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To evaluate the hypothesis that macular thickness correlates with the diagnosis of glaucoma.Cross-sectional study.We studied 367 subjects (534 eyes), including 166 eyes of 109 normal subjects, 83 eyes of 58 glaucoma suspects, 196 eyes of 132 early glaucoma patients, and 89 eyes of 68 advanced glaucoma patients.We used optical coherence tomography (OCT) to measure macular and nerve fiber layer (NFL) thickness and to analyze their correlation with each other and with glaucoma status. We used both the commercial and prototype OCT units and evaluated correspondence between measurements performed on the same eyes on the same days.Macular and NFL thickness as measured by OCT.All NFL parameters both in prototype and commercial OCT units were statistically significantly different comparing normal subjects and either early or advanced glaucoma (P0.001). Inner ring, outer ring, and mean macular thickness both in prototype and commercial OCT devices were found to be significantly different between normal subjects and advanced glaucomatous eyes (P0.001). The outer ring was the only macular parameter that could significantly differentiate between normal and early glaucoma with either the prototype or commercial OCT unit (P = 0.003, P = 0.008, respectively). The area under the receiver operator characteristic (AROC) curves comparing mean NFL thickness between normal and advanced glaucomatous eyes was 1.00 for both the prototype and commercial OCT devices for eyes scanned on both machines on the same day. The AROC comparing mean macular thickness in normal and advanced glaucomatous eyes scanned on both machines on the same day was 0.88 for the prototype OCT device and 0.80 for the commercial OCT.Both macular and NFL thickness as measured by OCT showed statistically significant correlations with glaucoma, although NFL thickness showed a stronger association than macular thickness. There was good correspondence between findings using both the prototype and commercial OCT units. Macular and NFL thickness measurements made with OCT may have usefulness in the clinical assessment of glaucoma.

Purpose: To describe the clinical findings and treatment modalities of persistent hypotony following primary trabeculectomy with mitomycin C. Methods: We retrospectively analyzed 9 eyes with persistent hypotony, which was defined as intraocular pressure less than or equal to 5 mmHg for more than 2 months. Results: Mean hypotony duration was 7.4 months (standard deviation (SD) ± 6.7 months, range 2 to 23 months). Associated findings included choroidal detachment (2 eyes) and maculopathy (5 eyes). All patients who developed maculopathy were relatively young (mean age = 37 years old, SD ± 16, range 18 to 79 years). Treatments included bandaged contact lens, autologous blood injection, phacoemulsification, resuturing of the scleral flap, scleral patch graft, and Simmons' shell. After treatment, intraocular pressure (IOP) raised in all patients (mean final IOP = 11.1 mmHg, SD ± 3.5). On the first day of hypotony, the mean IOP was 3 mmHg (SD ±1.7). At the last follow up, visual acuity (VA) was unchanged in 3 eyes, worsened in 2 eyes (by 2 Snellen lines), and improved (by 1 to 4 Snellen lines) in 4 eyes. Of those eyes whose VA improved, 3 had undergone phacoemulsification. Conclusion: Hypotony after trabeculectomy with mitomycin C can be reversed with possible improvement in vision.Objetivo: Descrever os achados clínicos e as modalidades de tratamento da hipotonia persistente após trabeculectomia primária com mitomicina C. Método: Foram retrospectivamente analisados 9 olhos com hipotonia persistente, a qual foi definida como pressão intra-ocular igual ou menor que 5 mmHg por mais que 2 meses. Resultado: Tempo médio de duração da hipotonia foi de 7.4 meses, desvio padrão ± 6.7 meses. Complicações associadas à hipotonia incluíram descolamento de coróide (2 olhos), maculopatia (5 olhos). Todos os pacientes que desen-volveram maculopatia eram relativamente novos (idade media de 37 anos, desvio padrão ±16). Tratamentos incluíram lente de contato, injeção autóloga de sangue, facoemulsificação, re-sutura do retalho escleral, e concha de Simmons. Após tratamento, houve melhora da pressão intra-ocular (PIO) em todos os pacientes (média final da PIO= 11.1 mmHg, desvio padrão ±3.51, média da PIO no 1° dia = 3 mmHg, desvio padrão ±1.7). Na última visita, a acuidade visual (AV) permaneceu constante em 3 olhos, piorou em 2 olhos ( piora de 2 linhas de Snellen). Houve melhora da AV em 4 olhos (1 a 4 linhas de Snellen). Foi realizada facoemulsificação em 3 olhos dentre aqueles em que houve melhora da acuidade visual. Conclusão: Hipotonia pós-trabeculectomia com mitomicina C pode ser reversível com possível melhora da visão.

