Cup-disc Ratio Research Articles

Evaluation of the different methods of optic disc examination in glaucomatous patients

Background Glaucoma is a leading cause of blindness worldwide. Many patients discover glaucoma accidentally during regular checkups. Purpose To evaluate the agreement using slit lamp biomicroscopy, stereoscopic fundus photography, and optical coherence tomography (OCT) in the evaluation of the optic disc area, the cup area, and the vertical cup disc ratio (VCDR) in glaucomatous patients. Patients and methods This cross-sectional observational study includes 28 eyes of glaucomatous patients. All patients underwent slit lamp biomicroscopy using a +90 D lens, stereoscopic fundus photography using a computerized program to measure the optic disc parameters, and OCT for optic disc evaluation. Three examiners did the analysis. Results Comparing results obtained on stereoscopic fundus photography and OCT, examiner one reported moderate reliability regarding disc area, cup area, and the VCDR with an intraclass coefficient (ICC) of 0.67, 0.67, and 0.50 and P values of 0.68, 0.61, and 0.01, respectively. Examiner two reported moderate reliability regarding disc area, cup area, and VCDR with an ICC of 0.66, 0.63, and 0.54 and P values of 0.16, 0.69, and 0.03, respectively. Examiner three reported moderate reliability regarding disc area and VCDR with an ICC of 0.65, 0.71, and P values of 0.69 and 0.07, respectively. A good reliability for the cup area was reported with an ICC of 0.82 and a P value of 0.02. The slit lamp and stereoscopic fundus photos showed moderate reliability compared with fundus photography values. Conclusion There is an agreement between values obtained by slit lamp biomicroscopy, stereoscopic fundus photography, and OCT.

Contrast Sensitivity Is Impaired in Suspected Primary Open-Angle Glaucoma Patients.

To assess spatial contrast sensitivity (CS) in suspected primary open-angle glaucoma (POAG) patients. CS was measured using sinusoidal gratings of 4 cycles/degree. First, foveal and peripheral CS were assessed in 34 suspected POAG patients and compared with 71 and 28 age-matched healthy individuals for foveal and peripheral conditions, respectively. Second, foveal CS was assessed in 34 early POAG patients age-matched with suspected POAG patients. Analyses were performed considering two age ranges: Under and Over 50 y.o. Correlations were evaluated between CS and clinical parameters. Diagnostic accuracy was also analyzed. Peripheral CS was lower in older suspected POAG patients (23.4 ± 16.1) than the control group (39.1 ± 28.2) (p = 0.040). Foveal CS was reduced in suspected POAG participants (Under 50: 146.8 ± 63.3; p = 0.004. Over 50: 110.5 ± 65.0; p = 0.044) and in early POAG patients (Under 50: 141.2 ± 72.6; p = 0.002. Over 50: 80.2 ± 54.5 p < 0.001), both compared to the control group (Under 50: 213.5 ± 66.2. Over 50: 138.6 ± 71.7). CS was lower in early POAG than in POAG suspected in older patients (p = 0.042). Foveal CS was correlated with age (Early: p = 0.001. Suspect: p = 0.002) and with the cup-disc ratio only in early POAG patients (p < 0.001). Foveal CS had fair (AUC = 0.74) diagnostic accuracy for early POAG patients. CS in suspected POAG patients is lower than in healthy individuals. Our findings evidence the spatial vision loss before the onset of POAG.

The Clinical Usefulness of a Glaucoma Polygenic Risk Score in 4 Population-Based European Ancestry Cohorts

