Mm Hg OS Research Articles

Effectiveness and Safety of Resident-Performed Same-Day Bilateral 360-Degree Selective Laser Trabeculoplasty in Patients with Open-Angle Glaucoma.

Resident-performed same-day bilateral selective laser trabeculoplasty are safe and effective for patients with primary open-angle glaucoma or ocular hypertension. To assess the efficacy and safety of resident-performed same-day bilateral 360-degree selective laser trabeculoplasty (SLT). Retrospective chart review was performed for patients who received bilateral, resident-performed SLT at the University of Chicago from January 1, 2020 to December 31, 2022 under the supervision of one glaucoma surgeon (MQ). Patients were included in this analysis if they underwent same-day bilateral 360-degree SLT and had at least 6 months follow-up available. Data were collected on visual acuity, intraocular pressure (IOP), number of IOP-lowering medications, and complications for up to 2 years after the procedure. There were 48 patients included in this analysis, and the diagnosis was either primary open-angle glaucoma (85.4%) or ocular hypertension (14.6%). For patients whose SLT goal was to lower IOP (n=38), the mean baseline IOP in right eyes (OD) was 19.2 mmHg on 2.1 medications, and in left eyes (OS) was 19.5 mmHg on 2.1 medications. At final follow-up (mean 519 days), the mean IOP in right eyes was 15.8 mmHg on 2.0 medications, and in left eyes was 15.8 mmHg OS on 2.2 medications, resulting in an IOP reduction of 17.6% OD and of 18.8% OS. For patients whose SLT goal was to lower medication number (n=10), the mean baseline IOP in right eyes was 16.7 mmHg on 2.3 medications, and in left eyes was 16.4 mmHg OS on 2.3 medications. At final follow-up (mean 528 days), the mean IOP in right eyes was 17.6 mmHg on 1.1 medications, and in left eyes was 16.3 mmHg OS on 1.1 medications, resulting in a medication reduction of 1.1 fewer medications OD and 1.1 fewer medications OS. One patient experienced a 6 mmHg IOP rise above baseline 4 weeks after SLT, and another developed 2 small, focal areas of peripheral anterior synechiae. Six (12.5%) patients underwent additional IOP-lowering surgery during the chart review period. Resident-performed same-day bilateral 360-degree SLT is effective and associated with minimal complications, with rates comparable to those of attending-performed SLT in the literature. SLT can be individualized to patients' goals of IOP-lowering or medication reduction. Teaching institutions can consider incorporating this method of education for appropriate patients with primary open angle glaucoma or ocular hypertension.

The effect of systemic acetazolamide administration on intraocular pressure in healthy horses-A preliminary study.

In equine glaucoma, topical treatment with carbonic anhydrase inhibitors (CAIs) is recommended. Oral acetazolamide, a systemic CAI, is used in horses with hyperkalemic periodic paralysis. Information regarding its effect on equine intraocular pressure (IOP) is scarce. The aim of the study was to determine the effect of oral acetazolamide treatment on IOP in horses, in a case-control study. Ten healthy horses. Horses were treated with oral acetazolamide (4.4 mg/kg) BID for 1 week. Serum acetazolamide concentrations were determined by liquid chromatography/tandem mass spectrometry, and IOP were measured before treatment, daily during treatment, and at 48 and 72 h after treatment. Acetazolamide serum levels reached steady state at 72 h after the first oral dose. In a mixed effect model logistic regression, there was a significant decrease in IOP on the third treatment day, of 2.4 mmHg (p = .012) and 2.7 mmHg (p = .006) in the left (OS) and right eye (OD), respectively. On the seventh day, there was a decrease in 2.5 mmHg (p = .008) and 2.7 mmHg (p = .007) OS and OD, respectively. A significant increase occurred 48 h following treatment discontinuation (3.6 mmHg, p < .001 and 3.5 mmHg, p < .001 OS and OD, respectively). The area under the concentration versus time curve (AUC(0-10h)) was 1.1 ± 0.5 μg/mL*h, mean residence time 6.7 ± 4.3 h, peak plasma concentration (Cmax) 0.4 ± 0.4 μg/mL and time to reach Cmax 1.8 h. There was a significant increase in serum concentrations 1, 2, 48, 72, and 156 h following the first drug administration (p < .05). Further studies are required to determine whether acetazolamide is a potential treatment for equine glaucoma.

