Mika Harju

Optic Disc Topography Before and After Trabeculectomy in Advanced Glaucoma

BACKGROUND AND OBJECTIVE To analyze changes in the optic disc topography after filtration surgery. PATIENTS AND METHODS Laser scanning tomography was performed in 10 eyes of 9 patients (mean age 65.6 +/- 8.1 years; age range 55 to 75 years) after a mean follow-up of 3.7 months, and in 8 eyes of 7 patients (mean age 63.1 +/- 7.6 years; age range 55 to 75 years) after a mean follow-up of 13.1 months. RESULTS Preoperatively, the mean intraocular pressure (IOP) was 24.4 +/- 6.9 mm Hg with maximal medication. Postoperatively at 3.7 months it was 11.0 +/- 2.2 mm Hg, and at l2.1 months it was l3.6 +/- 2.8 mm Hg. An initial reduction in IOP of more than 30 percent at 3.7 months was achieved without medication in all but 1 eye. After 12.1 months, an IOP reduction of more than 30 percent was achieved in 6 of 8 eyes (1 with medication), while 2 eyes had IOP reductions of less than 15 percent (< or = 3 mm Hg) despite medication. In the 6 eyes, the optic disc cup volume showed a decrease of more than 30 percent, while the 2 eyes without marked IOP reductions had slight increases in cup volume. Of the 2 eyes without marked decreases in cup size, 1 had normal-tension glaucoma and 1 experienced an increase in IOP of more than 25 mm Hg during the first postoperative week. CONCLUSION The postoperative IOP should be kept low enough to permit reversal of optic disc changes.

Scanning Laser Doppler Flowmetry Shows Reduced Retinal Capillary Blood Flow in CADASIL

Background and Purpose— Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a progressive systemic nonatherosclerotic angiopathy which causes ischemic strokes and vascular subcortical dementia. A cross-sectional study was performed to examine the retinal vascular caliber and blood flow in CADASIL. Methods— Scanning laser Doppler flowmetry was used in a case–control study (11 patients and controls) of peripapillary retinal circulation. Automated full-field perfusion image analysis was used to analyze the flow data. Retinal vessel calibers were measured from retinal images acquired with scanning laser ophthalmoscopy. The caliber of the superior and inferior temporal retinal artery and vein were measured 1 and 2 mm from the disc rim, and the mean values were used for analysis. Results— Retinal capillary peak systolic flow (mean, 249 versus 311 arbitrary unit [AU]; P=0.072) was lower, and mean capillary flow (mean, 184 versus 224 AU; P=0.12) and minimum diastolic flow (mean, 105 versus 132 AU; P=0.16) tended to be lower in patients than in controls. No significant difference in the calibers of proximal retinal arteries (mean, 104 versus108 &mgr;m) and veins (mean, 150 versus 145 &mgr;m) was found between the patients and controls. Conclusions— Retinal capillary blood flow is mild to moderately reduced in CADASIL but that does not appear to cause major ischemic injury. Such reduction is analogous to that in the cerebral cortex in CADASIL patients with which retina appears to share its relative sparing from severe arterial ischemic tissue damage.

The effect of deep sclerectomy on intraocular pressure of normal‐tension glaucoma patients: 1‐year results

Purpose:  To study the intraocular pressure (IOP)‐reducing effect of deep sclerectomy on normal‐tension glaucoma (NTG) patients.

Scanning laser ophthalmoscopy of the optic nerve head in exfoliation glaucoma and ocular hypertension with exfoliation syndrome

AIMS To study the relation between optic nerve head topography (Heidelberg retina tomograph, HRT) and disc area, visual field index mean defect (MD), and intraocular pressure (IOP), and to see whether change in HRT parameters is associated with change in MD in a prospective follow up. METHODS 80 consecutive patients (69 patients with exfoliation glaucoma and 11 with ocular hypertension combined with exfoliation syndrome) were examined before IOP reducing intervention and prospectively followed every 6 months for 2 years. RESULTS At the entry point, multiple regression analysis showed significant linear association between MD and all HRT parameters, when controlling for disc area. Disc area showed significant association with cup area, cup/disc area ratio, rim area, cup volume, and mean RNFL thickness. Six months after intervention IOP had decreased significantly. Reversible changes in cup area, cup/disc area ratio, rim area, cup volume, rim volume, mean cup depth, and maximum cup depth were associated with decrease in IOP. During the follow up period from 6 month to 2 years, IOP did not change significantly, and MD was used as a measure of progression of glaucoma. During this period, only cup shape measure among HRT parameters showed significant association with subsequent change in MD. CONCLUSION Disc area should be taken into account when using HRT to compare patients. Any effect of change in IOP should be also taken into account when using HRT in follow up. Cup shape measure is a promising indicator of progression of glaucomatous damage.

