Changes in the posterior segment of the eye after an episode of acute ocular hypertension / 国际眼科杂志(Guoji Yanke Zazhi)

Rapidly increasing intraocular pressure(IOP)is a typical manifestation of acute angle-closure glaucoma and an important cause of ocular tissue damage, vision loss and even blindness in glaucoma patients. The sharp increase of intraocular pressure in a short period of time in acute angle-closure glaucoma will cause characteristic damage to the structure and function of retina, choroid and optic nerve. Currently, the diagnosis and evaluation of the course of glaucoma is largely dependent on the state of high IOP, changes in the optic nerve and visual field damage, but irreversible damage to the fundus has already been made in glaucoma patients by this time. The microstructural changes in the posterior segment of the eye are more sensitive to high IOP and often appear before optic nerve and visual field damage, which can indicate the damage of high IOP to the eye earlier. Through the evaluation of the imaging characteristics of the posterior segment of the eye, the morphological characteristics that affect the prognosis of glaucoma can be explored, which is clinically important for the early diagnosis of glaucoma.

Observation on the structural characteristics of optic discs in high myopia combined with primary open-angle glaucoma / 中华眼底病杂志

Objective:To observe and analyze the structural characteristics of the optic discs in high myopia (HM) combined with primary open-angle glaucoma (POAG) and the optic disc parameters with diagnostic efficacy.Methods:A cross-sectional study. From August 2020 to March 2021, a total of 114 eyes of 68 patients with POAG, HM and healthy volunteers who were diagnosed by Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University were included in the study. Among them, 21 POAG patients (39 eyes) were divided into H+P group (9 patients, 18 eyes) and non-H+P group (12 patients, 21 eyes) according to whether or not HM was combined; 26 HM patients (37 eyes) were selected as HM group; 21 healthy volunteers (38 eyes) were selected as normal control group. The subjects included 31 males (51 eyes) and 37 females (63 eyes), whose average age was 36.93±12.60 years old. Diopter, central corneal thickness (CCT) and axial length (AL) were measured. There was no significant difference in age ( F=8.333), sex composition ratio ( χ2=0.863), and CCT ( F=1.425) among the four groups ( P>0.05); while, there were significant differences in AL ( F=69.956), diopter ( F=37.711), visual field index (VFI) ( F=43.254) and mean defect (MD) ( F=49.793) among the four groups ( P<0.01). Enhanced depth imaging using optical coherence tomography was used to obtain the tilt parameters, the disc rim parameters, the lamina cribrosa parameters and the retinal nerve fiber layer (RNFL) thickness. The tilt parameters included optic disc horizontal diameter, optic disc vertical diameter, optic disc ellipse index (horizontal diameter/vertical diameter); the disc rim parameters included Bruch’s membrane opening-minimal rim width (BMO), optic cup area, optic disc area, disc rim area, cup-disc area ratio; the lamina cribrosa parameters included anterior laminar insertion depth (ALID), prelaminar neural tissue (PLNT), and lamina cribrosa thickness. The pairwise comparison between groups were performed by ANOVA test. Pearson correlation analysis was used to analyze the correlation between disc tilt parameters, disc rim parameters, lamina cribrosa parameters and visual field parameters, as well as between disc rim parameters and RNFL thickness. According to receiver operating characteristic (ROC) curve and area under the curve (AUC), the predictive value of those above related factors for HM combined with POAG was evaluated. Results:Tilt parameters: compared with the optic disc horizontal diameter of non-H+P group, those of normal control group, HM group and H+P group were significantly decreased ( P<0.05), the ellipse indices of HM group and H+P group were significantly lower than those of normal control group and non-H+P group ( P<0.05). The results of correlation analysis showed that the optic disc horizontal and vertical diameters were negatively correlated with MD ( r=-0.302,-0.235; P=0.002, 0.017), and negatively correlated with VFI ( r=-0.291,-0.246; P=0.003, 0.013). Disc rim parameters: the disc cup area and cup-disc area ratio of non-H+P group and H+P group were significantly larger than those of normal control group and HM group ( P<0.05). The disc rim area and the average BMO of HM group, non-H+P group and H+P group were significantly smaller than those of normal control group ( P<0.05). The results of correlation analysis showed that the cup-disc area ratio ( r=-0.584), the average BMO ( r=0.650) had the highest correlation with the average RNFL thickness ( P<0.001). The superior, inferior, nasal and temporal BMO were all positively correlated with the corresponding quadrant RNFL thicknesses ( r=0.431, 0.656, 0.362, 0.375; P<0.05); the optic disc rim area, the average BMO were positively correlated with MD ( r=0.449, 0.618) and VFI ( r=0.449, 0.605) ( P<0.05), among which the correlation of the average BMO was the highest; the optic cup area and cup-disc area ratio were negatively correlated with MD ( r=-0.346,-0.559) and VFI ( r=-0.312,-0.548) ( P<0.001), among which the correlation of the cup-disc area ratio was the highest. Lamina cribrosa parameters: ALID of non-H+P group and H+P group were significantly deeper than those of normal control group and HM group ( P<0.05). LC of non-H+P group and H+P group were significantly thinner than those of normal control group and HM group ( P<0.05). The results of correlation analysis showed that ALID was negatively correlated with MD and VFI ( r=-0.402, P<0.001), VFI ( r=-0.405, P=0.001); LC was positively correlated with MD and VFI ( r=0.403, P<0.001), VFI ( r=-0.401, P=0.015). Comparison of diagnostic efficiency between various optic disc parameters: the results of ROC analysis showed that the cup-disc area ratio had the highest diagnostic performance (AUC=0.847, P=0.007), the maximum Youden index was 0.563, the sensitivity and specificity were 0.833 and 0.730, respectively, and the best critical value was 0.340. Conclusions:Optic disc tilt is more pronounced in HM combined with POAG; BMO in each quadrant could objectively reflect the disc rim defect of HM combined with POAG; the thinning and the backward shift of the lamina cribrosa were consistent with the aggravation of the visual field defect. Among them, the cup-disc area ratio had better diagnostic performance.

