Glaucoma associated with uveitis

Clinical Experience with the Baerveldt Glaucoma Drainage Implant

A substantial fraction of glaucoma has a genetic basis. About 5% of primary open angle glaucoma (POAG) is currently attributed to single-gene or Mendelian forms of glaucoma (ie glaucoma caused by mutations in myocilin or optineurin). Mutations in these genes have a high likelihood of leading to glaucoma and are rarely seen in normal subjects. Other cases of POAG have a more complex genetic basis and are caused by the combined effects of many genetic and environmental risk factors, each of which do not act alone to cause glaucoma. These factors are more frequently detected in patients with POAG, but are also commonly observed in normal subjects. Additional genes that may be important in glaucoma pathogenesis have been investigated using quantitative traits approaches. Such studies have begun to identify genes that control the magnitude of important quantitative features of glaucoma that may also be important risk factors for POAG, such as central corneal thickness. Each of these different approaches to study glaucoma genetics is providing new insights into the pathogenesis of POAG.

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Primary open-angle glaucoma genes.

The ultimate goal of glaucoma management is the preservation of patients’ visual function and quality of life (QoL). The disease itself as well as the medical or surgical treatment can have an enormous impact on a patient’s QoL. Even the mere diagnosis of a chronic, irreversible, potentially blinding disorder can adversely affect the patient’s sense of well-being and QoL by eliciting significant anxiety. Patients with primary open-angle glaucoma rarely present with visual symptoms, at least early in the course of the disease. A better understanding of patient-reported QoL can improve patient–physician interaction and enhance treatment adherence by customizing treatment options based on individual patient profile, thus optimizing long-term prognosis. These aspects are summarized and critically appraised in this article.

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Quality of Life in Glaucoma: A Review of the Literature

The vast complexity of primary open angle glaucoma: disease genes, risks, molecular mechanisms and pathobiology.

Modified Schocket implant for refractory glaucoma. Experience of 55 cases.

Purpose: To assess the functional status and well-being in glaucoma patients who live in a developing country. Methods: Cross-sectional case control study, comprising 102 glaucoma patients and 58 controls. All subjects were administered the Medical Outcomes Study 36-item short-form survey (SF-36). SF-36 scores for study and control groups were compared. Statistical analysis included Student’s t-test for score data and Student’s t- and chi-square tests for demographic data. Results: Patients with glaucoma had significantly lower scores than healthy control subjects (p < 0.05) in five domains of the SF-36 survey (physical functioning, role-emotional, bodily pain, social functioning and mental health). Bodily pain was the domain with the lowest score. Conclusions: Patients with glaucoma who live in a developing country have less functional status than non-glaucomatous patients.

Quality of Life in Patients with Glaucoma Who Live in a Developing Country

Purpose: To verify the frequencies of T34T, E50K, M98K, 691_692insAG, and R545Q variants in the optineurin (OPTN) gene in Brazilian subjects with primary open-angle glaucoma (POAG) and controls. Patients and Methods: Ninety-nine patients with POAG and 100 normal controls were enrolled in this study. The frequency of alterations in the OPTN gene was analyzed by direct sequencing and enzymatic digestion of PCR products. Results: None of the five alterations evaluated was significantly associated with POAG when compared to controls. However, the T34T silent change was present in greater frequency in POAG patients (37.37% vs. 23.00% in controls), while the R545Q change was more prevalent in controls (23.00% vs. 10.10% in POAG). The M98K and 691_692insAG presented with low frequencies in POAG patients (1.01% and 2.02%, respectively) and controls (2.00% and 2.00%, respectively). The E50K substitution was not observed. Conclusion: Our data show no association between the five evaluated variants and POAG in the B...

Lack of association between optineurin gene variants T34T, E50K, M98K, 691_692insAG and R545Q and primary open angle glaucoma in Brazilian patients.

Aim: To evaluate the performance on automated perimetry (AP) after listening to a Mozart sonata in normal subjects naive to AP. Methods: 60 naive normal subjects underwent AP (SITA 24-2). The study group (30 subjects) underwent AP after listening to Mozart’s Sonata for Two Pianos in D Major and the control group (30 subjects) underwent AP without previous exposure to the music. Results: The study group had significantly less fixation loss, false positive, and false negative rates compared to controls (p Conclusion: Listening to Mozart seems to improve AP performance in normal naive subjects.

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Improved automated perimetry performance following exposure to Mozart

Purpose: To study frequency and characteristics of ocular manifestations in patients with multiple sclerosis (MS) in the State of Sao Paulo. Methods: From March, 1996 to November, 1998, 64 patients (48 female, 16 male, age 17 - 59) with MS underwent ophthalmologic examination and computerized visual field perimeter testing. Results: Forty-four (68.75%) of 64 examined patients presented some kind of ocular manifestation. The most frequent manifestation was optic neuritis (28 patients - 43.75%). It was the first manifestation of MS in 18 (28.1%) patients. Alterations of ocular motility were the second most frequent finding. Eight (12.5%) patients suffered from diplopia, of which 6 (9.37%) presented this as their first manifestation of MS. Sixth nerve palsy occurred in 2 patients (3.1%), with esotropia as a first sign of the disease. Other findings can be listed: uveitis (4 patients - 6.25%), changes in iridian topography with anterior lens capsule pigmentation (3 patients - 4.6%). The most frequent visual field defect in the patients who presented optic neuritis was arcuate scotoma with paracentral defects (46.4%). Two patients presented central scotomas and peripheral changes. None of the patients presented nystagmus. Conclusion: Our data shows that ocular findings in MS are frequent and many times are the initial manifestation of this disease. Although optic neuritis was the most frequent finding, we must emphasize the possibility of other ocular manifestations to be either preceding or occuring at the same time as this disease.

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Ralph Cohen

Papers

Modified Schocket implant for refractory glaucoma. Experience of 55 cases.

Quality of Life in Patients with Glaucoma Who Live in a Developing Country

Lack of association between optineurin gene variants T34T, E50K, M98K, 691_692insAG and R545Q and primary open angle glaucoma in Brazilian patients.

Improved automated perimetry performance following exposure to Mozart

Manifestações oculares em pacientes com esclerose múltipla em São Paulo