PURPOSE: To investigate the relationship between vitamin D and glaucoma. METHODS: This retrospective, cross-sectional study included subjects who underwent a health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were reviewed by ophthalmologists. The ophthalmologists determined if an eye was glaucomatous based on the criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and by the appearance of the retinal nerve fiber layer and optic disc. If the subjects previously underwent an ophthalmologic examination, they were enrolled based on the documented history. In addition to fundus photographs, each participant underwent a systemic examination including blood sampling and sociodemographic and behavioral questionnaires. The subjects were divided into five groups according to serum 25-hydroxyvitamin D (25(OH)D) level. Multivariate logistic regression models were constructed to assess possible associations between elevated glaucoma risk and systemic factors with a p < 0.2 on univariate analysis. RESULTS: Of the 169,208 subjects older than 20 years, 123,331 were eligible for the study. There was no difference in the prevalence of glaucoma according to quintile of serum 25(OH)D level based on sex (p = 0.412 for males, p = 0.169 for females). According to the multivariable-adjusted logistic analysis, the odds ratio of glaucoma for the fourth quintile was significantly lower than that of the first quintile in females (odds ratio, 0.713; 95% confidence interval, 0.520 to 0.979). CONCLUSIONS: Lower 25(OH)D level was significantly associated with an elevated risk of glaucoma in females compared with higher 25(OH)D level. Further evaluation is needed to investigate the relationship between glaucoma and vitamin D.
Adult ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Glaucoma/diagnosis/*epidemiology/etiology ; Humans ; Incidence ; Intraocular Pressure ; Male ; Optic Disk/diagnostic imaging ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Vitamin D/*blood ; Vitamin D Deficiency/blood/complications/*epidemiology ; Young Adult

PURPOSE: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.
Acute Disease ; Adolescent ; Adult ; Animals ; Antivenins/therapeutic use ; *Elapidae ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/diagnosis/*etiology/therapy ; Humans ; Male ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/therapy ; Prospective Studies ; Snake Bites/*complications/diagnosis/therapy ; Snake Venoms/*poisoning ; Tertiary Healthcare ; Time Factors ; Uveitis, Anterior/diagnosis/*etiology/therapy ; *Viperidae ; Young Adult

No abstract available.
Animals ; Anti-Bacterial Agents ; Antihypertensive Agents ; Corneal Edema/diagnosis/etiology/therapy ; Corneal Injuries/diagnosis/*etiology/therapy ; Corneal Ulcer/diagnosis/etiology/therapy ; Drug Combinations ; Eye Enucleation ; Eye Pain/etiology ; Glaucoma/diagnosis/etiology/therapy ; Glucocorticoids ; Humans ; Insect Bites and Stings/diagnosis/*etiology/therapy ; Intraocular Pressure ; Male ; Middle Aged ; Mydriatics ; Ophthalmia, Sympathetic/diagnosis/*etiology/therapy ; Visual Acuity ; *Wasps

PURPOSE: To report the long-term follow-up results after cyclocryotherapy, applied to the 3-o'clock and 9-o'clock positions in blind refractory glaucoma patients. METHODS: We retrospectively reviewed the charts of 19 blind patients, and a total of 20 eyes with refractory glaucoma who were treated with cyclocryotherapy. Cyclocryotherapy treatments were performed using a retinal cryoprobe. The temperature of each cyclocryotherapy spot was -80degrees C and each spot was maintained in place for 60 seconds. Six cyclocryotherapy spots were placed in each quadrant, including the 3-o'clock and 9-o'clock positions. RESULTS: The mean baseline pretreatment intraocular pressure (IOP) in all eyes was 50.9 ± 12.5 mmHg, which significantly decreased to a mean IOP at last follow-up of 14.1 ± 7.1 mmHg (p < 0.001). The mean number of antiglaucoma medications that patients were still taking at last follow-up was 0.3 ± 0.6. Devastating post-procedure phthisis occurred in only one eye. CONCLUSIONS: Cyclocryotherapy, performed at each quadrant and at the 3-o'clock and 9-o'clock position, is an effective way to lower IOP and, thus, is a reasonable treatment option for refractory glaucoma patients who experience with ocular pain and headaches.
Adult ; Aged ; Aged, 80 and over ; Blindness/etiology/*surgery ; Cryosurgery/*methods ; Female ; Follow-Up Studies ; Glaucoma/complications/physiopathology/*surgery ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Treatment Outcome ; *Visual Acuity

