Increased late-onset glaucoma risk following vitrectomy for macular pucker or hole.

OBJECTIVES: The long-term risk of developing glaucoma after vitrectomy remains uncertain. This retrospective population-based cohort study aimed to explore this risk following vitrectomy for macular pucker or hole. METHODS: Utilizing Taiwan's National Health Insurance Research Database (NHIRD), we included patients who were older than 18 years and had undergone vitrectomy surgery between 2011 and 2019. Exclusions were made for patients with prior diagnoses of glaucoma, congenital or secondary glaucoma, as well as those who had received previous vitreoretinal treatments or had undergone multiple vitrectomies. RESULTS: After an average follow-up period of 51 and 53 months respectively for the vitrectomized and non-vitrectomized group, our results showed a relative risk of 1.71 for glaucoma development in the vitrectomized group. Higher adjusted hazard ratios were also observed for open-angle glaucoma and normal tension glaucoma. Increased risks were associated with male sex, obstructive sleep apnoea, and migraine. In the subgroup analysis, phakic eyes at baseline and those who had undergone cataract surgery post-vitrectomy were associated with a lower risk of glaucoma development during follow-up. Among all glaucoma events, pseudophakic status at baseline had the shortest interval to glaucoma development following vitrectomy. CONCLUSIONS: These findings underscore the potential relationship between vitrectomy and glaucoma onset, emphasizing the need for vigilant monitoring and early detection of glaucoma in post-vitrectomy patients.

Comparing the morphology of optic nerve head and lamina cribrosa in full-term and preterm school-aged children.

OBJECTIVES: To evaluate the morphology of lamina cribrosa (LC) in preterm school-aged children. METHODS: A study of 120 eyes from 120 patients, including 42 full-term children (control group), 41 preterm children without retinopathy of prematurity (ROP), 16 children with ROP treated with intravitreal bevacizumab (IVB), and 21 children with ROP treated with laser. Five parameters of LC were measured by optical coherence tomography, including Bruch's membrane opening (BMO) diameter, minimum rim width (MRW), LC depth, prelaminar tissue (PLT) thickness, and LC curvature index (LCCI). RESULTS: The PLT thickness increased with age in full-term and preterm children (ß = 30.1, P = 0.003 and ß = 19.6, P < 0.001, respectively). LC depth and LCCI showed no differences between full-term and preterm children. Worse refractive errors in preterm children were associated with greater MRW and PLT thickness (ß = -17.1, P = 0.001 and ß = -5.7, P = 0.03, respectively). However, this relationship was not found in full-term children. Laser-treated children had greater MRW, PLT, temporal peripapillary retinal nerve fibre layer, and foveal thickness than full-term or other preterm children (all P < 0.05). CONCLUSIONS: Prematurity and ROP treatment may have an impact on the structural development of the LC. Refractive status plays a vital role in the LC structure of preterm children. This highlights the refractive errors of preterm children at school age that merit greater attention.

LONGITUDINAL CHANGES IN CHOROIDAL THICKNESS IN CHILDREN WITH A HISTORY OF PREMATURITY: An 18-Month Prospective Cohort Study.

PURPOSE: To evaluate choroidal changes over time in school-age children with a history of prematurity. METHODS: A study of 416 eyes of 208 eligible participants, including 88, 190, 36, 56, and 46 eyes in the full-term control, preterm, spontaneously regressed retinopathy of prematurity, intravitreal bevacizumab (injection of bevacizumab)-treated retinopathy of prematurity, and laser-treated retinopathy of prematurity groups, respectively, were enrolled in this study. The choroidal thickness was measured 4 times at 6-month intervals using optical coherence tomography. RESULTS: Of all the groups, the laser-treated children had the thinnest choroid compared with full-term children (-52.3 µ m, P = 0.04). Preterm children exhibited greater attenuation in choroidal thickness over time than did full-term children (-6.3 ± 26.9 and -1.1 ± 12.8 µ m/year, P = 0.03), whereas no difference was observed between injection of bevacizumab and laser treatments (-4.6 ± 18.9 and -2.0 ± 15.7 µ m/year, P = 0.46). In all groups, the changes in axial length were negatively associated with the changes in choroidal thickness (all P < 0.05). CONCLUSION: A greater attenuation in choroid thickness over time was observed in preterm children than in full-term children, but this attenuation did not differ between injection of bevacizumab and laser treatments. Axial elongation was associated with choroidal thinning in school-age children.

