Plateau Iris: A Review.

Purpose: To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management. Methods: This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management. Results: This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned. Conclusions: Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

One-year outcomes of combined phacoemulsification and viscogoniosynechialysis with and without endoscopic cyclophotocoagulation in primary angle-closure glaucoma.

PURPOSE: To compare the outcomes of combined phacoemulsification and viscogoniosynechialysis (VGSL) with and without endoscopic cyclophtocoagulation (ECP) in primary angle-closure glaucoma (PACG). METHODS: In this prospective interventional case series 52 eyes of 50 patients were enrolled. Twenty-seven eyes underwent combined phacoemulsification and VGSL (PV group) and 25 eyes underwent the same procedure plus circumferential ECP (PVE group). All eyes were followed 1 day, 1 week, 3 months, 6 months, and 1 year after the procedure. Intraocular pressure and antiglaucoma medications were compared between and within groups using generalized estimating equations. Kaplan-Meier survival analysis was carried out to compare intensity to failure between groups. RESULTS: The mean ± SD age was 63.23 ± 6.87 years and 50% of the cases were male in the entire group. Intraocular pressure (IOP) and antiglaucoma medications were significantly reduced at all time points in comparison with the baseline in both groups (p < 0.05). There was no significant difference between groups in either IOP or medications at specific time points (p > 0.05). One eye in each group developed a fibrinous reaction in the postoperative period. There was no statistically significant difference between groups regarding the intensity to failure (P = 0.169). CONCLUSION: There were no significant differences in IOP and medication reduction between groups. Also, the complications were comparable between groups.

Deep Learning-Based Classification of Subtypes of Primary Angle-Closure Disease With Anterior Segment Optical Coherence Tomography.

PRCIS: We developed a deep learning-based classifier that can discriminate primary angle closure suspects (PACS), primary angle closure (PAC)/primary angle closure glaucoma (PACG), and also control eyes with open angle with acceptable accuracy. PURPOSE: To develop a deep learning-based classifier for differentiating subtypes of primary angle closure disease, including PACS and PAC/PACG, and also normal control eyes. MATERIALS AND METHODS: Anterior segment optical coherence tomography images were used for analysis with 5 different networks including MnasNet, MobileNet, ResNet18, ResNet50, and EfficientNet. The data set was split with randomization performed at the patient level into a training plus validation set (85%), and a test data set (15%). Then 4-fold cross-validation was used to train the model. In each mentioned architecture, the networks were trained with original and cropped images. Also, the analyses were carried out for single images and images grouped on the patient level (case-based). Then majority voting was applied to the determination of the final prediction. RESULTS: A total of 1616 images of normal eyes (87 eyes), 1055 images of PACS (66 eyes), and 1076 images of PAC/PACG (66 eyes) eyes were included in the analysis. The mean ± SD age was 51.76 ± 15.15 years and 48.3% were males. MobileNet had the best performance in the model, in which both original and cropped images were used. The accuracy of MobileNet for detecting normal, PACS, and PAC/PACG eyes was 0.99 ± 0.00, 0.77 ± 0.02, and 0.77 ± 0.03, respectively. By running MobileNet in a case-based classification approach, the accuracy improved and reached 0.95 ± 0.03, 0.83 ± 0.06, and 0.81 ± 0.05, respectively. For detecting the open angle, PACS, and PAC/PACG, the MobileNet classifier achieved an area under the curve of 1, 0.906, and 0.872, respectively, on the test data set. CONCLUSION: The MobileNet-based classifier can detect normal, PACS, and PAC/PACG eyes with acceptable accuracy based on anterior segment optical coherence tomography images.

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension.

Purpose: Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN). Methods: In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan-Meier graph was used to demonstrate the survival status of the eyes. Results: Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%). Conclusion: Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).

Comparison of Vascular Density and Structural Patterns Between Primary Open Angle Glaucoma and Primary Angle Closure Glaucoma.

