Travoprost- and Tafluprost-induced Changes in Intraocular Pressure and Ocular Pulse Amplitude

Purpose@#To compare the intraocular pressure reduction and changes in ocular pulse amplitude of travoprost 0.003% and tafluprost 0.0015%. @*Methods@#We assessed patients who were diagnosed with open-angle glaucoma from January 2017 to July 2019 for the first time at our hospital. Forty-two eyes were assigned to the travoprost group (23 patients) and 26 eyes were assigned to the tafluprost group (14 patients). Changes in intraocular pressure were measured by Goldmann applanation tonometry (GAT), and corrected ocular pulse amplitude (cOPA) was measured using dynamic contour tonometry. Changes in these parameters were observed and compared for 1 year. @*Results@#No significant differences were observed between the GAT measurements and the cOPA of patients treated with travoprost and tafluprost for 1 year (p = 0.512, p = 0.105). The change in initial intraocular pressure on GAT observed after 1 week was -5.32 ± 2.63 mmHg for travoprost and -3.79 ± 3.19 mmHg for tafluprost (p = 0.0457). The initial change in cOPA was +0.04 ± 0.9 mmHg in the travoprost group and -0.76 ± 0.97 mmHg in the tafluprost group (p = 0.0028). @*Conclusions@#Travoprost and tafluprost reached the targeted intraocular pressure with no difference in the long-term effects of reduced intraocular pressure. However, travoprost was initially better at lowering intraocular pressure faster, and tafluprost had a greater effect on lowering OPA. Prostaglandin analogs can be selected individually by considering the aforementioned factors.

Travoprost- and Tafluprost-induced Changes in Intraocular Pressure and Ocular Pulse Amplitude

Purpose@#To compare the intraocular pressure reduction and changes in ocular pulse amplitude of travoprost 0.003% and tafluprost 0.0015%. @*Methods@#We assessed patients who were diagnosed with open-angle glaucoma from January 2017 to July 2019 for the first time at our hospital. Forty-two eyes were assigned to the travoprost group (23 patients) and 26 eyes were assigned to the tafluprost group (14 patients). Changes in intraocular pressure were measured by Goldmann applanation tonometry (GAT), and corrected ocular pulse amplitude (cOPA) was measured using dynamic contour tonometry. Changes in these parameters were observed and compared for 1 year. @*Results@#No significant differences were observed between the GAT measurements and the cOPA of patients treated with travoprost and tafluprost for 1 year (p = 0.512, p = 0.105). The change in initial intraocular pressure on GAT observed after 1 week was -5.32 ± 2.63 mmHg for travoprost and -3.79 ± 3.19 mmHg for tafluprost (p = 0.0457). The initial change in cOPA was +0.04 ± 0.9 mmHg in the travoprost group and -0.76 ± 0.97 mmHg in the tafluprost group (p = 0.0028). @*Conclusions@#Travoprost and tafluprost reached the targeted intraocular pressure with no difference in the long-term effects of reduced intraocular pressure. However, travoprost was initially better at lowering intraocular pressure faster, and tafluprost had a greater effect on lowering OPA. Prostaglandin analogs can be selected individually by considering the aforementioned factors.

Optic Neuritis Accompanied by Optic Perineuritis after Peribulbar Retinalamin Injection

PURPOSE: To report a case of optic neuritis accompanied by optic perineuritis after retinalamin peribulbar injection. CASE SUMMARY: A 46-year-old Kazakhstan woman presented with sudden vision loss, headache, and pain in both eyes which began 2 hours after the peribulbar injection of retinalamin approximately 10 days prior to her initial visit. At the initial visit, the best-corrected visual acuity was light perception in both eyes. A fundus examination showed bilateral optic disc swelling and fluorescein angiography showed late-phase leakage around the optic nerve and optic nerve sheath enhancement. On brain magnetic resonance imaging, the tram track sign and donut sign were seen in both eyes. Steroid pulse therapy was started after the diagnosis of optic neuritis accompanied by optic perineuritis. After 6 months, the patient's visual acuity improved up to 0.8 in the right eye and 1.0 in the left eye. The light reflex was recovered, the relative afferent pupillary defect decreased, and there was no evidence of optic disc swelling. CONCLUSIONS: When an unverified drug injection is performed (e.g., retinalamin), it could result in complications such as optic neuritis and optic perineuritis from an allergic reaction or peribulbar injection trauma. In such cases, high-dose steroid pulse therapy may be considered.