Reliability of Intraocular Pressure Measurements in a Low-Contact Drive-Through Setting.

Drive-through intraocular pressure (IOP) measurement using iCare tonometry is a promising method of low-contact, high-throughput IOP monitoring. However, owing to its vulnerability to variable measurement technique and local air currents, the iCare may overestimate IOPs. During the COVID-19 pandemic, a drive-through IOP measurement protocol using the iCare tonometer was established to facilitate low-contact monitoring of select glaucoma patients. As the iCare may be prone to error due to variable measurement technique and local air currents, we endeavored to assess the reliability of drive-through IOP measurements by comparing them with recent measurements taken in clinic settings. Inclusion criteria were patients with drive-through IOP measurements performed from April 28 to October 11, 2020; exclusion criteria were pre-drive-through IOPs >21mmHg. Drive-through IOP measurements were compared with the closest previous and/or subsequent in-clinic IOP measurements. Data were gathered using the Sight Outcomes Research Collaborative (SOURCE) data repository. The post-exclusion study group consisted of 314 patients receiving a total of 868 drive-through IOP measurements, all of whom had prior in-clinic measurements, and 56.8% of whom had subsequent in-clinic measurements. Drive-through IOPs were, on average, +2.4mmHg (+14.5%; SD 4.9) higher than in-clinic IOPs. Further sub-analysis of the data showed a difference of +2.1mmHg OD and +2.6mmHg OS. Compared with the closest previous in-clinic visit, the difference was +2.4mmHg OU (+2.1mmHg OD, +2.7mmHg OS); compared with the closest subsequent in-clinic visit, the difference was +2.3mmHg OU (+2.1mmHg OD, +2.5mmHg OS). 68.6% of all drive-through IOPs were higher than corresponding in-clinic IOPs; 21.1% were lower. 25.9% of drive-through IOPs were higher by more than 5mmHg, whereas 3.9% of drive-through IOPs were lower by more than 5mmHg. As teleophthalmology becomes an ever more important tool in glaucoma patient care, drive-through or walk-through IOP monitoring methods are likely to play an increasing role. However, our data reveals potential inaccuracies in drive-through iCare IOP measurements which tended to overestimate IOP. It is advisable to confirm large changes in IOP with in-clinic measurement before making management decisions. With better optimization of accuracy and reliability of measurements, drive-through tonometry is a promising, high-throughput, low-contact method of measuring IOP.

Pseudonictitating Membrane

A 69-year-old man presented with a membrane over the bulbar conjunctiva in his right eye (OD), encroaching cornea from the temporal side, and freely movable over the conjunctival and corneal surface (A). Extraocular movements were free. The patient had no history of pain, foreign body sensation, lacrimation, chronic illness, prior hospitalization, trauma, adverse drug reaction, or chemical injury. The Schirmer’s test showed normal tear film production. The patient had cataracts in both eyes, otherwise, anterior segment and fundus findings were normal. Uncorrected visual acuity was 6/36 OD and 6/18 in the left eye (OS). Intraocular pressure was 16 mmHg OD and 15 mmHg OS, respectively. Image of OD with membrane in (B) primary gaze, (C) down and out position, and (D) up and inwards (Magnified version of Figure A-D is available online at www.aaojournal.org).

Glaucomatous optic nerve damage in the contralateral eye of a patient with peripapillary retinoschisis: a case report

