Prevalence and management of elevated intraocular pressure in patients with Graves' orbitopathy

AIMS: To investigate the prevalence and to discuss the necessity of treating elevated intraocular pressures (IOP) in patients with Graves' orbitopathy (GO). In addition, to study the effects of orbital decompression and extraocular muscle surgery on IOP. METHODS: The records of consecutive patients with GO referred in a 5 year period were studied and those selected, in which glaucoma medication had been prescribed, or a diagnosis of primary open angle glaucoma (POAG) or of ocular hypertension (> or = 22 mm Hg) (OH) had been made. The necessity of treating these patients with glaucoma medication was questioned and the effects of corticosteroids, orbital decompression, and extraocular muscle surgery on the IOP were evaluated. RESULTS: Of 482 patients with GO, 23 (4.8%) met the inclusion criteria. Four patients (0.8%) had POAG, four had elevated IOPs and visual field defects consistent with dysthyroid optic neuropathy, and 15 (3.1%) had only elevated IOPs. Five patients with OH showed a permanent drop of IOP after orbital decompression, two had a marked decrease of their IOP after recession of the inferior rectus muscle. CONCLUSIONS: POAG has the same prevalence in the general Dutch population as in the GO subgroup. The combination of elevated IOPs and visual field defects in GO patients may be attributed to other mechanisms than obstructed aqueous outflow in the trabecular meshwork and should be treated accordingly. Orbital decompression and extraocular muscle surgery may lower the IOP in patients with GO.     

Novel trabecular meshwork inducible glucocorticoid response mutation in an eight-generation juvenile-onset primary open-angle glaucoma pedigree

OBJECTIVE: This study aimed to update a large kindred with juvenile-onset primary open-angle glaucoma (POAG) first described in 1940 and to identify the underlying genetic cause of the disease. DESIGN: Molecular genetic study of a single kindred, including clinical examination, retrospective review of clinical and family history records, linkage analysis, and mutation screening. PARTICIPANTS: The retrospective review included 957 members of a single large family. The linkage study included 40 members of 1 branch of the family in which juvenile-onset POAG is segregating in an autosomal-dominant pattern. Mutation screening included 15 at-risk family members with juvenile-onset POAG, probands of 40 families with adult-onset POAG, probands of 11 additional unrelated juvenile-onset POAG families, and 43 unrelated normal control subjects. INTERVENTION: Clinical and family history records were obtained, ophthalmologic examinations were performed, and blood samples were drawn for use in genotyping. MAIN OUTCOME MEASURES: Allele sizes of microsatellite repeat genetic markers from the vicinity of the GLC1A glaucoma gene on chromosome 1q were assigned based on size fractionation of DNA fragments generated by polymerase chain reaction (PCR). Linkage was established by the method of lod scores. Mutations were identified by determination of the DNA sequence of PCR products amplified from the trabecular meshwork inducible glucocorticoid response (TIGR) gene. Glaucoma status for purposes of linkage and mutation analysis was based on a combination of ophthalmologic examination, clinical records, family history, and previously published information. For some individuals reported in the pedigree, but not included in the genotyping studies, less information was available as presented in the text and tables. RESULTS: Autosomal-dominant POAG was confirmed or reported for 78 members of an 8-generation family. Linkage analysis showed significant evidence for linkage of juvenile-onset POAG in one branch of the family to D1S452 (maximum lod score of 6.42 at a recombination fraction of 0.00) and other markers in the vicinity of the GLC1A gene on chromosome 1q. Screening of the TIGR gene identified a mutation that results in substitution of asparagine for isoleucine at codon 477 near the carboxyterminal end of the protein. CONCLUSIONS: The authors' findings strongly suggest that the juvenile-onset POAG locus in this family is the GLC1A locus and that the underlying cause of the disease is the IIe477Asn TIGR mutation that cosegregates with juvenile-onset POAG in one branch of this large family. Lack of samples from deceased individuals prevented the authors from determining whether reported adult-onset cases in this family could also be attributed to the IIe477Asn TIGR mutation. Absence of the IIe477Asn TIGR mutation from other juvenile- and adult-onset POAG families implies that this TIGR mutation is not a common cause of glaucoma.     

