Journal of Current Glaucoma Practice最新文献

Purpose: To assess the optic nerve head (ONH) parameters in normal male Saudi eyes using swept-source optical coherence tomography (SS-OCT).

Materials and methods: The study included 86 healthy men with a mean age of 23.6 ± 4.82 years. The metrics collected using SS-OCT from each individual was disk area (DA), rim area (RA), cup volume (CV), linear cup-disk ratio (LCDR), vertical cup-disk ratio (VCDR), and total retinal nerve fiber layer (RNFL) thickness, superior RNFL thickness, and inferior RNFL thickness. All the metrics were correlated with the DA. The right eye data were used for the correlation analysis.

Results: The mean DA in OD was 1.78 mm² (range 1.09-2.70 mm²). The mean RA was 1.28 mm² (range 0.72-2.47 mm²). The DA showed a significant positive correlation (p < 0.05) with RA, cup area (CA), CV, VCDR, LCDR, and total RNFL thickness.

Conclusion: For the first time, using sweeping source OCT (DRI OCT Triton, Topcon Corporation), a normative database of ONH parameters was made accessible to the Saudi male population. While assessing the optic disk for progressive optic neuropathies like glaucoma, disk size should be taken into consideration since the optic DA affects ONH topography, especially in Saudi eyes.

How to cite this article: Challa NK. Optic Nerve Head Parameters in Saudi Male Young Adults Using Swept-source Optical Coherence Tomography. J Curr Glaucoma Pract 2023;17(2):58-62.

Objective: To compare anterior segment biometry parameters in progress and non-progress primary angle closure glaucoma (PACG) among Malay and Chinese patients.

Materials and methods: A cross-sectional study was conducted between November 2015 and December 2016 involving 75 patients with PACG (43 Malays and 32 Chinese) who were recruited from a single glaucoma center in Malaysia. Ocular examination included anterior segment biometry measurements on the selected eye. Axial length (AL) and anterior chamber depth (ACD) measurement was done using a noncontact partial coherence interferometer (IOL Master, Carl Zeiss, Germany). Anterior chamber angle (ACA) was measured by Anterior Segment-OCT (Spectralis Heidelberg, Germany). Humphrey visual field (HVF) 24-2 analysis of the same eye was conducted and compared with the HVF when diagnosis was made. Progression of PACG patients was assessed according to the Hodapp, Parrish and Anderson's (HPA) classification, they were then divided into progress and non-progress groups. Comparison of anterior segment biometry parameters between Malay and Chinese PACG patients with and without progression was analyzed using independent T test. Multivariate ANOVA analysis was used to compare the anterior segment parameters between progress and non-progress PACG patients, with adjustment for age, gender, lens status, family history and presence of diabetes mellitus.

Results: Chinese PACG patients have significant shorter AL (22.18 mm ± 0.76) and narrower ACA (11.96° ± 6.00) compared to Malay PACG patients. Among the progress group, Chinese PACG patients have significant shorter AL, shallower ACD and narrower ACA compared to Malays. However, after controlling for confounding factors, there was significant difference in ACA between Malay and Chinese PACG. There was also no significant difference of ocular biometry measurement between Chinese and Malay patients in progress and non-progress group.

Conclusion: There was racial influence in ocular biometry measurement in PACG patients. Chinese have significant narrower ACA compared to Malays. Serial AS-OCT monitoring is important in management of PACG.

How to cite this article: Neoh FP, Azhany Y, Siti-Azrin AH, et al. Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese. J Curr Glaucoma Pract 2023;17(1):3-8.

How to cite this article: Kanadani FN, F Campos LD, Dorairaj S, et al. Transscleral Cyclophotocoagulation: New Perspectives for Uncontrolled Glaucoma Management. J Curr Glaucoma Pract 2023;17(1):1-2.

Aim: We report on an 88-year-old female patient who presented with a relapse in aqueous misdirection 15 years after being treated with pars plana vitrectomy (PPV) with hyaloidotomy-zonulectomy-iridotomy (HZI) for the same cause.

Case description: A 73-year-old pseudophakic woman with a history of pseudoexfoliation underwent a trabeculectomy in the left eye in our institution because of uncontrolled intraocular pressure. Days after trabeculectomy, the patient developed aqueous misdirection and was treated with PPV combined with HZI. In the following years, the patient had regular follow-up appointments in our instruction, and she had normal intraocular pressures in the left eye without any treatment. A total of 15 years after the vitrectomy, the patient developed gradual swallowing in the anterior chamber and increased intraocular pressure. Neodymium (Nd): yttrium aluminum garnet (YAG) laser hyaloidotomy through the iridectomy opening was performed, the anterior chamber was immediately deepened, and the intraocular pressure was reduced to normal limits. The anterior chamber remained deep, and the intraocular pressure remained normal through the 36 months of follow-up.

