Correlation of Visual Acuity and Outer Retinal Thickness in Myopic Atrophic Maculopathy: A Retrospective Review.

INTRODUCTION: Myopic atrophic maculopathy is prevalent among patients with pathologic myopia and frequently leads to relentless vision loss. Several grading systems were established to facilitate the understanding of myopic atrophic maculopathy. However, the anatomical details in different stages of myopic maculopathy are so far not clearly elucidated. This study aims to investigate the visual acuity and retinal sublayer features in highly myopic eyes with varying severities of myopic atrophic maculopathy (MAM). METHODS: The clinical records of 111 consecutive patients (158 eyes) with high myopia (refractive error ≤ -6.0 D and axial length ≥ 26.0 mm) were reviewed. Fundus photography, optical coherence tomography (OCT), and best-corrected visual acuity (BCVA) were measured. MAM was graded according to the META-analysis for Pathologic Myopia (META-PM) classification system. Myopic choroidal neovascularization (mCNV) and dome-shaped macula (DSM) were also investigated. RESULTS: Among the 158 eyes, 18 (11%), 21(13%), 24 (15%), 25 (16%), 23 (15%), and 24 (15%) had tessellated fundus, diffuse chorioretinal atrophy, diffuse chorioretinal atrophy with DSM, patchy atrophy, patchy atrophy with DSM, and MAM with mCNV, respectively. A total of 23 (15%) eyes had macular atrophy without mCNV. Progressive thinning in the Henle's fiber and outer nuclear layers, myoid and ellipsoid zone (MEZ), outer segment (OS), and interdigitation zone and retinal pigmented epithelium based on the severity of MAM (p-value < 0.001) was found. MEZ and OS were most significantly reduced in thickness (p-value < 0.001). The presence of mCNV demonstrated significant outer retinal layer thinning compared with that of the tessellated fundus (p-value = 0.031). Patchy atrophy with DSM showed statistically poorer BCVA compared with that without (p-value = 0.008). CONCLUSION: Visual acuity and outer retinal sublayer characteristics were correlated with the severity of MAM. Outer retinal sublayer analysis by spectrum-domain OCT shed some light on the mechanisms of MAM progression.

Characteristics and response of subretinal hyperreflective material to anti-vascular endothelial growth factor in myopic choroidal neovascularization.

This retrospective study evaluated the characteristics and response of subretinal hyperreflective material (SHRM) to anti-vascular endothelial growth factor (VEGF) treatment in eyes with myopic choroidal neovascularization (CNV). The visual acuity (VA) was assessed at 3, 6, and 12 months after initiating anti-VEGF treatment in 116 patients (119 eyes) with SHRM and myopic CNV. Multimodal imaging, including color fundus photography, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A), were performed. We compared type 2 neovascularization (NV) (n = 64), subretinal hyperreflective exudation (SHE) (n = 37), NV with hemorrhage (n = 15), and fibrosis (n = 3). The type 2 NV group, and NV with hemorrhage groups showed significant VA improvement after 12 months of treatment (p < 0.05 in both groups); the SHE group failed to show improvement (p = 0.366). All groups showed a significant reduction in central foveal thickness after 12 months of treatment (all p < 0.05). The SHE group had a significantly higher incidence of interrupted ellipsoid zone than the other groups (p < 0.05). Myopic CNV can present as SHRM on OCT-A. Visual prognoses vary in different SHRM types. OCT-A and FA may help predict the outcomes of different subtypes of myopic CNV. SHE is predictive of outer retinal layer atrophy in patients with various SHRM types.

Vitreoretinal Interface Changes After Anti-vascular Endothelial Growth Factor Treatment in Highly Myopic Eyes: A Real-World Study.

