Comparing Patients Diagnosed With Ineffective Esophageal Motility by the Chicago Classification Version 3.0 and Version 4.0 Criteria.

Background: The Chicago Classification version 4.0 (CCv4.0) of ineffective esophageal motility (IEM) is more stringent than the Chicago Classification version 3.0 (CCv3.0) definition. We aimed to compare the clinical and manometric features of patients meeting CCv4.0 IEM criteria (group 1) versus patients meeting CCv3.0 IEM but not CCv4.0 criteria (group 2). Methods: We collected retrospective clinical, manometric, endoscopic, and radiographic data on 174 adults diagnosed with IEM from 2011 to 2019. Complete bolus clearance was defined as evidence of exit of the bolus by impedance measurement at all distal recording sites. Barium studies included barium swallow, modified barium swallow, and barium upper gastrointestinal series studies, and collected data from these reports include abnormal motility and delay in the passage of liquid barium or barium tablet. These data along with other clinical and manometric data were analyzed using comparison and correlation tests. All records were reviewed for repeated studies and the stability of the manometric diagnoses. Results: Most demographic and clinical variables were not different between the groups. A lower mean lower esophageal sphincter pressure was correlated with greater percent of ineffective swallows in group 1 (n = 128) (r = -0.2495, P = 0.0050) and not in group 2. In group 1, increased percent of failed contractions on manometry was associated with increased incomplete bolus clearance (r = 0.3689, P = 0.0001). No such association was observed in group 2. A lower median integrated relaxation pressure was correlated with greater percent of ineffective contractions in group 1 (r = -0.1825, P = 0.0407) and not group 2. Symptom of dysphagia was more prevalent (51.6% versus 69.6%, P = 0.0347) in group 2. Dysphagia was not associated with intrabolus pressure, bolus clearance, barium delay, or weak or failed contractions in either group. In the small number of subjects with repeated studies, a CCv4.0 diagnosis appeared more stable over time. Conclusions: CCv4.0 IEM was associated with worse esophageal function indicated by reduced bolus clearance. Most other features studied did not differ. Symptom presentation cannot predict if patients are likely to have IEM by CCv4.0. Dysphagia was not associated with worse motility, suggesting it may not be primarily dependent on bolus transit.

Iatrogenic Esophagopleural Fistula After the Management of Acute Variceal Hemorrhage With Minnesota Tube Placement.

An esophagopleural fistula (EPF) is a rare condition. EPFs are typically of spontaneous, iatrogenic, or neoplastic origin. A 50-year-old man with hepatitis C and alcoholic cirrhosis presented with a history of recurrent variceal hemorrhage requiring esophageal banding, Minnesota tube placement, and a transjugular intrahepatic portosystemic shunt. His hospital course after esophageal perforation and EPF was complicated by acute respiratory failure and empyema, necessitating intubation and thoracostomy tube placement. To the best of our knowledge, this is the first reported case of EPF secondary to Minnesota tube placement. The EPF completely healed after endoscopic repair.

Endoscopic hemostatic spray for uncontrolled bleeding after complicated endoscopic mucosal resection or endoscopic submucosal dissection: a report of 2 cases.

BACKGROUND AND AIMS: There is a significant bleeding risk after gastric endoscopic submucosal dissection (ESD) and EMR cases. This case series describes the use of an endoscopic hemostasis spray, which is not typically used to treat this type of bleeding, after multiple attempts with other modalities failed. METHODS: We present 2 patient cases of ESD and EMR used to treat a gastric adenoma (case 1) and 2 gastric hyperplastic masses (case 2) with refractory bleeding after use of multiple other treatment modalities. Both patients were not surgical candidates because of their medical comorbidities. RESULTS: Bleeding was eventually controlled with the use of endoscopic hemostasis spray after attempts were made using SB Knife Jr tip, Coagrasper Hemostatic Forceps, Argon Photocoagulation, and scope tamponade. CONCLUSIONS: In very specific cases, endoscopic hemostasis spray may have some utility for refractory bleeding after dissection of gastric lesions. After using this spray, it became technically challenging to suture endoscopically because of the mud-like quality of the hemostasis material.

Rare Variant Hirschsprung Disease Presenting as Large Bowel Obstruction in Adulthood: Hypoganglionosis in the Anorectal Canal.

