PRECIS:The Baby Vision Screener (BaViS) is a device that can test visual fields in infants and young children. Using this device, visual field constriction can be documented in young children with primary congenital glaucoma. PURPOSE:Visual field extent is compromised in patients with glaucoma. While it is relatively easy to quantify visual fields in adults, monitoring visual fields in infants and young children with glaucoma is challenging. Lack of readily available diagnostic equipment is also a barrier. This study aimed to investigate the feasibility of a new device called Baby Vision Screener (BaViS) for measuring visual field extent in this population. METHODS:BaViS is a dome-shaped device with LEDs on its surface and an infrared camera mounted to monitor in real-time and record the tested individual's face, along with the presented stimuli. Stato-kinetic LED stimuli were presented in BaViS to perform kinetic perimetry. Fourteen infants (mean age ± SD: 4.4±3.4 mo) and 15 young children (mean age ± SD: 3.5±1.8 y) diagnosed with bilateral primary congenital glaucoma were tested using BaViS monocularly, binocularly, or both. RESULTS:Visual field isopters were plotted in 77% of the participants. The youngest infant tested using this device was 29 days old. The youngest participant for whom we could map a reliable visual field isopter was 2.3 months old. Constriction of the visual field was observed in 50% of the participants on whom a reliable visual field could be obtained. CONCLUSION:This preliminary study demonstrates that BaViS can be used to test the visual fields in young infants and children with glaucoma. Such a test may be useful for long-term follow-up until the child is ready to be tested using other conventional devices.
PRECIS:This study used fNIRS during a Go/No-Go task to reveal altered prefrontal activation in POAG patients, indicating compensatory cortical recruitment and subtle cognitive dysfunction, highlighting glaucoma's broader neurodegenerative and cognitive impact. PURPOSE:To evaluate cognitive function in individuals with primary open-angle glaucoma (POAG) by assessing prefrontal cortical activity during a behavioral inhibition test (Go/No-Go task) using functional near infrared spectroscopy (fNIRS). PATIENTS:Fifteen patients with mild to moderate POAG and fifteen age and gender matched healthy controls. METHODS:In this pilot case-control study, all participants underwent cognitive assessment using Addenbrooke's Cognitive Examination III (ACE-III), and quality-of-life assessment using EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Prefrontal cortical activation patterns were assessed in the prefrontal cortex using a 17-channel fNIRS system during a block-design Go/No-Go task assessing sustained attention and response inhibition. Using statistical parametric mapping (SPM) with general linear model (GLM) analysis, the study observed activation/deactivation in prefrontal cortical regions. RESULTS:Mean age and gender ratio were comparable between the two groups. POAG patients demonstrated significantly lower cognitive scores on ACE-III and reduced health-related quality of life compared to healthy controls (P<0.001). fNIRS demonstrated abnormal prefrontal activation in POAG, with significant hyperactivation during Go versus Rest at channels 8, 13, and 14 (P<0.05), not observed in healthy controls. Conversely, in No-Go vs Rest, healthy controls exhibited significant activation at channels 8, 10, and 15 (P<0.05), absent in POAG. Finally, the Go vs No-Go contrast revealed heightened deactivation in POAG at channel 17 (P<0.05), not observed in healthy controls. CONCLUSIONS:Patients with POAG demonstrated altered and less efficient prefrontal cortical activation patterns during tasks requiring attention and inhibition. These fNIRS based findings suggest early cortical dysfunction in glaucoma.
