High Pulse Wave Velocity Is Associated With Decreased Macular Vessel Density in Normal-Tension Glaucoma.

Purpose: To investigate the relationship between pulse wave velocity (PWV) and retinal vessel density (VD) measured by optical coherence tomography angiography (OCTA) in patients with normal-tension glaucoma (NTG). Methods: This retrospective study included 103 patients with NTG and 109 healthy controls who underwent glaucoma examination and PWV measurements. Each group was classified into two subgroups according to a brachial-ankle PWV of 1400 cm/s. NTG was diagnosed when the maximum untreated intraocular pressure was < 21 mmHg on three repeated measurements obtained at different times in the presence of glaucomatous optic discs (neuroretinal rim thinning and excavation), peripapillary retinal nerve fiber layer defects, and glaucomatous visual field defects. Healthy controls did not have glaucomatous optic discs or visual field defects and exhibited normal retinal nerve fiber layer thickness. The interval between glaucoma examination and PWV measurements did not exceed six months. Univariate and multivariate logistic regression analyses were performed to identify factors associated with high PWV. Results: PWV was higher in the NTG group than in the control group, while peripapillary VD and macular VD (mVD) were lower (all P < 0.05). Stepwise logistic regression analysis revealed that high PWV was significantly associated with age, mean arterial pressure (MAP), and mVD in the NTG group. Meanwhile, high PWV was significantly associated with age, MAP, and low-density lipoprotein cholesterol levels in healthy controls. Conclusions: High PWV is associated with decreased mVD in NTG patients, suggesting that systemic arterial stiffness might be involved in the pathogenesis of NTG.

Corneal endothelial cell changes and surgical results after Ahmed glaucoma valve implantation: ciliary sulcus versus anterior chamber tube placement.

We compared the changes in corneal endothelial cells and surgical outcomes after Ahmed glaucoma valve (AGV) implantation with the valve tip inserted either into ciliary sulcus (CS) or anterior chamber (AC). We retrospectively reviewed the medical records of patients treated with CS AGV (n = 24) and AC AGV (n = 38). We compared the preoperative and postoperative central corneal endothelial cell density (ECD), endothelial cell coefficient of variation (CV), best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications in the two groups. Both groups had similar baseline characteristics and follow-up period. At the last follow-up, the AC AGV group had significantly higher mean monthly ECD loss (17.47 ± 11.50 cells/mm2 vs. 6.40 ± 7.69 cells/mm2, p < 0.0001) and greater proportion of mean monthly ECD loss than the CS AGV group (0.84 ± 0.53 vs. 0.36 ± 0.39%, p < 0.0001). Both groups had similar mean monthly CV changes. The qualified success rates at 2 years were 83.3% and 76.3% for the CS AGV and AC AGV groups, respectively. Although similar surgical outcomes including visual acuity, IOP, number of glaucoma medications, and postoperative complications were obtained following CS AGV and AC AGV, corneal ECD loss was higher in the AC AGV group. Thus, CS AGV may be a better surgical option than AC AGV.

Glaucoma Progression after Delivery in Patients with Open-Angle Glaucoma Who Discontinued Glaucoma Medication during Pregnancy.

In this retrospective study, clinical characteristics and glaucoma progression of open-angle glaucoma (OAG) patients who discontinued intraocular pressure (IOP)-lowering medication during pregnancy were investigated. Glaucoma progression was determined using either serial visual field tests or optic disc/retinal nerve fiber layer (RNFL) photographs. Age, number of previous pregnancies, diagnosis, average IOP, IOP fluctuation, visual field mean deviation, pattern standard deviation, and RNFL thickness were examined, and their association with glaucoma progression was determined using linear regression analysis. Among 67 eyes (37 patients), 19 eyes (28.4%) exhibited glaucoma progression 13.95 ± 2.42 months after delivery. The progression group showed significantly higher mean IOP than the nonprogression group in the first, second, and third trimesters (p = 0.02, 0.001, and 0.04, respectively). The average IOP in the second, and third trimesters and IOP fluctuation during the entire pregnancy were significantly associated with glaucoma progression according to a univariate analysis (p = 0.04, 0.031, and 0.026, respectively). In conclusion, IOP elevation during pregnancy is associated with glaucoma progression after delivery in patients who had discontinued medication during pregnancy. Therefore, close monitoring of glaucoma is necessary, particularly if patients discontinue medication during pregnancy, and appropriate intervention should be considered in case of increased IOP.

