●AIM:To assess the necessity of neuroimaging in patients with neurological or atypical findings of normal tension glaucoma(NTG)who do not exhibit typical glaucoma manifestations.●METHODS:A retrospective analysis was...●AIM:To assess the necessity of neuroimaging in patients with neurological or atypical findings of normal tension glaucoma(NTG)who do not exhibit typical glaucoma manifestations.●METHODS:A retrospective analysis was conducted on 90 atypical NTG patients who underwent cranial magnetic resonance imaging(MRI)due to atypical symptoms.The demographic characteristics,clinical parameters,and radiological findings were recorded.●RESULTS:Among the patients,66.7%had abnormal radiology results,with the most common findings being gliosis(34.4%),sequelae of cerebrovascular events and vascular malformations(14.4%),and benign intracranial mass lesions(11%).Non-glaucomatous visual field defects were more frequently observed in patients with abnormal neuroimaging results.However,there were no significant differences in intraocular pressure,optic disc parameters,retinal nerve fiber layer thickness,and visual field indices between patients with normal and abnormal radiological results.The mean age of the patients was 58.74y.Interestingly,there was a significant age difference,with the abnormal radiology group having a higher median age(P=0.021).●CONCLUSION:The study highlights the importance of cranial imaging in older NTG patients to detect underlying pathologies and prevent misdiagnosis.It suggests that neuroimaging may be warranted in NTG patients with atypical visual field defects incompatible with glaucoma.However,routine neuroimaging in all NTG patients without classic neurological signs may not be necessary.展开更多
Normal tension glaucoma(NTG)is a multifactorial optic neuropathy characterized by normal intraocular pressure,progressive retinal ganglion cell(RGC)death,and glaucomatous visual field loss.Recent studies have describe...Normal tension glaucoma(NTG)is a multifactorial optic neuropathy characterized by normal intraocular pressure,progressive retinal ganglion cell(RGC)death,and glaucomatous visual field loss.Recent studies have described the mechanisms underlying the pathogenesis of NTG.In addition to controlling intraocular pressure,neuroprotection and reduction of RGC degeneration may be beneficial therapies for NTG.In this review,we summarized the main regulatory mechanisms of RGC death in NTG,including autophagy,glutamate neurotoxicity,oxidative stress,neuroinflammation,immunity,and vasoconstriction.Autophagy can be induced by retinal hypoxia and axonal damage.In this process,ischemia can cause mutations of optineurin and activate the nuclear factor-kappa B pathway.Glutamate neurotoxicity is induced by the over-stimulation of N-methyl-D-aspartate membrane receptors by glutamate,which occurs in RGCs and induces progressive glaucomatous optic neuropathy.Oxidative stress also participates in NTG-related glaucomatous optic neuropathy.It impairs the mitochondrial and DNA function of RGCs through the apoptosis signal-regulating kinase-JUN N-terminal kinase pathway.Moreover,it increases inflammation and the immune response of RGCs.Endothelin 1 causes endothelial dysfunction and impairment of ocular blood flow,promoting vasospasm and glaucomatous optic neuropathy,as a result of NTG.In conclusion,we discussed research progress on potential options for the protection of RGCs,including TANK binding kinase 1 inhibitors regulating autophagy,N-methyl-D-aspartate receptor antagonists inhibiting glutamate toxicity,ASK1 inhibitors regulating mitochondrial function,and antioxidants inhibiting oxidative stress.In NTG,RGC death is regulated by a network of mechanisms,while various potential targets protect RGCs.Collectively,these findings provide insight into the pathogenesis of NTG and potential therapeutic strategies.展开更多
AIM:To compare the corneal biomechanical properties difference by ocular response analyzer(ORA) in normal tension glaucoma(NTG) patients with different visual field(VF) progression speed. METHODS:NTG patients with wel...AIM:To compare the corneal biomechanical properties difference by ocular response analyzer(ORA) in normal tension glaucoma(NTG) patients with different visual field(VF) progression speed. METHODS:NTG patients with well-controlled Goldmann applanation tonometer(GAT) who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled.GAT and ORA parameters including corneal compensated intraocular pressure(lOPcc),Goldmann estimated intraocular pressure(lOPg),corneal hysteresis(CH),corneal resistance factor(CRF) were recorded.VF was tested by Swedish interactive threshold algorithm(SITA)-standard 30-2 fields.All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up.Patients were divided into four groups according to VF change over 3y,and ORA findings were compared between the upper 25^(th) percentile group(slow progression group) and the lower 25^(th) percentile group(rapid progression group).RESULTS:Eighty-two eyes of 56 patients were studied.There were 21 eyes(21 patients) each in rapid and slow progression groups respectively.GAT,lOPcc,lOPg,CH,CRF were 12.1+1.4 mm Hg,15.8±1.8 mm Hg,12.8±2.0 mm Hg,8.4±1.1 mm Hg,7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg,13.5±2.1 mm Hg,11.2±1.6 mm Hg,9.3±1.1 mm Hg,8.2±0.9 mm Hg respectively in slow progression group(P=0.214,<0.001,0.007,0.017,0.413,respectively).In bivariate correlation analysis,lOPcc,lOPcc-GAT and CH were significant correlated with m△MD(r =-0.292,-0.312,0.228 respectively,P =0.008,0.004,0.039 respectively).CONCLUSION:Relatively rapid VF progression occurred in NTG patients whose lOPcc are rather high,CH are rather low and the difference between lOPcc and GAT are relatively large.Higher lOPcc and lower CH are associated with VF progression in NTG patients.This study suggests that GAT measures might underestimate the IOP in such patients.展开更多
