Border tissue morphology is associated with the pattern of visual field progression in open-angle glaucoma.

The etiology of open-angle glaucoma (OAG) is yet unclear. This study investigated possible risk factors, such as the morphology of the border tissue that affect the pattern of visual field (VF) progression in eyes with OAG. 166 eyes of 166 OAG patients with an externally oblique border tissue (EOBT) at least in one direction were included. EOBT was obtained by analyzing enhanced depth imaging spectral-domain optical coherence tomography images. A pointwise linear regression was used to determine VF progression by measuring the deterioration rate of each point in the VF. The odds ratio of VF progression for each risk factor was estimated using logistic regression analysis. Seventy (42.2%) eyes showed VF deterioration. In multivariate analysis, longer follow-up period, higher baseline intraocular pressure (IOP), lower mean ocular perfusion pressure (MOPP), and smaller angular location of the longest EOBT were associated with VF progression (all p values were below 0.05). In the multivariate analysis, the location of the longest EOBT was significantly associated with inferior (p = 0.002) and central (p = 0.017) VF progression. In conclusion, VF progression pattern in OAG eyes is associated with the location of the longest EOBT as well as other known risk factors.

Comparative Topographical Analysis of Choroidal Microvascular Dropout Between Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy.

Purpose: To identify the presence of choroidal microvascular dropout (MvD) in nonarteritic anterior ischemic optic neuropathy (NAION) eyes and to characterize the topographical distribution for the mechanistic interpretation of MvD development. Methods: We performed optical coherence tomography angiography on 47 open-angle glaucoma (OAG) and 19 NAION eyes with ß-zone peripapillary atrophy (ßPPA). We recorded the presence of MvD and compared between the peripapillary topographical measures of MvD, retinal nerve fiber layer (RNFL) defect, and ßPPA in angular width and location. Results: MvD was present in both diseases, marginally more frequently in NAION eyes (19/19, 100.0%) than in OAG eyes (38/47, 80.6%, P = 0.050), without a discernable difference in appearance. NAION eyes also showed wider MvD and RNFL defects compared to OAG eyes (both P < 0.001). In topographical measurements, the distribution of MvD showed a strong correspondence to superimposition areas of ßPPA and RNFL defects, more distinctly than to RNFL defects (all P < 0.001). The outline of superimposition area also remarkably resembled the MvD area. Conclusions: MvD was present in both the OAG and NAION groups. The ßPPA-RNFL defect superimposition area topographically and morphologically matched MvD. Further investigations are needed to elucidate the role of RNFL defects in the pathogenesis of MvD and the clinical significance.

Ahmed implant coated with poly(2-methacryloyloxyethyl phosphorylcholine) inhibits foreign body reactions in rabbit eyes.

PURPOSE: Wound healing after Ahmed glaucoma valve (AGV) implantation often entails fibrosis as a foreign body reaction to the silicone plate. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) forms an antifouling surface that inhibits fibrosis during wound healing. In this study, we aimed to compare the effects of the implantation of AGV coated with PMPC (wPMPC) versus AGV without PMPC (woPMPC) in rabbits. METHODS: Six New Zealand White rabbit does underwent AGV implantation in both eyes. For each rabbit, one eye was randomly selected for implantation of AGV wPMPC and a conventional AGV (woPMPC) was implanted in the contralateral eye. Gross conjunctival vascularity was compared between the two groups at the first, second, and fourth weeks after surgery. The eyes were enucleated in four weeks and subjected to staining with hematoxylin and eosin and Masson's trichrome stain. The fibrosis and inflammation status among the eye samples were compared by measuring the thickness of the fibrotic walls and counting the number of chronic inflammatory cells around the AGV. Counting of inflammatory cells and measuring fibrotic wall thickness were done in a blinded method to eliminate observer bias. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Gross and histological examinations revealed no toxic effects of PMPC. There were no apparent differences in overall conjunctival vascularity between the two groups at weeks 1, 2, and 4 after surgery. The average inflammatory cell counts were 14.3 ± 5.8 per slide and 27.3 ± 8.6 per slide in the wPMPC and woPMPC groups, respectively (p = 0.037). The average thicknesses of the fibrotic wall were 57.9 ± 11.3 µm and 81.5 ± 21.3 µm in the wPMPC and woPMPC groups, respectively (p = 0.025). CONCLUSION: Compared to the woPMPC group, the number of inflammatory cells and fibrosis were significantly decreased in the wPMPC group.