Conclusion: Relapse of aqueous misdirection may occur many years after vitrectomy, even when HZI is performed. An Nd: YAG- laser hyaloidotomy should be attempted before a second HZI is considered.

Clinical relevance: A close and long-lasting follow-up of patients with aqueous misdirection is warranted, especially if the patients are treated not with complete PPV but by a limited disruption of the anterior hyaloid face along with HIZ.

How to cite this article: Halkiadakis I, Tzimis V, Markopoulos I, et al. Late-onset Relapse of Aqueous Misdirection after Pars Plana Vitrectomy: Case Report and Literature Review. J Curr Glaucoma Pract 2023;17(1):49-51.

Aim: To describe a unique finding in a patient with Sturge-Weber syndrome (SWS) accompanied by glaucoma.

Background: Cases with SWS may have an associated choroidal angioma and glaucoma. The localized retinal nerve fiber layer (RNFL) defects induced by the associated glaucoma are better detected against the red background of the associated choroidal angioma.

Case description: A 15-year-old boy was presented with left-side SWS. The case was subjected to full clinical examination, intraocular pressure (IOP) measurements, color fundus photography, ultrasonography, visual field assessment, and optical coherence tomography (OCT) of the peripapillary RNFL and ganglion cell layer (GCC) analysis. The main clinical finding was the enhanced detection of defects of the RNFL against the red color of associated choroidal angioma in this glaucomatous eye.

Conclusion: There is enhanced clinical visibility of RNFL defects in presence of associated diffuse choroidal angioma in Sturge-Weber glaucoma.

Clinical significance: Easier clinical detection of RNFL defects in SWS glaucoma associated with diffuse choroidal angioma.

How to cite this article: Abdelrahman AM. Enhanced Visibility of the Retinal Nerve Fiber Layer Defects by the underlying Diffuse Choroidal Angioma in Sturge Weber Syndrome with Glaucoma. J Curr Glaucoma Pract 2023;17(1):52-54.

Aim: The purpose of this study is to investigate the difference of change in the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) thickness according to age in glaucoma suspect individuals and healthy subjects.

Materials and methods: Thicknesses of RNFL and GCC were measured with spectral domain optical coherence tomography (SD-OCT) in glaucoma-suspected individuals and healthy subjects. The differences in age, overall mean, four quadrants, and 12 clock-hour sectors of RNFL and overall mean, superior half, and inferior half GCC thicknesses between glaucoma suspects and healthy participants were analyzed and compared using linear regression analyses.

Results: There were 201 glaucoma-suspect individuals and 121 healthy subjects with a mean age of 38.89 and 40.26 years, respectively (p = 0.27). The mean overall RNFL thickness was found to be 97.76 and 97.43 µm in healthy individuals and glaucoma suspects (p = 0.72). The mean overall GCC thickness was found to be 111.30 and 104.67 µm in healthy individuals and glaucoma suspects, respectively (p < 0.001). There was a 0.11 µm decrease per year found in overall GCC thickness in glaucoma suspects and 0.23 µm decreases per year in overall GCC thickness in healthy individuals (p < 0.001). There was a 0.02 µm decrease per year found in overall RNFL thickness in glaucoma suspects and a 0.29 µm decrease per year in overall RNFL thickness in healthy individuals (p < 0.001). However, these per-year decreases in GCC thickness glaucoma suspects and healthy individuals were not found to be statistically significant (p = 0.21); on the other hand, this difference for RNFL thickness was significant (p < 0.001).

Conclusion: It was found that the thicknesses of RNFL and GCC were different between glaucoma suspects and healthy individuals. However, age-related decay in the RNFL and GCC thicknesses was not uniform in healthy individuals and glaucoma suspects.

Clinical significance: It was found that the RNFL thickness and GCC thickness were lower in glaucoma suspects than in healthy controls eyes. However, an age-related decrease of RNFL and GCC thicknesses were found to be less in glaucoma suspects compared with healthy controls.

How to cite this article: Firatli G, Elibol A, Altinbas E, et al. The Comparison of Age-related Change in Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses between Glaucoma Suspects and Healthy Individuals. J Curr Glaucoma Pract 2023;17(1):22-29.

Aim: This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period.

