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Intravascular irradiation of the blood with He-Ne laser at a wavelength 680 nm and 0.5 mWt power via Leukocyte light-guide introduced into one of the cubital veins was used in the treatment of patients with primary glaucoma. Treatment efficacy was assessed from changes in vision acuity, visual field, angioscotomas, blind spot, ophthalmic tone, and tonographic parameters. Treatment efficacies of traditional therapy and the suggested exposure were compared. Endovascular laser therapy exerted a more marked effect as regarded improvement of vision acuity, decrease of the blind spot and angioscotomas, reduction of intraocular pressure, and improvement of tonographic parameters. This recommends such exposure for the treatment of primary glaucoma patients in complex with other treatment modalities.

The blood viscosity and related factors were determined in 31 patients with primary open-angle glaucoma (POAG) and 30 normal subjects. It was found that (1) the blood viscosity was significantly higher in the POAG group than in the normal controls, as were also the plasma viscosity, the hematocrit, the fibrinogen content, the index of erythrocyte aggregation and the blood yielding stress, and (2) there was no difference in the value of TK which was a measure of erythrocyte deformability between the two groups. The study showed that patients with glaucoma had blood hyperviscosity which could be caused by the elevated hematocrit and plasma viscosity. The possible relevance of blood hyperviscosity to glaucomatous optic atrophy was discussed.

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p < or = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

Researches of glaucoma visual function damage, hemorheology, ocular rheography and other related multiplex factors, with computed multifactorial stepwise regression analysis, indicate that the elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic perfusion pressure in ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platelet adhesion rate. The characteristic of ocular rheographic changes in POAG patients of controlled IOP suggest that the abnormal changes of hemorheology be responsible for the damage of visual function. The abnormal changes of plasma viscosity, blood apparent viscosity, blood viscoelasticity, hematocrit, mean red cell volume etc could be found in addition to the reduction of PO2, SO2% and trace elements (Cr, Zn, Mg, Fe) in patients with POAG. Computed multiply stepwise regression analysis and Bayes discrimination were made among the deteriorate rate of quantitative visual field and 28 factors from the combined investigation. Only the hemorrheological index could be introduced into the multiply regression equations. The more the damage of visual function in POAG patients, the more accurate the discriminatory effect. Based upon the results, and the reports of articles published as well as the search of 1982-1989 Compact Combridge MEDLINE Medical data base, the new clinical concept could be presented that POAG might belong to the scope of blood hyperviscosity syndromes. When IOP elevation and the decrease of ocular artery pressure existed, the damage of visual function in POAG patients should be deteriorated.

This paper deals with the relation of disorders of carbohydrate metabolism to etiopathogenesis of glaucoma. 102 patients with primary glaucoma of an open angle were examined and it was discovered that 80 patients from this group (78%) had an abnormal immuno-reactive insulin curve, in particular of the hypersecretory type. Standard gauge test for abnormal glucose level was administered with 31 glaucomatous patients (30%). From this point of view screening for immuno-reactive insulin is a more sensitive and reliable method than the glucose standard gauge test. It is recommended that testing for immuno-reactive insulin should be introduced for all glaucomatous patients because this can help both in the detection of early stages of diabetes and in the administration of primary prevention of atherosclerosis among the population.

Observing interrelation between carbohydrate metabolism disorders and contrainsular mechanisms in a group of 102 glaucomatous patients, a higher level of cortisol in plasma was detected in 40.2% of glaucomatous patients of whom 31% had increased levels of cortisol together with IRI. In isolation the increased level of cortisol occurred in 8.9%. The frequency of increased cortisol level in glaucomatous patients is substantially lower (40.2%) than the frequency of abnormal insulin curves (78%). Increased levels of growth hormone in the group of patients occurred in 9.3% of cases and these were almost always associated with an abnormal immuno-reactive insulin curve (IRI curve). Accordingly, it is evident that hormonal disorders are a major factor in the onset of both diabetes and glaucoma.

Computed multifactorial stepwise regression analysis of quantitative visual field deterioration in relation to 28 factors showed that only the hemorheological indices entered the multiplex regression equations, especially accurately for POAG patients with severe visual damages. Besides, the patients might also have lower antioxidant capability in the red cell membrane protein. Based on the present results and data abroad, POAG might pertain to the blood hyperviscosity syndrome, and with elevated intraocular pressure and decreased ocular arterial pressure, the visual function damage would be aggravated.

The second part of the investigation revealed that POAG patients manifested abnormalities in plasma viscosity, whole blood apparent viscosity and viscoelasticity, hematocrit, and mean red cell volume, with concurrent reduction in oxygen partial pressure degree of oxygen saturation, and levels of trace elements Cr, Zn, Mg, and Fe. The hemorheological factors should be taken into account in addition to intraocular pressure in the development of visual damages.

Researches of glaucomatous visual damage, hemorheology, ocular rheograph and other multiplex factors, with computed multifactorial stepwise regression analysis, indicate that elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic perfusion pressure in the ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platelet adhesion rate. The characteristic ocular rheographic changes in POAG patients of controlled IOP suggest that hemorheological factors play a role in the visual function damage.

