Glaucoma Basic and Clinical Concepts Edited by Shimon Rumelt GLAUCOMA - BASIC AND CLINICAL CONCEPTS Edited by Shimon Rumelt INTECHOPEN.COM Glaucoma - Basic and Clinical Concepts http://dx.doi.org/10.5772/792 Edited by Shimon Rumelt Contributors Raghu Krishnamoorthy, Brett Mueller, Dorota Stankowska, Elena Vecino, Sansar Sharma, Mutay Aslan, Serdar Dogan, Yoshiaki Kiuchi, Hideki Mochizuki, Kiyoshi Kusanagi, Yasemin Ustündağ Budak, Müberra Akdogan, Jair Giampani Junior, Adriana Borges-Giampani, Claudio Campa, Luisa Pierro, Paolo Bettin, Francesco Bandello, Tharwat Mokbel, Sarper Karakucuk, Jin Li, Mengqing Xiang, Feng Qiu, Haisong Jiang, Kangxin Jin, William Alan Hare, Cun-Jian Dong, Larry Wheeler, Ingeborg Stalmans, Luis Abegão Pinto, Umar Mian, Anurag Shrivastava, Paul Rolf Preußner, Jochen Wahl, Rakhshandeh Alipanahi, Sima Sayyahmelli, Antonio Fea, Dario Damato, Umberto Lorenzi, Federico Grignolo, Hosam Sheha, Sorina Demea, Rodica Holonec, Horea Demea, Marlene Moster, Parul Ichhpujani, Maria D. Pinazo- Duran, Roberto Gallego-Pinazo, Manuel Serrano, Vicente Zanon-Moreno, Shimon Rumelt, Jean-Louis Girardin, Ferdinand Zizi, Eitan Z. Rath, Avraham Cohen, Georgios Labiris, Athanassios Giarmoukakis, Vassilios Kozobolis, Tsvi Sheleg, Michael Rumelt, M.D. Emeritus, Mohammad Shahidullah, Waleed Hassan Al-Malki, Nicholas Delamere © The Editor(s) and the Author(s) 2011 The moral rights of the and the author(s) have been asserted. All rights to the book as a whole are reserved by INTECH. The book as a whole (compilation) cannot be reproduced, distributed or used for commercial or non-commercial purposes without INTECH’s written permission. Enquiries concerning the use of the book should be directed to INTECH rights and permissions department (permissions@intechopen.com). Violations are liable to prosecution under the governing Copyright Law. Individual chapters of this publication are distributed under the terms of the Creative Commons Attribution 3.0 Unported License which permits commercial use, distribution and reproduction of the individual chapters, provided the original author(s) and source publication are appropriately acknowledged. If so indicated, certain images may not be included under the Creative Commons license. In such cases users will need to obtain permission from the license holder to reproduce the material. More details and guidelines concerning content reuse and adaptation can be foundat http://www.intechopen.com/copyright-policy.html. 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. First published in Croatia, 2011 by INTECH d.o.o. eBook (PDF) Published by IN TECH d.o.o. Place and year of publication of eBook (PDF): Rijeka, 2019. IntechOpen is the global imprint of IN TECH d.o.o. Printed in Croatia Legal deposit, Croatia: National and University Library in Zagreb Additional hard and PDF copies can be obtained from orders@intechopen.com Glaucoma - Basic and Clinical Concepts Edited by Shimon Rumelt p. cm. ISBN 978-953-307-591-4 eBook (PDF) ISBN 978-953-51-6568-2 Selection of our books indexed in the Book Citation Index in Web of Science™ Core Collection (BKCI) Interested in publishing with us? Contact book.department@intechopen.com Numbers displayed above are based on latest data collected. For more information visit www.intechopen.com 4,200+ Open access books available 151 Countries delivered to 12.2% Contributors from top 500 universities Our authors are among the Top 1% most cited scientists 116,000+ International authors and editors 125M+ Downloads We are IntechOpen, the world’s leading publisher of Open Access books Built by scientists, for scientists Meet the editor Dr. Shimon Rumelt received his medical degree and a diploma in ophthalmology from Tel Aviv Universi- ty, Israel. He completed his ophthalmology residency program at Western Galilee - Nahariya Medical Center in Nahariya, Israel,an oculoplastics fellowship at Massa- chusetts Eye and Ear Infirmary, Boston, Massachusetts, and vitreoretinal fellowship at Boston University. He earned a master degree in Public Administration (Health Systems) from Clark University, Worcester, MA. Dr. Rumelt is a senior ophthalmologist at the Western Galilee - Nahariya Medical