Optic Disc Changes Research Articles

The Effect of Glaucoma on the Quality of Patient’s Life

Abstract Glaucoma is a chronic, progressive opticopathy with morphological optic disc changes and visual field disturbances. Visual field disturbances change the patient’s life habits. Medical as well as surgical treatments also disturb patients` activities of daily living. According to this, glaucoma is the disease which affects quality of patient’s life (QQL). Visual field (VF) evaluation is very important in glaucoma disease diagnostic process. Location of the VF defects also have an impact on the QOL. Patient`s daily activities, such as walking, low light condition adaptation, peripheral seeing of the objects, can be affected by glaucoma progression and with VF defects. All social, religious, cultural and traveling events are more difficult for the severe glaucomatous patients (MD<-12dB) in comparison with mild glaucomatous, defined as patients with MD > −6 dB. Every day usage of the local antuglaucomatous therapy disturbs patients’ QOL. The side effects of the eye drops can produce burning sensation, bronchospasm, bradycardia, increased iris pigmentation, increased eyelash length. Also, locally applied therapy provokes ocular surface disease. Benzalkonium chloride provokes destruction of the epithelial cells junction with development of the epitheliopathy and ocular surface disease. Surgically treated glaucoma patients can have disturbed QOL due to ocular surface disease symptoms (foreign body sensation, eye pain, redness, and increased tearing). These symptoms are caused by trabeculectomy and they are correlated with filtering bleb existence.To achieve QOL of the glaucomatous patients, different founded instruments are used. They are classified in: general health, vision specific, and glaucoma specific.

English

BACKGROUND Lens induced glaucomas are common in India. There were different types of lens induced glaucomas based on clinical features and morphological features. This study was undertaken to evaluate the various characteristics and presentations of glaucomas, to define the risk factors and to evaluate as to how they influence the post-operative visual acuity, intra ocular pressure, inflammation and optic disc changes. METHODS This longitudinal study included 90 cases of lens induced glaucoma admitted in the ophthalmic wards of the Great Eastern Medical School and Hospital, Srikakulam, during the period March 2018 to March 2020. All consecutive patients diagnosed as lens induced glaucoma on the basis of clinical symptoms and signs were included. At presentation, visual acuity, IOP, inflammation including corneal changes were recorded, which were repeated after institution of medical line of treatment and postoperatively patients were followed up regularly at 2, 4 and 6 weeks intervals and the same parameters were evaluated including optic disc changes. RESULTS Occurrence of lens induced glaucoma in the hospital during the study period was 1.72 %. The mean age of presentation of various types of glaucomas was 60.57 years and the female to male ratio was 2:1. The most frequent type of lens induced glaucoma was phacomorphic glaucoma (70 %). In 34.4 % patients best corrected visual acuity was found to be better than 6 / 18. In 14.4 % of cases, visual acuity was found be worse than 6 / 60. In patients who presented with symptoms of less than two weeks duration, better visual acuity of 6 / 12 or more was noted (76.2 %, P < 0.01). In 60 % patients who presented with IOP levels of less than 35 mmHg, better visual acuity of 6 / 12 or more was noted in 76.2 %. The mean IOP noted in patients with symptoms of 2 to 4 weeks duration was found to be 40.33 ± 9.36 mmHg. Inflammation was more severe in patients who were symptomatic for more than 2 weeks (37.50 %, P < 0.05) and also in cases with IOP more than 35 mmHg (40 %). Optic disc of the presented eye was found to be damaged in 35.5 % of cases and in patients presenting with symptoms of more than 2 weeks’ duration it was 62.5 % (P < 0.01). CONCLUSIONS Presentation with intraocular pressure value greater than 35 mm of Hg and with symptoms of more than two weeks would result in severe inflammation further affecting the cornea and causing optic nerve damage which would ultimately jeopardize vision. This can be prevented by early presentation and regular screening of people above 60 years of age. KEYWORDS Lens-Induced, Glaucoma, Cataract

Impact of binocular integrated visual field defects on healthy related quality of life in glaucoma.

