Comparison of Horizontal Corneal Diameter Measurements Using Orbscan IIz, OPD Scan III, and IOLMaster 700.

PURPOSE: To compare three automated devices for measuring the horizontal corneal diameter (white to white [WTW]). METHODS: In 65 eyes of 38 patients, the WTW distance was measured independently by three examiners using the following techniques: Orbscan IIz tomography system (Bausch & Lomb), IOLMaster 700 (Carl Zeiss Meditec), and OPD Scan III (NIDEK). We tested for systematic differences in measurements and estimated the limits of agreement (LoA) using linear mixed-effects models. RESULTS: The mean WTW distance was 11.8±0.40 mm with Orbscan IIz, 12.1±0.5 mm with IOLMaster 700 and 12.0±0.4 mm with OPD Scan III. The mean difference between IOLMaster 700 and Orbscan IIz was 0.33 (95% CI, 0.28 to 0.38; P<0.001), between OPD Scan III and Orbscan IIz was 0.24 mm (95% CI, 0.21 to 0.28; P<0.001), and between IOL Master 700 and OPD Scan III was 0.09 (95% CI, 0.05 to 0.12; P<0.001). The 95% LoA for Orbscan IIz versus IOLMaster 700 was -0.69 to 0.03 mm, Orbscan IIz versus OPD Scan III was -0.52 to -0.03 mm, and OPD versus IOLMaster 700 was -0.39 to 0.22 mm. CONCLUSIONS: The data suggest that these devices are not interchangeable for usual clinical practice. Adjustments based on mean differences were not enough to compensate for interinstrument discrepancy in WTW measurements.

Visual field progression in patients with severe glaucoma.

PURPOSE: To assess the cumulative risk of progression in glaucomatous eyes in the severe stage of disease. METHODS: This was a retrospective observational study. Patients that had severe damage in at least one eye, as defined by three criteria including a mean deviation of ≤ - 20 dB, were included. Glaucoma progression was defined as a loss of ≥ 2 dB in mean deviation confirmed in three consecutive visual field tests, or a persistent loss of two or more lines of vision-not attributable to non-glaucomatous causes-in three consecutive follow-up examinations. Kaplan-Meier survival analysis was used to assess the cumulative incidence of progression of the first eye to reach endpoint in cases where both eyes were eligible. RESULTS: A total of 143 eyes from 119 patients, were studied over a mean period of 4.9 ± 2.9 years. Baseline mean deviation was - 25.3 ± 3.6 dB. Twenty-three eyes of 22 patients reached the progression endpoint: 14 eyes by visual field criteria and 9 by visual acuity criteria. The cumulative 5-year risk of progression estimated by Kaplan-Meier analysis was 14.6% (95% confidence interval: 6.1-22.2%). CONCLUSIONS: In severe glaucoma patients, we found a cumulative incidence of progression of 2.9% per year during the first 5 years of follow-up. Similar incidences have been reported in other studies of glaucoma at different stages of severity.

Subconjunctival Injections of Mitomycin C Are Associated with a Lower Incidence of Hypertensive Phase in Eyes with Ahmed Glaucoma Valve.

