Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold ...standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15–19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure.
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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
We sought to construct and evaluate a deep learning (DL) model to diagnose early glaucoma from spectral-domain optical coherence tomography (OCT) images.
Artificial intelligence diagnostic tool ...development, evaluation, and comparison.
This multi-institution study included pretraining data of 4316 OCT images (RS3000) from 1371 eyes with open angle glaucoma (OAG) regardless of the stage of glaucoma and 193 normal eyes. Training data included OCT-1000/2000 images from 94 eyes of 94 patients with early OAG (mean deviation > −5.0 dB) and 84 eyes of 84 normal subjects. Testing data included OCT-1000/2000 from 114 eyes of 114 patients with early OAG (mean deviation > −5.0 dB) and 82 eyes of 82 normal subjects. A DL (convolutional neural network) classifier was trained using a pretraining dataset, followed by a second round of training using an independent training dataset. The DL model input features were the 8 × 8 grid macular retinal nerve fiber layer thickness and ganglion cell complex layer thickness from spectral-domain OCT. Diagnostic accuracy was investigated in the testing dataset. For comparison, diagnostic accuracy was also evaluated using the random forests and support vector machine models. The primary outcome measure was the area under the receiver operating characteristic curve (AROC).
The AROC with the DL model was 93.7%. The AROC significantly decreased to between 76.6% and 78.8% without the pretraining process. Significantly smaller AROCs were obtained with random forests and support vector machine models (82.0% and 67.4%, respectively).
A DL model for glaucoma using spectral-domain OCT offers a substantive increase in diagnostic performance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This study was aimed to review the etiology and the outcomes of current posterior chamber phakic intraocular lens (Visian ICL, STAAR Surgical) extraction. This review comprised 770 eyes of 403 ...consecutive patients undergoing ICL extraction. We evaluated prevalence, etiology, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), predictability, and patient satisfaction. ICL extraction was required in 8 of 770 (1.0%) eyes. The most common reason was the progression of the pre-existing cataract formation in 5 eyes (63%), followed by residual refractive errors in 3 eyes (38%). Of the 7 eyes targeted for emmetropia, 7 (100%) and 6 (86%) achieved UDVAs of 20/40 and 20/20 or better, respectively. Three eyes (38%) showed no change in CDVA, 3 eyes (38%) gained 1 line, 2 eyes (25%) gained 3 or more lines. 88% and 100% were within ± 0.5 and 1.0 diopter (D), respectively, of the targeted correction. Patient satisfaction improved significantly, from 3.0 ± 1.4 preoperatively, to 8.0 ± 2.4 postoperatively. No vision-threatening complications occurred. ICL extraction was required in approximately 1% of ICL-implanted eyes. Visual and refractive outcomes were good, and patient satisfaction was overall high, even in ICL-extracted eyes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Purpose To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas in eyes undergoing combined cataract surgery and ...trabeculectomy. Methods We retrospectively reviewed the clinical charts of 56 consecutive eyes undergoing cataract surgery and trabeculectomy. IOL power calculations were performed using the Barrett Universal II and SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ± 0.5 D and ±1.0 D of the targeted refraction, 3 months postoperatively, and also investigated the relationship of the prediction error with the keratometric readings and axial length, using the two formulas. Results The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the Barrett Universal II formula was significantly smaller than that using the SRK/T formula (p = 0.039). We found significant correlations of the prediction error with the axial length (Pearson correlation coefficient, r = 0.273, p = 0.042), and the keratometric readings (r = -0.317, p = 0.017), using SRK/T formula, but no significant correlations between them (r = 0.219, p = 0.167, and r = -0.023, p = 0.870), using the Barrett Universal II formula. Conclusions The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the axial length and the corneal shape, than the SRK/T formula. The Barrett Universal formula, rather than the SRK/T formula, may be clinically helpful for improving the refractive accuracy in such eyes.