Difference In Mean Intraocular Pressure Research Articles

A comparison of iCare and Goldmann applanation tonometry measurements during the COVID-19 pandemic: a retrospective study

PurposeTo evaluate factors associated with differences in intraocular pressure (IOP) readings between iCare and Goldmann applanation tonometry (GAT) in established glaucoma patients.MethodsThis retrospective comparative study included clinical data of 350 eyes from 350 established glaucoma patients who had iCare and GAT IOP measured by an ophthalmic technician and a glaucoma specialist, respectively. The main outcome measure was the difference in IOP measurements of the right eyes with iCare and GAT.ResultsThe intraclass correlation coefficient (ICC) between GAT and iCare was 0.90. The mean IOP difference between tonometers was − 0.18 ± 2.89 mmHg. Bland–Altman plots indicated a 95% limit of agreement of − 5.8 to 5.5 mmHg. Central corneal thickness (CCT) and age were significantly correlated with the difference in IOPs of the iCare and GAT. GAT-IOP and age were significantly associated with the absolute difference in measured IOP of the two tonometers. The difference in measurements was not significantly associated with prior glaucoma surgery, average global index of optical coherence tomography, axial length, technician years of experience and certification, and IOP range.ConclusionAlthough there is good agreement between the iCare and GAT mean values, these devices are not interchangeable in glaucoma patients due to the wide range of the limit of agreement.

A comparison of rebound and applanation tonometry in children with and without primary congenital glaucoma

Background: Intraocular pressure (IOP) measurement should be accurate in a paediatric population with primary congenital glaucoma (PCG).Aim: This study aims to investigate the difference between the change in IOP measurements using rebound tonometry (RBT) and handheld applanation tonometry (AT) (Perkins applanation tonometer [PAT]) in patients with and without PCG.Setting: Johannesburg, South Africa.Methods: Measurements were taken under anaesthesia, using RBT and AT at 0 min, 5 min and 10 mins after induction and prior to intubation. Corneal pachymetry and corneal diameters were measured.Results: Sixty-five children were included, 19 with PCG and 46 without PCG. The mean age (standard deviation [s.d.]) was 3.2 (2.25) years and 4.8 (2.4) years, respectively. The overall mean difference in IOP between RBT and PAT across both PCG and non-PCG groups was found to be 4.92 mmHg (95% confidence interval [CI]: 2.80 – 7.03) p 0.001, with RBT having higher readings. This difference was greater in the PCG group, with the IOP difference of 9.05 mmHg (95% CI: 2.6 – 15.5) p = 0.004. Mean corneal pachymetry (s.d.) was 585.6 (81.48) µm in the PCG group and 518.31 (39.9) µm in the non-PCG group. Univariate analysis showed that IOP was significantly related to corneal pachymetry, with a 11 mmHg increase in IOP for every 100 μm change in corneal thickness for measurements done with RBT (p 0.001), compared to 4 mmHg using PAT (p = 0.008).Conclusion: Intraocular pressure measurements done with RBT in children with and without PCG were overestimated compared to PAT.Contribution: This difference was more pronounced in PCG patients. In addition, IOP was significantly related to corneal thickness.

Outcomes of phaco-trabeculectomy versus phaco-viscocanalostomy for primary open angle glaucoma

