Comparison of surgical outcomes with and without Ologen collagen matrix augmentation during XEN gel stent implantation.

BACKGROUND: To compare the surgical outcomes and postoperative complications with and without Ologen collagen matrix augmentation during XEN gel stent implantation. METHODS: We retrospectively analyzed patients who underwent XEN gel stent implantation with an ab externo technique. The amount of intraocular pressure (IOP) reduction, percentage of postoperative complications and additional management, and surgical success defined as IOP reduction greater than 20% compared with the preoperative IOP measurement were compared between Ologen-augmented and non-augmented groups. Groups of patients who underwent XEN gel stent implantation alone and combined with phacoemulsification were analyzed separately. RESULTS: A total 103 eyes of 103 participants were included. Of those, 72 eyes underwent standalone XEN gel stent implantation: 42 eyes with Ologen augmentation (Oloxen group) and 30 eyes without Ologen augmentation (Xen group). Thirty-one eyes underwent XEN gel stent implantation with phacoemulsification: 19 eyes with Ologen augmentation (Phaco-Oloxen group) and 12 eyes without Ologen augmentation (PhacoXen group). The surgical success rate at six months postoperatively was not different between the Oloxen and Xen groups (56.4% vs 43.3%, P > 0.05) or between the Phaco-Oloxen group and PhacoXen group (57.9% vs 41.7%, P > 0.05). The prevalence of postoperative hypotony, 5-fluorouracil injections, use of anti-glaucoma medications, bleb needling, and additional glaucoma surgeries was not different between the Oloxen and Xen groups or between the Phaco-Oloxen and PhacoXen groups when assessed six months postoperatively. CONCLUSIONS: All groups showed significant IOP reduction after XEN gel stent implantation, but there was no significant difference between the Ologen collagen matrix augmented and non-augmented groups in surgical outcomes.

Optical Coherence Tomography Angiography Characteristics and Predictors of Visual Outcomes in Patients With Acute and Chronic Nonarteritic Anterior Ischemic Optic Neuropathy.

BACKGROUND: To investigate the correlation between optical coherence tomography angiography (OCTA) characteristics and visual outcomes in patients with acute and chronic nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: We retrospectively reviewed clinical data and OCTA images of 26 eyes of 26 patients who had been diagnosed with unilateral NAION. OCTA images were acquired from 17 eyes at the acute stage and from 21 eyes at the chronic stage of NAION. We analyzed the peripapillary vessel density (VD) and macular VD in various layers of the retina and choroid for all images. Possible correlations between the OCTA parameters and visual outcomes were investigated. RESULTS: Among the OCTA parameters for the acute stage of NAION, the temporal peripapillary VD was found to be positively correlated with final visual acuity and visual field with statistical significance (P = 0.039 and 0.009, respectively). In the chronic stage of NAION, both peripapillary and superficial macular VDs were positively correlated with visual outcomes. The nasal perifoveal VD in the superficial capillary plexus (SCP) also had a significant correlation with final visual acuity for both acute and chronic stages (the Spearman correlation coefficient = 0.565 and 0.685, respectively). CONCLUSIONS: In patients with NAION, significant correlations were found between OCTA parameters and visual outcomes. The temporal peripapillary VD measured during the acute stage was a significant predictor of final visual outcomes. The decreased nasal perifoveal VD in the SCP was strongly associated with poor visual prognosis.

Patterns of Progressive Ganglion Cell-Inner Plexiform Layer Thinning in Glaucoma Detected by OCT.

