Peripapillary Versus Macular Thinning to Detect Progression According to Initial Visual Field Loss Location in Normal-Tension Glaucoma.

PURPOSE: To investigate the predictive capabilities of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thinning to detect visual field (VF) progression in normal-tension glaucoma patients with an initial parafoveal scotoma (IPFS) or nasal step (INS). DESIGN: Retrospective cohort study. METHODS: 185 early-stage glaucoma eyes, followed for 10 years, were retrospectively stratified into IPFS and INS groups. Progressive pRNFL and mGCIPL thinning were assessed using spectral-domain optical coherence tomography and VF progression using both event- or trend-based analysis. Kaplan-Meier survival analysis compared VF survival in each VF phenotype with or without progressive pRNFL and mGCIPL thinning. Cox proportional regression analysis identified VF progression factors. RESULTS: VF progression was detected in 42 IPFS (n=86) and 47 INS (n=99) eyes. Among VF progressors, pRNFL thinning was significantly faster in INS group compared to IPFS group (P < 0.01), while mGCIPL thinning was similar (P = 0.16). At five years, eyes with progressive mGCIPL thinning showed significantly lower VF survival in both VF phenotypes (all P < 0.05). Progressive pRNFL thinning showed significantly lower VF survival only in INS eyes (P = 0.015). Cox multivariate regression revealed that mGCIPL thinning predicted subsequent VF progression in IPFS eyes, while mGCIPL and pRNFL thinning had significant associations with VF progression in INS eyes. CONCLUSIONS: mGCIPL outperforms pRNFL at early follow-up in detecting VF progression in IPFS eyes but not INS eyes. Appropriate selection of structural parameters (mGCIPL vs pRNFL) maximizes early VF progression detection according to initial VF defect location.

Association of baseline optical coherence tomography angiography with the development of glaucomatous visual field defects in preperimetric glaucoma eyes.

AIMS: To evaluate whether baseline vessel density (VD) parameters derived from optical coherence tomography angiography (OCT-A) is associated with the development of glaucomatous visual field (VF) defects in preperimetric glaucoma (PPG) patients. METHODS: One eye from each of 200 consecutive PPG patients with a normal standard automated perimetry and OCT-A at baseline was retrospectively analysed. OCT-A was used to measure the circumpapillary VD (cpVD) and the parafoveal and perifoveal VD. The retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer thicknesses were measured as reference standards. Two patient groups were stratified based on the development of repeatable glaucomatous VF loss. A Cox proportional hazards model was constructed to determine the predictive ability of OCT-A parameters for VF defects. The correlation between these baseline OCT-A parameters and the rate of global VF sensitivity loss (dB/year) was calculated using linear regression analysis. RESULTS: During a 3.1-year average follow-up period, 18 eyes (9.0%) developed glaucomatous VF defects. At baseline, the lower inferior temporal cpVD (HR (95% CI)=0.934 (0.883 to 0.988); p=0.017) and thinner inferior RNFL (HR (95% CI)=0.895 (0.839 to 0.956); p=0.001) were predictive of glaucomatous VF loss. A lower inferior temporal cpVD and thinner RNFL at baseline were associated with faster rate of global VF sensitivity loss (ß=0.015; p=0.001). CONCLUSION: In PPG eyes, a lower baseline inferior temporal cpVD is significantly associated with glaucomatous VF defect development and a faster rate of global VF loss.

Association Between Optic Disc Perfusion Determined by Swept-Source Optical Coherence Tomography Angiography and Visual Field Progression in Glaucoma.

