Trombosis séptica portal secundaria a diverticulitis / Portal septic thrombophlebitis secondary to diverticulitis

Resumen La trombosis séptica de la vena porta es una complicación infrecuente de la diverticulitis, la apendicitis y de otras infecciones intraabdominales. Se asocia a elevadas tasas de complicaciones, como isquemia mesentérica, absceso hepático, hipertensión portal o muerte. Se presenta el caso de un paciente de 67 años quien consultó por fiebre, dolor abdominal e ictericia, y en quien se documentó bacteriemia por Escherichia coli y Streptococcus dysgalactiae. En las imágenes se identificó trombosis de la porta hepática secundaria a enfermedad diverticular aguda, lo que configura un diagnóstico de pileflebitis séptica. El paciente recibió terapia antibiótica dirigida, sin anticoagulación, obteniéndose adecuada respuesta clínica. Se realiza una discusión sobre el diagnóstico, etiología y tratamiento de la trombosis séptica portal.

Abstract Septic thrombosis of the portal vein is a rare complication of diverticulitis, appendicitis and other intra-abdominal infections; it is associated with high rates of complications, such as mesenteric ischemia, liver abscess, portal hypertension or death. We present the case of a 67-year-old patient who consulted for fever, abdominal pain and jaundice, and in whom Escherichia coli and Streptococcus dysgalactiae bacteremia was documented; images showed hepatic portal thrombosis secondary to acute diverticular disease, which configures a diagnosis of septic pylephlebitis. The patient received targeted antibiotic therapy without anticoagulation, with adequate clinical response. The diagnosis, etiology, and treatment of portal septic thrombosis are discussed.

Objective evaluation of static and dynamic behavior of different toric silicone-hydrogel contact lenses.

PURPOSE: The present study aimed to estimate how orientation position, recovery time, and contact lens decentration, associated with visual performance, may vary on several designs of the most recent toric silicone-hydrogel toric contact lenses in two-time different moments. METHODS: To evaluate the toric silicone-hydrogel toric contact lens position and stability, it was conducted with a prospective, observational, randomized, and single-center case series including 95 astigmatic eyes wearing four toric silicone-hydrogel toric contact lenses for two weeks. Orientation and decentration were analyzed with ImageJ software from video-frames extracted with a Python application. Recovery time was evaluated after 45 degrees of inferior-temporal misorientation. RESULTS: Evaluation of misorientation after 20 min of wear revealed the highest amount for Saphir RX, -20.41 ± 10.84 deg, and lowest for Air Optix Aqua for Astigmatism, -1.43 ± 7.48 deg. The highest horizontal misalignment was found for Air Optix Aqua for Astigmatism, -0.627 ± 0.330 mm, and lowest for Biofinity Toric, 0.004 ± 0.270 mm. Vertical misalignment presented the highest value for Acuvue Vita for Astigmatism, -0.652 ± 0.369 mm, and lowest for Air Optix Aqua for Astigmatism, -0.126 ± 0.231 mm. Recovery time showed the highest amount for Saphir RX, 80.70 ± 33.26 s, and lowest for Biofinity Toric 43.67 ± 23.70 s. Only Air Optix Aqua for Astigmatism presented significant differences after two-week of wear for misorientation (P = 0.02) and horizontal misalignment (P < 0.001). When pairwise comparisons are made between toric silicone-hydrogel toric contact lenses, significant differences (P < 0.001) are found. CONCLUSIONS: Although there was acceptable fitting, based upon decentration, orientation, and recovery with the study contact lenses, the stabilization and profile design used in the Air Optix Aqua for Astigmatism helped to minimize rotation and vertical misalignment. In addition, the peri-ballast and thickness profile of the Biofinity Toric improved rotational recovery and horizontal misalignment compared to the other contact lenses. Finally, lenses with a better fitting profile showed better visual performance.

Case Report: Effect of Haploscopic Filter on Contrast Sensitivity Function and Color Vision Tests.

