Inferior Visual Field Defect Research Articles

A Case of Nonarteritic Anterior Ischemic Optic Neuropathy that Recurred in the same Eye within a Month

A 78-year-old woman presented with an upper visual field defect in the left eye. On ophthalmic examination, her best-corrected visual acuity (BCVA) was 1.2 in both eyes. Fundoscopy revealed inferior optic disc swelling. Goldmann visual field test showed an upper visual field defect. The patient was diagnosed with nonarteritic anterior ischemic optic neuropathy (NAION) of the left eye and was followed up without treatment. One month after the initial visit, her BCVA decreased to 0.15 in the left eye. Fundoscopy revealed superior optic disc swelling. Goldmann visual field test showed an inferior visual field defect and central relative scotoma. Based on her clinical findings, she was diagnosed with recurrent NAION. Three months after the initial visit, her BCVA was 0.2 in the left eye, and the optic nerve developed atrophy. This case highlights the importance for clinicians to be aware of NAION recurred in the same eye within a short period of time.

Correlation of retrobulbar perfusion deficits with glaucomatous visual field defects.

This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects. Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined. The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects. Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV. ChiCTR2200059048 (2022-04-23).

LONG-TERM FOLLOW-UP ON A RARE CASE OF PERIOPERATIVE POSTERIOR ISCHEMIC OPTIC NEUROPATHY: FINDING HOPE IN THE DARKNESS

Abstract
 Introduction : Perioperative posterior ischemic optic neuropathy (PION) following maxillectomy is a rare and devastating condition that leads to permanent vision loss in most reported cases. This case report offers a different perspective through long-term follow-up, providing valuable insights into the prognosis and potential treatments for PION.
 Case Illustration : Following a left maxillectomy for ameloblastoma, a 28-year-old female experienced sudden vision loss in her left eye. The visual acuity was 5/60, and an altitudinal inferior visual field defect with a superior extension was present. Ishihara's color vision examination revealed 15/38. The patient was diagnosed with perioperative PION and treated with neurotropic and folic acid. After 16 months, optic atrophy was observed. However, there are complete recovery in visual acuity to 5/5 and Ishihara score to 38/38, along with a significant improvement in the visual field defect.
 Discussion : The current management of perioperative PION is focused on prevention, because once vision loss occurs, it is usually severe and irreversible. In our case, the patient exhibited a favorable outcome after a long follow-up period, suggesting that there is still potential for improvement in PION patients. The finding is consistent with previous study, which reported that a small percentage of patients may still experience improved vision during follow-up. The role of neurotropics in improving patient outcomes is further supported by in vitro studies that demonstrate early neurotropic treatment significantly prevents loss of retinal ganglion cells in PION.
 Conclusion : Visual improvement is still possible in perioperative PION and early neurotropic administration may be considered in therapy

The Relationship Between Kiritsu-Meijin-Derived Autonomic Function Parameters and Visual-Field Defects in Eyes with Open-Angle Glaucoma

Purpose This retrospective cross-sectional study aimed to investigate the association between autonomic parameters measured using the Kiritsu-Meijin device and visual-field defects in patients with open-angle glaucoma. Methods A total of 79 eyes of 42 patients with open-angle glaucoma were enrolled in this study. Kiritsu-Meijin testing comprised three phases: sitting, standing, and sitting again (2 min, 2 min, and 1 min, respectively). Continuous electrocardiograms were recorded for five minutes. Autonomic parameters were extracted from the resulting data and analyzed, including activity, balance, reaction, switchover, and recovery; these are five representative parameters derived from Kiritsu-Meijin testing. Correlations between these parameters and mean deviation from Humphrey visual field testing were determined. Additionally, we used a linear mixed-effects model to observe sectoral differences in the relationship between total deviation and the Kiritsu-Meijin parameters. In this study, we focused on superior, central, and inferior total deviations. Results Significant positive correlations were observed between activity, balance, and recovery and mean deviation values (β = 0.29–0.38, p < .05). The β value between activity and inferior total deviation was higher than that between activity and superior total deviation (β = 0.22, p < .05). Balance did not show any sectoral differences (p > .05). Recovery was more strongly associated with central to inferior total deviation than superior total deviation (β = 0.17–0.25, p < .05). Conclusion Our findings suggest that in patients with open-angle glaucoma, lower activity and recovery are associated with more severe central and/or inferior visual field defects in the superior quadrant. These results imply that measurements of autonomic function made with the Kiritsu-Meijin device may have clinical utility in the management of glaucoma.

