A 4-Year Retrospective Study: Clinical Outcomes of XEN45 in Patients with Glaucoma.

INTRODUCTION: The main purpose of the current study was to evaluate the long-term effectiveness and safety of XEN45 implant, either alone or in combination with cataract surgery, in patients with glaucoma. METHODS: Retrospective and single center study conducted on consecutive patients who underwent a XEN45 implant, either alone or in combination with cataract surgery, between November 2016 and October 2021. The primary endpoint was the mean intraocular pressure (IOP) lowering from preoperative values. RESULTS: Among the 230 screened patients, 206 eyes (176 patients) were included. Fifty-three (25.7%) eyes had undergone XEN alone and 153 (74.3%) eyes had undergone a combined procedure (XEN+phacoemulsification). The mean preoperative IOP was significantly higher in the XEN-alone (22.2 ± 5.9 mm Hg) than in the XEN+Phaco (19.8 ± 4.5 mm Hg) group (p = 0.0035). In the overall study population, the mean preoperative IOP was significantly lowered from 20.5 ± 5.0 mm Hg to 15.8 ± 4.4 at year-4, p < 0.0001. The mean preoperative (95% confidence interval) IOP was significantly lowered from 22.2 (20.6-23.8) mm Hg and 19.8 (19.1-20.6) mm Hg to 15.6 (12.2-16.9) mm Hg and 15.9 (15.2-16.5) mm Hg at year-4 in the XEN-alone and XEN+Phaco groups, respectively (p < 0.0001 each, respectively). The number of ocular hypotensive medications was significant reduced from 2.6 ± 1.0 drugs to 1.3 ± 1.3 drugs, with no significant differences between XEN-alone and XEN+Phaco groups (p = 0.1671). On the first postoperative day, 62 (30.1%) eyes presented some type of complication. Fifteen (7.3%) eyes underwent a needling procedure. CONCLUSION: XEN45, either alone or in combination with phacoemulsification, significantly lowered the IOP and reduced the need of ocular hypotensive medication in the long-term.

The use of zonal analysis of peripapillary choroidal thickness in primary open-angle glaucoma.

PURPOSE: To evaluate automatic peripapillary choroidal thickness (PPCT) measurements in a wide area around the optic disc and various established zones in primary open-angle glaucoma (POAG) patients and age- and sex-matched healthy controls using a new swept-source optical coherence tomography (SS-OCT) device. STUDY DESIGN: Single center cross-sectional observational study. METHODS: A total of 135 POAG patients and 86 healthy subjects were consecutively enrolled. An optic disc 6.0 × 6.0 mm three-dimensional scan OD was obtained using the SS-OCT Triton. A 26 × 26 cube-grid centered in the optic disc was generated to automatically measure choroidal thickness. Seven choroidal zones were established (superior temporal, central, and nasal; inferior temporal, central, and nasal, and the optic nerve head) and compared between healthy controls and POAG patients. RESULTS: PPCT was significantly thinner in the central superior, nasal superior, and nasal inferior zones of the POAG subjects. Choroidal thickness in the central superior zone was 124.61 ± 54.95 µm in POAG group vs 156.17 ± 80.89 µm in healthy controls (p = 0.029); in the nasal superior zone, 133.84 ± 58.89 µm in the POAG group vs 168.34 ± 73.45 µm in healthy controls (p = 0.012); and in the nasal inferior zone, 113.45 ± 49.93 µm in the POAG group vs 137.47 ± 65.96 µm in healthy controls (p = 0.049). CONCLUSION: Compared with healthy subjects, glaucoma patients present with peripapillary choroidal thinning, especially in the central superior, nasal superior, and nasal inferior zones. The new SS-OCT could be a useful tool to evaluate choroidal thinning, and it could be an additional support to facilitate glaucoma diagnosis.

Peripapillary Choroidal Thickness Analysis Using Swept-Source Optical Coherence Tomography in Glaucoma Patients: A Broader Approach.

