Visual Field Cluster Map Corresponding to Retinal Nerve Fiber Layer Sectors in Glaucoma

PURPOSE: To generate a map relating visual field (VF) test points to corresponding areas of the retinal nerve fiber layer (RNFL) measured with optical coherence tomography (OCT) in patients with localized RNFL defects. METHODS: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects, underwent standard automated perimetry (SAP) and OCT measurements. To define zones of related point, factor analysis of the mean thresholds for the SAP test points was performed, independently for each hemifield. A map relating the VF zones to the 12 OCT sectors was plotted based on the strongest correlations between both techniques. RESULTS: Factor analysis divided the VF points into five VF zones for each hemifield. Distribution of the VF zones for the superior and inferior hemifields was slightly asymmetric. Linear regression results showed that superior VF zones corresponding to the superior arcuate and nasal step regions were best correlated with 6- and 7-o'clock RNFL sectors (inferior and inferior temporal) of thickness (r = 0.51-0.59). RNFL thinning (defined by abnormal sector at p < 5%) and regional decreases in SAP sensitivity (defined by abnormal pattern deviation at p < 5%) were topographically related. CONCLUSIONS: A newly developed VF cluster map revealed significant topographical structure-function relationships, especially in the arcuate and nasal step region of the VF.

Optic Nerve Head Appearance in Chronic Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

PURPOSE: To evaluate the morphologic characteristics of the optic nerve head in chronic primary angle-closure glaucoma (CPACG) and primary open-angle glaucoma (POAG). METHODS: The study included 77 normal subjects, 82 patients with CPACG, and 120 patients with POAG. Age and refraction in the POAG and normal control groups were matched to those of the CPACG group. Using color optic disc photographs, the presence or absence of qualitative signs for differentiating between normal and glaucoma eyes were recorded. RESULTS: A rim notch was observed in 9 eyes (11.0%) in the CPACG group and in 27 eyes (22.5%) in the POAG group (P=0.04). Disc hemorrhage was found in 4 eyes (3.3%) in the POAG group and was not found in the CPACG group (P=0.15). Neither groups varied significantly in frequency of rim shape alteration (alteration of ISN'T rule), thinnest rim width outside the temporal sector, baring of the circumlinear vessel, bayonetting of vessel, nasalization of vessel, abnormally large peripapillary atrophy, abnormal form of peripapillary atrophy, or zone beta. CONCLUSIONS: Compared with the CPACG group, rim notches and disc hemorrhages were found more often in the POAG group. These results suggest that CPACG and POAG have at least partially different pathogenesis.

The Influence of Demographic Characteristics on the Qualitative Signs of Glaucomatous Optic Disc

PURPOSE: To evaluate the influence of age, gender, and refractive error on the qualitative signs of glaucomatous optic nerve damage in normal eyes. METHODS: We evaluated color optic disc photographs for the presence or absence of 10 qualitative signs: rim shape alteration (alteration of ISN'T rule), thinnest rim width outside the temporal sector, rim notch, optic disc hemorrhage, baring of circumlinear vessel, bayonetting of vessel, nasalization of vessel, abnormally large peripapillary atrophy, abnormal form of peripapillary atrophy, and zone beta in 181 eyes of 181 normal subjects. The influence of age, gender, and refractive error on each qualitative sign was analysed by multiple logistic regression. RESULTS: Refractive error was related to zone beta (odds ratio=2.29, 95% confidence interval [CI]=1.21~4.33, p=0.009) and the frequency of zone beta was higher in myopic eyes. Age was weakly associated with abnormally large peripapillary atrophy (odds ratio=1.03, 95% CI=1.01~1.06, p=0.02). Gender, on the other hand, had no influence on qualitative signs. CONCLUSIONS: Our findings indicate that the qualitative signs of glaucomatous optic nerve damage were not affected by age, gender, and refractive error, except for zone beta and abnormally large peripapillary atrophy. Myopia was related to zone beta, and age was related to abnormally large peripapillary atrophy in normal eyes.

Diagnostic Ability of Qualitative Signs and Characteristics of Optic Disc in Angle-Closure Glaucoma and Open-Angle Glaucoma

PURPOSE: To evaluate the ability of qualitative signs for glaucoma diagnosis, both alone and in combination, to discriminate between eyes with and without glaucomatous visual field damage. Furthermore, we investigated whether the characteristic optic disc changes in primary angle-closure glaucoma (PACG) differ from those in primary open-angle glaucoma (POAG). METHODS: Using color polaroid optic disc photographs, we examined 10 qualitative signs in 177 patients with PACG, 184 patients with POAG, and 181 normal subjects. RESULTS: Rim notches and rim shape alteration were found more frequently in patients with POAG than in those with PACG (p-6 dB) of the PACG and POAG groups, the best qualitative sign was rim shape alteration, and area under the receiver operating characteristic (ROC) curve was 0.696 and 0.768, respectively. The area under the ROC curve for the combination of qualitative signs was 0.802 and 0.918, respectively. CONCLUSIONS: These results suggest that glaucomatous disc damage was less pronounced in the PACG eyes than in the POAG eyes with similar visual field damage. A combination of the qualitative signs of optic disc using multiple logistic regression modelling improved the diagnostic ability.

