Trabeculectomy in Eyes With High Myopia.

PRCIS: Primary trabeculectomy was safe and effective at lowering intraocular pressure (IOP) in patients with primary open angle glaucoma and high myopia. PURPOSE: To investigate the efficacy and safety of trabeculectomy in patients with glaucoma and high myopia. PATIENT AND METHODS: Retrospective case-control study. Glaucomatous patients with high myopia undergoing primary trabeculectomy surgery with at least 1 year of follow-up were compared with an age-matched control group without high myopia undergoing the same procedure. Surgical success was defined as: IOP ≤ 15 mm Hg with (qualified) or without (complete) antiglaucoma medications and at least 20% reduction from baseline IOP at the end of 48 months of follow-up. RESULTS: We included a total of 90 eyes from 90 patients (45 eyes with high myopia and 45 controls). Within the 90 eyes, 70 eyes underwent trabeculectomy and 20 eyes underwent combined phacoemulsification and trabeculectomy. Although patients with high myopia had higher chances for failure (37% vs. 22%) compared with controls, the difference was not statistically significant ( P =0.067). In the multivariable analysis, patients of African descent ( P =0.043) and those with juvenile glaucoma ( P =0.001) had more chances of failure, even after adjusting for myopia. There was no statistically significant difference between complication rates in both groups. CONCLUSION: Trabeculectomy was effective in reducing IOP in patients with high myopia and glaucoma, without the additional risk of complications compared with a control group.

Swept-source optical coherence tomography detects anterior-chamber changes in patients with angle-closure after laser peripheral iridotomy / Tomografia de coerência óptica swept-source detecta alterações na câmara anterior em pacientes com fechamento angular após iridotomia

ABSTRACT Purpose: This study aimed to compare an teriorchamber parameters acquired by a swept-source anteriorsegment optical coherence tomography before and after laser peripheral iridotomy. Methods: This study prospectively evaluated 14 patients with primary-angle closure and six patients with primary-angle closure glaucoma. Gonioscopy and anterior-segment optical coherence tomography using the DRI OCT Triton® were performed before and after laser peripheral iridotomy. Anterior-segment optical coherence tomography parameters were studied using scleral spur as reference: angle opening distance at 250, 500, and 750 µm, trabecular-iris space at 500 µm, trabecular-iris angle, trabecular-iris contact length, and iris curvature. Results: Anterior-segment optical coherence tomography identified 61% of the patients with two or more quadrants closed. Gonioscopy identified more closed angles than anterior-segment optical coherence tomography before laser peripheral iridotomy. In angle parameters, only the angle opening distance of 250 µm at the nasal quadrant was not significantly increased after laser peripheral iridotomy. The iris curvature and trabecular-iris contact length showed a significant reduction induced by the laser procedure. Even in eyes in which gonioscopy did not identify angular widening after laser peripheral iridotomy (n=7), the angle opening distance of 750 µm increased (nasal, 0.15 ± 0.10 mm to 0.27 ± 0.16 mm, p=0.01; temporal, 0.14 ± 0.11 mm to 0.25 ± 0.12 mm, p=0.001) and the iris curvature decreased (nasal, 0.25 ± 0.04 mm vs. 0.11 ± 0.07 mm, p=0.02; temporal, 0.25 ± 0.07 mm vs. 0.14 ± 0.08 mm, p=0.007). Conclusions: Anterior-chamber changes induced by laser peripheral iridotomy could be quantitatively evaluated and documented by DRI OCT Triton®

