Comparison of peripapillary vessel density between preperimetric and perimetric glaucoma evaluated by OCT-angiography.

PURPOSE: To determine peripapillary vessel density in eyes with perimetric glaucoma (PG) or preperimetric glaucoma (PPG) compared to normal controls using optical coherence tomography-angiography (OCT-A). METHODS: We recruited 13 patients with unilateral perimetric normal-tension glaucoma (NTG) and fellow preperimetric NTG showing only inferotemporal retinal nerve fiber layer (RNFL) defect in red-free RNFL photography in both eyes. We also enrolled 9 healthy controls. Using OCT-A, radial peripapillary capillary densities at inferotemporal and superotemporal regions were evaluated. Paired comparison of peripapillary vessel density was performed for PG eye, PPG eye, and normal eye. RESULTS: A total of 26 eyes of the 13 patients with unilateral PG and fellow PPG eyes and 18 eyes of 9 normal controls were analyzed. Vessel densities at the whole peripapillary region and inferotemporal region in PG eyes were significantly lower than those in PPG eyes (P = 0.001, P<0.001, respectively). Comparison between PPG and normal eyes showed no significant difference in the whole peripapillary region or the inferotemporal region (P = 0.654, P = 0.174, respectively). There was no significant (P = 0.288) difference in vessel density at superotemporal region among the three types of eyes (PG eye, PPG eye, and normal eye). CONCLUSION: PPG eyes and normal eyes were found to have the similar densities of peripapillary microvasculature at the area with nerve fiber layer defect, whereas in PG eye, there was a significant decrease in vessel density at the area of RNFL thinning. This provides evidence that microvascular compromise in the retina might be a secondary change to nerve fiber layer degeneration in the pathogenesis of NTG.

The Characteristics of Deep Optic Nerve Head Morphology in Myopic Normal Tension Glaucoma.

Purpose: To investigate the relationship between axial length (AL) and deep optic nerve head (ONH) structure and to evaluate the characteristics of deep ONH structures in myopic normal tension glaucoma (NTG). Methods: The following parameters were assessed using spectral-domain optical coherence tomography (SD-OCT): externally oblique border tissue (EOBT) length, ONH tilt angle, optic canal (OC) obliqueness, and ß-zone peripapillary atrophy (PPA). In addition, the angular location of the maximal value of each parameter and retinal nerve fiber layer (RNFL) defect were measured using infrared and red-free photos. Results: A total of 74 myopic NTG eyes and 67 myopic control eyes with a spherical equivalent < -0.5 diopters from 141 subjects were included. AL was correlated with the maximal values of EOBT length, ONH tilt angle, OC obliqueness, and ß-zone PPA (P < 0.001, P = 0.003, P < 0.001, and P < 0.001, respectively). Multivariate logistic regression analysis revealed that temporally located maximal values of EOBT length, ONH tilt angle, and OC obliqueness were associated with the presence of myopic NTG (P = 0.014, P = 0.016, and P = 0.030, respectively). In myopic NTGs, RNFL defect locations were consistent with the locations of maximal values of EOBT length, ONH tilt angle, OC obliqueness, and ß-zone PPA (P < 0.001, P < 0.001, P < 0.001, and P = 0.003, respectively). Conclusions: Temporalized angular locations of deep ONH parameters were associated with the presence of NTG in myopia. In myopic NTGs, the locations of deep ONH parameters were consistent with the locations of RNFL defect.

Oculomotor neuromyotonia with lid ptosis on abduction.

Ocular neuromyotonia is an episodic involuntary contraction of one or more of the extraocular muscles resulting from spontaneous neural discharges of the oculomotor nerve. It is characterized by symptomatic diplopia for the duration of the contraction and occurs either spontaneously or after a sustained eccentric gaze. Although the mechanism of ocular neuromyotonia is not fully understood, primary or secondary aberrant regeneration and consequent ephaptic transmission generally are held to be involved. We report the case of a patient with right oculomotor neuromyotonia accompanied by lid ptosis on abduction of the left eye who was successfully treated with oral carbamazepine.

A case of synchronous double primary cancer of the penis and urinary bladder.

Multiple primary cancers are the occurrence of more than two cancers of different origin in an individual. Penile cancer is a rare disease, and finding it combined with other cancers is even rarer. A 64-year-old man with a painful penile mass was referred to us from a primary urological clinic. We performed a biopsy of the penile mass and the histology revealed a well-differentiated squamous cell carcinoma. Abdominal computed tomography showed a localized bladder tumor with inguinal lymphadenopathy. The patient underwent a partial penectomy, transurethral resection of the bladder tumor and inguinal lymph node dissection. The histology of the bladder tumor was high-grade papillary carcinoma, and that of the lymph node was squamous cell carcinoma. The penile and bladder tumors were in stage II (T1N1M0) and stage I (T1N0M0), respectively. We successfully treated the patient with adjuvant radiotherapy and systemic chemotherapy.