INFLUENCE OF GLAUCOMA ON DIABETES-INDUCED CHANGES IN THE ANTERIOR OCULAR SEGMENT.

AIM: To monitor the influence of glaucoma on the changes caused by diabetes in the anterior ocular segment. MATERIAL AND METHODS: Prospective, comparative clinical study, which included the patients with glaucoma and diabetes assessed at the Iasi "Sf. Spiridon" Hospital, "Euro Medi Center" Clinic and "Oftaprof" Clinic. The study included a number of 142 patients, divided into two groups: 67 patients with glaucoma and diabetes (study group) and 75 patients with diabetes mellitus (control group). Upon enrollment the patients were subjected to a complete assessment of their ophthalmologic and metabolic status. Monitored aspects: prevalence of lens changes, extent of ocular surface disease and identification of the changes in corneal biomechanical parameters in the patients with glaucoma and diabetes. RESULTS: In both monitored groups, the cortical lens changes prevailed, both at the beginning and at the end of the study, with no statistically significant differences between groups (p>0.05). The risk of developing lens changes reaches 50% in the patients who have had diabetes for 20 years. In the patients in the study group, tear secretion was significantly lower at the end of the study (Schirmer's test values 11.61 vs. 10.67 mm, p=0.045). Tear film instability was present in 37.3% of the patients. Corneal hysteresis (CH) and comeal resistance factor were significantly reduced in the group with glaucoma and diabetes, as compared to the group with diabetes (p=0.001). CONCLUSIONS: There is significant ocular surface disease in the patients with glaucoma and diabetes, as compared to those with diabetes alone. Glaucoma and the number of antiglaucoma drugs are associated with a significant reduction in tear secretion. The association of glaucoma resulted in the reduction in CH and corneal resistance factor in the patients with glaucoma and diabetes as compared to the healthy ones.

SHORT TERM EVALUATION OF PERIMETRIC PROGRESSION IN PATIENTS WITH OPEN ANGLE GLAUCOMA AND DIABETES.

AIM OF STUDY: Progression rate in patients with glaucoma and diabetes. MATERIAL AND METHOD: cohort prospective study in Ophthalmology Clinic "Sf. Spiridon" University Hospital Iasi. We recruited patients with positive history for diabetes and of open angle glaucoma (OAG). The control group included subjects with OAG (74 eyes from 74 patients) and the study group (44 eyes, from 44 patients) included subjects with OAG and diabetes. At enrollment all patients had a complete ophthalmologic evaluation along with full metabolic status assessment. There were included only incipient and moderate forms of glaucoma, with mild or no diabetic retinopathy changes. Perimetric progression was assessed at 24 months with automated methods. RESULTS: globally, from 118 investigated eyes, 56.40% cases had primary open angle glaucoma, 41.03% normal tension glaucoma and 2.36% pseudoexfoliative glaucoma. Glaucoma severity classification showed early defects (mean deviation < -6 db) in the study group of 77.27% vs. 83.78% in control group, whereas moderate defects (mean deviation > -6 db) were found in 22.63% in study group vs. 16.21.0% in control group. Mean age of the patients was higher in absolute value in the open angle glaucoma group (64.31 +/- 1.66 years), vs. diabetes + open angle glaucoma (62.69 +/- 1.8 years), with comparable visual acuities (0.91 +/- 0.15 vs. 0.89 +/- 0.16), CID ratios and other clinical pa- rameters (p > 0.05). Mean baseline lOP in the study group was 18.18 +/- 3.55 mrnHg vs. 17.08 +/- 2.4 nimHg in controls (p > 0.05). Analysis of visual field parameters at baseline showed a significant difference (p = 0.48) between groups in MD levels -3.63 +/- 3.35 db (control group) vs. -4.40 +/- 5.78 db (study group), but no difference (p > 0.05) in PSD levels: 3.71 +/- 3.06 db (control group) vs. 4.05 +/- 3.04 dB (study group). Perimetric progression was estimated at 24 months by Glaucoma Progression Analysis software (GPA-Humphrey Visual Field Analyzer II) using 6 reliable visual field (VF) exams. Progression rate was similar between groups--0.19 +/- 0.78 dB/year (OAG) vs. -0.18 +/- 0.05 dB/year (OAG+DM), p > 0.05 and no other risk factor could have been linked to an increased progression rate, except visual field parameters at final and baseline evaluation, in both groups. CONCLUSIONS: On short term, functional deterioration in open angle glaucoma patients having early or moderate stages, occurs similarly in the presence or absence of diabetes.

