Is Myopic Optic Disc Appearance a Risk Factor for Rapid Progression in Medically Treated Glaucomatous Eyes With Confirmed Visual Field Progression?

PURPOSE: To investigate visual field (VF) progression rates in glaucomatous eyes with myopic optic disc appearance, refractive error, and progressive VF changes and to compare the rates with those of a nonmyopic group. PATIENTS AND METHODS: Data on 158 eyes from 131 patients with open-angle glaucoma who had progressive VF deterioration during follow-up were retrospectively analyzed. The myopic and nonmyopic groups were compared in terms of rates of change of mean thresholds in global and regional areas using central 10 degrees, peripheral 10 to 24 degrees, and glaucoma hemifield test maps by using a linear-mixed model and controlling for confounding covariates. Clinical factors associated with rapid VF progression at global and regional VF areas were investigated in each group. RESULTS: The 2 groups did not significantly differ in the mean global VF progression rate (-0.36 vs. -0.35 dB/y, respectively; P=0.951). Likewise, both groups showed similar VF progression rates at all regional clusters (P>0.05). No significant association was found between the rate of VF change and clinical factors in the myopic group. The mean follow-up intraocular pressure was significantly associated with VF progression rates in the nonmyopic group (P<0.05). CONCLUSIONS: Open-angle glaucoma eyes with myopic optic disc appearance experiencing progressive VF changes showed similar VF progression rates globally and regionally when compared with nonmyopic eyes after controlling for clinical factors related to VF progression. None of the clinical factors in the myopic group were significantly associated with VF progression rate, whereas the mean follow-up intraocular pressure was in the nonmyopic group.

Baseline Anterior Segment Parameters Associated with the Long-term Outcome of Laser Peripheral Iridotomy.

PURPOSE: To investigate the baseline anterior segment (AS) parameters determined by AS optical coherence tomography (AS OCT) in the prediction of long-term outcome of laser peripheral iridotomy (LPI) in primary angle closure suspect (PACS) eyes Methods: Participants were imaged at pre-LPI and at 2 weeks and 3 years post-LPI using AS OCT. Based on these images, anterior chamber depth (ACD), iris curvature (IC), anterior chamber width (ACW), iris thickness at 750 µm from the scleral spur (IT750), lens vault (LV), and iris area (IA) were estimated using the Image J software (version 1.46). Proportional change (%) in angle opening distance at 750 µm from the scleral spur (AOD750) was used as an outcome measure for LPI. Univariate and multivariate regression analyses were performed to evaluate baseline AS parameters associated with changes in AOD750. RESULTS: A total of 39 PACS eyes were included. At 2 weeks post-LPI, thinner IT750 (p = 0.006) and less AOD750 (p < 0.001) at baseline were related to a greater AOD750 change. When assessed at 3 years post-LPI, thinner IT750 (p = 0.039) and less AOD750 (p = 0.003) at baseline were associated with a greater AOD750 change. CONCLUSIONS: Thin peripheral iris and less AOD750 at baseline were associated with greater changes in longitudinal assessment after LPI. PACS eyes with thick peripheral iris at baseline showed less AOD750 change at both early and late follow up after LPI; therefore, such eyes should be followed with caution despite successful LPI.

Development and progression of diabetic retinopathy and associated risk factors in Korean patients with type 2 diabetes: the experience of a tertiary center.

The aim of this study was to evaluate the incidence of and risk factors for the development of diabetic retinopathy (DR) and progression to proliferative DR (PDR) in Korean patients. Patients diagnosed with type 2 diabetes and followed for more than 5 years at a university-based clinic since 2000 were consecutively enrolled in this retrospective cohort study. Based on the DR classification at the initial and final visits, the incidence and progression of DR was determined and patient characteristics were compared according to DR progression. Hazard ratios of each putative risk factor for DR progression were calculated with a multivariate Cox proportional hazard model. Rate of DR development and progression to PDR were 32.1/1,000 and 26.2/1,000 person-years, respectively. A longer duration of diabetes and higher mean HbA1c level were significant risk factors for the development of DR. Regarding progression to PDR, higher mean HbA1c level, higher standard deviation of HbA1c, and higher urine albumin-to-creatinine ratio were significant risk factors. The rates of development of DR and progression to PDR in Koreans with type 2 diabetes are lower than those reported over the last decade. An inadequate blood glycemic control is the common risk factor for development and progression of DR.

