Age-specific distribution of intraocular pressure in elderly Iranian population and its associated factors.

Background: The purpose of this study was to determine the distribution of intraocular pressure (IOP) and assess its association with age, sex, systemic blood pressure, diabetes mellitus, body mass index (BMI) and tobacco smoking in Iranian elderly population. Methods: This cohort-based, cross-sectional study assessed elderly individuals aged 60-90 years in Amirkola, northern Iran, in 2016-2017. Past medical history, blood pressure, diabetes mellitus, BMI and tobacco smoking were recorded through an interview and physical examination. IOP was assessed using non-contact tonometry. Results: Total of 1377 individuals participated in this study, out of which 1346 IOP measurements were included for the final analysis. The mean age of participants was 69.4 ± 7.1 years and mean IOP was determined to be 16.7 ± 3.2 mmHg. Majority of the participants were males (56.1% vs 43.1%), 73.8% of participants were overweight or obese, 6.1% smoked tobacco, 28.9% had diabetes mellitus and 84.9% had higher than normal blood pressure. Through multiple regression analysis, it was determined that age (ß=-0.132, p<0.001) was negatively associated with IOP, and the presence of diabetes mellitus (ß=0.118, p<0.001), systolic blood pressure (ß=0.101, p<0.001), and BMI (ß=0.020, P=0.020) were positively associated with IOP. Conclusion: Mean IOP of individuals in this study was higher than average based on other studies. Age, was negatively and systemic blood pressure, BMI and presence of diabetes mellitus were positively associated with mean IOP of elderly Iranian population. Sex and tobacco smoking were not correlated with IOP.

Comparison of intraocular pressure readings with Perkins, Tonopen, iCare 200, and iCare Home to manometry in cadaveric eyes.

AIM: To compare intraocular pressure (IOP) readings obtained with Perkins tonometry, iCare Home, iCare 200, and Tonopen to IOP readings obtained with the manometer of a perfusion system to assess the accuracy and reproducibility of each method of tonometry at set pressures. METHODS: The IOP of human cadaveric eyes (n=2) was measured using a manometer inserted into the eye through the optic nerve. IOP measurements were obtained using a Perkins tonometer, iCare Home, iCare 200, and Tonopen. These measurements were compared to set point IOP measurements of a manometer to determine accuracy and reproducibility of each device. RESULTS: Mean IOP readings obtained with the Perkins tonometer compared to manometer readings demonstrated a difference of -1.0±5.0 mm Hg (P=0.45), indicating a lower reading on average than manometery although not significant. Mean IOP difference between iCare 200 and manometer was 5.3±2.2 mm Hg (P<0.0001). Mean difference in IOP between iCare Home and manometer was 3.5±2.4 mm Hg (P=0.0004). Mean IOP difference compared to manometer was 4.6±4.0 mm Hg for the Tonopen (P<0.0001). IOP measurements obtained with the Perkins tonometer demonstrated a standard deviation of 5.0 mm Hg while the Tonopen measurements demonstrated a 4.0 mm Hg standard deviation. In comparison, iCare 200 and iCare Home demonstrated 2.2 and 2.4 mm Hg standard deviation, respectively. CONCLUSION: Applanation tonometry produces more accurate IOP readings than rebound tonometry or Tonopen, however it demonstrates greater variability than the other forms of tonometry. Rebound tonometry is more reproducible but tends to over-estimate IOP.

Comparison of Central Corneal Thickness Measurements by Contact and Non-contact Pachymetry Devices.

