Association of Quality of Life and Visual Function in Glaucoma with Tests of Structure and Function.

PRCIS: In addition to standard automated perimetry tests, contrast sensitivity testing and macular analyses may predict changes in the quality of life in patients at different stages of glaucoma. PURPOSE: To examine the relationship between functional and structural tests of visual function and the 25-item National Eye Institute-Visual Function Questionnaire (NEI-VFQ-25) and the 36-item Short Form Health Survey (SF-36) in patients with different stages of glaucoma. MATERIALS AND METHODS: Standard automated perimetry tests, optical coherence tomography scans, and contrast sensitivity (CS) testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related quality of life questionnaires (NEI-VFQ-25, SF-36) were also administered to all patients. RESULTS: The study group comprised 29 patients with suspected glaucoma, 104 with mild glaucoma, 15 with moderate glaucoma, and 12 with severe glaucoma. The mean total score of the NEI-VFQ-25 was 88.8±8.2. The SF-36 did not show a significant correlation with the data on functional and structural tests of visual function, whereas the NEI-VFQ-25 showed a low to moderate correlation (r=0.212--0.492). Vision parameters can explain up to 18.6% of the total score of the NEI-VFQ-25. CS was the only function significantly correlated with glaucoma suspects, while in the early stages, VA was the strongest correlated function with the NEI-VFQ-25 total score (P=0.003 and r=0.551; P=0.001 and r=0.343, respectively). The impact of the visual field on vision-related quality of life increased in the advanced stages (P=0.013, r=0.688). The macular retinal ganglion cell plus inner plexiform layer thickness remained associated with NEI-VFQ-25 at all stages of glaucoma (r=0.335-0.802). The NEI-VFQ-25 total score and most of the subscales were correlated with the physical and mental component summary scores of the SF-36 (r=0.159-0.587). CONCLUSION: VA correlated the most with quality of life in glaucoma patients, as measured with the NEI-VFQ-25 to assess quality of life in glaucoma. The impact of visual functions on quality of life varies at different stages of glaucoma.

Structure-function relationship of reading performance in patients with early to moderate glaucoma.

PURPOSE: To assess reading performance in patients with mild to moderate primary open-angle glaucoma (POAG), and to determine the relationship between reading ability and visual field (VF), microperimetry, and optical coherence tomography (OCT) parameters. METHODS: Reading performance of 30 POAG patients examined by the Minnesota Reading Acuity Chart (MNREAD) was compared to that of 21 age-matched controls collected from Ankara University in Turkey. Humphrey Field Analyzer (HFA) 24-2 SITA Standard and 10-2 patterns, and microperimetry were used for VF measurements. All subjects underwent OCT analysis for retinal nerve fiber layer thickness (RNFLT), optic nerve head (ONH) measurements, and ganglion cell inner plexiform layer thickness (GCIPLT). The linear relationship between reading parameters and VF, microperimetry, and OCT parameters was investigated. Univariate and multiple logistic regression models were used to identify the risk factors for glaucoma. RESULTS: In POAG patients, maximum reading speed (MRS) had a significant association with average rim area, mean cup-to-disc ratio (CDR), and cup volume (p < 0.05, for all). Decreased MRS was associated with thinner average GCIPLT and inferotemporal, superior, and inferior GCIPLT quadrants (p < 0.05, for all). Global index values for the HFA 24-2/10-2 tests, microperimetry, and ONH/RNFLT parameters had no correlation with reading performance. After accounting for the better and worse eyes, gender, education, age, and visual acuity of the glaucoma patients, MRS score was 23 units lower in the worse eye (p = 0.009), critical print size (CPS) was 0.21 units larger in the better eye (p = 0.03) and 0.25 units larger in the worse eye (p < 0.001), reading accesibility index (ACC) was 0.11 units lower in the better eye (p = 0.02) and 0.13 units lower in the worse eye (p = 0.002), and RA was 0.13 units higher in the worse eye (p = 0.003) of POAG patients. CONCLUSION: POAG had significantly lower reading performance when compared to healthy subjects. Reading speed was associated with decreased macular GCIPLT indicating that reading performance may be affected in the earlier stages of the disease.

