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Yoo L, Kadambi N, Bohnsack BL. Corneal characteristics and OCT-angiography findings in pediatric glaucoma and glaucoma suspects. J AAPOS 2023; 27:327.e1-327.e6. [PMID: 37913864 DOI: 10.1016/j.jaapos.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To analyze corneal biomechanics, specular microscopy, and optical coherence tomography-angiography findings in children with glaucoma. METHODS Pediatric patients (<18 years of age) with glaucoma (n = 38), increased cup:disk ratio and normal intraocular pressure (IOP) glaucoma suspects (n = 36), and controls (n = 67) were prospectively enrolled. Patients underwent testing with Ocular Response Analyzer, CellChek Specular Microscope, and Heidelberg OCT-A. RESULTS Average age of participants was 12.4 ± 3.5 years, with no difference between groups (P = 0.71). Glaucoma patients had undergone more intraocular surgeries (P < 0.0001) and showed worse logMAR visual acuity (P < 0.0001) than suspects or controls. Central corneal thickness (CCT) was greater in glaucoma patients (642.8 ± 85.9 μm [P < 0.0001]) and suspects (588 ± 43.7 μm [P = 0.003]) compared with controls (561 ± 39.9 μm). Corneal hysteresis (CH) was decreased in eyes with glaucoma (10.4 ± 3.0) compared with controls (11.7 ± 1.5 [P = 0.006]), but not suspects (11.3 ± 2.0 [P = 0.1]). Glaucoma patients had lower endothelial cell density (2028.4 ± 862.7 [P < 0.0001]) and greater average cell area (547.2 ± 332.4 [P < 0.0005]) compared with suspects (2919.3 ± 319.1, 347.5 ± 46.2) and controls (2913.7 ± 399.2, 350.8 ± 57.7), but there was no difference in polymegathism (P = 0.12) or pleomorphism (P = 0.85). No differences in vessel density or vessel skeletal density in the retinal vascular complex (P = 0.3077, P = 0.6471) or choroidal vascular complex (P = 0.3816, P = 0.7306) were detected. CONCLUSIONS Children with glaucoma showed thicker corneas with lower endothelial cell density and greater cell area, but no difference in retinal/choroidal vascular densities compared with suspects and controls.
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Affiliation(s)
- Lauren Yoo
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Namrata Kadambi
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brenda L Bohnsack
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.
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Xydaki F, Arribas-Pardo P, Burgos-Blasco B, Garcia-Feijoo J, Mendez-Hernandez C. Peripapillary Vascular Density in Childhood Glaucoma: A Pilot Comparative Study with Age and Sex Matched Healthy Subjects. J Clin Med 2023; 12:6982. [PMID: 38002598 PMCID: PMC10672179 DOI: 10.3390/jcm12226982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE The aim of this study concerns the evaluation of peripapillary vessel indices in childhood glaucoma (CG) and healthy subjects. MATERIAL AND METHODS In this prospective, unicenter, observational cross-sectional study, patients with CG and age and sex-matched healthy subjects were included. We compared retinal nerve fiber layer (RNFL) measurements in optical coherence tomography (OCT), peripapillary vessel density (PVD), and the flux index (FI) of the superficial vascular plexus from OCT angiography (OCT-A) between CG patients and control groups. RESULTS We included 39 patients (68 eyes) with CG and 50 (95 eyes) healthy subjects. The peripapillary RNFL thickness, vessel density, and flux index were significantly lower in the CG group than in the control group. The mean PVD of CG patients was 0.52 ± 0.043%, compared with 0.55 ± 0.014%, p < 0.0001 in healthy subjects. The mean FI was 0.32 ± 0.054 versus 0.37 ± 0.028, p < 0.0001, in CG patients and healthy subjects, respectively. PVD and FI in the superior, inferior, and temporal sectors were significantly lower in CG. The peripapillary RNFL thickness showed a higher area under the ROC curve (AUROC) for discriminating healthy and CG eyes and was significantly different than the PVD (0.797, 95%CI 0.726-0.869; p < 0.0001 vs. 0.664, 95%CI 0.574-0.752; p 0.00037), p 0.012. CONCLUSIONS PVD and FI show lower values in CG and correlate with RNFL thickness measurement but have lower diagnostic ability than RNFL thickness measurement. Our results reveal possible differences in the pathogenesis of microvascular compromise in childhood glaucoma patients.
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Affiliation(s)
- Flora Xydaki
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
| | - Paula Arribas-Pardo
- Ophthalmology Department, Central Defense Hospital “Gomez Ulla”, 28047 Madrid, Spain
| | - Barbara Burgos-Blasco
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Julian Garcia-Feijoo
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Carmen Mendez-Hernandez
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
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Yeh HW, Chung CT, Chang CK, Yeh CB, Wang BY, Lee CY, Wang YH, Yeh LT, Yang SF. Association of Glaucoma with the Risk of Peripheral Arterial Occlusive Disease: A Retrospective Population-Based Cohort Study. J Clin Med 2023; 12:4800. [PMID: 37510915 PMCID: PMC10381850 DOI: 10.3390/jcm12144800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to investigate the potential association between glaucoma and peripheral arterial occlusive disease. The study recruited patients, including 101,309 with glaucoma and 1,860,528 without a glaucoma diagnosis, from a population of 2 million patients in the Longitudinal Health Insurance Database. Propensity score matching was performed between the two groups, matching for age, sex, and comorbidities. In total, 95,575 patients with glaucoma and 95,575 patients without glaucoma were analyzed for their risk of developing peripheral arterial occlusive disease. The analysis of the data revealed that the glaucoma group had a higher incidence density (ID = 4.13) of peripheral arterial occlusive disease than the non-glaucoma group (ID = 3.42). The relative risk for the glaucoma group was 1.21 (95% C.I. = 1.15-1.28). Cox proportional hazard model analysis indicated that the glaucoma group had a higher risk of developing peripheral arterial occlusive disease (HR = 1.18; 95% C.I. = 1.12-1.25). The subgroup analysis of the risk of PAOD showed that the glaucoma group had a higher risk of developing peripheral arterial occlusive disease in the age group of 20 to 39 (p for interaction = 0.002). In conclusion, patients with glaucoma were associated with a higher risk of subsequent peripheral arterial occlusive disease compared with those without a diagnosis of glaucoma.
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Affiliation(s)
- Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan City 333, Taiwan
| | - Chi-Tzu Chung
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 100, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 515, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Bo-Yuan Wang
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Nobel Eye Institute, Taipei 100, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 412, Taiwan
| | - Yu-Hsun Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Liang-Tsai Yeh
- Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
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Chen R, Liu X, Yao M, Zou Z, Chen X, Li Z, Chen X, Su M, Lian H, Lu W, Yang Y, McAlinden C, Wang Q, Chen S, Huang J. Precision (repeatability and reproducibility) of papillary and peripapillary vascular density measurements using optical coherence tomography angiography in children. Front Med (Lausanne) 2023; 10:1037919. [PMID: 37035305 PMCID: PMC10076795 DOI: 10.3389/fmed.2023.1037919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Importance Optical coherence tomography angiography (OCTA) has been widely applied into children, however, few studies have assessed the repeatability and reproducibility of papillary and peripapillary VD in healthy children. Objective To assess the precision of papillary and peripapillary vascular density (VD) measurements using optical coherence tomography angiography (OCTA) and analyze the effects of the signal strength index (SSI) and axial length (AL) on precision estimates. Design setting and participants This was a prospective observational study. Seventy-eight children aged 6-16 years underwent 4.5 × 4.5 mm OCTA (RTVue XR Avanti) disc scans: two scans by one examiner (repeatability) and two additional scans by another examiner (reproducibility). Within-subject standard deviation (Sw), test-retest reproducibility (TRT), within-subject coefficient of variation (CoV), intraclass correlation coefficient (ICC), and Bland-Altman analysis were performed. Main outcomes and measures In repeatability measurement, the fluctuation ranges (minimum to maximum) of VD between intraexaminer A/B in Sw, TRT, CoV, and ICC were (1.05-2.17)% / (1.16-2.32)%, (2.9-6)% / (3.21-6.44)%, (1.9-4.47)% / (2.08-5)%, and (0.588-0.783)% / (0.633-0.803)%, respectively. In reproducibility measurement, the fluctuation ranges of VD in Sw, TRT, CoV, and ICC were 1.11-2.13%, 3.07-5.91%, 1.99-4.41%, and 0.644-0.777%, respectively. VD was negatively correlated with SSI in most sectors of the peripapillary (e.g., inferior nasal, temporal inferior, temporal superior, superior temporal, and superior nasal). AL was positively correlated with inferior temporal VD and negatively correlated with superior nasal VD. Conclusion and relevance Optical coherence tomography angiography showed moderate-to-good repeatability and reproducibility for papillary and peripapillary perfusion measurements in healthy children. The SSI value affects most of the peripapillary VD, while AL affects only the temporal inferior and nasal superior peripapillary VD.
