IOP Measurements Research Articles

Quality of Glaucoma Care in the Greater Hamburg Area

Background There is insufficient data on the quality of health services and health-related quality of life of patients with glaucoma. The purpose of this study was to investigate the extent to which the health services for glaucoma patients in the Greater Hamburg area conform to the guidelines set by the German Ophthalmological Society (DOG). Materials and Methods 196 glaucoma patients were offered an interview-administered questionnaire during their inpatient diurnal IOP measurement. The quality of glaucoma care and examinations recommended by the DOG were analysed. The results of the questionnaire were correlated with glaucoma severity, according to the stage of visual field defects. The correlation to the type of glaucoma was also analysed. Results The frequency of visits to the ophthalmologist was 5.1 per year. Most patients reported quarterly medical consultations. The majority of patients reported short waiting periods, because appointments were made in advance. In 92 % of cases, an intraocular pressure measurement was performed with each medical consultation. Half of the patients stated that their intraocular pressure had been measured at different times of the day. The visual field was tested a mean of 0.9times per year at the ophthalmology clinic, but 1.4 times per year in the outpatient area. Further measures for glaucoma diagnostic testing were carried out 0.8 times per year at the ophthalmology clinic, and 0.4 times per year in the outpatient area. For the majority of patients, there were no additional costs for outpatient glaucoma diagnostic testing. Only 4 % of patients had to pay more than 100 € per year for these services. Conclusions For the majority of glaucoma patients in the Greater Hamburg area, the glaucoma health services conform to the guidelines set by the German Ophthalmological Society. Intraocular pressure measurements were performed on almost all patients at the regular check-ups and visual fields were examined as recommended. However, for about one-fifth of the patients, regular procedures for optic nerve analysis do not take place. The date of the next appointment was arranged immediately, allowing close follow-up, with little or no additional costs for the majority of patients.

The First Results of New Russian Lens Exchange IOL in Patients with High Myopia

Purpose: To evaluate safety, precision and stability of refractive results after phacoemulsification with implantation of NanOptica (Russia) IOL like a method for high myopia correction. Patients and methods. 4 eyes of 2 patients aged 34 and 81 y.o. with high myopia: sph -6.5D — sph -12.0D (mean -9.12Д±2.39) were operated by phacoemulsification with hydrophylic IOL “Aquamarine” NanOptica (Russia) implantation. In first case operation was performed in young female, for correction of myopia with clear lens, the target was about -2.0 D. The second patient was treated for mature cataract by the same method. Study included evaluation UCVA, UCVA, Autorefractometry, IOP measurement, IOL master, ultrasound biometry, slit lamp examination, fundus examination, keratotopography, Cirrus OCT of posterior segment. Pre op mean UCVA (Decimal) 0.0475 (0.04–0.05 ), mean ВCVA 0.73 (0.4–1.0). Biometry (А method) from 26.82 mm to 28.49 mm, average 27.48 mm ±0.72. For IOL calculation we used SRK/T formula. The standard phacoemulsification was performed. Incision 2.4 mm. Injector Comfort C, RET, (Korea) was used for IOL delivery into the eye. There were no difficulty with IOL positioning in cartridge, injection in the eye and centration. Follow up period was 4 months. Study was performed at International Center for Ophthalmology in Moscow, Russia. Results: Early postoperative period was without any complications. Post op mean UCVA (Decimal) was 0.66±0.27 (0.4–0.9), mean ВCVA — 0.95±0.05 (0.9–1.0). Target refraction corresponded to predetermined values: sph -1.75D–0.0 D (average -0.81). 34 years old patient had signs of posterior capsule fibrosis I st. after 3 months after operation. It didn’t affect at the visual acuity. Conclusion: First successful results of IOL “Aquamarine” Naooptica (Russia) implantation were reached. Refractive target have been achieved. Aquamarine can be recommend for correction in patients of different age with high myopia patients. Future follow-up study is required.

Ophthalmology and mathematics: crossroad or scientific interface?