AIM: To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer(pR NFL) and macular layers measured by spectral-domain optical coherence tomography(SD-OCT) in patients with e...AIM: To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer(pR NFL) and macular layers measured by spectral-domain optical coherence tomography(SD-OCT) in patients with early stage of primary open angle glaucoma(POAG) and normal tension glaucoma(NTG).METHODS: A total of 117 patients with early stage of glaucoma(54 patients with POAG and 63 patients with NTG) and 32 normal subjects were recruited for the study. The pR NFL thickness, total macular layer(TML) thickness, and isolated inner macular layer(IML) thickness were measured by SD-OCT. Hemisphere TML thickness asymmetry measured by the posterior pole asymmetry scan was evaluated. Thickness differences of pR NFL and IML between superior and inferior quadrants were calculated. Asymmetry indices(AIs) of the p RNFL, TML and isolated IML were also computed. Areas under the receiver-operating characteristic curves(AROCs) were generated to determine the diagnostic capabilities of different parameters. RESULTS: Intraocular p RNFL thickness differences and AIs between the superior and inferior quadrants were significantly different between normal and NTG groups(P=0.009 and P<0.001, respectively). Intraocular p RNFL thickness differences and AIs between the temporal-superior and temporal-inferior sectors were also significantly different between normal and NTG groups(P=0.035 and P<0.001, respectively). The thickness differences and AIs of TML between superior and inferior hemispheres were significantly different between normal and NTG groups(P=0.001 and P=0.001, respectively) and between normal and POAG groups(P=0.032 and P=0.020, respectively). The thickness differences and AIs of macular ganglion cell layer(mG CL) between superior and inferior quadrants were significantly different between normal and NTG groups(P=0.013 and P=0.004, respectively), and between NTG and POAG groups(P=0.015 and P=0.012, respectively). The thickness difference of TML between superior and inferior hemispheres showed the highest diagnostic capability for early NTG eyes(AROC=0.832).CONCLUSION: Intraocular retinal thickness asymmetry in pR NFL, TML and mG CL are found in early stage of NTG. Hemisphere TML thickness asymmetry is also found in POAG eyes. Asymmetry analysis of retinal thickness can be an adjunctive modality for early detection of glaucoma.展开更多
AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer(GCIPL) loss in normal tension glaucoma(NTG) and primary open angle glaucoma(POAG) in a detailed, disease severity-matched way;and to assess ...AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer(GCIPL) loss in normal tension glaucoma(NTG) and primary open angle glaucoma(POAG) in a detailed, disease severity-matched way;and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects.METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer(RNFL) thickness were obtained by Cirrus optical coherence tomography(OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic(AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found(all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter(minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG(inferior RNFL;P=0.076) and indiscriminating POAG(average RNFL;P=0.913) from normal eyes.CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.展开更多
Glaucoma is a chronic, progressive optic neuropathy characterized by the loss of peripheral vision first and then central vision. Clinically, normal tension glaucoma is considered a special subtype of glaucoma, in whi...Glaucoma is a chronic, progressive optic neuropathy characterized by the loss of peripheral vision first and then central vision. Clinically, normal tension glaucoma is considered a special subtype of glaucoma, in which the patient’s intraocular pressure is within the normal range, but the patient experiences typical glaucomatous changes. However, increasing evidence has challenged the traditional pathophysiological view of normal tension glaucoma, which is based only on intraocular pressure, and breakthroughs in central nervous system imaging may now greatly increase our knowledge about the mechanisms underlying normal tension glaucoma. In this article, we review the latest progress in understanding the pathogenesis of normal tension glaucoma and in developing imaging techniques to detect it, to strengthen the appreciation for the connection between normal tension glaucoma and the brain.展开更多
AIM: To determine whether red blood cell(RBC)membrane and plasma lipids, particularly long-chain polyunsaturated fatty acids such as eicosapentaenoic acid(EPA), docosahexaenoic acid(DHA), arachidonic acid(AA) are sign...AIM: To determine whether red blood cell(RBC)membrane and plasma lipids, particularly long-chain polyunsaturated fatty acids such as eicosapentaenoic acid(EPA), docosahexaenoic acid(DHA), arachidonic acid(AA) are significantly correlated with severity of normal tension glaucoma(NTG).METHODS: This study included 35 patients with NTG and 12 healthy normal control subjects, matched for age and sex with the study group. The stage of glaucoma was determined according to the Hodapp-Parrish-Anderson classification. Lipids were extracted from RBC membranes and plasma, and fatty acid methyl esters prepared and analyzed by gas chromatography-mass spectrometry(GC-MS).RESULTS: When RBC lipids were analyzed, the levels of EPA, the levels of DHA and the ratio of n3 to n6 were positively associated with the Humphrey Perimetry mean Deviation(MD) score(r =0.617, P <0.001; r =0.727, P <0.001 and r =0.720, P <0.001, respectively), while the level of AA was negatively associated with the MD score(r =-0.427, P =0.001). When plasma lipids were analyzed,there was a significant positive relationship between the levels of EPA and the MD score(r =0.648, P <0.001), and the levels of AA were inversely correlated with the MD score(r =-0.638, P <0.001). CONCLUSION: The levels of n3 and n6 polyunsaturated fatty acids in RBC membrane and plasma lipids were associated with severity of NTG.展开更多
