Purpose:To investigate spatially distinctive features in fundus photographs of highly myopic glaucoma (HMG) by integrating radiomics and deep learning. Design:Cross-sectional study. Participants:Semi-automated optic disc segmentation was performed on 2000 images sourced from the Retinal Fundus Glaucoma Challenge Edition and Pathologic Myopia Challenge public data sets. We trained models with 628 images, including 217 cases of high myopia (HM), 221 cases of primary open-angle glaucoma (POAG), and 190 cases of HMG. An external validation set of 106 images was collected including 31, 36, and 39 fundus photographs from patients with HM, HMG, and POAG, respectively. Methods:Semi-automated optic disc segmentation was performed by U-Net combined with manual delineation. Additionally, 5 regions of interest (ROIs) covering the optic disc and its surrounding region were explored. Fundus photography-based radiomics feature selection and optimization were conducted using random forest and support vector machine algorithms, which underwent fivefold cross-validation. Model performance was evaluated for radiomics, clinical, and combined models. An external validation set was used to evaluate the models performance, and we also examined radiomics features varied across glaucoma stages. Main Outcome Measures:A total of 414 radiomics features were extracted from 5 regions of interest. We evaluated the model performance using accuracy, recall, precision, F1 score, and area under the receiver operating characteristic curve (AUROC). The Youden index was used to determine the cut-off value, and sensitivity and specificity were calculated. Results:The U-Net-based optic disc segmentation reached a Dice Similarity Coefficient of 0.95. The radiomics model detected HMG from HM and POAG achieved the accuracies of 0.97 and 0.85, respectively. Both results exceeded the performance of the clinical model, which achieved 0.90 and 0.71. The top radiomics features achieved AUROC of 0.984 and 0.855 for HMG versus HM and HMG versus POAG in the external validation, respectively, including intensity features in the extra-optic nerve and textural features in the optic nerve. These features showed strong diagnostic capability when stratified by Youden values and exhibited independence from glaucoma progression. Conclusions:The study combined U-Net and radiomics to delineate the spatial distribution biomarkers of HMG, establishing a quantitative classification model correlated with anatomical features. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The ultrasound biomicroscope (UBM), leveraging the characteristics of high-frequency ultrasound (50-100 MHz), has overcome the limitations of optical examinations and emerged as a crucial tool for measuring and evaluating anterior segment structures. It is widely applied in various fields, including corneal diseases, glaucoma, cataracts, ocular trauma, and refractive surgery. However, several issues persist in current UBM parameter measurements: the lack of parameter standardization results in different names for the same parameter or inconsistent definitions for parameters with the same name; non-standardized measurement methods lead to poor comparability across different studies; and inadequate and non-detailed image quality standards affect measurement accuracy. These problems undermine the precision of measurements and constrain multi-center research and data interoperability. To address these challenges, this review systematically outlines standardized measurement methods for UBM parameters related to the cornea, anterior chamber, anterior chamber angle, iris, posterior chamber, lens and zonular fibers, and ciliary body. It also summarizes contradictions in parameter definitions across different studies. Furthermore, factors contributing to measurement errors are analyzed, including discrepancies between the assumed and actual sound velocities, interference from contact-based operation on the eyeball, variations in operator experience, and objective differences compared to measurements from other devices. Building on this analysis, we propose improvement strategies, such as establishing standardized examination protocols, clarifying parameter definitions and measurement methods, developing scenario-specific image quality standards, and implementing unified device calibration schemes. In the future, UBM parameter measurement is expected to achieve automated parameter measurement with the aid of artificial intelligence (AI). By integrating three-dimensional imaging technology and Doppler techniques, it will enhance the comprehensiveness of parameters and evolve toward intelligence and multi-dimensionality, providing more holistic support for precision ophthalmic diagnosis and treatment.

