Characteristics of the Foveal Microvasculature in Asian Patients with Dry Age-Related Macular Degeneration: An Optical Coherence Tomography Angiography Study.

PURPOSE: To evaluate changes in the foveal microvasculature in patients with dry age-related macular degeneration (dry AMD) using optical coherence tomography angiography (OCTA). METHODS: Eighty-three eyes with dry AMD and 83 age- and sex-matched normal eyes were enrolled. A 3 × 3 mm2 OCTA (Zeiss HD-OCT 5000 with AngioPlex; Carl Zeiss Meditec, Dublin, CA, USA) scan was used to acquire images. Vessel density (VD), perfusion density (PD), and the foveal avascular zone (FAZ) of the superficial capillary plexus were analyzed. RESULTS: The VD of the full area, central area, and inner ring of the dry AMD patients (18.61, 8.41, and 20.45, respectively) were significantly lower than those of the controls (20.06, 11.09, and 22.51, respectively). The PD of the full area, central area, and inner ring of the dry AMD patients (0.34, 0.15, and 0.37, respectively) were also significantly lower than those of the controls (0.36, 0.19, and 0.40, respectively). The FAZ area and perimeter in the dry AMD patients (0.29 mm2 and 2.47 mm, respectively) were larger than those in the controls (0.23 mm2 and 2.09 mm, respectively). The FAZ circularity index in the dry AMD patients was smaller than that in the controls (0.61 vs. 0.66). Using univariate linear regression, age, best-corrected visual acuity (BCVA), central macular thickness (CMT), and ganglion cell-inner plexiform layer (GC-IPL) thickness were associated with both VD and PD of the full area. Using multivariate analysis, only GC-IPL thickness was significantly associated with the VD and PD of the full area (p = 0.001 and p = 0.004, respectively). CONCLUSIONS: OCTA revealed changes in the foveal microcirculation of patients with dry AMD. Age, BCVA, CMT, and GC-IPL thickness should be considered when analyzing the OCTA data of patients with dry AMD. GC-IPL thickness is particularly important during clinical evaluation of VD and PD in patients with dry AMD.

Longitudinal Changes in Peripapillary Retinal Nerve Fiber Layer Thickness in High Myopia: A Prospective, Observational Study.

PURPOSE: To determine longitudinal change of peripapillary retinal nerve fiber layer (pRNFL) thickness in patients with high myopia without ophthalmic disease. DESIGN: Prospective observational study. PARTICIPANTS: Participants were divided into 2 groups: a high myopia group (80 eyes) that included eyes with an axial length ≥26.0 mm and a control group (80 eyes) that included eyes with a spherical equivalent (SE) between +3.0 and -6.0 diopters (D). Both groups were further divided into age subgroups by decade: 20s, 30s, 40s, and 50s. Each subgroup included 20 eyes. METHODS: After the initial visit, pRNFL thickness measurements were performed 2 times more with at least 1-year intervals between examinations using spectral-domain OCT. The mean pRNFL thickness was fitted with linear mixed models. MAIN OUTCOME MEASURES: The pRNFL thickness and rate of pRNFL thickness reduction. RESULTS: The mean patient age and thickness of the pRNFL at the first visit were 39.5±12.5 years and 90.16±9.06 µm, and 41.5±12.2 years and 96.80±9.50 µm in the high myopia and control groups, respectively. The high myopia group showed a significant reduction in mean pRNFL thickness between the first and second visits, and between the second and third visits (P < 0.001 and P = 0.002, respectively). For individuals aged 50 to 59 years, the reduction rate was -1.69 and -0.63 µm/year in the high myopia and control groups, respectively; the interaction between group and duration was significant (P = 0.014). The reduction rate in individuals aged 40 to 49 years was -1.70 and -0.48 µm/year in the 2 groups, respectively; the interaction was also significant (P = 0.031). Among those aged 30 to 39 years and 20 to 29 years, no such significant interactions were observed (-0.95 vs. -0.57 µm/year, P = 0.086 and -0.31 vs. -0.19 µm/year, P = 0.858, respectively). CONCLUSIONS: Highly myopic eyes had a significantly greater decrease in pRNFL over 2 years than normal eyes. In addition, the reduction rate of pRNFL thickness was greater in older patients with high myopia, whereas similar values were shown in normal controls except individuals aged 20 to 29 years.

Effect of combined goniotomy and phacoemulsification on intraocular pressure in open-angle glaucoma patients.

IMPORTANCE: Although goniotomy is known to be successful in treating congenital glaucoma, its effect in adult glaucoma patients remains unclear. BACKGROUND: To evaluate the efficacy and safety of goniotomy performed simultaneously with cataract surgery in treatment of open-angle glaucoma (OAG). DESIGN: Retrospective comparative study. PARTICIPANTS: A total of 76 patients with moderately controlled OAG (intraocular pressure [IOP] ≤ 21 mmHg using medications) undergoing cataract surgery. METHODS: Comparison of patients who underwent the conventional goniotomy during cataract surgery (combined goniotomy group) with those who underwent cataract surgery alone (phaco group). MAIN OUTCOME MEASURES: Changes in IOP and medications, and complications through 12 months. RESULTS: Baseline IOP was 18.2 ± 2.4 mmHg in the combined goniotomy group and 17.4 ± 1.9 mmHg in the phaco group; number of medications was 2.6 ± 1.1 and 2.4 ± 0.9, respectively (P > 0.05). The reduction in IOP and medication use from baseline in the combined goniotomy group was significantly greater at 12 months compared to the phaco group (-3.1 ± 2.9 mmHg vs -1.3 ± 2.4 mmHg and -1.2 ± 0.9 vs -0.7 ± 0.9, respectively, both P < 0.05). The success rate was 76.7% in the combined goniotomy group and 50.0% in the phaco group at 12 months (P = 0.021). No significant complication was observed in either group. CONCLUSIONS AND RELEVANCE: Combined goniotomy and cataract surgery showed a significantly greater reduction in IOP and number of medications compared to cataract surgery alone at 1 year after surgery, with similarly favourable safety profiles.

Fibromyxoma of the Tarsus: A Case Report.

A 61-year-old woman presented with a slow-growing mass on the right upper eyelid. The hard, fixed, and nontender mass was apparent on the right upper eyelid. It was immobile, and it seemed to be adhered to the tarsus. Total excision of the mass was performed. A histopathological examination revealed a solid mass with fibrous and myxoid areas with scattered spindle- to stellate-shaped cells in a fibromyxoid matrix. The immunochemistry examination stained positively for CD34 and CD99. Based on these findings, the lesion was diagnosed as a tarsal fibromyxoma. Although rare, a fibromyxoma originating from the tarsus should be considered in the differential diagnosis of solid tarsal lesions.

Clinical features and change in incidence of acute acquired comitant esotropia: a 15-year single-centre study in South Korea.

BACKGROUND/OBJECTIVES: We investigated the clinical features and change in incidence of AACE in South Korea. SUBJECTS/METHODS: We reviewed the medical records of AACE patients who visited the Strabismus Clinic of at a tertiary referral hospital from 2007 to 2021. Clinical features were retrieved, including age at onset, angle of deviation, refractive errors, neuroimaging findings, and treatment outcomes. For each year, the proportion of new AACE patients among all new patients who visited the clinic, and the ratio of new AACE patients to new intermittent exotropia (IXT) patients, were analysed to estimate the incidence of AACE. RESULTS: Overall, 59 patients were included in the study. The mean age of the patients was 24.7 ± 9.3 years; the incidence of AACE was highest in teenagers and young adults. No patients had a history of visual occlusion, recent physical or psychological stress, or uncorrected myopia, unlike to classic AACE; moreover, no patients exhibited abnormalities in neuroimaging. There was a significantly increasing trend in the proportion of new AACE patients among all new patients (linear regression analysis, R2 = 0.778, p < 0.001). There was also a significantly increasing trend in the ratio of new AACE patients to new IXT patients (R2 = 0.803, p < 0.001). CONCLUSIONS: A new type of AACE, distinct from the classic types, is increasingly common in South Korea; this increasing incidence also appears to be a global phenomenon. Large-scale investigations are needed to define the exact clinical features, incidence, and pathophysiology of this new type of AACE.

Intercalary staphyloma after strabismus surgery in a patient with Marfan syndrome: A case report.

RATIONALE: A few cases of intercalary staphyloma have been reported in patients with Marfan syndrome, but we believe that this is the first case of intercalary staphyloma in Marfan syndrome developing after strabismus surgery. PATIENT CONCERNS: A 9-year-old girl diagnosed with Marfan syndrome visited a strabismus clinic for treatment of esotropia. Both eyes were aphakic and had 60 prism diopter esotropia at distance and 55 prism diopter esotropia at near. There were no corneal, conjunctival, or scleral abnormalities. Six millimeters of recession was performed on both medial rectus muscles via an inferonasal fornix approach under general anesthesia. 5 days after surgery, a dark gray protruding lesion was observed on the upper nasal side of the left eye. DIAGNOSES: Intraocular ultrasonography showed no bleeding, retinal detachment, or other abnormal findings. Computed tomography showed a conical protrusion of the scleral wall which was diagnosed as intercalary staphyloma. INTERVENTIONS: To reduce risk of progression of the staphyloma in the left eye and to reduce risk of development of a new staphyloma, intraocular pressure lowering eye drops were administered. OUTCOMES: We just observed it without any intervention except the intraocular pressures lowering eye drops. It remained stable for 12 months. LESSONS: Clinicians need to be alert to the possibility of this serious complication in Marfan syndrome patients after minor surgical trauma, which can occur during uneventful strabismus surgery.

Epibulbar osseous choristoma with dermolipoma: A case report and review of literature.

BACKGROUND: A choristoma is defined as a growth of histologically normal tissue in an abnormal location. Epibulbar osseous choristoma is the rarest type among all ocular choristoma with less than 100 cases reported. Here, we report a case of epibulbar osseous choristoma combined with dermolipoma and a literature review. METHODS: A 15-year-old female patient presented with an accidentally found subconjunctival mass in her left eye. Slit lamp examination revealed a 10 × 10 mm elevated, sigmoid-shaped mass in the supratemporal quadrant of the bulbar conjunctiva. We performed a debulking excisional biopsy of the mass. RESULTS: The pathology confirmed osseous tissue surrounded by mature adipose tissue. At 1 week after the operation, the wound was clear and the patient was satisfied with the treatment. A systematic literature review of 14 previously published cases taken from PubMed dating back to 1987 along with ours was undertaken. The average age at presentation was 11.6 years and there was a female preponderance with 10 cases being female and the other 5 cases being male. Supratemporal conjunctiva was the most common site of presentation. There was no systemic disease associated with any of the cases. Since it is a benign tumor, it can be managed by observation, but if necessary, it can be treated by surgical removal. CONCLUSION: In pediatric subconjunctival mass, particularly located in supratemporal quadrant of bulbar conjunctiva, osseous choristoma should be considered in the differential diagnosis. Pre-operative CT scans will helpful to not also reduce complication with surgical excision but also helpful in prediction of diagnosis and prognosis.

Multiple facial candidal abscesses after self-administered acupuncture in a patient with undiagnosed diabetes mellitus: a case report.

BACKGROUND: Facial abscess caused by Candida albicans infection is a rare condition even in immunocompromised patients, and only a few cases have been reported. To our knowledge, this is the first case of multiple facial candidal abscesses caused by self-administered acupuncture in an undiagnosed diabetes mellitus patient. CASE PRESENTATION: A 57-year-old woman who had self-acupuncture treatment 2 weeks previously, presented with a 1-week history of progressive left eyelid swelling, erythema, and pain. Despite the antibiotic treatment, the lesion progressed. Surgical incision and drainage was performed and Candida albicans was isolated from the obtained pus culture. The patient was diagnosed with type 2 diabetes mellitus based on a random serum glucose level of 350 mg/dl and 9.2% HbA1c. The abscess resolved after seven incision and drainage cycles and 4 weeks of intravenous fluconazole treatment with an appropriate control of diabetes mellitus. CONCLUSION: Unusual organisms and underlying immunocompromised condition should be suspected in cases of recurrent abscess showing an inadequate response to antibiotic treatment.

Risk Factors for Orbital Implant Extrusion after Evisceration.