Comparison of Aqueous Flare Values after Micropulse Transscleral Laser Treatment and Continuous Wave Transscleral Cyclophotocoagulation.

PURPOSE: The purpose of this study was to analyse the changes in flare values after Micropulse Transscleral Laser Treatment for Glaucoma (MP-TLT) in patients with refractory glaucoma and to compare with the outcomes of patients who underwent continuous wave (CW) diode laser cyclophotocoagulation (CW-TSCPC). METHODS: In this single-centre study, we reviewed the medical records of 54 patients who underwent MP-TLT and 35 patients who underwent CW-TSCPC at Ankara University Faculty of Medicine, Department of Ophthalmology. Aqueous flare values were measured by laser flare photometry. RESULTS: The mean laser flare values in both groups (MP-TLT/CW-TSCPC) increased after surgery from 20.85 ± 8.74/22.14 ± 7.39 ph/ms at baseline to 48.52 ± 18.23/57.38 ± 20.08 ph/ms (P = .001) on day 1 and then progressively decreased to 44.13 ± 18.32/52.24 ± 20.56 in week 1, 40.5 ± 18.5/48.24 ± 19.23 week 2 and 35.28 ± 17.09/41.11 ± 16.7 month 1 (all p < .05) and returned to similar levels to baseline at month 3 and month 6 (both p > .05). Patients who achieved treatment success had significantly higher flare values than patients who failed on post-operative day 1, week 1 and week 2 in both groups. The flare values were significantly lower in the MP-TLT group than the CW-TSCPC group on post-operative day 1, week 1, week 2 and month 1 (all p < .05). There were no cases of prolonged post-operative inflammation or serious complications in both groups. CONCLUSION: Intraocular inflammation, quantified by aqueous flare, may be a contributing factor to the IOP lowering effect of transscleral diode laser cyclophotocoagulation in the early post-operative period.

Macular integrity assessment microperimeter, Humphrey field analyzer and OCT in glaucoma practice: a correlation study.

OBJECTIVE: To compare and correlate retinal sensitivities measured with macular integrity assessment microperimetry (MAIA-MP) and Humphrey field analyzer (HFA) 10-2 tests with structural parameters obtained from optical coherence tomography (OCT) in primary open-angle glaucoma (POAG) and ocular hypertension. METHODS: This study included 63 participants (22 with POAG, 20 with ocular hypertension, and 21 control individuals). All participants underwent HFA 10-2 and MAIA-MP (macular retinal sensitivity tests) and measurements for optic nerve head (ONH), peripapillary retinal nerve fibre layer thickness (PRNFLT), and ganglion cell inner plexiform layer thickness (GCIPLT) using OCT. The relationship between macular retinal sensitivity and OCT parameters was evaluated by Pearson correlation analysis and linear regression modelling. RESULTS: POAG cases had a strong association between the MAIA-MP and ONH parameters (optic disc area [ODA], p = 0.037; cup volume, p = 0.043), PRNFLT (average, p = 0.009; inferior PRNFLT, p = 0.004), and GCIPLT in all macula sectors (p ≤ 0.005 for all). HFA 10-2 had a moderate correlation with the ONH parameters (cup-to-disc ratio [CDR], p = 0.042; vertical CDR, p = 0.037; cup volume, p = 0.037; ODA, p = 0.014), PRNFLT (average, inferior, and nasal, p < 0.05 for all), and GCIPLT in all macula sectors (p < 0.005 for all). OHT cases had a weak correlation between HFA 10-2 and nasal and superior PRNFLTs (p = 0.035 and p = 0.047, respectively). CONCLUSION: MAIA-MP and HFA 10-2 functional parameters have strong correlations with the structural parameters obtained by OCT in POAG cases. Both devices are useful in assessing the central visual field in glaucoma, with MAIA-MP potentially beneficial in patients with limited cooperation or poor vision.