RESUMO Objetivo: Comparar os parâmetros de câmara anterior obtidos através da tomografia de coerência óptica de segmento anterior antes e após a iridectomia periférica a laser. Métodos: Quatorze pacientes com fechamento angular primário e seis com glaucoma primário de ângulo fechado foram prospectivamente avaliados neste estudo. Gonioscopia e tomografia de coerência óptica de segmento anterior com DRI OCT Triton® foram realizadas antes e após a iridectomia periférica a laser. Os seguintes parâmetros de tomografia de coerência óptica de segmento anterior, baseados na localização do esporão escleral, foram avaliados: ângulo de abertura angular a 250 µm, 500 µm e 750 µm, área do espaço entre a íris e o trabeculado a 500 µm, ângulo entre a íris e o trabeculado, extensão do contato entre a íris e o trabeculado e curvatura da íris. Resultados: A tomografia de coerência óptica de segmento anterior identificou 61% dos indivíduos com dois ou mais quadrantes fechados. A gonioscopia identificou mais quadrantes com ângulo fechado do que tomografia de coerência óptica de segmento anterior antes da iridectomia periférica a laser. Quanto aos parâmetros angulares, apenas ângulo de abertura angular a 250 µm no quadrante nasal não aumentou significativamente após a iridectomia periférica a laser. A curvatura da íris e a extensão do contato entre a íris e o trabeculado apresentaram redução significativa induzida pelo procedimento a laser. Mesmo nos olhos em que a gonioscopia não identificou aumento da amplitude angular após iridectomia periférica a laser (n=7), ângulo de abertura angular a 750 µm aumentou (nasal: 0,15 ± 0,10 mm para 0,27 ± 0,16 mm, p=0,01; temporal: 0,14 ± 0,11 mm para 0,25 ± 0,12 mm, p=0,001), e ICURVE diminuiu (nasal: 0,25 ± 0,04 mm vs. 0,11 ± 0,07 mm, p=0,02; temporal: 0,25 ± 0,07 mm vs. 0,14 ± 0,08 mm, p=0,007). Conclusões: As alterações na câmara anterior induzidas pelo iridectomia periférica a laser puderam ser avaliadas quantitativamente e documentadas pelo DRI OCT Triton®.

Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure.

Aim: To compare the usefulness of gonioscopy performed by general ophthalmologists (GO) and anterior segment optical coherence tomography (AS-OCT) in detecting angle closure in patients with a shallow anterior chamber. Methods: Forty-four patients with a shallow anterior chamber (defined by a ratio of peripheral anterior chamber depth to peripheral corneal thickness lower than 1/2) were included in this cross-sectional study. Gonioscopy was performed in all subjects by two glaucoma experts (GE1 and GE2) and one GO. Anterior segment imaging was performed using Visante® OCT (Carl Zeiss Meditec Inc.). Agreement between examiners was assessed with first-order agreement coefficients (AC1). Diagnostic accuracies of GO gonioscopy and AS-OCT were evaluated using sensitivity, specificity, and area under the receiver operating characteristic (AROC) curves. Results: For static gonioscopy, the agreement between GE1 and GE2 was substantial (AC1 = 0.65), and that between GE1 and GO was moderate (AC1 = 0.50). For indentation gonioscopy, the agreement between GE1 and GE2 was slightly lower (AC1 = 0.55); however, the agreement between GE1 and GO showed a larger reduction (AC1 = 0.12). GO's gonioscopy presented a low specificity (25%) and the AROC to angle closure detection was lower than AS-OCT (0.56-0.73). Combined information of GO gonioscopy and AS-OCT improved specificity (85.7%) and AROC (0.77) of angle closure evaluation. Conclusion: Agreement between GO and glaucoma experts was moderate for static gonioscopy and slight for indentation gonioscopy. AS-OCT performed better than GO gonioscopy in detecting angle closure in patients with a shallow anterior chamber. The addition of AS-OCT to clinical information in patients with GO positive gonioscopy improved the specificity and AROC of gonioscopy test. How to cite this article: Esporcatte BLB, Vessani RM, Melo Jr LAS, et al. Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure. J Curr Glaucoma Pract 2022;16(1):53-58.

Structural Changes in the Optic Disc and Macula Detected by Swept-Source Optical Coherence Tomography After Surgical Intraocular Pressure Reduction in Patients with Open-Angle Glaucoma.

PURPOSE: To evaluate the magnitude of change in optic disc, peripapillary retinal nerve fiber layer (RNFL) and macular parameters measured by swept-source optical coherence tomography (SS-OCT) in glaucomatous eyes after filtration surgery, and to determine any possible relationship between these measurements and baseline factors. PATIENTS AND METHODS: This multicenter, prospective, consecutive observational study included patients with open-angle glaucoma who required glaucoma filtering surgery (surgical group, 29 eyes) and those with stable disease (control group, 25 eyes). Patients from the surgical group underwent measurement of optic disc, peripapillary retinal nerve fiber layer (RNFL) and macular parameters before and after surgery. RESULTS: In the surgical group, there was a significant increase in rim area and a significant decrease in the linear cup/disc ratio, vertical cup/disc ratio and cup volume 1 and 2 months postoperatively (p< 0.05). No significant change in the mean RNFL thickness and also sectorial measurements were observed from baseline to 1 and 2 months after surgery (p>0.05). Furthermore, significant increases in macular parameters were observed until 2 months after surgery (p<0.05). No significant changes were observed for all SS-OCT measurements in the control group. There was a significant correlation between the magnitude of the structural measurements change and the IOP reduction for two topographic parameters (rim area and linear cup-disc ratio) and macular average thickness 1 month and 2 months postoperatively. CONCLUSION: In open-angle glaucoma patients submitted to surgical IOP reductions, improvements in topographic and macular OCT parameters measured by SS-OCT were observed for at least 2 months.

