A rabbit model of age-dependant ocular hypertensive response to topical corticosteroids

OBJECTIVE

To investigate the ocular hypertensive response to topical dexamethasone (DEX), rimexolone (RIM), loteprednol etabonate (LOT) and fluorometholone (FML) in rabbits of different ages.

METHODS

Seventy-five rabbits of three age groups (7 weeks, 6 months and 1-year old) received topical administration of 0.1% DEX, 1% RIM, 0.5% LOT, 0.1% FML or balanced salt solution four times daily for 1 month. Intraocular pressure (IOP) was monitored at regular time intervals. After a month, eyes were harvested for histological study with haematoxylin and eosin (H&E), periodic acid Schiff and Masson trichrome staining. Trabecular meshwork changes were graded by masked ocular pathologists.

RESULTS

Topical DEX caused the greatest increase in IOP, followed by RIM and FML. LOT caused the least IOP increase. Similar pattern of IOP response to the four corticosteroids was observed in the three studied age groups. Young rabbits (7 week) were the most responsive to corticosteroids among the age groups. Extracellular matrix thickening in the trabecular meshwork region and loss of trabecular meshwork cells were observed after DEX, FML or RIM treatments.

CONCLUSION

Young rabbits are more susceptible to steroid induced increase in IOP, even for milder steroids such as fluorometholone and rimexolone.

[The effect of AQP4 gene on the activation of retinal glial cells in chronic high intraocular pressure mice]

OBJECTIVES

To investigate whether aquaporin 4 (AQP4) gene can affect the activation of glial cells and cause the injury of retina of chronic high intraocular pressure mice models, and to discuss its possible mechanism.

METHODS

Experimental study. The chronic high intraocular pressure models were established by burning the scleral venous of the right eye, which as the experiment group, and the left eye without any treatment as the control group. The intraocular pressure (IOP) was measured by rebound tonometer. Selected each of the successful model of chronic high intraocular pressure male AQP4 knockout mice (AQP-/-) and their wild-type (WT) male mice 40, divided the two type of mice into five groups after scleral venous burn according to the time of establishing models (24 h, 3 d, 1 w, 2 w, 4 w after scleral venous burn), 8 mouse in each group. And then producing the paraffin sections of mouse eye. Immunohistochemical staining methods was used to observe the expression of the glial fibrillary acid protein (GFAP) in retina glial cells, and observe the expression of the AQP4 in the retina of the WT mouse. Image was acquired under the fluorescence microscopy. The intraocular pressure was analyzed by t-test.

RESULTS

After scleral venous burn (24 h, 3 d, 1 w, 2 w, 4 w), there were significant difference (t = 6.66 - 18.08, all P value < 0.05) in the IOP of the AQP4-/- mice (11.30 ± 1.59, 11.20 ± 1.15, 10.60 ± 1.53, 10.75 ± 1.45, 10.45 ± 1.39) and WT mice (11.50 ± 2.56, 11.25 ± 1.65, 10.75 ± 1.33, 10.60 ± 1.33, 10.40 ± 1.19) between the experimental groups and control groups (6.60 ± 0.94, 6.35 ± 0.99, 6.55 ± 0.94, 6.45 ± 0.99, 6.50 ± 0.94 and 6.60 ± 1.05, 6.50 ± 0.89, 6.40 ± 1.09, 6.30 ± 1.13, 6.50 ± 1.05). Since 24 hours after the scleral venous burn, the expression of GAFP of the two type mice began to increase and reached to peak at 1 week after burning. This peak of WT mice was more obvious than that of AQP4-/- mice. The concentration of GAFP began to decrease at 2 weeks after burning and reached to bottom at 4 weeks later. To the WT mice, the expression of AQP4 was remarkable higher in experimental group than that in control group at 1 week after the scleral venous burn. The expression of AQP4 was related to the expression of GAFP in high intraocular pressure of WT mice at 1 w, 2 w, and 4 w after the scleral venous burn.

CONCLUSIONS

The chronic high intraocular pressure models can be established successfully by burning the scleral venous. AQP4 gene can affect the activation of the glial cells in chronic high intraocular pressure mice and lead to the injury of retina.

