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Glaucoma is a disease that relates to the vision of human eye,Glaucoma is a disease that affects the human eye's vision. This sickness is regarded as an irreversible condition that causes eyesight degeneration. One of the most common causes of lifelong blindness is glaucoma in persons over the age of 40. Because of its trade-off between portability, size, and cost, fundus imaging is the most often utilised screening tool for glaucoma detection. Fundus imaging is a two-dimensional (2D) depiction of the three-dimensional (3D), semitransparent retinal tissues projected on to the imaging plane using reflected light. The idea plane that depicts the physical display screen through which a user perceives a virtual 3D scene is referred to as the "image plane”. The bulk of current algorithms for autonomous glaucoma assessment using fundus images rely on handcrafted segmentation-based features, which are influenced by the segmentation method used and the retrieved features. Convolutional neural networks (CNNs) are known for, among other things, their ability to learn highly discriminative features from raw pixel intensities. This work describes a computational technique for detecting glaucoma automatically. The major goal is to use a "image processing technique" to diagnose glaucoma using a fundus image as input. It trains datasets using a convolutional neural network (CNN). The Watershed algorithm is used for segmentation and is the most widely used technique in image processing. The following image processing processes are performed: region of interest, morphological procedures, and segmentation. This technique can be used to determine whether or not a person has Glaucoma. Keywords: Recommender system, item-based collaborative filtering, Natural Language Processing, Deep learning.

Purpose To review the published literature on the visual acuity results and complications of different surgical techniques for intraocular lens (IOL) implantation in the absence of zonular support. Methods Peer-reviewed literature searches were conducted last in PubMed and the Cochrane Library in July 2019. The searches yielded 734 citations of articles published in English. The panel reviewed the abstracts of these mostly retrospective case series studies, and 45 were determined to be relevant to the assessment objectives. Three articles were rated as level II evidence, and 42 articles were rated as level III evidence. Results Eight different types of IOL fixation techniques with at least 6-month follow-up were evaluated: anterior chamber IOL (ACIOL), iris-claw IOL, retropupillary iris-claw IOL, 10-0 polypropylene iris-sutured posterior chamber IOL (PCIOL), 10-0 polypropylene scleral-sutured PCIOL, 8-0 polypropylene scleral-sutured PCIOL, CV-8 polytetrafluoroethylene, and intrascleral haptic fixation (ISHF). Eight articles reported data comparing 2 techniques. The 45 studies had insufficient statistical power to compare the techniques conclusively. A qualitative analysis of similar types showed that trends in visual acuity outcomes were not inferior to those of ACIOL implantation, but the severity of preoperative pathologic features was not controlled for. Compared with ACIOL, complications of cystoid macular edema were higher in 10-0 polypropylene iris-sutured PCIOL and 8-0 polypropylene scleral-sutured PCIOL. Non–anterior chamber IOL techniques were less likely to report chronic uveitis. Chronic glaucoma was highest in the 8-0 polypropylene scleral-sutured PCIOL group. Although retinal detachment was infrequent overall, it was twice as common in both iris- and scleral-sutured PCIOLs (except CV-8 polytetrafluoroethylene suture) compared with nonsutured methods: ACIOL, iris-clipped IOL, and ISHF PCIOL. Conclusions The evidence reviewed shows no superiority of any single IOL implantation technique in the absence of zonular support. The various techniques seem to have equivalent visual acuity outcomes and safety profiles. Each technique has its own profile of inherent risk of postoperative complications. Surgeons must educate patients on the importance of close, long-term follow-up as a result of the uncertain nature of these techniques. Large prospective studies are needed to confirm the long-term complication profiles of these various IOL implantation techniques.

The corneal epithelium represents one of the main structures that undergo degenerative alterations due to antiglaucomatous therapy. Chronic glaucoma therapy containing benzalkonium chloride induces epithelial cellular changes and inflammatory infiltration that in turn causes ocular surface changes resulting in ocular discomfort. Also, age-related changes can involve the tear film stability and the corneal epithelium surface with reduction of microvilli. The objective of this study is to gain insights about the changes in corneal epithelium in glaucomatous patients divided according to age, type and duration of therapy using anterior-segment optical coherence tomography (AS-OCT). This study evaluated a total of 81 eyes of 42 patients for whom corneal epithelium thickness (CET) was measured in different sectors of the cornea. Our results showed no significant differences in CET among patients divided according to type and duration of treatment, while younger patients showed a thinner CET in comparison with older patients. AS-OCT results demonstrated that the physiological age-related alterations contributed to corneal epithelium changes in patients undergo chronic antiglaucoma therapy.

In a general ophthalmic practice majority of patients who are diagnosed as glaucoma or glaucoma suspects do not present with complaints related to glaucoma but are picked up in the clinic during their routine eye check-up or when they come for their glass prescription including presbyopic glasses. A high index of suspicion is therefore the key to pick up patients with glaucoma before they become symptomatic. In these days of ‘cataract hunting’ it is not uncommon for people to miss obvious glaucoma-related eye changes and seeing only a cataract. By the time the patients with primary chronic glaucoma are symptomatic reversing the symptoms is not possible at this present time. Early diagnosis and prevention of disability is therefore the key in management of glaucoma.

Aim To evaluate ocular surface changes and its correlation with the central corneal subbasal nerve fibre layer in chronic glaucoma patients. Methods A prospective comparative study of ocular surface evaluation was performed in 50 eyes of 25 patients using two or more antiglaucoma medications for at least 6mo and 50 eyes of 25 normal subjects without any ocular problems as controls. The study parameters evaluated included visual acuity, intraocular pressure, ocular surface evaluation parameters [fluorescein break-up time (FTBUT), Schirmer's I test, ocular surface staining scores and ocular surface disease index score (OSDI)], central corneal sensation (Cochet Bonnett aesthesiometer), central subbasal nerve fiber layer density (SBNFLD) by confocal microscopy. Results The mean values in the glaucoma cases and control groups respectively were as follows: OSDI score (35.89±16.07/6.02±3.84; P=0.001), Schirmer's I test score (7.63±2.64 mm/12.86±1.93 mm; P=0.001), FTBUT (9.44±2.76s/11.8±1.88s; P=0.001), corneal (5.7±2.33/ 1.1±0.58; P=0.001) and conjunctival staining score (5.06±1.94/0.84±0.46; P=0.001), corneal sensitivity (4.68±0.44/5.07±0.37; P=0.076), mean subbasal nerve fiber number (3.58±0.99/5.40±1.70; P=0.001), SBNFL length (1101.44±287.56 µm/1963.70±562.56 µm; P=0.001) and density (6883.94±1798.03 µm/mm2/12 273.15±3516.04 µm/mm2; P=0.001). Dry eye severity of level 2 and 3 was seen in 66% of glaucoma group. Corneal (R2=0.86) and conjunctival staining (R2=0.71) and OSDI score (R2=0.67) showed statistically significant negative correlation with central corneal SBNFLD while FTBUT (R2=0.84), corneal sensitivity (R2=0.52) showed positive correlation to central corneal SBNFLD in the long term topical antiglaucoma medication group. Conclusion Ocular surface changes and antiglaucoma therapy induced dry eye is found to be associated with decreased SBNFLD in eyes on long term topical antiglaucoma medications.

