Goldmann Applanation Tonometry Research Articles

Comparison of Air Puff Tonometer with Gold Standard Applanation Tonometer for Measurement of Intraocular Pressure in Adult Population

Detecting and treating glaucoma early is vital to prevent vision loss. Two main instruments, the Air Puff Tonometer and the Gold Standard Applanation Tonometer, are used to measure Intraocular Pressure (IOP). However, there is ongoing debate among ophthalmologists regarding the accuracy and reliability of these devices. Objective: To evaluate and contrast the measurements of intraocular pressure obtained through Air puff tonometry and Goldmann applanation tonometry. Methods: A cross-sectional comparative study was conducted upon 900 patients of Glaucoma, selected through purposive sampling technique, attending the Eye OPD of Isra University Hospital, Hyderabad. Patients with age more than 18 years, of both genders who provided consent for eye examination and treatment, were included in the study while patients with corneal disease or prior surgery, ocular trauma, or those presenting with active infection or ocular disease were excluded from the study. Results: 396 (44.0%) of patients were males and 504 (56.0%) were females. The results indicate that the mean IOP measurement for air puff tonometry (17.43 mm Hg) is significantly higher (p-value=0.0001) than the mean measurement obtained by Goldman tonometry (13.84 mm Hg). Overall, the distribution of IOP was similar for both types of tonometry, with a slightly higher proportion having high IOP values (19-22 mmHg) with Goldman tonometry compared to air puff tonometry. Conclusions: The findings of this research demonstrated a noteworthy contrast between the two techniques, where the air puff tonometry produced noticeably elevated intraocular pressure measurements in comparison to the widely accepted applanation tonometry

Agreement of Serial iCare HOME2 and Goldmann Applanation Tonometry

PurposeTo assess agreement of iCare HOME2 and Goldmann applanation tonometry over a wide range of IOP. DesignA prospective, observational cohort study. SubjectsTwenty-six adult patients undergoing intravitreal injection, which temporarily raises IOP, were recruited from the Palo Alto Medical Foundation Retina Clinic between October 2022 and February 2023. MethodsSubjects had serial iCare HOME2 (IOPI) and Goldmann applanation (IOPG) IOP measurements before and at 0 and 5-10 minutes after injection. Baseline IOPs and pachymetry were taken in both eyes. Main Outcome MeasuresCorrelation between IOPI and IOPG was tested by within-subjects Intraclass Correlation Coefficient (ICC) for repeated measures. Agreement between IOPI and IOPG was evaluated by a Bland-Altman plot with correction for multiple measurements. The difference between IOPI and IOPG was evaluated between eyes at baseline (Pearson’s r) and within the injected eye over different timepoint (ICC for absolute agreement). Linear regression was used to evaluate the effect of age, sex, glaucoma, and corneal thickness. ResultsThe mean IOPI and IOPG were 25.3 (range: 9 – 55) and 23.5 (range: 8 – 56) mmHg, respectively. Correlation between IOPI and IOPG was 0.99 (p<0.001). The mean difference (IOPG - IOPI) was 2.2 mmHg (95% limits of agreement: -3.4 to 7.8 mmHg). The bias in measurements was correlated between eyes (r: 0.68, p<0.001) and in the injected eye across all timepoints (ICC: 0.86, 95% CI: 0.75 to 0.93), but did not show a relationship with age, sex, glaucoma or corneal thickness. ConclusionIOPI and IOPG showed excellent correlation, however there was a stable bias toward IOPG being higher than IOPI over a large range of IOP.

Comparison of intraocular pressure profiles during the water drinking test and the modified diurnal tension curve