BackgroundPeripapillary retinoschisis (PPRS) is often associated with glaucomatous eyes. It usually occurs in eyes with a more advanced stage of glaucoma with obvious optic nerve damage. We report a patient who was found to have PPRS in one eye during a routine physical examination without obvious glaucoma symptoms. Further examination revealed glaucomatous visual field loss and retinal nerve fiber layer defects in the contralateral eye.Case presentationA 55-year-old man presented for a routine physical examination. The anterior segment was normal in both eyes. Fundus examination revealed an elevated and red optic disc in the right eye. In addition, scattered patchy red lesions were seen on the retina on the temporal side of the optic disc. The color and boundary of the left optic disc were normal, and the cup-to-disc ratio was 0.6. Optical coherence tomography showed retinoschisis on the optic nerve head of the right eye throughout the entire circumference, extending to the retina on the temporal side of the optic disc. The intraocular pressure was 18 mmHg OD and 19 mmHg OS. The patient was diagnosed with PPRS (OD). However, no optic disc pit or optic disc coloboma was found. Further examination showed that the visual field of the patient’s right eye was generally normal, while a glaucomatous visual field defect was found in the left eye, which manifested as a nasal step visual field defect. Moreover, stereophotography and a red-free fundus image revealed two retinal nerve fiber layer defects in the supratemporal and infratemporal regions of the retina of the left eye. Continuous intraocular pressure measurement found that the intraocular pressure fluctuated between 18 and 22 mmHg OD and 19–26 mmHg OS during the daytime. Primary open-angle glaucoma was then diagnosed.ConclusionsIn this case, we found that PPRS was associated with glaucomatous optic nerve changes and visual field defects in the fellow eye.

Isolated traumatic aniridia with full and partial iris expulsion in pseudophakic eyes

BackgroundTotal aniridia after ocular trauma without disruption of the intraocular lens (IOL) has been reported in patients with a history of small-incisional cataract surgery. We report one case each of total and partial aniridia after accidental falls experienced by two elderly Japanese women.Case presentationsCase 1. A 76-year-old woman with a history of small-incisional cataract surgery more than 10 years previously fell onto concrete and had a contusion that affected the left side of her face. At the initial visit, the best-corrected visual acuity (BCVA) was hand motions and the intraocular pressure (IOP) was 38 mmHg in her left eye (OS). A blood clot was present in the well-formed anterior chamber and expulsed iris tissue was seen beneath the conjunctiva. Exploratory surgery showed no scleral laceration other than the previous sclerocorneal tunnel. After hyphema removal, total aniridia and an intact in-the-bag fixed IOL were seen. By 4 months, the BCVA was 1.2 and the IOP was 13 mmHg OS. Case 2. An 88-year-old woman with a history of small-incisional cataract surgery more than 10 years previously had a fall that resulted in right-sided zygomatic and maxillary bone fractures. The BCVA was light perception and the IOP was 29 mmHg in her right eye (OD). Exploratory surgery showed no scleral laceration and the previous sclerocorneal tunnel was found; iris strand prolapsing from the sclerocorneal tunnel was seen. After hyphema removal, partial iris loss and an intact lens position were seen. By 1 week postoperatively, the BCVA was 0.05 OD and the IOP was 12 mmHg OD.ConclusionsIt has been postulated that previously created small-incision tunnels can function as release valves during blunt trauma by preventing further global rupture and limiting IOL prolapse or retinal injury. Our cases suggested this can happen even long periods after cataract surgery. The case with partial aniridia demonstrated the process of the expulsive aniridia, and its findings do not contradict the postulated mechanisms.

Survey of ocular abnormalities in draft horses.

To determine the prevalence of ocular disease in draft horses in the United States. Draft horses of various breeds and ages. Nondilated ophthalmic examination was performed using slit lamp biomicroscopy and indirect ophthalmoscopy. Intraocular pressures were measured when possible. One hundred sixty-five draft horses were examined. Age range: 10 days to 33 years (mean 10.8 years, median 10 years); 87 geldings (52.7%), 71 mares (43.0%), 7 stallions (4.2%); 64 Percherons (38.8%), 51 Belgians (30.9%), 29 Clydesdales (17.6%), 15 Shires (9%), and 6 other draft breed (3.6%). Intraocular pressure: mean 24.7 mmHg OD, range 13-37 mmHg; mean 25.0 mmHg OS, range 11-37 mmHg. Vision-threatening disease was present in 9 horses (5.5%): complete cataracts 1, post-traumatic optic nerve atrophy 1, uveitis and secondary glaucoma 1, retinal detachment 1, large chorioretinal scar 3, phthisis bulbi 2. Non-vision-threatening ocular disease was present in 56 horses (33.9%) involving one or more ocular structures: eyelid trauma/notch defect 14 (8.5%), SCC-type adnexal lesions 12 (7.3%), corneal scars 16 (9.7%), keratitis 6 (3.6%), corpora nigra cyst 15 (9.1%), incipient/punctate cataract 50 (30.3%), vitreous degeneration 10 (6.1%), asteroid hyalosis 1, "bullethole" chorioretinal scars 3, RPE coloboma 1. Linear keratopathy was present in 28 horses (17%) with 2/28 having concurrent vision threatening ocular disease. Ocular abnormalities, in particular minor cataracts, were relatively common in this population, but not typically vision-threatening. Additionally, this survey demonstrated a greater prevalence of linear keratopathy in draft horses compared with reports in other breeds; however, it does not appear to be associated with concurrent ocular disease.