Hirschsprung disease (HD) is a congenital bowel innervation disorder characterized by the absence of ganglion cells in the neural plexus of the colorectal wall. Variant HD describes a heterogeneous group of intestinal innervation disorders in which clinical presentation resembles HD despite the presence of ganglion cells seen in rectal biopsies. We present the first reported case of a rare variant HD, hypoganglionosis isolated in the anorectal canal, diagnosed in an adult who presented with a long history of constipation and treated with proctosigmoidectomy with coloanal anastomosis. Histopathology showed rare ganglion cells isolated in the anorectal canal.

Hepatic parasitic abscess resistant to traditional anthelmintics: difficulty of diagnosis and treatment of fascioliasis in the USA.

We report a case of human fascioliasis in the USA that encountered many diagnostic uncertainties. Numerous tests available for detection of fascioliasis were utilised but the diagnosis remained elusive. Confounders included three negative stool ova and parasite examinations, positive hepatitis A virus IgM antibody, cross-reactive false-positive Echinococcus IgG antibody, absence of characteristic image findings and unrevealing liver biopsy. Praziquantel was started as empiric treatment for helminth infections, but was ineffective. Due to the rarity of the disease in the USA, serologic testing and triclabendazole were only available from the Centers for Disease Control and Prevention, which led to a delay in diagnosis and treatment.

In-utero Diagnosis of Double Encephalocele - Imaging Features and Review of Literature.

Encephalocele is protrusion of brain parenchyma through a defect in the cranium. It is classified into various types based on the defect location: sincipital (fronto-ethmoidal), basal (trans-sphenoidal, spheno-ethmoidal, trans-ethmoidal, and spheno-orbital), occipital and parietal. Double encephaloceles are very rare with only a handful of cases reported in the literature and most of these cases involved either occipital or sub-occipital region. All, except one, cases of double encephaloceles were diagnosed postnatally. We present a case of double encephalocele with parietal and occipital components diagnosed in utero. To the best of our knowledge, this is the first case of double encephalocele involving the parietal and occipital skull bones diagnosed in-utero.

Incidence of Ultrathin Descemet Stripping Endothelial Keratoplasty Corneal Graft Rejection following Steroid Discontinuation.

Purpose/Aims: To determine the incidence of corneal graft rejection in patients with approximately 1 year of steroid therapy following uDSEK. A shortened course of corticosteroids may be beneficial and a viable option in Ultrathin Descemet's Stripping Endothelial Keratoplasty (uDSEK).Materials and Methods: This retrospective cohort study evaluated corneal graft rejection rate in 170 cases of uDSEK that met inclusion criteria with approximately 1 year of steroid therapy. Corneal graft rejection was defined by anterior chamber cell/flare, keratic precipitates with/without corneal edema, and/or a rejection line. The following were collected retrospectively from January 1, 2005 through January 1, 2013: gender, age, race, indication for uDSEK, length of follow-up, length of steroid therapy. Continuous data were compared using Wilcoxon Rank Sum Test and categorical data were compared using Fisher's Exact Test.Results: The included eyes had an average length of steroid therapy of 431 days (range 85-720 days) with an average follow-up of 1274 days (range 395-3186 days). During the follow-up period without steroid, 5 of the 170 eyes were diagnosed with rejection (2.94%). Of the five eyes that experienced rejection, four eyes resolved after topical prednisone was reinstituted alone and did not require repeat uDSEK. The other eye was lost to follow-up. The cumulative probability of rejection after steroid cessation was calculated at 0.67% after 12 months, 2.20% after 18 months, 3.08% after 24 months, and 4.55% after 36 months.Conclusion: Discontinuation of topical steroid at approximately 1 year after uDSEK results in a low rate of corneal graft rejection and may prove extended use unnecessary.

Incidence of cystoid macular edema following routine cataract surgery using NSAIDs alone or with corticosteroids / Incidência de edema macular cistóide após cirurgia de catarata de rotina com a utilização de AINEs isoladamente ou com corticosteroides

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.

RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.

Incidence of cystoid macular edema following routine cataract surgery using NSAIDs alone or with corticosteroids.

PURPOSE: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. METHODS: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. RESULTS: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). CONCLUSIONS: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste-roidal anti-inflammatory drugs with corticosteroids.

Association between light-to-dark changes in angle width and iris parameters in light, dark and changes from light-to-dark conditions.