The Progression of Peripapillary Retinoschisis May Indicate the Progression of Glaucoma.

Purpose: To identify the temporal correlation between the increase in peripapillary retinoschisis (PPRS) and glaucoma progression during PPRS fluctuation. Methods: We performed a comparative clinical timeline analysis for PPRS and glaucomatous progression in eyes with PPRS. In particular, the interval between the increase in PPRS extent and glaucoma progression was analyzed. Temporal correlation was defined when the interval was less than one year between glaucoma progression and PPRS increase, including both de novo development and an increase in the amount of retinoschisis on serial optical coherence tomography. Results: We included 33 eyes of 30 patients, with an average follow-up period of 7.5 ± 3.0 years and a total of 253 glaucoma examinations. Glaucoma progression was observed in 21 of 33 eyes; 19 (90.5%) of the 21 eyes with glaucoma progression and 29 (74.4%) of the 39 episodes of PPRS increase showed temporal correlation. The de novo development of PPRS during the follow-up period over baseline PPRS was more frequently observed in the glaucoma progression group than in the no-progression group (P = 0.006). Conclusions: In glaucomatous eyes with PPRS, the increase in PPRS temporally correlated with glaucoma progression. Possible glaucoma progression may be considered around the time of increase and de novo development of PPRS.

Evidence-based understanding of disc hemorrhage in glaucoma.

Disc hemorrhage is a characteristic finding that is highly associated with glaucoma development or progression. Consequently, the literature commonly designates disc hemorrhage as a "risk factor" for glaucoma progression; however, the exact cause-and-effect relationship or mechanism remains unclear. In this review, we discuss the emerging evidence that disc hemorrhage is a secondary development that follows glaucomatous damage. As our understanding of disc hemorrhage has progressed in recent decades, we suggest the terminology be changed from "risk factor" to "indicator" of ongoing glaucomatous development or progression for a more accurate description, better indication of the clinical implications and, ultimately, a better guide for future research.

Evaluation and validation of sustained upgaze combined with the ice-pack test for ocular myasthenia gravis in Asians.

The accuracy of the ice-pack test for diagnosing myasthenia gravis (MG) has been reported to be excellent, however, the sensitivity is low in patients with mild ptosis which is common in Asians who have absent or low double eyelid folds. Herein, we performed the ice-pack test after sustained upgaze and tested its validity for diagnosing MG. The study included 30 newly diagnosed MG patients with ptosis (median age 47 years, range 2-87 years) and 30 controls with ptosis other than MG (median age 58 years, range 5-83 years). All MG patients initially presented with ptosis and/or diplopia; 26 patients had purely ocular MG while 4 patients progressed to generalized MG. All patients performed the new ice-pack test after sustained upgaze for 2 min. The ice-pack test was judged positive if there was an improvement of at least 2 mm of margin reflex distance compared to the level of ptosis before (conventional ice-pack test) or after (new ice-pack test) sustained upgaze. Subgroup analysis was performed according to the level of ptosis. The conventional test showed 43.3% sensitivity and 100% specificity for diagnosing MG, while the new ice-pack test achieved 73.3% sensitivity and 96.7% specificity, respectively. In patients with mild ptosis, the sensitivity and specificity for diagnosing MG were 27.8% and 100% by the conventional test, and 72.2% and 96.7% by the new ice-pack test, respectively. The new ice-pack test combined with sustained upgaze was more sensitive for diagnosing MG, particularly in patients with mild ptosis which is common in Asians.