Association of macular pigment optical density with risk factors for wet age-related macular degeneration in the Indian population

Purpose

To investigate macular pigment optical density (MPOD) in patients with and without wet age-related macular degeneration (AMD) and to elucidate the association between MPOD and the risk factors for AMD in an Indian population.

Methods

Thirty-three subjects with wet AMD and 29 controls above 50 years old underwent MPOD measurement with the ‘Macular Densitometer''. The subjects were also tested for their smoking history, lifetime ultraviolet (UV) exposure, dietary intake of carotenoids, and body mass index (BMI).

Results

Smokers had a higher risk for AMD than the non-smokers (P=0.032) and a lower MPOD level than non-smokers (mean (95% CI)) (0.16 (0.09–0.23) vs 0.28 (0.22–0.34), adjusted P=0.026). Subjects with lowest UV exposure had higher MPOD than those with the highest (0.46 (0.38–0.54) vs 0.17 (0.01–0.33), P=0.01). MPOD was significantly lower among those with the lowest quartile of dietary intake of carotenoids (0.14 (0.08–0.21) vs 0.25 (0.13–0.36), P=0.012). Smoking, obesity, and UV index showed an inverse association with the MPOD. Low MPOD, smoking, and UV exposure had 5.11 (1.73–15.08), 3.54 (1.08–11.57), and 5.24 (1.06–25.96) odds for AMD, respectively, whereas higher dietary intake of carotenoids showed a protective effect for AMD.

Conclusion

We found an inverse association between wet AMD and MPOD. Among the established risk factors of wet AMD, we found an inverse association of smoking, UV index, and obesity with MPOD, whereas a positive association was found between dietary intake of carotenoids and MPOD.     

Detection of progressive macular thickness loss using optical coherence tomography in glaucoma suspect and glaucomatous eyes

Aims

To examine the rate of macular thickness loss using time-domain optical coherence tomography (OCT) in functionally progressing versus non-progressing eyes, determined by standard automated perimetry (SAP).

Methods

Glaucoma suspects (GS) and glaucomatous (G) eyes underwent SAP and OCT imaging every 6 months. Functional progression was determined using pointwise linear regression, defined as 2 contiguous locations losing ≥1.0 dB/year at P<1.0% in the same hemifield. The annual rate of macular thickness loss was calculated from inner and outer regions of the macular map.

Results

72 eyes (43 GS and 29G) with ≥30 months of follow-up were enroled. Fourteen eyes demonstrated SAP progression. The annual rate of macular thickness loss (μm/year) in progressing eyes was faster (all P<0.05) than non-progressing eyes in temporal outer (−1.90±2.97 vs 0.33±2.77), nasal inner (−1.70±2.66 vs 0.14±2.76), superior inner (−2.15±4.57 vs 0.51±2.99), temporal inner quadrants (−2.58±5.05 vs −0.38±2.34), and the average of inner macular quadrants (−1.84±2.90 vs 0.03±2.10). The rate of loss in the nasal inner (P=0.02) and temporal outer (P=0.02) macular regions was associated with optic disc haemorrhage.

Conclusions

Eyes with SAP progression have significantly greater rates of macular thickness loss consistent with glaucomatous retinal ganglion cell atrophy, as compared with non-progressing eyes.     

Two-wavelength fundus autofluorescence and macular pigment optical density imaging in diabetic macular oedema

Purpose

To evaluate the application of 488 and 514 nm fundus autofluorescence (FAF) and macular pigment optical density (MPOD) imaging in diabetic macular oedema (DMO) and to demonstrate the typical imaging features.

Patients and Methods

A hundred and twenty-five eyes of 71 consecutive patients with diabetic retinopathy who underwent examination at a specialist university clinic employing a modified Heidelberg Retina Angiograph, using two different light sources of 488 and 514 nm wavelength, were retrospectively reviewed. MPOD images were calculated using modified Heidelberg Eye Explorer software. All images were evaluated by two independent masked graders. Features from FAF and MPOD images were correlated with optical coherence tomography (OCT) imaging findings and inter-grader variability, sensitivity and specificity were calculated using OCT as reference.

