To compare early-stage intrableb structural changes after Ex-PRESS surgery using anterior-segment optical coherence tomography between primary open-angle glaucoma (POAG) and exfoliation glaucoma ...(XFG).
Twenty-five POAG eyes and 15 XFG eyes that underwent Ex-PRESS surgery were evaluated. Intrableb images were classified into four categories based on previously reported scattering intensity: high-, medium-, and low-scattering walls and fluid-filled spaces. Bleb measurements were evaluated in both groups throughout 6 postoperative months. The 3-year surgical success was defined by the criteria intraocular pressure (IOP) < 18 mmHg and IOP < 15 mmHg with or without medications.
The fluid-filled space volume at 3 and 6 months (P = 0.005 and P = 0.022, respectively) and the volume ratio of the low-scattering wall to the bleb wall (P = 0.028) at 6 months were significantly smaller in XFG than POAG postoperatively. The volume ratio of the high-scattering wall to the bleb wall was correlated positively (P = 0.007) with the IOP, and that of the low-scattering wall to the bleb wall was correlated negatively (P = 0.002) with the IOP in XFG. The 3-year surgical success rates for both criteria were significantly lower in XFG than POAG.
Fluid-filled spaces were smaller in XFG than in POAG after Ex-PRESS surgery. The proportion of the high-scattering wall tended to increase and the low-scattering wall tended to decrease in XFG eyes with high IOP. Early-stage intrableb structural changes differed between POAG and XFG and may affect the prognosis.
Our cutting-edge observation of intrableb fibrosis can be an important predictor of the surgical outcome.
To evaluate and compare the abilities of enhanced depth imaging (EDI) and high-penetration optical coherence tomography (HP-OCT) to visualize the deep optic nerve head (ONH) and deep parapapillary ...structures.
Horizontal and vertical optic nerve images were obtained using EDI-OCT and HP-OCT, during the same visit, from 24 eyes of 12 patients with glaucoma. Three graders, using a three-point grading system, independently graded the visibility of the deep ONH structures (prelaminar tissue surface, anterior laminar surface, posterior laminar border, and laminar pores) and deep parapapillary structures (intrascleral vessels, cerebrospinal fluid space, and parapapillary choroid). The differences in the visibility scores between the EDI-OCT and the HP-OCT images and among the image locations were analyzed statistically. The agreement in scoring among the graders also was analyzed.
The visibility of three ONH structures, the anterior laminar surface, posterior laminar border, and laminar pores, was significantly better with EDI-OCT (P = 0.0010, P < 0.0001, and P = 0.0141, respectively). In contrast, the visibility of all parapapillary structures was significantly better with HP-OCT (P < 0.0001, P = 0.0176, and P < 0.0001, respectively). The visibility scores were better in the vertical images compared with the horizontal images and were best in the temporal quadrants. The intergrader agreement was moderate for all parameters examined.
Both EDI-OCT and HP-OCT are useful for evaluating the deep ONH and parapapillary structures. The visibility scores of the deep ONH structures were better with EDI-OCT, in contrast to the better visibility scores of the deep parapapillary structures with HP-OCT. Both systems should be chosen depending on the target tissue to observe.
To determine the incidence and risk factors for delayed-onset intraocular pressure (IOP) elevations after vitrectomy for Stages 4 and 5 retinopathy of prematurity and, in addition, to determine the ...results of treating the IOP elevations.
Fifty-five consecutive eyes with successful retinal reattachment and at least 24 months of follow-up after vitrectomy were studied. The ophthalmic examinations included slit-lamp biomicroscopy, wide-field digital retinal imaging, and IOP measurements. Eyes were classified into 2 groups: eyes with a postoperative IOP elevation to ≥ 21 mmHg and eyes whose IOP was always <21 mmHg.
Eight eyes (14.5%) developed an IOP elevation to ≥ 21 mmHg from 2 months to 4 months (median: 2.5 months) after the vitrectomy. In two of these eyes, the IOP was controlled with antiglaucoma medications. In the other six eyes, trabeculotomy for eyes with open angles and trabeculectomy or goniosynechialysis for eyes with closed angles were performed. The IOPs were successfully controlled after an average of 1.5 glaucoma surgeries. Multivariate logistic regression analyses identified that a young gestational age (odds ratio = 1.147, 95% confidence interval: 1.024-1.346) and lensectomy (odds ratio = 8.795, 95% confidence interval: 1.262-183.3) were significantly associated with the IOP elevation.
Delayed-onset IOP elevation after vitrectomy for retinopathy of prematurity occurs in 14.5% of the eyes, and it is significantly associated with a young gestational age and presence of lensectomy.
To evaluate the clinical outcomes and biologic effects on the aqueous humor concentrations of vascular endothelial growth factor (VEGF) in patients with neovascular glaucoma (NVG) treated with ...intravitreal bevacizumab (IVB).
