Comparison of Corneal Thickness After the Instillation of Topical Anesthetics

Morphology of the cornea and iris in the Australian lungfish Neoceratodus forsteri (Krefft 1870) (Dipnoi): Functional and evolutionary perspectives of transitioning from an aquatic to a terrestrial environment

The Australian lungfish, Neoceratodus forsteri (Krefft 1870), is the sole extant member of the Ceratodontidae within the Dipnoi, a small order of sarcopterygian (lobe-finned) fishes, that is thought to be the earliest branching species of extant lungfishes, having changed little over the last 100 million years. To extend studies on anatomical adaptations associated with the fish-tetrapod transition, the ultrastructure of the cornea and iris is investigated using light and electron (transmission and scanning) microscopy to investigate structure-function relationships and compare these to other vertebrate corneas (other fishes and tetrapods). In contrast to previous studies, the cornea is found to have only three main components, comprising an epithelium with its basement membrane, a stroma with a Bowman's layer and an endothelium, and is not split into a dermal (secondary) spectacle and a scleral cornea. The epithelial cells are large, relatively low in density and similar to many species of non-aquatic tetrapods and uniquely possess numerous surface canals that contain and release mucous granules onto the corneal surface to avoid desiccation. A Bowman's layer is present and, in association with extensive branching and anastomosing of the collagen fibrils, may be an adaptation for the inhibition of swelling and/or splitting of the stroma during its amphibious lifestyle. The dorsal region of the stroma possesses aggregations of pigment granules that act as a yellow, short wavelength-absorbing filter during bright light conditions. Desçemet's membrane is absent and replaced by an incomplete basement membrane overlying a monocellular endothelium. The iris is pigmented, well-developed, vascularised and contractile containing reflective crystals anteriorly. Based upon its ultrastructure and functional adaptations, the cornea of N. forsteri is more similar to amphibians than to other bony fishes and is well-adapted for an amphibious lifestyle.

A Comparison Between Ultrasound Pachymetry and CASIA2 (Anterior-Segment Optical Coherence Tomography) in the Measurement of Central Corneal Thickness

Background and objective Due in part to its effect on intraocular pressure (IOP) measurements, the assessment of central corneal thickness (CCT) is recognized as an essential part of the initial glaucoma assessment. The most widely utilized clinical technique to measure CCT is ultrasound pachymetry (USP). In recent years, many dedicated anterior-segment optical coherence tomography scanners (AS-OCTs) have been developed. Previous studies have compared CCT measurements between USP and various AS-OCTs. This study aimed to assess the degree of agreement between USP and CASIA2 (Tomey Corporation, Nagoya, Japan), a second-generation swept-source AS-OCT developed in Japan. Methodology The data on CCT screening measurements of 156 eyes (88 patients) performed over a period of three months, from January to March 2020, on glaucoma patients attending the Royal Hallamshire Hospital (RHH) in Sheffield, UK were collected retrospectively and statistically analyzed. Results The average age of the 88 patients included in the study was 66 years (range: 20-86 years). Our findings show that when compared to CASIA2 measurements, USP measurement of the CCT resulted in significantly thicker values (paired t-test: t=23.15,p<2.2 x 10^-16). The average difference between the two methods was 19.98 ± 10.78 μm. It is hypothesized that this difference may be due in part to inaccurate probe placement during ultrasound probe measurement, resulting in thicker CCT values. Conclusion The observed difference may be clinically significant as it could induce clinical discrepancy in terms of perceived glaucoma risk in patients. Therefore, USP and CASIA2 should not be used interchangeably, and clinicians should take into account the significant difference between these methods.

The alterations of corneal biomechanics in adult patients with corneal dystrophy

PURPOSE

To evaluate the changes of corneal biomechanics in granular, lattice and macular corneal dystrophy (GCD, LCD and MCD), and to assess the agreement of intraocular pressure (IOP) between Corvis ST tonometer (CST) and Goldmann applanation tonometer (GAT) and the agreement of central corneal thickness (CCT) between CST and ultrasound pachymeter (USP) in patients with corneal dystrophy.

METHODS

Fifty-nine eyes with corneal dystrophy (26 eyes with GCD, 18 eyes with LCD and 15 eyes with MCD) and 48 eyes from healthy subjects were included in this study. All subjects received ocular examination and anterior segment photography under slit-lamp microscope. Corneal biomechanical parameters were obtained using CST. IOP and CCT were obtained using GAT and USP, respectively. Mixed-effects models were fitted for group comparisons and Bland-Altman analyses were applied for assessing the agreement of IOP or CCT between devices.

RESULTS

GCD, LCD and MCD showed higher First Applanation Deformation Amplitude (A1DA) and Corvis Biomechanical Index (CBI), and a lower Stiffness Parameter at First Applanation (SPA1), compared to controls. After CCT adjustment, MCD group showed a higher A1DA compared to GCD or LCD. The IOP measured by CST demonstrated an overestimated bias to the one obtained by GAT in all groups. The CCT measured by CST and USP showed good agreement in healthy eyes but not in those with corneal dystrophy.

CONCLUSION

Corneal biomechanical alterations were observed in GCD, LCD and MCD. IOP and CCT measured by CST should be interpreted carefully in eyes with corneal dystrophy.

The functional anatomy of the cornea of the Shorthead lamprey, Mordacia mordax (Mordaciidae, Agnatha): A comparison between downstream and upstream migrants

The Shorthead lamprey Mordacia mordax (Mordaciidae, Agnatha) represents one of the earliest stages of vertebrate evolution. This study investigates the ultrastructural anatomy of the cornea, iris and anterior chamber in the eyes of this species in both the downstream and upstream migrant phases of its protracted lifecycle to assess the morphological and quantitative changes associated with growth, corneal function and vision. Using light and both scanning and transmission electron microscopy, the cornea is found to be divided into dermal and scleral components separated by a mucoid layer. A range of distinguishing corneal features are compared in the two adult phases of the lifecycle, including epithelial microprojections, mucus-secreting epithelial cells, the number, thickness, formation and level of branching and anastomosing of collagen lamellae, the type and distribution of vertical sutures, the structure of the mucoid layer and annular ligament and the number and distribution of a large number of basement membranes throughout the cornea. Significant differences are found between the two phases, which are thought to reflect adaptations to the variable environmental conditions encountered throughout this species' lifecycle. The study provides insights into the evolutionary pressures on extant representatives of the earliest stages in the evolution of the vertebrate eye.

Comparison of central corneal thickness in healthy eyes using ultrasound pachymetry, non-contact specular microscopy and a high-resolution Scheimpflug camera

PURPOSE

To compare and analyze the interchangeability in measuring central corneal thickness (CCT) using ultrasonic pachymetry (USP, PACHMATE 2, DGH, Inc, Exton, PA, USA), non-contact specular microscopy (NCSM, CEM-530, Nidek CO, LTD, Gamagori, Japan) and a high-resolution Scheimpflug Camera (Pentacam HR, OCULUS, Wetzlar, Germany).

METHODS

An observational, cross-sectional study was performed recruiting 216 volunteers, for a sample size of 216 eyes with no ocular abnormalities other than refractive errors. All subjects underwent pachymetric measurements obtained by USP, NCSM and Pentacam HR. Examinations were performed by the same examiner with USP always following the noncontact examinations.

