Search

Purpose: To evaluate the efficacy and safety of excisional goniotomy performed with the Kahook Dual Blade (KDB) combined with cataract surgery in patients with pimary open angle glaucoma (POAG) and Normal Tension Glaucoma (NTG) under topical therapy. Further sub-analysis was performed to compare between 90 and 120 degrees goniotomy., Methods: This was a prospective case series of 69 eyes from 69 adults (age 78 ± 5.9 years; male = 27, female = 42). Indications for surgery included insufficient IOP control with topical medication, glaucomatous damage progression under topical therapy and reduction of medication burden. Complete success was defined as IOP lowering below 21 mmHg without the need for topical medication. For NTG patients, complete success was defined as IOP lowering below 17 mmHg without the need for topical medication., Results: IOP was significantly lowered from 19.7 ± 4.7 to 15.1 ± 2.7 at 2 months, 15.8 ± 2.3 at 6 months and 16.1 ± 3.2 at 12 months (p < 0.05) for POAG and 15.1 ± 2.5 to 14.1 ± 2.4 at 2 months, 14.1 ± 3.1 at 6 months and 13.6 ± 1.8 at 12 months (p > 0.08) for NTG, respectively. Complete success was achieved in 64% of the patients. IOP lowering under 17 mmHg without the need for topical medication was achieved in 60% of the patients at 12 months. In NTG patients (14 eyes) IOP lowering under 17 mmHg without the need for topical medication was achieved in 71%. No significant difference was recorded in terms of IOP lowering at 12 months in-between 90° and 120° of treated trabecular meshwork (p > 0.7). No severe adverse reactions were recorded in this study., Conclusion: One-year results show that KDB combined with cataract surgery is an effective treatment option for glaucoma patients. IOP lowering was successfully achieved in NTG patients with complete success in 70% of the patients. In our study, no significant differences were recorded in-between 90° and 120° of treated trabecular meshwork., (© 2023. The Author(s).)

Purpose: Single-use dual blade goniotomy (SBG) is a novel ab interno procedure that removes three to five clock hours of trabecular meshwork (TM). We analysed the reduction of intraocular pressure (IOP) and topical glaucoma medication (Meds) in eyes following combined cataract surgery and SBG (Cat-SBG)., Methods: IOP and Meds were evaluated retrospectively in 55 eyes of 38 patients. 44 eyes had high tension glaucoma (HTG) and eleven eyes had normal tension glaucoma (NTG). Complete success (no Meds) and qualified success (with Meds) for IOP levels ≤ 21, ≤ 18 , ≤ 16 mmHg or ≥ 20% IOP reduction at the two- and six-month follow-up were evaluated., Results: IOP and Meds were significantly reduced from before to two months after Cat-SBG in HTG- and NTG-patients (HTG: IOP 19.4 ± 3.3 to 15.1 ± 3.3 mmHg; p < 0.001; Meds 2.1 ± 1.3 to 0.8 ± 1.3; p < 0.001; NTG: IOP 14.0 ± 2.3 to 11.5 ± 2.3 mmHg; p = 0.004; Meds 1.6 ± 0.7 to 0.3 ± 0.7; p < 0.001). IOP and Meds did not change significantly from two to six months after Cat-SBG. In HTG, complete and qualified success rates were 43% (19/44) and 93% (41/44) for IOP ≤ 18 mmHg, 36% (16/44) and 64% (28/44) for IOP ≤ 16 mmHg and 30% (13/44) and 43% (19/44) for ≥ 20% IOP reduction six months after surgery. In NTG, complete and qualified success was 81% (9/11) and 100% (11/11) for IOP ≤ 18 and ≤ 16 mmHg, and 27% (3/11) for IOP reduction ≥ 20%. IOP and Meds reduction were comparable between HTG and NTG eyes. Only minor postoperative complications occurred., Conclusion: Cat-SBG is an efficient method to significantly lower IOP in patients with HTG and NTG., (© 2022. The Author(s).)

