Optical coherence tomography angiography in Purtscher-like retinopathy associated with dermatomyositis: a case report.

PURPOSE: To describe a multimodal imaging diagnosis of retinopathy in dermatomyositis. CASE PRESENTATION: A 21-year-old white woman with a history of fatigue and a cutaneous rash complained of visual impairment in her left eye. A funduscopic examination showed multiple confluent cotton-wool spots in both eyes. Swept source-optical coherence tomography presented macular edema in both eyes; optical coherence tomography angiography revealed superficial and deep capillary occlusion in all areas affected by cotton-wool spots; and fluorescein angiography showed vascular walls enhancement, veins dilatation, and capillary leakage. After large doses of intravenously administered glucocorticoid therapy, followed by a cyclophosphamide regimen, best corrected visual acuity returned to 20/20 in both eyes. CONCLUSIONS: This case report presents optical coherence tomography angiography clinical findings in a rare case of dermatomyositis-associated retinopathy, remarking the importance of a multi-imaging approach for a correct diagnosis and treatment of eye injuries, in order to avoid serious complications and permanent sequelae.

Short-term changes in the optic nerve head and visual field after trabeculectomy.

UNLABELLED: AIMS OR PURPOSE: To evaluate short-term changes in optic nerve head topography and visual field induced by surgical reduction of intraocular pressure. METHODS: A prospective study was performed on 56 eyes of 56 patients with uncontrolled primary open-angle glaucoma despite maximum medical therapy, which underwent trabeculectomy. Optic nerve head evaluations by means of Heidelberg Retina Tomograph, and visual field tests were performed pre-operatively, and at 3 and 6 months after surgery. Differences in intraocular pressure, visual field indices, and Heidelberg Retina Tomograph parameters were evaluated with the t-test for paired data. A linear regression model was calculated to analyze the relationship between intraocular pressure reduction and visual field changes, and optic nerve head changes. RESULTS: Mean intraocular pressure decreased from 24.4 ± 5.0 mm Hg to 12.1 ± 3.1 mm Hg (month 3, P<0.001), and 10.6 ± 2.8 mm Hg (month 6, P<0.001) after trabeculectomy. Mean retinal nerve fiber layer thickness (baseline, 0.19 ± 0.034; month 3, 0.24 ± 0.039, P=0.05; month 6, 0.21 ± 0.037, P=0.05) showed a statistical significant change compared with baseline values. CONCLUSIONS: In this 6-months study, a significant increase in retinal nerve fiber layer thickness was detected after glaucoma filtration surgery.

Agreement to detect glaucomatous visual field progression by using three different methods: a multicentre study.

AIM: To examine the level of agreement among nine clinicians in assessing progressive deterioration in visual field (VF) overview using three different methods of analysis. METHODS: Each visual field was assessed by Humphrey Field Analyzer (HFA), program 24-2 SITA Standard. Nine expert clinicians assessed the progression status of each series by using HFA 'overview printouts' (HFA OP), the Guided Progression Analysis (GPA) and the Guided Progression Analysis (GPA2). VF series were presented in random order, but each patient's VF remained in chronological order within a given field series. Each clinician adopted his personal methods based on his knowledge to evaluate VF progression. The level of agreement between the clinicians was evaluated by using weighted κ statistics. RESULTS: A total of 303 tests, comprising 38 visual field series of 7.9 ± 3.4 tests (mean ± SD), were assessed by the nine glaucoma specialists. When the intra-observer agreement was evaluated between HFA OP and GPA, the mean κ statistic was 0.58 ± 0.13, between HFA OP and GPA2, κ was 0.55 ± 0.06 and between GPA and GPA2 it was 0.56 ± 0.17. When the inter-observer agreement was analysed κ statistic was 0.65 for HFA OP, 0.54 for GPA and 0.70 for GPA2. CONCLUSIONS: Using any procedure for evaluating the progression of a series of VF, agreement between expert clinicians is moderate. Clinicians had higher agreement when GPA2 was used, followed by HFA OP and GPA printouts, but these differences were not significant.

Untreated 24-h intraocular pressures measured with Goldmann applanation tonometry vs nighttime supine pressures with Perkins applanation tonometry.

