Diagnostic value of three-dimensional neuroretinal rim thickness for differentiation of superior segmental optic nerve hypoplasia.

Little is known about the diagnostic utility of three-dimensional neuroretinal rim thickness (3D-NRRT) for differentiating patients with superior segmental optic nerve hypoplasia (SSOH) from normal-tension glaucoma (NTG). Since SSOH is defined by characteristic optic nerve head features, investigation of diagnostic usefulness of 3D-NRRT is necessary. In this cross-sectional study, 49 SSOH eyes, 52 NTG eyes, and 41 normal eyes were enrolled. Retinal nerve fiber layer thickness (RNFLT) and 3D-NRRT values, as obtained in the right-eye orientation by optical coherence tomography (OCT), were recorded. On RNFLT clock-hour comparison, the 11-3 clock-hour sectors were significantly thinner for SSOH than for NTG (all P < 0.01). As for 3D-NRRT, whereas the 1 and 2 sectors were significantly thinner for SSOH (P < 0.001, P = 0.004), the 6-11 sectors were significantly thinner for NTG (all P < 0.01). The area under receiver operating characteristic (AUROC) curves of the superior and nasal quadrants of RNFLT (0.838, 0.729) were significantly greater than those of 3D-NRRT (0.518, 0.588; P < 0.001, P = 0.043). However, the AUROCs of the inferior and temporal quadrants were significantly greater for 3D-NRRT (0.728, 0.760) than for RNFLT (0.527, 0.550; P = 0.008, P = 0.019). The appropriate use of 3D-NRRT can be useful in differentiating SSOH from NTG.

Relative Risks for Dementia among Individuals with Glaucoma: A Meta-Analysis of Observational Cohort Studies.

PURPOSE: To investigate the relative risks (RRs) for dementia among individuals with glaucoma. METHODS: We conducted a search of PubMed, Web of Science, Scopus, and Cochrane databases for observational cohort studies examining the association between glaucoma and dementia until March 2023. Two authors independently screened all titles and abstracts according to predefined inclusion and exclusion criteria. Pooled RR and 95% confidence intervals (CIs) were generated using random-effect models. RESULTS: The meta-analysis included 18 cohort studies conducted in eight countries and involving 4,975,325 individuals. The pooled RR for the association between glaucoma and all-cause dementia was 1.314 (95% CI, 1.099-1.572; I2 = 95%). The pooled RRs for the associations of open-angle glaucoma with Alzheimer dementia and Parkinson disease were 1.287 (95% CI, 1.007-1.646; I2 = 96%) and 1.233 (95% CI, 0.677-2.243; I2 = 73%), respectively. The pooled RRs for the associations of angle-closure glaucoma with all-cause dementia and Alzheimer dementia were 0.978 (95% CI, 0.750-1.277; I2 = 17%) and 0.838 (95% CI, 0.421-1.669; I2 = 16%), respectively. No evidence of publication bias was detected in the Begg-Mazumdar adjusted rank correlation test (p = 0.47). CONCLUSIONS: Based on current observational cohort studies, there is evidence supporting that glaucoma is a risk factor for dementia in the adult population.

Natural History of Optic Disc With Physiologic Large Cup: Incidence, Predictors of Glaucoma Conversion After Minimum 10-Year Follow-up.

PURPOSE: To investigate the natural history of optic disc with physiologic large cup (PLC) (ie, vertical cup/disc ratio [VCDR] ≥0.6 without retinal nerve fiber layer defect) and the risk factors for glaucoma conversion. DESIGN: Observational retrospective cohort study. METHODS: Subjects who underwent a health screening examination at Seoul National University Hospital Healthcare System Gangnam Center from 2003 to 2010 (n = 76,030) were involved. The prevalence of PLC in the cohort was analyzed. The incidence rate of glaucoma conversion was estimated per 100 person-years among cases with a follow-up period longer than 10 years. Multivariate Cox proportional hazards regression was used to identify ocular and systemic factors associated with glaucoma conversion. RESULTS: Among 74,617 eligible subjects, 3569 subjects (4.8%) had PLC. Of those with a follow-up period longer than 10 years (n = 859), the incidence rate of glaucoma conversion was 0.95 per 100 person-years. A total of 12.1% of PLC eyes progressed to glaucoma after 8.7 ± 3.9 years (range, 2.0-16.5 years). Higher VCDR (adjusted hazard ratio [aHR] = 4.36; 95% CI = 2.675-7.103), violation of the inferior superior nasal temporal neuroretinal rim thickness rule (aHR = 1.86; 95% CI = 1.057-3.258), presence of retinal arterial sclerosis (aHR = 1.63; 95% CI = 1.040-2.550), and lower total bilirubin level (aHR = 0.58; 95% CI = 0.340-0.991) were associated with glaucoma development. CONCLUSION: This study identified the prevalence of PLC as well as the incidence rate of glaucoma conversion and the risk factors for glaucoma development in PLC eyes. The natural history of PLC may help clinicians to better understand its risk factors and the specific management needs of their patients.

