Combined trabeculotomy-trabeculectomy as a first surgical procedure for primary congenital glaucoma

Early surgical results (mean follow-up=163 days) following combined trabeculotomy-trabeculectomy as a first surgical procedure for 20 consecutive cases in 14 children with primary congenital glaucoma were retrospectively examined. Mean pretreatment intraocular pressure was 25.55±9.58 mmHg, decreasing to 14.55±6.15 mmHg following treatment. Primary combined trabeculotomy-trabeculectomy was a useful initial procedure to control intraocular pressure in primary congenital glaucoma. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

Relationship between optic disc cupping change and intraocular pressure control in adult glaucoma patients

• Background: Until recently, there has been a paucity of quantitative evidence for intraocular pressure (IOP)-dependent optic disc cupping change in adult glaucoma patients. Therefore, we investigated the relationship between optic disc cupping change and IOP control. • Methods: The study involved 78 eyes of 78 randomly selected adult patients with early to moderate chronic open-angle glaucoma (COAG), treated on various therapeutic regimens, who had had two consecutive successful optic disc analyses with the Rodenstock Optic Nerve Head Analyzer 15.8 ± 14.8 weeks apart. • Results: The mean initial IOP of 27 eyes (34%) with cupping reversal did not differ from that of 17 eyes (22%) demonstrating progressive deterioration (29.2 ± 8.8 vs 26.2 ± 6.1 mmHg,P > 0.5), but the reversal group did have a significantly greater mean IOP decrease than the progression group (−10.8 ± 7.9 vs −1.0 ± 7.7 mmHg,P < 0.001) and significantly lower mean final IOP (18.3 ± 6.1 vs 25.2 ± 7.9 mmHg,P < 0.003). • Conclusion: A decrease of optic disc cupping is more likely with a greater IOP reduction and a lower final IOP, and an increase of cupping is more likely with less or no IOP reduction and a higher final IOP. Part of the content was presented as a paper of PAAO at the 1991 Joint Annual Meeting of the AAO/PAAO, Anaheim, California The authors have no proprietary interest in the Rodenstock Optic Nerve Head Analyzer     

The effect of lateral decubitus position on intraocular pressure in healthy young subjects

Purpose: To investigate the effect of change of body posture from supine to lateral decubitus position (LDP) on intraocular pressure (IOP) in healthy young subjects. Methods: We evaluated 38 eyes of 19 healthy young Korean subjects. IOP was measured using Tonopen XL^® in both eyes in the sitting and supine position, 5 and 30 min after right LDP and 5 min after returning to the supine position. A week later, IOP was measured in the same sequence except that the subjects assumed the left LDP. The eye on the lower side in the LDP was termed as a dependent eye. Results: The mean IOP of the dependent eyes increased significantly at 5 min after changing from supine to right (16.26 ± 2.73 mmHg versus 18.54 ± 2.95 mmHg, p < 0.01) or left LDP (15.53 ± 2.41 mmHg versus 17.53 ± 3.37 mmHg, p < 0.01); this IOP increase in the dependent eyes persisted at 30 min after changing to right (18.47 ± 2.97 mmHg, p < 0.01) or left LDP (17.79 ± 2.20 mmHg, p < 0.01). Upon returning to the supine position, IOP of the dependent eyes decreased significantly (16.83 ± 2.67 mmHg, p < 0.01 for right LDP and 16.47 ± 2.32 mmHg, p < 0.01 for left). However, this effect of the positional change was not found in the non‐dependent eyes (all, p > 0.05). Mean IOP in the dependent eye was significantly higher than that in the non‐dependent eye at 30 min after changing to the right (+0.89 ± 1.52 mmHg) or left LDP (+1.84 ± 2.03 mmHg). Conclusion: The postural change from supine to LDP significantly increased IOP of the dependent eyes.     