ObjectivesTo compare intraocular pressure (IOP) during the water drinking test (WDT) and modified diurnal tension curve (mDTC) in open-angle glaucoma (OAG) patients, using multimodal, observer-masked tonometry.MethodsOpen-angle glaucoma subjects were prospectively enroled, excluding those who had undergone glaucoma filtration or laser surgery. Two-hourly mDTC Goldmann applanation (GAT) and rebound tonometry (RT) was performed between 8:00 and 16:00, and every 15 min for 45 min after ingestion of 800mls of water. Blood pressure, heart rate, pupillometry measurements, and optical coherence tomography (AS-OCT) were also recorded.ResultsForty-two subjects’ right eyes were included. 48% were using topical glaucoma medication. Mean baseline IOP was 14.9 ± 4.52 mmHg, with mean visual field mean deviation (±SD) −5.05 ± 5.45 dB. Strong association was found between maximum IOP during mDTC and WDT (r = 0.90, 95% CI 0.82–0.95 p < 0.0001) with agreement (mDTC-WDT) bias −0.82 mmHg, 95% LoA −1.46 to −0.18. During the WDT, mean systolic blood pressure (±SD) increased from 140.0 ± 20.0 to 153.3 ± 24.0 mmHg (p < 0.0001), mean heart rate ( ± SD) reduced from 69.5 ± 11.3 bpm to 63.6 ± 10.0 bpm (p < 0.0001), and temporal iridocorneal angle increased from 29.2 ± 6.0° to 29.6 ± 5.2° (p = 0.04).ConclusionThis study presents repeated, observer-masked IOP data showing strong correlation between maximum IOP during mDTC and WDT using multimodal tonometry. This supports WDT as a meaningful alternative to mDTC when investigating diurnal IOP characteristics in clinic, with reduced time requirements and associated costs.

Comparing Intraocular Pressure, Ocular Blood Flow, and Retinal Nerve Fiber Layer Thickness in Early and Chronic Hypertensives With Normotensives

Purpose To compare blood pressure (BP), intraocular pressure (IOP), ophthalmic artery flow (OAF) velocity, retinal nerve fiber layer (RNFL) thickness, and visual fields in newly diagnosed hypertension (HT) patients (before treatment), chronic HT (on antihypertensive medications >5 years) and normotensives. Methods A prospective, cross-sectional study at a tertiary care centre in India. Three groups of 45 patients each: group 1 - early HT, group 2 - chronic HT, and Group 3 - normotensives, underwent evaluation of BP, IOP by Goldmann applanation tonometry (GAT), OAF velocity by transcranial doppler (TCD), RNFL analysis by spectral-domain optical coherence tomography (SD-OCT), and visual fields. Results The BP was highest in early HT > chronic HT > normotensives (p < 0.001). The IOP of early HT, chronic HT, and normotensives were 15.87 ± 2.19 mmHg, 13.47 ± 1.92 mmHg, and 15.67 ± SD 1.75 mmHg (p < 0.001). The OAF velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV) in cm/sec] was lowest in chronic HT (30.80 ± 7.05, 8.58 ± 1.58) < early HT (35.47 ± 5.34, 10.02 ± 1.74) < normotensives (36.29 ± 4.43, 10.44 ± 2.29), (p < 0.001). The average RNFL thickness was significantly lower in chronic HT (p = 0.022). The PSV, EDV, and MFV showed significant correlation with IOP (r = 0.247, p = 0.004; r = 0.206, p = 0.016; r = 0.266, p = 0.002) and average RNFL thickness (r = 0.309, p= <0.001; r = 0.277, p = 0.001; r = 0.341, p < 0.001) Conclusions Patients with chronic HT demonstrated the lowest retrobulbar flows, IOP and lower RNFL measurements. Lower ocular perfusion may be associated with lower IOP and may be a risk factor for end-organ damage (RNFL) independent of IOP.

REDUCTION OF INTRAOCULAR PRESSURE POST MICRO PULSE TRANSSCLERAL CYCLOPHOTOCOAGULATION IN REFRACTORY GLAUCOMA PATIENTS

Introduction &amp; ObjectivesCyclodestructive laser is one of the last resource managements for refractory glaucoma, especiallywith low visual potential. Conventional laser using CW-TSCPC showed unstable IOP reduction withcollateral tissue damage. MP-TSCPC using on and off cyclic waves is considered to have a gooddegree of IOP reduction and fewer complications. The purpose of this study is to assess the IOPreduction after the MP-TSCPC procedures for patients with refractory glaucoma.&#x0D; MethodsThis is a prospective observational study for refractory glaucoma patients treated with the MPTSCPClaser procedure. Measurement of IOP was carried out preoperatively and on postoperativedays 1, 7, and 30 with the gold standard Goldmann applanation tonometry.&#x0D; ResultsA total of 33 eyes from 33 patients were enrolled in this study. The mean baseline IOP was 48.45 ±12,79 mmHg. The mean degree of IOP reduction on follow-up days 1, 7, and 30 were 14.39 ±23.52%, 45,83 ± 24,80 and 27.09 ± 23.86% respectively. On the 30th day after the laser treatment,no complications were observed. The number of anti-glaucoma medication was reduced from 2.39 ±0.49 at the baseline to 1.91 ± 0.58 at one month follow up.&#x0D; ConclusionMicro-pulse transscleral cyclophotocoagulation laser showed a good degree of IOP reduction with noincidence of complication observed at day 30.

