessment. For evaluation of visual fields, mean defect and pattern standard deviation indices were used. Ocular blood flow was assessed by means of color Doppler imaging of the central retinal artery (CRA) and the temporal short posterior ciliary artery (PCA). For each vessel, peak systolic (PSV) and end-diastolic (EDV) blood flow velocities were measured and resistivity index (RI) calculated. After exclusion of one noncompliant patient, the study was completed with 31 eyes of 31 patients. Both drugs significantly reduced IOP (p<0.05). The mean IOP lowering effect of latanoprost was significantly higher than that of betaxolol (p=0.03). Visual field indices exhibited no significant changes in either group (p>0.05). There were no significant changes in PSV or EDV measurements of CRA or PCA in either group (p>0.05). RI decreased in both CRA and PCA with both drugs. The mean changes between baseline and 3 month blood flow measurements were not significantly different between betaxolol and latanoprost (p>0.05). Over a treatment period of 3 months, both betaxolol and latanoprost tended to improve ocular blood flow without one of them being superior to the other. The results suggest that the direct (non IOP-dependent) influence on ocular circulation is better for betaxolol than for latanoprost. In addition, neither drug caused significant generalized

  19. Assessment of SNPs associated with the human glucocorticoid receptor in primary open-angle glaucoma and steroid responders.

    PubMed

    Fingert, John H; Alward, Wallace L; Wang, Kai; Yorio, Thomas; Clark, Abbot F

    2010-04-03

    While chronic glucocorticoid (GC) therapy leads to ocular hypertension in about one third of individuals, almost all primary open-angle glaucoma (POAG) patients show this response and are called "steroid responders." Two differentially spliced isoforms of the glucocorticoid receptor (GR), GRalpha and GRbeta, regulate GC responsiveness in trabecular meshwork (TM) cells. GRbeta acts as a dominant negative regulator of GC activity and is expressed at lower levels in glaucomatous TM cells, making them more sensitive to GCs. Several arginine/serine-rich splicing factor (SR) proteins have been implicated in alternative splicing of the GR. We have previously demonstrated that immunophilins FKBP5 and FKBP4 are required for GRalpha and GRbeta translocation into the nucleus, which is essential for their biologic activity. The purpose of the present study was to use single nucleotide polymorphism (SNP) genotyping to determine whether there are any allele frequency differences in GR, FKBP4/5, or SR genes between normal control, POAG, and steroid responder populations. Clinically characterized individuals (400 normal controls, 197 POAG, and 107 steroid responders) were recruited from the U. Iowa Ophthalmology Clinics after IRB approved consent. Genotyping of DNA samples for 48 SNPs in SFRS3, SFRS5, SFRS9, FKBP4, FKBP5, and NR3C1 was done at GeneSeek using a mass spectroscopy based system. All 48 SNPs displayed high call rates (99%). There were no significant differences in allele frequencies or genotypes in SNPs for SFRS5, SFRS9, FKBP4, FKBP5, and NR3C1 between the 3 groups. Up to three SNPs in SFRS3 had p-values <0.05 when comparing controls to POAG or steroid responders, but this statistical significance was lost when the p values were adjusted for multiple measures. Although these 6 genes may be involved in the pathogenesis of GC-induced ocular hypertension, it does not appear that major heritable risk alleles in these genes are responsible for the development of GC

  20. Risk Factors for Motor Vehicle Collisions in Patients with Primary Open-Angle Glaucoma: A Multicenter Prospective Cohort Study

    PubMed Central

    Yuki, Kenya; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Asaoka, Ryo; Tsubota, Kazuo

    2016-01-01

    Purpose To identify the incidence rate of motor vehicle collisions (MVCs) in patients with no ocular pathology other than primary open-angle glaucoma (POAG) and determine the putative risk factors for MVCs in this group of patients. Methods We designed a prospective cohort study across three centers utilizing a consecutive sampling method to identify all patients with POAG between the ages of 40 and 80 years old. Patients with glaucoma were consecutively screened for eligibility. All study participants answered a questionnaire about motor vehicle collisions at baseline, and answered the questionnaire again every 12 months (± 1 month) after baseline for three years. A binocular integrated visual field was calculated for each patient by merging a patient’s monocular Humphrey Field Analyzer (HFA) visual fields (VFs), using the ‘best sensitivity’ method. Patients with incident MVCs were defined as the “MVC+” group and patients without incident MVCs were defined as the “MVC-" group. Adjusted odds ratios for the incidence of MVCs were estimated with a logistic regression model. Results One hundred and ninety-one Japanese POAG patients were analyzed in this study. The age of the participants was 63.7 ± 10.2 [mean ± standard deviation]. A total of 28 participants experienced a MVC during the follow up period of three years (4.9% per year). Ten patients (5.2%) experienced a MVC in the first year, 13 patients (6.8%) in the second year, and 11 patients (5.8%) in the third year (some patients experienced multiple MVCs over different years). Best corrected visual acuity in the worst eye was significantly worse in the MVC+ group (0.03 ± 0.01, mean ± standard deviation, LogMar) compared with the MVC- group (0.01 ± 0.003, p = 0.01), and was the only variable identified as a significant predictor of future MVCs in the multiple logistic regression model [odds ratio: 1.2, 95% confidence interval (CI): 1.1 to 1.4]. Conclusion Deterioration in visual acuity in the

  1. A survey of preoperative blood tests in primary open-angle glaucoma patients versus cataract surgery patients

    PubMed Central

    Cohen, Laura P.; Wong, Jessica; Jiwani, Aliya Z.; Greenstein, Scott H.; Brauner, Stacey C.; Chen, Sherleen C.; Turalba, Angela V.; Chen, Teresa C.; Shen, Lucy; Rhee, Douglas J.; Wiggs, Janey L.; Kang, Jae Hee; Loomis, Stephanie; Pasquale, Louis R.

    2014-01-01

    Purpose To investigate biomarker differences in routine preoperative blood tests performed on primary open-angle glaucoma (POAG) case and control patients presenting for anterior segment eye surgery. Methods POAG cases and age-related cataract surgery patients (controls) who underwent anterior segment surgery at Massachusetts Eye and Ear from January 2009 through March 2012 were identified by retrospective record review. Patients with diabetes mellitus, secondary glaucoma, and cataract due to trauma or steroid exposure were excluded. Data on demographic features, preoperative ophthalmological and medical diagnosis, blood pressure, anthropometric measures, basic metabolic panel, and complete blood count were extracted from the medical records. Univariate differences in lab values between POAG cases and controls were assessed using unpaired t tests. Multivariate logistic regression analysis was completed to determine the independent associations of biomarkers with POAG. Results A total of 150 cases and 150 age-related controls were included. In multivariate analysis, higher AG was inversely associated with POAG (odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.80–1.00), and higher Cl− level was positively associated with POAG (OR = 1.15; 95% CI, 1.02–1.29). The lower AG in POAG patients could be explained by higher IgG levels as the available data in post hoc analysis showed a nonsignificant trend toward higher IgG in cases compared to controls (17 vs 23; 1142 ± 284 mg/dl vs 1028 ± 291 mg/dl; P = 0.22). Furthermore, in multivariable analysis, a higher red blood cell count was also associated with POAG (OR = 1.91; 95% CI, 1.11–3.28). Conclusions Patients with POAG presenting for anterior segment surgery had a lower AG compared to age-related cataract surgery patients. The etiology of this reduced gap is unclear but the possible contribution of IgG warrants further exploration. The etiology of higher red blood cell counts in POAG cases is unknown and

  2. Topical Ocular Sodium 4-Phenylbutyrate Rescues Glaucoma in a Myocilin Mouse Model of Primary Open-Angle Glaucoma

    PubMed Central

    Zode, Gulab S.; Bugge, Kevin E.; Mohan, Kabhilan; Grozdanic, Sinisa D.; Peters, Joseph C.; Koehn, Demelza R.; Anderson, Michael G.; Kardon, Randy H.; Stone, Edwin M.

