Aqueous humor concentrations of topical fluoroquinolones alone or in combination with a steroid.

PURPOSE: To compare the aqueous humor (AH) concentrations of moxifloxacin 0.5% and gatifloxacin 0.3% solutions alone or when treatment was combined with steroids, and to correlate these concentrations with the minimum inhibitory concentrations (MIC) for the most common endophthalmitis-causing organisms. METHODS: Patients undergoing phacoemulsification were enrolled to receive one drop of one of the following solutions: moxifloxacin (G1), moxifloxacin + dexamethasone (G2), gatifloxacin (G3), or gatifloxacin + c (G4), every 15 min, 1h before surgery. AH samples were collected before surgery and analyzed using HPLC-tandem mass spectrometry. RESULTS: The mean antibiotic concentrations in the AH were: G1= 1280.8 ng/mL; G2= 1644.3 ng/mL; G3= 433.7 ng/mL; and G4= 308.1 ng/mL. The mean concentrations statistically differed between G1 and G2 (p=0.01), and G3 and G4 (p=0.008). All samples achieved the MIC for Staphylococcus epidermidis; 100% of the samples from G1 and G2, and 97% from G3 and G4 reached the MIC for fluoroquinolone-sensitive Staphylococcus aureus; 100% of the samples from G1 and G2, 88% from G3, and 72% from G4 reached the MIC for enterococci (p<0.001); and 100% of samples from G1 and G2, 59% from G3, and 36% from G4 reached the MIC for Streptococcus pneumoniae (p<0.001). For fluoroquinolone-resistant S. aureus, 23% from G1, 44% from G2, and no samples from G3 or G4 achieved the MIC (p<0.001). CONCLUSIONS: Moxifloxacin + dexamethasone demonstrated a higher concen-tration in the AH than the moxifloxacin alone. Gatifloxacin + steroids demonstrated less penetration into the anterior chamber than gatifloxacin alone. Moxifloxacin was superior to gatifloxacin considering the MIC for enterococci, S. pneumoniae, and fluoroquinolone-resistant S. aureus.

Influence of automated disc margin determination on Stratus OCT optic nerve head measurements.

PURPOSE: To analyze the influence of manual correction of the automatically determined edge of the optic nerve head (ONH) in optic disc measurements in cases in which the optical coherence tomography did not identify the disc limits correctly. METHODS: The study included 127 eyes from 127 consecutive patients with glaucoma, suspects, and healthy individuals. In a retrospective analysis, eyes that underwent testing with the Stratus OCT (software version 4.0, Carl Zeiss Meditec, Dublin, CA, USA) Fast Optic Disc protocol were evaluated. Forty-seven eyes in which either the manual assignment was not necessary or the signal strength was below six were excluded. After image acquisition and processing, one expert examiner manually corrected the determination of the edge of the ONH, identified as the end of the retinal pigment epithelium/choriocapillaris complex. Disc area, cup area, rim area, and cup/disc area ratio results were compared before and after the optic disc margin manually corrected determination. Paired t-test was performed to evaluate the differences, and Bland-Altman plots were used to display the relationships between measurements. RESULTS: Eighty eyes from 80 individuals were included in the analyses. No statistically signifiant difference (P=.538) was found when analyzing results obtained with automated and manual determination of rim area (mean ± standard deviation; 1.30±0.45 mm(2) and 1.29±0.39 mm(2), respectively). Cup area (1.39±0.58 mm(2) and 1.31±0.55 mm(2), respectively), cup/disc area ratio (0.50±0.16 mm(2) and 0.49±0.15 mm(2), respectively), and disc area results (2.69±0.55 mm(2) and 2.60±0.51 mm(2), respectively) were significantly different. CONCLUSION: The Stratus OCT ONH Report results were little influenced when optic disc limits were manually determined. Therefore the standard automated Stratus OCT disc margin assignment is adequate, and manual correction is not necessary.

[Logistic regression analysis in the combination of diagnostic methods in glaucoma]. / Análise de regressão logística na combinação de métodos propedêuticos no diagnóstico do glaucoma.

