Retinal Nerve Fiber Layer Optical Texture Analysis and 10-2 Visual Field Assessment in Glaucoma.

PURPOSE: To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) to 1) investigate the association between papillomacular and papillofoveal bundle defects with 10-2 visual field (VF) sensitivity abnormalities, and 2) integrate the information from RNFL bundle defect and 24-2 VF central test locations to determine the likelihood of 10-2 VF sensitivity abnormalities. DESIGN: Cross-sectional. METHODS: A total of 841 eyes (144 healthy, 317 glaucoma suspect, and 380 glaucoma) of 442 participants were included. Eyes underwent 24-2, and 10-2 VF testing and OCT for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate, papillomacular, and papillofoveal bundles was determined for each eye. Multilevel logistic regression analysis was applied to evaluate the structure-function association. RESULTS: Papillomacular (92.1%) and papillofoveal (37.9%) RNFL bundle defects were prevalent in eyes with glaucoma. A 10-2 VF location that was projected onto a papillomacular or a papillofoveal RNFL bundle defect had a significantly increased likelihood of reduced sensitivity (ORs of 18.61 at PDP < 5%, and 20.17 at TDP < 5%, respectively, P < .001 for both). When predicting the likelihood of VF abnormality in a 10-2 test location, noticeably higher odds ratios were observed when overlapping with an RNFL bundle defect, compared to when an abnormal corresponding 24-2 central point was present. CONCLUSIONS: Papillomacular and papillofoveal RNFL bundle defects are present in a considerable proportion of eyes with glaucoma. When detected, they significantly increase the likelihood of abnormality in the corresponding central VF test locations assessed by the 10-2 test.

Smoking Intensity is Associated With Progressive Optic Nerve Head Vessel Density Loss in Glaucoma.

PRCIS: A lifetime history of greater smoking consumption was associated with faster vessel density loss over time. Smoking intensity should be considered when assessing the risk of glaucoma progression, as well as its management. PURPOSE: To investigate the relationship of smoking and smoking intensity, with the rate of optic nerve head (ONH) whole image capillary density (wiCD) loss in primary open angle glaucoma (POAG) and glaucoma suspect patients. METHODS: In this longitudinal study, patients with POAG who had at least 2 years of follow-up and optical coherence tomography angiography (OCTA) performed at a minimum of 4 visits were selected for study. The smoking intensity was calculated as the pack-year at the baseline OCTA. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of wiCD loss over time. Nonlinear least-squares estimation with piecewise regression model was used to investigate the cutoff point for the relationship between wiCD loss and smoking intensity. RESULTS: One hundred sixty-four eyes (69 glaucoma suspect and 95 POAG) of 110 patients were included with a mean (95% CI) follow-up of 4.0 (3.9 to 4.1) years. Of the 110 patients, 50 (45.5%) had a reported history of smoking. Greater smoking intensity was associated with faster wiCD loss [-0.11 (-0.23 to 0.00)] %/year per 10 pack-year higher; P =0.048) after adjusting for covariates. The wiCD thinning became significantly faster when smoking intensity was greater than 22.2 pack-years. Smoking had no effect on the rate of wiCD thinning in patients who smoked <22.2 pack-years during their lifetime. CONCLUSIONS: A history of greater smoking consumption was associated with faster vessel density loss, suggesting smoking intensity as a potential risk factor for glaucoma.

Correlation between Maternal Vitamin D and Thyroid Function in Pregnancy with Maternal and Neonatal Outcomes: A Cross-Sectional Study.

BACKGROUND: The aim of this study was to evaluate the prevalence of vitamin D deficiency in pregnant women to investigate the relationship between vitamin D level and thyroid function. METHODS: In this cross-sectional descriptive study, a total number of 66 patients during the three trimesters of pregnancy were investigated; 22 pregnant women were studied in each trimester of pregnancy. We evaluated thyroid function tests and thyroid autoantibodies (TPOAb and TGAb), as well as the serum level of 25OHD, to determine the relationship between vitamin D level and autoimmune or non-autoimmune thyroid disease in pregnancy. RESULTS: Pearson's correlation in all subjects showed that vitamin D levels did not have a significant relationship with maternal age. Only in the third trimester, there was a significant difference in maternal age based on their vitamin D status. There was no significant difference between the trimesters of pregnancy and vitamin D status (P > 0.05). Also, there were no significant differences between serum levels of vitamin D within three trimesters. Examination of thyroid function tests during pregnancy in relation to vitamin D showed that there was no significant Spearman's correlation between thyroid function status and serum vitamin D level (P > 0.05). There was no significant difference in the mean level of serum 25OH vitamin D in each subgroup of thyroid status (P > 0.05). Regarding the pregnancy outcomes, two newborns were admitted to NICU, meconium aspiration was in one case, and IUFD in another case led to pregnancy termination. These four cases were related to the maternal history of hypothyroidism. CONCLUSION: There was no significant relationship between vitamin D and pregnancy trimester. The serum level of vitamin D had no particular effect on the outcome of pregnancy and the thyroid gland function.

Memantine for axonal loss of optic neuritis.