Glaucoma is the leading cause of irreversible blindness worldwide [1, 2]. Though trabeculectomy still remains the “gold standard” in glaucoma surgery, it is associated with significant morbidity such as hypotony and bleb-related complications [3–5]. With this background, there has been a constant search for alternative procedures that are less invasive and safer, have optimal IOP-lowering effect, and improve quality of life in patients with chronic glaucoma.

The purpose of this paper is to give an updated review of the last clinical entities in pathological myopia proposed by means of new generation optical coherence tomography (OCT), including enhanced depth imaging (EDI-OCT) and swept source OCT (SS-OCT). PubMed and Google engine search were carried out using the terms "pathological myopia" associated with "coherence tomography," "enhanced depth imaging," and "swept source OCT." Latest publications up to Jan 2015 about myopia-related complications, including open-angle chronic glaucoma, peripapillary retinal changes, acquired macular diseases, and choroidal neovascularization, have been reviewed. New OCT technologies have led to a greater insight in pathophysiology of high-grade myopia. However, further investigation is needed in order to prevent irreversible visual loss and optic nerve damage.

To evaluate changes in ocular surface and central corneal sub-basal nerve fiber layer (SBNFL) after topical cyclosporin therapy in chronic glaucoma patients on long-term topical antiglaucoma therapy.A prospective comparative study of ocular surface evaluation of chronic glaucoma patients on long-term topical therapy treated concurrently with a topical cyclosporine 0.05% twice daily for 6 months and controls was done. The study parameters evaluated at recruitment and at the 6-month follow-up included details of topical antiglaucoma medications, visual acuity, intraocular pressure, ocular surface evaluation parameters (TBUT, Schirmers I, ocular surface staining scores and ocular surface disease (OSD) index score (OSDI)), central corneal sensation (Cochet Bonnett aesthesiometer), and central confocal microscopy to study the SBNFL density (SBNFLD).Thirty-two eyes of 16 patients with chronic glaucoma and 30 eyes of 15 normal subjects as controls were studied. Mean TBUT, pre/post CsA treatment was 8.67±3.01/12.24±1.83 s (P=0.007). Mean conjunctival/corneal staining scores pre/post CsA treatment were 3.38±1.93/1.50±0.718 (P=0.00) /5.19±1.82/1.81±0.78 (P=0.098), respectively. Mean OSDI pre/post CsA treatment scores were 30.63±14.61/14.76±6.06 (P=0.007). Mean corneal sensations scores pre/post CsA treatment were 4.64±0.46/4.94±0.39 (P=0.002). Central corneal SBNFLD pre and post CsA treatment was 8811.35±2985.29/10335.13±4092.064 μm/mm(2) (P=0.0001).Schirmer's test, ocular surface staining scores, OSDI, corneal sensations, and corneal SBNFLD showed a statistically significant improvement following a 6-month concurrent topical CsA therapy.

The term "Glaucoma" is used to describe a number of diseases of the eye characterized by a particular form of optic nerve damage that is often associated with high intraocular pressure (IOP). The open-angle glaucoma is the most common form that is also referred to as chronic glaucoma. This is described as an optic neuropathy with multifactorial nature in which there is a loss of characteristics of the optic nerve fibers. Therapeutic options for the treatment of this disease are different, you can take advantage of eye drops, laser therapy and conventional surgery or more combined treatments. Medicated eye drops are the most common way to treat glaucoma. Although eye drops are widely used, adverse reactions are not frequently observed and described. In particular, the adverse skin reactions are not frequently described in the literature, but often seen in dermatologic clinic, we reported their skin reactions and possible alternative treatments described in literature and their patent applications.

Several clinical and experimental studies have demonstrated that ocular surface disease is common in glaucoma patients receiving chronic glaucoma drops, and that the preservatives in these drops play a major role in the occurrence of ocular surface disease. These ocular surface changes may induce both symptoms reported by the patients and anterior segment clinical signs, and should be systematically assessed by history and exam in all glaucoma patients. In these patients with ocular surface disease, reducing the amount of preservatives administered to the eye should be strived for, rather than adding additional eye drops to alleviate or mask the side effects of the glaucoma drops.

For many years, the intraocular lymphatic system and particularly the drainage of the aqueous humor by this system have been considered non-existant. Our study is the first to demonstrate, in a dynamic in vivo fashion, the existence of lymphatic drainage in the mouse eye. This has become possible with lymphoscintigraphy with nano-molecules of rhenium sulphide, marked by technetium-99m and injected into the anterior chamber of the mouse eye. Readings were taken using an experimental gamma camera specially built for the small animal. The hypothesis of a "uveolymphatic" drainage pathway within the ciliary body, contributing to aqueous outflow, has recently been highlighted by new improvements in microbiology (discovery of lymphatic endothelial-specific markers) and imaging. This new pathway may lead to many prospects: the development of techniques for visualization and quantification of this in vivo lymphatic flow may help to increase our understanding of the physiopathology and perhaps treatment of chronic glaucoma as well as neoplastic conditions.