SIGNIFICANCE: The options that can help patients with congenital color vision defect, to a better professional and leisure adaptation, are very limited. Different haploscopic lenses can be considered, and their effects need to be investigated in patients with different defects. PURPOSE: The purpose of this study was to present and discuss the effect of a pair of asymmetric long-pass filters fitted for deuteranopia, with the result of a 60% improvement in distinguishing red-green plates when compared with baseline. CASE REPORT: We report the case of a 51-year-old man with congenital deuteranopia fitted with haploscopic ChromaGen filters. During the 2-month follow-up, we observed a decrease in left-eye logMAR visual acuity and contrast sensitivity with an increased ability to discriminate the plates of different color vision tests (Ishihara, Farnsworth, and Hardy-Rand-Rittler). The visual outcomes are discussed considering the spectral sensitivity curves of each filter, measured with a spectrophotometric device. CONCLUSIONS: This report describes an improvement in the ability to resolve color vision plates after using asymmetric haploscopic filters showing a left-eye decrease in logMAR visual acuity and contrast sensitivity function. Subjects with a history of color vision deficiency might benefit from using haploscopic filters that selectively minimize the transmittance within a specific bandwidth to improve the color discrimination in deutan color vision deficiency. The simultaneous analysis of the color vision outcomes and transmittance spectrum of the haploscopic filters might contribute to a better understanding of the mechanisms behind the claimed efficacy of these devices.

Vision-Specific Quality of Life: Laser-Assisted in situ Keratomileusis Versus Overnight Contact Lens Wear.

OBJECTIVES: To compare the visual-related quality of life in myopic subjects with different refractive treatments such as continuous wear of silicone-hydrogel contact lenses (CL), corneal refractive therapy (CRT), and laser-assisted in situ keratomileusis (LASIK). METHODS: The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) questionnaire was administered to 96 subjects with a mean age of 30.0±7.9 years. There were 72 myopic subjects with a mean spherical equivalent of -2.74±0.98 D (-5.50 to -1.25 D). Subjects were corrected with LASIK (n=24), Paragon CRT orthokeratology lenses (n=24), and lotrafilcon A silicone-hydrogel CL under continuous wear (n=24). The NEI RQL-42 survey was used to compare differences between groups as well as with an emmetropic group (n=24). RESULTS: After 1 year of treatment, significant differences were found among all groups in the subscales glare (P=0.017), symptoms (P=0.016), dependence on correction (P<0.001), and worry (P<0.001). The mean difference compared with emmetropes were -5.5% (P=0.063) for LASIK patients, -2.0% (P=0.212) for orthokeratology subjects, and +1.6% (P=0.934) for the silicone-hydrogel CL group. CONCLUSIONS: Myopic subjects analyzed in this study reported better vision-related quality of life when they were corrected with continuous wear silicone-hydrogel lenses. The average score reached by CRT was similar to emmetropes, which showed the main disadvantage in worry subscale. The patients who underwent LASIK had the lowest valuation, highlighting the decreases in scores of diurnal fluctuations, glare, and especially in expectations and worry subscales, due to the first and second subscales, but especially to the false expectations created about treatment.

Corneal morphology and visual outcomes in LASIK patients after orthokeratology: A pilot study.

A STATEMENT OF SIGNIFICANCE: For the first time, this study shows that corneas that previous undergone orthokeratology treatment do not respond differently to LASIK compared with previous soft contact lens wear experience. PURPOSE: To evaluate and compare the corneal morphology and visual outcomes of long-term soft and orthokeratology (OK) contact lens fitting in wearers undergoing corneal refractive surgery (LASIK) for myopia correction. METHODS: Sixteen (16) myopic patients wearing hydrophilic soft contact lens (SCL, n = 8 subjects, control group) and OK (n = 8 subjects, OK group) lenses who undergone LASIK were retrospectively evaluated. Preoperative fitting of contact lenses and one year postoperative were studied using Pentacam (Oculus, Inc. GmbH, Wetzlar, Germany). Corneal pachymetry and volume, corneal topography, anterior and posterior surface elevation data and the anterior surface aberrometry of the cornea were recorded and used for fitting. RESULTS: Age, refractive error and topographic parameters before LASIK did not showed statistically significant differences between the two study groups. LASIK post-treatment results showed identical changes in both control and OK groups and did not show significant differences in all the parameters evaluated. The changes on corneal parameters and HOA due to refractive surgery intervention were not different between Control and OK group (p > 0.050). CONCLUSIONS: Corneal changes due to OK treatment are reversible after its discontinuation. The present study gives an overview of how OK does not impair future LASIK surgery for the correction of myopia and does not influence the success/results of such intervention. These findings suggest that OK CL wear does not change corneal biomechanics and does not compromise a possible LASIK refractive surgery. Although this is a pilot study and there is a need of evaluate this results/changes in future studies.

