PREVALENCE OF VITREOUS CORTEX REMNANTS IN EYES WITH PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT UNDERGOING VITRECTOMY.

BACKGROUND/PURPOSE: To evaluate the prevalence and extent of vitreous cortex remnants (VCR) on the surface of the retina in eyes with primary rhegmatogenous retinal detachment (RRD) and posterior vitreous detachment. METHODS: Triamcinolone acetonide was injected in the vitreous cavity of 100 consecutive cases of acute primary RRD undergoing pars plana vitrectomy. A multivariate regression analysis was performed to determine any association between the presence and pattern of stained VCR on the surface of the retina and the following variables: age, diabetes, axial length, phakic status, extent of RRD, and macular status. RESULTS: Vitreous cortex remnants were found in 42 eyes. These were focal in eight eyes and diffuse in 34 eyes. Age was the only strong and independent risk factor associated with the presence of VCR (P = 0.0019). Age (P < 0.0001), axial length (P = 0.0037), and phakia (P = 0.01) were independent risk factors associated with the diffuse pattern. Neither diabetes, extent of RRD, nor macular status were significant risk factors for the presence or extent of VCR. CONCLUSION: Older patients with primary RRD and posterior vitreous detachment seem to be at a higher risk of having diffuse VCR. Further studies are needed to investigate the relevance of VCR in the pathogenesis, progression and treatment of RD.

Long-term Visual Outcomes and Complications of Boston Keratoprosthesis Type II Implantation.

PURPOSE: To report the long-term visual outcomes and complications after Boston keratoprosthesis type II implantation in the largest single-center case series with the longest average follow-up. DESIGN: Retrospective review of consecutive clinical case series. PARTICIPANTS: Between January 1992 and April 2015 at the Massachusetts Eye and Ear Infirmary, 48 eyes of 44 patients had keratoprosthesis type II implanted by 2 surgeons (C.H.D. and J.C.). METHODS: For each eye, data were collected and analyzed on the preoperative characteristics, intraoperative procedures, and postoperative course. MAIN OUTCOME MEASURES: Visual acuity outcomes, postoperative complications, and device retention. RESULTS: The most common indications for surgery were Stevens-Johnson syndrome in 41.7% (20 of 48 eyes) and mucous membrane pemphigoid in 41.7% (20 of 48 eyes). Mean follow-up duration was 70.2 months (standard deviation, 61.8 months; median, 52 months; range, 6 months to 19.8 years). Almost all patients (95.8%, 46 of 48 eyes) had a preoperative visual acuity of 20/200 or worse. Postoperative visual acuity improved to 20/200 or better in 37.5% (18 of 48 eyes) and to 20/100 or better in 33.3% (16 of 48 eyes) at the last follow-up visit. The most common postoperative complication was retroprosthetic membrane formation in over half (60.4%, 29 of 48 eyes). The most pressing postoperative complication was glaucoma onset or progression in about a third. Preexisting glaucoma was present in 72.9% (35 of 48 eyes). Glaucoma progressed in 27.1% (13 of 48 eyes) and was newly diagnosed in 8.3% (4 of 48 eyes) after surgery. Other postoperative complications were tarsorrhaphy revision in 52.1% (25 of 48 eyes), retinal detachment in 18.8% (9 of 48 eyes), infectious endophthalmitis in 6.3% (3 of 48 eyes), and choroidal detachment or hemorrhage in 8.3% (4 of 48 eyes). Half of eyes retained their initial keratoprosthesis at the last follow-up (50.0%, 24 of 48 eyes). CONCLUSIONS: The Boston keratoprosthesis type II is a viable option to salvage vision in patients with poor prognosis for other corneal procedures. Retroprosthetic membranes, keratoprosthesis retention, and glaucoma are major challenges in the postoperative period; however, the keratoprosthesis can still provide improved vision in a select group of patients.

Non-topography-guided photorefractive keratectomy for the correction of residual mild refractive errors after ICRS implantation and CXL in keratoconus.

PURPOSE: To evaluate the safety and clinical outcomes of non-topography-guided photorefractive keratectomy (PRK) for the treatment of residual mild refractive errors 6 months after sequential intracorneal ring segment (ICRS) implantation and corneal collagen cross-linking (CXL) in stable keratoconus. METHODS: This retrospective study included 17 eyes of 14 patients with mild to moderate keratoconus. The ICRS implantation and CXL were performed sequentially with a 4-week interval and non-topography-guided PRK was performed at least 6 months after CXL. Data were collected preoperatively and at the 6-month follow-up visits. RESULTS: ICRS implantation and CXL induced a significant decrease in keratometry and refraction and an increase in visual acuity. At the 6-month follow-up after ICRS implantation and CXL, uncorrected and corrected distance visual acuity (UDVA and CDVA) significantly improved from 1.17 ± 0.38 and 0.44 ± 0.09 logMAR preoperatively to 0.45 ± 0.11 and 0.17 ± 0.08 logMAR (P = .001) postoperatively, respectively. The mean spherical error decreased from -5.45 ± 1.64 to -2.57 ± 1.15 D (P = .01) and the mean cylinder from 3.86 ± 1.15 to 2.13 ± 1.11 D (P = .01). At the 6-month follow-up after PRK, UDVA significantly improved to 0.18 ± 0.06 logMAR and CDVA was 0.15 ± 0.05 logMAR. The mean spherical error and mean cylinder significantly decreased to -1.10 ± 0.41 D (P = .02) and 0.98 ± 0.37 D (P = .046), respectively. No intraoperative or postoperative complications occurred. CONCLUSIONS: At the 6-month follow-up, non-topography-guided PRK after ICRS implantation and CXL was found to be an effective and safe option for correcting residual refractive error and improving visual acuity in patients with moderate keratoconus.

Clinical and molecular findings in three Lebanese families with Bietti crystalline dystrophy: report on a novel mutation.

PURPOSE: Bietti crystalline dystrophy (BCD) is a rare autosomal recessive disorder caused by mutation of the cytochrome P450, family 4, subfamily V, polypeptide 2 (CYP4V2) gene and characterized by retinal pigmentary abnormalities and scattered deposits of crystals in the retina and the marginal cornea. The aim of this study was to investigate the spectrum of mutations in CYP4V2 in Lebanese families, and to characterize the phenotype of patients affected with BCD. METHODS: Nine patients from three unrelated Lebanese families were clinically and molecularly investigated. Detailed characterization of the patients' phenotype was performed with comprehensive ophthalmic examination, color vision study, fundus photography, visual field testing, retinal fluorescein angiography, electroretinography, and electrooculography. One family was followed for 12 years. The 11 exons of the CYP4V2 gene were sequenced. RESULTS: Symptoms consisting of night blindness, loss of paracentral visual field, and disturbed color vision were apparent during the third decade of life. Ophthalmoscopy revealed posterior pole crystalline deposits and areas of retinal pigment epithelium atrophy. Fluorescein angiography disclosed geographic areas of the pigment epithelium layer and choriocapillaris atrophy in the posterior pole and fundus periphery. The most striking findings were those of normal electroretinographic responses in some patients and clinical heterogeneity. Two mutations in CYP4V2 were found: p.I111T (c.332T>C) in exon 3 in two families and the novel p.V458M (c.1372G>A) mutation in exon 9 in one family. CONCLUSIONS: These patients are affected with Bietti crystalline dystrophy without corneal involvement. Variation in disease severity and electroretinographic responses suggests that environmental or additional genetic factors influence the course of the retinal disease. The CYP4V2 p.I111T (c.332T>C) mutant allele may be especially prevalent among patients with BCD in Lebanon, resulting from a single founder.

Six months' follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy.

