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      Detection of the progression of retinal nerve fiber layer loss by optical coherence tomography in a patient with glaucomatocyclitic crisis

      case-report

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          Abstract

          A 30-year-old man presented with glaucomatocyclitic crisis, also known as Posner–Schlossman syndrome, and acute intraocular pressure elevation. Changes in the longitudinal retinal nerve fiber layer (RNFL) and the cup-to-disc (C/D) ratio of the optic disc were detected by Stratus optical coherence tomography (OCT). The average RNFL thickness in the affected eye was greater than that in the unaffected eye on Day 3 (132.99 μm, C/D ratio: 0.24 vs. 105 μm, C/D ratio: 0.26). However, the RNFL thickness continued to decrease and the C/D ratio progressively increased in the affected eye over 12 months (60 μm, C/D ratio: 0.67), although the intraocular pressure was controlled at <21 mmHg during that period. Glaucomatous visual field defects were also found. A progressive decrease in the thickness of the RNFL was demonstrated by Stratus optical coherence tomography following an elevation in the acute intraocular pressure in the patient. Prompt treatment and longitudinal monitoring are necessary to prevent and detect glaucomatous damage.

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          Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT.

          Donald L. Budenz, Jonathan Savell, S Greenfield … (2007)
          To determine the effects of age, optic disc area, ethnicity, eye, gender, and axial length on the retinal nerve fiber layer (RNFL) in the normal human eye as measured by Stratus OCT (optical coherence tomography). Cross-sectional observational study. Three hundred twenty-eight normal subjects 18 to 85 years old. Peripapillary Fast RNFL scans performed by Stratus OCT with a nominal diameter of 3.46 mm centered on the optic disc were performed on one randomly selected eye of each subject. Linear regression analysis of the effects of age, ethnicity, gender, eye, axial length, and optic disc area on peripapillary RNFL thickness. The mean RNFL thickness for the entire population was 100.1 microm (standard deviation, 11.6). Thinner RNFL measurements were associated with older age (P<0.001); being Caucasian, versus being either Hispanic or Asian (P = 0.006); greater axial length (P<0.001); or smaller optic disc area (P = 0.010). For every decade of increased age, mean RNFL thickness measured thinner by approximately 2.0 microm (95% confidence interval [CI], 1.2-2.8). For every 1-mm-greater axial length, mean RNFL thickness measured thinner by approximately 2.2 microm (95% CI, 1.1-3.4). For every increase in square millimeter of optic disc area, mean RNFL thickness increased by approximately 3.3 microm (95% CI, 0.6-5.6). Comparisons between ethnic groups revealed that Caucasians had mean RNFL values (98.1+/-10.9 microm) slightly thinner than those of Hispanics (103.7+/-11.6 microm; P = 0.022) or Asians (105.8+/-9.2 microm; P = 0.043). There was no relationship between RNFL thickness and eye or gender. Retinal nerve fiber layer thickness, as measured by Stratus OCT, varies significantly with age, ethnicity, axial length, and optic disc area. These variables may need to be taken into account when evaluating patients for diagnosis and follow-up of glaucoma, particularly at the lower boundary of the normal range. Due to the relatively small numbers of subjects of Asian and African descent in the normative database, conclusions regarding the effect of ethnicity should be interpreted with caution.
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            Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients.