Neonatal Onset Glaucoma in a Case with Gorlin-Goltz Syndrome: An Unusual Association.

Aim and objectiveTo report a unique presentation of Gorlin–Goltz syndrome (GGS) with congenital glaucoma.Materials and methodsWe report a case of a 3-month-old female patient with bilateral uncontrolled intraocular pressures (IOP), who was already diagnosed with GGS. Examination under anesthesia demonstrated microcornea, iris coloboma, lens subluxation in both eyes, and edematous cornea in the left eye. Intraocular pressure was 17 mm Hg in OD and 35 mm Hg in OS with Icare (Icare® PRO) tonometer on repetitive measurements. On dilated fundus examination, a large chorioretinal coloboma was seen on both eyes.ResultsOn physical examination, cutaneous, dental, and skeletal anomalies associated with the GGS were found. As previously reported ocular abnormalities associated with the GGS; coloboma and microphthalmia were noted. In addition, congenital glaucoma which is not one of the known associations of GGS was also detected. For treatment, 270° transscleral diode cyclophotoablation was performed for the left eye and medical treatment was reorganized for both eyes.ConclusionNeonatal-onset glaucoma might be one of the important ocular manifestations of GGS.How to cite this articleTefon Arıbaş AB, Aktaş Z, Özdek Ş. Neonatal Onset Glaucoma in a Case with Gorlin–Goltz Syndrome: An Unusual Association. J Curr Glaucoma Pract 2021;15(2):99–101.

Macroscopic Pseudoexfoliation Material within the Iridocorneal Angle

During routine follow-up of an 85-year-old man with bilateral pseudoexfoliative glaucoma, unusually large newly deposited macroscopic sheets of pseudoexfoliation material were observed in the right inferior iridocorneal angle (Panel A). These sheetlike accumulations were further characterized as hyper-reflective filamentous structures on anterior segment optical coherence tomography (Panel B). Pseudoexfoliative glaucoma had been diagnosed four years prior with intraocular pressures of 34 mmHg OD and 28 mmHg OS, and vertical cup-to-disc ratios of 0.9 OD and 0.85 OS. Intraocular pressure (IOP) was initially managed with topical latanoprost and timolol OU, followed by trabeculectomy OD. With continued topical therapy, his IOP remained well controlled for three years, after which selective laser trabeculoplasty OD was performed due to increasing IOP and severe visual field loss. Pseudoexfoliation syndrome is a systemic disease often associated with glaucoma due to accumulation of pseudoexfoliation material within the trabecular meshwork, and consequent impairment of aqueous outflow

Estimation of the accuracy and informativeness of measuring intraocular pressure in patients with their contact lenses on by transpalpebral scleral tonometry