Deep sclerectomy in normal‐tension glaucoma with and without mitomycin‐c

To compare the outcome of deep sclerectomy (DS) with and without mitomycin‐C (MMC) in patients with normal‐tension glaucoma (NTG).

Deep sclerectomy in primary open-angle glaucoma and exfoliative glaucoma

Purpose To study the effect of deep sclerectomy (DS) in primary open-angle glaucoma (POAG) and exfoliative glaucoma (EXG). Methods We retrospectively analyzed the intraocular pressure (IOP)-lowering effect of DS in 235 consecutive eyes. Eyes were divided into 2 groups according to glaucoma subtype: POAG (127 eyes) and EXG (108 eyes). Postoperative IOP was the main outcome measurement. We recorded complete and qualified surgical success, need for YAG-laser goniopuncture, and need for postoperative glaucoma medication. We studied factors related to outcome of surgery in a Cox regression model. Results In the POAG group, the mean (SD) IOP decreased from 22.6 (5.1) mm Hg preoperatively to 16.8 (7.5) mm Hg, with qualified success achieved in 70% of eyes. Postoperatively, 57% were without medication. In the EXG group, IOP decreased from 25.5 (6.5) mm Hg preoperatively to 16.5 (7.8) mm Hg postoperatively, with qualified success achieved in 66% of eyes. Postoperatively, 50% were without medication. Decrease in IOP was statistically significant in both groups (p<0.001). In the POAG group, 12%, and in the EXG group, 24% needed a reoperation in the follow-up period (p = 0.037). In the Cox regression model, 1 week IOP between 2 and 14 mm Hg without medication lowered the hazard rate of losing complete success by 34% (p = 0.031) and the hazard rate of losing qualified success by 54% (p = 0.004). Conclusions The IOP 1 week postoperatively seems to be a prominent indicator of surgical success. Deep sclerectomy is effective in reducing IOP in POAG and EXG subgroups, with reoperations more common in EXG eyes.

Change in retinal blood flow and retinal arterial diameter after intraocular pressure reduction in glaucomatous eyes.

To study retinal blood flow and vessel diameter after intra‐ocular pressure (IOP) reduction in high‐ and low‐pressure glaucomas, that is, exfoliation glaucoma (ExG) and normal‐tension glaucoma (NTG).

Macular blood flow measured by blue‐field entoptoscopy and Heidelberg retinal flowmetry: comparison of two techniques in type 1 diabetes women during pregnancy

Purpose:  This study compared macular capillary leucocyte velocity values measured with a psychophysical blue‐field entoptic simulation (BFS) technique and confocal scanning laser Doppler flowmetry.

A Randomized, Prospective Study on the Use of Sodium Hyaluronate (Healon) in Trabeculectomy

The effect of injecting sodium hyaluronate (Healon) before fistulization in trabeculectomy was investigated in a prospective, randomized study of 107 consecutive eyes. Fifty-two eyes were operated on with the viscoelastic and 55 without. An early postoperative intraocular pressure (IOP) peak of 21 mm Hg or more occurred in 27% of the study eyes versus 17% of the control eyes, an insignificant difference. The mean peak IOPs of the study and the control eyes did not differ significantly (29.8 +/- 9.0 mm Hg versus 32.7 +/- 10.2 mm Hg), nor did the mean IOPs and the need for glaucoma medications 1 month after surgery. Shallow/flat anterior chamber and choroidal detachment were equally frequent in both groups, but hyphema occurred significantly more often in the study group (40%) than in the control group (18%).

Intravenous hypertonic saline to reduce intraocular pressure.

Purpose:  To quantitate the effect of intravenous hypertonic saline (IVHTS) injection on elevated intraocular pressure (IOP).