Comparison of microvascular parameters and diagnostic ability of optical coherence tomography angiography between eyes with primary angle closure glaucoma and primary open angle glaucoma.

BACKGROUND: To investigate and compare the peripapillary and macular microvascular parameters between eyes with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). METHODS: Seventy-nine eyes of 43 patients with primary angle closure glaucoma (PACG), 78 eyes of 43 patients with primary open-angle glaucoma (POAG), 64 eyes of 35 patients with primary angle closure (PAC), and 73 eyes of 40 control subjects underwent imaging with OCTA. Perfusion density (PD) and vessel density (VD) for the macular area, and PD and flux index (FI) for the peripapillary area were calculated automatically. The area under receiver operator characteristic curves (AUC) were constructed to distinguish PACG and POAG eyes from healthy control eyes. RESULTS: The peripapillary FI in all quadrants and PD and VD of the macular outer circle in superior and inferior quadrants were significantly lower in PACG and POAG eyes than in control eyes. The peripapillary FI in the inferior quadrant was significantly lower in the POAG group than in the PACG group (0.348 ± 0.06 vs. 0.369 ± 0.06, p = 0.04). The remaining OCTA parameters in the peripapillary and macular area did not show a significant difference between the POAG and PACG groups. Eyes with PAC presented significantly lower PD and VD than healthy control eyes at the superior and inferior quadrant of the macular outer circle, while retinal nerve fiber layer and ganglion cell inner complex thickness were not significantly different from than control eyes. The best diagnostic parameter was peripapillary FI in both PACG (AUC: 0.922) and POAG (AUC: 0.938) eyes. CONCLUSIONS: We found significantly lower peripapillary FI in the inferior quadrant in POAG eyes compared to the PACG eyes, which may indicate the different underlying pathogenesis between POAG and PACG. The PAC eyes had lower macular PD and VD than normal eyes. This suggests that retinal vascular impairment may develop earlier than structural damage in PAC eyes.

Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy.

Objectives: To investigate the intraocular pressure (IOP)-lowering efficacy, safety, and treatment tolerability of brinzolamide/brimonidine fixed combination (BBFC) in maximum medical therapy. Materials and Methods: The medical records of 92 patients with glaucoma or ocular hypertension who had previously been treated with a different antiglaucomatous regimen and were switched to a treatment regimen that included BBFC were retrospectively analyzed. Patients were divided into 4 groups including 22, 20, 27, and 23 patients based on previous glaucoma treatment. All patients received maximum medical treatment regimen by adding a combination of beta blocker-prostaglandin analogue therapy along with BBFC. IOP values at baseline and month 1, month 3 and month 6 after starting BBFC and ocular adverse effects at follow-up visits were evaluated. Results: The mean age of all patients was 62.7±16.6 years (range: 18-90). Fifty-two patients (56.5%) were women and 40 (43.5%) were men. Forty-eight (52.2%) patients had primary open-angle glaucoma, 35 (38.0%) had pseudoexfoliation glaucoma, and 9 (9.8%) had ocular hypertension. The IOP of the all eyes was 21.1±4.8 mmHg (range: 17-25) before and 17.6±3.7 mmHg, 17.3±3.4, and 17.0±3.5 mmHg at month 1, 3, and 6 after the introduction of BBFC, respectively (p<0.001 for all time points compared to baseline). In all 4 groups, a significant decrease in IOP was observed at month 1, 3, and 6 follow-ups compared to baseline after the introduction of BBFC. The mean number of antiglaucoma drops was significantly reduced from 2.5±0.6 at baseline to 2 after BBFC (p<0.001). The most frequent ocular adverse event was ocular allergic reactions reported in 8 patients (8.7%), conjunctival hyperemia in 5 patients (5.4%), and ocular discomfort in 2 patients (2.5%). Conclusion: Maximum medical therapy with BBFC provides significant IOP reduction and antiglaucoma therapy simplification with a favorable safety profile in patients with glaucoma.

