Inaccuracy of intraocular pressure measurement in congenital corneal opacity: three case reports

Background To report three cases of congenital corneal opacity where intraocular pressure (IOP) readings were high despite the use of multiple anti-glaucoma eye drops and normalized after corneal transplantation. Case presentation Three Korean infants presented with bilateral dense stromal opacification which had been present since birth. IOPs measured by rebound tonometer were high despite administration of multiple anti-glaucoma medications. One eye of each patient underwent penetrating keratoplasty (PK) because corneal opacity impaired visual development. Immediately after PK, IOPs were normalized and maintained normal without medication, whereas they remained high in the contralateral unoperated eye. On histology, stromal fibrosis was observed in the removed corneal button, and molecular assays revealed increased levels of type 1 and 5 collagens. Conclusion The IOP measurement using the conventional applanation-based tonometry can be inaccurate in congenital corneal opacity which is marked by corneal fibrosis. Therefore, IOP values should be interpreted with caution in these patients, and the possibility of false-positive diagnosis of glaucoma considered.This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (NRF-2018R1A2B2004108). The funder supported funding for molecular assay for corneal collagens in this study

Clinical features and outcome of corneal opacity associated with congenital glaucoma

Background To investigate the clinical features of corneal opacity and the surgical outcome of penetrating keratoplasty (PK) in eyes with congenital glaucoma. Methods A retrospective review was made of the records from 320 eyes of 193 patients who were diagnosed with congenital glaucoma between January 1981 and January 2016. Anterior segment photographs at disease presentation were examined for the presence and severity of corneal opacity. Data on patient demographics, intraocular pressure (IOP), ocular and systemic comorbidities, ocular surgery and its outcome were collected. Results Overall, corneal opacification was observed in 248 of 320 eyes (77.5%). Out of 248 eyes with corneal opacification, 53 eyes had Haab striae alone, and 195 eyes presented with either nebulomacular corneal opacity (128 eyes, iris details visible through opacity) or leukomatous corneal opacity (67 eyes, iris details invisible through opacity). In 12 eyes with severe leukomatous corneal opacity, PK was performed at the mean age of 18.6 months (range 4–57 months). The grafts failed in 6 eyes (50%) due to endothelial rejection (4 eyes) or graft infection (2 eyes) during the mean 80.6 months of follow-up (range 15–228 months). The median survival time was 36 months. The graft failure was significantly associated with smaller corneal diameter at the time of surgery, but not with the age, IOP, combined aniridia, simultaneous glaucoma or lens surgery. Conclusion Congenital glaucoma was combined with corneal opacity in 77.5%. The corneal transplant survival was 50% in eyes with congenital glaucoma and total corneal opacity

Investigation of the Association between Normal-tension Glaucoma and Single Nucleotide Polymorphisms in Natriuretic Peptide Gene

summary:Let $(M,\omega )$ be a symplectic manifold admitting a metaplectic structure (a symplectic analogue of the Riemannian spin structure) and a torsion-free symplectic connection $\nabla$. Symplectic Killing spinor fields for this structure are sections of the symplectic spinor bundle satisfying a certain first order partial differential equation and they are the main object of this paper. We derive a necessary condition which has to be satisfied by a symplectic Killing spinor field. Using this condition one may easily compute the symplectic Killing spinor fields for the standard symplectic vector spaces and the round sphere $S^2$ equipped with the volume form of the round metric

Glaucoma Diagnostic Ability of Layer-by-Layer Segmented Ganglion Cell Complex by Spectral-Domain Optical Coherence Tomography

Citation: Kim HJ, Lee S-Y, Park KH, Kim DM, Jeoung JW. Glaucoma diagnostic ability of layer-by-layer segmented ganglion cell complex by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2016;57:4799-4805. DOI: 10.1167/iovs.16-19214 PURPOSE. To evaluate the diagnostic ability of layer-by-layer segmented macular ganglion cell complex (GCC) using spectral-domain optical coherence tomography (OCT) for detection of glaucoma and to analyze the topographic patterns of the segmented thicknesses in open-angle glaucoma. METHODS. Seventy-seven open-angle glaucoma patients and 59 healthy subjects were enrolled in this cross-sectional study. Spectral-domain OCT with automated segmentation was used to measure the separate thicknesses of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). We compared the specific diagnostic abilities of the GCC (RNFLþGCLþIPL), ganglion cell-inner plexiform layer (GCIPL: GCLþIPL), and circumpapillary RNFL (cpRNFL) to discriminate between normal eyes and glaucoma. RESULTS. The mRNFL, GCL, IPL, and cpRNFL thicknesses in glaucoma patients were all significantly thinner compared with healthy subjects and showed different topographic patterns. The GCC, mRNFL, and GCL thicknesses were best able to discriminate between the glaucoma and normal groups. The areas under the curve of receiver operating characteristics (AUROCs) of the mRNFL and GCL did not show significant difference from that of the cpRNFL. The AUROC of the GCL did not show significant difference from that of GCIPL after Bonferroni correction. The global IPL thickness had the smallest AUROC and showed lower diagnostic performance than the GCL, GCIPL, and GCC. CONCLUSIONS. The diagnostic ability of segmented mRNFL and GCL to discriminate between normal and glaucoma eyes is high and comparable to that of cpRNFL thickness. The measurement and monitoring of GCL could be a practical and effective approach to glaucoma diagnostics

