Retinal Nerve Fiber Layer Measurements Research Articles

Comparison of Pattern Electroretinography and Optical Coherence Tomography Parameters in Patients with Primary Open-Angle Glaucoma and Ocular Hypertension

Objectives:To investigate the correlation of visual field (VF), pattern electroretinography (PERG) and Fourier domain optical coherence tomography (FD-OCT) results in patients with ocular hypertension (OHT) and early primary open-angle glaucoma (POAG).Materials and Methods:The study included 72 eyes of 37 patients with early POAG, 76 eyes of 38 patients with OHT, and 60 eyes of 30 controls. All subjects underwent full ophthalmologic examination, VF assessment with 24-2 Humphrey standard automated perimetry (Swedish Interactive Thresholding Algorithm (SITA)-Standard), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness measurement with FD-OCT, and PERG P50 and N95 wave latency and amplitude measurements with electroretinography (Nihon Kohden).Results:With the exception of the nasal quadrant, all GCC parameters and RNFL results were significantly lower in the POAG group compared to the OHT and control groups. There was no statistically significant difference between the OHT and control group. PERG amplitudes were lower in the POAG and OHT groups than in the control group. Reduction in N95 amplitude was greater than that of P50 amplitude. No difference was detected in PERG latencies among groups. GCC was significantly correlated with VF and RNFL in the POAG group. Conclusion:Significant thinning of the GCC and RNFL occurs in addition to VF pathologies in patients with early POAG, and these examinations should be concomitantly evaluated. During diagnostic assessment of patients with early POAG, GCC and RNFL analysis by FD-OCT are highly effective. GCC is as reliable as RNLF in the early diagnosis of glaucoma and there is a highly significant correlation between them. Dysfunction of ganglion cells in patients with OHT may be detected earlier using PERG amplitude analysis.

Intraeye retinal nerve fiber layer and macular thickness asymmetry measurements for the discrimination of primary open-angle glaucoma and normal tension glaucoma

PurposeThe aim of this study was to evaluate the diagnostic capability of intraeye retinal nerve fiber layer (RNFL) thickness and macular thickness (MT) asymmetry measurements for the discrimination of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT). MethodsA total of 90 subjects were enrolled including 30 consecutive healthy subjects, 30 consecutive subjects with POAG, and 30 consecutive subjects with NTG. RNFL thicknesses around the optic disc as well as MT measurements were taken with circular and radial SD-OCT scans. Intraeye retinal and MT asymmetry were calculated as the absolute difference between superior and inferior hemispheres of the eye using posterior pole asymmetry analysis protocol. Analysis of variance was used for comparison and areas under the receiver operating characteristic (AROC) were obtained for different parameters among the three diagnostic groups. ResultsThere was a significant difference in MT asymmetry for all comparison groups (normal-NTG, p<0.05; normal-POAG, p<0.001; and NTG-POAG, p<0.001). Intraeye retinal nerve fiber thickness asymmetry measurements were not different between the groups (normal-NTG, p<0.187; normal-POAG, p<0.056; and NTG-POAG, p<0.837). The area under ROC curves exceeded 0.800 for all the studied parameters, including the MT asymmetry except for intraeye RNFL thickness asymmetry which had the lowest AROC as well as the least sensitivity for identifying subjects with NTG from normal (AROC=0.626, sensitivity=30%); POAG from normal (AROC=0.644, sensitivity=37%) and NTG from POAG (AROC=0.533, sensitivity=13%). ConclusionThe intraeye MT asymmetry holds significant potential as a distinguishing parameter for NTG and POAG.

Diagnostic Accuracy of the Spectralis and Cirrus Reference Databases in Differentiating between Healthy and Early Glaucoma Eyes

To evaluate and compare the diagnostic accuracy of global and sector analyses for detection of early visual field (VF) damage using the retinal nerve fiber layer (RNFL) reference databases of the Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Cirrus (Carl Zeiss Meditec, Dublin, CA) spectral-domain optical coherence tomography (SD OCT) devices. Healthy subjects and glaucoma suspects from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluation Study (ADAGES) with at least 2 years of follow-up were included. Global and sectoral RNFL measures were classified as within normal limits, borderline (BL), and outside normal limits (ONL) on the basis of the device reference databases. The sensitivity of ONL classification was estimated in glaucoma suspect eyes that developed repeatable VF damage. A total of 353 glaucoma suspect eyes and 279 healthy eyes were included. A total of 34 (9.6%) of the glaucoma suspect eyes developed VF damage. In glaucoma suspect eyes, Spectralis and Cirrus ONL classification was present in 47 eyes (13.3%) and 24 eyes (6.8%), respectively. The sensitivity of the global RNFL ONL classification among eyes that developed VF damage was 23.5% for Cirrus and 32.4% for Spectralis. The specificity of within-normal-limits global classification in healthy eyes was 100% for Cirrus and 99.6% for Spectralis. There was moderate to substantial agreement between Cirrus and Spectralis classification as ONL. The Spectralis and Cirrus reference databases have a high specificity for identifying healthy eyes and good agreement for detection of eyes with early glaucoma damage.

Helvacioglu reproducibility index: a new algorithm to evaluate the effects of misalignments on the measurements of retinal nerve fiber layer by spectral-domain OCT.

To evaluate the effect of misalignment on the measurements of retinal nerve fiber layer (RNFL) by spectral-domain optical coherence tomography (OCT). A total of 42 eyes from 21 healthy young subjects underwent RNFL measurements with RTVue spectral-domain OCT (Optovue Inc., Fremont, California, USA). Two baseline measurements with perfectly aligned central circle to the borders of the optic nerve and four misaligned measurements which were misaligned towards to four quadrants were taken. The differences in RNFL between the baseline and misaligned measurements were analyzed with a new algorithm called Helvacioglu reproducibility index (HRI) which is designed to measure the reproducibility of the scans by evaluating the RNFL changes in the four main quadrants. The average RNFL scores of the first two baseline measurements have good correlation (c=0.930) and good reproducibility scores (0.15±0.07). Superior misaligned measurements had significantly lower superior quadrant score and higher inferior quadrant score, similar nasal and little higher temporal scores (P1, P2<0.001, P3=0.553, P4=0.001). Inferior misaligned measurements had significantly higher superior quadrant score and lower inferior quadrant score with similar temporal and little lower nasal scores (P1, P2<0.001, P3=0.315, P4=0.016). Nasal misaligned measurements had significantly higher temporal quadrant score and lower nasal quadrant score with little lower superior and inferior scores (P1, P2, P4<0.001, P3=0.005). Temporal misaligned measurements had significantly higher nasal quadrant score and lower temporal quadrant score with similar superior and little higher inferior scores (P1, P2<0.001, P3=0.943, P4=0.001). Good alignment of the central circle to the borders of optic nerve is crucial to have correct and repeatable RNFL measurements. Misalignment to a quadrant resulted in falsely low readings at that quadrant and falsely high readings at the opposite quadrant.

Effect of Inhaled Fluticasone Propionate on Retinal Nerve Fiber Layer Thickness in Asthmatic Children

Corticosteroids are under suspicion of playing an important role in the development of retinopathy. We aimed to determine peripapillary retinal nerve fiber layer (RNFL) thinning by spectral-domain optical coherence tomography (OCT) in children being treated with inhaled fluticasone propionate due to asthma. Thirty-eight children diagnosed with allergic asthma (mean age 9.8 ± 2.8 years, age range 6-13 years) and 40 age-similar controls were enrolled in this study. All children with asthma were taking inhaled fluticasone propionate at a dosage of 250 µg or more per day for at least 1 year. The RNFL thickness measurements were performed using Cirrus HD spectral-domain OCT 400. Central subfield thickness, cube average thickness, and cube volume were also measured. Among the 38 children with asthma and 40 healthy subjects who completed follow-up, children with asthma had similar mean peripapillary RNFL thicknesses compared with control children. The mean central subfield thickness was significantly higher than that of controls (248.8 ± 23.4 vs 237.5 ± 23.5, p&lt;0.037). There was a positive linear relationship between cube average thickness and eosinophil count with a Pearson correlation coefficient of 0.336 (p&lt;0.039) and a negative correlation was found between central subfield thickness and disease duration (r = -0.385, p = 0.017) in children with asthma. Asthmatic children have similar peripapillary RNFL measurements compared to controls on spectral-domain OCT. Raised eosinophil counts in asthmatic children were found to be significantly associated with cube average thickness.

Effect of Signal Intensity on Measurement of Ganglion Cell Complex and Retinal Nerve Fiber Layer Scans in Fourier-Domain Optical Coherence Tomography.

We determined the effect of Fourier-domain optical coherence tomography (OCT) signal strength index (SSI) and cropping on retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) scan repeatability and measurement thickness. Eyes were enrolled in the longitudinal Advanced Imaging for Glaucoma Study. At each visit, three repeat scans from the optic nerve head and macular protocols were obtained. Each measurement was associated with an SSI value from 0 to 100. Measurements with similar SSI scores were grouped to calculate repeatability defined as pooled standard deviation. Within-visit analysis was used to determine how measured thickness changed in relation to change in SSI level. The study included 1130 eyes of 569 patients. Cropped images yielded significantly worse repeatability and they were excluded from subsequent analyses. The within-visit repeatability for RNFL and GCC measurements were significantly better with higher signal strength, and optimal cutoffs were SSI ≥ 37 and ≥ 44, respectively. The coefficient of variation was <1.8% for RNFL scans with SSI ≥ 37 and < 2% for GCC with SSI ≥ 44. For scans above the cutoff SSI, higher SSI's were correlated with thicker RNFL among normal (slope = 0.056 μm/SSI unit, P < 0.001) eyes and glaucoma suspect and perimetric glaucoma (GSPPG) eyes (slope = 0.060 μm/SSI unit, P < 0.001), but not for perimetric glaucoma (PG) eyes. No significant correlation was found for GCC. Repeatability of RNFL and GCC thickness measurements may be improved by excluding images with cropped anatomic features and weak signal strength below recommended SSI cutoffs. Measurement precision and image quality of inner eye structure by advanced imaging modality are important for clinical diagnosis and tracking of glaucoma disease.

The effect of macular edema on the measurement of retinal nerve fiber layer thickness and the thickness of peripapillary retina

PurposeWith advanced in accuracy and reproducibility of spectral domain optical coherent tomography, It issuggested that the serial changes of retinal nerve fiber layer (RNFL) thickness could reflect the progression of glaucoma. But, patient may have accompany disease that affect retinal structure such as diabetes, venular occlusive diasese and macular degenerative diasese. So, we investigated the factors that influence the measurement of RNFL and peripapillaryretina.MethodsIn this retrospective controlled case series, we reviewed the eyes with macular edema. Analyzed factorsassociated RNFL thickness and peripapillary retina ranging from 3 mm and 5 mm of optic disc included age, IOP, visualacuity, central macular thickness (CMT), central macular thickness changes and kinds comorbid diasese. All themeasured values were obtained at initial presentation and the presentation when macular edema was relieved. The RNFL thickness and peripapillary retinal thickness were measured by SD‐OCT (Spectralis OCT).ResultsThe measured value RNFL thickness and peripapillary retina were significantly fluctuate with the macularedema. The initial CMT, CMT changes were quantitively correlated with RNFL thickness alteration (p &lt; 0.01). The initialCMT, CMT changes also significantly correlated with peripapillary retina ranging from 3 and 5 mm of optic disc, butthere was distinction associated with geographic difference. In the subgroup analysis, there were difference associations according to kinds comorbid diasese.ConclusionsThe macular edema effected the RNFL and the peripapillary retina. The measurements of RNFL andperipaillary retina were quantitively correlated in some kinds of comorbid diasese. The central macular thickness shouldbe considered in clinical application of detection about decreased RNFL thickness in patients who have macular edema.

Comparison of Optical Coherence Tomography Measurement Reproducibility between Children and Adults

PurposeTo compare the reproducibility of SD‐OCT (spectral‐domain optical coherence tomography) measurements of RNFL (retinal nerve fiber layer) and macular thickness between children and adults.MethodsSeventy‐one eyes of 71 healthy myopic children and 71 eyes of 71 normal adults were enrolled. RNFL and macular thicknesses were measured by one operator, with a brief rest between measurements. The two measurements were obtained using the eye tracking and retest function of Spectralis SD‐OCT. Reproducibility was evaluated with reference to COVs (coefficients of variation) and ICCs (intraclass correlation coefficients). The ICC values of the RNFL and macular thicknesses were compared, respectively between the two groups, by Fisher's z‐test.ResultsThe RNFL and macular thicknesses did not differ between the two groups. The COVs of the RNFL measurements ranged from 0.945 to 4.531% in the children group and from 0.496 to 1.391% in the adults group. In most of the RNFL sectors, the ICCs of the children group (range: 0.784–0.987) were significantly lower than those of the adults group (range: 0.986–0.993). The COVs of the macular measurements ranged from 0.496 to 1.157% in the children group and from 0.275 to 0.656% in the adults group. The ICCs (range: 0.859–0.973) in the children group, significantly lower than for the adults (range: 0.989–0.995), in all of the macular sectors.ConclusionsThe reproducibility of SD‐OCT RNFL and macular measurements for healthy myopic children was excellent, albeit statistically lower than that for adults.

Influence of disc-fovea angle and retinal blood vessels on interindividual variability of circumpapillary retinal nerve fibre layer

BackgroundTo assess whether intersubject variability of circumpapillary retinal nerve fibre layer (RNFL) thickness in healthy subjects acquired with spectral domain optical coherence tomography (SD-OCT) can be reduced by considering the...

Evaluation of the peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer measurements in patients with iron deficiency anemia with optical coherence tomography

Objective: To evaluate the thickness of the peripapillary retinal fiber layer (RNFL) and macula ganglion cell-inner plexiform layer (GCL+) using optical coherence tomography (OCT) in patients with iron deficiency (ID) anemia.Methods: This study included 73 eyes of 39 patients with ID anemia and 68 eyes of 34 age- and sex-matched healthy subjects. The measurements included the peripapillary RNFL thicknesses as average, 4 quadrant and 12 clock-hour (CH) based and macula GCL+ thicknesses as average and 6 quadrant based. All measurements were completed with Cirrus HD-OCT and the results were compared between the groups.Results: A total of 73 eyes of 39 patients with ID anemia and 68 eyes of 34 healthy subjects were included to the study. Regarding peripapillary RNFL thicknesses of the study and control patients, the values of average and quadrants revealed no significant differences between the groups. In CH sectors comparison, peripapillary RNFL thicknesses were significantly decreased only in CH4 (68.7 ± 14.5 μm in study versus 72.0 ± 13.4 μm in control patients, p = 0.049) and CH5 (93.4 ± 20.0μm in study versus 102.2 ± 20.1 μm in control patients, p = 0.01) sectors. All measured quadrants were statistically similar, when macula GCL+ thicknesses were compared between the groups. When the correlations between peripapillary RNFL and macula GCL+ thicknesses and serum hemoglobin and ferritin levels of study and control patients were calculated, the only statistically significant parameter was the correlation of peripapillary RNFL thickness in CH10 sector with serum ferritin level (p = 0.032, Spearman correlation coefficient: 0.369).Conclusion: The study revealed that peripapillary RNFL is thinner in nasal-inferior quadrant in patients with ID anemia. The measurements of macula GCL+ thicknesses were similar between the groups. Analyzing the retinal layers using OCT may provide valuable information in neurodegenerative events.

Impact of segmentation errors and retinal blood vessels on retinal nerve fibre layer measurements using spectral-domain optical coherence tomography.

To investigate the impact of retinal blood vessels and retinal nerve fibre layer (RNFL) segmentation errors on RNFL measurement. One eye of 180 subjects (60 normal, 66 mild-to-moderate and 54 advanced glaucoma subjects) was randomly selected for RNFL imaging with a spectral-domain OCT. The boundaries of the RNFL detected by the instrument software were checked, and the segmentation errors were corrected by a customized computer program. The differences in average and regional RNFL thicknesses (RNFLT) before and after the correction were analysed to determine the frequency of segmentation error (defined as an absolute difference in average RNFLT >5.0 μm). The ratio of retinal blood vessel cross-sectional area to RNFL cross-sectional area was calculated. The difference in average RNFLT (postsegmentation minus presegmentation refinement) ranged from -3.0 to 2.5 μm (mean ± standard deviation: 0.83 ± 0.86 μm) in the normal, -2.5 to 5.0 μm (0.56 ± 1.08 μm) in the mild-to-moderate glaucoma and -11.0 to 9.5 μm (0.05 ± 3.49 μm) in the advanced glaucoma groups (p = 0.003). A total of 15% of eyes had average RNFLT measurement error >5.0 μm in the advanced glaucoma group. The proportion of retinal blood vessels in the RNFL also increased with the severity of glaucoma (p < 0.001) with 4.2 ± 1.0% in the normal group, 4.9 ± 1.5% in the mild-to-moderate and 8.5 ± 3.5% in the advanced glaucoma groups. Inclusion of retinal blood vessels and RNFL segmentation error could adversely affect RNFL measurement, particularly in advanced glaucoma when the RNFL was thin.

Detection of retinal changes in idiopathic Parkinson's disease using high-resolution optical coherence tomography and heidelberg retina tomography.

The study was performed to analyse the retina of patients with Parkinson's disease (PD) for morphological changes compared to healthy controls (HC) using spectral-domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy. We enrolled 108 patients with idiopathic PD and 165 HC. All study participants underwent an ophthalmological examination to exclude ophthalmological disorder potentially interfering with the retinal analyses. Peripapillary retinal nerve fibre layer (RNFL) thickness and macular thickness and volume were measured by a SD-OCT device (Heidelberg Spectralis(®) ). Stereometric parameters of the optic disc were acquired by Heidelberg Retina Tomograph (HRT III). The RNFL thickness did not significantly differ between patients with PD and HC. The thickness of the central minimum and the centre of the macular area were significantly reduced in patients with PD, while the total macular volume did not significantly differ between the groups. Furthermore, we noted an inverse correlation between the central minimum thickness and the disease severity (assessed by the Hoehn and Yahr scale). HRT data showed no significant differences. The HRT device and the RNFL measurements of the SD-OCT did not prove to be a clinically valid diagnostic tool to distinguish eyes of patients with PD and HC. However, the macular region and especially the foveola (central minimum) with the highest density of photoreceptor cells seem to be more sensitive and might be potential biomarkers.

Ganglion cell layer analysis unmasks axonal loss in anterior optic neuritis.

Optical coherence tomography is a valuable tool for evaluating patients with neuro-ophthalmic disorders. In the acute phase of anterior optic neuritis (ON), peripapillary retinal nerve fiber layer (pRNFL) measurements can underestimate the amount of damage as axonal swelling could mask the true degree of RNFL loss. Contrary to pRNFL evaluation, we hypothesize that macular ganglion cell layer analysis could detect true neuronal loss before swelling resolution in anterior ON. We describe 4 patients with anterior ON in whom ganglion cell layer and inner plexiform layer (GCIPL) thinning was detected earlier than pRNFL loss. GCIPL analysis may provide more accurate information than pRNFL thickness and serve as an early structural indicator of irreversible neuronal loss.

Retinal nerve fiber layer sector-specific compromise in relapsing and remitting multiple sclerosis.