This review discusses the evidence concerning the effect of topical medications and their preservatives on the ocular surface in glaucoma patients. The role of topical anti-glaucoma medication remains critical in the management of chronic glaucoma worldwide but the beneficial effects of treatment are counterbalanced by the adverse effects of corneal and conjunctival toxicity. Areas covered: This article covers the effect of topical ocular drops and preservatives, particularly benzalkonium chloride, on the cornea and conjunctiva. Both basic science and clinical evidence will be presented. The first part reviews the relationship between ocular surface disease and benzalkonium chloride and the evidence from non-benzalkonium chloride preserved drops. The second part discusses the effects of benzalkonium chloride on the histopathology of the conjunctiva and its impact on clinical care as well as quality of life. Expert opinion: Topical anti-glaucoma medication will continue to be used in the management of this blinding disease for the foreseeable future. Treatment outcomes will benefit from minimized exposure to benzalkonium chloride. The development of alternative preservatives, preservative-free topical options, and non-drop therapeutics such as drug-eluting systems for the delivery of ocular medications, will be very helpful in the care of glaucoma patients.

Chronic Glaucoma, commonly known as glaucoma, is a misunderstood disease since given a separate entity in the 1850s. Currently, there are many conflicting views of glaucoma but on one issue we have complete agreement: the million or so densely packed nerve fibers (NFs) in the optic nerve head (ONH) are being destroyed in an orderly tandem fashion from peripheral to central, never randomly–a pathognomonic feature. The orderly destruction of NFs is perhaps the only lead we have in solving the mystery of glaucoma, but rarely discussed. If the NFs were not destroyed in a predictable orderly sequence, the role of perimetry in glaucoma would be meaningless. Various theories have been postulated regarding the pathogenesis of glaucoma, but none of them have addressed the crucial question of orderly destruction of NFs, which can’t be ignored. For any glaucoma theory to prevail, it must incorporate the issue of the orderly destruction of NFs otherwise it will be of no value. The ‘cupping’ theory dating back 160 years and the more recent theories like apoptosis, neurodegeneration, vascular pressure and others fail to answer the question of orderly loss of NFs in glaucoma. This article examines the prevalent theories of glaucoma in the context of orderly loss of NFs and attempts to describe the hypothesis of the sinking disc and severance of nerve fibers corroborating with orderly loss in glaucoma.

The visual field (VF) test is currently the most useful technique both for an unambiguous diagnosis and for the follow-up of chronic glaucoma. Relative paracentral scotomas and nasal step are usually

Background: Phacoemulsification is a common cataract operation nowadays. During phacoemulsification, variation in intraocular pressure (IOP) may occur, which might change the retinal nerve fiber layer (RNFL) thickness. This study was aimed to evaluate the change in peripapillary RNFL thickness and mean deviation (MD) of visual field after phacoemulsification in chronic primary glaucoma and non-glaucoma patients. Methods: Cohort prospective study was done on 26 patients (13 chronic glaucoma eyes and 13 non-glaucoma eyes) who underwent phacoemulsification. The changes in peripapillary RNFL thickness and MD of visual field were measured as the primary outcome. Comparison between pre- and post-surgery was analyzed with paired t-test, while unpaired t-test was used for comparison between groups.Results: There were no significant changes in RNFL thickness on both groups. Average RNFL thickness in glaucoma group before and after phacoemulsification were 94.9±20.0 μm and 99.1±21.3 μm, respectively (p>0.05). Average RNFL thickness in non-glaucoma group were 100.2±11.1 μm and 101.7±6.8 μm, respectively (p>0.05). Glaucoma patients yielded decreasing mean deviation (MD) of visual field, but it was not statistically significant (p=0.071). In contrast, the MD of visual field after surgery was significantly increased in non-glaucoma group (p=0.005).Conclusion: Phacoemulsification tended to increase peripapillary RNFL thickness in glaucoma or non-glaucoma patients. The visual field tended to decrease in glaucoma patients, but was significantly increased in non-glaucoma patients.

Citation information: Ho S & Vernon SA. Decision making in chronic glaucoma – optometrists vs ophthalmologists in a shared care service. Ophthalmic Physiol Opt 2011, 31, 168–173. doi: 10.1111/j.1475-1313.2010.00813.x Abstract Purpose: Shared care schemes have become popular in glaucoma management in the UK over the past 20 years. Published audits of decision making processes by non-ophthalmologists working in such schemes are however rare. Our aim was to audit the appropriateness of optometrists’ decision-making when working in an in-house shared care glaucoma scheme. Methods: A single masked comparison study utilising retrospective consensus decisions by two ophthalmologists compared with ‘live’ optometrist decisions from three optometrists who reviewed patients with glaucoma, suspect glaucoma and ocular hypertension. Results: Comparisons were made on management decisions on 140 consecutive eligible patients. There were high degrees of agreement (>88%) in terms of visual field interpretation, medical and surgical management decisions, timing of next appointment and ordering of visual field tests. Accuracy of communication with primary physicians was excellent with two optometrists but sub-optimal in a third. Conclusion: An audit model of decision-making in shared care is demonstrated that in this case supported the apprenticeship model of training utilised in the clinic.

Purpose To compare ocular findings in eyes with primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG) at the time of diagnosis when identical diagnostic criteria for glaucoma were applied. Methods We conducted a study on records of 519 consecutive, unselected patients with chronic glaucoma filing for cost-free medication from the Finnish National Social Insurance Institute (FSII). Fourteen cases were excluded for having other types of glaucoma. The documents were provided by eye hospitals or by licensed ophthalmologists. The criteria for glaucoma were set by the Parliament of Finland and applied by FSII. A total of 329 patients had POAG and 176 had EG. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), cup-to-disc ratio of the optic nerve head (C/D), and glaucomatous changes of the visual fields (VF). Results As regards sex, the 2 groups were comparable: 66% female with POAG and 68% with EG. The EG patients were older (mean ± SD 74 ± 8.6 years) vs POAG (68 ± 11.4 years). The EG eyes had slightly lower BCVA. The POAG eyes had mean intraocular pressure (IOP) 24 ± 5.4 mm Hg. A total of 12% in this group had highest IOP of less than 18 mm Hg (low-tension glaucoma [LTG]) but there were none of EG. All EG eyes had a mean IOP 28.3 ± 9.3 mm Hg. Among EG patients, 26% had unilateral disease, with a mean IOP of 33.7 ± 8.7 mm Hg, while the opposite eyes had a mean of 19 ± 3 mm Hg. There was not much difference in the C/D ratios of POAG and EG eyes and the VF profiles were similar. Conclusions At diagnosis, patients with EG were older than those with POAG and had higher mean IOP values. Among patients with POAG, there were 12% with LTG, but none among EG. A total of 26% among EG had unilateral disease with marked IOP asymmetry. The C/D and VF profiles were similar because the patients had been seen early in the disease course. Early recognition and lifelong most effective therapy of EG are strongly advocated.

