Comparation of the new rebound tonometer IOPen and the Goldmann tonometer, and their relationship to corneal properties

Purpose To compare the intraocular pressures (IOPs) obtained with the IOPen rebound tonometer, Goldmann applanation tonometer (GAT) and the ocular response analyzer (ORA) and investigate the effects of corneal biomechanical properties on IOPen measurements. Methods A total of 198 normal eyes were included in this cross-sectional and randomized study. Three measurements were taken using IOPen. Agreement between tonometers was calculated using the Bland and Altman limits of agreement (LoA) analysis. Results The median IOPen IOP was 3mmHg below the GAT (Po0.001), 3mmHg below the ORA IOP similar to Goldmann (IOPg), and 3mmHg below the ORA IOP corrected using corneal parameters (IOPcc)(Po0.01). The LoA width between the IOPen and GAT IOPs varied between 13.92 (mean IOPen IOP) and 15.99mmHg (third IOPen measurement). The central corneal thickness (CCT) was unrelated to IOPen measurements (P40.05). Corneal hysteresis (CH) and corneal rigidity factor (CRF) were correlated with IOPen and GAT. Conclusions IOPen underestimated the IOP compared with GAT and ORA. The effect of measurement quality or measurement order on IOPen was low. CCT did not affect the IOPen, but the CH and CRF did. The LoA width between the IOPen and GAT IOPs was higher than between the ORA IOPg or ORA IOPcc and GAT IOPs

Acrysof® toric intraocular lens implantation in cataract surgery

Aim: To assess the medium term outcomes of Acrysof® toric intraocular lens implantation in 54 patients (54 eyes). Methods: Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), preoperative astigmatism, residual postoperative astigmatism, and global average and model-specific intraocular lens (IOL) rotation grade were analyzed. Results: At 2-months of follow-up,the mean UCVA was 0.83 (SD: 0.14) Snellen scale, with 73.9% of the patients ≥0.8, and 32.6% with 1.0. Mean BCVA achieved was 0.94 (SD: 0.10). Mean preoperatory astigmatism was –2.25 diopters (D) (SD: 0.78), and mean postoperative astigmatism was -0.32 D (SD: 0.56), with significant differences between both groups (p<0.001). Model-specific mean residual astigmatism was –0.1 D for T3, –0.27 D for T4 and –0.43 D for T5, without significant differences between the three models (p=0.483). Mean IOL-axis rotation grade was 3.87±3.25 degrees, with 91.6% of implanted lens within 10° of predicted axis. Discussion: T3, T4 and T5 Acrysof® Toric intraocular lenses can correct preoperative astigmatism with a high success rate in terms of UCVA, and residual postoperative astigmatism, with minimum IOL-rotation grade at 2 months follow-up period

Intravitreal bevacizumab associated with grid laser photocoagulation in macular edema secondary to branch retinal vein occlusion

To evaluate intravitreal bevacizumab (IVB) combined with grid laser photocoagulation in macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Eight eyes (8 patients) with ME associated with BRVO with at least 3 months of evolution since symptom onset were included. All subjects underwent measurement of best-corrected visual acuity (BCVA) and imaging with spectral domain optical coherence tomography (SD-OCT) at baseline and 1, 3, 6, and 12 months. Intravitreal bevacizumab was administered at baseline and macular grid laser photocoagulation 1 month later. During follow-up, additional IVB was administered based on physician discretion if persistent or recurrent intraretinal fluid (cysts) was observed on SD-OCT. The mean BCVA and SD-OCT central subfield thickness (CST) values were determined at each time point. Fisher exact test was performed to assess differences between baseline and post-treatment BCVA and SD-OCT measurements. RESULTS: The mean baseline BCVA was 0.28+/-0.14 (mean+/-SD), and the mean CST was 479+/-137 microm. The mean BCVAs at 1, 3, 6, and 12 months were 0.47+/-0.18 (p=0.031), 0.56+/-0.50 (p=0.031), 0.65+/-0.60 (p=0.008), and 0.66+/-0.65 (p=0.016), respectively. The mean CST values at 1, 3, 6, and 12 months were 295+/-60 microm (p=0.008), 333+/-114 microm (p=0.070), 339+/-80 microm (p=0.008), and 335+/-109 microm (p=0.008). A mean 2.13 injections were administered; the second injection was administered a mean of 2.71 months after baseline. CONCLUSIONS: Combined treatment with IVB and macular grid photocoagulation provided good results and may be considered as an alternative therapy for ME in BRVO. Further studies are needed to assess these preliminary results

Intravitreal bevacizumab associated with grid laser photocoagulation in macular edema secondary to branch retinal vein occlusion

