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PRéCIS:: This observed patient-specific features and treatment-driven conditions that were significantly associated with the impairment of health-related quality of life (HRQOL) among glaucoma patients. The results suggest that more systematic strategies should be implemented to improve an HRQOL.To determine factors contributing to an HRQOL and assess total, direct and indirect, effects that may exist between the determinants using path analysis.Data were derived from previous Korea glaucoma outcomes research. A total of 847 glaucoma outpatients with ≤2 years of eye-drop use were included in the present study. Including factors and their hypothetical pathways to an HRQOL were based on the literature review and consultation with specialists. Age, sex, comorbidities, and education levels were included as underlying conditions and treatment patterns were defined by the number of daily instillations of prescribed eye-drops. Treatment satisfaction and adherence were estimated using a Treatment Satisfaction Questionnaire for Medication, which assessed side-effects, effectiveness, convenience, global satisfaction, and pill count. An HRQOL was assessed by EQ-5D and EQ-visual analogue scale (EQ-VAS).In EQ-5D analysis, male individuals showed total effects (β=0.102, P=0.0026), including both direct (β=0.076, P=0.0095) and indirect effects (β=0.0253, P=0.0020), which were mediated by treatment satisfaction in the side effects and global satisfaction categories. Higher education (β=0.197, P=0.0020) and satisfaction in the side effect (β=0.095, P=0.0076) and global satisfaction (β=0.075, P=0.0414) categories were found to have direct effects on EQ-5D. For EQ-VAS, higher education levels had significant total effects (β=0.153, P=0.0020) accounting for direct effects (β=0.131, P=0.0030) and indirect effects (β=0.0223, P=0.0531) through global satisfaction. In addition, male individuals had indirect effects (β=0.274, P=0.0165), which was indirectly mediated by satisfaction in the global satisfaction category. Comorbidity (β=-0.096, P=0.0090) and satisfaction in the effectiveness (β=0.094, P=0.0302), convenience (β=0.076, P=0.0390), and global satisfaction (β =0.144, P=0.0020) categories showed indirect effect on EQ-VAS.Higher education and better treatment satisfaction had positive effects on HRQOL both in direct and indirect ways whereas comorbidities indirectly showed negative associations with HRQOL.

To evaluate the occurrence of hyperemia with, and efficacy of, bimatoprost 0.01 % for patients in Korea previously treated for open-angle glaucoma (OAG; including normal tension glaucoma) or ocular hypertension (OHT). In this multicenter, observational study (Asia Pacific Patterns from Early Access of Lumigan 0.01 % in Korea; APPEAL Korea), patients with unachieved target intraocular pressure (IOP) despite previous treatment received bimatoprost 0.01 % daily for 12 weeks. The primary endpoint was incidence of hyperemia and its severity, graded using the standard 5-point photographic scale and grouped as “none to mild” and “moderate to severe”. Hyperemia shifts were reported. IOP and adverse events (AEs) were recorded. Of 800 patients (intent-to-treat/safety population), 248 were switched from previous treatment to bimatoprost 0.01 % monotherapy. Hyperemia shifts from baseline at weeks 6 and 12 were unchanged (84.8, 89.8 %), improved (4.4, 4.8 %), or worsened (10.8, 5.4 %), respectively. The shift was significant at week 6 (P

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Background/aims To investigate the effect of peripapillary retinoschisis on the peripapillary retinal nerve fibre layer (RNFL) thickness measurement by using optical coherence tomography (OCT) in glaucomatous eyes. Methods We included 19 glaucomatous eyes of 19 subjects with peripapillary retinoschisis defined as the splitting of the peripapillary RNFL with schisis cavities (retinoschisis group) and 38 age-matched, refractive error-matched and visual field mean deviation-matched glaucomatous eyes from 38 subjects without peripapillary retinoschisis (control group) that had undergone RNFL thickness measurements by using OCT. RNFL thickness was compared between the two groups. For the retinoschisis group, the RNFL thicknesses prior to peripapillary retinoschisis formation, at the time of peripapillary retinoschisis, and after peripapillary retinoschisis resolution were compared. Results The average RNFL was greater in the eyes in the retinoschisis group (median, 81.6 µm) than in those in the control group (median, 69.7 µm, p=0.009). In the retinoschisis group, the average RNFL thickness at the time of peripapillary retinoschisis was greater than that prior to peripapillary retinoschisis formation (p=0.013) or after peripapillary retinoschisis resolution (p=0.001). The RNFL thickness was not different prior to peripapillary retinoschisis formation and after peripapillary retinoschisis resolution (p>0.05). Conclusions Transient increase in RNFL thickness as determined by OCT was observed in glaucomatous eyes with peripapillary retinoschisis. Caution is warranted when interpreting the RNFL thickness measurement in eyes with peripapillary retinoschisis.

