Does overnight duty affect vascular endothelial function?

BACKGROUND: The reactive hyperemia index (RHI), which is obtained from the measurement of peripheral arterial tonometry (PAT), is highly associated with the percentage change in the end-diastolic arterial diameter (%flow-mediated dilatation) at reactive hyperemia. Low RHI is reported to be a mortality risk in patients with a high risk of cardiovascular (CV) disease. CV events are thought to be induced by physical and mental stress, including long-term fatigue and lack of sleep. However, the relationship between fatigue, lack of sleep, and endothelial function has not yet been established. METHODS: Healthy hospital workers (n = 13, 6 men and 7 women) with an average age of 31.6 years were assigned to this study after they provided written informed consent. During the study period, we conducted 72 measurements of reactive hyperemia-peripheral arterial tonometry (RH-PAT) in the morning before or after their duty. At each measurement of the RH-PAT, we recorded the participants' hours of sleep and evaluated their degree of fatigue using a visual analog scale (VAS). RESULTS: Although the VAS was significantly less (36 ± 16% and 64 ± 12%, p < 0.001) and the hours of sleep were longer (6.0 ± 1.1 h and 2.3 ± 1.0 h, p < 0.001) before duty compared to those after duty, the RHI was comparable between them (2.12 ± 0.53 vs. 1.97 ± 0.50, p = 0.21). The VAS score was significantly higher in participants with low RHI (< 1.67) than in those with normal RHI (≥ 2.07) (59 ± 13% and 46 ± 21%, respectively, p < 0.05). However, binary logistic regression showed no significant association between low RHI and the VAS when adjusted for systemic blood pressure (SBP) and heart rate variability (HRV). In a simple regression analysis, the RHI was significantly correlated with the VAS score but not with sleep duration. A multiple linear regression analysis also showed no significant association between the RHI and VAS scores after adjustment for SBP and HRV. CONCLUSIONS: Vascular endothelial function was not associated with overnight duty, hours of sleep, or degree of fatigue in healthy young adults. Since the RHI may be decreased in severe fatigue conditions through autonomic nerve activity, one should consider the physical and mental conditions of the examinee when evaluating the RH-PAT results.

Evaluation of autonomic functions of patients with multiple system atrophy and Parkinson's disease by head-up tilt test.

The aim of this study was to evaluate the autonomic neural function in Parkinson's disease (PD) and multiple system atrophy (MSA) with head-up tilt test and spectral analysis of cardiovascular parameters. This study included 15 patients with MSA, 15 patients with PD, and 29 healthy control (HC) subjects. High frequency power of the RR interval (RR-HF), the ratio of low frequency power of RR interval to RR-HF (RR-LF/HF) and LF power of systolic BP were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively. Both patients with PD and MSA showed orthostatic hypotension and lower parasympathetic function (RR-HF) at tilt position as compared to HC subjects. Cardiac sympathetic function (RR-LF/HF) was significantly high in patients with PD than MSA at supine position. RR-LF/HF tended to increase in MSA and HC, but decreased in PD by tilting. Consequently, the change of the ratio due to tilting (ΔRR-LF/HF) was significantly lower in patients with PD than in HC subjects. Further analysis showed that compared to mild stage of PD, RR-LF/HF at the supine position was significantly higher in advanced stage. By tilting, it was increased in mild stage and decreased in the advanced stage of PD, causing ΔRR-LF/HF to decrease significantly in the advanced stage. Thus, we demonstrated that spectral analysis of cardiovascular parameters is useful to identify sympathetic and parasympathetic disorders in MSA and PD. High cardiac sympathetic function at the supine position, and its reduction by tilting might be a characteristic feature of PD, especially in the advanced stage.

Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up.

