Marta Pérez-López

Visual Field Index Rate and Event-Based Glaucoma Progression Analysis: Comparison in a Glaucoma Population

Aims: The aim of the study was to compare event-based glaucoma progression analysis (GPA) I with new GPA II software and pattern deviation-based trend analyses (visual field index [VFI]) to detect progression in a glaucoma population. Methods: This was a retrospective study that included 90 eyes of 90 patients with a minimum of five reliable visual field tests and a follow-up period of at least 2 years. Results: Event-based GPA II detected progression in 16.7% of eyes in which trend analysis VFI failed. GPA detected progression 6.8 months earlier than VFI. GPA I and II showed excellent agreement (k = 0.94). Agreement between VFI and mean deviation (MD) linear analysis and with GPA criteria was k = 0.52 and k = 0.48, respectively. Mean rates of progression of MD and VFI were −0.41 dB and −1.30% annually, respectively (rho = 0.824; p<0.0001). Using VFI, mean follow-up time was 6.12 and 4.89 years (p = 0.004) and the mean number of visual field tests was 7.33 and 6.01 (p = 0.023) in eyes with and without progression, respectively. Conclusions: Event-based software GPA I and II had excellent agreement. Event analysis showed earlier and greater sensitivity for detecting progression than VFI analysis and both had only moderate agreement. Trend analysis VFI is likely to detect progression in patients with a greater number of visual field tests and a longer follow-up time. The VFI analysis seems to be more accurate than MD analysis for determining rate of progression.

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy.

PurposeTo compare intrascleral blebs characteristics after deep sclerectomy (DS) with three intrascleral implants using the Visante anterior segment optical coherence tomography.MethodsThis is a cross-sectional study including 60 eyes of 51 patients that underwent DS with Sk-Gel, Esnoper, and Aquaflow implant. Intraocular pressure (IOP) measurement, slit-lamp examination, and Visante scans were performed the same day in all the patients. Visante scans were done through the intrascleral bleb at 45°, 90°, and 135° and the bleb height was measured.ResultsSk-Gel was used in 19 eyes (31.66%), Esnoper in 22 eyes (36.66%), and Aquaflow in 19 eyes (31.66%). The median time lapsed from the surgery was 15.50 months 25th and 75th percentiles (p25 8.25; p75 20). The median IOP was 13 mm Hg (p25 10; p75 15), with no significant differences among implants (P=0.232). Overall, the correlation between the scleral bleb height and the IOP was statistically significant at 45° (r=−0.359; P=0.004), 90° (r=−0.410; P=0.001), and 135° (r=−0.417; P=0.001). However, Sk-Gel did not show any statistically significant correlation between the scleral height and IOP whereas the other two groups (Esnoper and Aquaflow) showed a significant correlation. There were no differences in the bleb height among implants.ConclusionThere was a moderate inverse correlation between the scleral bleb height and the IOP measurement after DS with Esnoper and Aquaflow implants. There were no differences in bleb height among the three implants.

Treatment of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids.