PRCIS:This study shows that GCC thickness is most sensitive for detecting progression at the onset of glaucoma, but less sensitive than cpRNFL thickness. These findings suggest no clear additional value of GCC thickness over cpRNFL overall, although further evaluation in larger cohorts with advanced glaucoma is warranted. PURPOSE:To compare the sensitivity of ganglion cell complex (GCC) thickness in the macula to circumpapillary retinal nerve fiber layer (cpRNFL) thickness from OCT, and Mean Deviation (MD) and Visual Field Index (VFI) from Standard Automated Perimetry (SAP), for detecting glaucomatous progression across glaucoma stages. METHODS:Using longitudinal data from 205 eyes (125 participants), contrast-to-noise ratios (CNRs) were calculated for GCC, cpRNFL, MD and VFI. Glaucoma stage was defined by MD. Contrast was the parameter difference between two stages; noise was the variability from linear regression residuals from five consecutive OCT scans and HFA 24-2 tests per eye. Higher CNR indicates greater sensitive for detecting progression between stages. RESULTS:CNRs ranged from 3.7 to 13.2. In the transition from suspect to mild glaucoma, cpRNFL (13.2) and GCC (8.7) had significantly higher CNRs than MD (4.5) and VFI CNR (4.8); cpRNFL was also significantly higher than GCC. No significant CNR differences were found between structural and functional measures in later stages. CONCLUSIONS:GCC thickness is more sensitive than functional measures, but less than cpRNFL thickness, for detecting progression at glaucoma onset. In later stages, structural and functional parameters showed comparable sensitivity within the limits of the available data.
The purpose of this brief report is to report on the outcome of glaucoma management in children after pars plana vitrectomy (PPV) in Alexandria Main University hospital. The Medical records of children presenting with glaucoma after PPV were reviewed. Data extracted included patients' demographic data, antenatal, natal and postnatal history, indication for PPV and surgical details, details of glaucoma surgery, clinical preoperative and postoperative follow up. Success of glaucoma surgery was defined as an IOP ≤ 16 mmHg and ≥ 20% reduction from the presenting IOP. The study included 9 eyes of 8 children, that had undergone PPV for ROP (6 eyes) and vitreous haemorrhage (3 eyes). All study eyes were subjected to combined trabeculectomy-trabeculotomy with Mitomycin C. The mean ± standard deviation of the age at glaucoma surgery and follow up duration were 7.9±4.43 and 11.1±10.0 months respectively. The mean ± standard deviation of the preoperative and last visit IOP and C/D ratio were 22.9±6.9 mmHg, 0.8±0.2, 16.9±5.8 mmHg (P=0.063) and 0.4±0.3 (P=0.036) respectively. The success rate at final follow up was 55.6%. In this study, glaucoma after PPV has a poor prognosis and does not generally respond to combined filtering and angle surgery.
PRCIS:Intraoperative triamcinolone injection plus a reduced topical steroid schedule was compared with the standard topical steroid regimen post-trabeculectomy. Overall success was similar between the groups, although complete success was more likely with the standard, intensive topical steroid schedule. PURPOSE:Compare trabeculectomy outcomes between patients receiving a standard prednisolone acetate postoperative regimen (Drop group) and those receiving intraoperative periocular injection of triamcinolone (16 mg) combined with a reduced steroid regimen (TAC group). PATIENTS AND METHODS:Patients receiving one of the 2 steroid regimens were reviewed retrospectively for 2 years postoperatively. Primary outcome was surgical success defined as (1) intraocular pressure (IOP) ≤18 mm Hg with >20% reduction without or with glaucoma medication (complete or qualified success); and (2) no clinical hypotony, further glaucoma surgery, or loss of visual acuity. RESULTS:Complete success at 24 months was 51.8% in the Drop group (56 eyes) and 37.5% in the TAC group (26 eyes; P =0.02 by logistic regression). Overall success (complete plus qualified) at 24 months was 88.8% in the Drop group and 87.5% in the TAC group, comparable in the 2 groups ( P =0.13). Postoperative IOP was similar between the 2 groups at 24 months (Drop: 10.26±3.75 mm Hg; TAC: 11.08±3.69 mm Hg; P >0.20). No differences were observed in surgical complications. CONCLUSION:Complete success is more likely in the Drop group, but overall success was high and similar between the 2 groups. These results suggest that TAC and an abbreviated steroid schedule are a viable alternative to the more intense traditional drop regimen, particularly in patients who might not be able to follow an intense postoperative drop schedule due to dexterity issues, inconvenience, or poor compliance.
