Effect of Prostaglandin Analogues on Corneal Biomechanical Parameters Measured With a Dynamic Scheimpflug Analyzer

Biomechanical Properties Measured With Dynamic Scheimpflug Analyzer in Myopic Maculopathy

PURPOSE

Corneal biomechanical properties are associated with axial elongation. We aimed to characterize corneal biomechanical properties in highly myopic eyes with myopic maculopathy (MM).

DESIGN

Retrospective cross-sectional study.

METHODS

We included patients examined between June 2022 and August 2023 who underwent corneal visualization Scheimpflug technology (Corvis ST) measurements. MM in highly myopic eyes (axial length >26.0 mm) was evaluated using META-PM (meta-analyses of pathologic myopia) study classification based on fundus photographs with subfoveal choroidal thickness measured via spectral domain optical coherence tomography. A linear mixed model was used to analyze the association of MM features with axial length (AL) and corneal biomechanical parameters, followed by model selection using the second-order-corrected Akaike information criterion.

RESULTS

We included 189 eyes from 109 participants. A significant correlation was observed between AL and biomechanical parameters that characterize maximal corneal deformation (maximal deflection amplitude and peak distance) and stiffness parameter (stress-strain index) (P < .05). Model selection revealed that both AL and maximal deflection amplitude were independently associated with MM with category ≥2 severe, as well as with subfoveal choroidal thickness in highly myopic eyes (AL >26.0 mm).

CONCLUSIONS

In highly myopic eyes, a greater maximal deflection amplitude was identified as a risk factor for MM. Corneal biomechanical properties may serve as biomarkers for predicting the development and progression of MM.

Factors affecting corneal deformation amplitude measured by Corvis ST in eyes with open-angle glaucoma

PURPOSE

To evaluate the factors affecting corneal deformation amplitude (DA) measured using Corvis ST in eyes with open-angle glaucoma.

METHODS

This prospective, longitudinal study included 48 eyes with open-angle glaucoma who required additional intraocular pressure (IOP)-lowering drops. All eyes underwent a complete eye examination at baseline, including a Corvis ST, which was repeated 4-8 weeks after the change in therapy. Factors affecting the corneal biomechanics, namely the DA, were determined using mixed effect models.

RESULTS

The mean age of the cohort was 65.0 ± 7.9 years. The mean IOP reduced from 23.4 ± 5.4 mmHg to 17.9 ± 5 mmHg after the change in glaucoma treatment ( P < 0.001). The DA increased from 0.89 ± 0.16 mm to 1.00 ± 0.13 mm after IOP reduction ( P < 0.001). On mixed effect model analysis, IOP (-0.02 ± 0.001, P < 0.001) and corneal pachymetry (-0.0003 ± 0.0001, P = 0.02) affected the change in the DA.

CONCLUSION

IOP and corneal pachymetry affect the DA and must be accounted for when using Corvis ST to evaluate corneal biomechanics in glaucoma.

Comparing corneal biomechanic changes among solo cataract surgery, microhook ab interno trabeculotomy and iStent implantation

Minimally invasive glaucoma surgery has expanded the surgical treatment options in glaucoma, particularly when combined with cataract surgery. It is clinically relevant to understand the associated postoperative changes in biomechanical properties because they are influential on the measurement of intraocular pressure (IOP) and play an important role in the pathogenesis of open-angle glaucoma (OAG). This retrospective case-control study included OAG patients who underwent cataract surgery combined with microhook ab interno trabeculotomy (µLOT group: 53 eyes of 36 patients) or iStent implantation (iStent group: 59 eyes of 37 patients) and 62 eyes of 42 solo cataract patients without glaucoma as a control group. Changes in ten biomechanical parameters measured with the Ocular Response Analyzer and Corneal Visualization Scheimpflug Technology (Corvis ST) at 3 and 6 months postoperatively relative to baseline were compared among the 3 groups. In all the groups, IOP significantly decreased postoperatively. In the µLOT and control groups, significant changes in Corvis ST-related parameters, including stiffness parameter A1 and stress‒strain index, indicated that the cornea became softer postoperatively. In contrast, these parameters were unchanged in the iStent group. Apart from IOP reduction, the results show variations in corneal biomechanical changes from minimally invasive glaucoma surgery combined with cataract surgery.

