Effects of Axial Lengths in High Myopia on the Significance Maps of Optical Coherence Tomography

Purpose@#We corrected the axial lengths of the macular and peripapillary significance maps using software embedded in a commercial spectral domain optical coherence tomography (SD-OCT) package. We evaluated the accuracy of glaucoma diagnosis in patients with high myopia, and the clinical implications. @*Methods@#Seventy eyes of 70 highly myopic patients with or without normal-tension glaucoma were retrospectively reviewed. The sensitivities and specificities of the color-coded significance maps were calculated using 1% (red) or 5% (yellow) as the abnormality criteria, and the values compared before and after axial length corrections performed using embedded SD-OCT software. @*Results@#At the 1% level of the normative database, we found no significant difference in specificity or sensitivity. At the 5% level, the increase in specificity was significant only for the inferotemporal sectors of the macular significance map. The specificity of the inferotemporal sector of the inner scan circle increased from 61.9 to 78.6% (p = 0.016) and that of the outer scan circle from 69 to 83.8% (p = 0.031). The specificities of the entire chart, the superior sector of the superior/inferior chart, and the 12-clockwise map increased significantly from 54.8 to 78.6% (p = 0.002), 59.5 to 76.2% (p = 0.039), and 59.5 to 76.2% (p = 0.002) respectively. @*Conclusions@#Clinicians should note that axial length correction of significance maps reduces the false-positive glaucoma diagnostic rates in highly myopic eyes. Correction of significance maps using embedded software may thus aid clinicians in the diagnosis of glaucoma in high myopic eyes.

Corneal Endothelial Cell Loss after Phacoemulsification in Eyes with a Prior Acute Angle-closure Attack

Purpose@#To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). @*Methods@#The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. @*Results@#The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). @*Conclusions@#Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

Corneal Endothelial Cell Loss after Phacoemulsification in Eyes with a Prior Acute Angle-closure Attack

Purpose@#To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). @*Methods@#The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. @*Results@#The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). @*Conclusions@#Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

A Comparison of Retinal Thickness Changes According to Initial Optic Disc Edema in Optic Neuritis Patients

Purpose@#To compare early changes in the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (mGCIPL) thicknesses according to the severity of initial optic disc edema in optic neuritis patients using swept-source optical coherence tomography (SS-OCT). @*Methods@#We retrospectively reviewed 18 eyes of patients diagnosed with naïve optic neuritis along with optic disc edema who underwent SS-OCT. The central thickness of the optic nerve head and the peripapillary retinal thickness were measured at the initial visit. To quantitate the degree of initial optic disc edema, we calculated the difference of each measurement between the affected eye and the normal fellow eye. The mRNFL and mGCIPL thicknesses were measured at the initial visit and at the 1 month follow-up. The association between changes in mRNFL and mGCIPL thicknesses at the 1 month follow-up and the severity of initial optic disc edema were evaluated. @*Results@#In the affected eye, the mGCIPL thickness was reduced at 1 month. The central thickness of the optic nerve head at the initial visit correlated with the reduction in the temporal mGCIPL at 1 month (R = 0.648, p = 0.045). Furthermore, thicker nasal peripapillary retinal thickness at the initial visit correlated with a reduction in nasal (R = 0.659, p = 0.038) and temporal (R = 0.774, p = 0.009) mGCIPL at 1 month. Thicker temporal peripapillary retinal thickness at the initial visit correlated with reduction in the nasal (R = 0.646, p = 0.044) and temporal (R = 0.760, p = 0.011) mGCIPL at 1 month. @*Conclusions@#In optic neuritis patients with optic disc edema, severe optic disc edema, evaluated by peripapillary retinal thickness and central thickness of the optic nerve at the initial visit was associated with a reduced temporal mGCIPL thickness at 1 month. This study suggested that initially severe optic disc edema in optic neuritis patients can predict a rapid decline in the mGCIPL.

The Effect of Intravitreal Injection on the Corneal Endothelium

PURPOSE: To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug. METHODS: The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively. RESULTS: The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm² before injection and 2,686.8 ± 288.7 cells/mm² 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups. CONCLUSIONS: There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the various drugs.