Relationship between N95 Amplitude of Pattern Electroretinogram and Optical Coherence Tomography Angiography in Open-Angle Glaucoma.

PURPOSE: The pattern electroretinogram (PERG) is useful to detect retinal ganglion cell (RGC) damage in patients with glaucoma. Optical coherence tomography angiography (OCTA) measures retinal vessel density (VD), which is known to be reduced in glaucoma. There may be correlations between parameters of the PERG and OCTA in open-angle glaucoma (OAG). METHODS: In total, 95 eyes of 95 OAG patients and 102 eyes of 102 normal controls were included in this study. N35, P50, and N95 latency along with P50 and N95 amplitude were obtained using the PERG. Retinal VD was measured around the peripapillary and macular area according to the ETDRS grid (concentric circles with diameters of 1, 3, and 6 mm), which is named a center (≤1 mm), an inner (1-3 mm), an outer (3-6 mm), and a full (≤6 mm) area. Pearson correlation analysis was done between parameters, and partial correlation analysis was done after adjusting confounding factors. RESULTS: P50 amplitude, N95 amplitude, and VD of most measured areas were significantly lower in the OAG group compared to the normal group. N95 amplitude showed a statistically significant correlation with parameters of optical coherence tomography and visual field, peripapillary outer and full VD, and macular outer and full VD even after adjusting confounding factors. There was no significant correlation between parameters in the normal group. CONCLUSIONS: N95 amplitude was associated with structural and functional change including VD reduction in OAG. Microvascular alterations may be associated with dysfunctional changes of RGC recorded by the PERG in OAG.

Stroke risk among adult patients with third, fourth or sixth cranial nerve palsy: a Nationwide Cohort Study.

PURPOSE: This study sought to determine whether isolated third, fourth and sixth cranial nerve palsies (NPs) are associated with increased short- and long-term risk of a subsequent stroke. METHODS: This was a nationwide retrospective propensity score-matched cohort study. A cohort of patients with NP (n = 466) and a randomly selected, propensity-matched control cohort (n = 2281) were extracted from the Korean national insurance claim database. Subjects were tracked for 5 years total, subdivided into periods of 0-1 years, 1-3 years and 3-5 years. We assessed the risk of stroke using hazard ratios (HRs) and confidence intervals (CIs) after adjustments using Cox regression at different time intervals. RESULTS: The median follow-up was 3.1 years. Stroke developed in 18.9% of the NP cohort and 7.5% of the control cohort. Stroke risk after NP was highest in the first year [14.7 per 100 person-year at 0-1 years (HR = 6.6), 3.1 per 100 person-year at 1-3 years (HR = 1.6) and 4.3 per 100 person-year at 3-5 years (HR = 2.8)]. Each type of NP was also associated with stroke risk: within 0-1 years, stroke risk was increased in third (HR = 7.6), fourth (HR = 6.0) and sixth (HR = 5. 84) NPs. In the 3- to 5-year period, risk was increased in sixth (HR = 4.7) and fourth (HR = 3.3) NPs, but not third (HR = 0.6) NPs. CONCLUSION: Patients in the NP cohort were more likely to have a stroke than those in the matched control cohort; the increased risk was both time- and cranial nerve-dependent.

Retinal microstructures are altered in patients with idiopathic infantile nystagmus.

