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Purpose To examine the risk of open-angle glaucoma (OAG) among patients receiving alpha1-adrenoceptor (α1-AR) antagonists for lower urinary tract symptoms (LUTS). Methods This was a nationwide, population-based, retrospective cohort study from Asia/Taiwan. One million beneficiaries were randomly sampled from among 27.38 million individuals enrolled in the National Health Insurance program, and subjects with a diagnosis of LUTS from 2001 to 2012 were identified (N = 105,341). After 1:1 propensity score matching by gender, age, comorbid medical diseases, number of all medical visits during the observational period, and index date, 4081 patients were enrolled in the study group, comprised of patients who had taken α1-AR antagonists, and 4081 patients were enrolled in the control group, comprised of patients who had never taken α1-AR antagonists. The incidence and risk of OAG (defined as two ambulatory visits with a ICD-9 diagnosis code 365, excluding ICD-9 diagnosis codes 365.2-365.6, 365.02, 365.03, 365.13, 365.14, and 365.8) were calculated. Results Patients taking α1-AR antagonists had a higher incidence ratio of 1.86 (95% confidence interval [CI], 1.30-2.65) for developing OAG. After adjusting for age, gender, and comorbidities, the hazard ratio (HR) for OAG for patients taking α1-AR antagonists was 1.66 (95% CI, 1.16-2.39; P = 0.006). Among patients with hypertension, the hazard ratio for OAG associated with taking α1-AR antagonists increased to 1.79 (95% CI, 1.07-2.99; P = 0.003). On the other hand, the association of α1-AR antagonists with OAG was not significant among patients with diabetes mellitus, hyperlipidemia, or older age. Conclusions The findings of our study suggest an increased risk for OAG among patients taking α1-AR antagonists for LUTS, especially in patients with hypertension.

Deep learning of fundus photograph has emerged as a practical and cost-effective technique for automatic screening and diagnosis of severer diabetic retinopathy (DR). The entropy image of luminance of fundus photograph has been demonstrated to increase the detection performance for referable DR using a convolutional neural network- (CNN-) based system. In this paper, the entropy image computed by using the green component of fundus photograph is proposed. In addition, image enhancement by unsharp masking (UM) is utilized for preprocessing before calculating the entropy images. The bichannel CNN incorporating the features of both the entropy images of the gray level and the green component preprocessed by UM is also proposed to improve the detection performance of referable DR by deep learning.

OBJECTIVE To investigate the relationship between diabetes and future development of age-related macular degeneration (AMD). RESEARCH DESIGN AND METHODS Longitudinal, retrospective cohort study data for the period between 1997 and 2012 were obtained from the Longitudinal Health Insurance Database (LHID) of Taiwan. The final available 71,904 patients with diabetes and 270,213 patients without diabetes ≥50 years of age were further matched by age, sex, and Charlson comorbidity index. In the end, 54,616 study subjects in each of the diabetes and nondiabetes groups were recruited. The stratified populations of patients with diabetes with diabetic retinopathy (DR) (n = 7,119) versus those with diabetes who do not have DR (n = 7,119) and populations of patients with proliferative DR (PDR) (n = 2,134) versus those with nonproliferative DR (NPDR) (n = 2,134) were also obtained. Competing risk regression models were used to assess the adjusted hazard ratio (HR) and 99% CI. The main outcome measures were the first-ever diagnosis of AMD during the observational period. RESULTS The incidences of nonexudative AMD (HR 1.23; P = 0.108) and exudative AMD (HR 1.37; P = 0.023) were not significantly associated with cohorts of persons with diabetes compared with cohorts without diabetes. The stratified analysis showed that nonexudative AMD (HR 3.89; P = 0.001) and exudative AMD (HR 3.42; P < 0.001) were significantly correlated to diabetes with DR cohorts, compared with diabetes without DR cohorts. The incidences of nonexudative AMD (HR 0.53; P = 0.277) and exudative AMD (HR 2.27; P = 0.058) were not significantly different between PDR cohorts compared with NPDR cohorts. CONCLUSIONS This study provides large-scale, population-based evidence that diabetes with retinopathy is independently associated with an increased risk of subsequent AMD development.

Purpose To evaluate the anterior chamber angle status and estimate the intraocular pressure (IOP) in patients with mucopolysaccharidoses (MPSs) type I, II, IV, and VI. Design Prospective cross-sectional study. Methods This study enrolled 27 consecutive MPS patients (8 patients with MPS I, 4 patients with MPS II, 9 patients with MPS IV, and 6 patients with MPS VI) and 20 normal control subjects. Anterior chamber angle status was evaluated by swept-source optical coherence tomography and IOP was estimated by the new-generation tonometer Corvis ST. Results Twelve eyes (6 patients) of 15 eyes (8 patients) with MPS I had narrow angles or peripheral iridocorneal touches together with elevated IOP (80%). Six eyes (3 patients) of 8 eyes (4 patients) with MPS II had plateau iris configuration, but all 8 eyes had normal IOP. All 18 eyes (9 patients) with MPS IV had normal angle structures, but 8 eyes (4 patients) had elevated IOP (44.4%). Nine eyes (5 patients) of 11 eyes (6 patients) with MPS VI had shallow but not closed angles (81.8%). Among these 9 eyes, 5 eyes had elevated IOP, and 4 of these 5 eyes had IOP >30 mm Hg. The trabecular iris angles of MPS types I, II, and VI were smaller than those of MPS type IV and of the control subjects. The angle recess areas of MPS types I and VI were smaller than those of MPS type IV and of the control subjects. Conclusions MPS type I patients are prone to have glaucoma with narrow or closed angles; MPS type II patients tend to have plateau iris; MPS type IV patients are vulnerable to open-angle glaucoma; MPS type VI patients have narrow angles not as close as those of MPS type I. MPS types I, IV, and VI had higher IOP estimates than the control subjects, but only MPS I and IV had higher corrected IOP estimates than the control subjects. The ordinary IOP estimates in MPS VI patients may be falsely high because of clouded corneas and increased corneal rigidity. Swept-source optical coherence tomography helps ophthalmologist investigate the angle structure and the pathophysiology of glaucoma caused by MPS.

Purpose: To report the effectiveness of combined surgery for neovascular glaucoma. Methods: Six eyes of six consecutive patients with neovascular glaucoma underwent the com- bined surgery: trabeculectomy with Mitomycin C, Pars Plana Vitrectomy (PPV), endolaserpan- retinal photocoagulation, intravitreal and intracameral injection of bevacizumab. Results: The intraocular pressure returned to normal range soon after operation. The neovas- cularization of iris regressed in a few days. Mild hyphema developed in three patients. All six patients had improved or stable visual acuity, and achieved normal intraocular pressure without antiglaucoma medications three months after operation. Conclusions: This combined surgery may break the vicious cycle of neovascularglaucoma and preserve useful vision in these patients.

A diabetic woman had been suffering from progressively blurry vision in the right eye for 1 year after cataract surgery. Slit lamp examination revealed bilateral band keratopathy with quiescent anterior-chamber reaction, an intumescent cataract in the left eye, and dense posterior capsular opacity in the right eye. Capsulotomy was performed, but this led to neovascular glaucoma. Because of a refractory elevation in intraocular pressure, trabeculectomy with mitomycin C treatment, vitrectomy with panretinal photocoagulation, and intravitreal injection of bevacizumab were performed. A positive rapid plasma reagin test and a positive Treponema pallidum hemagglutination assay led to the impression of syphilitic uveitis, and the patient was treated with intravenous penicillin for 2 weeks. The visual acuity of the right eye was 0.1 at the 12th-month follow up. This case shows that neovascular glaucoma may present as a complication of capsulotomy in uveitic/diabetic eyes.

Obstructive sleep apnea (OSA) causes intermittent nocturnal hypoxemia and is associated with obesity, diabetes, inflammation, endothelial dysfunction, and hypertension, possibly leading to micro- and macro-vascular disease. OSA has been associated with higher risk of clinical cardiovascular disease (CVD) independent of traditional risk factors and severity of atherosclerosis. Microvascular disease may be a potential mediator for the association of OSA with clinical CVD. However, evidence for the association between OSA and microvascular dysfunction is conflicting. Since the retinal microvasculature is structurally and functionally similar to microvasculature elsewhere in the body and can be directly visualized via ophthalmoscopy, several studies have assessed the relationship of OSA with retinal microvascular characteristics but shown inconsistent results. Notably, the multi-ethnic study of atherosclerosis (MESA) recently revealed that the associations of OSA severity with retinal microvascular signs may differ by sex. Moderate/severe OSA was associated with retinal vascular calibers in men, but not women.

