(IGR: 15-2) | International Glaucoma Review #

Top-Eight of the 45^th Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists
November 2-7, 2013, Hobart, Tasmania

Amplitude of retinal vein pulsations are associated with retinal nerve fiber layer thickness in glaucoma. Glaucoma patients have significantly reduced spontaneous retinal venous pulsatility (SVPs) and that patients with absent SVPs are more likely to progress. There is a positive correlation between amplitude of SVPs and nerve fibre layer thickness with less SVPs associated with thinner nerve fibre layers. Additionally, SVPs are present in all individuals when quantified by digital video recording; however, the degree of pulsatility is altered in glaucoma. These dynamic parameters may be useful as a novel biomarker for glaucoma risk assessment. (Mojtaba Golzan, Sydney, Australia)

Corneal endothelial abnormalities after selective laser trabeculoplasty. We analyzed corneal specular microscopy photographs of 142 eyes before and after SLT. About 24% of patients showed significant dark spots after SLT, which correspond to white spots on the corneal endothelium seen on slit lamp biomicroscopy after SLT. These corneal endothelial abnormalities after SLT may represent corneal endothelial burns. There was a suggestion that the endothelial cell count in this group was reduced at one month (P = 0.1). This would probably not cause any significant problem after one or two SLT procedures in most corneas, but there is concern that in some corneas, several repeated SLT procedures may lead to corneal endothelial compromise. (Keith Ong, Sydney, Australia)

The rise of intraocular pressure in a caffeine test versus the water-drinking test in patients with glaucoma. A caffeine test was used to compare with the water-drinking test in patients with glaucoma as the water-drinking test may not be tolerated or appropriate in patients. The caffeine test showed a minor increase in intraocular pressure, however, was inferior to the water-drinking test and was not seen to be an effective alternative. (Tuan Tran, Melbourne, Australia)

Measuring of capsular porosity with a novel implant and measurement system. Egress of fluid through the fibrous capsule (porosity) around a glaucoma drainage device (GDD), which accounts for the pressure lowering efficacy of the device, is difficult to measure. This paper demonstrates how porosity can be measured, in rabbit eyes, using a novel 3D printed GDD and a constant pressure syringe pump system. We found this system to be reliable, and believe it will be useful in characterizing GDDs and help develop betters ones. (Surinder S. Pandav, Melbourne, Australia)

Assessment of photographic disc hemorrhage and impact on clinical glaucoma diagnosis. In our study, we demonstrated high levels of agreement for the detection of optic disc hemorrhages; however, there exists some discrepancy in the assessment of glaucoma likelihood between glaucoma subspecialists and optometrists. Optometrists were more likely to under-call glaucoma likelihood when not guided by a disc hemorrhage. This may reflect differences between the two groups in the detection of retinal nerve fiber loss and the perceived significance of rim loss in glaucoma; and should be considered an area for further investigation to improve diagnostic accuracy. (Bob Wang, Melbourne, Australia)

Anterior segment spectral-domain optical coherence tomography (OCT) analysis of bleb morphology following deep sclerectomy verses trabeculectomy. This prospective study aimed to compare filtration blebs following deep sclerectomy (n = 13) and trabeculectomy (n = 15) using the Indiana Bleb Grading Scale (IBGS) and anterior segment spectral domain optical coherence tomography (AS-OCT). Three months after surgery, the IBGS revealed shallower (1.3 v 2.0, p < 0.01), narrower (1.77 v 2.53, p < 0.01) and more vascular blebs (2.13 v 1.53, p < 0.01) in deep sclerectomy eyes whose AS-OCT demonstrated shallower blebs (95.3 v 318.4 microns, p < 0.01) that were less likely to contain a bleb cavity (23.1% v 86.7%; p < 0.01), intra-conjunctival cysts (53.8% v 86.7%; p < 0.01) or posterior flow (30.8% v 82.4%; p < 0.01). These findings are consistent with the known differences in aqueous outflow following deep sclerectomy verses trabeculectomy. (Julie Lam)

Gender and inheritance in advanced glaucoma cases - Australian & New Zealand Registry of Advanced Glaucoma Data. Data was collected for patients with advanced primary open-angle glaucoma (POAG) from ANZRAG (Australian and New Zealand Registry of Advanced Glaucoma) and analyzed to examine gender differences and lines of inheritance. Whilst no overall gender difference was observed across all POAG cases, when analyzed according to highest recorded intraocular pressure, a statistically significant increase in female cases was noted with normal tension glaucoma. With regards to line of inheritance, and increased incidence of self reported family history of glaucoma in maternal relatives was present, however this was of a smaller magnitude than has previously been reported in population based studies. (Jude Fitzgerald, Adelaide, Australia)

Diagnosing glaucoma with an ibopamine challenge. Ibopamine, a prodrug of epinine and an analogue of dopamine, is a topical drug which temporarily increases aqueous production. When administered topically as a challenge test, glaucoma suspect patients may be differentiated from those with manifest glaucoma by their intraocular (IOP) response, with glaucoma patients showing a higher IOP rise. In addition, stable glaucoma patients may be differentiated from those with rapidly progressive glaucoma by the change in their IOP and in their optic cup volume following an ibopamine challenge. (John Landers, Adelaide, Australia)