Stratus-OCT imaging in early glaucomatous and in ocular hypertensive patients with and without frequency-doubling technology abnormalities

Color Doppler imaging analysis of retrobulbar blood flow velocities in primary open-angle glaucomatous eyes: a meta-analysis

Background

To analyze the diagnostic value of color Doppler imaging (CDI) of blood flow in the retrobulbar vessels of eyes with primary open-angle glaucoma (POAG).

Methods

Pertinent publications were retrieved from the Cochrane Central Register of Controlled Trials, PubMed and the ISI Web of Knowledge up to October 2012. Changes in peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA) of POAG eyes and normal controls were evaluated by CDI. Subgroup analyses were conducted according to whether patients received IOP-lowering drugs treatment and were defined as treated and untreated.

Results

PSV and EDV were statistically significantly reduced in the OA of POAG eyes (P = 0.0002; P<0.00001; respectively), with significant heterogeneity (P_{heterogeneity}<0.00001, I² = 94%; P_{heterogeneity}<0.00001, I² = 85%; respectively). Similar results were demonstrated for the CRA (P<0.00001; respectively) and SPCA (P = 0.005; P<0.00001; respectively), with significant heterogeneities for both the CRA (P_{heterogeneity}<0.00001, I² = 81%; P_{heterogeneity}<0.00001, I² = 98%; respectively) and the SPCA (P_{heterogeneity}<0.00001, I² = 96%; P_{heterogeneity}<0.00001, I² = 93%; respectively). Significant increases in RI were found in all retrobulbar vessels (P<0.00001; respectively), with significant heterogeneities (P_{heterogeneity}<0.00001, I² = 95%; P_{heterogeneity}<0.00001, I² = 94%; P_{heterogeneity}<0.00001, I² = 97%; respectively).

Conclusions

This meta-analysis suggests that CDI is a potential diagnostic tool for POAG.

First-visit diagnosis of preperimetric glaucoma

Purpose:

To present a revised interpretation of the work-up data that enabled diagnosis of preperimetric glaucoma (PPG) at the first examination.

Methods:

a) Literature analysis on PPG; b) 6-year follow-up of a glaucoma-suspect patient.

Results:

Two new concepts may be adapted: (a) the objective finding of retinal nerve fiber layer (RNFL) thinning below the normal border in the opposing typical glaucoma locations, the inferior and superior quadrants, and in a non-diffuse pattern, appears asymptomatically and simultaneously only in glaucoma; and (b) the imaging-related RNFL thickness may be considered the reference glaucoma standard, whereas the suspicious early glaucomatous optic neuropathy, having a potential diagnostic inaccuracy, would serve as a complementary revealing finding. That approach enabled, in retrospect, a first-visit diagnosis of low-tension PPG in the patient. Diagnosis was confirmed after 6 years, when cecocentral scotoma and further RNFL thinning emerged despite treatment.

Conclusions:

A revised approach enabled PPG diagnosis during the first visit.