Rebound Tonometers versus Other Tonometers: Agreement among Readings and the Effects of Axial Length, Ocular Pulse Amplitude, and Central Corneal Thickness on Readings

OBJECTIVE: The aim of this study was to use intraocular pressure (IOP) measurements obtained via rebound tonometry (RBT, the I-care instrument), Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), dynamic contour tonometry (DCT, PASCAL), and the TonoPen to investigate the consistency of readings among methods and the influence of ocular pulse amplitude (OPA), axial length (AL), and central corneal thickness (CCT) on RBT data. METHODS: We prospectively studied 123 eyes. IOP was measured via RBT, GAT, NCT, DCT, and the TonoPen. In addition, OPA was measured via DCT, AL, and CCT. Correlations among measurements using the various methods were evaluated, as were the effects of OPA, AL, and CCT on RBT data. RESULTS: RBT data were significantly correlated with data obtained via GAT, NCT, DCT, and the TonoPen; the highest correlation was with GAT. OPA was significantly correlated with IOP measured via GAT but not with IOP measured via RBT. Both AL and CCT were significantly correlated with IOP data obtained via RBT and GAT. CONCLUSION: Significant correlations were evident among IOP measurements obtained via RBT and other tonometry methods. However, the influence of AL and CCT on IOP measurements obtained via RBT requires careful consideration and interpretation. Although the IOP values obtained by GAT were correlated with OPA values obtained by DCT, this was not true of IOP data obtained by RBT. This might be associated with characteristic of RBT which has the relatively short corneal contact time.

Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

PURPOSE: To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population. METHODS: A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m²) + 0.16 diastolic blood pressure (mm Hg) - 0.18 age (years) - 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure. RESULTS: The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively (p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower (p < 0.001; beta: -0.12; B: -2.306; 95% confidence interval [CI]: -2.717, -1.895) in OAG group than in non-glaucomatous group and the mean TLCPD was distributed higher (p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively. CONCLUSIONS: Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.

Comparison of Corvis ST Tonometer to Other Tonometers and Clinical Usefulness of Corvis ST Tonometer

PURPOSE: To compare the accuracy and agreement of intraocular pressure (IOP) and central corneal thickness (CCT) measurements with noncontact tonometer Corvis Scheimpflug Technology (Corvis ST) versus noncontact tonometer (NCT), Goldmann applanation tonometer (GAT), rebound tonometer (RBT), and ultrasound-based corneal pachymetry (US-CCT). The secondary objective was to evaluate the corneal biomechanical values using Corvis ST tonometer in patients with glaucoma. METHODS: Thirty-one healthy participants and 47 patients with primary open angle glaucoma and normal tension glaucoma were enrolled in this study. One eye was selected randomly. In each participant, GAT, NCT, RBT, US-CCT and measurements with Corvis ST (Corvis-IOP and Corvis-CCT) were obtained. IOP and CCT measurements of each device were compared. Device agreement was calculated by Bland-Altman analysis. Additionally, corneal highest concavity parameters were compared between healthy subjects and glaucoma patients. RESULTS: Mean IOPs in all examined eyes were 13.28 +/- 2.32 mm Hg for CST, 14.71 +/- 2.95 mm Hg for GAT, 14.44 +/- 3.10 mm Hg for NCT, and 13.23 +/- 2.89 mm Hg for RBT. There was no statistical difference in IOP measurements among tonometers. Correlation analysis showed a high correlation between each pair of tonometers (all p < 0.0001). Bland-Altman plots of all devices revealed good agreement of the IOP and CCT measurements. In glaucoma patients, highest concavity time and peak distance of highest concavity parameters were statistically lower than in normal subjects (16.93 +/- 0.66 ms vs. 16.48 +/- 0.84 ms p = 0.020, 4.23 +/- 1.34 mm vs. 3.41 +/- 1.27 mm p = 0.017, respectively). CONCLUSIONS: The CST, a newly-developed tonometer with features of visualization and measurement of the corneal deformation response to an air impulse, can be considered a reliable alternative method for measuring IOP and CCT in healthy subjects and glaucoma patients. Highest concavity parameters could be another important indicator identifying corneal viscosity or elasticity in patients with glaucoma.

