Analysis of macular volume in normal and glaucomatous eyes using optical coherence tomography.

PURPOSE: To evaluate macular volume in normal and glaucomatous eyes using optical coherence tomography (OCT). DESIGN: Case control study. METHOD: The authors assessed 272 eyes of 164 subjects as part of an institutional study at New England Eye Center in Boston, Massachusetts; 202 eyes were in the study group and 70 eyes in the control group. Eyes were categorized as normal (70 eyes of 43 subjects), glaucoma suspect (70 eyes of 44 subjects), early glaucoma (70 eyes of 47 subjects), or advanced glaucoma (62 eyes of 43 subjects). Subjects underwent analysis with the commercially available OCT1 unit. Optical coherence tomography macular neurosensory retinal thickness maps were used to calculate macular volume for comparison to Humphrey visual field testing, intraocular pressure measurement, and stereo biomicroscopy of the optic nerve head and nerve fiber layer. RESULTS: Using repeated measures regression, macular volume in normal (2.37 +/- 0.11 mm(3)) glaucoma suspect (2.33 +/- 0.16 mm(3)), and early glaucoma eyes (2.27 +/- 0.13 mm(3)) was significantly greater than in eyes with advanced glaucoma (2.12 +/- 0.23 mm(3), P =.0001, P =.0001, and P =.0008, respectively). Macular volume in normal eyes was significantly greater than in early glaucoma eyes (P =.01). CONCLUSIONS: Optical coherence tomography retinal macular volume correlates with known structural defects of glaucoma, providing a potential objective and quantitative parameter for evaluation. Our data show a significant difference in macular volume between normal, glaucoma suspect, and early glaucoma eyes, compared with advanced glaucomatous eyes as well as between normal and early glaucomatous eyes. This correlates with a trend of decreasing macular volume in eyes with more advanced disease.

Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome.

UNLABELLED: To characterize the differences in technique, complications, and outcomes in a large series of cataract extractions in patients with and without pseudoexfoliation (PEX) syndrome. SETTING: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. METHODS: A retrospective analysis was performed of 297 cases of cataract extraction in patients with PEX and 427 cases of cataract extraction in patients without PEX. This study examined and quantified the intraoperative and postoperative complications, performed a comparative outcomes analysis of intraocular pressure (IOP) change, and determined the prevalence of systemic vascular diseases in these patients. RESULTS: The overall rate of vitreous loss was 4% (7/297) in the PEX population and 0% (0/427) in the non-PEX group. There were no overall differences in the rate of postoperative complications. At 2 years, IOP had declined from a mean of 16.8 to 13.9 mm Hg in the PEX group and from 16.3 to 14.4 mm Hg in the non-PEX group. The decline was significantly greater in the PEX group. The prevalence of hypertension and diabetes was significantly greater in the non-PEX group (50% and 11%, respectively) than in the PEX group (38% and 5%, respectively). CONCLUSIONS: The increased frequency of intraoperative complications during cataract extraction in PEX patients stemmed from zonular weakness rather than capsule tears. Postoperative IOP declines were greater in the PEX group even 2 years after cataract extraction, suggesting the potential for long-term improvement in outflow facility in patients with coexisting cataract and glaucoma.

Rhegmatogenous retinal detachment with Schwartz's syndrome following Nd:YAG laser peripheral iridectomy in the management of pigmentary glaucoma.

A case of rhegmatogenous retinal detachment complicated by Schwartz's syndrome following Nd:YAG laser peripheral iridectomy in the management of pigmentary glaucoma is described. A 36-year-old man underwent Nd:YAG laser peripheral iridectomy for pigmentary glaucoma. Three days later, he had a rhegmatogenous retinal detachment. The break remained open following scleral buckling with persistent subretinal fluid, "iridocyclitis," and elevated intraocular pressure. Two months later, the patient underwent revision of the scleral buckle. Following closure of the retinal break, the retina flattened, and within 2 weeks the "iridocyditis" resolved and the intraocular pressure decreased to approximately 20 mm Hg. Rhegmatogenous retinal detachment may occur following laser peripheral iridectomy, and suggests the necessity for a prospective dinical trial to evaluate the role of laser peripheral iridectomy in the management of pigmentary glaucoma.