Kaori Tenkumo

Evaluation of peripapillary choroidal thickness in patients with normal-tension glaucoma

BackgroundTo compare peripapillary choroidal thickness measurements between normal and normal-tension glaucoma eyes.MethodsCross-sectional comparative study. 50 normal and 52 normal-tension glaucoma subjects were enrolled in the study. Peripapillary choroidal thickness was measured with spectral-domain optical coherence tomography and enhanced depth imaging. After obtaining circular B-scans around the disc, choroidal thicknesses were calculated based on the exported segmentation values. Visual fields were measured using automated perimetry. Difference in peripapillary choroidal thickness between the normal subjects and the patients with normal-tension glaucoma was analyzed.ResultsThere were no significant differences in age, axial length, or refraction between the two groups. Peripapillary choroidal thickness was inversely correlated with age in both the normal (r = −0.287, P = 0.04) and normal and normal-tension glaucoma (r = −0.322, P = 0.02) groups. Peripapillary choroidal thickness of inferonasal (125 vs 148u2009μm, P < 0.05), inferior (101 vs 122u2009μm, P < 0.05), or inferotemporal (100 vs 127u2009μm, P < 0.05) regions were significantly thinner in the normal-tension glaucoma group as compared to normal subjects. Superior visual hemifield defect was significantly worse than inferior visual hemifield defect in normal and normal-tension glaucoma patients.ConclusionAs compared to normal subjects, peripapillary choroidal thickness was significantly thinner in the normal and normal-tension glaucoma patients, at least in some locations.

One-Year Results of Reduced-Fluence Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

PURPOSEnTo report 1-year results of reduced-fluence photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) in Japanese patients.nnnDESIGNnProspective interventional case series.nnnMETHODSnIn the present study, 28 treatment-naïve eyes of 28 consecutive patients underwent PDT with a reduced laser fluence of 25 J/cm(2). Patients were followed up at baseline and 1 week and 3, 6, 9, and 12 months after PDT. Choroidal perfusion changes were evaluated by indocyanine green angiography (ICGA) and leakage from PCV lesions and exudative changes by fluorescein angiography and optical coherence tomography. Treatment safety was assessed according to visual acuity (VA) and adverse events. The best-corrected VA (BCVA) obtained by Landolt ring tests was converted into the logarithm of the minimal angle of resolution (logMAR).nnnRESULTSnAt baseline, the mean logMAR BCVA was 0.45 (geometric mean: 7/20). At 12 months, the mean logMAR BCVA significantly improved to 0.29 (geometric mean: 10/20) (P = 0.0001). The logMAR BCVA was stable or improved by >or=0.2 in 26 eyes (93%) at 1-year follow-up. In 10 eyes with VA better than 20/40 at baseline, the mean logMAR BCVA was significantly improved compared with baseline at 12 months. Although 16 of 28 eyes (57%) showed mild to moderate nonperfusion of choriocapillaris in early ICGA at 1 week, 27 eyes (96%) showed recovery to pretreatment levels at 3 months. Mean number of treatment sessions during the 12 months was 1.3. No severe side effects related to treatment were encountered.nnnCONCLUSIONSnReduced-fluence PDT is an effective treatment for PCV and could improve vision even in eyes with VA better than 20/40.

Correlation between the ganglion cell-inner plexiform layer thickness measured with cirrus HD-OCT and macular visual field sensitivity measured with microperimetry

PURPOSEnTo evaluate relationships between the macular visual field (VF) mean sensitivity and the ganglion cell and inner plexiform layer (GCA) thicknesses.nnnMETHODSnSeventy-one glaucoma patients and 29 healthy subjects were included in this cross-sectional study. At each visit, GCA thicknesses were measured by Cirrus HD-OCT and static threshold perimetry was performed using Macular Integrity Assessment (MAIA). The relationship between the VF sensitivity and GCA thickness was examined globally, and in the superior hemiretina, inferior hemiretina, and six VF sectors with both VF and optical coherence tomography (OCT) in retinal view. Regression analysis was used to investigate the relationship between the GCA thickness and macular sensitivity.nnnRESULTSnMacular VF sensitivity (dB) and GCA thickness relationships were statistically significant in each sector (R = 0.365-0.706, all P < 0.001). The highest correlation observed was between the inferotemporal average mean sensitivity and the inferotemporal average GCA thickness (R = 0.706) with both VF and OCT in retinal view. Strength of the structure-function relationship for each of the corresponding inferior sectors was higher than those for the corresponding superior sectors. The strength of the structure-function relationship of the temporal sector was higher than that of the nasal sector.nnnCONCLUSIONSnGCA thickness measured by Cirrus HD-OCT showed statistically significant structure-function associations with central VF. Inferotemporal central VF had the strongest association.

