Detecting the Progression of Normal Tension Glaucoma: A Comparison of Perimetry, Optic Coherence Tomography, and Heidelberg Retinal Tomography

PURPOSE: We compared the abilities of Stratus optical coherence tomography (OCT), Heidelberg retinal tomography (HRT) and standard automated perimetry (SAP) to detect the progression of normal tension glaucoma (NTG) in patients whose eyes displayed localized retinal nerve fiber layer (RNFL) defect enlargements. METHODS: One hundred four NTG patients were selected who met the selection criteria: a localized RNFL defect visible on red-free fundus photography, a minimum of five years of follow-up, and a minimum of five reliable SAP, Stratus OCT and HRT tests. Tests which detected progression at any visit during the 5-year follow-up were identified, and patients were further classified according to the state of the glaucoma using the mean deviation (MD) of SAP. For each test, the overall rates of change were calculated for parameters that differed significantly between patients with and without NTG progression. RESULTS: Forty-seven (45%) out of 104 eyes displayed progression that could be detected by red-free fundus photography. Progression was detected in 27 (57%) eyes using SAP, 19 (40%) eyes using OCT, and 17 (36%) eyes using HRT. In early NTG, SAP detected progression in 44% of eyes, and this increased to 70% in advanced NTG. In contrast, OCT and HRT detected progression in 50 and 7% of eyes during early NTG, but only 30 and 0% of eyes in advanced NTG, respectively. Among several parameters, the rates of change that differed significantly between patients with and without progression were the MD of SAP (p = 0.013), and the inferior RNFL thickness (p = 0.041) and average RNFL thickness (p = 0.032) determined by OCT. CONCLUSIONS: SAP had a higher detection rate of NTG progression than other tests, especially in patients with advanced glaucoma, when we defined progression as the enlargement of a localized RNFL defect. The rates of change of the MD of SAP, inferior RNFL thickness, and average RNFL thickness differed between NTG patients with and without progression.

Diurnal Fluctuation of Ocular Perfusion Pressure in the Fellow Eyes of Branch Retinal Vein Occlusion

PURPOSE: To investigate diurnal change in blood pressure (BP), intraocular pressure (IOP), and ocular perfusion pressure (OPP) in patients with unilateral branch retinal vein occlusion (BRVO) and compare the results with healthy controls. METHODS: We conducted a prospective case-control study which included 50 patients with unilateral BRVO and 50 age-matched volunteers as controls. Each participant underwent a comprehensive ophthalmic examination including optical coherence tomography (OCT). BP and IOP were evaluated 4 times daily at 8 AM, 10 AM, 2 PM and 6 PM. The mean and fluctuation of BP, IOP, mean arterial pressure (MAP), mean OPP (MOPP), and diastolic OPP (DOPP) were compared between fellow eyes of BRVO patients and normal control eyes. RESULTS: The average retinal nerve fiber layer (RNFL) thickness was significantly reduced in the fellow eyes of BRVO patients compared to control eyes (p < 0.001). Mean IOP and IOP fluctuation did not differ, but BP fluctuation (systolic BP fluctuation, p = 0.045; diastolic BP fluctuation, p = 0.037) and MAP fluctuation (p = 0.011) were greater in the fellow eyes of BRVO patients compared to normal eyes. The mean MOPP and DOPP did not differ between groups, however, the fluctuation of MOPP (p < 0.001) and DOPP (p < 0.001) were significantly increased in the fellow eyes of BRVO patients. The mean and fluctuation of BP, MAP, MOPP and DOPP were associated with reduced average RNFL thickness in the fellow eyes of BRVO patients. CONCLUSIONS: These results suggest the fellow eyes of unilateral BRVO patients may be at risk of developing glaucomatous damage.

Two Cases of Aggravation of Submacular Hemorrhage after Intravitreal Gas Injection

PURPOSE: To report two cases of submacular hemorrhage worsened after intravitreal gas (sulfuric hexafluoride; SF6) injection without tissue plasminogen activator. METHODS: Two old men complaining of decreased visual acuity in their one eye visited clinic. On ocular examination, both of them had subretinal hemorrhage in macular area choroidal neovascularization on fluorescein angiography. 0.5cc sulfuric hexafluoride (SF6) gas was injected into vitreous cavity and patients were educated to keep strict prone position. Several days after intravitreal injection, visual acuity decreased and subretinal hemorrhage increased and spread to adjacent area. RESULTS: In cases of the intravitreal injection, aggravation of subretinal hemorrhage should be considered, even without tPA and if so, it is necessary to monitor and informed the patients in detail.