Shunsuke Nakakura

Relation between office intraocular pressure and 24-hour intraocular pressure in patients with primary open-angle glaucoma treated with a combination of topical antiglaucoma eye drops.

PurposeTo determine the relation between office intraocular pressure (IOP) and 24-hour IOP in patients with primary open-angle glaucoma (POAG) treated with 3 kinds of antiglaucoma eye drops. Patients and MethodsSubjects were 42 patients with POAG (71 eyes). All were being treated with 3 different topical antiglaucoma eye drops (latanoprost, β-blocker, and carbonic anhydrase inhibitor). Twenty-four-hour IOP values were obtained in the sitting position with a Goldmann applanation tonometer at 3-hour intervals. ResultsMaximum 24-hour IOP (mean±SD) was 19.76±5.65 mm Hg, minimum 24-hour IOP was 13.06±4.75 mm Hg, mean 24-hour IOP was 16.30±4.90 mm Hg, and 24-hour IOP fluctuation was 6.70±2.81 mm Hg. Office IOP was 16.23±4.58 mm Hg, and office IOP fluctuation was 2.75±1.68 mm Hg. There was no significant difference between office IOP and mean 24-hour IOP (P=0.93). There was no correlation between office IOP and 24-hour IOP fluctuation (r=0.15; P=0.25) or between office IOP fluctuation and 24-hour IOP fluctuation (r=0.19; P=0.17). Maximum 24-hour IOP occurred during office hours in 22 eyes (33.8%). The frequency of maximum 24-hour IOP occurring during office hours was significantly less than that of minimum 24-hour IOP (P<0.001). ConclusionsIn POAG patients treated with 3 kinds of antiglaucoma eye drops, office IOP was similar to mean 24-hour IOP. However, it was difficult to estimate 24-hour IOP fluctuation and maximum 24-hour IOP on the basis of office IOP.

Latanoprost therapy after sunken eyes caused by travoprost or bimatoprost.

Purpose. To report clinical results of switching to latanoprost therapy in patients with deepening of the upper eyelid sulcus caused by travoprost and bimatoprost. Methods. Prospective, clinical, observational case reports. Four patients presented with eyelid changes giving the eye a sunken eye appearance; two were being treated with travoprost and two with bimatoprost. Both patients on bimatoprost and one of the patients on travoprost therapy were switched to latanoprost while the eyelid sign was evident. The other patient discontinued the travoprost therapy for 4 months and switched to latanoprost therapy 1 month later, i.e., 5 months after discontinuing travaprost therapy. The physical changes in the eyelids were documented by photography and the intraocular pressure by Goldmann applanation tonometry. Results. Three patients had a resolution of the sunken eye appearance 2 to 3 months after switching to latanoprost. The one patient who switched to latanoprost after recovery of the sunken eye had no recurrence during a 6 months follow-up period. There were no significant changes in the intraocular pressure in any of the subjects. Conclusions. A deepening of the upper eyelid sulcus is a complication of prostaglandin F2&agr; analogs. However, this side effect may be less common with latanoprost and eyes with this side effect caused by travoprost or bimatoprost may tolerate latanoprost therapy.

The Relationship between Corvis ST Tonometry Measured Corneal Parameters and Intraocular Pressure, Corneal Thickness and Corneal Curvature

The purpose of the study was to investigate the correlation between Corneal Visualization Scheimpflug Technology (Corvis ST tonometry: CST) parameters and various other ocular parameters, including intraocular pressure (IOP) with Goldmann applanation tonometry. IOP with Goldmann applanation tonometry (IOP-G), central corneal thickness (CCT), axial length (AL), corneal curvature, and CST parameters were measured in 94 eyes of 94 normal subjects. The relationship between ten CST parameters against age, gender, IOP-G, AL, CST-determined CCT and average corneal curvature was investigated using linear modeling. In addition, the relationship between IOP-G versus CST-determined CCT, AL, and other CST parameters was also investigated using linear modeling. Linear modeling showed that the CST measurement ‘A time-1’ is dependent on IOP-G, age, AL, and average corneal curvature; ‘A length-1’ depends on age and average corneal curvature; ‘A velocity-1’ depends on IOP-G and AL; ‘A time-2’ depends on IOP-G, age, and AL; ‘A length-2’ depends on CCT; ‘A velocity-2’ depends on IOP-G, age, AL, CCT, and average corneal curvature; ‘peak distance’ depends on gender; ‘maximum deformation amplitude’ depends on IOP-G, age, and AL. In the optimal model for IOP-G, A time-1, A velocity-1, and highest concavity curvature, but not CCT, were selected as the most important explanatory variables. In conclusion, many CST parameters were not significantly related to CCT, but IOP usually was a significant predictor, suggesting that an adjustment should be made to improve their usefulness for clinical investigations. It was also suggested CST parameters were more influential for IOP-G than CCT and average corneal curvature.

