The Effect of Ametropia on Glaucomatous Visual Field Loss

Myopia has been discussed as a risk factor for glaucoma. In this study, we characterized the relationship between ametropia and patterns of visual field (VF) loss in glaucoma. Reliable automated VFs (SITA Standard 24-2) of 120,019 eyes from 70,495 patients were selected from five academic institutions. The pattern deviation (PD) at each VF location was modeled by linear regression with ametropia (defined as spherical equivalent (SE) starting from extreme high myopia), mean deviation (MD), and their interaction (SE × MD) as regressors. Myopia was associated with decreased PD at the paracentral and temporal VF locations, whereas hyperopia was associated with decreased PD at the Bjerrum and nasal step locations. The severity of VF loss modulated the effect of ametropia: with decreasing MD and SE, paracentral/nasal step regions became more depressed and Bjerrum/temporal regions less depressed. Increasing degree of myopia was positively correlated with VF depression at four central points, and the correlation became stronger with increasing VF loss severity. With worsening VF loss, myopes have increased VF depressions at the paracentral and nasal step regions, while hyperopes have increased depressions at the Bjerrum and temporal locations. Clinicians should be aware of these effects of ametropia when interpreting VF loss.

Modified superior oblique intrasheath tenectomy in A-pattern with superior oblique overaction

Background To evaluate the effect of modified superior oblique intrasheath tenectomy (MSOIT) on superior oblique overaction (SOOA) with A-pattern. Methods We retrospectively reviewed the data of 66 patients (130 eyes) with SOOA and A-pattern underwent MSOIT at the nasal border of the superior rectus under an operating microscope between January 1, 2004 and December 31, 2018. The superior oblique (SO) tendon fibres were resected, and the sheath was preserved in all patients. The preoperative and postoperative SOOA, objective torsion, ocular motility, and A-pattern deviation findings were compared. The correlation between the preoperative A-pattern deviation and the corrected deviation was analysed. The average follow-up period was 33.45 ± 29.88 (range: 12–122) months. Results The mean SOOA deviation improved from 2.95 ± 0.54 to 0.34 ± 0.55 (P < 0.001), while the A-pattern deviation difference between upgaze and downgaze improved from 23.15 ± 7.59 prism diopters (PD) to 3.50 ± 2.90 PD (P < 0.001). The average objective fundus intorsion value improved from + 2.96 ± 0.58 to + 0.38 ± 0.60 (P < 0.001). The magnitude of correction in A-pattern was significantly correlated with the preoperative severity of A-pattern (r = 0.812, P < 0.001). Conclusions MSOIT at the nasal border of the superior rectus (SR) under an operating microscope is safe and yields beneficial outcomes in patients with SOOA and A-pattern.

Estimation of the Absolute Defects in the Visual Field using OCT in Glaucoma Patients who Cannot Perform a Reliable Test.

Background: To find a method to predict the visual field (VF) of glaucoma patients who cannot perform a reliable test by using RNFL thickness and VF of other glaucoma patients. Methods: Seventy eight primary open angle and pseudoexfoliation glaucoma follow-up patients were included in the study. Optic disc OCT measurements and VF analysis were obtained in the same day. Garway-Heats maps made, RNFL sectors matched with pattern deviation 24-2 VF sectors and absolute defects were counted. Regression analysis were made. Equations generated between RNFL thickness and absolute defect number. Correlation analysis were performed for the numbers of absolute defects and the findings.Results: The regression analysis was significantly linear for defect number and RNFL thickness in sectors 3, 4, and 6 (t values were 0.047, 0.04, and 0.001, respectively, p < 0.05). The analysis was nonlinear in other sectors (t values were 1.66, 0.37, 0.14, 0.88, and 0.36, respectively, for sectors 1, 2, 5, 7, and 8, p > 0.05). The linear and nonlinear equations were generated for these sectors. The correlation between the number of absolute defects of the patient and the number we found by using our formulas in VF Sectors of 1,3,4 and 8 there was a strong correlation (r=0.68, r=0.57, r=0.82 and r=0.58 respectively). In VF sectors 3,5,6 and 7 there was a weak correlation (r= 0.22, r= 0.47, r=0.32 and r=0.48 respectively).Conclusion: We think the method that we found is practical to predict the VF of a patient who can not perform it.

Modified Superior Oblique Intrasheath Tenectomy in a-pattern With Superior Oblique Overaction

Background: To evaluate the effect of modified superior oblique intrasheath tenectomy (MSOIT) on superior oblique overaction (SOOA) with A-pattern.Methods: We retrospectively reviewed the data of 66 patients (130 eyes) with SOOA and A-pattern underwent MSOIT at the nasal border of the superior rectus under an operating microscope between January 1, 2004 and December 31, 2018.. The preoperative and postoperative SOOA, objective torsion, ocular motility, and A-pattern deviation findings were compared. The correlation between the preoperative A-pattern deviation and the corrected deviation was analysed. All patients were followed up for more than 12 months. Results: The superior oblique (SO) tendon fibres were resected, and the sheath was preserved in all patients. The average follow-up period was 33.45±29.88 (range: 12–122) months. The mean SOOA deviation improved from 2.95±0.54 to 0.34±0.55 (P < 0.001), while the A-pattern deviation difference between upgaze and downgaze improved from 23.15±7.64 prism dioptres (PD) to 3.50±2.90 PD (P < 0.001). The average objective fundus intorsion value improved from +2.96±0.58 to +0.38±0.60 (P < 0.001). The magnitude of correction in A-pattern was significantly correlated with the preoperative severity of A-pattern (r = 0.812, P<0.001).Conclusions: MSOIT at the nasal border of the superior rectus (SR) under an operating microscope is safe and yields beneficial outcomes in patients with SOOA and A-pattern.

The efficacy of superior oblique posterior tenotomy in the treatment of A-pattern strabismus without ocular intorsion: A retrospective study

Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion. Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tenectomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical alignment change and the superior oblique posterior tenectomy procedure. Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction associated A pattern strabismus without ocular intorsion.

The efficacy of superior oblique posterior tenectomy in the treatment of A-pattern exotropia without ocular intorsion: A retrospective study

Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion. Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tentomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs. Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical and horizontal alignment change and the superior oblique posterior tenectomy procedure. Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical and horizontal deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction (SOOA)-associated A pattern strabismus without ocular intorsion.