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.

Long-term Results of Deep Sclerectomy with Small Collagen Implant in Korean

PURPOSE: To describe the long-term results of deep sclerectomy with collagen implant (DSCI) with or without adjuvant mitomycin C in Korean patients with primary or secondary open-angle glaucoma (OAG). METHODS: This retrospective review was comprised of 65 Korean patients who received DSCI with or without adjuvant mitomycin C due to primary or secondary OAG. Patients were followed for 72 months after surgery. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with or without medication. RESULTS: Mean postoperative follow-up period was 53.0 +/- 16.2 months. Mean IOP was 30.5 +/- 11.7 mmHg preoperatively, 8.4 +/- 4.3 mmHg at postoperative day one and 13.4 +/- 3.8 mmHg 60 months after surgery. The mean number of glaucoma medications was decreased from 3.6 +/- 1.1 to 1.6 +/- 1.3 at 60 months after the operation. Complete and qualified success rates were 36.7% and 79.6% at postoperative 60 months, respectively (Kaplan-Meier survival curve). No shallow or flat anterior chamber, endophthalmitis, or surgery-induced significant cataract was observed. CONCLUSIONS: The results of DSCI in Korean patients presented here seem reasonably excellent with qualified success rates of over 70% at six years with negligible complications.

A Case of Non-Arteritic Anterior Ischemic Optic Neuropathy after Bilateral Selective Neck Dissection

PURPOSE: To report a case of non-arteritic anterior ischemic optic neuropathy after bilateral selective neck dissection. CASE SUMMARY: A 48-year-old man presented with a visual field defect in his right eye 11 days after bilateral selective neck dissection. His corrected visual acuity in the right eye was 20/20; fundus photographs revealed a segmental optic disc swelling in the superior half of the right eye, and the Humphrey visual field test showed an inferior altitudinal defect in the right eye, corresponding to the disc swelling. The fluorescein angiography revealed a delayed filling on the superior half of the optic disc in the right eye. The diagnosis was non-arteritic anterior ischemic optic neuropathy. Orbital and brain MRIs showed an increase in caliber of the right optic nerve, but no other mass or enhanced lesion was noted. After 3 months, the patient's visual acuity and visual field were maintained, but segmental atrophy developed on the superior half of the right optic disc. CONCLUSIONS: With the risk factors of ischemic optic neuropathy, the possibility of postoperative visual impairment or field defect should be considered after a selective head and neck surgery.