BACKGROUND: To compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD). METHODS: This study prospectively evaluated changes in the CECD in 60 eyes of 60 patients who underwent trabeculectomy and 50 eyes of 45 patients who underwent EX-PRESS device implantation. Baseline patient data recorded included age at surgery, sex, type of glaucoma medications, and lens status. Using a noncontact specular microscope, corneal specular microscopy was performed preoperatively at the central cornea and then at 6, 12, 18 and 24 months after surgery. CECD before and after surgery was compared using a paired t-test. RESULTS: There was a significant decrease in the IOP and number of antiglaucoma medications in both groups after the surgery. The mean CECD in the trabeculectomy group was 2505 ± 280 cells/mm2 at baseline, while it was 2398 ± 274 cells/mm2 (P < 0.001), 2349 ± 323 cells/mm2 (P < 0.001), 2293 ± 325 cells/mm2 (P < 0.001), and 2277 ± 385 cells/mm2 (P = 0.003) at 6, 12, 18, and 24 months, respectively. However, the CECD in the EX-PRESS group was 2377 ± 389 cells/mm2 at baseline, while it was 2267 ± 409 cells/mm2 (P = 0.007), 2292 ± 452 cells/mm2 (P = 0.043), 2379 ± 375 cells/mm2 (P = 0.318), and 2317 ± 449 cells/mm2 (P = 0.274) at 6, 12, 18, and 24 months, respectively. CONCLUSIONS: As compared to trabeculectomy, EX-PRESS device implantation appears to be a safer procedure with regard to the endothelial cell loss risk.

Visual acuity and corneal higher-order aberrations after EX-PRESS or trabeculectomy, and the determination of associated factors that influence visual function.

PURPOSE: This study investigated postoperative visual acuity and corneal higher-order aberrations following EX-PRESS or trabeculectomy. METHODS: Out of 56 eyes of 56 patients analyzed, 30 eyes were treated using trabeculectomy, while 26 eyes were treated with EX-PRESS. Visual acuity and corneal higher-order aberrations were analyzed in both groups before and at 2 weeks, 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence corneal higher-order aberrations were evaluated. RESULTS: Significant reductions in the IOP were observed at 3 months after the surgery in both groups. Although a significant decrease in the visual acuity (logMAR) was observed at 2 weeks after the surgery in both groups, at 1 month after the surgeries, there were no significant differences found for the vision as compared to the baseline. At each study visit in the trabeculectomy group, significantly higher corneal higher-order aberrations compared to baseline were noted. In the EX-PRESS group, however, these aberrations were no longer significantly different from the baseline at month 2 (P = 0.36). Analysis of the risk factors indicated that hypotony could influence corneal higher-order aberrations after surgery. CONCLUSIONS: Corneal higher-order aberrations were significantly increased at 1 month after EX-PRESS treatment, with levels returning to baseline by 2 months. After trabeculectomy, however, corneal higher-order aberrations remained significantly increased at 3 months after the procedure.

Vision-related quality of life following glaucoma filtration surgery.

BACKGROUND: To evaluate vision-related quality of life (VR-QOL) following glaucoma filtration surgery. METHODS: A total of 103 glaucoma patients scheduled to undergo glaucoma filtration surgery. Prior to and at three months after glaucoma filtration surgery, trabeculectomy or EX-PRESS, all patients completed the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). A total of 48 patients underwent combined cataract and filtration surgery. The clinical data collected pre- and postoperatively included best-corrected visual acuity (BCVA) and intraocular pressure (IOP). RESULTS: The IOP decreased significantly from 19.0 ± 8.1 mmHg to 9.7 ± 3.9 mmHg (P < 0.001). Preoperative VFQ-25 composite score (65.8 ± 15.6) was similar to the postoperative score (67.8 ± 16.6). A significantly improved VFQ-25 composite score (pre: 63.2 ± 17.1, post: 67.7 ± 17.8; P = 0.001) was observed in the patients who underwent combined cataract and filtration surgery. There was a significant association between the BCVA changes in the operated eye and the changes in the VFQ-25 composite score (r = -0.315, P = 0.003). CONCLUSIONS: Although glaucoma filtration surgery by itself did not decrease the VR-QOL in glaucoma patients, there was significant improvement in the VR-QOL after the patients underwent combined cataract and glaucoma filtration surgery.

Effect of the renin inhibitor aliskiren against retinal ischemia-reperfusion injury.

