Corneal biomechanical changes and intraocular pressure in patients with thyroid orbitopathy.

AIM: To determine the relevance of the objective parameters addressing the altered biomechanical properties of cornea for glaucoma monitoring in patients with mild or moderate thyroid associated orbitopathy (TAO), and in healthy individuals. METHODS: Twenty-five patients with TAO (group 1) and 25 healthy adults (group 2) were included to the study. Both groups were of a similar age and the ratio women:man. For each patient, the following parameters of both eyes were measured with ocular response analyzer (ORA): corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc). In both groups participating in our study, all measurements were performed within minutes to reduce the diurnal effects. RESULTS: The mean age in group 1 was 56±11y and 76% were women, 24% were men. The mean age in group 2 was 64±11y and 68% were women, 32% were men. CH correlated negatively with IOPg in group 1 (r (2)=0.10, P<0.05). IOPg strongly correlated with IOPcc in both groups (group 1: r (2)=0.79, P<0.0001; group 2: r (2)=0.85, P<0.0001). There was positive correlation between CRF and IOPg in group 1 (r (2)=0.12, P<0.05) and in group 2 (r (2)=0.31, P<0.0001). Statistical analysis revealed no significant correlation between CRF and IOPcc in group 1 (r (2)=0.009, P>0.05) and also no significant correlation in group 2 (r (2)=0.04, P>0.05). CRF mean value in group 2 (11.51±1.72 mm Hg) was higher than in group 1 (10.85±1.45 mm Hg) (P<0.05). IOPg strongly correlated with IOPcc in both groups (group 1: r (2)=0.79, P<0.0001; group 2: r (2)=0.85, P<0.0001). There was also strong correlation between CRF and CH in both populations: group 1: (r (2)=0.58, P<0.0001), group 2: (r (2)=0.41, P<0.0001). CONCLUSION: Biomechanical parameters of cornea, as quantified by CH and CRF, and measured together with IOPcc, precisely reveal glaucoma staging in TAO and thus are reliable for diagnosing and follow-up in clinical practice.

Axial Length of the Eyeball Is Important in Secondary Dislocation of the Intraocular Lens, Capsular Bag, and Capsular Tension Ring Complex.

Purpose. To analyze the patients with secondary dislocation of CTR and IOL within 5 years from cataract surgery, to determine predisposing factors. Methods. 16 eyes of 15 patients aged 66.2 ± 6.7 (from 49 to 82) with CTR/IOL complex dislocation within 5 years from cataract surgery were compared with 26 patients aged 67.1 ± 7.2 (from 53 to 85), implanted with CTR during cataract surgery to manage zonule dehiscence and did not dislocate for at least 5 years, in respect of cause, axial length and IOL power, refraction, coexistent pathology, and trauma. Results. Axial length of the eyeball was 23.8 ± 1.3 (from 21 to 29) in the group of patients with CTR/IOL dislocation and 20.7 ± 1.2 (from 19 to 24) in patients with no dislocation present (p = 0.008). Crystalline lens dislocation was diagnosed before surgery in 13 of 16 patients with CTR/IOL complex dislocation as opposed to 7 of 26 eyes in the control group (p = 0.01). Pseudoexfoliation was present in 50% and 58% in both groups, respectively. Traumatic dislocation was present in 8 patients, none of them with CTR/IOL dislocation (p = 0.04). Conclusion. Longer axial length may contribute to the failure of the CTR to prevent in-the-bag IOL dislocation. Traumatic dislocation appears to be well fixed with the CTR.

Latanoprost is effective in reducing high intraocular pressure associated with Graves' ophthalmopathy.