PURPOSE: This study reports on the combination of excisional goniotomy and cataract extraction in the management of glaucoma in terms of intraocular pressure (IOP) and glaucoma medication reduction. METHODS: This is a retrospective case series. Twenty-eight eyes of 22 patients with the diagnosis of cataract and ocular hypertension or glaucoma of any stage underwent combined phacoemulsification and Kahook Dual Blade (KDB) goniotomy, between March 2019 and September 2020. The parameters evaluated were postoperative best-corrected visual acuity, mean IOP reduction, number of IOP-lowering medications, and the surgical success rate defined as IOP reduction >20% and/or reduction in glaucoma medications >1. RESULTS: The mean IOP reduction at 6 months was 4.5 mmHg (P = 0.0007), which translates to 24.9% reduction from preoperative IOP. The mean preoperative number of glaucoma medications was 2.9 ± 1.0 (median of 3). It was reduced to 1.1 ± 1.1 (median of 1.5), 1.46 ± 1.17 (median of 2), 1.44 ± 1.28 (median of 2), and 1.56 ± 1.28 (median of 2) at 1 week, 1 month, 3 months, and 6 months, respectively. Twenty-nine percent (8/28) of the patients were off glaucoma medications at 6 months and 46% (13/28) had a reduction of more than 50% of their glaucoma medications. CONCLUSION: Combined phacoemulsification-KDB excisional goniotomy may be an effective and safe alternative to more invasive filtering surgery in glaucoma patients of any stage.

Micropulse Transscleral Cyclophotocoagulation.

How to cite this article: Abdelmassih Y, Tomey K, Khoueir Z. Micropulse Transscleral Cyclophotocoagulation. J Curr Glaucoma Pract 2021;15(1):1-7.

Spontaneous Trabeculectomy Bleb Reformation and Regain of Function Following Phacoemulsification.

Phacoemulsification and cataract surgery in general often lead to trabeculectomy bleb failure. We herein describe an unusual occurrence in a 79-year-old female who had a failed trabeculectomy bleb for one year prior to presentation, and whose failed bleb became reformed, and she regained function on the first day post-phacoemulsification, manifesting as a decrease in intraocular pressure. Topical corticosteroids were used for one month postoperatively and the bleb remained functional over more than six months of follow-up. It is most likely that the intraocular pressure elevation that occurs during phacoemulsification was responsible for the reformation of the bleb, even after having been a failed bleb for a whole year.

Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial.

AIM AND OBJECTIVE: Evaluate the short-term safety and efficacy of dexmedetomidine (0.0055%) drops on intraocular pressure (IOP) in healthy eyes. MATERIALS AND METHODS: In this randomized controlled trial, patients with normal eye exams were randomly assigned to receive, in a randomly selected eye, one drop of either balanced salt solution (BSS) or dexmedetomidine (0.0055%). Goldmann applanation tonometry was performed at baseline and then 30 minutes, 4 hours, and 24 hours after drop instillation. RESULTS: Forty-nine eyes of 49 normal volunteers were enrolled in the study, with 21 eyes (group I) receiving BSS and 28 (group II) dexmedetomidine. Both groups were comparable at baseline as far as age and IOP (p = 0.55 for both parameters). Intraocular pressure significantly decreased from baseline in group II at 30 minutes and 4 hours (p = 0.001 and 0.05, respectively). Maximum IOP decrease was obtained at 30 minutes after dexmedetomidine instillation, with a 9% decrease from baseline (mean decrease: 1.15 mm Hg). The percentage of IOP decrease was significantly higher in group II at 30 minutes compared with group I (9 vs 1.1%; p = 0.05). No side effects were recorded. CONCLUSION: In this pilot study, dexmedetomidine 0.0055% drops have shown good safety and efficacy in lowering IOP in normal healthy volunteers with no history of glaucoma. This medication has a short onset of action, with a 10% reduction of IOP occurring 30 minutes post-instillation. TRIAL REGISTRATION NUMBER: NCT03690622. HOW TO CITE THIS ARTICLE: Fakhoury H, Abdelmassih Y, El-Khoury S, et al. The Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial. J Curr Glaucoma Pract 2021;15(2):58-63.

