Comparing the morphology of optic nerve head and lamina cribrosa in full-term and preterm school-aged children.

OBJECTIVES: To evaluate the morphology of lamina cribrosa (LC) in preterm school-aged children. METHODS: A study of 120 eyes from 120 patients, including 42 full-term children (control group), 41 preterm children without retinopathy of prematurity (ROP), 16 children with ROP treated with intravitreal bevacizumab (IVB), and 21 children with ROP treated with laser. Five parameters of LC were measured by optical coherence tomography, including Bruch's membrane opening (BMO) diameter, minimum rim width (MRW), LC depth, prelaminar tissue (PLT) thickness, and LC curvature index (LCCI). RESULTS: The PLT thickness increased with age in full-term and preterm children (ß = 30.1, P = 0.003 and ß = 19.6, P < 0.001, respectively). LC depth and LCCI showed no differences between full-term and preterm children. Worse refractive errors in preterm children were associated with greater MRW and PLT thickness (ß = -17.1, P = 0.001 and ß = -5.7, P = 0.03, respectively). However, this relationship was not found in full-term children. Laser-treated children had greater MRW, PLT, temporal peripapillary retinal nerve fibre layer, and foveal thickness than full-term or other preterm children (all P < 0.05). CONCLUSIONS: Prematurity and ROP treatment may have an impact on the structural development of the LC. Refractive status plays a vital role in the LC structure of preterm children. This highlights the refractive errors of preterm children at school age that merit greater attention.

Early Glaucoma Detection by Using Style Transfer to Predict Retinal Nerve Fiber Layer Thickness Distribution on the Fundus Photograph.

Objective: We aimed to develop a deep learning (DL)-based algorithm for early glaucoma detection based on color fundus photographs that provides information on defects in the retinal nerve fiber layer (RNFL) and its thickness from the mapping and translating relations of spectral domain OCT (SD-OCT) thickness maps. Design: Developing and evaluating an artificial intelligence detection tool. Subjects: Pretraining paired data of color fundus photographs and SD-OCT images from 189 healthy participants and 371 patients with early glaucoma were used. Methods: The variational autoencoder (VAE) network training architecture was used for training, and the correlation between the fundus photographs and RNFL thickness distribution was determined through the deep neural network. The reference standard was defined as a vertical cup-to-disc ratio of ≥0.7, other typical changes in glaucomatous optic neuropathy, and RNFL defects. Convergence indicates that the VAE has learned a distribution that would enable us to produce corresponding synthetic OCT scans. Main Outcome Measures: Similarly to wide-field OCT scanning, the proposed model can extract the results of RNFL thickness analysis. The structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR) were used to assess signal strength and the similarity in the structure of the color fundus images converted to an RNFL thickness distribution model. The differences between the model-generated images and original images were quantified. Results: We developed and validated a novel DL-based algorithm to extract thickness information from the color space of fundus images similarly to that from OCT images and to use this information to regenerate RNFL thickness distribution images. The generated thickness map was sufficient for clinical glaucoma detection, and the generated images were similar to ground truth (PSNR: 19.31 decibels; SSIM: 0.44). The inference results were similar to the OCT-generated original images in terms of the ability to predict RNFL thickness distribution. Conclusions: The proposed technique may aid clinicians in early glaucoma detection, especially when only color fundus photographs are available.

Application and Validation of LUXIE: A Newly Developed Virtual Reality Perimetry Software.