PRCIS: Reduced optic disc vessel density determined by swept-source optical coherence tomography angiography (SS-OCTA) was associated with visual field (VF) deterioration in glaucomatous eyes, which suggested that this parameter can be a potential biomarker that correlates well with functional deterioration. PURPOSE: The purpose of this study was to identify the association between optic disc perfusion evaluated by SS-OCTA and VF progression in primary open angle glaucoma (POAG) eyes. METHODS: A total of 266 POAG eyes of 266 patients (5.4 y of mean follow-up) were included. Optic nerve head SS-OCTA was performed to evaluate the optic disc vessel density (dVD), parapapillary choroidal vessel density (pcVD), choroidal microvascular dropout (cMvD), and optic disc microvascular dropout (dMvD). VF progression was defined using Early Manifest Glaucoma Trial criteria. Factors associated with VF worsening were assessed by Cox proportional hazard analysis. RESULTS: Eighty (30.1%) out of the 266 POAG eyes showed VF progression. The progression group showed a significantly higher proportion of disc hemorrhage, cMvD, and dMvD but lower dVD and pcVD than the stable group (all P <0.05). Considering the strong association between the parameters [dMvD vs. dVD ( r = -0.757, P =0.010], cMvD vs. pcVD ( r = -0.745, P =0.012), dMvD vs. cMvD ( r = 0.802, P <0.001], dVD vs. pcVD ( r = 0.862, P <0.001), CMvD vs. dVD ( r = -0.698, P =0.031), and dMvD vs. pcVD ( r = -0.688, P =0.034)], 6 models with different combinations of covariates compensating for multicollinearity were developed. Younger age, presence of disc hemorrhage, and lower dVD were consistently associated with progression in all models that included these parameters. CONCLUSIONS: Optic disc perfusion, represented as dVD, may be a useful biomarker that correlates well with functional deterioration in POAG eyes.

Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension.

PURPOSE: To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. DESIGN: Retrospective cohort study. METHODS: A total of 127 eyes from 127 newly diagnosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parameters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan-Meier survival analysis was used to compare VF survival estimates in patients with and without MBPS. RESULTS: VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multivariate Cox regression model, a greater MBPS (hazard ratio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF progression was significantly greater in patients with higher MBPS (P = .021) at baseline according to Kaplan-Meier survival analysis. CONCLUSIONS: An increased MBPS at baseline is a significant independent predictor of subsequent VF progression in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment.

Change of Choroidal Microvasculature Dropout After Trabeculectomy as Assessed by Optical Coherence Tomography Angiography.

PRCIS: Reduction in the angular circumference of choroidal microvascular dropout (CMvD AC) was found in POAG patients after trabeculectomy. Greater percentage of IOP reduction was significantly associated with decreased CMvD AC. PURPOSE: The purpose of this study was to investigate the change of choroidal microvasculature dropout (CMvD) after trabeculectomy and its associated factors in primary open angle glaucoma (POAG) eyes using optical coherence tomography angiography. METHODS: Fifty eyes of 50 POAG participants who had preoperative CMvD and underwent trabeculectomy were prospectively enrolled. Angular circumference (AC) of CMvD was determined from choroidal layer images by optical coherence tomography angiography preoperatively and at postoperative 1 year. The cutoff for significant AC of CMvD decrease was determined by the Bland-Altman method, and accordingly, patients were divided into 2, decreased and stable/increased CMvD AC groups. Changes in intraocular pressure (IOP) and CMvD AC were compared between the groups preoperatively and at postoperative 1 year. Factors associated with CMvD AC decrease were assessed by linear regression analysis. RESULTS: The cutoff for significant CMvD AC decrease was 3.58 degrees; accordingly, 26 eyes (52.0%) were categorized as decreased CMvD AC group. No significant intergroup differences in baseline characteristics were found. However, the decreased CMvD AC group presented significantly lower IOP (10.7±3.7 vs. 12.9±2.6 mm Hg, P =0.022), lower CMvD AC (32.03±33.95% vs. 53.44±39.33%, P =0.044), and higher parapapillary choroidal vessel density ( P =0.014) compared with the increased/stable CMvD AC group at postoperative 1 year. The greater percentage of IOP reduction was significantly associated with decreased CMvD AC ( P =0.046). CONCLUSIONS: CMvD AC reduction associated with IOP lowering was found after trabeculectomy. The long-term clinical relevance of postoperative CMvD reduction should be further investigated.