Comparison of two analyzer measurements focusing on material stiffness among normal, treatment-naïve, and treated glaucoma eyes

To investigate differences in biomechanical properties focusing on stiffness parameters between normal, treatment-naïve primary open-angle glaucoma (POAG), and treated POAG eyes. Retrospective case-control study, This study included 46 treatment-naïve POAG eyes, 46 POAG eyes treated with prostaglandin analogues, and 49 normal eyes used as controls; matched in terms of age and axial length. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using an ocular response analyzer (ORA). Fifteen biomechanical parameters were measured with the Corneal Visualization Scheimpflug Technology (Corvis ST), including biomechanical glaucoma factor (BGF) and two stiffness parameters of 'SP A1' and 'stress-strain index (SSI)', which were compared among the three groups. Additionally, the area under the curve (AUC) values of the receiver-operating curve to discriminate control and treatment-naïve POAG eyes were calculated for BGF and CH. Treatment-naïve POAG eyes had higher 'SSI' than normal eyes even after controlling for IOP (p < 0.05, Tukey-Cramer test). Treated POAG eyes had significantly lower CRF, and higher BGF than treatment-naïve POAG eyes. There were also significant differences in CH or SP A1 among the three groups. BGF and CH had similar AUC values (0.61 and 0.59). Treatment-naïve POAG eyes had stiffer corneas compared to normal eyes, which seemed to result from the material/structure of the cornea rather than higher intraocular pressure. Antiglaucoma topical medication alters biomechanical properties measured with Corvis ST. These results are important for understanding the pathogenesis and improving the management of POAG.

Effect of prostaglandin analogues on the biomechanical corneal properties in patients with open-angle glaucoma and ocular hypertension measured with dynamic scheimpflug analyzer

PURPOSE

The aim of the study is to evaluate the effect of topical prostaglandin (PG) treatment on the corneal biomechanical properties in treatment-naïve patients with either primary open-angle glaucoma (POAG) or ocular hypertension (OHT) using the Corvis ST device.

METHODS

This is an observational study. We analyzed the Corvis ST dynamic corneal response parameters of our database using the newest software available. Thirty-four eyes of 34 patients were included. They were all newly diagnosed and treatment-naïve. Patients were evaluated at baseline and after 6 months of treatment with prostaglandin analogues. Ultrasound pachymetry, Optical Coherence Tomography (OCT) and a 24-2 visual field test were performed in baseline visit. Goldman Applanation Tonometry (GAT-IOP) and Corvis ST dynamic corneal response parameters were registered at baseline and at the 6-month visit.

RESULTS

After 6 months of treatment, the IOP decrease (Δ) values obtained with the different tonometers were ΔGAT -6.5 ± 3.7, ΔIOPnct -4.4 ± 5.7 and ΔbIOP -3.8 ± 5.4. The differences between ΔGAT vs ΔIOPnct, ΔGAT vs ΔbIOP, and ΔIOPnct vs ΔbIOP, were statistically significant (p < 0.05 for all comparisons). Statistically significant lower values of the stress-strain index (SSI) (1.77 ± 0.3 at baseline vs 1.54 ± 0.27 at the 6-month visit) were found (p = 0.0002).

CONCLUSION

The SSI provided by the Corvis ST seems to decrease significantly after topical prostaglandin therapy. We believe that our results support the hypothesis that topical PG therapy does decrease the corneal stiffness and thus, that the ocular hypotensive effect of these drugs is overestimated if GAT is used for IOP measurement.