PURPOSE: To report the application of LUXIE and validate its reliability by comparing the test results with those of Humphrey Field Analyzer 3 (HFA3). METHODS: In this pilot study, we prospectively recruited participants who had received HFA3 SITA standard 30-2 perimetry and tested them with LUXIE on the same day. LUXIE is a software designed for visual field testing cooperating with HTC Vive Pro Eye, a head-mounted virtual reality device with an eye-tracking system. The test stimuli were synchronized with eye movements captured by the eye-tracking system to eliminate fixation loss. The global, hemifields, quadrants, glaucoma hemifield test (GHT) sectors, and point-by-point retinal sensitivities were compared between LUXIE and HFA3. All participants were asked to fill out a post-test user survey. RESULTS: Thirty-eight participants with 65 eyes were enrolled. LUXIE demonstrated good correlations with HFA3 in global (r = 0.81), superior hemifield (r = 0.77), superonasal, superotemporal, and inferonasal quadrants (r = 0.80, 0.78, 0.80). The user survey showed that participants were more satisfied with LUXIE in operating difficulty, comfortability, time perception, concentration, and overall satisfaction. CONCLUSIONS: LUXIE demonstrated good correlations with HFA3. Fixation loss could be eliminated in LUXIE with the eye-tracking system. The application of virtual reality devices such as the HTC Vive Pro Eye makes telemedicine and even home-based self-screening visual field tests possible. KEY MESSAGES: 1. Virtual reality perimetry is a developing technology that has the potential in telemedicine, and home self-screening visual field tests. 2. LUXIE demonstrated good correlations with Humphrey Field Analyzer 3 in visual field retinal sensitivities.

Glaucoma diagnostic performance of macular ganglion cell complex thickness using regular and long axial length normative databases.

The risks of misdiagnosing a healthy individual as glaucomatous or vice versa may be high in a population with a large majority of highly myopic individuals, due to considerable morphologic variability in high myopic fundus. This study aims to compare the diagnostic ability of the regular and long axial length databases in the RS-3000 Advance SD-OCT (Nidek) device to correctly diagnose glaucoma with high myopia. Patients with high myopia (axial length ≥ 26.0 mm) in Chang Gung Memorial Hospital, Taiwan between 2015 and 2020 were included. Glaucoma was diagnosed based on glaucomatous discs, visual field defects and corresponding retinal nerve fiber layer defects. The sensitivity, specificity, diagnostic accuracy and likelihood ratios of diagnosing glaucoma via mGCC thickness in both superior/inferior and GChart mapping using the regular and long axial length normative databases. The specificity and diagnostic accuracy of mGCC thickness for distinguishing glaucomatous eyes from nonglaucomatous eyes among highly myopic eyes were significantly improved using the long axial length database (p = 0.046). There were also significant proportion changes in S/I mapping as well as GChart mapping (37.3% and 48.0%, respectively; p < 0.01) from abnormal to normal in the myopic normal eye group when using the long axial length normative database. The study revealed that clinicians could utilize a long axial length database to effectively decrease the number of false-positive diagnoses or to correctly identify highly myopic normal eyes misdiagnosed as glaucomatous eyes.

Micropulse transscleral cyclophotocoagulation in a Taiwanese population: 2-year clinical outcomes and prognostic factors.

PURPOSE: To evaluate the 2-year efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in Taiwanese patients with glaucoma. METHODS: We included the patients who received standardized MP-TSCPC with follow-up examinations on a regular basis for 24 months. Treatment success was defined as the attainment of a postoperative intraocular pressure (IOP) between 6 and 21 mmHg or a ≥ 20% reduction in IOP from baseline without an increase in glaucoma medications. RESULTS: A total of 60 eyes from 56 patients who underwent MP-TSCPC for refractory glaucoma were included. The median age at MP-TSCPC intervention was 58.9 ± 12.4 years. The percentage of treatment success was 88.3% at 3 months, 83.3% at 6 months, 78.3% at 12 months, and 75.0% at 24 months. The mean baseline IOP prior to MP-TSCPC was 34 ± 11.9 mmHg (range 14-56 mmHg). The mean postoperative IOP decreased to 20.9 ± 10.0 mmHg, 18.0 ± 7.8 mmHg, 17.5 ± 6.4 mmHg, and 18.2 ± 7.1 mmHg after 3 months, 6 months, 12 months, and 24 months, respectively, in successful cases. The mean number of glaucoma medications at baseline was 3.8 ± 0.2, and the mean numbers of glaucoma medications at postoperative months 3, 6, 12, and 24 were 2.6 ± 0.7, 2.8 ± 0.6, 2.5 ± 1.4 and 2.6 ± 1.4, respectively, in successful cases. Younger age and prior CW-TSCPC significantly contributed to surgical failure in the multivariate model. Complications after MP-TSCPC included mild anterior chamber inflammation, conjunctival hemorrhage, hypotony, and mydriasis, and all subsided after treatment. None of the eyes developed vitreous hemorrhage, cystoid macular edema, or phthisis bulbi in the late postoperative period. CONCLUSIONS: This study demonstrated that younger age and prior CW-TSCPC were risk factors for MP-TSCPC failure within 2 years. MP-TSCPC might be safe and effective for refractory glaucoma patients with maximal antiglaucoma medications.

