Change in Corneal Biomechanical Parameters in Diabetes Mellitus

PURPOSE: In this study, we examined the changes in corneal biomechanical parameters in patients with diabetes mellitus (DM). METHODS: Fifty patients with DM were divided into 2 subgroups, 25 diabetic patients with glycated hemoglobin (HbA1c 7%) and compared with the eyes of 80 healthy subjects. Corneal biomechanical parameters were measured using ocular response analyzer (ORA). Differences in corneal biomechanical properties between healthy subjects and diabetic patients were compared. Additionally, differences in corneal biomechanical properties between diabetic patients with HbA1c 7% were compared. RESULTS: Corneal hysteresis, corneal resistance factor and central corneal thickness (CCT) were statistically significantly higher in patients with diabetes compared to healthy subjects. Goldmann tonometer, non-contact tonometer and Goldmann-correlated intraocular pressure (IOPg) were statistically significantly higher in patients with DM compared to healthy subjects, but corneal compensated IOP (IOPcc) was not statistically significantly different between healthy subjects and diabetic patients. However, corneal biomechanical parameters, which were statistically significantly different between healthy subjects and DM patients, were not statistically significantly different between diabetic patients with HbA1c 7%. CONCLUSIONS: Considering that corneal properties are different between diabetic patients and healthy subject, IOPcc measured with ORA is considered clinically useful for measuring IOP as it reflects CCT and biomechanical properties that should be revised. In diabetes, changes in corneal biomechanical properties depend on long-term glucose control rather than short-term glucose control.

Diagnostic Availability of Ocular Response Analyzer in Korean Patients with Normal Tension Glaucoma

PURPOSE: To compare the parameters measured with the ocular response analyzer (ORA; Reichert Inc., Depew, NY, USA) between normal control subjects and patients with normal tension glaucoma (NTG) and to investigate clinical usefulness of ORA. METHODS: Intraocular pressure (IOP) and central corneal thickness (CCT) were measured using the Goldmann applanation tonometer (GAT) in 100 eyes of 100 normal subjects and 100 eyes of 100 NTG patients. Four types of ORA parameters, corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated IOP (IOPg), and corneal-compensated IOP (IOPcc) were also measured. RESULTS: The mean CH values were 11.2 mm Hg and 10.3 mm Hg and the mean CRF values were 10.8 mm Hg and 9.9 mm Hg in the normal subjects group and the NTG group, respectively. Mean CH and CRF were significantly lower in NTG patients (p < 0.001) and the IOPcc were higher than normal subjects (p = 0.004). IOPg was in agreement with the GAT IOP (ICC = 0.811) and IOPcc was not correlated with CCT. The cut-off value of 'IOPcc - IOPg' as the diagnostic standard parameter was -0.05 mm Hg (sensitivity; 76%, specificity; 55%). CONCLUSIONS: IOPg measurements were similar to GAT IOP, and other ORA parameters (CH, CRF, IOPcc) were significantly different between normal subjects and NTG patients. Consequently, the difference of IOPcc and IOPg could be a useful parameter in NTG diagnosis.

Choroidal Thickness in Primary Open-Angle Glaucoma Using Spectral-Domain Optical Coherence Tomography

PURPOSE: To evaluate the choroidal thickness in patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) using spectral-domain optical coherence tomography (SD-OCT), and to explore the relationship between the choroidal thickness and glaucoma. METHODS: A retrospective analysis was performed on patients who had been diagnosed with POAG or NTG at Ewha Womans University, Mokdong Hospital. SD-OCT scans were obtained to estimate retinal nerve fiber layer (RNFL) thickness, macular thickness, and subfoveal and peripapillary choroidal thickness in groups of POAG patients, NTG patients, and normal controls. RESULTS: A total of 21 patients with POAG, 53 patients with NTG, and 42 normal subjects were enrolled in this study. RNFL thickness and macular thickness were significantly thinner in the POAG and NTG groups compared to the normal subjects. In contrast, there were no significant differences in subfoveal and peripapillary choroidal thickness among the 3 groups. There was no significant correlations between the peripapillary choroidal thickness and retinal nerve fiber layer thickness. CONCLUSIONS: Choroidal thickness does not seem to differ between glaucoma patients and normal subjects, and there were no significant correlations between the choroidal thickness and glaucomatous optic neuropathy.

Corneal Biomechanical Properties of Normal Tension Glaucoma in Young Patients Evaluated with the Ocular Response Analyzer

PURPOSE: To evaluate the corneal biomechanical properties and clinical characteristic of normal tension glaucoma (NTG) in young patients. METHODS: We compared corneal biomechanical properties using an Ocular response analyzer (ORA) of under age 40 of 37 eyes of patients with NTG and 42 eyes of normal group. RESULTS: The mean corneal resistance factor (CRF) and mean corneal hysteresis (CH) were significantly lower in NTG eyes (CRF, 9.2 +/- 2.1 mm Hg; CH, 9.8 +/- 1.8 mm Hg) than in normal eyes (CRF, 10.7 +/- 2.3 mm Hg; CH, 10.9 +/- 2.0 mm Hg; p = 0.01, p < 0.01). CH and CRF were associated with central corneal thickness (CCT) (CH; beta = 0.354, p < 0.01, CRF; beta = 0.348, p < 0.01) and glaucoma status (p < 0.01, p < 0.01). CONCLUSIONS: The CRF and CH were significantly lower in NTG group while IOP cc was not significantly different between the group. In diagnosing the NTG in young patients, ORA maybe useful for distinguishing between the glaucoma eyes and normal eyes.

A Case of Intramuscular Hemanagiomas of Upper Eyelids

PURPOSE: We report a case of intramuscular hemangioma (IMH) in upper eyelid-misdiagnosed as pseudotumor-along with its pathologic findings. CASE SUMMARY: A 48-year-old male patient presented with three months of upper eyelid swelling in his left eye of no symptom relief with oral corticosteroid for 5 weeks. Computed tomography findings show diffuse enhancement in left upper eyelid suggested for pseudotumor and retreated with oral corticosteroids and intralesional corticosteroid injections. However, lid inflammation was not improved. The patient underwent incisional biopsy. CONCLUSIONS: Microscopically, the lesion was composed of proliferating vessels of various sizes between the individual muscle fibers. Intramuscular hemangioma that is rarely presented benign tumor in the head and neck region can be presented by diffuse swelling mimicking the pseudotumor rather than a palpable mass.