Glaucomatous Disc Research Articles

Location of Disc Hemorrhage and Direction of Progression in Glaucomatous Retinal Nerve Fiber Layer Defects

To investigate the relationship between glaucomatous disc hemorrhage (DH) location with respect to the nasal or temporal margin of the retinal nerve fiber layer defect (RNFLD) and the direction of RNFLD widening. This is a retrospective, cross-sectional study. Patients with any documented episode of glaucomatous DH throughout the follow-up period, and definite RNFLD widening on retinal nerve fiber layer photographs were analyzed. The location of DH was recorded as either nasal or temporal, and the direction of RNFLD widening was investigated. The laterality of DH location on the RNFLD border and the direction of RNFLD widening were correlated with each other. We also compared clinical parameters between eyes with nasal versus temporal margin DHs. We analyzed 123 eyes from 116 patients with definite widening of the RNFLD and glaucomatous DH at the border between the healthy and damaged retinal nerve fiber layer. The most common diagnosis was normal-tension glaucoma (109, 87.9%). The most frequent location of DH was the temporal margin of an inferotemporal RNFLD (75, 61.0%), and the most frequent pattern of change in RNFLD was temporal widening (89, 72.4%). The absolute congruency was 82.9% and the total congruency was 99.2%. No significant differences were identified between eyes with nasal versus temporal margin DHs. The lateral location of DH on the RNFLD border was highly congruent with the direction of RNFLD widening. This correspondence of laterality between DH development and progression of RNFLD may suggest an intimate structural relationship during the pathogenesis of DH, at the enlarging RNFLD border.

The Profile and Management of Glaucoma in Adult Aphakic Patients Following Complicated Cataract Surgery.

ObjectivesTo determine the profile and clinical course of glaucoma in adult aphakic patients following complicated cataract surgery.Materials and MethodsRetrospective chart review of 22 adult aphakic patients (29 eyes) with glaucoma.ResultsMean age was 57.69±14.18 years when aphakia occurred. Mean age at time of presentation to our glaucoma clinic was 62.57±12.47 years. Mean follow-up time was 42.83±57.04 months. Changes between the first and last follow-up visits were as follows: mean intraocular pressure decreased from 26.21±13.86 mmHg to 18.14±9.63 mmHg (p=0.003); mean number of glaucoma medications used increased from 1.41±1.27 to 2.07±1.04 (p=0.005); and mean vertical cup/disc ratio increased from 0.69±0.25 to 0.78±0.24 (p=0.024). Glaucoma was managed using medications in 26 eyes (89.7%), whereas 3 eyes underwent surgical treatment. However, surgery alone was not sufficient to control intraocular pressure and additional glaucoma medications were needed.ConclusionPrevention of glaucomatous optic neuropathy in aphakic patients is challenging both medically and surgically. Although a significant decrease in intraocular pressure can be achieved with glaucoma medications, glaucomatous disc changes may progress.

Shared Cared for Stable Glaucoma Patients: Economic Benefits and Patient-centered Outcomes of a Feasibility Trial.

The purpose of this article is to assess the quality of care and economic benefits of a shared care model managing patients with stable glaucoma in a primary eye care (PEC) clinic compared with a tertiary specialist outpatient clinic (SOC) in Singapore. A randomized equivalence feasibility trial was preformed comparing the PEC with SOC models. Participants recruited from the SOC had no visual field progression or change in management for at least 3 years, were on a maximum of a single glaucoma medication, had no previous tube-shunt implant and were at least 3-year posttrabeculectomy surgery.Primary outcomes were clinical assessment and management, economic benefits, and patient satisfaction. Differences were analyzed using equivalence testing and generalized odds ratios. The trial included 233 patients, consisting of 42.1% glaucoma disc suspects (PEC: 47.4%; SOC: 36.8%), 27.5% primary angle closure suspects (PEC: 25.0%; SOC: 29.9%), 13.7% with ocular hypertension (PEC: 13.8%; SOC: 13.7%), 3.9% with primary angle closure glaucoma (PEC: 4.3%; SOC: 3.4%), and 3.0% with primary open angle glaucoma (PEC: 1.7%; SOC: 4.3%). Glaucoma clinical care for patients at PEC was as good as SOC [rate difference, 6.83%; 95% confidence interval (CI), 2.84-11.12) and management (rate difference, 7.69%; 95% CI, 3.21-12.17). In 23 cases (9.9%), 5.2% at PEC and 14.5% at SOC, there was disconcordance with the gold standard of senior consultant. Patient satisfaction at the PEC was equally high when compared with SOC (generalized odds ratio, 1.43; CI, 0.50-2.00). Direct costs per patient visit were 43% lower at PEC compared with SOC. Managing stable glaucoma patients at a primary care setting is a cost saving, safe, and effective shared care while enhancing professional collaboration between hospital and community settings.