90 glaucoma cases (160 eyes) with field defects in at least one eye have been subjected to automatic perimetry on at least 5 occasions. The condition of the field defect is represented by the regression coefficient. The frequency distribution of the coefficients in groups based on references to age, sex, intraocular pressure, exfoliations, haemorrhages and therapy illustrates the possible importance or insignificance of these factors to the decay. The need for several consecutive examinations to establish with some significance a progression of field defects is demonstrated.

A classification of the optic disc (the upper and lower half treated separately) was performed independently by 3 observers. The material consisted of 40 single colour photographs of eyes with glaucomatous field defects and of fellow eyes. The consistency between the observers was found to be good. The sensitivity for the detection of visual field defects from the appearance of the corresponding disc half was 75%. The specificity was 85%.

Local administration of beta-blockers to the eye has proven effective in the treatment of chronic simple glaucoma. However, varying degrees of impaired ventilation, even to the point of being life-threatening, have been reported. The effect of 1% pindolol and 0.5% timolol eye-drops, twice daily applied locally to the eye, on eyeball pressure and airway resistance was measured in 19 patients with chronic glaucoma. Compared with timolol eye-drops, pindolol had little effect on ventilatory functions, i. e. there was a significant difference between them. But the two preparations had similar effects in lowering eye-ball pressure. The likely explanation of this divergent action is the intrinsic sympathomimetic activity of pindolol.

Objective—To determine the effect of acute (clinical history of glaucoma for ≤ 2 days) and chronic (clinical history of glaucoma for 7 days) goniodysgenesis-related glaucoma on various stress-inducible proteins in canine retinas. Sample Population—15 canine retinas (5 from control eyes, 5 from eyes with acute glaucoma, and 5 from eyes with chronic glaucoma). Procedures—Globes were obtained from the Comparative Ocular Pathology Laboratory of Wisconsin. Eyes were characterized on the basis of clinical history. The distribution of glial fibrillary acidic protein (GFAP), heat shock protein (HSP) 60, and hypoxia-inducible factor (HIF)-1α was determined by use of immunohistochemical analysis. Results—Intensity of GFAP staining increased with temporal progression of glaucoma. In specimens from eyes with acute glaucoma, staining for HSP 60 was more variable among eyes, compared with that of the control eyes, whereas specimens from eyes with chronic glaucoma typically had less HSP 60 staining than was evident in the control eyes. Neither the control eyes nor specimens from the eyes with acute glaucoma had nuclear staining for HIF-1α in the retinas. Four of 5 specimens from eyes with chronic glaucoma had nuclear staining for HIF-1α in cells of the outer nuclear layer. Staining for HIF-1α was distributed segmentally in regions of more severe atrophy and disorganization. Conclusions and Clinical Relevance—Results of the study reported here supported a clinically evident, rapidly progressive disease with a shift in cell regulation between acute and chronic glaucoma and also supported ischemia as a mechanism of retinal injury in this disease.

To present the largest series reported so far of brimonidine induced granulomatous anterior uveitis.Retrospective chart review of patients with chronic glaucoma on treatment with brimonidine presenting with anterior uveitis.19 eyes of 12 patients with chronic glaucoma developed anterior uveitis with granulomatous keratic precipitates after being treated with brimonidine for periods of 7 days to 5 years (mean 19.7 months, +18.6 months). One patient had a gap of 1 year between onset in one eye and onset in the other. Ten eyes (52.6%) had concurrent granulomatous conjunctivitis; 16 eyes were pseudophakic. Stopping brimonidine led to complete, rapid resolution of uveitis in all patients, in most cases (11 eyes, 58%) without topical corticosteroids. No recurrences have occurred after withdrawal of brimonidine, over a follow-up period of 12-52 months (mean 27.9 months, +13.8 months).Ophthalmologists should be aware of this easily reversible uveitis syndrome that is induced by a common glaucoma medication. Familiarity with this entity is essential in making the correct diagnosis and avoiding unnecessary investigations and interventions.

Background: We studied the effect of argon laser trabeculoplasty (ALT) on medically controlled, pressure-stable glaucoma patients to verify whether it is possible to reduce ocular hypotensive medication after ALT while keeping intraocular pressure levels similar to those observed before the procedure. Methods: Seventy-one consecutive chronic glaucoma patients, all of whom were taking ocular hypotensive medication and had intraocular pressure at adequate levels, underwent ALT. After the laser procedure, each patient discontinued one hypotensive drug. Mean follow-up was 16.39 ± 5.39 months. We performed diurnal pressure curves on each patient before and after trabeculoplasty to determine the effect on intraocular pressure. Results: In 39 (54.9%) patients, it was possible to reduce ocular hypotensive medication and still maintain intraocular pressure levels similar to those achieved before ALT. Interpretation: For some medically controlled, chronic glaucoma patients, ALT can reduce the amount of ocular hypotensive medication without significantly altering intraocular pressure.

Topical medications have a very important role in chronic glaucoma treatment. Long-term use of these medications can cause significant changes on ocular surfaces. In this study, the ocular surfaces of 20 control subjects (group I), 20 primary open-angle glaucoma patients (group II) treated (mean 21.20 ± 1.32 months) with 0.50% timolol maleate, and 20 primary open-angle glaucoma patients (group III) treated (mean 21.70 ± 1.34 months) with 0.50% timolol maleate +1% dipivefrin hydrochloride were evaluated. Studied parameters included Schirmer's test, tear break-up time, conjunctiva impression cytology and goblet cell density. These results suggest that long-term applications of topical anti glaucoma medications damage the ocular surface.

