Assessment of cup-to-disc ratio with slit-lamp funduscopy, Heidelberg Retina Tomography II, and stereoscopic photos.

PURPOSE: To compare optic disc measurements achieved by slit-lamp funduscopy, Heidelberg Retina Tomography II (HRT II), and stereoscopic optic nerve photos (SONP) in glaucomatous, ocular hypertensive, and normal eyes. METHODS: A total of 176 eyes (glaucomatous [n=87], ocular hypertensive [n=40], and normal eyes [n=49]) of 90 participants were studied. Each participant underwent a full ophthalmic examination, including automated perimetry, slit-lamp funduscopy, HRT II, and SONP. To compare the three different methods being investigated, the following measurements were used: vertical cup to disc ratio (VCDR), horizontal cup to disc ratio (HCDR), and cup to disc area ratio (CDR). Slit-lamp funduscopy was evaluated only with respect to VCDR. HRT II and SONP were evaluated with all three measurements (VCDR, HCDR, and CDR). RESULTS: CDR measurements in ocular hypertensive eyes did not differ significantly according to the measurement methods used (p=0.4). CDR in the other groups of participants, as well as VCDR and HCDR, all differed significantly within each group according to the method used (p<0.05 for all). Mean VCDR measured with funduscopy was smaller than mean VCDR measured with either HRT II or SONP in the glaucoma and ocular hypertension groups (p=0.0001). However, overall, the three methods showed a strong correlation in terms of VCDR, HCDR, and CDR measurements. CONCLUSIONS: Despite the correlation among the three methods, the significant differences between their measurements of optic disc parameters may be too large for these methods to be used interchangeably in clinical situations.

Comparison of dynamic contour tonometry and noncontact tonometry in ocular hypertension and glaucoma.

PURPOSE: To assess the agreement in the measurement of intraocular pressure obtained by dynamic contour tonometer (DCT) and noncontact tonometer (NCT) in patients with glaucoma and ocular hypertension, to investigate the effect of corneal thickness on pressure readings by both instruments, and to assess the reproducibility of dynamic contour tonometer. METHODS: NCT and DCT measurements were made on 104 eyes of 104 patients with primary open-angle glaucoma (n=75) or ocular hypertension (n=29), and agreement was assessed by means of Bland-Altman plots. The effect of corneal thickness on both tonometers was assessed by linear regression analysis. Interobserver and intraobserver variations for dynamic contour tonometer were assessed in 41 eyes of 41 patients. RESULTS: The mean difference+/-SD (95% limits of agreement) between NCT and DCT was -0.80+/-2.98 (-6.6 to 5.1) mm Hg (P=0.009) and no relation between NCT/DCT differences and average was found. The intraocular pressure readings obtained by noncontact tonometer depended on central corneal thickness (P<0.001, adjusted r(2)=0.301). However, dynamic contour tonometer readings showed no effect of corneal thickness (P=0.388, adjusted r(2)=-0.002). The coefficient of repeatability for DCT was 0.92 (95% CI 0.85-0.96, P=0.001). CONCLUSION: In subjects with primary open-angle glaucoma and ocular hypertension, NCT and DCT readings are not interchangeable. DCT measurements, unlike NCT measurements, did not depend on corneal thickness.

Patient comfort and surgeon satisfaction during cataract surgery using topical anesthesia with or without dexmedetomidine sedation.

PURPOSE: To determine the safety and efficacy of perioperative dexmedetomidine (Dex) sedation on patient comfort and surgeon satisfaction during cataract surgery under topical anesthesia. METHODS: Forty-four patients having routine clear corneal phacoemulsification surgery under topical anesthesia were included in the study. Patients were randomly divided into two groups: Dex group (n=22) and control group (n=22). Patients in the Dex group were to receive intravenous Dex using an infusion pump and those in the control group were to receive 0.9% saline infusion. Primary outcome measures were patient comfort, surgeon satisfaction, and patient pain perception. RESULTS: There was no significant difference between the groups in terms of baseline characteristics including age, sex, eye side, pupil diameter, and vital signs (p>0.05 for all). Patient comfort and surgeon satisfaction in Dex group was better than in control group (p=0.042 and p=0.003, respectively). The mean pain perception score was lesser in the Dex group (1.23+-.72) than control group (3.64+/-1.43), (p<0.001). The mean surgical time and intraoperative complications were similar in both groups (p>0.05). There was no significant effect of the Dex sedation on vital signs perioperatively (p>0.05 for all). CONCLUSIONS: Dex sedation improved patient and surgeon satisfaction and decreased patients' pain perception while undergoing cataract surgery under topical anesthesia. It appears to be a safe and suitable choice of sedation for cataract surgery.

Protein carbonyl levels in the aqueous humour and serum of patients with pseudoexfoliation syndrome.

PURPOSE: Protein oxidation is an oxidative stress marker and the oxidation of proteins is analysed by measuring the carbonyl groups. Protein oxidation can have a role in the physiopathology of pseudoexfoliation (PEX) syndrome. The aim of this study was to investigate the protein oxidation in the aqueous humour and serum of cataract patients with and without PEX. METHODS: A multicenter study was carried out. Aqueous humour and serum samples were collected from patients who underwent routine cataract surgery. Patients were divided into PEX (n=29) and control (n=27) groups. Patients had no elevated intraocular pressure or glaucoma. Spectrophotometer was used to measure protein carbonyl (PC) levels in the samples. RESULTS: Mean PC concentration in the PEX aqueous (2.18+/-1.51 nmol/l) and serum (119.62+/-13.2 nmol/l) samples was significantly higher than that measured in the control aqueous (1.31+/-0.47 nmol/l) and serum (105.85+/-11.76 nmol/l) samples, respectively (P< 0.001). CONCLUSION: The increased PC levels in the aqueous humour and serum of PEX patients suggest that protein oxidation may play a role in the physiopathology of PEX.