Microperimetry, Humphrey field analyzer, and optical coherence tomography in detecting glaucoma: a comparative performance study.

PURPOSE: To evaluate and compare the diagnostic performance of microperimetry (MP), visual field (VF) 10-2 and 24-2 tests, and spectral-domain optical coherence tomography (SD-OCT) in primary open-angle glaucoma (POAG). METHODS: The study consisted of 35 POAG and 42 control eyes were enrolled in this prospective study. Eligible participants were ≥ 50 years old. VF assessments were carried out using the Humphrey field analyzer (HFA) and Macular Integrity Assessment. Optic nerve head (ONH), retinal nerve fiber layer thickness (RNFLT), and ganglion cell inner-plexiform-layer thickness (GCIPLT) were measured by SD-OCT. Areas under the receiver operating characteristic curves (AUC) and sensitivities at 95% specificity were calculated for each parameter. RESULTS: HFA 24-2 had the largest AUC value among the functional parameters to differentiate POAG from control eyes [AUC: 0.950 (0.906-0.994), sensitivity at 95%:60]. HFA 24-2 showed a significantly better performance than the 10-2 test (p = 0.036). Among the SD-OCT structural parameters, minimum GCIPLT had the largest AUC value to differentiate POAG from control eyes [AUC: 0.952 (0.905-0.999), sensitivity at 95%:80]. In comparison of the functional and structural parameters, HFA 24-2 showed a significantly better performance than the 10-2 test (p = 0.036). In macular parameters, minimum GCPLT performed significantly better than HFA 10-2 (p = 0.015) in detecting POAG. There was no statistically significant difference between the comparative diagnostic performance of the RNFL, ONH, HFA, and MP (p > 0.05 for all comparisons). CONCLUSION: The structural and functional test results revealed that GCIPLT measurements had the highest diagnostic performance in detecting POAG. HFA 24-2 test performed better than 10-2 test in distinguishing glaucoma from healthy eyes. MP showed a similar performance with HFA 10-2 and may be considered a complementary diagnostic tool.

Comparative efficacy and safety of micropulse transscleral laser cyclophotocoagulation using different duration protocols in eyes with good visual acuity.

PURPOSE: To compare the success rates and safety of micropulse transscleral laser cyclophotocoagulation (MP-TSCPC) for the treatment of refractory glaucoma using the 240-s and 160-s duration protocols in eyes with good visual acuity. METHODS: A retrospective analysis of patients with refractory glaucoma who underwent MP-TSCPC from December 2017 to September 2019 with baseline best-corrected visual acuity (BCVA) of ≥ 20/60. Laser treatments for the moderate and short duration protocols were defined as 240 s and 160 s with settings of 2000 mW/Cm2 and a duty cycle of 31.3%. Follow-up examinations were performed regularly until 12 months after the procedure. RESULTS: Seventy-six eyes of 76 patients were included with BCVA ranging from 20/60 to 20/20. Forty-four eyes were treated with 240 s and 32 eyes were treated with 160-s duration protocols. There was no significant reduction in mean logMAR BCVA and visual field parameters from baseline at any follow-up point in both groups. Visual acuity remained unchanged or improved in 39 of 44 patients (88.6%) in 240-s group and in 28 of 32 patients (87.5%) in 160-s group. Seven of 44 eyes (15.9%) in 240-s group and 12 of 32 eyes (37.5%) in 160-s group required re-treatment for adequate IOP control. After the re-treatments, both protocols showed similar success rates of 79.5% in 240-s group and 75% in 160-s group at 12 months, respectively (p > 0.05). CONCLUSIONS: MP-TSCPC can be offered as a primary surgical treatment for the management of refractory glaucoma in patients with good visual acuity. Considering the high re-treatment rates in 160-s group, the 240-s duration protocol appears to be more effective than 160-s protocol for adequate IOP control.

Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma.