Comparison of Central Corneal Thickness Measured by Standard Ultrasound Pachymetry, Corneal Topography, Tono-Pachymetry and Anterior Segment Optical Coherence Tomography.

PURPOSE: To compare central corneal thickness (CCT) measured by standard ultrasound pachymetry (USP), and three non-contact devices in healthy eyes. METHODS: A cross-sectional study of CCT measurement in 52 eyes of 52 healthy volunteers was done by a single examiner at Ocular Surface and Contact Lens Laboratory. Three consecutive measurements were done by standard USP, non-contact tono-pachymeter, Pentacam corneal topographer, and Anterior Segment Optical Coherence Tomography (AS-OCT). The mean values were used for assessment. The results were compared using multivariate ANOVA, linear regression, and Pearson correlation. Agreement among the devices was analyzed using mean differences and Bland-Altman analysis with 95% limits of agreement (LoA). Finally, reliability was analyzed using intraclass correlation coefficient (ICC). RESULTS: Mean CCT by ultrasound pachymeter, tono-pachymeter, corneal topographer and AS-OCT were 558.9 ± 31.2 µm, 525.8 ± 43.1 µm, 550.4 ± 30.5 µm, and 545.9 ± 30.5 µm respectively. There was a significant positive correlation between AS-OCT and USP (Pearson correlation = 0.957, p < 0.001), corneal topography and USP (Pearson correlation = 0.965, p < 0.001), and corneal topography and AS-OCT (Pearson correlation = 0.965, p < 0.001). There was a lower correlation between CT-1P tono-pachymeter and the other three modalities. Intraclass correlation coefficients show an excellent reliability between pairs except for CT-1P against the other three instruments that were found moderate. CONCLUSIONS: CT-1P tono-pachymeter underestimates CCT measurements compared to Scheimpflug system, AS-OCT device, and USP. Mean CCT among USP, Pentacam and AS-OCT were comparable and had significant linear correlations. In clinical practice, these three modalities could be interchangeable in healthy patients.

Manifestaciones cardiovasculares en pacientes con dengue durante dos brotes epidémicos en Colombia / Cardiovascular manifestations in dengue fever patients during two epidemic breakouts in Colombia

la afección cardiovascular es una presentación atípica del dengue, que abarca desde bradicardia sinusal asintomática hasta miocarditis grave, aunque no hay datos locales de esta presentación. Objetivo: describir las características clínicas de una serie de pacientes con dengue y evidencia de afección cardiovascular. Materiales y métodos: se realizó un estudio observacional, de corte trasversal, de pacientes admitidos con dengue a un centro de referencia cardiovascular en Medellín, Colombia, durante dos epidemias del virus entre junio de 2010 y diciembre de 2016. Se evaluaron variables clínicas y paraclínicas. Resultados: se registraron un total de 60 pacientes, de los cuales el 30% (18/60) tuvieron compromiso cardiovascular y fueron incluidos en este estudio. La edad media de estos pacientes fue de 63 años y el 56% (10/18) eran hombres. La comorbilidad más frecuente fue la hipertensión arterial esencial (61%, 11/18). La alteración del ritmo cardíaco afectó al 72% (13/18) de los pacientes, con presencia de bloqueo auriculoventricular de primer grado (46%), bradicardia sinusal (38%), fibrilación/aleteo/taquicardia atriales (23%) y ritmo de la unión (8%). La miocarditis y la pericarditis se presentaron en el 17% (3/18) y 11% (2/18) de los pacientes, respectivamente. Otros hallazgos menos comunes fueron la disfunción ventricular izquierda y la angina de pecho (11%, 2/18). No hubo muertes durante la realización del estudio. Conclusiones: las alteraciones asintomáticas del ritmo cardiaco fueron las manifestaciones cardiovasculares más frecuentes del dengue y las afecciones cardiovasculares graves fueron infrecuentes. Se recomienda atención a los síntomas leves de disfunción cardiovascular en los pacientes con dengue

