Corneal Biomechanical Properties of Various Types of Glaucoma and Their Impact on Measurement of Intraocular Pressure.

INTRODUCTION: Corneal biomechanical properties could affect intraocular pressure (IOP) measurement. The aim of this study was to evaluate the differences in corneal biomechanical properties of various types of glaucoma, assess their effect on IOP measurements. METHODS: This is an observational clinical study of 486 subjects including 102 normal subjects, 104 ocular hypertension (OHT), 89 normal tension glaucoma (NTG), and 191 high tension glaucoma (HTG). Corneal biomechanical parameters were measured using an ocular response analyzer. The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure measurement (IOPg), and corneal-compensated intraocular pressure (IOPcc). Ultrasound pachymetry was used to measure central corneal thickness (CCT). IOP was measured by a Goldmann applanation tonometer (GAT) and a noncontact tonometer (NCT). Visual field (VF) and refractive status were also recorded. Results were analyzed by one-way analysis of variance, univariate and multivariate linear regression analyses, and Bland-Altman plots. RESULTS: Multiple comparison by analysis of variance showed significantly lower CH and CRF in NTG compared to HTG, OHT, and normal subjects (CH: 0.011, 0.015, and 0.033; CRF: 0.001, <0.001, and 0.042, respectively). CRF and CH associated with IOP were measured using either GAT, NCT and IOPcc-GAT, IOPcc-NCT, yet CCT was not. GAT correlated strongly with IOPg (r = 0.79; p < 0.001) and IOPcc (r = 0.77; p < 0.001), but limits of agreement between the measurements were poor. CH and CRF were both negatively correlated with VF change (p < 0.01). CONCLUSION: CH and CRF affect the measurement of IOP and were related to types of glaucoma or severity of glaucoma. Pure CCT should not be used to correct IOP values or estimate the risk of disease.

Results of modified CO2 laser-assisted sclerectomy monotherapy versus trabeculectomy combination therapy in the eyes with uveitic glaucoma.

This study compared the efficacy of modified CO2 laser-assisted sclerectomy surgery (CLASS) with combined CLASS and trabeculectomy (CLASS-TRAB) in patients with uveitic glaucoma (UG). UG patients who underwent CLASS-TRAB between August 2015 and April 2019 were retrospectively compared with a control group who underwent a modified CLASS standalone procedure during the same period. Visual acuity, intraocular pressure (IOP), use of supplemental medical therapy and postoperative complications were recorded at baseline, 1 week, 3 months, 6 months and 12 months. Forty patients (40 eyes) were enrolled, and each group had 20 patients (20 eyes). The age and sex distribution were matched between groups (P > 0.05). Both the preoperative IOP (CLASS: 34.9 ± 9.3 mmHg, CLASS-TRAB: 36.8 ± 8.7 mmHg; P > 0.05) and number of glaucoma medications (CLASS: 3.3 ± 0.4, CLASS-TRAB: 3.5 ± 0.5; P > 0.05) were relatively higher in the CLASS-TRAB group than in the CLASS group. At the final follow-up, the IOP (CLASS: 12.9 ± 3.4 mmHg, CLASS-TRAB: 11.2 ± 2.5 mmHg) and number of glaucoma medications (CLASS: 0.4 ± 0.7 and CLASS-TRAB: 0.2 ± 0.5) significantly decreased in both groups (P < 0.01). Both the complete success rate and qualified success rate were comparable between the two groups (CLASS versus CLASS-TRAB: 55% versus 80%, P = 0.09; 80% versus 95%, P = 0.34). CLASS-TRAB is as efficient as modified CLASS in terms of the IOP-lowering effect, providing a new option for patients with UG that is severe and ineligible for other treatments.

A Case of Refractory Childhood Glaucoma Secondary to Weill-Marchesani Syndrome: Management with Combined CO2 Laser-Assisted Sclerectomy Surgery and Trabeculectomy.

A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature, short and stubby hands and feet, language disorders and mental retardation. He developed bilateral angle closure glaucoma, ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome. The child was successfully treated by combined CO2 laser-assisted sclerectomy surgery and trabeculectomy.

Optical Coherence Tomography Angiography of the Macula in Patients with Primary Angle-Closure Glaucoma.

