Yoshiyuki Kita

Macular retinal ganglion cell complex damage in the apparently normal visual field of glaucomatous eyes with hemifield defects.

PurposeTo compare the thicknesses of the macular ganglion cell complex (mGCC), the entire macular retina, and the peripapillary retinal nerve fiber layer (ppRNFL) in the apparently normal visual field of glaucomatous eyes with hemifield defects with thicknesses in normal eyes. In addition, to evaluate the relationship between the structural and retinal sensitivity parameters by standard automated perimetry. MethodsThis single institution study included 50 eyes of 50 glaucoma patients with visual field defects restricted to the superior or inferior hemifield, in addition to 25 eyes of 25 normal controls matched for age, sex, and refractive errors. We measured the thickness of the 3 areas of interest using the automatic algorithm of a spectral-domain optical coherence tomography device. We subsequently compared the difference in these values between the defective and normal hemifields. Furthermore, each optical coherence tomography parameter was correlated with the total deviation values of the parameters in the Humphrey visual field corresponding to each hemisphere. ResultsThe thickness of the mGCC in the normal hemifield of the glaucomatous eyes was significantly less than in normal eyes. In contrast, the total thickness of the macular retinas between the glaucomatous and normal eyes showed no significant difference. In addition, the thicknesses of the mGCC and ppRNFL in the normal hemisphere of the glaucomatous eyes were significantly correlated with the total deviation in the visual field parameters of the corresponding area. ConclusionsIn addition to ppRNFL thickness, the mGCC thickness could be a structural parameter for detecting preperimetric glaucoma.

Ability of optical coherence tomography-determined ganglion cell complex thickness to total retinal thickness ratio to diagnose glaucoma.

Purpose:To evaluate the usefulness of the spectral-domain optical coherence tomography (SD OCT)–determined ganglion cell complex thickness to total retinal thickness ratio (G/T ratio) in diagnosing glaucoma. Methods:A total of 99 eyes with primary open-angle glaucoma and 35 normal eyes were enrolled in the study. SD OCT (RTVue-100) was used to measure the macular ganglion cell complex thickness, total retinal thickness, outer retinal thickness, and circumpapillary retinal nerve fiber layer (RNFL) thickness. A new macular parameter, the G/T ratio, was also calculated. The ability of each parameter to diagnose glaucoma was examined by analyzing the area under the receiver operating characteristics curve (AUROC) and the sensitivity at fixed specificity. Results:The G/T ratio was 36.0±1.5% in normal eyes, 31.8±1.7% in early glaucoma, and 30.2±2.6% in advanced glaucoma. These decreases in the ratio were statistically significant. For the AUROC, the individual SD OCT parameters were 0.982 for the G/T ratio, 0.968 for the macular ganglion cell complex thickness, 0.942 for the RNFL thickness, and 0.841 for the total retinal thickness. The AUROC for the G/T ratio was significantly higher than that seen for the total retinal and RNFL thicknesses (P<0.05). Analyses of the sensitivity at a specificity of >90% indicated that the G/T ratio (sensitivity, 93.94%) was the best diagnostic parameter. Conclusions:Decreases in the G/T ratio occur during the early stages of glaucoma. When using SD OCT to diagnose glaucoma, the G/T ratio may improve the diagnostic ability of the macular parameter.

Glaucomatous eye macular ganglion cell complex thickness and its relation to temporal circumpapillary retinal nerve fiber layer thickness

