Ana Fernandez-Vidal

Comparison of rebound tonometer and goldmann handheld applanation tonometer in congenital glaucoma

PurposeTo compare intraocular pressure (IOP) measurements obtained using the rebound tonometer (RBT) and the handheld Goldmann applanation tonometer (Perkins) in children with congenital glaucoma. MethodsUsing both tonometers, the IOP was prospectively determined in 68 eyes of 68 patients with congenital glaucoma aged 3 to 13 years. Corneal curvature, central corneal thickness (CCT), and axial length were also measured in each patient. The ease of the use of each tonometer was scored using a visual analog scale. ResultsIOP readings obtained using the RBT and Perkins tonometer showed good correlation (r=0.869, P<0.001) although RBT readings were consistently higher (mean difference: 3.1 ±4.0 mm Hg). According to the Bland-Altman plot, the 95% limits of agreement between the 2 methods were −4.8 to 10.9 mm Hg (slope=0.589, P<0.001). When estimating CCT, the 2 tonometers behaved similarly and correlation was observed between IOP measurements and CCT, with higher IOPs obtained as the CCT increased. In contrast, no correlation was detected between corneal curvature or axial length and the IOPs recorded using either tonometer. Ease of use scores awarded by the examiner was higher for the RBT. ConclusionsThe RBT overestimates the IOP compared with the Perkins tonometer in patients with congenital glaucoma. Differences in readings between the 2 tonometers become larger as the CCT increases.

Circadian IOP-lowering efficacy of travoprost 0.004% ophthalmic solution compared to latanoprost 0.005%

ABSTRACT Purpose: The primary objective of this study was to determine the intraocular pressure- (IOP) lowering efficacy over two consecutive 24-h periods of travoprost 0.004% ophthalmic solution (Travatan†) compared to latanoprost 0.005% (Xalatan†) dosed once daily in patients with primary open-angle glaucoma or ocular hypertension. † Travatan is a registered trademark of Alcon Laboratories Inc., Fort Worth, TX, USA ‡ Xalatan is a registered trademark of Pfizer Inc., New York, NY, USA Methods: This was a double-masked trial conducted at the Hospital Clínico San Carlos, Madrid, Spain. The primary objective of this study was to determine the IOP lowering efficacy of travoprost and latanoprost. During the eligibility visit, patients’ IOP was measured throughout two consecutive 24‐h periods every 4 h. Patients were then randomized to travoprost or latanoprost (one drop at 8 p.m. daily for 2 weeks). Sixty-two patients were randomized (travoprost n = 32; latanoprost n = 30). IOP was measured at week 2 every 4 h throughout two 24‐h periods. All measurements were taken in both supine and sitting positions with the aid of Perkins applanation tonometry. Limitations of the study include a small sample size (due to the difficulty in recruiting patients in a study of this type) which enrolled only Caucasian patients and a short study duration. However, with 25 subjects per group, there was at least 90% power to detect a mean IOP change from baseline of 2.9 mmHg and 80% power to detect a difference of 2.5 mmHg between treatments. Results: Patients on travoprost therapy showed lower mean IOP levels than those on latanoprost. This difference was statistically significant ( p < 0.05) at 12, 16, 20, 24, 36, 40, and 48 h after the last dose for the supine position. The mean IOPs in the supine position throughout the first and the second 24‐h period of the week 2 visit as well as for the 48‐h visit were statistically lower ( p < 0.05) for the travoprost group. Adverse events were mild and included hyperemia and corneal staining. Travoprost and latanoprost were both well tolerated. Conclusion: Mean IOP values were significantly lower for patients on travoprost for the majority of time points in the supine position.

Concomitant administration of travoprost and brinzolamide versus fixed latanoprost/timolol combined therapy: three-month comparison of efficacy and safety

SUMMARY Purpose: To compare the efficacy and safety of the concomitant administration of travoprost 0.004% once daily and brinzolamide 0.1% twice daily with those of a fixed combination of latanoprost 0.005%/timolol 0.5% once daily. Research, design and methods: Forty-four patients with primary open-angle glaucoma or ocular hypertension with elevated IOP insufficiently responsive to monotherapy were randomly assigned to one of the two treatment groups: concomitant administration of travoprost 0.004% once daily and brinzolamide 0.1% twice daily (TB group: 22 patients) or latanoprost 0.005% plus timolol 0.5% once daily (LT group: 22 patients). Visits were undertaken at screening (current ocular hypotensive therapy was discontinued), baseline (randomization), and after 2 weeks, 1 month, 2 months and 3 months of therapy. Main outcome measures: IOP was determined at 9 a.m., 12 p.m. and 4 p.m. at each study visit, and diurnal IOP was calculated as the mean of these recordings. Adverse events were recorded at each visit. Results: IOP at the baseline visit was similar in both groups. Overall mean IOP was significantly lower in the TB as compared to the LT group after 1 month, 2 month and 3 month follow-up; only 9 a.m. measurements were significantly different, reaching a maximum difference (16.9 ± 0.9 mmHg vs 18.4 ± 1.8 mmHg, p < 0.001) at the 3 month check. The percentage of responders (IOP decrease ≥ 30%) was higher in the TB group. Both treatments were well tolerated and there were no cases of withdrawal from treatment. Conclusions: Travoprost 0.004% and brinzolamide 0.1% concomitant therapy showed a greater efficacy than the fixed latanoprost 0.005%/timolol 0.5% combination in terms of absolute IOP decreases. Travoprost/brinzolamide therapy also offered the advantages of a greater percentage of responders.

