Goldman Applanation Tonometer Research Articles

Comparison of Intraocular Pressure Measurement by iCare Tonometer and Goldman Applanation Tonometer

Objective: To compare the Intraocular Pressure measured by the Goldmann Applanation tonometer with by iCare ic100 tonometer in normal human eye to determine the accuracy and reliability of both methods. Study Design: Comparative cross-sectional study. Place and Duration of Study: Ophthalmology Department, Combined Military Hospital, Quetta Pakistan, from Oct 2022 to Apr 2023. Methodology: Approval was secured prior to enrolling every individual, protecting their privacy throughout the process. All instruments adhered to the manufacturer's guidelines for calibration. A single ophthalmologist assessed the intraocular pressure of all participants. In our study we included 400 eyes (200 right and 200 left) among 200 patients. Initially, study eyes were inspected using a slit lamp. Subsequently, iCare tonometer and Goldman applanation tonometer were employed to gauge the intraocular pressure. Results: Out of 200, 87 patients (43.5%) were male and 113(56.5%) were females. Median age of the patients was 51.00(45-58) years range from 22-77 years. Mean IOP measured by iCare was 19.01±7.86 mmHg and by Goldman applanation tonomter was 20.14±8.15 mmHg. The correlation coefficient value between the readings of two instruments was r=0.866 with significant p value (p< 0.001). Conclusion: The iCare ic100 consistently provides high intraocular pressure measurements (2-3mmHg) compared to the Goldmann Applanation tonometer across various sub Groups.

Influence of Age, Sex, and Refractive Error on Intraocular Pressure Measurement Using Applanation Tonometer Among Healthy Individuals in Shahat

The present study aimed to estimate the distribution of IOP and the relation with gender, age, and refractive error in a healthy Libyan population. This observational cross-sectional study was conducted in Cyrenaic Teaching Hospital from December 2023 to February 2024. 200 patients who presented to the hospital took part in the questionnaire. A Goldman applanation tonometer was used to measure IOP following the instillation of a drop of Benzoyl Peroxide. There were no significant differences noted between IOP in the right and left eyes. There was a correlation between IOP and age, but there was no correlation between IOP and gender (p < 0.05). IOP is one of the most important indicators for monitoring the health of the eyes. Concerning age, the mean IOP increased with age and refractive errors. Conclusion: This study supported the hypothesis that age and high myopia are major risk factors for ocular hypertension development.

Comparison of intraocular pressure measurements with the tono-pen, goldmann applanation tonometer, and noncontact tonometer in nonglaucomatous pseudophakic children.

To evaluate the agreement between the Goldman applanation tonometer (GAT), Tono-Pen, and noncontact tonometer (NCT) in the measurement of intraocular pressure (IOP) in pseudophakic children. The medical records of nonglaucomatous pseudophakic children between 2009 and 2019 were retrospectively analyzed. A total of 46 eyes of 23 patients operated for bilateral pediatric cataract were included in the study. The patients' mean age was 13.4 ± 4.1years. Central corneal thickness (CCT) and IOP values measured with the GAT, Tono-Pen, and NCT were recorded. Agreement between the tonometers was evaluated by intraclass correlation coefficients (ICC) and the Bland-Altman method. The mean IOP of the 46 eyes included in the study was measured as 13.7 ± 2.3mm Hg with the GAT, 16.0 ± 2.3mm Hg with NCT, and 16.5 ± 2.3mm Hg with the Tono-Pen (p < 0.001). There is no statistical difference between NCT and Tono-Pen measurements, while GAT measurements were significantly lower than those of the NCT and Tono-pen. ICC values showed fair agreement between NCT and Tono-Pen (ICC = 0.720), whereas there was poor agreement between GAT and NCT (ICC = 0.501) and Tono-pen (ICC = 0.314). With all devices included in the study, thicker corneas were associated with higher IOP measurements. Although there was moderate agreement between the NCT and Tono-Pen, there was a statistically significant difference in the IOP values provided by the three devices. Our results suggest these devices should not be used interchangeably.

