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Corneal thickness measurement is important for assessing intraocular pressure in patients with glaucoma. This study investigated the changes in corneal epithelial thickness (CET) induced by antiglaucoma medications and explored the factors affecting CET measurement. CET was measured over a 9.0 mm diameter area by using Fourier domain optical coherence tomography in 125 patients with primary open-angle glaucoma and 125 age-matched controls without glaucoma. The influence of sex, age, benzalkonium chloride (BAK)-containing instillations, disease severity, and types and numbers of medications was analyzed using simple and multiple regression analyses. CET over 25 sectors was smaller in the glaucoma group than in the control group (mean difference of 4.2 µm in the central 2.0 mm zone, 52.8 ± 3.6 vs. 48.5 ± 3.9, p &lt, 0.001). Simple regression analysis revealed age, use of β-blockers, prostaglandin, carbonic anhydrase inhibitors, total number of medications, and number of daily BAK-containing instillations were associated with a thinner epithelium. Multiple regression analysis revealed β-blockers, prostaglandin, and number of BAK-containing instillations were significant factors. Use of β-blockers and number of BAK-containing instillations were also associated with a thinner epithelium in the monotherapy subgroup analysis. CET was significantly smaller in patients with glaucoma receiving topical medications and was affected by the use of β-blockers, prostaglandin, and BAK.

Purpose To report the outcome of unilateral small incision lenticule extraction (SMILE) in a patient with granular corneal dystrophy type 2 (GCD2). Methods Slit-lamp photography and Fourier domain optical coherence tomography were used to document the clinical course and appearance of the corneas in a patient with genetically determined GCD2 who underwent unilateral SMILE in the right eye. Results Slit-lamp examination of a 23-year-old woman revealed 2 faint opacities at the surgical interface approximately 2 months after the SMILE procedure had been performed on her right eye. Nine and 3 typical GCD2 deposits located immediately beneath the Bowman layer were observed in the right and left corneas, respectively. Over time, the deposits at the interface increased in size, density, and number in the right eye. Fourier domain optical coherence tomography performed 33 months after the SMILE procedure revealed deposits at the SMILE interface that were distinct from those located immediately beneath the Bowman layer. The severity of disease exacerbation was less in this patient than what is typically observed in others who have undergone laser-assisted in situ keratomileusis or photorefractive keratectomy. Conclusions SMILE is contraindicated in patients with GCD2, as are other corneal refractive surgical procedures. This case highlights the importance of genetic testing before the performance of refractive corneal procedures-especially for patients with corneal opacities on preoperative slit-lamp examination or a family history of corneal disease compatible with that of a corneal dystrophy.

PurposeTo assess the repeatability, reproducibility, and agreement of central corneal thickness (CCT) measured by non-contact Fourier domain optical coherence tomography (FD-OCT; OptoVue) with the other two contact devices, ocular response analyzer (ORA; Reichert Ophthalmic Instruments) and Ultrasound Pachymetry (USP; DGH Technologies).MethodsThis observational cross-sectional study measured CCT sequentially using FD-OCT, ORA and USP. The first 16 volunteers (32 eyes) received three measurements by two independent examiners in a single session to determine intra-observer repeatability and inter-observer reproducibility. An additional 27 volunteers (54 eyes) received one measurement by the same examiner. The measurements of all 86 eyes were analyzed for the difference, correlation, and agreement among the three devices.ResultsFD-OCT measured the thinnest while USP measured the thickest CCT (548.6 ± 28.3 μm, 556.9 ± 28.8 μm, and 560.0 ± 28.8 μm by FD-OCT, ORA, and USP, respectively, p

Author(s): Rashid, Saadia; Pilli, Suman; Chin, Eric K; Zawadzki, Robert J; Werner, John S; Park, Susanna S | Abstract: PurposeTo evaluate serially long-term macular morphologic changes after successful macula-involving rhegmatogenous retinal detachment repair and correlate changes with macular function.MethodsRepeat Fourier domain optical coherence tomography (FD OCT) imaging and microperimetry (MP-1) testing of 8 of the initial cohort of 17 eyes studied 5 years earlier.ResultsThe mean follow-up after rhegmatogenous retinal detachment repair was 3.4 months (range, 1-8.5 months) for the first FD OCT and 5 years (range, 3.75-5.75 years) for the follow-up FD OCT. The final postoperative best-corrected visual acuity mean was 20/201 (range, 20/20 to counting fingers). Six eyes with final best-corrected visual acuity g20/40 had an intact external limiting membrane and progressive resolution of photoreceptor inner segment-outer segment junction disruption and/or subretinal fluid on serial FD OCT, which correlated with improvement in macular function on MP-1. Two eyes with poor or worsening best-corrected visual acuity on follow-up had persistent or worsening inner segment-outer segment disruption on serial FD OCT. External limiting membrane was intact in one eye and persistently disrupted in the other.ConclusionMacular function may progressively improve or worsen long-term after successful rhegmatogenous retinal detachment repair. Progressive resolution of subretinal fluid and/or inner segment-outer segment disruption on FD OCT correlated with improvement in macular function, whereas worsening or persistent inner segment-outer segment disruption correlates with worsening or persistently poor visual outcome.

