Icare PRO Research Articles

Comparing 24-hour IOP fluctuation slope curve between newly diagnosed ocular hypertension and primary open-angle glaucoma

ObjectiveTo compare the 24-hour intraocular pressure (IOP) fluctuation slope curve between newly diagnosed patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG).Methods and analysisNewly diagnosed and untreated OHT and...

Профилактический эффект ингибитора карбоангидразы на повышение внутриглазного давления после интравитреальных инъекций анти-VEGF препарата

Purpose. To evaluate the effect of a carbonic anhydrase inhibitor (brinzolamide 1%) on the short-term increase of intraocular pressure (IOP) after intravitreal injections (IVI) of an anti-VEGF drug in patients with neovascular AMD (nAMD). Material and methods. This study included 60 patients with newly diagnosed nAMD. In group 1 (30 people), prophylactic drugs were not used; in group 2 (30 people), brinzolamide 1% was instilled twice the day before the injection (at 8 pm) and on the day of injection 2 hours before the procedure (at 8 am). IOP was measured with an ICare Pro before IVI (T0), 1 minute after IVI (T₁), 30 minutes (T₂), 60 minutes (T₃). Results. Dynamic changes of IOP in all groups occurred with the same pattern: IOP increased immediately after IVI of the anti-VEGF drug, after 30 minutes IOP decreased and returned to the initial IOP level over the next 60 minutes. Brinzolamide 1% led to a statistically significant decrease in IOP immediately after injection during the first IVI by an average of 3.84 ± 5.1 [95 % CI 1.58–6.1] mm Hg. compared with the control group (p < 0.001), during the second IVI by 5.26 ± 5.7 [95 % CI 2.86–7.66] mm Hg (p < 0.001), by 5.49 ± 5.8 [95 % CI 3.1–7.88] mm Hg (p < 0.001) during the third IVI. Conclusions. Prophylactic instillation of carbonic anhydrase inhibitor (brinzolamide 1%) twice led to a statistically significant decrease in ocular hypertension immediately after IVI of anti-VEGF drug compared to the control group over three loading injections. Keywords: anti-VEGF drug, intraocular pressure, carbonic anhydrase inhibitor

Topical application of hypotensive drugs for the prevention of intraocular pressure elevation after intravitreal injections of anti-VEGF drugs

This study evaluates the effect of topical hypotensive drugs on the short-term IOP rise after IVI of anti-VEGF drugs in patients with nAMD. The prospective study included 80 patients with newly diagnosed nAMD. Before the start of treatment, the patients were divided into 4 groups of 20 people each: 1st - controls, who received no prophylactic drugs, in the 2nd, 3rd and 4th groups local instillations of one drop of hypotensive drugs brinzolamide 1%, brinzolamide-timolol, brimonidine-timolol were performed in the conjunctival sac twice: 1 day before the injection (at 20:00) and on the day of the injection 2 hours before the manipulation (at 08:00), respectively. IOP was measured in each patient using ICare Pro non-contact tonometer before injection, as well as 1 min, 30 and 60 min after injection. Prophylactic use of hypotensive drugs was associated with a significant decrease in IOP immediately after IVI compared to the same parameter in the 1st group (p<0.001), the maximum decrease in IOP values was observed when using a fixed combination of brimonidine-timolol by 12.1 mm Hg compared to the controls (p<0.001), the combination of brinzolamide-timolol reduced IOP by 8.5 mm Hg (p<0.001), brinzolamide 1% led to the smallest decrease in IOP - by 5.1 mm Hg (p<0.001). Study patients that received instillations of brimonidine-timolol combination of one drop into the conjunctival sac 1 day before the injection and on the day of the injection showed the maximum decrease in IOP compared to patients of the other groups.