INTRODUCTION: To investigate changes in the vitreoretinal interface after anti-vascular endothelial growth factor (anti-VEGF) treatment in highly myopic eyes. METHODS: Eyes with myopic choroidal neovascularization (mCNV) treated with intravitreal injection of anti-VEGF in a single-center were retrospectively reviewed. Fundus abnormalities and features of optical computed tomography were studied. RESULTS: A total of 295 eyes from 254 patients were recruited to the study. Prevalence of myopic macular retinoschisis (MRS) was 25.4%, and the rates of progression and onset of MRS were 75.9% and 16.2%, respectively. Outer retinal schisis (ß = 8.586, p = 0.003) and lamellar macular hole (LMH) (ß = 5.015, p = 0.043) at baseline were identified risk factors for progression and onset of MRS, whereas male sex (ß = 9.000, p = 0.039) and outer retinal schisis at baseline (ß = 5.250, p = 0.010) were risk factors for MRS progression. Progression of MRS was first detected in outer retinal layers in 48.3% of eyes. Thirteen eyes required surgical intervention. Spontaneous improvements of MRS were observed in five eyes (6.3%). CONCLUSION: Changes in the vitreoretinal interface, such as progression, onset, and improvement of MRS, were observed after anti-VEGF treatment. Outer retinal schisis and LMH were risk factors of progression and onset of MRS after anti-VEGF treatment. Intravitreal injection of ranibizumab and retinal hemorrhage were protective factors for surgical intervention for vision-threatening MRS.

Comparison of Refractive Outcomes in Patients with Highly Myopic Versus Non-highly Myopic Eyes Undergoing Phacovitrectomy.

INTRODUCTION: Combined phacovitrectomy is gaining popularity due to efficiency and immediate visual improvement. However, concerns regarding erroneous intraocular lens (IOL) calculation in combination surgery are increasing, such as myopic shift owing to a thick macula and consequent underestimation of the axial length. Therefore, this study aimed to compare the refractive outcomes of combined phacovitrectomy in patients with highly myopic and non-highly myopic eyes. METHODS: A retrospective chart review was performed on patients who received combined phacoemulsification, intraocular lens implantation, and small gauge pars plana vitrectomy for cataract and macular pathologies in highly myopic and non-highly myopic eyes. Pre- and postoperative evaluation and ocular parameters were recorded, and analyses were performed using the Student's t test and regression analysis. RESULTS: A total of 133 patients with macular pathologies, including myopic tractional maculopathy, macular hole, and epiretinal membrane, were enrolled. SRK II or SRK/T models were used for calculating IOL. The mean absolute error of refraction change was 0.65 D; 83.5% of patients were within 1-D error, 57.9% within 0.5-D error, and 35.3% within 0.25-D error, with SRK/T showing better precision and yielding more myopic shift. Furthermore, the predictive accuracy of SRK II or SRK/T was better in patients with non-highly myopic eyes. Moreover, Barrett's universal II formula was not superior to SRK II or SRK/T in the prediction of postoperative refractive error (p = 0.48). CONCLUSION: Refractive outcomes were satisfactory in the cohort of patients with highly myopic eyes. The combined implementation of SRK II and SRK/T was not inferior to Barrett's universal II formula in predicting satisfactory refractive outcomes. Combination surgery can be an option for patients with both cataract and macular pathologies.

Characteristics and treatment response of polypoidal choroidal vasculopathy in highly myopic eyes.

BACKGROUND: To compare the characteristics and treatment responses of polypoidal choroidal vasculopathy (PCV) between highly myopic and non-highly myopic eyes. METHODS: This retrospective cohort study included patients diagnosed with PCV at the clinic of National Taiwan University Hospital between 2013 and 2019. The diseased eyes were grouped per refractive error and axial length at diagnosis. Imaging data were used to retrieve the PCV characteristics, and electronic medical records were used to retrieve the treatment responses. RESULTS: Among 116 eyes with PCV, 11 eyes of 10 patients were highly myopic; seven of these patients were women. All highly myopic eyes showed a thin subfoveal choroid, while three eyes had a pachychoroid phenotype with significant focal choroidal thickening. After treatment with either intravitreal anti-vascular endothelial growth factor (VEGF) injections, photodynamic therapy (PDT), or both, best-corrected visual acuity was better in the high-myopia group at 1 year. Visual acuity at presentation and the presence of feeder vessels were found to be predictors of the visual outcome. CONCLUSIONS: In this study we reported, to the best of our knowledge, the largest cohort of PCV in highly myopic eyes to date. Female predominance, lower incidence of subretinal haemorrhage, and a thin choroid with a focal pachychoroid phenotype were found to characterise PCV in highly myopic eyes. Visual acuity transiently improved after either anti-VEGF monotherapy or combination therapy with PDT.

