Purpose: The purpose of this study was to evaluate the structure function relationship of circumpapillary vessel density (cpVD) with visual field sensitivity (VFS) and compare its characteristics with circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in early glaucomatous (EG) and normal eyes with and without high myopia (HM). Methods: Seventy-five EG (mean deviation > −6 dB) and 7 normal eyes with HM (axial length [AL] >26.5 mm) and 111 EG and 11 normal eyes without HM were enrolled in this retrospective cross-sectional study. All patients underwent circumpapillary optical coherence tomography (OCT) and OCT angiography (OCTA) scanning with the Cirrus HD-6000 with AngioPlex OCTA (Carl Zeiss Meditec, Dublin, CA, USA). Structure function correlations were determined by comparing global, superior, inferior, and Garway-Heath sectoral values for cpVD and cpRNFLT with its corresponding 24-2 and 10-2 VFS of Humphrey Visual Field (HFA) analyzer. Results: CpVD showed no significant correlations with AL except for the nasal sector (P = 0.044), whereas cpRNFLT demonstrated significant positive association with AL in the global (P = 0.024), nasal (P = 0.020), and temporal (P < 0.001) sectors. In HM eyes, global and sectoral cpVD significantly correlated with corresponding VFS in all 24-2/10-2 VF sectors (all P < 0.05). CpVD-VFS correlation was significantly stronger than cpRNFLT-VFS in the nasal sector of HM eyes (P = 0.002) and temporal and inferior temporal sector of eyes without HM (P = 0.008 and P = 0.042, respectively). Conclusions: In EG eyes with HM, cpVD was less affected by AL in comparison to cpRNFLT and cpVD-VFS correlation was significant in all 24-2/10-2 VF sectors. AL-associated advantages of cpVD-VFS over cpRNFLT-VFS were observed.

To evaluate the location-specific association of deep optic nerve head (ONH) structures and background characteristics with visual field (VF) sensitivity in eyes with peripapillary intrachoroidal cavitation (PICC). Prospective cross-sectional study. 129 eyes of 93 consecutive cases with PICC determined on fundus photographs and confirmed on optical coherence tomography (OCT). PICC location was determined on ONH-centered OCT radial slices according to Garway-Heath sectors. VF defect (VFD) corresponding to the location of PICC sector was considered absent when the pattern deviation probability plot showed no point with a probability less than 1% within the corresponding 24-2 Humphrey VF sector. Sectoral mean total deviation (TD) was calculated for structure-function analysis. The presence of full thickness retinal defect was determined, and PICC depth and deep ONH parameters were calculated with OCT slices. A best-fit multivariable linear mixed model was applied to identify factors associated with sectoral mean TD corresponding to PICC location. Explanatory variables included age, sex, axial length, intraocular pressure, presence of full thickness retinal defect, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), PICC depth, Bruch's membrane opening (BMO) area, scleral flange opening (SFO) area and SFO/BMO offset magnitude. Among 254 sectors with PICC, 136 sectors (54%) did not present corresponding VFD. Suspected VFD was most frequent in the temporal (34/50, 68%) and inferior temporal (67/104, 64%) sectors. In the best-fit multivariable analysis, worse sectoral TD in the PICC sectors was associated with the presence of full thickness retinal defect (p=0.036) and thinner cpRNFLT (p<0.001) but was not associated with PICC depth or other deep ONH parameters. Although PICC alone did not necessarily cause corresponding VFD, PICC in the temporal sectors should be carefully examined for VFD. Full thickness retinal defect, a myopia-induced tissue disruption, and cpRNFL thinning at the PICC location were significantly associated with worse VF, while PICC size and other myopia-related deep ONH structural changes were not. Identification of these factors provides a foundation for understanding VF sensitivity reduction in eyes with characteristic highly myopic ONH changes.

Adult Still’s disease (ASD) is a rare systemic inflammatory disorder in which ocular manifestations have rarely been described. We report a 29-year-old Japanese woman with a rare case of refractory ASD complicated by Purtscher-like retinopathy. She was diagnosed with ASD and started on a high dose of oral prednisolone. Two days after the initiation of the treatment, she presented with blurred vision in the left eye, and the funduscopic examination revealed bilateral Purtscher-like retinopathy. Despite treatment with high-dose oral prednisolone for 2 weeks, she developed macrophage activation syndrome. Considering the severity of ASD, intravenous pulse methylprednisolone therapy and tocilizumab injection were administered. Although all the laboratory data and Purtscher-like retinopathy gradually improved, nerve fiber layer defect (NFLD) in both eyes appeared and visual field defect remained corresponding to the NFLD. In conclusion, Purtscher-like retinopathy might be useful as a poor prognostic factor of ASD, which needs appropriate systemic immunosuppressive treatment. Early detection and long-term follow-up of Purtscher-like retinopathy is important because it has the possibility of developing permanent visual field defect.

