Diode Laser Photocoagulation in Retinopathy of Prematurity

We used diode laser photocoagulation to treat 22 eyes of 12 patients with retinopathy of prematurity. Three infants were followed for at least six months and nine for at least one year. We treated 14 eyes with threshold disease and 8 eyes with prethreshold disease. The treatment was administered within 72 hours of diagnosis and topical anesthesia and sedation were used. No evidence of lesions of the anterior segment of preretinal or vitreous hemorrhages was found after the treatment. External inflammatory signs were neglibible. Systemic complications occurred only in three treatment sessions. Eight of the 14 eyes with threshold disease (57%) and all eight eyes with prethreshold disease had favorable outcomes. In total 73% with ROP had favorable outcomes. Treatment with the diode laser is easily performed, effective essentially in cases of prethreshold disease but in threshold disease too, with minimal ocular or systemic complications.

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.

Progressive Changes in the Retinal Nerve Fiber Layer in Patients with Multiple Sclerosis

Purpose

To quantify changes in the retinal nerve fiber layer (RNFL) of patients with multiple sclerosis (MS) over a 1-year time period and to compare the ability of noninvasive diagnostic imaging devices and visual evoked potentials (VEP) to detect axonal loss in these patients.

Methods

Eighty-one patients with MS underwent a complete ophthalmic examination that included assessment of visual acuity and color vision, refractive evaluation, visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (GDx), and measurement of VEP. All the patients were re-evaluated after a period of 12 months in order to quantify any change in the RNFL. Only one randomly chosen eye from each patient was included in the study.

Results

Statistically significant differences between the 2 examinations were recorded for the overall mean and inferior RNFL thickness and the macular volume, as assessed by OCT, as well as for the temporal-superior-nasal-inferior-temporal average standard deviation provided by GDx. The greatest differences were obtained for the mean RNFL thickness (90.46 μm vs 85.96 μm). Changes in the optic nerve were detected by structural measurements but not by functional assessments.

Conclusions

Axonal loss in the optic nerve of patients with MS is greater than that expected in healthy subjects, regardless of the presence of a previous optic neuritis.

[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.

[Atrophy of the retinal nerve fibre layer in multiple sclerosis patients. Prospective study with two years follow-up]

OBJECTIVE

To evaluate the changes over two years in the retinal nerve fibre layer (RNFL) of patients with multiple sclerosis (MS). To compare the ability of optical coherence tomography (OCT), scanning laser polarimetry (GDx), visual evoked potentials (VEP) and visual field examination to detect axonal loss in these patients.

MATERIAL AND METHODS

Fifty eyes of MS patients without episodes or optic neuritis during follow-up were enrolled in this study. All patients underwent a complete ophthalmic examination that included visual acuity (VA), colour vision, refractive evaluation, visual field examination, OCT, GDx and VEP. All the patients were re-evaluated over a period of 12 and 24 months. Correlations between parameters were analysed by Pearson's test.

RESULTS

There were changes in the RNFL thickness in MS patients with a 12 and 24-month follow-up. Differences between baseline and 2-year evaluation were statistically significant (p ≤ 0.05, t test) in the mean, superior and inferior RNFL thickness and macular volume provided by OCT, while no significant differences were found using functional parameters (VA, colour vision, visual field and VEP) and GDx. The greater differences were obtained in the inferior RNFL thickness (113.67 frente a 105.39 μm, p < 0.001). Correlations were observed between structural parameters using GDx and TCO.

CONCLUSIONS

Progressive axonal loss can be detected in the optic nerve of MS patients. Measurements provided by TCO are useful tools to evaluate structural abnormalities in the RNFL and changes in macular volume, however these changes were not detected using functional tests or GDx.

[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.

[Ranibizumab as treatment for myopic choroidal neovascularization]

OBJECTIVE

To evaluate the efficacy of intravitreal Ranibizumab as treatment for choroidal neovascularisation due to pathological myopia.

MATERIALS AND METHODS

A retrospective, non-comparative study of 18 eyes treated with intravitreal injections of Ranibizumab. Ten eyes had been treated previously with photodynamic therapy and eight received Ranibizumab as first therapy. After thorough ophthalmologic examination, fluorescein angiography (FAG) and optical coherence tomography (OCT), intraocular injection of Ranibizumab was performed. In subsequent monthly follow ups and taking into account visual acuity, presence or absence of metamorphopsia, biomicroscopy and OCT examination, further treatment was decided.