Optical Coherence Tomography Angiography of the Retinal Circulation Following Trabeculectomy for Glaucoma.

PRCIS: Despite successful trabeculectomy, eyes with similar levels of peripapillary and macular vessel densities but with worse preoperative visual field mean deviations may experience functional and vascular decline after surgery. PURPOSE: To evaluate the retinal microcirculation change after trabeculectomy according to glaucoma severity using optical coherence tomography angiography (OCTA). METHODS: We enrolled 59 eyes of primary open angle glaucoma patients who underwent trabeculectomy. The eyes were categorized into 3 groups by preoperative visual field (VF) mean deviation (MD), group 1: MD>-12.0 dB, group 2: MD -12.0 to -20.0 dB, and group 3: MD <-20.0 dB. OCTA was performed preoperatively and 1 year after trabeculectomy. The differences in the radial peripapillary capillary vessel density (pVD) and macular VD between preoperative and postoperative assessment were analyzed and compared in each group. Factors associated with the VD change after trabeculecomy were determined using linear regression analysis. RESULTS: Mean postoperative IOP and IOP reduction did not differ among the 3 groups after trabeculectomy. Preoperative pVD (37.2 vs. 36.6%, P =1.00) and macular VD (39.0 vs. 38.4%, P =1.00) did not differ between groups 1 and 2. Group 1 and 3 showed no changes in VD parameters after trabeculectomy (all, P >0.05). However, group 2 showed statistically significant decreases in pVD (36.6 vs. 32.9%, P <0.001) and macular VD (38.4 vs. 36.0%, P =0.010) after trabeculectomy. The reduction of pVD was associated with a decrease of IOP (Coefficient (ß); 0.14, P =0.032) and VF MD (ß; 0.15, P =0.0116) in group 2, respectively. CONCLUSION: Following successful trabeculectomy surgery for uncontrolled glaucoma with similar IOP reduction, glaucoma eyes with advanced visual field loss showed reduced pVD and macular VD measured by OCT-A. These findings may be relevant to disease progression.

Reduced intradisc vessel density is associated with optic disc hemorrhage in eyes with primary open-angle glaucoma.

We sought to investigate the association between optic nerve head (ONH)/choroidal microvasculature perfusion and optic disc hemorrhage (ODH) in eyes with primary open-angle glaucoma (POAG) using swept-source optical coherence tomography angiography (SS-OCTA). A total of 266 POAG eyes (59 with a single instance of ODH, 40 with a history of recurrent ODH, and 167 eyes without ODH) with a mean follow-up of 5.4 years were included. Intradisc vessel density (VD), parapapillary choroidal VD, optic disc microvascular dropout (MvD), and choroidal microvascular dropout (CMvD), were evaluated on a 3 × 3 mm SS-OCTA image of ONH and compared between eyes with and without ODH. Recurrent ODH was defined as occurrence 1 year after first ODH detection during the total follow-up period. Logistic regression analyses were performed to investigate factors associated with ODH. The prevalence of CMvD, optic disc MvD, and ß-parapapillary atrophy were not different among the no ODH, single ODH, and recurrent ODH groups. Eyes with ODH had lower intradisc VDs than those without ODH (P = 0.021), but no difference was found in intradisc VDs between the single and recurrent ODH groups (P = 0.977). Better VF MD at baseline (odds ratio [OR], 1.150; 95% confidence interval [CI], 1.055-1.254; P = 0.002) and lower intradisc VD (OR, 0.863; 95% CI, 0.812-0.918; P < 0.001) were associated with ODH occurrence. Among POAG eyes, those with ODH had lower intradisc VDs than those without ODH. POAG eyes in an earlier disease stage or those with lower intradisc VDs should be monitored for the possibility of ODH occurrence.

Vasculature-function relationship in open-angle glaucomatous eyes with a choroidal microvasculature dropout.

