[Fluctuation of intraocular pressure in 24-hour telemonitoring compared to tonometry during normal office hours]. / Fluktuationen des intraokularen Augendrucks - ein intraindividueller Vergleich zwischen 24-Stunden-Teletonometrie-Monitoring und ambulanter Augendruckmessung.

BACKGROUND: Elevated intraocular pressure (IOP) is a clinically relevant factor in glaucoma progression. As a dynamic parameter the IOP depends on various internal and exogenic influencing factors. Therefore, we analysed intraindividual IOD variations between ambulant care and 24-h home-monitoring using self-tonometry. PATIENTS AND METHODS: This study is based on paper-based glaucoma cards of 25 patients with primary open angle glaucoma. Additionally, all patients participated in a telemedical home-monitoring study with self-measurements of IOP and blood pressure stored in an electronic patient record. The glaucoma cards contained a total number of 409 IOP values with documentation periods from 0.5 to 10 years. In the teletonometry project all 25 patients were observed for 6 months with 1490 recorded IOP values. Statistical analysis was performed with SPSS software. RESULTS: Average IOP values for all 25 glaucoma patients were 16.3 +/- 2.9 mmHg for both eyes in glaucoma card documentation, whereas the electronic patient records showed IOP averages of 18.9 +/- 4.7 mmHg for right eyes and 18.2 +/- 4.4 mmHg for left eyes. Corresponding to the practice opening hours the glaucoma cards contained no IOP records from 12:00 pm to 01:30 pm as well as between 06:00 pm and 07:15 am. In these time periods 17 % of all IOP values recorded in 24-hour teletonometry were higher than 20 mmHg. However, statistical analysis and clinical evaluation of device parameters and measurement characteristics revealed sporadic measuring errors. CONCLUSIONS: The additional involvement of self-tonometry in telemedical 24-h home-monitoring is a feasible method to record and detect intraday IOP fluctuations. Compared to single IOP measurements documented in common paper-based glaucoma cards, the 24-h electronic patient record showed more frequent circadian IOP variations. As a result, self-tonometry and home-monitoring can be a useful link to fill the gap between singular ambulant IOP measurement and hospitalisation with 24-hour IOP profiles.

[Application of EMLA creme before upper lid blepharoplasty]. / Adjuvante Wirkung von EMLA-Creme bei der Oberlidblepharoplastik.

BACKGROUND: The injection of local anesthesia before upper lid blepharoplasty is perceived as unpleasant and painful by some patients. METHODS: In an intraindividual randomized prospective study, 14 patients undergoing upper lid blepharoplasty on both sides were examined. Before the operation the EMLA creme was put on one side. The pain sensibility was checked before and after using EMLA creme and during the infiltration of anesthesia and the operation. RESULTS: The sensitivity before putting on EMLA creme was equal in all patients on both sides. After application there was a distinct difference between the sides. During the infiltration of anesthesia 12 patients reported low and 2 patients medium pain on the treated side, while on the non-treated side 5 patients reported low, 4 patients medium, and 5 patients severe pain. CONCLUSIONS: Applying EMLA creme before an operation reduces the pain sensitivity during infiltration of anesthesia and during the operation.