Teres minor denervation and pathologies resulting in shoulder joint instability and rotator cuff tears: A retrospective cross-sectional MRI study.

Teres minor denervation (TMD) has gained increasing attention in recent years, particularly with the advent of magnetic resonance imaging (MRI). The potential association between TMD and shoulder instability or rotator cuff tear remains a subject of interest in the orthopedic community. In this retrospective and cross-sectional study, authors aim to investigate the potential association between TMD and shoulder instability or rotator cuff tears. Authors retrospectively analyzed MRI findings from 105 patients with TMD, focusing on rotator cuff pathologies, posterior labrocapsular complex (PLCC) tears, and posteroinferior glenohumeral joint capsule alterations. Authors assessed the association between TMD and rotator cuff and PLCC tears. For the multivariate analysis, partial proportional odds models were constructed for subscapularis (SSC) and SSP tears. Rotator cuff tears were present in 82.9% of subjects, with subscapularis (SSC) tears being the most frequent (77.1%). A significant association was observed between TMD and rotator cuff pathology (P = .002). PLCC tears were found in 82.3% of patients, and humeral position relative to the osseous glenoid was noted in 60% of patients with TMD. A significant association was identified between TMD and shoulder instability or labral/capsular abnormalities (P < .001). More than half of the cases exhibited a long tethering appearance toward the axillary neurovascular bundle on T1-weighted sagittal images. Our findings suggest that TMD is significantly associated with rotator cuff tears and shoulder instability. This study highlights the importance of identifying and treating PLCC tears in patients with TMD to address shoulder instability. Further research is needed to elucidate the role of TMD in the pathogenesis of shoulder instability and rotator cuff pathology.

Progressive Changes in the Anterior Segment and Their Impact on the Anterior Chamber Angle in Primary Angle Closure Disease.

PURPOSE: To investigate longitudinal changes in the anterior segment (AS) using serial optical coherence tomography (OCT) images and determine the impact of these changes on the anterior chamber angle (ACA) in eyes with primary angle closure disease (PACD) treated with laser peripheral iridotomy (LPI). DESIGN: Retrospective clinical cohort study. METHODS: This study included 103 patients with PACD who underwent LPI and were followed up by a mean 6.7 ± 1.7 AS-OCT examinations for a mean 6.5 ± 2.9 years. Temporal changes in AS-OCT parameters, including anterior chamber depth (ACD), angle opening distance (AOD750), angle recess area (ARA750), iris thickness (IT750), lens vault (LV), and pupil diameter (PD), were analyzed by multivariate linear mixed effects models (LMEMs). RESULTS: Multivariate LMEMs showed that decrease in AOD750 was not significant (-1.59 µm/y, P = .222); however, ARA750 decreased over time (-2.3 × 103 µm2/y, P = .033) and SSA showed marginal significance (-0.20°/y, P = .098), and LV increased significantly (11.6 µm/y, P < .001) after LPI. Mean LV change was negatively associated with AOD750, ARA750, and SSA, whereas PD was negatively associated with ARA750 (P < .001 each). PD decreased with aging (-13.7 µm/y, P = .036), accompanied by thinning of IT750 (-1.7 µm/y, P = .063). CONCLUSIONS: LV tends to increase with aging, which contributes to the shallowing of the anterior chamber and narrowing of ACA in PACD eyes treated with LPI. In the meantime, pupillary constriction and subsequent peripheral iris thinning associated with aging could possibly offset the effect of ACA narrowing.

Translation of paired fundus photographs to fluorescein angiographs with energy-based cycle-consistent adversarial networks.