PURPOSE: To assess the efficacy and tolerability of latanoprost in the treatment of glaucoma and ocular hypertension associated with Graves' ophthalmopathy. Prospective interventional case series. MATERIALS AND METHODS: 28 patients (19 females and 9 males) aged from 31 to 68 (mean age 45.5 +/- 5.6), presenting with diagnosis of Graves' ophthalmopathy and intraocular pressure equal to 25.0 mmHg or more. 18 Patients presented with inflammatory stage of Graves' ophthalmopathy. 22 patients were within the first two years from the onset of symptoms of Graves' ophthalmopathy. 6 patients had exophthalmos and history of active Graves' ophthalmopathy. Intraocular pressure was measured before treatment, and at two, four and six weeks of treatment with latanoprost at 9 am. Ocular symptoms and signs were noted before and after the treatment period. RESULTS: The mean baseline intraocular pressure was 26.6 +/- 2.5 mmHg, ranging from 25.0 mmHg to 42 mmHg. In two weeks of treatment, the mean intraocular pressure was 18.6 +/- 2.3 mmHg (min 12.0 mmHg, max 27.0 mmHg). At 4 weeks mean intraocular pressure was 18.4 +/- 2.2 mmHg (min 11.0 mmHg, max 28.0 mmHg). At 6 weeks mean intraocular pressure was 18.7 +/- 1.9 mmHg (ranging from 11 mmHg to 25.0 mmHg). 3 patients experienced mild side effects. CONCLUSIONS: Latanoprost is effective and well tolerated in the treatment of increased intraocular pressure associated with Graves' ophthalmopathy.

Sub-Tenon injection of 2% lidocaine prevents intra-operative floppy iris syndrome (IFIS) in male patients taking oral α-adrenergic antagonists.

PURPOSE: To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. METHODS: From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α-adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra-cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and iris prolapse. RESULTS: Intra-operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00). CONCLUSION: Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α-adrenergic inhibitors as compared with intra-cameral lidocaine.

Intraocular matrix metalloproteinase 2 and 9 in patients with diabetes mellitus with and without diabetic retinopathy.

INTRODUCTION: We aimed to investigate activities of metalloproteinases 2 (MMP-2) and MMP-9 in aqueous humour of patients with diabetes mellitus with various stages of diabetic retinopathy. MATERIAL AND METHODS: We included 36 samples of aqueous humour of patients suffering from diabetes mellitus, undergoing routine cataract surgery. Seven of them suffered from proliferative diabetic retinopathy (PDR), 3 had diabetic maculopathy and the remaining 26 had background or minimal background retinopathy only. Metalloproteinases 2 and MMP-9 activities in aqueous humour were measured by gelatin zymography combined with the densitometric imaging system. Total protein content in aqueous humour samples was also assessed. RESULTS: Metalloproteinases 2 activities were present in almost all samples of aqueous humour (32 of 36) and were 2.6-fold higher in patients who suffered from diabetic ocular complications (p < 0.0001). Activities of MMP-2 correlated well with the duration of the disease (correlation = 0.37, p = 0.03) and tended to correlate with total protein levels in aqueous humour (correlation = 0.43, p = 0.06). Metalloproteinases 9 activities were observed only in 2 of 7 patients with proliferative diabetic disease and the enzyme was absent from aqueous humour samples of patients without proliferative retinopathy. CONCLUSIONS: Increased activities of MMP-2 in aqueous humour of patients with PDR may be related to the disease process and support the hypothesis that MMP-2 may be of particular importance in diabetic retinal neovascularization. MMP-9 may be activated at a certain disease stage only.

Monoclonal anti-TNFalpha antibody (infliximab) in the treatment of patient with thyroid associated ophthalmopathy.

TNFalpha (tumor necrosis factor alpha) plays a central role in the development of thyroid associated ophthalmopathy (TAO). We describe and document by ophthalmic (CAS and NO SPECS scales) and radiological (MRI) evaluation a positive effect of anti-TNFalpha antibody (infliximab) administration on active TAO in a 58 years old woman with Graves' disease. The single dose of infliximab administration resulted in a dramatic reduction of inflammation studies and improvement of visual function as measured by MRI and CAS and NO SPECS scales, without noticeable short-term side effects. A randomized prospective study is needed to determine whether infliximab proves to be sufficiently effective in reducing the inflammatory symptoms of TAO, and whether it can be administered safely for a prolonged period without side effects.