RESUMO
PURPOSE: To compare the central and peripheral pachymetry measurements determined using Orbscan IIz (Bausch & Lomb, Rochester, NY), Visante optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA), and RTVue OCT (Oculus Technologies, Wynwood, WA) with ultrasound pachymetry in eyes with established keratoconus and to evaluate the agreement between them. DESIGN: Evaluation of diagnostic technologies. PARTICIPANTS: One hundred six eyes of 67 consecutive patients with a clinical diagnosis of keratoconus ranging in age from 12 to 40 years. METHODS: Central corneal thickness (CCT) was determined by all the 4 techniques. Peripheral corneal thicknesses were determined using Orbscan IIz, Visante OCT, and RTVue at 8 points (superior, inferior, temporal, nasal, superior-temporal, inferior-temporal, superior-nasal, and inferior-nasal) all in the 5.0- to 7.0-mm arcuate zone. MAIN OUTCOME MEASURES: Central and peripheral keratoconus thickness. RESULTS: Ultrasound pachymetry determined significantly higher CCT values than Orbscan IIz (P<0.001), Visante (P<0.001), and RTVue (P = 0.037), with a mean ± standard deviation difference of 14±3 µm, 13±2 µm, and 5±3 µm, respectively. The mean CCT difference was minimal (1±3 µm; P = 0.69) between the Orbscan IIz and Visante. A strong correlation was found (r>0.80) between all the CCT measurement techniques. Orbscan IIz significantly overestimated the peripheral thickness compared with the rest, and the mean differences ranged between 21 and 60 µm. Mean peripheral thickness differences between RTVue and Visante OCT always remained less than 20 µm. Weak correlations and larger limits of agreement were found between the techniques in thinner and peripheral zones. CONCLUSIONS: Orbscan IIz, Visante, RTVue, and ultrasound pachymetry show high correlation, although Orbscan IIz and Visante significantly underestimated CCT measurements compared with ultrasound pachymetry in keratoconus. Orbscan IIz significantly overestimated peripheral corneal thickness compared with RTVue and Visante.
Assuntos
Córnea/patologia , Paquimetria Corneana/instrumentação , Topografia da Córnea , Ceratocone/diagnóstico , Tomografia de Coerência Óptica , Ultrassonografia , Adolescente , Adulto , Criança , Paquimetria Corneana/métodos , Feminino , Humanos , Pressão Intraocular , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Tonometria Ocular , Adulto JovemRESUMO
PURPOSE: To study the effects of age, sex, intraocular pressure (IOP), corneal thickness, axial length (AXL), disc area, and the signal strength of the scan on optical coherence tomography (OCT) parameters of normal subjects in the L V Prasad Eye Institute-Glaucoma Epidemiological and Molecular Genetic Study (LVPEI-GLEAMS), a population-based study. DESIGN: Cross-sectional study. METHODS: A total of 1,100 eyes (1,100 subjects) of normal adults aged between 40 and 80 years from LVPEI-GLEAMS underwent macular and optic nerve head imaging with spectral-domain OCT (SDOCT). Effect of age, sex, IOP, central corneal thickness (CCT) and AXL, disc area, and signal strength of the OCT scan on retinal nerve fiber layer (RNFL) thickness, rim area, and ganglion cell-inner plexiform layer (GC-IPL) thickness measurements were evaluated using univariate and multivariate regression models. RESULTS: Mean rim area, RNFL, and GC-IPL thickness were 1.31 mm2 (standard deviation [SD] = 0.22), 93.7 µm (SD = 9.3) and 79.6 µm (SD = 8.7), respectively. Age had a negative association with RNFL thickness (coefficient: -0.18, P < .001) and GC-IPL thickness (-0.18, P < .001). GC-IPL thickness was significantly less in women than in men (-1.05, P < .001). AXL had a negative association with rim area (-0.05, P < .001). Disc area was positively associated with RNFL thickness (4.90, P < .001) and rim area (0.15, P < .001). Signal strength of OCT scan was positively associated with RNFL thickness (1.6, P < .001) and negatively associated with rim area (-0.02, P < .001). CONCLUSION: Age, sex, AXL, disc area, and signal strength of the scan were significantly associated with OCT measurements. These factors may need to be considered while interpreting the OCT parameters in pathologic conditions such as glaucoma.
