PURPOSE: To determine the frequency of ocular diseases in infants visiting the ophthalmology department of a tertiary care hospital. METHODS: This was a cross-sectional descriptive study conducted in the department of ophthalmology, Abbasi Shaheed Hospital, from January 2015 to May 2016. The study included 377 infants ranging in age from 1 day to less than 1 year who were, selected by a nonprobability consecutive sampling technique. A detailed history was taken, and a complete ocular examination was performed. Descriptive statistics were used to calculate the mean and standard deviation for age. Frequencies were calculated for ocular diseases along with the percentages. Outcome variables included various congenital and acquired diseases such as conjunctivitis, congenital cataract, glaucoma, nasolacrimal duct blockage, squint, trauma, and fundus abnormalities. RESULTS: The mean age of infants was 5.0 ± 3.7 months. There were 196 (52%) males and 181 (48%) females. The sample included 330 (87.5%) full term infants. Acquired ocular diseases occurred in 230 (61%) infants; and congenital diseases, in 147 (39%). The most common ocular disease was conjunctivitis, which occurred in 173 (46%) infants, followed by congenital blocked nasolacrimal duct, which occurred in 57 (15 %) infants. Conjunctivitis was more common among neonates than infants. CONCLUSIONS: Acquired ocular diseases were more common than congenital ocular diseases. The most common ocular pathology was conjunctivitis, followed by congenital nasolacrimal duct obstruction, in infants. Conjunctivitis was more common in neonates than infants.
Cataract ; Conjunctivitis ; Female ; Glaucoma ; Humans ; Infant ; Infant, Newborn ; Male ; Nasolacrimal Duct ; Ophthalmology ; Pathology ; Strabismus ; Tertiary Healthcare

PURPOSE: To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. MATERIALS AND METHODS: The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. RESULTS: For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. CONCLUSION: The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma.
Area Under Curve ; Color ; Early Diagnosis ; Female ; Glaucoma/diagnosis ; Humans ; Male ; Mass Screening/methods ; Middle Aged ; Nerve Fibers/pathology ; ROC Curve ; Reproducibility of Results ; Retina/pathology ; Retinal Ganglion Cells ; Sensitivity and Specificity

PURPOSE: To investigate the use of ganglion cell inner plexiform layer (GC-IPL) thickness, as measured by spectral domain optical coherence tomography, to detect central visual field (VF) progression. METHODS: This study included 384 eyes from 384 patients (219 preperimetric and 165 perimetric glaucomatous eyes; average follow-up, 4.3 years). Photographic assessment of retinal nerve fiber layer (RNFL) and serial VF analysis were performed to detect glaucoma progression in the central (within 10°) area. Study inclusion required at least five serial spectral domain optical coherence tomography exams at different visits. The long-term test-retest variability of average GC-IPL thicknesses was calculated in 110 stable preperimetric glaucomatous eyes. The sensitivity and specificity of GC-IPL measurements for the detection of central VF progression were calculated in an event-based analysis using the calculated variability as a cut-off and were compared with those of central RNFL photographic assessment. RESULTS: The intersession test-retest variability, defined as the 95% confidence interval, was 1.76 µm for average GC-IPL thickness. The sensitivity and specificity of the average GC-IPL thickness for detecting central VF progression were 60.7% and 78.9%, respectively. Among six sectors, the inferonasal GC-IPL sector showed the highest sensitivity (53.6%). The sensitivity of the ≥1 sector GC-IPL to detect central VF progression was significantly higher than that of central RNFL photographic progression (p = 0.013). Other GC-IPL parameters showed comparable sensitivity and specificity to detect central VF progression compared with RNFL photographic progression. CONCLUSIONS: Serial GC-IPL measurements show comparable performance in the detection of central glaucomatous VF progression to RNFL photographic assessment.
Disease Progression ; Female ; Follow-Up Studies ; Glaucoma/*diagnosis/physiopathology ; Humans ; *Intraocular Pressure ; Macula Lutea/*diagnostic imaging ; Male ; Middle Aged ; ROC Curve ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence/*methods ; *Visual Fields