RESULTS

Eighteen eyes from 16 patients were finally included. Patients were followed up for a minimum of 6 months. The mean age at initial treatment was 56.4 years. Mean refractive error was -13.3 diopters. Regarding FAG, all neovascular membranes were classical and sub or juxtafoveal localised. At the end of the sixth month after treatment fourteen eyes (77.7%) showed better visual acuity ranging from one or more lines on the Snellen chart, eleven eyes (61.1%) improved two lines or more, three eyes (16.6%) did not show any change and one eye (5.5%) worsened by one line. At 6 months the mean best-corrected visual acuity improved from 0.25 to 0.46 (p= 0.001). The mean central macular thickness decreased from 344.9 to 212.6 (p=0.015).

CONCLUSIONS

Ranibizumab may be a good therapeutic option as treatment for choroidal neovascularisation due to pathological myopia; it improved visual acuity and anatomical features, even in non-responders to photodynamic therapy (Arch Soc Esp Oftalmol 2009; 84: 507-514).

[Long-term tensional results after trabeculectomy. A comparative study among types of glaucoma and previous medical treatment]

OBJECTIVES

To evaluate long-term intraocular pressure results after trabeculectomy in low risk patients. Therefore differences among glaucoma type and previous medical treatment will be evaluated.

METHODS

A retrospective follow-up study, ranging between 3 and 20 years, was carried out on 965 trabeculectomy surgeries without any surgical- failure factor. Follow-up was carried-out one day, one week, one month, three months, six months and annually after surgery until the last visit. Primary open angle (POAG) (671 eyes), pseudoexfoliative (PSXG) (156 eyes) and chronic closure angle glaucomas (CCAG) (138 eyes) were included. IOP under 21 Hg mm without medical treatment was considered absolute success, relative success included those eyes with pressures under 21 and one or two daily antiglaucomatous drops.

RESULTS

Mean IOP ranged between 15 and 17 Hg mm. Mean IOP decreased from 30.7 to 37.4%. Relative success ten years after surgery was better in POAG; whereas absolute success resulted to be similar in POAG and PSXG. The group of patients less treated before surgery showed greater rate of absolute and relative success.

CONCLUSIONS

Trabeculectomy alone is an efficient technique in long-term tensional control for uncomplicated eyes. The group of patients less treated before surgery and POAG showed greater rate success.

[Usefulness of apraclonidine in the diagnosis of Horner syndrome]

CASE REPORTS

We present four cases: two males with Horner Syndrome, who were diagnosed by means of apraclonidine 0.5% and cocaine 4% tests respectively. Two children with anisocoria, one of whom had Horner Syndrome confirmed with apraclonidine 1% and the other, in whom an apraclonidine test ruled out this syndrome but in whom pilocarpine 0.125% confirmed Adie's pupil.

DISCUSSION

Apraclonidine drops (1% and 0.5%) may aid in the diagnosis of Horner Syndrome and are easier to obtain than cocaine.

Ability of optical imaging devices to detect early structural damage in ocular hypertension

We evaluated the ability of functional and structural technologies to detect early damage in ocular-hypertensive (OHT) eyes with normal standard automated perimetry (SAP) in 48 normal and 130 ocular-hypertensive subjects. We found that optical imaging devices may detect early damage in the RNFL and the optic nerve head in ocular-hypertensive eyes with no defect in SAP.

Ability of different optical imaging devices to discriminate between healthy and glaucomatous eyes

We compared the ability to discriminate between healthy and glaucomatous eyes of three optical imaging devices in 140 eyes from 140 subjects. No statistically significant differences were found among the AUCs of these parameters. However, AUCs were significantly higher in OCT and HRT parameters than most of GDx VCC ones. Thus, structural parameters assessed by the optical imaging devices are useful to discriminate glaucomatous damage, but showed no significant difference among the best parameters from HRT, OCT or GDx VCC.

Comparative study of retinal nerve fiber layer thickness in normal eyes, ocular hypertensives, preperimetric glaucoma and glaucomatous subjects

We assessed and compared the retinal nerve fiber layer (RNFL) thickness in normal eyes, ocular hypertensives, preperimetric glaucoma and glaucomatous subjects by means of optical coherence tomography in 449 eye. RNFL in glaucoma patients was significantly thinner than in normal subjects in every location evaluated. Use of optical coherence tomography detects glaucomatous RNFL losses in preperimetric glaucoma and can improve our ability to detect structural damage in clinical practice.

Comparison of the efficacy and safety of contact versus peribulbar anaesthesia in combined eye surgery

PURPOSE

To compare the combined levels of comfort, the presence of complications and the results of phacotrabeculectomy surgery obtained with 2 different forms of anaesthesia: topical contact anaesthesia and peribulbar injected anaesthesia.

PROCEDURES

In total, 120 consecutive patients undergoing phacotrabeculectomy were randomly assigned to each anaesthesia group. The patients were asked to rate their pain level on a 5-point scale at 3 time points during the procedure. Early and late surgical complications and clinical parameters of success were evaluated.

RESULTS

Administration of contact anaesthesia was clearly associated with less pain than injection of peribulbar anaesthesia. The amount of pain or discomfort experienced during or following surgery did not differ between the patient groups. No long-term differences in the tensional results were observed between the groups of the study.

CONCLUSION

The application of contact anaesthesia in the phacotrabeculectomy procedure provides a level of comfort and safety that is comparable to that achieved with peribulbar anaesthesia. Likewise, patients that received contact anaesthesia were as comfortable as patients that received the peribulbar injection of anaesthesia, not only during the immediate postoperative period, but also in terms of their tensional results and their visual acuity in the mid and long term.

[Comparative study of refractive errors in simple congenital myogenic ptosis and control children]

PURPOSE

To study refractive errors in children with relatively serious congenital myogenic ptosis and to carry out a comparative study in relation to control children in our population.

METHODS

We included 35 children with simple congenital myogenic ptosis, 27 of them had minor ptosis, 3 moderate ptosis and 5 serious ptosis. Thirty-five children were also in the control group. One eye of every subject was included, the worst eye in subjects of the ptosis group and an eye selected at random in control group subjects. A comparative study of refractive data in every group was carried out, using the Student's t-test, ANOVA and Chi square or Yates correction tests.

RESULTS

We obtained significant differences between children with ptosis and controls in average spherical equivalent (3.08/1.49), in average absolute sphere (2.80/1.42) and in average absolute cylinder (0.81/0.31) (p<0.05). We also observed a relation between the presence of astigmatism and the seriousness of ptosis (chi2=6.88>5.99), and between the need for optical correction and the presence of ptosis (chi2=15.92>3.84).

CONCLUSIONS

Children with simple congenital myogenic ptosis in our enviroment have greater refractive errors than control children. Ptosis children require optical correction more frequently than control. The more serious the ptosis, the more likelihood there is of having astigmatism.

Retinal nerve fiber layer evaluation in open-angle glaucoma. Optimum criteria for optical coherence tomography

PURPOSE

To determine the optimum criteria for optical coherence tomography (OCT) to discriminate best between healthy and glaucomatous eyes.

DESIGN

A prospective cross-sectional study.

METHODS

In total, 164 eyes selected from clinical practice were included in this study. These were classified into 98 healthy and 66 glaucomatous eyes, depending on the intraocular pressure, appearance of the optic disc and standard automated perimetry results. Only 1 eye per subject was randomly included. The retinal nerve fiber layer (RNFL) was evaluated by means of OCT (Stratus OCT 3000). The sensitivity and specificity values of different diagnostic criteria (4 abnormal quadrants and 1-5 abnormal clock-hours) were calculated with different probability levels (p < 0.05 and p < 0.01).

RESULTS

The criterion with the best sensitivity-specificity balance was the presence of >or=2 hour positions with an RNFL thickness outside of the 95% confidence interval (CI; sensitivity = 77.2%, specificity = 91.9%). For the 99% CI, the best criterion was the presence of at least 1 abnormal hour position (sensitivity = 71.2%, specificity = 91%). Regarding retinal quadrants, the presence of at least 1 quadrant with RNFL thickness outside of the CI was the criterion that best discriminated the existence of glaucomatous damage.

CONCLUSIONS

The definition of diagnostic criteria based on OCT structural parameters may improve its diagnostic ability. The highest diagnostic ability was provided by the presence of at least 2 hour positions or RNFL average thickness outside the 95% CI.

[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.

Magnification characteristics of the Optical Coherence Tomograph STRATUS OCT 3000

PURPOSE

To evaluate the magnification characteristics of an Optical Coherence Tomograph (STRATUS OCT 3000) used to measure optic disc size.

METHODS

An eye model was designed, built and used to measure changes in the magnification of the Optical Coherence Tomograph (OCT) with variation in the axial length of the eye and OCT correction lenses. Theoretical calculations using ray-tracing were used to compare the experimental and theoretical results.

RESULTS

OCT-performed fundus measurements have a magnification that depends on two factors: eye axial length and optical correction with the focusing dial of the OCT. Theoretical calculations showed that the size of the optic disc image for greater axial lengths of the eye model (myopic eye) was less than that for smaller axial lengths (hyperopic eye). The disc diameter measurements of the image obtained with the OCT did not agree with the real disc size. By focussing with the focusing dial of the OCT, the power of the optics can be varied from -12.0 D to +12.0 D and the image size is decreased for all axial lengths. The maximum variation of the disc area was 2.1%. Differences in area measured at intervals of 2.0 D after correcting the eye refraction for measurements with the OCT were equivalent to the repeatability error at that point.

CONCLUSIONS

Our results confirm that any variation in the optical system of the eye, in the OCT, and/or in the distance between them, induces a change in the magnification of the tomograph images. These variations will affect the measurements of any of the structures in the retinal plane.

[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.

Discriminating between Normal and Glaucoma-Damaged Eyes with the Heidelberg Retina Tomograph 3

PURPOSE

To determine and validate the diagnostic ability of a linear discriminant function (LDF) based on global stereometric parameters obtained using the Heidelberg Retina Tomograph version 3 (HRT3) for discriminating between healthy eyes and eyes with glaucomatous visual field loss.

DESIGN

Cross-sectional study.

PARTICIPANTS

The authors prospectively selected 81 consecutive healthy subjects and 85 consecutive patients with open-angle glaucoma. Another prospective sample of 225 normal eyes and 210 glaucoma eyes was used to evaluate how well the LDF performed in another population.

METHODS

Participants were divided into 2 groups depending on the results of standard automated perimetry and intraocular pressure. All participants underwent imaging of the optic nerve head with the HRT3.

MAIN OUTCOME MEASURES

The LDF was calculated according to the stepwise logistic regression results of global optic nerve head parameters and glaucoma probability score numerical values. The diagnostic accuracy of the LDF and other parameters included in the software of the HRT3 was evaluated in another independent population.

RESULTS

Based on the results of the stepwise binary logistic regression analysis, the function proposed was LDF = 8.23 - 8.00 x contour line modulation temporal superior + 9.41 x cup shape measure - 4.07 x rim area. The areas under the receiver operating characteristic curve were 0.875 for the LDF, 0.845 for the Frederick S. Mikelberg (FSM) discriminant function, and 0.838 for the Reinhard O. W. Burk (RB) discriminant function. There were no significant differences between these values. The LDF and the FSM and RB discriminant functions yielded sensitivities of 74.2%, 70.4%, and 67.6%, respectively, at a fixed specificity of 85%.

CONCLUSIONS

Compared with the HRT-provided parameters, the proposed LDF exhibited higher diagnostic ability than most available analyses. The LDF had a better sensitivity and specificity balance than the FSM and RB discriminant functions, regardless of optic disc size.

Effect on diurnal intraocular pressure of the fixed combination of latanoprost 0.005% and timolol 0.5% administered in the evening in glaucoma

We evaluated the efficacy of fixed combination of 0.005% latanoprost and 0.5% timolol maleate administered once daily in the evening for treating glaucoma patients. This combination proved an effective alternative to achieve an additional intraocular pressure IOP lowering effect in patients treated with either drug alone and as an alterative in patients treated with unfixed combination of latanoprost and timolol and optimal IOP control.

[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.

Diagnostic ability of different tools for detection of glaucoma with confocal scanning laser tomography (Heidelberg Retina Tomograph II)

We evaluated the diagnostic ability of various diagnostic tools to detect glaucomatous damage in 101 normal eyes and 102 glaucomatous eyes. Mikelberg's linear discriminant function (LDF) obtained the best sensitivity followed by our own four formulas. With respect to specificity, Burk's LDF showed better results than Mikelberg's LDF and our formulae. Several Heidelberg retina tomograph analysis tools are useful to discriminate healthy from patients with glaucoma. Alternative tools based on normative databases derived from different autochthon populations add evidence needed to support their global use.

[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.

Can Frequency-doubling Technology and Short-wavelength Automated Perimetries Detect Visual Field Defects Before Standard Automated Perimetry in Patients With Preperimetric Glaucoma?