ObjectiveWe used a polygenic risk score (PRS) to identify high-risk groups for primary open-angle glaucoma (POAG) within population-based cohorts. DesignSecondary analysis of four prospective population-based studies. ParticipantsWe included four European-ancestry cohorts: the United States (US) based Nurses’ Health Study (NHS), NHS2, and the Health Professionals Follow-up Study, and the Rotterdam Study (RS) in the Netherlands. The US cohorts included female nurses and male health professionals aged 55+ years. The RS included residents aged 45 years or older living in Rotterdam, the Netherlands. MethodsPRS weights were estimated by applying the Lassosum method on imputed genotype and phenotype data from the UK-Biobank. This resulted in 144,020 variants, single nucleotide polymorphism (SNPs) and indels, with non-zero betas that we used to calculate a PRS in the target populations. Using multivariable Cox proportional hazard models, we estimated the relationship between the standardized PRS and relative risk for POAG. Additionally, POAG prediction was tested by calculating these models’ concordance (Harrell’s C-statistic). Finally, we assessed the association between PRS tertiles and glaucoma-related traits. Main Outcome MeasuresThe relative risk for POAG and Harrell’s C-statistic (the equivalent of an area-under-the-curve for longitudinal models). ResultsAmong 1,046 cases and 38,809‬ controls, the relative risk (95% confidence interval) for POAG for participants in the highest PRS quintile was 3.99 (3.08, 5.18) in the US cohorts, and 4.89 (2.93, 8.17) in the Rotterdam Study, compared with participants with median genetic risk (3rd quintile). In restricted cubic spline analyses, the relation between continuous PRS and POAG risk increased exponentially in the US and Rotterdam cohorts (Pspline<0.05). Combining age, sex, intraocular pressure >25 mmHg, and family history resulted in a meta-analyzed concordance of 0.75 (0.73, 0.75). Adding the PRS to this model improved the concordance to 0.82 (0.80, 0.84). In a meta-analysis of all cohorts, cases in the highest tertile had a larger cup-disc ratio at diagnosis, by 0.11 (0.07, 0.15), and a 2.07-fold increased risk of requiring glaucoma surgery (1.19, 3.60). ConclusionsIncorporating a PRS into a POAG predictive model improves identification concordance from 0.75 up to 0.82, supporting its potential for guiding more cost-effective screening strategies.

Best Vitelliform Macular Dystrophy Presenting with Choroidal Neovascular Membrane in an Adolescent: A Case Report and a Review of the Literature

Abstract An 11-year-old boy presented to the retina outpatient clinic with a -5-year history of poor vision in the left eye. The best corrected visual acuity at presentation was 6/5 and 6/36, respectively, in the right and left eyes. Ocular examination revealed normal anterior segments in both eyes. Binocular indirect ophthalmoscopy of the right eye revealed a pink disc with a cup disc ratio (CDR) of 0.3, normal vessels while the macula had a yellowish lesion with a scrambled egg appearance and surrounding dome-shaped subretinal fluid with a flat retina and no treatable peripheral retinal lesions. The left eye had a pink disc with CDR O.3, normal vessels with a hyperpigmented lesion at the macula surrounded by a small cuff of subretinal fluid with a flat retina and no treatable peripheral retinal lesions. Optical coherence tomography scan revealed subretinal fluid in both eyes with an active choroidal neovascular membrane in the left eye. He was advised on the need for left intravitreal anti-vascular endothelial growth factor injections.

Linking physiology and demographics, non-ocular pathology and pharmaceutical drug use to standard OCT measures of the inner retina: The PPP project.

To assess the associations between physiology and demographics, non-ocular pathology and pharmaceutical drug use against peri-papillary retinal nerve fibre layer thickness (pRNFL T) and other optical coherence tomography (OCT) inner retinal measures in normal, healthy eyes. A retrospective, cross-sectional study of 705 consecutive participants with bilateral normal, healthy optic nerves and maculae. PRNFL Ts, vertical cup/disc ratio (CDR), cup volume and macular ganglion cell layer-inner plexiform layer (GCL-IPL) Ts were extracted from Cirrus OCT scans, then regressed against predictor variables of participants' physiology and demographics (eye laterality, refraction, intraocular pressure [IOP], age, sex, race/ethnicity, etc.) and non-ocular pathology and pharmaceutical drug use according to the World Health Organisation classifications. Associations were assessed for statistical significance (p < 0.05) and clinical significance (|β| > 95% limits of agreement for repeated measures). A multitude of non-ocular pathology and pharmaceutical drug use were statistically and clinically significantly associated with deviations in standard OCT inner retinal measures, exceeding the magnitude of other factors such as age, IOP and race/ethnicity. Thinner inner retina and larger optic nerve cup measures were linked to use of systemic corticosteroids, sex hormones/modulators, presence of vasomotor/allergic rhinitis and other diseases and drugs (up to -29.3 [-49.88, -8.72] μm pRNFL T, 0.31 [0.07, 0.54] vertical CDR, 0.29 [0.03, 0.54] mm3 cup volume and -10.18 [-16.62, -3.74] μm macular GCL-IPL T; all p < 0.05). Thicker inner retina and smaller optic nerve cup measures were diffusely associated with use of antineoplastic agents, presence of liver or urinary diseases and other diseases and drugs (up to 67.12 [64.92, 69.31] μm pRNFL T, -0.31 [-0.53, -0.09] vertical CDR, -0.06 [-0.11, 0] mm3 cup volume and 28.84 [14.51, 43.17] μm macular GCL-IPL T; all p < 0.05). There are a multitude of systemic diseases and drugs associated with altered OCT inner retinal measures, with magnitudes far exceeding those of other factors such as age, IOP and race/ethnicity. These systemic factors should at least be considered during OCT assessments to ensure precise interpretation of normal versus pathological inner retinal health.