PURPOSE: To investigate the spatial characteristics and patterns of progressive macular ganglion cell-inner plexiform layer (GCIPL) thinning in glaucomatous eyes assessed by OCT Guided Progression Analysis (GPA). DESIGN: Longitudinal, retrospective, observational study. PARTICIPANTS: Two hundred ninety-two eyes of 192 patients with primary open-angle glaucoma with a mean follow-up of 6.0 years (range, 3.2-8.1 years) were included. METHODS: Macular GCIPL imaging and visual field (VF) examination were performed at 6-month intervals for 3 years or more. Progressive GCIPL thinning was evaluated by a Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) GPA device. Spatial characteristics of progressive GCIPL thinning were assessed by the GCIPL thickness change map. The pattern of progressive GCIPL thinning was evaluated by comparing the baseline GCIPL thickness deviation map and the final GCIPL thickness change map. Visual field progression was determined by Early Manifest Glaucoma Trial criteria and linear regression of the VF index. MAIN OUTCOME MEASURES: Spatial characteristics and patterns of progressive GCIPL thinning. RESULTS: Seventy-two eyes of 62 participants (24.7% [72/292]) showed progressive GCIPL thinning in the GCIPL thickness change map. Progressive GCIPL thinning was detected most frequently (25.0%) at 2.08 mm from the fovea, and it extended in an arcuate shape in the inferotemporal region (250°-339°). Compared with the baseline GCIPL defects, the progressive GCIPL thinning extended toward the fovea and optic disc. The most common pattern of progressive GCIPL thinning was widening of GCIPL defects (42 eyes [58.3%]), followed by deepening of GCIPL defects (19 eyes [26.4%]) and newly developed GCIPL defects (15 eyes [20.8%]). Visual field progression was accompanied by progressive GCIPL thinning in 41 of 72 eyes (56.9%). Progressive GCIPL thinning preceded (61.0% [25/41]) or occurred concomitantly with (21.9% [9/41]) VF progression. CONCLUSIONS: The use of OCT GPA maps offers an effective approach to evaluate the topographic patterns of progressive GCIPL thinning in glaucomatous eyes. Progression of GCIPL thinning occurred before apparent progression on standard automated perimetry in most glaucomatous eyes. Understanding specific patterns and sequences of macular damage may provide important insights in the monitoring of glaucomatous progression.

Ganglion Cell-Inner Plexiform Layer Change Detected by Optical Coherence Tomography Indicates Progression in Advanced Glaucoma.

PURPOSE: To examine the performance of Guided Progression Analysis (GPA; Carl Zeiss Meditec, Dublin, CA) in spectral-domain optical coherence tomography (OCT) in detecting progressive thinning of ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) in glaucoma. DESIGN: Longitudinal, observational study. PARTICIPANTS: A total of 196 eyes of 123 primary open-angle glaucoma patients (mean follow-up, 5.0 years). METHODS: Macular GCIPL and peripapillary RNFL thicknesses were measured by Cirrus HD-OCT (Zeiss, Dublin, CA), and progressive GCIPL and RNFL thinning were assessed by GPA. The reference standard of glaucoma progression was determined by visual field (VF) progression. Glaucomatous eyes were classified into mild (117 eyes) or moderate to advanced (79 eyes) groups based on VF defects. Ganglion cell-inner plexiform layer and RNFL thinning rates were compared between progressors and nonprogressors. Visual field survival estimates in eyes with and without progressive GCIPL and RNFL thinning were evaluated by Kaplan-Meier survival analysis and compared with the log-rank test. MAIN OUTCOME MEASURES: Progressive GCIPL and RNFL thinning assessed by OCT GPA. RESULTS: Seventy-six eyes (38.8%) and 43 eyes (21.9%) demonstrated progressive GCIPL and RNFL thinning, respectively, and 48 eyes (24.5%) were classified as progressors by reference standard. The rate of change in the average GCIPL thickness was significantly higher in progressors (-1.05±0.98 µm/year for mild glaucoma and -0.66±0.30 µm/year for moderate to advanced glaucoma) than in nonprogressors (-0.47±0.54 µm/year for mild glaucoma and -0.31±0.50 µm/year for moderate to advanced glaucoma), regardless of glaucoma severity (P < 0.05). Eyes with progressive GCIPL thinning had lower VF survival estimates than eyes without, regardless of glaucoma severity. However, the rate of change in the average RNFL thickness did not differ significantly in moderate to advanced glaucoma (P = 0.765; -0.26±0.55 µm/year for progressors and -0.33±0.92 µm/year for nonprogressors), and VF survival estimates did not differ significantly between eyes with and without progressive RNFL thinning in moderate to advanced glaucoma (P = 0.781). CONCLUSIONS: Ganglion cell-inner plexiform layer GPA provides a new approach for evaluating glaucoma progression. It may be more useful for detecting progression in the advanced stages of glaucoma than RNFL GPA.

Subclassification of Primary Angle Closure Using Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopic Parameters.