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study was aimed to determine the effect of the amount of astigmatism on distance visual acuity, and to provide a prediction formula of visual acuity according to astigmatism, in a presbyopic ...population. We comprised 318 eyes of 318 consecutive patients (158 phakic and 160 pseudophakic subjects) without any eye diseases, except for refractive errors with astigmatism of 3 diopter or less. We assessed the relationship of the spherical equivalent visual acuity (SEVA) with astigmatism, and also provided a regression formula of visual acuity according to astigmatism in such subjects. We found a significant correlation between the SEVA and the amount of astigmatism (r = 0.715, p < 0.001) in the entire study population. We obtained similar results, not only in phakic eyes (r = 0.718, p < 0.001), but also in pseudophakic eyes (r = 0.717, p < 0.001). The regression formula was expressed as follows: y = 0.017x
+ 0.125x - 0.116 (R
= 0.544), where y = logMAR SEVA, and x = astigmatism. We also found no significant differences in the SEVA for matched comparison among the with-the-rule (WTR), against-the-rule (ATR), and oblique (OBL) astigmatism subgroups (p = 0.922). These regression formulas may be clinically beneficial not only for estimating the visual prognosis after astigmatic correction, but also for determining the surgical indication of astigmatic correction.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
This study was aimed to assess the outcomes of simultaneous phototherapeutic keratectomy (PTK) and photoastigmatic keratectomy (PAK), with special attention to astigmatic correction. We comprised 70 ...eyes of 70 patients who underwent simultaneous PTK and PAK in patients having granular corneal dystrophy and band keratopathy with refractive astigmatism of 1 diopter (D) or more. Preoperatively and 6 months postoperatively, we assessed corrected uncorrected distance visual acuity (UDVA), distance visual acuity (CDVA), manifest spherical equivalent, refractive astigmatism, corneal astigmatism, and higher-order aberrations (HOAs). LogMAR CDVA significantly improved, from 0.27 ± 0.27 preoperatively, to 0.13 ± 0.21 postoperatively (Paired t test, p < 0.001). LogMAR UDVA also significantly improved, from 0.70 ± 0.32 preoperatively, to 0.57 ± 0.41 postoperatively (p = 0.043). Refractive astigmatism significantly decreased, from 2.12 ± 0.95 D preoperatively, to 0.89 ± 0.81 D postoperatively (p < 0.001). Corneal astigmatism also significantly decreased, from 2.17 ± 0.90 D preoperatively, to 1.08 ± 0.71 D postoperatively (p < 0.001). Corneal HOAs did not significantly change, from 0.54 ± 0.30 µm preoperatively, to 0.48 ± 0.20 µm postoperatively (p = 0.140). No significant complications occurred in any eye. Simultaneous PTK and PAK treatment is effective not only for improving visual acuity, but also for reducing astigmatism.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The aim of the study was to investigate the usefulness of processing visual field (VF) using a variational autoencoder (VAE). The training data consisted of 82,433 VFs from 16,836 eyes. Testing ...dataset 1 consisted of test-retest VFs from 104 eyes with open angle glaucoma. Testing dataset 2 was series of 10 VFs from 638 eyes with open angle glaucoma. A VAE model to reconstruct VF was developed using the training dataset. VFs in the testing dataset 1 were then reconstructed using the trained VAE and the mean total deviation (mTD) was calculated (mTD
). In testing dataset 2, the mTD value of the tenth VF was predicted using shorter series of VFs. A similar calculation was carried out using a weighted linear regression where the weights were equal to the absolute difference between mTD and mTD
. In testing dataset 1, there was a significant relationship between the difference between mTD and mTD
