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PurposeTo describe the normal macular thickness and assess its associations.MethodsThe Handan Eye Follow-up Study was conducted between 2012 and 2013. Macular thickness was scanned by spectral-domain optical coherence tomography (OCT). The built-in software generated a retinal thickness (RT) map, which was divided into three regions (central, internal and external regions) and nine quadrants (one in central and four in internal and external regions each).ResultsFor 5394 subjects in the Handan Eye Follow-up Study, 4793 received OCT examination, 2946 of whom (accounting for 61.46% of the total subjects, mean age 58.91±10.95, 55.6% were women) were included for analysis. The mean RT in central macula, inner and outer rings were (237.38 µm±23.05 µm), (309.77 µm±18.36 µm) and (278.29 µm±14.38 µm), respectively (overall difference, p＜0.001). In inner ring, the RT in temporal was thinnest, followed by nasal, superior and inferior. In outer ring, the RT in superior was thinnest, with the next subfields being temporal, inferior and nasal, respectively. The RT in central macula, inner and outer rings were significantly thicker in men than in women. Multivariate linear regression analysis showed that in central macula, RT increased in subjects younger than 60 years and thinned above the age of 60. In inner and outer rings, RT thinned along with age (p＜0.001).ConclusionsThis study finds that RT in central macula is the thinnest, followed by the outer ring, the RT in the inner ring is the thickest. Age and gender are related to RT. These associated factors need to be considered when explaining RT.

PURPOSE To assess the distribution and factors related to intraocular pressure (IOP) in a Chinese children population in Northern China. METHODS 1,238 offspring aged 6 to 18 years, residing in six villages, were recruited for this current study, the Handan Offspring Myopia Study. Participants underwent an interviewer-administered questionnaire and a complete ocular examination, including standardized measurement of IOP with Perkins applanation tonometry. RESULTS 1,648 eyes of 828 children were included in the analysis. The mean IOP was 13.9 ± 1.6 mmHg. The mean IOP for the study population increased from 13.0 ± 1.5 mmHg for those 6 to 7 years of age to 14.2 ± 1.4 mmHg for those 15 years of age or older (P

Aims To study the risk factors associated with blindness after treatment of acute primary angle closure (APAC), and to identify the critical time window to decrease rate of blindness. Methods In this multicentre retrospective case series, 1030 consecutive subjects (1164 eyes) with APAC in China were recruited. The rates of blindness were analysed up to 3 months after treatment of APAC. A logistic regression was used to identify the risk factors associated with blindness, including age, gender, distance to hospital, rural or urban settings, treatment method, education level, time from symptom to treatment (TST, hours) and presenting intraocular pressure (IOP). The critical time window associated with a blindness rate of ≤1% was calculated based on a cubic function by fitting TST to the rate of blindness at each time point. Results The rate of blindness after APAC was 12.54% after treatment. In multivariate regression, education level, TST and presenting IOP were risk factors for blindness (p=0.022, 0.004 and 0.001, respectively). The critical time window associated with a blindness rate of ≤1% was 4.6 hours. Conclusions and relevance Education level, TST and presenting IOP were risk factors for blindness after APAC. Timely medical treatment is key in reducing blindness after APAC.

Background: To report the changes in anterior chamber angle and progression rate to PAC(primary angle closure) following laser peripheral iridotomy (LPI) in primary angle closure suspects(PACS).Methods: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥ 180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12 months’ post LPI.Results: 80 of 134 patients (59.7%) could be followed up at one year. The mean IOPin treated eyes was 15.9±2.7 mmHg at baseline, 15.4±3.0 mmHg on day 7; 16.5±2.9 mmHg at one month and 15.5±2.9 mmHg at 12 months; the IOP in untreated eyes was similar (p=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The progression rate to PAC in untreated eyes was 3.75% and one developed acute angle closure glaucoma(AACG), the progression rate to PAC(primary angle closure) in treated eyes 2.5% in treated eyes, none had developed PAS or AACG. Conclusion: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees. IOP remained similar in treated and untreated eyes. Further research is needed to determine the full implications of residual closure as well as the need for follow up and treatment in PACS. The cumulative incidence for PAC/AACG in treated eyes were not significantly different from untreated eyes.Trial registration: Chinese Clinical Trial Registry ChiCTR-TCH-10000820. Registered on 08 April 2010(retrospectively registered).