Evaluation of early period changes in intraocular pressure, ocular biometry and anterior segment after upper eyelid blepharoplasty.

To investigate the acute effects of upper eyelid blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters. This prospective cross sectional study examined the eyes of 49 patients with dermatochalasis. Following a detailed ophthalmological examination, corneal topography was used to evaluate the eyes mesopic and photopic pupil diameter, anterior chamber depth, and corneal astigmatism on the day of surgery and on days first and seventh postoperatively. Ocular biometry was used to assess axial length and intraocular lens power. Goldmann applanation tonometry was used to measure intraocular pressure. Forty-nine eyes (26 males and 23 females) of 49 patients aged between 44 and 76years (mean 61 ± 7.9) were included in our study. The mean anterior chamber depth (ACD) was 2.90 ± 0.37mm preoperatively, 3.00 ± 0.29mm at postoperative day first, and 3.04 ± 0.29mm at postoperative day seventh, and the increase in anterior chamber depth was statistically significant (p < 0.001). The mean astigmatism values were measured as preoperative 0.73 ± 0.69 D, postoperative first day 0.93 ± 0.81 D, and postoperative seventh day 1.26 ± 0.90 D. The increase in astigmatism values was statistically significant (p < 0.001).The mean pupil diameter measurements in the mesopic environment were 4.20 ± 0.61mm preoperatively, 4.40 ± 0.59mm on the first postoperative day, and 4.39 ± 0.57mm on the seventh postoperative day, and there was a statistically significant difference between the three measurements (p = 0.03). The mean IOP measurements of the patients were 15.91 ± 3.51mmHg preoperatively, 16.81 ± 3.36mmHg on the first postoperative day, and 16.97 ± 3.13mmHg on the seventh postoperative day. The increase between these three measurements was statistically significant (p = 0.013). This study includes important insights into the potential acute phase impact of blepharoplasty surgery on ocular findings. Patients undergoing upper eyelid surgery should be informed about the possible change in ocular biometric parameters, intraocular pressure, and pupil diameter.

A Comparative Analysis of Intraocular Pressure Measurement Accuracy With Reused iCare Probes

ObjectiveTo assess the accuracy of reused iCare probes after disinfection with 70% isopropyl alcohol and ethylene glycol compared to new iCare probes and Goldmann Applanation Tonometry (GAT). DesignProspective comparative analysis Participants118 eyes from 59 patients recruited from the Aravind Eye Hospital glaucoma clinic in Tirupati, South India. MethodsIntraocular pressure (IOP) was measured on each eye using a new iCare tonometer probe, an iCare probe previously used and disinfected one time prior (once used probe) and five times prior (multiply used probe), as well as with GAT. Probes were disinfected after each use with 70% isopropyl alcohol swabs and ethylene oxide sterilization. Main Outcome MeasuresAgreement demonstrated with intraclass correlation coefficients (ICC), mean difference in IOP values with limits of agreement, and Bland-Altman plots among IOP measurement approaches. ResultsCompared to new iCare probes, both once used probes (ICC=0.989, 95%CI 0.985–0.993) and multiply used probes (ICC=0.989, 95%CI 0.984–0.992) showed excellent agreement, and the mean difference in IOP was minimal for both once used probes (0.70 mmHg, 95%CI 0.29–1.11) and multiply used probes (0.75 mmHg, 95%CI 0.66–0.82) compared to new probes. Bland-Altman plots demonstrated minimal differences between new and reused probes across the spectrum of IOP. When comparing multiply used probes to once used probes, there was a high level of agreement (0.993 (95%CI 0.990-0.995) and negligible mean IOP difference 0.04 mmHg (95% CI -0.32-0.40). Additionally, ICC values for new probes (0.966, 95%CI 0.951–0.976), once used probes (0.958, 95%CI 0.940–0.971), and multiply used probes (0.957, 95%CI 0.938–0.970) compared to GAT were similar and all showed excellent agreement. Both new and reused iCare probes underestimated IOP by 2-3 mmHg compared to GAT. ConclusionsIn this prospective comparative analysis, we found that reusing iCare probes up to five times does not compromise the accuracy of IOP measurements when disinfected with 70% isopropyl alcohol swabs and ethylene oxide. Reusing iCare probes has the potential to transform care by reducing cost, decreasing environmental waste, and allowing for glaucoma screening camps and increased glaucoma monitoring in low resource settings leading to earlier identification and treatment of glaucoma.