PurposeThis study aimed to compare the intraocular pressure (IOP)-lowering effect and postoperative adverse effects of combined phacoemulsification and trabeculectomy (PT) and combined phacoemulsification and viscocanalostomy (PVC) in eyes with primary open-angle glaucoma (POAG). MethodsIn this prospective study, eighty-one consecutive patients (81 eyes) with POAG and cataract were enrolled. The eyes were randomly assigned to either the PT group (40 eyes) or the PVC group (41 eyes). The main outcomes included the success rate based on IOP and the evaluation of adverse effects during the 6-month follow-up period. The surgery was considered a complete success if the IOP was between 6 and 20 mmHg and reduced by ≥30% without glaucoma medications or additional surgery compared to the preoperative level. A qualified success was characterized by an IOP within the range of 6−20 mmHg and a 20−30% reduction in IOP achieved through the use of glaucoma medications. ResultsThe mean baseline IOP was 23.20 ± 7.94 mmHg in the PT group and 21.29 ± 6.81 mmHg in the PVC group (P = 0.249). At 6 months, the mean postoperative IOP in the PT and PVC groups were 13.50 ± 2.49, and 13.73 ± 1.70, respectively. There was no significant difference in mean IOP between the groups at any time (P > 0.05). At 6 months, 22 patients (55%) in the PT group and 22 patients (53.66%) in the PVC group achieved complete success. Nine eyes (22.50%) in the PT group and 10 eyes (24.39%) in the PVC group achieved qualified success. The other patients (9 eyes in each group) did not meet the criteria for at least a qualified success and were considered failures (P = 0.980). Intraoperative microperforation of Descemet's membrane occurred in 2 cases (15%) in the PVC group. Postoperative complications included 4 cases (10%) of shallow/flat anterior chamber, 1 case (2.5%) of choroidal effusion, and 1 case (2.5%) of aqueous misdirection in the PT group. The rate of these postoperative adverse effects was not significant between the two groups (P > 0.05). ConclusionsThere was no significant difference in IOP reduction between PT and PVC in patients with POAG. Furthermore, PVC is safe enough in these patients, compared to PT.

Effect of topical nasal steroids on intra-ocular pressure in a Nepalese population: a tertiary hospital based prospective observational study

BACKGROUND: Impact of intranasal corticosteroid (INC) on intraocular pressure (IOP) has been a topic of longstanding debate with various studies showing variable results. This study aims to assess the effect of INC on IOP in the Nepalese population in a tertiary hospital of Nepal. METHODOLOGY: This was prospective observational study conducted in a tertiary hospital from May 2021 to November 2022. IOP of patients who met our inclusion criteria were measured before and after 6 weeks of the initiation of INC. Data were collected and compiled in Microsoft Excel. The statistical test was done using SPSS version 25. RESULTS: A total of 48 cases were evaluated. We observed that the mean IOP difference before and after nasal steroid usage exhibited no statistically significant variance: 0.5 mean IOP in the right eye and 0.12 mean IOP in the left eye. CONCLUSIONS: This study proposes that intranasal steroids pose a minimal risk of inducing ocular hypertension in the Nepalese population. Nonetheless, larger cohort studies with extended follow-up durations are warranted to substantiate these findings.

A STUDY ON ASSOCIATION OF SYSTOLIC BLOOD PRESSURE, DIASTOLIC BLOOD PRESSURE, AND PULSE PRESSURE WITH INTRAOCULAR PRESSURE IN RELATION TO PRIMARY OPEN-ANGLE GLAUCOMA

Objective: This study aims to probe the relationship among pulse pressure (PP), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the intraocular pressure (IOP) in normal persons and primary open-angle glaucoma (POAG) patients. Design: This was an institution-based observational study. Methods: This study was conducted on 240 patients attending the ophthalmology department and glaucoma clinic of a tertiary hospital. Included subjects were asked about their ocular and systemic problems and undergone detailed examination of eyelids, conjunctiva, cornea, anterior chamber by slit lamp, visual acuity, refraction, and fundus examination. IOP was measured by Goldmann applanation tonometer. Blood pressure was measured by sphygmomanometer. Results: In this study, we found that SBP, DBP, PP, and IOP – both eyes were found to be higher in subjects with POAG than normal control subjects. Among these, differences in mean SBP, DBP, and IOP – both eyes between subjects with POAG and normal subjects were statistically significant. IOP was found to be positively correlated with SBP, DBP, and PP both in subjects with POAG as well as in normal subjects. Conclusion: Although involving a limited number of eyes, the key findings of the study suggest that IOP is positively correlated with PP, SBP, and DBP. This opens up the possibility of early detection of glaucoma patients with raised PP, SBP, and DBP.

