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Selections from the Third International Glaucoma Symposium
March 21-25, 2001, Prague, Czech Republic
Joel S. Schuman and Shlomo Melamed
The Third International Glaucoma Symposium spanned four days and attracted more than 1500 registrants from over 50 countries worldwide. It was one of the largest international glaucoma meetings to date. The meeting was a mix of science and socializing, with significant participation by industry. There were free papers and posters, as well as several sponsored sessions and courses. One two-hour session was broadcast live via satellite to 26 sites worldwide.
Kaufman and Johnson each reported on viscocanulostomy, providing critical pieces of the puzzle of this procedure. In his talk, "Outflow facility and morphology after viscocanalostomy in rhesus monkeys", Paul Kaufman demonstrated Schlemm's canal inner wall breaks and persistent Healon V in eyes six months after viscocanulostomy. Outflow facility increased with this procedure in living monkeys. Doug Johnson, in "How does non-penetrating glaucoma surgery work?" showed microperforations in the inner wall of Schlemm's canal with mechanical unroofing of Schlemm's canal alone. Microruptures were further seen with cannulation and viscoelastic injection, exposing the juxtacanalicular tissue, especially anteriorly. Johnson characterized this procedure, based on his findings, as a 'canal-otomy', in which aqueous is permitted to enter the canal through microruptures of the inner wall of Schlemm's canal wall in order to bypass the suspected sites of outflow resistance in glaucoma.
According to Latina and Damji, selective laser trabeculoplasty works at least as well as standard laser trabeculoplasty, and is superior to ALT in retreating eyes that have failed standard laser trabeculoplasty. Alvarado showed minimal tissue damage, and hypothesized that the procedure may function through the stimulation of IL-1 production, which can increase outflow facility. The procedure appears to be both gentle and repeatable.
In a fascinating study, Marty Wax showed that astroglial TNFa may play a role in retinal ganglion cell (RGC) death. In "TNFa: a new villain in glaucomatous neurodegeneration", Wax showed that TNFa induces the apoptotic cascade in RGCs. He demonstrated through cell culture studies that the TNFa was generated by stressed astroglia, and not by the RGCs themselves.
In "Gene delivery to retinal ganglion cells in culture using feline immunodeficiency virus", Margaret Good demonstrated that feline immunodeficiency virus (FIV) could be used as a vector to transfect RGCs with high transduction efficiency resulting long-lasting gene expression.
James G. Fujimoto presented "Ultrahigh Resolution Optical Coherence Tomography". He reviewed the technical requirements for this innovation, and demonstrated a multitude of medical uses for the technology. He showed the highest resolution images ever acquired in vivo in the eye. At 2-3-µm resolution, it was possible to identify each retinal layer, and to make out substructure within those layers. Fujimoto showed images from the Xenopus toad demonstrating cellular details using this device (nuclei, mitotic figures).
Stuart Graham discussed multifocal ventricular evoked potentials (mVEP) in "Multifocal objective perimetry (MOP) in glaucoma". He showed dramatic correlations between subjective and objective perimetry. While his system still may not be ready for widespread clinical use, Graham provided data showing some of the best evidence to date for the potential utility of objective perimetry
