The severity of visual field defect and the defective angles of localized retinal nerve fiber layer using a novel approach.

BACKGROUND/PURPOSE: A modified novel analytical method for evaluating photographic retinal nerve fiber layer defect (RNFLD) was developed for the purpose of estimating the severity of early glaucomatous eyes. This new method was then compared with the original method, as described below, in relation to the visual field defect severity. METHODS: The clinical records of 47 glaucomatous eyes with qualified photographs were obtained from a prior retrospective study. The reference point of the angle was set at the center of the optic disc center (COD group) and the central vessel trunk (COV group). Angle α was the angular width between the fovea and the proximity of RNFLD, while angle ß (+c) was the sum of the angular width(s) of localized RNFLD. The correlation between the visual field parameters and the angles of RNFLD in the above two groups were analyzed. RESULTS: There were significant differences in angle α (p = 0.001) and angle ß (+c) (p = 0.016) between the two groups. Angle ß (+c) showed significant correlation with MD (p = 0.012), PSD (p = 0.035), VFI (p = 0.042) and MD (p = 0.016), PSD (p = 0.035), VFI (p = 0.031) in the COD and COV group, respectively. No correlation was found between angle α and the presence of central scotoma in both groups. CONCLUSION: Our novel method was more convenient in a clinical setting and noninferior to the original method.

Defective angles of localized retinal nerve fiber layer reflect the severity of visual field defect- a cross-sectional analysis.

BACKGROUND: In order to detect glaucomatous optic nerve damages early on and evaluate the severity of glaucoma, a previously developed analytic method based on photographic retinal nerve fiber layer (RNFL) angle defect was proposed. However, the correlation between these defective angles and the severity of visual field defect has not been verified. This study aimed to confirm the correlation described above. METHODS: We reviewed a total of 227 glaucomatous eyes (38 enrolled, 189 excluded) during an interval of 5 years. The angles of all eyes were measured on RNFL photograph, of which angle α is the angular width between the macula center and the proximity of RNFL defect, and angle ß (+c) is the sum of angular width(s) of localized RNFL defect. The severity of visual field defect was determined by mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). Correlation analysis was performed on angle α and angle ß (+c) with the presence of central scotoma and visual field defect parameters, respectively. RESULTS: Angle ß (+c) showed significant correlation with MD (P = 0.007), PSD (P = 0.02), VFI (P = 0.03), and average RNFL thickness (P = 0.03). No correlation was found between angle α and the presence of central scotoma. CONCLUSIONS: In conclusion, measuring the angular width of localized RNFL defect is a viable method for determining the severity of visual field defect.

Macular Diagnostic Ability in OCT for Assessing Glaucoma in High Myopia.

PURPOSE: To compare the diagnostic abilities of spectral-domain optical coherence tomography (SD-OCT; Spectralis OCT) and time-domain OCT (TD-OCT; Stratus OCT). Changes in macular parameters in highly myopic eyes of glaucoma patients and highly myopic eyes of glaucoma suspects were evaluated and compared. METHODS: We collected data from 72 highly myopic eyes (spherical equivalent, ≤-6.0D). Forty-one eyes had perimetric glaucoma and 31 eyes were suspected to have glaucoma (control group). All eyes underwent SD-OCT and TD-OCT imaging. Area under the receiver operating characteristic (AUROC) curve and sensitivity were examined on macular volume and thickness parameters at a fixed specificity and compared between groups. RESULTS: The highest TD-OCT AUROC curves were found using outer inferior sector macular thickness (AUROC curve, 0.911) and volume (AUROC curve, 0.909). The highest SD-OCT AUROC curves were found using outer inferior region thickness (AUROC curve, 0.836) and volume (AUROC curve, 0.834). The difference between the two imaging modalities was not statistically significant (thickness, p = 0.141; volume, p = 0.138). The sensitivity of TD-OCT macular outer inferior average thickness was highest and was 88.2%, with a specificity of 80.4%. The sensitivity of TD-OCT average volume measurements in this same region was 76.5%, with a specificity of 91.3%. The SD-OCT average thickness measurements also had the highest sensitivity in this region, which was 78.6%, with a specificity of 82.1%. The SD-OCT volume measurements had a sensitivity of 67.9%, with a specificity of 92.3%. CONCLUSIONS: Both SD-OCT and TD-OCT measurements of outer inferior macular thickness and volume can differentiate between eyes of glaucoma patients and glaucoma suspects with high myopia. These independent predictors all had good sensitivity. Based on our results, SD-OCT and TD-OCT have similar diagnostic abilities. These parameters may provide useful additional data in highly myopic eyes to complement standard glaucoma diagnosis tools.