Effect of Phacoemulsification Cataract Surgery on the Clinical Outcomes of Advanced Glaucoma Patients

Purpose: To identify the clinical outcomes of cataract surgery in patients with advanced glaucoma.Methods: A retrospective chart review of open-angle glaucoma patients who underwent cataract surgery and were followed-up for 1 year was conducted. Advanced glaucoma was defined as a mean deviation (MD) < -12 dB on the preoperative visual field test. A group with mild-to-moderate glaucoma (MD ≥ -12 dB) served as the control group. Changes in intraocular pressure (IOP) at 1, 3, 6, and 12 months, and in the postoperative visual acuity (VA) as well as in the visual field indices (MD and the pattern standard deviation), and the number of antiglaucoma medications were compared.Results: Eighty-seven eyes (87 patients) of the advanced group and 109 eyes (109 patients) of the mild-to-moderate group were finally included. From 1 week to 24 months postoperatively, both groups evidenced IOP decreases compared to the preoperative values (both <i>p</i> < 0.05). The IOP spike prevalence was similar in the two groups (11% vs. 13%, <i>p</i> = 0.199). The mean IOP difference between the two groups was not significant at months 1, 3, 6, 12, or 24 postoperatively (all <i>p</i> > 0.05). Both groups evidenced VA improvements at 1 year postoperatively and the visual field (VF) indices did not differ from those before surgery. The numbers of antiglaucoma medications used decreased after surgery, but the decrease was significant only in the advanced glaucoma group (<i>p</i> = 0.030).Conclusions: The advanced and mild-to-moderate glaucoma groups evidenced similar IOP and VF changes after cataract surgery. The VA improved and the number of antiglaucoma medications decreased. Our findings suggest that cataract surgery for patients with advanced glaucoma may afford similar clinical outcomes compared to other less severe glaucoma groups.

Twenty-Four-Hour Intraocular Pressure in Chronic Primary Angle-Closure Disease.

Primary angle closure and primary angle closure glaucoma may exhibit normal intraocular pressure. Twenty-four-hour intraocular pressure fluctuation is highest in primary angle closure glaucoma. The degree of peripheral anterior synechiae was associated with a 24-hour intraocular pressure pattern in primary angle-closure disease without laser iridotomy. The purpose of this study was to study 24-hour intraocular pressure (IOP) patterns in eyes with chronic primary angle-closure disease and evaluate associations between peripheral anterior synechiae (PAS) and 24-hour IOP pattern. In this prospective cohort study, 59 eyes of 35 Asian patients with chronic primary angle-closure disease underwent complete ocular examinations at Ramathibodi Hospital, Mahidol University. Twenty-four-hour IOP records were obtained using Goldmann applanation tonometry at 2-hour intervals. Peak, mean, and trough 24-hour IOP values and 24-hour IOP fluctuation (difference between peak and trough values) were compared among groups. None of the participants received any treatment before complete data collection. Even univariable analysis demonstrated a significant difference in peak, mean, and trough IOP and 24-hour IOP fluctuation between the 3 groups; the magnitude of trough IOP was not higher than 21mmHg in all groups. In multivariable analysis, PAC and PACG eyes showed significantly higher peak IOP ( P =0.020 and 0.006, respectively) and 24-hour IOP fluctuation ( P =0.048 and 0.001, respectively) compared with PACS eyes. In comparison between combined PACS and PAC eyes versus PACG eyes, PACG eyes revealed significantly higher 24-hour IOP fluctuation. The degree of PAS was associated with peak and mean IOP values and with 24-hour IOP fluctuation in PAC and PACG eyes. Twenty-four-hour IOP fluctuation was highest in PACG eyes. Although PAC and PACG eyes showed higher peak IOP and 24-hour IOP fluctuation values, compared with PACS eyes, trough IOP in PAC and PACG eyes were mostly below 21mmHg. In addition, the degree of PAS was associated with a 24-hour IOP pattern in either PAC or PACG eyes.