BACKGROUND: To determine the effect of memantine on axonal loss and visual function during the course of optic neuritis (ON). METHODS: Sixty ON patients in a single-center, institutional setting were randomly assigned to the memantine or placebo groups. Patients with first attack of acute unilateral optic neuritis, with visual symptoms of 8 days' duration or less were enrolled in this trial. No patient had known multiple sclerosis, and none had taken immunomodulatory agent prior to or at the time of presentation. For all patients, the following characteristics were recorded and compared at initial presentation and 3 months afterward: visual acuity, retinal nerve fiber layer (RNFL) thickness, visual field parameters (mean deviation and pattern standard deviation), visual evoked potential, and contrast sensitivity. RESULTS: Fifty-four patients completed the 3-month follow up. There were no significant differences between the placebo and memantine groups for any of the characteristics at initial presentation. After 3 months, the only statistically significant difference between the two groups was in RNFL thickness. Memantine group subjects had higher thickness in nasal (P = 0.01), superior (P = 0.006), inferior (P = 0.01) quadrants and average (P = 0.01). However, temporal quadrant thickness was not different between two groups (P = 0.35). CONCLUSION: Memantine was effective in reduction of RNFL thinning, although this structural difference was not associated with improved visual function.

Randomized trial of pterygium surgery with mitomycin C application using conjunctival autograft versus conjunctival-limbal autograft.

PURPOSE: To compare the outcomes of free conjunctival autograft (CAU) versus conjunctival-limbal autograft (CLAU) in the prevention of recurrence after pterygium surgery with adjunctive mitomycin C application in patients with primary or recurrent pterygia. DESIGN: Prospective, randomized study. PARTICIPANTS AND CONTROLS: Eighty-seven eyes of 86 patients with primary or recurrent nasal pterygia were included. METHODS: All eyes underwent pterygium excision followed by removal of subconjunctival fibrovascular tissue and application of 0.02% mitomycin C for 3 minutes. The eyes then were assigned randomly to receive either CAU (44 eyes) or CLAU (43 eyes). MAIN OUTCOME MEASURES: Rate of conjunctival or corneal recurrence of pterygium after surgery. RESULTS: A follow-up of at least 12 months (mean, 14 ± 2.2 months) was achieved in 78 eyes of 78 patients, including 39 eyes in the CAU group (31 primary and 8 recurrent pterygia) and 39 eyes in the CLAU group (33 primary and 6 recurrent pterygia). After surgery, no eye in the CLAU group developed pterygium recurrence; however, recurrence was seen in 2 eyes (5.1%) in the CAU group, including 1 of 31 patients (3.2%) with primary pterygia and 1 of 8 patients (12.5%) with recurrent pterygia. There was no statistically significant difference in recurrence rates between the 2 groups or in the primary and recurrent subgroups. In the CLAU group, a localized pannus formation at the donor site of the limbal graft was noted in 5 eyes (12.8%), with the appearance of pseudopterygium in 1 eye. CONCLUSIONS: There was no significant difference in recurrence rates of pterygium after surgery with mitomycin C application between the CAU and CLAU groups, more remarkably in primary cases. Limbal damage was seen in some eyes with CLAU.

Evaluation of conjunctival graft thickness after pterygium surgery by anterior segment optical coherence tomography.

BACKGROUND: To evaluate changes in thickness of the conjunctival graft after pterygium surgery by anterior segment optical coherence tomography (AS-OCT). MATERIALS AND METHODS: Eleven eyes of 11 patients with primary nasal pterygium underwent excision followed by free conjunctival autograft. Imaging with AS-OCT was performed at 1 week, 1 month and 3 months after surgery to measure thickness of the conjunctival graft at 1, 2 and 3 mm posterior to the scleral spur. As the control, thickness of the normal bulbar conjunctival epithelium in the temporal area was also measured at the same locations. RESULTS: Average thickness of the graft decreased from 458 ± 171 µm at 1 week after surgery to 306 ± 64 µm at 1 month (p < 0.0001). Although the graft thickness decreased to 291 ± 124 µm at 3 months postoperatively, the difference between 1-month and 3-month values was not statistically significant (p = 0.94). Average thickness of the normal conjunctival epithelium was 58 ± 13 µm, 60 ± 19 µm and 61 ± 12 µm at 1 week, 1 month and 3 months after surgery, respectively, with no statistically significant difference. Graft thickness was significantly greater than thickness of the normal conjunctival epithelium at various time points (p < 0.05). CONCLUSION: Evaluation by AS-OCT showed that there was significant thickening of the conjunctival graft at 1 week after pterygium surgery which continued to decrease up to 3 months. Quantitative data by AS-OCT allows accurate evaluation of the conjunctival changes over time.

Effect of preemptive topical diclofenac on postoperative pain relief after photorefractive keratectomy.

PURPOSE: To assess the prophylactic effect of preoperative application of topical diclofenac on postoperative pain control in patients having photorefractive keratectomy (PRK). SETTING: Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. DESIGN: Randomized masked clinical trial. METHODS: In this paired-eye study, patients having bilateral PRK received 1 drop of diclofenac 0.1% in 1 eye and 1 drop of placebo in the fellow eye 2 hours before PRK. Postoperatively, both arms of the trial (both eyes of each patient) received topical diclofenac every 6 hours for 2 days. One day and 2 days postoperatively, patients were asked to rate the perceived pain in each eye using an 11-point verbal numerical rating scale. A trained examiner noted the eye-specific responses. RESULTS: All 70 patients (140 eyes) completed the study and were included in the statistical analysis. Twenty-four hours after PRK, patients reported pain scores that were clinically and statistically significantly lower in the eyes pretreated with diclofenac than in the fellow eyes (0.97 versus 2.09) (P=.018). Pain scores at 2 days did not differ significantly (P=.877). CONCLUSION: Administration of a single drop of topical diclofenac 0.1% 2 hours before PRK seemed to increase the efficacy of postoperative pain management in a clinically and statistically significant manner. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.