PURPOSE: To compare the pattern of vascular density and structural damage in primary open angle glaucoma (POAG) with primary angle closure glaucoma (PACG) using optical coherence tomography (OCT) and OCT angiography (OCTA) in the optic nerve head, circumpapillary, and macular regions, respectively. MATERIALS AND METHODS: One hundred thirty-one eyes of 82 patients (53 eyes with PACG and 78 eyes with POAG) were enrolled in this study. The patients underwent complete ophthalmic examination, Bruch membrane opening minimum rim width, circumpapillay retinal nerve fiber layer (cpRNFL), and macular ganglion cell complex (GCC) measurements and vascular density determination of the peripapillary and macular area with OCT and OCTA. A linear mixed model was used for the statistical analysis. RESULTS: There was no significant difference between the 2 groups in terms of age ( P =0.94) and visual field mean deviation ( P =0.78). Female-to-male ratio was higher in PACG patients than the POAG group ( P =0.02), and AL was shorter in PACG eyes ( P <0.001). cpRNFL and GCC were not different between the 2 groups (all P values>0.05, except for nasal segment cpRNFL). Vessel densities in the peripapillary and macular areas were comparable between the 2 groups (all P values>0.05). Although Bruch membrane opening minimum rim width was thicker in PACG eyes on univariate analysis, the multivariable analysis showed no significant difference between the 2 groups ( P >0.05). CONCLUSIONS: PACG and POAG eyes with similar visual field damages have comparable structural damage patterns in the peripapillary and inner macular thickness and vessel density measurements.

The role of optical coherence tomography angiography in moderate and advanced primary open-angle glaucoma.

PURPOSE: To evaluate the relationship between structure and function in moderate and advanced primary open-angle glaucoma (POAG) and to determine the accuracy of structure and vasculature for discriminating moderate from advanced POAG. METHODS: In this cross-sectional study, 25 eyes with moderate and 40 eyes with advanced POAG were enrolled. All eyes underwent measurement of the thickness of circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (GCC), and optical coherence tomography angiography (OCTA) of the optic nerve head (ONH) and macula. Visual field (VF) was evaluated by Swedish interactive threshold algorithm and 24-2 and 10-2 patterns. The correlation between structure and vasculature and the mean deviation (MD) of the VFs was evaluated by a partial correlation coefficient. The area under the receiver operating characteristic curve (AUC) was applied for assessing the power of variables for discrimination moderate from advanced POAG. RESULTS: Including all eyes, whole image vessel density (wiVD) of the ONH area, and vessel density (VD) in the inferior quadrant of perifovea were the parameters with significant correlation with the mean deviation (MD) of the VF 24-2 in OCTA of the ONH and macula (r = .649 and .397; p < .05). The greatest AUCs for discriminating moderate and advanced POAG belonged to VD of the inferior hemifield of ONH area (.886; 95% CI (.805, .967)), and VD in the inferior quadrant of perifovea (.833; 95% CI (.736, .930)) without statistically significant difference (.886 Versus .833; p = .601). CONCLUSION: Among vascular parameters of the ONH area, wiVD had the strongest correlation with the MD of the VF 24-2 while VD of the inferior hemifield of the ONH area had the greatest AUC for discriminating moderate and advanced POAG. Vessel density in the inferior quadrant of perifovea had a significant correlation with the MD of VF 24-2 and also the greatest AUC for discriminating moderate and advanced POAG.

Management of Malignant Glaucoma.