Placebo Effect and Its Determinants in Ocular Hypotensive Therapy: Meta-analysis and Multiple Meta-regression Analysis.

TOPIC: The placebo effect and its potential determinants in ocular hypotensive therapy. CLINICAL RELEVANCE: The placebo effect has been studied and documented within a wide clinical context. It remains unclear whether placebo is effective in glaucoma treatment or, if so, which factors are determinative of effect size (ES). METHODS: Randomized controlled trials (RCTs) of topical ocular hypotensive therapy for patients with open-angle glaucoma or ocular hypertension, conducted through June 2, 2022, were included. First, a perceived placebo effect was measured as the overall intraocular pressure (IOP) change from the baseline. It was evaluated in terms of the ES (mean difference between the baseline and the end point) and then was compared with the ES, as obtained from the untreated control participant to obtain a true placebo effect. The primary outcome was ES based on 4 weeks of treatment. Meta-analysis-based statistical pooling was performed where appropriate, and 95% confidence intervals (CIs) were used for comparison. Potential placebo effect determinants were scrutinized using a multiple meta-regression model (PROSPERO identifier, CRD42022348098). RESULTS: A total of 40 RCTs (7829 eyes) with 33 placebo groups (2055 eyes) along with 7 untreated groups (1184 eyes) were included. Among placebo-controlled trials, placebo was determined to be effective in lowering IOP (ES, -1.30 mmHg; 95% CI, -1.75 to -0.84 mmHg). Using NMA, the ES for placebo was -2.27 mmHg (95% CI, -3.52 to -1.01 mmHg) greater than ES for untreated control participants.. According to the multiple meta-regression model, the active treatment ES was a significant factor to predict the amount of placebo effect. Placebo additionally lowered IOP by -0.45 mmHg per -1 mmHg of active treatment effect. Add-on study design and larger sample size also were associated with greater amount of placebo effect. No publication bias was evident in either a funnel plot or the Begg and Mazumdar adjusted rank correlation test results (P = 0.24). DISCUSSION: This meta-analysis indicated that placebo is effective in lowering IOP and is superior to the effect observed for the untreated control participants. However, caution is required in interpreting the results because of the small number of untreated controlled trials and potential bias from the lack of direct comparison between the placebo and untreated arms. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Clinical usefulness of layer-by-layer deviation maps of Spectralis OCT: comparison with Cirrus OCT.

BACKGROUND/AIMS: To compare the diagnostic abilities of Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Cirrus (Carl Zeiss Meditec, Dublin, California, USA) spectral domain-optical coherence tomography (OCT) for retinal nerve fibre layer (RNFL) defect detection among patients with preperimetric glaucoma (PPG) and early glaucoma (EG). METHODS: In this cross-sectional study, a total of 144 eyes (47 healthy, 43 PPG, 54 EG; MD≥-6 dB) of 144 participants underwent Spectralis and Cirrus OCT on the same day. The presence of RNFL defect on red-free RNFL photography and the respective deviation maps of Spectralis and Cirrus OCT was rated. Areas under the receiver operating characteristic curves (AUCs), sensitivities and specificities were analysed for each deviation layer to discriminate healthy eyes from PPG and EG eyes. RESULTS: The RNFL, ganglion cell layer (GCL) and retinal layers of Spectralis OCT and the RNFL and macular ganglion cell-inner plexiform layer of Cirrus OCT showed high diagnostic performance (all AUCs >0.8) in discriminating PPG and EG eyes from healthy eyes. Among them, RNFL layer of Cirrus OCT had the largest AUC (0.840 for PPG, 0.959 for EG) but showed no statistical differences from RNFL and retinal layers of Spectralis OCT. The inner plexiform layer (IPL) of Spectralis OCT had the smallest AUC (0.563 for PPG, 0.799 for EG). CONCLUSIONS: The Spectralis and Cirrus OCT deviation maps showed good diagnostic abilities except for the IPL layer of Spectralis. In the clinical setting, both Spectralis and Cirrus OCT can be useful for detection of RNFL defects in PPG and EG eyes.