BACKGROUND: For several years it has been discussed whether cyclocryotherapy is still an up-to-date treatment of resistant inadequately controlled glaucoma. This retrospective study investigates the clinical aspects of 185 cyclocryotherapies between 1988 and 1997. PATIENTS AND METHODS: At the University Eye Clinic of Tubingen, 114 patients received in 119 eyes (64.3%) one cyclocryotherapy, and in 66 eyes (35.7%) multiple cyclocryotherapies. The standard surgical techniques for cyclocryotherapy can be summarized as followed: probe placements per eye, 4 to 6; location of probe placement, inferior circumference (63.9%); distance of the applicator from limbus, 3 mm (50.7%); temperature of the probe tip, -70 degrees C (34.2%); and time of the treatment, 60 seconds (89.9%). RESULTS: Intraocular pressure was on average 33.8 mm Hg before treatment. In all analysed glaucoma types intraocular pressure was lowered to 10.2 mm Hg (30%). The most frequent type of glaucoma was the neovascular glaucoma (55%). One year after treatment, this type showed on average, relative to all other types of glaucoma, the highest intraocular pressure (28.1 mm Hg) and a lowering of intraocular pressure by 8.3 mm Hg (22.7%). Half a year after cyclocryotherapy, a highly significant (p < 0.002) reduction of antiglaucomatous medication was achieved in comparison to the preoperative medication. CONCLUSION: Despite the fact that cyclocryotherapy is not always effective, it is an ambulant surgical technique easy to apply, non-invasive, cost-effective and can be repeated to lower intraocular pressure in resistant chronic glaucoma. We conclude that cyclocryotherapy will remain useful until new techniques, like the diode laser cyclophototherapy (especially ultrasonic controlled), are developed as alternative therapies.

Dear editor We read with great interest the paper by Tsilis et al entitled “Systematic review of the association between Alzheimer’s disease and chronic glaucoma” published recently in this journal.1 The potential overlap in the pathobiological background of Alzheimer’s disease (AD) and primary open angle glaucoma (POAG) is currently a topic of intense discussion and could provide further insight into both of these complex diseases. Last year, we published an extensive review on POAG and the potential link between AD and POAG.2 Both AD and POAG consist of several clinical subtypes, and are genetically heterogeneous disorders. In our POAG disease model, we found that at least 65 candidate disease genes, together defining several molecular mechanisms (developmental dysfunction, lipid metabolism, and inflammatory processes), underlie the disease.2 For AD, at least 31 genes have been associated with the disease.3 We also showed that, on a molecular level, there is overlap between the molecular mechanisms of POAG and those of AD.4 When comparing two (genetically) heterogeneous disease entities, the conclusion that high heterogeneity and nonassociation will be found seems obvious. The study by Cumurcu et al5 cited by Tsilis et al, concerns a very distinct form of glaucoma, ie, pseudoexfoliation glaucoma, caused uniquely by mutations in the LOXL1 gene,6 and AD. We believe that this study should be considered separately, or pooled with data from other pseudoexfoliation glaucoma (and AD) studies. The data from this study cannot be extrapolated to others. We agree with Tsili et al that large and high-quality association studies, preferably with long follow-up, are needed to clarify the existence and nature of possible associations between POAG and AD. However, at the same time, these studies will only be useful if specific clinical or genetic subtypes of glaucoma and AD are considered. In this respect, we proposed to investigate the existence of a possible association between normal tension glaucoma and AD.2

Purpose To evaluate whether eyes with chronic glaucoma have a larger or smaller optic disk than normal eyes. Design Population-based, cross-sectional cohort study. Methods The study included 4439 subjects out of 5324 subjects invited to participate with an age of 40+ years. Color optic disk photographs (45°) were morphometrically examined. Results After exclusion of aphakic eyes, pseudophakic eyes, and highly myopic eyes, data of 3989 subjects entered the statistical analysis. The mean optic disk area did not vary significantly ( P > .05) between the nonglaucomatous group (2.61 ± 0.50 mm 2 ), eyes with glaucomatous appearance of the optic disk (2.69 ± 0.63 mm 2 ), eyes with glaucomatous optic disks and visual field defects (2.66 ± 0.70 mm 2 ), and eyes with elevated intraocular pressure (2.63 ± 0.49 mm 2 ). Conclusions In adult Chinese, optic disk size may not markedly differ between normal eyes and eyes with chronic glaucoma.

PURPOSE To apply scanning electron microscopy to impression cytology (IC) to evaluate conjunctival damage in patients undergoing topical glaucoma therapy. METHODS All patients undergoing glaucoma therapy and without ocular surface disorders between September 2012 and January 2013 were enrolled. An age- and gender-matched group without glaucoma served as the control group. Conjunctival epithelium was evaluated with the ferning test (FT), impression cytology with light optic microscopy (ICOM), and impression cytology with scanning electron microscopy (ICSEM). RESULTS Twenty patients (40 eyes; 11 men and 9 women, mean age 59.9 ± 11 years) constituted the treated group. The mean duration of glaucoma therapy was 25.5 ± 13.8 months (range, 6-48 months). The mean FT, ICOM, and ICSEM grades were 2.52 ± 0.5, 2.52 ± 0.6, and 2.55 ± 0.7, respectively. Treatment duration was not significantly correlated with FT/IC grade (P = 0.1), whereas it was significantly correlated with microvilli count at ICSEM (P = 0.01). The mean FT, ICOM, and ICSEM grades were significantly lower in the control group (40 eyes; 11 men and 9 women, mean age 61.1 ± 7.12 years) than in the treated group (1.22 ± 0.4, 1.25 ± 0.4 and 1.15 ± 0.3, respectively, P < 0.001). CONCLUSIONS The FT, ICOM, and ICSEM grades were lower in eyes undergoing glaucoma therapy than in control eyes. Treatment duration was significantly associated with a reduced microvilli count at ICSEM, but not with FT or ICOM grades. Reduction of microvilli could be the first sign of cellular damage during chronic glaucoma therapy.

e-Ophthalmology is the use of information and telecommunications technologies to provide or support a group of activities related to ophthalmic care. Chronic glaucoma is an ocular disease characterized by optic neuropathy that leads to progressive loss of the visual fields and often is associated with elevated intraocular pressure levels. Glaucoma is an important public health problem because it is one of the main causes of blindness worldwide and generates an important demand for ophthalmologic consultations. The aim of this chapter is to discuss the application e-Ophthalmology-based models in the diagnosis and follow-up of chronic glaucoma. The authors describe the current status of the use of e-Ophthalmology-based models in the screening and follow-up of chronic glaucoma, the main advantages of these models, the technologic requirements for their implementation, and future trends in this field.