BACKGROUND/AIMS: To evaluate the association between light-to-dark changes in angle width parameters and iris parameters in light, dark and changes from light-to-dark conditions. METHODS: In this prospective, cross-sectional study, anterior segment optical coherence tomography images, obtained under light and dark conditions, were analysed to determine angle opening distance measured at 500 µm from the scleral spur (AOD500), trabecular-iris space area at 500 µm from the scleral spur (TISA500), iris thickness measured at 750 µm from the scleral spur (IT750), iris thickness measured at 2000 µm from the scleral spur (IT2000), iris area (IArea) and pupil diameter (PD). Multivariable linear mixed-effect regression models were used to evaluate the association between light-to-dark changes in angle width parameters (AOD500, TISA500) and iris parameters (IT750, IT2000, IArea, PD) in light, dark and changes from light-to-dark conditions. RESULTS: 534 eyes from 314 non-glaucomatous subjects were analysed. IT750, IT2000, IArea and PD in light conditions were significantly associated with light-to-dark changes in AOD500 (p<0.05). IT750, IT2000 and IArea in light conditions were significantly associated with light-to-dark changes in TISA500 (p<0.05). IT750 in dark conditions was significantly associated with light-to-dark changes in AOD500 and TISA500 (p<0.05). Light-to-dark changes in IT2000, IArea and PD were significantly associated with light-to-dark changes in AOD500 (p<0.05). Light-to-dark changes in IArea were significantly associated with light-to-dark changes in TISA500 (p<0.05). CONCLUSIONS: Evaluation of iris parameters in light, dark and changes from light-to-dark conditions demonstrated that IT750, IT2000, IArea and PD in light conditions are significant predictors of light-to-dark changes in angle width.

Association Between Trabecular Meshwork Anteroposterior Length and Anterior Chamber Angle Width.

PURPOSE: To investigate the association between trabecular meshwork anteroposterior length and anterior chamber angle width in nonglaucomatous subjects. DESIGN: Prospective, cross-sectional study. METHODS: Time-domain and spectral-domain anterior segment optical coherence tomography images for 561 eyes from 366 nonglaucomatous subjects were analyzed to determine trabecular meshwork anteroposterior length and 3 anterior chamber angle width parameters measured at different distances from the scleral spur: angle opening distance at 250 µm (AOD250), 500 µm (AOD500), and 750 µm (AOD750) from the scleral spur; trabecular-iris space area at 500 µm (TISA500) and 750 µm (TISA750) from the scleral spur; angle recess area at 750 µm (ARA750) from the scleral spur. Univariable and multivariable linear mixed-effect regression models, the latter adjusting for age, sex, ethnicity, axial length, and the use of both eyes in the same subject, were used to evaluate the association between trabecular meshwork anteroposterior length and anterior chamber angle width parameters. RESULTS: Mean trabecular meshwork anteroposterior length was 824.86 ± 181.77 µm. Univariate regression analyses showed a significant positive association between trabecular meshwork anteroposterior length and all anterior chamber angle width parameters: AOD250 (P < .001; ß = 335.13), AOD500 (P < .001; ß = 271.84), AOD750 (P < .001; ß = 202.56), TISA500 (P < .001; ß = 780.78), TISA750 (P < .001; ß = 449.17), ARA750 (P < .001; ß = 381.39). Multivariate regression analyses showed a significant positive association between trabecular meshwork anteroposterior length and all anterior chamber angle width parameters: AOD250 (P = .005; ß = 294.02), AOD500 (P = .036; ß = 172.94), AOD750 (P = .049; ß = 125.58), TISA500 (P = .004; ß = 611.51), TISA750 (P = .011; ß = 333.96), ARA750 (P < .0001; ß = 309.12). CONCLUSIONS: Wider anterior chamber angle is associated with greater trabecular meshwork anteroposterior length.

The Effect of Cumulative Dissipated Energy on Changes in Intraocular Pressure After Uncomplicated Cataract Surgery by Phacoemulsification.