RESULTS

The mean CCT (± SD) was 560.30 ± 38.80 μm, 556.76 ± 36.83 μm and 547.31 ± 35.28 μm for USP, NCSM and Pentacam HR, respectively. The Bland-Altman analysis showed that the highest concordance was found between USP and NCSM, with differences between - 13.18 μm and 20.26 μm. For the differences between measurements obtained with Pentacam HR and USP, the differences at Bland-Altman plot were between - 28.25 and 13.57 μm. The lowest concordance was found for the CCT values measured with Pentacam HR and NCSM, with differences between - 25.67 and 6.86 μm. The intraclass correlation coefficient (ICC) between all pairs of measurements was between 0.979 and 0.987, suggesting that the mean measurements were strongly correlated.

CONCLUSION

Measurements obtained with all three devices had high correlation. USP and NCSM were found in good agreement and high concordance, too. The above results indicate that these two devices are interchangeable in clinical practice. Pentacam HR may be a useful alternative for measuring CCT; however, it significantly underestimates CCT and cannot be used interchangeably with the other devices that we studied.

Reproducibility, Repeatability, and Correlation of Central Corneal Thickness Measurement with the Pentacam Scheimpflug System and Ultrasound Pachymetry

BACKGROUND/AIM

The importance of an accurate determination of central corneal thickness (CCT) relies on its diagnostic and therapeutic implications in glaucoma, corneal ectasias, corneal edema and endothelial function monitoring, and refractive surgery suitability, among others. We aimed to analyze the repeatability, reproducibility, correlation, and laterality variations of CCT measurements performed with the Pentacam HR and the standard of care ultrasound A-scan (USP).

METHODS

A cross-sectional study including CCT measurements of healthy individuals was performed by three independent examiners with the Pentacam HR and USP. Intra-observer and inter-observer variations were calculated with intra-class correlation coefficients (ICCs). Bland-Altman plots and 95% limits of agreement (95% LoA) were used to assess the agreement between devices. Linear correlation was calculated with Pearson's coefficient.

RESULTS

Thirty individuals (60 eyes), including 10 (33.3%) men and 20 (66.6%) women, with a mean age of 30.0 ± 9.1 years, were studied. No statistical differences were found in CCT measurements between Pentacam HR (range 500 - 609 µm) and USP (range 498 - 628 µm). There was a high degree of correlation in repeatability and reproducibility of each independent device (ICC > 0.90). Pearson's correlation between 1 vs. 2, 2 vs. 3, and 3 vs. 1 Pentacam HR attempts were 0.914, 0.958, and 0.925, respectively (p < 0.001). Corresponding results for USP were 0.957, 0.957, and 0.943 (p < 0.001). The Pentacam HR tended to overestimate CCT by a mean difference of 3.77 µm (95% LoA, - 24.9 - 18.4). Right eyes were also overestimated (- 3.6 ± 14.1 µm) with the Pentacam HR device, whereas left eyes were underestimated (1.3 ± 11.1 µm).

CONCLUSIONS

The Pentacam HR device provides reliable operator-independent estimates of CCT. Right eyes exhibited a tendency to overestimate with the Pentacam HR. We suspect this difference is due to USP underestimation related to patients' position while performing the study. In clinically relevant scenarios, performing a third measurement and cautiously measuring right eyes can provide higher accuracy.

The Functional Anatomy of the Cornea and Anterior Chamber in Lampreys: Insights From the Pouched Lamprey, Geotria australis (Geotriidae, Agnatha)

Extant lampreys (Petromyzontiformes) are one of two lineages of surviving jawless fishes or agnathans, and are therefore of critical importance to our understanding of vertebrate evolution. Anadromous lampreys undergo a protracted lifecycle, which includes metamorphosis from a larval ammocoete stage to an adult that moves between freshwater and saltwater with exposure to a range of lighting conditions. Previous studies have revealed that photoreception differs radically across the three extant families with the Pouched lamprey Geotria australis possessing a complex retina with the potential for pentachromacy. This study investigates the functional morphology of the cornea and anterior chamber of G. australis, which is specialised compared to its northern hemisphere counterparts. Using light microscopy, scanning and transmission electron microscopy and microcomputed tomography, the cornea is found to be split into a primary spectacle (dermal cornea) and a scleral cornea (continuous with the scleral eyecup), separated by a mucoid layer bounded on each side by a basement membrane. A number of other specialisations are described including mucin-secreting epithelial cells and microholes, four types of stromal sutures for the inhibition of stromal swelling, abundant anastomosing and branching of collagen lamellae, and a scleral endothelium bounded by basement membranes. The structure and function of the cornea including an annular and possibly a pectinate ligament and iris are discussed in the context of the evolution of the eye in vertebrates.

Functional morphology of the cornea of the Little Penguin Eudyptula minor (Aves)

The cornea is a specialized component of the vertebrate eye that provides protection, refractive power, transparency for optical imaging and mechanical support. However, the corneas of birds have received little attention with no comprehensive study of their functional morphology. Using light microscopy and both scanning and transmission electron microscopy, the first description of the ultrastructure of all of the main components of the cornea in two different-sized individuals of the Little Penguin Eudyptula minor is presented. Two types of microprojections protrude from the surface of the cornea with a predominance of microridges and microvilli found in central (flattened) and peripheral regions, respectively. Epithelial cell density is higher in peripheral cornea, especially in the larger (older) individual, while there is a reduction of epithelial cell density with age. The cornea comprises a thick epithelium uniquely attached to the basement membrane with numerous incursions rather than anchoring fibres and anchoring plaques as is found in other vertebrate corneas. Posterior to Bowman's layer, the orthogonally-arranged collagen fibril lamellae in the stroma form extensive branches and anastomoses. Desçemet's membrane is well-developed with an anterior or foetal portion with long banding. However, the thickness of Desçemet's membrane is larger in the older individual with the inclusion of an additional irregular pale-staining posterior portion. Polygonal endothelial cells extend across the cornea as a monolayer with often tortuous cell junctions. Endothelial cell density increases towards the periphery, but decreases with age. Primary cilia are observed protruding through the central region of some endothelial cells into the anterior segment but subsurface structures resembling cilia suggest that these features may be more common. The ultrastructure of the corneal components reveals a range of functional adaptations that reflect the amphibious lifestyle of this seabird.

Corneal sensitivity is required for orientation in free-flying migratory bats

The exact anatomical location for an iron particle-based magnetic sense remains enigmatic in vertebrates. For mammals, findings from a cornea anaesthesia experiment in mole rats suggest that it carries the primary sensors for magnetoreception. Yet, this has never been tested in a free-ranging mammal. Here, we investigated whether intact corneal sensation is crucial for navigation in migrating Nathusius' bats, Pipistrellus nathusii, translocated from their migratory corridor. We found that bats treated with corneal anaesthesia in both eyes flew in random directions after translocation and release, contrasting bats with a single eye treated, and the control group, which both oriented in the seasonally appropriate direction. Using a Y-maze test, we confirmed that light detection remained unaffected by topical anaesthesia. Therefore our results suggest the cornea as a possible site of magnetoreception in bats, although other conceivable effects of the anaesthetic are also explored. Furthermore, we demonstrate that the corneal based sense is of bilateral nature but can function in a single eye if necessary.

Pentacam pachometry: comparison with non‐contact specular microscopy on the central cornea and inter‐session repeatability on the peripheral cornea

PURPOSE

Our aim was to compare specular microscopy (SM) and a new corneal topographer with rotating Scheimpflug camera (Pentacam) for non-contact pachometry of the central cornea. The repeatability of Pentacam for topographic pachometry was also studied.

