Thinning rates of retinal nerve layer and ganglion cell-inner plexiform layer in various stages of normal tension glaucoma.

AIMS: To compare the changes in the macular retinal nerve fibre layer (mRNFL), macular ganglion cell layer and inner plexiform layer (mGCIPL), and circumpapillary retinal nerve fibre layer (cpRNFL) in various stages of normal tension glaucoma (NTG) using spectral domain optical coherence tomography. METHODS: Eyes with NTG (n=218) were assigned into three groups based on initial mean deviation (MD) as follows: mild (MD>-6 dB), moderate (-6 dB≥MD≥-12 dB) and severe (-12 dB>MD>-20 dB). Annual rates of change in mRNFL, mGCIPL and cpRNFL thickness were calculated by linear regression analysis. RESULTS: Age, gender, spherical equivalent, and average intraocular pressure during follow-up were not significantly different among the three groups. There were significant differences in the mRNFL, mGCIPL and cpRNFL among the three groups at baseline (p<0.0001 in all sectors except for the mRNFL in the superonasal sector). The average thinning rates of the mRNFL, mGCIPL and cpRNFL were -0.38±0.32 µm/year, -0.62±0.46 µm/year and -0.86±0.83 µm/year, respectively. No significant difference in the rates of change in the mRNFL and mGCIPL were found among the groups in any sector. However, there was a significant difference in the rate of change in the cpRNFL among the groups (in all sectors: p<0.0001). CONCLUSIONS: Changes in the mRNFL and mGCIPL can reflect the progression of NTG even in its advanced stage. However, careful interpretation of changes in the cpRNFL in the advanced stage of glaucoma is warranted due to a potential floor effect.

Comparison of Changes in Macular Ganglion Cell-Inner Plexiform Layer Thickness Between Medically and Surgically Treated Eyes With Advanced Glaucoma.

PURPOSE: To compare changes in the macular ganglion cell layer and inner plexiform layer (mGCIPL) thickness over 5 years between surgically treated eyes (STE) and medically treated eyes (MTE) with advanced glaucoma. DESIGN: Retrospective, comparative case series. METHODS: Eighty-six patients comprising 43 with open-angle glaucoma (OAG) with trabeculectomy and 43 with medically treated OAG. The mGCIPL thickness was measured more than 5 times during follow-up by optical coherence tomography. Main outcome measure was differences in mGCIPL thickness thinning rate between the groups. RESULTS: The mean age at study initiation was 62.5 ± 9.2 years in STE and 62.7 ± 9.5 years in MTE. The mean deviations (MD), according to the Humphrey Field Analyzer central program 30-2, and the mGCIPL thickness in each sector showed no significant differences at initial measurement. The averaged intraocular pressure (IOP) throughout follow-up was 10.5 ± 2.0 mm Hg in STE and 10.8 ± 0.8 mm Hg in MTE (P = .429; Mann-Whitney U test). There was no significant difference in the MD changes over 5 years between the 2 groups (P = .405; Mann-Whitney U test). Changes in the mGCIPL thickness over 5 years in MTE were significantly greater than that in STE in all sectors (all 6 sectors P < .0001, Mann-Whitney U test). The IOP fluctuation over 5 years in STE was significantly less than that in MTE (P < .0001, Mann-Whitney U test). CONCLUSIONS: The structure of the mGCIPL was better preserved in STE than in MTE, even when the IOPs during follow-up were similar.

Development of Glaucomatous Visual Field Defects in Preperimetric Glaucoma Patients Within 3 Years of Diagnosis.

PURPOSE: To determine the characteristics of eyes diagnosed with preperimetric glaucoma (PPG) that developed glaucomatous visual field defects (VFDs) within 3 years of the diagnosis. PATIENTS AND METHODS: The medical charts of 77 eyes of 77 patients with PPG were reviewed. An eye was diagnosed with PPG when there was neuroretinal rim thinning, cupping of the optic disc, or a suspicious retinal nerve fiber layer (RNFL) defect, and had no conditions fulfilling Anderson's criteria for glaucoma. The Central 30-2 SITA-Standard program of the Humphrey Field Analyzer was used to determine the presence of VFDs and the thicknesses of the retinal layers was determined by spectral-domain optical coherence tomography. RESULTS: Ten of the 77 patients with PPG (13.0%) developed glaucomatous VFD. These 10 eyes had significantly thinner macular ganglion cell and inner plexiform layer (mGCIPL) thickness in the inferior and inferotemporal sectors, and also the circumpapillary retinal nerve fiber layer (cpRNFL) thickness at the 7 or 8 o'clock sectors. In the 3 years post-PPG period, these eyes had significant decreases in the mGCIPL thickness of all the inferior sectors, and cpRNFL at the 7 or 8 o'clock sectors. The mean intraocular pressure in eyes with VFDs (15.2±2.0 mm Hg) was significantly higher than that in those without VFDs (13.5±2.6 mm Hg; P=0.042). CONCLUSIONS: Significant structural changes were observed in the mGCIPL and cpRNFL at PPG diagnosis, before the development of a VFDs. Close monitoring of intraocular pressure is essential for the appropriate management of PPG.

