We present cases of primary open angle glaucoma patients without previous history of pseudoexfoliation who developed pseudoexfoliative materials on the anterior surface of the intraocular lens after cataract surgery. Among 5 unilateral pseudophakic pseudoexfoliation cases, 3 showed a more advanced state of glaucoma in the affected eye. The other 2 cases showed progression of glaucoma in the affected eye after the development of pseudophakic pseudoexfoliation, while the unaffected eyes remained stable. In the latter 2 cases, control of intraocular pressure was difficult, and more glaucoma medication was needed in the affected eye. Pseudophakic pseudoexfoliation in glaucoma patients with no history of pseudoexfoliation syndrome or pseudoexfoliative glaucoma has not been reported. In our cases, the eyes which developed pseudophakic pseudoexfoliation showed a more advanced state of glaucoma, more difficulty controlling intraocular pressure, and faster progression of glaucoma. More observation is needed, but we cautiously postulate that pseudophakic pseudoexfoliation may have a role as a clinical risk factor in the prediction of glaucoma progression.
Aged ; Exfoliation Syndrome/*etiology/*therapy ; Female ; Glaucoma, Open-Angle/*complications/*therapy ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; Phacoemulsification

PURPOSE: To evaluate the expression of the Na(+)-K(+)-2Cl(-)-cotransporter 2 (NKCC2) in the ischemic rat retina. METHODS: Retinal ischemia was induced by pressures 90 to 120 mmHg, above systemic systolic pressure. Immunohistochemistry and western blot analysis were performed. RESULTS: NKCC2 is expressed in the normal retina and its expression is increased by ischemia caused by intraocular pressure elevation. NKCC2 immunoreactivity was observed mainly in axon bundles of ganglion cells and horizontal cell processes in the retina. NKCC2 expression continuously increased with a peak value 3 days (to 415% of normal levels) after ischemic injury, and then gradually decreased to 314% of controls until 2 weeks post injury. The mean density of NKCC2-labeled ganglion cells per mm2 changed from 1,255 +/- 109 in normal retinas to 391 +/- 49 and 185 +/- 37 at 3 days and 2 weeks after ischemia, respectively (p < 0.05), implying cell death of ganglion cells labeled with NKCC2. CONCLUSIONS: Taken together, these results suggest that NKCC2, which is expressed in retinal ganglion and horizontal cells, may contribute to cell death by ischemic injury in the retina, although the molecular mechanisms involved remain to be clarified.
Animals ; Blotting, Western ; Disease Models, Animal ; Immunohistochemistry ; Intraocular Pressure ; Ischemia/etiology/*metabolism ; Male ; Microscopy, Confocal ; Ocular Hypertension/*complications/metabolism/physiopathology ; Rats ; Rats, Sprague-Dawley ; Retinal Diseases/etiology/*metabolism ; Retinal Ganglion Cells/*metabolism/pathology ; Sodium-Potassium-Chloride Symporters/*biosynthesis

PURPOSE: In this study, we evaluated systemic hemodynamic factors of normal tension glaucoma. METHODS: Forty patients with normal tension glaucoma and thirty healthy people were investigated with regard to hemoglobin, hematocrit, RBC count, WBC count, platelet count, fasting glucose, HbA1c, total cholesterol, triglycerides, LDL, HDL, and high-sensitivity C-reactive protein (hsCRP). Also, ET-1 and MCP-1 were measured using enzyme-linked immunosorbent assay kits. RESULTS: The results of the blood examinations showed no statistically significant differences in hemoglobin, hematocrit, RBC count, WBC count, platelet count, fasting glucose, HbA1c, total cholesterol, LDL, HDL, and hsCRP. Only triglycerides showed a statistically significant difference between the groups (P=0.03). The level of serum ET-1 was significantly higher in the normal tension glaucoma group (P=0.007). The results of MCP-1 showed no statistically significant difference. CONCLUSIONS: We conclude that normal tension glaucoma Is associated with an increased level of triglycerides and that the level of ET-1 could be a hemodynamic cause of normal tension glaucoma.
C-Reactive Protein ; Cholesterol ; Cholesterol, LDL ; Endothelin-1 ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Glaucoma ; Glucose ; Hematocrit ; Hemodynamics ; Hemoglobins ; Humans ; Low Tension Glaucoma ; Platelet Count ; Triglycerides

