Comparison of the Additive Effects of Nipradilol and Carteolol to Latanoprost in Open-Angle Glaucoma

Purpose

To compare the effects of nipradilol and carteolol on intraocular pressure (IOP) when added to latanoprost treatment for glaucoma patients.

Methods

Fifty patients with primary open-angle glaucoma were treated with latanoprost 0.005% once daily for 3 months. Then they were assigned to one of two groups randomly. One group received nipradilol 0.25% twice daily (nipradilol preceding group; n = 25), and the other carteolol hydrochloride 2% twice daily (carteolol preceding group; n = 25), for 3 months in addition to latanoprost. Then, nipradilol and carteolol were switched, and the subjects were treated for 3 more months. One eye was selected randomly for analysis.

Results

In the nipradilol preceding group, IOP was 21.4 ± 2.3?mmHg (mean ± SD) at baseline, and 16.8 ± 1.9?mmHg at the end of latanoprost monotherapy (P < 0.01). The addition of nipradilol decreased IOP to 15.8 ± 1.7?mmHg, and the change to carteolol, to 15.3 ± 2.0?mmHg. In the carteolol preceding group, IOP was 21.2 ± 2.0?mmHg at baseline, and 17.0 ± 2.1?mmHg at the end of latanoprost monotherapy (P < 0.01). The addition of carteolol decreased IOP to 15.4 ± 1.8?mmHg, and the change to nipradilol, to 16.3 ± 1.9?mmHg. Additional IOP reduction was greater with carteolol than with nipradilol (cross-over analysis of variance; P = 0.0005).

Conclusions

Both nipradilol and carteolol have additive effects when used in combination with latanoprost. Carteolol, however, may have a more potent effect than nipradilol. Jpn J Ophthalmol 2006;50:33–37 © Japanese Ophthalmological Society 2006     

Investigation of blood flow regulation and oxygen saturation of the retinal vessels in primary open-angle glaucoma

Purpose

To examine the supply of oxygen to the retina in primary open-angle glaucoma (POAG).

Methods

Forty-one patients with primary open-angle glaucoma (mean age 64.1?±?12.9 years) and 40 healthy subjects (63.6?±?14.1 years) were included. Fundus images, centered at the optic disc, were taken using the Retinal Vessel Analyzer (RVA). The vessel diameters were calculated as central retinal artery (CRAE) and vein equivalent (CRVE) from diameter measurements in the peripapillary vessels. The oxygen saturation of the arteries and veins was investigated employing a two-wavelengths technique. After the measurement at baseline, the vascular response to flicker light exposure was measured.

Results

In glaucoma patients the mean oxygen saturation of the retinal veins at baseline was higher than in the healthy controls (64.36?±?7.11 vs. 59.78?±?8.47, p?=?0.01), whereas the mean arteriovenous oxygen saturation difference was lower (33.07?±?5.24 vs. 37.53?±?6.95, p?=?0.002). The arterial oxygen saturation as well as the arterial and venous diameters showed no difference between the groups. The increase of the CRVE during flicker light stimulation (3.72?±?3.29 % vs. 5.43?±?4.04, p?=?0.039), as well as the change of the venous oxygen saturation (2.08?±?3.74 % vs. 4.18?±?3.88 %, p?=?0.016) and the arteriovenous saturation difference (?2.1?±?3.31 % vs. ?4.43?±?3.6 %, p?=?0.003) were smaller in POAG patients than in the healthy group.

Conclusions

The reduction in the arteriovenous difference in oxygen saturation in POAG patients might show a decreased oxygen demand of the retina caused by the glaucomatous loss of neuroretinal tissue. The lower extent of the flicker light-induced change of the diameter of retinal veins and the venous oxygen saturation could indicate an impairment of blood flow regulation.     

Retinal vessel diameter in normal-tension glaucoma patients with asymmetric progression

Purpose

To investigate the longitudinal changes in the central retinal vessel diameter in asymmetric progressive normal-tension glaucoma (NTG) patients.