PURPOSE The aim of this study was to investigate the changes in longitudinal retinal nerve fiber layer thickness (RNFLT) as determined by spectral-domain optical coherence tomography (OCT) after optic disc hemorrhage (DH) in glaucomatous eyes. METHODS A total of 65 eyes with unilateral DH and 65 contralateral eyes without DH were subjected to RNFLT measurements by using OCT at the time of DH detection and at 1 year (12±2 mo) and 2 years (24±2 mo) later. For the definition of event-based significant RNFLT changes (a change beyond the upper limit of the 95% confidence interval of test-retest variability), 50 eyes with stable glaucoma without DH that had undergone OCT examinations 3 times with a 1-year interval were also enrolled. Clock-hour sector RNFLT in the eyes with DH and clock-hour sector RNFLT at equivalent locations in the contralateral eyes without DH were analyzed to assess localized and spatially compatible RNFLT changes associated with DH. RESULTS Of the eyes with DH, 38.5% showed decrease in RNFLT and 6.2% showed increase in RNFLT 1 year after DH detection, whereas 58.5% showed decrease in RNFLT and no eye showed increase in RNFLT 2 years after DH detection. Significant decreases in RNFLT in the eyes with DH were associated with the presence of recurrent DH and greater baseline RNFLT (P

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To compare the rate of change of circumpapillary retinal nerve fiber layer (cRNFL) thickness, macular volume and thickness, and optic nerve head (ONH) parameters assessed using spectral-domain optical coherence tomography (SD-OCT) between eyes with progressing and nonprogressing glaucoma.Longitudinal, observational study.Two hundred seventy-nine eyes from 162 glaucoma patients followed for an average of 2.2 years.Eyes were classified as progressors and nonprogressors according to assessment of optic disc and RNFL photographs and visual field progression analysis. Linear mixed effects models were used to evaluate the overall rate of change of cRNFL thickness, macular volume and thickness, and ONH parameters after adjustment for age, spherical equivalent, signal strength, and baseline SD-OCT measurements.The rate of change of cRNFL thickness, macular volume, and thickness and ONH parameters.Sixty-three eyes (22.6%) from 52 subjects were identified as progressors. Average, inferior quadrant, and 6- and 7-o'clock sector cRNFL thickness decreased faster in progressors than in nonprogressors (-1.26 vs -0.94, -2.47 vs -1.75, -3.60 vs -2.52, and -2.77 vs -1.51 μm/year, respectively; all P0.05). The ONH rim area decreased faster, and average and vertical cup-to-disc ratio increased faster in progressors than in nonprogressors (-0.016 vs -0.006 mm(2)/year, and 0.004 vs 0.002 and 0.006 vs 0.004 per year, respectively; all P0.05). Macular cube volume and the thickness of temporal outer and inferior inner macular sectors decreased faster in progressors than in nonprogressors (-0.068 vs -0.048 mm(3)/year, and -2.27 vs -1.67 and -2.51 vs -1.73 μm/year, respectively; all P0.05).Serial measurement of parameters in all 3 areas (cRNFL, macula, and ONH) by SD-OCT may permit identification of progression in glaucomatous eyes.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

International audience; 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.