Aldosterone: a mediator of retinal ganglion cell death and the potential role in the pathogenesis in normal-tension glaucoma.

Glaucoma is conventionally defined as a chronic optic neuropathy characterized by progressive loss of retinal ganglion cells (RGCs) and optic nerve fibers. Although glaucoma is often associated with elevated intraocular pressure (IOP), significant IOP reduction does not prevent progression of the disease in some glaucoma patients. Thus, exploring IOP-independent mechanisms of RGC loss is important. We describe chronic systemic administration of aldosterone and evaluate its effect on RGCs in rat. Aldosterone was administered via an osmotic minipump that was implanted subcutaneously into the mid-scapular region. Although systemic administration of aldosterone caused RGC loss associated with thinning of the retinal nerve fiber layer without elevated IOP, the other cell layers appeared to be unaffected. After chronic administration of aldosterone, RGC loss was observed at 2 weeks in the peripheral retina and at 4 weeks in the central retina. However, administration of mineralocorticoid receptor blocker prevented RGC loss. These results demonstrate aldosterone is a critical mediator of RGC loss that is independent of IOP. We believe this rat normal-tension glaucoma (NTG) animal model not only offers a powerful system for investigating the mechanism of neurodegeneration in NTG, but can also be used to develop therapies directed at IOP-independent mechanisms of RGC loss.

Use of the structure-function relationship in detecting glaucoma progression in early glaucoma

BackgroundTo evaluate the use of optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness and visual field (VF) measurements in detecting disease progression in patients with early glaucoma.MethodsOver a 3-year period, this study examined 60 eyes of 39 glaucoma patients whose total deviation in the superior or inferior hemifield was more than -6xa0dB. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least three years. On the same day as the RNFL imaging, VF testing was also performed by using the Swedish Interactive Threshold Algorithm Standard 30–2 program of the Humphrey Field Analyzer. Serial RNFL thicknesses and VF progression were assessed using the Guided Progression Analysis (GPA) software program. RNFL thickness progression and VF progression were evaluated by the event analysis.ResultsThe mean observation period was 57.6u2009±u200910.0xa0months, and during this time, a total of 366 OCT and 366 VF measurements were performed. Using only OCT, progression was found in 2 eyes, while progression was found in 1 eye when only using VF GPA. When combined measurement findings were used, the analysis found progression in 8 eyes.ConclusionsWhen mild VF defect is present, OCT RNFL thickness measurements can be helpful in discerning glaucoma progression.

Evaluation of relationship between retinal nerve fiber layer thickness progression and visual field progression in patients with glaucoma

PurposeTo evaluate the capability of optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, and visual field (VF) measurements in glaucoma progression detection.MethodsThe study examined 62 eyes of 37 glaucoma patients observed over a 3-year period. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least 3xa0years. VF testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer (HFA) on the same day as the RNFL imaging. Both serial RNFL thicknesses and VF progression were assessed by the guided progression analysis (GPA) software program. RNFL thickness progression was evaluated by event analysis. Total deviation (TD) in the superior or inferior hemifield was also examined.ResultsA total of 295 OCT scans and 295 VFs were analyzed. Five eyes exhibited progression by OCT only and 8 eyes exhibited progression by VF GPA only. When the analysis was based on the combined measurement findings, progression was noted in 6 eyes. The average of the progressive hemifield TD at baseline for combined RNFL and VF progression was −3.21xa0±xa01.38 dB, while it was −2.17xa0±xa01.14 dB for RNFL progression and −9.12xa0±xa03.75xa0dB for VF progression. The average of the progressive hemifield TD indicated a significant advancement of VF progression as compared to RNFL progression (Pxa0=xa00.002).ConclusionsWhen a mild VF defect is present, OCT RNFL thickness measurements are important in helping discern glaucoma progression.