BACKGROUND: The retinal microvasculature within the macula in glaucomatous eyes is not clear. OBJECTIVES: To detect macular vessel density (MVD) changes in primary angle-closure glaucoma (PACG). METHODS: Twenty-two PACG patients who had an episode of acute primary angle closure were included. Structural optical coherence tomography (OCT) scans were conducted to measure the thickness of the peripapillary retinal nerve fiber layer and macular ganglion cell complex (GCC). The MVD was measured with OCT angiography. RESULTS: A weakened macular microvascular network that had an expanded fovea avascular zone was observed in the case group. Compared with the control group, the case group had a lower MVD (p < 0.001). Single correlation analysis revealed a significant correlation of the MVD with best-corrected visual acuity (BCVA) (r = -0.65, p = 0.001), GCC (r = 0.50, p = 0.018), and the visual field mean deviation (r = -0.54, p = 0.009) in the case group. Moreover, in the mixed-effect models, the MVD was found to be positively correlated with GCC (p = 0.017) and negatively correlated with LogMar BCVA (p < 0.001). CONCLUSIONS: After an acute angle-closure attack, the macular microvascular network is attenuated, and the MVD decreases significantly.

[Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO2 Laser-assisted Sclerectomy Surgery].

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO2 laser-assisted sclerectomy surgery(CLASS).Methods This was a case series study.A combination of modified CLASS and preoperative laser iris management was administered to 28 eyes.Visual acuity,intraocular pressure(IOP),and slit-lamp examinations,visual field testing,and gonioscopy were carried out at baseline and until 24 months postoperatively.UBM examination was performed at 1,3,12 and 24 months postoperatively.Results Compared with the mean preoperative IOP [(30.61±10.59)mmHg],the IOP at each time point after operation was significantly lowered [(15.15±5.87),(12.56±3.24),(13.15±2.73),(13.75±2.55)and(13.75±2.46)mmHg at 1,3,6,12 and 24 months,respectively;all P<0.001].Complete success rates and qualified success rates at 12 months and 24 months were 60.71%,89.29% and 53.57%,85.71%,respectively.UBM images can present "dolphin head sign" after successful CLASS.The thickness of trabeculo-Descemet's window was(0.13±0.03)mm,which had no significant correlation with postoperative IOP at 12(r=-0.278,P=0.144)and 24 months(r=0.026,P=0.895).UBM examination revealed a severe scleral lake diminution(a change > 50%)in 1 eye(3.57%)at 12 months and 3 eyes(10.71%)at 24 months.There was no statistical significance detected between the size of the scleral lake and IOP after CLASS.Non-founctional blebs were found in 16 eyes(57.14%)at 12 months and 25 eyes(89.28%)at 24 months.Two eyes(7.14%)demonstrated severe peripheral anterior synechiae at 24 months,requiring surgical intervention.Conclusions UBM can effectively observe the morphology of the scleral lake,anterior chamber angle and filtering blebs in post-operative follow-up after modified CLASS,and give early warning of complications.It plays an important role in ensuring the success of CLASS.

Heat shock protein 47 is up-regulated in conjunctival bleb scarring after filtration surgery in rats.

BACKGROUND: Heat shock protein 47 (HSP47), a collagen-specific molecular chaperone, is involved in the biosynthesis and secretion of procollagen. Recent studies have shown a close association between increased HSP47 and excessive accumulation of collagens in various fibrotic diseases. This study was conducted to evaluate whether HSP47 plays a role in conjunctival bleb scarring after filtration surgery in rats. METHODS: Trabeculectomy of the right eye was performed in Sprague-Dawley (SD) rats. Eight rats were euthanized at 2, 5, 8 and 11 days after surgery. Four rats were used to extract mRNA and the other four were used to extract protein. Blebs and normal control conjunctival tissues were collected. Real-time PCR (RT-PCR) and Western blot methods were used to evaluate alterations in HSP47 levels and type I and type III collagen. RESULTS: Bleb formation was observed in all eyes. Both the expression of HSP47 mRNA and protein in conjunctival blebs increased at 2, 5, 8 and 11 days postoperatively compared with that in normal control conjunctival tissues. The differences of both the mean mRNA and protein levels of HSP47 in blebs at each time point and in the normal control conjunctiva were statistically significant (mRNA level: F = 175.811, p < 0.001; protein level: F = 68.356, p < 0.001). Type I and type III collagen levels in blebs were raised at different time points both at mRNA and at protein levels. The differences between mean mRNA and protein levels of both type I and type III collagen in blebs at 2, 5, 8 and 11 days after surgery and in the normal control conjunctiva were statistically significant (mRNA level: FI = 182.210, p I < 0.001; FIII = 125.490, p III < 0.001; protein level: FI = 160.092, p I < 0.001; FIII = 62.374, p III < 0.001 ). The amount of HSP47 in bleb positively correlated with that of both type I and type III collagens (mRNA level: rsI = 0.688, p I = 0.003; rsIII = 0.900, p III < 0.001; protein level: rsI = 0.688, p I = 0.003; rsIII = 0.832, p III < 0.001). CONCLUSIONS: HSP47 is likely to be involved in the pathogenesis of conjunctival bleb scarring and may play a role in the process of conjunctival bleb fibrosis.