Photodynamic therapy and intravitreal triamcinolone for extrafoveal choroidal neovascularization in neovascular age-related macular degeneration

We report a case of extrafoveal choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration treated with photodynamics therapy (PDT) and intravitreal triamcinolone. Nine months following PDT and intravitreal triamcinolone, no ophthalmoscopic or angiographic evidence of recurrent CNV in the left eye was found. The intraocular pressure (IOP) increased from 10 mmHg on presentation to 20 mmHg at 9 months. No IOP-lowering agents were required. The mild nuclear sclerosis remained unchanged. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not dicuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

Latanoprost vs combined therapy with timolol plus dorzolamide in open-angle glaucoma a 24-month study

Objective To compare the long-term efficacy and shortterm escape from effective treatment of 0.005% latanoprost administered once daily vs 0.5% timolol plus 2% dorzolamide twice daily for 24 months to patients with open-angle glaucoma. Design Prospective study. Setting and number of patients A total of 117 eyes of 61 subjects with open-angle glaucoma were included in this study. The eligible patients were randomized to receive either 0.005% latanoprost once daily or 0.5% timolol and 2% dorzolamide twice daily. Measurements The intraocular pressure (IOP) figures were recorded at baseline and at 0.5 1, 3, 6, 9, 12, 15, 18, 21, and 24 months of treatment. Results Compared with baseline measurements, both latanoprost and timolol plus dorzolamide treatments caused a significant (p<0.001) reduction of IOP at each visit trroughout the duration of therapy. The IOP was reduced to 17.1±2.4, 16.6±2.2, and 15.9±2.04 with latanoprost and 18.2±2.1, 18.6±2.4, and 18.4±1.9 with timolol plus dorzolamide after 6, 12, and 24 months, respectively. After 24 months, 82% of the patients who initially responsed to treatment were still controlled in the latanoprost group, with a maintained reduction of IOP and no signs of upward drift. However, only 56% of the patients of the timolol plus dorzolamide group were controlled at the end of the study with increase of IOP figures. Conclusions Administered once daily, 0.005% latanoprost is more effective than timolol plus dorzolamide twice daily for the long-term treatment of patients with open-angle glaucoma, showing a maintained effect on IOP reduction. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do, however, discuss the use of off-label products, which includes unlabeled, unapproved, or investigative devices.     

The effect of repeated applanation on subsequent IOP measurements

Background: In studies aimed at assessing the accuracy and repeatability of non‐contact tonometers, the order in which these tonometers and the Goldmann tonometer are used is usually randomised despite studies in the literature that demonstrate an ocular massage effect that occurs post‐applanation but not after non‐contact tonometry. The purpose of this study was to investigate the effect of repeated corneal applanation on subsequent assessments of IOP. Methods: Data were obtained from 65 left eyes of 65 young, oculovisual normals. Three sets of IOP measurements were obtained, one set with the Goldmann applanation tonometer and two with the Topcon CT80 non‐contact tonometer (one set each before and after applanation with the Goldmann tonometer), in each one of two separate measurement sessions, one week apart. Results: The average (and SD) IOP measured with the Goldmann tonometer in the first session (14.8 ± 2.9 mmHg) did not vary significantly from the IOP measured with the non‐contact tonometer (pre‐applanation) in both sessions or with the average Goldmann IOP in the second session. The bias (mean difference ± SD) between methods was 0.3 ± 1.4 mmHg and 0.4 ± 1.4 mmHg, respectively, for the first and second sessions, with the CT80 (pre‐applanation) recording the higher IOP in both sessions. The within‐session repeatability coefficients were ±2.3 mmHg, ±2.6 mmHg, ±2.1 mmHg and ±2.0 mmHg for the CT80 (pre‐applanation) in the first and second sessions, and the Goldmann tonometer in the first and second sessions, respectively. Test‐retest repeatability coefficients were ±2.8 mmHg and ±2.5 mmHg for the CT80 (pre‐applanation) and the Goldmann tonometer respectively. Post‐applanation with the Goldmann tonometer, there was a statistically significant (p < 0.05) reduction (1.5 ± 1.2 mmHg in session 1) in the IOP measured with the non‐contact tonometer in both sessions. Conclusion: These results suggest that repeated corneal applanation leads to a statistically significant reduction in IOP on subsequent measurements.     

A comparison between Goldmann applanation tonometry and dynamic contour tonometry after photorefractive keratectomy

Background

The intraocular pressure (IOP) could be measured by both Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). Although these two methods have been discussed widely after laser-assisted sub-epithelial keratectomy (LASIK), there is little data in the cases undergoing photorefractive keratectomy (PRK). We aimed to compare the changes of IOP measurements obtained by GAT and DCT after PRK for myopia/myopic astigmatism.

