XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study

BACKGROUND AND OBJECTIVE

Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant.

METHODS

A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement.

RESULTS

Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments.

CONCLUSIONS

This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.

Effectiveness and safety of XEN63 in patients with primary-open-angle glaucoma

This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.

Influence of ocular biometric factors on the defocus curve in an enlarged depth-of-focus intraocular lens

BACKGROUND

To assess the influence of biometric measurements on the defocus curve after the implantation of enlarged depth-of-focus (EDoF) intraocular lens (IOL).

METHODS

Patients who underwent cataract surgery with bilateral implantation of Tecnis Symfony IOL were enrolled. Preoperatively, axial length (AL), corneal keratometry (K), pupil size and corneal aberrations were measured. 1 month after surgery, distance, intermediate, and near visual acuities (VA) were recorded. At 3 months, monocular and binocular corrected contrast sensitivities under photopic and mesopic lighting conditions were measured with CSV-1000E test. At 6-months, the defocus curve between -5.00 to + 3.00 diopters (D) was assessed in steps of 0.50 D, and NEI-RQL-42 questionnaire was administered.

RESULTS

One hundred thirty one eyes of 66 patients were included. Binocular logMAR VA better than 0.1 for intermediate vision was obtained in 90% of patients, whereas only 17.7% obtained that result in near vision. The rate of satisfaction was high (96%) and most of them (85.5%) had no or little difficulties in near vision. The mean amplitude of the defocus curve was 2.35D ± 0.73D, and smaller AL, smaller pupils, younger age, and male sex were associated with wider range of clear vision.

CONCLUSIONS

Tecnis Symfony IOL enables functional vision at all distances, but demographic variables and preoperative biometric measurements like AL and pupil size influence the postoperative amplitude of the defocus curve. These parameters could be used to predict the performance of EDoF IOLs.

Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life

PURPOSE

To evaluate the inner retinal layers in fibromyalgia (FM) patients compared to control subjects using posterior pole protocol (PPole) analysis in optical coherence tomography (OCT) and to correlate structural retinal changes with subjective quality of life.

METHODS

Seventy-four eyes of healthy subjects and 55 eyes of those with FM were analyzed. All subjects underwent retinal evaluation using the PPole protocol for Spectralis OCT (Heidelberg Engineering) to obtain measurements of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) in the macular area. The EuroQol (EQ-5D) questionnaire and Fibromyalgia Impact Questionnaire (FIQ) were performed to analyze health-related quality of life. Additionally, the FM group was divided into three groups depending on the disease phenotype (atypical, depressive and biological).

RESULTS

: Patients with FM presented with a reduction of the RNFL thickness compared to controls in 17/64 cells of the PPole area, and a reduction of the GCL thickness in 47/64 cells. Depressive FM phenotype showed the greatest number of cells with significant reduction compared with the control group in both RNFL and GCL layers. A correlation between temporal-inferior cells of the GCL and the EuroQol 5D questionnaire results was observed.

CONCLUSIONS

Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients.

Bias of near-infrared light in evaluation of patients implanted with multifocal intraocular lenses

PURPOSE

To compare visual quality between subjective tests and optical devices using near-infrared (NIR) light in patients implanted with monofocal, multifocal and enlarged depth-of-focus (EDoF) intraocular lenses (IOLs).

METHODS

Cross-sectional study enrolling patients aged between 55 and 75 (axial length between 22 and 25 mm) bilaterally implanted with Tecnis IOLs (Johnson & Johnson) four months previously: 40 patients (80 eyes) with monofocal ZCB00, 41 patients (82 eyes) with bifocal diffractive ZMB00 and 48 patients (96 eyes) with EDoF Symfony. They were examined using subjective and objective tests. The subjective tests comprised visual acuity (VA) with ETDRS charts, contrast sensitivity (CS) with Pelli-Robson and CSV-1000E tests, and clear vision range (CVR). The objective tests using NIR light were performed with the KR-1 W wavefront analyzer and the OQAS.

RESULTS

In the subjective tests, the monofocal group achieved the best outcomes in some of the VA and CS sections, while the bifocal group obtained the worst outcomes in some of the CS sections. In the objective tests, the bifocal group achieved the best results for VA and CS. Discrepancies between pseudoaccommodation range and CVR were found in the bifocal and EDoF groups.

CONCLUSIONS

Assessment of visual quality using NIR light implies greater bias for diffractive lenses than for EDoF lenses. This bias may be even greater with devices using longer light wavelengths or Hartmann-Shack technology. The difference in wavelength between NIR and visible light leads to dimming of near-vision focus and magnification of distance focus.

Morphometric Study of Wound Healing in a Model of Filtering Surgery with Mitomycin-C

Background

Failure of filtering surgery may be related to excessive wound healing in the surgical area. This effect diminishes with the use of antimetabolic agents. Mitomycin-C (MMC) has proved to be the most effective drug to reduce myofibroblastic proliferation in experimental in vivo and in vitro models. To our knowledge, the objective changes induced by mitomycin-C in the size of wound healing areas have not been investigated. Methods: Filtering surgery was performed on both eyes of 40 pigmented rabbits. Preoperatively one of the eyes received MMC (0.5 mg/ml), and the fellow eye received balance salt solution as placebo. Animals were killed on days 6, 15, 30 and 58. Microscopic healing areas were measured by digital procedures. The areas of target and fellow control eyes were compared by the Wilcoxon test.

Results

This study showed significant differences (p<0.05) between treated and untreated groups, the healing are a gradually becoming smaller.

Conclusions

Objective methods to quantify the microscopic effects of MMC can be useful to improve our knowledge about the action on this antimetabolite and to enable us to adjust more accurately the timing and dosage when applying the drug in glaucoma filtering surgery.

Long-Term Effects of Postoperative Subconjunctival Injections of Mitomycin-C in the Rabbit Eye

Aim

Single or multiple subconjunctival injections of mitomycin-C (MMC) may offer one way of establishing the total dosage of MMC more accurately. The method also allows re-applications later postoperatively. In this experimental, randomized prospective study we compared the effects of a single intraoperative application of MMC at the filtering site and a single postoperative subconjunctival injection of the drug.

Methods

The left eyes of 32 pigmented rabbits were divided into two groups. In the first group we applied MMC intraoperatively (10) with a 4×1 mm surgical sponge soaked in a MMC solution (0.5 mg/ml). In the second group we injected 0.4 ml of the same solution subconjunctivally (SC) immediately after (conjunctival) suture. Post-operative evaluation was carried out every day during the first week, then every three days until day 58. Survival analyses were done for intraocular pressure (IOP) and bleb failure. Log-rank tests were used to compare survival differences between the groups.

Results

The IO group showed longer survival parameters than the SC group (p<0.05), both in the control of IOP and as regards blebs. The histological persistence of fistulas was similar. The IO group, however, had a higher incidence of undesirable side effects.

Conclusions

Our findings suggest IO application of MMC is more effective in reducing fibroblast ingrowth. However, subconjunctival application offers certain advantages such as the possibility of repeating the treatment postoperatively and, therefore, using a smaller initial dose.

Visual dysfunction and its correlation with retinal changes in patients with Parkinson's disease: an observational cross-sectional study

OBJECTIVES

To evaluate visual dysfunction and its correlation with structural changes in the retina in patients with Parkinson's disease (PD).