Acute primary angle closure concurrent with coronavirus disease 2019 recurrence in Northern China: A retrospective multi-centre study

Aims and objectivesDuring the new coronavirus disease 2019 (COVID-19) outbreak period, there was increasing presentation in the number of patients with acute primary angle closure (APAC). This study aimed to report the occurrence of APAC during the COVID-19 post-restriction period and investigate the related characteristics of these patients with APAC. MethodsThis retrospective, multi-center study included consecutive patients seeking APAC treatment at two eye centers in China from December 7, 2022 to January 13, 2023 (post-restriction period) and from December 7, 2021 to January 13, 2022 (control period). Electronic medical records were reviewed, and ocular data of the affected eye(s) were analyzed for patients with unilateral or bilateral APAC. Information including COVID-19 related symptoms, medications used for COVID-19 infection, and living habits and emotions related to the COVID-19 outbreak during the post restriction period were collected using a questionnaire. ResultsOverall, 189 (219 APAC eyes) and 51 (54 APAC eyes) patients with APAC were identified during the post-restriction and control periods, respectively. The patients identified during the post-restriction period were younger (P = 0.043) and had a longer duration from symptoms to treatment (P = 0.039), shorter axial length (P = 0.002), larger pupil diameter (P = 0.004), larger vertical cup disc ratio (P = 0.004), poorer mean deviation values (P = 0.003), and more glaucomatous optic neuropathy diagnoses (P = 0.032) compared with the patients with APAC identified during the control period. Among 151 included patients with APAC who completed the questionnaires, 130 patients with APAC were diagnosed with concurrent COVID-19 infection, of which 54 (41.5 %) had coughing and/or vomiting as the main symptoms. Of these, 89.2 % spent 0 h per day on outdoor activity; 44.6 % drank more water than usual, with 14.6 % drinking more than twice the amount of water than usual; 91.5 % used antipyretics; and 20.0 % had mood swings, including anxiety, depression, and tension, during the concurrent COVID-19 infection. ConclusionIn our study, a significant increase in the number of patients presenting with APAC with certain characteristics was observed during the COVID-19 post-restriction period. And whether COVID-19 symptoms, such as coughing and vomiting, and behavioral and psychological changes caused by COVID-19 infection contributing to the concurrence of APAC and COVID-19 recurrence require further investigation.

Optic cup morphology associated with glaucomatous damage: Findings from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study

