apgc-2012: abstracts book

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ABSTRACTS

http://www.apgc2012.org

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TABLE OF CONTENTS

Program at a Glance 4

Symposia 5

Instruction Courses 42

Free Paper (Oral Presentations) 57

Poster Session Abstracts 102

Index of Authors 233

Hall 1 Hall 2 Hall 3 Hall 1 Hall 2 Hall 3 Hall 1 Hall 2

08:30-09:00

09:00-09:30

09:30-10:00

10:00-10:30

10:30-11:00

11:00-11:30

11:30-12:00

12:00-12:30

12:30-13:00

13:00-14:00

14:00-14:30

14:30-15:00

15:00-15:30

15:30-16:00

16:00-16:30

16:30-17:00

17:00-17:30

17:30-18:00

18:00-18:30

Evening Presidential Dinner (by invitation only)

IC05: Glaucoma drainage devices: what? when? how?

IC06: Glaucoma clinical trials: what they mean to my clinical practice

S05: Medical therapy for glaucoma

S06: Glaucoma imaging FP03: Glaucoma surgery and lasers

APGS Annual General Meeting

IC08: Glaucoma lasers S07: Ethnic variations in glaucoma prevalence, detection, and treatment outcomes

FP04: Glaucoma diagnosis and imaging II

IC07: A practical approach to ophthalmology

Poster Session / Visit to Exhibition / Tea Break


Cultural Dinner (open to all registered participants)

Lunch Symposium (sponsored by Alcon)

Lunch Symposium (sponsored by Santen)

FP02: Glaucoma diagnosis and imaging I

Friday Prayers


S03: Updates on new surgical procedures

IC02: Trabeculectomy: how I do it

S02: Advances in basic sciences: implications for clinical management of glaucoma

IC03: Imaging and evaluating the retinal nerve fiber layer: from red-free photography to high-resolution optical coherence tomography

TimeDec 7 (Fri) Dec 8 (Sat) Dec 9 (Sun)

S01: ACG IC01: Interpretation of visual fields: single field, follow up, pitfalls & cases

FP01: Epidemiology of glaucoma & glaucoma progression S04: NTG IC04: Getting a handle on

the angle; know your outflow

S08: Challenging cases in glaucoma

FP05: Others

Opening Ceremony

Poster Session / Visit to Exhibition / Tea Break Visit to Exhibition / Tea Break

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SYMPOSIA

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Friday, December 7, 2012 08:30‐10:00 Hall 1 S01: Angle Closure Glaucoma Chairpersons: C. Liu, Taiwan R.O.C.; C. Tham, Hong Kong SAR; Z. Zhang, China

S01‐03

RISK FACTORS FOR DEVELOPING PERIPHERAL ANTERIOR SYNECHIAE IN EYES WITH A SHALLOW PERIPHERAL ANTERIOR CHAMBER

M. Araie

Kanto Central Hospital, the Mutual Aid Association of Public School Teachers, Tokyo, Japan

We studied factors associated with future peripheral anterior synechiae (PAS) formation on ultrasound biomicroscopy (UBM) in eyes with a shallow peripheral anterior chamber. 15 subjects with a shallow peripheral anterior chamber but no PAS in both eyes in 2001 that had no medical or surgical intervention until 2008 were included. The same examiners performed gonioscopy and UBM at the 3, 6, 9, and 12 o'clock limbal positions under dark and light conditions in 2001 and 2008. A masked examiner performed a quantitative evaluation of the angle configurations in the UBM images. The presence or absence of PAS was determined by compression gonioscopy. The UBM parameters and the number of appositional closures per eye were compared between PAS‐positive eyes and PAS‐negative eyes.

The gonioscopic gradings and UBM parameters did not change significantly (P>0.1) between 2001 and 2008. Seven (47%) of 15 eyes developed PAS. In 2001, under dark conditions, the appositional angle closure in 3 to 4 quadrants was found more often (P=0.026) in 7 eyes where PAS developed during the following 7 years than in other 8 eyes.

In eyes with a shallow peripheral anterior chamber but no PAS, PAS developed in 47% of eyes followed without intervention for 7 years. PAS was significantly more likely to develop in eyes with the appositional angle closure found in 3 to 4 quadrants under dark conditions.

APGC-2012: Abstracts Book - © 2012 APGC

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S01‐04

IS ANGLE CLOSURE GLAUCOMA PURELY A PRESSURE‐DEPENDANT DISEASE?

Y.‐C. Ko1,2, C.J.‐L. Liu2

1Ophthalmology, Taipei Veterans General Hospital, 2Ophthalmology, National Yang‐Ming University, Taipei, Taiwan R.O.C.

Primary angle closure glaucoma (PACG) is much more common in East Asia and more visually destructive than primary open angle glaucoma (POAG). PACG is currently defined as eyes with occludable anterior chamber angles and glaucomatous optic neuropathy, identified by diagnostic algorithms established for POAG. It is unclear whether PACG has different pathogenic mechanisms of optic neuropathy from POAG.

Current theories postulate a mixed mechanism of optic neuropathy in POAG: the interplay between intraocular pressure (IOP) and vascular dysregulation. Contrarily, PACG is considered to be an IOP‐dependent disease, which evolves from primary angle closure with progressive peripheral anterior synechia formation and IOP elevation. This is supported by a more generalized visual field defect in PACG than POAG. However, many PACG eyes identified in population studies have presenting IOPs less than the 97.5th percentile of the population distribution. For PACG eyes without a history of acute angle closure attack, IOP is not a predictor for disease progression. On the other hand, disturbed blood flow in the optic nerve head, choroid and retrobulbar vessels has been identified in eyes with PACG. Disc hemorrhage, most commonly seen in eyes with normal tension glaucoma, is detected in eyes with PACG with similar presentation and incidence as those in POAG. These observations raise a possibility that vascular dysregulation may also contribute to the pathogenesis of optic neuropathy in PACG, in addition to elevated IOP.


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S01‐05

ARGON LASER PERIPHERAL IRIDOPLASTY

C. Tham

Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China

This presentation covers all you need to know about Argon Laser Peripheral Iridoplasty (ALPI), from indications, contraindications, techniques and pearls, results, to complications and their management. This presentation aims to empower the attendee to safely, effectively, and confidently, perform ALPI in the appropriate patients.


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S01‐06

PROGNOSIS OF PACG AFTER LASER IRIDOTOMY AND TRABECULOTOMY

T. Yamamoto, A. Sawada, K. Kawase

Ophthalmology, Gifu University Graduate School of Medicine, Gifu‐shi, Japan

The purpose of the study is to know the outcome of laser iridotomy and trabeculotomy for primary angle‐closure (PAC) and to find the prognostic factors.

1. Outcome of laser iridotomy for chronic PAC The clinical course of CPAC eyes after iridotomy was reviewed. According to the extent of peripheral anterior synechiae (PAS), they were classified into three groups: primary angle‐closure suspect (PACS), PAC with mild PAS (PAC1), and one with moderate PAS (PAC2). A 10‐year success rate was calculated to be over 90% in PACS and PAC1; whereas it was about 70% in PAC2. We concluded that the majority of CPAC eyes can maintain good IOP control with anti‐glaucoma drugs in a 10‐year period and that the PAS extent is the major prognostic factor for the IOP control following laser iridotomy.

2. Outcome of phaco‐trabeculotomy for chronic PAC Trabeculotomy decreases outflow resistance at the trabecular meshwork. Combined trabeculotomy with cataract surgery may be effective in chronic PAC. We reviewed the surgical outcomes of trabeculotomy combined with PEA/IOL in chronic PAC eyes with poor IOP control. The IOP decreased significantly from 24.2‐29.5 mmHg preoperatively to 11.6‐14.9 mmHg postoperatively. No shallow chambers and choroidal detachments were observed. Phaco‐trabeculotomy may be effective and less complicated for chronic ACG.


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S01‐07

PHACOEMULSIFICATION IN PRIMARY ANGLE CLOSURE GLAUCOMA

C. Liu

Dept Ophthalmology, School of Medicine, National Yang‐Ming University, Taipei, Taiwan R.O.C.

Accumulating evidence in recent decades has indicated a thick and anteriorly‐positioned lens plays an important role in primary angle closure (PAC) disease. Meanwhile, advances in technology and technique for phacoemulsification (PHCE) and intraocular lens (IOL) have boosted the safety of and visual satisfaction after cataract surgery, in addition to increasing the anterior chamber angle depth and alleviating the extent of peripheral anterior chamber in PAC eyes. Many studies have found the mean intraocular pressure (IOP) decreases with reduced need of glaucoma medication in PAC/PAC glaucoma after PHCE and IOL implantation. However, some will require subsequent glaucoma procedure to control their IOP.

The conventional step‐by‐step approach in the management of PACG has receiving increasing challenges in recent decade. Instead of trabeculectomy for medication‐uncontrolled PACG with coexistent cataract, cataract surgery or combined cataract and glaucoma surgery is recommended. But which procedure is more appropriate for one particular patient? What surgical procedure to suggest for these patients if they have no vision‐threatening cataract? For newly diagnosed PACG without cataract, should we perform laser iridotomy, followed by medication if needed, or is lens extraction a better option in terms of long‐term visual outcome, quality of life and disease‐related cost? I will review recent studies that touch on these issues in this presentation.


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S01‐08

GONIOSYNECHIALYSIS

S.M.J. Lai

Ophthalmology, The University of Hong Kong, Cyberport, Hong Kong S.A.R.

Introduction: Goniosynechialysis (GSL) is a surgical technique used to open up a permanently closed angle. The peripheral anterior synechiae is stripped using a blunt spatula. The aqueous will regain access to the trabecular meshwork and the clinical effect is a reduction in the intraocular pressure. GSL can be done alone or combined with phacoemulsification.

Aims: The technique of goniosynechialysis and the published results in the treatment of angle closure glaucoma from various centers will be reviewed.

Methods: Literatures review.

Conclusion: GSL is a surgical option in the treatment of angle closure glaucoma.


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Friday, December 7, 2012 14:30‐16:00 Hall 2 S02: Advances in Basic Sciences: Implications for Clinical Management of Glaucoma Chairpersons: T. Yamamoto, Japan; M. Kook, Republic of Korea; I. Sumantri, Indonesia

S02‐01

PERFORMANCE OF MOORFIELDS MOTION DISPLACEMENT TEST FOR IDENTIFYING EYES WITH GLAUCOMA

A. How1, E. Ong1, Y. Zheng1, T. Aung1,2

1Singapore National Eye Centre, 2National University Hospital, National University Health System, Singapore, Singapore

Introduction: The Moorfields Motion Displacement Test (MMDT, ESTA Version 1, London, UK) is a 31‐point suprathreshold test for visual field assessment using moving line stimuli displayed on a standard laptop computer.

Aim: To evaluate the diagnostic performance of the MMDT for discriminating between healthy eyes and eyes with glaucoma.

Methods: This was an observational case‐control study of glaucoma subjects and normal controls. All participants underwent a standardized ophthalmological examination including the MMDT and Heidelberg Retina Tomography (HRT, Heidelberg Engineering, Heidelberg, Germany) scanning of the optic disc. The MMDT employed a Pandora response version of Enhanced Standard Threshold Algorithm (ESTA) without optical correction. The performance (area under the curve receiver operating characteristic (AUROC), sensitivity and specificity) of global probability of true damage (global PTD, ranging from 0‐100%, calculated as a sum of individual PTD values for all 31 visual locations expressed as a quotient of 100) for diagnosing glaucoma was evaluated.

Results: A total of 78 subjects with glaucoma (mean age: 66.6+/‐13.1, male gender: 55.1%) and 363 healthy subjects (mean age: 55.6+/‐9.5, male gender: 35.5%) were analysed. The AUROC was 0.920 (95% confidence interval: 0.883, 0.958) for diagnosing glaucoma. At 85% specificity, the MMDT demonstrated a sensitivity of 88.5%. This decreased to 73.1% at 95% specificity. At the global PTD cut off point value of 2.0, the sensitivity was 85.9% and the specificity was 92.6%.

Conclusion: The suprathreshold MMDT showed good diagnostic performance for diagnosing glaucoma when defined by a structural criterion.


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S02‐03

ADVANCES IN GLAUCOMA‐GENETICS: POTENTIAL IMPACT ON GENOTYPE‐PHENOTYPE CORRELATION

K.K. Abu‐Amero1,2

1Ophthalmology, King Saud University, College of Medicine, Riyadh, Saudi Arabia, 2Ophthalmology, University of Florida, Jacksonville, FL, USA

Recent advances in genetics techniques such as Genome Wide Association Studies (GWAS) had its great impact on discovering new genes associated with various types of glaucoma. We came lone way since the first gene associated with glaucoma was identified utilizing linkage analysis technique. Once the gene is discovered, genetic testing, disease‐severity prediction and genetic counseling will become available to the glaucoma patients and their families. Here, I will present an overview of what is currently known on the correlation between genes and various clinical parameters important for determining glaucoma occurrence, severity and progression. I will also detail how these genotype‐phenotype informations will be helpful for the treating physicians and patients.


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S02‐04

NANOPARTICLES FOR NEUROPROTECTION: RECENT PROGRESS AND FUTURE SCIENCE

J.W. Jeoung1, K.H. Park1, J. Park1, Y.J. Kim1, M. Jeun2, S. Bae2

1Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea, 2Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore

Introduction: A magnetic hyperthermia using superparamagnetic nanoparticle agents (SPNPAs) has been considered to be a promising biotechnical approach to induce heat shock proteins (HSPs) in a target tissue because this modality can generate a localized heating with an accurate control of the heat temperature.

Objective: We present that the induction of HSPs by local magnetic hyperthermia using engineered SPNPAs is promisingly feasible for a physiologically tolerable ocular neuroprotection modality.

Methods: Cell Counting Kit‐8 assay was performed for the evaluation of cytotoxicity of magnetic nanoparticles. Transmission electron microscopic images were taken to investigate the distribution of magnetic nanoparticles and ultrastructural changes of retinal ganglion cells (RGCs). Analysis of HSP induction with different concentrations of the nanoparticles for cell uptake was performed at the frequencies ranging from 40 to 210 kHz and the magnetic fields varied from 60 to 140 Oe.

Results: The mean percentage of cell viabilities of RGC‐5 cells was decreased in dose‐dependent manner, but was within relatively non‐cytotoxic ranges except one material. Magnetic nanoparticles could enter the RGC‐5 via phagocytotic pathway without cellular damages. Hyperthermia therapy with different concentrations of SPNPAs causes significant induction of HSP expression in RGCs.

Conclusions: The results suggested that these magnetic nanoparticles could be applied to RGCs for in vivo magnetic hyperthermia system to induce heat shock proteins without significant cellular damages.


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S02‐05

IMPLICATIONS FOR CLINICAL MANAGEMENT OF GLAUCOMA DRUGS AND MEUROPROTECTION

T. Nakazawa

Ophtalmology, Tohoku University Graduate School of Medicine, Sendai, Japan

In Asia, the most common type of glaucoma is normal tension glaucoma (NTG), a type in which treatment to lower intraocular pressure (IOP) is of limited efficacy. In order to prevent glaucoma‐induced blindness, the need for development of treatments besides lowering IOP is urgent. It is important to elucidate the mechanism of the process of GON (glaucomatous optic neuropathy) to develop a neuroprotective treatment for patients with NTG. As human studies have been limited, and unable to explore molecular pathogenesis in depth, we chose a mouse model to investigate axonal damage‐induced RGC death. NF‐E2 related factor2 (Nrf2) is a transcription factor that plays a pivotal role in countering oxidative stress. Calpastatin is an endogenous inhibitory protein for the activation of calpain. We demonstrated that oxidative stress and calpain activation played a critical role in axonal damage‐induced RGC death. Using small compounds, we also found that Nrf2 activation and calpain inhibition had a neuro‐protective effect against axonal damage‐induced RGC death. I would like to discuss drug targets for future neuroprotective treatment in patients with NTG.


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S02‐07

VISUALIZATION OF GLAUCOMA OPTIC NEUROPATHY

M. Inatani

Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan

Disruption of the axonal transport plays a critical role in the apoptosis of retinal ganglion cells (RGCs) in glaucomatous optic neuropathy. We examined whether axonal transport of RGCs could be visualized in living RGCs, and whether the disturbance of axonal transport could be detected in axon‐damaged RGCs as well as in the optic nerve with high intraocular pressure.

For in vitro study, the dynamics of brain‐derived neurotrophic factor tagged with green fluorescent protein (BDNF‐GFP) was analyzed in cultivated rat RGCs by time‐lapse imaging. The axonal transport of BDNF‐GFP was disturbed by 1 mM colchicine. For in vivo study, the dynamic imaging of axonal transport was evaluated in mice eyes with high intraocular pressure.

Time‐lapse imaging quantified the mean velocity of BDNF‐GFP in the RGC axons (0.86 m/s). Colchicine‐induced axonal damage dramatically disturbed the axonal transport of BDNF‐GFP, which was followed by RGC death. Moreover, axonal transport of RGCs in the anterograde as well as retrograde directions was visualized in the living mice eye. We found that the elevation of intraocular pressure in the mice eyes disturbed the axonal transport before the glaucoma optic neuropathy.

We visualized the axonal transport of RGCs in vitro as well as in vivo. We confirmed the stopping of axonal transport before glaucoma optic neuropathy. Dynamic imaging for axonal transport of RGCs might be useful for early detection of glaucoma optic neuropathy.


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S02‐08

CELLULAR REGULATION OF WOUND‐HEALING AFTER GLAUCOMA SURGERY

P.R. Healey

University of Sydney, Sydney, NSW, Australia

Introduction: Regulation of scarring is an essential step in successful glaucoma filtering surgery.

Aims: To outline the key features of the post surgical wound healing response and its regulation.

Methods: Primary cultures of Tenon´s fibroblasts obtained during surgery. Cell flow cytometry using Annexin V/PI staining, Western blotting, mRNA RT‐PCR.

Results: Tenons fibroblast vary in their native sensitivity to Mitomycin‐C (MMC). Interferons can enhance MMC‐induced cell death in MMC‐sensitive cells through a Fas‐mediated and Caspase‐3 dependent pathways. Interferons alone have mild antifibrotic effects.

Conclusions: The use of interferons can reduce the proliferation of tenon´s fibroblasts and sensitise them to subsequent exposure to MMC.


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Friday, December 7, 2012 16:30‐18:00 Hall 1 S03: Updates on New Surgical Procedures Chairpersons: N. Aquino, Philippines; P. Healey, Australia; S. Seah, Singapore

S03‐01

AQUESYS SHUNT

N. Strouthidis1,2

1Glaucoma Service, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK, 2Singapore Eye Research Institute, National University Singapore, Singapore, Singapore

The greatest challenge in glaucoma filtering surgery is perhaps finding the correct balance of efficacy (in other words IOP‐lowering effect) and safety in terms of preventing hypotony and infection. The success of conventional filtering techniques ‐ whether trabeculectomy, non‐penetrating surgery or tube surgery ‐ all to a greater or lesser degree are limited by a failure to achieve the correct balance between efficacy and safety in all cases. The scope for novel surgical techniques and devices in glaucoma is therefore broad, particularly for methods which ´spare´ the conjunctiva thereby reducing the risk of scarring/failure, infection and not compromising any future conventional surgery. One such novel device is the aquesys shunt, a collagen cross‐linked tube with a 60 micron lumen diameter. This tube is inserted via the anterior chamber using a specially designed introducer into the angle superonasally, to emerge 3 mm away from the limbus into the subconjunctival space. The intention is to generate non‐limbal aqueous egress into a surgically‐undisturbed subconjunctival environment. In this presentation, the early experiences of using this device in patients with uveitic glaucoma at Moorfields Eye Hospital will be presented.


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S03‐02

MINIMALLY PENETRATING TRABECULECTOMY

N. Baig

Associate Consultant, Hong Kong Eye Hospital, Hong Kong

Surgical options for glaucoma were used to be limited and consisted of filtration surgery with trabeculectomy or drainage implants (such as Ahmed, Baerveldt, Molteno). Trabeculectomy with or without an antimetabolite (5‐FU or MMC) has been the gold standard for decades. Non‐penetrating glaucoma surgery (NPGS) has been introduced in the last 2‐3 decades as a safer procedure, however its learning curve can be long.

Newer techniques are collectively referred as minimally invasive glaucoma surgery (MIGS). These consist of glaucoma devices such as Ex‐PRESS (Alcon) and other new miniature metallic devices: i‐Stent (Glaukos), Solx Gold Shunt, AquaSys; and non‐metallic devices: CyPass (Transcend Medical), Hydrus (Ivantis). MIGS also include other techniques such as trabectome and ECP (endolaser cyclophotocoagulation) (Endo Optiks). MIGS are generally less invasive and safer. They are usually blebless, thus avoiding bleb‐related complications. The main limitation is that they may not produce as large pressure lowering effect as trabeculectomy does. In addition, the resulting effect is not as reliable as the traditional filtering procedures.

In this presentation, we will focus on minimally penetrating trabeculectomy which can be classified under the category of MIGS. The main procedure to be discussed is Ex‐PRESS glaucoma filtration device (Alcon). Other devices and trabectome will also be introduced. We shall include the procedures, their indications, efficacy, outcomes and reported complications.

Finally, it is important to note that this variety of surgical options of minimally penetrating trabeculectomy should allow for better customization to individual patients.


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S03‐03

LENS EXTRACTION IN ANGLE CLOSURE

S. Loon

Ophthalmology, National University Hospital of Singapore, Singapore, Singapore

Introduction: Angle‐closure glaucoma is associated with significant visual morbidity and is one of the leading causes of blindness in East Asia. Glaucomatous optic neuropathy has been predicted to affect up to 79.6 million people by 2020 in epidemiological studies.

Objective: This lecture aims to:

‐ Discuss treatment options

‐ Showcase methods of lens extraction

‐ Share tips of surgery

‐ Discuss potential complications and also methods to overcome such issues.


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S03‐04

NEW FORMS OF MINIMALLY INVASIVE GLAUCOMA SURGERY

D. Su

Glaucoma, Singapore National Eye Centre, Singapore, Singapore

Minimally invasive glaucoma surgery (MIGS) describes a group of procedures that differ from trabeculectomy and glaucoma drainage implants. They generally use an ab interno approach, do not require any conjunctival incision and have a shorter recovery period. MIGS procedures attempt to lower intraocular pressure by bypassing the site of maximal resistance to aqueous outflow ‐ the juxtacanalicular trabecular meshwork. Some techniques involve implanting devices that allow direct communication between the anterior chamber and the Schlemm's canal or suprachoroidal space. Others create openings in the trabecular meshwork with laser or diathermy. Various surgical trials have reported a decrease in IOP and need for glaucoma medications using these techniques though the reduction cannot match that obtained in trabeculectomy. As most of the MIGS techniques are fairly new, follow‐up is limited. The efficacy and safety of MIGS has yet to be proven through randomized‐controlled trials.


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S03‐06

EVALUATING NEW SURGICAL PROCEDURES: WHAT THE SURGEON NEEDS TO KNOW

P.R. Healey


Introduction: New surgical procedures offer the potential to improve outcomes and decrease side‐effects. But many procedures that initially seem successful, do not withstand the test of time.

Aims: To describe a practical way to evaluate new surgical procedures and the published literature concerning their efficacy and side effects.

Methods: Literature searching, quality of evidence ranking, evaluating potential biases, the importance of comparative groups, standardising surgical techniques, surgical audit.

Conclusion: at the end of this presentation, delegates should have a clear idea of how to evaluate a new surgical procedure and when and how to try it themselves.


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Saturday, December 8, 2012 09:00‐10:30 Hall 1 S04: NTG Chairpersons: M. Araie, Japan; K.H. Park, Republic of Korea; D.Y.‐L. Leung, Republic of Korea

S04‐02

ORBITAL CEREBROSPINAL FLUID IN GLAUCOMA: ANATOMICAL FACTS AND MYTHS

J. Jonas

Heidelberg, Mannheim, Germany

As anatomical and physiological fact, the orbital cerebrospinal fluid pressure is counter.pressure against the intraocular pressure across the lamina cribrosa. As myth, the orbital cerebrospinal fluid pressure orbital cerebrospinal fluid pressure may play a role in the pathogenesis of glaucomatous optic neuropathy.


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S04‐05

DISC HEMORRHAGE AND STRUCTURAL CHANGE IN NTG

K. Sugiyama

Ophthalmology, Kanazawa University, Kanazawa, Japan

To elucidate the association for disc hemorrhage and structural change in normal‐tension glaucoma (NTG), we measured retinal nerve fiber layer defects (RNFLD) angles and divided NTG cases into 2 groups, enlarged RNFLD and stable RNFLD. Disc hemorrhages were found significantly more frequent in the enlarged group than in the stable group (P< 0.0001). RNFLD enlarged in the direction of disc hemorrhage in over 80% of eyes. In majority of eyes of the enlarged group, the enlargement of RNFLD was toward the fovea. The cumulative probability of non progression in the visual field was significantly lower in the enlarged group than in the stable group (P=0.0019). The enlargement of RNFLD in NTG was closely associated with disc hemorrhage occurrence and the deterioration of visual field loss.

We developed simultaneous structure and function evaluation technique combining spectral‐domain (SD) OCT and fundus‐oriented perimeter for detection of visual field abnormality in RNFLD area. We observed disc hemorrhage adjacent to the border of RNFLD in progressive NTG cases. The borderline of RNFLD seemed to be the thinnest RNFL and the lowest retinal sensitivity in relatively early stage of NTG with disc hemorrhage.


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S04‐06

VISUAL FIELD PROGRESSION IN NORMAL TENSION GLAUCOMA

C. Liu

Dept Ophthalmology, School of Medicine, National Yang‐Ming University, Taipei, Taiwan R.O.C.

Most of our understanding of the natural course of normal tension glaucoma (NTG) comes from the Collaborative Normal Tension Glaucoma Study (CNTGS), which found highly variable rates of progression among individuals without treatment; about 55% of untreated patients showed no progression after nearly 6 years of follow‐up. Later on, the Early Manifest Glaucoma Trial (EMGT) found the median visual field progression rate in the 22 younger patients with NTG was almost nil after a follow‐up of 6 years.

On the other hand, while the CNTGS demonstrated an intraocular pressure (IOP) reduction of 30% may slow the rate of visual field progression, some treated eyes showed progressive deterioration even after successful IOP reduction. Risk factors associated with progression if left untreated include female gender, with migraine headache, with disc hemorrhage at initial diagnosis, older age, larger cup‐to‐disc ratio, and higher IOP, thus closer follow‐up is recommended for patients with these factors at least during the first few years after diagnosis. Other clinical studies have found risk factors for progression In treated NTG patients include diurnal variation of IOP, mean IOP during follow‐up, visit‐to‐visit IOP fluctuation, the initial visual field damage and the occurrence of disc hemorrhage.

In addition, some IOP‐independent factors may play a role regarding disease progression in NTG, which will also be discussed in this presentation.


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S04‐07

DISC APPEARANCE

P.R. Healey


Aims: To describe the differences and similarities in optic disc appearance in Normal Tension Glaucoma.


27

Saturday, December 8, 2012 11:00‐12:30 Hall 1 S05: Medical Therapy for Glaucoma Chairpersons: I. Goldberg, Australia; P. Healey, Australia; A. Gandasubrata, Indonesia

S05‐02

CHALLENGES: ADHERENCE, PERSISTENCE, DYSCOMPLIANCE

P.R. Healey


Introduction: Medical therapy is the mainstay of glaucoma treatment. But writing a prescription only gives the patient the power to treat themselves.

Aims: This paper describes the pathway between writing a prescription and lowering intraocular pressure and the potential barriers to good adherence and persistence with glaucoma eye drops.


28


S05‐03

FIX COMBINATIONS: NECESSARY OR OPTIONAL?

A. Gandasubrata

Ophthalmology, Padjadjaran University / Cicendo Eye Hospital, Bandung, Indonesia

The initial treatment of glaucoma tipically is to prescribe a single ocular hypotensive medication to reduce the intraocular pressure (IOP). Frequently, more than one medication is required to achieve adequate control of IOP. However,the need for adjunctive therapy may cause a dilemma : whether to add a second drug or change to a fixed combination. There are several potential benefits of fix combination medications compared with using the individual components separetely. This include a reduction in the total number of drops and preservative instilled per day, cost savings, improved tolerability and compliance and avoiding the washout effect resulting from rapid‐sequence instillation of multiple drops. Fix combination treatments offer effective IOP control while reducing the washout effect and exposure to preservatives. However, fix combinations also remove the posibility of titrating the individual components both in terms of consentration and timing of administation. In addition, fix combinations might not always provide the same efficacy as proper use of the individual components. The clinician must make individualised assessments when weighing the convenience of these medications against their limitations for specific patients.


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S05‐04

ADVANCE FOR THE PAST DECADE

M. Araie

Kanto Central Hospital, the Mutual Aid Association of Public School Teachers, Tokyo, Japan

Although no drugs of new category such as prostaglandin‐related compounds have become commercially available in the last 10 years, advance over the past 10 years in medical therapy for glaucoma would be itemized into the following three:

1. Several kinds of fixed combination have become available and widely used.

2. Anti‐glaucoma eye drops free of benzalchonium chloride (BAC) or preservatives have become commercially available and their beneficial effects on ocular surface have been recognized.

3. Topically instilled brimonidine may exert neuroprotective action in normal tension glaucoma patients.

Each of the above 3 items will be briefly reviewed and our contribution will be also presented.


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S05‐06

MEDICAL THERAPY FOR PRIMARY JUVENILE ONSET OPEN ANGLE GLAUCOMA (JOAG)

V. Gupta

R.P. Centre for Ophthalmic Sciences, Delhi, India

JOAG is considered as POAG occurring between the age group of 10 – 40 years. Within this age group there is varying clinical presentation, with some patients presenting in the first decade of life with IOP in the early twenties while others presenting at a later age with IOP more than 50mmHg.Gonioscopically there is a wide variation in the degree of angle dysgenesis. While some have normal appearing angle others may varying dysgenesis. These patients need to be sub grouped, into those which behave like congenital glaucomas in definitely requiring surgery and those which are variants of adult onset POAG and can be controlled on medical therapy for long. Contrary to the prevalent belief that majority need surgery to control IOP we found that IOP can be controlled medically for as many as 2/3 of these patients1. The treatment of JOAG is individualized as for any other glaucoma and it is difficult to identify at the outset the patients who are likely to require surgery and those who can be controlled on medical therapy over a long period. However certain features may help to decide which patients can be controlled on medical therapy alone and which would require surgery.

Reference:

1. Gupta V, Mary OV, Rao A, Sharma A, Sihota R. Long term structural and functional outcomes of therapy for Juvenile onset primary open angle glaucoma: A 5 year follow up. Ophthalmologica, 2012; 228:19‐25


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S05‐07

THE ROLES OF ANTI‐ENDOTHELIAL GROWTH FACTORS IN GLAUCOMA

N. Kitnarong

Ophthalmology, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand

Anti‐vascular endothelial growth factor (anti‐VEGF) has been reported as an additional treatment for glaucoma managements especially neovascular glaucoma (NVG). Bevacizumab (Avastin, Genentech, Inc., San Francisco, CA), which is approved as an anti‐angiogenic agent for the treatment of metastatic colorectal cancer in combination with chemotherapy, has been reported as an off‐lable use as intravitreal injection. It effectively reduces neovascularization in ocular tissues including age‐related macular degeneration (AMD), proliferative diabetic retinopathy and NVG. Ranibizumab (Lucentis; Genentech Inc, San Francisco, CA) is a recombinant, humanized antibody antigen‐binding fragment (Fab) and is approved by the US Food and Drug Administration for the treatment of neovascular age‐related macular degeneration (AMD) as it neutralizes all active forms of VEGF‐A. Up to date, ranibizumab is not yet widely applied for a treatment of NVG. Intravitreal injection of ranibizumab (IVR) in NVG has been reported in radiation‐induced neovascular glaucoma resulted in a rapid improvement of the rubeosis iridis and reduction of intraocular pressure (IOP). The regression of iris rubeosis is theoretically beneficial as a surgical adjuvant to reduce intraoperative bleeding during trabeculectomy. The combination of intravitreous anti‐VEGF and retinal treatment are ideal and theoretically more effective in controlling the retinal ischemia. The early administering of anti‐VEGF can limit ocular tissue damage, especially in eyes which PRP could not apply. There are several evidences supported the use of anti‐VEGF for wound modulation in glaucoma surgery. Although it is uncertain but may be comparative to 5‐FU or mitomycin C.


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Saturday, December 8, 2012 11:00‐12:30 Hall 2 S06: Glaucoma imaging Chairpersons: T. Aung, Singapore; C. Kai Shun Leung, Hong Kong S.A.R; D. Istiantoro, Indonesia

S06‐04

AN UPDATE OF TECHNOLOGIES FOR OPTIC DISC AND RNFL IMAGING

A.K. Narayanaswamy

SERI, Sinagpore, Singapore

Optic disc and RNFL imaging is available in various platforms and is carving an important niche in glaucoma care and practice. The technologies currently available are based on principles of confocal scanning (HRT), low coherence interferometry (OCT) and scanning laser polarimetry (GDx). These technologies have the advantages of being objective and allow quantitative measurements of the optic disc and RNFL. All of these applications have had their learning curves and have gone considerable changes since their introduction. Irrespective of their abilities, these tools continue to be adjuncts in our practices and cannot substitute our clinical judgments. The aim of this update would be to review the current version of these diagnostic tools, the pitfalls and summarize the consensus on the use of these technologies.


33

Saturday, December 8, 2012 11:00‐12:30 Hall 2 S06: Glaucoma imaging Chairpersons: T. Aung, Singapore; C. Kai Shun Leung, Hong Kong S.A.R; D. Istiantoro, Indonesia

S06‐07

NEW METHODS OF ANGLE IMAGING

S.A. Perera

Glaucoma, Singapore National Eye Centre, Singapore, Singapore

Angle imaging has always had a place as an adjunct to gonioscopy. However, there have been great advances in the sophistication of imaging devices available to ophthalmologists in recent years. They offer objective and reproducible methods of viewing the angle either meridionally or circumferentially. Delegates will be able to incorporate the recent improvements into their clinical practice and be given a taste of the future of angle imaging.


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Saturday, December 8, 2012 16:00‐17:30 Hall 2 S07: Ethnic Variations in Glaucoma Prevalence, Detection, and Treatment Outcomes Chairpersons: P. Rojanapongpun, Thailand; D. Friedman, USA; I. M. A. Kusumadjaja, Indonesia

S07‐02

ETHNIC VARIATION IN ANGLE CLOSURE (GLAUCOMA)

B. Mani1,2

1Glaucoma, Singapore Eye Research Institute, 2Office of Clinical Sciences, DUKE‐NUS Graduate Medical School Singapore, Singapore, Singapore

The prevalence estimates of primary angle closure glaucoma among East Asians were 0.5 to 1.74%; among South Asians were 0.23 to 0.9%; South East Asians were 0.12 to 2.5% while 0 to 0.4% among whites above 40 to 50 years. Those at risk of glaucoma ranged from 2% to 10.4%, the highest being of Chinese ethnicity while the lowest come from West. Similarly progression to angle closure glaucoma varies between 19.4% in whites to 22 to 33% among Asians in 3 to 6 years. Intra and inter‐ethnic variations in lens vault, anterior chamber metrics and iris structure between open and narrow angle eyes were documented in recent studies. Overall Chinese/Asians had the lowest anterior chamber width and volume, thicker iris and intermediate lens vault compared to the Whites. Urbanization and cataract surgery services dictate shift to myopia and lowering angle closure status among communities. Differences in predominant mechanism of angle closure and health services may explain the ethnic and regional variations; however, data on dynamic iris and choroid characteristics and genetic variations need further evidence to complete this complex picture of angle closure (glaucoma) heterogeneity.


35


S07‐04

ETHNIC VARIATION OF OPTIC NERVE HEAD CHARACTERISTICS

J. Jonas

Heidelberg, Mannheim, Germany

The optic nerve head size as any quantitiative biologic parameter shpows a marked inter‐individual variation. In addition, the optic nervehead size depends on the background, according to the rule of thumb, the closer to the equator, the larger gets the optic disc and the thinner gets the cornea). The presentation will include associations of the disc size with the ethnic background and other systemic andocular parameters.


36


S07‐05

ETHNIC DIFFERENCE IN IOP AND CCT IN ASIANS

C.‐Y. Cheng1,2

1Department of Ophthalmology, National University of Singapore, 2Singapore Eye Research Institute, Singapore, Singapore

Between 2004 and 2011, we conducted three population‐based studies of ethnic Malays, Indians and Chinese aged 40 years or older in Singapore to compare the difference in intraocular pressure (IOP) and central corneal thickness (CCT) distributions across three ethnic groups ‐ Chinese, Malays and Indians. IOP readings were obtained by Goldmann tonometry. CCT was measured with ultrasound pachymetry. We examined a total of 10,016 persons (75.7% response rate). The mean (SD) IOP in the Chinese, Malay, and Indian participants without history of glaucoma was 14.7 (3.1), 15.3 (3.7), 15.8 (2.9) mmHg, respectively (P < 0.001). The Chinese participants on average had 1.0 (P < 0.001) and 1.6 mmHg (P < 0.001) lower IOP than the Malays and Indians, respectively, after adjustments for potential confounders. The mean (SD) CCT was 552.6 (33.5), 540.9 (33.6) and 540.6 (35.7) µm in the Chinese, Malay and Indian participants, respectively (P < 0.001). In the Chinese participants, 8.1% of the eyes showed a CCT greater than 600 µm, while only 4.3% of the eyes did in the Malays and Indians (P < 0.001). On average, the Chinese participants had 12.2 µm (P < 0.001) and 13.1 µm (P < 0.001) thicker CCT than the Malays and Indians, respectively. In summary, Chinese have lower IOP but thicker CCT, compared with the other two ethnic groups. This disparity across ethnic groups should be taken into account by future studies investigating IOP and CCT as risk factors or diagnostic tests for glaucoma in Asian populations.


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Sunday, December 9, 2012 09:00‐10:30 Hall 1 S08: Challenging Cases in Glaucoma Chairpersons: B. Jamyanjav, Mongolia; S.K. Fang, Malaysia; D.W. Lu, Taiwan R.O.C.

S08‐03

CHALLENGING CASE FOR EARLY DIAGNOSIS

H.S.‐L. Chen

Chang Gung Memorial Hospital, Taipei, Taiwan R.O.C.

Aims: The structural changes at the optic disc, retina nerve fiber layer and ganglion cell loss are the most common first signs of glaucoma neuropathy and usually precede the functional visual field deterioration. Several subjective evaluation methods for detection of early glaucomatous signs is extremely difficult due to poor sensitivity and high inter‐ and intra‐observer variability. We report a patient and use new glaucoma imaging parameters to differentiate eyes with preperimetric glaucoma.

Methods: case report.

Results: A 30‐year‐old female who was referred for evaluation and treatment of glaucoma suspect. We evaluate several structural and functional examination results of this patient and discuss the new optical coherence tomography (OCT)‐derived parameters and strategies to improve glaucoma detection in clinical management.

Conclusions: Spectral domain OCT provide sensitive, reproducible quantitative measurements of the optic disc and the retina nerve fiber layer structure, and can detect glaucoma‐related structural changes before the visual field defects development. OCT also provides a segmented evaluation of the macular inner retinal layers and could be a structural parameter for detecting preperimetric glaucoma. Although early glaucoma detection remains a challenge, combining structural and functional testing improves the diagnostic ability. Early detection of glaucoma is essential not only to maximize the benefits of treatment for patients, but also to minimize the economic burden of glaucoma in society.


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S08‐04

VOGT KOYANAGI HARADA SYNDROME WITH UNCONTROLLED IOP

L. Sharmini Ahmad Tajudin

Department of Ophthalmology School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu Kelantan, Malaysia

A 26 years old gentleman presented with bilateral sudden reduction of vision. He claimed he has history of headache, neck stiffness and generalised tiredness. He denied any tinnitus or any hearing disturbance. On examination his best corrected vision was 6/36 on the right eye and 6/60 on the left eye. Relative afferent pupillary defect was positive on the left eye. There was severe anterior segment inflammation with large keratic precipitates and iris nodules. Bilateral optic nerves were hyperaemic with serous retinal detachment. There was mild vitritis. Both lenses were clear. IOP was elevated with 36mmHg and 42mmHg respectively. IOP was failed to be controlled by topical and systemic pressure lowering medication. Ocular inflammation persisted even on maximum dosage of oral prednisolone and topical cyclosporine.

Due to his financial constraint, right augmented trabeculectomy was performed. Trabeculectomy failed after a months. Later left phacoemulsification with IOL implantation and glaucoma drainage device was inserted. A month later similar procedure was conducted. The management of uncontrolled IOP and uncontrolled inflammation will be discussed.


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S08‐05

GLAUCOMA FOLLOWING VITREO‐RETINAL (VR) SURGERY

V. Lingam

Director ,Smt Jadhavabai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, India

Causes for glaucoma following VR surgery can be variable and commonly are due to the following causes ‐ preexisting glaucoma, steroid induced, following inflammation, due to silicone oil, secondary angle closure and neovasularisation. Management options are dictated by the visual potential, conjunctival scarring because of previous surgeries, concomitant procedures to be performed etc. Presentation of glaucoma can be simple or very complex. In view of this the management also varies. This case based presentation will contain various case scenarios with glaucoma following VR surgery and will discuss how we managed those cases. At the end of the presentation audience will get an overall view of this complex situation namely glaucoma following VR surgery.


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S08‐06

RECURRENT TUBE BLOCKAGE

B. Ang1, A. Azuara‐Blanco2

1Royal Victorian Eye & Ear Hospital, East Melbourne, VIC, Australia, 2Aberdeen Royal Infirmary, Aberdeen, UK

We present a 46‐year old Caucasian lady who was diagnosed with uncontrolled glaucoma in association with lens dislocation and Marfan syndrome. Due to high intraocular pressures despite maximal medical therapy, she underwent Baerveldt implant surgery to both eyes. Unfortunately, this was complicated by recurrent vitreous occlusion of both drainage tubes necessitating further multiple surgical procedures. The interventions and clinical course are described in this presentation.


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S08‐07

GLAUCOMA DRAINAGE DEVICE IN PATIENT WITH SILICONE OIL COMPLICATION

N. Kitnarong

Dept of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

A 26 year‐old male presented with the history of blurry vision in the right eye for 1 year. He underwent retinal surgery about 2 years ago due to retinal detachment. His visual acuity after successful surgery was 20/70 with silicone oil filled in the vitreous cavity. He lost to follow and was seen occasionally by a general ophthalmologist. He was referred to retinal specialist for management of the emulsified silicone oil in the anterior chamber with secondary glaucoma. His visual acuity deteriorated to hand motion. After silicone oil removal and conventional trabeculectomy, the ocular pressure was 45 mmHg with maximal medical therapy. His visual acuity was good light projection with attached retina. He was blind on the left eye because of car accident. To deal with secondary glaucoma from silicone oil complication, the glaucoma drainage device was then considered. What is the proper method to perform the GDD implantation in this situation?


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INSTRUCTION COURSES


43

Friday, December 7, 2012 08:30‐10:00 Hall 2 IC01: Interpretation of Visual Fields: Single Field, Follow‐up, Pitfalls & Cases Senior Instructors: I. Goldberg, Australia; R. Thomas, Australia; M. Zahari, Malaysia

IC01‐01

INTERPRETATION OF VISUAL FIELDS: SINGLE FIELD, FOLLOW UP, PITFALLS & CASES

I. Goldberg

Ophthalmology, University of Sydney, Sydney, NSW, Australia

Once you have obtained an optimal visual field assessment by suitably trained assistants working with the patient, using a strategy (usually SITA‐Standard) and an appropriate extent of examination for the patient (usually a 24‐2, sometimes with a 10‐2 as well), follow these simple steps to maximize the information's usefulness for diagnosis and management:

1. Check patient identity, date of birth, perimetric strategy and extent.

2. Check patient reliability parameters: fixation losses, false positives and false negatives.

3. Eyeball the gray scale of two eyes together then cover the gray scale with your coffee cup!

4. Look at Total deviation and Total deviation probability plots along with the Mean Deviation (MD).

5. Look at Pattern deviation and Pattern deviation probability plots along with Pattern Standard Deviation (PSD).

6. Look for patterns of pathological depression in sensitivities.

7. Determine whether or not additional perimetric strategies are needed then and there.


44

Friday, December 7, 2012 14:30‐16:00 Hall 1 IC02: Trabeculectomy: How I Do It Senior Instructors: D. Istiantoro, Indonesia; J. Lai, Hong Kong S.A.R.

IC02‐01

FORNIX BASED TRABECULECTOMY

P.R. Healey


Objective: Describe the key features of fornix‐based trabeculectomy.

Methods: Video, still photos and descriptions.

Results: The key features, surgical steps, variations and desired post‐op appearance for fornix based trabeculectomy will be described.

Conclusions: At the end of the presentation delegates will have a better understanding of how to perform successful fornix based trabeculectomy.


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IC02‐02

TRABECULECTOMY: HOW I DO IT

V. Lingam

Smt. Jadhavabai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, India

Limbus based trabeculectomy:

Trabeculectomy is the most frequently performed glaucoma filtering procedure to lower IOP. One of the techniques used is doing the procedure with a limbal‐based conjunctival flap. Major advantage is less chance of leaks and this allows safe use of 5 FU or digital massage or laser suterlysis.

Basic steps are as follows:

‐ Application of traction suture.

‐ Conjunctival incision is 8 mm from limbus.

‐ Gentle wet field cautery application for the bleeders.

‐ Mitomycin C is application on the sclera using Weck‐cel sponge.

‐ Partial thickness scleral flap dissection.

‐ The shape can be a triangular or quadrangular.

‐ The anterior chamber entry with a 15 degree knife or sharp razor blade.

‐ The osteum creation either using a Vannas scissors or Kellys trabeculectomy punch.

‐ A large peripheral iridectomy to avoid plugging of stoma by iris.

‐ It is preferable to use releasble sutures.

‐ Base sutures should be close to the limbus to facilitate posterior flow of aqueous.

‐ 8‐0 polyglactin on a round body needle is used to close the Tenon's and conjunctiva.

‐ After the closure the wound is checked for any leaks.


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IC02‐03

TRABECULECTOMY WITH EX‐PRESS DEVICE

J. Chan

Department of Ophthalmology, Queen Mary Hospital, Hong Kong, Hong Kong S.A.R.

The conventional trabeculectomy continues to evolve since its adoption as the standard glaucoma procedures almost half a century ago. The implantation of the Ex‐PRESS shunt, introduced in 1998, closely resembles that of a simplifed trabeculectomy but with much more predictable outcome.

For this part of the instruction course on personal techniques of trabeculectomy , I will share my own surgical experience in using the Ex‐PRESS device. The indications and advantages over conventational trbeculectomy will be discussed, along with surgical tips and avoidable pitfalls.


