Spontaneous resolution of long-standing choroidal effusion after glaucoma drainage implant surgery without significant visual deterioration : a case report.

BACKGROUND: Choroidal effusion is a common complication of glaucoma surgery. Although most cases of choroidal effusions resolve spontaneously with observation or medical management alone as intraocular pressure normalizes, surgical drainage might be needed in severe or persistent cases. Herein, we report a case of spontaneous resolution of long-standing severe choroidal effusion after Ahmed glaucoma valve implantation. CASE PRESENTATION: An 85-year-old man with uncontrolled primary open-angle glaucoma and medical history of chronic kidney disease underwent uneventful Ahmed glaucoma valve implantation. On postoperative day 8, transient hypotony occurred, and large 360° peripheral choroidal detachments developed. Although the intraocular pressure increased to normal levels on postoperative day 15, choroidal effusion did not resolve. Fundus examination over 8 months showed that the large choroidal effusion persisted despite a well-controlled intraocular pressure. Laboratory test performed at preoperatively and follow-up period revealed persistently elevated potassium and creatinine levels. On postoperative 9 months, the lesion resolved spontaneously without any surgical intervention. We found that the patient's creatinine level was normalized, pre-existing hyperkalemia was corrected, and accordingly his general condition was improved. CONCLUSIONS: Considering the underlying medical condition may be helpful in patients with persistent choroidal effusion of an unclear etiology following glaucoma filtering surgery.

Predictors of long-term visual field outcome after an episode of acute primary angle closure.

BACKGROUND: To investigate the long-term visual field (VF) outcome and baseline factors associated with functional sequelae in patients who experienced an episode of acute primary angle closure (APAC) and underwent subsequent lens extraction. METHODS: Fifty patients (50 eyes) who experienced an APAC episode and underwent subsequent lens extraction at Chonnam National University Hospital were enrolled in this retrospective study. Patients underwent VF examinations after 1 year of an acute episode. They were classified into two groups based on whether they had significant VF defects or not. Demographic data were recorded, and baseline anterior-segment OCT (AS-OCT) images were analysed. Multivariate logistic regression analysis was performed to assess baseline risk factors for presence of VF defects. RESULTS: Twenty-five (50%) eyes were found to have varied degree of VF defects after 1 year of an acute episode. Longer duration between the symptom onset and IOP lowering (p = 0.005), a higher presenting IOP (p = 0.014), and flat iris curvature (p = 0.037) at baseline AS-OCT measurement were significant predictors of VF loss. The area under the receiver operating characteristic curve (AUC) revealed that combination of these three potential baseline factors could predict the long-term VF outcome (AUC = 0.921). CONCLUSIONS: Patients exhibiting a long duration between symptom onset and IOP lowering, a high presenting IOP, and flat iris curvature were at a higher risk of visual impairment after an episode of APAC. The eyes with such features may require more careful follow-up after an episode of APAC.

High VEGF Concentrations Accelerate Human Trabecular Meshwork Fibrosis in a TAZ-Dependent Manner.

We aimed to investigate the effects of different concentrations of vascular endothelial growth factor (VEGF) on the extracellular matrix (ECM) and fibrotic proteins in human trabecular meshwork (TM) cells. We also explored how the Yes-associated protein (YAP)/transcriptional co-activator with PDZ-binding motif (TAZ) signaling pathway modulates VEGF-induced fibrosis. We determined cross-linked actin network (CLAN) formation using TM cells. Changes in fibrotic and ECM protein expression were determined. High VEGF concentrations (10 and 30 ng/mL) increased TAZ and decreased p-TAZ/TAZ expression in TM cells. Western blotting and real-time PCR revealed no YAP expression changes. Fibrotic and ECM protein expression decreased at low VEGF concentrations (1 and 10 ρg/mL) and significantly increased at high VEGF concentrations (10 and 30 ng/mL). CLAN formation increased in TM cells treated with high VEGF concentrations. Moreover, TAZ inhibition by verteporfin (1 µM) rescued TM cells from high-VEGF-concentration-induced fibrosis. Low VEGF concentrations reduced fibrotic changes, whereas high VEGF concentrations accelerated fibrosis and CLAN formations in TM cells in a TAZ-dependent manner. These findings reflect the dose-dependent influences of VEGF on TM cells. Moreover, TAZ inhibition might be a therapeutic target for VEGF-induced TM dysfunction.