Prostaglandin-associated periorbitopathy in latanoprost users

Purpose We investigated the incidence of prostaglandin-associated periorbitopathy (PAP) in subjects with glaucoma treated with latanoprost ophthalmic solution. Subjects and methods One eye and the forehead in 22 subjects were evaluated. All patients had used latanoprost for more than 1 year (range, 12 to 45 months; mean, 26.0 months) and were prostaglandin F2α analogue treatment-naïve. Digital photographs of the subjects obtained before latanoprost therapy and at the last examination were compared retrospectively. Four signs of PAP (deepening of the upper eyelid sulcus (DUES), upper eyelid ptosis, flattening of the lower eyelid bags, and inferior scleral show) and supplemental side effects around the eyelids (eyelash growth, poliosis, and eyelid pigmentation) were judged to be negative or positive by three independent observers. If the observers unanimously rated a sign as positive, the result was defined as positive. Results Twelve subjects (54.5%) had no apparent signs. Three subjects were judged to have DUES (13.6%), and two subjects each were judged to have flattening of the lower eyelid bags and eyelid pigmentation (9.0%). The other signs were judged as positive in only one subject each, respectively (4.5%). A univariate logistic regression analysis showed no significant associations between any of the signs and age, sex, or the duration of therapy. Conclusion Latanoprost induced DUES, upper eyelid ptosis, flattening of the lower eyelid bags, inferior scleral show, and supplemental side effects around the eyelids; however, the rates of such occurrence might be relatively low.

Effect of travoprost on 24-hour intraocular pressure in normal tension glaucoma

Purpose: The effect of travoprost 0.004% on 24-hour intraocular pressure (IOP) was examined in patients with normal tension glaucoma (NTG). Subjects and methods: This study included 17 patients with newly diagnosed unilateral NTG. IOP was measured at three-hour intervals over 24 hours by Goldman applanation tonometer in patients taking topical travoprost 0.004% and was compared retrospectively with 24-hour IOP data in untreated eyes. Results: IOP values were significantly reduced at individual time points after treatment (P < 0.01). Mean 24-hour IOP, maximum 24-hour IOP, minimum 24-hour IOP, and 24-hour IOP fluctuations at baseline (mean ± SD) were 12.9 ± 2.2 mmHg, 15.4 ± 2.7 mmHg, 10.5 ± 2.2 mmHg, and 4.9 ± 1.2 mmHg, respectively, and were significantly reduced to 10.3 ± 2.0 mmHg, 12.4 ± 2.5 mmHg, 8.5 ± 1.9 mmHg (all P < 0.001), and 3.9 ± 1.5 mmHg (P < 0.05), respectively, after treatment. The rate of IOP reduction greater than 20% was 58.8% (10 eyes) for maximum 24-hour IOP and 53.0% (nine eyes) for mean 24-hour IOP. Conclusion: Travoprost reduced IOP throughout the 24-hour study period, with over half of the eyes examined showing IOP reduction exceeding 20%.

Selective laser trabeculoplasty for glaucoma after penetrating keratoplasty.

