To compare the 2-year efficacy of phacoemulsification and intraocular lens implant (phaco/IOL) with laser peripheral iridotomy (LPI) in the early management of acute primary angle closure (APAC) and ...coexisting cataract.
Randomized, controlled trial.
We included 37 subjects presenting with APAC who had responded to medical treatment such that intraocular pressure (IOP) was ≤30 mmHg within 24 hours, and had cataract with visual acuity of ≤6/15.
The primary outcome measure was failure of IOP control defined as IOP between 22 to 24 mmHg on 2 occasions (readings taken within 1 month of each other) or IOP ≥25 mmHg on 1 occasion, either occurring after week 3. Secondary outcome measures were complications, degree of angle opening, amount of peripheral anterior synechiae, visual acuity, and corneal endothelial cell count (CECC).
Subjects were randomized to receive either LPI or phaco/IOL in the affected eye within 1 week of presentation and were examined at fixed intervals over 24 months. Patients underwent a standardized examination that included Goldmann applanation tonometry, gonioscopy, and CECC measurements. Logistic regression was used to estimate the effect of treatment on failure of IOP control. Time to failure was evaluated using the Kaplan-Meier technique and Cox regression was used to estimate the relative risk of failure.
There were 18 patients randomized to LPI and 19 to phaco/IOL. The average age of subjects was 66.0±9.0 years and mean IOP after medical treatment was 14.5±6.9 mmHg. The 2-year cumulative survival was 61.1% and 89.5% for the LPI and phaco/IOL groups, respectively (P = 0.034). There was no change in CECC for either group from baseline to month 6. There was 1 postoperative complication in the phaco/IOL group compared with 4 in the LPI group (P = 0.180).
Performed within 1 week in patients with APAC and coexisting cataract, phaco/IOL resulted in lower rate of IOP failure at 2 years compared with LPI.
To investigate the variation in macular retinal thickness in otherwise normal young Asian myopic subjects by using optical coherence tomography (OCT).
One hundred thirty ophthalmically normal men 19 ...to 24 years of age with myopia (spherical equivalent, -0.25 to -14.25 D) underwent examination of one randomly selected eye. Visual acuity, refraction, slit lamp examination, applanation tonometry, gonioscopy, A-scan ultrasound, fundus examination, visual field testing, and optic disc photography were performed. Exclusion criteria were visual acuity worse than 20/30, previous intraocular surgery, intraocular pressure >21 mm Hg, or other ocular diseases. Three horizontal transfixation and three vertical transfixation OCT scans (ver.4.1; Carl Zeiss Meditec, Dublin, CA) of 6 mm each were conducted on each eye by a single operator. Neurosensory retinal thicknesses at 100 points along each scan were measured, and the overall average, maximum, and minimum retinal thicknesses were analyzed by simple linear regression and analysis of variance.
The average macular retinal thickness (overall) was 230.9 +/- 10.5 microm and was not significantly related to the degree of myopia. The mean maximum retinal thickness (at the parafovea) was 278.4 +/- 13.0 microm, and correlated negatively with axial length (P = 0.03). The mean minimum retinal thickness (at the foveola) was 141.1 +/- 19.1 microm, and this was positively correlated with axial length (P = 0.015) and spherical equivalent (P = 0.0002). The retina was thicker at the superior and nasal parafovea compared to the inferior or temporal parafovea.
Average retinal thickness of the macula does not vary with myopia. However, the parafovea was thinner and the fovea thicker with myopia.
Background
To assess the efficacy and safety of collagen matrix implant (Ologen) in phacotrabeculectomy.
Design
Prospective, non‐randomized, comparative study.
Participants
Sixty‐six Asian patients.
...Methods
Thirty three consecutive patients underwent phacotrabeculectomy with Ologen implant and intraocular lens implantation, and 33 subjects recruited as controls underwent surgery with mitomycin C augmentation.
Main Outcome Measures
The primary outcome measure was postoperative intraocular pressure at month 12. Additional postoperative treatments, such as bleb needling, and adverse events were secondary outcomes.
Results
The overall percentage reduction in intraocular pressure was 13% (95% confidence interval 6.7–19.2) in the Ologen group and 26% (95% confidence interval 14.8–37.9) in the mitomycin C group (P = 0.05). At 1 year after surgery (after adjusting for baseline differences), intraocular pressure decreased by 4.2 mmHg (95% confidence interval 2.8–5.6 mmHg) and 5.6 mmHg (95% confidence interval 4.2–7.0 mmHg), respectively (P = 0.16). Needling with 5‐fluorouracil was required more often in the Ologen group (39% vs. 6%; P = 0.003). There was similar frequency (<10%) of adverse events in both groups, and there were no complications directly related to the Ologen implant. The blebs in the mitomycin C group had greater central area (P = 0.005), maximal area (P = 0.01) and height (P = 0.005), and were less vascular (P = 0.023) than the Ologen blebs.
Conclusions
At 1 year, the overall performance of Ologen in combined phacotrabeculectomy was suboptimal compared with combined surgery with mitomycin C. Eyes in the Ologen group required more frequent bleb needling procedures.