An alteration in the lateral geniculate nucleus of experimental glaucoma monkeys: in vivo positron emission tomography imaging of glial activation

We examined lateral geniculate nucleus (LGN) degeneration as an indicator for possible diagnosis of glaucoma in experimental glaucoma monkeys using positron emission tomography (PET). Chronic intraocular pressure (IOP) elevation was induced by laser trabeculoplasty in the left eyes of 5 cynomolgus monkeys. Glial cell activation was detected by PET imaging with [¹¹C]PK11195, a PET ligand for peripheral-type benzodiazepine receptor (PBR), before and at 4 weeks after laser treatment (moderate glaucoma stage). At mild, moderate, and advanced experimental glaucoma stages (classified by histological changes based on the extent of axonal loss), brains were stained with cresyl violet, or antibodies against PBR, Iba-1 (a microglial marker), and GFAP (an activated astrocyte marker). In laser-treated eyes, IOP was persistently elevated throughout all observation periods. PET imaging showed increased [¹¹C]PK11195 binding potential in the bilateral LGN at 4 weeks after laser treatment; the increase in the ipsilateral LGN was statistically significant (P<0.05, n = 4). Immunostaining showed bilateral activations of microglia and astrocytes in LGN layers receiving input from the laser-treated eye. PBR-positive cells were observed in LGN layers receiving input from laser-treated eye at all experimental glaucoma stages including the mild glaucoma stage and their localization coincided with Iba-1 positive microglia and GFAP-positive astrocytes. These data suggest that glial activation occurs in the LGN at a mild glaucoma stage, and that the LGN degeneration could be detected by a PET imaging with [¹¹C]PK11195 during the moderate experimental glaucoma stage after unilateral ocular hypertension. Therefore, activated glial markers such as PBR in the LGN may be useful in noninvasive molecular imaging for diagnosis of glaucoma.

A cell-permeable phosphine-borane complex delays retinal ganglion cell death after axonal injury through activation of the pro-survival extracellular signal-regulated kinases 1/2 pathway

The reactive oxygen species (ROS) superoxide has been recognized as a critical signal triggering retinal ganglion cell (RGC) death after axonal injury. Although the downstream targets of superoxide are unknown, chemical reduction of oxidized sulfhydryls has been shown to be neuroprotective for injured RGCs. On the basis of this, we developed novel phosphine-borane complex compounds that are cell permeable and highly stable. Here, we report that our lead compound, bis (3-propionic acid methyl ester) phenylphosphine borane complex 1 (PB1) promotes RGC survival in rat models of optic nerve axotomy and in experimental glaucoma. PB1-mediated RGC neuroprotection did not correlate with inhibition of stress-activated protein kinase signaling, including apoptosis stimulating kinase 1 (ASK1), c-jun NH2-terminal kinase (JNK) or p38. Instead, PB1 led to a striking increase in retinal BDNF levels and downstream activation of the extracellular signal-regulated kinases 1/2 (ERK1/2) pathway. Pharmacological inhibition of ERK1/2 entirely blocked RGC neuroprotection induced by PB1. We conclude that PB1 protects damaged RGCs through activation of pro-survival signals. These data support a potential cross-talk between redox homeostasis and neurotrophin-related pathways leading to RGC survival after axonal injury.

Interference of the apoptotic signaling pathway in RGC stress response by SP600125 in moderate ocular hypertensive rats

The aim of the present study was to investigate the effect of SP600125 (1,9-pyrazoloanthrone), an inhibitor of JNK, on apoptosis of retinal ganglion cells (RGCs) induced by moderate elevation of intraocular pressure (IOP) in male rats. IOP was elevated by suture-pulley compression on eyeballs. Cell apoptosis, expression of phosphorylated JNK (p-JNK) and cleaved caspase-3 in retina were studied by TUNEL staining and immunohistochemistry. The expression of c-Jun in retina was assayed by Western blot. Following IOP elevation (about 45 mmHg) for 6 h, the number of TUNEL, p-JNK and cleaved caspase-3 positive cells and the amount of c-Jun expression in retina were significantly increased. All these changes were reversed by SP600125 treatment. The immune positive cells for TUNEL, p-JNK and cleaved caspase-3 following IOP elevation were localized at the RGC layer. We conclude that moderate elevation of IOP for 6 h induced apoptosis of RGCs, and SP600125 treatment attenuated this process by suppressing c-Jun expression.

Polyquad-preserved travoprost/timolol, benzalkonium chloride (BAK)-preserved travoprost/timolol, and latanoprost/timolol in fixed combinations: a rabbit ocular surface study

INTRODUCTION

The aim of this study was to use a validated acute rabbit model to test the toxicity of a novel formulation of fixed-combination travoprost 0.004%/timolol 0.5% ophthalmic solution, which contains the antimicrobial preservative polyquaternium-1 (PQ), compared with the commercial formulation of fixed combinations travoprost 0.004%/timolol 0.5% ophthalmic solution and latanoprost 0.005%/timolol 0.5% ophthalmic solution, which both contain the preservative benzalkonium chloride (BAK).

