Optical coherence tomographic findings of glaucomatous eyes with papillomacular retinoschisis.

OBJECTIVES: To investigate the relationship between the shape of the optic nerve head (ONH) margin detected by optical coherence tomography (OCT) and the clinical characteristics of glaucomatous eyes with papillomacular retinoschisis (PMRS). METHODS: The medical record of patients with a PMRS in a glaucomatous eye were reviewed. The eyes were placed into two groups determined by the shape of the ONH margin in the OCT images; eyes with an externally oblique ONH margin (Group 1) and eyes with an internally oblique ONH margin (Group 2). We compared the clinical characteristics of the PMRS of these two groups. RESULTS: We studied 31 eyes of 29 patients with PMRS and glaucoma with 24 eyes in Group 1 and 7 eyes in Group 2. The optic nerve fibre layer schisis on the lamina cribrosa (LC), beta zone, and gamma zone, and found that the LC defects were detected significantly more frequently in Group 1 than in Group 2 eyes (P < 0.05). A retinal nerve fibre schisis was observed around the ONH significantly more frequently in Group 2 than in Group 1 eyes (P < 0.01). CONCLUSION: The cases of glaucoma-associated PMRS could be classified into two groups according to the obliquity of the ONH. They had differences in the findings of OCT and FA. The possibility that the mechanism of PMRS development is different in both groups is suggested.

Influence of Refractive Error on Circumpapillary Structure-Function Versus Vessel Density-Function Relationships in Open Angle Glaucoma.

PRCIS: In Japanese open angle glaucoma (OAG) eyes correlation of 30-degree visual field mean deviation (MD) and visual field index (VFI) with circumpapillary vessel density is systematically stronger than that with circumpapillary retinal nerve fiber layer thickness (RNFLT), and is preserved in myopia and high myopia. PURPOSE: The purpose of this study was to investigate the influence of refractive error on the relationship between circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and circumpapillary vessel density (cpVD), respectively, and global visual field parameters in Japanese open angle glaucoma (OAG) eyes. MATERIAL AND METHODS: One eye of 81 Japanese OAG patients (spherical equivalent refractive error: +3.0 to -9.0 D) underwent 360-degree cpRNFLT and cpVD measurements with Cirrus HD 5000-AngioPlex optical coherence tomography and 30-2 Humphrey visual field testing for mean deviation (MD) and visual field index (VFI) within 1 month. Correlations were determined for the whole population and each refractive error subgroups, separately: emmetropia/hyperopia (n=24), mild (n=18), moderate (n=20), and high myopia (n=19). RESULTS: For the total population, significant strong to very strong correlations were found between MD, VFI, and both cpRNFLT and cpVD, respectively, with consistently higher r -values for cpVD (highest r -values: 0.532 for cpRNFLT, P <0.001; 0.722 for cpVD, P <0.001). Of the refractive subgroups, statistically significant correlations between cpRNFLT and the visual field parameters were maintained only in the hyperopia/emmetropia and moderate myopia groups. In contrast, statistically significant, strong to very strong correlations between cpVD and both MD and VFI, always exceeding the corresponding r -values found for cpRNFLT were found in all refractive subgroups, with r -values ranging between 0.548 ( P =0.005) and 0.841 ( P <0.001). CONCLUSIONS: Our results suggest that in Japanese OAG eyes the relationship of MD and VFI with cpVD is strong. It is systematically stronger than that with cpRNFLT and preserved in each conventional refractive error category including high myopia.

Effect of Topical Pilocarpine Instilled Before Laser Peripheral Iridotomy on Regional Iris Thickness in Primary Angle Closure Disease: A Swept-Source Anterior Segment Optical Coherence Tomography Pilot Study.