Morphological assessment of lamina cribrosa in idiopathic intracranial hypertension

Purpose: Technological development of optic coherence tomography has enabled a detailed assessment of the optic nerve and deeper structures and in vivo measurements. The aim of this study was to compare the lamina cribrosa morphology of the optic nerve in idiopathic intracranial hypertension (IIH) and healthy individuals. Methods: The lamina cribrosa morphology of optic nerve in 15 eyes with IIH and 17 eyes of healthy individuals were compared. Four parameters such as Bruch membrane opening (BMO), lamina cribrosa thickness (LCT), prelaminar tissue thickness (PTT), and anterior lamina cribrosa surface depth (ALCSD) were retrospectively evaluated. Results: By enhanced depth imaging-optic coherence tomography (EDI-OCT), PTT and BMO were found to be significantly greater (574,35 � 169,20 ?m and 1787,40 � 140,87 ?m, respectively) in IIH patients than healthy individuals (187,18 � 132,15 ?m and 1632,65 � 162,58 ?m, respectively), whereas ALSCD was found to be significantly less in IIH patients (234,49 � 49,31 ?m) than healthy individuals (425,65 � 65,23 ?m). There was not a statistically significant difference regarding LCT between the IIH patients (238,59 � 17,31 ?m) and healthy individuals (244,96 � 15,32 ?m). Conclusion: Increased intracranial pressure causes morphological changes in lamina cribrosa. Assessment of lamina cribrosa with EDI-OCT is important for diagnosis and follow-up of patients with IIH. EDI-OCT is objective, reproducible, and cost-effective assistive imaging tool in IIH patients.

