Changes in Macular Thickness after Cataract Surgery in Patients with Open Angle Glaucoma.

BACKGROUND: The purpose of this study was to examine the changes in IOP, total macular and RNFL, ganglion cell layer (GCL) thickness, and aqueous humour flare in open angle glaucoma (OAG) patients before and 6 months after cataract surgery. METHODS: This was a prospective observational case-control age- and gender-matched study. Groups: 40 subjects in a controlled OAG (OAGc) group, 20 subjects in an uncontrolled OAG (OAGu) group, and 60 control group subjects. EXAMINATION: complete ophthalmic evaluation, IOP measurement, anterior and posterior segment Optical Coherence Tomography (OCT), and laser flare photometry before and 6 months postoperatively. RESULTS: Six months postoperatively IOP decreased in all groups. An increase in macular thickness was found postoperatively in all groups. Preoperative aqueous humour flare was higher in the OAGc group than in the control group. After cataract surgery, aqueous humour flare was higher in the control group compared to the preoperative result. CONCLUSIONS: Changes in IOP following cataract surgery were strongly negatively correlated with preoperative IOP. An increase in macular thickness was observed 6 months postoperatively in all groups. Aqueous humour flare did not differ in OAGc and OAGu groups pre- and postoperatively but significantly increased in the control group postoperatively.

Changes in ocular morphology after cataract surgery in open angle glaucoma patients.

The purpose of this study was to evaluate intraocular pressure (IOP) pre- and postoperatively, together with anterior chamber angle (ACA) parameters and biometrical results in cataract patients with or without open angle glaucoma (OAG). The prospective observational case-control study included 15 eyes with cataract and OAG in the glaucoma group and 25 eyes with only cataract in control group. Examination included full ophthalmic evaluation, IOP, ocular biometry and anterior segment optical coherence tomography measuring ACA pre- and 6 months postoperatively. OAG patients had a larger absolute IOP reduction compared to control group. Anterior chamber depth (ACD) and ACA width significantly increased in both groups. The OAG group had a tendency of narrower ACA preoperatively, but overall ACA parameters did not differ in either group pre- and postoperatively. The ACD change after surgery correlated with ACA parameters in the control group, but not in OAG group. Axial length was shorter postoperatively in the control group, but remained similar in the OAG group. Absolute IOP reduction was more pronounced in cataract patients with OAG than in cataract patients without glaucoma. ACD and ACA postoperatively increased in both groups and AL shortening was observed in non-OAG in cataract group.

Anterior segment optical coherence tomography imaging and ocular biometry in cataract patients with open angle glaucoma comorbidity.

BACKGROUND: Anterior chamber angle anatomy in perspective of ocular biometry may be the key element to intraocular pressure (IOP) reduction, especially in glaucoma patients. We aim to investigate anterior chamber angle and biometrical data prior to cataract surgery in patients with and without glaucoma comorbidity. MATERIALS AND METHODS: This prospective comparative case-control study included 62 subjects (38 with cataract only and 24 with cataract and glaucoma). A full ophthalmic examination including, Goldmann applanation tonometry, anterior chamber swept source optical coherence tomography (DRI OCT Triton plus (Ver.10.13)) and swept source optical biometry (IOL Master 700 v1.7) was performed on all participants. RESULTS: We found that ocular biometry parameters and anterior chamber parameters were not significantly different among groups. However, when we added cut-off values for narrow angles, we found that glaucoma group tended to have more narrow angles than control group. IOP was higher in glaucoma group despite all glaucoma patients having medically controlled IOP. In all subjects, anterior chamber parameters correlated well with lens position (LP), but less with relative lens position, while LP cut-off value of 5.1 mm could be used for predicting narrow anterior chamber angle parameters. CONCLUSIONS: Cataract patients tend to develop narrow anterior chamber angles. Anterior chamber angle parameters have a positive moderate to strong relationship with lens position. LP may be used predicting narrow angles.

The effect of nebulized dorzolamide/timolol fixed combination mist versus drops on retrobulbar blood flow and intraocular pressure in glaucoma patients.