PURPOSE

To assess the ability of frequency-doubling technology (FDT) perimetry and short-wavelength automated perimetry (SWAP) to detect glaucomatous damage in preperimetric glaucoma subjects.

PARTICIPANTS

Two hundred seventy-eight eyes of 278 subjects categorized as normal eyes [n=98; intraocular pressure <20 mm Hg, normal optic disc appearance, and standard automated perimetry (SAP)]; preperimetric glaucoma eyes (n=109; normal SAP and retinal nerve fiber layer defects or localized optic disc notching and thinning); and glaucoma patients (n=71; intraocular pressure >21 mm Hg, optic disc compatible with glaucoma, and abnormal SAP).

METHODS

The preperimetric glaucoma group underwent at least 2 reliable full-threshold 24-2 Humphrey SAPs, full-threshold C-20 FDT, full-threshold 24-2 SWAP, optic disc topography using the Heidelberg Retina Tomograph II, laser polarimetry using the GDx VCC, and Optical Coherence Tomography (Zeiss Stratus OCT 3000). Receiver operating characteristic curves were plotted for the main Heidelberg Retina Tomograph, Optical Coherence Tomography, and GDx VCC parameters for the normal and glaucoma patients. The area under the receiver operating characteristic curve was used to determine the parameters indicating glaucomatous damage in the optic disc or retinal nerve fiber layer, which were used to establish additional subgroups of patients with preperimetric glaucoma. FDT and SWAP sensitivities were calculated for the patient subsets with structural damage and normal SAP.

RESULTS

At least 20% of the patients with preperimetric glaucoma demonstrated functional losses in FDT and SWAP. The more severe the structural damage, the greater the sensitivity for detecting glaucomatous visual field losses.

CONCLUSIONS

FDT and SWAP detect functional losses in cases of suspected glaucoma before glaucomatous losses detected by SAP.

Diagnostic ability of Heidelberg Retina Tomograph 3 classifications: glaucoma probability score versus Moorfields regression analysis

PURPOSE

To evaluate the usefulness of the glaucoma probability score (GPS), which does not require manual outlining of the disc boundaries, and the Moorfields regression classification (MRA), which requires manual outlining of the disc boundaries, for discriminating between healthy and glaucomatous eyes, using the Heidelberg Retina Tomograph.

DESIGN

Cross-sectional study.

PARTICIPANTS

We prospectively selected 71 consecutive healthy subjects and 115 consecutive patients with open-angle glaucoma.

METHODS

Participants were divided into 2 groups depending on the results of standard automated perimetry and intraocular pressure. All participants underwent imaging of the optic nerve head with the Heidelberg Retina Tomograph 3. All tests were performed within 1 month of each subject's date of enrollment into the study by examiners masked to the other findings.

MAIN OUTCOME MEASURES

The sensitivity and specificity of all parameters of the MRA and GPS classifications were calculated. The diagnostic accuracy at different severities of glaucoma and optic disc sizes was also evaluated. Receiver operating characteristic curves were plotted for the GPS values.

RESULTS

The MRA global classification had a sensitivity of 73.9% and a specificity of 91.5%. The GPS global classification had a sensitivity of 58.2% and a specificity of 94.4%. The GPS had slightly higher sensitivity and somewhat lower specificity than the MRA when there was mild damage indicated by visual field tests. The MRA had the best discrimination capability for moderate and severe glaucoma. Both the GPS and MRA had lower sensitivity and higher specificity for small optic discs (<1.7 mm2) compared with medium and large discs.

CONCLUSIONS

In general, the diagnostic performance of the GPS was similar to that of the MRA. The diagnostic accuracy of both classifications depends on the optic disc size and the glaucoma severity.

[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.

[Retinal toxicity following chloroquine therapy]

CASE REPORT

Two cases of bilateral ocular toxicity following chloroquine therapy in two women with systemic lupus erythematosus are presented.

DISCUSSION

Retinal toxicity due to chloroquine is an uncommon iatrogenic disease. It is dose-dependent. New cases are still being described despite the application of ophthalmic screening techniques.

[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.

Multivariate analysis of structural parameters of the optic nerve head assessed by means of confocal scanning laser (Heidelberg retina tomograph II)

We evaluated the optic nerve head parameters measured by confocal scanning laser that discriminated between normal and glaucomatous subjects in 97 normal eyes and 94 glaucomatous eyes. Several different linear regression formulas can discriminate the presence of glaucomatous. The use of linear regression functions of HRT parameters elaborated from autochthon population around the world will add the amounts of evidence needed to support the global use of these functions.

