Role of Optical Coherence Tomography in the Evaluation and Management of Glaucoma

Glaucoma is the leading cause of irreversible, yet preventable, blindness throughout the world. Since it is a disease which can be treated but not cured, it is crucial for the treating ophthalmologist to catch the disease as early as possible. The diagnosis of glaucoma is currently based on the appearance of the optic disc and standard achromatic perimetry. However, to detect glaucoma in its early stages, there are various diagnostic modalities of which optical coherence tomography serves as a novel tool. Optical coherence tomography has emerged over the years with the ability to detect changes in the optic nerve head, retinal nerve fiber layer, and currently the ganglion cell layer much earlier than the defects manifest functionally. Thus, optical coherence tomography acts as an important diagnostic aid to diagnose and monitor the progression of this sight threatening disease called glaucoma

Management of Secondary Glaucoma, a Rising Challenge

Secondary glaucoma has increased exponentially in recent times. This is partially due to the increase in complex eye surgeries like corneal transplantation and vitreoretinal surgery and partly due to the increase in life style related diseases like diabetes causing an increase in the prevalence of neovascular glaucoma. The other leading causes of secondary glaucoma are post-trauma, post-cataract surgery, and lens-induced glaucoma. Secondary glaucoma is an important cause of visual morbidity. The management of this complex glaucoma is difficult as they are mostly intractable and do not respond to anti-glaucoma medications. Many patients who are not managed by medical management may require surgical intervention along with vigilant control of their primary pathology. This course would address the stepwise approach to the management of these glaucomas and the tips and tricks to tackle the nuances during management. This chapter would specifically address the management of neovascular glaucoma, Post-PK glaucoma, lens-induced glaucoma, traumatic glaucoma, and uveitic glaucoma

Discriminating ability of Cirrus and RTVue optical coherence tomography in different stages of glaucoma

Purpose: The aim of this study is to determine which parameter of Cirrus and RTVue optical coherence tomography (OCT) has the highest ability to discriminate between early, moderate, and advanced glaucoma. Simultaneously, to compare the performance of the two OCT devices in terms of their ability to differentiate the three stages of glaucoma. Further, to analyze the macular parameters of both devices and compare them with the conventional retinal nerve fiber layer (RNFL) parameters. Methods: One hundred and twenty eyes (30 healthy and 90 glaucomatous [30 mild, 30 moderate, and 30 advanced glaucoma]) of 65 participants (15 healthy, 50 glaucomatous [15 mild, 15 moderate, and 20 advanced glaucoma]) underwent Cirrus and RTVue OCT scanning on a single visit. Results: Average RNFL thickness and superior RNFL thickness of both the devices and inferior (ganglion cell complex [GCC] of RTVue device best differentiated normals from all stage glaucomatous eyes (P > 0.05). Cirrus average RNFL thickness and superior RNFL thickness performed better than other parameters (P < 0.05) in differentiating early glaucoma from moderate and advanced. In differentiating advanced from early and moderate glaucoma, RTVue average, superior, and inferior RNFL thickness and inferior GCC parameters had the highest discriminating ability (P < 0.05). Conclusion: Overall, average RNFL thickness had the highest ability to distinguish different stages of the disease. No significant difference was found between RTVue and Cirrus OCT device in different severity levels. No significant difference was observed between RNFL and macular parameters in different stages of glaucoma

Intraocular amyloidosis with multifocal iris and anterior chamber translucent spherules.

Ocular amylodosis, although a rare entity, is known to affect the conjunctiva, extraocular muscles, orbit, lacrimal gland, and skin around the eyes. Intraocular deposition of amyloid mainly confines to the vitreous and cornea. In this report, we describe two cases of intraocular amyloidosis presenting as multiple iris and anterior chamber cysts. Histopathological examination with special stain like Congo Red and Transmission Electron Microscopy confirmed the diagnosis of amyloidosis. Systemic investigations ruled out systemic association confirming the diagnosis of primary ocular amyloidosis