Posture-induced changes in intraocular pressure after ab externo XEN45 gel-stent implantation in patients with primary open-angle glaucoma.

BACKGROUND: To investigate posture-induced changes in intraocular pressure (IOP) after ab externo XEN45 Gel-Stent implantation in patients with medically uncontrolled primary open-angle glaucoma (POAG). METHODS: This prospective study included thirty-two eyes with POAG that underwent XEN45 Gel-Stent implantation as a standalone procedure using an ab externo approach at Chonnam National University Hospital. IOP was measured sequentially in the sitting position, supine position, and lateral decubitus position (LDP) before and at 1, 2, 3, and 6 months after surgery using an iCare IC200 rebound tonometer. In the LDP, the eye with XEN45 Gel-Stent implantation was in the dependent position. RESULTS: IOP at each position was significantly reduced after XEN45 Gel-Stent implantation. Posture-induced changes in IOP were maintained during the follow-up. The range of postural IOP changes was reduced at 1 month; however, no significant change was observed after that point compared with baseline levels. CONCLUSIONS: A XEN45 Gel-Stent inserted using the ab externo approach can reduce IOP in various body positions, but seems to have limited effects on posture-induced changes in IOP in patients with POAG.

Long-term outcomes of prediction error after combined phacoemulsification and trabeculectomy in glaucoma patients.

BACKGROUND: To investigate long-term outcomes of prediction error after phacotrabeculectomy and to determine risk factors that may cause unstable prediction error after phacotrabeculectomy in glaucoma patients. METHODS: A total 120 eyes of 120 patients who had underwent uncomplicated phacotrabeculectomy (combined group) or phacoemulsification (phaco-only group) were included. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) were measured before and after surgery, and anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), and anterior vault (AV) measured using anterior-segment optical coherence tomography were compared between the two groups. The mean absolute error (MAE) at 3, 6, 12, and 24 months postoperatively were compared. Risk factors associated with unstable prediction error (MAE ≥ 0.5) were investigated in the combined group. RESULTS: In both groups, BCVA was improved and IOP was decreased significantly. MAE at 3, 6, 12, 24 months postoperatively were not significantly different between two groups. The risk factors for unstable prediction error after 12 months of phacotrabeculectomy were old age and LV. Whereas, the only factor predicting unstable prediction error after 24 months of phacotrabeculectomy was LV. The cut-off value of LV for predicting unstable refractive error analyzed by the ROC curve was 0.855 mm. CONCLUSIONS: Phacotrabeculectomy may be an effective treatment with stable long-term outcomes of prediction error similar to phacoemulsification in patients with glaucoma. However, elderly patients or patients with large LV may be predisposed to unstable prediction error after phacotrabeculectomy.

Anterior Scleral Thickness in Myopic Eyes and Its Association with Ocular Parameters.

