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Background: Better identification of high-risk individuals of type 2 diabetes mellitus (T2DM) for focused delivery of preventive measures requires risk prediction models using novel predictors. We evaluated the predictive value of long-term variability of systolic blood pressure (SBPV), which was recently reported to be associated with T2DM incidence, if added to a model with conventional T2DM predictors in a Japanese cohort study. Methods: A cohort of 3017 Japanese individuals (2446 male, 571 female) ages 36-65 years were followed from 2007 to 2019. Root-mean-square error (RMSE) and slope of systolic blood pressure (SBP) change regressed on year were calculated per individual using SBP values obtained consecutively from 2003 to 2007 to represent SBPV. An initial Cox model included age, sex, smoking status, regular exercise, family history of diabetes, body mass index (BMI), baseline SBP, blood levels of triglycerides (TG), high-density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG), and backward elimination was used for variable selection. The c-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare the performance of prediction models without (Model 1) and with SBPV (Model 2). Results: During 9.8-year (median) follow-up, 135 developed T2DM. We confirmed that RMSE was significantly associated with T2DM incidence independent of other variables used in a conventional model. Backwards elimination procedure selected BMI, TG, HDLC, FBG, SBP RMSE, and SBP slope for the final model (Table 1). Although the c-indices were not statistically different between Model 1 (0.77) and Model 2 (0.78) as well as the NRI (7.1%), the IDI was statistically significant (0.8%, p Conclusions: The present study revealed that long-term variability of SBP slightly improved the predictive value of T2DM if added to a conventional prediction model.

To investigate the visual symptoms and to determine the impact of visual symptoms on vision-related quality of life (QoL) in patients with early to moderate glaucoma. A retrospective, hospital-based, cross-sectional study was conducted from July 1 to August 31, 2014, at a university referral center. A total of 176 patients with early to moderate glaucoma underwent a comprehensive ocular examination, including Humphrey visual field testing. The patients were divided into six groups based on visual symptoms that could be verified by forced-choice questions. Vision-related QoL was assessed by the Korean version of the National Eye Institute Visual Function Questionnaire 25 (K-NEI-VFQ-25). We compared the mean deviation (MD) and questionnaire scores among the groups. Of 352 eyes, 107 (30.4%) were symptomatic. The most common visual symptoms were partial blurring (15.91%), followed by a missing part (7.67%) and a black part (5.97%) of the image. The symptomatic groups (blurred part and missing part) had a significantly worse MD than the asymptomatic group. The symptomatic groups tended to have more visual field defects than the asymptomatic group. The overall NEI-VFQ-25 score in the symptomatic group (black part) was significantly lower than that in the asymptomatic group. Similar effects were observed for other subscale scores, including social functioning, mental health, role difficulties, dependency, and peripheral vision. Vision-related QoL may be severely compromised in glaucoma patients with visual symptoms. Patients with visual disorders should be evaluated for glaucoma and QoL.

PURPOSE To evaluate clinical risk factors of disease progression after cataract surgery using phacoemulsification with posterior chamber intraocular lens implantation, in eyes with chronic angle-closure glaucoma (CACG) and coexisting cataract. DESIGN Retrospective study. METHODS The data of 56 eyes of 45 CACG patients who had undergone uncomplicated phacoemulsification with posterior chamber intraocular lens implantation were retrospectively analyzed. Disease progression was defined as glaucomatous optic nerve change or visual field (VF) deterioration according to the European Glaucoma Society guideline. Correlations between VF progression and various preoperative and postoperative factors were determined by χ and independent t tests. Linear regression analysis [(odds ratio (OR)] was used to determine predictive risk factors for disease progression using univariate and multivariate analyses. RESULTS The mean postoperative follow-up period was 45.13 ± 17.54 (24 to 84) months. Fourteen eyes (25%) with cataracts diagnosed with CACG progressed after phacoemulsification, but the remaining 42 eyes (75%) did not. According to univariate analysis, disease progression was significantly associated with older age, more number of preoperative/postoperative antiglaucoma drugs, higher scores of preoperative pattern standard deviation, and lower scores of preoperative and postoperative visual field index (VFI) (P

