J. García-Feijoo

Fluorophotometric Study of the Effect of the Glaukos Trabecular Microbypass Stent on Aqueous Humor Dynamics

PURPOSE. To evaluate the changes in aqueous humor dynamics and the efficacy and safety of the iStent (Glaukos Corp., Laguna Hills, CA), in combination with cataract surgery. METHODS. This investigation was a prospective, randomized, clinical study in patients with open-angle glaucoma or ocular hypertension who were undergoing cataract surgery. Aqueous flow (F) and trabecular outflow facility (C(T)) were measured by fluorophotometry before surgery and at months 1, 6, and 12 in both groups. RESULTS. Thirty-three eyes of 33 patients were randomized to either two stents and cataract surgery (n = 17, group 1) or cataract surgery alone (n = 16, group 2). Before surgery, F and C(T) were similar in groups 1 and 2 (1.78 +/- 0.44 and 1.74 +/- 0.82 microL/min, P = 0.18; 0.12 +/- 0.03 and 0.13 +/- 0.06 microL/min/mm Hg, P = 0.71, respectively). After surgery, there were no changes of note in F, however, C(T) increased in both groups. At 1 year, C(T) was 0.45 +/- 0.27 microL/min/mm Hg in group 1 and 0.19 +/- 0.05 microL/min/mm Hg in group 2 (P = 0.02), which represented increases of 275% and 46%, respectively. Mean IOP reduction was also greater in group 1 than in group 2 (6.6 +/- 3.0 mm Hg vs. 3.9 +/- 2.7 mm Hg; P = 0.002). The mean number of medications was significantly lower in group 1 than in group 2 (0.0 vs. 0.7 +/- 1.0, respectively; P = 0.007). CONCLUSIONS. Compared with cataract surgery alone, implantation of the iStent concomitant with cataract extraction significantly increased trabecular outflow facility, reduced IOP, and reduced the number of medications at 1 year. Longer follow-up is needed to assess the long-term effect on outflow facility. (ClinicalTrials.gov number, NCT00326066.).

Effect of pharmacologic pupil dilation on OLCR optical biometry measurements for IOL predictions.

Purpose To determine the possible influence of pupil dilation on intraocular lens (IOL) power predictions made using optical biometry with Lenstar LS 900® (Haag-Streit AG, Koeniz, Switzerland). Methods A total of 72 eyes of 72 patients scheduled to undergo cataract surgery were prospectively examined using the optical low-coherence reflectometry (OLCR) optical biometer before and after pupil dilation with tropicamide 1%. The measurements made were axial length, central corneal thickness, anterior chamber depth (ACD), lens thickness, mean keratometry, corneal diameter (CD), and pupil diameter. Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between the 2 measurement modes (with and without dilation) was assessed by calculating intraclass correlation coefficients (ICC) and constructing Bland-Altman plots. Results The mean age of the patients was 74.71 ± 7.53 years (range 56–90). Among the variables determined, only ACD varied significantly according to pupil dilation (p<0.001). The ICC data revealed excellent intraobserver correlation between measurements made with and without dilation, except for CD. The IOL power predictions were unmodified. Conclusions The use of pupil dilation does not seem to influence measurements and IOL predictions made using this OLCR optical biometer.

Immunosuppressive Drug Discontinuation in Noninfectious Uveitis From Real-Life Clinical Practice: A Survival Analysis

PURPOSEnTo assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs.nnnDESIGNnLongitudinal retrospective cohort study.nnnMETHODSnWe included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models.nnnRESULTSnWe analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs.nnnCONCLUSIONSnClinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs.

Concordancia entre la tonometría de Goldmann, Icare Pro y Corvis ST

PURPOSEnTo compare intraocular pressure (IOP) between the new non-contact tonometer Corvis ST (CST), the Goldmann applanation tonometry (GAT) and Icare Pro rebound tonometer (PRO).nnnMETHODSnA total of 178 eyes of 178 healthy subjects were selected for the study. Measurements of IOP were made in a random order with GAT, PRO and CST. Central corneal thickness (CCT) was determined by ultrasound pachymetry. The mean of three valid measurements of each variable was used in the statistical analysis. The relationship between the tonometers was established using Bland-Altman plots.nnnRESULTSnMean IOP was 15.5 ± 2.8 mmHg for GAT, 15.4 ± 2.8 mmHg for CST, and 14.6 ± 2.3 mmHg for PRO. The mean differences between pairs of tonometers were: GAT-PRO=0.9 ± 1.7 mmHg (P<.001), GAT-CST: 0.1 ± 2.2 (P=.398), and PRO-CST: -0.8 ±-0.7 mmHg, p<0.001. A positive relationship was detected between CCT and the three tonometers: GAT: r=0.325, P<.001; PRO: r = 0.385, P<.001, and CST: r = 0.428; P<.001.nnnCONCLUSIONSnThe differences found between PRO and GAT were significantly higher than those found between CST and GAT, which showed non-significant differences. The measurements of the three tonometers were affected by the CCT.

