There is increasing literature regarding the role of macular imaging by optical coherence tomography (OCT) in glaucoma care. Spectral domain OCT (SD-OCT) has allowed for high resolution imaging of the total macula and macular segments. With the use of asymmetry analysis, macular thickness is a measurement that can be used for the detection and progression of glaucoma. Some artifacts seen on retinal nerve fiber layer (rNFL) scans may be overcome by macular SD-OCT imaging. Also, nonglaucomatous optic neuropathies may be more easily identified on macular thickness plots than rNFL scans. Special populations, such as children or myopes, may also have improved glaucoma surveillance using macular SD-OCT. In this review we explore the advantages and pitfalls of macular OCT in glaucoma care and offer an approach on how to use macular thickness scans in clinical practice.

Optical coherence tomography has evolved over the past 2 decades to be an important ancillary method to evaluate diseases of the anterior and posterior segments of the eye. The more recent development of swept-source optical coherence tomography (SS-OCT) with a wavelength-tunable laser centered at 1050 nm and deeper imaging depth of 2.6 mm has enabled clinicians to evaluate congenital optic disc anomalies including optic disc pits, optic disc colobomas, and morning glory syndrome in more detail. The SS-OCT findings of the posterior precortical vitreous pocket, Cloquet’s canal, lamina cribrosa that is torn from the peripapillary sclera, and the retrobulbar subarachnoid space immediately posterior to the highly reflective tissue lining the bottom of the excavation are presented. In addition, abnormal com munications between the vitreous cavity and the subretinal and subarachnoid spaces in eyes with congenital optic disc anomalies are also reviewed. The retinal complications associated with congenital optic disc anomalies are treated by vitreous surgery, silicone oil tamponade, and peripapillary laser photocoagulation or scleral buckling. However, the surgical outcomes are limited and not entirely satisfactory. Analyses by SS-OCT of congenital optic disc anomalies should make the treatment corre spond better with the pathological findings.

Background/Purpose: To evaluate and compare the diagnostic discriminative ability for detecting glaucoma in highly myopic eyes from a normative database of macular ganglion cell complex (mGCC) thickness based on nonhighly myopic and highly myopic normal eyes. Methods: Forty-nine eyes of 49 participants with high myopia (axial length ≥ 26.0 mm) were enrolled. Spectral-domain optical coherence tomography scans were done using RS-3000, and the mGCC thickness/significance maps within a 9-mm diameter circle were generated using built-in software. We compared the difference of sensitivity, specificity, and diagnostic accuracy between the nonhighly myopic database and the highly myopic database for differentiating the early glaucomatous eyes from the nonglaucomatous eyes. Results: This study enrolled 15 normal eyes and 34 eyes with glaucoma. The mean mGCC thickness of the glaucoma group was significantly less than that of the normal group (p < 0.001). Sensitivity was 96.3%, and the specificity was 50.0% when using the nonhighly myopic normative database. When the highly myopic normative database was used, the sensitivity was 88.9%, and the specificity was 90.0%. The false positive rate was significantly lower when using the highly myopic normative database (p < 0.05). Conclusion: The evaluations of glaucoma in eyes with high myopia using a nonhighly myopic normative database may lead to a frequent misdiagnosis. When evaluating glaucoma in high myopic eyes, the mGCC thickness determined by the long axial length high myopic normative database should be applied.

Background/Purpose: To describe small hyper-reflective spherical bodies in sub-silicone oil-foveal depression (SSO-FD) space using spectral domain optical coherence tomography (SD-OCT) and its effect on visual outcomes in eyes undergoing silicone oil removal (SOR). Methods: This was a prospective interventional comparative study comprising 42 eyes undergoing SOR with clear media. All patients underwent detailed clinical examination and SD-OCT scan of fovea pre-operatively and at 30 days and 90 days postoperatively. Patients were divided into Group A (n = 21) and Group B (n = 21) depending on presence or absence, respectively, of small hyper-reflective spherical bodies in the SSO-FD space in preoperative scans. The findings between SD-OCT and best-corrected visual acuity were correlated and analyzed. Results: The mean age of patients was 41.9 years (range, 23–60 years) in Group A and 45.6 years (range, 23–60 years) in Group B. Twenty-one eyes showed small hyper-reflective spherical bodies on SD-OCT imaging. These were thought to represent emulsified silicone oil globules trapped in the potential space created by silicone oil meniscus and foveal pit, which is the SSO-FD space. These bodies were absent in all post SOR scans of Group A and Group B. Group A had significant visual improvement (p = 0.0001) after SOR with clearance of these hyper-reflective bodies as compared to Group B(p = 0.356). Conclusion: We conclude that these small hyper-reflective spherical bodies in the SSO-FD space were most likely emulsified silicone oil globules and correlated with significant visual improvement with their clearance after silicone oil removal.