OBJECTIVE: The aim of this study was to evaluate intraocular pressure (IOP), retrobulbar blood flow (RBF), and ocular side effects after the application of topical dorzolamide/timolol fixed combination (DTFC) drops vs topical nebulized DTFC mist in patients with primary open-angle glaucoma. MATERIAL AND METHODS: A total of 15 POAG patients were enrolled in a prospective study. Retrobulbar blood flow was measured in the ophthalmic (OA) and central retinal (CRA) arteries using color Doppler imaging. DTFC mist or drops were applied to the experimental eye, and it was examined after 15 and 60 minutes. DTFC mist was applied 6 times for 30 seconds using a misting device. RESULTS: DTFC mist significantly increased peak-systolic (PSV) and end-diastolic (EDV) velocities after 15 and 60 minutes in both the arteries (OA: increase of 12.5% and 9.6% in PSV, P=0.01; increase of 25.8% and 23.1% in EDV, P=0.03; CRA: increase of 11.5% and 8.7% in PSV, increase of 32% and 21.6% in EDV, respectively, P<0.05). DTFC drops had a similar effect on PSV and EDV in the CRA after 15 and 60 minutes (increase of 8.1% and 9.6% in PSV; increase of 17.1% and 23% in EDV, respectively, P=0.03), but a significant effect on PSV and EDV in the OA was documented only after 15 minutes (increase of 9% and 21.4%, respectively, P=0.02). DTFC mist reduced the resistance index in the CRA after 15 and 60 minutes (decrease of 8.5% and 10.2%, respectively, P=0.04). Both methodologies showed a significant decrease in IOP after 15 and 60 minutes (P<0.05). All patients complained of ocular irritation after drop application, and 1 patient complained of general weakness after mist treatment. CONCLUSIONS: Nebulized DTFC mist significantly reduced IOP and increased blood flow in the OA and the CRA, causing no ocular irritation as compared with traditional DTFC drop methodology.

Possible predisposing factors for late intraocular lens dislocation after routine cataract surgery.

OBJECTIVE: The aim of this study was to evaluate possible risk factors for late intraocular lens (IOL) dislocation after routine cataract surgery. MATERIAL AND METHODS: A retrospective analysis of medical records of all the patients who were treated in the university hospital between 2011 and 2012 for late IOL dislocation requiring surgical management after routine cataract surgery was performed. In total, 58 patients (58 eyes) were included into the study. RESULTS: The mean time between cataract surgery and late IOL dislocation was 67.8 months (SD, 34.9). A negative correlation was found between the patient age at cataract surgery and the time between cataract surgery and IOL dislocation (r=-0.29; P=0.042). Late in-the-bag dislocation occurred in 87.9% and late out-of-the-bag dislocation in 12.1% of the cases. Pseudoexfoliation was present in 56.9% and 42.9% of the eyes with in-the-bag and out-of-the-bag dislocation, respectively. The odds ratio for IOL dislocation within 43 months after complicated cataract surgery was 24.0 (95% confidence interval [95% CI] 4.5-127.4; P<0.001) and for in-the-bag IOL dislocation 24.9 (95% CI, 4.2-148.0; P<0.001). The odds ratio for in-the-bag IOL dislocation within 43 months after advanced cataract surgery was 18.8 (95% CI, 2.0-180.0; P=0.011). Moreover, in-the-bag IOL dislocation occurred earlier in the patients with past uveitis (P=0.020) or zonule laxity (P=0.037). CONCLUSIONS: Complicated cataract surgery increased the risk of both late in-the-bag and out-of-the-bag IOL dislocation, and advanced cataract increased the risk of late in-the-bag IOL dislocation. The time to in-the-bag IOL dislocation shortens with pseudoexfoliation syndrome, advanced age, or past uveitis. These factors must be taken into account while planning a postoperative follow-up.

Effects of preservative-free tafluprost on tear film osmolarity, tolerability, and intraocular pressure in previously treated patients with open-angle glaucoma.