Background/aims This study aimed to investigate treatment patterns and medication adherence of glaucoma. It also identified key factors associated with non-adherence. Methods It was a cross-sectional, observational study. Patients who use eye-drops for ≤2 years were recruited at 15 eye clinics from March to November 2013. Data were collected through self-administered questionnaires and medical chart review. Medication adherence was evaluated using patients’ self-report on pill count and defined as patients’ administering drug for ≥80% of prescribed days. Medication adherence rate was calculated by dividing actual number of administration from total prescribed number of administration for 7 days. Patients whose self-reported prescription was different from total daily doses of physicians9 prescription were considered as non-adherent. Results A total of 1050 patients included, and medication adherence rate was evaluated in 1046 patients whose verification of adherence was available. Of the total, 27.4% were non-adherent, and the medication adherence rates of the total, the adherent, and the non-adherent were 90.6±17.8%, 96.8±5.5% and 56.6±24.7%, respectively. The most commonly used medication was prostaglandin (PGA) alone and the second was combination of two-class (β-blocker and carbonic anhydrase inhibitor (CAI)) and three-class combination of PGA, β-blocker and CAI followed. In multivariate analysis, the risk of non-adherence was 1.466 times greater in males than in females (95% CI 1.106 to 1.943) and 1.328-fold greater as the daily number of administration was increased (95% CI 1.186 to 1.487). Conclusion Approximately, one-third of the patients were non-adherent, and males and increased daily number of administration were associated with non-adherence. It highlights that more systematic treatment strategies should be considered for better medication adherence, leading to effective glaucoma management.

To investigate the prevalence of, and factors associated with, errors in neuroretinal rim measurement by Cirrus high-definition (HD) spectral-domain optical coherence tomography (OCT) in myopic eyes.Neuroretinal rim thicknesses of 255 myopic eyes were measured by Cirrus HD-OCT. The prevalence of, and factors associated with, optic disc margin detection error and cup margin detection error were assessed by analysing 72 cross-sectional optic nerve head (ONH) images obtained at 5° intervals for each eye.Among the 255 eyes, 45 (17.6%) had neuroretinal rim measurement errors; 29 (11.4%) had optic disc margin detection errors at the temporal (16 eyes), superior (11 eyes), and inferior (2 eyes) quadrants; 19 (7.5%) showed cup margin detection errors at the nasal (17 eyes) and temporal (2 eyes) quadrants; and 3 (1.2%) had both disc and cup margin detection errors. Errors in detection of temporal optic disc margin were associated with presence of parapapillary atrophy (PPA), higher myopia, and greater axial length (AL) (p0.001). Cup margin detection errors were associated with vitreous opacities attached to the ONH surface or acute cup slope angles (p0.001).Errors in neuroretinal rim measurement by Cirrus HD-OCT were found in myopic eyes, especially in eyes with PPA, higher myopia, greater AL, vitreous opacity or acute cup slope angle. These findings should be considered when interpreting neuroretinal rim thickness measured by Cirrus HD-OCT.

Purpose: To study the concentration of vascular endothelial growth factor (VEGF) in the aqueous humor before and after intracameral injection of bevacizumab in eyes with neovascular glaucoma, and to detect the duration of an anti-VEGF effect of bevacizumab in the anterior chamber. Methods: In this prospective interventional case series, 1.25 mg of bevacizumab was injected into the anterior chamber of five eyes in five neovascular glaucoma patients. Aqueous humor samples were obtained just before intracameral injection of bevacizumab and two weeks after injection. The concentrations of VEGF in the aqueous humor were measured using ELISA. To investigate corneal endothelial damage after intrecameral bevacizumab injection, specular microscopy was performed before injection and two weeks after injection. Slit lamp photo and iris fluorescent angiography was performed to determine the regression of iris neovascularization. Results: After injection, substantial regression of neovascularization or fluorescein leakage was seen in all treated eyes. The VEGF concentrations in the aqueous humor in eyes with NVG were 1181.8±1248.3 pg/mL before intracameral injection of bevacizumab. Two weeks after injection, the VEGF concentrations decreased to 33.2±12.2 pg/mL (p=0.04, Wilcoxon signed rank test). There were no significant changes in IOP or corneal endothelial cells. Conclusions: Intracameral bevacizumab injection can remarkably reduce iris neovascularization in neovascular glaucoma patients. VEGF levels were significantly decreased two weeks after injection and corneal toxicity was not observed during short term follow-up. Korean J Ophthalmol 2009;23:188-192