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: Multifocal visual evoked potential (mfVEP) is a newly introduced method used for objective visual field assessment. Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard automated perimetry (SAP) visual field assessment, and others were not very informative and needed more adjustment and research work. In this study we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. METHODS: Three groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey field analyzer (HFA) test 24-2 and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the hemifield sector analysis (HSA) protocol. Analysis of the HFA was done using the standard grading system. RESULTS: Analysis of mfVEP results showed that there was a statistically significant difference between the three groups in the mean signal to noise ratio (ANOVA test, p < 0.001 with a 95% confidence interval). The difference between superior and inferior hemispheres in all subjects were statistically significant in the glaucoma patient group in all 11 sectors (t-test, p < 0.001), partially significant in 5 / 11 (t-test, p < 0.01), and no statistical difference in most sectors of the normal group (1 / 11 sectors was significant, t-test, p < 0.9). Sensitivity and specificity of the HSA protocol in detecting glaucoma was 97% and 86%, respectively, and for glaucoma suspect patients the values were 89% and 79%, respectively. CONCLUSIONS: The new HSA protocol used in the mfVEP testing can be applied to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patients. Using this protocol can provide information about focal visual field differences across the horizontal midline, which can be utilized to differentiate between glaucoma and normal subjects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss.
Adult ; Aged ; *Early Diagnosis ; Evoked Potentials, Visual/*physiology ; Female ; Follow-Up Studies ; Glaucoma/complications/*diagnosis/physiopathology ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Scotoma/*diagnosis/etiology/physiopathology ; Visual Field Tests/*methods ; Visual Fields/*physiology ; Young Adult

PURPOSE: Multifocal visual evoked potential (mfVEP) is a newly introduced method used for objective visual field assessment. Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard automated perimetry (SAP) visual field assessment, and others were not very informative and needed more adjustment and research work. In this study we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. METHODS: Three groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey field analyzer (HFA) test 24-2 and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the hemifield sector analysis (HSA) protocol. Analysis of the HFA was done using the standard grading system. RESULTS: Analysis of mfVEP results showed that there was a statistically significant difference between the three groups in the mean signal to noise ratio (ANOVA test, p < 0.001 with a 95% confidence interval). The difference between superior and inferior hemispheres in all subjects were statistically significant in the glaucoma patient group in all 11 sectors (t-test, p < 0.001), partially significant in 5 / 11 (t-test, p < 0.01), and no statistical difference in most sectors of the normal group (1 / 11 sectors was significant, t-test, p < 0.9). Sensitivity and specificity of the HSA protocol in detecting glaucoma was 97% and 86%, respectively, and for glaucoma suspect patients the values were 89% and 79%, respectively. CONCLUSIONS: The new HSA protocol used in the mfVEP testing can be applied to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patients. Using this protocol can provide information about focal visual field differences across the horizontal midline, which can be utilized to differentiate between glaucoma and normal subjects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss.
Adult ; Aged ; *Early Diagnosis ; Evoked Potentials, Visual/*physiology ; Female ; Follow-Up Studies ; Glaucoma/complications/*diagnosis/physiopathology ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Scotoma/*diagnosis/etiology/physiopathology ; Visual Field Tests/*methods ; Visual Fields/*physiology ; Young Adult

The purpose of this study was to report developmental glaucoma and pseudopapilledema in a patient with Proteus syndrome. We defined the presence of developmental glaucoma, right pseudopapilledema and myopia in a 4.5-year-old patient with Proteus syndrome. Marked right hemihypertrophy, lipoma, macrodactyly, and asymmetry of the limbs were observed on systemic examination. A cavernoma was also detected in magnetic resonance imaging of the brain. The patient underwent bilateral goniotomy surgery due to glaucoma. The surgical outcomes were satisfactory in both eyes. In conclusions developmental glaucoma and pseudopapilledema might be associated with Proteus syndrome.
Child, Preschool ; Disease Progression ; Glaucoma/diagnosis/*etiology/physiopathology ; Humans ; Intraocular Pressure/*physiology ; Magnetic Resonance Imaging/*methods ; Male ; Proteus Syndrome/*complications

Branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO) rarely cause neovascular glaucoma (NVG). A 58-year-old woman with hypertension and type 2 diabetic mellitus complained of progressive visual loss in her right eye for the previous 3 months. At initial examination, visual acuity was 20 / 63 in the right eye. Angle neovascularization was observed and the intraocular pressure (IOP) was 30 mmHg in her right eye. Fundus examination and fluorescein angiography showed BRAO combined with BRVO. We immediately injected intravitreal and intracameral bevacizumab in her right eye. The next day, we performed scatter photocoagulation in the nonperfusion area. One month later, visual acuity was 20 / 20 in her right eye and the IOP was 17 mmHg with one topical antiglaucoma agent. The neovascularization had regressed completely. We report a case of unilateral NVG which was caused by BRAO with concomitant BRVO and advise close ophthalmic examination of the iris and angle in BRVO with BRAO.
Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*etiology/physiopathology ; Humans ; Intraocular Pressure ; Middle Aged ; Retinal Artery Occlusion/*complications/diagnosis ; Retinal Vein Occlusion/*complications/diagnosis

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects