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Alpogan O, Un Y, Tekcan H, Kose AO, Bolac R. Evaluation of Anterior Scleral Thickness and Angle Parameters in Eyes with Pseudoexfoliation Syndrome and Glaucoma. J Glaucoma 2024; 33:785-793. [PMID: 38771636 DOI: 10.1097/ijg.0000000000002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/11/2024] [Indexed: 05/23/2024]
Abstract
PRCIS The relationship between anterior scleral thickness (AST) and scleral spur (SS) length was disrupted in eyes with pseudoexfoliation (PX), and SS length was shorter in eyes with pseudoexfoliative glaucoma (PXG). OBJECTIVES To evaluate AST in eyes with PX and to examine the relationship between AST and Schlemm canal (SC), trabecular meshwork (TM), and SS. PATIENTS AND METHODS Thirty-eight patients with PX syndrome (PXS), 38 patients with PXG, and 38 healthy patients were included in the study. Using sweep source anterior segment optical coherence tomography, AST (0, 1, 2, and 3 mm from the SS), SC, and TM were visualized in the nasal and temporal areas, and measurements were compared between groups. The relationships between corneal thickness, TM, SS, SC, and AST were then evaluated. RESULTS In all groups, the AST, SC, and TM measurements were similar ( P > 0.05). In the PXG group, SS lengths in the temporal area were shorter than those in the control and PXS groups ( P = 0.012). There were significant correlations between TM length and AST in the PXG group ( P < 0.05). The SS length exhibited moderately positive correlations with SC length and mean TM thickness in the PXG ( P < 0.05). There was a significant relationship between AST0 and SS in healthy eyes ( P < 0.05), but not in other eyes. CONCLUSIONS The shorter SS length observed in eyes with PXG may be a sign of structural changes. In addition, disruption of the relationship between AST and SS may be an early sign of pathologic processes, especially in eyes with PXS, and may require closer follow-up of these eyes.
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Affiliation(s)
- Oksan Alpogan
- Department of Ophthalmology, Health Sciences University, Haydarpasa Numune Training and Research Hospital
| | - Yasemin Un
- Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Hatice Tekcan
- Department of Ophthalmology, Health Sciences University, Haydarpasa Numune Training and Research Hospital
| | - Alev Ozcelik Kose
- Department of Ophthalmology, Health Sciences University, Haydarpasa Numune Training and Research Hospital
| | - Ruveyde Bolac
- Department of Ophthalmology, Health Sciences University, Haydarpasa Numune Training and Research Hospital
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2
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Koizumi H, Imanaga N, Terao N. Central serous chorioretinopathy and the sclera: what we have learned so far. Jpn J Ophthalmol 2024; 68:419-428. [PMID: 39150610 PMCID: PMC11420308 DOI: 10.1007/s10384-024-01101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/13/2024] [Indexed: 08/17/2024]
Abstract
Central serous chorioretinopathy (CSC) is a common disorder characterized by serous retinal detachment. Several studies using indocyanine green angiography (ICGA) have revealed that choroidal filling delay, choroidal vascular dilation, and choroidal vascular hyperpermeability are the characteristic findings of CSC. These ICGA findings confirm that choroidal circulatory disturbances are the primary factors in the pathogenesis of CSC. With advancements in optical coherence tomography (OCT), choroidal thickness has been found to be significantly greater in eyes with CSC than in normal eyes. Dilated large choroidal vessels reportedly account for the thickened choroid in eyes with CSC. Although many possible mechanisms and risk factors have been suggested, the pathophysiologic features of choroidal circulatory disturbances and choroidal thickening in eyes with CSC have not yet been fully elucidated. Recently, using anterior segment OCT, we proposed that the sclera may induce choroidal circulatory disturbances since CSC eyes have significantly thicker sclera than do normal eyes. This review summarizes updated information on the close relationship between CSC pathogenesis and the sclera.
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Affiliation(s)
- Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan.
| | - Naoya Imanaga
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Nobuhiro Terao
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
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3
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Teeuw GJ, Vergouwen DPC, Ramdas WD, Sanchez-Brea L, Andrade De Jesus D, Rothova A, Vingerling JR, Ten Berge JC. Assessment of conjunctival, episcleral and scleral thickness in healthy individuals using anterior segment optical coherence tomography. Acta Ophthalmol 2024; 102:573-580. [PMID: 38140822 DOI: 10.1111/aos.16606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To determine the thickness of the conjunctiva, episclera and sclera in healthy individuals using anterior segment optical coherence tomography (AS-OCT). METHODS We prospectively included 107 healthy individuals of different age groups (18-39 years, 40-54 years, 55-69 years and ≥70 years). For each eye, AS-OCT scans of four quadrants (temporal, nasal, superior and inferior) were acquired. The thickness of the conjunctiva, episclera and sclera was measured for each scan. In addition, the axial length of both eyes was measured, and general characteristics, including smoking, allergies and contact lens use, were collected. RESULTS The mean conjunctival thickness was significantly different between the nasal and superior quadrants (87 ± 30 μm vs. 77 ± 16 μm; p < 0.001), as well as the superior and inferior quadrants (77 ± 16 μm vs. 86 ± 19 μm; p = 0.001). The mean episcleral thickness was larger in the superior (174 ± 54 μm) and inferior (141 ± 43 μm) quadrants, compared to the nasal (83 ± 38 μm) and temporal quadrants (90 ± 44 μm). The mean scleral thickness of the inferior quadrant was the largest (596 ± 64 μm), followed by the nasal (567 ± 76 μm), temporal (516 ± 67 μm) and superior (467 ± 52 μm) quadrants (all p < 0.001). The averaged scleral thickness increased 0.96 μm per age year (0.41-1.47 μm, p < 0.001). CONCLUSIONS This study provides an assessment of the thickness of scleral and adjacent superficial layers in healthy individuals determined on AS-OCT, which could enable future research into the use of AS-OCT in diseases affecting the anterior eye wall.
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Affiliation(s)
- G J Teeuw
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W D Ramdas
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Sanchez-Brea
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Andrade De Jesus
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J R Vingerling
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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4
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Pan M, Kwok S, Pan X, Liu J. Biomechanical Correlations Between the Cornea and the Optic Nerve Head. Invest Ophthalmol Vis Sci 2024; 65:34. [PMID: 38776117 PMCID: PMC11127493 DOI: 10.1167/iovs.65.5.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/10/2024] [Indexed: 05/27/2024] Open
Abstract
Purpose A thin cornea is a potent risk factor for glaucoma. The underlying mechanisms remain unexplained. It has been postulated that central corneal thickness (CCT) may be a surrogate for biomechanical parameters of the posterior eye. In this study, we aimed to explore correlations of biomechanical responses between the cornea and the optic nerve head (ONH) and the peripapillary sclera (PPS) to elevated intraocular pressure (IOP), the primary risk factor of glaucoma. Methods Inflation tests were performed in nine pairs of human donor globes. One eye of each pair was randomly assigned for cornea or posterior eye inflation. IOP was raised from 5 to 30 millimeters of mercury (mmHg) at 0.5 mmHg steps in the whole globe and the cornea or the ONH/PPS was imaged using a 50 MHz ultrasound probe. Correlation-based ultrasound speckle tracking was used to calculate tissue displacements and strains. Associations of radial, tangential, and shear strains at 30 mmHg between the cornea and the ONH or PPS were evaluated. Results Corneal shear strain was significantly correlated with ONH shear strain (R = 0.857, P = 0.003) and PPS shear strain (R = 0.724, P = 0.028). CCT was not correlated with any strains in the cornea, ONH, or PPS. Conclusions Our results suggested that an eye that experiences a larger shear strain in the cornea would likely experience a larger shear strain in its ONH and PPS at IOP elevations. The strong correlation between the cornea's and the ONH's shear response to IOP provides new insights and suggests a plausible explanation of the cornea's connection to glaucoma risk.