Methods

This prospective study enrolled 77 candidates (154 eyes) for PRK to correct myopia or myopic astigmatism and 30 matched patients (30 eyes) with myopia or myopic astigmatism who served as controls. Changes of the IOP measurements (ΔIOP) obtained by GAT and DCT before and at 6 months after PRK in the operated eyes, and at baseline and 6 months later in the controls, were documented. Changes of the central corneal thickness (ΔCCT) were determined in the same fashion.

Results

The mean IOP readings obtained by DCT were comparable before and at 6 months after procedure (18.34 ± 3.03 mmHg and 17.87 ± 2.61 mmHg respectively, p?=?0.41); whereas the mean IOP reading obtained by GAT decreased significantly 6 months postoperatively (17.92 ± 3.63 mmHg and 16.25 ± 2.66 mmHg, p?<?0.001). A significant correlation was present between the ΔIOP obtained by GAT and ΔCCT (r?=?0.61, p?<?0.001). Similar correlation was not significant between the DCT-obtained ΔIOP and the ΔCCT (r?=?0.07, p?=?0.44). The mean ΔIOP obtained by GAT was significantly higher in the operated eyes than in the controls (?1.54?±?1.45 vs 0.07?±?0.44 mmHg, p?=?0.02). The mean DCT-obtained ΔIOP was just marginally insignificant between the operated and nonoperated eyes (?0.63?±?0.59 vs 0.02?±?0.38 mmHg respectively; p?=?0.09).

Conclusions

The authors recommend DCT after PRK in the cases with myopia or myopic astigmatism     

Pneumatic trabeculoplasty a new method to treat primary open-angle glaucoma and reduce the number of concomitant medications

Pneumatic trabeculoplasty (PNT), when used in combination with antiglaucoma medication, was evaluated in two studies: a feasibility study involving 177 patients, and a separate efficacy study involving 317 eyes. Both studies were nonblinded, single-armed, and nonrandomized; the primary efficacy end point in each study was a decrease in intraocular pressure (IOP) compared with baseline. The first study reported a mean drop in IOP of 6.3 mmHg across the entire group. The second study showed a mean IOP after PNT treatment level at least 1 mmHg less than the pretreatment mean; except at 3, 6, 9, and 12 months, when it was at least 2 mmHg less than the initial mean IOP. The lesser reduction observed in the second study can be explained by the fact that a number of the patients were at least partially controlled by antiglaucoma medications at enrollment, and, as a result, the group had a lower starting IOP than those enrolled in the first study. In both studies, a clear trend to less medication was observed when PNT was added to a patient’s treatment regime. The ability of PNT to reduce IOP and medication requirements, along with its relatively benign safety profile, supports the use of PNT as part of a glaucoma patient’s treatment regimen. Drs. Leo D. Bores and John T. LiVecchi have stated that they do have significant financial interest or other relationship with a product manufacturer or for Ophthalmic International and (Dr. LiVecchi is Medical Director and a member of the Board of Directors of Coronado Industries). Dr. Guillermo Avalos Urzúa has no financial interest the device. The authors also do discuss the use of off-label products, which includes unlabeled, unapproved, or investigative devices.     

Silicone punctal plugs as an adjunctive therapy for open‐angle glaucoma and ocular hypertension

