The Relationship between Transcranial Doppler Ultrasonography and Visual Field Test Results in Glaucoma and Glaucoma Suspect Patients

Purpose@#To evaluate the relationships between parameters of transcranial ultrasonography and results of visual field tests in patients with open angle glaucoma or suspected of having glaucoma. @*Methods@#This retrospective study was based on data from medical records of patients who visited the Department of Ophthalmology in Kangbuk Samsung Hospital from January 1, 2016, to October 17, 2019, and underwent transcranial Doppler ultrasonography as part of a routine health examination. Ophthalmic data were visual acuity, intraocular pressure, optical coherence tomography, and Humphrey visual field test results. Retinal nerve fiber layer defect was confirmed by a glaucoma specialist. Patients’ ophthalmic data, such as average ganglion cell layer thickness, visual field index, pattern standard deviation, and mean deviation, were divided into quartiles. Each ophthalmic artery parameter from transcranial Doppler ultrasonography was compared between quartiles. @*Results@#A total of 162 patients were reviewed. There was no difference in Doppler ophthalmic artery (OA) parameters between patients with or without retinal nerve fiber layer defect. None of the quartile groups of average ganglion cell layer thickness showed significant difference in any OA parameters. Patients in the low–visual field index quartile showed significant low peak systolic velocities of OAs when adjusted for age, sex, and presence of diabetes mellitus or hypertension (p = 0.016). A higher pattern standard deviation showed lower peak systolic velocity (p = 0.046). There was no significant tendency between any other OA parameter and mean deviation value. @*Conclusions@#Our study suggests that hemodynamic parameters of ophthalmic arteries might be associated with visual field status of patients. Further large-population studies are needed in order to better understand the relationship between visual function and ocular blood flow.

Retinal Vascular Caliber Changes in Early Type 2 Diabetic Patients without Retinopathy

Purpose@#To evaluate the retinal vascular caliber in early type 2 diabetic patients without retinopathy. @*Methods@#This retrospective study reviewed the medical records of 85 patients who were diagnosed with type 2 diabetes (age, 10-48 years) and sex-matched healthy controls. Dilated fundus examinations were performed to confirm the absence of diabetic retinopathy. Fundus photographs were acquired and analyzed using software that semi-automatically measured retinal vascular caliber. Central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) were determined using the revised Parr-Hubbard formula. Healthy controls were examined using the same approach. @*Results@#There were no significant differences between patients and controls in terms of CRAE (149.92 ± 21.29 µm and 144.85 ± 17.14 µm, respectively; p = 0.137) or CRVE (195.85 ± 22.94 µm and 196.69 ± 18.43 µm, respectively; p = 0.829). However, AVR was significantly higher in the patient group (0.768 ± 0.088 vs. 0.737 ± 0.061; p = 0.031). In the patient group, AVR was significantly correlated with hemoglobin A1c (r = 0.325, p = 0.006), but not with body mass index (p = 0.478). @*Conclusions@#An increase in peripapillary AVR may be an early feature of retinal vessels observed in patients with type 2 diabetes, which is closely related to elevated blood sugar.

The Efficacy and Safety of Preservative-containing and Preservative-free Brimonidine-Timolol Fixed Combination in Normal Tension Glaucoma

Purpose@#To analyze the efficacy and safety of preservative-containing and preservative-free 0.2% brimonidine tartrate and 0.5% timolol maleate fixed combination drug in normal tension glaucoma. @*Methods@#Fifty-one patients (84 eyes) who were diagnosed with normal tension glaucoma and with preservative-containing or preservative-free brimonidine-timolol fixed combinations alone were analyzed retrospectively from January 2017 to February 2020. Intraocular pressure (IOP) was measured four times a day (9 a.m., 11 a.m., 2 p.m., and 4 p.m.) before and at 6 months after applying eye drops. We analyzed and compared the effect of lowering IOP and the occurrence of intra or extra-ocular adverse effects. @*Results@#A significant mean IOP reduction was shown in both groups: -1.95 ± 2.50 mmHg (-12.26 ± 15.87%) in the preservative-containing group and -1.60 ± 2.06 mmHg (-10.54 ± 13.94%) in the preservative-free group at 6 months after eyedrop instillation. The IOP was lowest in both groups at 11 a.m. There were no significant differences between the two groups in lowering IOP. Serious adverse effects causing discontinuation of the eye drops were not observed. @*Conclusions@#Both preservative-containing and preservative-free brimonidine-timolol fixed combinations are effective in lowering IOP in normal tension glaucoma patients and are considered to be effective as eye drops without serious adverse effects.

