Discriminating performance of macular ganglion cellinner plexiform layer thicknesses at different stages of glaucoma

AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer(GCIPL) parameters between all the consecutive stages of glaucoma(from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer(RNFL) parameters and optic nerve head(ONH) parameters.METHODS: Totally 147 eyes(40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography(OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve(AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients(P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio(AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the bestGC-IPL parameters being minimum and inferotemporal(AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area(AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients.CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other(from glaucoma suspect to moderate-tosevere glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.

Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.

Short-duration transient visual evoked potentials and color reflectivity discretization analysis in glaucoma patients and suspects

AIM： To evaluate the use of short-duration transient visual evoked potentials（VEP） and color reflectivity discretization analysis（CORDA） in glaucomatous eyes,eyes suspected of having glaucoma,and healthy eyes.METHODS： The study included 136 eyes from 136 subjects： 49 eyes with glaucoma,45 glaucoma suspect eyes,and 42 healthy eyes.Subjects underwent Humphrey visual field（VF） testing,VEP testing,as well as peripapillary retinal nerve fiber layer optical coherence tomography imaging studies with post-acquisition CORDA applied.Statistical analysis was performed using means and ranges,ANOVA,post-hoc comparisons using Turkey＇s adjustment,Fisher＇s Exact test,area under the curve,and Spearman correlation coefficients.RESULTS： Parameters from VEP and CORDA correlated significantly with VF mean deviation（MD）（P〈0.05）.In distinguishing glaucomatous eyes from controls,VEP demonstrated area under the curve（AUC） values of 0.64-0.75 for amplitude and 0.67-0.81 for latency.The CORDA HR1 parameter was highly discriminative for glaucomatous eyes vs controls（AUC=0.94）.CONCLUSION： Significant correlations are found between MD and parameters of short-duration transient VEP and CORDA,diagnostic modalities which warrant further consideration in identifying glaucoma characteristics.

Validation and reproducibility of the Heidelberg Edge Perimeter in the detection of glaucomatous visual field defects

AIM: To validate the ability of the Heidelberg Edge Perimeter(HEP) in detecting glaucomatous visual field(VF) defects compared to the Octopus Visual Field(OVF) Analyzer and to determine the test-retest repeatability of both modalities.METHODS: This prospective, cross-sectional study was conducted at Wills Eye Hospital, Philadelphia, PA. Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry(SAP) Ⅲ 30-2 Adaptive Staircase Thresholding Algorithm(ASTA) FAST protocol and OVF G-TOP white-on-white strategy. Testing order was randomized. Pearson's correlation coefficient was calculated for both mean deviation(MD) and pattern standard deviation/square root of loss of variance(PSD/s LV). Receiver operating characteristic(ROC) curves were used to determine the diagnostic abilities of both modalities. Glaucoma subjects returned for repeat testing and intraclass correlation coefficients(ICCs) were calculated to assess test-retest repeatability. RESULTS: Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled. HEP and OVF were significantly correlated for both MD(r=-0.84; P<0.01) and PSD/s LV(r=0.79; P<0.01). Areas under the ROC curves(AUCs) were also comparable between HEP and OVF for both MD(0.74 and 0.79, respectively; P=0.26) and PSD/sL V(0.74 and 0.82; P=0.08). ICC was high for both HEP (0.96 for MD, 0.95 for PSD/s LV) and OVF(0.82 and 0.88, respectively). Mean test duration(min) was significantly shorter for OVF(2.63) compared to HEP(5.15; P<0.01). CONCLUSION: HEP and OVF show strong correlation for both MD and PSD/s LV, and have similar validity for detecting glaucoma. The test-retest repeatability is high for both HEP and OVF, however the average testing duration of HEP is significantly longer than that of OVF.

Changes in macular thickness following glaucoma surgery

Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assessed changes in macular thickness following such intervention.Our aim was to investigate the impact of intraocular pressure(IOP)reduction after glaucoma surgery on total macular thickness

Head trauma can cause transient elevation of intraocular pressure in patients with open angle glaucoma

AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.

Perspective on early lens extraction for primary angle-closure glaucoma

Primary angle-closure glaucoma(PACG)is a subtype of glaucoma that affects 16 million people worldwide,of whom4 million are bilaterally blind.This prevalence of PACG is expected to increase to 21 million cases by 2020,and it is expected that 5.3 million people will become

多指(趾)致病基因研究进展

多指(趾)畸形是最常见肢体畸形之一,具有遗传性,分为综合征型和非综合征型两大类型.非综合征型按照解剖位置可分为轴前、轴后及中央型多指,综合征型多指(趾)是指除多指表型以外,还伴随其他症状.近些年,多用连锁分析、全外显子测序等对相关致病基因的定位及突变进行分析,并通过分析突变的基因所表达的蛋白,了解其对相关信号通路可能产生的影响.通过总结多指(趾)畸形主要致病基因最新研究及影响肢体前后模式主要通路,旨在了解多指(趾)致病基因的研究方向和热点,为今后能在胚胎阶段阻断多指(趾)形成的研究提供依据和思路.

Implantation of trabecular micro-bypass stent using a novel “landing strip” technique

AIM：To describe a novel technique of creating a landing strip within the trabecular meshwork to guide trabecular micro-bypass stent（iStent） implantation in patients who underwent phacoemulsification.METHODS：Thirty-four eyes from 30 patients who underwent i Stent implantation after phacoemulsification from May 2014 to February 2015 were included in our retrospective study. All iStents were implanted via the ＂landing strip＂ technique. A 25-gauge microvitreoretinal blade was used to bisect the trabecular meshwork to less than 1 clock-hour, effectively creating a landing strip. The iStent applicator was pressed along the landing strip and then the stent was released into the trabecular meshwork. RESULTS：Of the 34 eyes with iStent implantation, 27（79.4%） eyes had primary open-angle glaucoma, 6（17.6%） eyes had pseudoexfoliation glaucoma, and 1（2.9%） eye had ocular hypertension. At 6-month follow-up（n=17）, the mean number of hypotensive medications decreased from 2.2±1.2 at baseline to 0.8±1.3（P=0.05） and mean intraocular pressure decreased from 19.7±4.1 mm Hg at baseline to 16.7±2.1 mm Hg（P=0.58）. Two eyes（5.9%） required subsequent trabeculectomy. CONCLUSION：The ＂landing strip＂ technique appears to be an effective way to assist with iS tent implantation.

Long-term outcomes in patients initially responsive to selective laser trabeculoplasty

AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODSThe Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTSSeventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (&#x000b1;14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P&#x0003c;0.001, P&#x0003c;0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSIONSLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.