This study analyzed risk factors for extrusion of orbital implants after evisceration by comparing patients with and without implant extrusion. METHODS: We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2019 at the Chungnam National University Hospital. Age, sex, underlying systemic diseases, axial length of the fellow eye, the cause of evisceration, endophthalmitis type, implant type and size, and preoperative computed tomography findings were evaluated. Logistic regression analysis was used to identify the risk factors for implant extrusion. RESULTS: Of the 140 eyes of 140 patients, extrusion occurred in five eyes (3.6%). Endophthalmitis (odds ratio (OR), 15.49; 95% confidence interval (CI), 1.70 to 2038.56; p = 0.010), endogenous endophthalmitis (OR, 18.73; 95% CI, 3.22 to 125.21, p = 0.002), orbital cellulitis (OR, 320.54; 95% CI, 29.67 to 44801.64; p < 0.001), implant size (OR, 0.50; 95% CI, 0.30 to 0.79; p = 0.004), and hydroxyapatite for the implant (OR, 0.07; 95% CI, 0.00 to 0.66; p = 0.016) were risk factors for implant extrusion in univariate logistic regression analysis. Multiple logistic regression analysis identified orbital cellulitis as the only risk factor for extrusion (OR, 52.98; 95% CI, 2.18 to 15367.34; p = 0.009). CONCLUSIONS: Evisceration with primary orbital implantation is a feasible option in endophthalmitis, but the risk of extrusion should be taken into consideration. When performing evisceration in a patient with orbital cellulitis, secondary implantation should be carried out only after any infection is controlled.

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis.

PURPOSE: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. METHODS: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). RESULTS: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). CONCLUSIONS: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

Modified ocular surface disease index as a screening criteria for dry eye syndrome presenting after successful dacryocystorhinostomy.

OBJECTIVE: To find preoperative screening criteria for dry eye syndrome (DES) that present after successful endoscopic dacryocystorhinostomy (EDCR). METHODS: We retrospectively analyzed medical records of 110 patients who underwent EDCR for nasolacrimal duct obstruction. DES diagnostic criteria were defined as tear break-up time (TBUT) less than 10 seconds, and ocular surface disease index (OSDI) score greater than 13 points. After EDCR, patients were divided into DES group and control group according to the DES diagnostic criteria. Preoperative OSDI score alone or in combination of preoperative TBUT and OSDI score were used to find screening criteria, which could discriminate the two groups preoperatively with a high positive predictive value (PPV). Criteria A was set same as the diagnostic criteria of DES, and Criteria B and C were set to improve PPV by increasing specificity while maintaining similar sensitivity to Criteria A. RESULTS: Thirty patients (27.3%) were diagnosed with DES after EDCR, while 80 patients (72.7%) were normal. In patients with DES, preoperative TBUT was not different (p = 0.851), but OSDI score was significantly higher (p<0.001). Criteria A showed a sensitivity of 73.3%, specificity of 55.0%, and PPV of 38.0%. Criteria B and C excluded preoperative TBUT, which had no difference between the two groups, and set screening criteria with preoperative OSDI score alone. Criteria B (preoperative OSDI score of 19.6 points or more) showed a sensitivity of 75.0%, specificity of 60.6%, PPV of 41.7% and AUC of 0.739 (p < 0.001). Criteria C was consisted of 5 out of 12 OSDI items that showed significant differences between the two groups; blurred vision, reading, working with a computer, low humidity, and air conditioning. Criteria C (preoperative 5-item OSDI score of 24.4 points or more) was a better predictability, with a sensitivity of 75.0%, specificity of 71.3%, PPV of 49.5%, and AUC of 0.804 (p < 0.001). The AUC of Criteria C was significantly higher than that of Criteria B (p = 0.0037). CONCLUSION: DES occurred after successful EDCR in 27.3% of patients, and an OSDI questionnaire helped to screen DES. The predictability could improve using the modified OSDI score which showed noticeable difference in five OSDI items before and after EDCR.

Longitudinal changes in the ganglion cell-inner plexiform layer thickness of age-related macular degeneration.