Purpose : to compare the tonometry results obtained by transpalpebral scleral tonometry and pneumotonometry for patients with their contact lenses on. Material and methods . Intraocular pressure (IOP) was measured in 30 (60 eyes) patients with various refraction errors including 5 patients (10 eyes) aged 11–63 (45.0 ± 21.0) years with hyperopia of +1.75 to +9.0 D (+4.4 ± 2.6 D) and 25 patients (50 eyes) aged 12–57 (26.4 ± 13.5) years with myopia of -0.5 to -11.25 D (-4.4 ± 2.4 D). In most of cases patients used soft daily disposable contact lenses (spherical or multifocal). IOP was determined in both eyes of each patient using 1) transpalpebral scleral tonometry (EASYTON tonometer), and 2) corneal pneumotonometry. IOP was first measured when the patient was without their contact lenses, by both methods consecutively. 20 minutes after putting the lenses on, IOP was measured once again. Each measurement was taken three times and the average IOP value was determined. The data were analyzed using parametric statistics: the mean value and the standard deviation (M ± SD) of each parameter were calculated. Results . On average, patients without contact lenses showed transpalpebral IOP (IOPtr) of 16.3 ± 2.9 mmHg in the right eye (OD) and 16.6 ± 3.2 mmHg in the left eye (OS) and pneumotonometry IOP (IOPpn) of 16.0 ± 3.8 in OD and 15.6 ± 3.3 mmHg in OS. When the lenses were put on, the values of IOPtr stayed practically the same: 16.0 ± 3.9 mmHg in OD and 16.7 ± 3.1 mmHg in OS. IOPpn also changed insignificantly: 15.7 ± 2.9 mmHg in OD and 15.5 ± 2.8 mmHg in OS, but individual IOPpn data scattered more when the lenses were put on. IOPtr of hyperopic patients both with the lenses (19.5 ± 3.9 mmHg in OD and 19.7 ± 3.3 mmHg in OS) and without them (19.3 ± 2.8 mmHg in OD and 19.6 ± 3.1 mmHg in OS) was higher than IOPpn both with the lenses (14.0 ± 1.8 mmHg in OD and 14.2 ± 1.7 mmHg in OS) and without them (13.5 ± 2.7 mmHg in OD and 13.2 ± 1.6 mmHg in OS). A higher IOPtp in the hyperopic group seems more plausible because most patients in this group were significantly older than in myopic group. In hyperopic patients, IOPpn level in lenses tended to be higher than without them, while IOPtr was the same in either case. It may be due to the fact that contact lenses for high hyperopia are rather thick, which affects the air impact on the cornea during pneutonometry. In the myopic group the difference between IOPtr (15.2 ± 3.5 mmHg in OD and 16.0 ± 2.7 mmHg in OS) and IOPpn (16.1 ± 2.9 mmHg in OD and 15.9 ± 3.0 mmHg in OS) in lenses and IOPtr (15.7 ± 2.6 mmHg in OD and 15.9 ± 2.9 mmHg in OS) and IOPpn (16.6 ± 3.8 mmHg in OD and 16.1 ± 3.4 mmHg in OS) without them was insignificant. Conclusion . Transpalpebral scleral tonometry using EASYTON is an adequate method to measure IOP of patients with contact lenses on and can be the method of choice in a some of clinical cases, since its results and their repeatability are not affected by factors associated with the presence of a contact lens.

Evaluating intraocular pressure-lowering solutions for the treatment of open-angle glaucoma: comparison between bimatoprost 0.03% and bimatoprost 0.01% &amp;ndash; an observational switch study

PurposeThe purpose of this study is to evaluate the intraocular pressure (IOP)-lowering efficacy of bimatoprost 0.01% solution in patients with primary open-angle glaucoma (POAG), who were switched from bimatoprost 0.03% solution, compared to patients with POAG who continued on bimatoprost 0.03% solution.MethodsA retrospective review evaluated 35 patients (35 right eyes [OD], 34 left eyes [OS]) who remained on bimatoprost 0.03% and 30 patients (27 OD, 30 OS) who were switched to bimatoprost 0.01% during the period January 8, 2010 to December 26, 2012. Mean IOP was measured 6 and 3 months before the switch, at switch, and 3, 6, and 12 months after the switch. Hyperemia scores were recorded before and after the switch and were compared to a picture scale.ResultsMean IOP in the group that switched was 16.96±5.03 mmHg in OD and 17.67±5.33 mmHg in OS at baseline. Mean IOP postswitch to bimatoprost 0.01% solution was 17.60±4.34 mmHg in OD and 17.00±3.37 mmHg in OS. IOP was not significantly reduced in either OD or OS postswitch to bimatoprost 0.01% (P1=0.5 OD, P2=0.2 OS). The hyperemia scores improved remarkably when bimatoprost 0.03% solution was switched to bimatoprost 0.01% solution (P<0.001).ConclusionTo our knowledge, this is the first switch study evaluating the hypotensive efficacy and tolerability of bimatoprost in a group of patients with open-angle glaucoma. In this study comparing bimatoprost 0.03% and 0.01% solution, we found improved tolerability postswitch to 0.01% from 0.03% bimatoprost, similar efficacy between the two concentrations before and after switch in the same patient population, and similar IOPs comparable to nonswitch bimatoprost 0.03% solution.

