Comparison of spectral domain optical coherence tomography parameters between disc suspects and "pre-perimetric" glaucomatous discs classified on disc photo.

Purpose: The aim of this study was to compare SD-OCT parameters between disc suspects and "pre-perimetric" glaucomatous discs classified on disc photos. Methods: Disc photos of suspicious discs with normal Humphrey visual fields (HVF) were graded as normal or pre-perimetric glaucomatous based on the consensus of three masked glaucoma specialists. RNFL and GCL-IPL maps of SD-OCT (Cirrus OCT) of these eyes were studied. Quantitative RNFL parameters were compared. Both groups were also compared with respect to parameters being classified as abnormal (at the 1% level), and the pattern of GCL-IPL and NFL maps were assessed qualitatively and classified as normal or pre-perimetric glaucomatous by a masked glaucoma specialist. Results: The average and inferior RNFL thicknesses were decreased in pre-perimetric glaucomatous eyes compared to normal eyes (p 0.01) The average, minimal, inferotemporal and inferior sector GCL-IPL thicknesses were decreased in pre-perimetric glaucomatous eyes (all P < 0.002) The highest AUC was for the inferior RNFL thickness (0.771) followed by average RNFL thickness (0.757) The sensitivity and specificity for any one abnormal RNFL parameter was 71.9% and 59.7%, for GCL-IPL parameters was 70% and 69.1% The positive (PLR) and negative likelihood ratios (NLR) were 1.78 and 0.47 for RNFL and 2.26 and 0.43 for GCL-IPL parameters. For the qualitative assessment of RNFL and GCL-IPL maps, the sensitivity, specificity, PLR and NLR were 75%, 77.2%, 3.29, and 0.32, respectively. Conclusion: Pre-perimetric disc suspects had greater OCT changes compared to normal disc suspects. Qualitative assessment of RNFL and GCL-IPL maps had the highest discriminatory ability.

Secondary ocular hypertension post intravitreal dexamethasone implant (OZURDEX) managed by pars plana implant removal along with trabeculectomy in a young patient.

We report a case of refractory secondary ocular hypertension after insertion of dexamethasone implant (OZURDEX) for posterior uveitis in a young patient, which necessitated removal of the implant through pars plana vitrectomy along with a trabeculectomy. A young male developed secondary ocular hypertension following dexamethasone implant (OZURDEX) injection for control of posterior uveitis. As the implant was still present in the vitreous cavity, we successfully performed a pars plana removal of the implant along with trabeculectomy with mitomycin C. Early intervention is essential to prevent glaucomatous optic neuropathy in young uveitic patients receiving OZURDEX implant.

A case of idiopathic necrotizing scleritis with secondary glaucoma treated successfully with golimumab and Ahmed valve implantation.

A 52-year-old woman presented with idiopathic active scleritis not responding to oral cyclophosphamide, azathioprine, and oral steroid. Her intraocular pressure in the left eye was 45 mm of Hg in spite of using combination of brinzolamide 1% and brimonidine 0.2% (thrice a day), timolol maleate 0.5% (twice a day) eye drops in both eyes and oral acetazolamide. She was administered subcutaneous golimumab 50 mg injection every 4 weeks along with oral methotrexate 15 mg/week. The scleral inflammation responded and she underwent Ahmed glaucoma valve implantation after two months of initiation of golimumab therapy. After one week of surgery her IOP in left eye was the reduced to 8 mm of Hg. The index case showed that Golimumab can be a useful drug in the management of necrotizing scleritis refractory to the conventional therapy.

Can Corneal Biomechanical Properties Explain Difference in Tonometric Measurement in Normal Eyes?

SIGNIFICANCE: Corneal biomechanical parameters can affect intraocular pressure (IOP) measurements by different tonometers compared with Goldmann applanation tonometer. This study implies that corneal hysteresis (CH) and corneal resistance factor (CRF) better explain variability in IOP measurements. PURPOSE: The aim of this study was to evaluate the effect of corneal properties on the difference in IOP measured by the Ocular Response Analyzer (ORA), Rebound Tonometer (RBT), Dynamic Contour Tonometer (DCT), and Tono-Pen from the Goldmann applanation tonometer (GAT). METHODS: An observational study was done on healthy participants in a tertiary eye care center. Corneal curvature was measured with a manual keratometer prior to IOP measurements. Intraocular pressure was measured by a single trained examiner with ORA, RBT, DCT, GAT, and Tono-Pen. CH and CRF were measured using the ORA. Central corneal thickness was measured using the ultrasonic pachymeter. Only the right eye was included for analysis. One-way analysis of variance was performed to compare variables, Bland-Altman plots to assess agreement, and regression analyses to study associated factors. RESULTS: We included 82 eyes of 82 participants with a mean age of 40.9 (14.3) years. Mean ± SD DCT IOP (15.22 ± 1.98) mmHg was significantly higher than GAT IOP (13.73 ± 2.42) (P = .01) and ORA Goldmann correlated IOP (13.66 ± 3.16) (P = .003). The limits of agreement between GAT and other tonometers measurements ranged between -5.0 and 2.1 mmHg. With multiple linear regression analyses, CH and CRF were found to be associated with the measured IOP differences between GAT and ORA (corneal compensated IOP and Goldmann correlated IOP) (P < .001) and DCT (P = .014, <.001) whereas differences between GAT and RBT measurements were independently explained by corneal curvature (P = .035) and central corneal thickness (P = .045). CONCLUSIONS: There was good agreement between GAT and other tonometers, but was not good enough for them to be used interchangeably. A combination of CH and CRF may better explain the variability between GAT and tonometers.