INTRAOCULAR BIODISTRIBUTION OF INTRAVITREAL INJECTED FLUORESCENT DEXAMETHASONE-CHITOSAN NANOPARTICLES IN RABBIT EYES.

AIM: To evaluate intraocular biodistribution of fluorescent nanoparticles composed of dexamethasone bound to chitosan after intravitreal administration in rabbit eyes. MATERIAL AND METHODS: The chitosan and gelatin based nanoparticles were synthetized using a reverse emulsion-double crosslinking technique (ionic and covalent) and then dexamethasone was bound. Two units of 1% suspension of these nanoparticles in saline solution were injected intravitreally into rabbit eyes. The histologic sections obtained at 72 hours were analyzed by confocal microscopy. RESULTS: The chitosan-fluorescein conjugate bound to dexamethasone was present in all ocular tissues at 72 hours. The nanoparticles were present in the retina and lens in a larger amount than in the other ocular tissues. CONCLUSIONS: The reverse emulsion-double crosslinking technique was efficient in synthesizing a biocompatible polymeric nanosystem. The in vivo study of intraocular biodistribution of fluorescein-marked nanoparticles capable of binding dexamethasone revealed their affinity for the retina and lens after intravitreal administration.

Glaucoma evolution in patients with diabetes.

UNLABELLED: Glaucoma and diabetes are two chronic diseases with a long suspected pathogenic relationship. PURPOSE: Screening for glaucoma in patients with diabetes. MATERIAL AND METHODS: A retrospective study on 92 eyes from 46 patients with primitive open angle glaucoma (POAG) (normal and hypertensive) and intraocular hypertension (OHT) receiving medication and/or surgery associated with diabetes mellitus (DM) (type I, type II, mixed) is presented. Participants were divided into two groups as following: 16 eyes with glaucoma and diabetic retinopathy changes (group 1) and 76 eyes with glaucoma and without diabetic retinopathy changes (group 2). The following parameters were analysed: ocular pressure (Goldmann aplanotonometry), perimeter development (computerized perimetry) and fundus condition (absence, presence or progression of diabetic retinopathy). RESULTS: In patients with glaucoma and diabetic retinopathy (8 patients) we found a mean difference between treated intraocular pressure (IOP) and IOP last untreated control of 4.95 mmHg; a depreciation of the MD by 4.18 dB and an average number of glaucoma medications used of 0.889 +/- 1.054. Predominant changes in proliferative diabetic retinopathy were mild. In patients with glaucoma in the absence of diabetic retinopathy, the average difference between untreated IOP and IOP under treatment at the last check-up was 1.63 mmHg, the MD depreciation was by 0.65 dB and the average number of glaucoma medications used was 0.795 +/- 0.978. CONCLUSIONS: No statistically significant differences in terms of initial and final pressure were found. No statistically significant differences in the evolution of changes in perimeter between the two groups were observed. The presence of non-proliferating diabetic retinopathy influenced (only marginally statistically) the glaucomatous disease progression. Large comparative prospective studies are needed for the long-term follow up.

[Management of intraoperative floppy iris syndrome]. / Managementul sindromului de flaciditate iriana intraoperatorie.