High myopia (HM) is a major risk factor for glaucoma. However, glaucomatous optic neuropathy is often undiagnosed owing to atypical structural alterations with axial elongation. Moreover, an algorithm to detect glaucoma in highly myopic eyes has not yet been reported. We recruited 2643 colour fundus photographs to train a ResNet-50 network for discriminating eyes with highly myopic glaucoma (HMG) from HM or glaucoma alone. We employed a 10-fold cross-validation strategy to evaluate the model's performance and applicability across diverse patient groups. Multiple metrics were computed to gauge the model's diagnostic process. The diagnostic ability of the model was then juxtaposed with those made by ophthalmologists to determine concordance. The gradient-weighted class activation maps were used for visual explanations. Our model demonstrated an overall accuracy of 97.7% with an area under the curve of 98.6% (sensitivity, 91.2%; specificity, 98.0%) for the differential diagnosis among HM, glaucoma, HMG and normal controls. These metrics notably outperformed the diagnostic performances of two attending ophthalmologists, who achieved accuracies of 64.7% and 69.9%. The activation maps derived from the model suggested that the most discriminative lesions for diagnosing HMG were predominantly in the disc, peripapillary area and inferior region of the disc, which are often displayed with a tessellated fundus. These results were slightly different from the understanding of the attending ophthalmologists. Our proposed model demonstrates high efficacy and suggests specific features for distinguishing eyes with HMG, enabling potential clinical value in assisting the intricate diagnosis of this vision-threatening disease.

BackgroundHigh myopia (HM) is a major risk factor for glaucoma. However, glaucomatous optic neuropathy is often undiagnosed owing to atypical structural alterations with axial elongation. Moreover, an algorithm to detect glaucoma in highly myopic eyes has not yet been reported.MethodsWe recruited 2643 colour fundus photographs to train a ResNet-50 network for discriminating eyes with highly myopic glaucoma (HMG) from HM or glaucoma alone. We employed a 10-fold cross-validation strategy to evaluate the model's performance and applicability across diverse patient groups. Multiple metrics were computed to gauge the model's diagnostic process. The diagnostic ability of the model was then juxtaposed with those made by ophthalmologists to determine concordance. The gradient-weighted class activation maps were used for visual explanations.ResultsOur model demonstrated an overall accuracy of 97.7% with an area under the curve of 98.6% (sensitivity, 91.2%; specificity, 98.0%) for the differential diagnosis among HM, glaucoma, HMG and normal controls. These metrics notably outperformed the diagnostic performances of two attending ophthalmologists, who achieved accuracies of 64.7% and 69.9%. The activation maps derived from the model suggested that the most discriminative lesions for diagnosing HMG were predominantly in the disc, peripapillary area and inferior region of the disc, which are often displayed with a tessellated fundus. These results were slightly different from the understanding of the attending ophthalmologists.ConclusionsOur proposed model demonstrates high efficacy and suggests specific features for distinguishing eyes with HMG, enabling potential clinical value in assisting the intricate diagnosis of this vision-threatening disease.

BACKGROUND:Ocular hypertension (OHT) is the most significant risk factor for glaucoma. We aimed to develop a model for predicting OHT progression to early glaucoma and to identify key predictors. METHODS:Patients with OHT with at least two follow-up visits within 3 years were categorized into non-progressive and progressive groups based on optic nerve morphology and/or functional changes during follow-up. Data were split into training and testing sets (8:2 ratio). Least absolute shrinkage and selection operator regression and logistic regression were used to select predictors. Machine learning models were constructed using the selected predictors as input and evaluated using area under the receiver operating characteristic (AUC) and precision-recall (AP) curve values. The optimal model was further evaluated using 10-fold cross-validation and a validation set. The Shapley additive explanations method was applied to interpret the predictors. RESULTS:Overall, 395 eyes from 395 patients were included (non-progressive: n = 295; progressive: n = 100). The random forest model outperformed all others, achieving AUC values of 0.881 (95 % confidence interval [CI]: 0.835-0.926) in the training set and 0.937 (95 % CI: 0.884-0.991) in the testing set. In the independent validation set (n = 82), the AUC and AP values were 0.865 (95 % CI: 0.782-0.947) and 0.707, respectively. Key predictors were baseline intraocular pressure, rim area, ganglion cell-inner plexiform layer (GCIPL) inferior-temporal thickness difference, and GCIPL superior-temporal thickness difference. Family history and male sex also contributed. CONCLUSIONS:The developed model could effectively predict the risk for OHT progression to early glaucoma and may aid devising individualized treatment plans and follow-up protocols.