Lamina cribrosa surface position in idiopathic intracranial hypertension with swept-source optical coherence tomography

Purpose: The purpose of this study is to compare the thickness and depth measurements of the lamina cribrosa (LC) obtained using a swept-source optical coherence tomography (SS-OCT) device in idiopathic intracranial hypertension (IIH) patients and healthy subjects. Methods: This retrospective, cross-sectional observational study included 16 eyes with IIH and 20 control eyes. The LC measurements with serial horizontal B scans of the optic nerve head were obtained using SS-OCT (Topcon 3D DRI OCT Triton). The anterior lamina surface (ALS) depth, posterior lamina surface (PLS) depth, and LC thickness measurements were evaluated. Results: In patients with IIH, the mean ALS depth was 225.00 ± 58.57 ?m and the mean PLS depth was 449.75 ± 63.50 ?m. In the IIH control group, the corresponding values were 359.40 ± 105.38 and 570.10 ± 99.41 ?m (P < 0.05). The difference in LC thickness between the IIH and control subjects was not statistically significant. Conclusion: LC can be evaluated using an SS-OCT device. LC was displaced anteriorly in patients with IIH compared with normal controls. The assessment of LC level with SS-OCT in IIH cases is a valuable and reproducible adjunctive imaging method in terms of diagnosis and follow-up.

Purification and characterization of rat optic nerve head astrocytes / 眼科新进展

Objective To develop a set of methods for the culture and purification of astrocytes grown from explanted rat optic disc.Methods Rat optic disc and optic nerve were separated with anatomic microscopy and the blocks were cultivated primarily in culture flask with the medium containing DMEM/F-12.After digested by 2.5 g · L-1 trypsin,astrocytes were purified on the selective medium and passaged for two generations.Then cells were identified by immunofluorescent staining of glial fibrillary acidic protein (GFAP),neural cell adhesion molecule (NCAM) and Vimentin.Next,epidermal growth factor (EGF) was used to stimulate the purified cells for 24 h to observe their morphologic alteration.Finally,Western blot was used to detect the expression of GAFP,NCAM and Vimentin in the cells.Results When the tissue blocks were attached to the wall for 10 days,cells began to crawl out of the tissues and had different morphologies.After purified by the selective culture medium,satellite or anomalistic cells,possessing abundant cytoplasm,began to take a leading place.Immunofluorescent staining showed GFAP,NCAM and Vimentin were stained positively,and the purity of positive cells was above 90％.After stimulated by EGF,cells proliferated and the morphology changed;meanwhile,there was an increasing expression of GFAP,NCAM and Vimentin after stimulated by EGF when compared with the blank control group,and the difference was statistically significant (P ＜ 0.05).Conclusion Highly-purified astrocytes can be achieved by the culture of explanted lamina cribiosa and optic disc of rats in vitro.

Relationship between Progressive Changes in Lamina Cribrosa Depth and Deterioration of Visual Field Loss in Glaucomatous Eyes

PURPOSE: To investigate the relationship between the progression of visual field (VF) loss and changes in lamina cribrosa depth (LCD) as determined by spectral-domain optical coherence tomography (SD-OCT) enhanced depth imaging in patients with primary open angle glaucoma (POAG). METHODS: Data from 60 POAG patients (mean follow-up, 3.5 ± 0.7 years) were included in this retrospective study. The LCD was measured in the optic disc image using SD-OCT enhanced depth imaging scanning at each visit. Change in the LCD was considered to either ‘increase’ or ‘decrease’ when the differences between baseline and the latest two consecutive follow-up visits were greater than the corresponding reproducibility coefficient value (23.08 µm, as determined in a preliminary reproducibility study). All participants were divided into three groups: increased LCD (ILCD), decreased LCD (DLCD), and no LCD change (NLCD). The Early Manifest Glaucoma Trial criteria were used to define VF deterioration. Kaplan-Meier survival analysis and Cox's proportional hazard models were performed to explore the relationship between VF progression and LCD change. RESULTS: Of the 60 eyes examined, 35.0% (21 eyes), 28.3% (17 eyes), and 36.7% (22 eyes) were classified as the ILCD, DLCD, and NLCD groups, respectively. Kaplan-Meier survival analysis showed a greater cumulative probability of VF progression in the ILCD group than in the NLCD (p < 0.001) or DLCD groups (p = 0.018). Increased LCD was identified as the only risk factor for VF progression in the Cox proportional hazard models (hazard ratio, 1.008; 95% confidence interval, 1.000 to 1.015; p = 0.047). CONCLUSIONS: Increased LCD was associated with a greater possibility of VF progression. The quantitative measurement of LCD changes, determined by SD-OCT, is a potential biomarker for the prediction of VF deterioration in patients with POAG.

