XEN® 45 en el manejo quirúrgico del glaucoma en fases tempranas: estudio nacional de consenso según metodología Delphi / XEN-45 in the management of Early Glaucoma Surgery: A National Delphi Consensus Study

Antecedentes y objetivo: Las recomendaciones sobre el manejo general del glaucoma y el uso de cirugías mínimamente-invasivas y microincisionales en fases tempranas son limitadas. El objetivo de este estudio fue establecer un consenso sobre el manejo del glaucoma, centrándose en el implante XEN 45 (AbbVie Inc., North Chicago, IL, EE. UU.). Métodos: Se utilizó un método Delphi. El comité científico dirigió el estudio, identificó el panel de expertos y participó en la elaboración del cuestionario. Se invitó a 51 expertos a completar, en una escala Likert de 9 puntos, un cuestionario de 89 ítems que cubría 3 bloques temáticos. Se realizaron 2 rondas Delphi. Se logró consenso si≥66,6% de los expertos llegaron a un acuerdo o desacuerdo. Resultados: Los panelistas acordaron 84 ítems relacionados con la calidad de vida, el algoritmo terapéutico y el perfil del paciente, y el manejo quirúrgico pre y postoperatorio. Los panelistas consideraron el implante XEN idóneo para tratar el glaucoma en diferentes etapas y para diferentes perfiles de pacientes: pacientes jóvenes/ancianos/con comorbilidades-significativas, glaucoma-miópico, pacientes con fracaso quirúrgico previo y con postoperatorio complejo. El implante XEN se consideró un paso terapéutico previo a la cirugía filtrante clásica y una posible primera opción quirúrgica en pacientes ancianos con comorbilidades y presión intraocular descontrolada. El implante XEN permite al paciente retomar sus actividades diarias más rápidamente que las cirugías filtrantes convencionales y reducir y/o eliminar los tratamientos tópicos. Conclusiones: Este consenso según la metodología Delphi proporcionó una serie de recomendaciones generales para el tratamiento del glaucoma, incluidas aquellas relacionadas con la calidad de vida del paciente, el algoritmo terapéutico y el perfil del paciente, y específicas con respecto al uso del implante XEN.(AU)

Background and objective: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. Methods: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results: Panelists agreed on 84 items related to the patients’ quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. Conclusions: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.(AU)

XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study.

BACKGROUND AND OBJECTIVE: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. METHODS: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. RESULTS: Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. CONCLUSIONS: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.

Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life.

PURPOSE: To evaluate the inner retinal layers in fibromyalgia (FM) patients compared to control subjects using posterior pole protocol (PPole) analysis in optical coherence tomography (OCT) and to correlate structural retinal changes with subjective quality of life. METHODS: Seventy-four eyes of healthy subjects and 55 eyes of those with FM were analyzed. All subjects underwent retinal evaluation using the PPole protocol for Spectralis OCT (Heidelberg Engineering) to obtain measurements of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) in the macular area. The EuroQol (EQ-5D) questionnaire and Fibromyalgia Impact Questionnaire (FIQ) were performed to analyze health-related quality of life. Additionally, the FM group was divided into three groups depending on the disease phenotype (atypical, depressive, and biological). RESULTS: Patients with FM presented with a reduction of the RNFL thickness compared to controls in 17/64 cells of the PPole area, and a reduction of the GCL thickness in 47/64 cells. Depressive FM phenotype showed the greatest number of cells with significant reduction compared with the control group in both RNFL and GCL layers. A correlation between temporal-inferior cells of the GCL and the EuroQol 5D questionnaire results was observed. CONCLUSIONS: Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients.

Visual dysfunction and its correlation with retinal changes in patients with Alzheimer's disease.

AimTo evaluate visual dysfunction and its correlation with structural changes in the retina in patients with Alzheimer's disease (AD).MethodsPatients with AD (n=24) and controls (n=24) underwent evaluation of visual acuity (VA), color vision (using the Farnsworth and L'Anthony desaturated (D) 15 color tests), and contrast sensitivity vision (CSV; using the Pelli-Robson chart and CSV-1000E test) to measure visual dysfunction. Structural measurements of the retinal nerve fiber layer (RNFL) and macular thickness were obtained using spectral domain-optical coherence tomography (SD-OCT).ResultsCSV at three of the four spatial frequencies was significantly worse in AD patients than in controls. Color vision was significantly affected in AD patients based on the Farnsworth color test. Compared with controls, macular thinning was detected in all sectors except the fovea, and the RNFL exhibited significant thinning in the superior quadrant and lower average thickness (P<0.05). CSV was the functional parameter most strongly correlated with structural measurements in patients with AD. Color vision was strongly associated with macular volume (r>0.70, P<0.05). VA at different levels of contrast was associated with macular and RNFL thickness.ConclusionsPatients with AD had visual dysfunction that correlated with structural changes evaluated by SD-OCT. Macular measurements may be reliable indicators of visual impairment in AD patients.