MicroPulse Transscleral Laser Therapy with Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined with Phacoemulsification for Angle-Closure Glaucoma: A Case Report.

PURPOSE: To report the efficacy and safety of MicroPulse transscleral laser therapy (TLT) and Kahook Dual Blade excisional goniotomy and goniosynechialysis combined with phacoemulsification for chronic angle-closure glaucoma (ACG). PATIENTS AND METHODS: A 39-year-old hyperopic female with a known history of ACG presented with a 2-week history of blurry vision, headache, and photophobia in the right eye (RE) following surgical peripheral iridectomy at another hospital. On examination, her uncorrected visual acuity was 20/50 in the RE, and 20/25 in the left eye (LE). Goldman applanation tonometry revealed an intraocular pressure (IOP) of 51 mmHg in the RE and 12 mmHg in the LE. Ocular examination of the RE revealed conjunctival hyperemia, corneal edema, shallow anterior chamber, posterior synechia, mid-dilated non-reactive pupil, and early cataractous changes. Anterior segment examination findings in the LE were normal except for a shallow anterior chamber. Gonioscopy revealed a closed angle (Schaffer grade 0) with 360° peripheral anterior synechia in the RE and a narrow angle (Schaffer grade 2) in the LE. The cup-to-disc ratios were 0.5 RE and 0.3 LE. The patient underwent MicroPulse TLT with phacoemulsification, Kahook Dual Blade-assisted goniosynechialysis, and excisional goniotomy in the RE. RESULTS: At the 1-year follow-up, her IOP remained stable without the need for antiglaucoma medications. No further optic nerve or visual field deterioration was noted. CONCLUSION: MicroPulse TLT combined with phacoemulsification and Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely reduced IOP and the need for antiglaucoma medications in chronic ACG, avoiding the complications associated with incisional glaucoma surgery.

Update on Micropulse Transscleral Cyclophotocoagulation.

Micropulse transscleral cyclophotocoagulation is a promising and relatively new technique that uses repetitive micropulses of diode laser energy, delivered with the Cyclo G6 Glaucoma Laser System (Iridex Corporation), in an off-and-on cyclical manner. This review article provides an update on the latest data available for this technique, including a discussion of the aspects in which there is still limited data, such as the precise mechanism of action, the ideal laser parameters based on total energy levels, as well as an overview of other potentially relevant variables that may be playing an important role in outcomes.

Artifact Rates for 2D Retinal Nerve Fiber Layer Thickness Versus 3D Retinal Nerve Fiber Layer Volume.

Purpose: To compare artifact rates in two-dimensional (2D) versus three-dimensional (3D) retinal nerve fiber layer (RNFL) scans using Spectralis optical coherence tomography (OCT). Methods: Thirteen artifact types in 2D and 3D RNFL scans were identified in 106 glaucomatous eyes and 95 normal eyes. Artifact rates were calculated per B-scan and per eye. In 3D volume scans, artifacts were counted only for the 97 B-scans used to calculate RNFL parameters for the 2.5-3.5-mm annulus. 3D RNFL measurements were calculated twice, once before and again after deletion of B-scans with artifacts and subsequent automated interpolation. Results: For 2D scans, artifacts were present in 58.5% of B-scans (62 of 106) in glaucomatous eyes. For 3D scans, a mean of 35.4% of B-scans (34.3 of 97 B-scans per volume scan) contained an artifact in 106 glaucomatous eyes. For 3D data of glaucoma patients, mean global RNFL thickness values were similar before and after interpolation (77.0 ± 11.6 µm vs. 75.1 ± 11.2 µm, respectively; P = 0.23). Fewer clinically significant artifacts were noted in 3D RNFL scans, where only 7.5% of glaucomatous eyes (8 of 106) and 0% of normal eyes (0 of 95) had artifacts, compared to 2D RNFL scans, where 58.5% of glaucomatous eyes (62 of 106) and 14.7% of normal eyes (14 of 95) had artifacts. Conclusions: Compared to 2D RNFL scans, 3D RNFL volume scans less often require manual correction to obtain accurate measurements. Translational Relevance: 3D RNFL volume scans have fewer clinically significant artifacts compared to 2D RNFL thickness scans.

