Usefulness of the Icare ic200 Rebound Tonometer in Korean

Purpose@#To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). @*Methods@#A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. @*Results@#The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. @*Conclusions@#Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.

Comparison of Surgical Outcomes after Phacoemulsification between Trabeculectomized Eyes and Ahmed Valve-implanted Eyes

Purpose@#We compared the outcomes of cataract surgery in patients who underwent trabeculectomy and Ahmed glaucoma valve implantation. @*Methods@#Twenty-nine trabeculectomized eyes of 29 patients (group 1) and 20 Ahmed glaucoma valve-implanted eyes of 20 patients (group 2) were enrolled consecutively. All subjects underwent thorough ophthalmic examinations, including slit-lamp microscopy and Goldmann applanation tonometry preoperatively, on postoperative days 1 and 7, and at postoperative months 1, 3, and 6. The surgical outcomes including intraocular pressure (IOP) and the required number of IOP-lowering medications were compared between the two groups. @*Results@#The mean preoperative IOP in groups 1 and 2 was 15.34 ± 4.34 and 16.35 ± 3.44 mmHg, respectively (p = 0.265). In group 1, the IOP on postoperative day 1 increased significantly (by 3.86 ± 9.69 mmHg, p = 0.038), and the number of IOP-lowering medications rose at both 3 months (0.28 ± 0.70, p = 0.046) and 6 months (0.34 ± 0.94, p = 0.047) postoperatively. Group 2 exhibited no change in the IOP postoperatively or the number of IOP-lowering medications required in the postoperative period. Subconjunctival 5-fluorouracil injections for IOP control were required by two group 1 patients within 1 month postoperatively. @*Conclusions@#In patients with a trabeculectomized eye, the IOP increased immediately after cataract surgery; additional IOP-lowering procedures were required by some patients. The number of IOP-lowering medications increased after 3 months postoperatively. As cataract surgery may compromise filtering bleb function to a greater extent in trabeculectomized than in Ahmed glaucoma valve-implanted eyes, the former eyes require closer observation during the early postoperative period.

Usefulness of the Icare ic200 Rebound Tonometer in Korean

Purpose@#To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). @*Methods@#A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. @*Results@#The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. @*Conclusions@#Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.

Comparison of Surgical Outcomes after Phacoemulsification between Trabeculectomized Eyes and Ahmed Valve-implanted Eyes

Purpose@#We compared the outcomes of cataract surgery in patients who underwent trabeculectomy and Ahmed glaucoma valve implantation. @*Methods@#Twenty-nine trabeculectomized eyes of 29 patients (group 1) and 20 Ahmed glaucoma valve-implanted eyes of 20 patients (group 2) were enrolled consecutively. All subjects underwent thorough ophthalmic examinations, including slit-lamp microscopy and Goldmann applanation tonometry preoperatively, on postoperative days 1 and 7, and at postoperative months 1, 3, and 6. The surgical outcomes including intraocular pressure (IOP) and the required number of IOP-lowering medications were compared between the two groups. @*Results@#The mean preoperative IOP in groups 1 and 2 was 15.34 ± 4.34 and 16.35 ± 3.44 mmHg, respectively (p = 0.265). In group 1, the IOP on postoperative day 1 increased significantly (by 3.86 ± 9.69 mmHg, p = 0.038), and the number of IOP-lowering medications rose at both 3 months (0.28 ± 0.70, p = 0.046) and 6 months (0.34 ± 0.94, p = 0.047) postoperatively. Group 2 exhibited no change in the IOP postoperatively or the number of IOP-lowering medications required in the postoperative period. Subconjunctival 5-fluorouracil injections for IOP control were required by two group 1 patients within 1 month postoperatively. @*Conclusions@#In patients with a trabeculectomized eye, the IOP increased immediately after cataract surgery; additional IOP-lowering procedures were required by some patients. The number of IOP-lowering medications increased after 3 months postoperatively. As cataract surgery may compromise filtering bleb function to a greater extent in trabeculectomized than in Ahmed glaucoma valve-implanted eyes, the former eyes require closer observation during the early postoperative period.