Using Enhanced Depth Imaging Optical Coherence Tomography-Derived Parameters to Discriminate between Eyes with and without Glaucoma: A Cross-Sectional Comparative Study.

INTRODUCTION: New technologies have been developed in order to decrease interpersonal influence and subjectivity during the glaucoma diagnosis process. Enhanced depth imaging spectral-domain OCT (EDI OCT) has turned up as a favorable tool for deep optic nerve head (ONH) structures assessment. OBJECTIVE: A prospective cross-sectional study was conducted to compare the diagnostic performance of different EDI OCT-derived parameters to discriminate between eyes with and without glaucoma. MATERIAL AND METHODS: The following ONH parameters were measured: lamina cribrosa (LC) thickness and area; prelaminar neural tissue (PLNT) thickness and area; average Bruch's membrane opening - minimum rim width (BMO-MRW), superior BMO-MRW, and inferior BMO-MRW. Peripapillary retinal nerve fiber layer (pRNFL) thickness was also obtained. RESULTS: Seventy-three participants were included. There were no significant differences between AUCs for average BMO-MRW (0.995), PLNT area (0.968), and average pRNFL thickness (0.975; p ≥ 0.089). However, AUCs for each of these 3 parameters were significantly larger than LC area AUC (0.701; p ≤ 0.001). Sensitivities at 80% specificity were: PLNT area = 92.3%, average BMO-MRW = 97.4%, and average pRNFL thickness = 94.9%. CONCLUSIONS: Comparing the diagnostic performance of different EDI OCT ONH parameters to discriminate between eyes with and without glaucoma, we found better results for neural tissue-based indexes (BMO-MRW and PLNT area) compared to laminar parameters. In this specific population, these neural tissue-based parameters (including PLNT area, which was investigated by the first time in the present study) had a diagnostic performance comparable to that of the conventional pRNFL thickness protocol.

Structure-function relationships in glaucoma using enhanced depth imaging optical coherence tomography-derived parameters: a cross-sectional observational study.

BACKGROUND: To investigate structural and functional correlations in glaucoma patients using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT)-derived parameters. METHODS: We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (SITA - Standard 24-2; Carl Zeiss Meditec, Dublin, CA) and EDI OCT imaging (Spectralis; Heidelberg Engineering Co., Heidelberg, Germany). The following optic nerve head parameters were measured on serial vertical EDI OCT B-scans by two experienced examiners masked to patients clinical data: lamina cribrosa (LC) thickness and area, prelaminar neural tissue thickness and area, anterior LC depth, Bruch's membrane opening (BMO) and average, superior, and inferior BMO-minimum rim width (BMO-MRW). Only good quality images were considered, and whenever both eyes were eligible, one was randomly selected for analysis. Scatter plots were constructed to investigate correlations between each anatomic parameter and patient's VF status (based on VF index [VFI] values). RESULTS: A total of 73 eyes of 73 patients were included. All EDI OCT parameters evaluated differed significantly between glaucomatous and control eyes (P ≤ 0.045). A secondary analysis, in which glaucomatous patients were divided according to VF mean deviation index values into 3 groups (mild [G1; > - 6 dB], moderate [G2; - 6 to - 12 dB] and advanced [G3; <- 12 dB] glaucoma), revealed that average BMO-MRW was the EDI OCT parameter that presented more significant differences between the different stages of glaucoma. Significant structure-function correlations were found between VFI values and prelaminar neural tissue area (R2 = 0.20, P = 0.017), average BMO-MRW (R2 = 0.35, P ≤ 0.001), superior BMO-MRW (R2 = 0.21, P = 0.012), and inferior BMO-MRW (R2 = 0.27, P = 0.002). No significant correlations were found for LC area and anterior LC depth (P ≥ 0.452). CONCLUSIONS: Evaluating the distribution pattern and structure-function correlations of different laminar and prelaminar EDI OCT-derived parameters in glaucomatous patients, we found better results for neural tissue-based indexes (compared to LC-derived parameters). The diagnostic utility of each parameter deserves further investigations.

Exfoliation syndrome associated with LOXL1 gene polymorphisms in a Black patient from Latin America: a case report / Síndrome de esfoliação associada a polimorfismos do gene LOXL1 em paciente negro da América Latina: relato de caso

ABSTRACT A 89-year-old Black female with a 6-year history of advanced open-angle glaucoma was referred to the Glaucoma Service of the Ophthalmology Department - Federal University of São Paulo (UNIFESP). Best-corrected visual acuity was 20/400 in the right eye and 20/60 in the left eye. Pseudoexfoliation material was observed at the iris border, angle, and the anterior lens surface. Anterior biomicroscopy revealed exfoliation material forming an evident peripheral zone and a central disc separated by a clear intermediate zone on the anterior lens surface OU. Gonioscopy showed an open-angle Sampaolesis's line and whitish material deposits OU. Fundus examination revealed a cup-to-disc ratio of 1.0 OU with peripapillary atrophy. Genetic analysis for single nucleo­tide polymorphisms of the lysyl oxidase-like 1 gene linked to exfoliation syndrome identified two such single nucleotide polymorphisms, rs1048661 and rs216524.

RESUMO Uma mulher negra de 89 anos com um histórico de seis anos de glaucoma avançado de ângulo aberto avançado foi encaminhada ao Serviço de Glaucoma do Departamento de Oftalmologia da Universidade Federal de São Paulo (UNIFESP). A acuidade visual melhor corrigida era 20/400 no olho direito e 20/60 no olho esquerdo. Material pseudo-exfoliativo foi observado na borda iriana, ângulo e superfície anterior do cristalino. A biomicroscopia de segmento anterior demonstrou material exfoliativo formando uma zona periférica evidente e um disco central separado por uma zona intermediária livre na cápsula anterior do cristalino. A gonioscopia mostrou uma linha de Sampaolesi de ângulo aberto e depósitos esbranquiçados. O exame de fundo de olho revelou disco óptico com escavação total em ambos os olhos com atrofia peripapilar. A análise genética para polimorfismos de nucleotídeo único do gene semelhante à lysyl oxidase-like 1 ligado à síndrome de esfoliação identificou dois desses polimorfismos de nucleotídeo único, rs1048661 e rs216524.

Exfoliation syndrome associated with LOXL1 gene polymorphisms in a Black patient from Latin America: a case report.

A 89-year-old Black female with a 6-year history of advanced open-angle glaucoma was referred to the Glaucoma Service of the Ophthalmology Department - Federal University of São Paulo (UNIFESP). Best-corrected visual acuity was 20/400 in the right eye and 20/60 in the left eye. Pseudoexfoliation material was observed at the iris border, angle, and the anterior lens surface. Anterior biomicroscopy revealed exfoliation material forming an evident peripheral zone and a central disc separated by a clear intermediate zone on the anterior lens surface OU. Gonioscopy showed an open-angle Sampaolesis's line and whitish material deposits OU. Fundus examination revealed a cup-to-disc ratio of 1.0 OU with peripapillary atrophy. Genetic analysis for single nucleo-tide polymorphisms of the lysyl oxidase-like 1 gene linked to exfoliation syndrome identified two such single nucleotide polymorphisms, rs1048661 and rs216524.

In vivo analysis of glaucoma-related features within the optic nerve head using enhanced depth imaging optical coherence tomography.

Structural differences between optic nerve head (ONH) parameters in glaucomatous and non-glaucomatous eyes has been documented, however the association between such parameters in patients with different disease stages is yet to be elucidated. We investigated the relationship between different laminar and prelaminar ONH structures using enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT) in a population with and without glaucoma. In this observational case-control study, we prospectively enrolled healthy individuals and glaucomatous patients with different disease stages. All participants underwent EDI OCT imaging (Heidelberg Engineering). Following ONH parameters were measured on serial vertical B-scans by two examiners masked to patient's clinical data: lamina cribrosa (LC) and prelaminar neural tissue (PLNT) thicknesses, Bruch's membrane opening (BMO) and cup depth. Associations between cup depth, and laminar and prelaminar parameters were evaluated controlling for possible confounding factors such as axial length and disc size. Sixty-four eyes of 64 patients were included (30 with glaucoma and 34 controls). Eyes with glaucoma had significantly lower mean LC and PLNT thickness, and greater mean cup depth than controls (p<0.01). There was a significant negative association between PLNT thickness and cup depth in glaucomatous eyes (R2 = 0.158, p = 0.029). In addition, LC thickness correlated significantly with cup depth (R2 = 0.135, p = 0.045). Eyes with thinner LCs presented deeper cups. Overall, cup depth and BMO had the best and LC thickness had the worst intraobserver and interobserver reproducibility grading. In conclusion, significant associations were seen between cup depth, LC and PLNT thickness. Eyes with deeper cups not only had less neural tissue, but also thinner LCs, independent of disc size and axial length. Best reproducibility was found for prelaminar parameters compared to deeper ONH structures.