The purpose of this study was to investigate the effect of the renin inhibitor, aliskiren, on retinal ischemia-reperfusion injury. Retinal ischemia was induced by increasing intraocular pressure to 130 mmHg. At 7 days after ischemia, retinal damage was evaluated by measuring the retinal thickness and the number of retinal ganglion cells. Western blot was used to measure changes in the (pro)renin receptor expression. Retinal mRNA expressions of prorenin, angiotensinogen and angiotensin II type 1 receptor (AT1-R) were measured by real-time polymerase chain reaction. Rats were treated with the renin inhibitor, aliskiren. Although the number of retinal ganglion cells and the inner retinal thickness were significantly decreased at 7 days after ischemia, treatment with aliskiren significantly inhibited retinal ischemic injury. Administration of aliskiren increased mRNA expression of prorenin in the retina at 3 h after the reperfusion. The expression of the (pro)renin receptor was not changed after ischemia-reperfusion injury with or without aliskiren. Although there was an increase in the retinal expression of AT1-R at 3 h after the reperfusion, aliskiren administration suppressed this expression. A renin inhibitor attenuated subsequent ischemic damage in the rat retina via the inhibition of the prorenin-induced angiotensin generation.

Use of the structure-function relationship in detecting glaucoma progression in early glaucoma.

BACKGROUND: To evaluate the use of optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness and visual field (VF) measurements in detecting disease progression in patients with early glaucoma. METHODS: Over a 3-year period, this study examined 60 eyes of 39 glaucoma patients whose total deviation in the superior or inferior hemifield was more than -6 dB. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least three years. On the same day as the RNFL imaging, VF testing was also performed by using the Swedish Interactive Threshold Algorithm Standard 30-2 program of the Humphrey Field Analyzer. Serial RNFL thicknesses and VF progression were assessed using the Guided Progression Analysis (GPA) software program. RNFL thickness progression and VF progression were evaluated by the event analysis. RESULTS: The mean observation period was 57.6 ± 10.0 months, and during this time, a total of 366 OCT and 366 VF measurements were performed. Using only OCT, progression was found in 2 eyes, while progression was found in 1 eye when only using VF GPA. When combined measurement findings were used, the analysis found progression in 8 eyes. CONCLUSIONS: When mild VF defect is present, OCT RNFL thickness measurements can be helpful in discerning glaucoma progression.

A case of arrhythmogenic right ventricular cardiomyopathy in a 70-year-old patient.

A 70-year-old man was admitted because of syncope and dyspnea. Two months before admission, exertional dyspnea occurred with syncope. Ventricular tachycardia with a monomorphic left bundle-branch block configuration was detected. An echocardiographic examination showed severe dilatation and diffuse, severe hypokinesis of the right ventricle, with thrombus formation in the right ventricular apex. Based on the clinical picture, the patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC). This case emphasizes the need for early identification of RV abnormalities in patients with ARVC to determine appropriate therapy.

Effect of ripasudil after trabeculectomy with mitomycin C: a multicentre, randomised, prospective clinical study.

BACKGROUND: To investigate if there are improvements in trabeculectomy outcomes supporting filtration bleb formation caused by Rho-associated protein kinase (ROCK) inhibitors. METHODS: This prospective, multicentre, randomised, open-label clinical study examined open-angle glaucoma patients who underwent trabeculectomy or trabeculectomy combined with cataract surgery followed by 3-month postoperative ripasudil treatments. After randomly allocating patients to ripasudil-ROCK inhibitor (ripasudil) or without ripasudil (non-ripasudil) groups. Mean intraocular pressure (IOP) changes, success rate, and number of eyedrops were compared for both groups. RESULTS: A total of 17 and 15 subjects dropped out in the ripasudil group and non-ripasudil group, respectively. At baseline, the mean IOP was 16.8±5.0 mm Hg in the ripasudil group (38 patients) and 16.2±4.4 in the non-ripasudil group (52 patients). The IOP decreased to 11.4±3.2 mm Hg, 10.9±3.9 mm Hg and 10.6±3.5 mm Hg at 12, 24 and 36 months in the ripasudil group, while it decreased to 11.2±4.1 mm Hg, 10.5±3.1 mm Hg and 10.9±3.2 mm Hg at 12, 24 and 36 months in the non-ripasudil group, respectively. There was a significant decrease in the number of IOP-lowering medications after trabeculectomy in the ripasudil group versus the non-ripasudil group at 24 (p=0.010) and 36 months (p=0.016). There was no statistically significant difference between the groups for the 3-year cumulative probability of success. CONCLUSION: Although ripasudil application did not increase the primary trabeculectomy success rate, it did reduce IOP-lowering medications after trabeculectomy with mitomycin C.

Altered Feedback-Related Negativity in Mild Cognitive Impairment.

