Strategies to estimate the characteristics of 24-hour IOP curves of treated glaucoma patients during office hours

Background: It is known that office-hour measurements might not adequately estimate IOP mean, peaks and fluctuations in healthy subjects. The purpose of the present study is to verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP) in treated POAG patients. Methods: The 24-hour IOP curves of 70 eyes of 70 caucasian patients with treated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine (TonoPen XL) and sitting (Goldmann tonometer) positions. The ability of five strategies to estimate IOP mean, peak and fluctuation was evaluated. Each method was analyzed both with regression of the estimate error on the real value and with "hit or miss" analysis. Results: The least biased estimate of the Peak IOP was obtained using measurements from both supine and sitting positions, also yielding the highest rate of correct predictions (which was significantly different from 3 of the remaining 4 strategies proposed, p < 0.05). Strategies obtained from the combination of supine, sitting and peak measurements resulted to be least biased for the Mean IOP and the IOP Fluctuation estimate, but all strategies were not found significantly different in terms of correct prediction rate (the only significant difference being between the two strategies based on sitting or supine measurements only, with the former being the one with the highest correct prediction rate). Conclusions: The results of this study remark the concept that IOP is a dynamic parameter and that intensive measurement is helpful in determining its characteristics. All office-hour strategies showed a very poor performance of in correctly predicting the considered parameters within the thresholds used in this paper, all scoring a correct prediction rate below 52 %

Transient Esotropia in the Child : Case Report and Review of the Literature

The aim of this report is to investigate the possible causes of acute acquired onset of transient esotropia (AATE) in children and to help to differentiate ophthalmoplegic migraine (OM) from accommodative spasm (AS). A case of an 8-year-old Caucasian female affected by AATE and diplopia is described. The day before AATE onset, the patient complained of slight headache without nausea and vomiting, with spontaneous resolution. AATE diagnosis is challenging. The most likely ophthalmological causes of AATE are AS and OM. In these cases it is important to evaluate the presence of both a familial history of recurrent headaches and an AATE associated with migraine, ptosis, nausea, and vomiting. A full ophthalmological evaluation and a thorough refractive examination in cycloplegia are mandatory to exclude ophthalmological causes

Peripapillary Microvascular and Neural Changes in Diabetes Mellitus: An OCT-Angiography Study

Purpose: To evaluate peripapillary vessel density and morphology in patients with diabetes mellitus (DM) without clinical signs of diabetic retinopathy (DR) and with mild, nonproliferative DR and to correlate with peripapillary nerve fiber layer (NFL) thickness.Methods: One hundred seventeen eyes (34 healthy controls, 54 patients with DM without DR [noDR group] and 24 patients with mild DR [DR group]) were prospectively evaluated. All subjects underwent peripapillary and macular optical coherence tomography angiography (OCT-A). Peripapillary NFL thickness was also recorded. OCT-A slab of radial peripapillary plexus (RPC) and macular superficial capillary plexus (SCP) were analysed in order to calculate perfusion density (PD) and vessel density (VD). Further an image analysis of RPC slab was performed to identify number of branches (NoB) and total branches length (tBL).Results: In peripapillary area there was a significant decrease in VD (P = 0.003), NoB (P < 0.001), and tBL (P < 0.001) in noDR group versus controls; PD values were not different among groups (P = 0.126); there was a significant decrease in average NFL thickness in DR versus controls (P = 0.008) and in the inferior quadrant in noDR group versus controls (P = 0.03); there was a significant correlation between OCT-A and NFL thickness values (\u3c1 ranging from 0.19-0.57). In macular region PD and VD were decreased only in DR group (P < 0.05).Conclusions: There are early changes in the peripapillary vessel morphology and VD of the RPC in patients with DM without DR that correlate to NFL thinning. Earlier changes in superficial vessel density are documented in the peripapillary than in the macular region. These data may confirm a coexistence of an early neuronal and microvascular damage in patients with DM without clinical signs of DR

Repeatability and reproducibility of applanation resonance tonometry : a cross-sectional study

Background: To assess repeatability (intra-observer variability) and reproducibility (inter-operator variability) of intraocular pressure (IOP) measurements with servo-controlled Bioresonator Applanation Resonance Tonometry (ART) and to evaluate possible influential factors. Methods: The study included 178 patients (115 glaucoma and 63 controls; one eye per subject). IOP was measured once with a Goldmann applanation tonometer (GAT) and twice by ART (ART1, ART2), in randomized sequence, by a single operator to assess intra-operator variability. Each ART measurement consisted on 3 readings. To assess inter-operator variability 2 evaluators performed 2 measurements each (in random order) on the same patient. Repeatability and reproducibility were assessed by the coefficient of variation (CoV) and intraclass correlation coefficient (ICC). Results: In the entire cohort, ART1 was 0.4 \ub1 2.2 mmHg (-7.0 to 5.7 mmHg) higher than ART2 (p = 0.03) regardless of test order. Intra-operator CoV was 7.0% \ub1 6.3%, and ICC was 0.80-0.92. Inter-operator CoV ranged between 5.7% \ub1 6.1% and 8.2% \ub1 7.2%, and ICC between 0.86 and 0.97. ART1 and 2 were respectively 1.7 \ub1 3.1 and 1.3 \ub1 3.1 mmHg higher than GAT (p < 0.01). Test-retest difference with ART fell within \ub11 mmHg in 41% of cases, within \ub12 mmHg in 70%, within \ub13 mmHg in 85%. 15% had a test-retest difference higher than \ub1 3 mmHg; Bland-Altman 95% intervals of confidence were -3.9 and +4.6 mmHg. Results were unaffected by age, diagnosis, central corneal thickness, keratometry, operator, randomization sequence. Conclusions: In most cases ART repeatability and reproducibility were high, with no differences due to patients' characteristics. ART measurements overestimated GAT by a mean of 1.3-1.7 mmHg