To compare the efficacy and safety of laser peripheral iridotomy with or without laser peripheral iridoplasty in the treatment of eyes with synechial primary angle-closure or primary angle-closure glaucoma.Randomized, controlled clinical trial.Consecutive patients older than 40 years with synechial primary angle-closure or primary angle closure glaucoma were recruited. Eligible patients were randomized to 1 of 2 treatment options, iridotomy or iridotomy plus iridoplasty, and were followed up for 1 year. Main outcome measures were intraocular pressure (IOP), peripheral anterior synechiae, corneal endothelial cell count, and complications.Seventy-seven eyes (77 patients) were randomized to the iridotomy group, and 81 eyes (81 patients) were randomized to the iridotomy plus iridoplasty group. Sixty-one patients (79.2%) in the iridotomy and 65 patients (80.2%) from the iridotomy plus iridoplasty groups completed 1 year of follow-up. There were no significant differences between the groups in the baseline data. IOP was reduced from 24.66 +/- 13.76 mm Hg to 19.03 +/- 6.21 mm Hg in the iridotomy group (P.001) and from 27.96 +/- 13.06 mm Hg to 20.45 +/- 7.26 mm Hg in the iridotomy plus iridoplasty group (P.001). Extent of peripheral anterior synechiae was decreased by 1 more clock-hour after iridoplasty compared with that after iridotomy in the iridotomy plus iridoplasty group (P.001). There was no significant difference in IOP, medications, need for surgery, or visual function between groups at the 1-year visit.In eyes with synechial primary angle-closure or primary angle-closure glaucoma, both iridotomy alone or combined with iridoplasty provide a significant and equivalent reduction in IOP. There is also a possible reduction in peripheral anterior synechiae, more so in the iridoplasty group.

Author(s): Wang, Ning Li; Hao, Jie; Zhen, Yi; Liu, John HK; Li, Si Zhen; Wang, Hao; Chen, Hui; Peng, Xiao Xia; Han, Wei; Fan, Su Jie; Weinreb, Robert N | Abstract: Purpose(1) To investigate the reference value of peak-trough difference in circadian rhythm of intraocular pressure (IOP) in habitual position and (2) to compare the IOP parameters among 3 age groups.Materials and methodsHabitual IOP of healthy subjects sampled from the population in the Handan Eye Study was measured every 2 hours in the seated position during light-wake period (7:30 AM, 9:30 AM, 11:30 AM, 1:30 PM, 3:30 PM, 5:30 PM, 7:30 PM, 9:30 PM) and in the supine position during dark-sleep period (11:30 PM, 1:30 AM, 3:30 AM, 5:30 AM). Blood pressure and heart rate were obtained subsequently at each IOP measurement.ResultsTwo hundred six healthy subjects were included in the final analyses (n=20, 30 to 39 y old; n=95, 40 to 49 y old; n=91, 50 to 59 y old). For peak-trough difference (7.2±2.3 mm Hg; 6.8 to 7.5 mm Hg, 95% confidence interval) in habitual position, the reference value was described as median 7.0 mm Hg, 25th percentile 5.5 mm Hg, and 95th percentile 11.5 mm Hg. No significant differences in peak-trough difference, acrophase (cosine-fit analysis derived peak timing) and amplitude (half distance between the cosine-fit maximum and minimum) were found among the 3 age groups. In the cosine model, the nocturnal acrophase (3:49±0.53 AM; 3:42 to 3:55 AM, 95% confidence interval) was detected for the entire group. Furthermore, 106 subjects (52%) had a nocturnal peak pattern, 36 subjects (17%) had a diurnal peak pattern, and 64 subjects (31%) had no evident pattern.ConclusionsIn habitual position, 75% of healthy subjects from a population-based investigation had IOP variation g5.5 mm Hg and 95% subjects had l11.5 mm Hg variation. Aging may not influence the circadian habitual IOP rhythm.