PURPOSE: To evaluate the association of intraoperative and postoperative subconjunctival injections of mitomycin C (MMC) and rate of the hypertensive phase after implantation of the Ahmed glaucoma valve (AGV). DESIGN: Comparative case series. PARTICIPANTS: This retrospective comparative study included 37 eyes of 35 patients with uncontrolled glaucoma on maximum tolerated medical therapy who underwent implantation of AGV by a single surgeon. METHODS: Consecutive cases operated without the use of MMC from 2015 to 2017 were compared with consecutive cases operated from 2018 to 2019 under a standardized protocol of subconjunctival MMC injections. The MMC group received 0.1 ml of MMC (0.25 mg/ml) injected intraoperatively, at 1 and 4 weeks after the surgery. MAIN OUTCOME MEASURES: Incidence of the hypertensive phase (defined as intraocular pressure [IOP] >21 mmHg during the first 3 postoperative months) was compared across groups. Intraocular pressure and glaucoma medications were also compared during the course of the first 6 postoperative months. RESULTS: In the MMC and no-MMC groups, 17.6% (3/17) and 55.0% (11/20) of the cases exhibited a hypertensive phase (P = 0.04), respectively. Both groups were comparable in baseline characteristics, including age, preoperative IOP, preoperative glaucoma medications, and previous glaucoma surgeries. At 6 months, mean IOP was 14.0 ± 0.8 mmHg and 14.7 ± 0.9 mmHg for the MMC and no-MMC groups, respectively (P = 0.6). The mean number of glaucoma medications at 6 months was 1.2 ± 0.2 and 2.2 ± 0.3 in the MMC and no-MMC groups, respectively (P = 0.007). CONCLUSIONS: Eyes that underwent implantation of AGV experienced a lower incidence of hypertensive phase and required fewer medications when using a standardized protocol of intraoperative and postoperative subconjunctival MMC injections.

Population-Based Study of Trachoma in Guatemala.

PURPOSE: A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women aged 40 years and older was carried out in four districts in the Sololá region in Guatemala, which is suspected of still having a trachoma problem. METHODS: Population-based surveys were undertaken in three districts, within 15 randomly selected communities in each district. In addition, in a fourth district that borders the third district chosen, we surveyed the small northern sub-district, by randomly selecting three communities in each community, 100 children aged under 10 years were randomly selected, and all females over 40 years. Five survey teams were trained and standardized. Trachoma was graded using the World Health Organization simplified grading scheme and ocular swabs were taken in cases of clinical follicular or inflammatory trachoma. Prevalence estimates were calculated at district and sub-district level. RESULTS: Trachoma rates at district level varied from 0-5.1%. There were only two sub-districts where active trachoma approached 10% (Nahualá Costa, 8.1%, and Santa Catarina Costa, 7.3%). Trichiasis rates in females aged 40 years and older varied from 0-3%. Trachoma was likely a problem in the past. CONCLUSIONS: Trachoma is disappearing in the Sololá region in Guatemala. Health leadership may consider further mapping of villages around the areas with an especially high rate of trachoma and infection, and instituting trichiasis surgery and active trachoma intervention where needed.

Selective laser trabeculoplasty compared with medical treatment for the initial management of open angle glaucoma or ocular hypertension.

Selective laser trabeculoplasty is a relatively new therapeutic alternative for the management of open angle glaucoma and ocular hypertension. On the other hand, medical treatment has robust data supporting its efficacy and has progressed in last decades with the introduction of prostaglandin analogues. To compare these two therapies, we searched Epistemonikos database, which is maintained by screening 30 databases, and identified four systematic reviews including four randomized and one non-randomized clinical trial. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that selective laser trabeculoplasty leads to a smaller absolute intraocular pressure reduction than medical treatment. However, it is not clear if there are differences in treatment success rate or need of additional antiglaucomatous interventions, because the quality of the evidence is low.

La trabeculoplastía láser selectiva es una alternativa terapéutica relativamente reciente para el manejo del glaucoma de ángulo abierto y la hipertensión ocular. Por otro lado, el tratamiento médico es de efectividad probada, e incluso ha mejorado en las últimas décadas con la introducción de los análogos de prostaglandinas. Buscamos la evidencia que compara ambos tratamientos utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos. Identificamos cuatro revisiones sistemáticas que en conjunto incluyen cuatro estudios aleatorizados y un estudio no aleatorizado y realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la trabeculoplastía láser selectiva produce una reducción absoluta de presión intraocular de menor magnitud que el tratamiento médico. Sin embargo, no está claro si existen diferencias en la tasa de éxito del tratamiento o la necesidad de intervenciones antiglaucomatosas adicionales porque la certeza de la evidencia es muy baja.