Based on the results of examinations of 300 patients with primary glaucoma after trabeculectomy, the author has developed clinical criteria for the evaluation of the intensity of the reparative processes at the site of intervention. Plasma fibronectin levels were found to grow with the progress of glaucoma (from Stage I to Stage II almost twofold). Analysis of correlations and regressions has revealed reliable relationships between plasma fibronectin levels and clinical values of the intensity of reparative processes at the site of surgery. Preoperative measurements of plasma fibronectin help predict with a high degree of probability the hypotensive effect of surgery.

Platelet aggregation in vitro, deterioration of visual field defects (VFD) and the prevalence of disc haemorrhages (DH) were assessed in 49 patients with primary open angle glaucoma (POAG) and compared with the findings for 67 individuals with suspected glaucoma (GS) in a seven-year follow-up study (range 5.8 to 8.2 years). The percentage patients with spontaneous platelet aggregation (SPA) was higher for POAG patients with visual field deterioration (60%) than both POAG patients without progressive loss of visual fields (12.5%; P less than 0.005) and those with suspected glaucoma (22.4%; P less than 0.005). The occurrence of DH was higher among POAG patients with progressive loss of visual field (28%) compared to the GS group (8.4%; P less than 0.025) and the group of patients consisting of POAG patients without deterioration of VFD and GS (9.9%; P less than 0.05). DH also occurred more often in patients with low tension glaucoma (41.6%) than in the remaining POAG patients (13.5%; P less than 0.05). No relation between the patients with SPA and the patients with DH was observed.

Total biologic plasma glucocorticoid activity of normal, ocular hypertensive, and open-angle glaucoma patients was compared using a glucocorticoid receptor-based competitive binding assay. Multiple linear-regression analysis was used to adjust for the effects of significant ocular and nonocular variables, including therapy for glaucoma. The glaucoma patients had significantly greater plasma glucocorticoid activities than did normal subjects. A comparison of receptor-based assay values to values obtained with a cortisol radioimmunoassay showed that significant amounts of biologic glucocorticoid activity in the plasma of the glaucoma patients could not be explained by cortisol alone. In the normal and ocular hypertensive groups, however, virtually all of the plasma glucocorticoid activity could be accounted for by cortisol. These results suggest that in open-angle glaucoma patients, noncortisol glucocorticoids are responsible for elevating biologic plasma glucocorticoid activity. Thus, open-angle glaucoma may be associated with a disturbance of the hypothalamic-pituitary-adrenal axis that produces increased plasma levels of both cortisol and other noncortisol glucocorticoids.

Studies of platelet aggregation coefficient and blood viscosity in 53 patients with open-angle glaucoma have revealed a statistically significant elevation of this coefficient value in the patients vs. the normal subjects. Possible mechanisms of this shift are discussed. The authors consider it useful that studies on the efficacies of drugs used in the treatment of open-angle glaucoma be carried out.

In this study platelet aggregation was determined in 79 patients with primary open angle glaucoma (POAG) and 81 patients suspected of having glaucoma (ocular hypertension). There is a positive association between high age and the presence of vascular diseases (p less than 0.01). An age dependent association between spontaneous platelet aggregation (SPA) and the presence of POAG was also observed (p less than 0.05). This indicates that the incidence of SPA in the elder group of patients with POAG is higher than in the elder glaucoma suspect group and in the group of younger patients. The association between vascular diseases and SPA and between vascular diseases and the presence of POAG were not significant at the 5% level. The incidence of SPA is not influenced by sex distribution, by the presence of diabetes, smoking or the use of timolol maleate topically.

We carried out analysis of plasma lipid and lipoprotein levels in 183 patients (92 women and 91 men) referred because of suspected glaucoma. We found an excess of hypertriglyceridemia among the women. Type IV lipoproteinemia was the most common lipoprotein abnormality. Lipid analysis was unhelpful in determining whether glaucoma was present or what type of glaucoma was present. The prevalence of cardiovascular disease was similar among patients with and without a lipoprotein abnormality.

Aqueous humour catecholamine concentrations were assayed in open angle glaucoma, and cataract patients during surgery, under general anaesthesia. Plasma catecholamines were measured at the same time. Aqueous humour noradrenaline is apparently reduced by pretreatment with adrenaline, timolol and pilocarpine. (Noradrenaline concentrations were 0.599 +/- 0.239 ng/ml in glaucoma, and 0.970 +/- 0.445 ng/ml in cataract patients.) Dopamine was found in two of six cataract patients (0.123 and 0.318 ng/ml), and in all the glaucoma group (0.221 +/- 0.170 ng/ml). Plasma noradrenaline concentration was probably increased in glaucoma, when compared to the cataract patients. These results confirm our findings in the non-human primate, and suggest that adrenaline may act, at least in part, by causing denervation or inhibition of noradrenaline release in the anterior segment of the eye, and probably by release of dopamine into the aqueous humour. The unexplained and new finding of dopamine in the aqueous humour may have some bearing on the action of dopaminergic drugs for the treatment of glaucoma. Future treatment of ocular hypertension may rely more on sympathetic denervation than on conventional adrenergic therapy.