PURPOSE: To determine whether the temporal-superior or the nasal-superior iris area becomes thinner (more optimal) for laser peripheral iridotomy (LPI) after pilocarpine instillation in primary angle closure disease (PACD); and to identify an angle for optimal penetration of the laser beam. PATIENTS AND METHODS: Iris thickness at 2 mm from the iris root in the preset scanning axes was measured using swept-source anterior segment optical coherence tomography before and 60 minutes after the instillation of pilocarpine 2% in one eye of 30 consecutive Japanese PACD patients with thick, dark brown iris. Iris thickness at 1:30 and 10:30 clock hour positions were evaluated in sagittal and oblique directions, resulting sagittal iris thickness (SIT) and minimum iris thickness (MIT) parameters, respectively. RESULTS: Compared to the baseline values, iris thickness decreased significantly (P < .001) in both locations after pilocarpine instillation. Both before and after pilocarpine instillation the temporal-superior iris thickness was significantly smaller than the nasal-superior thickness (P ≤ .001). After pilocarpine instillation, the temporal-superior iris was significantly thinner in an approximately 13° angle direction temporal to the sagittal direction than in the sagittal direction (MIT: 0.322 mm; SIT: 0.346 mm, P < .001). CONCLUSIONS: After pilocarpine instillation, the temporal-superior iris and an approximately 13° angle temporal to the sagittal direction may provide an optimal location and laser beam angle for LPI in PACD eyes.

Combining Optical Coherence Tomography and Fundus Photography to Improve Glaucoma Screening.

We aimed to evaluate the accuracy of glaucoma screening using fundus photography combined with optical coherence tomography and determine the agreement between ophthalmologists and ophthalmology residents. We used a comprehensive ophthalmologic examination dataset obtained from 503 cases (1006 eyes). Of the 1006 eyes, 132 had a confirmed glaucoma diagnosis. Overall, 24 doctors, comprising two groups (ophthalmologists and ophthalmology residents, 12 individuals/group), analyzed the data presented in three screening strategies as follows: (1) fundus photography alone, (2) fundus photography + optical coherence tomography, and (3) fundus photography + optical coherence tomography + comprehensive examination. We investigated the diagnostic accuracy (sensitivity and specificity). The respective sensitivity and specificity values for the diagnostic accuracy obtained by 24 doctors, 12 ophthalmologists, and 12 ophthalmology residents were as follows: (1) fundus photography: sensitivity, 55.4%, 55.4%, and 55.4%; specificity, 91.8%, 94.0%, and 89.6%; (2) fundus photography + OCT: sensitivity, 80.0%, 82.3%, and 77.8%; specificity, 91.7%, 92.9%, and 90.6%; and (3) fundus photography + OCT + comprehensive examination: sensitivity 78.4%, 79.8%, and 77.1%; specificity, 92.7%, 94.0%, and 91.3%. The diagnostic accuracy of glaucoma screening significantly increased with optical coherence tomography. Following its addition, ophthalmologists could more effectively improve the diagnostic accuracy than ophthalmology residents. Screening accuracy is improved when optical coherence tomography is added to fundus photography.

Risk factors for failure of resolving optic disc pit maculopathy after primary vitrectomy without laser photocoagulation.

PURPOSE: To determine factors significantly correlated with the failure of macular reattachment by pars plana vitrectomy (PPV) without laser photocoagulation of the optic disc margin to treat optic disc pit (ODP) maculopathy. DESIGN: Retrospective, interventional case series. METHODS: We reviewed the medical records of 35 consecutive patients with ODP maculopathy who underwent PPV without laser photocoagulation. PPV with the creation of a posterior vitreous detachment (PVD) was performed in 34 eyes. An epiretinal membrane and internal limiting membrane present in the other eye with a PVD were removed. Patients were followed for 12-193 months (mean 58 months) after surgery. The main outcome measures were the postoperative rate of retinal reattachment and best-corrected visual acuity. The preoperative clinical characteristics of the successful cases were compared to those of the unsuccessful cases. RESULTS: A complete retinal reattachment was attained in 31 of 35 eyes and it required about one year. The 4 other eyes that did not achieve a macular reattachment after the primary PPV underwent additional therapies. The factors that were significantly associated with a failure of a retinal reattachment after primary PPV were the presence of a retinal detachment connected to the optic disc (P < 0.001) and the presence of preoperative headaches (P = 0.030). CONCLUSIONS: Clinicians should be aware that the presence of a preoperative macular detachment connected to the optic disc margin and preoperative headaches are indicators for an unsuccessful outcome of PPV without laser photocoagulation in eyes with ODP maculopathy.

Myopic Peripapillary Pits with Spatially Corresponding Localized Visual Field Defects: A Progressive Japanese and a Cross-Sectional European Case.

We report 2 peripapillary pit cases, in which the isolated visual field defects spatially correspond to the pit-related retinal nerve fiber layer and optical coherence tomography (OCT) angiography (OCTA) perfusion damage areas. A high myopic eye of a 39-year-old Japanese male patient, and a moderate myopic eye of a 47-years old Caucasian female patient were evaluated with OCT, OCTA, and visual field testing for peripapillary pits and spatially corresponding localized visual field defects. In the Japanese patient a temporal and in the Caucasian patient an inferotemporal peripapillary pit was confirmed, both spatially associated with a myopic peripapillary atrophy area. In both cases, the retinal nerve fibers herniated into the pit. En face OCT and OCTA revealed retinal nerve fiber bundle defects and reduced vessel density in the corresponding areas, both projecting to the pit. The visual field showed localized scotomas spatially corresponding to the nerve fiber bundle/OCTA defects in both patients. The visual field defect was a progressing (extending and deepening) paracentral scotoma in the Japanese patient, and a localized superior paracentral and superior arcuate scotoma in the Caucasian patient. Our cases show that peripapillary pits occurring in both Japanese and white European eyes can cause localized retinal nerve fiber bundle and OCTA damage and visual field defects of which some can worsen during the follow-up. To separate scotomas due to peripapillary pits and glaucoma is therefore of clinical importance and requires special attention from ophthalmologists.

Detection of Glaucoma and Other Vision-Threatening Ocular Diseases in the Population Recruited at Specific Health Checkups in Japan.

BACKGROUND: The efficacy of vision screening for adults has not been well established. The present study aimed to investigate the prevalence of vision-threatening ocular diseases, including glaucoma, among subjects who participated in specific health checkups in Japan. METHODS: This cross-sectional study included 1360 individuals who underwent comprehensive ophthalmic examinations at 16 ophthalmology clinics located in three municipalities. We surveyed the study participants using a questionnaire. The participants also underwent visual acuity and refraction tests, intraocular pressure tests, slit-lamp microscopy, fundus examinations, fundus photography, optical coherence tomography, and static perimetry. RESULTS: The mean age of the subjects was 63.7 ± 8.7 years (range, 40-74 years). Among the 1360 participants, 168 (12.4%) were diagnosed with glaucoma and 33 (2.4%) with preperimetric glaucoma. Cataracts were seen in 741 participants (54.5%), and 77 (5.7%) were diagnosed with clinically significant cataracts. Retinal diseases included macular degeneration (1.2%), diabetic retinopathy (1.0%), chorioretinal atrophy (0.5%), macular epiretinal membrane (2.9%), branch retinal vein occlusion (0.7%), and others (2.0%). Regarding the type of glaucoma, 93.5% of participants with glaucoma were diagnosed with open-angle glaucoma in a broad sense (81.0% with normal-tension glaucoma and 12.5% with primary open-angle glaucoma). Multivariate analysis showed that male sex, age, systemic comorbidities, and myopia were significant risk factors for open-angle glaucoma. CONCLUSION: Many adults with ocular diseases were screened by ophthalmic checkups. The addition of simultaneous ophthalmic checkups to specific health checkups could be an effective measure for the prevention of visual impairment in the older population.

RETeval Portable Electroretinogram Parameters in Different Severity Stages of Glaucoma.