Results

Sixty-seven eyes had DMO on OCT. The inter-grader variability was 0.84 for 488 nm FAF, 0.63 for 514 nm FAF and 0.79 for MPOD imaging. Sensitivity and specificity for detection of DMO were 80.6 and 89.7% for 488 nm FAF; 55.2 and 94.8% for 514 nm FAF; and 80.6 and 91.4% for MPOD imaging. In 488 nm FAF and MPOD imaging, DMO was better visualised in comparison with 514 nm FAF imaging, P<0.01. MPOD revealed displacement of macular pigment by intraretinal cysts.

Conclusion

MPOD imaging, and particularly its combination with 488 nm and 514 nm FAF, provides a valuable addition to OCT in the evaluation of DMO and is clinically useful in rapid en-face assessment of the central macula.     

Comparison of trabeculectomy and Ex-PRESS implantation in fellow eyes of the same patient: a prospective, randomised study

Purpose

To compare intraocular pressure (IOP) over time after standard trabeculectomy vsEx-PRESS implantation in patients with bilateral primary open-angle glaucoma (POAG).

Design

Prospective, randomised study.

Patients and methods

This study included adult patients with bilateral POAG necessitating surgery. Each patient underwent trabeculectomy in one eye and Ex-PRESS implantation under a scleral flap in the other eye according to randomised contralateral allocations. Efficacy was assessed by IOP values and success rates (IOP threshold and/or need for topical glaucoma medication) during 30 months. Statistical analysis included Generalised Estimate Equation and Cox Survival models, and paired t-tests.

Results

Thirty eyes of 15 patients were studied for a mean of 23.6 months (SD, ±6.9). At the last follow-up visit, mean pre-operative IOP decreased from 31.1 (±14.2) to 16.2 (±1.5) mm Hg after trabeculectomy, and from 28.1 (±9.0) to 15.7 (±1.8) mm Hg after Ex-PRESS implantation (P=0.001). The mean number of anti-glaucoma medicines prescribed at the last follow-up decreased from 3.7 pre-operatively (both groups) to 0.9 after trabeculectomy vs0.3 after Ex-PRESS implantation (P=0.001). Complete success rates (5P=0.0024). Postoperative complications were more frequent after trabeculectomy (33%) compared with Ex-PRESS (20%), with four trabeculectomy eyes (27%) needing postoperative interventions, compared with none with Ex-PRESS.

Conclusions

Trabeculectomy and Ex-PRESS implantation provided similar IOP control, but the Ex-PRESS group had a lower rate of complications, fewer postoperative interventions, and needed less glaucoma medications.     

Three horizontal muscle surgery for large-angle infantile esotropia: validation of a table of amounts of surgery

Purpose

To validate a table of amounts of three horizontal muscle surgery in patients with large-angle infantile esotropia (≥60 prism dioptres, PD).

Methods

A prospective interventional case series reporting the postoperative alignment of 51 patients (27 male, 24 female) over a 15-year period was conducted. Surgery amounts were according to a published table developed on a previous patient cohort (n=49), using bilateral medial rectus recession with graded unilateral lateral rectus resection. Kaplan–Meier life-table survival curves were formulated for success to orthotropia (±10 PD) after one and subsequent horizontal muscle surgeries for up to 8 years follow-up.

Results

The median preoperative deviation was 65 PD (range 60–80 PD) and median age at surgery was 11.8 months (range 5.1 months–3.6 years). Surgical success to orthotropia (±10 PD) after one surgery was 100% at 2 months, 95.7% at 6 months, 91.3% at 12 months, 77.8% at 4 years, and 73.6% at 8 years. Postoperative failure requiring further horizontal surgery occurred in 17.6% (residual esotropia 4, consecutive exotropia 5).

Conclusions

Our second cohort has reproduced the success rate of the previous cohort (77.8% vs 77.1% at 4 years). If the published table of surgical amounts is used, three horizontal muscle surgery in large-angle infantile esotropia (≥60 PD) appears to have a good long-term success rate, and does not lead to the high rates of either residual esotropia or consecutive exotropia reported by others in the literature.     