Ocular Complication in Vernal Keratoconjunctivitis Patients

Background: Vernal keratoconjunctivitis (VKC) is a chronic ocular allergic condition predominantly affecting the pediatric population. It is characterized by severe inflammation of the conjunctiva and cornea, leading to a spectrum of complications if not adequately treated. The prevalence and impact of VKC vary geographically and demographically, necessitating region-specific investigations to understand its epidemiology, clinical manifestations, and outcomes. Objective: The study aimed to investigate the distribution of VKC types among affected individuals in a specific region, identify the prevalence of associated ocular complications, and evaluate the demographic characteristics of the patient population. Methods: This descriptive study was conducted over an 8-month period, assessing 200 patients diagnosed with VKC at the outpatient department of ophthalmology in HMC Peshawar. Patients were included based on recurrent signs and symptoms of VKC, excluding those with other ocular conditions. A comprehensive ophthalmic examination was performed, encompassing uncorrected and corrected visual acuity tests, anterior slit lamp examination, fundus examination with a 78D lens, intraocular pressure measurement using a Goldman applanation tonometer, and keratometry. Corneal topography was conducted for suspected cases. Data were analyzed using SPSS version 25.0, focusing on the distribution of VKC types, gender prevalence, and complication rates. Results: The study revealed a significant male predominance (73%) among VKC patients, with the limbal type being the most common form of the condition (45%). Complications were observed in 21% of the patients, with irregular astigmatism (35.7%) and keratoconus (26.2%) being the most prevalent. The gender distribution and types of VKC highlighted the need for targeted clinical attention, especially considering the potential for serious complications such as corneal scarring, cataract, and glaucoma. Conclusion: VKC remains a significant pediatric ocular health concern, with a marked male predominance and a high incidence of complications that can impact the quality of life. Early diagnosis, effective management, and regular follow-up are crucial to mitigate the risk of long-term visual impairment. The findings underscore the importance of awareness and education among healthcare providers and caregivers regarding the potential severity of VKC and the necessity for timely intervention.

Accuracy of Icare Rebound Tonometer and Its Comparison with Goldman Applanation Tonometer

Purpose: To determine accuracy of iCare rebound tonometer (IRT) in terms of agreement with Goldman Applanation Tonometer (GAT) and effect of Central corneal thickness (CCT) on its accuracy. Study Design: Comparative cross sectional study. Place and Duration of Study: Ophthalmology Department of Ittefaq Hospital Lahore from September 2022 to May 2023. Methods: Participants of the study were recruited through non-probability convenient sampling. With Icare PRO® rebound tonometer (IRT), two consecutive sets of measurements with 6 measurements for each set were made, and the averaged values were used for the statistical analyses. After 5 minutes GAT measurement was taken for intraocular pressure (IOP). CCT was measured by ultrasound pachymetry from mean of 2 measurements noted. Data was analyzed by Bland-Altman plots for determining agreement of GAT-IOP and IRT-IOP. Pearson correlation coefficient determined the correlation of GAT-IOP and IRT-IOP with CCT. Results: Out of 200 participants there were 76 (38%) males and 124 (62%) females. Mean age of participants was 27.84 ± 6.1 years. Mean IOP with IRT was 16.24 ± 2.02 (range 12.1 – 20.3 mmHg). Mean IOP with GAT was 14.40 ± 1.98 (range 11.00 – 19 mmHg). Mean IOP with adjusted CCT using GAT was 14.40 ± 1.64 (range 11 – 18 mmHg). Mean CCT was 544.81 ± 42.04 (range 615 – 471 um). Mean IOP-GAT &amp; IOP-IRT with adjusted CCT showed normal distribution. Mean difference of IOP-GAT and IOP-IRT with t test was 1.83 ± 1.12 (p = .079). Conclusion: There is a strong agreement between IOP-GAT and IOP-IRT. CCT had a strong impact on IOP measurements with both tonometers. However, CCT affected IOP reading of GAT more than IRT.

