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Top-Ten of the closed meeting of the European glaucoma society
August 30-31, 2002, Vienna, Austria
John Thygesen
- Increased levels of transforming growth factor-beta2 (TGF-b2) in the aqueous humor may lead to an increase of transglutaminase (tTgase) expression and activity in the human trabecular meshwork, causing an increase of irreversibly cross-linked extracellular matrix proteins. This mechanism may play a role in the increased outflow resistance seen in glaucomatous eyes.
- Benzalkonium chloride (BAC)-preserved antiglaucoma drugs significantly increased proapoptotic activity in an in vitro model of human trabecular cells, while unpreserved drugs had no apoptotic effect.
- The postoperative administration of CAT-152, an anti-transforming growth factor-a2 antibody, significantly improved surgical outcome, reduced subconjunctival scarring, and minimized the risk of corneal side-effects compared to the gold standard anti-scarring agent 5-FU.
- Potential photodynamic modulation of wound healing in glaucoma filtration surgery. Cellular photoablation only reacts to cells that have incorporated the PDT dye BCECF-AM and have been exposed to light at an appropriate wavelength (blue light, 450-490 nm). In contrast to trabeculectomy with MMC or 5-FU, no toxic reactions or endophthalmitis were noticed.
- Important morphological predictive factors for progression of the glaucomatous appearance of the optic nerve head in Caucasians are small size of the neuroretinal rim and a large beta zone area of parapapillary atrophy. The progression of glaucomatous optic nerve head changes is independent of the size and shape of the optic disc, size of the alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth.
- Glaucomatous eyes show significantly decreased arterial oxygen saturation in the retinal vessels, while the venous oxygen saturation shows no change.
- As shown by one study, the new antiglaucoma medications will not replace surgery in the long-term management of glaucoma: despite long-term topical medication, 26% of eyes required glaucoma surgery over a six-year period in order to achieve an intraocular pressure (IOP) of less than 21 mmHg. By the end of the study, topical therapy could achieve an IOP consistently below 18 mmHg in only 17% of the eyes.
- YAG laser iridotomy in pigment dispersion syndrome offered a protective effect in a ten-year follow-up in high-risk pigment dispersion eyes (i.e., a positive epinephrine test and a concave iris root, on gonioscopy). The ten-year conversion rate to PG proved low in low-risk pigment disperson eyes (i.e., a negative epinephrine test and a flat iris root on gonioscopy).
- In ocular hypertensives the addition of the Heidelberg Retina Tomograph II (HRTII), as a diagnostic aid, may reduce or increase the number of patients receiving treatment, depending on whether protocols included baseline morphometric and/or IOP criteria.
- Large-scale randomized control trials have resulted in the setting of new lower target pressures for preventing further progression of glaucomatous optic nerve damage. This has posed considerable challenges, as the current multicenter trials and surveys suggest that the incidence of complications associated with glaucoma surgery is still significant.