Methods

This study included 27 patients with bilateral NTG without any systemic vascular disease who showed glaucomatous progression in one eye at the mean follow-up of 24.3 months (range, 18–29 months). Progression was determined by the development of new retinal nerve fiber layer (RNFL) defects or widening of pre-existing defects on red-free RNFL photographs. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were measured at baseline and at the mean follow-up of 24.3 months. We classified the eyes of each patient as either progressed or stable eyes, and compared the differences and changes in the CRAE and CRVE.

Results

No significant inter-eye difference was observed at baseline in the mean CRAE (167.5?±?22.2 μm vs. 168.2?±?15.5 μm, p?=?0.809) and in the mean CRVE (276.3?±?18.2 μm vs. 281.6?±?21.9 μm, p?=?0.267) between the progressed and stable eyes. There were significant changes in CRAE in the progressed eyes between baseline and 2 years after baseline (from 167.5?±?22.2 μm to 146.9?±?18.0 μm, p?p?=?0.084).

Conclusions

In our series of NTG patients with asymmetric progression, central retinal artery diameter decreased over time in the progressed eyes, whereas no significant decrease in the central retinal artery diameter was seen in the stable eyes.     

Retinal neurovascular coupling in patients with glaucoma and ocular hypertension and its association with the level of glaucomatous damage

Purpose

To analyze neurovascular coupling in the retina of untreated primary open-angle glaucoma (POAG) and ocular hypertension (OHT) patients.

Patients and methods

Maximal vessel dilation in response to flicker light was analyzed with Retinal Vessel Analyzer (RVA) in temporal superior/inferior arterioles and veins in 51 POAG patients, 46 OHT and 59 control subjects. RVA parameters were compared between groups, between contralateral POAG eyes, and correlated to intraocular pressure, visual field mean defect and retinal nerve fiber layer thickness.

Results

POAG eyes demonstrated generally smaller response of all vessels to flicker light than the other two groups (ANOVA p?=?0.026; mean arterial flicker response in percent of baseline, averaged superior and inferior was 3.48?±?2.22 % for controls , 2.35?±?2.06 % for POAG patients , and 2.97?±?2.35 % for OHT patients; corresponding values for venules were 3.88?±?1.98 %, 2.89?±?1.72 %, 3.45?±?2.77 %). There was no difference in flicker response between the eye with more and less advanced damage in each patient of the POAG group (ANOVA p?=?0.79). Correlation of flicker response to intraocular pressure (IOP) was borderline at best, correlations to the level of glaucomatous damage were not significant. Correlation of flicker response of superior and inferior vessels of the same eye was significant for the arteries (Pearson r?=?0.23, p?=?0.004), as well as venules (r?=?0.52, p?<?0.001).

Conclusion

General vessel response to flicker light was decreased in POAG patients, compared to normal controls and OHT patients. In contrast to significant correlation between the two contralateral eyes of the flicker response itself, only its borderline correlation to IOP was seen. There was no correlation to the level of damage, altogether indicating a systemic dysregulation phenomenon.

Grants

Swiss National Foundation Grant 3200B0-113685, Velux Stiftung Grant, Freie Akademische Gesellschaft (FAG) Grant, Pfizer Inc. Grant

Clinical trial registration reference number

ClinicalTrials.gov NCT00430209     

Comparison of Spectralis-OCT, GDxVCC and GDxECC in assessing retinal nerve fiber layer (RNFL) in glaucomatous patients

Background

Glaucomatous optic neuropathy is characterized by a progressive loss of retinal ganglion cells (RGCs). The defects in the peripapillary retinal nerve fiber layer (RNFL) have been reported to be the earliest sign of glaucoma. We determined the agreement between RNFL thickness assessments from spectral-domain OCT (Spectarlis HRA?+?OCT; Heidelberg Engeneering, Heidelberg, Germany), scanning laser polarimetry (SLP) with variable cornea compensation (GDxVCC; Carl Zeiss Meditec, Dublin, CA, USA), and SLP with enhanced cornea compensation (GDxECC; Carl Zeiss Meditec, Dublin, CA, USA) in glaucomatous patients. Furthermore, we investigate the influence of typical scan score (TSS) on the results of GDx assessments.