To compare background characteristics, deep optic nerve head (ONH) structures, and optic disc morphology in participants with unilateral peripapillary intrachoroidal cavitation (PICC). Retrospective cross-sectional study. One hundred six eyes of 53 participants with unilateral PICC determined on OCT. Twelve ONH-centered OCT radial slices were used to manually measure Bruch membrane opening (BMO) area, BMO ovality, scleral flange opening (SFO) area, SFO ovality, and SFO/BMO offset magnitude which represents the degree of SFO/BMO centroid displacement and clinically corresponds to the peripapillary atrophy–gamma and delta zones. Optic disc tilt, rotation, area, and longest and shortest diameters were measured from line scanning laser ophthalmoscopy images. Paired t tests and Wilcoxon signed-rank tests were used to compare background characteristics and obtained parameters between PICC eyes and their contralateral eyes. False discovery rate was controlled using the Benjamini–Hochberg method to account for multiple comparisons. Peripapillary intrachoroidal cavitation eyes showed significantly larger BMO area (P < 0.001) and its ovality (P = 0.020), larger SFO area (P = 0.003), larger SFO/BMO offset magnitude (P = 0.007), greater optic disc tilt (P < 0.001), and smaller optic disc shortest diameter (P = 0.010). There was no significant difference in axial length (AL) (P = 0.081) and optic disc rotation (P = 0.067). Although AL was similar between PICC eyes and their contralateral eyes, significant intereye differences in deep ONH structures and optic disc morphology were observed. Peripapillary intrachoroidal cavitation eyes exhibited a more elliptically expanded BMO, larger SFO, greater SFO/BMO misalignment, and greater optic disc tilt, which are structural changes associated with border tissue elongation. Our findings indicate a strong association between the presence of PICC and myopia-related characteristic deep ONH remodeling, providing a foundation for understanding structural abnormalities in myopic eyes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Background/Objectives: The aim of this study was to investigate the longitudinal visual field (VF) and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) changes in open-angle glaucomatous (OAG) participants with unilateral peripapillary intrachoroidal cavitation (PICC) and to identify factors associated with VF progression. Methods: Sixty eyes of 30 OAG patients with unilateral PICC were included in this retrospective longitudinal observational study. Humphrey 24–2 VF testing and optical coherence tomography scanning were performed in all eyes over a period exceeding 5 years. VF progression was assessed using mean deviation (MD) and superior and inferior total deviation (TD) slopes. Structural progression was evaluated using global, superior, and inferior cpRNFLT thinning rates. Longitudinal changes were compared between PICC eyes and their contralateral non-PICC eyes. Factors associated with superior or inferior TD slopes were analyzed using linear mixed-effects models. The following variables were included as explanatory variables: age, sex, intraocular pressure, axial length, Bruch’s membrane opening (BMO) and scleral flange opening (SFO) area, SFO/BMO offset magnitude, disk tilt, disk rotation, baseline superior or inferior TD, baseline corresponding cpRNFLT, and the presence of PICC. Results: MD slope was −0.24 ± 0.35 dB/year in PICC eyes and −0.35 ± 0.53 dB/year in contralateral eyes. There was no significant difference in MD slope, superior and inferior TD slope, or the rate of cpRNFLT thinning (all p > 0.05). In multivariable analysis, the presence of PICC was associated with slower progression in the corresponding superior VF (p = 0.037), whereas greater SFO/BMO offset magnitude was associated with faster progression (p = 0.047). Conclusions: OAG eyes with PICC exhibited modest functional and structural progression over 5 years, comparable to that of contralateral non-PICC eyes. The presence of PICC was associated with slower corresponding superior VF progression, whereas greater myopia-associated structural change was related to faster progression. Our findings characterize the clinical course of eyes with pronounced myopic ONH deformation, highlighting the importance of detailed ONH structural assessment in the management of myopic glaucoma.