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      One year structural and functional glaucoma progression after trabeculectomy

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          Abstract

          We evaluated the changes in visual field mean deviation (VF MD) and retinal nerve fibre layer (RNFL) thickness in glaucoma patients undergoing trabeculectomy. One hundred patients were examined with VF and spectral-domain optical coherence tomography (OCT) before trabeculectomy and 4 follow-up visits over one year. Linear mixed models were used to investigate factors associated with VF and RNFL. VF improved during the first 3 months of follow-up (2.55 ± 1.06 dB/year) and worsened at later visits (−1.14 ± 0.29 dB/year). RNFL thickness reduced by −4.21 ± 0.25 µm/year from 1st month of follow-up. Eyes with an absence of initial VF improvement (β = 0.64; 0.30–0.98), RNFL thinning (β = 0.15; 0.08–0.23), increasing intraocular pressure (IOP; β = −0.11; −0.18 to −0.03) and severe glaucoma (β = −10.82; −13.61 to −8.02) were associated with VF deterioration. Eyes with VF deterioration (β = 0.19; 0.08–0.29), increasing IOP (β = −0.09; −0.17 to −0.01), and moderate (β = −6.33; −12.17 to −0.49) or severe glaucoma (β = −19.58; −24.63 to −14.52) were associated with RNFL thinning. Changes in RNFL structure and function occur over a 1-year follow-up period after trabeculectomy. Early VF improvement is more likely to occur in patients with mild/moderate glaucoma, whereas those with severe glaucoma show greater decline over one year. Our findings indicate that progression is observable using OCT, even in late-stage glaucoma.

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          Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial.

          Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure, but to our knowledge no placebo-controlled trials have assessed visual function preservation, and the observation periods of previous (unmasked) trials have typically been at least 5 years. We assessed vision preservation in patients given latanoprost compared with those given placebo.
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            The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Collaborative Normal-Tension Glaucoma Study Group.

            In a companion paper, we determined that intraocular pressure is part of the pathogenesis of normal-tension glaucoma by analyzing the effect of a 30% intraocular pressure reduction on the subsequent course of the disease. We report an intent-to-treat analysis of the study data to determine the effectiveness of pressure reduction. One eligible eye of 145 subjects with normal-tension glaucoma was randomized either to no treatment (control) or to a 30% intraocular pressure reduction from baseline. To be eligible for randomization, the normal-tension glaucoma eyes had to show documented progression of field defects or a new disk hemorrhage or had to have field defects that threatened fixation when first presented for the study. Survival analysis compared time to progression of all randomly assigned patients during the course of follow-up from the initial baseline at randomization. In a separate analysis, data of patients developing cataracts were censored at the time that cataract produced 2 lines of Snellen visual acuity loss. Visual field progression occurred at indistinguishable rates in the pressure-lowered (22/66) and the untreated control (31/79) arms of the study (P = .21). In an analysis with data censored when cataract affected visual acuity, visual field progression was significantly more common in the untreated group (21/79) compared with the treated group (8/66). An overall survival analysis showed a survival of 80% in the treated arm and of 60% in the control arm at 3 years, and 80% in the treated arm and 40% in the controls at 5 years. The Kaplan-Meier curves were significantly different (P = .0018). The analyses gave different results because of a higher incidence of cataract in the group that underwent filtration surgery. The favorable effect of intraocular pressure reduction on progression of visual change in normal-tension glaucoma was only found when the impact of cataracts on visual field progression, produced largely by surgery, was removed. Lowering intraocular pressure without producing cataracts is beneficial. Because not all untreated patients progressed, the natural history of normal-tension glaucoma must be considered before embarking on intraocular pressure reduction with therapy apt to exacerbate cataract formation unless normal-tension glaucoma threatens serious visual loss.
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              Shadow removal and contrast enhancement in optical coherence tomography images of the human optic nerve head.

              To improve the quality of optical coherence tomography (OCT) images of the optic nerve head (ONH). Two algorithms were developed, one to compensate for light attenuation and the other to enhance contrast in OCT images. The former was borrowed from developments in ultrasound imaging and was proven suitable with either time- or spectral-domain OCT. The latter was based on direct application of pixel intensity exponentiation. The performances of these two algorithms were tested on spectral-domain OCT images of four adult ONHs. Application of the compensation algorithm significantly reduced the intralayer contrast (from 0.74 ± 0.16 to 0.17 ± 0.12; P < 0.001), indicating successful blood vessel shadow removal. Furthermore, compensation dramatically improved the visibility of deeper ONH tissues, such as the peripapillary sclera and lamina cribrosa. Application of the contrast-enhancement algorithm significantly increased the interlayer contrast (from 0.48 ± 0.22 to a maximum of 0.89 ± 0.05; P < 0.001) and thus allowed a better differentiation of tissue boundaries. Contrast enhancement was robust only when compensation was considered. The proposed algorithms are simple and can significantly improve the quality of ONH images clinically captured with OCT. This study has important implications, as it will help improve our ability to perform automated segmentation of the ONH; quantify the morphometry and biomechanics of ONH tissues in vivo; and identify potential risk indicators for glaucoma.
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                Author and article information

                Contributors
                leopold.schmetterer@seri.com.sg
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                18 February 2020
                18 February 2020
                2020
                : 10
                : 2808
                Affiliations
                [1 ]ISNI 0000 0000 9960 1711, GRID grid.419272.b, Singapore Eye Research Institute, Singapore National Eye Centre, ; Singapore, Singapore
                [2 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Academic Clinical Program, Duke-NUS Medical School, ; Singapore, Singapore
                [3 ]ISNI 0000 0001 2243 2806, GRID grid.6441.7, Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, ; Vilnius, Lithuania
                [4 ]ISNI 0000 0001 2243 2806, GRID grid.6441.7, Department of Eye Diseases, , Vilnius University Hospital Santaros Klinikos, ; Vilnius, Lithuania
                [5 ]ISNI 0000 0001 0706 4670, GRID grid.272555.2, SERI-NTU Advanced Ocular Engineering (STANCE) Program, ; Singapore, Singapore
                [6 ]ISNI 0000 0001 2224 0361, GRID grid.59025.3b, Department of Ophthalmology, , Lee Kong Chian School of Medicine, Nanyang Technological University, ; Singapore, Singapore
                [7 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, , National University of Singapore, ; Singapore, Singapore
                [8 ]GRID grid.449688.f, GePaSud Laboratory, , University of French Polynesia, ; Tahiti, French Polynesia
                [9 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Yong Loo Lin School of Medicine, , National University of Singapore, ; Singapore, Singapore
                [10 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Department of Clinical Pharmacology, , Medical University of Vienna, ; Vienna, Austria
                [11 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Center for Medical Physics and Biomedical Engineering, , Medical University of Vienna, ; Vienna, Austria
                Author information
                http://orcid.org/0000-0002-6474-5293
                http://orcid.org/0000-0002-1169-6547
                Article
                59792
                10.1038/s41598-020-59792-9
                7029027
                32071369
                a14003ca-24d1-46af-b2d0-bd167488bb93
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 4 September 2019
                : 4 February 2020
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100001349, MOH | National Medical Research Council (NMRC);
                Award ID: TA/MOH-000249-00/2018
                Award ID: NMRC CG/C010A/2017 and OFIRG/0048/2017
                Award Recipient :
                Funded by: Duke-NUS Medical School (Duke-NUS-KP(Coll)/2018/0009A)
                Categories
                Article
                Custom metadata
                © The Author(s) 2020

                Uncategorized
                diagnostic markers,optic nerve diseases
                Uncategorized
                diagnostic markers, optic nerve diseases

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