Outcomes of laser peripheral iridotomy in angle closure subgroups according to anterior segment optical coherence tomography parameters.

PURPOSE: To investigate the effect of laser peripheral iridotomy (LPI) in subgroups of angle closure eyes based on anterior segment optical coherence tomography (AS OCT)-derived parameters. METHODS: Angle closure (primary angle closure [PAC] or PAC glaucoma [PACG]) eyes were imaged using AS OCT before and 2 weeks after LPI. A hierarchical cluster analysis was performed using AS OCT parameters obtained before LPI, such as anterior chamber depth (ACD), anterior chamber width (ACW), iris cross-sectional area (IA), angle opening distance and iris thickness at 750 µm from the scleral spur (AOD750, IT750), iris curvature (IC), lens vault (LV), and anterior chamber area (ACA) to subclassify angle closure eyes. After LPI, parameters were compared to evaluate whether the outcome of LPI differed among the subgroups determined by cluster analysis. RESULTS: Cluster analysis generated two distinct clusters showing significantly different anatomical features. Cluster 1 (61 eyes) had lower ACD (P<0.001), higher LV (P=0.008), lower AOD750 (P<0.001), and lower ACW (P<0.001) than cluster 2 (27 eyes). The proportional change in AOD750 after LPI was significantly greater in cluster 1 than in cluster 2 (116.4±117.3% and 46.4±45.7%, respectively, P=0.007). CONCLUSIONS: The outcomes of LPI differed between angle closure subgroups with different anatomical characteristics. Our results provide evidence that angle closure patients can be grouped according to different anatomical anterior segment features and that the pathogenic mechanism of angle closure may differ among subgroups, suggesting that the treatment and follow-up plan should be customized according to subgroup features.

Relationship between the lamina cribrosa, outer retina, and choroidal thickness as assessed using spectral domain optical coherence tomography.

PURPOSE: To evaluate the characteristics and relationship between peripapillary choroidal thickness (pCT), lamina cribrosa thickness (LCT), and peripapillary outer retinal layer thickness (pORT) as determined using spectral domain optical coherence tomography (SD-OCT) enhanced depth imaging (EDI). METHODS: In total, 255 participants were included (87 healthy subjects, 87 glaucoma suspects (GS), and 81 glaucoma cases). The pORT, defined as the thickness between the posterior outer plexiform layer and the retinal pigment epithelium (RPE) interface, and the pCT, between the outer margin of the RPE and the choroidal-scleral interface, were manually measured using EDI scanning of the circumpapillary retinal nerve fiber layer (RNFL). LCT was determined by EDI scanning of the optic nerve head (ONH). Baseline characteristics, including axial length (AXL) and the SD-OCT measurements of the participants, were compared among the three groups. The correlation between putative factors and pCT was determined using univariate and multivariate linear regression analyses. RESULTS: In all three groups, both pORT and pCT were thinnest in the inferior area among the four quadrants. In the healthy group, the mean peripapillary RNFL, pORT, and LCT were significantly greater in comparison with those of the GS and glaucoma groups (p < 0.001, p < 0.038, and p < 0.001, respectively). The pCT demonstrated no significant differences among the three groups (p = 0.083). Only age and AXL were associated with pCT by multivariate analysis. CONCLUSIONS: The pCT is substantially thinner in the inferior area of the ONH. In addition, the pCT demonstrates the strongest correlation with age and AXL, but was not associated with glaucoma or LCT.

Long-term effects of multiple intravitreal antivascular endothelial growth factor injections on intraocular pressure.

PURPOSE: To evaluate long-term effects of multiple intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure (IOP) in eyes with neovascular age-related macular degeneration (AMD) or retinal vein occlusion (RVO). DESIGN: Retrospective cohort study. METHODS: This study enrolled patients who underwent multiple (more than 3) intravitreal anti-VEGF injections and who were followed for more than 12 months after their last injection. IOP elevation was defined as an increase of 5 mm Hg over the baseline measurement on 2 consecutive visits. The frequency of IOP elevation was determined. A hazard ratio of each putative risk factor for IOP elevation was calculated using the Cox proportional hazard model for all participants, incorporating underlying disease as a covariate, as well as for each cohort. RESULTS: Included in the analysis were 629 eyes with neovascular AMD and 95 eyes with RVO. Twenty eyes with neovascular AMD (3.0%) and 7 eyes with RVO (7.4%) experienced IOP elevation after multiple anti-VEGF injections, with an overall incidence of 3.7%. In the Cox proportional hazard analysis of total participants, a diagnosis of RVO (3.424, P = 0.005), a history of glaucoma (8.441, P = 0.001), and low baseline IOP (0.865, P = 0.040) were all significant risk factors for IOP elevation after multiple anti-VEGF injections. CONCLUSION: A history of multiple intravitreal anti-VEGF injections was not a significant risk factor for IOP elevation in our study. IOP elevation was more common in eyes with RVO than with AMD after anti-VEGF injection.