Assessment of intraocular pressure measurement between Goldman applanation tonometer, rebound tonometer, non-contact tonometer, and its correlation with central corneal thickness

To compare readings of intraocular pressure (IOP) taken with the Goldmann applanation tonometer (GAT), the non-contact tonometer (NCT), and the rebound tonometer (RBT), and to compare their correlation with central corneal thickness (CCT).This was a prospective, cross-sectional, observational study to which patients above 18 years of age were enrolled. A total of 400 eyes of 200 non-glaucomatous patients underwent IOP recordings using the GAT, NCT, and RBT, and CCT was also noted. Informed consent of the patients was taken. The IOP readings taken via the three methods were compared and correlated with CCT. Paired t test was used to compare the two devices. Simple and multivariate linear regression analyses were used to study the relationship between factors. A P value less than 0.05 was considered significant. Correlation was determined using the Pearson correlation coefficient, and a Bland-Altman graph was plotted.Mean IOP measured by the NCT was 15.65 ± 2.80 mmHg, by the RBT was 14.23 ± 3.05 mmHg, and by the GAT was 14.69 ± 2.97 mmHg. The mean CCT was 510.61 ± 33.83 microns. The difference between mean IOP recorded by the NCT and that by the RBT was 1.41 ± 2.39 mmHg, between the NCT and GAT was 0.95 ± 2.03 mmHg, and between the GAT and RBT was 0.45 ± 2.22 mmHg. The difference between the IOP values was statistically significant (P < 0.005). All tonometers showed a statistically significant correlation with CCT, but it was observed that the NCT had a stronger correlation (0.4037).The IOP readings taken by all the three methods were comparable; however, RBT values were closer to GAT values. CCT did influence the IOP values, and this should be kept in mind while evaluating.

Impact of preoperative posterior segment evaluation on surgical intervention in camp patients

Purpose: To retrospectively study impact of preoperative posterior segment evaluation on surgical intervention in camp patients recruited for cataract surgery in Gujarat India. Methods: Retrospective analysis of six months data collected from hospital electronic medical record (EMR) system of 9820 admitted patients recruited from screening camp for cataract surgery from 1/10/2019 to 31/3/2020 in Tertiary Eye Hospital in Gujarat, India, has been done. Comprehensive clinical evaluation, of both anterior and posterior segment which included detailed history; best corrected visual acuity (BCVA); intraocular pressure measurement with non-contact tonometer (NCT) and when required with Goldman applanation tonometer; slit lamp examination; and fundus examination with + 90 diopter lens as well as indirect ophthalmoscope as and when indicated. In case there was no view of retina, a B-scan ultrasound was done to rule out any posterior segment pathology. Immediate surgical intervention done was assessed and results analyzed in percentage. Results: Cataract surgery was advised for 8390 patients (85.43%). Surgical intervention for management of glaucoma was done for 68 patients (0.692%). Retina intervention was done for 86 patients. Posterior segment evaluation changed immediate surgical plane of management for 154 (1.57%) patients. Conclusion: Comprehensive clinical evaluation is economical and should be mandatory especially in community services as comorbid conditions like glaucoma, diabetic retinopathy, retinal vein occlusion, and other varied posterior segment diseases contribute significantly to visual disability in elderly age group. It is difficult to follow these patients later if manageable comorbidity is not informed about and if indicated dealt simultaneously for visual rehabilitation of patient.

Persistent Intraocular Pressure Elevation after Silicon Oil Removal in Patients with Post-Pars Plana Vitrectomy

Background: It is well-known that silicon oil (SO) injection into the vitreous cavity after pars plana vitrectomy is usually associated with high intraocular pressure. Objectives: To determine the influence of silicon oil (SO) removal on IOP level after pars plana vitrectomy for spontaneous rhegmatogenous retinal detachment (RRD) Subjects and Methods: A prospective study was conducted at Ibn Al-Haitham eye teaching hospital, Baghdad- Iraq. Intraocular pressure (IOP) was measured pre and post SO removal in patients who have underwent retinal detachment surgery with SO injection of 1000 centistokes (cSt) viscosity. Baseline IOP was measured for all the patient before the SO removal. Follow-up was performed at 1, 4, and 8 weeks after SO removal. IOP was measured by Goldman applanation tonometer. Patients with IOP &gt; 21 mm Hg at 8 weeks post-operatively with or without anti-glaucoma mediations were considered as persistent IOP elevation after SO removal. Result: Sixty eyes of 60 patients were included. Twenty eyes had persistent IOP elevation after SO removal on first week postoperative. It decreased to 14 eyes on 4th week after SO removal and further decreased to 12 eyes on 8th week af-ter SO removal. The percentage of persistent IOP elevation following SO remov-al was about 20% on 8th week of SO removal. Conclusion: Persistent IOP elevation sometimes happens after SO removal. Therefore, removing SO does not simply treat the elevated IOP happened during SO injection. Patients after SO removal should be followed up for IOP for several weeks and should be treated medically or surgically as required.