PURPOSE: To compare the effects on tolerability, tear osmolarity, and intraocular pressure (IOP)-lowering effect of switching from benzalkonium chloride (BAK) containing prostaglandin analog (PGA) latanoprost to preservative-free tafluprost. PATIENTS AND METHODS: Thirty patients with open-angle glaucoma (N = 60 eyes), 26 women (87%) and four men (13%) aged 64.1 (SD 14.1) years, showing abnormal values of tear osmolarity, corneal fluorescein staining, tear film break-up time (TBUT), or subjective discomfort with current latanoprost treatment were included. After tear osmolarity (TearLab™ Osmolarity System), TBUT, corneal fluorescein staining, and baseline IOP (Goldmann tonometer) measurements and the completion of Ocular Surface Disease Index and Ocular Surface Symptoms in Glaucoma Scale questionnaires, patients were assigned to preservative-free tafluprost treatment. Measurements were repeated 2, 6 and 12 weeks after change of medication. RESULTS: No statistically significant differences in IOP were observed 2, 6, and 12 weeks after switching to preservative-free tafluprost. Mean IOP at baseline was 16.4 mmHg (SD 2.9), after 2 weeks 16.2 mmHg (2.8), after 6 weeks 16.2 (2.6), and after 12 weeks 16.3 mmHg (2.3). Mean tear osmolarity decreased significantly from 315.7 mOsm/L (SD 15.1) at baseline to 308.0 ± 14.4 mOsm/L (P = 0.002), 301.7 ± 14.5 mOsm/L (P < 0.001), and 302.0 ± 9.9 mOsm/L (P < 0.001) 2, 6, and 12 weeks after changing medication to preservative-free tafluprost, respectively. Tear osmolarity was lower in 37 eyes (61.7%) after 2 weeks, in 46 eyes (76.7%) after 6 weeks, and in 49 eyes (81.7%) after 12 weeks (P < 0.005; t-test). At baseline corneal fluorescein staining was observed in 43 eyes (71.7%), after 2 weeks in 34 eyes (56.7%), after 6 weeks in 12 eyes (20.0%), and after 12 weeks in 7 eyes (11.7%) (P < 0.005; McNemar test). Mean TBUT increased from 3.7 seconds (SD 1.1) at baseline to 4.1 seconds (SD 1.0) at week 2, 5.2 seconds (SD 1.5) at week 6, and 6.5 seconds (SD 1.5) at week 12 (P < 0.001; t-test). The number of patients expressing discomfort with latanoprost diminished from 30 (100%) at baseline, to 19 (63.3%) after week 2, and to 11 (36.6%) (P < 0.05; McNemar test) after 12 weeks. CONCLUSION: Preservative-free tafluprost is better tolerated than BAK-containing latanoprost, showing lower tear osmolarity levels while maintaining effective IOP control.

Comparison of intraocular pressure fluctuations measured by goldmann applanation tonometer and pulsatile ocular blood flow analyser.

BACKGROUND: Intraocular pressure (IOP) is the major known risk factor in glaucoma and the primer mover of the functional damage in glaucomatous patients but it is not a unique determinant of glaucomatous damage. Clinical assessment of glaucoma patients may not be a true reflection of overall IOP control. Evaluation of the effect of glaucoma medication is restricted by measurement of IOP as a dynamic physiological parameter. PURPOSE: To compare IOP fluctuations over time using Goldmann applanation tonometry (IOPGAT) and pulsatile ocular blood flow analyzer (IOP-POBFA) under the Dorzolamide/timolol or latanoprost treatment regimes. DESIGN: Prospective 1 year follow-up study. PARTICIPANTS: 30 randomly chosen controlled open angle glaucoma patients (60 eyes): 16 patients (32 eyes) receiving Dorzolamide/timolol fixed combination (D/T) and 14 (28 eyes) latanoprost 0.005% treatment. MAIN OUTCOME MEASURES: Changes in IOP and perfusion pressure dynamics. RESULTS: THERE WAS NO STATISTICALLY SIGNIFICANT DIFFERENCE IN BASELINE IOP PARAMETERS BETWEEN STUDY GROUPS: 15.69 ± 2.02 mmHg with D/T and 16.71 ± 2.84 mmHg with latanoprost (p=0.314). Both treatment regimes were tolerated and patients were adherent to treatment. Determined a strong positive correlation between IOP-GAT and IOP-POBFA; verified over time period under particular treatment regime. After 1 year follow-up D/T and latanoprost results referred to statistically significant tachyphylaxis effect, i.e. IOP-GAT increased in 2.31mmHg with D/T (p=0.007) and 2.72 mmHg (p=0.004) with latanoprost and IOP-POBFA increased in 1.74 mmHg (p=0.026) and 3.13 mmHg (p=0.007) respectively. Multiple regression analysis revealed no important blood flow factors as predictors in the increase of IOP. CONCLUSIONS: Strong positive correlation was revealed between IOP-POBFA and IOP-GAT over a time period. Observed tachyphylaxis effects after 1 year under both treatment regimes should be assessed with respect to patient compliance and persistence to treatment.