Assuntos
Córnea/anatomia & histologia , Pressão Intraocular/fisiologia , Fibras Nervosas , Disco Óptico/diagnóstico por imagem , Células Ganglionares da Retina/citologia , Tomografia de Coerência Óptica/normas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comprimento Axial do Olho , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
OBJECTIVES: To assess the ability of teleophthalmoscopic grading of peripheral anterior chamber depth (PACD) using the van Herick (vH) technique in detecting gonioscopically occludable angle; and to determine whether combining results from vH grading and ocular biometry can improve the accuracy to diagnose gonioscopically occludable angle METHODS: This cross-sectional study was an offshoot of a rural population-based study, Glaucoma Epidemiology and Molecular Genetic Study (GLEAMS). A masked urban ophthalmologist graded digital slit lamp photographs of PACD by vH technique. Sussman four-mirror lens was used to perform dark room indentation gonioscopy. Cutoff values of the tests were, vH technique: grade ≤ 2, central anterior chamber depth (ACD), as well as axial length: ≤ 25th percentile and lens thickness ≥ 75th percentile value of the study population. RESULTS: We studied 1965 eyes of 1029 adult participants. The vH grade was ≤2 in 188 (9.5%) eyes. The angle was occludable by gonioscopy in 101 (5.1%) eyes. The performance of the vH test to rule out gonioscopically occludable angle was good [negative predictive value (NPV): 97.3%], despite low sensitivity (52.5%), while its efficacy to rule in the condition was low [positive predictive value (PPV): 28.2%] despite high specificity (92.8%). However, test combination strategy increased the PPV nearly twofold (53.8%). The calculated PPV at 10% prevalence of gonioscopically occludable angle was even higher (70.5%). CONCLUSIONS: Van Herick technique can be incorporated into a teleophthalmology program by means of slit lamp photographs of PACD. Combined vH grading and ocular biometry improved the predictability of a gonioscopically occludable angle.
Assuntos
Glaucoma de Ângulo Fechado , Glaucoma , Oftalmologia , Telemedicina , Adulto , Câmara Anterior , Estudos Transversais , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma de Ângulo Fechado/genética , Gonioscopia , Humanos , Biologia MolecularRESUMO
PURPOSE: To compare the abilities of retinal nerve fiber layer (RNFL) parameters of variable corneal compensation (VCC) and enhanced corneal compensation (ECC) algorithms of scanning laser polarimetry (GDx) in detecting various severities of glaucoma. METHODS: Two hundred and eighty-five eyes of 194 subjects from the Longitudinal Glaucoma Evaluation Study who underwent GDx VCC and ECC imaging were evaluated. Abilities of RNFL parameters of GDx VCC and ECC to diagnose glaucoma were compared using area under receiver operating characteristic curves (AUC), sensitivities at fixed specificities, and likelihood ratios. RESULTS: After excluding 5 eyes that failed to satisfy manufacturer-recommended quality parameters with ECC and 68 with VCC, 56 eyes of 41 normal subjects and 161 eyes of 121 glaucoma patients [36 eyes with preperimetric glaucoma, 52 eyes with early (MD>-6 dB), 34 with moderate (MD between -6 and -12 dB), and 39 with severe glaucoma (MD<-12 dB)] were included for the analysis. Inferior RNFL, average RNFL, and nerve fiber indicator parameters showed the best AUCs and sensitivities both with GDx VCC and ECC in diagnosing all severities of glaucoma. AUCs and sensitivities of all RNFL parameters were comparable between the VCC and ECC algorithms (P>0.20 for all comparisons). Likelihood ratios associated with the diagnostic categorization of RNFL parameters were comparable between the VCC and ECC algorithms. CONCLUSION: In scans satisfying the manufacturer-recommended quality parameters, which were significantly greater with ECC than VCC algorithm, diagnostic abilities of GDx ECC and VCC in glaucoma were similar.
Assuntos
Algoritmos , Córnea/fisiologia , Glaucoma/diagnóstico , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Polarimetria de Varredura a Laser/métodos , Adulto , Área Sob a Curva , Estudos de Casos e Controles , Feminino , Glaucoma/classificação , Humanos , Pressão Intraocular/fisiologia , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Campos Visuais/fisiologiaRESUMO
PURPOSE: To evaluate the ability of the neuroretinal rim (NRR) rules determined using spectral domain optical coherence tomography (SDOCT) in diagnosing glaucoma and to study the effect of optic disc size and disease severity on the diagnostic ability of these rules. METHODS: In a cross-sectional study, 125 eyes of 96 glaucoma patients and 96 eyes of 72 control subjects underwent optic nerve head (ONH) imaging with SDOCT. Inferior (I), superior (S), nasal (N) and temporal (T) NRR areas were automatically determined by the sdoct software. Diagnostic abilities of ISNT (I > S > N > T), IT (I > T) and ST (S > T) rules in glaucoma were evaluated using sensitivity, specificity and likelihood ratios (LR). Effect of optic disc size and disease severity [based on mean deviation (MD) on visual fields] on the diagnostic ability of the NRR rules was evaluated using regression models. RESULTS: Sensitivities of ISNT, IT and ST rules were 80.8%, 60.0% and 29.6%, respectively, and the specificities were 32.3%, 84.4% and 93.8%, respectively. Positive LRs of ISNT, IT and ST rules were 1.19, 3.84 and 4.74, respectively, and negative LRs were 0.60, 0.47 and 0.75, respectively. Sensitivities of ISNT (coefficient: -1.06, p = 0.02) and IT (-0.71, 0.05) rules decreased with increasing disc size. Positive LR of IT rule increased significantly (-0.01, 0.04) with decreasing MD, and negative LR of IT rule decreased (got better) significantly (0.26, 0.05) with decreasing disc size. CONCLUSIONS: Neuroretinal rim rules, as determined by SDOCT, do not allow robust differentiation of glaucomatous from non-glaucomatous discs.