Transpalpebral intraocular pressure measurement by Diaton compared to Goldman applanation tonometer in myopic eyes before and after transepithelial photorefractive keratectomy in Saudi Arabia.

To compare intraocular pressure (IOP) measured via the trans palpebral IOP (tpIOP) method using a Diaton or with a Goldman applanation tonometer (GAT) and study the determinants of IOP difference in eyes undergoing transepithelial photorefractive keratectomy (TPRK) for myopia. This cross-sectional validation study was held in 2020 in an eye hospital in Saudi Arabia. IOP was measured by Diaton and GAT before treatment, after one week, and one month of TPRK. It is considered if IOP difference by Diaton and GAT was less than ±2 mm Hg acceptable. The IOP difference was tested if correlated to spherical equivalent (SE), central corneal thickness (CCT), age, gender, or tpIOP. Totolly 200 myopic eyes of 100 patients were included in the study. The mean difference of IOP measured by two methods before TPRK, 1wk, and 1mo after TPRK were 0.790, -0.790, and -0.920 mm Hg, respectively (P<0.001). Diaton could measure IOP effectively 89.5% eyes before TPRK and 82% and 84% at 1wk and 1mo after TPTK, respectively. At week 1, IOP differences were significantly correlated to baseline CCT (P=0.02) and tpIOP at week 1 (P<0.001). One month after TPRK, only tpIOP was significantly correlated to the difference in IOP (P<0.001). Diaton is a good screening tool for IOP before TPRK. It helps in monitoring IOP after surgery. Although more practical, it is less efficient than GAT. In eyes with high myopia and low tpIOP before surgery, IOP post-TPRK by Diaton and GAT could differ.

Analysis of the influence of corneal properties and densitometry on applanation and rebound tonometry in primary open angle glaucoma

To evaluate the influence of corneal densitometry on portable applanation (Perkins) and rebound (iCare ic100 and PRO) tonometry. A secondary goal was to assess if there was a relationship between various corneal properties and the severity of primary open angle glaucoma (POAG). Seventy-five eyes of 75 patients with primary open angle glaucoma were studied, divided by severity into 3 groups: 25 mild, 25 moderate and 25 advanced. Intraocular pressure (IOP) was measured 3 times in each participant with a Perkins applanation tonometer (PAT), a handheld version of the Goldman applanation tonometer (GAT), an iCare PRO and an iCare ic100. Mean values were then calculated. Corneal topography with the Pentacam HR (Oculus, Wetzlar, Germany) was also performed in all individuals. Mean age and sex were comparable in all groups, as were densitometry values (P>0.05). The mean visual field defect (MD) was 2.85 (±1.23) dB in the mild glaucoma group, 8.26 (±1.90) dB in the moderate group and 15.66 (±3.46) dB in the advanced group. Three multivariate regression analyses were performed. The first and second calculations assessed the effect of IOP obtained with iCare ic100 and PAT as dependent variables with age, sex, CCT and mean keratometry (Km) within the glaucoma subgroups and the global sample. The third analysis was carried out to assess the relationship between corneal densitometry as the dependant variable and the aforementioned corneal parameters among the glaucoma groups. In the first multivariate regression analysis, a statistically significant correlation was found between ic100 rebound tonometry and CCT in the POAG global sample (coef. 0.117; IC [-0.21-(-0.01)]; P=0.025). No statistically significant correlation was found in the subgroup analyses. In the second multivariate analysis, no significant correlation was found between PAT and CCT, Km, age or sex (P>0.05). In the third analysis, densitometry was correlated with age in all glaucoma subgroups (P<0.001) and with CCT in the moderate glaucoma subgroup (coef. -0.037; IC [-0.67-(-0.01)]; P=0.021). Tonometry appeared to be minimally influenced by corneal densitometry, with a mild positive linear correlation seen (R=0.03). IOP values were similar with 3 of the tonometers: PAT 16.07 (±3.18) mmHg, PRO 16.27 (±3.42) mmHg and ic100 15.17 (±4.28) mmHg. There was, however, a significant underestimation of IOP with ic100 (-0.89mmHg) compared to PAT (P=0.007). Corneal densitometry did not show significant differences between glaucoma severity groups. A positive correlation was seen with CCT and both corneal densitometry and age. No correlation was found with keratometry or severity of glaucoma. The influence of corneal densitometry on IOP measurements appears weak, with little clinical relevance identified.

