Analysis of retinal nerve layers in idiopathic, LRRK2-associated Parkinson's disease and unaffected carriers of G2019S mutation.

INTRODUCTION: In both prodromal and early symptomatic stages of idiopathic PD (iPD) peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell layer (mGCL) thinning have been identified. Here we assessed whether these alterations can also be detected in symptomatic and presymptomatic stages of LRRK2-PD. METHODS: 218 eyes belonging to 20 iPD, 19 LRRK2-PD (L2PD), 24 LRRK2 non-manifesting carriers (L2NMC), and 46 controls (HCs). pRNFL, mGCL thickness (squares), and Bruch's membrane opening minimum rim width were evaluated by SD-OCT. In L2NMC, 123I-ioflupane SPECT (DaT-SPECT) with semi-quantitative analysis was carried out. RESULTS: Compared to HCs, iPD patients showed significant thinning of the temporal (BMO-MRW and pRNFL), superior-temporal (BMO-MRW), inferior-temporal (BMO-MRW), superior-nasal (BMO-MRW) and central sectors (BMO-MRW) (p < 0.05), as well as in five mGCL sectors (p < 0.05). No significant differences were found between the L2PD or L2NMC and HCs. BMO-MRW thickness in its temporal-superior, superior-nasal and middle sectors was influenced by disease duration (p < 0.05) and mGCL thickness in sectors TS1, TS2, TS3, NS1 and NS3 was influenced by UPDRSIII and age (p < 0.05). CONCLUSION: LRRK2-PD is distinguished from iPD by absent or less retinal nerve involvement, both in clinical and preclinical stages.

Geriatric assessment in hematology scale predicts treatment tolerability in older patients diagnosed with hematological malignancies: The RETROGAH study.

INTRODUCTION: The GAH (Geriatric Assessment in Hematology) scale is a psychometrically valid tool aimed at identifying older patients with hematological malignancies at higher risk of treatment-related toxicity. Our objective in this study was to determine the weights for each dimension of the GAH scale and the cut-off point to reliably predict treatment tolerability in this population, estimated by a weighted receiver operating characteristic (ROC) analysis and quantified by the area under the curve (AUC). MATERIAL AND METHODS: The RETROGAH was a retrospective cohort study including 126 patients who had previously participated in the GAH study. Patients were ≥ 65 years old with newly diagnosed myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML), multiple myeloma (MM), or chronic lymphoid leukemia (CLL) and treated with standard front-line therapy within three months after having completed the GAH scale. RESULTS: The optimal cut-off value of the GAH total score to discriminate patients at higher risk of treatment toxicity was 42, with 68.5% sensitivity and 55.8% specificity. Using this value, 66.1% of patients evaluated were found to develop some type of toxicity. The AUC was 0.6259 (95% CI: 0.512-0.739; p = 0.035). DISCUSSION: The GAH scale not only would enable clinicians to individualize therapy based on individual risk of toxicity but also discriminate patients that will benefit most from intensive treatments from those requiring an adapted approach. While futures studies in clinical practice may improve the model and overcome its limitations, the GAH scale should not be used alone when making treatment decisions.

Tocilizumab in visual involvement of giant cell arteritis: a multicenter study of 471 patients.

Background: Visual involvement is the most feared complication of giant cell arteritis (GCA). Information on the efficacy of tocilizumab (TCZ) for this complication is scarce and controversial. Objective: We assessed a wide series of GCA treated with TCZ, to evaluate its role in the prevention of new visual complications and its efficacy when this manifestation was already present before the initiation of TCZ. Design: This is an observational multicenter study of patients with GCA treated with TCZ. Methods: Patients were divided into two subgroups according to the presence or absence of visual involvement before TCZ onset. Visual manifestations were classified into the following categories: transient visual loss (TVL), permanent visual loss (PVL), diplopia, and blurred vision. Results: Four hundred seventy-one GCA patients (mean age, 74 ± 9 years) were treated with TCZ. Visual manifestations were observed in 122 cases (26%), of which 81 were present at TCZ onset: PVL (n = 60; unilateral/bilateral: 48/12), TVL (n = 17; unilateral/bilateral: 11/6), diplopia (n = 2), and blurred vision (n = 2). None of the patients without previous visual involvement or with TVL had new episodes after initiation of TCZ, while only 11 out of 60 (18%) patients with PVL experienced some improvement. The two patients with diplopia and one of the two patients with blurred vision improved. Conclusion: TCZ may have a protective effect against the development of visual complications or new episodes of TVL in GCA. However, once PVL was established, only a few patients improved.