Fluorescein angiography is a crucial examination in ophthalmology to identify retinal and choroidal pathologies. However, this examination modality is invasive and inconvenient, requiring intravenous injection of a fluorescent dye. In order to provide a more convenient option for high-risk patients, we propose a deep-learning-based method to translate fundus photography into fluorescein angiography using Energy-based Cycle-consistent Adversarial Networks (CycleEBGAN) We propose a deep-learning-based method to translate fundus photography into fluorescein angiography using CycleEBGAN. We collected fundus photographs and fluorescein angiographs taken at Changwon Gyeongsang National University Hospital between January 2016 and June 2021 and paired late-phase fluorescein angiographs and fundus photographs taken on the same day. We developed CycleEBGAN, a combination of cycle-consistent adversarial networks (CycleGAN) and Energy-based Generative Adversarial Networks (EBGAN), to translate the paired images. The simulated images were then interpreted by 2 retinal specialists to determine their clinical consistency with fluorescein angiography. A retrospective study. A total of 2605 image pairs were obtained, with 2555 used as the training set and the remaining 50 used as the test set. Both CycleGAN and CycleEBGAN effectively translated fundus photographs into fluorescein angiographs. However, CycleEBGAN showed superior results to CycleGAN in translating subtle abnormal features. We propose CycleEBGAN as a method for generating fluorescein angiography using cheap and convenient fundus photography. Synthetic fluorescein angiography with CycleEBGAN was more accurate than fundus photography, making it a helpful option for high-risk patients requiring fluorescein angiography, such as diabetic retinopathy patients with nephropathy.

Development of Cumulative Order-Preserving Image Transformation Based Variational Autoencoder for Anterior Segment Optical Coherence Tomography Images.

Purpose: To develop a variational autoencoder (VAE) suitable for analysis of the latent structure of anterior segment optical coherence tomography (AS-OCT) images and to investigate possibilities of latent structure analysis of the AS-OCT images. Methods: We retrospectively collected clinical data and AS-OCT images from 2111 eyes of 1261 participants from the ongoing Asan Glaucoma Progression Study. A specifically modified VAE was used to extract six symmetrical and one asymmetrical latent variable. A total of 1692 eyes of 1007 patients were used for training the model. Conventional measurements and latent variables were compared between 74 primary angle closure (PAC) and 51 primary angle closure glaucoma (PACG) eyes from validation set (419 eyes of 254 patients) that were not used for training. Results: Among the symmetrical latent variables, the first three and the last demonstrated easily recognized features, anterior chamber area in η1, curvature of the cornea in η2, the pupil size in η3 and corneal thickness in η6, whereas η4 and η5 were more complex aggregating complex interactions of multiple structures. Compared with PAC eyes, there was no difference in any of the conventional measurements in PACG eyes. However, values of η4 were significantly different between the two groups, being smaller in the PACG group (P = 0.015). Conclusions: VAE is a useful framework for analysis of the latent structure of AS-OCT. Latent structure analysis could be useful in capturing features not readily evident with conventional measures. Translational Relevance: This study suggested that a deep learning-based latent space model can be applied for the analysis of AS-OCT images to find latent characteristics of the anterior segment of the eye.

Development of a ß-Variational Autoencoder for Disentangled Latent Space Representation of Anterior Segment Optical Coherence Tomography Images.

PURPOSE: To investigate the feasibility of extracting a low-dimensional latent structure of anterior segment optical coherence tomography (AS-OCT) images by use of a ß-variational autoencoder (ß-VAE). METHODS: We retrospectively collected 2111 AS-OCT images from 2111 eyes of 1261 participants from the ongoing Asan Glaucoma Progression Study. After hyperparameter optimization, the images were analyzed with ß-VAE. RESULTS: The mean participant age was 64.4 years, with mean values of visual field index and mean deviation of 86.4% and -5.33 dB, respectively. After experiments, a latent space size of 6 and ß value of 53 were selected for latent space analysis with ß-VAE. Latent variables were successfully disentangled, showing readily interpretable distinct characteristics, such as the overall depth and area of the anterior chamber (η1), pupil diameter (η2), iris profile (η3 and η4), and corneal curvature (η5). CONCLUSIONS: ß-VAE can successfully be applied for disentangled latent space representation of AS-OCT images, revealing the high possibility of applying unsupervised learning in the medical image analysis. TRANSLATIONAL RELEVANCE: This study demonstrates that a deep learning-based latent space model can be applied for the analysis of AS-OCT images.

Can Artificial Intelligence Predict Glaucomatous Visual Field Progression? A Spatial-Ordinal Convolutional Neural Network Model.