EFFECT OF INHALED TIOTROPIUM ON INTRAOCULAR PRESSURE IN PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Introduction: Chronic Obstructive Pulmonary Disease is one of the leading causes of morbidity and mortality with increasing prevalence worldwide. Tiotropium bromide a long acting antimuscarinic agent used in management. In the eye it causes pupil dilation, leading to closure of anterior chamber angles, consequently leading to increased intra ocular pressure. Objectives: To study the effect of inhaled tiotropium on intraocular pressure in patients of Chronic Obstructive Pulmonary Disease. Methods: This is a prospective observational study done over a period of one year on 100 patients of Chronic Obstructive Pulmonary Disease using tiotropium inhaler and fulfilling the inclusion and exclusion criteria. Clinical details and other essential information had been collected using a proforma that was filled by the investigator. During study period tiotropium is administered at a dose of 18mcg/day. The Schiotz tonometer is used to assess intraocular pressure at baseline, at the end of 1 month and 3 month follow up period. The results were organized and analyzed statistically. Results: A total of 100 patients recruited for study which included 88 males and 12 females. Intra ocular pressure (IOP) of both eyes were compared in our study using Schiotz tonometer at baseline, one month and at end of follow up period of three months. We found a statistically significant difference in mean IOP by paired t-test at baseline and 3rd month, one month as well as three months, but changes in IOP was not significant between baseline and one month. Conclusion: We found a statistically significant difference in mean IOP by paired t-test at baseline and third month.

Reliability of the Non-contact TONO-i Tonometer Compared with the Goldmann Applanation Tonometer

Purpose: The accuracy and agreement of intraocular pressure (IOP) measurements using a noncontact self-measuring tonometer, TONO-i, compared with the Goldmann applanation tonometer (GAT).Methods: A total of 35 healthy participants and 42 primary open angle or normal tension glaucoma patients were enrolled in this study. TONO-i and GAT measurements were obtained and the mean difference in IOPs was analyzed using a paired <i>t</i>-test. IOP agreement was calculated using the two-way random effects model. Bland-Altman analysis and simple linear regression were used to estimate the disagreement between IOP measurements.Results: The mean IOPs measured using the TONO-i and GAT were 15.9 ± 3.3 mmHg and 16.4 ± 5.1 mmHg, respectively. In glaucoma patients, the mean values measured using the TONO-i (16.7 ± 4.1 mmHg) were lower than those measured using the GAT (17.9 ± 6.1 mmHg; <i>p</i> < 0.001). However, there was no significant difference among the healthy participants (<i>p</i> = 0.273). The intraclass coefficients (95% confidence interval) for all participants, normal participants, and glaucoma patients were 0.847 (0.702-0.920), 0.882 (0.804-0.941), and 0.828 (0.742-0.887), respectively, indicating good agreement between the IOP measurements. The mean difference and limits of agreement were not statistically significant. As IOP increased, the absolute difference between the GAT and TONO-i measurements also increased.Conclusions: The TONO-i, a novel tonometer, may be used reliably for IOP self-measurement and detecting IOP elevations. However, caution must be exercised because of the possibility of underestimating high IOPs.

Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients.

To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population. This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti-glaucoma medications, best corrected visual acuity (BCVA), and complications. Sixty-seven eyes of 66 patients were included in study with mean follow-up of 25.04 months (range, 12-69 months) in the CS group and 17.4 months (range, 13-28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow-up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow-up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

The Effect of Combined Phacoemulsification and Endo-Cyclophotocoagulation on Intraocular Pressure Fluctuation Assessed by the Water Drinking Test in Patients with Primary Open Angle Glaucoma