Brimonidine related acute follicular conjunctivitis: Onset time and clinical presentations, a long-term follow-up.

ABSTRACT: To evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy.We retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008 to November 30, 2020. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP, and season of onset were evaluated.292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60-120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy (P < .001), which was even higher in the brimonidine monotherapy group (9.2%, P < .001). There was no significant IOP elevation in patients treated with multiple glaucoma medications.Around half of brimonidine allergy occurred within 6 months, with a peak in 2 to 4 months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy. It is recommended to switch to other types of glaucoma medications for better IOP control.

Comparison of Visual Field Progression Rate before and after Cataract Surgery in Patients with Open-Angle and Angle-Closure Glaucoma.

PURPOSE: To evaluate Humphrey visual field (VF) progression rate before and after cataract surgery in patients with open-angle glaucoma (OAG) and angle-closure glaucoma (ACG). METHODS: After reviewing all records in our Humphrey VF database from July 1, 2001, to December 31, 2018, eyes of OAG and ACG that had received uncomplicated phacoemulsification with intraocular lens implantation during the period and had been followed up regularly for more than one year with ≥3 reliable VF tests before and after cataract surgery, respectively, were enrolled. The VF progression rate, visual acuity, and intraocular pressure (IOP) before and after cataract surgery were compared. RESULTS: Seventy-seven eyes (OAG: 51; ACG: 26) from 60 patients were enrolled. The mean preoperative and postoperative follow-up durations were 4.89 ± 2.70 and 5.48 ± 2.30 years in the OAG group and 5.14 ± 3.31 and 5.97 ± 2.35 years in the ACG group. IOP and visual acuity significantly improved postoperatively in both groups. In the OAG group, there was no significant change in the VF progression rate (pre-op: -0.39 ± 0.94 dB/year; post-op: -0.47 ± 0.72 dB/year) (P=0.619), whereas, in the ACG group, the rate significantly flattened after surgery from -1.39 ± 1.31 dB/year to -0.34 ± 0.64 dB/year (P=0.003). CONCLUSIONS: The VF progression rate did not differ between preoperative and postoperative eyes with OAG, but those with ACG exhibited rapid VF decline preoperatively, which was significantly flattened postoperatively.

Correlation of Visual Field With Peripapillary Vessel Density Through Optical Coherence Tomography Angiography in Normal-Tension Glaucoma.

Purpose: To investigate the retinal vessel density (VD) in healthy and normal-tension glaucoma (NTG) eyes through optical coherence tomography angiography (OCTA) and to determine the correlation between VD and the retinal nerve fiber layer (RNFL) thickness and functional visual field (VF) defects for different locations. Methods: A total of 74 NTG eyes and 24 healthy eyes were included. OCTA VD at 4.5 × 4.5 mm peripapillary region and 3.0 × 3.0 mm macula area, RNFL thickness, and VF pattern deviation results were individually analyzed on the basis of the Garway-Heath sectorization. Correlations between VD and VF/RNFL and VF were compared. Results: In the NTG group, peripapillary VD, superficial macula VD, RNFL thickness, and ganglion cell complex thickness were significantly lower. In the whole peripapillary area and inferotemporal sector, anatomic correlations between VD and VF pattern deviation values were significantly higher than those between the RNFL thickness and VF values. In the subgroup analysis, VD was anatomically correlated with VF in early-, moderate-, and severe-stage NTG eyes, whereas the RNFL thickness was correlated with VF in moderate- and severe-stage NTG eyes. Conclusions: We observed VD reduction in the peripapillary retina and superficial macula area in NTG eyes. The microvascular dropout of VD in the peripapillary retina, especially in the inferotemporal sector, provided a more accurate anatomic correlation with functional VF defects than that of the RNFL thickness, especially in early-stage NTG eyes. Translational Relevance: In patients who cannot comply VF exam, VD is a good tool for disease detection.

