Search

Purpose: To assess diurnal variations of intraocular pressure (IOP) in suspected normal-tension glaucoma (NTG) patients with subsequent long-term observation to detect changes that may lead to a new diagnosis., Methods: Diurnal variation of IOP was measured in a sitting position at 2-h intervals for 24 h in a total of 569 subjects with suspected NTG., Results: Thirty of the 569 subjects (5.3%) showed IOP values exceeding 20 mmHg during the 24-h monitoring and were diagnosed as having primary open-angle glaucoma (POAG). In subjects in whom NTG was definitely diagnosed based on the results of the 24-h monitoring, the average maximum, minimum, and mean IOP was 16.1, 11.7, and 13.9 mmHg, respectively, and the mean diurnal variation in IOP was 4.4 mmHg. The peak time was observed outside clinic hours (1800-0800) in 41.4% of patients, and the trough time was observed during clinic hours (1000-1600) in 15.9%. In 2.9% of NTG subjects, the diagnosis was eventually changed to POAG during follow-up., Conclusion: Assessment of diurnal variations of IOP in suspected NTG patients is useful for the differential diagnosis of POAG from NTG and for establishment of a baseline, which may affect the management plan., (Copyright Japanese Ophthalmological Society 2006.)

Objective: To evaluate the results of Ahmed Glaucoma Valve implantation in African American and white patients., Methods: In this retrospective, comparative case-control study, we reviewed 86 eyes of 86 patients, comparing the surgical outcomes in white patients (n = 43) with matched African American patients (n = 43). Success was defined as an intraocular pressure (IOP) between 6 mm Hg and 21 mm Hg with or without glaucoma medicines, without further glaucoma surgery, and without loss of light perception (definition 1) and an IOP between 6 mm Hg and 21 mm Hg and achievement of a 20% reduction in IOP from the preoperative level (definition 2)., Results: The mean follow-up was 2.3 years for white patients and 2.5 years for African American patients (P = .50). At the last follow-up, the mean +/- SD IOP was 15.3 +/- 3.3 mm Hg and 15.3 +/- 3.5 mm Hg (P = .77) in white and African American patients, respectively. Life table analysis showed a significantly lower success rate for African American patients compared with white patients by both definition 1 (P = .03) and definition 2 (P = .006). Cox proportional hazards regression analysis detected African American race as a risk factor for surgical failure by both definitions. Visual outcomes and complications were comparable between the 2 groups., Conclusion: African American patients have a greater risk of surgical failure after Ahmed Glaucoma Valve implantation compared with white patients.

Approximately, one fifth of primary congenital glaucoma patients fail primary surgery. Also, some pediatric glaucomas respond poorly to goniotomy or trabeculectomy. In these situations, clinicians often choose trabeculectomy with mitomycin-C or a drainage implant as a surgical treatment. Glaucoma drainage device implantation is a useful option in refractory patients. When other surgical treatments have a poor prognosis for success, prior conventional surgery fails, or significant conjunctival scarring precludes filtration surgery, glaucoma drainage implant may effectively control intraocular pressure. Patients often require adjunctive glaucoma medications after surgery and may develop complications. Most of these complications, however, are reversible or resolve spontaneously, and most are not associated with vision loss.

Purpose: Glaucomatous visual field loss and optic disc damage differ by intraocular pressure (IOP) levels. In this study, we compared the optic disc topography in the high-tension group and the low-tension group in normal-tension glaucoma (NTG)., Method: We selected NTG patients with mean deviation (MD) > or = -10.00 dB and the highest recorded IOP of < 14 mmHg or > or = 17 mmHg without glaucoma treatment. We classified NTG eyes into the following two groups: 1) a low-tension group with the highest recorded IOP of < 14 mmHg, 2) a high-tension group with the highest recorded IOP of > or = 17 mmHg. The optic disc parameters in the low-tension group eyes were compared with those in the high-tension group eyes using a Heidelberg Retina Tomograph., Results: Nineteen eyes of nineteen patients were selected for each group. The cup/disc area ratio in the global sector, and the rim volume in the nasal sector of the low-tension group had deteriorated more than in the high-tension group., Conclusions: The disc topography is different between the low-tension group and the high-tension group in the nasal sector, suggesting that different pathogenetic mechanisms exist in the optic disc damage in NTG.