Goldmann applanation tonometry after myopic photorefractive keratectomy.

PURPOSE: To determine the accuracy of applanation tonometry in patients with corneas thinned by photorefractive keratectomy, and to correlate corneal changes with tonometric readings. METHODS: The intraocular pressure was measured with Goldmann applanation tonometry in 87 patients who underwent photorefractive keratectomy before and 1, 6 and 12 months after treatment. The treatments ranged from -1.5 to -14 diopters (mean=-7.6+/-4.1 diopters) and the fellow eyes were used as controls. RESULTS: In the treated eyes the intraocular pressure before surgery ranged from 11 to 26 mmHg (mean=17.7+/-2.8 mmHg). One month after surgery it ranged from 5 to 22 mmHg (mean=11.9+/-2.7 mmHg) with a significant underestimation (P=1x10(-33)). Six months after surgery it ranged from 6 to 22 mmHg (mean=12+/-3 mmHg) with a significant underestimation (P=5x10(-30)). Twelve months after surgery it ranged from 8 to 22 mmHg (mean=12.7+/-2.7 mmHg) with a significant underestimation (P=5x10(-31)). CONCLUSIONS: A correcting factor should be applied when using applanation tonometry to measure intraocular pressure in patients who have undergone PRK.

Non-contact tonometry in patients that underwent photorefractive keratectomy.

To determine the accuracy of non-contact tonometry in patients with corneas thinned by photorefractive keratectomy, the authors measured the intraocular pressure with a non-contact tonometer and the corneal thickness with an ultrasonic pachymeter in 47 patients before and 9 months after photorefractive keratectomy. The patients were divided into three groups according to the degree of treatment: group I between 1 and 5 diopters (14 eyes), group II between 6 and 10 diopters (18 eyes), group III between 11 and 15 diopters (15 eyes). In the first group of patients mean intraocular pressure was 16.1 (+/-3.85) mm Hg before surgery, and 13.2 (+/-3.14) mm Hg after surgery with a significant difference (p = 0.0027). In the second group of patients mean intraocular pressure was 16.0 (+/-4.13) mm Hg before surgery and 13.0 (+/-3.0) mm Hg after surgery with a significant difference (p = 0.0045). In the third group of patients mean intraocular pressure was 17.7 (+/-3.8) mm Hg before surgery and 12.4 (+/-2.6) mm Hg after surgery, with a significant difference (p = 0.0005). In conclusion, according to our results, non-contact tonometry needs a correcting factor for measuring the intraocular pressure in patients that underwent photorefractive keratectomy, related to the degree of refractive treatment.

Macula study with standardized echography.

At an early clinical stage, patients with cystoid macular oedema show no significant changes in their vision. This phase is described as angiographic cystoid macular oedema. Echographic macular studies have in the past years shown that the macular thickness is increased in the early stages of cystoid macular oedema. In these patients there was no evidence of cystoid macular oedema with the visual acuity test, B-scan echography and fluorescein angiography. In this paper an echographic macular study by standardized A-scan echography was performed in 537 patients before extracapsular cataract extraction and intraocular lens implantation in posterior chamber (ciliary sulcus). The results showed that this method is very sensitive in detecting patients with high risk of cystoid macular oedema.

Standardized A-scan echography and the normal optic nerve. Experience with the new Mini A equipment.

The potential of making differential diagnosis in optic nerve disease with standardized A-Scan echography has been well established. With this technique it is possible to differentiate 'solid' and 'fluid' thickening. A few years ago a new standardized A-scan equipment was built: The Mini A. With this equipment, it is possible to distinguish spikes coming from the pia, the arachnoid, and the dura around the optic nerve, and to measure the thickness of these structures with a precision of 0.03 mm. We found dura distance 4.0-5.3 mm, arachnoid 3.2-4.0 mm, an pial diameter 2.8-3.4 mm. In this paper the authors discuss their preliminary findings in a normal population.