from the first VF and the difference between mTD in the first and second VFs. In testing dataset 2, mean squared prediction errors with the weighted mTD trend analysis were significantly smaller than those form the unweighted mTD trend analysis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The aim of this cross-sectional study was to evaluate the results of a visual field (VF) test for patients with glaucoma and pseudo-fixation loss. These patients exhibit fixation loss (FL) rates >20% ...with the Humphrey Field Analyzer (HFA); however, actual fixation stabilizes when a head-mounted perimeter (imo) is used. This device is able to adjust the stimulus presentation point by tracking eye movements. We subjected 54 eyes of 54 patients with glaucoma and pseudo-FL to the HFA 30-2 or 24-2 Swedish Interactive Threshold Algorithm -Standard protocol. All patients also underwent the imo 30-2 or 24-2 Ambient Interactive Zipper Estimated Sequential Testing protocol after HFA measurement. We compared HFA and imo reliability indices including false-positive (FP) responses, false-negative (FN) responses, and FL rate, global indices including mean deviation (MD), visual field index (VFI), and pattern standard deviation (PSD), and retinal sensitivity for each test point. There were no significant differences in MD, VFI, and PSD between HFA and imo, and these measures were strongly correlated (r > 0.96, p < 0.01). There were no significant differences in FP and FN between both devices, while FL measured with HFA (27.5%) was significantly reduced when measured with imo (13.2%) (p < 0.01). There was no correlation in FL and FN between both devices, and a weak correlation for FP (r = 0.29, p = 0.04). At each test point, retinal sensitivity averaged 1.7 dB higher with HFA, compared with imo (p < 0.01). There was no significant variability in global indices in patients with pseudo-FL. The FP response rate might have influenced measures of FL in patients with glaucoma and pseudo-FL.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PURPOSE:The purpose of this study was to evaluate the influence of trabectome surgery on corneal endothelial cells by site.
METHODS:Retrospective observational study. Trabectome surgeries were ...performed on 159 eyes of 132 adult Japanese patients. Corneal endothelial cells were measured at the center (C), inferior (I), nasal inferior (NI), nasal superior (NS), superior (S), temporal superior (TS), and temporal inferior (TI) sectors at <1 month preoperatively and 3, 6, 12, 24, and 36 months postoperatively, for changes in corneal endothelial cell density (ECD), coefficient of variation (CV), and incidence of hexagonal cells (6A).
RESULTS:Mean preoperative ECD in all groups were 2401±451 (SD) cells/mm (C), 2366±450 cells/mm (I), 2397±479 cells/mm (NI), 2476±554 cells/mm (NS), 2493±596 cells/mm (S), 2464±558 cells/mm (TS), and 2329±510 cells/mm (TI). The 12-month postoperative mean ECDs were 2344±480 cells/mm (C), 2312±469 cells/mm (I), 2325±536 cells/mm (NI), 2473±517 cells/mm (NS), 2438±607 cells/mm (S), 2227±578 cells/mm (TS), and 2193±523 cells/mm (TI). There was no change in ECD in all sectors before and after surgery. ECD decreased at the TS and TI in combination with cataract surgery (2620±430 and 2445±384 cells/mm) preoperatively to 2264±501 and 2216±477 cells/mm at 12 months postoperatively. CV and 6A did not change at all sites in all surgical procedures before and after surgery.
CONCLUSIONS:Trabectome surgery involves minimal effects to corneal endothelial cells, although long-term prospective studies with greater sample sizes are necessary to confirm this conclusion.
This study was aimed to assess the predictability of intraocular lens (IOL) power calculation after cataract surgery for keratoconus. We retrospectively reviewed the clinical charts of 102 eyes of 71 ...consecutive keratoconic patients who developed cataract. We determined manifest spherical equivalent, prediction errors, and absolute errors, 1 month postoperatively. The achieved refraction was significantly more hyperopic than the targeted refraction, when keratometric readings were used (p = 0.001). At 1 month, 36% and 63% of the eyes were within ±0.5 and ±1.0 D, respectively, of the targeted correction. We found a significant correlation between the prediction error and the mean keratometry (Pearson correlation coefficient r =-0.545, p < 0.001). No vision-threatening complications occurred in any case. The achieved refraction was significantly more myopic than the targeted refraction, when total corneal refractive power was used (p = 0.013). Phacoemulsification with IOL implantation appeared to be safe and effective, and the accuracy was also good in mild keratoconus, but not in severe keratoconus. It should be noted that that a large amount of hyperopic shift occurred especially in advanced keratoconic patients, when keratometric readings were used for IOL power calculation, and that a slight, but significant, myopic shift occurred, when total corneal refractive power was used.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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