Introduction: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). Methods: This was a prospective observational study carried out at a tertiary referral centre. POAG patients on topical antiglaucoma medications and planned for phaco-ECP were recruited. WDT was performed before surgery and 6 weeks postoperatively by drinking 10 mL/kg of water in 5 min followed by serial IOP by Goldmann applanation tonometry measurements at 15, 30, 45, and 60 min. Mean IOP, IOP fluctuation (difference between highest and lowest IOP), IOP reduction, and factors affecting IOP fluctuation were analysed. Results: Twenty eyes from 17 patients were included. Baseline IOP was similar before (14.7 ± 2.7 mm Hg) and after (14.8 ± 3.4 mm Hg, p = 0.90) surgery. There was no difference in mean IOP (17.6 ± 3.4 mm Hg vs. 19.3 ± 4.7 mm Hg pre- and postoperative, respectively, p = 0.26) or peak IOP (19.37 ± 3.74 mm Hg vs. 21.23 ± 5.29 mm Hg, p = 0.25), albeit a significant reduction in IOP-lowering medications (2.2 ± 1.15 vs. 0.35 ± 0.93, p < 0.001) postoperatively. IOP fluctuation was significantly greater (6.4 ± 3.2 mm Hg vs. 4.6 ± 2.1 mm Hg, p = 0.015) with more eyes having significant IOP fluctuation of ≥6 mm Hg (11 eyes [55%] vs. 4 eyes [20%], p < 0.001) postoperatively. Factors that were significantly associated with increased postoperative IOP fluctuations were higher preoperative IOP fluctuation (β = 0.69, 95% CI 0.379–1.582, p = 0.004) and more number of postoperative antiglaucoma medications (β = 0.627, 95% CI 0.614–3.322, p = 0.008). Conclusion: Reducing aqueous production with phaco-ECP does not eliminate IOP fluctuation in POAG patients. The increase in postoperative IOP fluctuation suggests increased outflow resistance after phaco-ECP.

Comparison of intraocular pressure readings with Perkins, Tonopen, iCare 200, and iCare Home to manometry in cadaveric eyes.

To compare intraocular pressure (IOP) readings obtained with Perkins tonometry, iCare Home, iCare 200, and Tonopen to IOP readings obtained with the manometer of a perfusion system to assess the accuracy and reproducibility of each method of tonometry at set pressures. The IOP of human cadaveric eyes (n=2) was measured using a manometer inserted into the eye through the optic nerve. IOP measurements were obtained using a Perkins tonometer, iCare Home, iCare 200, and Tonopen. These measurements were compared to set point IOP measurements of a manometer to determine accuracy and reproducibility of each device. Mean IOP readings obtained with the Perkins tonometer compared to manometer readings demonstrated a difference of -1.0±5.0 mm Hg (P=0.45), indicating a lower reading on average than manometery although not significant. Mean IOP difference between iCare 200 and manometer was 5.3±2.2 mm Hg (P<0.0001). Mean difference in IOP between iCare Home and manometer was 3.5±2.4 mm Hg (P=0.0004). Mean IOP difference compared to manometer was 4.6±4.0 mm Hg for the Tonopen (P<0.0001). IOP measurements obtained with the Perkins tonometer demonstrated a standard deviation of 5.0 mm Hg while the Tonopen measurements demonstrated a 4.0 mm Hg standard deviation. In comparison, iCare 200 and iCare Home demonstrated 2.2 and 2.4 mm Hg standard deviation, respectively. Applanation tonometry produces more accurate IOP readings than rebound tonometry or Tonopen, however it demonstrates greater variability than the other forms of tonometry. Rebound tonometry is more reproducible but tends to over-estimate IOP.

Efficacy and safety of a fixed combination of 1% brinzolamide and 0.1% brimonidine as treatment for glaucoma: a retrospective study focusing on the number of ingredients

ObjectiveTo evaluate the intraocular pressure (IOP)-lowering effect based on the number of ingredients and survival rate due to adverse reactions of brinzolamide (1%)/brimonidine (0.1%) fixed combination (BBFC).Methods and analysisAmong 424...

Intraocular Pressure Measurements in Standing, Sitting, and Supine Position: Comparison between Tono-Pen Avia and Icare Pro Tonometers.

