Eyes with Large Disc Cupping and Normal Intraocular Pressure: Using Optical Coherence Tomography to Discriminate Those With and Without Glaucoma

We evaluated the ability of spectral-domain optic coherence tomography (SD-OCT) to differentiate large physiological optic disc cupping (LPC) from glaucomatous cupping in eyes with intraocular pressure (IOP) within the normal range.  We prospectively enrolled patients with glaucoma or presumed LPC. Participants  had optic discs with confirmed or suspected glaucomatous damage (defined as a vertical cup-to-disc ratio≥0.6), and all eyes had known untreated IOP<21 mmHg. For glaucomatous eyes, a reproducible glaucomatous visual field (VF) defect was required. LPC eyes required normal VF and no evidence of progressive glaucomatous neuropathy (follow-up≥30 months). Peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (GCC) thicknesses were obtained using SD-OCT. For all studied parameters of pRNFL and GCC thicknesses, eyes with glaucoma (n=36) had significantly thinner values compared to eyes with LPC (n=71; P<0.05 for all comparisons). In addition, pRNFL parameters had sensitivity of 66.7% and specificity of 83.1%, and GCC parameters had sensitivity of 61.2% and specificity of 81.7%. The combination of the two analyses increased the sensitivity to 80.6%. In conclusion, while evaluating patients with large optic disc cupping and IOP in the statistically normal range, SD-OCT had only limited diagnostic ability to differentiate those with and without glaucoma. Although the diagnostic ability of the pRNFL and the GCC scans were similar, these parameters yielded an increase in sensitivity when combined, suggesting that both parameters could be considered simultaneously in these cases

Posture-induced Intraocular Pressure Changes: Considerations Regarding Body Position in Glaucoma Patients

Although glaucoma is a multifactorial disease, elevated intraocular pressure (IOP) remains the most important known risk factor. Different systemic and local factors are thought to influence an individual's TOP. There can be a clinically significant rise in TOP when going from upright to horizontal or inverted body positions. Although there is a significant interindividual variability, the magnitude of the IOP change is greater in glaucomatous eyes. As patients usually spend a significant portion of their lives in the horizontal position, mainly during sleep, this is highly relevant. in this review we discuss the relationship between postural changes and 1013 fluctuation, including changes in both body and head position. the possible mechanisms involved and the main implications for glaucomatous eyes are discussed. Finally, considerations with regard to sleep position in glaucoma patients are made based on evidence in the literature. (Surv Ophthalmol 55:445-453, 2010. (C) 2010 Elsevier Inc. All rights reserved.)New York Eye & Ear Infirm, Dept Ophthalmol, Einhorn Clin Res Ctr, New York, NY 10003 USAUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilDept Ophthalmol, Santa Casa of Belo Horiz, MG, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

Intraocular Pressure Spikes within First Postoperative Hours following Standard Trabeculectomy: Incidence and Associated Factors

Purpose: To evaluate the incidence of intraocular pressure (IOP) spikes within the first postoperative hours following trabeculectomy (TRAB) and to determine possible associated factors. Methods: An observational study was carried out. We enrolled consecutive patients undergoing standard TRAB with mitomycin C. They were examined twice within the first few postoperative hours (hours 1-2 and 4-6) and 3 times after TRAB (on days 1, 7, and 30). Demographic and ocular data were collected. Main outcome measurements were postoperative IOP values at each time point and the frequency of IOP spikes, defined as IOP >= 25 mm Hg. Results: A total of 40 eyes of 40 patients were included (mean age 59.62 +/- 13.37 years). Although IOP was significantly reduced to 11.14 +/- 7.99 mm Hg at hours 1-2 (p < 0.01) and to 11.52 +/- 7.30 mm Hg at hours 4-6 (p < 0.01), IOP spikes were documented in 3 patients (7.5%). In the group of patients with IOP spikes, we noted that there was a high incidence of black patients and that the surgeries had been performed by fellow surgeons. Conclusion: Although the majority of the cases (92.5% of the patients) did not present IOP spikes, 7.5% of our patients presented the event. In selected cases, such as those with advanced disease, fixation threat, and of black race, IOP should be monitored during the first few postoperative hours for the identification and adequate management of potential IOP spikes, preventing undesirable outcomes. (C) 2017 S. Karger AG, BaselUniv Fed Sao Paulo, Glaucoma Serv, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilHMO, Glaucoma Unit, Osasco, BrazilHosp Oftalmol Sorocaba BOS, Glaucoma Serv, Dept Ophthalmol, Sorocaba, BrazilUniv Hosp, Eyes Inst Med Sci, Dept Ophthalmol, Belo Horizonte, MG, BrazilMayo Clin, Dept Ophthalmol, Glaucoma Unit, Jacksonville, FL 32224 USAUniv Fed Sao Paulo, Glaucoma Serv, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilWeb of Scienc