PURPOSES: In this research was studied the diagnostic ability of the Heidelberg Retinal Tomograph (HRT II), GDx nerve fiber analyzer (GDx), Short-wavelenght Automated Perimetry (SWAP) and Frequency-doubling technology (FDT), all of them together and also separately in the diagnosis of glaucoma. METHODS: Sixty glaucomatous patients and 60 normal ones were submitted to examination with the technology of HRT II, GDx, FDT and SWAP. In the interpretation of HRT, based on the Moorfields regression analysis, were considered abnormal when at least one area of the neuroretinal ring was outside the bounds of normality. GDx was defined as altered, when it was observed that at least one index was considered by equipment program as outside of normal limits, excluding the index symmetry, or when "the deviation from normal graph" appeared a quadrant with significance below 5%. The FDT was considered abnormal when at least one region tested presented with severe defects, or two contiguous moderate defects in at least two reliable tests. For SWAP was adopted the abnormality criteria proposed by Anderson. Logistic regression analysis was performed. RESULTS: When the technologies were studied separately, the Logistic regression analysis showed better odds ratio rates to test positive for glaucoma with HRT (22.49), followed by EAP (21.71), FDT (3.97) and GDx (2.73). When positive tests were associated with different technologies, the odds ratios increased. In cases with HRT, FDT and PAA tests, outside normal bounds, the odds ratio was 252.6. Concerning the HRT, GDx and PAA the result have changed to 173.1. When we associate positive tests from different technologies, the odds ratio of glaucomatous patients have increased considerably, reaching 689.7 with all the tests outside normal bounds, which have happened with 26 patients of this study. CONCLUSIONS: The Logistic Regression analysis confirmed that the abnormal tests of HRT and PAA have shown to be the highest reasons for glaucoma occurrence. The association of abnormal tests increased the odds ratio, especially when the HRT and PAA were out of normal bounds.

Color Doppler imaging of the ophthalmic artery in patients with chronic heart failure.

PURPOSE: To evaluate the ophthalmic artery hemodynamics in patients with chronic heart failure. METHODS: Doppler parameters of ophthalmic artery of 18 patients with chronic heart failure in different stages of the disease were compared with 21 healthy volunteers (control group). These parameters were also correlated with echocardiographic assessments and clinical cardiologic status. RESULTS: Mean diastolic velocity was 5.14 ± 2.4 cm/s in the chronic heart failure group and 7.44 ± 3.5 cm/s in the control group (p=0.007). Mean resistance index of the ophthalmic artery was 0.76 ± 0.08 in the chronic heart failure group and 0.70 ± 0.08 in the control group (p=0.04). Mean systolic velocity of the ophthalmic artery was 22.03 ± 7.7 cm/s in the chronic heart failure group and 25.32 ± 9.2 cm/s in the control group (p=0.24). There was a negative correlation between the resistance index of the ophthalmic artery and systemic blood pressure of patients with chronic heart failure (r= -0.47, p=0.007). Diastolic velocity of the ophthalmic artery correlated positively with systemic blood pressure (r=0.44, p=0.02). CONCLUSION: Lower diastolic velocity and higher resistance index were observed in the ophthalmic artery of chronic heart failure patients when compared to the control group, which probably reflects the presence of orbital vasoconstriction in response to low cardiac output. Therefore, the influence of these findings on the structure and function of the optic nerve head deserves investigation.

Intraocular pressure, corneal thickness, and corneal hysteresis in Steinert's myotonic dystrophy.