PURPOSE: To develop an artificial neural network model incorporating both spatial and ordinal approaches to predict glaucomatous visual field (VF) progression. DESIGN: Cohort study. Methods From a cohort of primary open-angle glaucoma patients, 9212 eyes of 6047 patients who underwent regular reliable VF examinations for >4 years were included. We constructed all possible spatial-ordinal tensors by stacking 3 consecutive VF tests (VF-blocks) with at least 3 years of follow-up. Trend-based, event-based, and combined criteria were defined to determine the progression. VF-blocks were considered "progressed" if progression occurred within 3 years; the progression was further confirmed after 3 years. We constructed 6 convolutional neural network (NN) models and 2 linear models: regression on global indices and pointwise linear regression (PLR). We compared area under the receiver operating characteristic curve (AUROC) of each model for the prediction of glaucomatous VF progression. RESULTS: Among 43,260 VF-blocks, 4406 (10.2%), 4376 (10.1%), and 2394 (5.5%) VF-blocks were classified as progression-based on trend-based and event-based and combined criteria. For all 3 criteria, the progression group was significantly older and had worse initial MD and VF index (VFI) than the nonprogression group (P < .001 for all). The best-performing NN model had an AUROC of 0.864 with a sensitivity of 0.42 at a specificity of 0.95. In contrast, an AUROC of 0.611 was estimated from a sensitivity of 0.28 at a specificity of 0.84 for the PLR. CONCLUSIONS: The NN models incorporating spatial-ordinal characteristics demonstrated significantly better performance than the linear models in the prediction of glaucomatous VF progression.

Implications of the Relationship Between Refractive Error and Biometry in the Pathogenesis of Primary Angle Closure.

Purpose: The purpose of this study was to investigate the relationship between refractive error and ocular biometry and its implication in the pathogenesis of primary angle closure (PAC). Methods: We have retrospectively recruited 119 PAC eyes and 388 non-PAC eyes with an axial length (AL) of ≤25.0 mm and a spherical equivalent (SE) of ≥-6.0 diopters (D). Stepwise multiple regression was performed for keratometry value (K), AL, anterior chamber depth (ACD), and SE. Results: PAC eyes were more likely to be in women and have a higher IOP and shorter AL than non-PAC eyes. In a multiple regression analysis, SE was not associated with PAC. The associations between AL and SE or AL and ACD were not different in PAC eyes compared with non-PAC eyes. However, the cornea was flatter in PAC eyes (ß = -0.448, P < 0.001), and a flatter cornea was associated with more hyperopic refraction (ß = -0.454, P < 0.001) and shallower ACD (ß = 0.073, P < 0.001) in PAC eyes. ACD was not associated with SE in non-PAC eyes, but shallower ACD was associated with greater myopic refraction in PAC eyes (ß = 1.117, P = 0.006). Conclusions: PAC eyes seem to have flatter cornea compared with non-PAC eyes. A shallower ACD seems to be associated with greater myopic refraction in PAC eyes, but not in non-PAC eyes.

Nasalization of Central Retinal Vessel Trunk Predicts Rapid Progression of Central Visual Field in Open-Angle Glaucoma.

Central visual field (CVF) loss is important in maintaining vision-related quality of life in eyes with open-angle glaucoma (OAG). The present study investigated whether nasalized location of central retinal vessel trunk (CRVT) at baseline is associated with rapid rate of CVF loss in early-stage OAG eyes. This study included 76 OAG eyes with high nasalization CRVT [HNL] group and 75 OAG eyes with low nasalization CRVT [LNL] group matched for glaucoma severity at baseline that showed progressive visual field (VF) loss. The rates of mean threshold changes at various regions were compared in the two groups using a linear mixed model. Clinical variables associated with rapid rate of CVF progression were also identified using a linear mixed model. The rate of CVF loss in the central 10° was significantly higher in the HNL group than that in the LNL group (-0.452 dB/year vs. -0.291 dB/year, P < 0.001). The average and inferior hemi-macular ganglion cell inner plexiform layer (GCIPL) progression rates were significantly faster in the HNL group than in the LNL group (P < 0.05). Nasalized location of CRVT was an independent predictor of a more rapid VF loss in the central 10° region (P < 0.05).

Vitreous Zonule and its Relation to Anterior Chamber Angle Characteristics in Primary Angle Closure.