A glaucoma locus, GLC1A, was identified previously on chromosome 1q. A gene within this locus (encoding the protein myocilin) subsequently was shown to harbor mutations in 2–4% of primary open angle ...glaucoma patients. A total of 1703 patients was screened from five different populations representing three racial groups. There were 1284 patients from primarily Caucasian populations in Iowa (727), Australia (390) and Canada (167). A group of 312 African American patients was from New York City and 107 Asian patients from Japan. Overall, 61 different myocilin sequence variations were identified. Of the 61 variations, 21 were judged to be probable disease-causing mutations. The number of probands found to harbor such mutations in each population was: Iowa 31/727 (4.3%), African Americans from New York City 8/312 (2.6%), Japan 3/107 (2.8%), Canada 5/167 (3.0%), Australia 11/390 (2.8%) and overall 58/1703 (3.4%). Overall, 16 (76%) of 21 mutations were found in only one population. The most common mutation observed, Gln368Stop, was found in 27/1703 (1.6%) glaucoma probands and was found at least once in all groups except the Japanese. Studies of genetic markers flanking the myocilin gene suggest that most cases of the Gln368Stop mutations are descended from a common founder. Although the specific mutations found in each of the five populations were different, the overall frequency of myocilin mutations was similar (∼2–4%) in all populations, suggesting that the increased rate of glaucoma in African Americans is not due to a higher prevalence of myocilin mutations.
The purpose of this study was to evaluate the associations between macular volume and thickness, as assessed by optic coherence tomography (OCT), with refraction and axial length (AL) in children.
A ...total of 104 Chinese school children (51 girls and 53 boys) 11 to 12 years of age were randomly selected from one school during the 2005 examination in the Singapore Cohort Study of the Risk Factors for Myopia (SCORM). Cycloplegic autorefraction was performed to obtain refraction (defined as spherical equivalent SE) and ultrasound biometry performed to obtain the AL. Macular volume and thickness were then measured (StratusOCT3; Carl Zeiss Meditec, Dublin, CA).
Children with moderate myopia (SE at least -3.0 D) tended to have smaller total macular volume and thinner quadrant-specific macular thickness (except in the inferior and superior inner quadrants), followed by children with low myopia (-0.5<or=SE<-3.0 D), compared with children with no myopia (SE>-0.5 D). Total macular volume was positively associated with SE (beta=1.58, 95% CI, 0.84 to 2.32, standardized beta=0.14, P<0.001) and negatively associated with AL (beta=-1.20, 95% CI, -1.62 to -0.79, standardized beta=0.45, P<0.001) in multiple linear regression models controlling for age and gender.
In children, increasing axial myopia was associated with reduced macular volume and thickness. These findings suggest that early anatomic changes may be present in the retinas of children with axial myopia.
To determine the relationship between peripapillary retinal nerve fiber layer (RNFL) thickness and myopia using optical coherence tomography (OCT).
Prospective observational case series.
One hundred ...thirty-two young males with myopia (spherical equivalent SE, -0.50 to -14.25 diopters) underwent ophthalmic examination of one randomly selected eye. Optical coherence tomography (OCT-1, version 4.1) was performed by a single operator using circular scans concentric with the optic disc with scan diameters of 3.40 mm, 4.50 mm, and 1.75 x vertical disc diameter (VDD). For each scan diameter, mean peripapillary RNFL thickness was calculated. Statistical analysis comprised repeated-measurements analysis and Pearson correlation.
Mean peripapillary RNFL thickness did not correlate with SE for the 3.40-mm (r = -0.11, P = 0.22), 4.50-mm (r = -0.103, P = 0.24), or 1.75xVDD (r = -0.08, P = 0.36) OCT scan diameters. Neither did mean peripapillary RNFL thickness correlate with axial length for the 3.40-mm (r = -0.04, P = 0.62), 4.50-mm (r = 0.03, P=0.75), or 1.75xVDD (r = -0.02, P = 0.78) scan diameters. Mean peripapillary RNFL thicknesses for the 3.40-mm, 4.50-mm, and 1.75xVDD scans were 101.1+/-8.2 microm (95% confidence interval CI, 99.4-102.8), 78.9+/-8.2 microm (95% CI, 77.5-80.3), and 97.5+/-10.9 microm (95% CI, 95.6-99.4), respectively.
Mean peripapillary RNFL thickness did not vary with myopic SE or axial length for any OCT scan diameter investigated. Retinal NFL thickness measurements may be a useful parameter to assess and monitor glaucoma damage in myopic subjects.
Postoperative fibrin pupillary-block glaucoma, an uncommon complication of intraocular surgery, develops when an inflammatory fibrin membrane occludes the pupil, resulting in peripheral angle ...closure. We present a series of 4 patients with this condition and describe the role of anterior segment optical coherence tomography and ultrasound biomicroscopy in distinguishing fibrin pupillary-block glaucoma from other forms of postoperative acute glaucoma. Specific to this condition is the presence of a fibrin membrane across the pupil and accumulation of aqueous in the posterior chamber, as would be expected in pupil block, but with a clear separation between the intraocular lens and the iris. The possible risk factors are discussed and various treatment modalities reviewed.