The retinal ganglion cell layer reflects neurodegenerative changes in cognitively unimpaired individuals.

BACKGROUND: To evaluate a wide range of optical coherence tomography (OCT) parameters for possible application as a screening tool for cognitively healthy individuals at risk of Alzheimer's disease (AD), assessing the potential relationship with established cerebrospinal fluid (CSF) core AD biomarkers and magnetic resonance imaging (MRI). METHODS: We studied 99 participants from the Valdecilla Study for Memory and Brain Aging. This is a prospective cohort for multimodal biomarker discovery and validation that includes participants older than 55 years without dementia. Participants received a comprehensive neuropsychological battery and underwent structural 3-T brain MRI, lumbar puncture for CSF biomarkers (phosphorylated-181-Tau (pTau), total Tau (tTau), beta-amyloid 1-42 (Aß 1-42), and beta-amyloid 1-40 (Aß 1-40)). All individuals underwent OCT to measure the retinal ganglion cell layer (GCL), the retinal nerve fiber layer (RFNL), the Bruch's membrane opening-minimum rim width (BMO-MRW), and choroidal thickness (CT). In the first stage, we performed a univariate analysis, using Student's t-test. In the second stage, we performed a multivariate analysis including only those OCT parameters that discriminated at a nominal level, between positive/negative biomarkers in stage 1. RESULTS: We found significant differences between the OCT measurements of pTau- and tTau-positive individuals compared with those who were negative for these markers, most notably that the GCL and the RNFL were thinner in the former. In stage 2, our dependent variables were the quantitative values of CSF markers and the hippocampal volume. The Aß 1-42/40 ratio did not show a significant correlation with OCT measurements while the associations between pTau and tTau with GCL were statistically significant, especially in the temporal region of the macula. Besides, the multivariate analysis showed a significant correlation between hippocampal volume with GCL and RNFL. However, after false discovery rate correction, only the associations with hippocampal volume remained significant. CONCLUSIONS: We found a significant correlation between Tau (pTau) and neurodegeneration biomarkers (tTau and hippocampus volume) with GCL degeneration and, to a lesser degree, with damage in RFNL. OCT analysis constitutes a non-invasive and unexpensive biomarker that allows the detection of neurodegeneration in cognitively asymptomatic individuals.

Retinal changes in amyotrophic lateral sclerosis: looking at the disease through a new window.

Amyotrophic lateral sclerosis (ALS) is the most frequent degenerative disease affecting motor neurons (MN). ALS has been traditionally considered as a pure motor system disease; however, there are currently sufficient evidences supporting the involvement of other non-motor systems. Recently, the development and the implementation of the optical coherence tomography (OCT) have provided new data regarding the ocular involvement in the disease. In this sense, alterations in retinal nerve fiber layer thickness (RNFL), other retinal layers thicknesses such as outer nuclear layer (ONL) and inner nuclear layer (INL) and changes in the retinal blood vessels have been described in ALS patients. Interestingly, the study of ocular alterations in ALS appears not only as new biomarker tool, but also as a new opportunity to deep into the pathogenesis of the disease. In this article we will review and standardize published studies regarding OCT and ALS, emphasizing both their strengths and weaknesses.

Ganglion Cell Layer Thinning in Alzheimer's Disease.