Application and Validation of LUXIE: A Newly Developed Virtual Reality Perimetry Software.

PURPOSE: To report the application of LUXIE and validate its reliability by comparing the test results with those of Humphrey Field Analyzer 3 (HFA3). METHODS: In this pilot study, we prospectively recruited participants who had received HFA3 SITA standard 30-2 perimetry and tested them with LUXIE on the same day. LUXIE is a software designed for visual field testing cooperating with HTC Vive Pro Eye, a head-mounted virtual reality device with an eye-tracking system. The test stimuli were synchronized with eye movements captured by the eye-tracking system to eliminate fixation loss. The global, hemifields, quadrants, glaucoma hemifield test (GHT) sectors, and point-by-point retinal sensitivities were compared between LUXIE and HFA3. All participants were asked to fill out a post-test user survey. RESULTS: Thirty-eight participants with 65 eyes were enrolled. LUXIE demonstrated good correlations with HFA3 in global (r = 0.81), superior hemifield (r = 0.77), superonasal, superotemporal, and inferonasal quadrants (r = 0.80, 0.78, 0.80). The user survey showed that participants were more satisfied with LUXIE in operating difficulty, comfortability, time perception, concentration, and overall satisfaction. CONCLUSIONS: LUXIE demonstrated good correlations with HFA3. Fixation loss could be eliminated in LUXIE with the eye-tracking system. The application of virtual reality devices such as the HTC Vive Pro Eye makes telemedicine and even home-based self-screening visual field tests possible. KEY MESSAGES: 1. Virtual reality perimetry is a developing technology that has the potential in telemedicine, and home self-screening visual field tests. 2. LUXIE demonstrated good correlations with Humphrey Field Analyzer 3 in visual field retinal sensitivities.

Glaucoma diagnostic performance of macular ganglion cell complex thickness using regular and long axial length normative databases.

The risks of misdiagnosing a healthy individual as glaucomatous or vice versa may be high in a population with a large majority of highly myopic individuals, due to considerable morphologic variability in high myopic fundus. This study aims to compare the diagnostic ability of the regular and long axial length databases in the RS-3000 Advance SD-OCT (Nidek) device to correctly diagnose glaucoma with high myopia. Patients with high myopia (axial length ≥ 26.0 mm) in Chang Gung Memorial Hospital, Taiwan between 2015 and 2020 were included. Glaucoma was diagnosed based on glaucomatous discs, visual field defects and corresponding retinal nerve fiber layer defects. The sensitivity, specificity, diagnostic accuracy and likelihood ratios of diagnosing glaucoma via mGCC thickness in both superior/inferior and GChart mapping using the regular and long axial length normative databases. The specificity and diagnostic accuracy of mGCC thickness for distinguishing glaucomatous eyes from nonglaucomatous eyes among highly myopic eyes were significantly improved using the long axial length database (p = 0.046). There were also significant proportion changes in S/I mapping as well as GChart mapping (37.3% and 48.0%, respectively; p < 0.01) from abnormal to normal in the myopic normal eye group when using the long axial length normative database. The study revealed that clinicians could utilize a long axial length database to effectively decrease the number of false-positive diagnoses or to correctly identify highly myopic normal eyes misdiagnosed as glaucomatous eyes.

Comparison of foveal thickness in preschool children with a history of retinopathy of prematurity and laser photocoagulation or anti-vascular endothelial growth factor treatment: a prospective, longitudinal study.