Background: Primary open‐angle glaucoma is a progressive optic neuropathy that can cause an irreversible loss of vision. A reduction in intraocular pressure (IOP) is beneficial in slowing or halting its progression. Once‐per‐day monotherapy glaucoma medications, such as prostaglandin analogues, are effective in lowering IOP while maintaining patients' adherence. Achieving the desired target IOP often requires multiple medications. The present study evaluates punctal occlusion of both the inferior and superior puncta as an adjunctive therapy to travoprost ophthalmic solution 0.004% for patients with primary open‐angle glaucoma or ocular hypertension in order to reduce IOP. Methods: Thirteen patients who were using travoprost 0.004% ophthalmic solution for the treatment of open‐angle glaucoma or ocular hypertension received silicone punctal plugs in the superior and inferior puncta of one eye. After one month, the IOP was remeasured. The percentage change of the IOP from the baseline was analysed by using a paired sample t‐test. Results: The mean baseline IOP was 19.82 ± 1.19 mmHg in the test eyes and 18.32 ± 1.11 mmHg in the control eyes. The mean IOP at the one‐month visit was 18.23 ± 1.17 mmHg in the test eyes and 18.45 ± 1.04 mmHg in the control eyes. The test eyes demonstrated a decrease in IOP of 1.59 (± 0.95) mmHg from the baseline, or a 6.82 per cent decrease in the IOP from the baseline. The control eyes had an increase in IOP of 0.14 ± 0.77 mmHg from the baseline, or a 1.91 per cent increase in the IOP. The relative difference in the IOP between the test eyes and the control eyes at the one‐month visit was 1.73 mmHg, or 8.74 per cent. Conclusion: Based on the results of this study, punctal occlusion offers a statistically and clinically significant decrease in IOP when it is used as an adjunctive therapy to travoprost 0.004% for patients who are suffering from open‐angle glaucoma or ocular hypertension.     

Sinnhaftigkeit von Tages-/Nacht-Augeninnendruckmessungen über 48 h

Purpose

Diurnal intraocular pressure (IOP) measurements are recommended in cases of visual field deterioration in glaucoma patients. In this study the rationale of 24 h versus 48 h IOP measurements was investigated.

Patients and methods

Mean IOP and maximum IOP values were obtained in 80 patients over a period of 48 h. The IOP measurements (Goldmann tonometry) of day 1 and 2 (taken every 4 h) were compared. To reduce interindividual and intraindividual differences of measurements the statistical calculation took a tolerance level of ±?2 mmHg and ±?1 mmHg into account.

Results

Maximum IOP measurements were found to differ between 37.5 % and 65.0% respectively for right eyes and 28.8 % and 47.5% respectively for left eyes depending on the measurement tolerance (±2 mmHg or ±1 mmHg) between day 1 and day 2. Mean IOP values were found to differ by 25 % and 51.3 % respectively for right eyes and 26.3 % and 46.3% respectively for left eyes (±?2 or ±?1 mmHg in) between day 1 and day 2. A time-related clustering of extreme deviations could not be found but the maximum values from all patients were found to be roughly equally distributed over daytime and nighttime hours.

Conclusions

Both maximum IOP and mean IOP measurements were found to differ by at least ±?2 or ±?1 mmHg between day 1 and 2 at a significant percentage and the maximum values did not peak at a predictable time point during the 48 h. Therefore, 48 h IOP measurements appear to be more reliable than 24 h measurements.     

Intraocular pressure in keratoconus

Purpose: This study aimed to investigate intraocular pressure (IOP) measurements taken using the dynamic contour tonometer (DCT) and the non‐contact tonometer (NCT) in subjects with keratoconus. Methods: Intraocular pressure was measured in 20 keratoconus subjects and 20 age‐matched control subjects using the DCT and NCT instruments. Central and off‐centre measures were taken with the DCT in order to highlight any systematic errors associated with corneal biomechanical factors. Measures of anterior and posterior corneal topography and thickness were also taken in each subject. Results: No significant difference was found between the central and off‐centre DCT IOP readings for the keratoconus subjects and age‐matched controls (p > 0.05). The average DCT IOP was 14.2 ± 1.4 mmHg in the keratoconus subjects and 14.2 ± 1.6 mmHg in the controls. However, the average NCT readings differed significantly (p < 0.001) between the keratoconus subjects (9.2 ± 1.5 mmHg) and the controls (12.9 ± 2.4 mmHg). Intraocular pressure measurements taken with the DCT showed no significant (p > 0.05) correlation with the severity of keratoconus as determined through measures of corneal topography and thickness. Equivalent IOP measurements taken with the NCT correlated significantly with certain measures of corneal curvature and thickness in the keratoconus population. The difference between DCT and NCT IOP was strongly correlated with measures of corneal topography and thickness, with differences increasing in more advanced keratoconus. Conclusions: The measurements obtained with the DCT do not appear to be dependent upon corneal factors, unlike those taken with the NCT. The presence or severity of keratoconus was not correlated with DCT IOP values.     