AIMS: To compare supine nighttime intraocular pressure measurements with Perkins applanation tonometry to 24-h sitting intraocular pressures with Goldmann applanation tonometry. METHODS: A prospective, untreated, uncontrolled, observational cohort of qualified consecutive ocular hypertensive or primary open-angle glaucoma patients. Patients underwent sitting intraocular pressure measurements over 24-h by Goldmann and patients had their supine nighttime intraocular pressure measurements by Perkins. RESULTS: In 100 completed patients, the mean intraocular pressure at 1000, 2200, 0200 and 0600 hours while sitting was 22.5+/-3.7 mm Hg, and in the supine position, 23.5+/-4.3 mm Hg (P<0.001). The mean sitting Goldmann intraocular pressures across the three daytime points was 23.3+/-3.4 mm Hg and across three nighttime points was 21.5+/-4.0 mm Hg (P<0.001). In contrast, the mean daytime sitting Goldmann intraocular pressure was not different than the mean nighttime supine intraocular pressure evaluated with Perkins (22.8+/-4.4 mm Hg, P=0.07). However, only 70% of patients were within 1.0 mm Hg of the highest daytime reading for all nighttime supine and sitting intraocular pressures. CONCLUSION: This study suggests that with Perkins applanation tonometry the untreated mean supine intraocular pressures are not higher at night than daytime sitting Goldmann applanation tonometry. However, the highest daytime sitting intraocular pressure measurement does not consistently predict the highest nighttime sitting or supine intraocular pressure value.

Optic nerve head changes in early glaucoma: a comparison between stereophotography and Heidelberg retina tomography.

OBJECTIVE: To evaluate and compare the diagnostic accuracy of the Heidelberg retina tomograph (HRT) version 3 with that of glaucoma specialists using stereophotography in discriminating between normal eyes and patients with early glaucomatous visual field loss. METHODS: A total of 105 eyes of 105 individuals were prospectively and consecutively recruited. The sample comprised 51 normal and 54 early glaucomatous eyes, as defined by intraocular pressure and standard automated perimetry results, regardless of optic disc appearance. Receiver operating characteristic (ROC) curves were plotted for the HRT3 parameters and a linear discriminant function (LDF) developed in our hospital. Best sensitivity-specificity pairs were compared between the HRT3 parameters, with the highest areas under the ROC curve (AUCs) and evaluation of optic disc stereophotographs. Agreement between methods for measuring vertical cup-to-disc ratio was evaluated with the Bland-Altman plot. RESULTS: The average visual field mean deviation was -2.90 dB. The HRT3 parameters with the largest AUCs were our LDF (0.900), rim volume (0.883), and vertical cup/disk ratio (0.880), with no significant differences between these parameters. Sensitivity-specificity pairs were 79.6-100% (clinical evaluation), 83.3-86.3% (our LDF), 64.8-96.1% (final glaucoma probability score), and 68.5-90.2% (global Moorfields regression analysis). CONCLUSIONS: The diagnostic accuracy for differentiating normal eyes from those with early visual field defects was similar between clinical evaluation of the optic disc and evaluation with the HRT3. The use of our LDF increased the sensitivity-specificity balance with respect to the HRT-provided parameters. The diagnostic accuracy of the HRT classifications was comparable to that of an experienced glaucoma specialist.

Diagnostic ability of a linear discriminant function for optic nerve head parameters measured with optical coherence tomography for perimetric glaucoma.

BACKGROUND/AIMS: To calculate and validate a linear discriminant function (LDF) for optical coherence tomography (OCT) to improve the diagnostic ability of isolated optic nerve head (ONH) parameters to discriminate between healthy individuals and glaucoma patients. METHODS: Two independent samples (teaching and validating sets) were prospectively selected. The teaching set (54 normal eyes and 73 glaucoma patients) was used to calculate the LDF. The validating set (70 healthy individuals and 67 glaucoma patients) was used to test the performance of the LDF in an independent population. Receiver operating characteristic (ROC) curves were plotted and compared with the ONH parameters measured using OCT. RESULTS: The optimized function was: LDF=8.204+(2.59xdisc area)-(9.25xhorizontal rim width). The largest areas under the ROC curve were 0.923 and 0.898 for our LDF and the vertical rim area in the validating population respectively. There were no significant differences between the areas. At 95% fixed specificity, the LDF (71.64%) and the vertical rim area (65.67%) yielded the highest sensitivity values. CONCLUSIONS: All ONH parameters obtained with OCT, except disc area, had a good ability to differentiate between healthy and glaucoma individuals. As judged by the area under the ROC curve, the LDF performed better than any single parameter, although statistics did not prove it better than vertical cup/disc ratio or vertical rim area with the number of subjects we studied.

