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Silicones*

This study was conducted to establish glaucomatous diagnostic criteria and to investigate its sensitivity and specificity with the confocal scanning laser ophthalmoscope(TopSSTM) on the basis of the normal values of the optic disc parameters in previous study. Abnormal ratio of optic disc parameters were analysed in 80 primary open angle glaucoma eyes - the subjects were divided into three groups according to visual field defects, each group of mild, moderate, and severe. and then glaucomatous diagnostic critera was established. According to this diagnostic criteria, we calculated its sensitivity and specificity. We established the glaucomatous diagnostic criteria with high sensitive five parameters(1/2 depth area, C/D ratio, neuroretinal rim area(NRRA), volume above, and notching), the established criteria are 1) If NRRA is decreased, one of the four parameters is abnormal. 2) If NRRA is normal, notching and one of the other three parameters are abnormal. Notching was defined as decreased neuroretinal area at either 6 o/c or 12 o/c sector. With this criteria, the sensitivity was 89.7% in mild group and 100% in moderate and severe groups and the specificity was 89.1% in normal groups. This criteria showed high sensitivity and specificity in the diagnosis of glaucoma, so as to be useful in the early detection of glaucomatous spticdisc changes.
Diagnosis ; Glaucoma ; Glaucoma, Open-Angle ; Ophthalmoscopes* ; Reference Values ; Sensitivity and Specificity* ; Visual Fields

We analyzed the outcome of primary trabeculectomy performed with intraoperative 5-fluorouracil(5-FU) sponge application on episclera and under lamella scleral flap in seventeen uncomplicated glaucoma eyes. The mean preoperative intraocular pressure(IOP) was 36.8+/-11.0mmHg. The mean postoperative IOP was 14.2+/-3.5mmHg after mean follow-up of 11.4 months. Two eyes required additional anti-glaucoma medications. Compliations included chronic hypotony(1 eye), shallow anterior chamber(2 eyes), and hyphema (1 eye). No eye showed corneal problems, hypotonic maculopathy, and bleb leakage. This study suggests that a single intraoperative use of 5-FU in primary trabeculectomy is an effective way of improving IOP control and of decreasing complications in eyes with uncomplicated glaucoma.
Blister ; Fluorouracil* ; Follow-Up Studies ; Glaucoma ; Hyphema ; Porifera ; Trabeculectomy*

A 60-year-old man visited our clinic with a sudden blurred vision and ocular pain in his right eye occurring 15 years after cataract surgery. The intraocular pressure (IOP) was 55 mmHg in the right eye and gonioscopy revealed a wide open angle with white cortical lens material in the inferior angle. Since the IOP was unable to be controlled with medical therapy, removal of the lens material was performed by irrigation and aspiration. Following surgery, the IOP was decreased to 18 mmHg without medication and the patient's vision recovered to 20/20. The pathology of the aqueous humor showed macrophages with engulfed lens particles.
Aqueous Humor/*cytology ; Case Report ; Cataract Extraction/*adverse effects ; Glaucoma/*etiology/*pathology ; Human ; Lens, Crystalline/*pathology ; Macrophages/pathology ; Male ; Middle Age

The purpose of this study is to evaluate the eligibility of gene therapy in treating glaucoma by constructing a replication deficient recombinant adenovirus carrying cDNA of stromelysin and by observing its expression in the rat eye. Stromelysin cDNA was obtained by RT-PCR using total RNA extracted from the cultured human trabecular cells. The cDNA was cloned into TA vector and subsequently into p deltaA. CMV. pA. The adenovirus vector containing stromelysin cDNA was constructed by co-transfection of pJM17 and p delta A. CMV-str. pA into the 293 cells. The expression of stromelysin in the trabecular meshwork and uveoscleral outflow channel of the rat eyes was detected by in situ hybridization and immunohistochemistry. In conclusion, this study showed the possibility of gene therapy in glaucoma by showing the expression of stromelysin with recombinant adenovirus vector containing stromelysin cDNA in the rat eye.
Adenoviridae* ; Animals ; Clone Cells ; DNA, Complementary ; Gene Expression* ; Genetic Therapy ; Glaucoma ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Matrix Metalloproteinase 3* ; Rats* ; RNA ; Trabecular Meshwork