PURPOSE: To investigate and compare the progression of medically treated primary open angle glaucoma according to the baseline intraocular pressure (IOP). METHODS: This study included a total of 345 eyes from 345 patients (mean follow-up period, 4.5 years). Eyes were classified into either conventional normal tension glaucoma (cNTG, < or =21 mmHg) or conventional high-tension glaucoma (cHTG, >21 mmHg) groups according to the conventional cut-off value of the IOP. Additionally, the median IOP (15 mmHg) was used to create two other groups (median NTG [mNTG] < or =15 mmHg and median HTG [mHTG] >15 mmHg). Using these values, 306, 39, 153, and 192 eyes were assigned to the cNTG, cHTG, mNTG, and mHTG groups, respectively. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer photographs or serial visual field data. RESULTS: Mean reduction of IOP after medical treatment and of central corneal thickness was lower in the cNTG group, while the prevalence of disc hemorrhage and baseline visual field mean deviation did not differ between the cNTG and cHTG groups. A mean reduction in the IOP was observed after medical treatment, and central corneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in the mHTG group. Among the 345 analyzed eyes, 100 (29%) showed progression during the follow-up period. In the cHTG group, a higher baseline IOP (hazard ratio, 1.147; p = 0.024) was associated with glaucoma progression. Disc hemorrhage (hazard ratio, 15.533; p < 0.001) was also strongly associated with progression in the mNTG group. CONCLUSIONS: Baseline IOP was a significant risk factor for glaucoma progression in cHTG patients (10% of our total participants), while disc hemorrhage showed the strongest association with progression in the mNTG group, indicating that a cut-off value other than the conventional 21 mmHg is required to define true low-tension glaucoma in populations where NTG predominates among all glaucoma patients.
Aged ; Disease Progression ; Female ; Glaucoma, Open-Angle/*diagnosis ; Gonioscopy ; Humans ; Intraocular Pressure ; Low Tension Glaucoma/*diagnosis ; Male ; Middle Aged ; Nerve Fibers/pathology ; Optic Disk/pathology ; Optic Nerve Diseases/*diagnosis ; Photography/standards ; Retinal Ganglion Cells/pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Tonometry, Ocular ; Vision Disorders/diagnosis ; Visual Field Tests/standards ; Visual Fields

This study was done to report the epidemiologic characteristics of medical retirement from the Republic of Korea (ROK) Army due to visual impairment and to suggest a practical screening system for the draft. The medical records of 423 eyes of 301 patients who retired from the ROK Army due to visual impairment were reviewed retrospectively between January 2010 and December 2014. The patients were grouped by the presence of trauma, and each group was subdivided by military rank. We analyzed demographic and ophthalmic data, including the etiology of ophthalmologic disease. The etiology was classified into 5 anatomical categories (ocular surface, lens, retina, optic nerve and extraocular visual pathway, and extraocular muscle and orbit), which were then subdivided into the type of disease. The mean age was 24.5 years, and non-traumatic mechanisms accounted for 81.1% (343/423 eyes) of medical retirements. Visual acuity was better in patients without trauma. In enlisted soldiers, disease in the optic nerve and extraocular visual pathway was the most common anatomical category (40.5%), and primary open angle glaucoma (30.8%), retinal dystrophy (18.3%), congenital cataract (14.5%), and retinal detachment (9.7%) were the four most common diseases. Most medical retirements due to visual impairment resulted from non-traumatic mechanisms, even though patients were young. The fundus examination and visual field test would be more useful tools than a conventional vision test for large-scale draft screening for the most common two disease types: primary open angle glaucoma and retinal dystrophy.
Adult ; Cataract/epidemiology ; Cohort Studies ; Glaucoma, Open-Angle/epidemiology ; Humans ; Male ; Middle Aged ; Military Personnel ; Republic of Korea/epidemiology ; Retinal Dystrophies/epidemiology ; *Retirement ; Retrospective Studies ; Vision Disorders/epidemiology/*pathology ; Visual Acuity ; Young Adult

