M. Araie

Ocular and systemic factors related to intraocular pressure in Japanese adults: the Tajimi study

Background: As intraocular pressure (IOP) and age are consistent risk factors of glaucoma, it is of special interest to know the association between IOP and possibly relating factors including age in Japan where a high prevalence of normal-tension glaucoma has been reported. The aim of this report was to evaluate the distribution of and factors related to applanation IOP in a population-based study in Japan. Methods: A randomly sampled group of 3021 residents (response rate 78.1%) of Tajimi City, aged 40 years or older, underwent screening examinations including measurements of IOP with Goldmann applanation tonometry and central corneal thickness. Results: Among right eyes without glaucoma, suspected glaucoma or other disorders which could affect correct IOP measurements, IOP averaged 14.6 (SD 2.7) and 14.5 (2.5) mm Hg in men and women, respectively, with no significant intergender difference (p = 0.342). Multiple regression analyses revealed that age was significantly negatively correlated with IOP (non-standardised beta (B) = −0.020/year, p = 0.0001). Higher body mass index (B = 0.14/BMI, p<0.0001), higher mean blood pressure (B = 0.022/mm Hg, p<0.0001), history of diabetes (p = 0.0019), thicker cornea (B = 0.014/μm, p<0.0001), higher myopia (B = 0.055/dioptres, p = 0.0043) and steeper corneal curvature (B = −0.72/mm, p = 0.0002) were also significantly correlated with higher IOP. Conclusions: In an adult Japanese population, applanation IOP averaged 14.5 mm Hg and was negatively correlated with age after adjusting for other related factors. A positive correlation between IOP and myopia was found.

Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis

PURPOSE To analyse clinical outcomes of trabeculectomy with mitomycin C (MMC) in eyes with uveitic glaucoma (UG) with inactive uveitis and compare them to those in eyes with primary open-angle glaucoma (POAG). DESIGN Retrospective non-randomized comparative interventional case series. METHODS A total of 53 eyes with UG and 80 eyes with POAG that received MMC trabeculectomy as an initial ocular surgery with average follow-up of 5.4 years were reviewed retrospectively. The intraocular pressure (IOP) control and persistence of filtering bleb were analysed using the Kaplan-Meier life-table method based on two definitions of successful IOP control, ie complete success (IOP<or=15 mm Hg without anti-glaucoma medications) and qualified success (IOP<or=15 mm Hg with topical anti-glaucoma medications). The incidences of postoperative complications were also examined. RESULTS Complete success rate for postoperative IOP control at 5 years after trabeculectomy was 57.1+/-7.5% (mean+/-SE) in UG, being comparable to that in POAG (53.7+/-6.1%), and those of qualified success was 64.7+/-7.0 and 65.9+/-5.5% (P=0.60 and 0.53) respectively. Persistence of filtrating blebs was shorter in UG than in POAG (P=0.031). Postoperative inflammation in UG was associated with worse postoperative IOP control and loss of filtering bleb (P=0.027 and 0.021). Postoperative long-standing ocular hypotony was more frequent in UG (P=0.0063). CONCLUSIONS An MMC trabeculectomy for UG with inactive uveitis as an initial ocular surgery had IOP control comparable to that for POAG, suggesting that pre-existing uveitis itself is not a risk factor for failure of a filtering surgery.

Topical application of autologous serum for the treatment of late-onset aqueous oozing or point-leak through filtering bleb

AbstractPurposeTo evaluate the efficacy of topical autologous serum application to stop aqueous oozing or point-leak through filtering bleb after trabeculectomy.Patients and MethodsA total of 21 consecutive eyes with oozing and 21 eyes with a point-leak through a functional bleb after trabeculectomy with 5-fluorouracil or mitomycin C were enrolled in this randomized, case–control study. In eyes randomly assigned to the serum group, an antibiotic and the autologous serum, which was sterilely diluted to 20% with physiological saline, were topically applied four times a day for up to 12 weeks. In eyes assigned to the control group, the antibiotic alone was applied according to the same protocol. Intraocular pressure (IOP) and the presence of oozing or a point-leak were tested before and every 2 weeks after starting the treatments.ResultsIn the serum and control groups, oozing stopped in 62.5 and 0% of eyes, respectively (P=0.003), and point-leaks stopped in 27.3 and 18.2%, respectively (P>0.9). IOP significantly increased from 10.0±3.2 (mean±standard deviation) to 11.8±3.3 mmHg in eyes in which oozing stopped (P=0.066), and from 11.4±2.7 to 15.4±2.3 mmHg in eyes in which a point-leak stopped (P=0.042).ConclusionsAutologous serum application was significantly effective to stop aqueous oozing but not point-leaks. Stopping oozing or point-leaks was significantly associated with an increase in IOP.

Allergens in Japanese patients with allergic conjunctivitis in autumn.