    2012-01-01

    Purpose. Mutations in the myocilin gene (MYOC) are the most common known genetic cause of primary open-angle glaucoma (POAG). The purpose of this study was to determine whether topical ocular sodium 4-phenylbutyrate (PBA) treatment rescues glaucoma phenotypes in a mouse model of myocilin-associated glaucoma (Tg-MYOCY437H mice). Methods. Tg-MYOCY437H mice were treated with PBA eye drops (n = 10) or sterile PBS (n = 8) twice daily for 5 months. Long-term safety and effectiveness of topical PBA (0.2%) on glaucoma phenotypes were examined by measuring intraocular pressure (IOP) and pattern ERG (PERG), performing slit lamp evaluation of the anterior chamber, analyzing histologic sections of the anterior segment, and comparing myocilin levels in the aqueous humor and trabecular meshwork of Tg-MYOCY437H mice. Results. Tg-MYOCY437H mice developed elevated IOP at 3 months of age when compared with wild-type (WT) littermates (n = 24; P < 0.0001). Topical PBA did not alter IOP in WT mice. However, it significantly reduced elevated IOP in Tg-MYOCY437H mice to the level of WT mice. Topical PBA-treated Tg-MYOCY437H mice also preserved PERG amplitudes compared with vehicle-treated Tg-MYOCY437H mice. No structural abnormalities were observed in the anterior chamber of PBA-treated WT and Tg-MYOCY437H mice. Analysis of the myocilin in the aqueous humor and TM revealed that PBA significantly improved the secretion of myocilin and reduced myocilin accumulation as well as endoplasmic reticulum (ER) stress in the TM of Tg-MYOCY437H mice. Furthermore, topical PBA reduced IOP elevated by induction of ER stress via tunicamycin injections in WT mice. Conclusions. Topical ocular PBA reduces glaucomatous phenotypes in Tg-MYOCY437H mice, most likely by reducing myocilin accumulation and ER stress in the TM. Topical ocular PBA could become a novel treatment for POAG patients with myocilin mutations. PMID:22328638

  3. Risk Factors for Motor Vehicle Collisions in Patients with Primary Open-Angle Glaucoma: A Multicenter Prospective Cohort Study.

    PubMed

    Yuki, Kenya; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Asaoka, Ryo; Tsubota, Kazuo

    2016-01-01

    To identify the incidence rate of motor vehicle collisions (MVCs) in patients with no ocular pathology other than primary open-angle glaucoma (POAG) and determine the putative risk factors for MVCs in this group of patients. We designed a prospective cohort study across three centers utilizing a consecutive sampling method to identify all patients with POAG between the ages of 40 and 80 years old. Patients with glaucoma were consecutively screened for eligibility. All study participants answered a questionnaire about motor vehicle collisions at baseline, and answered the questionnaire again every 12 months (± 1 month) after baseline for three years. A binocular integrated visual field was calculated for each patient by merging a patient's monocular Humphrey Field Analyzer (HFA) visual fields (VFs), using the 'best sensitivity' method. Patients with incident MVCs were defined as the "MVC+" group and patients without incident MVCs were defined as the "MVC-" group. Adjusted odds ratios for the incidence of MVCs were estimated with a logistic regression model. One hundred and ninety-one Japanese POAG patients were analyzed in this study. The age of the participants was 63.7 ± 10.2 [mean ± standard deviation]. A total of 28 participants experienced a MVC during the follow up period of three years (4.9% per year). Ten patients (5.2%) experienced a MVC in the first year, 13 patients (6.8%) in the second year, and 11 patients (5.8%) in the third year (some patients experienced multiple MVCs over different years). Best corrected visual acuity in the worst eye was significantly worse in the MVC+ group (0.03 ± 0.01, mean ± standard deviation, LogMar) compared with the MVC- group (0.01 ± 0.003, p = 0.01), and was the only variable identified as a significant predictor of future MVCs in the multiple logistic regression model [odds ratio: 1.2, 95% confidence interval (CI): 1.1 to 1.4]. Deterioration in visual acuity in the worst eye is a risk factor for future MVCs in

  4. Association between primary open angle glaucoma and genetic polymorphisms GSTM1/GSTT1 in patients from Goiânia Central-West Region of Brazil.

    PubMed

    Silva, C T X; Costa, N B; Silva, K S F; Silva, R E; Moura, K K V O

    2014-10-31

    In this study, we evaluated the genotype profile of GSTM1 and GSTT1 polymorphisms in patient carriers of primary open-angle glaucoma in the population of Goiânia, GO, Brazil. This case-control study included 100 Brazilian patients with glaucoma and 53 patients without glaucoma. Blood samples were genotyped for polymorphisms in GST genes using polymerase chain reaction-based methods. Polymorphism frequencies were compared using the X(2) test and odds ratio (α = 0.05). The GSTM1-present genotype was 40% in the glaucoma group and 71.6% in the control group, while the GSTM1 null genotype was 60 and 28.3% in the same groups, respectively. The GSTT1-present genotype was 52% in the primary open-angle glaucoma group and 66% in the control group; the null genotype was 48% in the case group and 34% in the control group. The GSTM1 null genotype was more frequent in the glaucoma group than in the control group (P = 0.0004; odds ratio = 6.7; 95% confidence interval = 2.7- 20.3). The combined GSTM1 null and GSTT1-present genotypes were more frequent in the primary open-angle glaucoma group compared to the control group (P = 0.02; odds ratio = 3.1; 95% confidence interval = 1.2-7.9).

  5. Genome-wide linkage and association analysis of primary open-angle glaucoma endophenotypes in the Norfolk Island isolate.

    PubMed

    Matovinovic, Elizabeth; Kho, Pik Fang; Lea, Rodney A; Benton, Miles C; Eccles, David A; Haupt, Larisa M; Hewitt, Alex W; Sherwin, Justin C; Mackey, David A; Griffiths, Lyn R

    2017-01-01

    Primary open-angle glaucoma (POAG) refers to a group of heterogeneous diseases involving optic nerve damage. Two well-established risk factors for POAG are elevated intraocular pressure (IOP) and a thinner central corneal thickness (CCT). These endophenotypes exhibit a high degree of heritability across populations. Large-scale genome-wide association studies (GWASs) of outbred populations have robustly implicated several susceptibility gene variants for both IOP and CCT. Despite this progress, a substantial amount of genetic variance remains unexplained. Population-specific variants that might be rare in outbred populations may also influence POAG endophenotypes. The Norfolk Island population is a founder-effect genetic isolate that has been well characterized for POAG endophenotypes. This population is therefore a suitable candidate for mapping new variants that influence these complex traits. Three hundred and thirty participants from the Norfolk Island Eye Study (NIES) core pedigree provided DNA. Ocular measurements of CCT and IOP were also taken for analysis. Heritability analyses and genome-wide linkage analyses of short tandem repeats (STRs) were conducted using SOLAR. Pedigree-based GWASs of single-nucleotide polymorphisms (SNPs) were performed using the GenABEL software. CCT was the most heritable endophenotype in this cohort (h(2) = 0.77, p = 6×10(-6)), while IOP showed a heritability of 0.39 (p = 0.008). A genome-wide linkage analysis of these POAG phenotypes identified a maximum logarithm of the odds (LOD) score of 1.9 for CCT on chromosome 20 (p = 0.0016) and 1.3 for IOP on chromosome 15 (p = 0.0072). The GWAS results revealed a study-wise significant association for IOP at rs790357, which is located within DLG2 on chr11q14.1 (p = 1.02×10(-7)). DLG2 is involved in neuronal signaling and development, and while it has not previously been associated with IOP, it has been associated with myopia. An analysis of 12 known SNPs for IOP showed that rs12419342

  6. Scleral buckling for primary rhegmatogenous retinal detachment using noncontact wide-angle viewing system with a cannula-based 25 G chandelier endoilluminator

    PubMed Central

    Imai, Hisanori; Tagami, Mizuki; Azumi, Atsushi

    2015-01-01

    Purpose The aim of this study is to report the result of scleral buckling (SB) using a combination of a noncontact wide-angle viewing system and a cannula-based 25 G chandelier endoilluminator. Methods Retrospective analyses of the medical records of 79 eyes of 79 patients with primary uncomplicated rhegmatogenous retinal detachments who had underwent SB using a combination of a noncontact wide-angle viewing system and a chandelier endoilluminator were performed. Results There were 50 men and 29 women. The mean ± standard deviation age was 43.7±16.0 years. Their preoperative best-corrected visual acuity (BCVA) was 0.31±0.65 logMAR units. The final BCVA was 0.10±0.31 logMAR units, which was significantly better than the preoperative BCVA (P<0.01). The initial and final anatomical success rates were 92.4% and 100%, respectively. Backward logistic multiple regression analysis revealed no relationship between explanatory variables and the primary anatomic success (P=0.104). Conclusion SB using a combination of a noncontact wide-angle viewing system and a chandelier endoilluminator is a modified new technique and may be a valid option for the management of rhegmatogenous retinal detachments. PMID:26635466

  7. Evolution of Fascial Closure Optimization in Damage Control Laparotomy.

    PubMed

    Lauerman, Margaret H; Dubose, Joseph J; Stein, Deborah M; Galvagno, Samuel M; Bradley, Matthew J; Diaz, Jose; Scalea, Thomas M

    2016-12-01

    Management of patients undergoing damage control laparotomy (DCL) involves many surgical, medical, and logistical factors. Ideal patient management optimizing fascial closure with regard to timing and closure techniques remains unclear. A retrospective review of patients undergoing DCL from 2000 to 2012 at an urban Level I trauma center was undertaken. Mortality of DCL decreased over the study period from 62.5 to 34.6 per cent, whereas enterocutaneous fistula rate decreased from 12.5 to 3.8 per cent. Delayed primary fascial closure rate improved from 22.2 to 88.2 per cent. Time to closure (P < 0.001), time to first attempted closure (P < 0.001), and number of explorations (P < 0.001) were associated with ability to achieve delayed primary fascial closure. In subgroup analysis, achievement of delayed primary fascial closure was decreased with time to closure after one week (91.7% vs 52.0%, P = 0.002) and time to first attempted closure after two days (86.5% vs 70.0%, P = 0.042). In multivariate analysis, time to closure (odds ratio: 0.13, 95% confidence interval: 0.04-0.39; P < 0.001) and time to first attempted closure (odds ratio: 0.61, 95% confidence interval: 0.37-0.99; P = 0.046) were the only factors associated with achieving delayed primary fascial closure. Timing of attempted closure plays a significant role in attaining delayed primary fascial closure, highlighting the importance of early re-exploration.

