Water-drinking Test and Pharmacologic Mydriasis as Provocative Tests in Primary Angle Closure Suspects

Purpose: To compare the water-drinking test (WDT) and pharmacologic mydriasis as provocative tests in patients with primary angle closure suspect (PACS). Methods: This observational non-randomized comparative study evaluated changes in intraocular pressure (IOP) in 21 patients with PACS who underwent pharmacologic mydriasis and compared it with IOP changes in 26 patients given the WDT. Ocular biometric and anterior chamber parameters were also assessed. Tests were repeated on the same patient two weeks after performing laser peripheral iridotomy (LPI). Results: The mean age ± standard deviation was 60 ± 7 and 57 ± 9 years in the mydriasis and WDT groups, respectively (P = 0.201). Before LPI, both provocative tests were associated with a significant increase in IOP (mydriasis: 15.1 ± 3.1 to 16.6 ± 3.5 mmHg, P = 0.025; WDT: 16.2 ± 2.8 to 18.5 ± 3.3 mmHg, P < 0.001). However, the IOP changes were not statistically different between groups (P = 0.102). After LPI, only the WDT group showed a continued significant IOP elevation after the test (mydriasis: 16.4 ± 3.3 to 16.7 ± 3.5 mmHg, P = 0.569; WDT: 14.9 ± 3.0 to 17.8 ± 4.1 mmHg, P < 0.001). The post-test IOP change was significantly greater in the WDT than in the mydriasis group (3.0 versus 0.3 mmHg, respectively; P = 0.002). Step-wise multiple regression analysis verified the type of provocative test as the only independent factor affecting the post-test IOP change after LPI (regression coefficient: 2.664; P = 0.002). Conclusion: Pharmacologic mydriasis and the WDT had similar IOP elevation before LPI, but after LPI, IOP elevation was much greater in the WDT group

Intraocular Pressure Changes after Water Drinking Test in Surgically Treated Primary Congenital Glaucoma

Purpose: To assess intraocular pressure (IOP) changes after the water drinking test (WDT) in patients with primary congenital glaucoma (PCG). Methods: In this prospective interventional study, 20 eyes of 20 patients with PCG were included. All patients had undergone trabeculotomy. Six out of twenty eyes had received a glaucoma drainage device (GDD) implantation. IOP was measured using an air-puff tonometer at baseline, and 15, 30, 45, and 60 min after WDT. The repeated-measures analysis of variance test was used to compare the mean IOPs at different time points. Results: The mean (± standard deviation) of participants’ age was 9.9 ± 2.7 years (range, 6 to 16 years), and 8 (40%) participants were male. The mean IOPs at baseline and 15, 30, 45, and 60 minutes after the WDT were 15.8 ± 3.7, 18.6 ± 3.4, 19.0 ± 3.8, 17.9 ± 3.8, and 16.9 ± 3.5 mmHg, respectively (P < 0.001). Pairwise comparisons revealed that the mean IOPs after 15 and 30 min were significantly greater than the baseline IOP (P < 0.001 and P = 0.002, respectively); however, the difference in mean IOPs after 45 and 60 min were not statistically significant from the baseline IOP. The averages of IOP peak and IOP fluctuation after the WDT were 20.0 ± 3.5 and 4.2 ± 2.9 mmHg, respectively. IOP fluctuation in those who underwent trabeculotomy alone was twice that of those with GDDs, but the difference was not statistically significant (5.0 vs 2.5 mmHg; P = 0.08). Conclusions: In patients with PCG, WDT induced significant IOP elevation 15 and 30 min after the test, which returned to pre-test values after 45 min

Corneal Parameters in Healthy Subjects Assessed by Corvis ST

Purpose: To evaluate corneal biomechanics using Corvis ST in healthy eyes from Iranian keratorefractive surgery candidates. Methods: In this prospective consecutive observational case series, the intraocular pressure (IOP), central corneal thickness (CCT), and biomechanical properties of 1,304 eyes from 652 patients were evaluated using Corvis ST. Keratometric readings and manifest refraction were also recorded. Results: The mean (±SD) age of participants was 28 ± 5 years, and 31.7% were male. The mean spherical equivalent refraction was –3.50 ± 1.57 diopters (D), the mean IOP was 16.8 ± 2.9 mmHg, and the mean CCT was 531 ± 31 μm for the right eye. The respective means (±SD) corneal biomechanical parameters of the right eye were as follows: first applanation time: 7.36 ± 0.39 milliseconds (ms); first applanation length: 1.82 ± 0.22 mm; velocity in: 0.12 ± 0.04 m/s; second applanation time: 20.13 ± 0.48 ms; second applanation length: 1.34 ± 0.55 mm; velocity out: –0.67 ± 0.17 m/s; total time: 16.84 ± 0.64 ms; deformation amplitude: 1.05 ± 0.10 mm; peak distance: 4.60 ± 1.01 mm; and concave radius of curvature: 7.35 ± 1.39 mm. In the linear regression analysis, IOP exhibited a statistically significant association with the first and second applanation times, total time, velocity in, peak distance, deformation amplitude, and concave radius of curvature. Conclusion: Our study results can be used as a reference for the interpretation of Corvis ST parameters in healthy refractive surgery candidates in the Iranian population. Our results confirmed that IOP is a major determinant of Corvis parameters

