Valor de la neumotonometría en el despistaje de la enfermedad glaucomatosa

Evaluar la habilidad de la neumotonometría como técnica para el despistaje del glaucoma primario de ángulo abierto (GPAA). Se seleccionaron de forma consecutiva sujetos mayores de 35 años que acudieron al CME San José y a la óptica Vista Actur. Todos ellos fueron sometidos a una exploración oftalmológica básica y a la medición de la presión intraocular (PIO) mediante neumotonometría. Aquellos que presentaron un valor igual o superior a 21 mm de Hg Se evaluaron 135 sujetos, la edad media de la muestra fue de 53,64 años y la proporción entre hombres y mujeres fue de 54,42 % y 53,21% respectivamente. 20 sujetos, presentaron un valor de PIO > 21mmHg mediante neumotonometría. Tras realizar tonometría de aplanación 4 de ellos seguían teniendo PIO alta por lo que fueron evaluados como sospechosos de padecer GPAA y finalmente 2 sujetos fueron diagnosticados de ello. Se evaluaron aquellos sujetos que presentaron PIO normal y antecedentes familiares de GPPA detectando 1 casos de GPAA. Como técnica de despistaje la neumotonometría es útil para detectar casos de GPAA en la población de riesgo. En la muestra de sujetos de los barrios de San José y Actur, localizados en Zaragoza la prevalencia de GPAA es del 2,2%. En la muestra estudiada necesitamos localizar 7,14 sujetos con PIO elevada para obtener un caso de GPAA

Visual acuity of pseudophakic patients predicted from in-vitro measurements of intraocular lenses with different design

The optical quality of a set of IOLs (modeling set: one monofocal and two bifocals) was assessed through focus by the area under the modulation transfer function (MTFa) metric and related to the visual acuity (VA) defocus curves of pseudophakic patients implanted with said IOLs. A non-linear relationship between the MTFa and clinical VA was obtained with an asymptotic limit found to be the best VA achievable by the patients. Two mathematical fitting functions between clinical VA and MTFa were derived with high correlation coefficients (R-2 >= 0.85). They were applied to the MTFa obtained from a different set of IOLs with advanced designs (trial set: one extended range of vision -ERV-, one trifocal ERV and one trifocal apodized) to predict VA versus defocus of patients implanted with these IOLs. Differences between the calculated VA and the clinical VA for both fitting models were within the standard deviation of the clinical measurements in the range of -3.00 D to 0.00 D defocus. thus proving the suitability of the MTFa metric to predict clinical VA performance of new IOL designs. (C) 2018 Optical Society of America under the terms of the OSA Open Access Publishing Agreemen

Relación entre la perimetría automatizada convencional y la topografía papilar realizada con el tomógrafo Heidelberg

espanolObjetivo: Determinar las correlaciones entre los parametros de la cabeza del nervio optico (CNO) obtenidos mediante el laser confocal de barrido (HRT), y los resultados de la perimetria automatizada convencional (PA) en sujetos normales, hipertensos oculares (HTO), sospechosos de glaucoma y glaucomatosos. Metodos: Cuatrocientos veintitres ojos fueron incluidos en el estudio y clasificados segun la presion intraocular basal, morfologia papilar y los resultados de la PA en 4 grupos: 87 normales, 192 hipertensos oculares, 70 sospechosos de glaucoma y 74 glaucomatosos. En los diferentes grupos diagnosticos, se calcularon los coeficientes de correlacion de Pearson entre los parametros de la CNO y la desviacion media (DM), la desviacion estandar de la media (DSM), el numero de puntos alterados en cada cuadrante del campo visual (superior-nasal, inferior-nasal, superior-temporal e inferior-temporal), el numero de puntos alterados segun los niveles de probabilidad y los valores umbral en cada punto de la PA. Resultados: En el grupo normal y de hipertensos oculares, se encontraron pocas correlaciones debiles entre los parametros del HRT y los resultados de la PA. La fuerza y el numero de correlaciones significativas aumentaron en el grupo de sospechosos de glaucoma. En el grupo de glaucomas, las correlaciones fueron mas fuertes, especialmente entre los cocientes excavacion/disco y anillo/disco con la DM (r=0,479) y entre el area de anillo con la DSM (r=0,444). Conclusiones: Se encontraron correlaciones debiles o moderadas entre algunos parametros de la CNO medidos con el HRT y los resultados de la PA, en el grupo de glaucomas. EnglishPurpose: 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 grou

Study of association between Pre-Senile cataracts and the polymorphisms rs2228000 in XPC and rs1042522 in p53 in Spanish population

To determine if the presence of certain polymorphisms in the DNA repair gene XPC and the apoptosis inductor gene p53 is associated with pre-senile cataract development. Methods We have performed a retrospective study over three groups of patients. The group with presenile cataract formed by 72 patients younger than 55 with cataract surgery. The group with senile cataract formed by 101 patients older than 55 with cataract surgery. The group without cataract was formed by 42 subjects older than 55 without lens opacities. We analyzed the presence of SNP rs2228000 from XPC and rs1042522 from p53; and the relationship between risk factors such as smoking, alcohol intake, hypertension or diabetes. Results The comparison of the genotype distribution in XPC, within the different groups, did not show any statistically significant association in any of our analysis (p>0, 05). The comparison of the genotype distribution in p53 within the different groups did not show any statistically significant association (p>0, 05); except for the comparison between the pre-senile cataract group and the group with senile cataract where the genotype Pro/Pro (C/C) in the recessive inheritance model showed a higher risk for developing pre-senile cataract (p = 0, 031; OR = 1.04-15.97). This association decreased when we performed the analysis adjusting by the studied risk factors (p = 0.056). Conclusions Allelic variants in the gene XPC are not associated with an increased risk for developing pre-senile cataract. The presence of the genotype Pro/Pro in p53 might be associated with a major risk for developing pre-senile cataract

