Patrycja Krzyżanowska-Berkowska

Long-Term Outcomes of Prostaglandin Analog Versus Timolol Maleate in Ocular Hypertensive or Primary Open-Angle Glaucoma Patients in Europe

PURPOSE To determine the direct costs of therapy over 5 years of a European monotherapy cohort begun on a prostaglandin (PTG) versus timolol in patients with primary open-angle glaucoma or ocular hypertension. METHODS A retrospective, multicenter, active-controlled, observational study. Data were abstracted for European patients treated as initial monotherapy in 1996 or afterward, with 5 years of available records. RESULTS This study included 271 patients (166 on a PTG and 105 on timolol at baseline). The average cost/month/patient over 5 years was

Glaucomatous and Age-Related Changes in Corneal Pulsation Shape. The Ocular Dicrotism

45.47±12.61 for PTG and

Clinical utility of spectral analysis of intraocular pressure pulse wave.

31.50±15.47 for timolol (P<0.001, based on German prices). After 5 years, although there was no difference in number of glaucoma medicines prescribed between groups (1.0 PTGs and 1.1 timolol, P=0.41), the timolol group demonstrated a higher intraocular pressure (17.7±2.9 vs. 16.5±3.0 mm Hg, P<0.001), more medication changes (P=0.01), greater incidence of glaucomatous progression (P=0.04), and less patients persistent on original monotherapy (P<0.001) than the PTG cohort. CONCLUSIONS Patients originally on timolol monotherapy have a lower cost of care over 5 years than those started on a PTG. However, timolol patients during follow-up may demonstrate a higher intraocular pressure, more progression, more medication changes, and lower persistency of the original monotherapy.

Application of optical coherence tomography in glaucoma suspect eyes.

Purpose To ascertain whether the incidence of ocular dicrotic pulse (ODP) increases with age, it is more pronounced in glaucomatous than in normal eyes and whether it is related to cardiovascular activity. Methods 261 subjects aged 47 to 78 years were included in the study and classified into four groups: primary open angle glaucoma (POAG), primary angle-closure glaucoma (PACG), glaucoma suspects with glaucomatous optic disc appearance (GODA) and the controls (CG). Additionally, in each group, subjects with ODP were divided into two age subgroups around the median age. A non-contact ultrasonic method was used to measure corneal indentation pulse (CIP) synchronically with the acquisition of electrocardiography (ECG) and blood pulse signals. ODP was assessed from the acquired signals that were numerically processed in a custom written program. Results ODP incidence was about 78%, 66%, 66% and 84% for CG, GODA, POAG, and PACG group, respectively. With advancing age, the ODP incidence increased for all subjects (Δ = 12%), the highest being for the PACG and POAG groups (Δ = 30%). GODA group did not show an age-related increase in the incidence of ODP. Conclusions The ocular dicrotism, measured with non-contact ultrasonic method, was found to be a common phenomenon in elderly subjects. The increased ODP incidence in PACG and POAG group may correspond to either higher stiffness of glaucoma eyes, biochemical abnormalities in eye tissues, changes in ocular hemodynamics, may reflect the effect of medications or be a combination of all those factors. The results of GODA group suggest different mechanisms governing their ocular pulse that makes them less susceptible to generating ODP and having decreased predisposition to glaucoma.

Age-Related Changes in Ocular Blood Velocity in Suspects with Glaucomatous Optic Disc Appearance. Comparison with Healthy Subjects and Glaucoma Patients.

BackgroundTo evaluate the clinical utility of spectral analysis of intraocular pressure pulse wave in healthy eyes of a control group (CG), patients having glaucomatous optic disc appearance or ocular hypertension, and patients with primary open angle glaucoma or primary angle closure glaucoma.MethodsThis is a prospective study that enrolled 296 patients from a single glaucoma clinic. Age matched CG consisted of 62 individuals. Subjects underwent comprehensive clinical diagnostic procedures including intraocular pressure (IOP) measurement with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT). DCT time series were analyzed with custom written software that included signal preprocessing, filtering and spectral analysis. An amplitude and energy content analysis, which takes into account non-stationarity of signals but also provides methodology that is independent of IOP and ocular pulse amplitude (OPA) levels, was applied. Spectral content up to the 6th harmonic of the pressure pulse wave was considered. Statistical analyses included descriptive statistics, normality test, and a multicomparison of medians for independent groups using Kruskal-Wallis test.ResultsGAT IOP showed statistical significance (Kruskal-Willis test p < 0.05) for three out of 10 considered multiple comparisons, DCT IOP and OPA showed statistically significant results in five and seven cases, respectively. Changes in heart rate and central corneal thickness between the groups were statistically significant in two cases. None of the above parameters showed statistically significant differences between CG and the suspects with glaucomatous optic disc appearance (GODA). On the other hand, spectral analysis showed statistically significant differences for that case.ConclusionsSpectral analysis of the DCT signals was the only method showing statistically significant differences between healthy eyes and those of GODA suspects.

Immediate sequential bilateral cataract surgery: Who might benefit from the procedure?

Purpose:  The aim of the study was to compare the optical coherence tomography (OCT) parameters of the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) and to identify which measurements are best able to differentiate between normal and glaucoma suspect eyes.