To determine whether hemorrheologic factors play a part in optic nerve cupping and visual field loss in glaucoma, blood viscosity was measured at three shear rates in 27 patients with primary open-angle glaucoma and 18 healthy control subjects matched for sex, mean arterial blood pressure and smoking habits. The study was conducted between 1984 and 1986. The mean viscosity was significantly higher in the glaucoma group than in the control group at all three shear rates. The possible relevance of raised blood viscosity as a causal factor in optic nerve cupping in patients with glaucoma is discussed.

ABO-blood groups and Rh-factor (D-antigen) were determined in 236 patients with POAG, 104 simple and 132 capsular glaucoma. There was a statistical significant difference in the ABO-distribution between the two glaucoma subgroups, and also between the capsular-group and our control material. The simplex-group did not differ from the control material in this respect. For the Rh-group (D-antigen) no differences were found, neither between the two glaucoma subgroups nor between each of them and a reference material.

The effects of 3 mg orally administered dexamethasone on the intraocular pressure (IOP) were examined in four patients with primary open-angle glaucoma hospitalized for this study. Plasma-free glucocorticoid activity was measured by a radioreceptor assay. Diurnal rhythms of IOP and plasma-free glucocorticoid activity were detected prior to administration of dexamethasone. The plasma-free glucocorticoid activity rose two- to threefold in the 30-min period following steroid administration and then declined throughout the rest of the day. IOP was approximately 2 mmHg higher in the 0-4-hr period and approximately 5.5 mmHg higher in the 4-8-hr period following the pharmacologic doses of dexamethasone compared with similar periods on control days. The increase in the IOP was highly significant (P less than 0.006) in the latter time period. These findings suggest that the glucocorticoids may have a greater role in regulating IOP than generally has been appreciated.

In 375 patients aged 68.5 +/- 9.4 years (mean +/- 1 SD) with primary glaucoma subdivided by irido-corneal angle configuration into closed-angle glaucoma (123 cases), ocular hypertension (186 cases), and open-angle glaucoma (66 cases), diabetic status was determined by standard 75 g oral glucose tolerance tests. In 63 patients with impaired glucose tolerance who were retested one year later, 16% had progressed to diabetes mellitus. The results confirm a significant association between non-insulin dependent diabetes mellitus and primary glaucoma which may result from autonomic dysfunction in parasympathetic tone causing anterior chamber angle closure.

50 patients with diabetes mellitus of 2-7 years' duration were divided by a random method into 2 equal groups, one of which received 1,500 mg of Doxium (calcium dobesilate) daily for 3 months, the other group receiving a placebo. All the patients had diabetic retinopathy, open-angle glaucoma, raised intraocular pressure, and hyperviscosity of whole blood, plasma, and aqueous humor. 10 patients in each group underwent operation for glaucoma. At the end of the trial the state of the retina, the visual acuity, and the visual fields had improved, and the intraocular pressure and the 3 viscosity values had fallen to a statistically significant extent in the Doxium group compared with the initial status and with the placebo group. These results are consistent with Doxium's known action in reducing capillary fragility, microvascular hyperpermeability, and blood viscosity.

Values of plasma free cortisol (not bound to plasma proteins), total plasma cortisol, and percent free cortisol were determined in normal, ocular hypertensive, and open angle glaucomatous subjects. Median total plasma, plasma free, and percent free cortisol levels were higher in ocular hypertensive and glaucomatous individuals. The most significant differences occurred with percent free cortisol values between normal and glaucomatous subjects. There was a significant positive correlation between percent free cortisol and total cortisol levels in normal subjects only. For subjects with glaucoma and hypertension, the percent free cortisol values were independent of the total cortisol values. Multilinear regression analysis also indicated that besides diagnosis and level of total plasma cortisol, male sex, blood sampling late in the day, and increased diastolic blood pressure were the only variables significantly related to increased values of plasma free cortisol and percent free cortisol. Ocular medication for glaucoma and use of beta-blockers were not found to be significant independent variables in the regression models for either plasma free cortisol or percent free cortisol. These observations further suggest that a disorder of the pituitary adrenal axis and/or a binding of plasma cortisol is associated with ocular hypertension and open angle glaucoma.

Blood viscosity and its determinants were measured in 27 patients with primary open-angle glaucoma, 15 patients with ocular hypertension and 18 healthy control subjects matched for sex, blood pressure and smoking habits. The mean blood viscosity value was significantly higher in the glaucoma group than in the two other groups at all three shear rates studied; there was no difference in viscosity between the hypertension group and the control group. The mean hematocrit value was significantly lower in the hypertension group than in the two other groups. The results suggest that blood viscosity may contribute to nerve damage in patients with primary open-angle glaucoma. The low hematocrit observed in the patients with ocular hypertension may, by contributing to low viscosity, in some measure protect this group from optic nerve damage.