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Affiliation(s)
- Manqi Pan
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | - Sunny Kwok
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, United States
| | - Jun Liu
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
- Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus, Ohio, United States
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5
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Factors Associated with Deterioration of Primary Angle Closure after Lens Extraction. J Clin Med 2022; 11:jcm11092557. [PMID: 35566683 PMCID: PMC9101945 DOI: 10.3390/jcm11092557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of the study was to explore factors associated with glaucomatous deterioration in eyes with primary angle closure (PAC) after lens extraction, including PAC suspect (PACS), PAC, and PAC glaucoma (PACG). We retrospectively analyzed data of 77 eyes with PACS, PAC, and PACG that underwent lens extraction with more than 2 years postoperative follow-up. Postoperative glaucoma progression was analyzed by either structural (optic disc/retinal nerve fiber layer (RNFL) photographs or optical coherent tomography (OCT)) or functional (visual field (VF)) criterion. Cox proportional hazard analysis (hazard ratio (HR)) was used to determine risk factors for progression using uni-and multivariate analysis. The analysis was conducted in groups with or without glaucomatous optic neuropathy (PACS/PAC vs. PACG). Forty-one eyes with PACS/PAC and 36 eyes with PACG were included. The mean postoperative follow-up period was 3.5 ± 1.4 years. Intraocular pressure (IOP) was reduced postoperatively from 23.1 ± 14.4 to 13.4 ± 2.1 mmHg. In the PACS/PAC group, seven eyes (17.0%) showed structural progression, but none showed progression in VF. Preoperative RNFL thickness was the only risk factor for structural progression (HR = 0.928, p = 0.002) in the PACS/PAC group. In the PACG group, 24 eyes (66.7%) showed structural progression and 12 eyes (33.3%) showed VF progression. Thinner preoperative RNFL thickness (HR = 0.964, p = 0.043) and high postoperative IOP fluctuation (HR = 1.296, p = 0.011) were significantly associated with VF progression; none of the factors were associated with structural progression. Angle closure eyes with thinner baseline RNFL thickness and higher postoperative IOP fluctuation may require careful follow-up for glaucoma progression after lens extraction.
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Thinner Central Corneal Thickness is Associated with a Decreased Parapapillary Vessel Density in Normal Tension Glaucoma. J Ophthalmol 2022; 2022:1937431. [PMID: 35378886 PMCID: PMC8976629 DOI: 10.1155/2022/1937431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
This retrospective cross-sectional study, which enrolled 124 normal tension glaucoma (NTG) eyes and 68 healthy eyes as the control, determined the association between central corneal thickness (CCT) and ocular parameters in NTG. CCT was measured using the Pentacam® system, optical coherence tomography angiography (OCT-A) was adopted to measure the peripapillary and macular area VDs, and spatial data were based on the Garway–Heath map as illustrated in OCT-A. Univariate and multivariate linear regressions were used to statistically analyze for associations between CCT and other factors. In this study, the mean age was similar for both the NTG and control groups. The mean CCT of the NTG group was significantly thinner than that of the control group (533.97 ± 33.11 µm vs. 546.78 ± 38.21 µm;
= .022). Considering all the factors, CCT negatively correlated with visual field (VF) pattern standard deviation (univariate,
= .045). To analyze structural and functional factors separately, we found a significant positive correlation between CCT and whole disc radial peripapillary capillary VD (VDRPC; multivariate,
= .019). To analyze the relationship between all factors and sectoral changes in VDRPC, a significant positive correlation was observed between CCT and inferior temporal VDRPC (univariate,
= .039) and inferior nasal VDRPC (VDRPC IN; univariate,
= .048). In conclusion, this novel study shows that among NTG participants, a thinner cornea correlated with weaker biomechanical properties susceptible to optic nerve tissue displacement, especially in response to mild transient elevation of IOP, leads to compromised ocular microcirculation.
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7
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Lee DC, Lee SY, Jun JH. Alterations of lower- and higher-order aberrations after unilateral horizontal rectus muscle surgery in children with intermittent exotropia: A retrospective cross-sectional study. PLoS One 2022; 17:e0264037. [PMID: 35176076 PMCID: PMC8853472 DOI: 10.1371/journal.pone.0264037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background This retrospective, cross-sectional study investigated changes in corneal lower- and higher-order aberrations that cause visual disturbance after lateral rectus recession and medial rectus resection in children. Methods Eighty-five eyes of 85 patients (44 boys; 8.64±2.88 years) who underwent lateral rectus recession and medial rectus resection to correct intermittent exotropia were assessed. The Galilei G4 Dual Scheimpflug Analyzer was used for wavefront analysis. Risk factors (age, sex, amount of surgery, preoperative axial length, preoperative intraocular pressure) were determined. Outcome measures included simulated and ray-tracing mode keratometry with secondary defocus, oblique, and vertical astigmatism (for lower-order aberrations) and the root mean square, 3rd-order vertical and horizontal coma, oblique and horizontal trefoil, 4th-order spherical aberration, oblique and vertical secondary astigmatism, and oblique and vertical quadrafoil (2nd‒8th sums) (for higher-order aberrations). Results Myopic with-the-rule changes in low-order aberrations and increases in simulated and ray-tracing mode keratometry during the 3 months following lateral rectus recession and medial rectus resection were attributed to muscle healing and stability changes. High-order aberrations altered in the week following surgery almost returned to normal within 3 months. Axial length, the amount of surgery, age, and sex affected astigmatism due to differences in patients’ scleral states. Conclusions Clinicians should consider changes in high-order aberrations of young individuals who underwent lateral rectus recession and medial rectus resection and may not be able to verbalize changes in vision.
