Clinical Staging of Prostaglandin-Associated Periorbitopathy Syndrome in Glaucoma: A Review from Asia.

PURPOSE: Topical prostaglandin analogues are commonly used to treat patients with glaucoma, but may cause periocular and periorbital complications known as prostaglandin-associated periorbitopathy syndrome (PAPS). METHODS: A literature review was conducted on PAPS. Given the lack of consensus on grading PAPS, glaucoma specialists from Asia convened to evaluate current PAPS grading systems and propose additional considerations in grading PAPS. RESULTS: Existing grading systems are limited by the lack of specificity in defining grades and consideration for patients' subjective perception of symptoms. Patient-reported symptoms (e.g., via a self-assessment tool) and additional clinical assessments (e.g., exophthalmometry, lid laxity, differences between tonometry results, baseline measurements, and external ocular photographs) would be beneficial for grading PAPS systematically. CONCLUSIONS: Effective management of PAPS could be facilitated by a common clinical grading system to consistently and accurately diagnose and characterise symptoms. Further research is required to validate specific recommendations and approaches to stage and monitor PAPS.

Comparison of near vision in glaucoma patients using standard and reversed-contrast charts.

CLINICAL RELEVANCE: Reversed-contrast testing is easy to perform via electronic devices and may improve reading performance and the quality of life of most glaucoma patients. BACKGROUND: Electronic devices are becoming increasing popularity and most devices have easily adjustable contrast settings. This study investigated near vision acuity and preference between the standard visual acuity chart (black text on white background) and a reversed-contrast chart (white text on black background) in glaucoma patients with decreasing contrast sensitivity. METHODS: This cross-sectional study evaluated 177 eyes of 177 patients from a single glaucoma clinic. The better eye of primary glaucoma patients (visual acuity of 6/20 or better) was evaluated. Patients with any other condition affecting visual acuity or reading performance were excluded. Near visual acuity was measured using a device with an anti-glare screen at 40 cm distance for both standard and reversed-contrast charts. RESULTS: Glaucoma patients had a significantly better average near visual acuity using the reversed-contrast chart than using the standard chart (median best-corrected visual acuity, LogMAR = 0.12; interquartile range = 0.18 vs median best-corrected visual acuity, LogMAR = 0.2; interquartile range = 0.26; respectively; P < 0.01), with more prominent differences in the advanced glaucoma group (median best-corrected visual acuity of reversed contrast chart: median best-corrected visual acuity of standard chart = 0.12:0.2, 0.12:0.13, and 0.18:0.22 in the early, moderate, and severe groups, respectively, P < 0.01 in early and severe group and P = 0.02 in moderate group). One hundred and nine (109) out of 177 patients (61.58%) preferred the reversed contrast version. CONCLUSION: Reversed contrast materials may improve the reading performance and quality of life of patients with glaucoma, especially those with severe disease.

Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma.

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

Incidence of steroid induced-ocular hypertension in postoperative pterygium excision.

BACKGROUND: Steroid eye drops were widely used for suppression ocular inflammation in many conditions. Unfortunately, steroid eye drops can cause many side effects; the important one was steroid-induced ocular hypertension that may progress to seconday glaucoma. OBJECTIVE: To evaluate incidence ofsteroid responder following topical dexamethasone use after pterygium excision with amniotic membrane graft. DESIGN: Prospective descriptive study. MATERIAL AND METHOD: The present study was designed to evaluate intraocular pressure (IOP) change from topical dexamethasone eye drops in postoperative pteiygium excision with amniotic membrane grafting. The subjects were routinely prescribed CD-oph (1 mg/ml dexamethasone sodium phosphate, 5 mg/nd chloramphenicol and 0.25 mg/ml Tetrahydrozaline hydrochloride) eye drops every 1 hour for 1 week, then every 2 hours until 1 month, then four times daily until 3 months postoperatively. The subjects were measured IOP at I week, 1 month, and 3 month postoperatively by applanation tonometer The steroid responder was defined as an elevation ofIOP at least 10 mmHgfrom preoperative. The incidence was calculated, trend of IOP rising and timing of peak IOP were assessed. RESULTS: Ofthe 62 patients, 6 were diagnosed as steroid responders (IOP >10 mmHg), 9.68% (95% CI 3.6-19.9). Mean of peak IOP rising was 4.02+/-3.18 mmHg with maximum IOP rising was 11 mmHg. 4 of 6 cases of steroid responders occur at 3 month postoperative, 2 another cases occur at 1 week and I month postoperative. Most of the subjects had IOP rising in range of 0-4 mmHg (62.90%), follow by 5-9 mmHg (2 7.42%), and > 10 mmHg (9.68%), respectively. Maximum IOP mostly in range of 16-20 mmHg (43.55%), follow by 11-15 mmHg (40.32%), 21-25 mmHg (9.68%), and more than 26 mmHg (6.45%), respectively. 45.16% of subjects showed the time of peak lOP at postoperative 1 month. CONCLUSIONS: Steroid response is a common problem in steroid use, especially with topical steroid eye drops. The incidence of steroid responderfrom this study was 9.68%, which may differ from the others by type, frequency of the topical steroid used, including criteria to diagnosis of steroid responder