Comparison of the Intraocular Pressure Variation Provoked by Postural Change and by the Water Drinking Test in Primary Open-angle Glaucoma and Normal Patients.

PURPOSE: To evaluate the intraocular pressure (IOP) peak and variability detected by moving the body from sitting to supine position (postural test) and by the water drinking test (WDT) in normal and primary open-angle glaucoma (POAG) subjects. PATIENTS AND METHODS: Prospective, cross-sectional observational analysis of 14 eyes of 14 normal subjects and 31 eyes of 31 patients with POAG. All POAG subjects were under clinical therapy. IOP measurements were all performed on the same day. RESULTS: When the subjects moved to the supine position, there was an IOP increase of 1.36±1.34 and 2.84±2.21 mm Hg in the normal and POAG groups, respectively (P=0.011). During the WDT, mean IOP peak and fluctuation in the POAG group was 19.29±4.10 and 4.13±2.33 mm Hg, respectively. These levels were significantly higher in comparison with the normal group (16.50±3.76 and 2.71±0.99 mm Hg; P=0.018 and 0.022, respectively). The mean peak IOP observed in the WDT was significantly higher than the IOP in the supine position (19.29±4.10 vs. 17.32±4.66 mm Hg, P=0.013). The mean IOP increase during the WDT was also significantly higher when compared with the postural test (4.13±2.33 vs. 2.84±2.21 mm Hg, P=0.019). CONCLUSIONS: POAG eyes demonstrated a significant IOP increase when assuming the supine position and during the WDT. The IOP increase during the WDT was significantly higher than the IOP increase after postural test. Hence, the results of both tests are not interchangeable.

Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy.

OBJECTIVE: To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM-FC) in patients not achieving the target IOP of ≤18 mmHg while on timolol 0.5% (TIM) monotherapy. METHODS: A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19-35 mmHg in ≥1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM-FC was initiated and administered once daily at 8 pm for 4-6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance). RESULTS: A total of 49 patients were enrolled (mean age, 63 [range, 42-82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM-FC was 31 days. Mean ± standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM-FC) was -5.0±3.6 mmHg. IOP decreased significantly (P<0.0001) from baseline (22.1±2.6 mmHg) to study end (17.1±3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP ≤18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs. CONCLUSIONS: TRAV/TIM-FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP ≤18 mmHg with TRAV/TIM-FC. TRAV/TIM-FC was well tolerated in this population.

Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysis.

PURPOSE: To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. METHODS: Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. RESULTS: A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45-75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. CONCLUSION: In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS.

Staging glaucoma patient: why and how?

Staging glaucomatous damage into appropriatecategories enhances management of the disease. Automated static perimetry is the benchmark for testing visual function in glaucoma. Numerous examples of standard automated perimetry staging systems have been proposed but difficulties such as lack of accuracy, absence of information related to location and depth of the defect(s) and need of time-consuming analysis of every visual field test result may reduce their day-to-day clinical usefulness.A new visual field staging system is proposed: the University of São Paulo Glaucoma Visual Field Staging System (USP-GVFSS). In this system, qualitative and quantitative characteristics of the visual field defect are described. The method is intuitive, comprehensible and describes severity, extension and hemi field involvement.

Comparison of quantitative imaging devices and subjective optic nerve head assessment by general ophthalmologists to differentiate normal from glaucomatous eyes.