METHODS

Adult male New Zealand albino rabbits (n=24) were randomly divided into four groups. Phosphate-buffered saline (PBS), travoprost/timolol PQ, travoprost/timolol BAK, or latanoprost/timolol BAK were instilled onto rabbit eyes one drop, 15 times at 5 minute intervals. The ocular surface reactions were investigated at hour 4 and day 1 using slit lamp examination; in-vivo confocal microscopy (IVCM) for cornea, limbus, and conjunctiva-associated lymphoid tissue (CALT); conjunctival impression cytology; and standard immunohistology in cryosections for detecting CD45+ infiltrating cells and MUC-5AC-labeled cells.

RESULTS

Travoprost/timolol PQ was better tolerated than travoprost/timolol BAK or latanoprost/timolol BAK. This improved tolerance was evident via clinical observation under slit lamp, IVCM in different layers of the cornea and conjunctiva, conjunctival impression cytology of superficial epithelium aspects, and immunohistochemistry for inflammatory infiltration of CD45+ cells in the cornea and goblet cell distribution. Travoprost/timolol PQ was similar to PBS in regards to in-vivo findings, the Draize test for ocular irritation, and epithelial and limbal aspects as evaluated with IVCM. Treatment with either travoprost/timolol PQ or PBS produced no obvious inflammatory infiltration inside and outside the CALT follicles, yielded similar IVCM toxicity scores and CD45+ cell counts, and eyes treated with either solution had normal goblet cells.

CONCLUSION

The fixed combination of travoprost/timolol with 0.001% PQ had decreased ocular surface toxicity relative to the BAK-containing solutions. The potential benefit to the human ocular surface with oncedaily dosing needs to be evaluated clinically.

[Up to date methods of optic nerve evaluation in patients with optic neuropathy of various etiology]

132 patients (188 eyes) with proven optic neuropathy of non-glaucomatous origin were examined using static perimetry, visual evoked potential (flash and pattern types), optic coherent tomography of papilla and thickness of peripapillary nerve fiber layer. Sensitivity/ specificity of methods for identification of optic nerve diseases in acute stage were 92/75%, 92/84%, 90/92% respectively. Combination of these three methods let us identify optic neuropathy in 100% of cases, including latent forms.

Retinal ganglion cells function measured by the PERG test in patients with ocular hypertension

PURPOSE

To assess the retinal ganglion cells function in patients with ocular hypertension (OHT).

MATERIAL AND METHODS

In one hundred eyes of 50 patients with ocular hypertension [mean age: 48 +/- 13 years, intraocular pressure mean: 26 +/- 3.0 mmHg; Humphrey Field Analyzer (HFA) 24-2 W-W mean deviation (MD) > -2 decibels (dB), normal optic nerve fiber layer results in scanning laser polarimetry (GDX)], PERG recordings were performed according to the modified methodology described by Parisi V et al. (Ophthalmology 2006; 113: 216-228). Main parameters measured in the PERG test were as follows: amplitude of the P50 and N95 waves, AN95/AP50 ratio as well as implicit time of P50 wave. Pattern Electroretinogram P50 implicit times were considered delayed when exceeding the limit of mean values plus 2 standard deviations (SDs) from controls. PERG amplitudes of P50, N95 waves and AN95/AP50 ratio were considered reduced when they were below the mean values minus 2 SDs from controls. Control group consisted of age, sex, and refractive error matched one hundred eyes of 50 healthy subjects with intraocular pressure mean equal to 16 +/- 4.0 mmHg.

RESULTS

In the OHT eyes, significant reductions of AN95-wave (p < 0.0002) and AN95/AP50 ratio (p < 0.002) were obtained in comparison to controls. The PERG test revealed the abnormalities mostly in AN95/AP50 ratio (32/100 of OHT eyes--32%). Other less frequent abnormalities were observed in amplitude of N95-wave (10/100 of OHT eyes--10%) and in amplitude of P50-wave (6/100 of OHT eyes--6%). The implicit times of P50 and N95-waves were within normal limits.

CONCLUSIONS

In the eyes of the OHT patients, retinal ganglion cells dysfunction is present and can be detected by the PERG test. Longer follow-up is necessary to show predictable value of the PERG examination in separation of the OHT patients with a high risk of glaucoma development.