Changes in intraocular pressure and biometric parameters of the anterior segment of the eye after intravitreal injections

This study compares the changes in the parameters of the anterior chamber of the eye using anterior segment optical coherence tomography (AS-OCT) in patients with a natural and artificial lens after treatment of neovascular age-related macular degeneration (nAMD) by multiple intravitreal injections (IVI) of anti-VEGF drugs. The patients were divided into 2 groups: group 1 (control) included 30 patients (30 eyes) with a natural lens, group 2 - 30 patients (30 eyes) with an intraocular lens (IOL). AS-OCT was performed using the Revo NX tomograph (Optopol, Poland) to analyze anterior chamber depth (ACD) and the parameters of anterior chamber angle (ACA). Intraocular pressure (IOP) was measured with a contact tonometer ICare Pro. In patients with an IOL, the IOP level 1 minute after intravitreal injection (IVI) of an anti-VEGF drug was statistically lower than in the control group, on average by 17.8% during the first IVI and by 28.7% after 1 year of observation (p<0.001). ACD before treatment was statistically significantly higher in patients with IOL compared to patients of group 1 by an average of 39.3% (p<0.001). ACA from the nasal and temporal sides in the meridian 0°-180° before the start of treatment was statistically significantly wider in phakic patients than in the control group, by an average of 15.9±9.3° (p<0.001) and 16.9±8.2° (p<0.001), respectively. According to AS-OCT, there was no shift of the iris-lens diaphragm in patients with an IOL after multiple IVI of an anti-VEGF drug, in contrast to the control group. AS-OCT was used to determine for the first time the changes in the parameters of the anterior chamber of the eye in patients with a natural and artificial lens after multiple injections of an anti-VEGF drug in the treatment of nAMD.

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.

Assessing biomechanical corrections: A comparison between Corvis ST and ICare tonometer for intraocular pressure measurement

This study aims to compare the accuracy of IOP measurements in pediatric patients using two different tonometers: ICare PRO and Corvis ST (CST). However, the choice of tonometers may vary between screening centers, depending on patient suitability. To address this, we enrolled 30 patients with retinopathy of prematurity over a period of 33 days for experimentation. A head-to-head comparison revealed a strong correlation between the Corvis ST (CST) and ICare PRO tonometers (r = 0.867). Furthermore, no significant difference was observed in IOP values obtained with the Corvis ST (CST) and ICare PRO tonometers (P > 0.05). However, it is worth noting that the Corvis ST (CST) measurements were significantly higher than those obtained from the ICare PRO tonometers (P < 0.05). In conclusion, this study demonstrates that the Corvis ST (CST) tonometer exhibits a high correlation coefficient comparable to that of the ICare PRO tonometer, making it a reliable tool for assessing IOP in pediatric patients. These findings are crucial for enhancing our understanding of the physiological function of melatonin in the eye and its potential to target melatonin receptors and their complexes for addressing various eye pathologies.

Cross-Sectional Study of Differences between Intraocular Pressure Measurements using Goldmann, iCare, and Air-Puff Tonometers and their Correlation with Central Corneal Thickness.

To investigate the agreement between the Goldmann tonometer (GAT), the air-puff tonometer, and the iCare tonometer in intraocular pressure (IOP) evaluation as well as their association with central corneal thickness (CCT) in normal participants, glaucoma patients, and patients following refractive surgery. This is a cross-sectional study conducted on 204 eyes from 102 patients. The study consisted of three equal groups: group I (control group, n = 34), group II (glaucoma patients on medication, n = 34), and group III (refractive surgery patients, n = 34). All patients were subjected to examination (complete ocular examination, refraction, and IOP measurement). A total of 102 participants were included in the study with both genders distributed equally. The mean ± standard deviation age was 44.12 ± 12.8 years in the control group while it was 46.29 ± 13.24 years in the glaucoma group and 40.68 ± 15.86 years in the refractive surgery group. Overall, there was a high correlation between the three methods. The mean IOP measured by GAT was 14.03 ± 3.43. The mean IOP measured by iCare was 15.16 ± 3.46. The mean IOP measured by air-puff was 16.66 ± 3.6. The iCare showed the most significant agreement with the GAT (intraclass correlation coefficient [ICC] 0.985, P > 0.05) and the mean difference in IOP between GAT and iCare was 1.1 (95% limits of agreement, -0.62-+2.85 mmHg). The mean difference in IOP between iCare and air-puff was 1.5 and it was 2.6 between GAT and air-puff. There were no significant differences in IOP measurements between GAT and iCare tonometer or between iCare tonometer and air-puff in all groups (P > 0.05). However, there were significant differences in IOP measurements between GAT and air-puff in all groups (P < 0.001). The ICC between all studied methods was strong (ICC > 0.92 for all). Regarding CCT, the mean CCT was 517.14 ± 29.82 μm. There were significant positive correlations between increasing CCT and increasing IOP by GAT, iCare, and air-puff tonometer among the three groups (P < 0.001). In conclusion, the iCare tonometer, specifically the iCare PRO RT model, is a reliable and efficient alternative instrument for assessing IOP. The IOP values obtained with the iCare PRO RT were found to be consistent with those obtained using the air-puff and GAT.