Purpose: To investigate the relationship of ocular blood flow (via arteriovenous passage time, AVP) and contrast sensitivity (CS) in healthy as well as normal tension glaucoma (NTG) subjects., Design: Mono-center comparative prospective trial METHODS: Twenty-five NTG patients without medication and 25 healthy test participants were recruited. AVP as a measure of retinal blood flow was recorded via fluorescein angiography after CS measurement using digital image analysis. Association of AVP and CS at 4 spatial frequencies (3, 6, 12, and 18 cycles per degree, cpd) was explored with correlation analysis., Results: Significant differences regarding AVP, visual field defect, intraocular pressure, and CS measurement were recorded in-between the control group and NTG patients. In NTG patients, AVP was significantly correlated to CS at all investigated cpd (3 cpd: r =  - 0.432, p< 0.03; 6 cpd: r =  - 0.629, p< 0.0005; 12 cpd: r =  - 0.535, p< 0.005; and 18 cpd: r =  - 0.58, p< 0.001), whereas no significant correlations were found in the control group. Visual acuity was significantly correlated to CS at 6, 12, and 18 cpd in NTG patients (r =  - 0.68, p< 0.002; r =  - 0.54, p< .02, and r =  - 0.88, p< 0.0001 respectively), however not in healthy control patients. Age, visual field defect MD, and PSD were not significantly correlated to CS in in the NTG group. MD and PSD were significantly correlated to CS at 3 cpd in healthy eyes (r = 0.55, p< 0.02; r =  - 0.47, p< 0.03)., Conclusion: Retinal blood flow alterations show a relationship with contrast sensitivity loss in NTG patients. This might reflect a disease-related link between retinal blood flow and visual function. This association was not recorded in healthy volunteers., (© 2021. The Author(s).)

Purpose: Vascular dysfunction and ischemia are believed to play an important part in the pathogenesis of glaucoma and especially of normal tension glaucoma (NTG). The aim of the present study was to analyze the blood pressure (BP) and heart rate variability patterns in patients with primary open-angle glaucoma (POAG) and NTG compared with controls., Methods: In total, 37 patients with POAG, 27 patients with NTG, and 82 control subjects were included in a prospective clinical validation study. Continuous BP and heart rate were simultaneously recorded over 30 min (Glaucoscreen, aviant GmbH, Jena, Germany) under resting conditions. Time series of heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were extracted and analyzed calculating univariate linear (time domain, frequency domain), nonlinear (symbolic dynamics), and bivariate (joint symbolic dynamics) indices., Results: Overall, 12 parameters could be identified that were significantly different when comparing POAG patients and controls, whereas 80 parameters were significantly different in NTG patients compared with controls. The optimum set consisting of three indices showed a sensitivity of 81.5% at a specificity of 86.6% for NTG patients compared with a sensitivity of 62.2% at a specificity of 82.9% for POAG patients., Conclusions: Alterations in BP variability and coupling with heart rate suggest impaired patterns of autonomic cardiovascular regulation in glaucoma patients especially in patients with NTG.

Purpose: Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG)., Patients and Methods: 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years., Results: Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect) at baseline was -7.61 ± 7.49 dB. The overall VFI progression was -1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found., Conclusion: Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters.

Purpose: Fluorescein angiographic studies revealed prolonged arteriovenous passage (AVP) times and increased fluorescein filling defects in normal tension glaucoma (NTG) compared to healthy controls. The purpose of this study was to correlate baseline AVP and fluorescein filling defects with visual field progression in patients with NTG., Patients and Methods: Patients with a follow-up period of at least 3 years and at least 4 visual field examinations were included in this retrospective study. Fluorescein angiography was performed at baseline using a confocal scanning laser ophthalmoscope (SLO, Rodenstock Instr.); fluorescein filling defects and AVP were measured by digital image analysis and dye dilution curves (25 Hz). Visual field progression was evaluated using regression analysis of the MD (Humphrey-Zeiss, SITA-24-2, MD progression per year (dB/year)). 72 patients with NTG were included, 44 patients in study 1 (fluorescein filling defects) and 28 patients in study 2 (AVP)., Results: In study 1 (mean follow-up 6.6 ± 1.9 years, 10 ± 5 visual field tests), MD progression per year (-0.51 ± 0.59 dB/year) was significantly correlated to the age (P = 0.04, r = -0.29) but not to fluorescein filling defects, IOP, or MD at baseline. In study 2 (mean follow-up 6.6 ± 2.2 years, 10 ± 5 visual field tests), MD progression per year (-0.45 ± 0.51 dB/year) was significantly correlated to AVP (P = 0.03, r = 0.39) but not to age, IOP, or MD at baseline., Conclusion: Longer AVP times at baseline are correlated to visual field progression in NTG. Impaired retinal blood flow seems to be an important factor for glaucoma progression.

