Since glaucoma is a progressive and irreversible optic neuropathy, accurate screening and/or early diagnosis is critical in preventing permanent vision loss. Recently, optical coherence tomography (OCT) has become an accurate diagnostic tool to observe and extract the thickness of the retinal nerve fiber layer (RNFL), which closely reflects the nerve damage caused by glaucoma. However, OCT is less accessible than fundus photography due to higher cost and expertise required for operation. Though widely used, fundus photography is effective for early glaucoma detection only when used by experts with extensive training. Here, we introduce a deep learning-based approach to predict the RNFL thickness around optic disc regions in fundus photography for glaucoma screening. The proposed deep learning model is based on a convolutional neural network (CNN) and utilizes images taken with fundus photography and with RNFL thickness measured with OCT for model training and validation. Using a dataset acquired from normal tension glaucoma (NTG) patients, the trained model can estimate RNFL thicknesses in 12 optic disc regions from fundus photos. Using intuitive thickness labels to identify localized damage of the optic nerve head and then estimating regional RNFL thicknesses from fundus images, we determine that screening for glaucoma could achieve 92% sensitivity and 86.9% specificity. Receiver operating characteristic (ROC) analysis results for specificity of 80% demonstrate that use of the localized mean over superior and inferior regions reaches 90.7% sensitivity, whereas 71.2% sensitivity is reached using the global RNFL thicknesses for specificity at 80%. This demonstrates that the new approach of using regional RNFL thicknesses in fundus images holds good promise as a potential screening technique for early stage of glaucoma.

Intracorneal epithelial cysts are a rare clinical condition that can occur anywhere in the corneal tissue; however, they appear most commonly in the stroma. They are sometimes challenging to treat because of their location, depth, and visual outcomes. Herein, we report a pre-Descemet epithelial cyst that was successfully treated surgically, with guidance from Fourier-domain optical coherence tomography (FD-OCT). This interventional case report presents a patient with gradually decreasing vision caused by a pre-Descemet epithelial cyst. A 4-year-old girl with no history of trauma or ocular surgery showed a deep-seated intracorneal cyst in her left eye (8 o’clock corneoscleral area, dissecting into the pre-Descemet cornea). The cyst was threatening the visual axis. An epithelial cyst was diagnosed after drainage on the basis of the cyst contents. We irrigated inside the cyst using 10% trichloroacetic acid (TCA), distilled water, and 1% 5-fluorouracil (5-FU) solutions for chemical cyto-destruction of the lining epithelial cells of the cystic wall. We used a portable FD-OCT during operation to guide this procedure, without perforating the Descemet’s membrane and endothelial layer. Recurrence could be prevented after removal of the cystic tissue located in the sclera area outside of the limbus. No recurrence was noted during the 4-year follow-up. When treating centrally deep-seated intracorneal epithelial cysts, clinicians must consider recurrence, endothelial damage, and visual outcome. Herein we report the case of a deep-seated, intracorneoscleral epithelial cyst that was completely resolved with chemical cyto-destruction and removal of the intrascleral cystic tissue under the guidance with FD-OCT; thus, endothelial damage could be minimized.

Introduction To investigate the efficacy of autologous serum gel in patients with lagophthalmos combined with neurotrophic persistent corneal epithelial defects (PEDs). Methods This is retrospective, case-series study enrolled 15 patients with lagophthalmos complicated by neurotrophic PEDs refractory to medical treatment including autologous serum eye drops. They were treated with autologous serum gel in conjunction with conservative treatment. The following information was collected from medical records: demographics, underlying diseases, and past ocular history. PEDs healing time was evaluated with visual acuity, visual analog scale (VAS) scores, esthesiometer scores, and the areas of the epithelial defects. Results Six men and nine women with a mean age of 63.3 ± 9.9 years were included. The most common cause of the neurotrophic PEDs and lagophthalmos in this group was postherpetic infection (46.7%) and cerebral hemorrhage (26.7%) each. Two months following treatment with autologous serum gel, there was a reduction in the area of the epithelial defects (from 19.2 ± 9.9 to 0.6 ± 1.5 mm²) and a significant improvement in best-corrected visual acuity (BCVA) (from 0.8 ± 0.5 to 0.5 ± 0.4 logMAR) and VAS scores (from 5.1 ± 1.1 to 2.1 ± 0.6) in 13 eyes (87%). Among the 11 completely healed eyes, the mean epithelial healing time was 3.2 ± 1.8 weeks. Conclusions Autologous serum gel reduces symptoms and promotes corneal epithelialization of refractory neurotrophic PEDs in patients with lagophthalmos. Therefore, it may be well tolerated and a beneficial addition in the management of neurotrophic PEDs in patients with lagophthalmos.

Yoon YS, et al. J Korean Ophthalmol Soc. 2018 Jul;59(7):622-628. https://doi.org/10.3341/jkos.2018.59.7.622