Thermal Injury Induces Small Heat Shock Protein in the Optic Nerve Head In Vivo

Purpose@#To investigate the induction pattern of various heat shock protein (HSP) in the optic nerve head after thermal stress using transpupillary thermotherapy and to determine the dose-response relationship of thermal stress on the induction of various HSP. @*Methods@#The 810-nm diode laser with 50-μm spot size was aimed to the center of optic nerve head of right eye of Norway brown rats. First, the various exposure powers (100, 120, 140 mW) were used with the same exposure duration, 60 seconds, to investigate power dosing effect. Second, the various exposure durations (1, 2, 3, and 5 minutes) were applied under constant 100 mW laser power to investigate time dosing effect. Left eyes were served as controls. To quantify HSP expression, enucleation was performed at 24 hours after transpupillary thermotherapy. HSP 27 and αB-crystallin inductions in optic nerve head were examined with Western blot. @*Results@#All type of HSP was observed in normal state. After thermal injury, the expression of HSP 27 were increased, and the αB-crystallin were decreased. @*Conclusions@#Induction pattern of each HSP in the optic nerve head were different after thermal injury. Some HSPs were induced or exhausted. Further research is needed on the characteristic functions and induction conditions of each HSP.

The Long-term Effects of Prostaglandin Analogues on Central Corneal Thickness and Intraocular Pressure

Purpose@#To evaluate the long-term effect of 0.005% latanoprost (LA) and 0.0015% tafluprost (TA) on intraocular pressure (IOP) and central corneal thickness (CCT) in glaucoma patients. @*Methods@#This study was a retrospective study, which enrolled open-angle glaucoma (OAG) patients treated with one of two prostaglandin analogues. The patients were observed for at least three years and underwent corneal thickness measurements at least once a year. Patients with a history of ocular surgery except cataract surgery or another glaucoma medication during the follow-up were excluded. Goldmann applanation tonometry and specular microscopy were used to measure the IOP and CCT, respectively. Changes in IOP and CCT were compared between the two groups. @*Results@#A total of 55 OAG patients (110 eyes) were enrolled. The patients were divided into two groups; one group (50 eyes) used LA as anti-glaucoma eye drops, and the other group (60 eyes) used TA. Statistically significant reductions in IOP and CCT were observed in both groups. The mean reduction in IOP over a three year period was -2.18 ± 2.83 mmHg in the LA group and -2.08 ± 2.40 mmHg in the TA group (paired t-test, p < 0.001, for both). In terms of CCT, the mean reduction was -20.24 ± 22.92 μm in the LA group and -32.90 ± 32.04 μm in the TA group (paired t-test, p < 0.001, for both) for three years. The decrease in CCT was not significantly different between the two groups (p = 0.061). There was no significant difference in the IOP reduction between the two drugs nor was there a significant correlation between the IOP and the CCT. @*Conclusions@#This study indicated that 0.005% LA and 0.0015% TA had similar effects on the reduction of IOP and CCT for three years without damaging the corneal endothelium.

Positional Intraocular Pressure of Vitrectomized and Normal Fellow Eyes

PURPOSE: To compare posture-induced intraocular pressure (IOP) changes in vitrectomized eyes and normal eyes of patients who had vitrectomy in one eye. METHODS: A total of 31 patients older than 20 years of age who underwent vitrectomy were enrolled in the study. At least six months after vitrectomy, we measured IOP in both eyes using a rebound tonometer 10 minutes after the patient assumed sitting, supine, right lateral decubitus, and left lateral decubitus positions. Patients with a history of ocular surgery (not including vitrectomy) or recent medication use associated with IOP were excluded. IOP and ocular parameters of vitrectomized and normal fellow eyes were compared. For the decubitus position, IOP values of dependent and nondependent eyes were compared. RESULTS: No significant difference was observed in IOP between vitrectomized and normal eyes in the sitting and supine positions. The IOP for dependent eyes (on the lower side in the lateral decubitus position) was significantly higher than the IOP for nondependent eyes in both right lateral decubitus (right vitrectomized eye 19.31 ± 4.20 vs. 16.71 ± 4.02 mmHg, p < 0.001; left vitrectomized eye 18.35 ± 1.75 vs. 16.04 ± 3.02 mmHg, p = 0.003) and left lateral decubitus (right vitrectomized eye 17.32 ± 4.63 vs. 19.15 ± 3.83 mmHg, p = 0.004; left vitrectomized eye 16.19 ± 1.81 vs. 18.12 ± 2.29 mmHg, p < 0.001) positions. CONCLUSIONS: IOP was higher in the dependent than the nondependent eye in the lateral decubitus position, for both vitrectomized and nonoperated eyes.