PRéCIS:: Four parameters of the noninvasive, portable RETeval electroretinogram (ERG) system were found to correlate with visual field mean deviation and optical coherence tomography (OCT) thickness parameters, and may therefore be suitable for glaucoma detection. PURPOSE: To investigate the RETeval full-field ERG parameters for accuracy of separating glaucoma and normal eyes, and correlation with glaucoma severity. PATIENTS AND METHODS: Sixty-two eyes of 62 primary open-angle glaucoma patients [visual field mean deviation (MD) range: -0.44 to -31.15 dB] and 39 eyes of 39 healthy controls underwent one RETeval test (photopic negative response protocol), OCT imaging, and Humphrey 30-2 visual field testing. The glaucoma patients were divided into early (MD≥-6dB, n=33) and moderate-to-advanced (MD<-6 dB, n=29) groups. RESULTS: Significant correlations were found between the best-performing 4 RETeval ERG parameters and the glaucoma severity measures (MD and OCT thickness parameters) for all eyes, all glaucoma eyes and the moderate-to-advanced glaucoma eyes [photopic negative response amplitude at 72 ms (PhNR 72) and MD: r=-0.333, -0.414, and -0.485, respectively, P≤0.008; PhNR 72 and average circumpapillary retinal nerve fiber layer thickness; r=-0.429, -0.450, and -0.542, respectively, P≤0.002]. Except for P-ratio, there was no significant difference between the area under the receiver-operating characteristic (AUROC) values of the OCT thickness parameters (range: 0.927 to 0.938) and the 4 best-performing RETeval ERG parameters (range: 0.839 to 0.905) in the early glaucoma versus control separation. For differentiating the control and the moderate-to-advanced glaucoma eyes, the AUROC values of the 4 best-performing RETeval ERG parameters ranged between 0.924 and 0.958, and no significant difference was found between them and those of the OCT parameters. CONCLUSIONS: The noninvasive, portable RETeval full-field ERG device may be useful to detect glaucoma in moderate-to-advanced stages.

MACULAR DEHISCENCE-ASSOCIATED EPIRETINAL PROLIFERATION IN EYES WITH FULL-THICKNESS MACULAR HOLE.

PURPOSE: To determine the characteristics of the macular dehiscence-associated epiretinal proliferations (EPs) in eyes with full-thickness macular holes (MHs). METHODS: The presence of EPs and the integrity of the retinal microstructures in eyes with MHs were determined by spectral domain optical coherence tomography in 390 eyes of 379 patients (29-89 years). The clinical findings, closure of the MH, the preoperative and postoperative best-corrected visual acuity, and the microstructural changes were compared between eyes with and without EPs. RESULTS: Epiretinal proliferations were detected in 31 of 390 eyes (7.9%). The preoperative best-corrected visual acuity and duration of reduced vision were not significantly different in the group with and without EPs (P = 0.09, P = 0.28). The axial lengths were significantly longer (P = 0.001), MH stage more advanced (P = 0.006), and the incidence of epiretinal membranes (P < 0.001) and intraretinal splitting (P < 0.001) were higher in eyes with EP. The EP was significantly correlated with the length of the ellipsoid zone defects (P < 0.001) and medium-reflective bridging tissue over the closed MH (P < 0.001). The closure rates and postoperative best-corrected visual acuities were not significantly different between the two groups (P > 0.99, P = 0.99). CONCLUSION: The presence of EP was correlated with retinal microstructural changes and may support postoperative visual improvements with medium-reflective bridging tissue over the closed MH.

Circumpapillary microperimetry to detect glaucoma: a pilot study for sector-based comparison to circumpapillary retinal nerve fiber layer measurement.