AIMS: To evaluate and compare peripapillary choroidal thickness (PPCT) in a wide area around the optic disk and various choroidal established zones in healthy controls and primary open-angle glaucoma (POAG) patients using a new swept-source (SS) optical coherence tomography (OCT) device. METHODS: A total of 246 eyes were finally included in this observational, prospective, cross-sectional study: 111 healthy controls and 135 POAG patients. The healthy subjects were divided into 2 populations: the teaching population (25 used to establish choroidal zones) and the validating population (86 used for comparing choroidal thickness with POAG patients). A 26 × 26 cube grid centered on the optic disk was generated using an SS-OCT to automatically measure choroidal thickness. Four choroidal zones were established and used to compare PPCT between healthy controls and POAG patients. RESULTS: PPCT was significantly thinner in zones 3 and 4 of the POAG group. The choroid exhibited a similar pattern in controls and patients with POAG; it was thickest in the superior region, followed in order by the temporal, nasal, and inferior regions. CONCLUSIONS: Peripapillary choroidal tissue shows a concentric pattern in both groups, and glaucoma patients present with peripapillary choroidal thinning compared with healthy subjects, especially in areas further away from the optic disk.

Evaluation of the Macular Ganglion Cell-Inner Plexiform Layer and the Circumpapillary Retinal Nerve Fiber Layer in Early to Severe Stages of Glaucoma: Correlation with Central Visual Function and Visual Field Indexes.

OBJECTIVES: To compare the circumpapillary retinal nerve fiber layer (cpRNFL) and the macular ganglion cell-inner plexiform layer (GCIPL) in glaucoma patients at different disease stages and to evaluate correlations between optical coherence tomography (OCT) parameters with central visual function and visual field (VF) indexes. PATIENTS AND METHODS: One hundred forty patients were included in this prospective cross-sectional study. Subjects diagnosed with chronic open-angle glaucoma and 20/40 or better vision were recruited and classified as having early, moderate, or severe VF defects based on Hodapp-Parrish-Anderson criteria. cpRNFL and macular GCIPL were measured using Cirrus high-definition OCT. Central retinal sensitivity and visual acuity were recorded. RESULTS: All OCT measurements differed significantly between patients with early and severe VF defects (p < 0.001). Correlations between central vision and VF indexes with OCT measurements were moderate but significant; better-correlated OCT parameters were the inferior cpRNFL quadrant, average cpRNFL thickness, inferior and inferior temporal GCIPL sectors, and minimum GCIPL thickness (r = 0.63-0.71, p < 0.001). Visual acuity was not correlated with either circumpapillary or macular OCT measurements. CONCLUSIONS: Inner macular parameters performed as well as cpRNFL in patients with different stages of glaucoma. Inferior macular GCIPL sectors, minimum GCIPL thickness, and the inferior cpRNFL quadrant best differentiate disease severity and correlate with central visual function and VF indexes.

Relationship between Visual Dysfunction and Retinal Changes in Patients with Multiple Sclerosis.

AIM: To evaluate structural changes in the retina and their correlation with visual dysfunction in patients with multiple sclerosis. METHODS: Patients with multiple sclerosis (n = 84) and healthy controls (n = 84) underwent structural evaluation of the retinal nerve fiber layer, and macular and ganglion cell layer thicknesses using Spectral domain optical coherence tomography (SD-OCT). All subjects underwent high and low contrast visual acuity, color vision (using the Farnsworth and L´Anthony desaturated D15 color tests), and contrast sensitivity vision using the Pelli Robson chart and CSV 1000E test. RESULTS: Macular, retinal nerve fiber layer, and ganglion cell layer thinning was observed in multiple sclerosis patients compared to healthy controls (p<0.05). High- and low-contrast visual acuity and contrast sensitivity vision at four different spatial frequencies were significantly reduced in comparison with healthy subjects (p<0.05). Macular, retinal nerve fiber layer and ganglion cell layer measurements correlated with high and low contrast visual acuity, and contrast sensitivity vision. Contrast sensitivity vision was the functional parameter that most strongly correlated with the structural measurements in multiple sclerosis and was associated with ganglion cell layer measurements. The L´Anthony color vision score (age-corrected color confusion index) was associated with macular measurements. CONCLUSIONS: Patients with multiple sclerosis had visual dysfunction that correlated with structural changes evaluated by SD-OCT. Macular and ganglion cell layer measurements may be good indicators of visual impairment in multiple sclerosis patients.