AIM: To evaluate the effect of laser peripheral iridoplasty(LPIP)to treat acute angle-closure glaucoma(AACG)which could not controlled by drugs and with persistent ocular hypertension. METHODS: Totally 67 patients(69 eyes)with AACG were performed LPIP when intraocular pressure(IOP)was still over 30mmHg after the medicine therapy for 3-6 hours. Visual acuity and intraocular pressure were under detection before laser treatment and 30 minutes, 60 minutes and 2 hours after laser treatment. We measured the anterior chamber depth, width of angle, iris thickness with ultrasound biomicroscope(UBM). Dynamic gonioscopy was used to evaluate the degree of peripheral anterior synechia(PAS).RESULTS: Angle open distance(AOD)after iridoplasty was increased(PPF=151.79, PCONCLUSION: LPIP can deepen peripheral anterior chamber, increase the angle access and lower the IOP immediately. It is an important ongoing adjuvant treatment, which can reduce the patients suffering by lowering the IOP quickly, reduce the damage of visual function caused by long-term high intraocular pressure, avoid side effect of the drugs, and can improve the prognosis.

To study the association of intraoperative intraocular pressure (IOP) at the conclusion of primary trabeculectomy with postoperative IOP on days 1, 7, and 30 and report the ability of intraoperative IOP to predict early postoperative IOP.Prospective, observational, case series. Ninety-seven consecutive patients with primary open-angle or angle-closure glaucoma underwent primary trabeculectomy. The IOP was measured 3 minutes after the closure of scleral flap with a formed anterior chamber. Clinical details and complications were recorded over a 30-day follow-up. The patients were grouped as A (intraoperative IOP≤10.0 mm Hg), B (10, ≤15.0 mm Hg), and C (15 mm Hg).Mean age was 60.8±9.9 years. Forty (41.3%) patients were males. Eighty-two (84.5%) had primary angle-closure glaucoma. Mitomycin-c (MMC) was used in 75 (77.3%) eyes. Mean IOP in group C was significantly higher than group A at all visits (P=0.005, 0.002, and 0.05). Postoperative IOP was associated with intraoperative IOP, age, duration, and dose of MMC in univariable regressions. On multivariable analysis, the intraoperative IOP was associated with postoperative IOP's on day 1 (regression coefficient b=0.24, P=0.039, R(2)=0.24) and day 7 (b=0.47, P0.001, R=0.42), but not on day 30 (b=0.22, P=0.065, R(2)=0.12). IOP on day 7 was predicted by -8.6+0.47×(intraoperative IOP)+0.27×age-11.7×(dose of MMC in mg/mL). Prediction for day 30=9.8+0.27×(intraoperative IOP).In patients undergoing uncomplicated primary trabeculectomy, intraoperative IOP is associated with and may predict early postoperative IOP. Adjusting the IOP during the operation may optimize postoperative IOP.