Inner retinal cleavage can be misdiagnosed as a glaucomatous retinal nerve fiber layer (RNFL) defect. This study was performed to characterize eyes with inner retinal cleavage. Inner retinal cleavage is defined as the appearance of a dark spindle-shaped space between the nerve fibers. Patients who presented at our institution with inner retinal cleavage were enrolled in the study. All participants were evaluated by fundus examination, visual field testing with standard automated perimetry, and optical coherence tomography (OCT) imaging. A total of 15 eyes of 11 subjects with inner retinal cleavage were included in the study. The median age of the subjects was 57 years (age range, 30–67 years). In each case, inner retinal cleavage was located adjacent to retinal blood vessels. Tissue bridging the cleavage area was observed in ten eyes. Six eyes had epiretinal membranes (ERMs), two eyes had glaucoma, and one eye had ERM in addition to glaucoma. Six eyes with inner retinal cleavage without combined ocular abnormalities had highly myopic refractive error (−6.50 to −8.50 diopters). Cross-sectional OCT images of the areas of inner retinal cleavage demonstrated defects with irregular margins and empty spaces in the inner layers of the retina. During the follow-up period, no eye showed changes in inner retinal layer cleavage or visual field sensitivity. Inner retinal cleavage was found in eyes with high myopia or ERMs. Inner retinal cleavage was associated with structural changes distinct from those associated with glaucomatous RNFL defects.

Excess scarring of the conjunctiva after glaucoma filtration surgery is a major cause of failure. Transforming growth factor (TGF)-β is critically involved in post-operative scarring. Lithium inhibits TGF-β-induced gene protein expression in corneal fibroblasts and inhibits TGF-β-induced epithelial mesenchymal transition. Here, we investigated the effects of LiCl on TGF-β1-mediated signaling pathways and on myofibroblast transdifferentiation of human Tenon's capsule fibroblasts (HTFs). LiCl treatment reduced expression of TGF-β1-induced α-SMA expression in HTFs. LiCl also decreased Akt phosphorylation induced by TGF-β1. TGF-β1-induced α-SMA expression was significantly decreased by LY294002 and Akt siRNA indicating that these changes are mediated by the PI3K/Akt pathway. Thus, LiCl induces the suppression of transdifferentiation stimulated by TGF-β1 by the regulation of PI3K/Akt signaling in HTFs.

Purpose To investigate the ability of Cirrus high-definition optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) macular ganglion cell analysis (GCA) sector, deviation, and thickness maps to detect early glaucoma. Design Cross-sectional study. Participants We enrolled 131 eyes with early glaucoma (mean deviation >−6.0 dB) and 132 age- and refractive error–matched healthy eyes. Methods Macular GCA maps were obtained using Cirrus HD-OCT. The location, angular distance, and width of circumpapillary retinal nerve fiber layer (RNFL) defects were investigated by using red-free fundus photographs. The presence of a structural abnormality in the GCA map was defined as (1) yellow/red color codes in the sector map, (2) yellow/red pixels (>10) in the deviation map, and (3) blue areas in the thickness map. Main Outcome Measures The prevalence of and factors associated with the presence or absence of abnormal GCA findings were assessed. Results Among the 131 glaucomatous eyes, 105 (80.2%), 115 (87.8%), and 104 (79.4%) showed structural abnormalities in the GCA sector, deviation, and thickness maps, respectively. The absence of abnormal findings in the GCA maps of glaucomatous eyes was associated with the presence of RNFL defects in the superior hemisphere, a greater angular distance between the fovea and the RNFL defect, a narrower width of the RNFL defect, less severe visual field defects, or an isolated peripheral nasal step (outside 10 degrees of fixation) ( P 0.05). A greater angular distance of the RNFL defect remained significant in multivariate analyses ( P 0.05). Among the 132 healthy eyes, 28 (21.2%), 37 (28.0%), and 20 (15.2%) had abnormal findings in the GCA sector, deviation, and thickness maps, respectively. The presence of abnormal GCA findings in healthy eyes was associated with a higher degree of myopic refractive error ( P 0.05). Conclusions Cirrus HD-OCT GCA maps showed a good ability to detect early glaucoma. However, GCA maps did not show abnormal findings in glaucomatous eyes when the angular distance between fovea and RNFL defect was great. These findings should be considered when diagnosing early glaucoma using GCA maps.