Clinical Characteristics of Highly Myopic Patients With Asymmetric Myopic Atrophic Maculopathy-Analysis Using Multimodal Imaging.

Purpose: To evaluate the factors associated with asymmetric myopic atrophic maculopathy (MAM) in highly myopic patients. Methods: We enrolled highly myopic patients with asymmetric MAM according to the atrophy, traction, and neovascularization (ATN) classification. The results of color fundus photography, optical coherence tomography (OCT), OCT angiography, and corneal visualization Scheimpflug technology (Corvis ST tonometry) were reviewed. The association between inter-eye differences in clinical features and MAM grading was analyzed using logistic regression analysis. Results: Among the 72 eyes of 36 patients 61.0 ± 9.3 years of age, 9, 33, 17, and 13 eyes had A1, A2, A3, and A4, respectively. The mean axial length was 30.44 ± 1.92 mm, and there was no significant difference between eyes with less severe and more severe MAM. The inter-eye differences in MAM grading were associated with the inter-eye differences in the presence of Bruch's membrane defects (P = 0.014), ellipsoid zone disruption (P = 0.013), vessel density of the deep retinal layer (P = 0.022), foveal avascular zone circularity (P = 0.012), foveal avascular zone area (P = 0.049), flow area of the choriocapillaris (P = 0.013), vessel diameter (P = 0.045), and fractal dimension (P = 0.015). No Corvis ST parameter was statistically significant. A higher difference in the choriocapillaris flow area (P = 0.013; adjusted odds ratio = 1.10 [1.02-1.18]) remained associated with higher inter-eye differences in MAM grading in the multivariable regression. Conclusions: A smaller choriocapillaris flow area was associated with more severe MAM, suggesting that vascular factors play pivotal roles in MAM.

Biomarkers in the pathogenesis of epiretinal membrane and myopic traction maculopathy: Effects of internal limiting membrane incompliance and posterior staphyloma.

BACKGROUND: This study compared the structural and vascular intraretinal changes between epiretinal membrane and myopic traction maculopathy eyes. METHODS: An observational retrospective study of treatment-naïve epiretinal membrane and myopic traction maculopathy eyes was conducted to identify biomarkers of a 3 × 3 mm macular region centered on the fovea, using optical coherence tomography angiography. RESULTS: The myopic traction maculopathy and epiretinal membrane groups comprised 27 and 32 eyes, respectively. In the myopic traction maculopathy group, the spherical equivalent was more myopic and the axial length was longer than in the epiretinal membrane group. Myopic traction maculopathy eyes had larger outer and smaller inner retinal volumes, larger area and perimeter of foveal avascular zones, greater circularity of foveal avascular zones, and smaller foveal vessel density in the superficial layer than epiretinal membrane eyes. Internal limiting membrane incompliance and staphyloma were significantly more in the myopic traction maculopathy group than in the epiretinal membrane group. CONCLUSIONS: The intraretinal changes in myopic traction maculopathy eyes compared with epiretinal membrane eyes showed larger avascular zones, which may have been caused by tangential internal limiting membrane incompliance. Anteroposterior traction forces from staphyloma in myopic traction maculopathy eyes may lead to larger outer retinal volumes. In epiretinal membrane eyes, traction forces confined to the superficial retina caused large inner retinal volumes and foveal acircularity.

The effect of human platelet lysate on corneal nerve regeneration.

AIM: This study aimed to test whether human platelet lysate (HPL) has neurotrophic ability for corneal nerve regeneration. METHODS: We measured the neurotrophic factors in human peripheral serum (HPS) and two commercially available HPLs, UltraGRO and PLTMax. In vitro, we compared the growth rates, neuronal differentiation and immunostaining of neuron markers in mouse neuroblastoma cell line (Neuro-2a) and primary culture of mouse trigeminal ganglion cells that were cultivated in different concentrations of fetal bovine serum, HPS and HPL. In vivo, we created corneal wounds on Sprague Dawley rats with a rotating burr and evaluated the effects of topical HPL on wound healing and corneal nerve regeneration by in vivo confocal microscopy and corneal aesthesiometry. RESULTS: HPLs had significantly higher concentrations of various neurotrophic factors compared with HPS (p<0.05). In Neuro-2a cells, 3% HPL was better at promoting neuronal growth and differentiation compared with HPS at the same concentration. HPL was also found to have superior neurotrophic effects compared with HPS in primary cultures of mouse trigeminal ganglion cells. In vivo, HPL-treated eyes had better corneal epithelial wound healing rate, nerve regeneration length and corneal touch threshold compared with eyes treated with artificial tears (p<0.05). CONCLUSION: HPL has significantly higher concentrations of neurotrophic factors compared with HPS. It showed not only in vitro but also in vivo corneal neurotrophic abilities. Our results suggest that HPL may have a potential role in the treatment of diseases related to corneal nerve damage or degeneration.

Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis.

Purpose: Radial keratoneuritis (RK) is a common feature of Acanthamoeba keratitis (AK). In vivo confocal microscopy (IVCM) is noninvasive and provides real-time images for the diagnosis of corneal diseases by allowing the visualization of corneal structures and morphologies of living organisms at the cellular level. Images of AK with RK obtained using commercial white light IVCM devices have not been frequently evaluated. In the present study, a white light IVCM device was used to evaluate the corneal findings and describe spatial changes in the corneal nerves at different depths in cases of early-stage AK with RK. Methods: In this retrospective, observational study, white light IVCM images focused on RK were evaluated for Acanthamoeba cysts/trophozoites, corneal deposits, and altered corneal nerves, with special emphasis on three-dimensional spatial changes in the corneal nerves at different depths. Results: Seventeen eyes of 17 patients exhibiting early-stage AK with RK were included in the study. Acanthamoeba cysts/trophozoites were observed in the corneal epithelium of 13 eyes and stroma of 7 eyes. Alterations in the corneal nerve morphology and density were observed from the basal epithelial layer to the stromal layer in 12 eyes. Acanthamoeba trophozoites were attached to the corneal stromal nerves in five eyes. Conclusion: These findings suggest that white light IVCM can identify consistent corneal findings, particularly spatial changes in the corneal nerves, in cases of early-stage AK with RK.

Natural course of the intraretinal hyperreflective sign after macular haemorrhage absorption in eyes with pathologic myopia.

PURPOSE: We investigated the natural course of the intraretinal hyperreflective (IRH) sign after macular haemorrhage (MHE) absorption in eyes with pathologic myopia. METHODS: This prospective observational cohort study evaluated 28 patients with pathologic myopia and MHE. The eyes were categorized into IRH and non-IRH sign groups according to IRH sign development. All eyes were evaluated; follow-up visits were scheduled at 1, 3, 6, 12 and 24 months after MHE absorption. RESULTS: Of 28 patients (14 eyes each in the IRH and non-IRH groups), nine (32.1%) were men and 19 (67.9%) were women. The average age (mean ± SD) was 46.64 ± 11.92 versus 52.71 ± 12.19 years in the IRH and non-IRH groups. The IRH sign coincided with the MHE invasion site. The sign persisted for the entire follow-up period in all but two eyes, in which it disappeared at 12 and 24 months, respectively. Maximal MHE thickness was significantly greater in the IRH sign group (162.9 ± 67.84 versus 104.2 ± 32.34 µm, p = 0.013). The mean logarithm of the minimum angle of resolution visual acuity was significantly better in the non-IRH sign group at 12 (p = 0.029) and 24 (p = 0.033) months. The incidence of myopic traction maculopathies (MTM) was significantly higher in the IRH (57.1%) than in the non-IRH sign group (14.3%; p = 0.046). CONCLUSION: The IRH sign can develop after MHE in pathologic myopia and can remain stable long after MHE absorption; furthermore, it is predictive of future MTM.

Myopic traction maculopathy biomarkers on optical coherence tomography angiography-An overlooked mechanism of visual acuity correction in myopic eyes.

BACKGROUND/OBJECTIVES: Myopic traction maculopathy of the retinoschisis type is a unique entity that has been frequently overlooked in refraction correction in daily practice in myopic eyes. The objective of this study was to describe the imaging characteristics of myopic traction maculopathy (MTM) seen on optical coherence tomography angiography (OCTA) and to detect biomarkers of the associated functional changes. SUBJECTS/METHODS: We performed OCTA on eyes with MTM and retinoschisis (RS group; n = 27) and highly myopic eyes without MTM (control group; n = 27). The RS group was further divided into a dome-shaped macula (DSM) group and a non-DSM group. The groups were compared for morphologic and perfusion characteristics. RESULTS: The RS and control groups had comparable spherical equivalence (p = 0.65), but the RS group had worse best-corrected visual acuity (p < 0.01), larger retinal volumes (p < 0.01), and greater subfoveal choroid capillary vessel density values (p = 0.04). Compared to the non-DSM group, the DSM group had significantly smaller inner retinal volumes (p = 0.05) and significantly larger choroid capillary vessel density values in both the whole macula (p = 0.005) and the fovea (p = 0.03). CONCLUSIONS: Our high-resolution OCTA morphologic and vascular perfusion data correlated well with functional abnormalities encountered in myopic eyes. Changes in vessel density may elucidate the pathogenesis of MTM and characterize the mechanical stretch forces acting in eyes with MTM.

Spectral-domain optical coherence tomography of peripheral lattice degeneration of myopic eyes before and after laser photocoagulation.

PURPOSE: To investigate the microstructural characteristics of lattice degenerations before and after laser photocoagulation in myopic eyes by spectral-domain optical coherence tomography (SD-OCT). METHODS: Twenty-five eyes of 25 consecutive patients at the High Myopia Clinic of the National Taiwan University Hospital were retrospectively reviewed. Myopic eyes with peripheral lattice degeneration were enrolled in the study. Best-corrected visual acuity (BCVA), axial length measurement, color fundus photography was performed. SD-OCT analyses on the lattice degeneration were performed before and after prophylactic laser photocoagulation. All patients were followed for at least 6 months. RESULTS: In total, 25 myopic eyes with peripheral lattice degenerations were studied. The mean refractive error was -9.92 ± 4.77 Diopters (D) with 21 (84%) of the eye being highly myopic (Over -6.0 D). The average axial length was 27.7 ± 1.86 mm. In these myopic eyes, retinal thinning was the most common finding (92%), followed by vitreoretinal traction (72%), retinoschisis (44%), vitreous membrane with deposits (36%), and retinal break with subretinal fluid (4%). A blunting effect of the vitreoretinal tractions was found after laser photocoagulation. CONCLUSION: To our knowledge we firstly investigated the pre- and post-laser photocoagulation microstructural changes using SD-OCT. It demonstrated a beneficial effect of retinoplasty, which released vitreoretinal tractions after laser photocoagulation. Combined with the findings of subtle microstructural retinal breaks and subretinal fluid, early prophylactic laser treatment warrants sincere consideration in these myopic eyes.

Multimodal imaging of linear lesions in the fundus of pathologic myopic eyes with macular lesions.

PURPOSE: To detect, using multimodal imaging, lacquer cracks (LCs) and myopic stretch lines (MSLs) in pathologic myopic eyes with macular hemorrhage (MHE) and those without. METHODS: We collected 18 consecutive pathologic myopic eyes (spherical equivalent ≤ -8.0 diopters) that had presented with linear, yellowish-white lesions in the macula. We categorized the eyes into either the MHE group or the non-MHE group. All underwent fluorescein angiography (FA), near infrared autofluorescence (NIA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT). RESULTS: In all 18 eyes, the linear lesions were hyperfluorescent under NIA imaging, but hypofluorescent under ICGA. All ten eyes in the MHE group had LCs, and two had both LCs and MSLs. None of the eight eyes in the non-MHE group had LCs. Regarding proximity to the MHE, LCs tended to locate closer than MSLs. Incidental perforating scleral vessels were clearly visible on the tracked SD-OCT scanning line, joining the choroid beneath the border of MHE. Sample cases are illustrated using delicate photographs and explanations. CONCLUSION: NIA imaging combined with SD-OCT and ICGA can detect and differentiate early the subtle difference between the two types of linear lesions in pathological myopic eyes. Notably, MSLs were not associated with MHEs or LCs in our consecutive series.