The Effect of a Fixed Combination of 0.0015% Tafluprost-0.5% Timolol in Normal Tension Glaucoma Patients

PURPOSE: This study evaluated the effect of a fixed combination of 0.0015% tafluprost-0.5% timolol (Tapcom®, Santen, Osaka, Japan) in glaucoma patients. METHODS: This study included 23 patients who were diagnosed with normal tension glaucoma and treated with a fixed combination of 0.0015% tafluprost-0.5% timolol as the first therapy. Diurnal intraocular pressure (IOP) was measured every 2 and 0.5 hours between 9:00 am and 4:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eye-drop instillations. IOP fluctuation was defined as the standard deviation of IOP measurements. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: The mean reduction in IOP in the 0.0015% tafluprost-0.5% timolol fixed combination-treated eyes was −3.37 ± 2.39 mmHg (−19.70 ± 13.97%) for the right eye and −3.22 ± 2.27 mmHg (-18.81 ± 13.28%) for the left eye (paired t-test, p < 0.001). The mean positional IOP measured at 4 pm at 6 months after 0.0015% tafluprost-0.5% timolol fixed combination instillation showed statistically significant reduction from the mean positional IOP at baseline. There was a significant difference in the number of patients with ≤3 mmHg IOP variation over four time points between baseline and at 6 months in the 0.0015% tafluprost-0.5% timolol fixed combination-treated eyes (McNemar test, p < 0.001). There was no serious adverse event causing ocular damage. CONCLUSIONS: Use of 0.0015% tafluprost-0.5% timolol fixed combination was effective and well tolerated in reducing IOP and in maintaining its effectiveness in glaucoma patients.

Clinical Effectiveness of a Brinzolamide 1%-Brimonidine 0.2% Fixed Combination for Normal Tension Glaucoma in South Koreans

PURPOSE: This study evaluated the efficacy and safety of a brinzolamide 1%-brimonidine 0.2% fixed combination (BBFC) for normal tension glaucoma (NTG) in a South Korean population. METHODS: This study included 45 patients who were newly diagnosed with NTG and treated with BBFC as the first therapy from January 2016 through December 2016. The unilateral eye of NTG eyes of all patients were enrolled. If both eyes were eligible, the eye with the more severe glaucomatous change was selected. If the glaucomatous change was similar in both eyes, the right eye was selected. The patients received the BBFC twice a day. Diurnal intraocular pressure (IOP) was measured every 2 and 1/2 hours between 09:00 am and 04:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eyedrop instillation. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: Ten patients were excluded due to an allergic reaction or follow-up loss. A total of 35 patients were enrolled in this study. The mean IOP was 15.32 ± 4.00 mmHg at baseline and 13.38 ± 3.30 mmHg at 6 months after BBFC instillation (p < 0.001). The IOP fluctuation decreased from 3.33 ± 3.10 to 2.35 ± 1.40 mmHg after BBFC instillation; however, the difference was not statistically significant (p = 0.150). The mean change in positional IOP showed a statistically significant reduction from 16.94 ± 3.18 to 14.80 ± 3.27 mmHg (p = 0.025). There was no serious adverse drug reaction except in three cases of allergic reaction. CONCLUSIONS: BBFC is effective for the reduction of mean IOP and positional IOP in NTG patients.