Corneal biomechanics measured with the ocular response analyser in patients with unilateral open‐angle glaucoma

Purpose: To evaluate the relationship between biomechanical properties of the cornea and intraocular pressure (IOP) and the role of biomechanical properties in eyes of patients with unilateral primary open‐angle glaucoma (POAG). Methods: The biomechanical properties of corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured with the ocular response analyser (ORA). In an experimental setting, three human donor eyes with Schiotz‐tonometry‐controlled IOP were investigated. In addition, a series of patients with unilateral POAG were evaluated. Main outcome measures were CH, CRF, corneal‐compensated IOP (IOPcc), standard automated perimetry parameters mean defect (MD) and pattern standard deviation, central corneal thickness, Goldmann applanation tonometry (GAT), and cup‐to‐disc ratio. Results: A highly significant linear correlation between CH and the corneal‐compensated IOP (IOPcc, r = ?0.926; p < 0.001) was found. The correlation between IOP_CC and CRF was not significant (r = 0.335; p = 0.08). In total, 36 eyes of 18 patients with unilateral POAG were examined. Regarding uncorrected CH (mean 7.73 ± 1.46 mmHg glaucomatous eye and 9.28 ± 1.42 mmHg fellow eye), there was a highly significant difference between both eyes. This difference disappears, when CH was corrected for IOP (9.44 ± 3.78 mmHg and 9.97 ± 3.22 mmHg, respectively). Conclusions: Corneal hysteresis but not corneal resistance factor is dependent on IOP. In patients with unilateral POAG, IOP is higher in the affected eye. When CH is corrected for IOP, corneal biomechanical properties do not differ in both eyes of patients with unilateral POAG.     

Real-world comparison between the Tonopen and Goldmann applanation tonometry in a university glaucoma clinic

Purpose

To determine whether Tonopen intraocular pressure (IOP) measurements by Ophthalmic technicians are interchangeable with Goldmann applanation tonometry (GAT) by a specialist in our glaucoma clinic.

Methods

Ophthalmic technician Tonopen and glaucoma specialist GAT IOP measurements were performed on both undilated eyes of 300 consecutive patients during the same visit to our glaucoma clinic.

Results

Among all 600 eyes of 300 patients (age 65.4, range: 23–92 years, male: 44.3%), Tonopen and GAT IOPs were similar (15.5?±?0.6 vs. 15.4?±?0.7 mmHg, respectively, p?=?0.63) and directly correlated (r²?=?0.58, p?<?0.0001). However, among 120 patients with bilateral primary open-angle glaucoma GAT IOP was significantly higher than Tonopen in the right eyes (17.1?±?1.1 vs. 16.2?±?0.9 mmHg, p?=?0.024) and in the left eyes (17.0?±?1.0 vs. 16.3?±?1.0 mmHg, p?=?0.029). In all 300 right eyes, Tonopen underestimated IOP in 48.3% of eyes and overestimated in 39% (difference range: (???)14 to (?+?)12 mmHg), with IOP difference?>??±?3 mmHg in 34% of eyes. In eyes with GAT IOP?≥?22 mmHg, Tonopen IOP was significantly lower (24.7?±?2.6, range: 11–43 mmHg vs. 28.2?±?2.2, range: 22–43 mmHg, p?=?0.0002, mean difference:???3.6?±?1.7 mmHg), and the Tonopen measured IOP?≤?21 mmHg in 33.3% of eyes. In eyes with Tonopen IOP?≤?10 mmHg GAT measured IOP of 11–17 mmHg in 65.7% of eyes.

Conclusions

Tonopen may mask a third of eyes with elevated IOP and two third of eyes with potentially above-goal IOP. The Tonopen may not be interchangeable with GAT or sufficiently reliable for patient management or screening in our glaucoma clinic. However, further study is recommended to assess the limitations of the Tonopen IOP measurements in eyes with higher or lower GAT IOPs.

Clinical Trials Registration

The Institutional review board, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY does not require this retrospective study to register.