Corneal thickness and endothelial change after use of ocular hypotensive agents.

Corneal transplantation can restore visual function when visual impairment is caused by a corneal disease. However, this treatment is associated with the scarcity of cornea donors. The suitability of corneal donation from patients with glaucoma using ocular hypotensive agents (OHAs) is controversial. This study aimed to elucidate changes in corneal thickness, corneal endothelial cell density, and corneal endothelial cell hexagonality after OHA use in patients with primary open-angle glaucoma. We retrospectively reviewed the data of 53 glaucoma suspect eyes without OHA use and 106 primary open-angle glaucoma eyes under OHA use. All participants underwent corneal parameter assessment using SP-3000P (Topcon Corp., Tokyo, Japan) at the time of diagnosis and the final visit. The OHA dose and timing of use were recorded. The ocular hypotensive agents score (OHAS) was determined based on the number, formula, frequency, and duration of OHA use. Baseline data showed no significant differences between the two groups with and without OHA use. At the final visit, the OHA-treated group showed significantly lower corneal thickness and corneal endothelial cell density than those of the control group. A weak positive correlation between the OHAS and changes in corneal endothelial cell hexagonality was noted. However, no correlation was observed between the OHAS and changes in corneal thickness or endothelial cell density. In conclusion, patients with glaucoma and using OHAs should undergo the corneal structural properties examinations before donation to ensure the quality of donor cornea.

Assessing Agreement and Variability Among Alternative Devices for Intraocular Pressure Measurement: A Comparative Study.

Purpose: Intraocular pressure (IOP) measurement is critical in diagnosing and managing eye conditions. This study aims to assess the comparability of three alternative devices for measuring IOP: Noncontact tonometer, Icare rebound tonometer, and Tono-Pen. Patients and Methods: A cross-sectional study included 172 adult participants (87 males and 85 females) who underwent IOP and central corneal thickness (CCT) assessments. IOP was measured using Noncontact (Canon TX-20), Icare (Icare TA01i), and Tono-Pen (Tonopen XL). CCT was measured with the built-in pachymetry of the Noncontact tonometer. Correlation coefficients and Bland-Altman analyses were conducted to assess the relationships and agreements between these tonometers. Participants were grouped based on IOP and CCT levels. The mean of the standard deviation of the three tonometer results was calculated to evaluate measurement result variability. One-way analysis of variance was conducted for comparing between the groups. Results: IOP measurements among the three devices were not significantly different, indicating their comparability. Correlation analysis revealed strong correlations between the tonometers. Bland-Altman analysis showed good agreement, with the Icare rebound tonometer and Tono-Pen exhibiting narrower limits of agreement. Furthermore, IOP levels influenced measurement result variability, with higher IOP levels associated with greater variance. Conclusion: This study demonstrates that the alternative devices examined can provide reliable IOP measurements. It highlights the potential of these alternative devices for IOP measurement. These findings have implications for clinical practice, offering practitioners additional tools for accurate IOP assessment.

Treatment of Myopia with Atropine 0.125% Once Every Night Compared with Atropine 0.125% Every Other Night: A Pilot Study.