INTRODUCTION: Feedback-related negativity (FRN) is electrical brain activity related to the function of monitoring behavior and its outcome. FRN is generated by negative feedback input, such as punishment or monetary loss, and its potential is distributed maximally over the frontal-central part of the skull. Our previous study demonstrated that FRN latency was delayed and that the amplitude was increased in patients with mild Alzheimer's disease (AD). As mild cognitive impairment (MCI) is considered to be a prodromal stage of AD, we speculated that FRN would also be altered in MCI, as in AD. The aim of this study is to examine whether MCI patients showed changes in FRN during a gambling task. METHODS: Thirteen MCI patients and thirteen age-matched healthy elderly individuals participated in a simple gambling task and underwent neuro-psychological assessments. The participants were asked to choose one out of two options and randomly received positive or negative feedback to their response. An EEG was recorded during the task, and FRN was obtained by subtracting the positive feedback-related activity from the negative feedback-related activity. RESULTS: The reaction time to probe stimuli was comparable in the two groups. The group comparisons revealed that the FRN amplitude was significantly larger for the MCI group than for the healthy elderly (F(1,24) = 6.4, ηp2 = 0.22, p = 0.019), but there was no group difference in the FRN latency. The FRN amplitude at the frontocentral electrode positively correlated with the mini-mental state examination score (Spearman's rhopartial = 0.41, p = 0.043). The finding of increased FRN amplitude in MCI was consistent with the previous finding in AD. CONCLUSION: Our findings indicate that monitoring dysfunction might also be involved in the prodromal stage of dementia.

Correlation of increased fundus autofluorescence signals at closed macula with visual prognosis after successful macular hole surgery.

PURPOSE: To study the significance of the increased fundus autofluorescence (FAF) signals at closed macula with spectral-domain optical coherence tomography and visual prognosis after successful surgery in eyes with idiopathic full-thickness macular holes (MHs). METHODS: Seventy-eight eyes of 78 consecutive patients with full-thickness MHs underwent successful standard vitrectomy, with internal limiting membrane peeling and followed by 10% sulfur hexafluoride gas injection. Simultaneous FAF and optical coherence tomography images were recorded at 10 days, and 1, 3, and 6 months postoperatively, using a combined spectral-domain optical coherence tomography-fluorescein angiography device (Spectralis™/HRA Heidelberg Retina Angiograph 2). The appearance of increased FAF in the macula postoperatively and the relationship of FAF and optical coherence tomography findings to best-corrected visual acuity were examined. RESULTS: Stage 2, 3, and 4 MHs were present in 31, 29, and 18 eyes, respectively. The median patient age was 66 years, with a range of 54 to 79 years. In all patients, the MHs were successfully closed, and the preoperative increased FAF corresponding to MH disappeared 10 days after surgery. In 36 eyes (46.2%), however, hyperautofluorescence again appeared in the macular area 1 month postoperatively. This hyperautofluorescence was significantly associated with the recovery of the external limiting membrane lines at the fovea 1 month after surgery (P = 0.001, multiple logistic regression analysis). Also, this recovery of the external limiting membrane lines 1 month postoperatively was significantly associated with the recovery of photoreceptor inner and outer segment junction line 3 months postoperatively at the fovea (P < 0.001, Fisher exact test). Moreover, a good best-corrected visual acuity of 20/28 or better at 6 months after surgery was significantly associated with hyperautofluorescence in the macula 1 month postoperatively, the recovery of the photoreceptor inner and outer segment lines at the fovea 3 months postoperatively, and preoperative good visual acuity (P < 0.05, multiple logistic regression analysis). CONCLUSION: In full-thickness MHs, 46.2% of our patients showed increased FAF in the macula 1 month after successful MH surgery. This hyperautofluorescence could be a sign of good visual prognosis postoperatively.

Quantitative ultrasound and vertebral fractures in patients with type 2 diabetes.