Optical coherence tomography (OCT) is a new diagnostic technology for high resolution, cross-sectional, quantitative imaging of the human retina. OCT is a noninvasive, noncontact technique which uses near infra-red, lowcoherent light passing through a Michaelson interferometer. OCT is essentially analogous to ultrasound B-mode imaging except that optical rather than acoustic reflectivity is measured. OCT is unique, amidst other current technologies, in its cross-sectional scanning of the tissue which provides "anatomic" tomographic representation of the retinal layers and their pathologies, and in its exceptionally high resolution (approximately 10 μm) and reproducibility. OCT provides powerful diagnostic information which is complementary to conventional studies such as fundus photography and fluorescein angiography, and is extremely useful in the diagnosis and monitoring of retinal disorders such as macular hole and macular edema of various origins, and for nerve fiber layer thickness measurement in glaucoma. In addition, OCT has the potential for a wide variety of corneal and anterior segment imaging.

Purpose: To describe the clinical findings and treatment modalities of persistent hypotony following primary trabeculectomy with mitomycin C. Methods: We retrospectively analyzed 9 eyes with persistent hypotony, which was defined as intraocular pressure less than or equal to 5 mmHg for more than 2 months. Results: Mean hypotony duration was 7.4 months (standard deviation (SD) ± 6.7 months, range 2 to 23 months). Associated findings included choroidal detachment (2 eyes) and maculopathy (5 eyes). All patients who developed maculopathy were relatively young (mean age = 37 years old, SD ± 16, range 18 to 79 years). Treatments included bandaged contact lens, autologous blood injection, phacoemulsification, resuturing of the scleral flap, scleral patch graft, and Simmons' shell. After treatment, intraocular pressure (IOP) raised in all patients (mean final IOP = 11.1 mmHg, SD ± 3.5). On the first day of hypotony, the mean IOP was 3 mmHg (SD ±1.7). At the last follow up, visual acuity (VA) was unchanged in 3 eyes, worsened in 2 eyes (by 2 Snellen lines), and improved (by 1 to 4 Snellen lines) in 4 eyes. Of those eyes whose VA improved, 3 had undergone phacoemulsification. Conclusion: Hypotony after trabeculectomy with mitomycin C can be reversed with possible improvement in vision. Objetivo: Descrever os achados clínicos e as modalidades de tratamento da hipotonia persistente após trabeculectomia primária com mitomicina C. Método: Foram retrospectivamente analisados 9 olhos com hipotonia persistente, a qual foi definida como pressão intra-ocular igual ou menor que 5 mmHg por mais que 2 meses. Resultado: Tempo médio de duração da hipotonia foi de 7.4 meses, desvio padrão ± 6.7 meses. Complicações associadas à hipotonia incluíram descolamento de coróide (2 olhos), maculopatia (5 olhos). Todos os pacientes que desen-volveram maculopatia eram relativamente novos (idade media de 37 anos, desvio padrão ±16). Tratamentos incluíram lente de contato, injeção autóloga de sangue, facoemulsificação, re-sutura do retalho escleral, e concha de Simmons. Após tratamento, houve melhora da pressão intra-ocular (PIO) em todos os pacientes (média final da PIO= 11.1 mmHg, desvio padrão ±3.51, média da PIO no 1° dia = 3 mmHg, desvio padrão ±1.7). Na última visita, a acuidade visual (AV) permaneceu constante em 3 olhos, piorou em 2 olhos ( piora de 2 linhas de Snellen). Houve melhora da AV em 4 olhos (1 a 4 linhas de Snellen). Foi realizada facoemulsificação em 3 olhos dentre aqueles em que houve melhora da acuidade visual. Conclusão: Hipotonia pós-trabeculectomia com mitomicina C pode ser reversível com possível melhora da visão.

To investigate optical coherence tomography (OCT) measurements of retinal nerve fiber layer (RNFL) thickness change associated with elevated intraocular pressure (IOP) over a period of time, and to compare in vivo OCT RNFL thickness measurements with morphologic measurements of the same tissues.One eye of each of 12 cynomolgus monkeys was treated with argon laser to the anterior chamber angle to induce elevated IOP. OCT measurements were made weekly in the treated and the contralateral eyes of each monkey for 14 weeks after the laser insult. The monkeys were killed at the conclusion of the experiment, and comparisons were made between the terminal OCT RNFL measurements and quantitative histomorphometric assessments in the same eyes. Effects of exposure to elevated IOP on RNFL were characterized by a mixed-effects model. Linear mixed-effects models provided unbiased analysis of balanced and unbalanced repeated-measures data, detection of group effects (fixed effects), and individual subject effects (random effects), thereby making the best use of all available data.Increased IOP was achieved in 10 eyes. Exposure to high IOP was associated with the loss of mean RNFL thickness at a median rate of 3.77 +/- 0.08 microm/wk. On average, OCT RNFL thickness measurements were higher than histomorphologic measurements by 5.7 microm (95% confidence interval, 3.6-7.8; P = 0.003).Thinning of the RNFL associated with elevated IOP was demonstrated with OCT in a group of experimentally glaucomatous monkey eyes over a period. OCT measurements corresponded with histomorphometric measurements of the same tissues.