Purpose: To compare the outcomes of various invasive and noninvasive approaches to the treatment of malignant glaucoma. Methods: Glaucoma-related keywords were looked up in PubMed and Google Scholar, and related articles up to 2022 were used to put together this review article. Results: Numerous surgical methods and techniques have been introduced in the past few years. This review outlined current knowledge regarding the nonsurgical and surgical management of malignant glaucoma. In this regard, we first briefly outlined the clinical presentation, pathophysiology, and diagnosis of this disorder. Then, the current evidence on the management of malignant glaucoma was reviewed. Finally, we discuss the need for treatment of the other eye and the factors that might affect the outcome of surgical intervention. Conclusions: Fluid misdirection syndrome, or malignant glaucoma, is a severe disorder that can occur spontaneously due to surgical intervention. The pathophysiology of malignant glaucoma is complicated, and numerous theories exist about the underlying mechanisms that may contribute to the disease. Malignant glaucoma can be treated conservatively using medications, laser therapy, or surgery. Laser treatments and medical treatments have been adequate for the treatment of glaucoma, but the effects have generally been short-lived, and surgical treatment has proved to be the most effective. There have been a variety of surgical methods and techniques introduced. Still, none have been studied in a large proportion of patients as a control case to compare effectiveness, outcomes, and recurrence. Pars plana vitrectomy with irido-zonulo-capsulectomy still seems to have the best results.

Optic nerve head vessel density in different stages of pseudoexfoliation disease.

PURPOSE: To evaluate the superficial vascular density of the optic nerve head in different stages of pseudoexfoliation disease using optical coherence tomography angiography (OCTA). METHODS: In this cross-sectional study, 57 normal eyes, 41 eyes with pseudoexfoliation syndrome (PXS), 82 eyes with pseudoexfoliation glaucoma (PXG) and 27 non-glaucomatous fellow eyes of PXG (NL-PXG) that had OCTA were included. Circumpapillary RNFL (cpRNFL) thickness and circumpapillary capillary density (cpCD) were compared among the groups after adjusting for confounders using linear-mixed model. RESULTS: PXG eyes had thinner global RNFL and lower cpCD (74.2±14.3 µm and 36.7±10.0%) than control (103.3±8.6 µm and 52.5±2.3%), PXS (96.8±8.8 µm and 51.5±2.3%), and NL-PXG eyes (96.3±11.1 µm and 50.1±3.9%) (p<0.001). After adjustment for age, gender and signal strength index, global cpRNFL thickness was comparable among control, PXS and NL-PXG. NL-PXG had the lowest cpCD (p=0.045) and sectoral cpCD compared to PXS and control eyes. Although cpCD was comparable between control and PXS (p=0.425) eyes, sectoral differences (p=0.009 and 0.004, for inferonasal and temporal-inferior cpCD, respectively) were detectable between the two groups. AUROC for differentiating NL-PXG eyes from normal were better for cpCD (0.78) compared to cpRNLF (0.69). CONCLUSIONS: OCTA can detect reduced capillary density before significant changes in cpRNFL in fellow eyes of PXG patients. This can enable earlier detection of glaucomatous loss in pseudoexfoliation disease and enhance management of the disease.

Evaluation of Anterior Segment Parameters in Pseudoexfoliation Disease Using Anterior Segment Optical Coherence Tomography.

PURPOSE: To compare anterior segment and angle parameters between pseudoexfoliation syndrome (PEX) and PEX glaucoma (PEXG) and normal control subjects using anterior segment optical coherence tomography (AS-OCT) imaging. DESIGN: Cross-sectional study. METHODS: One hundred and two subjects with PEXG, PEX, and normal eyes as the control group were recruited from an academic referral institution. All subjects underwent a complete ophthalmologic examination, axial length measurement, and AS-OCT imaging. Anterior segment and angle parameters were evaluated. RESULTS: After excluding 4 eyes because of poor imaging of the scleral spur, data from 34 eyes with PEXG, 33 eyes with PEX, and 31 eyes of normal control subjects were analyzed. Anterior chamber depth was significantly shallower in eyes with PEXG compared with eyes of control subjects (P < .001). The differences in anterior chamber angle parameters (AOD500, AOD750, TISA500,and TISA750) were significant among study groups, with lower values in the PEXG group compared with the PEX and control subject groups. Lens vault (mean [mm]±SD) was higher in the PEXG (0.46 ±0.21) and PEX (0.427 +0.28) groups compared with the control group (0.305+ 0.20). CONCLUSIONS: PEXG eyes have the narrowest anterior chamber angle parameters. There is a progressive decrease in angle parameters from control subjects to the PEX group to the PEXG group. Narrow anterior chamber angle and anterior chamber depth may have a role in the progression of PEX to PEXG. Detection of narrow angle in these patients may help clinicians manage the disease more properly.

