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Top-Ten IVth Asian-Oceanic Glaucoma Society Meeting
October 1-3, 2003, Hongkong
Dennis Lam and Clement Tham
- A genetic locus for primary angle closure glaucoma was identified on chromosome 10q11 in a large Singaporean Chinese family. This study may arouse interest in the study of the genetics underlying angle closure glaucoma, a very important eye disease in the Asian-Oceanic region.
- ELT is a new surgical procedure that involves the creation of small holes with excimer laser in the trabecular meshwork and inner wall of Schlemm's canal, and thus allowing aqueous access to the Schlemms' canal. Data from the early European studies were encouraging, and ELT may well become one of the first choices of surgical methods for the invasive treatment of glaucoma.
- The results of phacoemulsification and intraocular lens implantation in various forms of angle-closure glaucoma were excellent, and the mid-term follow-up (mean follow-up of 18.4 months) of the 285 eyes in this study revealed very good intraocular pressure control and visual rehabilitation.
- Argon laser peripheral iridoplasty (ALPI) has been shown, in a randomized controlled trial (RCT), to be superior to conventional systemic medications in initial lowering of intraocular pressure and symptomatic relief in acute PACG. Mid-term follow up of patients in this RCT revealed no significant complications arising from the immediate ALPI. Other than ALPI, immediate paracentesis and lens extraction also appear to hold promises as immediate treatment for acute PACG, but further studies are needed to delineate their roles.
- The results of lens extraction in over 100 eyes with acute primary angle closure glaucoma (APACG) were impressive. These eyes received initial medical therapy to lower > intraocular pressure (IOP), and then received early phacoemulsification, with intraocular lens implantation, under topical anesthesia. Post-lens extraction IOP control was excellent, and it would be interesting to see if the subsequent rate of progression to chronic angle closure glaucoma (CACG) would be significantly decreased in these eyes.
- The authors set out to investigate whether neural stem cells can rescue degenerated retinal ganglion cells in mice with hereditary glaucoma. They found that allogeneic brain stem cells could indeed survive, and differentiate into neurons and astrocytes, in mice with glaucoma. Further investigations are necessary to determine if the differentiated brain stem cells extend neuritis into the optic nerve.
- 13 novel sequence changes were identified in the optineurin (OPTN) gene in Chinese subjects, and 4 of these were found exclusively in patients with primary open angle glaucoma (POAG). This study further confirmed the role of OPTN gene as a causative gene for POAG, and suggested a mutation pattern of OPTN in Chinese different from that in Caucasians.
- A new classification system for situations of angle closure based on morphological (optic nerve head changes) and / or functional (visual field changes) losses is proposed. The conventional system of classification based on symptomatology ('acute' versus 'chronic') may be less useful, as mixed presentations are common.
- Using microarray technology, the investigators were able to demonstrate the effects of dexamethasone on global gene expression in human trabecular meshwork cells. 15 genes were identified to be significantly up-regulated after dexamethasone exposure. Some of these genes have overlapping roles in anti-inflammatory response and outflow resistance.
- The CNTGS demonstrated that significant intraocular pressure (IOP) reduction with drugs in eyes with normal tension glaucoma (NTG) was able to stabilize glaucoma progression, and this study by Yamamoto et al complemented CNTGS by confirming that a similarly significant IOP reduction by surgical means (trabeculectomy with adjunctive antiproliferative therapy) was able to reduce the frequency of disc hemorrhage in NTG. Disc hemorrhage is believed to be closely related to progression in NTG.