Dear Editor, We sincerely appreciate Hayreh ́s letter [1] and fully understand his displeasure. In fact, we were the first to be upset with our findings. The main purpose of the current study [2] was to objectively quantify changes after systemic corticosteroid under Hayreh ́s protocol treatment in acute NA-AION, using both structural and functional tests (OCT and automated perimetry). It was not the aim of our study to contrast Hayreh ́s, results as we expected to confirm better outcomes in patients treated with steroid therapy using objective measurable tests. Unfortunately, we were forced to prematurely interrupt the recruitment by the unexpectedly high rate of complications and the absence of significant beneficial effect (neither visual nor anatomic) of systemic steroid therapy when given during the acute phase of NAION. During treatment, one patient suffered a prednisoneinduced depression requiring the discontinuation of treatment. Another patient previously controlled with oral therapy for diabetes mellitus had to start on insulin while on study treatment, and had to remain on insulin even after completing the steroid treatment. Two further patients needed topical medication to control steroid-induced ocular hypertension while on treatment, and in one of them IOP elevation was not reversible despite cessation of steroid use. In Hayreh ́s cohort, treatment was not stopped in any case and he did not mention any side-effects. We cannot justify our higher rate of complications due to differences in steroid dose or treatment duration, as we used the same systemic therapy protocol he had previously described (80 mg prednisone daily for 2 weeks, then 70 mg for 5 days, 60 mg for 5 days, and then cutting down by 5 mg every 5 days to 40 mg until the optic disc edema was resolved; after that, it was tapered off). One important concern in treating patients with systemic corticosteroid therapy is the possibility of ocular and systemic side-effects [3]. Moreover, co-morbid diseases and polypharmacy pose particular challenges in an older population. In Hayreh ́s prospective study (we apologize for the erratum saying retrospective in the Introduction section) where 312 patients were treated, we could not find any mention of common side-effects associated with the use of systemic steroids (worsening of diabetes control, arterial hypertension, steroid-induced glaucoma, nausea, vomiting, loss of appetite, trouble sleeping, mood changes...) that might have occurred, even if they were mild or not as serious as to require discontinuation of the treatment. This information is not reflected throughout the article. Authors disclose no financial interest. Authors have full control of all primary data and they agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review their data upon request. G. Rebolleda : F. J. Muñoz-Negrete Ophthalmology Service, Ramon y Cajal Hospital, Carretera Colmenar Viejo Km 9,100, Madrid CP 28034, Spain

Relationship between corneal hysteresis and lamina cribrosa displacement after medical reduction of intraocular pressure

Purpose To evaluate the relationship between the displacement of the lamina cribrosa (LC) and prelaminar tissue with corneal hysteresis (CH) using spectral-domain coherence tomography (SD-OCT) after reducing intraocular pressure (IOP) with medical treatment. Methods Sixty-one eyes of 61 patients with ocular hypertension or primary open-angle glaucoma who were going to start with treatment were imaged by means of 12 cross-sectional scans of the optic nerve using enhanced depth imaging SD-OCT before and after 1 week of treatment. We used the ‘follow-up’ mode to make sure that all the measurements were performed in the same location. We also measured the CH using an Ocular Response Analyzer, and we related it to the magnitude of displacement of LC and prelaminar tissue and the thickness of both structures. Results There was a significant variation of LC thickness from 132.66±37.40 to 160.09±41.13 µm (p<0001). LC distance was significantly reduced from 258.53±145 µm before treatment to 239.86±135 µm after it. No significant changes were found in the thickness and movement of prelaminar tissue before and after treatment. The only factors related with LC displacement were CH (R2=0.48) and age (R2=0.42). Conclusions A significant increase in LC thickness and a reduction in the posterior displacement of LC but not in the prelaminar tissue were demonstrated after IOP reduction with medical treatment. The factors most related with LC displacement were age and CH.

A 10-year review of orbital biopsy: the Newcastle Eye Centre Study

PurposeTo review the histopathological diagnoses, visual outcome, and complication rate of orbital biopsy in a UK tertiary referral centre.MethodsThis was a retrospective, clinical–pathological, interventional, consecutive case series. All orbital biopsies performed between July 2004 and June 2014 in Newcastle Eye Centre (Newcastle upon Tyne, UK) were included in this study. All relevant data collected from the local electronic database and medical records were analysed.ResultsA total of 166 orbital biopsies were identified during the study period: 86 patients (53.1%) were female and the mean age was 53.7±19.7 years. Of all the cases, orbital biopsies were performed unilaterally in 158 (97.5%) patients and bilaterally in 4 (2.5%) patients. The mean follow-up period was 2.2±2.3 years. The two most common histopathological diagnoses were non-specific inflammatory disease (62, 38.3%) and lymphoproliferative disease (40, 24.7%). None of the patients experienced ≥2-Snellen line visual loss. There were 7 (4.2%) postoperative complications noted: 1 (0.6%) orbital haemorrhage with no loss of vision, 4 (2.4%) diplopia, 1 (0.6%) short-term symblepharon, and 1 (0.6%) conjunctival granuloma. Postoperative diplopia was associated with lateral orbitotomy (P=0.044) and excisional biopsy (P=0.015).ConclusionsOrbital biopsy serves as a safe diagnostic tool in managing orbital diseases. Patient should be made aware of the risk of postoperative diplopia. Our data provides useful guidance to clinicians when counselling patients for orbital biopsy.