  8. Primary limited lumbar discectomy with an annulus closure device: one-year clinical and radiographic results from a prospective, multi-center study.

    PubMed

    Lequin, Michiel B; Barth, Martin; Thomė, Claudius; Bouma, Gerrit J

    2012-12-01

    Discectomy as a treatment for herniated lumbar discs results in outcomes after surgery that are not uniformly positive. Surgeons face the dilemma between limited nucleus removal which is associated with a higher risk of recurrence, or more aggressive nucleus removal which may lead to disc height loss and persistent back-pain. annulus closure devices may allow for the benefits of limited nucleus removal without the increased risk of recurrence. This is an interim report of an ongoing 24-month post-marketing study of the Barricaid® annulus closure device, consisting of a flexible polymer mesh that blocks the defect, held in place by a titanium bone anchor. We prospectively enrolled 45 patients at four hospitals, and implanted the Barricaid® after a limited discectomy. annulus defect size and volume of removed nucleus were recorded. Reherniations were reported, pain and function were monitored and imaging was performed at regular intervals during 24 months of follow-up. At 12 months postsurgery, pain and function were significantly improved, comparing favorably to reported results from limited discectomy. Disc height has been well maintained. One reherniation has occurred (2.4%), which was associated with a misplaced device. No device fracture, subsidence or migration has been observed. The use of an annulus closure device may provide a reduction in reherniation rate for lumbar discectomy patients with large annulus defects who are at the greatest risk of recurrence. Using such a device should provide the surgeon increased confidence in minimizing nucleus removal, which, in turn, may preserve disc height and biomechanics, reducing degeneration and associated poor clinical outcomes in the long-term. A randomized multicenter study evaluating limited discectomy with and without the Barricaid® is currently underway, and will provide a higher level of evidence.

  9. Five-year extension of a clinical trial comparing the EX-PRESS glaucoma filtration device and trabeculectomy in primary open-angle glaucoma.

    PubMed

    de Jong, Leo; Lafuma, Antoine; Aguadé, Anne-Sophie; Berdeaux, Gilles

    2011-01-01

    This study compared the efficacy of the EX-PRESS(®) glaucoma filtration device and trabeculectomy in primary open-angle glaucoma up to five years after surgery. Patients from a previously reported randomized, open-label, parallel-arm clinical trial in which 78 patients received either the EX-PRESS glaucoma filtration device or underwent a trabeculectomy were followed for up to an additional four years (five total) beyond the original study (39 eyes per treatment group). Risk-benefit data were obtained for up to five years after glaucoma surgery. Outcome variables were intraocular pressures and intraocular pressure medications. Complete success was denoted by intraocular pressure values ≤ 18 mmHg without medication. The EX-PRESS glaucoma filtration device controlled intraocular pressure more effectively without medication for more patients from year 1 (86.8% versus 61.5%, P = 0.01) to year 3 (66.7% versus 41.0%, P = 0.02) than trabeculectomy. At year 1, only 12.8% of patients required intraocular pressure medication after EX-PRESS implantation, compared with 35.9% after trabeculectomy. The proportions became closer at year 5 (41% versus 53.9%). The responder rate was higher with EX-PRESS and time to failure was longer. In addition, surgical interventions for complications were fewer after EX-PRESS implantation. This five-year analysis confirmed and extended the results reported after one year. Compared with trabeculectomy, EX-PRESS provided better intraocular pressure control in the first three years, and patients required fewer intraocular pressure medications and fewer surgical interventions during the five-year study period. For patients with primary open-angle glaucoma, the EX-PRESS glaucoma filtration device, implanted under a superficial scleral flap, produced significantly higher success rates than trabeculectomy. EX-PRESS is an effective device for long-term treatment of primary open-angle glaucoma.

  10. Common variants near CAV1 and CAV2 are associated with primary open-angle glaucoma in Caucasians from the USA.

    PubMed

    Wiggs, Janey L; Kang, Jae Hee; Yaspan, Brian L; Mirel, Daniel B; Laurie, Cathy; Crenshaw, Andrew; Brodeur, Wendy; Gogarten, Stephanie; Olson, Lana M; Abdrabou, Wael; DelBono, Elizabeth; Loomis, Stephanie; Haines, Jonathan L; Pasquale, Louis R

    2011-12-01

    Primary open-angle glaucoma (POAG) is a genetically complex common disease characterized by progressive optic nerve degeneration that results in irreversible blindness. Recently, a genome-wide association study (GWAS) for POAG in an Icelandic population identified significant associations with single nucleotide polymorphisms (SNPs) between the CAV1 and CAV2 genes on chromosome 7q31. In this study, we confirm that the identified SNPs are associated with POAG in our Caucasian US population and that specific haplotypes located in the CAV1/CAV2 intergenic region are associated with the disease. We also present data suggesting that associations with several CAV1/CAV2 SNPs are significant mostly in women.

  11. Changes in Anterior Segment Morphology and Predictors of Angle Widening after Laser Iridotomy in South Indian Eyes.

    PubMed

    Zebardast, Nazlee; Kavitha, Srinivasan; Krishnamurthy, Palaniswamy; Friedman, David S; Nongpiur, Monisha E; Aung, Tin; Quigley, Harry A; Ramulu, Pradeep Y; Venkatesh, Rengaraj

    2016-12-01

    To compare anterior segment optical coherence tomography (ASOCT) angle morphology before and after laser peripheral iridotomy (LPI) in a cohort of South Indian subjects with primary angle-closure suspect (PACS) or primary angle-closure/primary angle-closure glaucoma (PAC/PACG) and to examine baseline parameters associated with angle widening. Prospective observational study. A total of 244 subjects aged ≥30 years with PACS or PAC/PACG in at least 1 eye. The ASOCT images and angle gonioscopic grades were analyzed for all subjects at baseline and 2 weeks after LPI. Multivariable linear and logistic regression models were used to determine predictors of angle widening (change in mean angle opening distance [AOD750]) and angle opening (all 4 quadrants with trabecular meshwork [TM] visible on gonioscopy after LPI). Change in ASOCT parameters with LPI and baseline predictors of angle widening. Laser peripheral iridotomy resulted in angle widening on ASOCT with significant increases in AOD750, angle recess area, and trabecular iris surface area (P < 0.05 for all). Gonioscopically, 44.7% of all subjects had open angles in all 4 quadrants after LPI, with a greater percentage of angles open in the PACS group compared with the PAC/PACG group (52.4% vs. 36.4%; P = 0.01). In multivariable regression analyses, greater postoperative angle widening as defined by change in AOD750 was associated with shorter baseline AOD750 and axial length, and greater baseline anterior chamber depth, iris curvature, and lens vault (P ≤ 0.002 for all). Gonioscopic angle opening after LPI was more common with wider baseline angle width (modified Shaffer grade) and lower cup-to-disc ratio (P < 0.001 for both). In a South Indian population with PACS or PAC/PACG, LPI results in significant anterior chamber angle widening seen on both ASOCT and gonioscopy, although some degree of persistent iridotrabecular contact was present in approximately half of PACS eyes and approximately two thirds of PAC

  12. Optimal Number of Angle Images for Calculating Anterior Angle Volume and Iris Volume Measurements

    PubMed Central

    Blieden, Lauren S.; Chuang, Alice Z.; Baker, Laura A.; Bell, Nicholas P.; Fuller, Timothy S.; Mankiewicz, Kimberly A.; Feldman, Robert M.

