AIM:To investigate short-and long-term intraocular pressure(IOP)fluctuations and fur ther ocular and demographic parameters as predictors for normal tension glaucoma(NTG)progression.METHODS:This retrospective,longitud...AIM:To investigate short-and long-term intraocular pressure(IOP)fluctuations and fur ther ocular and demographic parameters as predictors for normal tension glaucoma(NTG)progression.METHODS:This retrospective,longitudinal cohort study included 137 eyes of 75 patients with NTG,defined by glaucomatous optic disc or visual field defect with normal IOP(<21 mm Hg),independently from therapy regimen.IOP fluctuation,mean,and maximum were inspected with a mean follow-up of 38 mo[standard deviation(SD)18 mo].Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry,Heidelberg retina tomograph(HRT)imaging,and optic disc photographs.The impact of IOP parameters,myopia,sex,cup-to-disc-ratio,and visual field results on progression of NTG were analyzed using Cox regression models.A sub-group analysis with results from optical coherence tomography(OCT)was performed.RESULTS:IOP fluctuations,average,and maximum were not risk factors for progression in NTG patients,although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression(P=0.054).The 46/137(33.5%)eyes progressed over the followup period.Overall progression(at least three progression confirmations)occurred in 28/137 eyes(20.4%).Most progressions were detected by perimetry(36/46).Longterm IOP mean over all pressure profiles was 12.8 mm Hg(SD 1.3 mm Hg);IOP fluctuation was 1.4 mm Hg(SD 0.8 mm Hg).The progression-free five-year rate was 58.2%(SD 6.5%).CONCLUSION:Short-and long-term IOP fluctuations do not result in progression of NTG.As functional changes are most likely to happen,NTG should be monitored with visual field testing more often than with other devices.展开更多
In this review, we summarize the progression of several parameters assessed by spectral-domain optical coherence tomography （SD-OCT） in recent years for the detection of glaucoma. Monitoring the progression of defec...In this review, we summarize the progression of several parameters assessed by spectral-domain optical coherence tomography （SD-OCT） in recent years for the detection of glaucoma. Monitoring the progression of defects in the retinal nerve fiber layer （RNFL） thickness is essential. Imaging and analysis of retinal ganglion cells （RGCs） and inner plexiform layer （IPL）, respectively, have been of great importance. Optic nerve head （ONH） topography obtained from 3D SD-OCT images is another crucial step. Other important assessments involve locating the Bruch＇s membrane opening （BMO）, estimating the optic disc size and rim area, and measuring the lamina cribrosa displacement. Still other parameters found in the past three years for glaucoma diagnosis comprise central retinal artery resistive index, optic disc perfusion in optical coherence tomography angiography （OCTA） study, peripapillary choroidal thickness, and choroidal area in SD-OCT. Recently, several more ocular fundus parameters have been found, and compared with the earlier parameters to judge the accuracy of diagnosis. While a few of these parameters have been widely used in clinical practice, a fair number are still in the experimental stage.展开更多
In this perspective,we discuss the use of an anti-fibrotic agent Decorin to treat established fibrosis associated with glaucoma originally published by Hill et al.（2015）.Glaucoma describes a group of progressive opt...In this perspective,we discuss the use of an anti-fibrotic agent Decorin to treat established fibrosis associated with glaucoma originally published by Hill et al.（2015）.Glaucoma describes a group of progressive optic neuropathies that have the potential to cause irreversible blindness.展开更多
Background:In recent years,remarkable advancements in the comprehension of glaucoma pathophysiology have highlighted the necessity of looking beyond the conventional focus on mean intraocular pressure(IOP)levels.IOP f...Background:In recent years,remarkable advancements in the comprehension of glaucoma pathophysiology have highlighted the necessity of looking beyond the conventional focus on mean intraocular pressure(IOP)levels.IOP fluctuations have been identified as a potential factor that could exert a substantial impact on the progression of glaucoma.Main text:IOP exhibits dynamic variations throughout a 24-h cycle.Glaucoma patients exhibit substantially more pronounced IOP fluctuations compared to healthy individuals,even when the mean IOP remains within the normal range.This implies that IOP fluctuations may play a role in glaucoma progression through mechanisms independent of elevated mean IOP.In this review,an exhaustive examination of studies spanning the past decade was conducted to analyze the relationship between IOP fluctuations and disease progression in primary openangle glaucoma(POAG),ocular hypertension(OHT),normal tension glaucoma(NTG),and primary angleclosure glaucoma(PACG).While a few studies present conflicting results,the majority of research supports the notion that elevated IOP fluctuations significantly contribute to disease progression in POAG patients.This association has also been confirmed in PACG patients.However,in NTG or OHT patients,other risk factors may outweigh IOP fluctuations in disease progression or glaucoma conversion.Additionally,we summarized common factors affecting IOP fluctuations to provide a basis for the identification of patients prone to significant daily IOP variations.Finally,the efficacy of various IOP-lowering interventions in modulating IOP fluctuations is concisely summarized,offering insights for the formulation of comprehensive treatment strategies that incorporate IOP fluctuation management.Conclusions:IOP fluctuations play a significant role in disease progression in POAG and PACG.Individuals with certain systemic or ocular characteristics are more predisposed to pronounced and recurrent IOP fluctuations.Consequently,a comprehensive assessment of IOP fluctuation that transcends mean IOP values,as well as the integration of IOP fluctuations management into glaucoma treatment strategies are of paramount importance.展开更多
Glaucoma is a group of degenerative retinal diseases that damage the eye’s optic nerve and can result in vision loss and blindness.It is characterized by optic neuropathy,cupping of the optic disk.