cardiovascular involvement is an atypical presentation of dengue infection. There range from asymptomatic sinus bradycardia to severe life-threatening myocarditis. Data are lacking regarding epidemiology on this topic. Objective: To describe clinical characteristics of patient's series with dengue and evidence of cardiovascular involvement. Materials and methods: It was performed a cross-section, observational study of patients admitted with dengue fever in a cardiovascular reference center in Medellín, Colombia during two epidemic viral outbreaks from June 2010 to December 2016. Results: A total of 60 patients were registred, 30% of them with evidence of cardiovascular involvement. Mean age of patients was 63 years old and 55% were male. Most common comorbidity was hypertension (61%, 11/18). Rhythm disturbances affected 72% (13/18) of patients: first grade AV block (46%), sinus bradycardia (38%), atrial fibrillation/flutter/tachycardia (23%) and junctional rhythm (8%). Myocarditis and pericarditis were present in 17% (3/18) and 11% (2/18) of patients, respectively. Other less common findings were left ventricular dysfunction and angor pectoris (11%, 2/18). There were no deaths during the study period. Conclusions: Asymptomatic rhythm disturbances were the most common cardiovascular manifestations of dengue fever and severe forms of cardiovascular dengue were rare. It is recommended to be attentive to the mild symptoms of cardiovascular dysfunction in patients with dengue

Estudio comparativo de cefuroxima y cefazolina como profilaxis en cirugía cardiovascular / A comparative study of Cefuroxime versus Cefazolin as prophylaxis in cardiovascular surgery

Introducción: la infección del sitio operatorio aumenta la morbimortalidad, el uso de antibióticos, la resistencia bacteriana y los costos de atención. Objetivo: comparar la incidencia de infección del sitio operatorio en pacientes sometidos a cirugía cardiaca con profilaxis de cefuroxima por 24 horas frente a cefazolina por 48 horas, en una clínica de la ciudad de Medellín en los años 2011 a 2012. Material y Métodos: cohorte histórica de una muestra a conveniencia de 448 historias clínicas de pacientes mayores de edad sometidos a cirugía de cambio valvular, bypass coronario o cirugía mixta. Las variables se tomaron teniendo en cuenta factores de riesgo endógenos. Las variables cualitativas se presentan con frecuencias absolutas y relativas; las cuantitativas, previas pruebas de Shapiro Wilk, con medidas de tendencia central, dispersión y posición. Las pruebas para contrastar diferencias de proporciones fueron chi cuadrado de Pearson y prueba exacta de Fisher; adicional a esto se calculó el riesgo relativo (RR) y se asumió significancia estadística con p<0,05. Resultados: la incidencia de infección en el grupo de cefazolina fue 8,7 % y en el de cerufoxima 7,9 %, (p=0,73). Las variables asociadas a la infección del sitio operatorio fueron: transfusión sanguínea RR=6,5; dislipidemia RR=2,9; tabaquismo RR=3,3; diabetes RR=2,9; reintervención RR=3,9. El uso de catéter Swan-Ganz se comportó como potencial confusor. Conclusión: no se encontró diferencia en la incidencia de infección entre el uso de cefazolina comparado con la cefuroxima en cirugía cardiaca.

Introduction: Surgical site infection increases morbidity and mortality, use of antibiotic, bacterial resistance and healthcare costs. Aim: to compare the incidence of surgical site infection in patients undergoing cardiac surgery with cefuroxime for 24 hours versus cefazolin for 48 hours. Methods: Historical cohort of a convenience sample of 448 adult patients undergoing valve replacement surgery, coronary bypass surgery or mixed. Endogenous risk factors were: age, sex, weight, BMI, diabetes, COPD, smoking and exogenous factors: type of surgery, aortic campling time and perfusion, temperature of hypothermia, length hospital stay, blood transfusion, reintervention. Qualitative variables were presented with absolute and relative frequencies, quantitative variables with measures of central tendency, dispersion and position. Differences in proportions were compare with Chi square and Fisher exact test; further to this the RR was calculated and statistical significance was assumed at p <0.05. Results: infection incidence in cefazolin group was 8,7 % and 7,9 % in cefuroxime group (p=0,73). Associated variables to surgical site infection were: Intraoperative blood transfusion RR=6,5; dyslipidemia RR=2,94; smoking RR=3,3; diabetes RR=2,9; reoperation RR=3,9. Swan-Ganz catheter was introduced as potential confounder. Conclusion: There was no difference in the incidence of surgical site infection between cefazolin 48 hours versus cefuroxime for 48 hours in cardiac surgery.