Methods

The enrolled subjects were devided into different groups by modified HODAPP visual field criteria. The peripapillary RNFL thickness was assessed with the three devices . ANOVA test, Pearson and Spearman correlation coefficient, and Bland-Altman plots were used to analyse the RNFL thickness assessments.

Results

Ninety-two eyes from 92 glaucomatous subjects were analysed. These were divided into four groups: preperimetric glaucoma (n?=?26), mild glaucoma (n?=?18), moderate glaucoma (n?=?21), and severe glaucoma (n?=?27). For Spectralis-OCT, the average RNFL thickness (mean ± SD) was 99.25?±?26.31 μm, 80.52?±?16.63 μm, 71.59?±?21.15 μm, and 63.85?±?20.86 μm for preperimetric, mild, moderate, and severe glaucoma respectively. For GDxVCC, the corresponding assessments were 52.63?±?8.18 μm, 52.95?±?10.20 μm, 46.77?±?10.62 μm, and 49.70?±?13.34 μm. For GDxECC, the assessments were 49.35?±?6.52 μm, 45.92?±?7.21 μm, 42.19?±?8.00 μm, and 39.53?±?8.45 μm. All Spectralis-GDxVCC and Spectralis-GDxECC differences were statistically significant by ANOVA test. The differences between GDxVCC and GDxECC were statistically significant only for severe glaucoma. There was a highly significant correlation between Spectralis-OCT and GDxECC, as well as Spectralis-OCT and GDxVCC, in assessing the RNFL thickness. The best instrument agreement was found between GDxECC and Spectralis-OCT. The RNFL thickness assessed with Spectralis-OCT and GDxECC showed a better correlation to visual field defects than GDxVCC. Evaluating GDx assessments with typical retardation pattern GDxVCC and GDxECC showed very similar RNFL thickness results.

Conclusions

RNFL thickness assessments between GDxVCC, GDxECC, and Spectralis-OCT cannot be directly compared. The assessments are generally higher with Spectralis-OCT than with GDxVCC and GDxECC, because of differences in method of the devices. The atypical retardation pattern has a major impact on the RNFL thickness results of GDx devices. This must be taken into account when evaluating the assessed RNFL thickness results.     

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Purpose

To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

Methods

In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp–Anderson–Parish classification. Pearson’s correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

Results

Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70?±?46.28 mm³; 167.40?±?45.36 mm³) than in the mild glaucoma group (264.03?±?78.53 mm³; 264.76?±?78.88 mm³) and the control group (297.80?±?71.45 mm³; 296.56?±?71.02 mm³). Moderate correlation was observed between: RNFL thickness and ON volume (r?=?0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r?=?0.60, p?<?0.001). ON volume below 236 mm³ was 96 % sensitive and 80 % specific for the detection of severe glaucoma.

Conclusions

MRI measured optic nerve volume is a reliable method of assessing glaucomatous damage beyond the optic nerve head. A value of 236 mm³ and below can be used to define severe glaucoma.     

Conjunctival findings in hyperbaric and low‐tension glaucoma: an in vivo confocal microscopy study