Lamina Cribrosa Changes after Laser In Situ Keratomileusis in Myopic Eyes

PURPOSE: To determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia. METHODS: Enhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators. RESULTS: Forty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month. CONCLUSIONS: The LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.

Features of the Lamina Cribrosa and the Autonomic Nervous System in Glaucoma Patients with Disc Hemorrhages

PURPOSE: To assess the effects of structural changes in the lamina cribrosa (LC) and the status of the autonomic nervous system on disc hemorrhages (DHs). METHODS: A retrospective study was performed on 68 eyes of 68 patients with primary open-angle glaucoma and optic DHs. We divided the patients into two groups using optical coherence tomography according to the presence of LC defects, and then compared both groups. We also analyzed autonomic nervous system function using the heart rate variability test, and compared the two groups. RESULTS: Eyes with LC defects had significantly longer axial lengths than those without defects (p = 0.029), and the DH was located more proximally (p < 0.001). A significantly larger proportion of eyes without LC defects had configurational optic disc changes such as optic disc rim notching, focal rim thinning, or generalized thinning (p = 0.001). On heart rate variability testing, the group without LC defects had a significantly higher “low frequency/high frequency ratio” than the group with defects (p = 0.008). CONCLUSIONS: There was a difference in the clinical features of DH between eyes with and without LC defects. Eyes with LC defects were more myopic and the proximal part of the DH tended to be on the disc cup or characterized by peripapillary atrophy. These results suggest that the DH developed due to a mechanical cause in eyes with LC defects. Patients without LC defects had a more dysregulated autonomic nervous system. The DH location was related to disc rim notching and neural rim losses, which implies ischemia as the pathogenic mechanism involved in the development of DH in eyes without LC defects. Therefore, more careful observations of the LC would facilitate a better understanding of the specific pathogenic mechanisms underlying DH.

Application of EDI-OCT in measuring the plate thickness in patients with branch retinal vein occlusion / 眼科新进展

Objective To analyze the application value of enhanced depth imaging optical coherence tomography (EDI-OCT) in measuring the lamina cribrosa thickness(LCT) in patients with branch retinal vein occlusion (BRVO).Methods The clinical data of 65 patients with unilateral BRVO treated in our hospital from September 2014 to March 2016 were selected as the observation group.The single healthy eyes of 40 healthy individuals who received physical examination in the hospital during the same period were selected as the control group.The changes of retinal nerve fiber layer (RNFL) thickness,LCT,central corneal thickness,axial length,transverse diameter of optic disc,vertical diameter of optic disc,diopter and extent of visual field defect in the two groups were determined by EDI-OCT.Results There was no significant difference in the central corneal thickness,axial length,transverse diameter of optic disc,vertical diameter of optic disc and diopter between the two groups (all P ＞ 0.05).LCT of different regions of optic disc in the observation group were lower than those in the control group (all P ＜ 0.05).The range of visual field defects in the observation group was larger than that in the control group,and the RNFL thickness was lower than that in the control group (P ＜ 0.05).LCT was positively correlated with the thickness of whole RNFL in patients with BRVO,and was negatively correlated with the visual field defects (P ＜ 0.05).Conclusion EDI-OCT is an effective means for measuring LCT.LCT of patients with glaucoma BRVO is thinner than that of normal healthy people,and LCT is positively correlated with RNFL.thickness,and negatively correlated with visual field defects.