Macular pigment optical density measurements: evaluation of a device using heterochromatic flicker photometry

Purpose

Accurate assessment of the amount of macular pigment (MPOD) is necessary to investigate the role of carotenoids and their assumed protective functions. High repeatability and reliability are important to monitor patients in studies investigating the influence of diet and supplements on MPOD. We evaluated the Macuscope (Macuvision Europe Ltd., Lapworth, Solihull, UK), a recently introduced device for measuring MPOD using the technique of heterochromatic flicker photometry (HFP). We determined agreement with another HFP device (QuantifEye; MPS 9000 series: Tinsley Precision Instruments Ltd., Croydon, Essex, UK) and a fundus reflectance method.

Methods

The right eyes of 23 healthy subjects (mean age 33.9±15.1 years) were measured. We determined agreement with QuantifEye and correlation with a fundus reflectance method. Repeatability of QuantifEye was assessed in 20 other healthy subjects (mean age 32.1±7.3 years). Repeatability was also compared with measurements by a fundus reflectance method in 10 subjects.

Results

We found low agreement between test and retest measurements with Macuscope. The average difference and the limits of agreement were −0.041±0.32. We found high agreement between test and retest measurements of QuantifEye (−0.02±0.18) and the fundus reflectance method (−0.04±0.18). MPOD data obtained by Macuscope and QuantifEye showed poor agreement: −0.017±0.44. For Macuscope and the fundus reflectance method, the correlation coefficient was r=0.05 (P=0.83). A significant correlation of r=0.87 (P<0.001) was found between QuantifEye and the fundus reflectance method.

Conclusions

Because repeatability of Macuscope measurements was low (ie, wide limits of agreement) and MPOD values correlated poorly with the fundus reflectance method, and agreed poorly with QuantifEye, the tested Macuscope protocol seems less suitable for studying MPOD.     

Phakic intraocular lenses outcomes and complications: Artisan vs Visian ICL

Purpose

To evaluate the safety and visual outcomes of two phakic intraocular lenses (IOLs) for correction of high myopia: Artisan and Visian ICL (ICL).

Patients and methods

In this retrospective study, a phakic IOL was implanted in 68 highly myopic eyes of 34 patients; 42 eyes received an Artisan IOL, and 26 eyes received ICL IOL.

Results

All patients completed a 1-year follow-up. The mean preoperative spherical equivalent (SEQ) was −12.89±3.78, and −12.44±4.15 diopters (D) for Artisan and ICL (P=0.078), respectively. The mean postoperative (1-year) uncorrected distance visual acuity was 0.39±0.13 and 0.41±0.15 logMAR for Artisan and ICL, respectively (P=0.268). The mean postoperative (1-year) corrected distance visual acuity was 0.36±0.12 and 0.31±0.12 logMAR for Artisan and ICL, respectively (P=0.128). The mean postoperative SEQ was −0.86±0.5 and −0.63±0.38 D for Artisan and ICL, respectively (P=0.67). Intraocular pressure change at 1 year was 0.64±2.7 and 1.88±0.6 mm Hg for Artisan and ICL, respectively (P=0.77).

Conclusion

Artisan and ICL showed equal and comparable safety, predictability, and efficacy.     

X-linked retinoschisis maculopathy treated with topical dorzolamide, and relationship to genotype

Purpose

To correlate the response of topical dorzolamide (Trusopt; Merck) in patients with X-linked retinoschisis (XLRS) with genotype.

Methods

We carried out a retrospective evaluation of four patients (seven eyes) with XLRS, treated with topical dorzolamide. The change in best-corrected visual acuity (VA) and central macular thickness (CMT; central 1 mm subfield thickness) from optical coherence tomography (OCT) was analysed over the follow-up period, using Student''s t-test. Each patient also had genetic analysis for mutations in the retinoschisisgene (RS1).

Results

The mean age at the start of treatment was 14.7±11 years, and mean follow-up duration was 21.7±7.7 months. Mean CMT at the final follow-up was significantly better than at baseline (291±123 vs352±119 μm, P=0.007); however, mean VA was worse (0.38±0.25 vs0.31±0.24 logMAR score, P=0.041). All four patients had a mutation in the RS1gene; there was no apparent association between the type of mutation and the response to topical dorzolamide.

Conclusion

Topical dorzolamide may have some effect in reducing central macular thickness in patients with XLRS, but this does not necessarily correlate with improvement in VA. In our case series, genotypic information did not predict the response to this treatment.     