Twenty-nine consecutive patients (35 eyes) treated with 1.0- or 0.1-mg injections of IVB for NVG between January and December 2009 were enrolled in this retrospective, interventional pilot study. The visual prognosis and changes in intraocular pressure (IOP) were followed for >6 months after the initial injection. Aqueous humor samples were obtained at the initial IVB injection from all study eyes and 1 week after the first injection in eyes undergoing a second intervention to measure the VEGF concentration.
The VEGF concentrations in the 35 eyes significantly correlated (r=0.535, P<0.001) with the pretreatment IOP. The mean reductions of the VEGF levels 1 week after IVB did not differ significantly between the 1.0- and 0.1-mg groups (P=0.738). Despite more repeated injections in the 0.1-mg group and additional medical or surgical interventions in both groups, both dosages inhibited the neovascular activity. The ability to control the IOP after IVB did not differ significantly between groups at 1 week (P=0.625) and 6 months (P>0.99). Visual improvements also did not differ significantly between groups during the 6-month follow-up (P=0.437).
Aqueous humor levels of VEGF were significantly correlated with the IOP. Low-dose (0.1 mg) IVB was as effective as the currently used higher dose (1.0 mg) for treating NVG within at least 6 months after the initial injection.
•An ONH model with asymmetric central retinal vessels was created.•Realistic CRV geometry was constructed from OCT images.•The CRVs resulted in anisotropic deformation in the ONH region.•Local strain ...concentration was found in the upper neural tissues of ONH.
Optic nerve head (ONH) biomechanics are associated with glaucoma progression and have received considerable attention. Central retinal vessels (CRVs) oriented asymmetrically in the ONH are the single blood supply source to the retina and are believed to act as mechanically stable elements in the ONH in response to intraocular pressure (IOP). However, these mechanical effects are considered negligible in ONH biomechanical studies and received less attention. This study investigated the effects of CRVs on ONH biomechanics taking into consideration three-dimensional asymmetric CRV geometries. A CRV geometry was constructed based on CRV centerlines extracted from optical coherence tomography ONH images in eight healthy subjects and superimposed in the idealized ONH geometry established in previous studies. Mechanical analyses of the ONH in response to the IOP were conducted in the cases with and without CRVs for comparison. Obtained results demonstrated that the CRVs induced anisotropic ONH deformation, particularly in the lamina cribrosa and the associated upper neural tissues (prelamina) with wide ranges of spatial strain distributions. These results indicated that the CRVs result in anisotropic deformation with local strain concentration, rather than function to mechanically support in response to the IOP as in the conventional thinking in ophthalmology.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Précis:
Treatment with topical prostaglandin analogues (PGAs) induces increased corneal compliance in glaucoma eyes measured with a dynamic Scheimpflug analyzer.
Purpose:
The purpose of this study ...was to evaluate the effect of topical PGAs on the corneal biomechanical properties.
Methods:
We retrospectively studied the biomechanical parameters of 31 eyes of 19 consecutive patients with glaucoma measured using a dynamic Scheimpflug analyzer (Corvis ST) before and after initiation of treatment with topical PGAs. No patients had a history of glaucoma treatment before the study and no other antiglaucoma medication was used during the study period. Nine biomechanical parameters were evaluated before and 61.6±28.5 days (range: 21 to 105 d) after initiation of the treatment. The changes in the corneal biomechanical parameters before and after treatment were analyzed using multivariable models adjusting for intraocular pressure and central corneal thickness. The Benjamini–Hochberg method was used to correct for multiple comparison.
Results:
In multivariable models, PGA treatment resulted in shorter inward applanation time (
P
=0.016, coefficient=−0.151) and larger deflection amplitude (
P
=0.023, coefficient=0.055), peak distance (
P
=0.042, coefficient=0.131), and deformation amplitude ratio at 1 mm (
P
=0.018, coefficient=0.028). These associations consistently indicated increased corneal compliance (deformability) after PGA treatment.
Conclusion:
Topical PGAs resulted in greater corneal compliance, suggesting that the changes in the corneal biomechanical properties may lead to overestimation of the intraocular pressure–lowering effects.
Introduction
This study aimed to clarify the efficacy and safety of omidenepag isopropyl (OMDI) in a retrospective, real-world, multicenter setting.
Methods
A retrospective medical chart review of ...patients with glaucoma and ocular hypertension receiving OMDI from November 2018 to November 2019 with at least 12 weeks of follow-up was conducted in 11 eye clinics in Japan. The participants were categorized into three therapy groups, designated the naïve monotherapy, switching monotherapy, and concomitant therapy groups. The main outcome measures were the change in intraocular pressure (IOP) at week 4 and week 12 after the initiation of OMDI treatment, and frequency of adverse drug reactions.