AbstractRetinitis pigmentosa (RP) is characterized by progressive photoreceptor cells death accelerated by the proliferation and activation of microglia pathologically. No consensus exists on the treatment. Minocycline is recognized as a microglia inhibitor with great anti-inflammatory and neuro-protective functions. However, efficacy of minocycline in RP patients is lacking. We conducted a prospective, open-label, and single-arm trial, in which daily oral minocycline of 100 mg was administered for 12 months in RP patients with light-adapted 30 Hz flicker electroretinography (ERG) amplitude >0 µV in at least one eye (NCT04068207). The primary outcome was the proportion of participants with improvement in the ERG amplitude at month 12. The secondary outcomes included improvements of the following items: other ERGs amplitudes, visual field, best-corrected visual acuity, contrast sensitivity, color vision, and NEI-VFQ-25. 35 of 288 patients met inclusive criteria were enrolled (median [IQR] age, 36 [31–45] years; 17 female [48.6%]). 32 participants completed all examinations, while 3 participants completed the 12-month online visit via conducting NEI-VFQ-25. The primary outcome showed improvement was 34.3% (12 of 35 [95% CI 19.1–52.2]). Similarly, all secondary outcomes showed improvements. Adverse events were reported in 22 participants (62.9%) and were all resolved without extra medication during the study period. No severe adverse events were recorded. Our findings identified daily oral minocycline of 100 mg for 12 months was beneficial in improving the visual function of RP patients with good safety. This study indicates minocycline may be a promising therapy for RP, but a randomized controlled trial is still needed of further exploration.

BACKGROUND:Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS), autoimmune inflammatory diseases of the central nervous system, affect the optic nerve and brain. A lumbar puncture to obtain biomarkers is highly invasive. Serum biomarkers and optical coherence tomography angiography (OCTA) are more accessible and less expensive than magnetic resonance imaging and provide reliable, reproducible measures of neuroaxonal damage. This study investigated the association between serum neurofilament light chain (sNfL), serum glial fibrillary acidic protein (sGFAP), and OCTA metrics. Serum sNfL and sGFAP levels, OCTA values, and clinical characteristics were compared among 91 patients with NMOSD, 81 patients with MS, and 34 healthy controls (HCs) at baseline and 1-year follow-up.RESULTS:sNfL and sGFAP levels were higher while the sGFAP/sNfL quotients were significantly lower in NMOSD and MS patients than those in HCs. At baseline, the average thicknesses of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGC-IPL) were significantly smaller in NMOSD and MS patients than those in HCs (pRNFL: MS 92.0 [80.2; 101] μm, NMOSD 80.0 [59.0; 95.8] μm, vs HC 99.0 [92.0; 104] μm, p < 0.001; mGC-IPL: MS 74.5 [64.2; 81.0] μm, NMOSD 68.0 [56.0; 81.0] μm, vs HC 83.5 [78.0; 88.0] μm, p < 0.001). The vessel density (VD) and perfusion density (PD) were increased in MS patients without optic neuritis compared to HCs (VD: MS 16.7 [15.6; 17.9] HC 15.3 [13.4; 16.9], p = 0.008; PD: MS 0.41 [0.38; 0.43], HC 0.37 [0.32; 0.41], p = 0.017). In NMOSD patients without optic neuritis, sNfL was significantly associated with PD at baseline (r = 0.329, q = 0.041). The baseline and follow-up values of the sNfL level and average pRNFL and mGC-IPL thicknesses in MS patients showed significant differences. NMOSD patients showed significant differences between baseline and follow-up sNfL and sGFAP levels but not OCTA metrics.CONCLUSION:Changes in retinal microvasculature might occur earlier than those in retinal structure and may therefore serve as a promising diagnostic marker for early NMOSD. The combination of serum markers and OCTA metrics could be used to evaluate and differentiate between MS and NMOSD.