Ophthalmology and mathematics: crossroad or scientific interface?

Comparison of Goldmann applanation tonometry and Pascal dynamic contour tonometry in relation to central corneal thickness and corneal curvature.

PurposeThe aim of the study was to assess the influence of central corneal thickness (CCT) and corneal curvature in tonometry measurements taken by Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT).MethodsThis was a prospective study of 185 eyes from 97 subjects, attending outpatient ophthalmology appointments, who underwent intraocular pressure measurements by GAT and Pascal DCT. CCT and corneal curvature were obtained using ultrasound pachymetry and Orbscan topography, respectively. All measurements were carried out among males and females during the period 2009–2012. Apart from the usual descriptive and exploratory data analysis, one-way analysis of variance and agreement analysis were performed, linear as well as intraclass correlation coefficients were estimated, and multiple scatter and Bland–Altman plots were produced.ResultsMean IOP measurements obtained were 17.21±4.10 mmHg by DCT and 13.23±4.07 mmHg by GAT. Mean difference between the GAT and DCT measurements was 3.88±2.8 mmHg. Mean CCT and corneal curvature were 522.78±52 μm and 43.83±2.9823 D, respectively.ConclusionIntraocular pressure measured by GAT was consistently lower when compared with DCT, and this difference was greatest with thinner CCT. Flat corneas seem to influence GAT measurements compared to DCT.

Abstracts: European Society of Veterinary Ophthalmologists, Toulouse, France, October 6‐9, 2016

Purpose: To evaluate the effects of 2% Dorzolamide, 0.5% Timolol and 0.005% Latano- prost on the biometrics of the anterior segment in normotensive cats. Material/Methods: Three groups of 15 clinically healthy randomly selected cats received one single molecule on the right eye during 7 days (Group 1: 2% Dorzolamide BID, Group 2: 0.5% Timolol BID, Group 3: 0.005% Latanoprost SID). Left eyes received no treatment and were used as con- trols. Complete ophthalmic examination, IOP measurement and anterior segment assessment by Ultrasound Biomicroscopy (UBM) were performed in the same conditions at day 1 and day 7, on both eyes. Eight anatomical parameters of the anterior segment were evaluated: the geometric iridocorneal angle (ICA) – formed by the plane of the iris root and the inter- nal corneoscleral limbus – the width of the opening of the ciliary cleft (CC), the width of the mid-CC, the length of the CC, the anterior chamber (AC) depth (distance between the corneal endothelium and the anterior lens capsule), the central and peripheral corneal thick- nesses, then the distance between the anterior lens capsule and the internal corneoscleral limbus. Results: The use of the controlateral eye as control was statistically validated, as well as the representativeness of fifteen-cat cohorts. A significant decrease of IOP was observed only for dorzolamide (5.3%). None of the eight anatomical parameters were statistically modified by the topical instillation of the three drugs. Discussion: The use of the three first-line antiglaucomatous agents does not significantly alter the anterior segment architecture in normotensive cats.

Impact of gender‐specific differences in corneal elasticity upon IOP measurements using vibration tonometry

PurposeVibration Tonometry enables precise non‐contact tonometry independently of CCT and post LASIK using induced corneal vibrations response to calculate IOP using different algorithms for men and women. This corneal vibrations response reflects different tissue elasticity between men and women. We calculate IOP error using gender‐inverted algorithms: female algorithm for men and vice versaMethodsVibration Tonometry IOP data from clinical trials in 324 subjects in 3 IOP groups and in 3 age groups. 1,040 and 1,031 measurements were used respectively in women and in menResultsUsing men algorithm for women mean IOP difference was −0.376 mm Hg; 0.07 mmHg; 1.937 mmHg respectively in the <16 mm; 16–23 mm and in the >23 mm Hg group significantly different p < 0.0001. In 3 age groups women showed IOP mean difference of −0.086 mm Hg, 0.077 and −0.224 mm Hg respectively in <50; 50–60 and >60 years old women. Kruskal Wallis test used showed all 3 groups differed significantly p < 0.001, when compared 2 to 2 the error in the 50–60 group differed significantly from that in >60 years old group. For Men mean IOP difference was −0.115 mm Hg in the <16 mm group versus 0.385 in the 16–26 mm Hg group and −1.002 in the >23 mm Hg group all significantly different (Ttest p < 0.0009). The 3 age groups in men showed IOP mean difference of −0.129 mmHg, 0.185 and 0.259 mmHg (SD = 1.286) respectively in <50; 50–60 and >60 years old men. Kruskal Wallis test non significant p < 0.056, when compared 2 to 2 the error in the <50 group differed nearly significantly from that in >60 years old p = 0.025ConclusionsGender related difference in IOP measurement is most significant in the higher IOP, >60 years old and most significantly in women with higher corneal elasticity. These analyses confirm the important need for gender specific tonometry as uniquely provided by Vibration Tonometry.