METHODS

Thirty-nine subjects were recruited and one eye was selected randomly for non-contact pachometry by SM and by Pentacam, in random order. The corneal thickness (CT) was monitored at 30-second intervals for 10 minutes. Baseline CT was defined as the average of all measurements taken over the 10 minutes. Subjects were required to return within one to two weeks for a second corneal evaluation by Pentacam. Comparisons were made on the central CT between the two devices and on the topographic CT from Pentacam between the two visits.

RESULTS

The spontaneous variation of central CT was similar for the two instruments. Central CT varied within +/-2.3 microm during the 10 minutes. The 95% limits of agreement between SM and Pentacam were within +/-15 microm for the central CT. The spontaneous variation of peripheral CT was within +/-3.1 microm. There was no significant difference (p > 0.05) between the two visits on CT at different regions. Further analysis found that with Pentacam three measurements should be taken to obtain topographic CT measurement of one per cent precision.

CONCLUSION

Non-contact specular microscopy and Pentacam have good agreement for central CT measurement. Topographic pachometry from Pentacam requires three repeated measurements for one per cent precision.

Comparison of central corneal thickness measurements with three different optical devices

Purpose:

The purpose of this study was to compare and evaluate the agreement of central corneal thickness (CCT) values obtained with three different devices working according to optical principle in healthy eyes.

Methods:

60 eyes of 60 individuals (30 men and 30 women) were enrolled in this study. CCT measurements performed with Scheimpflug–Placido topographer (Sirius), spectral-domain optical coherence tomography (RTVue) with an anterior segment module, and optical biometer (AL-Scan) were compared. Bland–Altman analysis was used to demonstrate agreement between methods.

Results:

The mean age was 30.07 ± 7.313 years (range, 18–47 years). The mean CCT values obtained by RTVue, Sirius, and AL-Scan were 518.25 ± 36.38 µm, 526.08 ± 36.33 µm, and 513.50 ± 39.09 µm, respectively. The mean differences in CCT were 7.83 ± 14.15 µm between Sirius and RTVue, 12.58 ± 11.87 µm between Sirius and AL-Scan, and 4.75 ± 4.50 µm between RTVue and AL-Scan. The mean CCT was statistically different among the three groups (p < 0.05). All three modalities of CCT measurements correlated closely with each other, with Pearson’s correlation coefficients ranging from 0.924 to 0.961. The 95% limits of agreement were −19.90 to 35.56 µm between Sirius and RTVue, −10.69 to 35.85 µm between Sirius and AL-Scan, and −4.07 to 13.58 µm between RTVue and AL-Scan.

Conclusion:

Different results could be obtained through different noncontact devices in CCT measurements. Although the measurement values obtained by these devices show a high level of correlation, it would be a more correct approach to not use them directly interchangeably in clinical practice. Evaluation and follow-up of CCT should be performed using the same device.

Non-contact specular microscopy with Topcon instruments to assess central corneal thickness of healthy human eyes - A 20 year review

BACKGROUND

The purpose of this review was to evaluate the consistency of central corneal thickness (CCT) values reported with use of Topcon SP-2000 P and SP-3000 P non-contact specular microscopes since their introduction in 1999 with the two microscopes having been commonly used in a wide range of studies.

METHODS

As a primary resource, PubMed was used to search for peer-reviewed articles in any language that included CCT values obtained with non-contact specular microscopy reported for humans with nominally healthy corneas. Relevant articles were obtained and any cited publications also checked.

RESULTS

A total of 76 articles were identified which reported CCT on different small-to-moderate sized groups of individuals, published between 1999 and 2019. From these, an overall group mean CCT value of 0.525 ± 0.013 mm (median 0.525 mm) can be calculated. An estimated 95 % confidence interval (CI, based on 1.96 SD) would be between 0.500 and 0.550 mm. For the two Topcon models, the group mean ± SD values were 0.529 ± 0.013 mm and 0.517 ± 010 mm respectively. An assessment of the CCT data sets in relation to the reported average age indicated no statistically significant effect (p = 0.289, r = -0.129). Very similar average CCT values were also encountered in 4 other reports where these microscopes were used in large-scale population studies as well as in 2 other reports using the newer Topcon SP-1 P model.

CONCLUSIONS

The Topcon stand-alone non-contact specular microscopes have yielded consistent and predictable corneal thickness measures over many years.

Corneal delivery of moxifloxacin and dexamethasone combination using drug-eluting mucoadhesive contact lens to treat ocular infections

The important causes of loss of vision are ocular infections, including keratitis and conjunctivitis. Attaining an adequate concentration of topically applied antibiotics to prevent or treat infections within the cornea is challenging. The study aimed to design and develop a drug-eluting polymeric contact lens for the effective delivery of moxifloxacin (MF) and dexamethasone (DM). The polymeric contact lens was prepared using chitosan, glycerol, and polyethylene glycol. MF and DM were loaded into the contact lens, both separately and in combination. The MF and DM loaded contact lenses were characterized for thickness, swelling index, surface topography, and mucoadhesion strength. Furthermore, studies were performed to understand the in vitro drug release behavior, ex vivo corneal permeation, and in vitro and in vivo antimicrobial activity. The drug-loaded contact lens was compared with the standard drug solutions. The physical characteristics of the polymeric contact lens were similar to the commercially available contact lens. Compared to the topically applied standard drug solutions, the drug-loaded contact lens showed significantly (p < 0.05) greater corneal drug distribution after 24 h incubation. In vitro and in vivo antimicrobial activity of the MF loaded contact lens was superior to the standard drug solution. In vivo drug distribution studies showed greater tissue concentration of MF in cornea, sclera, and aqueous humor with contact lens application compared with drug solutions. Overall, the polymeric contact lens was efficient in delivering MF and DM at required therapeutic concentrations. The findings from the present study show that drug-eluting contact lenses could be used in post-operative conditions to prevent ocular infections.

A comparison of the ultrastructure of the cornea of the pre- and post-metamorphic axolotl (Ambystoma mexicanum, Amphibia)

The corneal ultrastructure of the pre- and post-metamorphic stages of the neotenic axolotl Ambystoma mexicanum is examined using light microscopy and both scanning and transmission electron microscopy to reveal whether there are any morphological changes associated with a switch in lifestyle. Although the complement of corneal layers remains the same, there are significant quantitative changes in corneal, epithelial and stromal thickness, epithelial and endothelial cell size and density, and the thickness of Bowman's layer and Desçemet's membrane. Microholes in the epithelium and vertical sutures within the stroma are predominant features in the pre-metamorphic stage but are rarely seen in the post-metamorphic stage. There are also significant quantitative centro-peripheral differences in the thickness of the whole cornea, primarily due to differences in the thickness of the stroma in both metamorphic stages. These changes may reflect the physiological demands on the cornea as it switches from a purely aquatic to an amphibious lifestyle, which includes venturing onto land.