Relationship between intraocular pressure fluctuation and visual field progression rates in the United Kingdom Glaucoma Treatment Study

To investigate whether intraocular pressure (IOP) fluctuation is independently associated with the rate of visual field (VF) progression in the United Kingdom Glaucoma Treatment Study. Randomized, double-masked, placebo-controlled multicenter trial. Participants with ≥5 VFs (213 placebo, 217 treatment). Associations between IOP metrics and the VF progression rates (mean deviation (MD) and five fastest locations) were assessed with linear mixed models. Fluctuation variables were mean ocular pulse amplitude (OPA), standard deviation (SD) of diurnal IOP (diurnal fluctuation), and SD of IOP at all visits (long-term fluctuation). Fluctuation values were normalized for mean IOP to make them independent from mean IOP. Correlated non-fluctuation IOP metrics (baseline, peak, mean, supine and peak phasing IOP) were combined with principal component analysis (PCA), and principal component 1 (PC1) was included as a covariate. Interactions between covariates and time from baseline modelled the effect of the variables on VF rates. IOP was measured with Goldmann applanation tonometry and OPA with Pascal tonometry. Analyses were conducted separately in the two treatment arms. Associations between IOP fluctuation metrics and rates of MD and five fastest test locations. In the placebo arm, only PC1 was significantly associated with the MD rate (estimate [standard error (SE)]: -0.19 [0.04] dB/year, p<0.001), while normalized IOP fluctuation metrics were not. No variable was significantly associated with MD rates in the treatment arm. For the fastest five locations in the placebo group, PC1 (estimate [SE]: -0.58 [0.16] dB/year, p<0.001), CCT (estimate [standard error (SE)]: 0.26 [0.10] dB/year for 10 μm thicker, p=0.01) and normalized OPA (estimate [SE]: -3.50 [1.04] dB/year, p=0.001) were associated with rates of progression; normalized diurnal and long-term IOP fluctuations were not. In the treatment group, only PC1 (estimate [SE]: -0.27 [0.12] dB/year, p=0.028) was associated with the rates of progression. There is no evidence to support that either diurnal or long-term IOP fluctuation, as measured in clinical practice, are independent factors for glaucoma progression; other aspects of IOP, including mean IOP and peak IOP, may be more informative. OPA may be an independent factor for faster glaucoma progression.

Even-number measurement bias with Goldmann applanation tonometry in patients with glaucoma and glaucoma suspects

ABSTRACT Clinical Relevance Goldmann applanation tonometry is widely used for the diagnosis and management of glaucoma and its use is considered standard of care. However, the precision of this method may be reduced by a clinician tendency to round to even numbers. Background Studies have previously demonstrated an even-number measurement bias with Goldmann applanation tonometry during examination of a general patient population. Since it has not been determined whether this bias persists among glaucoma suspects and patients with glaucoma, further investigation was conducted. Methods A retrospective analysis was conducted on a random sample from a large dataset of >69,000 patients seen during a six-year period at an urban, academic primary eye care service. Patients without suspicion of glaucoma, patients with a suspicion of glaucoma, and patients with glaucoma were selected who had Goldmann tonometry performed. Chart reviews were performed to confirm status, and even/odd-numbered Goldmann tonometry measurement frequencies were compared. Results The analysis included 961 controls, 506 glaucoma suspects, 159 ocular hypertensives not taking medication, and 314 patients taking medications who carried a diagnosis of glaucoma or ocular hypertension. Among controls the Goldmann tonometry even/odd digit proportions were 62.8%/37.2% (N = 961, p < 0.0001), and the even-number bias persisted among the other groups with specific even/odd distributions being 61.9%/38.1% (N = 506, p < 0.0001) for glaucoma suspects not taking medications, 66.0%/34.0% (N = 159, p < 0.0001) for ocular hypertensives not taking medications, and 64.3%/35.7% (N = 314, p < 0.0001) for glaucoma/ocular hypertension patients taking medications. Conclusion An even-number measurement bias with Goldmann tonometry may be prevalent even when the examiner is aware of there being greater importance for intraocular pressure measurement accuracy.