PURPOSE: To evaluate the incidence of IFIS in male patients whith alfa 1-AB treatment for benign prostatic hyperplasia (BPH) who underwent cataract surgery and also the pre and intraoperatory management and IFIS profilaxy. SETTING: Iasi "Sf Spiridon" Emergency Hospital and "Oftaprof" private practice METHODS: Observational retrospective study that took place over a period of 2 years (july 2009-july 2011) and reviewed 2484 eyes that underwent cataract surgery. A number of 1199 eyes were from 1049 male patients. RESULTS: Out of the 1049 male patients, 139 (13,25%) underwent treatment for BHP using the medication as follows: 119 used tamsulosin (85,6%); 18 used doxazosin, (12,94%); 2 used alfuzosin (1,43%). Out of the 139 men, 32 (23,02%) showed IFIS but only the ones treated with tamsulosin. After introducing a surgical protocol that comprised of the use of large amounts of vascoelastic material (Viscoat), intracamerular fenilefrin (Mezaton), the use of iris retractors and low faco parameters the incidence and severity of IFIS was significantly reduced. CONCLUSIONS: Correct evauation before surgery is necessary in order to anticipate the condition as its frequency and severity can be reduced by a proactive behavior which demands experience and adequate endowment.

[Long-term clinical course after cataract surgery in patients with diabetes mellitus]. / Evolutia functionala pe termen lung dupa operatia de cataracta la pacientii cu diabet.

PURPOSE: To determine the visual outcome at 5 years postoperatively in patients operated for cataract associated with diabetes mellitus. PATIENTS AND METHODS: Retrospective study on a group of 41 eyes in patients with diabetes, who were operated for cataract (the same surgeon) by facoemulsification and IOL implantation in the capsular bag, without intraoperative complications, for 60 months (during 2003-2007). RESULTS: 27 patients with diabetes were included in the study, the average duration of diabetes was 10, 3 years. Average postoperative visual acuity (VA) was 0.5 at six weeks postoperatively. Preoperative VA improvement was observed in 78%. There was a decrease in VA of 85% at more than 5 years after surgery and 15% of eyes had preserved VA. VA decrease was due to the occurrence, progression and worsening of retinopathy (69%) and diabetic maculopathy, posterior capsular opacification (34%), glaucoma, age-related macular degeneration (12%). CONCLUSIONS: Visual acuity was maintained in 15% and decreased in 85% of patients due to diabetic retinopathy, glaucoma, age-related macular degeneration.

[Comparision of two new optical biometry devices with an ultrasonic immersion biometer]. / Compararea a doua noi biometre optice cu un biometru ultrasonic.

PURPOSE: To compare two new optical biometry devices with an ultrasonic immersion biometer. SETTING: Oftaprof Clinic, Iasi, Romania. METHODS: In this prospective comparative observational study were included 420 eyes that underwent cataract extraction. Axial length measurements were performed using a Allegro BioGraph biometer, which uses optical low-coherence reflectometry (OLCR), an IOLMaster 500 biometer, which uses partial coherence interferometry (PCI) and an OcuScan ultrasonic biometer. The measurement duration and the number of eyes in which the measurements with each device could be performed were compared. Intraocular lens (IOL) power calculation was performed and the IOL prediction error was calculated for each eye four weeks postoperatively. RESULTS: The mean difference in axial length measurements was 0.02 mm +/- 0.04 (SD) between the new PCI and the OLCR device, 0.14 +/- 0.13 (SD) mm between the ultrasonic biometer and the new PCI device and 0.18 +/- 0.09 (SD) mm between the ultrasonic biometer and the OLCR device (P=.52, P=.001 and P<.001, respectively). Measurements with the OLCR device took significantly longer than with the ultrasonic device (mean difference 88 +/- 27 seconds), and measurements with the ultrasonic device took significantly longer than with the new PCI device (mean difference 188 +/- 46 seconds) (P<.001). The mean absolute error in IOL power prediction was 0.49 D +/- 0.29 (SD) with the OLCR device and 0.52 +/- 0.33 (SD) D with the PCI unit and 0.77 +/- 0.65 (SD) with the ultrasonic biometer. The measurements could be performed in 420 eyes (100%) with the ultrasonic biometer, in 152 eyes (36.2%) with the OLCR device and in 151 eyes (35,9%) with the new PCI device. CONCLUSIONS: Measurements of the axial length were comparable between OLCR device and the new PCI device. There was a good correlation between the measurements with optical devices and the ultrasonic biometer. Measurements with the OLCR device took the longest to perform. Implant power calculation were comparable between the two optical devices. The ultrasonic biometry remains a very useful tool in cases with severe lens opacification which are extremely frequent in our service.