PURPOSE: This study was designed to determine whether the anterior scleral thickness is affected by axial elongation and to investigate the association between anterior scleral thickness and various ocular parameters in myopic eyes. METHODS: This cross-sectional study included 79 healthy myopic participants. Anterior scleral thickness was measured in 8 meridians (superior-nasal, superior, superior-temporal, temporal [T], inferior-temporal, inferior [I], inferior-nasal, and nasal [N]) using anterior segment optical coherence tomography. Bruch's membrane opening (BMO) area, width of ß-parapapillary atrophy with and without Bruch's membrane (PPA+BM and PPA-BM), and the global peripapillary and subfoveal choroidal thickness were additionally measured. Age- and sex-adjusted partial correlation analysis and linear regression analysis were performed to examine the effects of axial length and various ocular parameters on anterior scleral thickness in myopic eyes. RESULTS: The mean age of the included participants was 27.03 ± 2.70 years. Overall, the anterior scleral thickness varied topographically according to the meridians and distance from the scleral spur. In the partial correlation analysis controlled for the effect of age and sex, increasing axial length was related to anterior scleral thinning at several measurement points along the T, I, and N meridians. Among the several ocular parameters, multivariate linear regression analysis with age, sex, and axial length as covariates revealed that central corneal thickness, intraocular pressure, and BMO area were significantly associated with anterior scleral thickness. CONCLUSION: In conclusion, there was a close relationship between the anterior scleral thickness and several ocular parameters in myopic eyes. These features should be taken into consideration when managing myopia, and our results might have important implications for understanding the pathogenesis of scleral changes during axial elongation.

The protective effect of 3% diquafosol on meibomian gland morphology in glaucoma patients treated with prostaglandin analogs: a 12-month follow-up study.

BACKGROUND: To determine if 3% diquafosol (DQS) can preserve the meibomian gland morphology in glaucoma patients treated with prostaglandin analogs (PGA) for a 12-month follow-up period. METHODS: This study included 84 eyes of 46 normal tension glaucoma (NTG) patients who were treated with either preservative-containing PGA (PC-PGA; 16 patients, 28 eyes), preservative-free PGA (PF-PGA; 21 patients, 39 eyes), or a combination of PC-PGA and 3% DQS (PC-PGA + DQS; 9 patients, 17 eyes). The meibography of the upper eyelid was acquired using Keratograph® 5 M at baseline and at each follow-up (1, 3, 6, 9, and 12 months). Meibomian gland loss (MGL) was quantitatively analyzed by using ImageJ software. RESULTS: In the PC-PGA group, MGL increased significantly from baseline to month 9 and month 12, whereas no significant changes were observed in the PF-PGA and PC-PGA + DQS groups during the entire 12 months. All groups showed similar MGL at each follow-up time from baseline to six months. However, MGL in the PC-PGA group was significantly higher than those in the PF-PGA and PC-PGA + DQS groups at the 9 and 12 months. CONCLUSIONS: Combining 3% DQS with PC-PGA was as effective as PF-PGA in preserving the meibomian gland morphology for at least 12 months. Our results suggest that 3% DQS may be a promising strategy for managing glaucoma patients with a high risk of developing meibomian gland dysfunction due to preservative-containing topical medications.

Association of macular thickness with parapapillary atrophy in myopic eyes.

BACKGROUND: To investigate whether macular structure could be affected by axial elongation and to determine the association between macular intraretinal thickness and the microstructure of ß-zone parapapillary atrophy (PPA) in myopic eyes. METHODS: The study recruited 113 healthy myopic subjects (113 eyes). Images of the macula, subfoveal choroid, and optic nerve head were acquired using spectral-domain optical coherence tomography (SD-OCT). An automatic segmentation algorithm was used to segment the macular images into 7 intraretinal layers. PPA widths with and without Bruch's membrane (PPA+BM and PPA-BM, respectively) were evaluated. Linear regression analysis was performed to evaluate the association between macular intraretinal thickness and axial length and the microstructure of PPA. RESULTS: An increase in axial length was associated with a decrease in whole macular thickness of the peripheral region and an increase in whole macular thickness of the central region. Thickness alterations of the macular intraretinal layers were most apparent in the peripheral region. A significant correlation was found between PPA-BM width and macular intraretinal layer thickness, whereas no significant correlation was found between PPA+BM width and macular intraretinal layer thickness. Moreover, both PPA+BM and PPA-BM widths significantly correlated with subfoveal choroidal thickness. CONCLUSIONS: Macular intraretinal layer thickness may be affected by PPA-BM width. These findings indicate that the microstructure of PPA should be considered when evaluating the macula in patient with myopia and glaucoma.