Comparison of Long-Term Effects Following Phacoemulsification Combined with Goniosynechialysis and Trabeculectomy in Patients with Primary Angle-Closure Glaucoma and Cataract.

INTRODUCTION: Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract. METHODS: A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed. RESULTS: The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group. CONCLUSIONS: Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG.

Natural History and Risk Factors for Glaucoma Progression in Chinese Patients With Normal-Tension Glaucoma.

Purpose: To characterize the natural history of normal-tension glaucoma (NTG) in Chinese patients. Methods: The prospective observational cohort study included patients with untreated NTG with a minimum follow-up of 2 years. Functional progression was defined by visual field (VF) deterioration, while structural progression was characterized by thinning of the retinal nerve fiber layer (RNFL) or ganglion cell inner plexiform layer (GCIPL). Results: Among 84 participants (mean age, 60.5 years; mean deviation, -5.01 decibels [dB]) with newly diagnosed NTG followed for an average of 69.7 months, 63.1% progressed during the observation period. Specifically, 29.8% progressed by VF, and 48.8% progressed by either RNFL or GCIPL. In Cox proportional hazards analysis, disc hemorrhage (hazard ratio [HR], 2.82; 95% confidence interval [CI], 1.48-5.35), female gender (HR, 1.98; 95% CI, 1.08-3.62), and mean IOP during the follow-up period (HR, 1.14 per mm Hg; 95% CI, 1.00-1.31) were significant predictors of glaucomatous progression. Additionally, longer axial length (AL; HR, 0.57 per millimeter; 95% CI, 0.35-0.94) was protective against VF progression faster than -0.50 dB/y, and higher minimum diastolic blood pressure (DBP; HR, 0.96 per mm Hg; 95% CI, 0.92-1.00) was protective against structural progression. Conclusions: Nearly two-thirds of untreated Chinese patients with NTG progressed over an average follow-up of 70 months by VF, RNFL, or GCIPL. Disc hemorrhage, female gender, higher mean IOP, shorter AL, and lower minimum DBP were significant predictors for disease progression.

Progressive peripapillary capillary vessel density loss and long-term visual field progression in Normal tension glaucoma.

PURPOSE: To explore the association between progressive peripapillary capillary vessel density (pcVD) reduction and the progression of visual field (VF) impairment in individuals with normal tension glaucoma (NTG). DESIGN: Prospective cohort study. METHODS: The study enrolled 110 participants with one eye each, totalling 110 NTG eyes. VF defects were evaluated using standard automated perimetry mean deviation (MD), while pcVD measurements were obtained using optical coherence tomography angiography throughout the follow-up period. Estimates of VF progression were determined by event-based and trend-based analyses. Fast VF progression was defined as an MD slope steeper than -0.5 dB/year, while the slow progression or stable VF was defined as an MD slope better or equal to -0.25 dB/year. Linear mixed-effects models were employed to analyse the rates of change in pcVD reduction and VF MD decline over time. Additionally, univariable and multivariable linear models were used to examine the relationship between pcVD changes and VF loss rates in NTG. RESULTS: Slow VF progression or stable VF was observed in 45% of subjects, while 25% had moderate progression and 30% showed fast progression. Patients with VF progression exhibited faster rate of pcVD reduction in peripapillary global region (-0.73 ± 0.40%/year vs. -0.56 ± 0.35%/year, p = 0.022). Moreover, this rate positively correlated with VF MD decline in NTG (estimate 0.278, 95% CI 0.122-0.433, p = 0.001). CONCLUSION: In individuals with NTG, faster VF progression was linked to a quicker reduction in pcVD, suggesting a positive correlation between pcVD decline and VF deterioration.

[Expressions of vascular endothelial growth factor and its receptors in rat conjunctival fibroblasts].