METHODS

Patients with PD (n=37) and controls (n=37) were included in an observational cross-sectional study, and underwent visual acuity (VA), colour vision (using the Farnsworth and Lanthony desaturated D15 colour tests) and contrast sensitivity vision (CSV; using the Pelli-Robson chart and CSV 1000E test) evaluation to measure visual dysfunction. Structural measurements of the retinal nerve fibre layer (RNFL), and macular and ganglion cell layer (GCL) thicknesses, were obtained using spectral domain optical coherence tomography (SD-OCT). Comparison of obtained data, and correlation analysis between functional and structural results were performed.

RESULTS

VA (in all different contrast levels) and all CSV spatial frequencies were significantly worse in patients with PD than in controls. Colour vision was significantly affected based on the Lanthony colour test. Significant GCL loss was observed in the minimum GCL+inner plexiform layer. A clear tendency towards a reduction in several macular sectors (central, outer inferior, outer temporal and superior (inner and outer)) and in the temporal quadrant of the RNFL thickness was observed, although the difference was not significant. CSV was the functional parameter most strongly correlated with structural measurements in PD. Colour vision was associated with most GCL measurements. Macular thickness was strongly correlated with macular volume and functional parameters (r>0.70, p<0.05).

CONCLUSIONS

Patients with PD had visual dysfunction that correlated with structural changes evaluated by SD-OCT. GCL measurements may be reliable indicators of visual impairment in patients with PD.

A Diagnostic Calculator for Detecting Glaucoma on the Basis of Retinal Nerve Fiber Layer, Optic Disc, and Retinal Ganglion Cell Analysis by Optical Coherence Tomography

PURPOSE

The purpose of this study was to develop and validate a multivariate predictive model to detect glaucoma by using a combination of retinal nerve fiber layer (RNFL), retinal ganglion cell-inner plexiform (GCIPL), and optic disc parameters measured using spectral-domain optical coherence tomography (OCT).

METHODS

Five hundred eyes from 500 participants and 187 eyes of another 187 participants were included in the study and validation groups, respectively. Patients with glaucoma were classified in five groups based on visual field damage. Sensitivity and specificity of all glaucoma OCT parameters were analyzed. Receiver operating characteristic curves (ROC) and areas under the ROC (AUC) were compared. Three predictive multivariate models (quantitative, qualitative, and combined) that used a combination of the best OCT parameters were constructed. A diagnostic calculator was created using the combined multivariate model.

RESULTS

The best AUC parameters were: inferior RNFL, average RNFL, vertical cup/disc ratio, minimal GCIPL, and inferior-temporal GCIPL. Comparisons among the parameters did not show that the GCIPL parameters were better than those of the RNFL in early and advanced glaucoma. The highest AUC was in the combined predictive model (0.937; 95% confidence interval, 0.911-0.957) and was significantly (P = 0.0001) higher than the other isolated parameters considered in early and advanced glaucoma. The validation group displayed similar results to those of the study group.

CONCLUSIONS

Best GCIPL, RNFL, and optic disc parameters showed a similar ability to detect glaucoma. The combined predictive formula improved the glaucoma detection compared to the best isolated parameters evaluated. The diagnostic calculator obtained good classification from participants in both the study and validation groups.

Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software

PURPOSE

We measured the amount of hemoglobin at the optic nerve head of fibromyalgia (FM) patients using new colorimetric analysis software. We also investigated whether perfusion defects of the optic nerve head in patients with FM lead to tissue atrophy and corresponding retinal nerve fiber layer (RNFL) thinning measured by optical coherence tomography (OCT).

METHODS

We recruited for this cross-sectional study 118 FM patients and 76 sex- and age-matched healthy controls. All subjects underwent a complete neuro-ophthalmologic examination, which also included visual field testing using the Spark strategy in an Easyfield perimeter, and OCT examinations using the Spectralis. One photograph of the optic disc was obtained using a Cirrus™ Photo 800 multi-modality imager. We analyzed fundus photographs using Laguna ONhE software, a new method that allows hemoglobin levels to be measured at the optic nerve head. We compared hemoglobin percentages in different sectors of the nerve head and RNFL thicknesses between the two groups.

RESULTS

Mean hemoglobin percentages and hemoglobin content in all optic nerve head sectors calculated by the Laguna ONhE program were significantly lower in FM patients than in healthy controls, and the main differences were detected in the outer ring, which corresponds with the neuroretinal rim. However, only the differences in the superotemporal RNFL were statistically significant. Correlations between the RNFL thickness and the percentage of hemoglobin in the different sectors were weak.

CONCLUSION

Optic disc perfusion was decreased in patients with FM, especially within the neuroretinal rim, without clear involvement in the RNFL.

[Finding of retinal nerve fiber layer hypertrophy in ataxia of Charlevoix-Saguenay patients]

PURPOSE/METHODS

To present the neuro-ophthalmology examination in 5 spastic ataxia of Charlevoix-Saguenay (ARSACS) patients showing significant increases in retinal nerve fiber layer (RNFL) thickness.

RESULTS/CONCLUSIONS

All patients showed abnormal visual fields, normal optic discs with increased visibility of RNFL in color stereo-photographs, normal examination with Heidelberg Retina Tomography instrument, and moderate to markedly increased RNFL thickness in Cirrus Optical Coherence Tomography evaluation (average thickness: 119 to 220 microns). We found evidence that RNFL hypertrophy may be an alternative funduscopic finding to the hypermyelinated retinal fibers in previous reports. A revision of ARSACS diagnostic criteria, particularly with regard to retinal alterations, is necessary.

Three-dimensional geometries representing the retinal nerve fiber layer in multiple sclerosis, optic neuritis, and healthy eyes

BACKGROUND

To represent and interpret the three-dimensional (3D) geometry and the distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON).

METHODS

MS patients (n = 122) and age-matched healthy subjects (n = 108) were enrolled. The Spectralis optical coherence tomography system was used to determine the circumpapillary RNFL thickness. The 768 RNFL thickness measurements were used to evaluate thickness measurements in patients with or without antecedent ON and to design a 3D reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes.

RESULTS

RNFL thickness was decreased in MS patients, and was higher in the MS group with previous ON. Statistical analysis and 3D RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area (101.77 µm in MS vs. 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in MS eyes and 149.26 µm in healthy eyes).

CONCLUSIONS

The 3D representation of RNFL thickness based on measurements allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.

[Functional relationship between retinal sensitivity threshold values assessed by standard automated perimetry in glaucoma]

OBJECTIVE

To study the correlation between the sensitivity threshold values of the different points assessed by the Humphrey visual field analyzer (24-2 Swedish interactive threshold algorithm [SITA] standard strategy) in glaucoma patients.

SUBJECTS, MATERIAL AND METHODS

Prospective cross-sectorial study. One-hundred and four eyes of 104 glaucoma patients, defined by the appearance of the optic nerve head, were evaluated. Retinal threshold sensitivity points of standard automated perimetry (SA) with SITA standard 24-2 program were obtained. The upper and the lower hemifields were studied separately. Pearson correlation coefficients were calculated between the mean threshold sensitivity value at each point of the visual hemifield and the rest of the threshold points in the same hemifield.