Long-term changes in corneal structure and tear inflammatory mediators after orthokeratology and LASIK.

PURPOSE: To monitor changes in corneal structure and level of inflammatory mediators in tears of myopic patients following orthokeratology (OK) and laser in situ keratomileusis (LASIK). METHODS: Sixty-two myopic subjects were analyzed in this prospective study. Thirty-two had worn Paragon CRT contact lenses and 30 underwent standard LASIK. Thirty-two control subjects were also recruited. Pachometry and corneal topography were performed 12 months after both interventions. Tears were collected and assayed using ELISA for IL-6, IL-8, matrix metalloproteinase-9 (MMP-9), and epidermal growth factor (EGF). RESULTS: Corneal power decreased in the central area and increased in the paracentral area. Simultaneously, there was a central corneal thinning with mid-peripheral thickening for OK. No changes were observed for LASIK. In comparison with controls, IL-6, IL-8, MMP-9, and EGF levels were increased significantly for OK (P < 0.01). Only MMP-9 (P < 0.01) and EGF (P < 0.01) were increased for LASIK. Pro-inflammatory response was found to be associated with the degree of myopia in the OK group. The MMP-9 and EGF upregulation was linked to the presence of iron deposition in both groups, whereas increased levels of EGF were connected with the presence of myopic regression after LASIK. CONCLUSIONS: Both interventions involved important tissue reshaping. The physical presence of a reverse geometry contact lens caused certain markers to change significantly in comparison with no lens wear or LASIK in the long-term response. MMP-9 was significantly higher in tears of subjects presenting iron deposition after OK or LASIK, and EGF levels seemed to play an important role in postoperative refractive outcomes after LASIK.

Pigmented corneal ring associated with orthokeratology in Caucasians: case reports.

BACKGROUND: The aim was to report the appearance of a pigmented ring in both eyes of two patients undergoing overnight orthokeratology. METHODS: Two Caucasian patients, one male and one female, were fitted with orthokeratology lenses to correct myopia between -2.00 and -2.50 DS with Paragon corneal refractive therapy lenses worn overnight. Treatment was successful in both patients achieving uncorrected vision of 6/6 or better monocularly under high (100 per cent) and low (10 per cent) contrast conditions. RESULTS: At the six-month visit both patients presented with pigmented rings under slitlamp examination in both eyes. The location of the ring was consistent with the corneal area being flattened for myopic correction. Clinical examination was otherwise normal. CONCLUSIONS: Despite being initially reported in Asian patients from Hong Kong, a pigmented ring related to orthokeratology treatment is also present in Caucasian patients, reducing the potential role of an ethnic link. Further large-scale studies need to be done to estimate the actual incidence of this condition and the potential implications for corneal health.

Tear film inflammatory mediators during continuous wear of contact lenses and corneal refractive therapy.

OBJECTIVES: To study changes in tear film inflammatory mediators following continuous wear of silicone-hydrogel lenses and corneal refractive therapy with reverse geometry contact lenses. DESIGN: A prospective, case-control study. METHODS: Twenty-eight subjects had worn silicone-hydrogel lenses on a 30-night continuous wear basis. Thirty-two subjects had worn corneal refractive therapy lenses on an overnight basis. Thirty-two matched control subjects were also recruited. Tear samples were obtained 12 months after initial fitting and assayed using ELISA for cytokines (interleukin (IL)-6 and IL-8), matrix metalloproteinase 9 (MMP-9) and epidermal growth factor (EGF). RESULTS: EGF was significantly increased 12 months after both interventions. IL-6, IL-8 and MMP-9 were significantly increased only after corneal refractive therapy. The inflammatory response for the corneal refractive therapy patients was found to be associated with the degree of myopia corrected and the presence of corneal staining. Moreover, an increased level of MMP-9 and EGF was found to be associated with the presence of corneal-pigmented arc in the corneal refractive therapy group. CONCLUSIONS: This research showed long-term increased tear levels of inflammatory markers in subjects wearing corneal refractive therapy lenses when compared with continuous wear of silicone-hydrogel lenses or no lens wear.

