Lamina cribrosa surface position in idiopathic intracranial hypertension with swept-source optical coherence tomography.

Purpose: The purpose of this study is to compare the thickness and depth measurements of the lamina cribrosa (LC) obtained using a swept-source optical coherence tomography (SS-OCT) device in idiopathic intracranial hypertension (IIH) patients and healthy subjects. Methods: This retrospective, cross-sectional observational study included 16 eyes with IIH and 20 control eyes. The LC measurements with serial horizontal B scans of the optic nerve head were obtained using SS-OCT (Topcon 3D DRI OCT Triton). The anterior lamina surface (ALS) depth, posterior lamina surface (PLS) depth, and LC thickness measurements were evaluated. Results: In patients with IIH, the mean ALS depth was 225.00 ± 58.57 µm and the mean PLS depth was 449.75 ± 63.50 µm. In the IIH control group, the corresponding values were 359.40 ± 105.38 and 570.10 ± 99.41 µm (P < 0.05). The difference in LC thickness between the IIH and control subjects was not statistically significant. Conclusion: LC can be evaluated using an SS-OCT device. LC was displaced anteriorly in patients with IIH compared with normal controls. The assessment of LC level with SS-OCT in IIH cases is a valuable and reproducible adjunctive imaging method in terms of diagnosis and follow-up.

Short- to long-term results of Ahmed glaucoma valve in the management of elevated intraocular pressure in patients with pediatric uveitis.

OBJECTIVE: The aim of this study was to evaluate the long-term outcome of Ahmed glaucoma valve (AGV) implant for elevated intraocular pressure (IOP) in pediatric patients with uveitis. DESIGN: This was a retrospective chart review. PARTICIPANTS: The study included 16 eyes (11 children) with uveitis. METHODS: Success was defined as having IOP between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucoma medications and without the need for further glaucoma or tube extraction surgery. RESULTS: Mean age of patients at the time of AGV implantation was 14.19 ± 3.25 years. AGV implantation was the first glaucoma surgical procedure in 12 eyes (75%). Average postoperative follow-up period was 64.46 ± 33.56 months. Mean preoperative IOP was 33.50 ± 7.30 mm Hg versus 12.69 ± 3.20 mm Hg at the last follow-up visit (p < 0.001). Three eyes (18.7%) were determined as cases of "failure" because of tube removal in 2 eyes and a second AGV implantation in 1 eye. The cumulative probability of complete success was 68.8% at 6 months, 56.3% at 12 months, 49.2% at 36 months, 42.2% at 48 months, and 35.2% at 84 months, and the cumulative probability of eyes without complication was 75.0% at 6 months, 66.7% at 24 months, 58.3% at 36 months, 48.6% at 48 months and 24.3% at 108 months based on Kaplan-Meier survival analysis. CONCLUSIONS: Although AGV implant is an effective choice in the management of elevated IOP in pediatric uveitis, antiglaucoma medications are frequently needed for control of IOP. Tube exposure is an important complication in the long term. Differential diagnosis between relapse of uveitis and endophthalmitis is important in patients who received AGV implantation.

A Case of Presumed Tuberculosis Uveitis with Occlusive Vasculitis from an Endemic Region.

In this report, we present a case with presumed unilateral tuberculosis uveitis from an endemic region. A 23-year-old male presented with decreased vision in his left eye for 15 days. Visual acuities were 1.0 in his right eye and 0.3 in his left eye. Ophthalmologic examination was normal for the right eye. Slit-lamp examination revealed 2+ cells in the vitreous without anterior chamber reaction in his left eye. Fundus examination revealed occlusive vasculitis and granuloma. His history revealed that he had a respiratory infection with fever 3 months ago while visiting his native country, Rwanda, and was treated with non-specific antibiotic therapy. His visual symptom started 2 weeks after his systemic symptoms resolved. Laboratory findings included 15 mm induration in purified protein derivative tuberculin skin test, HIV negativity, and parenchymal lesions in chest X-ray. Bronchoalveolar lavage was negative for acid-fast bacillus. A pulmonary disease consultant reported presumed tuberculosis because of the patient's history. Anti-tuberculosis treatment was initiated. The patient's visual acuity improved rapidly and his signs regressed. A careful history should be taken from patients with uveitis. Travel to tuberculosis-endemic areas may be important for diagnosis and should be asked about directly.

Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD). PATIENTS AND METHODS: A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery. RESULTS: Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed. CONCLUSIONS: This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).

The Effect of Adjuvant Intracameral Triamcinolone Acetonide on the Surgical Results of Trabeculectomy with Mitomycin C.

OBJECTIVES: To evaluate the effect of adjuvant intracameral triamcinolone acetonide (TA) on the surgical results of trabeculectomy with mitomycin C. MATERIALS AND METHODS: All consecutive trabeculectomy cases performed in the glaucoma clinic between July 2012 and December 2013 were retrospectively reviewed from the patient charts. Only those with follow-up of 12 months or longer were included. Patients with intraoperative intracameral TA (study group, n=19) were compared to those without TA (control group, n=21) in terms of surgical success, intraocular pressure (IOP) change, medication use and complications. RESULTS: Forty eyes of 31 patients (21 male/10 female, mean age 64.2±13.8 years) were included in the study. The mean follow-up period was 20.9±5.1 months and 20.7±6.7 months in the study and control groups, respectively (p=0.830). Baseline IOP was 26.4±9.9 and 25.2±7.6 mmHg (p=0.979), and final IOP was 12.7±2.6 and 13.6±3 mmHg in both groups respectively (p=0.226). At the final follow-up, complete success was observed in 68.4% and 52.4% of the study and control groups (p=0.349) and anti-glaucoma medication was used by 31.6% (mean number of medications: 0.79±1.2) and 47.6% (mean number of medications: 1.33±1.7), respectively (p>0.05). Bleb encapsulation, leakage, suture-lysis and hypotony rates were similar in both groups (for all, p>0.05). Cataract progression was noted in six (35.3%) and in five (26.3%) of the phakic eyes in the study and control groups, respectively (p=0.720). CONCLUSION: When used intracamerally, TA did not increase the complication rate in trabeculectomy surgery. Although the group that received TA showed lower IOP levels, use of fewer medications and fewer eyes requiring medication, the differences did not reach significance.

Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate outcomes of patients with uveitic glaucoma secondary to Behçet disease (BD) who underwent Ahmed glaucoma valve (AGV) implantation. PATIENTS AND METHODS: A retrospective chart review of 14 eyes of 10 patients with uveitic glaucoma associated with BD who underwent AGV implantation at a tertiary referral center. Treatment success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with or without antiglaucoma medication, without further additional glaucoma surgery or loss of light perception. The main outcome measures were IOP, best-corrected visual acuity measured with Snellen charts, and number of glaucoma medications. RESULTS: Mean duration of postoperative follow-up was 18.2±6.6 months (range, 6 to 31 mo). Of the 14 eyes, 10 (71.4%) were pseudophakic and 5 (35.7%) had primary AGV implantation without a history of previous glaucoma surgery. At the most recent follow-up visit, 13 of the 14 eyes had an IOP between 6 and 21 mm Hg. Mean IOP was significantly reduced during follow-up, as compared with preoperative values (P≤0.005). The cumulative probability of surgical success rate was 90.9% at 18 months based on Kaplan-Meier survival analysis. The mean number of antiglaucoma medications required to achieve the desired IOP decreased from 3.4±0.5 preoperatively to 1.0±1.1 postoperatively (P≤0.05). Visual acuity loss of >2 lines occurred in 4 eyes (28.5%) due to optic atrophy associated with retinal vasculitis. Temporary hypotony developed during follow-up in 4 eyes (28.5%) at first postoperative week. CONCLUSIONS: For the management of uveitic glaucoma associated with BD, AGV implantation is a successful method for glaucoma control but requires additional surgical interventions for high early hypotony rates.

Selective laser trabeculoplasty for glaucoma secondary to emulsified silicone oil after pars plana vitrectomy: a pilot study.