    2015-01-01

    Purpose. We determined the optimal number of angle images required to obtain reliable measurements of trabecular-iris circumferential volume (TICV) and iris volume (IV) using swept-source Fourier domain anterior segment optical coherence tomography (SSFD-ASOCT) scans in narrow angle eyes. Methods. Scleral spur landmarks (SSL) were manually identified on ASOCT angle images from 128 meridians from each of 24 eyes with chronic primary angle closure (PAC) spectrum of disease. The anterior and posterior corneal curves, and the anterior and posterior iris surfaces were identified automatically by the anterior chamber analysis and interpretation (ACAI) software, then manually examined and edited by the reader if required. Trabecular-iris circumferential volume at 750 μm from SSL (TICV750) and IV were subsequently calculated using varying numbers of angle images. Threshold error was determined to be less than the lower 95% confidence limit of mean absolute percent error (MAPE) of the change in TICV or IV resulting from laser peripheral iridotomy, which would be 17% for TICV and 5% for IV, based on previous studies. The optimal number of angle images was the smallest number of images where MAPE was less than this threshold for TICV and IV. Results. A total of 32 equally-spaced angle images (16 meridians) was required to estimate TICV750 and 16 angle images (8 meridians) to estimate IV. Both were within 4.6% and 1.6% of MAPE, respectively. Conclusions. It is possible to determine TICV and IV parameters reliably in narrow angles without evaluating all 128 meridians obtained with SSFD-ASOCT. PMID:25829412

  13. Novel and known MYOC exon 3 mutations in an admixed Peruvian primary open-angle glaucoma population

    PubMed Central

    Mendoza-Reinoso, Veronica; Guevara-Fujita, Maria L.; Fernández, Silvia; Vargas, Enrique; Castillo-Herrera, Wilder; Perez-Grossmann, Rodolfo; Lizaraso-Caparó, Frank; Richards, Julia E.; Fujita, Ricardo

    2012-01-01

    Purpose The aim of this study was to characterize a representative sample of the Peruvian population suffering open-angle glaucoma (OAG) with respect to the myocilin gene (MYOC) mutations, glaucoma phenotype, and ancestry for future glaucoma risk assessment. Methods DNA samples from 414 unrelated Peruvian subjects, including 205 open-angle glaucoma cases (10 juvenile glaucoma [JOAG], 19 normal-tension glaucoma [NTG], and 176 POAG) and 209 randomly sampled controls, were screened for nucleotide changes in MYOC exon 3 by conformational sensitive gel electrophoresis (CSGE) and mutation screening. Results We identified a probable causative novel MYOC missense mutation, Gly326Ser, in one POAG case and found a consistent genotype-phenotype correlation in eight of his relatives. We also found the known causative MYOC mutation Trp286Arg in one JOAG case and one POAG case. A known causative single base MYOC deletion, T1357, was found in one POAG case. Two previously reported silent polymorphisms, Thr325Thr and Tyr347Tyr, were found in both the case and the control populations. A novel missense variant, Met476Arg, was identified in two unrelated controls. Conclusions The screening of exon 3 of MYOC in a representative sample of 205 independent POAG patients from Peru and 209 matched controls identified novel and previously reported mutations (both pathogenic and nonpathogenic) from other global regions. These results reflect the complex admixture of Amerindian and Old World ancestry in urban populations of Latin America, in general, and in Peru, in particular. It will be important to gather information about the ancestral origin of MYOC and other POAG gene mutations to develop screening panels and risk assessment for POAG in Peru. PMID:22879734

  14. Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma.

    PubMed

    Wasyluk, Jaromir T; Jankowska-Lech, Irmina; Terelak-Borys, Barbara; Grabska-Liberek, Iwona

    2012-03-01

    We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18-70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in µm) differ significantly between GDx and all OCT devices. Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients.

  15. Examining Delay Intervals in the Diagnosis and Treatment of Primary Open Angle Glaucoma in an Egyptian Population and Its Impact on Lifestyle

    PubMed Central

    Abu Hussein, Nahla B.; Habib, Ahmed E.; El Sayed, Yasmine M.

    2016-01-01

    Purpose. To examine causes as well as extent of delay in diagnosis and treatment of primary open angle glaucoma patients in a sample of Egyptians. Patients and Methods. 440 patients with primary open angle glaucoma were interviewed to evaluate delay in their diagnosis and treatment. The extent and cause of delay were investigated. The total delay interval, if any, was correlated with socioeconomic and other factors. Results. The median total delay was one year, with 50% of patients having a total delay of 1 year or less, of which 25% exhibited zero total delay. 25% of patients had a delay ranging from 1 to 3 years, and 25% had a total delay ranging from 3 to 27 years. Diagnostic delay accounted for 43.03% of cases. Longer delays were met in patients with certain socioeconomic factors. Patients with a positive family history of glaucoma displayed shorter delay periods. Conclusion. Significant delay in the diagnosis and treatment of glaucoma was found. Poor socioeconomic status seems to hinder timely diagnosis and treatment of POAG. Certain socioeconomic factors seem to correlate with the extent of delay. More effort is thus needed to subsidize the cost of investigations and treatment for glaucoma patients. PMID:28116140

  16. Fixed combination of bimatoprost and timolol in patients with primary open-angle glaucoma or ocular hypertension with inadequate IOP adjustment

    PubMed Central

    Brief, Gerrett; Lammich, Tobias; Nagel, Edgar; Pfennigsdorf, Sabine; Spraul, Christoph W; Ho, Selwyn

    2010-01-01

    Objective To assess the efficacy and tolerability of a fixed combination of bimatoprost and timolol (BTFC) in a large patient sample in a clinical setting. Methods In this multicenter, observational, noncontrolled, open-label study, patients (n = 1862) with primary open-angle glaucoma or ocular hypertension were treated with BTFC. Assessments were made at baseline, six weeks, and three months. Results Prior to starting BTFC, 92.3% of patients were taking other ocular hypotensive medications. In the overall group at three months, mean intraocular pressure was reduced from baseline (21.7 ± 4.5 mmHg and 21.8 ± 4.9 mmHg for the right and left eye, respectively) to 16.1 ± 3.0 mmHg for each eye (P < 0.0001). The majority of patients (92%) reported no adverse events. The most commonly reported adverse events (in >1% of patients) were eye irritation, and ocular and conjunctival hyperemia. Adherence to treatment was generally better than (35.4%) or the same as (57.5%) with prior therapy. BTFC tolerability was rated as excellent or good by 92.3% of physicians and 85.8% of patients. Conclusions In a large group of patients with primary open-angle glaucoma or ocular hypertension, treatment with BTFC was associated with consistent reductions in IOP, improved adherence to treatment, and good tolerability. PMID:20957059

  17. The TopClosure® 3S System, for skin stretching and a secure wound closure.

    PubMed

    Topaz, Moris; Carmel, Narin-Nard; Silberman, Adi; Li, Ming Sen; Li, Yong Zhong

    2012-07-01

    The principle of stretching wound margins for primary wound closure is commonly practiced and used for various skin defects, leading at times to excessive tension and complications during wound closure. Different surgical techniques, skin stretching devices and tissue expanders have been utilized to address this issue. Previously designed skin stretching devices resulted in considerable morbidity. They were invasive by nature and associated with relatively high localized tissue pressure, frequently leading to necrosis, damage and tearing of skin at the wound margins. To assess the clinical effectiveness and performance and, to determine the safety of TopClosure® for gradual, controlled, temporary, noninvasive and invasive applications for skin stretching and secure wound closing, the TopClosure® device was applied to 20 patients for preoperative skin lesion removal and to secure closure of a variety of wound sizes. TopClosure® was reinforced with adhesives, staples and/or surgical sutures, depending on the circumstances of the wound and the surgeon's judgment. TopClosure® was used prior to, during and/or after surgery to reduce tension across wound edges. No significant complications or adverse events were associated with its use. TopClosure® was effectively used for preoperative skin expansion in preparation for dermal resection (e.g., congenital nevi). It aided closure of large wounds involving significant loss of skin and soft tissue by mobilizing skin and subcutaneous tissue, thus avoiding the need for skin grafts or flaps. Following surgery, it was used to secure closure of wounds under tension, thus improving wound aesthetics. A sample case study will be presented. We designed TopClosure®, an innovative device, to modify the currently practiced concept of wound closure by applying minimal stress to the skin, away from damaged wound edges, with flexible force vectors and versatile methods of attachment to the skin, in a noninvasive or invasive manner.

  18. A 7 year prospective comparative study of three topical beta blockers in the management of primary open angle glaucoma.