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Friday, December 7, 2012 16:30‐18:00 Hall 2 IC03: Imaging and Evaluating the Retinal Nerve Fiber Layer Senior Instructors: K.H. Park, Republic of Korea; C. Kai Shun Leung, Hong Kong S.A.R.; K. Sugiyama, Japan

IC03‐01

IMAGING AND EVALUATING THE RETINAL NERVE FIBER LAYER: FROM RED‐FREE PHOTOGRAPHY TO HIGH‐RESOLUTION IMAGING MODALITY

K.H. Park1, M. Hangai2, C. Leung3, K.R. Sung4, K. Sugiyama5

1Seoul National University College of Medicine, Seoul, Republic of Korea, 2Kyoto University, Kyoto, Japan, 3Chinese University of Hong Kong, Hong Kong, Hong Kong S.A.R., 4Ulsan University, Seoul, Republic of Korea, 5Kanazawa University, Kanazawa, Japan

A change in retinal nerve fiber layer (RNFL) has been well‐known as a characteristic finding of glaucomatous optic nerve damage. Compared to the detection of change in the neuroretinal rim of the optic nerve head, the detection of changes in RNFL seems to be more sensitive and specific especially for the early and minute changes due to a nature of the orientation of the nerve fibers.

The conventional red‐free RNFL photography has an advantage to detect localized RNFL defect especially for Asian with more retinal pigments than western population. It can detect early change even when the standard automated perimetry shows normal values. By comparison with serial photographs the progression of glaucoma can be evaluated as well. However the limitation of this technique remains in its weakness in the quantitative measurement. Recently the introduction of optical coherence tomography enables objective and quantitative evaluation of RNFL thickness and statistical interpretation using a normative database. The area of evaluation by OCT in glaucoma has enlarged its region involving the macular where the density of the retinal ganglion cell (RGC) is highest. Further this technique could evaluate the thickness of choroid and lamina cribrosa.

At the conclusion of this course, the attendee will be able to understand the current techniques of RNFL imaging and to interpret the result in clinical practice. Further the attendee will have full knowledge on the choroid, lamina, RGC complex imaging and structure‐function relationships.


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IC03‐02

MONITORING GLAUCOMA PROGRESSION WITH OCT

M. Hangai

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

Monitoring disease progression is essential for the management of glaucoma. Glaucoma progression has been monitored based on functional changes on standard automated perimetry (SAP) and structural changes including progressive narrowing of the neuroretinal rim and thinning of the retinal nerve fiber layer (RNFL). Spectral‐domain optical coherence tomography (SD‐OCT) allows high‐resolution imaging of the RNFL and macular inner retinal layers. Our goal was to demonstrate the relationship of structural and functional progression in glaucoma using spectral‐domain optical coherence tomography (SD‐OCT). For this purpose, SD‐OCT (RTVue‐100, Optovue) and SAP24‐2 (Humphrey 24‐2 Swedish Interactive Threshold Algorithm, Carl Zeiss Meditec) examinations were performed in eyes with open‐angle glaucoma on the same day every 3 months for 3 years. Progressive changes of MD of SAP24‐2, average circumpapillary RNFL (cpRNFL) thickness, and average macular ganglion cell complex (mGCC) thickness were analyzed by linear regression analysis. The survival probability of each parameter was assessed by Kaplan‐Meier estimator and compared with log‐rank test. The results of our study indicated that each parameter showed significantly progressive changes in more than 15% eyes. However, only 3% 4% of the study eyes showed progressive changes both of MD and one of structural parameters. Both cpRNFL and mGCC tended to show lower survival probability for progression analysis than MD, but this difference was not statistically different. Thus, our results based on SD‐OCT imaging were basically consistent with those on time‐domain OCT. In this symposium, the interpretation of these results and future idea for improving the detection of glaucoma progression will be discussed.


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IC03‐04

GANGLION CELL COMPEX IMAGING

K.R. Sung

Ophthalmology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea

Optical coherence tomography (OCT) is an interferometry‐based imaging modality that generates high‐resolution cross‐sectional images of the retina. Circumpapillary retinal nerve fibre layer (cpRNFL) and optic disc assessments are the mainstay of glaucomatous structural measurements. However, because these measurements are not always available or precise, it would be useful to have another reliable indicator. The macula has been suggested as an alternative scanning location for glaucoma diagnosis. Using time‐domain (TD) OCT, macular measurements have been shown to provide good glaucoma diagnostic capabilities. Performance of cpRNFL measurement was generally superior to macular assessment. However, macular measurement showed better glaucoma diagnostic performance and progression detection capability in some specific cases, which suggests that these two measurements may be combined to produce a better diagnostic strategy. With the adoption of spectral‐domain OCT, which allows a higher image resolution than TD‐OCT, segmentation of inner macular layers becomes possible. Therefore, segmented inner macular imaging, so called ganglion cell complex imaging became available in clinical practice. The role of ganglion cell complex measurements for detection of glaucoma progression is still under investigation. Improvement of image quality would allow better visualization, development of various scanning modes would optimize macular measurements, and further refining of the analytical algorithm would provide more accurate segmentation. With these achievements, macular measurement including ganglion cell complex imaging can be an important surrogate for glaucomatous structural assessment.


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IC03‐05

SIMULTANEOUS EVALUATION OF STRUCTURE AND FUNCTION IN GLAUCOMA

K. Sugiyama

Ophthalmology, Kanazawa University, Kanazawa, Japan

Eyes with glaucomatous optic neuropathy with normal standard automated perimetry (SAP) results are known as preperimetric glaucomatous eyes. The sparse number of test points may be one reason why glaucomatous visual field defects are not detected in eyes with structural abnormalities. We used an automated fundus‐oriented perimeter (AP‐7000, Kowa, Japan) to examine visual field disturbances in the retinal area that were selected on the fundus image displayed on a monitor. The density of test points in the selected area was much higher than those in SAP. This fundus‐oriented perimeter can detect the presence of decreased retinal sensitivity corresponding to localized retinal area within the retinal nerve fiber layer defect (RNFLD) in preperimetric glaucoma patients.

We also developed simultaneous structure and function evaluation technique combining spectral‐domain (SD) OCT and fundus‐oriented perimeter for detection of visual field abnormalities in RNFLD area. We superimposed the ganglion cell complex map by SD‐OCT on the fundus‐oriented perimeter image. We observed very early or preperimetric normal‐tension glaucoma and also disc hemorrhage site located adjacent to the border of RNFLD. The borderline of RNFLD seemed to be the thinnest RNFL and the lowest retinal sensitivity in early stage of glaucoma.


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Saturday, December 8, 2012 09:00‐10:30 Hall 2 IC04: Getting a Handle on the Angle: Know Your Outflow Senior Instructors: R. Hitchings, UK; P. Chew, Singapore

IC04‐04

IS ULTRASOUND BIOMICROSCOPY NECESSARY?

M.C. Aquino

Ophthalmology, National University Hospital, National University Health System, Singapore, Singapore

Since Pavlin's introduction of ultrasound biomicroscopy (UBM) in the early 1990's, the utility of this imaging system in characterizing peripheral anterior chamber angle and visualizing structures behind the iris has aided analysis and diagnosis of anterior segment disorders. After two decades, UBM remains a useful tool in anterior segment especially glaucoma imaging. This presentation highlights the role of UBM in identifying the underlying mechanisms of primary angle closure and its application in certain glaucoma diagnostic dilemmas.


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Saturday, December 8, 2012 14:00‐15:30 Hall 1 IC05: Glaucoma Drainage Devices: What? When? How? Senior Instructors: I. Goldberg, Australia; D. Istiantoro, Indonesia; P. Chew, Singapore

IC05‐01

INDICATIONS

C. Tham

Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China

This presentation aims to review the accepted indications for implantation of glaucoma drainage devices, especially in the light of recent evidence from clinical trials.


53

Saturday, December 8, 2012 14:00‐15:30 Hall 1 IC05: Glaucoma Drainage Devices: What? When? How? Senior Instructors: I. Goldberg, Australia; D. Istiantoro, Indonesia; P. Chew, Singapore

IC05‐04

OUTCOMES

S.K. Fang

International Specialist Eye Centre, Kuala Lumpur, Malaysia

The outcomes of various studies comparing the commonly used glaucoma drainage devices will be presented and discussed.


54

Saturday, December 8, 2012 14:00‐15:30 Hall 2 IC06: Glaucoma Clinical Trials: What They Mean to My Clinical Practice Senior Instructors: C.L. Ho, Singapore; D.W. Lu, Taiwan R.O.C.; C.Y. Kim, Republic of Korea

IC06‐04

TRAB VS. SHUNT

D.‐W. Lu

Dept. of Ophthalmology, Tri‐Service General Hospital, Taipei, Taiwan R.O.C.

The Tube Versus Trabeculectomy (TVT) Study is a multicenter, randomized clinical trial comparing the safety and efficacy of tube‐shunt surgery to trabeculectomy with mitomycin C (MMC) in patients with previous cataract or glaucoma surgery.

The five‐year follow‐up data from the TVT study shows that, at five years, the efficacy of both intraocular pressure (IOP)‐lowering procedures was similar, as was the use of adjunctive medications. The cumulative probability of failure, however, was higher among patients assigned to trabeculectomy with MMC compared with patients assigned to tube‐shunt surgery. The need for an additional glaucoma surgery was statistically significantly higher in trabeculectomy patients compared with the tube group.

In addition, at five years of follow‐up, late‐occurring complications, reoperations and vision loss due to complications, and the rate of cataract progression among phakic patients were similar between the two groups. As for safety, a high rate of complications occurred after both types of surgery, although the adverse events were noted to be largely self‐limiting.

The TVT Study supports the expanded use of tube shunts beyond the surgical management of only refractory glaucoma. Tube‐shunt surgery was shown to be effective in a patient population at lower risk of surgical failure than has traditionally had this procedure. However, the TVT Study data should be analyzed and interpreted critically, and appropriate conclusions may then be made to help surgeons in selecting the optimal glaucoma procedure for individual patients


55

Saturday, December 8, 2012 16:00‐17:30 Hall 1 IC08: Glaucoma Lasers Senior Instructors: H.T. Wong, Singapore; I. Sumantri, Indonesia

IC08‐02

ARGON LASER PERIPHERAL IRIDOPLASTY

R. Ritch

Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA

Argon laser peripheral iridoplasty (ALPI) is a procedure designed to eliminate appositional angle‐closure resulting from mechanisms other than pupillary block. For eyes with angle‐closure originating at an anatomic level posterior posterior to the iris, such as pleateau iris, lens‐induced angle‐closure, or posterior segment processes (malignant glaucoma) iridotomy alone may be insufficient to eliminate the underlying disease mechanism(s). ALPI is useful in these cases to open the angle. ALPI can be used to break an acute angle‐closure attack which is unresponsive to medical therapy, or it can be used as a primary procedure without prior medical therapy. It is successful when corneal edema, a shallow anterior chamber, or marked inflammation preclude immediate laser iridotomy. It can relieve appositional angle‐closure due to plateau iris syndrome, or lens‐related angle‐closure, and to widen the angle prior to laser trabeculoplasty.

Peripheral location of long‐duration, low‐power, large spot‐size burns is essential for success. The argon laser is set to produce contraction burns (500 µm spot size, 0.5 to 0.7 second duration, and, initially, 240 mW power). Occasionally, in light blue or gray irides, a 200 µm spot size may be more effective in achieving stromal contraction. Approximately 24 to 30 spots are placed over 360°, leaving approximately 2 spot‐diameters between each spot and avoiding large visible radial vessels if possible. The presence of an arcus senilis should be ignored. An extremely shallow anterior chamber and corneal edema, which are relative contraindications to LPI , do not preclude ALPI. ALPI will not eliminate synechial angle‐closure.


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Saturday, December 8, 2012 16:00‐17:30 Hall 1 IC08: Glaucoma Lasers Senior Instructors: H.T. Wong, Singapore; I. Sumantri, Indonesia

IC08‐04

SELECTIVE LASER TRABECULOPLASTY

I. Sumantri

Jakarta Eye Center, Jakarta, Indonesia

SLT increase aqueous outflow through trabecular meshwork, and seems to be a safe and effective means of IOP reduction in eyes with glaucoma, and can reasonably be applied as primary or adjunctive therapy.

SLT creates less coagulative damage and can avoid extensive damage to TM due to mechanical effect such as in the case of ALT. The advantage of SLT is that it is a repeatable and cheaper treatment when compared to glaucoma medications and surgery.Indications of SLT include inability to tolerate glaucoma medications, pigmentary glaucoma, pseudoexsfoliation glaucoma and as an alternative primary treatment to POAG. Contra indications of SLT are juvenile glaucoma, non pigmented glaucoma, unable to see trabecular meshwork.

This course will address frequently raised issues pertinent to SLT in clinical practice. The parameter for SLT is 532 nm wavelength, 400 mm diameter and 0.8‐1 mJ laser energy with 50‐100 confluent 180°‐ 360°. On the basis of the peer‐reviewed medical literature, SLT demonstrates equivalent efficacy and comparable safety to argon laser trabeculoplasty, and is also equally as effective as topical medical therapy.


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FREE PAPER (ORAL PRESENTATIONS)


58

Friday, December 7, 2012 08:30‐10:00 Hall 3 FP01: Epidemiology of Glaucoma & Glaucoma Progression Chairpersons: M. Agulto, Philippines; K.Y. Wu, Taiwan

148

THE IMPACT OF BINOCULAR VISUAL FIELD ON QUALITY OF LIFE IN PATIENTS WITH PRIMARY OPEN ANGLE GLAUCOMA

H.‐C. Cheng1,2, C.J.‐L. Liu1,2, N. Huang3, M.‐R. Chen1,2

1Ophthalmology, Taipei Veterans General Hospital, 2Department of Ophthalmology, School of Medicine, 3Institute of Hospital and Health Care Admisnistration, National Yang‐Ming University, Taipei, Taiwan R.O.C.

Introduction: The ultimate goal in glaucoma management is maintenance of quality of life (QoL) through the preservation of vision. Several reports from western countries have demonstrated patients with glaucoma may have poorer QoL compared to the general population.

Purpose: To assess the impact of binocular visual field on QoL in patients with primary open angle glaucoma(POAG) in Asian population.

Methods: We conducted a prospective cross‐sectional study from January 2012 to July 2012 in Taipei Veterans General Hospital. Eligible patients with POAG were enrolled consecutively. The QoL was assessed by the self‐administrated Short Form‐36(SF‐36) and the 25‐item National Eye Institute Visual Function Questionnaire (NEI VFQ‐25). Reliable visual field tests were obtained while enrollment and the associated parameters were then transformed to binocular integrated visual field(IVF). The correlation between QoL and IVF was further evaluated by multivariate analysis.

Results: A total of 134 patients with POAG were enrolled in this study, with a mean age of 58.37 years(range, 32‐86) and IVF mean deviation (MD) of ‐5.01decibel (dB) (range, ‐27.56‐2.17). After multivariate analysis, the IVF MD had significant correlation with the composite scores of NEI VFQ‐25(p< 0.001, 95% CI 0.43‐1.22). While stratified into upper and lower visual field, the lower IVF MD was significantly associated with the composite score of NEI VFQ‐25(p< 0.001, 95% CI 0.51‐1.34). The IVF MD had no significant association with the physical or mental component summary in SF‐36 (p>0.05).

Conclusions: Binocular IVF, especially inferior IVF, has significant impact on vision‐related QoL, assessed by NEI VFQ‐25, in patients with POAG.


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167

ANALYSIS OF HEMATOLOGICAL AND BIOCHEMICAL DATA IN PRIMARY OPEN‐ANGLE GLAUCOMA PATIENTS

Y. Maruyama1, K. Mori1, K. Yoshii2, H. Yoshikawa1, Y. Ikeda1, M. Ueno1, K. Tashiro2, S. Kinoshita1

1Ophthalmology, 2Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan

Purpose: Recent studies have shown that primary open‐angle glaucoma (POAG) patients have more systemic disease compared with normal subjects. The purpose of this present study was to analyze the hematological and biochemical data of POAG patients and normal control subjects, and then compare the differences between those two sets of data.

Methods: This study involved 385 POAG patients (POAG group; 188 females and 197 males, mean age: 62.1±8.2 years) and 438 age‐matched normal controls (NC group; 220 females and 218 males, mean age: 62.4±7.2 years) who consulted at the Glaucoma Clinic of Kyoto Prefectural University of Medicine, Kyoto, Japan. Hematological and biochemical data (23 parameters) were analyzed and compared between the two groups using the Welch´s t test. Bonferroni's correction was performed, and a p‐value of < 0.002 was considered statistically significant. In addition, a comparison between the females and males of both groups, respectively, was performed.

Results: Of the 23 parameters, a significant difference was found in the following10 parameters:LDH, ALT, total protein (T‐Pro), albumin (Alb), HbA1c, red blood cell (RBC) counts, hemoglobin, hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and platelet counts (Plt). All examination values except MCHC were found to be significantly higher in the POAG group than in the NC group. There were significant differences in T‐Pro, Alb, Hct, Plt with females and LDH, T‐Pro, Hct with males, respectively.

Conclusions: The findings of this study show that POAG patients have significant differences in the multiple parameters of blood serum data compared with age‐matched normal control subjects.


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185

DIURNAL INTRAOCULAR PRESSURE FLUCTUATION IN EYES WITH ANGLE CLOSURE

S. Bhartiya1, P. Ichhpujani2

1Ophthalmology, Fortis Memorial Research Institute, Gurgaon, 2Ophthalmology, Government Medical College and Hospital, Chandigarh, India

Introduction: Intraocular pressure (IOP) varies with age, sex, time of day, season and position of the patient. There is paucity of data on diurnal IOP variation in subjects with angle closure.

Aim: To investigate diurnal IOP fluctuation in eyes with angle closure.

Methods: Sixty four eyes of 64 newly diagnosed patients with angle closure (30 primary angle‐closure suspects [PACS], 18 primary angle closure [PAC] and 16 subjects with primary angle‐closure glaucoma [PACG]) were enrolled after laser peripheral iridotomy for this prospective, cross‐sectional study.

IOP was recorded at 08:00, 12:00, 16:00, 20:00, and 04:00 hours. Mean diurnal IOP, peak IOP, trough IOP, and IOP fluctuation (peak ‐trough) were compared between groups.

Results: Mean age of the enrolled subjects was 56.8±5.4 years (46 males and 18 females). Intraocular pressure fluctuation was significantly higher in the PACG (7.4±2.8 mmHg) and PAC (5.6±2.3 mmHg) groups compared with PACS subjects (4.1±2.3 mmHg). The highest IOP was recorded at 04:00 hours in all but two patients. Fifteen (9 and 6 with PAC and PACG, respectively) out of 21 patients (15 and 6 with PAC and PACG, respectively) with normal office hour IOP had IOP peaks>21mm of Hg at night. Of 30 PAC subjects, 2 had IOP>21mmHg at 04:00 hours.

Conclusions: PACG and PAC eyes showed diurnal IOP fluctuations greater than 5 mmHg in most subjects, with peak IOP recorded at 04:00 hours. Peak IOP was higher than office hour IOP. A diurnal variation curve is recommended especially in cases with controlled IOP during office hours.


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203

24‐HOUR OCULAR PERFUSION PRESSURE AMONG PATIENTS WITH PRIMARY OPEN ANGLE GLAUCOMA: THE HANDAN EYE STUDY

Y.B. Liang1, Q. Zhou2, D.S. Friedman3, L.X. Guo4, L.P. Sun4, X.F. Zong4, X.D. Yang2, N.L. Wang2, the Handan Eye Study Group

1The Chinese University of Hong Kong, Hong Kong, Hong Kong S.A.R., 2Beijing Tongren Eye Center, Capital Medical University, Beijing, China, 3Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA, 4Handan Eye Hospital, Handan, Hebei, Province, Handan, China

Purposes: To compare the 24 hour ocular perfusion pressure (OPP) among patients with POAG and POAG suspects identified in a population‐based study in China.

Methods: 47 POAG (47/66, 71.2%) and 35 POAG suspects (35/41, 85.3%) attended the 24‐hour OPP study. 24‐hour IOP and blood pressure (BP) were measured at 2am, 6am, 10am, 2pm, 6pm, and 10pm, and subjects were not taking any medications to lower IOP or BP. IOP was measured with Goldmann applanation in an upright sitting position. BP was measured in supine position using a digital automatic BP monitor (OMRON model Hem‐907, OMRON, Tokyo, Japan). Mean arterial pressure (MAP) was calculated as: diastolic BP +1⁄3×(systolic BP ‐ diastolic BP). Mean OPP (MOPP) was defined as: 2⁄3×MAP ‐ IOP. Systolic OPP (SOPP): 2⁄3× systolic BP ‐ IOP, diastolic OPP (DOPP) : 2⁄3×diastolic BP ‐ IOP.

Results: The minimum MOPP, mean MOPP, minimum SOPP, and minimum DOPP in eyes with POAG was significantly different from that for eyes of POAG suspects (P< 0.05), and the maximum SOPP, mean SOPP, and mean DOPP were of a borderline significance for a difference between the POAG and POAG suspects (p< 0.10). After adjustment for age and gender, the maximum, mean, and minimum of SOPP, DOPP, and MOPP were statistically significant lower in POAG than POAG suspects (p< 0.05).

Conclusions: SOPP, DOPP and MOPP were consistently lower in eyes with POAG than POAG suspects identified from a Chinese population‐based study, providing further evidence that OPP plays a role in the development of glaucoma.


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210

QUANTIFYING THE IMPACT OF UNILATERAL (ASYMMETRICAL) GLAUCOMA ON GLAUCOMA‐SPECIFIC QUALITY OF LIFE IN ASIANS

P.P.‐C. Chiang1,2, T. Aung3,4, T.Y. Wong3,4,5, Y. Zheng3,6, W. Tay7, J. Chee8, D. Chen9, S. Perera4, T.T. Wong4, E. Lamoureux3,10

1Epidemiology/Health Services Research, Singapore Eye Research Institute, 2Office of Clinical Sciences, DUKE‐NUS Graduate Medical School Singapore, 3Singapore Eye Research Institute, 4Singapore National Eye Centre, 5National University Hospital of Singapore, Singapore, Singapore, 6Zhongshan Ophthalmic Center, Guangzhou, China, 7Statistics, Singapore Eye Research Institute, 8National University of Singapore, Singapore, Singapore, 9Johns Hopkins University, Baltimore, MD, USA, 10Centre for Eye Research Australia, Melbourne, VIC, Australia

Purpose: To quantify the impact of unilateral (asymmetric) glaucoma on glaucoma‐specific functioning (GF) in Asians.

Methods: Patients with unilateral glaucoma aged 40+ were recruited in a tertiary hospital clinic in Singapore. Unilateral glaucoma was defined as the presence of glaucomatous optic neuropathy (GON) in the affected eye, with corresponding visual field (VF) loss in the absence of VF loss or GON in the fellow eye. Primary glaucomas were classified according to the ISGEO definition. The fellow eye may or may not have risk factors for glaucoma but was without any GON or corresponding VF loss. The Glaucoma Quality of Life‐15 (GQL‐15) questionnaire, validated using Rasch analysis, was used to evaluate the impact of unilateral glaucoma. Multivariate linear regression was performed to assess the impact of unilateral glaucoma on GF.

Results: 190 patients were analyzed (150 unilateral glaucoma cases and 40 normal controls). The mean±standard deviation age was 67.0±9.8 years, 58.9% were male. Unilateral glaucoma participants had a systematic reduction in GQOL score compared to those with normal vision in primary glaucomas: primary open angle glaucoma (POAG) ‐34.5% (95% confidence interval [CI]‐34.7%,‐34.2%, p< 0.001); primary angle closure glaucoma (PACG) ‐38.1% (CI‐39.3%,‐36.5%, p< 0.001); and severity: mild ‐27.7% (CI‐30.3%,‐25.2%, p=0.006); moderate ‐30.0% (CI‐30.1%,‐29.8%, p=0.001); and severe ‐40.9%, (CI‐41.5%,‐40.0%, p< 0.001).

Conclusions: Unilateral glaucoma is significantly associated with a worse deterioration in GF among Asians. Our study highlights the need to concurrently include screening of patients with unilateral glaucoma to prevent further deterioration, particularly in patients with PACG and/or severe stages of glaucoma.


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255

OUTCOME OF VISUAL ACUITY AND INTRAOCULAR PRESSURE (IOP) AFTER THE DEVELOPMENT OF BLEB‐RELATED INFECTION

I. Shiraki1, T. Yamamoto1, Y. Kuwayama2, Study Group for the Japan Glaucoma Society Survey of Bleb‐Related Infection

1Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, 2Fukushima Eye Clinic, Osaka, Japan

Objective: To identify changes in visual acuity and intraocular pressure (IOP) 12 months after the development of bleb‐related infection.

Methods: Data obtained from 146 eyes of 146 patients with bleb‐related infection were analyzed as a part of the Japan Glaucoma Society Survey of Bleb‐related Infection. Multiple logistic regression analysis was conducted to identify factors associated with poor prognosis in visual acuity and IOP, and for being stage

Ⅲ.

Results: The logMAR increased by a mean of 0.140, 0.440, 1.099, and 1.122 at 12 months post‐infection for

stage Ⅰ, Ⅱ, Ⅲa, and Ⅲb infections, respectively. The logMAR was significantly worse at 6 and 12 months

post‐infection in stage Ⅲb and at 6 months post‐infection in stage Ⅲa. The IOP was significantly elevated

following infection in both stage Ⅲa and stage Ⅲb. The multiple logistic regression analysis revealed that

being stage Ⅲ was a significant risk factor for poor outcome for both visual acuity and IOP and that positive

culture was a prognostic factor for poor visual acuity. Pseudophakia or aphakia was significantly associated

with stage Ⅲa and stage Ⅲb infections.

Conclusions: Stage Ⅲ bleb‐related infection causes significant visual loss and IOP elevation within 12

months after development. Therefore, prevention measures should be taken to prevent progression, especially in cases that are pseudophakic or aphakia.


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133

INTRAOCULAR PRESSURE CHANGES AFTER WATER DRINKING IN ANGLE CLOSURE PATIENTS

A. Prutthipongsit, M. Makornwattana, N. Srisamran, M. Bordoloi

Ophthalmology Department, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand

Introduction: Intraocular pressure (IOP) fluctuation is risk factors for visual field (VF) progression. Water drinking test was used as predictor for VF progression in primary open angle glaucoma. IOP elevation caused by elevation of episcleral venous pressure and choroidal engorgement may cause edema of ciliary body and iris root leading to alteration in outflow facility. Angle‐closure patients could be affected by these mechanisms.

Objective: To determine whether there is correlation between IOP and water drinking in angle‐closure patients.

Methods: Nine eyes with primary angle‐closure suspect (PACS), 29 eyes with primary angle‐closure (PAC) and 26 eyes with primary angle‐closure glaucoma (PACG) patients were included. A total of 1,000 ml of water (250 ml, 4 times, 15‐minute interval) was taken. IOP was measured 15 minutes after each drink using Goldmann tonometry. Primary outcome is IOP fluctuation.

Results: Mean IOP fluctuation in PACG, PAC, PACS groups were 5.46 ± 2.28 mmHg (range=2‐10 mmHg), 5.06 ± 3.8 mmHg (range=0‐15 mmHg) and 3.44 ± 2 mmHg (range=0‐6 mmHg), respectively. Twelve of 64 eyes (18.75%) had IOP elevation ≥ 8 mmHg.

Among PACG and PAC groups, mean of IOP fluctuation was reduced from 5.77 ± 3.49 to 4.58 ± 2.58 mmHg in patients with laser peripheral iridotomy (LPI) compared to patients without LPI (P=0.16). Some patients with LPI still had close angles.

Conclusions: Water drinking in PACG and PAC patients can result in IOP rise. IOP fluctuation may be greater than 10 mmHg. Although not statistical significant, LPI may help decrease IOP fluctuation.


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247

DETECTION OF PROGRESSION OF GLAUCOMATOUS VISUAL FIELD DAMAGE USING THE POINT‐WISE METHOD WITH THE BINOMIAL TEST

R. Asaoka1, A. Karakawa1, T. Saeki2, H. Hirasawa1, C. Mayama1, M. Aihara1, H. Murata1

1University of Tokyo, 2Showa General Hospital, Tokyo, Japan

Purpose: To create a new method to detect the progression of glaucomatous visual field (GVF) damage using the binomial test.

Methods: 16 VFs (Humphrey Field Analyzer, SITA standard, 30‐2) of 99 eyes of 59 open angle glaucoma patients (53±12 years, mean±sd) were collected retrospectively. 15 VFs (6.0±1.5 years), excluding the first VF, were used for the analysis. Using the total deviation (td) of each point on the 2nd to 16th VF (VF2‐16), linear regression analysis was carried out. The numbesr of the test points with p< 0.025, 0.05, 0.075 and 0.1 was calculated to perform binomial test (one‐side) and the median value of the p values was calculated. It was defined as “progression” if the median value was < 0.025 (“point‐wise method”). Similarly, the progression analysis was carried out using VF2‐6 to VF2‐15. Then these probabilities were calculated; VF2‐16 and prior VFs were “progressive” (sensitivity), VF2‐16 and prior VFs were “non‐progressive” (sensitivity), and VF2‐16 was “non‐progressive” and prior VFs were “progressive” (false positive). Same probabilities were calculated using the MD slope.

Results: The, specificity and false positive rates with the point‐wise method (42±24, 8±10%) were significantly higher/lower than those of MD slope (38±25, 18±13%, P< 0.05), but the specificities were not significantly different (96±2 and 96±3% p=0.95).

Conclusions: It was suggested that the point‐wise method may be capable of detecting the progression of GVF.


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317

EVALUATION OF THE MACULAR CHOROIDAL THICKNESS IN HIGHLY MYOPIC GLAUCOMA WITH PERIPAPILLARY ATROPHY OPTIC DISC

K. Tamaki1, I. Kimura1, Y. Imamura2, S. Watanabe1, Y. Nakazawa1, N. Ebihara1

1Juntendo University Urayasu Hospital, Urayasu, 2Teikyo University Hospital Mizonokuchi, Kawasaki, Japan

Purpose: To investigate correlation between the choroidal thickness and the degree of peripapillary atrophy(PPA).

Participants: 94 eyes from 55 patients(aveage age 54.0±11.8years old)diagnosed as POAG including preperimetric glaucoma withspherical equivalent refractive error under ‐6 diopters.

Methods: 94eyes were classified into the group which had the disc with surrounding peripapillary atrophy (S group) and the the group which had not the disc with surrounding peripappilary atrophy (L group). 42 eyes were S group,52 eyes were L group. Subfoveal choroidal thickness were measured by Cirrus HD‐OCT (Carl Zeiss Meditec). We studied the choroidal thickness between 2 groups and investigated the correlation between choroidal thickness and MD score of Humphrey SITA standerd (30‐2).

Results: Mean macular choroidal thickness in the S group was significantly thinner in the L groups. (114.3±58.5µm VS 152.7±65.4µm P=0.0038). After revicing with an age and a refractive index, there was a significant difference (p=0.047).

The subfoveal choroidal thickness correlates with MD score significantly (r=0.29、p=0.003).

Conclusion: A case of the disc with surrounding peripapillary atrophy is significantly thin in highly myopic glaucoma. The possibility that choroidal thickness is associated with the degree of visual field disturbance in highly myopic glaucoma was suggested.


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Friday, December 7, 2012 16:30‐18:00 Hall 3 FP02: Glaucoma Diagnosis and Imaging I Chairperson: R. Ekantini, Indonesia

8

PUPIL RUFF ATROPHY AND ASYMMETRY OF INTRAOCULAR PRESSURE AND CUP‐TO‐DISC RATIO

G.S. Ang1,2, T. Wong2, S. Nicholas2, A. Wells2

1Royal Victorian Eye & Ear Hospital, East Melbourne, VIC, Australia, 2Capital Eye Specialists, Wellington, New Zealand

Introduction: Pupil ruff changes are typically considered normal with age. However, in a glaucoma clinic population, can they also be an independent risk factor for raised intraocular pressure (IOP) and glaucoma?

Aim and objective: To evaluate the correlations between pupil ruff changes and associated gonioscopy findings with IOP and cup‐to‐disc ratio (CDR).

Methods: Prospective observational comparative study of 103 patients from a glaucoma clinic population. Patients with pseudoexfoliation, previous intraocular surgery and IOP lowering medication were excluded. Pupillary ruff and associated gonioscopy findings were graded from photographs based on the Pupil Ruff Atrophy grading system1. Inter‐eye differences were determined and analyzed for correlations with inter‐eye differences in IOP and CDR based on HRT II imaging.

Results: The mean study participant age was 64 years. The average amount of abnormal and missing ruff was 9.5 and 5 clock hours respectively. Inter‐eye IOP asymmetry was significantly associated with asymmetry of abnormal ruff (P = 0.034) and missing ruff (P = 0.022). Inter‐eye CDR asymmetry was significantly associated with asymmetry of the amount of missing ruff (P = 0.001) and trabecular meshwork pigmentation (P = 0.006). The eye with the most pupillary ruff loss was 25% more likely to have the greater CDR.

Conclusions: Asymmetric pupillary ruff changes were associated with asymmetry in both IOP and CDR. The clinical significance of this finding requires further evaluation.

References:

1. A novel grading system for pupillary ruff changes and associated features. Wong T, Ang GS, Nicholas S, Wells AP. In press: Clin Experiment Ophthalmol


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59

AN ASSESSMENT OF IRIS VOLUME DYNAMICS IN SUBTYPES OF ANGLE CLOSURE

A.K. Narayanaswamy1, Z. Ce1, S. Perera2, H.M. Htoon1, M.‐G. He3, B. Mani1, T. Aung1

1SERI, 2SNEC, Singapore, Singapore, 3Zhongshan Ophthalmic Center, Guangzhou, China

Introduction: Acute angle closure is an extreme spectrum of angle closure and recent studies have postulated that the pathogenesis of angle closure may be related to dynamic processes related to the iris and the choroid. We have explored one such aspect in this study.

Aim: To compare the change in iris volume with pupil dilation using anterior segment optical coherence tomography (AS‐OCT) in eyes of subjects with different subtypes of angle closure.

Methods: 44 fellow eyes (FA group) of subjects with acute primary angle closure (APAC) and 56 subjects (AC group) with primary angle closure (PAC) and /or angle closure glaucoma (PACG) were enrolled. All participants underwent AS‐OCT imaging under dark and light conditions. The main outcome variable analyzed was mean change in iris volume between light and dark conditions in a multivariate linear regression analysis.

Results: Eyes in FA group showed an increase in iris volume (1.50 ± 6.73 mm3; p= 0.19) whereas eyes in the AC group showed a significant decrease in iris volume (1.52 ± 3.07 mm3; p< 0.001) when illumination was changed from light to dark. Inter‐ group comparisons of iris volume change between the two groups was statistically significant (p= 0.01). On multivariate analysis, age (β = ‐ 0.397; p < 0.001 and diagnostic category (AC group Vs. FA group; β = 0.347; p < 0.001) were important determinants of volume change.

Conclusions: A higher residual iris volume in a mydriatic state may be an important risk factor for acute angle closure in subjects at risk.


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128

SIDE SLEEP AND INTEROCULAR ASYMMETRY OF VISUAL FIELD INDICES IN PATIENTS WITH OPEN ANGLE GLAUCOMA

C. Yoo, Y.M. Choi, Y.Y. Kim

Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea

Purpose: To investigate the relationship between side sleep and interocular asymmetry of visual field indices in patients with open angle glaucoma.

Methods: We identified 153 patients with newly diagnosed bilateral open angle glaucoma who had completed a questionnaire about their sleep position on their initial visit. Patients were considered as normal tension glaucoma (NTG) if their untreated intraocular pressure (IOP) was less than 21 mmHg. According to their predominant sleep position, patients were divided into 3 groups: Group A, left lateral decubitus position (LDP); Group B, right LDP; Group C, neither right nor left LDP.We evaluated the interocular difference in predominant sleep position, IOP, visual field index (VFI), mean deviation (MD), and pattern standard deviation (PSD).

Results: There were 28 patients (22, NTG) in Group A, 42 patients (33, NTG) in Group B, and 83 patients (56, NTG) in Group C. Among the 111 NTG patients, 55 (49.6%) slept predominantly on the side. In Group A, MD and VFI were lower in the left eye (p<0 .05), whereas PSD was higher in the left eye. In Group B, MD and VFI were lower in the right eye (p< 0.05). Mean MD, PSD and VFI did not differ between fellow eyes in Group C.

Conclusion: Many NTG patients seem to sleep on the side. VF indices of the ipsilateral dependent eyes were worse than those of the fellow eyes in side‐sleeping NTG patients. These results suggest an association between side sleep and asymmetric glaucomatous damage in NTG patients.


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140

CORRELATION BETWEEN OCT‐RNFLT AND HRTII DISC PARAMETER IN OPEN ANGLE GLAUCOMA WITH GENERALIZED ENLARGEMENT TYPE OPTIC NERVE HEAD

T. Kokubun, S. Tsuda, Y. Shiga, Y. Yokoyama, N. Aizawa, K. Omodaka, T. Nakazawa

Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan

Purpose: Excavation of optic nerve head (ONH) is an important sign of glaucoma,which is caused by loss of optic nerve fiber and astrocytic abnormality. The study examined the relation between a loss of optic nerve fiber loss and excavation of ONH in open angle glaucoma (OAG) patients with generalized enlargement (GE) type optic disc cup.

Methods: The study comprised 42 eyes of 30 OAG patients with GE type optic disc cup (mean 62.5±6.9 years, male/female : 20/10). Optical coherence tomography (OCT) provided circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements, and the Heidelberg Retina Tomograph II (HRTII) provided disc parameters. The correlation between cpRNFL thickness and the HRTII disc parameters was analyzed using Spearman´s rank correlation coefficient. P values less than 0.05 were accepted as statistically significant.

Results: Correlation coefficient values for the HRTⅡ disc parameters and cpRNFL thickness (disc area, cup

area, rim area, cup/disc area ratio, cup volume, rim volume, mean cup depth, maximum cup depth, cup shape measure, and vertical cup/disc ratio) were ‐0.06 (p = 0.69), ‐0.65 (p< 0.0001), ‐0.78 (p< 0.0001), ‐0.78 (p< 0.0001), ‐0.61 (p< 0.0001), 0.68 (p< 0.0001), ‐0.13 (p=0.39), ‐0.07 (p=0.65), ‐0.40 (p=0.0094), and ‐0.85 (p< 0.0001) respectively.

Conclusions: The vertical cup/disc ratio showed the strongest correlation with cpRNFL thickness. This result may be helpful in distinguishing the glaucomatous optic disc cup of GE type from large cup disc or neurologic ophthalmologic diseases that may have no correlation between RNFL thickness and the excavation of ONH.


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143

CHARACTERISTIC CORRELATION OF THE STRUCTURE‐FUNCTION RELATIONSHIP IN THE DIFFERENT GLAUCOMATOUS DISC TYPES

N. Takada, K. Omodaka, M. Ryu, Y. Yokoyama, Y. Shiga, S. Tsuda, M. Yasuda, T. Nakazawa

Ophthalmology, Tohoku University, School of Medicine, Sendai, Japan

Introduction: Glaucoma is characterized by optic nerve fiber atrophy that causes a visual field loss corresponding to the damaged area of the optic nerve head. There are a variety of optic disc morphologies, which may influence the correlation between structure and function.

Aims: To assess the characteristic correlation between circumpapillary retinal nerve fiber layer thickness (cpRNFLT), measured by OCT, and mean deviation (MD), measured by the Humphrey Field Analyzer (HFA), in the different disc types.

Methods: A total of 227 eyes of 227 Japanese adult patients with open angle glaucoma were classified into four groups: myopic (MY), focal ischemic (FI), senile sclerotic (SS), and generalized (GE). Stratus OCT provided measurements of total cpRNFLT, as well as in the superior, temporal, inferior, and nasal quadrants. The Spearman coefficient of correlation was calculated to determine the power of correlation between cpRNFLT and MD.

Results: The correlation coefficient for total cpRNFLT and MD was significant in the complete group (r=0.56) and the MY (0.64), GE (0.57), and SS (0.56) groups, but not the FI (0.32) group. Inferior quadrant cpRNFLT was most significantly correlated in the complete group (r = 0.62), and in the FI (0.46), MY (0.71), and SS (0.61) groups, while, in the GE, total cpRNFLT (r=0.57) correlated most significantly.

Conclusion: The correlation between structure and function was different for each disc type, suggesting that classification of the optic disc may help improve evaluation of glaucomatous damage.


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151

LOW LUMINANCE ACHROMATIC (LLA) & BLUE‐ON‐YELLOW (BONY) MULTIFOCAL VISUAL EVOKED POTENTIALS (MFVEP) IN EARLY GLAUCOMA

H. Arvind1,2, P. Sriram1, A. Klistorner1,2, S. Graham1,2

1Ophthalmology, Macquarie University, 2Ophthalmology, University of Sydney, Sydney, NSW, Australia

Purpose: (a) To examine the sensitivities of LLA and BonY MfVEP stimulation in identifying visual loss in early, including pre‐perimetric, glaucoma. (b) To examine the role of each, along with other tests, in identifying such glaucoma.

Methods: 54 patients with atleast one glaucomatous disc and normal or early defect(s) on achromatic Humphrey visual fields (HVF) were examined. VA< 6/9, cataract and/or other ocular abnormality were excluded. LLA and Bony mfVEP were performed on all participants. Other tests included SITA‐SWAP, FDT‐Matrix, Spectralis OCT (RNFL) and dilated optic disc stereo‐photography. Optic disc photographs were assessed by 2 independent examiners in a masked fashion.

Results: 87 eyes (including 54 with normal HVF), of 54 patients were analyzed (average MD ‐1.07 ± 2.3dB). 48(55.2%) eyes demonstrated abnormalities on LLA mfVEP, while 36 (41.4%) eyes demonstrated abnormalities on BonY mfVEP (p< 0.0001). 31 eyes showed abnormalities on both tests. Among 48 eyes with LLA defects, 37 (77.1%) had abnormalities on atleast one of the other perimetric tests. Of 36 eyes with BonY defects, 26 (72.2%) had such defects.

The presence of LLA and FDT‐Matrix defects were significantly correlated (p=0.002). 29 subjects were normal on HVF, Matrix and SITA‐SWAP. Of these 14 eyes (48.3%) showed mfVEP defects as the only evidence of functional loss. 10 eyes were positive on both LLA and BonY.

Conclusions: LLA MfVEP demonstrated better sensitivity than BonY mfVEP in identifying early glaucomatous losses. Together, they identify defects in about 50% eyes that are normal on SWAP, FDT and achromatic VF.


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179

QUALITATIVE ASSESSMENT OF CONVENTIONAL CROSS‐SECTIONAL IMAGING (2 FRAMES) VS 360O CIRCUMFERENTIAL IMAGING (128 FRAMES) USING SWEPT‐SOURCE OPTICAL COHERENCE TOMOGRAPHY IN ANGLE CLOSURE

C.W.L. Yau1, M. Baskaran2, T.A. Tun2, S.A. Perera3, T. Aung2,3,4

1Yong Loo Lin School of Medicine, National University of Singapore, 2Singapore Eye Research Institute, 3Singapore National Eye Centre, 4National University Hospital, Singapore, Singapore

Aim: To compare the agreement of using conventional 2 frames imaging (1 angle image per quadrant), and novel circumferential 360o imaging of the anterior segment using swept‐source optical coherence tomography (SSOCT) against gonioscopic reference standard.

Methods: This cross‐sectional study included 147 subjects recruited from glaucoma clinics in Singapore. Subjects underwent dark‐room gonioscopy and anterior segment OCT (AS‐OCT) using swept‐source Fourier‐domain OCT in one randomly selected eye. Each of the 128 frames (256 angles) were manually analysed qualitatively to determine if the angles were opened or closed based on the presence of irido‐trabecular contact. All 256 angles were divided into 4 quadrants (superior, nasal, inferior, temporal) and compared against the 2 frames representing conventional AS‐OCT imaging. Agreement Coefficient Statistics 1 (AC1) was performed to compare at least two quadrant angle closures by all methods.

Results: Gonioscopic angle closure was noted in 25.2% (37/147) of the eligible eyes. Conventional 2 frames imaging method diagnosed significantly more closed angles (64/147, 43.5%) than circumferential imaging (56/147, 38.1%, McNemar's test, p=0.039). Both were in moderate agreement to gonioscopic angle closure (AC1 ‐ 0.461 and 0.467) while having substantial agreement between each other (AC1‐0.842). Angle status was difficult to assess in 5.2% (Range ‐ 0 to 39.8) images in circumferential imaging.

Conclusion: Significant discrepancy was noted between 360° circumferential imaging and gonioscopy for angle closure discrimination. There is a need to standardise gonioscopic methodology to avoid misdiagnosis. Conventional 2 frames imaging method may over diagnose angle closure compared to circumferential imaging.


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112

EVALUATION OF ANTERIOR CHAMBER ANGLE WIDTH USING HONG'S GRADING METHOD

S.H. Kim1, J.H. Kang2, K.H. Park3, C. Hong4

1Boramae Hospital, 2Kyung Hee University Hospital at Gangdong, 3Seoul National University Hospital, 4Dr. Hong's Eye Clinic, Seoul, Republic of Korea

Purpose: To compare Hong's grading method with anterior segment optical coherence tomography (AS‐OCT), gonioscopy, and the dark‐room prone‐position test (DRPT) for evaluating anterior chamber width.

Methods: Anterior chamber angle was graded using Hong's grading method and Hong's angle width was calculated from the arctangent of Hong's grades. The correlation between Hong's angle width and AS‐OCT parameters were analyzed. The area under receiver‐operating characteristic curves (AUC) of Hong's grading for discriminating between narrow and open angles determined by gonioscopy were calculated. Correlation analysis was performed between Hong's angle width and intraocular pressure (IOP) change determined by DRPT.

Results: A total of 60 subjects were enrolled. Of these subjects, 53.5% had narrow angle. Hong's angle width was significantly correlated with AS‐OCT parameters (r = 0.562‐0.719, p < 0.01). A Bland‐Altman plot showed a relatively good agreement between Hong's angle width and angle width by AS‐OCT. Discrimination capability of Hong's grading between open and narrow angles was good (AUC = 0.868, 95% CI 0.756‐0.942). A significant linear correlation was found between Hong's angle width and IOP change by DRPT (r = ‐0.761, p < 0.01).

Conclusions: Hong's grading method was useful for detecting narrow angles. Hong's grading correlated well with AS‐OCT parameters and DRPT.


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145

COMBINING MULTIPLE PARAMETERS OF OPTICAL COHERENCE TOPOGRAPHY USING THE 'RANDOM FOREST' DECISION TREE METHOD IMPROVES THE DIAGNOSIS OF GLAUCOMATOUS VISUAL FIELD DAMAGE

K. Sugimoto, H. Murata, H. Hirasawa, M. Yanagisawa, C. Mayama, M. Aihara, R. Asaoka

Department of Ophthalmology, University of Tokyo, Tokyo, Japan

Purpose: To examine whether combining multiple parameters of Optical Coherence Topography using the 'Random Forest' decision tree method improve the diagnosis of glaucomatous visual field damage

Target and method: Measurement of OCT (Topcon 3D OCT‐2000), permetry (Humphrey Field Analyzer, SITA standard, 24‐2 or 30‐2) and axial length (AL) were conducted to 205 eyes of 122 cases, 205 oculi of glaucoma (age range;15 to 58) suspected. Glaucomatous visual field damage was defined using the

definition of Anderson‐Patella. These combinations of parameters were examined; ①:macular retinal nerve

fiber layer (m‐RNFL), ②:RNFL around optic papilla alone (cp‐RNFL), ③:Layer of Ganglion cells + Inner

Plexiform Layer (GCL + IPL), ④:rim area, ⑤:①‐②, ⑥:①‐③, ⑦:①‐④, ⑧:⑦+age and AL. In the analysis,

the work out process was taken as below; i) Divide all data to 60% (learning set) and 40%(testing set) in randomly. ii) Create the 'Random Forest' system using parameters above to determine presence/absence of visual field damage with the learning set. iii) predict the presence/absence of visual field damage and the diagnostic accuracy was calculated, using the testing set. The process of i) to iii) was repeated 10,000 times.