Background/AimsTo distinguish the clinical feature of nanophthalmos (NNO) caused by mutations in protease serine 56 (PRSS56), membrane-type frizzled-related protein (MFRP), myelin regulatory factor (MYRF) and transmembrane protein 98 (TMEM98) and to evaluate the association between angle-closure glaucoma (ACG) and NNO.MethodsVariants in those four genes were identified through exome sequencing/whole genome sequencing data, and bioinformatic analysis was conducted to identify pathogenic/likely pathogenic (P/LP) variants. This observational study comprehensively summarised ophthalmological data of 67 patients with NNO from 63 families. Ocular parameters from 68 eyes without surgical treatment were subjected to further analysis.ResultsTotally, 67 patients from 63 families harboured 57 P/LP variants in the four genes, including 30 inPRSS56(47.6%), 23 inMFRP(36.5%), 5 inTMEM98(7.9%) and 5 inMYRF(7.9%). ACG was present in 79.1% of patients. An analysis of ocular parameters from 68 eyes revealed that shorter axial length (AL), lower vitreous-to-AL ratios and severe foveal hypoplasia were associated with variants inPRSS56andMFRP. Uveal effusion was more common in patients withPRSS56variants, while retinitis pigmentosa was frequently observed in patients withMFRPvariants. Patients withMYRFvariants exhibited the thinnest retinal nerve fibre layer thickness. Patients withTMEM98variants had an earlier average onset age of glaucoma.ConclusionVariants inPRSS56andMFRPare the most common genetic cause of NNO. ACG is a severe complication frequently observed in these patients. Earlier onset of ACG is observed in patients with dominant NNO, while foveal hypoplasia is more common in patients with recessive disease. Recognising these features is helpful in clinical care and genetic counselling.

AimsTo characterise retinal microvascular alterations in the eyes of pregnant patients with anaemia (PA) and to compare the alterations with those in healthy controls (HC) using optical coherence tomography angiography (OCTA).MethodsThis nested case‒control study included singleton PA and HC from the Eye Health in Pregnancy Study. Fovea avascular zone (FAZ) metrics, perfusion density (PD) in the superficial capillary plexus, deep capillary plexus and flow deficit (FD) density in the choriocapillaris (CC) were quantified using FIJI software. Linear regressions were conducted to evaluate the differences in OCTA metrics between PA and HC. Subgroup analyses were performed based on comparisons between PA diagnosed in the early or late trimester and HC.ResultsIn total, 99 eyes of 99 PA and 184 eyes of 184 HC were analysed. PA had a significantly reduced FAZ perimeter (βcoefficient=−0.310, p<0.001), area (βcoefficient=−0.121, p=0.001) and increased circularity (βcoefficient=0.037, p<0.001) compared with HC. Furthermore, higher PD in the central (βcoefficient=0.327, p=0.001) and outer (βcoefficient=0.349, p=0.007) regions were observed in PA. PA diagnosed in the first trimester had more extensive central FD (βcoefficient=4.199, p=0.003) in the CC, indicating impaired perfusion in the CC.ConclusionIt was found that anaemia during pregnancy was associated with macular microvascular abnormalities, which differed in PA as pregnancy progressed. The results suggest that quantitative OCTA metrics may be useful for risk evaluation before clinical diagnosis.Trial registration numbers2021KYPJ098 and ChiCTR2100049850.