Assuntos
Técnicas de Diagnóstico Oftalmológico , Glaucoma de Ângulo Aberto/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Tomografia de Coerência Óptica/métodos , Idoso , Estudos Transversais , Reações Falso-Negativas , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Transtornos da Visão/diagnóstico , Campos VisuaisRESUMO
PURPOSE: To compare the abilities of standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SDOCT) in diagnosing eyes with glaucomatous optic neuropathy (GON). METHODS: In a cross-sectional study, 280 eyes of 175 subjects referred to tertiary eye care center by general ophthalmologists for a glaucoma evaluation underwent retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) imaging with SDOCT. All subjects had at least 2 reliable and repeatable SAP. Two glaucoma experts masked to clinical and SAP results classified the optic nerves into GON and nonglaucomatous groups based on digital optic disc photographs. Ability of SDOCT parameters and SAP to discriminate GON eyes from nonglaucomatous eyes was evaluated using sensitivity, specificity, and likelihood ratios (LR). RESULTS: Experts classified 179 eyes into GON and 101 eyes into nonglaucomatous group. Sensitivity of SAP (69.8%) was significantly lower (P<0.05) than that of inferior quadrant RNFL thickness (83.8%), average RNFL thickness (77.2%), GCC focal loss volume (FLV, 81.5%), and global loss volume (GLV, 82.6%). Specificity and positive LR of SAP (95% and14.1, respectively) were significantly greater than those of all RNFL parameters, FLV (84.2% and 5.1) and GLV (82.2% and 4.6). Negative LR of SAP (0.32) was significantly inferior to that of inferior quadrant RNFL thickness (0.22), FLV (0.22), and GLV (0.21). CONCLUSIONS: Most of the RNFL and GCC parameters of SDOCT had better sensitivities and negative LRs to diagnose GON compared with SAP. The specificities and positive LRs of most SDOCT parameters were inferior to that of SAP.
Assuntos
Glaucoma/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Estudos Transversais , Reações Falso-Positivas , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fotografação , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Campos Visuais/fisiologiaRESUMO
PURPOSE: To evaluate the relationship between the reference standard used to diagnose glaucoma and the diagnostic ability of spectral domain optical coherence tomograph (SDOCT). METHODS: In a cross-sectional study, 280 eyes of 175 consecutive subjects, referred to a tertiary eye care center for glaucoma evaluation, underwent optic disc photography, visual field (VF) examination, and SDOCT examination. The cohort was divided into glaucoma and control groups based on 3 reference standards for glaucoma diagnosis: first based on the optic disc classification (179 glaucoma and 101 control eyes), second on VF classification (glaucoma hemifield test outside normal limits and pattern SD with P-value of <5%, 130 glaucoma and 150 control eyes), and third on the presence of both glaucomatous optic disc and glaucomatous VF (125 glaucoma and 155 control eyes). Relationship between the reference standards and the diagnostic parameters of SDOCT were evaluated using areas under the receiver operating characteristic curve, sensitivity, and specificity. RESULTS: Areas under the receiver operating characteristic curve and sensitivities of most of the SDOCT parameters obtained with the 3 reference standards (ranging from 0.74 to 0.88 and 72% to 88%, respectively) were comparable (P>0.05). However, specificities of SDOCT parameters were significantly greater (P<0.05) with optic disc classification as reference standard (74% to 88%) compared with VF classification as reference standard (57% to 74%). CONCLUSIONS: Diagnostic parameters of SDOCT that was significantly affected by reference standard was the specificity, which was greater with optic disc classification as the reference standard. This has to be considered when comparing the diagnostic ability of SDOCT across studies.