⑨These prediction accuracies were compared with the diagnosis by the comparison with the normative

data base (on the OCT print out).

Result: The diagnostic accuracies were; ①:79.1±4.1(average ± standard deviation)%, ②:75.1±4.1％,

③GCC:72.3±4.0％: ④:rim area：71.7±4.2%, ⑤:80.1±3.5％, ⑥:80.6±3.5％, ⑦:81.0±3.5％, ⑧:82.7±3.3％.

The diagnostic accuracies of ⑨ were between 51.1 to 77.6%.

Conclusion: Combining multiple parameters using Random forest was beneficial for the diagnosis of glaucomatous visual field damage.


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Saturday, December 8, 2012 11:00‐12:30 Hall 3 FP03: Glaucoma Surgery and Lasers Chairpersons: T.‐H. Wang, Taiwan; I. M. A. Kusumadjaja, Indonesia

16

THE APPLICATION OF ANTERIOR LENS CAPSULE AUTOTRANSPLANTATION IN TWO‐SITE PHACOTRABECULECTOMY

J. Ji, W. Liu, T. Tian, X. Xing, A. Liu

Tianjin Medical University Eye Center, Tianjin, China

Purpose: To determine whether the autotransplantation of human anterior lens capsule (ALC) in the two‐site phacotrabeculectomy site can aid filtration.

Methods: We conducted a prospective, randomized and masked clinical trial to evaluate the outcome of human ALC autotransplantation in two‐site phacotrabeculectomy. Sixty patients with coexisting cataract and uncontrolled glaucoma despite maximum medical therapy were enrolled in this study. In the ALC group, combined phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy were performed in 29 eyes, the anterior lens capsule was sutured under the scleral flap. In the mitomycin‐C (MMC) group, phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy were performed in 31 eyes, MMC was used intraoperatively. Follow‐up period was 12 months. The appearance of filtering bleb, intraocular pressure, and best corrected visual acuity were evaluated.

Results: (1) There was no statistical difference between the ALC group and the MMC group in the formation of functional filtering blebs (χ2=0.912, P>0.05), intraocular pressure (t=1.468, P>0.05), the number of antiglaucoma medications (Z=‐0.800, P>0.05), and best corrected visual acuity (t= ‐0.022, P>0.05). (2) The anterior lens capsule could be detected in the filtering site by ultrasound biomicroscopy 1 month after surgery.

Conclusions: Anterior lens capsule autotransplantation could get comparable outcome as MMC in two‐site phacotrabeculectomy with few complications.


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93

RISK FACTORS ASSOCIATED WITH MACULAR FOLDS DETECTED BY SPECTRAL‐DOMAIN OCT AFTER TRABECULECTOMY

K. Kano, Y. Kuwayama

Fukushima Eye Clinic, Osaka, Japan

Purpose: To investigate risk factors associated with macular folds detected by optical coherent tomography (OCT) after trabeculectomy.

Patients and methods: Using the vertical section of spectral‐domain OCT, we prospectively investigated whether macular folds had formed or not at 1 month and 3months following trabeculectomy undergone between February 2012 and April 2012. We analyzed the relation between the presence of macular folds and various pre‐ and post‐operative risk factors using an unpaired‐t test or a chi‐square test.

Results: Thirty‐six eyes were included in this study, their mean age 65.4±12.0 years old, mean intraocular pressure 23.8±9.0 mmHg, mean pre‐operative axial length 25.4±1.6 mm and mean spherical equivalent ‐4.4±3.7 diopters. 24 eyes underwent trabeculectomy and 12 eyes underwent phacotrabeculectomy. The rate of patients who developed macular folds at 1 month after surgery was 33.3% and at 3 months after surgery was 16.7%. The ratio of axial length change, the number of lysis sutures, choroidal detachment, shallow anterior chamber and the ratio of visual acuity change had a statistically significant relation with macular folds at 1 month after surgery (p< 0.05), and age and the ratio of axial length change had a statistically significant relation with macular folds at 3 month after surgery (p< 0.05).

Conclusions: Macular folds after trabeculectomy are associated with the ratio of axial length change. Hypotony seems to be an important risk factor for macular folds in the early post‐operative period, but age rather than hypotony seems to be an important risk factor at 3 months after surgery.


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98

LASER PERIPHERAL IRIDOTOMY VERSUS TRABECULECTOMY AS AN INITIAL TREATMENT FOR CHRONIC PRIMARY ANGLE‐CLOSURE GLAUCOMA: A NON‐RANDOMIZED COMPARATIVE STUDY

Y.B. Liang1,2, Y.Y. Chen2, R. Thomas3, S.J. Fan4, H.L. Meng5, X. Wang6, N.L. Wang2

1Chinese University of Hong Kong, Hong Kong, 2Beijing Tongren Eye Center, Capital Medical University, Beijing, China, 3Queensland Eye Institute & Prevent Blindness Foundation, South Brisbane, QLD, Australia, 4Handan Eye Hospital, Handan, 5Anyang Eye Hospital, Anyang, 6Fushun Eye Hospital, Fushun, China

Purpose: To compare the efficacy of Laser peripheral iridotomy (LPI) versus trabeculectomy as an initial treatement for primary angle‐closure glaucoma (PACG) in a developing setting in China.

Methods: 165 patients with chronic PACG, who had been participated in two randomized studies from 2006 to2008 and followed‐up for a minimum of 12 months, were retrospectively included. 77 eyes from 54 patients were initially treated with LPI: group 1, Peripheral anterior synechia (PAS) < 6 clock hours, 23 eyes; group 2, PAS>=6 clock hours, n=54 eyes. 111 patients (PAS>>=6 clock hours) were primarily performed with trabeculectomy; group 3, n=111 eyes. Intraocular pressure (IOP), medications, and complications were recorded post 1m, 3m, 6m, 12m, and 18m.

Results: IOP at each visit (1m, 3m, 6m, 12m, 18m) was significantly lower in group 3 than group 1 and group 2 (p< 0.05). Mean IOP in group 3 (13.98±3.10mmHg) was significantly lower than in group 1 (17.00±3.15mmHg, p< 0.05) and group 2 (22.32±7.48mmHg, p< 0.05). Long‐term IOP fluctuation (defined as Max IOP‐Min IOP) in group 2 (10.73±9.09mmHg) was larger than that in group3 (6.59±3.83mmHg). 34.8% eyes (8/23) in group 1 and 42.6% eyes (23/54) in group 2 needed IOP‐lowering medications, while 6.3% (7/111) in group 3. Six eyes in patients by LPI were performed by trabeculectomy and all had a baseline PAS>=6 clock hours.

Conclusions: Trabeculectomy for chronic PACG appears to be better in lowering IOP and maintain lower long‐term IOP fluctuation. About 40% of the eyes with chronic PACG treated with LPI needs additional medications.


79

Saturday, December 8, 2012 11:00‐12:30 Hall 3 FP03: Glaucoma Surgery and Lasers Chairperson: T.‐H. Wang, Taiwan; I. M. A. Kusumadjaja, Indonesia

122

COMPARISON OF EX‐PRESS GLAUCOMA FILTRATION DEVICE (EGFD) WITH TRABECULECTOMY IN AFRICAN AMERICAN (AA) POPULATION: 1 YEAR RESULTS

R.D. Fechtner, M. Lu, T.L. Berezina, A.S. Khouri

Ophthalmology, UMDNJ, New Jersey Medical School, Newark, NJ, USA

Introduction: AA race is a risk factor for trabeculectomy failure. EGFD offers an alternative technique.

Objective: Determine whether EGFD and trabeculectomy differ in efficacy or post‐operative care in an AA population.

Aim: Compare outcomes of EGFD versus trabeculectomy in AA.

Methods: Retrospective chart review of AA patients who underwent EGFD (Group A) or trabeculectomy (Group B) between 8/03/2004 and 6/30/2011. Data on intraocular pressure (IOP), IOP‐lowering medication use, visual acuity (baseline, 1‐12m), and postoperative interventions (5‐fluorouracil injections (5FUI), bleb needle revision (BNR) were collected.

Purpose: Compare the efficacy and post‐operative interventions in AA patients undergoing EGFD or trabeculectomy.

Results: 40 eyes of 39 subjects (Group A 20 eyes, Group B 20 eyes) were included. IOP and number of medications were significantly reduced in both groups. There were no significant differences between groups in IOP reduction and number of medication reduction at any time point. Post‐operative interventions (5‐FUI and BNR) were significantly lower in A than B (mean 2.7 vs. 3.7, p=0.04). Mean recovery of vision was faster in A though not statistically significant. Both groups showed similar long‐term success rates:

Success criteria Months 1 3 6 9 12≥20‰ reduction and 5<IOP≤18 Trab 10/20 (50%) 13/20 (65%) 13/17 (76%) 10/16 (63%) 8/18 (44%) Ex‐PRESS 14/20 (70%) 18/19 (95%) 16/19 (84%) 11/17 (65%) 11/17 (65%) P value 0.11 0.02* 0.28 0.28 0.13

[N of eyes (%) meeting surgical success criteria]

Conclusions: In this cohort of AA patients the EGFD and trabeculectomy were similar in reducing IOP and need for IOP‐lowering medications. The Ex‐PRESS group required less intensity of post‐operative interventions.


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127

RISK FACTORS FOR COMPLICATIONS AND ROLE OF PROPHYLACTIC DECOMPRESSION SURGERY IN NANOPHTHALMIC EYE

N. Rao, P. Rewri, L. Vijaya

Srimati Jadhavabai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, India

Aims and objectives: To study the relationship between axial length and surgical complications and to evaluate role of additional surgical procedure in preventing those complications in nanophthalmos.

Materials and methods: A retrospective case study of nanophthalmic eyes [Axial length < 20 mm] that underwent cataract or glaucoma surgery from year 2000‐2010. Demographic details, ocular examination and investigations including keratometry, pachymetry, biometry ultrasonography and surgical details were studied.

Results: Twenty five eyes with mean axial length (MAL) of 17.18 ± 1.74 mm and mean lens thickness /axial length (L/AL) ratio of 23% underwent cataract or glaucoma surgery. Of these, 22 eyes had prophylactic procedure (Prophylactic sclerotomy‐16 eyes and Sclerectomies‐6 eyes). The MAL of these eyes was 16.52±1.88. Inspite of prophylaxis, 6 eyes (27%) had serous choroidal effusion or secondary retinal detachment. The MAL of these eyes was 15.95 ±0.63 which was significantly shorter (p value < 0.001) than the study group axial length. Shorter axial length and higher L/AL ratio had statistically significant relation (p values < 0.001) with occurrence of choroidal effusion in post operative period. No eye with axial length of ≥ 17.00 mm developed complications irrespective of prophylactic sclerotomies.

Conclusion: Nanophthalmic eyes need careful pre‐operative assessment and post‐operative care in view of high likelihood of complications. The risk of complication was reduced by prophylactic procedures in over 70% cases but in shorter eyes risk may still be there.


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219

COMPARISION OF THE OUTCOME OF SILICONE AHMED GLAUCOMA VALVE IMPLANTATION WITH A SURFACE AREA BETWEEN 96MM2 AND 184MM2

S.W. Yoon, Y.H. Sohn

Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea

Purpose: To compare the success rates, complications, and visual outcome of silicone Ahmed glaucoma valve implantation with a surface area between 96mm2 and 184mm2.

Methods: A retrospective review of the records of 134 eyes (132 patients) that underwent silicone Ahmed glaucoma valve (AGV) implant surgery from January 1, 2006 to July 31, 2011. 44 eyes (42 patients) were excluded according to exclusion criteria. The outcomes of 24 eyes of 24 patients with refractory glaucoma who had undergone 96mm2‐sized AGV implantation were compared with those of 76 eyes of 76 patients with 184mm2‐sized AGV implantation. Demographic, preoperative, and postoperative data including intraocular pressure (IOP), visual acuity, and number of medications, and complications were recorded. Success was defined as postoperative IOP between 5 and 21mmHg and at least a 20% reduction from baseline IOP at postoperative 1‐year.

Results: There were no significant differences in baseline ocular or demographic characteristics between the study groups. Average follow‐up period and final IOP also showed no difference (p=0.273 and 0.187, respectively). Comparing the overall IOPs and the numbers of antiglaucoma medications, the IOP of postoperative day 1 through postoperative week 1 with 96 mm²‐group was only relatively lower (p=0.031). The success rates were higher in 96 mm²‐group (79.16%) than 184 mm²‐group (72.72%) (P=0.535). There was no statistical difference in the rates of complications between the two groups (p=0.415).

Conclusion: The 96mm2‐sized and 184mm2‐sized AGV group showed no statistical difference in terms of IOP reduction, decrease in number of glaucoma medications, and preservation of vision.


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278

CLINICAL ANALYSIS OF DIAGNOSIS AND MANAGEMENT OF 158 CASES WITH MALIGNANT GLAUCOMA

J. Ge1, W.Z. Zhang2, H. Jingjing1, H. Li1, Z. Chengguo1

1Glaucoma, Zhongshan Ophthalmic Center, Guangzhou, 2Ophthalmology, People's Hospital of Jiang Su Province, Nan Jing, China

Purpose: To analyze the clinical features and management of malignant glaucoma in a 7‐year retrospective survey in Zhongshan Ophthalmic Center ( ZOC).

Methods: Medical records of 7‐year malignant glaucoma patients were retrospectively reviewed in Zhongshan Ophthalmic Center. The following indications were checked and analyzed,such as age, gender, original disease, duration before attack, axial length and the change of depth of anterior chamber, intraocular pressure and visual acuity.

Results: 158 cases of malignant glaucoma were hospitalized in ZOC from April 2005 to May 2012. Average age of malignant glaucoma patients was yonger than that of patients with primary angle closure glaucoma (PACG). The mean axial length of malignant glaucoma patients was shorter than that of normal people. Malignant glaucoma variably appeared from 1 day and 4.5 years after original surgery. Lens extraction and anterior vitrectomy showed more effective than anterior chamber reforming combined with vitreous aspiration. Surgical results easily failed on younger patients after anterior chamber reforming and vitreous aspiration.

Conclusion: Malignant glaucoma is secondary and iatrogenic. About 90% of the patinets presented secondary to the trabeculectomy in patients of PACG. Atropine is the indispensable medication. Lens extraction combined with anterior vitrectomy has more effective than that of anterior chamber reforming combined with vitreous aspiration. It is necessary to take much more attention to do trabeculectomy in PACG patients.


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289

EFFECT OF PHACOEMULSIFICATION ON INTRAOCULAR PRESSURE IN EYES TREATED WITH SELECTIVE LASER TRABECULOPLASTY FOR OPEN ANGLE GLAUCOMA

T.Q. Kwong, E. Ansari

Maidstone and Tunbridge Wells NHS Trust, Kent, UK

Introduction: Selective Laser Trabeculoplasty (SLT) is a well known and effective treatment for Glaucoma. It is however not known what the effect of cataract surgery has on the intraocular pressure of eyes which have previously under gone SLT.

Purpose: To assess the effect of phacoemulsification and lens implantation (phaco+IOL) performed by a single surgeon on intraocular pressure (IOP) in SLT‐treated eyes and to determine if SLT induced lowering of IOP is maintained post surgery.

Methods: Retrospective single‐centre review of 45 eyes from 35 patients diagnosed with open angle glaucoma (OAG), which were initially treated successfully with SLT by a single surgeon (EA) and then had routine phaco+IOL by the same surgeon. All patients had SLT first‐line for the treatment of OAG. No patients were taking ocular hypotensive drops post SLT. Time between SLT and phaco+IOL ranged between 2‐36 months. IOP was measured at 3, 6 and 12 months following phaco+IOL.

Results: The main outcome measures were baseline (SLT‐treated) IOP and IOP at 3, 6 and 12 months following routine phaco+IOL. Secondary outcome measures were visual acuity pre and post phaco+IOL and any complications. The mean baseline IOP (SD) was 15.8mmHg (1.8). At 3, 6 and 12 months post phaco+IOL, the mean IOP (SD) were 13.9mmHg (1.5), 14.3mmHg (1.7), 14.8mmHg (1.8). All cases were routine with mean pre‐op visual acuity of 6/18, improving to 6/9+2 at 12 months.

Conclusion: IOP reduction with SLT is not significantly affected by subsequent phaco+IOL in eyes with OAG.


84

Saturday, December 8, 2012 16:00‐17:30 Hall 3 FP04: Glaucoma Diagnosis and Imaging II

183

COMPARING AUTOMATED VISUAL FIELD LOSS CLASSIFICATION SYSTEMS FOR GLAUCOMA IN CASE OF SPARK‐PERIMETRY

Z. Gagyi‐Palffy1,2

1Dept. of Theoretical Physics and Mathematics, Optics, Plasma and Lasers, University of Bucharest, Bucharest, Romania, 2OCULUS Optikgeräte GmbH, Wetzlar, Germany

Introduction: SPARK is a new fast examination strategy of standard perimetry, providing averaged threshold values to reduce test‐retest variability.

Objective: Assessing the agreement between available automated field classification systems when using SPARK‐perimetry.

Aims: Evaluating the performances of the Glaucoma Staging Program (GSP) and the Enhanced Glaucoma Staging System (GSS2) in case of perimetry examinations performed using the SPARK strategy.

Methods: Visual field examinations of 112 patients (aged 63.8±13.8 years, 51 OD, 61 OS), with suspected or confirmed glaucoma, performed using SPARK‐perimetry on the OCULUS Easyfield were reviewed. Every examination was analyzed with the GSP and the GSS2 classifiers. GSP delivered the classifications into visual field classes and risk classes, and the Glaucoma Likelihood Index (GLI) for each examination. GSS2 evaluated the stage and type for the visual field damage. To compare diagnostic abilities, the optimized cut‐off value of the MD (‐2.3 dB), and the built‐in criteria of GSP and GSS2 were applied.

Purpose: Obtaining a quantitative measure of agreement between assessment methods available on OCULUS Easyfield.

Results: Very good diagnostic agreement between the methods is found (κMD‐GSS2=94.3%, κMD‐GSP=87.9%, κGSP‐GSS2=92.0%). GLI shows a strong correlation with MD (R2=0.909). 101 examinations (90.17%) are classified correctly by GSP.

Conclusions: Evaluations of the novel GSP and the established GSS2 classifiers show a very good agreement for examinations performed with SPARK strategy on Easyfield. Furthermore, the results do not differ significantly from the case when other threshold strategies are used. Thus, the short duration of SPARK‐perimetry presents an advantage in clinical practice.


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184

USING NEURAL NETWORKS TO DETECT GLAUCOMA SUSPECTS AND PREDICT PROGRESSION IN A COMMUNITY BASED SCREENING PROGRAMME

A. White1,2, P. Thomas1, J. Keenan1, K. Martin1,2

1Cambridge University Teaching Hospitals NHS Foundation Trust, 2NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK

Purpose: A pilot study to assess the performance of simple artificial neural networks (ANN) in detecting patients requiring onward referral to a hospital ophthalmologist from a community glaucoma screening service.

Methods: The Community Optometrist Glaucoma Screening Service in Cambridge receives routine referrals from local optometrists and general practitioners for the non‐urgent assessment of glaucoma suspects. Retrospective data for 612 patients referred to this service were available to this study. 512 patients were used for training the ANN, with the remaining 100 used for validation of performance. False negatives were defined as patients who did require hospital assessment, but were not identified as such by the ANN, with false positives defined as the converse of this.

Results: Our simple ANN was 89% correct in triaging patients in or out of referral onwards. No false negatives were found in the validation sample. More complex network designs (with multiple hidden layers) did not yield a substantial improvement in performance. The primary limiting factor to the network's performance was the size of the training set.

Discussion: Simple ANNs, as described here, achieve good agreement with clinical decision making, and do so with an extremely low false negative rate. Over time, we expect the performance of our networks to improve further. We are currently looking at a further 1000 patients with sufficient longitudinal data to see if we can now adapt this network to predict progression in known primary open angle glaucoma patients and suspects enabling for an enhanced community based glaucoma referral refinement service.


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192

DIAGNOSTIC ABILITY OF A LINEAR DISCRIMINANT FUNCTION FOR RETINAL NERVE FIBER LAYER AND MACULAR GANGLION CELL‐INNER PLEXIFORM LAYER THICKNESS USING HIGH‐DEFINITION OPTICAL COHERENCE TOMOGRAPHY

Y.J. Choi, J.W. Jeoung, K.H. Park, D.M. Kim

Seoul National University Hospital, Seoul, Republic of Korea

Objective: To determine and validate the diagnostic ability of a linear discriminant function (LDF) based on the retinal nerve fiber layer (RNFL) and ganglion cell‐inner plexiform layer (GCIPL) thickness obtained using high‐definition optical coherence tomography (Cirrus HD‐OCT) for discriminating between healthy control and early to moderate glaucoma patients.

Methods: We prospectively selected 150 healthy control and 150 glaucoma patients (teaching set) to calculate the LDF. Another independent sample of 150 healthy control and 150 glaucoma patients (validating set) was used to test the performance of the LDF. Receiver operating characteristic curves were plotted and compared with the various parameters measured using Cirrus HD‐OCT.

Results: The proposed function was LDF = ‐7.135 + (0.024 x superior RNFL) + (0.027 x inferior RNFL) ‐ (0.038 x superonasal GCIPL) + (0.068 x minimum GCIPL). In the validating set, the largest area under the receiver operating characteristic (AUROC) curve was 0.942 for our LDF. The LDF showed significantly higher AUROC than average RNFL (0.899) and minimum GCIPL (0.905) (Graph 1). The LDF yielded a sensitivity of 64.0% at a fixed specificity of 95%.

Conclusion: The LDF based on the RNFL and GCIPL thickness had a good diagnostic ability to differentiate between healthy and glaucoma individuals. Classification algorithm based on the LDF can be used in HD‐OCT analysis for glaucoma diagnosis.

[ROC curve of the validating set ]


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195

ANTERIOR SEGMENT OCT CHANGES INDUCED BY LASER PERIPHERAL IRIDOPLASTY

J. O'Connor1, B. Ang2, A. Wells3

1Royal Victorian Eye & Ear Hospital, 2Glaucoma, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia, 3Capital Eye Specialists, Wellington, New Zealand

Purpose: To evaluate by anterior segment optical coherence tomography (AS‐OCT) the changes in the anterior chamber structures induced by Argon Laser Peripheral Iridoplasty (ALPI).

Methods: Retrospective study of consecutive primary angle closure (PAC) or primary angle closure glaucoma (PACG) patients who underwent ALPI over an 18‐month period at a specialist glaucoma practice. All patients had previously undergone laser peripheral iridotomy (PI), with poor response. AS‐OCT images of the temporal and nasal angles (in light and dark) before and after ALPI were analysed. Parameters studied were trabecular‐iris angle (TIA), angle opening distance (AOD), trabecular‐iris space area (TISA), trabecular‐iris contact length (TICL), iris thickness (IT) and maximum iris bow height (MIBH).

Results: Images of 14 eyes of 14 patients were assessed. Mean age at ALPI was 55.9 ± 10.9 years. Eleven (78.6%) were women, and 4 (28.6%) had PACG. The mean time from ALPI to the follow‐up AS‐OCT scan was 6.25 ± 2.87 weeks. The IT did not alter significantly after ALPI, but there were significant increases in the TIA, AOD and TISA, as well as a significant decrease in TICL in dark conditions, and MIBH in both light and dark. There was no difference in magnitude of change seen between temporal and nasal angles, or between PAC and PACG eyes.

Conclusions: ALPI resulted in significant angle widening (increased TIA, AOD and TISA) and iris profile flattening (decreased MIBH) based on AS‐OCT imaging in both light and dark. It may represent a useful adjunctive treatment in those with poor response to PI.


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242

CORRELATION BETWEEN CORNEAL HYSTERESIS, INTRAOCULAR PRESSURE AND CENTRAL CORNEAL THICKNESS

C. Muthuraman1, A.V. Nallampalli Venugopal2

1Department of Glaucoma, 2Glaucoma Services, Uma Eye Clinic, Chennai, India

Introduction: Apart from intraocular pressure (IOP) and central corneal thickness (CCT) corneal biomechanical factors are increasingly recognized as indicators of the severity and progression of glaucoma and great interest isevinced on recording them to study the course of glaucoma.

Aim: To measure correlations between Corneal Hysteresis (CH) measured with Ocular Response Analyzer (ORA) and CCT measured with Ultrasonic Pachymetry (CCT US) and IOP measured with Goldman Applanation Tonometer (GAT).

Methods: A 12 months prospective single center study conducted. 249 eyes of 128 patients studied. Four groups established based on diagnosis. Normal (n = 71), Glaucoma (n = 90), Keratoconus (n= 14) and post LASIK (n=74). CH, Corneal Resistance Factor (CRF), Corneal compensated IOP (IOPcc) and Goldman correlated IOP (IOPg) measured using the ORA. Irreproducible ORA readings were excluded. IOP was measured with GAT and CCT with CCT US. All recordings performed by masked examiners. Statistical analysis done by students t test and Fisher ‐ Snechdor test.

Results: CH has no strong correlation with IOP and CCT. CRF was strongly correlated with CCT and IOPg. IOP values were lower in keratoconus and LASIK than in normals. CH and CRF was lower in keratoconus and LASIK group. CRF was greater than CH in normal and glaucoma patients and CH was greater than CRF in keratoconus and LASIK groups.

Conclusion: CH had moderate dependence on IOP and CCT. Weaker corneas should be screened with ORA and low CH could be a factor resulting in underestimation of IOP.


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254

A NEW MORPHOLOGIC DIFFERENTIATION OF PERIPAPILLARY ATROPHY USING SPECTRAL DOMAIN‐OPTICAL COHERENCE TOMOGRAPHY

M. Kim1,2, T.‐W. Kim1,2, R.N. Weinreb3, E.J. Lee1,2, K.H. Park1, D.M. Kim1

1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, 2Seoul National University Bundang Hospital, Seongnam, Republic of Korea, 3Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA

Purpose: To characterize features of peripapillary atrophy (PPA) with respect to the presence or absence of Bruch's membrane (BM) and to determine factors associated with each PPA subgroup.

Methods: This study analyzed 162 eyes from 162 patients who had a minimum temporal PPA of 200µm. Based on the presence of BM within the PPA area, eyes were categorized as intact BM (61eyes, group A), discontinuous BM (80eyes, group B), and lacking BM (21eyes, group C). Factors associated with each type were compared using ANOVA tests. The distance from the temporal optic disc margin to the temporal margin of PPA and to the edge of the BM/RPE complex were measured on the horizontal scan.

Results: The mean age of group A was significantly higher than that of groups of B and C. Te average AXL was greatest in group C, and least in group A. There was no difference between the groups with respect to untreated IOP, IOP at imaging, visual field severity, and central corneal thickness (all P>0.05). In group A, the border tissue had a mainly non‐oblique orientation, whereas most eyes in group B and all eyes in group C had an externally oblique configuration (P< 0.001). A longer AXL correlated with a broader bare sclera.

Conclusions: A new differentiation of PPA according to the presence of BM on its bed increases our understanding of PPA pathogenesis. Morphologic differences were related to the AXL, supporting the theory that eyeball elongation might play a key role in developing PPA.


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277

FEATURES AND FREQUENCY OF INNER RETINAL LAYER CAVITATION ASSOCIATED WITH GLAUCOMA

T. Togano, T. Fukuchi, T. Tanaka, Y. Sakaue, J. Ueda

Devision of Ophthalmology and Visual Science, Niigata University, Niigata City, Japan

Purpose: To report the features and the frequency of inner retinal layer cavitaition observed in glaucoma patients.

Methods: We defined Inner Retinal layer Cavitation associated with Glaucoma (IRCG) as consecutive no signal area between the retinal ganglion cell layer and the retinal nerve fiber layer in images acquired by 3D‐disc scan of spectral‐domain OCT (3D‐OCT 2000, TOPCON). In a Cross‐sectional study, 259 eyes from 152 patients with glaucoma and ocular hypertension were examined. In eyes with IRCG, correlation between the area size of IRCG and the mean deviation of SAP was investigated.

Results: IRCGs were identified in seven eyes with POAG (NTG) and one eye with developmental glaucoma. The locations of IRCG area were concerned with the patterns of glaucomatous visual field defects, but the significant correlation between the IRCG area size and the mean deviation of SAP was not detected.

Conclusions: This study suggests that aberrant cavitation may occur in the inner retinal layer of glaucomatous eyes in addition to the thinning of nerve fiber layer and ganglion cell layer. To clarify the pathogenesis and the clinical meaning of this condition, further study is needed.


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338

OPTIC NERVE VOLUME AS A PARAMETER FOR GLAUCOMA SEVERITY: A STUDY USING 3T MRI

F.A. Rahman1, S. Sidek2, M. Peyman1, N. Ramli1, M. Zahari1, N. Ramli2, K. Rahmat2

1Department of Ophthalmology, 2Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia

Introduction: 3Tesla magnetic resonance imaging (3T MRI) is a non‐invasive technique that has been applied in recent times to visualize the visual pathway with a high level of spatial resolution.

Objective: To find a more robust objective method of clinical assessment of severity glaucoma.

Aim: To find a more robust objective method of clinical assessment of severity glaucoma.

Methods: 41 patients with bilateral symmetrical glaucoma and 19 non‐glaucomatous control patients were recruited from those attending ophthalmology clinic of University Malaya. Retinal nerve fiber layer (RNFL) thickness measurements were taken using optical coherent tomography. Optic nerve volume encompassing intraorbital, intracanalicular and intracranial portion up to anterior chiasm was measured using 3T MRI. Results were compared statistically using repeated‐measures analysis of variance (ANOVA) and Pearson's correlation coefficient.

Purpose: To correlate functional and anatomical glaucomatous changes with optic nerve volume using volumetric assessment with 3T MRI.

Results: Mean RNFL thickness correlated significantly with optic nerve volume (Pearson's rho=0.6, p < 0.001). Mean deviation values on Humphrey visual field testing also correlated significantly with optic nerve volume(Pearson's rho =0.5, p < 0.001). Optic nerve volume was significantly thicker in non‐glaucoma control patients (346.31 +/‐ 85.11 mm³) compared with mild glaucoma (283.52 +/‐ 84.76 mm³) and severe glaucoma (175.00 +/‐ 50.70 mm³) (p < 0.001).

Conclusion: Optic nerve volume measurements measured with 3T MRI reflects both functional and anatomical glaucomatous damage in accordance to severity. This has implications on the use of this parameter as another tool for glaucoma assessment.


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129

IMPROVED REPRODUCIBILITY IN MEASURING THE LAMINAR THICKNESS ON ENHANCED DEPTH IMAGING SD‐OCT IMAGES USING MAXIMUM INTENSITY PROJECTION

E.J. Lee1, T.‐W. Kim1, R.N. Weinreb2

1Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea, 2Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA

Purpose: To investigate whether the thin‐slab maximum intensity projection (MIP) image improve the reproducibility of lamina cribrosa thickness (LCT) measurement.

Methods: Optic discs of 63 open angle glaucoma patients or glaucoma suspects were scanned with enhanced depth imaging spectral domain optical coherence tomography. The B‐scan images were constructed 3‐dimensionally using MIP. The whole MIP volume was then cut into thin slabs of 2 scan line distance width (approximately 64 µm) at 3 locations: mid‐horizontal, and superior and inferior mid‐peripheral regions of the optic nerve head. The LCT was measured in the thin‐slab MIP images (LCT‐MIP) and the 3 B‐scans corresponding to each thin‐slab MIP image (LCT‐Bscan) at the 3 regions in each eye. The interobserver and intraobserver reproducibility of measuring the LCT‐MIP and LCT‐Bscan were evaluated by calculating the intraclass correlation coefficient (ICC) and coefficient of variation (CV). The agreement between the LCT‐MIP and the LCT‐Bscan was assessed by Bland‐Altman analysis.

Results: The thin‐slab MIP images provided better image contrast with more distinct borders of the lamina cribrosa compared to the B‐scan images. Both intraobserver and interobserver ICCs were higher for LCT‐MIP than for LCT‐Bscan in all areas. The 95% limit of agreement of measurement differences between LCT‐Bscan and LCT‐MIP ranged from ‐29.43 to 32.55 µm.

Conclusions: The thin‐slab MIP images provided a higher reproducibility in measuring the LCT than the B‐scan images. With thin‐slab MIP images, the detection of the laminar borders was more straightforward. This technique should facilitate the evaluation of the lamina cribrosa.


93

Sunday, December 9, 2012 09:00‐10:30 Hall 2 FP05: Others Chairperson: M. Effendi, Indonesia

71

THE PERSISTENCE OF ANTI‐GLAUCOMATOUS MEDICAL THERAPY IN TAIWAN ‐ A POPULATION‐BASED STUDY

D.K. Hwang, C.J.‐L. Liu, Y.‐J. Chou, P. Chou

1Department of Ophthalmology, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, 2Department of Public Health and Institute or Public Health, National Yang‐Ming University, 3Department of Ophthalmology, Taipei Veterans General Hospital, 4Department of Ophthalmology, Faculty of Medicine, National Yang‐Ming University, Taipei, Taiwan R.O.C.

Introduction: Most glaucoma patients are treated with long‐term glaucoma medication, so the persistence of medication is crucial for the success of treatment. Knowledge about persistence of glaucoma medication in Asia is still limited.

Objective: To investigate the persistence of medical treatment in glaucoma patients and explore the risk factors for non‐persistence in Taiwan.

Methods: Patients with newly‐diagnosed glaucoma after 1st Jan. 2001 were retrieved from a random sample of one million subjects from the Taiwan National Health Insurance Research Database (NHIRD). Cases that had been followed for at least two years and made two or more claims to glaucoma medications were enrolled for analysis. Multivariate Cox proportional regression analysis was performed to evaluate the relation between persistence of glaucoma medication to a variety of variables.

Results: A total of 5125 patients with glaucoma were enrolled. The persistent rate at the end of the follow up was 25.1%. Risk factors for non‐persistence included patients aged between 20 and 40 years, living in rural area, history of surgical or laser treatment, diagnosed and treated by male doctors or in medical utilities of small size, using multiple medications, and treated with pilocarpine. Regarding the pharmacological factors, patients treated with prostaglandin analogs had a lower risk of non‐persistence.

Conclusions: Many factors may influence the persistence of glaucoma medication, including patient‐related, doctor‐related, and drug‐related factors. In light of the low persistence rate at the end of 2‐year follow‐up, more efforts should be made to improve the persistence of glaucoma treatment.


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178

OBJECTIVE ANALYSIS OF CONJUNCTIVAL HYPEREMIA INDUCED BY PROSTAGLANDIN ANALOGUES

Y. Kiuchi1, Y. Yuasa1, M. Yanagi1, A. Fukushima2, T. Yoneda2, T. Sumi2, Y. Hoshikawa3, M. Kobayashi3

1Hiroshima University, Hiroshima, 2Kochi University, Kochi, 3Nidek, Gamagori, Japan

Introduction: Conjunctival hyperemia is a common side effect induced by prostaglandin eye drops, and one factor to reduce the adherence of patients. The clinical evaluation of conjunctival hyperemia is usually subjective and relies on grading scales.

Purposes: To evaluate the conjunctival injection induced by prostaglandin analogues using automated hyperemia analysis software.

Materials and methods: We recruited the glaucoma patients under prostaglandin mono‐therapy for more than one month. We enrolled 110 subjects and 184 eyes (mean age 66.6 years; 62 male and 58 female). A slit lamp was used to take pictures of the conjunctiva on the temporal side of each subject's eye. Photographic conditions were standardized by using a single photographer. Images were transferred to software for automatic pixel value calculation in the region of interest (ROI). We extracted blood vessel images by setting RGB threshold values. Pixel frequencies for the conjunctival vessels were automatically calculated.

Results: Average % coverage ± standard deviation in the ROI of bimatoprost users was 14.5± 3.6; travoprost, 12.8 ± 5.4; latanoprost,11.5 ± 3.4 and tafluprost, 8.2 ± 3.9. Conjunctival hyperemia induced by tafluprost was significantly smaller than other prostaglandin analogues (bimatoprost vs. tafluprost P< 0.001, travoprost vs. tafluprost: P=0.042, latanoprost vs. tafluprost: P=0.012). Latanoprost caused milder hyperemia than bimatoprost (P=0.013).

Conclusions: Automated hyperemia analysis software enabled us to evaluate the amount of conjunctival hyperemia induced by prostaglandin analogues objectively. Conjunctival hyperemia caused bimatoprost was strongest among prostaglandin analogues. Tafluprost induced mildest hyperemia than others.


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227

EVALUATION OF THE EFFECT OF LATANOPROST 0.005% ON CORNEAL BIOMECHANICS MEASURED WITH THE OCULAR RESPONSE ANALYZER

A. Saini, S.S. Pandav, S. Kaushik, S. Raj, S. Ojha

Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Introduction: Experimental studies have shown that prostaglandin analogues may alter the extra cellular matrix of the cornea thereby altering its biomechanical properties.

Objective: To study the effect of latanoprost 0.005% on corneal biomechanics.

Aims: This study aimed to evaluate the change in corneal hysteresis (CH) and corneal rigidity factor (CRF) using the ocular response analyzer (ORA) after instilling topical latanoprost 0.005%.

Methods: This prospective study included 65 eyes of 33 adult patients. Intraocular pressure (IOP), CH and CRF were recorded prior to, at 1 month and 3 months following initiating latanoprost 0.005% treatment.

Purpose: To see if alteration of corneal properties by latanoprost 0.005% may alter IOP measurement.

Results: The baseline IOP (22.08±7.97) mmHg decreased to 16.52±7.97 at 1 month; p< 0.001, and 16.12±7.97mmHg; p< 0.001 at 3 months. Without treatment, CH negatively correlated (p=0.015), and CRF positively correlated (p< 0.001) with IOP. The CRF at baseline changed from 10.53±2.91 mm Hg to 10.31±2.93 mm Hg at 1 month (p=0.42) and significantly to 9.53 ± 2.26 (p< 0.001) at 3 months. There was no significant change in CH from baseline (8.51± 2.18 mm Hg) to one month (8.83±2.12; p=0.21) or 3 months (8.89±1.86mm Hg; p=0.24).

Conclusions: Though the CRF decreased significantly after treatment with latanoprost, it was also found to be significantly correlated to the IOP. It is not clear at the present time whether the change in CRF was due any effect of the drug itself, or due to decrease in IOP per se.


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258

DETERMINATION OF EX VIVO PERMEATION AND IRRITATION POTENTIAL OF RAPIDLY DISINTEGRATING TOPICALLY ADMINISTERED SOLID EYE DROPS

R.M. Moosa1, Y.E. Choonara1, L.C. du Toit1, P. Kumar1, V.M.K. Ndesendo2, T. Carmicheal3, V. Pillay1

1Department of Pharmacy and Pharmacology, University of the Witwatersrand, Johannesburg, South Africa, 2School of Pharmacy & Pharmaceutical Sciences, St. John's University of Tanzania, Dodoma, Tanzania, 3Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa

Introduction: Topical ocular drug delivery using a conventional system such as liquid eye drops is associated with several drawbacks. Reflex eye closure and difficulty in manipulating the eye drop bottle are some examples. This results in poor patient compliance and hinders the treatment process. Ocular diseases such as glaucoma are on the increase and development of novel drug delivery systems for improved treatment is therefore necessitated.

Objective: To fabricate and pragmatically evaluate instantly dissolvable biodegradable topical ocular solid eye drops.

Aims: Evaluation of design formulations by ex vivo permeation studies of model drug timolol maleate across rabbit corneas and conduction of ocular toxicity tests of optimized formulation.

Methods: Permeation testing was conducted using the Franz diffusion cell apparatus (Permagea, Arnie Systems, USA). The methodology for HET CAM (Hens Egg Chorioliontic Membrane) test involved using fertilized hen's eggs and scoring of any injury due to samples on the CAM.

Purpose: To determine the permeation capability of the formulations compared to a pure drug dispersion. The occurrence of any injury due to a substance in the HET CAM test can be compared to that of the eye in vivo.

Results: Ex vivo permeation studies revealed that the solid eye drop formulations had improved flux (0.0041‐0.0052mg.cm‐2.min‐1) compared to pure drug (0.00378 mg.cm‐2.min‐1). Ocular toxicity studies revealed that the formulation was practically non‐irritant.

Conclusions: Results indicated that the optimized formulation was safe for topical ophthalmic application. In vivo studies are currently underway.


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75

LOW NOCTURNAL OCULAR PERFUSION PRESSURE AS A RISK FACTOR FOR NORMAL TENSION GLAUCOMA

N. Ramli1,2, N.B. Suliman1, N.N. Hairi3, Z. Mimiwati1,2, M.S. Kook4

1Department of Ophthalmology, 2University of Malaya Eye Research Centre, 3Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia, 4Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Centre, Seoul, Republic of Korea

Objectives: Normal tension glaucoma (NTG) is associated with progressive optic neuropathy without raised intraocular pressure (IOP). In the absence of raised IOP, haemodynamic parameters have been implicated in the development of NTG. The purpose of this study is to compare 24 hour IOP and haemodynamic parameters in NTG patients and non‐glaucoma patients.

Methods: This is a cross sectional study involving 72 NTG patients from University of Malaya Medical Centre eye clinic glaucoma registry. The non‐glaucoma patients were randomly selected from the eye clinic patients. All enrolled patients underwent 24‐hour IOP and blood pressure monitoring via 2‐hourly IOP and BP measurements. All readings were taken in the sitting position during the diurnal period (0800‐1000 hours) and in the supine position during the nocturnal period (0000‐0600 hours).

Results: Comparison of the haemodynamic parameters, the nocturnal mean SBP, nocturnal mean DBP and nocturnal MAP were significantly lower in the NTG group. The systemic ocular perfusion pressures (SOPP), diastolic OPP and mean OPP taken at night were also significantly lower in the NTG group. All these parameters differences between the groups were still manifest after controlling for age and presence of hypertension.

Conclusion: Our findings showed no difference in terms of 24‐hour IOP pattern and fluctuation between NTG and non‐glaucoma patients. The nocturnal blood pressure parameters (systolic, diastolic and mean), and ocular perfusion pressure were significantly lower in the NTG group. Reduction in the nocturnal ocular perfusion pressure may reflect defective autoregulatory mechanisms in these patients.


98


142

STAGE‐DEPENDENT DECREASES IN OPTIC NERVE HEAD MICROCIRCULATION MEASURED USING LASER SPECKLE FLOWGRAPHY‐NAVI IN GLAUCOMA PATIENTS WITH MYOPIC GLAUCOMATOUS DISC

N. Aizawa, Y. Yokoyama, K. Omodaka, T. Nakazawa

Department of Ophthalmology, Tohoku University of Graduate School of Medicine, Sendai‐shi, Japan

Purpose: To evaluate the efficacy of laser speckle flowgraphy (LSFG) parameters in glaucoma patients with myopic optic disc.

Method: This study comprised 122 eyes of 71 patients with myopic disc, with a mean age of 54.3 ± 7.6 years. LSFG was used to determine microcirculation in the optic disc, and mean blur rate (MBR) was calculated from this. The Anderson‐Patella criteria were used to classify the patients into stages (normal, or early, middle, and late stage glaucoma). The correlation between circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and MBR of the corresponding area of the optic disc was determined by a simple regression analysis. The area under the curve (AUC) and cut off score were calculated by logistic regression analysis.

Result: MBR was significantly correlated with cpRNFLT (r = 0.63, p＜0.01 ). The average MBR was 26.3 ± 5.1

(27 eyes) in normal patients, 21.9 ± 5.4 (54 eyes) in early stage patients, 18.2 ± 4.0 (18 eyes) in middle stage patients, and 16.8 ± 4.6 (23 eyes) in late stage patients. These data were significant for all groups besides the middle and late stages. The AUC of the MBR was 0.81 and the cut off score was 23.1 AU.

Conclusions: There was a detectible decrease in MBR in early and middle stage glaucoma patients with myopic optic disc. LSFG can thus provide beneficial information for the diagnosis and indexing of glaucomatous damage, and can serve as an objective diagnostic instrument.


99


162

THE ROLE OF AN INTEGRAL MEMBRANE PROTEIN IN RETINAL GANGLION CELL SURVIVAL

Y. You1, V. Gupta1, J. Li1, A. Klistorner2, S.L. Graham1,2

1Macquarie University, 2Sydney University, Sydney, NSW, Australia

Purpose: Recent studies indicate the involvement of Caveolin (Cav‐1) gene locus in the pathogenesis of primary open‐angle glaucoma (POAG). Caveolin protein is principal component of Caveolae and comprises cav1, 2 and 3 isoforms. We studied the rat retinal structural and functional alterations in the lack of cav isoforms. Since insulin like growth factor receptor (IGF‐1R) signalling is neuroprotective in the retina, the effect of cav loss on the IGF‐1R signalling was also investigated.

Methods: Scotopic threshold response (STR) recordings were performed in rats to assess the functional changes in the inner retina. The retinas were imaged in vivo using optical coherence tomography (OCT). Retinal ganglion cells (RGCs) were isolated from rat retinas using the CD90.1 magnetic separation technique. Cav knockdown was carried out using intravitreal injections of anti‐sense oligonucleotides. Co‐immunoprecipitations and immunoblotting were used to investigate the expression and activation of IGF‐1R.

Results: The knockdown of cav isoforms in the retina resulted in a preferential loss of inner retinal function over a period of 20 weeks as measured by the STR recordings (p< 0.005). A thinning of the retinal layers was observed in OCT scans (p< 0.01). Cav loss resulted in increase in IGF‐1R expression and its activation (p< 0.05) in the rat RGCs.

Conclusion: Our results indicate that cav isoforms play a critical role in maintaining the normal inner retinal function. Activation of IGF‐1R in RGCs was observed with cav knockdown. Our experiments indicate that IGF‐1R expression and activation in RGCs is dependent on the normal cav expression.


100


173

IOP LOWERING EFFECT OF LOW INTENSITY ULTRASOUND ON CHRONIC OCULAR HYPERTENSIVE RAT MODEL USING MICROBEAD

C.Y. Kim1, S. Rho1,2, N. Lee1, C.‐K. Lee1, S. Hong1

1Institute of Vision Research, Yonsei University College of Medicine, Seoul, 2CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea

Purpose: To report the intraocular pressure (IOP) lowering effect of low intensity ultrasound (LIUS) on eyes of ocular hypertensive rats.

Methods: Continuous radiation of LIUS on ocular hypertensive eyes induced by unilateral microbeads injection was performed. A round plane ultrasound transducer operating at a frequency of 1MHz was utilized to deliver a sonication of 240mW/cm2 in acoustic intensity. LIUS was treated on both eyes of rats (n=5) simultaneously and the IOP measurements of treated group were compared with those of untreated group (n=5).

Results: The mean IOPs of LIUS‐treated eyes and un‐treated eyes were 9.4 ± 0.55 mmHg and 9.6 ± 0.55 mmHg, respectively at baseline. After an intracameral injection of microbeads, IOPs were reached to 18.6 ± 4.037 mmHg and 22.8 ± 3.493 mmHg (p=0.580) at 3 days after microbeads injection. Then the IOPs were decreased by 39.47 % and 9.68 %, respectively at 1 day after a single sonication.

