Changes in anterior segment parameters following insertion of ExPRESS mini glaucoma implant vs. trabeculectomy.

PURPOSE: To compare changes in anterior segment parameters following ExPRESS Mini Glaucoma Shunt surgery vs. trabeculectomy using the Pentacam rotating Scheimpflug camera. METHODS: In this prospective, comparative study, 27 patients with glaucoma treated at the Rabin Medical Center from 2009 to 2013 were enrolled in this prospective comparative study: 19 participants (19 eyes) underwent ExPRESS shunt implantation and 12 (13 eyes) underwent trabeculectomy. Changes in anterior chamber parameters at postoperative day 1 and postoperative month 3 were evaluated on Scheimpflug images. RESULTS: Intraocular pressure decreased significantly from baseline in both groups. The decrease in both groups was similar at postoperative month 3 (p=0.82). ExPRESS surgery caused a transient increase in posterior corneal astigmatism (p=0.008) and a transient decrease in anterior chamber depth (p=0.016) and volume (p=0.006) on postoperative day 1. At postoperative month 3, these parameters were no longer statistically significant (p=0.65, p=0.51, and p=0.57 respectively). Trabeculectomy caused a transient increase in anterior and posterior corneal astigmatism on postoperative day 1 (p=0.003 and p=0.005, respectively), which were not evident at postoperative month 3 (p=1.0 and p=1.0, respectively). At postoperative month 3, both ExPRESS and trabeculectomy showed similar changes in anterior chamber parameters. CONCLUSIONS: Both ExPRESS mini glaucoma implant and trabeculectomy significantly decreased intraocular pressure and had transient effects on anterior segment parameters, with minor differences between the methods.

Changes in anterior segment parameters following insertion of ExPRESS mini glaucoma implant vs. trabeculectomy / Alterações nos parâmetros do segmento anterior após a inserção de implantes ExPRESS Mini para Glaucoma e após trabeculectomia

ABSTRACT Purpose: To compare changes in anterior segment parameters following ExPRESS Mini Glaucoma Shunt surgery vs. trabeculectomy using the Pentacam rotating Scheimpflug camera. Methods: In this prospective, comparative study, 27 patients with glaucoma treated at the Rabin Medical Center from 2009 to 2013 were enrolled in this prospective comparative study: 19 participants (19 eyes) underwent ExPRESS shunt implantation and 12 (13 eyes) underwent trabeculectomy. Changes in anterior chamber parameters at postoperative day 1 and postoperative month 3 were evaluated on Scheimpflug images. Results: Intraocular pressure decreased significantly from baseline in both groups. The decrease in both groups was similar at postoperative month 3 (p=0.82). ExPRESS surgery caused a transient increase in posterior corneal astigmatism (p=0.008) and a transient decrease in anterior chamber depth (p=0.016) and volume (p=0.006) on postoperative day 1. At postoperative month 3, these parameters were no longer statistically significant (p=0.65, p=0.51, and p=0.57 respectively). Trabeculectomy caused a transient increase in anterior and posterior corneal astigmatism on postoperative day 1 (p=0.003 and p=0.005, respectively), which were not evident at postoperative month 3 (p=1.0 and p=1.0, respectively). At postoperative month 3, both ExPRESS and trabeculectomy showed similar changes in anterior chamber parameters. Conclusions: Both ExPRESS mini glaucoma implant and trabeculectomy significantly decreased intraocular pressure and had transient effects on anterior segment parameters, with minor differences between the methods.

