Hideko Sawada

Tumor Necrosis Factor-α Concentrations in the Aqueous Humor of Patients with Glaucoma

PURPOSE To investigate the concentration of tumor necrosis factor (TNF)-alpha in the aqueous humor of patients with glaucoma, including correlations with glaucoma subtypes and intraocular pressure. METHODS The study population comprised 84 patients with open-angle glaucoma who were scheduled for filtration or cataract surgery. Glaucoma subgroups included 29 cases of primary open-angle glaucoma (POAG), 28 cases of normal-tension glaucoma (NTG), and 27 cases of exfoliation glaucoma (ExG). Seventy-nine patients with senile cataract were recruited as control subjects. The concentrations of TNF-alpha in the aqueous humor were measured with an enzyme-linked immunosorbent assay. The percentages of samples positive for TNF-alpha and the measured concentrations in the glaucoma and cataract groups were compared. In addition, the relationships with the glaucoma subtypes, intraocular pressure, and glaucoma severity were analyzed. RESULTS A significantly higher percentage of subjects in the glaucoma group were positive for TNF-alpha compared with the cataract group (P = 0.011). The mean TNF-alpha concentrations among the positive cases were not different between the groups (P = 0.689). TNF-alpha-positive samples were higher in the POAG (13.7%) and NTG (10.7%) subgroups than in the cataract group without significance, but higher in ExG subgroup (29.6%) with significance (P = 0.001). Relationships between the TNF-alpha concentration and the intraocular pressure or the clinical stage of glaucoma were not observed. CONCLUSIONS TNF-alpha levels were significantly higher in the glaucoma group than in the cataract group, with a particularly large difference observed in those with ExG. The results suggest that TNF-alpha plays a key role in the progression of glaucoma.

Assessment of the vision-specific quality of life using clustered visual field in glaucoma patients.

Purpose:To investigate the significance of vision-specific quality of life (QOL) in glaucoma patients based on the location of visual field defects. Patients and Methods:We examined 336 eyes of 168 patients. The 25-item National Eye Institute Visual Function Questionnaire was used to evaluate patients’ QOL. Visual field testing was performed using the Humphrey Field Analyzer; the visual field was divided into 10 clusters. We defined the eye with better mean deviation as the better eye and the fellow eye as the worse eye. A single linear regression analysis was applied to assess the significance of the relationship between QOL and the clustered visual field. Results:The strongest correlation was observed in the lower paracentral visual field in the better eye. The lower peripheral visual field in the better eye also showed a good correlation. Correlation coefficients in the better eye were generally higher than those in the worse eye. For driving, the upper temporal visual field in the better eye was the most strongly correlated (r=0.509). For role limitation and peripheral vision, the lower peripheral visual field in the better eye had the highest correlation coefficients at 0.459 and 0.425, respectively. Conclusions:Overall, clusters in the lower hemifield in the better eye were more strongly correlated with QOL than those in the worse eye. In particular, the lower paracentral visual field in the better eye was correlated most strongly of all. Driving, however, strongly correlated with the upper hemifield in the better eye.

Oxidative Stress Markers in Aqueous Humor of Patients with Senile Cataracts

Purpose: To investigate the levels of oxidative stress markers in human eyes with senile cataracts. Methods: We conducted a retrospective, case-controlled study of 57 patients with senile cataracts. To assess oxidative stress markers in the eye, we measured the enzymatic activities of superoxide dismutase (SOD) and catalase (CAT) as well as the total protein levels in aqueous humor. Results: In aqueous humor, SOD and CAT activity levels were 0.133 ± 0.020 and 1.223 ± 0.081 U/ml, respectively; protein levels were 2.372 ± 0.166 mg/ml (means ± SEM). We observed a significant increase in SOD activity and the protein level in progressed nuclear cataracts. No significant age-associated difference in antioxidant enzyme levels was detected. Conclusion: Significant increases in the levels of SOD activity and total protein correlated with the severity of the cataract but not with patient age, suggesting that progressed cataract is associated with molecules leaking from the lens capsule.