Circadian pattern of intraocular pressure fluctuations in young myopic eyes with open-angle glaucoma.

PURPOSE: To characterize the circadian pattern of habitual-position intraocular pressure (IOP) and its association with ocular dimension in young myopic patients with open-angle glaucoma (OAG). METHODS: A total of 108 young OAG patients with moderate to severe myopia (myopia group) and 67 age-matched OAG patients with emmetropia or mild myopia (control group) were recruited prospectively over 3 years. IOP was recorded 11 times over a 24-hour period by a single, well-trained ophthalmology resident using a handheld tonometer. RESULTS: A total of 87 men and 88 women were included in this study. Analysis of the entire myopia group indicated no acrophase in habitual-position IOP over 24 hours. Subgroup analysis indicated that 44 patients (40.7%) had a diurnal acrophase, 17 patients (15.7%) had a nocturnal acrophase, and 47 patients (43.6%) had no evident acrophase. By contrast, the control group showed an overall nocturnal acrophase in habitual-position IOP, with 14 patients (20.8%) having a diurnal acrophase, 30 patients (44.8%) having a nocturnal acrophase, and 23 patients (34.4%) having no evident acrophase in subgroup analysis. There was a negative correlation between nocturnal habitual-position IOP elevation and axial length in the overall population. CONCLUSIONS: In young myopic OAG eyes, there is no significant nocturnal elevation in habitual-position IOP, while IOP increases at night-time in age-matched control eyes. The overall 24-hour IOP pattern in the myopia group did not show an acrophase. Finally, data showed a negative relationship between nocturnal habitual-position IOP elevation and axial length.

Optic disc torsion presenting as unilateral glaucomatous-appearing visual field defect in young myopic Korean eyes.

PURPOSE: To investigate the ocular features of companion eyes in an attempt to find eye-related factors that are associated with unilateral glaucomatous-appearing visual field (VF) defects in young myopic subjects. DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: Thirty-nine patients (age range, 20-50 years) with unilateral glaucomatous-appearing VF defect and myopia. METHODS: A comparison was performed between VF-affected eyes and contralateral normal eyes. Optic disc torsion and tilt ratio were measured from disc photographs. Logistic regression analysis and linear regression analysis were performed to investigate various ocular parameters, including torsion degree and tilt ratio, that may be associated with the presence and severity of VF defect. MAIN OUTCOME MEASURES: Torsion degree, tilt ratio, and the severity of VF defect. RESULTS: Optic disc torsion degree (16.63±9.78°) of VF-affected eyes was statistically greater than that of the normal contralateral eyes (8.69±7.28°; P<0.001). Optic disc torsion was more prevalent in VF-affected eyes (66.6%) than in normal contralateral eyes (15.3%; P<0.001). In the multivariate analysis, the degree of optic disc torsion was associated significantly with the presence of VF defect (P = 0.005). The torsion degree (P = 0.006) and retinal nerve fiber layer thickness (P = 0.004) were associated significantly with the severity of VF defect. CONCLUSIONS: The prevalence and degree of optic disc torsion in the VF-affected eyes were significantly greater than those of contralateral normal eyes in unilateral, young, myopic patients with glaucomatous-appearing VF defect. Optic disc torsion should be considered in the presence of unilateral glaucomatous-appearing VF defect in young myopic eyes.

In vivo validation of the new Tonopen AVIA tonometer using manometers placed in the anterior chamber and the vitreous cavity under various vitreous conditions.