OBJECTIVE: To detect the expressions of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptors (VEGFR) in cultured rat conjunctival fibroblasts. METHODS: Experimental study. Conjunctiva was obtained from each eye of five Sprague Dawley (SD) rats under local anesthesia. Tissues were minced and grown in culture flask containing Dulbecco's Modified Eagle's medium (DMEM). The fibroblasts were identified by observing cell morphology, and the expression of staining of cytokeratin and vimentin by inverted microscopy and indirect immunofluorescence technique. mRNA primers were designed for VEGF(164), VEGFR-1 (Flt-1), and VEGFR-2 (Flk-1). mRNA was extracted by Trizol method. cDNA was synthesized under the action of RNA reverse transcriptase. Ladder-like pattern of DNA fragmentation appeared upon 2% agarose gel electrophoresis. The amplification curves and dissociation curves of VEGF(164), VEGFR-1(Flt-1), and VEGFR-2 (Flk-1) were detected by realtime polymerase chain reaction (PCR). The expression of VEGFR-1 on fibroblast was observed by immunofluorescence technique. RESULTS: The fluorescent staining was negative in cytokeratin of fibroblasts, but was positive in vimentin of fibroblasts. The mRNA expressions of VEGF(164), VEGFR-1 (Flt-1) and VEGFR-2 (Flk-1) were detected in fibroblast and verified by gene sequencing. The peaks of the dissociation curves were all steep and specific. The fluorescent staining of VEGFR-1 was positive. CONCLUSIONS: Our results demonstrate that the expression of VEGF, VEGF receptors, and VEGFR-1 cytokine in rat conjunctival fibroblasts suggests that anti-VEGF compounds may exert a direct influence to the growth of rat conjunctival fibroblast.

Comparison of Long-Term Effects After Modified CO2 Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma.

INTRODUCTION: To compare the long-term effect after modified CO2 laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients. This was a retrospective comparative study. METHODS: A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively. RESULTS: Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group. CONCLUSIONS: MCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

Surgical Outcomes of Modified CO2 Laser-assisted Sclerectomy for Uveitic Glaucoma.

PURPOSE: To evaluate the clinical safety and efficacy of modified CO2 laser-assisted sclerectomy surgery (CLASS) in patients with uveitic glaucoma (UG) using primary open-angle glaucoma (POAG) patients for a comparison. METHODS: This retrospective study included UG and POAG patients from the modified CLASS Study Group database. Intraocular pressure (IOP) and the number of glaucoma medications were compared between groups by the Wilcoxon test. The Kaplan-Meier method was used for survival analysis; complete success was defined as 5≤ IOP≤18 mmHg and a ≥ 20% reduction in IOP from baseline without medication. RESULTS: Twenty-three and 25 eyes in UG and POAG groups were included. At the 12-month visit in both groups, the mean IOP and mean number of IOP-lowering medications were significantly reduced compared to baseline, with complete success rates of 60.9% and 64.0% in the UG and POAG groups (P = .859). CONCLUSIONS: Modified CLASS yields similar outcomes for patients with UG and POAG.

Stereoscopic vs. monoscopic photographs on optic disc evaluation and glaucoma diagnosis among general ophthalmologists: A cloud-based real-world multicenter study.

Purpose: To investigate whether stereoscopic vs. monoscopic viewing condition influences the evaluation of optic disc photographs for morphologic features and glaucoma likelihood in a general ophthalmologist population from multicenters on a cloud-based platform. Methods: A cross-sectional study of 519 pairs of stereoscopic and monoscopic photographs of optic discs with adequate quality were selected and presented using a cloud-based platform. A total of 21 general ophthalmologists from 14 centers assessed 15 morphologic features based on 5R's rules and estimated glaucoma likelihood for each assigned photograph. There were 93 pairs of stereoscopic and monoscopic photographs evaluated by a panel of glaucoma specialists and set as ground truth. The main outcome measures were the agreement between estimates and ground truth and the inter-grader agreements. Results: There were good agreements between ground truth and both monoscopic and stereoscopic estimates (stereo κ 0.532 and mono κ 0.494). There was also a substantial intra-grader agreement between monoscopic and stereoscopic evaluation of glaucoma likelihood (κ 0.636). In eyes with probable glaucoma, the accuracy of the stereo method was greater than that of the mono method (stereo 0.238 vs. mono 0.118) When compared with ground truth, stereoscopic photographs had a better agreement for disc size (stereo κ 0.447 vs. mono κ 0.183), disc color (stereo κ 0.612 vs. mono κ 0.549), neuroretinal rim shape (stereo κ 0.356 vs. mono κ 0.274) on the whole. The stereoscopic method also had a better inter-grade agreement for disc size, disc color, neuroretinal rim shape, and glaucoma likelihood (stereo κ 0.402 vs. mono κ 0.359) on the whole. Conclusions: In the evaluation of optic disc photographs for morphologic features and glaucoma likelihood, the stereoscopic method showed superiority compared to the monoscopic method for general ophthalmologists. The stereoscopic method is more likely to identify glaucomatous eyes which need medical intervention.