RESUMO Objetivo: Comparar as alterações nos parâmetros do segmento anterior após a cirurgia ExPRESS Mini Glaucoma Shunt vs. trabeculectomia usando a câmera Scheimpflug Pentacam rotativa. Métodos: Neste estudo comparativo prospectivo, 27 pacientes com glaucoma tratados no Centro Médico Rabin de 2009 a 2013 foram incluídos neste estudo comparativo prospectivo: 19 participantes (19 olhos) foram submetidos ao implante de derivação ExPRESS e 12 (13 olhos) foram submetidos à trabeculectomia. Alterações nos parâmetros da câmara anterior no dia 1 e em 3 meses de pós-operatório foram avaliadas pelas imagens de Scheimpflug. Resultados: A pressão intraocular diminuiu significativamente em relação aos valores iniciais nos dois grupos. A diminuição nos dois grupos foi semelhante no 3º mês pós-operatório (p=0,82). A cirurgia com ExPRESS causou um aumento temporário do astigmatismo posterior da córnea (p=0,008) e uma diminuição temporária da profundidade da câmara anterior (p=0,016) e do volume (p=0,006) no primeiro dia do pós-operatório. Ao final de três meses, esses parâmetros não foram mais estatisticamente significativos (p=0,065, p=0,51 e p=0,57, respectivamente). A trabeculectomia causou um aumento temporário do astigmatismo anterior e posterior da córnea no primeiro dia do pós-operatório (p=0,003 e p=0,005, respectivamente), mas isso não foi observado ao final de 3 meses (p=1,0 e p=1,0, respectivamente). Após 3 meses, tanto o EXPRESS quanto a trabeculectomia mostraram alterações semelhantes nos parâmetros da câmara anterior. Conclusões: O implante ExPRESS Mini para glaucoma e a trabeculectomia diminuíram significativamente a pressão intraocular e tiveram efeitos temporários nos parâmetros do segmento anterior, com pequenas diferenças entre os métodos.

Early isolated optic neuropathy caused by cyclosporine.

PURPOSE: To examine, for the first time, whether cyclosporine intake has an early isolated effect on the optic nerve. MATERIALS AND METHODS: This observational case series consisted of 192 eyes of 98 patients treated with cyclosporine. Patient age and duration and dosage of cyclosporine were recorded, and visual acuity, optic nerve function, visual fields, and visual evoked potential (VEP) were tested. Fundus examination was also performed. Patients with glaucoma, vascular retinopathies, and deep amblyopia were excluded. RESULTS: Mean patient age was 46 years, average duration of treatment was 6 years, and median dosage of cyclosporine was 200 mg daily. VEP was tested in 73 patients (142 eyes) and yielded a delayed P100 wave in 9 (12.32%) (14 eyes). Among these 9 patients, abnormal findings were also noted on the Ishihara colour test in 42.86% of the eyes, and on the visual field test in 64.3% of the eyes. Abnormal VEP showed a significant correlation (p < 0.05) with older age (> 46 years) and a non-significant correlation with longer duration of treatment. Higher abnormal VEP potential was not correlated with higher cyclosporine dose, and there was no correlation between abnormal VEP and blood level of cyclosporine. CONCLUSION: Optic neuropathy was significantly associated with older age in cyclosporine-treated patients. A correlation between optic neuropathy with longer duration of cyclosporine treatment was noted but was not statistically significant. We suggest that tests of optic nerve function, including VEP, be a part of the follow-up of patients receiving cyclosporine.

Changes in anterior segment parameters after insertion of Ex-PRESS miniature glaucoma implant.

PURPOSE: The aim of this study was to evaluate the effect of Ex-PRESS Miniature Glaucoma Implant surgery on corneal curvature and anterior segment parameters obtained with the Pentacam rotating Scheimpflug camera (Oculus Inc.). PATIENTS/METHODS: In this prospective study, a total of 19 eyes of 19 consecutive patients (11 men, 8 women) were evaluated preoperatively, on the first postoperative day, and at 1 week, 1 month, and 3 months postoperatively with the Pentacam. We compared measurements of anterior and posterior corneal curvature, anterior and posterior corneal astigmatism, anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle before and after surgery. All study eyes were pseudophakic. RESULTS: Intraocular pressure decreased significantly from 31.9±10.1 mmHg preoperatively to 6.1±5.7 mmHg on the first postoperative day (P<0.0001) and 15.7±3.6 mmHg at 3 months after surgery (P=0.0011). On the first postoperative day, the anterior corneal astigmatism increased from 2.6±3.3 to 4.7±3.1 D (P=0.19), the posterior corneal astigmatism increased from 0.4±0.2 to 0.9±0.5 D (P=0.008), the ACD decreased from 4.3±0.7 to 3.5±1 mm (P=0.015), and the ACV decreased from 193±35 to 160±49 mm (P=0.006). All of these changes in anterior segment parameters were not statistically significant at 3 months after surgery. CONCLUSIONS: Ex-PRESS Miniature Glaucoma Implant surgery significantly decreased intraocular pressure and had a transient effect on anterior segment parameters. Corneal curvatures, ACD, ACV, and anterior chamber angle were not affected at 3 months of follow-up.