    PubMed

    Watson, P G; Barnett, M F; Parker, V; Haybittle, J

    2001-08-01

    To determine the long term efficacy of monotherapy with topically applied beta blocking agents and to determine whether selective beta blockers were able to preserve the visual field more effectively than non-selective agents. A prospective randomised, open, comparative study of three topically applied beta blockers-timolol, betaxolol, and carteolol-was carried out on 153 patients (280 eyes) with newly diagnosed open angle glaucoma. Those patients who were not withdrawn were followed by the same observers for a minimum of 2 years and a maximum of 7 years, with clinical observations, Goldmann tonometry and 24.2 Humphrey visual field analysis. All three drugs lowered the IOP significantly from untreated levels but betaxolol took up to 12 months in some instances to reach the maximum pressure reduction. After 7 years only 43% of the eyes begun on timolol, 34% of those started on carteolol, and 29% of those on betaxolol were still being treated with these medications alone. Visual fields were analysed throughout the trial by CPSD and MD and at the end by linear regression analysis (PROGRESSOR). The visual fields remained the same without apparent improvement or deterioration throughout the period of follow up. Eight patients (11 eyes) were withdrawn because of continuing field loss in spite of reduction in IOP (six using carteolol and five using betaxolol). Analysis shows that less than half the eyes initially treated with topical beta blockers might be expected to still be being treated with their original medication after 5 years. The rest required either additional medication or trabeculectomy. There was no statistically significant improvement or deterioration in the visual fields over a 7 year period. On the evidence of this trial there are no particular advantages in using selective beta blockers.

  19. The impact of a needle exchange's closure.

    PubMed

    Broadhead, R S; van Hulst, Y; Heckathorn, D D

    1999-01-01

    The Windham, Connecticut, needle exchange closed in May 1997 after becoming embroiled in a public controversy in which it was blamed for the city's drug problem, discarded syringes, and even the economic decline of the city itself. The authors interviewed injection drug users and conducted a community survey of discarded drug paraphernalia to explore the effects of the needle exchange's closure. After the needle exchange was closed in March 1997, the authors re-recruited former participants in an AIDS prevention research project, the majority of whom were clients of the needle exchange. The authors analyzed responses from these respondents' pre-closure interviews and from III post-closure initial interviews and 78 post-closure follow-up interviews as well as data on discarded syringes and "dope bags". Following the closure of the needle exchange, significant increases were found in the percentage of respondents who reported an unreliable source as their primary source of syringes, in respondents' reports of the frequency of reusing syringes, and in the percentage of respondents who reported sharing of syringes. Surveys of outdoor drug-use areas found that the closure of the needle exchange did not reduce the volume of discarded syringes and other drug-injection debris. The problems in Windham that led to the closure of the exchange still remain, and the city's drug injectors are engaging in higher levels of HIV risk behavior.

  20. Controlled five-year follow-up study of laser trabeculoplasty as primary therapy for open-angle glaucoma

    SciTech Connect

    Tuulonen, A.; Niva, A.K.; Alanko, H.I.

    1987-10-15

    We followed up 32 eyes of 32 patients with early glaucoma (22 with capsular glaucoma and ten with simple glaucoma) who received laser trabeculoplasty as a primary therapy. These eyes were compared with a matched control group of 32 eyes treated with medication initially. The success rate (intraocular pressure below 22 mm Hg with laser alone or medication alone) at five years was 50% (16 of 32 eyes) in the laser-treated group and 22% (seven of 32 eyes) in the control group (P less than .02). The control group required more modifications of their therapy to control intraocular pressure. The neuroretinal rim area in the control eyes decreased 2.5 times as much as in the laser group (P = .017). Changes in the Friedmann visual fields did not differ significantly between the two groups.

  1. Association of NT-proANP Level in Plasma and Humor Aqueous with Primary Open-Angle Glaucoma.

    PubMed

    Baumane, Kristine; Ranka, Renate; Laganovska, Guna

    2017-02-01

    The aim of this study is to determine differences in the levels of NT-proANP in the plasma and aqueous humor of glaucoma and cataract patients and to evaluate whether any relationships are present. The study group consisted of 58 patients with primary-open glaucoma (POAG) undergoing trabeculectomy surgery. The control group was comprised of 32 age-matched cataract patients. The concentration of the N-terminal fragment of the proatrial natriuretic peptide (NT-proANP, 1-98) in the aqueous humor and blood plasma samples was measured using an immunochemical method (ELISA). The plasma NT-proANP concentration was significantly increased in patients with POAG compared to that in the control group (7.00 vs. 4.65 nmol/L, P = 0.0054). Similarly, the NT-proANP concentration in the aqueous humor was significantly higher in the POAG patients (0.47 vs. 0.09 nmol/L, P = 0.0112). However, there was no correlation between the NT-proANP values in the aqueous humor and the plasma of the POAG patients, as well as between the NT-proANP values in the aqueous humor and the intraocular pressure. We identified an association between the levels of NT-proANP in the plasma and the aqueous humor with POAG. Our data support the idea of the involvement of NP system in the development of POAG and highlight ANP as a possible biomarker of glaucoma.

  2. Ocular hypotensive efficacy and safety of travoprost 0.004% in inadequately controlled primary open-angle glaucoma or ocular hypertension: short-term, multicenter, prospective study.

    PubMed

    Blini, Mirella; Rossi, Gemma Caterina Maria; Trabucchi, Giuseppe; Curatola, Maria R; David, Alessandro; Radaelli, Rosella; Merlo, Giancarlo; Ratiglia, Roberto

    2009-01-01

    To evaluate the intraocular pressure (IOP) lowering efficacy and safety of travoprost 0.004% in patients with open-angle glaucoma or ocular hypertension, poorly controlled with or intolerance to beta-blockers. To record the short-term effect on diastolic ocular perfusion pressure (DOPP). One hundred and three patients with open-angle glaucoma or ocular hypertension were treated with travoprost 0.004% once daily for 90 days in an open-label, non-controlled study. Efficacy and safety were assessed at baseline, after 45 and 90 days. Clinical registry number IT0301. The primary outcome measure, IOP, was recorded at 10 am, 12 pm, and 4 pm at each visit. DOPP was evaluated at 10 am, at baseline and visit 3. Safety measures included adverse events, biomicroscopy, visual acuity, heart rate, and blood pressure. Mean IOP was reduced from 22.2 +/- 1.7 mmHg to 16.5 +/- 2.1 after 45 days (p < 0.0001), and to 16.1 +/- 2.2 after 90 days (p < 0.0001). The DOPP increased by 5.3 +/- 6.3 mmHg after 90 days of treatment (p < 0.0001). No drug related serious adverse events were reported during the study. The open-label and non-comparative nature of the study represented its principal limitations. The study confirmed the efficacy and tolerability of travoprost in the treatment of open-angle glaucoma or ocular hypertension, in a subset of patients unsuccessfully treated with beta-blockers. In this study, travoprost significantly increased DOPP at short-term follow-up. Further studies to assess the effect of travoprost on DOPP are warranted.

  3. Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device.

    PubMed

    Zannis, John; Angobaldo, Jeff; Marks, Malcolm; DeFranzo, Anthony; David, Lisa; Molnar, Joseph; Argenta, Louis

    2009-04-01

    Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. Once the compartment pressure has been relieved and stabilized, the wound should be closed as quickly and early as possible to avoid later complications. Skin grafting can lead to morbidity and scarring at both the donor and fasciotomy site. Primary closure results in a more functional and esthetic outcome with less morbidity for the patient, but can often be difficult to achieve secondary to edema, skin retraction, and skin edge necrosis. Our objective was to examine fasciotomy wound outcomes, including time to definitive closure, comparing traditional wet-to-dry dressings, and the vacuum-assisted closure (VAC) device. This retrospective chart review included a consecutive series of patients over a 10-year period. This series included 458 patients who underwent 804 fasciotomies. Of these fasciotomy wounds, 438 received exclusively VAC. dressings, 270 received only normal saline wet-to-dry dressings, and 96 were treated with a combination of both. Of the sample, 408 patients were treated with exclusively VAC therapy or wet-to-dry dressings and 50 patients were treated with a combination of both. In comparing all wounds, there was a statistically significant higher rate of primary closure using the VAC versus traditional wet-to-dry dressings (P < 0.05 for lower extremities and P < 0.03 for upper extremities). The time to primary closure of wounds was shorter in the VAC. group in comparison with the non-VAC group. This study has shown that the use of the VAC for fasciotomy wound closure results in a higher rate of primary closure versus traditional wet-to-dry dressings. In addition, the time to primary closure of wounds or time to skin grafting is shorter when the VAC was employed. The VAC used in the described settings decreases hospitalization time, allows for earlier rehabilitation, and ultimately leads to increased patient satisfaction.

  4. Identification of Mutations in Myocilin and Beta-1,4-galactosyltransferase 3 Genes in a Chinese Family with Primary Open-angle Glaucoma.