PRECIS: Primary angle-closure (PAC) eyes with no vitreous zonule (VZ) appear to have a narrower angle despite similar lens vault and iris configuration than eyes with visible VZ. PURPOSE: To assess the clinical significance of the VZ in PAC. METHODS: Medical records of 91 eyes of 91 participants with PAC or PAC glaucoma were retrospectively reviewed. Anterior segment parameters were measured using anterior segment optical coherence tomography; presence of the VZ was assessed with ultrasound biomicroscopy. Parameters were compared between eyes with vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Factors associated with VZ presence were determined using logistic regression analysis. RESULTS: The NVZG was more likely to have PAC glaucoma than PAC (51.4% vs. 25.0%; P=0.010) and use more glaucoma medications (0.77 vs. 0.36; P=0.004) than the VZG. The NVZG had a smaller anterior chamber area than the VZG (13.6 mm vs. 15.1 mm; P=0.020) but there were no significant between-group differences in anterior chamber depth (1.97 vs. 2.08 mm; P=0.119) and lens vault (1.21 vs. 1.13 mm; P=0.337). NVZG had a smaller scleral spur angle (11.5 vs. 17.4 degrees; P<0.001), angle opening distance at 500 µm (AOD500, 105 vs. 168 µm; P<0.001), and trabecular-ciliary process angle (75.7 vs. 81.9 degrees; P=0.029) than VZG. Older age [odds ratio (confidence interval), 1.087 (1.014-1.164); P=0.018], less AOD500 (0.984 (0.975-0.993); P<0.001), and less trabecular-ciliary process angle (0.938 (0.901-0.977); P=0.002) were independently associated with an absence of VZ. CONCLUSIONS: PAC eyes with no VZ had a narrower angle and required more glaucoma medications than eyes with a VZ.

Spatial and Temporal Characteristics of Visual Field Progression in Glaucoma Assessed by Parallel Factor Analysis.

PURPOSE: To explore spatial and temporal characteristics of glaucomatous visual field (VF) progression through multi-way decomposition of data. METHODS: Six serial VF exams with intervals of 6.0 ± 1.0 months in 121 pre-perimetric glaucoma eyes and 80 perimetric glaucoma eyes were arranged into a three-dimensional cube. The data were decomposed using parallel factor analysis. RESULTS: Three tri-linear components (i.e., spatial scores, temporal loadings, and subject-specific loadings) were identified. Component 1 clearly showed differences between superior and inferior hemispheres, linear trends over time, and wide variability in perimetric glaucoma. Findings were compatible with well-known characteristics of glaucomatous VF defects. Component 2 showed nasal and central areas in contrast with superior, inferior, and temporal peripheral locations, whereas component 3 showed a contrast between nasal and temporal hemispheres. Both components 2 and 3 failed to show clear temporal trends. CONCLUSIONS: Identification of spatio-temporal patterns shows new possibilities for a multi-way decomposition methodology for earlier diagnosis and prediction of glaucomatous VF progression.

Rapid Central Visual Field Progression Rate in Eyes with Open-Angle Glaucoma and Choroidal Microvasculature Dropout.

Central visual field (CVF) loss has been linked to poorer vision-related quality of life in eyes with open-angle glaucoma (OAG) and can occur even in early-stage OAG eyes. The present study investigated whether the detection of choroidal microvasculature dropout (CMvD) during follow-up, which may be a sign of perfusion deficiency in the optic nerve head, is associated with rapid rate of CVF loss in early-stage OAG eyes. This study included 44 Korean OAG eyes with CMvD, identified by optical coherence tomography angiography, and 44 Korean OAG eyes without CMvD matched for age and severity of visual field loss at initial presentation. The rates of mean threshold changes in global and CVF were compared in eyes with and without CMvD using a linear mixed model. Clinical variables associated with rapid rate of CVF progression were also identified using a linear mixed model. The CVF progression rate was significantly higher in eyes with CMvD than in those without CMvD (-0.584 dB/year vs. -0.190 dB/year; P < 0.001) and detection of CMvD during follow-up was an independent predictor of rapid CVF progression rate. The presence of CMvD may aid in identification of high-risk patients who may show faster CVF progression and require more aggressive treatment.