It was investigated if regulation of the trabecular extracellular matrix tumover rate and remodeling plays an important role in decreasing outflow resistance by determining the effect of intracamerally given interleukin-1alpha a known stimulator of the expression of trabecular matrix metallopro-teinases, on outflow facility of albino rat eyes. Forty normal albino rats (Sprague dawley) weighing 250 to 300gm were studied. Rats were anesthetized by intraperitoneal pentobarbital sodium(30mg/kg) injection. The rats were grouped into 4 groups and given 5, 10, 25, 50 units of interleukin-1alpha injected intracamerally in one eye of each rat. Bovine serum albumin in phosphate buffered saline, which was used to dissolve the interleukin-1alpha, was injected in the other eye as a control. Outflow facility was measured by two level constant pressure perfusion at 1, 3, and 7 days after injection. The eyes treated with 50 units of interleukin-1alpha showed a statistically significant increase of outflow facility by 37% compared to the contralateral control eyes at 3 days after injection, but retumed to normal level in 7 days. The eyes treated with 5, 10, 25, 50 units of interleukin-1alpha increased the outflow facility, supporting the hypothesis that regulation of trabecular meshwork extracellular matrix plays a role in trabecular outflow resistance.
Animals ; Extracellular Matrix ; Interleukin-1alpha* ; Interleukins ; Pentobarbital ; Perfusion ; Rats* ; Serum Albumin, Bovine ; Trabecular Meshwork

Although adjunctive use of Mitomycin C(MMC)increased the success rate of trabeculectomy, intractable bleb leakage-related complications increased. As a consequence, demand for MMC related bleb leakage repair is increasing. We attempted to observe whether the cultured autologous fibroblast injected into the subconjunctival space of rabbit may be used as a new treatment modality in the MMC related bleb leakage. Similar situation to extensive bleb leakage after trabeculectomy with MMC was prepared by repeated injections of 0.1cc of 0.05% MMC into subconjunctival space in 30 eyes of 15 New Zealand white rabbits weekly for 3 times and devided them into control, autologous blood injection and autologous fibroblast injection groups. Then, we observed the change of conjunctiva and enucleated it for histopathologic study at 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks, respectively. In control group, the conjunctiva was thin and transparent. Subconjunctival fibroblasts were hardly visible and collagen fibers were arranged coarsely. In contrast, cultured autologous fibroblast injection group showed thickened and less transparent conjunctiva along with packed fibroblasts and collagen fibers. In autologous blood injection group, the transparency of conjunctiva and the density of fibroblast and collagen fiber arrangement were between those of the other two groups. The cultured autologous fibroblast injection may be a feasible and an effective treatment modality in intractable bleb leakage after trabeculectomy with MMC.
Blister ; Collagen ; Conjunctiva ; Fibroblasts* ; Mitomycin* ; Rabbits ; Trabeculectomy

We attempted to observe the expression of stromelysin, which regulates the extracellular matrix of trabecular meshwork and is one of the family of the matrix metalloproteinases, in the trabecular cells after transfection of replication deficient recombinant adenovirus vector containing stromelysin cDNA. Stromelysin cDNA was produced by RT-PCR with total RNA extracted from cultured human trabecular cells after induction with interleukin-1 alpha, and cloned by inserting the cDNA into the TA vector. Adenovirus vector that contains stromelysin cDNA was constructed by cotransfection of pJM17 and p delta A. CMV. PA-str into the 293 cells. The expression of stromelysin in the trabecular cells was assayed by Western blot and zymography. The sequence of stromelysin cDNA was consistent with that previously reported. The constructed adenovirus vector had stromelysin cDNA but had no E1 region. The expression of stromelysin in the trabecular cells by this vector was detected in 4 days and peaked in 7 days after transfection. In conclusion, this study showed the possibility of gene therapy in the glaucoma treatment by transfecting the trabecular cells with the replication deficient recombinant adenovirus vector containing stromelysin cDNA.
Adenoviridae* ; Blotting, Western ; Clone Cells ; DNA, Complementary ; Extracellular Matrix ; Genetic Therapy ; Glaucoma ; Humans* ; Interleukin-1alpha ; Matrix Metalloproteinase 3 ; Matrix Metalloproteinases ; RNA ; Trabecular Meshwork ; Transfection