Purpose: To investigate the levels of renin-angiotension system (RAS) components in normal tension glaucoma patients and normal controls. Methods: Blood samples were obtained from 11 normal tension glaucoma(NTG)patien...Purpose: To investigate the levels of renin-angiotension system (RAS) components in normal tension glaucoma patients and normal controls. Methods: Blood samples were obtained from 11 normal tension glaucoma(NTG)patients and 11 age and sex matched controls. The levels of renin and angiotensin AⅡof 11 NTG patients and normal controls were examined by radio-immunity test. Statistical analyses were performed by paired t test. Results:The levels of renin of NTG patients and normal controls are (769.085±183.217) pg/ml/n and (822.035 ±124.140) pg/ml/n, while the levels of angiotensin A Ⅱof NTG patients and normal controls are (37.347±10.669)pg/ml and (24.836±10.665)pg/ml respectively. No statistically significant differences were observed between the levels of renin and angiotensin among NTG patients and normal controls. Conclusion: There were not many abnormalities of the levels of circulating rennin and angiotensin AⅡof NTG patients in our study. Eye Science 2005 ;21 :192-195.展开更多
This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,ch...This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,characterized by optic nerve damage and visual field loss despite normal intraocular pressure,has long puzzled clinicians.One emerging perspective suggests that alterations in ocular blood flow,particularly within the optic nerve head,may play a pivotal role in its pathogenesis.While NTG shares commonalities with its high-tension counterpart,its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration.It navigates through the complex web of vascular dysregulation,blood pressure and perfusion pressure,neurovascular coupling,and oxidative stress,seeking to uncover the hidden threads that tie the heart and eyes together in NTG.This review explores into the intricate mechanisms connecting cardiovascular factors to NTG,shedding light on how cardiac dynamics can influence ocular health,particularly in cases where intraocular pressure remains within the normal range.NTG's enigmatic nature,often characterized by seemingly contradictory risk factors and clinical profiles,underscores the need for a holistic approach to patient care.Drawing parallels to cardiac health,we examine into the shared vascular terrain connecting the heart and the eyes.Cardiovascular factors,including systemic blood flow,endothelial dysfunction,and microcirculatory anomalies,may exert a profound influence on ocular perfusion,impacting the delicate balance within the optic nerve head.By elucidating the subtle clues and potential associations between cardiology and NTG,this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition.As the understanding of these connections evolves,so too may the prospects for early diagnosis and tailored interventions,ultimately enhancing the quality of life for those living with NTG.展开更多
AIM:To investigate the change of anterior chamber angle morphology and intraocular pressure(IOP) reduction after cataract surgery in patients with normal-tension glaucoma(NTG) using swept-source optical coherence tomo...AIM:To investigate the change of anterior chamber angle morphology and intraocular pressure(IOP) reduction after cataract surgery in patients with normal-tension glaucoma(NTG) using swept-source optical coherence tomography(SS-OCT).METHODS:This prospective,comparative,observational study recruited patients into two groups. Group 1 was the control group including normal subjects except those with cataracts(cataract group,n=67 eyes of 67 patients),and group 2 was NTG group including patients who were diagnosed with NTG and cataracts(n=43 eyes of 43 patients),which were treated with phacoemulsification and intraocular lens implantation. Before surgery,and at postoperative 1 and 6mo,anterior chamber angles were evaluated by SS-OCT under dark conditions using threedimensional angle analysis scan protocol. Angle opening distance(AOD),angle recess area(ARA),and trabeculariris surface area(TISA) at four quadrants(temporal,nasal,superior,and inferior) were calculated automatically by SS-OCT,after the observer marked scleral spurs.RESULTS: A total of 106 patients(54 males and 52 females) were enrolled in the study. Angle parameters,AOD,ARA,and TISA were increased after surgery in both groups. However,changes of angle parameters were only significant in group 2.In group 2,preoperative IOP was 13.2±2.9 mm Hg,and postoperative IOP at 1 and 6mo were 10.5±3.0 and 10.7±2.8 mm Hg,respectively. In group 1,preoperative IOP was 12.4±2.8 mm Hg,and postoperative IOP at 1 and 6mo were 11.6±2.5 and 12.0±2.8 mm Hg,respectively. After cataract surgery,angle parameters changed significantly while IOP significantly reduced and was maintained in group 2(P<0.001). The changes in angle parameters(ΔAOD500,ΔTISA500 at temporal; ΔAOD500,ΔARA500 at nasal) were linearly correlated with postoperative IOP changes.CONCLUSION: Cataract surgery may have improved anterior chamber angle parameters and decreased IOP in展开更多
● AIM: To analyze the diagnostic capabilities of peripapillary retinal nerve fiber layer(p RNFL) thickness and segmented inner macular layer(IML) thickness measured by spectraldomain optical coherence tomography for ...● AIM: To analyze the diagnostic capabilities of peripapillary retinal nerve fiber layer(p RNFL) thickness and segmented inner macular layer(IML) thickness measured by spectraldomain optical coherence tomography for detection of early glaucoma.● METHODS: Fifty-three patients with primary open angle glaucoma(POAG), 60 patients with normal tension glaucoma(NTG) and 32 normal control subjects were enrolled. Thicknesses of p RNFL, total macular layers(TML), and the IML, including macular RNFL(m RNFL) and macular ganglion cell layer(m GCL) were assessed. The areas under the receiver operating characteristic curves(AROC) were calculated to compare the diagnostic power of different parameters.● RESULTS: There were no differences in the parameters of p RNFL, TML, and IML between POAG and NTG groups. The thicknesses of superior and inferior m GCL showed significant correlation with mean deviation of visual field(R2=0.071, P=0.004; R2=0.08, P=0.002). The m GCL thickness significantly correlated with the p RNFL thickness in the superior and inferior quadrants(R2=0.156, P<0.001; R2=0.407, P<0.001). The thickness of the inferior-outer sector of macula had greater AROCs than those in the inferior-inner sector of macula. The AROCs for superior(0.894) and inferior(0.879) p RNFL thicknesses were similar with the AROCs for superior(0.839) and inferior m GCL(0.864) thicknesses. Sensitivities at 80% specificity for global p RNFL, inferior-outer m GCL and inferior-outer m RNFL thicknesses were 0.938, 0.867, and 0.725, respectively.● CONCLUSION: The diagnostic capability of the m GCL thickness is comparable to that of the p RNFL thickness in patients with early glaucoma. The inferior-outer sector of IML has a better diagnostic capability than the inferiorinner sector of IML for detection of early glaucoma.展开更多