A descriptive subgroup analysis of within hospital glaucoma referral in a tertiary center in Portugal

PurposeGlaucoma is a progressive and irreversible optic neuropathy carrying tremendous burden in healthcare systems. The aim of our study was to characterize the population referred to a glaucoma subspecialty department (GSD) in a university hospital.MethodsWe analyzed retrospectively the within‐hospital referral to the GSD. Electronic medical records and referral letters between Jan and Dec 2014 were screened. Data was screened for ancillary exams, type of tonometry, number of IOP‐lowering medications and extent of the disease (HODAPP classification). Statistics were performed with STATA v13.0.ResultsA total of 151 patients (78 males) were referred. Mean age was 68.2 (range 18–91). Thirty‐six patients (23.8%) were referred with visual field, pachimetry and OCT. Of those with a visual field, 38 (55.1%) had a mean defect >6 db (of which 17 had >12 dB), with 34 patients having at least two exams. In contrast, 16 (10.6%) were referred with no ancillary exam performed and 67 (50%) had all IOP measurements performed with pneumotonometry. Sixteen patients (10.6%) had a description of a gonioscopy. All patients were under IOP‐lowering treatment, of which 83 (55%) were under 2 or more IOP‐lowering medications. The number of patients referred with more than 80 years old was 29 (19.2%), 5 (18.52)% of which had a complete documentation of the disease. In this subset of patients, 6 (42.8%) had an advanced form of the disease.ConclusionsBetter understanding of our population characteristics will lead to a more accurate referral system. In a significant part of GDS referrals there was insufficient or poor quality clinical data. Our study raises awareness on the importance of an efficient within hospital subspecialist referral, leading to economic and health gain in Ophthalmology departments.

Changes in choroidal thickness and mean ocular perfusion pressure with hemodialysis

PurposeThe goals of hemodialysis (HD) in end‐stage renal disease (ESRD) are to remove uremic substances and to control the composition and volume of body fluid. Several associated systemic and ocular hemodynamic changes occurring along with HD have already been described. Our goal was to evaluate the changes in subfoveal choroidal thickness (SFCT) and mean ocular pressure perfusion (MOPP) in HD.MethodsProspective cohort study including 16 eyes of 16 black patients (8 women) under chronic HD. Macular enhanced depth imaging spectral domain ocular coherence tomography (EDI‐OCT) cross scans were performed and IOP measurements obtained using Tonopen® 1 h before and 1 h after HD. Hemodynamic data was also obtained at both time points. MOPP was calculated as MOPP = 2/3(mean arterial pressure) – IOP. The same experienced operator manually measured SFCT using the EDI‐OCT built‐in caliper. STATA v.13.0 was used as statistical package.ResultsMean age of ESRD patients was 46.81 ± 7.72 [range 28–60] years. The mean time under HD was 17.38 ± 14.67 months. After HD, SFCT increased from 245.38 ± 73.86 μm to 269.13 ± 69.74 μm (p < 0.001). Adjusting for age, a linear regression model revealed a strong relationship between SFCT and MOPP with hemodialysis (p < 0.01).ConclusionsIn our study of ESRD patients, SFCT increased with HD. Shifting of molecules and fluid between the blood and choroidal interstitium during HD may be involved in SFCT changes, which are correlated with MOPP fluctuations.