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Affiliation(s)
- Dong Cheol Lee
- Department of Ophthalmology, School of Medicine, Keimyung University, Daegu, Korea
| | - Se Youp Lee
- Department of Ophthalmology, School of Medicine, Keimyung University, Daegu, Korea
| | - Jong Hwa Jun
- Department of Ophthalmology, School of Medicine, Keimyung University, Daegu, Korea
- * E-mail:
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8
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Yan X, Li M, Chen Z, Zhou X. The anterior scleral thickness in eyes with primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2022; 260:1601-1610. [PMID: 35067770 PMCID: PMC9007782 DOI: 10.1007/s00417-021-05523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022] Open
Abstract
Abstract
Purpose
To investigate the anterior scleral thickness (AST) and its associations with Schlemm’s canal (SC) area, trabecular meshwork (TM) thickness and length, and scleral spur (SS) length in healthy and primary open-angle glaucoma (POAG) groups.
Methods
Thirty-five eyes of 35 healthy subjects and 23 eyes of 23 patients with POAG were included. The AST, SC area, TM thickness and length, and SS length were measured using swept-source optical coherence tomography. AST was measured at 0 mm (AST0), 1 mm (AST1), 2 mm (AST2), and 3 mm (AST3) from SS. Associations between AST and SC area, TM thickness and length, and SS length were also estimated.
Results
AST0 (728.84 ± 99.33 vs. 657.39 ± 67.02 μm, p < 0.001), AST1 (537.79 ± 79.55 vs. 506.83 ± 57.37 μm, p = 0.038), AST3 (571.09 ± 79.15 vs. 532.13 ± 59.84 μm, p = 0.009), SC area (6304.26 ± 1238.72 vs. 4755.64 ± 1122.71 μm2, p < 0.001), TM thickness (107.21 ± 31.26 vs. 94.51 ± 24.18 μm, p = 0.035), TM length (736.20 ± 141.85 vs. 656.43 ± 127.03 μm, p = 0.004), and SS length (219.89 ± 50.29 vs. 174.54 ± 35.58 μm, p < 0.001) were significantly greater in healthy group than in POAG group. In addition, SC area, TM thickness, and SS length were significantly and positively associated with AST0 in the healthy group, whereas no similar associations were observed in the POAG group.
Conclusions
Compared with the healthy group, AST was significantly thinner in the POAG group, which also had smaller SC and TM dimensions. Moreover, the SC area, TM thickness, and SS length were significantly and positively associated with AST in the healthy group. Thus, AST might play an important role in maintaining TM and SC morphology and further in the pathogenesis of POAG.
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Affiliation(s)
- Xiaoqin Yan
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mu Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhiqi Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiongwu Zhou
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Fernández-Vigo JI, Moreno-Morillo FJ, Shi H, Ly-Yang F, Burgos-Blasco B, Güemes-Villahoz N, Donate-López J, García-Feijóo J. Assessment of the anterior scleral thickness in central serous chorioretinopathy patients by optical coherence tomography. Jpn J Ophthalmol 2021; 65:769-776. [PMID: 34491476 DOI: 10.1007/s10384-021-00870-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the anterior scleral thickness (AST) and describe the presence of a visible supraciliary space (SCS) in central serous chorioretinopathy (CSC) patients by swept-source optical coherence tomography (SS-OCT). STUDY DESIGN Cross-sectional comparative study. MATERIAL AND METHODS Three groups were studied: 1) 64 eyes of 54 patients with CSC with persistent subretinal fluid (SRF); 2) 42 fellow eyes of CSC patients without SRF; 3) 65 eyes of 65 controls matched by age, sex and axial length (AL). The AST was measured in the temporal and nasal quadrants at 0, 1, and 2 mm from the scleral spur by SS-OCT. The presence of a visible SCS was also assessed. RESULTS No differences were observed in the AST0 among the three groups (p≥ 0.665). The temporal AST1 was significantly thicker in the CSC group (530.3 ±67.1 µm) than in the controls (505.5 ±73.9; p=0.041). Mean AST2 was also thicker in the CSC group and the fellow eyes both for the temporal (519.4 ±89.1 µm and 519.8 ±98.5 µm respectively) and nasal quadrants (564.2 ±124.9 µm and 570.5 ±131.0 µm) than in the controls (450.1 ±76.8 and 473.3 ±111.6 µm) (all p≤0.001). A visible SCS was detected in the eyes of 8 CSC patients, in 4 fellow eyes and only in 1 control eye. CONCLUSIONS AST measured by SS-OCT was significantly greater in CSC eyes than in healthy eyes. Also, a visible SCS was detected in CSC eyes. Thus, thicker sclera in CSC eyes could be associated with the physiopathology of this disease.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain. .,Centro Internacional de Oftalmología Avanzada, Zurbano 71, 28010, Madrid, Spain.
| | - Francisco Javier Moreno-Morillo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain
| | - Hang Shi
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Zurbano 71, 28010, Madrid, Spain
| | - Fernando Ly-Yang
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain
| | - Bárbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain
| | - Noemí Güemes-Villahoz
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain
| | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain
| | - Julián García-Feijóo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Professor Martin Lagos s/n, 28040, Madrid, Spain.,Faculty of Medicine, Department of Ophthalmology, Universidad Complutense, Madrid, Spain
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10
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Fernández-Vigo JI, Shi H, Burgos-Blasco B, Fernández-Aragón S, De-Pablo-Gómez-de-Liaño L, Kudsieh B, Macarro-Merino A, Fernández-Vigo JÁ. Anterior scleral thickness dimensions by swept-source optical coherence tomography. Clin Exp Optom 2021; 105:13-19. [PMID: 34134598 DOI: 10.1080/08164622.2021.1924629] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Clinical relevance: Given the association of scleral characteristics with many ophthalmological diseases, there is an important need to measure the anterior scleral thickness (AST).Background: This study examined the AST by swept-source optical coherence tomography (SS-OCT) in a large healthy population, assessing also the reproducibility of AST measurements and the correlation with different parameters.Methods: Cross-sectional study in 605 eyes of 605 subjects. AST measurements were made in the temporal and nasal quadrants at 1 (AST1) and 3 mm (AST3) from the scleral spur using SS-OCT. These dimensions were then assessed for associations in a multivariate model with the factors age, sex, refractive error, conjunctival-Tenon capsule thickness (CTT), anterior chamber angle (ACA), intraocular pressure (IOP), iris thickness (IT), limbus-sulcus distance (LSD), and ciliary muscle thickness (CMT). The reproducibility of the AST measurements was determined in 30 of the participants.Results: The mean age was 42.6 ± 17.3 years (range 5 to 86 years). The following means were recorded: AST1 was 522.3 ± 65.7 µm (355 to 761) and 558.4 ± 71.5 µm (357 to 889); AST2 was 513.3 ± 67.3 µm (343 to 732) and 574.4 ± 71.6 µm (389 to 789), and AST3 548.8 ± 71.9 µm (356 to 762) and 590.1 ± 76.6 µm (414 to 873) in the temporal and nasal quadrants respectively, being thicker the nasal quadrant (all p < 0.001). A positive correlation was detected between AST and age, sex, temporal ACA and LSD (all p ≤ 0.043), being negative the correlation with CMT (p ≤ 0.044). No correlation was observed between AST measurements and refractive error, CTT and IT (p ≥ 0.064). The reproducibility of AST measurements was excellent (intraclass correlation coefficient ≥0.951).Conclusions: SS-OCT allows for in vivo AST measurements. Our data contained a wide range of measurements, showing an association between AST and age, sex, ACA, LSD and CMT.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - Hang Shi
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - Bárbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | | | | | - Bachar Kudsieh
- Department of Ophthalmology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Macarro-Merino
- Department of Ophthalmology, Centro Internacional de Oftalmología Avanzada, Madrid, Spain
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11
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Effect of prostaglandin analogues on anterior scleral thickness and corneal thickness in patients with primary open-angle glaucoma. Sci Rep 2021; 11:11098. [PMID: 34045600 PMCID: PMC8160208 DOI: 10.1038/s41598-021-90696-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/04/2021] [Indexed: 11/15/2022] Open
Abstract
Prostaglandin (PG) analogues are usually prescribed as a first-line therapy in patients with glaucoma because of its once-daily dosing benefit and effective intraocular pressure (IOP) reduction. However, the mechanism of PG analogues is not completely understood. In this study, we investigated the effect of PG analogues on the anterior scleral thickness (AST) in treatment-naïve eyes with primary open-angle glaucoma using anterior segment optical coherence tomography. The AST was measured at the location of the scleral spur, 1000 μm, and 2000 μm posterior to the scleral spur and was compared before and after using the medications for 3 months and 1 year. Among 54 patients enrolled in this study, 31 patients used prostaglandin analogues and 23 patients used dorzolamide/timolol fixed combination (DTFC) drugs. There was no significant difference in untreated IOP, glaucoma severity, and baseline AST values between the two groups. While there was no significant changes in AST after using the DTFC drugs, the AST at all 3 locations showed a significant reduction in both the nasal and temporal sectors after using PG analogues for 1 year (all, P < 0.05). These findings suggest that the AST reduction after using PG analogues might be related with the increased uveoscleral outflow.