RESULTS

Perimetric correlation maps between retinal threshold sensitivity values in the same hemifield were obtained. Most of the points showed moderate to high correlations (r≥0.65. P<0.001) with neighboring points and distant points in the same hemifield.

CONCLUSIONS

There is a functional relationship between neighboring and distant points in Humphrey Visual Field Analyzer (SITA Standard 24-2) in glaucoma patients. This correlation is related to the anatomical arrangement of ganglion cell axons. This fact enables perimetric patterns of glaucoma defects to be obtained.

[Relationship between standard automated perimetry and optic nerve head topography performed with the Heidelberg Retina Tomograph]

PURPOSE

To determine the correlations between optic nerve head (ONH) parameters measured with the Heidelberg Retina Tomograph (HRT), and the main outcomes of standard automated perimetry (SAP) in normal, ocular hypertensive, glaucoma suspects and glaucomatous subjects.

METHODS

Four hundred and twenty-three patients were enrolled in the study and classified into four groups depending on baseline intraocular pressure, optic nerve head morphology, and SAP results: 87 normal eyes, 192 ocular hypertensive eyes, 70 glaucoma suspects and 74 glaucomatous eyes. In the different diagnostic groups, Pearson's correlation coefficients were calculated between ONH parameters and mean deviation, pattern standard deviation (PSD), number of altered points in each quadrant of the visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number of points altered at different probability levels, and threshold values at each point of SAP.

RESULTS

In the normal and ocular hypertensive groups, only a few weak correlations were found between HRT and SAP parameters. The strength and number of significant correlations increased in the suspected glaucoma group. The glaucoma group had the strongest correlations, particularly between cup/disc ratio and rim/disc ratio with MD (r=0.479) and between rim area and PSD (r=0.444).

CONCLUSIONS

Weak to moderate correlations were found between some ONH parameters obtained with the HRT and SAP results in the glaucoma group.

[Relationship between standard automated perimetry and retinal nerve fiber layer parameters measured with laser polarimetry]

PURPOSE

To determine the relationship between the structural parameters of the retinal nerve fiber layer (RNFL) obtained by using the scanning laser polarimetry with variable corneal compensation (GDx VCC) and the results of standard automated perimetry (SAP), in normal, ocular hypertensive, preperimetric glaucomas and glaucoma subjects.

METHODS

A total of 423 eyes of 423 consecutive subjects were prospectively included in the study and classified depending on the basal intraocular pressure, optic nerve head appearance and SAP results into four groups: 87 normal eyes, 192 ocular hypertensive eyes, 70 preperimetric glaucomas and 74 glaucomatous eyes. Pearson's correlation coefficients, between mean deviation (MD), pattern standard deviation, number of points altered in each quadrant, and number of points altered at different probability levels of SAP and structural parameters of RNFL obtained by using GDx VCC, were calculated in the different diagnostic groups. In the glaucoma group correlations between the 52 points tested by 24- 2 SITA standard and GDx parameters were also calculated. Regression curves were plotted for the strongest correlations.

RESULTS

Weak or non-significant correlations were found in the normal, ocular hypertensive and preperimetric glaucoma groups. However, the glaucoma group presented weak to moderate correlations between several GDx VCC parameters and the SAP variables analysed. The strongest correlation was observed between the standard deviation TSNIT and the MD (0.460).

CONCLUSIONS

RNFL parameters measured with the GDx VCC presented weak to moderate correlations with the visual field indices and the number of altered points in the glaucoma group.

[Optic nerve head parameters as measured by confocal scanning laser (Heidelberg Retina Tomograph II) in normal, ocular hypertensive and glaucomatous subjects]

PURPOSE

To compare the optic nerve parameters measured by confocal scanning laser in normal, ocular hypertensive and glaucomatous eyes; and in groups of ocular hypertensive eyes, classification of these according to the optic nerve appearance and to short-wavelength automated perimetry (SWAP) results.

METHODS

101 eyes of 101 normal subjects, 247 eyes of 247 ocular hypertensive subjects and 102 eyes of 102 glaucomatous subjects were studied. Subjects were classified based on intraocular pressure and standard automated perimetry (AP) performance. Hypertensive subjects were classified into ocular hypertensive and preperimetric glaucoma, and into ocular hypertensive with normal SWAP and hypertensive with pathological SWAP findings. Every patient underwent evaluation of the optic nerve, AP, SWAP and confocal scanning laser ophthalmoscopy (HRT II), resulting in the acquisition of topographic parameters of the optic nerve, which were then compared between the different groups.

RESULTS

Significant differences (p<0.05) were found between normal subjects and glaucomatous eyes in all optic nerve parameters except disc area (2.23/2.1), height variation contour (0.41/0.39) and average variability (0.05/0.04). Ocular hypertensive eyes showed an overlap when compared with normal and glaucoma groups. No differences were found between normal subjects and those with ocular hypertension in mean retinal nerve fiber layer thickness (0.24/0.24) or between those with ocular hypertension and glaucoma in mean cup depth (0.28/0.3). Nevertheless, when those with ocular hypertension were segregated based on clinical evaluation of optic nerve or SWAP performance, the ability to define the presence of structural glaucoma damage improved significantly.

CONCLUSIONS

HRT enables moderate discrimination between normal, ocular hypertensive and glaucoma subjects. The use of diagnostic tests to detect early glaucomatous damage (such as short-wavelength automated perimetry) in ocular hypertensive eyes improves the ability of HRT to discriminate glaucoma.

[Diagnostic ability of GDx VCC for glaucoma diagnosis]

PURPOSE

To assess the diagnostic ability of scanning laser polarimetry (GDx VCC) to differentiate between normal and glaucomatous eyes.

METHODS

417 eyes of 417 consecutive subjects were prospectively selected. They were classified into 60 healthy controls, 218 ocular hypertensive eyes, 68 glaucoma suspects, and 71 glaucomatous eyes, depending on intraocular pressure, optic nerve head morphology and standard automated perimetry results. All underwent a scanning laser polarimetry with the GDx VCC. Retinal nerve fiber layer (RNFL) parameters of the GDx-VCC were compared among the four groups. Receiver operating characteristic (ROC) curves were plotted between normal and glaucomatous eyes. The best parameters were defined according to the area under the ROC curve and the best sensitivity/specificity balance.

RESULTS

Most parameters of GDx-VCC exhibited differences between the glaucoma group and the rest of the groups. Some parameters were also different between healthy patients and glaucoma suspects. The best parameter was the nerve fiber indicator (NFI; area under the ROC curve: 0.876). NFI, superior normalized area, and inferior normalized area yielded the highest sensitivities at 85% and 90% fixed specificity.

CONCLUSIONS

Most RNFL parameters measured with the GDx-VCC provided good diagnostic ability for open-angle glaucoma. The best GDx-VCC parameter in differentiating between normal and glaucomatous eyes was the NFI.

[Evaluation of four new discriminant functions for HRT II in glaucoma diagnosis]

PURPOSE

To assess the diagnostic usefulness of four linear discriminant functions for Heidelberg retina tomograph (HRT) II obtained in our population.

METHODS

450 eyes of 450 patients were studied. Eyes were classified as those of healthy subjects (101), those with ocular hypertension (126), those suspected to have glaucoma (121) or those with glaucoma (103). Intraocular pressure, optic nerve head appearance in stereophotographs, and standard automated perimetry results were assessed. ANOVAs among the groups were calculated for all global parameters and the 4 formulas. Receiver operating characteristic (ROC) curves were plotted for the 4 multivariate functions designed in our hospital and the areas under the ROC curves were compared. Sensitivity at 80% and 90% fixed specificities were also calculated.

RESULTS

All functions discriminated well between healthy and glaucoma suspects, and between healthy and glaucomatous eyes. At 90% fixed specificity, sensitivities ranged from 54% to 60% in differentiating between healthy and glaucoma suspects, and from 65% to 68% in discriminating between control and glaucoma subjects. No differences were found between the areas under the ROC curves of these functions.

CONCLUSIONS

The evaluated linear discriminant functions increased the diagnostic ability of HRT II isolated parameters in detecting glaucoma. These functions performed better than the HRT-provided discriminant functions.

[Importance of central corneal thickness when studying ocular hypertensive eyes, glaucoma suspects and preperimetric glaucomatous eyes]

PURPOSE

To compare the central corneal thickness, measured with an ultrasound pachymeter, in normal subjects, those with ocular hypertension, glaucoma suspects and patients with preperimetric glaucoma.

METHODS

61 normal eyes (control group), 131 eyes with ocular hypertension, 62 glaucoma suspects (optic nerve head morphology compatible with glaucoma) and 36 patients with preperimetric glaucoma (abnormal short-wavelength automated perimetry) were prospectively and consecutively selected. Scatter plots of central corneal thickness, against the intraocular pressure values were calculated for each of the study groups. Ultrasound pachymetry measurements were compared between those with normal eyes and the other groups.

RESULTS

Ocular hypertensive subjects had higher pachymetry values than the control group (p=0.009). No differences were found in the central corneal thickness between normal eyes and those who were glaucoma suspects, and between normal and preperimetric glaucomatous eyes. A mild direct logarithmic correlation was evident between central corneal thickness and the Goldmann tonometry result in the ocular hypertensive group.

CONCLUSIONS

Ocular hypertensive subjects had thicker corneas than the other groups studied. Glaucoma suspects and preperimetric glaucoma patients had similar corneal thickness to the control group.

[Correlation between standard automated perimetry global indices and Heidelberg Retina Tomograph II parameters]

PURPOSE

To correlate the optic nerve head topographic parameters measured by the Heidelberg Retina Tomograph II (HRT) with the perimetric indices of standard automated perimetry (SAP).

METHODS

This study included 101 normal subjects, 247 ocular hypertensive eyes (increased intraocular pressure with normal SAP) and 102 glaucomatous subjects (IOP above 21 mm Hg and abnormal standard automated perimetry). Only one eye was randomly chosen from each subject for the study. The visual field was evaluated by means of Humphrey Field Analyzer (24-2 full threshold strategy). The HRT II (Heidelberg Engineering) was used to acquire and measure the optic disc topographic parameters. Pearson correlations between topographic data and perimetric indices were performed for the total sample and each group of patients. The distribution of values obtained in the samples was normal.

RESULTS

A significant correlation was found between several optic disc parameters and the global indices of SAP. Rim area, rim volume, cup/disc area ratio, rim/disc area ratio, cup shape measurement, RNFL cross-sectional area, and discriminant functions FSM and RB, showed the strongest correlation with the visual field indices in the total and glaucoma groups (RIM AREA: total group: r=0.32; p=4.14x10(-11)/glaucoma group: r=0.28; p=0.004. RIM VOLUME: total group: r=0.26; p=1.55x10(-7)/glaucoma group: r=0.26; p=0.006). The ocular hypertensive group showed few significant correlations.

CONCLUSIONS

The correlations found between standard automated perimetry and HRT defined topographic parameters allow a better understanding of glaucomatous damage and make decision-making easier.

[Relationship between standard automated perimetry and HRT, OCT and GDx in normal, ocular hypertensive and glaucomatous subjects]

PURPOSE

To determine the correlations between structural parameters of the optic nerve head and the retinal nerve fiber layer (RNFL) obtained by using a Heidelberg Retina Tomograph II (HRT II), optic coherence tomography (OCT), and laser polarimetry (GDX-VCC) and the perimetric indices of standard automated perimetry (SAP) in normal, ocular hypertensive and glaucomatous subjects.

METHODS

Three hundred and eighty-nine patients were enrolled in the study and classified into three separate groups: 43 with normal eyes, 274 with ocular hypertensive eyes and 72 with glaucomatous eyes. Subjects were classified according to the basal intraocular pressure and the SAP results. Pearson's correlation coefficients were calculated between the global perimetric indices, mean deviation (MD) and pattern standard deviation (PSD), and structural parameters of the RNFL and optic disc obtained by using HRT II, OCT and GDX-VCC in the different diagnostic groups.

RESULTS

Mild to moderate correlations were found between the structural parameters measured by HRT, OCT and GDX and the global perimetric indices, in the glaucoma group. Mild or no significant correlations were found in the normal and ocular hypertensive groups. Correlations were stronger for MD than for PSD. Parameters based on the study of the retinal nerve fiber layer showed stronger correlations than those based on the study of the optic nerve head.

CONCLUSIONS

The relationship between structural and functional measurements in glaucoma is weak and therefore the results of these ancillary tests should be interpreted together to increase diagnostic accuracy.

[Diagnostic ability of stratus optical coherence tomography (OCT) in pre-perimetric glaucoma diagnosis]

OBJECTIVE

To compare retinal nerve fiber layer (RNFL) measurements performed with Stratus OCT 3000 in normal, ocular hypertensive, pre-perimetric and glaucomatous eyes.

METHODS

98 normal subjects, 156 ocular hypertensives with short-wavelength automated perimetry (SWAP), 21 ocular hypertensives with altered SWAP (pre-perimetric glaucoma) and 66 glaucomatous eyes were included in the study. Diagnostic groups were classified based on intraocular pressure, optic nerve head appearance, achromatic automatic perimetry and SWAP. RNFL parameters were obtained using a Stratus OCT 3000 (Humphrey Zeiss instruments). RNFL measurements were compared among the groups.

RESULTS

RNFL average thickness, superior, inferior and nasal quadrant thickness, and each 12 clock-hour positions except for H9, H10 and H11 showed significant differences between glaucomatous and pre-perimetric glaucoma eyes. RNFL average thickness, inferior quadrant and H10 clock-hour position showed significant differences between normal and ocular hypertensive subjects. Pre-perimetric glaucomas and ocular hypertensives showed differences in H11 clock-hour position exclusively.

CONCLUSION

RNFL measurements performed using Stratus OCT showed differences between the study groups. OCT may be as useful as SWAP in early glaucoma diagnosis.

[Diagnostic usefulness of optical coherence tomography (OCT), scanning laser tomography (HRT-II) and laser polarimetry (GDx) in open-angle glaucoma]

PURPOSE

To evaluate the diagnostic ability of three digital imaging technologies (HRT-II, OCT and GDx VCC) in detecting glaucomatous damage.