THE ADVANTAGES OF USING THE TONO-PEN VET TONOMETER IN THE MEASUREMENT OF IOP IN VETERINARY PRACTICE

Objective The aim of this study was to evaluate and to validate the accuracy of the Tono-Pen Vet applanation tonometer in the measurement of IOP in dogs and to observe the advantages and disadvantages of using the Tono-Pen Vet tonometer in clinical practice.Animals Both eyes of 41 conscious and healthy dogs were evaluated.Procedure Readings of IOP were taken using tonometry (measured with a Tono-Pen Vet applanation tonometer). The IOP measurement with Tono-Pen Vet tonometer in conscious dogs was accomplished by instillation of 0,5% Alcaine eye drops.Results The mean IOP readings with the Tono-Pen Vet were 18,5 ± 3,7 mmHg (range 11,5 – 24,5 mmHg).The correlation coefficient (r²) between both eyes was 0,26826 in dogs.Conclusion Mean values measured by Tono-Pen Vet where in the correct range for dogs, but we conclude in comparison with the data of other studies, that values measured with a Tono-Pen Vet could be 5-6 mmHg higher than measured by another tonometers, like Perkins or TonoVet.The advantages of using the Tono-Pen Vet tonometer include the ease of taking the IOP measurement reading, ease of visualization of measurement readings, ease of disinfecting and long-term battery life. The disadvantages include frequent calibration, reduced accuracy and underestimation of true IOP compared to manometry and cost of the Tono-Pen Vet is higher, than for example Schiotz Tonometer or Perkins.

Correlations between the deformation parameters measured by Corvis ST and corneal morphology parameters in myopic patients

Background The novel dynamic biomechanical device Corvis ST can measure a variety of corneal deformation parameters and record the dynamic process of cornea deformation.Understanding various corneal deformation parameters is of important clinical significance for morphological and functional prediction for myopic eyes in corneal refractive surgery.However, the range and meaning of corneal deformation parameters in myopic eyes are still unknown. Objective This study was to establish the range of corneal defamation parameters by Corvis ST and explore its clinical significance in myopic eyes. Methods A descriptive study was designed under the approval of Ethic Committee of Tianjin Eye Hospital and informed consent of patients.This study protocol complied with Helsinki Declaration.Four hundred and seventy-seven eyes of 257 myopic patients who were going to receive corneal refractive surgery were included in Tianjin Eye Hospital from June 2014 to January 2015.The corneal deformation parameters including the first applanation time (1st A-time), first applanation lengh (1st A-length), first applanation velocity (1st A-velocity), second applanation time (2nd A-time), second applanation length(2nd A-length), second applanation velocity (2nd A-velocity), highest concavity time (HC-time), highest concavity deformation amplitude (HC-DA), highest concavity peak distance (HC-PD), highest concavity radius (HC-R), non-contact intraocular pressure (IOPnct) and the central corneal thickness (CCTst) were measured by Corvis ST.Corneal structural parameters including CCT and corneal curvature were measured by 3-D anterior segment analysis system( Pentacam), and corneal biomechanical parameters including corneal resistance factor (CRF), corneal hysteresis (CH), intraocular pressure mimic Goldmann (IOPg) and intraocular pressure of corneal compensation (IOPcc) were measured by Ocular Response Analyzer (ORA). The distributions of the data were tested with the Shapiro-Wilk test and 95% confidence intervals (CI) were calculated.The correlations of the variables were evaluated by Pearson correlation coefficient and Spearman rank correlation coefficient.Multiple linear regression was used to analyze the changes of 1st A-time, 2nd A-time and HC-DA with corneal morphology and biomechanical parameters. Results Only 1st A-time, 2ndA-time, HC-time, HC-DA, CCTst and IOPnct showed the normality distribution in corneal deformation parameters.The positive correlations were found between 1st A-time, 1st A-length, 2nd A-length, 2nd A-velocity, HC-R with CCT (r=0.338, rs=0.129, rs=0.282, rs=0.374, r=0.306, all at P<0.01), while 1st A-velocity, 2nd A-time, HC-D and HC-PD showed the negative correlations with CCT (rs=-0.235, r=-0.130, r=-0.259, r=-0.226, all at P<0.01). CRF and CH showed positive correlations with 1st A-time, 2nd A-length, 2nd A-velocity, HC-time, HC-R and negative correlations with HC-PD, △A-length (all at P<0.05).1st A-time, 2nd A-time and HC-DA changed with CRF and IOPcc with the regression formations of 1st A-time =6.185+ 0.066CRF+ 0.034IOPcc (F=300.123, P=0.000), 2nd A-time=23.397-0.074IOPcc-0.044CRF (F=227.979, P=0.000) and HC-DA= 1.523-0.017IOPcc-0.017CRF (F=152.662, P=0.000). The CCTst, IOPst and IOPnct values by Corvis ST were significantly lower than CCT by Pentacam ([548.23±26.31]μm, IOPg ([15.02±2.72]mmHg and ([16.02±2.56]mmHg) by ORA respectively (t=11.00, 2.919, 6.815, all at P<0.01). Conclusions The corneal deformation parameters by Corvis ST can quantitatively describe corneal biomechanical properties in myopic eyes.Both IOP and the corneal steep curvature of the 3 mm center area (K2) affect the deformation response of cornea.The reliability of Corvis ST in the measurement of CCT and IOP remains to be further studied. Key words: Cornea/physiopathology; Cornea/anatomy h Myopia/physiopathology; Biomechanical phenomena/physiology; Elasticity/physiology; Corneal deformation parameters