Trabeculectomy with Mitomycin-C (MMC) and glaucoma drainage device implantation remain the most commonly performed surgical procedures for the treatment of Open Angle Glaucoma (OAG). Numerous studies have shown good efficacy for these surgical procedures [1-3]; however, a high rate of complications [4] has prompted the glaucoma community to search for alternative surgeries to treat OAG.

Purpose Developing a basis for personalized medicine requires instrumentation that has a high throughput and appropriate senstivity. To discover proteomic biomarkers of ocular surface diseases using quantitative mass spectrometry for discovery of molecular representatives within the tear film that can be used for clinical application and pharmacological development. Additionally, proteomics carried out by mass spectrometry provides a ready tool for use with quantitative biomarkers. Methods Tear samples can be collected by several means, our lab usually uses type I Schirmer’s test from patients and has been used successfully with patients with dry eye, pterygium or on anti-glaucoma medications as well as age-matched healthy unmedicated controls. Tear proteins are analyzed using iTRAQ (Isobaric tags for relative and absolute quantification) based quantitative proteomics or SELDI mass spectrometry. ELISA is used for confirmation of proteomic findings. Results In dry eye patients, over 200 tear proteins have been identified. Potential biomarkers include up-regulated proteins, alpha-enolase, alpha-1-acid glycoprotein 1, S100 A8, S100 A9, S100 A4 and S100. In chronic glaucoma patients, 128 tear proteins were identified with 99% confidence. We found 5 proteins whose iTRAQ ratios showed significant changes (p < 0.05) when comparing non-medicated control group and medicated group. Levels of 4 tear proteins (S100 A8, S100 A9, mammaglobin B and 14-3-3 z/d protein) were elevated. Conclusion Proteomic biomarkers provide new insights into the disease process as with the inflammatory S100 proteins found here and they are measurable end points for drug development, diagnosis and response to treatment. A biomarker panel for dry eye has been developed for patient use.

Purpose: It was the aim of this study to evaluate the prevalence of major depressive disorder (MDD) in chronic glaucoma patients on a topical β-blocker (timolol). Design: An observational case control study was performed. Methods: The subjects recruited were divided into 3 groups. Group I included 98 patients with chronic glaucoma on topical β-blocker therapy, group II included 64 chronic glaucoma patients on prostaglandin analogues, and group III included 150 normal controls. All subjects were screened for MDD by the self-administered questionnaire Prime-MD Today (Primary Care Evaluation of Mental Disorders, New York, N.Y., USA). Results: The control group had a significantly higher age (p < 0.001) compared to the glaucoma patients on timolol or prostaglandin analogues; 9/98 patients (9.2%) on timolol, 1/64 patients (1.5%) on prostaglandins and 3/150 (2%) control subjects were screened positive for MDD. The odds ratios adjusted for age, sex and duration of glaucoma showed that patients on β-blocker therapy were 6.4 and 4.9 times more likely to have depression compared to those on prostaglandin analogues and control subjects, respectively. Conclusions: Glaucoma patients on topical timolol should be screened for depression and referred for appropriate psychiatric consultation and treatment if indicated.

Introducción: La viscocanalostomía constituye una alternativa en el tratamiento quirúrgico del glaucoma. Esta técnica no penetrante favorece el drenaje del acuoso a través del canal de Schlemm evitando la aparición de ampollas de filtración y de las patologías relacionadas con éstas. Las complicaciones asociadas a esta cirugía son escasas; una de ellas es el desprendimiento de la membrana de Descemet (DMD). Caso clínico: Mujer de 64 años diagnosticada de glaucoma crónico de ángulo abierto cuyo ojo izquierdo fue intervenido mediante viscocanalostomía. En el posoperatorio inmediato apareció un DMD hemorrágico en el cuadrante temporal inferior. Tras adoptar inicialmente una actitud expectante, a los 15 días de la cirugía no se objetivó mejoría del DMD y se instauró un edema corneal que produjo disminución de la visión. Se procedió a la reaplicación quirúrgica del defecto mediante micropunción de la membrana de Descemet e inyección de SF6 en cámara anterior. Se consiguió una mejoría anatómica y funcional del cuadro. Discusión: Pensamos que la salida del material viscoelástico al espacio supradescemético fue consecuencia de la alta presión en el proceso de inyección del hialuronato de alta densidad. El manejo de un DMD hemorrágico está condicionado fundamentalmente por su localización, tamaño y evolución. La actuación diferida mediante micropunción endotelial y posterior descematopexia por medio de inyección en cámara anterior de SF6 al 20% resultó de utilidad para solucionar esta complicación. Introduction: Viscocanalostomy is an option in the surgical treatment of glaucoma. This non-penetrating technique favours aqueous drainage through the Schlemm channel while avoiding filtering blebs and their related pathologies. Complications associated to this surgery are unusual, one of which is Decemet´s membrane detachment (DMD) Clinical case: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose had undergone a viscocanalostomy of the left eye. In the immediate postoperative period we noticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and see attitude, we did not find improvement 15 days after surgery and corneal edema was established with vision decrease. We proceeded to a surgical reapplication by means of Descemet´s membrane micropuncture and SF6 injection into the anterior chamber and achieving an anatomical and functional improvement Discussion: We believe that the intrusion of viscoelastic material into the supradescemetic was a consequence of the high-pressure during the high-density hyaluronate injection. Hemorrhagic DMD management is mainly determined by its location, size and evolution. In our case, the posterior endothelial micropuncture and descematopexy by means of 20% SF6 injection into the anterior chamber was useful in resolving this complication.

There are many unanswered questions about chronic glaucoma which cannot be investigated in the available animal models. The present experiments were designed to develop a rabbit model of chronic intraocular hypertension with characteristics similar to human chronic glaucoma by ligating vortex veins or by making single or multiple intraocular injections of 0.5% or 1% alpha-chymotrypsin, 20% chondroitin sulphate, 2% hydroxypropyl methylcellulose, 2% sodium carboxymethylcellulose or 1% or 2% methylcellulose. Evaluation was based on the clinical findings, intraocular pressure and the retrograde axoplasmic transport function of the optic nerve using a horseradish peroxidase histochemical technique. Most methods either failed to produce moderate chronic intraocular hypertension or were associated with other complications. However, a reliable and relatively long period (eight weeks) of intraocular hypertension was developed by a series of four intra-anterior chamber injections of 1% or 2% methylcellulose. This model has been proved suitable for the study of structural and functional damage to the retina and optic nerve caused by chronic glaucoma.