Positional Intraocular Pressure between Phakic and Pseudophakic Eyes after Cataract Surgery in a Single Eye

PURPOSE: In the present study, the dependence of intraocular pressure (IOP) on body position was compared between pseudophakic and phakic eyes after cataract surgery performed at least 3 months prior. METHODS: IOP was measured in 214 patients over 40 years of age who received cataract surgery at least 3 months prior. The present study included 104 patients who did not have any other ocular disease which could influence visual acuity or IOP. The IOP was measured in 4 different positions, sitting, supine, right decubitus, and left decubitus by a single skilled researcher using Icare tonometer. In addition, IOP was compared between the phakic and pseudophakic eyes, specifically, the dependent eye in the decubitus position. RESULTS: The comparison between the phakic and pseudophakic eyes in patients after cataract surgery in a single eye showed IOP was not different between the sitting and supine positions; however, in the decubitus position, IOP in the dependent eye was significantly higher than the non-dependent eye (p = 0.001). Additionally, regardless of lens status, IOP was significantly higher in the dependent eye than non-dependent eye. CONCLUSIONS: Both body position and lens status can affect IOP. After cataract surgery, regardless of lens status, IOP was higher in the dependent eye than non-dependent eye of patients in the decubitus position.

Long-term Reliability of Diurnal Intraocular Pressure Patterns in Healthy Asians

PURPOSE: To determine the long-term repeatability of diurnal intraocular pressure (IOP) patterns in healthy Asian subjects without glaucoma. METHODS: Twenty-three eyes in 23 healthy Asian subjects without glaucoma underwent diurnal IOP measurements using Goldmann applanation tonometry every 2 hours from 9 AM to 11 PM during two visits that were 8 weeks apart. To validate repeatability between visits, we calculated intra-class correlation coefficients (ICCs) mean IOP, peak IOP, minimum IOP, and IOP fluctuation at each time point and expressed the results as the difference between peak IOP and minimum IOP or as the standard deviation of all diurnal IOP values in the diurnal IOP curve. RESULTS: IOP repeatability was excellent at all time points, with ICCs ranging from 0.812 to 0.946 (p < 0.001). The 9 AM IOP showed the best repeatability between visits (ICCs, 0.946). Repeatability of mean IOP, peak IOP, and minimum IOP was also excellent (ICCs ranging from 0.899 to 0.929). However, IOP fluctuations showed poor repeatability, with an ICC lower than 0.15. CONCLUSIONS: Long-term repeatability of diurnal IOP patterns in healthy Asian subjects was excellent. These findings suggest that IOP measurements at standardized times of the day will be useful for assessing the effectiveness of glaucoma therapy.

The Relationship between Vitamin D and Glaucoma: A Kangbuk Samsung Health Study

PURPOSE: To investigate the relationship between vitamin D and glaucoma. METHODS: This retrospective, cross-sectional study included subjects who underwent a health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were reviewed by ophthalmologists. The ophthalmologists determined if an eye was glaucomatous based on the criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and by the appearance of the retinal nerve fiber layer and optic disc. If the subjects previously underwent an ophthalmologic examination, they were enrolled based on the documented history. In addition to fundus photographs, each participant underwent a systemic examination including blood sampling and sociodemographic and behavioral questionnaires. The subjects were divided into five groups according to serum 25-hydroxyvitamin D (25(OH)D) level. Multivariate logistic regression models were constructed to assess possible associations between elevated glaucoma risk and systemic factors with a p < 0.2 on univariate analysis. RESULTS: Of the 169,208 subjects older than 20 years, 123,331 were eligible for the study. There was no difference in the prevalence of glaucoma according to quintile of serum 25(OH)D level based on sex (p = 0.412 for males, p = 0.169 for females). According to the multivariable-adjusted logistic analysis, the odds ratio of glaucoma for the fourth quintile was significantly lower than that of the first quintile in females (odds ratio, 0.713; 95% confidence interval, 0.520 to 0.979). CONCLUSIONS: Lower 25(OH)D level was significantly associated with an elevated risk of glaucoma in females compared with higher 25(OH)D level. Further evaluation is needed to investigate the relationship between glaucoma and vitamin D.