Glaucoma is defined as an optic disc neuropathy meaning the nerve fibers are being atrophied similar to the fate occurring in non-glaucomatous optic atrophies. Furthermore, the nerve fibers are always being destroyed ...Glaucoma is defined as an optic disc neuropathy meaning the nerve fibers are being atrophied similar to the fate occurring in non-glaucomatous optic atrophies. Furthermore, the nerve fibers are always being destroyed randomly in all the non-glaucomatous optic atrophies. In contrast, the nerve fibers in glaucoma are invariably destroyed in an orderly tandem fashion, from peripheral to central, never randomly. Is glaucoma really an optic disc neuropathy in light of orderly destruction of nerve fibers in glaucoma? The current prevailing theories in glaucoma such as posterior bowing of the lamina cribrosa or cupping can’t explain the orderly destruction of nerve fibers occurring in glaucoma. In fact, there is no biological mechanism acting directly on the nerve fibers or their RGCs which could lead to their orderly destruction. Therefore, there should be some mechanical way, which could result in the orderly destruction of nerve fibers even though this mechanical scenario may have resulted from the direct biological effect of raised IOP on some important component of the optic disc. It is proposed that the border tissue of Elschnig (BT) atrophies due to chronic ischemia caused by raised IOP, and as a result, the lamina cribrosa (LC) begins sinking in the scleral canal—a mechanical problem. Due to sinking of the LC, the nerve fibers get stretched and broken starting with the most peripheral nerve fibers being closest to the edge of the scleral opening and ending with the most central nerve fibers in an orderly tandem fashion. Therefore, in view of the orderly destruction of nerve fibers, glaucoma may not be an optic disc neuropathy but an optic disc axotomy.展开更多
Objective To evaluate the variations of intraocular pressure (IOP) in suspected open-angle glaucoma (OAG) patients. Methods The variations of IOP were measured in 216 eyes of suspected OAG patients at 4-hour intervals...Objective To evaluate the variations of intraocular pressure (IOP) in suspected open-angle glaucoma (OAG) patients. Methods The variations of IOP were measured in 216 eyes of suspected OAG patients at 4-hour intervals for 48 h. Based on the results of the serial IOP measurements, optic disc changed and visual field defected, the patients were diagnosed as primary OAG (POAG), normal tension glaucoma (NTG), ocular hypertension (OHT), or physiologic cup (PC). Results After the serial IOP measurements, 16.7% of the suspected OAG patients were diagnosed as POAG, 32.4% as NTG, 24.5% as OHT, and 26.4% as PC. The highest percentages of the POAG group had peak IOP at 8 AM (19.4%) and their trough IOP at 10 PM (27.8%); the NTG group had peak IOP at 12 AM (18.6%) and their trough IOP at 12 PM (22.9%); the OHT group had peak IOP at 4 AM (22.6%) and their trough IOP at 10 PM (26.4%); and the PC group had peak IOP at 4 AM (21.1%) and their trough IOP at 12 PM (21.1%). The percentages of peak IOP outside clinic (8 AM-4 PM) in the POAG, NTG, OHT and PC groups were 55.6%, 50.0%, 58.4% and 45.7%, respectively. The mean magnitude of variance was 5.1-6.7 mmHg in those suspected OAG patients. There was a strong positive correlation in IOP between both eyes at each time point of measurement and the variation curves of the right and left eyes had parallel profiles in those suspected OAG patients. Conclusion Serial measurement of IOP is still needed, in order not to miss the peak and the trough IOP readings in suspected OAG patients, which helps in better management of glaucoma.展开更多
Background:Normal tension glaucoma(NTG)is a less pressure-dependent type of glaucoma with characteristic optic neuropathy.Recently,the biomechanical mechanism has been thought to account for glaucomatous optic neuropa...Background:Normal tension glaucoma(NTG)is a less pressure-dependent type of glaucoma with characteristic optic neuropathy.Recently,the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree.We intended to compare dynamic corneal response parameters(DCRs)among patients with primary open-angle glaucoma with normal tension or hypertension and controls.The correlations between DCRs and known risk factors for glaucoma were also analyzed.Methods:In this cross-sectional study,49 NTG subjects,45 hypertension glaucoma(HTG)subjects,and 50 control subjects were enrolled.We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG,HTG,and control groups.We also analyzed the correlations between DCRs and known risk factors for glaucoma(eg,central corneal thickness[CCT],intraocular pressure[IOP],etc).Results:The maximum inverse concave radius(NTG:0.18[0.17,0.20]mm-1;control:0.17[0.16,0.18]mm-1;P=0.033),deformation amplitude ratio of 2 mm(DAR 2 mm,NTG:4.87[4.33,5.39];control:4.37[4.07,4.88];P<0.001),and DAR 1 mm(NTG:1.62[1.58,1.65];control:1.58[1.54,1.61];P<0.001)were significantly higher in NTG than in the controls.The integrated radius(IR,NTG:8.40±1.07 mm-1;HTG:7.64±1.31 mm-1;P=0.026)and DAR 2 mm(NTG:4.87[4.33,5.39];HTG:4.44[4.12,5.02];P<0.007)were significantly higher,whereas the stiffness parameter at the first applanation(SP-A1,NTG:91.23[77.45,107.45];HTG:102.36[85.77,125.12];P=0.007)was lower in NTG than in HTG.There were no significant differences in the DCRs between HTG and control groups(P>0.05).In the univariate and multivariate analyses,some of the DCRs,such as IR,were negatively correlated with CCT and IOP,whereas SP-A1 was positively correlated with CCT and IOP.Conclusions:The cornea was more deformable in NTG than in HTG or controls.There were no significant differences in corneal deformability between HTG and controls.The cornea was more deformable with the thinner cornea and lower IOP.展开更多