Patients with type 2 diabetes (T2DM) are known to have increased risks of femoral neck and vertebral fractures, although their bone mineral density (BMD) is normal or even slightly increased compared to non-DM controls. This observation suggests that bone fragility not reflected by BMD, possibly deterioration of bone quality, may participate in their fracture risks. Quantitative ultrasound (QUS), unlike BMD, could possibly evaluate bone quality, especially the microarchitecture, and therefore may be useful for assessing fracture risk in T2DM. To test this hypothesis, we measured calcaneal QUS as well as BMD at the lumbar spine, femoral neck, and 1/3 radius in 96 women (mean age 66.6 years old) and 99 men (64.7 years old) with T2DM, and examined their associations with prevalent vertebral fractures (VFs). Calcaneal QUS was performed by CM-200 (Elk Corp., Osaka, Japan), and speed of sound (SOS) values were obtained. BMD was measured by QDR4500 (Hologic, Waltham, MA). In T2DM patients, VFs were found in 33 and 45 subjects in women and men, respectively. When compared between subjects with and without VFs, there were no significant differences in values of SOS or BMD at any site between the groups in either gender. The distribution of SOS as a function of age showed that those with VFs were scattered widely, and there were no SOS thresholds for VFs in either gender. Logistic regression analysis adjusted for age and BMI showed that either SOS or BMD was not significantly associated with the presence of VFs in either gender. These results show that QUS as well as BMD are unable to discriminate T2DM patients with prevalent VFs from those without VFs. It seems necessary to seek other imaging modalities or biochemical markers evaluating bone fragility and fracture risk in T2DM.

A sub-centimeter HCC with bright loop appearance diagnosed by contrast-enhanced ultrasonography.

Detection of a hepatocellular carcinoma (HCC) in the early stage is critical, as clinical stage influences treatment selection and patient prognosis. Carcinogenetic development of an HCC is a multi-step process, and a differential diagnosis between a dysplastic nodule and a well-differentiated HCC is often difficult. A bright loop appearance is a significant finding that indicates disappearance of fatty deposition in the central area of the nodule during the progression toward HCC, however such a finding is rare in cases of sub-centimeter-sized HCCs. We encountered a case of HCC that developed a bright loop appearance on ultrasound (US) without enlargement approximately 2 years after diagnosis as a dysplastic nodule. Moreover, the hypoechoic area in the center of the nodule showed an HCC pattern in contrast enhanced US with Sonazoid™. Vascularity in the nodule could not be observed on dynamic contrast-enhanced CT or Gd-EOB-DTPA-enhanced MRI. When a change in the intranodular echo pattern is observed in sub-centimeter-sized nodules, examination of intranodular vascularity by contrast-enhanced US is important to evaluate borderline lesions.

Effect of trabeculectomy on corneal endothelial cell loss.

AIM: To investigate changes in corneal endothelial cell density (CECD) after trabeculectomy. METHODS: This prospective, observational study followed 117 eyes of 117 patients for 2 years after trabeculectomy. The central cornea was examined by corneal specular microscopy prior to and at every 6 months after the surgery. Survival analysis of patients who exhibited a 10% or less reduction of the postoperative CECD compared with preoperative levels was assessed using the Kaplan-Meier survival curve. A Cox proportional hazards model was used to evaluate prognostic factors for decreasing CECD. RESULTS: At baseline, the mean CECD was 2420±357 cells/mm2, while at 6, 12, 18 and 24 months after surgery, the mean CECD was 2324±373 cells/mm2 (p<0.001), 2276±400 cells/mm2 (p<0.001), 2290±398 cells/mm2 (p<0.001) and 2267±446 cells/mm2 (p<0.001), respectively. At 6, 12, 18 and 24 months after surgery, the results of the Kaplan-Meier survival analysis of the 10% loss of CECD from baseline were 91%, 85%, 83% and 77%, respectively. Uveitic glaucoma was a significant prognostic factor for decreasing CECD (p=0.041). CONCLUSIONS: CECD significantly and continuously decreased after trabeculectomy.

Assessment of primary open-angle glaucoma peripapillary and macular choroidal area using enhanced depth imaging optical coherence tomography.

