To compare the rates of global and sectoral neuroretinal rim area (NRA) and peripapillary atrophy area (PPAA) change in open-angle glaucoma patients and normal control subjects and to determine the ...relationship between rates of NRA and PPAA change.
Prospective, longitudinal cohort study of cases and controls.
Ninety-four patients with open-angle glaucoma and 54 control subjects.
Patients and controls were imaged with confocal scanning laser tomography every 6 months. The NRA and PPAA in 1 eye were analyzed to determine the rate of change globally and in 12 30 degrees sectors by regression analysis. Rates of global NRA and PPAA change were correlated. Sectors were ranked from 1 to 12 each according to the magnitude of NRA and PPAA change and were compared between patients and controls using rank-order correlation. Spatial concordance between rates of NRA and PPAA change was calculated as sector rank distance between correspondingly ranked sectors.
Rates of global and sectoral NRA and PPAA change.
The mean (+/-standard deviation) follow-up was 8.6+/-2.9 years for patients and 7.1+/-3.6 years for controls. Globally, NRA declined more rapidly in patients compared with controls, expressed either in absolute units (medians, -5.33x10(-3) mm(2)/year and -1.25x10(-3) mm(2)/year, respectively; P = 0.006) or percentage of baseline NRA (medians, -0.42%/year and -0.07%/year, respectively; P = 0.001). The global rate of PPAA change was not significantly higher in patients compared with controls (12.66x10(-3) mm(2)/year and 9.43x10(-3) mm(2)/year, respectively; P = 0.173). Rates of global and sectoral NRA and PPAA change were correlated poorly in either group. There was a high correlation between ranked sectors of NRA change in patients and controls (P</=0.001), indicating similar patterns of NRA decline in patients and controls; however, this was not the case for rates of PPAA change.
These findings indicate an age-related regional susceptibility of the optic disc that may be accelerated in glaucoma. The poor relationship between rates of NRA and PPAA change suggests their temporal dynamics are uncoupled.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Background: Transscleral diode laser cyclophotocoagulation (TSCPC) is an established method of treatment for refractory glaucoma, but is associated with significant complications. This study ...evaluates the efficacy and safety of a new form of TSCPC using micropulse diode laser and trans‐pars plana treatment with a novel contact probe.
Methods: Prospective interventional case series of 40 eyes of 38 consecutive patients with refractory glaucoma treated with micropulse TSCPC with a novel probe. Outcomes measured were success, hypotony and response rates.
Results: The mean age of patients was 63.2 ± 16.0 years. The mean follow‐up period was 16.3 ± 4.5 months. The mean intraocular pressure (IOP) before micropulse TSCPC was 39.3 ± 12.6 mmHg. Mean IOP decreased to 31.1 ± 13.4 mmHg at 1 day, 28.0 ± 12.0 mmHg at 1 week, 27.4 ± 12.7 mmHg at 1 month, 27.1 ± 13.6 mmHg at 3 months, 25.8 ± 14.5 mmHg at 6 months, 26.6 ± 14.7 mmHg at 12 months and 26.2 ± 14.3 mmHg at 18 months (P < 0.001 at all time points). No patient had hypotony or loss of best‐corrected visual acuity. The overall success rate after a mean of 1.3 treatment sessions was 72.7%.
Conclusion: Micropulse TSCPC is a safe and effective method of lowering IOP in cases of refractory glaucoma and is comparable with conventional TSCPC.
To evaluate noncontact anterior segment optical coherence technology (AS-OCT) as a qualitative method of imaging the anterior chamber angle and to determine its ability to detect primary angle ...closure when compared with gonioscopy in Asian subjects.
Prospective observational case series.
Two hundred three subjects were recruited from glaucoma clinics in Singapore with diagnoses of primary angle closure, primary open-angle glaucoma, ocular hypertension, or cataract. Both eyes (if eligible) of each patient were included in the study. Exclusion criteria were pseudophakia or previous glaucoma surgery.