Scanning protocol choice affects optical coherence tomography (OCT-3) measurements.

PURPOSE: To determine the optimal OCT-3 scanning protocol. METHODS: Normal subjects, ocular hypertensive, and open-angle glaucoma patients were enrolled. The "fast" RNFL scan protocol consists of 3 consecutive circular scans, each containing 256 A-scans obtained in a single 1.92 second session. The "regular" RNFL scan protocol contains 3 separate circular scans, each of which consists of 512 A-scans and is obtained in 1.28 seconds (total 3.84 seconds). A customized 256-point scan was created from the 512-point "regular" RNFL scan by extracting the RNFL measurements from every second point. Mean RNFL thickness measurements and mean coefficients of variation (CV) were calculated for each of the scan types. RESULTS: Thirty-one eyes with visual field defects (31 glaucoma eyes) and 30 eyes with normal fields (10 normal and 20 ocular hypertensive eyes) were enrolled. There was no difference in RNFL thickness or CV between fast, regular, or customized RNFL scans in the eyes with VF defects (P > 0.05 for all comparisons). Although eyes with normal fields showed no difference in CV between fast, regular, and customized RNFL scans (P > 0.05 for all comparisons), there was a thicker RNFL measurement using the fast RNFL scan (P = 0.01). CONCLUSIONS: Optimal sampling density for OCT-3 assessment of parapapillary RNFL thickness is not more than 256 axial determinations. Although both scanning protocols have good reproducibility, the scanning protocol should remain constant during serial OCT-3 evaluation.

Effect of pupillary dilation on retinal nerve fiber layer thickness measurements using optical coherence tomography.

PURPOSE: To evaluate the effect of pupillary dilation on retinal nerve fiber layer thickness (RNFL) measurements using optical coherence tomography (OCT-3). METHODS: Randomly chosen eyes of healthy individuals were scanned before and after pupillary dilation by two trained operators (R.G.O., R.V.) using OCT-3 (Carl Zeiss Meditec, Inc., Dublin, CA). Fast and regular RNFL (256 A-scans) OCT-3 protocols (software version A1.1) were used in each scanning session. RNFL thickness measurements before and after dilation were compared. RESULTS: Ten eyes of 10 subjects (6 females, 4 males) were enrolled. Mean age was 32.0 +/- 11.2 years (range, 21 to 52 years). Mean pupillary diameter before and after dilation was 2.9 +/- 0.6 mm and 7.6 +/- 0.8 mm, respectively (P < 0.0001, paired t-test). There was no significant difference in RNFL thickness measurements before and after dilation using both fast and regular RNFL protocols (P > or = 0.05 for all comparisons, paired t-test). Mean coefficients of variation for mean RNFL thickness measurements were 15.3% before and 13.7% after dilation for operator 1; and 10.8% before and 12.7% after dilation for operator 2 for the fast RNFL protocol and 11.3% versus 10.4% and 12.9 versus 11.1%, respectively, for the regular RNFL protocol. CONCLUSION: Pupillary dilation is not necessary in all subjects to obtain reproducible RNFL thickness measurements using OCT-3.