Retinal fiber layer edema and visual field correlation after pars plana vitrectomy with internal limiting and epiretinal membrane peeling

Purpose:To analyze the relationship between retinal fiber layer (RNFL) edema and visual field (VF) defects in patients who underwent pars plana vitrectomy with internal limiting membrane (ILM) and epiretinal membrane peeling. Methods:In this retrospective, interventional consecutive case series, twenty-five eyes of 25 patients that underwent pars plana (23-25 Ga) vitrectomy with (ILM) peeling between December 2009 and May 2010 were studied. No patiens with glaucoma, retinal vein occlusion or diabetic retinopathy were included. Eyes were divided into two groups according to the use of indocianine green (ICG +/-) during surgery. Spectralis HRA + OCT( Heidelberg Engineering, Heidelberg Germany) was used for the evaluation of RNFL edema one and four weeks after surgery and (Humphrey Field Analyzer) to test VF a week, one, three and six months after surgery. Results:Fifteen patients (60%), 9 (36%) ICG+ and 6 (24%) ICG-, did not show postoperative RNFL edema. Ten patients (40%) had RNFL edema a week after surgery and only 7 (28%) of them underwent ICG assisted vitrectomy (chi square test, p=0.69). No edema was observed after four weeks in these patients but VF defects corresponding with previous edema areas were maintained at the end of the follow-up in all of them. Conclusions:Postoperative VF defects were observed in all the patients with temporary RNFL edema, suggesting that it is caused by a mechanical injury of the inner layer of the retina during the ILM peeling and probably does not depend on the use of intraoperative ICG

Corneal involvement in uneventful cataract surgery : an in vivo confocal microscopy study

Purpose: To evaluate corneal subbasal layer changes after uneventful cataract surgery by means of in vivo confocal microscopy. Methods: This prospective study included 30 patients. Before surgery, and 1, 3, 6, 8 and 10 months after cataract surgery, all patients underwent a complete ophthalmological and confocal microscopy examination in the central and temporal corneal areas. Number of fibers, beading, tortuosity and reflectivity were analyzed. Results: Important changes were shown in the central cornea up to 3 months after surgery: a reduction in nerve fiber number (baseline: 4.4 \ub1 1.7; month 1: 1.2 \ub1 0.5, p < 0.0001; month 3: 2.5 \ub1 1.2, p < 0.005) and reflectivity (baseline: 3.6 \ub1 0.5; month 1: 1.4 \ub1 0.6, p < 0.0001; month 3: 1.9 \ub1 0.9, p < 0. 0001), and an increase in beading (baseline: 0.3 \ub1 0.5 beads/100 \u3bcm2; month 1: 2.7 \ub1 0.6 beads/100 \u3bcm2, p < 0.0001; month 3: 2.6 \ub1 0.5 beads/100 \u3bcm2, p < 0. 0001). The confocal parameters completely progressively recovered thereafter (60% at 6 months, 87% at 8 and 10 months). The temporal plexus was absent at 1 month and fully recovered in all patients at month 8. Conclusion: Uneventful cataract surgery induces relevant corneal modifications when inspected by means of confocal microscopy

Corneal Confocal Microscopy in Patients With Diabetic Retinopathy

Purpose:to study the subbasal corneal plexus in patients with diabetic retinopathy (DR) treated or non-treated with panretinal Argon laser photocoagulation (ALP). Methods:50 consecutive patients with DR and 50 age- and sex-mached normal controls were examined using Heidelberg Retina Tomograph (HRT), Rostock Cornea Module (RCM) by a masked well trained evaluator. Intraobserver agreement for image scores was calculated by means of intraclass correlation coefficient (ICC= 0.70= substantial agreement).The following subbasal plexus nerves parameters were considered: number per frame , tortuosity and reflectivity. Diabetic patients were divided into two groups, according to the presence of proliferative vs non proliferative retinopathy (classification of the ETDRS). Results:number per frame and reflectivity were significantly lower in diabetic patients as compared with controls (2.4\ub11 vs 2.9\ub10.8, P=0.01and 2.3\ub10.9 vs 2.6\ub10.9, P=0.04 respectively). Tortuosity was significantly higher in diabetic patients (2.5\ub10.9 vs 2.0\ub10.8, P=0.002). Number per frame of SCP (respectively 2,0\ub10,9 vs 2.9\ub10,9, P=0.001) and reflectivity (respectively 2,0\ub10.8 vs 2.6\ub10.7, P=0.003) were significantly lower in diabetic patients with proliferative retinopathy as compared with non proliferative retinopathy. Tortuosity was significantly higher in diabetic patients with proliferative retinopathy (2.2\ub10.8 vs 2.8\ub10.9, P=0.008). In the group of proliferative DR, patients treated with ALP had significantly lower subbasal nerves number as compared with non-treated patients (p=0,01). Conclusions:diabetic retinopathy may induce remarkable changes in the SCP. There is a difference between proliferative and non proliferative retinopathy and in the former group between ALP treated and non-treated patients