PURPOSE: The aim of this study is to compare the outcomes of micropulse transscleral cyclophotocoagulation between primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. METHODS: Outcomes of 96 consecutive patients with refractory, end-stage glaucoma treated with micropulse transscleral cyclophotocoagulation were retrospectively reviewed. Follow-up examinations were performed on a regular basis until 12 months postoperatively. Surgical successes were defined as maintaining intraocular pressure ⩽18 mmHg and ⩾20% reduction in intraocular pressure (criteria A), ⩽15 mmHg intraocular pressure and ⩾25% reduction in intraocular pressure (criteria B), and ⩽12 mmHg intraocular pressure and ⩾30% reduction in intraocular pressure from baseline (criteria C). RESULTS: Ninety-six eyes of 96 patients (50 (52%) females, 46 (48%) males) were included. Among all eyes, 32 were primary open-angle glaucoma, 30 were pseudoexfoliation glaucoma, and 34 were other types of secondary glaucoma. The mean age was 59.37 ± 11.45 (range: 20-91) years. The mean follow-up period was 14.2 ± 3.9 (range: 12-16) months. At 12 months, the success rates of primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma group were 68.75%, 66.6%, and 64.7% (p = 0.185) for criteria A; 56.25%, 53.3%, and 50% (p = 0.153) for criteria B; and 43.75%, 43.3%, and 38.2% (p = 0.146) for criteria C. Four patients (12.5%) in primary open-angle glaucoma group, 5 patients (16.6%) in pseudoexfoliation glaucoma group, and 14 (41.2%) patients in other secondary glaucoma group required reoperation during the follow-up (p < 0.05). CONCLUSION: Micropulse transscleral cyclophotocoagulation is an equally effective method of lowering intraocular pressure in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. The rate of reoperation was higher in refractory secondary glaucoma patients.

Characteristics of uveitic glaucoma in Turkish patients.

PURPOSE: To evaluate the prevalence of uveitic glaucoma (UG) in the Turkish population and investigate the primary underlying diseases. METHODS: This multicenter, cross-sectional, prospective study included patients who presented to the glaucoma units of 10 tertiary ophthalmology departments in Ankara, Turkey from 15th March to 16th May 2015 and fulfilled the criteria of UG. Patients were inspected for age, sex, medical history, best corrected visual acuity, biomicroscopic findings, intraocular pressure values, and visual field results. RESULTS: During the study period, 4604 eyes of 2541 patients with glaucoma were screened and 145 eyes of 104 patients (4.1%) were identified as having UG. One hundred and thirty-four eyes (92.4%) had open-angle glaucoma and 11 eyes (7.6%) had closed-angle glaucoma. The mean patient age was 47 ± 16 (6-90) years. Idiopathic uveitis (54 eyes), Behçet's disease (26 eyes), Fuchs heterochromic cyclitis (21 eyes), Herpes Simplex virus infectious uveitis (14 eyes), and ankylosing spondylitis (six eyes) were the leading types of uveitis associated with glaucoma. Acute anterior uveitis was the most common type of uveitis diagnosed in 72 patients (105 eyes), whereas 21 patients (27 eyes) had panuveitis, eight patients (nine eyes) had intermediate uveitis, and three patients (four eyes) had posterior uveitis. The need for surgical intervention was 37.2% among all cases and the most common surgery was trabeculectomy in 45 eyes. CONCLUSION: UG is a vision-threatening complication commonly seen in patients with uveitis. This study demonstrates the epidemiological features and underlying etiologies of UG in the Turkish population. The most common primary causes of UG were Behçet's disease and Fuchs heterochromic cyclitis.

Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes.