AIMS: To determine longitudinal differences in foveal thickness in preschool-aged patients with or without a history of type I retinopathy of prematurity (ROP). METHODS: A study of 201 eyes, including 32 laser±intravitreal bevacizumab (IVB)-treated eyes, 37 IVB-treated eyes, 14 spontaneously regressed ROP eyes, and 118 age-matched controls were enrolled in this study. The retinal thicknesses (full, inner and outer) were measured in the foveal area at 6-month intervals four consecutive times by optical coherence tomography. RESULTS: The foveal thicknesses among the four groups were similar at all four visits (all p>0.05) after gestational age (GA) adjustment and remained similar with no differences after the full retinal thickness was divided into inner and outer thicknesses (all p>0.05). The full and outer foveal thicknesses of premature children increased over time (0.17 µm/month and 0.17 µm/month; p=0.0001 and 0.0003, respectively), but the inner foveal thickness remained unchanged with time (0.002 µm/month; p=0.09). Moreover, the positive correlation with best-corrected visual acuity was stronger for outer foveal thickness than for inner foveal thickness (γ=0.281, p<0.0001 and γ=0.181, p<0.0001, respectively). CONCLUSION: The thickness of fovea in laser±IVB-treated, IVB-treated, regressed ROP and preterm eyes showed no difference after GA adjustment. The whole and outer foveal thicknesses increased with time in preschool-aged children over a 1.5-year follow-up period, but the inner foveal thickness remained unchanged with time.

Micropulse transscleral cyclophotocoagulation in a Taiwanese population: 2-year clinical outcomes and prognostic factors.

PURPOSE: To evaluate the 2-year efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in Taiwanese patients with glaucoma. METHODS: We included the patients who received standardized MP-TSCPC with follow-up examinations on a regular basis for 24 months. Treatment success was defined as the attainment of a postoperative intraocular pressure (IOP) between 6 and 21 mmHg or a ≥ 20% reduction in IOP from baseline without an increase in glaucoma medications. RESULTS: A total of 60 eyes from 56 patients who underwent MP-TSCPC for refractory glaucoma were included. The median age at MP-TSCPC intervention was 58.9 ± 12.4 years. The percentage of treatment success was 88.3% at 3 months, 83.3% at 6 months, 78.3% at 12 months, and 75.0% at 24 months. The mean baseline IOP prior to MP-TSCPC was 34 ± 11.9 mmHg (range 14-56 mmHg). The mean postoperative IOP decreased to 20.9 ± 10.0 mmHg, 18.0 ± 7.8 mmHg, 17.5 ± 6.4 mmHg, and 18.2 ± 7.1 mmHg after 3 months, 6 months, 12 months, and 24 months, respectively, in successful cases. The mean number of glaucoma medications at baseline was 3.8 ± 0.2, and the mean numbers of glaucoma medications at postoperative months 3, 6, 12, and 24 were 2.6 ± 0.7, 2.8 ± 0.6, 2.5 ± 1.4 and 2.6 ± 1.4, respectively, in successful cases. Younger age and prior CW-TSCPC significantly contributed to surgical failure in the multivariate model. Complications after MP-TSCPC included mild anterior chamber inflammation, conjunctival hemorrhage, hypotony, and mydriasis, and all subsided after treatment. None of the eyes developed vitreous hemorrhage, cystoid macular edema, or phthisis bulbi in the late postoperative period. CONCLUSIONS: This study demonstrated that younger age and prior CW-TSCPC were risk factors for MP-TSCPC failure within 2 years. MP-TSCPC might be safe and effective for refractory glaucoma patients with maximal antiglaucoma medications.

Accuracy of perceived glaucoma risk by patients in a clinical setting.

OBJECTIVE: To determine whether patients attending the ophthalmology department underestimate their glaucoma risks. METHOD: We conducted a cross-sectional survey with a final study population of 1203 individuals from two medical centers in Taiwan during January 1-June 30, 2019. The "High concern" group was defined as the set of patients who rated themselves as having low risk but who had been rated by physicians as having medium or high risk of developing glaucoma over the next year. RESULTS: Approximately 12% of the respondents belonged to the "High concern" group. For those with education at the college level or higher, the interaction term was estimated to be 0.294 (95% CI = 0.136-0.634). Marginal effect calculations revealed significant sex-based differences in the effect of knowledge at specific age intervals. CONCLUSIONS: A considerable proportion of patients attending the ophthalmology department underestimate their glaucoma risks. Misjudgment of glaucoma risks can lead to delays in seeking of medical attention. Glaucoma education should be designed according to each patient's education level and sex, as its effect is not consistent across different education and sex clusters.