Intraocular pressure (IOP) is influenced by body position. The purpose of this study is to compare the IOP measurements obtained with two different devices, to investigate IOP changes in standing, sitting, and supine positions. In this comparative prospective case series, IOP was measured in sitting, supine, prone, and standing (standing 1) positions and again five minutes after standing (standing 2), utilizing an Icare Pro (ICP) and a Tono-Pen Avia (TPA) in the 64 eyes of 32 healthy subjects. Compared to the sitting position, both devices showed an increase in the IOP both in supine and standing 2 positions (p &lt; 0.05). The mean IOP difference between the two devices was: in the sitting position, 0.57 ± 2.10 mmHg (range: -3.80 to 6.60 mmHg) (p &lt; 0.05), in the supine position, 0.93 ± 2.49 mmHg (range: -4.50 to 7.10 mmHg) (p &lt; 0.05), in the standing 1 position, 0.37 ± 1.96 mmHg (range: -5.20 to 5.00 mmHg) (p = 0.102), and in the standing 2 position 0.73 ± 2.03 mmHg (range: -4.5 to 6.4 mmHg) (p &lt; 0.001). The results highlight an agreement between the TPA and ICP, both confirming not only the increase in IOP in the supine position, but also showing an increase in the standing 2 position. Therefore, it is suggested to perform such measurements in patients with glaucoma, to explain its progression in an apparently normal tension or in compensated patients.

A systematic review and meta-analysis of randomised controlled trials in the management of neovascular glaucoma: absence of consensus and variability in practice

PurposeNeovascular glaucoma (NVG) is characterised by neovascularisation of the angle and therefore elevated intraocular pressure (IOP). This results in progressive optic neuropathy and loss of visual acuity. Treatment aims to reduce IOP in order to prevent optic nerve damage. A systematic review was completed synthesising results from randomised control trials (RCTs) comparing interventions for the management of NVG and their efficacy and safety.MethodsData was sourced from Web of Science, Embase and Medline after 1st January 2000. The primary outcome measures were mean IOP at follow-up and success rate. The secondary outcomes included mean IOP lowering medications and total complications. A meta-analysis was completed on comparative studies using Revman (version 5.4).ResultsFor the two studies comparing Ahmed glaucoma valve (AGV) + pan-retinal photocoagulation (PRP) vs AGV + PRP + intra-vitreal bevacizumab (IVB), there was no difference in mean IOP or odds of success from the meta-analysis. From the 4 studies examining the utilisation of anti-vascular endothelial growth factor (anti-VEGF), one study showed lower mean IOP at 1 (p = 0.002) and 3 months (p = 0.033) for IVB vs sham injection. In the 2 studies studying transcleral diode laser (TDL), there were no significant findings. From the 4 studies looking at trabeculectomy (trab), lower mean IOP at 6 (p = 0.001), 9 (p = 0.01), 12 (p = 0.02) and 18 months (p = 0.004) was shown for intra-vitreal ranibizumab (IVR) + PRP + visco-trabeculectomy vs IVR + PRP + trab, and a significantly lower mean IOP was present in the Baerveldt group vs trab at 6 months (p = 0.03). In the 2 studies investigating the AGV, there was a lower mean IOP at 1 month (p = 0.01) in the AGV + triamcinolone (TCA) group. The risk of bias was low for 4 studies, high for 4 studies and 6 studies had some concerns.ConclusionThis is the first meta-analysis of RCTs in the management of neovascular glaucoma. The lack of high-quality evidence contributes to the lack of consensus in managing NVG. Our results highlight modern treatment strategies and the need for better powered RCTs with long-term follow-up in order to establish optimal treatment modalities and true patient outcomes.

Effect of manual upper eyelid elevation on intraocular pressure measurement by noncontact tonometer.