PURPOSE: To validate intraocular pressure (IOP) measurements using the new Tonopen AVIA® tonometer by comparing values obtained with those measured by manometers placed in the anterior chamber (AC) and the vitreous cavity (VC). MATERIALS AND METHODS: Seventy-nine consecutive patients awaiting phacovitrectomy for epiretinal membrane (ERM) or macular hole (MH) (n=29), vitreous hemorrhage (DMVH) (n=27) or silicone oil removal (n=23) were included in this prospective observational study. A clinician masked to patient information performed a complete ophthalmologic examination, including measurements of corneal thickness (CT), AC depth and axial length. Another examiner simultaneously measured conventional IOP using the Tonopen AVIA® (TIOP) and AC and VC IOPs (ACIOP and VCIOP) using two transducers. RESULTS: The mean TIOP, ACIOP and VCIOP were 16.1 ± 3.8, 16.1 ± 4.4 and 15.5 ± 4.6 mmHg, respectively. There was a good agreement between the TIOP and ACIOP; however, the agreement between TIOP and VCIOP was relatively poor in subgroup analysis. VCIOP was significantly higher than TIOP in the ERM and MH group, with a mean difference of 1.0 mmHg (p=0.042); however, they were significantly lower in the DMVH group, with a mean difference of -0.7 mmHg (p=0.026) and in the silicone oil group (mean difference, -2.3 mmHg) (p<0.0001). In multivariate analysis, TIOP correlated significantly only with CT (p<0.037) and increased by 2.7 mmHg per 100 µm increase in CT. CONCLUSIONS: IOP measurements using the Tonopen AVIA® tonometer showed good agreement with ACIOP values, although TIOP measurements were affected by CT. However, the VCIOP values using the transducer may have over- or underestimated IOP relative to TIOP and ACIOP under various vitreous conditions. Further validation of VCIOP using a cannular type of manometer should be considered.

Discrepancy between optic disc and nerve fiber layer assessment and optical coherence tomography in detecting glaucomatous progression.

PURPOSE: To compare the outcomes of Cirrus spectral-domain optical coherence tomography (OCT) and optic disc/retinal nerve fiber layer (RNFL) photographic assessment in detecting glaucomatous progression. METHODS: Two-hundred twenty-six eyes of 130 glaucoma patients (mean follow-up: 2.5 years) with at least 5 OCT examinations were included. Eyes were classified into one of four groups (diffuse RNFL defect; localized RNFL defect; no RNFL defect; unidentifiable RNFL status) based on baseline RNFL photographs. After performing the entire series of optic disc/RNFL photographic assessments, the eyes were classified into one of three groups: stable, progressed, and undetermined. Progression was divided into one of four categories (optic disc rim thinning; widening RNFL defect; deepening RNFL defect; new disc hemorrhage). OCT progression was determined using guided progression analysis (GPA) software. RESULTS: One-hundred thirty-nine eyes had diffuse RNFL defects, 34 eyes had localized RNFL defects, 42 eyes had no RNFL defects, and 11 eyes had unidentifiable RNFL at baseline. Forty-six eyes showed at least one category of progression upon expert assessment of optic disc/RNFL photographs, while OCT GPA detected progression in 35 eyes. Among the 34 eyes in which progression was observed in photographs only, 15 showed a new disc hemorrhage, 12 presented deepening of an RNFL defect, 10 showed optic disc rim change, and 6 had widening of an RNFL defect. Among the 23 eyes processed only by OCT GPA, 18 had a diffuse RNFL defect at baseline. CONCLUSION: OCT GPA was more sensitive in eyes with a diffuse RNFL defect whereas photographic assessment was better for detecting optic disc hemorrhage and deepening of an RNFL defect when evaluating structural progression.

Relationship between 24-hour mean ocular perfusion pressure fluctuation and rate of paracentral visual field progression in normal-tension glaucoma.