Brimonidine related acute follicular conjunctivitis: Onset time and clinical presentations, a long-term follow-up.

ABSTRACT: To evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy.We retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008 to November 30, 2020. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP, and season of onset were evaluated.292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60-120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy (P < .001), which was even higher in the brimonidine monotherapy group (9.2%, P < .001). There was no significant IOP elevation in patients treated with multiple glaucoma medications.Around half of brimonidine allergy occurred within 6 months, with a peak in 2 to 4 months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy. It is recommended to switch to other types of glaucoma medications for better IOP control.

Comparison of Visual Field Progression Rate before and after Cataract Surgery in Patients with Open-Angle and Angle-Closure Glaucoma.

PURPOSE: To evaluate Humphrey visual field (VF) progression rate before and after cataract surgery in patients with open-angle glaucoma (OAG) and angle-closure glaucoma (ACG). METHODS: After reviewing all records in our Humphrey VF database from July 1, 2001, to December 31, 2018, eyes of OAG and ACG that had received uncomplicated phacoemulsification with intraocular lens implantation during the period and had been followed up regularly for more than one year with ≥3 reliable VF tests before and after cataract surgery, respectively, were enrolled. The VF progression rate, visual acuity, and intraocular pressure (IOP) before and after cataract surgery were compared. RESULTS: Seventy-seven eyes (OAG: 51; ACG: 26) from 60 patients were enrolled. The mean preoperative and postoperative follow-up durations were 4.89 ± 2.70 and 5.48 ± 2.30 years in the OAG group and 5.14 ± 3.31 and 5.97 ± 2.35 years in the ACG group. IOP and visual acuity significantly improved postoperatively in both groups. In the OAG group, there was no significant change in the VF progression rate (pre-op: -0.39 ± 0.94 dB/year; post-op: -0.47 ± 0.72 dB/year) (P=0.619), whereas, in the ACG group, the rate significantly flattened after surgery from -1.39 ± 1.31 dB/year to -0.34 ± 0.64 dB/year (P=0.003). CONCLUSIONS: The VF progression rate did not differ between preoperative and postoperative eyes with OAG, but those with ACG exhibited rapid VF decline preoperatively, which was significantly flattened postoperatively.

A donor twin discordant with Peters anomaly in a twin-twin transfusion syndrome case: a case report.

BACKGROUND: Peters anomaly is a rare form of anterior segment ocular dysgenesis, the antenatal image of Peters anomaly had not been reported. We herein showcased a discordant finding of Peters anomaly in a monozygotic twin complicated with twin-twin transfusion syndrome (TTTS) and exhibited its antenatal sonographic images, CASE PRESENTATION: A 38-year-old gravida 2 para 1 pregnant woman visited our clinic at the gestational age of 18 weeks where TTTS stage III was diagnosed and the following laser therapy was done successfully. Ten days after the surgery, the follow-up ultrasound detected the opacity of both fetal eyeballs in the donor twin and thus congenital cataract was suspected initially. Then magnetic resonance imaging (MRI) examination was arranged at the gestational age of 23 weeks, and no central nervous system or other anomaly was found. At the 29 weeks of gestation, the opacity of both fetal eyeballs of the donor twin did not clear. The pregnancy resulted in cesarean section at the gestational age of 37 weeks indicated by malpresentation where two male live births were born. Examination under anesthesia was arranged for donor twin after delivery and Peters anomaly was diagnosed based on central corneal opacity with iridocorneal and corneolenticular adhesions. CONCLUSIONS: The prenatal image of Peters anomaly may present as the opacity of the fetal eyeballs similar to congenital cataract. Some cases of the Peters anomaly had been reported with a genetic abnormality, but since our case presented discordant presentation in monozygotic twin pregnancy where both twins are supposed to share the same genetic make-up, therefore other factors that are epigenetic may be held accountable. Nevertheless, a genetic origin of the anomaly in our case cannot be excluded.

Macular Structures, Optical Components, and Visual Acuity in Preschool Children after Intravitreal Bevacizumab or Laser Treatment.