Lamina depth and thickness correlate with glaucoma severity.

Purpose: To evaluate the correlation between lamina cribrosa (LC) morphology and glaucoma severity in patients with primary forms of open‑angle glaucoma (OAG) using enhanced depth imaging spectral‑domain optical coherence tomography (SD‑OCT) and Humphrey visual field test (HVF). Subjects and Methods: Patients with OAG (n = 166), divided into normal‑tension glaucoma (NTG) and high‑tension glaucoma (HTG) groups (n = 66 and n = 100), were imaged using SD‑OCT to obtain horizontal B‑scan images of the optic nerve head (ONH). Laminar depth (LD) and laminar thickness (LT) were measured at the center of ONH. Results: The mean (±standard deviation) values of LD, LT, and visual field mean deviation (MD) were 555.4 ± 142.3 μm, 179.9 ± 49.7 μm, and − 5.7 ± 6.4 dB, respectively. In the multivariate linear regression analysis, LD, LT, and intraocular pressure (IOP) were significantly correlated with MD (P = 0.007, P = 0.037, and P = 0.004, respectively). In the subgroup analyses, only LD was associated with MD in the NTG group (n = 66), whereas LT and IOP were correlated with MD in the HTG group (n = 100). Neither axial length nor central corneal thickness was associated with LD or LT. Conclusions: Glaucoma severity, as measured by HVF MD, shows significant correlations with LD and LT, with greater severity associated with increasing LD and decreasing LT. Normal‑ and high‑tension OAG patients have different associations with LD and LT, which implies that the pathogenesis of these two entities might be different.

Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

PURPOSE: To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population. METHODS: A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m²) + 0.16 diastolic blood pressure (mm Hg) - 0.18 age (years) - 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure. RESULTS: The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively (p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower (p < 0.001; beta: -0.12; B: -2.306; 95% confidence interval [CI]: -2.717, -1.895) in OAG group than in non-glaucomatous group and the mean TLCPD was distributed higher (p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively. CONCLUSIONS: Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.

Correlation between Trans-lamina Cribrosa Pressure Difference and Morphologic Parameters of Optic Disc in Normal Tension Glaucoma Patients

PURPOSE: To investigate the relationship between trans-lamina cribrosa pressure difference (TLCPD) and morphologic parameters of optic disc (OD) in normal tension glaucoma (NTG) patients. METHODS: Data from 31 NTG patients (31 eyes) and 29 controls (29 eyes) were analyzed retrospectively. Their cerebrospinal fluid pressure was estimated using diastolic pressure (DBP), body mass index (BMI) and age. TLCPD was defined as the difference of intraocular pressure (IOP) and the estimated cerebrospinal fluid pressure (ECSFP). Measurements of the rim area (RA), disc area (DA), average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT) and cup volume (CV) were taken for all patients using optical coherence tomography. The correlation between TLCPD and morphologic parameters of OD were assessed. RESULTS: There were no significant differences between the two groups in terms of age, DBP, IOP and spherical equivalent (SE) and BMI. The mean ECSFP was significantly higher in the controls (10.7 ± 2.8 vs. 12.2 ± 2.2 mm Hg, p = 0.031) and TLCPD was significantly higher in patients (2.4 ± 2.1 vs. 4.9 ± 3.7 mm Hg, p = 0.002). In the NTG group, there was a negative correlation between TLCPD and RA (r = -0.595) and positive correlations between TLCPD and the average C/D ratio (r = 0.504), vertical C/D ratio (r = 0.434) and CV (r = 0.420). Average RNLFT was also significantly correlated with TLCPD (r = -0.500) and RNFLT for four quadrants, except the nasal quadrant, in NTG patients. CONCLUSIONS: NTG patients had higher TLCPD. A higher TLCPD was associated with a narrower RA, larger C/D ratio, and thinner RNFLT.