Nationwide Incidence of Infantile Cataract Surgery and Risk of Secondary Glaucoma in a Population-based Birth Cohort.

PURPOSE: To determine the nationwide birth cohort incidence of infantile cataract (IC) surgery and the risk of secondary glaucoma in a Korean population. DESIGN: A population-based, retrospective cohort study. METHODS: We accessed the Korean National Health Claims database to identify patients with IC who were diagnosed before 1 year of age and who underwent IC surgery among all Koreans born between 2008 and 2018 (n = 9,593,003). We estimated IC surgery incidence in a birth cohort. The incidence rates of post-IC surgery glaucoma were estimated per 100 person-years, based on the Poisson distribution. The risk factors for post-IC surgery glaucoma, including ophthalmic and systemic comorbidities, were analyzed by multivariable logistic regression analysis. RESULTS: During the 11-year study period, 692 patients underwent IC surgery. The annual birth cohort incidence of IC surgery in the general population ranged from 5.10 to 9.29 cases per 100,000 individuals. Among patients who had been followed up for longer than 1 year (n = 650), 92 (14.2%) developed glaucoma, and its incidence rate was 2.29 (95% confidence interval, 1.86-2.80) per 100 person-years. The mean time from IC surgery to glaucoma development was 4.7 ± 3.5 years. No factors were identified as being associated with post-IC surgery glaucoma risk other than primary or secondary intraocular lens implantation, which reduces the risk (all P < .05). In patients without primary intraocular lens implantation, the risk of glaucoma increased steeply during the first 2 years after IC surgery. CONCLUSION: This study identified the birth cohort incidence of IC surgery and secondary glaucoma risk in individuals of East Asian ethnicity. These estimates may help to better understand the epidemiologic features and clinical courses of patients with IC.

Demographics Prediction and Heatmap Generation From OCT Images of Anterior Segment of the Eye: A Vision Transformer Model Study.

Purpose: To predict demographic characteristics from anterior segment optical coherence tomography (AS-OCT) images of eyes using a Vision Transformer (ViT) model. Methods: A total of 2970 AS-OCT images were used to train, validate, and test a ViT to predict age and sex, and 2616 images were used for height, weight, and body mass index (BMI). The main outcome measure was the area under the receiver operating characteristic curve (AUC) of the ViT. Results: The ViT achieved the largest AUC (0.910) for differentiating age ≤75 versus >75 years, followed by age ≤60 versus 60-75 versus >75 years (AUC, 0.844), and for discriminating sex (AUC, 0.665). The prediction abilities for the other demographic characteristics were lower: an AUC of 0.521 for classifying height ≤170 versus >170 cm in males and ≤155 versus >155 cm in females; 0.522 for weight <70 versus ≥70 kg in males and 0.503 for <55 versus ≥55 kg in females, and 0.517 for BMI <23 versus 23-25 versus ≥25 kg/m2. Heatmaps highlighted the area of the iridocorneal angle for its contribution to the prediction of age ≤75 versus >75 years. Conclusions: Although the ViT demonstrated a good ability to classify age from AS-OCT images, it performed poorly for sex, height, weight, and BMI. The heatmap obtained of the prediction will provide clues to understanding the age-related anterior segment changes in eyes. Translational Relevance: The ViT can determine age-related anterior segment structural changes using AS-OCT images, which will aid clinicians in the management of ocular diseases.

Nasal and temporal curvatures of lamina CRIBROSA in myopic eyes.

Little is known about the myopic characteristics of lamina cribrosa (LC) curvature. As such, we investigated nasal and temporal LC curvatures in myopia. In this retrospective, cross-sectional study, 144 myopic eyes (refraction < - 2D) and 88 non-myopic eyes (refraction > - 0.5D) underwent swept-source optical coherence tomography scanning of the LC. The anterior border of LC curvature was delineated with 17 points and interpolated with the "cardinal spline" curve-fitting method. The average curvature indices of the temporal and nasal sides were presented as the temporal and nasal curvatures. Myopic eyes had a mean refraction of - 6.7 ± 2.8D, while for non-myopic eyes, the value was 0.3 ± 1.0D. Nasal LC curvature was visible in 54 myopia (37.5%) and 42 non-myopia (47.7%) cases (P = 0.126), and temporal LC curvature was visible in 142 myopia (98.6%) and 68 non-myopia (77.3%) cases (P = 0.001). The nasal LC curvature was significantly larger in myopia than in non-myopia (P < 0.001). Contrastingly, the temporal LC curvature was significantly smaller in myopia than in non-myopia (P < 0.001). Axial length was associated with larger nasal LC curvature, smaller temporal LC curvature, and larger nasal-temporal LC curvature difference (all P's < 0.05). In myopic relative to non-myopic eyes, LC curvature was decreased temporally and increased nasally.