The purpose of this article is to trace the development of the term 'chronic glaucoma' from early beginnings to the present day. I will look at the evolution of the term, what we mean by the term 'chronic glaucoma' today and how we might be defining it tomorrow.

A condition involving ocular pigment deposition was diagnosed in six cairn terriers. In each, there was pigment deposition in a number of ocular sites, including the episclera, and ventral anterior chamber and drainage angle. Four of the dogs (aged 10 years or older) had developed a chronic glaucoma, which was presumed to be secondary to pigment deposition in the drainage angle. The other two dogs (six-year-old litter mates) had not developed glaucoma but there were pigmented particles in the aqueous and abnormal pigment deposition within the episclera and drainage angle. They also had a raised circumferential band protruding from the periphery of the iris into the anterior chamber.

This study aims to employ in vivo dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate the ocular transport following an induction of ocular hypertension in a rat model of chronic glaucoma. Upon systemic administration of Gd-DTPA solution, T1-weighted signal increase was observed in the vitreous body of the glaucomatous eye but not the control eye. This increase occurred earlier in the anterior vitreous body than the preretinal vitreous. Further, there was an earlier Gd-DTPA transport into the anterior chamber in the majority of glaucomatous eyes. Our DCE-MRI findings revealed the leakage of Gd-DTPA at the aqueous-vitreous interface, which was likely resulted from increased permeability of blood-aqueous or aqueous-vitreous barrier. These may explain the sources of changing biochemical compositions in the chamber components, which may implicate the neurodegenerative processes in the glaucomatous visual components.

Of 34 consecutive patients with chronic glaucoma seen in north-east Ghana, 22 (65%) were male and seven (21%) were aged under 40 years. Only 17% of eyes had a visual acuity better than 6/18 at presentation. Sixteen of 23 patients who underwent gonioscopy had PAS of which 13 had positive skin snips for onchocerciasis, compared with two out of seven patients with positive skin snips who had open angle glaucoma (p = 0.003). Of 22 trabecular meshworks examined by light microscopy ten (45%) showed marked melanin pigmentation which was more common in younger patients but did not correlate with onchocerciasis infection.

Purpose: To compare the abilities of scanning laser polarimetry with the variable corneal compensator (GDx VCC) with those of optical coherence tomography (Stratus OCT) in discriminating between healthy and early-to-moderate perimetric glaucomatous eyes. Methods: A total of 95 glaucomatous patients (mean deviation − 3.7 ± 3.0 dB, pattern standard deviation 4.5 ± 2.7 dB) and 62 control subjects underwent imaging by the GDx VCC and Stratus OCT using both optic nerve head (ONH) and retinal nerve fibre layer (RNFL) scan protocols. One eye per patient was considered. Sensitivity at ≥ 90% specificity and area under the receiver operating characteristic curve (AROC) were calculated for each GDx VCC and Stratus OCT index. Results: The largest AROCs with Stratus OCT were associated with cup : disc area ratio (0.88) for ONH scan indices, and with average thickness (0.84) for RNFL scan indices. The nerve fibre indicator provided the greatest AROC for the GDx VCC indices (0.85). Conclusions: Both the GDx VCC and Stratus OCT instruments were shown to be useful in the detection of glaucomatous damage. The best performing indices for the GDx VCC and Stratus OCT with both ONH and RNFL scans gave similar AROCs, showing a moderate sensitivity in early-to-moderate glaucoma patients.

But Comparer l’efficacite et la securite d’une instillation quotidienne de timolol sans conservateur a une instillation quotidienne de timolol a liberation prolongee chez des patients porteurs d’un glaucome a angle ouvert ou d’une hypertonie oculaire et recevant deja du latanoprost. Patients et methodes Une etude randomisee, prospective, multicentrique, ouverte et parallele a ete realisee chez 73 patients traites par latanoprost et timolol a liberation prolongee. Le betabloquant a ete substitue par du timolol sans conservateur le matin chez 36 patients pendant trois mois. La pression intraoculaire (PIO) a ete evaluee, ainsi que la tolerance locale et systemique et l’observance. Resultats A 3 mois, les 2 traitements etaient equivalents pour la modification de la PIO entre J0 et J84. Les differences avec la PIO initiale etaient de -0,08 ± 2,22 mmHg et -0,38 ± 2,41 mmHg dans le groupe timolol sans conservateur et le groupe timolol a liberation prolongee respectivement, (IC95 % [-0,79 ; 1,38]). A J84, la proportion des troubles visuels a l’instillation (5,9 %) et des depots sur les paupieres (5,9 %) avait diminue dans le groupe timolol sans conservateur alors qu’elle etait stable dans l’autre groupe (respectivement 33,3 % et 24,2 %). Ces differences aussi bien pour les troubles visuels (p Conclusion Dans cette etude a court terme, une instillation quotidienne de betabloquant non conserve a montre son equivalence therapeutique au betabloquant a liberation prolongee chez des patients necessitant une bitherapie. De plus, cette formulation galenique a permis d’ameliorer la tolerance locale.

