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Selection from the 12th Annual Scientific Meeting of the Japanese Glaucoma Society
August 31st-September 2nd, 2001, Hiroshima, Japan
Makato Araie
This year, the Professor Suda Memorial Lecture was given by Professor Abe at Niigata University. Moreover, there was a special lecture by Professor Tsuji from the Brain Research Institute of Niigata University, three invited lectures (Professors Shields, Spaeth, and Weinreb), four symposia, and three morning and three luncheon seminars, as well as 101 free papers and 64 poster presentations. Approximately 1500 participants registered during the meeting period. At this meeting, the free papers were classified into three categories: surgical treatment, medical treatment, and diagnosis and examinations.
Non-penetrating filtering surgery
Suzuki et al. from Showa University presented their long-term results of non-penetrating trabeculectomy. In 58 eyes of 48 patients with chronic open-angle glaucoma, those who had undergone non-penetrating trabeculectomy with the adjunctive use of mitomycin C were followed for two years. The mean intraocular pressure (IOP) at 30 months after operation was 13.0 ± 4.4 mmHg. The survival rate by Kaplan-Meier analysis at 34 months after operation was 0.93 when the end point of IOP was set at 21 mmHg. The percentage of eyes needing laser goniopuncture was 37.9%. However, Futa et al. from Kyu-shyu Hospital pointed out that non-penetrating trabeculectomy was not very effective in eyes with capsular glaucoma. They examined specimens of angle tissue obtained from eyes with capsular glaucoma that had undergone trabeculectomy, and found that the corneoscleral meshwork of many such eyes adhered to itself, although such adherence was not observed in eyes with primary open-angle glaucoma. Kawagoe et al. from the Osaka Red Cross Hospital reported the results of combined cataract surgery (PEA + IOL) and non-penetrating trabeculectomy or ordinary trabeculectomy. The main outcome measure was the degree of corneal astigmatism after operation evaluated using Cravy's and Jaffe's methods. They found that combined cataract surgery and non-penetrating trabeculectomy showed greater astigmatism after operation than combined cataract surgery and penetrating trabeculectomy. In order to reduce the rate of filtering bleb related infection, trabeculectomy with a fornix-based conjunctival incision seems to have some degree of advantage, because it tends to make a diffuse filtering bleb with a relatively thick wall. However, on the other hand, such a conjunctival incision may have the disadvantage of wound leakage if mitomycin C is applied intraoperatively. Takahashi et al. from Jikei Medical College performed trabeculectomy using a fornix-based incision with the adjunctive use of mitomycin C in 355 eyes of 287 glaucoma patients, and followed them up for over four years. The mean IOP before operation, and three and four years after operation was 23.6 ± 5.3, 12.3 ± 3.4, and 14.1 ± 3.3 mmHg, respectively. During the follow-up period, five eyes developed bleb-related infections, and 13 presented with reopening of the incised portion of the conjunctiva. Conjunctival closure seems to be a crucial point for such a procedure.
Medical treatment
Kano et al. from the Kosei-Nenkin Hospital in Osaka investigated the relationship between the pattern of the diurnal variation of IOP and the effectiveness of prostaglandin-related analogues. They demonstrated that, for any type of diurnal IOP variation, both unoproston and latanoprost showed a significant reduction in IOP throughout the day- and nighttime. Chiba et al. from Yamanashi Medical College prospectively evaluated the ratio of iris pigmentation with the use of latanoprost. Seventy-one patients with various types of glaucoma were followed for 12 months. They took photographs of the iris and cilia with the same settings before using latanoprost and at one, three, six, and 12 months after its use. Three glaucoma specialists evaluated the photographs independently in a masked manner, and when all three agreed on the changes, it was determined that these eyes had developed a change in iris color and cilia length. Twelve months after the use of latanoprost, 60.9% of patients showed an increase in iris pigmentation, and 31.6% showed cilia elongation.
Calcium channel blockers (CCB) have been reported to have a favorable effect on the visual field, particularly in patients with normal-tension glaucoma. Ishida et al. from Gifu University reported the effect of CCB in preventing visual field progression and their relevance to disc hemorrhages in normal-tension glaucoma patients. They divided 218 patients with normal-tension glaucoma (mean follow-up period, 81.8 months) into four subgroups based on the use of CCB and the development of disc hemorrhages (DH) during the follow-up period. Using Kaplan-Meier life-table analysis, the no progression probability was 5.0 ± 3.3% in the group of patients with DH (+) and CCB (-), while it was 56.7 ± 9.8% in those with DH (-) and CCB (+). On the other hand, in the group with DH (+) and CCB (+), the probability was 24.1 ± 17.7%. CCB may have a favorable effect on protection against further visual field deterioration, even in patients with disc hemorrhages.
Diagnosis and examination
Yamazaki et al. from Nihon University reported the influence of age and lens opacity on short wavelength perimetry (SWAP). They performed both white-on-white perimetry and SWAP in 24 normal volunteers. Lens opacity was evaluated by Fluoromaster. Although white-on-white did not show any correlation with lens opacity, SWAP showed a statistically significant correlation with the autofluorescence intensity of the lens in the points located at the inferior Bjerrum area. Inoue et al. from the University of Tokyo performed frequency doubling technology (FDT) perimetry with the N-30 threshold program as well as Humphrey perimetry with the central 30-2 program in 13 patients with ischemic optic neuropathy. The mean deviation values of FDT and Humphrey perimetry significantly correlated with each other in patients with normal-tension glaucoma (r = 0.879, p = 0.002), while no such correlation was observed in those with ischemic optic neuropathy (r = 0.456, p = 0.114). Ohtake et al. from Keio University determined the percentage of CYP1B1 mutation in 66 Japanese congenital glaucoma patients by multicenter, collaborative study. Fourteen of the 66 patients (21.1%) had CYP1B1 mutation. As could be seen from the clinical aspects of the patients, the CYP1B1 mutation group comprised six males and five females, while the non-mutation group included 19 males and two females. The group with mutation developed glaucoma at a mean age of 1.8 months, while this was 3.1 months in the non-mutation group. There were no significant differences between the mutation and non-mutation groups regarding gonioscopic aspects and the degree of corneal opacification.