The impact of ocular hypertension on retinal nerve fiber layer and optic disc perfusion during treatment with brolucizumab in patients with neovascular form of age-related macular degeneration

PURPOSE. To evaluate the effect of elevated intraocular pressure (IOP) after multiple intravitreal injections (IVI) of brolucizumab on changes in the retinal nerve fiber layer (RNFL) and perfusion of the optic nerve head.METHODS. The study included 20 patients with newly diagnosed exudative form of age-related macular degeneration (AMD). All patients underwent IVI of brolucizumab. IOP measurements were taken with an ICare Pro tonometer before IVI, one minute after IVI, then after 30 minutes and 180 minutes. Thickness of the peripapillary RNFL was measured using Spectralis OCT (Heidelberg Engineering, Germany). The optic disc was examined using OCT angiography on Revo NX (Optopol Technology SA, Poland). All studies were carried out before the start of treatment, after one month, after the third injection, and one year after the start of treatment.RESULTS. Analysis of peripapillary scans in a patient with a history of multiple IVI a year after the start of treatment with brolucizumab showed a statistically significant decrease in perfusion density and fractal dimensions (skeleton) in the entire optic nerve head (ONH) (p&lt;0.001), in the inner ONH area (p&lt;0.001, p=0.01, respectively), in the nasal sector (p=0.03, p=0.04, respectively), temporal sector (p&lt;0.001) and inferotemporal sector (p=0.03) according to OCT angiography. It was determined that a greater increase of IOP one min after IVI was associated with a greater decrease in the density and fractal dimensions of the radial peripapillary capillaries of the inner ONH (p=0.005, rs=0.5; p=0.004, rs=0.6, respectively). A decrease in RNFL thickness was found one year after the start of IVI treatment with brolucizumab (p&lt;0.001).CONCLUSION. According to OCT angiography, vascular perfusion density of the ONH was decreased during IVI of brolucizumab, and RNFL thickness was also decreased one year after the start of treatment.

Comparison of intraocular pressure measurements obtained by icare pro tonometer, non-contact tonometer and Goldmann applanation tonometer in healthy individuals

The goal of this paper was to compare the intraocular pressure (IOP) measurements obtained via iCare Pro rebound (IRT), non-contact tonometry (NCT), and Goldmann applanation (GAT) tonometry in healthy subjects. One hundred and twenty-five healthy individuals were included in this study. The participants' IOP measurements were obtained via non-contact tonometry. After routine ophthalmic examination, central corneal thickness (CCT) was measured with a topography device. Intraocular pressure was measured via iCare Pro rebound tonometry. After waiting for 5minutes, three measurements were taken with GAT under topical anaesthesia, and their means were recorded. Interdevice agreement was evaluated with the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The mean IOP measurements for NCT, IRT, and GAT were 15.97±2.99, 17.47±2.86, and 16.46±2.68mmHg, respectively. The mean difference between NCT and GAT was -0.49± 1.89mmHg, the mean difference between IRT and GAT was 1.01±1.90mmHg, and the mean difference between NCT and IRT was -1.50±2.02mmHg. Agreement between devices was found to be >0.8 for each tonometry ICC. There were significant positive correlations between the measurements obtained via these three instruments and CCT. In this study, IOP was measured slightly lower with NCT than GAT, but it was about 1mmHg higher with IRT than GAT on average. All three devices appeared to be affected by CCT, with NCT being the most affected in this regard. The three instruments can be used for routine inspection and screening. However, considering the differences in the measurements obtained by using them, it is clear that following up IOP measurements with GAT measurements is beneficial in advanced glaucoma patients.