Aim The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria. Methods This cross-sectional study evaluated the Kihon Checklist and activities of daily living based on self-records maintained with the assistance of nurses in a convenience sample of 164 elderly outpatients who lived without care or support. Body composition was measured using dual energy X-ray absorptiometry. Physical functions, nutritional status, cognitive function and depressive mood were assessed using standardized evaluations. Frailty status was evaluated using the Cardiovascular Health Study frailty criteria. Results The total Kihon Checklist score closely correlated with validated assessments of physical functions, nutritional state, cognitive function, depressive mood and the number of frailty phenotypes defined by the Cardiovascular Health Study criteria (ρ = 0.655, P

Background To investigate the incidence and risk factors of glaucoma in normal-tension glaucoma (NTG) suspect patients who had been lost-to-follow-up for at least 24 months. Methods Seventy-two eyes of 72 NTG suspect patients who returned to the hospital after at least 24 months of follow-up loss were enrolled in this study between January 2009 and June 2013. The data were collected retrospectively. The incidence of glaucoma was investigated using a comprehensive glaucoma evaluation in lost-to-follow-up NTG suspect patients. The patients were classified into the glaucoma group, who developed glaucoma during the study period, and the glaucoma suspect group, who did not, to analyse the risk factors for glaucoma. Results The number of patients who developed glaucoma was 7 (9.7 %) out of the 72 NTG suspect patients who had been mean lost-to-follow-up for 44 months. The rate of progression from suspected to glaucoma was 2.6 %/year. In the glaucoma group, the baseline intraocular pressure (IOP) was 18.43 ± 2.44 mmHg, and the average retinal nerve fiber layer (RNFL) thickness was 78.14 ± 7.60 μm; in the glaucoma suspect group, the baseline IOP was 14.95 ± 2.47 mmHg, and the average RNFL thickness was 92.55 ± 7.65 μm. The study results showed that the glaucoma group had higher baseline IOP and a thinner average RNFL (p = 0.003; p

To characterize the central corneal thickness (CCT) in Koreans and assess CCT variation in different types of glaucoma.Observational cross-sectional study.Patients previously diagnosed as primary open-angle glaucoma (POAG, n = 343), normal-tension glaucoma (NTG, n = 192), and ocular hypertension (OHT, n = 44), as well as nonglaucomatous patients (n = 224) examined in a glaucoma clinic in Korea.Participants' CCT was measured by ultrasound pachymetry.Mean CCT and its correlations with glaucoma diagnosis, age, spherical equivalent, gender, diabetes, and hypertension.Mean CCT was highest in eyes with OHT (582.1 microm, P0.0001), lowest in NTG (537.5 microm, P0.0001), and intermediate and similar in eyes with POAG and healthy eyes (550.7 and 553.6 microm, respectively, P = 0.289). Central corneal thickness was inversely correlated with age (r = -0.12; P0.0001). There was no statistically significant difference in mean CCT between eyes with different gender or presence of diabetes and hypertension. Mean CCT in normal and OHT eyes was weakly correlated with refractive error (P0.05).In Korean subjects, CCT is greatest in eyes with OHT and least in eyes with NTG.

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.

The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria.This cross-sectional study evaluated the Kihon Checklist and activities of daily living based on self-records maintained with the assistance of nurses in a convenience sample of 164 elderly outpatients who lived without care or support. Body composition was measured using dual energy X-ray absorptiometry. Physical functions, nutritional status, cognitive function and depressive mood were assessed using standardized evaluations. Frailty status was evaluated using the Cardiovascular Health Study frailty criteria.The total Kihon Checklist score closely correlated with validated assessments of physical functions, nutritional state, cognitive function, depressive mood and the number of frailty phenotypes defined by the Cardiovascular Health Study criteria (ρ = 0.655, P 0.001). The area under the receiver operating characteristics curves for the evaluation of frailty status was 0.81 for prefrailty and 0.92 for frailty. The sensitivity and the specificity were 70.3% and 78.3% for prefrailty, and 89.5% and 80.7% for frailty at total Kihon Checklist scores of 3/4 and 7/8, respectively.The Kihon Checklist is a useful tool for frailty screening. Analyzing the results of this self-reporting questionnaire, together with other more high-tech screening modalities, will cost-effectively improve the quality of life for many elderly individuals in a timely manner. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making.