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12
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Lee DC, Lee SY. Analysis of astigmatism outcomes after horizontal rectus muscle surgery in patients with intermittent exotropia. PLoS One 2020; 15:e0240026. [PMID: 33031390 PMCID: PMC7544045 DOI: 10.1371/journal.pone.0240026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
This study examined the factors affecting corneal curvature change after lateral rectus recession and medial rectus resection surgery in patients with intermittent exotropia. This was a retrospective cross-sectional study in intermittent exotropia patients who underwent rectus resection surgery. The study involved 41 male and 42 female patients (mean age: 9.55 ± 5.03 years, range: 3-28 years). Corneal astigmatism analysis was performed using the Galilei G4 Dual Scheimpflug Analyzer. The values of simulated and ray tracing corneal keratometry (K) of astigmatism, including axis changes, were determined preoperatively and at 1 week and 3 months postoperatively. The factors found to affect corneal curvature change were sex, extent of surgery, and axial length. Simulated and ray tracing changes were significant preoperatively and at 1 week and 3 months after rectus resection surgery (p < 0.05); however, there were no differences in astigmatism (D) at any time. The spherical equivalent had a myopic change after rectus resection surgery with cycloplegic refraction, and in ray tracing mode, flat K was decreased at 1 week from baseline and increased 3 months later. Steep, mean K, and axis increased continuously from baseline to 1 week and 3 months. Astigmatism, in contrast, was increased at 1 week, but decreased at 3 months, with no return to baseline. Univariable linear regression analyses showed that the extent of surgery had an effect on flat K change and that sex had an effect on steep K and axis. Additionally, axial length affected steep K and astigmatism, while age had no effect on any variable. Ray tracing values were significantly different from simulated values. In ray tracing mode, rectus resection surgery may result in astigmatism shifted toward with-the-rule, and myopic changes may be caused by differences in thickness and flexibility of the sclera. Notably, age did not affect any variable.
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Affiliation(s)
- Dong Cheol Lee
- Department of Ophthalmology, School of Medicine, and Institute for Medical Science, Keimyung University, Daegu, Korea
| | - Se Youp Lee
- Department of Ophthalmology, School of Medicine, Keimyung University, Daegu, Korea
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13
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Bataille L, Piñero DP. Characterization of the geometric properties of the sclero-conjunctival structure: a review. Int J Ophthalmol 2020; 13:1484-1492. [PMID: 32953590 DOI: 10.18240/ijo.2020.09.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
To revise the peer-reviewed literature on geometric properties of the scleral-conjunctival structure in order to define their clinical relevance and the potential relationship between their changes and myopia development or progression. A bibliographic search focused on the study of the geometry of conjunctiva and/or sclera as well as those studies evaluating the relationship between geometric changes in the scleral-conjunctival structure and myopia was carried out. Several studies have been performed with different diagnostic technologies, including optical coherence tomography, profilometry and Scheimpflug imaging, to detect geometric changes of the scleral-conjunctival tissue in different physiological conditions of the eye, after use of contact lenses and in different ocular pathologies. Likewise, these technologies have been shown to be a valuable clinical tool to optimize scleral contact lens fitting. Future studies should investigate new potential clinical applications of such technologies, including the evaluation of anterior scleral changes related to myopia, as well as to define standardized clinical standard operating procedures for obtaining accurate and reproducible clinical measurement of the scleral-conjunctival morphology.
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Affiliation(s)
- Laurent Bataille
- Research and Development Department, VISSUM, Alicante 03016, Spain.,Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante 03690, Spain
| | - David P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante 03690, Spain
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14
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Radcliffe NM, Tracer N, De Moraes CGV, Tello C, Liebmann JM, Ritch R. Relationship between optic disc hemorrhage and corneal hysteresis. Can J Ophthalmol 2019; 55:239-244. [PMID: 31879066 DOI: 10.1016/j.jcjo.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the relationship between optic disc hemorrhage (DH) and corneal hysteresis (CH). METHODS Consecutive patients with prior or current photographic evidence of unilateral DH who had undergone CH measurement with the Ocular Response Analyzer (ORA; Reichert, Buffalo, NY) were enrolled. Eyes with a history of corneal disease, refractive surgery, or bilateral DH were excluded. Central corneal thickness (CCT), visual field data, 5 consecutive previous intraocular pressures (IOPs), and maximum documented peak IOP were obtained by chart review. Vertical cup-to-disc ratio (VCDR), the presence of neuroretinal rim notching, number of clock hours of beta zone parapapillary atrophy (ßPPA), and eye with greater ßPPA width were determined from photographs by 2 masked expert examiners. RESULTS We identified and analyzed 49 patients with photographically documented unilateral DH. Compared to fellow non-DH eyes, eyes with DH had lower CH (8.7 ± 1.9 vs 9.2 ± 1.7; p = 0.002), higher IOP (15.6 ± 3.6 vs 14.3 ± 4.1; p = 0.017), and greater VCDR (0.79 ± 0.13 vs 0.68 ± 0.23; p < 0.001), but were similar with respect to CCT, ßPPA extent, rim notching, peak IOP, and visual field damage (all p > 0.05). Using multivariate conditional logistic regression analysis, only CH (p = 0.012) and VCDR (p = 0.004) predicted the laterality of the DH. CONCLUSIONS Lower CH and greater VCDR are independently associated with DH. This suggests that CH may be a structural biomarker for an abnormality of the optic nerve complex that may be associated with progressive glaucoma. Eyes in which DH were detected had lower CH.