PurposeWhile it has been well established that advanced glaucoma is associated with a large cup-to-disc ratio (CDR), it is not known if the shape of the cup, particularly excavated cups with expanded lower portions (bean-pot cups), play any additional role in glaucomatous damage. We investigated this among individuals of African ancestry, a population that is more vulnerable to glaucoma than any other ethnic group. DesignCase-control study Methods SettingInstitutional (University of Pennsylvania) Subjects3,255 eyes from 1,734 glaucoma cases from the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. ProcedureTwo graders independently assessed quantitative and qualitative aspects of the optic cup, with any discrepancies adjudicated by an ophthalmologist. The predominant cup shape (>50 %) was chosen in cases in which features of two or more cup shapes were present in the same eye. Comparisons of demographic and ocular characteristics among three cup shape groups (conical, cylindrical, and bean-pot) performed using generalized linear models, and generalized estimated equations applied to account for inter-eye correlation. Main Outcome MeasuresQualitative features of cup shape and phenotypic traits, in conjunction with demographic and genetic information. ResultsOf 3,255 eyes, a total of 1,339 (41.1 %) exhibit a conical cup shape, 1,470 (45.2 %) have a cylindrical cup shape, and 446 (13.7 %) display a bean-pot cup shape. Compared to other cup morphology, bean-pot cups are significantly associated with lower MD, larger CDR, higher IOP, thinner RNFL, and worse VA in logMAR (all p < 0.001). Genetic analysis does not show any association between various genetic variants and cup shape. Factors independently predictive of bean-pot cupping include younger age at diagnosis (aOR 0.96 per 1 year increase in age of enrollment, p < 0.0001), CDR (adjusted odds ratio (aOR) 1.87, p < 0.0001), and the presence of certain optic disc features, including visible pores in the LC (aOR 2.76, p < 0.0001), nasalization of vessels (aOR 2.64, p < 0.0001), and vessel bayonetting (aOR 2.94, p < 0.0001). ConclusionThis study shows the clinical significance of different cup shapes in glaucoma in an African ancestry population and suggests that bean-pot cups are associated with the most severe glaucomatous damage, independent of cup-disc ratio. This association should be considered when determining prognosis following glaucoma interventions.

Research on segmentation model of optic disc and optic cup in fundus

BackgroundGlaucoma is a worldwide eye disease that can cause irreversible vision loss. Early detection of glaucoma is important to reduce vision loss, and retinal fundus image examination is one of the most commonly used solutions for glaucoma diagnosis due to its low cost. Clinically, the cup-disc ratio of fundus images is an important indicator for glaucoma diagnosis. In recent years, there have been an increasing number of algorithms for segmentation and recognition of the optic disc (OD) and optic cup (OC), but these algorithms generally have poor universality, segmentation performance, and segmentation accuracy.MethodsBy improving the YOLOv8 algorithm for segmentation of OD and OC. Firstly, a set of algorithms was designed to adapt the REFUGE dataset’s result images to the input format of the YOLOv8 algorithm. Secondly, in order to improve segmentation performance, the network structure of YOLOv8 was improved, including adding a ROI (Region of Interest) module, modifying the bounding box regression loss function from CIOU to Focal-EIoU. Finally, by training and testing the REFUGE dataset, the improved YOLOv8 algorithm was evaluated.ResultsThe experimental results show that the improved YOLOv8 algorithm achieves good segmentation performance on the REFUGE dataset. In the OD and OC segmentation tests, the F1 score is 0.999.ConclusionsWe improved the YOLOv8 algorithm and applied the improved model to the segmentation task of OD and OC in fundus images. The results show that our improved model is far superior to the mainstream U-Net model in terms of training speed, segmentation performance, and segmentation accuracy.

Standardizing the diagnosis and treatment of ocular hypertension based on evidence-based medicine

Ocular hypertension (OHT) refers to a condition in which the intraocular pressure increases without causing glaucomatous optic nerve changes or visual field damage. The incidence rate of OHT in people over 40 years old is as high as 4% to 10%. According to the OHT Treatment Study (OHTS), the incidence of primary open angle glaucoma (POAG) among OHT patients is increasing year by year, so it is necessary to conduct long-term follow-up. This article elaborates on five major risk factors for the progression of OHT to POAG: age, intraocular pressure, vertical cup-disc ratio, pattern standard deviation of visual field, and central corneal thickness. It also summarizes other potential risk factors, such as long-term fluctuations in intraocular pressure, asymmetry of intraocular pressure and visual field between the two eyes, structural phenotypes of the optic disk, and optic disk hemorrhage. Predicting the risk of OHT progression to POAG based on risk factors, patients with different risk levels require different timing for treatment initiation and follow-up intervals. Those with higher risks should start preventive treatment earlier and have shorter follow-up intervals. Both drug therapy and selective laser trabeculoplasty can serve as initial treatment options for OHT. Combining evidence-based medicine research and individualized evaluation of treatment can enhance the clinical diagnosis and treatment level of OHT.

Evaluation of Intrascleral Lakes after Phaco-Viscocanalostomy using Anterior Segment Optical Coherence Tomography.

This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary open-angle glaucoma (POAG). In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup-disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 7.22 mmHg on 2.47 1.1 medications, and the mean postoperative IOP reduced to 11.11 2.58 mmHg on 0.11 medications, which was statistically significant (P 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP.