[Panretinal photocoagulation with or without focal photocoagulation--the effect on central retinal thickness]. / Panfotocoagularea retiniana cu sau fara fotocoagulare maculara--efectul asupra grosimii retinei centrale.

PURPOSE: To assess the effect of panretinal photocoagulation (with or without focal macular photocoagulation) on central retinal thickness measured by OCT METHOD: Prospective, interventional, non-comparative case series. Panretinal photocoagulation (PRP) was performed in 3 sessions in 28 eyes with proliferative diabetic retinopathy In 9 eyes who had also initial macular edema we have associated focal macular laser treament concomitant with the first PRP session. Macular thickness was assessed by optical coherence tomography at baseline and after 4 and 10 weeks. RESULTS: Baseline mean central retinal thickness was 252 +/- 95 microm. It was modified to 260 +/- 105 microm at 4 weeks, then to 232 +/- 49 microm at 10 weeks. There was no statistical significance of these variations. In 2 eyes (7, 14%) we have noticed an increase of more than 100 microm in central retinal thickness. In the subgroup of 9 eyes with associated initial macular edema, combined PRP-focal treatment resulted in the decrease of central retinal thickness from 306 +/- 123 microm to 236 +/- 49 microm at 10 weeks. CONCLUSIONS: Panretinal photocoagulation can be associated with a significant increase of central retinal thickness in a small percentage of eyes. The PRP-focal macular laser combination is effective in eyes who present with proliferative diabetic retinopathy and macular edema.

[The role of iridectomy in glaucoma surgery]. / Rolul iridectomiei periferice în chirurgia antiglaucomatoasa.

PURPOSE: analysis of the influence of peripheral iridectomy on the efficiency and safety of trabeculectomy and phacotrabeculectomy in patients with open-angle glaucoma. METHODS: interventional, prospective, randomized and comparative study with two groups: 44 eyes with trabeculectomy (group 1) and 24 eyes with phacotrabeculectomy (group 2). Each of the two groups was divided into two main subgroups (with and without iridectomy), compared with each other in terms of efficacy and safety of surgical procedure. RESULTS: Iridectomy was performed on 22 eyes in group 1 (subgroup 1A) and on 12 eyes in group 2 (subgroup 2A), the remaining cases in each group forming subgroups without peripheral iridectomy (subgroup 1B, 2B respectively). Statistical analysis reveals that iridectomy does not seem to influence the efficiency of filtration procedure, regardless of the postoperative moment of analysis (early or final). In all four subgroups at 1 year was a significant decreasing of intraocular pressure, with a low rate of complications. CONCLUSIONS: A proper selection of open-angle glaucoma cases allows the abandonment of peripheral iridectomy in trabeculectomy and phacotrabeculectomy.

[Treatment with bevacizumab in exudative age-related macular degeneration]. / Tratamentul cu bevacizumab în forma exudativa a DMLV.

OBJECTIVES: evaluation of the treatment with bevacizumab for advanced exudative AMD. MATERIAL AND METHOD: prospective study on 163 patients (December 2006-February 2009). All patients received a series of 3 intravitreal injections with bevacizumab (1.25 mg/0.05 ml) at 6 weeks intervals followed by surveillance and continuation or restart of therapy based on clinical criteria and central macular thickness (CMT). The series was subdivided in three groups based on initial VA (VA < or = 0, 1; VA = 0, 1-0, 3; VA > or = 0,3). RESULTS: Final VA increased or remained constant in 88% of patients. VA increased in all three groups: from 0.029 to 0.069 in the first group; from 0.152 to 0.245 in the second group; and from 0.409 to 0.612 in the third group. In all three groups the increase in VA achieved statistical significance (p < 0.001). The whole series manifested an anatomical improvement (final mean CMT of 243.3 microm, as compared to initial mean CMT of 345.3 microm). CONCLUSION: intravitreal treatment with bevacizumab is efficient but should be followed by aggressive follow-up and rapid resume of the treatment if recurrence is diagnosed.

