Glaucoma is a malady that occurs due to the buildup of fluid pressure in the inner eye. Detection of glaucoma at an early stage is crucial as by 2040, 111.8 million people are expected to be ...afflicted with glaucoma globally. Feature extraction methods prove to be promising in the diagnosis of glaucoma. In this study, we have used optical coherence tomography angiogram (OCTA) images for automated glaucoma detection. Ocular sinister (OS) from the left eye while ocular dexter (OD) were obtained from right eye of subjects. We have used OS macular, OS disc, OD macular and OD disc images. In this work, local phase quantization (LPQ) technique was applied to extract the features. Information fusion and principal component analysis (PCA) are used to combine and reduce the features. Our method achieved the highest accuracy of 94.3% using LPQ coupled with PCA for right eye optic disc images with AdaBoost classifier. The proposed technique can aid clinicians in glaucoma detection at an early stage. The developed model is ready to be tested with more images before deploying for clinical application.
•Automated detection of glaucoma using OCTA images.•OS macular, OS disc, OD macular and OD disc images are considered.•LPQ, Information fusion, PCA, and AdaBoost classifier are used.•Obtained accuracy of 94.3% for OD optic disc images.
Purpose
Primary angle-closure glaucoma (PACG) is associated with increased intraocular pressure, optic nerve damage, and progressive vision loss, but the molecular mechanism that underpins retinal ...ganglion neuropathy in PACG remains poorly understood. To better understand the pathogenesis of human PACG, we performed the first comprehensive proteomic analysis of aqueous humor (AH) samples from PACG patients and matched control donors to study pathogenic alteration in AH composition in disease.
Methods
High-resolution, label-free, liquid chromatography–tandem mass spectrometry-based quantitative proteomic analyses were performed in AH samples collected from PACG patients and a matched control cohort of patients with cataracts.
Results
The AH proteome comprised of 1363 distinct proteins, of which more than 50% were differentially expressed in PACG (773 total; 501 up-regulated, 272 down-regulated). AH from PACG patients was enriched in atypical collagens and fibronectins, suggesting that the composition of the trabecular matrix is significantly altered in disease. Pathway and cluster analyses revealed that AH protein modulation in PACG is closely associated with biological processes including platelet degranulation, cellular import/export mechanisms, and control of protease activity. In addition, critical mediators of oxygen homeostasis and neuronal function in AH were significantly dysregulated in disease, strongly implicating oxidative stress responses in PACG-associated nerve damage.
Conclusions
Altered AH proteome in human PACG indicated oxidative stress in the neuronal damage that preceded vision loss. Identifying key mediators of PACG pathology will yield new prognostic biomarkers and novel targets for future therapeutic interventions.
PURPOSETo determine the repeatability of retinal nerve fiber layer (RNFL) measurement from 2 spectral domain optical coherence tomography (OCT) instruments and assess the level of agreement. A ...secondary objective was to assess if pupillary dilatation affected the repeatability of RNFL measurement.
DESIGNProspective, observational study.
PARTICIPANTSFifty normal participants were recruited after being screened for exclusion criteria, which included preexisting glaucoma and significant cataract.
METHODSPeripapillary RNFL thickness was measured from either eye of the 50 participants using both the Cirrus and Spectralis OCTs. Three scans were performed consecutively for each instrument and the process was repeated after pupillary dilatation.
MAIN OUTCOME MEASURESTest-retest variability, coefficient of variation, and intraclass correlation coefficient (ICC) for repeatability of RNFL measurement. ICC and Bland-Altman plots for agreement between both devices.
RESULTSTest-retest variability for the Cirrus and Spectralis OCTs were 4.89 μm and 4.95 μm, respectively. RNFL measurements were less repeatable in the 4 quadrants, ranging from 5.02 to 15.00 μm. The temporal quadrant was the most repeatable quadrant for the Cirrus OCT with a variability of 7.81 μm, whereas the nasal quadrant was the most repeatable for Spectralis OCT with 5.02 μm. Test-retest variability was poorer for the Cirrus OCT in the nasal, inferior, and superior quadrants. Pupillary dilatation increased repeatability of RNFL measurement for Cirrus OCT, particularly in the superior quadrant, whereas not affecting measurements from Spectralis OCT. ICC values for agreement between both instruments were good. For average RNFL as well as RNFL in the superior, inferior, and temporal quadrants, ICC ranged from 0.859 to 0.908. The nasal quadrant had a lower ICC of 0.663. Bland-Altman plots showed that the Spectralis OCT provided the thicker RNFL measurement in general, except in the nasal quadrant when RNFL was thin.