Huge Lateral Rectus Solitary Plasmacytoma Causing Shunt Extrusion.

A 54-year-old man with a history of radiotherapy for right maxillary sinus plasmacytoma 3 years previously was referred to an orbital clinic with progressive proptosis in his right eye. His vision had deteriorated after an initial improvement after phacoemulsification 2 years before. He had undergone shunt implantation and later shunt removal following plate extrusion with the diagnosis of neovascular glaucoma following CRVO. His vision remained at no light perception afterwards, despite a controlled IOP with topical medications. In his CT scan, a large orbital mass was seen with lateral rectus involvement. He underwent deep orbitotomy for tumor resection following worsening of symptoms, and his symptoms were improved afterwards. Pathology report was consistent with plasmacytoma with anaplastic features. After tumor resection, he underwent another course of radiotherapy with complete remission of symptoms afterwards.

Comparison between sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant.

PURPOSE: To compare sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant in the tunnel. METHODS: In this comparative interventional case series, 41 eyes of 40 patients having open-angle glaucoma (OAG) underwent sutureless scleral tunnel phacotrabeculectomy (Group A) and 28 eyes of 24 patients underwent the same procedure with placement of anterior capsule remnant in the tunnel (Group B). Baseline intraocular pressure (IOP) and IOP at 1 day, 1 month and 6 months after surgery were recorded. IOP < 21 mmHg and 20% reduction in IOP from baseline without and with antiglaucoma medication(s) were considered as complete and qualified success, respectively. Any further procedures or complications that require returning the patient to the operating room or becoming no light perception (NLP) were defined as failure. RESULTS: Mean preoperative IOP was 26.6 ± 10.08 and 26.64 ± 6.31 mmHg in group A and B, respectively (P-value = 0.984). Mean IOP at 1 month was significantly lower in group B (14.24 ± 4.4 versus. 12.07 ± 3.1, P = 0.027) but at 6 months there was no significant difference between groups (14.38 ± 3.56 versus. 14.8 ± 1.85, P = 0.590). The qualified success rate in group B was higher than group A (78.6 versus. 58.5%) at month 1, while the complete success rate was higher in group A than B (34.1% versus. 17.9%). Neither of any group had complete success at month 6. The qualified success rate was 94.7% and 100% in group A and B, respectively, at 6 months. CONCLUSION: Placement of anterior capsule remnant in the ostomy during combined phacotrabeculectomy may improve the outcome of the procedure.

Ahmed glaucoma valve implantation with and without subconjunctival bevacizumab in refractory glaucoma.

PURPOSE: To evaluate the effects of subconjunctival bevacizumab injection on intraocular pressure (IOP), hypertensive phase, and failure and success rates of Ahmed Glaucoma Valve (AGV) implantation. METHODS: A total of 63 eyes of 63 patients (30 cases in control and 33 cases in bevacizumab group) were included in this randomized masked prospective clinical trial. Pre- and postoperative BCVA, IOP, number of medications, complications and success rates were compared between AGV + bevacizumab and AGV alone group. RESULTS: Both groups showed statistically significant reductions in IOP in all their follow-up visits (P < 0.05). The mean IOP was lower in the AGV + Bevacizumab group than AGV group in all follow-up visits. However, the difference was only significant at the 3rd month (17.3 ± 6.2 vs. 20.7 ± 4.6, p = 0.04). The number of medications was not differed significantly between the two groups at their last visit (p value = 0.84) Complete success rate was higher in AGV + Bevacizumab. However, the difference was not significant (p = 0.73). The qualified and overall success rate, failure rate and the need for second tube were not statistically different between the two groups. The hypertensive phase was not statistically significant between the 2 groups (33.3% in AGV + Bevacizumab group and 50% in AGV group, p = 0.06) CONCLUSION: Adjunctive use of Bevacizumab during AGV implantation is beneficial in controlling hypertensive phase and IOP control and may lead to higher success rates and lower failure rates after AGV implantation. However, whether it's clearly beneficial or its exact role remains to be investigated.