Use of Diagnostic Codes for Primary Open-Angle Glaucoma Polygenic Risk Score Construction in Electronic Health Record–Linked Biobanks

Polygenic risk scores (PRSs) likely predict risk and prognosis of glaucoma. We compared the PRS performance for primary open-angle glaucoma (POAG), defined using International Classification of Diseases (ICD) codes versus manual medical record review. Retrospective cohort study METHODS: We identified POAG cases in Mount Sinai BioMe and Mass General Brigham (MGB) biobank using ICD codes. We confirmed POAG based on optical coherence tomograms and visual fields. In a separate 5% sample, the absence of POAG was confirmed with intraocular pressure and cup-disc ratio criteria. We used genotype data and either self-reported glaucoma diagnoses or ICD-10 codes for glaucoma diagnoses from the UK Biobank and the lassosum method to compute a genome-wide POAG PRS. We compared the area under the curve (AUC) for POAG prediction based on ICD codes versus medical records. We reviewed 804 of 996 BioMe and 367 of 1,006 MGB ICD-identified cases. In BioMe and MGB, respectively: positive predictive value was 53% and 55%; negative predictive value was 96% and 97%; sensitivity was 97% and 97%; and specificity was 44% and 53%. Adjusted PRS AUCs for POAG using ICD codes vs. manual record review in BioMe were not statistically different (p≥0.21) by ancestry: 0.77 vs. 0.75 for African, 0.80 vs. 0.80 for Hispanic, and 0.81 vs. 0.81 for European. Results were similar in MGB (p≥0.18): 0.72 vs. 0.80 for African, 0.83 vs. 0.86 for Hispanic, and 0.74 vs. 0.73 for European. A POAG PRS performed similarly using either manual review or ICD codes in two EHR-linked biobanks; manual assessment of glaucoma status might be unnecessary for some PRS studies. However, caution should be exercised with using ICD codes for glaucoma diagnosis given their low specificity (44-53%) for manually confirmed cases of glaucoma.

Automated Classification of Physiologic, Glaucomatous, and Glaucoma-Suspected Optic Discs Using Machine Learning.

In order to generate a machine learning algorithm (MLA) that can support ophthalmologists with the diagnosis of glaucoma, a carefully selected dataset that is based on clinically confirmed glaucoma patients as well as borderline cases (e.g., patients with suspected glaucoma) is required. The clinical annotation of datasets is usually performed at the expense of the data volume, which results in poorer algorithm performance. This study aimed to evaluate the application of an MLA for the automated classification of physiological optic discs (PODs), glaucomatous optic discs (GODs), and glaucoma-suspected optic discs (GSODs). Annotation of the data to the three groups was based on the diagnosis made in clinical practice by a glaucoma specialist. Color fundus photographs and 14 types of metadata (including visual field testing, retinal nerve fiber layer thickness, and cup-disc ratio) of 1168 eyes from 584 patients (POD = 321, GOD = 336, GSOD = 310) were used for the study. Machine learning (ML) was performed in the first step with the color fundus photographs only and in the second step with the images and metadata. Sensitivity, specificity, and accuracy of the classification of GSOD vs. GOD and POD vs. GOD were evaluated. Classification of GOD vs. GSOD and GOD vs. POD performed in the first step had AUCs of 0.84 and 0.88, respectively. By combining the images and metadata, the AUCs increased to 0.92 and 0.99, respectively. By combining images and metadata, excellent performance of the MLA can be achieved despite having only a small amount of data, thus supporting ophthalmologists with glaucoma diagnosis.

