Longitudinal changes in optical coherence tomography angiography characteristics in normal-tension glaucoma with or without high myopia.

PURPOSE: To evaluate the structural, microvascular, and functional progression of normal tension glaucoma (NTG) with or without high myopia by examining longitudinal changes in optical coherence tomography angiography (OCTA) and visual field (VF) parameters. METHODS: We evaluated 61 NTG eyes and classified 25 of the eyes with axial lengths (ALs) of ≥26 mm as highly myopic. We assessed the rate of change in OCTA parameters, namely radial peripapillary capillary (RPC) vessel density (VD), parafovea VD, deep parafovea VD, retinal nerve fibre layer (RNFL) thickness, and ganglion cell complex thickness. We evaluated the correlation of the rate of change in OCTA parameters with VF loss and AL. RESULTS: Among the 61 NTG eyes, rates of loss of RPC VD, parafovea VD, deep parafovea VD, and RNFL thickness were significantly different from zero despite the nonsignificant rate of change in VF mean deviation (MD). Changes in these OCTA parameters did not differ significantly in highly myopic NTG eyes. The rate of change in VF MD was significantly correlated with the rate of change in parafovea VD in highly myopic and non-highly myopic NTG eyes. In highly myopic NTG eyes, AL was negatively correlated with the rates of loss of RNFL thickness, VF MD, and VF PSD. CONCLUSION: NTG eyes with a relatively stable VF exhibited loss of VD and RNFL thickness. VF progression in NTG was correlated with decreasing parafovea VD, indicating a structure-function correlation. Greater AL may indicate faster VF loss and RNFL thinning in highly myopic NTG eyes.

Retina-TransNet: A Gradient-Guided Few-Shot Retinal Vessel Segmentation Net.

Due to the high labor cost of physicians, it is difficult to collect a rich amount of manually-labeled medical images for developing learning-based computer-aided diagnosis (CADx) systems or segmentation algorithms. To tackle this issue, we reshape the image segmentation task as an image-to-image (I2I) translation problem and propose a retinal vascular segmentation network, which can achieve good cross-domain generalizability even with a small amount of training data. We devise primarily two components to facilitate this I2I-based segmentation method. The first is the constraints provided by the proposed gradient-vector-flow (GVF) loss, and, the second is a two-stage Unet (2Unet) generator with a skip connection. This configuration makes 2Unet's first-stage play a role similar to conventional Unet, but forces 2Unet's second stage to learn to be a refinement module. Extensive experiments show that by re-casting retinal vessel segmentation as an image-to-image translation problem, our I2I translator-based segmentation subnetwork achieves better cross-domain generalizability than existing segmentation methods. Our model, trained on one dataset, e.g., DRIVE, can produce segmentation results stably on datasets of other domains, e.g., CHASE-DB1, STARE, HRF, and DIARETDB1, even in low-shot circumstances.

Longitudinal follow-up of pediatric Graves' disease in preschool children: Clinical characteristics and a case report.

RATIONALE: Pediatric Graves' disease at preschool age is a rare condition. Previous reports have indicated that adolescents with this disease are girls. Pediatric Graves' ophthalmopathy in young children is rare, and long-term follow-up reports are lacking. PATIENT CONCERNS: The patient had hyperthyroidism and bilateral proptosis for 2 years, but she was only 4 years old. DIAGNOSES: The blood test revealed hyperthyroidism and the ophthalmic examination revealed proptosis. The patient had Graves' disease and Graves' ophthalmopathy. INTERVENTIONS: Initially, she was followed up in the pediatric department. Bilateral proptosis developed, and she was brought to the ophthalmology department for assistance. Orbital computed tomography revealed borderline enlargement of the extraocular muscles bilaterally. Other initial clinical findings included bilateral upper and lower eyelid trichiasis and mild punctate epithelial erosions of the cornea. She received conservative medical treatment in the ophthalmology department. OUTCOMES: Remission of hyperthyroidism was achieved 2 years after medical control. No elevated intraocular pressure, strabismus, or optic neuropathy developed during follow-up. Significant cosmetic improvement and gradual resolution of punctate epithelial erosions were found over 10 years. Finally, the patient had only mild bilateral lower trichiasis. LESSONS: Longitudinal follow-up revealed that the ocular manifestations of proptosis and eyelid trichiasis may have good outcomes. Proptosis gradually improved as the patient grew up.

