A study of retinal parameters measured by optical coherence tomography in patients with multiple sclerosis.

AIM: To investigate the difference of retinal nerve fiber layer (RNFL) thickness and macular fovea thickness/volume between multiple sclerosis (MS) patients and healthy normal individuals using optical coherence tomography (OCT) and assess its association with visual field parameters. METHODS: Thirty consecutive MS patients and 28 healthy controls were recruited in this prospective study. Comprehensive standardized ophthalmic examinations included visual acuity, cycloplegic refraction, intraocular pressure, gonioscopy, visual field, and RNFL thickness and macular fovea thickness/volume detection using Humphrey OCT. Mean values for the thickness of the peripapillary RNFL and macular volume were calculated. Associations between visual field parameters and RNFL thickness/macular volume were analyzed by Pearson correlation analysis. RESULTS: The RNFL thicknesses in each quadrant, the average macular thickness, and the average macular volume in MS patients were all less than those in healthy controls, with statistically significant differences. The RNFL thickness and macular fovea thickness/volume were greater in eyes without optic neuritis than in eyes with optic neuritis. The average visual field parameters had positive correlations with the RNFL thickness and negative correlations with macular parameters in MS patients. CONCLUSION: OCT measurements can effectively identify the nerve changes of MS patients, which provide more data for the diagnosis of MS.

Ultrasound Biomicroscopic Evaluation of Uveal Effusion in Acute Primary Angle Closure.

PURPOSE: The aim of this study was to determine the prevalence of uveal effusion in acute primary angle closure (APAC), chronic primary angle-closure glaucoma (PACG), and primary open-angle glaucoma (POAG). METHODS: A total of 152 consecutive patients (287 eyes) with APAC, PACG, and POAG were enrolled in this prospective and observational case series study. Intraocular pressure-lowering medications were used and ultrasound biomicroscopy examination was undertaken to determine the presence of uveal effusion and measure anterior chamber parameters. RESULTS: Overall, uveal effusion was evident in 40 of 194 affected eyes (20.6%) and no uveal effusion was seen in their fellow eyes. The prevalence of uveal effusion in APAC, chronic PACG, and POAG was 29.3%, 10.9%, and 3.1%, respectively (χ=226.63, P<0.001). APAC eyes had the highest prevalence of effusion and no effusion in their fellow eyes. In 40 eyes with uveal effusion, grade 1 effusion was seen in 17 eyes (42.5%), grade 2 in 15 eyes (37.5%), and grade 3 in 8 eyes (20%). In APAC eyes, the difference in the mean anterior chamber depth (ACD) among effusion grades 3, 2, and 1 was significant (F=5.425, P=0.017), and the eyes with grade 3 effusion had shallower ACD compared with grade 1 (P=0.031), but the difference was not significant compared with grade 2 (P=0.368). CONCLUSIONS: The eyes with APAC are associated with a higher prevalence of uveal effusion compared with PACG and POAG and probably as a result of rapid reduction in intraocular pressure with aggressive hypotensive therapy and inflammatory response to the process of acute attack.

Surgical management of secondary glaucoma in Fuchs' heterochromic iridocyclitis.

PURPOSE: To access surgical effects in patients with secondary glaucoma in Fuchs' heterochromic iridocyclitis. METHODS: We had employed medical or surgical treatment for 22 patients who had been diagnosed as secondary glaucoma and Fuchs' heterochromic iridocyclitis. Thirteen patients had undergone trabeculectomy with intraoperative applications of mitomycin C (MMC), of whom 11 patients had been followed up postoperatively for 25.09 ± 14.4 months (range 6-48 months). RESULTS: Intraocular pressure (IOP) were controlled medically in 17 of 22 (77.3 %) patients. In 11 patients who had surgical therapy, mean IOP fell from a preoperative initial value of 38.05 ± 7.26 mmHg to 20.63 ± 6.15 mmHg (P = 0.000), and mean number of lowering IOP medications fell from preoperative value of 2.27 ± 0.78 to 1.09 ± 1.22 at postoperative final follow-up time (P = 0.014). The result of Kaplan-Meier analysis showed a total success of 90.9 % was achieved at 1 year, 62.3 % success at 4 years and 63.6 % complete success was achieved at 1 year and 31.8 % at 4 years. Exacerbations of intraocular inflammation with transient IOP rise at the early postoperative period occurred in six patients (23 %), and were controlled with topical corticosteroid. No frequent postoperative uveitic relapses were observed. CONCLUSION: Fuchs' heterochromic iridocyclitis has high morbidity of secondary glaucoma. Regular follow-up and close observation should be carried out. Trabeculectomy with MMC is a moderately effective procedure for patients with secondary glaucoma.

Long-term effects of simultaneous subconjunctival and subscleral mitomycin C application in repeat trabeculectomy.

PURPOSE: To assess the efficacy and safety of simultaneous mitomycin C application under conjunctival and scleral flaps in patients with repeat trabeculectomy. METHODS: A total of 44 patients (44 eyes) with previous failed filtering surgery were randomized to one of two groups. The both-flaps group comprised 22 patients (22 eyes) with trabeculectomy and intraoperative mitomycin C application under conjunctival and scleral flaps, whereas the subconjunctival group comprised 22 patients (22 eyes) with subconjunctival application of mitomycin C. Particular attention was paid to intraocular pressure, postoperative medications, visual acuity, filtering bleb appearance, and complications. The mean follow-up time was 38.18 +/- 12.48 months. RESULTS: The mean preoperative intraocular pressure decreased from 39.1 +/- 7.3 mm Hg to the postoperative level of 15.6 +/- 4.8 mm Hg in the both-flaps group (P = 0.014), and from 39.4 +/- 8.4 to 18.7 +/- 5.8 mm Hg in the subconjunctival group (P = 0.018). There was a statistically significant difference in intraocular pressure at all follow-up times, except at 1 week and 1 month postoperatively. Kaplan-Meier survival analysis showed there was no significant difference in total success rate (complete plus qualified success) between the two groups (P = 0.622, log-rank test). However, the two survival curves for the complete success subgroups (without additional medications) confirmed that mitomycin C applications under both flaps had a higher success rate than subconjunctival application (P = 0.043, log-rank test). No statistically significant difference in medications was present between the two groups, and no severe complications developed in either group. CONCLUSIONS: Trabeculectomy augmented with mitomycin C application at both sites could produce a greater lowering of intraocular pressure with low incidence of postoperative complications, and could provide an increased chance of long-term success. The procedure is effective and safe in patients with repeat trabeculectomy.