Identifying biomarkers associated with functional impairment is important in monitoring glaucoma patients. This retrospective cross-sectional study investigated the vasculature-function relationship in open-angle glaucoma (OAG) eyes with choroidal microvasculature dropout (CMvD) versus in OAG eyes without. Optical coherence tomography (OCT) angiography-derived circumpapillary (cpVD) and macular vessel densities (mVD) were measured in 159 early-stage OAG eyes (mean deviation > -6 dB) in accordance with the presence or not of a CMvD. OCT-derived circumpapillary retinal nerve fibre layer thickness (cpRNFLT) and macular ganglion cell-inner plexiform layer thicknesses (mGCIPLT) were also measured as reference standards. The vasculature (cpVD and mVD)-function [24-2 visual field mean sensitivity (VFMS) and central 10° VFMS (cVFMS)] and structure (cpRNFLT and mGCIPLT)-function (24-2 VFMS and cVFMS) relationships were compared using global and sectoral maps between OAG eyes with (CMvD+) and without CMvD (CMvD-). The CMvD+ eyes showed significantly steeper cpVD-24-2 VFMS and mVD-cVFMS correlations (P < 0.05). In contrast, there were no significant differences in the cpRNFLT-24-2 VFMS and mGCIPLT-cVFMS relationships between the two groups (P > 0.05). In conclusion, OAG eyes with a CMvD have significantly stronger vasculature-function relationships than eyes without. Vessel density parameters may be useful biomarkers of disease progression in early-stage OAG patients with a CMvD.

Comparison of surgical outcomes with and without Ologen collagen matrix augmentation during XEN gel stent implantation.

BACKGROUND: To compare the surgical outcomes and postoperative complications with and without Ologen collagen matrix augmentation during XEN gel stent implantation. METHODS: We retrospectively analyzed patients who underwent XEN gel stent implantation with an ab externo technique. The amount of intraocular pressure (IOP) reduction, percentage of postoperative complications and additional management, and surgical success defined as IOP reduction greater than 20% compared with the preoperative IOP measurement were compared between Ologen-augmented and non-augmented groups. Groups of patients who underwent XEN gel stent implantation alone and combined with phacoemulsification were analyzed separately. RESULTS: A total 103 eyes of 103 participants were included. Of those, 72 eyes underwent standalone XEN gel stent implantation: 42 eyes with Ologen augmentation (Oloxen group) and 30 eyes without Ologen augmentation (Xen group). Thirty-one eyes underwent XEN gel stent implantation with phacoemulsification: 19 eyes with Ologen augmentation (Phaco-Oloxen group) and 12 eyes without Ologen augmentation (PhacoXen group). The surgical success rate at six months postoperatively was not different between the Oloxen and Xen groups (56.4% vs 43.3%, P > 0.05) or between the Phaco-Oloxen group and PhacoXen group (57.9% vs 41.7%, P > 0.05). The prevalence of postoperative hypotony, 5-fluorouracil injections, use of anti-glaucoma medications, bleb needling, and additional glaucoma surgeries was not different between the Oloxen and Xen groups or between the Phaco-Oloxen and PhacoXen groups when assessed six months postoperatively. CONCLUSIONS: All groups showed significant IOP reduction after XEN gel stent implantation, but there was no significant difference between the Ologen collagen matrix augmented and non-augmented groups in surgical outcomes.

Development of Cumulative Order-Preserving Image Transformation Based Variational Autoencoder for Anterior Segment Optical Coherence Tomography Images.