Visual dysfunction and its correlation with retinal changes in patients with Parkinson's disease: an observational cross-sectional study.

OBJECTIVES: To evaluate visual dysfunction and its correlation with structural changes in the retina in patients with Parkinson's disease (PD). METHODS: Patients with PD (n=37) and controls (n=37) were included in an observational cross-sectional study, and underwent visual acuity (VA), colour vision (using the Farnsworth and Lanthony desaturated D15 colour tests) and contrast sensitivity vision (CSV; using the Pelli-Robson chart and CSV 1000E test) evaluation to measure visual dysfunction. Structural measurements of the retinal nerve fibre layer (RNFL), and macular and ganglion cell layer (GCL) thicknesses, were obtained using spectral domain optical coherence tomography (SD-OCT). Comparison of obtained data, and correlation analysis between functional and structural results were performed. RESULTS: VA (in all different contrast levels) and all CSV spatial frequencies were significantly worse in patients with PD than in controls. Colour vision was significantly affected based on the Lanthony colour test. Significant GCL loss was observed in the minimum GCL+inner plexiform layer. A clear tendency towards a reduction in several macular sectors (central, outer inferior, outer temporal and superior (inner and outer)) and in the temporal quadrant of the RNFL thickness was observed, although the difference was not significant. CSV was the functional parameter most strongly correlated with structural measurements in PD. Colour vision was associated with most GCL measurements. Macular thickness was strongly correlated with macular volume and functional parameters (r>0.70, p<0.05). CONCLUSIONS: Patients with PD had visual dysfunction that correlated with structural changes evaluated by SD-OCT. GCL measurements may be reliable indicators of visual impairment in patients with PD.

Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software.

PURPOSE: We measured the amount of hemoglobin at the optic nerve head of fibromyalgia (FM) patients using new colorimetric analysis software. We also investigated whether perfusion defects of the optic nerve head in patients with FM lead to tissue atrophy and corresponding retinal nerve fiber layer (RNFL) thinning measured by optical coherence tomography (OCT). METHODS: We recruited for this cross-sectional study 118 FM patients and 76 sex- and age-matched healthy controls. All subjects underwent a complete neuro-ophthalmologic examination, which also included visual field testing using the Spark strategy in an Easyfield perimeter, and OCT examinations using the Spectralis. One photograph of the optic disc was obtained using a Cirrus™ Photo 800 multi-modality imager. We analyzed fundus photographs using Laguna ONhE software, a new method that allows hemoglobin levels to be measured at the optic nerve head. We compared hemoglobin percentages in different sectors of the nerve head and RNFL thicknesses between the two groups. RESULTS: Mean hemoglobin percentages and hemoglobin content in all optic nerve head sectors calculated by the Laguna ONhE program were significantly lower in FM patients than in healthy controls, and the main differences were detected in the outer ring, which corresponds with the neuroretinal rim. However, only the differences in the superotemporal RNFL were statistically significant. Correlations between the RNFL thickness and the percentage of hemoglobin in the different sectors were weak. CONCLUSION: Optic disc perfusion was decreased in patients with FM, especially within the neuroretinal rim, without clear involvement in the RNFL.

Reliability and validity of Cirrus and Spectralis optical coherence tomography for detecting retinal atrophy in Alzheimer's disease.

