Impact of intraocular pressure reduction on visual field progression in normal-tension glaucoma followed up over 15 years.

PURPOSE: To investigate the impact of surgical or medical reduction of intraocular pressure (IOP) on progressive normal-tension glaucoma followed up over 15 years. METHODS: Sixty eyes of 60 patients were divided into 3 intervention groups: group 1 (trabeculectomy, n = 17); group 2 (IOP reduction rate ≥15% with prostaglandin analogs, n = 24); and group 3 (IOP reduction rate <15% with prostaglandin analogs, n = 19). The preintervention and postintervention mean deviation (MD) slopes and IOP were compared. Factors associated with the rate of visual field progression were identified by multiple regression analysis. RESULTS: The mean follow-up was 19.8 years. In group 1, the preintervention and postintervention IOPs were 14.7 ± 1.3 and 9.1 ± 2.0 mmHg, respectively (P < .001, 38% reduction). The MD slope decreased significantly after trabeculectomy (-0.86 ± 0.51 versus -0.19 ± 0.20 dB/y; P < .001). In group 2, the preintervention and postintervention IOPs were 14.7 ± 1.5 and 11.7 ± 1.2 mmHg, respectively (P < 0.001, 20% reduction), with significant differences in the MD slope (-0.52 ± 0.37 versus -0.31 ± 0.30 dB/y; P = .019). In group 3, the preintervention and postintervention IOPs were 14.4 ± 1.8 and 13.2 ± 1.6 mmHg, respectively (P < 0.001, 8% reduction), with no differences in the MD slope (-0.40 ± 0.27 versus -0.50 ± 0.65 dB/y; P > .05). Multiple regression analysis showed that the average IOP, IOP reduction rate, and preintervention MD slope were related to the extent of the postintervention reduction in the MD slope. The difference in the preintervention and postintervention MD slopes significantly correlated with the rate of IOP reduction (r = 0.559, P < .001). CONCLUSIONS: A pressure-dependent maintenance effect of the visual field was confirmed in progressive normal-tension glaucoma.

Case of late-onset bleb associated endophthalmitis caused by Rothia mucilaginosa.

Rothia mucilaginosa is a gram-positive coagulase-negative coccus of the family Micrococcaceae. Although R. mucilaginosa forms part of the oropharyngeal microflora, it has only recently been isolated in ocular infections. We report a case of a 41-year-old man who developed late-onset bleb-related endophthalmitis (BRE). He had undergone glaucoma surgery 21 years earlier and had a thin-walled cystic bleb prior to the development of endophthalmitis in his right eye. He immediately received intravitreal injections of ceftazidime and vancomycin, topical levofloxacin and cefmenoxime, and intravenous cefozopran. Culture of the aqueous humor specimen identified R. mucilaginosa by 16S rRNA sequence analysis. To our knowledge, this is the first report of late-onset BRE caused by R. mucilaginosa. Our case indicates that R. mucilaginosa can be a cause of late-onset BRE, and that molecular analysis is an accurate method to identify R. mucilaginosa.

Case of recurrence of spiradenoma in palpebral conjunctiva.

BACKGROUND: To report a rare case of a recurrence of spiradenoma that developed in the upper eyelid. CASE PRESENTATION: A 49-year-old woman who had a second recurrence of a tumor in the right palpebral conjunctiva underwent local resection of the lesion with adjunctive cryotherapy to the surgical site. The tumor consisted of smooth, round to oval nodular lesions approximately 1-3 mm in size with enlarged blood vessels. Histopathologically, the solid and well-circumscribed nodule was located beneath the conjunctival epithelium. It was composed of cells with slightly basophilic-to-clear cytoplasm and round-to-oval nuclei arranged in a trabecular pattern. Periodic acid-Schiff stain was positive in the cytoplasm, and the staining disappeared after digesting by diastase. Many cells in mitosis were observed throughout the tumor but no necrotic cells. Immunohistochemistry showed that the Ki-67 labeling index was 12%. From these findings, we diagnosed this tumor as a recurrence of the spiradenoma. There has been no recurrence and no signs of malignancy in the 6 months after the surgical excision. CONCLUSION: Our findings indicate that a spiradenoma should be completely excised surgically because of malignant transformation after repeated recurrences.

Macular ganglion cell complex thickness in glaucoma with superior or inferior visual hemifield defects.

PURPOSE: To elucidate the relationship between the macular ganglion cell complex thickness (GCCT) and its corresponding superior or inferior visual hemifield defects, and the apparently normal visual hemifield, and to explore the relationship between the macular GCCT of the corresponding apparently normal hemifield and the severity of the glaucomatous visual field defects in the same eye. METHODS: Sixty-seven eyes of 67 patients with open-angle glaucoma showed superior or inferior hemifield defects. We measured the visual field using the Humphrey Field Analyzer programs Central 30-2 and 10-2, and the GCCT using spectral domain optical coherence tomography. For the GCCT measurement, we selected 3 points each in the inner or outer sectors of the parafovea. RESULTS: We observed a significant correlation between the macular GCCT of the inner or outer sector of the parafovea and in the change of the visual field in each hemifield defect or the apparently normal hemifield. The decrease of the GCCT corresponding to the apparently normal hemifield correlated with the progression of the severity of the glaucomatous defects, using the Anderson classification. CONCLUSIONS: The macular GCCT is a sensitive marker of early glaucomatous change, allowing detection of structural changes associated with glaucoma even in the apparently normal hemifield.

Anterior ischemic optic neuropathy in patient with hereditary spherocytosis and coexisting angioid streaks.

Purpose. To describe a rare case of hereditary spherocytosis (HE) with angioid streaks that developed anterior ischemic optic neuropathy (AION).
Method. Case report.
Results. A 53-year-old woman with HE had a 3-day history of blurred vision in the lower hemifield in the left eye. At presentation, her visual acuity was 20/20 OD and 20/200 OS. Perimetric testing showed a relative scotoma in the superior parafoveal region in the right eye and an inferior altitudinal field defect in the left eye. Fundus examination demonstrated angioid streaks in both eyes with swelling of the optic disc in the left eye. Both parvovirus B19 immunoglobulin M and immunoglobulin G were identified in her serum. 
Conclusions. This is the first report of AION in HE and coexisting angioid streaks. The infection by parvovirus itself might be involved in the development of AION.