Evaluation of Intraocular Pressure in Eyes After Femtolasik Surgery

Introduction: Femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) surgery is a surgical procedure performed in the treatment of refractive errors. Given the changes in central corneal thickness, intraocular pressure may be lower and underestimated, which may lead to a late diagnosis of ocular hypertension/glaucoma. Aims: The aim of this study was to evaluate and compare intraocular pressure, by different methods, before and after FS-LASIK, for correction of myopia or myopic astigmatism. Methods: Retrospective and observational study, which included eyes undergoing FS-LASIK surgery (November 2020 to November 2022). The intraocular pressure values were measured (preoperatively, on the 1st, 3rd and 6th postoperative month) using contact tonometry (Goldmann applanation tonometry) and non-contact tonometry (by Corvis®ST according to the formulas: pachymetry – Ehlers, Shah, Dresden, Spoerl – and biomechanics – corrected and uncorrected). The intraocular pressure values obtained at 6 months with the different methods were compared with the Goldmann applanation tonometry intraocular pressure values obtained at baseline. Results: Ninety patients (of a total of 174 eyes) underwent FS-LASIK, with a preoperative spherical equivalent of -3.7±1.7. Preoperatively (mean ± standard deviation) Goldmann applanation tonometry was 15.0±1.9 mmHg; the intraocular pressure values obtained through the Corvis® ST (in mmHg) according pachymetry: Ehlers (13.5±2.6), Shah (14.3±2.3), Dresden (14.5±2.2) and Spoerl (14.5±2.1); and biomechanics: corrected (14.4±1.9) and not corrected (15.3±2.1), respectively. At 6 months postoperatively, all showed statistically significant differences, with the exception of Shah's formula (p=0.074); comparing the preoperative Goldmann applanation tonometry with each of the formulas at the end of the follow-up, the Ehlers formula did not present statistically significant differences (p=0.434), the Shah formula a value of p=0.047 and the others a value of p&lt;0.001. Conclusion: Femtosecond laser-assisted laser in situ keratomileusis surgery underestimates intraocular pressure measurement by contact tonometry. In non-contact tonometry, at 6-month follow-up, the Shah formula appears to be less influenced by this bias. More studies are needed to evaluate the best method to assess I intraocular pressure measurement after FS-LASIK surgery.

Glaucoma screening: How and why?

Purpose: To assess the results of glaucoma screening in the population over age 40.Methods: A population‐based glaucoma screening was performed at Habib Thameur Hospital, Tunis TUNISIA on March 12, 2023. Screening included intraocular pressure (IOP) measurement with Goldmann applanation tonometry, visual acuity measurement (VA) with the Snellen chart, fundus examination to detect characteristic optic disc changes, and questions regarding systemic diseases, family history of glaucoma, and current medications.Results: A total of 280 subjects were examined. Forty‐six had ocular hypertension, including 12 glaucomatous. All these patients were referred to the ophthalmology department for a complete ophthalmological examination, explorations (pachymetry, OCT of the optic nerve, visual field), treatment and regular follow‐up. Twenty‐two had unilateral or bilateral cataracts which we scheduled for surgery and fifteen had diabetic retinopathy at various stages which were referred to our specialist consultation for treatment.Conclusions: The need for effective and early detection and management of glaucoma may reduce the prevalence of glaucoma‐induced blindness.

Intraocular pressure and central corneal thickness in a healthy student population

Introduction/Objective. Intraocular pressure is an important parameter of eye health, especially when glaucoma is suspected. So far, few studies have been published that aimed to determine the average value of intraocular pressure and central corneal thickness in a healthy population aged 20?30 years. The aim of this study was to determine the distribution of the values of intraocular pressure and central corneal thickness in healthy student population. Methods. In a cross-sectional study, intraocular pressure and central corneal thickness were measured on a sample of a healthy population, aged 22?37 years. Intraocular pressure was measured using the Goldmann applanation tonometry method, while central corneal thickness was measured using ultrasound pachymetry. The analysis of numerical values was done using the methods of descriptive statistics. Results. By measuring intraocular pressure and central corneal thickness in 641 subjects (1282 eyes), the average value of intraocular pressure was determined to be 14.79 ? 2.31 mmHg, and central corneal thickness was 553.92 ? 25.56 ?m. By comparing two groups of subjects, one male group and the other one female, we determined that there was no statistically significant difference in the average value of intraocular pressure (t-test, p &gt; 0.05), and the average value of central corneal thickness (t-test, p &gt; 0.05) between the sexes. Conclusion. The determined average value of intraocular pressure and central corneal thickness is similar to those determined in other cross-sectional studies of this type. No statistically significant difference was found in the intraocular pressure values and the central thickness of the cornea by sex.