PURPOSE: To classify eyes with primary angle closure (PAC) in terms of the features visualized using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). DESIGN: Retrospective, observational study. PARTICIPANTS: A total of 73 eyes of 73 patients with PAC. METHODS: Participants' eyes that had undergone laser peripheral iridotomy (LPI) were imaged using AS-OCT and UBM under the same lighting conditions. Anterior chamber depth, anterior chamber width, iris cross-sectional area, peripheral iris thickness, iris curvature, lens vault (LV), and angle opening distance 500 µm from the scleral spur (SS) were determined using the AS-OCT image; trabecular-ciliary process angle (TCA), trabecular-ciliary process distance (TCPD), and ciliary body (CB) thickness 1 mm posterior to the SS were estimated on the UBM image using ImageJ software (Wayne Rasband, National Institutes of Health, Rockville, MD). Iris insertion, iris angulation, iris convexity, presence of ciliary sulcus, irido-angle contact, and CB orientation assessed on the UBM image were included. Partitioning around the medoids algorithm was used for cluster analysis based on the parameters obtained using AS-OCT and UBM. Axial length and pupil diameter were incorporated into statistical models. MAIN OUTCOME MEASURES: Clinical and anatomic characteristics were compared between the clusters, as classified using the partitioning around medoids algorithm method. RESULTS: Cluster analysis revealed that 2-group clustering produced the best results. The 2 clusters, which were defined in terms of parameters obtained using AS-OCT and UBM, showed differences in iris curvature (0.16±0.08 vs. 0.11±0.04 mm), TCA (91.0°±13.4° vs. 63.7°±6.2°), TCPD (0.99±0.22 vs. 0.78±0.16 mm), CB orientation (neutral/anterior, 35/13 vs. 0/25), and iris insertion (basal/middle/apical, 37/9/2 vs. 12/11/2). Pre-LPI intraocular pressure (IOP) (18.8±5.4 vs. 16.2±4.5 mmHg; P = 0.037) and percentage of IOP reduction after LPI (22.3%±17.9% vs. 8.3%±19.5%; P < 0.003) showed a significant difference between the 2 clusters. CONCLUSIONS: The most distinct difference between the 2 subgroups in the cluster analysis was TCA, suggesting that the position of the CB is important in subclassifying PAC. By using UBM, clinicians may obtain more clues about the mechanisms of PAC; in turn, they may learn to predict the IOP-lowering effects of LPI.

IR + VUV double resonance spectroscopy and extended density functional theory studies of ketone solvation by alcohol: 2-butanone·(methanol)n, n = 1-4 clusters.

Infrared plus vacuum ultraviolet (IR + VUV) photoionization vibrational spectroscopy of 2-butanone/methanol clusters [MEK·(MeOH)n, n = 1-4] is performed to explore structures associated with hydrogen bonding of MeOH molecules to the carbonyl functional group of the ketone. IR spectra and X3LYP/6-31++G(d,p) calculations show that multiple isomers of MEK·(MeOH)n are generated in the molecular beam as a result of several hydrogen bonding sites available to the clusters throughout the size range investigated. Isomer interconversion involving solvating MeOH rearrangement should probably occur for n = 1 and 2. The mode energy for a hydrogen bonded OH stretching transition gradually redshifts as the cluster size increases. Calculations suggest that the n = 3 cluster isomers adopt structures in which the MEK molecule is inserted into the cyclic MeOH hydrogen bond network. In larger structures, the cyclic network may be preserved.

Optical coherence tomography angiography vessel density mapping at various retinal layers in healthy and normal tension glaucoma eyes.

PURPOSE: To investigate peripapillary vessel density at various spatial locations and layers in healthy and normal tension glaucoma eyes using optical coherence tomography angiography (OCTA). METHODS: A commercial OCTA device (AngioPlex; Carl Zeiss Meditec) was used to image microvasculature in a 6 × 6-mm optic disc region. Vessel densities of superficial and deep retinal layers were calculated using an automatic thresholding algorithm. Vessel density maps were plotted by averaging individual angiogram images. The spatial characteristics of vessel densities were analyzed at clock-hour sectors and in five 0.7-mm-thick concentric circles from a diameter of 2.0 to 5.5 mm. Areas under the receiver operating characteristics curves (AUCs) assessed the glaucoma diagnostic ability. RESULTS: Vessel density maps of superficial and deep retinal layers were significantly reduced at the 7 and 11 o'clock positions in glaucomatous eyes. In superficial layer, vessel density significantly decreased as the distance from the optic disc margin increased, except in the innermost circle (2.0-2.7-mm). There were significant differences in AUCs of superficial vessel density between innermost circle and the other outer circles. In the deep layer, the innermost circle showed significantly higher vessel density than the outer circles. Vessel density at 7 o'clock showed the best diagnostic performance (AUCs, 0.898 and 0.789) both in the superficial and deep layers. The innermost circle showed eccentric feature compared to the outer circles in terms of spatial characteristics and diagnostic ability. CONCLUSIONS: Understanding of the spatial characteristics of peripapillary vasculature may be helpful in clinical practice and determining the optimal measurement area of vessel density.