Center and is engaged with various fields in ophthalmology. He is engaged with clinical activities, surgery, research and teaching medical students, residents and fellows. Dr. Rumelt edited three books and is the author and co-author of approx- imately 100 scientific articles and book chapters. He is a member of the editorial board of Evidence - Based Ophthalmology and a reviewer for multiple professional journals. Contents Preface X II I Part 1 Basic Concepts 1 Chapter 1 Mechanism of Aqueous Humor Secretion, Its Regulation and Relevance to Glaucoma 3 Mohammad Shahidullah, Waleed Hassan Al-Malki and Nicholas A. Delamere Chapter 2 Retinal Ganglion Cell Death 33 Yasemin Budak and Müberra Akdogan Chapter 3 Adaptive Changes in the Retina and Central Visual Areas in Glaucoma 57 Sansar C. Sharma, Jin Li and Elena Vecino Chapter 4 Molecular Control of Retinal Ganglion Cell Specification and Differentiation 65 Mengqing Xiang, Haisong Jiang, Kangxin Jin and Feng Qiu Chapter 5 The Role of Retinal Oxidative and Nitrative Injury in Glaucomatous Neurodegeneration 85 Serdar Dogan and Mutay Aslan Chapter 6 Excitotoxic Injury to Retinal Ganglion Cells 113 William A. Hare, Cun-Jian Dong, and Larry Wheeler Chapter 7 Neuroprotection in Glaucoma 137 Brett H. Mueller II, Dorota L. Stankowska and Raghu R. Krishnamoorthy Chapter 8 Neural Mechanisms Underlying Brimonidine’s Protection of Retinal Ganglion Cells in Experimental Glaucoma 185 Cun-Jian Dong, William A. Hare and Larry Wheeler X Contents Chapter 9 Glaucoma Genetics – Regulation of Cell Surviving and Death in the Retina 207 Maria D. Pinazo-Durán, Roberto Gallego-Pinazo, Vicente Zanón-Moreno and Manuel Serrano Chapter 10 A Vascular Approach to Glaucoma 225 Luís Abegão Pinto and Ingeborg Stalmans Chapter 11 Corneal Viscoelastical Properties Related to Glaucoma 255 Horea Demea, Sorina Demea and Rodica Holonec Chapter 12 Effects of High Altitude Related Oxidative Stress on Intraocular Pressure and Central Corneal Thickness – A Research Model for the Etiology of Glaucoma 271 Sarper Karakucuk Chapter 13 Sleep Apnea and Glaucoma – Greater Risk for Blacks? 291 Ferdinand Zizi, Adnan Mallick, Monika Dweck, Douglas Lazzaro and Girardin Jean-Louis Chapter 14 Quality of Life (QoL) in Glaucoma Patients 307 Georgios Labiris, Athanassios Giarmoukakis and Vassilios P. Kozobolis Chapter 15 Glaucoma Animal Models 319 Elena Vecino and Sansar C. Sharma Part 2 Clinical Concepts – Glaucoma Evaluation and Management 335 Chapter 16 Management of Glaucoma in the Era of Modern Imaging and Diagnostics 337 Anurag Shrivastava and Umar Mian Chapter 17 Anterior Chamber Angle Assessment Techniques 371 Claudio Campa, Luisa Pierro, Paolo Bettin and Francesco Bandello Chapter 18 End Stage Glaucoma 391 Tharwat H. Mokbel Chapter 19 Update on Modulating Wound Healing in Trabeculectomy 401 Hosam Sheha Chapter 20 Novel Glaucoma Surgical Devices 417 Parul Ichhpujani and Marlene R. Moster Contents X I Chapter 21 Cyclodestructive Procedures 443 Sima Sayyahmelli and Rakhshandeh Alipanahi Chapter 22 Another Look on Cyclodestructive Procedures 451 Antonio Fea, Dario Damato, Umberto Lorenzi and Federico M. Grignolo Chapter 23 Controlled Cyclophotocoagulation 469 Paul-Rolf Preußner Part 3 Clinical Concepts – Specific Glaucoma Entities 481 Chapter 24 Congenital Glaucoma 483 Jair Giampani Junior and Adriana Silva Borges Giampani Chapter 25 Primary Angle Closure Glaucoma 499 Michael B. Rumelt Chapter 26 Plateau Iris 523 Yoshiaki Kiuchi, Hideki Mochizuki and Kiyoshi Kusanagi Chapter 27 Normal-Tension (Low-Tension) Glaucoma 535 Tsvi Sheleg Chapter 28 Drug-Induced Glaucoma (Glaucoma Secondary to Systemic Medications) 547 Eitan Z. Rath Chapter 29 Steroid Induced Glaucoma 559 Avraham Cohen Chapter 30 Glaucoma in Cases of Penetrating Keratoplasty, Lamellar Procedures and Keratoprosthesis 569 Shimon Rumelt Preface The glaucoma specialty underwent an enormous change in the last two decades and a book that is published now is different from one that was published even two years ago. It just reflects this change. We are evident to better understanding the genetics and pathogenesis of different types of glaucomas that will enable us to develop novel approaches