PURPOSE: To determine longitudinal changes of the ganglion cell-inner plexiform layer (GC-IPL) thickness in patients with non-exudative age-related macular degeneration (AMD) without other ophthalmic disease. METHODS: Thirty-three eyes of 33 patients with early and intermediate non-exudative AMD (non-exudative AMD group) and 33 normal control eyes were followed for 2 years, and GC-IPL thickness was measured by spectral domain optical coherence tomography at 1-year intervals. The mean rate of GC-IPL reduction was estimated using a linear mixed model and compared between two groups. RESULTS: The mean age of patients in the non-exudative AMD group and control groups were 68.82 ± 6.81 years and 67.73 ± 5.87 years, respectively (p = 0.488). The mean GC-IPL thickness at the first visit was 76.61 ± 16.33 µm in the non-exudative AMD and 81.76 ± 3.69 µm in control group (p = 0.387), and these values significantly decreased over time, with an average reduction rate of average GC-IPL -0.86 µm/year in the non-exudative AMD group and -0.32 µm/year in the control group. The difference between two groups was statistically significant (p < 0.001), and there was also a significant interaction between group and duration in linear mixed models in mean GC-IPL thickness (p = 0.001). CONCLUSIONS: The reduction rate of the GC-IPL thickness was greater in non-exudative AMD eyes, even at relatively early stages of the disease. Physicians should maintain awareness of the presence of non-exudative AMD in various cases of ophthalmic diseases where GC-IPL thickness evaluation is necessary.

Characterization of ozone disinfection of murine norovirus.

Despite the importance of human noroviruses (NoVs) in public health, little information concerning the effectiveness of ozone against NoVs is available. We determined the efficacy of ozone disinfection using murine norovirus (MNV) as a surrogate of human NoV. MNV in ozone demand-free buffer was exposed to a predetermined dose of ozone at two different pHs and temperatures. The virus remaining in the solution was analyzed by plaque assay, real-time TaqMan reverse transcriptase PCR (RT-PCR) (short template), and long-template conventional RT-PCR. Under all conditions, more than 99% of the MNV was inactivated by ozone at 1 mg/liter within 2 min. Both RT-PCR assays significantly underestimated the inactivation of MNV, compared with that measured by plaque assay. Our results indicate that NoV may be more resistant to ozone than has been previously reported. Nevertheless, proper ozone disinfection practices can be used to easily control its transmission in water.

Longitudinal Changes in Ganglion Cell-Inner Plexiform Layer of Fellow Eyes in Unilateral Neovascular Age-Related Macular Degeneration.

PURPOSE: To determine longitudinal changes in the ganglion cell-inner plexiform layer (GC-IPL) thickness of the fellow eyes of patients with neovascular age-related macular degeneration (AMD). DESIGN: Prospective cohort study. METHODS: Patients with unilateral neovascular AMD, unilateral polypoidal choroidal vasculopathy (PCV), and control subjects were included. After the initial visit, GC-IPL thickness was measured twice more with at least a 1-year interval between examinations using spectral domain optical coherence tomography. RESULTS: Twenty-seven fellow eyes of patients with unilateral choroidal neovascularization (CNV), 33 fellow eyes of patients with unilateral PCV, and 35 eyes of control subjects were enrolled. The GC-IPL thickness of the fellow eyes was 78.41 ± 9.23, 81.20 ± 5.52, and 81.60 ± 3.83 µm in the CNV, PCV, and control groups, respectively, and they showed a significant change over time (P < .001, P = .001, and P = .003, respectively). The reduction rate of GC-IPL thickness was -0.88, -0.41, and -0.31 µm per year in the fellow eyes of the CNV, PCV, and control groups, respectively (CNV > PCV, control, P < .001). In a linear mixed model determination of factors associated with GC-IPL reduction in the fellow eyes of the CNV group, the interaction between baseline GC-IPL thickness and duration showed a significant result (P < .001). CONCLUSIONS: The fellow eyes of patients with neovascular AMD showed a greater reduction rate of GC-IPL thickness compared with fellow eyes of patients with unilateral PCV and control subjects. In patients with unilateral neovascular AMD, fellow eyes with a thicker GC-IPL at baseline showed a greater reduction in GC-IPL thickness over time.

Influence of Epiretinal Membranes on the Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography in Glaucoma.