AIM AND OBJECTIVE: To compare central corneal thickness (CCT) measurements obtained by handheld contact ultrasound pachymetry (HCUP) and non-contact pachymetry devices. MATERIALS AND METHODS: Ninety eyes of 90 patients (52 male and 38 female) were included in the study. Measurements from two non-contact devices, -specular microscopy (SM, Konan Medical, CA, USA) and Oculus Pentacam (Oculus Inc., Germany)-were compared against HCUP (Pachmate 2, DGH Technology, Inc, PA, USA). Ultrasound measurements were obtained 3 times by the same user and averaged. The differences were calculated by one-way ANOVA. Agreement between measurements were assessed by Bland-Altman plots and intraclass correlation coefficient tests. Coefficient of repeatability (%, CR) was defined as 1.96*standard deviations of the differences between pairs of measurements divided by the average of the means. RESULTS: The mean age was 34.31 ± 14.39 (14-74) years, and the mean intraocular pressure was 16.48 ± 2.63 mm Hg (12-21). Mean CCT measured by HCUP, SM, and Pentacam was 557.76 ± 36.76 µm, 550.29 ± 43.74 µm, and 541.41 ± 35.7 µm, respectively (p < 0.05). In the Bland-Altman plot, 95% limit of agreements were 19.5 and 14.18 µm among HCUP measurements, 34.55 µm between HCUP and Pentacam, 41.49 µm between SM and Pentacam, and 46.98 µm between HCUP and SM. CR values (%) were 3.49, 2.54, 6.28, 7.68, and 8.47, respectively. CONCLUSION: There were significant differences between the mean CCT values of the measurement devices. CLINICAL SIGNIFICANCE: Contact and non-contact devices may not interchangeable in the clinical assessment of CCT. HOW TO CITE THIS ARTICLE: Mayali H, Altinisik M, Diri I, et al. Comparison of Central Corneal Thickness Measurements by Contact and Non-contact Pachymetry Devices. J Curr Glaucoma Pract 2021;15(1):28-31.

A Comparative Study Between the Goldmann Applanation Tonometer and the Non-Contact Air-Puff Tonometer (Huvitz HNT 7000) in Normal Eyes.

OBJECTIVE: To assess whether the non-contact air-puff tonometer (NCT) is an appropriate alternative to the Goldmann applanation tonometer (GAT) for measuring intraocular pressure (IOP). PATIENTS AND METHODS: An observational, cross-sectional, and comparative study with a quantitative approach was carried out. Two techniques for IOP measurements using the standard GAT and the NCT were compared. A total of 180 eyes from 90 patients were included in the study. RESULTS: The total mean IOP according to NCT measurements was 14.12 mmHg, and the total mean IOP according to the GAT was 12.98 mmHg; these values were significantly different (p=0.0018). When dividing the participants into three groups according to the measurement range obtained and comparing the mean NCT and GAT measurements in each group, in Group 1 (10-15 mmHg), no statistically significant difference was found between the means of the two tonometers (p=0.3100), a difference was observed between Group 2 (16-19 mmHg) and Group 3 (20 mmHg or more) (p<0.001). When dividing the participants by age group, the means obtained by the two tonometers also differed significantly between Group 4 (40-59 years) and Group 5 (60 years or more) (p<0.0001). In all groups, the mean measurements by the NCT were higher than those by the GAT. CONCLUSION: The NCT presented an approximate mean of the measures with the GAT in group 1 but was overestimated in the measurements of the groups 2 and 3.

Effect of Body Position on Intraocular Pressure Measured by Rebound Tonometer in Healthy Children.

Objectives: To evaluate the effect of body position on intraocular pressure (IOP) measurement in the pediatric age group. Materials and Methods: Children whose general condition was healthy and ophthalmic examination was within normal limits were included. Forty-nine eyes of 49 pediatric patients were included in the study. IOP was measured with an ICARE rebound tonometer (ICARE PRO; ICARE, Helsinki, Finland) while patients were in standing, sitting, and supine positions. Differences between the consecutive measurements were compared statistically. Results: Twenty-two of the 49 patients were female, 27 were male. The mean age was 9.61±2.66 (5-15) years. Mean IOP values in the standing, sitting, and supine positions were 18.81±2.97 (11.6-26.2) mmHg, 18.88±3.44, (12-28.2) mmHg, and 19.01±2.8 (13.5-25.9) mmHg, respectively. There were no statistically significant differences in pairwise comparisons of the measurements taken in the different positions (p=0.846, p=0.751, p=0.606). There was a statistically significant correlation between corneal thickness and intraocular pressure values in all measurements (p=0.001, r=0.516). Conclusion: IOP values measured with the ICARE rebound tonometer in healthy children are not affected by body position.