PURPOSE: The current study investigated differences in the peripapillary and macular choroidal areas between patients with primary open-angle glaucoma (POAG) and healthy controls because the choroid may potentially play a role in glaucoma pathophysiology. METHODS: We assessed 57 healthy controls and 42 POAG patients in a cross-sectional comparative study. We used enhanced depth imaging optical coherence tomography (EDI-OCT) and then converted the luminal and interstitial areas to binary images using the Niblack method to obtain peripapillary and macular choroidal images. The relationship between the choroidal area and demographic and ocular characteristics were determined with univariate and multivariate linear regression analysis. RESULTS: Regarding the peripapillary choroidal area, no significant differences were noted between healthy controls and POAG patients (1,836,336 ± 605,617 µm2 vs. 1,775,566 ± 477,317 µm2, respectively, P = 0.60). There were also no differences found for the macular choroidal area (controls: 347,220 ± 115,409 µm2, patients: 342,193 ± 104,356 µm2, P = 0.83). Multivariate regression analysis in the POAG patients revealed there was a significant relationship between the macular choroidal area and age (ß = -0.525, P = 0.002) and axial length (ß = -0.458, P = 0.005). In contrast, no correlation was found between peripapillary choroidal areas and various attributes in the POAG patients. CONCLUSIONS: EDI-OCT showed no differences in the peripapillary or macular choroidal area in healthy individuals compared to POAG patients.

Retinal Nerve Fiber Layer Thickness Progression after Robotic-Assisted Laparoscopic Radical Prostatectomy in Glaucoma Patients.

PURPOSE: To investigate the effect of the steep Trendelenburg position surgical procedure on the retinal structure and function during robotic-assisted laparoscopic radical prostatectomy (RALP) in glaucoma patients. METHODS: At 1 month and 1 day before and at 1 and 2 months after the RALP operation, 10 glaucoma patients underwent standard automated perimetry and optical coherence tomography. After placing patients in a supine position, intraocular pressure (IOP) was measured at 5 min after intubation under general anesthesia (T1), at 5 discrete time points (5, 30, 60, 120, and 180 min; T2-6) and at 5 min after returning to a horizontal supine position (T7). The Guided Progression Analysis software program was used to assess serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression. RESULTS: Eight additional patients were newly diagnosed in addition to the two previous glaucoma patients. Average IOP (mmHg) at each time point was as follows: T1 = 11.2 ± 3.8, T2 = 19.0 ± 4.4, T3 = 23.3 ± 6.3, T4 = 25.1 ± 4.3, T5 = 25.5 ± 5.1, T6 = 28.3 ± 4.8, and T7 = 22.6 ± 5.4. IOP significantly increased during RALP. RNFL thickness progressed in two eyes of two patients after the surgery, even though there was no progression of the visual field. CONCLUSIONS: Two eyes of two patients exhibited significant RNFL thickness progression. Since an increased IOP during the surgery was the probable cause of the changes, ophthalmologic examinations should be performed before and after RALP, especially in glaucoma patients.

Influence of Disc Size on the Diagnostic Accuracy of Cirrus Spectral-Domain Optical Coherence Tomography in Glaucoma.

PURPOSE: To examine the influence of optic disc size on the diagnostic accuracy of optic nerve head (ONH) parameters determined by Cirrus spectral-domain optical coherence tomography (Cirrus HD-OCT). METHODS: A total of 51 eyes of 51 normal participants and 71 eyes of 71 glaucoma patients were examined. ONH imaging was obtained by Cirrus HD-OCT. Sensitivity at a fixed 90% specificity along with the area under the receiver operating characteristic curve (AUC) for continuous parameters were analyzed. We also examined the coefficients of variation (CoV) for sensitivity estimates, as these have been used to test and quantify the influence of optic disc size on diagnostic accuracy. The influence of optic disc size on the glaucoma diagnosis was assessed by the likelihood ratio chi-square test. RESULTS: Among the continuous parameters, the best diagnostic accuracy was seen for the average rim area, which had an AUC of 0.96. The most reliable factor across the disc size groups was the rim area (CoV, 2.8%). The diagnostic accuracy of the rim area did not appear to be influenced by optic disc size (P = 0.17). CONCLUSIONS: The high diagnostic accuracy of the rim area demonstrated by Cirrus HD-OCT for the quantitative assessment of the ONH was not significantly affected by disc size in this study.

Peripapillary and macular choroidal area in patients with normal-tension glaucoma.