Test-retest variability of intraocular pressure and ocular pulse amplitude for dynamic contour tonometry: a multicentre study.

AIMS: To assess the test-retest variability of intraocular pressure (IOP) and ocular pulse amplitude (OPA) measurements utilising dynamic contour tonometry (DCT) and to evaluate possible influential factors. METHODS: The study included 350 consecutive subjects (175 glaucoma, 175 control; one eye per subject) from seven European centres. IOP was measured once with a Goldmann applanation tonometer (GAT) and twice by DCT (DCT1, DCT2) in a randomised sequence. OPA was also recorded for both DCT measurements. Differences (DCT1-DCT2; OPA1-OPA2; GAT-DCT1; GAT-DCT2) were assessed using the t test. The intraclass coefficient of correlation (ICC) and coefficient of variation (CoV) for DCT and OPA were calculated. RESULTS: DCT1 was 0.6+/-1.6 mm Hg higher than DCT2 (p<0.001); OPA1 was 0.1+/-0.7 mm Hg higher than OPA2 (p=0.02). Results were not influenced by randomisation test order. In both glaucoma and normal subjects, DCT and OPA showed ICC>0.90 and >0.76, and CoV=4.8-5.0% and 10.3-10.5%, respectively. DCT1 and 2 were 2.4+/-2.6 and 1.8+/-2.6 mm Hg higher respectively than GAT (p<0.001). DISCUSSION: DCT test-retest variability was almost perfect for IOP and good for OPA. Tonometry measurements with DCT tended to be overestimated compared with GAT.

Relación entre la perimetría automatizada convencional y la topografía papilar realizada con el tomógrafo Heidelberg / Relationship between standard automated perimetry and optic nerve head topography performed with the Heidelberg retina tomograph

Objetivo: Determinar las correlaciones entre losparámetros de la cabeza del nervio óptico (CNO)obtenidos mediante el láser confocal de barrido(HRT), y los resultados de la perimetría automatizadaconvencional (PA) en sujetos normales, hipertensosoculares (HTO), sospechosos de glaucoma yglaucomatosos.Métodos: Cuatrocientos veintitrés ojos fueronincluidos en el estudio y clasificados según la presiónintraocular basal, morfología papilar y losresultados de la PA en 4 grupos: 87 normales, 192hipertensos oculares, 70 sospechosos de glaucomay 74 glaucomatosos. En los diferentes grupos diagnósticos,se calcularon los coeficientes de correlaciónde Pearson entre los parámetros de la CNO yla desviación media (DM), la desviación estándarde la media (DSM), el número de puntos alteradosen cada cuadrante del campo visual (superior-nasal,inferior-nasal, superior-temporal e inferior-temporal),el número de puntos alterados según los nivelesde probabilidad y los valores umbral en cada punto de la PA.Resultados: En el grupo normal y de hipertensosoculares, se encontraron pocas correlaciones débilesentre los parámetros del HRT y los resultados dela PA. La fuerza y el número de correlaciones significativasaumentaron en el grupo de sospechososde glaucoma. En el grupo de glaucomas, las correlacionesfueron más fuertes, especialmente entre loscocientes excavación/disco y anillo/disco con laDM (r=0,479) y entre el área de anillo con la DSM(r=0,444).Conclusiones: Se encontraron correlaciones débileso moderadas entre algunos parámetros de laCNO medidos con el HRT y los resultados de la PA,en el grupo de glaucomas(AU)