Intraocular Pressure Elevation after 0.7 mg Intravitreal Dexamethasone (Ozurdex(R)) Implantation: A One Year Follow-Up

PURPOSE: To investigate the percentage and time of intraocular pressure (IOP) elevation and the factors influencing IOP elevation and treatment. METHODS: Thirty patients (33 eyes) who received intravitreal dexamethasone implantation from July 2012 to December 2013 and followed up more than 1 year were evaluated by measuring Goldmann IOP and confirming changes in IOP. The definition of IOP elevation was IOP above 20 mm Hg or IOP increase greater than 6 mm Hg. RESULTS: In 16 eyes (48.5%), IOP was elevated after intravitreal dexamethasone implantation. The first IOP elevation was mean 2.0 +/- 0.7 months. In 21 eyes which received intravitreal dexamethasone implantation more than twice, the mean intervals of implantation were 4.5 months. In steroid responders, IOP after dexamethasone implantation was significantly increased at 1, 2, 3, 6, and 7 months. IOP increase in the treated eye was significant at 1, 2, 3, 5, and 7 months after dexamethasone implantation. CONCLUSIONS: After intravitreal dexamethasone implantation, IOP was highest at 2 months. Additionally, IOP was elevated in approximately half of the patients (48.5%). Although the intravitreal dexamethasone implantation is effective against various diseases which occur due to macular edema, thorough identification of suitable patients and frequent IOP control is necessary for long-term treatment.

Analysis of Clinical Effectiveness of Tafluprost by Ocular Pulse Amplitude

PURPOSE: To analyze the clinical effectiveness of tafluprost used in the treatment of glaucoma, using ocular pulse amplitude (OPA) measurements with dynamic contour tonometry (DCT). METHODS: Sixty patients (119 eyes) with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) treated with tafluprost or other eyedrops were investigated in the present study. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry (GAT), and OPA was measured with DCT, before and after treatment, retrospectively. RESULTS: In 20 patients treated with tafluprost, IOP decreased from 17.1 mm Hg before treatment to 13.0 mm Hg 3 months after treatment (24.0% descent rate), and OPA decreased from 2.35 to 1.57 (33.2% descent rate). For 20 patients who switched from another monotherapy to tafluprost, IOP decreased from 15.7 mm Hg to 13.2 mm Hg from 15.7 mm Hg (15.3%) and OPA from 2.38 to 1.69 (27.7%). CONCLUSIONS: Tafluprost used to treat glaucoma has a large OPA and IOP lowering effect and, therefore can be applied to patients who have a large OPA with glaucoma progression in spite of well controlled IOP.

Vitrectomy and Ahmed Valve Implantation in Neovascular Glaucoma Patients with Vitreous Hemorrhage

PURPOSE: To compare the surgical outcomes between sequential -and simultaneous combined vitrectomy and Ahmed valve implantation (AVI) in neovascular glaucoma (NVG) patients with vitreous hemorrhage. METHODS: The medical records of 22 eyes of 22 patients, who had NVG with vitreous hemorrhage treated with vitrectomy and AVI, were retrospectively reviewed. Surgical success was defined as 6 mm Hg < or = IOP < or = 21 mm Hg, with or without the use of antiglaucoma medications and failure was defined as cases that had no light perception during the study period and which required additional surgery. The authors of the present study evaluated the surgical success rates and factors affecting surgical success between sequential and simultaneous combined vitrectomy and AVI. RESULTS: The cumulative surgical success rate by the Kaplan-Meier survival analysis was 45% in sequential combined vitrectomy and AVI (group1), and 18% in combined vitrectomy and AVI (group 2), at 1 year, a significant difference. Preoperative panretinal photocoagulation was related to surgical success rate by Cox's regression model analysis. CONCLUSIONS: Simultaneous combined vitrectomy and AVI is considered as a primary procedure in a patient who has NVG with vitreous hemorrhage. Panretinal photocoagulation in the preoperative periods, is thought to increase the surgical success rate.

A Study of Driving Behaviors among Patients with Chronic Ophthalmological Disorders

PURPOSE: This study examines driving behaviors among patients treated for chronic ophthalmologic disorders and the effects of visual acuity and visual field on driving performance. METHODS: A 15-item survey was given to 153 patients treated for chronic ophthalmologic disorders including diabetic retinopathy, glaucoma, retinal vessel occlusions, and senile macular degeneration. Six items questioned the patient's discomfort based on a five-point scale according to different driving conditions and one item involved a self-assessment of driving problems. Results were compared with the best corrected visual acuity (BCVA) and visual fields of the patients. RESULTS: In total, 16.2% of first-class drivers and 24.1% of second-class drivers rated below the evaluation standards of the driving license aptitude test. Overall, 82.6% of the patients continued to drive, while 7.8% renounced driving due to decreased visual acuity. Patient discomfort was significantly correlated with visual acuity (r = -0.503, p < or = 0.01). Among the patients scoring below the evaluation standards, 74.2% responded that their visual acuity had become a problem while driving. CONCLUSIONS: These results call for appropriate driving programs and measures to educate people about responsive driving considering the visual function of patients treated for chronic ophthalmologic disorders.

Progressive Localized Retinal Nerve Fiber Layer Defect Following Cotton Wool Spots and a Dot Hemorrhage

We report two cases of progressive localized retinal nerve fiber layer (RNFL) defect following cotton wool spots and a dot hemorrhage, 63-year-old woman with RNFL defect in inferior temporal retina of the right eye and 43-year-old man with RNFL defect in superior temporal retina of the right eye. Case 1 showed a dot hemorrhage adjacent to RNFL defect in the right eye and a new slit-like localized RNFL defect in the left eye 5 months later. The visual field in the left eye demonstrated corresponding field defect 9 months later. Case 2 showed a slit-like RNFL defect starting from cotton wool spots in the right eye and corresponding visual field defect. Cotton wool spots and dot hemorrhages represented ischemic damages at the nerve fiber layer. Two noticeable cases showed the progression of RNFL defect caused by repetitive localized microvascular ischemic events, resulting in visual field loss.

Preserved Fascia Lata Transplantation for Implant Plate Exposure after Ahmed Glaucoma Valve Implant Surgery: One Case

We report one case of implant plate exposure after Ahmed valve implantation, treated with preserved fascia lata transplantation. Exposure of implant occurred in 47-year-old patient with Ahmed glaucoma valve implantation. She was treated with preserved fascia lata graft and amniotic membrane transplantation. No recurrent implant plate exposure has been found since then. Intraocular pressure has been maintained well for 3 months of follow-up. In cases of implant plate exposure, additional preserved fascia lata graft and amniotic membrane transplantation can improve surgical success.