A comparison of three different tonometric methods in the measurement of intraocular pressure in the pediatric age group.

INTRODUCTION AND AIM: To compare intraocular pressure (IOP) measurements obtained with non-contact tonometry (NCT), Icare rebound tonometry (IRT) and Goldmann applanation tonometry (GAT) in pediatric cases and to examine the effect of topical anesthesia on measurements obtained using IRT. MATERIALS AND METHODS: Pediatric cases in a healthy general condition and with ophthalmic examination findings within normal limits were included in the study. IOP measurements were taken with NCT and IRT devices in all cases. Topical anesthesia was subsequently applied, and IOP measurements were then repeated using IRT and GAT tonometer devices. Differences between measurements were subjected to statistical analysis. RESULTS: One hundred ten eyes of 55 patients, 27 male, with a mean age of 11.44 ± 2.31 years (7-17) were included. Mean pre-anesthesia IOP values were 16.47 ± 2.89 mmHg with NCT and 17.49 ± 2.57 mmHg with IRT. Mean IOP values after topical anesthesia were 16.91 ± 2.17 mmHg with IRT and 15.51 ± 2.41 mmHg with GAT. IOP measurement values obtained with all three devices exhibited positive correlation with central corneal thickness values. Statistically significant correlation was present in terms of IOP measurement values between all three devices. However, IOP values obtained with the three devices exhibited statistically significant differences. The application of topical anesthesia caused a statistically significant decrease in IRT measurements; however, statistically significant this small change (0.58 mmHg) in recorded IOP would not be considered clinically significant. CONCLUSION: IOP measurements obtained with NCT, IRT and GAT devices in the pediatric age group correlate with one another, but differ from one another in a statistically significant manner. Application of topical anesthesia affects IRT measurements; however, these small changes would not be considered clinically significant.

Ocular findings in a group of healthy captive leopard geckos.

OBJECTIVE: Leopard Geckos (Eublepharis macularius) are popular pets and can be affected by a range of ocular disorders. Our objective was to report ocular findings in a group of healthy captive leopard geckos and to establish reference ranges for commonly performed ocular diagnostic tests. ANIMALS STUDIED: Twenty-six healthy male geckos aged 1 year old (n = 4) and >2 years old (n = 22). PROCEDURES: All animals underwent ophthalmic examination, corneal esthesiometry, modified Schirmer tear test (mSTT), rebound tonometry, conjunctival bacterial aerobic and fungal culture, and measurement of ocular dimensions. Student's t test was used to compare values of corneal esthesiometry, tonometry and mSTT between groups. Multiple correlations were assessed by Pearson correlation coefficient. RESULTS: All animals had a normal ocular examination. Tear production as measured with a mSTT (mean ± SD) technique was 3.1 ± 1.3 mm/min and tonometry values (mean ± SD) were 8.2 ± 1.7 mm Hg. Corneal touch threshold (median, range) was 4.4 cm, 2.5-5.0. Younger animals had a significantly increased corneal sensitivity compared to older animals (P = .0383). Results of culture showed no growth for fungal organism in any animals. Conjunctival bacterial isolation rates were low, with only 7/26 samples positive for nine bacterial species. CONCLUSIONS: Leopard geckos are amenable to ophthalmic examination and ocular diagnostic database testing with minimal manual restraint.

Quantitative rise in intraocular pressure in patients undergoing robotic surgery in steep Trendelenburg position: A prospective observational study.