    PubMed

    Liao, Rong-Feng; Zhong, Zi-Lin; Ye, Min-Jie; Han, Li-Yun; Ye, Dong-Qing; Chen, Jian-Jun

    2016-12-05

    Glaucoma is a major cause of irreversible blindness worldwide. There is evidence showing that a subset of the disease is genetically determined. In this study, we screened for mutations in chromosome 1q-linked open-angle glaucoma (GLC1A) in a Chinese family with primary open-angle glaucoma (POAG). A total of 23 members from five generations of a family were enrolled and underwent thorough ophthalmologic examinations. In addition, 200 unrelated healthy Chinese controls were also recruited as normal control. GLC1A gene was amplified by polymerase chain reaction, and DNA sequencing was performed to screen for mutations. Six members were diagnosed as POAG, with severe clinical manifestations, and history of high intraocular pressures. The mean age of disease onset was 26.3 years. However, the others were asymptomatic. In six affected and three asymptomatic members, gene sequencing revealed a mutation c.C1456T in exon 3 of myocilin gene (MYOC). Furthermore, we also identified a novel mutation c.G322A in beta-1,4-galactosyltransferase 3 (B4GALT3) gene in all six affected and three asymptomatic members, which was not reported previously in POAG patients. The two newly identified variants were absent in other family members as well as controls. The mutations c.1456C < T (p.L486F) in MYOC and c.322G < A (p.V108I) in B4GALT3 are likely responsible for the pathogenesis of POAG in this family.

  5. [Clinical phenotype of a Japanese family with primary open-angle glaucoma caused by a Ala 363 Thr mutation in the MYOC gene].

    PubMed

    Ohyama, Akihiro; Fujimaki, Takuro; Kimura, Tairoh; Kawabata, Kiho; Fujiki, Keiko; Ishikawa, Karin; Mashima, Yukihiko; Murakami, Akira

    2006-01-01

    Myocilin is a gene that causes primary open-angle glaucoma (POAG). We report a family whose members had an Ala 363 Thr mutation in the myocilin gene. We present the clinical phenotype of this family. The proband was a 57-year-old man diagnosed with POAG. His younger sister (50 years old) was also diagnosed with POAG. Visual field impairment did not worsen and ocular pressure decreased with eyedrop treatment. Although two of their children in their 30s had ocular hypertension, they did not have any sign of glaucomatous optic neuropathy. Genetic analysis revealed that all four family members had an Ala 363 Thr mutation in myocilin gene. Ala 363 Thr mutation was considered to be the cause of open-angle glaucoma. In this family, age at onset was comparatively high The two patients in their 30s had high intraocular pressure but no loss in visual acuity. The family members who had POAG and those who did not have POAG were not different from each other in the results of standard ocular examinations, only in age. Patients with this mutation will develop high intraocular pressure after 30 years of age and glaucomatous neuropathy after 50 years of age. When this gene mutation is detected in juvenile patients, careful follow-up and early therapy are necessary.

  6. Funduscopic versus HRT III Confocal Scanner Vertical Cup-Disc Ratio Assessment in Normal Tension and Primary Open Angle Glaucoma (The Leuven Eye Study).

    PubMed

    Willekens, Koen; Bataillie, Sophie; Sarens, Inge; Odent, Sofie; Abegão Pinto, Luìs; Vandewalle, Evelien; Van Keer, Karel; Stalmans, Ingeborg

    2017-01-01

    To compare funduscopic and confocal scanning vertical cup-disc ratio (VCDR) assessments and their respective predictive value for estimating functional glaucomatous damage. Data from a single eye of open angle glaucoma patients from the Leuven Eye Study were included: age, gender, intra-ocular pressure, visual acuity, refractive error, visual field mean deviation and pattern standard deviation, funduscopic and HRT III VCDRs as well as mean retinal nerve fibre layer thickness. Non-parametric tests to compare differences within and between diagnostic groups were used, and receiver-operating characteristic curves as well as Bland-Altman plots constructed. Three hundred and one eyes of 301 subjects with primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) were included. The average VCDR assessed with HRT III was significantly smaller than the funduscopic measurement (0.69 ± 0.16 vs. 0.81 ± 0.14, respectively; p < 0.001). The predictive value of both measurement techniques did not differ in NTG patients, but the funduscopic estimate yielded a significantly larger predictive power in patients with severe POAG. Funduscopic and confocal scanner estimates of VCDR differ significantly and should not be used interchangeably. In POAG patients with severe glaucoma, a subjective VCDR predicts functional glaucomatous damage significantly better. © 2016 S. Karger AG, Basel.

  7. Common variants near CAV1 and CAV2 are associated with primary open-angle glaucoma in Caucasians from the USA

    PubMed Central

    Wiggs, Janey L.; Hee Kang, Jae; Yaspan, Brian L.; Mirel, Daniel B.; Laurie, Cathy; Crenshaw, Andrew; Brodeur, Wendy; Gogarten, Stephanie; Olson, Lana M.; Abdrabou, Wael; DelBono, Elizabeth; Loomis, Stephanie; Haines, Jonathan L.; Pasquale, Louis R.

    2011-01-01

    Primary open-angle glaucoma (POAG) is a genetically complex common disease characterized by progressive optic nerve degeneration that results in irreversible blindness. Recently, a genome-wide association study (GWAS) for POAG in an Icelandic population identified significant associations with single nucleotide polymorphisms (SNPs) between the CAV1 and CAV2 genes on chromosome 7q31. In this study, we confirm that the identified SNPs are associated with POAG in our Caucasian US population and that specific haplotypes located in the CAV1/CAV2 intergenic region are associated with the disease. We also present data suggesting that associations with several CAV1/CAV2 SNPs are significant mostly in women. PMID:21873608

  8. Determination of Serum Ceruloplasmin Concentration in Patients with Primary Open Angle Glaucoma with Cataract and Patients with Cataract Only: A Pilot Study

    PubMed Central

    Sarnat-Kucharczyk, Monika; Rokicki, Wojciech; Zalejska-Fiolka, Jolanta; Pojda-Wilczek, Dorota; Mrukwa-Kominek, Ewa

    2016-01-01

    Background The aim of this article was to describe the role of ceruloplasmin and to report preliminary results of ceruloplasmin concentrations in patients with primary open-angle glaucoma (POAG) with cataract and in patients with only cataract. Glaucoma, a neurodegenerative disease, is a heterogeneous group of conditions characterized by loss of retinal ganglion cells (RGC), their axons, progressive optic nerve damage, and visual field deterioration. Material/Methods The POAG group included 30 patients and the cataract group included 25 patients. Results Ceruloplasmin plays an essential role in iron metabolism and inactivating free radicals. In the presented pilot study, serum ceruloplasmin level was lower in the POAG group in comparison to the group with only cataract. Conclusions In treating persistent inflammation in the course of glaucoma, antiglaucoma drugs may increase the permeability of the blood-ocular barrier, which may be connected with the lower concentration of serum ceruloplasmin in the glaucoma patients group. PMID:27109647

  9. Genetic heterogeneity of primary open angle glaucoma and ocular hypertension: linkage to GLC1A associated with an increased risk of severe glaucomatous optic neuropathy.

    PubMed Central

    Brézin, A P; Béchetoille, A; Hamard, P; Valtot, F; Berkani, M; Belmouden, A; Adam, M F; Dupont de Dinechin, S; Bach, J F; Garchon, H J

    1997-01-01

    The GLC1A locus for autosomal dominant juvenile and middle age onset primary open angle glaucoma (OAG) has been mapped to chromosome 1q21-q31. OAG, however, is a heterogeneous disease. We tested linkage of OAG and ocular hypertension (OHT), a major risk factor for OAG, to GLC1A in eight French families with multiple cases of juvenile and middle age onset OAG. There was strong evidence of genetic heterogeneity, four families being linked to GLC1A and two or three others being unlinked, depending on whether the complete OAG phenotype was analysed alone or jointly with OHT. Peak intraocular pressure (IOP) did not differ significantly between the two groups of families, while linkage to GLC1A conferred a highly increased risk of developing OAG and of having severe glaucomatous optic neuropathy. Testing linkage of familial OAG to GLC1A may therefore have prognostic value too. PMID:9222961

  10. Monte Carlo simulation of electron depth distribution and backscattering for carbon films deposited on aluminium as a function of incidence angle and primary energy

    NASA Astrophysics Data System (ADS)

    Dapor, Maurizio

    2005-01-01

    Carbon films are deposited on various substrates (polymers, polyester fabrics, polyester yarns, metal alloys) both for experimental and technological motivations (medical devices, biocompatible coatings, food package and so on). Computational studies of the penetration of electron beams in supported thin film of carbon are very useful in order to compare the simulated results with analytical techniques data (obtained by scanning electron microscopy and/or Auger electron spectroscopy) and investigate the film characteristics. In the present paper, the few keV electron depth distribution and backscattering coefficient for the special case of film of carbon deposited on aluminium are investigated, by a Monte Carlo simulation, as a function of the incidence angle and primary electron energy. The simulated results can be used as a way to evaluate the carbon film thickness by a set of measurements of the backscattering coefficient.