Influence of baseline demographic and clinical characteristics in the visual outcome of intermediate uveitis: a survival analysis

Background/aims To describe in patients diagnosed with intermediate uveitis (IU) the incidence rate (IR) of visual loss and newly diagnosed clinical complications during follow-up. Also, to analyse the influence of baseline complications on visual loss. Methods Longitudinal retrospective cohort study which included 97 affected eyes of 67 consecutive patients diagnosed with IU according to the Standardization of Uveitis Nomenclature group, first seen in our clinic between 1986 and 2014, and until loss to follow-up, or 1 January 2015. Kaplan–Meier curves were set to account for temporary and permanent visual loss and development of clinical complications during follow-up. Coxs bivariate and multivariate regression models were constructed to examine the risk factors for visual loss. Results IRs (in events per 100 eyes-year) for the development of cystic macular oedema (CMO), epiretinal membrane (ERM) and cataracts were 5.9 (3.70–9.4), 1.2 (0.50–2.6) and 6.6 (4.4–10.1), respectively. IRs per 100 eyes-year of temporary moderate and severe visual loss episodes were 43.8 (37.3–51.4) and 6.4 (4.5–9.0), respectively. IR of permanent moderate visual loss was 5.3 (3.3–8.3). After 2u2005years of follow-up, 21% of eyes had developed a permanent moderate visual loss. Presence at baseline of lower visual acuity was associated with higher IR of temporary visual loss episodes, and CMO was associated with higher IR of temporary moderate visual loss. Conclusions IU seems to have a favourable long-term prognosis. Permanent visual loss occurs during the first year of the disease. Baseline characteristics could identify patients with a higher risk of poor visual prognosis.

Chronic Angle-closure Glaucoma Related to Paroxetine Treatment

Abstract Purpose: To present a unique case of a 33-year-old woman using paroxetine who presented with acute unilateral visual loss due to chronic angle-closure glaucoma. Methods: Case report. Results: A 33-year-old women who had been under paroxetine treatment for the past four months presented at the emergency room due to a sudden loss of visual acuity (VA) in the left eye (LE). Narrow anterior chamber was detected. Intraocular pressure (IOP) was 29u2009mmHg right eye (RE) and 42u2009mm Hg LE. A fundus exam revealed a cup-to-disc ratio of 0.9–1 for the LE and of 0.1–0.2 for the RE. Paroxetine treatment was suspended, and after 48u2009h IOP was 10u2009mm Hg in both eyes (BE). ND-YAG laser iridotomy was performed in BE. In the subsequent visit, IOP was 25u2009mm Hg in the RE and 41u2009mm Hg in the LE; on her own initiative the patient had resumed paroxetine treatment. After requesting the patient again to stop taking the anti-depressant, IOP was 10u2009mm Hg in BE in the next exam 48u2009h later. Conclusions: As far as we are aware, there are no other reports of chronic angle-closure glaucoma related to the use of paroxetine. We thus consider that, before initiating treatment with this drug, patients should be informed of its potential ocular risks and they should be subjected to an ophthalmologic examination before its use is authorized.

Estudio de la influencia del dispositivo de ayuda a la dosificación Travalert® sobre el cumplimiento del tratamiento médico y calidad de vida de los pacientes con glaucoma

PURPOSEnTo study compliance in the medical treatment of glaucoma, its possible association with other factors, and quality of life of patients with glaucoma.nnnMATERIAL AND METHODSnLongitudinal prospective study of 60 patients with ocular hypertension or glaucoma who were treated with travoprost, or with a fixed combination of travoprost/timolol nightly. All subjects were given a Travalert(®) dosing aid and were reviewed after one and four months. Strict and relative compliance data were collected on each visit. The relationship between compliance and other variables was studied using univariate analysis. To analyse quality of life, patients were given self-assessment STAI anxiety questionnaires after the first and last visits.nnnRESULTSnRelative compliance for the four months was significantly greater than the strict compliance (P=.001). In the group of least compliance the number of patients on treatment with combination therapy was significantly higher than those on monotherapy. In the lost cases, the number of men was significantly higher than women. No association was found in the other variables. The anxiety was similar to that in the normal population.nnnCONCLUSIONSnCompliance is very important in the treatment of glaucoma, and our study provides objective data through the use of Travalert dosing aid with relative compliances of 70%. Patients with combined therapies have lower compliance than those on monotherapy.