for treatment, new imaging techniques such as anterior segment OCT, GDx, or HRT, application of new devices such as the ExPress shunt, iStent and Solx Gold shunt and new procedures such as canaloplasty and deep sclerostomy to minimize postoperative complications of the traditional trabeculectomy without compromising the success of the procedure. The book is arranged in a systematic approach discussing first the basic concepts of glaucomas, including the final offenders, the retinal ganglion cells and many other topics. The clinical concepts include evaluation and management of glaucoma and the different types of glaucomas, their features, evaluation, differential diagnosis and specific approaches for treatment. The book covers most but not all of the field. It is a product of a balance between expedited publishing process and encompassing the entire field. The book is intended for the general ophthalmologists, glaucoma specialists, and researchers in the field, residents and fellows. It covers both basic and clinical concepts of glaucoma and all authors incorporated their perspectives on each topic adding their own theories, future trends and research. Therefore, the book should enable researches and clinicians to adopt new ideas for further basic and clinical research. “Glaucoma - Basic and Clinical Concepts” is a result of contributions from multi- national glaucoma specialists worldwide with a common characteristic of taking care of patients. Some of the authors have been engaged for many years in this field, some are just at their beginning. Some authors are researches, other clinicians. Some are world leaders in glaucoma research, others will be. We hope that our readers will be of wide variety just as our authors are. The book is accessed online to allow free access to as many readers worldwide as possible and is also available on print for those who do not have online access or are interested in having their own hard copy. This will definitely contribute to distributing the knowledge on glaucoma among researchers and clinicians. X Preface I would like to acknowledge each and every one of the contributors for their excellent work on each chapter. Each of them devoted time and effort to write a chapter and to contribute to the success of this book and for the advancement of glaucoma research. I would like to thank Mr. Davor Vidic, the book Publishing Process Manager for his tremendous efforts to publish an excellent book and his endless support, Ms. Ana Nikolic, the Head of Editorial Consultants at InTech for her useful assistance and for choosing me to be the Editor of the book. Many thanks to the technical editors for their arranging the book in a uniform format and to InTech – Open Access publisher - without this initiative, the book would have never been published. Lastly, to my family, teachers and students from whom I studied throughout the years. I hope that this book will be the first in a series of books in all the different specialties within ophthalmology. I wish you, the reader, an enjoyable journey through glaucoma, one of the most interesting and challenging specialties in medicine in general and, in ophthalmology, in particular. The book is a product of global cooperation for the benefit of physicians and patients all over the world. I hope that it will serve as an example for others to follow. Shimon Rumelt, MD, MPA Department of Ophthalmology, Western Galilee – Nahariya Medical Center, Nahariya, Israel Part 1 Basic Concepts 1 Mechanism of Aqueous Humor Secretion, Its Regulation and Relevance to Glaucoma Mohammad Shahidullah 1 , Waleed Hassan Al-Malki 2 and Nicholas A. Delamere 1 1 Department of Physiology, University of Arizona, Tucson, AZ 85724 2College of Pharmacy, Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, 1USA 2 KSA 1. Introduction The principal function of the eye is to receive the light signal from the environment and transmit it to the brain to create vision. This requires that the structures of the eye involved in light transmission, such as the cornea and the lens, must be transparent. Unlike other tissues of the body, nutrients and oxygen supply to these structures must be accomplished without