文摘●AIM:To assess the necessity of neuroimaging in patients with neurological or atypical findings of normal tension glaucoma(NTG)who do not exhibit typical glaucoma manifestations.●METHODS:A retrospective analysis was conducted on 90 atypical NTG patients who underwent cranial magnetic resonance imaging(MRI)due to atypical symptoms.The demographic characteristics,clinical parameters,and radiological findings were recorded.●RESULTS:Among the patients,66.7%had abnormal radiology results,with the most common findings being gliosis(34.4%),sequelae of cerebrovascular events and vascular malformations(14.4%),and benign intracranial mass lesions(11%).Non-glaucomatous visual field defects were more frequently observed in patients with abnormal neuroimaging results.However,there were no significant differences in intraocular pressure,optic disc parameters,retinal nerve fiber layer thickness,and visual field indices between patients with normal and abnormal radiological results.The mean age of the patients was 58.74y.Interestingly,there was a significant age difference,with the abnormal radiology group having a higher median age(P=0.021).●CONCLUSION:The study highlights the importance of cranial imaging in older NTG patients to detect underlying pathologies and prevent misdiagnosis.It suggests that neuroimaging may be warranted in NTG patients with atypical visual field defects incompatible with glaucoma.However,routine neuroimaging in all NTG patients without classic neurological signs may not be necessary.
基金supported in part by the Technology Foundation of Tianjin Eye Hospital of China, No. YKQN1911 (to WCS)Tianjin Health Science and Technology Project, No. TJWJ2021QN071 (to WCS)Translational Medicine Research Project of State Key Laboratory of Experimental Hematology of China, No. Z21-11 (to BQH)
文摘Normal tension glaucoma(NTG)is a multifactorial optic neuropathy characterized by normal intraocular pressure,progressive retinal ganglion cell(RGC)death,and glaucomatous visual field loss.Recent studies have described the mechanisms underlying the pathogenesis of NTG.In addition to controlling intraocular pressure,neuroprotection and reduction of RGC degeneration may be beneficial therapies for NTG.In this review,we summarized the main regulatory mechanisms of RGC death in NTG,including autophagy,glutamate neurotoxicity,oxidative stress,neuroinflammation,immunity,and vasoconstriction.Autophagy can be induced by retinal hypoxia and axonal damage.In this process,ischemia can cause mutations of optineurin and activate the nuclear factor-kappa B pathway.Glutamate neurotoxicity is induced by the over-stimulation of N-methyl-D-aspartate membrane receptors by glutamate,which occurs in RGCs and induces progressive glaucomatous optic neuropathy.Oxidative stress also participates in NTG-related glaucomatous optic neuropathy.It impairs the mitochondrial and DNA function of RGCs through the apoptosis signal-regulating kinase-JUN N-terminal kinase pathway.Moreover,it increases inflammation and the immune response of RGCs.Endothelin 1 causes endothelial dysfunction and impairment of ocular blood flow,promoting vasospasm and glaucomatous optic neuropathy,as a result of NTG.In conclusion,we discussed research progress on potential options for the protection of RGCs,including TANK binding kinase 1 inhibitors regulating autophagy,N-methyl-D-aspartate receptor antagonists inhibiting glutamate toxicity,ASK1 inhibitors regulating mitochondrial function,and antioxidants inhibiting oxidative stress.In NTG,RGC death is regulated by a network of mechanisms,while various potential targets protect RGCs.Collectively,these findings provide insight into the pathogenesis of NTG and potential therapeutic strategies.
文摘AIM:To compare the corneal biomechanical properties difference by ocular response analyzer(ORA) in normal tension glaucoma(NTG) patients with different visual field(VF) progression speed. METHODS:NTG patients with well-controlled Goldmann applanation tonometer(GAT) who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled.GAT and ORA parameters including corneal compensated intraocular pressure(lOPcc),Goldmann estimated intraocular pressure(lOPg),corneal hysteresis(CH),corneal resistance factor(CRF) were recorded.VF was tested by Swedish interactive threshold algorithm(SITA)-standard 30-2 fields.All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up.Patients were divided into four groups according to VF change over 3y,and ORA findings were compared between the upper 25^(th) percentile group(slow progression group) and the lower 25^(th) percentile group(rapid progression group).RESULTS:Eighty-two eyes of 56 patients were studied.There were 21 eyes(21 patients) each in rapid and slow progression groups respectively.GAT,lOPcc,lOPg,CH,CRF were 12.1+1.4 mm Hg,15.8±1.8 mm Hg,12.8±2.0 mm Hg,8.4±1.1 mm Hg,7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg,13.5±2.1 mm Hg,11.2±1.6 mm Hg,9.3±1.1 mm Hg,8.2±0.9 mm Hg respectively in slow progression group(P=0.214,<0.001,0.007,0.017,0.413,respectively).In bivariate correlation analysis,lOPcc,lOPcc-GAT and CH were significant correlated with m△MD(r =-0.292,-0.312,0.228 respectively,P =0.008,0.004,0.039 respectively).CONCLUSION:Relatively rapid VF progression occurred in NTG patients whose lOPcc are rather high,CH are rather low and the difference between lOPcc and GAT are relatively large.Higher lOPcc and lower CH are associated with VF progression in NTG patients.This study suggests that GAT measures might underestimate the IOP in such patients.