Macular sector-wise decision tree model for the prediction of parafoveal scotoma not detected by 24-2 visual field test.

BACKGROUND: Development of a macular sector-wise decision tree model (DTM) for the prediction of parafoveal scotoma. METHODS: This prospective study enrolled 126 patients with early-stage open-angle glaucoma (mean deviation ≥-6 decibels) without the signs of parafoveal scotoma on the 24-2 visual field (VF) test (i.e., any abnormalities at the four innermost points). Based on the central 36 points of the 10-2 pattern deviation plot, patients were classified as being with or without 10-2 parafoveal scotoma. For the discrimination of patients from those without 10-2 parafoveal scotoma, a macular ganglion cell-inner plexiform layer (mGCIPL) sector-wise DTM analysis was performed. RESULTS: Among 126 eyes without 24-2 parafoveal scotoma, 10-2 parafoveal scotoma was detected in 77 (61.1%) eyes. The balanced accuracy of DTM was best in the inferotemporal sector (0.9286; 95% CI, 0.7458-0.9697) and worst in the inferior sector (0.8373; 0.6484-0.9204). DTM revealed that even in the absence of VF abnormalities at the innermost 4 points on the 24-2 test, (1) 10-2 parafoveal scotoma should be strongly suspected when the adjacent 24-2 perifoveal point in the correlated sector is abnormal; (2) if the 24-2 perifoveal point is normal, and if the probability colour codes of the correlated mGCIPL sector are green, the probability of 10-2 parafoveal scotoma is very low. CONCLUSIONS: In clinical practice, the evaluation of the 24-2 perifoveal test points along with the probability colour codes of mGCIPL can be a useful decision-support tool in determining whether 10-2 tests are needed for a given patient.

Decision Tree Algorithm-Based Prediction of Vulnerability to Depressive and Anxiety Symptoms in Caregivers of Children With Glaucoma.

PURPOSE: Development and validation of a decision tree model (DTM) for prediction of mental health status in Korean caregivers of children with glaucoma. DESIGN: Cross-sectional study. METHODS: Caregivers of children younger than 18 years with diagnosed primary childhood glaucoma (n = 42), secondary childhood glaucoma (n = 51), and glaucoma suspect (GS; n = 36) were prospectively enrolled at Seoul National University Children's Hospital, Seoul, Korea. The participants completed 2 questionnaires, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7) Assessment. A DTM analysis for discrimination of those with moderate-to-severe depressive (PHQ-9 score ≥10) and anxiety (GAD-7 score ≥11) symptoms was performed with recursive partitioning algorithms based on the obtained clinical, demographic, and socioeconomic data. RESULTS: The mean PHQ-9 and GAD-7 scores did not significantly differ among the 3 groups (P = .823 for PHQ-9 score; P = .730 for GAD-7 score). The DTM's balanced accuracies were 0.875 (95% CI = 0.778-0.972) for the PHQ-9 score and 0.880 (95% CI = 0.800-0.960) for theGAD-7 score. The DTM of the PHQ-9 revealed that in caregivers of children with glaucoma, depressive symptoms should be strongly suspected when (1) the child has undergone more than 2 glaucoma surgeries; or (2) the visual acuity (VA, converted to logarithm of minimum angle of resolution [logMAR]) in the better eye is worse than 0.4 if the child has had only 1 or no surgery. CONCLUSIONS: Evaluation of the number of glaucoma surgeries and VA in the better eye can be a useful decision support tool in predicting mental illness in caregivers of children with glaucoma.

Incidence and risk factors of glaucoma after surgery for congenital cataract diagnosed under one year of age: Protocol for Korean Nationwide Epidemiological Study for Childhood Glaucoma (KoNEC).