METHODS

A total of 427 eyes from 427 subjects were included in this cross-sectional study. Each subject was classified as healthy, ocular hypertensive or glaucomatous, according to intraocular pressure levels, standard automated perimetry and optic disc morphology. All of them underwent examination by means of HRT, OCT and GDx VCC. Receiver operating characteristic (ROC) curves were plotted and sensitivities at fixed specificities (85% and 95%) were calculated for each parameter assessed.

RESULTS

The parameters with the higher diagnostic ability were: FSM discriminant function from HRT-II (AUC=0.899), retinal nerve fiber layer average thickness from OCT (AUC=0.929) and NFI from GDx VCC (AUC=0.879), with no statistically significant differences between them.

CONCLUSION

The HRT-II, OCT and GDx VCC provide measurements of the retinal nerve fiber layer and the optic nerve head with high discriminating ability in open-angle glaucoma.

[Reproducibility of optic nerve head and retinal nerve fiber layer thickness measurements using optical coherence tomography]

PURPOSE

To evaluate the reproducibility of repeated quantitative measurements of optic nerve head topography and retinal nerve fiber layer thickness.

METHODS

This study included 32 normal subjects, 41 patients with ocular hypertension and 33 patients with glaucoma. The study groups were defined by the intraocular pressure levels, optic disc stereo-photographs and perimetric performance. Optic disc and retinal nerve fiber layer assessments were performed by ocular coherence tomography (OCT III, Zeiss Instruments). OCT examination was repeated three times in each subject and the coefficient of variability was elaborated for each parameter and group of the study, and compared among them.

RESULTS

The average retinal nerve fiber layer thickness measurement showed the best reproducibility figures with a coefficient of variability of 5.9%. The inferior quadrant and the 10, 6 and 7 clock-hours (coefficients of variability 6.3%, 7.4%, 7.5% and 8.6% respectively) showed higher reproducibility. The optic nerve head assessment showed the best reproducibility for the cup-to-disc ratios (vertical, horizontal and area ratios), with a coefficient of variability of 5.0%, 4.2% and 6.6% respectively. Although differences among groups were barely statistically significant, the glaucoma group showed coefficients of variability higher than the other two groups.

CONCLUSIONS

Optic nerve head analysis and retinal nerve fiber layer thickness can be reproducibly assessed by OCT. The reproducibility of the device supports its potential use for ocular hypertension follow-up, although its use in glaucoma patients may present difficulties in some parameters.

[Sector-based analysis of the distribution of the neuroretinal rim by confocal scanning laser in the diagnosis of glaucoma]

PURPOSE

To evaluate the diagnostic ability of the Moorfields regression analysis (MRA; neuroretinal rim sector-based analysis) by means of confocal scanning laser.

METHODS

200 eyes were included in this study: 101 normal subjects and 99 glaucoma patients (standard automated perimetry with glaucomatous defects -MD or CPSD with p<0.02 or a cluster of three or more points with p<0.05 or a cluster of two or more points with p<0.01 or abnormal Glaucoma Hemifield Test). All subjects underwent a full ophthalmic evaluation, visual field evaluation by means of a Humphrey Field Analyzer, 24-2 full threshold strategy, and optic disc topography by Heidelberg retina tomograph (HRT-II). The outcome parameters were sensitivity and specificity of the MRA for each sector.

RESULTS

The highest sensitivity in detecting structural defects based on MRA (p<0.05) was observed in the nasal-superior sector (48%) and nasal-inferior sector (45%); however the highest specificity was found in the temporal-superior (98%) and inferior (98%) sectors. The highest sensitivity for MRA (p<0.01) was found in the temporal-inferior sector (31%) and nasal-superior sector (30%) while the temporal-superior and inferior-sectors showed the highest specificity (100%). The diagnosis of glaucoma based on the presence of any sector alteration showed sensitivity figures of 67% with p<0.05 and 46% with p<0.01 and specificity values of 84% with p<0.05 and 96% with p<0.01.

CONCLUSIONS

The analysis of the distribution of the neuroretinal rim by means of HRT-II contributes effectively to the diagnosis of glaucoma based on perimetry in a sample derived from a Spanish population.

[Malignant glaucoma following combined Ahmed valve implant and phacoemulsification surgery for chronic angle-closure glaucoma]

CASE REPORT

Simultaneous Ahmed valve implant, combined with phacoemulsification cataract surgery, is a useful therapeutic option for patients with chronic angle-closure glaucoma, when conventional filtering surgery fails. This combined approach permits both control of intraocular pressure and early recovery of visual function. We report the results in five patients successfully treated with this combined procedure, two of whom developed early postoperative malignant glaucoma.

DISCUSSION

Predisposing anatomic features in patients with chronic angle-closure glaucoma, associated with sudden anterior chamber decompression and increased postoperative inflammation, may facilitate the development of malignant glaucoma following combined glaucoma implant and phacoemulsification surgery.

A 6-month assessment of bimatoprost 0.03% vs timolol maleate 0.5%: hypotensive efficacy, macular thickness and flare in ocular-hypertensive and glaucoma patients

AIM

To compare 6 months of treatment with bimatoprost and timolol in terms of their hypotensive efficacy and secondary effects, including changes in macular thickness and the inflammatory reaction induced in the anterior chamber.

METHODS

A prospective, randomized, parallel-group trial performed on 30 eyes of 30 patients per group. The main outcome measure was the difference between the IOP value taken between the baseline visit and the 6-month-visit. Macular thickness determined through optical coherence tomography and anterior chamber inflammation estimated using the laser flare meter was also evaluated. Adverse events were recorded during the study period.

RESULTS

Bimatoprost treatment gave rise to a significantly lower mean IOP than timolol in all follow-up visits as from the first month (P<0.05). Bimatoprost achieved high percentage IOP reductions from baseline in a significantly higher proportion of patients (P<0.05). Macular thickness and anterior chamber flare failed to vary significantly both between the two groups and within each group during the 6-month evaluation (P>0.05).

CONCLUSIONS

Bimatoprost 0.03% once daily showed a greater efficacy then timolol 0.05% twice daily in patients with elevated IOP. No significant differences were detected in macular thickness or anterior uveitis using optical coherence tomography and laser flare photometry.

Contact-topical plus intracameral lidocaine versus peribulbar anesthesia in combined surgery: a randomized clinical trial

PURPOSE

To compare the efficiency and safety of contact-topical anesthesia versus peribulbar injection anesthesia for phacotrabeculectomy.

MATERIALS AND METHODS

A total of 80 patients undergoing combined cataract and glaucoma surgery were randomly allocated to receive either contact or peribulbar anesthesia. No systemic sedatives were used in either group. Patients were asked to rate their pain level on a 5-point scale for 4 periods: during administration of the anesthetic agent; during surgery; immediately after surgery; and 24 hours postoperatively, while the surgeon recorded his subjective assessment of ease of surgery using a standardized template. The patients' general condition during surgery, as well as the results and short-term complications, were assessed.

RESULTS

The injected anesthesia group showed higher rates of discomfort and pain, and 37 patients reported pain ranging from mild to severe during anesthetic administration. The difference between groups was statistically significant (P < 0.001). During surgery, there were no differences in vital signs, patients' subjective pain evaluation, or surgeon stress. We found no differences between pain rates after surgery. Complications included prolonged chemosis, and we also noted that conjunctival hemorrhage occurred more frequently in the peribulbar group than in the contact anesthesia group.