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Affiliation(s)
- Ruru Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinyu Liu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mingyu Yao
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhilin Zou
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinyi Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zheng Li
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengjuan Su
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hengli Lian
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weiwei Lu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yizhou Yang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Colm McAlinden
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Swansea, United Kingdom
- Department of Ophthalmology, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Qinmei Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- *Correspondence: Qinmei Wang,
| | - Shihao Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Shihao Chen,
| | - Jinhai Huang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Jinhai Huang,
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Selvan H, Gupta S, Wiggs JL, Gupta V. Juvenile-onset open-angle glaucoma - A clinical and genetic update. Surv Ophthalmol 2022; 67:1099-1117. [PMID: 34536459 PMCID: PMC9192165 DOI: 10.1016/j.survophthal.2021.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 01/03/2023]
Abstract
Juvenile-onset open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma that is diagnosed before 40 years of age. The disease may be familial or non-familial, with proportions varying among different populations. Myocilin mutations are the most commonly associated. JOAG is characterized by high intraocular pressures (IOP), with many patients needing surgery. The mean age at diagnosis is in the 3rd decade, with a male preponderance. Myopia is a common association. The pathophysiology underlying the disease is immaturity of the conventional outflow pathways, which may or may not be observed on gonioscopy and anterior segment optical coherence tomography. The unique optic nerve head features include large discs with deep, steep cupping associated with high IOP-induced damage. Progression rates among JOAG patients are comparable to adult primary glaucomas, but as the disease affects younger patients, the projected disability from this disease is higher. Early diagnosis, prompt management, and life-long monitoring play an important role in preventing disease progression. Gene-based therapies currently under investigation offer future hope.
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Affiliation(s)
- Harathy Selvan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Janey L Wiggs
- Ocular Genomics Institute, Massachusetts Eye and Ear, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, MA, USA
| | - Viney Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Ciociola EC, Klifto MR. Juvenile open angle glaucoma: current diagnosis and management. Curr Opin Ophthalmol 2022; 33:97-102. [PMID: 34698671 DOI: 10.1097/icu.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to summarize up-to-date research on the diagnosis and management of juvenile open-angle glaucoma (JOAG). RECENT FINDINGS JOAG can be subclassified into four clinical phenotypes, and faster myopic shift is a risk factor for disease progression. Vessel density is associated with structural damage and worsening visual acuity in JOAG and can be monitored with optical coherence tomography angiography. Genetic studies have revealed molecular causes of JOAG including variants in CPAMD8, MYOC, and CYP1B1. Tube shunt surgeries as well as gonioscopy-assisted transluminal trabeculotomy have been shown to be successful in JOAG. SUMMARY Although genetic advances may improve future screening, intraocular pressure monitoring and fundoscopic exam remain the current mainstay of diagnosis. Medical treatment alone for JOAG is typically insufficient with patients requiring surgical management. Selective laser trabeculoplasty may delay or decrease the need for surgery. Trabeculectomy has traditionally been shown to be effective in JOAG, but tube shunt surgery and microinvasive glaucoma surgery are effective alternatives.
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Affiliation(s)
| | - Meredith R Klifto
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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