Raised Intraocular Pressure Following Phacoemulsification; A Comparative Study with Two Different Viscoelastic

The new modalities in surgical phacoemulsification techniques are intended to restore the visual acuity and have minimized postoperative astigmatism. Objective: To evaluate the difference in the raised intraocular pressure after phacoemulsification and insertion of an intraocular lens using 2% hydroxymethyl cellulose and 1% sodium hyaluronate as viscoelastic. Methods: This group comparative study was performed in the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar for six months. A thorough slit lamp examination was executed to confirm intraocular inflammation or proof of prior intraocular surgery. For glaucoma, Gonioscopy was performed along with proper fundus examination. Patients in Group 1 received 2% Hydroxymethyl Cellulose while in Group 2 patients received 1% Sodium Hyaluronate as viscoelastic. No pressure lowering drug was used and mean intraocular pressure was calculated using Goldman Applanation Tonometer. Intraocular pressure was measured preoperatively and then after 6, 12 and 24 hours and then after one week of surgery. Results: In Group 1, mean age was 65 ± 8.5 and mean Pre Op IOP was 13.1 ± 2.1. Mean Postop IOPs were 13.8, 14.2, 15.1 and 17.5 at 6, 12, and 24 hours and after 1 week respectively. In Group 2, mean age was 62.7 ± 8.3 and mean Preop IOP was 13.2 ± 2.3. Mean Postop IOPs were 13.5, 13.9, 15.1 and 15.9 at 6, 12, and 24 hours and after 1 week respectively. Conclusions: Mean intraocular pressure rise was significantly greater at one week after phacoemulsification and insertion of an intraocular lens using 2% hydroxymethyl cellulose as viscoelastic.

A Case of Neovascular Glaucoma with Branch Retinal Vein Occlusion Accompanied by Severe Anemia

Purpose: Here we report a case of neovascular glaucoma in a patient with branch retinal vein occlusion and severe anemia due to advanced gastric cancer.Case summary: A 79-year-old hypertensive male was transferred to the emergency room because of ocular pain and high intraocular pressure (IOP) in the right eye. He had a history of sectoral retinal photocoagulation for branch retinal vein occlusion in the right eye at a local hospital 9 months previously, and was suspected of having ocular ischemic syndrome for the past 7 days. At the time of admission, his best-corrected visual acuity was hand motion in the right eye and 1.0 in the left eye. His IOP was 28 mmHg in the right eye and 15 mmHg in the left eye, measured using a Goldman applanation tonometer. Neovascularization was observed in the iris on slit-lamp examination; detailed fundus examination and gonioscopy could not be performed because of hyphema in the right eye. Ahmed valve implantation was planned based on a diagnosis of neovascular glaucoma. Preoperative blood tests showed severe anemia (hemoglobin: 7.8 g/dL), indicating gastrointestinal bleeding. Advanced gastric cancer was confirmed on endoscopy and biopsy. Ahmed valve implantation was performed in the right eye and the IOP was maintained within the normal range. Distal gastrectomy was performed by the general surgery department.Conclusions: Severe neovascular glaucoma in branch retinal vein occlusion patients requires careful systemic examination for concomitant factors that may worsen the retinal blood supply.

Comparison of changes in retinal nerve fiber layer thickness and intraocular pressure between glaucoma and non-glaucoma patients after phacoemulsification.

To compare the changes in Retinal Nerve Fiber Layer (RNFL) thickness and Intraocular Pressure (IOP) after phacoemulsification in patients with glaucoma versus without glaucoma. This was a quasi-experimental study, done at Lahore General Hospital, from January 2021 to December 2021. Patients with senile cataract were divided into two groups. One group included 40 patients, with ≥40 years of age and diagnosed with primary open angle glaucoma compared with a second group of 40 age-matched controls without glaucoma, undergoing phacoemulsification and Intraocular Lens Implantation (IOL). Goldman Applanation Tonometer (GAT) and Spectral Domain Optical Coherence Tomography (SD-OCT) were used to record IOP and RNFL thickness, before surgery, at one week and one month after surgery. The results were compared with baseline readings and also between the two groups. A total of 80 patients were included in the study. Mean age was 60.3±7.9 years with male to female ratio of 1:1. Mean change in RNFL thickness in glaucomatous eyes group and non-glaucomatous Eyes group from pre-operative baseline was 11.33±4.30μm and 4.08±2.59μm respectively after one month (p-value<0.001). Difference of mean change in RNFL thickness from baseline was statistically significant between both groups (p< 0.001). Difference of mean change in IOP from baseline at four weeks was statistically significant in the individual groups but between both groups was statistically insignificant (p= 0.234). Phacoemulsification results in increase in RNFL thickness and decrease in IOP, which are good prognostic factors in control of glaucoma. However, a mean change of IOP of 1mmHg in glaucoma patient does not affect management of glaucoma.