Assuntos
Glaucoma/diagnóstico , Disco Óptico/patologia , Tomografia de Coerência Óptica/normas , Campos Visuais/fisiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Fotografação , Curva ROC , Padrões de Referência , Células Ganglionares da Retina/patologia , Sensibilidade e EspecificidadeRESUMO
IMPORTANCE: Standard automated perimetry is the current criterion standard for assessment of visual field (VF) loss in glaucoma. The 3 commonly used reliability indices to judge the quality of standard automated perimetry results are fixation losses (FLs) and false-positive (FP) and false-negative (FN) response rates. However, the influence of reliability indices, when within the manufacturer-recommended limits, on VF classification has been sparsely studied. OBJECTIVE: To evaluate the role of VF reliability indices in ruling out glaucoma. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 291 eyes of 291 participants referred to a tertiary eye care facility by general ophthalmologists. The participants were suspected to have glaucoma based on optic disc appearance, but the eyes were judged to be normal with physiological cupping by glaucoma experts on masked evaluation of optic disc photographs. All participants underwent VF testing with the Swedish interactive threshold algorithm standard 24-2 program. MAIN OUTCOMES AND MEASURES: Logistic regression models were used to evaluate the associations between reliability indices and FP classifications on VF testing (glaucoma hemifield test as outside normal limits and pattern standard deviation with P < .05). RESULTS: Median FL, FP, and FN response rates were 7%, 1%, and 2%, respectively. Among the 241 participants with reliable VF results (FL <20% and FP response rate <15%), the VF classification was normal in 188 (78.0%) and glaucoma (FP) in 53 (22.0%). Probability of FP VF classification was associated with FN response rates (odds ratio [OR], 1.36; 95% CI, 1.25-1.48, P < .001) but did not appear to be associated with FLs (OR, 0.96; 95% CI, 0.90-1.03, P = .30) or FP response rates (OR, 0.96; 95% CI, 0.83-1.12, P = .64). Predicted probability of FP VF classification was 9% (95% CI, 6%-14%), 40% (32%-49%), and 82% (68%-91%) at FN response rates of 0%, 8%, and 16%, respectively. CONCLUSIONS AND RELEVANCE: This study suggests that FN response rates have an effect on the ability of automated VF assessments to rule out glaucoma. Since FN response rates are ignored by the manufacturer while flagging a test as unreliable, clinicians and researchers may benefit by realizing that FN response rates can lead to FP VF classification, even when their frequencies are small.
Assuntos
Glaucoma/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Testes de Campo Visual/normas , Campos Visuais , Adulto , Algoritmos , Estudos Transversais , Reações Falso-Positivas , Feminino , Indicadores Básicos de Saúde , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tonometria Ocular , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate the effect of typical scan score (TSS), when within the acceptable limits, on the diagnostic performance of retinal nerve fibre layer (RNFL) parameters with the enhanced corneal compensation (ECC) protocol of scanning laser polarimetry (SLP) in glaucoma. METHODS: In a cross-sectional study, 203 eyes of 160 glaucoma patients and 140 eyes of 104 control subjects underwent RNFL imaging with the ECC protocol of SLP. TSS was used to quantify atypical birefringence pattern (ABP) images. Influence of TSS on the diagnostic ability of SLP parameters was evaluated by receiver operating characteristic (ROC) regression models after adjusting for the effect of disease severity [based on mean deviation (MD)] on standard automated perimetry). RESULTS: Diagnostic abilities of all RNFL parameters of SLP increased when the TSS values were higher. This effect was statistically significant for TSNIT (coefficient: 0.08, p<0.001) and inferior average parameters (coefficient: 0.06, p=0.002) but not for nerve fibre indicator (NFI, coefficient: 0.03, p=0.21). In early glaucoma (MD of -5 dB), predicted area under ROC curve (AUC) for TSNIT average parameter improved from 0.642 at a TSS of 90 to 0.845 at a TSS of 100. In advanced glaucoma (MD of -15 dB), AUC for TSNIT average improved from 0.832 at a TSS of 90 to 0.947 at 100. CONCLUSION: Diagnostic performances of TSNIT and inferior average RNFL parameters with ECC protocol of SLP were significantly influenced by TSS even when the TSS values were within the acceptable limits. Diagnostic ability of NFI was unaffected by TSS values.
Assuntos
Córnea/fisiologia , Glaucoma/diagnóstico , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Polarimetria de Varredura a Laser/métodos , Adulto , Birrefringência , Estudos Transversais , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Curva ROC , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
AIM: To evaluate optic nerve head, retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thickness measurements in children operated for primary congenital glaucoma (PCG) using spectral domain optical coherence tomography (SDOCT). METHODS: In a case-control study, 45 eyes of 37 children operated for PCG and 72 eyes of 41 normal children underwent optic nerve head, RNFL and GCC imaging with SDOCT. Differences in SDOCT parameters between PCG and control group, correlation between SDOCT parameters and a range of clinical variables, namely preop corneal diameter, intraocular pressure, degree of corneal oedema and age at which surgery was performed in PCG eyes, were evaluated. RESULTS: Mean (±SD) age of children in PCG group was 10.1±3.6 years and control group was 13.6±3.2 years (p<0.001) at the time of SDOCT imaging. Visual fields, whenever possible were unreliable in 20 of 23 PCG and 30 of 46 normal eyes. All SDOCT parameters were significantly different (p<0.001) in PCG compared with control group. All global SDOCT parameters (rim area, average RNFL and GCC thickness) correlated significantly with the clinical cup to disc ratio measurements (correlation coefficients better than -0.70) in children with PCG. Age at which surgery was performed was inversely related to SDOCT parameter thickness but was not statistically significant. CONCLUSIONS: All SDOCT parameters were significantly different in children operated for PCG compared with normal children. Future research should evaluate the test-retest variability of SDOCT and its ability to diagnose progression in children unable to perform reliable visual field tests.
