Comparison of microRNA expression in pseudoexfoliation syndrome with and without glaucoma.

Objective: To discuss the correlation between the peripapillary retinal nerve fiber layer (RNFL) thickness and the visual field mean defect in different periods of pseudoexfoliation glaucoma (PXG). Methods: This was a clinical case control study. In the study, samples were selected consecutively from patients who were hospitalized in the Glaucoma Department of the First Hospital of Shijiazhuang from January 2013 to January 2018. The PXG group included 97 eyes of 97 patients who were divided into an early PXG group (28 eyes), a medium PXG group (27 eyes), and a late PXG group (42 eyes). The normal control group consisted of 32 eyes of 32 people who were matched for age, gender and refractive error. All subjects underwent spectral domain optical coherence tomography (SD-OCT) scans to measure peripapillary RNFL thickness in every quadrant. The SD-OCT and the visual field measurements among the different groups were compared using analysis of variance, and the correlation between the average RNFL thickness and visual field defects were analyzed with a Pearson correlation. Results: The average RNFL thickness in the normal control group, and the early, medium and late PXG groups was 104±11 μm, 92±14 μm, 82±12 μm, and 54±18 μm, respectively. The difference between the 4 groups in nasal, nasal superior, temporal superior, temporal, temporal inferior, nasal inferior quadrants and the average RNFL thickness were all statistically significant (F=24.38, 36.40, 47.84, 8.70, 95.46, 54.75, 82.28, all P<0.001). The differences between the normal control group and the early PXG group in the temporal superior, temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences between the normal control group and the medium PXG group in the nasal, nasal superior, temporal superior, temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences in RNFL thickness between the normal control group and the late PXG group in every quadrant were statistically significant (P<0.001). The average RNFL thickness was positively correlated with visual field mean differences in the medium PXG group and the late PXG group (r=0.404, P=0.037; r=0.582, P<0.001). Conclusions: The average peripapillary RNFL thickness is positively correlated with visual field mean differences in the medium and late PXG eyes. The changes of peripapillary RNFL thickness can be monitered by SD-OCT, which can be used as an important reference index for the status and follow-up of PXG. Key words: optical coherence tomography; pseudoexfoliation glaucoma; peripapillary retinal nerve fiber layer thickness; visual field mean defect; correlation

To compare peripapillary vascular parameters derived from two optical coherence tomography angiography devices in pseudoexfoliation glaucoma, primary open-angle glaucoma, and healthy controls and to evaluate their diagnostic accuracy. Observational, cross-sectional study. In total, 20 eyes with pseudoexfoliation glaucoma, 20 primary open-angle glaucoma eyes matched by peripapillary retinal nerve fiber layer thickness, and 20 control eyes were recruited. Participants underwent standard automated perimetry and peripapillary retinal nerve fiber layer analysis by Optovue and Cirrus optical coherence tomography. Vascular parameters provided by Angiovue and Angioplex optical coherence tomography angiography were compared. Their diagnostic accuracy and correlation with structural and functional parameters were assessed. All peripapillary optical coherence tomography angiography vascular parameters were significantly different among groups (all p < 0.05). The whole image capillary density and peripapillary capillary density by Angiovue were significantly lower in pseudoexfoliation glaucoma compared with primary open-angle glaucoma (p = 0.009 and p = 0.001, respectively). Conversely, vascular parameters by Angioplex were not statistically different between primary open-angle glaucoma and pseudoexfoliation glaucoma. A good correlation was found using Angiovue between whole image capillary density and visual field mean deviation (0.758, p < 0.001), peripapillary capillary density and visual field mean deviation (0.729, p = 0.001), and peripapillary capillary density and peripapillary retinal nerve fiber layer thickness in eyes with pseudoexfoliation glaucoma (0.716, p = 0.001). Angiovue parameters showed higher area under the receiver operating characteristic curves than Angioplex to discriminate among groups. Only Angiovue detected a significantly lower capillary density in pseudoexfoliation glaucoma compared to primary open-angle glaucoma at similar glaucoma damage. Both, Angiovue and Angioplex demonstrated a decreased capillary density in glaucoma eyes compared to healthy eyes. Furthermore, Angiovue-derived vascular parameters showed better correlation with functional and structural parameters and a higher diagnostic capacity to discriminate among groups compared to Angioplex.