Digital versus film stereo-photography for assessment of the optic nerve head in glaucoma and glaucoma suspect patients.

PURPOSE: One of the leading methods for optic nerve head assessment in glaucoma remains stereoscopic photography. This study compared conventional film and digital stereoscopy in the quantitative and qualitative assessment of the optic nerve head in glaucoma and glaucoma suspect patients. METHODS: Fifty patients with glaucoma or suspected glaucoma underwent stereoscopic photography of the optic nerve head with a 35-mm color slide film and a digital camera. Photographs/images were presented in random order to 3 glaucoma specialists for independent analysis using a standardized assessment form. Findings for the following parameters were compared among assessors and between techniques: cup/disc (C/D) ratio, state of the optic rim, presence of peripapillary atrophy and appearance of the retinal nerve fiber layer, blood vessels, and lamina cribrosa. The film-based and image-based diagnoses (glaucoma yes/no) were compared as well. RESULTS: Despite high level of agreement across graders using the same method for the horizontal and vertical C/D ratio, (intraclass correlations 0.80 to 0.83), the agreement across graders was much lower for the other parameters using the same method. Similarly the agreement between the findings of the same grader using either method was high for horizontal and vertical C/D ratio, but low for the other parameters. The latter differences were reflected in the disagreement regarding the final diagnosis: The diagnoses differed by technique for each grader in 18% to 46% of eyes, resulting in 38.5% of eyes diagnosed with glaucoma by film photography that "lost" their diagnosis on the digital images, whereas 18.7% of eyes diagnosed as nonglaucomatous by film photography were considered to have glaucoma on the digital images. CONCLUSIONS: Although there is consistency between 35-mm film stereoscopy and digital stereoscopy in determining the cup/disc (C/D) ratio, in all other parameters large differences exist, leading to differences in diagnosis. Differences in capturing images between digital and film photography may lead to loss of information and misdiagnosis. Further studies are needed to determine the reliability of the new digital techniques.

Effect of repeated applanation tonometry on the accuracy of intraocular pressure measurements.

PURPOSE: To evaluate the stability of successive applanation tonometry measurements in glaucomatous eyes. METHODS: A prospective, comparative, randomized, and evaluator-masked study was conducted in a tertiary medical center. Sixty-seven patients with glaucoma attending our glaucoma clinic underwent four successive intraocular pressure (IOP) measurements with Goldmann-type applanation tonometry. Findings were compared with 70 patients scheduled for cataract surgery, similar in age and sex. The results were statistically analyzed with repeated measures analysis. RESULTS: In the glaucoma group, the difference between the first and second IOP measurements was statistically significant (15.94 mmHg vs 14.9 mmHg, p < 0.0001), as was the decrease in IOP from the first measurement to each of the other successive measurements. No significant change in IOP was noted in the control group (mean, 13.7 mmHg). CONCLUSIONS: Patients with glaucoma show a decrease in IOP on repeated applanation tonometry measurements. By contrast, in individuals without glaucoma, no significant decrease in IOP on repeated applanation tonometry measurements was found.

The novel Y371D myocilin mutation causes an aggressive form of juvenile open-angle glaucoma in a Caucasian family from the Middle-East.