VISUAL OUTCOME CORRELATES WITH INNER MACULAR VOLUME IN EYES WITH SURGICALLY CLOSED MACULAR HOLE SUMAN PILLI, MD, ROBERT J. ZAWADZKI, P H D, JOHN S. WERNER, P H D, SUSANNA S. PARK, MD, P H D Purpose: To determine the macular morphologic features that correlate best with visual outcome in eyes with surgically closed idiopathic macular hole. Methods: Transversal observational case series of 24 eyes (22 subjects) imaged postoperatively using high-resolution Fourier domain optical coherence tomography (FD- OCT). Total and inner macular volume for central 3 mm area, central foveal thickness, and size of foveal inner segment–outer segment junction abnormality were correlated with best- corrected visual acuity. Microperimetry (MP-1) test was performed in a subset of 18 eyes. Results: Mean postoperative best-corrected visual acuity was 20/36 (range, 20/25–20/ 70). Postoperative follow-up mean was 32.97 ± 24.68 months (range, 5–96 months). Eigh- teen eyes underwent internal limiting membrane (ILM) peeling. Among FD-OCT parameters, logarithm of the minimum angle of resolution best-corrected visual acuity and mean total microperimetry-1 sensitivity correlated best with inner macular volume in all eyes and ILM- peeled eyes (P , 0.05). Macular surface irregularities were noted in 12 eyes (66.7%) with ILM peeling but in none of the non–ILM-peeled eyes (P = 0.02). No significant correlation was found between microperimetry-1 sensitivity and other FD-OCT parameters. Conclusion: Because inner macular volume strongly correlated with visual outcome in eyes with surgically closed macular hole, the possible effect of ILM peeling on visual outcome needs to be further investigated. RETINA 32:2085–2095, 2012 S ince the first introduction of vitrectomy surgery for closure of idiopathic macular hole by Kelly and Wendel in 1991, there have been several refinements in the surgical technique aimed to improve the anatom- ical and functional outcome of the surgery. Despite these refinements, visual acuity often does not return to normal in eyes with macular hole after surgical closure of the hole. 1 To understand the factors that may limit visual recovery in eyes with surgically closed macular hole, commercial time domain (TD) or Fourier domain (FD) optical coherence tomography (OCT) imaging has been used to study the pre- and postoperative mor- phologic features of the macula in eyes with surgically closed macular hole. 2–19 Studies using TD-OCT have shown a negative correlation between the preoperative macular hole dimensions and postoperative visual recovery. 3,5 Several groups have studied postoperative macular morphologic features in eyes with surgically closed macular hole using OCT, but no clear consis- tent morphologic feature that strongly correlates with postoperative visual acuity has been found so far. Sev- eral studies noted foveal photoreceptor abnormalities in eyes with surgically closed macular hole that tended to be more common in eyes with poorer vision, but the correlation between the size of this abnormality and postoperative vision was not consistently found. 10–19 Other studies attempted to correlate the foveal thickness measurements obtained using TD-OCT with postoper- ative best-corrected visual acuity (BCVA) with variable From the Department of Ophthalmology and Vision Science, University of California Davis Eye Center, Sacramento, California. Supported by Research to Prevent Blindness, New York, NY (unrestricted departmental grant and a Senior Scientist Award to J.S.W.) and the National Eye Institute, Bethesda, MD (Grant 014743 to J.S.W.). Presented in part as a paper at the Macula Society Meeting, Boca Raton, Florida, March 10, 2011; and at World Ophthalmology Congress, Berlin, Germany, June 2010; and as a poster at the American Society of Retina Specialists Meeting, Vancouver, August 2010. The authors declare no conflicts of interest. Reprint requests: Susanna S. Park, MD, PhD, Department of Ophthalmology and Vision Science, University of California Davis Eye Center, 4860 Y Street, Suite 2400, Sacramento, CA 95817; e-mail: susanna.park@ucdmc.ucdavis.edu

Purpose Fourier Domain Optical Coherence Tomography (FD-OCT) provides high resolution cross-sectional images of the retina and the anterior segment. It has become an important tool in ophthalmology in the examination, diagnosis, and treatment of important and common diseases. Present OCT imaging systems are stand-alone devices. The aim of this paper is to show the quality of images made with a prototype of a Fourier Domain (FD-) OCT imaging system (SLSCAN-1) integrated into a slit lamp. Methods Different representative pathologies of the posterior and anterior segment were observed with the slit lamp and simultaneously scanned with a prototype of the slit lamp-integrated FD-OCT system. The clinical interpretation of posterior segment images made with the prototype were compared to those obtained with a stand-alone FD-system (3D-OCT-1000 Mark II, Topcon). Results Images made with the slit lamp-integrated FD-OCT were of sufficient quality to allow for a correct interpretation of the observed pathological conditions. Conclusions based on the images of the posterior segment of the prototype were identical to the conclusions based on the images of a stand-alone FD-system (3D-OCT-1000 Mark II, Topcon). In addition to the images of the posterior segment, images could be made of the anterior segment. The OCT system did not interfere with the normal functionality of the slit lamp. Conclusion The slit lamp-integrated FD-OCT system provided high quality images of both the anterior and the posterior segment. Scans made with the slit lamp-integrated FD-OCT system could be of use in clinical practice. Eye (2010) 24, 980-984; doi: 10.1038/eye.2009.269; published online 13 November 2009