Glaucoma is characterized by loss of retinal ganglion cells (RGCs) and their axons. Retrograde axoplasmic transport blockade and excitotoxicity were proposed to be a major cause of RGC apoptosis. We conducted this study to characterize the episcleral vessel cauterization glaucoma model in the rat with respect to decreased retrograde axoplasmic flow and subsequent apoptotic RGC death. After episcleral vessels were cauterized in Sprague-Dawley rats, Fluorogold was injected into their superior colliculi by stereotactic method. Retrograde axoplasmic flow and TUNEL-stained apoptotic dead cells were observed microscopically. Elevated intraocular pressure was maintained for up to 6 weeks during follow-up. Retrograde axoplasmic flow to the rat retina was significantly decreased. Apoptotic RGC was selectively TUNELstained in the retina, especially at the ganglion cell layers. We concluded that elevated intraocular pressure caused apoptotic RGC death through retrograde axoplasmic flow blockage. Further studies will elucidate the neuroprotection strategies in glaucoma patients.
Animals ; *Apoptosis ; Axonal Transport ; Disease Models, Animal ; In Situ Nick-End Labeling ; *Intraocular Pressure ; Male ; Ocular Hypertension/*complications ; Rats ; Rats, Sprague-Dawley ; Retinal Ganglion Cells/*pathology ; Retrograde Degeneration/etiology ; Sclera/blood supply

PURPOSE: We retrospectively studied the clinical restults of Ahmed valve implantation in the aspects of complications in refractory glaucoma. METHODS: One hundred fourteen eyes of 112 patients who had undergone Ahmed glaucoma valve implantation from February 1996 to April 2002 were reviewed retrospectively. Patients with less than 6 months of follow-up were excluded from the analysis. Etiology of glaucoma, change of intraocular pressure and visual acuity and the incidence of complications were evaluated. RESULTS: Postoperative complications included persistent shallow ant.chamber with hypotony in 10 eyes, choroidal detachment in 11 eyes, hyphema in 16 eyes, vitreous hemorrhage in 3 eyes, suprachoroidal hemorrhage in 2 eyes, valve obstruction in 15 eyes (10 by fibrous membrane, 3 by vitreous, 1 by silicone oil and 1 by gas tamponade), valve malposition in 14 eyes (6 by corneal contact 4 by iris contact or incarceration, 1 by lens contact, 1 by intraocular lens contact and 2 by shortage of valve tip), scleral graft exposure in 2 eyes, conjunctival scarring in 2 eyes, encapsulated bleb in 2 eyes, EOM limitation due to giant bleb in 2 eyes, corneal graft rejection in 1 eye and phthisis bulbi in 10 eyes. Various kinds of complications were observed in 66 eyes of the total 114 eyes. CONCLUSIONS: Ahmed glaucoma valve implantation was effective in controlling intraocualr pressure and maintenance of visual acuity. However, Ahmed valve showed many kinds of complications in the follow-up periods.
Blister ; Choroid ; Cicatrix ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Hemorrhage ; Humans ; Hyphema ; Incidence ; Intraocular Pressure ; Iris ; Lenses, Intraocular ; Membranes ; Postoperative Complications ; Retrospective Studies ; Silicone Oils ; Transplants ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: Scar tissue formation by proliferation, migration and contraction of fibroblasts may result in the failure of trabeculectomy. The author investigated inhibitory effects of Mitomycin C (MMC) and Taxol on proliferation of cultured rabbit subconjunctival fibroblasts. METHODS: Tenon's fibroblasts of rabbits were cultured and exposed to various concentrations of each drug for 6 days. Cell viability was measured using MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide) assay. RESULTS: Both MMC and Taxol inhibited proliferation of fibroblasts significantly in a dose-dependent manner, with ID50s of 0.27 mg/l and 0.08 mg/l, respectively. CONCLUSIONS: We have confirmed that Taxol is as potent inhibitor of fibroblast proliferation as Mitomycin C. This result may possibly support the use of Taxol in trabeculectomy to improve the success rate of trabeculectomy.
Cell Survival ; Cicatrix ; Fibroblasts* ; Mitomycin* ; Paclitaxel* ; Rabbits ; Trabeculectomy