Reconsidering the connection between vitamin D levels and age-related macular degeneration

Purpose

Recent evidence has suggested a correlation between reduced vitamin D levels and delayed angiogenesis and reduced inflammatory response, which are known to have a major role in the development and progression of age-related macular degeneration (AMD).

Design

Cross-sectional study.

Participants

Members of the Maccabi Healthcare Services (MHS, one of the four largest Israeli Health Maintenance Organization) aged ≥60 years, whose vitamin D levels were taken as part of routine examinations between 2000 and 2008.

Methods

All data for this study were obtained from MHS databases that include medical information on 1.8 million subscribers.

Main outcome measures

Serum 25-OH vitamin D levels.

Results

The total study population comprised of 1045 members diagnosed as having AMD, and 8124 as non-AMD, for whom there was information on vitamin D levels. The mean±SD level of 25-OH vitamin D was 24.1±9.41 ng/ml (range 0.8–120) for the AMD patients and 24.13±9.50 ng/ml (range 0.0–120) for the controls (P=ns). One-third (33.6%) of the AMD patients and 32.86% of the controls had a 25-OH vitamin D level <16 ng/ml, and the proportions of tests in which the 25-OH vitamin D level was >74 ng/ml were 0.19 and 0.14%, respectively (P=ns)

Conclusions

No association was detected between vitamin D levels and the presence of AMD in this cross-sectional study. These results raise some doubt about an association between reduced vitamin D levels and the prevalence of AMD.     

Correlation of leaking microaneurysms with retinal thickening in diabetic retinopathy

AIM: To investigate the contribution of fluorescein angiographic leaking microaneurysms (leak-MA) versus non-leaking microaneurysms (non-leak-MA) to retinal thickening in diabetic retinopathy. METHODS: A consecutive series of 38 eyes from 24 patients with diabetic retinopathy was included. Leak-MA and non-leak-MA in each eye were selected in pairs at corresponding topographic location. Leaking was defined by late phase fluorescein angiograms compared to early phase. Retinal thickness was measured with Heidelberg Spectralis OCT topographically aligned on early phase angiograms at the MA site and within a 1 mm circle. RESULTS: In all eyes, significant retinal thickening at the site of leaking compared to non-leaking microaneurysms was observed (356±69μm vs 318±56μm, P <0.001), showing a mean increase in thickness in the areas of leak-MA vs non-leak-MA of 38±39μm (95% confidence interval 25-51μm, P<0.001). All 1mm area measurements also showed significant (P<0.001) thickening of the leak-MA with average thickness of leak-MA vs non-leak-MA as 351±67μm vs 319±59μm; minimum thickness 311±62μm vs 284±60μm; maximum thickness 389±78μm vs 352±66μm; and retina volume 26.4±6.0mm vs 23.6±3.7mm3, respectively. CONCLUSION: Leaking of microaneurysms on fluorescein angiography appears to cause focal thickening of retina, which can be measured with high-resolution OCT. Therefore, targeting leaking microaneursyms in diabetic retinopathy has the potential to reduce retinal thickening.     

A new, pachymetry-based approach for diagnostic cutoffs for normal, suspect and keratoconic cornea

Purpose

To analyze whether an association exists between keratometric and pachymetric changes in the cornea, and whether it can be used to create pachymetric cutoff criteria secondary to keratometric criteria.

Methods

In this cross-sectional study, 1000 candidates presenting to the refractive surgery services of a tertiary care hospital underwent bilateral Orbscan IIz (Bausch and Lomb) assessment along with other ophthalmic evaluation.

Results

Stepwise regression analysis-based models showed that simulated keratometry (simK) astigmatism was significantly predicted by the minimum corneal thickness (MCT) and difference between central and MCT (δCT), mean SimK by the MCT and δCT, and maximum keratometry in the central 10-mm zone by the MCT and δCT (P<0.001). The mean MCT values were 542.5±39.6, 539.9±39.2, 524.2±49.5, and 449.3±73.7 μm for flatter normal (<44 D), steeper normal (≥44 D), keratoconus suspect and keratoconic eyes, respectively (P<0.001). The mean differences between central corneal thickness and MCT (δCT) were 12.2±7.1 μm, 12.4±7.4 μm, 14.4±8.9 μm and 23.2±10.1 μm for the flatter normal, steeper normal, keratoconus suspect, and keratoconic eyes, respectively (P<0.001). Mean and 2SD cutoff were used to suggest that a cornea having MCT<461 μm or δCT>27 μm has only a 2.5% chance of being normal and not a keratoconus suspect or worse.