(1) Purpose: To investigate the efficacy of myopia treatment in children using atropine 0.125% once every two nights (QON) compared with atropine 0.125% once every night (HS). (2) Methods: This retrospective cohort study reviewed the medical records of two groups of children with myopia. Group 1 comprised children treated with atropine 0.125% QON, while group 2 included children treated with atropine 0.125% HS. The first 6 months of data of outcome measurements were subtracted as washout periods in those children undergoing both atropine QON and HS treatment. The independent t-test and Pearson's chi-square test were used to compare the baseline clinical characteristics between the two groups. A generalized estimating equations (GEE) model was used to determine the factors that influence treatment effects. (3) Results: The average baseline ages of group 1 (38 eyes from 19 patients) and group 2 (130 eyes from 65 patients) were 10.6 and 10.2 years, respectively. There were no significant differences in axial length (AL) or cycloplegic spherical equivalent (SEq) at baseline or changes of them after 16.9 months of follow-up. GEE showed that the frequency of atropine 0.125% use has no association with annual AL (QON vs. HS: 0.16 ± 0.10 vs. 0.18 ± 0.12) and SEq (QON vs. HS: -0.29 ± 0.44 vs. -0.34 ± 0.36) changes in all children with myopia. It also showed that older baseline age (B = -0.020, p < 0.001) was associated with lesser AL elongation. (4) Conclusion: The treatment effects of atropine 0.125% HS and QON were similar in this pilot study. The use of atropine 0.125% QON may be an alternative strategy for children who cannot tolerate the side effects of atropine 0.125% HS. This observation should be confirmed with further large-scale studies.

Steroid-Induced Ocular Hypertension in a Pediatric Patient with Acute Lymphoblastic Leukemia: A Case Report.

Glucocorticoids play a pivotal role in therapeutic protocols in acute lymphoblastic leukemia (ALL) treatment. Systemic steroids are known to be less likely to elevate the intraocular pressure when compared to topical administration, and reports addressing hypertensive ocular response in the Asian pediatric ALL population are currently limited. We report a case of a nine-year-old girl with acute lymphoblastic leukemia (ALL) who was found to have highly elevated intraocular pressure (IOP) during maintenance treatment when taking oral dexamethasone (6 mg/m2/day). Her IOP increased on day 5 after taking dexamethasone, reached a peak on day 7 or 8, and returned back to baseline on day 13 before anti-glaucoma medications were used. Thus, we prescribed IOP-lowering agents for 10 consecutive days starting on the day oral dexamethasone was administered, and observed that not only did the peak levels lower remarkably, but the IOP levels returned to baseline more rapidly as well.

Segmental inner macular layer analysis with spectral-domain optical coherence tomography for early detection of normal tension glaucoma.

PURPOSE: To segment the inner macular layers (IML) and compare the discriminating abilities of the macular and peripapillary retinal nerve fiber layer (mRNFL and pRNFL, respectively) thicknesses in patients with early-stage normal tension glaucoma (NTG). DESIGN: Cross-sectional study. METHODS: Forty-nine normal subjects and 69 preperimetric glaucoma (PPG) and 60 NTG patients were enrolled. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain pRNFL and macular thickness parameters and segment the IML in all subjects. Area under the receiver operating characteristic (AUROC) curves were used to compare the diagnostic capabilities of different parameters. RESULTS: The pRNFL, total macular layer (TML), mRNFL, and macular ganglion cell layer (mGCL) were significantly thinner in the NTG group than in the PPG and normal groups. The global and superotemporal pRNFL and the mGCL in the superior outer area were the three best parameters for detecting early NTG. The discriminating capabilities of the superior and inferior mGCL were comparable to those of the corresponding pRNFL (p = 0.573, 0.841). Concerning location, the mGCL had higher AUROCs in the outer sectors (0.863, 0.837) than in the inner sectors (0.747, 0.747). Pearson's correlation coefficients also revealed significant correlations between the mGCL and pRNFL (superior: r = 0.499, inferior: r = 0.624). The strongest correlation was between the mGCL and mean deviation (MD) (superior: r = 0.434 and inferior: r = 0.402). CONCLUSIONS: The diagnostic value of mGCL thickness is comparable to that of pRNFL thickness. IMLs in the outer sectors had better diagnostic capabilities than those in the inner sector for detecting early NTG.

Tracking the Reflective Light Particles Spreading on the Cornea: An Emerging Assessment for Tear Film Homeostasis.