PURPOSE: To compare changes in corneal endothelial cell density (CECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy. METHODS: Changes in corneal endothelium in patients that underwent AGV implantation or trabeculectomy were prospectively evaluated. Corneal specular microscopy was performed at the central cornea using a non-contact specular microscope before surgery and 6 months and 12 months after surgery. The CECD, hexagonality of the endothelial cells, and the coefficient of variation of the cell areas were compared between the two groups. RESULTS: Forty eyes of 40 patients with AGV implantation and 28 eyes of 28 patients with trabeculectomy were studied. Intraocular pressure in the AGV implantation group was significantly higher than that in the trabeculectomy group (p < 0.001), but there was no significant difference in other clinical variables between the two groups. In the AGV implantation group, the mean CECD significantly decreased by 9.4% at 6 months and 12.3% at 12 months compared with baseline values (both, p < 0.001), while it decreased by 1.9% at 6 months and 3.2% at 12 months in the trabeculectomy group (p = 0.027 and p = 0.015, respectively). The changes at 6 months and 12 months in the AGV implantation group were significantly higher than those in the trabeculectomy group (p = 0.030 and p = 0.027, respectively). In the AGV implantation group, there was a significant decrease in the CECD between baseline and 6 months and between 6 months and 12 months (p < 0.001 and p = 0.005, respectively). However, in the trabeculectomy group, a significant decrease was observed only between baseline and 6 months (p = 0.027). CONCLUSIONS: Both the AGV implantation group and the trabeculectomy group showed statistically significant decreases in the CECD 1 year after surgery. The decrease in CECD in the AVG implantation group was greater and persisted longer than that in the trabeculectomy group.
Cell Count ; Endothelium, Corneal/*pathology ; Female ; Follow-Up Studies ; Glaucoma/diagnosis/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; *Intraocular Pressure ; Male ; Middle Aged ; Postoperative Period ; Prospective Studies ; Prosthesis Implantation/*methods ; Time Factors ; Trabeculectomy/*methods ; Treatment Outcome

PURPOSE: Rebound tonometer has been used to measure the intraocular pressure (IOP) in the supine as well as normal upright positions. We investigated the reliability of IOP measurements using the rebound tonometer in the upright and supine positions. METHODS: IOP was measured in 30 patients (60 eyes) with open-angle glaucoma who had no history of ocular surgery and no anterior segment pathology, in both the upright and supine positions using rebound tonometer (IcarePRO; Icare Finland Oy, Finland). The average IOP value after 6 measurements was recorded. We measured IOP repeatedly until 3 reliable values within normal limits of the measurement's variation were obtained. We calculated the intraclass correlation coefficient (ICC), coefficient of variation, and number of repeated measurements necessary to obtain 3 reliable IOP values in each position as measured by one examiner. RESULTS: ICC values for IOP measurements were 0.852 (95% confidence interval [CI], 0.784-0.903; p < 0.001) in the upright position and 0.684 (95% CI, 0.563-0.784; p < 0.027) in the supine position. Coefficient of variation was 8.7 +/- 0.1% in the upright position and 24.0 +/- 0.1% in the supine position. An average of 3.3 times of repeated measurements in the upright position and 6.2 times in the supine position were necessary to obtain 3 reliable IOP values within the normal range of standard deviation. CONCLUSIONS: When measuring IOP using the IcarePRO rebound tonometer, the measurement reliability was different between the upright and supine positions. Reproducibility of IOP measurements was lower in the upright than the supine position.
Finland ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Iron-Dextran Complex ; Pathology ; Reference Values ; Supine Position*

Aged ; Anterior Eye Segment ; pathology ; Female ; Glaucoma ; therapy ; Humans ; Pseudophakia ; therapy ; Tomography, Optical Coherence ; methods