CONCLUSIONSThe repeatability of RNFL thickness measurement in normal participants was excellent for both the Cirrus and Spectralis OCTs. Agreement of RNFL measurement between both the devices was generally good, with the exception of the nasal quadrant in which a linear relationship exists. Pupillary dilatation improved the repeatability of RNFL measurement for Cirrus while having minimal influence on Spectralis OCT. More studies will be required to ascertain the relationships of RNFL measurement between the different spectral domain OCT instruments in normal and glaucomatous patients.
Purpose
This study aims to evaluate the efficacy and safety of XEN45 gel stent (Allergan plc, Dublin, Ireland) in East Asian patients with glaucoma.
Methods
A retrospective study of consecutive XEN45 ...gel stent implantation surgeries with or without concurrent cataract surgery from May 2017 to August 2018 was performed in a single institution. The clinical charts of all cases were reviewed to examine the safety and efficacy of the implant. Primary outcome measures were intraocular pressure (IOP), number of topical glaucoma medications required, additional procedures done and adverse outcomes. All patients included were required to fulfil a minimum of three follow-up visits by post-operative month 1.
Results
Sixty-three eyes were included in the study. The median duration of follow-up was 6 months interquartile range (IQR) 2–9. Median IOP was significantly lowered from 19 mmHg (IQR 16–24) pre-operatively to 15 mmHg (IQR 11–18) at the end-of-follow-up (
p
< 0.001). The median number of medications was reduced from 3 (IQR 2–4) at baseline to 0 (IQR 0–2) at the end-of-follow-up (
p
< 0.001). 66.7% of patients were medication-free by the end of follow-up. Post-operative bleb intervention was required for 61.9% of eyes. Adverse events included post-operative hypotony requiring intervention (4.8%) and post-operative gross hyphaema (9.6%).
Conclusion
The XEN45 gel stent when used as a sole procedure or in combination with cataract surgery in East Asian eyes is effective in the treatment of glaucoma. However, a high rate of post-operative bleb intervention appears to be required to support its efficacy.
The XEN45 gel stent implant (Allergen, CA, USA) is one of many micro-invasive surgical options available to glaucomatologists. Our case series describes the presentation, treatment, and possible risk ...factors of XEN45 gel stent related endophthalmitis.
A 71 year old Chinese man and a 88 year old Caucasian woman underwent XEN45 gel stent implantation for primary open angle glaucoma. They presented with endophthalmitis at 7 and 4 months post-surgery respectively. The first patient had stent exposure with blebitis while the second patient did not show any signs of conjunctival defect, stent exposure, bleb leak nor blebitis. Both patients were treated immediately with intravitreal, topical and systemic antibiotics, followed by early vitrectomy. The implant was removed in the first, but not in the second patient. Vitreous cultures grew Streptococcus Viridans in the first patient and Haemophilus influenzae in the other. Unfortunately, the first patient eventually sustained a total retinal detachment requiring surgery and did not recover his vision. The second patient however, recovered with a good Snellen's visual acuity of 6/9 and maintenance of good intraocular pressure and bleb formation.
Exogenous endophthalmitis related to XEN45 gel stent implantation is a rare but devastating complication. The risks factors identified were multiple post-operative procedures, bleb exposure, conjunctival defect, use of antifibrotics, blepharitis and prolonged post-operative antibiotics. XEN45 gel stent implant provides a different challenge to ophthalmologists compared to trabeculectomy as more post-operative procedures are required to prevent subconjunctival scarring. Great care should be taken to individualize the use of antifibrotics in each patient to balance the risk of subconjunctival fibrosis with the risk of infection. In patients with stent exposure we propose early closure of the conjunctiva to close off the portal of entry for pathogens and reduce the need for prophylactic topical antibiotics.
AIMTo investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients. METHODSProspective cross-sectional study with consecutive sampling in South-East Asian population ...was performed. Validated questionnaires: the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered prospectively. Subjects with non-glaucomatous optic neuropathy or concomitant retinal pathology were excluded. Glaucoma severity was based on HVF 24-2 perimetry. Binocular single vision was represented based on the better eye. Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared. RESULTSA total of 79 primary open angle glaucoma (POAG), 27 primary angle-closure glaucoma (PACG) patients, and 89 controls were recruited. PACG patients had higher median PSQI scores (P=0.004) and poorer sleep quality (P<0.001). Compared to controls, PACG patients were 3.34 times more likely to have poor sleep quality (P=0.008), which remained significant after adjustment for demographics (P=0.016) and predictive variables (P=0.013). PACG patients have poorer sleep quality when visual acuity (VA) was 6/15 or worse (P=0.009). Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance. CONCLUSIONPACG patients have poorer sleep quality but not daytime sleepiness. This is important in South-East Asian population with heavy disease burden. Evaluations on sleep disturbances can be considered to provide more holistic care.
