Estudio del grosor corneal en diferentes zonas corneales en pacientes sanos y con glaucoma primario de ángulo abierto: efecto sobre la tonometría de aplanación de Goldmann, tonometría de contorno y tonometría de rebote

Dada la controversia actual sobre el papel del grosor corneal, no solo a nivel central sino también en la periferia corneal, y su influencia en las medidas tonométricas, es plausible preguntarse de qué manera pueden afectar diferentes zonas de segmentación corneal diferentes a la del punto central, en la medida de los tonómetros más usados en la práctica clínica como son la tonometría de aplanación de Goldmann (TAG), el tonómetro de contorno dinámico (TCD) o la tonometría de rebote (TR), y reconocer si existen patrones característicos que pudieran ayudarnos a discriminar entre pacientes afectos de glaucoma primario de ángulo abierto (GPAA) o sujetos sanos. Objetivos: El objetivo principal de este trabajo fue construir 5 modelos de segmentación circulares adaptados a la forma del contorno de la córnea, en una muestra de sujetos sanos y enfermos con GPAA a fin de determinar: 1. El grosor corneal central (GCC) determinado mediante paquimetría ultrasónica, el grosor medio de toda la córnea y el grosor medio de las regiones corneales generadas en la segmentación, así como su influencia sobre la TAG, la TCD y la TR. 2. Las diferencias existentes, entre los grosores medios de las zonas generadas en la segmentación de controles sanos y pacientes afectos de GPAA..

Therapeutic Response After Immunosuppressive Drug Prescription in Non-infectious Uveitis: A Survival Analysis

Immunosuppressive drugs; Response to therapyMedicaments immunosupressors; Resposta al tractamentMedicamentos inmunosupresores; Respuesta al tratamientoIntroduction To identify factors affecting the response rate to immunosuppressive drugs (ISDs) in patients with non-infectious uveitis (NIU). Methods This longitudinal retrospective cohort study included patients from the Hospital Clinico San Carlos Uveitis Clinic diagnosed with NIU from 1992 to 2016. Subjects were followed up from ISD prescription until the achievement of good therapeutic response (GTR), ISD treatment change, or up to 12 months. GTR was defined as the complete resolution of the eye inflammatory manifestations with a corticosteroid dose ≤ 10 or ≤ 5 mg per day of prednisone or equivalent (GTR10 and GTR5, respectively) maintained for at least 28 days. Kaplan–Meier curves were estimated for GTR. Demographic, clinical, and treatment-related factors were analyzed using Cox robust regression. Results A total of 73 patients (100 episodes of ISD prescription) were analyzed. In 44 and 41 episodes, GTR10 and GTR5 were achieved, respectively. A lower hazard for both GTRs was associated with uveitic macular edema at prescription and with a higher “highest oral corticosteroid dose prescribed in the year before ISD prescription”. GTR10 was higher if cyclosporine was prescribed (compared to other ISDs), and if a higher number of ISDs had been previously prescribed. GTR5 hazard was lower for patients with posterior uveitis or if the ISDs were prescribed before 2008, and higher if periocular corticosteroids had been administered before ISD prescription, or if the duration of the posterior segment activity was shorter. Conclusions Factors associated with GTR to ISDs may help to identify patients with NIUs who could benefit from a thorough follow-up.This work was supported by the Instituto de Salud Carlos III, Ministry of Health, Madrid, Spain [ICI19/00020; PI20/01221; RD21/002/0001]. The sponsor or funding organization had no role in the design or conduct of this research. The journal’s Rapid Service Fee was funded by the institution employing the senior author of the manuscript (Fundación Biomédica del Hospital Clínico San Carlos)

Dependence of dynamic contour and Goldmann applanation tonometries on peripheral corneal thickness