Images of the nasal, temporal, and inferior angles were obtained with AS-OCT in dark and then light conditions. Gonioscopic angle width was graded using the Spaeth classification for each quadrant in low lighting conditions.
Angle closure was defined by AS-OCT as contact between the peripheral iris and angle wall anterior to the scleral spur and by gonioscopy as a Spaeth grade of 0 degree (posterior trabecular meshwork not visible). Comparison of the 2 methods in detecting angle closure was done by eye and by individual. Sensitivities and specificities of AS-OCT were calculated using gonioscopy as the reference standard.
Complete data were available for 342 eyes of 200 patients. Of the patients, 70.9% had a clinical diagnosis of treated or untreated primary angle closure. Angle closure in > or =1 quadrants was detected by AS-OCT in 142 (71%) patients (228 66.7% eyes) and by gonioscopy in 99 (49.5%) patients (152 44.4% eyes). The inferior angle was closed more frequently than the nasal or temporal quadrants using both AS-OCT and gonioscopy. When performed under dark conditions, AS-OCT identified 98% of those subjects found to have angle closure on gonioscopy (95% confidence interval CI, 92.2-99.6) and led to the characterization of 44.6% of those found to have open angles on gonioscopy to have angle closure as well. With gonioscopy as the reference standard, specificity of AS-OCT in the dark was 55.4% (95% CI, 45.2-65.2) for detecting individuals with angle closure.
Anterior segment OCT is a rapid noncontact method of imaging angle structures. It is highly sensitive in detecting angle closure when compared with gonioscopy. More persons are found to have closed angles with AS-OCT than with gonioscopy.
To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT).
Prospective cross-sectional study.
Fifty-five patients who had previously undergone trabeculectomy surgery.
...All blebs were imaged with a prototype of the AS-OCT. Standardized color monophotographs of blebs were also obtained. Blebs were assessed for the following qualitative features: bleb height, thickness of the conjunctiva in the bleb wall, presence of cystic spaces within the bleb wall, apposition of the scleral flap to underlying sclera, and patency of the internal ostium.
For blebs with preoperative intraocular pressure (IOP) > 18 mmHg with or without ocular hypotensive medication, success was defined as last recorded IOP< or =18 mmHg without topical glaucoma medication. For blebs with preoperative IOP< or =18 mmHg with ocular hypotensive medication, success was defined last recorded IOP< or =18 mmHg with cessation of ocular hypotensive medication. For blebs with preoperative IOP< or =18 mmHg without ocular hypotensive medication, a 20% drop in IOP with no ocular hypotensive medication was accepted as success.
Seventy-eight blebs in eyes of 55 patients were imaged. There were 32 (58.2%) men and the mean age was 68.9+/-11.5 years. Fifty-seven (73.1%) blebs were classified as successful. Anterior segment optical coherence tomography identified the following bleb characteristics: total bleb height, bleb cavity, bleb wall thickness, tangential and radial dimensions, scleral flap thickness, and patency of the internal ostium. The majority of successful blebs displayed thickening of the bleb wall. Failed blebs were mostly low and were characterized by ostial occlusion, apposition of conjunctiva-episclera to sclera or apposition of the scleral flap to its bed. Thickening of the bleb wall was typically absent.
AS-OCT is a promising tool to image trabeculectomy blebs. It was able to demonstrate features of bleb morphology not visible with the slit lamp.
PURPOSETo quantify changes in bleb morphology after laser suture lysis (LSL) using anterior segment optical coherence tomography (AS-OCT).
PATIENTS AND METHODSThis was a prospective observational ...case series of patients who underwent trabeculectomy surgery with mitomycin-C and required subsequent LSL. Subjects were assessed before and immediately after LSL, and at 3 months after LSL. At each visit, a standardized cross-sectional AS-OCT image of the bleb was obtained, from which a masked observer measured bleb height (hB), cavity height (hC), wall cross sectional area (AW), cavity cross sectional area (AC), and bleb cross sectional area (AB) using custom software.