PURPOSE: To investigate the relationship between unstable mean ocular perfusion pressure (MOPP) and the rate of paracentral visual field (PVF) progression in patients with medically treated normal-tension glaucoma (NTG). METHODS: The data of 157 eyes of 122 patients with NTG who were followed for more than 6 years (mean follow-up, 8.7 years ± 12.6 months) and had more than 5 reliable standard visual field (VF) tests were analyzed retrospectively. Groups in the highest, middle, and lowest tertiles of 24-hour MOPP fluctuation (HMF, MMF, and LMF, respectively) were compared in terms of rates of change of mean thresholds in the central 10° (PVF), 10° to 24°, and global areas by using a linear mixed model. Clinical factors associated with rapid PVF progression were also investigated. RESULTS: The LMF and HMF groups did not differ significantly in the mean global rate of VF changes (-0.52 vs. -0.71 dB/y; P = 0.07). The HMF group had a significantly faster progression of VF defects in the central 10° area than the LMF group (-1.02 vs. -0.54 dB/y; P < 0.001) but did not differ in terms of progression of VF defects in the peripheral 10° to 24° area (-0.39 vs. -0.495 dB/y; P = 0.425). PVF progression was significantly associated with 24-hour MOPP fluctuation (ß = -0.31, P < 0.001) and VF damage severity at initial presentation (ß = 0.134, P = 0.011). CONCLUSIONS: Medically treated NTG eyes with greater 24-hour MOPP fluctuations (HMF) had faster PVF defect progression than eyes with stable 24-hour MOPP (LMF). Twenty-four hour MOPP fluctuation associated significantly with PVF progression velocity.

The glaucoma detection capability of spectral-domain OCT and GDx-VCC deviation maps in early glaucoma patients with localized visual field defects.

PURPOSE: To evaluate and compare the glaucoma detection capabilities afforded by retinal nerve fiber layer (RNFL) thickness and deviation maps obtained using Cirrus spectral domain optical coherence tomography (Cirrus OCT), and GDx employing variable corneal compensation (GDx-VCC) in glaucoma patients with early, localized visual field (VF) loss. METHODS: This prospective controlled, comparative study was performed on 42 eyes with localized VF defects, and 42 age/refractive error-matched healthy eyes. All participants were imaged by both imaging devices at the same visit. The area of the RNFL defect in each deviation map, corresponding to a VF defect, was analyzed by direct counting of color-coded superpixels in each device. Receiver operating characteristic (ROC) curves were constructed and compared between Cirrus OCT and GDx-VCC. RESULTS: The areas under the ROCs (AUCs) of RNFL quadrant thicknesses in hemifields with visual field (VF) defects did not differ significantly (Cirrus OCT; 0.961, GDx-VCC; 0.919, P = 0.07). However, Cirrus OCT afforded a better diagnostic ability, by deviation map analysis, than did GDx-VCC (0.972 vs 0.887, P = 0.02). CONCLUSIONS: The RNFL thicknesses assessed by either Cirrus OCT or GDx-VCC were comparable in terms of early glaucoma diagnostic capability. However, when areas containing RNFL defects were analyzed via deviation mapping, Cirrus OCT was better than GDx-VCC.

Ocular pulse amplitude as a dynamic parameter and its relationship with 24-h intraocular pressure and blood pressure in glaucoma.

Abnormal ocular blood flow (OBF) has been suspected as one of the underlying mechanisms of glaucoma. The ocular pulse amplitude (OPA) is considered a possible surrogate parameter for ocular blood flow (OBF) measurement and has been studied in its association with glaucoma. Although there have been several studies that reported various ocular and systemic factors in association with OPA, all of these studies were based on a single measurement of these factors as well as OPA. The purpose of this study was to determine the 24-h (h) dynamic variability and any associations between OPA and intraocular pressure (IOP) and blood pressure (BP) variables using 24-h data collected from untreated patients with normal-tension glaucoma (NTG). One hundred and forty-four patients with NTG were consecutively enrolled. All patients underwent 24-h monitoring of IOP, OPA, and BP variables. A cosinor model was used to describe the patterns and statistical significance of the 24-h OPA rhythm, as well as the IOP and BP variables. Associations between 24-h OPA data, IOP and BP variables, and ocular and demographic factors were also assessed using the generalized estimating equation. Over the course of 24-h, OPA (p = 0.007) demonstrated significant dynamic diurnal rhythms that were similar to the other dynamic variables (all p < 0.05). Based on the 24-h data, IOP (p < 0.001), arterial pulse pressure (p = 0.034), and the spherical equivalent (p < 0.001) positively correlated with the OPA, whilst male sex (p < 0.001) negatively correlated with the OPA. These results indicate that OPA is primarily influenced by IOP as well as arterial pulse pressure, spherical equivalent, and gender. In conclusion, OPA is a dynamic ocular parameter that demonstrates a 24-h short-time fluctuation in NTG patients.

Longitudinal changes in anterior segment parameters after laser peripheral iridotomy assessed by anterior segment optical coherence tomography.