CONCLUSION

Both anesthetic methods provide high levels of pain control without additional sedation during surgery. The use of contact-topical anesthesia avoids pain and reduces the possibility of complications during administration of anesthetics.

Histological Toxicity of Grepafloxacin after Intravitreal Injection

PURPOSE

To determine the intravitreal levels of grepafloxacin after intravitreal injection of 80 microg and to evaluate the retinal toxicity after intravitreal injection of different doses of grepafloxacin in rabbit eyes.

METHODS

Fifteen female New Zealand white rabbits and 15 female pigmented 'Gigantes de España' rabbits were injected with 80 microg of grepafloxacin into the vitreous cavity. The grepafloxacin concentration was determined with HPLC after 2, 4, 8, 12 and 24 h. Eighteen female rabbits (9 New Zealand white rabbits and 9 pigmented 'Gigantes de España' rabbits) were used for a study of toxicity. The rabbits were divided into 6 treatment groups: group 1 (3 pigmented rabbits) received an intravitreal injection of 80 microg of grepafloxacin in 0.1 ml of saline solution, group 2 (3 white rabbits) 80 microg of grepafloxacin in 0.1 ml, group 3 (3 pigmented rabbits) 800 microg of grepafloxacin, group 4 (3 white rabbits) 800 microg of grepafloxacin, group 5 (3 pigmented rabbits) and group 6 (3 white rabbits) 0.1 ml of saline solution. Clinical examination was performed prior to injection and 24 h and 10 days after surgery. The animals were sacrificed 10 days after the injection, and the eyes were enucleated and fixed for histopathology. The specimens were stained with hematoxylin-eosin and toluidine blue.

RESULTS

No relevant complications were found during the clinical follow-up. All the eyes showed no abnormalities in the histologic evaluation.

CONCLUSION

Grepafloxacin can be considered as a safe alternative for intravitreal injection for the treatment of intraocular infections.

[Benefit of scanning laser ophthalmoscopy for detecting retinal nerve fiber layer defects in patients with intraocular hypertension]

PURPOSE

To compare the ability to identify RNFL alterations between standard images and SLO images in a group of patients suffering from ocular hypertension.

METHODS

We evaluated RNFL in sixty patients with ocular hypertension and with normal perimetry, by using standard photography and SLO. Two different independent observers evaluated the images on two different ocassions.

RESULTS

We studied 118 eyes, twelve eyes were rejected because of the low quality of the images. Four cases of diffuse atrophy and five patients with wedge shaped defects were observed using both methods. Statistical analysis showed no differences between both exploration techniques or between observers.

CONCLUSIONS

RNFL study with SLO seems to be at least as reliable as standard photography as a method to evaluate RNFL defects. SLO has also proved to be much easier, and faster than traditional methods.

[Selective ophthalmic artery fibrinolysis in acute central retinal artery occlusion]

PURPOSE

To evaluate efficacy and reliability of local intra-arterial fibrinolysis (LIF) in Retinal Central Artery Occlusion (RCAO).

MATERIAL AND METHOD

We have studied 12 patients with RCAO. Seven patients (group I) were treated with conventional therapy and 5 patients (group II) underwent treatment with urokinase via transcutaneous femoral catheter into the ophthalmic artery. Thereafter patients received heparin sulfate for 3 days.

RESULTS

Mean follow up was 14 months and mean time from onset of symptoms to the beginning of therapy was 11 hours. One patient in group I showed improvement of visual acuity (from counting fingers to 0.1). In all patients in group II there was angiographic evidence of improved perfusion of retinal arteries and 4 patients (80%) showed improvement in visual acuity. The best results were obtained when LIF was performed before 10 hours after onset of symptoms. No complications were observed after the fibrinolysis treatment.

CONCLUSION

LIF in ophtalmic arteries for the treatment of RCAO reduces dosage of fibrinolytic agents and becomes a safe and useful treatment during the first hours post RCAO.

Glaucomatous damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects

PURPOSE

To determine the glaucomatous visual field damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects, and to compare the frequency of diffuse visual field losses and localized defects.

METHODS

157 eyes of 157 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm Hg and normal standard visual fields) were studied. SWAP was done with a modified Humphrey Field Analyzer. Total (TD) and Pattern Deviation (PD) probability maps were calculated for SWAP. The frequency of abnormlities in the TD and PD were determined, analyzing the visual field loss components.

RESULTS

The involvement of the test points was more frequent on the TD plots than on the PD plots for all levels of defects (p< 0.001). The glaucomatous defects also showed certain topographical distribution.

CONCLUSIONS

A diffuse sensitivity component of visual field loss was found at all SWAP defect depths in glaucoma suspects.

[Neuroretinal rim width in normal, hypertensive and glaucomatous subjects]

PURPOSE

To determine width and shape of neuro-retinal rim in normal hypertensive subjects and patients with glaucomatous damage.

MATERIAL AND METHOD

Patients underwent a perimetry and a photographic retinal nerve fiber evaluation. Patients were divided in three groups: normal subjects (n=34), ocular hypertension subjects (n=38) and glaucoma patients (n=34). Neuro-retinal rim was measured using 40 degrees stereoscopic photographs with center in the optic nerve head based on a biomorphometry technique.

RESULTS

In normal subjects neuro-retinal rim appeared wider in the lower pole, followed by the upper, nasal and temporal aspects. Optic nerve fiber layer showed a decreased thickness in hypertensive and glaucoma patients, particularly in sectors of the temporal aspect of the optic nerve (p<0.05).

CONCLUSIONS

A Planimetry study of the optic nerve is able to detect alterations in normal neuro-retinal rim configuration and can as well detect thinning of the rim, particularly in temporal, upper and lower areas.

[Early glaucomatous changes in neuroretinal rim shape]

PURPOSE

To assess the differences in neuroretinal rim shape in ocular hypertensive patients (normal white-white automated perimetry) with and without perimetric injury in the short wave length automated perimetry (blue-yellow).

MATERIAL AND METHODS

72 eyes from 72 hypertensive ocular patients with normal achromatic automated perimetry examination were included. Forty eyes had normal short wave length automated perimetries while 32 subjects presented an abnormal condition. The neuroretinal rim morphology was quantified by means of a planimetric study from the papillary images obtained with confocal laser scanning.

RESULTS

The subjects with abnormal blue-yellow perimetry showed a decrease in the neuroretinal rim area in the inferior and temporal positions. The differences were significant (p<0.05) at the 9 o'clock position (below the middle line) and almost significant (p<0.10) at the 10 o'clock position.

CONCLUSIONS

There are differences in the neuroretinal rim shape in ocular hypertensive subjects with normal achromatic perimetry according to whether there are abnormalities in the blue-yellow perimetry.

Functional and structural measurements in a multifactorial glaucoma risk model

PURPOSE

To evaluate the relationship between a multifactorial probability risk model of developing glaucomatous visual field defects and the assessment of the retinal nerve fiber layer (RNFL) and short-wavelength automated perimetry (SWAP) in glaucoma suspects.

METHODS

157 eyes of 157 glaucoma suspects were included in the study. The risk of developing glaucomatous defects was assessed by applying a multifactorial model that included intraocular pressure, vertical cup-to-disk ratio, age and family history. Photographs of the RNFL and SWAP were performed.

RESULTS

The SWAP was abnormal in 54 cases (34.3%); 21% of abnormal perimetries were obtained in the low-risk group, 37% in the moderate risk group and 56% in the high risk group. The nerve fiber layer evaluation in the different risk stages showed a pattern similar to the results obtained with SWAP. Multiple regression analyses, performed with the four variables included in the model with SWAP and RNFL evaluation, showed the relationship between the risk factors and the presence of glaucomatous damage--evaluated by RNFL and SWAP (p<0001).

CONCLUSIONS

The probability model showed a good correlation between the risk scale and the RNFL and SWAP assessment.

Latanoprost versus combined therapy with timolol plus dorzolamide: IOP-lowering effect in open-angle glaucoma

PURPOSE

To compare the effect on intraocular pressure of latanoprost versus timolol plus dorzolamide in open-angle glaucoma.

METHODS

Thirty-five patients with open-angle glaucoma were randomized, 18 to latanoprost once daily and 17 to timolol plus dorzolamide twice daily. Intraocular pressure and ocular side effects were recorded at baseline, and after 2 weeks and 3 months of treatment.

RESULTS

Latanoprost reduced the intraocular pressure 1.09 and 1.58 mm Hg more than timolol plus dorzolamide after 2 weeks and 3 months of treatment, respectively. These differences were statistically significant (p<0.05) at the end of the study. After 3 months of treatment, 32.3% of the eyes in the latanoprost group reduced the intraocular pressure in 30% or more with respect to baseline, while 15.6% of the eyes in the timolol plus dorzolamide group achieved this reduction.

CONCLUSIONS

Latanoprost administered once daily reduced the intraocular pressure at least as well as timolol plus dorzolamide twice daily in patients with open-angle glaucoma.

Optimum criteria for short-wavelength automated perimetry

OBJECTIVE

To determine the optimum perimetric criteria for short-wavelength automated perimetry on the basis of probabilistic maps that best discriminate between normal and glaucoma.

DESIGN

Comparative cross-sectional study.

PARTICIPANTS

Ninety-five glaucomatous eyes and 128 normal eyes were included in the study.

INTERVENTIONS

The subjects underwent retinal nerve fiber layer photographic evaluation and short-wavelength automated perimetry.

MAIN OUTCOME MEASURES

A probabilistic map of differential points for short-wavelength automated perimetry was elaborated, and the number of altered points was calculated for each visual field and level of significance (95%, 98%, 99%, and 99.5%).

RESULTS

The presence of a cluster of four or more points outside 95% normal probability limit showed a good combination of sensitivity and specificity. At deeper levels, P: < 1% and P: < 0.5%, the best combination is achieved with three points outside the normal probability limits.

CONCLUSIONS

The optimum criterion to define glaucomatous abnormalities in short-wavelength automated perimetry is the presence of a cluster of four points lower than P: < 5% or a cluster of three points lower than P: < 1%.

Subconjunctival injection of low doses of mitomycin C: effects on fibroblast proliferation

We evaluated the effect of low doses of mitomycin C (MMC) in subconjunctival injection on fibroblast viability. Eighteen rabbits received subconjunctival injections: group 1 was injected with balanced salt solution (BSS), group 2 received MMC 0.025 mg, and group 3 MMC 0.005 mg. Tissue samples were taken 1 h after the injection (conjunctiva, sclera and cornea at 0 and 90 degrees) and cultured. The average scleral and conjunctival outgrowth in the MMC-treated groups was significantly inferior to the outgrowth of the samples treated with BSS. Subconjunctival injections of MMC (0. 025 and 0.005 mg) have an inhibitory effect on conjunctiva at 0 degrees and on scleral fibroblast populations.

[Inhibitory effect of nicardipine on fibroblast proliferation mechanisms]

PURPOSE

To assess the effect of nicardipine (NCP) on fibroblast migration and proliferation, and its cellular toxicity.

METHODS

In vitro wound repair was assessed in confluent fibroblast monolayer. Mechanical round wounds were performed in the monolayers and the cultures were incubated in fresh media plus NCP. The cell-free area was monitored after 0, 18, 24 and 48 hours. Groups of treatment: Group 1, Sham. Group 2, NCP 10(-4)M in the media. Group 3, NCP 7.5x10(-5)M. Group 4, NCP 5x10(-5)M. Group 5, NCP 2.5x10(-5)M. Group 6, NCP 10(-5)M. Group 7, NCP 10(-6)M. Group 8, NCP 10(-7)M. Group 9, NCP 10(-3)M. Each experiment consisted of three tests that were repeated four times.

RESULTS

The fibroblast migration and proliferation was inhibited at 5x10(-5)M or higher doses. The proliferation after 48 hours with NCP 2.5x10(-5)M was statistically inferior to the control group and groups 7, 8, and 9. NCP 5x10(-5)M or higher doses showed cellular atypia and cell death.

CONCLUSIONS

NCP effectively inhibits fibroblastic wound repair process at doses 2.5x10(-5)M and shows toxicity at doses over 5x10(-5)M.

Anatomic results and complications in a long-term follow-up of pneumatic retinopexy cases

BACKGROUND

The use of pneumatic retinopexy is controversial because 1) intraocular gas could increase the risk of proliferate vitreoretinopathy and 2) it has been reported to achieve low rates of success after a single procedure.

METHODS

A total of 219 consecutive cases of SF6 pneumatic retinopexy were reviewed retrospectively. The follow-up period ranged from 2 to 5 years.

RESULTS

A total of 179 (81.73%) of 219 eyes were treated successfully with a single procedure. The success rate increased with reoperations to 98.89%. Preoperative factors related to primary failure or redetachment were aphakia or pseudophakia (P = 0.0058) and breaks localized on horizontal meridia (P = 0.0305). Cryopexy was significantly associated with failure (P = 0.0007). A total of 31.05% of eyes showed early complications. The most frequent incidence was delay in subretinal fluid reabsorption (36.76%), followed by new breaks (26.47%). Late complications were observed in 6.84% of the eyes (six eyes with macular pucker, three with new retinal detachments, three with cataracts, and three with new breaks without detachment).

CONCLUSIONS

Failures of pneumatic retinopexy were related to lens status, localization of the break, and cryopexy. The occurrence of early and late complications was similar to that in other procedures.

[Inhibitory effect of alpha tocopherol succinate on fibroblast wound healing]

PURPOSE

To evaluate and compare the effect of acid tocopherol succinate (ATS) on fibroblast migration and proliferation.

METHODS

In vitro wound repair was determined in confluent fibroblast monolayer. Conjunctival fibroblasts were incubated with serum-deprived medium for 24 hours. After this time an artificial wound was made and the cells were incubated with fresh medium plus the doses of ATS to be tested. The cell free area was monitored at 0, 18, 24 and 48 hours. Groups of treatment: Group 1: ethanol 0.1%. Group 2: ATS 25 microM dissolved in ethanol (final concentration 0.1%) Group 3: ATS 50 microM in ethanol 0.1%. Each experiment was carried out in triplicate and repeated 4 times.

RESULTS

There were no differences among the groups during the first 24 hours. ATS showed significantly larger cell-free area at 48 hours. There were no signs of cellular toxicity.

CONCLUSIONS

25 microM and 50 microM ATS inhibit fibroblast proliferation without cellular toxicity.

Short-wavelength automated perimetry and neuroretinal rim area

PURPOSE

To determine the correlation between neuroretinal rim area and functional losses detected by short-wavelength automated perimetry (SWAP) in a population of patients with suspected glaucoma.

METHODS

Forty-two eyes of 42 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm of Hg and normal conventional visual fields) were studied. A planimetric optic nerve head study was performed, determining the total and sectorized neuroretinal rim areas. SWAP was also done, with a modified Humphrey field analyzer.

RESULTS

There were no significant correlations between the neuroretinal rim areas and the global perimetric parameters. However, the correlations between the inferotemporal neuroretinal rim area and some superonasal visual field regions (areas 3 and 4) were significant.

CONCLUSIONS

There is a relation in the topography of some visual field areas assessed by SWAP and the inferotemporal neuroretinal rim area, which may play a role in the diagnosis and follow-up of suspected glaucoma.

Alpha-tocopherol derivatives and wound healing in an experimental model of filtering surgery

OBJECTIVE

To describe the effect of alpha-tocopherol derivatives (acetate and acid-succinate) on the histopathological characteristics of the surgical fistula in an experimental model of filtering surgery.

MATERIALS AND METHODS

Thirty pigmented rabbits were divided into 3 groups. Twenty-four hours before surgery the animals were injected subconjunctivally with 0.5 mL of solution that depended on the group of treatment: Group 1 (n = 10) 0.75% ethanol in balanced salt solution (BSS); Group 2 (n = 10) 100 microg alph-tocopherol-acetate in 0.75% ethanol in BSS; Group 3 (n = 10) 100 microg alpha-tocopheryl-acid-succinate in 0.75% ethanol in BSS. Histological findings were evaluated 30 days after surgery.

RESULTS

The groups treated with alpha-tocopherol derivatives showed a higher percentage of persistence of the fistula and better intraocular pressure (IOP) control.

CONCLUSIONS

Alpha-tocopherol derivatives showed antiproliferative properties in this experimental model of filtering surgery.

[Reproducibility of planimetric optic nerve head analysis with scanning laser ophthalmoscope]

PURPOSE

To determine the variability of disc and cup area measurements in digital images obtained with scanning laser ophthalmoscope.

METHODS

10 sets of images of 4 optic discs (normal, myopic, ocular hypertensive and glaucomatous) were obtained with the Rodenstock scanning laser ophthalmoscope. Images focused at different depths were used by 2 operators (with and without experience in planimetry) to determine the disc and cup areas by means of an image analysis program (Visilog). This study was performed in 10 images obtained from the same optic nerve (inter-image analysis) and 10 times in the same image of each optic nerve (intra-image analysis).

RESULTS

The variability of all the measurements was under 5%. Disc area measurements were lower than cup area determination. The experienced operator obtained lower variability. The myopic optic disc images were less reproducible than the other groups of images.

CONCLUSIONS

The planimetric analysis of optic nerve head digital images obtained with scanning laser ophthalmoscope is reproducible and allows quantification of optic disc areas.

Alpha-tocopherol derivatives in an experimental model of filtering surgery

PURPOSE

To evaluate the efficiency and reliability of alpha-tocopherol in an experimental model of glaucoma filtering surgery.

METHODS

Thirty pigmented rabbits were randomly divided into three study groups. Twenty-four hours before surgery, the animals were injected subconjunctivally with 0.5 ml of solution that depended on the group of treatment: group I (n = 10), 0.75% ethanol in balanced saline solution (BSS); group II (n = 10), 100 mg alpha-tocopherol acetate (ATA) in 0.75% ethanol in BSS; group III (n = 10), 100 mg alpha-tocopherol acid succinate (ATS) in 0.75% ethanol in BSS. The animals were followed during 30 days (intraocular pressure, IOP; filtering surgery; inflammatory reaction).

RESULTS

IOPs were significantly lower in the treatment groups (ATA and ATS) than in the control group from days 7 and 10, respectively, till the end of the study. On day 7, the mean IOP in the ATA group was 15.8 versus 22.1 mm Hg in the control group. On day 10, the mean IOP in the ATS group was 15 versus 22.78 mm Hg in the control group. Filtering blebs showed statistically significant differences between the control and treated groups from day 5 to day 16.

CONCLUSIONS

alpha-Tocopherol (ATA and ATS) showed better IOP control and bleb survival in this experimental model of filtering surgery.

Correlation of functional and structural measurements in eyes suspected of having glaucoma

PURPOSE

This study was conducted to determine the correlation between structural changes in the retinal nerve fiber layer (RNFL) and functional loss detected on short-wavelength automated perimetry (SWAP) in a population of patients with suspected glaucoma.

METHODS

With a selection criteria of intraocular pressure (IOP) more than 21 mmHg and normal results of conventional automated perimetry, 49 eyes of 49 patients with ocular hypertension were enrolled in the study. The SWAP was performed with a modified Humphrey field analyzer, and visual field indexes (mean deviation [MD], corrected pattern standard deviation [CPSD]) were calculated. Semiquantitative RNFL scores were given separately to diffuse and localized defects of the RNFL.

RESULTS

The MD increased significantly with higher diffuse and total RNFL scores, with good correlation coefficients. A weak correlation was found between CPSD and diffuse, total, and localized RNFL scores.

CONCLUSION

Diffuse RNFL loss are associated with abnormalities in visual field indexes (MD), whereas focal structural damage showed no correlation with visual field loss.

Quantification of intraoperative administration of mitomycin-C in filtering surgery with surgical sponge material

PURPOSE

To determine the absorption and release of mitomycin-C 0.4 and 0.2 mg/mL from sponge-like specimens of Spongostan film (Ferrosan, Copenhagen, Denmark) and the scleral and conjunctival impregnation in an experimental model of filtering surgery.

METHODS

The maximum amount of mitomycin per volume unit that Spongostan is able to absorb was determined physically as the difference between dry weight and soaked weight. Mitomycin-C activity in known volumes of Spongostan after mitomycin-C release in vitro also was determined at 0, 1, 10, and 30 seconds and 1, 3, 5, 10, 15, and 30 minutes. Antibiotic activity of the specimens was evaluated by means of bioassay. Millimeters of inhibition of bacterial growth were related to microg of mitomycin activity according to a reference curve obtained from known amounts of mitomycin-C. Finally, 10 eyes of 10 rabbits underwent filtering surgery with intraoperative application of mitomycin by means of the Spongostan film. The Spongostan implants then were removed and tested for mitomycin activity. Scleral and conjunctival specimens were obtained for bioassay.

RESULTS

The maximum capacity of 25 mm2 x 0.5 mm thick Spongostan films saturated in 0.4 and 0.2 mg/mL solutions of mitomycin-C were 8.49 microg and 4.23 microg, respectively. Biologic activity (bioassay determination) was 8.24 microg and 4.19 microg of mitomycin-C, respectively. In vitro release of mitomycin was gradual until 30 minutes. In vivo mitomycin release from Spongostan after 5 minutes was 6.91 microg. Impregnation with the antimitotic was better in conjunctiva than sclera.

CONCLUSION

Bioassay permits quantification of mitomycin-C activity. The release from sponge specimens is gradual, and impregnation was better in conjunctiva than sclera.