Morphological changes in the trabecular meshwork and Schlemm's canal after treatment with topical intraocular pressure-lowering agents.

Glaucoma treatment is usually initiated with topical medication that lowers the intraocular pressure (IOP) by reducing the aqueous production, enhancing the aqueous outflow, or both. However, the effect of topical IOP-lowering medications on the microstructures of the aqueous outflow pathway are relatively unknown. In this retrospective, observational study, 56 treatment-naïve patients with primary open-angle glaucoma were enrolled. Images of the nasal and temporal corneoscleral limbus were obtained using anterior segment optical coherence tomography (AS-OCT). The conjunctival vessels and iris anatomy were used as landmarks to select the same limbal area scan, and the trabecular meshwork (TM) width, TM thickness, and Schlemm's canal (SC) area were measured before and after using the IOP-lowering agents for 3 months. Among the 56 patients enrolled, 33 patients used prostaglandin (PG) analogues, and 23 patients used dorzolamide/timolol fixed combination (DTFC). After 3 months of DTFC usage, the TM width, TM thickness, and SC area did not show significant changes in either the nasal or temporal sectors. Conversely, after prostaglandin analog usage, the TM thickness significantly increased, and the SC area significantly decreased (all P < 0.01). These findings warrant a deeper investigation into their relationship to aqueous outflow through the conventional and unconventional outflow pathways after treatment with PG analogues.

Comparison of the Progression of Localized Retinal Nerve Fiber Layer Defects in Red-free Fundus Photograph, En Face Structural Image, and OCT Angiography Image.

PRECIS: This study demonstrated the high topographic correlation between the red-free fundus photographs and en face structural images in eyes with glaucomatous progression. PURPOSE: The purpose of this study was to compare the progression of localized retinal nerve fiber layer (RNFL) defects in red-free fundus photographs, en face structural images, and optical coherence tomography angiography (OCTA) images. METHODS: We performed a retrospective, comparative study on 45 glaucomatous eyes showing RNFL defect widening in red-free photography. The localized RNFL defect in the red-free photographs was termed as red-free defect. The wedge-shaped hyporeflective area radiating from the optic nerve head in the optical coherence tomography (OCT) en face structural images and OCTA images was defined as en face defect and OCTA defect, respectively. The baseline and follow-up angular parameters of each red-free defect were compared with those of en face defect and OCTA defect. RESULTS: When the baseline angular parameters were compared, there were no significant differences between red-free defect and en face defect, and between red-free defect and OCTA defect (all, P>0.017). In addition, the follow-up angular parameters showed no difference between red-free defect and en face defect. However, the OCTA defect showed significantly greater values compared with red-free defect and en face defect with respect to the distal angular location and angular width at follow-up visit (36.78±15.10 vs. 34.10±15.09 vs. 33.40±15.05 degrees, both, P<0.001). CONCLUSIONS: Localized RNFL defects detected in red-free photographs showed high topographic correlation with defects detected in OCT en face structural images, and this correlation was also noted in eyes with progressive glaucoma. The OCT en face structural images may be an alternative to red-free photography for identifying progressive RNFL defects in eyes with glaucoma.

Efficacy and Safety of Conjunctival Cystectomy Using High-Frequency Radiowave Electrosurgery: A Preliminary Report.

PURPOSE: To evaluate the efficacy and safety of conjunctival cystectomy using high-frequency radiowave electrosurgery. METHODS: This retrospective study included 11 patients who underwent conjunctival cystectomy using high-frequency radiowave electrosurgery and had a follow-up of at least 6 months. Briefly, conjunctival opening with a diameter of 1 mm was made with using high-frequency radiowave electrosurgery (Ellman Surgitron; Ellman International, Inc., Hewlett, NY) in cut mode. The cyst was then extracted using a nontoothed forceps through the opening without rupture. Medical record of the patients was reviewed. RESULTS: In all the 11 patients, conjunctival wound healed in 1 week without any complication. No recurrence was detected in any patients over the 6-month follow-up. CONCLUSIONS: Conjunctival cystectomy with the adjunctive use of high-frequency radiowave electrosurgery was shown to be effective and safe.

Primary antiphospholipid syndrome presenting with homonymous quadrantanopsia.

PURPOSE: To report a case of primary antiphospholipid syndrome presenting with isolated homonymous superior quadrantanopsia. OBSERVATIONS: A 50-year-old Korean man presented with subjective visual disturbance for 1 month. Visual field testing showed a right homonymous superior quadrantanopsia. Brain magnetic resonance imaging (MRI) revealed an old infarct in his left occipital lobe and multiple lesions in other areas of the brain. Laboratory tests showed a marked increase in serum anti-ß2 glycoprotein I antibody, which remained elevated after 12 weeks. He was diagnosed with primary antiphospholipid syndrome and started anticoagulation therapy. CONCLUSIONS AND IMPORTANCE: This is the first case report of primary antiphospholipid syndrome presenting with isolated homonymous quadrantanopsia. Antiphospholipid syndrome should be considered as a differential diagnosis in patients with homonymous visual field defects accompanying multiple cerebral infarcts.

Delayed unilateral abducens nerve palsy following contralateral post-traumatic epidural hematoma.

A 26-year-old Asian woman presented with diplopia occurring at 1 week after conservative treatment for left temporal bone fracture and left temporo-occipital epidural hematoma (EDH). At presentation, right abducens nerve palsy was observed with esotropia and abduction limitation in the right eye. Six weeks later, the abducens nerve palsy fully recovered with complete absorption of the EDH.