Retinal morphological differences in atypical Parkinsonism: A cross-sectional analysis of the AlzEye cohort

ObjectiveAtypical Parkinsonian syndrome (APS) describes a heterogeneous group of disorders mimicking the clinical presentation of Parkinson disease (PD) but with disparate natural history and pathophysiology. While retinal markers of PD are increasingly described, APS has been afforded less attention possibly owing to its lower prevalence. Here, we investigate retinal morphological differences in individuals with APS in a large real world cohort. MethodsWe conducted a cross-sectional analysis of the AlzEye study, a retrospective cohort where ophthalmic data of individuals attending Moorfields Eye Hospital between January 2008 and March 31st 2018 (inclusive) has been linked with systemic disease data through national hospital admissions. Retinal features were extracted from macula-centered color fundus photography (CFP) and optical coherence tomography (OCT) and compared between individuals with APS and those unaffected. Individuals with idiopathic PD were excluded. Retinal neural and vascular features were measured using automated segmentation and analyzed with multivariable-adjusted regression models. ResultsAmong a cohort of 91,170 patients, there were 51 patients with APS and 91,119 controls. Individuals with APS were older and more likely to have hypertension and diabetes mellitus. After adjusting for age, sex, hypertension and diabetes melitus, individuals with APS had a thinner ganglion cell-inner plexiform layer (-3.95 microns, 95% CI: −7.53, −0.37, p = 0.031) but no difference in other retinoneural or retinovascular indices. Optic nerve cup-to-disc ratio was similar between groups. ConclusionOur cross-sectional analysis of the AlzEye cohort reveals distinct retinal morphological characteristics in APS compared to healthy controls. The study notably identifies a thinner ganglion cell-inner plexiform layer in APS patients, without accompanying changes in the inner nuclear layer or significant alterations in retinovascular indices and optic nerve cup-disc ratio. These changes are distinct from those observed in PD, where thinning of the inner nuclear layer (INL) is a characteristic feature. SignificanceThese findings demonstrate a retinal phenotype in APS, markedly different from both healthy controls and idiopathic Parkinson's disease, highlighting the potential of retinal imaging in differentiating neurodegenerative disorders. By establishing a distinct retinal phenotype for APS, our findings underscore the potential of retinal imaging as a valuable, non-invasive diagnostic tool. This advancement is particularly significant for enhancing diagnostic accuracy, facilitating early detection, and offering a window into the underlying disease mechanisms in APS, thereby aiding in the development of targeted therapeutic interventions and personalized patient care strategies.

A Suspicious Cup Disc with High Intraocular Pressure (IOP) and Normal Perimetry: A Rare Self Case Report

Background: Intraocular pressure (IOP) assessment involves evaluating the force exerted by aqueous humor on the internal surface of the anterior eye. Elevated IOP poses a substantial risk for glaucomatous optic neuropathy and is a key modifiable clinical risk factor. This study aims to explore cases of ocular hypertension coupled with optic nerve cupping, suspected to be glaucoma, providing comprehensive details of examination results, diagnosis, and subsequent management.&#x0D; Case presentation: A 23-year-old Asian male underwent an ocular examination, revealing average IOP levels measured using non-contact tonometry. Despite no complaints, consecutive measurements noted 28 mmHg for the right eye and 26 mmHg for the left eye. Initial assessments by a glaucoma specialist indicated open-angle anterior chambers. Optical coherence tomography revealed cup disc ratios of 0.7 to 0.8 for both eyes. Medication (Timol) was prescribed, adjusting with oral citicoline and brinzolamide. The diagnosis evolved to juvenile open-angle glaucoma (JOAG). Visual field testing showed normal results. Discontinuation of treatment led to reclassifying the diagnosis as ocular hypertension and scheduling follow-up OCT examinations for five years.&#x0D; Conclusion: The patient exhibited corneal thickness ≥610 μm, CDR ≥0.7 μm, IOP &gt;25 mmHg, and maintained good visual field conditions. Additional research is essential to understand the correlation between corneal thickness and other eye conditions. Recognizing potential overdiagnosis due to high IOP and large CDR emphasizes the need for meticulous clinical assessment and advanced diagnostic examinations to distinguish physiological and pathological conditions.

Steroid Induced Glaucoma and Primary Angle Closure Glaucoma: A Case Report of Mixed Mechanism Glaucoma

Introduction : Steroid induced glaucoma is a form of secondary open angle glaucoma (OAG) caused by adverse effects of steroid usage. Primary angle closure glaucoma (PACG) is characterized by shallow anterior chamber accompanied by peripheral anterior synechiae (PAS), elevated IOP and glaucomatous optic neuropathy (GON).&#x0D; Case Illustration : A 58 year-old woman presented with red eye, blurry vision, pain in her right eye radiating to the head, watery eye and halo. History of experiencing recurrent red eye, improving after taking steroid topical drug for about 3 months. Visual acuity 6/20 ph 6/20, IOP 39 mmHg, mixed conjunctival injection, shallow anterior chamber Van Herick 1-2, dilated pupil and iris pigment on anterior capsule of lens. Posterior segment showed glaucomatous optic neuropathy with cup disc ratio 0.8-0.9, anterior chamber depth 2.58, and thinning of optic nerve head layer. Patient was diagnosed with steroid induced glaucoma and mixed mechanism PACG. The patient underwent trabeculectomy procedure after mannitol injection was given to reduce IOP.&#x0D; Discussion : We diagnosed the patient with steroid induced glaucoma and mixed mechanism PACG based on history, clinical findings, and diagnostics. Steroid raised IOP by accumulating polymerized glycosaminoglycans (GAGs) in the trabecular meshwork, producing "biologic edema" thus increased outflow resistance. PACG was determined based on Van Herick and anterior chamber depth. Trabeculectomy remains an effective treatment in this case where medications were failed to control IOP.&#x0D; Conclusion : Steroid induced glaucoma commonly found in OAG, definitive treatment includes halting steroid drugs and trabeculectomy. Further follow-up is needed to evaluate angle closure mechanism.

Silent Progressive Glaucoma in Encephalofacial angiomatosis (Sturge-Weber Syndrome): A Vision-Preserving Trabeculectomy

Introduction : Encephalofacial angiomatosis, also known as Sturge-Weber Syndrome (SWS), is a rare, non- hereditary condition affecting multiple organs. Glaucoma occurs in almost 70% SWS children, more commonly when the port-wine stain involves the upper eyelid skin. Secondary glaucoma was present due to elevated venous pressure.&#x0D; Case Illustration : An 8-year-old boy with typical port-wine stain involving eyelid, came with recurrent painful right eye (RE) and headache in the past 3 months. He was diagnosed with SWS at 1 year and was on daily doses of carbamazepine and valproic acid for seizure control. His best visual acuity and intraocular pressure were 0.5/60 RE, 6/38 LE, 38 mmHg RE, 28 mmHg LE, respectively. Examination revealed Cup-disc-ratio (CDR) 0.9-1.0 RE and 0.5-0.6 LE. During the first three months, he showed favourable outcome with timolol and latanoprost (controlled IOP with target of &lt;12 mmHg and markedly similar Cup-Disc Ratio). However, at 4th and 5th month visit, his IOP significantly increased despite of additional regiments, thus underwent trabeculectomy on both eyes for preserving his sight. After procedure, his IOP remained stable &lt;12mmHg with maintained bleb, deep anterior chamber, also attached posterior segment.&#x0D; Discussion : Treatments of secondary glaucoma of SWS typically involved surgery with significantly lower success rate compared to Primary Congenital Glaucoma. Trabeculectomy or tube shunt surgery should be performed with caution due to risks of choroidal effusion and hemorrhages.&#x0D; Conclusion : Secondary glaucoma in children with SWS is common and challenging. Trabeculectomy should be pursued when the benefit outweighs the risks, even with a slim chance, to preserve the vision.

The Correlation between Retinal Nerve Fibre Layer Thickness, Optic Nerve Head Parameter, and Related Risk Factor in Glaucoma Patient

Introduction &amp; ObjectivesTo investigate the correlation between retinal nerve fibre layer (RNFL) thickness and the past RNFLthickness, related risk factor (gender, age, myopia, intraocular pressure (IOP), blood pressure). AndRNFL parameter (symmetricity and four quadrants RNFL thickness) and optic nerve head parameter(rim area and vertical cup disc ratio)&#x0D; Methods39 right eyes of both sex and various age underwent examination including IOP measurement,subjective refraction for determining refractive error, and optical coherence tomography (OCT) forRNFL and ONH analysis. The follow up were done after one year.&#x0D; ResultsThe RNFL symmetricity, superior, nasal, inferior, temporal RNFL thickness showed significancecorrelation with RNFL thickness (R= 0.487, p= 0.002), (R= 0.915, R= 0.749, R= 0.897, R= 0.702with p= &lt;0.001), but not showed significance correlation with rim area and vertical cup disc ratio(R= 0.175, p= 0.286) and (R= -0.093, p= 0.574). A significance correlation also showed withincreasing age, gender, and systolic blood pressure (R= -0.387, p= 0.015), (R= 0.441, p= 0.005) and(R= -0.418, p= 0.008). But not showed significance correlation with history of past RNFL thickness,refractive error, IOP, and diastolic blood pressure (R= 0.258, p= 0.113), (R= 0.005, p= 0.975), (R=-0.234, p=0.152), and (R= 0.060, p=0.717).&#x0D; ConclusionRNFL thickness measurements showed significance correlation with RNFL parameter. It is not clearif past RNFL thickness, refractive error and IOP related with RNFL thickness even showedsignificance correlation with age, gender, and systolic blood pressure.