Therapeutical Management for Ocular Rosacea

Purpose: The purpose of this study is to describe a case of ocular rosacea with a very complex evolution. Rosacea is a chronic dermatological disease that may affect the ocular structures up to 6-72% of all cases. This form is often misdiagnosed, which may lead to long inflammatory processes with important visual consequences for affected patients. Therefore, an early diagnosis and an adequate treatment are important. Methods: We report the case of a 43-year-old patient who had several relapses of what seemed an episode of acute bacterial conjunctivitis. Two weeks later, he developed a corneal ulcer with a torpid evolution including abundant intrastromal infiltrators and calcium deposits. He was diagnosed with ocular rosacea and treated with systemic doxycycline and topical protopic. Results: A coating with amniotic membrane was placed in order to heal the ulcer, but a deep anterior lamellar keratoplasty to restore the patient''s vision because of the corneal transparency loss was necessary. Conclusions: Ocular rosacea includes multiple ophthalmic manifestations ranging from inflammation of the eyelid margin and blepharitis to serious corneal affectations. A delayed diagnosis can result in chronic inflammatory conditions including keratinization and loss of corneal transparency, which lead to important visual sequelae for affected patients. (C) 2016 The Author(s) Published by S. Karger AG, Base

Role of color doppler imaging in early diagnosis and prediction of progression in glaucoma

This longitudinal and prospective study analyzes the ability of orbital blood flow measured by color Doppler imaging (CDI) to predict glaucoma progression in patients with glaucoma risk factors. Patients with normal perimetry but having glaucoma risk factors and patients in the initial phase of glaucoma were prospectively included in the study and divided, after a five-year follow-up, into two groups: “Progression” and “No Progression” based on the changes in the Moorfields regression analysis (MRA) classification of Heidelberg retina tomograph (HRT). An orbital CDI was performed in all patients and the parameters obtained were correlated with changes in HRT. A logistic discrimination function (LDF) was calculated for ophthalmic artery (OA) and central retinal artery (CRA) parameters. Receiver operating characteristics curves (ROC) were used to assess the usefulness of LDFs to predict glaucomatous progression. A total of 71 eyes were included. End-diastolic velocity, time-averaged velocity, and resistive index in the OA and CRA were significantly different ( ) between the Progression and No Progression groups. The area under the ROC curves calculated for both LDFs was of 0.695 (OA) and 0.624 (CRA). More studies are needed to evaluate the ability of CDI to perform early diagnosis and to predict progression in glaucoma in eyes

Evaluation of Contrast Sensitivity, Chromatic Vision, and Reading Ability in Patients with Primary Open Angle Glaucoma

Purpose. To compare contrast sensitivity, acquired color vision deficiency, and reading ability in patients with glaucoma at different stages of the disease and to establish correlations between visual field parameters and visual function scores. Methods. This prospective cross-sectional study included 121 glaucoma patients. Subjects with a diagnosis of chronic open angle glaucoma were recruited and classified according to Hodapp-Parrish-Anderson criteria. Patients with severe visual field defects were excluded because they were older, which could bias the interpretation of visual function tests. Contrast sensitivity was measured using the Pelli-Robson Chart and the CSV1000E test. Chromatic vision was evaluated using the Farnsworth-panel D15 and the L''Anthony D15 tests of Vision Color Recorder software. Reading ability was measured using Radner-Vissum test. Results. Contrast sensitivity (with photopic and mesopic luminance with glare) differed significantly between patients with early and moderate visual field defects (p < 0.05). Reading ability scores and results of the chromatic vision tests did not differ significantly between the two groups. Significant and moderate Spearman correlations between visual field indexes and contrast sensitivity tests were detected. Conclusions. Contrast sensitivity was significantly worse in patients with moderate glaucoma compared to those with early-stage glaucoma. Evaluation of visual function in clinical practice provides important information to address a glaucoma patient''s vision complaints

Continuous intraocular pressure monitoring in patients with obstructive sleep apnea syndrome using a contact lens sensor

Purpose To analyse nocturnal intraocular pressure (IOP) fluctuations in patients with obstructive sleep apnea syndrome (OSAS) using a contact lens sensor (CLS) and to identify associations between the OSAS parameters determined by polysomnographic study (PSG) and IOP changes. Method Prospective, observational study. Twenty participants suspected of having OSAS were recruited. During PSG study, IOP was monitored using a CLS placed in the eye of the patient. The patients were classified according to the apnea-hypopnea index (AHI) in two categories, severe (>30) or mild/moderate (<30) OSAS. We evaluated several parameters determined by the IOP curves, including nocturnal elevations (acrophase) and plateau times in acrophase (PTs) defined by mathematical and visual methods. Results The IOP curves exhibited a nocturnal acrophase followed by PTs of varying extents at which the IOP remained higher than daytime measurement with small variations. We found significant differences in the length of the PTs in patients with severe OSAS compared to those with mild/moderate disease (P = 0.032/P = 0.028). We found a positive correlation between PTs and OSAS severity measured by the total number of apneic events (r = 0.681/ 0.751 P = 0.004/0.001) and AHI (r = 0.674/0.710, P = 0.004/0.002). Respiratory-related arousal and oxygen saturation also were associated significantly with the IOP PT length. Conclusions Periods of nocturnal IOP elevation lasted longer in severe OSAS patients than those with mild/moderate OSAS and correlate with the severity of the disease. The length of the nocturnal PT is also associated to respiratory parameters altered in patients with OSAS

Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD

This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a "spike"and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs