HLA antigens and primary open-angle glaucoma in black Americans

Black patients with primary open-angle glaucoma, when compared to nonglaucomatous individuals, demonstrate significantly increased prevalences of the HLA antigens B7 and B12 and significantly decreased frequencies of A1 and A11. White patients with primary open-angle glaucoma have in common with blacks the increases in B7 and B12 and the decrease in A11, but present no deficit of A1. In addition, white patients with primary open-angle glaucoma demonstrate a significant increase of A3 and a decrease of Bw35, both of which are not found in blacks.     

Family history in primary open-angle glaucoma

A family history of glaucoma was found in 50% of patients with primary open-angle glaucoma (POAG) and 43% of patients with ocular hypertension (OH). Positive family history was twice as prevalent in those with OH and either HLA-B7 or B12 antigens than in OH with neither antigen (P less than .01). Although POAG occurred equally in men and women, the prevalence of a positive family history of glaucoma on the maternal side of the family in POAG patients was six to seven times greater than on the paternal side (P less than .0005). However, in patients with OH, but no glaucomatous field loss, there was no difference in prevalence of maternal and paternal family history. Even in OH with HLA-B7 or B12 antigens, there was no predominance of maternal family history. The implication that offspring were more likely to develop POAG when their mother's side of the family rather than their father's side had the disease has provided an additional potentially useful risk factor in patients with OH. In addition, it has raised interesting questions as to possible maternal cytoplasmic factors in the transmission and pathogenesis of POAG.     

Genetic mapping of autosomal dominant primary open-angle glaucoma (POAG) in Sardinia

Primary open-angle glaucoma (POAG) can be subdivided into two groups according to age of onset: (1) the more prevalent middle to late-age-onset chronic open-angle glaucoma (COAG) diagnosed after age 40, and (2) the less common form, juvenile open-angle glaucoma (JOAG), which occurs between 3 years of age and early adulthood. Susceptibility to either COAG or JOAG has been found to be inherited. The discovery of several genetic markers spanning the region 1q21-q24 in genetic linkage with autosomal dominant juvenile open-angle glaucoma (adJOAG) represents a major breakthrough towards the localisation of gene(s) responsible for the disease. Linkage analysis is a powerful means of distinguishing disease loci in large families with dominant disease. However the size of the group of families may represent a crucial factor for the linkage analysis. Sardinia is an island with a relatively isolated ethnic group showing a relatively high frequency of ad JOAG and COAG (Fossarello et al, 1994) and it is genetically more homogeneous than most Western populations. Therefore it represents an ideal ethnic group to search for linkage. We identified 18 families affected by POAG in which the disease appears to be inherited as autosomic dominant trait. In all families but two, occurrence of both JOAG and COAG in the same kindred was observed. Identification of adPOAG locus was performed by linkage analysis using 9 microsatellite markers spanning the region 1q21-q24. No significant linkage was observed. Our findings provide further evidence for genetic heterogeneity in autosomal dominant primary open angle glaucoma, even in a geographic area where a relatively homogeneous genetic background exists.     

Immunohemostatic mechanisms in the development of primary open-angle glaucoma

The charts of 247 allergic patients (all ages) who were receiving immunotherapy were studied retrospectively. They belong to a private setting at the city of Santa Ana Chiautempan, Tlax (Mexico). We looked at whether they were compliant or noncompliance. Compliance was considered as those who did not stop immunotherapy during a 18-month period, and shorter periods s noncompliance. One hundred and fifty two (62%) were compliant and 95 (38%) were not. Noncompliance causes were: 29 patients felt better soon, 19 claimed high costs, 8 changed to alternative medicine. 6 felt worse because of immunotherapy, 6 moved to other cities, 2 preferred other allergists and 25 did not answer the questionnaire. Forty six per cent stopped during the first 2 to 6 months and 56% within 8 and 14 with a median of 5.4. Eighty per cent from those who were compliant claimed they felt much better and 18% only slightly better. The average length-compliance was 29.7 months.     

