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GLAUCOMA – CURRENT CLINICAL AND RESEARCH ASPECTS Edited by Pinakin Gunvant Glaucoma – Current Clinical and Research Aspects Edited by Pinakin Gunvant Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Petra Zobic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Yuri Arcurs, 2011. Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Glaucoma – Current Clinical and Research Aspects, Edited by Pinakin Gunvant p. cm. ISBN 978-953-307-263-0 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Basic Science Research in Understanding Pathogenesis in Glaucoma 1 Chapter 1 Oxidative Stress in Anterior Segment of Primary Open Angle Glaucoma 3 Sergio C. Saccà and Alberto Izzotti Chapter 2 Manipulating Glia to Protect Retinal Ganglion Cells in Glaucoma 25 Denise M. Inman, Caroline B. Lupien and Philip J. Horner Chapter 3 Role of the Matrix Metallo-Proteinases in the Cellular Re-Modeling in a Glaucoma Model System in Rat 51 Claudio De Seta, Nicola Calandrella, Valerio Berardi, Antonio Mazzarelli, Gianfranco Scarsella and Gianfranco Risuleo Chapter 4 Systemic C-Reactive Protein Levels in Normal-Tension Glaucoma and Primary Open-Angle Glaucoma 63 Wei-Wen Su and Shih-Tsung Cheng Chapter 5 Molecular Analysis of Italian Patients with Congenital Glaucoma 71 Italo Giuffre’ Part 2 Review of Evidence in Clinical Management of Glaucoma 83 Chapter 6 Tonometry – Past, Present and Future 85 Elliot M. Kirstein, Ahmed Elsheikh and Pinakin Gunvant VI Contents Chapter 7 Clustered Trend-Type Analysis to Detect Progression of Visual Field Defects in Patients with Open-Angle Glaucoma 109 Takeo Fukuchi, Takaiko Yoshino, Masaaki Seki, Tetsuya Togano, Hideko Sawada and Haruki Abe Chapter 8 Neovascular Glaucoma 127 Kurt Spiteri Cornish Chapter 9 Current Diagnosis and Management of Angle-Closure Glaucoma 145 Rafael Castañeda-Díez, Mariana Mayorquín-Ruiz, Cynthia Esponda-Lamoglia and Oscar Albis-Donado Part 3 Various Issues Related to Medical Therapy in Glaucoma 169 Chapter 10 Topical Pressure Lowering Drug: Racial Respond Variation and Pharmacogenetics 171 Ahmad Tajudin Liza-Sharmini Chapter 11 Pharmacogenomics of Open-Angle Glaucoma 187 Stephen G. Schwartz and Tomomi Higashide Chapter 12 Drops, Drops, and More Drops 197 John Walt and Fern Alexander Chapter 13 Pressure Lowering Medications 223 Liza-Sharmini Ahmad Tajudin and Yaakub Azhany Part 4 Review of Evidence in Using Lasers in Management of Glaucoma 255 Chapter 14 Selective Laser Trabeculoplasty 257 Silvia Pignatto, Daniele Veritti, Andrea Gabai and Paolo Lanzetta Part 5 Various Surgical Aspects in Glaucoma 273 Chapter 15 Combined Approach to Coexisting Glaucoma and Cataract: Choice of Surgical Techniques 275 Brig JKS Parihar, Lt Col Jaya Kaushik, Surg Lt Cdr AS Parihar and Ashwini KS Parihar Chapter 16 A Surgical Technique for Difficult Glaucoma Cases: Combined Cyclectomy/Trabeculectomy 325 Kaya N. Engin and Günay Engin Contents VII Chapter 17 Glaucoma Surgery with Fugo Blade 337 Daljit Singh and Richard Fugo Chapter 18 Secondary Glaucoma After Vitreoretinal Procedures 361 Lizette Mowatt Preface It is difficult to imagine how intellectually gifted individuals, like Leonardo da Vinci, could demonstrate such mastery of so many subjects: art, mathematics and medicine. Such comprehensive academic proficiency was uncommon in the 15 th century, and perhaps is even more rare today. It would be an understatement to say that we live in an era where information is exploding at a rate faster than what can be assimilated. This means that it is nearly impossible to be specialists in all areas and has, in turn, produced “super specialists” in all fields––including medicine. This book features a collection of articles authored by various researchers who are super specialists in the pathogenesis, diagnosis and treatment of glaucoma. With such a heterogeneous nature, you may even argue that glaucoma is not one disease, but a group of diseases. A lot is already known about glaucoma, and a lot more has yet to be determined. Likewise, what information we deem to be "fact" today may be questioned and deconstructed by the thought leaders of tomorrow. But, that is the beauty of science and research. This book summarizes current literature about research and clinical science in glaucoma. By no means is this a comprehensive guide to the subject; rather, it is more of a synopsis and translation of the research conducted by individuals who are known in each of their respective areas. The book can be divided into two broad sections: basic science and clinical science. The basic science section examines bench- and animal-modeling research in an attempt to understand the pathogenesis of glaucoma. The clinical science section addresses various diagnostic issues and the medical, laser and surgical techniques used in glaucoma management. We hope that both clinicians and scientists find this work useful and stimulating. The e-book and open-access model provided by the publishers ensure that the information in this book will be widely circulated and available to everyone who wants to learn. This model echoes the words of Nobel laureate Rabindranath Tagore who wrote the poem given below in his book Gitanjali about 100 years ago: “Where the mind is without fear and the head is held high; Where knowledge is free; X Preface Where the world has not been broken up into fragments by narrow domestic walls; Where words come out from the depth of truth; Where tireless striving stretches its arms towards perfection; Where the clear stream of reason has not lost its way into