Intravitreal Injection of Liposomes Loaded with a Histone Deacetylase Inhibitor Promotes Retinal Ganglion Cell Survival in a Mouse Model of Optic Nerve Crush.

Various neuroprotective agents have been studied for the treatment of retinal ganglion cell (RGC) diseases, but issues concerning the side effects of systemically administered drugs and the short retention time of intravitreally injected drugs limit their clinical applications. The current study aimed to evaluate the neuroprotective effects of intravitreally injected trichostatin A (TSA)-loaded liposomes in a mouse model of optic nerve crush (ONC) and determine whether TSA-loaded liposomes have therapeutic potential in RGC diseases. The histone deacetylase inhibitor, TSA, was incorporated into polyethylene glycolylated liposomes. C57BL/6J mice were treated with an intravitreal injection of TSA-loaded liposomes and liposomes loaded with a lipophilic fluorescent dye for tracking, immediately after ONC injury. The expression of macroglial and microglial cell markers (glial fibrillary acidic protein and ionized calcium binding adaptor molecule-1), RGC survival, and apoptosis were assessed. We found that the liposomes reached the inner retina. Their fluorescence was detected for up to 10 days after the intravitreal injection, with peak intensity at 3 days postinjection. Intravitreally administered TSA-loaded liposomes significantly decreased reactive gliosis and RGC apoptosis and increased RGC survival in a mouse model of ONC. Our results suggest that TSA-loaded liposomes may help in the treatment of various RGC diseases.

HDAC2 Regulates Glial Cell Activation in Ischemic Mouse Retina.

The current study was undertaken to investigate whether histone deacetylases (HDACs) can modulate the viability of retinal ganglion cells (RGCs) and the activity of glial cells in a mouse model of retinal ischemia-reperfusion (IR) injury. C57BL/6J mice were subjected to constant elevation of intraocular pressure for 60 min to induce retinal IR injury. Expression of macroglial and microglial cell markers (GFAP and Iba1), hypoxia inducing factor (HIF)-1α, and histone acetylation was analyzed after IR injury. To investigate the role of HDACs in the activation of glial cells, overexpression of HDAC1 and HDAC2 isoforms was performed. To determine the effect of HDAC inhibition on RGC survival, trichostatin-A (TSA, 2.5 mg/kg) was injected intraperitoneally. After IR injury, retinal GFAP, Iba1, and HIF-1α were upregulated. Conversely, retinal histone acetylation was downregulated. Notably, adenoviral-induced overexpression of HDAC2 enhanced glial activation following IR injury, whereas overexpression of HDAC1 did not significantly affect glial activation. TSA treatment significantly increased RGC survival after IR injury. Our results suggest that increased activity of HDAC2 is closely related to glial activation in a mouse model of retinal IR injury and inhibition of HDACs by TSA showed neuroprotective potential in retinas with IR injuries.

Assessment of superficial retinal microvascular density in healthy myopia.