Gonioscopic features of pseudoexfoliation syndrome and its relation with glaucoma

Aim: The aim is to determine the gonioscopic features of pseudoexfoliation (PXF) and to study its relation with glaucoma as measured by intraocular pressure (IOP) and optic nerve head changes. Materials and Methods: A cross-sectional study was conducted among forty eyes with PXF at a tertiary care center in South India from March 2016 to March 2017. Corrected IOP based on central corneal thickness was recorded and gonioscopic examination was done to grade angle, detect PXF deposits in angle and grade trabecular meshwork and sampaolesi line (SL). Eyes were dilated for glaucomatous optic disc change and optical coherence tomography was done to record retinal nerve fiber layer thickness. Data were entered in Microsoft Excel and frequency of different variables was calculated. Statistical analysis was done using Chi-square test and t-test as applicable. Results: Thirteen eyes had Grade 4 pigmentation, of which seven eyes had high IOP and ten had disc damage. Seven eyes had PXF in angle with glaucomatous change in four eyes. Two eyes had occludable angle with both eyes having glaucomatous change. SL was seen in 15 eyes. Conclusion: Pigmentation of trabecular meshwork, pseudoexfoliation deposits in angle and occludable angle in gonioscopy have positive correlation with high IOP and degree of glaucomatous disc damage. This study proves the significance of gonioscopy in PXF.

Retinoschisis and neurosensory detachment in advanced focal glaucoma

Abstract Clinical case A 71-year-old woman with normotensive primary open-angle glaucoma presented with an asymptomatic temporal peripapillary retinoschisis, associated with serous retinal detachment in the eye with the more advanced glaucoma. It was located at the inferior pole of the optic disc, in the proximity of a glaucomatous focal disc defect. Discussion Although congenital optic pits are strongly related with juxta-papillary retinoschisis, retinoschisis can also arise from acquired defects in the proximity of glaucomatous optic discs. As symptoms depend on the extent of the retinoschisis, the prevalence of this complication could be greater than that reported in glaucomatous eyes.

A novel hypothesis for the pathogenesis of glaucomatous disc hemorrhage.

Disc hemorrhage is known to be associated with glaucoma development and progression. Several hypotheses have been proposed to explain the pathogenesis of disc hemorrhage in glaucoma, including mechanical and ischemic theories. However, no theory has yet provided a clear explanation of cellular-level events and related histologic findings. Moreover, research has yet to elucidate why glaucomatous disc hemorrhage occurs around the optic disc and at the margin of the retinal nerve fiber layer defect. Understanding the pathogenic mechanism of disc hemorrhage will facilitate interpretation of its clinical importance, and provide better insight into clinical practice. In this review, we sought to provide a plausible hypothesis for the development of glaucomatous disc hemorrhage that could explain the aforementioned characteristic features. We suggest a new and detailed mechanism for disc hemorrhage. Critical microscopic events are also discussed in relation to reactive gliosis in glaucoma. With proliferative reactive gliosis, fibrous glial scar forms, and we suggest that the traction force induced by glial scar formation might disrupt capillary at the border between the healthy and damaged retinal nerve fiber layer, and develop splinter-shaped peripapillary hemorrhage. In addition to glial scar formation, remodeling and deformation of lamina cribrosa beams would insult the capillary surrounding the pore of the lamina cribrosa, and lead to development of round blotch-shaped cup hemorrhage. Histopathologic confirmation of these findings should be explored in future investigations.

Compressed 3D and 2D digital images versus standard 3D slide film for the evaluation of glaucomatous optic nerve features

SynopsisClinicians can feel confident compressed three-dimensional digital (3DD) and two-dimensional digital (2DD) imaging evaluating important features of glaucomatous disc damage is comparable to the previous gold standard of stereoscopic slide...

Comparing glaucomatous disc change using stereo disc viewing and the MatchedFlicker programme in glaucoma experts and trainees

Background/aimsThe objective of this study is to evaluate the accuracy and speed of trainees and experienced glaucoma specialists using the MatchedFlicker software against the manual examination of stereoscopic disc photographs...

Relationship between Plasma Homocysteine Level and Glaucomatous Retinal Nerve Fiber Layer Defect

ABSTRACTAims: To investigate the association between plasma homocysteine levels and glaucomatous retinal nerve fiber layer (RNFL) defect in South Korean population.Materials and methods: This retrospective cross-sectional study included subjects who underwent screening at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013. Subjects underwent physical examination and provided samples for laboratory analysis of homocysteine. Subjects were divided equally into four quartiles (Qs) based on plasma homocysteine level. Digital fundus photographs of both eyes were obtained. Determination of glaucomatous disc appearance was based on criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and based on the appearance of the RNFL and optic disc. Multivariate logistic regression models were used to define elevated glaucoma risk with P < 0.2 on univariate analysis.Results: A total of 78,049 subjects were included; 76,093 subjects were male, and 1956 subjects were female. When analyzed by gender, the mean homocysteine level in the male group with glaucomatous RNFL defects (11.05 ± 3.80 µmol/L) was higher than those without RNFL defects (10.81 ± 4.12 µmol/L (P = 0.000, χ2 test). Upon multifactorial logistic regression analysis adjusted for age, gender, creatinine, diabetes mellitus, hypertension, and hyperlipidemia, glaucomatous RNFL defects had a significant correlation with plasma homocysteine level. Based on the Q2 level, the odds ratio (OR) of Q3 was 1.267, while the OR of Q4 was 1.285 (95% CI = 1.067−1.505, 1.081−1.529, respectively, P for trend = 0.001).Conclusion: Our results suggest that homocysteine level is associated with the presence of glaucomatous RNFL defects.

Role of Diagnostic Endoscopy in Posterior Segment Evaluation for Definitive Prognostication in Eyes With Corneal Opacification

Direct visualization of the posterior segment is not possible with conventional imaging techniques in eyes with corneal opacification. This study evaluated the efficacy of videoendoscopy in visualizing and hence prognosticating the visual outcomes in such eyes. Prospective, noncomparative, consecutive interventional case series. This study included 64 eyes of 64 patients with corneal opacification who underwent a diagnostic ophthalmic endoscopy procedure from March 2014 to May 2016. All eyes also underwent conventional B-scan ultrasonography as part of their comprehensive ocular examination. The findings that were noted during endoscopy included the optic disc characteristics, anatomic integrity of the retina, and condition of the retinal blood vessels. The principal outcome measure was the determination of whether the results of the videoendoscopy helped in establishment of or brought a change in the management plan; accordingly, they were classified as either "contributory" or "noncontributory." The videoendoscopy findings were classified as contributory in 62 of 64 eyes. The remaining 2 eyes had vitreous hemorrhage; endoscopic vitrectomy was done in them to detect an inoperable retinal detachment in 1 eye. With the help of the stereoscopic picture of the fundus provided by the endoscope, a poor visual prognosis in 17 eyes with retinal detachment and 22 eyes with attached retina was determined. Additionally, in eyes that had an attached retina on ultrasound B-scan, the endoscope helped in detecting a glaucomatous disc in 10 of those eyes; 7 of them had glaucomatous optic atrophy. In 3 patients ultrasound did not detect a retinal detachment (false-negative). One eye with detached retina on ultrasound did not actually have a retinal detachment (false-positive). Thus ultrasound had a sensitivity of 88.4% and a specificity of 97.3% in detecting RD as compared with an endoscopic evaluation. Based on the endoscopic findings, 34 of 64 (53%) eyes were identified as having a better visual prognosis and underwent subsequent vision-restoring procedures. This included 10 (16%) patients who directly underwent a corneal procedure and 24 (37.5%) patients who had endoscopic vitreoretinal procedures initially before undergoing a corneal procedure. Endoscopy helped in identifying poor prognosis in 30 of 64 (46.8%) eyes; thus, further invasive procedures could be avoided. The endoscopy procedure in itself did not lead to any complications. Diagnostic endoscopy provided invaluable supplemental information about the posterior segment in eyes with corneal opacification. This helped in better prognostication and in reserving corneal reconstructive procedures for eyes with a favorable visual prognosis.

Retinosquisis y desprendimiento neurosensorial peripapilar asociado a glaucoma focal avanzado

Clinical caseA 71-year-old woman with normotensive primary open-angle glaucoma presented with an asymptomatic temporal peripapillary retinoschisis, associated with serous retinal detachment in the eye with the more advanced glaucoma. It was located at the inferior pole of the optic disc, in the proximity of a glaucomatous focal disc defect. DiscussionAlthough congenital optic pits are strongly related with juxta-papillary retinoschisis, retinoschisis can also arise from acquired defects in the proximity of glaucomatous optic discs. As symptoms depend on the extent of the retinoschisis, the prevalence of this complication could be greater than that reported in glaucomatous eyes.

Difference in glaucoma progression between the first and second eye after consecutive bilateral glaucoma surgery in patients with bilateral uveitic glaucoma.

PurposeTo determine whether the second eyes (SE) of patients with bilateral uveitic glaucoma undergoing filtration surgery have more glaucomatous progression in terms of visual acuity, visual field (VF) and optic nerve changes compared to the first eyes (FE).MethodsThis retrospective study analysed data of 60 eyes from 30 patients with bilateral uveitic glaucoma who had undergone glaucoma surgery in both eyes on separate occasions. Humphrey VF progression was assessed using the Progressor software.ResultsThe pre-operative IOP between the FE (43.1 ± 7.7 mmHg) and SE (40 ± 8.7 mmHg) was not statistically significant (p = 0.15). IOP reduction was greater in the FE (64 %) than SE (59.7 %) post-operatively, but the mean IOP at the final visit in the FE (12.3 ± 3.9 mmHg) and SE (14.5 ± 7 mmHg) was not statistically different (p = 0.2). There was no significant change in mean logMAR readings pre and post-operatively (0.45 ± 0.6 vs 0.37 ± 0.6, p = 0.4) or between the FE and SE. The number of SE with CDR > 0.7 increased by 23 % compared to the FE. From 23 available VFs, five SE (21.7 %) progressed at a median of five locations (range 1–11 points) with a mean local slope reduction of 1.74 ± 0.45 dB/year (range −2.39 to −1.26), whereas only one FE progressed. However, there was no significant difference between mean global rate of progression between the FE (−0.9 ± 1.6 dB/year) and SE (−0.76 ± 2.1 dB/year, p = 0.17) in the Humphrey VF.ConclusionIn eyes with bilateral uveitic glaucoma requiring glaucoma surgery, the SEs had more progressed points on VF and glaucomatous disc progression compared to FEs at the final visit.

Comparing Glaucomatous Disc Change Using Stereo Disc Viewing and the MatchedFlicker Software Program in Ophthalmologists-in-Training

To compare the accuracy and speed of using the computerized MatchedFlicker software program (EyeIC Inc, Narberth, Pennsylvania, USA) to evaluate glaucomatous optic disc change against the traditional gold standard of manually examining stereoscopic disc photographs. A prospective evaluation of diagnostic technology. Two resident ophthalmologists and 1 glaucoma fellow at the University of Florida independently evaluated 140 image pairs from 100 glaucomatous/ocular hypertensive patient eyes using a handheld stereo viewer and the MatchedFlicker program. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and the OHTS Endpoint Committee in the OHTS, and 50 more had photographs taken a few minutes apart, which were negative controls with no progression. Twenty photograph pairs from each group were duplicated to determine reviewer variability. Photographs were examined in alternating blocks of 70 photograph pairs for each method, with the starting viewing method randomized. Reviewer accuracy and time to review for each method were measured. Using the handheld stereo viewer, the reviewers correctly identified progression or nonprogression in 76.0% of the slide pairs. Using the MatchedFlicker software, 87.6% were correctly identified (P= .011). Evaluator speed averaged 34.1 seconds per image pair with the stereo viewer vs 24.9 seconds with the MatchedFlicker program (P= .044). Overall, Flicker was significantly more specific but less sensitive than stereo slides. Trainees appeared more reluctant to identify glaucoma progression from slides than from Flicker. For the 2 less experienced trainees Flicker was significantly more accurate. The MatchedFlicker software had a greater accuracy and was quicker to perform than using a handheld stereoscopic viewer.

Raised Intraocular Pressure in Nonjuvenile Idiopathic Arthritis-Uveitis Children: Risk Factors and Effect on Retinal Nerve Fiber Layer.

To determine risk factors for intraocular pressure (IOP) elevation and glaucoma in children with nonjuvenile idiopathic arthritis-related uveitis and any IOP-related changes in the retinal nerve fiber layer (RNFL) thickness. Clinical data were collected from children attending a tertiary referral uveitis clinic between May 2010 and October 2012. We assigned 206 eyes of 103 children into 32 normal eyes, 108 normotensive uveitics (NU), 41 hypertensive uveitics (HU: raised IOP without glaucomatous disc), and 25 glaucomatous uveitics (GU: raised IOP with glaucomatous disc). Risk factors for raised IOP, glaucoma and steroid response (SR) were evaluated and RNFL thickness across groups was compared with determine changes related to raised IOP. IOP elevation occurred in 40 patients (38.8%) or 66/174 eyes with uveitis (37.9%); and SR occurred in 35.1% of all corticosteroid-treated eyes. Chronic uveitis was a significant risk factor for raised IOP [odds ratio (OR)=9.28, P=0.001], glaucoma, and SR (OR=8.4, P<0.001). Higher peak IOP was also a risk factor for glaucoma (OR=1.4, P=0.003). About 70% of SR eyes were high responders (IOP increase >15 mm Hg from baseline), associated with younger age and corticosteroid injections. Although no significant RNFL thinning was detected between HU and NU eyes, significant thinning was detected in the inferior quadrant of GU (121.3±28.9 μm) compared with NU eyes (142.1±32.0 μm, P=0.043). Children with chronic uveitis are at higher risk of raised IOP and glaucoma. Thinning of the inferior RNFL quadrant may suggest glaucomatous changes in uveitic children with raised IOP.

Update on Normal Tension Glaucoma.

Normal tension glaucoma (NTG) is labelled when typical glaucomatous disc changes, visual field defects and open anterior chamber angles are associated with intraocular pressure (IOP) constantly below 21 mmHg. Chronic low vascular perfusion, Raynaud's phenomenon, migraine, nocturnal systemic hypotension and over-treated systemic hypertension are the main causes of normal tension glaucoma. Goldmann applanation tonometry, gonioscopy, slit lamp biomicroscopy, optical coherence tomography and visual field analysis are the main tools of investigation for the diagnosis of NTG. Management follows the same principles of treatment for other chronic glaucomas: To reduce IOP by a substantial amount, sufficient to prevent disabling visual loss. Treatment is generally aimed to lower IOP by 30% from pre-existing levels to 12-14 mmHg. Betaxolol, brimonidine, prostaglandin analogues, trabeculectomy (in refractory cases), systemic calcium channel blockers (such as nifedipine) and 24-hour monitoring of blood pressure are considered in the management of NTG. The present review summarises risk factors, causes, pathogenesis, diagnosis and management of NTG.

Optimizing the Detection of Preperimetric Glaucoma by Combining Structural and Functional Tests

We evaluated the performance of low contrast achromatic (LLA) multifocal visual evoked potentials (mfVEP) in preperimetric glaucoma and compared its diagnostic performance to other early diagnostic tests. We identified the clinically most useful tests and combinations in preperimetric glaucoma. We studied 59 patients with at least one glaucomatous disc, with normal, reliable visual fields in that eye, and 17 normal controls. All participants underwent complete ophthalmic examination including Humphrey visual fields (HVF), short wavelength automated perimetry (SWAP), frequency doubling perimetry (FDT Matrix), Spectralis optical coherence tomography (OCT), Heidelberg retinal tomography (HRT 3), and color stereoscopic optic disc photographs. We recorded mfVEPs using LLA stimulation. We studied 85 eyes of 59 patients (64.89 ± 8.15 years) and 34 eyes of 17 controls (64.28 ± 13.06 years; P = 0.64). Heidelberg retinal tomography and LLA mfVEP demonstrated the best sensitivities (50.6% and 51.8%, respectively) in identifying preperimetric glaucoma, and were not significantly different from each other. Both tests had significantly better sensitivity than all other tests (P < 0.0001). Of the eyes, 76.5% were identified by the combination of (any one of) LLA mfVEP and HRT. Sensitivity of the combination was significantly better than any of the individual tests (P < 0.05 for all pairs), or any other combinations of tests, with better negative than positive predictive value. The LLA mfVEP test identified approximately 50.6% eyes with preperimetric glaucoma, which was significantly higher than other perimetric methods, and similar to HRT. The combination of LLA mfVEP and HRT had exceptionally high sensitivity of 76.5% for preperimetric glaucoma.

Lamina cribrosa defects in eyes with glaucomatous disc haemorrhage.

To investigate the frequency of focal abnormalities of the lamina cribrosa (LC) in eyes with glaucomatous disc haemorrhage (DH) using swept-source optical coherence tomography (SS-OCT). We analysed 72 glaucomatous eyes with DH (72 subjects) detected by masked grading of stereophotographs along with 63 glaucomatous eyes without DH (63 subjects) consecutively recruited from the cohort of DH Study from Seoul National University Hospital. All of the subjects underwent stereoscopic optic disc photography and invivo SS-OCT LC imaging based on a customized optic disc scanning protocol (Topcon, Inc., Tokyo, Japan). Two masked graders evaluated each eye's serial en face images for focal LC defects. En face image/optic disc photograph overlay images were evaluated to determine the relationship between the respective focal LC defect and DH locations. Among the eyes with DH, the proportion with ≥1 LC defect was 80.6% (58 of 72 eyes), significantly higher than that for eyes without DH (39.7%, 25 of 63 eyes; p<0.001). In the 58 eyes with DH and ≥1 LC defect, the location of the focal LC defect corresponded with that of the RNFL defect in 47 eyes (81.0%), and the location of the focal LC defect corresponded with the DH in 36 eyes (62.1%). Focal LC defects are more frequently visible in eyes with glaucomatous DH than in eyes without DH. DH and LC defects, moreover, are often spatially correlated. These findings suggest that DH is associated with focal abnormalities of the LC.

Lamina Cribrosa Depth Variation Measured by Spectral-Domain Optical Coherence Tomography Within and Between Four Glaucomatous Optic Disc Phenotypes.

To study lamina cribrosa (LC) depth variation measured by spectral-domain optical coherence tomography (SD-OCT) in four glaucomatous optic disc phenotypes. In this cross-sectional study, 59 normal eyes and 180 open-angle glaucoma (OAG) eyes were grouped into 56 focally injured discs (FI), 30 generalized enlargement of the optic cup discs (GE), 69 myopic glaucomatous discs (MY), and 25 senile sclerotic discs (SS). They were imaged by enhanced depth imaging SD-OCT, obtaining multiple horizontal and vertical optic disc B-scans. Mean and maximum LC depths were measured relative to Bruch's membrane opening (BMO) and the anterior sclera (AS) reference planes. Lamina cribrosa depths were compared between and among the normal and OAG group disc phenotypes. Lamina cribrosa depth differences within groups were examined as well as the overlap between them. Mean and maximum LC depths relative to the BMO and AS reference planes were greater in the OAG group than in the normal group (P < 0.0001). Among glaucomatous phenotypes, the GE group had the greatest (P < 0.001) and the SS group had the smallest (P < 0.05) mean and maximum LC depths. There was a wide range of LC depth overlap between the normal and SS groups, and a high proportion of SS eyes had LC depths within the 95% confidence interval of the normal group. The LC was displaced posteriorly in OAG group compared to the normal group. The LC depth was significantly different among four glaucomatous disc phenotypes. The LC depth of the SS group was similar to the normal group.

Characteristic correlations of the structure-function relationship in different glaucomatous disc types.

To investigate the influence of the optic disc type on the overall and regional correlation between structure and function in open angle glaucoma (OAG). We divided 144 eyes of 144 patients with OAG into four groups according to Nicolela et al.'s classification of optic disc type: focal ischemic (FI), myopic glaucomatous (MY), senile sclerotic (SS), and generalized enlargement (GE). We measured the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) with the 3D OCT-2000 and the mean deviation (MD) with the Humphrey Field Analyzer in each group and determined the influence of the disc type on these parameters with the Spearman rank correlation. We found that cpRNFLT and MD were significantly correlated in the MY (r = 0.61, P < 0.001), GE (r = 0.62, P < 0.001), and SS groups (r = 0.52, P = 0.002), but not in the FI group (r = 0.25, P = 0.130). The region of the optic disc with the highest correlation coefficient between structure and function differed according to the disc type. The correlation between cpRNFLT and MD varied according to the optic disc morphology in OAG. This suggests that different disc types have characteristic regional variations in the correlation between structure and function. The disc type should therefore be considered in investigations of the correlation between structure and function in glaucoma.

Clinical manifestation of Fuchs uveitis syndrome in childhood.

The aim of this study was to describe clinical signs and complications of Fuchs uveitis syndrome (FUS) with onset in childhood. Ophthalmologic findings and complications in patients with FUS becoming manifest before the age of 16 years were analyzed in a retrospective study at a tertiary referral uveitis center. Inclusion criteria were the presence of pathognomonic FUS findings at any time point and exclusion of any systemic immune-mediated or infectious disease. A total of 23 patients (male = 16, female = 7) with juvenile FUS (unilateral n = 20, bilateral n = 3 patients) were included in the study. Mean ages at uveitis and FUS diagnosis were 12.0 ± 4.2 and 22.7 ± 10.7 years, respectively. In six patients, inflammation was noted at age ≤ 7 years. The following inflammatory signs were observed in a total of 26 eyes: ≤ 1+ anterior chamber cell grade (n = 26), vitreous cells (n = 24), fine keratic precipitates (KPs; n = 23), stellate KPs (n = 11), mutton-fat KPs (n = 23), diffuse (n = 24) or inferior (n = 8) distribution of KPs, Koeppe nodules (n = 10), and iris heterochromia (n = 14). A representative subgroup of patients (n = 5) is shown who presented with non-specific clinical signs in the beginning and in whom typical FUS signs became manifest only at a later stage. Secondary complications such as cataract (n = 19), ocular hypertension (n = 3), or glaucomatous disc damage (n = 2) were found after a mean uveitis duration of 11.6, 19.5, and 20.3 years, respectively. FUS may begin in early childhood, and the characteristic findings may not be present at onset of disease. The diagnosis is often delayed for years, occasionally with the consequence of overtreatment with anti-inflammatory drugs.