PURPOSE: To compare segmented retinal layer thicknesses between patients with idiopathic infantile nystagmus (IIN) and controls. METHODS: This retrospective case-control study included 66 patients with IIN and 66 age-matched controls. The retinal layers were examined using spectral domain optical coherence tomography with autosegmentation. Central foveal thickness (CFT), outer nuclear layer (ONL), and outer segment length (OSL) thickness were measured at the fovea center. Mean values for retinal nerve fiber layer, ganglion cell inner plexiform layer (GCIPL), inner nuclear layer, outer plexiform-outer nuclear layer (OPNL) thicknesses were calculated at two measurement points (nasal and temporal hump points at the macula area). RESULTS: There were no significant between-group differences in age, gender, or refraction error. The CFT was thicker in the IIN group compared with the control group (225.0 µm vs. 217.8 µm, P = 0.017) and OSL was shorter in IIN than in controls (40.0 µm vs. 43.7 µm., P < 0.001). The ONL thickness at the central fovea was not statistically different between the two groups. At the nasal and temporal position where the ganglion cell density was thickest, the GCIPL thickness was thinner in the IIN group compared to the controls (99.5 µm vs. 102.8 µm, P = 0.010). The GCIPL thickness was negatively correlated with logMAR visual acuity (Spearman's rho = -0.502, P < 0.001). CONCLUSIONS: The foveal pit was shallower, OSL was shorter, and the GCIPL thicknesses at macular humps were decreased in the patients with IIN compared with that of controls. The faulty development of the macula may be related to unknown pathophysiologic mechanism during fovea maturation in IIN or continuous eye movement itself interrupt fovea development.

Effect of trabeculectomy on the accuracy of intraocular lens calculations in patients with open-angle glaucoma.

BACKGROUND: The objective of the study is to examine the effect of trabeculectomy on intraocular lens power calculations in patients with open-angle glaucoma (OAG) undergoing cataract surgery. DESIGN: The design is retrospective data analysis. PARTICIPANTS: There are a total of 55 eyes of 55 patients with OAG who had a cataract surgery alone or in combination with trabeculectomy. METHODS: We classified OAG subjects into the following groups based on surgical history: only cataract surgery (OC group), cataract surgery after prior trabeculectomy (CAT group), and cataract surgery performed in combination with trabeculectomy (CCT group). MAIN OUTCOME MEASURES: Differences between actual and predicted postoperative refractive error. RESULTS: Mean error (ME, difference between postoperative and predicted SE) in the CCT group was significantly lower (towards myopia) than that of the OC group (P = 0.008). Additionally, mean absolute error (MAE, absolute value of ME) in the CAT group was significantly greater than in the OC group (P = 0.006). Using linear mixed models, the ME calculated with the SRK II formula was more accurate than the ME predicted by the SRK T formula in the CAT (P = 0.032) and CCT (P = 0.035) groups. CONCLUSIONS: The intraocular lens power prediction accuracy was lower in the CAT and CCT groups than in the OC group. The prediction error was greater in the CAT group than in the OC group, and the direction of the prediction error tended to be towards myopia in the CCT group. The SRK II formula may be more accurate in predicting residual refractive error in the CAT and CCT groups.

Disappearance of soft drusen and subsequent development of choroidal neovascularization following macular hole surgery: a case report.

BACKGROUND: Drusen are important risk factor for neovascular age-related macular degeneration (AMD) and have a dynamic nature as they can enlarge, newly form, or disappear over time. There have been few reports on drusen regression or choroidal neovascularization (CNV) development after macular hole surgery. We report, to our knowledge, the first case of both drusen regression and subsequent CNV development within 7 months of successful macular hole surgery. CASE PRESENTATION: A 73-year-old woman presented with a stage 3 full-thickness macular hole and large, confluent soft macular drusen in the right eye and a neovascular age-related macular degeneration (AMD) in the fellow eye. Four months after the successful macular hole surgery, significant regression of drusen was seen, especially in the temporal area to the fovea. Three months later, the patient developed CNV and her best-corrected visual acuity decreased to 20/100, despite further regression of macular drusen. CONCLUSIONS: Macular hole patients with macular soft drusen need to be carefully followed up after surgery for possible drusen regression and CNV development.

Topographical variation of macular choroidal thickness with myopia.