Purpose: To develop a variational autoencoder (VAE) suitable for analysis of the latent structure of anterior segment optical coherence tomography (AS-OCT) images and to investigate possibilities of latent structure analysis of the AS-OCT images. Methods: We retrospectively collected clinical data and AS-OCT images from 2111 eyes of 1261 participants from the ongoing Asan Glaucoma Progression Study. A specifically modified VAE was used to extract six symmetrical and one asymmetrical latent variable. A total of 1692 eyes of 1007 patients were used for training the model. Conventional measurements and latent variables were compared between 74 primary angle closure (PAC) and 51 primary angle closure glaucoma (PACG) eyes from validation set (419 eyes of 254 patients) that were not used for training. Results: Among the symmetrical latent variables, the first three and the last demonstrated easily recognized features, anterior chamber area in η1, curvature of the cornea in η2, the pupil size in η3 and corneal thickness in η6, whereas η4 and η5 were more complex aggregating complex interactions of multiple structures. Compared with PAC eyes, there was no difference in any of the conventional measurements in PACG eyes. However, values of η4 were significantly different between the two groups, being smaller in the PACG group (P = 0.015). Conclusions: VAE is a useful framework for analysis of the latent structure of AS-OCT. Latent structure analysis could be useful in capturing features not readily evident with conventional measures. Translational Relevance: This study suggested that a deep learning-based latent space model can be applied for the analysis of AS-OCT images to find latent characteristics of the anterior segment of the eye.

Association of Superficial and Deep Macular Microvasculature with Central Visual Field Sensitivity in Glaucomatous Eyes with High Myopia.

PURPOSE: To investigate the relationship between two distinct layers of macular vessel density (superficial vascular plexus (SVP) and deep vascular plexus (DVP)) and central visual field sensitivity (cVFS) in open-angle glaucoma (OAG) eyes with high myopia. METHOD: This retrospective cross-sectional study included 148 OAG eyes (64 highly myopic (HMG) and 84 non-highly myopic glaucomas (NMG)) as well as 54 healthy eyes. High myopia was defined as a spherical equivalent of less than -6.0 diopters or an axial length of ≥26.0 mm. The global and sectoral SVP-cVFS and DVP-cVFS relationships were compared in each group. Macular ganglion cell-inner plexiform layer thickness (mGCIPLT)-cVFS relationships were also investigated as reference standards. Linear regression analysis was performed to identify the clinical factors associated with cVFS. RESULTS: DVP-cVFS correlations were as strong as those for SVP-cVFS and mGCIPLT-cVFS in HMG eyes. In contrast, DVP-cVFS correlations were significantly lower than SVP-cVFS and mGCILT-cVFS correlations in NMG eyes. In linear regression analysis, both SVP and DVP were significantly associated with cVFS in HMG eyes, but only SVP showed a significant correlation with cVFS in NMG eyes. CONCLUSION: DVP assessment using OCT-A may be a useful tool for detecting and monitoring OAG eyes with high myopia.

Progression detection capabilities of circumpapillary and macular vessel density in advanced glaucomatous eyes.

This study investigated the progression detection capabilities of circumpapillary and macular vessel density (cpVD and mVD) in advanced primary open angle glaucoma (POAG) eyes using the rates of change in VD (trend-based analysis) and variability limits derived from healthy eyes. (event-based analysis) This study included 75 POAG eyes [visual field (VF) mean deviation < - 10 decibels, mean follow-up; 2.3 years] and 33 healthy eyes. Of 75 POAG eyes, 17 (22.7 %) and 58 eyes (77.3 %) were classified into the VF progression and stable groups, respectively. The VF progression group showed significantly faster VD loss than the stable group. (cpVD; - 1.76 vs. - 0.84 %/year, mVD; - 1.10 vs. - 0.47 %/year, P < 0.05) However, the rates of change in circumpapillary retinal nerve fiber layer and macular ganglion cell complex thickness were similar between the groups. (cpRNFLT; - 0.67 vs. - 0.53 [Formula: see text]m/year, GCCT; - 0.48 vs. - 0.12 [Formula: see text]m/year, P > 0.05) Event-based analysis showed stronger agreement between VD and VF progression (cpVD; kappa value (k) = 0.630, mVD; k = 0.667, P < 0.05) than that between structure and VF progression. (cpRNFLT; k = 0.111, GCCT; k = 0.194, P > 0.05). In conclusion, VD loss showed better progression detection capabilities than structural loss in advanced POAG eyes. Detection of cpVD and mVD loss may be useful for detecting progression in the advanced stages of POAG to complement other reference standard strategies.

