Use of a new ocular insert versus conventional mydriasis in cataract surgery.

BACKGROUND: To compare the efficacy and safety of a new ocular insert versus conventional mydriasis in cataract surgery. METHODS: We selected 70 patients undergoing cataract surgery. Thirty five patients (Group 1) received instillation of mydriatic drops (tropicamide 1%, phenylephrine 10%, and cyclopentolate 1%) prior to surgery, and 35 patients (Group 2) had a Mydriasert insert (Théa Pharma) (0.28 mg of tropicamide and 5.4 mg of phenylephrine hydrochloride) placed in the inferior fornix. Pupil size before and after surgery, blood pressure, and heart rate were measured. RESULTS: Before surgery, pupil diameter was 9.44 ± 1.17 mm in Group 1 and 9.05 ± 1.54 in Group 2 (P > 0.05). Twenty four hours after surgery, pupil diameter was 5.20 ± 1.54 mm in Group 1 and 3.33 ± 1.15 in Group 2 (P < 0.001). There were no statistically significant differences in blood pressure or heart rate between groups. CONCLUSIONS: The effect of the Mydriasert insert was similar to conventional mydriatic agents. Pupil size was restored to normal faster when using the Mydriasert insert compared with conventional mydriatic agents for pupil dilation.

[Optic nerve head parameters as measured by confocal scanning laser (Heidelberg Retina Tomograph II) in normal, ocular hypertensive and glaucomatous subjects]. / Estudio de los parámetros de la cabeza del nervio óptico en sujetos normales, hipertensos oculares y glaucomatosos obtenidos mediante láser confocal de barrido (Heidelberg Retina Tomograph II).

PURPOSE: To compare the optic nerve parameters measured by confocal scanning laser in normal, ocular hypertensive and glaucomatous eyes; and in groups of ocular hypertensive eyes, classification of these according to the optic nerve appearance and to short-wavelength automated perimetry (SWAP) results. METHODS: 101 eyes of 101 normal subjects, 247 eyes of 247 ocular hypertensive subjects and 102 eyes of 102 glaucomatous subjects were studied. Subjects were classified based on intraocular pressure and standard automated perimetry (AP) performance. Hypertensive subjects were classified into ocular hypertensive and preperimetric glaucoma, and into ocular hypertensive with normal SWAP and hypertensive with pathological SWAP findings. Every patient underwent evaluation of the optic nerve, AP, SWAP and confocal scanning laser ophthalmoscopy (HRT II), resulting in the acquisition of topographic parameters of the optic nerve, which were then compared between the different groups. RESULTS: Significant differences (p<0.05) were found between normal subjects and glaucomatous eyes in all optic nerve parameters except disc area (2.23/2.1), height variation contour (0.41/0.39) and average variability (0.05/0.04). Ocular hypertensive eyes showed an overlap when compared with normal and glaucoma groups. No differences were found between normal subjects and those with ocular hypertension in mean retinal nerve fiber layer thickness (0.24/0.24) or between those with ocular hypertension and glaucoma in mean cup depth (0.28/0.3). Nevertheless, when those with ocular hypertension were segregated based on clinical evaluation of optic nerve or SWAP performance, the ability to define the presence of structural glaucoma damage improved significantly. CONCLUSIONS: HRT enables moderate discrimination between normal, ocular hypertensive and glaucoma subjects. The use of diagnostic tests to detect early glaucomatous damage (such as short-wavelength automated perimetry) in ocular hypertensive eyes improves the ability of HRT to discriminate glaucoma.

Estudio de los parámetros de la cabeza del nervio óptico en los sujetos normales, hipertensos oculares y glaucomatosos obtenidos mediante láser confocal de barrido (Heildeberg retina tomograph II) / Optic nerve head parameters as measured by confocal scanning laser (Heildeberg retina tomograph II) in normal, ocular hypertensive and glaucomatous subjects