[Postoperative endophthalmitis after non-pentrating deep sclerectomy]. / Endoftalmita postoperatorie dupa sclerectomie profuonda nepenetranta--caz clinic.

This is a case report concerning a patient that was subject to non-penetrating deep sclerectomy (with intraoperative Mytomicin C) for the management of advanced open angle glaucoma in the only functional eye. The surgery was uneventful, the visual acuity was preserved and the intraocular pressure was reduced. After 2 months the patient presented with symptoms of postoperative bleb-related endophthalmitis. The treatment of this condition (including pars plana vitrectomy) did not succeed in preventing a severe retinal necrosis that resulted in the loss of visual acuity This is, to our knowledge, the first published case of endophthalmitis after non-penetrating deep sclerectomy.

[Non-pentrating deep sclerectomy--between safety and efficacy]. / Sclerectomia profunda nepenetranta: intre siguranta si eficacitate.

PURPOSE: To find the indications that would benefit the most from non penetrating deep sclerectomy (NPDS) major advantages. METHOD: Retrospective study that included 40 eyes with open angle glaucoma (primary or pseudoexfoliative) which were subject to NPDS as ambulatory surgery without an implant, but with intraoperative application of mitomycin C. We have determined the LOP C/D ratio, visual acuity and the number of antiglaucoma drugs preoperatively and at 3 months postoperatively. We have analyzed the intraoperative and postoperative complications of NPDS and also the profile of the patients selected for this surgery. RESULTS: Global success (LOP < 21 mmHg + C/D ratio that remained unchanged postoperatively + visual acuity that remained unchanged postoperatively) was obtained in 90% of cases; the number of antiglaucoma drugs was significantly decreased (from 2.72 +/- 0.73 preoperatively to 0.26 +/- 0.21 postoperatively, p < 0.00002). Complete success (LOP < 21 mmHg without antiglaucoma medication) was achieved in 80% of cases. The rate of qualified success (LOP < 21 mmHg with antiglaucoma medication) was 95%; 50% of eyes have LOP < 15 mmHg at 3 months. Intraoperative complications were rare (4 cases) and minor. Postoperative complications were: ocular hypotony (1 case), bleb fibrosis (2 cases), bleb-related endophthalmitis (1 case). The best candidates for NPDS were patients over 70 years with important extraocular comorbidities, advanced open angle glaucoma with preserved visual acuity or monophthalmic patients. CONCLUSIONS: NPDS with intraoperative application of Mitomycin C as ambulatory surgery provides significant LOP reduction while preserving visual acuity and has a low rate of complications in elderly patients with advanced open angle glaucoma or monophthalmic patients.

[The use of optical coherence tomography for identifying retinal nerve fiber layer progressive damage]. / Utilizarea tomografului în coerenta optica pentru evidentierea progresiei afectarii stratului fibrelor nervoase retiniene.

PURPOSE: To identify threshold values above which the intersession reduction of the retinal nerve fibers layer (RNFL) can be considered significant. METHOD: In 79 eyes (41 patients) we have performed RNFL measurements with the Stratus OCT twice in the same session. The differences between these measurements were used to calculate the test-retest variability (on clock hours, quadrants and the average RNFL thickness) using the formula: Test-retest variability = 1.96 x standard deviation (95% confidence) The resulted "threshold values" were used to identify the possible progression in a study group of 119 eyes (61 patients), followed for an average of 2 years. RESULTS: RNFL reduction exceeding the "threshold values" in 2 consecutive sessions was noticed in 18 eyes (15.12%). 12 eyes (10.08%) have fulfilled this criterion on 2 or more clock hours. 3 patients have had the criterion present on both eyes. CONCLUSIONS: This appears to be a plausible method for identifying the progression of structural damage in glaucoma, deserving further researches for validation.