Purpose: To analyse the epithelial features of the bulbar conjunctiva in hyperbaric and low‐tension glaucoma (LTG) using in vivo confocal microscopy (IVCM). Methods: Thirty‐six eyes of 36 patients [18 affected by primary open‐angle glaucoma (POAG) and 18 with LTG] were studied; control group was constituted by 28 eyes of 28 healthy subjects. All eyes were examined using digital confocal laser‐scanning microscopy (HRT II Rostock Cornea Module). The main IVCM outcome measurements were mean density (MMD: cysts/mm²) and mean total area (MMA: μm²) of the epithelial microcysts. Results: The mean intraocular pressure level (mmHg ± SD) was 15.1 ± 1.7, 16.3 ± 3.1 and 12.6 ± 1.8 in healthy, POAG and LTG eyes, respectively. Conjunctival microcysts were found in all patients and subjects: for healthy subjects, MMD = 10.9 ± 11.1 cysts/mm² and MMA = 1501.9 ± 1191.1 μm²; for patients infected with POAG, MMD = 36.8 ± 28.6 cysts/mm² and MMA = 7904.8 ± 7050.5 μm²; and for patients infected with LTG MMD = 45.6 ± 29.0 cysts/mm² and MMA =7946.9± 5227.5 μm². MMD and MMA were not significantly different between patients infected with POAG and those with LTG, whereas they were significantly greater in patients (fourfold and fivefold, respectively) than healthy subjects. Conclusions: The present study demonstrated that conjunctival microcysts represent an in vivo feature in all eyes with medically controlled POAG and LTG. Therefore, conjunctiva deserves careful analysis, because its accurate microscopic definition could help clarify the pathophysiology of aqueous outflow in glaucoma.     

Corneal biochemical features of patients with vernal keratoconjunctivitis

Background

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, seasonally exacerbated, allergic inflammation of the ocular surface, involving bulbar and ? or tarsal conjunctiva and cornea. The ocular response analyzer (ORA) measures corneal biomechanical properties in vivo by monitoring and analyzing the corneal behavior when its structure is submitted to a force induced by an air jet. This study was designed to examine corneal biomechanical properties and intraocular pressure in patients with VKC, and to compare with control eyes.

Methods

ORA measurements were performed on the both eyes of 26 patients with VKC (group I) and 14 healthy children who served as the control group (group II). Corneal hysteresis (CH), corneal resistance factor (CRF) and intraocular pressure [Goldmann correlated (IOPg) and corneal compensated (IOPcc)] were recorded with ORA.

Results

Mean age of patients with VKC and control groups were 11.3?±?5.8 and 10.6?±?1.9 years for groups I and II respectively. Mean (± SD) of the CH and CRF readings were 10.1?±?1.6 versus 10.5 ±1.6 (p?>?0.05) and 9.5?±?1.7 versus 10.8?±?1.7 mmHg (p?<?0.05), in groups I and II respectively. Mean (± SD) of the IOPg and IOPcc recordings were 13.3 ±3.4 versus 16.6 ±3.6 mmHg (p?<?0.05) and 14.3?±?3.4 versus 16.9?±?3.7 mmHg (p?>?0.05) in groups I and II respectively. Statistical analysis revealed significant differences for CRF and IOPg between the study groups.

Conclusion

The mean CRF and IOPg values of patients with VKC were lower than those of controls. According to the results of our study, one can conclude that corneal biomechanical property, CRF, could be different in VKC patients compared to normals.     

Clinical results of selective laser trabeculoplasty in silicone oil-induced secondary glaucoma

Background

To analyze the efficacy of selective laser trabeculoplasty (SLT) on silicone oil-induced secondary glaucoma in terms of intraocular pressure (IOP).

Patients and Methods

42 patients (42 eyes) with silicone oil-induced secondary glaucoma were selected, and SLT was performed with 360° of the trabecular meshwork. During the 12-month follow-up, the complications, IOP, and antiglaucoma medication usage were observed.

Results

The mean IOP decreased from 23.1?±?1.9 mmHg before treatment to 18.4?±?3.7 mmHg after treatment (p?<?0.05). Mean number of antiglaucoma medications used for IOP control also decreased from 2.17?±?1.21 to 1.25?±?0.89 (p?<?0.05). The 12-month success rate in the total sample was 59.5 %. The success rate was 60.7 % (17 eyes) and 57.1 % (eight eyes) for phakic and aphakic eyes, respectively (p?>?0.05)

Conclusions

SLT is a safe and effective option for the treatment of patients with silicone oil-induced secondary glaucoma.     