The main advantages of optical retinal imaging may allow researchers to achieve deeper analysis of retinal ganglion cells (GC) in vivo using optical coherence tomography (OCT). Using this device to elucidate the impact of Alzheimer's disease (AD) on retinal health with the aim to identify a new AD biomarker, a large amount of studies has analyzed GC in different stages of the disease. Our review highlights recent knowledge into measuring retinal morphology in AD making distinctive between whether those studies included patients with clinical dementia stage or also mild cognitive impairment (MCI), which selection criteria were applied to diagnosed patients included, and which device of OCT was employed. Despite several differences, previous works found a significant thinning of GC layer in patients with AD and MCI. In the long term, an important future direction is to achieve a specific ocular biomarker with enough sensitivity to reveal preclinical AD disorder and to monitor progression.

Different follow-up OCT analyses of traumatic optic neuropathy. A case report.

PURPOSE: Optical coherence tomography (OCT) is established as a promising technology for assessing the optic nerve atrophy progression after trauma. However, reports on the effectiveness and sensitivity of ganglion cell layer (GCL) and Bruch's membrane opening-minimum rim width (BMO-MRW) for studying this damage course over time are still lacking. OBSERVATIONS: A 53-year-old man with severe optic nerve trauma had repeated OCT scans of the retinal nerve fiber layer (RNFL), GCL and BMO-MRW during 12 months after the injury. There was gradual damage in all measurements. Interestingly, BMO-MRW was the first analysis affected whilst GCL showed the greatest damage over time. CONCLUSIONS: Our outcomes suggest that OCT might be able to assess axonal loss after traumatic optic neuropathy. BMO-MRW measurement might be more sensitive than other analyses in the first two weeks after trauma and GCL might better monitor belated damage. Thus, it might be possible to combine all these sets of measurements to increase diagnostic sensitivity an specificity.

Evaluation of choroidal thickness in prodromal Alzheimer's disease defined by amyloid PET.

OBJECTIVE: To assess and compare the involvement of choroidal thickness (CT) in patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) defined by amyloid PET and healthy controls (HC). METHODS: Sixty-three eyes from 34 AD patients [12 eyes (19.0%) with dementia and 51 eyes (80.9%) with MCI], positive to 11C-labelled Pittsburgh Compound-B with positron emission tomography (11C-PiB PET/CT), and the same number of sex- and age-paired HC were recruited. All participants underwent enhanced depth imaging optical coherence tomography (EDI-OCT) assessing CT at 14 measurements from 2 B-scans. Paired Student t-test was used to compare CT measurements between MCI, dementia and sex- and age-paired HC. A univariate generalized estimating equations model (GEE) test was performed to compare MCI and dementia individually with all HC included. RESULTS: Compared with HC, eyes from patients with positive 11C-PiB PET/CT showed a significant CT thinning in 5 selected locations (in foveal thickness in vertical scan, in temporal scan at 1500µm, in superior scan at 500µm and in inferior scan at 1000µm and 1500µm, p = 0.020-0.045) whilst few significant CT reduction data was reported in MCI or dementia individually versus HC. However, the GEE test identified significant CT thinning in AD compared with all HC included (p = 0.015-0.046). CONCLUSIONS: To our knowledge, the present study is the first measuring CT in eyes from MCI and dementia eyes positive to 11C-PiB PET/CT reporting a significant trend towards CT thinning in MCI patients which became more pronounced in dementia stage. We support further investigation involving larger and prospective OCT studies in AD population characterized with available biomarkers to describe whether choroidal vascular damage occurs specifically in prodromal stages of AD.

Biologic Therapy in Refractory Non-Multiple Sclerosis Optic Neuritis Isolated or Associated to Immune-Mediated Inflammatory Diseases. A Multicenter Study.

We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet's disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 µm vs. 183.4 ± 139.5 µm; p = 0.02), mean ± SD MT (270.7 ± 23.2 µm vs. 369.6 ± 137.4 µm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10-61.5) mg/day at baseline to. 2.5 (0-5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.

