Agreement in identification of glaucomatous progression between the optic disc photography and Heidelberg Retina Tomography in young glaucomatous patients

AIM:To evaluate concordance between the clinical assessment of glaucomatous progression of the optic disc photography and progression identified by Heidelberg Retina Tomograph(HRT)in patients with suspected primary juvenile open angle glaucoma(JOAG).METHODS:Optic disc photographs and corresponding HRTⅡseries were reviewed.Optic disc changes between first and final photographs were noted as well as progression identified by HRT topographic change analysis(TCA)and rim area regression line(RARL)Agreement between progression indentified by photography and HRT methods was assessed.Progression,determined from optic disc photographs by consensus assessment was used as the reference standard.RESULTS:A total of 31 patients(59 eyes)with suspected JOAG were studied.Agreement for progression/no progression between TCA and photography was obtained in 4 progressing eyes and 38stable eyes(71.19%,k=0.11).Agreement for progression/no progression between RARL and photography was detected in 5 progressing eyes and in 34 stable eyes(66.10%,k=0.15).The number of HRT per patient was statistically higher in the progressing group(P=0.034).CONCLUSION:Agreement for detection of longitudinal changes between photography and HRT analysis was poor.One way to improve the chance of discovery of the progression could be increasing the number of HRT examinations.

Retinal ganglion cell complex changes using spectral domain optical coherence tomography in diabetic patients without retinopathy

AIM：To assess the ganglion cell complex（GCC）thickness in diabetic eyes without retinopathy. METHODS：Two groups included 45 diabetic eyes without retinopathy and 21 non diabetic eyes. All subjects underwent full medical and ophthalmological history,full ophthalmological examination,measuring GCC thickness and central foveal thickness（CFT）using the RTVue~？ spectral domainoptical coherence tomography（SD-OCT）,and HbA1C level.RESULTS：GCC focal loss volume（FLV%）was significantly more in diabetic eyes（22.2% below normal）than normal eyes（P=0.024）. No statistically significant difference was found between the diabetic group and the control group regarding GCC global loss volume（GLV%）（P=0.160）. CFT was positively correlated to the average,superior and inferior GCC（P=0.001,0.000 and 0.001 respectively）and negatively correlated to GLV% and FLV%（P=0.002 and0.031 respectively）in diabetic eyes. C/D ratio in diabetic eyes was negatively correlated to average,superior and inferior GCC（P=0.015,0.007 and 0.017 respectively）. The FLV% was negatively correlated to the refraction and level of Hb A1c（P=0.019 and 0.013 respectively）and positively correlated to the best corrected visual acuity（BCVA）in log MAR in diabetic group（P=0.004）.CONCLUSION：Significant GCC thinning in diabetes predates retinal vasculopathy,which is mainly focal rather than diffuse. It has no preference to either the superior or inferior halves of the macula. Increase of myopic error is significantly accompanied with increased focal GCC loss. GCC loss is accompanied with increased C/D ratio in diabetic eyes.

Real-life experience of ranibizumab therapy for neovascular age-related macular degeneration from Turkey

AIM： To report the real-life experience and clinical results of intravitreal ranibizumab injections to neovascular agerelated macular degeneration（nAMD） in a single institution in Turkey.METHODS： A total of 101 eyes of 89 patients with nAMD treated with intravitreal ranibizumab injection, followed up for at least 24 mo between 2009 and June 2014, which were evaluated retrospectively. A pro re nata（PRN） treatment protocol was performed after the patients had received three, monthly loading injections. Best corrected visual acuity（BCVA） and central macular thickness measurements were evaluated at baseline and 3, 6, 12, 18, and 24 mo. Number of injections and visits were also recorded.RESULTS： Of the 89 patients, 34（38.2%） were male and 55（61.8%） were female and the mean age was 74.0±9.5（52-91）y. The mean follow-up period was 24.82±4.4（24-29）mo. Mean number of visits was 8.4±1.12（7-12） in the first year and 6.6±1.33（4-12） in the second year. The mean number of injections was 5.8±1.6（3-10） and 4.2±2.2（0-9） in the first and second year, respectively. The mean BCVA was 59±15.8 letters at baseline by the Early Treatment Diabetic Retinopathy Study（ETDRS） chart. The mean BCVA at 3, 12, and 24 mo was 70.3±15.9, 67.9±14.3 and 67.3±16.9 letters, respectively. Improvement in visual acuity for each of the visits from baseline was found to be statistically significant（P〈0.01）. Visual acuity in 9 eyes at month 3, 7 eyes at month 12, and 13 eyes at month 24 did not change. The mean central macular thickness（CMT） was 437.99±164.78 μm at baseline. The mean CMT was 348.05±138.47 μm, 349.27±139.79 μm, and 344.13±146.30 μm at months 3, 12, and 24, respectively. The decrease in CMT for each of the visits from baseline was found to be statistically significant（P〈0.01）.CONCLUSION： Anatomical and functional achievement are obtained in our study, but the mean number of injections and visits are found to be lower than the findings reported in randomized controlled clinical trials in the literature. However, the mean number of injections and visits in our study are compatible with the findings reported in real-life experience studies in the literature.