Conclusions: These results showed that continuous low intensity ultrasound suppresses the IOP elevation in experimental glaucoma model using microbeads injection into anterior chamber. By the reason of its non‐invasiveness and repeatability, LIUS could be an alternative method for glaucoma treatment in near future.


101


198

TRKB SIGNALLING AXIS IN THE RETINAL GANGLION CELLS IN GLAUCOMA IS ENHANCED BY A NOVEL FLAVONOID DERIVATIVE

V. Gupta1, Y. You1, J. Li1, A. Klistorner1,2, S. Graham1,2

1Macquarie University, 2Sydney University, Sydney, NSW, Australia

Purpose: The loss of Brain derived neurotrophic factor (BDNF) and its receptor TrkB signalling has been implicated as a major factor responsible for the degeneration of retinal ganglion cells (RGCs) in glaucoma. We investigated the involvement of Shp2 phosphatase in the deactivation of BDNF‐TrkB signalling. The protective effects of flavonoid derivative 7,8‐Dihydroxyflavone (7,8‐DHF) on TrkB signalling as well as on the survival of RGCs were studied.

Methods: Rats were subjected to an increased intra‐ocular pressure (IOP) by microbead injections into the eye. RGCs were isolated using the CD90.1 magnetic separation. RGCs were exposed to Glutamate+H2O2 for stress induction and the effects of 7,8‐DHF studied. TrkB kinase activity was assessed by immunoprecipitations followed by ELISA. Cell viability and apoptosis were evaluated using cell proliferation assay and caspase‐3 activation respectively.

Results: BDNF/TrkB signalling in RGCs exposed to increased IOP is negatively regulated by Shp2. Shp2 binding to TrkB is enhanced under these conditions (p>0.01) and results into increased dephosphoryaltion of TrkB receptors. 7,8‐DHF treatment resulted in enhanced TrkB (p< 0.001) as well as downstream survival signalling in RGCs. 7,8‐DHF also induced neuritogenesis by stimulating neurite outgrowth in the cells. Cell counting, proliferation assay and caspase‐3 activation demonstrated that 7,8‐DHF treatment protected RGCs (p< 0.03) against glutamate and H2O2 induced cell death in culture.

Conclusion: Deactivation of TrkB mediated neurotrophin signalling leads to onset of RGC degeneration. 7,8‐DHF improves RGC viability and suppresses apoptosis under stress thereby suggesting a possible therapeutic strategy for protection of RGCs in glaucoma.


102

POSTER SESSION ABSTRACTS


103

Saturday, December 8, 2012 09:00‐17:30 Poster Area Glaucoma Surgery and Lasers

10

THE CLINICAL OUTCOMES OF DESCEMET‐STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY IN ASIAN PATIENTS WITH PREVIOUS AHMED GLAUCOMA VALVE IMPLANT SURGERIES

M.‐C. Tai, D.‐W. Lu

Department of Ophthalmology, Tri‐Service General Hospital, Taipei, Taiwan R.O.C.

Purpose: To evaluate the clinical outcomes of descemet‐stripping automated endothelial keratoplasty (DSAEK) in Asian eyes with previous Ahmed glaucoma valve implant.

Methods: A retrospective review of all patients with previous Ahmed glaucoma valve implant underwent DSAEK surgeries. The Ahmed tubes are trimmed and reposition to prevent contact with graft. Then the donor tissue is unfolded by deepening the chamber with chamber maintainer followed by the insertion of an air bubble to complete the unfolding. The anterior chamber (AC) is completely filled with air by consistent pumping machine and surface sweeping is performed to remove interface fluid. The 10 minutes of complete air fill of the AC intraoperatively was maintained before exchange with BSS to enhance graft adherence. Investigations of the outcomes of DSAEK and intraocular pressure (IOP) postoperatively were followed.

Results: The study group was composed of 10 eyes of 10 patients underwent DSAEK successfully with previous Ahmed glaucoma valve implant between May 2010 and December 2011. The follow‐up period ranged from 3 to 15 months. The average preoperative IOP was 18.9 +/‐5.7 mm Hg and postoperative IOP was 13.6 +/‐4.4 mm Hg. No occurrence of postoperative primary graft failure or pupillary block glaucoma. One case (10%) developed graft detachment treated with rebubbling procedure. The endothelial cell loss was 22% and 27% mean cell loss at 6 months and 1 year postoperatively.

Conclusions: These patients with previous Ahmed glaucoma valve implant and endothelial failure can be successfully managed with DSAEK with low complications and well IOP control.


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19

ARGON LASER PERIPHERAL IRIDOPLASTY (ALPI) VERSUS SYSTEMIC INTRAOCULAR PRESSURE LOWERING MEDICATIONS AS THE IMMEDIATE MANAGEMENT FOR ACUTE PHACOMORPHIC ANGLE CLOSURE

J.W.Y. Lee1, J.S.M. Lai1, D.W.F. Yick2, C.Y.F. Yuen2

1The Eye Institute, The University of Hong Kong, Hong Kong, 2Department of Ophthalmology, Caritas Medical Centre, Kowloon, Hong Kong S.A.R.

Purpose: To compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) to systemic intraocular pressure (IOP) lowering medications in the immediate management of acute phacomorphic angle closure.

Methods: Consecutive cases of acute phacomorphic angle closure from December 2009 to 2010 were randomized to receive intravenous (IV) and oral carbonic anhydrase inhibitor or ALPI as the initial treatment. IV mannitol was administered for presenting IOP>60mmHg or IOP>40mmHg 2 hours post treatment. All cases received topical Timolol, Atropine, and steroids prior to definitive cataract extraction. The following parameters were compared between the arms: Snellen best correct visual acuity (BCVA); symptom duration; presenting IOP and serially post treatment; and post‐operative trabecular‐iris angle, retinal nerve fibre layer (RNFL), cup‐disc ratio (CDR), endothelial cell count, BCVA and IOP.

Results: Ten consecutive cases were included, 6 cases received medical therapy and 4 received ALPI. Fifty percent in the medical and none in the ALPI group required IV mannitol. Statistical differences in variance were found between the 2 groups using the F test: time taken to lower the IOP to 25mmHg (115.0±97.0 versus 18.8±7.5 minutes in the medical and ALPI group respectively; p=0.001); amount of IOP reduction within 30 minutes (20.8±13.5mmHg versus 34.8±3.2mmHg in the medical and ALPI group respectively; p=0.04), and post attack CDR (0.60±0.20 versus 0.50±0.02 in the medical and ALPI group respectively; p=0.002). Other post‐operative parameters were comparable in both groups.

Conclusion: ALPI is safer, more consistent and effective than systemic IOP lowering medications during an acute attack of phacomorphic angle closure.


105

Saturday, December 8, 2012 09:00‐17:30 Poster Area Basic Science Related to Glaucoma

22

VISUAL PATHWAY STRUCTURE AND THE SEVERITY OF VISUAL FIELD DEFECT IN GLAUCOMA

A.T. Hernowo1, N. Jansonius2, J. Hooymans2, F. Cornelissen2

1Ophthalmology, Gadjah Mada University, Yogyakarta, Indonesia, 2Ophthalmology, Groningen University, Groningen, The Netherlands

This study aims to find if there is any structure‐function correlation between the visual pathway structures volume and the visual field sensitivity in primary open‐angle glaucoma (POAG). Seventeen subjects with varying stage of POAG voluntarily participated in the study. Only POAG patients with a minimum of three years of established diagnosis were included. The visual fields were taken with automated static perimetry to obtain the mean deviation (MD) of the visual field sensitivity. Magnetic resonance (MR) brain diffusion tensor imaging (DTI) and anatomical T1‐weighted (T1W) imaging of all subjects were acquired on a 3T MR scanner. T1W images were processed to allow for volume measurement. Diffusion‐weighted (DW) image processing were done to obtain fractional anisotropy (FA) maps. Both T1W‐ and DW‐derived images were eventually subjected to voxel‐wise analyses to compare the brains in voxel‐to‐voxel manner. Structure to structure comparison was approached with regions‐of‐interest (ROI) based analyses. Voxel‐wise analyses revealed that the MD was correlated with pregeniculate (p< 0.05, FWE‐corrected) and LGB volumes

(p< 0.05, uncorrected). ROI‐based analyses showed only the pregeniculate volume was moderately correlated with MD (R=0.65; p< 0.05, Bonferroni‐corrected). Voxel‐wise analyses showed that FA was correlated with MD (p< 0.05, uncorrected) in geniculocalcarine region. ROI‐based analyses failed to show any correlation between FA and MD. In summary, visual field sensitivity is primarily correlated with the volume of the pregeniculate visual pathway.


106

Friday, December 7, 2012 08:30‐18:00 Poster Area Glaucoma Diagnosis and Imaging

30

CROSS SECTIONAL IMAGE OF OPTIC NERVE HEAD WITH CIRRUS SPECTRAL DOMAIN OCT IN PATIENTS WITH MONOCULAR ACUTE INTRAOCULAR PRESSURE ELEVATION

M.H. Park1, J.‐I. Moon2

1Ophthalmology, Yeouido St. Mary's Hospital, 2The Catholic University of Korea, Seoul, Republic of Korea

Purpose: To analyze the acute change of optic nerve head (ONH) and peripapillary region during intraocular pressure (IOP) elevation period in patients with monocular IOP elevation using spectral‐domain optical coherence tomography (SD‐OCT).

Study design: Retrospetive review of medical records.

Patients and methods: Parameters from 200x200 cube scan and cross‐sectional images from high definition 5‐line raster scan of ONH were analyzed in 12 patients with monocular IOP elevation >30 mmHg. 5 patients had previous history of IOP elevation.

Results: Average‐, inferior quadrant‐, and vertical (1, 5, 6) clock hour retinal nerve fiber layer (RNFL) thickness, rim area, vertical cup/disc ratio, cup volume, cup depth, central and mid‐inferior prelaminar layer thickness, and nasal retinal slope were significantly different between study eyes and normal fellow eyes. Backward curving of peripapillary retina and Bruch's membrane, and narrowing of choroidal vessels were observed in some cases.

Conclusions: We could clearly observe the changes of ONH and peripapillary region during the acute IOP elevation with SD‐OCT. RNFL and ONH analysis showed changes in the vertical rim. In addition to ONH change, backward curving of peripapillary region and narrowing of choroidal vessels were observed. These evidences support both mechanical and ischemic mechanisms may simultaneously involve in glaucoma.


107


34

OPTIC DISC TORSION DIRECTION PREDICTS THE LOCATION OF GLAUCOMATOUS DAMAGE IN NORMAL TENSION GLAUCOMA PATIENTS WITH MYOPIA

H.‐Y.L. Park1, C.K. Park2

1Seoul St. Mary's Hospital, Catholic University, 2Department of Ophthalmology, Seoul St. Mary's Hospital, Catholic University, Seoul, Republic of Korea

Purpose: To characterize optic disc tilt and torsion in normal tension glaucoma (NTG) patients with myopia and evaluate relationship with the location of visual field defect.

Methods: Two hundred twenty‐five NTG patients were divided into myopic NTG group (spherical equivalent greater than ‐2.00 diopters (D) or axial length greater than 24.0 mm; n=166) and non‐myopic NTG group (spherical equivalent less than ‐0.50 D or axial length less than 24.0 mm; n=59). Disc tilt, which was identified by the tilt ratio, disc torsion, and area of peripapillary atrophy (PPA) were measured from disc photographs. Patients were further divided into superior and inferior defect groups according to the location of the visual field (VF) defect in the pattern deviation map. Logistic regression analysis was used to determine the relationship between ocular factors and the VF defect location.

Results: Disc tilt (45.8%) and torsion (75.9%) were significantly more prevalent in the myopic NTG group than the non‐myopic NTG group. VF defect location was significantly different between the two groups, with superior defects more prevalent in the myopic NTG group (69.9%, P < 0.001). Torsion degree was significantly different in the superior defect group (18.45 degrees) compared to the inferior defect group (‐3.81 degrees, P = 0.001). Torsion degree was the only factor related to VF defect location in both univariate and multivariate logistic regression analyses.

Conclusions: Optic disc tilt and torsion were highly prevalent in Korean NTG patients with myopia. The direction of the optic disc torsion may predict the location of damage.


108


42

COMPARISON OF INTRAOCULAR PRESSURE AFTER WATER DRINKING TEST IN PRIMARY OPEN ANGLE GLAUCOMA PATIENTS CONTROLLED WITH LATANOPROST AND TRABECULECTOMY

E. Rusmayani1, I. Sumantri2

1Department of Ophthalmology, 2Ophthalmology, Kirana Eye Center Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia

Introduction: Primary open angle glaucoma (POAG) patients with controlled intraocular pressure (IOP), could still showed disease progressions. This is thought due to undetected IOP peak and fluctuation during visit in office hours. In daily practice, 24 hours IOP measurement is difficult to obtain and costly. Nowadays water drinking test is proposed as a new method to estimate circadian IOP.

Objective: To compare intraocular pressure (IOP) after water drinking test in POAG patients controlled with latanoprost 0.005% and trabeculectomy.

Methods: Observational study with cross‐sectional design of 28 eyes with POAG patients. Subjects were divided into two groups, 14 patients controlled with trabeculectomy and 14 patients with latanoprost monotherapy. All subjects were under clinical therapy and had IOP equal or lower than 18 mm Hg, monitored during the follow up period. All subjects were submitted to the water drinking test. The results of the water drinking test, which were peak and fluctuation of IOP, were then compared between groups.

Results: There were no significant difference between IOP peak between two groups (p=0.88). IOP fluctuation also showed no significant difference between groups (p=0.84). In both groups, baseline IOP strongly correlated with peak IOP in water drinking test with correlation coefficient r=0.96 (p< 0.001) and r=0.71 (p=0.04), while baseline IOP in trabeculectomy group was strongly correlated with IOP fluctuation with correlation coefficient r=0.86 (p< 0.001).

Conclusions: Peak and fluctuation of IOP after water drinking test in POAG patients controlled with latanoprost and trabeculectomy showed no significant difference.


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THE ROLE OF COMBINED TRABECULOTOMY AND TRABECULECTOMY IN THE MANAGEMENT OF ADVANCED DEVELOPMENTAL GLAUCOMA

D. Yanuhardi, H. Rasyidin

Department of Ophthalmology, University of Andalas, M. Djamil Hospital, Padang, Indonesia

Introduction: The treatment for developmental glaucoma is surgical. Treatment options include goniotomy, trabeculotomy, combined trabeculotomy & trabeculectomy, and trabeculectomy. Combining trabeculotomy and trabeculectomy offers many theoretical and practical advantages, with superior results over the other conventional techniques in controlling the intraocular pressure.

Purpose: To highlight the role of combined trabeculotomy and trabeculectomy in the management of advanced developmental glaucoma.

Methods: A five years old boy was diagnosed as congenital glaucoma of right eye. His left eye was in normal condition with visual acuity of 20/20. Right eye's visual acuity was light perception with doubt projection. Cornea was enlarged and hazy. Intraocular pressure was N+1 (palpation). He underwent a combined trabeculotomy and trabeculectomy procedure under general anasthesia on 8th October 2011. Examination under anasthesia was also performed to asses corneal diameter and intraocular pressure correctly. Corneal diameter was 17 mm (vertically) x 14 mm (horizontally) and intraocular pressure before surgery was 37 mmHg.

Results: After underwent a combined trabeculotomy and trabeculectomy procedure, his right eye visual acuity became light perception with true projection. Intraocular pressure was normal (palpation). Cornea became clearer than before.

Conclusions: Combined trabeculotomy and trabeculectomy is a better procedure for surgical treatment of advanced developmental glaucoma patient. The technique allows greater surgical flexibility in advanced buphthalmos patient.


110

Friday, December 7, 2012 08:30‐18:00 Poster Area Epidemiology of Glaucoma

52

MACHINE LEARNING TO PREDICT GLAUCOMA BEFORE VISUAL FIELD TESTING

S. Hong1,2, E. Oh1, T.K. Yoo1, C.Y. Kim1, G.J. Seong1

1Ophthalmology, 2Institute of VIsion Research, Yonsei University, Seoul, Republic of Korea

Introduction: Early detection of glaucoma is critical in preventing blindness worldwide. However, due to it is asymptomatic in early stages, its timely diagnosis is not easy even in developed countries.

Objective: To predict glaucoma before visual field testing.

Aims: To develop a classification model to predict glaucoma without visual field testing using machine learning methods.

Methods: We collected medical records from Korean glaucoma patients based on the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted in 2010. The training data set was used to construct models.

Results: The informative variables selection was done with algorithm of consistency subset evaluation. We used k‐fold cross validation to optimize performance. The test data set was used to assess performance using the area under curve of the receiver operating characteristic (ROC). The machine learning models performed well under various conditions of training. The accuracy for prediction was about 80%.

Conclusions: The machine learning method we demonstrated through predictors of glaucoma before visual field testing can help to select patients who need to perform the visual field test.


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SCLERAL FIXATION OF TUBE TIP FOR REPOSITIONING OF MALPOSITIONED AHMED VALVE

K.T. Ma1, C.Y. Kim2, G.J. Seong2, J.H. Kim3

1Jeil Eye Clinic, Suwon, 2Severance Hospital, 3Siloam Eye Hospital, Seoul, Republic of Korea

Purpose: Corneal touch of the tube end is not a rare case after Amhed valve implantation. Removal of the tube might be the treatment of choice but in some cases due to the fragile status of the eye, anterior chamber collapse or bleeding might occur during manipulation. So, we would like to introduce more simple method of repositioning the tube tip.

Methods: While maintaining the anterior chamber with an anterior chamber maintainer, puncture is made right above the tube entering the anterior chamber. Tube end is pulled out through the puncture site and 10‐0 prolene double‐arm straight needle is passed through near the tube end. Scleral flap is made at a 90 degrees position and using the 27G dental needle double armed straight needle once again penetrated at the scleral flap and tied firmly.

Results: Patients have been followed up for an average of two months and there was no more touching of the cornea and IOP was under good control.

Conclusion: Although further evaluation would be needed, this new surgical technique of Ahmed valve tube repositioning with scleral flap might be helpful for managing cases with tube tip touch of the cornea. However considering the limitation of cases, a larger follow‐up group would be necessary.


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60

ANGIOGRAPHIC FEATURES IN ACUTE DRUG‐INDUCED ANGLE CLOSURE WITH CILIOCHOROIDAL EFFUSION

Y.C. Park1, S.J. Kwon1, J.P. Shin2

1Nune Eye Hospital, 2Kyungpook National University, Daegu, Republic of Korea

Purpose: Firstly, to report four cases of acute drug‐induced angle closure with ciliochoroidal effusion and, secondly, to suggest a pathogenesis of this condition with a review of characteristic angiographic signs.

Methods: This study is an observational case series. For four patients with acute drug‐induced angle closure with ciliochoroidal effusion, clinical examination, ultrasound biomicroscopy, FA and ICGA were performed. Authors have first reviewed characteristic angiographic signs during the acute phase of disease and convalescence.

Results: Four patients presented with bilateral decreased vision and ocular pain. All patients presented a shallow anterior chamber and elevated intraocular pressure(IOP) in both eyes. They showed a myopic shift to range from ‐0.5 to ‐17.0 diopters(D). Ultrasound biomicroscopy revealed annular ciliochoroidal effusion with diffuse thickening of the ciliary body in all cases. Rapid clinical improvement occurred in all patients after suspected drugs was stopped. Authors analyzed three angiographic signs: one major sign (Multiple hypofluorescent dark dots) and two minor signs (Tortous and dilated vessels, multiple hyperfluorescent pinpoints in the late phase). Multiple hypofluorescent dark dots indicating the involvement in choroidal layer were the most constant and easily recordable sign that authors found in all cases.

Conclusion: The basic mechanism of this condition involves an idiocyncratic reation in uveal tissue to systemic drugs. Angiographic features reveal that extravascular fluid accumulation in choroidal layer have a main role to pathogenesis. Angiography could be the useful method to explain the pathophysiology of this condition through imaging of the choroidal layer.


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SEASONAL VARIATIONS OF ACUTE ANGLE‐CLOSURE GLAUCOMA

K.W. Lee1, S.C. Cha2, T.Y. Lee1, J.W. Lee1, J.H. Kim1

1Ophthalmology, Cheil Eye Hospital, 2Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea

Objective: To investigate the seasonal variations of acute angle‐closure glaucoma in South Korea.

Methods: A retrospective analysis was made of 87 patients (94 eyes) who underwent laser iridotomy for the last 5 years. Monthly and seasonal variations were investigated as well as the difference in seasonal variations according to sex, age and inhabited area were inspected in this study.

Results: Acute angle‐closure glaucoma occurred most frequently in January (13.8%) for monthly variations. Incidence of glaucoma was the highest during winter months with 26 patients (29.9%), and slightly decreased in spring and summer, each with 23 patients (26.4%) then gradually dropped to 15 patients (17.2%) in autumn. In urban areas, the frequency of incidence was the highest in spring (31.8%), the lowest in autumn (19.7%) and slightly increased in winter (27.3%). However, in rural areas, the incidence was the highest in summer (42.9%) and winter (38.1%). There were significant differences between urban and rural areas.

Conclusions: Overall seasonal incidence of acute angle‐closure glaucoma was the highest in winter and decreased towards autumn. There was significant disparity in frequency of incidence of glaucoma between different regions in South Korea.


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COMBINED TRABECULOTOMY AND TRABECULECTOMY GIVES GOOD RESULT IN PRIMARY CONGENITAL GLAUCOMA

M. Purnama1, A. Kusumadjaja1, N.K. Rahayu2

1Ophthalmology, Sanglah Hospital, Udayana University, 2Ophthalmology, Indera Hospital, Denpasar, Indonesia

Purpose: To report a patient whose diagnosed as primary congenital glaucoma that shows good result after combined trabeculotomy and trabeculectomy on her both eyes.

Method: Case Report Study. A 3 month old baby girl with corneal haziness on both eyes about 1 day. Her eyes could not follow the light. Examination of the right eye we obtained corneal diameter vertical and horizontal were 14 mm, haziness of cornea and there were haab striae, fundus reflex was negative, the intra ocular pressure (IOP) was 27.2 mmHg axial length 23 mm. Examination of the left eye we obtained corneal diameter vertical and horizontal were 14 mm, haziness of cornea and there were haab striae, fundus reflex was positive, cup disc (CD) ratio 0.3 ‐ 0.4, the IOP was 27.2 mmHg, axial length 22 mmHg. The patient was diagnosed with primary congenital glaucoma and underwent combined trabeculotomy and trabeculectomy.

Result: Almost one year after surgery, both corneal haziness were gone, corneal diameter on both eyes were stable, decrease of cupping on CD ratio of both eyes and the IOP of both eyes were stable.

Conclusion: Combined trabeculotomy and trabeculectomy were effective treatment for primary congenital glaucoma.


115

Friday, December 7, 2012 08:30‐18:00 Poster Area Diagnosis and Imaging

77

THE ASSOCIATION BETWEEN HAEMODIALYSIS FREQUENCY AND RETINAL NERVE FIBER LAYER

H. Rasyidin


Introduction: Intraocular Pressure (IOP) maybe increased while haemodialysis process and reduce retinal nerve fiber layer thickness.

Objective: To study association between haemodialysis frequency and retinal nerve fiber layer thickness.

Methods: Observational study from 15th August to 15th September 2012, with cross sectional analysis of 100 eyes of haemodialysis patients. Subjects divided into 5 groups based on frequency of haemodialysis. Group I: Frequency of haemodialysis 1‐200 Group II: Frequency of haemodialysis 201‐400 Group III: Frequency of haemodialysis 401‐600 Group IV: Frequency of haemodialysis 601‐800 Group V: Frequency of haemodialysis 801‐1000 All of five subjects groups underwent Optical Coherence Tomography (OCT) examination to determine the thickness of retinal nerve fiber layer. Results of the examinations will be analysed statistically.

Results: To be presented.

Conclusions: To be presented.


116

Saturday, December 8, 2012 09:00‐17:30 Poster Area Ocular Blood Flow and Glaucoma

79

OCULAR PULSE AMPLITUDE MEASUREMENT OF TREATED HYPERTENSION PATIENTS USING ANGIOTENSIN CONVERTING ENZYME INHIBITOR AND CALCIUM CHANNEL BLOCKER COMPARE TO HEALTHY SUBJECTS

W. Ferraniza1, A.P. Gandasubrata1, A.S. Kartasasmita1, R. Supriyadi2

1Department of Ophthalmology, Padjadjaran University, Cicendo National Eye Hospital Bandung, 2Department of Internal Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia

Introduction and objective: Beyond intraocular pressure (IOP), vascular factor is thought to play important role in open angle glaucoma, particularly normotension glaucoma patients. The decreased in ocular perfusion can reduce blood flow to optic nerve head (ONH) and causing ischemia. Healthy subjects reveal small mean changes of ONH perfusion during daytime and a significant reduction at night. It presumed related to physiologic nocturnal dip in blood pressure. Secondary nocturnal dip caused by angiotensin converting agent inhibitor (ACEI) and calcium channel blocker (CCB) can aggravate this condition. Ocular perfusion can be represented by ocular pulse amplitude (OPA), the IOP difference during systole and diastole blood pressure.

Aim: To compare the OPA measurement between the treated hypertension patients and healthy subjects.

Methods: This comparative study using cross‐sectional method, conducted from July‐December 2011 in Cicendo Eye Hospital Bandung in collaboration with kidney‐hypertension unit in Hasan Sadikin Hospital Bandung. Samples were consisted of essensial hypertension patients group who regularly treated with ACEI and CCB for at least one year (17 subjects) and healthy participants group (17 subjects), recruited by consecutive admission. OPA were examined using Pascal tonometer. Hypothetical analysis was done using independent t‐test.

OPA Group 1 34 eyes Group 2 34 eyes p Value (unpaired t test_)Mean 1.565 1.935 0.033

Range 0.9‐2.25 1.09‐2.2.8

[Mean of OPA between group 1 and group 2]

Result: Mean OPA in hypertensive patients treated by ACEI and CCB (1.565 mmHg) was statistically significant lower than healthy subjects (1.935 mmHg), p=0,033.

Conclusion: OPA of hypertension patients treated by ACEI and CCB were lower than healthy subjects.


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83

CLINICAL OUTCOME OF COMBINED PHACOEMULSIFICATION WITH TRABECULECTOMY WITH BIODEGRADABLE COLLAGEN MATRIX IMPLANT AS AN ADJUVANT: A SIX MONTHS FOLLOW UP STUDY

C. Muthuraman, A.V. Nallampalli Venugopal

Glaucoma Services, Uma Eye Clinic, Chennai, India

Introduction: Ologen collagen matrix implant is a biodegradable scaffolding matrix used as a wound modulator in GFS which induces regenerative wound healing process eliminating need for antifibrotic agents.

Aim and objective: To analyze efficacy and safety of Ologen used as adjuvant in phacoemulsification with trabeculectomy

Methods: Prospective clinical trial with six months follow ‐ up. 15 glaucoma patients (17 eyes) assigned to undergo phacoemulsification and trabeculectomy with Ologen. All patients underwent fornix ‐ based trabeculectomy with triangular scleral flap closed with one releasable 10 ‐ 0 nylon suture. A 6 mm X 2mm Ologen implant placed over scleral flap and conjunctiva sutured with 8 ‐0 vicryl.

Purpose: Primary outcome analyzed was achievement of target IOP ≤21 and ≤ 18. IOP control was grouped as either complete success or qualified success. Secondary outcomes studied included bleb evaluation; glaucoma medications needed, post ‐ operative complications.

Results: The mean preoperative IOP was 25.4 mm Hg (±4.8). The IOP reduction at end point was 8.6 (± 4.5) (P= 0.005). Complete success achieved in 12 eyes (70.58%) and qualified success achieved in 5 eyes (29.42%). The mean number of antiglaucoma medications needed reduced at the end point (P=0.0001) from 2.5 (± 0.4) to 0.9 (± 0.3). Suture removal was performed in 12 patients (70.58%). There was CD seen in 2 eyes (11.76%) which happened after SR and managed conservatively. No adverse reaction to the Ologen implant or erosion noted.

Conclusion: The Ologen collagen matrix implant is a safe, effective adjuvant in trabeculectomy.


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86

SELECTIVE LASER TRABECULOPLASTY AS PRIMARY TREATMENT FOR OPEN ANGLE GLAUCOMA: TWO YEARS FOLLOW UP STUDY

C. Muthuraman1, A.V.N. Venugopal2

1Department of Glaucoma, 2Glaucoma Services, Uma Eye Clinic, Chennai, India

Introduction: Selective Laser Trabeculoplasty is a new treatment that enhances outflow facility in trabecular meshwork by biological enhancement.

Aim and objective: To analyze the safety and efficacy of selective laser trabeculoplasty as primary treatment in patients with open angle glaucoma.

Methods: 43 eyes of 25 patients with open angle glaucoma or ocular hypertension underwent selective laser trabeculoplasty as primary treatment. All patients underwent complete ophthalmic evaluation before and at intervals after treatment. Selective Laser Trabeculoplasty was done in all patients with 80 ‐ 100 non‐overlapping spots over 360 degrees. The intraocular pressure was measured at 1st day, 2 weeks, 6 weeks and 3, 6, 12, 18 and 24 months post operatively.

Purpose: Primary outcome analyzed was achievement of intraocular pressure < 18 mm Hg or at least 20% reduction from baseline Intra ocular pressure. Secondary outcome studied was complications and need for anti ‐ glaucoma medications to maintain target IOP.

Results: Intraocular pressure (Mean ± SD) decreased by 7.6 ± 2.8 mm Hg (30%) from 26.6 ± 2.7 mm Hg to 16.9 ± 2.7 mm Hg (P< 0.001). 4 eyes (9.30%) did not respond to selective laser trabeculoplasty and altogether 8 eyes (18.60%) required topical medications to control IOP at end of follow ‐ up. Complications included redness and injection in 24 eyes (55.81%) on the first postoperative day.

Conclusion: Selective Laser Trabeculoplasty is effective and safe as a primary treatment for patients with open angle glaucoma and ocular hypertension.


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91

INTEROCULAR ASYMMETRY OF RETINAL NERVE FIBER LAYER THICKNESS USING SPECTRAL‐DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN HEALTHY MYOPIC EYES

J.H. Lee1, D.J. Yeom1, Y.H. Hwang2

1Department of Ophthalmology, Inje University Sanggye Paik Hospital, 2Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Seoul, Republic of Korea

Objective: To characterize interocular symmetry and associated factors in the retinal nerve fiber layer (RNFL) and optic nerve head (ONH) of healthy myopic eyes using Cirrus HD spectral‐domain optical coherence tomography (OCT).

Methods: The RNFL and ONH of 292 myopic eyes from 146 healthy subjects were examined using Cirrus HD OCT. RNFL characteristics (thickness and peak location) and ONH parameters were compared between right and left eyes.

Results: The cutoff limits for normal interocular differences in average, quadrant, clock‐hour sector RNFL

thickness were 8.3, 20.3, and 48.3 ㎛, respectively. The average RNFL thickness between the right and left

eyes was not significantly different. In quadrant analysis, the superior RNFL of the right eye was thinner and the temporal RNFL of the right eye was thicker than those of the left eye (each p < 0.001). In correlation analysis, the interocular differences in superior and temporal RNFL thickness were associated with the interocular difference in RNFL peak location (p < 0.05). Differences in ONH parameters between the right and left eyes were not significant.

Conclusions: The interocular asymmetry of RNFL thickness should be considered when glaucoma is diagnosed at an early stage, because there could be the interocular asymmetry of RNFL thickness in healthy myopic eye.


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94

THE NEUROPROTECTIVE EFFECT OF CARNOSINE (Β‐ALANYL‐L‐HISTIDINE) ON RETINAL GANGLION CELL IN ACUTE ISCHEMIC MOUSE RETINA

S.‐W. Park, J.‐W. Park

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea

Purpose: To investigate whether carnosine can increase retinal ganglion cell (RGC) survival in ischemic mouse retina and determine the possible mechanisms of neuroprotection.

Methods: Retinal ischemia was induced by IOP elevation during constant 60 minutes with pretreatment of carnosine (1000mg/kg) or saline in C57BL/6 mice. Hypoxia inducing factor‐1 alpha (HIF‐1α), glial fibrillary acidic protein (GFAP), and dynamin‐related protein‐1 (Drp‐1) expression were assessed at 6, 12, and 24 hours after retinal ischemia by Western blot. RGC survival was assessed by retrograde FluoroGold labeling at 2 weeks after retinal ischemia.

Results: The expression of HIF‐1α, GFAP and Drp‐1 was increased within 24 hours after ischemic injury. Carnosine treatment effectively decreased the elevated expression of HIF‐1α, GFAP and Drp‐1 in ischemic mouse retina. Carnosine treatment also protected against RGC loss in ischemia mouse retina.

Conclusions: Our findings showed that carnosine treatment significantly decreased RGC loss through blocking of increased HIF‐1α, GFAP and Drp‐1 expression in ischemic mouse retina. We suggest that carnosine can be an effective endogenous neuroprotective molecule in the prevention of RGC loss in ischemic retina.


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COMPARISON OF INTRA OCULAR PRESSURE STABILITY AFTER TRABECULECTOMY WITH RELEASABLE SUTURE AND STANDARD ON PRIMARY GLAUCOMA PATIENTS

A. Kusumadjaja1, D.S. Mendala1, W. Widyaartini2, Prospective Study

1Ophthalmology, Sanglah Hospital, Udayana University, Denpasar, 2Ophthalmology, Cipto Mangunkusumo Hospital, Indonesia University, Jakarta, Indonesia

Objective: To assess the comparison of intra ocular pressure (IOP) stability after trabeculectomy with releasable suture and standard on primary glaucoma patients.

Methods: We conducted randomized open clinical trial to 28 eyes (26 patients). Subjects randomly assigned into two groups: 14 eyes in trabeculectomy standard group and 14 eyes in trabeculectomy with releasable suture group. The main outcome is IOP stability in one month after surgery. We also analyzed anterior chamber depth (ACD), bleb score, and complication on both groups.

Results: Intra ocular pressure stability after trabeculectomy with releasable suture (57.14%) was higher than after standard trabeculectomy (35.71%), though statistically not differ significantly (p=0.26). The IOP after surgery average of both groups showed decreasement than before surgery, but between groups showed no significant differences (p>0.05). The ACD after surgery average of both groups showed significant improvement on the fourth and second week than before surgery, but ACD between both groups only showed difference on first day after surgery (p=0.02). The bleb score average on both groups showed increasement than first day after surgery, but between both groups the significant differences showed only on first and fourth week, p< 0.01 and p=0.04, respectively. The complication on both groups were low, but hypotony only happened after standard trabeculectomy (7.14%).

Conclusion: Intra ocular pressure stability and bleb score after trabeculectomy with releasable suture tend to be higher if compared to standard trabeculectomy.


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107

EFFECT OF ELEVATED INTRAOCULAR PRESSURE INDUCED CASPASE‐3 AND BAX EXPRESSION ON RATTUS NORVEGICUS RETINAL GANGLION CELLS

E. Komaratih, S. Fatmariyanti, N. Nurwasis, E. Rochmawati

Ophthalmology, Airlangga University, Surabaya, Indonesia

Purpose: To investigate the effect of elevation of intraocular pressure (IOP) on retinal ganglion cell (RGC) apoptosis and the correlation of effect of IOP‐induced expression of Caspase 3 and Bax in the RGC.

Methods: Twenty six Wistar rats, 13 treated group and 13 control group. Thirteen treated group had elevated IOP induced in the left eye by episcleral vein cauterization. IOP was measured with an applanation tonometer (Tonopen). Eyes were examined in 2 weeks and enucleated . Caspase‐3 and Bax expression in the RGC layer was examined by immunohistochemistry.

Results: There was no difference between pre cauter IOP treated and control eyes ((21,50 (7,60) mmHg versus 24,67 (11,02)) mmHg, p.0,375). During follow‐up (2 weeks), the IOP of treated eyes was significantly higher than the control eyes (at final examination, IOP of control eyes was (28,32±12,2) mmHg and IOP of treated eyes (48,00±8,65) mmHg, p.000). Two weeks after cauterization, in the RGC layer, Caspase‐3 positive cells of treated eyes was significantly higher than the control eyes ((49,8 (32,00‐63,8) versus 30,8 (12,40‐52,60), p.0,000)), while Bax positive cells was also significantly higher than the control eye ( 4,00 (3,00‐7,00) versus 1,00 (1,00‐3,00), p,000).

Conclusion: The episcleral vein cauterization produces a consistent elevation of IOP. This study demonstrated that expression of Caspase‐3 and Bax significantly correlates with elevation of IOP.


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109

GONIOSCOPIC ANGLE CHANGE AFTER ARTISAN PHAKIC INTRAOCULAR LENS IMPLANTATION IN GLAUCOMA SUSPECTS

S.H. Lee, J.M. Lee, J.B. Lee

Yonsei Plus Eye Center, Sungnam, Republic of Korea

Purpose: To evaluate the clinical characteristics of glaucoma suspects after artisan phakic intraocular lens (IOL) implantation for correction of high myopia.

Methods: This was a retrospective,case control study. 21 subjects (10 glaucoma suspects with high myopia, 11 control with high myopia) was enrolled. Visual field test was performed using SITA 24‐2 program of Humphrey field analyzer before and after surgery, and mean deviation (MD) and pattern standard deviation(PSD) from Humphrey SITA strategy was also compared perioperatively. Central corneal thickness, cup to disc (C/D) ratio, gonioscpy and intraocular pressure were compared perioperatively.

Results: The mean refractive error was ‐10.54 Diopter and the follow up period was 12 months after artisan phakic IOL implantation. The mean photopic pupil diameter was 3.01mm (range :2.53‐3.5mm). Vertical C/D ratio was 0.68 and the ratio was not changed until 12month postoperative. No significant change of MD and PSD was recognized after surgery.

Conclusions: Artisan phakic IOL implantation may be a viable option in some glaucoma suspects. But, careful patients education and life long follow up is mandatory after surgery.


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110

RISK FACTORS FOR AN INITIAL CENTRAL SCOTOMA COMPARED WITH AN INITIAL PERIPHERAL SCOTOMA IN NORMAL TENSION GLAUCOMA

B. Park, B.J. Cho

Ophthalmology, Konkuk University Medical Center, Seoul, Republic of Korea

Introduction: Central scotomas, as opposed to peripheral scotomas, is suggested to be developed in response to risk factors other than or in addition to elevated IOP.

Purpose: To uncover difference in risk factors between an initial central scotoma (ICS) group and an initial peripheral scotoma (IPS) group in NTG.

Method: On the basis of 2 reliable, consistent 24‐2 SITA VFs, 2 NTG patients groups were analyzed: those with an ICS in 1 hemifield (≥3 adjacent points with P< 5% within the central 10 degrees, ≥1 point with P< 1% lying at the central 10 degrees, no VF abnormality outside the central 10 degrees) and those with an IPS in 1 hemifield (≥3 adjacent points with P< 5%, ≥1 point with P< 1% in the periphery outside 10 degrees, no VF abnormality within the central 10 degrees). Various systemic factors were analyzed between the 2 groups.

Results: We included 166 eyes with NTG (ICS group; 60 eyes, IPS group; 106 eyes). Disc hemorrhage frequency was significantly higher in the ICS group than in the IPS group. Systemic risk factors such as hypotension, migraine, Raynaud's phenomenon, snoring were higher in the ICS group than in the IPS group. There were no statistic differences in lifestyle risk factor such as smoking, body mass index.

Conclusions: Patients with an ICS and IPS in NTG have different risk factor profiles and clinical characteristics. This suggests that the pattern of the VF loss may be useful to identify patients at higher risk of central field loss.


125

Friday, December 7, 2012 08:30‐18:00 Poster Area Glaucoma Progression

113

CORRELATION CENTRAL CORNEAL THICKNESS WITH CUP DISC RATIO OF THE OPTIC NERVE HEAD AND RETINAL NERVE FIBER LAYER THICKNESS IN PRIMARY OPEN ANGLE GLAUCOMA

N.L.P. Meigawati

Ophthalmology, Udayana University, Denpasar, Indonesia

Introduction: Primary open angle glaucoma (POAG) refers to glaucoma with extracellular matrix abnormality on the trabecular meshwork. Risk factors associated with the progressivity include intraocular pressure, central corneal thickness (CCT), cup disc ratio (CDR) of the optic nerve head, and retinal nerve fiber layer (RNFL) thickness.

Objective: This study was aimed to determine the correlation between CCT with CDR of the optic nerve head and RNFL thickness in POAG.

Method: This cross sectional study was taking place in the eye clinic of RSUP Sanglah Denpasar, from September 20011 until April 2012. Consecutively taken samples underwent examinations for CCT, CDR of the optic nerve head, and RNFL thickness with Stratus (OCT). Correlation test was done with Spearman's test and linear regression.

Results: Eighty five eyes of 51 subjects were eligible to enroll in this study. Mean CCT was 517.80 ± 29.36 µm, mean CDR of the optic nerve head was 0.72 ± 0.15 and mean RNFL thickness was 73.13 ± 19.46 µm. Significant correlation was found between CCT and CDR of the optic nerve head (p = 0.000 and r = 0.627), with linear regression supported the finding (p = 0.000, r = 0.628 and r2 = 0.394). CCT and RNFL also reveal significant correlation (p = 0.000 and r = 0.659) and linear regression (p = 0.000, r = 0.637 and r2 = 0.406).

Conclusions: This study concludes there was significant correlation between CCT with CDR of the optic nerve head and RNFL thickness.


126

Saturday, December 8, 2012 09:00‐17:30 Poster Area Medication Therapy of Glaucoma

114

ANALYSIS OF CLINICAL EFFICACY OF TAFLUPROST ON IOP AND OCULAR PULSE AMPLITUDE IN GLAUCOMA PATIENTS

S.J. Ha

Ophthalmology, Soonchunhyang University Hospital, Seoul, Republic of Korea

Introduction: Impaired blood flow to the optic nerve may contribute to glaucomatous optic neuropathy. OPA is an indirect indicator of the choroidal perfusion, and reflects the ocular blood flow, and is thought to have some clinical role in the progression of glaucoma.

Objective: To analyze clinical effectiveness of Tafluprost which is used in the treatment of glaucoma, using ocular pulse amplitude measurements with dynamic contour tonometry.

Aims: IOP and OPA lowering efficacy of Tafluprost.

Methods: Forty patients (79 eyes) with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) treated with tafluprost were investigated, intraocular pressure (IOP) was measured with Goldmann applanation tonometry (GAT), and ocular pulse amplitude (OPA) was measured with dynamic contour tonometry, before and after treatment.

Purpose: To analyze IOP and OPA lowering efficacy of Tafluprost in new treatment group and switching treatment group from other mono‐therapy to Tafluprost.

Results: For twenty patients who were treated with tafluprost, IOP decreased to 13.0 at three months after treatment from 17.1 before treatment (24% descent rate), and OPA to 1.57 from 2.34 (33%). For twenty patients who switched from another monotherapy to tafluprost, IOP decreased to 13.3 from 15.6 (15%) and OPA to 1.7 from 2.3 (28%).

Conclusions: Tafluprost used to treat glaucoma has large OPA lowering effect as well as IOP lowering effect, therefore it can be applied to patients who have a risk of glaucoma progression because of large OPA due to large amount of IOP fluctuation.


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119

THE CLINICAL APPROACH OF OPTIC NERVE DAMAGE IN POSNER‐SCHLOSSMAN SYNDROME

H. Zhou1, W. Jiang1, B. Tian2, Q. Ye1

1Ophthalmology Department, Wuhan General Hospital of Guangzhou Military Region, 2Wuhan General Hospital of Guangzhou Military Region, Southern Medical University, Wuhan City, China

Objective: This study was undertaken to analyze the clinical approach of glaucoma optic nerve damage in Posner‐Schlossman syndrome (PSS) patients, as well as respective proportion and clinical characteristics,to provide the clinical indication for PSS.

Methods: 208 patients with PSS were retrospectively evaluated for the change occurred in the optic nerve by means of ophthalmoscopy and perimetry,in which 71 cases with optic nerve damage were analyzed and discriminated for the clinical approach, according to clinical manifestations described by posner and schlossman and method developed by our preliminary studies.

Results: There were 71 cases(34.1%) with optic nerve damage, in which 12 cases(16.9%) of suspicious damage,35 cases(49.3%) of early damage,11 cases (15.5%) of middle damage, 11 cases (15.5%) of late damage ,2cases (2.8%) of absolute damage. There were 59 cases(83.1%) regarded as clear damage, in which 27 cases(45.8%) were caused by cumulative effect of high intraocular pressure, 6 cases(10.2%) were caused by secondary glaucoma,19 cases(32.2%) were caused by concurrent primary open‐angle glaucoma, 7 cases(11.9%) were caused by concurrent primary closed‐angle glaucoma.

Conclusions: Pay attention to the glaucoma optic nerve damage in PSS patients as its relatively high

incidence rate and possible serious consequences. There are four clinical approach to the damage，which

correspond to different clinical manifestations and treatment principles.


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THE ANTI‐PROLIFERATIVE EFFECT OF VARIOUS DRUGS IN THE HUMAN TENON'S FIBROBLAST CULTURE

J.Y. Kim, E.‐S. Kim, M.J. Kim, H. Tchah

Ophthalmology, University of Ulsan College, Medicine Asan Medical Center, Seoul, Republic of Korea

Purpose: To investigate the anti‐proliferative effect of various drugs including bevaciaumab, tacrolimus, mitomycin C, and low‐molecular‐weight heparin taurocholate 7 (LHT7) in vitro human Tenon's fibroblast (HTF) culture.

Methods: The human Tenon's fibroblast was cultured in vitro. PDGF or bFGF were used to induce the HTF growth. WST‐1 and thymidine uptake assays were performed to investigate HTF proliferation and cell toxicity. Bio‐plex suspension array system was used to monitor the specific inflammatory cytokines including IL‐6, IL‐8, and VEGF involved in the wound healing after treatment of various drugs.

Results: Tacrolimus showed more anti‐proliferative effect than the other drugs on the cultured HTFs induced by PDGF and bFGF. In Bio‐plex suspension array system, the group treated with PGDF and tacrolimus showed decreased IL‐6, IL‐8, and VEGF levels.

Conclusions: Tacrolimus can be used as an anti‐proliferative against HTF in the glaucoma field, based on the in vitro study.


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COMPARISON OF THE REPRODUCIBILITY OF THE RETINAL NERVE FIBER LAYER DEVIATION MAP PARAMETERS BETWEEN NORMAL AND GLAUCOMATOUS EYES

M.H. Suh1, K.H. Park2, D.M. Kim2, W.‐S. Kim1, J.‐E. Lee1, S.J. Lee1, H.J. Park1

1Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 2Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea

Aims: To compare the reproducibility of Cirrus HD‐OCT retinal nerve fiber layer (RNFL) thickness maps between normal and glaucomatous eyes.

Methods: Ninety‐two patients with unilateral OAG were included. Cirrus HD‐OCT was performed 3 times on the same visit to determine intravisit reproducibility and on 4 different days within a 2‐month period to

determine intervisit reproducibility. RNFL thickness at each point of the 50 ⅹ 50 superpixels of the

deviation map were derived. RNFL defect area index (RDAI) was calculated as the percentage area of the RNFL defects identified as superpixels coded in red or yellow. Intraclass correlation coefficients (ICC), coefficients of variation (CV), test‐retest standard deviations (TRT‐SD), and tolerance limits, which were

calculated using the formula 1.645 ⅹ √2 ⅹ intervisit TRT‐SD.