Objetivo: Comparar los parámetros del nervio óptico obtenidos mediante láser con focal en sujetos normales, hipertensos oculares y glaucomatosos yen los subgrupos de hipertensos clasificados según el aspecto papilar y la perimetría automatizada de longitud de onda corta (PALOC). Métodos: Se incluyeron 101 ojos de 101 sujetos normales, 247 ojos de 247 hipertensos oculares y102 ojos de 102 glaucomatosos. Los sujetos fueron clasificados según la presión intraocular y resultados de la perimetría automatizada (PA). Se clasificó a los hipertensos en hipertensos oculares y glaucomas preperimétricos, y en hipertensos oculares con PALOC normal e hipertensos con PALOC alterada. Se realizó evaluación papilar, PA y PALOC y un estudio mediante láser con focal Heidelberg Retina Tomograph II obteniendo los valores de las variables topográficas del nervio, que fueron comparados entre los grupos, así como entre cada subgrupo de hipertensos y el grupo de sujetos normales y glaucomatosos. Resultados: Se observaron diferencias significativas (p<0,05) entre normales y glaucomatosos en todos los parámetros excepto área papilar (2,23/2,1), variación de altura de contorno(0,41/0,39) y variabilidad media (0,05/0,04). Los hipertensos mostraron solapamiento de resultados respecto a controles y glaucomatosos, no hubo diferencias entre hipertensos y controles en grosor decapa de fibras (0,24/0,24) o entre hipertensos y glaucomas en profundidad media de excavación(0,28/0,3). Sin embargo, la división de hipertensos según el aspecto papilar o sus resultados en la PALOC mejoró la capacidad de discriminación entre grupos. Conclusiones: El HRT proporciona moderada capacidad de discriminación entre sujetos normales, hipertensos oculares y glaucomatosos. Otras herramientas (como la PALOC) mejoran la capacidad discriminatoria del HRT

Purpose: To compare the optic nerve parameters measured by confocal scanning laser in normal, ocular hypertensive and glaucomatous eyes; and in groups of ocular hypertensive eyes, classification of these according to the optic nerve appearance and to short-wavelength automated perimetry (SWAP) results. Methods: 101 eyes of 101 normal subjects, 247eyes of 247 ocular hypertensive subjects and 102eyes of 102 glaucomatous subjects were studied. Subjects were classified based on intraocular pressure and standard automated perimetry (AP) performance. Hypertensive subjects were classified intoocular hypertensive and preperimetric glaucoma, and into ocular hypertensive with normal SWAP and hypertensive with pathological SWAP findings. Every patient underwent evaluation of the optic nerve, AP, SWAP and confocal scanning laser ophthalmoscopy(HRT II), resulting in the acquisition of topographic parameters of the optic nerve, which were then compared between the different groups. Results: Significant differences (p<0.05) were found between normal subjects and glaucomatous eyes in all optic nerve parameters except disc area(2.23/2.1), height variation contour (0.41/0.39) and average variability (0.05/0.04). Ocular hypertensive eyes showed an overlap when compared with normal and glaucoma groups. No differences were found between normal subjects and those with ocular hypertension in mean retinal nerve fiber layer thickness (0.24/0.24) or between those with ocular hypertension and glaucoma in mean cup depth(0.28/0.3). Nevertheless, when those with ocular hypertension were segregated based on clinical evaluation of optic nerve or SWAP performance, the ability to define the presence of structural glaucoma damage improved significantly. Conclusions: HRT enables moderate discrimination between normal, ocular hypertensive and glaucoma subjects. The use of diagnostic tests to detect early glaucomatous damage (such as short-wavelength automated perimetry) in ocular hypertensive eyes improves the ability of HRT to discriminate glaucoma

[Correlation between standard automated perimetry global indices and Heidelberg Retina Tomograph II parameters]. / Correlación entre los índices globales de la perimetría automatizada convencional y los parámetros topográficos papilares (Heidelberg Retina Tomograph II).

PURPOSE: To correlate the optic nerve head topographic parameters measured by the Heidelberg Retina Tomograph II (HRT) with the perimetric indices of standard automated perimetry (SAP). METHODS: This study included 101 normal subjects, 247 ocular hypertensive eyes (increased intraocular pressure with normal SAP) and 102 glaucomatous subjects (IOP above 21 mm Hg and abnormal standard automated perimetry). Only one eye was randomly chosen from each subject for the study. The visual field was evaluated by means of Humphrey Field Analyzer (24-2 full threshold strategy). The HRT II (Heidelberg Engineering) was used to acquire and measure the optic disc topographic parameters. Pearson correlations between topographic data and perimetric indices were performed for the total sample and each group of patients. The distribution of values obtained in the samples was normal. RESULTS: A significant correlation was found between several optic disc parameters and the global indices of SAP. Rim area, rim volume, cup/disc area ratio, rim/disc area ratio, cup shape measurement, RNFL cross-sectional area, and discriminant functions FSM and RB, showed the strongest correlation with the visual field indices in the total and glaucoma groups (RIM AREA: total group: r=0.32; p=4.14x10(-11)/glaucoma group: r=0.28; p=0.004. RIM VOLUME: total group: r=0.26; p=1.55x10(-7)/glaucoma group: r=0.26; p=0.006). The ocular hypertensive group showed few significant correlations. CONCLUSIONS: The correlations found between standard automated perimetry and HRT defined topographic parameters allow a better understanding of glaucomatous damage and make decision-making easier.