AIM: To determine the effects of peripheral corneal thickness (PCT) on dynamic contour tonometry(DCT) and Goldmann applanation tonometry (GAT). METHODS: A cross-sectional study. We created a software which calculates the corneal contour (CC) as a function of the radius from the corneal apex to each pixel of the contour. The software generates a central circumference with a radius of 1 mm and the remainder of the cornea is segmented in 5 rings concentric with corneal apex being its diameter not constant around the corneal circumference as a consequence of the irregular CC but keeping constant the diameter of each ring in each direction of the contour. PCT was determined as the mean thickness of the most eccentric ring. Locally weighted scatterplot smoothing (LOWESS) regression was used to determine the pattern of the relationship between PCT and both DCT and GAT respectively. Thereafter, two multivariable linear regression models were constructed. In each of them, the dependant variable was intraocular pressure (IOP) as determined using GAT and DCT respectively. In both of the models the predictive variable was PCT though LOWESS regression pattern was used to model the relationship between the dependant variables and the predictor one. Age and sex were also introduced control variables along with their first-degree interactions with PCT. Main outcome measures include amount of IOP variation explained through regression models (R2) and regression coefficients (B). RESULTS: Subjects included 109 eyes of 109 healthy individuals. LOWESS regression suggested that a 2nd-degree polynomial would be suitable to model the relationship between both DCT and GAT with PCT. Hence PCT was introduced in both models as a linear and quadratic term. Neither age nor sex nor interactions were statistically significant in both models. For GAT model, R2 was 17.14% (F=9.02; P=0.0002), PCT linear term B was -1.163 (95% CI: -1.163, -0.617). PCT quadratic term B was 0.00081 (95% CI: 0.00043, 0.00118). For DCT model R2 was 14.28% (F=9.29; P=0.0002), PCT linear term B was -0.712 (95% CI: -1.052, -0.372), PCT quadratic term was B=0.0005 (95% CI: 0.0003, 0.0007). CONCLUSION: DCT and GAT measurements are conditioned by PCT though this effect, rather than linear, follows a 2nd-degree polynomial pattern

Anatomical characterization of central, apical and minimal corneal thickness

<b>AIM:</b> To anatomically locate the points of minimum corneal thickness and central corneal thickness (pupil center) in relation to the corneal apex.<b>METHODS:</b> Observational, cross-sectional study, 299 healthy volunteers. Thickness at the corneal apex (AT), minimum corneal thickness (MT) and corneal thickness at the pupil center (PT) were determined using the pentacam. Distances from the corneal apex to MT (MD) and PT (PD) were calculated and their quadrant position (taking the corneal apex as the reference) determined:point of minimum thickness (MC) and point of central thickness (PC) depending on the quadrant position. Two multivariate linear regression models were constructed to examine the influence of age, gender, power of the flattest and steepest corneal axes, position of the flattest axis, corneal volume (determined using the Pentacam) and PT on MD and PD. The effects of these variables on MC and PC were also determined in two multinomial regression models.<b>RESULTS:</b> MT was located at a mean distance of 0.909 mm from the apex (79.4% in the inferior-temporal quadrant). PT was located at a mean distance of 0.156 mm from the apex. The linear regression model for MD indicated it was significantly influenced by corneal volume (B=-0.024; 95%CI:-0.043 to -0.004). No significant relations were identified in the linear regression model for PD or the multinomial logistic regressions for MC and PC.<b>CONCLUSION:</b> MT was typically located at the inferior-temporal quadrant of the cornea and its distance to the corneal apex tended to decrease with the increment of corneal volume

Correlations between corneal and optic nerve head variables in healthy subjects and patients with primary open angle glaucoma

AIM: To correlate corneal variables (determined using the Pentacam) with optic nerve head (ONH) variables determined using the Heidelberg retina tomograph (HRT) in healthy subjects and patients diagnosed with primary open angle glaucoma (POAG). METHODS: Measurements were made in 75 healthy eyes and 73 eyes with POAG and correlations examined through Pearson correlation coefficients between the two sets of variables in the two subject groups. The corneal variables determined were corneal volume (CVol), central corneal thickness (CCT), overall corneal thickness (OvCT), the mean thickness of a circular zone centered at the corneal apex of 1 mm radius (zone I) and the mean thickness of several concentric rings, also centered at the apex until the limbus, each of 1 mm width (zones II to VI respectively). The ONH variables were determined using the HRT. RESULTS: The following pairs of variables were correlated in the control group: CCT-disc area (DAr) (-0.48; P<0.0001), Zone I-DAr (-0.503; P<0.0001) and Zone II-DAr (-0.443; P<0.0001); and in the POAG group: CCT-cup-to-disc area ratio (CDRa) (-0.402; P<0.0001), Zone I-CDRa (-0.418; P<0.0001), Zone II-CDRa (-0.405; P=0.006), Zone I-cup shape measure (CSM) (-0.415; P=0.002), Zone II-CSM (-0.405; P=0.001), Zone IV-height variation contour (HVC) (0.378; P=0.002); Zone V-HVC (0.388, P<0.0001). CONCLUSION: AS-OCT-derived lens thickness measurement is valid and comparable to the results obtained by A-scan US. It can be used as a reliable noncontact method for measuring lens thickness in adults with or without significant cataract

Validation of UVEDAI: An Index for Evaluating the Level of Inflammatory Activity in Uveitis