The Role of Optical Coherence Tomography Angiography in Non-Arteritic Ischemic Optic Neuropathy: A Case Report

Introduction: Non-arteritic ischemic optic neuropathy (NAION) is the second most common optic neuropathy in adults. Since circulatory insufficiency is presumed to have a role in pathogenesis of NAION, optical coherence tomography angiography (OCTA) is suggested as a tool in assessing NAION patients, while optical coherence tomography (OCT) can detect structural changes. This case report aims to describe the congruity of visual field defect with OCT and OCTA result in a case of bilateral NAION, highlighting the role of both OCT and OCTA in NAION. Case Report: A 52-years-old male came due to painless, progressive blurry vision in both eyes, especially in lower visual field, for the past 7 months. Humphrey visual field examination revealed inferior visual field defects in both eyes. OCTA showed reduced retinal perfusion in the superior part bilaterally. OCT revealed ganglion cell loss in the superior part of his right eye and almost all parts of his left eye. Retinal nerve fiber layer (RNFL) thinning was found in the superior part bilaterally. Discussion: In this case, the congruity of visual field defect, reduced perfusion, ganglion cell-inner plexiform layer (GCIPL), and RNFL thinning portrayed the connection of hypoperfusion as the presumed underlying mechanism of NAION, neuron loss as the result of the hypoperfusion, and the visual field loss as the presenting symptom in NAION. Conclusion: This finding demonstrates the role of OCT-A and OCT in diagnosing and monitoring progression in patients with NAION.OCT-A is a useful tool to evaluate microvascular changes, while OCT can be used to evaluate RNFL and GCIPL thinning.

Paracentral Acute Middle Maculopathy in a Patient with Cilioretinal Artery Occlusion

Introduction: A 49-year-old woman presented at Inoda Eye Clinic with inferior visual field defect in the left eye. Ophthalmoscopic examination revealed well-demarcated retinal edema of the superior region at the posterior pole in the left eye. The area of retinal edema was consistent with the area of the cilioretinal artery, and therefore, cilioretinal artery occlusion was suspected. Optical coherence tomography showed hyperreflective bandlike lesions involving the middle layers of the retina at the level of the inner nuclear layer. Optical coherence tomography angiography showed decreased flow sign in outer retina layer and choriocapillaris layer rather than in superficial layer. Based on these findings, the patient was diagnosed with paracentral acute middle maculopathy due to cilioretinal artery occlusion. Optical coherence tomography angiography is a useful diagnostic examination instead of fluorescein angiography for evaluation of cilioretinal artery occlusion.

Successful outcome of paediatric cytomegalovirus optic neuritis treated with combined steroid and valganciclovir: A case report

AbstractPurpose: To report the clinical approach for diagnosis and management of paediatric optic neuritis.Methods: A 13 years old girl patient came to the emergency room with complaints of sudden blurred vision in both eyes and pain with eye movement. On Ophthalmic examination, the visual acuity in the right eye was 6/30 and the left eye was no light perception. There was a positive relative afferent pupillary defect in the left eye. Both the optic disc was swollen. The colour vision was abnormal and there was inferior visual field defect. Laboratory examination showed an increase leukocyte, increase in cytomegalovirus (CMV) immunoglobulin G (IgG) antibody, and decrease in cluster of differentiation 4 (CD4) cell. The head and orbital MRI did not show any intracranial pathological lesion. The patient was diagnosed with optic neuritis caused by CMV and treated with intravenous methylprednisolone 250 mg every 6 h for 3 days followed by oral prednisone 1 mg/kg daily and valganciclovir 16 mg/kg daily for 3 weeks.Results: After 3 days of only intravenous steroid treatment, her visual acuity improved to 6/9 in right eye and 1/300 in left eye. The vision increase significantly to 6/6 in the right eye and 6/7.5 in the left eye after 1 month treated with combined steroid and valganciclovir.Conclusions: A comprehensive examination, includes history taking, optic nerve examination, laboratory and serology tests related to infection, also head and orbital MRI to rule out other causes is important in the management of paediatric optic neuritis. Appropriate treatment with IV methylprednisolone and valganciclovir provide a better visual prognosis for paediatric CMV optic neuritis.

Shot in the dark

A 43-year-old woman presented with decreased vision in the right eye associated with painful eye movements 10 days after receiving her first dose of Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (Pfizer Inc, New York, NY). Two days later she developed painful loss of vision in the left eye. Clinical presentation and magnetic resonance imaging findings were consistent with bilateral optic perineuritis transitioning to optic neuritis. Extensive evaluation including aquaporin-4 immunoglobin G (IgG), myelin oligodendrocyte glycoprotein IgG, and lumbar puncture was unrevealing. Visual acuity at nadir was counting fingers in both eyes, but after receiving intravenous steroids and plasma exchange vision eventually improved to 20/20 in each eye, although she was left with inferior visual field defects and bilateral optic disc pallor. This case highlights the diagnostic challenge in the evaluation of atypical optic neuritis with a review of post-COVID-19 vaccination-associated optic neuritis.

Path to Diagnosis and Clinical Characteristics of Advanced Glaucoma at Initial Diagnosis: a Tertiary Single Center Experience

Purpose: As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma.Methods: We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic.Results: We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively.Conclusions: We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.

Bilateral Non Arteritic Anterior Ischemic Optic Neuropathy Associated With Optic Nerve Head Drusen And Vascular Risk Factors

We report case history of 52 year old male who presented with sudden painless diminution of vision in right eye and with similar complaint of diminution of vision in left eye six months back. He was diagnosed as Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) in left eye with Optic Nerve Head Drusen (ONHD) in both the eyes. He was otherwise well and his medical history revealed systemic hypertension. Fundus examination revealed hyperaemic disc in the right eye and temporal pallor of the disc in the left eye. On visual field examination, inferior altitudinal visual field defect in both the eyes.ONHD can mimic as disc oedema and it can very rarely cause NAION. In addition, multiple vascular risk factors can also cause NAION, hence detailed investigations and periodic follow up should be done to rule out ischemic disc complication.

Vertical Position of the Central Retinal Vessel in the Optic Disc and Its Association With the Site of Visual Field Defects in Glaucoma

The purpose of this study was to investigate the association between the vertical position of the central retinal vessel (CRV) within the optic nerve head (ONH) and the site of visual field defects (VFDs) in glaucoma. Cross-sectional study. The vertical position of the CRV was identified in 134 glaucoma eyes and 61 normal eyes at the point at which CRV exited the lamina cribrosa (LC) onto the ONH surface, by using spectral-domain optical coherence tomography (exit position). The position was also identified at the entry point into the LC from the retrolaminar ONH region (entry position), which was little influenced by glaucomatous LC deformation, therefore close to the original position before the glaucoma development. Positions were compared among glaucoma eyes with different sites of VFDs, and between glaucoma and normal eyes. In glaucoma eyes, the entry position of the CRV was in the superior ONH region in 63.0% of eyes with superior VFDs and in the inferior ONH region in 97.8% of eyes with inferior VFDs (P < .0001). The exit position exhibited a similar percentage. The vertical CRV positions were not significantly different between glaucoma and normal eyes, both at the entry and exit positions. Eyes with CRVs in the superior ONH region were significantly more likely to form VFDs in the superior hemifields and vice versa. The vertical position of the CRV was little altered by the development of glaucoma. The original position of the CRV before the development of glaucoma may influence regional susceptibility to glaucomatous stress and may be useful in predicting initial sites of VFDs.

The Impacts of Face Mask Use on Standard Automated Perimetry Results in Glaucoma Patients.

The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.

Hemisphere opposite to vascular trunk deviation is earlier affected by glaucomatous damage in myopic high-tension glaucoma.

PurposeTo investigate whether the position of the central vascular trunk, as a surrogate of lamina cribrosa (LC) shift, is associated with the initial hemisphere of visual field defect in myopic high-tension glaucoma (HTG) eyes.MethodsThe deviation of the central vascular trunk was measured from the center of the Bruch’s membrane opening (BMO), which was delineated by OCT imaging. The angular deviation was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The initial hemisphere developing visual field defect was defined as three connected abnormal points (having a P value with less than 0.5% probability of being normal) appearing in only one hemisphere in pattern deviation plots. If those points were observed in both hemispheres initially, the eye was classified as bi-hemispheric visual field defect.ResultsInitially, 36 eyes (44%) had superior visual field defects, 27 (33%) inferior visual field defects, and 18 (22%) bi-hemispheric visual field defects. After a mean follow-up of 5 years, the number of bi-hemispheric visual field defects had increased to 34 (42%). A logistic regression analysis revealed that inferior deviation of vascular trunk was the only factor associated with initial inferior visual field defect (P = 0.001), while initial bi-hemispheric visual field defects were associated with worse mean deviation at initial visits (P<0.001). A conditional inference tree analysis showed that both the angular deviation (P<0.001) and initial mean deviation (P = 0.025) determined the initial hemispheres developing visual field defect.ConclusionsAlthough both hemispheres were involved as glaucoma progression, the axons on the side counter to the vascular trunk deviation were damaged earlier in HTG. This finding implies the LC shift could add additional stress to axons exposed to high intraocular pressure.

Usefulness of Optical Coherence Tomography Angiography in the Differential Diagnosis Between Superior Segmental Optic Hypoplasia and Normal-tension Glaucoma

The differential diagnosis of superior segmental optic hypoplasia (SSOH) and normal-tension glaucoma (NTG) is an issue in the ophthalmologic field. To date, several modalities have been developed to solve this issue; however, no standard methods have been established. Recently, optical coherence tomography angiography (OCTA) has been introduced to better evaluate the volumetric angiography images. Therefore, in this study, we investigated the usefulness of OCTA in differentiating between SSOH and NTG. In this retrospective study, we included 26 patients with SSOH who had definite visual field defects and 40 patients with NTG who had only inferior visual field defects. Age, sex, intraocular pressure, refractive error, retinal nerve fiber layer thickness, and visual field defects were compared between the groups. In addition, we analyzed and compared the peripapillary vessel density (VD) measured on OCTA between the groups. The area under the receiver operating characteristic curves were obtained for each parameter. On Cirrus HD-OCT, the retinal nerve fiber layer in patients with SSOH was thinner in the superonasal segment and thicker in the superotemporal segment compared with patients with NTG. In the analysis of OCTA, the peripapillary VD of the superonasal segment was significantly lower in the SSOH group than in the NTG group, while it was significantly higher in the superotemporal segment in the SSOH group than in the NTG group. The optimal superonasal-to-superotemporal ratio cutoff was 0.8828, with a sensitivity of 95% and specificity of 92.3%, for the diagnosis of SSOH (area under the receiver operating characteristic curve=0.962). Our findings suggest that the superonasal-to-superotemporal VD ratio measured on OCTA may be used to distinguish between SSOH and NTG. However, further large-scale studies are required to verify our findings.

Atypical presentation of optic neuritis with unilateral inferior altitudinal visual field defect in multiple sclerosis

Background: The purpose of this paper was to report a case of retrobulbar optic neuritis as the first manifestation of multiple sclerosis, with atypical presentations which include a sudden painless reduction in vision, without optic disc swelling and presence of unilateral inferior altitudinal visual field defect. Case report: A 17-year-old girl presented to our clinic with right eye sudden painless drop in visual acuity to counting finger associated with headache. Her right eye optic nerve function tests were positive, but her optic disc was not swollen. Bjerrum’s visual field chart noted right eye unilateral inferior altitudinal visual field defect with foveal involvement. Her blood investigations were normal, and magnetic resonance imaging (MRI) of brain and orbit was suggestive of multiple sclerosis. She was commenced on three days of high dose intravenous steroi, and was referred to neuromedical team for further management. At 3-month follow up, her right eye visual acuity improved to 6/6 with the restoration of normal colour vision. Conclusions: In presence of atypical presentation of optic neuritis, multiple sclerosis must be thought of especially in young patients. Hence early co-management with neuromedical discipline is important to reduce the frequency and severity of attacks in the future.