PURPOSE: To compare the ability of subjective assessment of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) by general ophthalmologists and by a glaucoma expert with objective measurements by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Inc), confocal scanning laser ophthalmoscope (HRT III; Heidelberg Engineering, Heidelberg, Germany), and scanning laser polarimetry (GDx enhanced corneal compensation; Carl Zeiss Meditec Inc, Dublin, CA) in discriminating glaucomatous and normal eyes. METHODS: Sixty-one glaucomatous and 57 normal eyes of 118 subjects were included in the study. Three independent general ophthalmologists and 1 glaucoma expert evaluated ONH stereophotographs. Receiver operating characteristic curves were constructed for each imaging technique and sensitivity at fixed specificity was estimated. Comparisons of areas under these curves (aROCs) and agreement (k) were determined between stereophoto grading and best parameter from each technique. RESULTS: Best parameter from each technique showed larger aROC (Stratus OCT RNFL=0.92; Stratus OCT ONH vertical integrated area=0.86; Stratus OCT macular thickness=0.82; GDx enhanced corneal compensation=0.91; HRT3 global cup-to-disc area ratio=0.83; HRT3 glaucoma probability score numeric score=0.83) compared with stereophotograph grading by general ophthalmologists (0.80) in separating glaucomatous and normal eyes. Glaucoma expert stereophoto grading provided equal or larger aROC (0.92) than best parameter of each computerized imaging device. Stereophoto evaluated by a glaucoma expert showed better agreement with best parameter of each quantitative imaging technique in classifying eyes either as glaucomatous or normal compared with stereophoto grading by general ophthalmologists. The combination of subjective assessment of the optic disc by general ophthalmologists with RNFL objective parameters improved identification of glaucoma patients in a larger proportion than the combination of these objective parameters with subjective assessment of the optic disc by a glaucoma expert (29.5% vs. 19.7%, respectively). CONCLUSIONS: Diagnostic ability of all imaging techniques showed better performance than subjective assessment of the ONH by general ophthalmologists, but not by a glaucoma expert. Objective RNFL measurements may provide improvement in glaucoma detection when combined with subjective assessment of the optic disc by general ophthalmologists or by a glaucoma expert.

The effect of prostaglandin analogs and prostamide on central corneal thickness.

OBJECTIVE: The aim of this study was to verify the influence of prostaglandin analogs and prostamide on central corneal thickness (CCT). METHODS: A prospective analysis was done of CCT in glautomatous patients submitted to monotherapy with prostaglandin analogs (latanoprost 0.005% or travoprost 0.004%) or prostamide (bimatoprost 0.03%) during an 8-week period. A control group of patients without any ocular medication was also evaluated. CCT measurements were performed with a commercially available ultrasound pachymeter. A total of 73 patients were included in this study. Mean age was 68.5 +/- 9.2 (range, 48-85) years old. RESULTS: A statistically significant reduction in CCT was observed in all groups, except the control group (n = 21): Bimatoprost 0.03% group (n = 21): 544.41 +/- 35.4 vs. 540.35 +/- 35.9 microm (P = 0.039); travoprost 0.004% group (n = 17): 538.47 +/- 32.0 vs. 532.25 +/- 30.4 microm (P = 0.009); latanoprost 0.005% group (n = 14): 548.57 +/- 32.4 vs. 543.88 +/- 35.6 microm (P = 0.036). CONCLUSION: Topical therapy with prostaglandin analogs and bimatoprost is associated with CCT reduction over a period of at least 8 weeks.

Intraocular pressure profile during the modified diurnal tension curve using Goldman applanation tonometry and dynamic contour tonometry.

The aim of this study was to compare the intraocular pressure (IOP) profile during the modified diurnal tension curve (mDTC) using Goldman applanation tonometry (GAT) and dynamic contour tonometry (DCT) in treated glaucomatous eyes. Eligible subjects were submitted to the mDTC using GAT and DCT in this sequence. IOP measurements were performed at 8 a.m., 10 a.m., 2 p.m., and 4 p.m.. Central corneal thickness was measured using ultrasound pachymetry in the morning. Statistical analysis was performed using paired Student's t test and Bland-Altman plot. The mean difference between DCT and GAT measurements was 0.9 mmHg. The mean +/- SD IOP measurements during the mDTC were 19.68 +/- 4.68, 17.63 +/- 4.44, 17.25 +/- 5.41, and 17.32 +/- 4.25 mmHg using GAT and 19.97 +/- 4.75, 18.79 +/- 4.61, 19.53 +/- 5.30, and 19.43 +/- 5.45 mmHg using DCT. IOP measurements were higher in the morning (8 a.m.) and decreased throughout the day using both tonometers. The difference between IOP measurements using GAT and DCT was smaller in the morning and increased throughout the day. The IOP variability using GAT was higher than using DCT. Corneal biomechanical properties might help explain our findings.

[Localized neural loss detected by macular thickness reduction using optical coherence tomography: case report]. / Detecção de perda neural localizada através da redução da espessura macular na tomografia de coerência óptica: relato de caso.

A 22-year-old man developed a central scotoma in the left eye during an episode of severe headache 6 months previously. He had a diagnosis of migraine headaches with aura since age 15. Ophthalmic examination showed retinal nerve fiber layer thickness reduction on the papilomacular bundle in the left eye and unremarkable in the right. Optical coherence tomography documented severe macular thickness reduction and a mild and localized retinal nerve fiber layer loss on the temporal side of the optic disc in the left eye. Systemic investigation, neuroimaging and cardiovascular studies were non-revealing. The cause of his visual loss was possibly related to retinal migraine, although an ischemic episode of another origin could not be excluded. Our case is interesting because it draws attention to the fact that optical coherence tomography may be able to identify localized neural loss not only by measuring peripapillary retinal nerve fiber layer but also by means of macular thickness measurements.

Detecção de perda neural localizada através da redução da espessura macular na tomografia de coerência óptica: relato de caso / Localized neural loss detected by macular thickness reduction using optical coherence tomography: case report

Paciente de 22 anos, sexo masculino, notou mancha central no olho esquerdo durante um episódio da cefaléia de forte intensidade há aproximadamente 6 meses. Referia diagnóstico de enxaqueca com aura, apresentando crises recorrentes desde os 15 anos de idade. O exame oftalmológico revelou perda da camada de fibras nervosas da retina na região do feixe papilomacular do olho esquerdo. A tomografia de coerência óptica demonstrou importante redução da espessura macular, acompanhada de redução localizada da camada de fibras nervosas da retina no setor temporal do disco óptico no olho esquerdo. Avaliação sistêmica, exames de imagem e avaliação cardiovascular nada revelaram e a causa da perda da perda visual foi atribuída a possível enxaqueca retiniana, embora um evento isquêmico de outra natureza não pudesse ser descartado. Nosso caso é interessante porque demonstra que a tomografia de coerência óptica pode ser útil na detecção de perda neural localizada não apenas pela medida da camada de fibras nervosas da retina, mas também pela avaliação da espessura macular.

A 22-year-old man developed a central scotoma in the left eye during an episode of severe headache 6 months previously. He had a diagnosis of migraine headaches with aura since age 15. Ophthalmic examination showed retinal nerve fiber layer thickness reduction on the papilomacular bundle in the left eye and unremarkable in the right. Optical coherence tomography documented severe macular thickness reduction and a mild and localized retinal nerve fiber layer loss on the temporal side of the optic disc in the left eye. Systemic investigation, neuroimaging and cardiovascular studies were non-revealing. The cause of his visual loss was possibly related to retinal migraine, although an ischemic episode of another origin could not be excluded. Our case is interesting because it draws attention to the fact that optical coherence tomography may be able to identify localized neural loss not only by measuring peripapillary retinal nerve fiber layer but also by means of macular thickness measurements.

Comparison of retinal nerve fiber layer measurements using Stratus OCT fast and regular scan protocols in eyes with band atrophy of the optic nerve and normal controls.

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements made with two different protocols of optical coherence tomography in eyes with band atrophy (BA) of the optic nerve and controls. METHODS: Twenty-nine eyes with BA from chiasmal compression and 30 normal eyes underwent RNFL scans using both the fast (256 A-scans) and the regular (512 A-scans) protocols. The two sets of measurements were compared. RESULTS: In eyes with BA, fast RNFL measurements were significantly greater compared with regular RNFL measurements in the superior and inferior quadrants and significantly smaller at the 30-degree segments located at the 3 and 6 o'clock meridians. In normal eyes, fast RNFL measurements of the total average, superior and inferior quadrants and the segments corresponding to the 1, 3, 4 and 12 o'clock meridians were significantly greater than regular protocol measurements. Measurements with both protocols were significantly different in eyes with BA compared to normal eyes. CONCLUSIONS: Although both fast and regular RNFL measurements were equally efficient at differentiating eyes with BA from controls the fast protocol yielded greater values in areas with thick RNFL and smaller values in areas with thin RNFL when compared with the regular scanning protocol. One should be aware of such differences when comparing measurements with both scanning protocols.