Switching efficacy on intraocular pressure from latanoprost to bimatoprost in eyes with open angle glaucoma: implication to the changes of central corneal thickness

Purpose

Intraocular pressure (IOP)-lowering effects of 0.03 % bimatoprost in eyes with open angle glaucoma (OAG) was compared with that of 0.005 % latanoprost.

Methods

Thirty-one patients with OAG who had received three kinds of ocular hypotensive agents (latanoprost, beta-blocker, and topical carbonic anhydrase inhibitor) were included in this study. In these patients, bimatoprost was administered for 8 weeks after switching from latanoprost. The IOP was measured with a goldmann applanation tonometer (GAT) at the baseline, and Weeks 2, 4 and 8 after switching the treatment. The IOP at the baseline and at the end of treatment period was measured at 10:00, 12:00, and 16:00. The central corneal thickness (CCT) was measured at each visit using an ultrasonic pachymeter.

Results

At the baseline, the mean IOP was 18.8 ± 1.4 mmHg, and the CCT was 530.7 ± 29.5 μm. At Week 8 after switching treatment, bimatoprost significantly reduced the IOP by 2.0 ± 1.6 mmHg from the baseline (p < 0.001). The CCT tended to be reduced (p = 0.009; Repeated ANOVA) and Bonferroni test indicated a statistically significant decrease of the CCT at Week 8 in comparison with that at the baseline (p = 0.013).

Conclusions

Bimatoprost has an IOP-lowering effect superior to that of latanoprost in glaucoma patients after switching from latanoprost. The use of bimatoprost can decrease the CCT for a relatively short period in a linear regression fashion.     

In diabetic eyes, multifocal ERG reflects differences in function between the nasal part and the temporal part of the macula

Purpose

The purpose of the present study was to compare retinal function between the perifoveal nasal and perifoveal temporal areas of diabetic eyes using multifocalERG (mfERG).

Methods

We included 36 eyes from 27 patients with diabetes (age 58?±?14?years; duration of diabetes 13?±?9?years; HbA_1c 7.1?±?1.8%) and a control group with 18 eyes from 18 healthy subjects (age 57?±?11?years). Retinal thickness was assessed with optical coherence tomography (OCT) in the perifoveal areas corresponding to the summed nasal and temporal inner and outer areas. MfERG amplitude and implicit time were recorded from corresponding areas.

Results

Diabetic eyes showed lower mfERG amplitude in the nasal area than in the temporal area (14?±?6 vs 17?±?7?nV/deg²; p?p?=?0.005). In the control group, there were no significant differences between the two areas.

Conclusion

Diabetic eyes showed lower amplitude and longer implicit time in the nasal area than in the temporal, which might indicate that the nasal area is more vulnerable. These findings may be of importance for evaluation of diabetic maculopathy and outcome after laser treatment.     

Variations in the degree of epiblepharon with changes in position and induction of general anesthesia

Background

To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia.

Methods

Sixty-three pediatric patients (126 eyes) underwent surgery for epiblepharon between April 2008 and September 2008 (35 females, 28 males; average age: 4.74 years). The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1–4) and area of ciliocorneal touch (scored 1–3) while the patient was in upright and supine positions before induction of general anesthesia and in supine position after induction of anesthesia.

Results

The severity of epiblepharon was significantly reduced by a positional change to supine position and induction of general anesthesia. Skin-fold height scores decreased when patients were moved from upright (estimated mean ± standard error [SE]; 2.98?±?0.08) to supine position (2.63?±?0.09) (P?<?0.001) prior to induction of anesthesia, and decreased further after induction of general anesthesia (2.12?±?0.08) (P?<?0.001). Ciliocorneal touch scores also decreased after patients were moved to supine position and after induction of general anesthesia (upright: 2.17?±?0.05; supine: 1.95?±?0.06; general anesthesia: 1.64?±?0.07, P?<?0.001).