To evaluate intravitreal bevacizumab (IVB) combined with grid laser photocoagulation in macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Eight eyes (8 patients) with ME associated with BRVO with at least 3 months of evolution since symptom onset were included. All subjects underwent measurement of best-corrected visual acuity (BCVA) and imaging with spectral domain optical coherence tomography (SD-OCT) at baseline and 1, 3, 6, and 12 months. Intravitreal bevacizumab was administered at baseline and macular grid laser photocoagulation 1 month later. During follow-up, additional IVB was administered based on physician discretion if persistent or recurrent intraretinal fluid (cysts) was observed on SD-OCT. The mean BCVA and SD-OCT central subfield thickness (CST) values were determined at each time point. Fisher exact test was performed to assess differences between baseline and post-treatment BCVA and SD-OCT measurements. RESULTS: The mean baseline BCVA was 0.28+/-0.14 (mean+/-SD), and the mean CST was 479+/-137 microm. The mean BCVAs at 1, 3, 6, and 12 months were 0.47+/-0.18 (p=0.031), 0.56+/-0.50 (p=0.031), 0.65+/-0.60 (p=0.008), and 0.66+/-0.65 (p=0.016), respectively. The mean CST values at 1, 3, 6, and 12 months were 295+/-60 microm (p=0.008), 333+/-114 microm (p=0.070), 339+/-80 microm (p=0.008), and 335+/-109 microm (p=0.008). A mean 2.13 injections were administered; the second injection was administered a mean of 2.71 months after baseline. CONCLUSIONS: Combined treatment with IVB and macular grid photocoagulation provided good results and may be considered as an alternative therapy for ME in BRVO. Further studies are needed to assess these preliminary results

Comparative study measuring the dilatory effect of a mydriatic device (Mydriasert(®)) versus topical drops

AIM: To compare the mydriatic efficacy of an ophthalmic insert (Mydriasert, MY) versus phenylephrine and tropicamide (PT) eye drops. METHODS: Two controlled, prospective, randomized, single-blind studies were performed. In the first study, a total of 80 eyes from 40 outpatient-clinic patients were analyzed. PT drops were applied to the right eye, and a MY device was inserted in the left eye for 30min. Time until maximal pupil dilation for each eye was then assessed. In the second study, 80 eyes from 80 patients undergoing cataract surgery were analyzed. Pupil dilation was achieved using either PT drops three-times for one hour prior to surgery (40 patients), or a MY device was inserted one hour prior to surgery (40 patients). RESULTS: In the first study, MY achieved superior mydriasis compared to PT eye drops at 90min (9.04 +/- 1.33mm vs 8.78 +/- 1.37mm, P=0.012). However MY took longer than PT drops to achieve maximal dilation, and mydriasis was inferior in eyes with MY compared to PT drops at 30min (7.21 +/- 1.73mm vs8.22 +/- 1.43mm, P < 0.001), the two groups only becoming similar by 60min (8.85 +/- 1.44mm vs8.71 +/- 1.27mm, P=0.236). In the second study, both MY and PT achieved similar levels of mydriasis at the beginning of surgery (8.75 +/- 0.76mm with MY vs8.77 +/- 0.63mm with PT), and also at the end of surgery (7.96 +/- 1.06mm with MY vs 8.32 +/- 0.72mm with PT), with no significant difference between groups (P=0.08). MY was well tolerated and cardiovascular effects were not influenced by dilation method. CONLUSION: MY could be a safe and efficacious alternative for mydriasis. The mydriatic effect of MY is as good as conventional PT eye drops after 60min, and is superior after 90min. MY also maintains good pupil dilation during cataract surgery

Comparative study measuring the dilatory effect of a mydriatic device (Mydriasert(®)) versus topical drops

AIM: To compare the mydriatic efficacy of an ophthalmic insert (Mydriasert, MY) versus phenylephrine and tropicamide (PT) eye drops. METHODS: Two controlled, prospective, randomized, single-blind studies were performed. In the first study, a total of 80 eyes from 40 outpatient-clinic patients were analyzed. PT drops were applied to the right eye, and a MY device was inserted in the left eye for 30min. Time until maximal pupil dilation for each eye was then assessed. In the second study, 80 eyes from 80 patients undergoing cataract surgery were analyzed. Pupil dilation was achieved using either PT drops three-times for one hour prior to surgery (40 patients), or a MY device was inserted one hour prior to surgery (40 patients). RESULTS: In the first study, MY achieved superior mydriasis compared to PT eye drops at 90min (9.04 +/- 1.33mm vs 8.78 +/- 1.37mm, P=0.012). However MY took longer than PT drops to achieve maximal dilation, and mydriasis was inferior in eyes with MY compared to PT drops at 30min (7.21 +/- 1.73mm vs8.22 +/- 1.43mm, P < 0.001), the two groups only becoming similar by 60min (8.85 +/- 1.44mm vs8.71 +/- 1.27mm, P=0.236). In the second study, both MY and PT achieved similar levels of mydriasis at the beginning of surgery (8.75 +/- 0.76mm with MY vs8.77 +/- 0.63mm with PT), and also at the end of surgery (7.96 +/- 1.06mm with MY vs 8.32 +/- 0.72mm with PT), with no significant difference between groups (P=0.08). MY was well tolerated and cardiovascular effects were not influenced by dilation method. CONLUSION: MY could be a safe and efficacious alternative for mydriasis. The mydriatic effect of MY is as good as conventional PT eye drops after 60min, and is superior after 90min. MY also maintains good pupil dilation during cataract surgery