Comparison of ocular hypotensive actions of fixed combinations of brimonidine/timolol and dorzolamide/timolol

Abstract Objective: To compare brimonidine/timolol fixed combination (BrTFC; Combigan with dorzolamide/timolol fixed combination (DTFC; Cosopt in terms of ability to lower intraocular pressure (IOP) in primary open-angle glaucoma (POAG). Methods: This was a prospective, randomized, double-masked, crossover study. After 6 weeks of therapy with timolol maleate 0.5% twice daily, patients were randomized to BrTFC twice daily or DTFC twice daily for 6 weeks, before being crossed over to the other treatment arm for a further 6 weeks. At all follow-up visits, IOP was measured at 09.00 (pre-instillation) 12.00 and 16.00. The primary outcome measure was change in mean diurnal IOP from baseline at 6 weeks. The secondary outcome was percentage of patients with IOP <18 mmHg at 6 weeks. Data were analyzed from all patients who completed the study. Results: Twenty-five patients were randomized and 20 completed the study. Mean diurnal IOP (mean ± standard deviation [SD]) was 20.28 ± 2.03 mmHg at timolol-treated baseline. After 6 weeks, mean diurnal IOP was 16.28 ± 2.07 mmHg following BrTFC and 17.23 ± 2.29 mmHg following DTFC (difference: 0.95 mmHg, 95% CI 0.10–1.80, p = 0.03). Mean IOP at 09.00 was 20.95 ± 2.31 mmHg at baseline. This was reduced to 15.85 ± 2.56 mmHg following BrTFC and 17.55 ± 2.67 mmHg following DTFC (difference: 1.70, 95% CI 0.80–2.60, p = 0.001). For the 12.00 and 16.00 timepoints, the mean changes from baseline in the two arms were comparable. Percentages of patients achieving a target IOP of <18 mmHg were 85% following BrTFC and 60% following DTFC (p = NS [not significant]). No treatment-related adverse events were reported with either therapy. Key limitations include the small size of the study population and the 6-week duration of treatment periods, which prevents drawing conclusions regarding long-term therapy. Conclusion: Reductions from baseline in mean diurnal IOP and morning IOP were greater with BrTFC than with DTFC.

Topical intraocular pressure therapy effects on pregnancy

Purpose To assess the course of intraocular pressure (IOP), visual field progression, and adverse effects of antiglaucoma medication used during pregnancy. Methods Thirteen eyes of eight patients with glaucoma were examined. Their clinical records were reviewed to compare IOP, number of medications, and visual field indices (VFI) before, during, and after pregnancy using a two-tailed paired t-test. Results In seven (87.5%) of the eight patients, no disease progression was observed. IOP (mmHg) remained stable (baseline 17.3 ± 3.6; first trimester 17.4 ± 5.2, P = 0.930; second trimester 18.1 ± 4.7, P = 0.519; third trimester 20.2 ± 8.7, P = 0.344; and postpartum 21.5 ± 7.6, P = 0.136). The mean number of glaucoma treatments fell from 1.7 ± 0.52 before pregnancy to 0.83 ± 0.75 (P = 0.04) in the second and third trimesters. In one patient, IOP increased during pregnancy and there was further visual field loss. In the only patient kept on fixed combination timolol–dorzolamide therapy throughout pregnancy, labor was induced because of delayed intrauterine growth. Conclusions No changes in IOP and VFI were detected in most patients despite a reduction in the number of hypotensive agents required. Delayed intrauterine growth in one patient under fixed combination timolol–dorzolamide treatment was observed whereas no other adverse effects were detected.

Ocular inflammatory signs observed in a cohort of Spanish patients with Behcet disease and ocular inflammation

Purpose To study the clinical characteristics of a cohort of Spanish patients diagnosed with Behçet disease and who also presented ocular inflammation. Methods Thirty cases of Behçet disease were studied retrospectively. The authors studied age distribution, distribution by sex, clinical course, laterality, type of uveitis, secondary glaucoma, corneal involvement, hypopyon, iris-lens synechiae, secondary cataract, cystoid macular edema (CME), and papillitis (optic neuritis). Results Fourteen of the patients were men and 16 were women (ratio 0.875:1). The mean age of the patients was 35.24 years (±10.917; 21–61 years). In 23 patients, the disease course was recurrent. In 9 patients, the disease manifested unilaterally. In 5 patients showing unilateral onset, the contralateral eye became affected. In 2 of the 30 patients, uveitis exclusively affected the anterior segment. In 8 patients, uveitis was solely posterior. There was one case of intermediate uveitis. The remaining 19 patients showed panuveitis. Three had focal chorioretinitis. One had diffuse chorioretinitis. Fifteen showed signs of diffuse vasculitis. Eight patients showed focal vasculitis. Conclusions Women were slightly more affected than men, although the authors found no significant correlation between sex and the clinical variables examined. Apart from one unexpected case of intermediate uveitis, the observations are similar to those reported for other patient series.