OBJETIVO: Verificar a técnica da instilação de colírio em pacientes portadores de glaucoma crônico. MÉTODOS: Estudo prospectivo realizado em 193 pacientes glaucomatosos. Para cada participante era entregue um frasco de colírio lubrificante (Dunason®, Laboratório Alcon, São Paulo, Brasil) e solicitado que realizasse uma instilação. RESULTADOS: Os participantes utilizaram, em média, 1,64 ± 1,26 gotas de colírio por instilação e 54,5% dos pacientes fizeram contato do bico do colírio com a superfície ocular. Em 3,1% das instilações nenhuma gota de medicamento atingiu o olho, com o paciente não se dando conta do fato. A oclusão do ponto lacrimal ou a manutenção do olho fechado por dois minutos após a instilação não foi realizada em 87,0% dos participantes, e 61,6% piscaram repetidas vezes imediatamente após instilar a droga. CONCLUSÕES: Verificou-se que a maior parte dos participantes deste estudo efetuou a instilação do colírio de modo incorreto. Isto significa desperdiçar grande parte do conteúdo do frasco, aumentar as possibilidades de toxicidade sistêmica, não aproveitar a plenitude do efeito hipotensor das drogas e contaminar a extremidade do frasco de colírio. Portanto, o ensino da técnica adequada da instilação de colírio é absolutamente necessária para todos os pacientes. PURPOSE: To observe eye drop instillation technique in chronic glaucoma patients. METHODS: This is a prospective study enrolling 193 glaucomatous patients. Each received a sample of lubricant eye drop bottle (Dunason®, Alcon Laboratories, São Paulo, Brazil) and was instructed to use it once. RESULTS: All patients used a mean amount of 1.64 ± 1.26 drops. In 54.5% of the patients, the eyedropper touched the eye and adnexa. In 3.1% the drops were not placed in the eye, without the patient being aware of this. In 87.0% of them, neither the lacrimal point occlusion nor the closure of the eyes for two minutes after instillation were observed, and 61.6% repeatedly blinked right after instilling the drop. CONCLUSIONS: Most patients did not use the eye drops properly. That may result in some undesirable consequences, such as, a partial wastage of the bottle's content, a possible increase in systemic toxicity, the risk of contamination of the bottletip, and, mainly, a decrease in the full hypotensive effect of the drugs. Therefore, the patients have to be carefully taught the correct way to use eye drops.

Purpose To document the prevalence of non-compliance and to investigate patients perceptions concerning glaucoma in a Greek cohort. Methods We investigated 100 consecutive patients referred to our glaucoma clinic and already treated for chronic glaucoma. Compliance and patients insight were ascertained by two independent observers by means of a predetermined questionnaire. All patients were subsequently assessed for their ability to instil their eyedrops accurately. Results Fifty one per cent of our patients were not aware of the nature of glaucoma, but 80% were afraid it might lead to blindness. Clinically significant non-compliance (more than two doses missed per week) was established in 44% of our patients. Men and those using eyedrops more than 4 times a day were more likely to default. Non-compliant patients exhibited higher mean intraocular pressure (22.9 vs 18.5 mmHg; p > 0.001) and worse visual field loss (10.8 vs 7.0 dB; p = 0.008) compared with compliant patients. Involuntary non-compliance was also common in our group, with only 53% instilling their eye drops accurately. Conclusion Non-compliance is a significant limiting factor in glaucoma therapy in Greece.

Frequency-doubling perimetry (FDP) is a new, out-of-the-ordinary, visual field testing method. Its sensitivity and reliability was tested in 16 patients (32 eyes) with ocular hypertension and 21 patients (37 eyes) with early chronic glaucoma. Significant defects were found in almost 10% of hypertensive eyes and in 67.7% of glaucomatous eyes. FDP is an effective and sensitive technique for glaucoma functional loss assessment.

The management of chronic glaucoma has to be directed towards the prevention of further visual loss. Although it has been traditional to lower intraocular pressure, this approach can only be seen as manipulation of a risk factor for progression. The true outcomes for management are both the halting/slowing of the rate of visual loss and glaucomatous cupping of the optic disc. Here, I discuss whether there is a role at the present time for optic disc imaging in management of POAG. Can sequential imaging of the optic disc demonstrate changes which indicate progression, and can these changes be seen to predate changes in the visual field?

Purpose: Visual field assessment is extremely important in glaucoma management, but interpretation is affected by the quality of the patient's performance. The authors have investigated the reliability of visual field performance by a randomly selected sample of the chronic glaucoma population at an urban tertiary care practice. Methods: Patient reliability in Humphrey automated visual field testing was studied in 106 randomly selected chronic open-angle glaucoma patient charts, which provided 768 tests (mean, 7.2 ± 4.8 fields; range, 2–18 fields). Reliability criteria were established as less than 20% fixation losses, less than 33% false-negative error, and less than 33% false-positive error, as recommended by Humphrey Instruments, Inc (San Leandro, CA). Results: Patients performed reliably in 61% of right eye fields, 58% of left eye fields, and 59.5% overall. Of the 106 patients, only 35 (33%) were always reliable in both eyes, whereas 8 (7.5%) were always unreliable in both eyes. The most common cause of unreliability was fixation loss (39%), whereas false-positive error (5%) and false-negative error (9%) were less frequent. A more severely depressed mean deviation correlated significantly with poorer performance on the three reliability indices, with false-negative error having the greatest correlation, followed by fixation loss and false-positive error. Corrected pattern standard deviation correlated closely only with false-negative error. Prolonged test time also correlated with all three reliability indices. Age was a significant factor for fixation loss but not for false-negative or false-positive error. Conclusions: The authors conclude that fewer than two thirds of the Humphrey visual fields were reliable with the authors' urban tertiary care population of patients with glaucoma. Relaxing the fixation loss criterion to less than 33% improved the rate of reliability to approximately 75%. The severity of glaucomatous visual field defects, test time, and age were identified as factors influencing the reliability of the Humphrey visual fields.

Purpose The aim of this study was to study the relationship between bleb parameters (height and extent) evaluated using ultrasound biomicroscopy and intraocular pressure (IOP) after subscleral trabeculectomy with mitomycin C in high-risk glaucoma patients. Design This was a prospective interventional observational uncontrolled study. Patients and methods Forty eyes of 26 patients with chronic glaucoma with uncontrolled IOP undergoing subscleral trabeculectomy with intraoperative mitomycin C (0.4%) applied for 2 min were followed up for 3 months. An ultrasound biomicroscopy was performed at day 90 to measure the bleb height and extent and a correlation was found between the mean IOP, the percent reduction in IOP, and the bleb height and extent at the same interval. Results The mean bleb height was 1.065 ± 0.991 mm (range 0-3.6 mm) and the mean bleb horizontal extent was 3.214 ± 1.997 mm (range 0-7.9 mm). A moderate positive linear correlation was observed for bleb horizontal extent between 1.8 and 4.97 mm and percentage change in IOP [ΔIOP (%), r = 0.374], and the results were statistically significant (P = 0.054). In terms of bleb height, the correlations with IOP and ΔIOP were found to be weak and of were not statistically significant. Conclusion We concluded that bleb extent is more representative of bleb function than bleb height and it appears that the percent reduction in IOP is more influenced by the bleb dimensions than the mean IOP.