A simple air-liquid interface exposure system for exposing cultured human 3D epidermis and cornea to PM2.5 collected through cyclonic separation.

Particulate matter (PM) is among the major air pollutants suspended in the atmosphere. PM2.5 has a particle size of 2.5 µm; it is known to cause inflammation, especially in the respiratory tract and skin. Since the skin acts a primary barrier against harmful environmental substances that may enter the body, it is highly exposed to PM2.5 present in the environment. However, the adverse health effects of PM2.5 exposure on human skin have not been accurately examined due to the lack of a system that exposes human epidermal tissue to the actual environmental concentration of PM2.5. In this study, we developed an air-liquid interface exposure system for exposing cultured human 3D epidermis and cornea to PM2.5 collected through cyclonic separation. PM2.5 suspension was nebulized in an acrylic chamber, and the resulting mist was pumped through a diffusion dryer into a glass exposure chamber. A particle counter was connected to the exposure chamber to continuously measure the spatial mass concentration of PM. Human 3D epidermis was cultured in the exposure chamber. Exposure of the human 3D epidermis to PM aerosol increased interleukin-8 release into the media around 50 µg/m3. Mass concentrations above 100 µg/m3 caused cell death. Furthermore, a human corneal model showed similar responses against PM2.5 exposure as 3D epidermis. The air-liquid interface exposure system developed in this study is considered useful for evaluating the health effects induced by environmental PM2.5 and can be used as an alternative to experiments involving actual human or animals.

Safety and stable survival of stem-cell-derived retinal organoid for 2 years in patients with retinitis pigmentosa.

Transplantation of induced pluripotent stem cell (iPSC)-derived retinal organoids into retinal disease animal models has yielded promising results, and several clinical trials on iPSC-derived retinal pigment epithelial cell transplantation have confirmed its safety. In this study, we performed allogeneic iPSC-derived retinal organoid sheet transplantation in two subjects with advanced retinitis pigmentosa (jRCTa050200027). The primary endpoint was the survival and safety of the transplanted retinal organoid sheets in the first year post-transplantation. The secondary endpoints were the safety of the transplantation procedure and visual function evaluation. The grafts survived in a stable condition for 2 years, and the retinal thickness increased at the transplant site without serious adverse events in both subjects. Changes in visual function were less progressive than those of the untreated eye during the follow-up. Allogeneic iPSC-derived retinal organoid sheet transplantation is a potential therapeutic approach, and the treatment's safety and efficacy for visual function should be investigated further.

Ten-year outcomes of cataract surgery for glaucoma management in patients with primary angle-closure disease.

PURPOSE: To investigate the long-term outcomes of cataract surgery for glaucoma management in patients with primary angle-closure disease (PACD). STUDY DESIGN: Retrospective case series. METHODS: We reviewed the medical records of 87 eyes of 87 patients with PACD who underwent uncomplicated cataract surgery alone at the Kobe City Medical Center General Hospital. Only patients with a minimum follow-up of 10 years were included. The patients were divided into PACD spectrum categories: primary angle-closure glaucoma (PACG), primary-angle closure (PAC), and primary angle-closure suspect (PACS). The treatment outcomes were compared among the 3 groups. Intraocular pressure (IOP), number of glaucoma eye drops, requirement of additional glaucoma treatment, visual field progression, and progression to glaucoma during the follow-up period were evaluated. RESULTS: Among the 87 patients, 39 had PACG; 26, PAC; and 22, PACS. Ten years after surgery, the IOP had significantly decreased from baseline in all 3 groups. The rate of requirement of additional glaucoma treatment during the follow-up period was significantly higher in the PACG group than in the other groups. Almost half of the patients with PACG required additional glaucoma treatment; of those patients, six (15.4%) underwent glaucoma surgery. Three patients (11.5%) with PAC required additional glaucoma medication. Visual field progression was observed in 28.1% of the patients with PACG. In 1 patient with PAC, the condition progressed to PACG, but there was no such progression in any of the patients with PACS. CONCLUSIONS: We confirmed that cataract surgery had a long-term (> 10 years) effect on IOP reduction in eyes with PACD. Early intervention with cataract surgery may be preferable for glaucoma management in patients with PACD.

One-year outcomes and predictable factors for microhook ab interno trabeculotomy.

AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy (µLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent µLOT (including combination of µLOT and cataract surgery) between February 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure (IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using Kaplan-Meier survival analysis. A multivariate Cox proportional-hazards regression model was used to investigate the factors associated with surgical failure. RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma (POAG) and 31 with secondary open angle glaucoma (SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg (P<0.01) and 2.1±1.8 (P<0.01), respectively, 12mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes (80.0% vs 48.0%; P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio (aHR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike (IOP>25 mm Hg within 2wk post-surgery; P<0.001, aHR: 5.382, 95%CI: 2.113-13.707) as independent factors associated with surgical failure. CONCLUSION: The µLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.

HLA-Matched Allogeneic iPS Cells-Derived RPE Transplantation for Macular Degeneration.

Immune attacks are key issues for cell transplantation. To assess the safety and the immune reactions after iPS cells-derived retinal pigment epithelium (iPS-RPE) transplantation, we transplanted HLA homozygote iPS-RPE cells established at an iPS bank in HLA-matched patients with exudative age-related macular degeneration. In addition, local steroids without immunosuppressive medications were administered. We monitored immune rejections by routine ocular examinations as well as by lymphocytes-graft cells immune reaction (LGIR) tests using graft RPE and the patient's blood cells. In all five of the cases that underwent iPS-RPE transplantation, the presence of graft cells was indicated by clumps or an area of increased pigmentation at 6 months, which became stable with no further abnormal growth in the graft during the 1-year observation period. Adverse events observed included corneal erosion, epiretinal membrane, retinal edema due to epiretinal membrane, elevated intraocular pressure, endophthalmitis, and mild immune rejection in the eye. In the one case exhibiting positive LGIR tests along with a slight fluid recurrence, we administrated local steroid therapy that subsequently resolved the suspected immune attacks. Although the cell delivery strategy must be further optimized, the present results suggest that it is possible to achieve stable survival and safety of iPS-RPE cell transplantation for a year.

Bilateral retinitis after influenza virus infection in a case report.

PURPOSE: To report 2 years' longitudinal retinal changes using spectral domain optical coherence tomography (SD-OCT) images in a case of retinitis after influenza virus infection. OBSERVATIONS: A 48-year-old female complained of scotoma in the central visual field after influenza virus infection. Her best visual acuity was 20/16, her fundus examination was normal, and fluorescein angiography demonstrated no evident leakage in either the retina or the optic disc. However, SD-OCT images showed a disrupted, blurred inner-segment ellipsoid zone in the macula of both eyes. Two steroid pulse therapy sessions in the first 3 months showed temporary improvement of the central scotoma. However, atrophy of the photoreceptor layer at the juxta fovea gradually progressed in OCT images during the follow-up period. In contrast, the fovea itself was mostly intact and visual acuity was maintained in the 2-year period. CONCLUSIONS AND IMPORTANCE: We experienced a unique case of retinitis after influenza infection, in whom progressive atrophy of the photoreceptor layer was observed in SD-OCT images.

Evaluation of Transplanted Autologous Induced Pluripotent Stem Cell-Derived Retinal Pigment Epithelium in Exudative Age-Related Macular Degeneration.

PURPOSE: To report the results after 4 years of follow-up in a previously presented first case of induced pluripotent stem cell (iPSC)-derived retinal pigment epithelium (RPE) sheet autologous transplantation using multimodal imaging. DESIGN: Follow-up of a single case. PARTICIPANT: A patient with exudative age-related macular degeneration and polypoidal choroidal vasculopathy. METHODS: Transplantation of an autologous iPSC-derived RPE cell sheet after removal of choroidal neovascularization (CNV) in September 2014. MAIN OUTCOME MEASURES: The function of the graft was assessed 4 years after surgery by color fundus photography, spectral-domain (SD) OCT, fluorescein angiography, indocyanine green angiography, and an adaptive optics (AO) retinal camera. RESULTS: At the 4-year follow-up, the transplanted autologous iPSC-derived RPE sheet had survived beneath the retina with slight expansion of the pigmented area and no adverse events. The outer nuclear layer above and adjacent to the graft showed acceptable thickness and an organized structure. Fluorescein angiography and SD OCT suggested the presence of vessel-like structures confined to the grafted area associated with the remaining trunk vessel of preoperative polypoidal choroidal vasculopathy but with no exudative changes. Visual acuity has been stable with no additional injections of anti-vascular endothelial growth factor agent. The choroidal volume at the graft site is relatively preserved when compared with the volume outside this site without RPE after removal of the CNV. Indocyanine green angiography revealed a preserved choriocapillaris around the iPSC-derived RPE sheet. Dark cell-like structures with a predominantly hexagonal arrangement were observed by AO imaging in an area located near the margin of the graft sheet. The average intercell distance was found to be stable over time. CONCLUSIONS: Thus far, the grafted iPSC-derived RPE sheet has survived for 4 years and seems to support photoreceptors and choroidal vessels. The morphologic characteristics of the RPE are observed at the transplant site.

Comparison of pretreatment measurements of anterior segment parameters in eyes with acute and chronic primary angle closure.

PURPOSE: To compare pretreatment anterior segment parameters between eyes with acute primary angle closure (APAC) and chronic primary angle closure (CPAC), and to identify the characteristics of eyes with APAC. STUDY DESIGN: Retrospective. METHODS: We measured pretreatment anterior chamber depth (ACD), iris convexity (IC), and pupil diameter in eyes with APAC and CPAC using anterior segment optical coherence tomography. The risk of APAC associated with anterior segment parameters was investigated using multiple logistic regression. Eyes with APAC were discriminated from eyes with CPAC using the receiver-operating characteristic (ROC) curve and area under the curve (AUC). The best cutoff for these variables was determined. RESULTS: Thirty-four eyes with APAC and 60 eyes with CPAC were included. The mean intraocular pressure was 52.3 ± 12.6 mmHg in APAC and 15.5 ± 3.5 mmHg in CPAC (P < .001). Eyes with APAC had a shallower ACD (1.407 ± 0.301 mm vs. 1.960 ± 0.205 mm, P < .001) and less IC (0.233 ± 0.087 mm vs. 0.294 ± 0.068 mm, P < .001) than eyes with CPAC. In multivariate analysis, significant variables associated with APAC were ACD (P < .001) and IC (P = .001). The AUC for ACD was 0.931 and for IC, 0.742. The best cutoff for ACD was 1.699 mm (sensitivity 0.824, specificity 0.917) and for IC, 0.282 mm (sensitivity 0.853, specificity 0.533). CONCLUSIONS: Eyes with APAC had a shallower ACD and less IC. Eyes with an ACD < 1.7 mm may be at risk for APAC.

A case of bilateral vasculitis associated with pineal germinoma.

PURPOSE: To report a rare case of bilateral periphlebitis associated with a pineal germinoma. OBSERVATIONS: A 17-year-old male teenager presented at a local clinic complaining of blurred vision in both eyes. The treating physician identified bilateral uveitis, and prescribed the patient with a local steroid treatment. However, the inflammatory findings did not improve with the treatment, and the patient was referred to our hospital for further examination. At the first visit, his best-corrected visual acuities were 0.3 for the right eye and 0.06 for the left eye; we found no inflammation in the anterior ocular segment, but observed bilateral retinal periphlebitis and a proliferative membrane from the papilla to the macula in the ocular fundus. In addition, we found a tractional serous retinal detachment in the macula. We suspected tuberculous uveitis clinically and initiated treatment with an antituberculous drug. However, the condition of the patient did not improve. Two months after our initial examination, left optic neuritis appeared, and we initiated a steroid pulse therapy. Although the periphlebitis remained, the left optic nerve findings and the visual acuity of both eyes improved. Thus, we reduced the oral steroid dose gradually. However, two months after initiating the dose reduction, the patient suffered a consciousness disturbance, and we detected a pineal tumor by magnetic resonance imaging (MRI). The patient was diagnosed as having a germ cell tumor by pathological examination and underwent radiation and chemotherapy. We noted marked improvements in both the periphlebitis findings and in the visual acuity following the treatment for the pineal tumor. CONCLUSIONS AND IMPORTANCE: Cases of pineal tumor accompanied with retinal periphlebitis have been reported rarely. Because juvenile retinal vasculitis cases of unknown cause can be associated with pineal germinomas, we recommend brain MRI examinations for such cases.

Efficacy of additional topical betamethasone in persistent cystoid macular oedema after carbonic anhydrase inhibitor treatments in retinitis pigmentosa.

OBJECTIVE: We investigated the efficacy of additional topical betamethasone in persistent cystoid macular oedema (CMO) after carbonic anhydrase inhibitors (CAIs) therapy. METHODS AND ANALYSIS: This retrospective cohort study included 16 eyes of 10 patients with retinitis pigmentosa (RP). All patients were previously administered CAI for at least 3 months to treat CMO secondary to RP and lacking an effective reduction (≥11%) of central foveal thickness (CFT). We administered topical 0.1% betamethasone daily in each affected eye following a preceding course of the CAI medication as a first treatment. CMO was diagnosed using spectral-domain optical coherence tomography. CFT was regarded as the average of vertical and horizontal foveal thickness. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained from patient medical records. We compared the CFT and BCVA between baseline and the average of 1-3, 5-7, 10-14 and 16-20 months period. RESULTS: In treatments with brinzolamide in 14 eyes, dorzolamide in 2 eyes and bromfenac in 2 eyes, CFT effectively decreased in 12 of 16 eyes (81%). CFT decreased significantly in 1-3 months (326±102 µm; n=16; P=0.029) and 5-7 months (297±102 µm; n=12; P=0.022) compared with baseline but not within 10-14 months (271±96 µm; n=9; P=0.485) or 16-20 months (281±134 µm; n=9; P=0.289). There were no significant intergroup differences in BCVA throughout the study. Betamethasone treatment was stopped in three patients because of IOP elevation. CONCLUSION: Our data suggested that additional betamethasone might improve treatments for persistent CMO. Topical steroids could be an alternative option for managing persistent CMO in RP.

Optical coherence tomography angiography in patients with retinitis pigmentosa who have normal visual acuity.

PURPOSE: To investigate flow area changes measured using optical coherence tomography angiography (OCTA; RTVue XR Avanti® ) in patients with retinitis pigmentosa (RP) with preserved visual acuity (VA). METHODS: This was an age- and refraction-matched case-control study. Consecutive patients with a best-corrected visual acuity (BCVA) of ≥20/20 and normal subjects were recruited. Fifty eyes (32 patients) and 22 eyes (12 controls) were included. The flow area and foveal avascular zone (FAZ) were measured in both superficial and deep layers within a 3 × 3 mm central area of the fovea. Association between OCTA parameters and the length of the inner segment ellipsoid (ISe) and external limiting membrane (ELM), the area without abnormal fluorescence in fundus autofluorescence (normal FAF area ratio) and the area of I-2e of the Goldmann perimeter were analysed using mixed-effects regression analysis. RESULTS: Foveal avascular zones were significantly smaller in patients with RP than in controls in superficial (p = 0.004) but not in deep layers (p = 0.25). The flow area in superficial (p = 0.007) and deep layers (p = 0.004) was significantly smaller in patients with RP than in controls. In patients with RP, flow areas in the superficial layers, but not in the deep layers, were significantly associated with the lengths of ISe (p = 0.001) and ELM (p = 0.002) and the I-2e area (p = 0.036), but not with the normal FAF area ratio (p = 0.399). CONCLUSION: Optical coherence tomography angiography (OCTA)-measured flow area in superficial layers gradually reduced with RP progression and may be a useful parameter of RP pathogenesis.

Unique circumferential peripheral keratitis in relapsing polychondritis: A case report.

RATIONALE: Relapsing polychondritis (RP) is a rare collagen disease characterized by inflammation and destruction of cartilage throughout the body. The paper details the clinical course of a case of RP with unique circumferential peripheral keratitis. PATIENT CONCERNS: A 54-year-old Japanese woman was referred to the hospital presenting with auricular and ocular pain. DIAGNOSES: Based on the auricle biopsy results and the three presenting symptoms (bilateral auricular chondritis, inflammatory arthritis and ocular inflammation), her condition was diagnosed as RP. INTERVENTIONS: The three presenting symptoms gradually improved with prednisolone (PSL), methylprednisolone and cyclophosphamide combination therapy, followed by PSL, methotrexate and infliximab combination therapy. However, one month after the initial visit, despite ongoing treatment, a unique circumferential peripheral keratitis suddenly occurred, in which the corneal infiltration gradually clumped together and shrank at the peripheral area. The eye and ear pain showed exacerbations and remissions on reducing the dosage of steroid drugs. The general condition was improved on altering systemic therapy to PSL, methotrexate and tocilizumab. OUTCOMES: Keratitis gradually disappeared within 10 months of the initial visit. LESSONS: This is the first report of a case of RP causing unique circumferential peripheral keratitis. This keratitis occurred despite use of focal and systemic steroids and showed improvement with general recovery. This may indicate that stabilization of general condition is important for recovery from keratitis in RP.

Autologous Induced Stem-Cell-Derived Retinal Cells for Macular Degeneration.

We assessed the feasibility of transplanting a sheet of retinal pigment epithelial (RPE) cells differentiated from induced pluripotent stem cells (iPSCs) in a patient with neovascular age-related macular degeneration. The iPSCs were generated from skin fibroblasts obtained from two patients with advanced neovascular age-related macular degeneration and were differentiated into RPE cells. The RPE cells and the iPSCs from which they were derived were subject to extensive testing. A surgery that included the removal of the neovascular membrane and transplantation of the autologous iPSC-derived RPE cell sheet under the retina was performed in one of the patients. At 1 year after surgery, the transplanted sheet remained intact, best corrected visual acuity had not improved or worsened, and cystoid macular edema was present. (Funded by Highway Program for Realization of Regenerative Medicine and others; University Hospital Medical Information Network Clinical Trials Registry [UMIN-CTR] number, UMIN000011929 .).

Mice that produce ApoB100 lipoproteins in the RPE do not develop drusen yet are still a valuable experimental system.

PURPOSE: Mice typically produce apolipoprotein B (apoB)-48 and not apoB100. Apolipoprotein B100 accumulates in Bruch's membrane prior to basal deposit and drusen formation during the onset of AMD, raising the possibility that they are a trigger for these Bruch's membrane alterations. The purpose herein, was to determine whether mice that predominantly produce apoB100 develop features of AMD. METHODS: The eyes of mice that produce apoB100 were examined for apoB100 synthesis, cholesteryl esterase/filipin labeling for cholesteryl esters, and transmission electron microscopy for lipid particles and phenotype. RESULTS: Apolipoprotein B100 was abundant in the RPE-choroid of apoB100, but not wild-type mice by Western blot analysis. The apolipoprotein B100,(35)S-radiolabeled and immunoprecipitated from RPE explants, confirmed that apoB100 was synthesized by RPE. Apolipoprotein B100, but not control mice, had cholesteryl esters and lipid particles in Bruch's membrane. Immunoreactivity of ApoB100 was present in the RPE and Bruch's membrane, but not choroidal endothelium of apoB100 mice. Ultrastructural changes were consistent with aging, but not AMD when aged up to 18 months. The induction of advanced glycation end products to alter Bruch's membrane, did not promote basal linear deposit or drusen formation. CONCLUSIONS: Mice that produce apoB100 in the RPE and liver secrete lipoproteins into Bruch's membrane, but not to the extent that distinct features of AMD develop, which suggests that either additional lipoprotein accumulation or additional factors are necessary to initiate their formation.

Effect of axial length reduction after trabeculectomy on the development of hypotony maculopathy.

PURPOSE: To measure changes in axial length before and after trabeculectomy with noncontact, partial coherence laser interferometry and identify patient factors that lead to the development of hypotony maculopathy and axial length shortening in 25 eyes with intraocular pressure (IOP) ≤ 6 mmHg at 4 weeks after mitomycin C-augmented trabeculectomy. METHODS: A retrospective comparative case series. Hypotony maculopathy was identified with both ophthalmoscopy and spectral-domain optical coherence tomography. Axial length and IOP were serially measured pre- and postoperatively. Logistic regression analysis was performed to identify factors associated with the presence of hypotony maculopathy at 4 weeks after trabeculectomy and multiple regression analysis to identify factors associated with axial length changes. RESULTS: Ten eyes exhibited hypotony maculopathy, whereas the remaining 15 did not. Patients with hypotony maculopathy were significantly younger (47.7 ± 6.2 years) compared with those without it (63.3 ± 9.6 years, P = 0.0002, unpaired t test). The percent reduction of axial length after trabeculectomy was significantly larger in the former group (5.91 ± 2.76 %) compared with the latter group (1.51 ± 0.91 %) (P = 0.0001, Mann-Whitney U test). Multivariate analyses showed that only age was associated with the presence of hypotony maculopathy, with an odds ratio of 0.82 (P = 0.0075), when age, sex, type of glaucoma, lens status, percent changes in axial length and IOP before and after trabeculectomy, and central corneal thickness were included as independent variables (R (2) = 0.543, P = 0.003). CONCLUSIONS: Age-dependent axial length reduction is a risk factor for the development of hypotony maculopathy after trabeculectomy.

Assessment of IcareONE rebound tonometer for self-measuring intraocular pressure.

PURPOSE: To evaluate the precision of the IcareONE rebound tonometer, which was developed for self-measuring intraocular pressure (IOP) and to compare IcareONE measurement with Goldmann applanation tonometry (GAT). METHODS: Twenty-four healthy eyes and 81 glaucomatous eyes were enrolled. IOP measurements (three times per session) with IcareONE were made in a random order by an ophthalmologist (Icare(O)) and by the subject (Icare(S)). Intraclass correlation coefficients (CCs), kappa values and mean values of IOP were compared among the two types of Icare recordings and GAT. Bland-Altman analysis was used to assess agreement between methods. Multiple regression analysis was performed to identify the subject factors that influenced the discordant measurements between IcareONE and GAT. RESULTS: The mean value of Icare(O) and Icare(S) measurements was 13.5±5.2 and 13.5±5.4 mmHg, respectively, neither of which was significantly different from GAT (13.8±4.4). The intrarater CC of Icare(O) and Icare(S) was 0.968 and 0.885, respectively. The intermethod CC and weighted kappa between Icare(O) and Icare(S) were 0.907 and 0.684, respectively. All pairwise correlations between the two types of IOP measurement showed coefficients of determination >0.8. Bland-Altman analysis did not show any proportional biases. Multiple regression analysis revealed that the differences between GAT and Icare(O) or Icare(S) were positively correlated with central corneal thickness (CCT) and negatively correlated with age. CONCLUSIONS: Intraocular pressure measurements with IcareONE by a physician and by the subject showed excellent agreement with GAT measurements; IcareONE measurements between a physician and the subject had high intrarater reliability, and good agreement thicker CCT led IcareONE measurement to overestimate IOP, while higher age caused it to underestimate IOP compared with GAT.

The ability of macular parameters and circumpapillary retinal nerve fiber layer by three SD-OCT instruments to diagnose highly myopic glaucoma.

PURPOSE: To compare the ability of circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macular parameters obtained by three spectral-domain optical coherence tomography (SD-OCT) instruments to detect highly myopic glaucoma. METHODS: In this study, 84 glaucomatous eyes, 53 normal eyes with high myopia, and 86 normal eyes (not highly myopic) were enrolled. Each participant was imaged using Cirrus, RTVue, and 3D OCT to evaluate the average and quadrant cpRNFL thicknesses. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer + inner plexiform layer (GCL/IPL), and mRNFL + GCL/IPL (GCC) thicknesses were analyzed. The areas under the receiver operating characteristic curves (AUCs) were compared between the instruments. In addition, the best parameters for the AUC were compared between the cpRNFL parameters and macular parameters in each instrument. RESULTS: These analyses revealed similar AUCs for the average cpRNFL and GCC thicknesses between the instruments. RTVue displayed a significantly higher AUC in the nasal cpRNFL thickness than both Cirrus (P = 0.0004) and 3D OCT (P = 0.0006). 3D OCT showed higher AUCs than Cirrus in the mRNFL parameters. There were no significant differences between the best cpRNFL parameters and macular parameters in each instrument. CONCLUSIONS: The average cpRNFL and GCC thicknesses that were measured using these OCT instruments exhibited similar abilities for diagnosing highly myopic glaucoma, and RTVue exhibited better diagnostic abilities than Cirrus and 3D OCT for nasal cpRNFL. 3D OCT had better ability than Cirrus in the mRNFL. Both cpRNFL and GCC in each instrument were comparable, and their measurements offered good ability for diagnosing glaucoma with high myopia. (http://www.umin.ac.jp/ctr/index/htm9, UMIN000006900.).