Three-dimensional Neuroretinal Rim Thickness and Visual Fields in Glaucoma: A Broken-stick Model.

PRECIS: In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable. PURPOSE: To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable. METHODS: In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. "Broken-stick" regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs. RESULTS: Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31% of global MDB thickness, and 36.8% and 43.6% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates. CONCLUSIONS: When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.

Intraocular application of Mitomycin C to prevent proliferative vitreoretinopathy in perforating and severe intraocular foreign body injuries.

AIM: To assess the long-term anatomical and functional outcomes in addition to complications of a new surgical technique of localized intraocular application of mitomycin C (MMC) to prevent proliferative vitreoretinopathy (PVR) in eyes with open globe trauma. METHODS: Prospective non-comparative interventional case series of 16 consecutive eyes with perforating and deep choroidal impact foreign body injuries presenting over a 2-year period. Patients underwent vitrectomy with intraocular application of MMC at the site of the chorioretinal injury and were followed-up for 1 year. The primary outcome measure was the rate of postoperative PVR. Secondary outcome measures were number of vitreoretinal surgeries (VRS) required, best corrected visual acuity (BCVA), final anatomical success rate and globe survival rate (GSR). RESULTS: Patients underwent VRS at a mean time of 8.5 ± 4.6 days after the injury. Postoperative PVR developed in 2 (13 %) eyes and required only one additional VRS each. One other eye underwent further peeling of an epimacular membrane. BCVA improved from mean LogMAR 3.08 ± 0.72 preoperatively to 0.66 ± 0.79 at 1 year. All 10 eyes without a macular injury had a final BCVA of LogMAR 0.40 or better. The final anatomical success rate was 94% and GSR rate was 100%. There were no complications related to the intraocular use of MMC. CONCLUSIONS: Vitrectomy and intraocular application of Mitomycin C may have a potential role in reducing the rate of post traumatic PVR and improving anatomical and functional outcomes in eyes with perforating and deep choroidal impact foreign body injuries.

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients.

PURPOSE: This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. METHODS: Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems). Follow-up examinations took place on a regular basis until 15 months postoperatively. RESULTS: Seventy-five eyes of 69 patients (53.6% male patients) were included. Mean age was 55.5±22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. Mean prelaser IOP was 26.0±7.91 mm Hg. This was reduced significantly to 13.8±5.6 mm Hg (44.0% reduction, P<0.001) at week 1, and to 18.0±7.7, 18.4±7.1, 16.7±6.2, 15.1±4.1, 15.7±5.32, and 14.8±5.50 mm Hg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma drops decreased significantly up to 12 months of follow-up (P=0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P<0.001). The success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely. CONCLUSIONS: MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.

Three-Dimensional Optical Coherence Tomography Imaging For Glaucoma Associated With Boston Keratoprosthesis Type I and II.