     

Vitamin D and intraocular pressure – results from a case –control and an intervention study

Purpose: To study the associations between serum 25‐hydroxy‐vitamin D (25(OH)D) levels, vitamin D administration and intraocular pressure (IOP). Methods: The design of the study included a nested case–control study and a randomized controlled intervention trial. In the first part, healthy Caucasians with high or low serum 25(OH)D levels were recruited from a population‐based study. IOP of the right eye was measured by the use of a rebound tonometer. In the second part, those with low serum 25(OH)D levels were randomized to receive either capsules of vitamin D₃ 20 000 IU twice per week or placebo for 6 months before IOP was measured again. Results: Intraocular pressure in the 87 participants with low serum 25(OH)D levels (mean 40.1 ± 12.9 nm ) did not differ from IOP in the 42 participants with high serum 25(OH)D levels (mean 85.1 ± 14.0 nm ) (15.9 ± 3.3 mmHg versus 15.6 ± 3.1 mmHg, p = 0.56, independent t‐test). After intervention, IOP decreased by ?0.8 ± 2.1 mmHg (p = 0.017, paired t‐test) in the vitamin D group (n = 39) and ?0.8 ± 2.5 mmHg (p = 0.059) in the placebo group (n = 39), but the change was not significantly different between the groups (p = 0.92, independent t‐test). Conclusion: This study in healthy participants revealed no associations between serum 25(OH)D levels and IOP, and administration of vitamin D₃ to participants with low levels of 25(OH)D did not affect IOP. These results do not support a role of vitamin D in the regulation of IOP.     

Early vs late intraocular pressure following trabeculectomy with releasable suture in advanced glaucoma

We retrospectively studied long-term outcome after trabeculectomy with releasable suture in advanced glaucoma in 67 consecutive glaucomic eyes. Intraocular pressure (IOP) was recorded preoperatively and periodically following surgery for up to 2 years. Early (<1 month) postoperative IOP was a reasonable indicator of long-term IOP control in eyes with advanced glaucoma. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

Diode laser cyclophotocoagulation: longer term follow up of a standardized treatment protocol

Background : Diode laser cyclophotocoagulation (cyclodiode) is gaining acceptance as a therapy for refractory or end‐stage glaucoma. The aim of the study was to establish whether a reproducible dose–effect relationship exists following a single standardized cyclodiode treatment to lower intraocular pressure (IOP). Methods : This paper reports results from a longer‐term follow up of a trial involving the study of 30 patients with uncontrolled IOP and advanced glaucoma who were treated with a single episode of either a half or a full standardized dose of laser depending on clinical risk of phthisis and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. Results : A lowering of IOP at the final follow up was achieved in 83% of patients, with a mean follow‐up time of 21 months. For patients receiving a full standardized laser dose, preoperative IOP was 49.4 ± 11.2 mmHg (mean ± SD) and postoperative IOP was 28.5 ± 20.0 mmHg (42% reduction); 45% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction > 30%. For the half treatment cases, the preoperative IOP was 29.4 ± 4.3 mmHg (mean ± SD) and the postoperative IOP was 18.3 ± 10.0 mmHg (38% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Of 22 sighted eyes, nine (41%) recorded no change in vision; and nine (41%) lost and four (18%) gained vision. Hypotony was seen in 4/22 (18%) of full standardized laser dose cases. Conclusion : Longer follow‐up times confirm that diode laser cyclophotocoagulation is a convenient and useful therapy in the control of IOP in end‐stage glaucoma. Response of IOP to the laser therapy is highly variable, particularly in the neovascular glaucoma group, and it does not appear to be possible to predict an IOP outcome for an individual eye. Circumferential treatments in neovascular eyes should be avoided. Prospects for long‐term vision retention in end‐stage eyes are poor, perhaps due to progression of the underlying disease.     

Long-term results with argon laser trabeculoplasty

The long-term effectiveness of argon laser trabeculoplasty (ALT) is still questioned. In order to assess the long-term effect of ALT in our hands we reviewed the results of 102 patients who underwent ALT nine to 11 years ago. Thirty eyes of 22 patients were still available for follow-up at 9.5 years, having a fall in intraocular pressure (IOP) from 23 ± 7 mmHg (range, 15 to 44 mmHg) before treatment to 17 + 4 mmHg (10 to 30 mmHg) at 9.5 years. A mean field loss of 39%± 29% in 21 eyes with IOP controlled in a range of 15 mmHg or less progressed another 5%+ 4% additional loss. In eight eyes whose IOP could not be controlled below 20 mmHg a mean field loss of 10%± 24% sustained an additional 22%± 24% loss. Pressure control in the range of 16 to 20 mmHg gave intermediate results for progression of field loss. Argon laser trabeculoplasty with adjunctive medical therapy continues to lower IOP long term, but IOP control at 15 mmHg or less optimally slows field loss.     

