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WGA Rescources

Top-Ten of the American Glaucoma Society Meeting

March 2-5, 2006, Charleston, South Carolina, USA

Jamie Brand and Jody Piltz-Seymour

The sixteenth annual meeting of the American Glaucoma Society was held in Charleston, South Carolina. Over 400 AGS members and guests participated in the meeting, which consisted of a mixture of platform paper presentations, poster presentations, invited mini-symposia and workshops. This year's honored guest was E. Michael Van Buskirk, MD of Portland, Oregon. The AGS Lecture, entitled 'Biomechanics of the Aqueous Outflow System', was delivered by Murray A. Johnstone, MD of Seattle; the Clinician-Scientist Lecture was delivered by George A. 'Jack' Cioffi, MD of Portland and was entitled 'Quotes, Questions and Quandaries Regarding Optic Nerve ischemia and Glaucoma'.

  • An intriguing, low-tech way of performing goniosynechialysis with microforceps during phacoemulsification in patients with angle closure through a clear cornea incision was found to be safe and effective in selected patients.
  • A retrospective review of 368 eyes that had lensectomy for congenital cataracts was performed to evaluate the risk factors for the development for aphakic glaucoma. The strongest risk factors were lensectomy within the first year of life, and postoperative complications. No significant differences in risk were detected amongst the patients who had surgery under one year of age.
  • The Tube versus Trabeculectomy (TVT) study is a prospective, randomized clinical trial, involving over 200 patients comparing mitomycin-C augmented trabeculectomy to Baerveldt Glaucoma Implant (BGI) in patients at high risk of conventional trabeculectomy failure (prior failed filter, prior cataract surgery or both). The one year results suggest similar IOP results with slightly higher medication use among the BGI subjects. However, surgical failure was higher among the trabeculectomy group (14.8%) than in the BGI group (3.9%).
  • A review of the first year of the Tube versus Trabeculectomy TVT study demonstrates slightly higher rates of postoperative complications in the trabeculectomy group than in the tube group. Most complications were self-limited, with no difference between the groups in terms of the need for more surgery to manage complications. Patients in either group who developed complications, experienced greater vision loss than patients without complications.
  • The OHTS investigators have initiated a collaboration with the investigators of the European Glaucoma Prevention Study (EGPS) to externally validate the risk prediction model of the OHTS. Predictive factors (e.g., IOP, CCT, MD, C/D ratio) identified by the OHTS were found to confer almost identical risk ratios in the EGPS. A joint model for predicting risk is being developed that, because it will be based on larger numbers of patients, should extend the generalizeability of the predictive model to lower IOPs as well as narrow the confidence intervals of the risk ratios.
  • A novel technique of cannulating the Canal of Schlemm using a fiberoptic probe and then placing a polypropylene 'stent' to place tension on the canal was described. Initial results appear promising for this high-tech approach to Canal surgery.
  • The investigators of the Collaborative Initial Glaucoma Treatment Study have analyzed a small subset of subjects who entered the CIGTS as newly-diagnosed glaucoma patients presenting with advanced visual field loss. These individuals appear to have fared better with initial trabeculectomy than with initial medical therapy
  • In the Australian Twins Eye Studies, hundreds of sets of both identical and fraternal (homozygous and heterozygous) twins were examined, and it was recently reported that CCT is highly heritable. In this paper, the same research group reports that optic disc morphology is highly heritable as well. The group's work may lead to the identification of promising candidate glaucoma genes based on the heritability of CCT and optic nerve morphology which may underlie some aspects of disease susceptibility.
  • Severe glaucoma induced by intravitreal triamcinolone (IVTA) administered for vitreoretinal disease is becoming a more common problem. Anecortave acetate is an investigational compound (Alcon) that appears to block the IOP-raising effect of IVTA and may prove beneficial in some of these patients.
  • Immunization of rats with heat shock protein (hsp) antigens resulted in significant retinal ganglion cell death and axonal loss after four months. Inflammatory cytokine Fas-L released from activated t-lymphocytes was identified as the mediator of RGC apoptosis. Retinal microglia activated by the hsp-immunization could protect against t-cell mediated RGC apoptosis by inducing apoptosis of the activated t-cells. This study supports an autoimmune etiology in a subset of glaucoma patients.

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