PRECIS: Three-dimensional (3D) spectral domain optical coherence tomography (OCT) volume scans of the optic nerve head (ONH) and the peripapillary area are useful in the management of glaucoma in patients with a type I or II Boston Keratoprosthesis (KPro). PURPOSE: The purpose of this study was to report the use of spectral domain OCT in the management of glaucoma in patients with a type I or II Boston KPro. MATERIALS AND METHODS: This study is an observational case series. Four consecutive patients with KPro implants were referred for glaucoma evaluation. A comprehensive eye examination was performed which included disc photography, visual field testing, and high-density spectral domain OCT volume scans of the ONH and the peripapillary area. 2D and 3D parameters were calculated using custom-designed segmentation algorithms developed for glaucoma management. RESULTS: Spectral domain OCT parameters provided useful information in the diagnosis and management of 4 KPro patients. OCT parameters which can be used in KPro patients included 2D retinal nerve fiber layer (RNFL) thickness, 3D peripapillary RNFL volume, 3D peripapillary retinal thickness and volume, 3D cup volume, and 3D neuroretinal rim thickness and volume. In 3 of 4 cases where the traditional 2D RNFL thickness scan was limited by artifacts, 3D spectral domain OCT volume scans provided useful quantitative objective measurements of the ONH and peripapillary region. Therefore, 3D parameters derived from high-density volume scans as well as radial scans of the ONH can be used to overcome the limitations and artifacts associated with 2D RNFL thickness scans. CONCLUSIONS: Spectral domain OCT volume scans offer the possibility to enhance the evaluation of KPro patients with glaucoma by using both 2D and 3D diagnostic parameters that are easily obtained in a clinic setting.

Analysis of Neuroretinal Rim by Age, Race, and Sex Using High-Density 3-Dimensional Spectral-Domain Optical Coherence Tomography.

PRéCIS:: Neuroretinal rim minimum distance band (MDB) thickness is significantly lower in older subjects and African Americans compared with whites. It is similar in both sexes. PURPOSE: To evaluate the relationship between age, race, and sex with the neuroretinal rim using high-density spectral-domain optical coherence tomography optic nerve volume scans of normal eyes. METHODS: A total of 256 normal subjects underwent Spectralis spectral-domain optical coherence tomography optic nerve head volume scans. One eye was randomly selected and analyzed for each subject. Using custom-designed software, the neuroretinal rim MDB thickness was calculated from volume scans, and global and quadrant neuroretinal rim thickness values were determined. The MDB is a 3-dimensional neuroretinal rim band comprised of the shortest distance between the internal limiting membrane and the termination of the retinal pigment epithelium/Bruch's membrane complex. Multiple linear regression analysis was performed to determine the associations of age, race, and sex with neuroretinal rim MDB measurements. RESULTS: The population was 57% female and 69% white with a mean age of 58.4±15.3 years. The mean MDB thickness in the normal population was 278.4±47.5 µm. For this normal population, MDB thickness decreased by 0.84 µm annually (P<0.001). African Americans had thinner MDBs compared with whites (P=0.003). Males and females had similar MDB thickness values (P=0.349). CONCLUSION: Neuroretinal rim MDB thickness measurements decreased significantly with age. African Americans had thinner MDB neuroretinal rims than whites.

Diagnostic Capability of 3D Peripapillary Retinal Volume for Glaucoma Using Optical Coherence Tomography Customized Software.

PRéCIS:: The diagnostic capability of peripapillary retinal volume is similar to peripapillary retinal nerve fiber layer thickness for diagnosing glaucoma, but with fewer artifacts. PURPOSE: To compare the diagnostic capability of 3-dimensional peripapillary retinal volume (RV) versus 2-dimensional peripapillary retinal nerve fiber layer (RNFL) thickness for open-angle glaucoma. PATIENTS AND METHODS: A retrospective cross-sectional analysis was conducted. A total of 180 subjects (113 open-angle glaucoma, 67 normal participants) had spectral domain optical coherence tomography volume scans and RNFL thickness measurements. Peripapillary RV values were calculated using a custom-designed program with 4 circumpapillary annuli (CA): CA1 had circle diameters of 2.5 and 3.5 mm; CA2, 3 and 4 mm; CA3, 3.5 and 4.5 mm; and CA4, 4 and 5 mm. Area under the receiver operating characteristic curves were calculated for global, quadrant, and octant regions for RV (CA1 to CA4) and RNFL thickness. Pair-wise comparisons were conducted. Artifacts rates were determined. RESULTS: Mean age was 62.7±15.4 years, and 47.8% (86/180) were male. Among RV measurements, best diagnostic performances were for the smallest 2 annuli for inferior RV (CA1: 0.964, CA2: 0.955). Of the 4 annuli, CA1 had the highest diagnostic performance. Of specific regions, the inferior RV quadrant had the highest performance across CA1 to CA4. Peripapillary RV had similar diagnostic capability compared with RNFL thickness (P>0.05). The artifact rate per B-scan for RV was 6.0%, which was significantly lower compared with 2-dimensional RNFL thickness in the same patient population (32.2%, P<0.0001). CONCLUSIONS: The diagnostic capability of RV is similar to RNFL thickness for perimetric open-angle glaucoma, but RV had fewer artifacts compared with RNFL thickness.