Vision-related Quality of Life in Patients with Non-infectious Uveitis: A Cross-sectional Study

ABSTRACT Purpose: To analyze the influence of socio-demographic, comorbidity, and clinical-related variables in the vision-related quality of life (VR-QoL) of non-infectious uveitis patients. Methods: Cross-sectional study includes 156 consecutive non-infectious uveitis patients from a tertiary uveitis clinic from Madrid (Spain). The main outcome was the log-transformed composite score of the Visual Functioning Questionnaire 25. Bivariate and multivariate ordinary least-squares regression models were performed and results expressed using effect sizes with 95% confidence intervals (95% CI). Results: In the multivariate analysis, one unit increase in the logarithm of the minimum angle of resolution scale [i.e., worse best corrected visual acuity (BCVA)] was associated with a seven times worse VR-QoL (a 0.14-fold change [95% CI: 0.07–0.27]). Patients with ocular comorbidities had a 64% worse VR-QoL (a 0.61-fold change [95% CI: 0.49–0.77]). Conclusions: Lower BCVA and the presence of ocular comorbidities had a significant, independent, and deleterious effect in the VR-QoL of non-infectious uveitis patients.

Assessment of ocular redness measurements obtained with keratograph 5M and correlation with subjective grading scales

OBJECTIVEnTo examine correlations between ocular redness scores provided by the Keratograph 5M and those determined using two image-based grading scales.nnnMETHODSnObservational prospective cross-sectional study. Two hundred and twenty six eyes of two hundred and twenty six participants (175 patients using anti-glaucoma eye drops and 51 subjects untreated). All subjects were scored automatically using the keratograph 5M. These redness scores (RS) were then correlated with the gradings provided by the Efron and McMonnies/Chapman-Davies scale (MC-D) scales (two observers).nnnRESULTSnExcellent reproducibility was observed for both the Efron (weighted K=0.897, 95% CI 0.823-0.904) and MC-D (weighted K=0.783, 95% CI 0.752-0.795) scales. Keratograph RS and the scores obtained with both Efron (Spearmans Rho=0.43, P<0.001) and MC-D (Spearmans Rho=0.48, P<0.001) scales were significantly correlated. RS for the bulbar and limbal - nasal and temporal quadrants also correlated moderately with the two subjective scales. Through Bland Altman analysis, poor agreement was detected between the objective and subjective methods: agreement values for the Efron scale or MC-D scale (matching scorers between observers) versus overall RS showed high biases (-15.58 and -22.05 respectively) and wide limits of agreement (LOA) (-46.169 to 15.005 and -52.534 to 8.19 respectively). Lowest bias was observed between temporal limbal RS and Observer 2 Efron score (-0.04).nnnCONCLUSIONSnAlthough it emerged as a reliable objective method, the keratograph 5M overestimated the scores compared with the subjective grading scales when used to grade the degree of ocular redness. Therefore, they should not be interchangeable methods.

Primary congenital glaucoma including next-generation sequencing-based approaches: clinical utility gene card

1. Name of the disease (synonyms)Primary congenital glaucoma (PCG).Glaucoma, congenital (GLC).2. OMIM# of the disease231300- GLC3A.600975- GLC3B.613085- GLC3C.613086- GLC3D.617272- GLC3E.3. Name of the analysed genes or DNA/chromosome segmentsCYP1B1.LTBP2.MYOC.FOXC1.TEK.4. OMIM# of the gene(s)CYP1B1 MIM# 601771.LTBP2 MIM# 602091.MYOC MIM# 601652.FOXC1 MIM# 601090.TEK MIM# 600221.n Review of the analytical and clinical validity, as well as of the clinical utility of DNA-based testing for variants in theCYP1B1, LTBP2andMYOCgene(s) in⊠ diagnostic,⊠ predictive and⊠ prenatal settings and for⊠ risk assessment in relatives.