BACKGROUND AND AIMS: Raised intraocular pressure (IOP) is one of the known causes of anterior ischemic optic neuropathy. In the case of robotic urological-gynecological surgeries, patient is kept in steep Trendelenburg supine-lithotomy position. Aim of this study was to observe the quantitative rise in IOP in steep Trendelenburg position (>45°) in robotic-assisted prostatectomy and hysterectomy. MATERIAL AND METHODS: After institutional ethical clearance and written informed consent, 100 patients undergoing robotic surgeries in steep Trendelenburg position were recruited for the study. IOP was measured at different time intervals in steep Trendelenburg position using Schiotz tonometer: Post intubation (T1), post pneumoperitoneum (T2), post steep Trendelenburg (T3), and rest readings were taken 30 min apart. T9 was taken 10 min after patient is made supine and parallel to the ground. Mean arterial pressure (MAP), positive inspiratory pressure (PIP), and end-tidal carbon dioxide (EtCO2) values were recorded at different time points. Descriptive analysis, linear regression analysis, and Freidman's nonparametric tests were used to analyze the results. RESULTS: Ninety-five patients were included for statistical analysis as five patients were excluded due to intraoperative interventions leading to alteration of results. Mean IOP at T1 was 19.181/18.462 mmHg in L/R eye. A gradual rise in IOP was observed with every time point while patient was in steep Trendelenburg position which reverts back to near normal values once the patient is changed to normal position 21.419/20.671: Left/right eye in mm of Hg. Uni and multiple regression analysis showed insignificant P value, thus no correlation between MAP, PIP, and EtCO2 with IOP. CONCLUSION: Steep Trendelenburg position for prolong duration leads to significant rise in intraocular pressure.

Ketamine impact on intraocular pressure of children: a systematic review and qualitative synthesis of evidence / Impacto de la ketamina sobre la presión intraocular en niños: revisión sistemática y síntesis cualitativa de la literatura

Abstract Introduction: Intraocular pressure (IOP) measuring in children is a defiant challenge for ophthalmologists due to the unwillingness to collaborate of patient; therefore, it is necessary to perform these examinations under anesthesia (EUA) in order to facilitate the measuring. Among the anesthetic drugs, ketamine is safe in both children and adults and different studies have stated that it might have lower impact on IOP than other anesthetic drugs. Objective: To determine whether ketamine has any impact on IOP in pediatric patients. Also, defining if this drug can be recommended to perform EUA in children with glaucoma. Methods: Systematic review of literature was conducted including articles published in Ovid, PubMed, ScienceDirect, Cochrane, and LILACS from January 1970 to February 2019. The studies included were those with patients aged under 18 years to whom ocular tonometry had been performed. Intervention consisted on administering ketamine and the primary outcome to be assessed was changes in IOP after ketamine administration. Intra operative and postoperative complications were also assessed as secondary outcomes. Report is made according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results: Nine studies were selected for the systematic review. The administration of ketamine and its effects on intraocular pressure values were described in 293 children. Three studies found rising of intraocular pressure and 6 little or clinically not significant changes. Conclusion: In children, there is low-quality evidence that suggests a minimal impact of ketamine on IOP modification. Better quality studies (controlled clinical trials) are required to clearly recommend the use of ketamine to perform EUA in children with glaucoma.

Resumen Introducción: La medición de la presión intraocular (PIO) en niños es desafiante para el oftalmólogo debido a la falta de colaboración por parte del paciente; esto hace necesario llevar a cabo estos exámenes bajo anestesia (EBA) para facilitar la medición. Entre los medicamentos anestésicos generales, la ketamina es segura tanto en adultos como en niños, y se ha planteado en varios estudios que puede tener menor efecto sobre la PIO que otros fármacos anestésicos. Objetivo: Determinar si la ketamina tiene un efecto sobre la presión intraocular en población pediátrica. De esta manera, definir si es recomendable utilizar este medicamento para realizar los exámenes bajo anestesia general en niños con diagnóstico de glaucoma. Métodos: Se realizó una revisión sistemática de la literatura de los artículos publicados en Ovid, PubMed, ScienceDirect, Cochrane y LILACS desde enero de 1970 hasta febrero de 2019. Se incluyeron aquellos estudios con pacientes menores de 18 años en quienes se realizó tonometría ocular. La intervención fue la administración de ketamina y se evaluó como desenlace primario los cambios en la PIO después de su administración. También se evaluaron las complicaciones intra y posoperatorias como desenlaces secundarios. Se reporta de acuerdo con los lineamientos PRISMA. Resultados: Un total de nueve artículos se incluyeron para la revisión sistemática; en 293 niños se describió la administración de ketamina y medición de presión intraocular después de la misma. Tres estudios encontraron elevación de la PIO y seis refieren cambios mínimos o sin significancia clínica. Conclusiones: En niños existe evidencia de baja calidad que sugiere un impacto mínimo de la ketamina sobre la modificación en la PIO. Se requieren estudios de mejor calidad (ensayos clínicos controlados) que permitan crear una recomendación clara sobre el uso de este medicamento para realizar EBA en niños con glaucoma.