PURPOSE: To evaluate retinal microvasculature in healthy myopia and investigate the correlation between microvascular density and ocular factors. METHODS: A total of 174 eyes from 174 healthy Korean subjects were included. The eyes were divided into four groups according to refraction: emmetropia [21 eyes, - 1.00 D ≤ mean spherical equivalent (MSE) < + 0.75 D], mild myopia (32 eyes, - 3.00 D ≤ MSE < - 1.00 D), moderate myopia (76 eyes, - 6.00 D ≤ MSE < - 3.00 D), and high myopia (45 eyes, MSE < - 6.00 D). Images of retinal vasculature in parapapillary and parafoveal area were obtained using optical coherence tomography angiography. Superficial retinal microvascular density was measured for correlation analysis with ocular parameters. RESULTS: High myopia was found to have a lower superficial parapapillary microvascular density compared with the other groups in total parapapillary area, and in sectors of nasal and inferonasal (all p ≤ 0.001). The superficial parapapillary microvascular density showed a negative correlation with axial length (AL) and intraocular pressure (IOP) (ß = - 0.479, p = 0.008 and ß = - 0.160, p = 0.048, respectively), and a positive correlation with parapapillary retinal nerve fiber layer (RNFL) thickness (ß = 0.140, p < 0.001). However, there was no significant difference in superficial parafoveal microvascular density among all groups (p > 0.05). CONCLUSIONS: This study reveals that superficial parapapillary microvascular density is lower in high myopia and has correlation with AL, IOP, and parapapillary RNFL thickness. It also indicates that superficial parafoveal microvascular density tends to be unaffected by healthy myopia. These retinal microvascular alterations may facilitate understanding the pathogenesis of glaucomatous optic nerve damage in high myopia.

Association of Interleukin-1 gene clusters polymorphisms with primary open-angle glaucoma: a meta-analysis.

BACKGROUND: Previous studies have associated the Interleukin-1 (IL-1) gene clusters polymorphisms with the risk of primary open-angle glaucoma (POAG). However, the results were not consistent. Here, we performed a meta-analysis to evaluate the role of IL-1 gene clusters polymorphisms in POAG susceptibility. METHODS: PubMed, EMBASE and Cochrane Library (up to July 15, 2017) were searched by two independent investigators. All case-control studies investigating the association between single-nucleotide polymorphisms (SNPs) of IL-1 gene clusters and POAG risk were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for quantifying the strength of association that has been involved in at least two studies. RESULTS: Five studies on IL-1ß rs16944 (c. -511C > T) (1053 cases and 986 controls), 4 studies on IL-1α rs1800587 (c. -889C > T) (822 cases and 714 controls), and 4 studies on IL-1ß rs1143634 (c. +3953C > T) (798 cases and 730 controls) were included. The results suggest that all three SNPs were not associated with POAG risk. Stratification analyses indicated that the rs1143634 has a suggestive associated with high tension glaucoma (HTG) under dominant (P = 0.03), heterozygote (P = 0.04) and allelic models (P = 0.02), however, the weak association was nullified after Bonferroni adjustments for multiple tests. CONCLUSIONS: Based on current meta-analysis, we indicated that there is lack of association between the three SNPs of IL-1 and POAG. However, this conclusion should be interpreted with caution and further well designed studies with large sample-size are required to validate the conclusion as low statistical powers.

Optic Disc Rotation as a Clue for Predicting Visual Field Progression in Myopic Normal-Tension Glaucoma.

PURPOSE: To investigate factors associated with visual field (VF) progression in myopic normal-tension glaucoma (NTG) and to determine the relationship between optic disc rotation and VF progression. DESIGN: Retrospective, observational study. SUBJECTS: Ninety-two patients with myopic NTG, with VF loss confined to a single hemifield, who were followed up over a 2-year period. METHODS: Systemic and ocular findings such as optic disc tilt and optic disc rotation were evaluated. The eyes with optic disc rotation accompanying a corresponding VF defect were defined as those with correspondence. Visual field progression was defined by Early Manifest Glaucoma Trial criteria. The Cox proportional hazards model was used to determine the risk factors for VF progression. MAIN OUTCOME MEASURES: Progression of VF. RESULTS: The mean age of subjects was 37.83±10.89 years, mean spherical equivalent refractive error was -5.51±3.37 diopters, and mean axial length was 26.18±1.79 mm. Mean follow-up duration was 55.78±30.12 months. Among 92 eyes, 37 showed VF progression. A multivariate Cox proportional hazard model revealed that percentage reduction in intraocular pressure (IOP) from baseline (hazard ratio [HR], 0.965; P = 0.013), optic disc hemorrhage (HR, 2.623; P = 0.019), and optic disc rotation-VF defect correspondence (HR, 0.441; P = 0.016) were associated with VF progression in myopic NTG eyes. CONCLUSIONS: In addition to the percentage reduction in IOP from baseline and optic disc hemorrhage, optic disc rotation-VF defect correspondence may be an important prognostic factor for patients with myopic NTG.

