To evaluate optical coherence tomography (OCT) measurement of peripapillary retinal nerve fiber layer (RNFL) thickness in patients with mild papilledema associated with idiopathic intracranial ...hypertension.
Patients with papilledema underwent a complete ophthalmic examination, including peripapillary RNFL analysis with OCT (Fast RNFL thickness 3.46; Carl Zeiss Meditec, Inc., Dublin, CA) at diagnosis and 3, 6, and 12 months after presentation. Age- and sex-matched control subjects underwent a similar evaluation. Changes in RNFL overall thickness and by quadrant and interocular differences were evaluated and studied regarding changes in visual field global indices (mean deviation MD and pattern SD PSD).
Both eyes of 22 patients with mild papilledema and 22 control subjects were included. At diagnosis, the RNFL thickness was 183.3 +/- 74.7 microm and 74.9% (78.5 microm) greater than in control eyes. Mean RNFL thicknesses in all quadrants were significantly greater in eyes with papilledema (P = 0.000). The mean average RNFL was significantly correlated with the MD (sigma = -0.451, P = 0.002) and PSD (sigma = 0.370, P = 0.013) at diagnosis. The RNFL thickness decreased significantly (P = 0.000), whereas the mean MD and the mean PSD improved (P = 0.000 and P = 0.005, respectively) at each follow-up visit. Regression analysis showed that for every 10 microm of mean RNFL thickness increase at baseline, there was a 0.6-dB decrease in MD at the last follow-up.
Peripapillary RNFL thickness abnormalities assessed by OCT in patients with mild papilledema were quantitatively correlated with visual field sensitivity losses. The data support the possible use of OCT as a noninvasive quantitative method of monitoring the amount and evolution of papilledema.
Purpose
To report 1‐year treatment outcomes of P50 EX‐PRESS implant versus nonpenetrating deep sclerectomy (NPDS) with Esnoper V2000 combined with phacoemulsification.
Design
Randomized, prospective ...and multicentre clinical trial.
Methods
Settings: Six clinical centres. Population: Patients 54–89 years of age without previous filtering surgery with cataract and glaucoma who required lower levels of intraocular pressure (IOP). Interventions: Phaco‐EX‐PRESS P50 or Phaco‐NPDS with Esnoper V2000, both groups with mitomycin C (0.2 mg/ml for 2 min). Main outcome measures: IOP, complete success rate (IOP: ≥6 and ≤18 mmHg), visual acuity, use of medical therapy and systematic assessment of complications and postoperative interventions.
Results
A total of 98 eyes were enrolled, including 50 in the EX‐PRESS group and 48 in the NPDS group. At 12 months, IOP (mean ± SD) was 13.9 ± 3.3 mmHg in EX‐PRESS group and 13.3 ± 3.6 mmHg in NPDS group (p = 0.38). Success rate was 75% and 80% in EX‐PRESS and NPDS groups, respectively (p = 0.53). The number of glaucoma medications (mean ± SD) was 0.2 ± 0.55 in EX‐PRESS group and 0.17 ± 0.44 in NPDS group (p = 1.00). The total number of complications was 66 in 35 subjects in EX‐PRESS group and 39 in 23 subjects in NPDS group (p = 0.02). The incidence of more than one complication was n = 13 (26%) versus n = 9 (18.8%) in EX‐PRESS and NPDS groups, respectively (p = 0.38). The total number of required postoperative interventions was 59 and 26 in EX‐PRESS and NPDS groups, respectively (p = 0.01). Visual acuity was similar in both groups at month 12 (p = 0.13). Surgical time (mean ± SD) was 52.6 ± 13.6 min in EX‐PRESS group and 63.3 ± 19.4 min in NPDS group (p = 0.01).
Conclusion
Phaco‐EX‐PRESS surgery had similar success rate compared to Phaco‐NPDS during 1 year of follow‐up. Both procedures were associated with similar IOP reduction and use of additional medical therapy at 12 months. EX‐PRESS surgery required more postoperative interventions and had more complications, but needed less surgical time compared to NPDS.
