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      Glaucomatous Maculopathy: Thickness Differences on Inner and Outer Macular Layers between Ocular Hypertension and Early Primary Open-Angle Glaucoma Using 8 × 8 Posterior Pole Algorithm of SD-OCT

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          Abstract

          The purpose of this study was to compare the thickness of all inner and outer macular layers between ocular hypertension (OHT) and early primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT) 8 × 8 posterior pole algorithm (8 × 8 PPA). Fifty-seven eyes of 57 OHT individuals and fifty-seven eyes of 57 early POAG patients were included. The thickness of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform and nuclear layer, photoreceptor layer (PRL) and retinal pigment epithelium were obtained in 64 cells for each macular layer and mean thickness of superior and inferior hemispheres was also calculated. Thinning of superior and inferior hemisphere mean thickness in mRNFL, GCL and IPL and thickening of superior and inferior hemisphere mean thickness in PRL and inferior hemisphere in INL were found in early GPAA group. Otherwise, heatmaps representing cell-to-cell comparisons showed thinning patterns in inner retinal layers (except for INL) and thickening patterns in outer retinal layers in GPAA group. We found that 8 × 8 PPA not only allows the detection of significant thinning patterns in inner retinal layers, but also thickening patterns in outer retinal layers when comparing early POAG eyes to OHT eyes.

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          Most cited references24

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          Swelling and loss of photoreceptors in chronic human and experimental glaucomas.

          To determine whether outer retinal changes occur in chronic, presumed primary open-angle glaucoma (POAG). The outer retinas from 128 human eyes with a diagnosis of chronic glaucoma (presumably POAG in most cases) and 90 control eyes were examined histologically by 3 masked observers for photoreceptor swelling and loss. Retinas from 9 rhesus monkeys with glaucoma induced experimentally by laser trabecular destruction were compared with 7 fellow (control) eyes. The mean pressure elevations in the eyes with laser trabecular destruction ranged from 26.6 to 53.6 mm Hg with durations varying from 7 to 33 weeks. Swelling of the red- and green-sensitive cones was observed in a statistically significantly greater proportion of human eyes with presumed POAG compared with the control eyes. Patchy loss of red/green cones and rods was also found in some of the glaucomatous retinas. In a subset of the human eyes with end-stage disease, cone swelling was a variable finding. Although no photoreceptor loss was found in the 9 monkey eyes with experimental glaucoma, 8 had swelling of their red/green cones that was remarkably similar to that seen in the human eyes. Swelling was not present in any of the control monkey eyes. The photoreceptors are affected by chronically elevated intraocular pressure. These findings may explain some of the abnormalities of color vision and the electrophysiological effects that have been observed in patients with POAG.
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            Risk assessment in the management of patients with ocular hypertension.

            To develop a model for estimating the global risk of disease progression in patients with ocular hypertension and to calculate the "number-needed-to-treat" (NNT) to prevent progression to blindness as an aid to practitioners in clinical decision making. Development of a mathematical model for estimating risk of glaucoma progression. Population-based studies of patients with ocular hypertension and glaucoma were reviewed by a panel of glaucoma specialists. Measures of disease progression risks derived from three long-term studies and assumptions based on the available data were used to estimate the risk of progression from ocular hypertension to glaucoma and glaucoma to unilateral blindness for untreated and treated patients over a 15-year period. Using these estimates, the NNT (1/absolute risk reduction on treatment) to prevent unilateral blindness in one patient with ocular hypertension was calculated. In untreated patients, the estimated risk of progression from ocular hypertension to unilateral blindness was 1.5% to 10.5% and in treated patients, the estimated risk of progression was 0.3% to 2.4% over 15 years. From these estimates, between 12 and 83 patients with ocular hypertension will require treatment to prevent one patient from progressing to unilateral blindness over a 15-year period. Global risk assessment that incorporates all available data plays a vital role in managing patients with ocular hypertension. A more precise understanding of long-term vision loss should be factored into decisions pertaining to the initiation of glaucoma therapy. Undoubtedly, these estimates will evolve and change with the availability of new population-based epidemiologic information and improvements in multivariable model testing.
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              DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY PROVIDES ACCURATE OUTER NUCLEAR LAYER AND HENLE FIBER LAYER MEASUREMENTS.

              The outer nuclear layer (ONL) contains photoreceptor nuclei, and its thickness is an important biomarker for retinal degenerations. Accurate ONL thickness measurements are obscured in standard optical coherence tomography (OCT) images because of Henle fiber layer (HFL). Improved differentiation of the ONL and HFL boundary is made possible by using directional OCT, a method that purposefully varies the pupil entrance position of the OCT beam.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                16 May 2020
                May 2020
                : 9
                : 5
                : 1503
                Affiliations
                [1 ]Department of Ophthalmology, General University Hospital Morales Meseguer, 30007 Murcia, Spain
                [2 ]Department of Ophthalmology, General University Hospital Reina Sofia, 30003 Murcia, Spain; a.palazoncabanes@ 123456gmail.com (A.P.-C.); mpville@ 123456um.es (M.P.V.-P.)
                [3 ]Department of Ophthalmology and Optometry, University of Murcia, 30120 Murcia, Spain
                [4 ]Ophthalmic Research Unit Santiago Grisolia/FISABIO, 46017 Valencia, Spain
                [5 ]Cellular and Molecular Ophthalmolobiology Group, Surgery Department of the University of Valencia, 46010 Valencia, Spain
                [6 ]Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), Instituto de Salud Carlos III, 28029 Madrid, Spain
                [7 ]Department of Anesthesiology, University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain; monicadelriov@ 123456hotmail.com
                [8 ]Area of Health Sciences, Valencian International University, 46002 Valencia, Spain; vczanon@ 123456universidadviu.com
                Author notes
                [†]

                J.J.G.-M. and M.d.-R.-V. equally contributed and shared the first authorship.

                [‡]

                V.Z.-M. and M.P.V.-P. shared last authorship as senior authors.

                Author information
                https://orcid.org/0000-0002-6245-7271
                https://orcid.org/0000-0002-0118-7837
                https://orcid.org/0000-0003-1179-1592
                https://orcid.org/0000-0002-5734-482X
                Article
                jcm-09-01503
                10.3390/jcm9051503
                7290368
                32429480
                a797d2a8-6dee-4d7d-81b1-482173e6dc9f
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 12 April 2020
                : 14 May 2020
                Categories
                Article

                glaucoma,ocular hypertension,optical coherence tomography,posterior pole algorithm,macula,layer,heatmap,spectralis,outer retina,inner retina

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