PURPOSE: To implement an emerging noninvasive approach for assessing the dynamic tear film (TF) homeostasis. METHODS: The video records of dynamic TF from 12 healthy orthokeratology lens wearers were obtained by a clinically available TF analyzer and decomposed as image sequences. The trajectories of TF particles were analyzed by two tracking models, the full-span model (FSM) and the fixed-duration model (FDM). FSM tracked a particle for a complete opening blink cycle, while FDM tracked 1 second of the same cycle. A power-law fitting operation [Formula: see text] was used to extract homeostasis markers based on the tracking model for each subject. RESULTS: Comparing two tracking models (N = 6), only one subject had statistical difference in averaged momentary moving speed (MMS; P = 0.0488), while none had significant difference in averaged momentary moving direction (MMD). However, both models showed good correlations in average MMS (ρ = 0.94, P = 0.0048) and MMD (ρ = 1.00, P < 0.0001) and all extracted homeostasis markers [α, ß, MMS(0.1), and MMS(2.0)]. Assessing interblink reliability in these markers under FDM tracking (N = 12), only one subject in the MMS (0.1) and another subject in the MMS (2.0) were outside 95% limits of agreement, respectively. CONCLUSIONS: FDM is a good alternative to FSM and has tracking properties of higher efficiency and easier implementation. The homeostasis markers under FDM tracking showed a good interblink consistence; therefore this approach will be a promising method for analyzing dynamic TF homeostasis in future practice. TRANSLATIONAL RELEVANCE: FDM analytical architecture can practice the past experimental platform on a TF analyzer to obtain homeostasis markers of TF.

Analysis of peripapillary retinal nerve fiber layer and inner macular layers by spectral-domain optical coherence tomography for detection of early glaucoma.

AIM: To analyze the diagnostic capabilities of peripapillary retinal nerve fiber layer (pRNFL) thickness and segmented inner macular layer (IML) thickness measured by spectral-domain optical coherence tomography for detection of early glaucoma. METHODS: Fifty-three patients with primary open angle glaucoma (POAG), 60 patients with normal tension glaucoma (NTG) and 32 normal control subjects were enrolled. Thicknesses of pRNFL, total macular layers (TML), and the IML, including macular RNFL (mRNFL) and macular ganglion cell layer (mGCL) were assessed. The areas under the receiver operating characteristic curves (AROC) were calculated to compare the diagnostic power of different parameters. RESULTS: There were no differences in the parameters of pRNFL, TML, and IML between POAG and NTG groups. The thicknesses of superior and inferior mGCL showed significant correlation with mean deviation of visual field (R2=0.071, P=0.004; R2=0.08, P=0.002). The mGCL thickness significantly correlated with the pRNFL thickness in the superior and inferior quadrants (R2=0.156, P<0.001; R2=0.407, P<0.001). The thickness of the inferior-outer sector of macula had greater AROCs than those in the inferior-inner sector of macula. The AROCs for superior (0.894) and inferior (0.879) pRNFL thicknesses were similar with the AROCs for superior (0.839) and inferior mGCL (0.864) thicknesses. Sensitivities at 80% specificity for global pRNFL, inferior-outer mGCL and inferior-outer mRNFL thicknesses were 0.938, 0.867, and 0.725, respectively. CONCLUSION: The diagnostic capability of the mGCL thickness is comparable to that of the pRNFL thickness in patients with early glaucoma. The inferior-outer sector of IML has a better diagnostic capability than the inferior-inner sector of IML for detection of early glaucoma.

Intraocular retinal thickness asymmetry in early stage of primary open angle glaucoma and normal tension glaucoma.

AIM: To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer (pRNFL) and macular layers measured by spectral-domain optical coherence tomography (SD-OCT) in patients with early stage of primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS: A total of 117 patients with early stage of glaucoma (54 patients with POAG and 63 patients with NTG) and 32 normal subjects were recruited for the study. The pRNFL thickness, total macular layer (TML) thickness, and isolated inner macular layer (IML) thickness were measured by SD-OCT. Hemisphere TML thickness asymmetry measured by the posterior pole asymmetry scan was evaluated. Thickness differences of pRNFL and IML between superior and inferior quadrants were calculated. Asymmetry indices (AIs) of the pRNFL, TML and isolated IML were also computed. Areas under the receiver-operating characteristic curves (AROCs) were generated to determine the diagnostic capabilities of different parameters. RESULTS: Intraocular pRNFL thickness differences and AIs between the superior and inferior quadrants were significantly different between normal and NTG groups (P=0.009 and P<0.001, respectively). Intraocular pRNFL thickness differences and AIs between the temporal-superior and temporal-inferior sectors were also significantly different between normal and NTG groups (P=0.035 and P<0.001, respectively). The thickness differences and AIs of TML between superior and inferior hemispheres were significantly different between normal and NTG groups (P=0.001 and P=0.001, respectively) and between normal and POAG groups (P=0.032 and P=0.020, respectively). The thickness differences and AIs of macular ganglion cell layer (mGCL) between superior and inferior quadrants were significantly different between normal and NTG groups (P=0.013 and P=0.004, respectively), and between NTG and POAG groups (P=0.015 and P=0.012, respectively). The thickness difference of TML between superior and inferior hemispheres showed the highest diagnostic capability for early NTG eyes (AROC=0.832). CONCLUSION: Intraocular retinal thickness asymmetry in pRNFL, TML and mGCL are found in early stage of NTG. Hemisphere TML thickness asymmetry is also found in POAG eyes. Asymmetry analysis of retinal thickness can be an adjunctive modality for early detection of glaucoma.