文摘AIM: To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer(pR NFL) and macular layers measured by spectral-domain optical coherence tomography(SD-OCT) in patients with early stage of primary open angle glaucoma(POAG) and normal tension glaucoma(NTG).METHODS: A total of 117 patients with early stage of glaucoma(54 patients with POAG and 63 patients with NTG) and 32 normal subjects were recruited for the study. The pR NFL thickness, total macular layer(TML) thickness, and isolated inner macular layer(IML) thickness were measured by SD-OCT. Hemisphere TML thickness asymmetry measured by the posterior pole asymmetry scan was evaluated. Thickness differences of pR NFL and IML between superior and inferior quadrants were calculated. Asymmetry indices(AIs) of the p RNFL, TML and isolated IML were also computed. Areas under the receiver-operating characteristic curves(AROCs) were generated to determine the diagnostic capabilities of different parameters. RESULTS: Intraocular p RNFL thickness differences and AIs between the superior and inferior quadrants were significantly different between normal and NTG groups(P=0.009 and P<0.001, respectively). Intraocular p RNFL thickness differences and AIs between the temporal-superior and temporal-inferior sectors were also significantly different between normal and NTG groups(P=0.035 and P<0.001, respectively). The thickness differences and AIs of TML between superior and inferior hemispheres were significantly different between normal and NTG groups(P=0.001 and P=0.001, respectively) and between normal and POAG groups(P=0.032 and P=0.020, respectively). The thickness differences and AIs of macular ganglion cell layer(mG CL) between superior and inferior quadrants were significantly different between normal and NTG groups(P=0.013 and P=0.004, respectively), and between NTG and POAG groups(P=0.015 and P=0.012, respectively). The thickness difference of TML between superior and inferior hemispheres showed the highest diagnostic capability for early NTG eyes(AROC=0.832).CONCLUSION: Intraocular retinal thickness asymmetry in pR NFL, TML and mG CL are found in early stage of NTG. Hemisphere TML thickness asymmetry is also found in POAG eyes. Asymmetry analysis of retinal thickness can be an adjunctive modality for early detection of glaucoma.
基金Supported by National Natural Science Foundation of China(No.81800879)Natural Science Foundation of Guangdong Province(No.2017A030310372)+2 种基金Fundamental Research Funds of the State Key Laboratory of Ophthalmology,China(No.2018KF04 No.2017QN05)Sun Yat-Sen University Clinical Research 5010 Program(No.2014016)
文摘AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer(GCIPL) loss in normal tension glaucoma(NTG) and primary open angle glaucoma(POAG) in a detailed, disease severity-matched way;and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects.METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer(RNFL) thickness were obtained by Cirrus optical coherence tomography(OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic(AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found(all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter(minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG(inferior RNFL;P=0.076) and indiscriminating POAG(average RNFL;P=0.913) from normal eyes.CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.
基金supported in part by the National Basic Research Program of China,No.81300766(to XSM)the Cultivation and Innovation Fund from the First Affiliated Hospital of Jinan University,China,No.802168(to XSM)+2 种基金the fund of Leading Talents of Guangdong Province,China,No.87014002(to KFS)the fund of Ningxia Key Research and Development Program(Yinchuan,Ningxia Hui Autonomous Region,China)Programme of Introducing Talents of Discipline to Universities,China,No.B14036(to KFS)
文摘Glaucoma is a chronic, progressive optic neuropathy characterized by the loss of peripheral vision first and then central vision. Clinically, normal tension glaucoma is considered a special subtype of glaucoma, in which the patient’s intraocular pressure is within the normal range, but the patient experiences typical glaucomatous changes. However, increasing evidence has challenged the traditional pathophysiological view of normal tension glaucoma, which is based only on intraocular pressure, and breakthroughs in central nervous system imaging may now greatly increase our knowledge about the mechanisms underlying normal tension glaucoma. In this article, we review the latest progress in understanding the pathogenesis of normal tension glaucoma and in developing imaging techniques to detect it, to strengthen the appreciation for the connection between normal tension glaucoma and the brain.
基金supported by National Natural Science Foundation of China (No. 81000370)
文摘AIM: To determine whether red blood cell(RBC)membrane and plasma lipids, particularly long-chain polyunsaturated fatty acids such as eicosapentaenoic acid(EPA), docosahexaenoic acid(DHA), arachidonic acid(AA) are significantly correlated with severity of normal tension glaucoma(NTG).METHODS: This study included 35 patients with NTG and 12 healthy normal control subjects, matched for age and sex with the study group. The stage of glaucoma was determined according to the Hodapp-Parrish-Anderson classification. Lipids were extracted from RBC membranes and plasma, and fatty acid methyl esters prepared and analyzed by gas chromatography-mass spectrometry(GC-MS).RESULTS: When RBC lipids were analyzed, the levels of EPA, the levels of DHA and the ratio of n3 to n6 were positively associated with the Humphrey Perimetry mean Deviation(MD) score(r =0.617, P <0.001; r =0.727, P <0.001 and r =0.720, P <0.001, respectively), while the level of AA was negatively associated with the MD score(r =-0.427, P =0.001). When plasma lipids were analyzed,there was a significant positive relationship between the levels of EPA and the MD score(r =0.648, P <0.001), and the levels of AA were inversely correlated with the MD score(r =-0.638, P <0.001). CONCLUSION: The levels of n3 and n6 polyunsaturated fatty acids in RBC membrane and plasma lipids were associated with severity of NTG.