Introduction: This study investigated the clinical characteristics of and risk factors for microcystic macular edema (MME) in patients with chronic primary angle-closure glaucoma (CPACG) and primary open-angle glaucoma (POAG). Methods: This retrospective observational study included 1,588 eyes from 926 glaucoma inpatients and analyzed the patients’ basic demographic information, visual field parameters, macular scans, and peripapillary retinal nerve fiber layer thickness. Results: Our findings were that the incidence rate of MME was 3.97% (34/857) in CPACG and 5.88% (43/731) in POAG. MME was predominantly diagnosed at an advanced stage in CPACG (almost 100%) compared to POAG (93.02%). MME was most frequently involved in the inferior (83.12%) quadrant of the peri-macular region in both CPACG and POAG. Risk factors for MME occurrence in CPACG and POAG included lower visual field mean deviation (OR = 1.14, 95%: CI 1.05-1.24, p = 0.003; OR = 1.14, 95% CI: 1.06–1.21, p < 0.001) and younger age (OR = 0.92, 95% CI: 0.88-0.96, p < 0.001; OR = 0.96, 95% CI: 0.93–0.99, p = 0.003), while female sex (OR = 0.30, 95% CI: 0.11–0.84, p = 0.022) reduced the MME occurrence in POAG. Conclusion: MME could develop in both CPACG and POAG patients, occurring earlier in POAG. The inferior peri-macular region is commonly affected. Younger age and poorer visual field are risk factors for MME in glaucoma patients.

Anterior segment optical coherence tomography angiography (AS-OCTA) has superior advantages in objective assessment of anterior segment (AS) vessels. Resolving noise interference in image is necessary to optimize the application of AS-OCTA. The study aimed to explore an automated denoising algorithm based on deep learning (DL). The algorithm was built through 21,000 pairs of images, and tested with 30 healthy eyes, 47 preoperative eyes with glaucoma, and 30 eyes undergone trabeculectomy (Trab). The real pure noise images were acquired by artificial simulation of eye movements through AS-OCTA. The algorithm included deep convolutional generative adversarial network (DCGAN), Res-Unet and Otsu. ImageJ software quantified vessel density (VD) and vessel diameter index (VDI). Images after noise reduction had relatively satisfactory peak signal-to-noise ratio (PSNR) and structural similarity (SSIM). Indiana bleb appearance grading scale (IBAGS), Kronfeld grading system (KGS) and intraocular pressure (IOP) used for Trab analysis. The DL method was superior to the conventional methods (PSNR = 16.45, SSIM = 0.52, both P < 0.001), and the denoising reduced measurement error of VD and VDI (P < 0.001). The denoising methods enabled the differentiation of V2 in IBAGS from V0 and V1 (P < 0.001) or that of II in KGS from I (P = 0.020). VD and VDI could better reflect IOP after noise reduction (R2 increased from 0.25 to 0.63, 0.14 to 0.41, both P < 0.001). Our research offered a DL denoising algorithm which improved the quality of AS-OCTA and the accuracy of AS vessel analysis.

PRÉCIS:The current study highlights distinct choroidal alterations in primary open angle (POAG) and primary angle closure (PACG) glaucomas, underscoring the potential of the Choroidal Vascularity Index (CVI) as a valuable indicator for understanding glaucoma pathogenesis. PURPOSE:To evaluate choroidal structural changes in patients with POAG and PACG and healthy controls utilizing the CVI and subfoveal choroidal thickness by enhanced depth imaging optical coherence tomography. METHODS:This study was cross-sectional. A total of 171 eyes of 171 subjects, comprising 69 eyes with untreated POAG, 58 eyes with untreated PACG, and 44 healthy eyes, were enrolled in this study. Subfoveal choroidal thickness, luminal area (LA), stromal area (SA), and total choroidal area were measured on enhanced depth imaging-optical coherence tomography scans. The CVI parameter is calculated as the proportion of LA to the total choroidal area. RESULTS:This study included 69 patients with POAG with a mean age of 51.4 ± 13.3 years, 58 patients with PACG with a mean age of 57.0 ± 7.3 years, and 44 healthy subjects with a mean age of 51.11 ± 10.7 years. The CVI in the POAG and PACG groups was significantly lower than that in the control group ( P = 0.001 and P = 0.005, respectively); however, not significantly different between the two glaucoma groups ( P = 1.000). POAG eyes had significantly lower LA than PACG and controls ( P = 0.014 and P = 0.049, respectively), whereas PACG eyes had significantly greater SA than controls ( P = 0.041). CONCLUSIONS:The CVI of POAG and PACG eyes was significantly lower than that of normal eyes. A reduced LA was observed mainly in eyes with POAG, and an increased SA was observed mainly in eyes with PACG. The role of the choroid may differ between POAG and PACG eyes.