PURPOSE We investigated the distribution of central corneal thickness (CCT), and its association with age, sex, intraocular pressure (IOP), anterior chamber depth (ACD), axial length (AL), and the presence of systemic hypertension and diabetes in a Korean population. METHODS Our study is a population-based glaucoma prevalence study of residents aged ≥40 years in Namil-meon area, located in central South Korea. All subjects underwent a complete ophthalmic examination that included CCT measurement with an ultrasonic pachymeter, ACD and AL measurements by optical biometry, and Goldmann applanation tonometry. The right eye of all subjects was analyzed. RESULTS The mean (SD) CCT of the 1259 right eyes was 530.9 (31.5) μm. In univariate analysis, a thicker CCT was associated with a higher IOP (P < 0.001), a longer AL (P = 0.003), and a younger age (P < 0.001). ACD was not correlated significantly with CCT (P = 0.087). Men had a 5.7 μm higher CCT than women (age adjusted, P = 0.001). Subjects with hypertension had a 4.1 μm lower CCT than those without hypertension (age, sex-adjusted, P = 0.027), and the presence of diabetes was not associated significantly with CCT (age, sex-adjusted, P = 0.892). In multivariate analysis, a higher CCT was associated with a higher IOP (P < 0.001), younger age (P = 0.001), male sex (P = 0.005), and the absence of hypertension (P = 0.018). CONCLUSIONS The mean CCT of a Korean population was 530.9 μm. CCT was associated with IOP, age, sex, and hypertension.

To evaluate optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, and macular thickness by using Cirrus HD spectral-domain optical coherence tomography (OCT) in young patients with retinitis pigmentosa (RP).ONH parameters, RNFL thickness, and macular thickness were measured and compared between 36 eyes from 36 young RP patients (RP group; mean age, 23.08 years) and 70 eyes from 70 healthy young subjects (control group; mean age, 22.66 years) using Cirrus HD-OCT. The effects of the presence of optic disc pallor and the severity of visual field (VF) defects on OCT parameters were also evaluated.The RP group had a greater rim area, smaller cup-to-disc ratio, smaller cup volume, thicker RNFL, and thinner macula than the control group (p ≤ 0.024). ONH parameters were not affected by the presence of optic disc pallor (p ≥ 0.239). Eyes with more severe VF defects (mean deviation ≤ -13.88 dB) had thinner average macular areas than eyes with less severe VF defects (mean deviation ≥ -13.88 dB; p = 0.002). Meanwhile, the ONH parameters and average peripapillary RNFL thickness were not significantly different between the two groups (p ≥ 0.275).Young eyes with RP exhibited different OCT parameters compared to healthy eyes. Among the various OCT parameters, only macular thickness was associated with disease severity. These findings should be considered when evaluating young RP patients.

Purpose To describe and quantify the appearance of the optic disk in patients with advanced age-related macular degeneration (ARMD). Design Retrospective comparative study. Methods A total of 316 charts were reviewed. From these, 45 subjects with advanced ARMD (defined as geographic atrophy or disciform scar) in at least one eye were enrolled. Patients with glaucoma or glaucoma visual field defects were excluded. The probability of glaucomatous optic nerve damage was scored by evaluation of stereoscopic optic disk photographs in a masked fashion, according to a predefined evaluation scale and measured with confocal ophthalmoscopy (Heidelberg Retinal Tomograph; HRT). The area of macular involvement was measured in units of disk area. The optic disk evaluation scores and HRT measurements of a group of eyes with a large area of ARMD were compared with their fellow eyes with smaller areas of ARMD. The correlations between the area of macular involvement with the optic disk evaluation scores and HRT measurements were analyzed. Main outcome measures The optic disk evaluation scores and the HRT measurements between study groups. Results Eyes with larger areas of ARMD had optic disks that were more likely to be classified as glaucomatous by clinical evaluation (3.45 ± 0.23 vs 3.05 ± 0.18, P = .015) and by HRT imaging analysis (−0.995 ± 0.423 vs −0.376 ± 0.249, P = .030) than the fellow eyes with smaller areas of ARMD. For eyes with six or more disk areas of ARMD, larger areas of ARMD correlated with a higher cup/disk ratio ( P = .022), smaller neuroretinal rim area ( P = .022), and glaucomatous classification ( P = .040) with HRT discriminant function analysis. Conclusions Eyes with large areas of geographic or diskiform ARMD have optic disk structural alterations that resemble glaucomatous optic neuropathy. This should be taken into consideration when evaluating patients with ARMD for glaucomatous damage.