Purpose To determine the reproducibility of morphoscopic contrast sensitivity test values in healthy subjects using the Visual Capacity Analyzer (VCA) (L2 Informatique). Setting Institute of Vision Research, Department of Ophthalmology, Yong-Dong Severance Hospital, Yonsei University, Seoul, South Korea. Methods Five healthy volunteers were recruited for this study. With the VCA, 1 eye of each person was tested with different sized letters displayed on a computer screen at 11 spatial frequencies ranging from low (3.0 cycles/deg [cpd]) to high (30.0 cpd). The measurement was repeated 5 times under 2 screen luminance levels (maximum and 3 cd/m 2 ). Results Under maximum luminance background, the coefficient of variation (CV) and reliability coefficient (RC) at the spatial frequencies examined ranged from 4.3% to 35.0% and 89.1% to 99.8%, respectively. Under a screen luminance of 3 cd/m 2 , the CV ranged from 0.5% to 15.9% and the RC, from 97.5% to 100.0%. Conclusion At the spatial frequencies examined, morphoscopic contrast sensitivity testing using the VCA had a high level of reproducibility and may be useful in measuring a patient's visual function in the actual environment.

Purpose To compare the surgical results of trabeculectomy and Ahmed glaucoma valve implantation after a previous failed trabeculectomy. Methods A retrospective comparative case series review was performed on 31 eye surgeries in 20 patients with primary congenital glaucoma who underwent trabeculectomy or Ahmed glaucoma valve implantation after a previous failed trabeculectomy with mitomycin C. Results The preoperative mean intraocular pressure was 25.5 mmHg in the trabeculectomy group and 26.9 mmHg in the Ahmed glaucoma valve implantation group (p = 0.73). The 48-month postoperative mean intraocular pressure was 19.6 mmHg in the trabeculectomy group and 20.2 mmHg in the Ahmed glaucoma valve implantation group (p = 0.95). The 12-month trabeculectomy success rate was 69%, compared with 64% for Ahmed glaucoma valve implantation, and the 48-month success rates were 42% and 36% for trabeculectomy and valve implantation, respectively. The success rates following the entire follow-up period were not significantly different between the two groups (p > 0.05 by log rank test). Postoperative complications occurred in 25% of the trabeculectomy-operated eyes and 9% of the Ahmed-implanted eyes (p = 0.38). Conclusions There was no significant difference in surgical outcome between the trabeculectomy and Ahmed glaucoma valve implantation groups, neither of which had favorable results. However, the trabeculectomy group demonstrated a higher prevalence of adverse complications such as post-operative endophthalmitis.

Although dermal/subcutaneous injection of filler into the face is a popular aesthetic surgery, severe complications related to arterial occlusion, including skin necrosis and visual loss, have been reported. Herein, we report a case of intra-arterial hyaluronidase infusion in the ophthalmic artery and other arteries supplying the facial skin following hyaluronic acid injection at the glabella and nasal ala. Despite direct hyaluronidase infusion into the ophthalmic artery, retinal arterial perfusion was not restored, but branches of the ophthalmic and facial arteries were recanalised. Skin discoloration was normalised, and partial recovery of retinal and choroidal perfusion and complete recovery of ocular movement were achieved.

* BACKGROUND AND OBJECTIVE: To deter mine the prophylactic effect of 0.2% brimonidine in reducing the elevated intraocular pressure (IOP) in patients undergoing Nd: YAG laser posterior capsulotomy. * PATIENTS AND METHODS: The 81 patients (81 eyes), who underwent Nd: YAG laser posterior capsulotomy, were allocated to two treatment groups. One drop of 0.2% brimonidine or vehicle was instilled 1 hour preoperatively and one drop immediately after capsulotomy. IOPs were measured preoperatively and 1, 2, 3, and 24 hours postoperatively. * RESULTS: Intraocular pressure decreased from the baseline in the brimonidine group by the third postoperative hour (P * CONCLUSIONS: One drop of 0.2% brimonidine instilled 1 hour preoperatively and immediately after capsulotomy was found to be efficacious and safe in preventing IOP elevations that frequently follow Nd:YAG laser posterior capsulotomy. [Ophthalmic Surg Lasers 2000:31:308-314]

Fifty-two eyes of 26 healthy volunteers were recruited for evaluating the effects of 0.005% latanoprost on optic nerve head (ONH) and peripapillary retinal blood flow. In a randomized double-blind design, one eye received one drop of 0.005% latanoprost and its fellow eye received one drop of a placebo eyedrop. Intraocular pressure (IOP), ONH and peripapillary retinal blood flow were measured with Heidelberg retinal flowmetry (HRF) before, 2 and 24 h after administration of eyedrops. IOP was decreased significantly in latanoprost-treated eyes at 2 and 24 h after administration (p < 0.05). In the volume, flow or velocity of ONH and peripapillary retina, there were no significant changes from the baseline values at 2 and 24 h after latanoprost administration in either latanoprost-treated eyes or their fellow eyes (p > 0.05). No significant differences were found in the measured quantities between latanoprost-treated eyes and their fellow eyes at each time point (p > 0.05). This result may suggest that 0.005% latanoprost in healthy subjects does not have any adverse effect on ONH and peripapillary retinal blood flow.