AIM: To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), ocular hypertension (OHT) and normal eyes using optical coherence tomography angiography (OCTA). METHODS: A total of 114 POAG, PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included. The PXG, POAG, OHT, and control groups (aged 68.17±6.30y, 61.11±10.26y, 58.1±8.9y, and 56.9±4.6y, respectively) contained of 46, 36, 32, and 46 eyes, respectively. Measurements of vessel density (VD) in the peripapillary region and macula, average retinal inner thickness, and retinal nerve fiber layer thickness (RNFLT) were compared among groups. In order to test the accuracy of differentiation between eyes with and without glaucoma, the area was calculated under the receiver operating characteristic (ROC) curves. RESULTS: The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors (44.35%±6.78% vs 50.47%±1.83%, P<0.001), the superficial (44.08%±5.46% vs 51.28%±2.85%, P<0.001) and the deep (45.13%±8.55% vs 54.20%±5.44%, P<0.001) vascular plexus. There was a significant difference in peripapillary VD between glaucomatous and OHT eyes (44.35%±6.78% vs 49.86%±2.45%, P<0.001). The OHT group featured a lower superficial (48.06%±4.32% vs 51.28%±2.85%, P=0.027) and deep plexus (48.70%±5.99% vs 54.20%±5.44%, P=0.013) whole image vessel density (wiVD) than did the control group. The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG (42.22%±5.36% vs 46.54%±5.56%, P=0.046). CONCLUSION: OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT, and these results are correlated to functional and structural glaucomatous alterations. Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG. Furthermore, the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.

The Significance and Reliability of Imaging Findings in Pseudotumor Cerebri.

The objective of our study was to provide a comparative assessment of previously reported magnetic resonance imaging (MRI) parameters in primary and secondary pseudotumor cerebri (PTC) patients, to examine their diagnostic contribution, and to evaluate their association with symptoms, neuro-ophthalmological findings, laboratory results, and cerebrospinal fluid characteristics. Twenty-eight consecutive patients with PTC were included in the study. Age- and sex-matched 20 individuals with normal neurologic examination served as the control group. Modified Dandy Criteria were used for the diagnosis of PTC. Orbital and cranial MRI and MR venography of all patients and controls were assessed by three radiologists. According to our study, posterior flattening of the globe (64% sensitive, 100% specific), optic nerve sheath distention (46% sensitive, 100% specific), vertical tortuosity of the optic nerve (30% sensitive, 95% specific), and partial empty sella (43% sensitive, 100% specific) emerged as particularly valuable markers for a diagnosis of PTC.

Investigation of the Presence of Glaucoma in Patients with Obstructive Sleep Apnea Syndrome Using and Not Using Continuous Positive Airway Pressure Treatment

Objectives: To evaluate the frequency of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) using and not using continuous positive airway pressure treatment. Materials and Methods: This prospective study included 59 patients diagnosed with OSAS based on the Apnea-Hypopnea Index (AHI). OSAS patients were divided into 3 groups according to their AHI scores: 5-15 was considered mild (19 patients), 16-30 was considered moderate (16 patients), and >30 (24 patients) was considered severe. Twenty-eight (47.5%) of the OSAS patients had been using continuous positive airway pressure treatment. The control group included 19 healthy subjects. Retinal nerve fiber layer and ganglion cell complex (GCC) thickness analyses were performed. Results: Average GCC thickness in left eyes was significantly lower in the mild OSAS group than in the control group (p=0.013). The GCC was significantly thinner in the inferior and inferonasal sectors of both eyes in the mild OSAS group compared to the control group (p=0.029, p=0.022, p=0.037, and p=0.019 respectively). Minimum GCC thickness in the left eyes of all OSAS groups was significantly lower than in the control group (p<0.05). Conclusion: In OSAS patients, there may be changes in retinal nerve fiber layer and ganglion cell complex thickness before alterations in the visual field emerge.

Evaluation of the retinal nerve fiber layer and ganglion cell complex thicknesses in patients with exfoliation syndrome

Background/aim: This study aimed to evaluate retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses using spectral domain optical coherence tomography (SD-OCT) in both unilateral and bilateral exfoliation syndrome (XFS) patients Materials and methods: Twenty-four patients with unilateral XFS, 20 patients with bilateral XFS, and 23 healthy subjects were enrolled in this study. Eyes with XFS were compared with both fellow eyes and age-matched control subject eyes in terms of mean and segmental RNFL thickness and minimum, mean, and segmental GCC thickness. Results: In the bilateral XFS group, minimum GCC of the right eye (75.80 ± 11.6 µm) was significantly thinner compared with the right eyes of the control group (81.83 ± 6.6 µm) (P < 0.05). Also, superior RNFL was thinner in the right eye (106.90 ± 16.7 µm) compared with left eye (114.15 ± 18.1 µm) in the bilateral XFS group (P < 0.05). No significant differences in the unilateral XFS group were detected in GCC and RNFL analysis. Conclusion: Minimum GCC value may be the first parameter affected in the conversion of XFS to exfoliative glaucoma followed by RNFL changes.

Assessment of the Anterior Chamber Flare and Macular Thickness in Patients Treated with Topical Antiglaucomatous Drugs.

PURPOSE: To determine the changes in the anterior chamber flare and central macular thickness (CMT) under topical antiglaucomatous therapy. METHODS: This study included 121 eyes of 73 patients and 36 eyes of 18 controls. Glaucoma patients were divided into 3 groups (timolol maleate, latanoprost, and bimatoprost). Control eyes did not receive any medications. Flare and CMT measurements were performed at baseline and follow-up visits (15th day, and 1st, 3rd, 6th, and 12th month). RESULTS: Statistically significant increases were detected in the flare values in the bimatoprost and latanoprost groups (P < 0.001, P = 0.011, respectively). Significant increases were also found in CMT values measured in these 2 groups (P < 0.001, P = 0.002, respectively). However, increased flare and CMT values were not clinically manifested as uveitis and macular edema. Flare and CMT values did not change statistically in the timolol maleate and control groups. CONCLUSIONS: Although the use of prostaglandin (PG) analogs was found to be associated with increased flare and CMT, these increases were not clinically significant. PG analog monotherapy may be safely and effectively used in the treatment of glaucoma.

Optic disc area in different types of glaucoma.

AIM: To evaluate the possible relationship of optic disc area with retina nerve fiber layer in different glaucoma subtypes. METHODS: One eye each was chosen from 45 patients with ocular hypertension, 45 patients with primary open angle glaucoma, 45 patients with pseudoexfoliation glaucoma and 45 healthy controls followed in our hospital. The records of the patients were reviewed retrospectively. Optic disc area and circumpapillary retina nerve fiber layer measurements were obtained using optical coherence tomography. Central corneal thickness was measured by ultrasound pachymetry. RESULTS: The median disc area in the patients with primary open angle glaucoma was significantly higher than the patients with ocular hypertension (2.19 vs 1.90 mm(2), P=0.030). The median retina nerve fiber layer was thinner in the patients with primary open angle glaucoma and pseudoexfoliation glaucoma than the patients with ocular hypertension for superior, inferior and temporal quadrants. After adjustment for age, no difference in central corneal thickness was found between the groups. Greater disc area was associated with thicker retinal nerve fiber layer for superior, inferior and nasal quadrants in the patients with primary open angle glaucoma. There was no correlation between disc area and central corneal thickness measurements of the groups. CONCLUSION: Disc size affects the retinal nerve fiber layer thickness in eyes with primary open angle glaucoma and is a possible risk factor for glaucomatous optic nerve damage.

Periocular changes in topical bimatoprost and latanoprost use.