HL-A antigens and sacroiliitis

Lymphocyte typing for HL-A B27 is useful under conditions in which data based on history and examination are suggestive but not diagnostic of a seronegative spondyloarthropathy. The presence of HL-A B27 would increase the probability of a patient's having one of these entities, but its absence does not rule out such a diagnosis. Furthermore, tissue-typing allows one to predict the probability that a patient with inflammatory bowel disease will develop AS and the likelihood that the family member of a patient with AS will develop a related disease.     

Understanding the new primary open-angle glaucoma preferred practice pattern

Recent developments in our knowledge of the renin-angiotensin system (RAS) necessitate an update of the classical view on this system. These developments pertain to the pathways leading to formation of angiotensin II and other active metabolites, their receptors, biological functions and the presence of renin-angiotensin systems in tissues. The implications of the above new developments for the current interest in tissue renin-angiotensin systems as potential targets for drug therapy in cardiovascular disease are discussed in this review.     

Prevalence of primary chronic open-angle glaucoma in Ivory Coast

BACKGROUND: The aim of this study was to determine and analyze the rate of chronic open-angle glaucoma in C?te d'Ivoire. METHODS: The prevalence of chronic glaucoma (POAG) was retrospectively evaluated in a population of 33,000 patients attending a private clinic including 24,751 black subjects and 8,249 white subjects. Patients with a cup/disc superior to 0.5 and an abnormal Goldmann's kinetic perimetry, associated with (POAG with "elevated" pressure or not (POAG with normal pressure) with an intraocular hypertension (intra ocular pressure superior to 21 mmHg) were distinguished. RESULTS: Prevalence was from 2.1% for the black subjects and 0.75% for the white subjects. Mean age was 46.4 +/- 12.5 years for blacks subjects versus 52.8 +/- 12.2 years for white subjects. This prevalence increased with age in both populations. Out of 571 cases of POAG, 465 (81.4%) were previously known and 450 of them were treated; 38.5% of the POAG cases had normal pressure. CONCLUSION: Primary open-angle glaucoma is a major health care problem emphasizing the need for detection and prevention in C?te d'Ivoire.     

Diabetes in primary open-angle glaucoma patients with inferior visual field defects

We reviewed the charts of 144 randomly selected patients with primary open-angle glaucoma who had Aulhorn's stage 1, 2, or 3 visual field defects to investigate whether primary open-angle glaucoma patients with predominantly inferior visual field defects had a higher prevalence of diabetes mellitus than primary open-angle glaucoma patients without such visual field defects. Of the 59 patients with mainly inferior visual field defects in one or both eyes, 19 (32%) had diabetes mellitus, while 11 of 85 (13%) patients without such defects had diabetes mellitus. This difference was statistically significant (P = 0.0096). These results suggest that primary open-angle glaucoma patients with predominantly inferior visual field defects in one or both eyes are more likely to have diabetes and that such patients with no known history of diabetes may benefit from glucose tolerance testing to detect occult impaired glucose tolerance or diabetes mellitus.     

Non-penetrating deep sclerectomy (NPDS) with or without collagen device (CD) in primary open-angle glaucoma: middle-term retrospective study

The purpose of this study is to evaluate the middle-term tonometric results of a new filtering procedure, the nonpenetrating deep sclerectomy with or without collagen device, in primary open-angle glaucoma. This technic aims to eliminate or minimize the complications of classical trabeculectomy. METHOD: This procedure was carried out by Koslov and colleagues. This is performed under a limbal-based conjunctival flap and a superfical scleral flap, the ablation of a deep scleral flap taking away the external wall of Schlemm's canal, only living in place the Descemet membrane. One must obtain a visible filtration across the opened Schlemm's canal and Descemet membrane. To improve the aqueous filtration, a cylindric collagen device, made from porcine scleral tissue, biocompatible, known for its high water content, is fixed in the deep scleral bed with a 10/0 nylon suture. This device provides a support for the elimination route of aqueous humor and acts like a sponge, carrying the liquid by capillary action. It is sterilized by irradiation. Full guarantee against viral contamination is provided. This procedure ends in one suture (10/0 nylon) of superficial scleral flap and conjunctival closing suture. When NPDS is performed without CD a sponge of 5FU is used and the superficial scleral flap is not sutured. RETROSPECTIVE STUDY: Our material included 111 patients, 148 eyes in CD group; 43 patients, 55 eyes in the group without CD. The average follow-up was 13.3 +/- 5.8 months in the CD group, 7.2 +/- 3.5 months in the group without CD. All patients presented a POAG without risk factors of bleb failure. RESULTS: The delta average IOP before the operation and at the end of the follow-up period was 7.2 +/- 6.3 mmHg in the CD group; 8.3 +/- 7.6 mmHg in the group without CD (no significant difference). The probability-success rate with the Kaplan-Meier method (IOP < or = 20 mmHg) was, in the CD group, at 18 months, 68% and 69% in the group without CD, without medical treatment. With monotherapy, the success rate was 85% in the CD group, 74% in the group without CD (p < or = 0.05). PROSPECTIVE STUDY: Afterwards, we have conducted a prospective study comparing two groups of patients with POAG without risk factors of bleb failure, operated with and without collagen device, without 5FU in the second group. Our material included 31 patients, 31 eyes, one eye for each patient, two surgeons; 17 eyes in the CD group, 14 eyes in the group without CD. The average age was 65.8 +/- 8.2 years in the first group; 64.1 +/- 10.3 in the second group. The average follow-up was 11 months in both groups. RESULTS: delta average IOP was 8.3 +/- 5.8 in the CD group; 12.3 +/- 6 in the group without CD (p < 0.05). The probability-success rate without treatment at 12 months: 58% in the first group, 90% in the second group (p < 0.05) and with monotherapy: 80% and 90% (N.S.). In both studies, in both groups, except microperforations, more frequent in the prospective group without CD, no complications of the trabeculectomy were observed. The mean change in visual acuity was inferior to 0.1 at the end of the follow-up. A postoperative rise in IOP can occur. It can be due to an internal obstruction (goniosynechiae or bad filtration). It can be treated with Nd-Yag laser. It can also be due to external obstruction, treated by 5FU injections into the bleb. The success of these procedures were similar in the whole group. CONCLUSION: Non penetrating deep sclerectomy can be considered as an excellent alternative to trabeculectomy in open and wide angles. It does not modify visual acuity. It carries away less complications than trabeculectomy and the use of antimitotic agents is safer. Collagen device does not seem, at middle-term, to improve tonometric results.     

A comparative study of visual field damage in low-tension and primary open-angle glaucoma

Methods to encapsulate biological materials are now widely used. Sometimes bioencapsulation is considered as a universal technique conducting to identical results independently on the biological material used. For instance, a similar behavior is frequently waited for different strains of immobilized microorganisms without taking into account substantial differences in its physiological and morphological characteristics. Often interactions with the matrix support are also neglected. Thus, some concepts developed throughout all these years working in bioencapsulation merits to be revisited.     

HL-A antigens in lichen planus

An electron microscopic observation was performed on the follicular capillary of thyroid of Hashimoto's disease. Material was the thyroid obtained from a 41-years-old female showing typical features of this disease both clinically and histologically. Some remarkable findings were the presence of multi-layered basement membrane like structure, and the accumulation of dense minute granular materials concerning with long processes of lymphcyte in the widened pericapillary space. From the above-mentioned findings, it was postulated that there was abnormal transport on follicular basement membrane-pericapillary space-endothelial basement membrane system.     

Influence of axial length on visual field defects in primary open-angle glaucoma

With the high frequency of myopia in Taiwan, potential complications or associated conditions, such as glaucoma, are of great concern. To investigate the role of axial length in glaucoma, we enrolled 307 primary open-angle glaucoma (POAG) patients from 1986 through 1996. For the control group, 124 persons were recruited from a survey of a non-glaucoma population and the Ophthalmology Out-patient Department of the National Taiwan University Hospital. Routine eye examination, stereophotography of the optic disc, automated visual field tests, and A-scan ultrasonography were performed on each patient. The Glaucoma Hemifield test was used for analysis of visual field results. The mean axial length was longer in the POAG group than in the control group, especially in the younger age groups (40-59 yr). The POAG group was divided into a short-axial-length (SAL, axial length < 26 mm) group and a long-axial-length (LAL, axial length > or = 26 mm) group. Both subgroups had the deepest visual field defects in the upper and lower nasal areas. The LAL group had deeper visual field defects and the defects were more frequently involved in all sectors analyzed than the SAL group defects. The upper visual field had deteriorated more in the SAL group, whereas the depth of scotoma was similar in the upper and lower hemifields in the LAL group. Our results support the idea that glaucoma patients have a longer axial length than people without glaucoma, and that visual field defects are more pronounced in patients with LAL than in those with SAL.     

