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In both pre-perimetric and early perimetric glaucoma, the diagnostic agreements between optic disc, retinal nerve fiber layer and ganglion cell inner plexiform layer parameters based on Cirrus HD-OCT normative database classification were mostly fair, suggesting that abnormal classification in one anatomic area may suffice for the diagnosis of glaucoma in early stages.To evaluate the agreement of normative database diagnostic classification between optic disc, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) in patients with early glaucoma.Retrospective cross-sectional study involving 66 eyes (66 patients) with pre-perimetric and 97 eyes (97 patients) with early perimetric glaucoma. Normative database diagnostic classifications were retrieved from Cirrus HD-OCT scans of one eye per participant. An eye was considered abnormal if any of the optic disc, RNFL, or GCIPL was abnormal (yellow or red color-coded classification). For combined parameters, the eye had to be flagged as abnormal by both classifications, regardless of the parameters that were abnormal (global or sectorial). Agreement was assessed with Cohen's Kappa statistics.The agreement between RNFL and GCIPL was fair in both pre-perimetric (κ=0.25) and perimetric glaucoma (κ=0.21). Agreements between RNFL or GCIPL and ONH parameters (rim area and vertical cup-to-disc ratio; VCDR) were inconclusive due to insufficient date (P0.05). Combining GCIPL and rim area agreed fairly with RNFL both in pre-perimetric (κ=0.21) and perimetric glaucoma (κ=0.33). The best classification agreement (moderate) was achieved with the comparison RNFL-rim area versus VCDR (κ=0.48 in pre-perimetric, 0.45 in perimetric glaucoma). There were no significant differences between pre-perimetric and perimetric glaucoma coefficients of classification agreement.The normative database diagnostic agreements between optic disc, RNFL, and GCIPL were mostly fair in both pre-perimetric and early perimetric glaucoma. Clinicians should not wait for multiple structures to show abnormality on OCT to diagnose early glaucoma.

Purpose. To compare two threshold strategies for visual field assessment, ZETA Fast (Optopol Technology) and Humphrey SITA Fast (Carl Zeiss Meditec), in controls and subjects with glaucoma. Patients and Methods. A prospective case-control study was carried out in which the clinical practice study included 26 controls and 26 glaucoma subjects. Testing for each strategy was monocular. Quantitative comparisons of mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and test duration were made using two one-sided t-tests and Wilcoxon signed-rank tests. Confusion matrices were constructed to assess Optopol’s detection as a proxy for Zeiss’s detection of early glaucomatous defects. Receiver operating characteristic (ROC) curves were used to assess MD and PSD’s discriminability. Results. The difference in MD values (Optopol-Zeiss) was within the margin for controls (difference = 0.36, p = 0.06 ), but not for glaucomatous subjects (difference = 2.16, p = 1.0 ). The Optopol strategy took longer than the Zeiss strategy in both controls (difference = 23 seconds, p = 0.001 ) and glaucomatous subjects (difference = 49 seconds, p < 0.001 ). PSD values were higher and VFI values were lower from Optopol in glaucomatous subjects ( p < 0.001 and p = 0.002 ). Optopol was 92% sensitive in capturing early glaucomatous defects with MD p < 0.001 ). ROC analysis shows Optopol yields higher discriminability than Zeiss for MD/PSD indices. Conclusions. Both strategies enable effective identification of glaucomatous defects within 6 minutes; they also offer high sensitivity with a high correlation in global indices between the two strategies. The Optopol strategy is an alternative to the Zeiss counterpart with the limitation of a marginally longer testing protocol but a higher sensitivity of detecting glaucomatous defects.

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum which is undergoing a global resurgence since its initial decline in the late 1980s. The authors present the case of a 30-year-old Caucasian female who was transferred to our institution for left-sided orbital cellulitis and ultimately diagnosed with ocular syphilis causing panophthalmitis. She was treated with intravenous penicillin and other broad-spectrum antibiotics, topical prednisolone, and cycloplegia, resulting in full recovery. Timely recognition of ocular syphilis by healthcare professionals is key in the prevention of visual sequelae from the infection.

Steven R Sarkisian,1 Basil Mathews,2 Kai Ding,2 Aashka Patel,2 Zachary Nicek2 1University of Oklahoma College of Medicine, Dean McGee Eye Institute, Oklahoma City, OK, USA; 2University of Oklahoma, Oklahoma City, OK, USA Purpose: The purpose of this study was to evaluate the safety and efficacy of microinvasive glaucoma surgery (MIGS) with 360° ab-interno trabeculotomy using the TRAB360 device as a stand-alone procedure in patients with refractory primary open-angle glaucoma (POAG) and preoperative IOP ≥18 mmHg.Setting: This study evaluated patients treated in a tertiary-referral clinical practice setting.Design: This study is a retrospective analysis of 81 eyes.Methods: Patients with refractory open-angle glaucoma underwent stand-alone 360° ab-interno trabeculotomy using the TRAB360 device. Effectiveness was determined by reduction in medicated IOP and the use of medications from baseline. Safety was determined by the rate of adverse events and secondary surgical interventions. The time points assessed were baseline and postoperative day 1, week 1, and months 1, 3, 6, and 12. A subgroup analysis was performed on eyes with medicated preoperative IOP values of ≥25 mmHg.Results: The reductions in IOP from 1 day to 12 months postoperatively were statistically significant compared to baseline values. The mean reduction in IOP at 12 months was 7.3±6.7 mmHg from baseline. At 12 months, 59% eyes achieved ≥20% reduction in IOP and IOP

Uterine rupture is a life-threatening emergency in obstetrics carrying an increased risk of maternal and foetal morbidity and mortality. Often, uterus ruptures during labour; however, scarred uterus may rupture before the onset of contractions in the late third trimester. Uterine rupture in an unscarred uterus occurs extremely rare. Various aetiology has been described in literature from anomalous uterus, uterine manoeuvres, and abnormal placentation to congenital exposure to Diethylstilbestrol. Maternal outcome depends greatly on the early diagnosis, prompt management and availability of emergency expert care and blood transfusion. However, the diagnosis is not always obvious with its varied non-specific presentation. Most common presentation of rupture uterus is acute abdomen, which is often mistaken for other causes like acute pancreatitis, appendicitis, cholecystitis, especially in the early pregnancy. Authors report a case of grand multipara at 19 weeks of gestation presented as acute abdomen. She was referred as incomplete abortion in need of blood transfusion, later diagnosed to be rupture of uterus. She had abdominal pain and vaginal bleeding for 14hours duration prior to admission. On further inquiry, history of blunt trauma to abdomen, the day prior was revealed.

Background: Oocyte retrieval in women with low ovarian reserve is challenging and often results in poor pregnancy outcomes. Aim: The aim was to compare outcomes of oocyte retrieval using three aspiration methods in women with normal and low antral follicle counts (AFCs). Study Design: Retrospective cohort study. Setting: Tertiary care hospital. Materials and Methods: Data from 172 women who underwent in-vitro fertilization/intracytoplasmic sperm injection over 3 years was studied after dividing into three groups: Group A (96) - normal AFC (≥10), direct oocyte retrieval at 120 mmHg, Group B (41) - low AFC ( 0.05) but were significantly less in Group C (P < 0.05). The pregnancy rates in Groups A and B were similar (35.4%, 39%) but were significantly less (17.1%) in Group C (P < 0.05). The live birth rate was 76% in Group A, 69% in Group B, and 50% in Group C. The miscarriage rates in the three groups were 21%, 31%, and 50%, respectively. Conclusion: Direct oocyte retrieval with 140-mmHg showed significantly better oocyte yield and pregnancy outcomes compared to flushing and aspiration in women with low AFC.

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