INTRODUCTION: Congenital cataract (CC) can cause childhood visual impairment, even after CC surgery, due to subsequent occurrence of glaucoma. The post-CC-surgery glaucoma study results vary, due largely to the lack of a sufficient number of population-based cohort studies. This study herein proposed aims to assess the incidence and risk factors of post-CC-surgery glaucoma in a nationwide cohort. The clinico-demographic factors associated with outcomes of post-CC-surgery glaucoma will be investigated as well. MATERIALS AND METHODS: This population-based, nested case-control study is planned as part of the Korean Nationwide Epidemiological Study for Childhood Glaucoma (KoNEC). Data for a nationwide retrospective cohort representative of the years 2008 to 2018 will be extracted from the National Institutes of Health database, which includes demographic information, diagnoses and medical visits as well as procedures, records of prescriptions, and comorbidities. Among the patients whose first CC diagnosis was made before age 1, only those who underwent surgery for CC will be included in the study. The rate of occurrence of post-CC-surgery glaucoma will be determined based on a Poisson distribution. Also, for cumulative incidence plotting, the Kaplan-Meier method will be used. To identify risk factors for occurrence and poor outcomes of post-CC-surgery glaucoma, we will perform a multivariable regression analysis of matched samples. The detailed patterns of post-CC-surgery glaucoma management will be studied as well. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/AWTEC.

Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy.

AIM: To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2y after focal laser photocoagulation treatment. The patients were diagnosed with PCV using indocyanine green angiography, and eyes with other comorbid ocular diseases were excluded. The measurement outcomes of the study were the post-treatment regression and recurrence of polyps, complications, and changes in visual acuities. Paired t-test was performed to compare visual outcome before and after the treatment. RESULTS: The mean age of the 13 patients was 70.2±5.5y, and the follow-up period was 72.3±31.0 (range, 25-118)mo. Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps. Of the 13 eyes, 9 eyes (69.2%) had regression of polyps 1.7±1.2 (range, 0.9-4)mo after focal laser photocoagulation. Five eyes (55.6%) showed recurrence of polyps during the follow-up periods, and the recurrence period was 12.8±18.9 (range, 1.9-48)mo. Mild subretinal hemorrhage occurred in two eyes (15.4%) 27 and 72d after laser treatment, respectively. There were no statistically significant differences in visual acuities at baseline; 1, 2, 3y post-treatment (all P>0.05); and last follow-up (0.63±0.5, 0.73±0.70, 0.67±0.57, 0.75±0.7, and 0.95±0.8 logMAR, respectively). CONCLUSION: Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up. Furthermore, it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.

Effects of Beta-zone Peripapillary Atrophy and Focal Lamina Cribrosa Defects on Peripapillary Vessel Parameters in Young Myopic Eyes.

PRECIS: The development of beta-zone peripapillary atrophy (ß-PPA) and focal lamina cribrosa defect (FLD) was significantly associated with decreased peripapillary optical coherence tomography angiography (OCTA) vessel parameters in young myopic eyes. PURPOSE: The purpose of this study was to investigate whether ß-PPA and FLD affect peripapillary vessel density (VD) or perfusion density (PD) from OCTA in young myopic eyes. MATERIALS AND METHODS: In a cross-sectional study, 330 eyes of 165 healthy volunteers with myopia were involved. Eyes underwent OCTA to measure peripapillary PD and VD. Eyes were grouped according to the presence of ß-PPA or FLD: eyes without ß-PPA or FLD (group A), eyes with ß-PPA but without FLD (group B), and eyes with both ß-PPA and FLD (group C). PD and VD were compared among 3 groups, and linear mixed-effect regression model was used to investigate the determinants of PD. RESULTS: ß-PPA was found in 219 eyes (66.4%), and FLD was detected in 27 eyes (8.2%). The average VD and PD were greatest in group A (19.13±2.04 mm-1 and 0.375±0.038), followed by group B (18.34±2.26 mm-1 and 0.363±0.042) and group C (16.71±2.81 mm-1 and 0.330±0.052) (P<0.001). The linear mixed-effect model demonstrated that presence of FLD (P=0.001) or ß-PPA (P<0.001), FLD count (P=0.004), and maximal ß-PPA width (P<0.001) were significantly associated with average PD after controlling for multiple confounding factors. CONCLUSIONS: Development of ß-PPA and FLD, which is closely related with axial elongation in myopic eyes, was significantly associated with reduced OCTA vessel parameters in young myopic eyes. OCTA may help to detect vascular changes and assess glaucoma risk in these eyes.

Quiescence and Subsequent Anterior Chamber Inflammation in Adalimumab-treated Pediatric Noninfectious Uveitis.