Effect of Topical 1% Tetracaine Hydrochloride on Intraocular Pressure in Ophthalmologically Normal Horses; a Pilot Study

The aim of this study was to evaluate the effect of topical 1% tetracaine hydrochloride on the intraocular pressure (IOP) in ophthalmologically normal horses. Thirty eyes of 15 clinically normal horses were used for this study. The animals were randomly assigned to two groups (treatment and control). Prior to the instillation of 1% tetracaine or placebo, the baseline IOPs (T0) of each animal were recorded in both groups. Then one drop of tetracaine was instilled randomly into one eye of each horse in the treatment group (8 horses). In the control group (7 horses), one drop of artificial tear was instilled in one randomly selected eye. The measurements were repeated at 2 minutes (T2), 5 minutes (T5), 15 minutes (T15), and 30 minutes (T30) post instillation via a rebound tonometer. There was no significant difference in the treatment group (P = .3). The peak IOP measured at T2 returned to the baseline value at T30. No significant difference was found in the mean IOP values between the treatment and the control groups, or between the males and females on any of the occasions (P > .05). The Results of this study revealed a nonsignificant increase of the IOP 2 minutes post instillation of 1% tetracaine in horses.

Comparison of Central Corneal Thickness Measurements Using Optical and Ultrasound Pachymetry in Glaucoma Patients and Elderly and Young Controls

PRéCIS:: Optical and ultrasound pachymetry cannot be used interchangeably in young, healthy adults. In elderly, healthy and glaucoma patients the speed of ultrasound in the cornea increases because of changing corneal biomechanical characteristics in age and disease and the different devices could be used interchangeably.

PURPOSE

The purpose of this study was to compare central corneal thickness (CCT) using optical and ultrasound pachymetry in patients with open-angle glaucoma and young as well as elderly, healthy controls. Further to investigate whether the devices could be used interchangeably.

METHODS

In total, 69 eyes of 41 glaucoma patients, 51 eyes of 32 elderly and 50 eyes of 25 young controls were consecutively included in this cross-sectional observational study. Optical CCT measurements were obtained using the noncontact Specular Microscope CEM-530 (NCSM). Ultrasound pachymetry (USP) was measured using the Pachy Meter SP 3000.

RESULTS

In young subjects (27.2±4.8 y), the mean CCT taken with NCSM and USP was 562.1±33.6 μm and 565.8±35.8 μm, respectively. This was significantly different (USP>NCSM, P=0.019). In elderly subjects (70.6±10.7 y) CCT measured with NCSM (562.5±27.8 μm) compared to USP (564.9±27.1 μm) was not statistically significantly different (P= 0.121). In glaucoma patients (65.0±11.1 y), USP measured thinner CCT values compared to NCSM, without significant differences between the devices (NCSM 525.3±32.3 μm; USP 522.9±33.15 μm; P=0.067). CCT was significantly thinner in comparison to both healthy groups (P< 0.001).

CONCLUSIONS

In young subjects, ultrasound pachymetry measurements are higher than they are with optical pachymetry. This difference is no longer observed in elderly subjects and is even reversed in glaucoma patients. A higher speed of ultrasound in the cornea due to changing corneal biomechanical properties in the elderly and glaucoma patients could explain this. The devices could be used interchangeably in older and glaucoma patients, but not in young individuals.

Long-acting liposomal corneal anesthetics

Eye drops producing long-acting ocular anesthesia would be desirable for corneal pain management. Here we present liposome-based formulations to achieve very long ocular anesthetic effect after a single eye drop instillation. The liposomes were functionalized with succinyl-Concanavalin A (sConA-Lip), which can bind corneal glycan moieties, to significantly prolong the dwell time of liposomes on the cornea. sConA-Lip were loaded with tetrodotoxin and dexmedetomidine (sConA-Lip/TD), and provided sustained release for both. A single topical instillation of sConA-Lip/TD on the cornea could achieve 105 min of complete analgesia and 608 min of partial analgesia, which was significantly longer than analgesia with proparacaine, tetrodotoxin/dexmedetomidine solution or unmodified liposomes containing tetrodotoxin and dexmedetomidine. sConA-Lip/TD were not cytotoxic in vitro to human corneal limbal epithelial cells or corneal keratocytes. Topical administration of sConA-Lip/TD provided prolonged corneal anesthesia without delaying corneal wound healing. Such a formulation may be useful for the management of acute surgical and nonsurgical corneal pain, or for treatment of other ocular surface diseases.

Accuracy of Cirrus HD-OCT and Topcon SP-3000P for measuring central corneal thickness

PURPOSE

To compare and analyze the interchangeability of three measuring systems, each based on a different technique, for central corneal thickness (CCT) analysis.

METHODS

CCT measurements were measured using optical coherence tomography (OCT), non-contact specular microscopy (NCSM), and ultrasonic pachymetry (USP) in 60 eyes of 60 healthy patients with a mean age of 66.5±15.0 years and a mean spherical equivalent of 0.43±1.14 D. Analysis of variations in measurement concordance and correlation among the three different methods were performed. Comparison of CCT measurements were done using Bland-Altman plots (with bias and 95% confidence intervals), intraclass correlation coefficient (ICC), and paired t-student analysis.

RESULTS

Mean CCT values were: 549.20±26.91μm for USP (range 503-618μm), 514.20±27.49μm for NCSM (range 456-586μm) and 542.80±25.56μm for OCT (range 486-605μm). CCT values obtained with NCMS were significantly lower than those obtained with OCT and USP methods. NCMS CCT value was 36.08±10.72μm lower than USP value (p<0.05), and NCMS CCT value was 7.88±8.86μm lower than OCT value (p<0.05). ICC between USP-NCSM pair was 0.488 and 0.909 between USP-OCT pair.

CONCLUSION

OCT and UPS offered highly comparable results, whereas NCSM offered lower mean CCT values compared to the other two methods. Therefore, NCSM should not be considered a reliable method for measuring CCT and should rather be considered for assessing longitudinal changes in the same patient.

Effect of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on intraocular pressure in dogs

PURPOSE

To measure IOP in animals, it is often necessary to use topical anesthetics. The use of these drugs may cause changes in IOP and interfere with the final results. To address this issue, the effects of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on IOP were investigated in ten adult dogs.

METHODS

One drop of tetracaine was instilled in the right eye of half of the dogs and in the left eye of the other dogs; normal saline was instilled in the fellow eyes. The IOP in each dog was measured before and at 0, 5, 10, 15, 20, 25, 30, and 35 min after drug instillation using an electronic rebound tonometer. The effects of the other anesthetics were studied in the same way at intervals of at least 1 week.

RESULTS

After instillation of tetracaine, the IOP decreased gradually, such that after 15 min, the IOP was significantly lower than the baseline (p = 0.022) and control values (p = 0.048). Proparacaine also reduced IOP after 10 min compared to baseline values (p = 0.046), but the two other drugs, bupivacaine and lidocaine, had no significant effect on IOP. The duration of eye anesthesia was 16, 20, 22, and 34 min for tetracaine, lidocaine, bupivacaine, and proparacaine, respectively.

CONCLUSION

We recommend using drugs that combine inducing longer anesthesia with producing the smallest change in IOP, such as bupivacaine and, subsequently, lidocaine. Tetracaine and proparacaine have a significant effect on IOP, and if these drugs are used, this effect should be considered.

Reproducibility of Central Corneal Thickness Measurements in Normal Eyes Using the Zeiss Cirrus 5000 HD-OCT and Pentacam HR

Objectives:

To determine the repeatability and reproducibility of Central Corneal Thickness (CCT) measurements using two different anterior segment imaging modalities, including those obtained with the new anterior segment lens attachments for the Cirrus 5000 HD-OCT.