To evaluate whether manual upper eyelid elevation (MUEE) affects intraocular pressure (IOP) values obtained with a noncontact tonometer (NT). This cross-sectional study included 122 eyes of 122 non-glaucomatous adults. All patients underwent IOP measurement using both NT and Goldmann applanation tonometer (GAT). The order of measurements was NT without MUEE, NT with MUEE, and GAT. Both eyes of each patient were measured and one of the eyes was randomly selected for inclusion in the study. Central corneal thickness (CCT) and palpebral fissure height (PFH; distance between upper and lower eyelids) was recorded. The patients' mean age was 43.91 ± 12.36 (20-61) years and 62.3% were women. Mean IOP values measured by NT without MUEE, NT with MUEE, and GAT were 15.98 ± 2.39, 15.84 ± 2.53, and 14.33 ± 2.3mmHg, respectively. There was no statistically significant difference in mean IOP between NT without and with MUEE (p = 0.506). Mean IOP values obtained by NT with and without MUEE were significantly higher than those obtained by GAT (p < 0.001). The difference in IOP values measured by NT without and with MUEE was positively correlated with PFH (r = 0.214; p = 0.018). CCT and IOP values obtained by NT without MUEE and GAT were positively correlated (r = 0.300; p = 0.001 and r = 0.311; p = 0.001, respectively). MUEE does not have a significant effect on IOP measurements by NT. The difference between IOP measured by NT without and with MUEE increases with greater PFH.

Comparison of the efficacy of latanoprost versus dorzolamide/timolol fixed combination therapy in patients with pseudoexfoliative glaucoma according to glaucoma stage.

Only a few trials have compared the intraocular pressure-lowering effects of prostaglandin analogs to carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy in patients with pseudoexfoliative glaucoma. Furthermore, the influence of the glaucoma stage on the intraocular pressure-lowering effects of these drug types has not been studied. The purpose of this study was to compare the IOP-lowering efficacy of latanoprost, a prostaglandin analog versus dorzolamide/timolol fixed combination, a carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy, in patients with pseudoexfoliative glaucoma based on glaucoma stage. The data of 32 eyes (32 patients) diagnosed with uniocular pseudoexfoliative glaucoma and treated with topical latanoprost (Group 1) or dorzolamide/timolol fixed combination (Group 2) were retrospectively assessed. The groups were subdivided into early and moderate-advanced stages. Patients' demographics, baseline intraocular pressure, final intraocular pressure, and intraocular pressure difference (the difference between the baseline and final intraocular pressure) were determined from medical records and compared between groups and according to glaucoma stage. The mean drug use duration was 17.7 ± 13.5 months. No significant differences in mean baseline intraocular pressure, mean final intraocular pressure and mean intraocular pressure difference between Groups 1 and 2. In Group 2, the mean intraocular pressure difference was significantly greater in patients with early versus moderate-advanced stage glaucoma (p=0.015). The difference, however, was not detected in Group 1. The mean intraocular pressure difference in early-stage glaucoma was significantly greater in Group 2 versus 1 (p=0.033). Latanoprost and dorzolamide/timolol fixed combination are effective treatments for newly diagnosed pseudoexfoliative glaucoma. In early-stage pseudoexfoliative glaucoma, greater intraocular pressure reduction was noted with dorzolamide/timolol fixed combination than with latanoprost; thus, dorzolamide/timolol fixed combination should be considered when a significant decrease in intraocular pressure is desired in early-stage glaucoma.

Can trainees perform Ahmed glaucoma valve surgery as effectively as attendings?

OBJECTIVE:To compare the surgical outcomes and early postoperative complications of Ahmed glaucoma valve (AGV) implantation performed by residents with those performed by attending physicians.METHODS:This is a retrospective, case–control study. Data were gathered from chart reviews of consecutive cases of AGV model FP7 implantation between January 2014 and July 2017. Postoperative 1-year results of patients who had at least 3 months follow-up were evaluated.RESULTS:One hundred and forty-four eyes of 144 patients were included in this study: 72 patients in the resident group, and 72 age- and sex-matched patients in the attending group. Hyphema and shallow anterior chamber were significantly more common in the resident group vs. attending group (25% vs. 2.8% and 19.4% vs. 7.0%; P = 0.001 and P = 0.04, respectively). Neovascular glaucoma (NVG) was more common in resident vs. attending group (30.6% vs. 1.4%; P < 0.001). No significant difference in mean intraocular pressure (IOP) was found at any postoperative follow-up visits between the surgery groups (P > 0.05, for all). The number of postoperative visits within 3 months was similar between the groups (P = 0.84).CONCLUSION:Resident-performed AGV surgery lowered IOP, similar to attending-performed surgery. More frequent complications were observed in the resident group, which might be due to the predominance of NVG in this group.