PURPOSE: To search for the genetic cause of juvenile open-angle glaucoma (JOAG) in a Caucasian family and to perform genotype/phenotype correlation studies in the kindred. METHODS: Six members of a three-generation family originating from Uzbekistan and now living in the Middle East were recruited from one large clinic in Israel. Ophthalmologic investigations comprised of visual field assessments, intraocular pressure measurements, optic disc evaluation, and gonioscopy. Medical charts were obtained to date the onset of glaucoma and to evaluate aggressivity of the trait. We screened the myocilin gene (MYOC, OMIM 601652) by direct genomic sequencing of its three exons in all family members. RESULTS: JOAG segregated as an autosomal dominant trait in four members of the family. The proband, a 14-year-old girl, had been diagnosed with juvenile open-angle glaucoma at 12 years old. Her mother, maternal aunt, and maternal grandfather all had JOAG that started at an early age. The disorder progressed rapidly even under optimal medical treatment, and all four patients had to undergo trabeculectomy. One missense mutation, Y371D (1111t-->g, Tyr [Y] 371 Asp [D]), was identified. This mutation cosegregated with the disorder in all affected members and was absent in 200 Caucasian controls. The Y371D MYOC mutation has not been reported before. One cousin of the proband was a silent heterozygotic carrier of the mutation and was still asymptomatic at nine years of age. CONCLUSIONS: We identified a novel mutation (Y371D) in MYOC from a Caucasian family who presented with an aggressive form of JOAG that required early trabeculectomy. Genetic screening of the MYOC mutation was beneficial in predicting one asymptomatic heterozygotic carrier.

[Enucleations and eviscerations in a large medical center between the years 1981 and 2007].

PURPOSE: The indications for enucleation and evisceration have decreased in the last decade, most probably because of improved treatment modalities. The aim of the study was to evaluate the use of these procedures in the last 26 years in our medical centre. METHODS: This study included all patients who underwent enucleation or evisceration at Rabin Medical Center from 1981 to 2007. We checked for age, gender, date and type of surgery, and indication for surgery. RESULTS: A total of 206 (74%) eviscerations and 73 (26%) enucleations were performed. The relative rates of performance of the two procedures were similar in 1981-1990 and 1991-2000. Mean age of the patients treated from 1981 to 1990 was 57.03 years (SD=22.23), from 1991 to 2000, 68.55 years (SD=17.94) and 69.23 years (SD=20.23) during the period 2001-2007 (p=0.001, t-test). Indications for surgery were: trauma in 91 eyes (32.6%), blind painful eye (mainly due to end-stage glaucoma) in 77 eyes (27.6%), endophthalmitis in 76 eyes (27.2%), and tumor in 35 eyes (12.6%). In the first 2 decades, trauma was the most common reason for evisceration, whereas, in the last few years, endophthalmitis or severe intraocular infection became the main reason for the procedure. Tumor was the most common reason for enucleation throughout all decades. CONCLUSIONS: The relative use of enucleation and evisceration and indications for these procedures has not changed over that last 2 decades. However, in recent years, severe intraocular infection became the most frequent indication for evisceration, while enucleation is less frequently performed then previously. There has been a significant shift to an older patient age group.

Puberty as a risk factor for less favorable visual outcome in idiopathic intracranial hypertension.

PURPOSE: To test the hypothesis that puberty is a risk factor for poorer visual outcome in idiopathic intracranial hypertension (IIH). DESIGN: Retrospective chart review case series. SETTING: Tertiary referral center, neuro-ophthalmology unit. PATIENT POPULATION: Ninety-six patients with IIH followed for a minimum of one year. OBSERVATION: Age (grouped into prepubertal, pubertal, teenage, or adult), obesity, initial intracranial pressure (ICP), measurements and presence of hypertension, anemia, or renal failure were correlated with final visual outcome using chi(2), stepwise logistic regression, and model-selection log linear analyses. MAIN OUTCOME MEASURES: Visual outcome was graded into "excellent" -- no evidence of an optic neuropathy or any permanent visual field defect in either eye, "moderate"-- evidence of an optic neuropathy and/or a mild (nasal constriction) visual field defect, or "poor outcome" (peripheral constriction) -- permanent visual field defect. RESULTS: Outcome data were complete for 96 patients. Moderate to poor visual outcome, as opposed to excellent, was significantly associated with puberty (P = .007 using the gender-specific definition of puberty, .0002 using the broad definition). Moderate-poor visual outcome occurred in none of seven IIH patients of prepubertal age (<9 years), in 15 of 26 patients presenting between nine to 16 years, in two of six patients aged 17 to 22 years, and in seven of 57 adult patients over the age of 23 years. CONCLUSIONS: In this series of 96 patients with IIH, visual outcome was less favorable in pubertal patients than in prepubertal, teenage, and adult patients. We recommend that clinicians maintain a high index of awareness when caring for pubescent children with IIH.