To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients’ quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.

Corneal endothelial cell density and microvascular changes of retina and optic disc in autosomal dominant polycystic kidney disease.

Purpose:Vascular endothelial dysfunction in autosomal dominant polycystic kidney disease (ADPKD) may affect the retinal vascular parameters due to structural similarities of kidney and retina. We aimed to evaluate the microvascular changes of retina and optic disc and also corneal endothelial cell density in patients with ADPKD.Methods:Forty-six eyes of 23 patients with ADPKD (Group 1), and 46 eyes of 23 sex- and age-matched healthy controls (Group 2) were included in this cross-sectional study. Demographic and ophthalmic findings of participants were collected. Corneal endothelial cell density (CECD) measurements were obtained by noncontact specular microscopy. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic nerve head were analyzed by optical coherence tomography angiography.Results:The mean ages were 41 ± 11 years for Group 1 and 39 ± 10 years for Group 2 (P = 0.313). CECD values were significantly lower in group 1 when compared to group 2 (2653 ± 306 cells/mm2 and 2864 ± 244 cells/mm2, respectively, P < 0.001). The foveal retinal thickness and RNFL thickness were similar, but superior quadrant thickness of RNFL was significantly lower in Group 1 than Group 2 (126 ± 14 μm vs. 135 ± 15 μm, P = 0.003). In Group 1, whole image of optic disc radial peripapillary capillary densities were significantly lower compared to Group 2 (49.4 ± 2.04%, and 50.0 ± 2.2%, respectively, P = 0.043). There was no significant difference regarding superficial, deep retinal vessel densities, foveal avascular zone and flow areas between the groups (P > 0.05 for all).Conclusion:Lower CECD values and decreased superior quadrant RNFL thickness, and microvascular densities of optic disc were revealed in patients with ADPKD. Evaluation of CECD and retinal microvasculature may be helpful in the management of these patients.

A clinical study of management and visual outcome in lens induced glaucoma

Background: Lens induced glaucoma (LIG) is the cause of poor postoperative vision even after uneventful cataract surgery.Aim: The aim is to know effect of surgery on post-operative visual acuity, intraocular pressure, inflammation including corneal changes and optic disc changes. And also the importance of early diagnosis, and efficient treatment in preventing these vision-threatening lens induced glaucomas.Setting: Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, KarnatakaDesign: Prospective interventional study.Material and Method: This longitudinal study included 50 cases of lens induced glaucoma, admitted in the ophthalmic wards in Basaveshwar Hospital, Mahadevappa rampure medical college Gulbarga, Karnataka. All consecutive patients diagnosed as LIG on the basis of clinical symptoms and signs were included. And postoperatively patients were followed up regularly at 2 and 7 weeks interval.Statistical Analysis: The results were tabulated on microsoft excel spreadsheet and data was statistically analysed using various tests such as, Paired ‘t’ test, Chi square test and pooled chi square test wherever applicable and a P value less than 0.05 was considered significant.Conclusion: A delay in presentation of more than two weeks and intraocular pressure of more than 35 mm Hg in association with severe inflammation affects the optic nerve which would ultimately jeopardize vision, in these potentially blinding lens induced glaucomas. This study has highlighted the characteristics, management and their visual outcome in lens induced glaucomas, and also the importance of early diagnosis, and efficient treatment in preventing these vision-threatening lens induced glaucomas.

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract.&lt;/p&gt; &lt;p&gt;Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated.&lt;/p&gt; &lt;p&gt;Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery.&lt;/p&gt; &lt;p&gt;Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome

Use of tacrolimus ointment (0.03%) for refractory VKC

We report a series of 8 children with severe vernal keratoconjunctivitis who presented to us over last two years. The mean age was 7.375 years. The mean vision was 0.375 OD and 0.3625 OS. All these children were using topical steroids of varying strengths for more than two year. 2 out of 8 children had secondary glaucoma. The mean intraocular pressure was 21.75 + 4.74 OD and 23.25 + 6.25 mm of Hg OS. The highest IOP recorded was 28 mm Hg. All patients with glaucoma had early optic disc changes. Topical steroids were stopped for all patients and they were started on topical tacrolimus eye ointment (0.03%) twice a day along with lubricants. Patients relative were counseled to avoid eye rubbing, ignore minimal redness of eyes and counseled against any form of steroids. All patients continued tacrolimus for 3 months. Tacrolimus ointment was stopped at 3 month and lubricants were continued. Follow up was done at 1st week, 3rd week, 6th week, 3rd month and monthly thereafter till 6 months. At 6 months follow up all except one patient was discontinued of antiglaucoma medication. Keywords: VKC, Tacrolimus.

Visual Loss following Daily Dose Regimen of Anti Tubercular Treatment

This article is to report on the increasing trend of visual loss following daily regimen of Anti Tubercular treatment. Review of 15 patients who presented with varying degrees of visual loss after starting Anti Tubercular treatment was done. The patients had variable time of presentation ranging from few weeks to 3 months. Pupillary reaction was bilaterally brisk but ill sustained in 80% cases. Fundus examination showed optic disc changes only in 20% cases. Ethambutol was stopped in all cases. 46.6% patients were given systemic steroids. Patients who presented early had better visual prognosis. No treatment was found to be effective in reversing the optic neuropathy except stopping of Ethambutol. Only early diagnosis could prevent total visual loss. Till the time the causes and risk factors get better elucidated it would be prudent to have a regular Ophthalmological evaluation of all patients who are started on daily regimen of anti-tubercular treatment.

Evaluation of microvascular changes in retinal zones and optic disc in pediatric patients with type 1 diabetes mellitus.

The objective of this study was to evaluate the vascular parameters of the retinal zones and the optic disc (OD) with the use of optical coherence tomography angiography (OCTA) in pediatric patients with type 1 diabetes mellitus (T1DM). This study enrolled 60 patients with T1DM without clinically detectable diabetic retinopathy (DR), along with 59 age-, gender-, and pubertal stage-matched controls. The ages of the participants in both groups were < 18 years. Retinal and OD measurements were carried out with OCTA. Foveal avascular zone (FAZ) area, non-flow area (NFA), FAZ perimeter (PERIM), acircularity index of FAZ (AI, the rate of the perimeter of FAZ and the perimeter of a circle with equal area), foveal density (FD), superficial (SCP), and the deep capillary plexus (DCP) were analyzed in the macular region. SCP and DCP were also scanned centered on the OD. Correlations between the OCTA parameters with duration of DM, glycated hemoglobin (HbA1c) levels, and microalbuminuria were evaluated among patients with T1DM. The mean values for NFA were significantly higher and mean FD were significantly lower in the diabetic group compared with the controls (p = 0.02 and p = 0.01, respectively). The mean values for SCP and DCP were significantly lower in diabetic group (p < 0.05). The mean values for capillary density in the OD were also significantly lower in diabetic group (p < 0.05). There were correlations between the duration of T1DM, HbA1c levels and microalbuminuria, and the investigated parameters of OCTA. The presence of microvascular changes in both retinal zones and the OD in children with T1DM without retinopathy is an important data. OCTA can be used for the early detection of DR in children.

Ocular side effects of anti-tubercular drugs in patients receiving Anti-Tb treatment at tertiary care center

India is among the countries that carry the highest burden for tuberculosis. Antitubercular drugs are frequently associated with ocular toxicity. Among ATT, ethambutol is the most commonly implicated drug causing optic neuropathy. For assessing spectrum of ATT induced ocular toxicity, clinical presentation, monitoring, and preventive measures a prospective observational follow up study was conducted.A newly diagnosed drug susceptible pulmonary tuberculosis patients referred to ophthalmology OPD during a study period from May 2018 - October 2019 at a tertiary care hospital. The detailed history, best corrected visual acuity, fundus examination, color vision test and visual fields were carried out in all patients at the start of treatment and thereafter every month up to 6 months after initiation of ATT.During six month follow up study, out of 94 study participants, 14 eyes of seven patients (7.44%) had drop in visual acuity from baseline (p value = 0.03). Total 10 eyes of five patients (5.32%) had developed colour vision abnormality (p=0.001) and 8 eyes of four patients had developed optic disc changes from baseline. Visual field defects were noted in ten (5.32%) eyes (p = 0.001). In our study ATT related ocular toxicity was found in 5.32% on standard HRZE drug regimen.The course of ethambutol-induced ocular toxicity is unpredictable. The early recognition of ocular toxicity is paramount to prevent irreversible visual loss.

Utility of Spectral-Domain Optical Coherence Tomography in Differentiating Papilledema From Pseudopapilledema: A Prospective Longitudinal Study.

Prospective and longitudinal studies assessing the utility of spectral-domain optical coherence tomography (SD-OCT) to differentiate papilledema from pseudopapilledema are lacking. We studied the sensitivity and specificity of baseline and longitudinal changes in SD-OCT parameters with 3D segmentation software to distinguish between papilledema and pseudopapilledema in a cohort of patients referred for evaluation of undiagnosed optic disc elevation. Fifty-two adult patients with optic disc elevation were enrolled in a prospective longitudinal study. A diagnosis of papilledema was made when there was a change in the appearance of the optic disc elevation on fundus photographs as noted by an independent observer at or before 6 months. The degree of optic disc elevation was graded using the Frisen scale and patients with mild optic disc elevation (Frisen grades 1 and 2) were separately analyzed. SD-OCT parameters including peripapillary retinal nerve fiber layer (pRNFL), total retinal thickness (TRT), paracentral ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, and optic nerve head volume (ONHV) at baseline and within 6 months of follow-up were measured. Twenty-seven (52%) patients were diagnosed with papilledema and 25 (48%) with pseudopapilledema. Among patients with mild optic disc elevation (Frisen grades 1 and 2), baseline pRNFL (110.1 µm vs 151.3 µm) and change in pRNFL (ΔpRNFL) (7.3 µm vs 52.3 µm) were greater among those with papilledema. Baseline and absolute changes in TRT and ONHV were also significantly higher among patients with papilledema. The mean GCL-IPL thickness was similar at baseline, but there was a small reduction in GCL-IPL thickness among patients with papilledema. Receiver operator curves (ROCs) were generated; ΔpRNFL (0.93), ΔTRT (0.94), and ΔONHV (0.95) had the highest area under the curve (AUC). The mean baseline and absolute changes in SD-OCT measurements (pRFNL, TRT, and ONHV) were significantly greater among patients with papilledema, and remained significantly greater when patients with mild optic disc elevation were separately analyzed. ROCs demonstrated that ΔpRNFL, ΔTRT, and ΔONHV have the highest AUC and are best able to differentiate between papilledema and pseudopapilledema.

Analysis of structural and vascular changes of the optic nerve head and macula in different stages of primary open angle glaucoma

Background/Aim. It is possible that patients with open-angle glaucoma be asymptomatic in the early stage of the disease. The aim of this study was to determine the structural and vascular changes of the optic disc (OD) and macula in healthy and primary open-angle glaucoma (POAG) eyes, detected by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) as well as the correlation of the OCT and OCTA measurements and their association with the presence of POAG. Methods. A total of 196 eyes were included and classified into four groups, out of them 48 were healthy eyes, 51 eyes were with mild POAG, 50 eyes with moderate POAG, and 47 eyes with advanced glaucoma. All subjects underwent standard ophthalmic examination. OCT measured the mean, superior and inferior retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (GCC). OCTA evaluated the vessel capillary density (VCD) in OD, foveal avascular zone (FAZ) and macular vessel density (VD) in the superficial (SL) and deep (DL) retinal vascular plexus. Results. Patient characteristics were similar except for decreased visual acuity, thinner corneas, higher intraocular pressure and higher cup/disc ratio in POAG patients. OCT results showed that RNFL and GCC thickness gradually de-creased according to POAG severity. Within the assessment conducted by OCTA, VCD?s value in OD also diminished with the progression of POAG, having the lowest value in patients with advanced glaucoma. The same pattern was observed in vessel density around FAZ and VD values. Comparing the structural and vascular changes, a significant positive correlation was found between RNFL thickness and VCD inside OD, and GCC and VD SL in the macular zone. Conclusion. OCT and OCTA allow of a noninvasive quantification of the structural and vascular changes in OD and the macular zone and accurately distinguish between healthy eyes and eyes with POAG, showing an association with the presence and progression of glaucoma.

Clinical Study of Optic Neuropathies

Introduction: Optic neuropathy is a frequent cause of vision loss encountered by ophthalmologist. The diagnosis is made on clinical grounds. The history often points to the possible etiology of the optic neuropathy. A rapid onset is typical of demyelinating, inflammatory, ischemic and traumatic causes. A gradual course points to compressive, toxic/nutritional and hereditary causes. The classic clinical signs of optic neuropathy are visual field defect, dyschromatopsia, and abnormal papillary response. Study objectives were to study etiological factors causing optic neuropathies. Materials and Method: This analytical study was performed in Krishna Medical College Hospital, Karad for a period of months. The initial examination was started with anterior segment examination on slit lamp and fundus examination with direct ophthalmoscope. The material for the present study consists of 65 optic neuropathy patients during the 18 months period from November 2017 to May 2019. Results: During this study, in Krishna Hospital karad we noticed that glaucomatous optic neuropathy is the most common type of optic neuropathy and traumatic optic neuropathy is the second most type. Conclusion: Glaucoma being frequent cause of vision loss , is unfortunately not diagnosed at early stage and as age advances the risk of glaucoma increases also hypertension is one of the risk factors, so routinely every patient &gt;40 years of age is to be assessed for glaucoma by noting optic disc changes and intra ocular pressure. If necessary Dynamic Perimetry is to be done for further evaluation.

Long term change of the optic disc and OCT parameters during myopic shift in children with large cup to disc ratio.

PurposeThis observational case series was to determine long term optic disc changes in eyes with large cup to disc ratio (CDR) and compare the changes induced by myopic shift during childhood with normal control eyes.MethodsChildren under 15 years of age who developed myopia with serial optic disc photographs and spectral domain (SD)-optical coherence tomography (OCT) images with a minimal interval of three years were evaluated. Children with average CDR ≥ 0.6 on SD-OCT were classified as having large CDR. The ratios of vertical disc diameter (VDD), horizontal disc diameter (HDD), and maximum peripapillary atrophy (PPA) width (PPW) were measured to quantify morphologic changes of optic discs and SD-OCT parameters, such as peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell and inner plexiform layer (GCIPL) thickness were measured.ResultsOf the 82 eyes (82 patients) analyzed, 42 eyes had large CDR and 40 eyes were normal controls. The mean age and refractive error at initial examination were not different between groups (P = 0.33, P = 0.76, respectively). The changes in HDD/VDD and PPW/VDD ratios during follow-up showed no significant difference among the groups (P = 0.45, P = 0.62, respectively). No statistical significance was found in changes in RNFL and GCIPL thickness between the two groups (P = 0.74, P = 0.79, respectively).ConclusionsChildren with enlarged CDR showed changes in optic disc morphology and RNFL/GCIPL thickness similar to normal children during myopic shift.

Evaluation of microvascular changes in optic disc and retina by optical coherence tomography angiography during Valsalva maneuver.

Optical coherence tomography angiography (OCTA) is an increasingly widespread imaging tool that allows the visualization of the microvascular structures of the eye. It should be kept in mind in clinical practice, Valsalva maneuver (VM) may have an effect on OCTA findings. We aimed to evaluate the effect of VM on the optic nerve and retinal blood flow parameters measured by OCTA. Sixty age- and sex-matched healthy volunteers were included into this prospective study. Optic disc status for radial peripapillary capillary (RPC) network [whole image, inside disc and peripapillary capillary densities], superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities and foveal avascular zone (FAZ) densities of volunteers were examined by OCTA both at rest and during VM. The mean age of the subjects was 31.48 ± 7.49 (18-50) years and 51.7% were male. Superficial whole, parafoveal and perifoveal vessel densities were found to be significantly decreased during VM (p = 0.008, p= 0.015, p = 0.017, respectively). Lower levels of deep whole, parafoveal and perifoveal vessel densities were also detected while VM (p < 0.001 for all). However, there were no significant differences in terms of foveal vessel and FAZ densities. Additionally, VM significantly decreased RPC densities for whole image, inside and peripapillary capillary (p = 0.005, p < 0.001, p = 0.039, respectively). VM may cause a significant decrease in optic nerve and para-perifoveal blood flow. Therefore, patient instruction about not holding breath is required before OCTA scanning.

Ab externo 240-degree trabeculotomy versus trabeculotomy–trabeculectomy in primary congenital glaucoma

This prospective study aimed to compare the surgical outcomes of ab externo 240-degree trabeculotomy and trabeculotomy-trabeculectomy in managing primary congenital glaucoma (PCG). The study included 30 eyes of 30 patients aged less than 3 years who were diagnosed with PCG and was conducted in Menofia University Hospital between November 2018 and January 2020. The studied eyes were divided into two equal groups. Ab externo 240-degree trabeculotomy and combined trabeculotomy with trabeculectomy with MMC were performed for groups I and II, respectively. Post-operative measurements included intraocular pressure (IOP), optic disc changes, alteration in corneal clarity and transverse corneal diameter, as they are needed for antiglaucoma therapy. Post-operative complications were followed up for 1-year. There was significant reduction in IOP in both groups during the follow-up period. The reduction was higher in group I, where mean preoperative IOP was 28.20 ± 1.74 mmHg. The IOP in the group II was 28.07 ± 3.51 mmHg. The mean IOP decreased to 13.93 ± 1.8 mmHg and 14.60 ± 1.24 mmHg in groups I and II, respectively, after 1 year (P < 0.001); however, the difference between the two groups was not significant. Regarding post-operative complications, post-operative hypotony was more common in group I. Other complications such as shallow anterior chamber, choroidal detachment and blebitis occurred more frequently in group II. However, post-operative hyphema was more common in group I. Corneal clarity improved significantly in both groups, but more so in group I, where an improvement was seen in 13 cases (86.6%), compared to 11 cases in group II (73.3%). Ab externo 240° trabeculotomy and trabeculotomy-trabeculectomy are effective techniques in primary congenital glaucoma with more reduction in IOP in Ab Externo 240° trabeculotomy. Ab externo 240° trabeculotomy provided more better surgical outcome with limited complications, especially those related to bleb formation.

Optical coherence tomography in preclinical diagnosis of optic nerve disk changes after chemotherapy in children with retinoblastoma

Purpose . Using optical coherence tomography (OCT), determine the preclinical changes in optic nerve head (ONH) after chemotherapy in children with retinoblastoma (RB). Material and methods . 38 patients (76 eyes) were examined and treated: 15 girls, 23 boys with RB averagely aged 21.0 ± 1.5 months. Of these, 58 affected eyes before treatment belonged to groups А (3), В (16), С (33), D (3), and Е (3). All tumor nodes were located on the fundus outside the optic disk. The examination of these eyes was carried out on an optical coherent tomograph SOCT Copernicus 4.2 (Poland). The 58 eyes were first tested before treatment, then after 3 or 4 courses of systemic chemotherapy (CT), once again after 6 courses of systemic CT and 1–3 courses of superselective intraarterial CT and 4–9 courses of intravitreal CT. 15 healthy children (30 eyes) of the corresponding age were examined as a control. Results . After 3 courses of systemic CT, OCT determined optic neuropathy with edema in 46.6 %. Morphometric data included parapapillary retinal cystic cavities, elevation of the contour of the optic disc towards the vitreous, increased rim volume (to 0.87 ± 0.12 mm 3 ) and average thickness of the nerve fiber layer increased to 0.39 ± 0.06 mm (p &lt; 0.01). After combined chemotherapy we revealed the thinning of the peripapillary choroid (to 80.0 ± 3.2 μm) with no retinal edema in 34.5 %, a reduction of rim volume to 0.34 ± 0.2 mm 3 and the layer of nerve fibers to 0.02 ± 0.01 mm (p &lt; 0.01). These changes are evidences of optic nerve disc atrophy. Conclusion . OCT is an informative method of examining the optic disc in children with RB at different stages of treatment, which identifies signs of edema and symptoms of atrophy more often (respectively, by 15.6 % and 17.3 %). Preclinical diagnostics of optic disc pathology with the help of OCT allows predicting visual functions in children with RB at its early stages and developing a differentiated approach to the choice of RB treatment.

Изменения макулярной зоны и диска зрительного нерва во время силиконовой тампонады

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

OCT-Diagnostik beim Glaukom: Tipps &amp; Tricks

High-resolution optical coherence tomography (OCT) with spectral-domain or swept-source techniques has become a mainstay in glaucoma and progression diagnosis. Imaging and morphometry of ganglion cell (GCL) and retinal nerve fiber (RNF) layer thickness and Bruch's membrane based minimum neuroretinal rim width (BMO-MRW) measurement allow the detection of pathologic changes. Graphic display of these measurements facilitate a comparison with normative data. False positive (red disease) and false negative (green disease) results represent pitfalls in OCT diagnosis. Pathologies of the posterior pole either caused by glaucoma or non-glaucoma associated changes of optic disc and retina play an important role. Epiretinal gliosis, age related macular degeneration and cystoid retinal changes cause measuring artefacts. A careful inspection of OCT B-scans is mandatory to detect these changes. Highly myopic eyes, underrepresented in normative databases cause changes resembling glaucoma and challenge the OCT glaucoma diagnosis. Neurological diseases present an important differential diagnosis when atrophy of neuroretinal tissue and ganglion cells occur. The location of the atrophy and the relationship of GCL, RNF and BMO-MRW changes may help in differential diagnosis. Sensory tests and imaging of the brain are mandatory in these cases. Drusen and disc edema cause thickening of BMO-MRW and may be followed by loss of RNF and GCL. Again a close observation of OCT B-scans and fundus may help to find the correct diagnosis. Good image quality, knowledge of OCT pathologies and technique of OCT imaging may help to avoid pitfalls in OCT glaucoma diagnosis.

A neuroglia-based interpretation of glaucomatous neuroretinal rim thinning in the optic nerve head.

Neuroretinal rim thinning (NRR) is a characteristic glaucomatous optic disc change. However, the precise mechanism of the rim thinning has not been completely elucidated. This review focuses on the structural role of the glioarchitecture in the formation of the glaucomatous NRR thinning. The NRR is a glia-framed structure, with honeycomb geometry and mechanically reinforced astrocyte processes along the transverse plane. When neural damage selectively involves the neuron and spares the glia, the gross structure of the tissue is preserved. The disorganization and loss of the glioarchitecture are the two hallmarks of optic nerve head (ONH) remodeling in glaucoma that leads to the thinning of NRR tissue upon axonal loss. This is in contrast to most non-glaucomatous optic neuropathies with optic disc pallor where hypertrophy of the glioarchitecture is associated with the seemingly absent optic disc cupping. Arteritic anterior ischemic optic neuropathy is an exception where pan-necrosis of ONH tissue leads to NRR thinning. Milder ischemia indicates selective neuronal loss that spares glia in non-arteritic anterior ischemic optic neuropathy. The biological reason is the heterogeneous glial response determined by the site, type, and severity of the injury. The neuroglial interpretation explains how the cellular changes underlie the clinical findings. Updated understandings on glial responses illustrate the mechanical, microenvironmental, and microglial modulation of activated astrocytes in glaucoma. Findings relevant to the possible mechanism of the astrocyte death in advanced glaucoma are also emerging. Ultimately, a better understanding of glaucomatous glial response may lead to glia-targeting neuroprotection in the future.