Diagnostic capability of peripapillary retinal nerve fiber layer parameters in time-domain versus spectral-domain optical coherence tomography for assessing glaucoma in high myopia.

AIM: To evaluate and compare the diagnostic capabilities of peripapillary retinal nerve fiber layer (p-RNFL) parameters of Spectralis optical coherence tomography (OCT) versus Stratus OCT to detect glaucoma in patients with high myopia. METHODS: This is a retrospective, cross-sectional study. Sixty highly myopic eyes of 60 patients were enrolled, with 30 eyes in the glaucoma group and 30 eyes in the control group. All eyes received peripapillary imaging of the optic disc using Stratus and Spectralis OCT. Areas under the receiver operating characteristic curve (AUROC) and the sensitivity at specificity of >80% and >95% for p-RNFL parameters obtained using the two devices to diagnose glaucoma were analysed and compared. RESULTS: In Spectralis OCT, p-RNFL thickness parameters with the largest AUROC were the temporal-inferior sector (0.974) and the inferior quadrant (0.951), whereas in Stratus OCT, the best parameters were the 7-o'clock sector (0.918) and the inferior quadrant (0.918). Compared to the Stratus OCT parameters, the Spectralis OCT parameters demonstrated generally higher AUROC; however, the difference was not statistically significant. CONCLUSION: The best p-RNFL parameters for diagnosing glaucoma in patients with high myopia were the temporal-inferior sector on Spectralis OCT and the 7-o'clock sector on Stratus OCT. There were no significant differences between the AUROCs for Spectralis OCT and Stratus OCT, which suggest that the glaucoma diagnostic capabilities of these two devices in patients with high myopia are similar.

Macular Diagnostic Ability in OCT for Assessing Glaucoma in High Myopia.

PURPOSE: To compare the diagnostic abilities of spectral-domain optical coherence tomography (SD-OCT; Spectralis OCT) and time-domain OCT (TD-OCT; Stratus OCT). Changes in macular parameters in highly myopic eyes of glaucoma patients and highly myopic eyes of glaucoma suspects were evaluated and compared. METHODS: We collected data from 72 highly myopic eyes (spherical equivalent, ≤-6.0D). Forty-one eyes had perimetric glaucoma and 31 eyes were suspected to have glaucoma (control group). All eyes underwent SD-OCT and TD-OCT imaging. Area under the receiver operating characteristic (AUROC) curve and sensitivity were examined on macular volume and thickness parameters at a fixed specificity and compared between groups. RESULTS: The highest TD-OCT AUROC curves were found using outer inferior sector macular thickness (AUROC curve, 0.911) and volume (AUROC curve, 0.909). The highest SD-OCT AUROC curves were found using outer inferior region thickness (AUROC curve, 0.836) and volume (AUROC curve, 0.834). The difference between the two imaging modalities was not statistically significant (thickness, p = 0.141; volume, p = 0.138). The sensitivity of TD-OCT macular outer inferior average thickness was highest and was 88.2%, with a specificity of 80.4%. The sensitivity of TD-OCT average volume measurements in this same region was 76.5%, with a specificity of 91.3%. The SD-OCT average thickness measurements also had the highest sensitivity in this region, which was 78.6%, with a specificity of 82.1%. The SD-OCT volume measurements had a sensitivity of 67.9%, with a specificity of 92.3%. CONCLUSIONS: Both SD-OCT and TD-OCT measurements of outer inferior macular thickness and volume can differentiate between eyes of glaucoma patients and glaucoma suspects with high myopia. These independent predictors all had good sensitivity. Based on our results, SD-OCT and TD-OCT have similar diagnostic abilities. These parameters may provide useful additional data in highly myopic eyes to complement standard glaucoma diagnosis tools.

