DIAGNOSTIC AND THERAPEUTIC CENTER OF ATHENS "HYGEIA" GREECE

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Presentation transcript:

DIAGNOSTIC AND THERAPEUTIC CENTER OF ATHENS "HYGEIA" GREECE 1st WORLD CONGRESS ON COPHy 4-7 MARCH 2010 PRAGUE DIAGNOSTIC COMPATIBILITY OF STUCTURAL AND HEMODYNAMIC PARAMETERS IN PREPERIMETRIC GLAUCOMA EDWARD ATH. SKOUFIS M.D., E. TSICHLIS M.D., G. NEOS M.D., N.MICHALOPOULOS M.D. DIAGNOSTIC AND THERAPEUTIC CENTER OF ATHENS "HYGEIA" GREECE

PURPOSE: To evaluate the diagnostic ability of retinal nerve fiber layer(RNFL), in relationship with ocular blood flow (OBF) discriminating between normal and preperimetric glaucoma patients.

METHOD : In this study participated 100 consecutive patients in follow-up one year,2008-2009 divided in two groups: A-Control normal group (CG) with 35 patients B-Preperimetric Glaucoma group(PGG) with 65 patients. A baseline glaucoma examination were performed included OCT-SLO(OTI),STANDARD AUTOMATED PERIMETRY(SAP)-HUMPHREY field analyzer, pulsatile ocular blood flow monitoring(OBF) with pulse amplitude(PA) PARADIGM ,CCT.The receiver operating characteristic(ROC) curves were plotted for RNFL parameters. Results were evaluated using T-test.

RESULTS: We identifed that the PGG compared CG had significantly thinner overall RNFL 79.9 ± 8.1 vs 89.8 ± 7.5,P<0.001 as well as inferior at inferotemporal quadrant, with MD in SAP -0,4 ± 0,3 vs within normal limits in CG .The OBF and PA were lower in PGG respectively 9.7 ± 1.6,2.9 ± 0.5,vs 13.6 ± 0.9, 3.7 ± 1.5. The areas under the ROC curve were 0.775(0.669-0.879) in PGG vs0.821(0.723-0.921) in CG. After one year follow-up we detected by OCT further mean thinning 20.1 ± 1.8 in PGG (-25.2%) while in CG remained stable,reflected in SAP with MD -2.1 ± 1.0 db.We have got a good concordance between OCT and OBF findings,showed OBF reduced 7.3 ± 1.5(-24.3%) and PA 2.2 ± 0.4 (-24.8%) p<0.01. It,s important that in PGG,48 cases(73.8%) remained stable, with unchanged OBF,but PA in 14 cases of them with asymmetric IOP fluctuations reduced 14.5% preceded for further progression whereas 13(20%) progression as assessed OCT and in OBF and finally 4 cases (6.2%) as assessed in OCT, OBF, SAP together p<0.01. The peripapillary OCT thickness demonstrated a statistically significant correlation between RNFL loss and OBF insuffiency p<0.01.The OCT and OBF analyzer reflect true structural changes preceding the apperance of functional changes.

CG in follow-up

PGG in follow-up

Final comparative results between CG & PGG

CONCLUSION -OCT and OBF accurately predict onset of Glaucoma. -PA is more sensible hemodynamic element discrimating between normal and preperimetric glaucoma patients. -A strong association among hemodynamic parameters and RNFL structural alterations observed.

Epilogue “ THE CONTROVERSY IN OPHTHALMOLOGY IS GRAND PRIX OF HIGHLIGHTS IN CRESCENDO” Our CONTROVERSY points: -Are the structural and hemodynamic analysis the best precursor tool of “latent glaucoma”? -Are blood perfusion changes with cerebral alterations in glaucoma avery “ sensible point”? -Are essential features axional and mitochondrial degeneration? -The silencing of gene expression and the activation of apoptosis appear to be epigenetic changes? -Is completely understood the”Glaucoma Puzzle”??