Морфометрические изменения параметров диска зрительного нерва на фоне трех загрузочных интравитреальных инъекций анти-VEGF препарата

Purpose. To study the dynamics changes in the internal and deep structures of the optic nerve head (ОNН) against the background of three monthly injections of an anti-VEGF drug. Material and Methods. The study included 20 patients (20 eyes) with newly diagnosed exudative form of age-related macular degeneration (nAMD). Intraocular pressure (IOP) was measured with an ICare Pro before intravitreal injection (IVI), 1 minute after IVI, 30 minutes, 60 minutes during the first, second, and third injections. All patients underwent optical coherence tomography of the optic disc using a Heidelberg Spectralis OCT scanner in the Enhanced Depth Imagine mode. The study was carried out before IVI anti-VEGF drug, 1 month after the first injection, a month after 3 injections. Results. Statistically significant increase in IOP was found 1 min after IVI in dynamics (p &lt; 0.001). Against the background of three loading IVI of the anti-VEGF drug, there was a tendency to increase the size of the excavation width, excavation depth, distance to the cribriform plate, however, no statistically significant changes were detected. Thus, 4 months after the start of antiangiogenic therapy after three IVI anti-VEGF drugs, increasing IOP immediately after IVI, which is transient, did not lead to morphological changes in the ONH. Conclusions. Аccording to optical coherence tomography, in patients with nAMD against the background of three loading IVIs of the antiVEGF drug, no statistically significant changes in the parameters of the internal and deep structures of the ONH were observed. Keywords: intraocular pressure, anti-VEGF therapy, optic nerve head

The role of anterior segment optical coherence tomography in the detection of predictors of ophthalmic hypertension associated with anti-VEGF injections

PURPOSE. To identify the predictors of increased intraocular pressure (IOP) after intravitreal injection (IVI) of an antiVEGF drug using anterior segment optical coherence tomography (AS-OCT), and to study changes in the iris-lens diaphragm produced by multiple injections in the treatment of neovascular form of age-related macular degeneration (nAMD).METHODS. IOP was measured with an ICare Pro tonometer before IVI, 1 minute after IVI, 30 minutes, 60 minutes and 180 minutes later. Anterior chamber depth (ACD), anterior chamber angle (ACA), and lens thickness were assessed using Revo NX tomograph (Optopol, Poland). The study was carried out before IVI, one month after the first IVI, one month after the third IVI, one year after the start of treatment. Axial length was measured once before IVI.RESULTS. An inverse correlation was found between axial length and an increase in IOP 1 min after IVI (r=0.65, p&lt;0.001). According to AS-OCT data, one year after the start of treatment there was a significant decrease in ACD compared to the data before treatment (p&gt;&lt;0.001), as well as a decrease in all parameters of ACA (p&gt;&lt;0.05). Shorter axial length (R2 =0.45, p&gt;&lt;0.05), shorter ACD (R2 =0.44, p&gt;&lt;0.05), smaller ACA on the nasal (R2 =0.37, p&gt;&lt;0.05) and temporal (R2 =0.39, p&gt;&lt;0.05) sides in patients with their own lens led to a greater rise in IOP 1 min after IVI.CONCLUSION. Predictors of a sharp increase in IOP after IVI of an anti-VEGF drug in patients with nAMD that can be detected with AS-OCT are shorter ACD and smaller ACA. The following prognostic model was determined — with a 1-mm decrease in the axial length, an increase in IOP by 2.3 mm Hg should be expected, a decrease in ACA from the temporal side by 1° leads to an increase in IOP of 0.28 mm Hg&gt;

Динамика изменения внутриглазного давления при интравитреальном введении афлиберцепта и бролуцизумаба при лечении неоваскулярной формы возрастной макулярной дегенерации