Purpose: To determine the correlations betweenoptic nerve head (ONH) parameters measured withthe Heidelberg Retina Tomograph (HRT), and themain outcomes of standard automated perimetry(SAP) in normal, ocular hypertensive, glaucomasuspects and glaucomatous subjects.Methods: Four hundred and twenty-three patientswere enrolled in the study and classified into fourgroups depending on baseline intraocular pressure,optic nerve head morphology, and SAP results: 87normal eyes, 192 ocular hypertensive eyes, 70 glaucomasuspects and 74 glaucomatous eyes. In thedifferent diagnostic groups, Pearson’s correlationcoefficients were calculated between ONH parametersand mean deviation, pattern standard deviation(PSD), number of altered points in each quadrant ofthe visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number ofpoints altered at different probability levels, andthreshold values at each point of SAP.Results: In the normal and ocular hypertensivegroups, only a few weak correlations were found between HRT and SAP parameters. The strengthand number of significant correlations increased inthe suspected glaucoma group. The glaucomagroup had the strongest correlations, particularlybetween cup/disc ratio and rim/disc ratio with MD(r=0.479) and between rim area and PSD (r=0.444).Conclusions: Weak to moderate correlations werefound between some ONH parameters obtainedwith the HRT and SAP results in the glaucomagroup(AU)

Efficacy of the fixed combinations of bimatoprost or latanoprost plus timolol in patients uncontrolled with prostaglandin monotherapy: a multicenter, randomized, investigator-masked, clinical study.

PURPOSE: To compare the efficacy and tolerability of a once-daily evening dose of bimatoprost/timolol fixed combination (BTFC) with that of a once-daily evening dose of latanoprost/timolol fixed combination (LTFC) in patients not controlled with prostaglandins analogues monotherapy. METHODS: A total of 82 patients on prostaglandin analogues monotherapy were enrolled in this prospective, multicenter, investigator masked, clinical study and were randomized to either BTFC (n=47) or LTFC (n=35) topical therapy once at night for 12 weeks. The primary endpoint of the study was to compare the mean daily intraocular pressure (IOP) reduction from baseline between the two treatment arms. Secondary endpoints included the mean daily IOP at 1 and 3 months compared to baseline and the percentage of patients showing a mean IOP reduction from baseline greater than or equal to 15% or 20%. RESULTS: Mean IOP at baseline was 22.7+/-2.0 and 22.1+/-2.6 mmHg in the BTFC and LTFC groups, respectively (p=0.23). Both treatments were effective in reducing the IOP from baseline. The mean IOP reduction was significantly greater in the BTFC group than in the LTFC group (-21.4% vs -13.7%, p<0.001). A higher percentage of patients in the BTFC group showed a mean IOP reduction from baseline >or=15% (72.3% vs 40.0%) and >or=20% (61.7% vs 17.1%) compared to patients in the LTFC group. CONCLUSIONS: Both BTFC and LTFC were more effective versus the monotherapy with prostaglandin analogues. BTFC demonstrated higher performance than LTFC in terms of relative IOP reduction.

[Relationship between standard automated perimetry and optic nerve head topography performed with the Heidelberg Retina Tomograph]. / Relación entre la perimetría automatizada convencional y la topografía papilar realizada con el Tomógrafo Heidelberg.

PURPOSE: To determine the correlations between optic nerve head (ONH) parameters measured with the Heidelberg Retina Tomograph (HRT), and the main outcomes of standard automated perimetry (SAP) in normal, ocular hypertensive, glaucoma suspects and glaucomatous subjects. METHODS: Four hundred and twenty-three patients were enrolled in the study and classified into four groups depending on baseline intraocular pressure, optic nerve head morphology, and SAP results: 87 normal eyes, 192 ocular hypertensive eyes, 70 glaucoma suspects and 74 glaucomatous eyes. In the different diagnostic groups, Pearson's correlation coefficients were calculated between ONH parameters and mean deviation, pattern standard deviation (PSD), number of altered points in each quadrant of the visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number of points altered at different probability levels, and threshold values at each point of SAP. RESULTS: In the normal and ocular hypertensive groups, only a few weak correlations were found between HRT and SAP parameters. The strength and number of significant correlations increased in the suspected glaucoma group. The glaucoma group had the strongest correlations, particularly between cup/disc ratio and rim/disc ratio with MD (r=0.479) and between rim area and PSD (r=0.444). CONCLUSIONS: Weak to moderate correlations were found between some ONH parameters obtained with the HRT and SAP results in the glaucoma group.

The effect of pneumatic trabeculoplasty on intraocular pressure: the results of a 6-month, open-label, multicenter study.