Correlation Between Intraocular Pressure and Central Corneal Thickness in Persian Children.

IntroductionThis study aimed to determine intraocular pressure (IOP) and central corneal thickness (CCT) measurements in healthy Persian children to find clinical reference values in this ethnicity. Additionally, we examined the possible relationship between these measurements.MethodsThis cross-sectional study included 262 eyes of 131 Persian primary school children between 6 and 13 years of age. All eyes were healthy and had no anterior or posterior segment abnormalities, corneal disease, or evidence of glaucoma. Specular microscopy was used to measure CCT and both noncontact tonometry (NCT) and Goldmann applanation tonometer (GAT) were used to measure IOP. Correlations between IOP measurements were also examined.ResultsMean CCT was 513.47 ± 34.51 μm in the right eye (OD) and 513.93 ± 33.88 μm in the left eye (OS). The CCT was not significantly different between older (10–13 years) and younger (6–9 years) patients. Mean IOP measured with GAT was 13.86 ± 2.13 mmHg OD and 13.72 ± 2.04 mmHg OS and mean IOP measured with NCT was 15.26 ± 2.38 mmHg OD and 15.11 ± 2.18 mmHg OS. The IOP and CCT measured with GAT were weakly correlated (OD: r = 0.141, P = 0.114; OS: r = 0.236, P = 0.007). However, IOP and CCT measured with NCT (OD: r = 0.487, P = 0.000; OS: r = 0.456, P = 0.000) were moderately correlated. Our outcomes demonstrated that for 100 μm increase in CCT, IOP measured with GAT and NCT increased by 0.8 and 3.3 mmHg, respectively, in OD and by 1.4 and 2.9 mmHg in OS. Based on intraclass correlation coefficients, IOP measurements made with GAT and NCT were in fair agreement in OD and in good agreement in OS.ConclusionThe IOP and CCT in healthy Persian school children (6–13 years old) were positively correlated. Our findings revealed that corneal thickness is thinner in Persian children than in most other racial groups.FundingThis study has been funded by deputy dean in research of School of Medicine and deputy vice chancellor of Shiraz University of Medical Sciences, Shiraz, Iran.

Angle closure glaucoma – misleading causes, delayed treatment

We present the clinical case of a 43 years old female patient, referred to our clinic for a red, painful left eye. Multiple bilateral similar attacks were reported by the patient in the last 2 years, for which a diagnosis of conjunctivitis or anterior uveitis was established. At current presentation we found bilateral marked inflammatory reaction in the anterior segment (extensive peripheral iris synechiae, inflammatory membrane in the pupillary area, iris “bombe”, pigment dispersion, but no keratic precipitates or cells in the anterior chamber. Intraocular pressure (IOP) was 12 mmHg in OD and 40 mmHg in OS, under topical treatment, started 24 before the current visit. Gonioscopy showed closed angle in both eyes, “openable” in various grades after indentation in all quadrants. Anterior segment ocular coherence tomography (AS-OCT) and ultrasonic biomicroscopy (UBM) suggested anatomical causes for acute angle closure, revealing multiple rolling folds on the iris surface, high insertion onto the scleral wall. Multiple laboratory investigations excluded any potential cause of uveitis, therefore the anatomical theory remained in discussion related to a disproportion between anterior structures leading to angle closure attacks. We performed laser peripheral iridotomy, in this patient with positive outcome: IOP decrease, deepening of the AC, open angle in gonioscopy. Misleading issues in this case confused the initial diagnosis and delayed the adequate treatment.

