Jessica S Maslin

Anterior segment imaging in glaucoma: An updated review

Anterior segment imaging allows for an objective method of visualizing the anterior segment angle. Two of the most commonly used devices for anterior segment imaging include the anterior segment optical coherence tomography (AS-OCT) and the ultrasound biomicroscopy (UBM). AS-OCT technology has several types, including time-domain, swept-source, and spectral-domain-based configurations. We performed a literature search on PubMed for articles containing the text “anterior segment OCT,” “ultrasound biomicroscopy,” and “anterior segment imaging” since 2004, with some pertinent references before 2004 included for completeness. This review compares the advantages and disadvantages of AS-OCT and UBM, and summarizes the most recent literature regarding the importance of these devices in glaucoma diagnosis and management. These devices not only aid in visualization of the angle, but also have important postsurgical applications in bleb and tube imaging.

Sturge-Weber Syndrome (Encephalotrigeminal Angiomatosis): Recent Advances and Future Challenges.

AbstractSturge-Weber syndrome (SWS) is a congenital, sporadically occurring, neurocutaneous syndrome that presents classically with port-wine stain, leptomeningeal angiomas, and glaucoma. The systemic implications of SWS are vast and involve not only ophthalmic manifestations but also dermatologic, neurologic, and oral manifestations. Neuroimaging, in particular, plays an important role in the diagnosis and management of this disease. Recent discoveries have been made regarding the genetic pathogenesis of SWS. In addition, recent advances have been made in the management of the 2 most common ophthalmic manifestations of SWS: diffuse choroidal hemangioma and glaucoma. Despite these new contributions to the field, many challenges still remain. The management of diffuse choroidal hemangioma is wide ranging and includes photodynamic therapy, brachytherapy, radiotherapy, and antivascular endothelial growth factor injections, but all have had limited or varied success. Although there have been recent advances in knowledge and technique, the management of glaucoma is extremely complex, given the high surgical risks for complications and a poor response rate to medical therapy. Further studies are critical to maximize our knowledge of this difficult disease.

Risk factors for visual impairment associated with corneal diseases in southern China

Purpose To identify the most common etiologies of corneal disease and the risk factors associated with worse visual outcomes in Changsha, Hunan, located in southern China. Methods This observational, cross-sectional study evaluated 100 consecutive patients seen at the cornea clinic of The Second Xiangya Hospital of Central South University. Ocular history, demographic information, and ocular use of traditional Chinese medicine were recorded and analyzed. Causes of infectious keratitis were diagnosed clinically. Fungal and acanthamoeba keratitis were confirmed by confocal microscopy. Visual impairment was categorized based on visual acuity according to World Health Organization recommendations. A binary logistic regression model was used to calculate odds ratio (OR). Results One hundred consecutive patients were evaluated. Sixty patients (60%) had noninfectious corneal diseases, most commonly dry eye syndrome (26.7%, n=16), followed by corneal abrasion (18.3%, n=11). Forty-five patients had infectious keratitis, five of whom had both infectious and noninfectious etiologies. Of the patients with infectious keratitis, viral keratitis was the most frequent cause (57.8%, n=26), followed by fungal (20%, n=9) and bacterial (20%, n=9). Older age (OR =5.08, P=0.048), male sex (OR =3.37, P=0.035), and rural residence (OR =3.11, P=0.017) had increased odds of having worse visual impairment. Rural residence was also associated with infectious keratitis (P=0.005), particularly bacterial and fungal keratitis (P=0.046), and a history of ocular trauma (P=0.003). Occupation was not a significant risk factor in this population. Fourteen patients reported use of traditional Chinese medicine, with no association with visual outcomes found. Conclusion Older age, male sex, and rural residence were associated with worse visual impairment. Prevalence and outcome of corneal diseases may be improved with an increased awareness in these populations.