BACKGROUND: To investigate the efficacy of selective laser trabeculoplasty (SLT) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO). METHODOLOGY/PRINCIPAL FINDINGS: Prospective, interventional, consecutive case series of 11 eyes with sustained elevation of IOP after SO removal. The mean IOP at baseline, week 1, month 1, month 3, and month 6 was evaluated. The mean baseline IOP was significantly decreased from 25 ± 2.7 mmHg to 18.4 ± 5.5 mmHg at week 1 (P = 0.01), 17.9 ± 3.1 mmHg at month 1 (P = 0.008), 15.8 ± 3.9 mmHg at month 3 (P = 0.003), and 16.2 ± 4.7 mmHg at month 6 (P = 0.004). IOP < 21 mmHg was achieved in 91% of the eyes without a significant complication at month 6. CONCLUSION/SIGNIFICANCE: SLT may be successful for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.

Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients.

OBJECTIVE: Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique. METHODS: A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded. RESULTS: This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9-49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8-55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series. CONCLUSIONS: The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.

A comparison of optic nerve head topographic measurements by Stratus OCT in patients with macrodiscs and normal-sized healthy discs.

PURPOSE: To evaluate and compare optic nerve head parameters and retinal nerve fiber layer (RNFL) thickness between large discs and normal-sized vital discs using Stratus optical coherence tomography (OCT). METHODS: A total of 293 healthy eyes (145 with macrodisc and 148 with normal-sized disc) were enrolled in the study. After a complete ophthalmic evaluation, measurement of optic nerve head parameters and RNFL thickness using OCT was performed in all subjects. Optic disc areas larger than 2.80 mm were accepted as macrodiscs. All OCT parameters were compared between normal-sized discs and macrodiscs. RESULTS: Participants' mean age was 46.5±10.6 years (range, 13 to 74 y). Average optic disc areas were 2.19±0.29 and 3.02±0.29 mm in the normal and the macrodisc groups, respectively. The optic disc area (P<0.0001), the cup area (P<0.0001), the horizontal cup disc ratio (P<0.0001), the vertical cup disc ratio (P<0.0001), and the cup disc area ratio (P<0.0001) were found to be significantly different in the macrodisc group and the control group. Rim areas (P=0.57) and RNFL thicknesses (inferior, superior, and mean) were found to be similar in both groups (P=0.75, 0.65, 0.85, respectively). CONCLUSIONS: A macrodisc may have a macrocup and should not be misdiagnosed as glaucoma. The present study showed that macrodiscs are identical to normal-sized discs in terms of rim area and RNFL thickness. We suggest that these 2 OCT parameters can help to differentiate a healthy macrodisc from a glaucomatous optic disc.

Medial transposition of a split lateral rectus muscle for complete oculomotor nerve palsy.

PURPOSE: To evaluate the effect on ocular alignment of Y splitting the lateral rectus muscle and then reattaching the 2 ends near the medial rectus muscle insertion in patients with complete oculomotor nerve palsy. METHODS: All eyes with oculomotor nerve palsy treated between May 2008 and February 2010 with Y splitting and transposition of the lateral rectus muscle to the medial rectus muscle were prospectively studied. In this procedure, the lateral rectus muscle was split: the upper half was transposed to the superior border and the lower half to the inferior border of the medial rectus insertion. For the muscles that had lost the ability to stretch and strain due to fibrosis, a hang-back technique was used. In some patients, the medial rectus muscle of the same eye was subsequently strengthened or the lateral rectus muscle of the fellow eye was recessed. Final deviation from 0(Δ) to 10(Δ) was considered a successful result. RESULTS: A total of 10 patients were included. Patients had a preoperative horizontal deviation >45(Δ) (range, 45(Δ)-90(Δ)). Of the 10 patients, 5 attained stable results following surgery, and 5 with postoperative undercorrection between 20(Δ) and 30(Δ) required further surgeries. Postoperatively, 2 patients improved their sensorial status in a very limited range of gaze and 2 patients had symptomatic diplopia. CONCLUSIONS: Acceptable aesthetic results can be achieved in the treatment of complete oculomotor nerve palsy with the transposition of the split lateral rectus muscle to the medial rectus muscle area.

Analysis of iris structure and iridocorneal angle parameters with anterior segment optical coherence tomography in Fuchs' uveitis syndrome.