Periventricular Leukomalacia in Patients With Pseudo-glaucomatous Cupping

Periventricular leukomalacia (PVL) is a structural loss of white matter pathways that carry visual information from the lateral geniculate bodies to the visual cortex. It is observed radiologically in patients with a history of prematurity and is associated with visual field (VF) defects and optic disc cupping. Advances in perinatal care have improved survival for premature babies, so many now present as adolescents and adults to comprehensive eye doctors who are unaware of the relationship of cupping, field defects, and prematurity and who may diagnose manifest or suspected normal tension glaucoma. We describe 2 such patients to raise awareness of this entity. Case series. Review of clinical information of 2 patients identified during clinical practice. Charts were reviewed for gestational age, optic nerve appearance, intraocular pressure (IOP), and sequelae of prematurity. Magnetic resonance imaging (MRI), optical coherence tomography (OCT), VF, and optic disc photographs were reviewed. Two young patients with a history of prematurity presented with enlarged cup-to-disc ratio and normal IOP. OCT thinning was most prominent superiorly, with VF defects more notable inferior and homonymous. No progression on VF or OCT was noted in the index case over almost 4 years. Periventricular leukomalacia should be added to the differential diagnosis of normal tension glaucoma (NTG) when there is a history of prematurity. Careful examination of the optic nerve will assist in differentiating from NTG. Specifically, horizontal cupping with minimal or no nasal displacement of vessels, and superior optic nerve thinning with inferior VF defects, suggest PVL.

MON-LB085 Blurred Vision and Hypocalcemia after Denosumab Injection in a Patient with Tertiary Hyperparathyroidism

Background: Denosumab is a human monoclonal antibody that targets the receptor activator of nuclear factor kappa B ligand (RANKL). It inhibits osteoclast-mediated bone resorption by binding to receptor. Denosumab prevents skeletal-related events (SREs) from osteoporosis and bone metastasis. However, there has been arising concern about hypocalcemia that is more vulnerable for patients with renal impairment due to elevated total osteoblast mass, coexisting calcitriol deficiency, inhibition by fibroblast growth factor 23. Clinical Case: A 66-year-old woman with ESRD on HD was transferred our endocrinology clinic for hypercalcemia and elevated intact parathyroid hormone(PTH); corrected calcium, 10.8 mg/dL(normal range: 8.5-10.2) and PTH, 164 pg/mL(8.00-72.00). I thought she had tertiary hyperparathyroidism(HPT). It is observed in patients with chronic secondary HPT who have been on dialysis therapy for years. I planned to examine sestamibi scan and neck ultrasonography to localize hypertrophied parathyroid glands. And then, I prescribed denosumab and a combined oral calcium/vitamin D supplement for her because she had persistent hypercalcemia and no medication for osteoporosis(DEXA T score is -3.8, -3.1 and -3.7 in L1-4, right femoral total, and neck respectively). After two weeks, she presented to our hospital for blurred vision of left eye. Papilledema and inferior visual field defect of left eye were observed in ophthalmology examination. Furthermore she had been receiving multiple dose of calcium and calcitriol injection during dialysis due to severe hypocalcemia at local dialysis center. Laboratory finding of dialysis clinic revealed corrected calcium decreased to 6.6 mg/dL(8.5-10.2) and PTH extremely increased to 3066 pg/mL(8.00-72.00). After rechecking her blood, laboratory work up showed corrected calcium, 7.7 mg/dL(8.5-10.2); 25(OH)vitamin D, 16.26 ng/mL(30-80); PTH, 1739 pg/mL(8.00-72.00). I examined sestamibi scan and neck USG. The results of sestamibi scan indicated hyperfunctioning parathyroid adenoma/hyperplasia in upper pole level of right thyroid gland and lower pole level of left thyroid gland that were matched with hypoechoic nodules of neck USG. We considered surgical interventions, total parathyroidectomy with autotransplantation or subtotal parathyroidectomy paying attention to postoperative complications such as hungry bone syndrome. Conclusion: Denosumab is an effective, tolerable anti-resorptive agent that has no nephrotoxicity, however, the risk of hypocalcemia is increasing, especially patients with chronic kidney disease. Hypocalcemia is a potentially life-threatening biochemical disorder that cause papilledema leading to the loss of vision. Therefore we should be aware of importance of monitoring calcium levels and renal function before and during denosumab therapy. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Factors Related to Superior and Inferior Hemifield Defects in Primary Open-Angle Glaucoma.

Purpose We aimed to investigate factors related to superior and inferior hemifield defects in primary open-angle glaucoma (POAG). Methods Sixty-seven subjects with newly diagnosed, untreated POAG underwent optical coherence tomography (OCT) of the disc area, macular ganglion cell complex (mGCC), and circumpapillary retinal nerve fiber layer (cpRNFL) thickness within 6 months of the visual field (VF) test. Based on the VF and OCT results, 40 subjects had a superior and 27 an inferior hemifield defect. Clinical data including visual acuity, refractive error, disc hemorrhage, VF indexes, and medical history were recorded. Results Average mGCC thickness corresponding to the defective hemifields was thinner in the superior VF defect group than in the inferior VF defect group (P=0.003). Average total deviation (TD) was comparable between the two groups. However, the superior VF defect group had a higher prevalence of defects (P=0.001) and lower TD (P=0.002) within central 5 degrees of VF than the inferior VF defect group. In multivariate regression analyses, the temporal-lower and inferior-temporal cpRNFL thicknesses were significant contributing factors to the inferior mGCC thickness in the superior VF defect group. In the inferior VF defect group, the disc area, family history of glaucoma, and temporal-upper cpRNFL thickness contributed to the superior mGCC thickness. Conclusion The inferior mGCC thickness corresponding to the superior hemifield defect group was significantly thinner than the superior mGCC thickness corresponding to the inferior hemifield defect group. The factors related to the reduction of the corresponding mGCC thickness may differ between superior VF defect and inferior VF defect groups.

Superior segmental optic hypoplasia as a differential diagnosis of glaucoma

Superior segmental optic hypoplasia (SSOH) is a congenital anomaly affecting the optic nerve head and retina. Although the conventional characterization of SSOH emphasizes the relatively superior entrance of the central retinal artery, the pallor of the superior optic disc, a superior peripapillary halo, and thinning of the superior nerve fiber layer, we encounter many cases with rim thinning in the superior nasal region that corresponds to a nerve fiber layer defect and an inferior wedge-shaped visual field defect connecting to the blind spot. However, among Asians, such cases usually lack pallor of the superior optic disc and more resemble glaucomatous optic neuropathy. We found the prevalence of SSOH to be 0.2%/eye and 0.3%/case among Japanese. We also noted that approximately half of all SSOH eyes show visual field changes. SSOH is an important differential diagnosis of glaucoma, especially normal-tension glaucoma, in Asian populations.

Clinical features of superior segmental optic hypoplasia: hospital-based study.

To determine the clinical features of patients diagnosed with superior segmental optic hypoplasia (SSOH) and to quantitatively compare retinal nerve fiber layer (RNFL) thickness in SSOH eyes, to that in normal subjects. Retrospective comparative case series. We examined the medical charts of 106 eyes of 59 patients with SSOH and 35 eyes of 35 normal subjects as controls. Forty-four of 59 patients had been examined by spectral-domain optical coherence tomography (SD-OCT). Eyes with SSOH were classified into a definite and a suspect type determined by standard automated perimetry. The definite type had inferior visual field (VF) defects, while the suspect type did not have inferior VF defects. The findings of the SD-OCT images of 35 eyes with SSOH were compared to those of the 35 normal eyes. Of the 106 eyes with SSOH, 56 (52.8%) were classified as the definite type and 50 (47.2%) as the suspect type. OCT showed that the average of the total RNFL thickness was significantly thinner in the SSOH group than in the normal group (P < 0.001; Mann-Whitney U test). Sectorial analysis demonstrated that the RNFL was thinner than controls in all quadrants (all P < 0.001; Mann-Whitney U test). The comparison of the hourly sectors showed that the RNFL was thinner at 10, 11, 12, 1, 2, 3, 5, and 6 o'clock sectors in the SSOH group than controls. Approximately one-half of eyes with SSOH had a detectable VF defect. OCT showed that eyes with SSOH have a thinner RNFL than controls except in 4 o`clock and from 7 o'clock to 9 o'clock.