Associations between Optic Cup-to-disc Ratio and Systemic Factors in the Healthy Korean Population

PURPOSE: To assess the relationships between optic cup-to-disc ratio (CDR) and age, sex, and other demographic and health characteristics in the healthy Korean population. METHODS: The study design was retrospective and population-based. A total of 28,377 subjects who participated in the Korea National Health and Nutrition Examination Survey between 2008 and 2011 were enrolled in this study. Participants underwent structured interviews as well as systemic and ophthalmic examinations. Patients with glaucoma who were diagnosed using the International Society of Geographical and Epidemiological Ophthalmology classification were excluded. Changes in vertical CDR were examined by age in relation to systemic variables on multiple regression analysis. RESULTS: The mean vertical CDR was 0.34 +/- 0.12. The vertical CDR increased with age from subjects in their 20s to those in their 80s (p < 0.001). The mean CDR in males was significantly higher than that of females (p < 0.001). On multiple regression analysis, the vertical CDR was positively associated with age (p < 0.001), male sex (p < 0.001), diastolic blood pressure (p = 0.009), and intraocular pressure (p < 0.001) but was negatively associated with body mass index (p < 0.001). CONCLUSIONS: Greater vertical CDR was related to age, male sex, higher diastolic blood pressure, higher intraocular pressure, and lower body mass index in healthy Koreans.

Risk Factors for Cataract Formation after Implantable Collamer Lens Implantation: Over a Mean 7.5-Year Follow-Up Period

PURPOSE: To determine the risk factors and incidence of cataract formation over a long-term mean follow-up of 7.5 years after type V4 implantable collamer lens (ICL) implantation. METHODS: We analyzed the preoperative, 3-month postoperative, 3-year postoperative, and last follow-up data of 228 eyes (118 patients) with mean preoperative spherical equivalent of -12.7 D and minimum postoperative follow-up of 3 years. Additionally, we determined the risk factors for cataract formation and calculated the 10.3 year cumulative cataract formation rate and 10.3 year cumulative cataract surgery rate using a survival curve. RESULTS: After type V4 ICL implantation with minimum follow-up of 3 years, the calculated 10.3 year cumulative cataract formation rate was 20% and actual cataracts developed in 34 eyes (14.9%). The 10.3 year cumulative cataract surgery rate was 12% based on a survival curve and actual cataract surgery was performed in 12 eyes (5.3%). The risk factors for cataract formation were age (odds ratio [OR] = 1.10, p = 0.00), preoperative spherical equivalent (OR = 0.90, p = 0.00), crystalline lens thickness (OR = 9.54, p = 0.00), axial length (OR = 1.33, p = 0.00), 3 months postoperative vault (OR = 0.50, p = 0.03), and existence of peripheral touch between ICL optic margin and crystalline lens at last follow-up (OR = 7.84, p = 0.00). CONCLUSIONS: We suggest one of the main risk factors for cataract formation after ICL implantation is decreased central vault and peripheral touch between ICL optic margin and crystalline lens.

The Effect of Fixed Combination of Brinzolamide 1% and Timolol 0.5% in Normal-Tension Glaucoma

PURPOSE: We conducted a study to evaluate the effects of brinzolamide/timolol fixed combination (BTFC) in normal-tension glaucoma (NTG) patients. METHODS: We reviewed the records of 33 normal-tension glaucoma patients treated with BTFC in the unilateral eye. We measured intraocular pressure (IOP) every 2 and 1/2 hours between 09:00 am and 04:30 pm. After using BTFC at 8:00 am and 8:00 pm for 6 months, we measured the IOP at the same time period. We analyzed and compared the IOP of eyes treated with BTFC and contralateral eyes. RESULTS: The mean reduction in IOP was -2.85 +/- 1.43 mm Hg (-18.36 +/- 8.58%) in the eyes treated with BTFC and -2.21 +/- 1.73 mm Hg (-13.90 +/- 10.66%) in the contralateral eyes. The IOP lowering effect was greater in the eyes treated with BTFC than in the contralateral eyes. After 6 months of BTFC instillation, the changes in IOP measurements were the lowest at 11:30 am and increased at each time point afterwards. The greatest reduction in IOP was observed at 1 month; however, significant IOP reduction was observed at 3 and 6 months in both BTFC and contralateral eyes. There was no serious adverse event causing ocular damage. CONCLUSIONS: BTFC provided a significant IOP reduction in both BTFC and contralateral eyes in NTG patients.