The effect of tolerance to noninherited maternal HLA antigens on the survival of renal transplants from sibling donors

BACKGROUND: During pregnancy and nursing, a baby's developing immune system is intimately exposed to the mother's antigens. To determine whether this exposure is of clinical benefit to patients who later receive an allograft as an adult, we analyzed the outcome of primary renal transplantations from sibling donors. METHODS: We retrospectively studied graft survival and rejection episodes in 205 patients who had received renal transplants at nine centers between 1966 and 1996 from sibling donors bearing maternal or paternal HLA antigens not inherited by the recipient. The sibling donors were categorized by analysis of family HLA-typing data. RESULTS: In the multicenter analysis, graft survival was higher at 5 years and at 10 years after transplantation in recipients of kidneys from siblings expressing maternal HLA antigens not inherited by the recipient than in recipients of kidneys from siblings expressing paternal HLA antigens not inherited by the recipient (86 percent vs. 67 percent at 5 years and 77 percent vs. 49 percent at 10 years, P=0.006 for both). Paradoxically, there was a higher incidence of early rejection in the former group, suggesting that fetal and neonatal exposure to maternal antigens results in immunologic priming. Pretransplantation transfusions of donor blood reduced the incidence of acute rejection while preserving the beneficial effect of tolerance to noninherited maternal antigens on graft survival. Since 1986, new immunosuppressive drugs have lessened the short-term, but not the long-term, survival advantage of grafts expressing maternal HLA antigens not inherited by the recipient. CONCLUSIONS: In the transplantation of a kidney from a sibling donor who is mismatched with the recipient for one HLA haplotype, graft survival is higher when the donor has maternal HLA antigens not inherited by the recipient than when the donor has paternal HLA antigens not inherited by the recipient.     

Influence of refraction on the visual field defects in normal tension glaucoma and primary open angle glaucoma eyes

The prevalence of normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) is higher in myopic populations and the prevalence of myopia and NTG is relatively high in the Japanese. To evaluate the influence of myopic refractive error on the central visual field defect in NTG eyes, the data obtained from NTG eyes with the Humphrey Visual Field Analyser were analysed in comparison with those from POAG eyes. One hundred and twenty NTG eyes and one hundred and ninety-seven POAG eyes were included. All of them had clear ocular media, but no myopic degeneration in the fundus. Multiple linear regression analysis was performed with a dependent variable of the deviation of the measured threshold value from normal reference value (total deviation, STATPAC) and independent variables of refractive error and mean deviation (STATPAC). Myopic power was found to be positively correlated with the depression in the lower papillo-macular area in both NTG and POAG eyes, and it was negatively correlated with the depression in an upper arcuate area extending just nasal to the fixation only in NTG eyes.     

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.     

Isolation of the ALG5 locus encoding the UDP-glucose:dolichyl-phosphate glucosyltransferase from Saccharomyces cerevisiae

Cataract extraction and posterior chamber intraocular lens (PC-IOL) implantation was carried out in 45 glaucoma eyes that had undergone glaucoma filtering surgery (Group A), and in 47 glaucoma eyes in which intraocular pressure (IOP) was well controlled with medication (Group B). To analyze the effects of PC-IOL implantation on the control of IOP and the functioning of the filtering bleb, a life-table analysis using the Kaplan-Meier method was carried out. In Group A the probability that IOP control will not worsen at 2 years was 56 +/- 12 (SE)% in eyes where a functioning filtering bleb had existed preoperatively. The probability that the filtering bleb was not cicatrized at 2 years postoperatively was 44 +/- 11 (SE)%. In Group B the postoperative IOP on the first postoperative day was significantly higher than the preoperative level in primary open angle glaucoma (POAG) eyes, while no such difference was seen in primary angle closure glaucoma (PACG) eyes. The postoperative IOP was significantly lower than the preoperative level from 3 to 6 months postoperatively in POAG eyes and from 1 to 12 months postoperatively in PACG eyes. Medication did not differ significantly pre- and postoperatively. In 64 +/- 11 (SE)% of POAG and 63 +/- 15% of PACG eyes the IOP control did not worsen at 2 years. In 70% of the eyes the IOP control improved postoperatively, and was maintained for 2 years with the probability of 44 +/- 12 (SE)%.     