Association of Intraocular Pressure and Optical Coherence Tomography Angiography Parameters in Early Glaucoma Treatment.

This prospective study aimed to explore the effect of medical intraocular pressure (IOP) reduction on structural and capillary vessel density (VD) change by optical coherence tomography (OCT) angiography in early glaucoma. Patients with newly diagnosed glaucoma and a follow-up of ≥6 months were enrolled. An ocular examination that included slit-lamp bio-microscopy, pneumatic tonometry, gonioscopy, standard automated perimetry, and OCT angiography was performed. Quantitative OCT angiography parameters were assessed using a linear mixed model that was adjusted for inter-eye correlation. The correlations between IOP changes and OCT angiography parameter changes were analyzed using Spearman's correlation test. In total, 52 eyes of 36 participants, including 33 glaucoma eyes of 17 participants and 19 healthy eyes of 19 participants served as the case and control groups, respectively. The IOP of the case group decreased from a baseline mean of 20.4 ± 0.8 mmHg to 15.7 ± 0.5 mmHg at 3 months (p < 0.001) and to 16.1 ± 0.5 mmHg at 6 months (p < 0.001). For the subgroup with an IOP reduction of >20%, the deep macula VD was negatively correlated with baseline IOP and significantly decreased at 3 months follow-up. Additionally, change in retinal nerve fiber layer (RNFL) was positively correlated with a change in IOP at 6 months. In conclusion, the deep-layer macula VD was correlated with baseline IOP and influenced by the reduction in IOP in the short term. The changes in VD revealed the vulnerability of the deep vascular complex. The OCTA parameters provide in vivo monitoring information during medical treatment for early glaucoma.

Pseudomonas keratitis complicated with spontaneous expulsive suprachoroidal hemorrhage: A case report.

INTRODUCTION: Spontaneous expulsive suprachoroidal hemorrhage (SESCH) is a rare condition. The correlation between SESCH and chronic glaucoma has been reported previously. However, few reports have indicated a correlation between infective keratitis and SESCHs. PATIENT CONCERNS: Here, we report the case of an 82-year-old woman with a corneal ulcer who presented with left eye pain for 6 days. DIAGNOSIS: We found that she has Pseudomonas keratitis and history of chronic glaucoma. INTERVENTIONS AND OUTCOMES: During admission, her left eye showed elevated intraocular pressure (IOP). Three days later, the eyeball began to bleed and became painful. She had high blood pressure on that day. Hours after complaints of eye pain, intraocular tissue exposure related to eyeball rupture, and SESCH. The patient underwent evisceration and insertion of a silicone ball for the socket reconstruction. Histopathological evaluation revealed acute inflammation of the cornea and the choroidal vessels. CONCLUSION: In elderly patients with infective keratitis and a history of glaucoma and hypertension, it is important to control intraocular pressure and blood pressure and pay attention to the risk of spontaneous expulsive suprachoroidal hemorrhage.

Efficacy of modified levator-muscle resection using Putterman ptosis clamp versus traditional levator-muscle resection for aponeurotic ptosis: A retrospective analysis.

BACKGROUND/OBJECTIVES: In recent years, a modified levator muscle resection using Putterman ptosis clamp was developed. We used a retrospective case-control study to compare the effects of the modified and traditional levator muscle resection methods. METHODS: Patients with moderate-to-severe ptosis who underwent the traditional or modified method for levator muscle resection were divided into two groups: Group I received the traditional method in 2013 and Group II received the modified method using Putterman clamp in 2015. During each postoperative visit, in addition to imaging, changes in the margin reflex distance 1 (MRD 1), and adverse events were recorded. Surgical time and final result in the last follow-up were recorded. RESULTS: Group I had 35 patients (54 eyes) and Group II had 33 patients (59 eyes). After the surgery, the MRD 1 in both groups was significantly improved at 1 week and at the final visit compared to baseline. Significant differences were observed in MRD 1 change at 1-week post-operation and the change at the final visit and the surgical time between Groups I and II (P < 0.05). Group II had a shorter surgical time than Group I. Compared with Group I (20.37%), the revision rate was lower in Group II (10.16%). CONCLUSIONS: The modified levator muscle resection using Putterman ptosis clamp and traditional levator muscle resection can both improve ptosis. Comparison results showed that using Putterman ptosis clamp assisted in levator muscle surgery had shorter operation time, faster postoperative recovery, and lower revision rate than the traditional method. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Outcomes in patients with lacrimal gland carcinoma treated with definitive radiotherapy or eye-sparing surgery followed by adjuvant radiotherapy.