Conclusion

Pachymetric diagnostic cutoffs can be used as adjuncts to the existing topographic criteria to screen keratoconus suspect and keratoconic eyes.     

Corneal hysteresis in patients with dry eye

Purpose

To measure corneal hysteresis and intraocular pressure (IOP) in patients with dry eye and to compare with normal subjects.

Methods

This cross-sectional study consists of 70 eyes of 40 patients with dry eye (group 1) and 75 eyes of 40 normal subjects (group 2). Eyes were diagnosed as dry eye or normal according to the clinical symptoms, biomicroscopical evaluation, and Schirmer test. Corneal hysteresis (CH), corneal resistance factor (CRF), and cornea-compensated intraocular pressure (IOPcc) were measured by the Ocular Response Analyser (ORA).

Results

Mean CH values were 10.56±0.25 mm Hg and 10.34±0.26 mm Hg, mean CRF values were 10.75±0.28 mm Hg and 10.70±0.28 mm Hg, mean CCT values were 542±3.20 μm and 543±3.89 μm in group 1 and group 2, respectively. There was no statistically significant difference between the groups for these three parameters. IOPcc values measured with ORA were 15.73±0.36 mm Hg in group 1 and 16.60±0.33 mm Hg in group 2, and there was no statistically significant difference between the two groups.

Conclusions

Corneal biomechanical parameters such as CH and CRF are not influenced in dry eye. Also statistical difference was not found between the two groups according to CCT and IOPcc values.     

Central 10-degree visual field change following trabeculectomy in advanced open-angle glaucoma

Purpose

To prospectively examine changes in the central visual field (VF) in patients with advanced open-angle glaucoma (OAG) with advanced late stage after trabeculectomy for 12 months.

Design

Prospective interventional case series.

Methods

In all, 27 eyes of 27 OAG patients at a single center with a best-corrected visual acuity (BCVA) of ≥40/200 and a mean total deviation of test locations of the 10-2 program of the Humphrey VF analyzer of ≤−20 dB preoperatively were enrolled. Intraocular pressure (IOP), VF parameters of the 10-2 program, and BCVA were examined for 12 months after trabeculectomy with mitomycin C. Slopes of VF parameters and their correlation with presumed risk factors were studied.

Results

IOP decreased from 19.7±5.8 to 9.7±2.6 mm Hg (P<0.001) over postoperative 1 year. The slopes of all VF parameters did not significantly differ from zero (P>0.33), and none of the presumed factors significantly correlated with the slopes of those parameters (P>0.14). There were two eyes (7%) and one eye (4%) with ≥2 lines of deterioration in BCVA (decimal fraction) at 1 and 12 months, respectively, after surgery with no apparent causes.

Conclusions

Trabeculectomy resulted in little change in the central 10-degree VF, but significant decrease in BCVA without apparent causes might occur approximately 5% of the cases.     

The biomechanical properties of the cornea in patients with systemic lupus erythematosus

Pupose:

The purpose of this study was to compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with systemic lupus erythematosis (SLE) and age-matched controls.

Patients and Methods:

In this prospective study, 30 healthy individuals (control group) and 30 patients with SLE (study group) underwent Reichert ocular response analyzer (ORA) measurements. In the right eye of each participant, the corneal hysteresis (CH), corneal resistance factor (CRF), and Goldman-related IOP (IOPg) were recorded using the ORA.

Results:

Mean CH, CRF, IOPg were significantly different between groups. Mean CH was 10.2±0.6 mm Hg in the study group and 11.3±1.3 in the control group (P=0.02); mean CRF was 9.7±1.1 mm Hg and 11.9±1.5 mm Hg, respectively (P=0.001). Mean IOP_g was 13.9±2.9 mm Hg in the study group and 16.9±2.6 mm Hg in the control group (P=0.001).

Conclusion:

The biomechanical properties of the cornea are altered in patients with SLE compared with normal controls. These findings should be taken into account when measuring IOP values in patients with SLE as IOP readings may be underestimated in SLE eyes.     