Automated Evaluation of Parapapillary Choroidal Microvasculature in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma.

OBJECTIVE: To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG). DESIGN: Cross-sectional study. METHODS: One hundred ninety-two eyes of 120 subjects from 2 academic referral institutions were enrolled. Automated PPCMv density was calculated using custom Matlab software in inner and outer annuli around the optic nerve region in addition to peripapillary superficial vasculature. Linear modeling was used to compare vessel densities among groups. RESULTS: Data from 64 eyes with PXS, 84 eyes with PXG, and 44 eyes healthy control subjects were analyzed. The differences of visual field mean deviation and peripapillary retinal nerve fiber layer thickness among study groups were statistically significant with lower values in PXG eyes compared with the PXS and control groups. Peripapillary superficial retinal vessel densities were significantly reduced in patients with PXG compared with patients with PXS and normal control subjects (all P < .001) without a difference between PXS and control eyes. Customized outer annular PPCMv density in the PXG group with a value of 11.1% (SD 5.1%) was lower than that in PXS with a value of 13.2% (SD 5.3%; P = .001). Similarly, PXS values were lower than those of control eyes with a value of 18.6% (SD 5.1%; P < .001). CONCLUSION: A progressive decrease in outer PPCMv from the control group to those with PXS without glaucoma to those with PXS and glaucoma (PXG) showed deep peripapillary vasculopathy in pseudoexfoliation syndrome. Choroidal vessel density may be affected early in the course of pseudoexfoliation before glaucoma develops.

Automated Evaluation of Parapapillary Choroidal Microvasculature in Ischemic Optic Neuropathy and Open Angle Glaucoma.

Purpose: To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between nonarteritic anterior ischemic optic neuropathy (NAION) and primary open angle glaucoma (POAG). Methods: Thirty-seven eyes with chronic NAION, 34 unaffected fellow eyes with NAION, 47 moderate and severe POAG eyes, and 54 healthy control subjects were evaluated. Automated PPCMv density was calculated using custom Matlab software in inner and outer annuli around the optic nerve region in addition to peripapillary superficial retinal vessels. Results: Linear models showed no difference in peripapillary retinal nerve fiber layer between NAION and POAG eyes. Mean peripapillary superficial small vessels in the NAION and POAG groups were 36.62 ± 7.1% and 39.72 ± 8.18% without a statistically difference between them (P = 0.16). Mean inner and outer annular region PPCMv densities in the NAION group were 26.55 ± 9.2% and 17.81 ± 6.9%, which were not different from unaffected fellow eyes and the control group. However, the POAG group had significantly reduced PPCMv density in both inner and outer annuli with values of 15.84 ± 6.5% and 12.80 ± 5.0%, respectively, compared with normal subjects (both P < 0.001). Inner and outer circle PPCMv densities were also significantly reduced in the POAG group compared with the NAION group. Conclusions: Reduced PPCMv density in POAG eyes shows that deep optic nerve head ocular blood flow may contribute to axonal damage in patients with glaucoma.

Vessel density and retinal nerve fibre layer thickness following acute primary angle closure.