Purpose. To study the dynamic changes of intraocular pressure (IOP) produced by intravitreal injection (IVI) of aflibercept and brolucizumab in patients with neovascular form of age-related macular degeneration (nAMD). Material and methods. This study included 40 patients with nAMD, who were randomly divided into 2 groups of 20 people. In 1st group, patients received aflibercept, in group 2nd – brolucizumab. IOP was measured with an ICare Pro point contact tonometer before IVI (T0), 1 minute (T1), 30 minutes (T2), 60 minutes (T3) after IVI. Measurement of IOP was performed during the first injection. Mathematical and statistical processing of the obtained data was performed using the statistical program SPSS 23.3. A p &lt; 0.05 value was considered statistically significant. Results. In the two groups, the dynamic changes of IOP was the same: IVI increased immediately, returned to normal within 30–60 minutes. Mean IOP values before the start of treatment were comparable in the two groups (p = 0.89), 1 min after IVI anti-VEGF drugs, the mean IOP was significantly higher in 2nd group compared to 1st group (p = 0.002), 30 min and 60 min after IVI IOP in 1st and 2st groups were not differ statistically (p = 0.36, p = 0.68, respectively). The number of patients with IOP 1 min after IVI more than 35 mm Hg in 2nd group was 75 %, while in 1st group – 50 %. Conclusions. In this study, we compared for the first time the dynamic changes of IOP after IVI of aflibercept and brolucizumab. To further study it is necessary to analyze longterm results in a larger sample of patients. Keywords: brolucizumab, aflibercept, intraocular pressure

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.

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.

Effectiveness and safety of hypotensive therapy of primary glaucoma with a Russian generic fixed combination of dorzolamide and timolol

Purpose: a comparative study of the efficacy and safety of the generic drug Dorzial Plus, an analogue of the original reference drug Cosopt®, in patients with primary open-angle glaucoma (POAG).Material and methods. The study involved 80 patients of both sexes aged 55–75 with newly diagnosed POAG of the initial and advanced stages with uncompensated intraocular pressure (IOP), of which 40 patients (study group) received Dorzial Plus and 40 patients (comparison group) received the reference drug (Cosopt®). Hypotensive efficacy of the drugs in both groups was assessed using a portable ophthalmic tonometer Icare PRO (Finland) by reducing IOP from the initial level after 1 week, 1 month and 3 months of treatment.Results. In both groups, the screening showed comparable average IOP values: 26.7 ± 3.2 mm Hg in the reference drug group and 27.4 ± 2.8 mm Hg in the Dorzial Plus group. After 1 week of therapy with Cosopt, IOP showed a significant decrease of 33% (reduction to 17.9 ± 3.2 mm Hg), while the group receiving Dorzial Plus demonstrated a 31% decrease (reduction to 18.9 ± 1.7 mm Hg). After 1 month of the instillation regimen, a slight increase in P0 (of about 3%) was recorded in both groups (increase to 18.7 ± 2.3 and 19.7 ± 2.0 mm Hg, respectively). By the end of the 3 months’ follow-up period, IOP decrease level with respect to the baseline remained practically the same, amounting to 30 and 29% (up to 18.6 ± 1.8 and 19.5 ± 2.3 mm Hg), respectively. The state of the ocular surface showed a slightly negative dynamics of tear film rupture time and OSDI index in the reference drug group, which could be observed throughout 3 months of therapy. In the study group, therapy with preservative-free drug containing a moisturizing agent (sodium hyaluronate) revealed a significantly changed OSDI index, manifesting itself in restructured severity of the evaluated features.Conclusion. Dorzial Plus reduces IOP in POAG patients by an average of 30% of the baseline, so that its hypotensive efficacy is comparable to the original fixed combination Cosopt. The tolerability analysis of the study drug demonstrates a significant positive dynamic of the state of the ocular surface as soon as 3 months after therapy start.

Comparison of intraocular pressure measured by iCare tonometers and Goldmann applanation tonometer