PURPOSE: To evaluate normal and normal-tension glaucoma (NTG) eyes for differences in peripapillary and macular choroidal area measurements. METHODS: This cross-sectional comparative study enrolled 52 normal subjects and 35 NTG patients. Peripapillary and macular choroidal images were recorded by enhanced depth imaging optical coherence tomography (EDI-OCT), with conversion of the luminal and interstitial areas to binary images performed using the Niblack method. RESULTS: While there was a significant difference between normal subjects and NTG patients for the peripapillary choroidal area (1,853,672 ± 626,501 µm2 vs. 1,606,448 ± 418,214 µm2, P = 0.047), there were no significant differences between the normal subjects and NTG patients observed for the macular choroidal area (345,365 ± 119,248 µm2 vs. 316,442 ± 85,732 µm2, P = 0.23). In the NTG patients, multivariate regression analysis demonstrated a correlation between the macular choroidal area and the axial length (ß = -0.345, P = 0.04). Furthermore, there was also a significant correlation between the peripapillary choroidal area and the age of the NTG patients (ß = -0.469, P = 0.004). In addition, there was no relationship between the glaucoma severity and the peripapillary and macular choroidal areas in the NTG patients. CONCLUSIONS: There was no correlation between the peripapillary choroidal area and glaucoma severity in NTG patients, even though the area was smaller in these patients.

Changes in choroidal area after intraocular pressure reduction following trabeculectomy.

PURPOSE: To investigate changes of the macular and peripapillary choroidal areas after trabeculectomy. METHODS: This prospective and interventional study examined 74 eyes of 74 patients with glaucoma uncontrolled by medical therapy. Enhanced depth imaging optical coherence tomography (EDI-OCT) recorded macular and peripapillary choroidal images at 1 day before trabeculectomy and at 2 weeks after surgery. The Niblack method was used to covert luminal and interstitial areas to binary images. RESULTS: At baseline, the mean intraocular pressure (IOP) was 17.6±6.3 mmHg, while it was 6.5±2.9 mmHg after trabeculectomy (P < 0.001). Increases were observed for the macular choroidal area after the surgery, with the total area increasing from 317,853±95,728 µm2 to 368,597±104,393 µm2, while the luminal area increased from 210,355±73,650 µm2 to 249,464±77,195 µm2, and the interstitial area increased from 107,498±27,613 µm2 to 119,133±31,811 µm2 (all P < 0.001). Increases were also observed after the surgery for the peripapillary choroidal area, with the total area increasing from 1,629,440±460,429 µm2 to 1,974,289±500,496 µm2, while the luminal area increased from 920,141±328,690 µm2 to 1,179,843±357,601 µm2, and the interstitial area increased from 709,299±153,179 µm2 to 794,446±169,029 µm2 (all P < 0.001). There was a significant increase in the ratio of the luminal to choroidal area in the macular area (67.2%) and in the peripapillary area (59.1%). Factors associated with the changes in the peripapillary choroidal area included decreases in the diastolic blood pressure and IOP. CONCLUSIONS: A reduction in the IOP after trabeculectomy led to increases in the macular and peripapillary choroidal areas. Observed changes in the choroidal area after trabeculectomy are primarily due to increases in the luminal areas.

Oxygen venular saturation correlates with a functional loss in primary open-angle glaucoma and normal-tension glaucoma patients.

PURPOSE: To investigate whether there are differences in retinal oxygen saturation in upper and lower visual field hemispheres in primary open-angle glaucoma (POAG) and in normal-tension glaucoma (NTG). METHODS: This study enrolled POAG and NTG patients exhibiting differences between the upper and lower total deviation (TD) that were either more than 10 or <5 dB. Retinal oxygen saturation measurements in these patients with glaucoma were performed by a non-invasive spectrophotometric retinal oximeter. The Student's t-test was used for statistical analysis. RESULTS: Evaluations of the worse and better hemifields in the patients with POAG who exhibited differences in the upper and lower hemifield TD that was <5 dB (n = 25) showed that there were no statistically significant differences for the retinal venous saturation of oxygen (SaO2 ). However, there was a higher mean SaO2 in the worse (57.0 ± 7.5%) versus the better (54.3 ± 7.0%) hemifield in the patients with NTG (n = 22; p = 0.007). Evaluations of the patients with more than a 10-dB difference in the upper and lower hemifield TD showed statistically significant differences for the retinal venous SaO2 in the venous vessels between the POAG (n = 19) and the NTG (n = 26) patients. CONCLUSION: Although there was no significant difference in retinal SaO2 in the venules between the better and worse hemifield when the difference between the better and worse hemifield in the patients with POAG was <5 dB, there was a higher SaO2 in the venous vessels in the worse hemifield in the patients with NTG.