A comparative evaluation of segmental analysis of macular layers in patients with early glaucoma, ocular hypertension, and healthy eyes.

PURPOSE: To compare macular layer thicknesses between early glaucoma, ocular hypertension, and healthy eyes and to evaluate the accuracy of spectralis optical coherence tomography (OCT) segmentation software in discriminating early glaucoma from ocular hypertension and healthy eyes. METHODS: OCT scans were performed using the standard macular and peripapillary retinal nerve fiber layer (pRNFL) protocols on the Spectralis-OCT. The following macular thickness parameters were compared in the inner and outer circles of the Early Treatment Diabetic Retinopathy Study: total macular thickness (MT), retinal nerve fiber layer (mRNFL), ganglion cell layer (mGCL), inner plexiform layer (mIPL), inner nuclear layer (mINL), outer plexiform layer (mOPL), outer nuclear layer (mONL) and ganglion cell complex (mGCC: sum of mRNFL, mGCL, and mIPL). Sectors and layers with the best area under the receiver operating characteristic curve (AUC) were determined and compared between groups. RESULTS: Of a total of 200 eyes included in this study, 64 eyes had primary open angle glaucoma, 69 had ocular hypertension, and 67 were healthy. Peripapillary RNFL was significantly thinner in the early glaucoma group (P<0.05). For the macular variables, there was a significant reduction in the MT, mGCC, mRNFL, mGCL, and mIPL thicknesses in the early glaucoma group; while there were no statistically significant differences between the ocular hypertension and control groups (P>0.05). For distinguishing early glaucoma from normal eyes, AUCs for mGCC, mGCL, and mRNFL were similar to the pRNFL; and for early glaucoma and ocular hypertension, AUCs for mGCC, mGCL mRNF and mIPL were comparable to the pRNFL. CONCLUSION: Macular segmentation can assist in the early diagnosis of glaucoma as a complementary study to pRNFL analysis.

Comparison of pars plana vitrectomy for retinal detachment after failed pneumatic retinopexy and primary pars plana vitrectomy.

PURPOSE: To compare secondary pars plana vitrectomy (PPV) after failed pneumatic retinopexy (PR) (Group 1) with primary PPV (Group 2) for repair of rhegmatogenous retinal detachment (RRD), with respect to single-procedure reattachment rate and visual outcome. METHODS: A consecutive series of RRD patients treated with PPV following failed PR (n=42) were compared with a selected group of RRD patients who were initially treated with PPV (n=29) with a similar location and distribution of retinal breaks. Main outcomes studied were retinal reattachment rate with single PPV in eyes treated with PPV and gas tamponade or after silicone oil removal in eyes with PPV and SO tamponade, as well as visual acuity at 1-year. RESULTS: The retinal reattachment rate was 90.5% and 93.1% in Group 1 and Group 2, respectively. There was no statistically significant difference in retinal reattachment between groups (P=0.69). Final anatomical reattachment rates after reoperations were 100% in each group. Visual acuity (logarithm of the minimum angle of resolution) improved from 1.95±0.84 at baseline to 0.67±0.35 in Group 1, and from 1.99±1.01 at baseline to 0.65±0.32 in Group 2. Both groups had a significant visual acuity improvement at 1-year compared to baseline (P<0.001 in each of them). Retinal reattachment rate was not associated with lens status (phakic vs pseudophakic) or intraocular tamponade (gas vs silicone oil). Visual outcomes were correlated with macular status at baseline and the number of reoperations. CONCLUSION: This study demonstrates that PPV after failed PR and primary PPV in patients with RRD caused by superiorly located retinal breaks have a similar rate of retinal reattachment along with an improved final VA. Initial success of PPV and macular status may be important predictors of final visual outcomes.