ObjectifÉvaluer la concordance entre le tonomètre à aplanation de Goldmann (TAG) et 2 tonomètres iCare (PRO et IC200) pour ce qui est de mesurer la pression intraoculaire (PIO) d'adultes chez lesquels on a diagnostiqué un glaucome ou on soupçonnait la présence d'un glaucome. Participants et méthodesOnt été évalués 101 yeux de 101 participants qui ont reçu un diagnostic de glaucome ou chez lesquels on soupçonnait la présence d'un glaucome. La PIO a d'abord été mesurée à l'aide des tonomètres iCare PRO et iCare IC200 selon une séquence aléatoire, puis à l'aide du TAG. On a ensuite procédé à des mesures de l’épaisseur centrale de la cornée. Après la mesure de la PIO, les participants ont noté leur degré de confort lors de l'utilisation de chaque tonomètre sur une échelle visuelle analogique. On a eu recours au coefficient de corrélation intraclasse (CCI) et à la méthode de Bland-Altman pour examiner la concordance entre les tonomètres. Les logiciels SPSS et Microsoft Excel ont servi à l'analyse statistique. RésultatsDans l'ensemble, on a noté une bonne concordance entre les 3 tonomètres de l’étude. Le CCI entre les tonomètres iCare PRO et iCare IC200 se chiffrait à 0,95 (p < 0,001), tandis que le CCI entre le tonomètre iCare PRO et le TAG, de même qu'entre le tonomètre iCare IC200 et le TAG, s’élevait à > 0,80 (p < 0,001). Cependant, les 2 tonomètres iCare ont sous-estimé la PIO d'environ 2 mm Hg comparativement au TAG, sans compter que 84 % des lectures sur les tonomètres iCare se situaient à ± 5 mm Hg des mesures du TAG. Ni l'indice de masse corporelle, ni l’épaisseur centrale de la cornée n'a eu d'effet sur la concordance entre les tonomètres. Si l'on se fie aux réponses des participants sur l’échelle visuelle analogique, les tonomètres iCare étaient plus confortables que le TAG. ConclusionNos résultats ont fait ressortir une bonne concordance entre les tonomètres iCare et le TAG; cela dit, les tonomètres iCare sous-estimaient la PIO, comparativement au TAG.

The effect of increased preset intraocular pressure level on choroidal blood flow during phacoemulsification

Purpose: to evaluate blood flow velocity in the posterior short ciliary arteries during phacoemulsification (PE) at different levels of intraocular pressure (IOP).Material and methods. The study included 29 patients aged 62–83 (average 71.2 ± 6.0) with initial-stage age-related cataract. PE was performed using the Alcon Centurion vision system at a preset IOP level of 60 mm Hg. Blood flow velocity was determined three times using an expert-class ultrasound scanner (GE Logiq S8): immediately before surgery (before opening the eyeball), intraoperatively at an IOP level of 58.77 ± 8.28 mm Hg, and after surgery and IOP normalization. Additionally, the IOP level was measured three times (by Icare PRO tonometer). The blood pressure level was monitored by the standard method on the brachial artery using the Dr ger Vista 120 system. The measurement results were compared with the control group which included 20 healthy fellow eyes.Results. A decrease in blood flow velocity was established upon reaching the IOP level of 58.77 ± 8.28 mm Hg. The maximum systolic blood flow velocity in the posterior short ciliary lateral artery decreased from 14.46 ± 2.92 to 11.22 ± 2.55 cm/s, while the final diastolic blood flow fell from 5.11 ± 1.83 to 2.97 ± 1.27 cm/s. The maximum systolic blood flow velocity on the medial side also fell from 12.37 ± 2.74 to 9.50 ± 1.68 cm/s, and the final diastolic velocity fell from 4.54 ± 1.35 to 2.73 ± 0.91 cm/s (p &lt; 0.05).Conclusion. During PE, the IOP level exceeding certain values leads to a decrease in blood flow velocity in the posterior short ciliary arteries. It is important to realize, however, that autoregulatory mechanisms for maintaining stable hemodynamics are limited if IOP levels are increased.

Effect of pupil dilation on intraocular pressure in preterm and term infants.

To evaluate the effect of pupil dilation on intraocular pressure in preterm and term newborns. This prospective study involved 55 eyes of 28 preterm infants and 38 eyes of 20 term infants. The infants were divided into two groups according to their gestational ages at birth as follows: preterm group, &lt;37 weeks and term group, ≥37 weeks. Pupil dilation was attained with tropicamide 0.5% and phenylephrine 2.5%. Intraocular pressure measurements were performed with Icare PRO (Icare Finland Oy, Helsinki, Finland) before and after pupil dilation. A paired t test was used to compare the measurements before and after pupil dilation. The mean intraocular pressure change was -1.04 ± 3.03 mmHg (6.20/-11.40 mmHg) in the preterm group and -0.39 ± 2.81 mmHg (4.60/-9.70 mmHg) in the term group. A statistically significant difference in intraocular pressure was observed only in the preterm group after pupil dilation (p=0.01). An unexpected alteration in intraocular pressure in newborns may occur after pupil dilation, especially in preterm infants.