Prognostic Value of Preoperative Positron Emission Tomography-Computed Tomography in Surgically Resected Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The diagnostic value of PET-CT, in gastric cancer is well known, but the prognostic value of pretreatment PET-CT has not been adequately evaluated. This study aimed to investigate the preoperative prognostic value of PET-CT in gastric cancer patients. METHODS: A total of 107 patients underwent surgical treatment for gastric cancer from April 2007 to December 2010 at Dong-A University Medical Center after confirming the presence of F-18 fluorodeoxyglucose (FDG) uptake on preoperative PET-CT. Among these patients, the following subjects were excluded: follow-up loss (13), palliative resection (5), neoadjuvant chemotherapy (1), and unrelated death (1). The remaining 87 patients were included in this study and data were collected by retrospectively reviewing the medical records. The median follow-up duration, defined as the period from operation to last imaging study date, was 34.2+/-14.8 months. FDG uptake values were represented by maximal standardized uptake value (SUVmax). In order to assess the correlation between SUVmax and recurrence, Kaplan-Meier's survival analysis with log-rank test and cox proportional hazard model were performed. Receiver operating characteristic (ROC) curve was employed to determine the optimal cutoff value of SUVmax. RESULTS: The result of Kaplan-Meier's survival analysis with log-rank test were significantly different between high SUVmax group and low SUVmax group (p=0.035), the cutoff value of which was 5.6. However, in multivariate analysis with cox proportional hazard model, T-staging, N-staging and SUVmax did not show statistical significance (p=0.190, p=0.307, and p=0.436, respectively). CONCLUSIONS: High SUVmax on PET-CT in gastric cancer can be a useful prognostic factor.

Prognostic Value of Preoperative Positron Emission Tomography-Computed Tomography in Surgically Resected Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The diagnostic value of PET-CT, in gastric cancer is well known, but the prognostic value of pretreatment PET-CT has not been adequately evaluated. This study aimed to investigate the preoperative prognostic value of PET-CT in gastric cancer patients. METHODS: A total of 107 patients underwent surgical treatment for gastric cancer from April 2007 to December 2010 at Dong-A University Medical Center after confirming the presence of F-18 fluorodeoxyglucose (FDG) uptake on preoperative PET-CT. Among these patients, the following subjects were excluded: follow-up loss (13), palliative resection (5), neoadjuvant chemotherapy (1), and unrelated death (1). The remaining 87 patients were included in this study and data were collected by retrospectively reviewing the medical records. The median follow-up duration, defined as the period from operation to last imaging study date, was 34.2+/-14.8 months. FDG uptake values were represented by maximal standardized uptake value (SUVmax). In order to assess the correlation between SUVmax and recurrence, Kaplan-Meier's survival analysis with log-rank test and cox proportional hazard model were performed. Receiver operating characteristic (ROC) curve was employed to determine the optimal cutoff value of SUVmax. RESULTS: The result of Kaplan-Meier's survival analysis with log-rank test were significantly different between high SUVmax group and low SUVmax group (p=0.035), the cutoff value of which was 5.6. However, in multivariate analysis with cox proportional hazard model, T-staging, N-staging and SUVmax did not show statistical significance (p=0.190, p=0.307, and p=0.436, respectively). CONCLUSIONS: High SUVmax on PET-CT in gastric cancer can be a useful prognostic factor.

Diurnal Intraocular Pressure with Bimatoprost/Timolol Fixed Combination versus Latanoprost/Timolol Fixed Combination in Healthy Subjects

PURPOSE: To evaluate the effects of a bimatoprost/timolol fixed combination (BTFC) and a latanoprost/timolol fixed combination (LTFC) on diurnal intraocular pressure (IOP) and anterior ocular parameters in healthy subjects. METHODS: We enrolled 58 healthy subjects in this prospective clinical study. Thirty subjects were treated with BTFC and 28 subjects were treated with LTFC. IOP was measured every 2 hours except from 01:00 and 05:00. Axial length, corneal curvature, and anterior chamber depth were obtained using the IOL master at baseline and 24 hours later. Adverse events were assessed by patient interview and by slit lamp examination. RESULTS: The largest difference in IOP between treated and untreated eyes 8 hours after instillation was 1.67 mmHg in the BTFC group (p < 0.001). The largest difference in IOP between treated and untreated eyes 10 hours after instillation was 1.93 mmHg in the LTFC group (p < 0.001). For anterior ocular parameters such as axial length, corneal curvature, anterior chamber depth at baseline and 24 hours after instillation, there were no significant differences between the baseline and 24-hour values in either the BTFC or LTFC group. The most frequently occurring adverse event was conjunctival hyperemia, which was found in 33.3% (n = 10) of the BTFC group and 25.0% (n = 7) of the LTFC group (p = 0.486). CONCLUSIONS: BTFC and LTFC provided a significant reduction in IOP from baseline without changing any anterior ocular parameters. Our results provide a reference for monocular trials to assess the effect of eye drops in a clinical condition.