Comparison between open-angle glaucoma and angle-closure glaucoma regarding the short-term optic disc vessel density changes after trabeculectomy

To compare the microvasculature of the optic disc in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) after trabeculectomy. This study included 34 patients divided into two groups based on the angle: (1) the OAG Group, which included 24 eyes from 24 patients, and (2) the ACG Group, which included ten eyes from 10 patients. All patients were subjected to comprehensive ophthalmic examinations. It included best-corrected visual acuity (BCVA), Goldmann applanation tonometry, gonioscopy, slit-lamp biomicroscopy, dilated fundus examination, and stereoscopic examination of the optic disc. The central corneal thickness was measured using a Nidek AL scan optical biometer. The visual field was evaluated by standard automated perimetry using Humphrey Field Analyzer (24–2 Swedish interactive threshold algorithm; Carl-Zeiss Meditec, Dublin, CA). Moreover, optical coherence tomography angiography (OCT-A) was performed utilizing the RTVue XR Avanti scanner (Optovue Inc., Fremont, CA, USA) preoperatively as well as 1 month after surgery. There was a statistically significant increase in optic disc vessel density (VD) in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in OAG after surgery. Regarding the change in VD after surgery in ACG patients, there was a statistically significant increase in optic disc VD in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in ACG after surgery.Regarding the percentage of VD change following trabeculectomy surgery, there were highly significant differences between the two groups for the whole image, radial peripapillary, inferior quadrant, and temporal quadrant VD. Statistically significant changes were also observed in the superior and nasal quadrants of VD. However, no significant change in VD was detected within the disc. In conclusion, the optic disc VD improved after the reduction of intraocular pressure (IOP) by surgery in both OAG and ACG. However, ACG demonstrated a significant improvement than the OAG.

The association between intraocular pressure dynamics during dark-room prone testing and intraocular pressure over a relatively long-term follow-up period in primary open-glaucoma patients

PurposeTo investigate the relationship between the dynamics of intraocular pressure (IOP) during dark-room prone testing (DRPT) and IOP over a relatively long-term follow-up period.MethodsThis retrospective study enrolled 84 eyes of 51 primary open-angle glaucoma patients who underwent DRPT for whom at least three IOP measurements made using Goldmann applanation tonometry were available over a maximum follow-up period of two years. We excluded eyes with a history of intraocular surgery or laser treatment and those with changes in topical anti-glaucoma medication during the follow-up period. In DRPT, IOP was measured in the sitting position, and after 60 min in the prone position in a dark room, IOP was measured again. In this study, IOP fluctuation refers to the standard deviation (SD) of IOP, and IOP max indicates the maximum value of IOP during the follow-up. The relationship between these parameters was analyzed with a linear mixed-effects model, adjusting for clinical parameters including age, gender, and axial length.ResultsIOP increased after DRPT with a mean of 6.13 ± 3.55 mmHg. IOP max was significantly associated with IOP after DRPT (β = 0.38; p < 0.001). IOP fluctuation was significantly associated with IOP change in DRPT (β = 0.29; p = 0.007).ConclusionOur findings suggest that short-term and relatively long-term IOP dynamics are associated. Long-term IOP dynamics can be predicted by DRPT to some extent.

