Pilar Casas-Llera

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 Biomechanical Properties and Optic Nerve Head Changes after Deep Sclerectomy

Purpose To evaluate corneal biomechanical properties and optic nerve head (ONH) changes following deep sclerectomy (DS) and the relation to each other. Methods Forty-nine eyes with primary open-angle glaucoma that underwent DS were studied. Corneal biomechanical properties were assessed using the Ocular Response Analyzer and the ONH was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology before surgery and 3 months postoperatively. Changes in corneal hysteresis (CH), corneal resistance factor (CRF), optic nerve cupping, prelaminar tissue thickness, and lamina cribrosa depth and thickness were registered. A correlation matrix and multiple linear regression models were used to determine predictors of ONH changes. Results At 3 months after surgery, mean corneal compensated intraocular pressure (IOPcc) significantly decreased by 27.9% (p<00.001) and mean Goldmann-correlated IOP (IOPg) decreased by 30.52% (p<00.001). Mean CH increased and CRF decreased by 18.4% and 10.1%, respectively (p<00.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (p<00.001). Significant associations were found between ONH cupping reversal and prelaminar tissue thickening with preoperative IOPcc (p = 0.046), IOPg (p = 0.02), and CRF (p = 0.002) and with changes in IOP, CH, and CRF (p<00.001, p = 0.004, p = 0.018, respectively) after surgery. Conclusions Corneal hysteresis increased and CRF decreased significantly 3 months after DS. Corneal resistance factor was the single largest preoperative factor influencing cupping reversal changes. Despite the influence of preoperative variables, postoperative IOP reduction was the only independent factor influencing changes observed in the ONH after surgery.

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.

Hematoma pre-descemético tras EPNP, tratado mediante membranotomía de la Descemet y hallazgos de OCT de segmento anterior: presentación de 2 casos clínicos

CASE PRESENTATION An 81 year-old woman and a 63 year-old man developed a pre-Descemet haematoma after deep sclerectomy (DS), the former during the surgery itself and the latter during the early post-operative period. The surgical technique is decribed that led to the evacuation of the haematoma and the preservation of the integrity of trabeculo-Descemet membrane. The anterior-segment OCT findings after surgery are also presented. CONCLUSIONS These are the first reported cases of pre-Descemet haematoma after DS that have been successfully repaired by an ab interno Descemet membranotomy. Surgeons should be aware of this rare, but potentially sight-threatening, complication.

Validation of a school-based amblyopia screening protocol in a kindergarten population

Purpose To validate a school-based amblyopia screening program model by comparing its outcomes to those of a state-of-the-art conventional ophthalmic clinic examination in a kindergarten population of children between the ages of 4 and 5 years. Methods An amblyopia screening protocol, which consisted of visual acuity measurement using Lea charts, ocular alignment test, ocular motility assessment, and stereoacuity with TNO random-dot test, was performed at school in a pediatric 4- to 5-year-old population by qualified healthcare professionals. The outcomes were validated in a selected group by a conventional ophthalmologic examination performed in a fully equipped ophthalmologic center. The ophthalmologic evaluation was used to confirm whether or not children were correctly classified by the screening protocol. The sensitivity and specificity of the test model to detect amblyopia were established. Results A total of 18,587 4- to 5-year-old children were subjected to the amblyopia screening program during the 2010-2011 school year. A population of 100 children were selected for the ophthalmologic validation screening. A sensitivity of 89.3%, specificity of 93.1%, positive predictive value of 83.3%, negative predictive value of 95.7%, positive likelihood ratio of 12.86, and negative likelihood ratio of 0.12 was obtained for the amblyopia screening validation model. Conclusions The amblyopia screening protocol model tested in this investigation shows high sensitivity and specificity in detecting high-risk cases of amblyopia compared to the standard ophthalmologic examination. This screening program may be highly relevant for amblyopia screening at schools.

Re: Kim et al.: Diagnostic classification of macular ganglion cell and retinal nerve fiber layer analysis: differentiation of false-positives from glaucoma (Ophthalmology 2015;122:502-10)

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