THE CORRELATION BETWEEN RETINAL NERVE FIBRE LAYER THICKNESS, OPTIC NERVE HEAD PARAMETER, AND RELATED RISK FACTOR IN GLAUCOMA PATIENT

Introduction and Objective: To investigate the correlation between retinal nerve fibre layer (RNFL) thickness and the past RNFL thickness, related risk factor (gender, age, myopia, intraocular pressure (IOP), blood pressure). And RNFL parameter (symmetricity and four quadrants RNFL thickness) and optic nerve head parameter (rim area and vertical cup disc ratio) Methods: 39 right eyes of both sex and various age underwent examination including IOP measurement, subjective refraction for determining refractive error, and optical coherence tomography (OCT) for RNFL and ONH analysis. The follow up were done after one year. Result: The RNFL symmetricity, superior, nasal, inferior, temporal RNFL thickness showed significance correlation with RNFL thickness (R= 0.487, p= 0.002), (R= 0.915, R= 0.749, R= 0.897, R= 0.702 with p= &lt;0.001), but not showed significance correlation with rim area and vertical cup disc ratio (R= 0.175, p= 0.286) and (R= -0.093, p= 0.574). A significance correlation also showed with increasing age, gender, and systolic blood pressure (R= -0.387, p= 0.015), (R= 0.441, p= 0.005) and (R= -0.418, p= 0.008). But not showed significance correlation with history of past RNFL thickness, refractive error, IOP, and diastolic blood pressure (R= 0.258, p= 0.113), (R= 0.005, p= 0.975), (R= -0.234, p=0.152), and (R= 0.060, p=0.717). Conclusion: RNFL thickness measurements showed significance correlation with RNFL parameter. It is not clear if past RNFL thickness, refractive error and IOP related with RNFL thickness even showed significance correlation with age, gender, and systolic blood pressure. Keywords: Glaucoma, RNFL thickness, optical coherence tomography, optic nerve head

A Case Report of Axenfeld-Rieger Anomaly

Axenfeld-Rieger (AR) syndrome is an inherited Autosomal Dominant (AD) disorder with ocular, dental, and craniofacial defects, whereas AR anomaly presents only with ocular changes. Hereby, the authors present a case report of 40-year-old male patient who reported to the Outpatient Department (OPD) with complaints of diminution of vision in Both Eyes (BE) for three years. There was a significant family history. Visual acuity was limited to hand movements in both eyes. Both eyes showed prominent Schwalbe’s line, iris atrophic patches, and ectropion uvea. Intraocular Pressure (IOP) was high in the Right Eye (RE) and within normal limits in the Left Eye (LE). No craniofacial or dental anomalies were detected. Gonioscopy revealed a closed angle with broad peripheral anterior synechiae in both eyes. Fundus examination revealed a Cup Disc Ratio (CDR) of 0.5 in the RE and 0.9 in the LE. AR anomaly is a rare case. Long-term follow-up of these cases is as important as early diagnosis and treatment to prevent blindness.

Superior segmental optic nerve hypoplasia with normotensive glaucoma: A case report

We report a 27-year-old woman with a cup disk ratio of 0.75:1, with a focal superior neuroretinal rim loss and corresponding nerve fiber layer defect in both eyes. Intraocular pressure was 10 mm Hg in both eyes with normal anterior segment. Perimetry showed inferior arcuate defects in both eyes. A diagnosis of superior segmental optic nerve hypoplasia (SSOH) was made. On follow-up, there was progression in field defects, which were confirmed by repeat field tests, despite normal intraocular pressures. We concluded that there was coexisting normotensive glaucoma (NTG) in this patient.