* BACKGROUND AND OBJECTIVE: The authors attempted to determine the effect of mitomycin-C (MMC) on postoperative corneal astigmatism in patients who underwent trabeculectomy or a triple procedure (trabeculectomy, extracapsular cataract extraction, and intraocular lens implantation). * PATIENTS AND METHODS: Using the vector analysis method, the authors measured the postoperative induced astigmatism of 76 eyes in 59 patients who underwent trabeculectomy or a triple procedure with or without the application of MMC. Postoperative induced astigmatism corresponding to the 180° axis was compared between the two groups. * RESULTS: The patients who underwent trabeculectomy with or without MMC showed a mean induced astigmatism of -1.01 D and -2.63 D, respectively, after 1 month (P < .05), and 0.34 D and -1.42 D after 12 months (P < .05). Those who underwent a triple procedure with or without MMC showed a mean induced astigmatism of -1.81 D and -4.50 D, respectively, after 7 days (P < .05), and 1.73 D and -0.13 D, respectively, after 12 months (P < .05). The entire amount of postoperative against-the-rule astigmatic shift was similar between the with-MMC group and the without-MMC group. The against-the-rule astigmatic shift of the group without MMC reached a plateau after 3 months. However, the group with MMC showed continuous against-the-rule astigmatic shift until 12 months. * CONCLUSION: This study suggests that MMC induces less with-the-rule astigmatism in early postoperative periods and continuous against-the-rule shift after 3 months following a trabeculectomy or a triple procedure. [Ophthalmic Surg Lasers 1998;29:484-489.]

* BACKGROUND AND OBJECTIVE: The opti mal number of laser applications for argon laser trabeculoplasty in patients with primary open-angle glaucoma has not been established. The purpose of this study was to determine the fewest number of burns necessary for clinically effective intraocular pressure reduction for these patients. * PATIENTS AND METHODS: Using a prospective, randomized, collaborative study, the authors examined the relationship between the number of laser trabeculoplasty burns and intraocular pressure for patients with primary open-angle glaucoma. A total of 122 patients received either 50 burns to half of the trabecular meshwork (group 1) or 35 burns to one third of the trabecular meshwork (group 2) . * RESULTS: The mean baseline intraocular pressures were similar between group 1 (22.3 ±4.1 mm Hg [mean ± SD]) and group 2 (22.8 ± 5.0 mm Hg) (P = .58). Intraocular pressure reduction at 9 to 12 months, although significant in both groups (group 1 : 4.4 ± 3.0 mm Hg, P < .0001; group 2: 3.9 ± 5.1 mm Hg, P < .0001), did not differ significantly between the two groups (P = .63). * CONCLUSION: This study demonstrated that 35 burns may be as clinically effective as 50 burns in reducing the intraocular pressure in primary openangle glaucoma patients. [Ophthalmic Surg Lasers 1997;28:900-904.]

It is unclear how hospitals should support a patient's decision to return home to die. Thus, we retrospectively examined the usefulness of support from an End-Of-Life Care Team in such difficult decision making. The subjects included non-cancer patients and the elderly. Our results suggest that the burden of making difficult decisions decreases with support from End- Of-Life Care Teams.

Neodymium:YAG (Nd:YAG) goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with a collagen implant (DSCI). The only reported complication of this procedure is choroidal detachment. However, we found an iris synechia in a patient whose intraocular pressure (IOP) was elevated again 1 month after Nd:YAG goniopuncture. Synechiolysis and peripheral iridectomy with Nd:YAG and argon lasers effectively removed the iris synechia, and IOP immediately dropped to the normal range. We believe that iris synechia is a potential complication that may cause elevated IOP after laser goniopuncture in patients having DSCI.