Assuntos
Córnea/patologia , Cirurgia Filtrante , Glaucoma/congênito , Glaucoma/diagnóstico , Disco Óptico/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Adolescente , Criança , Pré-Escolar , Córnea/cirurgia , Feminino , Seguimentos , Glaucoma/cirurgia , Humanos , Imageamento Tridimensional/métodos , Pressão Intraocular , Masculino , Estudos RetrospectivosRESUMO
PURPOSE: To report the outcomes of trabeculectomy in eyes with glaucoma in microspherophakia. MATERIALS AND METHODS: In a retrospective non-comparative case series, we analyzed 29 eyes of 18 patients with glaucoma in microspherophakia, who underwent primary trabeculectomy between 1998 and 2012. Success was defined as complete if the intraocular pressure (IOP) was ≤ 21 and > 5 mm Hg without any antiglaucoma medication and qualified if IOP ≤ 21 and >5 mm Hg with or without antiglaucoma medications. Eyes not falling into qualified success criteria were labeled as failure. RESULTS: The median age at the time of trabeculectomy was 23 years (inter quartile range: 12, 28). The mean IOP reduced from 31.1 ± 8.6 mm Hg to 14.6 ± 4.4 mm Hg after trabeculectomy over a median follow up of 77 months (P < 0.001). The probability of complete success was 96% (95% CI: 77-99%) at one year, 88% (95% CI: 67-96%) at 2 years, which was maintained till 7 years and decreased to 79% (95% CI: 50-92%) at 8 years. The probability of qualified success was 100% till 7 years and decreased to 90% (95% CI: 47-98%) at 8 years. The median number of postoperative medications reduced from 2 to 0 postoperatively (P < 0.001) . Five eyes (21%) developed post-operative shallow anterior chamber (AC) requiring anterior chamber reformation, with 2 of these eyes needing lensectomy for resolution of this complication. CONCLUSION: Primary trabeculectomy had good success rate in glaucoma associated with microspherophakia. Post-operative shallow AC was a frequent complication needing additional intervention.
Assuntos
Doenças da Córnea/cirurgia , Ectopia do Cristalino/cirurgia , Glaucoma de Ângulo Aberto/etiologia , Glaucoma/cirurgia , Pressão Intraocular , Iris/anormalidades , Trabeculectomia/métodos , Adolescente , Adulto , Criança , Doenças da Córnea/complicações , Ectopia do Cristalino/complicações , Feminino , Seguimentos , Glaucoma/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Iris/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: To report the clinical features, management, and treatment outcomes of glaucoma in microspherophakia. METHODS: Medical records of 159 eyes of 80 subjects with microspherophakia were reviewed. The clinical features at presentation, presence of glaucoma, methods of treatment, and their outcomes were noted. Glaucoma was diagnosed based on intraocular pressure (IOP)≥22 mm Hg on 2 different occasions and/or glaucomatous optic disc damage. Angle closure was defined as occludable angles >270 degrees with or without presence of peripheral anterior synechiae. RESULTS: Glaucoma was diagnosed in 81 eyes (51%). The mean age of subjects was 20±13 years, mean refractive error was -13.5±5.5, the mean IOP was 27.7±11.1 mm Hg. IOP≥22 mm Hg was present in 84% of eyes, disc damage in 59% of the eyes, 75% eyes had angle closure, and 25% had open angle on gonioscopy. Subluxation of crystalline lens was seen in 53 eyes and 14 eyes had dislocation of the lens; systemic associations were present in 21 subjects (3 Marfan syndrome, 18 Weill-Marchesani syndrome). Nine eyes out of 51 and 2 out of 16 eyes responded to medical treatment and laser iridotomy, respectively. Of the 48 eyes that required surgical intervention, 24 eyes underwent trabeculectomy. Complete success probability of trabeculectomy was 86% [95% confidence interval (CI), 63%-95%] at 6 months, 77% (95% CI, 53%-90%) at 1 year, which was maintained till 7 years, and reduced to 61% (95% CI, 26%-84%) at 8 years. Nearly 20% of eyes at presentation and 30% of the eyes at last follow-up were blind due to glaucoma. CONCLUSIONS: More than half of the eyes with microspherophakia in this series presented with glaucoma; angle closure was the predominant form of glaucoma. Blindness due to glaucoma in microspherophakia was 20% to 30%.