Corneal involvement in Crohn&apos;s disease : an in vivo confocal microscopy study

PURPOSE: To evaluate the corneal changes of patients with Crohn's disease (CD) using confocal microscopy and to investigate the association among confocal parameters and CD activity and CD treatment. METHODS: Thirty consecutive patients (age: 42 \ub1 12 years; 19 women and 11 men) affected by CD and 30 control eyes (age matched and gender matched) underwent an ophthalmic examination and, in 1 eye chosen at random, confocal microscopy of the central cornea using the cornea module of Heidelberg Retina Tomograph. The following confocal parameters were evaluated: density of basal epithelial cells, epithelial dendritic cells, anterior and posterior stromal keratocytes, and endothelial cells; the subbasal plexus was assessed for number and tortuosity of the nerve fibers. RESULTS: Routine ophthalmic evaluation was normal in the whole population. At confocal microscopy, 40% of patients with CD had hyperreflective dots in the basal epithelium, which were absent in the control group. Activation of keratocytes was found in 86.6% of patients with CD and was absent in the control group. Compared with controls, patients with CD had lower density of dendritic cells (12.2 \ub1 26.3 vs. 50.3 \ub1 37.6 cells per square millimeter; P = 0.001). The other confocal parameters were similar in the 2 groups. No correlation between CD activity index and confocal changes was found. CONCLUSION: Confocal microscopy can detect subtle corneal changes in patients with CD, which may be signs of subclinical inflammation

Corneal subbasal nerves changes in patients with diabetic retinopathy : an in vivo confocal study

PURPOSE: To study the subbasal corneal plexus (SCP) in patients with diabetic retinopathy (DR) treated or nontreated with panretinal Argon laser photocoagulation (ALP). METHOD: Fifty consecutive patients with DR and 50 age- and sex-matched normal control subjects were examined with retinal tomography by a masked evaluator. The following subbasal plexus nerves parameters were considered: number per frame, tortuosity, and reflectivity. Diabetic patients were divided into two groups, according to the presence of proliferative versus nonproliferative retinopathy, according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. RESULTS: The number of fibers per frame and reflectivity were significantly lower in diabetic patients compared with control subjects (2.4 +/- 1 vs. 2.9 +/- 0.8, P = 0.01 and 2.3 +/- 0.9 vs. 2.6 +/- 0.9, P = 0.04, respectively). Tortuosity was significantly higher in diabetic patients (2.5 +/- 0.9 vs. 2.0 +/- 0.8, P = 0.002). Number per frame and reflectivity were significantly lower in diabetic patients with proliferative diabetic retinopathy (PDR; respectively, 2.0 +/- 0.9 vs. 2.9 +/- 0.9, P = 0.001, and 2.0 +/- 0.8 vs. 2.6 +/- 0.7, P = 0.003). Tortuosity was significantly higher in the PDR group (2.2 +/- 0.8 vs. 2.8 +/- 0.9, P = 0.008). The PDR group treated with ALP had significantly lower subbasal nerves number compared with the nontreated group (P = 0.01). CONCLUSIONS: DR may induce substantial changes in the SCP. There is a difference between proliferative and nonproliferative retinopathy and in the former group between ALP treated and nontreated patient

A Comparison of Three Phacoemulsification Techniques in Cataract Surgery

Purpose:To compare the parameters of three phacoemulsification techniques (divide-and-conquer, DC; stop-and-chop, SC; phaco-chop, PC) in a series of cataract surgeries. Methods:60 consecutive eyes were randomized to receive cataract surgery using DC, SC, or PC techniques (20 eyes each). Patients with ocular diseases other than cataract (pseudoexfoliatio syndrome; glaucoma; etc) were not enrolled. No complications occurred during the three surgical procedures. Surgery was performed by a single, experienced operator (S.D.) using the Alcon Infiniti\uae Vision System with OZil\uae Torsional handpiece. The following parameters were measured for each patient: Surgery Duration (SurgDur, minutes), UltraSound Total Time (USTT), Cumulative Energy Dissipation (CED), Phaco Time (PhT, seconds), Phaco Power (PhP), Torsional Time (ToT, seconds), Torsional Amplitude (ToA), Aspiration Time (AsT). Inter-group differences were inspected by means of Wilcoxon test. Results:Mean data for each technique are given in the Table. Conclusions:The three techniques obtained similar results with the exception of a significant improvement of PhP and ToA with PC technique