Purpose. Postoperative intraocular pressure elevation is the most common complication to occur after penetrating keratoplasty (PKP). When topical antiglaucoma drops or oral systemic medication cannot lower this pressure, surgical intervention is necessary. However, surgery cannot yet be performed that does not adversely affect the graft, and better surgical treatments are required. Methods. A 62-year-old man had undergone PKP to treat bullous keratopathy in the left eye. Secondary glaucoma occurred early postoperation and was controlled through topical antiglaucoma eye drops, medication, and the decreasing use of topical steroids. However, 7 months postsurgery, intraocular pressure (IOP) in the eye re-elevated to 42 mm Hg (Goldmann applanation tonometer). Selective laser trabeculoplasty was performed inferiorly for 6 h and then added selective laser trabeculoplasty performed superiorly for 6 h, 1 week later. Complete slit lamp biomicroscopy, visual acuity, IOP, gonioscopy, and mydriatic funduscopy were performed pre- and posttreatment for 6 months. Results. IOP decreased from 42 to 27 mm Hg 1 week after selective laser trabeculoplasty (SLT) (inferior 180°). After an additional superior 180° SLT performed 2 weeks after this, IOP decreased to 15 mm Hg. Six months later, IOP was stable at 18 mm Hg, and graft rejection, new peripheral anterior synechiae, and visual acuity disturbance were not observed. Conclusions. IOP elevation after PKP was successfully treated with SLT. SLT will become a valuable therapeutic method that limits invasive surgery for treatment of secondary glaucoma after PKP.

Intraocular pressure of supine patients using four portable tonometers.

Purpose To evaluate the congruity of intraocular pressure (IOP) measurements from supine patients, which were obtained using four portable tonometers. Methods Intraocular pressure measurements were obtained from the right eye of 72 supine patients. We used the iCare (Tiolat Oy, Helsinki, Finland) rebound tonometer, the Diaton (BICOM Inc., Long Beach, NY) transpalpebral tonometer, the Tonopen XL (Reichert inc., Depew, NY), and a Kowa hand-held applanation tonometer (HAT; Kowa Company, Ltd., Nagoya, Japan). Relationships between mean IOPs were evaluated using Pearson correlation coefficients, and the mean differences between tonometers, using one-way analysis of variance followed by Tukey-Kramer post-hoc analysis. Levels of agreement were evaluated using Bland-Altman analysis. Results The mean IOPs (mean ± SD) were 18.2 ± 3.5 mm Hg for iCare, 14.8 ± 3.4 mm Hg for Diaton, 16.7 ± 3.7 mm Hg for Tonopen XL, and 16.8 ± 2.8 mm Hg for Kowa HAT. Pearson correlation coefficients between iCare, Tonopen XL, and Kowa HAT ranged from 0.382 to 0.577, whereas those between Diaton and other tonometers ranged from 0.041 to 0.286. Post-hoc analysis indicated significant differences between all pairs except Tonopen XL and Kowa HAT. The mean difference between measurements from iCare and Diaton was 3.39 ± 3.39 mm Hg; iCare and Tonopen XL, 1.47 ± 3.52 mm Hg; iCare and Kowa HAT, 1.49 ± 2.90 mm Hg; Diaton and Tonopen XL, −1.93 ± 4.90 mm Hg; Diaton and Kowa HAT, −1.90 ± 4.15 mm Hg; and Tonopen XL and Kowa HAT, 0.02 ± 3.61 mm Hg. Computation of the width of the 95% limits of agreement resulted in a wide bias range when comparing Diaton with all tonometers. Relatively good agreements were observed between iCare, Tonopen XL, and HAT. Conclusions Intraocular pressure measurements obtained in a supine position by four portable tonometers were not interchangeable. Although iCare and Tonopen XL significantly overestimated IOP values in eyes with a higher IOP when compared with Kowa HAT, the agreements between iCare, Tonopen XL, and Kowa HAT were at clinically acceptable levels.

Comparison of anterior chamber depth measurements by 3-dimensional optical coherence tomography, partial coherence interferometry biometry, Scheimpflug rotating camera imaging, and ultrasound biomicroscopy

