title: Atopic Glaucoma: Clinical and Pathophysiological Analysis.
abstract: OBJECTIVE
  Open-angle glaucoma associated with severe atopic dermatitis (atopic glaucoma) tends to be severe and difficult to treat because of ocular surface/eye lid inflammation. To determine the validity of regarding atopic glaucoma as a clinical entity, we carried out retrospective analysis and pathologic investigations.
  
  
  METHODS
  Forty-five cases (62 eyes) of atopic glaucoma were reviewed retrospectively. During surgical treatment, aqueous humor and trabeculectomy specimens were obtained. The aqueous humor samples were analyzed by multiplex cytokine assay. The surgical specimens were analyzed histologically.
  
  
  RESULTS
  Atopic glaucoma was often associated with atopic cataracts (43 eyes) and retinal detachments (19 eyes). A history of glucocorticoid medications was absent in 12 cases. A total of 50 eyes required surgical interventions because of advanced visual field defects and/or high intraocular pressures. Bleb-associated postsurgical infections were observed in 7 eyes. Elevated levels of inflammatory cytokines (IL-8 and CCL2) were observed in the aqueous humor samples obtained from atopic glaucoma patients compared with those from senile cataract patients. Ultrastructural analysis of trabecular meshwork tissues obtained from atopic glaucoma patients showed abnormal accumulation of 10 to 30 nm fibers in the corneoscleral meshwork.
  
  
  CONCLUSIONS
  We would like to propose atopic glaucoma as a new clinical entity, ranging from pure atopic glaucoma to a mixed type of atopic/steroid-induced glaucoma that should be considered as one of the clinical features of atopic ocular complications.
authors.affiliation: *Department of Ophthalmology, Juntendo University Graduate School of Medicine †Department of Ophthalmology, Japan Red Cross Society Medical Centre, Tokyo ‡Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto §Department of Ophthalmology, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Takakuwa
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Hamanaka
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Mori
authors.forename: Shinki
authors.initials: S
authors.lastname: Chin
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shinmei
authors.forename: Toshinari
authors.initials: T
authors.lastname: Funaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ebihara
authors.forename: Koichi
authors.initials: K
authors.lastname: Ono
authors.forename: Akira
authors.initials: A
authors.lastname: Murakami
authors.forename: Akira
authors.initials: A
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001082:Aqueous Humor / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism; D003876:Dermatitis, Atopic / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005902:Glaucoma, Open-Angle / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014129:Trabecular Meshwork / Q000648:ultrastructure; D014130:Trabeculectomy
chemical_list: D016207:Cytokines