[Comparison of Goldmann tonometry, pneumotonometry and the effect of the central corneal thickness]

PURPOSE

To compare the intraocular pressure (IOP) measurements using the Goldmann applanation tonometer (GAT) and contact pneumotonometer (NTC), and to evaluate the effects of central corneal thickness (CCT) on the readings.

METHODS

This was a prospective, observational clinical study, which included 96 eyes of 49 patients, 40 glaucomatous, 29 ocular hypertensive and 27 normal subjects. The IOP measurements were performed with each tonometer. The CCT was also measured.

RESULTS

A strong correlation coefficient between GAT and the NTC was found (Pearson=0.922, p<0.001). The mean of paired differences between GAT and NTC was 0.72 ± 2.82 mmHg. The mean difference between GAT and NTC was low at lower levels of PIO and higher at higher levels of IOP. Readings with the GAT showed a mean increase in IOP of 0.47 mmHg for every 10 μm of CCT, and the NTC 0.34 mmHg for every 10 μm, the diference was not statistically significant.

CONCLUSIONS

The contact pneumotonometer is a reliable method in diagnosis and follow up of our population. The effect of the central corneal thickness was more important for the Goldmann applanation tonometer.

Reduced endothelial progenitor cells and brachial artery flow-mediated dilation as evidence of endothelial dysfunction in ocular hypertension and primary open-angle glaucoma

PURPOSE

This study aimed to assess vascular endothelial function in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) by measuring: (a) endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery, and (b) circulating endothelial progenitor cells, which are believed to support the integrity of the vascular endothelium.

METHODS

We enrolled 25 patients with OHT, 23 with POAG and 26 control subjects, all of whom were aged < 65 years and had no medical history of cardiovascular disease or cardiovascular risk factors. All subjects underwent a complete ophthalmological examination, biochemistry study, assessment of cardiovascular parameters, brachial artery ultrasound assessment of endothelium-dependent FMD, generic circulating progenitor cell (CPC) and circulating endothelial progenitor cell (EPC) count with the use of flow cytometry.

RESULTS

Flow-mediated vasodilation values differed significantly in OHT (4.5 +/- 1.1%; p = 0.021) and POAG (4.0 +/- 0.9%; p = 0.003) patients compared with controls (7.7 +/- 0.8%). The CD34(+) KDR(+) EPC count was markedly lower in OHT (28.0 +/- 5.0; p < 0.001) and POAG (24.3 +/- 3.4; p < 0.001) patients compared with controls (73.1 +/- 8.1). Neither FMD not EPCs differed significantly between OHT and POAG patients. No significant differences in CPC count or cardiovascular parameters were found among OHT or POAG patients and controls. The levels of CD34(+) KDR(+) EPCs were directly correlated (p = 0.043) with FMD, and inversely correlated (p = 0.032) with baseline intraocular pressure in OHT and POAG patients.

CONCLUSIONS

Both OHT and POAG patients without cardiovascular risk factors have previously unreported severely reduced circulating EPCs and reduced FMD, both of which are indicators of endothelial dysfunction and increased risk of cardiovascular events.

Structural and functional neuroprotection in glaucoma: role of galantamine-mediated activation of muscarinic acetylcholine receptors

Glaucoma is the leading cause of irreversible blindness worldwide. Loss of vision due to glaucoma is caused by the selective death of retinal ganglion cells (RGCs). Treatments for glaucoma, limited to drugs or surgery to lower intraocular pressure (IOP), are insufficient. Therefore, a pressing medical need exists for more effective therapies to prevent vision loss in glaucoma patients. In this in vivo study, we demonstrate that systemic administration of galantamine, an acetylcholinesterase inhibitor, promotes protection of RGC soma and axons in a rat glaucoma model. Functional deficits caused by high IOP, assessed by recording visual evoked potentials from the superior colliculus, were improved by galantamine. These effects were not related to a reduction in IOP because galantamine did not change the pressure in glaucomatous eyes and it promoted neuronal survival after optic nerve axotomy, a pressure-independent model of RGC death. Importantly, we demonstrate that galantamine-induced ganglion cell survival occurred by activation of types M1 and M4 muscarinic acetylcholine receptors, while nicotinic receptors were not involved. These data provide the first evidence of the clinical potential of galantamine as neuroprotectant for glaucoma and other optic neuropathies, and identify muscarinic receptors as potential therapeutic targets for preventing vision loss in these blinding diseases.