Introduction Uveitis is the inflammation of the middle layer of the eye, the uvea, and is a major cause of blindness. None of the instruments used in clinical practice are, in themselves, sufficient to evaluate the course of uveitis. Therefore, it is necessary to develop instruments enabling standardized measurement of inflammatory activity. We developed a composite disease activity index for patients with uveitis known as UVEDAI, which considers the overall activity of the eye. The objective of this study was to validate the composite index of ocular inflammation, UVEDAI. Methods A multicenter cross-sectional study involving eight Spanish tertiary hospitals. Sixty-two patients aged ≥ 18 years with acute uveitis were recruited. Participants gave informed consent before participating in the study. A full ophthalmological examination was performed by two ophthalmologists to determine inflammatory activity: one used the UVEDAI score and the other used clinical judgment. The ophthalmologists did not share their findings with each other to avoid introducing bias into the analysis. Construct validity was established by means of factor analysis. The criterion validity of the index was determined using an ordinal multivariate regression model, in which the dependent variable was the degree of uveal inflammation (mild, moderate, or high/severe). Cut-off points were determined for the UVEDAI and for the receiver operating characteristic (ROC) curves. Results Sixty-two patients were included. Total variance with the three components accounted for 80.32% of the construct validity. Each of the three components identified one type of eye involvement. The discriminatory capacity of UVEDAI was 0.867 (95% CI 0.778; 0.955 p < 0.001) for mild versus moderate–high and 0.946 (95% CI 0.879; 1.000 p < 0.001) for high versus mild–moderate. Conclusions The variables included in UVEDAI enable ocular inflammatory activity to be described with a high degree of accuracy. The index may be used to evaluate and classify this activity with considerable discriminatory power.We would like to acknowledge the support of Abbvie: this study was conducted with an unrestricted grant from Abbvie. The Spanish Society of Rheumatology is the sponser and funder of this study and the journal's Rapid Service Fee, and has participated in the study design; in the analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The corresponding author had full access to all study data and had final responsibility for the decision to submit the manuscript for publication

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Optic neuropathy in a COVID-19 patient

Fac. de Óptica y OptometríaTRUEpu

Interferon-associated retinopathy in a patient with metastatic melanoma

We present the unusual case of a 35 year-old woman with stage IV melanoma and widespread metastases, who was undergoing treatment with interferon alpha-2b and who presented with interferon-associated retinopathy. The patient, who had been taking interferon treatment for three months, complained of a sudden loss of visual acuity in the left eye. An ocular examination revealed multiple cotton wool spots along the retina and macular involvement. Interferon treatment was suspended. Although rare, retinopathy represents a potentially serious adverse effect of interferon treatment. Although normally patients are asymptomatic, complications derived of its use may arise, which can lead to significant visual impairment. We therefore suggest that before initiating treatment with this drug, patients should be informed of its potential ocular risks, and that regular eye examinations are conducted along with the treatment

The Icare-Pro Rebound Tonometer Versus the Hand-held Applanation Tonometer in Congenital Glaucoma

PURPOSE: To compare intraocular pressure (IOP) measurements obtained using the new rebound tonometer Icare-Pro and the hand-held version of Goldmann Applanation Tonometer (Perkins tonometer) in children with primary congenital glaucoma (PCG) under general anesthesia. MATERIALS AND METHODS: Using both tonometers, 3 IOP measurements were prospectively determined in 1 single session. Icare-Pro was always used first, and then Perkins. All measurements were recruited in 50 eyes of 50 patients with PCG under general anesthesia. Central corneal thickness, anterior chamber depth, and axial length were also measured in each patient. Data were compared by determining interclass correlation coefficient for each tonometer and representing the differences detected as Bland-Altman plots. RESULTS: Good linear correlation was observed between IOP readings obtained using the Perkins and Icare-Pro (r=0.75, P<0.001), although the Icare-Pro readings were slightly higher (mean IOP difference 0.42 ± 3.69 mm Hg, P=0.41). A Bland-Altman plot revealed the 95% limits of agreement between the 2 methods: 7.7 to -6.8 mm Hg (slope=0.109, P=0.32). Intraclass correlation coefficient was 0.74 (95% confidence interval, 0.59-0.84) showing good agreement. For both tonometers, no correlation was detected between IOP measurements and central corneal thickness and axial length, but positive relation was found with anterior chamber depth. CONCLUSIONS: IOP measurements determined using the new Icare-Pro rebound tonometer showed good correlation with those obtained using the hand-held Perkins applanation tonometer in children with PCG under general anesthesia