Glaucomatous visual field loss associated with less travel from home.

PURPOSE: To determine the association between glaucoma and travel away from home. METHODS: Fifty-nine glaucoma suspect controls with normal vision and 80 glaucoma subjects with bilateral visual field (VF) loss wore a cellular tracking device during 1 week of normal activity. Location data were used to evaluate the number of daily excursions away from home as well as daily time spent away from home. RESULTS: Control and glaucoma subjects were similar in age, race, sex, employment, driving support, cognitive ability, mood, and comorbid illness (p > 0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 decibels (dB) in controls and -11.1 dB in glaucoma subjects. In multivariable models, glaucoma was associated with fewer daily excursions (ß = -0.20; 95% confidence interval [95% CI], -0.38 to -0.02) and a greater likelihood of not leaving home on a given day (odds ratio [OR], 1.82; 95% CI, 1.05 to 3.06). Each 5-dB decrement in the better-eye VF MD was associated with fewer daily excursions (ß = -0.06; 95% CI, -0.11 to -0.01) and a greater chance of not leaving home on a given day (OR, 1.24; 95% CI, 1.04 to 1.47). Time spent away from home did not significantly differ between the glaucoma subjects and suspects (p = 0.18). However, each 5-dB decrement in the better-eye MD was associated with 6% less time away (95% CI, -12 to -1%). CONCLUSIONS: Individuals with glaucoma, particularly those with greater VF loss, are more home bound and travel away from home less than individuals with normal vision. Because being confined to the home environment may have detrimental effects on fitness and health, individuals with glaucoma should be considered for interventions such as orientation and mobility training to encourage safe travel away from home.

The choroid is thicker in angle closure than in open angle and control eyes.

PURPOSE: To study factors associated with choroidal thickness (CT) and to compare CT in angle closure (AC), open angle (OA), and normal eyes. METHODS: Forty controls, 106 OA, and 79 AC subjects underwent measurements of posterior CT by spectral domain-optical coherence tomography, and of intraocular pressure (IOP), blood pressure, axial length (AL), and central corneal thickness (CCT). RESULTS: CT was significantly greater in AC than in OA and normal eyes (HSD test, P ≤ 0.05), but there was no significant difference between OA and normal CT; mean CT was 234, 235, and 318 µm in the normal, OA, and AC groups, respectively. With multivariable analysis among all participants, thinner CT was associated with older age, longer AL, higher IOP, and thicker CCT (all P ≤ 0.03, R(2) = 0.45). Adjusting for other relevant variables, the AC group had a significantly greater CT than either the normal or the OA group (P = 0.003 and 0.03, respectively). In multivariable analysis including only OA and AC patients, neither cup-to-disc ratio nor visual field mean deviation were significantly associated with CT. Multivariable analysis for CT among normal eyes found longer AL to be associated with thinner CT (P = 0.04). CONCLUSIONS: AC eyes had significantly thicker CT than OA and normal eyes, even after adjusting for the shorter AL in AC eyes, supporting hypotheses that choroidal expansion contributes to the development of AC disease. Age, AL, CCT, and IOP were also significantly associated with CT, while severity of glaucoma damage was not.

Choroidal thickness change after water drinking is greater in angle closure than in open angle eyes.