Functional and morphological effects of laser-induced ocular hypertension in retinas of adult albino Swiss mice

PURPOSE

To investigate the effects of laser photocoagulation (LP)-induced ocular hypertension (OHT) on the survival and retrograde axonal transport of retinal ganglion cells (RGC), as well as on the function of retinal layers.

METHODS

Adult albino Swiss mice (35-45 g) received laser photocoagulation of limbal and episcleral veins in the left eye. Mice were sacrificed at 8, 17, 35, and 63 days. Intraocular pressure (IOP) in both eyes was measured with a Tono-Lab before LP and at various days after LP. Flash electroretinogram (ERG) scotopic threshold response (STR) and a- and b-wave amplitudes were recorded before LP and at various times after LP. RGCs were labeled with 10% hydroxystilbamidine methanesulfonate (OHSt) applied to both superior colliculi before sacrifice and in some mice, with dextran tetramethylrhodamine (DTMR) applied to the ocular stump of the intraorbitally transected optic nerve. Retinas were immunostained for RT97 or Brn3a. Retinas were prepared as whole-mounts and photographed under a fluorescence microscope. Labeled RGCs were counted using image analysis software, and an isodensity contour plot was generated for each retina.

RESULTS

IOP increased to twice its basal values by 24 h and was maintained until day 5, after which IOP gradually declined to reach basal values by 1 wk. Similar IOP increases were observed in all groups. The mean total number of OHSt(+) RGCs was 13,428+/-6,295 (n=12), 10,456+/-14,301 (n=13), 12,622+/-14,174 (n=21), and 10,451+/-13,949 (n=13) for groups I, II, III, and IV, respectively; these values represented 28%, 23%, 26%, and 22% of the values found in their contralateral fellow retinas. The mean total population of Brn3a(+) RGCs was 24,343+/-5,739 (n=12) and 10,219+/-8,887 (n=9), respectively, for groups I and III; these values represented 49% and 20%, respectively, of the values found in their fellow eyes. OHT retinas showed an absence of OHSt(+) and DTMR(+) RGCs in both focal wedge-shaped and diffuse regions of the retina. By 1 wk, there was a discrepancy between the total number of surviving OHSt(+) RGCs and Brn3a(+) RGCs, suggesting that a large proportion of RGCs had impaired retrograde axonal transport. In the retinal areas lacking backlabeled RGCs, neurofibrillar staining revealed aberrant expression of RT97 within axons and RGC bodies characteristic of axotomy. Elevated IOP induced significant reductions in the registered ERG waves, including positive STR, a- and b-waves, that were observed by 24 h and remained throughout the period of study for the three groups analyzed.

CONCLUSIONS

LP of the perilimbal and episcleral veins resulted in OHT leading to a lack of retrograde axonal transport in approximately 75% of the original RGC population. This lack did not progress further between 8 and 63 days, and it was both focal (in sectors with the apex located in the optic disc) and diffuse within the retina. In addition, severe amplitude diminutions of the STR and a- and b-waves of the ERG appeared as early as 24 h after lasering and did not recover throughout the period of study, indicating that increased IOP results in severe damage to the innermost, inner nuclear, and outer nuclear layers of the retina.

[Changes of structures of anterior chamber angle in rabbit chronic high intraocular pressure model]

OBJECTIVE

To observe the anterior chamber angle changes occurred in compound Carbomer-induced chronic high intraocular pressure (IOP) model in rabbit eyes.

METHODS

It was an experimental study. Thirty two rabbits were randomly divided into eight groups. Compound Carbomer (0.3%, 0.3 ml) was injected into the left anterior chamber. A group of rabbits were randomly killed after 1, 2, 3, 4, 6, 8, 10 and 12 weeks. The anterior chamber of the rabbit eye specimens was observed.

RESULTS

IOP increased slowly following the application of the drug, high IOP lasted for 3 months. The drug-induced changes of anterior chamber angle consisted of early inflammatory response and late fibrous changes. Inflammatory response occurred in early stage and reduced or disappeared after 3 weeks. Fibrous degeneration and adhesion obstruction occurred in the anterior chamber angle after 4 weeks. Under the electron microscope, the trabecular was expanded and deformed, with hyperplasia of collagen and elastic fibers. Endothelial cells were separated from the trabecular, and showed the morphology of lymphocytes, with the function similar to the macrophages. Phagocytized Carbomer particles were transported through the vacuoles of Schlemm's canal endothelial cells. Large vacuoles gradually reduced. Excessive Carbomer particles were accumulated in the endothelial cells and obstructed the Schlemm's canal. This induced the fibrous proliferation and the destruction of anterior chamber angle structures.