Assuntos
Doenças da Córnea/complicações , Ectopia do Cristalino/complicações , Glaucoma de Ângulo Fechado/etiologia , Glaucoma de Ângulo Aberto/etiologia , Glaucoma/complicações , Iris/anormalidades , Adolescente , Adulto , Anti-Hipertensivos/uso terapêutico , Criança , Pré-Escolar , Doenças da Córnea/diagnóstico , Doenças da Córnea/cirurgia , Ectopia do Cristalino/diagnóstico , Ectopia do Cristalino/cirurgia , Feminino , Glaucoma/diagnóstico , Glaucoma/cirurgia , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Gonioscopia , Humanos , Lactente , Recém-Nascido , Pressão Intraocular/fisiologia , Iris/cirurgia , Fotocoagulação a Laser , Cristalino/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tonometria Ocular , Resultado do Tratamento , Acuidade Visual , Vitrectomia , Adulto JovemRESUMO
PURPOSE: To evaluate the (i) effects of biological (age and axial length) and instrument-related [typical scan score (TSS) and corneal birefringence] parameters on the retinal nerve fiber layer (RNFL) measurements and (ii) repeatability of RNFL measurements with the enhanced corneal compensation (ECC) protocol of scanning laser polarimetry (SLP) in healthy subjects. METHODS: In a cross-sectional study, 140 eyes of 73 healthy subjects underwent RNFL imaging with the ECC protocol of SLP. Linear mixed modeling methods were used to evaluate the effects of age, axial length, TSS, and corneal birefringence on RNFL measurements. One randomly selected eye of 48 subjects from the cohort underwent 3 serial scans during the same session to determine the repeatability. RESULTS: Age significantly influenced all RNFL measurements. RNFL measurements decreased by 1 µm for every decade increase in age. TSS affected the overall average RNFL measurement (ß=-0.62, P=0.003), whereas residual anterior segment retardance affected the superior quadrant measurement (ß=1.14, P=0.01). Axial length and corneal birefringence measurements did not influence RNFL measurements. Repeatability, as assessed by the coefficient of variation, ranged between 1.7% for the overall average RNFL measurement and 11.4% for th nerve fiber indicator. CONCLUSIONS: Age significantly affected all RNFL measurements with the ECC protocol of SLP, whereas TSS and residual anterior segment retardance affected the overall average and the superior average RNFL measurements, respectively. Axial length and corneal birefringence measurements did not influence any RNFL measurements. RNFL measurements had good intrasession repeatability. These results are important while evaluating the change in structural measurements over time in glaucoma patients.
Assuntos
Envelhecimento/fisiologia , Fibras Nervosas , Disco Óptico/anatomia & histologia , Células Ganglionares da Retina/citologia , Adulto , Idoso , Comprimento Axial do Olho/anatomia & histologia , Birrefringência , Córnea/fisiologia , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Polarimetria de Varredura a Laser , Campos Visuais , Adulto JovemRESUMO
PURPOSE: To evaluate the effect of scan quality on the diagnostic accuracies of optic nerve head (ONH), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) parameters of spectral-domain optical coherence tomography (SD OCT) in glaucoma. DESIGN: Cross-sectional study. METHODS: Two hundred fifty-two eyes of 183 control subjects (mean deviation [MD]: -1.84 dB) and 207 eyes of 159 glaucoma patients (MD: -7.31 dB) underwent ONH, RNFL, and GCC scanning with SD OCT. Scan quality of SD OCT images was based on signal strength index (SSI) values. Influence of SSI on diagnostic accuracy of SD OCT was evaluated by receiver operating characteristic (ROC) regression. RESULTS: Diagnostic accuracies of all SD OCT parameters were better when the SSI values were higher. This effect was statistically significant (P < .05) for ONH and RNFL but not for GCC parameters. In mild glaucoma (MD of -5 dB), area under ROC curve (AUC) for rim area, average RNFL thickness, and average GCC thickness parameters improved from 0.651, 0.678, and 0.726, respectively, at an SSI value of 30 to 0.873, 0.962, and 0.886, respectively, at an SSI of 70. AUCs of the same parameters in advanced glaucoma (MD of -15 dB) improved from 0.747, 0.890, and 0.873, respectively, at an SSI value of 30 to 0.922, 0.994, and 0.959, respectively, at an SSI of 70. CONCLUSION: Diagnostic accuracies of SD OCT parameters in glaucoma were significantly influenced by the scan quality even when the SSI values were within the manufacturer-recommended limits. These results should be considered while interpreting the SD OCT scans for glaucoma.
Assuntos
Técnicas de Diagnóstico Oftalmológico/normas , Glaucoma/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/normas , Estudos Transversais , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos , Tonometria OcularRESUMO
BACKGROUND: With the advent of spectral domain optical coherence tomography (SDOCT), there has been a renewed interest in macular region for detection of glaucoma. However, most macular SDOCT parameters currently are thickness parameters which evaluate thinning of the macular layers but do not quantify the extent of area over which the thinning has occurred. We therefore calculated a new macular parameter, "ganglion cell complex surface abnormality ratio (GCC SAR)" that represented the surface area over which the macular thickness was decreased. PURPOSE: To evaluate the ability of SAR in detecting perimetric and preperimetric glaucoma. DESIGN: Retrospective image analysis. MATERIALS AND METHODS: 68 eyes with perimetric glaucoma, 62 eyes with preperimetric glaucoma and 165 control eyes underwent GCC imaging with SDOCT. SAR was calculated as the ratio of the abnormal to total area on the GCC significance map. STATISTICAL ANALYSIS: Diagnostic ability of SAR in glaucoma was compared against that of the standard parameters generated by the SDOCT software using area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities. RESULTS: AUC of SAR (0.91) was statistically significantly better than that of GCC average thickness (0.86, P = 0.001) and GCC global loss volume (GLV; 0.88, P = 0.01) in differentiating perimetric glaucoma from control eyes. In differentiating preperimetric glaucoma from control eyes, AUC of SAR (0.72) was comparable to that of GCC average thickness (0.70, P > 0.05) and GLV (0.72, P > 0.05). Sensitivities at specificities of 80% and 95% of SAR were comparable (P > 0.05 for all comparisons) to that of GCC average thickness and GLV in diagnosing perimetric and preperimetric glaucoma. CONCLUSION: GCC SAR had a better ability to diagnose perimetric glaucoma compared to the SDOCT software provided global GCC parameters. However, in diagnosing preperimetric glaucoma, the ability of SAR was similar to that of software provided global GCC parameters.