Choice of treatment and in-home palliative care are important for the cancer care of the elderly. In recent years, comprehensive geriatric assessment (CGA), which has been developed as a multidimensional evaluation method for the elderly, has been attracting attention for cancer care as well. CGA can be a common language for the choice of treatment and in-home palliative care of elderly cancer patients. Also, advance care planning (ACP), is important as a process that supports decision making. In the future, better choices of treatment will become available, and in-home palliative care will be improved by carrying out cancer care using CGA, while continuously carrying out ACP as an organization, realizing a high quality of life (QOL) of the elderly.

PURPOSE The purpose of this study was to identify novel autoantigens that react with specific serum autoantibodies in patients with glaucoma. METHODS Sera from patients with glaucoma (n = 80) and healthy subjects without a known pathology (n = 20) were investigated by immunoblot performed with bovine optic nerve lysates and resolved by one- and two-dimensional electrophoresis. Proteins in the immunoreactive spots were selected and identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) data analysis. All the sera from subjects were assayed using enzyme-linked immunosorbent assay to identify autoantibodies. RESULTS We selected two prominent bands with molecular weights of 100 and 220 kDa by 8% sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, and these two bands were only found in the glaucoma patients. Using one-dimensional electrophoresis and LC-MS/MS analyses, we identified these proteins to be valosin-containing protein (VCP) and fodrin, respectively, and using two-dimensional electrophoresis and LC-MS/MS analyses, VCP was identified to be a common target antigen. In patients with primary open angle glaucoma and normal tension glaucoma, the frequency of autoantibodies to recombinant human VCP was 42.0 and 23.3%, respectively (p < 0.002). In the enzyme-linked immunosorbent assay tests, autoantibody titers to recombinant human VCP were significantly higher than that in healthy controls (p < 0.025). CONCLUSIONS VCP represents a potential candidate target for autoantibodies on the optic nerve in patients with glaucoma.

The aim of this study was to evaluate the potential benefit of intraocular pressure (IOP) reduction in normal tension glaucoma (NTG) Asian adult patients in South Korea.This was a retrospective, multicenter analysis of 166 NTG Asian adult patients in South Korea. The patient population consisted of Korean patients with NTG with at least 5 years of records available for evaluation. Patients all had typical glaucomatous optic-disc and/or visual-field changes but had never had a recorded IOP21 mmHg.Overall, 48 (29%) patients were progressed and 116 (71%) were stable over the follow-up period. Of patients with IOPsor=14 mmHg (21/93), 23% progressed andor=15 mmHg (27/73) 37% progressed (P = 0.041). The mean IOP for the stable group was 14.0 +/- 1.8 mmHg, whereas with the progressed group the average mean IOP was 14.4 +/- 1.6 mmHg (P = 0.20). The mean peak IOP was 17.4 +/- 2.2 mmHg in the stable group and 17.8 +/- 2.0 mmHg in the progressed group (P = 0.26). Multivariate linear regression analysis did not any identify independent risk factors for progression, including age, gender, or mean and peak IOP.This study provides initial evidence that Korean patients with normal-tension glaucoma, treated to lower IOPs, may have a decreased incidence of progression over 5 years than those patients with higher IOPs. More research is required to confirm this finding.

To determine the association of central corneal thickness (CCT) and visual field progression in patients with chronic primary angle-closure glaucoma (CPACG) with low intraocular pressure (IOP).Retrospective, comparative case series.A total of 163 eyes with CPACG and sustained IOP18 mm Hg were included. Initial and three-year after mean deviation (MD) on Humphrey field analyzer and CCT with ultrasonic pachymetry were recorded. On the basis of the CCT value, the sample was split in two groups (group 1540 microm; group 2or =540 microm).Mean CCT was 525.8 +/- 11.6 microm in group 1 and 574.4 +/- 24.0 microm in group 2. There was no significant difference for initial MD (P = .979), but a significant difference was found between two groups for follow-up MD (P = .023).Patients with CPACG with a thinner cornea are at greater risk for visual field progression even if they maintain a low IOP after treatment.