Glaucomatous Optic Nerve Damage in the Fellow Eyes of Acute Angle-Closure Glaucoma

PURPOSE: To determine whether glaucomatous optic nerve damage occurs in the fellow eyes of patients with unilateral acute primary angle-closure glaucoma. METHODS: This study included both eyes of 75 subjects with unilateral acute primary angle-closure glaucoma in one eye, and 92 eyes of age- and refraction-matched normal controls. The presence or absence of qualitative signs for differentiating between normal and glaucoma eyes, vertical cup to disc ratio, and extent of zone beta were recorded. All subjects underwent examination with a Humphrey Field Analyser. RESULTS: Twelve fellow eyes (16%), 28 attacked eyes (37.3%), and no eyes in the control group had a vertical cup to disc ratio of 0.7 or greater (p<0.05). Thinnest rim width outside the temporal sector, rim shape alteration (alteration of ISN'T rule), baring of circumlinear vessel, and abnormal form of peripapillary atrophy were detected more frequently in fellow eyes than in normal controls (P<0.05). After excluding the attacked eyes with vertical cup to disc ratios of 0.69 or less and their fellow eyes, interocular correlation of mean deviation (r=0.31), corrected pattern standard deviation (r=0.32), extent of zone beta (r=0.57), and vertical cup to disc ratio (r=0.38) for attacked and fellow eyes were significant (p<0.05). CONCLUSIONS: Some of the fellow eyes of patients with unilateral acute primary angle-closure glaucoma had glaucomatous optic nerve damage, particularly the fellow eyes with a large cup to disc ratio.

Anti-Tumor Necrosis Factor Monoclonal Antibody Treatment for Chronic Behcet's Disease: 3 Cases

PURPOSE: Despite intensive, chronic immunosuppressive therapy, permanent loss of vision resulting from relapsing ocular inflammation occurs frequently in patients with Behcet's disease. Since tumor necrosis factor (TNF) might have an important pathogenetic role in Behcet's disease, monoclonal anti-TNF antibody treatmant has introduced for chronic Behcet's disease. We report three cases of chronic Behcet's disease that were treated by monoclonal anti-TNF antibody. METHODS: We describe the use of the anti-TNF monoclonal antibody, infliximab (Remicade(R), Schering Plough), in three patients with Behcet's disease who exhibited a severe ocular involvement refractory to standard treatment. RESULTS: Remission of ocular inflammation was evident within the first 24~48 hours, and no relapse occurred during a 5~12 month follow up. No side effects were noted. CONCLUSIONS: We suggest that anti-TNF monoclonal antibody (infliximab) is a rapid and effective new therapy for sight-threatening ocular inflammation in Behcet's disease.

Combined Clear Corneal Phacoemulsification and Pars Plana Vitrectomy

PURPOSE: To report the technical effectiveness, outcome, and incidence of complications of combined clear cornea phacoemulsification with intraocular lens implantation and pars plana vitrectomy. METHODS: Single-center prospective, non-comparative, consecutive case series. Twenty-three eyes of 23 patients underwent combined clear cornea phacoemulsification and pars plana vitrectomy for various vitreoretinal disorders due to cataracts by a single surgeon between July 2003 and August 2004. Surgical feasibility, intraoperative and postoperative complications and outcome of clear cornea incisions in all combined procedure were evaluated. RESULTS: No significant adverse effect of clear corneal wound on pars plana vitrectomy procedures was noted in any of the patients. Operatively and postoperatively, no significant complications related to clear corneal wound were noted, even with the variations of pars plana vitrectomy procedures for cases with and without gas-fluid exchange and intravitreal tamponade. CONCLUSIONS: Clear corneal incisions is a safe and more reasonable alternative in combined phacoemulsification with intraocular lens implantation and pars plana vitrectomy. For a more comprehensive conclusion, a comparative study with scleral tunnel incisions may be necessary.