Acute Angle-closure Glaucoma as a First Presentation of Coats' Disease: A Case Report.

PURPOSE: The purpose of this study was to report an unusual first manifestation of Coats' disease presenting as an acute angle-closure glaucoma attack in an adult patient. PATIENTS AND METHODS: A 37-year-old African woman presented to the emergency department with severe headache, ocular pain, and no light perception in the left eye. The left pupil was middilated and nonreactive, and the intraocular pressure (IOP) by applanation tonometry was 47 mm Hg. Slit-lamp examination revealed anterior subcapsular opacification (glaukomflecken), posterior synechiae, and total angle closure with iris bombé. A fundus examination revealed macular exudation, inferior vascular dilation, and tortuosity with peripheral telangiectasia and macroaneurysms, in addition to partial exudative retinal detachment involving the macula. On the basis of these findings, Coats' disease was diagnosed. RESULTS: The patient was treated with antiglaucoma medications and laser peripheral iridotomy to control the IOP, which had decreased to 21 mm Hg the following day. Diode laser transscleral cyclophotocoagulation was performed to further decrease the IOP. After completing a 360 degree laser, the IOP decreased to 8 mm Hg and then stabilized around 12 mm Hg. The vision remained no light perception; however, the patient felt major symptomatic relief. CONCLUSIONS: The present case describes acute angle-closure glaucoma as an initial presentation of Coats' disease in adults. Clinicians should be aware that this unique presentation in Coats' disease can occur even without retinal detachment.

Effects of Age, Race, and Ethnicity on the Optic Nerve and Peripapillary Region Using Spectral-Domain OCT 3D Volume Scans.

PURPOSE: To evaluate the effects of age, race, and ethnicity on the optic nerve and peripapillary retina using spectral-domain optical coherence tomography (SD-OCT) three-dimensional (3D) volume scans in normal subjects. METHODS: This is a cross-sectional study performed at a single institution in Boston. All patients received retinal nerve fiber layer (RNFL) scans and an optic nerve 3D volume scan. The SD-OCT software calculated peripapillary RNFL thickness, retinal thickness (RT), and retinal volume (RV). Custom-designed software calculated neuroretinal rim minimum distance band (MDB) thickness and area. RESULTS: There were 272 normal subjects, including 175 whites, 40 blacks, 40 Asians, and 17 Hispanics. Rates of age-related decline were 2.3%, 2.0%, 1.7%, 3.3%, and 4.3% per decade for RNFL, RT, RV, MDB neuroretinal rim thickness, and MDB area, respectively. The RNFL was most affected by racial and ethnic variations, with Asians having thicker global, superior, and inferior RNFL, Hispanics having thicker inferior RNFL, and blacks having thinner temporal RNFL, compared to whites. For MDB thickness and area, Asians had smaller nasal values and blacks had smaller temporal values. Peripapillary RT and RV parameters were not influenced by race and ethnicity. CONCLUSIONS: All of the parameters exhibited age-related declines. RNFL, MDB thickness, and MDB area demonstrated racial and ethnic variations, while peripapillary RT and RV did not. TRANSLATIONAL RELEVANCE: This study demonstrates that both normal aging and ethnicity affect several novel 3D OCT parameters used to diagnose and monitor glaucoma (i.e., RT, RV, and MDB), and this should be factored in when making clinical decisions based on these parameters.