Methods: Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm² and a duty cycle of 31.3%.

Results: A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028).

Conclusions: Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis.

How to cite this article: Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.

Aim: This review summarizes current data on Rho-kinase (ROCK) inhibitors use in ocular diseases, primarily glaucoma.

Background: Translational research over the last decade culminating in the development of ROCK inhibitors has provided a much-needed shot in the arm to glaucoma pharmacopeia. ROCK pathway is intricately involved in cytoskeletal modulation with action on cell morphology, cell motility, cell adhesion, cell apoptosis, and smooth muscle contraction. This cytoskeletal modulation property has been utilized to modify trabecular meshwork (TM) resistance, resulting in the discovery of ROCK inhibitors to increase trabecular outflow.

Review results: Multicentric trials on ROCK inhibitors for antiglaucoma medications are summarized. The focus is on linking pharmacological action to the clinical utility of these drugs. While the Rho Kinase Elevated intraocular Pressure (IOP) Treatment (ROCKET) trials compared monotherapy with ROCK inhibitor netarsudil vs timolol, MERCURY trials compared a fixed dose combination of latanoprost and ROCK inhibitor netarsudil [fixed combination netarsudil-latanoprost (FCNL)] vs monotherapy with either and bimatoprost-timolol combination. While ROCKET trials showed ROCK inhibitors to be non-inferior to timolol, MERCURY trials showed FCNL achieving a much greater IOP reduction than monotherapy with either. Conjunctival hyperemia was the most common side effect reported with ROCK inhibitor use.

Conclusion: Moderate efficacy of ROCK inhibitors with a common side effect of conjunctival hyperemia, makes it an adjunctive antiglaucoma drug of choice and not a first-line therapy.

Clinical significance: ROCK inhibitors' action on diseased TM is more physiological compared to available antiglaucoma medications that either reduce aqueous secretion or enhance uveoscleral outflow. The property of ROCK inhibition to stabilize the endothelium of both retinal vasculature and cornea has opened a new chapter in the treatment of diabetic retinopathy and corneal decompensation.

How to cite this article: Singh K, Singh A. Rho-kinase Inhibitors in Ocular Diseases: A Translational Research Journey. J Curr Glaucoma Pract 2023;17(1):44-48.

A new technique for performing gonioscopy that facilitates finding Schwalbe´s line, and lowers the amount of time and light that enters through the pupil is presented. The technique is an alternative to the classic corneal wedge technique and is feasible in the horizontal quadrants without further adjustments to the slit lamp, in contrast to the tilting usually needed for these quadrants. Clinical photos and online videos are presented.

How to cite this article: Albis-Donado O, Ortiz-Arismendi GE, Bhartiya S. New Gonioscopy Technique for Finding Schwalbe's Line: The Ortiz Maneuver. J Curr Glaucoma Pract 2023;17(1):37-39.

Purpose: To evaluate the effects of micropulse transscleral cyclophotocoagulation (mCPC) and selective laser trabeculoplasty (SLT) on endothelial cell density (ECD) and reduction of the intraocular pressure (IOP) in patients with primary-open angle glaucoma (POAG).

Patients and methods: In this observational, retrospective study, 40 eyes with POAG were included. Patients were divided into three groups-group I was treated with SLT (n = 13), group II was treated with mCPC (n = 13), and group III included age-matched patients with medically treated glaucoma (n = 14) (control group). In both treatment groups (SLT and mCPC) preoperative and postoperative findings of best-corrected visual acuity (BCVA), ECD, and IOP were compared to the control group.

Results: The mean time interval before and after the treatment was 215 ± 120 days in group I (SLT) and 273 ± 177 days in group II (mCPC). The follow-up for group III (control group) was 209 ± 103 days. In both treatment groups (SLT and mCPC) there was a statistically significant reduction of the IOP postoperatively (group I: 3.5 ± 3.7 mm Hg (p = 0.005) and group II: 4.3 ± 4.1 mm Hg (p = 0.003)). The mean IOP for group III was 12.9 ± 3.7 mm Hg at visit 1 and did not change significantly (p = 0.353) at visit 2. In all three groups, there was no statistically significant change in ECD at the last visit.

Conclusion: According to our results, both SLT and mCPC seem to be effective in lowering the IOP, without showing any statistically significant effect on ECD in patients with POAG.However, larger and longer-term studies are necessary to understand the effects of the SLT and mCPC procedures on ECD.

How to cite this article: Garip Kuebler A, Priglinger S, Reznicek L. Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure. J Curr Glaucoma Pract 2023;17(1):40-43.