Noninferiority of efficacy was demonstrated for a preservative-free bimatoprost 0.01% compared with BAK-containing bimatoprost 0.01% following a 12-week treatment period in patients with open angle ...glaucoma or ocular hypertension. Improved tolerability, in particular conjunctival hyperemia, was also observed.
To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a preservative-free bimatoprost 0.01% ophthalmic gel (PFB 0.01% gel) compared with preserved bimatoprost 0.01% (PB 0.01%).
Phase III, international, multicenter, randomized, 2-parallel group, investigator-masked, 3-month treatment duration.
Patients with glaucoma or ocular hypertension were randomized after a 7-week run-in/washout period to receive once-daily PFB 0.01% gel (n=236) or PB 0.01% (n=249) for 3 months. The primary efficacy measure was changed from baseline in IOP at week 12. Safety measures included adverse events (AEs) and assessment of conjunctival hyperemia.
The mean changes from baseline in IOP at week 12 in the PFB 0.01% gel and PB 0.01% were -9.72±2.97 and -9.47±3.06 mm Hg, respectively, at 8 am , -9.41±3.03 and -9.19±3.12 mm Hg at 10 am , and -8.99±3.36 and -8.54±3.44 mm Hg at 4 pm . Noninferiority of PFB 0.01% gel to PB 0.01% was demonstrated at week 12 based on predetermined criteria (upper 95% CI margin of 1.5 mmHg at all time points). The most frequently reported AE was conjunctival hyperemia; 13 (5.5%) patients with PFB 0.01% gel and 17 (6.8%) patients with PB 0.01%. The percentage of patients experiencing a worsening from baseline in conjunctival hyperemia score was lower with PFB 0.01% gel compared to PB 0.01% at week 6 (20.1% vs. 29.3%, respectively) and week 12 (18.3% vs. 30.4%, respectively).
PFB 0.01% ophthalmic gel has the same efficacy in lowering IOP as PB 0.01% and demonstrated less aggravation of conjunctival hyperemia at weeks 6 and 12.
To define and quantify the upper lid contour by adapting Bézier curves with a newly developed software in normal subjects, assessing their reliability.
Fifty eyes of 50 healthy patients with no ...ocular pathology were included in this study from October 2020 to November 2020. All measurements were performed on Bézier curves adjusted to the upper lid contour. An original software was used to measure the radial and vertical midpupil-to-lid margin distances (MPLD), temporal-to-nasal (T/N) ratios, contour peak location and grade of superposition (GS) and asymmetry (GA) indexes. We calculated differences in the variables measured regarding age, gender or the side of the eye being assessed.
The mean Bézier curve showed an excellent level of inter-rater reliability (intraclass correlation coefficient of 0.99). The median GS index of each eyelid to the mean Bézier curve was 95.4%, 8.5 IQR, and the median GA index was 3%, 3.4 IQR. The mean contour peak location was -0.35 mm, SD 0.45. Overall, the mean central MPLD was 4.1 mm, SD 0.6. No significant differences were found between male and female patients in variables derived from Bézier curves.
Bézier curves may become a very useful tool for the assessment of upper lid contour, contour peak and symmetry. GS and GA indexes, along with the T/N area ratio are potential outcomes for this purpose. All current variables can be obtained just from one single Bézier curve measurement. Our results offer an in-depth exhaustive description of these variables and their distribution in the normal population.
To investigate and compare the false-positive (FP) diagnostic classification of the Bruch's membrane opening - minimum rim width (BMO-MRW) and retinal nerve fiber layer (RNFL) thickness in healthy ...eyes with tilted optic disc.
Fifty healthy eyes of 30 participants with tilted optic disc underwent BMO-MRW and RNFL scanning using Spectralis and macular Cirrus optical coherence tomography (OCT) scans.
The overall FP rate was significantly lower using BMO-MRW map compared with both RNFL map by Spectralis (8% vs 62%, respectively,
<0.001) and ganglion cell analysis (GCA) map by Cirrus (8% vs 50%, respectively,
<0.001). Specificity was significantly higher using BMO-MRW than RNFL in eyes with low (89.7% vs 41.4%,
<0.001) and moderate myopia (95.2% vs 33.3%,
<0.001).
