Paulo Augusto de Arruda Mello

Influence of keratometric readings on comparative intraocular pressure measurements with Goldmann, Tono-Pen, and noncontact tonometers.

Purpose: To evaluate the influence of keratometric measurements on the concordance of intraocular pressure (IOP) readings with three applanation tonometers. Patients and Methods: The IOPs of 404 eyes of 202 patients from a general eye clinic were measured by Goldmann, Tono‐Pen XL, and noncontact Nidek NT 2000 tonometers. Differences in the IOP measurements between Goldmann and the other two tonometers (▴IOPG‐TP and ▴IOPG‐NCT) were analyzed in the overall group and within three subgroups based on keratometry measures: flatter, intermediate, and steeper corneas (quartiles as cut‐off points). Regression analysis of &Dgr;IOP and keratometry measures was also performed. Right and left eyes were analyzed separately. Results: The IOP readings taken with the Goldmann tonometer were significantly higher than those taken with either of the other two tonometers within the overall study population. The &Dgr;IOP within the three keratometric subgroups was not statistically significant except for &Dgr;IOPG‐TP in the right eyes. Regression analysis showed that keratometry and &Dgr;IOPG‐TP and &Dgr;IOPG‐NCT had a significant but very weak coefficient of correlation in the right eye, but not in the left. Conclusion: Corneal curvature within the normal range does not have a clinically significant influence on the concordance of IOP readings obtained with Goldmann and Tono‐Pen or noncontact tonometers.

Structural and functional assessment in HIV-infected patients using optical coherence tomography and frequency-doubling technology perimetry.

PURPOSE To assess retinal nerve fiber layer (RNFL) and macular thickness using optical coherence tomography (OCT) on HIV-infected patients without ocular manifestations and to correlate these findings with frequency-doubling technology perimetry (FDT). DESIGN Cross-sectional study. METHODS setting: Single center. study population: Seventy-three patients (146 eyes) with clinically normal examination classified in 3 groups: group A, HIV-infected patients with CD4 count <100 cells/mm(3) for at least 6 months; group B, HIV-infected patients with CD4 count >100 cells/mm(3) since diagnosis; and group C, HIV-negative control subjects. observation procedures: Fast RNFL and fast macula scan strategies on Stratus OCT and Humphrey Matrix 24-2 full-threshold program. main outcome measures: OCT RNFL and macular thicknesses and FDT indices (mean deviation [MD], pattern standard deviation [PSD], and glaucoma hemifield test [GHT]). RESULTS Group A had a significantly thinner average RNFL, temporal outer macula, and inferior outer macula thicknesses when compared to groups B and C (P < .05). Statistically significant differences were observed in the FDT MD between groups A and C (P = .034) and in PSD in group A compared to groups B and C (P = .011). Eyes of HIV patients with GHT and PSD results outside normal confidence limits had thinner average RNFL thickness measures than eyes with results within normal limits in the same group of patients (P < .05). CONCLUSIONS HIV-infected patients with low CD4 count have a significant RNFL and macular thinning. Functional loss detected by FDT is related to RNFL thinning in HIV-infected patients.

Apraclonidine and early postoperative intraocular hypertension after cataract extraction

Abstract The efficacy of topical 1% apraclonidine in controlling early postoperative IOP rise after cataract extraction was evaluated. Topical 1% apraclonidine was applied to 20 patients who underwent extracapsular cataract extraction with posterior intraocular lens implantation. On another 20 patients, who acted as control group a placebo (artificial tears) was given. The IOP was measured before preoperative medication and postoperatively at 6, 12 and 24 h, using the Perkins hand‐held applanation tonometer. In the control group, 9 patients (45%) developed intraocular hypertension and in the treated group only 2 (10%) showed hypertension, but with short duration and a moderate IOP rise. The difference in frequency of intraocular hypertension between the groups was statistically significant (p < 0.02). The statistical analysis showed that the postoperative IOP of operated treated eyes was significantly smaller than the IOP of operated control eyes. Furthermore, the postoperative IOP and the initial IOP did not differ statistically. The results of this study demonstrate the efficacy of topical apraclonidine 1% in controlling the early and transient intraocular hypertension following cataract extraction.

Custo real do tratamento do glaucoma para o paciente

Objetivo: Avaliar o custo do tratamento do glaucoma para o paciente, numa instituicao de ensino medico. Casuistica e Metodos: Foram aplicados, aleatoriamente, questionarios, na forma de entrevista ativa, a 94 pacientes do ambulatorio do Setor de Glaucoma do Departamento de Oftalmologia da Universidade Federal de Sao Paulo, analisando gastos pessoais e com medicamentos antiglaucomatosos. Os dados foram agrupados, tabulados e foi realizada separacao da amostra em dois grupos: pacientes cirurgicos e nao-cirurgicos. Resultados: A mediana do gasto total anual estimado com glaucoma foi de R

Relationship between retinal nerve fiber layer and visual field function in human immunodeficiency virus-infected patients without retinitis.