The influence of topical anesthetic and fluorescein on non-contact tonometry measurements using ultra-high-speed dynamic Scheimpflug

This study aimed to investigate the effects of topical anesthetic and fluorescein drops on intraocular pressure (IOP), central corneal thickness (CCT) and biomechanical properties as measured by Corvis ST (CST-Oculus; Wezlar, Germany) in healthy eyes. A cross-sectional observational study was conducted on 46 healthy patients. The CST measurements were obtained before and immediately after the instillation of topical anesthetic and fluorescein drops. Pre-post instillation data were statistically analyzed. IOP measurements were compared to Goldmann's Applanation Tonometry (GAT), which was also performed after drops instillation. Biomechanical parameters analyzed included applanation 1 velocity, applanation 2 velocity, applanation 1 time, applanation 2 time, whole eye movement, deflection amplitude, and stiffness parameter at first applanation. A statistically significant difference in IOP, both for non-corrected IOP (IOPnct) and biomechanically corrected IOP (bIOP), was observed before and after the instillation of eyedrops. Despite this statistical significance, the observed difference lacked clinical relevance. The IOPnct demonstrated a significant difference pre and post-anesthetic and fluorescein instillation compared to GAT (14.99 ± 2.27 mmHg pre-instillation and 14.62 ± 2.50 mmHg post-instillation, versus 13.98 ± 2.04 mmHg, with p-values of 0.0014 and 0.0490, respectively). Comparable findings were noted when justaposing bIOP to GAT (14.53 ± 2.10 mmHg pre-instillation and 13.15 ± 2.25 mmHg post-instillation, against 13.98 ± 2.04 mmHg, with p-values of 0.0391 and 0.0022, respectively). Additionally, CCT measurements revealed a statistically significant elevation following the administration of topical anesthetic and fluorescein drops (from 544.64 ± 39.85 µm to 586.74 ± 41.71 µm, p < 0.01. None of the analyzed biomechanical parameters showed statistically significant differences after drops instillation. While the administration of topical anesthetic and fluorescein drops induced a statistically significant alteration in both IOPnct and bIOP readings, these changes were not clinically consequential. Furthermore, a notable statistical rise was observed in CCT measurements post-drops instillation, as determined by CST. Yet, corneal biomechanical parameters remained unaffected.

Klinik olarak Tek Taraflı Psödoeksfoliasyon Sendromu Olanların Ön Segment Parametrelerinin Schempflug Görüntüleme Tekniği ile değerlendirilmesi

Objective: We aimed to compare the intraocular pressure (IOP), keratometry values (K), and anterior segment parameters of patients with clinically unilateral pseudoexfoliation syndrome (PEX) with the other eyes without PEX and the control group. Material and Method: Fifty four patients with unilateral PEX findings and 40 participants without PEX findings in both eyes were included in the study as a control group. IOP was measured by Goldmann applanation tonometry. K values and anterior segment parameters [central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), and anterior chamber volume (ACV)] were measured using Scheimpflug imaging technique. Results: The mean age of PEX patients was 67.9±9.2 years, while the mean age of the control group was 58.9±5.7 years. The IOP values of the eyes with PEX were significantly higher than the other eyes (p=0.02), and there was no significant difference between them and the control group (p=0.59). In terms of K values and anterior segment parameters, the measurements of eyes with PEX and the other eyes, and eyes with PEX and control group were similar (p&amp;gt;0.05). Conclusion: In our study, eyes with PEX had higher IOP values than the fellow eyes and control group. In addition, thinner CCT, narrower ACD, and ICA values were found in eyes with PEX than in the other eyes. However, these values were not statistically significant.

A study to assess interobserver agreement for measuring the intraocular pressure using Goldmann applanation tonometry by two ophthalmologists

A study to assess interobserver agreement for measuring the intraocular pressure using Goldmann applanation tonometry by two ophthalmologists

Implantable Collamer Lens in Management of Unilateral High Myopia After Pseudophakia for Traumatic Cataract: Piggybacking With Two Lenses in the Sulcus

Purpose: To describe the management of unilateral high myopia after pseudophakia for traumatic cataract by piggybacking an Implantable Collamer Lens (ICL) (V4C ICL; STAAR Surgical) along with a primary intraocular lens (IOL) in the sulcus. Methods: A 24-year-old woman underwent lens aspiration with non-foldable IOL implantation in the sulcus at 5 years of age for post-traumatic cataract. She had regular follow-up for 21 years and developed unilateral high myopia. She was using contact lenses and wanted laser vision correction. An Implantable Collamer Lens in the sulcus was used to manage the unilateral high myopia in this pseudophakic patient with a rigid IOL in the sulcus. Results: Her corneal thickness was less than 500 µm. Except for raised intraocular pressure in the immediate postoperative period, she had uneventful postoperative recovery. Her uncorrected distance visual acuity (UDVA) at 4 weeks improved to 6/9. The patient was followed up for 7 months and had a UDVA of 6/9, intraocular pressure on Goldmann applanation tonometry of 14 mm Hg, adequate vault height (1.057 mm), good anterior chamber depth (1.739 mm), and no deposits on either of the lenses. Conclusions: An ICL can be used over a primary IOL in the sulcus for the correction of ametropia, although additional cases need to be evaluated for the proper sizing and results in similar patients. [ Journal of Refractive Surgery Case Reports. 2023;3(4):e42–e46.]