PURPOSE: To investigate the macular structures, optical components, and visual acuity in preschool-aged children with a history of type I retinopathy of prematurity who underwent either intravitreal bevacizumab (IVB), laser, or a combination of treatments. DESIGN: Comparative interventional case series. METHODS: Setting: A referred medical center in Taiwan. STUDY POPULATION: Eighty eyes from 42 patients (33 IVB-treated eyes from 17 children, 24 laser-treated eyes from 13 children, and 23 laser + IVB-treated eyes from 12 children). OBSERVATION PROCEDURE: Spectral-domain optical coherence tomography. MAIN OUTCOME MEASURES: The retinal thickness in the foveal area and the associated morphologic changes in foveal depression. RESULTS: Compared with the laser-treated and laser + IVB-treated eyes, the IVB-treated eyes had less myopia and deeper anterior chamber depths but presented similar axial lengths and corneal curvatures (P = .001, P = .002, P = .95, and P = .16, respectively). The IVB-treated eyes had significantly thinner foveal, parafoveal, and perifoveal retinal thicknesses (P < .01 for all) and a higher incidence of foveal depression than the laser- or laser + IVB-treated eyes. The macular and subfoveal choroidal thicknesses did not differ among the groups (P = .21 and P = .63, respectively). Moreover, compared with the eyes treated with laser or laser + IVB, the IVB-treated eyes had better uncorrected visual acuity, although a significant difference was not observed in best-corrected visual acuity (P = .008 and P = .29, respectively). CONCLUSIONS: Compared with laser therapy, IVB-treated eyes were associated with deeper anterior chamber depths and thinner foveal, parafoveal, and perifoveal thicknesses. Moreover, these IVB-treated eyes had fewer refractive errors and better uncorrected visual acuity.

Comparison of the Retinal Microvascular Density Between Open Angle Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy.

Purpose: To compare optical coherence tomography angiography (OCT-A) retinal vasculature measurements between nonarteritic anterior ischemic optic neuropathy (NAION) and open angle glaucoma (OAG) with altitudinal hemifield visual field defects. Methods: This retrospective cross-sectional study included 10 NAION eyes and 16 OAG eyes, both demonstrating hemifield visual field defects, and 27 normal eyes serving as controls. The peripapillary and macular OCT-A scans were acquired. The retinal vessel density data were compared among NAION, glaucomatous, as well as control eyes. Results: There was statistically significant difference in peripapillary whole image vessel density (wiVD), circumpapillary vessel density (cpVD), macular wiVD, and perifoveal vessel density (pfVD) between the three groups (P < 0.05 for all). In comparison between OAG and NAION groups, the NAION group demonstrated marked decrease in average cpVD (P = 0.008) and in most sectors of cpVD except the inferior one, while the OAG group demonstrated significant decreased macular wiVD and pfVD (P = 0.03 and 0.003, respectively). Multivariate analysis indicated that average thickness of retinal nerve fiber layer was the only predictor for peripapillary wiVD and cpVD (P = 0.005 for both). By contrast, thickness of ganglion cell complex was the only predictor for macular wiVD (P = 0.007). Conclusions: OCT-A detected significant difference in peripapillary and macular retinal vessel densities between OAG and NAION eyes. These differences might provide comparative insight into the pathophysiology of these two diseases.

Optical Coherence Tomography Angiography of the Superficial Microvasculature in the Macular and Peripapillary Areas in Glaucomatous and Healthy Eyes.