PurposeThe purpose of the current study is to evaluate the relation between various specific class E immunoglobulins (IgE) in the serum and allergic conjunctivitis in autumn.MethodsTotal IgE and specific IgE to 12 inhalant allergens were measured using the CAP system in 32 patients with allergic conjunctivitis in spring (spring group), 27 patients with allergic conjunctivitis in autumn (autumn group), and 40 healthy volunteers (control group).ResultsSpecific IgE levels caused by house dust, Dermatophagoides pteronyssinus, and orchard grass were higher in the autumn group than in the spring group. The highest positivity rate for a specific allergen was 51.9% for house dust, followed by D. pteronyssinus(48.1%) in the autumn group, while the highest rate was 68.8 % for cedar pollen, followed by cypress pollen (59.4%) in the spring group. Correlation analysis showed that house dust was significantly correlated with animal epithelia, D. pteronyssinus, acarus, and Alternaria tenuisin the autumn group (P<0.001).ConclusionsThese results suggest that house dust is the main cause of allergic conjunctivitis during autumn. In spring, cypress pollen is the largest cause of allergic conjunctivitis, while indoor allergens such as house dust, animal epithelia, D. pteronyssinus, and acarus are not causative allergens in Japan.

Topical phenylephrine decreases blood velocity in the optic nerve head and increases resistive index in the retinal arteries

PurposeTo investigate the effects of topical phenylephrine on circulation in the optic nerve head (ONH), posterior choroids, or retina in rabbits and healthy humans.MethodsTissue blood velocity in the ONH and posterior choroid was measured using the laser speckle method as normalized blur (NBONH and NBCH) in 28 anaesthetized albino rabbits. NB and intraocular pressure (IOP) in both eyes were measured for 180 min after unilateral single instillation of 5% phenylephrine and contralateral physiological saline as a control. In 11 normal volunteers aged 26.0±2.7 years, NBONH was measured for 180 min after unilateral three drops of 5% phenylephrine and contralateral physiological saline in a double-masked manner. In the other 17 normal volunteers aged 25.5±2.4 years, blood velocity and blood flow in a major branch of the central retinal artery were measured using the laser Doppler blood flow metre and IOP and systemic circulatory parameters were monitored in similar fashion. Analysis of variance was applied for intergroup comparisons.ResultsNBONH and NBCH decreased significantly only in the phenylephrine-treated eyes in rabbits by maximum of 9 and 20%, respectively (P=0.0046 and 0.0009), despite IOP decrease. In humans, NBONH decreased significant by maximum of 13% (P=0.0047) and resistive index in the retinal arteries increased by 10% (P=0.0067) unilaterally; whereas IOP, diameter, blood velocity, or blood flow of the arteries was not significantly changed.ConclusionTopical phenylephrine could exert a significant unfavourable effect on circulation in the ONH, choroidal tissue, and retinal arteries in rabbits and normal young humans.

Histopathological findings in filtering blebs with recurrent blebitis.

We report clinical courses and histopathological findings of excised blebs from two patients with recurrent blebitis. ### Case 1 A 79 year old man with a past history of lung cancer and diabetes mellitus underwent trabeculectomy with 5-fluorouracil in his right eye for a diagnosis of primary open angle glaucoma (POAG) in 1989. In January 1994, bleb leakage from an avascular bleb was confirmed for the first time and prophylactic topical erythromycin had been applied. In September 1994, he experienced ocular pain and hyperaemia in his right eye and blebitis was diagnosed. Culture of aqueous humour was positive for enterococcus. He was treated with topical ofloxacin, micronomicin, and a subconjunctival injection of amikacin and the infection resolved. After then, bleb leak was not observed at any regular visit. In March 1998, blebitis occurred with a bleb leak in the same …

Population-based prevalence of optic disc haemorrhages in elderly Japanese.

PurposeTo estimate the population-based prevalence of disc haemorrhages (DHs) in an elderly Japanese population and evaluate related factors including optic disc morphology.Patients and methodsColour fundus photographs were taken during the screening examination of the Tajimi Study, during which 3021 of 3870 eligible residents of the city aged 40 years or older were screened (response rate, 78.1%). All fundus photographs were graded by one masked examiner to determine the presence of DHs.ResultsGood quality fundus photographs were available for both eyes of 2761 subjects. DHs were found in at least one eye of 34 subjects (1.2%; 95% confidence interval (CI) 0.8–1.6%). The prevalence was 14.0% (95% CI, 8.0–19.9%), 9.7% (2.9–16.6%), and 0.4% (0.1–0.6%) in subjects with definitive glaucoma, glaucoma suspects, and subjects without glaucoma, respectively. Logistic regression analyses indicated that DHs were associated with glaucoma (P<0.001), glaucoma suspects (P<0.001), and older age (P=0.032). No Heidelberg Retina Tomograph parameters differed between subjects with and without DHs.ConclusionsThe prevalence of DHs was 1.2% in an elderly Japanese population, which was similar to other population studies. In addition to glaucoma, older age was associated with higher prevalence of DHs.