Purpose:To report the prevalence, clinical characteristics and risk factors for paracentral acute middle maculopathy (PAMM) following acute primary angle closure (APAC) and acute primary angle closure glaucoma (APACG).Methods:This retrospective study consecutively recruited patients diagnosed with APAC or APACG. Based on the spectral domain optical coherence tomography characteristics, PAMM eyes were divided into three stages. Characteristics of different stages such as the time from symptoms to treatment (TST), retinal thickness and BCVA improvement were analyzed. The risk factors of PAMM were evaluated by binary logistic regression models.Results:A total of 781 eyes of 781 APAC or APACG patients were included, and PAMM was found in 22 (2.9%) of them. Stage III eyes had a significantly longer TST than stage I eyes (P = 0.008) while exhibiting significantly thinner retinal thicknesses (P < 0.0001). The BCVA improvement was significantly worse in the eyes treated in stage III than in those treated in stage I (P = 0.008). Older age, longer axial length and without type 2 diabetes were associated with a lower risk of incident PAMM (OR = 0.95, P = 0.028; OR = 0.52, P = 0.019; OR = 3.92, P = 0.022).Conclusion:PAMM can be secondary to APAC or APACG at a rate of 2.9%. Different visual outcomes were observed in patients who received the intervention at different stages of PAMM. Younger patients with a shorter axial length and type 2 diabetes were found to be more susceptible to PAMM.

Purpose: The purpose of this study was to explore a quantitative grading system of the filtering bleb combined anterior segment optical coherence tomography angiography (AS-OCTA) vascular features and optical coherence tomography (OCT) morphological features. Methods: One hundred three eyes of 103 patients diagnosed with primary open-angle glaucoma and undergone trabeculectomy over 6 months were divided into success and failure groups according to postoperative intraocular pressure (IOP) level. Vessel density (VD) and vessel diameter index (VDI) were examined by AS-OCTA. Bleb's morphology, including bleb height (BH), and microcyst-structure (MCS) were detected by AS-OCT. Multi-vascular model score (MVMS) was calculated by comprehensive factor analysis, and the comprehensive grading system (MVMS-MCS-BH) was analyzed by linear regression. The efficiency our method was verified by receiver operating characteristic (ROC) analysis.Results: The VD and VDI were higher in the failure group and closely related to posttrabeculectomy IOP (all P = 0.000). The MVMS was mostly consisted of VD in all regions, and VDIs of nasal, central, and temporal positions in sequence. MVMS >= 0, BH <1.33, and non-MCS were significantly associated with IOP increasing (coefficient = -3.23, -3.69, and 8.10, all P = 0.000). MVMS-BH-MCS got a higher area under curve (AUC), sensitivity, and specificity (0.92, 100%, and 80.30%) than the slit-lamp method (0.62, 72.20%, and 46.43%, respectively). Conclusions: The quantitative vascular characteristics detected by AS-OCTA were significant for the bleb monitor. The MVMS-BH-MCS grading system had achieved outstanding accuracy in reflecting the surgical results.Translational Relevance: The multi-vascular biomarker and comprehensive evaluation combined vascular and morphological parameters yield useful information on surgical outcomes, and help ophthalmologists to monitor patients effectively.

Purpose:This study aimed to investigate the differences in longitudinal changes in the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell plus inner plexiform layer (GCIPL) caused by progressive myopia and glaucoma among adolescents. Design:This was a retrospective observational study. Methods:A total of forty-seven and 25 eyes of 47 and 25 adolescents with myopia progression (MP) and glaucoma progression (GP), respectively, who were followed up at the Zhongshan Ophthalmic Center for at least 3 years, were included in the study. The pRNFL and GCIPL that measured at the initial and last visits were analyzed. Results:The median follow-up period was 5 years for both two groups. During follow-up, the whole, superior, and inferior pRNFL decreased in both the MP and GP groups, (p < 0.001). Nasal pRNFL decreased in the MP group (p < 0.001) but had no significant difference in the GP group (p = 0.19). Temporal pRNFL was increased in the MP group (p < 0.001) but decreased in the GP group (p < 0.001). The average and sectoral GCIPL decreased in both groups (p < 0.001). The annual change rate of temporal pRNFL and pRNFL at 10-, 8-, 9-, and 7-clock-hour sectors and the inferotemporal GCIPL has better diagnostic value to differentiate glaucoma from myopia (the area under the receiver operating characteristic curve, AUC > 0.85). Conclusion:Glaucoma and MP could cause loss of the pRNFL and GCIPL in adolescents; however, the loss patterns were different between the two groups. The temporal quadrant and 7-, 8-, 9-, and 10-clock-hour sector pRNFL and the inferotemporal GCIPL can help distinguish pRNFL and GCIPL loss caused by glaucoma or MP.