Conclusions

Our study demonstrates that positional changes and general anesthesia using muscle relaxants affect the degree of epiblepharon. Surgeons should be aware of these variations for operative planning of epiblepharon.     

Serum dehydroepiandrosterone sulphate, total antioxidant capacity, and total oxidant status in central serous chorioretinopathy

Background

The objective of this work is to evaluate plasma total antioxidant capacity (TAC), total oxidant status (TOS), and dehydroepiandrosterone sulphate (DHEA-S) levels in patients diagnosed with acute central serous chorioretinopathy (CSCR) and control samples.

Methods

The TAC, TOS, and DHEA-S levels were assessed in the plasma of 46 CSCR patients and compared with 40 control samples.

Results

The TAC level was 1.16?±?0.08 and 1.20?±?0.09 mmol Trolox eq./l; TOS level was 28.77?±?33.33 and 19.95?±?10.42 μmol H₂0₂/l; DHEA-S level was 203.79?±?84.75 μg/dl and 249.36?±?122.93 μg/dl in the CSCR group and in the control group, respectively. The plasma TAC and DHEA-S values were significantly lower in the CSCR group than in the control group (p?=?0.027 and p?=?0.046, respectively). There was no significant difference between the CSCR and the control groups in terms of age, gender, and TOS levels (p?>?0.05).

Conclusions

We demonstrated that the levels of plasma DHEA-S and antioxidative parameters were reduced in CSCR. Our results suggest that the antioxidant defense system may be inadequate or corrupted in CSCR. Reduced DHEA-S level is one of the factors that trigger this insufficiency.     

Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis

Purpose

To evaluate the efficacy of vitrectomy including internal limiting membrane (ILM) peeling without gas tamponade for myopic foveoschisis (MF).

Method

In this retrospective study, 15 eyes of 13 consecutive patients with MF underwent pars plana vitrectomy and ILM peeling without gas tamponade. The main outcomes were measured using best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT).

Result

The mean refractive error was ?11.0?±?8.2 diopters and mean axial length was 30.8?±?2.6?mm. The mean BCVA increased from 0.78?±?0.53 to 0.61?±?0.75 logMAR unit (p?=?0.05), and the mean CMT decreased from 405?±?143?μm to 255?±?47?μm (p?=?0.002) during a follow-up of 11.8?months. OCT showed a complete resolution of the MF, with foveal reattachment in all eyes. Full-thickness macular hole developed in two eyes during follow-up.

Conclusion

ILM peeling without gas tamponade results in favorable anatomical and visual outcomes.     

A pilot study of the effect of intravenous erythropoetin on improvement of visual function in patients with recent indirect traumatic optic neuropathy

Background

To evaluate the efficacy of intravenous erythropoietin (EPO) on improvement of visual function and color vision in patients with recent indirect traumatic optic neuropathy (TON).

Methods

In a case series, 18 eyes of 18 patients with diagnosis of indirect TON with duration of less than 2 weeks underwent 20,000 IU intravenous EPO injections daily for 3 days. Best corrected visual acuity (BCVA) and color vision were checked by Ishihara test before, 1, and 3 months after injections. BCVA and color vision were compared before, 1, and 3 months after injections.

Results

The mean BCVA improved from a baseline of 2.21?±?0.97 to 1.48?±?1.29 and 1.31?±?1.27 log MAR at months 1 and 3, respectively. The differences were statistically significant (P?=?0.001, P?<?0.001). Color vision was changed from a baseline 2.24?±?4.29 to 2.94?±?4.64 and 3.41?±?5.09 plates at months 1 and 3, respectively. We observed some qualitative improvement that was, however, statistically insignificant at the time of evaluation. (P?=?0.063, P?=?0.068).

Conclusion

This case series showed noticeable effect of EPO on improvement of visual function in patients with recent indirect TON.     

Corneal biomechanical properties measured by the ocular response analyzer in acromegalic patients

Purpose

To investigate the effect of acromegaly on corneal biomechanical parameters.

Methods

This cross-sectional, comparative clinical study included 34 acromegalic patients and 30 age-matched and sex-matched healthy controls. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated intraocular pressure (IOPg and IOPcc, respectively) were measured using the Ocular Response Analyzer. Central corneal thickness (CCT) was determined with the ultrasonic pachymeter.

Results

The mean duration of disease for the acromegalic patients was 5.3 years. There was no significant difference between the groups regarding mean CH, CRF, IOPg and IOPcc values. The respective mean values in patients with acromegaly and controls were 10.3?±?2.2 and 9.5?±?1.5 mmHg (p?=?0.13) for CH; 10.5?±?2.4 and 9.7?±?1.7 mmHg (p?=?0.16) for CRF, 16.1?±?3.6 and 15.5?±?2.9 mmHg (p?=?0.49) for IOPg, 16.8?±?3.4 and 17.0?±?2.8 mmHg (p?=?0.82) for IOPcc, and 544.8?±?32.2 and 530.7?±?22.9 μm (p?=?0.05) for CCT. A significant moderate correlation was detected between the duration of acromegaly and IOPg OD (r?=?0.430, p?=?0.01). There was no significant correlation between other ocular parameters and levels of GH and IGF-1 at the time of diagnosis, the status of control, adenoma type, radiotherapy treatment, and drug usage.

Conclusions

In acromegalic patients, the duration of disease was correlated with IOPg OD level. Corneal biomechanical parameters and CCT values were not significantly different than those in age-matched and sex-matched healthy individuals.     

Photoreceptor inner and outer segment layer thickness in multiple evanescent white dot syndrome

Purpose

To evaluate the photoreceptor inner and outer segment layer thickness in eyes with MEWDS.

Design

Prospective, non-comparative, observational case series. The follow-up duration was 4 months.

Methods

Four women were diagnosed with unilateral MEWDS. The ages of the patients were 25, 24, 35, and 40 years. The retinal microstructure was assessed by spectral-domain optical coherence tomography (SD-OCT). The thickness of the photoreceptor inner (IS) and outer (OS) segments and sum of them (IS + OS) at the fovea were analyzed.

Results

The visual acuity was reduced in three of four eyes at the acute phase. SD-OCT showed that the border of IS and OS (IS/OS) line and the cone outer segment tips (COST) line in the macula area were not detected in all four eyes. The IS + OS thickness was 50.3?±?5.6 μm and that of the healthy fellow eyes was 73.5?±?7.0 μm (n?=?4 eyes). The thickness of the IS was 27.8?±?2.6 μm and that of the OS was 45.8?±?7.3 μm. In all eyes, there was a spontaneous improvement of the visual acuity. SD-OCT showed a recovery of only the IS/OS line in the macular area, but the COST line was not visible in three cases. The mean IS + OS thickness increased to 56.0?±?7.9 μm (n?=?4), IS?=?26.0?±?2.0 μm (n?=?3), and OS?=?30.1?±?8.7 μm (n?=?3) in the early recovery phase, and to 64.8?±?9.3 μm (n?=?4), IS?=?28.5?±?1.7 μm (n?=?4), and OS?=?36.3?±?7.9 μm (n?=?4) in the late recovery phase. The mean inner and outer segment thickness remained unchanged in the fellow eyes.

Conclusion

Eyes with MEWDS have changes in the photoreceptor microstructures. The change in the IS + OS thickness during the natural recovery course might be due to an increase in the OS length.     

Effects of trabeculectomy on posture-induced intraocular pressure changes over time

Introduction

To determine whether trabeculectomy affects postural-induced changes in intraocular pressure (IOP), and whether it is maintained.

Methods

Thirty-six eyes of 36 patients with open-angle glaucoma who were scheduled for their initial trabeculectomy with adjunctive mitomycin C were prospectively examined. The IOP was measured in the sitting and the lateral decubitus position with an ICare rebound tonometer before, and 1, 3, and 12?months after trabeculectomy.

Results

Twenty-nine eyes of 29 patients completed this study. The mean baseline IOP measured with the ICare tonometer was 17.4?±?4.9?mmHg in the sitting position and 21.3?±?5.6?mmHg in the lateral decubitus position (p?p?p?=?0.004 respectively). This decrease in the degree of posture-dependent IOP change was maintained at +1.7?±?2.2?mmHg at 1 year postoperatively (p?Conclusions Our results indicate that trabeculectomy not only reduces the IOP but also reduces the degree of posture-induced changes in the IOP. Our findings also speculate that measuring the postural IOP changes after trabeculectomy might provide a clue on the functioning of a filtering bleb.     

Macular microcirculation in patients with epiretinal membrane before and after surgery

Background

To investigate blood flow velocity (BFV) in the perifoveal capillaries before and after vitreous surgery for patients with epiretinal membrane (ERM).

Methods

Twenty-one eyes in patients with ERM and 16 eyes in healthy subjects were involved in this study. Fluorescein angiography was performed using a scanning laser ophthalmoscope and BFV was analyzed by the tracing method. Foveal thickness (FT) was measured by optical coherence tomography.

Results

BFV was significantly slower in the ERM patients (1.04?±?0.10?mm/s) than in the healthy subjects (1.49?±?0.11?mm/s ) (p?=?0.0010). BFV in the ERM patients 6?months after vitreous surgery (6?M) (1.21?±?0.02?mm/s) significantly increased compared with BFV before surgery (0?M) (1.04?±?0.10?mm/s) (p?=?0.0061). BFV 1?year after vitreous surgery (1?Y) significantly increased (1.38?±?0.02?mm/s) compared with BFV(6?M) (1.21?±?0.02?mm/s) (p?=?0.0235). FT was significantly greater in the ERM patients (351.7?±?87.1?μm) than in the healthy subjects (158.9?±?16.9?μm) (p?=?0.0011). FT (6?M) significantly decreased (285.3?±?36.9?μm) compared with FT before surgery (0?M) (351.7?±?87.1?μm) (p?=?0.0212). FT did not show significant differences between (6?M) and (1?Y). No significant correlation was found between BFV and FT before surgery.

Conclusions

Perifoveal capillary BFV in patients with ERM was slower than that in the healthy subjects, and significantly improved after vitreous surgery as time progressed. It can be said that perifoveal capillary BFV is related to the development and improvement of ERM in the long term.     

Children with dry eye type conditions may report less severe symptoms than adult patients

Background

To compare the symptom scores of children with those of adults with the same degree of mild ocular surface signs.

Methods

This study included patients with at least one ocular surface symptom and sign. Data obtained from 45 subjects aged 8.79?±?2.95 yr (Mean ± SD) (pediatric group) and 45 adults aged 52.87?±?10.87 yr (adult group) who were matched to each pediatric patient based on ocular surface signs were analyzed. Demographic data including age and sex; parameters of ocular surface signs including fluorescein staining score, tear film breakup time and Schirmer test score; symptom scores including ocular surface disease index (OSDI) and visual analog scale (VAS) were assessed and compared between the two groups.

Results

Significant differences emerged in sex ratio as well as in age between the two groups (P?<?0.001, for both). Regarding ocular surface signs and tear film tests, the study revealed no significant differences in fluorescein staining score (1.44?±?1.95 vs. 1.40?±?1.68 P?=?0.913), tear film break up time (4.96?±?1.94 vs. 3.82?±?1.85 s, P?=?0.612) and Schirmer score (12.79?±?9.05 vs. 10.11?±?8.45 mm / 5 min, P?=?0.370). Regarding dry eye symptoms, both OSDI and VAS were significantly lower in the pediatric group (P?=?0.001 and?<?0.001, respectively) than in the adult group.

Conclusion

Pediatric patients with mild ocular surface damage may report fewer dry eye symptoms compared to adult patients with similar stages of ocular surface damage.