Family history of glaucoma and risk factors in pigmentary glaucoma. A new clinical study

BACKGROUND: Whether a family history of glaucoma (FHG) in patients with pigmentary glaucoma (PG) is a prognostical indicator, is unknown. Therefore the aim of this study was to evaluate the influence of FHG on the severity of the disease in PG and pigment dispersion syndrome (PDS). Furthermore risk factors in PG and PDS were evaluated. METHODS: The findings of 207 patients with PG and PDS, who were able to give information about FHG, were evaluated (149 PG, 43 PDS with ocular hypertension (OH), 15 PDS without OH). RESULTS: Significance of FHG: FHG was found in 39.1%, and in one third of the patients more than one relative had the disease. FHG was found in PG not more frequent than in PDS. Pigmentary glaucomas in advanced stages of the disease did not have a higher incidence of FHG than patients in beginning stages. Out of 207 patients with PG and PDS 71% were male and 29% female (p < 0.001). In patients with FHG the share of men was 64.2% and not significantly different to the group without FHG with 75.4%. The sex distribution in parents and grandparents having a glaucomatous disease was 1:1. Risk factors: The pf1p4nts with and without FHG in PDS with and without OH, PG, and within the different stages of visual field loss, showed no significant differences in risk factors, for example in maximum intraocular pressure, refraction and cup-disc ratio. Myopia: Patients with PG had a significantly higher myopia than patients with PDS (p < 0.01). The higher the myopia, the earlier the disease was diagnosed (p = 0.008). Krukenberg spindle: During miotic therapy the Krukenberg spindle decreased in the upper half of the cornea. Time of diagnosis: PG was diagnosed at a higher age compared to PDS. CONCLUSION: FHG does not influence the severity of the disease in PG. Family history of glaucoma is a risk factor in patients with PG, but no prognostical indicator. Patients with FHG do not have primarily larger cup-disc ratios than patients without FHG. Myopia is a risk factor.     

Influence of non-inherited maternal HLA-DR antigens on susceptibility to rheumatoid arthritis

OBJECTIVE: It has recently been observed that non-inherited maternal DR4 antigens (NIMAs) of DR4 negative rheumatoid arthritis (RA) patients were increased compared with non-inherited paternal DR4 antigens (NIPAs). The aim of this study was to determine the prevalence of non-inherited DR4 antigens and DRB1 alleles in parents of RA patients. METHODS: HLA-DR serology and DRB1 typing was performed in 97 RA patients and their parents. NIMA and NIPA frequencies were compared, stratified according to the presence of DR4 and/or the shared epitope (SE). RESULTS: In DR4 negative patients, NIMA DR4 was increased compared with NIPA DR4 (OR 3.10, 95% CI 0.76, 12.70). When combined with results from a previous study this increase was significant (OR 3.65, 95% CI 1.29, 10.31). The NIMA effect of SE positive DR4 subtypes in this study (OR 4.73, 95% CI 0.94, 23.8) was stronger than the NIMA effect of combined SE positive DRB1 alleles (OR 2.19 95% CI 0.36, 13.22). CONCLUSIONS: The association between non-inherited maternal HLA-DR4 alleles and the susceptibility to RA was observed in two independent populations.     

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.     

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.     

Retroviral infection of Syrian hamster BHK cells depends on age and susceptibility toward sialidase

PURPOSE: To study the features of the motion perception (MP) and explore the worth of the clinical application of MP test in primary open angle glaucoma (POAG). METHODS: MPs were recorded from 41 patients (67 eyes) with POAG ang 56 normal subjects (112 eyes) by the MP software in PC compatible computer. Meanwhile, the MP ways and MP sites were analyzed and MP abnormal rate was compared to the clinical parameters and the visual function indices related to glaucoma. RESULTS: The results showed that the total abnormal rate of MP was 89.5% in POAG, and the abnormal rate was 81.6% in early stage of POAG, and MP abnormal degree had positive correlation with C/D, ocular tension and corrected loss variance (CLV), and negative correlation with visual acuity and mean sensitivity (MS), and no correlation with age and short-term fluctuation (SF) in the patients with POAG. CONCLUSION: These results suggest that the MP test provides a newly effective examination method in diagnosing the early POAG.     