Comparative evaluation of Goldman applanation tonometer, Perkins tonometer, and Non-contact tonometers in a tertiary care hospital

Measurement of intraocular pressure (IOP) is basic investigation in a general ophthalmic workup. We attempt to determine the agreement in the measurement of IOP obtained by Goldman applanation tonometer, Perkin’s applanation tonometer, Non-contact tonometer in patients attending general ophthalmology OPD in a tertiary care centre in South India and its use in a community ophthalmology settingA cross-sectional analytical study in which IOP was measured in patients using the three tonometers. Central corneal thickness (CCT) was measured using Ultrasonic pachymetry. Bland Altman analysis was done to evaluate the agreement between instruments. 800 eyes of 400 patients were included in the study. By Bland Altman method, Perkin’s tonometer was found to have better correlation to IOP obtained by Goldman applanation tonometer. Perkin’s tonometer was found to be most accurate when CCT was in the range of 501–550 microns and noncontact tonometer was found to be least accurate when CCT was greater than 600 microns. On comparing correlation at different age groups, both the methods had better correlation at &amp;#60;40 years age group.Both the tonometers showed a significant correlation with the gold standard technique GAT over a range of IOP and CCT with the Perkin’s tonometer better than the NCT. This study proves that Perkin’s tonometer can be recommended as a reliable screening tool in community outreach ophthalmology services. The twin advantages of portability and availability make the Perkin’s tonometer a popular choice among ophthalmology trainees and optometrists in a developing country like India.

Accuracy of Intraocular Pressure Measurements of Eyes with Therapeutic Contact Lenses after Vitrectomy

Purpose: To evaluate the accuracy of intraocular pressure (IOP) measurements obtained by a rebound and non-contact tonometer in eyes with a therapeutic contact lens (CL) after vitrectomy.Methods: In 60 eyes of 60 patients who underwent vitrectomy for vitreoretinal disease, IOP was measured using a rebound tonometer (iCare ic200®; IOPRT) and non-contact computerized air puff tonometer (CT-80, IOPNCT), before and after wearing a CL (Purevision2®, +0.0 diopter). The mean IOP of three consecutive measurements were analyzed, and a comparative analysis with IOP measured by a Goldman applanation tonometer (IOPGAT) was performed.Results: The mean IOPRT without and with the CL was 12.55 ± 5.43 and 13.12 ± 5.13 mmHg, respectively, showing a statistically significant difference (p = 0.02) and strong positive correlation (r = 0.90, p &lt; 0.001). The mean IOPNCT with and without the CL was 12.18 ± 3.24 and 12.17 ± 3.14 mmHg, showing no statistically significant difference (p = 0.17). The consistency with IOPGAT (12.57 ± 5.22 mmHg) was highest in IOPRT without the CL, followed by IOPRT with the CL, IOPNCT without the CL, and IOPNCT with the CL (intraclass correlation coefficients = 0.955, 0.945, 0.856, and 0.850, respectively). In addition, the rebound tonometer successfully measured IOP, regardless of whether the CL was worn; however, the non-contact tonometer failed to measure IOP in seven eyes without the CL and nine with the CL. No difference was observed according to intraocular tamponade type.Conclusions: A rebound tonometer can be used as an alternative IOL measuring method in eyes for which it is difficult to use a Goldman applanation tonometer due to the postoperative presence of a therapeutic CL.