Progression rate of total, and upper and lower visual field defects in open-angle glaucoma patients

Purpose We evaluated the progression rate of total, and upper and lower visual field defects in treated open-angle glaucoma patients. Patients and methods This study was a retrospective, nonrandomized, comparative study. Five-hundred forty-four eyes from 315 Japanese open-angle glaucoma patients were examined. The mean deviation (MD) and total deviation (TD) for both the upper and lower slopes on the Humphrey Field Analyzer were calculated and compared in high-tension glaucoma (>21 mmHg) and normal-tension glaucoma (≤21 mmHg). Results Patients with over −20 dB of MD and over −23 dB of upper or lower TD were enrolled into each analysis. Patients with −7.75 ± 5.30 (mean ± standard deviation) dB of MD, −9.16 ± 10.80 dB of upper TD, or −7.11 ± 6.02 dB of lower TD were followed up for 4–19 years. The mean MD slope was −0.41 ± 0.50 dB/year, the upper TD slope was −0.46 ± 0.65 dB/year, and the lower TD slope was −0.32 ± 0.53 dB/year. Comparing high-tension glaucoma and normal-tension glaucoma, the upper TD slope was similar for both types of glaucoma, but the MD and lower TD slopes in high-tension glaucoma were significantly lower than those in normal-tension glaucoma. Conclusions The progression rates in lower visual field defects in high-tension glaucoma might be faster than those in normal-tension glaucoma. The results of this study might be used to predict the prognosis of visual field defects, as well as the quality of vision in patients with open-angle glaucoma.

The Relationship Between the Mean Deviation Slope and Follow-up Intraocular Pressure in Open-angle Glaucoma Patients

Purpose:The purpose of this study was to analyze the relationship between the mean deviation (MD) slope as the progressive rate of visual field defects and the follow-up intraocular pressure (IOP) in open-angle glaucoma (OAG) patients. Methods:This study was a retrospective, nonrandomized comparative study. A total of 287 eyes from 287 Japanese OAG patients were examined. The MD slope of the Humphrey Field Analyzer was calculated and compared with the follow-up IOP. OAG was classified into the high-tension group (>21 mm Hg) and the normal-tension group (⩽21 mm Hg) on the basis of the highest recorded IOP without treatment, and then the 2 groups were compared. After setting a threshold for the progression rate at −0.3 dB/y, related factors were compared between the fast-progression and slow-progression eyes in each group. Results:The correlation line between the follow-up IOP and the MD slope was statistically significant in the high-tension group but not in the normal-tension group. Compared with eyes with slow progression, eyes with fast progression in the high-tension group were older and had a higher mean IOP, greater highest and lowest IOPs, and a smaller mean IOP reduction ratio, whereas eyes with fast progression in the normal-tension group had a greater SD of the mean IOP, a larger IOP range, and a greater highest IOP. Conclusions:Eyes with a faster visual field progression tended to have a higher follow-up IOP in the high-tension group and larger IOP fluctuations in the normal-tension group of OAG patients. We should monitor both the follow-up IOP and fluctuations in IOP to provide a safer and more reliable visual field prognosis for OAG.

Incidence, severity and factors related to drug-induced keratoepitheliopathy with glaucoma medications

Purpose To evaluate the incidence, severity, and factors related to drug-induced keratoepitheliopathy in eyes using antiglaucoma eye drops. Patients and methods In a cross-sectional study, 749 eyes from 427 patients who had used one or more antiglaucoma eye drops were examined at Niigata University Medical and Dental Hospital or related facilities. The incidence and severity of superficial punctate keratitis (SPK), patient gender and age, type of glaucoma, and type of eye drops were recorded. SPK was graded according to the AD (A, area; D, density) classification. The severity score (SS) was calculated from A × D. Results SPK was observed in 382 (51.0%) of 749 eyes that had received any type of antiglaucoma eye drops. While 254 eyes (33.9%) were classified as A1D1 (SS 1), 34 eyes (4.6%) had severe SPK with SS 4 or more. The number of eye drops and the total dosing frequency per day were significantly greater in SPK-positive eyes than in eyes without SPK. The number of eye drops was proportional to the frequency and severity of SPK. Among eyes that were treated with three or more eye drops, SPK was more severe and more frequent in older patients (≥71 years). In addition, a considerable difference was detected for each type of glaucoma. Conclusion Drug-induced keratoepitheliopathy is often observed in eyes that have received recent antiglaucoma eye drops. The number of eye drops, the total dose frequency per day, patient age, and type of glaucoma may affect this condition. We have to consider not only the effects on intraocular pressure but also the incidence and severity of drug-induced keratoepitheliopathy as a frequent side effect of glaucoma medications.

Evaluation of the relationship between quality of vision and visual function in Japanese glaucoma patients

Purpose: To evaluate the correlation between quality of vision (QOV) and visual function in glaucoma patients. Patients and methods: The relationship between QOV and visual function was investigated in 200 Japanese glaucoma patients. QOV was assessed using the Japanese version of the 25-item National Eye Institute Visual Function Questionnaire. The better eye and the worse eye were defined based on the mean deviation (MD) value of the Humphrey Field Analyzer program 30-2. A single linear regression analysis was applied to assess the relationship. Results: The lowest subscale score was observed in general health followed by general vision and driving. Visual acuity and the central 10° MD value in the better eye and the central 30° MD value in the worse eye were highly correlated with QOV. Threshold MD values at which patients began to have lower QOV ranged from −2 to −12 dB in the better eye and from −7 to −16 dB in the worse eye. Conclusion: Loss of visual function in both the better and the worse eye is significantly correlated to QOV. QOV of glaucoma patients begins to decrease in the early stages of visual field defects.