Methods:

A total of 32 eyes from 16 normal volunteers (8 male, 8 female) were enrolled in this prospective study. CCT was measured by the same examiner using the Cirrus 5000 HD-OCT and Pentacam HR. The results of CCT obtained by each method were averaged and compared using t-test analysis. The agreement between the measurement methods was evaluated. Coefficient of Repeatability (CoR) and Intra-Class Correlation Coefficient (ICC) were computed.

Results:

The mean measurements taken with the Cirrus OCT anterior chamber lens (CCT_AC), HD cornea lens (CCT_HDC) and pachymetry scans (CCT_Pach) were 545.35 ± 31.02, 537.87 ± 26.82, and 532.04 ± 29.82 µm, respectively. The mean CCT obtained with the Pentacam (CCT_Pent) was 545.51 ± 30.71 µm. CCT_Pent were significantly higher than CCT_HDC and CCT_Pach (p< 0.0001). In contrast, the CCT_Pent and CCT_AC were similar (p=0.87). CCT, as evaluated by the two different instruments, showed excellent correlation (r > 0.98, p< 0.0001) with an ICC > 0.99 (95% CI, 0.97 – 0.99). CoR was the highest for CCT_Pach (3.7 ± 1.4, 95% CI (3.0- 4.6)).

Conclusion:

CCT measurements from the Cirrus OCT using the new anterior segment lens attachments and the Pentacam HR are highly correlated. This should allow the use of a standardized correction factor if necessary to inter-relate the measurements between the two devices.

Corneal Thickness Response after Anesthetic Eye Drops: Our Own Results and Meta-Analysis

We aimed to test if there are different patterns in the central corneal thickness (CCT) response after instilling oxybuprocaine anesthetic eye drops and also to determine whether there is a significant change in the CCT. CCT was measured in 60 eyes of 60 healthy subjects before and during the hour after oxybuprocaine 0.4% eye drops were instilled. In addition, a systematic review and meta-analysis were carried out in order to answer the following PICO (patient, intervention, comparison, and outcome) question: What effect do anesthetic eye drops have on CCT values? We found no significant changes in the mean CCT values during the hour's observation (ANOVA, p = 0.209), and the meta-analysis revealed no statistically significant changes in the CCT after anesthesia (Q-Value = 1.111; p value = 1.000; I2 = 0.000; Tau2 = 0.000; Stderr = 0.020). However, we found three CCT response patterns 5 minutes after anesthesia: Pattern 1, subjects with no significant changes in their CCT values (n = 14, 46.7%); Pattern 2, subjects with significant CCT increases (n = 11, 36.7%); and Pattern 3, subjects with significant CCT decreases (n = 5, 16.7%). In sum, there are no significant changes in the CCT after anesthesia, but there are three different CCT response patterns 5 minutes after anesthesia.

Comparison of Central Corneal Thickness Measurements Using Ultrasonic Pachymetry, Anterior Segment OCT and Noncontact Specular Microscopy

PURPOSE

To evaluate and compare central corneal thickness (CCT) values measured with anterior segment optical coherence tomography (AS-OCT), noncontact specular microscopy (NCSM), and ultrasound pachymetry (USP).

MATERIALS AND METHODS

CCT was measured in 182 healthy eyes without ocular abnormalities other than refractive errors. Three consecutive measurements of CCT by the same examiner were obtained during the same session. The testing sequence of AS-OCT and NCSM was randomly selected. The USP always was performed after the noncontact examinations.

RESULTS

The average CCT measured by AS-OCT, NCSM, and USP were 535.8±35.5, 547.7±38.2, and 537.4±37.5 μm, respectively. The mean differences between modalities were 11.8±14.7 μm (P<0.01) between NCSM and AS-OCT, 10.3±17.7 μm (P<0.01) between NCSM and USP and 1.6±8.6 μm (P=0.02) between USP and AS-OCT.

CONCLUSIONS

AS-OCT, NCSM, and USP showed an overall strong agreement in measuring CCT. However, CCT measurements with AS-OCT showed a good correlation to those obtained by USP, NCSM tended to give statistically significant higher CCT readings than either alternative and showed the worse repeatability indices. On the basis of our results, CCT measurement obtained with different instruments cannot be considered directly interchangeable.

Comparison of Central Corneal Thickness using Anterior Segment Optical Coherence Tomography Versus Ultrasound Pachymetry

INTRODUCTION

Corneal thickness is an important and sensitive indicator of corneal health. It is useful in monitoring corneal diseases such as corneal oedema and keratoconus, and selecting patients for refractive surgery. Central Corneal Thickness (CCT) is a risk factor for Primary Open-Angle Glaucoma (POAG).

AIM

To compare CCT using ultrasound pachymetry and Anterior Segment Optical Coherence Tomography (AS-OCT), and also to find out the reproducibility of AS-OCT readings for both central and pericentral corneal areas.

MATERIALS AND METHODS

This prospective cross-sectional study was conducted on 120 patients above 40 years of age, and with clinically normal corneas, who underwent CCT measurements by both ultrasound and AS-OCT. Both the eyes were analysed. Two measurements by AS-OCT and 25 measurements by ultrasound pachymetry were taken. The readings were averaged and compared by paired t-test. Repeatability of the OCT pachymetry map sector averages, was assessed by pooled standard deviation, obtained from the two measurements taken from each eye.

RESULTS

The CCT in right eye by OCT and ultrasound was 516.28±29.76 µm and 532.42±29.71 µm, respectively. The CCT in left eye by OCT and ultrasound was 515.82±29.88 µm and 532.36±29.83 µm, respectively. The difference in CCT measurement by AS-OCT and ultrasound was statistically significant (p<0.001); mean ultrasound CCT being 16.14 µm and 16.54 µm greater than the mean AS-OCT, CCT in right eye and left eye respectively. For AS-OCT, intra-session repeatability was measured. Repeatability of the OCT mapping was 0.01 µm to 1.6 µm and 0.01 µm to 1.9 µm in the right eye and left eye respectively.

CONCLUSION

The CCT measurement by ultrasound pachymetry gives higher values compared to AS-OCT measurement. Hence, they cannot be interchangeably used in clinical practice. The AS-OCT provides highly repeatable pachymetry map measurements both centrally and pericentrally.

Repeatability of Central Corneal Thickness Measurement Using Rotating Scheimpflug Camera in Dry and Normal Eyes

PURPOSE

To compare the repeatability of central corneal thickness (CCT) measurement using the Pentacam between dry eyes and healthy eyes, as well as to investigate the effect of artificial tears on CCT measurement.

METHODS

The corneal thicknesses of 34 patients with dry eye and 28 healthy subjects were measured using the Pentacam. One eye from each subject was assigned randomly to a repeatability test, wherein a single operator performed three successive CCT measurements time points-before and 5 min after instillation of one artificial teardrop. The repeatability of measurements was assessed using the coefficient of repeatability and the intraclass correlation coefficient.

RESULTS

The coefficient of repeatability values of the CCT measurements in dry and healthy eyes were 24.36 and 10.69 μm before instillation, and 16.85 and 9.72 μm after instillation, respectively. The intraclass correlation coefficient was higher in healthy eyes than that of in dry eyes (0.987 vs. 0.891), and it had improved significantly in dry eyes (0.948) after instillation of one artificial teardrop. The CCT measurement fluctuated in dry eyes (repeated-measures analysis of variance, P<0.001), whereas no significant changes were detected in healthy eyes, either before or after artificial tear instillation.

CONCLUSIONS

Central corneal thickness measurement is less repeatable in dry eyes than in healthy eyes. Artificial tears improve the repeatability of CCT measurements obtained using the Pentacam in dry eyes.

Differences in Central Corneal Thickness between Spectral Domain-Optical Coherence Tomography and Ultrasound Pachymetry in Patients with Dry Eye Disease

Purpose. To compare central corneal thickness (CCT) values via Spectral Domain-Optical Coherence Tomography (SD-OCT) and ultrasonic pachymetry in patients with severe dry eye disease (DED) to determine the level of agreement between these 2 methods. Methods. The paired samples t-test was used to compare CCT values in severe DED patients. Matching analysis between methods was performed using intraclass correlation coefficient (ICC). Intrasession reliability of the measurement methods was calculated via the concordance correlation coefficient (CCC), variation equivalent, and Pearson's correlation coefficient. The Bland-Altman procedure was used to graphically represent the differences between CCT values. Results. The study included 56 eyes of 24 female and 4 male patients. Mean age of the patients was 50.9 ± 11.3 years. Mean CCT via Cirrus SD-OCT was 523.82 ± 30.98 μm versus 530.050 ± 31.85 μm via ultrasonic pachymetry (paired samples t-test, P < 0.001). The Bland-Altman plot showed good agreement between the examiners. The ICC for repeatability was 0.974. The CCC between the 2 methods' CCT values was 0.973. The variation equivalent was 0.976 and Pearson's correlation coefficient was 99.3%, which also indicated high correlation between the 2 methods' measurements. Conclusions. The present findings show that in patients with severe DED Cirrus SD-OCT provides reliable intraobserver CCT values.

Anterior Segment Biometry Changes with Cycloplegia in Myopic Adults

PURPOSE

To determine the effect of cycloplegia on corneal thickness, corneal curvature, anterior chamber depth (ACD), angle-to-angle (ATA) and white-to-white (WTW) distances, and axial length (AL).

METHODS

Changes in corneal thickness, corneal curvature, ACD, ATA and WTW distances, and AL with and without cycloplegia were analyzed in 31 eyes of 31 young myopic adults, aged 26.4 ± 3.0 years. Pentacam was used to measure the corneal thickness, corneal volume, and corneal curvatures. Visante optical coherent tomography (OCT) measured corneal thickness, ATA distance, ACD, and pupil size. The AL and WTW distance were measured using IOLMaster.

RESULTS

Cycloplegia induced significant flattening of corneal curvatures (p = 0.019, 0.001, and 0.003 for anterior sagittal, posterior tangential, and posterior sagittal curvatures, respectively). The difference in the posterior corneal curvature was greater in corneas with steeper posterior curvatures. Cycloplegia also induced significant deepening of ACD (0.08 ± 0.06, p < 0.001) and widening of both WTW (0.42 ± 0.43, p < 0.001) and ATA (0.08 ± 0.17, p = 0.015) distances. The cycloplegia-related increase in the ATA distance correlated negatively with AL (r = -0.361, p = 0.046), whereas the cycloplegia-related increase in WTW distance correlated weakly with the increase in ACD (r = 0.347, p = 0.056) but not with AL. The AL did not change with cycloplegia. Pentacam measured a slightly thicker cornea than OCT (p = 0.002). Both Pentacam and OCT detected a significant increase in corneal thickness of 4 μm, which could be attributed to reflex tearing, after cycloplegia.

CONCLUSIONS

Cycloplegia resulted in deeper ACD, greater ATA distance, and flatter corneal curvatures. Surgeons should be aware of these cycloplegia-related alterations for more accurate phakic/functional intraocular lens selection and better refraction results.

Effect of supine body position on central corneal thickness

BACKGROUND

To evaluate the effect of supine body position on central corneal thickness (CCT) in open-angle glaucoma patients and in healthy subjects.

DESIGN

A cross-sectional study at a university eye clinic.

PARTICIPANTS

Twenty-three subjects were recruited in each group, for a total of 46 patients.

METHODS

CCT was measured using an ultrasound pachymeter in each subject. Three consecutive measurements in each eye were first taken in the sitting position, and repeated after 10 min and 30 min in a supine position. Results were analyzed using mixed model repeated measures, which adjusted for age, gender and laterality of eyes.

MAIN OUTCOME MEASURES

CCT RESULTS: In healthy subjects, CCT decreased with supine positioning at 10 min (mean = -5.2 µm, P = 0.0043) and at 30 min (mean = -6.5 µm, P < 0.0001). In the glaucoma group, CCT decreased with supine positioning at 10 min (mean = -6.7 µm, P = 0.0043) and at 30 min (mean = -10.2 µm, P < 0.0001). There was no statistically significant difference between the CCT at 10 min supine and at 30 min supine in the healthy subjects (P = 0.37) and glaucoma patients (P = 0.14). CCT was shown to decrease linearly over time (P < 0.0001), and the slopes were not statistically different between groups (P = 0.40).

CONCLUSIONS

CCT is a dynamic measurement that can be influenced by body position. It decreases linearly in the first 30 min of supine positioning at a similar rate in both open angle glaucoma patients and in healthy subjects.

The effect of oxybuprocaine on corneal thickness as measured with optical coherence tomography

Background: No previous study in South Africa has used optical coherence tomography (OCT) in assessing corneal thickness changes following the instillation of an anaesthetic.Aim: The purpose of this study was to investigate the short-term effects of oxybuprocaine 0.4% on corneal thickness.Setting: The study was conducted at a university eye clinic in Westville, KwaZulu-Natal.Methods: A total of 34 (N = 34) participants, of both genders, aged 18–25 years participated in the study. Data collection commenced once ethical clearance was obtained. Baseline measurements of central corneal thickness (CCT) (within 0 mm – 2 mm of the corneal apex) and mid-peripheral corneal thickness (MPCT) (within 2 mm – 5 mm of the corneal apex) were taken using the Optovue iVue 100 OCT. Measurements were obtained using the standard iVue 100 corneal pachymetry map. One drop of oxybuprocaine was then instilled using a sterile technique in the right eye (RE) of each participant. Central and MPCT measurements were obtained using the OCT at time intervals of 30 s for the first 2 min and then for 60-s intervals up until 5 min. Baseline central and MPCT were then measured for the left eye (LE) using the OCT. The effect of two drops of oxybuprocaine on CCT was also investigated on the left eye only using the same procedure as on the right eye.Results: There were minimal fluctuations of the CCT and MPCT in the 5 min following instillation of either one or two drops of oxybuprocaine. The fluctuation of both the CCT and MPCT was within 10 µm irrespective of dosage and returned to baseline thickness after 5 min.Conclusion: Clinically, short-term CCT and MPCT changes following the instillation of oxybuprocaine are not large enough to affect the accuracy of Goldmann applanation tonometry.

Evaluation of Central Corneal Thickness Using Corneal Dynamic Scheimpflug Analyzer Corvis ST and Comparison with Pentacam Rotating Scheimpflug System and Ultrasound Pachymetry in Normal Eyes

Purpose. To assess the repeatability and reproducibility of central corneal thickness (CCT) measurements by corneal dynamic Scheimpflug analyzer Corvis ST in normal eyes and compare the agreement with Pentacam rotating Scheimpflug System and ultrasound pachymetry. Methods. 84 right eyes underwent Corvis ST measurements performed by two operators. The test-retest repeatability (TRT), within-subject coefficient of variation (CoV), and intraclass correlation coefficient (ICC) were used to evaluate the intraoperator repeatability and interoperator reproducibility. CCT measurements also were obtained from Pentacam and ultrasound pachymetry by the first operator. The agreement between the three devices was evaluated with 95% limits of agreement (LoA) and Bland-Altman plots. Results. Corvis ST showed high repeatability as indicated by TRT ≤ 13.0 μm, CoV < 0.9%, and ICC > 0.97. The interoperator reproducibility was also excellent. The CoV was <0.9%, and ICC was >0.97. Corvis ST showed significantly lower values than Pentacam and ultrasound pachymetry (P < 0.001). The 95% LoA between Corvis ST and Pentacam or ultrasound pachymetry were −15.8 to 9.5 μm and −27.9 to 12.3 μm, respectively. Conclusions. Corvis ST showed excellent repeatability and interoperator reproducibility of CCT measurements in normal eyes. Corvis ST is interchangeable with Pentacam but not with ultrasound pachymetry.

Corneal thickness differences between sexes after oxybuprocaine eye drops

PURPOSE

We aimed to analyze the corneal thickness (CT) values of female and male subjects before and after instillation of oxybuprocaine 0.4% anesthetic eye drops.

METHODS

The CT of 30 female subjects and 28 male subjects was measured using scanning-slit corneal topography (Orbscan Topography System II, Orbscan, Inc, Salt Lake City, UT). Measurements were carried out before and 3 minutes after the instillation of oxybuprocaine 0.4% eye drops.

RESULTS

The difference between the baseline values and those obtained after anesthesia ranged as follows: male subjects: central, -26 to +24 μm; superior, -24 to +23 μm; inferior, -19 to +20 μm; nasal, -25 to +30 μm; and temporal, -21 to +20 μm; female subjects: central, -16 to +24 μm; superior, -19 to +32 μm; inferior, -14 to +34 μm; nasal, -19 to +33 μm; and temporal, -36 to +16 μm. No significant differences were found in any corneal location in male subjects. The differences were significant at inferior (p = 0.001) and nasal (p = 0.011) corneal sites in female subjects.

CONCLUSIONS

Oxybuprocaine anesthetic eye drops induce significant CT increases in female subjects but not in male subjects.

Agreement and reliability in measuring central corneal thickness with a rotating Scheimpflug-Placido system and ultrasound pachymetry

PURPOSE

We compare the agreement and the reliability in measuring central corneal thickness (CCT) using two different technologies.

METHOD

The right eyes of 35 healthy individuals who had a negative history of ophthalmic disease, or ocular surgery were examined. The CCT was determined sequentially with a rotating Scheimpflug camera (Sirius; CSO), and an ultrasound pachymeter (P-1; Takagi). For statistical analysis, we used the methods suggested by Bland and Altman.

RESULTS

The mean values of CCT obtained from Sirius, and ultrasound were 537±28μm, and 550±35μm, respectively. There was a high correlation between Sirius and ultrasound (r=0.92; p<0.001), but the difference between the two measurements was statistically significant (t=-5.7; p<0.00001). The precision of Sirius and ultrasound were 9.4 and 15.9μm; repeatability 13.3 and 22.4μm, and coefficient of variation 0.9% and 1.5%, respectively. The intraclass correlation coefficient was 0.97 for Sirius and 0.95 for ultrasound.

CONCLUSIONS

The average difference between corneal thickness measured with Sirius and ultrasound pachymetry was small but clinically significant. This means that the two instruments cannot be used interchangeably. Sirius showed precision and repeatability almost twice as much as ultrasound pachymetry. Confidence interval of 13.3μm for Sirius can show variations in corneal thickness with an uncertainty value lower than 2.5% in 95% of cases. The simplicity of use, the possibility to obtain pachymetric maps, and less invasiveness make this instrument potentially useful in contact lens practice.

Comparison of central corneal thickness measured with anterior segment optical coherence tomography versus ultrasonic pachymetry

PURPOSE

To compare central corneal thickness measured with anterior segment optical coherence tomography (AS-OCT) and ultrasonic pachymetry (UP).

METHOD

A prospective, observational and cross-sectional study was performed. The central corneal thickness was measured in 112 eyes of 112 consecutive patients with AS-OCT and UP. All examinations were performed by the same examiner. The measurements obtained between the 2 instruments were compared to assess the level of agreement.

RESULTS

The average corneal thickness value obtained by AS-OCT was 531.47 ± 26.23 μm, while that measured by UP was 532.51 ± 26.04 μm. The intraclass correlation coefficient was 0.957 (P <.001). The Student's t-test did not show a statistically significant difference (1.04 ± 7.70 μm, P =.158). Finally, the Bland-Altman analysis showed a high level of agreement between 2 methods of measurement.

CONCLUSIONS

In the context of normal corneas, there was good agreement between the measurement of central corneal thickness with AS-OCT and UP, although there was a slight overestimation of the measurement using UP (1.04 μm).

Comparison of the influence of nonpreserved oxybuprocaine and a preserved artificial tear (thera tears) on human corneal thickness measured by two pachymeters

PURPOSE

To compare the effect of nonpreserved oxybuprocaine and preserved artificial tears on central corneal thickness (CCT) obtained by 2 pachymeters.

METHODS

In this prospective, placebo-controlled study, involving a random sample of 100 eyes of 50 subjects, aged 24±2.3 years, CCT readings were obtained in 2 separate sessions with the Topcon SP-3000P and ultrasound pachymetry (USP), respectively, before, 5 and 10 min after instillation of a drop each of either oxybuprocaine hydrochloride (oxybuprocaine HCl) (group 1) or carboxymethylcellulose sodium, thera tears (group 2), and placebo.

RESULTS

The baseline mean CCT for SP-3000P was 509±38 μm and 542±36 μm for USP. No statistical significant differences between baseline CCTs (P>0.05 for both devices) in both groups. In both group experimental eyes, neither SP-3000P nor USP-measured CCTs varied significantly from the control eyes at 5 (P>0.05) and 10 (P>0.05) mins postinstillation of drops in both sessions. In group one, the 95% confidence intervals (CIs) for the SP-3000P CCTs were similar at 5 (-16 to 17 μm) and 10 min (-16 to 17 μm), but in the USP-measured CCTs, it was wider at 10 min (-41 to 46 μm) than at 5 min (-30 to 41 μm) postinstillation. In group two, the 95% CIs at 5 and 10 mins postinstillation, respectively, ranged between -20 and 47 μm, -21 and 43 μm (SP-3000P) and -29 and 23 μm, -26 and 23 μm (USP). Within groups and between groups, variations in CCT were similar at both times intervals in all comparisons.

CONCLUSION

Although oxybuprocaine HCl and thera tears consistently did not affect the mean CCT obtained by both devices at both time intervals, variation in SP-3000P measured CCT was more consistent in both sessions and narrower in relation to USP-measured CCT. It may be reasonable to suggest that measurements of CCT in normal patients be taken before examinations requiring instillation of anesthetics or such measurements when obtained postinstillation of either oxybuprocaine or preserved artificial tears be interpreted with caution.

Corneal thickness in keratoconus: comparing optical, ultrasound, and optical coherence tomography pachymetry

PURPOSE

To compare the central and peripheral pachymetry measurements determined using Orbscan IIz (Bausch & Lomb, Rochester, NY), Visante optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA), and RTVue OCT (Oculus Technologies, Wynwood, WA) with ultrasound pachymetry in eyes with established keratoconus and to evaluate the agreement between them.