Effect of corneal cross linkage (CXL) on intraocular pressure (IOP) measurements in keratoconus patients

This study aims to determine the effect of corneal cross-linkage (CXL) on intraocular pressure (IOP) in keratoconus patients. Methods: A quasi-experimental study was carried out at the Cornea Clinic of Al Ibrahim Eye Hospital Malir, Karachi. A total of 60 eyes of 36 subjects with progressive keratoconus with the age range of 15 to 31 years were fulfilling the criteria of the study. Subjects were selected with convenient sampling and subjects with a previous history of CXL were excluded from the study. A complete history of the patient, clinical examination with slit-lamp biomicroscopy, and visual acuity (VA) with Snellen chart were recorded. Intraocular pressure (IOP) measurements of each subject were recorded with Goldman Applanation Tonometer (GAT) before and immediately after 15 minutes of CXL and on the 2nd day of CXL, 1month, and 3 months after CXL. SPSS version 22 was used to analyze the data. Results: The average preoperative measured intraocular pressure (IOP) was 20.22 +/- 3.97 mmHg. There was a statistically significant decrease in IOP measurements 18.96 +/- 3.73 mmHg on the same day after the corneal cross linkage procedure with (P 0.001) while there was no statistically significant change in intraocular pressure (IOP) measurements was observed on the 2nd day, 1 month and 3 months after CXL. The postoperative mean of IOP measurements was 19.61 +/- 3.47 mmHg on the 2nd day, 19.67 +/- 3.14 mmHg on 1 month, and 19.33 +/- 3.64 mmHg at 3 months respectively. Conclusion: This study shows that reductions in intraocular pressure (IOP) measurements were observed on the immediate response of corneal cross-linkage (CXL) on the same day. This change might be due to immediate alteration in the biomechanics of the cornea during corneal cross-linkage. These changes return to the normal position later because no change was seen on different follow-ups of patients after CXL in eyes with keratoconus.

Changes in the retinal ganglion cell complex and intraocular pressure during pregnancy measured by optical coherence tomography and Goldman applanation tonometer

Objetivo: Determinar los cambios en la presión intraocular y complejo de células ganglionares en los tres trimestres del embarazo y en pacientes controles no embarazadas. Material y Métodos: Se analizaron ambas variables (presión intraocular y complejo de células ganglionares de la retina) en un grupo de pacientes embarazadas a quienes se les realizaron mediciones cada trimestre de la gestación para posteriormente comparar los resultados con los de pacientes sanas no gestantes valoradas en tres trimestres consecutivos. De acuerdo con una prueba de equivalencia de medias se requirió una muestra de tamaño n=37 en el grupo de referencia y en el grupo control, con una potencia de 80% y una significancia del 5%. Se utilizó la base de datos del programa SPSS para la organización, codificación y análisis estadístico de los resultados. Resultados: los hallazgos de estos estudios difieren con lo descrito en la literatura en los que se mencionan una tendencia hacia la disminución de la presión intra-ocular; en este trabajo no se presentó variación clínica ni estadísticamente significativa durante la gestación en comparación con las pacientes no gestantes. En el complejo de células ganglionares de la retina tampoco se observó una variación clínica ni estadísticamente significativa. Conclusiones: Las pacientes estudiadas no contaban con diagnóstico de glaucoma, lo cual hace que los resultados no sean extrapolables a un grupo con la patología, pero permiten conocer la evolución del complejo de células ganglionares de la retina y la presión intraocular durante la gestación, cuestión importante ya que existen pocos estudios que analicen esta información. Palabras Clave: Gestación, glaucoma, presión intraocular, complejo de células ganglionares.