[Persistent hyperplastic primary vitreous--a case report of adult onset acute angle-closure glaucoma].

BACKGROUND We report a patient with persistent hyperplastic primary vitreous(PHPV) who presented with acute angle-closure glaucoma in his adult life. CASE A 30-year-old man had an attack of acute angle-closure glaucoma associated with retrolenticular fibrous tissue, atrophic retina, and elongated cilliary process in his right eye. RESULT Ultrasound biomicroscopy(UBM) study showed iris bowing, shallow anterior chamber, and elongated cilliary body which were being pulled by the retrolenticular mass. The posterior chamber was normal. CONCLUSION Although the mechanisms of secondary angle-closure glaucoma in PHPV are complicated, we suspected pupillary block resulting from constriction by the retrolenticular mass in this case.

Changes of scleral sulfated proteoglycans in three cases of nanophthalmos.

PurposeTo examine the composition of scleral sulfated proteoglycans in three nanophthalmic eyes by electron microscopic histochemistry.MethodsScleral tissues from three cases of nanophthalmos were collected from the Niigata University Hospital for transmission electron microscopic examination. Sulfated proteoglycans were studied using the cuprolinic blue (CB) dye binding method in conjunction with enzymatic digestion.ResultsCompared with the controls, the nanophthalmic sclerae were much thicker, and the collagen fibrils showed a less orderly arrangement. Twisting or fraying of collagen fibrils was noted in some areas, and fine fibrous materials surrounded the abnormal fibrils. CB-positive proteoglycan filaments were found around the collagen fibrils and in the fine fibrous materials in the nanophthalmic specimens. The number of proteoglycan filaments was smaller than that in the normal specimens. After enzymatic digestion, the CB-positive filaments were identified as dermatan/chondroitin sulfate proteoglycans. Although the number of dermatan sulfate filaments in nanophthalmos sclerae was similar to that in the controls, there were many fewer chondroitin sulfate filaments.ConclusionA loss of chondroitin sulfate proteoglycan was observed in nanophthalmic sclerae. The alteration may be related to the abnormal organization of collagen fibrils and the onset of uveal effusion.

Clustered Trend-Type Analysis to Detect Progression of Visual Field Defects in Patients with Open-Angle Glaucoma

Glaucoma remains one of the leading causes of acquired blindness worldwide (Thylefors & Negrel, 1994; Quigley & Broman, 2006). Open-angle glaucoma (OAG) including primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG), is the most common type of glaucoma and is just a representative chronic disease such as hyptertension and diabetes mellitus (Schwartz & Quigley, 2008; Quigley, 2011). Because the ultimate goal of glaucoma treatment is to maintain long-term visual function, glaucomatous patients require essentially lifelong follow-up. Thus, we need an approach to glaucoma management that considers patients’ present visual functions as well as their future prognosis. The pathogenesis of glaucomatous optic neuropathy as well as the details of its long-term progression have not beeen clered yet. Many clinical trials have confirmed the importance of intraocular pressure (IOP) in the development and progression of OAG (Kass et al., 2002; Gordon et al, 2002; Heijl et al. 2002; 2003; Leske et al, 1999; 2003; Collaborative normaltension glaucoma study group, 1998; 2001; Anderson et al, 2003; The AGIS Investigators, 1994; 2000; Katz, 1999; Musch et al, 2009; Parrish et al, 2009; Chauhan et al, 2008). These studies have shown that lowering IOP reduces the risk of developing OAG and slows its progression. The aim of current glaucoma treatment approaches is to maintain patients’ visual function for as long as possible by reducing IOP. In addition to visual function, of course, we monitor patients’ IOP, optic discs, and retinal changes. Since preservation of visual fields is the final outcome in glaucoma management, ongoing evaluation of patients’ visual fields must be the most important activity in clinical practice. Recently, the morphological evaluation of optic disc cupping, retinal nerve fiber layer defects, and the retinal ganglion cell complex by imaging systems such as optical coherence tomography (OCT) has become popular (Wollstein et al, 2005; Tan O et al, 2009). After all these systems provide only the ability to reliably and safely detect or predict glaucoma progression beside monitering visual field and visual acuity (Hood & Kordon, 2007; Harwerth et al, 2010; Parrish et al, 2009). Standard automated perimetry (SAP) is used to examine and evaluate visual fields, but the technique is difficult to perform and have still has many problems. Furthermore, there is