Purpose: To quantitatively evaluate the superficial microvasculature in the macular and peripapillary areas in glaucomatous and healthy eyes using optical coherence tomography angiography (OCT-A). Methods: We enrolled 26 eyes of medically managed primary open-angle glaucoma patients and 27 eyes of healthy subjects were enrolled in this prospective study. Measurements of OCT-A vessel density were acquired both in the macular and peripapillary areas. We compared vessel density values, the circumpapillary retinal nerve fiber layer (cpRNFL), the ganglion cell complex (GCC), and standard automated perimetry (SAP) parameters across study groups. Areas under the receiver operating characteristic (AUROC) curves were used to evaluate diagnostic accuracy. Quadratic regression models were used to determine the correlations between SAP severity and outcome measures. Results: The whole image vessel density (wiVD) in glaucomatous eyes was lower than that in healthy eyes in the macular (38.5% ± 2.2% vs. 43.2% ± 2.3%, P < 0.001) and peripapillary areas (43.8% ± 5.7% vs. 53.3% ± 3.0%, P < 0.001). The circumpapillary vessel density (cpVD) was also lower in glaucomatous eyes (53.3% ± 7.0% vs. 61.5% ± 3.2%, P < 0.001). We found the AUROCs for discriminating between glaucomatous and healthy eyes were highest for cpRNFL (0.95) and GCC (0.95); followed by macular wiVD (0.94); peripapillary wiVD (0.93); and cpVD (0.89). The correlations between SAP severity were strongest with peripapillary wiVD (R2 = 0.58); followed by cpVD (R2 = 0.55); GCC (R2 = 0.51); cpRNFL (R2 = 0.42); and macular wiVD (R2 = 0.36). Conclusions: Medically managed glaucomatous eyes show sparser superficial microvasculature in the macular area than do healthy eyes. The measurement of the macular superficial vessel density had similar diagnostic accuracy to peripapillary RNFL and macular GCC thickness for differentiating between glaucomatous and healthy eyes.

Anterior Chamber Angle and Anterior Segment Structure of Eyes in Children With Early Stages of Retinopathy of Prematurity.

PURPOSE: To compare structural differences in the anterior chamber angle (ACA) and related optic components in children with or without retinopathy of prematurity (ROP). DESIGN: Prospective cross-sectional study. METHODS: Setting: A referred medical center in Taiwan. STUDY POPULATION: The patients included preterm children with a history of ROP who had undergone laser therapy. The controls included age-matched healthy full-term children. OBSERVATION PROCEDURE: The ACA structures were evaluated using gonioscopy. MAIN OUTCOME MEASURES: The angularity of the anterior chamber and associated anatomic changes. RESULTS: We examined 54 eyes of 29 preterm children with ROP and 134 eyes of 67 children born at term. The eyes of the ROP children exhibited a narrower ACA, steeper iris curvature, and more anteriorly inserted iris than those of the full-term children (P < .001, P = .002, and P = .08, respectively). The eyes of the ROP children also exhibited steeper corneas, shallower anterior chamber depths, thicker lenses, and higher degrees of refractive errors (all P < .001) than those of the full-term children. The axial lengths did not differ between the 2 groups (P = .15). CONCLUSIONS: The eyes of the ROP children presented a narrower ACA and a more anteriorly curved and inserted iris than those of the full-term children. A steeper cornea, shallower anterior chamber, and greater lens thickness were the main structural changes in the anterior segment components of these patients. Further research is needed to investigate the association between these structural changes and the development of certain ocular diseases, such as glaucoma, in these patients.

The relationship of bleb morphology and the outcome of needle revision with 5-fluorouracil in failing filtering bleb.

To investigate the risk factors for failure of needling revision with 5-fluorouracil (5-FU) and to identify the correlation of outcomes of needling revision and the morphological features of dysfunctional filtration blebs using Moorfields bleb grading system.This retrospective, nonrandomized, comparative case-control study included 41 consecutive patients (41 eyes) who underwent 5-FU needling revision for failed or failing filtration blebs between July 2012 and August 2014 in Chang Gung Memorial Hospital, a referral center in Taiwan. The main outcome measures were the bleb survival and the correlation factors of bleb morphology before revision. The secondary outcome measure was the identification of any study factor associated with bleb failure.Forty-one eyes of 41 patients were included in this study. The most frequent glaucoma diagnoses were 10 cases (24%) of neovascular glaucoma and 8 cases (19%) of chronic open-angle glaucoma. Survival of bleb at 6, 12, and 24 months was 42%, 39%, and 23%. Fourteen cases (34%) maintained overall success at the last follow-up, with an average follow-up of 22.7 ±â€Š9.4 months (range: 12-48 months). The central bleb area and height were significantly different between the successful needling group and the failed needling group (P = 0.03 and 0.04, respectively). Further trend test confirmed that smaller central bleb extension and flatter height were associated with a higher chance of failure (P = 0.02 and 0.02, respectively). Time from initial trabeculectomy to needling of less than 4 months and higher intraocular pressure (IOP) in the first postoperative week also led to significantly higher risk for failure (P = 0.01 and 0.03, respectively).A small central area and the flat height of dysfunctional blebs were more likely to fail after the needle revision. Cautious case selections, taking account of the time from the initial filtering surgery and postoperative IOP, may improve the surgical outcome.