Central Corneal Thickness and its Associations With Ocular and Systemic Factors in an Urban West African Population

To assess the associations of central corneal thickness (CCT) with ocular and systemic factors in a West African population. Population-based cross-sectional study. Participants aged ≥40 years in the Tema Eye Survey who had clinically normal corneas were included in this study. CCT was determined bilaterally using handheld ultrasound pachymetry. The association between CCT and ocular or systemic factors was analyzed with univariable linear regression. Multivariable linear regression analysis was performed for variables significantly associated with CCT in the univariable analysis. Main outcome measures were CCT (μm) and its associations with age, sex, IOP, cup-to-disc ratio (CDR), glaucoma, hypertension, and diabetes. A total of 6806 eligible subjects were identified, of whom 5603 (82.3%) participated in the Tema Eye Survey. A total of 4737 participants (84.5% of participants) of West African descent and clinically normal corneas were included. The mean age ± standard deviation (SD) of participants was 51.2 ± 9.7 years and 38.7% were male. The mean ± SD CCT in the population was 533.9 ± 34.0μm. In the multivariable linear regression analysis, increased CCT was significantly associated with younger age, male sex, and higher IOP (all P < .001). There were no significant associations between CCT and CDR, glaucoma, hypertension, and diabetes. This population-based cross-sectional survey of West African adults found a significant association between increased CCT and younger age, male sex, and higher IOP but not glaucoma or CDR. Variations in corneal thickness may influence the accuracy of IOP measurements in African persons.

The Effect of Periocular Acupressure with a Medical Massager for Myopia Children

Objectives: Considering high prevalence of myopia in Asian countries, social cost paid for myopia may gradually increase in Korea. However, studies for developing myopia treatment are deficient. The study was to evaluate whether the periocular acupressure with a medical massager is effective for suppressing myopia progression. Methods: This study was an investigator-sponsored, prospective, open-labeled, and superiority pre and post single-armed study. 14 myopia children aged 7-12 years wore a medical massager for 15 minutes to stimulate periocular acupoints. For 24 weeks, the participants used the device twice a day. Based on prior studies, the refraction change of naturally proceeded myopia was set as -0.38 D. The axial length change of naturally proceeded myopia was set as 0.228 mm. To assess the safety, we performed vital sign check, physical examination, visual acuity test, slit lamp examination, IOP measurement, and fundus examination. Results: The refraction and axial length of the participants increased. For 24 weeks, the change in refraction was -0.38 D at the right eye and -0.40 D at the left. The change in axial length was 0.21 mm at the right and 0.22 mm at the left. In the safety assessment, any adverse event did not occur. Conclusions: There was no significant difference between the control group and the intervention group. The effect of growth may have more contributed to our result than that of acupressure. Based on our result, a full-scale study will not be conducted.