Intraocular pressure in a cohort of healthy eastern European schoolchildren: variations in method and corneal thickness

Purpose To evaluate retrobulbar blood flow characteristics of glaucoma suspects with glaucomatous optic disc appearance (GODA) in comparison to healthy control group (CG) and primary open angle glaucoma patients (POAG) and assess the effect of age. Methods 145 patients from a single glaucoma clinic were enrolled and classified into two diagnostic groups (GODA and POAG). Third group of subjects consisted of 67 age matched individuals (CG). Retrobulbar blood velocity measurement in central retinal artery was performed using color Doppler imaging (CDI). CDI images were processed in custom software leading a range of parameter estimates from a continuous waveform signal. The effect of age on the estimated parameters was evaluated with the stepwise forward regression and ANCOVA in which age was used as a continuous factor. One-way ANOVA was used to test for the differences in the CDI parameters between the three considered groups. Correlation between restive index (RI) and pulsatility index (PI) was assessed with a bilinear fitting guaranteeing no discontinuities in RI intercept estimate. Fisher test was used to assess the applicability of a bilinear PI/RI relationship, while the statistics of the RI intercept estimate were evaluated using the bootstrap. Results ANCOVA showed significant interaction between age and group (p<0.05) for five out of nine considered CDI parameters. The RI intercept for CG and GODA groups was 0.602±0.047, and 0.574±0.044 respectively, while the RI intercept of 0.934±0.066 was found for the POAG. Conclusions The observed similarity of CG and GODA group and dissimilarity between GODA and POAG groups in terms of PI/RI relationship is remarkable. Age may play some role in the different mechanisms occurring in blood velocity dynamics in GODA and POAG subjects but it is not a strongly determining factor.

Co-existence of Staphylococcus spp and Stenotrophomonas maltophilia infection in persistent endophthalmitis after cataract surgery

The glued intrascleral haptic fixation technique as described by Agarwal et al. requires an assistant to constantly hold the leading haptic to prevent its slipping into the eye. The IOL haptics become damaged when undue pressure is exerted on them. This causes a kink and when an attempt to straighten the haptic is made, the haptic breaks. Following this, the surgical maneuver increases, as the IOL must sometimes be replaced or the haptics must be externalized again after the slippage. The no-assistant technique is a modified method of haptic externalization that works on the principle of vector forces and does not require an assistant to hold the leadinghaptic, eliminating haptic-relatedproblems and making the surgery more surgeon dependent. This was indirectly reflected in the smaller degree of immediate postoperative inflammation and better CDVA at 1 week (P%.007), although 1-year followup showed no statistically significant between-group difference (PR.67) in the visual outcome. Following haptic breakage in 3 cases with the original technique, the corneal incision was enlarged, the IOL replaced, and the wound sutured with 10-0 nylon sutures. In the case of the dropped IOL, the IOL was lifted from the surface of the retina and brought into themidpupillary plane. Thiswas followed by externalization of the haptics using the handshake technique. A limitation of this study is that it has a small sample size and a short follow-up of 1 year. Studies with larger case series are needed to confirm the findings.

Influence of eye biometrics and corneal micro-structure on noncontact tonometry

BackgroundIntraocular pressure (IOP) in the developing eye of a child is not always easy to measure and there is no technique that is known to be the most accurate for the young eye. Measurements are needed on many cohorts of children with different tonometers to determine how the values correlate between instruments, whether corneal parameters affect readings and whether correlations between age and IOP values can be discerned. The aim of this study was to undertake a comparative analysis of three different tonometers on a group of healthy children to see whether differences exist and whether these may be related to central corneal thickness and/or radius of curvature. In addition, the study adds to the relatively small body of literature on IOP in the growing eye which will collectively allow trends to be identified and ultimately norms to be established.MethodsIOP was measured on 115 eyes in a group of Polish children, aged between 5–17 years (mean ± standard deviation [SD] 11.3 ± 3.0 years) using three different tonometers: non-contact (NCT), the ICare and Goldmann applanation (GAT). Readings obtained were compared between instruments and with central corneal thickness and radius of curvature.ResultsThe ICare tonometer provided statistically higher IOP values (16.9 ± 3.4 mmHg) than the GAT (14.7 ± 2.9 mmHg) regardless of corneal thickness and whether or not a correction factor was applied. A correlation was found between central corneal thickness (CCT) and IOP values obtained with all three tonometers but only the IOP values detected with the ICare tonometer showed a statistically significant correlation with radius of curvature (p < 0.004). No correlations with age or gender were found for IOP values measured with any of the instruments.ConclusionsIOP measurements on children vary significantly between instruments and correlations are affected by the corneal thickness. Further studies on children are needed to determine which instrument is most appropriate and to derive a normative IOP scale for the growing eye.

Age-related changes in ocular blood velocity in suspects with glaucomatous optic disc appearance. Comparison with healthy subjects and glaucoma patients

Department of Ophthalmology, SilesianPiasts University of Medicine in Wroclaw,PolandE-mail: ae.grzybowski@gmail.comSubmitted: 28 October 2009Revised: 17 June 2010Accepted for publication: 23 June 2010Post-operative endophthalmitis is usuallycaused by gram-positive bacteria. Infec-tions with gram-negative bacteria aremuch less common, their treatment is dif-ficult and prognosis for useful visualachievement is uncertain.