Frequency-doubling technology: searching for the optimum diagnostic criteria for glaucoma

PURPOSE

To determine the diagnostic criteria of perimetry using frequency-doubling technology (FDT) with the best possible sensitivity-specificity balance for glaucoma diagnosis.

METHODS

A total of 92 healthy control subjects and 110 patients with varying degrees of glaucomatous visual field loss on standard automated perimetry (SAP) were used to obtain the best diagnostic criterion for the disease, by using screening C-20-1 and threshold C-20 strategies from original FDT perimetry. Another prospective sample of 52 normal eyes and 64 glaucoma eyes was used to test how well this optimum criterion performs in other populations. Receiver operating characteristic (ROC) curves were plotted for the number of altered points at each level of probability for the C-20-1 and threshold C-20 modes. In addition, ROC curves were calculated for the global indices of the threshold C-20 strategy.

RESULTS

The best criterion for the C-20-1 strategy is the presence of one or more altered points with p < 1% (57.81% sensitivity and 100% specificity). The optimum criteria for glaucoma diagnosis for the threshold C-20 strategy are the presence of five or more altered points with p < 5% and/or two or more altered points with p < 2% and/or at least one altered point with p < 1% at any location (79.68% sensitivity and 94.2% specificity).

CONCLUSIONS

By using the C-20-1 strategy, a p < 1% defect anywhere showed 100% specificity with the lowest test duration. The criteria proposed for the threshold C-20 algorithm presented a good sensitivity-specificity balance. The threshold C-20 test provides higher sensitivity than the C-20-1 strategy but takes about five times longer to perform.

[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.

Grepafloxacin Concentration in Ocular Tissues after Intravenous Infusion in Rabbits with Intraocular Inflammation

PURPOSE

To determine the penetration of grepafloxacin into ocular tissues during experimental ocular inflammation.

METHODS

10 albino and 10 pigmented rabbits underwent a continuous intravenous infusion of the drug 24 h after injecting Salmonella typhimurium toxin intravitreously, creating ocular inflammation. The animals were killed and grepafloxacin levels were determined in plasma and ocular tissues using high performance liquid chromatography.

RESULTS

Grepafloxacin levels achieved a steady-state plasma concentration of 1.5 microg/ml. The drug diffused more towards vascularized tissues (chorioretina and iris) in both albino and pigmented rabbits with a tissue/serum ratio higher than 1. Grepafloxacin showed more affinity to pigmented tissue, rising levels of 40,000-50,000 ng/g in the chorioretina and iris in pigmented animals. After inflammation, grepafloxacin intraocular penetration increased in albino animals with levels exceeding the minimum inhibitory concentration for the most common ocular pathogens.

CONCLUSION

Grepafloxacin intraocular penetration is higher in pigmented tissues. Ocular inflammation increases the drug penetration into the vitreous.

[Photodynamic therapy for treatment of choroidal neovascularization]

PURPOSE

To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia.

METHODS

102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months.

RESULTS

CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT.

CONCLUSION

PDT is a moderately effective treatment without complications in treating subfoveal CNV.

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.

Contact versus peribulbar anaesthesia in trabeculectomy: a prospective randomized clinical study

PURPOSE

To compare the pre-, intra- and postoperative pain scores and complication rates in trabeculectomy under contact-topical anaesthesia versus peribulbar injection anaesthesia.

METHODS

A total of 100 patients selected to undergo primary trabeculectomy were randomly allocated to receive either contact or peribulbar anaesthesia. Patients were asked to rate their pain levels on a 5-point scale for four periods: during the administration of the anaesthetic agent, during surgery, immediately after surgery and 24 hours postoperatively. At the same time, the surgeon was asked to record his subjective assessment of the stress he himself had suffered during the course of the intervention. Surgical parameters, intra- and early postoperative complications were also evaluated.

RESULTS

The difference between groups was statistically significant during anaesthetic administration. Six patients who received contact-topical anaesthesia reported mild discomfort during delivery of the anaesthetic agent, while 43 patients complained of mild to severe pain during the injection of bupivacaine (p < 0.001). Thirty-two patients in the contact anaesthesia group and 26 in the injected anaesthesia group reported no pain during surgery (p = 0.127). Only one patient in each group reported mild pain 30 min postoperatively. We found no differences between pain rates after surgery. Complications included prolonged chemosis and we also noted that conjunctival haemorrhage occurred more frequently in the peribulbar group than in the contact anaesthesia group (p = 0.012).