Detecting Optic Atrophy in Multiple Sclerosis Patients Using New Colorimetric Analysis Software: From Idea to Application.

Neuro-ophthalmologists typically observe a temporal pallor of the optic disc in patients with multiple sclerosis. Here, we describe the emergence of an idea to quantify these optic disc color changes in multiple sclerosis patients. We recruited 12 multiple sclerosis patients with previous optic neuritis attack and obtained photographs of their optic discs. The Laguna ONhE, a new colorimetric software using hemoglobin as the reference pigment in the papilla, was used for the analysis. The papilla of these multiple sclerosis patients showed greater pallor, especially in the temporal sector. The software detected the pallor and assigned hemoglobin percentages below normal reference values. Measurements of optic disc hemoglobin levels obtained with the Laguna ONhE software program had good ability to detect optic atrophy and, consequently, axonal loss in multiple sclerosis patients. This new technology is easy to implement in routine clinical practice.

Measuring hemoglobin levels in the optic disc of Parkinson's disease patients using new colorimetric analysis software.

Objective. To evaluate a new method of measuring hemoglobin (Hb) levels and quantifying the color changes in the optic nerve head of Parkinson's disease (PD) patients. We also compared differences in retinal nerve fiber layer (RNFL) thicknesses obtained using spectral domain optical coherence tomography (OCT) device between PD group and healthy group. Methods. One hundred and fifty-five PD patients and 91 sex- and age-matched healthy subjects were included in this cross-sectional study. OCT examinations and one photograph of the optic disc were performed. The Laguna ONhE ("optic nerve hemoglobin"; Insoft SL, Tenerife, Spain) software was used to analyze the Hb level on the acquired optic disc photographs. Results. PD patients exhibited significantly reduced mean optic disc Hb percentages (57.56% in PD, 67.63% in healthy subjects; P = 0.001) as well as reduced Hb in almost all analyzed sectors, with the largest differences detected in the inferior and nasal sectors. RNFL parameters were significantly reduced in PD patients compared with healthy subjects, especially in the inferior quadrant. Conclusions. Measurements of optic disc Hb levels obtained with the Laguna ONhE software had good ability to detect optic nerve color changes (more papillary paleness and consequently this could suggest optic atrophy and axonal loss) in PD patients.

Diagnostic ability of a new method for measuring haemoglobin levels in the optic nerve head in multiple sclerosis patients.

AIMS: To evaluate a new method for measuring haemoglobin (Hb) levels and quantifying the colour changes in the optic nerve head of multiple sclerosis (MS) patients to detect axonal loss and consequently optic disc atrophy. MATERIAL AND METHODS: 40 MS patients and 40 age and sex-matched healthy subjects were included in this prospective cross-sectional study and underwent a full ophthalmological examination, including three photographs of the optic disc. The Laguna ONhE ('optic nerve hemoglobin'; Insoft SL, Tenerife, Spain) software was used to obtain the Hb analysis in each of the 24 sectors and average Hb of optic disc photographs acquired. Reproducibility of measurements provided by Laguna ONhE program was analysed. RESULTS: MS patients showed significant reduction of optic disc Hb percentages in average Hb (58.99% in MS, 65.39% in healthy subjects; p<0.001) and in almost all analysed sectors with the largest differences in temporal sectors. Laguna ONhE program showed good reproducibility measuring Hb percentages in MS patients and healthy subjects. CONCLUSIONS: Measurements of optic disc Hb levels obtained with Laguna ONhE software had good ability detecting optic atrophy and axonal loss in MS patients. This method had good reliability and is easy to implement in routine clinical practice.