Ejercicio y diabetes mellitus tipo 2 / Exercise and Type 2 Diabetes Mellitus

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Topographic paracentral corneal thickness with pentacam and orbscan: effect of acoustic factor.

PURPOSE: To evaluate the effect of an acoustic factor (AF) on the comparison of central corneal thickness (CCT) and peripheral corneal thickness (PCT) measurements with Orbscan II and Pentacam. METHODS: The CCT and PCT at 1, 2, and 3 radial distances from the corneal apex were measured using Orbscan II and Pentacam in 22 right eyes of 22 healthy adults (7 men, 15 women). Three measures were obtained from each 1 of the 25 points measured and then compared to gauge the agreement between both devices at the corneal center and anular areas located at 1-, 2-, and 3-mm distances from the central measurement. Orbscan II readings were considered with and without an AF correction. RESULTS: Pentacam provides statistically significant higher values than Orbscan II does at all the 25 locations analyzed (P<0.001). With a few exceptions, the average difference was fairly constant between 20 and 40 µm for all the corneal locations. A high correlation existed between central readings (r(2)=0.927; P<0.001) and average thickness at each one of the annular areas being analyzed (r(2)=0.897 at 1 mm, r(2)=0.876 at 2 mm, and r(2)=0.870 at 3 mm); Pentacam minus Orbscan II value averaged for all the points changed from -28±10 to -22±9 µm after the removal of the AF in Orbscan II. CONCLUSIONS: Central and peripheral measurements of the corneal thickness obtained with Orbscan II and Pentacam are significantly different. The removal of the AF in Orbscan II renders lower mean differences but decreases the agreement between both systems and potentially induces an overestimation of CCT and PCT by Orbsan II compared with Pentacam.

Comfort and vision scores at insertion and removal during 1 month of wear of Paragon CRT for corneal reshaping.

PURPOSE: The goal of this study was to evaluate the pattern of initial adaptation of neophytes to corneal refractive therapy (CRT) for overnight corneal reshaping in terms of comfort and subjective visual performance at lens insertion at night and lens removal in the morning. METHODS: Twenty-two young healthy subjects were enrolled in this study. All of them had been trialed to assess adaptation to conventional alignment-fit rigid gas permeable lenses and were only enrolled in this study after a 2-week wash-out period. Visual analog scales for subjective comfort and vision were recorded on a form given to the patient on days 1, 2, 3, 5, 7, 14, 21, and 28. Additionally, the patient attended the clinic on days 1, 7, 15, and 30 after fitting, for follow-up. RESULTS: Successful adaptation was obtained in 21 of the 22 initially enrolled individuals. The average overnight wearing time remained constant during the study at 8 hrs per day. Overall comfort rates increased significantly up to values of 8.02 and 9.12 out of 10 at insertion and removal, respectively (P<0.001). Subjective vision scores also increased significantly at the end of the 1-month study period (P<0.001). CONCLUSIONS: Adaptation to CRT is rapid in terms of subjective comfort and vision. Comfort significantly increases by day 5, whereas subjective vision in the morning reaches its maximum by days 15 to 21 and at the end of the day by days 10 to 15. These results are of interest to clinicians to provide evidence-based information to their patients about the expected time to adapt to CRT in terms of self-reported comfort and vision.

Central corneal thickness measured with three optical devices and ultrasound pachometry.