This study aimed to analyze the quantitative vascular biomarkers of filtering bleb function at different depths using anterior segment optical coherence tomography angiography (AS-OCTA). This cross-sectional study is registered on Clinicaltrails.gov (NCT 04515017). Forty-six eyes with primary open-angle glaucoma that had undergone trabeculectomy with mitomycin-C for more than six months were included. Vessel density (VD) and vessel diameter index (VDI) in the superficial layer (SL), Tenon’s layer (TL), and deep layer (DL) of the bleb were obtained. The VD and VDI were higher in the failure group (both p = 0.000). Significant correlations were found between the SL, TL, DL’s VDI, and IOP in the success group (p = 0.013, 0.016, 0.031, respectively). The VD of the TL and DL were related to IOP in the failure group (p = 0.012, 0.009). Tenon’s VD (TVD) and Tenon’s VDI (TVDI) correlated with IOP adjusting for TVD, TVDI, and the Indiana Bleb Appearance Grading Scale (IBAGS) (p = 0.009, 0.043) or Kenfeld grading system (KGS) (p = 0.011, 0.016). The area under curve (AUC) of the TVD, TVDI, IBAGS, and KGS to predict surgery failure were 0.960, 0.925, 0.770, and 0.850. AS-OCTA realized the quantitative evaluation of vessels, especially the invisible vascularity beneath the conjunctiva. TVD and TVDI as detected by AS-OCTA better reflected bleb function than conventional grading systems.

Introduction: The aim of this study was to investigate the long-term visual outcomes and factors associated with vision loss in Chinese patients with primary congenital glaucoma (PCG) after successful intraocular pressure (IOP) control (IOP ≤21 mm Hg). Methods: PCG patients with IOP control who were examined in the glaucoma clinic at Zhongshan Ophthalmic Center from 2019 to 2020 were enrolled. The final visual outcome was evaluated by the best corrected visual acuity (VA). Univariate and multivariate analyses were used to investigate the associations of visual impairment with potential risk factors. The causes for decreased VA (<20/50) were also analyzed. Results: Fifty-nine patients (95 eyes) were included in the cohort, with a mean age of 8.7 years. The mean logMAR VA was 0.62 ± 0.64. The VAs of eyes treated for PCG were good (≥20/50) in 56%, fair (20/60–20/200) in 30%, and poor (<20/200) in 14%. The most common cause of decreased VA was amblyopia (64.3%). Multivariate logistic regression analysis showed that undergoing multiple surgeries (OR: 4.86, 95% CI: 1.11–21.16, p = 0.035) was significantly associated with visual impairment. Conclusion: The results showed that good VA was attainable in approximately half of PCG eyes under IOP control. Prompt and effective treatment of PCG, management of amblyopia and ocular comorbidities may be potential steps toward achieving good visual outcomes in PCG patients.