Inferior Spear-like Lens Opacity as a Sign of Keratoconus

Purpose: To report 21 cases of typical inferior feather-shape lens opacity associated with keratoconus. Methods: In this cross-sectional study, we evaluated the association of keratoconus with inferior feather-shape lens opacity in refractive surgery candidates. Visual acuity, demographic, refractive, and topographic characteristics of 26 eyes of 21 patients with inferior feather-shape lens opacity were evaluated in detail. Pedigree analysis was also performed to assess possible inheritance. Results: Overall, 2122 out of 33,368 cases (6.4%) without lens opacity had keratoconus, while 20 out of 21 patients (95.2%) with peculiar lens opacity had definite keratoconus (P < 0.001). Lens opacity was bilateral in 5 cases (24%), and keratoconus was bilateral in all 20 patients with lens opacity. Nine eyes out of thirty-six with a complete data record (25%) had severe keratoconus and underwent deep lamellar keratoplasty, while 11 (31%) had forme fruste keratoconus. Pedigrees were drawn for eight patients, most families of whom suggested an X-linked recessive inheritance. Conclusion: The present study was the first to investigate patients with a peculiar inferior feather-shape lens opacity accompanied by bilateral keratoconus, which was observed in 95% of the patients. This finding should raise awareness as to the possibility of diagnosing keratoconus in the eyes of the patients with these characteristics

A Comparison of iCare and Goldmann Applanation Tonometry Measurements During the COVID-19 Pandemic: A Retrospective Study

PURPOSE: To evaluate factors associated with differences in intraocular pressure (IOP) readings between iCare and Goldmann applanation tonometry (GAT) in established glaucoma patients. METHODS: This retrospective comparative study included clinical data of 350 eyes from 350 established glaucoma patients who had iCare and GAT IOP measured by an ophthalmic technician and a glaucoma specialist, respectively. The main outcome measure was the difference in IOP measurements of the right eyes with iCare and GAT. RESULTS: The intraclass correlation coefficient (ICC) between GAT and iCare was 0.90. The mean IOP difference between tonometers was - 0.18 ± 2.89 mmHg. Bland-Altman plots indicated a 95% limit of agreement of - 5.8 to 5.5 mmHg. Central corneal thickness (CCT) and age were significantly correlated with the difference in IOPs of the iCare and GAT. GAT-IOP and age were significantly associated with the absolute difference in measured IOP of the two tonometers. The difference in measurements was not significantly associated with prior glaucoma surgery, average global index of optical coherence tomography, axial length, technician years of experience and certification, and IOP range. CONCLUSION: Although there is good agreement between the iCare and GAT mean values, these devices are not interchangeable in glaucoma patients due to the wide range of the limit of agreement

Early macular changes after phacoemulsification in eyes with high myopia

Purpose: To evaluate macular changes after cataract surgery in eyes with high myopia. Methods: This prospective cohort enrolled patients with high myopia (axial length ≥26 mm) who underwent phacoemulsification with intraocular lens implantation. Spectral-domain optical coherence tomography (OCT) scans were obtained at baseline and 2 and 6 months after the operation. Postoperative macular changes on OCT scans were regarded as the main outcome measure. Results: Thirty-four eyes of 31 patients with high myopia were included (age, 60 ± 10 years [mean ± SD]); of these, 14 patients (45.2%) were male. The mean axial length was 27.8 ± 1.5 mm. Epiretinal membrane (one eye, 2.9%), lamellar hole (one eye, 2.9%), myopic foveoschisis (2 eyes, 5.9%), and vitreomacular traction associated with foveoschisis (one eye, 2.9%) were notable findings at baseline examination; no eye showed cystoid macular edema (CME) at this time. At the 2-month examination, three eyes (8.8%) developed CME. At the 6-month follow-up, one eye with CME at 2 months improved, and a new case of CME (5.6%) was detected. The characteristics of epiretinal membrane, lamellar hole, vitreomacular traction, and foveoschisis did not change at the 2- and 6-month examinations and no new cases occurred. Conclusion: Uncomplicated phacoemulsification had no significant effect on the prevalence or characteristics of pre-existing macular abnormalities in eyes with high myopia up to 6 months of follow-up. The incidence of CME 2 months after uncomplicated cataract surgery in eyes with high myopia was about 9%

Outcomes of light silicone oil tamponade for failed idiopathic macular hole surgery