Axial Length Correlation to Lamina Cribrosa Thickness, Prelaminar Tissue Thickness, and Anterior Laminar Displacement

PURPOSE: In this study we determined the correlation of axial length to lamina cribrosa thickness (LCT), prelaminar tissue thickness (PT), and anterior laminar displacement (ALD) in young healthy eyes. METHODS: The optic discs of 60 eyes from 30 young healthy subjects with myopia were scanned using enhanced-depth imaging spectral-domain optical coherence tomography (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany). The LCT, PT, and ALD were measured at the superior midperipheral, middle, and inferior midperipheral of the optic nerve head, respectively. A linear mixed-effects model was used to determine the relationship between the axial length and the LCT, axial length and PT as well as axial length and ALD. RESULTS: The mean, superior midperipheral, and middle LCT were not significantly correlated with axial length. Conversely, the inferior midperipheral LCT was negatively correlated with axial length (p = 0.019, beta = -7.34). There was no significant association between axial length and PT. Mean ALD was negatively correlated with axial length (p = 0.022, beta = -17.17). CONCLUSIONS: In the present study, the inferior midperipheral LCT and mean ALD were negatively correlated with axial length, but PT showed no significant association with axial length.

Lamina Cribrosa Thickness in the Fellow Eyes of Patients with Unilateral Retinal Vein Occlusion

PURPOSE: To compare the lamina cribrosa thickness in fellow eyes of patients with unilateral retinal vein occlusion (RVO) with the normal control eyes and the type of RVO. METHODS: This study included 40 patients with unilateral RVO and 45 normal control subjects. We compared the lamina cribrosa thickness between the RVO eyes and the fellow eyes, the fellow eyes and the normal control eyes and the type of RVO eyes. We measured central lamina thickness using enhanced depth imaging spectral-domain optical coherence tomography. RESULTS: In patients with unilateral RVO, central lamina cribrosa thickness was not significantly different between the RVO eyes (211.33 microm) and the fellow eyes (204.13 microm; p = 0.202). However, central lamina cribrosa thickness in the fellow eyes was significantly reduced compared with the normal control eyes (217.76 microm; p = 0.046). Central lamina cribrosa thickness in the fellow eyes according to the type of RVO was not statistically significantly different (p = 0.672). CONCLUSIONS: This study showed that the central lamina cribrosa thickness in the fellow eyes of patients with unilateral RVO was thinner than in normal patients. Therefore, the lamina cribrosa thickness may be associated with RVO as well as glaucoma.

Measurement of Deep Optic Nerve Complex Structures with Two Spectral Domain Optical Coherence Tomography Instruments

PURPOSE: To assess the usefulness of two spectral domain optical coherence tomography (SD-OCT) instruments (Cirrus(R), Spectralis(R)) for evaluating optic nerve head and peripapillary structures. METHODS: Images of optic nerve complex were obtained from 136 eyes of 136 patients using enhanced depth imaging technique of 2 SD-OCT instruments. Optic nerve head and peripapillary structures were investigated for their visibility and morphological features in total eyes and glaucomatous eyes. Effect factors for laminar thickness measurement were evaluated and the reproducibility of the lamina cribrosa thickness measured by the 2 OCT instruments was analyzed. RESULTS: Lamina cribrosa thickness was better identified using Spectralis(R) OCT in total and glaucomatous eyes. Short posterior ciliary artery (in total eyes) and peripapillary choroid (in total and glaucomatous eyes) were also better identified using Spectralis(R) OCT (p < 0.001). A cup-disc ratio < or = 0.6 was the significant effect factor for laminar thickness measurement (p < 0.05). Interobserver reproducibility was excellent using both OCT instruments. Intraobserver reproducibility was excellent using Spectralis(R) OCT and moderate using Cirrus(R) OCT. CONCLUSIONS: Spectralis(R) OCT was better for visualizing optic nerve head and peripapillary structures and showed better reproducibility than Cirrus(R) OCT. Thus, the Spectralis(R) may be helpful for detecting and understanding features of the optic nerve complex.

