Objective: The Low- Pressure Glaucoma Treatment Study (LoGTS) seeks to evaluate visual field stability in low- pre- ssure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice ...Objective: The Low- Pressure Glaucoma Treatment Study (LoGTS) seeks to evaluate visual field stability in low- pre- ssure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice daily brimonidine tartrate 0.2% versus twice daily timolol maleate 0.5% . This article describes the LoGTS design and presents baseline characteristics of the subjects. Design: Randomized, multicenter, double- masked clinical trial. Participants: Low- pressure glaucoma patients 30 years of age or older were identified. Exclusion criteria included an untreated pressure of more than 21 mmHg, advanced visual field loss, and contraindications to study medications. Interventions: Randomization of both eyes to double- masked monotherapy with brimonidine or timolol. Follow- up visits included Humphrey 24- 2 full- threshold perimetry, tonometry every 4 months, and annual optic disc photography. Main Outcome Measure: Progression of visual field loss. Results: One hundred ninety patients were randomized between 1998 and 2000. Mean age (± standard deviation) was 64.9± 10.7 years. Women comprised 59.5% of the patients. Fifty- three patients (27.9% ) had unilateral field loss. The 137 patients with bilateral field loss were older than those with unilateral field loss: 65.7 versus 62.3 years of age (P< 0.05). Mean untreated diurnal intraocular pressures were similar between the eyes of the bilateral patients (mean, 15.5 mmHg in both eyes) and unilateral patients (mean, 16.0 mmHg in field loss vs. 15.6 mmHg in fellow eyes). Visual field mean deviation for all eyes was- 5.4± 4.7 decibels. Central corneal thickness in 168 phakic patients was 543± 35 μ m (range,435- 655 μ m); thickness was less than 500 μ m in 15 eyes and was more than 600 μ m in 11 eyes. Mean vertical cup- to- disc ratio for all eyes was 0.67± 0.15. Unilateral field loss patients had a larger cupto- disc ratio in the field loss eye (0.75± 0.12) than the fello weye with a normal field (0.60± 0.17, P< 0.0001). Disc hemorrhage was present at baseline in 29 patients (32 eyes). Conclusions: The LoGTS was successfully able to recruit and enroll patients with open- angle glaucoma and statistically normal intraocular pressure into a longitudinal, prospective clinical trial comparing 2 different glaucoma medications. Baseline characteristics of note were a preponderance of females, unilateral field loss in 27.9% of participants, and frequent optic disc hemorrhage. Central corneal thickness had a normal distribution and did not account for false low- pressure measurements in LoGTS patients.展开更多
Purpose:According to Quigley's hypothesis the dense of connective tissue is the least and the pores of the lamina cribrosa are the largest at the superior and infe-rior poles of the lamina cribrosa,therefore they ...Purpose:According to Quigley's hypothesis the dense of connective tissue is the least and the pores of the lamina cribrosa are the largest at the superior and infe-rior poles of the lamina cribrosa,therefore they are the most vulnerable location to be involved in the characteristic glaucomatous optic nerve damage,To get clin-ical evidence for the hypltheses,the reversal of optic cup in adults glaucoma after reduction of intraocular pressure(IOP)was examined.Methods:The stereoscopic flicker comparison on with computerized image sys-tem was used to monitor the optic cup's changing,2 serial superposed stereo pairs were displayed alternatively and rapidly and the changing parts appeared moving Under the stereoscopic observation ,hthe changes of 3-dimention optic cup could be seen and the false positive phenomena caused by photographic angle variation,vascular pulsation could be differentiated from the characteristic change of the cup.Stereo fundus photographs were taken from 31eyes with hy-pertension glaucoma before and after treatment of reduction of IOPs which was either diamox administration or trabeculectomy.Results:the result showed that the reversal of optic cups after reduction of IOPs were mostly asymmetrical,especially at the inferior and/or superior poles.By multiple stepwise regression.it is known that the amount of the change is only correlated with the initial elevated IOP.Conclusions:The study indicated that it was the distortion and deformity of the lamina cribrosa leading to shearing stress that results in glaucomatous character-istic damage in structure and function.The individul tolerance of the lamina cribrosa to the high intraocular pressure and the locations of indivdual vulnerable at he optic nerve head are various.Eye Science1995;11:155-160.展开更多
Background: Selective laser trabeculoplasty SLT is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. With a Q-switched, frequency-doubled Nd:YAG laser it targets the pigmented trabe...Background: Selective laser trabeculoplasty SLT is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. With a Q-switched, frequency-doubled Nd:YAG laser it targets the pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular microdisruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat created within the targeted cells does not have time to spread to the surrounding tissue. A clinical prospective study was conducted to evaluate the longterm results, safety and efficacy of SLT in the treatment of open angle glaucoma. Patients and Methods: Since 2002, we have performed a selective laser trabeculoplasty in 269 eyes: in 17 eyes with ocular hypertension, in 239 eyes with primary open angle glaucoma, in 11 eyes with low tension glaucoma, while 2 eyes had a secondary glaucoma due to uveitis. In 22 eyes the primary initial treatment was SLT. Results: Three months after treatment, the mean IOPreduction from baseline was 3.4 mm Hg, respectively 15%, after 12 months the mean IOPreduction was 3.0 mmHg (12.9%), and after 24 months 2.7 mmHg or 12.1%. The response curve of the eyeswith ocular hypertension greatly resembled the eyes with primary open angle glaucoma and with low tension glaucoma. Conclusions: SLT has shown reasonable efficacy in lowering IOPin eyes with primary open angle glaucoma and ocular hypertension, both as a first-line treatment and as a treatment in medication-refractory eyes. SLT is effective for patients who have had prior treatment with ALT. Long-term follow-up studies are needed to determine whether the IOPlowering effect is sustained over time, and to assess the efficacy of repeated SLT. The exact biological effect induced with the SLT is still not understood.展开更多