Depressive Symptoms and Quality of Life in Age-related Macular Degeneration Based on Korea National Health and Nutrition Examination Survey (KNHANES)

PURPOSE: This study was conducted to investigate the depressive symptoms and quality of life (QOL) in patients with age-related macular degeneration (AMD) using data obtained from the Korea National Health and Nutritional Examination Survey V-2 (KNHANES V-2) conducted in 2011. METHODS: This was a population-based, cross-sectional study that selected 329 participants from the fifth KNHANES (2011) who were diagnosed with AMD by an ophthalmologist based on fundus photography. The prevalence of depressive symptoms and the health-related QOL (using EuroQol indices) in this cohort were also estimated. Factors associated with depressive symptoms, including socioeconomic status, QOL indices, and associated chronic diseases, were investigated using multivariate regression models. RESULTS: Depressive symptoms were observed more frequently in AMD patients than in non-AMD controls (p = 0.013). Among the total 329 AMD participants, 65 (19.8%) had depressive symptoms. There were 16 males (24.6%) and 49 females (75.4%). Upon multivariate analysis, significant factors found to be associated with depressive symptoms were female gender (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.001 to 4.330), being in the “dependent” group for activities of daily living (OR, 4.638; 95% CI, 2.061 to 10.435), and having “some problems” in the “anxiety-depression” dimension of the EQ-5D (OR, 7.704; 95% CI, 1.890 to 31.408). CONCLUSIONS: Female gender and being dependent on others for activities of daily living increased the association of depressive symptoms in this cohort of AMD participants. Screening for depressive symptoms in East Asian AMD patients with these characteristics should be an important component of their care.

The Correlation between Cognitive Function and Glaucoma

PURPOSE: To compare mini-mental state examination (MMSE) score between glaucoma group and normal control group and to evaluate the correlation between MMSE score and spectral domain-optical coherence tomography (SD-OCT) values in both groups. METHODS: This prospective study includes thirty glaucoma patients (eleven primary open angle glaucoma and nineteen normal tension glaucoma) and thirty normal controls. Retinal nerve fiber layer (RNFL) and Ganglion cell-inner plexiform layer (GC-IPL) thickness were measured with SD-OCT, and the average values of both eyes were used. The cognitive function was evaluated with MMSE by a single examiner. RESULTS: The mean MMSE scores of glaucoma group and normal group were 26.07 ± 2.95, and 27.00 ± 1.68 respectively (p = 0.137). MMSE score of less than 24 only showed in glaucoma group. MMSE score and RNFL thickness showed statistically no signifance in correlation (R² = 0.236; p = 0.070), however, MMSE score and GC-IPL showed statistically significant correlation (R² = 0.256; p = 0.048). CONCLUSIONS: Glaucoma patients tend to show low cognitive function even though the correlation between glaucoma patient and low cognitive function was not statistically significant. Therefore, the aspect of cognitive depression should be concerned, when facing glaucoma patients.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

The Effect of Pattern Scan Laser Photocoagulation on Peripapillary Retinal Nerve Fiber Layer Thickness and Optic Nerve Morphology in Diabetic Retinopathy

PURPOSE: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. METHODS: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. RESULTS: The average RNFL thickness had increased by 0.84 microm two months after and decreased by 0.4 microm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 microm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 microm (p = 0.11) at six months in the PASCAL group. CONCLUSIONS: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.

Comparison of Rebound Tonometer, Non-Contact Tonometer, Goldmann Applanation Tonometer and the Relationship to Central Corneal Thickness

PURPOSE: To compare the level of accuracy of intraocular pressure (IOP) measurements of a rebound tonometer (RT) Icare(R), and non-contact tonometer (NCT), using Goldmann Applanation tonometer (GAT) as a reference to evaluate the influence of central corneal thickness (CCT) on IOP readings in the Korean population. METHODS: In a prospective study of 273 eyes, IOP was measured with RT, GAT, and NCT and compared to CCT measurements. Patients were assigned to one of 3 groups based on IOP measurements of GAT and 1 of 2 groups based on CCT. The comparison of the IOP values of RT, GAT, and NCT was performed between the IOP and CCT groups, and the differences among tonometers were evaluated. RESULTS: The RT showed statistically significant correlation with the GAT compared to the NCT. The CCT was related to RT measurements. The RT values compared to the GAT was underestimated in thin corneas and overestimated in thick corneas. CONCLUSIONS: There was a significant correlation between the RT and the GAT measurements compared with the NCT. However, RT is influenced by CCT and correlates less with GAT in low IOP ranges, suggesting that corneal thickness should be taken into consideration during such measurements.