BACKGROUND: The optimal treatment for lacrimal gland cancer remains unclear. Eye-preserving surgery, as opposed to exenteration, followed by adjuvant radiotherapy (RT), has recently been reported to deliver satisfactory outcomes, but evidence is sparse. The aim of the present study was to evaluate outcomes in patients with lacrimal gland cancer treated at two tertiary medical centers. METHODS: We retrospectively examined data from patients with lacrimal gland cancer who had received eye-preserving surgical treatment followed by adjuvant RT with or without chemotherapy, or (if the tumor was inoperable) needle biopsy with definitive RT with or without chemotherapy. Baseline clinical and pathological characteristics were considered. Outcomes of interest included post-treatment complications, overall survival (OS), locoregional progression-free survival (LPFS), and distant metastasis-free survival (DMFS). RESULTS: Eighteen patients were included. Two-year OS, LPFS, and DMFS rates were 69.0, 76.7, and 71.4%, respectively. Patients with early-stage (T1-T2) lacrimal gland cancer had significantly better outcomes than those with advanced-stage disease (T3-T4). Two-year OS, LPFS, and DMFS rates were each 100% in patients with disease stages T1-T2, and 37.5, 50, and 37.5%, respectively, in those with disease stages T3-T4 (P < 0.05). Orbital complications were well tolerated. CONCLUSIONS: Eye-sparing surgery with adjuvant RT can achieve satisfactory results in patients with T1-T2 lacrimal gland carcinoma. Disease stage T3 and above was associated with poor outcomes even with post-operative RT, likely due to distant metastasis. Adding neoadjuvant chemotherapy or adjuvant chemotherapy to current treatment strategies might be a suitable choice for this group of patients.

Modified Levator Muscle Resection Using Putterman Muller's Muscle-Conjunctival Resection-Ptosis Clamp.

BACKGROUND: The traditional technique for levator muscle resection includes a time-consuming dissection procedure that causes tissue trauma and swelling. The Putterman ptosis clamp has been popularly used in recent years for conjunctival müllerectomy. In this paper, we describe a modified surgical technique for ptosis treatment using the Putterman ptosis clamp. The modified technique improves the surgical results of levator muscle resection. OBJECTIVES: We performed a retrospective case-series study to determine the outcomes and complications associated with the use of the Putterman ptosis clamp in levator muscle resection. METHODS: Adults aged ≥18 years with moderate-to-severe ptosis underwent the modified technique for levator muscle resection. We first performed dissection to expose the aponeurosis and tarsus. Then, we placed the Putterman ptosis clamp to measure redundant aponeurotic and septal tissues and to perform the resection. Following the adjustment of the eyelid fissure, we refixed the levator muscle to the tarsus with 4-0 vicryl stitches. RESULTS: Seventeen patients (34 eyes) were included in the study. Of the 34 eyes, 31 (91.2%) experienced the complete resolution of ptosis after the surgery. One patient (2 eyes, 5.9%) had mild bilateral dermatochalasis and received revision surgery 6 months postoperative. One patient (1 eye, 2.9%) lost the crease of the left eye and received revision surgeries 2 and 6 months after the first surgery. No residual ptosis or severe adverse events were noted in the patients. CONCLUSIONS: Modified levator muscle resection using the Putterman ptosis clamp is an effective procedure for ptosis treatment.

Management of Senile Ptosis with Levator Muscle Resection Using the Putterman Clamp.

Putterman clamp, a muscle clamp, is commonly used in conjunctival müllerectomies. We report 3 cases of senile ptosis repaired with levator muscle resection using the Putterman clamp. The redundant levator aponeurosis was removed with electrocautery after clamping with the Putterman clamp. The levator muscle was refixed to the tarsus with three 4-0 Vicryl stitches after adjusting the height of the eyelid fissure. No intraoperative difficulties were encountered. Ecchymosis and edema were limited in the immediate postoperative period. No complications were noted during the follow-up. The benefits of using the Putterman clamp in levator muscle resection are illustrated in these cases.