Validating automated eye disease screening AI algorithm in community and in-hospital scenarios.

Purpose: To assess the accuracy and robustness of the AI algorithm for detecting referable diabetic retinopathy (RDR), referable macular diseases (RMD), and glaucoma suspect (GCS) from fundus images in community and in-hospital screening scenarios. Methods: We collected two color fundus image datasets, namely, PUMCH (556 images, 166 subjects, and four camera models) and NSDE (534 images, 134 subjects, and two camera models). The AI algorithm generates the screening report after taking fundus images. The images were labeled as RDR, RMD, GCS, or none of the three by 3 licensed ophthalmologists. The resulting labels were treated as "ground truth" and then were used to compare against the AI screening reports to validate the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the AI algorithm. Results: On the PUMCH dataset, regarding the prediction of RDR, the AI algorithm achieved overall results of 0.950 ± 0.058, 0.963 ± 0.024, and 0.954 ± 0.049 on sensitivity, specificity, and AUC, respectively. For RMD, the overall results are 0.919 ± 0.073, 0.929 ± 0.039, and 0.974 ± 0.009. For GCS, the overall results are 0.950 ± 0.059, 0.946 ± 0.016, and 0.976 ± 0.025. Conclusion: The AI algorithm can work robustly with various fundus camera models and achieve high accuracies for detecting RDR, RMD, and GCS.

[Novel exploration of emergency treatment for ueitic acute angle closure glacuma].

OBJECTIVE: To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG). METHODS: In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure (IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. RESULTS: The IOP values for the paracentesis plus pupillary block relief group were (9.2 ± 2.1) mm Hg, (12.4 ± 3.7) mm Hg and (14.1 ± 2.6) mm Hg at 1, 48 h and 10 d vs (24.5 ± 7.1) mm Hg, (22.2 ± 8.6) mm Hg and (19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1(1/14) patient from the paracentesis plus pupillary block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. CONCLUSION: Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG. And it may offer a basis for further therapy.

[Analysis of optical coherence tomography in early stage of optic neuritis in multiple sclerosis patients].

OBJECTIVE: To detect the changes in the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in the eyes of multiple sclerosis patients during the early stage of optic neuritis. METHODS: A prospective case series study. Suspected acute optic neuritis of multiple sclerosis (MS) patients who attended the department of ophthalmology in Peking Union Medical College hospital from Feb. 2007 to Nov. 2010 were collected. Twenty two MS patients were evaluated within the first week of the attack of acute optic neuritis. The average thickness of RNFL and GCC was measured and a three dimensional image of optic disk was reconstructed using optical coherence tomography (OCT). RESULTS: Within the first week of onset, the average thickness of RNFL and GCC of first attack eyes increased 75% and 64%, respectively. The average thickness of RNFL and GCC in relapsed eyes decreased 91.7% and 62.5% respectively. The average thickness of RNFL and GCC of the fellow eyes also increased 60% and 43% respectively, within the first week of onset. More cases of optic disk edema and thickening of RNFL were found by OCT than by direct ophthalmoscopy. CONCLUSIONS: Different changes of the thickness of RNFL and GCC and morphology of the optic disk were detected during the early stage of the initial attack or relapsed optic neuritis in MS patients. OCT could detect such differences.

Efficacy and Safety of High-Energy Selective Laser Trabeculoplasty for Steroid-Induced Glaucoma in Patients with Quiescent Uveitis.