Diurnal Intraocular Pressure with Bimatoprost/Timolol Fixed Combination versus Latanoprost/Timolol Fixed Combination in Healthy Subjects

PURPOSE: To evaluate the effects of a bimatoprost/timolol fixed combination (BTFC) and a latanoprost/timolol fixed combination (LTFC) on diurnal intraocular pressure (IOP) and anterior ocular parameters in healthy subjects. METHODS: We enrolled 58 healthy subjects in this prospective clinical study. Thirty subjects were treated with BTFC and 28 subjects were treated with LTFC. IOP was measured every 2 hours except from 01:00 and 05:00. Axial length, corneal curvature, and anterior chamber depth were obtained using the IOL master at baseline and 24 hours later. Adverse events were assessed by patient interview and by slit lamp examination. RESULTS: The largest difference in IOP between treated and untreated eyes 8 hours after instillation was 1.67 mmHg in the BTFC group (p < 0.001). The largest difference in IOP between treated and untreated eyes 10 hours after instillation was 1.93 mmHg in the LTFC group (p < 0.001). For anterior ocular parameters such as axial length, corneal curvature, anterior chamber depth at baseline and 24 hours after instillation, there were no significant differences between the baseline and 24-hour values in either the BTFC or LTFC group. The most frequently occurring adverse event was conjunctival hyperemia, which was found in 33.3% (n = 10) of the BTFC group and 25.0% (n = 7) of the LTFC group (p = 0.486). CONCLUSIONS: BTFC and LTFC provided a significant reduction in IOP from baseline without changing any anterior ocular parameters. Our results provide a reference for monocular trials to assess the effect of eye drops in a clinical condition.

The Effect of Anthocyanoside and Ginkgo Biloba Extract on Normal-Tension Glaucoma According to Presence of Diabetes

PURPOSE: This study was performed to evaluate the effect of anthocyanoside and ginkgo biloba extract (GBE) in patients with normal tension glaucoma (NTG), according to the presence of diabetes mellitus (DM). METHODS: A chart review of patients with normal tension glaucoma was retrospectively analyzed. All patients underwent a Humphrey visual field (HVF) test and logarithm of the minimal angle of resolution best-corrected visual acuity (log MAR BCVA) was measured over a 6 months period. Changes in mean deviation (MD), pattern standard deviation (PSD) of visual field and log MAR BCVA were compared among anthocyanoside, GBE and no medication (control) groups. Patients were divided according to the presence of DM. RESULTS: A total of 406 NTG patients, including 151 DM patients, were included in the present study. MD was improved in the anthocyanoside and GBE groups, but not in the control group. PSD was not significantly different in all groups. BCVA was improved in the anthocyanoside group, but deteriorated in the control group. The results were similar in patients with or without DM. The generalized linear model demonstrated that systemic medication affected changes in visual indices. CONCLUSIONS: The results from the present study suggest that anthocyanoside and GBE may be helpful for improving visual function in some patients with NTG regardless of their DM status.

Axial Length Change after Implantable Collamer Lens Implantation

PURPOSE: The axial length measurement is an important variable in calculating the intraocular lens (IOL) power in cataract surgery. In this study, the effects of the implantable collamer lens (ICL) on the axial length measurement were investigated. METHODS: The axial lengths of 141 eyes of 76 highly myopic patients were measured before ICL implantation and 1 month postoperatively using applanation A-scan ultrasound. RESULTS: The measured axial lengths before ICL implantation and 1 month after the surgery were 28.03 +/- 1.91 mm and 28.08 +/- 1.86 mm respectively, with a statistically significant difference of 0.05 mm (p = 0.036). These 2 values showed a high correlation (R2 = 0.9829, p < 0.0001). CONCLUSIONS: Even though the axial length after ICL implantation significantly increased, the 0.05 mm change was too small to influence the determination of the IOL diopters in cataract surgery. Therefore, ICL implantation history may be reflected when measuring the axial length for the IOL power calculation in cataract surgery, but the axial length measured immediately before the cataract surgery may be used to calculate the IOL power regardless of the ICL implantation history.