CONCLUSIONS

The obstruction of aqueous humor outflow induced by compound Carbomer in rabbit high IOP model is caused mainly by the changes in trabecular endothelial cells.

Penetrance and Phenotype of the Thr377MetMyocilinMutation in a Large Finnish Family with Juvenile- and Adult-Onset Primary Open-Angle Glaucoma

PURPOSE

To study the role of myocilin (MYOC) as a susceptibility gene for juvenile- and adult-onset open-angle glaucoma (JOAG and POAG, respectively).

METHODS

In a six-generation Finnish family with JOAG and POAG, we performed thorough ophthalmologic characterization (including assessment of the visual fields by Octopus perimetry, nerve-fiber layer thickness by photography, and disc size by Heidelberg tomography) of 51 individuals. The coding region of MYOC was screened for mutations by PCR amplification and direct sequencing.

RESULTS

We detected a C > T transition at codon 377 resulting in a substitution of a threonine residue for methionine (Thr377Met) in the olfactomedin-like domain of myocilin, segregating in the family. Of the 20 individuals heterozygous for the mutation, nine (45%) were glaucomatous and two (10%) had ocular hypertension (OHT). The mean age at diagnosis of glaucoma in these individuals was 34.3 years (range: 14-66 years). Moreover, three of these individuals suffered retinal vein occlusion (RVO) in one eye, while one individual without the mutation had RVO.

CONCLUSION

Our results further support the evidence that the Thr377Met mutation in MYOC may represent a susceptibility allele for glaucoma. These findings may facilitate genetic counseling, and early diagnosis and treatment of glaucoma. The possible interaction of factors contributing to RVO in conjunction with the Thr377Met mutation warrants further investigation.

Decrease of optic disc cupping and pallor of ocular hypertensives with timolol therapy

PURPOSE

The purpose of this study was to determine whether timolol drops compared to placebo drops had a significant effect on optic disc cupping and pallor in ocular hypertensives.

METHODS

Thirty-seven ocular hypertensives were randomly assigned to placebo or 0.5% timolol drops to both eyes in a double masked clinical trial. Measurements of ocular pressure and photographs of the optic disc for cupping by photogrammetry and pallor by computerized image analysis were made at about 3 month intervals, for 18 to 24 months of follow-up.

RESULTS

None of the subjects developed visual field loss when tested with the Goldmann perimeter by kinetic and static means at six month intervals. Subjects treated with timolol developed a significant decrease in ocular pressure and a significant decrease in optic disc cupping with a smaller decrease in pallor compared to subject treated with placebo. Multivariate analyses indicated that the decrease of optic disc cupping and pallor was not associated with the ocular pressure on treatment or the decrease in ocular pressure during the trial.

CONCLUSION

Timolol treatment was associated with a decrease in optic disc cupping and pallor. The effect of timolol appears to be related to mechanisms other than the decrease in ocular pressure.

Increase of retinal nerve fiber layer thickness in ocular hypertensives with timolol therapy

PURPOSE

The purpose of this study was to determine whether timolol drops compared to placebo drops had a significant effect on retinal nerve fiber layer thickness in ocular hypertensives.

METHODS

Thirty-seven ocular hypertensives were randomly assigned to receive placebo or 0.5% timolol drops to both eyes for 18 to 24 months in a double masked clinical trial. Measurements of ocular pressure and photographs of retinal nerve fiber layer using stereophotogrammetric techniques were made at about 3 month intervals for 18 to 24 months of follow-up.

RESULTS

None of the subjects developed visual field loss when tested with the Goldmann perimeter by kinetic and static means at six month intervals. Subjects treated with timolol had a significant decrease in ocular pressure and developed a significant increase in retinal nerve fiber layer thickness compared to subjects treated with placebo. Multivariate analyses indicated that the increase of retinal nerve layer thickness was not associated either with the ocular pressure on treatment or the decrease in ocular pressure on treatment.

CONCLUSION

Timolol treatment was associated with an increase of retinal nerve fiber thickness. The effect of timolol appears to be related to mechanisms other than the decrease in ocular pressure.

Increase of retinal vessel width in ocular hypertensives with timolol therapy

PURPOSE

The purpose of this study was to determine whether timolol drops compared to placebo drops had a significant effect on retinal vessel width in ocular hypertensives.