文摘Purpose: To investigate the levels of renin-angiotension system (RAS) components in normal tension glaucoma patients and normal controls. Methods: Blood samples were obtained from 11 normal tension glaucoma(NTG)patients and 11 age and sex matched controls. The levels of renin and angiotensin AⅡof 11 NTG patients and normal controls were examined by radio-immunity test. Statistical analyses were performed by paired t test. Results:The levels of renin of NTG patients and normal controls are (769.085±183.217) pg/ml/n and (822.035 ±124.140) pg/ml/n, while the levels of angiotensin A Ⅱof NTG patients and normal controls are (37.347±10.669)pg/ml and (24.836±10.665)pg/ml respectively. No statistically significant differences were observed between the levels of renin and angiotensin among NTG patients and normal controls. Conclusion: There were not many abnormalities of the levels of circulating rennin and angiotensin AⅡof NTG patients in our study. Eye Science 2005 ;21 :192-195.
文摘This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,characterized by optic nerve damage and visual field loss despite normal intraocular pressure,has long puzzled clinicians.One emerging perspective suggests that alterations in ocular blood flow,particularly within the optic nerve head,may play a pivotal role in its pathogenesis.While NTG shares commonalities with its high-tension counterpart,its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration.It navigates through the complex web of vascular dysregulation,blood pressure and perfusion pressure,neurovascular coupling,and oxidative stress,seeking to uncover the hidden threads that tie the heart and eyes together in NTG.This review explores into the intricate mechanisms connecting cardiovascular factors to NTG,shedding light on how cardiac dynamics can influence ocular health,particularly in cases where intraocular pressure remains within the normal range.NTG's enigmatic nature,often characterized by seemingly contradictory risk factors and clinical profiles,underscores the need for a holistic approach to patient care.Drawing parallels to cardiac health,we examine into the shared vascular terrain connecting the heart and the eyes.Cardiovascular factors,including systemic blood flow,endothelial dysfunction,and microcirculatory anomalies,may exert a profound influence on ocular perfusion,impacting the delicate balance within the optic nerve head.By elucidating the subtle clues and potential associations between cardiology and NTG,this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition.As the understanding of these connections evolves,so too may the prospects for early diagnosis and tailored interventions,ultimately enhancing the quality of life for those living with NTG.
文摘AIM:To investigate the change of anterior chamber angle morphology and intraocular pressure(IOP) reduction after cataract surgery in patients with normal-tension glaucoma(NTG) using swept-source optical coherence tomography(SS-OCT).METHODS:This prospective,comparative,observational study recruited patients into two groups. Group 1 was the control group including normal subjects except those with cataracts(cataract group,n=67 eyes of 67 patients),and group 2 was NTG group including patients who were diagnosed with NTG and cataracts(n=43 eyes of 43 patients),which were treated with phacoemulsification and intraocular lens implantation. Before surgery,and at postoperative 1 and 6mo,anterior chamber angles were evaluated by SS-OCT under dark conditions using threedimensional angle analysis scan protocol. Angle opening distance(AOD),angle recess area(ARA),and trabeculariris surface area(TISA) at four quadrants(temporal,nasal,superior,and inferior) were calculated automatically by SS-OCT,after the observer marked scleral spurs.RESULTS: A total of 106 patients(54 males and 52 females) were enrolled in the study. Angle parameters,AOD,ARA,and TISA were increased after surgery in both groups. However,changes of angle parameters were only significant in group 2.In group 2,preoperative IOP was 13.2±2.9 mm Hg,and postoperative IOP at 1 and 6mo were 10.5±3.0 and 10.7±2.8 mm Hg,respectively. In group 1,preoperative IOP was 12.4±2.8 mm Hg,and postoperative IOP at 1 and 6mo were 11.6±2.5 and 12.0±2.8 mm Hg,respectively. After cataract surgery,angle parameters changed significantly while IOP significantly reduced and was maintained in group 2(P<0.001). The changes in angle parameters(ΔAOD500,ΔTISA500 at temporal; ΔAOD500,ΔARA500 at nasal) were linearly correlated with postoperative IOP changes.CONCLUSION: Cataract surgery may have improved anterior chamber angle parameters and decreased IOP in
基金Supported by grants CMRPG8E1251 from Chang Gung Memorial Hospital,Taiwan
文摘● AIM: To analyze the diagnostic capabilities of peripapillary retinal nerve fiber layer(p RNFL) thickness and segmented inner macular layer(IML) thickness measured by spectraldomain optical coherence tomography for detection of early glaucoma.● METHODS: Fifty-three patients with primary open angle glaucoma(POAG), 60 patients with normal tension glaucoma(NTG) and 32 normal control subjects were enrolled. Thicknesses of p RNFL, total macular layers(TML), and the IML, including macular RNFL(m RNFL) and macular ganglion cell layer(m GCL) were assessed. The areas under the receiver operating characteristic curves(AROC) were calculated to compare the diagnostic power of different parameters.● RESULTS: There were no differences in the parameters of p RNFL, TML, and IML between POAG and NTG groups. The thicknesses of superior and inferior m GCL showed significant correlation with mean deviation of visual field(R2=0.071, P=0.004; R2=0.08, P=0.002). The m GCL thickness significantly correlated with the p RNFL thickness in the superior and inferior quadrants(R2=0.156, P<0.001; R2=0.407, P<0.001). The thickness of the inferior-outer sector of macula had greater AROCs than those in the inferior-inner sector of macula. The AROCs for superior(0.894) and inferior(0.879) p RNFL thicknesses were similar with the AROCs for superior(0.839) and inferior m GCL(0.864) thicknesses. Sensitivities at 80% specificity for global p RNFL, inferior-outer m GCL and inferior-outer m RNFL thicknesses were 0.938, 0.867, and 0.725, respectively.● CONCLUSION: The diagnostic capability of the m GCL thickness is comparable to that of the p RNFL thickness in patients with early glaucoma. The inferior-outer sector of IML has a better diagnostic capability than the inferiorinner sector of IML for detection of early glaucoma.