Investigation of collision-induced dissociation products and structures of gas-phase [ M·GlyGlyHis-H]+ ( M = Fe, Ni, Cu, and Zn) complexes.

Collision-induced dissociation is carried out for electrosprayed [Fe·GlyGlyHis-H]+, [Ni·GlyGlyHis-H]+, [Cu·GlyGlyHis-H]+, and [Zn·GlyGlyHis-H]+ complexes. [Fe·GlyGlyHis-H]+, [Ni·GlyGlyHis-H]+, and [Zn·GlyGlyHis-H]+ yield metal-bound peptide sequence ions and dehydrated ions as primary products, whereas [Cu·GlyGlyHis-H]+ generates a more extensive series of metal-bound sequence ions and a product arising from the unusual loss of a formaldehyde moiety; dehydration is significantly suppressed for this complex. Density functional theory calculations show that the copper ion-deprotonated peptide binding energy is substantially higher than those in other complexes, suggesting that there is a correlation between ion-ligand binding energy and their fragmentation behavior.

Dynamics and fragmentation of van der Waals and hydrogen bonded cluster cations: (NH3)n and (NH3BH3)n ionized at 10.51 eV.

A 118 nm laser is employed as a high energy, single photon (10.51 eV/photon) source for study of the dynamics and fragmentation of the ammonia borane (NH3BH3) cation and its cluster ions through time of flight mass spectrometry. The behavior of ammonia ion and its cluster ions is also investigated under identical conditions in order to explicate the ammonia borane results. Charge distributions, molecular orbitals, and spin densities for (NH3BH3)n and its cations are explored at both the second-order perturbation theory (MP2) and complete active space self-consistent field (CASSCF) theory levels. Initial dissociation mechanisms and potential energy surfaces for ionized NH3BH3, NH3, and their clusters are calculated at the MP2/6-311++G(d,p) level. Protonated clusters (NH3)xH(+) dominate ammonia cluster mass spectra: our calculations show that formation of (NH3)n-1H(+) and NH2 from the nascent (NH3)n(+) has the lowest energy barrier for the system. The only common features for the (NH3)n(+) and (NH3BH3)n(+) mass spectra under these conditions are found to be NHy(+) (y = 0,…,4) at m/z = 14-18. Molecular ions with both (11)B and (10)B isotopes are observed, and therefore, product ions observed for the (NH3BH3)n cluster system derive from (NH3BH3)n clusters themselves, not from the NH3 moiety of NH3BH3 alone. NH3BH2(+) is the most abundant ionization product in the (NH3BH3)n(+) cluster spectra: calculations support that for NH3BH3(+), an H atom is lost from the BH3 moiety with an energy barrier of 0.67 eV. For (NH3BH3)2(+) and (NH3BH3)3(+) clusters, a B(δ+)⋯H(δ-)⋯(δ-)H⋯(δ+)B bond can form in the respective cluster ions, generating a lower energy, more stable ion structure. The first step in the (NH3BH3)n(+) (n = 2, 3) dissociation is the breaking of the B(δ+)⋯H(δ-)⋯(δ-)H⋯(δ+)B moiety, leading to the subsequent release of H2 from the latter cluster ion. The overall reaction mechanisms calculated are best represented and understood employing a CASSCF natural bond orbital description of the valence electron distribution for the various clusters and monomers. Comparison of the present results with those found for solid NH3BH3 suggests that NH3BH3 can be a good hydrogen storage material.

Vacuum ultraviolet photoionization of carbohydrates and nucleotides.