[Variability of optical coherence tomography in assessment of optic disc and retinal nervous fibre layer]. / Variabilitatea OCT (optic coherence tomography) in evaluarea discului optic si stratului fibrelor nervoase retiniene.

PURPOSE: To study the short-term variability of retinal nerve fiber layer (RNFL) and optic disc measurements using Stratus OCT. METHOD: Transversal comparative study with repeated measurements. For each eye, the Fast Optic Disc and Fast RNFL protocols were repeated twice in the same session. The resulted measurements were compared using correlation and variation coefficients. RESULTS: 62 eyes (34 patients) were included in the study. For every analyzed parameter there was a highly significant correlation between the first and the second measurement (p < 0.001). For the C/D ratio (vertical, horizontal and area) the correlation coefficients varied from 0.939 to 0.961 (coefficients of variation 6.43 to 8.75%). Concerning the RNFL parameters, the correlation coefficients took values between 0.818 (for the nasal quadrant) and 0.964 (for the Average Thickness). The variation coefficients were between 4.24 and 15.14%. CONCLUSIONS: We have found an excellent reproducibility of C/D measurements (vertical, horizontal and area)--less studied in the OCT-related literature. From the RNFL parameters, the best reproducibility was found for the superior and inferior quadrant, and especially for the average thickness.

[Study of kini-kallikrein and renin--angiotensin systems in patients with primary open angle glaucoma]. / Studiul sistemelor biochimice kinina-kalikreina si renina--angiotensina în glaucomul primitiv cu unghi deschis.

PURPOSE: To evaluate the activity of Renin-Angiotensin (SRA) and Kinin-Kalikrein (SKK) systems in patients with primary open-angle glaucoma (POAG) in tears, blood and aqueous flow. METHODS: Components of SRA and SKK were analysed in the blood, tears and aqueous flow of 38 patients found in different stages of POAG. The samples of aqueous flow were harvested during glaucoma surgery The results were compared to those from a healthy group of patients (for tears and blood) and to a group of normal patiens that had ocular surgery for cataract and high ametropias (for samples af aqueous flow). RESULTS: In patients with high pressure primary open-angle glaucoma, when comparing them to those from the control group, the measurements showed: a high level of angiotensin converting enzyme (ACE) activity (in tears up to 108-125%, p < 0.001 and in aqueous flow up to 40-47% p < 0.001), a high level of kalikrein (in tears up to 21-29%, p < 0.001 and in aqueous flow up to 35-44% p < 0.001) and a high level of the summed activity of prekalikrein +kalikrein (up to 11-14, p < 0.001). A decrease in the prekalikrein/kalikrein ratio was found (up to 21-25% p < 0.01 in tears and aqueous flow) and this decrease was proved to be in direct correlation to the glaucoma stages of evolution. A decrease in prekalikrein activity was also found; up to 7% in the tears for each developing glaucoma stage. After the glaucoma surgery, the levels of ACE activity and kalikrein measured in tears decreased (up to 17% p < 0.001 and 17% p < 0.001 respectively) without reaching the levels in the normal group while the levels of prekalikrein and the prekalikrein/kalikrein ratio grew (up to 7% p < 0.01 and 16% < 0.001 respectively). CONCLUSIONS: The results show a high level of kalikrein and angiotensin converting enzyme (ACE) activity (measured in aqueous flow and tears) when comparing the group with POAG to the normal group. A decrease in prekalikrein activity was found, and the prekalikrein/kalikrein ratio was also low in the aqueous flow and tears. After the glaucoma surgery the levels of ACE activity and kalikrein decreased without reaching the levels in the normal group while the levels of prekalikrein and the prekalikrei/kalikrein ratio grew.

[The management of glaucoma patients in Romania: analysis of an evaluation questionnaire]. / Asistenta pacientilor cu glauçom in România; analiza unui chestionar de evaluare.