Early versus Delayed Phacoemulsification and Intraocular Lens Implantation for Acute Primary Angle-Closure.

PURPOSE: To compare the effects of early phacoemulsification and intraocular lens implantation (phaco/IOL), delayed phaco/IOL after initial laser peripheral iridotomy (LPI), and conventional LPI alone in patients with acute primary angle-closure (PAC). METHODS: Patients with acute PAC were included in the study, and those with secondary glaucoma, prior ocular trauma, or other ocular diseases and those who had undergone ocular surgeries previously were excluded. Patients were categorized into three groups: Group A, which underwent primary phaco/IOL after acute PAC; Group B, which underwent LPI initially after acute PAC, followed by phaco/IOL within 6 months; and Group C, which underwent LPI alone. The IOP control success at 12 months as well as changes in ocular characteristics and the number of antiglaucoma medications used after the treatment among the groups were evaluated. RESULTS: Eighty-one eyes were included in the study: 24 eyes in Group A, 23 eyes in Group B, and 34 eyes in Group C. The linear mixed model analysis demonstrated considerable IOP control in Groups A and B. Visual acuity, anterior chamber depth (ACD), and angle width improved significantly in Groups A and B, but not in Group C. The number of antiglaucoma medications used was significantly higher in Group C than in Groups A and B. CONCLUSIONS: Patients who underwent phaco/IOL had better IOP control, improved vision, deeper ACD, and wider angle and required less antiglaucoma medications than those who underwent LPI alone. Performing phaco/IOL weeks to months after the initial LPI did not appear to adversely affect outcomes compared with those of early phaco/IOL.

Correlation between structural progression in glaucoma and obstructive sleep apnea.

BACKGROUND/OBJECTIVES: To investigate the correlation between obstructive sleep apnea (OSA) severity and the structural and functional progression in patients with glaucoma. SUBJECTS/METHODS: This retrospective comparative cohort study included subjects from the polysomnography database in Chang Gung Memorial Hospital between June 1, 2009, and June 1, 2017, by identifying patients who had received diagnoses of primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), or glaucoma suspect. Patients with follow-up time of <3 years and/or <3 consecutive reliable optical coherence tomography (OCT) or visual field (VF) tests were excluded. Progression of overall peripapillary retinal nerve fiber layer (RNFL) thickness on OCT scans and VF mean deviation (MD) or VF index (VFI) were determined through linear regression trend analysis. RESULTS: Thirty-two patients were included. There was a trend to higher percentage of progression on RNFL thickness and VF in higher OSAS severity. After stratifying patients to no OSA/mild OSA (group 1) and moderate/severe OSA (group 2), group 2 exhibited a significantly higher percentage of RNFL thickness progression than did group 1 (64.7% vs 26.7%, P = 0.042). Multivariate Cox regression analysis showed that severe OSA had an 8.448-fold higher risk of RNFL thickness progression after age, sex, diabetes mellitus, hypertension, hyperlipidemia, and body mass index adjustment (95% confidence interval, 1.464-48.752, P = 0.017). CONCLUSIONS: Severe OSA is significantly correlated with a higher risk of structural deterioration in patients with glaucoma.

Visual Subfield Progression in Glaucoma Subtypes.

PURPOSE: To investigate visual field progression pattern and factors associated with progression in patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), and chronic angle-closure glaucoma (CACG). METHODS: The raw data of the 30-2 Humphrey Field Analyzer from glaucoma patients with definite visual field progression were processed with pointwise linear regression (PLR) analysis. The rate of change of retinal threshold sensitivity in the ten glaucoma hemifield test (GHT) zones, the upper and the lower hemifields, and the whole field was evaluated and was correlated with patients' basic demographic data. RESULTS: An average follow-up of 6.94 ± 2.69 years that showed the rate of change of visual field threshold sensitivity was correlated with the peak posttreatment intraocular pressure (IOP) and the long-term IOP fluctuations in all GHT zones except in the inferior arcuate area. The baseline IOP, the trough posttreatment IOP, the refractive status, and the CCT were not correlated with VF progression. CONCLUSION: The rate of visual field progression was correlated with the peak posttreatment IOP and the long-term IOP fluctuation but with subfield differences.