基金a DFG(German Research Foundation)Grant(HO 3277/2-1)。
文摘AIM:To investigate short-and long-term intraocular pressure(IOP)fluctuations and fur ther ocular and demographic parameters as predictors for normal tension glaucoma(NTG)progression.METHODS:This retrospective,longitudinal cohort study included 137 eyes of 75 patients with NTG,defined by glaucomatous optic disc or visual field defect with normal IOP(<21 mm Hg),independently from therapy regimen.IOP fluctuation,mean,and maximum were inspected with a mean follow-up of 38 mo[standard deviation(SD)18 mo].Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry,Heidelberg retina tomograph(HRT)imaging,and optic disc photographs.The impact of IOP parameters,myopia,sex,cup-to-disc-ratio,and visual field results on progression of NTG were analyzed using Cox regression models.A sub-group analysis with results from optical coherence tomography(OCT)was performed.RESULTS:IOP fluctuations,average,and maximum were not risk factors for progression in NTG patients,although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression(P=0.054).The 46/137(33.5%)eyes progressed over the followup period.Overall progression(at least three progression confirmations)occurred in 28/137 eyes(20.4%).Most progressions were detected by perimetry(36/46).Longterm IOP mean over all pressure profiles was 12.8 mm Hg(SD 1.3 mm Hg);IOP fluctuation was 1.4 mm Hg(SD 0.8 mm Hg).The progression-free five-year rate was 58.2%(SD 6.5%).CONCLUSION:Short-and long-term IOP fluctuations do not result in progression of NTG.As functional changes are most likely to happen,NTG should be monitored with visual field testing more often than with other devices.
基金Supported by the National Natural Science Foundation of China(No.81300755)the Key Project of the Natural Science Foundation of the Higher Educational Bureau of Anhui Province(No.KJ2013A147)
文摘In this review, we summarize the progression of several parameters assessed by spectral-domain optical coherence tomography （SD-OCT） in recent years for the detection of glaucoma. Monitoring the progression of defects in the retinal nerve fiber layer （RNFL） thickness is essential. Imaging and analysis of retinal ganglion cells （RGCs） and inner plexiform layer （IPL）, respectively, have been of great importance. Optic nerve head （ONH） topography obtained from 3D SD-OCT images is another crucial step. Other important assessments involve locating the Bruch＇s membrane opening （BMO）, estimating the optic disc size and rim area, and measuring the lamina cribrosa displacement. Still other parameters found in the past three years for glaucoma diagnosis comprise central retinal artery resistive index, optic disc perfusion in optical coherence tomography angiography （OCTA） study, peripapillary choroidal thickness, and choroidal area in SD-OCT. Recently, several more ocular fundus parameters have been found, and compared with the earlier parameters to judge the accuracy of diagnosis. While a few of these parameters have been widely used in clinical practice, a fair number are still in the experimental stage.
基金funded by the Biotechnology and Biological Sciences Research Council(BBSRC),No.BB/F017553/1
文摘In this perspective,we discuss the use of an anti-fibrotic agent Decorin to treat established fibrosis associated with glaucoma originally published by Hill et al.（2015）.Glaucoma describes a group of progressive optic neuropathies that have the potential to cause irreversible blindness.
基金supported by the Key Research and Development Program of Zhejiang Province(NO.2025C02154)the Key Program of the National Natural Science Foundation of Zhejiang Province(No.LZ23H120001)the National Natural Science Foundation of China(No.82171045).
文摘Background:In recent years,remarkable advancements in the comprehension of glaucoma pathophysiology have highlighted the necessity of looking beyond the conventional focus on mean intraocular pressure(IOP)levels.IOP fluctuations have been identified as a potential factor that could exert a substantial impact on the progression of glaucoma.Main text:IOP exhibits dynamic variations throughout a 24-h cycle.Glaucoma patients exhibit substantially more pronounced IOP fluctuations compared to healthy individuals,even when the mean IOP remains within the normal range.This implies that IOP fluctuations may play a role in glaucoma progression through mechanisms independent of elevated mean IOP.In this review,an exhaustive examination of studies spanning the past decade was conducted to analyze the relationship between IOP fluctuations and disease progression in primary openangle glaucoma(POAG),ocular hypertension(OHT),normal tension glaucoma(NTG),and primary angleclosure glaucoma(PACG).While a few studies present conflicting results,the majority of research supports the notion that elevated IOP fluctuations significantly contribute to disease progression in POAG patients.This association has also been confirmed in PACG patients.However,in NTG or OHT patients,other risk factors may outweigh IOP fluctuations in disease progression or glaucoma conversion.Additionally,we summarized common factors affecting IOP fluctuations to provide a basis for the identification of patients prone to significant daily IOP variations.Finally,the efficacy of various IOP-lowering interventions in modulating IOP fluctuations is concisely summarized,offering insights for the formulation of comprehensive treatment strategies that incorporate IOP fluctuation management.Conclusions:IOP fluctuations play a significant role in disease progression in POAG and PACG.Individuals with certain systemic or ocular characteristics are more predisposed to pronounced and recurrent IOP fluctuations.Consequently,a comprehensive assessment of IOP fluctuation that transcends mean IOP values,as well as the integration of IOP fluctuations management into glaucoma treatment strategies are of paramount importance.
文摘Glaucoma is a group of degenerative retinal diseases that damage the eye’s optic nerve and can result in vision loss and blindness.It is characterized by optic neuropathy,cupping of the optic disk.