PURPOSE: To evaluate the situation of glaucoma patients' management in Romania. METHOD: A questionnaire was presented to 400 ophthalmologists with experience in glaucoma management; they have responded anonymously to 32 questions. The obtained data were subject to statistical analysis (mean, standard deviation, statistical significance). RESULTS: 327 ophthalmologists have responded; 70% have more than 10 years of practice; 50% are each managing 100 to 500 glaucoma patients. 2/3 of participants are using the Goldmann aplanotonometer, 38% are assessing visual field in automated perimetry, 61% are examining the optic discs using an direct ophthalmoscope and 80% are currently performing gonioscopy. 55% are treating ocular hypertension under special circumstances, 93% are using initial monotherapy, 3/4 are using prostaglandin derivates as initial therapy and 79% are resorting to fixed combinations when the initial monotherapy has become inefficient. Most participants desire to use modern diagnostic methods and treatments in glaucoma, to continuously improve the education in glaucoma management and to collaborate efficiently with other healthcare partners. CONCLUSIONS: The questionnaire has provided useful information on the quality of glaucoma patients care in Romania; if it is periodically repeated (with necessary updates) it will reflect the dynamic of this issue in our country

[Correlation between structural and functional analysis in glaucoma suspects]. / Corelatii intre analiza structurala si cea functionala la suspectii de glaucom.

PURPOSE: To establish correlations between structural and functional parameters in glaucoma suspects. METHOD: In 43 patients (83 eyes) of glaucoma patients we have performed standard automated perimetry, scanning laser polarimetry (GDx-VCC) of the retinal nerve fiber layer (RNFL) and optical coherence tomography (Stratus OCT) of the RNFL and optic disc. RESULTS: Diagnostic concordance (achieved if one eye is deemed normal--respectively abnormal--by both tests) was 60.24% between perimetry and OCT respectively 61.44% between perimetry and GDx. The Areas under the Receiver Operating Characteristic curve were between 0.524-0.574 for OCT parameters and 0.518-0.548 for GDx parameters (considering the visual field examination as "gold standard"). The correlation between RNFL measurements in OCT and GDx took values between r = 0.481 and r = 0.352. CONCLUSIONS: Structural and functional damage are not consistent with each other in early glaucoma, resulting in the fact that both tests should be used in the diagnostic strategy

[Daily and nightly fluctuation of intraocular pressure and blood pressure in glaucoma and non-glaucoma patients]. / Fluctuatiile diurne si nocturie ale presiunii intraoculare si tensiunii arteriale sistemice la pacientii glaucomatosi si nongla'ucomatosi.

PURPOSE: To determine and compare 24-hour fluctuations of intraocular pressure (IOP) and systemic blood pressure (BP) in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG) versus non-glaucoma patients. METHODS: Applanation IOP and BP were measured every 2 hours by one observer for 24 hours in 102 patients. The patients were classified: group 1 - 21 patients with OHT and POAG without treatment, group 2 - 40 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP ? 21 mmHg), group 3 - 13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP > 21 mmHg), and group 0-28 non-glaucoma patients (control group). RESULTS: In all glaucoma patients groups 24-hour IOP fluctuations were greater than in the control group (group 0 - 3.62 +/- 0.82 mmHg, ANOVA p < 0.001). Untreated OHT/POAG had 24-hour IOP fluctuations significantly greater than those with good therapeutic control (group 1 - 5.66 +/- 1.66 mmHg versus group 2 - 4.27 +/- 1.86 mmHg, p = 0.0001). POAG with uncontrolled IOP under maximal tolerated medication had the 24-hour IOP fluctuations significantly greater than the other groups (group 3 - 8.38 +/- 3.78 mmHg, p?0.0001). In these patients there was an evident nocturnal mean IOP peak between 0-2 am which temporally correlates with nocturnal systemic BP "dip". Nocturnal IOP peaks (between 11 pm-7 am) were found more frequently in treated glaucoma patients (45.28% - groups 2 and 3 versus 10.2% - groups 0 and 1, p < 0.0001). CONCLUSIONS: Circadian lOP fluctuations in glaucoma patients, even with a satisfactory diurnal therapeutic control, are greater than in the age-matched control subjects. Patients with uncontrolled lOP under topical maximal tolerated medication had the greatest 24-hour lOP fluctuations. Nocturnal lOP peaks occur more often in medically treated patients and 24-hour monitoring of lOP may be useful in this patients.