Correlación entre los índices globales de la perimetría automatizada convencional y los parámetros topográficos papilares (Heidelberg Retina Tomograph II) / Correlationbetween standard automated perimetry global indices and Heidelberg retina tomograph parameters

Objetivo: Correlacionar los parámetros estructurales del nervio óptico obtenidos mediante Heidelberg Retina Tomograph II (HRT) con los índices perimétricos de la perimetría automatizada convencional. Metodos: Se incluyeron 101 sujetos normales, 247 hipertensos oculares [presión intraocular (PIO) elevada con perimetría automatizada convencional normal] y 102 sujetos glaucomatosos (PIO>21 mmHg y perimetría automatizada convencional alterada). Solo se incluyó un ojo de cada sujeto para el análisis. La perimetría automatizada se realizó mediante un perímetro Humphrey Field Analyzer (umbral completo, 24-2). El estudio papilar se realizó mediante láser confocal de barrido Heidelberg Retina Tomograph (HRT II). Se realizó un estudio de los coeficientes de correlación (Pearson) entre los parámetros topográficos papilares y los índices perimétricos en el total de sujetos y en cada uno de los grupos de estudio, ya que las muestras presentaban una distribución de sus valores ajustada a la normalidad. Resultados: Se observaron correlaciones significativas entre varios parámetros de la cabeza del nervio óptico y los índices globales de la perimetría automatizada convencional. En el total de sujetos y en el grupo glaucoma, las correlaciones más fuertes con los índices del campo visual se obtuvieron con el área (total: r = 0,32; p = 4,14x10-11/glaucoma: r = 0,28; p = 0,004) y volumen del anillo neurorretiniano (total: r = 0,26; p = 1,55x10-7/glaucoma: r = 0,26; p = 0,006), el cociente de área excavación/disco y anillo/disco, el índice de morfología papilar, el área de corte de la capa de fibras nerviosas de la retina y las funciones discriminantes FSM y RB. El grupo de hipertensión ocular obtuvo pocas correlaciones significativas. Conclusiones: Las correlaciones observadas entre la perimetría automatizada convencional y HRT II, permiten mejorar el conocimiento del daño glaucomatoso y facilitan la toma de decisiones con los resultados de todas las pruebas de las que disponemos en la actualidad

Purpose: To correlate the optic nerve head topographic parameters measured by the Heidelberg Retina Tomograph II (HRT) with the perimetric indices of standard automated perimetry (SAP). Methods: This study included 101 normal subjects, 247 ocular hypertensive eyes (increased intraocular pressure with normal SAP) and 102 glaucomatous subjects (IOP above 21 mm Hg and abnormal standard automated perimetry). Only one eye was randomly chosen from each subject for the study. The visual field was evaluated by means of Humphrey Field Analyzer (24-2 full threshold strategy). The HRT II (Heidelberg Engineering) was used to acquire and measure the optic disc topographic parameters. Pearson correlations between topographic data and perimetric indices were performed for the total sample and each group of patients. The distribution of values obtained in the samples was normal. Results: A significant correlation was found between several optic disc parameters and the global indices of SAP. Rim area, rim volume, cup/disc area ratio, rim/disc area ratio, cup shape measurement, RNFL cross-sectional area, and discriminant functions FSM and RB, showed the strongest correlation with the visual field indices in the total and glaucoma groups (RIM AREA: total group: r=0.32; p=4.14x10-11 / glaucoma group: r=0.28; p=0.004. RIM VOLUME: total group: r=0.26; p=1.55x10- 7 / glaucoma group: r=0.26; p=0.006). The ocular hypertensive group showed few significant correlations. Conclusions: The correlations found between standard automated perimetry and HRT defined topographic parameters allow a better understanding of glaucomatous damage and make decision-making easier

[Sector-based analysis of the distribution of the neuroretinal rim by confocal scanning laser in the diagnosis of glaucoma]. / Análisis de la distribución de anillo neurorretiniano por sectores mediante láser confocal de barrido en el diagnóstico del glaucoma.