Assuntos
Glaucoma/diagnóstico , Macula Lutea/patologia , Tomografia de Coerência Óptica/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Células Ganglionares da Retina/patologia , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the ability of normative database classification (color-coded maps) of spectral domain optical coherence tomograph (SDOCT) in detecting wedge shaped retinal nerve fiber layer (RNFL) defects identified on photographs and the factors affecting the ability of SDOCT in detecting these RNFL defects. METHODS: In a cross-sectional study, 238 eyes (476 RNFL quadrants) of 172 normal subjects and 85 eyes (103 RNFL quadrants with wedge shaped RNFL defects) of 66 glaucoma patients underwent RNFL imaging with SDOCT. Logistic regression models were used to evaluate the factors associated with false positive and false negative RNFL classifications of the color-coded maps of SDOCT. RESULTS: False positive classification at a p value of <5% was seen in 108 of 476 quadrants (22.8%). False negative classification at a p value of <5% was seen in 16 of 103 quadrants (15.5%). Of the 103 quadrants with RNFL defects, 64 showed a corresponding VF defect in the opposite hemisphere and 39 were preperimetric. Higher signal strength index (SSI) of the scan was less likely to have a false positive classification (odds ratio: 0.97, pâ=â0.01). Presence of an associated visual field defect (odds ratio: 0.17, pâ=â0.01) and inferior quadrant RNFL defects as compared to superior (odds ratio: 0.24, pâ=â0.04) were less likely to show false negative classifications. CONCLUSIONS: Scans with lower signal strengths were more likely to show false positive RNFL classifications, and preperimetric and superior quadrant RNFL defects were more likely to show false negative classifications on color-coded maps of SDOCT.
Assuntos
Glaucoma/diagnóstico , Fibras Nervosas/patologia , Tomografia de Coerência Óptica/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To compare the abilities of peripapillary retinal nerve fiber layer (RNFL) parameters of spectral domain optical coherence tomograph (SDOCT) and scanning laser polarimeter (GDx enhanced corneal compensation; ECC) in detecting preperimetric glaucoma. METHODS: In a cross-sectional study, 35 preperimetric glaucoma eyes (32 subjects) and 94 control eyes (74 subjects) underwent digital optic disc photography and RNFL imaging with SDOCT and GDx ECC. Ability of RNFL parameters of SDOCT and GDx ECC to discriminate preperimetric glaucoma eyes from control eyes was compared using area under receiver operating characteristic curves (AUC), sensitivities at fixed specificities and likelihood ratios (LR). RESULTS: AUC of the global average RNFL thickness of SDOCT (0.786) was significantly greater (p<0.001) than that of GDx ECC (0.627). Sensitivities at 95% specificity of the corresponding parameters were 20% and 8.6% respectively. AUCs of the inferior, superior and temporal quadrant RNFL thickness parameters of SDOCT were also significantly (p<0.05) greater than the respective RNFL parameters of GDx ECC. LRs of outside normal limits category of SDOCT parameters ranged between 3.3 and 4.0 while the same of GDx ECC parameters ranged between 1.2 and 2.1. LRs of within normal limits category of SDOCT parameters ranged between 0.4 and 0.7 while the same of GDx ECC parameters ranged between 0.7 and 1.0. CONCLUSIONS: Abilities of the RNFL parameters of SDOCT and GDx ECC to diagnose preperimetric glaucoma were only moderate. Diagnostic abilities of the RNFL parameters of SDOCT were significantly better than that of GDx ECC in preperimetric glaucoma.