Optical Coherence Tomography Angiography of the Superficial Microvasculature in the Macular and Peripapillary Areas in Glaucomatous and Healthy Eyes.

Purpose: To quantitatively evaluate the superficial microvasculature in the macular and peripapillary areas in glaucomatous and healthy eyes using optical coherence tomography angiography (OCT-A). Methods: We enrolled 26 eyes of medically managed primary open-angle glaucoma patients and 27 eyes of healthy subjects were enrolled in this prospective study. Measurements of OCT-A vessel density were acquired both in the macular and peripapillary areas. We compared vessel density values, the circumpapillary retinal nerve fiber layer (cpRNFL), the ganglion cell complex (GCC), and standard automated perimetry (SAP) parameters across study groups. Areas under the receiver operating characteristic (AUROC) curves were used to evaluate diagnostic accuracy. Quadratic regression models were used to determine the correlations between SAP severity and outcome measures. Results: The whole image vessel density (wiVD) in glaucomatous eyes was lower than that in healthy eyes in the macular (38.5% ± 2.2% vs. 43.2% ± 2.3%, P < 0.001) and peripapillary areas (43.8% ± 5.7% vs. 53.3% ± 3.0%, P < 0.001). The circumpapillary vessel density (cpVD) was also lower in glaucomatous eyes (53.3% ± 7.0% vs. 61.5% ± 3.2%, P < 0.001). We found the AUROCs for discriminating between glaucomatous and healthy eyes were highest for cpRNFL (0.95) and GCC (0.95); followed by macular wiVD (0.94); peripapillary wiVD (0.93); and cpVD (0.89). The correlations between SAP severity were strongest with peripapillary wiVD (R2 = 0.58); followed by cpVD (R2 = 0.55); GCC (R2 = 0.51); cpRNFL (R2 = 0.42); and macular wiVD (R2 = 0.36). Conclusions: Medically managed glaucomatous eyes show sparser superficial microvasculature in the macular area than do healthy eyes. The measurement of the macular superficial vessel density had similar diagnostic accuracy to peripapillary RNFL and macular GCC thickness for differentiating between glaucomatous and healthy eyes.

Comparison of the Retinal Microvascular Density Between Open Angle Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy.

Purpose: To compare optical coherence tomography angiography (OCT-A) retinal vasculature measurements between nonarteritic anterior ischemic optic neuropathy (NAION) and open angle glaucoma (OAG) with altitudinal hemifield visual field defects. Methods: This retrospective cross-sectional study included 10 NAION eyes and 16 OAG eyes, both demonstrating hemifield visual field defects, and 27 normal eyes serving as controls. The peripapillary and macular OCT-A scans were acquired. The retinal vessel density data were compared among NAION, glaucomatous, as well as control eyes. Results: There was statistically significant difference in peripapillary whole image vessel density (wiVD), circumpapillary vessel density (cpVD), macular wiVD, and perifoveal vessel density (pfVD) between the three groups (P < 0.05 for all). In comparison between OAG and NAION groups, the NAION group demonstrated marked decrease in average cpVD (P = 0.008) and in most sectors of cpVD except the inferior one, while the OAG group demonstrated significant decreased macular wiVD and pfVD (P = 0.03 and 0.003, respectively). Multivariate analysis indicated that average thickness of retinal nerve fiber layer was the only predictor for peripapillary wiVD and cpVD (P = 0.005 for both). By contrast, thickness of ganglion cell complex was the only predictor for macular wiVD (P = 0.007). Conclusions: OCT-A detected significant difference in peripapillary and macular retinal vessel densities between OAG and NAION eyes. These differences might provide comparative insight into the pathophysiology of these two diseases.

Retinal Vessel Density in Optical Coherence Tomography Angiography in Optic Atrophy after Nonarteritic Anterior Ischemic Optic Neuropathy.