Intraocular pressure and ocular biometric parameters changes in migraine.

BackgroundThe aim of this study was to assess the intraocular pressure and ocular biometric parameters in migraine patients during acute migraine attacks and compare them with painless period and healthy controls using a new optical biometer AL-Scan.MethodsIn this prospective, case–control study, the axial length, corneal curvature radius, anterior chamber depth, central corneal thickness, and pupil size of 40 migraine patients during acute migraine attacks and painless period and 40 age- and sex-matched healthy subjects were measured using a AL-Scan optical biometer (Nidek Co., Gamagori, Japan). All patients underwent a complete ophthalmic examination before the measurements. IOP and biometer measurements were taken at the same time of day (10:00–12:00) in order to minimize the effects of diurnal variation.ResultsThere was not a statistically significant difference in intraocular pressure between the migraine patients during acute migraine attacks (15.07 mmHg), painless period (14.10 mmHg), and the controls (15,73 ± 0,81). Also, the ocular biometric parameters did not significantly vary during the acute migraine attacks.ConclusionsFurther studies are needed to evaluate the etiopathologic relationship between intraocular pressure and ocular biometric parameters and acute migraine attack.

NorLeu3A(1-7) Accelerates Clear Corneal Full Thickness Wound Healing.

We evaluated the effect of the renin angiotensin system (RAS) peptide NorLeu3-Angiotensin (1-7) (NLE) formulated in a viscoelastic gel (USB004) on the healing of full-thickness corneal injuries. Dutch pigmented rabbits received conjunctival administration of 0.3% USB004, 0.03% USB004, or vehicle-control to healthy and full-thickness injured eyes administered once daily for 28 consecutive days. Safety was evaluated using IOP measurement, slit-lamp examination, and confocal microscopy. Evaluations for both efficacy studies included an oblique light examination, modified Seidel test (Seidel test with gentle ocular pressure) as well as during elevated IOP test, confocal microscopy imaging, and histologic analysis. Application of 0.3% USB004, 0.03% USB004, and vehicle-control was safe in healthy and incised eyes. Further, application of 0.3% and 0.03% USB004 following full-thickness corneal incision resulted in a 2-fold acceleration of resolution of edema and inflammation, reduction in duration of wound leakage on a modified Seidel test (Seidel test with gentle ocular pressure) as well as during elevated IOP test, and healing with near normal architecture without evidence of fibrosis and angiogenesis when compared to vehicle-control animals. Topical ocular application of 0.3% and 0.03% USB004 promotes full-thickness cornea wound healing without the evidence of fibrosis and angiogenesis. Further studies are warranted to determine the cornea-specific mechanism of action(s) that promotes regeneration leading to clear corneal healing.

Evaluation of retinal nerve fiber layer thickness and choroidal thickness in pseudoexfoliative glaucoma and pseudoexfoliative syndrome