Secondary Open-angle Glaucoma and Vitreous Opacity as Presenting Manifestations of Familial Amyloid Polyneuropathy

Purpose@#We report a case of familial amyloid polyneuropathy in a patient presenting with open-angle glaucoma and progressive vitreous opacity.Case summary: A 62-year-old female patient presented with uncontrolled intraocular pressure (IOP) in the left eye that did not respond to medical treatment. She had no history of systemic diseases other than hypertension. Trabeculectomy was performed in the left eye. Thirteen months later, as IOP in the right eye suddenly increased to 50 mmHg and was not controlled, trabeculectomy was also performed in the right eye. Anterior chamber angle was wide and open in both eyes and there were no abnormalities. Vitreous opacity increased gradually in both eyes. Neurological examination was conducted as the patient complained of numbness in the feet, and a diagnosis of familial amyloid polyneuropathy was confirmed. @*Conclusions@#Although rare, familial amyloid polyneuropathy and secondary glaucoma should be considered as differential diagnoses in open-angle glaucoma patients showing high intraocular pressure accompanied by progressive vitreous opacity.

Secondary Open-angle Glaucoma and Vitreous Opacity as Presenting Manifestations of Familial Amyloid Polyneuropathy

Purpose@#We report a case of familial amyloid polyneuropathy in a patient presenting with open-angle glaucoma and progressive vitreous opacity.Case summary: A 62-year-old female patient presented with uncontrolled intraocular pressure (IOP) in the left eye that did not respond to medical treatment. She had no history of systemic diseases other than hypertension. Trabeculectomy was performed in the left eye. Thirteen months later, as IOP in the right eye suddenly increased to 50 mmHg and was not controlled, trabeculectomy was also performed in the right eye. Anterior chamber angle was wide and open in both eyes and there were no abnormalities. Vitreous opacity increased gradually in both eyes. Neurological examination was conducted as the patient complained of numbness in the feet, and a diagnosis of familial amyloid polyneuropathy was confirmed. @*Conclusions@#Although rare, familial amyloid polyneuropathy and secondary glaucoma should be considered as differential diagnoses in open-angle glaucoma patients showing high intraocular pressure accompanied by progressive vitreous opacity.

Conjunctival Necrosis following Ahmed Valve Implantation and Subtenon Triamcinolone Injection

PURPOSE: We report a case of conjunctival necrosis in a glaucoma patient who underwent Ahmed valve implantation and subtenon triamcinolone injection. CASE SUMMARY: subconjunctival injections of mitomycin C in her right eye. Ahmed valve implantation and subtenon triamcinolone injection were performed in the right eye. Four weeks later, conjunctival necrosis was observed. After debridement of necrotic tissue, an additional conjunctival autograft was needed because of recurrence of the conjunctival necrosis. After amniotic membrane transplantation was performed for one more recurrent conjunctival necrosis, conjunctival epithelialization was completed. CONCLUSIONS: Although conjunctival necrosis after periocular injection of triamcinolone is a rare complication, previous multiple usage of antimetabolites such as mitomycin C might be associated with a higher risk of developing conjunctival necrosis. In such cases, aggressive surgical intervention may be helpful in the reconstruction of the conjunctival epithelium.

Comparison of Effects and Complications between Conventional Trabeculectomy and Trabeculectomy with a Collagen Matrix Insertion

PURPOSE: To compare the surgical outcomes between trabeculectomy with a collagen matrix (Ologen®) insertion and conventional trabeculectomy. METHODS: An ophthalmic examination, including tonometry and a slit lamp examination, was performed 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months postoperatively in glaucoma patients who underwent a trabeculectomy using Ologen® (experimental group) or a conventional trabeculectomy (control group). Clinical features including success rate and complications were compared between the two groups. RESULTS: In 21 eyes of the experimental group and 42 eyes of the control group, the success rates were 76% and 69%, respectively (p = 0.554). Needling with subconjunctival 5-fluorouracil injection or laser suture lysis of the scleral flap was required in three eyes (14.3%) in the experimental group and 18 eyes (42.9%) in the control group (p = 0.023). The types of complications differed, although the total number of complications did not differ between the two groups (23.8% vs. 19.0%, respectively; p = 0.745). The most common complication in the experimental group was an encapsulated bleb, which occurred in three eyes (14.3%), whereas an avascular bleb occurred in three eyes (7.1%) in the control group. CONCLUSIONS: The success rate of trabeculectomy with Ologen® was comparable to that of conventional trabeculectomy. However, postoperative interventions were less commonly required after trabeculectomy with Ologen®, and the complications differed between the groups. When choosing the surgical method and examining the postoperative condition, these differences should be considered.