Comparing Corneal Variables in Healthy Subjects and Patients with Primary Open-Angle Glaucoma

PURPOSE This study was designed to identify possible differences between healthy subjects and patients with primary open-angle glaucoma (POAG) in keratometry, central corneal thickness, overall corneal thickness, mean thickness of a circular zone centered at the corneal apex of 1-mm radius (zone I), and mean thickness of several concentric rings also centered at the apex of 1-mm width (zones II to VI, respectively). METHODS These variables were recorded in 126 healthy subjects and 130 patients with POAG. Corneal thicknesses and the power of the flattest and steepest axes were compared between the two populations using a t-test and the position of the flattest axis using a Mann-Whitney U test. A binary logistic regression procedure was used to determine the diagnostic capacity of the corneal variables using the area under the receiver operator characteristic curve (AUC) to select the best regression equation. RESULTS Significant differences between subjects and patients were detected in mean corneal thickness and in mean thicknesses of zones I to VI. The logistic regression model included as predictors the mean corneal thickness and the mean thicknesses of zones IV and VI; for this model, the AUC was 0.711, sensitivity was 67.7%, and specificity was 65.5%. CONCLUSIONS Healthy subjects and glaucoma patients differ significantly in terms of mean overall corneal thickness and thicknesses of the corneal zones I to VI defined here. The variables mean corneal thickness and mean thicknesses of zones IV and VI are able to discriminate between subjects with or without glaucoma.

Herpetic optic neuritis associated with herpetic keratitis.

PURPOSE To report a case of herpetic optic neuritis associated with herpetic keratitis. METHODS A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium. RESULTS Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved. CONCLUSIONS The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites.

Concordancia entre la tonometría de aplanación de Goldmann y la tonometría de contorno dinámico: efectos de la morfometría corneal

OBJECTIVES To compare intraocular pressure (IOP) measurements made by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). METHODS IOPs were measured by GAT and DCT in 63 eyes of 63 healthy subjects. A comparison was made by intraclass correlation coefficient. Passing-Bablok plot was constructed to establish the existence of systematic and/or proportional biases. Multivariate regression analysis was used to examine whether the measurements of both instruments were affected by the power of the steepest and flattest corneal axes, their orientation, age or central corneal thickness (CCT). RESULTS The intra-class correlations (ICCs) were 0.57 (95% confidence interval (95% CI): 0.29-0.74). Mean differences were 1.68 (DCT minus GAT) (95% CI: 0.92-2.44). Passing-Bablok analysis (X=DCT, Y=GAT) revealed a systematic bias (A=-14.35, 95% CI: -24.51-[-9.14]) and a proportional bias (B=1.74, 95% CI: 1.43-2.26). Multivariate regression analysis revealed that the DCT was independent of the corneal characteristics analysed while GAT was biased by CCT (B=0.042, 95% CI: 0.002-0.082). CONCLUSIONS While GAT was biased by corneal CCT; DCT readings were independent of corneal morphometry.

Agreement between slit lamp examination and optical coherence tomography in estimating cup-disc ratios.

Purpose To compare optical coherence tomography (OCT) cup-disc ratio measurements with those estimated by two independent examiners using the slit lamp in an evaluation of the optic nerve head (ONH). Methods In 47 eyes each of 47 patients with glaucoma and 47 healthy subjects, the ONH was examined using the slit lamp with a 78 D lens. Two examiners subjectively determined the cup-disc area ratio (A-CDR), the horizontal cup-disc ratio (H-CDR), and the vertical cup-disc ratio (V-CDR). These measurements were compared to objective OCT readings obtained by a third examiner blind to the slit lamp results. Results For the three variables determined, correlation indices between the OCT readings and the two sets of slit lamp measurements were significantly higher for the glaucoma group than the control group. In the patients with glaucoma, the OCT tended to underestimate A-CDR and overestimate H-CDR. For both these variables, Bland-Altmann analysis revealed significant differences between the two methods that persisted across the whole range of CDRs examined. In contrast, differences in V-CDR varied with disc size. Conclusions The OCT is a diagnostic tool that provides a complete automatic evaluation of the ONH. However, its measurements vary significantly from those obtained in subjective evaluations performed by experienced ophthalmologists.