ABSTRACTObjectives: To compare retinal nerve fiber layer thickness (RNFLT) and choroidal thickness (ChT) measurements in eyes with pseudoexfoliative (PEX) glaucoma, PEX syndrome and healthy control eyes.Methods: Eighteen patients with PEX glaucoma in one eye and PEX syndrome in the fellow eye were included. The right eyes of thirty-nine age- and sex-matched healthy subjects were included as control group. All participants underwent a detailed biomicroscopic and funduscopic examination. RNFLT and ChT measurements were performed with a commercially available spectral-domain optical coherence tomography (SD-OCT). ChT measurements were performed by using enhanced depth imaging (EDI) mode. Patients with PEX underwent diurnal IOP measurements with 4-hour intervals before inclusion in the study. RNFLT results included the average measurement and 6 quadrants (temporal, inferotemporal, inferonasal, nasal, superonasal and supero-temporal). ChT measurements were performed in the subfoveal region and around the fovea (500µm and 1500 µm nasal and temporal to the fovea), as well as around the optic disc (average peripapillary and eight quadrants in the peripapillary region (temporal, inferotemporal, inferior, inferonasal, nasal, superonasal, superior, supero-temporal)).Results: RNFLT in all quadrants and average thickness were significantly lower in PEX glaucoma eyes compared to PEX syndrome eyes and healthy control eyes (p<0.001 for both). RNFLT comparisons between PEX syndrome and healthy control eyes did not show a significant difference (p>0.05) except the inferotemporal quadrant. ChT measurements were similar between groups (p>0.05).Conclusions: Thinning of the RNFL in association with unchanged ChT may mean that the presence of PEX material is a much more significant risk factor than choroidal changes in the progression of PEX syndrome to PEX glaucoma.

COMPARISON OF RESULTS OF INTRAOCULAR PRESSURE MEASUREMENT BY DIFFERENT METHODS IN GENERAL PRACTICE IN PATIENTS WITH LIMITED MOBILITY

The article compares the results of intraocular pressure measurements by two methods - standard tonometry using a Maklakov tonometer (10 g), and transpalpebral tonometry by indicator IGD-03 diathera. The study was conducted in the outpatient clinic at the center of family medicine of the North-Western State Medical University named after. I. I. Mechnikov in the group of patients with limited mobility. The result of the study was the confirmation of the correlation of the results of IOP measurement by two methods

Intraocular pressure in infants and its association with hormonal changes with vaginal birth versus cesarean section.

To investigate cord arterial blood sample and the relationship between birth stress and intraocular pressure in infants at 5min after delivery. The IOP measurements were taken using Tonopen-Avia tonometer to 158 newborns (158 eyes) at 5th min after birth, in a university hospital. Cord blood was collected within 3min after delivery. Intraocular pressure, gender, gestation period, mode of delivery, and birth weight of newborns were noted from medical records. Sixty-two babies were delivered by normal vaginal delivery (NVD) and 96 by cesarian section (C/S). Mean IOP of NVD and C/S groups were 19.56±3.84 and 17.42±3.50, respectively. There was significant difference of mean IOP between two groups. (p<0.001) There were significant differences between two groups regarding APGAR score (p<0.001) and cord blood adrenaline (p=0.003), noradrenaline (p=0.008), and cortisol (p<0.001) levels. There was no difference between infant corneal thickness measurements (p=0.698). In correlation analyses, there is a strong negative correlation between the labor type and postpartum measurements except corneal thickness. Correlation analyses of the 5th min intraocular pressure of the groups individually revealed significant correlation in the NVD group. The conclusion is that the intraocular pressure of newborn infants was higher in NVD delivery compare to C/S. Blood hormonal changes in different anesthesia types and physical stress was thought as the main reason of this result.

Intra-Ocular Pressure Measurement in a Patient with a Thin, Thick or Abnormal Cornea.

Accurate measurement of intra-ocular pressure is a fundamental component of the ocular examination. The most common method of measuring IOP is by Goldmann applanation tonometry, the accuracy of which is influenced by the thickness and biomechanical properties of the cornea. Algorithms devised to correct for corneal thickness to estimate IOP oversimplify the effects of corneal biomechanics. The viscous and elastic properties of the cornea influence IOP measurements in unpredictable ways, a finding borne out in studies of patients with inherently abnormal and surgically altered corneal biomechanics. Dynamic contour tonometry, rebound tonometry and the ocular response analyzer provide useful alternatives to GAT in patients with abnormal corneas, such as those who have undergone laser vision correction or keratoplasty. This article reviews the various methods of intra-ocular pressure measurement available to the clinician and the ways in which their utility is influenced by variations in corneal thickness and biomechanics.