Inhibitory effects of antimicrobial agents against Fusarium species.

We investigated the inhibitory effects of antibacterial, biocidal, and antifungal agents against Fusarium spp. Seven Fusarium spp: four F. falciforme (Fusarium solani species complex), one Fusarium spp, one Fusarium spp. (Fusarium incarnatum-equiseti species complex), and one F. napiforme (Gibberella fujikuroi species complex), isolated from eyes with fungal keratitis were used in this study. Their susceptibility to antibacterial agents: flomoxef, imipenem, gatifloxacin, levofloxacin, moxifloxacin, gentamicin, tobramycin, and Tobracin® (contained 3,000 µg/ml of tobramycin and 25 µg/ml of benzalkonium chloride (BAK), a biocidal agent: BAK, and antifungal agents: amphotericin B, pimaricin (natamycin), fluconazole, itraconazole, miconazole, voriconazole, and micafungin, was determined by broth microdilution tests. The half-maximal inhibitory concentration (IC50), 100% inhibitory concentration (IC100), and minimum inhibitory concentration (MIC) against the Fusarium isolates were determined. BAK had the highest activity against the Fusarium spp. except for the antifungal agents. Three fluoroquinolones and two aminoglycosides had inhibitory effects against the Fusarium spp. at relatively high concentrations. Tobracin® had a higher inhibitory effect against Fusarium spp. than tobramycin alone. Amphotericin B had the highest inhibitory effect against the Fusarium spp, although it had different degrees of activity against each isolate. Our findings showed that fluoroquinolones, aminoglycosides, and BAK had some degree of inhibitory effect against the seven Fusarium isolates, although these agents had considerably lower effect than amphotericin B. However, the inhibitory effects of amphotericin B against the Fusarium spp. varied for the different isolates. Further studies for more effective medications against Fusarium, such as different combinations of antibacterial, biocidal, and antifungal agents are needed.

Case of keratitis caused by Streptomyces thermocarboxydus.

We describe a case of keratitis caused by Streptomyces thermocarboxydus and report the usefulness of molecular analysis in identifying the exact species of Streptomyces. A 50-year-old man was diagnosed with keratitis caused by Streptomyces sp. which was identified as S. thermocarboxydus by sequencing the 16S rDNA. He had no history of trauma or systemic diseases. He was initially treated with topical beta-lactams and fluoroquinolones, and systemic beta-lactams but the keratitis did not improve. His vision improved significantly after topical erythromycin (5 mg/ml) and oral minocycline (200 mg/day) therapy. Our findings demonstrate that molecular analysis can be used to identify the exact Streptomyces species causing the keratitis. This then allowed us to determine the susceptibility of this species to different antibacterial drugs which were used to treat our patient successfully.

Macular ganglion cell complex thickness in glaucoma with superior or inferior visual hemifield defects.

PURPOSE: To elucidate the relationship between the macular ganglion cell complex thickness (GCCT) and its corresponding superior or inferior visual hemifield defects, and the apparently normal visual hemifield, and to explore the relationship between the macular GCCT of the corresponding apparently normal hemifield and the severity of the glaucomatous visual field defects in the same eye. METHODS: Sixty-seven eyes of 67 patients with open-angle glaucoma showed superior or inferior hemifield defects. We measured the visual field using the Humphrey Field Analyzer programs Central 30-2 and 10-2, and the GCCT using spectral domain optical coherence tomography. For the GCCT measurement, we selected 3 points each in the inner or outer sectors of the parafovea. RESULTS: We observed a significant correlation between the macular GCCT of the inner or outer sector of the parafovea and in the change of the visual field in each hemifield defect or the apparently normal hemifield. The decrease of the GCCT corresponding to the apparently normal hemifield correlated with the progression of the severity of the glaucomatous defects, using the Anderson classification. CONCLUSIONS: The macular GCCT is a sensitive marker of early glaucomatous change, allowing detection of structural changes associated with glaucoma even in the apparently normal hemifield.

Late-onset bleb-related endophthalmitis caused by Streptococcus pseudopneumoniae.

We report our findings in a 63-year-old male who developed late-onset bleb-related endophthalmitis. The patient had undergone glaucoma surgery 46 years earlier, and had a thin-walled cystic bleb prior to the endophthalmitis in his right eye. He underwent immediate vitrectomy with intravitreal injections of ceftazidime and vancomycin. After surgery, he was given topical 0.5 % moxifloxacin and 1 % vancomycin, intravenous doripenem, and oral minocycline. Culture of the vitreous specimen identified Streptococcus pseudopneumoniae by 16S rRNA sequence analysis, by optochin susceptibility test, and by bile solubility test. Our findings indicate that S. pseudopneumoniae can be isolated from a late-onset bleb-related endophthalmitis and that molecular analysis and phenotypic testing can be accurate methods to identify S. pseudopneumoniae.

Macular retinal thickness in glaucoma with superior or inferior visual hemifield defects.

PURPOSE: To elucidate the relationship between macular retinal thickness and corresponding superior or inferior visual hemifield defects in glaucoma patients. METHODS: Thirty-nine eyes of 39 patients with open-angle glaucoma showed superior or inferior hemifield defects (superior hemifield defects, 27 eyes; inferior hemifield defects, 12 eyes). We measured the retinal thickness of the parafovea and fovea centralis corresponding to a defect or an apparently normal hemifield by spectral domain optical coherence tomography. We then analyzed the relationship between the retinal thickness corresponding to an apparently normal hemifield and the severity of the glaucomatous visual field defect on the other side of the same eye. RESULTS: We found that the retinal thickness of the parafovea and fovea centralis significantly decreased, as the hemifield defect increased. The retinal thickness of the parafovea, the inner sector, outer sector, and inner and outer sectors, corresponding to the apparently normal hemifields significantly decreased with the progression of the hemifield defect on the other side. The mean±SD age of patients was 66.5±9.1 years and the refraction was -1.3±2.4 D. CONCLUSIONS: Macular retinal thickness decreases with a corresponding visual hemifield defect in glaucoma patients. Retinal structural changes precede the loss of the visual field in the apparently normal side.

[Clinical manifestations, treatment and outcome of ocular infections caused by Paecilomyces species].

PURPOSE: To report the predisposing factors, patient background, treatment and outcomes of ocular infections caused by Paecilomyces spp. in Japan. METHODS: We reviewed the medical records and the published literature in Japan on ocular infections caused by microbiologically-proven Paecilomyces spp. Nineteen eyes of 18 patients; 4 eyes of 4 of our patients and 15 eyes of 14 published Japanese patients were studied. RESULTS: Ten men and 8 women (9 OD, 8 OS, 1 OU) were diagnosed with ocular infections caused by Paecilomyces spp. The mean age was 69 years (range 33 to 90 years). The initial diagnosis of ocular infection caused by Paecilomyces spp. was keratitis in 14 eyes and endophthalmitis in 5 eyes. The final diagnosis was keratitis in 2 eyes, keratitis with involvement of the anterior segment of the eye, i.e., hypopyon or corneal rupture, in 12 eyes, and endophthalmitis in 5 eyes. The predisposing factors had a history of ocular surgery, corneal trauma and soft contact lens use. Other factors were diabetes and old age. The infections developed more often in the fall and winter. The identified Paecilomyces spp. had a high sensitivity to micafungin and voriconazole, but low sensitivity to amphotericin B, flucytosine and fluconazole. The prognosis of Paecilomyces spp. ocular infections was very poor, viz., final vision was counting fingers or worse in 60%, ocular perforation in 42%, and eye enucleation in 11%. The percentage of eyes with a final visual acuity worse than counting fingers was 0% in those with keratitis, 50% in those with involvement of the anterior segment, and 100% in those with endophtalmitis (p = 0.0446). Among the antifungal agents, the percentage of cases with final vision of counting fingers or worse was 90% with fluconazole, 80% with itraconazole, 100% with miconazole, and 71% with voriconazole. CONCLUSION: The results show that if the Paecilomyces spp. infection spreads intraocularly, it is difficult to mitigate the clinical damage even with antifungal agents with high sensitivity.