PURPOSE: To investigate the association between ultrasound energy, expressed as cumulative dissipated energy (CDE), and changes in intraocular pressure (IOP) after uncomplicated cataract surgery by phacoemulsification. METHODS: In this prospective study, nonglaucomatous subjects underwent cataract surgery by phacoemulsification. IOP was compared by clustered linear regression at 4 separate time-points: preoperative, 1 day, 1 month, and 3 months after cataract surgery. Changes in the IOP were evaluated as a function of CDE using univariate and multivariate clustered linear regression models, which adjusted for sex, ethnicity, age, axial length, spherical equivalent, mean preoperative Shaffer gonioscopy grade of all 4 quadrants, cataract grade, preoperative IOP, central corneal thickness, and use of both eyes in the same subject. RESULTS: One hundred sixty-one eyes (89 Asian, 49 white, 12 African, and 11 Hispanic) from 116 nonglaucomatous subjects were analyzed. The 161 eyes included 81 right and 80 left eyes. The 89 Asian eyes included 46 Chinese, 35 Filipino, and 8 Vietnamese. Preoperative IOP was 14.9±3.2 mm Hg. Postoperative IOP significantly increased to 16.0±4.9 mm Hg at 1 day (P=0.037) and decreased to 12.4±3.1 and 12.3±3.0 mm Hg at 1 and 3 months, respectively (both P<0.0001). IOP changes at 1 day, 1 month, and 3 months did not demonstrate significant associations with CDE measurements in either univariate or multivariate clustered linear regression analyses (all P>0.05). CONCLUSIONS: The amount of ultrasound energy delivered to the eye during phacoemulsification, expressed as CDE, was not associated with postoperative changes in IOP.

Association of ocular conditions with narrow angles in different ethnicities.

PURPOSE: To quantify the predictive strength of anterior chamber area (ACA), anterior chamber volume (ACV), anterior chamber width (ACW), lens vault (LV), iris thickness (IT), and iris area (IArea) for 2 angle width parameters, trabecular-iris space area (TISA750) and angle opening distance (AOD750) at 750 µm from the scleral spur, in different ethnicities. DESIGN: Prospective, cross-sectional study. METHODS: Anterior segment optical coherence tomography images for 166 white, 90 African, 75 Hispanic, and 132 Chinese subjects were analyzed. First, ACA, ACV, ACW, LV, IT, and IArea were compared among ethnic groups. Second, associations of TISA750 and AOD750 with ACA, ACV, ACW, LV, IT, and IArea were investigated within each ethnic group using multivariable linear regression models, standardized regression coefficients (ß), and coefficients of determination (R(2)). RESULTS: Significant ethnic differences were observed in ACA, ACV, ACW, LV, IT, and IArea (all P < .05). ACA, ACV, and LV were significant predictors of TISA750 and AOD750 in all ethnic groups (all P < .001). ACW and IT were significant predictors of AOD750 in white and African subjects (all P < .05). ACW and IT were significant predictors of TISA750 in white subjects (all P < .05). IArea was a significant predictor of AOD750 in Chinese (P < .05). ACA, ACV, and LV had the highest predictive strength for both TISA750 and AOD750 in all ethnic groups based on ß and R(2). CONCLUSIONS: Despite ethnic differences in ACA, ACV, ACW, LV, IT, and IArea, the same 3 anterior segment parameters (ACA, ACV, and LV) were the strongest predictors of angle width (TISA750 and AOD750) in all 4 ethnic groups.

Association between baseline iris thickness and prophylactic laser peripheral iridotomy outcomes in primary angle-closure suspects.

OBJECTIVE: To evaluate the association between baseline measurements of iris thickness at 3 positions and change in anterior segment biometric parameters after prophylactic laser peripheral iridotomy (LPI). DESIGN: Prospective clinical cohort study. PARTICIPANTS: Fifty-two eyes of 52 nonglaucomatous subjects with anatomically narrow angles. METHODS: Anterior segment optical coherence tomography (ASOCT) images captured before and after LPI were analyzed using customized software, the Zhongshan Angle Assessment Program (ZAAP) (Zhongshan Ophthalmic Centre, Guangzhou, China). Differences in preoperative and postoperative measurements for anterior segment biometric parameters were compared by paired Student t tests. Multivariate linear regression models, adjusted for age, sex, ethnicity, and preoperative pupil diameter, were used to examine the association between the baseline measurements of iris thickness at 3 positions and the change in anterior segment biometric parameters after LPI. MAIN OUTCOME MEASURES: Baseline iris thickness measured at 750 µm from the scleral spur (IT750), iris thickness measured at 2000 µm from the scleral spur (IT2000), and maximal iris thickness (ITM). Changes in iris curvature (ICURV) and trabecular-iris space area at 500 µm from the scleral spur (TISA500) and 750 µm from the scleral spur (TISA750) after LPI. RESULTS: The ICURV significantly decreased, whereas TISA500 and TISA750 significantly increased after LPI (all P < 0.0001). Lower baseline IT750 was significantly associated with greater postoperative increases in TISA500 and TISA750 (both P < 0.05). Lower baseline IT2000 and ITM were significantly associated with greater postoperative decrease in ICURV (both P < 0.05). CONCLUSIONS: Our results showed that lower baseline measurements of iris thickness are associated with greater decrease in ICURV and increases in TISA500 and TISA750 after LPI. This suggests that eyes with thinner irides undergoing LPI were more likely to exhibit greater magnitude of change in terms of flattening of the iris convexity (i.e., ICURV) and widening of the anterior chamber angle (i.e., TISA500 and TISA750).