Results
Data were collected from 827 patients. The baseline IOP in the naïve group was 16.6 ± 4.2 mmHg. The mean IOP reduction at week 4 and week 12 was − 2.9 ± 3.2 mmHg (
P
< 0.0001) and − 2.5 ± 2.9 mmHg (
P
< 0.0001), respectively. Eyes with baseline IOP less than 16 mmHg also showed a significant reduction of IOP of − 1.4 ± 2.0 mmHg at week 12. OMDI significantly reduced IOP not only in eyes with primary open-angle glaucoma but also in eyes with primary angle-closure glaucoma and secondary glaucoma. In the switching monotherapy group, IOP did not change significantly after switching from most classes of medications to OMDI, but further IOP reduction was observed in the case of switching from beta-blockers to OMDI. The frequency of adverse drug reactions was 14.1% in all participants, and the most common adverse reaction was ocular hyperemia (7.6%). No serious and severe side effects were observed in this study.
Conclusion
OMDI showed an IOP-lowering effect in eyes with various types of glaucoma and using various therapeutic regimens in real-world clinical practice. In addition, OMDI did not show any serious and severe side effects, suggesting the potential of OMDI as a first-line medicine for the treatment of glaucoma.
Trial Registration
University Hospital Medical Information Network (UMIN): 000040040.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
PurposeTo investigate the relationship between biomechanical glaucoma factor (BGF) measured with Corvis ST and glaucomatous visual field (VF) progression, compared to corneal hysteresis (CH) measured ...with ocular response analyzer using a longitudinal dataset of primary open-angle glaucoma (POAG). The discriminative powers of BGF and CH were also compared using a cross-sectional dataset. MethodsThe longitudinal dataset included 166 POAG eyes. The rate of VF change during the follow-up period was evaluated using the mean of 52 pointwise total deviations in the Humphrey 24-2 field test. Variables associated with the VF progression rate were identified from BGF, CH, age, baseline VF severity, and intraocular pressure during the VF follow-up period by identifying the optimal model. The cross-sectional dataset included 68 POAG eyes and 68 healthy eyes. Using this dataset, the area under the curve (AUC) values of the receiver-operating curve were compared between CH and BGF. ResultsThe optimal multivariate linear mixed model to describe the VF rate included age and CH, but not BGF. Between POAG and healthy eyes, CH was statistically different (P < 0.001), although this was not the case with BGF. The AUC values were 0.61 and 0.71 for BGF and CH, respectively (P = 0.027). ConclusionsCH, but not BGF, was associated with VF progression in POAG patients under treatment. BGF was not useful to discriminate POAG between treated and normal eyes.
To report the efficacy of the perfluorocarbon liquid-air exchange with a head tilt toward the area of the giant retinal tear (GRT) using the heads-up surgery system to prevent retinal slippage during ...vitrectomy for GRT-associated retinal detachments.
Eyes with GRT-associated retinal detachments underwent vitrectomy using the heads-up surgery system and perfluorocarbon liquid-air exchange with a head tilt 45° toward the GRT to put the area of the tear in the most dependent position to drain fluid. This technique was evaluated to prevent retinal slippage.
Five consecutive cases were evaluated. The mean GRT size was 174° (range, 90-240°) and the GRT was located temporally in two eyes, nasally in two eyes, and superiorly in one eye. The tamponade types were air (1 eye), sulfur hexafluoride (3 eyes), and perfluoropropane (1 eye). Our technique was feasible and the slippage did not occur in any eyes. Although the microscope needed to be tilted for optimal fundus visualization, heads-up surgery allowed surgeons to maintain ergonomic postures. Retinal reattachment was achieved with a single surgery in all eyes.
The head-tilt perfluorocarbon liquid-air exchange with heads-up surgery is useful in preventing retinal slippage in eyes with GRT.
The purpose of this study was to clarify correlations between corneal deformation parameters measured with a dynamic Scheimpflug analyzer and baseline factors such as axial length, intraocular ...pressure (IOP), age, central corneal thickness (CCT), and corneal curvature.
Ninety-six eyes of 96 healthy subjects (mean 55.2 ± 16.1 years of age) were examined using a dynamic Scheimpflug analyzer. Eighteen of 35 deformation parameters were selected for analyses based on measurement reliability and clinical relevance. The associations between corneal deformation parameters and axial length, IOP, age, CCT, and average corneal power were evaluated using multivariate regression analyses.
Deformation parameters were correlated significantly with axial length (n = 13), IOP (n = 13), age (n = 8), and CCT (n = 6) in the multivariate models. Longer axial length corresponded with greater corneal deformability, less viscous damping, and less movement of the entire eye. Higher IOP was associated with greater corneal resistance and less movement of the entire eye. Older age was associated with less corneal deformability and greater movement of the entire eye. Corneal curvature was correlated significantly with only three deformation parameters.
This study clarified the substantial impact of axial length, age, and IOP on the biomechanical responses of the cornea and the entire eye. In contrast, corneal curvature did not affect most of the deformation parameters. The current results confirmed the importance of corneal biomechanics, especially in eyes with longer axial length and in older subjects.
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