480,15, o equivalente a 13% da renda anual mediana dos pacientes. Separadamente, o grupo dos pacientes cirurgicos obteve uma mediana dos gastos totais estimados de R

Evaluation of the Perkins® handheld applanation tonometer in the measurement of intraocular pressure in dogs and cats

677,94, o que corresponde a 19% da renda mediana anual. Ja o grupo dos pacientes nao-cirurgicos, apresentou mediana de R

No changes in anatomical and functional glaucoma evaluation after trabeculectomy

393,54, representando 11% da renda mediana anual. Foi encontrada diferenca estatisticamente significante entre os grupos cirurgico e nao-cirurgico para o gasto total anual (p = 0,012). Conclusao: Observou-se que o custo do tratamento na renda familiar de pessoas portadoras de glaucoma e consideravel, mesmo em uma instituicao publica

Hypotensive effect of juxtascleral administration of anecortave acetate in different types of glaucoma.

Purpose: To evaluate the spatial association between visual field (VF) sensitivity loss and retinal nerve fiber layer (RNFL) thinning in patients infected by the human immunodeficiency virus. Methods: Fifty-one eyes of 51 human immunodeficiency virus–infected patients and 22 eyes of 22 control subjects were enrolled. Patients were evaluated using the Fast RNFL scan strategy on Stratus OCT and the 24-2 full-threshold program on the Humphrey Matrix frequency doubling technology (FDT) perimeter. Associations between RNFL thickness and VF sensitivity were evaluated globally, in 12 clock-hour optical coherence tomography sectors and in 21 VF zones; linear and quadratic regression models were used in the statistical analysis. Results: The linear and quadratic regression associations between the FDT Matrix pattern standard deviation and the average RNFL thickness in human immunodeficiency virus–infected patients were r2 = 0.185 and r2 = 0.218 (P < 0.05), respectively. The correlation between the FDT Matrix mean deviation and the average RNFL thickness was not significant (P > 0.05). Stronger associations were found when regional RNFL thinning was compared with locally measured FDT Matrix pattern deviation, especially between nasal RNFL measurements and temporal VF zones, and between superior RNFL measurements and inferior VF zones. Conclusion: Retinal nerve fiber layer thinning was related to VF sensitivity loss in human immunodeficiency virus–infected patients and regional associations between optical coherence tomography and FDT Matrix sectors were stronger than the associations between global measurements.

Safety of Unoprostone Isopropyl as Mono- or Adjunctive Therapy in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension

OBJECTIVE To evaluate and to validate the accuracy of the Perkins handheld applanation tonometer in the measurement of IOP in dogs and cats. ANIMALS Twenty eyes from 10 dogs and 10 cats immediately after sacrifice were used for the postmortem study and 20 eyes from 10 clinically normal and anesthetized dogs and cats were used for the in vivo study. Both eyes of 20 conscious dogs and cats were also evaluated. PROCEDURE Readings of IOP postmortem and in vivo were taken using manometry (measured with a mercury column manometer) and tonometry (measured with a Perkins handheld applanation tonometer). The IOP measurement with Perkins tonometer in anesthetized and conscious dogs and cats was accomplished by instillation of proxymetacaine 0.5% and of 1% fluorescein eye drops. RESULTS The correlation coefficient (r(2)) between the manometry and the Perkins tonometer were 0.982 (dogs) and 0.988 (cats), and the corresponding linear regression equation were y = 0.0893x + 0.1105 (dogs) and y = 0.0899x + 0.1145 (cats) in the postmortem study. The mean IOP readings with the Perkins tonometer after calibration curve correction were 14.9 +/- 1.6 mmHg (range 12.2-17.2 mmHg) in conscious dogs, and were 15.1 +/- 1.7 mmHg (range 12.1-18.7 mmHg) in conscious cats. CONCLUSION There was an excellent correlation between the IOP values obtained from direct ocular manometry and the Perkinstonometer in dogs and cats. The Perkins handheld tonometer could be in the future a new alternative for the diagnosis of glaucoma in veterinary ophthalmology.

Conjunctival changes and inflammatory aspects in rabbits' conjunctivas induced by fixed combinations of prostaglandin analogues and timolol maleate

PurposeTo assess the influence of glaucoma filtration surgery on anatomical and functional tests for glaucoma evaluation.MethodsTwenty-five eyes (25 patients) with primary open-angle glaucoma were evaluated, prospectively. Data were collected on vision acuity, intraocular pressure, standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry (GDx) and confocal scanning laser ophthalmoscopy (HRT II) before and 3–6 months after surgery.ResultsMean (±SD) pre- and postoperative visual acuities (logMAR) were 0.28 (±0.18) and 0.30 (±0.17), respectively (P=0.346). In a mean time of 4.5 (±1.1) months after surgery, the mean preoperative intraocular pressure of 20.7 (±5.4) mmHg decreased to 11.04 (±2.52) mmHg (P<0.001). The results of the standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy diagnostic methods revealed no significant difference (P>0.162) between pre and postoperative values and no significant correlation (P>0.296) between intraocular pressure reduction and value changes.ConclusionNo significant change on any test variable was detected after glaucoma filtration surgery. Trabeculectomy does not appear to influence standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy (HRT II) results after a 4.5-month period of surgery in early to moderate glaucoma.