PURPOSE: To quantify long-term changes in anterior segment (AS) parameters after laser peripheral iridotomy (LPI) using AS optical coherence tomography (OCT) in primary angle-closure suspect (PACS). METHODS: Thirty-two PACS subjects were imaged at pre-LPI and 2 weeks and 18 months post-LPI using AS OCT. Anterior chamber depth (ACD), iris curvature (IC), iris thickness at 750 and 1500 µm from the scleral spur (IT750, 1500), lens vault (LV), anterior chamber area (AA), and iris area (IA) were estimated by ImageJ software (version 1.46). Anterior chamber angle (ACA) parameters (angle opening distance [AOD750], angle recess area [ARA750], and trabecular iris space area [TISA750]) were provided by the manufacturer. Parameters were compared before and after LPI. Uni- and multivariate regression analysis was performed to evaluate factors associated with ACA narrowing. RESULTS: Mean AA (14.63 vs. 15.87 mm(2)) and three ACA parameters (AOD750 [0.17 vs. 0.28 mm], TISA750 [0.07 vs. 0.11 mm(2)], and ARA750 [0.08 vs. 0.13 mm(2)]) increased at 2 weeks post-LPI (all P < 0.001). The IT750, 1500 and IC also showed change at 2 weeks post-LPI. Eighteen months post-LPI, IC (0.34 vs. 0.16 mm, P < 0.001) and LV (0.88 vs. 1.01 mm, P = 0.001) were significantly different, while three ACA parameters were not different from their pre-LPI status. At post-LPI 18 months, LV was significantly associated with ACA narrowing (P = 0.026). CONCLUSIONS: The ACA tended to be narrowed at 18 months post-LPI despite resolution of pupillary block, which may be due to LV increment. Our results warrant continuous follow-up of narrow-angle patients after LPI.

Evaluation of lamina cribrosa in pseudoexfoliation syndrome using spectral-domain optical coherence tomography enhanced depth imaging.

PURPOSE: To evaluate the features of the lamina cribrosa (LC) in pseudoexfoliation glaucoma (PXG) patients using enhanced depth imaging (EDI) of spectral-domain optical coherence tomography (SD OCT). The results were compared with those of patients with primary open-angle glaucoma (POAG). DESIGN: Cross-sectional study. PARTICIPANTS: Patients with PXG (n = 21) and POAG (n = 35) matched for age and visual field mean deviation (VF MD). METHODS: Participants were imaged using SD OCT. Lamina cribrosa thickness (LT) and anterior lamina cribrosa depth (ALD) were determined at 3 areas (mid superior, center, and mid inferior) by 2 examiners using an EDI mode of the optic nerve head. MAIN OUTCOME MEASURES: The LT and ALD were compared between PXG and POAG eyes. RESULTS: Mean ± standard deviation baseline untreated intraocular pressure was not significantly different between the 2 groups (PXG, 18.3 ± 8.2 mmHg; POAG, 15.3 ± 3.4 mmHg; P = 0.310). The mean VF MD was -12.7 ± 9.0 dB in the PXG group versus -11.6 ± 9.1 dB in the POAG group (P = 0.643). When compared with the POAG group, the PXG group demonstrated a significantly thinner LT in all 3 areas and a thinner mean LT (133.4 ± 14.5 µm in the POAG group vs. 121.3 ± 13.0 µm in the PXG group; P<0.001). Anterior lamina cribrosa depth did not demonstrate a significant difference in any of the 3 areas between both groups (mean ALD, 324.3 ± 91.9 µm in the POAG group vs. 358.7 ± 142.7 µm in the PXG group; P = 0.470). Of 21 eyes in the PXG group, 9 eyes demonstrated a unilateral clinical presentation. When we compared the PXG eyes and the apparently normal-looking fellow eyes of those 9 eyes, neither the LT nor ALD demonstrated a significant difference (P = 0.223 and P = 0.079, respectively). CONCLUSIONS: Eyes with PXG demonstrate a thinner LC compared with POAG eyes at similar levels of glaucoma severity. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Detection of glaucomatous progression by spectral-domain optical coherence tomography.