Factors Associated with Deterioration of Primary Angle Closure after Lens Extraction.

The purpose of the study was to explore factors associated with glaucomatous deterioration in eyes with primary angle closure (PAC) after lens extraction, including PAC suspect (PACS), PAC, and PAC glaucoma (PACG). We retrospectively analyzed data of 77 eyes with PACS, PAC, and PACG that underwent lens extraction with more than 2 years postoperative follow-up. Postoperative glaucoma progression was analyzed by either structural (optic disc/retinal nerve fiber layer (RNFL) photographs or optical coherent tomography (OCT)) or functional (visual field (VF)) criterion. Cox proportional hazard analysis (hazard ratio (HR)) was used to determine risk factors for progression using uni-and multivariate analysis. The analysis was conducted in groups with or without glaucomatous optic neuropathy (PACS/PAC vs. PACG). Forty-one eyes with PACS/PAC and 36 eyes with PACG were included. The mean postoperative follow-up period was 3.5 ± 1.4 years. Intraocular pressure (IOP) was reduced postoperatively from 23.1 ± 14.4 to 13.4 ± 2.1 mmHg. In the PACS/PAC group, seven eyes (17.0%) showed structural progression, but none showed progression in VF. Preoperative RNFL thickness was the only risk factor for structural progression (HR = 0.928, p = 0.002) in the PACS/PAC group. In the PACG group, 24 eyes (66.7%) showed structural progression and 12 eyes (33.3%) showed VF progression. Thinner preoperative RNFL thickness (HR = 0.964, p = 0.043) and high postoperative IOP fluctuation (HR = 1.296, p = 0.011) were significantly associated with VF progression; none of the factors were associated with structural progression. Angle closure eyes with thinner baseline RNFL thickness and higher postoperative IOP fluctuation may require careful follow-up for glaucoma progression after lens extraction.

Optic Disc Hemorrhage Is Not Associated with Global Choroidal Vessel Loss, but Is Associated with Localized Choroidal Vessel Loss in Glaucoma.

PURPOSE: To investigate the relationship between optic disc hemorrhage (ODH) and the geographic pattern (regional vs. global) of parapapillary choroidal vessel density (pCVD) loss within the ß-parapapillary atrophy (ß-PPA) in open-angle glaucoma (OAG) Methods: This retrospective cross-sectional study included 100 OAG eyes with visual field (VF) defects confined to a single hemifield (50 with and 50 without ODH, matched for age (≤10 years) and VF severity (≤1 decibel) at the same hemifield), as well as 50 healthy eyes. The pCVD was measured using optical coherence tomography angiography (OCTA). The relationships between pCVD and clinical factors were assessed globally and regionally. Logistic regression analyses were performed to determine the clinical factors associated with the presence of ODH. RESULTS: The pCVD values within ODH-affected hemiretinae of ODH+ eyes were significantly lower than those in the matched hemiretinae of ODH- eyes (p = 0.001). The presence of ODH was significantly correlated with a lower pCVD within ODH-dominant inferior hemiretinae (p < 0.05). Lower pCVD values at ODH-affected hemiretinae was significantly associated with the presence of ODH (p < 0.05). CONCLUSIONS: OAG eyes with ODH demonstrate a greater severity of regional pCVD loss at the hemiretinae spatially corresponding to the ODH location compared to OAG eyes without ODH.

Development of a ß-Variational Autoencoder for Disentangled Latent Space Representation of Anterior Segment Optical Coherence Tomography Images.