DESIGN

Evaluation of diagnostic technologies.

PARTICIPANTS

One hundred six eyes of 67 consecutive patients with a clinical diagnosis of keratoconus ranging in age from 12 to 40 years.

METHODS

Central corneal thickness (CCT) was determined by all the 4 techniques. Peripheral corneal thicknesses were determined using Orbscan IIz, Visante OCT, and RTVue at 8 points (superior, inferior, temporal, nasal, superior-temporal, inferior-temporal, superior-nasal, and inferior-nasal) all in the 5.0- to 7.0-mm arcuate zone.

MAIN OUTCOME MEASURES

Central and peripheral keratoconus thickness.

RESULTS

Ultrasound pachymetry determined significantly higher CCT values than Orbscan IIz (P<0.001), Visante (P<0.001), and RTVue (P = 0.037), with a mean ± standard deviation difference of 14±3 μm, 13±2 μm, and 5±3 μm, respectively. The mean CCT difference was minimal (1±3 μm; P = 0.69) between the Orbscan IIz and Visante. A strong correlation was found (r>0.80) between all the CCT measurement techniques. Orbscan IIz significantly overestimated the peripheral thickness compared with the rest, and the mean differences ranged between 21 and 60 μm. Mean peripheral thickness differences between RTVue and Visante OCT always remained less than 20 μm. Weak correlations and larger limits of agreement were found between the techniques in thinner and peripheral zones.

CONCLUSIONS

Orbscan IIz, Visante, RTVue, and ultrasound pachymetry show high correlation, although Orbscan IIz and Visante significantly underestimated CCT measurements compared with ultrasound pachymetry in keratoconus. Orbscan IIz significantly overestimated peripheral corneal thickness compared with RTVue and Visante.

Lenstar versus ultrasound for ocular biometry in a pediatric population

PURPOSE

To compare the central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) measured with Lenstar with those obtained with ultrasound pachymetry and A-scan contact ultrasound (ASU) in children.

METHODS

ODs of 565 school children were included. All measurements were obtained 30 min after instilling 1% tropicamide. For each instrument, three consecutive measurements per each child were performed. Initially, examiner 1 performed measurements with Lenstar to obtain CCT, AL, ACD, and LT. Later, examiner 2 performed measurements with corneal pachymetry to obtain CCT. Finally, ASU was used by examiner 2 to obtain AL, ACD, and LT. Four parameters obtained with Lenstar were compared with those obtained with pachymetry and ASU using Pearson correlation coefficients (r) and Bland-Altman analyses.

RESULT

Lenstar measurements were obtained in 557 of 565 subjects(mean age; 10.48 ± 2.11 years, mean spherical equivalent of the ODs; +0.47 ± 1.18 diopters) whereas ASU and pachymetry could be performed in 530 of 565. Four hundred seventy-nine subjects were statistically assessed after 41 subjects were extracted as outliers from 530 subjects in whom all instruments could be performed. Mean difference between pachymetry and Lenstar was 13.20 ± 13.13 μm [95% confidence interval (CI): 12.01 to 14.37]. Mean difference between ASU and Lenstar was -0.72 ± 0.35 mm (95% CI: -0.75 to -0.69) for AL, -0.27 ± 0.32 mm (95% CI: -0.30 to -0.24) for ACD, and 0.24 ± 0.28 mm (95% CI: 0.22 to 0.27) for LT. R values were 0.912 (p < 0.001), 0.904 (p < 0.001), 0.487 (p < 0.001), 0.369 (p < 0.001) for CCT, AL, ACD, and LT respectively.

CONCLUSIONS

AL and ACD were found to be greater with Lenstar, whereas CCT and LT measures were smaller. It is concluded that there was agreement between instruments for CCT and ACD, because the small differences between measures were clinically insignificant. AL and LT values cannot be used interchangeably. If these differences are considered, Lenstar can replace ASU and pachymetry for the majority of children.

A comprehensive comparison of central corneal thickness measurement

PURPOSE

To assess the repeatability and reproducibility of central corneal thickness (CCT) measurements by high-resolution rotating Scheimpflug imaging (Pentacam, Oculus) and Fourier-domain optical coherence tomography (RTvue-100, Optovue) after laser in situ keratomileusis (LASIK) and to compare the agreement with ultrasound pachymetry (USP).

METHODS

Forty-seven eyes of 47 patients after LASIK were included in the study. The first examiner took two successive Pentacam and RTvue CCT measurements, and this was repeated once again by the second examiner to assess intraobserver and interobserver repeatability and reproducibility. After performing non-contact examinations, the corneas were measured by USP to compare the level of agreement among the three devices.

RESULTS

All Pentacamcenter, Pentacamapex, Pentacamthinnest, and RTvue CCT measurements demonstrated high intraobserver repeatability, with respective precision (1.96 within-subject standard deviation) and intraclass correlation coefficients of 7.52, 7.43, 7.55, and 3.81 μm and 0.985, 0.986, 0.986, and 0.997; interobserver repeatability results were similar. All coefficients of variation were low: <1% for all measures. Compared with Pentacam and USP measurements, the RTvue measurement significantly underestimated CCT by a mean of 10.52 to 15.28 μm (p < 0.001) and 9.17 μm (p < 0.001), respectively. The agreement of USP with Pentacam and RTvue by Bland-Altman analysis spanned over 30 μm. The agreement of Pentacam with RTvue spanned approximate 20 μm.

CONCLUSIONS

Both Pentacam imaging and RTvue Fourier-domain optical coherence tomography provide reliable and interchangeable measurement of CCT in post-LASIK corneas. However, they cannot be considered to be clinically interchangeable with USP.

Measurement of central corneal thickness by high-resolution Scheimpflug imaging, Fourier-domain optical coherence tomography and ultrasound pachymetry

PURPOSE

To compare the repeatability and reproducibility of central corneal thickness (CCT) measurements by high-resolution (HR) rotating Scheimpflug imaging and Fourier-domain optical coherence tomography (FD-OCT). CCT measurements were compared to those determined by ultrasound pachymetry (UP).

METHODS

In 35 healthy eyes, intra-observer repeatability for HR Scheimpflug (Pentacam) and FD-OCT (RTVue) systems was determined in consecutive images taken by an observer in the shortest time possible. Imaging was repeated again by a second observer to evaluate inter-observer reproducibility. The CCT measurements were compared among Scheimpflug, FD-OCT and UP images.

RESULTS

Mean coefficients of repeatability were 0.48% for Scheimpflug and 0.26% for FD-OCT. For Scheimpflug, the coefficient of inter-operator reproducibility was 0.87%. For FD-OCT, the coefficient of inter-operator reproducibility was 0.45%. The CCT measurements by Scheimpflug, OCT and UP images were (mean ± standard deviation) 521.7 ± 27.6 μm, 510.8 ± 28.6 μm and 516.5 ± 27.6 μm, respectively. The differences between instruments were statistically significant. The 95% limits of agreement in CCT were -0.7 to 22.5 μm for Pentacam-OCT, -13.4 to 24.0 μm for Pentacam-UP and -26.7 to 15.4 μm for OCT-UP. There was a high degree of correlation between CCT measured by all 3 methods.

CONCLUSION

Noncontact measurements of CCT with HR Scheimpflug and FD-OCT systems yielded excellent repeatability and reproducibility and can be used interchangeably. Although both devices were comparable with UP; in clinical practice, the measurements acquired by optical modalities are not directly interchangeable with UP measurements.