To compare the performance of the scanning peripheral anterior chamber depth analyzer (SPAC) and the modified van Herick grading system in the assessment of angle closure, using gonioscopy as the ...reference standard.
Prospective comparative study.
One hundred twenty phakic subjects (53 with primary angle closure and 67 with open angles) with no history of laser or intraocular surgery.
The modified van Herick grading system was used to grade the peripheral anterior chamber depth (ACD) clinically. The SPAC was used to assess ACD, and this was graded categorically as S (suspect angle closure), P (potential angle closure), or N (normal) and numerically from 1 to 12. One randomly selected eye of each subject underwent examination with the modified van Herick grading, SPAC, Goldmann applanation tonometry, optic disc examination, and gonioscopy. The SPAC measurements, modified van Herick grades (0%, 5%, 15%, 25%, 40%, 75%, and > or =100% of corneal thickness), and gonioscopy (graded as narrow or open) were correlated using the Spearman correlation coefficient. The receiver operating characteristics of the 2 methods to detect angle closure also were compared.
Grading of ACD by the SPAC, the modified van Herick system, and gonioscopic grading of the angle.
The SPAC results correlated well with the modified van Herick grading system (categorical grade, r = 0.527; numerical grade, r = 0.542; P<0.0001). For eyes graded as having narrow angles by gonioscopy, the area under the curve (AUC) for SPAC categorical grade S or P was 0.790; sensitivity and specificity were 84.9% and 73.1%, respectively. For the modified van Herick grading system, using a cutoff of peripheral ACD < or = 25% corneal thickness, the AUC was 0.872 and sensitivity and specificity were 84.9% and 89.6%. Compared with gonioscopy that found 53 of 120 cases of narrow angles, the SPAC graded more eyes as having narrow angles (63/120) than the modified van Herick system (52/120).
The SPAC correlated well with the modified van Herick system in grading peripheral ACD. However, the SPAC appeared to overestimate the proportion of eyes with narrow angles relative to gonioscopy and the modified van Herick grading system.
PURPOSE:
To evaluate the relationship between visual function and retinal nerve fiber layer measurements obtained with scanning laser polarimetry and optical coherence tomography in a masked, ...prospective trial.
METHODS:
Consecutive normal, ocular hypertensive, and glaucomatous subjects who met inclusion and exclusion criteria were evaluated. Complete ophthalmologic examination, disk photography, scanning laser polarimetry, optical coherence tomography, and automated achromatic perimetry were performed.
RESULTS:
Seventy-eight eyes of 78 patients (17 normal, 23 ocular hypertensive, and 38 glaucomatous) were enrolled (mean age, 56.8 ± 11.5 years; range, 26 to 75 years). Eyes with glaucoma had significantly greater neural network scores on scanning laser polarimetry and lower maximum modulation, ellipse modulation, and mean retinal nerve fiber layer thickness measured with optical coherence tomography compared with normal and ocular hypertensive eyes, respectively (all
P < .005). Significant associations were observed between neural network number (
r = −.51,
r = .03), maximum modulation (
r = .39,
r = −.32), ellipse modulation (
r = .36,
r = −.28), and optical coherence tomography–generated retinal nerve fiber layer thickness (
r = .68,
r = −.59) and visual field mean deviation and corrected pattern standard deviation, respectively. All scanning laser polarimetry parameters were significantly associated with optical coherence tomography–generated retinal nerve fiber layer thickness.
CONCLUSION:
Optical coherence tomography and scanning laser polarimetry were capable of differentiating glaucomatous from nonglaucomatous populations in this cohort; however considerable measurement overlap was observed among normal, ocular hypertensive, and glaucomatous eyes. Retinal nerve fiber layer structural measurements demonstrated good correlation with visual function, and retinal nerve fiber layer thickness by optical coherence tomography correlated with retardation measurements by scanning laser polarimetry.
For many years, ophthalmologists have looked at the optic nerve head to evaluate the status of glaucoma. Clinical examination of the optic nerve head and retinal nerve fibre layer (RNFL) is however, ...subjective and sometimes variable. Recent developments in computer-based imaging technologies have provided a means of obtaining quantitative measurements of the optic nerve head topography and peripapillary retinal nerve fibre layer thickness.
Multiple searches using Medline were carried out. Additional searches were made using reference lists of published papers and book chapters.
Studies involving three imaging technologies namely, confocal scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography were reviewed. Overall, these technologies were reproducible and demonstrate good sensitivity and specificity in the range of 70 to 80%. Inclusion of age and ethnicity normative database will make these technologies more effective in screening and diagnosis. Quantitative measurements provide useful parameters for monitoring of patients.
There is no consensus on the best technology for assessing structural damage in glaucomatous optic neuropathy. Therefore, as with any investigation, the clinician should exercise clinical correlation and judgment before instituting the appropriate treatment.
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