  11. Effect of 2% dorzolamide on retinal blood flow: a study on juvenile primary open-angle glaucoma patients already receiving 0.5% timolol

    PubMed Central

    Costagliola, Ciro; Campa, Claudio; Parmeggiani, Francesco; Incorvaia, Carlo; Perri, Paolo; D’Angelo, Sergio; Lamberti, Giuseppe; Sebastiani, Adolfo

    2007-01-01

    Aim To investigate whether dorzolamide modifies peripapillary retinal haemodynamics in juvenile primary open-angle glaucoma (JPOAG) patients treated with timolol. Methods In 40 JPOAG subjects, before and after dorzolamide coadministration with timolol, the following examinations were achieved: intraocular pressure (IOP), blood pressure (BP), ocular perfusion pressure (OPP), heart rate (HR), visual field and retinal flowmetry. Results Adjunctive therapy with dorzolamide induced the following modifications: IOP reduction [1.75 mmHg, 95% confidence interval (CI) 1.23, 2.26; P < 0.05], OPP increase (5.09 mmHg, 95% CI 2.97, 7.20; P < 0.02) and retinal blood flow improvement (35.0 arbitrary units, 95% CI 12.20, 57.80; P < 0.03). BP, HR and visual field indices did not change. Conclusions Dorzolamide, in association or in fixed combination with timolol, significantly improves retinal blood flow in JPOAG patients. PMID:16981897

  12. Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma

    PubMed Central

    Wasyluk, Jaromir T.; Jankowska-Lech, Irmina; Terelak-Borys, Barbara; Grabska-Liberek, Iwona

    2012-01-01

    Summary Background We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Material/Methods Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18–70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. Results The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in μm) differ significantly between GDx and all OCT devices. Conclusions Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients. PMID:22367131

  13. Localization of a locus (GLC1B) for adult-onset primary open angle glaucoma to the 2cen-q13 region

    SciTech Connect

    Stoilova, D.; Trifan, O.C.; Sarfarazi, M.

    1996-08-15

    Primary open angle glaucoma (GLC1) is a common ocular disorder with a characteristic degeneration of the optic nerve and visual field defects that is often associated with an elevated intraocular pressure. The severe but rare juvenile-onset type has previously been mapped to 1q21-q31, and its genetic heterogeneity has been established. Herein, we present a new locus (GLC1B) for one form of GLC1 on chromosome 2cen-q13 with a clinical presentation of low to moderate intraocular pressure, onset in late 40s, and a good response to medical treatment. Two-point and haplotype analyses of affected and unaffected meioses in six families provided maximum linkage information with D2S417, GATA112EO3, D2S113, D2S373, and D2S274 (lod scores ranging from 3.11 to 6.48) within a region of 8.5 cM that is flanked by D2S2161 and D2S2264. Analysis of affected meioses alone revealed no recombination with an additional two markers (D2S2264 and D2S135) in a region of 11.2 cM that is flanked by D2S2161 and D2S176. Analysis of unaffected meioses identified only one healthy 86-year-old male who has inherited the entire affected haplotype and, hence, is a gene carrier for this condition. Eight additional families with similar and/or different clinical presentation did not show any linkage to this region and, therefore, provided evidence for genetic heterogeneity of adult-onset primary open angle glaucoma. 63 refs., 2 figs., 2 tabs.

  14. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria.

    PubMed

    Duke, Roseline; Akinye, Ayodele; Ameh, Soter

    2013-01-01

    To determine the presenting visual acuity (VA) of patients with primary open angle glaucoma (POAG) and the relationship to ocular comorbidity. A retrospective case note audit was undertaken in Eye Foundation Hospital, Calabar, between 1st January 2010 and 31st June 2011. The case notes of all newly presenting patients diagnosed with POAG were retrieved and data were extracted for analysis. Inclusion criteria for glaucoma was defined. Out of a total of 320 new patients, 88 patients were diagnosed with POAG, with a prevalence of 27.5% (95% CI: 22.7-32.7). The mean age for males is 57.1 ± 8.8 while that of females is 52.6 ± 11.2 and the total mean of 55.8 ± 9.7. Of the 88 patients, there were 84 self referrals [95.5% (95% CI: 88.8-98.7)], of these, 45, 53.6% (95% CI: 42.4-64.5) were for second opinion. There was no statistical significance between the gender, education and occupation and the level of VA seen on presentation. The best corrected visual acuity (BCVA ) in the right and left eye respectively, was significantly (p < 0.0001) related to the cup disk ratio. Ocular comorbid conditions were seen in 19 (22%) patients in the study. The presenting BCVA was significantly related to the presence of ocular comorbidity in the best eye. Comorbidity was not strongly related to the age of the patients. The course of glaucomatous progression is highly variable, identifying factors that not only predict progression but influence the VA and ocular health of the eye can help to guide clinical practice and patient treatment and monitoring. How to cite this article: Duke R, Akinye A, Ameh S. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria. J Current Glau Prac 2013;7(1):6-10.

  15. Apolipoprotein E gene ε4ε4 is associated with elevated risk of primary open angle glaucoma in Asians: a meta-analysis.

    PubMed

    Wang, Yong; Zhou, Yan-Feng; Zhao, Bing-Ying; Gu, Zheng-Yu; Li, Shou-Ling

    2014-05-19

    Epidemiological studies have evaluated the association between Apolipoprotein E (APOE) gene ε2/ε3/ε4 polymorphism and glaucoma susceptibility. However, the published data are still inconclusive. The aim of the present study is to evaluate the impact of APOE gene ε2/ε3/ε4 polymorphism on glaucoma risk by using meta-analysis. A comprehensive literature search of PubMed, EMBASE, Cochrane, Elsevier Science Direct and CNKI databases was conducted to identify relevant articles, with the last report up to January 5, 2014. Pooled odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of association by using the fixed or random effect model. Fifteen separate studies including 2,700 cases and 2,365 controls were included in the meta-analysis. We did not detect a significant association between APOE gene ε2/ε3/ε4 polymorphism and glaucoma in overall population (P > 0.0083). In Asians, we detected an association of the ε4ε4 genotype with elevated risk for glaucoma (OR = 5.22, 95% CI = 1.85-14.68, P = 0.002), mainly for primary open angle glaucoma (OR = 4.98, 95% CI = 1.75-14.20, P = 0.003). The meta-analysis suggests that APOE gene ε4ε4 may be associated with elevated risk for primary open angle glaucoma in Asians. However, more epidemiologic studies based on larger sample size, case-control design and stratified by ethnicity as well as types of glaucoma are suggested to further clarify the relationship between APOE gene ε2/ε3/ε4 polymorphism and genetic predisposition to glaucoma.

  16. Apolipoprotein E gene ε4ε4 is associated with elevated risk of primary open angle glaucoma in Asians: a meta-analysis

    PubMed Central

    2014-01-01

    Background Epidemiological studies have evaluated the association between Apolipoprotein E (APOE) gene ε2/ε3/ε4 polymorphism and glaucoma susceptibility. However, the published data are still inconclusive. The aim of the present study is to evaluate the impact of APOE gene ε2/ε3/ε4 polymorphism on glaucoma risk by using meta-analysis. Methods A comprehensive literature search of PubMed, EMBASE, Cochrane, Elsevier Science Direct and CNKI databases was conducted to identify relevant articles, with the last report up to January 5, 2014. Pooled odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of association by using the fixed or random effect model. Results Fifteen separate studies including 2,700 cases and 2,365 controls were included in the meta-analysis. We did not detect a significant association between APOE gene ε2/ε3/ε4 polymorphism and glaucoma in overall population (P > 0.0083). In Asians, we detected an association of the ε4ε4 genotype with elevated risk for glaucoma (OR = 5.22, 95% CI = 1.85-14.68, P = 0.002), mainly for primary open angle glaucoma (OR = 4.98, 95% CI = 1.75-14.20, P = 0.003). Conclusions The meta-analysis suggests that APOE gene ε4ε4 may be associated with elevated risk for primary open angle glaucoma in Asians. However, more epidemiologic studies based on larger sample size, case–control design and stratified by ethnicity as well as types of glaucoma are suggested to further clarify the relationship between APOE gene ε2/ε3/ε4 polymorphism and genetic predisposition to glaucoma. PMID:24885013

  17. Vacuum-assisted closure for mediastinitis after pediatric cardiac surgery.

    PubMed

    Hiramatsu, Takeshi; Okamura, Yoshitaka; Komori, Shigeru; Nishimura, Yoshiharu; Suzuki, Hiroyuki; Takeuchi, Takashi

    2008-10-01

    Two children, aged 1 and 14 years with methicillin-resistant Staphylococcus aureus mediastinitis after pediatric open-heart surgery, were fitted with a vacuum-assisted closure system. Complete healing was achieved in both cases, and primary wound closure could be carried out without an omental flap after 6 and 16 days.