To quantitatively evaluate the long-term changes in anterior segment morphology by using ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with primary angle closure (PAC).This was a clinical case series study. A total of 54 eyes with PAC of 31 consecutive patients were enrolled. Routine ophthalmic and UBM examination were performed at visit one (before LPI), 2 weeks, 6, and 12 months after LPI. The parameters of anterior chamber were measured by UBM and calculated. Results of each follow-up time were analyzed using repeated measures analysis of variance. Parameters of UBM measurement at 750 µm anterior to the sclera spur and at 500 µm counterpart were compared using paired student t-test.Compared to before LPI, anterior chamber depth (ACD) was deepened by approximate 0.10 mm after LPI, however, it was not statistically significant (F = 3.50, P0.05). Angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) and trabecular-ciliary process distance (TCPD) were significantly increased at 2 weeks, 6 and 12 months after LPI compared with respective baseline [AOD750: (165.0 ± 70.3), (185.8 ± 68.5), (196.1 ± 77.7) µm vs (66.2 ± 51.6) µm, F = 92.60; TIA750: 14.1° ± 6.3°, 15.5° ± 6.2°, 16.4° ± 5.9° vs 6.4° ± 4.9°, F = 92.60; ARA: (0.058 ± 0.024), (0.065 ± 0.023), (0.068 ± 0.026) mm(2) vs (0.025 ± 0.017) mm(2), F = 92.60; TCPD: (647.1 ± 113.0), (701.8 ± 93.4), (670.1 ± 95.4) µm vs (571.0 ± 97.2) µm, F = 34.00; P0.05]. The parameters of UMB measurement at 750 µm were significantly increased more than that at 500 µm anterior to the sclera spur (AOD: t = 5.90, TIA750: t = 2.70, P0.05; ARA: t = 2.00, P = 0.05).LPI can significantly widen the peripheral anterior angle in eyes with PAC lasting for at least 1 year after LPI. Parameters detected by UBM at 750 µm anterior to the sclera spur appear to be more sensitive in evaluating the alternation of peripheral angle structure.

To evaluate the correlation between morphologic appearance of blebs at 3 month and long-term intraocular pressure (IOP) effect in patients with primary angle-closure glaucoma (PACG) after trabeculectomy.Multi-centered cases series. Data were collected from 176 patients aged ≥ 40 years with PACG who were participated in a randomized clinical trial that aimed at addressing the efficacy of augmented releasable sutures after trabeculectomy. The bleb morphology was graded using the Modified Indian Bleb Appearance Grading Scale (IBAGS) based on standard photos at 3 month after trabeculectomy. IOPs were measured with Goldmann applanation tonometer. The correlation between bleb components and other selected testing influencing factors and long-term IOP was tested by linear Logistic regression analysis.150 patients (85.7%) completed 18 months of follow up. IOP was (15.6 ± 5.4) mm Hg at 18 month of post-operation. 135 eyes had an IOP ≤ 21 mm Hg without additional medications, 10 eyes ≥ 21 mm Hg, and the remaining 5 eyes required one or two medications to maintain normal IOP. Using IBAGS system, bleb was graded in 142 eyes as follows: H(0) in 3 eyes, H(1) in 45 eyes, H(2) in 90 eyes, and H(3) in 4 eyes, while V(0) was observed in 66 eyes, V(1-3) in 76 eyes. IOP at 18 months in bleb with microcysts was 2.77 mm Hg lower (β = -2.77, 95%CI = -0.46 to -5.08) than those without microcysts and in bleb with non-vascular was 2.07 mm Hg lower (β = -2.07, 95%CI = -0.15 to -3.98) than those with vascular at 3 months after surgery. IOP was significantly (β = -1.20, 95%CI: -0.00 to -2.40) decreased by 1.2 mm Hg with 10 years of age increase (P0.05).Early filtering bleb with microcysts, vascular, and age are identified as important factors to predict long-term IOP effect in patients with PACG after trabeculectomy but not early morphological appearance of filtering bleb.

Many studies indicated that short-term and long-term intraocular pressure (IOP) fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy (LPI) with or without laser peripheral iridoplasty.A total of 158 patients with primary angle closure suspect (PACS, n = 21), primary angle closure (PAC, n = 81) and primary angle closure glaucoma (PACG, n = 55) had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation (GEE) regression models was used to evaluate the association of long-term IOP fluctuation (maximum IOP minus minimum IOP) with gender, age, baseline IOP, baseline peripheral anterior synechia (PAS), baseline vertical cup/disc ratio (VCDR), baseline mean deviation (MD), need for IOP-lowering medications.IOP fluctuation during follow-up in PACS, PAC and PACG groups were (4.83 ± 2.90), (5.67 ± 3.35), and (9.40 ± 7.14) mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP (r = 0.356, P0.001), PAS (r = 0.374, P0.001). IOP fluctuation was higher in patients with higher baseline IOP (0.18 mmHg per unit increase, 95%CI: 0.05 - 0.31 mmHg).Long-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.