PURPOSE: To evaluate and compare the diagnostic performance of circumpapillary microperimetry (MP) sensitivity and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measured with optical coherence tomography (OCT) for detection of early to moderate open-angle glaucoma. METHODS: Eleven eyes (11 patients) with early or moderate open-angle glaucoma and seven normal eyes (7 subjects) underwent MP (MP-3 microperimeter, NIDEK, Japan) and cpRNFLT measurement (RS-3000 Advance OCT, NIDEK, Japan) using an identical circumpapillary circle and similar measurement sectors. The structure-function relationship and the area under the receiver-operating characteristics curve (AUROC) were investigated for each sector, respectively. RESULTS: Significant differences (P < 0.05) between glaucoma and normal eyes were found for five of the 12 OCT sectors and seven of the 24 MP sectors. High correlation between cpRNFLT and MP sensitivity was found in the inferotemporal area (OCT sector 5) and superotemporal area (OCT sector 1) (r = 0.818, P < 0.001, and r = 0.796, P < 0.001, respectively). The AUROC values in these sectors ranged 0.890-1.000 for cpRNFLT and 0.825-0.981 for MP sensitivity. Overall, the AUROC ranged 0.506-1.000 for sector cpRNFLT and 0.591-0.981 for sector MP sensitivity. CONCLUSIONS: In this pilot study, circumpapillary MP sensitivity and cpRNFLT showed similar diagnostic power. The structure-function relationship was strong for the superotemporal and inferotemporal circumpapillary areas. Our results suggest that circumpapillary MP represents a new aspect of microperimetry in glaucoma. Further studies on larger populations are necessary to clarify whether the current results are confirmed in clinical practice.

Optical coherence tomography angiography findings of an optic disc melanocytoma in a glaucoma eye.

PURPOSE: To determine the optical coherence tomography angiography (OCTA) characteristics of a case of optic disc melanocytoma (ODM) associated with glaucomatous visual field and retinal nerve fiber layer (RNFL) defects in normal tension glaucoma. METHODS: The left eye of a 37-year-old female patient followed for a stable ODM for 10 years was investigated with OCT, OCTA, fluorescein (FA), and indocyanine green (ICGA) angiography. The ODM was unchanged, but a previously unknown inferotemporal neuroretinal rim loss and inferotemporal and superotemporal wedge shape glaucomatous RNFL thinning were seen with corresponding glaucomatous visual field defects. The intraocular pressure was 12 mmHg without treatment. RESULTS: In the area of the ODM, FA showed minimal vasculature, and week staining in the late phase, while ICGA showed no signal. In contrast, OCTA showed a dense vasculature in both the superficial and deep layers of the melanocytoma, which was clearly separated from the capillaries of the peripapillary retina. OCTA also showed reduced peripapillary perfusion in the areas of the glaucomatous RNFL bundle defects. CONCLUSIONS: In the presented case of a stable ODM and newly detected normal tension glaucoma, OCTA provided more information on perfusion than FA and ICGA which are limited by the heavy pigmentation of the ODM. OCTA also showed a similarly decreased capillary perfusion in both RNFL bundle defects suggesting that the structural damage was related to glaucoma and not compression by ODM. These results suggest that OCTA may be a method preferred over conventional angiography in ODM cases.

Circumpapillary structure-function relationships with microperimetry and spectral domain optical coherence tomography in glaucoma: a pilot study.

PURPOSE: To compare the relationships between circumpapillary microperimetry (MP)-sensitivity measurements and various circumpapillary retinal thickness parameters in healthy and primary open-angle glaucoma (POAG) eyes. METHODS: In 14 eyes of 14 healthy subjects and 22 early-moderate POAG eyes of 22 patients, circumpapillary optical coherence tomography thickness measurements (RS-3000 Advance OCT, NIDEK) of the retinal nerve fiber layer (cpRNFL), total retina (cpTR), and ganglion cell complex (cpGCC) and outer retina (cpOR) and circumpapillary MP-sensitivity measurements (MP-3 microperimeter, NIDEK) were made in 12 sectors of identical circumpapillary circles. The structure-function relationship was investigated in each sector. RESULTS: Statistically significant correlations with circumpapillary MP-sensitivity values were found for cpRNFL in five sectors, cpTR in nine sectors, cpGCC in nine sectors, and cpOR in three sectors. The structure-function relationship was strong (r=0.4-0.69) in three sectors for cpRNFL, in six for cpTR, in four for cpGCC, and in one for cpOR. The relationship was very strong (r>0.7) in one sector for cpRNFL, cpTR, and cpGCC, and in no sectors for cpOR. The very strong relationships all occurred in sector 5 (inferotemporal sector). CONCLUSION: In our pilot study, the circumpapillary structure-function relationship was more extensive for cpTR thickness and cpGCC thickness than for cpRNFL thickness, which suggests that the former parameters may require greater attention in structure-function research into glaucoma.

Changes in the size of the foveal avascular zone after vitrectomy with internal limiting membrane peeling for a macular hole.

PURPOSE: To determine the size of the foveal avascular zone (FAZ) before and after vitrectomy for a macular hole (MH). STUDY DESIGN: Retrospective case series study. METHODS: Twenty-five eyes of 25 patients with a unilateral MH that had undergone vitrectomy with internal limiting membrane peeling were studied. The unaffected 17 fellow eyes were studied in the same way. En face images of the parafoveal region were obtained by optical coherence tomography angiography, and the images were used to measure the FAZ before and 1 month after the vitrectomy. The relationships between the different FAZ sizes and the ocular parameters were determined by Pearson product moment correlation analysis. RESULTS: Compared with the preoperative superficial FAZ (sFAZ), the postoperative sFAZ was significantly reduced (P < 0.001). The postoperative sFAZ was significantly smaller than that of the fellow eye (P < 0.001). The size of the postoperative sFAZ was significantly correlated with that of the preoperative sFAZ, the postoperative foveal thickness (FT), and the sFAZ of the fellow eyes (r = 0.520, P = 0.008; r = -0.515, P = 0.012; and r = 0.702, P = 0.002, respectively). The size of the postoperative deep FAZ (dFAZ) was significantly correlated with the postoperative FT and the dFAZ of the fellow eyes (r = -0.441, P = 0.035; and r = 0.499, P = 0.049, respectively). However, no significant correlation was found between the size of the postoperative FAZ and the size of the preoperative MH. CONCLUSIONS: MH closure leads to a significant decrease in the size of the FAZ symmetrical to the size of the fellow eye. The size of the postoperative FAZ is influenced by the postoperative FT independently of the size of the MH.

Circumpapillary ganglion cell complex thickness to diagnose glaucoma: A pilot study.

PURPOSE: The purpose of this study is to evaluate the applicability of a new optical coherence tomography parameter, the circumpapillary ganglion cell complex (cpGCC) thickness for glaucoma diagnostics. SUBJECTS AND METHODS: The RS-3000 Advance SD-OCT (NIDEK, Aichi, Japan) was used to measure global and sector macular GCC (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, cpGCC, and circumpapillary total retina (cpTR) thickness in 1 eye of 48 preperimetric/early perimetric primary open-angle glaucoma patients and 28 healthy Japanese participants. Area under the receiver-operating characteristic (AUROC) curves were used for between-method comparisons. RESULTS: All global and sector parameters except for the nasal sector differed significantly between the patient groups (P ≤ 0.009). The AUROC for global mGCC (0.917) was significantly higher (P < 0.01) than that for global cpRNFL (0.760), global cpGCC (0.828), and global cpTR (0.812). The AUROC values of global and temporal cpGCC were significantly higher than those of the corresponding cpRNFL parameters (P < 0.05). Correlation between the visual field means deviation and each of the global thickness parameters was similar (r: 0.418-0.473, P< 0.001). At >90% specificity, the cpGCC, cpTR, and cpRNFL were able to detect 4%, 10%, and 0% of glaucoma eyes that were not detected by the mGCC thickness. CONCLUSIONS: In Japanese eyes, the diagnostic accuracy of cpGCC is lower than that of mGCC but higher than that of cpRNFL. Our results suggest that the use of cpGCC may not improve glaucoma diagnostics when there is no macular disease but may be of benefit when macular diseases prevent successful mGCC measurements.

DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To compare the closure rate of macular hole closure and duration of the prone positioning after macular hole (MH) surgery with two protocols for halting the prone positioning. METHODS: The authors studied 129 eyes of 125 consecutive patients with MH who had undergone vitrectomy. In 60 eyes of 59 patients, the prone positioning was halted after detecting an MH closure in the swept-source optical coherence tomographic images (SS group). In 69 eyes of 66 patients, the prone position was halted by the surgeon's decision (conventional group). The MH closure rate and duration of the prone positioning were compared. RESULTS: Clear images of the MH were recorded in the SS group on postoperative Day 1 in 58 eyes (97%). In the SS group, MH closure was detected on postoperative Day 1 in 47 eyes (78%) and Day 2 in 4 eyes (7%). The MH was closed in 58 eyes (97%) in the SS group and 69 eyes (100%) in the conventional group (P = 0.21). None of the eyes had a reopening of the MH. The duration of prone positioning in the SS group was 1.8 ± 2.5 days, which was significantly shorter than that in the conventional group at 8.4 ± 4.2 days (P < 0.0001). CONCLUSION: The SS-OCT protocol can significantly decrease the duration of the prone positioning without a reopening of the MH.

Preserved retinal sensitivity in spatial correspondence to an intrachoroidal cavitation area with full thickness retinal defect: a case report.

BACKGROUND: Intrachoroidal cavitation (ICC) in the temporal peripapillary area is a relatively frequent finding in high myopia. However, ICC associated with a full thickness retinal defect rarely observed. We report an unusual case of ICC combined with a full thickness retinal defect in the papillo-macular bundle, in which the spatially corresponding visual field sensitivity was preserved. CASE PRESENTATION: A high myopic and pseudophakic left eye of a 79-year-old Japanese woman was evaluated with swept source optical coherence tomography (SS-OCT) and Humphrey 30-2 visual field testing for moderate glaucoma. The best-corrected visual acuity was 20/20, the axial length was 28.77 mm, the mean deviation -8.94 dB, and the intraocular pressure was 15 mmHg without medication. The horizontal SS-OCT scans showed a wide ICC with a full thickness retinal defect in the papillo-macular area at the outer border of the myopic peripapillary beta zone atrophy. The retina was herniated into the ICC area. While no sensitivity loss was seen in the central visual field corresponding to the full thickness retinal defect, a glaucomatous visual field deterioration spatially corresponding to the glaucomatous disc damage was present. The preserved retinal sensitivity spatially corresponding to the full thickness retinal defect was confirmed with microperimetry. CONCLUSIONS: Our case suggests that retina herniated in peripapillary ICC temporal to the disc may preserve some function despite the presence of a retinal defect.

The clinical utility of measuring the macular outer retinal thickness in patients with glaucoma.

PURPOSE: Few optical coherence tomography (OCT) studies have investigated outer retinal thickness including the photoreceptor layer in glaucoma. We measured changes in the macular outer retinal thicknesses using OCT in patients with glaucoma with an average follow-up of 2.9 ± 0.8 years. METHODS: A total of 39 eyes of 39 patients with primary open-angle glaucoma were analyzed. The RTVue-100 was used to measure the macular outer retinal, macular ganglion cell complex, and circumpapillary retinal nerve fiber layer thicknesses, global loss volume, and focal loss volume. Using the paired t test, baseline parameters were compared with those at the last follow-up. RESULTS: The average baseline mean deviation value in the Humphrey Field Analyzer was -2.13 dB. The ganglion cell complex thickness significantly decreased over the follow-up period (baseline thickness, 79.66 ± 7.71 µm; final thickness, 76.79 ± 7.39 µm; p<0.001). There were significant differences between baseline and final visit measurements for circumpapillary retinal nerve fiber layer thickness, global loss volume, and focal loss volume (p<0.001, p<0.001, and p = 0.004, respectively). However, there was no significant change in outer retinal thickness (baseline thickness, 167.56 ± 7.26 µm; final thickness, 167.25 ± 7.93 µm; p = 0.540). CONCLUSIONS: Outer retinal thickness was not altered during the follow-up period. The stability of outer retinal thickness may indicate the reliability of OCT analysis for glaucoma follow-up.