The aim of this study was to compare the prophylactic effect of brimonidine 0.2% versus brimonidine Purite 0.15% on intraocular pressure (IOP) increase after Nd:YAG laser posterior capsulotomy.In this prospective, double-masked, randomized, controlled study, 106 patients (106 eyes) who underwent Nd:YAG laser posterior capsulotomy were allocated to a brimonidine 0.2% group (35 eyes), a brimonidine Purite 0.15% group (36 eyes), or a vehicle group (35 eyes). One (1) drop of brimonidine 0.2%, brimonidine Purite 0.15%, or vehicle was instilled 1 h preoperatively and 1 drop immediately after Nd:YAG laser posterior capsulotomy. IOPs were measured preoperatively and at 1, 2, 3, and 24 h postoperatively.Decreases in IOP from baseline ranged from 2.3 to 2.7 mmHg in the brimonidine 0.2% group and 2.2-2.5 mmHg in the brimonidine Purite 0.15% group (P0.05), whereas the vehicle group exhibited a rise in IOP. IOP elevations of less than 5 mmHg occurred in 22.9% of patients in the brimonidine 0.2% group, 27.8% in the brimonidine Purite 0.15% group, and 48.6% in the vehicle group. Spikes of IOP greater than 10 mmHg occurred in 2.9% of patients in the brimonidine 0.2% group, 2.8% in the brimonidine Purite 0.15% group, and 8.6% in the vehicle group. The incidence of IOP elevation was not statistically significant between the brimonidine 0.2% and the brimonidine Purite 0.15% groups (P0.05).Brimonidine 0.2% and brimonidine Purite 0.15% have similar efficacy in the prevention of IOP elevation after Nd:YAG laser posterior capsulotomy.

Purpose: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in patients with large cup/disc ratio (CDR) and normal neuroretinal rim configuration who have normal perimetry (physiologic large cups, LC) and to compare these parameters with those of the normal and early glaucoma patients. Methods: Using Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT), 30 patients with LC, 29 normal subjects, and 31 early glaucoma patients were examined. One eye from each subject was randomly selected. Results: Significant differences between LC and glaucomatous eyes (GE) were found in parameters indicating loss of nerve fibers, such as rim area, rim volume, and mean RNFL thickness. However, there was no difference between LC and normal eyes (NE) in RNFL thickness, rim area, and rim volume. LC was able to be defined as a normal central excavation with a large disc and large CDR with a normal rim area. Conclusions: HRT ONH parameters and RNFL thickness obtained with OCT may be useful for differentiating between glaucoma and LC eyes.

Purpose To compare the effectiveness of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and retinal nerve fiber layer (RNFL) photography using the Heidelberg Retina Angiograph 1 (HRA1) for early glaucoma detection. Design Cross-sectional comparative study. Participants Seventy-two primary open-angle glaucoma patients with early-stage visual field defects and 48 healthy controls were included. Methods Measurements using Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1, as well as standard automated perimetry, were obtained. We constructed receiver operating characteristic (ROC) curves for all available parameters and calculated the area under the ROC curves (AUC) to seek the best discriminating parameter of each test. Subsequently, the ROC curves were calculated for the combinations of the best discriminating parameters of each test to seek the most effective combination for early glaucoma detection. Main Outcome Measure The AUC for various parameters of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1. Results The AUCs of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1 with the best discriminating parameter were 0.990, 0.906, 0.794, and 0.751, respectively. The AUC of the following best combination was 0.972, more than 5 points depressed below the level of 5% on the pattern deviation plot from Humphrey Matrix perimetry, and the nerve fiber indicator was larger than 20 from GDx VCC. Conclusions The AUC of the Humphrey Matrix perimetry was greater than that of the GDx VCC, Stratus OCT, and RNFL photography using HRA1.

The aim of the present study was to determine the effect of purified high-dose anthocyanoside oligomer administration on nocturnal visual function and clinical symptoms in low-to-moderate myopia subjects. The study was a randomized, double-blind, placebo-controlled trial and involved sixty subjects with asthenopia and refractive errors between −1·00 and −8·00 diopters in both eyes. Thirty subjects were administered a purified high-dose anthocyanoside oligomer (100 mg tablet comprising 85 % anthocyanoside oligomer), and thirty were given a placebo in tablet form twice daily for 4 weeks. Prior to the treatment, the placebo and anthocyanoside groups were similar in terms of age and contrast sensitivity. Before and after treatment, subjects completed a questionnaire to determine their clinical symptoms and were also assessed for nocturnal visual function using contrast sensitivity testing. Questionnaire data analysis showed that, following treatment, twenty-two (73·3 %) anthocyanoside subjects showed improved symptoms, whereas only one placebo subject showed an improvement (Fisher's exact test,Pttest,Pttest,P