  18. Identification of Mutations in Myocilin and Beta-1,4-galactosyltransferase 3 Genes in a Chinese Family with Primary Open-angle Glaucoma

    PubMed Central

    Liao, Rong-Feng; Zhong, Zi-Lin; Ye, Min-Jie; Han, Li-Yun; Ye, Dong-Qing; Chen, Jian-Jun

    2016-01-01

    Background: Glaucoma is a major cause of irreversible blindness worldwide. There is evidence showing that a subset of the disease is genetically determined. In this study, we screened for mutations in chromosome 1q-linked open-angle glaucoma (GLC1A) in a Chinese family with primary open-angle glaucoma (POAG). Methods: A total of 23 members from five generations of a family were enrolled and underwent thorough ophthalmologic examinations. In addition, 200 unrelated healthy Chinese controls were also recruited as normal control. GLC1A gene was amplified by polymerase chain reaction, and DNA sequencing was performed to screen for mutations. Results: Six members were diagnosed as POAG, with severe clinical manifestations, and history of high intraocular pressures. The mean age of disease onset was 26.3 years. However, the others were asymptomatic. In six affected and three asymptomatic members, gene sequencing revealed a mutation c.C1456T in exon 3 of myocilin gene (MYOC). Furthermore, we also identified a novel mutation c.G322A in beta-1,4-galactosyltransferase 3 (B4GALT3) gene in all six affected and three asymptomatic members, which was not reported previously in POAG patients. The two newly identified variants were absent in other family members as well as controls. Conclusion: The mutations c.1456C

  19. [Echographic follow-up of the chamber angle in suspected simple glaucoma].

    PubMed

    Makabe, R; Fries, U

    1992-06-01

    We have recently seen a number of patients with angle-closure glaucoma who had been treated for glaucoma simplex (primary open-angle glaucoma). The main cause of this misdiagnosis was gonioscopy, as its findings are subject to the impression of the examiners. For objective examination of the chamber angle and the iris configuration, B-scan ultrasonography was performed using a contact eye cup filled with saline. Two groups of patients were noted in particular. The first group contained relatively young patients, more men than women, with plateau iris and a central normal, deep anterior chamber. The second group consisted of patients with presumed glaucoma simplex. The findings were quite different between eyes. In the eye with a higher IOP, pronounced optic nerve damage and visual field defect, the chamber angle was distinctly more narrow and closed. Most of the patients were treated with beta-blocker drops, which they felt were agreeable.

  20. Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

    PubMed Central

    Chen, Yu; Ye, Jinning; Song, Wu; Chen, Jianhui; Yuan, Yujie; Ren, Jianan

    2014-01-01

    Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P < 0.0001) and complication incidence (RR, 0.68, P < 0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen. PMID:24987411

  1. Patient-reported vision-related quality of life differences between superior and inferior hemifield visual field defects in primary open-angle glaucoma.

    PubMed

    Cheng, Hui-Chen; Guo, Chao-Yu; Chen, Mei-Ju; Ko, Yu-Chieh; Huang, Nicole; Liu, Catherine Jui-ling

    2015-03-01

    Previous studies have found that glaucoma is associated with impaired patient-reported vision-related quality of life (pVRQOL) but few, to our knowledge, have assessed how the visual field (VF) defect location impacts the pVRQOL. To investigate the associations of VF defects in the superior vs inferior hemifields with pVRQOL outcomes in patients with primary open-angle glaucoma. Prospective cross-sectional study at a tertiary referral center from March 1, 2012, to January 1, 2013, including patients with primary open-angle glaucoma who had a best-corrected visual acuity in the better eye equal to or better than 20/60 and reliable VF tests. The pVRQOL was assessed by a validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire. Reliable VF tests obtained within 3 months of enrollment were transformed to binocular integrated VF (IVF). The IVF was further stratified by VF location (superior vs inferior hemifield). The association between each domain of the 25-item National Eye Institute Visual Function Questionnaire and superior or inferior hemifield IVF was determined using multivariable linear regression analysis. The analysis included 186 patients with primary open-angle glaucoma with a mean age of 59.1 years (range, 19-86 years) and IVF mean deviation (MD) of -4.84 dB (range, -27.56 to 2.17 dB). In the multivariable linear regression analysis, the MD of the full-field IVF showed positive associations with near activities (β = 0.05; R2 = 0.20; P < .001), vision-specific role difficulties (β = 0.04; R2 = 0.19; P = .01), vision-specific dependency (β = 0.04; R2 = 0.20; P < .001), driving (β = 0.05; R2 = 0.24; P < .001), peripheral vision (β = 0.03; R2 = 0.18; P = .02), and composite scores (β = 0.04; R2 = 0.27; P = .005). Subsequent analysis showed that the MD of the superior hemifield IVF was associated only with near activities (β = 0.04; R2

  2. Preservative-free bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension in clinical practice

    PubMed Central

    Pillunat, Lutz E; Eschstruth, Peter; Häsemeyer, Stefan; Thelen, Ulrich; Foja, Christian; Leaback, Richard; Pfennigsdorf, Stefan

    2016-01-01

    Background Intraocular pressure (IOP)-lowering medications for primary open-angle glaucoma and ocular hypertension commonly contain preservatives that can cause ocular surface damage in many patients. The purpose of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF) bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension (IOP ≥18 mmHg) in a clinical practice setting. Methods This open-label study observed patients who were switched to PF bimatoprost 0.03% for medical reasons. IOP was measured at baseline and ~12 weeks later at the final visit, and the change in IOP was calculated. Tolerability and continuation of therapy were assessed at two follow-up visits. Results A total of 1,830 patients were included in the study, and complete IOP data were available for 1,543 patients. Mean IOP was reduced by 23% from 21.64 mmHg to 16.59 mmHg (P<0.0001). In subgroup analyses, the mean IOP was significantly reduced compared with baseline, regardless of prior therapy, including those previously treated with PF monotherapy. A total of 85.7% of physicians reported the IOP-lowering efficacy of PF bimatoprost 0.03% to be as expected or better than expected. Adverse events (AEs) were experienced by 5.7% of patients, and there were no serious AEs reported. The most common AEs were eye irritation (1.7%) and hyperemia (1.4%). Physician-reported treatment compliance was reported as better than (48.7%) or equal to (43.6%) prior treatment in most patients. Most patients (82%) were expected to continue PF bimatoprost 0.03% after the end of the study. Conclusion This observational study showed that, in clinical practice, switching to PF bimatoprost 0.03% was associated with a significant IOP reduction from baseline. There was a low AE rate. PF bimatoprost 0.03% may, therefore, be an effective treatment option for patients who are intolerant of preservatives or have an inadequate response to prior IOP

  3. Sternal exploration or closure

    MedlinePlus

    ... Chronic pain Decreased lung function Increased risk of death More infections Need to repeat or revise the procedure Alternative Names VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection References ...

  4. Quick actuating closure

    NASA Technical Reports Server (NTRS)

    White, III, Dorsey E. (Inventor); Updike, deceased, Benjamin T. (Inventor); Allred, Johnny W. (Inventor)

    1989-01-01

    A quick actuating closure for a pressure vessel 80 in which a wedge ring 30 with a conical outer surface 31 is moved forward to force shear blocks 40, with conical inner surfaces 41, radially outward to lock an end closure plug 70 within an opening 81 in the pressure vessel 80. A seal ring 60 and a preload ramp 50 sit between the shear blocks 40 and the end closure plug 70 to provide a backup sealing capability. Conical surfaces 44 and 55 of the preload ramp 50 and the shear blocks 40 interact to force the seal ring 60 into shoulders 73 and 85 in the end closure plug 70 and opening 81 to form a tight seal. The end closure plug 70 is unlocked by moving the wedge ring 30 rearward, which causes T-bars 32 of the wedge ring 30 riding within T -slots 42 of the shear blocks 40 to force them radially inward. The end closure plug 70 is then removed, allowing access to the interior of the pressure vessel 80.

  5. Efficacy of Garcinia kola 0.5% Aqueous Eye Drops in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension

    PubMed Central

    Adefule-Ositelu, Adebukunola O.; Adegbehing