We investigated the relationship between the peripapillary retinal nerve fiber layer and peripapillary retinal thickness in patients with diabetic macular edema. Fifty eyes (group I) with non-proliferative diabetic retinopathy and diabetic macular edema receiving intravitreal anti-VEGF injection, and 90 eyes (group II) without diabetic macular edema were included in this case-control study. The peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, and a new retinal nerve fiber layer index using a modeled relationship between the two parameters were evaluated with spectral-domain optical coherence tomography, at baseline and at the 6-month follow-up. In group I, the peripapillary retinal nerve fiber layer thickness decreased from 126.4 μm at baseline to 117.6 μm at 6 months (p < 0.001), while the peripapillary retinal thickness decreased from 376.0 μm at baseline to 359.6 μm at 6 months (p < 0.001) after intravitreal anti-VEGF injection. In group II, however, both the parameters remained stable at the 6-month follow-up (100.7 to 102.1 μm and 311.1 to 316.2 μm, respectively, and all p > 0.01). Analysis with the new index to adjust for retinal edema showed no significant change from baseline to 6 months in both groups (p = 0.593 and p = 0.101, respectively). The peripapillary retinal nerve fiber layer thickness is strongly affected by the peripapillary retinal thickness. Therefore, the measured changes in peripapillary retinal nerve fiber layer thickness may not represent the real gain or loss of the retinal nerve fiber layer. Therefore, the new retinal nerve fiber layer index, which corrects for the component of macula edema, could be a better means of assessing the changes of peripapillary retinal nerve fiber layer thickness in patients with diabetic macular edema.

This cross-sectional study compared the peripapillary vessel density and retinal nerve fiber layer (RNFL) thickness in patients with exfoliation syndrome (XFS) and healthy controls for evaluation of the early structural and vascular alterations in XFS. One eye was included from 75 patients with XFS and 54 healthy controls. The patients with XFS were matched the controls for age, intraocular pressure and axial length. The vascular density of the radial peripapillary capillaries (RPCs) and the peripapillary RNFL thickness were evaluated with optical coherence tomography angiography. The mean peripapillary RNFL thicknesses of the groups were similar in all sectors (p > 0.05 for all). However, eyes with XFS demonstrated lower mean peripapillary vessel densities in all areas (p < 0.05 for all) except for the nasal sector (p = 0.68) compared to the controls. The gradual age correlated decline in the peripapillary RNFL thickness and the RPC vessel density observed in the healthy eyes was absent in XFS (r = - 0.14 p = 0.65 and r = - 0.23 p = 0.05). Alterations in the peripapillary vascular density despite a preserved RNFL thickness in XFS supports the hypothesis that vascular alterations may precede structural alterations and have an important role in the pathogenesis of XFS. XFS may have different effects on the microvasculature of different peripapillary areas, with the nasal sector being mostly preserved.

The study aimed to investigate the correlation between arterial hemodynamics measured by color Doppler ultrasonography and retinal microarchitecture parameters determined by spectral-domain optical coherence tomography (SD-OCT) in pseudoexfoliation glaucoma. This prospective study included 82 participants. Peripapillary retinal nerve fiber layer, ganglion cell inner plexiform layer, and ganglion cell complex values were measured. Ophthalmic artery and central retinal artery flows were evaluated with color Doppler ultrasonography, and resistivity index values were calculated. The study included 47 controls and 35 pseudoexfoliation glaucoma cases. In pseudoexfoliation glaucoma group, mean peripapillary retinal nerve fiber layer and ganglion cell complex thickness were statistically significantly lower in all quadrants compared to controls (p<0.001). Resistivity index values of the ophthalmic and central retinal arteries were significantly higher in pseudoexfoliation glaucoma group than in the controls (p<0.001 and r=0.684). Resistivity index values of the ophthalmic and central retinal arteries with ganglion cell complex thickness correlated significantly. On the other hand, no significant relationship for retinal nerve fiber layer thickness was identified. Structural changes (ganglion cell complex and ganglion cell inner plexiform layer) in patients with pseudoexfoliation glaucoma and early glaucomatous loss showed a significant correlation with changes in ocular vascular hemodynamics. In cases where systemic vascular resistance is increased, ganglion cell complex and ganglion cell inner plexiform layer may not exactly reflect glaucoma state. In such cases, thickness changes in the retinal nerve fiber layer may give more realistic results regarding glaucoma. We have seen that pseudoexfoliation glaucoma-induced structural deterioration and increased resistance in ocular hemodynamics correlated with ganglion cell complex, but not retinal nerve fiber layer.