The Value of Water Drinking Test as a Clue for Short Term Intraocular Pressure Fluctuation

Purpose: To assess the relations between the intraocular peaks detected during water drinking test (WDT) and modified diurnal tension curve (mDTC) in glaucomatous and non-glaucomatous eyes. Likewise to assess reliability of WDT as a reliable substitute. Patients and methods: Forty eyes from forty participants (21 males and 19 females) were recruited in this prospective cross-sectional study; twenty participants with known Primary Open Angle Glaucoma and the other twenty participants with non- glaucomatous healthy eyes which served as control. Four IOP measurements were taken at 8:00 am, 12:00 pm, 4:00 pm and 8:00 pm which represented the mDTC, while WDT was represented by a single measurement of IOP before ingestion of one liter of water over five minutes, followed by three IOP measurements after ingestion of this amount of water at thirty minute intervals. The data collected were statistically evaluated using the statistical package for social science (SPSS) program for presence of a correlation between the two methods. Results: The IOP peaks and fluctuations detected during the WDT were strongly correlated to peaks and fluctuations observed during the mDTC. 90% of participants had a peak IOP at 8:00 am, while 7.5% had a peak IOP at 12:00 pm, 2.5% at 4:00 pm and none of the participants had IOP peak at 8:00 pm during the mDTC. In the WDT, 87.5% of the participants had a peak IOP after 30 minutes of ingesting one liter of water, while 12.5% had a peak IOP after 60 minutes. None of the participants had IOP peak after 90 minutes of ingesting one liter of water. IOP fluctuation in mDTC ranged from: 1-4.5 mmHg in 95% of normal participants, 7-11 mmHg in 83.3% of glaucoma suspects, 1.5-5 mmHg in SST subgroup and 4-11 mmHg in the glaucoma on medication subgroup. There were relatively similar results in the WDT fluctuation, whereas 38 cases out of 40 (95%) showed a difference of ± 2 mmHg or less between the two methods. Conclusion: Intraocular pressure peaks and fluctuations detected during the water drinking test could be used in clinical practice to estimate the peaks and fluctuations observed during the modified diurnal tension curve.

Surgical and visual outcome of posterior polar cataract

Introduction: Posterior polar cataract is a rare form of congenital cataract with incidence ranging from 3 to 5 in 10001-2. It is bilateral in 65–80% of the cases with no gender predilection3. Posterior polar cataract presents a special challenge to the surgeon because of its predisposition to posterior capsular dehiscence and possible nucleus drop during surgery. The present study aims to evaluate the surgical outcome of phacoemulsification and manual small incision cataract surgery in patients with posterior polar cataract. Material and Methods: This prospective study included 119 eyes of 118 patients with posterior polar cataract, who underwent surgery at Sagarmatha Choudhary Eye Hospital, Lahan, Nepal, between March 2013 to March 2014. All patients underwent complete ophthalmologic examination including vision, slit-lamp Biomicroscopy, IOP measurement and posterior segment examination. Patients with complicated cataract, glaucoma, corneal opacity/ degeneration, retinal pathology were excluded from the study. Patients were scheduled for cataract surgery either with phacoemulsification or manual SICS with fish hook technique. Informed consent was obtained after explaining the type of surgery and possibility of posterior capsular rupture, a relatively long operative time, secondary posterior segment intervention, and a delayed visual recovery. Results: 119 eyes of 118 patients were included in the study. There were 63 males (53.39%) and 55 females (46.61%). The mean age was 53.24 (range 17-80) years. Among 118 patients 24 patients had other eye operated previously, 2 patients had lost their one eye due to trauma and in remaining 92 patients, 71 patients had bilateral posterior polar cataract (77.17%). Phacoemulsification was performed in 48 eyes and SICS in 71 eyes. The most common intraoperative complication was posterior capsule rupture, seen in 22 eyes (18.49%). Of these, 7 eyes(14.58%) had undergone phacoemulsification, 15(21.13%) had manual SICS. 103