Differences of Intrasession Reproducibility of Circumpapillary Total Retinal Thickness and Circumpapillary Retinal Nerve Fiber Layer Thickness Measurements Made with the RS-3000 Optical Coherence Tomograph.

PURPOSE: To evaluate the intrasession reproducibility of various thickness parameters used to diagnose and follow-up glaucoma, in particular circumpapillary total retinal thickness (cpTR) provided by the RS-3000 optical coherence tomograph (OCT). METHODS: Fifty-three healthy eyes of 28 subjects underwent three consecutive imaging with the RS-3000 Advance OCT (NIDEK, Aichi,Japan) to evaluate the intrasession reproducibility of circumpapillary total retinal thickness (cpTR), circumpapillary retinal nerve fiber layer thickness (cpRNFL), macular ganglion cell complex thickness (mGCC) and macular total retina thickness (mTR) measurements. Intraclass correlation (ICC), coefficient of variation (CV) and reproducibility coefficient (RC) were calculated for each parameter. RESULTS: The ICC and CV values for mean cpTR and cpRNFL were 0.987 and 0.897, and 0.60% and 2.81%, respectively. The RC values for the mean cpTR and cpRNFL were 5.95 µm and 9.04 µm, respectively. For all cpTR parameters the ICC values were higher and both the CV and RC values were lower than those for the corresponding cpRNFL parameters. The ICC and CV values for superior mGCC, inferior mGCC, superior mTR and inferior mTR were 0.983, 0.980, 0.983 and 0.988, and 0.84%, 0.98%, 0.48% and 0.43%, respectively. The RC values for superior mGCC, inferior mGCC, superior mTR and inferior mTR were 2.86 µm, 3.12 µm, 4.41 µm and 4.43 µm, respectively. CONCLUSIONS: Intrasession reproducibility of cpTR, mGCC and mTR measurements made on healthy eyes was high. Repeatability of cpTR measurements was better than that of the corresponding cpRNFL measurements. These results suggest that future clinical investigations addressing detection of glaucoma and glaucomatous progression with the RS-3000 OCT may benefit from focusing on the cpTR parameters.

Macular retinoschisis associated with glaucomatous optic neuropathy in eyes with normal intraocular pressure.

PURPOSE: The purpose of this study was to evaluate the clinical features, optical coherence tomography (OCT) findings, and surgical outcomes of eyes with macular retinoschisis associated with glaucomatous optic neuropathy and normal intraocular pressure (IOP). METHODS: In this retrospective interventional observational study, 11 eyes of 11 patients who underwent pars plana vitrectomy for macular retinoschisis and glaucomatous optic neuropathy were studied. All eyes had a vertical cup-to-disc ratio of ≥ 0.7 and retinal nerve fiber layer (RNFL) defects. Intraocular pressure (IOP) was <21 mmHg in all eyes, and there was no presence of congenital optic disc pits or high myopia in any eyes. The best-corrected visual acuity (BCVA) and the appearance of the fundus and OCT images were evaluated. RESULTS: The retinoschisis extended from the optic disc to the macula in all 11 eyes, and foveal detachment was present in 10 eyes. OCT showed vitreous adhesions near the RNFL defects and over the retinal vessels. The retinoschisis in the RNFL resolved immediately after the vitrectomy, and the BCVA improved significantly (p = 0.004). Macular retinoschisis resolved or decreased in all cases, although it required an average of 11 ± 3 months. The optic disc cup and RNFL defects were more clearly visible after resolution of the retinoschisis. CONCLUSIONS: Macular retinoschisis can develop from vitreous traction near the RNFL defect in eyes with glaucomatous optic neuropathy and normal IOP. We suggest that the traction on the structurally fragile RNFL contributed to the retinoschisis.