METHODS

Thirty-seven ocular hypertensives were randomly assigned to receive placebo or 0.5% timolol drops to both eyes for 18 to 24 months in a double masked clinical trial. Measurements of ocular pressure and retinal vessel width by computerized image analysis from fundus photographs were made at about 3 month intervals for 18 to 24 months of follow-up.

RESULTS

None of the subjects developed visual field loss when tested with the Goldmann perimeter by kinetic and static means at six month intervals. Subjects treated with the placebo showed no change in ocular pressure and a significant decrease in retinal vessel width over time especially in the right eye. Subjects treated with timolol had an increase in retinal vessel width compared to the placebo group significant especially for the superior temporal vein. Multivariate analyses indicated that the increase of retinal vessel width was not associated mainly with the ocular pressure on treatment or decrease in ocular pressure on treatment.

CONCLUSION

Timolol treatment was associated with an increase of retinal vessel width. The effect of timolol appears to be related primarily to mechanisms other than the decrease in ocular pressure.

Intraocular pressure in exfoliation syndrome

A retrospective follow-up study of 206 eyes with exfoliation in 164 patients was carried out. At the time exfoliation (EX) was initially diagnosed, there were 97 patients with unilateral and 42 patients (84 eyes) with bilateral exfoliation. In 25 patients the exfoliation was connected with hypertension or glaucoma in the fellow eye. The average age of the patients with unilateral EX was 66.3 years and that of the patients with bilateral EX 68.0 years. The initial mean IOP (+/- SD) of 17.9 (+/- 2.9) mmHg in 97 unilateral EX eyes was statistically significantly higher (2p less than 0.001) than in the normal fellow eye 16.1 (+/- 2.5) mmHg. Of the 97 eyes with unilateral EX, 45.3% with an initial mean IOP of 17.4 mmHg remained unchanged. The mean follow-up time was 5.0 years. Conversion of unilateral to bilateral EX was observed in 14.4% of cases. The mean time of conversion was 4.5 years. Of the 84 bilateral EX eyes with an initial mean IOP of 17.0 mmHg, 66.7% remained unchanged. Of the total sample of 206 EX eyes, 65.5% remained normotensive and 34.5% developed hypertension or glaucoma during the follow-up period. The initial mean IOP of those eyes which remained normotensive was statistically significantly lower than that of those which later on developed hypertension or glaucoma (2p less than 0.001).

Bioinformatic and statistical analysis of the optic nerve head in a primate model of ocular hypertension

BACKGROUND

The nonhuman primate model of glaucomatous optic neuropathy most faithfully reproduces the human disease. We used high-density oligonucleotide arrays to investigate whole genome transcriptional changes occurring at the optic nerve head during primate experimental glaucoma.

RESULTS

Laser scarification of the trabecular meshwork of cynomolgus macaques produced elevated intraocular pressure that was monitored over time and led to varying degrees of damage in different samples. The macaques were examined clinically before enucleation and the myelinated optic nerves were processed post-mortem to determine the degree of neuronal loss. Global gene expression was examined in dissected optic nerve heads with Affymetrix GeneChip microarrays. We validated a subset of differentially expressed genes using qRT-PCR, immunohistochemistry, and immuno-enriched astrocytes from healthy and glaucomatous human donors. These genes have previously defined roles in axonal outgrowth, immune response, cell motility, neuroprotection, and extracellular matrix remodeling.

CONCLUSION

Our findings show that glaucoma is associated with increased expression of genes that mediate axonal outgrowth, immune response, cell motility, neuroprotection, and ECM remodeling. These studies also reveal that, as glaucoma progresses, retinal ganglion cell axons may make a regenerative attempt to restore lost nerve cell contact.

The effects of acute intraocular pressure elevation on rat retinal glutamate transport

PURPOSE

To investigate the relationship between intraocular pressure (IOP), retinal glutamate transport and retinal hypoxia during acute IOP elevations of varying magnitude.

METHODS

Female Dark Agouti rats were anaesthetized by ketamine/xylazine/acepromazine (10/5/0.5 mg/kg i.p.). The anterior chamber was cannulated with a 30-gauge needle attached to a saline reservoir. The target IOP (20-120 mmHg, in 10 mmHg increments) was obtained by adjusting the reservoir height. After 10 mins of IOP stabilization, 2 microl of the non-endogenous glutamate transporter substrate, D-aspartate, was injected into the vitreous (final concentration 50 microm), and the elevated IOP maintained for a further 60 mins (total duration of IOP elevation was 70 mins). Glutamate transporter function was assessed by the immunohistochemical localization of D-aspartate. Retinal sections were examined for histological integrity. The experiment was repeated substituting the D-aspartate with the cellular hypoxia marker, Hypoxyprobe-1.

