Clinical Efficacy of Custom-built Software for the Early Detection of Glaucoma: A Comparison of Axial-length and Major Retinal Artery Location Data

PURPOSE: To assess the clinical efficacy for early detection of glaucoma using custom-built image software visualizing translucent retinal nerve fiber layer thickness (RNFLT) that is graphed based on a normative database. METHODS: This prospective study was conducted using a normative database constructed with RNFLT data of 151 healthy Korean eyes. The reference lines of the mean, the lower 5%, and the lower 1% limit were visualized as a translucent RNFLT graph produced by our software after inputting each subject's major retinal artery position and overlaying the results onto the RNFLT measurements. Fifty-eight additional healthy control and 79 early-glaucoma eyes were collected for the validation group. If a subject's RNFLT graph was outside the reference line of the lower 1% limit, the graph was defined as abnormal. The lower 1% limit, which was generated by three criteria (criterion 1, built-in software; criterion 2, axial-length data; criterion 3, major retinal artery data), was used to address the difference of agreement with a standard answer. RESULTS: For criteria 1, 2, and 3, the accuracy of our custom-built software was significantly higher than that of the manufacturer's database (kappa of 0.475 vs. 0.852 vs. 0.940; sensitivity of 62.0% vs. 91.1% vs. 97.5%, respectively) maintaining high specificity (87.9% vs. 94.8% vs. 96.6%, respectively). CONCLUSIONS: The custom-built imaging software with the constructed RNFLT normative database showed high clinical efficiency for early detection of glaucoma with negligible user-related variability.

Quarter-Shifted Microincisional Sutureless Vitrectomy in Patients with a Glaucoma Drainage Implant or Filtering Bleb

When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases.

Relationship between Preoperative Biometry and Intraocular Pressure Reduction after Phacoemulsification in Normal and Glaucoma Patients

PURPOSE: To investigate the relationships between preoperative factors and intraocular pressure (IOP) reduction after phacoemulsification in normal, open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) patients. METHODS: IOP was measured before and 3 months after cataract surgery in 30 normal, 24 OAG and 31 ACG patients. The relationship between IOP reduction after cataract surgery and preoperative parameters including anterior chamber depth (ACD), axial length (AL), preoperative IOP/ACD ratio (PD ratio), preoperative IOP/AL ratio (PL ratio) were investigated in the 3 groups. RESULTS: Significant IOP reduction was observed in all 3 groups after surgery (paired sample t-test; p < 0.05), and IOP reduction was correlated with preoperative IOP level in all 3 groups (Pearson's correlation; p < 0.05). Other preoperative parameters such as ACD and AL were not correlated with IOP reduction, and PD ratio was significantly correlated with IOP reduction only in the OAG group (Pearson's correlation; p < 0.001). PL ratio was significantly correlated with IOP reduction in all 3 groups (Pearson's correlation; p < 0.05) and showed the best sensitivity and specificity to predict significant reduction in IOP after cataract surgery among parameters including preoperative IOP, PD ratio and PL ratio. CONCLUSIONS: PL ratio was significantly correlated with IOP reduction after cataract surgery in all 3 groups and showed a higher predictive value for IOP reduction in the OAG group than in the other groups.

Recurrence Rates of Conjunctival Autograft Transplantation With Aminiotic Membrane Transplantation in Primary Pterygium Surgery

PURPOSE: To compare postoperative recurrence rates between conjunctival autograft transplantation alone and conjunctival autograft transplantation with amniotic membrane transplantation in primary pterygium surgery. METHODS: The authors conducted a retrospective analysis of 66 eyes from 62 patients who underwent primary pterygium surgery from January 2001 to May 2009. Twenty three eyes underwent conjunctival autograft transplantation alone, 43 eyes underwent conjunctival autograft transplantation with amniotic membrane transplantation. RESULTS: Recurrence of pterygium was observed in 5 of 23 eyes that received conjunctival autograft transplantation alone. There were 2 cases of recurrence of 43 eyes that received conjunctival autograft transplantation and amniotic membrane transplantation. No major complications such as necrotizing scleritis, sclera ulcer, or corneal perforation were observed in either group after surgery. CONCLUSIONS: The present study showed that receiving both conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery has a lower recurrence rate than conjunctival autograft transplantation alone.

Geriatric Foot Problems and Related Factors in Two Provinces of Korea

PURPOSE: The purpose of the study was to identify the prevalence, risk factors and clinical meanings of geriatric foot problems and to suggest implications for the future. METHODS: One hundred eighty nine elderly aged 60 and over from institution as well as community were investigated for their foot conditions by means of a questionnaire including general characteristics, self care capacity, risk factors, foot problem checklist, X-ray, podoscopy and foot scan. Descriptive statistics and chi-square-test was performed as appropriate utilizing SPSS version 14. Less than .05 of p-value was adopted as statistical significance level. RESULTS: All subjects had at least one kind of foot problem and the most prevalent ones were nail problems, foot deformities in order. Prevalence of foot pain and edema was relatively low. CONCLUSION: Foot problem in elderly is prevalent and geriatric foot is expected to emerge as one of the most important problems in the geriatric field. Therefore strategies to deal with geriatric foot should be developed and practiced for better quality of life in later life.