Fibrin glue as a suture substitute: histological evaluation of trabeculectomy in rabbit eyes.

PURPOSE: To describe the outcome of the use of fibrin adhesive (Quixil) in penetrating trabeculectomy in a rabbit model. METHODS: Fibrin adhesive was used experimentally to attach the conjunctiva and the scleral flap in two groups of 17 New Zealand albino adult rabbits (34 eyes). In the first experiment (20 eyes), the fibrin adhesive was used to reattach the tissue after conjunctival peritomy and scleral flap only in 14 eyes (experiment I). In 6 eyes (controls), the conjunctiva was attached with nylon sutures. In the second experiment (14 eyes), the fibrin adhesive was used after conjunctival peritomy, scleral flap, and penetrating trabeculectomy in 8 eyes (experiment II). In a control group of 6 eyes, nylon sutures were used to attach the scleral flap and the conjunctiva after penetrating trabeculectomy. Biomicroscopy and histopathological examinations were performed on postoperative days 1, 3, 7, 14, 21, and 30. Intraocular pressure was measured before and after surgery in the second experiment. Main outcome measures are histological presence of adhesive in the tissue, degree of capillary congestion, inflammatory reaction, collagen density [scar formation] and clinical (IOP measurements before and after surgery, conjunctival chemosis, anterior chamber reaction, presence of filtering bleb and wound leakage). RESULTS: In experiments I and II, the adhesive was well identified histologically in the tissue as an amorphic eosinophilic substance for up to day 3 and nearly disappeared by day 7. An acute inflammatory reaction was noted for up to 14 days, which converted to chronic inflammation with collagen deposits and scar formation by day 30. Similar inflammatory reaction was observed in the control group. The adhesive had no adverse effects on ocular tissue compared with sutures. One eye in experiment II demonstrated wound dehiscence. Intraocular pressure dropped from 17.35 mmHg preoperatively to 8.28 mmHg on postoperative day 1 in experiment II, and from 17.2 mmHg to 11.5 mmHg in the controls. No significant change in intraocular pressure was noted in experiment I. CONCLUSIONS: The fibrin adhesive had no adverse effects on ocular tissue compared with sutures. It might serve as an effective substitute for conjunctival and scleral wound closure in trabeculectomy surgery.

Cyclocryotherapy versus transscleral diode laser cyclophotocoagulation for uncontrolled intraocular pressure.

BACKGROUND AND OBJECTIVE: To compare the use of cyclocryotherapy and diode laser cyclophotocoagulation for the treatment of uncontrolled intraocular pressure. PATIENTS AND METHODS: Seventy consecutive patients (70 eyes) treated for high, unresponsive intraocular pressure during a 4-year period with cyclocryotherapy (n = 38) or diode laser cyclophotocoagulation (n = 32) with a follow-up period of at least 3 months (mean follow-up = 15.7 months) were compared for intraocular pressure, visual acuity, and complication rate. RESULTS: Mean intraocular pressure was reduced from 40.9 +/- 11.9 to 20.5 +/- 10.3 mm Hg in the cyclocryotherapy group, and from 35.9 +/- 9.3 to 21.3 +/- 10.7 mm Hg in the cyclophotocoagulation group. Intraocular pressure was controlled in 60.5% and 62.5% of eyes, respectively. Deterioration in visual acuity occurred in 31.5% of the cyclocryotherapy group and 37.5% of the cyclophotocoagulation group. Severe visual loss to no light perception was noted in 6 eyes and 2 eyes, respectively, and phthisis bulbi in 2 eyes in the cyclocryotherapy group (5.2%) and 1 eye in the cyclophotocoagulation group (3.1%). CONCLUSIONS: Cyclocryotherapy and diode laser cyclophotocoagulation are equally effective in decreasing intraocular pressure in patients with persistent uncontrolled glaucoma, with a lower rate of complications associated with diode laser cyclophotocoagulation.