This study aimed to evaluate the appropriateness of cataract surgery and identify the characteristics of patients and surgeons, clinical and functional outcomes, and surgical methods associated with appropriate cataract surgery. For this purpose, Korean cases of cataract surgery were rated as either 'necessity', 'appropriate', 'uncertain' or 'inappropriate', based on RAND/UCLA Ratings. For this assessment, the cases of 222 patients who underwent cataract surgery, on either one or both eyes, were studied. The surgeries were performed by 20 ophthalmologists practicing at one of fourteen medical institutions (university hospitals and general hospitals). Patients were interviewed and clinical data collected. The Doctors were questioned with self-entered questionnaire forms. The medical records were also examined to gain an understanding of the surgical process. The ratings were as follows: 30.6% (68 patients) of surgeries belonged to the bracket "necessity", 46.4% (103 patients) to "appropriate", 15.3% (34 patients) to "uncertain" and 7.7% (17 patients) to "inappropriate". In this study, "necessity" and "appropriate" were defined as "appropriate" (77.0%, 171 patients), and "uncertain" and "inappropriate" as "inappropriate" (23.0%, 51 patients). The low preoperative Snellen visual acuity and visual function, advanced age and male patients were associated with appropriate surgery. It is concluded that appropriate surgery was related to the clinical and functional outcomes (visual acuity and visual function) and patient characteristics (age and male).

In deep sclerectomy, collagen implant has been used to maintain space under the scleral flap. However, the effect of other implants has not been studied. In this retrospective study, we compared surgical outcomes between small collagen and chromic catgut used as implants in deep sclerectomy. Deep sclerectomy was performed on 23 patients (25 eyes) who either had an open angle and a high intraocular pressure (IOP) (> 22 mmHg) in spite of receiving the maximal tolerable medical treatment, or who were intolerant to medications. Our study consisted of 14 patients (15 eyes) in the small collagen group and 8 (9 eyes) in the chromic catgut group. The mean follow-up period was 8.6 +/- 3.3 months in the small collagen group and 4.4 +/- 1.2 months in the chromic catgut group. The mean preoperative IOP was not significantly different between the two groups. The complete success rate of the small collagen group was significantly better than that of the chromic catgut group at the final follow-up when data were analyzed using the Kaplan-Meier survival curve (87% versus 30%; P = .01). As for the qualified success rate, the small collagen group showed significantly better results at the final follow-up (93% versus 80%; P = .046). The mean number of postoperative medications was significantly lower in the small collagen group (0.26 versus 1.10; P < .05). These results confirmed that the use of small collagen implant in deep sclerectomy produced a higher success rate and a lowered need for postoperative medication compared to the use of chromic catgut implant. Because equal sized implants were used, the difference in biochemical properties, particularly the severity of inflammation caused by the implant, is presumed to be the cause of the different surgical outcomes.

We report a case of Descemet's membrane detachment, a rare complication of viscocanalostomy. During the operation, the injection cannula was directed slightly oblique to the Schlemm's canal rather than parallel to it. Localized corneal whitening developed adjacent to the injection site during viscoelastic injection. One week postoperatively, corneal edema decreased and Descemet's membrane detachment was noted. Nine months after surgery, the cornea was clear while the Descemet's membrane detachment remained. And IOP was 19 mmHg without any medications. We think that improper cannula positioning during viscoelastic injection may cause Descemet's membrane detachment, a rare complication of viscocanalostomy.

We evaulated the effectiveness and adverse effects of deep sclerectomy with collagen implant (DSCI), which is a kind of nonpenetrating filtering surgery. In this retrospective study, DSCI was performed in 15 eyes of 11 glaucoma patients. An trabeculo-Descemet's membrane (TDM) window is created by a deep sclerokeratectomy, and the collagen implant is placed in the sclera bed under a superficial flap (deep sclerectomy with collagen implant). In 3 of 15 eyes the DSCI was intraoperatively converted to conventional filtering surgery for a large perforation of the TDM. These eyes were not included in the results of the surgical outcomes. The mean age of the patients was 50.3 +/- 14.4 years, and the mean follow-up period was 11.1 +/- 5.9 months. A diagnosis of chronic open angle glaucoma was made in 7 eyes and a diagnosis of secondary glaucoma in 5 eyes. The mean preoperative IOP was 25.8 +/- 11.9 mmHg, the immediate postoperative IOP was 6.4 +/- 2.9 mmHg, and at the final follow-up, the IOP was 11.9 +/- 2.5 mmHg. The IOP in 5 eyes was under 6 mmHg temporarily. However, there was no serious complication such as shallow anterior chamber. DSCI is considered to be a good surgical procedure that has similar surgical outcomes to a conventional trabeculectomy without serious complications.