An attempt was made to observe the possibility of controlling intraocular pressure (IOP) without hypotony and ocular motility disorder by installing an experimentally designed glaucoma implant through a small conjunctival incision with the aid of a stylet and maintaining the aqueous reservoir using mitomycin C (MMC). The implant was made of silicone tube, of which one end was occluded by glue and on the same end 4 check-valve-like slits were made. Thirty-five healthy white rabbits were used and subdivided into 4 groups. In groups I to III, implants having 2.0, 2.5, 3.0 mm slit lengths, respectively, were installed with MMC application in one eye of each of the 10 rabbits. In group IV, a 2 mm slit-length implant was installed without MMC in one eye of each of the 5 rabbits. Pneumatonometry and ultrasonography were performed to check the IOP and the formation of aqueous reservoir in the implanted eyes for 8 weeks. In group I through III, there was a statistically significant 4-5 mmHg pressure-lowering effect in the implanted eyes compared to the contralateral control eyes for 8 weeks. The aqueous reservoirs were observed throughout the follow-up period. In group IV, we could observe neither a pressure-lowering effect nor aqueous reservoir formation in the implanted eyes after 2 weeks postoperatively. Hypotony did not occur in implanted eyes in any of the groups. This study shows the possibility of IOP control by installing a specially designed glaucoma implant with application of MMC.
Animals ; Anterior Eye Segment/ultrasonography ; Antibiotics, Antineoplastic/*therapeutic use ; Aqueous Humor/secretion ; Chemotherapy, Adjuvant ; Glaucoma/*therapy ; Intraocular Pressure ; Mitomycin/*therapeutic use ; Ocular Hypotension/prevention & control ; Ocular Motility Disorders/prevention & control ; *Prostheses and Implants ; Rabbits ; *Silicone Elastomers ; Tonometry, Ocular

PURPOSE: To identify the polymorphism in the regulatory region of trabecular meshwork inducible glucocorticoid response(TIGR) gene and evaluate the association of it with glaucoma. METHODS: 5'regulatory region of TIGR gene of 101 normal persons and 91 unrelated glaucoma patients were analyzed by DNA sequencing and restriction enzyme digestion. To know the possible effects of the polymorphism on the transcription rate of TIGR gene, electrophoretic mobility shift assay and luciferase reporter gene assay were performed with cultured cells, and their extracts of trabecular meshwork and ciliary body in which the gene was expressed. RESULTS: Of the 480 bp examined, G to A transition(G-241A) located at 241 bp upstream from transcription start site was identified and its frequency of occurrence was proved to be higher in steroid induced glaucoma patients(18.9%) compared with that in normal population(8.9%), POAG(8.3%) and normal tension glaucoma patients(6.7%, P<0.05). In mobility shift assay, the G-241A probe was proved to have affinity to some DNA-binding proteins and its affinity was revealed to be two times stronger than that of normal sequence. The luciferase activities, however, were observed to be similar in cells transfected with vectors having normal promoter sequence or G-241A containing one. CONCLUSION: The result suggest that G-241A itself is not a cause of steroid-induced glaucoma but is in linkage disequilibrium with the actual causes of the disease.
Cells, Cultured ; Ciliary Body ; Digestion ; DNA-Binding Proteins ; Electrophoretic Mobility Shift Assay ; Genes, Reporter ; Glaucoma* ; Humans ; Linkage Disequilibrium ; Low Tension Glaucoma ; Luciferases ; Regulatory Sequences, Nucleic Acid* ; Sequence Analysis, DNA ; Trabecular Meshwork ; Transcription Initiation Site