Glaucoma is a leading cause of irreversible blindness worldwide [1]. For the surgical treatment of glaucoma, filtering surgery, such as trabeculectomy, is performed as a standard procedure. However, in cases of intractable glaucoma, including neovascular glaucoma, uveitic glaucoma, aphakic or intraocular lens glaucoma, and glaucoma after penetrating keratoplasty, it has been reported that the success rate of trabeculectomy is low [2-6]. An aqueous outflow device was first used to treat intractable glaucoma by Zorab in 1912 [7]. Since then, various aqueous outflow devices have been developed for intraocular pressure (IOP) reduction in glaucoma refractory to glaucoma filtering surgeries [8]. The Ahmed glaucoma valve (AGV; New World Medical Inc., Rancho Cucamonga, CA, USA) was introduced in 1993 as the first aqueous shunting device that has a unidirectional valve mechanism designed to prevent postoperative hypotony [9]. Currently, there are 2 types of AGVs that differ in their surface areas: 96 mm2 (FP8), which is generally used in children and 184 mm2 (FP7), which is generally used in adults. In the clinical setting, implantation of the FP7 AGV is challenging in adult eyes with conjunctival scarring or limited subconjunctival space owing to previous ocular surgeries, inflammatory ocular disorders, or small eyes. In these cases, the FP8 AGV is used instead of the FP7 AGV in adult eyes with glaucoma. Although silicone AGV is widely used, little is known about the differences in the efficacy and safety between the 2 models. If the FP7 and FP8 AGVs are similar in terms of efficacy and safety for treatment of adult glaucoma, using the FP8 AGV in adult eyes with insufficient conjunctival or subconjunctival condition could be a useful surgical option for IOP control. This study was performed to compare the postoperative outcomes between FP7 and FP8 AGV implants in adult eyes with glaucoma.

PURPOSE. We evaluated the clinical use of segmented macular layer thickness measurement in terms of glaucoma diagnosis and the ability to detect progression, and to compare such outcomes to those by circumpapillary retinal nerve fiber layer (cRNFLT) and total macular thickness (TMT) measurements. METHODS. The study included 141 glaucomatous and 61 healthy eyes. All glaucomatous eyes were subjected to at least four spectral domain optical coherence tomography (SD-OCT) examinations (mean follow-up, 2.13 years). Segmented macular layers were the macular nerve fiber layer (NFL), ganglion cell and inner plexiform layer (GCA), and outer retinal layer (ORL; from outer plexiform layer to retinal pigment epithelium). Areas under receiver operating characteristic curves (AUCs) discriminating healthy from glaucomatous eyes were determined in baseline measurements. The sensitivity and specificity of these parameters in terms of glaucoma progression detection were determined, with reference to assessment of optic disc/retinal nerve fiber layer (RNFL) photographs/visual field (VF) deterioration as standard(s). RESULTS. GCA afforded the best diagnostic performance among three macular layers. The AUC of the GCA thickness (GCAT) was less than that of cRNFLT (0.869 vs. 0.953, P ¼ 0.018), but superior to that of TMT (0.790, P ¼ 0.05). Of the eyes, 38 showed progression during follow-up by standard methods. The sensitivities of TMT, GCAT, and cRNFLT values in terms of detection of progression were 14%, 8%, and 5%, respectively. CONCLUSIONS. Although baseline cRNFL measurement was optimal in terms of glaucoma diagnosis, the GCAT and TMT showed similar levels of sensitivity in progression detection. (Invest Ophthalmol Vis Sci. 2012;53:3817‐3826) DOI:10.1167/iovs.11-9369

PURPOSE This study investigated the effects of the tumor suppressor protein PTEN (phosphatase and tensin homolog) on transforming growth factor (TGF)-β1-mediated signaling pathways and the transdifferentiation of human subconjunctival fibroblasts (SCFs) after the transduction of this protein containing a transactivator of transcription (Tat) domain. METHODS The Tat-PTEN expression vector was constructed to express the Tat domain of HIV-1 fused to PTEN. After transduction of the fusion protein and TGF-β1 stimulation, the dose-dependent effect of the transduced Tat-PTEN fusion protein on Akt phosphorylation and the stability of the Tat-PTEN fusion protein in SCF cells were evaluated by Western blot analysis. The effect of the Tat-PTEN fusion protein on the TGF-β1-stimulated expression of α-SMA and fibronectin was also evaluated by Western blot analysis and immunocytochemistry. RESULTS To increase the efficiency of enzyme activity and to successfully deliver this protein to cells, the authors used a PTEN fusion protein that contained the transduction domain of the Tat protein from HIV-1. By Western blot analysis, the transduced Tat-PTEN fusion protein was found to modulate TGF-β1 signaling in SCF cells and result in the suppression of Akt phosphorylation. Furthermore, the transduction of the Tat-PTEN fusion protein was found to suppress the TGF-β1-stimulated expression of α-SMA and fibronectin by Western blot analysis and immunocytochemical staining, and the effects of the transduced fusion protein could be controlled in a dose-dependent manner. CONCLUSIONS The Tat-PTEN fusion proteins were successfully transduced into the SCF cells and induced the suppression of transdifferentiation and fibrosis through the regulation of TGF-β-mediated signaling. The ability of the Tat-PTEN fusion protein to regulate cell survival could potentially be applied to protein therapy to counteract postoperative scarring in glaucoma surgery.