Plasmin Enzyme-Assisted Vitrectomy in Pediatric Patients with Vitreoretinal Diseases.

PURPOSE: To evaluate the efficacy and safety of using plasmin-assisted vitrectomy in pediatric patients with vitreoretinal diseases. METHODS: We prospectively recruited children aged 16 years or younger who presented with vitreoretinopathies and underwent plasmin-assisted vitrectomy between 2012 and 2013. The main outcome measure was the induction of posterior vitreous detachment (PVD) using a suction power of 200 mm Hg or less during surgery. RESULTS: Eleven eyes of 11 patients (mean age: 3.7 years; average follow-up duration: 14.1 months) were included. Of these 11 patients, there were 3 (27%) cases of stage 5 retinopathy of prematurity, 2 (18%) cases of persistent fetal vasculature, 2 (18%) cases of rhegmatogenous retinal detachment, 2 (18%) cases of idiopathic epiretinal membrane, 1 (9%) case of traumatic macular pucker, and 1 (9%) case of traumatic vitreous hemorrhage (9%). PVD was achieved in all cases (100%) during surgery using low suction after plasmin treatment (mean: 150 ± 39 mm Hg; range: 100-200). Overall, anatomical success was achieved in 8 eyes (73%). Visual acuity improved in all 5 (100%) patients for whom vision could be measured at 6 months after the operation. Cataracts were found in 4 eyes (36%), and a rise in transient intraocular pressure was observed in 1 eye (9%). CONCLUSIONS: Plasmin-assisted vitrectomy offers an effective and less traumatic intervention for a variety of pediatric vitreoretinal diseases.

Anterior chamber depth and angle-closure glaucoma after central retinal vein occlusion.

BACKGROUND: The purpose of this study was to report the anterior chamber (AC) depth and the attack of angle-closure glaucoma (ACG) in eyes with the recent onset of central retinal vein occlusion (CRVO). METHODS: This retrospective case series included 24 patients with recent onset of CRVO (within one month of attack) from July 2001 to December 2002. The mean follow-up period of the patients was 46 months (range: 3 to 92 months). AC depth was measured using an ultrasound biomicroscopy. Clinical data, including systemic disorders, intraocular pressure, and visual outcomes were recorded. The main outcome measures were AC depth in the diseased eye and the fellow eye of the same patient and the attack of ACG after CRVO. RESULTS: The mean AC depth in the diseased eyes was significantly shallower than in the unaffected fellow eyes (2.43 ± 0.45 mm vs. 2.55 ± 0.46 mm; p < 0.001). Four patients (17 %) developed ACG after the onset of CRVO within one month of the CRVO attack. In these four patients, the mean AC depth in the diseased eyes was 1.91 ± 0.21 mm, which was much shallower than the eyes without ACG attack (2.53 ± 0.40 mm). CONCLUSIONS: AC depth is significantly shallower following the onset of CRVO. ACG can occur in patients after the onset of CRVO.

Acute angle-closure glaucoma in retinopathy of prematurity following pupil dilation.

BACKGROUND: Pupil dilation is a known risk factor for acute angle-closure glaucoma. Regular retinal evaluation is necessary for retinopathy of prematurity (ROP) cases. An acute attack of angle-closure glaucoma following pupil dilation in regressed ROP has never been reported. CASE PRESENTATION: A five-year-old girl presented to the hospital for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She had a history of stage 4A ROP in the right eye and received scleral buckling. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) showed that the angle in the right eye was closed 360 degrees circumferentially. In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values. In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye. CONCLUSION: Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future. Ophthalmologists should bear in mind that pupil dilation for a retina check-up could result in acute angle-closure glaucoma in ROP patients.