Results: For RNFL thicknesses and RDAI, ICCs of glaucomatous eyes ranged from 90.8 % to 99.6 %, and those of normal eyes ranged from 95.7 % to 99.8 %. Glaucomatous eyes had CVs of RNFL thicknesses ranging between 2.8 % and 5.8 %, and had statistically significant differences with those of normal eyes ranging between 1.3 % and 2.2 % (P < 0.05). CV of RDAI was 10.75 % for glaucomatous eyes. Glaucomatous eyes had inter‐visit tolerance limits of RNFL thicknesses ranging between 3.4 % and 4.9 %, and had statistically significant differences with those of normal eyes ranging between 2.1 % and 2.9 % (P < 0.05).

Conclusions: Reproducibility of Cirrus HD‐OCT deviation map of normal eyes was better than glaucomatous eyes.


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OCULAR PERFUSION PRESSURE AS A PREDICTOR FOR GLAUCOMA PROGRESSION: A PROSPECTIVE OBSERVATIONAL STUDY

T.W. Ch'ng1, U.K. Mohd Ali2, A. Yaakub1, L.S. Ahmad Tajudin1

1Department of Ophthalmology, University Sains Malaysia, Kubang Kerian, 2Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia

Introduction: Vascular and mechanical theories are the main pathogenesis for glaucoma. The interaction of ocular perfusion and intraocular pressure (IOP) may be responsible in acceleration of retinal fibre layer damage in glaucoma.

Objective: To determine the association between ocular perfusion pressure (OPP) and the progression of glaucoma.

Aims: To determine the impact of mean OPP(mOPP), diastolic OPP(dOPP) and systolic OPP(sOPP) in the progression of primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and primary angle closure glaucoma (PACG).

Methods: A prospective cohort study on inter‐visit blood pressure and ocular perfusion pressure was conducted involving POAG, NTG and PACG patients attending glaucoma clinic in Hospital Universiti Sains Malaysia and Hospital Raja Permaisuri Bainun Ipoh. The selected patients were followed up 3 monthly for a period of 12 months. Progression of glaucoma was determined by the difference of AGIS scoring at baseline and after 12 months of follow up.

Purpose: To determine the role of OPP as a predictor affecting progression of glaucoma.

Results: A total of 35 POAG, 22NTG and 9 PACG were recruited and 19% were found to progress after a year. mOPP (p=0.002), dOPP (p=0.025) and diastolic blood pressure (dBP) (p=0.03) have been found to associate with progression of PACG. dBP seem to be responsible for progression of NTG (p=0.016). There was no significant association between OPP and progression of POAG.

Conclusions: OPP and dBP have been found to accelerate progression of glaucoma. Adequate ocular perfusion is as important as reduction of IOP in preventing further glaucomatous damage.


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SURGICAL PROCEDURE FOR SECONDARY ANGLE‐CLOSURE GLAUCOMA DUE TO SOEMMERING´S RING

K. Mori, Y. Ikeda, M. Ueno, Y. Maruyama, H. Yoshikawa, S. Kinoshita

Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Introduction: Soemmering's ring is one form of after‐cataract and consists of a dense ring between the anterior and posterior capsules lying behind the iris.

Aims: To report a surgical procedure for secondary angle‐closure glaucoma due to Soemmering's ring.

Case: In December 1997, a 72‐year‐old female presented suffering from an acute angle‐closure attack in her right eye. After undergoing laser iridotomy, trabeculectomy with cataract extraction, and anterior vitrectomy for malignant glaucoma, her intraocular pressure (IOP) was stabilized. In 2010, she visited our clinic for the management of increased IOP and decreased corneal endothelial counts (CEC). At the initial visit, her IOP was 30 mmHg with full medication, and her CEC was 932 cells/mm2. Gonioscopy and ultrasound biomicroscopy showed a 360‐degree peripheral anterior synechiae (PAS) and dislocated intraocular lens (IOL) due to a swollen Soemmering's ring.

Surgical procedures: After making an irrigation port with a 25‐gauge vitrectomy system through pars plana, a 3 x 3 mm rectangular scleral flap with a 3‐mm knob was made and the IOL was extracted. The soemmering's ring was also extracted using a viscoextraction technique, and trabeculectomy was performed after adding anterior vitrectomy and IOL suturing on the sulcus.

Results: Although vitreous hemorrhage from the IOL suturing portion was sustained a few days postoperative, the filtering bleb was well‐formed and her IOP was controlled at around 10 mmHg for more than 2 years.

Conclusions: Trabeculectomy with ring extraction and IOL exchange is a useful surgical procedure for secondary angle‐closure glaucoma due to a swollen Soemmering's ring.


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EFFECT OF MYOPIA AND AGE ON OPTIC DISC MARGIN ANATOMY WITHIN THE PARAPAPILLARY ATROPHY AREA

J.J. Jung, Y.H. Hwang, H.K. Kim, Y.C. Jeong, S.W. Yoon, Y.H. Sohn

Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea

Purpose: To evaluate the effect of myopia and age on temporal optic disc margin anatomy within the parapapillary atrophy (PPA) area using spectral‐domain optical coherence tomography (OCT).

Methods: Horizontal cross‐sectional optic nerve head (ONH) images were obtained from 50 young myopic eyes with PPA, 50 aged emmetropic eyes with PPA, and 50 young emmetropic eyes without PPA using high‐definition OCT scans. For each scan, the configuration of border tissue of Elschnig, optic disc margin location, and integrity of retinal layers within the PPA area were analyzed.

Results: The most common border tissue configuration was externally oblique type (96%) in young myopic eyes with PPA and internally oblique type (54%) in young emmetropic eyes without PPA, respectively (P < 0.001). The clinically detected temporal optic disc margin most commonly coincided with border tissue (52%) in young myopic eyes with PPA, whereas it most commonly coincided with Bruch's membrane (66%) in young emmetropic eyes without PPA (P < 0.001). The retinal layers were more commonly impaired in the young myopic eyes with PPA than in the young emmertopic eyes without PPA (P < 0.001). There was no difference in temporal optic disc margin anatomy between aged emmetropic eyes with PPA and young emmetropic eyes without PPA (P > 0.05), except for the integrity of photoreceptor layer (P < 0.001).

Conclusions: Myopia and aging showed different structural changes in temporal optic disc margin anatomy within the PPA area. This finding implies that different mechanisms may underlie myopic and age‐related PPA development.


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GLAUCOMA DRAINAGE DEVICE EROSION REPAIR WITH AMNIOTIC MEMBRANE IN COMBINATION WITH SCLERA PATCH

J. Farrah, M.R. Kursiah, M.S. Ahmad

Ophthalmology Department, Hospital Sultanah Bahiyah, Alor Setar, Malaysia

Introduction: In glaucoma drainage device (GDD) surgery, tubal exposure is a known complication and potentially results in vision‐threatening ocular infection. Donor materials such as pericardium and sclera have been routinely utilized during GDD surgery. In this report, we will present a promising result in managing GDD tubal exposure in unhealthy conjunctiva secondary to multiple past local ocular surgeries using amniotic membrane in combination with sclera patch.

Method: Case report

Result: A 40 year old man was diagnosed as Juvenile Open Angle Glaucoma (JOAG) in year 2000 and had undergone bilateral trabeculectomy twice and bilateral phacoemulsification with posterior intraocular lens implantation. When his right eye second trabeculectomy failed in April 2008, GDD with pericardium patch was implanted. 6 weeks post surgery, noted a small area of tubal exposure. The exposure was then covered with host inferior conjunctiva patch. 5 months later again he had tubal exposure with increased IOP secondary to tubal blockage by exudates. He had undergone right GDD tube repositioning with cornea patch. 9 days post surgery a small tubal exposure noted with leakage and hypotony. The tubal exposure then closed with amniotic membrane in combination with sclera patch and we see good and fast conjunctival growth over the patched area until today.

Conclusion: We advocate the use of amniotic membrane with sclera patch in the repair of GDD tube erosions in patients for whom local conjunctiva is of variable quality or limited supply.


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CHANGE IN CORNEAL ENDOTHELIAL CELL DENSITY AFTER AHMED GLAUCOMA VALVE IMPLANTATION AND TRABECULECTOMY WITH MITOMYCIN‐C

E.‐K. Lee1, C.‐S. Kim2, K.‐S. Shin2

1Ophthalmology, Eyelove Eyeclinic, 2Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea

Aims: To compare the change in corneal endothelial cell density (ECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy with mitomycin‐C.

Methods: We prospectively investigated the change in corneal ECD after AGV implantation and trabeculectomy with mitomycin‐C. Forty four cases of Trabeculectomy with mitomycin‐C application and 38 cases of AGV implantation were enrolled to this study. Central corneal ECD was collected from each subject using non contact specular microscopic examination before surgery, and at 1, 6, 12 months after surgery.

Results: Average intraocular pressure and number of anti‐glaucoma medication were greater in AGV group than trabeculectomy group (p< 0.05). Average ECD before surgery showed no difference between 2 groups (p=0.121). The average ECD was significantly different from baseline value at all time intervals after surgery in both groups (p< 0.05). In addition, the ECD count was significantly different between 2 groups after surgery in trabeculectomy group and AGV group, respectively. The average decrease of ECD was 4.0% at 1 month, 5.8% at 6 months, and 6.1% at 12 months after surgery in trabeculectomy group, while it was 4.6%, 8.6%, and 12.6% respectively in AGV group, and the change was significantly greater in AGV group at all time intervals after surgery (p< 0.05).

Conclusions: The change in ECD was greater in AGV group compared to the trabeculectomy group from 1 month to 12 months after surgery, and the difference became greater as follow up duration increased up to 1 year after surgery.


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COMPARISON OF SWEPT‐SOURCE OCULAR COHERENT TOMOGRAPHY AND ULTRASOUND BIOMICROSCOPY FOR MEASUREMENTS OF ANTERIOR CHAMBER DEPTH IN PATIENTS WITH PRIMARY ANGLE CLOSURE OR ITS SUSPECT

Y. Otori

Ophthalmology, Osaka National Hospital, Osaka, Japan

Purpose: To compare the anterior chamber depth (ACD) measurements obtained with swept‐source optical coherence tomography (SS‐OCT) and ultrasound biomicroscopy (UBM) of primary angle closure (PAC) and PAC suspect in Japanese patients.

Patients and methods: This was a cross‐sectional study of PAC patients and PAC suspects who visited Osaka National Hospital. Thirty eyes of 16 patients (10 women, 6 men) with PAC or PAC suspect (age 64.9 ± 12.6 years) were enrolled in this study. The ACD was measured first with SS‐OCT (CASIA SS‐1000, Tomey) and then with 40MHz‐UBM (UD‐6000, Tomey). Mean values were compared by using a paired t test and the Bland‐Altman method was used to evaluate the agreement between the two methods.

Results: The mean ACDs measured with SS‐OCT and UBM were 1.90 ± 0.36 mm and 1.91 ± 0.38 mm, respectively, indicating a difference that was not statistically significant (P=0.62) and positive linear correlation between the two methods (r2=0.98). The Bland‐Altman plots showed no distorting tendency for either variable.

Conclusion: ACD measurements obtained with SS‐OCT and UBM for patients with PAC or PAC suspect showed excellent correlation between the two systems.


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REPRODUCIBILITY OF PERIPAPILLARY RETINAL NERVE FIBER LAYER THICKNESS MEASURED BY SPECTRAL‐DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN PSEUDOPHAKIC EYES

G.A. Kim1, J.H. Kim1, K.T. Ma2, C.Y. Kim3, G.J. Seong3

1Siloam Eye Hospital, 2Jeil Eye Clinic, 3Severance Hospital, Seoul, Republic of Korea

Introduction: It is unknown whether intraocular lens implantation have any influence on the reproducibility of Cirrus optical coherence tomography (OCT).

Objective and aim: To assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurement by spectral‐domain Cirrus OCT in pseudophakic eyes.

Methods: Two hundred fifty eyes from 250 participants (glaucoma suspect and glaucoma patients) underwent two repeated Cirrus OCT scans to measure RNFL thickness (optic disc cube 200 × 200). All eyes were classified as media clear (100 eyes), pseudophakic (60 eyes), and cataract (90 eyes) groups. Intraclass correlation (ICC) was calculated as indicators for RNFL measurement agreement. Inter‐scan measurement difference among 3 groups was compared using analysis of variance (ANOVA).

Purpose: The reproducibility of RNFL thickness measurements was compared between 3 groups.

Results: ICC showed excellent reproducibility in all 3 groups (ICC =0.992 (0.989‐0.994) in media clear group, ICC = 0.992 (0.986 ‐ 0.996) in pseudophakic group, and ICC = 0.990 (0.985 ‐ 0.993) in cataract group). Although ICC value in pseudophakic group was slightly higher than that in cataract group, they did not reach statistical significance. Inter‐scan measurement difference between 2 repeated scans were significantly higher in cataract group compared to media clear and pseudophakic groups. (P = 0.042 in ANOVA)

Conclusions: Agreement of RNFL measurement between 2 repeated Cirrus OCT scans in pseudophakic eyes was as good as that in clear media eyes. More studies will be required to ascertain the effect of lens status on reproducibility of Cirrus OCT according to different stages of glaucoma patients.


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FACTORS AFFECTING STABLE REFRACTIVE ERROR AFTER CATARACT SURGERY IN PATIENTS WITH ACUTE PRIMARY ANGLE CLOSURE

J.‐W. Park, S.‐W. Park

Department of Ophthalmology, Chonnam National University Hospital, Gwangju, Republic of Korea

Purpose: To determine preoperative factors related to refractive outcomes after cataract surgery in patients with a history of acute primary angle closure (APAC).

Methods: We retrospectively reviewed the medical records of patients having a history of APAC and then undergoing cataract surgery between 2007 and 2012. The difference between target refraction and 6 weeks postoperative spherical equivalent is within ±0.5D in the stable refractive error group and more than ±0.5D in the unstable refractive error group. We compared age, sex, visual acuity, refractive error, IOP, duration of acute attack (time interval between onset of symptoms and reduced IOP below 21mmHg), history of laser iridotomy and iridoplasty, axial length, C/D ratio, and use of capsular tension ring between two groups.

Results: Among the 50 patients, 19 were classified into stable refractive error group and 31 were classified into unstable refractive error group. Myopic/hyperopic shift was observed in 8/11 eyes in the stable group and 12/19 eyes in the unstable group, respectively. In the univariate logistic regression analysis, duration of acute attack, pre‐ and post‐ operative visual acuity, and preoperative astigmatism were associated with refractive stability after cataract surgery in patients with APAC history. However, duration of acute attack was only statistically significant factor in the multivariate analysis.

Conclusions: Shortening time between the onset of acute attack and resolution can improve the refractive stability and cause good outcome after cataract surgery in patients with a history of APAC.


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REVERSIBLE VISUAL LOSS CAUSED BY COMBINATION THERAPY OF ALFUZOSIN AND FINASTERIDE IN A PATIENT WITH UVEITIC GLAUCOMA

H.J. Lee, J.W. Lee

Ophthalmology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea

Aims: To report a case of ischemic optic neuropathy caused by medication for benign prostatic hyperplasia (BPH).

Methods: The medical record of a patient who experienced gradual visual loss during the BPH medication was retrospectively reviewed.

Results: A 60‐year‐old man who had uveitic glaucoma, presented with gradual decrease of visual acuity in the left eye over 3 months. There were no signs of increased IOP or recurrence of uveitis; however, the best‐corrected visual acuity of the left eye had decreased from 20/20 to 20/70. Decreased color vision and a relative afferent pupillary defect were present in the left eye. The patient had been taking a combination regimen of alfuzosin and finasteride for the past 6 months to treat BPH. He reported experiencing frequent episodes of dizziness after starting the BPH medication. Under the impression that he had ischemic optic neuropathy due to systemic hypotension caused by the medication, we switched his regimen to a monotherapy of tamsulosin. After 1 month, the visual acuity and color vision of the left eye was recovered.

Conclusions: Optic nerves affected by glaucoma may be more vulnerable to systemic hypotension, resulting in an increased risk of further ischemic injury. Drugs that can induce systemic hypotension should be prescribed with caution to glaucoma patients.


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COMPARISON OF GOLDMANN APPLANATION TONOMETER (GAT) WITH ICARE REBOUND TONOMETER (RBT) FOR EVALUATION OF INTRAOCULAR PRESSURE (IOP) VALUES IN GLAUCOMA PATIENTS AT THAMMASAT HOSPITAL

H. Sripairot, M. Makornwattana, N. Srisamran, A. Prutthipongsit

Ophthalmology Department, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand

Introduction: IOP is one of the most important risk factors in glaucoma patients. GAT is the current standard instrument for IOP measurement, however, it is difficult to be used in children or uncooperative patients. Recently, RBT has been developed. Without topical anesthesia, IOP measurement by RBT is more comfortable than GAT.

Objective: To compare IOP values measured by GAT and RBT in glaucoma patients.

Methods: IOP of 82 glaucoma subjects were measured by RBT. After that, 0.5 % of tetracaine eye drop was instilled. IOP measurement performed again by both GAT and RBT.

Result: One hundred and sixty four eyes were classified into 2 groups (IOP< 21 mmHg and IOP≥21 mmHg). In less‐than‐21 mmHg group, IOP values from GAT and RBT were 13.62 ± 3.85 mmHg and 13.51 ± 4.88 mmHg respectively. IOP values of GAT and RBT in more‐than‐ or equal‐to‐21 mmHg group were 26.56 ± 8.36 mmHg and 24.69 ± 9.68 mmHg, respectively. Less‐than‐21 mmHg group showed mean difference between GAT and RBT about 0.12 ± 3.92 mmHg (P=0.72). More‐than‐ or equal‐to‐21 mmHg group showed mean difference between GAT and RBT about 1.88 ± 5.52 mmHg (P=0.06). IOP values of RBT with and without topical anesthesia showed the mean difference about 0.037 ± 2.64 mmHg (P=0.86).

Conclusion: No significant difference of IOP values between GAT and RBT in both groups. However, more‐than‐ or equal‐to‐21 mmHg group showed more deviation. Using RBT with and without topical anesthesia, there was no significant difference in IOP values between 2 methods.


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INTERMITTENT GLAUCOMA

R. Kurniawan, H. Rasyidin


Introduction: Intermittent angle closure is a condition characterized by episodes of blurred vision, halos, and mild pain caused by elevated IOP. Incidence of intermittent glaucoma tends to be higher in women than men, commonly after 40 years. Treatment options in intermittent glaucoma are laser iridectomy, Iridoplasty, trabeculectomy, or lens extraction.

Objective: To report a case of intermittent glaucoma.

Methods: A 46‐year‐old female patient came to the DR M Djamil Hospital Padang on February 12th, 2011 with a chief complaint: red was often in the right eye, accompanied by recurrent and intermittent headaches since ± 3 weeks before. Right eye vision began to blur and like seeing rainbows around lights. Right eye visual acuity 5/60, the COA is rather shallow, relative clear lens, IOP 50.6 mmHg, funduscopy obtained comparison cup/disc 0.7 to 0.8. Gonioscopy: Narrow chamber angle in grade 1. Perimetry: Superior inferior arquata. OCT showed visible nerve fiber layer defect in the inferior and nasal. The left eye examination was normal condition. Patient was diagnosed as intermittent glaucoma in the right eye.

Results: Trabeculectomy was performed on 14th February 2011. Three days after surgery right eye visual acuity was 5/20, good condition bleb, IOP 22 mmHg. Three months follow‐up, visual acuity 5 / 20, good bleb, IOP 18 mm Hg.

Conclusions: Intermittent glaucoma diagnosis was based on episodic symptoms, intraocular pressure increment, and physiologic & anatomic changes of the optic nerve.


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IS CENTRAL CORNEAL THICKNESS ASSOCIATED WITH OPEN‐ANGLE GLAUCOMA IN THE JAPANESE POPULATION?

S. Kimura1, K. Ono1, A. Murakami2

1Juntendo Tokyo Koto Geriatric Medical Center, 2Juntendo University Hospital, Tokyo, Japan

Purpose: To investigate the association between central corneal thickness (CCT) and the presence of open‐angle glaucoma (OAG).

Participants and methods: All participants were recruited at Juntendo Tokyo Koto Geriatric Medical Center from April 2011 to March 2012. Subjects with a history of ocular surgery in the right eye were excluded. In this retrospective observational case comparison study, the association between CCT measured with a specular microscope (SP‐9000, Konan Medical, Tokyo) and the presence of OAG was calculated by logistic regression analysis. The age, sex, objective refraction, and axial length were selected as confounders, but use of prostaglandin (PG) ophthalmic solution was excluded from statistical analysis. STATA11 software (STATA Corp., Texas) was employed for statistical analysis. This study was approved by the institutional review board.

Results: Four hundred and eighty two eyes of 482 subjects were included in this study. The mean (standard deviation) CCT was 550.8 ± 43.5 mm (median: 550 mm). The odds ratio for CCT (per 50 mm) was 1.45 (95% confidence interval [CI]: 1.02‐2.04). This odds ratio was still significant [1.42 (95% CI: 1.01‐2.33)] after adjusting for all of the confounders.

Conclusion: Our study showed a significant association between a decrease of CCT and the presence of OAG. However, PG therapy might have contributed to the reduction of CCT in OAG patients.


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CHANGES IN CORNEAL BIOMETRY AFTER SELECTIVE LASER TRABECULOPLASTY

J.W.Y. Lee1, J.S.M. Lai1, J.C.H. Chan2

1The Eye Institute, The University of Hong Kong, 2Department of Ophthalmology, Queen Mary Hospital, Hong Kong, Hong Kong S.A.R.

Purpose: To investigate the changes in central corneal thickness, endothelial cell count, and refraction after a single session of selective laser trabeculoplasty (SLT) for primary open angle glaucoma (POAG).

Patients and methods: In this prospective study, patients with POAG received a single session of SLT delivered in a single burst mode to 360° of the trabecular meshwork and energy was titrated from 0.8mJ until bubble formation was just visible. The following parameters were measured pre‐SLT and 1 week and 1 month post‐SLT: central corneal thickness via videokeratography, endothelial cell count via specular microscopy, and spherical equivalent via autorefraction. A one‐way ANOVA with Tukey´s Multiple Comparison Test was performed for all time points in each parameter. Statistical significance was defined as p< 0.05.

Results: In 29 eyes of 17 patients, there were 15 left eyes and 14 right eyes. The mean number of SLT shots was115.6±26.4 with a mean energy of 1.0±0.05mJ. The mean endothelial cell count significantly decreased from 2512±422.4 at baseline to 2340±442.8 at 1 week, and significantly regained to 2495±454.8 at 1 month post‐SLT. There was no significant difference between the baseline and 1 month endothelial cell count. There were no significant differences in the central cornea thickness nor spherical equivalent at the various time points pre and post‐SLT.

Conclusion: SLT may induce a transient reduction in specular microscopy measured endothelial cell count at 1 week post‐SLT was a gradual regain to baseline levels, possibly accounted for by a reversible endothelial cell edema.


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OCULAR HYDRODYNAMIC SIMULATOR ‐ A DIGITAL MODEL

M.‐C. Huang1, T.‐J. Wang1, J.‐D. Ho1, T.‐H. Lee2, P.‐Y. Lee1, J.‐C. Dai+, D.‐J. Chen2, C.‐H. Tsai1

1Ophthalmology, Taipei Medical University, Taipei Medical University Hospital, 2Mechanical & Electro‐mechanical Engineering, Tamkang University, Taipei, Taiwan R.O.C.

Introduction: Elevated intraocular pressure (IOP) is a well‐known risk factor for the development of glaucomatous optic neuropathy. Clinically available measurements of intraocular pressure are indirect and can be affected by corneal condition like thickness, transparency, curvature and aging. Given the difficulty of directly measuring the intraocular pressure of the eye, an experimental digital model of ocular hydrodynamics has been established based on finite element analysis.

Aims: The goal of this study was to characterize the pressure distribution of the eye in the development of glaucoma using computer modeling techniques. Disclosing the hydrodynamic changes in glaucoma may provide additional information for practitioners in disease management.

Methods: The intraocular pressure of normal and glaucoma models was calculated with a finite element method numerical model. The data was then compared with the real conditions of disease and verify the feasibility of simulation of the eyeball model.

Results: The calculated intraocular pressure of normal and glaucoma models shows similar reading with clinical data. The highest intra‐ocular pressure present near the ciliary body in glaucoma model and passes backward to optic disc, causing optic injury.

Conclusions: The different pressure gradient inside the eyeball shows that the pressure is lower in the posterior pole than anterior chamber. This may imply that the threshold pressure of optic injury may lower than we thought before. The ocular digital model could be helpful in evaluating ocular hydrodynamic condition and clarifying the role of intraocular pressure distribution in the development of glaucoma.


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CORTICAL RESPONSES FOR GLAUCOMATOUS VISUAL FIELD DEFECTS WITH FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI)

M. Kato1, M. Yoshida1, M. Ida2, T. Nakano1, C. Boucard1, T.H. Nguyen3, A. Abanou3, T. Noda4, E.A. Cabanis5, H. Tuneoka1

1Ophthalmology, The Jikei University, 2Radiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo, Japan, 3Neuro‐Imaging, C.H.N.O. des XV‐XX, Paris, France, 4Ophthalmology, National Tokyo Medical Center, Tokyo, Japan, 5Académie Nationale de Médicine, Paris, France

Purpose: Visual field is essential tool to estimate various stages for glaucoma. Despite of evolution of optical coherence tomography (OCT), more objective exploration is needed to estimate visual field sensitivity. Functional magnetic resonance imaging (fMRI) is well established noninvasive technique that cans measure cortical response with high spacial resolution. We performed fMRI to estimate cortical response for glaucoma patients with two different visual stimuli.

Materials and methods: Three Glaucoma patients were recruited with informed consent. All functional data were acquired using GE EPI sequence with 2mm isotropicvoxel. T1 weighted anatomical images was succeeded with 1mm isotropicvoxel. All acquisitions were realized by using 3T clinical scanner. In order to definite cortical retinotopy, rotating wedge shaped stimuli and expanding ring stimuli were used for all patient. Cortical responses were estimated by means two types of checkerboard stimuli. Cortical responses were extracted respecting retinotopic organization. The data were analyzed with the Brain Voyager software.

Results: fMRI signals of each retinotopic areas were respected with visual field sensitivity for three glaucoma patients.

Conclusion: Our results suggest that our technique can estimate glaucomatous visual field defect objectively.


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ABILITY OF NON‐OPHTHALMOLOGIST DOCTORS TO DETECT EYES WITH OCCLUDABLE ANGLES USING THE FLASHLIGHT TEST

C.P.B. Gracitelli1, B. Landgren1, F.B. Graciani2, A.K.S. Sousa1, A. Paranhos Jr.1, T.S. Prata1

1Ophthalmology, 2Gynecology, Unifesp, São Paulo, Brazil

Introduction: Angle‐closure glaucoma is responsible for half of those who are blind from the disease. Different types of systemic medications may trigger an acute attack in eyes with predisposing.

Objective/purpose: To assess the ability of non‐ophthalmologist doctors to detect eyes with occludable angles using the flashlight test (FLT).

Methods: A total of 45 patients were prospectively enrolled. After a complete ophthalmological examination, those with any ocular disease other than glaucoma or previous ocular surgery were excluded. All patients underwent FLT by two non‐ophthalmologist examiners in a masked and standardized fashion. Two gynecologists were chosen, as they often deal with patients exposed to drugs that can trigger pupillary block. An occludable angle was defined as ≥ 2 quadrants in which the posterior trabecular meshwork was not visible by gonioscopy without indentation (performed by an experienced glaucoma specialist). Whenever both eyes were eligible, one was randomly selected for analysis. Values of sensitivity and specificity for detection of occludable angles were generated, and the agreement between examiners was assessed.

Results: Mean age was 47.1±16.41 years and most patients were women (67.7%). There was a good agreement between observers for FLT results (Kappa= 0.77 p=0.04). Similar values of sensitivity and specificity were found for the two examiners (92% and 67% vs 97% and 67%, respectively).

Conclusion: FLT showed good sensitivity to detect eyes with occludable angles. The fact that it can be easily and reliably performed by non‐ophthalmologist doctors highlights its use as a screening tool in patients requiring medications that can induce angle‐closure.


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EFFECT OF WEARING A TIGHT NECKTIE IN ANGLE CLOSURE EYES

M. Bordoloi1, A. Prutthipongsit1, N. Srisamran1,2,3, M. Makornwattana1

1Ophthalmology, Thammasat Hospital, Thammasat University, Rangsit, 2Clinical Instructor, Glaucoma Unit, Rajavithi Hospital, 3Glaucoma Consultant, Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand

Background: A tight necktie can influence intraocular pressure (IOP) in patients with primary open angle glaucoma. Mechanism of venous congestion of head and neck can cause elevation of episcleral venous pressure thus raising the IOP.

Objective: To determine IOP changes in patients with angle closure and a tight necktie wear.

Aim: To estimate IOP change after wearing a tight necktie in primary angle closure suspects (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG).

Method: A total of 27 eyes of 27 patients were included (PACS=5, PAC=11, and PACG=11). IOP was measured at baseline. A necktie was fastened around the neck of each participant and tightened until it caused a moderate discomfort. IOPs were measured at 3 minutes and 15 minutes after necktie wear. Necktie was then removed and IOP was measured again after 3 minutes. IOP measurements were performed using the Goldmann applanation tonometer.

Results: The study population showed a decrease in mean intraocular pressure of 0.63 mm of Hg (0.19)(range‐6 to +3) after 3 minutes of wearing the tight necktie. The mean intraocular pressure then increased by 0.30 mm of Hg (p=0.52)(range‐4 to +6) after 15 minutes of necktie wear. On removal of the necktie the mean intraocular pressure further increased by 0.04 mm of Hg(p=0.87) (range‐2 to +2) after 3 minutes.

Discussion: The change in mean IOP was not statistically significant.

Conclusion: Tight necktie wear does not change IOP significantly in patients with angle closure.


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AHMED GLAUCOMA VALVE BI‐PLATE FAILURE IN REFRACTORY GLAUCOMA: A CASE REPORT

P.C. Allarey, P.T.K. Chew

Ophthalmology, National University Hospital, Singapore, Singapore

Purpose: Glaucoma drainage devices (GDD) have been the focus of interest of many different researches because of their effectiveness as a primary or secondary treatment option especially in cases of refractory glaucoma. The bi‐plate Ahmed glaucoma valve (AGV) was introduced in 1999 to provide a larger surface area and lower intraocular pressure. However, there were only few reports on their use, long‐term outcome, and causes of failure. We aim to report a case of failed biplate AGV and to determine the cause of failure.

Methodology: We reviewed the case of a 24‐year old male patient who presented with refractory juvenile glaucoma with failed biplate AGV. Surgery was done to remove bleb adhesions and check the patency of the Ahmed tubes. The non‐functioning plate was removed and sent to pathology for evaluation. A new AGV implant was placed.

Results: Bleb adhesion and fibrosis were noted and patency of the main plate was re‐established. The second plate of the AGV was noted to be blocked and non‐functioning. Histpathology report revealed blockage of the tube with fibrous tissue associated with some macrophages, scattered chronic inflammatory cells, and some birefringent and refractile material.

Conclusion: In spite of a larger surface area offered by bi‐plate AGVs, tube blockage by fibrous tissue and inflammatory cells of the second plate may defeat its purpose and cause GDD failure.


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THE CORRELATION OF GLAUCOMATOUS STRUCTURAL DAMAGE BETWEEN CIRRUS HD‐OCT, AND HUMPHREY MATRIX 30‐2 TEST AND HUMPHREY FIELD ANALYZER

M. Kubota, T. Nakano, S. Ogawa, Y. Ito, H. Matsuda, T. Noro, H. Tsuneoka

Ophthalmology, The Tokyo Jikei University, Tokyo, Japan

Purpose: To compare the performance of Humphrey Matrix 30‐2 test and Humphrey Field Analyzer 30‐2 using Cirrus HD‐OCT in detecting glaucomatous structural damage.

Methods: This study examined 70 eyes of 36 patients, including 22 eyes with normal‐tension glaucoma (NTG), 2 eyes with primary open angle glaucoma (POAG), 10 eyes with ocular hypertension (OHT), 19 eyes with pre‐perimetric glaucoma (PPG) and 17 eyes normal. All patients underwent Humphrey Field Analyzer 30‐2 SITA‐standard (HFA), Humphrey Matrix 30‐2 FDT threshold (Matrix) and Cirrus HD‐OCT disc cube. Matrix mean deviation (MD), pattern standard deviation (PSD), and HFA MD, PSD, and OCT retinal nerve fiber layer (RNFL) thickness were measured. The correlation between Matrix or HFA and average RNFL thickness were analyzed using Spearman correlation coefficient(r).

Results: The mean time‐intervals were: 3.2±2.9 months between OCT and HFA, 2.4±2.8 months between OCT and Matrix, and 2.4±1.9 months between HFA and Matrix. Matrix MD and PSD were found to be highly correlated with those of HFA (r=0.52 and 0.67, respectively). The correlation coefficients between Matrix and average RNFL thickness were significant in both MD and PSD (r=0.43 p=0.0002 for MD; r=‐0.40 p=0.0005 for PSD). The correlation coefficients between HFA and average RNFL thickness were significant in PSD but not in MD (r=0.16 p=0.16 for MD; r=‐0.43 p=0.0004 for PSD).

Conclusions: Matrix seems to be valuable to detect the glaucomatous structural damage at the earlier stage than HFA for early glaucoma and PPG.


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NEEDLE REVISION OF FAILED BLEBS WITH SUBCONJUNCTIVAL BEVACIZUMAB AND 5‐FLUOROURACIL INJECTION: A COMPARATIVE CASE SERIES

P. Ichhpujani1, S. Bhartiya2

1Ophthalmology, Government Medical College and Hospital, Chandigarh, 2Ophthalmology, Fortis Memorial Research Institute, Gurgaon, India

Purpose: To compare the Intraocular pressure (IOP) lowering efficacy and complications of single transconjunctival bleb needling for failed blebs following trabeculectomy using bevacizumab versus 5‐fluorouracil (5‐FU).

Methods: Forty three eyes of patients with bleb failure were randomly assigned to receive either 5‐FU or bevacizumab. Twenty two eyes received subconjunctival Bevacizumab (1.25mg/0.1mL) while 5‐FU (5mg/0.1 ml) was injected in 23 eyes, post needling. IOP, bleb appearance and complications were noted for each group. Success was defined as complete if the IOP was 21mmHg or less without any antiglaucoma medication or surgical intervention at the last visit, and qualified if the IOP was 21mmHg or less with a single medication. Mean follow up was 10±3.2 months (range: 9‐19 months).

Results: The IOP dropped in the bevacizumab group on the first postoperative day from 34.2±5.2mmHg to 15.3±2.6mmHg. The IOP was less than 21mm Hg in 3 (13.63%) patients without medication and controlled with a single topical antiglaucomatous drops in 5 (22.72%) patients. Success was not achieved in 14 (63.63%) eyes. In the 5‐FU group, on the first postoperative day IOP reduced from 31.0±4.9mmHg to 11.8±3.6mmHg. 13 (56.52%) and 5 (21.73%) eyes had complete and qualified success, respectively. A statistically significant difference between groups in terms of success rates was observed (P=0.036). No major perioperative complications were noted.

Conclusions: Subconjunctival 5‐FU scores over bevacizumab for needling procedures in failed trabeculectomy blebs.


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THE USE OF MODERN IMAGING TO DIAGNOSE AND ASSESS TREATMENT EFFICACY IN NARROW ANGLE GLAUCOMA

J. Gayton, R.N. Sanders, R. Seabolt

Eyesight Associates, Warner Robins, GA, USA

Purpose: To utilize anterior segment imaging capabilities of the Zeiss® Cirrus™ HD‐OCT and the Haag‐Streit Lenstar LS 900® in order to examine efficacy of lensectomy as primary therapy for alleviating narrow angles.

Methods: Patients appearing to have narrow angles on slit‐lamp examination had anterior chamber scans performed with HD‐OCT to confirm the diagnosis. Lensectomy or Nd‐YAG laser peripheral iridotomy (LPI) was then considered for each patient. For lensectomy patients, biometry for intraocular lens implant calculation was obtained with the Lenstar®. Following surgery, patients were re‐imaged and measured. Qualitative analysis of HD‐OCT images was possible for all patients and quantitative analysis of anterior chamber depth was possible for lensectomy patients.

Results: Little apparent change was noted on anterior chamber angle OCT following LPI. In all patients examined, lensectomy resulted in visible widening of the angle seen on OCT as well as a measured increase in anterior chamber depth on the Lenstar®.

Conclusions: Lensectomy is efficacious for opening narrow angles and increasing anterior chamber depth. LPIs appear to work well in some cases and not in others. Due to inconsistencies in results of LPIs, as well as advances in technology and safety for lens surgery, lensectomy is an adequate primary therapy for patients with narrow angles.


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EFFECT OF CATARACT SURGERY ON INTRAOCULAR PRESSURE IN EYES WITH PRIOR SUCCESSFUL TRABECULECTOMY

S. Kuroda

Nagata ey Clinic, Nara, Japan

Objective: To examine the effect of cataract surgery after successful trabeculectomy on intraocular pressure(IOP) control.

Participant: Eighteen patients(18eyes) who underwent phacoemulsification and implantation of intraocular lens after successful trabeculectomy.

Results: The mean IOP(±standard deviation) before cataract surgery was 13.7±2.0mmHg and 13.4,14.1,12.6,13.3mmHg,after 1,3,5,7 years. The success rate of maintaining preoperative IOP control was 83,55,49,49% at 1,3,5,7 years, respectively (Kaplan‐Meier survival analysis).

Conclusion: When cataract surgery is performed after successful trabeculectomy, the rate of maintaining preoperative IOP control is about 50% at 5 years.


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CHALLENGES IN GLAUCOMA MANAGEMENT AFTER BOSTON TYPE 1 KERATOPROSTHESIS AND AHMED VALVE IMPLANTATION: ONE YEAR FOLLOW UP

S.P. Ayuningtyas, V.D. Oktariana, J. Hutauruk, T. Rahayu

Ophthalmology Department, Faculty of Medicine University of Indonesia, Jakarta, Indonesia

Introduction: Boston type 1 Keratoprosthesis (Kpro) offers an alternative technique to improve vision in patients with multiple graft failures. However, postoperative management is challenging, including management of glaucoma as one of the most common complication of KPro patients (15 to 38 %).

Objective and methods: This case report demonstrate the management of glaucoma after Boston KPro and Ahmed valve implantation which results in a good visual outcome and well controlled IOP.

Results: A 44 years old male, had a Boston type 1 KPro and Ahmed valve implantation in the right eye for corneal graft failure and preexisting glaucoma after penetrating keratoplasty due to corneal opacity in severe Graves ophthalmopathy, with simultaneous three‐wall orbital decompression prior to the implantation. The preoperative VA was light perception with good projection. On two weeks follow up, the uncorrected‐VA improved to 4/60. The funduscopy showed advanced glaucomatous optic nerve with 0.6‐0.7 CD ratio and a tunnel vision seen in the perimetry. A combination of Brinzolamide 1%, Latanoprost and Timol 0.5% was used to controlled the IOP. At 6 months follow up, transcleral cyclophotocoagulation was performed to control the IOP. Until 12 months follow up, the IOP was well controlled with best‐corrected VA of 6/9 and soft contact lens correction power of S ‐ 3.50.

Conclusion: Transcleral cyclophotocoagulation has a beneficial effect in controlling IOP for patients with corneal graft failure and refractory glaucoma after Boston type 1 KPro and Ahmed valve implantation.


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196

LASER PERIFER IRIDECTOMY IN PATIENTS WITH PRIMARY ANGLE CLOSURE IN UNDAAN EYE HOSPITAL IN THE PERIOD OF OCTOBER 2010 TO JULY 2012

L. Nuradianti

Undaan Eye Hospital, Surabaya, Indonesia

Aim: To report laser perifer iridotomy in 296 patients with primary angle closure.

Method: This is descriptif study samples from outpatient´s glaucoma undaan eye hospital check visual acuity, intraocular presssure with tonometer schiotz and non contact aplanation, optical nerve of papil, gonioscopy is already diagnosed with primary angle closure. The laser perifer iridotomy with Argon laser Quantel Medical combine Yag Laser alcon surgical 3000LE has been performed in partially primary angle closure during the period of october 2010 to julyy 2012. Then divided 3 groups, first group normal intraocular pressure without glaucoma medication, second group normal intraocular pressure with glaucoma medication, third group normal intraoccular pressure with reduction glaucoma medication.

Result: There are 501 patients with primary angle closure during the period of october 2010 to july 2012. 296 patients has been performed laser perifer iridotomy (59%), female 206(69,5%) and male 90(30,5%).

Conclusion: Laser perifer iridotomy is very effective in the early stages of primary angle closure.


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197

DIAGNOSTIC ACCURACY OF MACULAR GANGLION CELL‐INNER PLEXIFORM LAYER THICKNESS USING HIGH‐DEFINITION OPTICAL COHERENCE TOMOGRAPHY

Y.J. Choi, J.W. Jeoung, K.H. Park, D.M. Kim

Seoul National University Hospital, Seoul, Republic of Korea

Purpose: To evaluate and compare the diagnostic accuracy of macular ganglion cell‐inner plexiform layer (GCIPL), peripapillary retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) parameters by high‐definition optical coherence tomography (Cirrus HD‐OCT) for detecting early, moderate and severe glaucoma.

Methods: One hundred‐twenty normal subjects and 215 glaucoma patients (128 patients with early glaucoma, 50 with moderate glaucoma, and 37 with severe glaucoma) were enrolled in the present study. Macular GCIPL, peripapillary RNFL thickness, and ONH parameters were measured in each subject. Areas under the receiver operating characteristic curves (AUROCs) were calculated and compared. Based on the internal normative database, the sensitivity and specificity for detecting early, moderate and severe glaucoma were calculated.

Results: Of the ganglion cell analysis (GCA) parameters, the minimum GCIPL had the highest AUROCs for detecting early and moderate glaucoma (AUROC = 0.905 and 0.947, respectively); the inferotemporal GCIPL had the highest AUROC for severe glaucoma (AUROC = 0.982). The AUROC of mimimum GCIPL thickness for early glaucoma was higher than that of the best parameters from RNFL map; however, the difference was not significant (P = 0.43). For detecting early glaucoma, the sensitivity of the Cirrus GCA parameters ranged from 28.1% to 75.2%. The sensitivity of the Cirrus RNFL/ONH parameters ranged from 6.3% to 57.0% and from 50.5% to 63.3%, respectively.

Conclusions: There were no significant differences between the AUROCs for Cirrus GCA, RNFL and ONH parameters, indicating that the these maps have similar diagnostic potentials for glaucoma.


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SEMI‐AUTOMATED COUNTING METHOD OF AXONS IN TRANSMISSION ELECTRON MICROSCOPIC PHOTOS

S. Rho1, C.‐K. Lee2, N. Lee2, S. Hong2, G.J. Seong2, C.Y. Kim2

1CHA Bundang Medical Center, CHA University, Seongnam, 2Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea

Purpose: To evaluate the accuracy of semi‐automated method for axon counting in transmission electron microscopic (TEM) photographs.

Methods: Optic nerve cross‐sections were obtained from both eyes of 13 Sprague‐Dawley rats with unilateral induction of chronic ocular hypertension. Total 260 TEM photos (x3000) were taken and each photo was evaluated with two different methods (manual counting and semi‐automated counting). The assessment was performed by two different observers in a blinded manner. Semi‐automated counting was performed with ImageJ software (particle analysis tool) after image optimization. Statistical significance was assessed by Pearson's correlation coefficient and Bland‐Altman plots using PASW® ver. 18.0 (SPSS Inc., Chicago, IL, USA).

Results: The results of semi‐automated targeted sampling method demonstrated a very strong correlation with manual counting method (Pearson's correlation coefficient r=0.996, p< 0.001). Our method correctly counts axons with an error of 0.45 ± 8.36 % (average ± standard deviation). Mean difference was ‐104.88 ± 203.63 (/12000 µm2) and limits of agreements was between ‐46.02 and 55.98 (/1200 µm2). The average duration of counting time was 629.5±71.6 seconds in semi‐automated method and 3769.5±461.0 seconds in manual method.

Conclusions: Our semi‐automated axon counting with TEM photos had a strong correlation with the manual counting method. And also it has an excellent time‐saving benefit that takes almost 6 times shorter than manual counting method.


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SURGICAL RESULT OF PRIMARY TRABECULECTOMY FOR JUVENILE ONSET OPEN‐ANGLE GLAUCOMA

E. Mahanani1,2, R. Ekantini1, N. Imawati1

1Opthalmology, Gadjah Mada University, 2Opthalmology, Universitas Islam Indonesia, Sleman, Indonesia

Introduction: Juvenile onset open‐angle glaucoma (JPOAG) is a rare form of glaucoma, differs from POAG in its age of onset and often in the magnitude of high IOP elevation, that cannot be treated with only medication.

Objective: To evaluate the surgical outcome of primary trabeculectomy in JPOAG.

Methods: Case reports of two JPOAG. The first was 18‐years old boy. The BCVA 4/60 OD and 6/6 OS, with IOP 60 mmhg OD and 52 OS mmhg controlled by timolol 0,5 % and acetazolamid 250 mg for one month . The second was 22‐years old man. The BCVA 6/12 OD and 6/6 OS with IOP 46 mmHg OD and 16 mmHg OS controlled by timolol 0,5 % and Brinzolamid 1 % for 6 months. Optic nervehead damage and advanced visual‐field loss were present in both patients.

Results: First patient, trabeculectomy was performed on both eyes. IOP reduced from 60 mmHg to less than 4 mmHg. Shallow anterior chamber and subretinal haemorrhages were found in the left eye without any hypotony maculopathy, persisted for 2 weeks postoperatively. Two months after, the BCVA improved to 6/12 OS and 6/6 OS, with IOP 10 mmHg in both eyes. Second patient, trabeculectomy was performed for OD. IOP reduced from 45 mmHg to less than 4mmHg persisted for 1 weeks. After 2 months, the BCVA 6/12 OD and 6/6 OS, but the IOP was still 22 mmHg OD.

Conclusion: Trabeculectomy was a good treatment for this cases of JPOAG. Hypotony was found in this two cases.


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204

ROLE OF SELECTIVE LASER TRABECULOPLASTY IN LOWERING INTRAOCULAR PRESSURE IN OPEN ANGLE GLAUCOMA PATIENTS INADEQUATELY CONTROLLED WITH MEDICATION IN INDIAN EYES

S. Raj, S. Ojha, S.S. Pandav, S. Kaushik

Advanced Eye Centre, PGIMER, Chandigarh, India

Introduction: Role of SLT in OAG.

Objective: To study the effiicacy of SLT.

Aim: To evaluate IOP lowering effect in OAG patients inadequately controlled with medication.

Methods: Prospective Interventional , included 37 eyes (33 patients), 28 males & 5 females, between January 2011 to December 2011. Mean age was 58.64 ± 18.19 years. 25 POAG, 6 SOAG and 2 JOAG patients. Pre and post laser evaluation included visual acuity, slitlamp , , gonioscopy, VF and IOP on first day, 1 week, 1, 3 and 6 months postlaser.