Dear Editor, I read with great interest the article by Kim et al. [1] regarding the use of ImageJ to quantitatively analyze the color of optic discs. The authors proposed three points to measure the intensity per pixel area after grayscale conversion, namely nasal rim (NR), brightest cupping center (BCC), and inferior retinal vein (IRV). They found good inter-observer correlation with this method, along with an age-related decrease of BCC pixel intensity. However, the authors did not mention either the disc area or the characteristics of the subjects enrolled in the study. The optic disc area has a high inter-individual variability: large discs have a larger neuroretinal rim area, an increased total area of lamina cribrosa (LC) pores, and a higher ratio of interpore connective tissue area to total LC area [2]. Therefore, in large discs, it might be difficult to determine a representative region denoting BCC if significant pores of different color are located at the very center of the disc. In small discs, on the contrary, a minimal number of or no cups would make the measurement of BCC inaccurate or impossible. Both Varma et al. [3] and Kashiwagi et al. [4] pointed out there were no age-related differences in disc configuration 3,4. When the proportion of small : normal : large disc sizes in Kim's sample was not constant with age, there was a deviation of disc size in particular age group(s), indirectly reducing the accuracy of the correlation of BCC intensity with age. Also, objective measurements of lens status, color, and opalescence were not performed other than a brief mention of best-corrected visual acuity greater than 20 / 25 in all subjects. In patients suffering from nucleosclerotic cataract, the visual acuity can be much preserved with a disproportionate loss of transparency. Media opacities are likely to be present to some extent in some of the older subjects, which is a major confounding factor. This should prompt the use of a more objective lens assessment system such as Lens Opacity Classification System III or Scheimpflug images to adjust the obtained parameters 5. The ImageJ software enables a particular area of an image to be highlighted and a histogram of intensity to be calculated. Grewal et al. [5] employed this method to study different parts of a nuclear cataract and to determine correlations among several visual functions 5. Its importance, in our context, is highlighted in analyzing optic neuropathies with sectoral pallor, such as ischemic optic neuropathy, 'bow-tie' atrophy from chiasmal compression, and pathological temporal pallor in nutritional optic neuropathy. The contrast of 'intensity' between different areas of a disc might be enhanced in borderline cases, which helps with diagnosis. Serial measurements can serve as a tool to longitudinally monitor patients. Alternatively, the whole neuroretinal rim or cup can be highlighted to provide a more generalized quantitative analysis of the region of interest.

Purpose: To assess and compare the clinical outcomes of primary trabeculectomy with mitomycin C and Ahmed valve implantation for secondary open-angle glaucoma following uveitis. Methods: This study was conducted retrospectively on 30 eyes of 25 patients with open-angle glaucoma secondary to uveitis that had undergone trabeculectomy with mitomycin C and 33 eyes of 24 patients that had undergone Ahmed valve implantation. The clinical outcome indicators used in this study were intraocular pressure (IOP), number of anti-glaucoma agents, surgical success rate and occurrence of complications. Results: Mean IOP and surgical success rate in patients who had undergone trabeculectomy with mitomycin C after a 12 month postoperative period were 14.08.2 mmHg and 76.7%, respectively, while those of patients with Ahmed valve implantation were 13.27.7 mmHg and 81.8%. The data did not show clinical significance. There was greater risk of surgical failure in patients at a younger age and/or with diabetes mellitus in cases of having gone through trabeculectomy with mitomycin C. Conclusions: Both trabeculectomy with mitomycon C and Ahmed valve implantation can be considered as primary surgical treatments for patients with open-angle glaucoma secondary to uveitis. However, trabeculectomy with mitomycin C should only be applied to a limited extent in patients that are young and/or have diabetes mellitus.