Background: The purpose of this study was to analyze the ocular biometric parameters of primary angle-closure disease (PACD) in younger patients and compare them with those of elderly patients. Methods: This clinic-based, cross-sectional study included 154 eyes of 154 patients with PACD, consisting of 77 eyes of patients aged 40 years or younger and 77 eyes of patients older than 40. The PACD case definition was compatible with the ISGEO definition. Anterior segment parameters were measured by ultrasound biomicroscopy, axial length (AL) and lens thickness (LT) were measured by A-scan ultrasonography measurements, and the thickness of the retina and choroid were measured by optical coherence tomography. The differences in ocular biometric parameters between different age groups were compared by independent sample t-tests or Mann-Whitney U tests, and the correlation between the parameters and age was analyzed. Results: Compared to older PACD patients, the lens vault(LV),LV/LT and subfoveal choroidal thickness (SFCT) of younger patients were larger, while the peripheral and mean iris thickness (IT), trabecular-ciliary angle (TCA), ciliary body thickness (CBT), AL and LT were smaller (all P < 0.01). There was no significant difference in anterior chamber depth, anterior chamber width, pupil diameter, angle opening distance at 500 μm from the scleral spur, anterior chamber angle and iris convexity between the two groups (all P > 0.05). AL, LT, IT, TCA and CBT were positively associated with age (all P < 0.001), while LV and SFCT were negatively associated with age (P = 0.027 and P < 0.001, respectively). Conclusions: Compared with elderly patients, younger PACD patients had more anteriorly positioned lenses, thinner and more anteriorly rotated ciliary bodies, thicker choroids, and shorter axial length. These characteristics might be important anatomical bases for the earlier onset of PACD and the higher risk of malignant glaucoma after filtering surgery.

Primary open angle glaucoma (POAG) is the leading cause of irreversible blindness. Dysfunction of the trabecular meshwork (TM), resulting in decreased outflow of aqueous humor and increased intraocular pressure (IOP), plays an important role in the pathogenesis of POAG. However, the underlying mechanisms still remain unclear. In this study, we demonstrated that the eIF2-α/ATF4/CHOP branch of unfolded protein response (UPR) was activated in human trabecular meshwork cells (HTMCs) upon tert-butyl hydroperoxide (TBHP) exposure. Inhibition of ATF4 ameliorated TBHP-induced apoptosis and inflammatory cytokine production, while ectopic expression of ATF4 increased the expression of endothelial leukocyte adhesion molecule (ELAM)-1 and IL-8 in HTMCs. Furthermore, we found that ATF4 inhibition reduced tunicamycin-induced caspase-3 activation, ROS production, ELAM-1 expression, and HTMCs phagocytosis impairment. By an in vivo study in mice, we showed that overexpression of ATF4 in the TM induced C/EBP homologous protein (CHOP) expression and TM cells apoptosis, contributing to inflammatory cytokine production, and probably IOP elevation. More importantly, upregulation of ATF4 and CHOP, and colocalization of ATF4 with ELAM-1 were found in the TM of POAG patients. These results suggest that ATF4 is a critical mediator of oxidative stress and ER stress-induced TM cell dysfunction and apoptosis in POAG.

Purpose: To compare the choroidal vasculature characteristics by using the choroidal vascularity index (CVI) in eyes with malignant glaucoma (MG), fellow eyes with non-MG, and eyes with uncomplicated primary angle-closure glaucoma (PACG) after trabeculectomy by spectral-domain optical coherence tomography (SD-OCT).Methods: This case-control study included 53 patients diagnosed with MG after trabeculectomy. Eyes with MG (n = 53) and the fellow eyes with non-MG (n = 50) were included. Eyes with PACG without MG after trabeculectomy (n = 60) were also enrolled as controls. The choroidal parameters, including CVI and the subfoveal choroidal thickness (SFCT), were measured by using SD-OCT images.Results: Eyes with MG and the fellow eyes showed a significantly lower CVI than eyes with PACG controls (p < 0.001). After adjusting for age, sex, axial length (AL), and intraocular pressure (IOP), eyes with the greater CVI [odds ratio (OR), 0.44] were significantly related to MG. The area under the receiver operating characteristic curve of the CVI was greater than that of the SFCT in the diagnosis of MG (0.911 vs. 0.840, p = 0.034).Conclusion: Eyes with MG showed a significantly lower macular CVI than eyes with PACG controls. A higher macular CVI was an associated factor of eyes with MG. The CVI serves as a more stable and sensitive indicator for MG than the SFCT in this group of patients with PACG.