PURPOSE: To evaluate the reliability of three noninvasive pachometry methods against the ultrasound pachometer considered the gold standard. METHODS: Central corneal thickness (CCT) was measured using a Paxis ultrasound (US) pachometer, Orbscan II, Pentacam, and Topcon SP-3000 specular microscope in 22 right eyes of 22 healthy adults (7 men, 15 women). Three repeated measures were obtained and then compared to obtain the repeatability of each instrument and the agreement between pachometers. RESULTS: Pentacam is the optical system that renders values of CCT closer to those obtained with US pachometry. Conversely, a specular microscope shows a poorer agreement with US measures, and differences depend on the thickness being measured. The Orbscan system shows a consistent trend toward underestimation of CCT compared with US and Pentacam irrespective of the value measured. CONCLUSION: Different optical methods used to measure CCT showed significantly different results compared with US pachometry except for the Pentacam system. Clinicians should take into account the fact that specular microscopy might either underestimate or overestimate values of CCT, whereas Orbscan systematically overestimates CCT compared with US and Pentacam.

Clinical evaluation of the new TGDc-01 "PRA" palpebral tonometer: comparison with contact and non-contact tonometry.

PURPOSE: The TGDc-01 "PRA" (Ryazan State Instrument, Ryazan, Russia) tonometer is a new portable small-sized tonometer that measures intraocular pressure (IOP) through the eyelid. The purpose of this study is to assess the repeatability of the TGDc-01 IOP measurements by comparing them against those obtained with Goldmann tonometer and with those from Perkins applanation tonometer, Xpert (Reichert, Depew, NY) noncontact tonometer, and Tono-Pen XL (Medtronic Solan, Jacksonville, FL) digital tonometer. METHODS: Fifty-eight right eyes of 58 young subjects were measured with each of the tonometers. Noncontact tonometry was performed first, followed by Goldmann and Perkins applanation tonometer (in random order), digital Tono-Pen XL, and finally TGDc-01 tonometer (sitting and supine position). Correlation analysis was used to evaluate the relationship between the Goldmann tonometer and the remaining tonometers used in this study. Plotting the difference between the methods against mean was also done to compare the tonometers. The hypothesis of zero bias was examined by a paired t-test. The 95% limits of agreement (LoA) were also calculated. RESULTS: TGDc-01 showed no statistical difference between the IOP measurements obtained in sitting and supine positions. A poor relationship between the TGDc-01 and Goldmann tonometer was found (r = 0.173; p = 0.001). Although the mean differences between Goldmann and Tonopen XL, Xpert, and TGDc-01 IOP measurements were statistically significant, the wider 95% LoA was observed when comparing the Goldmann and TGDc-01 tonometers. Computation of the 95% LoA resulted in a wide bias range when comparing the TGDc-01 with all the tonometers used in this study. CONCLUSIONS: The TGDc-01 "PRA" tonometer was not comparable with the other techniques used in the study. The wide dispersion range of the values obtained shows low repeatability of the TGDc-01 for screening purposes. These results could be because of the technique of measurement and/or interindividual variables.

Accuracy and precision of EyeSys and Orbscan systems on calibrated spherical test surfaces.

BACKGROUND: It is important to know how well the surface topography can be measured with current devices for corneal topographic analysis. There are several applications that need an accurate and precise method to measure corneal shape and variations, such as the effect of contact lens wear and the different refractive surgery techniques. PURPOSE: The aim of this study is to compare the accuracy and reproducibility of the measurement of the central curvature on calibrated steel balls using the EyeSys videokeratoscope and the Orbscan corneal topography system. METHODS: The videokeratoscope (EyeSys Corneal Analysis System 2000, version 3.1) and the Orbscan corneal topography system (Orbscan II version 3.0) were used by four trained investigators to measure a series of five uniform and calibrated test surfaces with known radius of curvature ranging from 6.13 to 9.00 mm. RESULT: No statistically significant difference was found between the videokeratoscope and Orbscan systems in relation to accuracy or precision. The 95% confidence limits showed a close agreement between both instruments. The mean bias was less than +/-0.05 mm for both devices. The precision of the instruments was found to be similar. CONCLUSION: The EyeSys seems to measure more accurately, but the accuracy of the Orbscan was also acceptable, suggesting that both instruments are accurate and precise enough for research and clinical purposes. However, further studies of accuracy and repeatability of topographical measurements on human eyes generated by different topographers are necessary.