Open-angle glaucoma in Filipino and white Americans: a comparative study.

BACKGROUND: To compare the frequency of open-angle glaucoma (OAG) subtypes between Filipino and white Americans in a general ophthalmology clinic population. PATIENTS AND METHODS: In this retrospective cross-sectional epidemiologic study with prospective sampling, medical charts of 1113 patients aged 40 years or older (513 Filipinos, 600 whites) seen in 2008 were randomly sampled from 2 private comprehensive ophthalmology clinics. Glaucoma was diagnosed based on optic nerve appearance, visual field defects, and other ocular findings using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) scheme. The normal-tension subtype of OAG [normal-tension glaucoma (NTG)] was defined by intraocular pressure ≤21 mm Hg as determined by review of medical records. RESULTS: NTG comprised a greater proportion of all glaucomatous disease in Filipino subjects [Filipino (F) vs. white (W): 46.7% vs. 26.8%; P=0.02]. Filipinos were more commonly diagnosed with OAG and NTG than whites (F vs. W: OAG, 11.9% vs. 8.2%; NTG, 6.8% vs. 2.5%; P=0.04, 0.001, respectively). There was no significant difference in central corneal thickness between Filipino and white subjects with NTG (P=0.66). CONCLUSIONS: Both OAG and NTG may be more common in Filipino Americans than in white Americans with the propensity for NTG being particularly high in the former relative to the latter group.

Comparison of anterior segment morphology following prophylactic laser peripheral iridotomy in Caucasian and Chinese eyes.

BACKGROUND: To compare anterior segment biometric parameters between Caucasians and Chinese before and after laser peripheral iridotomy. DESIGN: Prospective clinical cohort study. PARTICIPANTS: Caucasian and Chinese primary angle-closure suspects. METHODS: Anterior segment optical coherence tomography images captured before and after laser peripheral iridotomy were analysed to measure anterior segment biometric parameters. Paired Student's t-tests were used for within-ethnic group comparisons. Univariate and linear mixed-effect regression models were used for between-ethnic group comparisons. MAIN OUTCOME MEASURES: Angle opening distance, angle recess area, iris thickness, iris curvature, anterior chamber area, anterior chamber volume and anterior chamber width. RESULTS: Caucasians had significantly greater preoperative angle recess area, anterior chamber width, and iris curvature and lower preoperative iris thickness compared to Chinese (P < 0.05). Significant postoperative increases in angle opening distance, angle recess area, anterior chamber area, anterior chamber volume, and anterior chamber width along with significant postoperative decrease in iris curvature were observed within both ethnic groups (P < 0.05). However, the amount of laser peripheral iridotomy-induced changes in angle opening distance, angle recess area, anterior chamber area, anterior chamber volume, anterior chamber width, and iris curvature did not differ between the two ethnic groups (P < 0.05). CONCLUSION: Both Caucasian and Chinese demonstrated opening of anterior chamber angle width, expansion of anterior chamber dimensions, and flattening of iris convexity after laser peripheral iridotomy. Although certain aspects of anterior segment anatomy differed between Caucasians and Chinese preoperatively, they did not translate into significant ethnic differences in the amount of laser peripheral iridotomy-induced changes in the anterior segment biometric parameters.

Ethnic variation in optic disc size by fundus photography.