Competitive quenching: a possible novel approach in protecting RPE cells from damage during PDT.

PURPOSE: The purpose of this study is to demonstrate feasibility of using our novel concept, termed competitive quenching, for protecting the choroidal extravascular compartment and retinal pigment epithelium (RPE) from verteporfin (VP)-induced phototoxicity using hypericin. Furthermore, we aim to achieve partitioning of the quencher, hypericin, in the extravascular space and VP within the microvascular compartment of the chorio-retinal complex in vivo. METHODS: We protect RPE cells from damage inflicted by photoactivated VP by introducing hypericin into these cells prior to photosensitization to quench the photosensitizing activity of VP. Cell protection levels were measured by MTT and Hemacolor viability assays. Wavelength range used for VP photoexcitation (700 +/- 40 nm) excludes the absorption range of hypericin, preventing the latter from photoactivation. Pharmacokinetic conditions, in which hypericin spreads throughout the choroidal and retinal extravascular space while VP is confined to the vasculature, are delineated using double-fluorescence imaging. RESULTS: Cell viability increased 3- to 5-fold when 10-20 microM hypericin were present in RPE cells during photosensitization with 0.1-0.5 microM VP. VP fluorescence intensity was unchanged by the presence of hypericin in the cells. Hypericin administered intravenously to rats was confined to the choroidal vasculature after 15 min to 2 hr. Subsequently, hypericin partitioned to the choroidal and retinal extravascular space. VP administered at this time was confined to the microvasculature. CONCLUSIONS: RPE and choroid may potentially be protected by compartmentalizing hypericin to the extravascular compartment while VP administered shortly before photosensitization is confined to the microvasculature. Adverse photodynamic therapy (PDT) damage to choroidal tissues adjacent to neovasculature targeted for photoablation have the potential of being prevented by competitive quenching with hypericin.

Plasminogen activator inhibitor-1 in the aqueous humor of patients with and without glaucoma.

OBJECTIVE: To determine the levels of plasminogen activator inhibitor-1 (PAI-1) and total protein in the aqueous humor of patients with glaucoma vs those without glaucoma. METHODS: A total of 125 aqueous humor samples (50-150 microL each) were collected at 3 institutions from patients with glaucoma and a control group of patients with cataract. Fifteen samples were excluded, and the levels of PAI-1 antigen were determined by enzyme-linked immunosorbent assay in 110 samples (36 glaucoma and 74 control). Total protein levels were determined by the Bradford method in 81 samples (28 glaucoma and 53 control), in which the aqueous humor collected was sufficient. Statistical analysis of the results was conducted using the Mann-Whitney U test. The correlation between PAI-1 and protein levels was calculated using the Spearman rank correlation coefficient. RESULTS: The mean +/- SD PAI-1 levels detected in aqueous humor samples of the control and glaucoma groups were 0.44 +/- 0.61 and 1.45 +/- 1.91 ng/mL, respectively. The mean +/- SD levels of total protein were 64.91 +/- 89.75 and 86.64 +/- 44.16 microg/mL, respectively. For both parameters, the difference between the 2 groups was significant (P< .001). The correlation between PAI-1 and total protein levels was moderate in the glaucoma group (r = 0.43; P = .01) and low in the control group (r = 0.23; P = .04). CONCLUSIONS: The glaucoma group showed in the aqueous humor a 3.3-fold increase in the mean level of PAI-1 compared with the control group, whereas the increase in total protein level was only 1.3-fold. These data are consistent with the possibility that intraocularly produced PAI-1 may contribute to glaucoma pathogenesis. CLINICAL RELEVANCE: Reducing the production or activity of PAI-1 in the eye could constitute a new target for the design of drugs to treat glaucoma.