Efficacy and Safety of Switching from Topical Latanoprost to Bimatoprost in Patients with Normal-Tension Glaucoma

PURPOSEnThe aim of this study was to evaluate the efficacy and safety of bimatoprost in Japanese patients with normal-tension glaucoma (NTG) who showed insufficient response to latanoprost.nnnMETHODSnA prospective, nonrandomized study was conducted in patients with NTG, with ≤20% intraocular pressure (IOP) decrease from pretreatment baseline with latanoprost monotherapy who had been switched to bimatoprost. The IOP was measured at 4, 8, and 12 weeks after the switch to bimatoprost. In 12 weeks after the switch to bimatoprost, efficacy and safety were evaluated.nnnRESULTSnPostswitch to bimatoprost, IOP was significantly reduced at every visit. Bimatoprost produced significantly greater mean% IOP reduction rate from pretreatment than that of latanoprost at week 12 (P<0.01). There was a significant correlation between% IOP reduction of bimatoprost and that of latanoprost (Pearson r(2)=0.374; P=0.007). No significant difference was observed in the mean scores of conjunctival hyperemia and corneal epithelial disorder between bimatoprost-treated eyes and latanoprost-treated eyes.nnnCONCLUSIONSnSignificant additional IOP lowering was achieved by switching to bimatoprost in Japanese patients with NTG with insufficient response to latanoprost. Bimatoprost treatment was safe and well tolerated.

Effect of the renin inhibitor aliskiren against retinal ischemia-reperfusion injury.

The purpose of this study was to investigate the effect of the renin inhibitor, aliskiren, on retinal ischemia-reperfusion injury. Retinal ischemia was induced by increasing intraocular pressure to 130xa0mmHg. At 7 days after ischemia, retinal damage was evaluated by measuring the retinal thickness and the number of retinal ganglion cells. Western blot was used to measure changes in the (pro)renin receptor expression. Retinal mRNA expressions of prorenin, angiotensinogen and angiotensin II type 1 receptor (AT1-R) were measured by real-time polymerase chain reaction. Rats were treated with the renin inhibitor, aliskiren. Although the number of retinal ganglion cells and the inner retinal thickness were significantly decreased at 7 days after ischemia, treatment with aliskiren significantly inhibited retinal ischemic injury. Administration of aliskiren increased mRNA expression of prorenin in the retina at 3xa0h after the reperfusion. The expression of the (pro)renin receptor was not changed after ischemia-reperfusion injury with or without aliskiren. Although there was an increase in the retinal expression of AT1-R at 3xa0h after the reperfusion, aliskiren administration suppressed this expression. A renin inhibitor attenuated subsequent ischemic damage in the rat retina via the inhibition of the prorenin-induced angiotensin generation.

Correlation between Intraocular Pressure Fluctuation with Postural Change and Postoperative Intraocular Pressure in Relation to the Time Course after Trabeculectomy

Background. To investigate the correlation between intraocular pressure (IOP) fluctuation with postural change and IOP in relation to the time course after trabeculectomy. Methods. A total of 29 patients who had previously undergone primary trabeculectomy with mitomycin C were examined. IOP was obtained at 1, 2, 3, 6, and 12 months and then every 6 months postoperatively. Results. The postural IOP difference before surgery was 3.0 ± 1.8u2009mmHg, which was reduced to 0.9 ± 1.1u2009mmHg at 1 month, 1.0 ± 1.0u2009mmHg at 2 months, 1.3 ± 2.0u2009mmHg at 3 months, 1.3 ± 1.4u2009mmHg at 6 months, 1.4 ± 1.5u2009mmHg at 12 months, and 1.1 ± 0.7u2009mmHg at 18 months after trabeculectomy (P < 0.01 each visit). The filtering surgery failed in 7 out of 29 eyes. Postural IOP changes were less than 3u2009mmHg in those patients who did not require needle revision at every visit. However, in patients who did require needle revision, the increase in the posture-induced IOP was greater than 3u2009mmHg prior to the increase in the sitting position IOP. Conclusions. Assessment of postural IOP changes after trabeculectomy might be potentially useful for predicting IOP changes after trabeculectomy.