            Reginald B H Tan, Aliza Jap, Ching-Lan Cheng … (2008)
            To describe the clinical presentation of cytomegalovirus (CMV) anterior uveitis in human immunodeficiency virus (HIV)-negative patients. Retrospective, interventional case series. HIV-negative patients with anterior uveitis associated with elevated intraocular pressure (hypertensive anterior uveitis) seen at the Singapore National Eye Centre had their aqueous analyzed for viral deoxyribonucleic acid by polymerase chain reaction, and their records were reviewed for demographic data, ocular findings, laboratory results, and treatment. Aqueous was obtained from 105 of 106 eligible eyes. Twenty-four eyes demonstrated positive results for CMV (22.8%). Eighteen eyes had Posner-Schlossman syndrome (PSS; 75%) at presentation, five eyesba had Fuchs heterochromic iridocyclitis (FHI; 20.8%), and one eye had a presumed herpetic anterior uveitis. Twelve of the 24 eyes were treated with ganciclovir. Of the 12 who completed treatment, all responded clinically, and their aqueous demonstrated negative results for CMV on repeat testing. However, nine had recurrences within eight months of stopping treatment and required further courses of ganciclovir. The 81 CMV-negative eyes included 30 with PSS, 11 with FHI, 27 with uveitic glaucomas of unknown cause, and 13 with presumed herpetic anterior uveitis. CMV anterior uveitis is not uncommon in our immunocompetent patients and it may present as a recurrent acute or chronic inflammation, resembling PSS, herpetic anterior uveitis, or FHI.
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              Optic nerve head and retinal nerve fiber layer analysis: a report by the American Academy of Ophthalmology.

              Shan Lin, Kuldev Singh, Henry D. Jampel … (2007)
              To evaluate the current published literature on the use of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) measurement devices in diagnosing open-angle glaucoma and detecting progression. A search of peer-reviewed literature was conducted on February 15, 2006 in PubMed and the Cochrane Library for the period January 2003 to February 2006. The search was limited to studies of adults in English-language journals and yielded 442 citations. The panel reviewed the abstracts of these articles and selected 159 articles of possible clinical relevance for review. Of these 159 full-text articles, 82 were determined to be relevant for the first author and methodologist to review and rate according to the quality of evidence. There were no studies classified as having the highest level of evidence (level I). The ONH and RNFL imaging instruments reviewed in this assessment were determined to be highly effective in distinguishing eyes with glaucomatous visual field (VF) loss from normal eyes without VF loss, based on level II evidence. In addition, some studies demonstrated that parameters from ONH or RNFL imaging predicted the development of VF defects among glaucoma suspects. Studies on detecting glaucoma progression showed that although there was often agreement on progression between the structural and functional (VF) tests, a significant proportion of glaucoma patients progressed by either the structural or the functional test alone. The ONH and RNFL imaging devices provide quantitative information for the clinician. Based on studies that have compared the various available technologies directly, there is no single imaging device that outperforms the others in distinguishing patients with glaucoma from controls. Ongoing advances in imaging and related software, as well as the impracticalities associated with obtaining and assessing optic nerve stereophotographs, have made imaging increasingly important in many practice settings. The information obtained from imaging devices is useful in clinical practice when analyzed in conjunction with other relevant parameters that define glaucoma diagnosis and progression.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Taiwan J Ophthalmol
                Journal ID (iso-abbrev): Taiwan J Ophthalmol
                Journal ID (publisher-id): TJO
                Title: Taiwan Journal of Ophthalmology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2211-5056
                ISSN (Electronic): 2211-5072
                Publication date (Print): Apr-Jun 2015
                Publication date (Electronic): 17 February 2015
                Volume: 5
                Issue: 2
                Pages: 90-93
                Affiliations
                [1] Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
                Author notes
                [* ]Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan. E-mail address: tsai4118@ 123456ms26.hinet.net .
                Article
                Publisher ID: TJO-5-90
                DOI: 10.1016/j.tjo.2014.12.001
                PMC ID: 5602734
                SO-VID: d737e0e5-02d0-4580-a377-f3aa72b093be
                Copyright © Copyright: © 2015, The Ophthalmologic Society of Taiwan
                License:

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 26 July 2014
                Date revision received : 29 November 2014
                Date accepted : 23 December 2014
                Categories
                Subject: Case Report

                Keywords: glaucoma,glaucomatocyclitic crisis,optical coherence tomography,posner–schlossman syndrome,retinal nerve fiber layer
                Data availability:
                Keywords: glaucoma, glaucomatocyclitic crisis, optical coherence tomography, posner–schlossman syndrome, retinal nerve fiber layer

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