PURPOSE: To evaluate the effect of adalimumab in pediatric uveitis and subsequent changes in anterior chamber inflammation following the inactivation of uveitis. METHODS: In this retrospective study, patients with noninfectious uveitis younger than 18 years of age who were treated with adalimumab for more than 12 months were included. The rate of complete suppression and the relapse in anterior chamber inflammation following the initiation of adalimumab therapy were evaluated using anterior chamber cell score and laser flare photometry (LFP) values, if available. Changes in visual acuity and the sparing effect of topical steroid agents were also evaluated. RESULTS: Among 22 eyes of 12 pediatric uveitis patients enrolled, 13 eyes were associated with juvenile idiopathic arthritis and nine eyes had idiopathic uveitis. The mean ± standard deviation age was 10.2 ± 3.6 years. Types of uveitis included anterior uveitis (n = 17) and panuveitis (n = 5). Quiescence was observed in 14 eyes (63.6%) at 3 months and in 21 eyes (95.5%) at 12 months after initiation, respectively. After achieving inactive uveitis, uveitis relapsed in two eyes at 6 months, even with adalimumab treatment. In 11 eyes, anterior chamber showed 0.5+ cell scores during the rest of the follow-up period and one of those eyes met the criteria for the relapse based on LFP values. The dosage of topical steroids decreased significantly at 3, 9, and 12 months after the initiation of therapy (p ≤ 0.05). Visual acuity did not show improvement. There were no severe adverse effects of anti-tumor necrosis factor-α treatment reported. CONCLUSIONS: In this study, adalimumab achieved a quiescent state in most eyes with pediatric noninfectious uveitis for 12 months with a relapse rate of 9.5%. LFP values together with the anterior chamber cell score can be utilized to monitor the improvement or relapse in anterior chamber inflammation in pediatric noninfectious uveitis.

Spontaneous regression of congenital corneal opacity.

PURPOSE: To determine the incidence of spontaneous regression of congenital corneal opacity (CCO) and identify clinical factors associated with the regression. METHODS: Medical records and anterior segment photographs were reviewed of 57 eyes in 35 patients with CCO that were not related to congenital glaucoma, tumors, infection, trauma, or metabolic disorders and were followed up without corneal transplantation for longer than one year at Seoul National University Hospital. Spontaneous regression of corneal opacity was defined as a decrease in corneal opacity significant enough for visual axis clearance. Data on demographics, systemic, and ocular characteristics were collected and compared between patients who had spontaneous regression of CCO and those who did not. RESULTS: Spontaneous regression of corneal opacity developed in 32 eyes (22 patients, 56.1%) out of 57 CCO eyes (35 patients) at the mean 8.2 ± 5.4 months of age (the median 6.7 months). Absence of combined ocular anomalies such as iris anomaly, lens opacity, and peripheral corneal vascularization was significantly associated with the regression of opacity. CONCLUSIONS: Corneal opacity can spontaneously regress in 56.1% of eyes with CCO during the first year of life. Careful follow-up with amblyopia management can be one of treatment options for CCO.

Benefits of Thromboelastography and Thrombin Generation Assay for Bleeding Prediction in Patients With Thrombocytopenia or Hematologic Malignancies.

BACKGROUND: Thromboelastography (TEG) provides comprehensive information on the whole blood clot formation phases, whereas thrombin generation assay (TGA) reveals the endogenous thrombin levels in plasma. We investigated the potential significance of TEG and TGA parameters for prediction of clinical bleeding in hematologic patients on the basis of the patient's platelet levels. METHODS: TEG and TGA were performed in 126 patients with thrombocytopenia or hematologic malignancies. The bleeding tendencies were stratified on the basis of the World Health Organization bleeding grade. RESULTS: Maximum amplitude (MA) and clot formation in TEG and endogenous thrombin potential (ETP) in TGA showed significant associations with high bleeding grades (P=0.001 and P=0.011, respectively). In patients with platelet counts ≤10×109/L, low MA values were strongly associated with a high bleeding risk. For bleeding prediction, the area under the curve (AUC) of MA (0.857) and ETP (0.809) in patients with severe thrombocytopenia tended to be higher than that of platelets (0.740) in all patients. Patients with platelet counts ≤10×109/L displayed the highest AUC of the combined MA and ETP (0.929). CONCLUSIONS: Both TEG and TGA were considered to be good predictors of clinical bleeding in patients with severe thrombocytopenia. Combination of the ETP and MA values resulted in a more sensitive bleeding risk prediction in those with severe thrombocytopenia.