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Purpose: To assess the combined estimate of retinal ganglion cell (RGC) count developed by Medeiros et al. as a tool for diagnosis of glaucoma in Japanese patients. Study design: Cross-sectional study. Methods: Thirty-one eyes of 19 healthy controls and 106 eyes of 70 glaucoma patients underwent standard automated perimetry (SAP) and three types of spectral domain optical coherence tomography (SD-OCT) imaging using the Cirrus, RTVue, and 3D-OCT instruments. RGC counts derived from SAP and SD-OCT data were estimated using the Harwerth model (SAPrgc and OCTrgc, respectively), from which the combined RGC count estimates (CRGC) were calculated using the formula developed by Medeiros et al. Receiver operating characteristic curve (ROC) analyses were conducted for mean deviation (MD), retinal nerve fiber layer thickness (RNFLT), and CRGC. Results: The mean OCTrgc derived from the Cirrus, RTVue, and 3D-OCT instruments were 1150, 1245, and 1316 (× 1000 cells), respectively, for the control group and 463, 519, and 516 (× 1000 cells), respectively, for the patient group. SAPrgc of the controls' group was 1526 and the patients' group, 731 (× 1000 cells), and were consistently greater than OCTrgc in both groups (a generalized estimating equation model, p < 0.001). Partial area under the curve (pAUC) of MD was 0.178, and that of RNFLT and CRGC for the three OCT instruments were 0.185, 0.18, 0.189 and 0.196, 0.196, 0.197, respectively. CRGC had larger pAUC than MD, whereas there was no or marginal difference in pAUC between CRGC and cpRNFLT, irrespective of OCT device used or glaucoma severity. Conclusion: CRGC proved well suited to discriminate glaucoma patients from controls. However, its clinical utility did not seem to overwhelm isolated structural measures in the tested Japanese patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare the relationship between visual field sensitivity (VFS) and macular parameters measured using three spectral-domain optical coherence tomography (SD-OCT) instruments and to determine a base level (=floor effect) for macular parameters. Methods: We imaged 127 glaucomatous eyes (1 eye per subject) using three different OCT instruments, i.e., the Cirrus, RTVue and 3D OCT devices; 76 normal eyes were evaluated as controls using the same instruments. The thicknesses of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer+inner plexiform layer (GCL/IPL), and mRNFL+GCL/IPL (GCC) were analyzed. The VFS of the area analyzed by OCT was expressed in decibels and the 1/Lambert scale. For each parameter, the structure-function relationship and the base level were evaluated by regression analysis. The strength of the correlations between the instruments was compared by the bootstrapping method. Results: All of the macular parameters evaluated exhibited statistically significant correlations with VFS. The average GCC measured by all three SD-OCT instruments and the average mRNFL thickness measured by the Cirrus and 3D OCT instruments had similar correlations with VFS. The average GCL/IPL thickness measured by the Cirrus OCT instrument was better correlated with VFS that was measured by the 3D OCT instrument ( p = 0.031). The base level GCC thickness measured by all three instruments was approximately 65 % of that of normal eyes. The base level mRNFL thickness measured with the Cirrus and OCT instruments was 52 and 48 %, respectively, of that of normal eyes. The base level GCL/IPL thickness measured with the Cirrus and 3D instruments was 71 and 75 %, respectively, of that of normal eyes. Conclusions: The three SD-OCT instruments evaluated showed similar structure-function relationships in terms of GCC and mRNFL measurements. The base levels of the macular parameters determined by the three instruments differed, due, at least partly, to the scanning area defined by each instrument. [ABSTRACT FROM AUTHOR]

Purpose: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE).Retrospective observational study.We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications.Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR.SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE.Study design: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE).Retrospective observational study.We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications.Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR.SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE.Methods: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE).Retrospective observational study.We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications.Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR.SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE.Results: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE).Retrospective observational study.We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications.Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR.SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE.Conclusion: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE).Retrospective observational study.We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications.Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR.SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE. [ABSTRACT FROM AUTHOR]