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Affiliation(s)
| | | | | | - Celso Tello
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY
| | - Jeffrey M Liebmann
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY
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15
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Anterior eye tissue morphology: Scleral and conjunctival thickness in children and young adults. Sci Rep 2016; 6:33796. [PMID: 27646956 PMCID: PMC5028711 DOI: 10.1038/srep33796] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/01/2016] [Indexed: 12/11/2022] Open
Abstract
The sclera and conjunctiva form part of the eye's tough, protective outer coat, and play important roles in the eye's mechanical protection and immune defence, as well as in determining the size and shape of the eye globe. Advances in ocular imaging technology now allow these tissues in the anterior eye to be imaged non-invasively and with high resolution, however there is a paucity of data examining the dimensions of these tissues in paediatric populations. In this study, we have used optical coherence tomography (OCT) imaging to examine the normal in vivo thickness profile of the anterior sclera and overlying conjunctiva in 111 healthy young participants, including a large proportion of paediatric subjects. We demonstrate that the thickness of the anterior sclera varies significantly with measurement location and meridian. Tissue thickness also varied significantly with age, with younger subjects exhibiting significantly thinner scleras and significantly greater conjunctival thickness. Males were also found to exhibit significantly greater scleral thickness. Refractive error however was not significantly associated with either scleral or conjunctival thickness in this population. These findings provide new data describing the normative dimensions of anterior eye tissues in children and the factors that can influence these dimensions in young populations.
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Tekeli O, Savku E, Abdullayev A. Optic disc area in different types of glaucoma. Int J Ophthalmol 2016; 9:1134-7. [PMID: 27588267 DOI: 10.18240/ijo.2016.08.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/27/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the possible relationship of optic disc area with retina nerve fiber layer in different glaucoma subtypes. METHODS One eye each was chosen from 45 patients with ocular hypertension, 45 patients with primary open angle glaucoma, 45 patients with pseudoexfoliation glaucoma and 45 healthy controls followed in our hospital. The records of the patients were reviewed retrospectively. Optic disc area and circumpapillary retina nerve fiber layer measurements were obtained using optical coherence tomography. Central corneal thickness was measured by ultrasound pachymetry. RESULTS The median disc area in the patients with primary open angle glaucoma was significantly higher than the patients with ocular hypertension (2.19 vs 1.90 mm(2), P=0.030). The median retina nerve fiber layer was thinner in the patients with primary open angle glaucoma and pseudoexfoliation glaucoma than the patients with ocular hypertension for superior, inferior and temporal quadrants. After adjustment for age, no difference in central corneal thickness was found between the groups. Greater disc area was associated with thicker retinal nerve fiber layer for superior, inferior and nasal quadrants in the patients with primary open angle glaucoma. There was no correlation between disc area and central corneal thickness measurements of the groups. CONCLUSION Disc size affects the retinal nerve fiber layer thickness in eyes with primary open angle glaucoma and is a possible risk factor for glaucomatous optic nerve damage.
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Affiliation(s)
- Oya Tekeli
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara 06590, Turkey
| | - Esra Savku
- Department of Ophthalmology, Islahiye State Hospital, Islahiye, Gaziantep 27800, Turkey
| | - Ahmed Abdullayev
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara 06590, Turkey
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17
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Omodaka K, Takahashi S, Matsumoto A, Maekawa S, Kikawa T, Himori N, Takahashi H, Maruyama K, Kunikata H, Akiba M, Nakazawa T. Clinical Factors Associated with Lamina Cribrosa Thickness in Patients with Glaucoma, as Measured with Swept Source Optical Coherence Tomography. PLoS One 2016; 11:e0153707. [PMID: 27100404 PMCID: PMC4839731 DOI: 10.1371/journal.pone.0153707] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/03/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the influence of various risk factors on thinning of the lamina cribrosa (LC), as measured with swept-source optical coherence tomography (SS-OCT; Topcon). Methods This retrospective study comprised 150 eyes of 150 patients: 22 normal subjects, 28 preperimetric glaucoma (PPG) patients, and 100 open-angle glaucoma patients. Average LC thickness was determined in a 3 x 3 mm cube scan of the optic disc, over which a 4 x 4 grid of 16 points was superimposed (interpoint distance: 175 μm), centered on the circular Bruch’s membrane opening. The borders of the LC were defined as the visible limits of the LC pores. The correlation of LC thickness with Humphrey field analyzer-measured mean deviation (MD; SITA standard 24–2), circumpapillary retinal nerve fiber layer thickness (cpRNFLT), the vertical cup-to-disc (C/D) ratio, and tissue mean blur rate (MBR) was determined with Spearman's rank correlation coefficient. The relationship of LC thickness with age, axial length, intraocular pressure (IOP), MD, the vertical C/D ratio, central corneal thickness (CCT), and tissue MBR was determined with multiple regression analysis. Average LC thickness and the correlation between LC thickness and MD were compared in patients with the glaucomatous enlargement (GE) optic disc type and those with non-GE disc types, as classified with Nicolela’s method. Results We found that average LC thickness in the 16 grid points was significantly associated with overall LC thickness (r = 0.77, P < 0.001). The measurement time for this area was 12.4 ± 2.4 minutes. Average LC thickness in this area had a correlation coefficient of 0.57 with cpRNFLT (P < 0.001) and 0.46 (P < 0.001) with MD. Average LC thickness differed significantly between the groups (normal: 268 ± 23 μm, PPG: 248 ± 13 μm, OAG: 233 ± 20 μm). Multiple regression analysis showed that MD (β = 0.29, P = 0.013), vertical C/D ratio (β = -0.25, P = 0.020) and tissue MBR (β = 0.20, P = 0.034) were independent variables significantly affecting LC thickness, but age, axial length, IOP, and CCT were not. LC thickness was significantly lower in the GE patients (233.9 ± 17.3 μm) than the non-GE patients (243.6 ± 19.5 μm, P = 0.040). The correlation coefficient between MD and LC thickness was 0.58 (P < 0.001) in the GE patients and 0.39 (P = 0.013) in the non-GE patients. Conclusion Cupping formation and tissue blood flow were independently correlated to LC thinning. Glaucoma patients with the GE disc type, who predominantly have large cupping, had lower LC thickness even with similar glaucoma severity.