HRT for the Diagnosis and Detection of Glaucoma Progression

Confocal scanning laser ophthalmoscopy through the Heidelberg Retina Tomograph (HRT) provides a rapid, safe, noncontact, and noninvasive imaging of the optic disc in three-dimensions, and provides precise detailed information about the optic disc beyond that which the clinical exam can measure. The HRT I was developed for research purposes only and was not used clinically. The HRT II was developed to be user-friendly, more rapid, and was used as an adjunct to clinical examination in the detection and progression of glaucoma. One of the main pitfalls of the HRT II was that it was operator-dependent. The HRT III was developed to be operator-independent. Initially the Moorsfield Regression Analysis provided the analysis of the stereometric optic disc parameters. The Glaucoma Probability Score, given its ease of use, operator-independence, and rapidity of use, soon gained popularity. Numerous studies have compared these two methods of analysis, with the conclusion that the Glaucoma Probability Score provides a higher sensitivity and a lower specificity than the Moorsfield Regression Analysis, which may indicate that it has potential as a screening test for glaucoma. However, there is no consensus on the use of the Glaucoma Probability Score as a screening test for glaucoma. While HRT data may be useful as a clinical adjunct in the screening and diagnosis of glaucoma, it should ultimately only be used to support clinical examination.

Free-Floating, Pigmented Cysts in the Anterior Chamber Causing Ocular Hypertension

Purpose: The aim of this study was to describe the clinical and histopathological features of a 36-year-old male with hundreds of recurrent, unilateral, free-floating, pigmented cysts in the anterior chamber causing ocular hypertension. Procedures: The patient was referred to ocular oncology for blurry vision of the right eye and was found to have myriad pigmented, free-floating cysts in the anterior chamber and heavy pigmentation of the angle on gonioscopy. Anterior chamber washout was performed, and the fluid recovered was sent for pathological analysis. Results: The pathology report demonstrated rare nonpigmented epithelial cells, more consistent with iris stromal cysts or secondary implantation epithelial cysts. Conclusions: This paper highlights the first documented case of innumerable spontaneously occurring, unilateral, free-floating, pigmented cysts in the anterior chamber. While clinical diagnosis suggested iris pigment epithelial cysts, pathology suggested iris stromal cysts or secondary implantation epithelial cysts.

Trends in ophthalmology resident surgical experience from 2009 to 2015.

Background Resident procedure minimums have been established in surgical training programs to ensure adequate training experience. However, achievement of these minimums may fluctuate. Review of resident experience is essential for maintaining successful training curricula. Objective To evaluate trends in ophthalmology resident surgical experience from 2009 to 2015. Methods This was a database study reviewing Accreditation Council for Graduate Medical Education ophthalmology resident surgical case logs. Case logs from 2,797 US ophthalmology residents were reviewed for trends in average surgical cases performed by residents as primary surgeon in the area of cataract, cornea, retina, glaucoma, pediatrics, plastics, and trauma from 2009 to 2015. Results Significant trends in resident surgical experience were demonstrated in the areas of cataract, retina, and glaucoma, while experience in cornea, pediatrics, plastics, and trauma remained stable. These trends included an increase in average cases of phacoemulsification cataract surgery from 143.8 to 173.6, vitreous tap/inject procedures from 31.3 to 93.1, and glaucoma shunt surgery from 4.5 to 6.7, with a decline in average cases of nonphacoemulsification cataract surgery from 3.8 to 2.2, retinal photocoagulation from 59.6 to 45.5, and filtering surgery from 6 to 4.5. Conclusion Trends in ophthalmology surgical experience in cataract, retina, and glaucoma paralleled new surgical or therapeutic developments as well as practice pattern shifts in these fields. Educators should be cognizant of the impact of such trends on resident experience and determine if curricular adjustments should be made to maintain comprehensive education of physicians-in-training.

Effect of supine body position on central corneal thickness

To evaluate the effect of supine body position on central corneal thickness (CCT) in open‐angle glaucoma patients and in healthy subjects.