BACKGROUND: To evaluate and compare the ability of two Fourier-domain optical coherence tomography (OCT) devices to detect retinal and retinal nerve fibre layer (RNFL) atrophy in patients with Alzheimer's disease (AD) compared with healthy subjects; to test the intra-session reliability of two OCT devices in AD patients and healthy subjects. METHODS: AD patients (n=75) and age-matched healthy subjects (n=75) underwent three Macular Cube 200 × 200 protocols using the Cirrus and Spectralis OCT devices and three 360° circular scans centred on the optic disc using the Cirrus OCT device, the classic glaucoma application, and the new Nsite Axonal Analytics application of the Spectralis OCT instrument. Differences between healthy and AD eyes were compared, and measurements provided by each OCT protocol were compared. Reliability was measured using intraclass correlation coefficients and coefficients of variation. Correlations between OCT measurements and disease duration and severity were also analysed. RESULTS: Retinal thinning was observed in AD eyes in all areas except the fovea using both OCT devices. RNFL atrophy was detected in AD eyes with all three protocols, but the Nsite Axonal application was the most sensitive. Measurements by the two OCT devices were correlated, but differed significantly. Reliability was good using all protocols, but better with the glaucoma application of Spectralis. Mean RNFL thickness provided by the Nsite Axonal application correlated with disease duration. CONCLUSIONS: Fourier-domain OCT is a valid and reliable technique for detecting subclinical RNFL and retinal atrophy in AD, especially using the Nsite Axonal application. RNFL thickness decreased with disease duration.

[Finding of retinal nerve fiber layer hypertrophy in ataxia of Charlevoix-Saguenay patients]. / Hallazgo de hipertrofia de la capa de fibras nerviosas de la retina en pacientes con ataxia de Charlevoix-Saguenay.

PURPOSE/METHODS: To present the neuro-ophthalmology examination in 5 spastic ataxia of Charlevoix-Saguenay (ARSACS) patients showing significant increases in retinal nerve fiber layer (RNFL) thickness. RESULTS/CONCLUSIONS: All patients showed abnormal visual fields, normal optic discs with increased visibility of RNFL in color stereo-photographs, normal examination with Heidelberg Retina Tomography instrument, and moderate to markedly increased RNFL thickness in Cirrus Optical Coherence Tomography evaluation (average thickness: 119 to 220 microns). We found evidence that RNFL hypertrophy may be an alternative funduscopic finding to the hypermyelinated retinal fibers in previous reports. A revision of ARSACS diagnostic criteria, particularly with regard to retinal alterations, is necessary.

[Functional relationship between retinal sensitivity threshold values assessed by standard automated perimetry in glaucoma]. / Relación funcional entre los puntos de sensibilidad retiniana de la perimetría automatizada en el glaucoma.

OBJECTIVE: To study the correlation between the sensitivity threshold values of the different points assessed by the Humphrey visual field analyzer (24-2 Swedish interactive threshold algorithm [SITA] standard strategy) in glaucoma patients. SUBJECTS, MATERIAL AND METHODS: Prospective cross-sectorial study. One-hundred and four eyes of 104 glaucoma patients, defined by the appearance of the optic nerve head, were evaluated. Retinal threshold sensitivity points of standard automated perimetry (SA) with SITA standard 24-2 program were obtained. The upper and the lower hemifields were studied separately. Pearson correlation coefficients were calculated between the mean threshold sensitivity value at each point of the visual hemifield and the rest of the threshold points in the same hemifield. RESULTS: Perimetric correlation maps between retinal threshold sensitivity values in the same hemifield were obtained. Most of the points showed moderate to high correlations (r≥0.65. P<0.001) with neighboring points and distant points in the same hemifield. CONCLUSIONS: There is a functional relationship between neighboring and distant points in Humphrey Visual Field Analyzer (SITA Standard 24-2) in glaucoma patients. This correlation is related to the anatomical arrangement of ganglion cell axons. This fact enables perimetric patterns of glaucoma defects to be obtained.

Three-dimensional geometries representing the retinal nerve fiber layer in multiple sclerosis, optic neuritis, and healthy eyes.

BACKGROUND: To represent and interpret the three-dimensional (3D) geometry and the distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON). METHODS: MS patients (n = 122) and age-matched healthy subjects (n = 108) were enrolled. The Spectralis optical coherence tomography system was used to determine the circumpapillary RNFL thickness. The 768 RNFL thickness measurements were used to evaluate thickness measurements in patients with or without antecedent ON and to design a 3D reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes. RESULTS: RNFL thickness was decreased in MS patients, and was higher in the MS group with previous ON. Statistical analysis and 3D RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area (101.77 µm in MS vs. 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in MS eyes and 149.26 µm in healthy eyes). CONCLUSIONS: The 3D representation of RNFL thickness based on measurements allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.