Correlation of OCT and Hemifield Pattern VEP in Hemianopia

PURPOSE: To analyze the correlation between RNFL thickness changes measured by OCT and hemifield pattern VEP in hemianopic visual field loss. METHODS: Twelve eyes of six patients with hemianopia were studied. Two patients had bitemporal hemianopia caused by chiasmal tumor, one patient had inferior hemianopia caused by traumatic optic neuropathy, and three patients had homonymous hemianopia caused by occipital lobe lesions. The retinal nerve fiber layer thickness around the optic disc was measured by optical coherence tomography (OCT) and visual pattern evoked potentials were measured using hemifield stimulations. RESULTS: Normal eyes of traumatic optic neuropathy patients were excluded from the analysis. The retinal nerve fiber layer thickness as measured by OCT corresponded to the visual field defect in 9 of 11 eyes (81.8%) and the hemifield pattern VEP response corresponded to visual field defect in 7 of 11 eyes (63.6%). CONCLUSIONS: RNFL thickness measurement by OCT and hemifield PVEP are useful in evaluation of patients with hemianopia. However, they should be performed with caution, and compared with various clinical examinations because of their incomplete correlation with visual field defects.

Evaluation of a New Scoring System for Retinal Nerve Fiber Layer Photography Using HRA1 in 964 Eyes

PURPOSE: To evaluate retinal nerve fiber layer (RNFL) defect by a new scoring system for RNFL photography using the Heidelberg Retina Angiograph 1 (HRA1). METHODS: This retrospective study included 128 healthy eyes and 836 primary open-angle glaucoma eyes. The RNFL photography using HRA1 was interpreted using a new scoring system, and correlated with visual field indices of standard automated perimetry (SAP). Using the presence of RNFL defect, darkness, width, and location, we established the new scoring system of RNFL photos. RESULTS: The mean RNFL defect score I in the early, moderate, severe, and control groups were 7.3, 9.2, 10.4, and 3.6, respectively. The mean RNFL defect score II in the early, moderate, severe, and control groups were 14.5, 28.5, 43.4, and 3.4, respectively. Correlations between the RNFL defect score II and the mean deviation of SAP was the strongest of the various combinations (r=-0.675, P<.001). CONCLUSIONS: Using a new scoring system, we propose a method for semi-quantitative interpretation of RNFL photographs. This scoring system may be helpful to distinguish between normal and glaucomatous eyes, and the score is associated with the severity of visual field loss.

Recurrent Intraocular Pressure Elevation during Hemodialysis in a Patient with Neovascular Glaucoma

PURPOSE: To report a patient with symptomatic intraocular pressure (IOP) elevation in an eye with neovascular glaucoma (NVG) during hemodialysis. METHODS: Case report. RESULTS: Recurrent episodes of severe ocular pain and elevated IOP in the NVG eye were noted during hemodialysis in a 29-year-old man. The patient was recently diagnosed at our ophthalmology clinic with NVG due to central retinal vein occlusion. IOP was temporarily controlled after the Ahmed valve implantation. However, after the fibrous membrane developed and occluded the tip of the Ahmed valve, IOP elevation during hemodialysis recurred. Further treatments with intravenous mannitol, oral carbonic anhydrase inhibitor, topical antiglaumatic agents and subconjunctival 5-fluorouracil (5-FU) injections all failed to control relapsing pain and IOP elevation. Eventually, evisceration and hydroxyappatite implantation were performed. CONCLUSIONS: Physicians must be alert to the possibility of IOP elevation in glaucomatous eyes during hemodialysis.

The Effects of Oral Ginkgo Biloba Extract on Visual Field Change in Patients with NTG

PURPOSE: To assess the effect of oral Ginkgo biloba extract (EGB 761) on visual field in patients with normal tension glaucoma (NTG) based on the vascular theory among the machanisms of glaucomatous optic nerve damage. METHODS: A retrospective automated visual field data were obtained from Ginkgo group (20 patients, 38 eyes) and control group (20 patients, 40 eyes). Both groups underwent five Humphrey C24-2 field program over at least 4 years, and had glaucomatous optic nerve damage and visual field change, whose IOP were maintained under 21mmHg during all follow-up periods. Linear regression was performed with respect to mean deviation (MD), corrected pattern standard deviation (CPSD), and mean thresholds of Glaucoma Hemifield test (GHT). Subjects were classified as progressive, improvement, stationary based on the slope and statistical significance. RESULTS: There were 6 eyes (15.8%) with improvements with regard to MD in Ginkgo group. There were 5 eyes (13.2%) with improvements in Ginkgo group and 3 eyes (7.5%) with improvements in control group with regard to CPSD. With GHT cluster analysis, there were 13 eyes (34.2%) with improvements in Ginkgo group and 5 eyes (12.5%) with improvements in control group. CONCLUSIONS: The visual field in patient with NTG was improved in GBE group through MD, CPSD, and GHT cluster mean threshold, which was relatively compatible with known NTG visual field defect.