BACKGROUND/AIM: To evaluate the periocular changes due to topical bimatoprost and latanoprost use and to investigate their effects on the lacrimal drainage system. MATERIALS AND METHODS: All participants (69 eyes of 43 patients, 52 eyes of 26 controls) were classified into three groups: bimatoprost (0.03%) users, latanoprost (0.005%) users, and healthy controls. Each patient was examined before prostaglandin therapy, and then at the first, third, sixth, and twelfth month of therapy. Palpebral fissure height, upper eyelid crease, and levator function were measured, and lacrimal system drainage irrigation was performed. Periocular hyperpigmentation and upper eyelid sulcus were also examined. RESULTS: No significant change was identified in palpebral fissure height or levator function in any group. However, in upper eyelid crease, among bimatoprost users, a statistically significant increase was observed when compared to the control group (P < 0.001). Patients with skin type II and III, in bimatoprost users, and patients with skin type III, in latanoprost users, had statistically significant hyperpigmentation (P < 0.001) after the third month of therapy. During follow-up, no lacrimal drainage system obstruction was seen. CONCLUSION: Topical bimatoprost therapy causes more periocular changes than latanoprost therapy. Thus, in unilateral cases, patients should be well informed about these probable changes before therapy.

SLITRK6 mutations cause myopia and deafness in humans and mice.

Myopia is by far the most common human eye disorder that is known to have a clear, albeit poorly defined, heritable component. In this study, we describe an autosomal-recessive syndrome characterized by high myopia and sensorineural deafness. Our molecular investigation in 3 families led to the identification of 3 homozygous nonsense mutations (p.R181X, p.S297X, and p.Q414X) in SLIT and NTRK-like family, member 6 (SLITRK6), a leucine-rich repeat domain transmembrane protein. All 3 mutant SLITRK6 proteins displayed defective cell surface localization. High-resolution MRI of WT and Slitrk6-deficient mouse eyes revealed axial length increase in the mutant (the endophenotype of myopia). Additionally, mutant mice exhibited auditory function deficits that mirrored the human phenotype. Histological investigation of WT and Slitrk6-deficient mouse retinas in postnatal development indicated a delay in synaptogenesis in Slitrk6-deficient animals. Taken together, our results showed that SLITRK6 plays a crucial role in the development of normal hearing as well as vision in humans and in mice and that its disruption leads to a syndrome characterized by severe myopia and deafness.

Tumor necrosis factor alpha-308 gene polymorphism and pseudoexfoliation glaucoma.

PURPOSE: To investigate the possible association between tumor necrosis factor alpha (TNF-alpha)-308 G/A polymorphism and pseudoexfoliation (PEX) glaucoma. METHODS: One hundred and ten Turkish PEX glaucoma patients and 110 healthy control subjects were enrolled in the study. All participants underwent a complete ophthalmic examination. TNF-alpha-308 was genotyped by polymerase chain reaction and restriction endonuclease analysis. RESULTS: We found a high prevalence of the G/G genotype in PEX glaucoma patients (OR=2.88, 95% CI 1.15-7.20). The A polymorphic allele frequency was 3.2% in patients with PEX compared with 8.2% in controls (p=0.023). CONCLUSIONS: Our results suggest that TNF-alpha-308 G/A genotype is not associated with PEX glaucoma. The -308G/A variant may be a possible protective factor against PEX.

Bevacizumab sterility in multiple doses from a single-use vial.

BACKGROUND: Recent reports have demonstrated that refrigerated bevacizumab can be stored for up to 3 weeks at 4 degrees C without loss of efficacy. There have been no previous reports addressing bevacizumab's sterility when stored and used as multiple doses from a single-use vial. OBJECTIVE: To evaluate the sterility of bevacizumab when used as multiple doses from a single-use vial. METHODS: Four groups of vials were used to simulate the storage and use conditions for bevacizumab. Each group contained 11 doses of 0.2 mL of bevacizumab. One sample from each group was cultured once each day at 37 degrees C for 10 days; one sample from each group was left for 15 days. MacConkey agar, blood agar, thioglycollate broth, and Sabouraud medium were used to assess bacterial and fungal growth. RESULTS: A total of 44 samples of bevacizumab were included in this study. Each sample was placed on 4 growth media for microbial readings. All samples were found to be negative for microbial growth. No significant differences were observed among the groups. Possible limitations of this study included the number of samples for each group and in vitro design of the study, which might have affected the growth of bacterial organisms. CONCLUSIONS: Storage and multiple use of bevacizumab from single-use vials does not seem to result in microbial contamination.