[Relationship between standard automated perimetry and retinal nerve fiber layer parameters measured with laser polarimetry]. / Relación entre la perimetría automatizada convencional y los parámetros de la capa de fibras nerviosas de la retina obtenidos con la polarimetría láser.

PURPOSE: To determine the relationship between the structural parameters of the retinal nerve fiber layer (RNFL) obtained by using the scanning laser polarimetry with variable corneal compensation (GDx VCC) and the results of standard automated perimetry (SAP), in normal, ocular hypertensive, preperimetric glaucomas and glaucoma subjects. METHODS: A total of 423 eyes of 423 consecutive subjects were prospectively included in the study and classified depending on the basal intraocular pressure, optic nerve head appearance and SAP results into four groups: 87 normal eyes, 192 ocular hypertensive eyes, 70 preperimetric glaucomas and 74 glaucomatous eyes. Pearson's correlation coefficients, between mean deviation (MD), pattern standard deviation, number of points altered in each quadrant, and number of points altered at different probability levels of SAP and structural parameters of RNFL obtained by using GDx VCC, were calculated in the different diagnostic groups. In the glaucoma group correlations between the 52 points tested by 24- 2 SITA standard and GDx parameters were also calculated. Regression curves were plotted for the strongest correlations. RESULTS: Weak or non-significant correlations were found in the normal, ocular hypertensive and preperimetric glaucoma groups. However, the glaucoma group presented weak to moderate correlations between several GDx VCC parameters and the SAP variables analysed. The strongest correlation was observed between the standard deviation TSNIT and the MD (0.460). CONCLUSIONS: RNFL parameters measured with the GDx VCC presented weak to moderate correlations with the visual field indices and the number of altered points in the glaucoma group.

Performance of GDx and HRT in the Finnish Evidence-Based Guideline for Open-Angle Glaucoma.

AIM: To compare the performance of Heidelberg retina tomograph (HRT) and scanning laser polarimetry (GDx) with photographic evaluation of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in the application of the Finnish Evidence-Based Guideline for Open-Angle Glaucoma. METHODS: A total of 41 control participants and 312 patients referred for glaucoma evaluation were included in the study. All the participants underwent ophthalmic evaluation, ONH stereophotography, monochromatic RNFL photography, HRT, optical coherence tomography, and GDx evaluation. Participants were classified on the basis of stereophotographic or imaging device results based by applying the Finnish Guideline. RESULTS: Agreement between the stereophotographic evaluation and that on the basis of the imaging devices was 52.9%. Classification of patients with similar management advice on the basis of these evaluations had 56.4% agreement. The specificity of the Finnish guideline for detecting normal patients was 78% (stereophotography) and 83% (imaging devices). Optic disc size interfered with the diagnosis in patients evaluated using the HRT3 glaucoma probability score. Structural changes were more frequently detected before functional changes. CONCLUSION: The Finnish Evidence-Based Guideline for Open-Angle Glaucoma is useful for classifying normal participants and patients with suspected glaucoma or glaucoma through either conventional stereophotographic evaluation of the neuroretinal structures or with the new imaging devices.

[Relationship between standard automated perimetry and optic nerve head topography performed with the Heidelberg Retina Tomograph]. / Relación entre la perimetría automatizada convencional y la topografía papilar realizada con el Tomógrafo Heidelberg.

PURPOSE: To determine the correlations between optic nerve head (ONH) parameters measured with the Heidelberg Retina Tomograph (HRT), and the main outcomes of standard automated perimetry (SAP) in normal, ocular hypertensive, glaucoma suspects and glaucomatous subjects. METHODS: Four hundred and twenty-three patients were enrolled in the study and classified into four groups depending on baseline intraocular pressure, optic nerve head morphology, and SAP results: 87 normal eyes, 192 ocular hypertensive eyes, 70 glaucoma suspects and 74 glaucomatous eyes. In the different diagnostic groups, Pearson's correlation coefficients were calculated between ONH parameters and mean deviation, pattern standard deviation (PSD), number of altered points in each quadrant of the visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number of points altered at different probability levels, and threshold values at each point of SAP. RESULTS: In the normal and ocular hypertensive groups, only a few weak correlations were found between HRT and SAP parameters. The strength and number of significant correlations increased in the suspected glaucoma group. The glaucoma group had the strongest correlations, particularly between cup/disc ratio and rim/disc ratio with MD (r=0.479) and between rim area and PSD (r=0.444). CONCLUSIONS: Weak to moderate correlations were found between some ONH parameters obtained with the HRT and SAP results in the glaucoma group.