Purpose: IOP reducing efficacy of SLT in OAG.

Results: Main outcome was decreased IOP on Goldmann AT. The mean IOP reduced from 23.78 ± ‐6.38 prelaser to to 14.16 ± 4.10mmHg (40.5%) on day1, 16.95 ± 4.731mmHg (28.6%) on day 7, 17.76 ± 4.77 mmHg (25.2%) at 4 weeks, 18.37 ± 4.40mmHg (22.7%) at 3 months and 17.05 ± 4.032 mmHg (28.2%) at 6 months. Minimum FU was 3 months and mean was 5.17 months. 3 and 6 months FU was completed in 37 eyes and 20 eyes. The medications number was reduced only in 2 patients. 4 patients required GFS after 3 months . At 3 & 6 months , 22 of 37 eyes (59.4%) and 13 of 20 eyes (65%)maintained at least 20% reduction.

Conclusion: SLT is effective and safe as an adjunctive for lowering IOP in patients with OAG inadequately controlled with medication in Indian eyes. It reduces medication, cost of treatment, have better compliance.


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EVALUATION OF THE OPTIC NERVE HEAD BY SPECTRAL‐DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND HEIDELBERG RETINAL TOMOGRAPHY IN DIAGNOSIS OF THE EARLY STAGE GLAUCOMA

A. Shpak, M. Sevostyanova, S. Ogorodnikova

Clinlcal & Functional Diagnostics, The S. Fyodorov Eye Microsurgery Complex ‐ Federal State Institution, Moscow, Russia

Introduction: The new Cirrus HD‐OCT software (5.2.0.210) measures the optic nerve head (ONH) as well as the retinal nerve fiber layer (RNFL) parameters. Few studies compared the value of ONH measurements by Cirrus HD‐OCT and HRT 3 in primary open‐angle glaucoma (POAG) diagnosis.

Purpose: To study the diagnostic value for POAG detection of the ONH measurements by Cirrus HD‐OCT in comparison with other ONH and RNFL measurements by Cirrus HD‐OCT and HRT 3 performed earlier.

Methods: The new Cirrus HD‐OCT software was used to measure ONH and RNFL parameters of 60 patients (60 eyes) with initial POAG and 58 healthy controls (58 eyes), examined also on HRT 3. Data of subjects examined earlier on Cirrus HD‐OCT and HRT 3 were re‐analyzed by the new software. The area under the ROC‐curve (AUC) and sensitivities at fixed specificities 80 and 95% were used for comparison.

Results: Analogous ONH measurements by Cirrus HD‐OCT and HRT 3 showed similar sensitivities and AUCs. Only Rim area measured by Cirrus HD‐OCT demonstrated much higher sensitivities and AUC as compared to HRT 3. Rim area was the single ONH parameter significantly correlated to RNFL thickness in healthy controls.

Conclusions: Rim area measurements by Cirrus HD‐OCT as compared to HRT 3 provides for better detection of the early stage POAG. It may be explained by the specific algorithm used by Cirrus HD‐OCT for ONH measurements. Other analogous ONH parameters measured by both instruments demonstrated similar diagnostic performance.


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NEEDLING WITH INTRAVITREAL AVASTIN FOR FAILED BLEBS

Y.Y.Y. Kwong1, F.C.H. Li2, C.C.Y. Tham3, D.S.C. Lam3

1Ophthalmology, Hong Kong Eye Hospital, 2Ophthalmology, Prince of Wales Hospital, 3Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong S.A.R.

A prospective, interventional case series to evaluate the clinical outcomes of needling with adjunctive intravitreal avastin is conducted. The results of the study with a mean follow up of 2 years will be presented. Intravitreal avastin appears to be a safe and effective adjunct for needling. Further large‐scale and controlled studies are warranted.


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JUVENILE GLAUCOMA

I. Rahayu, H. Rasyidin

Department of Ophthalmology, University of Andalas / M Djamil Hospital, Padang, Indonesia

Introduction: The description of the clinical and surgical outcomes among younger patients less than 20 years of age who diagnosed with glaucoma in a defined population during before 40 years old.

Objective: To report a case of juvenile glaucoma.

Methods: A 16 years old male suffered from blurred vision and visual field defect in his left eye. Examination revealed a high intra ocular pressure, the visual acuity of the left eye was 5/7, cup disc ratio 0,7 and advance visual field defect.

Results: The combination of topical and anti glaucoma drugs can not lower the intra ocular pressure. Surgery is the last choice but due to the severity of the visual field defect as a high risk for failure, maximal medical treatment as long as it does not affect quality of life is the only choice. During two months follow up intra ocular pressure become normal.

Conclusions: Juvenile glaucoma is a rare case and usually has an underlying disease as the cause of the elevated intra ocular pressure.


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SCHWARTZ‐MATSUO SYNDROME

I. Niani, H. Rasyidin

Department of Ophthalmology, University of Andalas / M Djamil Hospital, Padang, Indonesia

Introduction: Elevated IOP in association with a rhegmatogenous retinal detachment was described by Schwartz. Matsuo later demonstrated photoreceptor outer segments in the aquous humor.

Objective: To report a case of Schwartz‐Matsuo syndrome at Dr. M.Djamil Hospital, Padang.

Methods: A case report study.

Results: A 70 years old, man came to Dr. M. Djamil Hospital Padang with blurred vision of the left eye since 1 year ago. No history of trauma and underlying disease. Visual acuity RE 5/10 and LE 1/60. Both of the lens have posterior subcapsular cataracts. Funduscopy LE c/d 0,5‐0,6 and RE c/d 0,3‐0,4. Gonioscopy showed open angles. He had visual field defects. IOP RE and LE 20,6 mmHg. He had triple procedure of the LE but no improved vision. Indirect ophthalmoscopy showed rhegmatogenous retinal detachment.

Conclusion: POAG, elevated IOP with a rhegmatogenous retinal detachment.


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THE LEVEL OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN TENON'S TISSUE AND THE RESULTS OF GLAUCOMA SURGERY

J.A. Choi1, H.‐Y.L. Park2, J.‐H. Kim2, M.D. Ahn2, C.K. Park2

1Catholic University/St. Vincent Hospital, Suwon, 2Catholic University/Seoul St. Mary's Hospital, Seoul, Republic of Korea

Purpose: To find out the levels of vascular endothelial growth factor (VEGF) in both the aqueous humor and Tenon's tissue in patients with primary open‐angle glaucoma (POAG) and the associations between the VEGF and surgical outcomes of glaucoma surgery.

Methods: Nineteen POAG patients who were scheduled to undergo glaucoma surgery due to uncontrolled intraocular pressure (IOP) and 17 normal controls who were scheduled to undergo cataract surgery were enrolled. At the time of surgery, about 0.1 mL of aqueous humor was collected through an anterior chamber paracentesis and 4 x 4 mm sized Tenon's tissue was cut from the eye. Concentrations of VEGF were analyzed by enzyme‐linked immunosorbent assay. Spearman's correlation and regression analysis were used to assess the relationship with VEGF level to the clinical characteristics and postoperative intraocular pressure (IOP).

Results: The VEGF in Tenon's tissue was significantly elevated in POAG patients compared to the normal controls (p = 0.001). When POAG patients were divided into success or failure group after 1‐year of surgery, VEGF level was significantly higher in Tenon's tissue of the failure group compared to the success group (p = 0.014). The preoperative IOP was signficantly related to the VEGF level in Tenon's tissue in both the univariate (p = 0.001) and multivariate regressions (p = 0.012).

Conclusions: The VEGF level in Tenon's tissue at the time of surgery was significantly related to 1‐year surgical outcomes of glaucoma surgery and it was also significantly associated with the final IOP in POAG patients.


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SHORT‐TERM CHANGES OF INTRAOCULAR PRESSURE AND OCULAR PERFUSION PRESSURE AFTER INTRAVITREAL INJECTION OF BEVACIZUMAB OR RANIBIZUMAB

H.J. Lee, J.W. Lee, Y.G. Kim

Ophthalmology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea

Purpose: The aim of this study was to investigate the effect of intravitreal anti‐VEGF injection on IOP and mean ocular perfusion pressure (MOPP).

Methods: The MOPP results were obtained by measuring mean arterial pressure (MAP) and IOP just before the injection, immediately after the injection, 30minutes, one day and one week after the injection from the 65 eyes of 42 patients.

Results: Pre‐injection mean IOP was 16.66 ± 3.50 mmHg and the mean IOP immediately after the injection, 30 minutes, one day and one week after the injection were 43.81 ± 9.69 mmHg, 17.57 ± 4.44, 15.00 ± 4.21 mmHg, 15.90 ± 3.63 mmHg, respectively. Pre‐injection mean MOPP was 46.39 ± 5.78 mmHg and the mean MOPP immediately after the injection, 30 minutes, one day and one week after the injection were 25.14 ± 8.79 mmHg, 45.87 ± 6.31 mmHg, 46.93 ± 6.25 mmHg, 46.50 ± 4.94 mmHg, respectively.

Conclusion: The instant increase in IOP by the intravitreal anti‐VEGF injection evokes decrease in MOPP, but it is transient. Considering these aspects, instant increase in IOP after the intravitreal anti‐VEGF injection does not cause the significant impairment in retinal blood flow.


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215

ROLE OF COMPREHENSIVE EYE CARE IN DETECTING ANGLE CLOSURE DISEASE IN A COMMUNITY CATARACT SURGICAL PROGRAM

S. Krishnamoorthy1, R. George2

1Community Ophthalmology and Glaucoma Services, 2Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India

Aim: To assess the occurrence and detection of primary angle closure disease in a community based eye care centre in South India.

Method: We retrospectively analyzed records of all 4043 (2.3%) patients who were examined between August and December 2011 in a community cataract surgical program. All patients attending OPD underwent refraction, slitlamp evaluation and Goldmann applanation tonometry followed by dilated fundus examination. Those with suggestive history of glaucoma, raised IOP, VH grade I‐II and or disc or RNFL changes underwent 4 mirror indentation gonioscopy. Of these, eyes with occludable angles underwent Nd‐YAG peripheral iridotomy followed by further treatment.

Result: 173 eyes of 93 patients underwent iridotomy. 82% were between 50 and 70 yrs of age. Only 2 were aware of the disease (2.1%). 40.8% (38/93) had Snellen visual acuity of 6/12 or better.37.3% of them had IOP < 21 in both eyes. 9.3% had a positive history for ACG. 32.25% of them had undetected PACG (17.2% bilaterally).71/173 eyes had PACS and 21.4% of eyes had PAC .23.5% of them were lost for follow up after one post iridotomy visit.

Conclusion: With age, cataract and glaucoma co‐exist and most of the patients are asymptomatic and unaware. This study stresses the need for comprehensive eye examination and timely YAG peripheral iridotomy in community based cataract surgical programs.


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216

NORMO‐TENSION GLAUCOMA AND PRIMARY OPEN ANGLE GLAUCOMA: PATTERN OF DEMOGRAPHIC PROFILE ON FIRST ADMISSION

R. Christine

Ophthalmology, Gadjah Mada University, Jogjakarta, Indonesia

Introduction: Normo‐Tension Glaucoma (NTG) and Primary Open Angel Glaucoma (POAG) are found frequently encountered in Southeast Asia region.Evaluation of changes in the optic disc is crucial for early detection of glaucoma and often precedes visual field loss.

Objective: To describe the frequency of these types of glaucoma and demographic profile comparing NTG with POAG on first admission and to determine common visual field defects and neuroretinal rim thickness in open angle glaucoma patients (NTG and POAG).

Methods: We conducted a retrospective observational review of 120 glaucoma patients on their first admission RSUP Dr.Sardjito in Yogyakarta during January 2011 until December 2011. Data regarding sex and age distribution,refraction status, visual acuity, intraocular pressure,severity of visual field defects, neuroretinal rim thickness and number of glaucoma medications.

Results: 236 eyes from 120 patients were selected for this study,73 (60,9%)patients were diagnosed NTG and 47 (39,1%) patients were diagnosed as POAG.The mean age at NTG (38,6±32 years) was younger than at POAG (55.7±18.3 years).Males and females were no significantly different in number.The mean IOP for patients with NTG were 13,8±4,5mmHg and POAG were 25,4±2,7. There was a tendency towards more severe loss of visual acuity and visual fields among patients with POAG. Neuroretinal rim thickness at NTG was 102±28,5 µm and POAG was 69±16,2 µm. Patients with POAG (1.46 ± 2) tended to get more medications than patients with NTG (0,51±1).

Conclusions: Pattern of demographic profile seem to be different in NTG compared with POAG. Patients with POAG had thinner RNFL and larger CD ratio on their first admission.


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CLINICAL OUTCOME AFTER TRABECULECTOMY: VISUAL ACUITY, IOP REDUCTION, AND ITS COMPLICATION

H.T. Hasibuan

Ophthalmology, Gadjah Mada University, Yogyakarta, Indonesia

Introduction: Intraocular pressure (IOP) reduction by filtering surgery such as trabeculectomy is one of modality to prevent progression of the optic nerve damage.

Objective: To report clinical outcome including visual acuity, IOP reduction, and its post surgery complication in subjects with glaucoma who underwent trabeculectomy at DR. Sardjito General Hospital, from January to December 2011.

Methods: A retrospective study of 27 subjects with glaucoma who underwent trabeculectomy from medical record at Sardjito General Hospital, from January to December 2011. Visual acuity and IOP were carried out from clinical examination at pre‐ and post‐operation visit at 3 months follow up. Data included sex and age distribution, visual acuity, IOP, and its complication.

Results: Of 27 subjects, 14 (52%) male and 13 (48%) female, diagnosed as acute PCAG (n=12, 44.4%), secondary glaucoma (n=7, 25.9%), POAG (n=4, 14.9%), CACG (n=2, 7.4%), absolute glaucoma (n=1, 3.7%), and congenital glaucoma (n=1, 3.7%). After trabeculectomy, visual acuity was still remain unchanged, not significantly different to pre‐operation (logMAR BCVA from 0.22±0.31 to 0.28±0.33; p=0.116). Comparable with pre‐operation, post‐operation IOP was decreased significantly (from 41.07±12.31 to 13.70±5.73 mmHg). Complication was reported on 3 subjects, including shallow anterior chamber and flattened bleb.

Conclusions: Trabeculectomy does not improve visual acuity but only IOP, with manageable complication. The most often complication is shallow anterior chamber.


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PSEUDOEXFOLIATIVE GLAUCOMA: ITS EVOLUTION

N. Husain, T. Sandragasu, J. Mohamed Noor

Department of Ophthalmology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia

Purpose: To discuss a case of pseudoexfoliative glaucoma which evolved from open angle to close angle hence the treatment was tailored accordingly.

Methods: A case report.

Result: A 64‐year old Indian man was first diagnosed to have bilateral pseudoexfoliative glaucoma with open angle in 2004. He also presented with immature cataract, right branch retinal vein occlusion and left age related macular degeneration. His intraocular pressure (IOP) on presentation was 30 mmHg in the right eye with cup to disc ratio (CDR) of 0.5 and 20 mmHg in the left eye with CDR of 0.4. He was initially treated with one antiglaucoma medication and the IOP was stable till 2009. Over the next 2 years the antiglaucoma medications in the right eye were maximised. A repeat gonioscopy in 2011 revealed a narrow angle in the right eye and laser peripheral iridotomy was performed. Subsequently a stage procedure, right phacoemulsification with intraocular lens implantation was done and followed by trabeculectomy/MMC 0.03%, three months later. The IOP and visual field in the right eye are stable postoperatively without any medication.

Conclusion: Pseudoexfoliative glaucoma is an aggressive disease with poor response to medical therapy. This case illustrates its evolution from open angle to close angle and the change in approach to the management. Where filtering surgery is concerned, severe postoperative inflammation is the main factor that has to be dealt with for the survival of the bleb. We suggest a stage procedure of cataract and filtering surgery for a better outcome.


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EPIDEMIOLOGY OF GLAUKOMA IN THE TOMSK REGION (RUSSIAN FEDERATION): PROBLEMS AND WAYS OF PREVENTION

S.A. Zhuykov1, L.D. Zhuykova2, O.I. Krivosheina1, O.G. Shilova1, I.V. Zapuskalov1

1Ophthalmology, Siberian State Medical University, 2Epidemiology, Oncology Research Institute, Tomsk, Russia

Introduction: Early diagnostics is a major condition of the successful glaucoma treatment. 50 % of the patients do not have notion that they are sick and are checking the sight for the first time when 40 % of an optic nerve's functions are irrevocably lost.

Aims: To research the glaucoma's epidemiology in Tomsk region (TR) and to prove ways of its preventive maintenance.

Methods: We are using 2006‐2010 data for TR from the Federal Statistical Survey "Survey on the number of the diseases registered at patients living in area of the medical services”.

Results: In TR the glaucoma takes the 3rd place in the list of the eyes diseases (7.5 for 1000 persons of the population) after a cataract (26.1) and myopia (17.1), that is below than in Russian Federation (8.1) in general. In dynamics, within 5 years the parameters were decreased on 6.4 %. However, the relative density of ophthalmologic patients in the contingents of the recognized invalids in TR is 4.3 % and it is higher on 1.3 % than in the Russian Federation in general.

Conclusions: The personal approach in the definition of a threshold of intraocular pressure which excess is causing the irreversible glaucoma's defeat becomes the actual issue. Preventive work should be focused on formation and monitoring of the glaucoma risk groups , on the attraction of mass media to educate people on the timely vision check and on the utilization of the new forms of work with patients ‐ “School for the Glaucoma's Patient”.


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RARE PRESENTATION OF OPTIC DISC PIT WITH LOCALIZED RETINAL NERVE FIBER LAYER DEFECT AT THE MACULA ‐ GLAUCOMA MIMICKER

R.M. Choudhry

Glaucoma Services, ICARE Eye Hospital & PG Institute, Noida, India

Introduction: Case report of rare optic disc pit presenting with localized retinal nerve fiber layer(RNFL) defect at the macula with corresponding field defect mimicking glaucomatous optic neuropathy.

Aims and objective: To report this unusual presentation of optic disc pit and help distinguish it from early glaucomatous optic neuropathy.

Methods: A 40 year old healthy female was seen for glaucoma suspision.Her vision was 6/6,N6 both eyes. her anterior segment was normal with open angles on gonioscopy and the IOP was 17 mm Hg in both eyes. Fundus examination showed small localized superotemporal notch in the neuroretinal rim of left eye with associated localised RNFL defect superotemporally extending to macula. Right eye nerve was healthy. Visual field testing showed normal field in right eye and localized inferonasal para central scotoma in the left eye. OCT RNFL showed near normal scans both eyes with borderline focal superotemporal thinning of RNFL in left eye. OCT Macula showed normal scans in both eyes.

Results: Atypical macular RNFL defect suggested against the diagnosis of glaucoma and on reevaluation the localized notch looked suggestive of optic nerve pit and the localized corresponding defect in RNFL was attributed to old healed parapapillary retinoschisis in that area.

Conclusions: Optic disc pit can mimick early glaucoma when associated with localized RNFl defect caused by retinoschisis, and should be differentiated from it.


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EPIDEMIOLOGY OF PRIMARY CONGENITAL GLAUCOMA IN A TERTIARY CARE CENTRE IN NORTH INDIA

S. Kaushik1, J. Sharma1, S.S. Pandav1, S. Raj1, M.L. Guptasarma2

1Advanced Eye Centre, 2Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Introduction: Information regarding the patient profile of Primary congenital glaucoma (PCG) in North India is sparse.

Objective: To see the patient profile of PCG in Northern India.

Aims: To study the epidemiology and geographical distribution of PCG presenting to a tertiary care Institute in North India.

Methods: Records of patients of PCG who had presented between Jan 2006 and December 2011 were reviewed. Information regarding age, clinical features at presentation and geographical distribution were analyzed.

Purpose: To get an insight into the disease pattern of PCG in Northern India.

Results: Of 74 patients, 48 (64.9%) were male and 55 (74.3%) had bilateral disease (129 eyes). 4 patients had a sibling with PCG. The geographical distribution was as follows: 48:Punjab; 11:Haryana;8:Himachal Pradesh; 3:UP; 2: Bihar; 1 each: Rajasthan and J&K. The mean age of presentation was 4.5±6.1 months. Those from Haryana presented later compared to all other states (8.8 ±13.2 months). At presentation, mean IOP was 18.2±9.3 mm Hg and mean corneal diameter was 13.3 ±1.8 mm. Haabs' striae was seen in 53 (41.1%) eyes. 71 (55.03%) eyes had clear corneas, and 33 (25.6%) had corneal scarring. 37 (28.7%) eyes had cup‐disc ratio >0.7. The corneal status and IOP at presentation correlated with Haabs' striae, disc damage and number of procedures required to control IOP.

Conclusions: PCG in North India presents fairly early in infancy. Corneal status and IOP at presentation appear to be the most significant prognostic indicators of disease severity.


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ABILITY OF OPTICAL COHERENCE TOMOGRAPHY TO DETECT PROGRESSION IN GLAUCOMA SUSPECTS AND GLAUCOMA PATIENTS

S.V. Mulkutkar, S. Kaushik, S.S. Pandav, S. Raj, S. Ojha, A. Gupta


Introduction: Progression in glaucoma is difficult to define and automated perimetry has been the standard method for detecting progression. Decrease in average RNFL thickness by 20µm on STRATUS® optical coherence tomography(OCT) has been used as a criteria for structural progression.

Aims: To evaluate the ability of OCT in detecting progression in glaucoma suspects(GS) and glaucoma patients.

Objectives: To compare progression by OCT compared to visual fields.

Methods: GS and glaucoma patients who had undergone retinal nerve fiber layer(RNFL) analysis by STRATUS® OCT and baseline visual field(VF) examination by Humphrey's Visual Field Analyzer(HFA) prior to 2006 were included. 5‐year follow‐up STRATUS® OCT and VF was done. VF progression was defined by Anderson's criteria. 20µ and 10µ decrease in average RNFL thickness from baseline was considered as structural. Progression defined by all 3 methods was analyzed for concordance.

Purpose: To see if 20µ decrease in RNFL thickness was a valid criterion for progression.

Results: 124 eyes of 118 patients(94 GS and 30 POAG) were analyzed. 21 subjects(11 GS and 10 glaucoma) progressed by VF, of which 5 progressed using 20µ and 15 using 10µ criteria on OCT. There was concordance with VF in 3 subjects using 20µ and in 6 using 10µ criteria. The absolute decrease in RNFL thickness in glaucoma and GS patients who progressed were ‐6.26±10.03µ and ‐1.84 ± 15.49µ respectively.

Conclusions: The amount of decrease in RNFL thickness appears to depend upon the stage of glaucoma. There appears to be poor concordance between structural and functional criteria for progression.


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SELECTIVE LASER TRABECULOPLASTY AS AN ADDITIVE TREATMENT MODALITY IN INDIAN EYES

S. Ojha, S.S. Pandav, S. Kaushik, S. Raj, A. Saini


Introduction: Selective laser trabeculoplasty (SLT) is selective laser treatment of the trabecular meshwork in an attempt to increase aqueous outflow. Its efficacy in Indian eyes as an adjunctive to medical treatment has not been studied.

Aims: To evaluate the safety and efficacy of SLT as an adjunctive treatment for patients with open‐angle glaucoma not adequately controlled with medical therapy.

Objective: To see the extent of IOP control and medication requirement following SLT

Methods: This study included 37 eyes (33 patients) with Open Angle glaucoma not adequately controlled with medical treatment. 25 patients had Primary open Angle Glaucoma (POAG), 6 had secondary Open Angle Glaucoma and 2 were Juvenile Open Angle Glaucoma. 360 degrees of trabecular meshwork was treated. Efficacy was studied in terms of IOP control and requirement of medication 6 months following SLT.

Results: The mean baseline IOP was 23.78 ± 6.38, which reduced to 14.16 ± 4.10mmHg (45% reduction) on day 1, and stabilized at 18.37 ± 4.40mmHg (22.7% reduction) at 3 months, and 17.05 ± 4.032 mmHg (28.2% reduction) at 6 months The number of topical antiglaucoma medications remained the same following SLT in 33 eyes but the IOP could be controlled without additional medication. Four patients required glaucoma surgery after 3 months of follow up due to uncontrolled IOP.

Conclusions: Selective laser trabeculoplasty appears to be effective and safe as an adjunctive treatment to medical therapy in open angle glaucoma. Long‐term follow‐ up and larger number of patients need to be evaluated for this encouraging response.


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VISUAL OUTCOME AND RISK OF SUDDEN VISUAL LOSS FOLLOWING TRABECULECTOMY IN END STAGED GLAUCOMA

C. Muthuraman, A.V.V. Nallampalli

Department of Glaucoma, Uma Eye Clinic, Chennai, India

Introduction: "Wipe ‐ out" phenemenon is a rare but known complication after trabeculectomy.

Objective: To study if "wipe ‐ out" is common after trabeculectomy.

Aim: To assess visual outcome and risk of sudden visual loss following trabeculectomy in end staged glaucoma.

Method: This is prospective study done on patients with end ‐ staged glaucoma with advanced visual field loss (AGIS Visual Field Score > 17) who underwent trabeculectomy with Mitomycin ‐ C. The patients were followed up for three months after surgery. At final follow ‐ up, the measures studied included changes in best corrected visual acuity, intraocular pressure (IOP)levels, number of anti ‐ glaucoma medications used, mean deviation (MD) in the visual fields, number of points with sensitivity < 5 dB and in mean sensitivity of four central visual points.

Result: Twelve patients (12 eyes) were enrolled. Surgery resulted in statistically significant reduction of IOP by 15.2 ± 7.9 mm Hg (p < 0.0001) and decrease (2.3 ± 0.5) in number of anti ‐ glaucoma medications used (p < 0.0001). Mean value of deviation in visual fields was ‐ 28.5 ± 3.5 dB and ‐ 27.8 ± 3.4 before and three months after surgery respectively. There was no significant change (‐0.08 ± 0.3; p=0.338) in the parameters pertinent to central visual field sensitivity.

Conclusion: In this series of patients with end ‐ staged glaucoma, trabeculectomy reduced intraocular pressure effectively and vision preserved at three months follow ‐ up with no occurrence of “wipe ‐ out” phenomenon.


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COMPARISON OF INTRAOCULAR PRESSURE REDUCTION AFTER PHACOEMULSIFICATION CATARACT SURGERY BETWEEN GROUPS WITH ANGLE‐CLOSURE AND OPEN‐ANGLE ANTERIOR CHAMBER

R.I. Hapsari, A. Prahasta, S. Enus

Ophthalmology, Padjadjaran University, Cicendo National Eye Hospital, Bandung, Indonesia

Increased crystalline lens thickness in senile cataract causing resistance to aqueous humor outflow. Increased anterior chamber depth had a positive correlation with the widening of the anterior chamber angle and decreased of intraocular pressure (IOP) after cataract extraction. The purpose of this study was to compare IOP reduction after cataract surgery between angle‐closure and open‐angle group. This pre‐post test design study was to compare IOP after phacoemulsification cataract surgery in 26 eyes of 26 patients divided into angle‐closure and open‐angle groups consisting of 13 eyes each. The study was conducted in Cicendo Eye Hospital Bandung in period of March until June 2012. Patients who planned to have phacoemulsification cataract surgery were recruited consecutively. The anterior chamber angle was measured before surgery using Sussman 4‐mirror goniolens. The intraocular pressure were measured before and three weeks after surgery using Goldmann aplanation tonometer. Statistical analysis was done using t test. The results indicated that IOP reduction was statistically significant greater in the angle‐closure group (19.6%) compared with open‐angle group (11.3%) with p=0.022. In conclusions, IOP reduction after phacoemulsification cataract surgery was greater in the angle‐closure group compared with open‐angle group.


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COMPARISON OF PHACOTRABECULECTOMY WITH MITOMYCIN C IN PRIMARY OPEN ANGLE GLAUCOMA AND PRIMARY CLOSED ANGLE GLAUCOMA

Z.E. Djamal, I. Sumantri, D. Istiantoro, I. Soebijantoro

Jakarta Eye Center, Jakarta, Indonesia

Objective: To compare the result of phacotrabeculectomy with mitomycin C between primary open angle glaucoma(POAG) and primary closed angle glaucoma(PACG) by comparing intra ocular pressure target and visual acquity.

Method: Fourteen eyes with POAG and thirteen eyes with PACG that underwent phacotrabeculectomy with mitomycin c were studied restrospectively. Changes in number of anti glaucoma medication used, visual acquity and intra ocular pressure were evaluated in one year follow up.

Results: Anti glaucoma medication decrease drastically in both groups after medication with mean number of medication in POAG of 2.61 downt to 0.62 and in PACG down from 2.14 to 0.21. Preoperatively, visual acquity in both group is better than 6/15, (84.6%) in POAG improve to 100% and (71.4%) in PACG improved to 92.9%. Complete success (IOP< 21mmHg, without medication) was achieved in 69.2% in POAG and 85.7% in PACG. One case of hipotony(IOP < 5 mmHg) were reported in each group.

Conclusion: Phacotrabeculectomy with mitomycin c were effective in lowering IOP in both POAG and PACG and improving visual acquity. IOP lowering effect is greater in PACG group compared with POAG patients.


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OCULAR PERFUSION PRESSURE CHANGES ON SWITCHING TIMOLOL 0.5% TO TIMOLOL 0.1%

V.D.O. Asrory, D. Ekawati, S. Mustafa

Ophthalmology, University Indonesia, Jakarta Pusat, Indonesia

Objectives: To evaluate the ocular perfusion pressure while switching timolol drops 0.5% to Timolol 0.1%.

Methods: This is a pre post trial conducted on January ‐ May 2012 at Ophthalmology clinic Cipto Mangunkusumo hospital. The IOP of Open angle glaucoma patients whom controlled by Timolol drops 0.5% were measured using Goldmann applanation tonometer 2 hours after instillation. The blood pressure and USG Doppler examination were also done. The medication then switched to Timolol hydrogel 0.1% and 6 weeks later the patients underwent the same examination. The mean arterial pressure (MAP) and the mean ocular perfusion pressure (MOPP) were evaluated using the known formulas.

Results: There were 12 patients included in the study, nevertheless 1 patients did not complete the study due to side effects of medication. The mean age of the patients was 65 ± 8.8 years (50 ‐ 83 years). The IOP, Systolic pressure, Diastolic pressure, MAP and MOPP on Timolol drops 0.5% were 14.4 ± 2.8 mmHg, 134.5 ± 6.9 mmHg, 88.6 ± 3.2 mmHg, 103.9 ± 3.3 mmHg, and 54.9 ± 2.7 mmHg. Six weeks after switching the medication to Timolol hydrogel 0.1% the IOP, Systolic pressure, Diastolic pressure, MAP and MOPP were 14.6 ± 2.9 mmHg, 135.4 ± 6.9 mmHg, 85.4 ± 5.7 mmHg, 102.1 ± 5.4 mmHg, and 53.5 ± 4.9 mmHg respectively.

Conclusion: The mean ocular perfusion pressure was less in timolol hydrogel 0.1% treatment compare to timolol drops 0.5% although not proven to be statistically significant.


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A CASE OF NORMAL‐TENSION GLAUCOMA SUSPECT WITH OPTIC ATROPHY

J. Yamagami

Ophthalmology, JR Tokyo General Hospital, Tokyo, Japan

Purpose: To present a case of normal‐tension glaucoma (NTG) suspect with optic atrophy.

Methods: A 35‐year‐old man visited our clinic to have a further examination of NTG. He had consulted other ophthalmologist with left inferior visual field defect and been diagnosed as left NTG receiving Latanoprost eyedrop. At the first visit, his best corrected visual acuity was 2.0 / 1.5 and intraocular pressure 16 / 13mmHg, in the right / left eye respectively, and optical coherence tomography (OCT) of his left eye showed superior nerve fiber layer thinning corresponding glaucomatous visual field defect. These findings were compatible with NTG, but in his left eye optic nerve appearance was rather pallor and critical flicker frequency (CFF) slightly lower compared with those in his normal right eye, and furthermore, his left relative afferent pupillary defect (RAPD) was positive. No other abnormal findings were observed with routine ocular inspections, but nuclear magnetic resonance (NMR) showed a finding of optic atrophy.

Results: We diagnosed him as NTG suspect with optic atrophy. Though not being able to detect the cause of optic atrophy, we have been seeing him with no treatment without progression of visual field defect for 3 years.

Conclusions: We should always consider other possible pathologies in seeing patients with NTG, and not diagnose NTG only with results of visual field measurements or OCT.


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COMPARISON OF FORNIX‐BASED AND LIMBUS‐BASED CONJUNCTIVAL FLAPS IN THE LONG‐TERM RESULTS AFTER MMC TRABECULECTOMY

T. Fukuchi, Y. Sakaue, T. Togano, T. Tanaka, T. Yoshino, M. Seki, J. Ueda

Ophthalmology, Niigata University, Niigata, Japan

Purpose: To compare the long‐term results after MMC trabeculectomy between with fornix‐based (FB) and with limbus‐based (LB) conjunctval flaps.

Methods: Eighty‐eight Japanese glaucoma patients were treated by MMC trabeculectomy, with 39 eyes receiving a FB conjunctival flap and 49 eyes receiving a LB conjunctival flap. Postoperative intraocular pressure (IOP), the probability of success, complications, and bleb shapes were compared between the FB and LB groups.

Results: After follow‐up for 66.0±34.6 months, the IOP of the FB group was kept 11.5±4.5mmHg from 21.8±8.5mmHg, and the IOP of the LB group was 11.2±4.7mmHg from 21.2±6.5mmHg. Kaplan‐Meyer life‐table analysis showed that the survival rate was similar for the two groups, but tended to be lower in the early postoperative period for the FB group. 10 eyes (25.6%) in the FB group and 12 eyes in the LB group needed the cataract surgery respectively. Bleb related infection occurred in 2 eyes with the FB group (5.1%) and 3 eyes with the LB group (6.1%). 21 of 29 eyes (72.4%) in the FB group those IOP have kept equal or under 12 mmHg associated an ischemic bleb, otherwise 29 of 33 eyes (87.9%) combined it in the LB group (p=0.197).

Conclusion: MMC trabeculectomy results were similar between the FB and LB groups, in agreement with previous reports even after the long‐term follow‐up. Not only with the LB group but also with the FB group, MMC trabeculectomy often associates an ischemic bleb particularly in the cases those IOP have kept low for long‐term.


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A NOVEL METHOD TO ESTIMATE QUALITY OF VISUAL LIFE IN PATIENTS WITH GLAUCOMA

Y. Aoyama1, H. Murata1, H. Hirasawa1, M. Araie2, C. Mayama1, M. Aihara3, R. Asaoka1

1University of Tokyo, 2Kanto Central Hospital, Mutual Aid Association of Public School Teachers, 3Shirato Eye Clinic, Tokyo, Japan

Purpose: To identify crucial visual field test points for the quality of life in glaucoma considering the inter‐relationship among visual acuity and visual field test points, using the Random Forest machine learning method.

Method: Quality of visual life score was surveyed in 164 patients with glaucoma using the 'Sumi questionnaire'. The relationship between visual acuities of better and worse eye and total deviation values of all the test points on binocular visual field, and the quality of visual life was investigated using the Random Forest method. The quality of life score was predicted from these scores and prediction error was calculated. The prediction errors were also calculated from mean deviation of the binocular visual field, visual acuity of better eye, visual acuity of worse eye, and total deviation values of the binocular visual field and visual acuities of better and worse eyes.

Result: The visual acuity of worse eye was most important factor for all of the daily life. The important visual field test points existed widely around the horizontal line and specific test points were also chosen for each task of the daily life. The prediction errors from worse visual acuity and mean deviation were significantly better than those from visual acuity of better eye. Using the Random Forest method resulted in tightest prediction error, whereas using multiple regression method did not improve the prediction accuracy.

Conclusions: Accurate prediction of quality of visual life in patients with glaucoma was achieved and also crucial visual field test points were identified.


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IMMUNOREACTIVITY AGAINST RETINAL PROTEIN IN THE SERA OF PATIENTS WITH PRIMARY OPEN‐ANGLE GLAUCOMA AND MYOPIA ‐ A PRELIMINARY STUDY

F. Luthfia‐Rahmi1, R. Susilowati2, M. Marsetyawan2, S. Suhardjo3

1Post‐graduate Program, Department of Ophthalmology, Medical Faculty, Diponegoro University, Semarang, 2Department of Histology & Cell Biology, 3Department of Ophthalmology, Medical Faculty, Gadjah Mada University, Yogyakarta, Indonesia

Purpose: To observe the immunoreactivity against retinal protein in the sera of patients with Primary Open‐angle Glaucoma (POAG), POAG with myopia, myopia and no POAG no myopia.

Methods: Serum of patients with POAG, patients with POAG and myopia, patients myopia and no POAG no myopia were incubated with retinal protein isolated from patients that had undergone enucleation which had been transferred into nitrocellulose membrane after SDS‐PAGE.

Result: Immunoreactivity against retinal proteins were found in all sera of patients with POAG, POAG with myopia, myopia and no POAG no myopia. The POAG group showed immunoreactivities against retinal protein dominantly in 47 kDa, the POAG with myopia groups showed immunoreactivity dominantly in > 112 kDa, and the myopia group showed immunoreactivities dominantly in 47 kDa and > 112 kDa.

Conclusion: Using human retinal antigen, this study was able to demonstrate the immunorecativity in all groups. This study will be completed in order to develop serological method for early detection of POAG especially in myopia.


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LONG‐TERM OUTCOME OF TRABECULECTOMY WITH ADJUNCTIVE MITOMYCIN C IN GLAUCOMA PATIENTS

C.‐Y. Huang1,2, H.‐Y. Tseng1, K.‐Y. Wu1,3,4

1Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, 2Ophthalmology, Pingtung Hospital, Department of Health, Executive Yuan, Pingtung, 3Ophthalmology, Faculty of Medicine, Kaohsiung Medical University Hospital, 4Ophthalmology, Kaohsiung Municipal Ta‐Tung Hospital, Kaohsiung, Taiwan R.O.C.

Purpose: The purpose of this study was to quantify the three‐year success rate and complications of trabeculectomy with adjunctive mitomycin C (MMC).

Methods: A retrospective chart review was undertaken of 98 eyes that had undergone trabeculectomy with adjunctive MMC (concentration from 0.1‐0.27 mg/ml) and at least three years' follow‐up between January 2001 and July 2009.

Results: At 36 months, mean IOP was 16.0 ± 8.7 mmHg, with a mean IOP drop of 19.3 ± 14.1 mmHg. In primary glaucoma patients (n=43), 51.2% and 88.4% of eyes achieved the definition of complete success and qualified success, respectively, at three‐year follow‐up. Fifty‐four eyes (55.1%) developed one or more complications, from mild such as hyphema through to severe such as bleb leakage which may necessitate surgical intervention. Fifteen eyes developed severe complications, such as wound gap after five postoperative days, hypotony, hypotony maculopathy, choroidal detachment, overhanging bleb, bleb leakage, and endophthalmitis. There is no significant difference when comparing eyes with severe complications with other eyes in relation to different MMC amount, defined as MMC concentration multiplied by application duration (p = 0.127). Further glaucoma surgery was performed in 20 eyes (20.4%).

Conclusions: The outcome of trabeculectomy with low‐dose intraoperative mitomycin is favorable in primary glaucoma patients at three‐year follow‐up. Severe complications are not only related to MMC amount but also different individual sensitivity to MMC. Careful selection of MMC concentration and application time based on preoperative and intraoperative risk factors may further improve surgical result.


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DETECTION OF PRIMARY ANGLE CLOSURE USING SCANNING PERIPHERAL ANTERIOR CHAMBER DEPTH ANALYZER IN JAPANESE COMMUNITY HEALTH SCREENING

S. Watanabe, M. Ishikawa, N. Sato, Y. Sawada, T. Yoshitomi

Ophthalmology, Akita Graduate University, Akita, Japan

Introduction: Primary angle‐closure glaucoma (PACG) is a leading cause of blindness, and has particularly high incidence in Asia. There exists a spectrum of stages in the angle closure process; primary angle closure suspect (PACS), primary angle closure (PAC), and PACG. It is suggested that early detection and intervention could ameliorate the natural course of angle closure.

Objective: To investigate the influence of age and sex on the distribution of central and peripheral anterior chamber depth (ACD), the scanning peripheral anterior chamber depth analyzer (SPAC) was used in Japanese subjects visiting a health screening center.

Methods: All subjects underwent examination with SPAC. Paramedical staff measured the ACD of 1310 eyes of 658 participants, who visited the health screening center. Based on the data provided by SPAC, the following parameters were determined: distribution of ACD from the central and the peripheral region, distribution of the grades of ACD, and frequency of suspected or possible angle‐closure eyes.

Results: ACD decreased with age both in men and in women. The ACD tended to be shallower in women than in men in each generation. The prevalence of the eyes at risk for angle closure was 1.7% and 2.3% among men and women, respectively.

Conclusions: The decrease with age in peripheral ACD was shown quantitatively in both men and women. Eyes at risk for angle closure were more frequent in women 50 years of age or older.


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PROTECTIVE EFFECTS OF TAMOXIFEN AGAINST PRESSURE‐INDUCED INJURY IN A RAT EX VIVO HYDROSTATIC PRESSURE MODEL

M. Ishikawa1, T. Yoshitomi1, Y. Izumi2

1Ophthalmology, Akita Graduate University School of Medicine, Akita, Japan, 2Psychiatry, Washington University School of Medicine, St Louis, MO, USA

Background: Acute exposure to elevated hydrostatic pressure can cause axonal degeneration of retinal ganglion cells via down‐regulation of glutamate transporters (GTs). 17β‐estradiol (E2) and Tamoxifen (TX), a selective estrogen modulator, have been shown to possess neuroprotection by increase in expression of GTs.

Purpose: We have tested our hypothesis that E2 and TX reversed pressure‐induced decrease of GTs, and resulted in the protection of axonal damage in the rat ex vivo hydropressure model.

Methods: Ex vivo rat retinas were exposed to elevated hydrostatic pressure for 24 hours. The expression of GLAST and GS were examined using immunochemistry, Western blot, and real‐time PCR analysis. Also examined were the expression of apoptotic, antioxidant, and estrogen receptor genes.

Results: Western blot and real‐time RT‐PCR analyses revealed that elevated pressure (75 mmHg) depressed GLAST and GS expression, and induced axonal swelling in the NFL. Administration of E2 and TX attenuated the pressure‐induced axonal swelling. Protective effects by E2 and TX were inhibited by estrogen receptor β (ERβ) antagonists THC. Western blotting and real‐time RT‐PCR analysis revealed up‐regulation of GLAST and GS protein and gene in the E2‐ and TX‐treated retinas. Anti‐oxidant genes or apoptotic genes showed no remarkable changes after TX treatment.

Conclusions: The present study shows that E2 and TX effectively reverses pressure‐induced glutamate transport inhibition by restoring its expression, thus offering a potential therapeutic modality in pressure‐induced axonal impairment characterized by altered glutamate homeostasis.


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CHARACTERISTICS OF PSEUDOEXFOLIATION GLAUCOMA IN CICENDO EYE HOSPITAL INDONESIA

H. Ten, M. Rifada, E. Gustianty, A.P. Gandasubrata

Department of Ophthalmology, Faculty of Medicine Padjadjaran University, Bandung, Indonesia

Introduction: Pseudoexfoliation (PEX) syndrome was a common cause of secondary open angle glaucoma known as pseudoexfoliation glaucoma (PEXG) with poorer prognosis than primary open angle glaucoma.

Objective: To describe characteristics of patients with PEXG in Cicendo Eye Hospital Indonesia.

Methods: This retrospective descriptive study reviewed medical record of 71 patients (102 eyes) diagnosed with pseudoexfoliation glaucoma between January 2010 and December 2011.

Results: Among these 71 patients, 55 (77.5%) were males. The mean age was 68.4±9.4 (range:30‐88) year old when diagnosed. There were 40 (56.3%) patients with PEXG in one eye, and 31 (43.7%) in both eyes. Pseudoexfoliation syndrome with PEX material in anterior segment was found unilaterally in 28 (39.4%) patients, and bilaterally in 43 (60.6%) patients. The gonioscopic findings were open angle in 81 (79.4%) eyes and 9 (8.8%) eyes were angle closure. All of the PEXG eyes develop cataract, 15 (14.7%) of them were mature cataract, and 10 (9.8%) eyes had a previous cataract surgery. Mean baseline intraocular pressure (IOP) was 36.0±14.6 mmHg. Seventy three (71.6%) eyes were treated with anti‐glaucoma drugs without surgical intervention. Trabeculectomy, combined surgeries and cataract surgeries, were performed to 6 (5.8%), 20 (19.6%), and 3 (2.9%) eyes, respectively. Three intraocular lenses of the combined surgeries were using scleral fixation technique. The mean IOP was decreased from 34.9±12.9 mmHg to18.7±10.1 mmHg at one week after surgery.

Conclusion: Pseudoexfoliation glaucoma in Cicendo Eye Hospital was common in older male patients with cataract. Most patients were treated with medical treatment.


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THE INCIDENCE AND PROFILE OF GLAUCOMA PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL BETWEEN 2010‐2011

T.R. Herdiana, W. Artini

Ophthalmology, University of Indonesia, Jakarta Pusat, Indonesia

Purpose: To report the incidence and profile of glaucoma patients in Cipto Mangunkusumo hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

Method: This was a retrospective study. All data from new glaucoma patients who came to Department of Ophthalmology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, between Januari 2010 ‐ Desember 2011 were retrieved from medical records. Comprehensive eye examination were noted such as visual acuity, intraocular pressure (Goldmann applanation tonometry), dynamic goniosopy (Two‐mirror lens,Volk,USA), optic nerve evaluation (non contact superfield lens, Volk, USA) and Humphrey Visual Field Test with or without Ocular Computerized Tomography (OCT).

Results: A total of 1037 patients were included in this study. There were 51,69% male and the distribution of glaucoma increased with age, that accounted 68,56% in patients who were over 50 years old. The incidence of glaucoma with one blind eye was 42,59%, whereas bilateral blindness was 15,10%. The profile of glaucoma patients were noted as follows: secondary glaucoma (25,07 %), primary open‐angle glaucoma (POAG) (22,57%) and primary angle‐closure (21,60%). Primary angle‐closure consisted of acute primary angle closure‐APAC (0,87%), primary angle closure suspect‐PACS (1,74%), primary angle closure‐PAC (1,93%), and primary angle closure glaucoma‐PACG (17,94%).

Conclusion: The incidence of glaucoma increased significantly with age. The number of monocular blindness was found to be higher than bilateral blindness. Cases with secondary glaucoma were the highest glaucoma profile followed by POAG and PACG.


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PROFILE AND TREATMENT OUTCOME OF PRIMARY ANGLE CLOSURE IN CICENDO EYE HOSPITAL BANDUNG, INDONESIA

M.Y. Yustiana, M. Rifada, E. Gustianty, A.P. Gandasubrata

Department of Ophthalmology, Faculty of Medicine, University Padjadjaran, Cicendo Eye Hospital, Bandung, Indonesia

Introduction: Glaucoma is the second leading cause of world blindness. It has been estimated that Asians represent 47% of those with glaucoma and 87% of those with angle closure glaucoma.