PURPOSE: To investigate the risk factors for initial central scotoma (ICS) compared with initial peripheral scotoma (IPS) in normal-tension glaucoma (NTG). METHODS: Fifty-six NTG patients (56 eyes) with an ICS and 103 NTG patients (103 eyes) with an IPS were included. Retrospectively, the differences were assessed between the two groups for baseline characteristics, ocular factors, systemic factors, and lifestyle factors. Also, the mean deviation of visual field was compared between the two groups. RESULTS: Patients from both ICS and IPS groups were of similar age, gender, family history of glaucoma, and follow-up periods. Frequency of disc hemorrhage was significantly higher among patients with ICS than in patients with IPS. Moreover, systemic risk factors such as hypotension, migraine, Raynaud's phenomenon, and snoring were more prevalent in the ICS group than in the IPS group. There were no statistical differences in lifestyle risk factors such as smoking or body mass index. Pattern standard deviation was significantly greater in the ICS group than in the IPS group, but the mean deviation was similar between the two groups. CONCLUSIONS: NTG Patients with ICS and IPS have different profiles of risk factors and clinical characteristics. This suggests that the pattern of initial visual field loss may be useful to identify patients at higher risk of central field loss.
Female ; Humans ; Incidence ; *Intraocular Pressure ; Low Tension Glaucoma/*complications/diagnosis/physiopathology ; Male ; Middle Aged ; Optic Disk/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment/*methods ; Risk Factors ; Scotoma/diagnosis/*epidemiology/etiology ; Visual Fields/*physiology

PURPOSE: Chronic use of topical hypotensive agents induces several side effects caused by preservatives. The purpose of this study was to evaluate the effects of prostaglandin analogs with varying concentrations of benzalkonium chloride (BAC), preservative-free (PF), and alternative preservatives on mouse corneal tissue. METHODS: Thirty-five, 8- to 10-week-old female C57BL/6 mice (five mice for each group) were used for this study. To the control group, we applied normal saline, and to each drug-treated group we applied 0.02% BAC, bimatoprost 0.01% (with BAC 0.02%), latanoprost 0.005% (with BAC 0.02%), travoprost 0.004% (with 0.001% polyquad) or tafluprost 0.0015% with/without 0.001% BAC, once a day (9 p.m.) for 4 weeks. Corneal fluorescein staining was evaluated in all groups. After harvest, the corneal tissues were embedded in paraffin and then Hematoxylin-Eosin stain was performed for histopathological examination. Immunofluorescence staining was done against TNF-alpha, IL-6, HLA DR, pJNK, and pAkt. RESULTS: In corneal fluorescein staining, severe punctate epithelial keratitis was seen in the groups of 0.02% BAC, 0.02% BAC containing bimatoprost 0.01% and latanoprost 0.005%. The surface desquamation, irregular surface, loss of cell borders, anisocytosis and stromal shrinkage were observed in the groups of BAC-containing eye drops. Moreover, the groups treated with BAC-containing eye drops have high inflammatory markers, significantly decreased cell viability-related signal, pAkt, and higher apoptosis-inducing signal, pJNK, than the control group. On the other hand, travoprost 0.004% and PF tafluprost 0.0015% have less cellular morphologic changes, lower inflammation, and higher cellular viability than BAC-containing formulations. CONCLUSIONS: Corneal damage, increased inflammation and apoptosis and low cell viability were observed in BAC-containing groups. PF or alternatively preserved glaucoma medications seem to be a reasonable and viable alternative to those preserved with BAC.
Animals ; Cell Survival ; Conjunctiva/drug effects/*pathology ; Disease Models, Animal ; Epithelium, Corneal/drug effects/*pathology ; Female ; Glaucoma/*drug therapy/pathology ; Mice ; Mice, Inbred C57BL ; Microscopy, Fluorescence ; Ophthalmic Solutions ; Preservatives, Pharmaceutical ; Prostaglandins, Synthetic/*administration & dosage