PURPOSE: Low intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) is one of the ocular manifestations of Steinert's myotonic dystrophy. The goal of this study was to evaluate the corneal-compensated IOP as well as corneal properties (central corneal thickness and corneal hysteresis) in patients with myotonic dystrophy. METHODS: A total of 12 eyes of 6 patients with Steinert's myotonic dystrophy (dystrophy group) and 12 eyes of 6 age-, race-, and gender-matched healthy volunteers (control group) were included in the study. GAT, Dynamic Contour Tonometry (DCT-Pascal) and Ocular Response Analyzer (ORA) were used to assess the IOP. Central corneal thickness was obtained by ultrasound pachymetry, and corneal hysteresis was analyzed using the ORA device. In light of the multiplicity of tests performed, the significance level was set at 0.01 rather than 0.05. RESULTS: The mean (standard deviation [SD]) GAT, DCT, and corneal-compensated ORA IOP in the dystrophy group were 5.4 (1.4) mmHg, 9.7 (1.5) mmHg, and 10.1 (2.6) mmHg, respectively. The mean (SD) GAT, DCT, and corneal-compensated ORA IOP in the control group was 12.6 (2.9) mmHg, 15.5 (2.7) mmHg, and 15.8 (3.4) mmHg, respectively. There were significant differences in IOP values between dystrophy and control groups obtained by GAT (mean, -7.2 mmHg; 99% confidence interval [CI], -10.5 to -3.9 mmHg; P<0.001), DCT (mean, -5.9 mmHg; 99% CI, -8.9 to -2.8 mmHg; P<0.001), and corneal-compensated ORA measurements (mean, -5.7 mmHg; 99% CI, -10.4 to -1.0 mmHg; P=0.003). The mean (SD) central corneal thickness was similar in the dystrophy (542 [31] µm) and control (537 [11] µm) groups (P=0.65). The mean (SD) corneal hysteresis in the dystrophy and control groups were 11.2 (1.5) mmHg and 9.7 (1.2) mmHg, respectively (P=0.04). CONCLUSIONS: Patients with Steinert's myotonic dystrophy showed lower Goldmann and corneal-compensated IOP in comparison with healthy individuals. Since central corneal thickness and corneal hysteresis did not differ significantly between groups, the lower IOP readings documented in this dystrophy seem not to be related to changes in corneal properties.

Clinical results in phacoemulsification using the SRK/T formula.

PURPOSE: To evaluate the prediction of refraction using the SRK/T formula for intraocular lens (IOL) calculation in eyes with medium axial length after phacoemulsification. METHODS: This prospective study enrolled 33 eyes with nuclear cataract that underwent phacoemulsification. All procedures were performed by one surgeon with the intraocular lens placed within the capsular bag. The same technician who was unaware of the purpose of the study made all the measurements. The achieved refractive error one month after surgery was compared to the predicted postoperative refractive error by the SRK/T formula. RESULTS: The ocular axial length varied between 22.2 mm and 24.5 mm. The mean predicted refraction was -0.431 +/- 0.181 D and the mean achieved postoperative spherical equivalent was -0.220 +/- 0.732 D. Eighteen eyes (55%) had a refractive error between +/- 0.50 D and thirty eyes (91%) between +/- 1.00 D of the predicted refraction. There was a tendency toward hyperopic shift (mean +/- SD: 0.211 +/- 0.708 D, p=0.009). CONCLUSION: The SRK/T formula demonstrated a satisfactory accuracy to calculate the error of refraction in eyes with medium axial length.

Learning effect of standard automated perimetry in healthy individuals.

PURPOSE: To evaluate the learning effect in standard automated perimetry using SITA strategy, central 24-2 program, possible associated factors and spatial distribution in individuals with no perimetry experience. METHODS: A total of 55 healthy subjects were submitted to Humphrey perimetry in two different sessions in one day. Reliability and global indices, and threshold sensitivity at each point were compared between the two examinations. The influence of potential factors (age, gender, and educational level) and the spatial distribution were evaluated regarding alterations between these two examinations. RESULTS: The duration of the test was longer in the first session (median, 5.7 min; interquartile range [IQR], 1.7 min) than in the second (median, 5.3; IQR, 1.1 min) (p=0.002). The median (IQR) of false negative errors was 2% (6%) in the first examination and 0% (6%) in the second (p=0.04). The mean (standard deviation) in the mean deviation (MD) global index was -2.31 (1.86) dB in the first examination and -1.73 (1.69) dB in the second (p=0.07). No association was observed between the change in MD and age (p=0.29), gender (p=0.69) and educational level (p=0.27). The changes in threshold sensitivity were greater at the peripheral points than at the central points (p<0.001). CONCLUSION: The threshold sensitivity increased in the second examination compared to the first. No factors were associated with this change. The changes in threshold sensitivity were more evident at the peripheral points.

[Aqueous humor protein concentration in patients with primary open-angle glaucoma under clinical treatment]. / Concentração de proteínas no humor aquoso de pacientes com glaucoma primário de ângulo aberto em tratamento clínico.