Retinal Artery Contraction After Phenylephrine as a Cardiovascular Risk Biomarker.

BACKGROUND AND AIM: We investigated the in vivo changes of artery diameter (AD) and vein diameter (VD) after topical phenylephrine 2.5% instillation, and its relationship with the Systematic Coronary Risk Evaluation (SCORE). METHODS: This is a cross-sectional study. Healthy control patients were included. All of the participants underwent enhanced depth imaging by spectral-domain optical coherence tomography before and 30 minutes after phenylephrine instillation, using eye-tracking and follow-up software. Changes in AD and VD were assessed. RESULTS: The study included 45 eyes of 45 patients (14 males and 31 females). The mean age was 58.6 ± 15.1 years (26-88 years). Mean SCORE risk estimation value was 2.0 (0-14). No significant correlation was found between pre-phenylephrine AD or VD with age (p=0.237 and p=0.821, respectively), SCORE (p=0.545 and p=0.723, respectively). AD significant thinned after phenylephrine (p<0.001), whereas no significant changes could be depicted in VD (p=0.474). Changes in AD after phenylephrine were significantly related with SCORE risk estimation (p=0.035). Discordantly, changes in VD after phenylephrine were not significantly related with SCORE (p=0.505). CONCLUSION: As a significant thinning of AD occurred following phenylephrine instillation, and as the magnitude of this thinning is related with SCORE, it is useful to test the retinal artery contraction to infer the cardiovascular health status.

Outer Nuclear Layer Damage for Detection of Early Retinal Toxicity of Hydroxychloroquine.

In hydroxychloroquine (HCQ) retinopathy, early detection of asymptomatic retinal changes and the interruption of the drug are essential to prevent permanent vision loss. Our purpose was to investigate the roles of ganglion cell layer (GCL) and outer nuclear layer (ONL) thicknesses measured by optical coherence tomography (OCT) in the early diagnosis of retinopathy. One hundred and fourteen eyes of 76 individuals with HCQ treatment were enrolled in the study (42 eyes with impaired visual field (VF) and 72 eyes with nondamaged VF). We found that ONL was significantly decreased in the HCQ retinopathy group compared with the control group in the nasal macula (p = 0.032) as well as in four sectors (p < 0.044), whereas no significant differences were found comparing GCL in both groups. If VF were altered superiorly or temporarily, ONL was significantly thinned inferiorly (p = 0.029) and nasally (p = 0.008), respectively. Duration of HCQ treatment was significantly related with ONL in seven sectors of ONL (p < 0.047). We suggest that ONL measured with OCT might be used to assess early HCQ retinal toxicity.

Ganglion cell layer thinning in prodromal Alzheimer's disease defined by amyloid PET.

INTRODUCTION: The objective of this study was to investigate and compare optic nerve and retinal layers in eyes of patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) with paired control eyes using optical coherence tomography. METHODS: Sixty-three eyes of 34 subjects, 12 eyes with AD and 51 eyes with MCI, positive to 11C-labeled Pittsburgh Compound-B with positron emission tomography (11C-PiB PET/CT), and the same number of sex- and age-paired control eyes underwent optical coherence tomography scanning analyzing retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), Bruch's membrane opening-minimum rim width (BMO-MRW), inner plexiform layer (IPL), outer nuclear layer, and lamina cribrosa (LC). RESULTS: Compared with healthy controls, eyes of patients with positive 11C-PiB PET/CT showed a significant thinning of RNFL (P < .028) and GCL (P < .014). IPL and outer nuclear layer also showed significant thinning in two (P < .025) and one location (P < .010), respectively. No significant differences were found when optic nerve measurements BMO-MRW and LC were compared (P > .131 and P > .721, respectively). Temporal sector GCL, average RNFL, and temporal sector RNFL also exhibited significant thinning when MCI and control eyes were compared (P = .015, P = .005 and P = .050, respectively), and also the greatest area under the curve values (0.689, 0.647, and 0.659, respectively). GCL, IPL, and RNFL tend to be thinner in the AD group compared with healthy controls. DISCUSSION: Our study suggests that RNFL and GCL are useful for potential screening in the early diagnosis of AD. LC and BMO-MRW appear not to be affected by AD.