Rise Of Intraocular Pressure After Nd: YAG Laser Capsulotomy

Objective: Posterior capsule opacification (PCO) after cataract is a common complication of extra capsular cataract extraction with or without intraocular lens implantation. Aim of this study was to evaluate changes in intraocular pressure after Nd-Yag laser posterior capsulotomy for PCO.&#x0D; Methodology: This retrospective study using convenient sampling technique was done at Eye Department of Shaheed Mohtarma Benazir BhuttoMedical College Lyari, Sindh Government General Hospital, Karachi for six months (1st January 2020 to 30th June 2020. After ethical approval and informed permission from patients and guardian, data was collected and analyzed by SPSS version 20 and presented by calculating mean and standard deviation for quantitative data and frequency and percentages for qualitative data.&#x0D; Results: Total 50 patients (20 males and 30 females) were studied where 22 right and 28 left eyes. Mean age was 59.08 years. Mean pre-operative IOP was 13.28 and 13.12 mmHg of right and left eye respectively (Table I). At 2 hours mean IOP was 16.84±3.63 mmHg and after one week 12.48±2.0 mmHg. Base line pre-laser IOP was measured by Goldman Applanation Tonometer (GAT) and slit lamp examination. Pupils were dilated using 1% tropicamide eye drops. IOP was evaluated immediate post-procedure, two hours post–procedure and one week from date of laser.&#x0D; Conclusion: Nd –Yag laser capsulotomy is treatment of choice for PCO and associated with complications like Raised Intraocular Pressure (IOP), Intraocular lens pitting, cystoid macular oedema, retinal detachment. Raised IOP is most common complication and prescribing anti-glaucoma drugs in order to decrease intraocular pressure.

IOP change after phacoemulsification with PCIOL implantation and its association with ocular biometric parameters

: To assess the impact on intraocular pressure (IOP) after Phacoemulsification (PE) with Posterior Chamber Intraocular Lens (PCIOL) implantation and its relation with ocular biometric parameters. The study was a prospective observational study included 524 eyes with normal IOP (11-21 mmHg) who underwent uneventful Phacoemulsification with PCIOL Implantation surgery for age-related cataract. IOP, Central Corneal Thickness (CCT), Anterior Chamber Depth (ACD), Axial Length (AL) were measured pre-operatively and one month post-operatively by Goldman Applanation Tonometer, Corneal Pachymeter and Optical Coherence Biometer, respectively. The post-operative IOP change and its relation with preoperative biometric parameters were determined.: The mean pre-operative and post-operative IOP was 13.44±1.98 &amp; 11.54±1.66mmHg, respectively, with an average IOP reduction after one month of 1.90±0.61mmHg. The mean pre-operative and post-operative ACD was 3.27±0.24 and 3.66±0.27 mm, respectively, with an average increase of 0.39 ±0.3 mm. Paired t-test showed post-operative IOP reduction was significantly associated with preoperative IOP (p&amp;#60;0.001) and ACD (p&amp;#60;0.001). But CCT and AL were not significantly associated. The linear regression analysis confirmed the proportional reduction of post-operative IOP, r 0.921. So 92.1% of the preoperative IOP is proportional to post-operative IOP reduction. The graphical representation shows more the pre-operative IOP, more the post-operative IOP reduction.: IOP is significantly reduced, and ACD increased after PE with PCIOL implantation surgery and is associated with post-operative IOP reduction. The post-operative IOP reduction is proportional to pre-operative IOP, and more the preoperative IOP, more the post-operative IOP reduction.

Effect of Oral Contraceptive Pills on Tear Film Status and Intraocular Pressure

Purpose: To find out the effect of oral contraceptive pills on tear film and intraocular pressure of women of reproductive age group.&#x0D; Study Design: Observational study.&#x0D; Place and Duration of Study: Khalid Eye clinic, Karachi, from February 2019 to January 2020.&#x0D; Methods: Eighty females between the 20 to 40 years of age were recruited for this study. They were divided into two groups of forty each. Group A included females using oral contraceptive pills for at least last nine months. Whereas, group B included control group of age matched females not using any contraceptive pills. The study dynamics was explained to all participants and informed consent was obtained. Tear film status was assessed on the basis of Tear film break up time (TBUT) on slit lamp examination and Schirmer strip test 2 (without anesthesia). Intraocular pressures were checked using Goldman Applanation tonometer. Studywas approvedfrom ethical review committee of the hospital.&#x0D; Results: Mean age was 29.3 ± 3.27 years. Tear film break up time was &lt; 7 ± 1.5 sec in group A and &gt; 10 ± 1.2 sec in group B. Schirmer strip test was ≤ 9 ± 1 mm of wetting in group A and ≥ 13 ± 1 mm of wetting in group B. Mean intraocular pressure was 17 ± 2 mmHg in group A whereas 13 ± 2 mmHg in group B. Grittiness, heaviness and foreign body sensation were more common in group A.&#x0D; Conclusion: Use of oral contraceptive pills has an adverse effect on the tear film status and intraocular pressures.&#x0D; Key Words: Oral contraceptive pills, Tear film, TBUT, Schirmer’s test, Intraocular pressure.