Forty-one healthy volunteers were recruited for a study to compare the intraocular pressure (IOP)-lowering efficacy and side effects of 2% dorzolamide and 1% brinzolamide. In a randomized double-blind design, one eye received one drop of 2% dorzolamide and the other eye received one drop of 1% brinzolamide. The IOP and side effects were evaluated by Goldmann applanation tonometry and slit lamp biomicroscopy before administration, and 3, 7 and 14 days after the initial administration of eyedrops. The IOP decreased significantly from baseline for both drugs (p < 0.05). However, there were no statistically significant differences between 2% dorzolamide and 1% brinzolamide either before or after eyedrop administration (p > 0.05). The most frequent side effect was ocular pain in the case of 2% dorzolamide and blurred vision in 1% brinzolamide. The results suggested that 2% dorzolamide and 1% brinzolamide have similar IOP-lowering efficacies with different side effects

To investigate changes in the level of matrix metalloproteinase-2 (MMP-2) in the anterior chamber of rabbit with intraocular pressure (IOP) elevation. The IOP was elevated with scleral encircling in 12 rabbits. In the control group (4 rabbits), IOP was not changed after scleral encircling, and in group 1 (4 rabbits) and 2 (4 rabbits), IOP was elevated about 10 and 20 mmHg respectively after scleral encircling. At 2 days after scleral encircling, aqueous sampling was performed and levels of MMP-2 were checked by Western blots and gelatin zymograms. The greater the IOP elevation, the more MMP-2 expression in the anterior chamber by Western blots and gelatin zymograms. The increase in MMP-2 expression in response to IOP elevation may have important implications for the IOP feedback control mechanism.

The proliferation of residual lens epithelial cells following cataract surgery is assumed to be a major cause of posterior capsular opacification. To assess the efficacy of mitomycin-C in preventing posterior capsular opacification, we determined the effective concentration and exposure time of mitomycin-C in inhibiting rabbit lens epithelial cell proliferation. The fourth-passaged rabbit lens epithelial cells were maintained for one day and then exposed to mitomycin-C for 1, 2, 3, and 5 minutes, respectively. There were 9 different plating concentrations of mitomycin-C with two-fold serial dilution. The maintenance of the phenotypic properties of lens epithelial cells was confirmed by continuous transcription of lambda-crystalline mRNA determined by reverse transcription-polymerase chain reaction and the polymorphism of the restriction fragment. Cell proliferation was assayed with 3H-thymidine incorporation into DNA. The fourth-passaged cells maintained the expression of lambda-crystalline mRNA, suggesting that they are phenotypically authentic lens epithelial cells. The effective concentrations and exposure time of mitomycin-C were 0.1 mg/ml for 1 minute and 2 minutes, and 0.025 mg/ml for 2 minutes. By these results, we postulated that mitomycin-C at relatively short incubation times could be clinically used for prevention of posterior capsular opacification after cataract surgery.

Purpose To evaluate the changes in conjunctival impression cytology specimens from patients receiving various topical antiglaucoma medications. Design Cross-sectional comparative study. Methods Impression cytology specimens were obtained from the eyes taking no topical medication (n = 20) and from the eyes taking various antiglaucoma medications (timolol n = 34; latanoprost n = 40; dorzolamide n = 32; timolol + latanoprost n = 30; timolol + dorzolamide n = 34). Specimens were graded on a scale of zero to three according to Nelson’s method. Results Cytology scores were significantly higher in the medication group than the control group. Mean cytology scores of the control, timolol, latanoprost, dorzolamide, timolol + latanoprost, and timolol + dorzolamide group were 0.20, 1.62, 2.00, 1.75, 2.13, and 2.44, respectively. Among the medication groups, cytology scores were significantly lower in the monotherapy group than the fixed-combination therapy group. Conclusions Various topical antiglaucoma medications induce a significant degree of squamous metaplasia. Conjunctival surface could be altered after the long-term use of antiglaucoma medication.