Objective: To describe clinical profile and treatment outcome of primary angle closure patients in Cicendo Eye Hospital.

Methods: This retrospective analysis (January ‐ December 2011) reviewed medical records of patients diagnosed as primary angle closure in Cicendo Eye Hospital. International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification was used to classify primary angle closure into primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG). The patient's age, intraocular pressure (IOP), and management were collected.

Results: We analyzed 431 eyes (236 patients) with primary angle closure. Mean age at presentation was 59.94 ± 10.25 years. The most frequently diagnosed subtype was PACG (64%), 69.2% of them was creeping angle closure, followed by PACS (18%) and PAC (17%). Laser iridotomy (LPI) was done in 72 eyes (16.7%), trabeculectomy in 73 eyes (16.9%), combined surgery in 34 eyes (7.9%), and cataract surgery in 5 eyes (1.2%). Mean IOP prior to surgical treatment was 37.22 ± 15.80 mmHg and after one week was 13.40 ± 6.94 mmHg. Mean IOP prior to LPI was 21.32 ± 16.18 mmHg and after one week was 17.53 ± 8.04 mmHg.

Conclusion: PACG was the most common subtype of primary angle closure in Cicendo Eye Hospital. There was approximately a half mean IOP reduction in primary angle closure patients treated surgically.


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CHANGES IN VISUAL ACUITY AND ANTERIOR SEGMENT PARAMETERS AFTER EX‐PRESS GLAUCOMA FILTRATION DEVICE SURGERY

K. Murata, K. Ishida, T. Yamamoto

Department of Ophthalmology, Gifu Graduate School of Medicine, Gifu, Japan

Introduction: The assumed advantages of the EX‐PRESS Glaucoma Filtration Device TM (Alcon, USA) surgery over trabeculectomy include more precise and controlled outflow with predictable results. These advantages might be evaluated with stability of visual acuity (VA) and anterior segment parameters.

Aims: The aim of this study is to evaluate the effect of EX‐PRESS glaucoma surgery on VA, anterior chamber depth (ACD), and corneal curvature.

Methods: In this prospective study, a total of 15 eyes of 13 consecutive patients (8 men, 5 women) were evaluated preoperatively, at 1 week, 2 weeks, and 1 month postoperatively with the IOL master (Carl Zeiss Meditec, Germany). We compared measurements of ACD and average of horizontal and vertical corneal curvatures (CC) before and after surgery.

Results: Intraocular pressure (IOP) decreased significantly from 18.5 mmHg preoperatively to 8.6 mmHg (P=0.021) on the 1st postoperative day and 8.8 mmHg (P=0.010) at 1 month. VA decreased from 0.58 to 0.48 (P=0.049) on the 1st postoperative day, however recovered to insignificant level at 1 week postoperatively. ACD was 3.34±0.52 mm preoperatively and 3.28±3.82 mm (P=0.08) at 1 week and 3.35 ±0.63 mm (P=0.18) at 1 month postoperatively. CC was 43.8±1.3 D preoperatively and 43.9±1.0 D (P=0.27) at 1week and 44.3 ±0.7 D (P=0.34) at 1 month postoperatively.

Conclusions: EX‐PRESS Glaucoma Filtration Device surgery significantly decreased IOP. VA was affected transiently within one week after surgery. However ACD and CC were not affected significantly.


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DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH NEOVASCULAR GLAUCOMA IN CICENDO EYE HOSPITAL INDONESIA

A. Silitonga, R.M. Rifada, E. Gustianty, A.P. Gandasoebrata

Department of Ophthalmology, Padjadjaran University, Bandung, Indonesia

Introduction: Neovascular glaucoma (NVG) is a devastating secondary glaucoma associated with formation of new blood vessels with numerous causes. Management of NVG including treatment of underlying disease and control of intraocular pressure.

Objective: To describe the characteristics of patients with NVG in Cicendo Eye Hospital Indonesia, during January 2010 until December 2011.

Methods: This retrospective observational study included 150 eyes from 140 patients with NVG. The patient's age, gender, complete ophthalmology examinations, etiology of NVG, comorbid diseases and treatments were reviewed.

Results: Among these patients, 71 (50.7%) were females and 69 (49.3%) were males. The mean age (+ SD) was 56.2 + 15.3 years, with mean initial intraocular pressure (+ SD) was 49.1 + 16.2 mmHg. Iris and angle neovascularization were noticed in 145 (96.7%) and 30 (20%) patients, respectively. Most patients presented as NVG stage 3 (59.3%) and stage 2 (10.7%), with visual acuity of no light perception (56%), hand movement (17.3%), and light perception (16%). Identifiable etiologies were proliferative diabetic retinopathy (19.3%), end stage of angle‐closure glaucoma (14.7%), chronic ocular inflammation (12%), central retinal vein occlusion (9.3%), and retinal detachment (4.7%). Hypertension and diabetes mellitus were present in 43 (30.7%) and 35 (25%) patients,respectively. Treatments included medical therapy only (50.7%), transscleral cyclophotocoagulation (26%), panretinal photocoagulation and/or intravitreal bevacizumab (16%) and glaucoma filtering and/or cataract surgery with/without mytomicin C (7.3%).

Conclusion: Neovascular glaucoma in Cicendo Eye Hospital was frequent in older females with iris neovascularization and high intraocular pressure. Proliferative diabetic retinopathy was one of the identifiable cause.


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LENS PHACOEMULSIFICATION IS AN OPERATION OF FIRST CHOICE AT PRIMARY ANGLE CLOSURE GLAUCOMA WITH BLOCK INDUCED BY LENS

U. Fayzieva+, E. Egorova2

1Laser Surgery Department, Eye Clinic at the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan, 2Consult Department, Svyatoslav Fyodorov State Institution Eye Microsurgery Complex, Moscow, Russia

Introduction: Laser l iridotomy is a base operation in cases of primary angle closure glaucoma (PACG) with pupillary block. But sometimes its effect is short or may be absent due to other anterior chamber block mechanisms ‐ a lens block.

Objective: 90 Uzbek patients (140 eyes) with PACG and different degrees of lens opacity have been selected for this investigation.

Purpose: To determine indications to phacoemulsification of lens with foldable IOL implantation and to estimate its results in cases of PACG.

Methods: Parameters of iridocilliary structures and configuration of posterior chambers were measured by the ultrasound biomicroscopy (UBM Humphrey‐840, USA).

Results: Parameters of iridocilliary structures and their topographic relationships depended on the main mechanism of anterior chamber angle block. The features of block induced by lens were: decrease of iris‐lens distance, reflected lens move forward, decrease of posterior chamber area and volume with lose of its correct three‐angular configuration.The indications for phacoemulsification were determined in all cases of block induced by lens (63 eyes) independent of opacity. Phacoemulsiaicftion decreases the IOP from an average preoperative level by 13.5 ± 2.7 mmHg. Visual acuity improves in 84.5% of cases. Phacoemulsiaicftion eliminates block induced by lens restoring anatomic topographic relationships of structures of iridocilliary zone and posterior chamber configuration in all cases.

Conclusion: Anterior chamber angle block induced by lens has specific anatomic topographic features of iridociliary zone in PACG cases diagnosed by the UBM. Lens phacoemulsification with foldable IOL implantation is pathogenic operation in cases of PACG with lens block.


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CLINICAL CHARACTERISTIC OF LENS INDUCED GLAUCOMA

E. Gustianty, M. Rifada, A.P. Gandasubrata

Ophthalmology, Padjadjaran University, Cicendo Eye Hospital Bandung, Bandung, Indonesia

Introduction: Lens induced glaucoma represent a diversity in the presentation of the glaucomatous process. Surgical management in this situation can be challenging.

Purpose: To evaluate the type of lens induced glaucoma, visual acuity, intra ocular pressure and management of lens induced glaucoma.

Method: A retrospective study was conducted by reviewing the medical record of lens induced glaucoma patient between January ‐ December 2011 in Cicendo Eye Hospital.

Result: There were 37 cases of lens induced glaucoma; 21.6% were phacolytic, 48.7% were phacomorphic and 29.7% were phacotopic. Most of the patients aged ≥ 60 years, 81.1% had visual acuity worse than 1/300 (16% with no light perception). The presenting intra ocular pressure (IOP) were ≥ 30 mmHg in 81% patient. Cataract surgery alone was done in 8.1% patients, combined surgery in 46% patients, trabeculectomy in 5.4% patients and the rest (40.5%) were given medical therapy because they cannot afford or refused surgery. Most of combined surgery were done using manual small incision cataract surgery. Duration of the symptom was more than 15 days in 27% patients. One day after surgery 91% patients had IOP ≤ 21 mmHg. Two weeks after surgery 59.1% patient had visual acuity ≥ 0.1.

Conclusion: The most frequent type of lens induced glaucoma were phacomorphic glaucoma. They presented late in their disease. Most of the patient had normalization of IOP but only half of the patients had visual improvements after surgery.


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COMPARISON OF INTRAOCULAR PRESSURE BETWEEN MYOPIC AND EMMETROPIC SCHOOLCHILDREN IN TANGERANG

S. Basri, W.A. Wiyogo, E.S. Affandi

Department of Ophthalmology, Faculty of Medicine, University Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose: To examine intraocular pressure (IOP) in children and its comparison between myopic and emmetropic eyes.

Methods: A cross sectional survey of IOP was conducted in schoolchildren from four elementary school in Tangerang, West of Java. All of subjects underwent cycloplegicautorefraction, slitlampbiomicroscopy examination and intraocular pressure measurement using non contact of IOP instrument. Refraction was analysed as spherical equivalent (SE). Myopia was defined as SE ≤ ‐0.5 D and emmtetropia was defined as ‐0.5 D < SE < +0.5 D. Exclusion criteria were abnormalities of the anterior/posterior segment and other conditions that precluded assessment of refractive error.

Results: A total of 890 subjects with age range 5‐14 years was included in this study. The mean age of those children was 8.78 (SD 1.92) years old, and 46.0% were male. The total mean of IOP was 16.7 (SD 2.9) mmHg, and distribution of IOP was follows Gaussian curve skewed to the right, similar to normal IOP in adults. There were 125 subjects with myopic eyes and 485 subjects with emmetropic eyes with the mean IOP were 17.45 (SD 3.20) mmHg and 16.72 (SD 2.98) mmHg, respectively. There were significant IOP difference between two groups and IOP was correlated with myopia.

Conclusion: The results indicated that IOP in children was higher in myopic than in emmetropic eyes. There was an association between the level of IOP and myopia in children.


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EVALUATION OF THE NEW DIGITAL GOLDMANN APPLANATION TONOMETER TO MEASURE INTRAOCULAR PRESSURE

Y. Sakaue, J. Ueda, M. Seki, T. Tanaka, T. Togano, T. Yoshino, T. Fukuchi

Ophthalmology, Niigata University, Niigata, Japan

Purpose: To evaluate precision of the new digital Goldmann applanation tonometer (dGAT; AT900D, Haag‐Streit International) for measuring intraocular pressure (IOP) which displayed digitally in steps of 0.1 mmHg by comparison with the standard Goldmann applanation tonometer (sGAT).

Methods: Three consecutive IOP measurements were made in 120 eyes of 63 patients using both sGAT and dGAT with a 5 minutes interval. The average of IOP readings and the difference between the maximum and the minimum were compared.

Results: The average of IOP readings using sGAT is 16.17±6.56 mmHg and that of using dGAT is 16.27±6.57 mmHg. The Pearson correlation coefficient was 0.998. According to the average of IOP readings, we defined three IOP groups (IOP 14, 14< IOP< 20 and IOP 20 mmHg). Each the Pearson correlation coefficient was 0.940 , 0.971 and 0997. The difference between the maximum and the minimum of three consecutive measurements using sGAT is 0.93±0.37 mmHg and that of using dGAT is 0.71±0.33 mmHg, and there was a significant difference (p< 0.01) . Even though both eyes were read as the same IOP by sGAT, dGAT showed the difference of 0.47±0.31 mmHg between them.

Conclusions: The IOP measurement by dGAT was quite similar with those by sGAT. Furthermore, dGAT may be able to detect the smaller difference of IOP than those with sGAT.


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CHARACTERISTICS AND MANAGEMENTS OF UVEITIC GLAUCOMA IN CICENDO EYE HOSPITAL INDONESIA

D.M. Juhrie, A. Prahasta, E. Gustianty, M. Rifada

Department of Ophthalmology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

Introduction: Glaucoma is common and serious complication of uveitis. Prevalence of uveitic glaucoma varies 10‐20%. Control of intraocular pressure remains a therapeutic challenge. Surgical intervention is sometimes required in case of medical failure.

Objective: To describe the characteristics and managements of uveitic glaucoma in Cicendo Eye Hospital Indonesia.

Methods: Medical records of uveitic glaucoma patients attending glaucoma clinic in Cicendo Eye Hospital during 2010‐2011 were retrospectively reviewed. Age, gender, visual acuity, intraocular pressure (IOP), etiology, results of gonioscopy, comorbid diseases, and managements were documented.

Results: Seventy five eyes from 68 patients were reviewed. Patients consist of 44.12% men and 55.88% women. Mean age was 46.81 ± 15.98 years old. The most common etiology, gonioscopy results and comorbid disease were anterior uveitis (82.67%), open‐angle (33.33%), and cataract (41.33%) respectively. Majority of patients came with visual acuity < 0.1 (69.33%). Mean of initial IOP was 38.62 ± 13.53 mmHg. Mean of IOP reduction after 3 months of follow up was 15.67 ± 12.17 mmHg. Most patients used 3 kinds of antiglaucomatous therapy for initial treatment (42.67%). Twenty one eyes underwent surgery (28%) and among those eyes, 3 eyes required repeat surgery. After surgery, 15 eyes (71.43%) had IOP reduction to normal range. Majority of surgeries were combined procedure (47.62%).

Conclusions: In this study, uveitic glaucoma more commonly found in person older than 40 years old. It was associated with anterior uveitis, open‐angle mechanism, and cataract as comorbid disease. Medical and surgical managements were required to treat the elevated IOP.


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TREATMENT OUTCOMES OF BAERVELDT AND AHMED IMPLANTS IN THE MANAGEMENT OF REFRACTORY GLAUCOMA

E. Rusmayani1, I. Sumantri1,2, D. Istiantoro2, I. Soebijantoro2

1Ophthalmology, Faculty of Medicine University of Indonesia, 2Jakarta Eye Center, Jakarta, Indonesia

Objective: To evaluate the outcome of Baerveldt and Ahmed implants in patients with refractory glaucoma.

Methods: Retrospective, noncomparative study of 62 eyes from 58 patients who underwent implantation of Ahmed or Baerveldt implants performed at Jakarta Eye Center, Indonesia, from January 2010 to December 2011. The surgical outcomes assessed were final intraocular pressure (IOP), visual acuity, number of glaucoma medications postoperation, and incidence of complications. Complete success was defined as IOP ≤21mmHg for 2 consecutive visits, at least 3 months after procedure, with no additional glaucoma medications. Qualified success was defined as final IOP less IOP ≤ 21mmHg with additional glaucoma medications.

Results: Both drainage implants achieved remarkable reductions in IOP from preoperative IOP of 46.6±1.4 mmHg and 36.7±1.3 mmHg to postoperative IOP of 13.1±4.3 mmHg and 15.7±1.2 mmHg in the Baerveldt and Ahmed groups, respectively. Complete success rates were 20 (60.6%) for Baerveldt and 22 (75.9%) for Ahmed implants, whereas qualified success occurred in 9 (27.3%) Baerveldt and 2 (6.9%) Ahmed implants. Failure occurred in 4 (12.1%) Baerveldt implants and 5 (17.2%) Ahmed implants. In both group most of the patients had maintained or improved visual function. The mean number of glaucoma medications required was 1.6±0.7 in the Baerveldt group and 2.3±0.6 in the Ahmed group (P=0.13). In both group the most common complication was tube related (obstruction or exposed), and no visual threatening complication.

Conclusions: Both Baerveldt and Ahmed glaucoma drainage implants had good outcome in controlling IOP, preserving visual function, with low complication rates.


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CHANGE IN PRESCRIBED GLAUCOMA MEDICATION IN A UNIVERSITY HOSPITAL

S. Kokuzawa, K. Ishida, A. Sawada, K. Kawase, T. Yamamoto

Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan

Introduction: We reported the status of medication prescribed to glaucoma patients in 2003, and showed that latanoprost and beta‐blockers were the most frequently prescribed medications and that one drug alone was most frequently prescribed.

Purpose: To investigate the current status of glaucoma medication prescribed and to compare it with that of the previous study.

Methods: This retrospective study was made on 134 eyes of 134 patients who visited glaucoma clinic of Gifu University Hospital during April 2012. The series comprised 67 males and 67 females. The ages ranged from 18 to 82 years (average 60 years). There were normal‐tension glaucoma 78 cases, primary open‐angle glaucoma 43 cases, developmental glaucoma 8 cases, ocular hypertension 3 cases, and exfoliation glaucoma 2cases. We investigated intraocular pressure (IOP) before treatment, IOP at the latest examination, degree of visual field defect (MD), prescribed medication, and the number of medication.

Results: The mean IOP before treatment was 19.4mmHg and the mean latest IOP was 14.0mmHg. The mean MD was ‐10.85dB. The prescribed medication was prostaglandin‐related compounds in 125 cases, beta‐blockers in 84 cases, topical carbonic anhydrase inhibitors in 61 cases, fixed‐combination drugs in 18 cases, etc. One drug alone was prescribed in 32 cases, two in 44 cases, three in 45 cases, four in 12 cases, and five in 1 case.

Conclusions: As compared with the study conducted in 2003, prostaglandin‐related compounds and beta‐blockers are still the most frequently prescribed. The cases with multiple dosing have increased.


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287

THE ALTERATION OF OPHTHALMIC ARTERY BLOOD FLOW VELOCITY IN POAG AFTER INSTILLATION OF TIMOLOL 0.1% GEL (PATIENTS WERE PREVIOUSLY CONTROLLED BY TIMOLOL 0.5% SOLUTION)

D. Ekawati

Ophthalmology, Policlinic Kirana Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Aims: To evaluate the alteration of ophthalmic artery blood flow velocity with Trans Cranial Doppler (TCD) in primary open angle glaucoma with timolol 0.1% hydrogel, after Intra Ocular Pressure (IOP) was previously controlled by timolol 0.5% solution.

Methods: This study is pre and post test design conducted in January through May 2012 at Glaucoma division, Policlinic Kirana, Cipto Mangunkusumo Hospital. The subjects are primary open angle glaucoma (POAG) patients who were previously controlled by timolol 0.5% solution. The group consists of twelve patients with intra ocular pressure (IOP) < 21 mmHg, blood pressure (BP) ≤140 /90, pulse rate > 60 beats per minute, each patient was given timolol 0,1% hydrogel. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) were the main variable. IOP, systemic blood pressure , pulse rate were the addition variables. The evaluation was conducted before and six weeks after treatment.

Result: There were significant differences at increased of EDV and no significant difference at increased of PSV and decreased of RI before and six weeks after instillation of timolol 0.1% hydrogel. Increasing IOP, pulse rate and systolic blood pressure had no significant difference Sefore and after treatment. There were no serious effects after instillation of timolol 0.1 hydrogel.

Conclusions: Application of timolol 0.1% hydrogel once daily in primary open angle glaucoma increased ophthalmic artery blood flow velocity after IOP was previously controlled by timolol 0.5% solution with TCD examination.


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THE TYPE OF ANGLE CLOSURE IN 15 HOSPITALS IN INDONESIA

E. Gustianty1, R. Ekantini2, F. Sulasmi3, N.I. Sidiq4, S. Samadikoen5, M. Effendi6, I.M.A. Kusumadjaja7, N.K. Rahayu8, A.T. Devi9, N. Satolom10, U. Chusaida11, M.D. Sari12, H. Rasyidin13, F. Kamal14, A.P. Gandasubrata1, W. Artini15

1Ophthalmology, Padjadjaran University, Cicendo Eye Hospital Bandung, Bandung, 2Ophthalmology, Gajah Mada University, Yogyakarta, 3Ophthalmology, Diponegoro University, Semarang, 4Ophthalmology, Airlangga University, 5Ophthalmology, Undaan Eye Hospital, Surabaya, 6Ophthalmology, Brawijaya University, Malang, 7Ophthalmology, Udayana University, 8Ophthalmology, Indera Hospital, Denpasar, 9Ophthalmology, BKMM, Makasar, 10Ophthalmology, Samratulangi University, Manado, 11Ophthalmology, Haji Hospital, Surabaya, 12Ophthalmology, North Sumatra University, Medan, 13Ophthalmology, Andalas University, Padang, 14Ophthalmology, Sriwijaya University, Palembang, 15Ophthalmology, University Indonesia, Jakarta, Indonesia

Introduction: Glaucoma is the second leading cause of blindness in the world as in Indonesia. It has been estimated that Asians represent most of those with angle closure glaucoma.

Purpose: To assess the type of angle closure patients.

Methods: This is a retrospective study. Medical data from 15 hospitals (11 teaching hospitals from government medical faculty, 3 government hospitals and 1 private hospital) in 4 main islands (Java, Sumatra, Sulawesi and Bali) were analysed. The data from January 2011 ‐ December 2011 were reviewed.

Result: Angle Closure were determined in 1168 patients. Among this angle closure group, 15,50% had primary angle closure suspect (PACS), 5.05% primary angle closure (PAC), 7.53% acute primary angle closure (APAC), 1.37% acute angle closure glaucoma (APACG), 33.81 % primary angle closure glaucoma (PACG) and 36.73% chronic angle closure glaucoma (CACG).

Conclusion: Chronic angle closure glaucoma is the most common type in this study. Population based study need to be done to find out the prevalence of angle closure glaucoma in Indonesia.


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290

EX‐PRESS MINI GLAUCOMA SHUNT FOR THE SURGICAL MANAGEMENT OF COMPLEX GLAUCOMA

T.Q. Kwong, L. Pelosoni, E. Ansari

Maidstone and Tunbridge Wells NHS Trust, Kent, UK

Introduction: Use of Ex‐PRESS Mini Glaucoma (EMG) shunt implantation for glaucoma is a relatively new alternative to the traditional trabeculectomy. Their use however, in complex glaucoma cases, has yet to be evaluated fully.

Purpose: To assess the safety and efficacy of EMG shunts for the surgical treatment of complex glaucoma cases undertaken by a single surgeon.

Methods: Retrospective single centre review of 10 eyes considered complex glaucoma cases treated with EMG shunts. These were defined as eyes having failed glaucoma drainage surgery or eyes with high risk features (proliferative diabetic retinopathy, neovascular glaucoma, vitreoretinal surgery, ocular surface disease). End points measured include intraocular pressure (IOP), visual acuity, number of glaucoma drops used and the presence of postoperative complications. Success was defined as either unqualified (IOP< 19mmHg without IOP lowering drops) or qualified (IOP< 19mmHg with IOP lowering drops).

Results: 7 eyes (70%) showed unqualified success with a mean IOP of 11.6mmHg (SD 1.6) at 6 months. 3 cases required glaucoma drops to reach the target IOP (mean 18.7mmHg SD 0.8mmHg). At 6 months, mean number of IOP lowering medications were 1.3 compared with a mean of 3.7 medications preoperatively. Visual acuity was preserved in all cases.

Conclusions: In this small cohort of patients, EMG shunts were safe and effective in controlling IOP in complex cases of glaucoma. Insertion was relatively easy with minimal postoperative manipulation. IOP was stable at 6 months with a significant IOP reduction (p< 0.05) and a significant reduction in number of medications used (p< 0.05).


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THE COMPARISON OF BRAIN DERIVED NEUROTROPHIC FACTOR IN TEARS BETWEEN PRIMARY OPEN ANGLE GLAUCOMA PATIENTS AND NORMAL SUBJECTS

S.M. Rugun, M. Rifada, E. Gustianty, D. Budiman, A.P. Gandasubrata


Introduction: Primary Open Angle Glaucoma (POAG) is a progressively chronic optic neuropathy consist of loss of retinal ganglion cell (RGC) and their axons. The increasing of intraocular pressure causes obstruction in axonal transport, path that brings neurotropic factor called Brain Derived Neurothropic Factor (BDNF) that keeps RGC alives.

Objective: To compare BDNF level in tears of POAG patient with normal subject.

Methods: This was a cross sectional study that have been approved by ethical committee. There were 16 tear samples collected from each group that participating in this research. Those samples were collected using a‐10µl‐ Drummond glass microcapillary tubes, and being determined by enzyme‐linked immunosorbent assay using monoclonal antibodies specific for BDNF. Statistical analysis used Mann‐Whitney test.

Result: Sixteenth patients with POAG and 16 normal subjects with the similar age range were tested. The control group consisted of 12 men and 4 women (45 ‐ 75 yo), without any apparent ocular or systemic disease. The case group consisted of 12 men and 4 women (46 ‐ 78 yo) with POAG. The mean level of BDNF detected in the tears of POAG patients was 53,148±18,90ρg/ml and BDNF levels in the tears of control group were 139,070±31,30ρg/ml.There was statistically significant difference between two groups with p< 0.001.

Conclusion: BDNF level in the tears of POAG group is lower than normal subjects.


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COMPARISON OF INTRAOCULAR PRESSURE MEASUREMENT BETWEEN GOLDMANN APPLANATION TONOMETRY AND DYNAMIC CONTOUR TONOMETRY IN POST TRABECULECTOMY PATIENTS

L.S. Pasla, M. Rifada, E. Gustianty, F.K. Memed, A.P. Gandasubrata


Introduction: Goldmann applanation tonometry (GAT) is used widely for measuring intraocular pressure (IOP). However, it has limitation because of its accuracy are influenced by corneal surface, corneal curvature, central corneal thickness and ocular rigidity. Dynamic contour tonometry (DCT) is a tonometer which its measurement not affected by ocular biomechanics. After trabeculectomy the ocular biomechanics will change and alter ocular rigidity.

Purpose: To compare the intraocular pressure measurement after trabeculectomy with GAT and DCT.

Method: This is a cross sectional study to compare IOP between GAT and DCT for patients following trabeculectomy. Subject was selected consecutively in glaucoma unit Cicendo Eye Hospital. There were 20 eyes as a subject for this study. the result of this study was analyzed with wilcoxon test

Result: Mean measurement for GAT 12,10 ± 2,67 mmHg and 13,38 ± 2,23 mmHg (p value= 0,001.

Conclusion: GAT gives lower measurement than DCT.


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THE DISTRIBUTION OF INTRAOCULAR PRESSURE MEASURED BY DCT IN NORMAL SUBJECTS

K. Ito1, A. Tawara2, A. Watanabe2, T. Kubota3, Y. Ikeda4, T. Sakamoto5

1Moji Medical Center, 2University of Occupational and Environmental Health, Kitakyusyu, 3Oita Uviversity, Oita, 4Kyusyu University, Fukuoka, 5Kagoshima University, Kagoshima, Japan

Purpose: Dynamic contour tonometry (DCT) is theoretically less affected by either the central corneal thickness (CCT) or corneal rigidity. However, it is known that the mean IOP measured by DCT is different with that by GAT. The distribution of intraocular pressure measured by DCT in normal subjects is not evaluated in Japan. The purpose of this study is to evaluate the distribution of IOP measured by DCT in Japanese subjects without any intraocular diseases except for cataract.

Methods: We evaluated totally 200 eyes from 200 Japanese subjects live in Kyushu Island (102 Male and 98 female, the mean age: 52.3±23.6 years old) . We measured IOP by DCT and GAT, the CCT in the right eye of each subject between 1 PM and 5 PM. DCT and GAT measured three times and average was calculated. We compared IOP values measured by both GAT and DCT in normal eyes, and evaluate the distribution of IOP measured by DCT. Bland‐Altman plots were used to evaluate the agreement between IOP and the measurements obtained by DCT and GAT.We evaluated whether each measured value would have a difference between male and female .

Results: The mean IOP measured by DCT was 17.1±2.9mmHg, GAT was 13.7±2.6mmHg. DCT and GAT measured IOP had no difference between male and female. The standard value of DCT‐measured IOP calculated by the formula of mean IOP mean ± 2SD is 11.3‐22.9mmHg.

Conclusion: The standard value of DCT‐measured IOP in Japanese in Kyushu area is 11‐23 mmHg.


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RELATIONSHIP AMONG THE RETINAL NERVE FIBER LAYER BUNDLE ANGLE AT THE OPTIC DISC, THE CENTRAL RETINAL VESSEL ANGLES AND THE DOUBLE‐HUMP POSITION BY OCT

F. Tanabe1, C. Matsumoto1, S. Okuyama1, S. Takada1, S. Hashimoto1, H. Nomoto1, T. Kayazawa1, M. Eura1, T. Numata1, E. Arimura2, Y. Shimomura1

1Department of Ophthalmology, Kinki University Faculty of Medicine, Osaka, 2Department of Ophthalmology, Kinki University Faculty of Medicine, Sakai Hospital, Sakai, Japan

Introduction: Factors for the retinal nerve fiber bundle angle at the optic disc are important in examining the correspondence between visual field (VF) and fundus findings.

Objective: We assessed the central retinal vessel angle (the averaged vessel angle between the two central retinal arteries and veins on the temporal side) and the double‐hump angle (formed by the increased RNFL thickness in the superior and inferior positions).

Aims: The bundle angle at the optic disc was compared to the double‐hump and vessel angles.

Methods: Subjects (27 normal subjects and 4 patients with ocular hypertension) were examined by fundus photography (CF60Uvi) and Cirrus OCT (Optic Disc Cube 200×200, ONH and RNFL OU Analysis). Their average vessel angle and double‐hump angle were obtained. Each subject's fundus images by SLO (F‐10) were averaged to form a clear SLO image. Using the Octopus 900 custom test with 1º grid, the position of the blind spot was determined and used as a reference point to map the VF test points on the SLO image. The bundle angle from each test point to the optic disc along the bundle trajectory was measured and compared to the double‐hump and vessel angles.

Results: The double‐hump and vessel angles correlated well (Rs=0.86, P < 0.05). Within the superior and inferior Bijeum areas, the bundle angle correlated with the double‐hump and vessel angles.

Conclusions: The positions of the double hump by OCT corresponded to the locations of the central retinal vessels. Both angles appeared to be factors in the bundle angle.


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THE OUTCOME OF TRANSSCLERAL DIODE LASER CYCLOPHOTOCOAGULATION IN CICENDO EYE HOSPITAL

M. Rifada, E. Gustianty, A.P. Gandasubrata

Ophthalmology, University Padjadjaran, Cicendo Eye Hospital, Bandung, Indonesia

Introduction: Refractory glaucoma difficult to manage either by medication or surgery. Diode laser photocoagulation can be an alternative procedure to manage those kind of glaucoma.

Purpose: To investigate the outcome of contact transscleral cyclophotocoagulation (TSCPC) in Cicendo Eye Hospital.

Methods: This was retrospective study of 58 eyes of 58 patients with uncontrolled intraocular pressure in different type of glaucoma. All patients underwent contact TSCPC and were analysis for the outcome. All Eyes were treated with TSCPC parameter: 20‐35 spots and 1500‐2000 mW with exposure time 1500‐2000mSec. Most of patients have neovascular glaucoma. Postoperative follow up range from 1 to 12 months.

Results: Mean intraocular pressure was significantly reduce from 48.03±11.9 mmHg to 20.15±15.1 mmHg (p=0.001) after 6‐12 months follow up. Primary glaucoma both open and close angle seem had greater reduction of intraocular pressure compare to secondary glaucoma. Most of the patient received single treatment; only 2 patients received 2 times TSCPC. Hyphema occurred in 3 (5.3%) and hypotony in 2 (3.4%) patients as adverse event.

Conclusion: TSCPC could reduce intraocular pressure in quite long term follow up for different type of glaucoma with few complications.


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THE ASSOCIATION OF PRIMARY OPEN‐ANGLE GLAUCOMA / NORMAL TENSION GLAUCOMA AND OBSTRUCTIVE SLEEP APNEA IN THAI PATIENTS

S. Boonyaleephan1, C. Neruntarat2

1Ophthalmology, 2Chairat Neruntarat 1 Ophthalmology & Oto‐Rhino‐Laryngology Department, Srinakharinwirot University, Nakhornnayok, Thailand

Backgroud: The etiology of glaucoma remains unclear. Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstructions during sleep. The relationship between glaucoma and OSA has been studied in many reports. It is unclear whether glaucoma is associated with OSA.

Objective: To determine the association of primary open‐angle glaucoma / normal tension glaucomaand obstructive sleep apnea in Thai patients.

Methods and material: Eighty‐six patients consecutively admitted for polysomnographic evaluation of suspected obstructive sleep apnea were performed complete ophthalmologic examination. The association between glaucoma and OSA was determined by the Chi‐square test and Pearson correlation. P‐value < 0.05 were considered statistically significant.

Results: Forty‐four of the eighty‐six patients (51.16 %) who had an AHI higher than 10 and were diagnosed with OSA. Eighteen of them had mild OSA, twelve patients had moderated OSA and fourteen patients had severe OSA. There were two glaucoma patients in mild OSA group, one glaucoma patients in moderate OSA group and three glaucoma patients in severe OSA group. The Pearson correlation failed to show any correlation between glaucoma and mild, moderate, severe OSA (p‐value = 0.53, 0.63, 0.61 respectively).

In normal group, three glaucoma patients were found. The prevalence of glaucoma in the normal group was 7.14 %. The prevalence of glaucoma in patients with OSA was 13.64% . There was no statistically significant correlation between presence of glaucoma and OSA.

Conclusion: This study indicates that there is no statistically significant association between the presence of glaucoma and OSA in Thai patients.


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COMPARISON OF INTRAOCULAR PRESSURE REDUCTION AFTER TRABECULECTOMY AND COMBINED SURGERY IN PRIMARY OPEN AND ANGLE CLOSURE GLAUCOMA

S.M.D. Sihombing, I. Irfani, A.P. Gandasubrata, E. Gustianty

Ophthalmology Department, Medical Faculty of Padjajaran University, Bandung, Indonesia

Purpose: To compare the intraocular pressure (IOP) reduction after trabeculectomy, trabeculectomy with adjunctive Mitomycin C (MMC) and combined surgery in patients with primary open and angle closure glaucoma.

Methods: In this retrospective review (from January 2010 to December 2011), 43 eyes underwent trabeculectomy compared with 19 eyes underwent trabeculectomy with adjunctive MMC and 16 eyes underwent combined surgery. Intraocular pressure and its reduction, number of glaucoma medications, and visual acuity between the three groups were analyzed in 1 week, 1 month, 2 months, and 3 months postoperatively.

Results: After 3 months postoperatively the mean IOP in trabeculectomy group decreased from 37.76 mmHg (SD 13.70) to 14.40 mmHg (SD 5.44); in trabeculectomy with adjunctive MMC group decreased from 37.58 mmHg (SD 14.66) to 13.42 mmHg (SD 7.13) ; and 27.00 mmHg (SD 13.38) decreased to 12.56 mmHg (SD 4.63) in combined surgery group. The highest IOP reduction at 1 week and 1 month postoperatively was in trabeculectomy with adjunctive MMC group with a mean 25.11 mmHg (SD 18.62) and 24.61 mmHg (SD 17.50) respectively. However at 2 and 3 months postoperatively there were no significant differences in IOP reduction in all three groups.

Conclusion: IOP reduction until 1 month postoperatively was found better with trabeculectomy with adjunctive MMC compared with trabeculectomy and combined surgery in patients with primary glaucoma.


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TEST RETEST VARIABILITY OF OCTOPUS PERIMETER IN NORMALS AND PATIENTS WITH OPEN ANGLE GLAUCOMA

A. Niranjan, R. Bhagali, A.V. Sathi Devi, C.A.S. Nazareth, B.K. Shetty

Narayana Nethralaya, Bangalore, India

Introduction: The perimetric test retest variability in glaucoma is due to a flattened frequency of seeing curve due to which they exhibit wide fluctuation. This study was designed to detect the test‐retest variability among glaucoma patients and normals with Octopus Perimeter 900.

Aim: The visual field Indices of Octopus Perimeter‐ Mean Sensitivity (MS), Mean Defect (MD) in 4 quadrants and the squareroot of Loss Variance (sLV) were assessed for agreement between two consecutive tests in patients with glaucoma and controls.

Methods: 54 glaucoma patients and 30 controls, with prior perimetric experience, underwent 2 visual field tests using G‐dynamic program with Octopus Perimeter, within a 30 days interval, by a trained perimetrist. The parameters investigated to detect test retest variability were MS, MD in all 4 quadrants and sLV.

Results: Using Bland Altman Analysis, Mean intertest differences for MS, MD and sLV in glaucoma group were ‐0.196dB (95% limits of agreement[LoA], 3.987 to ‐4.380dB), 0.198dB (95%[LoA], 4.374 to ‐3.978dB), and 0.267dB (95%[LoA], 2.978 to ‐2.444dB) respectively. In controls, Mean intertest differences for MS, MD and sLV were ‐0.013dB (95%[LoA], 3.715 to ‐3.745dB), 0.020dB (95%[LoA], 3.760 to ‐3.720dB), and 0.293dB (95%[LoA], 3.050 to ‐2.463dB) respectively. The co‐efficient of agreement for MS, MD and sLV was 94.44%,92.59% and 100% in glaucoma group and 96.67% for all indices in controls.

Conclusions: The Octopus Perimeter has good test retest agreement in all visual field indices in control group. In Glaucoma group, MS, MD showed variability and only sLV which is indicative of localized defects showed good agreement on consecutive tests.


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QUALITATIVE AND QUANTITATIVE COMPARISON OF LASER IRIDOTOMY EFFECT ON ANGLE CLOSURE EYES USING ASOCT

J.M. Aduan1, M.C. Aquino1, P.T.K. Chew2

1Ophthalmology, National University Hospital of Singapore, SIngapore, 2Ophthalmology, National University Health System, Singapore, Singapore

Objective: Laser iridotomy is considered the standard treatment option for angle closure eyes. Anterior segment optical coherence tomography (ASOCT), a non‐contact imaging system provides objective basis for angle closure diagnosis and treatment outcome assessment. The main objective of this study is to examine the effectiveness of peripheral laser iridotomy in primary angle closure (PAC) and primary angle closure suspects (PACS) qualitatively and quantitatively.

Design: Prospective Observational Case Series.

Participants: 50 eyes with PAC and PACS.

Methods: Patients with PAC and PACS underwent peripheral laser iridotomy. Pre and post laser gonioscopy and anterior segment OCT were done. 3 senior glaucomatologists were asked to do gonioscopy and review the ASOCT of these patients to assess efficacy of laser iridotomy. Customized software (Anterior segment Analysis program, ASAP from NUH) was used to compute for anterior segment parameters.

Results: 50 eyes with PAC and PACS had undergone laser iridotomy. Using the ASAP software the ACA (anterior chamber area), ACD (Anterior Chamber depth), AOD (Angle opening distance), TISA (Trabecular Iris Space Area) and ARA (Angle recess area) were determined.

Conclusions: Correlating results of qualitative and quantitative analysis may assist clinicians in the assessment of laser iridotomy treatment effects.


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APPLICATION OF FREQUENCY‐DOMAIN OPTICAL COHERENCE TOMOGRAPHY NORMATIVE DATABASE IN THE DIAGNOSIS OF GLAUCOMA

P. Yingzi

Peking University First Hospital, Beijing, China

Aims: To evaluate the application of FD‐OCT racial specific normative database in the diagnosis of primary open angle glaucoma (POAG), build a scoring system and diagnostic models of POAG.

Methods: Cross‐sectional study. 133 healthy subjects and 99 early POAG patients were included in the study. The OCT scan parameters were graded and scored according to the normative database. The areas under the receiver operating characteristic curve (AROC) were calculated for the scores of parameters. All Retinal Nerve Fiber Layer (RNFL) parameters in ONH and RNFL3.45 scanning were divided into 4 sectors. We built 'new sector diagnostic models' by logistic regression using the best scoring system of each sector, and compare them to 'traditional sector diagnostic models'. We also built 'combined diagnostic models' with the best parameters of RNFL, Ganglion Cell Complex (GCC) and optic disc scanning, and validated those models by testing sample.

Results: 1. Significant differences were observed for all graded scores of parameters between normal and

early POAG groups (P＜0.05).

2. AROCs of 5 in 6 models were larger than 0.9 and had no significant differences between them. 3. The 'new sector diagnostic model' in ONH scanning was the simplest model and it has the larger AROC

than the best single parameter（P< 0.05）.

Conclusions: The FD‐OCT racial specific normative database is able to distinguish early POAG from normals. The scoring system and diagnostic models we built are able to increase AROC of the OCT parameters and might be more convenient to clinical application.


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BLEB APPEARANCE POST‐SODIUM HYALURONATE INJECTION IN TRABECULECTOMY PATIENTS

J. Tatsios, M.C.D. Aquino, A. Suryono, E.W.E. Chan, J.M. Aduan, P.T.K. Chew

National University Health System, Singapore, Singapore

Purpose: To investigate the efficacy of sodium hyaluronate (HealaFlow) injected in trabeculectomy surgery.

Patients and methods: In a non‐randomized case series of 7 patients undergoing trabeculectomy surgery, sodium hyaluronate 22.5mg/ml was injected below the scleral flap (0.01‐0.02ml) and subconjunctivally (0.3ml). Bleb appearance of all patients was evaluated and measured using anterior segment photos as well as anterior segment optical coherence tomography (Visante‐OCT) and compared to the bleb appearance of 7 patients without sodium hyaluronate injection.

Results: For the 7 eyes mean follow‐up time was one month with good results in keeping with the sodium hyaluronate acting as a spacer and holding off the conjunctiva from the scleral flap. Bleb appearances are uniformly raised and diffuse with well‐defined larger bleb cavities and well‐controlled intraocular pressures. Anterior chamber depth was measured in all patients using Visante‐OCT, nevertheless longer‐follow up period is necessary to show whether the anterior chamber is prone to shallowing.

Conclusions: Subconjunctival sodium hyaluronate is associated with more diffuse blebs after filtering surgery. However, further studies with longer follow‐up period are necessary to evaluate bleb appearance in the long‐term.


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ULTRASOUND BIOMICROSCOPIC STUDY OF ANTERIOR CHAMBER DEPTH AND CHAMBER ANGLE IN ADULT PHAKIC EYES AT A TERTIARY CARE HOSPITAL IN THE PHILIPPINES

B.J.M. Hidalgo, M. Lat‐Luna, P. Khu, M. Agulto

Ophthalmology, Philippine General Hospital, Manila, Philippines

Objective: To evaluate the anterior chamber depth (ACD) and angle width (ACA) of adult phakic eyes at a tertiary care hospital in the Philippines and determine their associations with ocular and general parameters.

Methods: This is a prospective, observational, cross‐sectional study of 123 adult phakic Filipino subjects from the General Clinic of a Tertiary Care Hospital in the Philippines conducted from June 2009 ‐ July 2009. The subjects underwent complete ophthalmologic examination including measurement of the anterior chamber depth and chamber angle by ultrasound biomicroscopy.(UBM). Chi‐square tests were used to compare proportions. All P values were two‐sided and is considered statistically significant when the values are less than .05.

Results: Of the 123 subjects recruited, UBM measurements were available for 105 subjects (85.36%) (aged 19+ years). Mean ACD measured was 2.54 ± 0.42 mm and mean ACA was 30.18 ± 8.49 degrees. In Univariate Analysis, a shallow ACD was significantly associated with age (P=0.002), female gender (P =0.046), presence of nuclear cataract (P=0.0043), short body stature (P=0.042), body weight (P=0.005), presence of PACG (P=0.0055) and PACS (P=0.0002). While a narrow ACA was associated with higher age (P=0.001) presence of nuclear cataract (P=0.0002), and PACS (P=0.0002).

Conclusion: In this hospital‐based study of adult Filipino eyes, a shallow ACD and a narrow ACA are significantly associated with increasing age, female gender, short body stature, weight, presence of nuclear cataract, PACG and PACS. In recent years, population based studies, also reveal similarity and consistency of association between a shallow ACD and narrow ACA in female subjects with increasing age, and short body stature.


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THE INCIDENCE AND PROFILE OF GLAUCOMA PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL IN YEAR 2000‐2010

W.A. Wiyogo, M. Faiqoh

Department of Ophthalmology, Faculty of Medicine University Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose: To assess the incidence of blindness caused by glaucoma and the glaucoma's profile in the period of 10 years in CiptoMangunkusumo Hospital (CMH) Jakarta, Indonesia.

Methods: This was a retrospective study on new glaucoma patients who came to Department of Ophthalmology, CMH from the year 2000 to 2010. Data were retrieved from medical records and documented. The datas included were BCVA, slit lamp examination, IOP, static and dynamic gonioscopy, optic nerve, and visual field evaluation. Exclusion criteria were patients with no suspect of glaucoma or incomplete data.

Results: A total of 3,203 new glaucoma patients were included in this study. There were 53% male and proportion of age over 40 years old was 78.96%. The mean IOP was 29.8±15.3(range: 12‐70)mmHg. The incidence rate of monocular and bilateral blindness was 39% and 15%. Early stage of glaucoma was found in 30.2%, and advanced stage was found in 23.1%. Primary glaucoma was higher(46%) than secondary glaucoma(31.6%). The profile of primary glaucoma revealed as follows; POAG(19.3%), PACG(18,7%), APAC(0.9%), primary angle closure(1.5%), congenital glaucoma(0.4%), and juvenile glaucoma(6%). While primary angle closure suspect and glaucoma suspect was 1% and 11.4%, respectively.

Conclusions: The incidence rate of monocular blindness was the highest. The percentage of POAG was almost similar to PACG.


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TEMPLATES FOR DOCUMENTATION OF OPTIC NERVE HEAD (ONH) FINDINGS IN GLAUCOMA

R. Tammineni

Sankar Fondation Eye Hospital, Visakhapatnam, India

Introduction: DDLS and CDR notations are complementary in Optic Nerve head (ONH) evaluation and unified template may enhance utility. Apparent Disc size depends on various biometric factors.

Objective: Enhanced accuracy and objectivity in documentation of the clinical features of ONH.

Aims: To create a ready‐reckoner table giving actual disc‐sizes and to design a unified Disc‐damage‐likelihood‐Scale (DDLS) grading & cup‐disc ratio (CDR) template.

Methods: The ratio number of the disc size to well‐focused image of 1mm slit‐lamp‐spot gives the as apparent image size factor, 's' in millimeters (mm) Using Microsoft Excel spreadsheet software and the formulas for disc size ( t=p.q.s), BRE2 formula for 'q' when Axial length is known, and Garaway, et al formula for ´q´ when Keratometry‐Ametropia are known, table cells were filled up with formulas to give corresponding actual Disc Sizes. Photographic templates are presented for apparent disc size estimation in mm compared to the 1 mm spot and a set of figures with labels for the DDLS‐CDR concept integration.

Purpose: The DDLS & CDR are complementary to each other and combined chart would enable better objectivity in documentation. Results The tables give estimated‐disc‐sizes for axial‐length & keratometry‐ametropia values; color formatting, DDLS‐CDR integration and legends add utility.

Conclusions: Disc‐sizing template, tables for correced size, and the unified DDLS‐CDR template are presented as ready‐reckoner.