PURPOSE: To evaluate the congruity of anterior chamber depth (ACD) measurements using 4 devices. SETTING: Saneikai Tsukazaki Hospital, Himeji City, Japan. DESIGN: Comparative case series. METHODS: In 1 eye of 42 healthy participants, the ACD was measured by 3‐dimensional corneal and anterior segment optical coherence tomography (CAS‐OCT), partial coherence interferometry (PCI), Scheimpflug imaging, and ultrasound biomicroscopy (UBM). The differences between the measurements were evaluated by 2‐way analysis of variance and post hoc analysis. Agreement between the measurements was evaluated using Bland‐Altman analysis. To evaluate the true ACD using PCI, the automatically calculated ACD minus the central corneal thickness measured by CAS‐OCT was defined as PCI true. Two ACD measurements were also taken with CAS‐OCT. RESULTS: The mean ACD was 3.72 mm ± 0.23 (SD) (PCI), 3.18 ± 0.23 mm (PCI true), 3.24 ± 0.25 mm (Scheimpflug), 3.03 ± 0.25 mm (UBM), 3.14 ± 0.24 mm (CAS‐OCT auto), and 3.12 ± 0.24 mm (CAS‐OCT manual). A significant difference was observed between PCI biometry, Scheimpflug imaging, and UBM measurements and the other methods. Post hoc analysis showed no significant differences between PCI true and CAS‐OCT auto or between CAS‐OCT auto and CAS‐OCT manual. Strong correlations were observed between all measurements; however, Bland‐Altman analysis showed good agreement only between PCI true and Scheimpflug imaging and between CAS‐OCT auto and CAS OCT manual. CONCLUSION: The ACD measurements obtained from PCI biometry, Scheimpflug imaging, CAS‐OCT, and UBM were significantly different and not interchangeable except for PCI true and CAS‐OCT auto and CAS‐OCT auto and CAS‐OCT manual. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Intradevice and Interdevice Agreement Between a Rebound Tonometer, Icare PRO, and the Tonopen XL and Kowa Hand-held Applanation Tonometer When Used in the Sitting and Supine Position.

Purpose:The aim of the study was to investigate the agreement between a new portable tonometer, Icare PRO, and the Tonopen XL and Kowa hand-held applanation tonometers (HAT). Methods:The right eyes of 127 healthy subjects were enrolled. Intraocular pressure (IOP) was measured in both sitting and supine positions using the Icare PRO, Tonopen XL, and Kowa HAT tonometers. The repeatability of the IOP measurements was evaluated by calculating intraclass correlation coefficients. Between-method agreements of tonometer measurements were evaluated using Bland-Altman analysis. Results:Intradevice agreement: The intraclass correlation coefficients (sitting, supine) of Icare PRO, Tonopen XL, and Kowa HAT were (0.863, 0.656), (0.845, 0.819), and (0.957, 0.956), respectively.Interdevice agreement: The Bland-Altman analysis revealed that, in the sitting position, the mean differences between Icare PRO and Tonopen XL, and between Icare PRO and Kowa HAT were −0.43 and 0.43 mm Hg, respectively (95% limits of agreement: −6.24 to 5.34 mm Hg, −4.04 to 4.90 mm Hg). In the supine position, the corresponding mean differences were −0.88 and 0.14 mm Hg (95% limits of agreement: −5.66 to 3.91 mm Hg, −4.06 to 4.33 mm Hg). IOP differences between Icare PRO and the other tonometers were unaffected by central corneal thickness. Conclusions:The repeatability of Icare PRO was slightly lower in the supine position than in the sitting position. Although Icare PRO underestimated IOP values in eyes with higher IOP when compared with Tonopen XL and Kowa HAT in both positions, we observed good interdevice agreement between Icare PRO and both Tonopen XL and Kowa HAT.

Effects of corneal thickness and axial length on intraocular pressure and ocular pulse amplitude before and after cataract surgery

OBJECTIVE To investigate the relationship between the biophysical properties of the cornea and eye on the intraocular pressure (IOP) and ocular pulse amplitude (OPA) before and after cataract surgery. DESIGN Intervention study. PARTICIPANTS The left eyes of 311 patients. METHODS The left eyes of 338 patients undergoing cataract surgery without other eye pathology were studied. IOP and OPA were recorded by dynamic contour tonometry (DCT) 1 week before and 14 weeks after cataract surgery. The axial length, corneal curvature, central corneal thickness, anterior chamber depth, and anterior chamber angle were measured 1 week before cataract surgery. Multiple regression analyses of these factors to the preoperative OPA were performed. The difference between the pre- and postoperative IOP and OPA were investigated by paired t tests. RESULTS Three hundred and eleven of 338 eyes were analyzed. The preoperative OPA was negatively correlated with axial length (β = -0.24, p < 0.0001) and positively correlated with the preoperative IOP (β = 0.13, p < 0.0001). The average OPA was significantly decreased after cataract surgery (p < 0.0001). The mean change in postoperative OPA was -0.45 ± 0.63 mm Hg (95% CI -0.52 to -0.38 mm Hg). CONCLUSIONS The preoperative OPA was negatively correlated with axial length as reported. A significant decrease in OPA was observed after the cataract surgery.