PURPOSE: To study the association between topographical variation of choroidal thickness and myopic features in healthy eyes, using spectral domain optical coherence tomography (OCT). METHODS: Choroidal thickness was measured at the foveal centre (CTF) and 1.5 mm superiorly (CTS), inferiorly (CTI), nasally (CTN) and temporally (CTT) from the foveal centre, using enhanced depth imaging OCT. The temporal width of ß zone of peripapillary atrophy (ßPPA) was measured on infrared fundus images. The ratio of ßPPA width to vertical disc diameter (PVDR) was calculated to correct retinal magnification. RESULTS: This study includes 85 eyes from 85 subjects who had a mean age of 53.9 ± 12.9 years, a mean axial length of 23.56 ± 0.82 mm, a mean refractive error of -0.14 ± 1.80 D, a mean ßPPA width of 218.6 ± 181.3 µm and a mean PVDR of 0.13 ± 0.11. The CTF was thickest (266.4 ± 81.6), followed by CTS (256.2 ± 82.5 µm), CTT (251.7 ± 68.4 µm), CTI (247.7 ± 90.3 µm) and CTN (211.0 ± 76.5 µm). There were 31 eyes (36.5%) with CTT thicker than CTF. The CTT/CTF negatively correlated with refractive error (p = 0.012) and positively correlated with axial length (p = 0.031), ßPPA width (p = 0.003) and PVDR (p = 0.006). CONCLUSIONS: There was a correlation between a thickened choroid, temporal to the foveal centre, with the severity of myopic components in normal eyes. Topographical changes might be induced by stretching of the choroid and sclera towards a temporal direction with eyeball elongation.

Management of long-standing partially torn and flipped laser in situ keratomileusis flaps.

UNLABELLED: We describe 2 cases of traumatized and torn laser in situ keratomileusis (LASIK) flaps, partially flipped anteriorly or posteriorly, fixed for 8 months or 4 months, and accompanied by epithelial ingrowth. The 2 patients had had uneventful bilateral LASIK 6 years and 1 year before the trauma. In Case 1, the anteriorly flipped flap was removed with transepithelial phototherapeutic keratectomy. Next, mitomycin-C 0.04% was applied for 30 seconds. In Case 2, the portion of the flap that was flipped posteriorly and buried under the remaining intact LASIK flap was restored to its original normal position and epithelial ingrowth was removed mechanically with a microcurette. Irrigation with 20% ethanol was performed to inhibit the recurrence of interfacial epithelial ingrowth. The stretched amniotic membrane overlay over the cornea and sclera was sutured tightly to the episclera as the biologic pressure patch for the inhibition of epithelial re-ingrowth. Good visual acuity was restored in both cases. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Neuroprotective and neurite outgrowth effects of maltol on retinal ganglion cells under oxidative stress.

PURPOSE: To evaluate the neuroprotective and neurite outgrowth effects of maltol, a natural aroma compound, on retinal ganglion cells (RGCs) under oxidative stress in vitro. METHODS: Mouse primary RGCs were isolated using immunopanning-magnetic separation and exposed to H2O2 in the presence of maltol. The cell viability and apoptosis were determined by using adenosine 5'-triphosphate (ATP) assay and terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL), respectively. Neurite outgrowth was assessed by immunofluorescence for α-tubulin. The activation of nuclear factor-κB (NF-κB) was also evaluated using immunofluorescence. RESULTS: When the RGCs were exposed to 20 µM of H2O2 for 16 h, their viability dropped to 40.3±3.4%. However, the maltol treatment restored the cells in a dose-dependent manner. The viability recovered to 73.9±5.1% with 10 µM of maltol and even reached 175.1±11.3% with 2 mM of maltol, as measured by ATP assay. This oxidative stress significantly increased the number of TUNEL-positive RGCs, but the maltol drastically reduced the proportion of those apoptotic cells. The oxidative stress hampered the neurite outgrowth of the RGCs, whereas maltol restored their ability to sprout neurites. Regarding NF-κB, the active form of phosphorylated NF-κB (pNF-κB) increased the oxidative stress level but the maltol treatment again reduced it to an unstressful level. CONCLUSIONS: Our data revealed that maltol attenuated the oxidative stress-induced injury in the primary mouse RGCs. Its neuroprotective and neurite outgrowth effects seemed to be related to NF-κB signaling. Maltol has potential as a new neuroprotective therapeutic agent for oxidative stress-related ocular diseases, including glaucoma.