PURPOSE: To study change in choroidal thickness (CT) after water drinking test (WDT), comparing angle closure (AC) to open angle (OA) eyes. METHODS: Before and 30 minutes after drinking 1 L of water, 88 glaucoma subjects underwent measurements of CT by spectral domain-optical coherence tomography, IOP, blood pressure (BP), axial length (AL), and anterior chamber depth (ACD). RESULTS: Baseline CT was significantly greater in AC than in OA eyes (P = 0.002). After WDT, BP, IOP, and AL increased significantly (all P ≤ 0.0001). Mean CT increased significantly in the AC group (5.6 µm, P = 0.04, n = 40) and among 80 subjects whose IOP rose > 2 mm Hg (responders; 3.2 µm, P = 0.048), but not in the OA group or among all subjects (2.5 µm increase overall, <1% of baseline CT, P = 0.10). ACD decreased in AC (-18 µm, P = 0.07), but not in OA eyes (+3 µm, P = 0.74). AC eyes had a significantly greater IOP increase after WDT than OA eyes (P = 0.002, multivariate regression). Among responders, CT increased more in those with larger diastolic perfusion pressure increase and in AC compared to OA eyes (P = 0.04 and P = 0.053, respectively, multivariate regression). CONCLUSIONS: A significant increase in CT and a decrease in ACD after WDT were observed in AC but not in OA eyes, and IOP increased significantly more in AC than in OA eyes, suggesting that the dynamic behavior of the choroid may play a role in the AC process. IOP increase after the WDT was not fully explained by CT increase.

RAND-like appropriateness methodology consensus for primary open-angle glaucoma in Latin America.

PURPOSE: To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States. DESIGN: A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America. METHODS: The 148 polling statements created for the RAND- like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND- like methodology before and after the panel meeting. RESULTS: Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making. CONCLUSIONS: This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world.

Association of vision loss in glaucoma and age-related macular degeneration with IADL disability.

PURPOSE: To determine if glaucoma and/or age-related macular degeneration (AMD) are associated with disability in instrumental activities of daily living (IADLs). METHODS: Glaucoma subjects (n = 84) with bilateral visual field (VF) loss and AMD subjects (n = 47) with bilateral or severe unilateral visual acuity (VA) loss were compared with 60 subjects with normal vision (controls). Subjects completed a standard IADL disability questionnaire, with disability defined as an inability to perform one or more IADLs unassisted. RESULTS: Disability in one or more IADLs was present in 18.3% of controls as compared with 25.0% of glaucoma subjects (P = 0.34) and 44.7% of AMD subjects (P = 0.003). The specific IADL disabilities occurring more frequently in both AMD and glaucoma subjects were preparing meals, grocery shopping, and out-of-home travelling (P < 0.05 for both). In multivariate logistic regression models run adjusting for age, sex, mental status, comorbidity, and years of education, AMD (odds ratio [OR] = 3.4, P = 0.02) but not glaucoma (OR = 1.4, P = 0.45) was associated with IADL disability. However, among glaucoma and control patients, the odds of IADL disability increased 1.6-fold with every 5 dB of VF loss in the better-seeing eye (P = 0.001). Additionally, severe glaucoma subjects (better-eye MD worse than -13.5 dB) had higher odds of IADL disability (OR = 4.2, P = 0.02). Among AMD and control subjects, every Early Treatment of Diabetic Retinopathy Study line of worse acuity was associated with a greater likelihood of IADL disability (OR = 1.3). CONCLUSIONS: VA loss in AMD and severe VF loss in glaucoma are associated with self-reported difficulties with IADLs. These limitations become more likely with increasing magnitude of VA or VF loss.

Real-world assessment of physical activity in glaucoma using an accelerometer.