Gln368STOP myocilin mutation in families with late-onset primary open-angle glaucoma

PURPOSE: To examine families ascertained for late-onset primary open-angle glaucoma (POAG) to determine mutations in the gene coding for myocilin. METHODS: The diagnosis of late-onset POAG was defined as age at diagnosis more than 35 years, intraocular pressure (IOP) 22 mm Hg or more in both eyes or 19 mm Hg or more while the patient was taking two glaucoma medications, glaucomatous optic neuropathy in both eyes, and visual field loss consistent with optic nerve damage in at least one eye of the proband. Two of three criteria were required in other family members. DNA from all families was screened for polymorphisms in myocilin using single-strand conformation polymorphism analysis. All polymorphisms were sequenced for mutations. RESULTS: Eighty-three affected people in 29 families with late-onset POAG were screened for mutations. Three mutations, two novel missense (Thr377Met and Glu352Lys) and one nonsense (Gln368STOP), were identified. The missense mutations did not segregate with the disease phenotype in these families. The nonsense mutation was found in 3 of 29 unrelated families with POAG. All affected family members and 8 of 12 in whom glaucoma was suspected had the Gln368STOP mutation. All people with this mutation had elevated IOP, and 78% had POAG by age 70. CONCLUSIONS: Three mutations were identified in the gene coding for myocilin in families with late-onset POAG. Of these, the Gln368STOP mutation was highly associated with the development of glaucoma. All people with this mutation had glaucoma or elevated IOP by age 70. In the United States, the Gln368STOP mutation in myocilin is strongly associated with the development of late-onset POAG. However, factors in addition to the presence of this mutation seem to play a role in the development of ocular hypertension and glaucoma in these families.     

Analysis of the systemic corticosteroid sensitivity of patients with primary open-angle glaucoma

Patients with primary open-angle glaucoma have an ocular and systemic sensitivity to corticosteroids. We adapted a cellular assay that used peripheral blood lymphocytes to detect this corticosteroid sensitivity in vitro in a microtiter assay. It reduced the time, cost, and amount of blood required to examine a patient. We examined ten subjects on three separate days and demonstrated that the reliability of one 50% inhibitory concentration was about 76%. We then studied 25 patients with primary open-angle glaucoma and 25 control subjects using this in vitro assay. The patients with primary open-angle glaucoma were significantly more sensitive to corticosteroids than the control subjects (P less than .001).     

The role of class I and class II HLA antigens in primary open angle glaucoma (POAG)

Several clinical and epidemiological studies have shown the role of genetic factors in the pathogenesis of primary open angle glaucoma (POAG). In this study, 30 patients affected by this disease were tissue-typed for HLA Class I and Class II antigens. The results pointed up an increased incidence of some antigens and, particularly, a statistically significant association with DQ1 and DR11 alleles.     

Plasma cortisol suppression test used to predict the development of primary open-angle glaucoma

Forty patients classified as high responders (GG) to dexamethasone testing (intraocular pressure greater than 31 mm Hg) without visual field loss were subjected to plasma cortisol suppression testing. After a five-year follow-up adequate data were available on 35 patients. Eighteen responded to 1.0 mg of dexamethasone-diphenylhydantoin suppression testing in a similar fashion to patients with primary open-angle glaucoma while 17 responded in a similar fashion to subjects classified as low (NN, intraocular pressure less than 20 mm Hg) and intermediate (NG, intraocular pressure 20 to 31 mm Hg) responders to dexamethasone testing. Eight of the 35 patients developed glaucomatous visual field loss during the follow-up period. These eight patients were not more sensitive to suppression of plasma cortisol than the 27 patients maintaining normal visual fields. Thus, plasma cortisol suppression testing failed to predict the development of primary open-angle glaucoma in GG responders.