Comparison of Diaton transpalpebral tonometer with applanation tonometry in keratoconus.

AIM: To investigate the added value of using a Diaton transpalpebral tonometer (DT) to measure IOP in keratoconus. Most type of tonometers use corneal applanation or biomechanical resistance to measure intraocular pressure (IOP); however, these factors can be altered by keratoconus. Specifically, we examined whether DT can detect false-negative low Goldmann applanation tonometry (AT) measurements. METHODS: Patients with keratoconus were recruited from our tertiary academic treatment center. Measurements included AT and DT (in random order) and Scheimpflug imaging. An age- and gender-matched group of control subjects with no history of corneal disease or glaucoma was also recruited. RESULTS: In total, 130 eyes from 66 participants were assessed. In the keratoconus group, mean AT was 11.0 ± 2.6, mean DT 11.2±5.5 (P=0.729), and the two measures were correlated significantly (P=0.006, R=0.323). However, a Bland-Altman plot revealed a wide distribution and poor agreement between both measurements. Previous corneal crosslinking, corneal pachymetry, and Krumeich classification had no effect on measured IOP. CONCLUSION: Measurements obtained using a Diaton tonometer are not affected by corneal biomechanics; however, its poor agreement with Goldmann AT values calls into question the added value of using a Diaton tonometer to measure IOP in keratoconus.

Lyme disease associated with sudden sensorineural hearing loss: case report and literature review.

OBJECTIVE: Is sudden sensorineural hearing loss associated with Lyme disease in adults? STUDY DESIGN: A retrospective case report and a systematic literature search in PubMed and Embase were performed. RESULTS: We describe a patient presenting with sudden sensorineural hearing loss, followed by a facial paralysis, which could be attributed to Lyme disease confirmed by positive serology and a positive immunoblot. She was successfully treated with ceftriaxone, with recovery of the facial paralysis, although no recovery of the hearing loss was observed. A systematic literature search resulted in 4 relevant and valid articles revealing that confirmed positive serology for Borrelia burgdorferi varies from 0% to 21.3%, suggesting active Lyme disease as a cause in patients with sudden sensorineural hearing loss. Two studies demonstrated a significantly higher incidence of confirmed positive serology for Borrelia burgdorferi as compared with the incidence in the general local population. CONCLUSION: Literature suggests that sudden sensorineural hearing loss may coincide with Borrelia burgdorferi infection. A higher incidence of confirmed positive serology for Borrelia burgdorferi in patients with sudden deafness seems to be depending on the country and on the tests used to confirm Lyme disease. This should be taken into account if serologic testing for Lyme disease in patients with sudden deafness is considered.