OBJECTIVE: To determine the association between glaucomatous visual field (VF) loss and the amount of physical activity and walking in normal life. DESIGN: Prospective, observational study. PARTICIPANTS: Glaucoma suspects without significant VF or visual acuity loss (controls) and glaucoma subjects with bilateral VF loss between 60 and 80 years of age. METHODS: Participants wore an accelerometer over 7 days of normal activity. MAIN OUTCOME MEASURES: Daily minutes of moderate or vigorous physical activity (MVPA) was the primary measure. Steps per day was a secondary measure. RESULTS: Fifty-eight controls and 83 glaucoma subjects provided sufficient study days for analysis. Control and glaucoma subjects were similar in age, race, gender, employment status, cognitive ability, and comorbid illness (P>0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 decibels (dB) in controls and -11.1 dB in glaucoma subjects. The median control subject engaged in 16.1 minutes of MVPA daily and walked 5891 steps/day, as compared with 12.9 minutes of MVPA daily (P = 0.25) and 5004 steps/day (P = 0.05) for the median glaucoma subject. In multivariate models, glaucoma was associated with 21% less MVPA (95% confidence interval [CI], -53% to 32%; P = 0.37) and 12% fewer steps per day (95% CI, -22% to 9%; P = 0.21) than controls, although differences were not statistically significant. There was a significant dose response relating VF loss to decreased activity, with each 5 dB decrement in the better-eye VF associated with 17% less MVPA (95% CI, -30% to -2%; P = 0.03) and 10% fewer steps per day (95% CI, -16% to -5%; P = 0.001). Glaucoma subjects in the most severe tertile of VF damage (better-eye VF MD worse than -13.5 dB) engaged in 66% less MVPA than controls (95% CI, -82% to -37%; P = 0.001) and took 31% fewer steps per day (95% CI, -44% to -15%; P = 0.001). Other significant predictors of decreased physical activity included older age, comorbid illness, depressive symptoms, and higher body mass index. CONCLUSIONS: Overall, no significant difference in physical activity was found between individuals with and without glaucoma, although substantial reductions in physical activity and walking were noted with greater levels of VF loss. Further study is needed to characterize better the relationship between glaucoma and physical activity. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Impact of eyelid closure on the intraocular pressure lowering effect of prostaglandins: a randomised controlled trial.

BACKGROUND/AIMS: To determine if eyelid closure (ELC) after topical prostaglandin instillation provides greater intraocular pressure (IOP) reduction than prostaglandin instillation without ELC. METHODS: Patients receiving chronic bilateral prostaglandin monotherapy were enrolled in this study. The study intervention, ELC, was randomly assigned to one eye, while the fellow eye served as control. ELC was performed for either 1 min or 3 min. After a 1-day washout, the IOP was measured in a masked fashion at baseline, 1 h and 24 h, and at a final visit that took place 7-14 days after enrolment. All visits were scheduled during the morning, and every individual patient's visits occurred at similar times during the day. The main outcome was difference between intervention eye and control eye in IOP-lowering from baseline. RESULTS: 51 patients meeting eligibility criteria were enrolled: 25 were randomised to ELC for 1 min and 26 to ELC for 3 min in the intervention eye. The pooled IOP-lowering difference (95% CI, p value) in intervention versus control eyes was 0.24 mm Hg (-0.5 to 0.9, p=0.50), 0.24 mm Hg (-0.7 to 1.2, p=0.61) and 0.24 mm Hg (-0.7 to 1.2, p=0.61) in the overall group, 1 min ELC subgroup and 3 min ELC subgroup, respectively. The effect of ELC did not change significantly across visits. CONCLUSIONS: ELC did not provide significant additional IOP reduction compared with no ELC in patients using chronic prostaglandin monotherapy. Trial Registration http://clinicaltrials.gov/ct2/show/NCT0083283.

Early lens extraction compared to standard treatment in acute primary angle closure.

This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the efficacy as well as harms of early lens extraction versus standard treatment in patients with acute primary angle closure.

Choroidal thickness measured by spectral domain optical coherence tomography: factors affecting thickness in glaucoma patients.

PURPOSE: To measure choroidal thickness and to determine parameters associated with it. DESIGN: Cross-sectional study. PARTICIPANTS: Seventy-four glaucoma patients and glaucoma suspects. METHODS: Spectral domain optical coherence tomography (SD-OCT) scans were obtained to estimate average choroidal thickness in a group of glaucoma suspects and glaucoma patients. The average thickness was calculated from enhanced depth SD-OCT images and manually analyzed with Image J software. Open-angle glaucoma, open-angle glaucoma suspect, primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspect were defined by published criteria. Glaucoma suspects had normal visual fields bilaterally. Glaucoma was defined by specific criteria for optic disc damage and visual field loss in ≥1 eye. The most affected eye was analyzed for comparisons across individuals, and right/left and upper half/lower half comparisons were made to compare thickness against degree of visual field damage. MAIN OUTCOME MEASURES: Average macular and peripapillary choroidal thickness measured using SD-OCT. RESULTS: The choroidal-scleral interface was visualized in 86% and 96% of the macular and peripapillary scans, respectively. In multivariable linear regression analysis, the macular choroid was significantly thinner in association with 4 features: Longer eyes (22 µm per mm longer [95% confidence interval (CI), -33, -11]), older individuals (31 µm thinner per decade older [95% CI, -44, -17]), lower diastolic ocular perfusion pressure (26 µm thinner per 10 mmHg lower [95% CI, 8, 44]), and thicker central corneas (6 µm per 10 µm thicker cornea [95% CI, -10, 0]). The choroid was not significantly thinner in glaucoma patients than in suspects (14 µm [95% CI, -54, 26]; P = 0.5). Peripapillary choroidal thickness was not significantly different between glaucoma and suspect patients. Thickness was not associated with damage severity as estimated by visual field mean deviation or nerve fiber layer thickness, including comparisons of right with left eye or upper with lower values. CONCLUSIONS: Age, axial length, CCT, and diastolic ocular perfusion pressure are significantly associated with choroidal thickness in glaucoma suspects and glaucoma patients. Degree of glaucoma damage was not consistently associated with choroidal thickness. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

A 6-week, multicenter, randomized, double-masked, parallel-group study comparing travoprost 0.004% to latanoprost 0.005% followed by 6-week, open-label treatment with travoprost 0.004%.

OBJECTIVE: The aim of this study was to compare the tolerability and efficacy of once-daily travoprost 0.004% versus latanoprost 0.005% for 6 weeks followed by 6 weeks of once-daily travoprost 0.004% in decreasing intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH). METHODS: This multicenter, randomized, doublemasked, active-controlled, parallel-group trial was conducted at 32 centers across Latin America. Patients aged > or =18 years with OAG or OH were randomly assigned to receive topical travoprost 0.004% or latanoprost 0.005% 1 drop QD (9 PM) for 6 weeks (masked phase). At 6 weeks, all patients were assigned to receive open-label travoprost 0.004% 1 drop QD (9 PM) for 6 additional weeks (open-label phase). Study visits were scheduled at weeks 1, 2, 4, 6, 8, and 12. At each study visit, IOP was measured at 5 PM (+/-1 hour; approximately 20 hours after study drug administration). IOP changes from baseline were combined (pooled) from the 1-, 2-, 4-, and 6-week data to provide a comparison between the 2 treatment groups. Ocular adverse events (AEs) were monitored using slit-lamp examination. RESULTS: A total of 302 patients were enrolled (travoprost group, 155 patients; latanoprost group, 147 patients). The mean (SD) age of the travoprost group was 61.9 (10.6) years; 60.6% were female; and 47.1% were white. The mean (SD) age of the latanoprost group was 60.5 (12.4) years; 62.6% were female; and 49.0% were white. Mean IOP values were not significantly different between the travoprost and latanoprost groups at baseline (24.7 vs 24.2 mm Hg) or 6 weeks; however, the between-group difference in reductions from baseline in pooled IOP during the masked phase of the study was statistically significant (-8.3 vs -7.5 mm Hg; P = 0.009). At weeks 6 and 12, mean lOP levels were 16.1 and 16.2 mm Hg, respectively, in the travoprost group and 16.4 and 16.1 mm Hg in the group that was switched from latanoprost to travoprost (all, P = NS). The most common ocular AEs that occurred with masked travoprost, latanoprost, and open-label travoprost were hyperemia (26.9%, 12.2%, and 5.3%, respectively), discomfort (3.2%, 3.4%, and 1.1%), and pruritus (4.5%, 2.0%, and 2.1%). CONCLUSIONS: In this population of patients with OAG or OH, 6-week treatment with travoprost 0.004% was associated with a significantly greater decrease from baseline in pooled IOP compared with latanoprost 0.005% 20 hours after administration. There were no significant differences between the 2 groups. Travoprost and latanoprost were well tolerated.

Variation in optineurin (OPTN) allele frequencies between and within populations.

PURPOSE: To evaluate the extent to which mutations in the optineurin (OPTN) glaucoma gene play a role in glaucoma in different populations. METHODS: Case-controlled study of OPTN sequence variants in individuals with or without glaucoma in populations of different ancestral origins and evaluate previous OPTN reports. We analyzed 314 subjects with African, Asian, Caucasian and Hispanic ancestries included 229 cases of primary open-angle glaucoma, 51 cases of juvenile-onset open-angle glaucoma, 33 cases of normal tension glaucoma, and 371 controls. Polymerase chain reaction-amplified OPTN coding exons were resequenced and case frequencies were compared to frequencies in controls matched for ancestry. RESULTS: The E50K sequence variant was identified in one individual from Chile with normal tension glaucoma, and the 691_692insAG variant was found in one Ashkenazi Jewish individual from Russia. The R545Q variant was found in two Asian individuals with primary open-angle glaucoma; one of Filipino ancestry and one of Korean ancestry. In addition to presenting OPTN allele frequencies for Caucasian and Asian populations that have been the subject of previous reports, we also present information for populations of Hispanic and black African ancestries. CONCLUSIONS: Our study contributes additional evidence to support the previously reported association of the OPTN E50K mutation with glaucoma. After finding an additional 691_692insAG OPTN variant, we can still only conclude that this variant is rare. Combined analysis of our data with data from more than a dozen other studies indicates no association of R545Q with glaucoma in most populations. Those same studies disagree in their conclusions regarding the role of M98K in glaucoma. Our analysis of the combined data provides statistically significant evidence of association of M98K with normal tension glaucoma in Asian populations, but not in Caucasian populations; however, the validity of this conclusion is questionable because of large differences in allele frequencies between and within populations. It is currently not possible to tell how much of the underlying cause of the allele frequency difference is attributable to demographic, technical, or ascertainment differences among the studies.

Aplastamiento de la cámara anterior hipotonía y miopía postraumáticas / Shallowing of the anterior chamber, hypotony and myopia post traumatic

La contusión ocular sin ruptura del globo produjo un cuadro de aplastamiento de la cámara anterior hipotonía y miopía en esta serie. En 5 de 6 casos se demostró una ciclodiálisis en la gonioscopia. En 3 casos de aplastamiento de la cámara estuvo presente en el examen a las 48 horas, en uno de los casos la miopía y la hipotonía estuvieron asociados a cámara anterior normal. Los tres elementos descritos siguieron un curso paralelo, volviendo simultáneamente a la normalidad en días a semanas del diagnóstico. La ciclodiálisis y la rotación anterior del cuerpo ciliar, constituyen el eje patogénico de los tres elementos postcontusionales descritos. Los pacientes fueron tratados con esteroides tópicos y cicloplégicos

Toxocariasis ocular / Ocular toxocariasis

Se presentan 14 pacientes con presunta toxocariasis ocular. El diagnóstico se basó en hallazgos fundoscópicos y un ELISA test mayor o igual a 1:8. Las manifestaciones clínicas más frecuentes fueron una masa inflamatoria periférica, granuloma de polo posterior y endoftalmitis. Presentaciones raras fueron granuloma del disco óptico y neurorretinitis y vitreítis difusa. Los esteroides fueron efectivos para combatir el proceso inflamatorio en la etapa aguda. La enfermedad condujo a una ceguera en 64,3% de los casos, a pesar del tratamiento. Se enfatiza la importancia de la prevención primaria