Meibomian Gland Performance in Glaucomatous Patients With Long-term Instillation of IOP-lowering Medications.

PURPOSE: To investigate the meibomian gland (MG) performance in patients with glaucoma under topical intraocular pressure (IOP)-lowering medications. MATERIALS AND METHODS: This was a cross-sectional case-control study. Patients with glaucoma under different dosages and instillation periods of topical IOP-lowering medications were included. A total of 30 eyes out of 30 healthy participants and 85 eyes out of 85 patients with glaucoma were analyzed. The burden of instilling antiglaucoma agents [burden of antiglaucoma (BAG)] was simply scored for each participant based on the number, formula, frequency, and duration of topical IOP-lowering medications used. All participants completed the MG and tear assessments, including Standard Patient Evaluation of Eye Dryness questionnaire, lipid layer thickness, MG secretion and dropout, Schirmer test, tear break-up time, and blinking patterns. RESULTS: Patients with glaucoma had significantly lower Standard Patient Evaluation of Eye Dryness scores, thinner lipid layer thickness, worse mebium quality, and lower MG secretion compared with healthy participants. Among the patients with glaucoma, MG loss ratio (P=0.006) and meiboscale (P=0.017) were significantly correlated with the BAG score. Compared with the low BAG group (score <80), the high BAG group (score ≥80) had significantly shorter tear break-up time (P=0.047), lower MG density (P=0.032), higher MG loss ratio (P=0.011), and higher meiboscale (P=0.036). CONCLUSIONS: Patients with a higher BAG agents had more unstable tear films and more severe MG dropout. Therefore, MG disease should be particularly observed in patients with glaucoma following a higher BAG regimen.

Longitudinal changes in retinal nerve fiber layer thickness after acute primary angle closure measured with optical coherence tomography.

PURPOSE: Longitudinal follow-up of peripapillary retinal nerve fiber layer (RNFL) thickness after an episode of acute primary angle closure (APAC) using Stratus optical coherence tomography (OCT). METHODS: Seventeen patients who had experienced a single unilateral APAC episode (intraocular pressure, >50 mm Hg) were enrolled. The average and superior, temporal, inferior, and nasal quadrant RNFL thicknesses of the affected and fellow eyes at 1, 4, and 12 weeks after remission were compared by using StratusOCT. The relationship between average RNFL thickness and interval of follow-up were evaluated with regression analysis. RESULTS: The mean duration of the APAC episode was 13.8 hours (range, 3-40). Comparison of the average and four quadrant RNFL thicknesses in the affected eyes longitudinally showed significant differences between 1 and 4, and 1 and 12 weeks, but not between 4 and 12 weeks. The average and four-quadrant RNFL thicknesses for the affected eyes were greater than the analogous values for fellow eyes at 1 week. In contrast, the inferior- and superior-quadrant RNFL thicknesses for the affected eyes were lower at 4 and 12 weeks, whereas the average and nasal quadrant values for the affected eyes were lower than those in fellow eyes at 12 weeks. Average RNFL thickness for the affected eyes was correlated with the interval of follow-up by using inverse regression analysis (P < 0.001; R(2) = 0.60). Controlling for duration of APAC episode, the interval of follow-up on RNFL thickness reduction remained significant (P < 0.001, r = -0.69). CONCLUSIONS: This study demonstrated an initial increase in diffuse RNFL thickness after a single APAC episode, followed by a subsequent decrease.

Diagnostic capability of peripapillary retinal nerve fiber layer parameters in time-domain versus spectral-domain optical coherence tomography for assessing glaucoma in high myopia.

AIM: To evaluate and compare the diagnostic capabilities of peripapillary retinal nerve fiber layer (p-RNFL) parameters of Spectralis optical coherence tomography (OCT) versus Stratus OCT to detect glaucoma in patients with high myopia. METHODS: This is a retrospective, cross-sectional study. Sixty highly myopic eyes of 60 patients were enrolled, with 30 eyes in the glaucoma group and 30 eyes in the control group. All eyes received peripapillary imaging of the optic disc using Stratus and Spectralis OCT. Areas under the receiver operating characteristic curve (AUROC) and the sensitivity at specificity of >80% and >95% for p-RNFL parameters obtained using the two devices to diagnose glaucoma were analysed and compared. RESULTS: In Spectralis OCT, p-RNFL thickness parameters with the largest AUROC were the temporal-inferior sector (0.974) and the inferior quadrant (0.951), whereas in Stratus OCT, the best parameters were the 7-o'clock sector (0.918) and the inferior quadrant (0.918). Compared to the Stratus OCT parameters, the Spectralis OCT parameters demonstrated generally higher AUROC; however, the difference was not statistically significant. CONCLUSION: The best p-RNFL parameters for diagnosing glaucoma in patients with high myopia were the temporal-inferior sector on Spectralis OCT and the 7-o'clock sector on Stratus OCT. There were no significant differences between the AUROCs for Spectralis OCT and Stratus OCT, which suggest that the glaucoma diagnostic capabilities of these two devices in patients with high myopia are similar.

Visual outcomes after spectacles treatment in children with bilateral high refractive amblyopia.

PURPOSE: The aim was to investigate the visual outcomes of treatment with spectacles for bilateral high refractive amblyopia in children three to eight years of age. METHODS: Children with previously untreated bilateral refractive amblyopia were enrolled. Bilateral high refractive amblyopia was defined as visual acuity (VA) being worse than 6/9 in both eyes in the presence of 5.00 D or more of hyperopia, 5.00 D or more of myopia and 2.00 D or more of astigmatism. Full myopic and astigmatic refractive errors were corrected, and the hyperopic refractive errors were corrected within 1.00 D of the full correction. All children received visual assessments at four-weekly intervals. VA, Worth four-dot test and Randot preschool stereotest were assessed at baseline and every four weeks for two years. RESULTS: Twenty-eight children with previously untreated bilateral high refractive amblyopia were enrolled. The mean VA at baseline was 0.39 ± 0.24 logMAR and it significantly improved to 0.21, 0.14, 0.11, 0.05 and 0.0 logMAR at four, eight, 12, 24 weeks and 18 months, respectively (all p = 0.001). The mean stereoacuity (SA) was 1,143 ± 617 arcsec at baseline and it significantly improved to 701, 532, 429, 211 and 98 arcsec at four, eight, 12, 24 weeks and 18 months, respectively (all p = 0.001). The time interval for VA achieving 6/6 was significantly shorter in the eyes of low spherical equivalent (SE) (-2.00 D < SE < +2.00 D) than in those of high SE (SE > +2.00 D) (3.33 ± 2.75 months versus 8.11 ± 4.56 months, p = 0.0005). All subjects had normal fusion on Worth four-dot test at baseline and all follow-up visits. CONCLUSION: Refractive correction with good spectacles compliance improves VA and SA in young children with bilateral high refractive amblyopia. Patients with greater amounts of refractive error will achieve resolution of amblyopia with a longer time.

Intraocular pressure fluctuation after water drinking test in primary angle-closure glaucoma and primary open-angle glaucoma.