Carbohydrates (2-deoxyribose, ribose, and xylose) and nucleotides (adenosine-, cytidine-, guanosine-, and uridine-5(')-monophosphate) are generated in the gas phase, and ionized with vacuum ultraviolet photons (VUV, 118.2 nm). The observed time of flight mass spectra of the carbohydrate fragmentation are similar to those observed [J.-W. Shin, F. Dong, M. Grisham, J. J. Rocca, and E. R. Bernstein, Chem. Phys. Lett. 506, 161 (2011)] for 46.9 nm photon ionization, but with more intensity in higher mass fragment ions. The tendency of carbohydrate ions to fragment extensively following ionization seemingly suggests that nucleic acids might undergo radiation damage as a result of carbohydrate, rather than nucleobase fragmentation. VUV photoionization of nucleotides (monophosphate-carbohydrate-nucleobase), however, shows that the carbohydrate-nucleobase bond is the primary fragmentation site for these species. Density functional theory (DFT) calculations indicate that the removed carbohydrate electrons by the 118.2 nm photons are associated with endocyclic C-C and C-O ring centered orbitals: loss of electron density in the ring bonds of the nascent ion can thus account for the observed fragmentation patterns following carbohydrate ionization. DFT calculations also indicate that electrons removed from nucleotides under these same conditions are associated with orbitals involved with the nucleobase-saccharide linkage electron density. The calculations give a general mechanism and explanation of the experimental results.

Endogenous endophthalmitis in the Korean population: a six-year retrospective study.

PURPOSE: To identify the clinical features, treatment outcomes, and prognostic factors of endogenous endophthalmitis in multiple tertiary referral centers of South Korea over a 6-year period. METHODS: The authors conducted a retrospective review of medical records of 57 eyes of 43 patients diagnosed with endogenous endophthalmitis from January 2005 to December 2011, which was referred to tertiary referral centers. RESULTS: Fifty-seven cases of 43 patients were followed for a mean of 18.7 months (range, 0.5-50 months). The common underlying diseases were diabetes mellitus (46.5%) and liver cirrhosis (20.93%). Liver abscess (39.5%) was the most common infection source. Among prognostic factors, the initial visual acuity was associated with favorable visual outcome significantly (P < 0.001). Endogeneous endophthalmitis with gram-negative bacteria had worse visual outcomes than gram-positive bacteria or fungus (P = 0.014). CONCLUSION: Similar to the findings of previous East Asian studies, this study showed that Klebsiella pneumoniae was the most common causative organism of endogenous endophthalmitis and liver abscess was the most common infection focus. Although endogenous endophthalmitis is generally associated with poor visual acuity outcomes, the prognosis depends mainly on the initial visual acuity and the pathogen.

Peripapillary Versus Macular Thinning to Detect Progression According to Initial Visual Field Loss Location in Normal-Tension Glaucoma.

PURPOSE: To investigate the predictive capabilities of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thinning to detect visual field (VF) progression in normal-tension glaucoma patients with an initial parafoveal scotoma (IPFS) or nasal step (INS). DESIGN: Retrospective cohort study. METHODS: A total of 185 early-stage glaucoma eyes, followed for 10 years, were retrospectively stratified into IPFS and INS groups. Progressive pRNFL and mGCIPL thinning were assessed using spectral-domain optical coherence tomography and VF progression using both event- or trend-based analysis. Kaplan-Meier survival analysis compared VF survival in each VF phenotype with or without progressive pRNFL and mGCIPL thinning. Cox proportional regression analysis identified VF progression factors. RESULTS: VF progression was detected in 42 IPFS (n = 86) and 47 INS (n = 99) eyes. Among VF progressors, pRNFL thinning was significantly faster in INS group compared to IPFS group (P < .01), while mGCIPL thinning was similar (P = .16). At 5 years, eyes with progressive mGCIPL thinning showed significantly lower VF survival in both VF phenotypes (all P < .05). Progressive pRNFL thinning showed significantly lower VF survival only in INS eyes (P = .015). Cox multivariate regression revealed that mGCIPL thinning predicted subsequent VF progression in IPFS eyes, while mGCIPL and pRNFL thinning had significant associations with VF progression in INS eyes. CONCLUSIONS: mGCIPL outperforms pRNFL at early follow-up in detecting VF progression in IPFS eyes but not INS eyes. Appropriate selection of structural parameters (mGCIPL vs. pRNFL) maximizes early VF progression detection according to initial VF defect location.

Optical Coherence Tomography Angiography of the Retinal Circulation Following Trabeculectomy for Glaucoma.