Accuracy of Optic Disc Parameters Obtained by the Heidelberg Retina Tomograph in the Diagnosis of Glaucoma

PURPOSE: To determine which optic disc topographic parameters, obtained by the Heidelberg Retina Tomograph (HRT), are most useful to distinguish normal eyes from those with early to moderate glaucomatous visual field defects. METHODS: From each of 92 normal subjects and 154 patients with primary open-angle glaucoma one randomly selected eye was studied. The Humphrey perimeter, program C 30-2 visual fields, and 13 HRT parameters (software 2.01, includes rim to disc area ratio) were utilized. Because some of the optic disc parameters depend on the optic disc area, these parameters were corrected for the effect of disc area. The total glaucoma group was divided into three subgroups according to the visual field defects: early (mean deviation [MD] >-6 dB, 65 eyes), moderate (MD -6 to -12 dB, 49 eyes), and severe (MD <-12 dB, 40 eyes) glaucoma groups. RESULTS: In eyes with early glaucoma (MD = -3.43 +/- 1.60 dB), the sensitivity, specificity, accuracy, and areas under the receiver operating characteristic curve were, respectively: rim area (69%, 71%, 70%, 0.802), rim to disc area ratio (69%, 72%, 71%, 0.799), cup area (72%, 70%, 71%, 0.789) and cup to disc area ratio (69%, 70%, 69%, 0.790). In eyes with moderate glaucoma (MD = -8.75 +/- 1.88 dB), they were, respectively: rim area (78%, 86%, 83%, 0.872), rim to disc area ratio (76%, 86%, 82%, 0.869), cup area (76%, 87%, 83%, 0.864) and cup to disc area ratio (78%, 84%, 82%, 0.862). There was considerable overlap in HRT parameters between the normal and early glaucoma groups. CONCLUSIONS: The diagnostic value of single optic disc parameter had its limitations in the diagnosis of early stage glaucoma.

The Influence of Age, Gender, Refractive Error, and Optic Disc Area on the HRT Parameters in Normal Eyes

PURPOSE: To study the influence of age, gender, refractive error, and optic disc size on the optic disc parameters measured with the Heidelberg Retina Tomograph (HRT; software 2.01) in normal eyes. METHODS: Ninety-two normal subjects (mean refractive error +/- SD: -0.15 +/- 1.64 D, range -6.63 to +3.38 D) were examined using HRT. The influence of age, refraction, and disc area on each parameter was analysed by multiple linear regression. RESULTS: Large discs had large values of cup area, cup volume, rim area, cup to disc area ratio, and mean cup depth. Large discs had small values of rim to disc area ratio. However, rim volume, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area were not related to disc area. Most parameters were independent of age or refractive error except for a few parameters. Age was weakly related to disc area. Refractive error was weakly associated with cup shape measure. Gender had no statistically significant influence on optic disc parameters. CONCLUSIONS: These results indicate that several optic disc parameters have better correlations with the optic disc area than age, gender, and refractive error. These differences must be considered in the evaluation of optic disc for glaucoma.

A Case of Acute Lymphoblastic Leukemia with Eyeball Deviation in the Early Stage

PURPOSE: Orbital infiltration secondary to leukemia arises from acute myelogenous leukemia (AML). In most cases, it occurs late in the disease. We report one case of acute lymphoblastic leukemia (ALL) who presented with right eyeball deviation in the early stage. METHODS: A boy presented with a 3-weeks history of upward deviation of the right eye and limitation of motion of right gaze. CT scan of the orbits revealed a right inferior orbital mass with obscure, border extending, into the maxillary sinus, ethmoid sinus and nasal cavity. and Bony destruction was presented. Biopsy specimens from the maxillary sinus and ethmoid sinus were obtained for examination and peripheral blood smear, bone marrow aspiration and biopsy were done. RESULTS: Laboratory studies showed normal leukocyte count. Histopathologic specimens from the maxillary sinus showed B-cell lymphoblastic lymphoma. Bone marrow aspiration and biopsy showed blast cells, and immunophenotyping showed ALL with L1/L2 (L2 over 60%). The results supported the diagnosis of ALL with B-cell lymphoma. CONCLUSIONS: Ed- there is only one conclusion here. In cases of leukemia, exophthalmos can be the first manifestation without abnormality of peripheral blood. Therefore we must observe exophthalmos in children carefully in spite of normal peripheral blood with plenty of time and when necessary perform bone marrow aspiration and biopsy.

Histological Changes of the Vitreous and Retina in Retinal Lattice Degeneration

PURPOSE: To investigate of the histological characteristics of the lattice degeneration of the human peripheral retina. METHODS: The histological characteristics of the lattice degeneration of the retina was checked by flat preparation and serial section of the lattice lesion in three eyes was investigated by transmission electron microscopy. RESULTS: Flat preparation showed lattice lesion with a hole at the lateral margin with overlying sclerotic vessel and pigment clumping within the lesion. The ultrastructural initial findings showed that the collagen filament in the vitreous cavity was continuous with Muller fiber of the retina with the defect of the inner retina. The full-thikness defect of the sensory retina leaded to the retinal hole. The vascular wall was replaced and occluded by fine fibrillar collagen. The glial cell proliferated into the neural tissue of the sensory retina. These glial cells may secrete long spacing collagen (LSC) and curvilinear material shown at the area of the sensory retinal defect and near the vitreoretinal interface. CONCLUSIONS: These results suggest that the thinning of the retina occurs from the inner retina leading to retinal hole as the lattice degeneration progresses. LSC and curvilinear material are suggestive of derivatives derived from the extracellular material secreted from the glial cell.