Lamina cribrosa displacement after optic nerve sheath fenestration in idiopathic intracranial hypertension: a new tool for monitoring changes in intracranial pressure?

Imaging in patients with idiopathic intracranial hypertension (IIH) is by definition normal but MRI may show dilatation of the subarachnoid space (SAS) around the optic nerve and a secondary flattening of the posterior sclera.1 Because of the existence of a trans-lamina cribrosa (LC) gradient, in patients with IIH the disc surface and thus the LC should be anteriorly displaced secondary to the raised intracranial pressure (ICP). In patients with glaucoma, an anterior displacement of the LC after lowering intraocular pressure (IOP) using spectral domain optical coherence tomography (SD-OCT) has been recently demonstrated.2–4 However, changes in the LC position after IIH treatment have not been reported previously. A 28-year-old woman diagnosed with IIH and treated with lumbo-peritoneal shunt presented with progressive visual loss despite well-controlled ICP. Bilateral sequential optic nerve sheath fenestration was planned and the patient underwent SD-OCT imaging using enhanced depth imaging technique3 (figure 1) of the …

Persistent subretinal fluid due to central serous chorioretinopathy after retinal detachment surgery.

Background The causes of persistent submacular detachment after successful rhegmatogenous retinal detachment (RRD) surgery remain unknown. Its presence is associated with poor postoperative visual acuity, but due to its spontaneous resolution no additional therapeutic or diagnostic procedure is recommended. Case report A case of central serous chorioretinopathy (CSC) that simulated persistent subfoveal fluid after RRD surgery is presented. Conclusion To the authors’ knowledge, no other case of visual impairment after successful retinal detachment surgery due to CSC has been reported in the PubMed database. In view of this report, CSC should be considered in the differential diagnosis of persistent subretinal fluid after successful retinal detachment surgery.

Radiologic-pathologic correlation of orbital diseases

Heterogeneity of orbital diseases often poses a diagnostic dilemma to the ophthalmologists. With advances in imaging technology, it has become increasingly common that orbital diseases are diagnosed on clinical and radiologic findings. Herein we report a 10-year experience (April 2004 –March 2014) of radiologic-pathologic correlation of orbital diseases in our unit. The consistency between radiologic impression and histopathologic diagnosis (achieved by orbital biopsy) was defined by radiologic-pathologic correlation (RPC), which was categorised into:

Exotropías intermitentes: tratamiento mediante retroinserción bilateral de rectos laterales y resultado a largo plazo

PURPOSE To describe the long-term surgical outcomes of bilateral lateral rectus recession in patients with intermittent exotropia. METHODS Retrospective review of 18 patients diagnosed with intermittent exotropia between 1995 and 2005 who underwent surgical treatment in the Ramon y Cajal Hospital. RESULTS Of the 18 patients with intermittent exotropia, 50% were basic subtype. All of them underwent bilateral lateral rectus recession, associated with a previous failed botulinum toxin injection in 8 of them. Satisfactory results (less than 10 PD orthophoria) were obtained in 68.2% of the patients after a 4.5-year follow-up period. CONCLUSIONS Bilateral lateral rectus recession is an effective and stable surgical procedure in the long-term motor control of intermittent exotropia, especially in basic subtype. Previous injection of botulinum toxin did not affect the results.