Outcomes and favourable prognostic factors in patients of phacomorphic and phacolytic glaucoma managed by manual small-incision cataract surgery: A retrospective study.

Purpose:To evaluate the outcomes and identify favorable prognostic factors in patients of phacomorphic (PMG) and phacolytic glaucoma (PLG) managed by manual small-incision cataract surgery (MSICS).Methods:The medical records of patients with PMG/PLG who had undergone MSICS in a tertiary eye hospital between September 2014 and August 2018 were retrospectively reviewed. Regression analyses were conducted to identify the predictors associated with intraoperative or postoperative complications and a favorable final outcome at 1 month, namely, a best-corrected visual acuity (BCVA) of 6/18 or better and an intraocular pressure (IOP) of <21 mm Hg. P < 0.05 was considered statistically significant.Results:The records of 209 patients with PMG and 279 patients with PLG were eligible for the review. The mean preoperative IOP for PMG and PLG were 43.15 ± 12.9 and 40.05 ± 12.0 mm Hg, respectively (P = 0.006). A younger age (<60 years) was associated with a lower risk of severe postoperative inflammation in both PMG and PLG [OR = 0.45 (0.21–0.99); P = 0.047 and OR = 0.44 (0.23–0.83); P = 0.011, respectively]. There was no significant difference in the final mean logMAR BCVA (P = 0.21) and IOP (P = 0.36) in the two groups. The likelihood of a final IOP of <21 mm Hg was significant for symptoms less than a week [OR = 3.52 (1.2–10.2); P = 0.02] in PMG and for absence of vitreous disturbance [OR = 35.0 (3.8–325.7); P = 0.002] in PLG. A BCVA of 6/18 or better was strongly associated with symptoms for less than a week [OR = 1.58 (1.0–2.4); P = 0.043] and absence of vitreous disturbance [OR = 23.53 (5.1–108.0); P < 0.001]Conclusion:Early diagnosis and management can translate to good outcomes in PMG and PLG.

Newborn Glaucoma: A Neglected Manifestation of Congenital Rubella Syndrome

To study the frequency of intrauterine rubella infection in a cohort of neonatal-onset glaucoma (NOG) and its effect on the treatment outcomes. Prospective cohort study. Infants with NOG presenting to the pediatric glaucoma service at a tertiary care center in northern India at Chandigarh between January 1, and September 30, 2018, with a minimum postoperative follow-up of 1 year were included in this study. Rubella immunoglobulin-M (IgM) antibodies were tested in all patients. Surgery for intraocular pressure (IOP) control comprised combined trabeculotomy with trabeculectomy or goniotomy. Presenting features and treatment outcomes at 1 year were compared among infants with and without rubella-IgM antibodies. Of 27 eligible infants, 7 (25.9%) were rubella-IgM positive, and all had bilateral glaucoma. One eye in a rubella-positive baby was an unsightly blind eye and required a prosthesis. A total of 13 eyes of 7 patients were compared with 34 eyes of 20 rubella-negative patients. There was no significant difference in mean age and IOP at presentation. Rubella-positive infants had significantly more opaque corneas (P < 0.001), shorter eyes (P < 0.001), and smaller corneal diameters (P= 0.007) at presentation. Two patients in the rubella group had bilateral cataracts, 3 patients had heart disease, and 1 patient had sensorineural deafness. Salt-and-pepper retinopathy was noted in both rubella-positive infants where fundus evaluation was possible. Despite comparable IOP control (P= 0.51), the corneal clarity remained significantly worse in the rubella-positive patients (P= 0.02). Twenty-five percent of those with newborn glaucoma had underlying intrauterine rubella infection, thus making them susceptible for development of congenital rubella syndrome (CRS). Neonatal-onset glaucoma is an important component of CRS, which may present without buphthalmos and persistent corneal clouding despite good IOP control.