Assuntos
Glaucoma/diagnóstico , Retina/fisiopatologia , Neurônios Retinianos/fisiologia , Polarimetria de Varredura a Laser/métodos , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Córnea/fisiopatologia , Estudos Transversais , Feminino , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas , Sensibilidade e Especificidade , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
PURPOSE: We determined the diagnostic performance of ganglion cell-inner plexiform layer (GCIPL) parameters of high definition optical coherence tomography (HD-OCT) in perimetric and preperimetric glaucoma, and compared it to optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) parameters. METHODS: In a cross-sectional study, 53 eyes of normal subjects and 83 eyes of glaucoma patients (62 perimetric and 21 preperimetric) from the Longitudinal Glaucoma Evaluation Study (LOGES) underwent HD-OCT imaging with Optic Disc and Macular Cube protocols. Diagnostic abilities of GCIPL, ONH, and RNFL parameters were determined using area under receiver operating characteristic curves (AUC) and likelihood ratios (LR). RESULTS: The AUCs of GCIPL parameters to diagnose perimetric glaucoma ranged from 0.84 to 0.90. The same of ONH and RNFL parameters ranged from 0.88 to 0.97 and 0.56 to 0.94, respectively. The AUCs of GCIPL, ONH, and RNFL parameters to diagnose preperimetric glaucoma ranged from 0.55 to 0.63, 0.77 to 0.92, and 0.39 to 0.80, respectively. For diagnosing preperimetric glaucoma, AUCs of all GCIPL parameters were significantly lower (P < 0.05) than those of the global ONH (vertical cup-to-disc ratio [CDR]; AUC, 0.92) and RNFL (average RNFL; AUC, 0.79) parameters. Outside normal limits category of GCIPL parameters also were associated with significantly smaller effects on the posttest probability of perimetric and preperimetric glaucoma. CONCLUSIONS: The diagnostic ability of GCIPL parameters was similar to that of ONH and peripapillary RNFL parameters in perimetric glaucoma. However, in preperimetric glaucoma, the diagnostic ability of GCIPL parameters was significantly lower than that of ONH and RNFL parameters.
Assuntos
Glaucoma/diagnóstico , Aumento da Imagem , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Estudos Transversais , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Curva ROCRESUMO
PURPOSE: : To determine the effect of cataract on the Visual Field Index (VFI) in glaucoma patients. METHODS: : Reliable visual fields (VFs) of 53 patients (53 eyes) with primary glaucoma who underwent phacoemulsification either alone or combined with trabeculectomy were analyzed before and after surgery. All patients had VFs within a period of 15 months before and after surgery. VFI, mean deviation (MD), and pattern standard deviation (PSD) before surgery were compared with those after surgery. RESULTS: : Median (25th and 75th percentiles) MD after cataract surgery [-10.52 dB (range, -19.25 to -4.86 dB)] was significantly better (P=0.003) than that before surgery [-11.74 dB (range, -20.61 to -7.15 dB)]. Median PSD after surgery [4.76 dB (range, 2.48 to 9.83)] was worse (P=0.01) than that before surgery [3.50 dB (range, 1.93 to 8.20 dB)] when eyes with MD better than -20 dB were considered (41 eyes). VFI after surgery [80% (range, 44% to 94%)] was similar (P=0.92) to that before surgery [77% (range, 37% to 92%)]. MD improved while VFI remained unchanged in both nuclear sclerotic (n=41) and posterior subcapsular cataracts (n=12). CONCLUSIONS: : MD and PSD were significantly affected, whereas VFI was not affected by cataract. VFI may be a more robust measure of VF damage than MD or PSD in glaucomatous eyes with coexisting cataracts.
Assuntos
Catarata/fisiopatologia , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Facoemulsificação , Trabeculectomia , Campos Visuais/fisiologia , Algoritmos , Feminino , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Disco Óptico/patologia , Estudos Retrospectivos , Tonometria Ocular , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate the relationship between intraocular pressure (IOP) and the rate of visual field (VF) progression in treated glaucoma. METHODS: In a clinic-based, retrospective study, data of consecutive primary open-angle and angle-closure glaucoma patients with ≥ 5 VFs between 1989 and 2008 were analyzed. The Guided Progression Analysis software, which provides the rate of change of Visual Field Index per year, was used to assess the rate of progression (ROP). IOP measurements during the VF examination visits were extracted, and mean, peak, and fluctuation (SD) of IOP during the follow-up were calculated. Relationships between IOP parameters and ROP were analyzed using regression models. Other risk factors evaluated were age, sex, type of glaucoma, presence of hypertension and diabetes, severity of VF loss at presentation, glaucoma surgery during follow-up, number of antiglaucoma medications, and follow-up duration. RESULTS: During the study period, 296 eyes of 213 glaucoma patients had undergone ≥ 5 VFs. IOP fluctuation was the only IOP parameter significantly associated with ROP (ß=-0.37, P=0.02). Evaluated in a multivariate model with other risk factors, the severity of VF damage at presentation (ß=0.08, P=0.002) and IOP fluctuation (ß=-0.35, P=0.02) remained significantly associated with ROP. Greater IOP fluctuation was seen in eyes undergoing glaucoma surgery and eyes requiring more antiglaucoma medications during follow-up. CONCLUSIONS: Long-term IOP fluctuation was the most important IOP parameter associated with increased ROP of glaucomatous VF loss. This association is likely due to the confounding effect of enhanced therapy in eyes suspected to be progressing.