Comparison of the Proview pressure phosphene tonometer performed by the patient and examiner with the Goldmann applanation tonometer

Objective: To compare the results of Proview pressure phosphene tonometry (PPPT) performed by the patient and an examiner with Goldmann applanation tonometry (GAT). Methods: A comparative case series of 96 (192 eyes) consecutive patients from a glaucoma clinic was conducted. Intraocular pressure (IOP) was measured with GAT by one examiner, PPPT by another examiner, and PPPT by the patient. All examiners were masked to the results from any preceding IOP measurement. Results: The coefficient of repeatability for repeated measurements for the GAT was ±0.48 mmHg. The limits of agreement for self‐measurement of IOP with the PPPT and examiner measured IOP with PPPT were 6.3 mmHg and 4.8 mmHg, respectively. The limits of agreement between GAT and self assessed PPPT were ±11.8 mmHg (mean difference of 0.63 mmHg). When the same comparison was made between GAT and examiner assessed PPPT, the results were limits of agreement of ±10 mmHg (mean difference of 2.86 mmHg). No significant difference was identified in the agreement of the GAT and the PPPT when subanalysed for age of patient or diagnosis (P > 0.05). The limits of agreement between self‐assessed IOP with the PPPT and the GAT were ±8.2 for those with IOP <20 mmHg and ±14.9 mmHg for those with IOP>20 mmHg. Conclusions: Poor agreement exists between IOP measured by GAT and PPPT measured by an examiner or by the patient.     

The acute effects of sildenafil on tear functions

The acute effects of 50 mg of sildenafil on tear functions were evaluated in 12 impotent patients. Mean tear breakup time, cotton thread, and Schirmer I tests were 19.42±6.45 s, 13.92±6.63 mm, and 16.58±12.19 mm, respectively before sildenafil and 20.33±10.40 s, 10.92±6.14 mm, and 18.08±12.36 mm, respectively, 1 hour after sildenafil. The results suggest that sildenafil does not adversely affect tear functions. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Intraocular pressure alterations after visual field testing

Purpose

To determine whether intraocular pressure (IOP) is significantly altered after visual field (VF) testing in eyes with open-angle glaucoma (OAG).

Methods

A prospective clinical trial of 106 OAG patients who had not had any previous surgical interventions. IOP was measured with a non-contact tonometer and refractive error with an auto refractometer. The measurements were made before and immediately after the VF test of the first eye (OD) and the second eye (OS).

Results

The baseline refractive error (spherical equivalent) was ?4.13 ± 3.61 diopters (D) OD and ?4.05 ± 3.63 D OS. The average VF testing time was 7.5 ± 1.4 min OU. The average baseline IOP was 12.8 ± 2.9 mmHg OD and 12.6 ± 2.8 mmHg OS. After the VF testing OD, the average IOP decreased significantly to 12.3 ± 2.6 mmHg (P = 0.001), but the IOP (12.5 ± 2.6 mmHg) OS was not significantly unchanged (P = 0.190). Following the VF testing OS, the IOP OD was 12.2 ± 2.6 mmHg (P = 0.252) and OS was 12.4 ± 2.7 mmHg (P = 0.487). An elevation of ≥2 mmHg in the IOP after the VF testing was found in 2.8 % of the right eyes and 0.9 % of the left eyes. The refractive error was not significantly changed after the VF testing. Multivariate analysis showed statistically significant correlations between the IOP decrease after the VF testing and the baseline IOP (P = 0.000) and the central corneal thickness (P = 0.034).

Conclusions

In the majority of eyes with OAG, VF testing did not lead to an increase in the IOP. The amount of IOP reduction after VF testing is significantly correlated with the baseline IOP and central corneal thickness.