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MUTATIONAL ANALYSIS OF CYP1B1 GENE IN PATIENTS WITH PRIMARY CONGENITAL GLAUCOMA (PCG) IN NORTH INDIA

H. Kumar1, S. Kaushik1, J. Sharma1, M.L. Guptasarma2, S.S. Pandav1, S. Raj1

1Advanced Eye Centre, 2Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Introduction: More than 40 different mutations have been identified in the human cytochrome P450 gene (CYP1B1) in patients of primary congenital glaucoma (PCG), but literature regarding this from North Indian ethnicity is sparse, and most studies have not screened the promoter region.

Objective: To study the molecular genetics of PCG in North India.

Aims: To screen the CYP1B1 gene for mutations in the promoter and coding regions in a cohort of North Indian patients.

Methods: 36 unrelated patients of PCG with typical clinical features were enrolled. Genomic DNA was prepared from peripheral lymphocytes by standard protocol. The coding region of the CYP1B1 gene was amplified from the exons II and III, and the 485 bp upstream regulatory region of the gene (2748 bp to 3233 bp) was also PCR amplified. All 4 PCR amplicons were sequenced and the results compared against CYP1B1 sequence to look for any mutations either in the coding or regulatory region of the gene.

Purpose: To see if the CYP1B1 gene harbored mutations in PCG patients.

Results: Mutations were detected in 2 of the 36 cases. One had a mutation in the exon II, C4645A, leading to a change in Cys at position 280 into a stop codon. The other patient had a mutation in the promoter region, G 3078T.

Conclusions: Mutations were detected in only 2 of 37 patients screened in this study. In North Indian patients, the mutation may lie in genes other than the CYP1B1.


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RELATIONSHIP OF LENS VAULT WITH VISUAL ACUITY IN ANGLE CLOSURE

M. Nongpiur1, S. Stewart2, H.M. Htoon1, A.K. Narayanaswamy1, M. He3, S. Perera1,4, T. Aung1,4

1Singapore Eye Research Institute, Singapore, Singapore, 2University College London, London, UK, 3State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‐sen University, Guangzhou, China, 4Singapore National Eye Centre, Singapore, Singapore

Purpose: To investigate the relationship between lens vault (LV) and visual acuity in eyes with angle closure.

Methods: We recruited 2047 subjects aged 50 years or more from a community polyclinic. All participants underwent a standardized ocular examination and anterior‐segment optical coherence tomography (ASOCT). Customized software was used to measure LV, defined as the perpendicular distance between the anterior pole of the crystalline lens and the horizontal line joining the 2 scleral spurs, on horizontal ASOCT scans. Visual acuity was measured using a logarithm of minimum angle of resolution chart (logMAR chart, Lighthouse Inc, Long Island, New York). An eye had angle closure if the posterior pigmented trabecular meshwork was not visible for at least 180° on gonioscopy.

Results: Data on 1453 community‐based subjects including 311 with angle closure subjects were analyzed. Eyes with angle closure were significantly older (p< 0.001), with shorter axial length (AL, p< 0.001), shallower anterior chamber depth (ACD, p< 0.001) and greater LV (p< 0.001), but there were no significant differences in visual acuity (p=0.14). The majority of angle closure subjects had normal visual acuity or mild visual impairment (85.2%), and no significant trend was noted in visual acuity (p=0.123) or spherical equivalent (p=0.635) with increasing magnitude of LV. After adjusting for age, gender, AL, ACD, and spherical equivalent, there was no significant correlation between LV and visual acuity (p = 0.35). Similarly, no significant association was found between LV and spherical equivalent (p=0.056).

Conclusion: LV was not associated with visual acuity or refractive error.


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EVALUATION OF AN AXIAL LENGTH REQUIRING ADJUSTMENT FOR OCULAR MAGNIFICATION IN CIRCUMPAPILLARY RETINAL NERVE FIBER LAYER MEASUREMENT

K. Hirasawa1, N. Shoji1,2, Y. Yoshii2, S. Haraguchi2

1Ophthalmology, 2Orthoptic and Visual Science, Kitasato University, Sagamihara, Japan

Methods: One hundred and thirty‐five eyes of 135 normal participants were used for an evaluation in this study. By two examiners, cpRNFL with 3D‐OCT 2000 was measured two times each before and after the adjustment. And an intra‐ and inter‐examiner range of the measurement error was calculated by using a difference between the two measurements. Based on the range of the measurement error, all participants were divided into three groups; a group which total cpRNFL thickness measured before and after adjustment was within the range of the measurement error, a group which total cpRNFL thickness was thinner than that after the adjustment, and a group which was thicker than that after the adjustment. The cut‐off value of an axial length which required the adjustment was calculated by receiver operating characteristic analysis.

Results: The measurement error of total cpRNFL thickness in intra‐ and inter‐examiner ranged from 4.2 to 5.3 µm, so the border line of the measurement error was defined 6 µm. As these results, the cut‐off value of a short and a long axial length were 23.77 mm (Area under the curve: AUC=0.926) and 25.55 mm (AUC=0.948), respectively.

Conclusions: The range of axial length which is insusceptible to the effect of the adjustment for ocular magnification was narrow, suggesting that it would be important to adjust for the ocular magnification according to each axial length.


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SWITCHING EFFECT TO FIXED COMBINATION OF LATANOPROST‐TIMOLOL MALEATE OPHTHALMIC SOLUTION (LTFC) FOR GLAUCOMA PATIENTS UNDER MULTIDRUG THERAPY

K. Matsumura1, N. Shoji2, T. Morita1, M. Kasahara1, S. Tatsui1, K. Shimizu1

1Ophthalmology, 2School of Allied Sciences, Kitasato University, Sagamihara‐shi, Japan

Purpose: To study prospectively the switching effect to fixed combination of latanoprost‐timolol maleate ophthalmic solution (LTFC) for glaucoma patients who were undergoing multidrug therapy.

Subjects and methods: This study was conducted on glaucoma patients who were treated for longer than four weeks in combination with multiple glaucoma eye drops including prostaglandin(PG) and beta‐blocker(β). After the patients' consents to this study were obtained, combined use of PG and βwere switched to a single medication of LTFC (applied 1 time at night) and intraocular pressure(IOP), blood pressure(BP) and changes in pulse rate(PR) were evaluated at 4, 8 and 12 weeks, respectively. Static perimetry was also taken before switching and at 12 weeks later, respectively, along with survey on the patients' views on the medication.

Results: Eighteen eyes of 18 patients were examined. Mean IOP was 14.7+/‐1.5, 13.7+/‐2.0mmHg, respectively, before switching, and 12 weeks later with no significant change. Mean systolic and diastolic BP had no significant change. Average PR was significantly increased from 68.1+/‐8.7 to 74.9+/‐10.2 times per minute (p=0.04). No significant change was observed for mean retina sensitivity. According to the survey, the number of patients who found it easy to apply the medication increased from 5 to 10 after switching.

Conclusion: This study suggested that switching to LTFC for glaucoma patients who were undergoing multidrug therapy has no effect on the patients' IOP and also there is a possibility that it has less systemic side effects.


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COMPARISON OF THE NEW REBOUND TONOMETER WITH GOLDMANN APPLANATION TONOMETER IN A CLINICAL SETTING

K.N. Kim, Y.J. Choi, J.W. Jeoung, K.H. Park, C. Hong, D.M. Kim

Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea

Purpose: To evaluate the clinical usefulness of a new rebound tonometer, Icare® PRO (IRT) by comparison with Goldmann applanation tonometry (GAT) in a study on glaucoma patients.

Methods: One hundred and seventy‐two eyes of 86 patients were enrolled in this study. All of the subjects were examined by an autorefractometer, IRT, slitlamp biomicroscope, GAT, ultrasound A‐scan, and pachymeter. Three intraocular pressure (IOP) measurements were obtained by IRT and GAT.

Results: There was a good correlation between the IOP measurement by GAT and that by IRT (r=0.642, p< 0.001). The intraclass correlation coefficients of IRT and GAT were 0.779 and 0.957, respectively. With IRT, the area under the receiver operator characteristic curve was 0.987, and the point that best discriminated between patients with IOP ≤ and > 21 mmHg by GAT was 20.9 mmHg (sensitivity: 100.0%; specificity: 98.2%). The IOP differences between IRT and GAT did not vary over the wide range of central corneal thickness (p=0.504), age (p=0.123), axial length (p=0.319) or spherical equivalent (p=0.084).

Conclusions: IRT was found to be a reliable method, and showed a good correlation with GAT. The IOP difference between IRT and GAT was not affected by the central corneal thickness, age, axial length, or spherical equivalent. IRT can be expected not only to be a good screening tool but also a good substitute for GAT, especially in patients for which GAT is technically challenging.


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COMPARISON OF INVASIVE AND REBOUND TOMOMETRY IN THE RABBIT

H. Zhang1,2,3, D. Yang1,2,3, C. Ross1,2, J.P. Wigg1,2, S. Pandav1

1Centre for Eye Research Australia, The University of Melbourne, 2Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia, 3Harbin Medical University, Harbin, China

Introduction: The induction‐impact (rebound) Tonovet tonometer provides a non‐invasive method of measuring IOP. Although rabbit models are often used in drug‐related and surgical glaucoma research, IOP measurement by Tonovet has not been fully validated in this species.

Objective: To determine the accuracy and variability of the rebound tonometer in the measurement of rabbit IOP.

Methods: IOP was set and measured manometrically in anesthetized adult New Zealand White rabbits (n=8) after anterior chamber cannulation through the peripheral cornea. The 26‐gauge needle used for anterior chamber cannulation was connected to a pressure transducer‐controlled syringe pump from Harvard Apparatus. IOP was raised in 1‐5mmHg steps from 5 to 50 mmHg using an open stopcock method. The IOP was measured with the TonoVet in both “p” and “d” modes by taking four to six readings at each point by two independent observers.

Results: TonoVet readings correlated well with manometric IOP (“d” mode: slope = 1.137, r(2) coefficient = 0.9966; “p” mode: slope = 1.4814, r(2) coefficient = 0.9941). No significant differences were observed when comparing right and left eyes. The TonoVet had a tendency to underestimate IOP compared to anterior chamber cannulation. TonoVet readings obtained with “d” mode were closer to manometric IOP than those obtained with the “p” mode, although conversion formulae were possible to calculate for both modes.

Conclusions: The TonoVet is a reliable and precise tool for the measurement of IOP in rabbits using a conversion formula. The “d” mode is more useful than “p” mode in measuring rabbit IOP.


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STUDY OF BACKGROUND FACTOR IN THE POOR PROGNOSIS CASE OF THE TRABECTOME OPERATIONV

S. Tatsui1, N. Shoji2, M. Kasahara1, K. Matsumura1, T. Morita1, K. Shimizu1

1Ophthalmology, 2School of Allied Siences, Kitasato University, Sagamiharashi, Japan

Purpose: To investigate background factor in the poor prognosis case of the trabeculotomy using Trabectome.

Subjects and methods: Retrospectively studied 14 eyes from 69 eyes of 61 glaucoma patients (average age 62.2 +/‐ 17.0 years old) which operated trabeculotomy using Trabectome in our hospital from December 2010 to April 2012 as a case of bad prognosis which needed additional operation (trabeculectomy or goniosynechialysis) within the follow‐up period of until 12 months. The operational methods of all these cases were temporal keratotomy and made the incision 120 degrees to the nose side using Trabectome. In performing cataract surgery at the same time, it was up to the operator whether to perform Trabectome first or not, but other operational procedures were conducted almost in the same manner in all the cases. Examined background factors in the poor prognosis case by logistic analysis‐ categorized into five factor: sex, smoking, hyperpiesia, diabetes and after selective laser trabeculoplasty (SLT).

Results: Only a history of SLT as the background factor in the poor which needed an additional operation was a significant risk factor in odd ratio 15.83(p=0.0011).

Conclusion: Prognosis of Trabectome suggested the possibility that a history of SLT is greatly influenced. There is a possibility that it is not the laser radiation itself that led to a poor performance of this operative procedure but a mechanism under which lowered ocular pressure failed to be obtained by laser and this operative method. Further study is necessary about the mechanism.


220


326

FIVE YEAR INCIDENCE OF OCCLUDABLE ANGLE AMONG HEALTH EXAMINATION RESIDENTS

T. Ogura, K. Kashiwagi, T. Chiba, F. Mabuchi, T. Furuya, H. Takahashi, S. Tsukahara

Ophthalmology, University of Yamanshi, Chuo, Japan

Purpose: To investigate incidence of angle closure (AC) and its associated factors among glaucoma health examination participants over a five‐year period.

Methods: Japanese residents aged 40 years or over who underwent two glaucoma health examinations held in 2005 and 2010 were enrolled. Of the participants of the 1st glaucoma health examination (1st examination), were chosen for the 2nd glaucoma health examination (2nd examination) after eliminating eyes with AC, glaucoma, incisional ocular surgery, or other conditions that could influence the results. In addition to routine ophthalmic examination, a scanning peripheral anterior chamber depth analyzer (SPAC) was employed to investigate the anterior chamber configuration. The incidence of AC over the five‐year period and its associated factors were investigated.

Results: Of the 754 participants of the 1st examination, 569 participants were invited for the 2nd examination and 331 participants (87 males and 244 females, age: 62.6±12.7 years), or 619 eyes, were analyzed after eliminating eyes matching exclusion criteria. In the five‐year period, the incidence of AC was 5.4% (95% CI: 3.5%‐8.4%) of participants or 5.5% (95% CI: 4.0%‐7.6%) of eyes, including eight eyes (1.3%) with primary angle closure glaucoma. Eyes that developed AC had a much smaller SPAC grade at the 1st examination and a greater decrease in SPAC grade than those that did not develop AC, whereas age and sex were not associated.

Conclusions: 5.4% of Japanese residents developed AC over the five‐year period. The shallow anterior chamber and the marked decrease in anterior chamber depth were associated with AC development.


221


327

POSNER SCHLOSSMAN SYNDROME; A CASE REPORT

N. Ihsan, W. Artini

Faculty of Medicine Universitas Indonesia ‐ Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose: To report clinical manifestation of recurrence of the glaucomatocyclitic crisis (Posner Schlossman Syndrome)

Case: A 38 years old women came to eye clinic with chief complain of discomfort, photopsia, and halos on her right eye. Her visual acuity was 6/6 on both eyes. Her intraocular pressure was 40 mmHg on right eye and 10 mmHg on left eye. Slit lamp examination revealed minimal conjungtiva‐ciliary injection, cells and flare in anterior chamber, and clear lens. On funduscopy showed no sign of glaucomatous optic nerve defect. She had recurent high IOP in every 3 month and after received topical anti inflammatory and topical‐oral pressure‐lowering agents, the attack was diminished. A year after, she underwent trabeculectomy with Mytomicin C because of appearing sign of glaucoma.

Conclusion: This interesting case with posner Schlossman syndrome indicated sign of glaucoma, meanwhile this desease was known as a benign glaucoma.


222


328

THE CHALLENGES IN MANAGING IRIDOCORNEAL ENDOTHELIAL (ICE) SYNDROME ‐ A CASE SERIES

D. Andalia1, W. Artini2

1University of Indonesia, RSCM, 2Ophthalmology, Universitas Indonesia, Jakarta, Indonesia

Purpose: To report the challenge in managing iridocorneal endothelial (ICE) Syndrome.

Cases: Case 1: Forty‐six years old female presented in eye clinic with history of soreness in her left eye. BCVA was 6/48 on left eye and 6/6 on right eye. Her left IOP was 41 mmHg. Slit lamp examination revealed cornea silver appearance, shallow AC with PAS. The pupil was correctopic and slightly retracted. There were multiple‐pigmented iris. She was diagnosed as iridocornea endothelial (ICE) syndrome and had treated with Trabeculectomy . Her eye symptoms worsened and IOP remained high (45 mmHg). Needling with 5 FU was performed but the IOP remained high. TCP also performed on this patient, the IOP was reduced to 4mmHg, then return to 41 mmHg. The Ahmed glaucoma valve was implanted. Case 2: Fifty‐nine years old female presented in eye clinic with pain in her left eye, which has worsened in three years. The BCVA were 6/48 on the left eye with IOP was 37 mmHg. On slit lamp examination revealed PAS and iris atrophy, cornea had silver appearance. She was diagnosed of ICE‐glaucoma syndrome. Trabeculectomy + MMC and Phacoemulsification + IOL performed on her left eye.

Conclusion: Management of ICE‐glaucoma syndrome was complicated due to the process of disease itself.


223


329

CORRELATION BETWEEN CENTRAL CORNEAL THICKNESS (CCT) AND INTRAOCULAR PRESSURE (IOP) IN MYOPIC PATIENTS

R. Ekantini, T.T. Gani

Department of Ophthalmology, Universitas Gadjah Mada, Yogyakarta, Indonesia

Introduction: Myopia is one of the most frequent refractive defects in the general population. Recently, no study has been conducted in Yogyakarta population to determine the central corneal thickness (CCT), intraocular pressure (IOP), and degree of myopia (DM) parameters and their relationships. Establishing these parameters and their relationships is important, because of the potential for CCT to influence intraocular pressure, and thus decision making on glaucoma treatment. These parameters are also very important in the field of refractive surgery because CCT and IOP may indicate whether a specific surgical photorefractive keratectomy (PRK), laster‐assisted in situ keratomileusis (LASIK) or intraocular lens technique should be applied or not

Objective: To calculate the correlation of central corneal thickness and intraocular pressure in myopia.

Methods: This is a cross‐sectional study. The subjects were myopias at Dr.Yap Eye Hospital Yogyakarta, Indonesia. Central corneal thickness was measured by pachymeter and intraocular thickness by non‐contact tonometer.

Results: There were 71 myopic eyes, aged between 17 ‐ 43 years old. Astigmatism was conversed to spherical calculation. The range of myopia was spherical ‐ 1.25 to ‐ 13.75. Mean of CCT was 583.3 ± 38.2 µm, and the range were 506 µm to 662 µm, and IOP was 14.7 ± 2.9 mmHg and the range were 9 mmHg to 22 mmHg. Correlation coefficient between CCT and IOP was 0.47 but there were no correlation between sex and age with CCT and IOP.

Conclusion: There was a moderate positive correlation between CCT and IOP in myopia.


224


330

EVALUATION OF OPTIC‐NERVE DISC SIZE IN NORMAL JAPANESE SUBJECTS

G. Ishida, Y. Ikeda, K. Mori, M. Ueno, Y. Maruyama, H. Yoshikawa, Y. Kato, S. Kinoshita


Introduction: The optic‐nerve disc size is important to detect and diagnose glaucoma, and it is often difficult to diagnose glaucoma in subjects with a small disc size.

Objective: To understand the optic disc in patients with glaucoma, it is important to elucidate the optic‐nerve disc size and its distribution in normal subjects.

Aim: In this study, we evaluate the optic nerve disc size in Japanese normal subjects by use of the Heidelberg Retina Tomograph II (HRT‐II; Heidelberg Engineering GmbH, Heidelberg, Germany).

Methods: This study involved 1165 subjects diagnosed as normal by glaucoma specialists at the Kyoto Prefectural University of Medicine between March 2005 and March 2010 by use of the HRT‐II performed on both eyes of each subject. Their refractive error was within ±12 diopters and HRT‐II SD was less than 50. Disc sizes ranging between 1.67‐2.87mm2 were considered normal; a smaller‐than 1.67mm2 disc was considered small and a larger‐than 2.87mm2 disc was considered large.

Results: The average disc size was 1.9 ± 0.5 mm2 in both eyes. The number of subjects who had bilateral normal‐size discs, small discs, and large discs were 658 (56.5%), 248 (21.3%), and 15 (1.3%), respectively. Subjects who had a unilateral normal and a unilateral small disc, and a unilateral large disc were 208 (17.9%) and 35 (3.0%), respectively. One subject (0.1%) had unilateral small disc and unilateral large disc.

Conclusions: In normal Japanese subjects, less‐than 60% had bilateral normal‐size discs, and almost 40% had a small disc in at least 1 eye.


225


331

EVALUATION OF AGE‐RELATED MORPHOLOGICAL CHANGE OF THE ANTERIOR CHAMBER IN JAPANESE NORMAL SUBJECTS

Y. Kato, K. Tada, Y. Ikeda, K. Mori, M. Ueno, Y. Maruyama, H. Yoshikawa, G. Ishida, S. Kinoshita


Introduction: Glaucoma attacks rarely occur in younger‐aged people, but do often occur in elder‐aged hyperopic women.

Objective: Age‐related morphological change of the anterior chamber is thought to be involved in the pathophysiology of an acute angle‐closure glaucoma attack.

Aim: In this study, we evaluated the anterior chamber morphology of healthy Japanese subjects in relation to patient age.

Methods: Of 1554 healthy Japanese volunteer subjects who underwent a glaucoma screening test at Kyoto Prefectural University of Medicine from March 2005 to March 2011, 1178 phakic, glaucoma‐free subjects (419 males, 759 females; mean age: 54.1±14.9 years) were enrolled in this study. Anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) measurements were obtained from all subjects by use of the Scheimpflug 3D camera (Pentacam; Oculus Inc., Wetzlar, Germany). The subjects were then divided into 6 groups according to age as follows: 1) less than 30 years of age, 2) 30‐39 years of age, 3) 40‐49 years of age, 4) 50‐59 years of age, 5) 60‐69 years of age, and 6) 70 or more years of more age. The ACD, ACV, and ACV data among the groups was then compared.

Results: Comparison of the ACD/ACV/ACA data between all age groups revealed a respective reduction rate of 22.1/39.9/25.9%, with the greatest reduction of ACD/ACV/ACA occurring in subjects in their 50s/50s/40s, respectively.

Conclusion: In normal Japanese subjects, the amount of age‐related reduction was largest in ACV. However, age‐related reduction appeared more rapidly in ACA.


226


335

COMPUTERIZED SUMMARIZING CHARTS FOR VISUAL FIELDS´ ANALYSIS AND CORRELATION TO IOP AND INTERVENTIONS

R. Tammineni

Anterior Segment and Glaucoma, Sankar Foundation Eye Hospital, Visakhapatnam, India

Introduction: The Visual Fields and Clinical data are often available from various patient visit locations, and they would have to be charted and analyzed.

Objective: Enhanced clarity regarding long term trends in Glaucoma Patients Aims To support the clinical decision making processes in long‐term management of Glaucoma for patients visiting multiple centers.

Methods: We have used Microsoft Excel software for the tabulation of data and creation of the charts to sum up and depict the clinical course. A time‐line based X‐axis is made to plot the data; summarizing tools are utilized to draw trend lines and future predictions. Parallel charts of other clinical parameters: Intra‐ocular‐pressures, medications and interventions of surgery or post‐operative augmentations, are presented after codification of the nominal data.

Purpose: An ideal tabulation format would be user‐friendly to input data and comprehensive in scope. The level of detail and complexity, and integration to other clinical parameters like IOP, medication or interventions can increase the value of the programming.

Results: Graphical depiction of patient clinical course with the trend lines and predictions regarding Mean Deviation are presented.

Conclusions: The spread sheet software output are an alternative when more detailed statistical analysis of the trends cannot be taken up.Software potential needs to be harnessed to the extent possible to enable standardization and to enhance quality of care while optimizing utilization of patient‐chair time.


227


[10 year follow up of a patient]


228


340

THE SWITCHING EFFECTS OF DIPIVEFRIN FROM PROSTAGLANDIN ANALOGUES

M. Shimizu1, I. Kimura1,2, S. Watanabe1, K. Tamaki1, A. Usui1, A. Murakami3, N. Ebihara1

1Department of Ophthalmology, Juntendo University Urayasu Hospital, Chiba, 2National Institute of Sensory Organs, Tokyo Medical Center, National Hospital Organization, 3Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan

Purpose: To assess the effects on glaucoma patients of dipivefrin (DP) ophthalmic solution in case of no‐responder by prostaglandin analogues (PG).

Methods: Retrospective study was conducted on glaucoma patients who were treated to use DP in case of no‐responder by PG. 8 glaucoma patients (5 males, 3 females, averaged age: 70.6±6.6 years old) were participated in this study and 16 eyes were investigated. The glaucoma types and cause of secondary glaucoma of patients, the contents of prescription before switching, and the change of intraocular pressure (IOP) were studied.

Results: The participants included 1 patient with iritis, 2 patients with exfoliation glaucoma, 2 patients (3 eyes) with intraocular lens, and 2 patients (4 eyes) with postoperative trabeculectomy. 3 patients had been

prescribed with 4 drugs: PG・β‐adrenergic blocking agent(β)・Carbonic anhydrase inhibitor (CAI)・α1‐

adrenergic blocking agent (α1), 3 patients with 3 drugs: PG・β・CAI, 1 patient with 3 drugs:

PG・CAI・α１, and 1 patient with 2 drugs: PG・β, before switching from PG to DP. The PGs before

switching consisted of latanoprost (2 cases), tafluprost (3 cases), travoprost (2 cases), and bimatoprost (1 case).

The mean IOP indicated 17.5±4.6mmHg before switching and 16.3±5.2mmHg after switching (p>0.05). The IOP decreased (>1mmHg) in 7 eyes, remained stable in 6 eyes, and increased (>1mmHg) in 3 eyes.

Conclusions: The switching treatment from PG to DP ophthalmic solution indicated sufficient IOP reduction in some cases though the mean IOP change was not statistically significant. It was suggested that DP is effective in case of no‐responder by PG use in some patients.


229


343

PERICARDIAL MEMBRANE PATCH OVER GLAUCOMA DRAINAGE DEVICES AS A FLOW RESTRICTOR: A CASE SERIES

A.N. Suryono1,2, M.C. Aquino1, P.T.K. Chew1

1Ophthalmology, National University Hospital, Singapore, Singapore, 2Ophthalmology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

Objective: To observe the intraocular pressure in cases with pericardial membrane patch placed over glaucoma drainage device during the early hypertensive phase.

Methods: Fifteen eyes with glaucoma device implant surgery were enrolled to this prospective, observational case series. A piece of Tutopatch® (Tutogen Medical GmbH, Germany), bovine pericardial membrane patch, was placed over the plate to restrict aqueous drainage flow into the subconjunctival space. The patch was cut to a rectangular shape of 10‐13 mm in width and 5‐7 mm in length, and were placed in the posterior part of the plate, 2 mm behind the tube opening.

Results: Fifteen eyes from fourteen patients underwent glaucoma implant surgery were included in this case series. Fourteen eyes was implanted with Ahmed TM glaucoma valve (New World Medical, CA, USA) and one eye with Baerveldt® glaucoma implant (Abbott Medical Optics, IL,USA). Four (26.67%) of 15 eyes developed the hypertensive phase as early as 1 month post operative period. Complete success rate was 73.3%,. Mean preoperative intraocular pressure was 18.5 ±4.8 mmHg, and postoperative intraocular pressure was 13±3.1 mmHg . Mean number of preoperative pressure lowering eye drops were 2.7 ±0.7 and postoperative eye drops were 0.5 ±11.7 at mid follow up.

Conclusion: The use of pericardial membrane patch as a flow restrictor in glaucoma drainage device implant surgery may result in milder intraocular pressure rise during hypertensive phase.


230


345

COMPARISON OF POSTOPERATIVE SUBCONJUNCTIVAL 5‐FLUOROURACIL (5‐FU) WITH 5‐FU NEEDLING IN FAILING TRABECULECTOMY SURGERY

K. Jaisingh, U. Yadava, P. Thacker, S. Gupta

Ophthalmology, Guru Nanak Eye Centre, New Delhi, India

Introduction: Early post trabeculectomy failures are amenable to survival by small interventions without resurgery.

Aim: To compare the efficacy of subconjunctival 5‐FU injections against 5‐FU needling in recent postoperative cases of trabeculectomy with failing blebs, done in primary Angle Closure Glaucoma (PACG).

Methods: A retrospective study was done on failing post trabeculectomy cases at Guru Nanak Eye Centre. 18 patients of PACG, 45‐65 years, undergone trabeculectomy with Mitomycin C but failed during initial 6 weeks, were reviewed. 8 patients (groupA) received a single subconjunctival 5‐FU injection(5mg) and 10 patients (groupB) had 5‐FU needling and followed for 6 months.

Results: Mean preoperative Intraocular pressure(IOP) was 40mm Hg. Mean post operative IOP was 25mm Hg. IOP decreased by an average of 7mm Hg(28%) in group B and 3mm of Hg(12%) in groupA. Complete success, IOP< 18mm Hg without need for any antiglaucoma medication or another intervention, was achieved in 6 patients(60%) in group B and none in group A. Qualified success, IOP< /=18mm Hg with 1 antiglaucoma medication or repeat subconjunctival injections / 5‐FU needling, was achieved in 4 patients(40%) in group A and 2(75%) in group B. Failure, IOP>18mm Hg on more than 1 antiglaucoma medication or requiring repeat surgery , was observed in 2 patients(25%) in group A and none in group B. Using fisher exact test, difference between 2 groups was stastically significant(p=0.004).

Conclusion: 5‐FU needling is better than 5‐FU subconjunctival injections in reviving the failing trabeculectomy surgeries in early postoperative period.


231


346

OCULAR SURFACE DISEASE IN GLAUCOMA PATIENTS ON CHRONIC OCULAR HYPOTENSIVE THERAPY

M. Sharma1,2, S. Ilyas3, N. Chaturvedi3, T. Dada3

1Opthalmology, RP Centre, All India Institute of Medical Sciences, 2Opthalmology, 3All India Institute of Medical Sciences, New Delhi, India

Methods: This cross‐sectional study included 90 eyes of 90 patients of primary open angle glaucoma using ocular hypotensive medications for a period equal to or greater than 6 months and 90 eyes of 90 age matched controls. All subjects were evaluated using the Schirmer 1 and Tear Film Breakup Time (TBUT). The severity grading used was as follows : TBUT ≥ 10 second ‐ normal; 5‐9 sec ‐ mild to moderate and < 5 seconds ‐ severe dry eye and for Schirmer 1, > 10 mm normal ; 6‐10 mm mild to moderate and 0‐5 mm severe dry eye.

Results: The mean age of the patients was 55.6 ±8.2 years as compared to 56.2 ±6.4 years in controls. The TBUT and Schirmer score were significantly decreased in glaucoma patients as compared to controls (p< 0.001).

Table 1: TBUT and Schirmer 1 values in Glaucoma vs controls.

Conclusion: There was a high prevalence of OSD in POAG patients on chronic ocular hypotensive therapy. This should be an important consideration in deciding the treatment strategy when medical management of glaucoma is being initiated.


232


347

PROPOSAL FOR A MORE DETAILED WORKING CLASSIFICATION FOR ANGLE CLOSURE GLAUCOMA

R. Tammineni

Anterior Segment and Glaucoma, Sankar Foundation Eye Hospital, Viskahapatnam, India

Objective: Enhanced objectivity in designation of the stage of the disease.

Aims: To create a rational sub‐categorization of the standard stages of the disease based on clinical course and general plans of management.

Methods: The course of the disease were observed in patients of angle closure glaucoma and an overview of the clinical course, advice and interventions was made.

Purpose: Sub‐categorization of the cases of PACG at various stages could lead to new definitions in the clinical course with distinct management implications.

Results: We the patients into 3 traditional entities prior to YAG Laser Iridectomy: 1) PACS, 2) PAC, & 3) PACG. We gave subscript suffix of 'o' to all patients prior to YAG PI: 1) PACSo, 2) PACo, & 3) PACGo. Otherwise it would be understood as “unspecified”. Categorization after YAG Iridectomy was proposed as follows: PACI Management similar to POAG PACIIa & PACGIIa Plateau Iris configuration (PIC) with no angle closure PACIIab & PACGIIab Some degree of permanent angle closure with or without PIC PACIIb & PACIIb Total PAS with or without PIC

Conclusions: The refinement in categorization enables characterization for staging, prognostication and management. Some permanent synechiae would thus push the case downhill from “a” to “ab” category, and once complete synechiae ensued, it would be in the late “b” category.


233

INDEX OF AUTHORS

A

Abanou, A., 144 Abu‐Amero, K., 13 Aduan, J., 207, 209 Affandi, E., 191 Agulto, M., 210 Ahmad Tajudin, L.S., 130 Ahmad, M.S., 133 Ahn, M.D., 162 Aihara, M., 65, 75, 179 Aizawa, N., 70, 98 Allarey, P., 147 Andalia, D., 222 Ang, B., 40, 87 Ang, G.S., 67 Ansari, E., 83, 198 Aoyama, Y., 179 Aquino, M.C., 51, 207, 209, 229 Araie, M., 6, 29, 179 Arimura, E., 202 Artini, W., 185, 197, 221, 222 Arvind, H., 72 Asaoka, R., 65, 75, 179 Asrory, V., 176 Aung, T., 12, 62, 68, 73, 214 Ayuningtyas, S.P., 152 Azuara‐Blanco, A., 40

B

Bae, S., 14 Baig, N, 19 Baskaran, M., 73 Basri, S., 191 Berezina, T., 79 Bhagali, R., 206 Bhartiya, S., 60, 149 Boonyaleephan, S., 204 Bordoloi, M., 64, 146

Boucard, C., 144 Budiman, D., 199

C

Cabanis, E.A., 144 Carmicheal, T., 96 Ce, Z., 68 Cha, S.C., 113 Chan, E., 209 Chan, J., 46, 142 Chaturvedi, N., 231 Chee, J., 62 Chen, D., 62 Chen, D.‐J., 143 Chen, H.S.‐L., 37 Chen, M.‐R., 58 Chen, Y.Y., 78 Cheng, C.‐Y., 36 Cheng, H.‐C., 58 Chengguo, Z., 82 Chew, P.T., 147, 207, 209, 229 Chiang, P.P.‐C., 62 Chiba, T., 220 Ch'ng, T.W., 130 Cho, B.J., 124 Choi, J.A., 162 Choi, Y.J., 86, 154, 217 Choi, Y.M., 69 Choonara, Y., 96 Chou, P., 93 Chou, Y.‐J., 93 Choudhry, R., 169 Christine, R., 165 Chusaida, U., 197 Cornelissen, F., 105

D

Dada, T., 231


234

Dai, J.‐C., 143 Devi, A., 197 Djamal, Z., 175 du, Toit, L., 96

E

Ebihara, N., 66, 228 Effendi, M., 197 Egorova, E., 189 Ekantini, R., 156, 197, 223 Ekawati, D., 176, 196 Enus, S., 174 Eura, M., 202

F

Faiqoh, M., 211 Fan, S.J., 78 Fang, S.K., 53 Farrah, J., 133 Fatmariyanti, S., 122 Fayzieva, U., 189 Fechtner, R., 79 Ferraniza, W., 116 Friedman, D., 61 Fukuchi, T., 90, 178, 192 Fukushima, A., 94 Furuya, T., 220

G

Gagyi‐Palffy, Z., 84 Gandasoebrata, A., 188 Gandasubrata, A., 28, 116, 184, 186, 190, 197, 199, 200, 203, 205

Gani, T., 223 Gayton, J., 150 Ge, J., 82 George, R., 164 Goldberg, I., 43 Graciani, F., 145 Gracitelli, C., 145 Graham, S., 72, 99, 101 Guo, L.X., 61

Gupta, A., 171 Gupta, S., 230 Gupta, V., 30, 99, 101 Guptasarma, M., 170, 213 Gustianty, E., 184, 186, 188, 190, 193, 197, 199, 200, 203, 205

H

Ha, S.J., 126 Hairi, N., 97 Hangai, M., 47, 48 Hapsari, R., 174 Haraguchi, S., 215 Hashimoto, S., 202 Hasibuan, H.T., 166 He, M., 214 He, M.‐G., 68 Healey, P., 17, 22, 26, 27, 44 Herdiana, T., 185 Hernowo, A., 105 Hidalgo, B.J., 210 Hirasawa, H., 65, 75, 179 Hirasawa, K., 215 Ho, J.‐D., 143 Hong, C., 74, 217 Hong, S., 100, 110, 155 Hooymans, J., 105 Hoshikawa, Y., 94 How, A., 12 Htoon, H.M., 68, 214 Huang, C.‐Y., 181 Huang, M.‐C., 143 Huang, N., 58 Husain, N., 167 Hutauruk, J., 152 Hwang, D.K., 93 Hwang, Y.H., 119, 132

I

Ichhpujani, P., 60, 149 Ida, M., 144 Ihsan, N., 221


235

Ikeda, Y., 59, 131, 201, 224, 225 Ilyas, S., 231 Imamura, Y., 66 Imawati, N., 156 Inatani, M., 16 Irfani, I., 205 Ishida, G., 224, 225 Ishida, K., 187, 195 Ishikawa, M., 182, 183 Istiantoro, D., 175, 194 Ito, K., 201 Ito, Y., 148 Izumi, Y., 183

J

Jaisingh, K., 230 Jansonius, N., 105 Jeong, Y.C., 132 Jeoung, J.W., 14, 86, 154, 217 Jeun, M., 14 Ji, J., 76 Jiang, W., 127 Jingjing, H., 82 Jonas, J., 23, 35 Juhrie, D., 193 Jung, J.J., 132

K

Kamal, F., 197 Kang, J.H., 74 Kano, K., 77 Karakawa, A., 65 Kartasasmita, A., 116 Kasahara, M., 216, 219 Kashiwagi, K., 220 Kato, M., 144 Kato, Y., 224, 225 Kaushik, S., 95, 157, 170, 171, 172, 213 Kawase, K., 9, 195 Kayazawa, T., 202 Keenan, J., 85 Khouri, A., 79

Khu, P., 210 Kim, C.‐S., 134 Kim, C.Y., 100, 110, 111, 136, 155 Kim, D.M., 86, 89, 129, 154, 217 Kim, E.‐S., 128 Kim, G.A., 136 Kim, H.K., 132 Kim, J.H., 111, 113, 136 Kim, J.‐H., 162 Kim, J.Y., 128 Kim, K.N., 217 Kim, M., 89 Kim, M.J., 128 Kim, S.H., 74 Kim, T.‐W., 89, 92 Kim, W.‐S., 129 Kim, Y.G., 163 Kim, Y.J., 14 Kim, Y.Y., 69 Kimura, I., 66, 228 Kimura, S., 141 Kinoshita, S., 59, 131, 224, 225 Kitnarong, N., 31, 41 Kiuchi, Y., 94 Klistorner, A., 72, 99, 101 Ko, Y.‐C., 7 Kobayashi, M., 94 Kokubun, T., 70 Kokuzawa, S., 195 Komaratih, E., 122 Kook, M., 97 Krishnamoorthy, S., 164 Krivosheina, O., 168 Kubota, M., 148 Kubota, T., 201 Kumar, H., 213 Kumar, P., 96 Kurniawan, R., 140 Kuroda, S., 151 Kursiah, M.R., 133 Kusumadjaja, A., 114, 121 Kusumadjaja, I.M., 197


236

Kuwayama, Y., 63, 77 Kwon, S.J., 112 Kwong, T., 83, 198 Kwong, Y., 159

L

Lai, J., 104, 142 Lai, S.M., 11 Lam, D., 159 Lamoureux, E., 62 Landgren, B., 145 Lat‐Luna, M., 210 Lee, C.‐K., 100, 155 Lee, E.J., 89, 92 Lee, E.‐K., 134 Lee, H.J., 138, 163 Lee, J.B., 123 Lee, J.‐E., 129 Lee, J.H., 119 Lee, J.M., 123 Lee, J.W., 104, 113, 138, 142, 163 Lee, K.W., 113 Lee, N., 100, 155 Lee, P.‐Y., 143 Lee, S.H., 123 Lee, S.J., 129 Lee, T.‐H., 143 Lee, T.Y., 113 Leung, C., 47 Li, F., 159 Li, H., 82 Li, J., 99, 101 Liang, Y.B., 61, 78 Lingam, V., 39, 45 Liu, A., 76 Liu, C., 10, 25, 93 Liu, C.J.‐L., 7, 58 Liu, W., 76 Loon, S., 20 Lu, D.‐W., 54, 103 Lu, M., 79 Luthfia‐Rahmi, F., 180

M

Ma, K.T., 111, 136 Mabuchi, F., 220 Mahanani, E., 156 Makornwattana, M., 64, 139, 146 Mani, B., 34, 68 Marsetyawan, M., 180 Martin, K., 85 Maruyama, Y., 59, 131, 224, 225 Matsuda, H., 148 Matsumoto, C., 202 Matsumura, K., 216, 219 Mayama, C., 65, 75, 179 Meigawati, N.L., 125 Memed, F., 200 Mendala, D., 121 Meng, H.L., 78 Mimiwati, Z., 97 Mohamed, Noor, J., 167 Mohd, Ali, U.K., 130 Moon, J.‐I., 106 Moosa, R., 96 Mori, K., 59, 131, 224, 225 Morita, T., 216, 219 Mulkutkar, S., 171 Murakami, A., 141, 228 Murata, H., 65, 75, 179 Murata, K., 187 Mustafa, S., 176 Muthuraman, C., 88, 117, 118, 173

N

Nakano, T., 144, 148 Nakazawa, T., 15, 70, 71, 98 Nakazawa, Y., 66 Nallampalli Venugopal, A.V., 88, 117 Nallampalli, A.V., 173 Narayanaswamy, A.K., 32, 68, 214 Nazareth, C., 206 Ndesendo, V., 96 Neruntarat, C., 204 Nguyen, T.H., 144


237

Niani, I., 161 Nicholas, S., 67 Niranjan, A., 206 Noda, T., 144 Nomoto, H., 202 Nongpiur, M., 214 Noro, T., 148 Numata, T., 202 Nuradianti, L., 153 Nurwasis, N., 122

O

O'Connor, J., 87 Ogawa, S., 148 Ogorodnikova, S., 158 Ogura, T., 220 Oh, E., 110 Ojha, S., 95, 157, 171, 172 Oktariana, V., 152 Okuyama, S., 202 Omodaka, K., 70, 71, 98 Ong, E., 12 Ono, K., 141 Otori, Y., 135

P

Pandav, S., 95, 157, 170, 171, 172, 213, 218 Paranhos, Jr., A., 145 Park, B., 124 Park, C.K., 107, 162 Park, H.J., 129 Park, H.‐Y., 107, 162 Park, J., 14 Park, J.‐W., 120, 137 Park, K.H., 14, 47, 74, 86, 89, 129, 154, 217 Park, M.H., 106 Park, S.‐W., 120, 137 Park, Y.C., 112 Pasla, L., 200 Pelosoni, L., 198 Perera, S., 33, 62, 68, 73, 214 Peyman, M., 91

Pillay, V., 96 Prahasta, A., 174, 193 Prata, T., 145 Prutthipongsit, A., 64, 139, 146 Purnama, M., 114

R

Rahayu, I., 160 Rahayu, N., 114, 197 Rahayu, T., 152 Rahman, F.A., 91 Rahmat, K., 91 Raj, S., 95, 157, 170, 171, 172, 213 Ramli, N., 91, 97 Rao, N., 80 Rasyidin, H., 109, 115, 140, 160, 161, 197 Rewri, P., 80 Rho, S., 100, 155 Rifada, M., 184, 186, 190, 193, 199, 200, 203 Rifada, R.M., 188 Ritch, R., 55 Rochmawati, E., 122 Ross, C., 218 Rugun, S., 199 Rusmayani, E., 108, 194 Ryu, M., 71

S

Saeki, T., 65 Saini, A., 95, 172 Sakamoto, T., 201 Sakaue, Y., 90, 178, 192 Samadikoen, S., 197 Sanders, R., 150 Sandragasu, T., 167 Sari, M., 197 Sathi, Devi, A.V., 206 Sato, N., 182 Satolom, N., 197 Sawada, A., 9, 195 Sawada, Y., 182 Seabolt, R., 150


238

Seki, M., 178, 192 Seong, G.J., 110, 111, 136, 155 Sevostyanova, M., 158 Sharma, J., 170, 213 Sharma, M., 231 Sharmini, Ahmad, Tajudin, L., 38 Shetty, B., 206 Shiga, Y., 70, 71 Shilova, O., 168 Shimizu, K., 216, 219 Shimizu, M., 228 Shimomura, Y., 202 Shin, J.P., 112 Shin, K.‐S., 134 Shiraki, I., 63 Shoji, N., 215, 216, 219 Shpak, A., 158 Sidek, S., 91 Sidiq, N., 197 Sihombing, S., 205 Silitonga, A., 188 Soebijantoro, I., 175, 194 Sohn, Y.H., 81, 132 Sousa, A., 145 Sripairot, H., 139 Sriram, P., 72 Srisamran, N., 64, 139, 146 Stewart, S., 214 Strouthidis, N., 18 Su, D., 21 Sugimoto, K., 75 Sugiyama, K., 24, 47, 50 Suh, M.H., 129 Suhardjo, S., 180 Sulasmi, F., 197 Suliman, N., 97 Sumantri, I., 56, 108, 175, 194 Sumi, T., 94 Sun, L.P., 61 Sung, K.R., 47, 49 Supriyadi, R., 116 Suryono, A., 209, 229

Susilowati, R., 180

T

Tada, K., 225 Tai, M.‐C., 103 Takada, N., 71 Takada, S., 202 Takahashi, H., 220 Tamaki, K., 66, 228 Tammineni, R., 212, 226, 232 Tanabe, F., 202 Tanaka, T., 90, 178, 192 Tashiro, K., 59 Tatsios, J., 209 Tatsui, S., 216, 219 Tawara, A., 201 Tay, W., 62 Tchah, H., 128 Ten, H., 184 Thacker, P., 230 Tham, C., 8, 52, 159 Thomas, P., 85 Thomas, R., 78 Tian, B., 127 Tian, T., 76 Togano, T., 90, 178, 192 Tsai, C.‐H., 143 Tseng, H.‐Y., 181 Tsuda, S., 70, 71 Tsukahara, S., 220 Tsuneoka, H., 148 Tun, T.A., 73 Tuneoka, H., 144

U

Ueda, J., 90, 178, 192 Ueno, M., 59, 131, 224, 225 Usui, A., 228

V

Venugopal, A.V., 118 Vijaya, L., 80


239

W

Wang, N.L., 61, 78 Wang, T.‐J., 143 Wang, X., 78 Watanabe, A., 201 Watanabe, S., 66, 182, 228 Weinreb, R., 89, 92 Wells, A., 67, 87 White, A., 85 Widyaartini, W., 121 Wigg, J., 218 Wiyogo, W., 191, 211 Wong, T., 67 Wong, T.T., 62 Wong, T.Y., 62 Wu, K.‐Y., 181

X

Xing, X., 76

Y

Yaakub, A., 130 Yadava, U., 230 Yamagami, J., 177 Yamamoto, T., 9, 63, 187, 195 Yanagi, M., 94 Yanagisawa, M., 75 Yang, D., 218 Yang, X.D., 61 Yanuhardi, D., 109 Yasuda, M., 71

Yau, C., 73 Ye, Q., 127 Yeom, D.J., 119 Yick, D., 104 Yingzi, P., 208 Yokoyama, Y., 70, 71, 98 Yoneda, T., 94 Yoo, C., 69 Yoo, T.K., 110 Yoon, S.W., 81, 132 Yoshida, M., 144 Yoshii, K., 59 Yoshii, Y., 215 Yoshikawa, H., 59, 131, 224, 225 Yoshino, T., 178, 192 Yoshitomi, T., 182, 183 You, Y., 99, 101 Yuasa, Y., 94 Yuen, C., 104 Yustiana, M., 186

Z

Zahari, M., 91 Zapuskalov, I., 168 Zhang, H., 218 Zhang, W.Z., 82 Zheng, Y., 12, 62 Zhou, H., 127 Zhou, Q., 61 Zhuykov, S., 168 Zhuykova, L., 168 Zong, X.F., 61


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