Viscoelastic substance or Mitomycin C(MMC)is not necessarily used in trabeculectomy. Hence, the authors investigated the rate of cataract development or progression after trabeculectomy related with using of the viscoelastic substance or MMC. The authors evaluated 119 eyes undergoing trabeculectomy and divided these eyes into 4 groups :group 1, 2, 3, and 4. In group 1, viscoelastic substance or MMC was not used(27 eyes). In group 2, only viscoelastic substance was used(35 eyes). In group 3, only MMC was used(15 eyes). In group 4, both viscoelastic substance and MMC were used(42 eyes). The cataract development or progression was examined with slit-lamp biomicroscope at postoperative 6 months and defined as the decrease of visual acuity more than 2 lines. The rate of cataract development or progression at postoperative 6 months was 18%in group 1, 14%in group 2, 40%in group 3, and 19%in group 4.The use of MMC without viscoelastic substance in trabeculectomy influenced cataract development or progression extremely. In conclusion, the results of this study suggest that the viscoelastic substance may reduce the rate of cataract development or progression after trabeculectomy in which MMC is used besides.
Cataract* ; Mitomycin* ; Trabeculectomy* ; Visual Acuity

In high myopic patients with optic disc tilting, reference height is underestimated and many parameters depending on reference height will be changed with previous Heidelberg Retina Tomograph[HRT, under version 1.01].Therefore, care must be taken to classify the patients with tilted optic disc because underestimation of the amount of their cup area and volume may cause faulty decision to normal disc. However, by using "tilted analysis method" in recent HRT program[ver.2.01], we can expect to overcome such problems so, in this study we try to find out how much the HRT results are different between tilted and untilted analysis methods.We evaluated 26 high myopic patients under -6 diopters with tilted optic disc and glaucomatous visual field defects from March 1998 to July 1998. We compared their HRT parameters measured by untilted and then tilted method to each other.The mean reference height was changed from 0.2735 to 0.2892, the cup volume from 0.1961 to 0.1790 and the neural rim volume from 0.3060 to 0.3358 but glaucoma classification, the final conclusion of test, was not changed significantly due to neural rim volume and height variation contour increase with constant cup shape measure. Therefore, although refrence height is lowered and cup volume decreased with HRT[ver.1.01]in high myopic patients, if considering other many parameters, we can interpretate results rightly.
Classification ; Glaucoma ; Humans ; Retina* ; Visual Fields

It has been suggested that normal tension glaucoma could be the result of pressure independent factors. One of the current theories is that normal tension glaucoma is the result of decreased optic nerve perfusion on the basis of vascular disease or other systemic factors such as altered blood viscosity or coagulation state. This study compared the vascular viscosity profiles, coagulation tests, and biochemical tests of 30 consecutive cases of normal tension glaucoma with 30 control cases to evaluate association of particular systemic state with normal tension glaucoma in Korean population. The data of total cholesterol and low density lipoprotein (LDL) cholesterol were significantly higher in the normal tension glaucoma group than in the control group. But there were no significant differences between the two groups with respect to the many other factors examined. These results support the vascular ischmic theory due to hyperlipidemia in the pathogenesis of the normal tension glaucoma. Inadequate circulation of optic nerve due to atherosclerotic change might play an important role in the pathogenesis of normal tension glaucoma.
Blood Viscosity ; Cholesterol ; Hyperlipidemias ; Lipoproteins ; Low Tension Glaucoma* ; Optic Nerve ; Perfusion ; Vascular Diseases ; Viscosity

The small-incision cataract surgery by phacoemulsification with foldable posterior chamber lens implantation have recently permitted new options for combined trabeculectomy with cataract extraction. In the present study, we performed phacoemulsification and foldable intraocular lens implantation using small clear corneal incision in 20 patients with 22 glaucomatous eyes who had previously undergone trabeculectomy and determined its effects on visual acuity, intraocular pressure, the number of medications applied, and status of the filtering blebs. The mean follow-up period was 10.1 months and the mean time interval between the two surgeries was 14.7 months. The mean best corrected visual acuity was 0.19 preoperatively and 0.60 postoperatively and the postoperative visual acuity had improved in 19 eyes(86.4%). The mean(+/-standard deviation, SD) preoperative IOP was 16.7+/-5.88 mmHg and the mean(+/-SD) postoperative IOP at final visit was 15.5+/-4.07 mmHg. Postoperatively, the IOPs remained well controlled in 20 eyes(90.9%) without additional ocular hypotensives and required additional medications for control in 2 eyes(9.09%). And the funictioning bleb failures occurred in 5 eyes(22.7%). We found the procedure to be effective in restoring vision while controlling intraoperative pressure and preserving the filtering blebs.
Blister* ; Cataract Extraction ; Cataract* ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular ; Phacoemulsification ; Trabeculectomy ; Visual Acuity