Dyslipidemia, Dyslipidemia Treatment, and Open-angle Glaucoma in the Korean National Health and Nutrition Examination Survey.

PURPOSE: The purpose of this study was to investigate the association between dyslipidemia treatment and open-angle glaucoma (OAG). PATIENTS AND METHODS: We included 16,939 participants aged ≥40 years from the Korea National Health and Nutrition Examination Survey (2008 to 2012) and classified them into 2 groups based on current dyslipidemia treatment. The prevalence of OAG was determined using the modified International Society of Geographical and Epidemiological Ophthalmology criteria. The association between dyslipidemia treatment and OAG was evaluated using logistic mixed-effects model and propensity-score-weighted odds ratios. RESULTS: Analyses using the 2 abovementioned models revealed that dyslipidemia treatment was not associated with OAG (odds ratio, 1.08; 95% confidence interval, 0.75-1.56; P=0.838 and 1.03; 0.71-1.48; P=0.882, respectively), presence of optic disc hemorrhage (0.64; 0.15-2.73; P=0.648 and 1.10; 0.39-3.11; P=0.855), high vertical cup-to-disc ratio or asymmetry (1.02; 0.81-1.28; P=0.736 and 0.95; 0.75-1.20; P=0.650), presence of retinal nerve fiber layer defects (0.97; 0.67-1.42; P=0.857 and 1.03; 0.75-1.42; P=0.857), and presence of visual field defects (0.93; 0.55-1.54; P=0.931 and 0.97; 0.81-1.52; P=0.528). Total cholesterol and high-density lipoprotein cholesterol were also not associated with OAG. However, higher serum triglyceride levels were associated with OAG in the treated patients (1.31; 1.02-1.68; P=0.027) but not in the untreated patients (1.03; 0.93-1.14; P=0.079). CONCLUSIONS: In the Korean population, dyslipidemia treatment was not significantly associated with open-angle glaucoma. However, hypertriglyceridemia was associated with OAG in treated patients.

Baseline Systolic versus Diastolic Blood Pressure Dip and Subsequent Visual Field Progression in Normal-Tension Glaucoma.

PURPOSE: To investigate the impact of systolic and diastolic blood pressure (DBP) dip at baseline on subsequent visual field (VF) progression in eyes with normal-tension glaucoma (NTG). DESIGN: Prospective cohort study. PARTICIPANTS: This study included 119 eyes of 119 newly diagnosed NTG patients followed up for at least 2 years (average, 40.4±16.9 months). METHODS: All participants underwent baseline 24-hour ambulatory blood pressure (BP) monitoring and measurements of intraocular pressure (IOP) and at least 5 serial VF examinations. Participants were followed up as outpatients at 4- to 6-month intervals. Visual field progression was defined according to Early Manifest Glaucoma Trial criteria. The associations of VF progression with systolic BP (SBP) and DBP measured during the day and at night and other clinical variables were analyzed. MAIN OUTCOME MEASURES: Factors associated with VF progression over time. RESULTS: During follow-up, 41 eyes (34%) showed VF progression. In the multivariate Cox regression model, lower nighttime trough DBP (hazard ratio, 0.953; P = 0.023) and greater nighttime DBP dip area (time multiplied by nighttime DBP > 10 mmHg less than mean daytime DBP; hazard ratio, 1.017; P = 0.003) at baseline were significant predictors of subsequent VF progression. None of the SBP parameters was associated with VF progression. Nocturnal DBP dip showed a greater association with VF progression than SBP dip. CONCLUSIONS: Nocturnal trough DBP and DBP dip area at baseline are significant predictors of subsequent VF progression in NTG. Nocturnal DBP dip may be more relevant to future VF progression than SBP dip in NTG eyes.

Greater Severity of Glaucomatous Damage in Eyes With Than Without Choroidal Microvasculature Dropout in Open-Angle Glaucoma.