To evaluate the differences in the biometric parameters of iridocorneal angle and iris structure measured by anterior segment optical coherence tomography (AS-OCT) in Fuchs' uveitis syndrome (FUS). Seventy-six eyes of 38 consecutive patients with the diagnosis of unilateral FUS were recruited into this prospective, cross-sectional and comparative study. After a complete ocular examination, anterior segment biometric parameters were measured by Visante(®) AS-OCT. All parameters were compared between the two eyes of each patient statistically. The mean age of the 38 subjects was 32.5 ± 7.5 years (18 female and 20 male). The mean visual acuity was lower in eyes with FUS (0.55 ± 0.31) than in healthy eyes (0.93 ± 0.17). The central corneal thickness did not differ significantly between eyes. All iridocorneal angle parameters (angle-opening distance 500 and 750, scleral spur angle, trabecular-iris space (TISA) 500 and 750) except TISA 500 in temporal quadrant were significantly larger in eyes with FUS than in healthy eyes. Anterior chamber depth was deeper in the eyes with FUS than in the unaffected eyes. With regard to iris measurements, iris thickness in the thickest part, iris bowing and iris shape were all statistically different between the affected eye and the healthy eye in individual patients with FUS. However, no statistically significant differences were evident in iris thickness 500 µm, thickness in the middle and iris length. There were significant difference in iris shape between the two eyes of patients with glaucoma. AS-OCT as an imaging method provides us with many informative resultsin the analysis of anterior segment parameters in FUS.

Surgical Management of Pseudophakic Malignant Glaucoma via Anterior Segment-Peripheral Iridectomy Capsulo-Hyaloidectomy and Anterior Vitrectomy.

Purpose. To describe our surgical technique in the management of pseudophakic malignant glaucoma refractory to conventional treatment. Methods. Two pseudophakic eyes with malignant glaucoma underwent peripheral iridectomy, lens capsulectomy, hyaloidectomy, and anterior vitrectomy through a clear corneal incision by using a vitreous cutter. Results. Prompt resolution of malignant glaucoma was achieved in both cases and no recurrence was observed during postoperative followup of five months. Conclusions. An anterior segment surgeon can treat pseudophakic malignant glaucoma successfully by using a vitreous cutter inserted through a corneal incision and performing peripheral iridectomy, capsulo-hyaloidectomy, and anterior vitrectomy.

Corneal biomechanical properties and intraocular pressure measurement in patients with nanophthalmos.

AIMS: To compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with nanophthalmos and age-matched controls. METHODS: In this prospective, cross-sectional and comparative study, 27 eyes of 27 healthy individuals (control group) and 27 eyes of 27 patients with nanophthalmos (study group) were enrolled. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann correlated intraocular pressure (IOPg) were recorded for the right eye of each participant using Reichert Ocular Response Analyser measurements. Also, all participants in this study underwent a standardised ocular examination including IOP measurement with Goldmann applanation tonometry (IOP(GAT)), central corneal thickness and axial length (AL) assessments. RESULTS: Mean CH in the nanophthalmic eyes and in the control eyes were 13.3 ± 2.4 mm Hg and 11.6 ± 1.7 mm Hg, respectively (p=0.003); mean CRF values in the nanophthalmic and the control eyes were 13.2 ± 1.8 mm Hg and 11.4 ± 1.9 mm Hg, respectively (p=0.001). Mean IOP(GAT) was 15.2 ± 3.3 mm Hg in the nanophthalmic eyes and 13.4 ± 2.7 mm Hg in the control group (p=0.031); mean IOPg values for the nanophthalmic and the control groups were 17.1 ± 5.3 mm Hg and 14.7 ± 3.5 mm Hg, respectively (p=0.042). Mean IOPcc values in the nanophthalmic and the control group were 13.6 ± 6.1 mm Hg and 14.8 ± 3.2 mm Hg, respectively (p=0.365). CONCLUSION: The CH, CRF, IOPg and IOP(GAT) were significantly higher in the nanophthalmic eyes, whereas no significant differences in IOPcc were observed. These findings may be taken into account when measuring IOP values in patients with nanophthalmos.

Biomechanical properties of axially myopic cornea.