the dreary desert sand of dead habit; Where the mind is led forward by thee into ever-widening thought and action Into that heaven of freedom, my Father, let my country awake.” My sincere gratitude goes to Subba Gollamudi MD, Eye Specialty Group, Memphis Tennessee; Shelly Gupta MD, faculty The Ohio State University, Columbus, Ohio; and Jasmine Yumori OD, Western University of Health Sciences, Pomona, California. Their expert opinion and assistance in reviewing parts of the book was invaluable. Additionally, I would like to thank the managing editor, Ms. Petra Zobic and editorial team manager Ms. Anna Nikolic for their assistance throughout the duration of this project. Most importantly, thanks to all the contributing authors whose dedication to research and the art of scientific knowledge dissemination has made this book a reality. Dr. Pinakin Gunvant College of Optometry, Western University of Health Sciences, Pomona California [...]... openangle glaucoma and nonglaucomatous normals Ophthalmology 91:56 4–5 79 Alvarado JA, Yeh RF, Franse-Carman L, Marcellino G, Brownstein MJ (2005b) Interactions between endothelia of the trabecular meshwork and of Schlemm's canal: a new 16 Glaucoma – Current Clinical and Research Aspects insight into the regulation of aqueous outflow in the eye Trans Am Ophthalmol Soc.103:148-62 Ames BN, Shigenaga MK and Hagen... Immunol 22: 16 5–1 73 Wordinger, R.J., Fleenor, D.L., Hellberg, P.E., Pang, I.H., et al (2007) Effects of TGF-beta2, BMP-4, and gremlin in the trabecular meshwork: implications for glaucoma Invest Ophthalmol Vis Sci 48: 119 1–1 200 Xu H, Chen M, Forrester JV (2009) Para-inflammation in the aging retina Prog Retin Eye Re 28:348-68 24 Glaucoma – Current Clinical and Research Aspects Yakes FM and van Houten... may induce collagen matrix remodeling and TM cell apoptosis independently of mitochondria (Veach 2004) Therefore in glaucoma course occurs a decline in total antioxidant defenses and in particular in AH (Ferreira et al 2004) that have a great impact on the TM endothelium: because this is not more protected 10 Glaucoma – Current Clinical and Research Aspects properly and because TM is the most sensitive... composed of the endothelia of iris, cornea, and trabecular meshwork (Brandt and O’Donnell 1999) Aqueous humor is secreted by the ciliary body into the posterior chamber of the eye Aqueous humor cannot traverse the intact iris and thus it passes through the pupil to reach the anterior chamber of the eye At the iris- 4 Glaucoma – Current Clinical and Research Aspects corneal angle, the main part of this... degeneration, resulting in the decay of HTM cellularity, causes IOP increase and triggers glaucoma (Saccà and Izzotti 2008) 5 6 Glaucoma – Current Clinical and Research Aspects metabolism (Wordinger et al., 2007) TGF in the AH is also responsible for anterior chamberassociated immune deviation, a mechanism that protects the eye from inflammation and immune-related tissue damage (Wilbanks et al., 1992) Indeed,... tissues, but like in vessels, is a real organ with the function of modulating 12 Glaucoma – Current Clinical and Research Aspects the tone and the flow rate in response to humoral, nervous and mechanics stimuli In physiological conditions the ACE plays an active role cellular interchange, being able to adapt functionally and structurally to changes in the environment (Verma et al 2003) The normal endothelial... large number of inflammatory genes, including genes involved 8 Glaucoma – Current Clinical and Research Aspects in complement activation and inflammatory cytokine/chemokine production, which in turn cause abnormal leukocyte-endothelial interactions and ultimately vascular damage (Xu et al 2009) Furthermore, the innate immune system in general and monocytes in particular play an important role in aqueous... relation to aging and pathology, Ann N Y Acad Sci 1011:86-100 Gherghel D, Griffiths HR, Hilton EJ, Cunliffe IA, Hosking SL.: Systemic reduction in glutathione levels occurs in patients with primary open-angle glaucoma Invest Ophthalmol Vis Sci 2005; 46: 877-83 18 Glaucoma – Current Clinical and Research Aspects Gibbons GH (1997) Endothelial function as a determinant of vascular structure and function:... correlation in patients with primary openangle glaucoma Arch Ophthalmol 123:458-63 Sakai H, Shen X, Koga T, et al (2007) Mitochondrial association of myocillin, product of a glaucoma gene, in human trabecular meshwork cells J Cell Physiol.; 213:775-784 22 Glaucoma – Current Clinical and Research Aspects Sawaguchi, S., Yue, B.Y., Chang, I.L., Wong, F and Higginbotham, E.J (1992) Ascorbic acid modulates... dedicated to My dear parents Minaben and Gunvant Davey for all that they have done so I am here today My darling wife Payal for her care and continued support to my professional career My beloved Professors Daniel O’Leary and Edward Essock, whose teaching laid the foundation of my research and understanding glaucoma Part 1 Basic Science Research in Understanding Pathogenesis in Glaucoma 1 Oxidative Stress in . GLAUCOMA – CURRENT CLINICAL AND RESEARCH ASPECTS Edited by Pinakin Gunvant Glaucoma – Current Clinical and Research Aspects Edited by Pinakin. orders@intechweb.org Glaucoma – Current Clinical and Research Aspects, Edited by Pinakin Gunvant p. cm. ISBN 978-953-307-263-0 free online editions of InTech Books and Journals can be found. questioned and deconstructed by the thought leaders of tomorrow. But, that is the beauty of science and research. This book summarizes current literature about research and clinical science in glaucoma.