Purpose: To compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs). Methods: The medical records of 62 consecutive refractory glaucoma patients who had undergone AGV implantion from March 2003 to December 2005 were reviewed retrospectively. Among the 62 patients, 32 patients underwent polypropylene AGV implantation (group P) and the other 30 patients underwent silicone AGV implantation (group S). Postoperative IOP, the complication rate, and the success rate were compared between the two groups. Results: The life-table success rates for the group P were 81.3% at 6 months and 71.2% at 12 months, and the success rates for the group S were 89.9% at 6 months and 78.6% at 12 months, showing no significant difference between the two groups. Complications, including non-tube-related complications, were observed more frequently in the group S, but there was no significant difference between the two groups. Conclusions: The silicone AGV can reduce IOP effectively but may be associated with non-tube-related complications. J Korean Ophthalmol Soc 49(5):791-797, 2008

Glaucoma is optic neuropathy with the loss of retinal ganglion cells (RGC) and their axons.1,2 The loss of RGC axons may be structurally apparent as a localized and/or diffused thinning of the retinal nerve fiber layer (RNFL).2-5 Optical coherence tomography (OCT) and scanning laser polarimetry (SLP) are two imaging technologies designed to measure peripapillary RNFL thickness. With OCT (Stratus OCT; Carl Zeiss Meditec, Dublin, California, USA), scanning interferometry is used to obtain a cross section of the retina based on the reflectivity of the different layers of the retina.6-8 A high reflectance layer located just under the inner surface of the retina corresponding to the RNFL is measured with a computer algorithm to determine RNFL thickness.8 The GDx VCC (Laser Diagnostic Technology, San Diego, California, USA) , the latest version of SLP, is equipped with a variable corneal compensator and estimates the thickness of the RNFL by measuring the summed retardation of a polarized scanning laser beam, induced by form-birefringent microtubules supporting the RGC axons.9-11 Despite previous studies' demonstration of relatively high diagnostic accuracy in detection of glaucoma with OCT and GDx VCC,12-18 it is not known whether the measurements of Stratus OCT and GDx VCC have any correlation at all. The purpose of this study was to investigate the relationship between Stratus OCT and GDx VCC peripapillary RNFL measurements in glaucoma. According to the severity of visual field defect, the relationship of these measurements will be evaluated.

Background This study evaluates the efficacy and tolerability (ie, occurrence and severity of hyperemia) of bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma (OAG) or ocular hypertension in the Korean clinical setting. Methods In this multicenter, open-label, observational study, treatment-naïve patients with OAG, including patients with normal-tension glaucoma (NTG, defined as IOP ≤21 mm Hg), or ocular hypertension received bimatoprost 0.01% once daily. Hyperemia was assessed at baseline and weeks 6 and 12, graded by a masked evaluator using a photonumeric scale (0, +0.5, +1, +2, +3), and grouped as (0 to +1) and (+2 to +3). Shifts between groupings were reported as no change, improved ([+2 to +3] to [0 to +1]), or worsened ([0 to +1] to [+2 to +3]). Other adverse events were monitored. Mean IOP changes from baseline at weeks 6 and 12 were reported. Supplemental analyses were conducted for IOPs >21 versus ≤21 mm Hg. Results Of 295 treatment-naïve patients included in the intent-to-treat/safety population, 73 (24.7%) had baseline IOP >21 mm Hg (mean, 25.7 ± 5.0 mm Hg) and 222 (75.3%) had baseline IOP ≤21 mm Hg (mean, 16.3 ± 3.0 mm Hg); 96.3% had hyperemia graded none (36.3%) to mild (17.3%). At week 12, hyperemia was graded none to mild in 83.7% (n = 220). Worsening occurred in 12.3% of patients by week 6 and 12.7% by week 12. Small improvements occurred in 0.8% and 0.5% of patients at weeks 6 and 12, respectively. Hyperemia scores were generally low and the majority of patients had no change in severity during the study. Mean IOP at weeks 6 and 12 was reduced to 16.4 ± 4.0 mm Hg (-34.5%; P 21 mm Hg group versus 13.3 ± 2.6 mm Hg (-17.8%; P