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Affiliation(s)
- Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seri Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shigeto Maekawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidetoshi Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
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The Conjunctiva in Normal Tension Glaucoma Patients is Thinner Than in Primary Open-Angle Glaucoma Patients: A Comparative Histologic Study. J Glaucoma 2016; 25:e546-9. [PMID: 26859359 DOI: 10.1097/ijg.0000000000000388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare histologically the thickness of conjunctival specimens of normal tension glaucoma (NTG) patients with primary open-angle glaucoma (POAG) patients. MATERIALS AND METHODS In this prospective study, 54 patients scheduled for trabeculectomy were categorized into NTG and POAG based on their maximum untreated intraocular pressure at any time (IOPmax) as measured by Goldmann applanation tonometry. Sixteen patients with NTG (IOPmax≤21 mm Hg) and 36 patients with high tension POAG (IOPmax>21 mm Hg) were included in the study. Biopsies were taken from the superior bulbar conjunctiva during trabeculectomy. The specimens were fixed in formalin, embedded in methacrylate, histologically sectioned, stained with toluidine blue, and analyzed with a light microscope. The stromal conjunctival thickness (CT) was measured in a standardized way and compared between the 2 groups. Intergroup comparisons were performed using the Mann-Whitney U test for continuous variables and the Fisher exact test for categorical variables. The correlation between the central cornea thickness (CCT) and the CT was investigated by the Spearman test. RESULTS The stromal CT was significantly thinner in NTG compared with POAG (64±31 vs. 103±44 µm, respectively; P=0.002). Stromal CT of the whole group was positively correlated with IOPmax (r=0.41; P=0.002; 95% confidence interval, 0.15-0.62) but not with central cornea thickness (r=-0.005; P=0.97; 95% confidence interval, -0.28 to 0.27). CONCLUSIONS The conjunctiva in patients with NTG was thinner than in POAG patients. This finding is an additional feature in the pattern of thinner ocular structures in patients with NTG.
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Shen L, Melles RB, Metlapally R, Barcellos L, Schaefer C, Risch N, Herrinton LJ, Wildsoet C, Jorgenson E. The Association of Refractive Error with Glaucoma in a Multiethnic Population. Ophthalmology 2016; 123:92-101. [PMID: 26260281 PMCID: PMC4695304 DOI: 10.1016/j.ophtha.2015.07.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/24/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the association between refractive error and the prevalence of glaucoma by race or ethnicity. DESIGN Cross-sectional study. PARTICIPANTS Kaiser Permanente Northern California Health Plan members with refractive error measured at 35 years of age or older between 2008 and 2014 and with no history of cataract surgery, refractive surgery, or a corneal disorder. METHODS We identified 34 040 members with glaucoma or ocular hypertension (OHTN; cases) and 403 398 members without glaucoma (controls). Glaucoma cases were classified as primary angle-closure glaucoma (PACG); 1 of the 4 forms of open-angle glaucoma: primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma (PIGM), and pseudoexfoliation glaucoma (PEX); or OHTN. Refractive error, expressed as spherical equivalent (SE), was coded as a continuous trait and also as categories. Logistic regression analyses were used to estimate the association between refractive error and the prevalence of glaucoma overall and in specific racial or ethnic groups. MAIN OUTCOME MEASURES The association between refractive error and glaucoma subtypes evaluated as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS In controls, the mean SE was -0.59 diopters (D) (standard deviation, 2.62 D). Each 1-D reduction in SE was associated with a 22% decrease in the odds of PACG (OR, 0.78; 95% CI, 0.77-0.80) and with increases in the odds of open-angle glaucoma ranging from 1.23 (95% CI, 1.20-1.26) for PIGM, to 1.07 (95% CI, 1.03-1.11) for PEX, and to 1.05 (95% CI, 1.04-1.06) for OHTN. In addition, we observed a stronger association between myopia and POAG among non-Hispanic whites (OR, 1.12; 95% CI, 1.11-1.13) and NTG among Asians (OR, 1.17; 95% CI, 1.15-1.20) and non-Hispanic whites (OR, 1.19; 95% CI, 1.15-1.22). CONCLUSIONS Myopia was associated with an increased prevalence of all forms of open-angle glaucoma and OHTN, whereas hyperopia was associated with a substantially increased prevalence of PACG. Although high myopia is a strong risk factor for glaucoma subtypes, low and moderate myopia also have a significant effect on glaucoma risk. Additionally, there were moderate racial differences in the association of myopia with the risk of POAG and NTG.
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Affiliation(s)
- Ling Shen
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California
| | - Ronald B Melles
- Department of Ophthalmology, Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, California
| | - Ravikanth Metlapally
- School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California
| | - Lisa Barcellos
- Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California
| | - Catherine Schaefer
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Neil Risch
- Institute for Human Genetics, University of California San Francisco - San Francisco, California; Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Christine Wildsoet
- School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California
| | - Eric Jorgenson
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
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Saenz-Frances F, Jañez L, Borrego-Sanz L, Berrozpe-Villabona C, Martinez-de-la-Casa JM, Morales-Fernandez L, Garcia-Sanchez J, Santos-Bueso E, Garcia-Feijoo J. Correlations between corneal and optic nerve head variables in healthy subjects and patients with primary open angle glaucoma. Int J Ophthalmol 2015; 8:1156-61. [PMID: 26682165 DOI: 10.3980/j.issn.2222-3959.2015.06.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 03/03/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To correlate corneal variables (determined using the Pentacam) with optic nerve head (ONH) variables determined using the Heidelberg retina tomograph (HRT) in healthy subjects and patients diagnosed with primary open angle glaucoma (POAG). METHODS Measurements were made in 75 healthy eyes and 73 eyes with POAG and correlations examined through Pearson correlation coefficients between the two sets of variables in the two subject groups. The corneal variables determined were corneal volume (CVol), central corneal thickness (CCT), overall corneal thickness (OvCT), the mean thickness of a circular zone centered at the corneal apex of 1 mm radius (zone I) and the mean thickness of several concentric rings, also centered at the apex until the limbus, each of 1 mm width (zones II to VI respectively). The ONH variables were determined using the HRT. RESULTS The following pairs of variables were correlated in the control group: CCT-disc area (DAr) (-0.48; P<0.0001), Zone I-DAr (-0.503; P<0.0001) and Zone II-DAr (-0.443; P<0.0001); and in the POAG group: CCT-cup-to-disc area ratio (CDRa) (-0.402; P<0.0001), Zone I-CDRa (-0.418; P<0.0001), Zone II-CDRa (-0.405; P=0.006), Zone I-cup shape measure (CSM) (-0.415; P=0.002), Zone II-CSM (-0.405; P=0.001), Zone IV-height variation contour (HVC) (0.378; P=0.002); Zone V-HVC (0.388, P<0.0001). CONCLUSIONS In the healthy subjects, significant negative correlation was detected between central and paracentral corneal thickness and optic disc area. In contrast, the POAG patients showed significant negative correlation between central and paracentral corneal thickness and the cup-disc ratio and CSM, and positive correlation between peripheral corneal thickness and HVC.
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Affiliation(s)
- Federico Saenz-Frances
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
| | - Luis Jañez
- Technology of Knowledge Institute, Complutense University of Madrid, Madrid 28223, Spain
| | - Lara Borrego-Sanz
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
| | - Clara Berrozpe-Villabona
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
| | | | - Laura Morales-Fernandez
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
| | - Julian Garcia-Sanchez
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
| | - Enrique Santos-Bueso
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
| | - Julian Garcia-Feijoo
- Department of Ophthalmology, Clinico San Carlos Hospital, Complutense University of Madrid, Madrid 28040, Spain
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21
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Buckhurst HD, Gilmartin B, Cubbidge RP, Logan NS. Measurement of Scleral Thickness in Humans Using Anterior Segment Optical Coherent Tomography. PLoS One 2015. [PMID: 26218188 PMCID: PMC4517791 DOI: 10.1371/journal.pone.0132902] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Anterior segment optical coherent tomography (AS-OCT, Visante; Zeiss) is used to examine meridional variation in anterior scleral thickness (AST) and its association with refractive error, ethnicity and gender. Scleral cross-sections of 74 individuals (28 males; 46 females; aged between 18-40 years (27.7±5.3)) were sampled twice in random order in 8 meridians: [superior (S), inferior (I), nasal (N), temporal (T), superior-temporal (ST), superior-nasal (SN), inferior-temporal (IT) and inferior-nasal (IN)]. AST was measured in 1mm anterior-to-posterior increments (designated the A-P distance) from the scleral spur (SS) over a 6mm distance. Axial length and refractive error were measured with a Zeiss IOLMaster biometer and an open-view binocular Shin-Nippon autorefractor. Intra- and inter-observer variability of AST was assessed for each of the 8 meridians. Mixed repeated measures ANOVAs tested meridional and A-P distance differences in AST with refractive error, gender and ethnicity. Only right eye data were analysed. AST (mean±SD) across all meridians and A-P distances was 725±46 μm. Meridian SN was the thinnest (662±57 μm) and I the thickest (806±60 μm). Significant differences were found between all meridians (p<0.001), except S:ST, IT:IN, IT:N and IN:N. Significant differences between A-P distances were found except between SS and 6 mm and between 2 and 4 mm. AST measurements at 1mm (682±48 μm) were the thinnest and at 6mm (818±49 μm) the thickest (p<0.001); a significant interaction occurred between meridians and A-P distances (p<0.001). AST was significantly greater (p<0.001) in male subjects but no significant differences were found between refractive error or ethnicity. Significant variations in AST occur with regard to meridian and distance from the SS and may have utility in selecting optimum sites for pharmaceutical or surgical intervention.
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Affiliation(s)
- Hetal D. Buckhurst
- Plymouth University, School of Health Professions, Peninsula Allied Health Centre, Derriford Road, Plymouth, United Kingdom
- * E-mail:
| | - Bernard Gilmartin
- Aston University, School of Life & Health Sciences, Birmingham, United Kingdom
| | - Robert P. Cubbidge
- Aston University, School of Life & Health Sciences, Birmingham, United Kingdom
| | - Nicola S Logan
- Aston University, School of Life & Health Sciences, Birmingham, United Kingdom
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Ebneter A, Häner NU, Zinkernagel MS. Metrics of the normal anterior sclera: imaging with optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2015; 253:1575-80. [PMID: 26067393 PMCID: PMC4548011 DOI: 10.1007/s00417-015-3072-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 05/17/2015] [Accepted: 05/25/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To investigate anterior scleral thickness in a cohort of healthy subjects using enhanced depth imaging anterior segment optical coherence tomography. METHODS Observational case series. The mean scleral thickness in the inferonasal, inferotemporal, superotemporal, and superonasal quadrant was measured 2 mm from the scleral spur on optical coherence tomography in healthy volunteers. RESULTS Fifty-three eyes of 53 Caucasian patients (25 male and 28 female) with an average age of 48.6 years (range: 18 to 92 years) were analysed. The mean scleral thickness was 571 μm (SD 84 μm) in the inferonasal quadrant, 511 μm (SD 80 μm) in the inferotemporal quadrant, 475 (SD 81 μm) in the superotemporal, and 463 (SD 64 μm) in the superonasal quadrant. The mean scleral thickness was significantly different between quadrants (p < 0.0001, repeated measures one-way ANOVA). The association between average scleral thickness and age was statistically significant (p < 0.0001, Pearson r = 0.704). CONCLUSIONS Enhanced depth imaging optical coherence tomography revealed the detailed anatomy of the anterior sclera and enabled non-invasive measurements of scleral thickness in a non-contact approach. The anterior scleral thickness varies significantly between quadrants, resembling the spiral of Tillaux. An association of increasing scleral thickness with age was found.
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Affiliation(s)
- Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland,
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Siegfried CJ, Shui YB, Bai F, Beebe DC. Central corneal thickness correlates with oxygen levels in the human anterior chamber angle. Am J Ophthalmol 2015; 159:457-62.e1. [PMID: 25461296 DOI: 10.1016/j.ajo.2014.11.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE To measure oxygen (pO2) in eyes of patients undergoing intraocular surgery and identify correlations with central corneal thickness (CCT). DESIGN Prospective, cross-sectional study. METHODS setting: Institutional. patient population: 124 patients undergoing cataract and/or glaucoma surgery. observation procedure: Prior to surgery, an oxygen sensor was introduced into the anterior chamber (AC) via peripheral corneal paracentesis. The tip of the flexible fiberoptic probe was positioned for 3 measurements in all patients: (1) near central corneal endothelium; (2) in mid-AC; and (3) in AC angle. In patients undergoing cataract extraction, additional measurements were taken (4) at the anterior lens surface and (5) in the posterior chamber. main outcome measures: pO2 measurements at 5 locations within the eye were compared to central corneal thickness measurements by multivariate regression analyses. RESULTS There was a statistically significant inverse correlation between CCT and pO2 in the anterior chamber angle (P = .048). pO2 was not significantly related to CCT at any other location, including beneath the central cornea. Regression analysis relating CCT to age, race, and oxygen levels in all 5 locations in the anterior segment revealed an association of a thinner cornea with increasing age (P = .007). CONCLUSIONS Physiologic correlations with central corneal thickness may provide clues to understanding why a thinner cornea increases the risk of open glaucoma. Associations between glaucoma risk, CCT, and pO2 in the AC angle suggest that exposure of the outflow system to increased oxygen or oxygen metabolites may increase oxidative damage to the trabecular meshwork cells, resulting in elevation of intraocular pressure.