Comparison of Ocular Biometry and Postoperative Refraction in Cataract Patients Between Lenstar(R) and IOL Master(R)

PURPOSE: To compare axial length, anterior chamber depth, and keratometric measurements of an optical low-coherence reflectometry device with those of other ocular biometry devices and evaluate the accuracy of predicting postoperative refraction. METHODS: A total of 32 eyes in 32 patients who received cataract surgery were included in the present study. The axial length, anterior chamber depth, and keratometry were measured by optical low-coherence reflectometry (Lenstar LS900(R)), partial coherence interferometry (IOL master(R)), and ultrasound. The SRK/T formula was used to calculate IOL power, and predictive error that subtracts predictive refraction from postoperative refraction was compared among ocular biometry devices. RESULTS: Axial length, anterior chamber depth, and keratometry had a strong correlation and demonstrated no statistically significant differences between Lenstar LS900(R) and other devices. The Bland-Altman plots showed a high degree of agreement between Lenstar LS900(R) and other devices. The mean absolute prediction errors in Lenstar LS900(R) and IOL master(R) were not significantly different. CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using Lenstar LS900(R) were as accurate as IOL master(R) and ultrasound.

Bilateral Simultaneous Acute Angle Closure Glaucoma Following Sexual Intercourse Aided by Sildenafil Citrate

PURPOSE: The authors of the present study report a case of bilateral simultaneous acute angle closure glaucoma following sildenafil citrate-aided sexual intercourse. CASE SUMMARY: A 63-year-old man visited the emergency department with sudden onset of bilateral ocular pain and blurred vision. The patient had taken 50 mg sildenafil citrate followed by sexual intercourse. His visual acuity on presentation was 0.3 in the right eye and 0.5 in the left eye. Intraocular pressure (IOP) was 54 mm Hg and 46 mm Hg in the right and left eye, respectively. Anterior chamber depths were shallow and angles were closed on gonioscopy in both eyes. The patient was treated with ocular hypotensive medication and subsequently managed with bilateral YAG laser peripheral iridotomies. During the 13 months of follow-up, there was no recurrent angle closure attack and IOPs were well-controlled. CONCLUSIONS: The mechanism of bilateral angle closure glaucoma caused by sildenafil citrate is not proven. Those who are predisposed towards developing angle-closure glaucoma may be at risk when having sexual intercourse aided by sildenafil citrate.

C-reactive Protein and Lipid Profiles in Korean Patients With Normal Tension Glaucoma

PURPOSE: To compare high-sensitivity C-reactive protein (hsCRP) levels and lipid profiles between Korean normal tension glaucoma (NTG) patients and healthy controls. METHODS: This cross-sectional study included 38 Korean patients with NTG and 38 age- and sex-matched healthy control subjects. We excluded the patients with cardiovascular risk factors and other systemic diseases that might affect CRP levels and lipid profiles. Each patient underwent a Humphrey visual field examination and blood sampling for hsCRP and lipid profile analyses. Subsequently, the NTG patients were classified into two groups based on their untreated intraocular pressure (IOP) level: low NTG (LNTG) with IOP13 and 0.05) after exclusion of Korean patients with cardiovascular risk factors. There was no significant association between hsCRP and visual field indices (p>0.05). CONCLUSIONS: High-sensitivity C-reactive protein-related vascular inflammatory conditions may not be directly associated with the development of NTG, regardless of the untreated IOP level.

Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.

Clinical Results of Single-Piece Hydrophilic IOL after Cataract Surgery

PURPOSE: To compare the clinical results of single-piece hydrophilic acrylic intraocular lenses (IOL) (Akreos AdaptTM, B&L) with those of three-piece hydrophobic acrylic IOL (Sensar(R), AMO) after cataract surgery. METHODS: This study was a prospective case-control study in which Akreos lenses were implanted for the experimental group and Sensar lenses were implanted for the control group. All surgical procedures were performed by the same surgeon. Best corrected visual acuity (BCVA), change of anterior chamber depth, degree of posterior capsule opacification (PCO), higher-order aberration, and contrast sensitivity (CS) were examined. Measurements were performed by masked examiners prior to the surgery and at 1 week, 1 month, 3 months, and 6 months, postoperatively. RESULTS: There were no statistically significant differences in BCVA, CS or PCO between the two groups. The Refractive error was -0.17+/-0.67D in the experimental group and -0.02+/-0.41D in the control group at 6 months, postoperatively. During the first postoperative month, forward movement of both IOLs was detected. Afterward, both IOLs moved backwards until 6 months. Fourth-order spherical aberrations were significantly higher in the Akreos group (p<0.05) at 1 month, 3 months, and 6 months, postoperatively. CONCLUSIONS: The clinical results for Akreos IOL and Sensar IOL were similar in most aspects.