PURPOSE: To investigate the feasibility of extracting a low-dimensional latent structure of anterior segment optical coherence tomography (AS-OCT) images by use of a ß-variational autoencoder (ß-VAE). METHODS: We retrospectively collected 2111 AS-OCT images from 2111 eyes of 1261 participants from the ongoing Asan Glaucoma Progression Study. After hyperparameter optimization, the images were analyzed with ß-VAE. RESULTS: The mean participant age was 64.4 years, with mean values of visual field index and mean deviation of 86.4% and -5.33 dB, respectively. After experiments, a latent space size of 6 and ß value of 53 were selected for latent space analysis with ß-VAE. Latent variables were successfully disentangled, showing readily interpretable distinct characteristics, such as the overall depth and area of the anterior chamber (η1), pupil diameter (η2), iris profile (η3 and η4), and corneal curvature (η5). CONCLUSIONS: ß-VAE can successfully be applied for disentangled latent space representation of AS-OCT images, revealing the high possibility of applying unsupervised learning in the medical image analysis. TRANSLATIONAL RELEVANCE: This study demonstrates that a deep learning-based latent space model can be applied for the analysis of AS-OCT images.

Glaucoma Progression After Lens Extraction in Primary Angle-closure Glaucoma According to Angle-closure Mechanism.

PRCIS: Long-term prognosis of primary angle-closure was assessed after lens extraction (LE) according to different mechanisms of angle closure (AC). Patients with pupillary block (PB) had a higher probability of glaucomatous progression than patients with plateau iris configuration (PIC). PURPOSE: The aim was to investigate and compare the clinical characteristics and long-term prognosis of primary angle-closure disease (PACD) after LE according to different mechanisms of AC. METHODS: In this retrospective observational cohort study, 118 eyes with PACD that underwent LE (mean follow-up; 6.0±3.5 y after surgery) were included. PACD eyes were categorized into three subgroups according to their dominant AC mechanisms, determined by anterior segment optic coherent tomography obtained before LE; PB, PIC, and exaggerated lens vault (ELV). Postoperative glaucomatous progression was determined according to functional (visual field) or structural (optic disc photographs or optic coherent tomography measured retinal nerve fiber layer thickness) criteria. Univariate and multivariate logistic regression analysis was performed to determine the risk factors associated with glaucomatous progression. RESULTS: Fifty-two, 51, and 15 eyes with PB, PIC, and ELV, respectively, were included. All eyes showed significant intraocular pressure reduction, with a greater reduction in the ELV group than in the PB group after LE (27.0% vs. 12.5%, P=0.018). Lower baseline retinal nerve fiber layer thickness [odds ratio (OR): 0.966, P=0.004] and thinner central corneal thickness (OR: 0.985, P=0.021), and the PB group (OR: 2.891, P=0.022, reference to PIC group) were significantly associated with glaucomatous progression after LE. CONCLUSIONS: In eyes with PACD, glaucoma progression was observed following LE despite reduced intraocular pressure. The probability of progression was highest in eyes with pupil block as a mechanism of AC. Close monitoring of glaucoma in these patients is suggested.

Glaucoma diagnostic capabilities of macular vessel density on optical coherence tomography angiography: superficial versus deep layers.

BACKGROUND/AIMS: To compare glaucoma diagnostic capabilities of superficial and deep macular vessel density (mVD) parameters in a series of healthy and open-angle glaucoma (OAG) eyes with central visual field (CVF) loss. METHODS: We consecutively enrolled 113 eyes of 113 patients with OAG and 47 eyes of 47 healthy participants in a retrospective manner. Superficial and deep mVDs were measured at foveal, parafoveal and perifoveal locations on optical coherence tomography (OCT) angiography. The macular ganglion cell-inner plexiform layer thickness (mGCIPLT) was measured on OCT as a reference standard. Glaucoma diagnostic capabilities of superficial and deep mVD parameters were assessed according to the glaucoma stage. Factors associated with the CVF mean sensitivity (MS) were evaluated using linear regression analyses in the OAG eyes. RESULTS: Glaucoma diagnostic capabilities of superficial perifoveal and parafoveal mVDs were significantly better than those of deep perifoveal and parafoveal mVDs, regardless of the glaucoma stage (both p<0.05). Both mGCIPLT and superficial parafoveal mVD were significantly associated with CVF MS (ß-coefficients=10.567 and 21.147, respectively, both p<0.05), independent of age and glaucoma severity. CONCLUSION: Superficial mVD parameters showed significantly greater glaucoma diagnostic capabilities and better correlation with CVF MS compared with deep mVD parameters.

