Desempeño del analizador de respuesta ocular para medir la presión intraocular en comparación con la tonometría de aplanación Goldmann / Ocular response analyzer´s performance to measure the intraocular pressure in comparison with Goldmann applanation tonometry

Objetivo: Comparar el desempeño clínico de la tonometría por aplanación de Goldmann ( TAG) y la medida por el Analizador de Respuesta Ocular (ORA) en una serie no consecutiva de casos con glaucoma o con sospecha de glaucoma, así como valorar la concordancia y la consistencia de las PIO medidas entre los dos métodos. Métodos: A los pacientes se les realizó evaluación oftalmológica integral, tonometría por aplanación de Goldmann, la medición de las propiedades biomecánicas de la córnea (incluida la PIO ajustada) empleando el ORA, campos visuales y un análisis imagenológico de los discos ópticos y la capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica. Se aplicó la prueba t de Student para variables independientes para comparar las diferencias en los promedios de las variables continuas y las pruebas no paramétricas chi cuadrada y U de Mann-Whitney para comparar las diferencias en proporciones de variables categóricas. Se determinó el grado de correlación entre los métodos tonométricos (TAG vs. ORA), empleando el coeficiente de Pearson, así como el coeficiente de variación para las mediciones duplicadas por los dos métodos tonométricos. Por último, se utilizó el método comparativo de Bland-Altman que grafica la dispersión de las diferencias en la medición. Se consideró un valor de P < 0.05 como estadísticamente significativo. Resultados: Se incluyeron 210 ojos (106 individuos), con una edad promedio de 61 años (D.E. ± 13.1), siendo la mayoría mujeres (64%) y portadores de glaucoma (62%). La PIO entre ojos con los diversos métodos no fue diferente (P > 0.05). La PIO media determinada por TAG (OD 14.9 ± 5.4 mm Hg, OI 14.5 ± 4.2 mm Hg) fue significativamente menor (P < 0.0001) que la medida por ORA (OD 18.4 ± 4.8 mm Hg, OI 17.9 ± 5.0 mm Hg) y no guardaron una correlación (OD, r = 0.15; OI r = 0.46). El coeficiente de variación para el OD (TAG vs.ORA) fue de 31% y para el OI de 25.8%. Conclusiones: La determinación de PIO medida por ORA difiere significativamente de la determinada por TAG y no parece guardar una correlación entre métodos (en ambos ojos) de la muestra analizada, tal como lo demuestran los hallazgos.

Purpose: To compare the clinical performance of Goldmann applanation tonometry (GAT) vs Ocular Response Analyzer (ORA) measurements in a non-consecutive case series of glaucoma or glaucoma suspects; to assess the concordance and consistency of the IOPs measured between the two methods. Methods: Th e patients underwent comprehensive ophthalmologic evaluation: GAT, measurement of the biomedical properties of the cornea (including adjusted IOP) using the ORA, visual fields and an image analysis of optical disks and nerve fiber layer of the retina using optical coherence tomography. The Student's test for independent variables was used to compare the differences in the mean of the continuous variables and the non-parametric tests of the chi square and Mann-Whitney for the differences in the proportions of categorical variables. The degree of correlation between the tonometric methods (GAT vs ORA), using the Pearson coeffi cient, as well as the coefficient of variation for the measurements duplicated by the two tonometric methods was used. Bland-Altman method was also used. A value of P <0.05 was considered statistically significant. Results: We included 210 eyes (106 patients), with a mean age of 61 years (64%), 62% had glaucoma. The IOP between eyes with the different methods was not statistical different (P> 0.05). The mean IOP determined by GAT (OD 14.9 ± 5.4 mm Hg, OI 14.5 ± 4.2 mm Hg) was lower (P <0.0001) than that measured by ORA (OD 18.4 ± 4.8 mm Hg, OS 17.9 ± 5.0 mm Hg). No correlation wasfounded (OD, r = 0.15; OS r = 0.46). The coefficient of variation for the OD (GAT vs. ORA) was 31% and for the OS of 25.8%. Conclusions: IOP measurements by ORA differ significantly from the GAT determination and apparently there is no correlation between methods (in both eyes)."

Ab externo trabeculectomy performed under topical anesthesia supplemented by conscious sedation.

BACKGROUND: Ab externo trabeculectomy (AET) is the most common surgical procedure to treat glaucoma; topical anesthesia supplemented by conscious sedation is one of the diverse anesthetic methods to perform such type of surgery. The efficacy and safety of using topical anesthesia supplemented with conscious sedation for performing trabeculectomy were assessed in this prospective study. METHODS: Twenty-six eyes of 26 consecutive patients underwent trabeculectomy under the effect of topical anesthesia and sedation. All cases were prospectively assessed during five different intra-operative times in which the degree of pain was measured using a visual analog scale (VAS). RESULTS: One patient was excluded from the study due to excessive somnolence. Performing the iridectomy caused less tolerance (p = 0.03) but with acceptable scores according to the VAS (score 2 = minimal and tolerable pain; p = 0.02), followed by conjunctival closure (nonsignificant p values). The entire procedure did not cause either moderate to extreme pain (scores 4 and 5 of the scale, respectively) in any of the patients. Levels of pain, blood pressure, heart rate, and oxygen saturation were compared among the different intra-operative times. No statistically significant (p >0.05) differences were demonstrated. Eighty percent (n = 4) of the patients with green or blue iris had symptoms during the surgery, but this was of borderline statistical significance (p = 0.053). No ocular or systemic side effects appeared related to the reported anesthesia regime. CONCLUSIONS: Topical anesthesia associated with conscious sedation seems to be efficacious and safe and can be recommended for performing trabeculectomy.

The efficacy and safety of two fixed combinations: timolol-dorzolamide-brimonidine versus timolol-dorzolamide. A prospective, randomized, double-masked, multi-center, 6-month clinical trial.

We compared the efficacy and safety of a new fixed combination of timolol 0.5%/odorzolamide 20%/brimonidine 0.2% in ophthalmic solution versus a fixed combination of timolol 0.5%/dorzolamide 2% in patients with open-angle glaucoma or ocular hypertension. The fixed triple combination was significantly more efficient in mean intraocular pressure reduction from baseline throughout the six-month follow-up.

Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a 'large circumference'?

OBJECTIVE: To measure the effect on blood pressure readings when a standard cuff is used on patients with arms of a large circumference, and to determine the frequency of arms of a large circumference. SUBJECTS: Blood pressures were taken in 120 subjects with an arm circumference greater than 33 cm. Also, the arm circumference was determined in 244 patients from a family health unit, and in 216 patients from a hypertension clinic. METHOD: A mercury sphygmomanometer and two different cuff sizes were used in a random sequence; therefore, 60 patients' blood pressure were first measured with a large cuff, followed by a standard cuff; the opposite sequence was then applied for another 60 patients. With the obtained values and using a regression analysis, the difference in blood pressure overestimation was calculated. Arm circumference measurement percentages were used to determine the frequency of arms of a large circumference. RESULTS: Both systolic and diastolic blood pressures were significantly greater when the standard cuff was used. For every 5 cm increase in arm circumference, starting at 35 cm, a 2-5 mmHg increase in systolic blood pressure, and a 1-3 mmHg increase in diastolic blood pressure was observed. The prevalence of arms with a large circumference in the family medicine unit and hypertension clinic was 42% and 41.8%, respectively. CONCLUSIONS: There is an overestimation of blood pressure when a standard cuff is used in obese subjects. The high prevalence of these individuals in our environment, both in the hypertensive and normotensive population, makes it necessary to have on hand different sizes of cuffs for taking blood pressure in order to avoid incorrect decisions.