PURPOSE: To compare optic disc size among Caucasian, Chinese, African, Filipino and Hispanic subjects recruited from a university-based general ophthalmology clinic. METHODS: In this retrospective cross-sectional study, optic disc size was calculated from fundus photographs. Differences in age, sex and spherical equivalent among the ethnic groups were examined with either Kruskal--Wallis test or Chi-square test. Ethnic differences in optic disc size were evaluated with linear mixed-effects regression models that adjusted for age, sex, spherical equivalent, glaucoma status, lens status and use of both eyes in the same subject. RESULTS: Five hundred and seventy-four eyes of 305 subjects were analyzed. The mean and standard deviation of the optic disc size were 2.16 ± 0.41 mm(2) for Caucasian, 2.30 ± 0.56 mm(2) for Chinese, 2.31 ± 0.41 mm(2) for Filipino, 2.38 ± 0.40 mm(2) for African and 2.40 ± 0.38 mm(2) for Hispanic subjects. Age and spherical equivalent differed among the ethnic groups by Kruskal--Wallis test (p < 0.05). Sex differed among the ethnic groups by Chi-square test (p < 0.05). Ethnic differences in optic disc size were not observed among African, Hispanic, Filipino and Chinese subjects in linear mixed-effects regression analyses (p > 0.05). However, Caucasian differed from the other ethnicities in linear mixed-effects regression analyses (p < 0.05). CONCLUSIONS: Optic disc size was significantly smaller in Caucasian compared to the other ethnic groups. Optic disc size differences among non-Caucasian ethnic groups were not significant.

Association between baseline angle width and induced angle opening following prophylactic laser peripheral iridotomy.

PURPOSE: To evaluate the association between baseline angle width and laser peripheral iridotomy (LPI)-induced opening of the anterior chamber angle. METHODS: Anterior segment optical coherence tomography images captured before and after LPI were analyzed to determine the angle opening distance at 250 µm (AOD250), 500 µm (AOD500), and 750 µm (AOD750) from the scleral spur; trabecular-iris space area at 500 µm (TISA500) and 750 µm (TISA750) from the scleral spur; angle recess area at 750 µm (ARA750) from the scleral spur; and trabecular-iris angle (TIA). Differences in preoperative and postoperative measurements for the anterior chamber angle width parameters were compared by paired Student's t-tests. Univariate and linear mixed-effects regression models were used to examine the association between baseline and LPI-induced opening of anterior chamber angle width parameters. RESULTS: Eighty-four eyes of 52 primary angle closure suspects were included in the analysis. AOD250, AOD500, AOD750, TISA500, TISA750, ARA750, and TIA significantly increased following LPI by paired Student's t-tests (all P < 0.0001). Lower baseline measurements were significantly associated with greater postoperative opening in all anterior chamber angle width parameters in both univariate and linear mixed-effects regression analyses (all P < 0.05). CONCLUSIONS: Our results showed significant opening of the anterior chamber angle width after LPI and demonstrated an inverse association between baseline and LPI-induced opening of the anterior chamber angle width, such that eyes with a more crowded anterior chamber angle undergoing LPI had a greater magnitude of increase in anterior chamber angle width after the procedure.

Differences in iris thickness among African Americans, Caucasian Americans, Hispanic Americans, Chinese Americans, and Filipino-Americans.

PURPOSE: To evaluate the capability of iris thickness parameters to explain the difference in primary angle-closure glaucoma prevalence among the different racial groups. METHODS: In this prospective study, 436 patients with open and narrow angles that met inclusion criteria were consecutively recruited from the UCSF general ophthalmology and glaucoma clinics to receive anterior segment optical coherence tomography imaging under standardized dark conditions. Images from 11 patients were removed due to poor visibility of the scleral spurs and the remaining images were analyzed using the Zhongshan Angle Assessment Program to assess the following measurements for the nasal and temporal angle of the anterior chamber: iris thickness at 750 and 2000 µm from the scleral spurs and the maximum iris thickness at middle one third of the iris. Iris thickness parameters were compared among and within the following 5 different racial groups: African Americans, Caucasian Americans, Hispanic Americans, Chinese Americans, and Filipino-Americans. RESULTS: In comparing iris parameters among the open-angle racial groups, significant differences were found for nasal iris thickness at 750 and 2000 µm from the scleral spurs in which Chinese Americans displayed the highest mean value (P=0.01, P<0.0001). Among the narrow-angle racial groups, significant difference was found for nasal iris thickness at 2000 µm from the scleral in which Chinese Americans showed the highest mean value (P<0.0001). Significant difference was also found for temporal maximum iris thickness at middle one third of the iris in which African Americans exhibited the highest mean value (P=0.021). Iris thickness was modeled as a function of angle status using linear mixed-effects regression, adjusting for age, sex, pupil diameter, spherical equivalent, ethnicity, and the use of both eyes in patients. The iris thickness difference between the narrow-angle and open-angle groups was significant (P=0.0007). CONCLUSIONS: Racial groups that historically showed higher prevalence of primary angle-closure glaucoma possess thicker irides.