RESULTSTwenty-five subjects (25 eyes) were examined. LSL was performed at a mean of 21.5±16.3 days after trabeculectomy. Immediately after LSL, there was a significant increase in mean hB (P=0.026) and mean hC (P=0.45) from pre-LSL. At 3 months after LSL, there was a significant increase in mean hB (P=0.003), mean AC (P=0.047), and mean AB (P=0.006) as compared with before LSL. Increase in hB and hC immediately after LSL was predictive of outcome at month 3.
CONCLUSIONSAS-OCT was able to quantify changes in bleb morphology after LSL, some of which were predictive of eventual outcome.
Aim:Using the anterior segment optical coherence tomography (AS-OCT) to quantify changes in anterior segment morphology going from light to dark and following laser iridotomy (LI).Methods:Prospective ...observational study. 17 consecutive subjects without peripheral anterior synechiae undergoing LI were evaluated using gonioscopy and AS-OCT. Angle configuration including angle opening distance (AOD) at 500 microns anterior to the scleral spur, AOD500, trabecular-iris space area up to 750 microns from the scleral spur, TISA750 and the increase in angle opening going from dark to light conditions was determined.Results:Both mean AOD500 and TISA750 increased nearly threefold going from dark to light. Both also significantly increased following LI (p<0.001) as did gonioscopic grading of the angle in all quadrants (p<0.001, McNemar’s test). Angles were more than twice as wide on average in the dark after LI than before LI (p<0.05). Both the mean absolute change and the mean proportionate change in AOD500 and TISA750 when going from light to dark were greater after LI than before (p<0.05).Conclusion:Increased illumination as well as LI resulted in significant widening of the anterior chamber angle. AS-OCT (which does not require a water bath and can be performed with the patient at the slit lamp) identified similar magnitude changes as those previously reported using ultrasound biomicroscopy (UBM). Furthermore, the angle appears to open more both in absolute terms and and proportionate terms in response to illumination after LI.
Background: To evaluate different mechanisms of primary angle closure and to quantify anterior chamber parameters in these mechanisms using anterior segment optical coherence tomography in an Asian ...population.
Design: Hospital‐based cross‐sectional observational study.
Participants: Forty‐eight consecutive patients with primary angle closure glaucoma.
Methods: Patients underwent complete ophthalmic examination and imaging of nasal‐temporal angles with anterior segment optical coherence tomography. Images were categorized into four primary angle closure mechanisms: pupil block, plateau iris configuration, Thick peripheral iris roll and exaggerated lens vault. Parameters computed: anterior chamber depth central, anterior chamber depth at 1000 µm and 2000 µm anterior to scleral spur, lens vault, anterior chamber area, angle opening distance, trabecular iris space area and iris thickness.
Main Outcome Measure: Anterior chamber parameters and primary angle closure mechanisms.
Results: Mean values of anterior chamber depths: central (P < 0.001), at 2000 µm (P < 0.001), 1000 µm (P < 0.001), lens vault (P < 0.001), anterior chamber area (P < 0.001), were significantly different among the four groups. Multivariate analysis showed anterior chamber depths: central, and anterior chamber depth at 2000 µm and anterior chamber area were higher in plateau iris and Thick peripheral iris roll and lower in exaggerated lens vault (P < 0.001) as compared to pupil block mechanism, lens vault was greater in exaggerated lens vault (P < 0.001) and lesser in plateau iris and Thick peripheral iris roll as compared to pupil block mechanism.
Conclusion: Anterior segment optical coherence tomography may be used for evaluation of underlying primary angle closure mechanism(s) in a patient and tailor the treatment accordingly.
Background: The aim of this work was to image trabeculectomy blebs using spectral domain optical coherence tomography (SDOCT).