Correction of involutional entropion with retractor redirection.

The study aims to report the surgical outcome of a retractor redirection procedure for involutional entropion repair for Asians. The study included all cases diagnosed with involutional entropion and significant ocular irritation who presented from 2008 to 2012. Sixty-seven eyelids in 54 patients were included in this study. All cases were operated on by one surgeon and had a minimum of 12-months follow-up. Success was defined as cases showing no recurrence of entropion with forceful eyelid squeezing postoperatively. A retrospective chart review was performed to assess the success rate, recurrences and complications of the procedure. During a mean follow-up period of 26.2 months (range, 12-53 months), 5 patients died during the study period. Two eyelids (3%) of one patient had a recurrence at 34 months postoperatively. One eyelid (1.5%) with a significant horizontal laxity developed postoperative ectropion and required a secondary horizontal shortening procedure. No other postoperative complications or dissatisfaction were reported. The retractor redirection procedure aims to repair the retractors and prevent orbicularis muscle overriding via inserting the retractors to the anterior lamellae. It yields a long-term success rate of 95.5% and is an effective technique for correcting involutional entropion.

Contact dermatitis on the lower eyelid related to tick infestation: A case report in Taiwan.

Tick bite on the lower eyelid is a rare condition. We reported a case of contact dermatitis on the lower eyelid related to the tick infestation. Ticks are vectors for disease transmission. Symptoms and treatments for tick-borne diseases were reviewed.

Correlation between myopic ametropia and stereoacuity in school-aged children in Taiwan.

PURPOSE: To investigate the correlation between stereoacuity, as analyzed by the Titmus stereotest, and the severity of myopia, astigmatism and anisometropia in a school-aged population in Taiwan. METHODS: Cycloplegic autorefraction, best corrected monocular visual acuity and stereoacuity were measured in 6- to 18-year-old school children. Children with amblyopia (best corrected visual acuity of <20/25) or strabismus were excluded from this study. The correlation between stereoacuity and the severity of myopia, astigmatism and anisometropia was analyzed by the Titmus stereotest. RESULTS: A total of 166 children (95 boys, 71 girls; mean age 10.75 years, range 6-18 years) with myopia or astigmatism were enrolled in the study. The mean spherical error was -2.22 ± 1.70 diopters (D) (range -0.25 to -9.50 D), and the mean astigmatism was -0.72 ± 0.89 (range 0 to -4.50) D. An anisometropia of >1.00 D and spherical anisometropia of >1.00 D were strongly associated with decreased stereoacuity on the Titmus stereotest (P < 0.001). Astigmatism was also correlated with the performance of stereopsis (P = 0.013). CONCLUSION: Anisometropia (>1.00 D), spherical anisometropia (>1.00 D), and astigmatism were associated with reduced stereoacuity in school-aged children.

Therapeutic penetrating keratoplasty in severe infective keratitis using glycerol-preserved donor corneas.

PURPOSE: To report the surgical outcome of therapeutic penetrating keratoplasty (TPKP) using glycerol-preserved donor corneas in severe infective keratitis. METHODS: Glycerol-preserved corneas were obtained from the recipient corneas of the patients who underwent optical penetrating keratoplasty and preserved in glycerol. Eight eyes of 8 patients (3 men/5 women; average age, 69.7 years) with severe corneal ulcer with perforation were treated with TPKP using glycerol-preserved corneas. RESULTS: With a mean follow-up time of 31.1 months (range, 9-58 months), satisfactory anatomical integrity was obtained in 7 patients (87.5%) at the end of the follow-up. Eradication of infection without recurrence was obtained in 7 eyes (87.5%). The mean reepithelialization time was 10.2 days. One patient (12.5%) received secondary optical penetrating keratoplasty. The pre-TPKP visual acuity ranged from no light perception to 0.06. After surgery, 4 eyes (50%) improved or maintained preoperative visual acuity and four eyes (50%) had no light perception but maintained anatomical integrity. One had a recurrent infection and needed antibiotics and amniotic membrane graft. One suffered from secondary glaucoma and received evisceration 19 months later. CONCLUSIONS: Glycerol-preserved donor corneas may be effective substitutes in TPKP to control severe infective keratitis and preserve anatomical integrity.