Anatomical Attributes of the Optic Nerve Head in Eyes with Parafoveal Scotoma in Normal Tension Glaucoma

<div><p>Purpose</p><p>To evaluate optic nerve characteristics independent of systemic factors predisposing to parafoveal scotoma in normal tension glaucoma.</p><p>Methods</p><p>We included 40 patients with bilateral normal tension glaucoma with parafoveal scotoma (visual field defect in one hemifield within 10° of fixation with at least one point at p<1% lying at the two innermost paracentral points) in only one eye (Parafoveal group, PF, n = 40) identified from the hospital database in this observational cross sectional study. The other eye with no parafoveal scotoma constituted the control group (n = 32). Red free fundus photographs were evaluated using Image J software analyzing parameters including vertical and horizontal disc diameter, disc haemorrhage, location and angular width of the retinal nerve fibre layer depth and displacement of the central vessel trunk, CVT (vertical and horizontal). Clinical characteristics and disc parameters were compared in the two groups.</p><p>Results</p><p>The PF group had lower mean deviation(MD) and visual field index (VFI) and higher pattern standard deviation (PSD) than control group (p≤0.001) for similar untreated IOP, (p = 0.9). Disc haemorrhages were more frequent in the PF group, p = 0.01. The PF group had greater width of nerve fibre layer defects, p = 0.05 and greater vertical displacement of the central vessel trunk, p = 0.001. On multivariate logistic regression, parafoveal scotoma was significantly associated with increased vertical distance of the CVT, p = 0.0001.</p><p>Conclusion</p><p>Increased vertical displacement of the CVT is associated with parafoveal scotoma in normal tension glaucoma. Localising the vessel trunk may help clinicians in identifying patients at risk for parafoveal involvement.</p></div

Multivariate regression of clinical variables predicting the need for medicines after GATT or MIT.

Multivariate regression of clinical variables predicting the need for medicines after GATT or MIT.</p

Parameters obtained from the red free fundus photograph.

<p>Reference line “c” is a line from the center of the optic disc to the center of the macula. The vertical distance of the central vessel trunk “a” and horizontal distance “b” was measured from the reference line and retinal nerve fibre layer width (RNFLW) using Image J software. Inset shows the division of the disc by two lines into 4 quadrants for determining the exit quadrant of the central vessel trunk.</p

Fig 1 -

A shows the trabecular meshwork being stripped with Microforceps in microincisional trabeculectomy. B-Shows 5–0 prolene suture used for threading the Schlemm’s canal and ripping the trabecular meshwork in gonioscopy-assisted transluminal trabeculotomy -See text for full description. C-shows the technique for blanching effect which is evident by loss of blood column within vessels in specific quadrants after injection of saline. D-shows the technique of Trypan blue staining after injecting the dye intracamerally-note the superficial episcleral veins that have stained with the dye (blue arrows).</p

The parafoveal scotoma group showed a predominance of superior field defects (29 of 40 eyes) and inferior retinal nerve fibre layer defects (25 of 40 eyes).

<p>The parafoveal scotoma group showed a predominance of superior field defects (29 of 40 eyes) and inferior retinal nerve fibre layer defects (25 of 40 eyes).</p

Comparison of the clinical profile of patients that underwent GATT or MIT.

Comparison of the clinical profile of patients that underwent GATT or MIT.</p

Extent of blanching and Trypan blue staining observed after GATT or MIT in the study.

See S1 Table for comparisons between GATT and MIT.</p

Clinical demographic profile of patients that underwent GATT and MIT in the study.

See S1 Table for comparisons between GATT and MIT.</p

Comparisons of blanching and blue staining for intraoperative outflow assessment after GATT or MIT.

Comparisons of blanching and blue staining for intraoperative outflow assessment after GATT or MIT.</p

Pattern of Pseudoexfoliation Deposits on the Lens and Their Clinical Correlation- Clinical Study and Review of Literature

<div><p>Purpose</p><p>To study the clinical correlates of pattern of deposits over the lens in patients with pseudoexfoliation syndrome (PXF) or pseudoexfoliation glaucoma.</p><p>Methods</p><p>This retrospective observational study screened 346 patients with PXF seen in glaucoma clinic of a tertiary hospital from 2011–2013. Details like pattern of deposits, location on the lens surface and pupillary abnormalities in slit lamp photographs and their correlation with clinical and demographic variables, were analysed.</p><p>Results</p><p>A total of 84 eyes of 42 patients with bilateral PXF were included for the study. Glaucoma was seen in 30 eyes with baseline IOP of 24+3.8 mm Hg. Comparing the type of deposits, namely classical (n = 39 eyes), radial pigmentary (RP) form (n = 39 eyes) and combined classical and radial pigmentary (CR) forms (n = 6 eyes) of deposits, pupillary ruff atrophy was common in all forms while poor dilatation was rare in the RP type (n = 5 vs n = 25 in classical forms, p<0.001). Mean deviation (MD) was worse in the classical and CR form as compared to RP type with the latter presenting much earlier, 43±3.2 years vs 48±4.1 years in CR and 56±5.7 years in classical form, p<0.001. The baseline IOP in the RP group (18±2.3 mm Hg) was significantly lower than the other two forms (CR 20±3.2 mm Hg, classical 28±2.3 mm Hg), p<0.001, with only 2 eyes on anti-glaucoma drugs at presentation.</p><p>Conclusion</p><p>Pattern of exfoliation deposits may indicate the stage and severity of the disease process in evolution with the RP representing an earlier/less severe form of pseudoexfoliation syndrome.</p></div