Topographic correlation and asymmetry analysis of ganglion cell layer thinning and the retinal nerve fiber layer with localized visual field defects.

PURPOSE: To evaluate the accuracy of the measurement of the ganglion cell layer (GCL) of the posterior pole analysis (PPA) software of the Spectralis spectral-domain (SD) optical coherence tomography (OCT) device (Heidelberg Engineering, Inc., Heidelberg, Germany), the asymmetry of paired GCL sectors, the total retinal thickness asymmetry (RTA), and the peripapillary retinal nerve fiber layer (pRNFL) test to discriminate between healthy, early and advanced glaucoma eyes. METHODS: Three hundred eighteen eyes of 161 individuals with reliable visual fields (VF) were enrolled in this study. All participants were examined using the standard posterior pole and the pRNFL protocols of the Spectralis OCT device. VF impairment was graded in hemifields, and the GCL sectors were correlated with this damage. Thicknesses of each GCL, the GCL map deviation asymmetry and the pRNFL were compared between control and glaucomatous eyes. The area under the receiver operating characteristic curve (AUC) of these analyses was assessed. RESULTS: Fourteen of the 16 sectors of the GCL and pRNFL were significantly thinner in eyes with glaucoma than in control eyes (p<0.006). Similarly, the GCL map deviation showed a significant difference between these eyes and both the control eyes as well as the eyes with early glaucoma (p = 0.001 and p = 0.039, respectively). The highest values of AUC to diagnose both early and advanced glaucoma corresponded to the average pRNFL analysis and the GCL map deviation (AUC>0.823, p<0.040 and AUC>0.708, p<0.188, respectively). CONCLUSIONS: Although 16 central sectors of the GCL observed with PPA showed good correlation with VF damage, the pRNFL and the GCL map deviation were more effective for discrimination of glaucomatous damage.

Peripapillary and macular choroidal thickness before and after phenylephrine instillation.

OBJECTIVES: We investigated the effects of topical phenylephrine 2.5% instillation on choroidal thickness (CT), peripapillary choroidal thickness (pCT) and retinal nerve fibre layer (RNFL). METHODS: Healthy control patients underwent enhanced depth imaging (EDI) by spectral-domain optical coherence tomography (OCT) before and 30 min after phenylephrine instillation, using eye-tracking and follow-up software. Changes in 14 different locations of CT, 2 locations of pCT and RNFL were assessed. RESULTS: The study included 119 eyes of 62 patients (19 males and 43 females), with a mean age of 59.8 ± 15.3 years (range: 26-88 years). Within 30 min after instillation, the mean subfoveal CT both in vertical and horizontal scan were significantly thinned (p = 0.005 and p = 0.018, respectively). In total, 1500, 1000 and 500 µm temporal CT measurements showed also a significant thinning (p = 0.021, p = 0.037 and p = 0.020, respectively), as well as 500 µm both superior (p = 0.045) and inferior (p = 0.009). 1500, 1000 and 500 µm nasal CT, and 1500 and 1000 µm CT superior and inferior measurements showed no significant thinning after phenylephrine instillation. pCT was significantly thinned after phenylephrine in both superior (p = 0.016) and inferior (p = 0.050) measurements. RNFL analysis did not significantly change after phenylephrine instillation (p = 0.209). CONCLUSIONS: A significant thinning of CT and pCT occurred following phenylephrine instillation. Future studies analysing CT and pCT should detail if this mydriatic agent was used or not.

Persistent isolated mydriasis as an early sign of internal carotid artery dissection: Pourfour du petit syndrome.