PRCIS: Despite successful trabeculectomy, eyes with similar levels of peripapillary and macular vessel densities but with worse preoperative visual field mean deviations may experience functional and vascular decline after surgery. PURPOSE: To evaluate the retinal microcirculation change after trabeculectomy according to glaucoma severity using optical coherence tomography angiography (OCTA). METHODS: We enrolled 59 eyes of primary open angle glaucoma patients who underwent trabeculectomy. The eyes were categorized into 3 groups by preoperative visual field (VF) mean deviation (MD), group 1: MD>-12.0 dB, group 2: MD -12.0 to -20.0 dB, and group 3: MD <-20.0 dB. OCTA was performed preoperatively and 1 year after trabeculectomy. The differences in the radial peripapillary capillary vessel density (pVD) and macular VD between preoperative and postoperative assessment were analyzed and compared in each group. Factors associated with the VD change after trabeculecomy were determined using linear regression analysis. RESULTS: Mean postoperative IOP and IOP reduction did not differ among the 3 groups after trabeculectomy. Preoperative pVD (37.2 vs. 36.6%, P =1.00) and macular VD (39.0 vs. 38.4%, P =1.00) did not differ between groups 1 and 2. Group 1 and 3 showed no changes in VD parameters after trabeculectomy (all, P >0.05). However, group 2 showed statistically significant decreases in pVD (36.6 vs. 32.9%, P <0.001) and macular VD (38.4 vs. 36.0%, P =0.010) after trabeculectomy. The reduction of pVD was associated with a decrease of IOP (Coefficient (ß); 0.14, P =0.032) and VF MD (ß; 0.15, P =0.0116) in group 2, respectively. CONCLUSION: Following successful trabeculectomy surgery for uncontrolled glaucoma with similar IOP reduction, glaucoma eyes with advanced visual field loss showed reduced pVD and macular VD measured by OCT-A. These findings may be relevant to disease progression.

Association Between Optic Disc Perfusion Determined by Swept-Source Optical Coherence Tomography Angiography and Visual Field Progression in Glaucoma.

PRCIS: Reduced optic disc vessel density determined by swept-source optical coherence tomography angiography (SS-OCTA) was associated with visual field (VF) deterioration in glaucomatous eyes, which suggested that this parameter can be a potential biomarker that correlates well with functional deterioration. PURPOSE: The purpose of this study was to identify the association between optic disc perfusion evaluated by SS-OCTA and VF progression in primary open angle glaucoma (POAG) eyes. METHODS: A total of 266 POAG eyes of 266 patients (5.4 y of mean follow-up) were included. Optic nerve head SS-OCTA was performed to evaluate the optic disc vessel density (dVD), parapapillary choroidal vessel density (pcVD), choroidal microvascular dropout (cMvD), and optic disc microvascular dropout (dMvD). VF progression was defined using Early Manifest Glaucoma Trial criteria. Factors associated with VF worsening were assessed by Cox proportional hazard analysis. RESULTS: Eighty (30.1%) out of the 266 POAG eyes showed VF progression. The progression group showed a significantly higher proportion of disc hemorrhage, cMvD, and dMvD but lower dVD and pcVD than the stable group (all P <0.05). Considering the strong association between the parameters [dMvD vs. dVD ( r = -0.757, P =0.010], cMvD vs. pcVD ( r = -0.745, P =0.012), dMvD vs. cMvD ( r = 0.802, P <0.001], dVD vs. pcVD ( r = 0.862, P <0.001), CMvD vs. dVD ( r = -0.698, P =0.031), and dMvD vs. pcVD ( r = -0.688, P =0.034)], 6 models with different combinations of covariates compensating for multicollinearity were developed. Younger age, presence of disc hemorrhage, and lower dVD were consistently associated with progression in all models that included these parameters. CONCLUSIONS: Optic disc perfusion, represented as dVD, may be a useful biomarker that correlates well with functional deterioration in POAG eyes.

Association of baseline optical coherence tomography angiography with the development of glaucomatous visual field defects in preperimetric glaucoma eyes.

AIMS: To evaluate whether baseline vessel density (VD) parameters derived from optical coherence tomography angiography (OCT-A) is associated with the development of glaucomatous visual field (VF) defects in preperimetric glaucoma (PPG) patients. METHODS: One eye from each of 200 consecutive PPG patients with a normal standard automated perimetry and OCT-A at baseline was retrospectively analysed. OCT-A was used to measure the circumpapillary VD (cpVD) and the parafoveal and perifoveal VD. The retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer thicknesses were measured as reference standards. Two patient groups were stratified based on the development of repeatable glaucomatous VF loss. A Cox proportional hazards model was constructed to determine the predictive ability of OCT-A parameters for VF defects. The correlation between these baseline OCT-A parameters and the rate of global VF sensitivity loss (dB/year) was calculated using linear regression analysis. RESULTS: During a 3.1-year average follow-up period, 18 eyes (9.0%) developed glaucomatous VF defects. At baseline, the lower inferior temporal cpVD (HR (95% CI)=0.934 (0.883 to 0.988); p=0.017) and thinner inferior RNFL (HR (95% CI)=0.895 (0.839 to 0.956); p=0.001) were predictive of glaucomatous VF loss. A lower inferior temporal cpVD and thinner RNFL at baseline were associated with faster rate of global VF sensitivity loss (ß=0.015; p=0.001). CONCLUSION: In PPG eyes, a lower baseline inferior temporal cpVD is significantly associated with glaucomatous VF defect development and a faster rate of global VF loss.

Reduced intradisc vessel density is associated with optic disc hemorrhage in eyes with primary open-angle glaucoma.

We sought to investigate the association between optic nerve head (ONH)/choroidal microvasculature perfusion and optic disc hemorrhage (ODH) in eyes with primary open-angle glaucoma (POAG) using swept-source optical coherence tomography angiography (SS-OCTA). A total of 266 POAG eyes (59 with a single instance of ODH, 40 with a history of recurrent ODH, and 167 eyes without ODH) with a mean follow-up of 5.4 years were included. Intradisc vessel density (VD), parapapillary choroidal VD, optic disc microvascular dropout (MvD), and choroidal microvascular dropout (CMvD), were evaluated on a 3 × 3 mm SS-OCTA image of ONH and compared between eyes with and without ODH. Recurrent ODH was defined as occurrence 1 year after first ODH detection during the total follow-up period. Logistic regression analyses were performed to investigate factors associated with ODH. The prevalence of CMvD, optic disc MvD, and ß-parapapillary atrophy were not different among the no ODH, single ODH, and recurrent ODH groups. Eyes with ODH had lower intradisc VDs than those without ODH (P = 0.021), but no difference was found in intradisc VDs between the single and recurrent ODH groups (P = 0.977). Better VF MD at baseline (odds ratio [OR], 1.150; 95% confidence interval [CI], 1.055-1.254; P = 0.002) and lower intradisc VD (OR, 0.863; 95% CI, 0.812-0.918; P < 0.001) were associated with ODH occurrence. Among POAG eyes, those with ODH had lower intradisc VDs than those without ODH. POAG eyes in an earlier disease stage or those with lower intradisc VDs should be monitored for the possibility of ODH occurrence.

Change of Choroidal Microvasculature Dropout After Trabeculectomy as Assessed by Optical Coherence Tomography Angiography.

PRCIS: Reduction in the angular circumference of choroidal microvascular dropout (CMvD AC) was found in POAG patients after trabeculectomy. Greater percentage of IOP reduction was significantly associated with decreased CMvD AC. PURPOSE: The purpose of this study was to investigate the change of choroidal microvasculature dropout (CMvD) after trabeculectomy and its associated factors in primary open angle glaucoma (POAG) eyes using optical coherence tomography angiography. METHODS: Fifty eyes of 50 POAG participants who had preoperative CMvD and underwent trabeculectomy were prospectively enrolled. Angular circumference (AC) of CMvD was determined from choroidal layer images by optical coherence tomography angiography preoperatively and at postoperative 1 year. The cutoff for significant AC of CMvD decrease was determined by the Bland-Altman method, and accordingly, patients were divided into 2, decreased and stable/increased CMvD AC groups. Changes in intraocular pressure (IOP) and CMvD AC were compared between the groups preoperatively and at postoperative 1 year. Factors associated with CMvD AC decrease were assessed by linear regression analysis. RESULTS: The cutoff for significant CMvD AC decrease was 3.58 degrees; accordingly, 26 eyes (52.0%) were categorized as decreased CMvD AC group. No significant intergroup differences in baseline characteristics were found. However, the decreased CMvD AC group presented significantly lower IOP (10.7±3.7 vs. 12.9±2.6 mm Hg, P =0.022), lower CMvD AC (32.03±33.95% vs. 53.44±39.33%, P =0.044), and higher parapapillary choroidal vessel density ( P =0.014) compared with the increased/stable CMvD AC group at postoperative 1 year. The greater percentage of IOP reduction was significantly associated with decreased CMvD AC ( P =0.046). CONCLUSIONS: CMvD AC reduction associated with IOP lowering was found after trabeculectomy. The long-term clinical relevance of postoperative CMvD reduction should be further investigated.

Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension.