BACKGROUND: To evaluate changes in circumpapillary vessel density (cpVD) and retinal nerve fibre layer (cpRNFL) thickness after a successfully treated episode of acute primary angle closure (APAC) and to identify factors associated with glaucoma progression in these eyes. METHODS: Twenty-six patients successfully treated for a unilateral episode of APAC were included in this prospective study. Optical coherence tomography (OCT) cpRNFL thickness and OCT angiography (OCTA) cpVD were compared between 2 and 8 months after treatment. Multiple logistic regression analysis was conducted to identify factors that influenced cpRNFL outcome. RESULTS: cpRNFL thicknesses was thinner in the affected eye (94.0 µm (95% CI: 87.3 to 100.8)) than in the unaffected fellow eye (103.1 µm (99.3 to 106.9)) at 2 months (p=0.039). The cpRNFL thickness of the affected eye decreased 8 months after remission (89.5 µm (84 to 95)), but was unchanged in the unaffected eye. Although cpVD was significantly lower (p=0.001) in APAC eyes 2 months after treatment (56.7% (53.8 to 59.7)) compared with fellow eyes (62.9% (61.4 to 64.4)), there was no significant change in cpVD of the affected eye between 2 and 8 months. In the multivariable analysis, the only factor that was associated with cpRNFL progression was lower cpVD at 2 months after APAC remission (OR=1.79, p=0.036). CONCLUSION: Early reductions of the vessel density and long-term decrease in cpRNFL thickness were observed during the first 8 months after an APAC attack. A lower vessel density at 2 months was the best predictor of conversion to an abnormal cpRNFL thickness. Glaucomatous progression should be suspected in eyes with lower vessel density even after remission of an episode of APAC.

Changes in Optic Nerve Head Vessel Density After Acute Primary Angle Closure Episode.

Purpose: To evaluate the changes in circumpapillary vessel density (cpVD) and retinal nerve fiber layer (RNFL) thickness after an acute primary angle closure (APAC) episode. Methods: Twenty-eight patients (28 pair of eyes) with unilateral APAC and 39 normal subjects (64 eyes) were included in this prospective, observational study. cpVD as measured by optical coherence tomography angiography and RNFL thickness as measured by spectral-domain optical coherence tomography were compared at 6 weeks after an APAC episode between affected, unaffected, and normal eyes. cpVD and RNFL thickness at 1 week and 6 weeks after APAC were also compared in APAC eyes in qualified images. Results: At 6 weeks, cpVD was significantly lower in APAC eyes (57.3% ± 6.8%), compared to fellow eyes (63.1% ± 3.5%) and control eyes (63.6% ± 3.4%) (P < 0.001). There was diffuse microvascular dropout with greater vessel density loss in the superonasal sector. APAC eyes had thinner RNFL globally and in each sector (except temporal and nasal sectors) than in fellow and normal eyes at 6 weeks. cpVD in the affected eyes was significantly greater at 1 week (56.3% ± 5.3%) than values at 6 weeks (53.5% ± 7%) (P = 0.003) but less than cpVD in the fellow eyes (62.4% ± 5.0%) (P < 0.001). RNFL thickness for the APAC eyes at 1 week (120.6 ± 18.0 µm) was greater than the analogous values for affected eyes (90.1 ± 13.2 µm; P = 0.037) and fellow eyes at 6 weeks (102.5 ± 5.7 µm; P = 0.001). Conclusions: Vessel density decreased over 6 weeks after an APAC episode compared with the contralateral unaffected eyes. In contrast, there was an initial increase in RNFL thickness that was followed by a subsequent decrease.

Comparison of different doses of subconjunctival sunitinib with bevacizumab in the treatment of corneal neovascularization in experimental rats.

BACKGROUND: To compare the efficacy of subconjunctival administration of bevacizumab and different doses of sunitinib malate in reducing corneal neovascularization (CNV). MATERIALS AND METHODS: In this experimental study, central corneal cauterization was created in the right eye of fifty male Sprague-Dawley rats. On day 1 (1 week after cauterization), rats were randomly assigned into five treatment groups. Group control (n = 10) received subconjunctival injection of 0.02 ml of base saline solution. Group 1 (n = 10) received 0.02 ml of bevacizumab (25 mg/ml). Group 2, 3, and 4 (n = 10 for each group) were treated with 0.02 ml of sunitinib malate (10, 20, and 50 µg/ml, respectively). On days 1, 7, and 14, digital photographs of the cornea were taken, and the area of CNV was measured. RESULTS: During the 2-week follow-up, CNV area in treatment groups was less than in control group (P < 0.05). On day 7, corneal avascular area was highest in Group 3 at 63%. On day 14, the area of CNV in Groups 2 and 3 was less than in Group 1 (P = 0.031 and 0.011, respectively), but the difference between Groups 2 and 3 was not statistically significant (P = 0.552). The decreased CNV area on day 14 in Group 4 was significant in comparison to bevacizumab, but it was not significant on day 7 (P = 0.25 on day 7 and 0.002 on day 14). CONCLUSION: Subconjunctival sunitinib malate is more effective than bevacizumab in regressing CNV. This effect is more prominent on day 14.