The iStent inject is an ab-interno trabecular microbypass stent used in the treatment of primary open-angle glaucoma. Intraoperative complications are uncommon. However, we present the first reported ...case of simultaneous double-stent implantation, occurring in a 62-year-old Chinese male with high myopia and normal-tension glaucoma. Following an initial implantation failure, upon a single activation of the injector, simultaneous penetration of both stents into the trabecular meshwork occurred. Surgeons should be aware of the risk of double-implantation in myopic eyes with altered scleral rigidity, particularly when the first device is already located distally in the hub of the injector.
PurposeTo evaluate the impact of a nurse-led glaucoma education program on patient knowledge and compliance levels in an Asian population.Materials and MethodsA 1-year prospective case series ...involving 69 adult glaucoma patients. Each patient attended a standardized nurse-led glaucoma education session. A questionnaire was administered by a single nurse-clinician and analyzed at three time points (preeducation for baseline, immediately posteducation, and at the 1-year follow-up) to evaluate for associations with patient knowledge and compliance motivation levels.ResultsA total of 64 patients were included in the final analysis. Patients with higher educational qualifications or who were employed had better baseline knowledge of glaucoma. Younger patients had higher baseline compliance motivation levels. Immediately posteducation, both median patient knowledge score and compliance motivation levels had a statistically significant increase. Patients on more glaucoma eye drops had greater immediate improvement in confidence in eye drop application. Patients with more positive Humphrey visual field mean deviation values had a greater immediate improvement in confidence in their understanding of glaucoma. A total of 34 patients were readministered the questionnaire at the 1-year time point. Median score for patient knowledge was highest at this point. Employed patients demonstrated better patient knowledge at baseline and at 1-year time point compared to unemployed patients. Unemployed patients experienced a significant improvement in scores from baseline to immediately posteducation, but improvement from immediately posteducation to the 1-year time point was insignificant was insignificant.ConclusionOur study has examined the effectiveness of a nurse-led glaucoma education program in an Asian population, demonstrating improvement in both patient knowledge and compliance motivation levels up to 1 year after intervention.How to cite this articleSng JJ, Ang BCH, Soo Hoo WC, et al. The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series. J Curr Glaucoma Pract 2023;17(3):149-156.
Objective: To systematically review the efficacy and tolerability of 4 prostaglandin analogues (PGAs) as first-line monotherapies for intraocular pressure (IOP) lowering in adult patients with ...primary open-angle glaucoma or ocular hypertension. Data Sources: A literature search was performed in PubMed (1965-June 2013) and the Cochrane Library (1980-June 2013) using the search terms ocular hypertension, open-angle glaucoma, prostaglandin analogues, bimatoprost, latanoprost, tafluprost, and travoprost. Additional studies were searched from the reference lists of identified publications. Study Selection and Data Extraction: In all, 32 randomized controlled trials comparing between PGAs (bimatoprost 0.03%, latanoprost 0.005%, tafluprost 0.0015%, and travoprost 0.004%) or PGA with timolol were selected. Data Synthesis: A network meta-analysis was conducted. Using timolol as reference, the relative risks (RRs) of achieving treatment success, defined as the proportion of patients achieving at least 30% IOP reduction, with 95% CIs, were as follows: bimatoprost, 1.59 (1.28-1.98); latanoprost, 1.32 (1.00-1.74); travoprost, 1.33 (1.03-1.72); and tafluprost, 1.10 (0.85-1.42). The mean IOP reductions after 1 month were 1.98 (1.50-2.47), 1.01 (0.55-1.46), 1.08 (0.59-1.57), and 0.46 (−0.41 to 1.33) mm Hg, respectively, and the results were sustained at 3 months. Bimatoprost was associated with the highest risk of developing hyperemia, whereas latanoprost had the lowest risk, with RRs (95% CI) of 4.66 (3.49-6.23) and 2.30 (1.76-3.00), respectively. Conclusions: Bimatoprost achieved the highest efficacy in terms of IOP reduction, whereas latanoprost had the most favorable tolerability profile. This review serves to guide selection of the optimal PGA agent for individual patient care in clinical practice.
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