Ophthalmological manifestation of the Klippel Trenaunay Syndrome

The Klippel-Trenaunay Syndrome (KTS) is a rare congenital disease, which the prevalence is higher in males, and its incidence of 25:100,000. It is presented in its classic form as the triad of port-wine stains, enlarged limbs and venous and / or lymphatic malformation. The diagnosis is essentially clinical and due to the complexity of the syndrome, the progressive characteristic and the wide variety of clinical presentations, a multidisciplinary team should treat patients individually. The ocular changes associated with KTS include vascular, orbit, iris, retina, choroid and optic nerve abnormalities. Case report: A 23-year-old female patient, carrier KTS, being followed at Vision Center - Federal University of Parana, complaining of decreased visual acuity in the right eye. The patient had port-wine stains in right hemibody and hypertrophy of ipsilateral members. Glaucoma was diagnosed and eye exams were performed to assess the degree of impairment of visual fields and fundus. The best correction was checked at 20/100 OD and 20/20 OS. At fundoscopy, there was increased excavation of the optic nerve right - 0.75 x 0.90 mm. Clinical treatment was chosen with Dorzolamide Hydrochloride, Latanoprost, Brimonidine and Timolol, presenting good long-term results - the tonometry showed 19 mmHg OD and 15 mmHg OS, despite the difficulty in stabilizing the disease. Conclusion: Reports have shown that the results of clinical and surgical treatments of glaucoma in association with KTS are unsatisfactory compared to other types of glaucoma - clinical control is not possible in about 1/ 3 of patients and the surgical management has a high rate of complications. Significant studies are needed to establish the correlation between glaucoma and KTS, and base the treatment of choice.

A Randomized, Prospective Study of Bimatoprost 0.01% or Travoprost/Timolol in Patients Previously Treated with Latanoprost and Timolol to Reduce Intraocular Pressure

To compare the efficacy and safety of bimatoprost 0.01% with the fixed combination travoprost 0.004%/timolol 0.5% in subjects with stable intraocular pressure (IOP) control on latanoprost and timolol. This was a randomized, prospective, investigator masked, crossover study comparing bimatoprost 0.01% with travoprost/timolol in 40 subjects diagnosed with primary open-angle glaucoma. Subjects were randomized to bimatoprost 0.01% qpm or travoprost/timolol qam and followed for 12 weeks, at which time they were crossed over to the alternate medication and followed for another 12 weeks. Intraocular pressure and hyperemia (rated on a standardized, 5-point photographic scale) were evaluated as change from baseline to 12 weeks following each therapy, and subject preference was elicited at the end of the study. Both treatments were well tolerated and the majority of patients achieved effective IOP control relative to baseline. After 12 weeks of treatment, mean reductions from baseline IOP were -1.68 mmHg OD (right eye) and -1.58 mmHg OS (left eye) with bimatoprost and -0.45 mmHg OD and -0.53 mmHg OS with travoprost/timolol, although the differences between drugs were not statistically significant. Hyperemia scores were significantly higher with the fixed combination of travoprost/timolol than bimatoprost 0.01% as measured at 8 am (both P<0.01). Subject preference at the end of the study was more than 3 to 1 in favor of bimatoprost, with most citing greater tolerability. Bimatoprost 0.01% and travoprost/timolol are both effective at reducing IOP in subjects with stable IOP control on latanoprost and timolol, but bimatoprost 0.01% is associated with less hyperemia.

Tonometry and Corneal Aesthesiometry in the Red-Eared Slider Turtle (Trachemys scripta elegans)

Abstract Tonometry, the estimation of intraocular pressure (IOP), is an essential component of ophthalmic examination. Understanding of this diagnostic tool is limited in chelonians. The purpose of this study was to evaluate two methods of tonometry for estimation of IOP in red-eared slider turtles (Trachemys scripta elegans) and report values for corneal sensitivity measured by corneal aesthesiometry. Adult redeared slider turtles (n = 6) were manually restrained for tonometry; rebound and applanation tonometers were used. Corneal aesthesiometry was performed with the use of a Cochet-Bonnet corneal aesthesiometer. Median IOP estimated with applanation tonometry was 31.5 mmHg (25–75%: 24.3–38.3 mmHg, min–max: 9–58 mmHg) OD and 23.5 mmHg (25–75%: 17.8-34.8 mmHg, min–max: 10–58 mmHg) OS. Mean IOP estimated with rebound tonometry with non–species-specific calibration was 6.1 mmHg (SD: 2.3 mmHg, min–max: 3–9 mmHg) OD and 5.7 mmHg (SD: 1.3 mmHg, min–max: 2–9 mmHg) OS, with canine-specific calibration it was 9....