Evaluation of Corneal Biomechanical Properties in Patients With Thyroid Eye Disease Using Ocular Response Analyzer.

PURPOSE: To assess variations in the corneal biomechanical properties in thyroid eye disease (TED) patients using ocular response analyzer (ORA). PATIENTS AND METHODS: In this observational cross-sectional study, 75 patients with TED and 57 healthy subjects were enrolled. The mean age of the patients and healthy subjects were 47.50±1.55 and 43.6±1.23 years, respectively (P=0.06). All study participants underwent comprehensive ophthalmologic examination, Goldmann applanation tonometry (GAT), corneal pachymetry, and corneal biomechanical analysis using ORA. Corneal hysteresis (CH), corneal resistance factor (CRF), cornea-compensated IOP value (IOPcc), and Goldmann-corrected IOP value (IOPg) were measured with ORA. RESULTS: Central corneal thickness (CCT) in patients group (536.18±36.20 µm) and control group (539.22±28.83 µm) were not significantly different (P=0.1). In TED group, the IOPcc (20.23±0.54 mm Hg) was significantly higher than both IOP-GAT (17.54±0.49 mm Hg, P<0.001) and IOPg (18.35±0.52, P<0.001). CH in TED patients (9.01±0.20) was significantly lower compared with CH in healthy subjects (10.45±0.21) (P<0.001). Although CRF was lower in TED patients (10.06±0.16) in comparison with normal subjects (10.42±0.29), this difference was not statistically significant (P=0.25). Both CH and CRF were positively correlated with CCT (r=0.52, P<0.001 and r=0.62, P<0.001, respectively) in TED group. CONCLUSIONS: In TED patients, CH seems to be lower than in normal subjects. GAT might underestimate the IOP due to differences in corneal properties of cornea in TED patients.

Chlorhexidine Monotherapy with Adjunctive Topical Corticosteroids for Acanthamoeba Keratitis.

PURPOSE: To assess the efficacy of chlorhexidine monotherapy for Acanthamoeba keratitis, and to determine the therapeutic outcomes of concomitant topical corticosteroids. METHODS: In this prospective interventional case series, 31 eyes of 31 patients with Acanthamoeba keratitis (AK) were treated with chlorhexidine 0.02% as monotherapy, from April 2010 to April 2011. The diagnosis of AK was made based on clinical manifestations and positive confocal microscopic (confoscan 3.4, Nidek Co. Ltd., Gamagori, Japan) results. We report the percentage of a favorable clinical response within two weeks of initiating treatment, worsening of the infection while receiving chlorhexidine, recovery of visual acuity (VA), duration of treatment with chlorhexidine and corticosteroids, necessity for addition of other anti-Acanthamoeba agents, presence of corneal scar at the end of the treatment, and need for penetrating keratoplasty (PK). RESULTS: Two weeks after initiation of chlorhexidine, improvement in signs and symptoms was observed in 26 (83.9%) patients but 3 eyes required the addition of propamidine. After initial improvement in one patient, the infection worsened, necessitating the addition of Polyhexamethylene Biguanide (PHMB) and propamidine. A total of 26 (83.9%) patients received topical corticosteroids with mean duration of 65.8 ± 45.1 days. In 22 (71%) eyes, final visual acuity was ≥0.80. Improved VA occurred in 29 eyes (93.5%). Optical PK was considered in 3 (9.7%) eyes and a corneal scar developed in 8 (25.8%) eyes. CONCLUSION: Chlorhexidine is effective for monotherapy in AK and could be a good choice for initiating treatment. After the initial response to anti-Acanthamoeba agents, corticosteroids can be used as adjunctive therapy depending on the clinical condition.