CONTEXT: Only a few studies have assessed intraocular pressure (IOP) changes during the water drinking test (WDT) in patients with primary angle-closure glaucoma (PACG). AIMS: The aim of this study is to investigate IOP changes during WDT in patients with PACG versus primary open-angle glaucoma (POAG). SETTINGS AND DESIGN: This was a prospective and single tertiary center study. MATERIALS AND METHODS: PACG and POAG patients (n = 15 each) without prior glaucoma surgery were enrolled and subjected to WDT, wherein they consumed an amount of water proportional to their body weight within 10 min. IOP was measured at baseline and every 15 min for 1 h after water intake. STATISTICAL ANALYSIS USED: Intergroup comparisons were performed using Mann-Whitney U-test for continuous variables and Chi-square test for categorical variables. Wilcoxon signed-ranks test was used for comparisons of IOP before and after water intake in the two groups. Regression analysis was used to determine factors associated with IOP fluctuations during WDT. RESULTS: IOP changes over 1 h after water intake showed no significant differences between groups. The mean maximum fluctuation from baseline was 3.61 ± 2.49 and 3.79 ± 1.91 mmHg, respectively, in the PACG and POAG groups. The mean peak IOP was 19.17 ± 4.32 and 19.87 ± 3.44 mmHg in the PACG and PAOG groups, respectively. The axial length and anterior chamber depth showed no correlations with IOP fluctuations. CONCLUSIONS: We found similar IOP fluctuation curves and peak IOP values in both PACG and POAG patients subjected to WDT. These findings suggest that WDT is a useful test to induce IOP peaks in both POAG and PACG patients.

Macular parameters of Stratus optical coherence tomography for assessing glaucoma in high myopia.

BACKGROUND: The aim was to assess the macular parameters of glaucoma in highly myopic subjects. METHODS: In a retrospective study, we enrolled 72 highly myopic eyes (spherical equivalent up to -6.00 D), of which 31 had early to moderate glaucoma and 41 formed a control group. The diagnosis of early to moderate glaucoma was based on glaucomatous visual-field defects with a mean deviation better than -12 dB. All patients underwent imaging with Stratus optical coherence tomography. We subsequently performed analysis for macular volume and thickness parameters between two groups. RESULTS: Using Stratus optical coherence tomography, we found significantly lower values in both macular thickness and volume over outer superior, outer nasal, outer inferior, inner temporal and inner inferior regions in highly myopic eyes with early to moderate glaucoma than in the control group. The macular outer inferior average thickness, macular outer inferior average volume and total average macular volume on Stratus optical coherence tomography had a best combination of sensitivity and specificity (85.4 and 74.2 per cent, respectively). The outer inferior average volume and outer inferior average thickness parameters showed areas under the receiver operating characteristic curve value of 0.85 (95% CI 0.76 to 0.94), which were best for discriminating between early to moderate glaucoma and the control group. CONCLUSION: Using Stratus optical coherence tomography, the outer inferior macular volume is the only independent predictor for detecting early to moderate glaucoma in high myopia. The macular outer inferior thickness and volume parameters showed good sensitivity, specificity and area under the receiver operating characteristic curve. These parameters may provide a complementary glaucomatous diagnosis in highly myopic eyes.

Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma.

PURPOSE: To compare postoperative outcomes and assess factors associated with intraocular pressure (IOP) reduction after phacotrabeculectomy in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS: This is a retrospective study of patients who underwent phacotrabeculectomy between 2010 and 2013. Factors including age, gender, visual field (VF), the number of glaucoma medications used, biometric changes, IOP, and surgical success rates were compared between groups. RESULTS: There were 27 PACG and 34 POAG patients. The PACG group had a greater mean IOP reduction after phacotrabeculectomy compared to the POAG group (5.5 ± 7.9 mmHg versus 2.0 ± 4.2 mmHg; p = 0.03). However, the final mean IOP was similar between the two groups (PACG: 12.2 ± 4.8 mmHg, POAG: 12.3 ± 3.1 mmHg; p = 0.92). Phacotrabeculectomy resulted in a mean decrease in axial length (AL) of 0.16 ± 0.15 mm in PACG and 0.16 ± 0.11 mm in POAG (p = 0.96), and an increase in anterior chamber depth (ACD) of 1.41 ± 0.91 mm in PACG, and 0.87 ± 0.86 mm in POAG (p = 0.04). At 2 years follow-up, the cumulative success rate of phacotrabeculectomy was 74% in PACG and 62% in POAG. Multivariate analysis found that early glaucoma stage, greater postoperative increase in ACD, and high preoperative IOP were factors associated with greater IOP reduction. CONCLUSION: Postoperative success rates and mean IOP on the final visit after phacotrabeculectomy were similar between the PACG and POAG groups. Factors associated with IOP reduction were greater postoperative increase in ACD, and high preoperative IOP.