Characteristics of Optic Disc Rotation in Myopic Eyes.

PURPOSE: To investigate the characteristics of optic disc rotation and ocular parameters affecting optic disc rotation in healthy myopic eyes. DESIGN: Cross-sectional, comparative study. PARTICIPANTS: A total of 220 participants with healthy myopic eyes. METHODS: Spherical equivalent (SE) refractive error, axial length, central corneal thickness, and intraocular pressure (IOP) were evaluated. Optic disc tilt ratio, degree of optic disc rotation, and area of ß-zone parapapillary atrophy (PPA) were measured. Optic nerve head (ONH) parameters and thickness of the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) were measured using Cirrus optical coherence tomography (Carl Zeiss Meditec Inc., Dublin, CA). Subjects were divided into 2 groups, group 1 with superior rotation and group 2 with inferior rotation of the optic disc, and various parameters were compared. Linear regression analysis was performed to evaluate the relationships between the degree of optic disc rotation and several parameters. MAIN OUTCOME MEASURES: Degree of optic disc rotation. RESULTS: Among 220 eyes, 147 showed superior rotation of the optic disc and 73 showed inferior rotation. The mean tilt ratio and rotation degree were 1.16 and -19.51°, respectively, in group 1 and 1.20 and 28.93°, respectively, in group 2, showing significant differences between the groups (P = 0.028 and P = 0.035, respectively). There were also significant between-group differences in IOP (15.59 vs. 16.34 mmHg), SE refractive error (-4.05 vs. -5.66 diopters [D]), axial length (25.51 vs. 26.26 mm), and area of ß-zone PPA (0.32 vs. 0.70 mm(2)). Overall, a multivariate linear regression analysis showed that IOP, axial length, and area of ß-zone PPA were significant parameters related to the degree of optic disc rotation (P = 0.011, P = 0.043, and P = 0.030, respectively). Group 2 showed thinner pRNFL and mGCIPL thickness in general compared with group 1. CONCLUSIONS: In healthy myopic eyes, superior rotation of the optic disc was more prevalent than inferior rotation. As the optic disc rotates inferiorly, there was a significant positive correlation with IOP, axial length, and area of the ß-zone PPA. Conversely, a significant negative correlation with pRNFL and mGCIPL thickness was observed.

Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma.

BACKGROUND: To compare refractive outcomes after cataract surgery between patients with closed-angle and open-angle glaucoma and evaluate the influence of preoperative factors on refractive outcomes in patients with glaucoma. METHODS: Patients diagnosed with glaucoma and who underwent uncomplicated cataract surgery were enrolled in this retrospective observational study. We collected data including age, history of prior laser peripheral iridotomy and trabeculectomy, type of glaucoma, manifest refraction, intraocular pressure, axial length, and various anterior segment parameters using anterior-segment optical coherence tomography. Factors associated with unsatisfactory refractive outcome at postoperative 6 month were evaluated. RESULTS: A total of 143 eyes (143 subjects) were included. Of these, 49 and 94 had closed-angle and open-angle glaucoma, respectively. At postoperative-6 month evaluation, the mean absolute error (MAE) predicted by the SRK-II and SRK-T formulae was 0.67 ± 0.61 and 0.81 ± 0.66 diopters (D), respectively. The overall predictability of achieving within ± 1.0 D of target was 76.92 % and 72.73 %, respectively. At a cutoff value of 1.0 D for MAE, there was no statistical significant difference in refractive outcome between the closed-angle and open-angle glaucoma groups. Logistic regression modeling showed that large lens vault (LV) was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma. CONCLUSIONS: When considering cataract surgery in patients with glaucoma, surgeons should recognize that the refractive outcomes may be unsatisfactory in eyes with large LV.

Macular inner plexiform and retinal nerve fiber layer thickness in glaucoma.

PURPOSE: To compare the parameters of the macular ganglion cell-inner plexiform layer (mGCIPL) thickness measured by Cirrus high-definition optical coherence tomography in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG). METHODS: Eighty patients with NTG, 80 patients with POAG, and 100 normal control subjects were enrolled. The mGCIPL and peripapillary retinal nerve fiber layer (pRNFL) thicknesses measured by Cirrus high-definition optical coherence tomography were compared in patients with glaucoma. The areas under the receiver operating characteristic curve (AROCs) were calculated to compare the diagnostic power of the mGCIPL thickness with that of the pRNFL thickness. Pearson correlation coefficients were determined to investigate the correlation between the mGCIPL or pRNFL thickness parameters and the mean deviation (MD) values of visual field tests. RESULTS: All parameters of the mGCIPL thickness were significantly different between normal control subjects and patients with glaucoma. The superior, superotemporal, and superonasal thickness of mGCIPL and the superior thickness of pRNFL showed significant reductions and significantly higher AROCs for distinguishing between normal eyes and eyes with glaucoma in POAG compared with those in NTG. In NTG or POAG groups, the mGCIPL and pRNFL parameters with the highest AROC were the minimum and average thickness, respectively. The average, minimum, inferior, inferotemporal, and inferonasal thickness of mGCIPL and the average and inferior thickness of pRNFL were correlated with MD in NTG (p < 0.05 for all parameters), whereas all parameters of the mGCIPL thickness except the inferonasal thickness and all parameters of the pRNFL thickness except the temporal thickness were correlated with MD in POAG (p < 0.05 for all parameters). CONCLUSIONS: The diagnostic ability of the mGCIPL thickness was comparable to that of the pRNFL thickness in patients with NTG or POAG. The mGCIPL loss in NTG was localized and mainly concentrated on the inferior portion compared with diffuse mGCIPL loss in POAG.

Arachnoid cyst accompanied by proptosis and unilateral high myopia.

An 8-year-old boy presented with proptosis of the left eye. On ophthalmic examination,unilateral axial elongation of the left eye was evident.Computed tomography and magnetic resonance imaging revealed an arachnoid cyst in the left middle cranial fossa, which expanded the bone and deformed the posterolateral wall of the left orbit. The lesion was observed with serial examinations and reviewed by a neurosurgeon and a radiologist. After 6 months of follow-up, there was no progression of the cyst. We believe this is the youngest reported case of an arachnoid cyst associated with isolated proptosis in the setting of unilateral high myopia. Neuroimaging should be considered in cases of prominent or progressive proptosis in the context of unilateral axial myopia in order to detect other possible etiologies.

Factors Associated with Visual Acuity in Advanced Glaucoma.

This study aimed to comprehensively analyze various parameters in advanced glaucoma patients to identify the factors that can affect best-corrected visual acuity (BCVA) in advanced glaucoma. This cross-sectional retrospective study included 113 patients (mean age, 61.66 ± 13.26 years; males, 67) who had advanced glaucomatous damage (113 eyes; mean BCVA, 0.18 ± 0.38 logMAR; mean deviation of 30-2 visual field [VF], -19.08 ± 6.23 dB). Peripapillary retinal nerve fiber layer (RNFL) and total and segmented macular thickness (RNFL, ganglion cell layer (GCL), and inner plexiform layer (GCL)) were measured using Spectralis optical coherence tomography (OCT). Correlations between BCVA and OCT parameters or 30-2 VF parameters were assessed using Pearson correlation analysis. Multivariate regression analysis was performed to determine the factors associated with BCVA in advanced glaucoma patients. Peripapillary RNFL thickness, subfoveal choroidal thickness, and global macular RNFL, GCL, IPL, and total thickness were found to be significantly correlated with BCVA and central visual function. Multivariate analysis showed a significant correlation between subfoveal choroidal thickness and BCVA. In addition, central VF mean sensitivity, especially inferior hemifield, showed a significant relationship with BCVA. In conclusion, subfoveal choroidal thickness and central VF sensitivity, especially the inferior hemifield area, are factors that affect BCVA in advanced glaucoma.