PURPOSE: We investigated changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) following the onset of an epiretinal membrane (ERM) in glaucoma patients. METHODS: Among regularly monitored glaucoma patients, patients with a newly diagnosed ERM were consecutively enrolled. Before and after the onset of ERM, the RNFL thickness was measured using spectral domain optical coherence tomography, and a visual field examination was performed using a Humphrey field analyzer. Changes in RNFL thickness parameters and global indices of the visual field analyzer were assessed. RESULTS: In a total of 28 eyes from 28 patients, the average RNFL thickness increased by a mean of 4.0 ± 7.4 µm (p = 0.009) after ERM onset. There was an increase in the superior, nasal, and temporal quadrant RNFL thicknesses, and the change in the temporal RNFL thickness was significant (14.4 ± 21.2 µm, p < 0.001). However, the inferior RNFL thickness decreased by -0.6 ± 7.5 µm (p = 0.116). In the visual field examination, the mean deviation decreased significantly by -0.8 ± 1.7 dB (p = 0.038), from -14.6 to -15.4 dB. CONCLUSIONS: A significant increase in average RNFL thickness was detected following ERM onset in glaucoma patients, although there was deterioration of the mean deviation in the visual field. When ERM occurs in glaucoma patients, clinicians should be aware that RNFL thickness measurements obtained with a spectral domain optical coherence tomography may underestimate the status of glaucomatous optic neuropathy.

Effect of Preoperative Factor on Intraocular Pressure after Phacoemulsification in Primary Open-angle Glaucoma and Primary Angle-closure Glaucoma.

PURPOSE: To compare the effects of cataract surgery on intraocular pressure (IOP) according to preoperative factor in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS: The medical records of 75 POAG and 95 PACG patients who underwent cataract surgery were reviewed. We classified POAG patients with a preoperative peak IOP of less than 31 mmHg and less than three medications used before surgery and PACG patients with a peak IOP of less than 42 mmHg, less than three medications used, and peripheral anterior synechiae of less than four clock hours into group 1. Patients with levels exceeding these thresholds were classified into group 2. The IOP, numbers of medications, and success rates were compared between two groups. RESULTS: At 36 months after surgery, IOP reduction in group 1 was significantly greater than that in group 2 among POAG patients (-1.7 ± 2.1 vs. -0.6 ± 2.0 mmHg, p = 0.021); however, there was no significant difference between the two groups for PACG patients (-2.5 ± 2.0 vs. -2.2 ± 3.3 mmHg, p = 0.755). The medication changes were similar between the two groups for both POAG and PACG patients. The success rate at 36 months was significantly higher in group 1 than in group 2 for POAG patients (66.7% vs. 35.7%, p = 0.009), but there was no significant difference between the two groups for PACG patients (79.1% vs. 69.2%, p = 0.264). CONCLUSIONS: For patients with relatively low peak IOP who used fewer medications before surgery, cataract surgery alone was effective for IOP control in both POAG and PACG patients. Conversely, For POAG patients with a history of higher peak IOP and who used more medications, cataract surgery was not effective in lowering IOP, whereas it resulted in relatively good IOP values in PACG patients.

The Importance of Signal Strength in Quantitative Assessment of Retinal Vessel Density Using Optical Coherence Tomography Angiography.

The quality of the scan image is important in microvascular circulation analysis using optical coherence tomography (OCTA). We aimed to investigate the effect of signal strength (SS) on OCTA metrics and minimum SS level that could be considered optimal. Macular 6 × 6 mm angiography images were acquired, and all subjects were divided into four groups according to the SS (SS 7, SS 8, SS 9, and SS 10) of the OCTA image. Vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) metrics of the superficial capillary plexus were compared. In total, 446 eyes from young healthy subjects were included. As the SS increased from 7 to 10, the VD and PD of the total area, and the FAZ area increased significantly (all, p < 0.001), but there were no significant difference between SS 9 and SS 10 in all metrics. Correlation analysis between the SS and each parameter showed a high correlation coefficient (VD, r = 0.668; PD, r = 0.671; FAZ area, r = 0.570; all, p < 0.001). The measurements of VD, PD, and FAZ using OCTA varied significantly with the SS, and at least 9 of SS is recommended. The physician should be careful in the analyses of OCTA measurements showing different values of the SS.