Intraocular pressure after cataract surgery using Provasc, Viscoat either separately or in combination.

PURPOSE: To compare the intraocular pressure values after small-incision cataract surgery using either Provisc or Viscoat, separately or in combination. DESIGN: Prospective, randomized and masked clinical study. PARTICIPANTS: 147 eyes of 147 consecutive cataract patients. METHODS: The patients were randomly assigned to receive either Provisc (P group), Viscoat (V group) or both (V+P group) and intraocular pressure was measured at 1, 2, 3, 6, 9 and 24 h after surgery. RESULTS: There were no statistically significant differences in intraocular pressure between the P and V+P group at any point in time during the follow-up period (p>0.05); however, in the V group the intraocular pressure was higher than in the other 2 groups at 1 h (p=0.005 and p=0.006 respectively) and 2 h (p<0.001 and p<0.001 respectively). In the V group, intraocular pressure was also higher than the P group at 3 h (p<0.001). Over 50% of patients from the V group had intraocular pressure values of 30 mmHg and over after 2 h and 3 h from surgery. There were no statistically significant differences between the study groups concerning the intraocular pressure values measured at 6 h, 9 h and 24 h postoperatively (p>0.05). CONCLUSIONS: Viscoat results more frequently in high intraocular pressure values during the initial 6 h after small-incision cataract surgery with frequent cases in which the intraocular pressure could increase over 30 mmHg; therefore, close follow-up of these patients is necessary.

[Concordance of nictemeral IOP variations between fellow eyes in glaucoma and non glaucoma patients]. / Concordanta fluctuatiilor nictemerale ale presiunii intraoculare între ochii congeneri la pacienti glaucomatosi si non-glaucomatosi.

PURPOSE: To study the concordance of nictemeral IOP variations between fellow eyes in patients with treated and untreated OHT/POAG versus non-glaucoma patients. Also, we evaluate the symmetry or asymmetry level of mean, peak and IOP fluctuations between fellow eyes in glaucoma patients compared with normal controls. DESIGN: Cross-sectional study. METHODS: Applanation IOP and blood pressure were measured every 2 hours by one observer for 24 hours in 124 patients. The patients were classified: group 1--36 non-glaucoma patients (control group), group 2--32 patients with OHT and POAG without treatment, group 3--43 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP>21 mmHg) and group 4--13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP>21 mmHg). RESULTS: The nictemeral curves of fellow eyes exhibited parallel profiles; according to the paired t-test there were no significant differences between fellow eyes throughout all measurement intervals. There is a high correlation of 24 h IOP between fellow eyes in all our study groups (r=0.8632, p<0.0001). There were no significant differences between fellow eyes in moment or value of peak IOP (paired t-test p=0.53). Comparing the mean absolute differences in IOP between fellow eyes throughout all 12 measurement points, the smallest differences between fellow eyes were found in groups 1 and 3 (0.85 mmHg, respectively 0.90 mmHg, p=0.47). The differences between fellow eyes were significantly greater in groups 2 and 4 (1.28 mmHg, respectively 2.6 mmHg, p<0.0001). The greatest probability of IOP differences to be in +/- 3 mmHg interval was found in normal patients (97.91%) and in patients with therapeutic control of IOP (97.26%). The greatest asymmetry of IOP was found in the group with therapeutically uncontrolled IOP (over 1/5 measurements were outside the +/- 3 mmHg interval). CONCLUSIONS: The nictemeral variation of IOP in glaucoma patients were largely concordant between fellow eyes and the 24-hour IOP curves of fellow eyes exhibited parallel profiles. There were no significant differences between fellow eyes in mean, peak and IOP fluctuations. The asymmetry over +/- 3 mmHg between fellow eyes varied from 2.09% in normals to 20.53% in patients with therapeutically uncontrolled IOP.