Nerve Fiber Layer Thickness

Evaluation of Changes in Peripapillary Nerve Fiber Layer Thickness after Deep Sclerectomy with Optical Coherence Tomography

ABSTRACTPurposeTo evaluate peripapillary retinal nerve fiber layer (RNFL) thickness and radial peripapillary capillary (RPC) vessel density (VD) in the eyes with unilateral primary angle-closure glaucoma (PACG) with the visual field (VF) defect confined to the superior hemifield and compare these parameters with the corresponding perimetrically intact regions of the fellow eye with primary angle-closure (PAC) and normal control eyes, using optical coherence tomography angiography (OCTA).Materials and methodsThis prospective, cross-sectional study included 28 eyes with unilateral PACG, with VF defects restricted to the superior hemifield, 28 fellow eyes with PAC, and 30 age-matched normal controls. Peripapillary RNFL thickness and RPC VD were measured in the eight peripapillary sectors, using OCTA, and these parameters were compared among the corresponding sectors of PACG, PAC, and healthy eyes using analysis of variance (ANOVA) with the Bonferroni post hoc analysis.ResultsIn PACG eyes, there was a significant difference in the RNFL thickness (p < 0.0001) and RPC VD (p = 0.001) between the superior and the inferior hemifield. In PAC and normal eyes, there was no significant difference in the RNFL thickness and RPC VD between the superior and the inferior hemifield. Within the perimetrically intact regions of the PACG eyes, the mean RNFL thickness was significantly reduced in the superonasal (SN) and upper nasal (UN) sectors (p = 0.02), but the VD did not show any significant difference, when compared to the fellow PAC eyes. In PACG eyes, the mean RNFL thickness was significantly reduced in the perimetrically normal SN and UN sectors (p < 0.0001) and the VD was reduced in the UN sector (p = 0.01), when compared to the normal eyes. When comparing the peripapillary sectors of the PAC and healthy eyes, RNFL thickness was reduced in UN (p = 0.02), lower nasal (LN) (p = 0.01), inferonasal (IN) (p = 0.02), and inferotemporal (IT) sectors (p = 0.03) and there was no significant difference in the VD in any of the sectors. Inside disc capillaries were preserved in all the three groups.ConclusionSector-wise RNFL thinning seems to precede the vascular changes and functional loss in the PAC and PACG eyes.How to cite this articleMansoori T, Balakrishna N. Peripapillary Vessel Density and Retinal Nerve Fiber Layer Thickness in Patients with Unilateral Primary Angle Closure Glaucoma with Superior Hemifield Defect. J Curr Glaucoma Pract 2019;13(1):21–27.

An Evaluation of Peripapillary Retinal Nerve Fiber Layer Thickness in Children With Epilepsy Receiving Treatment of Valproic Acid

PurposeTo compare clinical findings and peripapillary retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) in affected and fellow eyes of patients with unilateral pseudoexfoliation (PXF) syndrome with that of bilateral cases.MethodsThis cross-sectional study enrolled 91 subjects with PXF including 32 unilateral and 59 bilateral cases. Subjects with elevated intraocular pressure or findings suggestive of glaucoma were excluded. RNFL thickness and optic nerve head profile were studied in all eyes using the RNFL and optic nerve head analysis OCT protocol. Clinical and OCT features were compared in affected and unaffected eyes of unilateral PXF subjects to bilateral cases.ResultsBilateral cases with PXF were older (P<0.01) and had thinner RNFL (P=0.04) than unilateral cases. From a total of 32 unilateral PXF cases, 7 subjects demonstrated RNFL thinning in the clinically normal fellow eye; all of these eyes had evidence of pupillary ruff atrophy on slit lamp examination in the absence of evident exfoliation material in the eye. Similar ruff atrophy with RNFL thinning was seen in 38 of 59 bilateral and in 16 of 32 unilateral cases. Pupillary ruff atrophy predicted RNFL thinning with sensitivity of 88.9% (95% CI, 73-96.7%) and 79.2% (95% CI, 74-84.5%) in bilateral and unilateral cases respectively, with low specificity of 45.8% (95% CI, 33.9-51.7%) and 45.5% (95% CI, 22.9-68.8%) in the same order. ConclusionPatients with bilateral PXF have significantly thinner RNFL as compared to unilateral cases. Iris sphincter abnormality, clinically detected as pupillary ruff atrophy, may reflect early glaucomatous damage; however the specificity of this sign for predicting RNFL thinning is low.

Objetivo: Avaliar o efeito da cirrose na camada de fibras nervosas da retina e na espessura da coroide através da tomografia de coerência óptica com imagem de profundidade aprimorada. Métodos: Este estudo transversal, de único centro, foi realizado no departamento de Oftalmologia da Universidade Bulent Ecevit com a participação do departamento de medicina interna em gtastroenterologia. Os pacientes que foram tratados com o diagnóstico de cirrose (n = 75) foram examinados na clínica da oftalmologia. Foram incluídos pacientes correspondentes em [...]