Purpose: To assess the efficacy and safety of high-energy selective laser trabeculoplasty (SLT) for steroid-induced glaucoma in patients with quiescent uveitis.Methods: A retrospective study of steroid-induced glaucoma in quiescent uveitic patients who underwent SLT at our center from December 2014 to November 2017 and had been followed up for at least 1 year. Intraocular pressure (IOP) and IOP-lowering medications were recorded at baseline, and at 1 week, 1 month, 3 months, 6 months and 12 months after SLT. Treatment success was defined as IOP ≤18 mmHg and a ≥ 20% reduction in IOP without additional glaucoma surgery.Results: Twenty eyes from 19 patients were included. At the 12-month visit, mean IOP and mean number of IOP-lowering medications were significantly reduced as compared to baseline with an overall success rate of 65.0%.Conclusions: High-energy SLT appeared to be an effective and safe procedure for steroid-induced glaucoma with quiescent uveitis.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis.

AIM: To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. METHODS: We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. RESULTS: In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD=-0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. CONCLUSION: Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.

Modified CO2 Laser-assisted Sclerectomy Surgery in Chinese Patients With Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma: A 2-Year Follow-up Study.

PRECIS: A modified CO2 laser-assisted sclerectomy surgery (CLASS) based on the characteristics of Chinese eyeball was carried out in Chinese patient and was confirmed to be effective and safe during long-term follow-up. PURPOSE: The purpose of this study was to study the long-term efficacy and safety of modified CLASS in Chinese patients with primary open-angle and pseudoexfoliative glaucoma. METHODS: We enrolled 25 medically uncontrolled primary open-angle and pseudoexfoliative glaucoma patients in this prospective, interventional case series. A combination of modified CLASS and preoperative laser iris management was administered to 29 eyes. Visual acuity, intraocular pressure (IOP), slit-lamp examinations, visual field, and gonioscopy were carried out at baseline and until 24 months postoperatively. Ultrasound biomicroscopy examinations were repeated at 3, 12, and 24 months postsurgically. RESULTS: Mean patient age was 53.92±12.08 years. Mean preoperative IOP was 30.66±10.41 mm Hg; and mean postoperative IOP was 8.17±3.76, and 13.25±2.73, 13.76±2.50, and 13.76±2.50 mm Hg at 1 day, and 6, 12, and 24 months, respectively. Proportional changes in IOP from baseline at 6, 12, and 24 months was 58.33%, 56.25%, and 58.97% (P<0.001), respectively. Complete postoperative success rates at 12 and 24 months were 62.07% and 48.28%. Qualified success rates at 12 and 24 months postoperatively were both 89.66%. Number of medications administered per patient reduced from 3 at baseline to 0 at 12 and 24 months (P<0.0001). Two patients demonstrated severe peripheral anterior synechiae (6.90%). Ultrasound biomicroscopy examination revealed a severe scleral lake diminution in 1 patient (3.40%) at 12 months and 2 patients (6.90%) at 24 months. CONCLUSION: Combination of modified CLASS and preventive laser iris management was effective and safe in the long-term treatment of primary open-angle glaucoma patients.

Altered amplitude of low-frequency fluctuations and default mode network connectivity in high myopia: a resting-state fMRI study.

AIM: To analyze changes in amplitude of low-frequency fluctuations (ALFFs) and default mode network (DMN) connectivity in the brain, using resting-state functional magnetic resonance imaging (rs-fMRI), in high myopia (HM) patients. METHODS: Eleven patients with HM (HM group) and 15 age- and sex-matched non-HM controls (non-HM group) were recruited. ALFFs were calculated and compared between HM group and non-HM group. Independent component analysis (ICA) was conducted to identify DMN, and comparisons between DMNs of two groups were performed. Region-of-interest (ROI)-based analysis was performed to explore functional connectivity (FC) between DMN regions. RESULTS: Significantly increased ALFFs in left inferior temporal gyrus (ITG), bilateral rectus gyrus (REC), bilateral middle temporal gyrus (MTG), left superior temporal gyrus (STG), and left angular gyrus (ANG) were detected in HM group compared with non-HM group (all P<0.01). HM group showed increased FC in the posterior cingulate gyrus (PCC)/precuneus (preCUN) and decreased FC in the left medial prefrontal cortex (mPFG) within DMN compared with non-HM group (all P<0.01). Compared with non-HM group, HM group showed higher FC between mPFG and bilateral middle frontal gyrus (MFG), ANG, and MTG (all P<0.01). In addition, HM patients showed higher FC between PCC/(preCUN) and the right cerebellum, superior frontal gyrus (SFG), left preCUN, superior frontal gyrus (SFG), and medial orbital of the superior frontal gyrus (ORB supmed; all P<0.01). CONCLUSION: HM patients show different ALFFs and DMNs compared with non-HM subjects, which may imply the cognitive alterations related to HM.