Aims. To compare optical coherence tomography angiography (OCT-A) retinal vasculature measurements between normal and optic atrophy after nonarteritic anterior ischemic optic neuropathy (NAION) subjects. Design. This prospective observational study was conducted between July 2015 and August 2016 at the ophthalmology outpatient department of a referral center in Taiwan. Peripapillary (4.5 × 4.5 mm) and parafoveal (6 × 6 mm) OCT-A scans were acquired. Measurements of the peripapillary region were obtained in two areas: (1) circumpapillary vessel density (cpVD) and (2) whole enface image vessel density (wiVD). Results. 13 participants with optic atrophy after NAION had lower peripapillary vessel density than the 18 age-matched participants in the healthy control (HC) group (p < 0.001 for both cpVD and wiVD). However, the parafoveal vessel density was not significantly different between the two groups (p = 0.49). The areas under the receiver operating characteristic curve for the HC and NAION eyes were 0.992 for cpVD and 0.970 for wiVD. cpVD and wiVD were significantly correlated with the average retinal nerve fiber layer thickness (p < 0.001 for both). Conclusion. Peripapillary retinal perfusion is significantly decreased in optic atrophy after NAION. OCT-A may aid in the understanding of structure-function-perfusion relationships in NAION.

Comparison of glaucoma diagnostic accuracy of macular ganglion cell complex thickness based on nonhighly myopic and highly myopic normative database.

BACKGROUND/PURPOSE: To evaluate and compare the diagnostic discriminative ability for detecting glaucoma in highly myopic eyes from a normative database of macular ganglion cell complex (mGCC) thickness based on nonhighly myopic and highly myopic normal eyes. METHODS: Forty-nine eyes of 49 participants with high myopia (axial length ≥ 26.0 mm) were enrolled. Spectral-domain optical coherence tomography scans were done using RS-3000, and the mGCC thickness/significance maps within a 9-mm diameter circle were generated using built-in software. We compared the difference of sensitivity, specificity, and diagnostic accuracy between the nonhighly myopic database and the highly myopic database for differentiating the early glaucomatous eyes from the nonglaucomatous eyes. RESULTS: This study enrolled 15 normal eyes and 34 eyes with glaucoma. The mean mGCC thickness of the glaucoma group was significantly less than that of the normal group (p < 0.001). Sensitivity was 96.3%, and the specificity was 50.0% when using the nonhighly myopic normative database. When the highly myopic normative database was used, the sensitivity was 88.9%, and the specificity was 90.0%. The false positive rate was significantly lower when using the highly myopic normative database (p < 0.05). CONCLUSION: The evaluations of glaucoma in eyes with high myopia using a nonhighly myopic normative database may lead to a frequent misdiagnosis. When evaluating glaucoma in high myopic eyes, the mGCC thickness determined by the long axial length high myopic normative database should be applied.

Neovascular glaucoma after central retinal vein occlusion in pre-existing glaucoma.

BACKGROUND: To determine the outcome of central retinal vein occlusion (CRVO) in pre-existing glaucoma and the predisposing factors of developing neovascular glaucoma (NVG). METHODS: We retrospectively assessed a pre-existing glaucoma CRVO group and a non-glaucoma CRVO group to elucidate the demographics, clinical course and ocular parameters of these two cohorts. Among the pre-existing glaucoma cases, the predisposing factors for the development of NVG were monitored, including the retinal capillary non-perfusion status, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) at presentation. RESULTS: Of 642 CRVO patients reviewed in this 10-year cohort study, 60 (9.3%) had pre-existing glaucoma at a mean follow-up of 30.8 months, including 28 (4.4%) primary open angle glaucoma (POAG), 27 (4.2%) primary angle closure glaucoma (PACG), and 5 (0.8%) normal tension glaucoma (NTG) cases. Although the presence of glaucoma in the CRVO eyes was not significantly associated with the risk of developing NVG, the incidence of developing NVG in pre-existing glaucoma eyes was significantly higher in the group with IOP greater than 20 mmHg at CRVO presentation (P = 0.02, Chi-square test) as well as in the ischemic CRVO group compared to the non-ischemic patients (P = 0.005, Fisher's exact test). Overall, 20% of pre-existing glaucoma patients needed glaucoma surgery after a CRVO event, including 11.7% of patients who developed iris neovascularisation (INV) and 8.3% of patients who developed a high IOP without INV. CONCLUSIONS: Both the retinal non-perfusion status and uncontrolled IOP contribute to NVG in patients with pre-existing glaucoma after CRVO. Following CRVO, glaucoma surgery is necessary for pre-existing glaucoma cases with intractable elevated IOP with or without INV.