Association Between Parapapillary Microvasculature Dropout and Central Retinal Vessel Trunk in Primary Open Angle Glaucoma.

PRCIS: Central retinal vessel trunk displacement is an important factor in the generation and development of deep-layer microvasculature dropout in primary open angle glaucoma. PURPOSE: To investigate the association between the microvasculature dropout and the central retinal vessel trunk in primary open angle glaucoma eyes. METHODS: In total, 112 eyes from 112 patients with primary open-angle glaucoma were included. Matched 26 no microvasculature dropout eyes and 26 microvasculature dropout eyes, they had similar axial length and global retinal nerve fiber layer thickness. Central retinal vessel trunk shift index was calculated as the distance of the central retinal vessel trunk from the Bruch membrane opening center relative to that of the Bruch membrane opening border. The correlation of the presence, extent, and location of microvasculature dropout and the displacement extent and location of the central retina vessel trunk was analyzed. RESULTS: The central retinal vessel trunk shift index differed significantly between the 2 matched groups. Multivariate logistic analyses showed that in 112 eyes from 112 patients, eyes with microvasculature dropout was significantly associated with larger shift index than eyes without microvasculature dropout. The angular circumference of microvasculature dropout was significantly associated with adjusted shift index (a linear mixed model was constructed, exclude the influence of axial length and global retinal nerve fiber layer thickness on shift index). The location of the microvasculature dropout and central retinal vessel trunk contralateral were significantly correlated. CONCLUSIONS: In primary open angle glaucoma eyes, microvasculature dropout and the central retinal vessel trunk were significantly correlated. Because the central retinal vessel trunk represents the structural stability of the lamina cribrosa, microvasculature dropout seems to correlate with lamina cribrosa's structural stability.

Lamina Cribrosa Morphology in Normal Tension Glaucoma According to the Location of Visual Field Defects.

PRCIS: The morphologic alterations in lamina cribrosa (LC) may be related to the location of visual field (VF) defects. PURPOSE: The aim of this study was to investigate morphologic differences in the LC in normal tension glaucoma (NTG) according to the location of VF defects. DESIGN: This study was a retrospective, cross-sectional study. METHODS: Ninety-six eyes of 96 patients with NTG were included in this study. The patients were divided into 2 groups according to the location of VF defects [parafoveal scotoma (PFS) and peripheral nasal step (PNS)]. All patients underwent an optical coherence tomography of the optic disc and macula using swept-source optical coherence tomography (DRI-OCT Triton; Topcon, Tokyo, Japan). The parameters of the optic disc, macula, LC, and connective tissues were compared between the groups. The relationships between the LC parameters and other structures were analyzed. RESULTS: The temporal peripapillary retinal nerve fiber layer, average macular ganglion cell-inner plexiform layer, and average macular ganglion cell complex were significantly thinner in the PFS than in the PNS group ( P <0.001, P <0.001, and P =0.012, respectively). The PFS group showed a more glaucomatous LC morphology with a smaller lamina cribrosa-global shape index (LC-GSI, P =0.047), more LC defects ( P =0.034), and thinner LC ( P =0.021) than the PNS group. LC-GSI was significantly correlated with LC thickness ( P =0.011) but not with LC depth ( P =0.149). CONCLUSIONS: In patients with NTG, those with initial PFS showed a more glaucomatous LC morphology than those with initial PNS. The morphologic differences in LC may be related to the location of the VF defects.