Effect of Postoperative Trimming of the Tube Portion of Ahmed Glaucoma Valve on Corneal Endothelial Cell Loss.

PRCIS: We reduced the tube length through a small limbal incision in eyes that underwent Ahmed glaucoma valve (AGV) implantation and found that the rate of corneal endothelial cell (CEC) density was markedly reduced from -12.2% per year to -3.5% per year after this simple procedure. PURPOSE: The aim was to evaluate the effect of postoperative tube tip trimming (TT) after AGV implantation on CEC loss. METHODS: In this retrospective cohort study, a total of 75 eyes from 67 patients (41 eyes in the AGV implantation only group (AGVG: mean follow-up, 42.2±13.8 mo) and 34 eyes in the TT after AGV implantation group (TAGVG: mean follow-up, 64.9±18.5 mo) were analyzed. TT was performed through a small limbal incision at a mean of 41 months after AGV implantation. Both groups were followed up for at least 1 year and underwent at least 2 specular microscopic examinations after AGV implantation and/or TT. RESULTS: In the AGVG, CEC density was reduced from 2247.0±527.3 to 1665.7±643.3 cells/mm2 (P<0.001). In the TAGVG, it was reduced from 2383.1±619.4 to 1552.9±700.9 cells/mm2 before TT (mean 41 mo of follow-up) and after TT, to 1394.6±654.7 cells/mm2 (mean 26 mo of the follow-up). The reduction rate of CEC density before TT was -12.2±6.5% per year, and this rate was significantly reduced to -3.5±6.9% per year after TT in the TAGVG (P=0.002). The probability of corneal failure defined as a 15% reduction in CEC density was significantly reduced after TT in TAGVG (P=0.038). CONCLUSIONS: Tube TT after AGV implantation markedly reduced the rate of CEC loss without serious complications in eyes with AGV implantation.

Can Artificial Intelligence Predict Glaucomatous Visual Field Progression? A Spatial-Ordinal Convolutional Neural Network Model.

PURPOSE: To develop an artificial neural network model incorporating both spatial and ordinal approaches to predict glaucomatous visual field (VF) progression. DESIGN: Cohort study. Methods From a cohort of primary open-angle glaucoma patients, 9212 eyes of 6047 patients who underwent regular reliable VF examinations for >4 years were included. We constructed all possible spatial-ordinal tensors by stacking 3 consecutive VF tests (VF-blocks) with at least 3 years of follow-up. Trend-based, event-based, and combined criteria were defined to determine the progression. VF-blocks were considered "progressed" if progression occurred within 3 years; the progression was further confirmed after 3 years. We constructed 6 convolutional neural network (NN) models and 2 linear models: regression on global indices and pointwise linear regression (PLR). We compared area under the receiver operating characteristic curve (AUROC) of each model for the prediction of glaucomatous VF progression. RESULTS: Among 43,260 VF-blocks, 4406 (10.2%), 4376 (10.1%), and 2394 (5.5%) VF-blocks were classified as progression-based on trend-based and event-based and combined criteria. For all 3 criteria, the progression group was significantly older and had worse initial MD and VF index (VFI) than the nonprogression group (P < .001 for all). The best-performing NN model had an AUROC of 0.864 with a sensitivity of 0.42 at a specificity of 0.95. In contrast, an AUROC of 0.611 was estimated from a sensitivity of 0.28 at a specificity of 0.84 for the PLR. CONCLUSIONS: The NN models incorporating spatial-ordinal characteristics demonstrated significantly better performance than the linear models in the prediction of glaucomatous VF progression.