Study on intracranial pressure, glaucoma and research advance in noninvasive measurements about intracranial pressure / 国际眼科杂志(Guoji Yanke Zazhi)

Glaucoma is the first leading cause of irreversible blindness and the second leading cause of blindness worldwide. Numerous studies have shown that elevated intraocular pressure ( IOP ) is one of the major risk factors for the development and progression of glaucomatous optic nerve damage. However, there have been 50% of primary open-angle glaucoma ( POAG ) patients with typical glaucomatous optic neuropathy in whom the IOP measurements have always been in the normal range, and some patients develop typical glaucomatous optic neuropathy with the well controlled IOP. These phenomena cannot be explained by the theory of high intraocular pressure. The pathogenesis of glaucomatous optic nerve damage in these patients with normal IOP needs to be further discussed. Numerous studies at home and abroad have shown that: 1. the surrounding anatomy of the optic nerve including the IOP, the anatomy and biomechanics of the lamina cribrosa and retrobulbar orbital cerebrospinal fluid pressure may be of importance for the pathogenesis of the POAG;2. patients with normal tension glaucoma had significantly lower cerebrospinal fluid pressure and a higher trans - lamina cribrosa pressure difference compared with normal subjects; 3. patients with ocular hypertension had significantly higher cerebrospinal fluid pressure, however, there is no difference in trans -lamina cribrosa pressure compared with normal subjects. Based on the above research, now we make a review about the research advance of the relation between intracranial pressure and glaucoma optic nerve damage and the available measurements about noninvasive intracranial pressure in clinical in this paper.

Relationship between the Lamina Cribrosa, Outer Retina, and Choroidal Thickness as Assessed Using Spectral Domain Optical Coherence Tomography

PURPOSE: To evaluate the characteristics and relationship between peripapillary choroidal thickness (pCT), lamina cribrosa thickness (LCT), and peripapillary outer retinal layer thickness (pORT) as determined using spectral domain optical coherence tomography (SD-OCT) enhanced depth imaging (EDI). METHODS: In total, 255 participants were included (87 healthy subjects, 87 glaucoma suspects (GS), and 81 glaucoma cases). The pORT, defined as the thickness between the posterior outer plexiform layer and the retinal pigment epithelium (RPE) interface, and the pCT, between the outer margin of the RPE and the choroidal-scleral interface, were manually measured using EDI scanning of the circumpapillary retinal nerve fiber layer (RNFL). LCT was determined by EDI scanning of the optic nerve head (ONH). Baseline characteristics, including axial length (AXL) and the SD-OCT measurements of the participants, were compared among the three groups. The correlation between putative factors and pCT was determined using univariate and multivariate linear regression analyses. RESULTS: In all three groups, both pORT and pCT were thinnest in the inferior area among the four quadrants. In the healthy group, the mean peripapillary RNFL, pORT, and LCT were significantly greater in comparison with those of the GS and glaucoma groups (p < 0.001, p < 0.038, and p < 0.001, respectively). The pCT demonstrated no significant differences among the three groups (p = 0.083). Only age and AXL were associated with pCT by multivariate analysis. CONCLUSIONS: The pCT is substantially thinner in the inferior area of the ONH. In addition, the pCT demonstrates the strongest correlation with age and AXL, but was not associated with glaucoma or LCT.