BACKGROUND: The dissection of the internal carotid artery (ICA) is commonly associated with miosis in Bernard-Horner syndrome (BHS). The presence of mydriasis is exceptional but can occur in the context of Pourfour du Petit syndrome (PDPS), a rare entity opposite of BHS accompanied by eyelid retraction and hyperhidrosis and caused by hyperactivity of the sympathetic cervical chain. AIM: To report on a case of PDPS as the first manifestation of an ICA dissection. METHOD: A 54-year-old man presented with isolated left mydriasis with no other abnormalities in the examination. Six months later, he suffered an ischemic stroke in the left middle cerebral artery territory secondary to a left ICA dissection. RESULTS: The initial study with Intracranial computed tomographic angiography and brain magnetic resonance imaging ruled out compressive cause of the third cranial nerve or structural lesion in the midbrain. The absence of hypersensitivity to Pilocarpine discarded postganglionic parasympathetic involvement. CONCLUSIONS: In the presence of unilateral mydriasis and once common causes are ruled out an imaging examination of the supra-aortic trunks should be completed, since it could represent the first sign of carotid pathology in the context of PDPS.

Impact of Introducing 2 Simple Technique Modifications on the Descemet Membrane Endothelial Keratoplasty Learning Curve.

Purpose To analyze the impact of performing premarking of the Descemet roll and using SF6 20% on a surgeon's Descemet membrane endothelial keratoplasty (DMEK) learning process. Methods A total of 30 consecutive eyes with endothelial dysfunction undergoing DMEK during the learning curve of a surgeon were retrospectively analyzed. Prior to the study, the surgeon had already performed 10 DMEKs. The first 15 consecutive patients were included in group 1 (no premarking and air tamponade) and the other 15 consecutive patients were included in group 2 (premarking and SF6 tamponade). Main outcome parameters were best-corrected visual acuity (BCVA), endothelial cell density (ECD) loss at 6 months, and intraoperative and postoperative complications. Results Among the 2 groups, BCVA and ECD loss at 6 months were similar. However, there was a statistically significant reduction in primary graft failure (40% vs 0%) and need of rebubbling due to complete or partial graft detachment (40% vs 6%) when comparing group 1 versus group 2. In group 1, half of the patients needing rebubbling had primary graft failure. Conclusions Based on our personal experience, premarking the graft to assess orientation and using a SF6 gas tamponade dramatically reduces the risk of primary graft failure and the need for rebubbling even during the first stages of the learning curve. These findings should encourage surgeons to safely change from Descemet stripping automated endothelial keratoplasty to DMEK.

Differences in Corneal Biomechanics in Nonpenetrating Deep Sclerectomy and Deep Sclerectomy Reconverted into Trabeculectomy.

PURPOSE: To evaluate the differences in intraocular pressure (IOP) and in corneal biomechanics in eyes with uneventful nonpenetrating deep sclerectomy (NPDS) in 1 eye and with intended deep sclerectomy reconverted into trabeculectomy (RIT) in the fellow eye of the same patient. PARTICIPANTS: Forty eyes of 20 patients with both types of glaucoma surgery and more than 6 months of follow-up, and 31 eyes of 50 controls. METHODS: IOP was assessed with Goldmann applanation tonometry (GAT), ocular response analizer (ORA), and dynamic contour tonometer (DCT). Student t test for independent samples and a univariate generalized estimating equations model were used to analyze the results. MAIN OUTCOME MEASURES: Overall, no significant differences were found between IOP of NPDS and RIT eyes when measured with 3 tonometers. RESULTS: Although NPDS showed lower values of IOP measured with GAT and ORA, RIT presented lower IOP if DCT is the chosen tonometry. Biomechanically, NPDS eyes had higher corneal hysteresis (CH) and corneal resistance factor (CRF). When compared with control patients, eyes that underwent glaucoma surgery had lower IOP using GAT, DCT and ORA (P<0.001, 0.315, and 0.260, respectively), and lower CRF (P<0.001). CONCLUSIONS: Eyes with NPDS tended to have higher values of CH and CRF and lower IOP than RIT eyes, as measured with 3 of 4 tonometry methods; these differences did not reach statistical significance.