Changes of intraocular pressure and refractive status in children following cycloplegic refraction with 1% cyclopentolate and 1% tropicamide.

PURPOSE: To evaluate the effect of cycloplegic mydriasis with 1% cyclopentolate and 1% tropicamide on the intraocular pressure (IOP) and refractive status of children for cycloplegic refraction and compare the [OP and refractive changes between hyperopic and myopic groups. METHODS: This study was designed as a retrospective cohort study. Ninety one children received cycloplegic mydriasis. The IOP was measured with a noncontact tonometer before cycloplegic administration. One drop of 1% cyclopentolate was administered, which was followed by two drops of 1% tropicamide at an interval of 10 minutes. The IOP was then measured 30 minutes after tropicamide instillation. Autorefraction was assessed with an autorefractometer before and after cycloplegic mydriasis. RESULTS: The mean age of the 44 girls and 47 boys was 7.3 ± 2.4 years. The mean precycloplegic IOP was 14.45 ± 2.47 mmHg and the mean postcycloplegic IOP was 15.06 ± 3.08 mmHg in all eyes. A significant difference was noted in the IOP change (p = 0.033). In the 39 hyperopic eyes, the mean precycloplegic IOP and postcycloplegic IOP were 14.54 ± 2.53 mmHg and 15.69 ± 3.35 mmHg, respectively. There was a significant difference in the IOP change (p = 0.008). In the 52 myopic eyes, the mean precycloplegic IOP and postcycloplegic IOP were 14.38 ± 2.44 mmHg and 14.61 ± 2.80 mmHg, respectively (p = 0.72). There was no significant IOP change in the myopic group. The postcycloplegic IOP was significantly different between the hyperopic and the myopic groups (p = 0.021). Three eyes (3.3%) had an IOP elevation more than 5.0 mmHg after cycloplegic mydriasis. Postcycloplegic refraction showed significant hyperopic shifts in all eyes (p < 0.0001). CONCLUSION: Cycloplegic mydriasis with 1% cyclopentolate and 1% tropicamide caused IOP changes in preschool and school-aged children with hyperopia. Ophthalmologists should be very cautious in monitoring IOP changes for children with cycloplegic medication use.

Macular parameters of Stratus optical coherence tomography for assessing glaucoma in high myopia.

BACKGROUND: The aim was to assess the macular parameters of glaucoma in highly myopic subjects. METHODS: In a retrospective study, we enrolled 72 highly myopic eyes (spherical equivalent up to -6.00 D), of which 31 had early to moderate glaucoma and 41 formed a control group. The diagnosis of early to moderate glaucoma was based on glaucomatous visual-field defects with a mean deviation better than -12 dB. All patients underwent imaging with Stratus optical coherence tomography. We subsequently performed analysis for macular volume and thickness parameters between two groups. RESULTS: Using Stratus optical coherence tomography, we found significantly lower values in both macular thickness and volume over outer superior, outer nasal, outer inferior, inner temporal and inner inferior regions in highly myopic eyes with early to moderate glaucoma than in the control group. The macular outer inferior average thickness, macular outer inferior average volume and total average macular volume on Stratus optical coherence tomography had a best combination of sensitivity and specificity (85.4 and 74.2 per cent, respectively). The outer inferior average volume and outer inferior average thickness parameters showed areas under the receiver operating characteristic curve value of 0.85 (95% CI 0.76 to 0.94), which were best for discriminating between early to moderate glaucoma and the control group. CONCLUSION: Using Stratus optical coherence tomography, the outer inferior macular volume is the only independent predictor for detecting early to moderate glaucoma in high myopia. The macular outer inferior thickness and volume parameters showed good sensitivity, specificity and area under the receiver operating characteristic curve. These parameters may provide a complementary glaucomatous diagnosis in highly myopic eyes.