OCT-derived BMO-MRW analysis provides significantly greater specificity than RNFL in tilted disc irrespectively of the refractive error, and it is more specific than GCA analysis in tilted disc with moderate myopia.
To describe the morphological changes in the lamina cribrosa (LC) and prelaminar tissue (PT) from eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) using enhanced depth imaging ...(EDI) optical coherence tomography (OCT), and to evaluate whether these changes correlate with retinal nerve fibre layer (RNFL) thickness and visual acuity (VA).
A prospective case-control study was performed, including 17 study eyes with NAION and 17 control, uninvolved eyes from 17 patients. Eyes underwent scanning with Spectralis-OCT at onset, 2 and 6 months after NAION. Bruch's membrane opening (BMO), anterior LC surface depth (LCD), LC thickness and PT thickness (PTT) were compared between study and control eyes. Correlation analysis was performed to evaluate the association between these parameters, RNFL thickness and VA.
At presentation, average PT was 58.6% thicker in NAION eyes compared with healthy control eyes (p=0.001), followed by a significant thinning at 2 and 6 months (p=0.001). A significant LC forward displacement was observed at 2 and 6 months (p=0.001). BMO progressively shrunk at 2 and at 6 months (p<0.05). A significant correlation was found between PTT and RNFL thickness (ρ
=0.544, p=0.024) at onset, as well as between PTT and RNFL changes at 6 months (ρ
=0.545, p=0.036). BMO and RNFL changes were also correlated at 6 months (ρ
=0.750, p=0.001).
At onset, a significant PT thickening, backward LC movement and BMO enlargement occurred in NAION eyes compared with unaffected eyes, and these changes significantly reversed during follow-up. PTT and RNFL changes were significantly correlated.
Introduction
To compare the tolerability and efficacy of a preservative-containing latanoprost (PCL) to a preservative-free formulation of latanoprost (PFL) in patients with open-angle glaucoma or ...ocular hypertension.
Methods
A pooled analysis was performed of data from five published studies. The primary outcome was tolerability as evaluated by the severity of hyperemia. The secondary objectives were patient tolerance based on a composite ocular surface disease (OSD) score arising from ocular signs and symptoms, patient and investigator satisfaction, and a comparison of IOP-lowering efficacy.
Results
There were three randomized controlled trials and two observational studies included in the analysis. Conjunctival hyperemia improved significantly in 25.6% (388) of patients switched to the PFL group versus 11.7% (117) of patients switched to the PCL group (
p
< 0.001). PFL was two times superior to PCL in reducing ocular hyperemia (odds ratio = 1.96;
p
< 0.001). The mean OSD composite score decreased by 32.2% in patients switched to the PFL group and 14.1% in the PCL group (
p
< 0.001). At 3 months, the mean IOP was similar between groups (
p
= 0.312).
Conclusion
This post hoc pooled analysis confirmed the findings of the individual studies that PFL is as efficacious at reducing IOP as PCL but better tolerated. After switching to PFL, there was twice the improvement in the OSD composite score. PFL was twice as effective at reducing ocular hyperemia and other ocular signs. These findings suggest that PFL has features that may improve patient compliance, thereby potentially improving the IOP-lowering efficacy on a long-term basis.
Plain Language Summary
Preservatives in eye drops for glaucoma can cause side effects such as stinging and eye redness. These side effects can cause some patients to reduce the frequency of the drops as prescribed or stop using the drops. One of the most common drops for glaucoma is latanoprost. This study evaluated whether a preservative-free latanoprost (PFL) is as effective as preservative-containing latanoprost (PCL) for reducing eye pressure and whether PFL is better tolerated in patients with glaucoma. The results of the study indicated that PFL was as effective as PCL for reducing eye pressure. The results also indicated PFL was much better at reducing the side effects related to PCL. For example PFL reduces eye redness up to twofold compared to PCL. By reducing the side effects associated with PCL patients may continue to take their glaucoma drops as directed and thereby reduce the risk of vision loss from glaucoma.
BACKGROUND:Leber hereditary optic neuropathy (LHON) leads to bilateral central vision loss. In a clinical trial setting, idebenone has been shown to be safe and to provide a trend toward improved ...visual acuity, but long-term evidence of effectiveness in real-world clinical practice is sparse.
METHODS:Open-label, multicenter, retrospective, noncontrolled analysis of long-term visual acuity and safety in 111 LHON patients treated with idebenone (900 mg/day) in an expanded access program. Eligible patients had a confirmed mitochondrial DNA mutation and had experienced the onset of symptoms (most recent eye) within 1 year before enrollment. Data on visual acuity and adverse events were collected as per normal clinical practice. Efficacy was assessed as the proportion of patients with either a clinically relevant recovery (CRR) or a clinically relevant stabilization (CRS) of visual acuity. In the case of CRR, time to and magnitude of recovery over the course of time were also assessed.
RESULTS:At time of analysis, 87 patients had provided longitudinal efficacy data. Average treatment duration was 25.6 months. CRR was observed in 46.0% of patients. Analysis of treatment effect by duration showed that the proportion of patients with recovery and the magnitude of recovery increased with treatment duration. Average gain in best-corrected visual acuity for responders was 0.72 logarithm of the minimal angle of resolution (logMAR), equivalent to more than 7 lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Furthermore, 50% of patients who had a visual acuity below 1.0 logMAR in at least one eye at initiation of treatment successfully maintained their vision below this threshold by last observation. Idebenone was well tolerated, with most adverse events classified as minor.
CONCLUSIONS:These data demonstrate the benefit of idebenone treatment in recovering lost vision and maintaining good residual vision in a real-world setting. Together, these findings indicate that idebenone treatment should be initiated early and be maintained more than 24 months to maximize efficacy. Safety results were consistent with the known safety profile of idebenone.
Uveitic glaucoma (UG) typically is associated with very high intraocular pressure (IOP) and more intense optic nerve damage than other glaucoma types. This secondary glaucoma requires an early ...diagnosis and adequate management of both uveitis and glaucoma. It is mandatory to identify the mechanisms of IOP elevation that in many eyes have multiple combined mechanisms. Management of these patients commonly requires an interdisciplinary approach that includes a glaucoma specialist and rheumatologist to control the inflammation and IOP. Glaucoma surgery is required early in these patients due to the high IOP usually present and is less successful than in primary open-angle glaucoma. Recurrent uveitic episodes, multiple mechanism, and the complications associated with uveitis make surgical management of UG challenging. In this review, the management and treatment of UG are updated to clarify the pathogenesis and prevent optic nerve damage.
OCT: New perspectives in neuro-ophthalmology Rebolleda, Gema; Diez-Alvarez, Laura; Casado, Alfonso ...
Saudi journal of ophthalmology,
01/2015, Letnik:
29, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Optical coherence tomography (OCT) has become essential to evaluate axonal/neuronal integrity, to assess disease progression in the afferent visual pathway and to predict visual recovery after ...surgery in compressive optic neuropathies. Besides that OCT testing is considered a powerful biomarker of neurodegeneration and a promising outcome measure for neuroprotective trials in multiple sclerosis (MS).
Currently, spectral-domain OCT (SD-OCT) technology allows quantification of retinal individual layers. The Ganglion Cell layer (GCL) investigation has become one of the most useful tools from a neuro-ophthalmic perspective. It has a high correlation with perimetry, is predictive of future progression and is a highly sensitive, specific of several neuro-ophthalmic pathologies. Moreover the superior correlation with clinical measures compared to peripapillary retinal nerve fiber layer (pRNFL) suggests that GCL analysis might be a better approach to examine MS neurodegeneration.
In disorders with optic disk edema, such as ischemic optic neuropathy, papillitis and papilledema, reduction in RNFL thickness caused by axonal atrophy is difficult to distinguish from a swelling resolution. In this setting, and in buried optic nerve head drusen (ONHD), GCL analysis may provide more accurate information than RNFL analysis and it might be an early structural indicator of irreversible neuronal loss.
Enhanced depth imaging OCT (EDI-OCT) provides in vivo detail of ONHD, allowing to evaluate and quantify the drusen dimensions.
OCT is improving our knowledge in hereditary optic neuropathies. Furthermore, there is growing evidence about the role of OCT as an adjunctive biomarker of disorders such as Alzheimer and Parkinson’s disease.
PDF