ObjectiveTo evaluate quadrant and sector retinal nerve fiber layer (RNFL) thickness and total macular volume (TMV) in relapsing–remitting multiple sclerosis (RR-MS) patients.MethodsOptical coherence tomography measures of RNFL and TMV were studied in 321 eyes without prior optic neuritis (ON) (MS unaffected), 151 eyes with prior ON (MS affected), and 148 healthy control eyes.ResultsMean RNFL thickness was significantly lower in the MS affected and MS unaffected groups relative to the control group (p < 0.0001). RNFL thicknesses in the superior, inferior, and temporal quadrants were significantly reduced in MS unaffected (113 ± 15 μm, 119 ± 17 μm, 63 ± 13 μm) (p < 0.001) and MS affected groups (99 ± 19 μm, 103 ± 21 μm, 51 ± 13 μm) (p < 0.0001) compared with that in controls (120 ± 14 μm, 128 ± 15 μm, 69 ± 8 μm, respectively). TMV was significantly reduced in both the MS affected and MS unaffected groups compared with that in the controls (p < 0.0001).ConclusionQuadrant, sector, and PMB RNFL thicknesses are significant individual measures in RR-MS for both affected and unaffected eyes and may prove valuable in future investigations including biomarker and outcomes research.

Potential measurement errors due to image enlargement in optical coherence tomography imaging.

The effect of interpolation and super-resolution (SR) algorithms on quantitative and qualitative assessments of enlarged optical coherence tomography (OCT) images was investigated in this report. Spectral-domain OCT images from 30 eyes in 30 consecutive patients with diabetic macular edema (DME) and 20 healthy eyes in 20 consecutive volunteers were analyzed. Original image (OR) resolution was reduced by a factor of four. Images were then magnified by a factor of four with and without application of one of the following algorithms: bilinear (BL), bicubic (BC), Lanczos3 (LA), and SR. Differences in peak signal-to-noise ratio (PSNR), retinal nerve fiber layer (RNFL) thickness, photoreceptor layer status, and parallelism (reflects the complexity of photoreceptor layer alterations) were analyzed in each image type. The order of PSNRs from highest to lowest was SR > LA > BC > BL > non-processed enlarged images (NONE). The PSNR was statistically different in all groups. The NONE, BC, and LA images resulted in significantly thicker RNFL measurements than the OR image. In eyes with DME, the photoreceptor layer, which was hardly identifiable in NONE images, became detectable with algorithm application. However, OCT photoreceptor parameters were still assessed as more undetectable than in OR images. Parallelism was not statistically different in OR and NONE images, but other image groups had significantly higher parallelism than OR images. Our results indicated that interpolation and SR algorithms increased OCT image resolution. However, qualitative and quantitative assessments were influenced by algorithm use. Additionally, each algorithm affected the assessments differently.

Avaliação da Reprodutibilidade das Medições da Espessura da Camada de Fibras Nervosas Peripapilar usando o OCT de Domínio Espectral

Purpose : To assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness, measured with Spectralis ® OCT, in healthy and glaucomatous subjects, through of inter-examiner variability, intra-test and inter-test with and without software of followup. Methods : Cross-sectional and prospective study with 37 controls (63 eyes) and 33 patients with glaucomatous optic neuropathy (55 eyes). Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated. Results : Low inter-examiner, intra-test and inter-test variability, with ICC>0,75 e CV<10%, in both control group and patients with glaucoma. Conclusions : The Spectralis ® OCT shows excellent reproducibility of RNFL measurements, validating it as an useful tool for monitoring the progression of glaucoma.

Retinal nerve fiber layer structure abnormalities in patients with Neuro-Behcet's disease.

Our aim was the evaluation of retinal nerve fiber layer (RNFL) and central macular thickness (CMT) in patients with Neuro-Behcet's disease (NBD) and to compare the results with healthy control subjects. We recruited 50 eyes of 25 patients with NBD and 42 eyes of 21 age-matched healthy control subjects. Patients and control subjects underwent a thorough ophthalmic examination, including retinal nerve fiber layer and macular thickness measurements by optical coherence tomography. No significant difference was found between groups for age, sex, intra-ocular pressure and central corneal thickness measurements. The average RNFL in patients with NBD was significantly lower than that of healthy controls (86.92 ± 18.36 μm vs. 99.74 ± 8.73 μm; p = 0.00). There was significant thinning of the RNFL in three of four quadrants of the peripapillary area, superior (107.22 ± 30.91 μm vs. 125.57 ± 20.97 μm; p = 0.00), inferior (110.36 ± 25.57 μm vs. 132.19 ± 12.71 μm; p = 0.00) and nasal (68.84 ± 18.47 μm vs. 74.98 ± 11.42 μm; p = 0.05), in patients with NBD. Average CMT was significantly lower in NBD patients than in control subjects (244.06 ± 26.25 μm vs. 261.69 ± 25.71 μm; p = 0.00). There are significant differences in average RNFL and CMT between the two groups. RNFL and CMT thicknesses are reduced in patients with NBD compared with the healthy controls.

Visual Outcomes, Visual Fields, and Optical Coherence Tomography in Paediatric Craniopharyngioma

ABSTRACTTen patients with craniopharyngioma treated for the first time when younger than 18 were included. This study reviews the visual outcomes and provides information on visual field (VF) and optical coherence tomography (OCT) examination of craniopharyngioma. The best kappa concordance coefficients between VF and OCT parameters of atrophy were obtained for the ganglion cell (GC) thickness and the mean retinal nerve fibre layer (RNFL) thickness. The agreement between GC colour maps and VF defects was good. Optic nerve compression may be detected by RNFL measurement and GC analysis, and this may be valuable to predict visual recovery and in uncooperative patients to evaluate visual damage.

Prospective Evaluation of Acupuncture as Treatment for Glaucoma

To evaluate acupuncture as treatment for glaucoma. Prospective double-masked randomized crossover study. setting: Clinical practice. One eye per patient with primary open-angle glaucoma and stable intraocular pressure (IOP). Patients were randomized to receive 1 acupuncture series (12 sessions with either eye-related [eye-points] or non-eye-related [non-eye-points] acupoints) and then crossed over to receive the other series. IOP, blood pressure (BP), heart rate (HR), best-corrected visual acuity (BCVA), visual field (VF), optic disc and peripapillary retinal nerve fiber layer (RNFL) measurements, compliance, and adverse reactions. Probability to detect 3 mm Hg IOP difference between series was 90%. Twenty-two patients volunteered and 11 (50.0%) completed the study; 8 (36.4%) did not complete treatment owing to changes of health, moving away, lack of transportation, or family crisis; and 3(13.6%) were withdrawn owing to needle sensitivity or IOP elevation (8 mm Hg) in the contralateral eye. After an acupuncture session, mean IOP increased slightly with both eye-points (from 12.9 ± 1.8 mm Hg to 13.6 ± 2.0 mm Hg, P = .019) and non-eye-points (from 13.0 ± 1.5 mm Hg to 13.5 ± 1.7 mm Hg, P = .073) series. HR, diurnal IOP, and BCVA showed no statistically significant changes after 12 sessions of either series. Systolic and diastolic BP were reduced after 12 sessions of non-eye-points series (P = .040, P = .002, respectively). Optic disc, RNFL, and VF showed no statistically significant changes. Acupuncture has no overall effect on diurnal IOP or BCVA but may temporally increase the IOP immediately after a treatment session. BP is lowered by acupuncture with non-eye-points, but not with eye-points. Compliance and adverse event rates were low.

Evaluation of retinal nerve fiber layer thickness measured by optical coherence tomography in Moroccan patients with multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by focal inflammatory infiltrates, demyelinating lesions and axonal injury. The purpose of the study was to evaluate the retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) in Moroccan patients with MS and to assess the relationship between RNFL thickness and disease duration, Expanded Disability Status Scale (EDSS) score, visual acuity and automated visual field indices. Thirty-one patients with definite MS and thirty-one disease-free controls were enrolled in the study. After neurologic consultation, ophthalmologic examination including visual acuity, automated visual field testing and OCT were performed. Significant differences between both groups were observed in OCT parameters (total, temporal and macular ganglion cell layer) with lower thickness in the MS group. In patients without a history of optic neuritis, there were statistically significant inverse correlations between total RNFL thickness and disease duration, neurologic disability evaluated by the EDSS, logMAR visual acuity and automated visual field indices. OCT seems to be a reproducible test to detect axonal loss of ganglion cells in MS. Further and larger longitudinal prospective studies would be valuable to assess the evolution over time of the RNFL measurements in Moroccan MS patients.