PURPOSE: To compare the rate of change of circumpapillary retinal nerve fiber layer (cRNFL) thickness, macular volume and thickness, and optic nerve head (ONH) parameters assessed using spectral-domain optical coherence tomography (SD-OCT) between eyes with progressing and nonprogressing glaucoma. DESIGN: Longitudinal, observational study. PARTICIPANTS: Two hundred seventy-nine eyes from 162 glaucoma patients followed for an average of 2.2 years. METHODS: Eyes were classified as progressors and nonprogressors according to assessment of optic disc and RNFL photographs and visual field progression analysis. Linear mixed effects models were used to evaluate the overall rate of change of cRNFL thickness, macular volume and thickness, and ONH parameters after adjustment for age, spherical equivalent, signal strength, and baseline SD-OCT measurements. MAIN OUTCOME MEASURES: The rate of change of cRNFL thickness, macular volume, and thickness and ONH parameters. RESULTS: Sixty-three eyes (22.6%) from 52 subjects were identified as progressors. Average, inferior quadrant, and 6- and 7-o'clock sector cRNFL thickness decreased faster in progressors than in nonprogressors (-1.26 vs -0.94, -2.47 vs -1.75, -3.60 vs -2.52, and -2.77 vs -1.51 µm/year, respectively; all P<0.05). The ONH rim area decreased faster, and average and vertical cup-to-disc ratio increased faster in progressors than in nonprogressors (-0.016 vs -0.006 mm(2)/year, and 0.004 vs 0.002 and 0.006 vs 0.004 per year, respectively; all P<0.05). Macular cube volume and the thickness of temporal outer and inferior inner macular sectors decreased faster in progressors than in nonprogressors (-0.068 vs -0.048 mm(3)/year, and -2.27 vs -1.67 and -2.51 vs -1.73 µm/year, respectively; all P<0.05). CONCLUSIONS: Serial measurement of parameters in all 3 areas (cRNFL, macula, and ONH) by SD-OCT may permit identification of progression in glaucomatous eyes. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Usefulness of macular thickness derived from spectral-domain optical coherence tomography in the detection of glaucoma progression.

PURPOSE: To assess the reproducibility of circumpapillary retinal nerve fiber layer thickness (cRNFLT) and total macular thickness (TMT) parameters using Cirrus spectral domain optical coherence tomography (SD-OCT) and to apply this information to investigate its ability to detect cases where visual field (VF) progression was noted on event-based analysis in the eyes with early glaucomatous VF loss. METHODS: Intraclass correlation coefficient (ICC), coefficient of variation (COV), and intersession test-retest variability were calculated from the control group. The sensitivity and specificity of SD-OCT for the identification of progressive VF defects were tested on progressive and stable patients. RESULTS: All ICCs from cRNFLT and TMT measurements ranged from 94.8% to 99.0%. While average cRNFLT showed the lowest intersession COV (2.57%), the nasal-outer and superior-inner TMT sectors showed the lowest COV (0.96%). The sensitivities of Cirrus SD-OCT cRNFLT measurements ranged from 37.8% to 48.9%, while that of TMT measurement was 73.3% when tested at the 95% confidence interval (CI). The sensitivity for detecting progressive VF changes in the central 10° area improved to 84.8% with TMT measurement, while it remained unchanged with cRNFLT measurements. The agreement on progression detection between cRNFLT and TMT sector measurements was poor (κ = 0.072 for overall, and 0.102 for the central 10° area at 95% CI, respectively). CONCLUSIONS: Intersession measurements of both cRNFLT and TMT parameters with Cirrus SD-OCT showed excellent reproducibility. TMT parameters using Cirrus SD-OCT may be better than cRNFLT measurements in terms of detecting progressive VF loss. This sensitivity derived from TMT measurements increased when progressive VF loss occurred in the central 10° area.

A hierarchical cluster analysis of primary angle closure classification using anterior segment optical coherence tomography parameters.