Cluster analyses of grid-pattern display in macular parameters using optical coherence tomography for glaucoma diagnosis.

PURPOSE: Using spectral-domain optical coherence tomography (SD-OCT), we assessed the ability of cluster analyses, based on the grid-pattern of macular parameters, to detect glaucoma. METHODS: We enrolled 75 normal eyes, 64 early glaucomatous eyes (EG), and 40 preperimetric glaucomatous eyes (PPG). Each participant was imaged using 3-dimensional optical coherence tomography (3D-OCT) to examine the macular retinal nerve fiber layer (mRNFL) and the thickness of the ganglion cell layer, together with the inner plexiform layer (GCL/IPL). Diagnostic criteria based on the clustering of abnormal grids from the mRNFL and GCL/IPL measurements were applied. The sensitivity and specificity of glaucoma detection were compared between the cluster criteria (CC) and the average thickness criteria (ATC) of total and hemiretinal sectors, and the cut-off criteria were determined using receiver operating characteristic (ROC) curve analyses from our normal controls. RESULTS: The specificity values of CC and ATC from mRNFL measurements were 97% and 100%, respectively. The sensitivity of CC was 94% for EG and 68% for PPG. The sensitivity of ATC was 81% for EG and 38% for PPG. The specificity values of CC and ATC from GCL/IPL measurements were 96% and 100%, respectively. The sensitivity values of CC and ATC were 92% for EG and 63% for PPG. The sensitivity of ATC was 84% for EG and 25% for PPG. When compared to ATC and ROC-based cut-off criteria, CC showed a higher diagnostic capability. CONCLUSIONS: Judging abnormality based on a clustering of abnormal grids from macular OCT parameters may be a reliable approach for diagnosing early glaucoma. (http://www.umin.ac.jp/ctr/index/htm9 number, UMIN000006900.).

Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results.

PURPOSE: To compare the effect of photodynamic therapy (PDT) and intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy (PCV). DESIGN: Randomized clinical trial. SETTING: Multicenter. STUDY POPULATION: Total of 93 patients with treatment-naïve PCV. INTERVENTION: Patients were randomized to 2 arms. Patients in the PDT arm underwent a single session of PDT with verteporfin, and patients in the ranibizumab arm received 3 monthly ranibizumab injections at baseline. Additional treatment was performed as needed in each arm. MAIN OUTCOME MEASURES: Primary outcome measurement was the proportion of patients gaining or losing more than 0.2 logarithm of minimal angle of resolution (logMAR) units from baseline. Mean change of logMAR and central retinal thickness (CRT) were also evaluated. RESULTS: In the PDT arm (n = 47), 17.0% achieved visual acuity gain, 55.3% had no change, and 27.7% experienced visual acuity loss. The results were 30.4%, 60.9%, and 8.7%, respectively, in the ranibizumab arm (n = 46), significantly better than the PDT arm (P = .039). In the PDT arm, mean CRT improved (366.8 ± 113.6 µm to 289.1 ± 202.3 µm, P < .001), but logMAR was unchanged (0.57 ± 0.31 to 0.62 ± 0.40). The ranibizumab arm demonstrated improvement in both CRT (418.9 ± 168.6 µm to 311.2 ± 146.9 µm, P < .001) and logMAR (0.48 ± 0.27 to 0.39 ± 0.26, P = .003). Mean change of logMAR was also greater in the ranibizumab arm (P = .011). CONCLUSION: Intravitreal injection of ranibizumab is more effective than PDT for treatment-naïve PCV.