Comparison of Cirrus OCT and Stratus OCT on the Ability to Detect Localized Retinal Nerve Fiber Layer Defects in Preperimetric Glaucoma

PURPOSE. To evaluate and compare the diagnostic ability of Cirrus and Stratus optical coherence tomography (OCT) to detect localized retinal nerve fiber layer (RNFL) defects in patients with normal standard automated perimetry. METHODS. This study included 55 eyes of 55 subjects with preperimetric localized RNFL defects and 55 normal control eyes of 55 age-and sex-matched subjects. Areas under the receiver operating characteristic curves (AUROCs) were calculated and compared. Based on the internal normative database from each device, the sensitivity and specificity for detecting preperimetric localized RNFL defects were calculated. RESULTS. There was no statistically significant difference between the AUROCs for the best parameters from the Cirrus OCT (inferior thickness, AUROC = 0.728) and Stratus OCT (7 o`clock sector, AUROC = 0.760; P = 0.477). The sensitivity of the Cirrus OCT parameters ranged from 21.0% to 87.1% and that of the Stratus OCT parameters ranged from 4.8% to 30.7%, with the criterion of abnormal at the 5% level. Based on the normative database, the highest Cirrus OCT sensitivity was obtained with the deviation-from-normal map (sensitivity 87.1% and specificity 61.8%), and the highest Stratus OCT sensitivity was obtained with the TSNIT thickness graph (sensitivity 30.7% and specificity 85.5%). CONCLUSIONS. There were no significant differences between the AUROCs for Cirrus and Stratus OCT, indicating that the two devices have similar diagnostic potentials in preperimetric glaucoma. After comparison with their normative databases, Cirrus OCT had generally higher sensitivities; however, this was largely at the cost of lower specificities than Stratus OCT. (Invest Ophthalmol Vis Sci. 2010; 51: 938-945) DOI:10.1167/iovs.08-3335Jeoung JW, 2008, OPHTHALMOLOGY, V115, P2132, DOI 10.1016/j.ophtha.2008.08.024Jeoung JW, 2008, INVEST OPHTH VIS SCI, V49, P1753, DOI 10.1167/iovs.07-1408Hougaard JL, 2007, J GLAUCOMA, V16, P302Kim TW, 2007, INVEST OPHTH VIS SCI, V48, P1635, DOI 10.1167/iovs.06-0800Medeiros FA, 2007, BRIT J OPHTHALMOL, V91, P273, DOI 10.1136/bjo.2006.107409van Velthoven MEJ, 2007, PROG RETIN EYE RES, V26, P57, DOI 10.1016/j.preteyeres.2006.10.002Hwang JM, 2006, J GLAUCOMA, V15, P223Chen TC, 2005, ARCH OPHTHALMOL-CHIC, V123, P1715Jeoung JW, 2005, OPHTHALMOLOGY, V112, P2157, DOI 10.1016/j.ophtha.2005.07.012Schmidt-Erfurth U, 2005, INVEST OPHTH VIS SCI, V46, P3393, DOI 10.1167/iovs.05-0370Budenz DL, 2005, OPHTHALMOLOGY, V112, P3, DOI 10.1016/j.ophtha.2004.06.039Medeiros FA, 2004, ARCH OPHTHALMOL-CHIC, V122, P827Jaffe GJ, 2004, AM J OPHTHALMOL, V137, P156, DOI 10.1016/S0002-9394(03)00792-XKanamori A, 2003, AM J OPHTHALMOL, V135, P513Guedes V, 2003, OPHTHALMOLOGY, V110, P177Williams ZY, 2002, AM J OPHTHALMOL, V134, P538Greaney MJ, 2002, INVEST OPHTH VIS SCI, V43, P140GREENFIELD DS, 2002, CURR OPIN OPHTHALMOL, V13, P68Bowd C, 2001, INVEST OPHTH VIS SCI, V42, P1993Zangwill LM, 2001, ARCH OPHTHALMOL-CHIC, V119, P985Blumenthal EZ, 2000, OPHTHALMOLOGY, V107, P2278Schuman JS, 1996, OPHTHALMOLOGY, V103, P1889JAESCHKE R, 1994, JAMA-J AM MED ASSOC, V271, P703TUULONEN A, 1993, OPHTHALMOLOGY, V100, P587TUULONEN A, 1991, AM J OPHTHALMOL, V111, P485SIMEL DL, 1991, J CLIN EPIDEMIOL, V44, P763SOMMER A, 1991, ARCH OPHTHALMOL-CHIC, V109, P77DELONG ER, 1988, BIOMETRICS, V44, P837RADACK KL, 1986, ARCH PATHOL LAB MED, V110, P689SOMMER A, 1977, ARCH OPHTHALMOL-CHIC, V95, P2149HOYT WF, 1973, INVEST OPHTH VISUAL, V12, P8141