Determination of the tonographic effect in the human eye using a pneumatic pressure modulator

AbstractPurposeThe tonographic effect has been observed in several studies in occulopression, repeated tonometry or ophthalmodynamometry. It describes an intraocular pressure (IOP) decrease caused by an artifical IOP increase. In healthy eyes, an IOP drop of 2–3 mmHg/min was reported. However, there are studies that show a reduced decrease of the IOP drop for instance in glaucoma patients. In this work, we present a proof of principle to determine the tonographic effect in healthy eyes by utilizing a novel pneumatic pressure modulator.MethodsThe study was conducted on 8 healthy subjects (4 m, 4 f, 1 eye each, mean age 27.4 ± 7.1 yr). All subjects passed an ophthalmic examination procedure, including visual acuity determination, tonometry, objective refraction, slit lamp examination. Exclusion criteria were myopia &lt; ‐8 dpt, anamnestic surgeries, corneal scars, eye diseases, ocular hypertension, and ongoing ocular local therapy. No anaesthetics were used. A pressure modulator (IOPstim, Imedos Systems GmbH, Jena, Germany) was used to increase the IOP to initially pathologic IOP values of about 35 mmHg (36.6 ± 2.5 mmHg). The applied pressure was kept constant for 2 minutes. The IOP was measured 4 times (at 0s, 40s, 80s, and 120s) using a rebound tonometer (Icare PRO, Icare Finland Oy, Helsinki, Finland). Linear regression was performed to calculate the average IOP decrease within the 2‐minutes interval.ResultsFor all 8 subjects, a typical decrease of the IOP was observed during a 2 min constant pressure stimulation. The mean decrease of the pressure profiles was 2.77 mmHg/min (R2 = 0.94).ConclusionsWe successfully applied a pneumatic pressure modulator to determine the tonographic effect in the human eye. For 2 min we measured the mean decrease of the IOP drop with similar values known by the literature. Application of the pneumatic pressure modulator allows the investigation of pathological reduced IOP drops that differ from normal values as shown in this study.

Twenty-Four-Hour Intraocular Pressure Control with Omidenepag Isopropyl 0.002% in Patients with Glaucoma and Ocular Hypertension.

PurposeTo clarify the intraocular pressure (IOP)-lowering effect of a selective prostanoid EP2 receptor agonist, omidenepag isopropyl (OMDI) during a 24-hour period.Patients and MethodsSubjects aged ≥20 years and with diagnosed, untreated primary open-angle glaucoma or ocular hypertension were enrolled. IOP measurements were performed every 4 hours over a 24-hour period using a Goldmann applanation tonometer (GAT) and Icare PRO tonometer (PRO). The baseline 24-hour IOP was measured in untreated subjects. After the baseline measurements, participants were given OMDI 1 drop once daily at night for 4 weeks. At week 4, the IOP measurement was repeated under the same conditions. Diurnal (9 am, 1 pm, 5 pm) and nocturnal (9 pm, 1 am, 5 am) IOP measurements were compared between baseline and treatment with OMDI. Safety measures included adverse events, slit-lamp biomicroscopy, visual acuity, heart rate and blood pressure.ResultsOf 27 participants enrolled, 25 patients (20 males and 5 females, average age 52.2 ± 8.5 years) completed the study. In the sitting position, the baseline diurnal and nocturnal mean IOPs (GAT) were 19.1 ± 2.1 mmHg and 18.2 ± 2.6 mmHg, respectively, the diurnal and nocturnal mean IOP reduction from baseline were –2.8 ± 2.6 mmHg (p < 0.0001) and –3.3 ± 2.9 mmHg (p < 0.0001), respectively, mean 24-hour IOP (GAT) was significantly lower with the OMDI treatment (−3.1 ± 2.5 mmHg, p < 0.0001). In the supine position, the baseline nocturnal mean IOP (PRO) was 17.99 ± 2.22 mmHg, and the nocturnal mean IOP reduction from baseline was −1.78 ± 2.37 mmHg (p = 0.0009) after 4 weeks of the treatment. Nine adverse events were observed in 8 patients including mild conjunctival hyperemia (n = 8) and mild iritis (n=1). There were no significant effects on systemic safety.ConclusionOnce daily OMDI treatment was able to produce stable 24-hour IOP reduction.