PurposeTo clarify the correlation between temporal circumpapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (mGCC) thickness in glaucomatous eyes.MethodsSeventy-seven eyes of 77 subjects were categorized as normal, early glaucoma and moderate-to-advanced (moderate) glaucoma. After the circumpapillary RNFL thickness and mGCC thickness were measured, the temporal mean RNFL and mean mGCC were compared within the three groups. The study also investigated whether there was any correlation between the temporal RNFL and mGCC thicknesses.ResultsIn the glaucoma groups, significant thinning of the temporal RNFL and mGCC thicknesses was noted. With the exception of the papillomacular bundle (r = −0.078), correlations were seen in each of the early glaucoma mGCC and temporal RNFL sectors (r = 0.38–0.753). Correlations were also noted for the mGCC and all temporal RNFL sectors in the moderate glaucoma group (r = 0.425–0.809).ConclusionsFrom the early stage of glaucoma, similar decreases of the mGCC and RNFL occured, and a high correlation existed between the two. Therefore, like RNFL, mGCC can potentially be used to detect the early stages of glaucoma. However, in early glaucoma eyes, the papillomacular bundle of the RNFL may be spared, even though mGCC thinning is present.

Relationship between macular ganglion cell complex thickness and macular outer retinal thickness: a spectral-domain optical coherence tomography study.

To assess the relationship between macular ganglion cell complex and macular outer retinal thicknesses.

Macular Retinal Ganglion Cell Complex Thickness and Its Relationship to the Optic Nerve Head Topography in Glaucomatous Eyes with Hemifield Defects

Purpose. To evaluate the relationship between the macular ganglion cell complex (mGCC) thickness, which is the sum of the retinal nerve fiber, ganglion cell, and inner plexiform layers, measured with a spectral-domain optical coherence tomograph and the optic nerve head topography measured with a confocal scanning laser ophthalmoscope in glaucomatous eyes with visual field defects localized predominantly to either hemifield. Materials and Methods. The correlation between the mGCC thickness in hemispheres corresponding to hemifields with and without defects (damaged and intact hemispheres, respectively) and the optic nerve head topography corresponding to the respective hemispheres was evaluated in 18 glaucomatous eyes. Results. The mGCC thickness was significantly correlated with the rim volume, mean retinal nerve fiber layer thickness, and cross-sectional area of the retinal nerve fiber layer in both the intact and the damaged hemispheres (P < .05). Discussion. For detecting very early glaucomatous damage of the optic nerve, changes in the thicknesses of the inner retina in the macular area and peripapillary RNFL as well as rim volume changes in the optic nerve head are target parameters that should be carefully monitored.

Differences of Intrasession Reproducibility of Circumpapillary Total Retinal Thickness and Circumpapillary Retinal Nerve Fiber Layer Thickness Measurements Made with the RS-3000 Optical Coherence Tomograph

Purpose To evaluate the intrasession reproducibility of various thickness parameters used to diagnose and follow-up glaucoma, in particular circumpapillary total retinal thickness (cpTR) provided by the RS-3000 optical coherence tomograph (OCT). Methods Fifty-three healthy eyes of 28 subjects underwent three consecutive imaging with the RS-3000 Advance OCT (NIDEK, Aichi,Japan) to evaluate the intrasession reproducibility of circumpapillary total retinal thickness (cpTR), circumpapillary retinal nerve fiber layer thickness (cpRNFL), macular ganglion cell complex thickness (mGCC) and macular total retina thickness (mTR) measurements. Intraclass correlation (ICC), coefficient of variation (CV) and reproducibility coefficient (RC) were calculated for each parameter. Results The ICC and CV values for mean cpTR and cpRNFL were 0.987 and 0.897, and 0.60% and 2.81%, respectively. The RC values for the mean cpTR and cpRNFL were 5.95 μm and 9.04 μm, respectively. For all cpTR parameters the ICC values were higher and both the CV and RC values were lower than those for the corresponding cpRNFL parameters. The ICC and CV values for superior mGCC, inferior mGCC, superior mTR and inferior mTR were 0.983, 0.980, 0.983 and 0.988, and 0.84%, 0.98%, 0.48% and 0.43%, respectively. The RC values for superior mGCC, inferior mGCC, superior mTR and inferior mTR were 2.86 μm, 3.12 μm, 4.41μm and 4.43 μm, respectively. Conclusions Intrasession reproducibility of cpTR, mGCC and mTR measurements made on healthy eyes was high. Repeatability of cpTR measurements was better than that of the corresponding cpRNFL measurements. These results suggest that future clinical investigations addressing detection of glaucoma and glaucomatous progression with the RS-3000 OCT may benefit from focusing on the cpTR parameters.