[Optic nerve head parameters as measured by confocal scanning laser (Heidelberg Retina Tomograph II) in normal, ocular hypertensive and glaucomatous subjects]. / Estudio de los parámetros de la cabeza del nervio óptico en sujetos normales, hipertensos oculares y glaucomatosos obtenidos mediante láser confocal de barrido (Heidelberg Retina Tomograph II).

PURPOSE: To compare the optic nerve parameters measured by confocal scanning laser in normal, ocular hypertensive and glaucomatous eyes; and in groups of ocular hypertensive eyes, classification of these according to the optic nerve appearance and to short-wavelength automated perimetry (SWAP) results. METHODS: 101 eyes of 101 normal subjects, 247 eyes of 247 ocular hypertensive subjects and 102 eyes of 102 glaucomatous subjects were studied. Subjects were classified based on intraocular pressure and standard automated perimetry (AP) performance. Hypertensive subjects were classified into ocular hypertensive and preperimetric glaucoma, and into ocular hypertensive with normal SWAP and hypertensive with pathological SWAP findings. Every patient underwent evaluation of the optic nerve, AP, SWAP and confocal scanning laser ophthalmoscopy (HRT II), resulting in the acquisition of topographic parameters of the optic nerve, which were then compared between the different groups. RESULTS: Significant differences (p<0.05) were found between normal subjects and glaucomatous eyes in all optic nerve parameters except disc area (2.23/2.1), height variation contour (0.41/0.39) and average variability (0.05/0.04). Ocular hypertensive eyes showed an overlap when compared with normal and glaucoma groups. No differences were found between normal subjects and those with ocular hypertension in mean retinal nerve fiber layer thickness (0.24/0.24) or between those with ocular hypertension and glaucoma in mean cup depth (0.28/0.3). Nevertheless, when those with ocular hypertension were segregated based on clinical evaluation of optic nerve or SWAP performance, the ability to define the presence of structural glaucoma damage improved significantly. CONCLUSIONS: HRT enables moderate discrimination between normal, ocular hypertensive and glaucoma subjects. The use of diagnostic tests to detect early glaucomatous damage (such as short-wavelength automated perimetry) in ocular hypertensive eyes improves the ability of HRT to discriminate glaucoma.

[Evaluation of four new discriminant functions for HRT II in glaucoma diagnosis]. / Evaluación de cuatro nuevas funciones discriminantes del HRT II para el diagnóstico del glaucoma.

PURPOSE: To assess the diagnostic usefulness of four linear discriminant functions for Heidelberg retina tomograph (HRT) II obtained in our population. METHODS: 450 eyes of 450 patients were studied. Eyes were classified as those of healthy subjects (101), those with ocular hypertension (126), those suspected to have glaucoma (121) or those with glaucoma (103). Intraocular pressure, optic nerve head appearance in stereophotographs, and standard automated perimetry results were assessed. ANOVAs among the groups were calculated for all global parameters and the 4 formulas. Receiver operating characteristic (ROC) curves were plotted for the 4 multivariate functions designed in our hospital and the areas under the ROC curves were compared. Sensitivity at 80% and 90% fixed specificities were also calculated. RESULTS: All functions discriminated well between healthy and glaucoma suspects, and between healthy and glaucomatous eyes. At 90% fixed specificity, sensitivities ranged from 54% to 60% in differentiating between healthy and glaucoma suspects, and from 65% to 68% in discriminating between control and glaucoma subjects. No differences were found between the areas under the ROC curves of these functions. CONCLUSIONS: The evaluated linear discriminant functions increased the diagnostic ability of HRT II isolated parameters in detecting glaucoma. These functions performed better than the HRT-provided discriminant functions.

[Diagnostic ability of GDx VCC for glaucoma diagnosis]. / Capacidad diagnóstica del GDx VCC para el diagnóstico del glaucoma.