blood interference in transmission of light, i.e., these structures must be avascular. Apart from this, the eye must also maintain optimum pressure within the globe, which is important to give the rigidity necessary for optical alignment of the cornea, lens and the retina. The eye achieves this by the production, accumulation and circulation of a clear fluid called aqueous humor (AH). AH is produced by selective transfer of solutes and water from the blood plasma by a complex ocular epithelium, the ciliary epithelium. The fluid then accumulates in the two special compartments within the eye, and the excess leaves the globe to enter the blood through complex pressure dependent outflow pathways. This complex arrangement of production, accumulation and drainage of aqueous humor contributes to the nutrition and survival of the avascular tissues as well as to good optical properties of the eye. However, this also poses a problem in that any imbalance in the production and drainage of aqueous humor inevitably causes abnormal intraocular pressure (IOP). For example, in case of insufficient drainage, excess accumulation of fluid within the globe will raise the IOP to higher than the physiological level; a clinical condition called glaucoma. Abnormally high pressure causes death or degeneration of the light sensitive and signal transmitting tissues of the eye leading progressively to partial or complete blindness. Understanding the mechanism of AH secretion and its regulation is important to develop rational and target specific drugs for the treatment of glaucoma. In this chapter we will try to present the readers with a comprehensive and up to date description of the relevant ocular anatomy, physiology, biochemistry and pharmacology of AH secretion and its relevance to pathophysiology of ocular hypertension or glaucoma. Glaucoma - Basic and Clinical Concepts 4 2. Gross structures of the eye The two eyes together with the appendages (extraocular muscles, lacrimal glands) are situated within the conical or four-sided pyramidal cavities of the skull called the orbits. The eyeball is a sphere, with the segment of a smaller sphere, the cornea, in front. It is composed of three layers or tunics. The outermost protective layer is made up of the sclera posteriorly and the cornea anteriorly. The middle layer is mainly vascular, consisting of the choroid, ciliary body and iris. The innermost coat is the retina, containing the essential sensory elements responsible for vision - the rods and cones, bipolar and ganglion cells. Within the three layers are the refractory media - namely, the AH, the crystalline lens and a clear jelly, the vitreous humor (Fig. 1). Fig. 1. Diagram of the human eye in horizontal section showing major structures and the arrangement of the three layers (Forrester et al., 1996) (used with permission) The cornea, the first and the most powerful refracting surface of the optical system of the eye, occupies the anterior sixth of the outermost coat. The crystalline lens is a double convex, transparent body positioned between the iris and AH in front and the vitreous humor behind, and is supported by an elastic capsule and the ciliary zonules (the suspensory ligaments). The ciliary zonules attach the lens to the ciliary body. The iris, a pigmented structure, is the most anterior portion of the vascular tunic of the eye. It is composed of a flat bar of circular muscle fibers surrounding the pupil and a thin layer of smooth muscle fibers by which the pupil is dilated. Relaxation and contraction of the iris regulates the size of the pupil and hence the amount of light entering the eye. It is covered by two layers of epithelia, which are continuous extensions of the pigmented and nonpigmented layers of the ciliary body (CB) epithelium. The CB is the middle thickened portion of the vascular tunic anterior to the ora serrata (the terminating point of the retina at the CB), connecting the choroid with the iris. It is composed of corona ciliaris (the ciliary processes and folds), ciliary ring, ciliary muscle and a basal lamina. The ciliary processes are finger like projections that extend into the posterior chamber, approximately 70 in number