Purpose: To study the outcomes of redo macular hole surgery using light silicone oil tamponade. Methods: In this study, medical charts of consecutive patients who underwent redo pars plana vitrectomy, extended dye-assisted internal limiting membrane peel, and light silicone oil tamponade for failed previous macular hole surgery (from January 2010 to June 2014) were retrospectively reviewed. Best spectacle corrected visual acuity and anatomical closure rates were regarded as outcome measures. Results: Overall, data from 13 patients was recorded and analyzed. The mean (±SD) age of patients was 66 ± 7 years, and four (30.7%) were male. Mean interval between the primary and redo surgeries was 3.7 ± 2.0 months (range, 1 to 8 months). During redo surgeries, 11 (84.6%) subjects underwent additional internal limiting membrane peeling. Mean interval between the redo surgery and silicone oil removal was 5.9 ± 2.1 months (range, 3 to 10 months). After silicone oil removal, patients were followed for 21.8 ± 14.2 months (range, 3 to 51 months). Mean best spectacle corrected visual acuity improved from 20/452 before redo surgery to 20/121 in the last follow-up examination (P < 0.001). Anatomical success was achieved in 11 (84.6%) patients: nine (69.2%) macular holes were closed and two (15.4%) were flat-open. Conclusions: Redo pars plana vitrectomy with light silicone oil tamponade is an effective method for restoration of macular anatomy and function in patients with persistent macular holes

Botulinum toxin injection for treatment of acute traumatic superior oblique muscle palsy

Purpose: To evaluate the outcomes of botulinum toxin injection into the inferior oblique (IO) muscle for management of unilateral acute traumatic superior oblique (SO) palsy. Methods: In this prospective case series, 10-20 units of botulinum toxin A (Dysport, Ipsen, Biopharm Ltd., Wrexham, UK) was injected into the ipsilateral IO muscle of 13 consecutive patients with unilateral acute traumatic SO palsy. All patients received injections within four weeks of the incident. Results: Mean age was 29 ± 15 years and 12 (92%) subjects were male. Mean amount of hypertropia (in primary position) was decreased from 10.0 ± 3.9Δ at baseline to 4.6 ± 8.9Δ, one month after the injection, and to 1.5 ± 2.7Δ at final follow-up (P = 0.001). IO overaction improved from 2.7 ± 0.6 to 1.0 ± 1.2 and 0.6 ± 0.9 (P ≤ 0.001), and subjective torsion from 5.3 ± 3.9 to 3.2 ± 3.4 and 1.6 ± 2.5 degrees (P ≤ 0.001), at the same time intervals respectively. One month after the injection as well as at final follow-up, 10 (77%) patients were diplopia-free in primary and reading positions. Subgroup analysis showed that patients who recovered had less baseline hypertropia as compared to those who failed (8.3Δ vs. 15.7Δ, respectively; P = 0.01). All patients with a favorable outcome had baseline hypertropia of 10Δ or less. Conclusion: A single injection of BTA into the IO muscle can rapidly and safely resolve symptomatic diplopia in patients with acute traumatic SO palsy, while waiting for spontaneous recovery

In-vitro safety assessment of meropenem on human retinal pigment epithelium (RPE)

Purpose: Endophthalmitis is a severe infection accompanied by inflammation that affects the anterior and posterior parts of the eye. It is typically treated with a combination of antibiotics that cover various microorganisms. However, retinal pigment epithelium (RPE) cells are highly susceptible to damage from intravitreal injection therapy. This study aimed to investigate the impact of clinically relevant concentrations of meropenem (alone or in combination with vancomycin) on the viability and inflammation of RPE cells. Design: In-vitro Study. Methods: RPE cells from passages 5–7 were treated with different concentrations of meropenem (1/4x, x, and 4x; [x = 16 mg/L]), vancomycin (30 mg/L), and meropenem (x) plus vancomycin for 24 h. The morphology assessment and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay were performed to evaluate cytotoxicity due to drug treatment. Real-time PCR was used to measure the relative expression of apoptotic genes (BCL-2 and BAX) and inflammation biomarkers (IL-1b and IL-6). Results: Meropenem (alone or in combination with vancomycin) did not have any significant effect on RPE cell morphology, density, and viability. Gene expression analysis confirmed these results, showing no significant changes in the BCL-2/BAX ratio in drug-treated RPE cells compared to controls. Treatment with meropenem significantly induced the expression of IL-1b at all studied concentrations. Additionally, at concentrations of x and 4x, it also significantly increased the expression of IL-6, which was dose-dependent. However, this effect was not observed with vancomycin alone or in combination with meropenem. Conclusions: The results of this study suggest that meropenem, either alone or in combination with vancomycin, does not induce RPE cytotoxicity. There was an upregulation of IL-1b and IL-6 in meropenem monotherapy, the clinical implication of which should be elucidated in future in-vivo or clinical studies