Effects of corneal thickness on the intraocular penetration of travoprost 0.004%

Purpose

To determine whether the intraocular penetration of travoprost 0.004% is affected by central corneal thickness.

Methods

Sixty-four patients who were scheduled for cataract surgery without any other ophthalmologic pathology of significance were enroled in this study. At 120 min before surgery, one drop of travoprost 0.004% was instilled in the eye to be operated on. At the start of surgery, a sample of aqueous humour was extracted to subsequently determine its AL-5848 concentration. These concentrations were compared among three groups of patients established according to central corneal thickness measurements obtained by ultrasound pachymetry.

Results

Mean AL-5848 concentrations were 3.27±2.03 ng/ml in Group I (CCT<511 microns), 3.27±2.44 ng/ml in Group II (CCT≥511 and ≤574 microns), and 2.73±2.15 ng/ml in Group III (CCT>574 microns), indicating no significant differences among the groups.

Conclusions

We were unable to demonstrate the greater or lesser penetration of travoprost depending on corneal thickness, which could explain differences in patient responses to this drug.     

Correlation of serum insulin like growth factor-I with retinopathy in Malaysian pregnant diabetics

AIM: To study the association of serum insulin-like growth factor-I (IGF-I) with diabetic retinopathy. METHODS: Serum IGF-1 levels were measured in 25 pregnant diabetic patients and 25 pregnant non-diabetic patients who were matched for age, ethnicity, parity and period of gestation. Fundus examination was performed in both groups at 28, 32 and 36 weeks of gestation. RESULTS: The serum IGF-I level was significantly elevated in pregnant diabetics compared to pregnant non-diabetics (366±199μg/L vs 184±89μg/L, (P=0.0001) at 24 weeks, 535±251μg/L vs 356±89μg/L, (P=0.007) at 32 weeks and 404±166μg/L vs 264±113μg/L, (P=0.003) at 36 weeks of gestation). The pregnant diabetics with established diabetes had significantly higher IGF-1 level than gestational diabetes at 28, 32 and 36 weeks of gestation. The serum IGF-I level in pregnant diabetics with retinopathy was significantly higher than that in those without retinopathy at all periods of gestation. CONCLUSION: Increased serum IGF-1 in pregnancy may increase the risks for retinopathy.     

The tendon width of lateral rectus muscle in predicting the effect of recession: is it just age-related artifact?

Purpose

The tendon width of the lateral rectus muscle is known to be a useful indicator for estimation of the effect of lateral rectus recession in intermittent exotropia. This study was conducted to investigate whether the tendon width of the lateral rectus would differ according to different age groups.

Patients and methods

We studied 133 patients ranging from 0 to 51 years of age who had undergone bilateral lateral rectus (BLR) recession for the basic type of intermittent exotropia. A total of 133 patients were divided into four groups; 16 patients who were younger than 2 years old (group 1), 20 patients who were 2–5 years old (group 2), 75 patients who were 5–13 years old (group 3), and 22 patients who were older than 13 years (group 4). Under general anesthesia and before dissection of the muscle tendon from the sclera, the tendon width of the lateral rectus of both eyes near insertion was measured with calipers.

Results

The tendon width of each group was as follows: in group 1, 7.84±0.35 mm in the right eye and 7.66±0.44 mm in the left eye; in group 2, 7.70±0.50 mm and 7.65±0.52; in group 3 8.11±0.36, 7.95±0.48. In group 4, measurements were 8.14±0.49 mm and 8.05±0.38 mm, respectively. The difference of tendon width in both eyes was statistically significant in all four groups (P<0.01) and the tendon widths of group 1 and 2 were narrower than that of group 3 and 4.

Conclusion

Measurement of tendon width of the lateral rectus muscle for prediction of the effect in intermittent exotropia should be applied in patients ≥5 years of age.     

Short-term changes in the optic nerve head and visual field after trabeculectomy

Aims or Purpose

To evaluate short-term changes in optic nerve head topography and visual field induced by surgical reduction of intraocular pressure.

Methods

A prospective study was performed on 56 eyes of 56 patients with uncontrolled primary open-angle glaucoma despite maximum medical therapy, which underwent trabeculectomy. Optic nerve head evaluations by means of Heidelberg Retina Tomograph, and visual field tests were performed pre-operatively, and at 3 and 6 months after surgery. Differences in intraocular pressure, visual field indices, and Heidelberg Retina Tomograph parameters were evaluated with the t-test for paired data. A linear regression model was calculated to analyze the relationship between intraocular pressure reduction and visual field changes, and optic nerve head changes.

Results

Mean intraocular pressure decreased from 24.4±5.0 mm Hg to 12.1±3.1 mm Hg (month 3, P<0.001), and 10.6±2.8 mm Hg (month 6, P<0.001) after trabeculectomy. Mean retinal nerve fiber layer thickness (baseline, 0.19±0.034; month 3, 0.24±0.039, P=0.05; month 6, 0.21±0.037, P=0.05) showed a statistical significant change compared with baseline values.

Conclusions

In this 6-months study, a significant increase in retinal nerve fiber layer thickness was detected after glaucoma filtration surgery.     

The UK National Cyclodiode Laser Survey

Purpose

To evaluate current practice of transscleral diode laser cyclophotocoagulation (cyclodiode) laser treatment among consultant ophthalmologists in the United Kingdom.

Methods

A 31-question survey was emailed to all practising consultant ophthalmologists who were members of the Royal College of Ophthalmologists. All non-responders were sent a postal version of the questionnaire. This paper looked at cyclodiode practice patterns and consisted of questions on demographic data, transillumination, and power settings, factors influencing practice, post-operative care, and repeat treatment.

Results

A total of 510 participants (53.6%) responded. A total of 180 (35.3%) responders reported performing cyclodiode laser treatment, of which 84 (46.7%) were glaucoma subspecialists (GSS). Initial median power settings used were 1500 mW and 2000 ms. The average number of applications delivered per sitting was 25.5±1.2 applications for GSS vs20.6±2.0 for non-GSS in a seeing eye (P=0.0013). In all, 65% routinely transilluminated the globe of which 78% were GSS and 52.3% were non-GSS (P=0.0009). In all, 43% of the GSS vs17% of the non-GSS lowered power settings in uveitic glaucoma (P=0.013). In blind eyes, 30% of the GSS vs12% of the non-GSS increased energy levels (P=0.0014). In all, 60% of the responders performed cyclodiode at any visual acuity, whereas 22% performed combined cyclodiode and cataract surgery.

Conclusions

This survey highlights a wide variation in the use of cyclodiode laser treatment amongst GSS and non-GSS. However, the most frequently used practice may not be the optimal practice. A more individualised parameter according to the condition of the eyes may optimise the outcome.     

Effects of body mass index on intraocular pressure and ocular pulse amplitude

AIM: To investigate the effects of body mass index (BMI) on intraocular pressure (IOP) and ocular pulse amplitude (OPA).METHODS: Totally 140 healthy individuals without any systemic diseases were included in the study. BMI (kg/m²) was calculated for every individual. IOP and OPA were measured with Pascal Dynamic contour tonometer (DCT). Blood pressure was also measured along with the DCT. The patients were divided into three groups according to BMI as: Group1, BMI<25; Group2, 25≤BMI<30; Group3, BMI≥30. Mean values of IOP, OPA, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were used in statistical analysis.RESULTS: In Group1, the means of IOP, OPA, were 16.8±2.3mmHg, 2.7±0.7mmHg respectively; and SBP, DBP were 120.0±6.1mmHg, and 77.4±5.6mmHg respectively. In group2, the mean IOP, OPA, SBP, and DBP were found to be 16.6±2.1mmHg, 2.4±0.7mmHg, 121.7±5.3mmHg, and 79.5±4.9mmHg respectively. In group3, the mean IOP, OPA, SBP, and DBP were found to be 17.3±1.7mmHg, 2.1±0.7mmHg, 122.4±5.7mmHg, and 79.7±5.2mmHg respectively. There were no statistically significant difference between groups in terms of IOP, SBP and DBP, while OPA values were significantly lower in group3 (P=0.001).CONCLUSION: Decreased OPA values in individuals with higher BMI may indicate that subjects with higher BMI have lower choroidal perfusion and lower ocular blood flow.