Background/Purpose: Orbital fractures are a common facial fracture managed by multiple surgical specialties. Methods: A retrospective review of the electronic medical records of patients (age, 18–85 years) presenting to Northwestern Memorial Hospital and Northwestern Medical Faculty Foundation in Chicago, IL, USA with International Classification of Diseases, Ninth Revision codes for facial fractures or CPT (Current Procedural Terminology) codes for orbital fracture repair. Results: A review of the electronic medical records identified 504 individual incidents of orbital fractures with available imaging for review. The most common location for an orbital fracture was a floor fracture (48.0%) followed by a medial wall fracture (25.2%). Left-sided orbital fractures were statistically significantly more common than right-sided orbital fractures (99% confidence interval). Orbital fractures were more prevalent in younger age groups. The mean patient age was 39.3 years. The most common cause of all orbital fractures was assault followed by falls. However, falls were the most common cause of orbital fractures in women and in patients aged 50 years and older. Evaluation by an ophthalmologist occurred in 62.8% of orbital fracture patients, and evaluation by a team comprising the facial trauma service (Otolar-yngology, Plastic Surgery, and Oral and Maxillofacial Surgery) occurred in 81.9% of orbital fracture patients. Conclusion: Assault was the largest cause of all orbital fractures, and occurred most commonly in young males. Assaulted patients were more likely to have left-sided fractures compared to nonassaulted patients. In patients aged 50 years and older, falls were the most common cause of orbital fractures.

Background/Purpose: To evaluate the relationship between refractive error and vision-related quality of life in 16-year-old students in Taiwan. Methods: A cross-sectional study was designed for 16-year junior-high-school students in Taiwan. Myopia was defined as a spherical refractive error (SRE) < −0.50 D, hyperopia as SRE > +1.0 D, and emmetropia as SRE −0.5–h1.0 D in the better eye. Vision-related quality of life was assessed using the Taiwan Chinese version of the 25-Item National Eye Institute Visual Functioning Questionnaire. Results: Of the 688 participants, 466 (68%) had myopia and 22 (3%) had hyperopia. In logistic-regression models adjusted for gender, parents’ education, family income, and parental refractive error, myopia was an independent risk factor of poorer vision-related quality of life for both near vision (odds ratio 1.73, 95% confidence interval 1.22–2.45) and distance vision (odds ratio 3.11, 95% confidence interval 2.23–4.35). Hyperopia was not associated with near- or distance-vision difficulty. Conclusion: In this study population, myopia was associated with difficulties in near and distance vision compared to emmetropia. Further studies are needed to confirm our findings in other populations.

We present the clinical course, management, and final outcome of spontaneous suprachoroidal hemorrhage (SSCH) in an age-related macular degeneration (AMD) patient—a 64-year-old male receiving antiplatelet therapy who developed SSCH during the Valsalva maneuver. In addition to our case study, we discuss the results of a systemic review of the literature and reference lists of retrieved studies published from January 2001 to December 2013. Among a total of 31 patients (32 eyes), acute secondary glaucoma was a complication in 87.5% of the cases, and over half of the cases (20 eyes, 62.5%) received surgery. Twenty cases (64.5%) were characterized by systemic hypertension (HTN), followed by cardiovascular or cerebral vascular disease in 17 cases (54.8%). The Valsalva maneuver was performed in five cases (16.1%) prior to the episode. Twenty-three cases (74.2%) had abnormal hemostasis, including use of anticoagulants or thrombolytic agents (18 cases), chronic renal failure (CRF, 5 cases), and blood dyscrasia (3 cases). AMD was the most common (17 eyes of 16 patients, 53.1%) ocular disease. Visual acuity was classified as hand motion (HM) or worse in 20 eyes (of 28 eyes, 71.4%) at initial presentation and in 24 eyes (of 30 eyes, 80%) upon final examination. Anticoagulated patients with AMD should be informed of the risk of intraocular hemorrhage. Medical therapy usually fails in the treatment of glaucoma. Surgical intervention provides an option for the purpose of pain relief. Even so, the final visual prognosis is usually poor.

A 47-year-old man presented with epiphora and a mass around the lacrimal sac in his left eye. Imaging studies revealed a favorable diagnosis of sinusitis-related mucocele. However, the pathological study of the excised tumor demonstrated a diffuse large B cell lymphoma. The patient was consequently referred to the oncology department for further management. Malignant lymphomas of the lacrimal sac are rare and they can mimic mucoceles. As such, they should be included in the list of differential diagnoses for lacrimal sac mass.

Purpose: Anterior uveitis is the most common ocular manifestation of sarcoidosis. Ocular involvement affects approximately 30–60% of patients with systemic sarcoidosis; however, optic disc edema is a rare event. We report a patient who presented with a rare case of sarcoidosis with neuro-ophthalmic manifestations. Case report: A 22-year-old man was referred to our clinic with the primary complaint of a visual field defect over the temporal side of his right eye of 2 months duration. He did not have a history of systemic disease. At the first ophthalmic examination, the visual acuity, intraocular pressure, and slit lamp examination were normal. The fundus examination revealed bilateral optic disc edema. He was initially suspected of having a choroidal lesion between the disc and fovea of the right eye. To evaluate the possible lesion, the patient underwent brain magnetic resonance imaging (MRI), chest radiography, and chest computed tomography (CT). There were no abnormalities on the brain MRI, but the chest radiographs and CT images revealed bilateral mediastinal and hilar lymphadenomegaly. Histopathologic evaluation of an ultrasound-guided lymph node biopsy confirmed the diagnosis of sarcoidosis. Conclusion: Neuro-ophthalmic manifestations of sarcoidosis are rare but may be the only presenting sign of an otherwise occult disease. A high clinical suspicion for sarcoidosis and its inclusion as a differential diagnosis are key to establishing the diagnosis and proper treatment.