Comparison of central corneal thickness measurements by ultrasonic pachymetry, Orbscan II, and SP3000P in eyes with glaucoma or glaucoma suspect.

BACKGROUND: Intraocular pressure (IOP) measurements are affected by the central cornea thickness (CCT). The conventional method for CCT measurement is ultrasonic pachymetry. However, noncontact procedures lower the risk of infection and corneal damage. In this study, we compared the CCT measured by Orbscan II, SP3000P, and ultrasonic pachymetry in patients with glaucoma or glaucoma suspect. METHODS: The CCT of 208 eyes (46 eyes with glaucoma suspect, 42 with primary angle-closure glaucoma, and 120 with primary open-angle glaucoma) was measured using Orbscan II, SP3000P, and ultrasonic pachymetry. We compared the linear correlation of the CCT between each mode. RESULTS: The mean CCT measured by Orbscan II (563.63 ± 35.867 µm) was larger than with the other two devices. There were significant linear correlations between measurements with ultrasonic pachymetry and Orbscan II (Pearson correlation coefficient (r) = 0.793, p < 0.001), ultrasonic pachymetry and SP3000P (r = 0.890, p < 0.001), and Orbscan II and SP3000P (r = 0.803, p < 0.001). We divided the participants into 3 groups on the basis of the CCT measured with ultrasonic pachymetry: ≤ 500 µm, > 500 µm to ≤ 578 µm, and > 578 µm. There was no significant linear correlation between ultrasonic pachymetry and Orbscan II in the thin group. But, in the intermediate and thick CCT groups, there were significant linear correlations between each of the three devices. CONCLUSION: We showed good linear correlations of CCT measurements between each of 3 devices, especially in the intermediate and thickest CCTs. These results will be helpful in predicting the relationship between IOP and CCT for the diagnosis and screening of glaucoma; even we used optic systems.

Adjunctive intravitreal bevacizumab-combined trabeculectomy versus trabeculectomy alone in the treatment of neovascular glaucoma.

PURPOSE: To evaluate the effect of adjunctive intravitreal bevacizumab (ivBe) with trabeculectomy versus trabeculectomy alone in the management of patients with neovascular glaucoma (NVG). METHODS: Retrospective, consecutive, interventional case series. NVG patients were divided into groups by treatment: with adjunctive ivBe and trabeculectomy (ivBe group, n = 14 eyes) and with trabeculectomy only (control group, n = 28 eyes). The main outcome measure was visual acuity. Regression of iris neovascularization (NVI), change(s) in intraocular pressure (IOP), NVI recurrence, additional glaucoma surgeries required, eyes of leading to total blindness, intraoperative and postoperative complications, and number of topical medications required after trabeculectomy were regarded as second outcome measures. In the ivBe group, intravitreal injections of 2.5 mg bevacizumab were delivered using a sharp 27-gauge needle through the inferotemporal quadrant. RESULTS: Of 42 eyes of 42 patients identified, change in IOP, additional glaucoma surgeries required, and number of IOP-lowering topical medications required after trabeculectomy did not differ significantly between groups (P > 0.05 for all). However, the ivBe group had significantly higher frequency and rapidity of iris neovascular regression, improved visual acuity in the logarithm of minimum angle of resolution (logMAR), leading to total blindness in fewer eyes and intraoperative and postoperative complications in others than in the control group (P = 0.015, 0.002, 0.007, 0.023, and 0.008, respectively). The follow-up duration (mean +/- SD) from trabeculectomy surgery was 179 +/- 97 days (range, 93-315 days) and 196 +/- 108 days (range, 92-370 days) in the ivBe and control group (P = 0.324). CONCLUSIONS: Intravitreal bevacizumab might be a useful adjunctive therapy in addition to trabeculectomy in the management of NVG. Large controlled randomized studies for treatment of bevacizumab on NVG are warranted.