Primary phacoemulsification and intraocular lens implantation for acute primary angle-closure.

BACKGROUND: To investigate the effect of primary phacoemulsification on intraocular pressure (IOP) in patients with acute primary angle-closure (PAC) and coexisting cataract. METHODOLOGY: Sixteen eyes of 14 patients with acute PAC received phacoemulsification and intraocular lens implantation as initial management for medically uncontrolled IOP in a retrospective chart review. The effects on IOP, vision, anterior chamber depth (ACD), and number of antiglaucoma medications were evaluated. PRINCIPAL FINDINGS: The postoperative IOP was reduced in 16 eyes (100%). The mean ± standard deviation preoperative IOP was 48.81 ± 16.83 mm Hg, which decreased postoperatively to 16.46 ± 10.67 mm Hg at 1 day, 9.43 ± 3.03 mm Hg at 1 week, 9.49 ± 2.14 mm Hg at 2 weeks, 10.78 ± 3.56 mm Hg at 1 month, and 10.70 ± 2.80 mm Hg at 3 months (p < 0.001). The mean number of antiglaucoma medications decreased from 3.56 ± 1.14 to 0.13 ± 0.34 (p < 0.001). The average preoperative ACD was 2.08 ± 0.35 mm, which increased to 3.59 ± 0.33 mm after surgery (p < 0.001). Visual acuity (converted into logarithm of the minimum angle of resolution [logMAR]) improved from 1.14 ± 0.71 to 0.73 ± 0.53 (p =  0.001). CONCLUSIONS: Primary phacoemulsification plus intraocular lens implantation lowered IOP, reduced the use of antiglaucoma medications, and improved vision in patients with acute PAC. This is a safe and effective method of IOP control and can be considered a first treatment option in managing patients with acute PAC and coexisting cataract.

Secondary ocular hypertension after intravitreal injection with 2 mg or 4 mg of triamcinolone in retinal vein occlusion.

PURPOSE: To evaluate secondary ocular hypertension after intravitreal injection of triamcinolone acetonide (IVTA) with 2 mg/0.05 mL or 4 mg/0.1 mL for macular edema associated with retinal vein occlusion (RVO). METHODS: A retrospective chart review was performed. Patients with RVO, including central RVO and branch RVO, were divided into 2 groups. Group 1 was patients who received 2 mg IVTA and group 2 received 4 mg IVTA. The dose of IVTA was dependent on individual surgeon's decision. Secondary ocular hypertension was defined as intraocular pressure (IOP) >21 mmHg. Long-term antiglaucoma medication referred to eyes that required antiglaucoma agents for >6 months. RESULTS: Thirty-six eyes in group 1 and 32 eyes in group 2 were included in the analyses. The mean age of all the patients was 58.6 years, and 52.9% of patients were men. The mean follow-up period was 12.4 months. A wide range (from day 7 to month 8) of time until the onset of the IOP spike was recorded after the injection. The incidence of secondary ocular hypertension was not significantly different between group 2 and group 1 (38.9% vs. 50%, P = 0.36). However, group 2 had a higher proportion of long-term antiglaucoma medication usage than group 1 (5.6% vs. 40.6%; Pearson chi-square, P < 0.001). Ultimately, 2.9% of patients underwent filtration surgery. Macular edema diminished and best-corrected visual acuity improved at 3 months later in both groups. CONCLUSIONS: With a similar effect on vision recovery and alleviating macular edema associated with RVO, 2 mg IVTA required a shorter duration of medical control for secondary ocular hypertension than 4 mg IVTA.