PURPOSE: To investigate biomechanical parameters of the cornea measured with ocular response analyzer (ORA) in myopic eyes with high axial length and the relationship between these parameters and axial length (AL). METHODS: A total of 165 eyes of 165 consecutive patients were included. Eyes with AL greater than 26 mm were named group 1 and eyes with AL shorter than 26 mm were named group 2. Axial length and keratometric values were measured by intraocular lens (IOL) Master optical biometry. Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the ORA. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). RESULTS: The mean age of total subjects was 43.0 ± 15.6 years. Eighty-three eyes were included in group 1; 82 eyes were included in group 2. The CH and CRF of group 1 were significantly lower than group 2. The IOPcc was significantly higher in group 1 than group 2. When group 1 and group 2 were combined for analysis, CH was negatively correlated with age. Both CH and CRF were significantly correlated with SE. However, CH and CRF were negatively correlated with AL. Also, there was significant correlation between AL and IOPcc (p<0.05). CONCLUSIONS: Highly myopic eyes showed decreased CH and CRF. As the AL increased the IOPcc also increased and the CH decreased. We conclude that the biomechanical properties of the cornea change with elongation of the eye and this may have an impact on IOP measurement.

Comparison of selective laser trabeculoplasty success in patients treated with either prostaglandin or timolol/dorzolamide fixed combination.

PURPOSE: The purpose of this study was to compare the efficacy of selective laser trabeculoplasty (SLT) in eyes of patients with open-angle glaucoma receiving either a prostaglandin (PG) analog or a timolol/dorzolamide fixed combination (TDFC). METHODS: In this retrospective study, we analyzed 48 eyes of 35 patients who underwent SLT for open-angle glaucoma receiving either a PG analog (n=20) or a TDFC (n=28). Mean decrease in intraocular pressure (IOP) and success rates were compared between patients treated with PG and those treated with TDFC. Success was defined as an IOP reduction of at least 20% at postoperative 1 year. RESULTS: The mean decrease in IOP in eyes treated with PG and in eyes treated with TDFC were 4.1±3.1 and 4.6±3.5 at 1 week (P=0.579), 5.3±3.4 and 5.7±2.0 at 1 month (P=0.485), 5.2±3.1 and 5.5±2.5 at 3 months (P=0.271), 5.0±3.1 and 6.1±2.5 and at 6 months (P=0.044), and 4.7±3.1 and 6.5±2.9 at 1 year (P=0.017), respectively. The success rate at postoperative 1 year was 50.0% (standard deviation±16) in eyes receiving PG and 78.6% (standard deviation:±11) in eyes receiving TDFC (P=0.041). CONCLUSION: This study shows that the SLT seems to be more effective in TDFC users than PG analog users.

Correlation between optical coherence tomography results and the Scoring Tool for Assessing Risk (STAR) score in patients with ocular hypertension.

PURPOSE: To correlate retinal nerve fiber layer thickness (RNFL) and optic nerve head (ONH) parameters measured with optical coherence tomography (OCT) with the Scoring Tool for Assessing Risk (STAR) threshold in patients with ocular hypertension (OH). METHODS: The study included 92 patients with OH. They were divided into low-risk (n=32), moderate-risk (n=36), and high-risk (n=24) groups according to STAR criteria. RNFL and ONH OCT protocols were used to evaluate all study participants. Major parameters for RNFL analysis were average RNFL thickness, superior quadrant, nasal quadrant, inferior quadrant, temporal quadrant, and segmental thickness per 12 o'clock hour position. ONH parameters were vertical integrated rim area (VIRA), horizontal integrated rim width (HIRW), disc diameter, disc area, cup area, rim area, cup-to-disc (C/D) area ratio, horizontal C/D ratio, and vertical C/D ratio. RESULTS: The highest area under receiver operating characteristics curves for distinguishing the high-risk group from the other groups were vertical C/D ratio (0.88), C/D area (0.88), VIRA (0.87), and HIRW (0.81) for ONH parameters, and inferior (0.82) and 6 o'clock hour position (0.77) for peripapillary RNFL thickness measurements. CONCLUSIONS: Inferior average, 6 o'clock hour position analyses for RNFL measurement, and VIRA, HIRW, C/D area, and vertical C/D ratio for ONH measurement were the best parameters for STAR staging in patients with OH.

The effect of clinical severity and eyelid rash on ocular involvement in primary varicella infection.