Predictive Value of Dynamic Corneal Response Parameters Evaluated with Scheimpflug High-Speed Video (Corvis ST) on the Visual Field Progression in Prostaglandin Treated Ocular Hypertension and Open-Angle Glaucoma Patients.

The aim of this work is to compare the Corvis ST stress-strain index (SSI) and highest concavity (HC) parameters at baseline and 1month after initiating monotherapy with prostaglandin analogues (PGs) in eyes showing visual field (VF) progression or stability. In this prospective, single-center, observational study, newly diagnosed and treatment-naïve OAG patients were examined at baseline and 1month after beginning monotherapy with topical PGs monotherapy. Goldmann applanation tonometry pressure readings, Corneal Hysteresis (ORA-CH), and the Corvis ST measurements were obtained at both visits. VF progression (Humphrey) was evaluated based on data from 6 years of follow-up after the baseline visit. Stress-strain index (SSI) and HC parameters in progressing (P) and non-progressing (NP) eyes were the main outcome measures. Sixty-three eyes were analyzed; mean age was 64.63 ± 11.26years; 47 eyes were NP and 16 eyes were P according to the event analysis performed by the Humphrey device. There were no significant differences in IOP, CCT, or Corvis parameters between NP and P groups at baseline. Nevertheless, at 1 month, the SSI index was 1.60 ± 0.34 vs. 1.80 ± 0.34 (p = 0.003) in NP vs. P eyes, respectively. HC parameters were different between the groups at 1 month (p < 0.05) suggesting an increased scleral rigidity in the P group. There was no significant difference in IOP between groups at 1 month. The Corvis ST provides a corneal rigidity index (SSI) that seems to be related to VF progression when measured 1 month after initiating PGs monotherapy. Differences in HC parameters, indicative of increased scleral stiffness, are also evident at 1 month on latanoprost in the P eyes.

Transient Intraocular Pressure Fluctuations After Intravitreal Bevacizumab Injection in Proliferative Diabetic Retinopathy Patients: A Prospective Study.

The clinical use ofintravitreal bevacizumab (IVB),a recombinant humanized monoclonal antibody that functions as an anti-vascular endothelial growth factor (anti-VEGF), has recently increased in patients with retinal ischemic diseases such asproliferative diabetic retinopathy (PDR). The short-term and long-term complications associated with this procedure have not been well established. We aimedto study the possible short-term complication of intraocular pressure (IOP) fluctuations shortly after IVB injection in patients with PDR. A prospective case series of diabetic patients with PDR who underwent IVB injection was performed in the Department of Ophthalmology, Medical Teaching Institution, Khyber Teaching Hospital, Peshawar, Pakistan, from November 1, 2020, to May 1, 2021. The total number of PDR patients of both sexesincluded in the study was 101. A slit lamp examination was performed, and IOP readings were recorded before and 30 min after IVB injection using Goldmann applanation tonometry (GAT). IBM Statistical Package for the Social Sciences version 22 for Windowswas used to analyze the data. Safety of the procedure, defined as IOP ≤20 mmHg 30 min after IVB injection, was determined and stratified according to sex,age, duration of diabetes, and baseline IOP.A post-stratification chi-square test was applied,and a p-value <0.05 was taken as statistically significant. In this study, 60.4% of the participants were male and 39.6% were female. The age of the patients ranged from 30 to 75 years, with a mean age of 55.66±6.37 years. The mean duration of diabetes among the participants was 7.73±2.94 years and the mean baseline IOP was 15.40±1.77 mmHg. Safety(IOP ≤20 mmHg 30 min after IVB injection) was observed in 90.1% of the patients. IVBinjections are safe for use in patients with PDR in terms of immediate IOP changes. However, patients with higher baseline IOP (>15 mmHg) are more likely to develop increased IOP post-procedure and prophylaxis may be prudent in such cases.