Atypical retardation pattern in measurements of scanning laser polarimetry and its relating factors

PurposeTo assess the prevalence of atypical retardation pattern (ARP) in scanning laser polarimetry (SLP) with variable corneal compensation (VCC) and enhanced corneal compensation (ECC), and to evaluate the factors relating to typical scan score (TSS).MethodsMeasurements of SLP–VCC, SLP–ECC, and the Humphrey field analyzer (HFA) were performed in 105 normal subjects and 82 open-angle glaucoma (OAG) patients. ARP was defined as an SLP image with TSS<80.ResultsPrevalence of ARP with SLP–VCC was 13.3 and 14.6% in normal and OAG eyes, respectively, and that with SLP–ECC (2.9% and 1.2%) was lower than SLP–VCC (P<0.009). TSS with SLP–VCC was significantly correlated with age (partial correlation coefficient (PCC)=−0.22, P=0.003) and refractive error (PCC=0.26, P<0.001) after adjusting for each other. TSS with SLP–ECC was significantly correlated with neither age nor refractive error (PCC=−0.02, P=0.788; PCC=0.10, P=0.177, respectively). In OAG eyes, mean deviation (MD) of HFA was significantly correlated with TSS with SLP–VCC and SLP–ECC (PCC=0.35, P=0.001; PCC=0.23, P=0.039, respectively). In SLP-VCC, MD was significantly correlated with retinal nerve fibrr layer (RNFL) thickness only after excluding eyes with ARP (P<0.001).ConclusionsARP in SLP–VCC measurements was found in more than 10% of normal or glaucomatous eyes, and TSS was significantly lower in older subjects, more myopic eyes, or eyes with more advanced glaucomatous damage. The presence of ARP disturbs the accuracy of RNFL thickness measurement by SLP–VCC. In SLP–ECC measurements, prevalence of ARP was considerably lower and TSS was not affected by age or refractive error, suggesting the advantages of ECC in clinical practices.

Performance of GDx VCC in eyes with peripapillary atrophy: comparison of three circle sizes

PurposeA scanning laser polarimetry (GDx VCC) equips three different sized measurement circles. In eyes with peripapillary atrophy (PPA), the GDx measurement becomes inaccurate when the circle falls on PPA. The aim of this study was to evaluate performance of the three circles of GDx measurement in eyes with PPA.MethodsThree different sized circles were compared regarding frequency of PPA, which fell on each circle in 282 open-angle glaucoma (OAG) eyes, reproducibility of GDx parameters in 24 normal and 22 OAG eyes, and ability to detect glaucoma in 50 normal and 50 OAG eyes.ResultsPPA was observed in 230 (82%) of 282 OAG eyes. PPA fell on the small circle (default setting), medium, and large circles in 119 (43%), 38 (14%), and 12 (4%) of the 280 OAG eyes. Reproducibility of GDx parameters was not significantly different among three circles in normal eyes (P>0.05), whereas coefficients of reproducibility of TSNIT average (P=0.006) and superior average (P=0.035) were smaller in the smaller circles in OAG eyes. GDx parameters significantly correlated (P<0.001), but were significantly different (P<0.05) between the small and medium circles. The area under receiver operating characteristic curves for dividing OAG from normal eyes using GDx parameters was similar between the small and medium circles.ConclusionsIf the medium circles were used, obstructing influences of PPA on GDx measurement could be avoided more often in Japanese OAG eyes with similar reproducibility and comparable ability to detect glaucoma compared to those with the default small circle.

Penetrating keratoplasty for bullous keratopathy after trabeculectomy

PurposeTo evaluate the results of penetrating keratoplasty (PK) in eyes with bullous keratopathy having previously undergone trabeculectomy.MethodsWe reviewed medical records of patients that had undergone PK for bullous keratopathy having previously undergone trabeculectomy. A total of 34 eyes in 34 patients were included in the study. As a control group, we reviewed the medical records of 26 eyes in 26 patients that had no history of glaucoma and who had undergone PK for bullous keratopathy in the same period at the same institutes. Kaplan–Meier survival analysis was performed to estimate the cumulative probability of successful intraocular pressure (IOP) control, immune reaction-free graft, and graft survival.ResultsVisual acuity improved by more than two lines in 30–34 eyes (88%). Log-rank tests showed a statistically significant difference in the cumulative probability of successful IOP control between eyes with functioning blebs and eyes with non-functioning blebs (P=0.0005), but not between the experimental subjects of 34 eyes and the control group (P=0.198). The log-rank test did not show statistically significant differences in the cumulative probability of immune reaction-free grafts and graft failure between the subjects and the control group and between eyes with functioning blebs and eyes with non-functioning blebs.ConclusionThe outcomes for PK in bullous keratopathy are good for patients having previously undergone trabeculectomy. Surgical procedures should be performed before PK in eyes with non-functioning blebs even when IOP is controllable with medication.