Treatment of hypotony maculopathy caused by traumatic cyclodialysis

A 29-year-old male experienced abrupt visual loss in the left eye following an elastic cord rebounding injury that resulted in ocular hypotony. He received topical atropine and prednisolone eye drops for more than one month without improvement. On examination, his visual acuity was 1.0 OD and counting fingers at 80 cm OS. Initial intraocular pressure (IOP) was 15 mmHg OD and 6 mmHg OS. Gonioscopic evaluation of his left eye revealed a cyclodialysis cleft positioned between 6 and 7 o'clock. A fundus photograph showed signs of hypotony maculopathy including optic disc edema, tortuous vessels, and chorioretinal folds. B-scan ultrasound displayed choroidal thickening and optical coherence tomography (OCT) demonstrated macular edema, subretinal fluid, retinal striae, and choroidal folds. Pars plana vitrectomy and sulfur hexafluoride (SF6) tamponade were performed. After gas absorption, IOP was 11 mmHg OS and remained steady during follow-up. One week after surgery, his visual acuity improved to 0.9. The present case highlights that pars plana vitrectomy with gas tamponade is worth considering for patients with cyclodialysis cleft associated with hypotony maculopathy. Early surgical intervention remains the treatment of choice when hypotony maculopathy and deteriorated vision are noted. Conservative management may be suitable in cases when visual function is not impaired.

Ocular pulse amplitude measured by PASCAL dynamic contour tonometry in patients with a cavernous sinus dural arteriovenous fistula

Ocular pulse amplitude measured by PASCAL dynamic contour tonometry in patients with a cavernous sinus dural arteriovenous fistula

A case of developmental glaucoma suspected from megalophthalmos represented by obstetric ultrasonography

A male neonate was delivered normally in the 38th week of gestation. The patient weighed 2730 g and was 48.8 cm long at birth. The Apgar score was 10. He was referred to the Department of Ophthalmology, Mie University Hospital by a local ophthalmologist for megalophthalmos and elevated IOP in both eyes (OU) on the 10th day after birth. He had no significant family history. Family history revealed that the mother of the patient was a 20-year-old primipara receiving systemic steroid therapy for chronic nephritis. Obstetric ultrasonography at 30 gestational weeks had revealed the neonate to have megalophthalmos OU. At 35 gestational weeks, the ocular axial length measurements OU were 23–25 mm (Fig. 1) and about 24 mm based on B-scan ultrasonography and magnetic resonance imaging (MRI) images (Fig. 2), respectively. A disproportion in volume between eye and orbit was noticed, but no other abnormal findings were detected on the images. An ophthalmic examination revealed diffuse corneal opacification and corneal edema OU; consequently, the fundus could not be observed. The horizontal corneal diameter was 14 mm in the right eye (OD) and 13 mm in the left eye (OS). The intraocular pressure on a Perkins hand-held applanation tonometer was 34 mmHg OD and 42 mmHg OS. The diagnosis was bilateral early-onset developmental glaucoma. On his 17th day of life, the patient underwent a trabeculotomy of about 120 dextent OU with a scleral flap at

Phacoemulsification in a Patient with Small Pupil and a Large Iris Cyst

Peripheral iris cysts are generally asymptomatic and nonprogressive. They are usually located in the inferotemporal quadrant of the anterior segmen:, most commonly in the iridociliary sulcus. We report our management strategy in a patient with small pupil and a large iris cyst. Retrospective, case report. A 65-year-old man was referred, reporting blurred vision OS. Best-corrected visual acuity (BCVA) was 6/12 OD and 6/48 OS. Anterior chamber (AC) examination OS revealed an iris cyst protruding inferotemporally occupying almost one-third of AC volume. Intraocular pressure (IOP) was 32 mmHg OS and 19 mmHg OD. Aspiration with a 27-G cannula, without cyst resection, was performed. Phacoemulsification and intraocular lens implantation were uneventful. The BCVA improved to 6/9 1 week postoperatively and to 6/6 a month later. In the first postoperative visit, IOP dropped to 16 mmHg. The cyst was significantly decreased in size. Six months postoperatively, BCVA remained unchanged while AC examination revealed that the cyst remained in place with no signs of enlargement. In this case, cyst aspiration was elected as a treatment procedure that led to significant decrease in size. This management option, combined with an uncomplicated cataract extraction procedure, resulted in an excellent visual and a positive anatomic outcome.