PURPOSE: To compare total protein concentration in the aqueous humor of primary open-angle glaucoma and non-glaucomatous patients. METHODS: Aqueous humor samples were obtained from 22 patients just before trabeculectomy for clinically uncontrolled primary open angle glaucoma (POAG group). Aqueous humor (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber. The same procedure was performed in 22 non-glaucomatous patients just before cataract surgery (control group). Immediately after collection, the aqueous humor was stored at -20 degrees C. Aqueous humor total protein concentration was determined using a colorimetric assay. RESULTS: The geometric mean of total protein concentration of the aqueous humor samples was 32 mg/dL (range: 8-137 mg/dL) in the primary open angle glaucoma group and 16 mg/dL (range: 2-85 mg/dL) in the control group. The ratio of the protein concentration between the two groups was 2.0 (95% confidence interval: 1.3 to 3.2; p=0.003). CONCLUSIONS: The total protein concentration in primary open-angle glaucoma aqueous humor was approximately two times higher than that in non-glaucomatous subjects.

Epidemiological findings of ocular trauma in childhood.

PURPOSE: To describe epidemiological findings of ocular trauma in childhood in an emergency unit. METHODS: A retrospective study was carried out including patients under 16 years old who were treated for ocular trauma at the emergency unit of the Federal University of São Paulo from September 2001 to September 2004. Age, sex, involved eye, place, circumstance and mechanism of injury, initial visual acuity and immediate management were recorded. RESULTS: A total of 273 patients were included in the study. The age group comprising most cases was 7 to 10 years (39.9%). The most frequent cause of ocular injury was traumatism by external agents like stone, iron and wood objects (27.9%). The commonest place was the home (53.1%). Initial visual acuity was over 20/40 in 63.4% of cases. Closed globe injury occurred in 201 (73.6%) accidents. Seventy-six children (27. 8%) were treated with medicines and in forty-eight (17.6%) cases surgery was necessary. CONCLUSION: Ocular trauma in childhood was more frequent in the male schoolchild and was due mostly to traumatism with agents like stone, wood and iron pieces, domestic utensils and leisure objects. The injuries occurred most frequently at home. Closed globe injuries predominated. Programs of education and prevention for ocular trauma in childhood are necessary.

Influence of blue light spectrum filter on short-wavelength and standard automated perimetries.

PURPOSE: To evaluate the influence of a blue light spectrum filter (BLSF), similar in light spectrum transmittance to the intraocular lens Acrysof Natural, on standard automated perimetry (SAP) and short-wavelength automated perimetry (SWAP). METHODS: Twenty young individuals (< 30 y.o.), without any systemic or ocular alterations (twenty eyes) underwent a random sequence of four Humphrey visual field tests: standard automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) with and without a blue light spectrum filter. All patients had intraocular pressure lower than 21 mmHg, normal fundus biomicroscopy, and no crystalline lens opacity. Foveal threshold (FT), mean deviation (MD), and pattern standard deviation (PSD) indexes obtained from the visual field tests and the difference caused by eccentricity in short-wavelength automated perimetry examinations were analyzed using paired t test. Interindividual variability (standard deviation) was calculated using Pitman's test for correlated samples. RESULTS: Statistically significant reductions in the mean deviation (p < 0.001) and in the foveal threshold (p < 0.001) measured by short-wavelength automated perimetry with the use of the blue light spectrum filter in comparison to short-wavelength automated perimetry without the use of the blue light spectrum filter were observed, but not in standard automated perimetry exams. No other parameters showed statistically significant differences in the short-wavelength automated perimetry and standard automated perimetry tests. Interindividual standard deviation of the test points in the short-wavelength automated perimetry exams increased with eccentricity both with and without the use of the blue light spectrum filter, as sensitivity for inferior and superior hemifields (inferior hemifield minus superior hemifield), but no statistically significant difference in the variability when comparing the use or not of the blue light spectrum filter was noted. When comparing only the four most inferior points and the four most superior points, the inferior-superior difference increases in both situations - without and with the use of the blue light spectrum filter. The difference between without and with the use of the blue light spectrum filter was not statistically significant. CONCLUSION: Statistically significant reductions in mean deviation and foveal threshold in the short-wavelength automated perimetry with the use of the blue light spectrum filter were observed, but not in standard automated perimetry examinations. Additional studies are necessary to determine the influence of intraocular lenses with short-wavelength light filter after cataract extraction on short-wavelength automated perimetry.