Clinical Observation of Combined Trabeculotomy and Trabeculectomy on Congenital Glaucoma

PURPOSE: To investigate the result of combined trabeculotomy and trabeculectomy as an initial operative treatment of congenital glaucoma. METHODS: We retrospectively reviewed the medical records of 8 patients (14 eyes) who were operated with combined trabeculotomy and trabeculectomy as an initial operative treatment of congenital glaucoma from October 13, 1998 to February 20, 2001. The mean age of patients was 1.2 years (ranging from 0.75 to 2 years) and the mean follow-up period was 12.4 months (12.3+/-8.18). We assessed the mean age at surgery, preoperative corneal diameter, preoperative and postoperative intraocular pressure, preoperative and postoperative C/D ratio, postoperative complications. RESULTS: The mean age at first surgery was 4.4 months (4.3+/-2.45), the mean postoperative intraocular pressure (IOP) at the end of follow-up period was 13.2+/-2.01mmHg, significantly lower than the mean preoperative IOP which was 25+/-5.23mmHg (P<0.05), the mean postoperative C/D ratio at the end of follow-up period was 0.38+/-0.14, significantly lower than the mean preoperative C/D ratio which was 0.55+/-0.15 (P<0.05), C/D ratio of 3 eyes among them was decreased by more than 0.2. The overall success rate was 71.4% (10 eyes) after single procedure. All the 4 failed eyes underwent trabeculectomy again and the IOP was well controled. The complications included hyphema(5 eyes), corneal edema (3 eyes), vitreous prolapse (3 eyes), posterior synechiae (2 eyes), and they were all resolved spontaneously. CONCLUSIONS: The combined surgery of trabeculotomy and trabeculectomy as an initial single procedure of congenital glaucoma lowered the IOP without serious complications.

The Effects of Amniotic Membrane for Prevention of Adhesion in Strabismus Surgery in Rabbits

PURPOSE: The formation of adhesion following strabismus surgery resulted in restrictive ocular motility dysfunction, recurrence, and failure of adjustable strabismus surgery. From these results, authors used amniotic membrane and evaluated its effect for prevention of adhesion in strabismus surgery in rabbit eyes. METHODS: Recession of superior rectus muscle was performed in 48 eyes of 32 rabbits. In 16 rabbits, both eyes were operated. Sixteen left eyes of 16 rabbits, control group, received no treatment after operation. In 16 right eyes of 16 rabbits, a sponge soaked in mitomycin C was applied after recession of superior rectus muscle. In 16 right eyes of other 16 rabbits, amniotic membrane transplantation was performed after procedure. After operation, 4 rabbits were sacrified in 24 hours, 2 weeks, 4 weeks, 3 months and evaluated the change of inflammation & fibrosis. The degree of inflammatory cell infiltration was evaluated on H & E stain and Masson-trichrome stain was performed to evaluate the degree of fibrosis. An immunohistochemical stain for alpha-smooth muscle actin was done for detection of myofibroblasts. RESULTS: On post-operation 24 hours and 2 weeks, the amniotic membrane-used group and the mitomycin C-used group showed less inflammatory cell infiltration than control group. On post-operation 2 weeks, 4weeks, and 3 months, amniotic membrane-used group and the mitomycin C-used group showed less fibrosis and fibroblast proliferation than control group (P<0.05). CONCLUSIONS: From these findings, authors conclude that the use of amniotic membrane transplantation after strabismus surgery is an effective method for prevention of postoperative adhesion.