Ultrastructural changes in the trabecular meshwork of human eyes treated with corticosteroids

OBJECTIVES: To study the ultrastructure of the trabecular meshwork in human eyes with corticosteroid-induced glaucoma and to determine whether the changes noted also occur in the eyes of patients with primary open-angle glaucoma (POAG) who have been treated with corticosteroids. METHODS: The trabecular meshwork from 5 patients in whom corticosteroid-induced glaucoma was diagnosed and from 6 patients with POAG who had been treated with systemic or topical corticosteroids for months to years was investigated with light and electron microscopy. None of the eyes with POAG were considered to have corticosteroid-induced elevation of the intraocular pressure. RESULTS: Eyes with corticosteroid-induced glaucoma had the accumulation of extracellular material distinct from the sheath-derived plaques typical of POAG. A finger-printlike arranged material resembling basement membranes (FBM material), considered characteristic of corticosteroid-induced glaucoma, was found in all eyes with corticosteroid-induced glaucoma. In addition, an abnormal accumulation of densely packed, fine fibrils immediately beneath the inner wall endothelium of Schlemm's canal was present. The findings were similar among patients receiving topical or systemic treatment and among patients of different ages. In the eyes from donors with POAG who had been treated with corticosteroids, the fine fibrillar material and FBM material were present in small amounts in 3 of 6 donors and were not found in the other 3 donors. CONCLUSIONS: The extracellular material that accumulates in eyes with corticosteroid-induced glaucoma differs from that seen in eyes with POAG. Eyes with POAG exposed to long-term corticosteroid treatment did not all respond with the formation of the abnormal extracellular materials characteristic of those found in eyes with corticosteroid-induced glaucoma.     

A new HLA antigen apparently not controlled by the known HLA loci

The human allogeneic serum RM3 recognizes a lymphocyte structure inherited with the HLA chromosome. Population studies show several positive associations with antigens of the HLA-A and HLA-B series. Negative association have been found with antigens of the HLA-C series. Moreover the distribution of the RM3 factor is in Hardy-Weinberg equilibrium with that of the HLA-C alleles. However, serological investigations (namely the 'lysostrip' technique) bring evidence that RM3 serum does not appear to contain antibodies directed against any of the antigens of the HLA-A, B and C series. The study of a segregant family, showing a crossing over between the HLA-A and HLA-B loci, shows that the RM3 factor segregates on the side of the HLA-A locus. In conclusion, within the limits of the serological approach used, the present study presents evidence of a new serologically defined HLA locus, different from those so far described.     

Beta-thalassemia in Iran: a high incidence of the nonsense codon 39 mutation on the island of Queshm

Optic disc blood flow velocity was measured in healthy patients, those with primary open angle glaucoma (POAG), and patients with normal pressure glaucoma (NPG). The velocity of the red blood cells (RBCs) in the capillaries of the optic nerve head (ONH) has been measured with a laser Doppler velocimeter (LDV), and blood viscosity has been evaluated notably by determining the aggregability of the RBCs with an erythroaggregameter. Our results in POAG patients and NPG patients showed that their optic nerve blood flow velocity was reduced and that the aggregability of the RBCs was increased. The hyperaggregability of the erythrocytes is responsible for the increase of the local viscosity in the papillary capillary network. These haemodynamic modifications observed in patients with glaucoma support the hypothesis of a vasogenic mechanism that could impair the optic nerve in glaucoma patients.     

Immunogestosis: a new etiologic concept of "essential" EPH gestosis, with special consideration of the primigravid patient; preliminary report of a clinical study

Evidence for immunologic processes taking part in the pathogenesis of what until now has been called the "essential" form of EPH gestosis is cited. The name of immunogestosis (IG) is introduced. The data of this preliminary study suggest that regular "inoculation" of the female genital tract with allogeneic spermatozoal histocompatibility antigens reduces the incidence of IG. Information about preconceptional sexual habits and contraceptive measures was obtained from 83 selected primigravid patients. Twenty-eight women had mild to moderate IG (Group B);55 did not (Group A). Women in Group B had had less contact with spermatozoa of partners than did women in Group A. Oral contraceptive consumption was less in Group B than in Group A. Women in Group B were younger than women in Group A. All these differences were statistically significant. A new immunoetiologic hypothesis referring to IG, as well as the theoretic and clinical implications arising from it, are discussed. This hypothesis is based on the assumption that spermatozoal histocompatibility antigens can either induce immunologic tolerance or be responsible for the phenomenon of immunologic enhancement in the maternal immunosystem. As the fetus inherits paternal histocompatibility antigens, it is concluded that pre-existing tolerance (or enhancement) exerts an IG-preventive function in a subsequent pregnancy.     

Caring for the individual

AIM: Investigation of associations of reactive arthritis (ReA) with histocompatibility antigens class I and II and determination of new approaches to assessment of association ReA with antigen HLA B27. MATERIALS AND METHODS: 118 ReA patients with associated intestinal and 82 ReA patients with associated urogenital infection were studied. The infection was identified bacteriologically, with agglutination reaction, enzyme immunoassay, direct and indirect immunofluorescence, culturing. HLA-antigens were studied in lymphocytotoxic test: locus A, B and C in all the patients, DR in 65 patients. RESULTS: ReA triggers were intracellularly parasite bacteria: facultative parasites in the enterocolitic variant (Yersinia, as a rule), obligate parasite in the urogenital (Chlamidia, as a rule). HLA B27 antigen was discovered in 77.5% of patients (RR 45.8), HLA DR1--in 48.4% of patients (RR 3.3). In urogenital variant HLA B27 antigen occurred more frequently than in enterocolitic: 87.8% (RR 95.6) versus 70.3% (RR 31.5); p < 0.01). In HLA-B27-positive patients compared to HLA-B27-negative ones there were higher ESR (p < 0.001), leukocyte count (p < 0.05), concentrations of CRP and alpha-2-globulins (p < 0.001). CONCLUSION: In HLA-B27-subjects optimal conditions exist for generalization of obligate parasites and favorable for production of facultative ones. The degree of association of ReA with HLA B27 antigens is dependent on adaptive features of microorganisms appearing in the process of evolution--obligaty and facultativeness of their internal parasitivity.     

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.     

Reactive arthritis in patients attending an urban sexually transmitted diseases clinic

OBJECTIVE: To assess the prevalence, clinical manifestations, associated genital infections, and HLA associations of reactive arthritis (ReA) among patients attending an urban sexually transmitted diseases (STD) clinic. METHODS: Using a standardized questionnaire, 271 consecutive adults, primarily black, with possible or proven Chlamydia trachomatis genital infection were screened for symptoms of ReA. A followup questionnaire was administered 6 weeks later by mail. Patients who reported at least 1 symptom were evaluated by a rheumatologist. HLA-B typing was performed on patients with objective ReA features. RESULTS: Nine of 217 patients (4.1%) with genital infection/inflammation had objective ReA features. Chlamydial or nongonococcal STD syndromes were diagnosed in 8 of these 9 patients (88%). Genital infection/inflammation was asymptomatic in 78% of patients with ReA features. HLA-B27 or other B7-cross-reactive group antigens were not associated with the occurrence of ReA. CONCLUSION: Nongonococcal genital infections, often asymptomatic, can trigger a relatively mild ReA in a larger number of exposed patients than previously thought, irrespective of the individual's HLA status.     

Prosthetic arteriovenous fistulas and venous anastomotic stenosis: influence of a high flow velocity on the development of intimal hyperplasia

OBJECTIVE: To search a sensitive parameter for the early diagnosis of primary open angle glaucoma (POAG). METHOD: A system of computerized image analysis was used to acquire images of the optic nerve head of patients with POAG, suspect glaucoma (SG) and of normal persons. Each of these groups contained 31 eyes of 31 cases. The mean relative depths of disc rim and cup at different areas in the optic nerve head were measured. All these patients were followed up for four to six months, and the changes of the mean depths of every sector were compared between each pair of the three groups with statistic analysis. RESULTS: The mean depth of the neural rim and cup of each sector and that of total rim and total cup of POAG and SG patients were all deeper than that of normal controls. The mean depths of neural rim of the superior sector, inferior sector and the total rim area of POAG were deeper than that of SG patients. Compared to their first measurements, the changes of mean depths of neural rim of superior sector and total neural rim area of POAG patients were more prominent than that of normal controls and SG. We also compared the relative depth of the total rim area in the different areas in the optic nerve head with other two dimensional optic disc parameters such as cup/disc ratio, etc. CONCLUSION: Our study suggests that three-dimensional stereoscopic measurement of the surface of optic nerve head and follow-up be of paramount importance in the early diagnosis of POAG patients.     

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.