Purpose: To assess whether open-angle glaucoma (OAG) eyes with choroidal microvasculature dropout (CMvD) have greater severity of glaucomatous damage compared to those eyes without CMvD. Methods: In this retrospective case-control study, 80 eyes of 80 OAG patients with visual field (VF) defects confined to a superior hemifield (40 eyes with CMvD and 40 eyes without CMvD matched for age [≤10 years], axial length [≤1 mm], and VF loss [≤1 dB (decibel)]) and 43 healthy eyes were consecutively included. The circumpapillary retinal nerve fiber layer thickness (cpRNFLT), macular ganglion cell-inner plexiform layer thickness (mGCIPLT), circumpapillary vessel density (cpVD), parafoveal VD (pfVD), and VF mean sensitivity (VFMS) were measured. The relationships between CMvD angular extent and structural/VD/functional measures were assessed at both hemiretinae in OAG eyes with CMvD. Logistic regression analyses were performed to evaluate the associations between significant cpRNFLT reduction at perimetrically intact hemiretinae and relevant clinical variables. Results: Sectoral cpRNFLT and mGCIPLT in the perimetrically intact hemiretinae of eyes with CMvD were significantly lower than those of eyes without CMvD (P < 0.05). There were significant correlations between CMvD angular extent and sectoral measures of structural/VD/functional parameters at perimetrically intact hemiretinae as well as perimetrically affected hemiretinae in OAG eyes with CMvD. The presence and extent of CMvD had a significant influence on cpRNFLT reduction at perimetrically intact hemiretinae (P < 0.05). Conclusions: OAG eyes with CMvD showed significantly lower cpRNFLT and mGCIPLT than those without CMvD at the hemiretinae corresponding to intact hemifields, thus requiring more vigilant attention for greater disease severity.

Assessment of macular ganglion cell loss patterns in neurologic lesions that mimic glaucoma.

PURPOSE: To evaluate patterns of macular retinal ganglion cell (RGC) loss measured by spectral domain optical coherence tomography in patients with neurologic lesions mimicking glaucoma. METHODS: We evaluated four patients with neurological lesions who showed characteristic patterns of RGC loss, as determined by ganglion cell thickness (GCT) mapping. RESULTS: Case 1 was a 30-year-old man who had been treated with glaucoma medication. A left homonymous vertical pattern of RGC loss was observed in his GCT map and a past brain magnetic resonance imaging (MRI) revealed a hemorrhagic lesion around the right optic radiation. Case 2 was a 72-year-old man with a pituitary adenoma who had a binasal vertical pattern of RGC loss that corresponded with bitemporal hemianopsia. Case 3 was a 77-year-old man treated for suspected glaucoma. His GCT map showed a right inferior quadratic pattern of loss, indicating a right superior homonymous quadranopsia in his visual field (VF). His brain MRI revealed a left posterior cerebral artery territory infarct. Case 4 was a 38-year-old woman with an unreliable VF who was referred for suspected glaucoma. Her GCT map revealed a left homonymous vertical pattern of RGC loss, which may have been related to a previous head trauma. CONCLUSIONS: Evaluation of the patterns of macular RGC loss may be helpful in the differential diagnosis of RGC-related diseases, including glaucoma and neurologic lesions. When a patient's VF is unavailable, this method may be an effective tool for diagnosing and monitoring transneuronal retrograde degeneration-related structural changes.

Prediction of glaucomatous visual field progression: pointwise analysis.

PURPOSE: To evaluate whether pointwise regression analysis of serial measures of retinal sensitivity can predict future visual field (VF) loss. METHODS: Medical records of 158 patients with glaucomatous eyes with at least 6 years follow-up and 10 reliable VF exams were retrospectively analyzed. The entire follow-up period was divided into two, roughly corresponding to the first (early period) and second (late period) half of follow-up. Retinal sensitivity data obtained from the Swedish interactive threshold algorithm standard or full-threshold VF tests were analyzed, and linear and first-order exponential regression analyses of retinal sensitivity against time were performed to obtain the slope of regression analysis in each VF test location. Paired t tests were used to compare the slopes of the early and late period in each regression analysis. RESULTS: When assessed by linear regression analysis, inferior nasal location showed highest rate of change (-0.52 dB/year) in early period. Late period showed generally faster rate of progression compared to early period. Superior arcuate and superior and inferior nasal locations showed that early and late slopes did not show significant difference (p value, 0.19 ∼ 0.49). Central and edged locations showed significant difference between the two slopes (p value < 0.05). First-order exponential regression analysis showed similar result. DISCUSSION: Superior arcuate and superior and inferior nasal areas in VF had a consistent rate of change of retinal sensitivity, indicating that these locations may have the higher capability for prediction of future deterioration. These results suggest that location should be considered when predicting glaucomatous VF progression.