Purpose: To assess the reproducibility and repeatability of peripapillary retinal nerve fibre layer (RNFL) thickness measurements using a spectral-domain optical coherence tomography (SD-OCT) device in healthy subjects. Methods: In this observational study, 68 young Caucasian healthy volunteers (68 eyes) were subjected to Cirrus™ high-definition (HD) OCT (Zeiss) peripapillary RNFL thickness measurements by two experienced examiners in two different sessions. Average, 4-quadrant and 12-clock-hour sector RNFL thicknesses were analysed. For each option, intra-observer, intrasession repeatability and interobserver, intersession reproducibility were tested. To assess the repeatability of measurements, the Bland and Altman plots were used and the coefficient of repeatability was calculated. Interobserver and intersession reproducibilities were analysed by means of concordance correlation coefficients (CCCs). Results: The sample age ranged from 21 to 39 years (mean 29.09, standard deviation ±5.21). The average RNFL thickness ranged from 90.97 to 91.46 and from 91.34 to 91.78 µm, for the first and the second operator, respectively. The highest repeatability and reproducibility were obtained for average RNFL thickness with coefficients of repeatability of 5.30 and 6.05 µm for the first and the second operator, interoperator CCCs of 0.95 and 0.96 for the first and the second session, and intersession CCCs of 0.96 and 0.97 for the first and the second operator, respectively. Conclusions: Cirrus OCT peripapillary average RNFL thickness measurement in young healthy subjects showed high interoperator and intersession reproducibility. Intrasession repeatability as tested by coefficient of repeatability was next to the device resolution, with very similar results between the two operators. When analysing quadrant and clock hour sector RNFL thickness measurements, both repeatability and reproducibility tend to decrease.

Objectives: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods: This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. Results: A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups (p = 0.17), from 22.8 ± 0.7 to 13.3 ± 0.6 mmHg (p < 0.001; POAG) and from 24.3 ± 0.8 to 16.6 ± 1.2 mmHg (p < 0.001; PEXG). The number of IOP-lowering medications decreased comparably (p = 0.99), from 3.1 ± 0.1 to 1.7 ± 0.3 (p = 0.001; POAG) and from 3.4 ± 0.1 to 1.7 ± 0.2 (p < 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups (p = 0.31), from 60.6 ± 1.9 to 54.2 ± 2.4 µm (p < 0.001; POAG) and from 63.1 ± 1.7 to 58.0 ± 2.3 µm (p < 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively (p = 0.01). The qualified success rates were 63% and 40% (p = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes (p = 0.04). Conclusions: DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.

Automated Evaluation of Parapapillary Choroidal Microvasculature in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

To develop an automated method for the quantification of volumetric optic disc swelling in papilledema subjects using spectral-domain optical coherence tomography (SD-OCT) and to determine the extent that such volumetric measurements correlate with Frisén scale grades (from fundus photographs) and two-dimensional (2-D) peripapillary retinal nerve fiber layer (RNFL) and total retinal (TR) thickness measurements from SD-OCT. A custom image-analysis algorithm was developed to obtain peripapillary circular RNFL thickness, TR thickness, and TR volume measurements from SD-OCT volumes of subjects with papilledema. In addition, peripapillary RNFL thickness measures from the commercially available Zeiss SD-OCT machine were obtained. Expert Frisén scale grades were independently obtained from corresponding fundus photographs. In 71 SD-OCT scans, the mean (± standard deviation) resulting TR volumes for Frisén scale 0 to scale 4 were 11.36 ± 0.56, 12.53 ± 1.21, 14.42 ± 2.11, 17.48 ± 2.63, and 21.81 ± 3.16 mm(3), respectively. The Spearman's rank correlation coefficient was 0.737. Using 55 eyes with valid Zeiss RNFL measurements, Pearson's correlation coefficient (r) between the TR volume and the custom algorithm's TR thickness, the custom algorithm's RNFL thickness, and Zeiss' RNFL thickness was 0.980, 0.929, and 0.946, respectively. Between Zeiss' RNFL and the custom algorithm's RNFL, and the study's TR thickness, r was 0.901 and 0.961, respectively. Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SD-OCT volumes, with the mean volume appearing to be roughly linearly related to the Frisén scale grade. Using such an approach can provide a more continuous, objective, and robust means for assessing the degree of disc swelling compared with presently available approaches.