PURPOSE: To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. DESIGN: Retrospective cohort study. METHODS: A total of 127 eyes from 127 newly diagnosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parameters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan-Meier survival analysis was used to compare VF survival estimates in patients with and without MBPS. RESULTS: VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multivariate Cox regression model, a greater MBPS (hazard ratio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF progression was significantly greater in patients with higher MBPS (P = .021) at baseline according to Kaplan-Meier survival analysis. CONCLUSIONS: An increased MBPS at baseline is a significant independent predictor of subsequent VF progression in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment.

Choroidal thickness and volume mapping by a six radial scan protocol on spectral-domain optical coherence tomography.

PURPOSE: To report a 6 radial scan protocol, which simply generates a topographic map of choroidal thickness and volume on a commercial spectral-domain optical coherence tomography (SD-OCT) device. We analyzed the features of the resulting choroidal maps in healthy eyes. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Eighty eyes from 40 healthy volunteers who visited the healthcare clinic of Hanyang University Hospital from December 2010 to February 2011. METHODS: All participants underwent a 6 radial scanning protocol using an SD-OCT device. In a single session, the device produces 6 high-resolution averaging B-scan images. For segmentation of the choroid layer, the reference lines of the retinal boundary (internal limiting membrane-retinal pigment epithelium) were adjusted to the choroidal boundary (retinal pigment epithelium-choroid/sclera junction) in each of the 6 radial B-scans. A topographic map of choroidal thickness and volume was automatically generated by built-in software according to the Early Treatment Diabetic Retinopathy Study (ETDRS) layout. A statistical analysis was conducted to compare the choroidal thickness and volume measurements for each ETDRS subfield. MAIN OUTCOME MEASURES: An ETDRS-style topographic map of choroidal thickness and volume. RESULTS: The mean time required for segmentation adjustment was 167.4±15.8 seconds. The mean choroidal thickness of all ETDRS subfields was 285.9±53.0 µm, and the mean total choroidal volume of the entire ETDRS area was 7.72±1.2 mm(3). The nasal outer macula area was significantly smaller than any other ETDRS subfield (P<0.05) except for the adjacent superior and inferior outer macula subfields. Refractive error was correlated with choroidal thickness in all ETDRS subfields. Age was also correlated with choroidal thickness for almost all of the ETDRS subfields except for the temporal inner, nasal outer, and temporal outer macula areas. The total choroidal volume was correlated with the refractive error and age. CONCLUSIONS: A 6 radial scan protocol, using a commercial SD-OCT device, enables the production of reliable choroidal thickness and volume maps with an ETDRS layout. By using this protocol, more comprehensive choroidal evaluation is possible in clinical practice or research.

Glaucoma Progression After Lens Extraction in Primary Angle-closure Glaucoma According to Angle-closure Mechanism.

PRCIS: Long-term prognosis of primary angle-closure was assessed after lens extraction (LE) according to different mechanisms of angle closure (AC). Patients with pupillary block (PB) had a higher probability of glaucomatous progression than patients with plateau iris configuration (PIC). PURPOSE: The aim was to investigate and compare the clinical characteristics and long-term prognosis of primary angle-closure disease (PACD) after LE according to different mechanisms of AC. METHODS: In this retrospective observational cohort study, 118 eyes with PACD that underwent LE (mean follow-up; 6.0±3.5 y after surgery) were included. PACD eyes were categorized into three subgroups according to their dominant AC mechanisms, determined by anterior segment optic coherent tomography obtained before LE; PB, PIC, and exaggerated lens vault (ELV). Postoperative glaucomatous progression was determined according to functional (visual field) or structural (optic disc photographs or optic coherent tomography measured retinal nerve fiber layer thickness) criteria. Univariate and multivariate logistic regression analysis was performed to determine the risk factors associated with glaucomatous progression. RESULTS: Fifty-two, 51, and 15 eyes with PB, PIC, and ELV, respectively, were included. All eyes showed significant intraocular pressure reduction, with a greater reduction in the ELV group than in the PB group after LE (27.0% vs. 12.5%, P=0.018). Lower baseline retinal nerve fiber layer thickness [odds ratio (OR): 0.966, P=0.004] and thinner central corneal thickness (OR: 0.985, P=0.021), and the PB group (OR: 2.891, P=0.022, reference to PIC group) were significantly associated with glaucomatous progression after LE. CONCLUSIONS: In eyes with PACD, glaucoma progression was observed following LE despite reduced intraocular pressure. The probability of progression was highest in eyes with pupil block as a mechanism of AC. Close monitoring of glaucoma in these patients is suggested.