Methods: In this prospective cross‐sectional study, patients who had ...undergone trabeculectomy with at least 3 months of follow up were included. Blebs were imaged using an adapted SDOCT system (Cirrus HD‐OCT, Carl Zeiss Meditec Inc., Dublin, CA, USA) and time domain anterior segment optical coherence tomography (ASOCT) (Visante OCT, Carl Zeiss Meditec Inc.). An observer masked to clinical data assessed the utility of SDOCT and ASOCT in visualizing structures in successful and failed blebs.
Results: Fifty‐one eyes were imaged, of which 43 (84.3%) were successful. SDOCT showed wall thickening (93.0% vs. 67.4%, P = 0.006) and discrete hyporeflective spaces in the wall (88.4% vs. 14.0%, P < 0.0001) in a greater proportion of successful blebs than ASOCT. SDOCT showed the bleb cavity (23.3% vs. 48.8%, P = 0.02), scleral flap (34.9% vs. 90.7%, P < 0.0001), subflap space (20.9% vs. 72.1%, P < 0.0001) and ostium (9.3% vs. 88.4%, P < 0.0001) in fewer successful blebs than ASOCT. The internal ostium was not visualized in any failed bleb using SDOCT, whereas ASOCT showed the ostium in 87.5% of failed blebs (P = 0.001). SDOCT showed cystic spaces in the bleb wall in a greater proportion of successful blebs than failed blebs (88.4% vs. 37.5%, P = 0.005).
Conclusions: SDOCT imaging was able to show fine superficial features in the bleb wall. However, SDOCT had limited clinical utility in that it did not provide useful information about deep features such as flap position, bleb cavity formation or patency of the subflap space and internal ostium.
Management of angle closure glaucoma See, Jovina L S; Aquino, Maria Cecilia D; Aduan, Joel ...
Indian journal of ophthalmology,
01/2011, Letnik:
59 Suppl, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Primary angle closure glaucoma (PACG) is equally prevalent in Indian in Asian population as the primary open angle glaucoma. Eighty-six percent of people with PACG are in Asia, with approximately ...48.0% in China, 23.9% in India and 14.1% in southeast Asia. To understand PACG, it is mandatory to understand its classification and type of presentation with the underlying pathophysiology. The treatment options are medical, laser and/or surgical. The present article provides an overview of PACG.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To evaluate the efficacy and safety of Baerveldt and Ahmed glaucoma drainage implants in Asian patients with refractory glaucoma.
Retrospective nonrandomized study.
Forty-one patients.
The authors ...reviewed the insertion of 18 Ahmed glaucoma valved (AGV-S2) implants and 24 350 mm
2 Baerveldt glaucoma implants performed by a single surgeon at the Department of Ophthalmology, National University Hospital, Singapore, from January 1, 2000, to December 31, 2000. A total of 42 glaucoma drainage implants was inserted into the eyes of 41 patients. All patients had at least 6 months of follow-up.
Intraocular pressure (IOP), visual acuity, and complications.
Both drainage implants achieved remarkable reductions in IOP; from pretreatment IOP of 40.1±13.8 mmHg and 43.7±9.3 mmHg to postoperative IOP of 17.4±6.2 and 14.9±5.5 mmHg in the Baerveldt and Ahmed groups, respectively. A decrease in IOP of 56.6% and 65.9% had been achieved. Success rates were 20 (83.3%) for Baerveldt and 12 (66.7%) for Ahmed implants, whereas qualified success occurred in 1 (4.2%) Baerveldt and 3 (16.7%) Ahmed implants. Conversely, failure to control IOP occurred in 3 (12.5%) Baerveldt implants and 3 (16.7%) Ahmed implants. More than 80% of the patients had maintained or improved visual function, whereas only 4 (16.0%) of the patients with Baerveldt implants and 2 (16.7%) patients with Ahmed implants had loss of more than 1 Snellen line.
Both Baerveldt and Ahmed glaucoma drainage implants performed well in terms of IOP control, preservation of visual function, and having low complication rates.
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