PURPOSE: To assess the diagnostic ability of scanning laser polarimetry (GDx VCC) to differentiate between normal and glaucomatous eyes. METHODS: 417 eyes of 417 consecutive subjects were prospectively selected. They were classified into 60 healthy controls, 218 ocular hypertensive eyes, 68 glaucoma suspects, and 71 glaucomatous eyes, depending on intraocular pressure, optic nerve head morphology and standard automated perimetry results. All underwent a scanning laser polarimetry with the GDx VCC. Retinal nerve fiber layer (RNFL) parameters of the GDx-VCC were compared among the four groups. Receiver operating characteristic (ROC) curves were plotted between normal and glaucomatous eyes. The best parameters were defined according to the area under the ROC curve and the best sensitivity/specificity balance. RESULTS: Most parameters of GDx-VCC exhibited differences between the glaucoma group and the rest of the groups. Some parameters were also different between healthy patients and glaucoma suspects. The best parameter was the nerve fiber indicator (NFI; area under the ROC curve: 0.876). NFI, superior normalized area, and inferior normalized area yielded the highest sensitivities at 85% and 90% fixed specificity. CONCLUSIONS: Most RNFL parameters measured with the GDx-VCC provided good diagnostic ability for open-angle glaucoma. The best GDx-VCC parameter in differentiating between normal and glaucomatous eyes was the NFI.

[Importance of central corneal thickness when studying ocular hypertensive eyes, glaucoma suspects and preperimetric glaucomatous eyes]. / Importancia del espesor corneal central en el estudio de hipertensos oculares, sospechosos de glaucoma y glaucomas preperimétricos.

PURPOSE: To compare the central corneal thickness, measured with an ultrasound pachymeter, in normal subjects, those with ocular hypertension, glaucoma suspects and patients with preperimetric glaucoma. METHODS: 61 normal eyes (control group), 131 eyes with ocular hypertension, 62 glaucoma suspects (optic nerve head morphology compatible with glaucoma) and 36 patients with preperimetric glaucoma (abnormal short-wavelength automated perimetry) were prospectively and consecutively selected. Scatter plots of central corneal thickness, against the intraocular pressure values were calculated for each of the study groups. Ultrasound pachymetry measurements were compared between those with normal eyes and the other groups. RESULTS: Ocular hypertensive subjects had higher pachymetry values than the control group (p=0.009). No differences were found in the central corneal thickness between normal eyes and those who were glaucoma suspects, and between normal and preperimetric glaucomatous eyes. A mild direct logarithmic correlation was evident between central corneal thickness and the Goldmann tonometry result in the ocular hypertensive group. CONCLUSIONS: Ocular hypertensive subjects had thicker corneas than the other groups studied. Glaucoma suspects and preperimetric glaucoma patients had similar corneal thickness to the control group.

[Correlation between standard automated perimetry global indices and Heidelberg Retina Tomograph II parameters]. / Correlación entre los índices globales de la perimetría automatizada convencional y los parámetros topográficos papilares (Heidelberg Retina Tomograph II).

PURPOSE: To correlate the optic nerve head topographic parameters measured by the Heidelberg Retina Tomograph II (HRT) with the perimetric indices of standard automated perimetry (SAP). METHODS: This study included 101 normal subjects, 247 ocular hypertensive eyes (increased intraocular pressure with normal SAP) and 102 glaucomatous subjects (IOP above 21 mm Hg and abnormal standard automated perimetry). Only one eye was randomly chosen from each subject for the study. The visual field was evaluated by means of Humphrey Field Analyzer (24-2 full threshold strategy). The HRT II (Heidelberg Engineering) was used to acquire and measure the optic disc topographic parameters. Pearson correlations between topographic data and perimetric indices were performed for the total sample and each group of patients. The distribution of values obtained in the samples was normal. RESULTS: A significant correlation was found between several optic disc parameters and the global indices of SAP. Rim area, rim volume, cup/disc area ratio, rim/disc area ratio, cup shape measurement, RNFL cross-sectional area, and discriminant functions FSM and RB, showed the strongest correlation with the visual field indices in the total and glaucoma groups (RIM AREA: total group: r=0.32; p=4.14x10(-11)/glaucoma group: r=0.28; p=0.004. RIM VOLUME: total group: r=0.26; p=1.55x10(-7)/glaucoma group: r=0.26; p=0.006). The ocular hypertensive group showed few significant correlations. CONCLUSIONS: The correlations found between standard automated perimetry and HRT defined topographic parameters allow a better understanding of glaucomatous damage and make decision-making easier.