文摘Glaucoma is defined as an optic disc neuropathy meaning the nerve fibers are being atrophied similar to the fate occurring in non-glaucomatous optic atrophies. Furthermore, the nerve fibers are always being destroyed randomly in all the non-glaucomatous optic atrophies. In contrast, the nerve fibers in glaucoma are invariably destroyed in an orderly tandem fashion, from peripheral to central, never randomly. Is glaucoma really an optic disc neuropathy in light of orderly destruction of nerve fibers in glaucoma? The current prevailing theories in glaucoma such as posterior bowing of the lamina cribrosa or cupping can’t explain the orderly destruction of nerve fibers occurring in glaucoma. In fact, there is no biological mechanism acting directly on the nerve fibers or their RGCs which could lead to their orderly destruction. Therefore, there should be some mechanical way, which could result in the orderly destruction of nerve fibers even though this mechanical scenario may have resulted from the direct biological effect of raised IOP on some important component of the optic disc. It is proposed that the border tissue of Elschnig (BT) atrophies due to chronic ischemia caused by raised IOP, and as a result, the lamina cribrosa (LC) begins sinking in the scleral canal—a mechanical problem. Due to sinking of the LC, the nerve fibers get stretched and broken starting with the most peripheral nerve fibers being closest to the edge of the scleral opening and ending with the most central nerve fibers in an orderly tandem fashion. Therefore, in view of the orderly destruction of nerve fibers, glaucoma may not be an optic disc neuropathy but an optic disc axotomy.
文摘Objective To evaluate the variations of intraocular pressure (IOP) in suspected open-angle glaucoma (OAG) patients. Methods The variations of IOP were measured in 216 eyes of suspected OAG patients at 4-hour intervals for 48 h. Based on the results of the serial IOP measurements, optic disc changed and visual field defected, the patients were diagnosed as primary OAG (POAG), normal tension glaucoma (NTG), ocular hypertension (OHT), or physiologic cup (PC). Results After the serial IOP measurements, 16.7% of the suspected OAG patients were diagnosed as POAG, 32.4% as NTG, 24.5% as OHT, and 26.4% as PC. The highest percentages of the POAG group had peak IOP at 8 AM (19.4%) and their trough IOP at 10 PM (27.8%); the NTG group had peak IOP at 12 AM (18.6%) and their trough IOP at 12 PM (22.9%); the OHT group had peak IOP at 4 AM (22.6%) and their trough IOP at 10 PM (26.4%); and the PC group had peak IOP at 4 AM (21.1%) and their trough IOP at 12 PM (21.1%). The percentages of peak IOP outside clinic (8 AM-4 PM) in the POAG, NTG, OHT and PC groups were 55.6%, 50.0%, 58.4% and 45.7%, respectively. The mean magnitude of variance was 5.1-6.7 mmHg in those suspected OAG patients. There was a strong positive correlation in IOP between both eyes at each time point of measurement and the variation curves of the right and left eyes had parallel profiles in those suspected OAG patients. Conclusion Serial measurement of IOP is still needed, in order not to miss the peak and the trough IOP readings in suspected OAG patients, which helps in better management of glaucoma.
基金supported by grants from the Natural Science Foundation of Beijing Municipal(No.7202208)the Youth Clinical Research Project of Peking University First Hospital(No.2019CR01)。
文摘Background:Normal tension glaucoma(NTG)is a less pressure-dependent type of glaucoma with characteristic optic neuropathy.Recently,the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree.We intended to compare dynamic corneal response parameters(DCRs)among patients with primary open-angle glaucoma with normal tension or hypertension and controls.The correlations between DCRs and known risk factors for glaucoma were also analyzed.Methods:In this cross-sectional study,49 NTG subjects,45 hypertension glaucoma(HTG)subjects,and 50 control subjects were enrolled.We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG,HTG,and control groups.We also analyzed the correlations between DCRs and known risk factors for glaucoma(eg,central corneal thickness[CCT],intraocular pressure[IOP],etc).Results:The maximum inverse concave radius(NTG:0.18[0.17,0.20]mm-1;control:0.17[0.16,0.18]mm-1;P=0.033),deformation amplitude ratio of 2 mm(DAR 2 mm,NTG:4.87[4.33,5.39];control:4.37[4.07,4.88];P<0.001),and DAR 1 mm(NTG:1.62[1.58,1.65];control:1.58[1.54,1.61];P<0.001)were significantly higher in NTG than in the controls.The integrated radius(IR,NTG:8.40±1.07 mm-1;HTG:7.64±1.31 mm-1;P=0.026)and DAR 2 mm(NTG:4.87[4.33,5.39];HTG:4.44[4.12,5.02];P<0.007)were significantly higher,whereas the stiffness parameter at the first applanation(SP-A1,NTG:91.23[77.45,107.45];HTG:102.36[85.77,125.12];P=0.007)was lower in NTG than in HTG.There were no significant differences in the DCRs between HTG and control groups(P>0.05).In the univariate and multivariate analyses,some of the DCRs,such as IR,were negatively correlated with CCT and IOP,whereas SP-A1 was positively correlated with CCT and IOP.Conclusions:The cornea was more deformable in NTG than in HTG or controls.There were no significant differences in corneal deformability between HTG and controls.The cornea was more deformable with the thinner cornea and lower IOP.