Discrepancy between optic disc and nerve fiber layer assessment and optical coherence tomography in detecting glaucomatous progression.

PURPOSE: To compare the outcomes of Cirrus spectral-domain optical coherence tomography (OCT) and optic disc/retinal nerve fiber layer (RNFL) photographic assessment in detecting glaucomatous progression. METHODS: Two-hundred twenty-six eyes of 130 glaucoma patients (mean follow-up: 2.5 years) with at least 5 OCT examinations were included. Eyes were classified into one of four groups (diffuse RNFL defect; localized RNFL defect; no RNFL defect; unidentifiable RNFL status) based on baseline RNFL photographs. After performing the entire series of optic disc/RNFL photographic assessments, the eyes were classified into one of three groups: stable, progressed, and undetermined. Progression was divided into one of four categories (optic disc rim thinning; widening RNFL defect; deepening RNFL defect; new disc hemorrhage). OCT progression was determined using guided progression analysis (GPA) software. RESULTS: One-hundred thirty-nine eyes had diffuse RNFL defects, 34 eyes had localized RNFL defects, 42 eyes had no RNFL defects, and 11 eyes had unidentifiable RNFL at baseline. Forty-six eyes showed at least one category of progression upon expert assessment of optic disc/RNFL photographs, while OCT GPA detected progression in 35 eyes. Among the 34 eyes in which progression was observed in photographs only, 15 showed a new disc hemorrhage, 12 presented deepening of an RNFL defect, 10 showed optic disc rim change, and 6 had widening of an RNFL defect. Among the 23 eyes processed only by OCT GPA, 18 had a diffuse RNFL defect at baseline. CONCLUSION: OCT GPA was more sensitive in eyes with a diffuse RNFL defect whereas photographic assessment was better for detecting optic disc hemorrhage and deepening of an RNFL defect when evaluating structural progression.

Longitudinal changes in anterior segment parameters after laser peripheral iridotomy assessed by anterior segment optical coherence tomography.

PURPOSE: To quantify long-term changes in anterior segment (AS) parameters after laser peripheral iridotomy (LPI) using AS optical coherence tomography (OCT) in primary angle-closure suspect (PACS). METHODS: Thirty-two PACS subjects were imaged at pre-LPI and 2 weeks and 18 months post-LPI using AS OCT. Anterior chamber depth (ACD), iris curvature (IC), iris thickness at 750 and 1500 µm from the scleral spur (IT750, 1500), lens vault (LV), anterior chamber area (AA), and iris area (IA) were estimated by ImageJ software (version 1.46). Anterior chamber angle (ACA) parameters (angle opening distance [AOD750], angle recess area [ARA750], and trabecular iris space area [TISA750]) were provided by the manufacturer. Parameters were compared before and after LPI. Uni- and multivariate regression analysis was performed to evaluate factors associated with ACA narrowing. RESULTS: Mean AA (14.63 vs. 15.87 mm(2)) and three ACA parameters (AOD750 [0.17 vs. 0.28 mm], TISA750 [0.07 vs. 0.11 mm(2)], and ARA750 [0.08 vs. 0.13 mm(2)]) increased at 2 weeks post-LPI (all P < 0.001). The IT750, 1500 and IC also showed change at 2 weeks post-LPI. Eighteen months post-LPI, IC (0.34 vs. 0.16 mm, P < 0.001) and LV (0.88 vs. 1.01 mm, P = 0.001) were significantly different, while three ACA parameters were not different from their pre-LPI status. At post-LPI 18 months, LV was significantly associated with ACA narrowing (P = 0.026). CONCLUSIONS: The ACA tended to be narrowed at 18 months post-LPI despite resolution of pupillary block, which may be due to LV increment. Our results warrant continuous follow-up of narrow-angle patients after LPI.