PURPOSE: To evaluate the diagnostic ability of the Moorfields regression analysis (MRA; neuroretinal rim sector-based analysis) by means of confocal scanning laser. METHODS: 200 eyes were included in this study: 101 normal subjects and 99 glaucoma patients (standard automated perimetry with glaucomatous defects -MD or CPSD with p<0.02 or a cluster of three or more points with p<0.05 or a cluster of two or more points with p<0.01 or abnormal Glaucoma Hemifield Test). All subjects underwent a full ophthalmic evaluation, visual field evaluation by means of a Humphrey Field Analyzer, 24-2 full threshold strategy, and optic disc topography by Heidelberg retina tomograph (HRT-II). The outcome parameters were sensitivity and specificity of the MRA for each sector. RESULTS: The highest sensitivity in detecting structural defects based on MRA (p<0.05) was observed in the nasal-superior sector (48%) and nasal-inferior sector (45%); however the highest specificity was found in the temporal-superior (98%) and inferior (98%) sectors. The highest sensitivity for MRA (p<0.01) was found in the temporal-inferior sector (31%) and nasal-superior sector (30%) while the temporal-superior and inferior-sectors showed the highest specificity (100%). The diagnosis of glaucoma based on the presence of any sector alteration showed sensitivity figures of 67% with p<0.05 and 46% with p<0.01 and specificity values of 84% with p<0.05 and 96% with p<0.01. CONCLUSIONS: The analysis of the distribution of the neuroretinal rim by means of HRT-II contributes effectively to the diagnosis of glaucoma based on perimetry in a sample derived from a Spanish population.

Análisis de la distribución de anillo neurorretiniano por sectores mediante láser confocal de barrido en el diagnóstico del glaucoma / Sector-based analysis of the distribution of the neuroretinal rim by confocal scanning laser in the diagnosis of glaucoma

Objetivos: Valorar la capacidad diagnóstica delanálisis de la distribución de anillo neurorretinianopor sectores (regresión de Moorfields, MRA),medido mediante láser confocal de barrido.Material y métodos: Se estudiaron 200 ojos, de loscuales 101 eran normales y 99 glaucomas clasificadospor una perimetría automatizada convencionalcon defectos glaucomatosos (DM o DSPC conp<2% o grupo de 3 puntos con p<5% o 2 con p<1%o Glaucoma Hemifield Test alterado). A todos ellosse les realizó exploración oftalmológica completa,PA Humphrey 24-2 umbral completo y una topografíapapilar con HRT-II. Se calculó la especificidady la sensibilidad de los resultados de la clasificaciónMRA para cada uno de los sectores.Resultados: Se observó mayor sensibilidad paradetectar defectos estructurales basados en MRA(p<0,05) en los sectores nasal superior (48%) ynasal inferior (45%), mientras que la mayor especificidadse encontró en los sectores temporal superior(98%) e inferior (98%). La mayor sensibilidad para una MRA p<0´01 se obtuvo en el sector temporalinferior (31%) y nasal superior (30%), y lamayor especificidad en los sectores temporalessuperior e inferior y nasal inferior (100%). El diagnósticode glaucoma basado en la afectación de unoo más sectores reveló una sensibilidad de 67% parauna p<0,05 y 46% para una p<0,01 y una especificidadde 84% para una p<0,05 y 96% para unap<0,01.Conclusiones: El estudio de la distribución del anilloneurorretiniano con el HRT-II contribuye eficazmenteal diagnóstico de glaucoma perimétrico enuna muestra de población española

Purpose: To evaluate the diagnostic ability of the Moorfields regression analysis (MRA; neuroretinal rim sector-based analysis) by means of confocal scanning laser. Methods: 200 eyes were included in this study: 101 normal subjects and 99 glaucoma patients (standard automated perimetry with glaucomatous defects - MD or CPSD with p<0.02 or a cluster of three or more points with p<0.05 or a cluster of two or more points with p<0.01 or abnormal Glaucoma Hemifield Test). All subjects underwent a full ophthalmic evaluation, visual field evaluation by means of a Humphrey Field Analyzer, 24-2 full threshold strategy, and optic disc topography by Heidelberg retina tomograph (HRT-II). The outcome parameters were sensitivity and specificity of the MRA for each sector. Results: The highest sensitivity in detecting structural defects based on MRA (p<0.05) was observed in the nasal-superior sector (48%) and nasal-inferior sector (45%); however the highest specificity was found in the temporal-superior (98%) and inferior (98%) sectors. The highest sensitivity for MRA (p<0.01) was found in the temporal-inferior sector (31%) and nasal-superior sector (30%) while the temporal-superior and inferior-sectors showed the highest specificity (100%). The diagnosis of glaucoma based on the presence of any sector alteration showed sensitivity figures of 67% with p<0.05 and 46% with p<0.01 and specificity values of 84% with p<0.05 and 96% with p<0.01. Conclusions: The analysis of the distribution of the neuroretinal rim by means of HRT-II contributes effectively to the diagnosis of glaucoma based on perimetry in a sample derived from a Spanish population