Swedish interactive thresholding algorithm fast for following visual fields in prepubertal idiopathic intracranial hypertension.

OBJECTIVE: To examine the reliability of Swedish Interactive Thresholding Algorithm Fast (SITA Fast) visual fields (VFs) in prepubertal idiopathic intracranial hypertension (IIH) and to compare whether age, gender, or severity of visual outcome influenced the reliability of VF tests. DESIGN: Prospective, longitudinal cohort study. PARTICIPANTS: Twenty-six prepubertal children (<11 years of age; mean age, 7.2 years) with IIH. TESTING: Children were prospectively followed up using a child-oriented program, which included SITA Fast VF tests. Age, gender, and severity of visual outcome were correlated with reliability of performance on SITA Fast VFs using a 1-way analysis of variance, point-biserial correlation, and the chi-square test for independence of observation. MAIN OUTCOME MEASURES: Statistical analyses results that correlated the reliability of SITA Fast VFs with age, gender, and visual outcome. RESULTS: Three children were treated at the age of 2 years and were unable to perform automated VF tests. Four children were treated at the age of 4 years, 3 of whom were able to perform repeatable reliable SITA Fast VF tests. Forty-two eyes of 21 children had an average SITA Fast test time of 4.5 minutes for each eye, compared with 8 minutes using the Fastpac strategy. Age was not associated with reliability scores of SITA Fast tests (F = 0.971, not significant [ns]). Gender did not influence the reliability of SITA Fast VF tests (chi-square((1)) = 0.669, ns), nor did severity of visual outcome (chi-square((2)) = 3.348, ns). Visual deficits were observed in 55% of patients at presentation and in 27% of patients after resolution of papilledema. CONCLUSIONS: The SITA Fast VF tests can be performed from age 4 years and offer a reliable method for shortening test time. A child-oriented follow-up program, which entails a shortened testing time, may improve outcome in prepubertal IIH.

Elevated intraocular pressure associated with steroid treatment for infantile spasms.

PURPOSE: To evaluate the ocular changes and medical and surgical therapy after high-dose systemic steroid treatment in babies with infantile spasm and hypsarrhythmia. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: In 5 of the 9 (55%) babies with infantile spasm exposed to systemic corticosteroid treatment, an increase in intraocular pressure (IOP) and optic disc cupping was observed. INTERVENTION: Ophthalmic examination under mild sedation was conducted 3 to 4 weeks after initiation of systemic therapy. Antiglaucoma treatment was given to the patients found to have high IOPs and cup-to-disc ratio changes. Routine follow-up was continued until systemic therapy was completed. MAIN OUTCOME MEASURES: Controlled IOP with a decrease in cupping damage after antiglaucoma therapy. RESULTS: Five patients required antiglaucoma treatment; one also underwent augmented trabeculectomy. Mean IOP decreased in this subgroup from 30.1 +/- 9.5 mmHg to 15.4 +/- 4.2 mmHg in the right eye (P = 0.043) and from 32.6 +/- 7.4 mmHg to 15.2 +/- 1.8 mmHg in the left eye (P = 0.043). Mean cup-to-disc ratio improved from 0.53 +/- 0.2 to 0.37 +/- 0.04 in the right eye (P = 0.06) and from 0.57 +/- 0.12 to 0.35 +/- 0.05 in the left eye (P = 0.042). CONCLUSIONS: The rapid onset of IOP and cup-to-disc ratio changes in patients with infantile spasm and hypsarrhythmia treated by high-dose corticosteroids necessitates early and intensive monitoring to prevent anatomic ocular damage and visual impairment in the future.