The new Bruch's membrane opening - minimum rim width classification improves optical coherence tomography specificity in tilted discs.

BACKGROUND AND OBJECTIVE: To investigate and compare the false-positive (FP) diagnostic classification of the Bruch's membrane opening - minimum rim width (BMO-MRW) and retinal nerve fiber layer (RNFL) thickness in healthy eyes with tilted optic disc. MATERIALS AND METHODS: Fifty healthy eyes of 30 participants with tilted optic disc underwent BMO-MRW and RNFL scanning using Spectralis and macular Cirrus optical coherence tomography (OCT) scans. RESULTS: The overall FP rate was significantly lower using BMO-MRW map compared with both RNFL map by Spectralis (8% vs 62%, respectively, P<0.001) and ganglion cell analysis (GCA) map by Cirrus (8% vs 50%, respectively, P<0.001). Specificity was significantly higher using BMO-MRW than RNFL in eyes with low (89.7% vs 41.4%, P<0.001) and moderate myopia (95.2% vs 33.3%, P<0.001). CONCLUSION: OCT-derived BMO-MRW analysis provides significantly greater specificity than RNFL in tilted disc irrespectively of the refractive error, and it is more specific than GCA analysis in tilted disc with moderate myopia.

Optic Nerve Head Biomechanic and IOP Changes Before and After the Injection of Aflibercept for Neovascular Age-Related Macular Degeneration.

PURPOSE: We investigated the early effects of intravitreal aflibercept injection (IAI) on optic nerve head (ONH) morphology. METHODS: All of the participants underwent applanation tonometry and enhanced depth imaging by spectral-domain optical coherence tomography immediately before injection, and within 5 and 30 minutes after IAI. Changes in the anterior lamina cribrosa surface depth, prelaminar tissue thickness (PTT), optic cup width, optic cup depth, and Bruch's membrane opening (BMO) were assessed. RESULTS: The study included 30 eyes of 30 subjects with a mean age of 77.4 ± 6.8 years (range, 65-89 years) following IAI (2 mg in 0.05 ml). Within 5 minutes after injection, the mean cup depth, mean cup width, and BMO were significantly increased (P = 0.013, P = 0.000, and P = 0.004, respectively), whereas the mean PTT was thinned (P = 0.009). These morphologic changes returned to near baseline values 30 minutes after injection. Cup widening and BMO expansion (P = 0.000; r, 0.668), as well as cup deepening and prelaminar thinning (P = 0.000; r, -0.838), were significantly correlated. The magnitude of cup deepening and prelaminar tissue thinning correlated with the IOP change in the opposite direction than expected (P = 0.039; r, -0.379 and P = 0.377; r, 0.040). CONCLUSIONS: A significant widening and deepening of the optic cup, BMO expansion, and prelaminar tissue thinning occurred following IAI for neovascular AMD. Eyes having greater optic disc cup deepening and prelaminar tissue condensation after IAI, associated with a lower IOP increase after injection, suggesting that ONH compliance might buffer the effect of additional intravitreal fluid injection on IOP values.

DEXAMETHASONE IMPLANT REMOVAL FROM ANTERIOR CHAMBER: SURGICAL TECHNIQUE.

PURPOSE: To describe a surgical technique for complete and safe dexamethasone intravitreal implant (Ozurdex; Allergan, Inc., Irvine, CA) removal from anterior chamber. METHODS: Description of a new surgical technique for Ozurdex removal using a lens injector cartridge. RESULTS: Dexamethasone implant was removed completely from anterior chamber with no damage to corneal endothelium or posterior chamber luxation in a patient with Ozurdex anterior chamber migration. CONCLUSION: Dexamethasone implants can be removed from anterior chamber in an easy, cheap, fast, and save way.