CONCLUSION

Both anaesthetic methods provided high levels of pain control without additional sedation during surgery. The use of contact-topical anaesthesia reduces both pain and the possibility of complications during the administration of anaesthetics.

A comparison of the effects on intraocular pressure of latanoprost 0.005% and the fixed combination of dorzolamide 2% and timolol 0.5% in patients with open-angle glaucoma

PURPOSE

To compare the effects on intraocular pressure (IOP) of latanoprost 0.005% and the fixed combination of dorzolamide 2% and timolol 0.5%.

METHODS

Overall, 226 patients whose IOP was insufficiently controlled by timolol alone were randomized to receive either latanoprost once daily or the fixed combination of dorzolamide plus timolol twice daily. Intraocular pressure was measured at 10:00 am and 5:00 pm at baseline and after 3 months of treatment.

RESULTS

Mean IOP was reduced from baseline in both groups (p < 0.001), with a mean +/- SEM reduction of - 4.3 +/- 0.3 mmHg (19%) for the latanoprost treatment group and - 4.0 +/- 0.3 mmHg (17%) for the dorzolamide plus timolol treatment group. The two therapies were similarly effective in lowering IOP levels (mean difference in reduction: - 0.4 +/- 0.4; 95% confidence interval: - 1.1, 0.4).

CONCLUSIONS

Monotherapy with latanoprost once daily was as effective in reducing mean IOP as the fixed combination of dorzolamide plus timolol twice daily in patients with IOP insufficiently controlled by timolol alone.

Predictive value of short-wavelength automated perimetry: a 3-year follow-up study

PURPOSE

To determine whether structural changes in the retinal nerve fiber layer (RNFL) and functional abnormalities in short-wavelength automated perimetry (SWAP) can predict the onset of functional losses in standard automated perimetry patients suspected of having glaucoma.

DESIGN

Prospective observational case series.

PARTICIPANTS

A total of 160 eyes of ocular hypertensive subjects (intraocular pressure greater than 21 mmHg and normal standard automated perimetry) were included in the study.

INTERVENTIONS

The subjects underwent RNFL photographic evaluation and SWAP. Standard automated perimetries were repeated after 3 years to evaluate glaucomatous losses.

MAIN OUTCOME MEASURES

Onset of glaucomatous defects in conventional automated perimetry after 3 years of follow-up, with or without prior glaucomatous defects in RNFL and SWAP.

RESULTS

At the beginning of the study, 77 eyes showed RNFL losses (48%), and 58 eyes showed abnormalities in SWAP (36%). After the 3-year follow-up period, 14 of 77 eyes with RNFL losses had standard automated perimetry abnormalities (predicting sensitivity 93%), whereas 11 of 58 eyes with abnormal SWAP had standard automated perimetry losses (73% sensitivity).

CONCLUSIONS

RNFL and SWAP losses are signs of early glaucomatous damage and can predict functional losses in standard automated perimetry.

[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.

[Antiinflammatory capacity of topical ketorolac in experimental model of ocular inflammation]

PURPOSE

We studied the antiinflammatory effect of topical Ketorolac-Tromethamine on a model of endotoxin-induced uveitis in albino rabbits.

METHODS

Endotoxin-induced uveitis was produced by intravitreal injection in the right eye of 10 ng lipopolysaccharide (LPS) A Salmonella typhimurium endotoxin in 5 microl saline solution. We have used 60 animals (5 groups of 12 animals each). Control group (G-I) was injected with saline (5 microl); endotoxin group (G-II) was injected with 10 ng of endotoxin; groups III, IV and V were injected with the same amount of endotoxin and treated with topical ketorolac-tromethamine every 6, 4 and 2 hours respectively. The animals were sacrificed 24 hours after endotoxin administration. We determined the ocular clinical signs and inflammatory cells and protein concentration in the aqueous humor.

RESULTS

In all the groups treated with Ketorolac-Tromethamine we observed a significant reduction (p<0.05) in all parameters studied when compared with those of the endotoxin group (G-II).

CONCLUSION

Topical Ketorolac-Tromethamine has demonstrated a significant reduction of endotoxin-induced-uveitis inflammation.

[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.