PURPOSE: To describe ocular manifestations in primary varicella infection and their relationship to systemic severity and the associated eyelid rash. METHODS: One hundred consecutive children with primary varicella were examined prospectively. The cases were classified as mild, moderate, and severe according to the severity of clinical presentation. Excluding the presence of eyelid rash, children with ocular findings were assigned to group 1 (G1), and those without ocular findings were assigned to group 2 (G2). Patients in G1 were also evaluated according to the nature of ocular manifestations and the course of uveitis. RESULTS: Twenty-one percent of patients had ocular involvement (G1) and 79% had no ocular involvement (G2). While chickenpox had a mild course in 85.7% of patients in G1 and 88.6% of patients in G2, all others had a moderate course. None of the children had a severe course. A varicella eyelid rash was present in 28.6% of patients in G1 and 13.9% in G2. Among ocular findings, 38.1% of patients had conjunctivitis, 57.1% had anterior uveitis, and 4.8% had disciform keratouveitis. There was no significant association between severity of chickenpox and severity of ocular involvement (p=0.712). There was also no relationship between eyelid rash and ocular involvement (p=0.787). CONCLUSIONS: There is neither an association between the severity of chickenpox and the severity of ocular involvement nor an association between the presence of a varicella eyelid rash and the development of uveitis. As the prognosis regarding sequelae of ocular involvement in varicella infection is good, only those patients with ocular signs and symptoms need be referred by pediatricians for an ophthalmologic examination.

The correlation between visual field defects and focal nerve fiber layer thickness measured with optical coherence tomography in the evaluation of glaucoma.

PURPOSE: To study the correlation between known visual field defects and retinal nerve fiber layer (RNFL) thickness detected by optical coherence tomography (OCT) in glaucomatous eyes. MATERIALS AND METHODS: Visual field parameters and OCT RNFL measurements of 28 eyes of 28 glaucoma patients with various stages of glaucoma were compared with 38 eyes of 38 normal age-matched controls. A perimetric nerve fiber bundle map was built by dividing the visual field area into 21 zones. Mean deviation and pattern standard deviation values within these 21 zones were compared with OCT RNFL thickness measurements in 12 sectors and the results were analyzed. RESULTS: Average RNFL thickness was 62.90+/-16.56 microm in the glaucoma group and 111.90+/-6.00 microm in the control group (P<0.05). Pattern standard deviation and mean deviation visual field zones and corresponding OCT RNFL thickness sectors were significantly correlated at specific sectors in the glaucoma group (P<0.01). CONCLUSIONS: Analysis of RNFL thickness in eyes with focal glaucomatous visual field defects showed good structural and functional correlation with OCT. OCT contributes to the identification of focal defects in the RNFL of glaucoma patients.

Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma.

PURPOSE: This retrospective study was designed to evaluate the risk factors for the development of posttraumatic glaucoma after ocular trauma. METHODS: Data were obtained from the records of 102 patients (105 eyes) that experienced blunt or penetrating ocular trauma and presented to our center between January 1987 and April 2006. Logistic regression was used to evaluate the association between the baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals (CI) were obtained. RESULTS: Need for glaucoma surgery was independently associated with hyphema (odds ratio: 0.279; 95% CI: 0.085-0.916), corneal injury (odds ratio: 12.143; 95% CI: 2.029-72.66), presence of optic atrophy (odds ratio: 8.000; 95% CI: 1.615-39.636), visual acuity <20/200 (odds ratio: 50.00; 95% CI: 10.183-245.501), and a history of penetrating ocular trauma (odds ratio: 10.00; 95% CI: 2.819-38.635). Corneal (odds ratio: 1.113; 95% CI: 1.022-1.213) and vitreal injuries (odds ratio: 10.410; 95% CI: 1.232-87.97) were found to be statistically significant factors for the development of early glaucoma. CONCLUSIONS: This study found several independent predictive factors that were significantly associated with the need for glaucoma surgery in cases of posttraumatic glaucoma, including hyphema, corneal injury, presence of optic atrophy, visual acuity <20/200, and a history of penetrating ocular trauma. Additionally, some factors were found to affect the development of early glaucoma after ocular trauma, such as corneal and vitreal injury.