Purpose: The aim of the study was to investigate retrobulbar flow velocities during hypercapnia in patients with normal tension glaucoma (NTG) without systemic vasospasm and jn controls., Methods: A total of 16 NTG patients (mean age 58 ± 14 years) and 16 control subjects (mean age 50 ± 13 years, p = 0.10) were enrolled in this study. Flow velocities, peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive indices (RI) of the ophthalmic (OA) and central retinal arteries (CRA) were assessed using color Doppler imaging. Blood flow velocities were measured under normocapnic and hypercapnic conditions (increasing the end-tidal pCO(2) by 15%). Blood pressure, ventilation rate and oxygen saturation were monitored simultaneously., Results: During hypercapnia, velocity responses of the PSV (p = 0.044) and EDV (p = 0.037) of the CRA were significantly different in NTG patients and healthy controls, showing a greater increase of flow velocities in control subjects. Flow velocities of the OA increased significantly in both groups (PSV p = 0.039, EDV p = 0.003) during hypercapnia. Blood pressure, oxygen saturation and intraocular pressure changed similarly in both study groups with carbon dioxide provocation., Conclusions: Velocity response to hypercapnia was reduced in the CRA of NTG patients compared to controls. This may indicate a faulty vasodilatory response in NTG patients without vasospastic disease.

Purpose: The aim of this study was to evaluate the sensitivity to detect glaucoma by observer-dependent nerve fibre layer imaging and evaluation using a scanning laser ophthalmoscope., Patients and Methods: Fifty-four patients with primary open angle glaucoma (POAG), 41 patients with normal tension glaucoma (NTG) and 65 eyes of control subjects were included in a retrospective study. Nerve fibre layer imaging was performed using a confocal scanning laser ophthalmoscope (SLO, Rodenstock Instr., argon laser 488 nm). Digitised images of the nerve fibre layer were graded off-line by two masked experienced observers. The nerve fibre layer was graded for every single degree (defect or no defect) at 1.7 and 3.4 mm distance to the optic nerve head omitting the nasal 110 degrees. Sensitivity and specificity levels were calculated using ROC analysis., Results: Patients with POAG exhibited nerve fibre layer defects of 100 degrees +/- 94 degrees (1.7 mm and 3.4 mm distance) and patients with NTG of 94 degrees +/- 94 degrees (1.7 mm distance) and 103 degrees +/- 92 degrees (3.4 mm distance), significantly larger compared to controls (1 degrees +/- 3 degrees [1.7 mm, p < 0.0001] and 1 degrees +/- 4 degrees [3.4 mm, p < 0.0001]). Sensitivity at > 90 % specificity was 80 % (1.7 mm) and 82 % (3.4 mm) for POAG. In NTG, sensitivity at > 90 % specifity was 81 % (1.7 mm) and 85 % (3.4 mm). In early glaucoma (MD < -6 dB, n = 39) sensitivity decreased to 75 % (1.7 mm) and 81 % (3.4 mm)., Conclusion: Observer-dependent evaluation and grading of the nerve fibre layer using a scanning laser ophthalmoscope reaches considerably high sensitivity levels to detect glaucoma with negligible differences between the central and peripheral regions., ((c) Georg Thieme Verlag KG Stuttgart New York.)