Comparison of the Thickness of the Lamina Cribrosa and Vascular Factors in Early Normal-tension Glaucoma with Low and High Intraocular Pressures

PURPOSE: To compare the thickness of the lamina cribrosa (LC) and vascular factors of early normal-tension glaucoma (NTG) patients with high and low intraocular pressure (IOP) that are expected to be associated with the development of glaucoma. METHODS: Seventy-one Korean NTG patients with low IOP (the highest IOP 15 mmHg, 31 patients) were included in this study. The thickness of LC and vascular factors were compared. The thickness of the LC was measured using the enhanced depth imaging method with spectral domain optical coherence tomography (Heidelberg Spectralis). RESULTS: The mean thickness of the central LC was 190.0 +/- 19.2 microm in the low IOP group and 197.8 +/- 23.6 microm in the high IOP group, but there was no statistical significant difference between the two groups (p > 0.05). The prevalence of self-reported Raynaud phenomenon was significantly higher in the low IOP group (33.0%) than the high IOP group (10.3%, p = 0.04). CONCLUSIONS: The laminar thickness did not significantly differ between the high and low IOP groups. However, the prevalence of Raynaud phenomenon was higher in the low IOP groups. These results suggest that the development of glaucoma with low IOP patients may be more influenced by peripheral vasospasm, such as Raynaud phenomenon, rather than laminar thickness in NTG.

Age-Related Changes in the Thickness of the Lamina Cribrosa Measured by Spectral Domain OCT

PURPOSE: To measure the lamina cribrosa thickness (LCT) in vivo of healthy people and to determine any association between the LCT and age or sex. METHODS: We evaluated 100 eyes of 100 healthy volunteers. Forty eyes were selected and divided into 2 specific age groups (38-49 and 78-89 years) and the differences were assessed with respect to age and sex. Each participant underwent a complete eye examination and the LCT was evaluated with spectral domain optical coherence tomography (OCT) using enhanced depth imaging (EDI) mode. RESULTS: Eighty-seven eyes were considered for the measurement and analysis of the LCT and 13 eyes were excluded because of an unclear image for identifying the LCT. The mean age was 55.0 +/- 19.5 years. The mean LCT in healthy volunteers was 231.3 +/- 41.6 microm (range, 152.5 - 327.5 microm) and a negative relationship was found between LCT and age (LCT = -1.614 x age + 320.191 microm, 95% CI for slope -1.91 to -1.32, r2 = 0.572, p < 0.001). Regarding differences related to sex, males had relatively thicker LCT than females, irrespective of age, although not statistically significant (p = 0.623). CONCLUSIONS: The present study results showed a decrease in human LCT with increasing age. Therefore, a decreasing LCT with an increasing age could be considered a strong risk factor for the development of glaucoma. In addition, measuring the LCT may help to understand the disease prognosis.

Relationship between Central Retinal Vein Occlusion and Axial Length of Eye

Central retinal vein occlusion (CRVO) is a common retinal vascular disorder, and it has been suggested to occur by the occlusion of the sclerotic central retinal vein by thrombo- sis in the lamina cribrosa. Various systemic and local conditions have been considered to be predisposing factors to the development of CRVO, and it has been reported that CRVO occurs more frequently in hypermetropic small eyes. We studied on several factors such as age, refractive error, axial length and the association with systemic diseases in 32 eyes of unilateral CRVO. In the CRVO group,the mean axial length of the affected eyes was 23.13 +/-0.99 mm in males and 22.64 +/-0.63 mm in females. That of the unaffected eyes was 23.36 +/-1.17 mm in males and 22.64 +/-0.53 mm in females, the differences were statistically insignificant in males and females (p=0.250,p=0.496). The mean axial length of normal comparison eyes was 23.81 +/-0.73 mm in males and 23.07 +/-0.69 mm in females. The differences between the mean axial lengths of both eyes with unilateral CRVO and that of normal comparison eyes were statistically significant in males and females (p<0.05). In conclusion,the short axial length may play as an important related factor in the development of CRVO.