PURPOSE: To evaluate the effects of pneumatic trabeculoplasty (PNT) in ocular hypertension and glaucoma subjects. METHODS: A total of 63 consecutive subjects, either treated (79%) or untreated (21%), with intraocular pressure (IOP) between 20 and 25 mmHg were enrolled; the eye with higher IOP (or, in case of identical IOP, worse visual field) was treated with PNT, with the fellow eye used as control. Subjects underwent a baseline evaluation the day before treatment, two PNT treatments at day 0 and 7, visits at day 1, 8, 14, and at each month until the end of the study, which lasted 6 months. Safety was addressed at all visits; an IOP curve (at 8 and 10 AM, 2 and 4 PM) was obtained at baseline and during monthly visits. RESULTS: In PNT eyes, baseline IOP was 22.2-/+1.6 mmHg. Following PNT a statistically significant reduction of IOP occurred at all visits (p<0.0001), with a mean decrease ranging from -2.7-/+2.5 (-11.9-/+10.8%) to -3.6-/+2.6 mmHg (-16.0-/+11.6%); mean reduction was 12.8-/+11.5%. Although IOP diminished also in the control eyes after baseline (p<0.05), the change in IOP was significantly higher in PNT group at each visit (p<0.05). Mild side effects were experienced by 76% of subjects and they all resolved without sequelae. CONCLUSIONS: The results suggest the effect of this procedure in reducing IOP in glaucoma and ocular hypertensive subjects.

Stability of silicone band frontalis suspension for the treatment of severe unilateral upper eyelid ptosis in infants.

PURPOSE: To address the efficacy, safety, and stability of frontalis suspension of the upper eyelid with a silicone band for the treatment of severe congenital ptosis in infants. METHODS: Data from 22 pediatric patients undergoing unilateral frontalis suspension with silicone band were retrospectively reviewed with a follow-up ranging from 18 to 30 months. The margin-reflex distance (MRD) and the corneal staining had been evaluated at each pre- and postoperative visit. Data were analyzed by analysis of variance and t test for paired data. RESULTS: MRD was absent before surgery in all cases: it ranged from -1 mm to -4 mm (-2.4+/-0.8 mm). Immediately after surgery, it increased to 2.9+/-0.3 mm, and then progressively reduced by 0.6 mm within the first 3 months (p=0.001); a further reduction of 0.2 mm, occurring between 3 and 12 months after surgery, was not statistically significant. After the 12-month visit, no changes in MRD were found at follow-up for any patient. Corneal staining, which was present in five patients over the first 2 postoperative weeks, recovered without sequelae. Complications occurred in three eyes: overcorrection and corneal ulcer in one case requiring removal of the silicone band, one granuloma, and one extrusion of the silicone band from the upper frontal incision. CONCLUSIONS: During the study period, the frontalis suspension with a silicone band was an effective and safe procedure. MRD values were stable between month 3 and the end of follow-up, although this series does not preclude the possible occurrence of blepharoptosis at longer time intervals.

Circadian variations in central corneal thickness and intraocular pressure in patients with glaucoma.

AIM: To analyse 24 hour variations in intraocular pressure (IOP) and central corneal thickness (CCT) in a group of glaucomatous patients. METHODS: 30 patients with primary open angle glaucoma were hospitalised and underwent circadian evaluations (at 8 pm, midnight, 4 am, 8 am, noon, and 4 pm) of supine and sitting IOP, respectively, measured using a Perkins and a Goldmann tonometer, and CCT measured using an ultrasonic pachymeter (the mean value of three measurements within 5 mum). All patients were treated with timolol 0.5% twice daily and latanoprost 0.005% once daily. RESULTS: Mean supine IOP was 15.3 (SD 3.7) mm Hg (range 10-25), with circadian fluctuations of 7.3 (3.3) mm Hg. Mean sitting IOP was 15.1 (3.9) mm Hg (range 8-26), with circadian fluctuations of 5.4 (3.1) mm Hg. Mean CCT was 534 (39) microm (range 443-637 microm) with circadian fluctuations of 16.5 (6.2) microm (range 6-31 microm). Both the within patient and within time point fluctuations in CCT were statistically significant (p<0.0001, ANOVA). CONCLUSIONS: The authors found considerable fluctuations in 24 hour IOP. The circadian fluctuations in CCT were small and, although statistically significant, did not seem to interfere with the circadian IOP assessment.