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Top-ten Australian and New Zealand Glaucoma Interest Group Meeting
Australian and New Zealand Glaucoma Interest Group Meeting

Anne Brooks

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1. There has been an increasing trend for glaucoma specialists to implant shunts in preference to trabeculectomies that predates the results of the TVT study. There is a reasonable body of evidence to support the use of shunts in eyes that have had previous conjunctival surgery. The TVT study reported, medium, not low risk, eyes (88% had previous conjunctival surgery, and mean preoperative MD of 16dB), and provides evidence that tubes can achieve low target pressures, and significantly more often than repeat trabeculectomies, even though more patients require glaucoma medication in the longer term. (Keith Barton, London, UK)
2. The prevalence of avascular blebs and other patient outcomes from the first long-term human randomised control trial using subconjunctival bevacizumab plus 5-FU versus 5-FU only following primary uncomplicated trabeculectomy was reported. At 18 months a doubling in the prevalence of avascular blebs was found (47% vs 21% in the bevacizumab plus 5-FU and 5-FU only groups respectively, Fisher exact p=0.17); and 2 complications (1 blebitis and 1 suture abscess) in the bevacizumab plus 5-FU group. There was no significant difference in other outcome data such as final visual acuity, number of 5-FU injections or number of failed trabeculectomies, but there appeared a trend to lower IOP in the bevacizumab plus 5-FU group. Caution was urged against routine use of subconjunctival bevacizumab following trabeculectomy, and a call for more long-term controlled human studies with larger sample sizes to confirm its safety and efficacy profile. (Brian Chua, Melbourne, Australia)
3. The ANZRAG ® the Australian and New Zealand Register of Advanced Glaucoma recruits patients to examine clinical and genetic risk factors for glaucoma blindness. It also recruits secondary glaucoma subcategories, and screens all cases for myocilin mutations. So far these have been found in 4.5% of cases. (Jamie Craig, Adelaide, Australia)
4. Glaucoma specialists and neuroophthalmologists (n = 21) were asked to grade 60 coloured optic disc photographs taken from patients with diverse optic neuropathies to determine whether these neuropathies can be distinguished on the basis of disc phenotype alone. The proportion of optic discs correctly diagnosed as normal and glaucomatous was 85% and 75% respectively. However, the proportion of discs correctly diagnosed as autosomal dominant optic atrophy and Lebers Hereditary optic neuropathy was significantly lower at 28% and 17% respectively. (Jonathan Crowston, Melbourne, Australia)
5. Microglia are a population of very sensitive CNS cells with key roles in tissue surveillance, scavenging, antigen-presentation, neural repair and neurodegeneration. Following induction of experimental glaucoma in rats, microglia are markedly activated in a specific spatio-temporal pattern and change their immunohumoral phenotype. The degree of activation correlates well with axonal damage at individual time points and is a useful surrogate marker for damage quantification in the present model. (Andreas Ebneter, Adelaide, Australia)
6. There is increasing evidence implicating ischaemia in the pathogenesis and development of glaucoma. Following ischaemia, gap junctions remain open and may allow the propagation of apoptotic and necrotic signals to surrounding cells, thereby increasing cell death. Using a rodent model of high pressure-induced retinal ischaemia, an upregulation of the gap junction protein connexin43 (GJA1) at both the protein and transcript level was demonstrated. Connexin43 may present a potential target for neuroprotective therapies. (Nathan Mitchell Kerr, Auckland, New Zealand)
7. This study showed that in response to acute intraocular pressure elevation the retina of elderly mice showed greater loss of ganglion cell function and more oxidative stress production compared to young mice, while blood flow was affected to the same degree. This study provides further understanding of the effect of aging in glaucoma development. (George Kong, Melbourne, Australia)
8. The purpose of this study was to determine if high resolution blue-yellow mfVEPs, reduced visual field variability and increased resolution to detect early glaucomatous loss, compared with the conventional blue yellow mfVEP technique. 26 normal and 18 early glaucoma patients were recorded using both methods, intra-field variability was reduced and good correspondence was evident between the scotomas, although more extensive changes were seen on high resolution. All those with HVF abnormalities were detected using both methods and an additional 28% of fellow eyes displayed scotomas. Therefore high resolution mfVEP is a viable technique that improves detection and monitoring, by increasing spatial resolution and decreasing variability. (Alessandra Martins, Sydney, Australia)
9. Twenty four ocular hypertensive and glaucoma patients with multiple vein pulsation pressure measurements over a mean 14 months following therapeutic IOP reduction had full glaucoma workup to examine the association between various factors and vein pulsation pressure reduction. The only factor significantly associated was IOP difference (multivariate p = 0.003, univariate r = 0.81). This suggests that IOP reduction has a beneficial effect upon venous function in glaucoma and ocular hypertensive patients. (William Morgan, Perth, Australia)
10. In a survey of bleb-related infection (BRI) in more than 937 MMC trabeculectomies at Moorfields from 1993-2005, cumulative BRI incidence was initially 5.7% declining to 1.9%, 2.5%, 2.4% and 2.4 % in later years. Only 3 patients out of 937 (0.3%) lost 2 or more lines of Snellen visual acuity from their infection. This decline in BRI coincided with change from limbus-based to fornix-based flaps, and shorter duration, wider area application of lower concentrations of mitomycin. (Jonathan Ruddle, Melbourne, Australia)