PURPOSE: To investigate the possibility of classifying angle closure eyes in terms of features provided by anterior segment optical coherence tomography (AS OCT). METHODS: Angle closure (primary angle closure [PAC] or PAC glaucoma [PACG]) eyes diagnosed by gonioscopy were imaged using AS OCT under the same lighting conditions. Anterior chamber depth (ACD), anterior chamber width (ACW), iris cross-sectional area (IA), iris thickness at 750 µm from the scleral spur (IT750), iris curvature (IC), lens vault (LV), and anterior chamber area (ACA) were determined using Image J software (ver. 1.44). A hierarchical cluster analysis using Ward's method was performed using AS parameters obtained by AS OCT and axial length (AXL). RESULTS: A hierarchical cluster analysis was performed on 166 angle closure eyes and produced two clusters. The first cluster (84 eyes) was characterized by higher ACD (2.24 mm), higher ACA (12.5 mm(2)), higher IT750 (0.44 mm), higher ACW (11.2 mm), lower LV (0.85 mm), and higher AXL (23.5 mm) compared with the second cluster (82 eyes, 1.82 mm, 9.5 mm(2), 0.38 mm, 10.8 mm, 1.1 mm, and 22.8 mm, respectively). The second cluster had essentially higher LV and lower ACA than the first cluster. Most parameters were significantly different between two clusters except IC (P = 0.76). CONCLUSIONS: Our hierarchical cluster analysis indicated two clusters with quite different features existed in our total angle closure population. Our results suggest the possibility of subclassifying angle closure eyes according to AS OCT parameters.

Clinical results of modified anterior chamber tube shunt to an encircling band surgery for uncontrolled intraocular pressure.

PURPOSE: To evaluate the clinical outcome of a modified anterior chamber tube shunt to an encircling band (ACTSEB) procedure in eyes with uncontrolled intraocular pressure (IOP) after scleral encircling band (EB) implantation for treatment of retinal detachment. METHODS: Eight eyes of 7 consecutive patients were analyzed. Silicone tube (external/internal diameter, 0.64/0.30 mm) with 3 to 4 side ports around the distal portion was prepared. Temporary partial ligation of the tube was performed. The fibrous capsule around the EB was incised and the distal portion of each tube was placed under the EB and anchored to the sclera. The proximal part of the tube was inserted into the anterior chamber. IOP, use of antiglaucoma medication, and complications were recorded for 1 year after surgery. Success was defined as an IOP of 8 to 21 mm Hg and no requirement for an additional procedure; complete success was defined as control of IOP without use of antiglaucoma medication; and qualified success as control of IOP with the use of medication. RESULTS: Mean preoperative IOP was 40.1 mm Hg under maximum tolerated medical therapy. Mean IOP was 10.6 mm Hg at 1 day and 16.9 mm Hg at 1 year after surgery. Antiglaucoma medication was used in 3 eyes during follow-up. Tube exposure was detected in 1 eye at 10 months after surgery. The complete success rate was 50% (4 eyes) and the qualified success rate 37.5% (3 eyes). CONCLUSION: Our modification of the ACTSEB procedure resulted in good clinical outcomes, with favorable control of IOP and a low rate of complications.

Bevacizumab and rapamycin can decrease corneal opacity and apoptotic keratocyte number following photorefractive keratectomy.

PURPOSE: We investigated the effects of bevacizumab and rapamycin on central corneal opacity and apoptotic keratocyte number after photorefractive keratectomy (PRK) followed by ultraviolet B (UV-B) irradiation. METHODS: A total of 60 right eyes of Sprague-Dawley rats in four groups (n = 15 each) underwent PRK ablation to 80 µm with a 3-mm zone. Sponges soaked with 0.02% mitomycin C (MMC), 2.5% bevacizumab, 0.01% rapamycin, and balanced saline solution were applied for 2 minutes to these eyes in the MMC, bevacizumab, rapamycin, and control groups, respectively. At 3 weeks after PRK, all right eyes were exposed to 100 mJ/cm(2) UV-B irradiation. Biomicroscopy was used to determine the amount of haze, and TUNEL staining for apoptosis and histology were performed at 3, 6, and 12 weeks. RESULTS: Contrary to the results at 3 weeks, central corneal haze, and apoptotic keratocyte and keratocyte number decreased significantly in the MMC, bevacizumab, and rapamycin groups compared to the control group, and the keratocyte number was lower in the MMC group than the bevacizumab and rapamycin groups at 6 weeks (all P < 0.05). At 12 weeks, the apoptotic keratocyte number was lower in the MMC, bevacizumab, and rapamycin groups than the control group, and the keratocyte number was significantly lower in the MMC than the rapamycin and control groups (all P < 0.05). CONCLUSIONS: Intraoperative bevacizumab and rapamycin administration decreases central corneal haze and apoptotic keratocyte number after PRK. Bevacizumab and rapamycin may be safe alternatives to MMC during refractive surgery to prevent postoperative corneal opacity less affecting the keratocyte number.