文摘Objective: The Low- Pressure Glaucoma Treatment Study (LoGTS) seeks to evaluate visual field stability in low- pre- ssure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice daily brimonidine tartrate 0.2% versus twice daily timolol maleate 0.5% . This article describes the LoGTS design and presents baseline characteristics of the subjects. Design: Randomized, multicenter, double- masked clinical trial. Participants: Low- pressure glaucoma patients 30 years of age or older were identified. Exclusion criteria included an untreated pressure of more than 21 mmHg, advanced visual field loss, and contraindications to study medications. Interventions: Randomization of both eyes to double- masked monotherapy with brimonidine or timolol. Follow- up visits included Humphrey 24- 2 full- threshold perimetry, tonometry every 4 months, and annual optic disc photography. Main Outcome Measure: Progression of visual field loss. Results: One hundred ninety patients were randomized between 1998 and 2000. Mean age (± standard deviation) was 64.9± 10.7 years. Women comprised 59.5% of the patients. Fifty- three patients (27.9% ) had unilateral field loss. The 137 patients with bilateral field loss were older than those with unilateral field loss: 65.7 versus 62.3 years of age (P< 0.05). Mean untreated diurnal intraocular pressures were similar between the eyes of the bilateral patients (mean, 15.5 mmHg in both eyes) and unilateral patients (mean, 16.0 mmHg in field loss vs. 15.6 mmHg in fellow eyes). Visual field mean deviation for all eyes was- 5.4± 4.7 decibels. Central corneal thickness in 168 phakic patients was 543± 35 μ m (range,435- 655 μ m); thickness was less than 500 μ m in 15 eyes and was more than 600 μ m in 11 eyes. Mean vertical cup- to- disc ratio for all eyes was 0.67± 0.15. Unilateral field loss patients had a larger cupto- disc ratio in the field loss eye (0.75± 0.12) than the fello weye with a normal field (0.60± 0.17, P< 0.0001). Disc hemorrhage was present at baseline in 29 patients (32 eyes). Conclusions: The LoGTS was successfully able to recruit and enroll patients with open- angle glaucoma and statistically normal intraocular pressure into a longitudinal, prospective clinical trial comparing 2 different glaucoma medications. Baseline characteristics of note were a preponderance of females, unilateral field loss in 27.9% of participants, and frequent optic disc hemorrhage. Central corneal thickness had a normal distribution and did not account for false low- pressure measurements in LoGTS patients.
文摘Purpose:According to Quigley's hypothesis the dense of connective tissue is the least and the pores of the lamina cribrosa are the largest at the superior and infe-rior poles of the lamina cribrosa,therefore they are the most vulnerable location to be involved in the characteristic glaucomatous optic nerve damage,To get clin-ical evidence for the hypltheses,the reversal of optic cup in adults glaucoma after reduction of intraocular pressure(IOP)was examined.Methods:The stereoscopic flicker comparison on with computerized image sys-tem was used to monitor the optic cup's changing,2 serial superposed stereo pairs were displayed alternatively and rapidly and the changing parts appeared moving Under the stereoscopic observation ,hthe changes of 3-dimention optic cup could be seen and the false positive phenomena caused by photographic angle variation,vascular pulsation could be differentiated from the characteristic change of the cup.Stereo fundus photographs were taken from 31eyes with hy-pertension glaucoma before and after treatment of reduction of IOPs which was either diamox administration or trabeculectomy.Results:the result showed that the reversal of optic cups after reduction of IOPs were mostly asymmetrical,especially at the inferior and/or superior poles.By multiple stepwise regression.it is known that the amount of the change is only correlated with the initial elevated IOP.Conclusions:The study indicated that it was the distortion and deformity of the lamina cribrosa leading to shearing stress that results in glaucomatous character-istic damage in structure and function.The individul tolerance of the lamina cribrosa to the high intraocular pressure and the locations of indivdual vulnerable at he optic nerve head are various.Eye Science1995;11:155-160.
文摘Background: Selective laser trabeculoplasty SLT is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. With a Q-switched, frequency-doubled Nd:YAG laser it targets the pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular microdisruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat created within the targeted cells does not have time to spread to the surrounding tissue. A clinical prospective study was conducted to evaluate the longterm results, safety and efficacy of SLT in the treatment of open angle glaucoma. Patients and Methods: Since 2002, we have performed a selective laser trabeculoplasty in 269 eyes: in 17 eyes with ocular hypertension, in 239 eyes with primary open angle glaucoma, in 11 eyes with low tension glaucoma, while 2 eyes had a secondary glaucoma due to uveitis. In 22 eyes the primary initial treatment was SLT. Results: Three months after treatment, the mean IOPreduction from baseline was 3.4 mm Hg, respectively 15%, after 12 months the mean IOPreduction was 3.0 mmHg (12.9%), and after 24 months 2.7 mmHg or 12.1%. The response curve of the eyeswith ocular hypertension greatly resembled the eyes with primary open angle glaucoma and with low tension glaucoma. Conclusions: SLT has shown reasonable efficacy in lowering IOPin eyes with primary open angle glaucoma and ocular hypertension, both as a first-line treatment and as a treatment in medication-refractory eyes. SLT is effective for patients who have had prior treatment with ALT. Long-term follow-up studies are needed to determine whether the IOPlowering effect is sustained over time, and to assess the efficacy of repeated SLT. The exact biological effect induced with the SLT is still not understood.
