Association of intraocular pressure-related factors and retinal vessel diameter with optic disc rim area in subjects with and without primary open angle glaucoma.

IMPORTANCE: The data may support the notion that the intra-ocular pressure (IOP)-related factors and vascular factors were implicated concurrently in glaucomatous optic nerve damage. BACKGROUND: To study the association of intraocular pressure (IOP)-related factors, IOP, trans-lamina cribrosa pressure difference (TLCPD), cerebrospinal fluid pressure (CSFP) and retinal vessel diameters (RVD), central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) with neuro-retinal rim area (RA). DESIGN: A population-based, cross-sectional study. PARTICIPANTS: A total of 6830 people aged 30 years and over. METHODS: All participants underwent a comprehensive eye examination, fundus photograph-based measurements of RVD and Heidelberg retinal tomogram (HRT) measurement of optic disc. MAIN OUTCOME MEASURES: RA, CRAE, CRVE, IOP, body mass index (BMI), CSFP and TLCPD. RESULTS: Primary open-angle glaucoma (POAG) was diagnosed using two separate methods: 67 from expert consensus, and 125 from the International Society of Geographical and Epidemiologic Ophthalmology (ISGEO) classification. After excluding of those with high myopia or without gradable HRT images, 4194 non-glaucoma and 40 POAG were analysed for determinants of RA. On multivariable analysis determinants of reduced RA were POAG (P < 0.001), higher IOP (P = 0.03), higher refractive error (P < 0.01), longer axial length (P = 0.01), CRVE (P < 0.001), lower BMI (P = 0.015), older age (P < 0.001) smaller disc area (P < 0.001) and higher TLCPD (P = 0.03). When age and/or BMI were omitted from the model, reduced RA was also associated with lower CSFP (P < 0.001). CONCLUSIONS AND RELEVANCE: Reduced RA is associated with narrow CRVE and higher IOP or lower CSFP. The data supports the concurrent role of IOP-related and vascular factors in glaucomatous optic nerve damage.

Age-related changes in and determinants of macular ganglion cell-inner plexiform layer thickness in normal Chinese adults.

IMPORTANCE: Consideration of age-related changes in macular ganglion cell-inner plexiform layer (mGCIPL) thickness are important for glaucoma progression analysis. BACKGROUND: To report age-related changes in and the determinants of high-definition optical coherence tomography (HD-OCT) measurements of mGCIPL thickness. DESIGN: Cross-sectional study. PARTICIPANTS: 326 healthy adults. METHODS: All subjects underwent Cirrus HD-OCT measurements of mGCIPL. One-way analysis of variance (ANOVA) was used to compare mGCIPL thickness between 7 decades based age groups and macular sectors. Multiple regression analysis determined the association between mGCIPL thickness and age, gender, intraocular pressure (IOP), peripapillary retinal nerve fibre layer thickness (pRNFL) and spherical equivalent. MAIN OUTCOME MEASURES: Change in mGCIPL thickness and determinants of thickness. RESULTS: Mean mGCIPL thickness in 295 subjects was 80.80 ± 6.42 µm. Mean mGCIPL decreased by 0.12 µm (95% CI [confidence interval], 0.09-0.16) with every year of age; 1.61 µm (95% CI, 0.08-2.41) per decade. It showed two steep declines with age, first in the fifth and next in the seventh decade with relative stability between them. mGCIPL thickness was associated with pRNFL thickness (ß = 0.30, P < 0.001) and IOP (ß = -0.19, P = 0.03) but not with gender (ß = -1.09, P = 0.116) or spherical equivalent (ß = -0. 24, P = 0.145). CONCLUSIONS AND RELEVANCE: Mean mGCIPL thickness showed a small age-related linear decrease with two steep drops in the fifth and seventh decades. Thinner mGCIPL was independently associated with age, thinner pRNFL and higher IOP. These factors should be considered if using mGCIPL to detect progression of glaucoma and other optic neuropathies characterized by the loss of retinal ganglion cells.

Reproducibility of anterior chamber angle measurement using the Tongren ultrasound biomicroscopy analysis system.

PURPOSE: To assess the intraobserver and interobserver variability of new software for the analysis of anterior chamber-angle images obtained using ultrasound biomicroscopy (UBM). PATIENTS AND METHODS: Consecutive UBM images of 4 quadrants (the superior, the nasal, the temporal, and the inferior) of 30 primary angle-closure suspects (PACSs) and 30 normal subjects with open angles were selected. Two observers used the new UBM image analysis software to calculate the following parameters on 2 separate occasions: angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), and iris thickness (IT). Intraobserver and interobserver reproducibility were measured using intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: For intraobserver measurements in PACS, the range of ICC for AODs, TIAs, ARAs, TCPDs, ICPDs, and ITs in the 4 quadrants were 0.77 to 0.94, 0.80 to 0.92, 0.82 to 0.94, 0.51 to 0.73, 0.42 to 0.78, and 0.76 to 0.89; in open angles, these were 0.83 to 0.94, 0.80 to 0.93, 0.84 to 0.93, 0.57 to 0.89, 0.57 to 0.84, and 0.70 to 0.95. For interobserver measurements in PACS, the range of ICC for AODs, TIAs, ARAs, TCPDs, ICPDs, and ITs in the same quadrants as above were 0.52 to 0.89, 0.65 to 0.92, 0.68 to 0.92, 0.22 to 0.80, 0.48 to 0.93, and 0.29 to 0.75; in open angles, these were 0.57 to 0.87, 0.60 to 0.86, 0.64 to 0.90, 0.27 to 0.94, 0.56 to 0.93, and 0.28 to 0.66. CONCLUSIONS: Angle width (AOD, TIA, and ARA) and IT of both PACS and open angles could be reliably measured by the same observer; interobserver measurements and those related to the ciliary process (TCPD and ICPD) were more variable. For the current version of this software, we recommend measurements of anterior chamber parameters by the same observer.

Early efficacy and complications of releasable sutures for trabeculectomy in primary angle-closure glaucoma: a randomized clinical trial.

PURPOSE: To compare the postoperative intraocular pressure (IOP) and incidence of early complications after trabeculectomy with releasable suture to standard trabeculectomy in Chinese patients with primary angle-closure glaucoma. PATIENTS AND METHODS: One hundred seventy-five patients diagnosed as primary angle-closure glaucoma with 6 clock-hours or more of peripheral anterior synechia were randomly allocated to 2 treatment groups: 87 underwent standard trabeculectomy (S group: 2 interrupted permanent sutures to the scleral flap) and 88 received trabeculectomy with 2 permanent and 2 releasable sutures (R group). The postoperative IOP and complications during the first 3 months after surgery were compared. RESULTS: One hundred seventy-one patients (97.7%) attended the 3-month visit. The IOP in the first week after trabeculectomy was significantly higher in the R group: day 1, 17.3±8.6 versus 12.7±6.0 mm Hg (P<0.001); day 3, 18.0±7.3 versus 12.9±6.3 mm Hg (P<0.001); day 7, 14.8±6.3 versus 12.0±4.9 mm Hg (P=0.001), but no difference was observed after the second week (P=0.659 to 0.753). The incidence of transient hypotony was higher in S group (20.4%) than the R group (9.1%) (P=0.046); hypotony recovered in 80.8% (21/26) within 1 week. There was no difference in the occurrence of shallow chamber, choroidal detachment, macular edema, additional surgery, or hyphema (P=0.56 to 1.0). CONCLUSIONS: The technique of releasable sutures for trabeculectomy used in this study did not demonstrate significant advantages over standard trabeculectomy. Releasable sutures were associated with some decrease in visual acuity and increase in postoperative complaints.