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Affiliation(s)
- Carla J Siegfried
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
| | - Ying-Bo Shui
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
| | - Fang Bai
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
| | - David C Beebe
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri; Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, Missouri
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Lopilly Park HY, Lee NY, Choi JA, Park CK. Measurement of scleral thickness using swept-source optical coherence tomography in patients with open-angle glaucoma and myopia. Am J Ophthalmol 2014; 157:876-84. [PMID: 24412142 DOI: 10.1016/j.ajo.2014.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/02/2014] [Accepted: 01/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To use swept-source optical coherence tomography (OCT) to image the posterior sclera at the posterior pole and around the optic nerve head (ONH) and measure the subfoveal scleral thickness and laminar thickness to evaluate the relationship between the measured thicknesses and ocular parameters. DESIGN Prospective, cross-sectional design. METHODS The study included 103 patients with glaucoma and 43 controls with axial lengths more than 26 mm. Swept-source OCT images were obtained to capture the subfoveal and ONH regions. Subfoveal scleral thickness and laminar thickness were measured from obtained B-scan images. To verify the reproducibility of the measurement, intraclass correlation coefficients were calculated from selected B-scans. Scleral and laminar thicknesses in patients with normal-tension glaucoma (NTG) was compared with that in patients with primary open-angle glaucoma (POAG). A Pearson correlation was calculated to assess the relationships of scleral and laminar thicknesses with ocular parameters. RESULTS Posterior scleral thickness could be measured in 68.4% of patients, and laminar thickness could be measured in 88.6% by using swept-source OCT. Interobserver and intraobserver measurement reproducibility was moderate to excellent. The subfoveal scleral thickness was 670.84 ± 160.60 μm in the POAG group and 496.55 ± 115.20 μm in the NTG group; a significant difference between the groups was observed. Subfoveal scleral thickness (r = -0.677, P < 0.001) was negatively correlated with axial length only in patients with NTG, not in patients with POAG. CONCLUSIONS Swept-source OCT detected differences in the thicknesses of the posterior sclera between eyes with NTG and eyes with POAG. Subfoveal scleral thickness was negatively correlated with axial length only in eyes with NTG.
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Vergados A, Papaconstantinou D, Diagourtas A, Theodossiadis PG, Vergados I, Georgalas I. Correlation Between Optic Nerve Head Parameters, RNFL, and CCT in Patients with Bilateral Pseudoexfoliation Using HRT-III. Semin Ophthalmol 2013; 30:44-52. [DOI: 10.3109/08820538.2013.821509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Purpose To obtain information about scleral thickness in different ocular regions and its associations. Methods The histomorphometric study included 238 human globes which had been enucleated because of choroidal melanomas or due to secondary angle-closure glaucoma. Using light microscopy, anterior-posterior pupil-optic nerve sections were measured. Results In the non-axially elongated group (axial length ≤26 mm), scleral thickness decreased from the limbus (0.50±0.11 mm) to the ora serrata (0.43±0.14 mm) and the equator (0.42±0.15 mm), and then increased to the midpoint between posterior pole and equator (0.65±0.15 mm) and to the posterior pole (0.94±0.18 mm), from where it decreased to the peri-optic nerve region (0.86±0.21 mm) and finally the peripapillary scleral flange (0.39±0.09 mm). Scleral thickness was significantly lower in the axially elongated group (axial length >26 mm) than in the non-axially elongated group for measurements taken at and posterior to the equator. Scleral thickness measurements of the posterior pole and of the peripapillary scleral flange were correlated with lamina cribrosa thickness measurements. Scleral thickness measurements at any location of examination were not significantly (all P>0.10) correlated with corneal thickness measurements. Scleral thickness was statistically independent of age, gender and presence of glaucoma. Conclusions In non-axially elongated eyes, the sclera was thickest at the posterior pole, followed by the peri-optic nerve region, the midpoint between posterior pole and equator, the limbus, the ora serrata, the equator and finally the peripapillary scleral flange. In axially elongated eyes, scleral thinning occurred at and posterior to the equator, being more marked closer to the posterior pole and the longer the axial length was. Within the anterior and posterior segment respectively, scleral thickness measurements were correlated with each other. Posterior scleral thickness was correlated with lamina cribrosa thickness. Scleral thickness measurements at any location of examination were not significantly correlated with corneal thickness or with age, gender and presence of absolute secondary angler-closure glaucoma.
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Affiliation(s)
- Sujiv Vurgese
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
- * E-mail:
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Nishitsuka K, Kawasaki R, Kanno M, Tanabe Y, Saito K, Honma K, Oizumi T, Daimon M, Kato T, Kayama T, Yamashita H. Determinants and risk factors for central corneal thickness in Japanese persons: the Funagata Study. Ophthalmic Epidemiol 2011; 18:244-9. [PMID: 21961514 DOI: 10.3109/09286586.2011.594206] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association between glucose metabolism and central corneal thickness (CCT) in Japanese adults. METHODS A sub-sample of 322 Japanese adults participating in the Funagata Study was included in this analysis. CCT was measured using a specular microscope. Glucose metabolism was examined using 75-g oral glucose tolerance test. Mean differences in CCT (μm) and 95% confidence intervals were estimated with univariate, age-sex-adjusted and multivariate models using multiple linear regression. RESULTS The mean (± standard deviation) age of the study sample was 63.7 ± 11.4 years and 44% were men. The mean fasting plasma glucose (FPG), 2-hour post-load plasma glucose (2hPG) and haemoglobin A1c (HbA1c) concentrations were 96.8 ± 12.6mg/dl, 123.6 ± 41.2mg/dl and 5.3 ± 0.4%, respectively. CCT was normally distributed in the study sample, and the mean CCT was 544.7 ± 34.6μm. After multivariate adjustment, characteristics associated with increased CCT were 2hPG and HbA1c concentrations, impaired glucose tolerance, diabetes, body weight or body mass index and current smoking. CONCLUSION Impaired glucose tolerance, diabetes, obesity and current smoking are associated with increased CCT. Additional studies are required to examine whether interventions to affect these characteristics may reduce CCT.
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Affiliation(s)
- Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan.
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Abegão Pinto L, Vandewalle E, Pronk A, Stalmans I. Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma. Graefes Arch Clin Exp Ophthalmol 2011; 250:1075-80. [DOI: 10.1007/s00417-011-1878-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 11/08/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022] Open
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Non-invasive anterior segment and posterior segment optical coherence tomography and phenotypic characterization of aniridia. Can J Ophthalmol 2011; 46:337-44. [DOI: 10.1016/j.jcjo.2011.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/11/2011] [Accepted: 04/11/2011] [Indexed: 11/22/2022]
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Waisbourd M, Shemesh G, Top LB, Lazar M, Loewenstein A. Comparison of the Transpalpebral Tonometer TGDc-01 with Goldmann Applanation Tonometry. Eur J Ophthalmol 2010; 20:902-6. [DOI: 10.1177/112067211002000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Waisbourd
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
| | - Gabi Shemesh
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
| | - Lea Baras Top
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
| | - Moshe Lazar
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
| | - Anat Loewenstein
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
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Ha SG, Kim YY. Relationship Between Central Corneal Thickness and Scleral Thickness in Korean Glaucomatous Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.11.1485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Suk Gyu Ha
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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