RESULTS

Under control conditions, D-aspartate was preferentially taken up into the glial Müller cells by glutamate/aspartate transporter (GLAST). This function was maintained at pressures < or = 70 mmHg, whereafter perturbation of function was evidenced by decreased accumulation of D-aspartate by Müller cells. Failure of GLAST activity was coincident with the appearance of Hypoxyprobe-labelled cells in the inner retina and histological damage.

CONCLUSIONS

Glutamate transport does not appear to change linearly with increased IOP. A pressure threshold exists, above which Müller cell GLAST function is compromised. Moreover, ganglion cell glutamate uptake is only apparent at pressures above those that cause GLAST inhibition. The association between IOP, hypoxia, glutamate transporter dysfunction and subsequent retinal cell death may have important implications for the pathogenesis of IOP/ischaemia-related neuropathy and neuroprotective strategies.

[Pathological changes of retinal glial cells in a rat chronic ocular hypertension model]

OBJECTIVE

To study the pathological changes of retinal glial cells and its effect on retinal ganglion cells (RGC) damage in a rat chronic ocular hypertension model.

METHODS

Seventy-two of Sprague-Dawley (SD) rats with chronic elevated intraocular pressure (IOP) by ligating two superior or inferior episcleral veins were used in this study. Twelve normal rats served as control. The densities of glial cells were determined in flat mounted or transverse semithin sections of retinas, microglial cells were visualized by OX42 staining on whole-mounted retinas, and Muller cells were detected by expressing glial fibrillary acidic protein (GFAP) on frozen section or flat mounted retinas with confocal microscopy at 2 hours, 12 hours, 1 day, 1 week, 4 weeks, and 8 weeks after operation, respectively.

RESULTS

Compared with control group, the densities of activated microglial cells were significantly (F = 196.56, P < 0.01) increased at 1 day (215.00 +/- 18.60 vs 327.40 +/- 68.32/mm2) and reached a peak value at 1 week (965.06 +/- 86.63/mm2), then decreased gradually. But the densities of astrocytes and Miller cells were not significantly changed (F = 1.36, 1.89; P > 0.05) at all time points. The activated microglial cells were appeared at 2 hour while the activated Miller cells and astrocytes presented at 12 hours after operation. The activated Muller cells and astrocytes reached a peak value at 4 weeks, and then decreased gradually. The activated astrocyte had morphological changes including disappeared star-structure of cell body, stiffness, and shortness of cell processes.

CONCLUSIONS

The alteration of microglial cell densities appears to be the earliest pathological changes of retina in rat with chronic ocular hypertension. The activated astrocytes with morphological disorder may deteriorate the damage of RGC and result in a harmful microenvironment for axonal regeneration of RGC in glaucoma.

Evaluating the effect of the new alignment algorithm for longitudinal series of Heidelberg retina tomography images

PURPOSE

To evaluate the impact of a new image-alignment algorithm on the repeatability of longitudinal measurements obtained from Heidelberg retina tomograph (HRT) images.

METHODS

HRTI and HRTII image series from 124 patients with glaucoma or ocular hypertension were made available from previously reported studies and were reprocessed with the old and new image-alignment algorithms. Improvements afforded by the new alignment algorithm were examined by considering statistically significant improvement in repeatability of specific stereometric parameters (SP), namely rim area (RA), rim volume (RV), cup volume (CV) and cup shape measure (CSM). A further comparison was made by examining reduction in the variability of pixel-by-pixel height measures within image series.

RESULTS

In some HRT image series, the new algorithm automatically corrected obvious misalignment events that occurred with the previous algorithm. However, average improvement in repeatability of the SP in HRTI image series was not statistically significant (P = 0.13) and there was no statistically significant reduction in pixel-by-pixel height measurement variability (P =0.73). In HRTII image series, there was evidence of improvement, on average, in the repeatability of some parameters (RA, P = 0.01; RV, P = 0.02; CSM, P = 0.05), but not in CV (P = 0.22). There was a large reduction in pixel-by-pixel variability in HRTII image series (P < 0.001).

CONCLUSION

There was no evidence to show that the new algorithm improved repeatability, on average, in HRTI images. However, the application of the new algorithm to HRTII image series marginally improved repeatability in stereometric measures and yielded a significant reduction in pixel-by-pixel variability.