Immunoglobulin G4 (IgG4)-related disease is characterised by numerous aggregates of IgG4-positive plasma cells in multiple organs. We report two patients who had bilateral proptosis associated with extensive inflammation bilaterally in lacrimal glands, optic nerves, trigeminal nerves, and maxillary sinuses. The patients were treated as idiopathic orbital inflammation syndrome with corticosteroid pulse therapy. As symptoms relapsed upon tapering, a reassessment of immunohistochemical stains of the lacrimal glands confirmed the diagnosis of IgG4-related disease. During 2 years of follow-up, the inflammation regressed spontaneously without any medical treatment in the first patient; however, inflammation in the other patient progressed, and he lost his vision. The extensive orbital involvement, characteristic pathological findings, and slowly progressive clinical course might help practitioners differentiate orbital IgG4-related disease from presumed idiopathic orbital inflammation syndrome.

Delayed suprachoroidal hemorrhage (DSCH) is a rare but devastating complication of trabeculectomy, usually resulting in a poor visual prognosis. The typical presentation of DSCH includes acute visual loss, high intraocular pressure, a shallow anterior chamber, and choroidal elevation. We report a patient with hypertension who had DSCH following trabeculectomy, with an unusual presenting picture of a large blood clot hanging in a deep anterior chamber. Anterior chamber irrigation and choroidal taps were performed immediately. The intraocular pressure was soon controlled, and the visual acuity returned to 20/25 in 6 months.

ObjectivesTo compare cycloplegic wavefront refraction, autorefraction, and subjective manifest refraction.Materials and MethodsThirty-one myopic eyes in 17 patients were studied. Subjective manifest refraction was measured and deemed as the true refraction status. After inducing cycloplegia by administering 1% tropicamide, cycloplegic autorefraction was measured using a Topcon autorefractor, and wavefront refraction was measured with an Allegretto wave analyzer. Refraction data were presented as the spherical equivalent and astigmatism. Astigmatism was converted to vector power and analyzed by the Alpins method.ResultsBoth cycloplegic wavefront refraction and autorefraction showed good correlations with subjective refraction. The adjusted R2 value was 0.9726 between cycloplegic autorefraction and subjective manifest refraction, and 0.9693 between cycloplegic wavefront refraction and subjective manifest refraction. Compared with subjective manifest refraction, a myopic shift of −0.14 ± 0.06 D was noted in cycloplegic wavefront refraction (p = 0.0182). However, cycloplegic autorefraction was not different from subjective manifest refraction (p = 0.55). Astigmatism in both wavefront refraction and autorefraction differed from subjective astigmatism (p

In this report, we describe a Taiwanese (Han Chinese) family with Leber's hereditary optic neuropathy. The family carried a mitochondrial DNA mutation (mtDNA m.14484T>C) associated with spontaneous visual improvement. A 15-year-old boy from this family was diagnosed with Leber's hereditary optic neuropathy 6 months after losing his vision. His vision recovered after 8 months of supportive treatment. His mother, older brother, and two sisters also had the same mutation and had previously experienced vision loss. In this family, there was no male predominance.

PurposeTo investigate the influence of tropicamide 1% (as a cycloplegic mydriatic) and phenylephrine 10% (as a noncycloplegic mydriatic) on mydriasis, wavefront refraction, and wavefront aberrations.MethodsIn this prospective study, 31 myopic eyes with a large mesopic pupil size were evaluated with an Allegretto Wave analyzer in a natural dilated state, after instillation of tropicamide 1% or phenylephrine 10%. Aberrations expressed as Zernike polynomials up to the sixth order were analyzed. Wavefront refractions were compared with subjective manifest refraction.ResultsBoth tropicamide and phenylephrine cause significant mydriasis (p