Effect of high myopia on glaucoma diagnostic parameters measured with optical coherence tomography.

We examined the influence of high myopia on conventional spectral‐domain optical coherence tomographic parameters and assessed the macular ganglion cell complex thickness to macular outer retinal thickness ratio as a new optical coherence tomography parameter.

A case of malignant melanoma occurring 63 years after evisceration

BACKGROUND We report a rare case of a 69-year-old woman with malignant melanoma of her right socket, who had undergone evisceration of her right globe for unknown reasons at the age of 6. CASE A 69-year-old woman presented with the complaint of inability to keep the prosthesis in her socket. A large blackish brown mass was seen behind the eyelids, and biopsy of this tissue revealed a mixed type malignant melanoma. A right exenteration was performed and histopathologic examination demonstrated a large tumor mass anterior and adjacent to the remains of the eviscerated globe. CONCLUSION During evisceration, uveal pigment may be incompletely removed from the globe, or may be inadvertently scattered in the orbit. This case may demonstrate the development of a malignant melanoma from the uvea of an eviscerated globe. We recommend that careful long-term follow-up be performed on patients who have undergone evisceration.

DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY

Purpose: To compare the closure rate of macular hole closure and duration of the prone positioning after macular hole (MH) surgery with two protocols for halting the prone positioning. Methods: The authors studied 129 eyes of 125 consecutive patients with MH who had undergone vitrectomy. In 60 eyes of 59 patients, the prone positioning was halted after detecting an MH closure in the swept-source optical coherence tomographic images (SS group). In 69 eyes of 66 patients, the prone position was halted by the surgeons decision (conventional group). The MH closure rate and duration of the prone positioning were compared. Results: Clear images of the MH were recorded in the SS group on postoperative Day 1 in 58 eyes (97%). In the SS group, MH closure was detected on postoperative Day 1 in 47 eyes (78%) and Day 2 in 4 eyes (7%). The MH was closed in 58 eyes (97%) in the SS group and 69 eyes (100%) in the conventional group (P = 0.21). None of the eyes had a reopening of the MH. The duration of prone positioning in the SS group was 1.8 ± 2.5 days, which was significantly shorter than that in the conventional group at 8.4 ± 4.2 days (P < 0.0001). Conclusion: The SS-OCT protocol can significantly decrease the duration of the prone positioning without a reopening of the MH.

The clinical utility of measuring the macular outer retinal thickness in patients with glaucoma.

Purpose Few optical coherence tomography (OCT) studies have investigated outer retinal thickness including the photoreceptor layer in glaucoma. We measured changes in the macular outer retinal thicknesses using OCT in patients with glaucoma with an average follow-up of 2.9 ± 0.8 years. Methods A total of 39 eyes of 39 patients with primary open-angle glaucoma were analyzed. The RTVue-100 was used to measure the macular outer retinal, macular ganglion cell complex, and circumpapillary retinal nerve fiber layer thicknesses, global loss volume, and focal loss volume. Using the paired t test, baseline parameters were compared with those at the last follow-up. Results The average baseline mean deviation value in the Humphrey Field Analyzer was −2.13 dB. The ganglion cell complex thickness significantly decreased over the follow-up period (baseline thickness, 79.66 ± 7.71 μm; final thickness, 76.79 ± 7.39 μm; p<0.001). There were significant differences between baseline and final visit measurements for circumpapillary retinal nerve fiber layer thickness, global loss volume, and focal loss volume (p<0.001, p<0.001, and p = 0.004, respectively). However, there was no significant change in outer retinal thickness (baseline thickness, 167.56 ± 7.26 μm; final thickness, 167.25 ± 7.93 μm; p = 0.540). Conclusions Outer retinal thickness was not altered during the follow-up period. The stability of outer retinal thickness may indicate the reliability of OCT analysis for glaucoma follow-up.