Intraocular pressure variation by pneumatic tonometer before and after phacoemulsification.

OBJECTIVE: To evaluate the intraocular pressure variation before and after phacoemulsification through pneumatic tonometry in addition to correlating it with the age, gender, and preoperative intraocular pressure of the patients evaluated. METHODS: This is a cross-sectional observational study. Inclusion criteria were older than 18 years, deep anterior chamber visualized by the slit lamp and estimation of open angle using the Van Herick technique, intraocular pressure less than 21 mmHg, without surgical complications, and without any ocular disease. The intraocular pressure was measured by the pneumatic tonometer. The intraocular pressure assessment was performed at the last consultation before phacoemulsification surgery and 30 days after. RESULTS: A sample of 182 eyes was used. The mean age was 68.41 ± 10.84 years. Of the patient, 65% were females and 35% were males. The mean intraocular pressure in the preoperative period was 16.0 mmHg (±3.3 mmHg) and the mean intraocular pressure in the postoperative period was 13.44 mmHg (±3.31 mmHg). There was no correlation between intraocular pressure variations in both eyes (age-matched open angle) and age. There was a statistically significant correlation between the preoperative intraocular pressure value and the intraocular pressure changes in the postoperative period. In the comparison of the intraocular pressure variation between the genders, the female gender presented a statistically significant negative variation. CONCLUSION: We conclude that the cataract surgery is related to the reduction of intraocular pressure in the postoperative period and this reduction is more influenced by its preoperative value. Other studies of high epidemiological impact are needed, which may corroborate that the cataract surgery could directly influence intraocular pressure variation.

Reproducibility of the water drinking test.

OBJECTIVES: To investigate the reproducibility of the water drinking test in determining intraocular pressure peaks and fluctuation. It has been suggested that there is limited agreement between the water drinking test and diurnal tension curve. This may be because it has only been compared with a 10-hour modified diurnal tension curve, missing 70% of IOP peaks that occurred during night. METHODS: This was a prospective, analytical and comparative study that assesses the correlation, agreement, sensitivity and specificity of the water drinking test. RESULTS: The correlation between the water drinking test and diurnal tension curve was significant and strong (r=0.93, Confidence interval 95% between 0.79 and 0.96, p<01). A moderate agreement was observed between these measurements (pc=0.93, Confidence interval 95% between 0.87 and 0.95, p<.01). The agreement was within±2mmHg in 89% of the tests. DISCUSSION: Our study found a moderate agreement between the water drinking test and diurnal tension curve, in contrast with the poor agreement found in other studies, possibly due to the absence of nocturnal IOP peaks. CONCLUSIONS: These findings suggest that the water drinking test could be used to determine IOP peaks, as well as for determining baseline IOP.

Comparación en la medición de presión intraocular con los tonómetros de Goldmann, Pascal® y ORA (Ocular Response Analyzer) / Intraocular pressure measurement with Goldmann, Pascal and ORA tonometers

Introducción: el glaucoma es la principal causa de ceguera irreversible en el mundo, siendo la presión intraocular alta el factor de riesgo más importante para desarrollarlo, por eso la importancia de realizar una adecuada medición de la presión intraocular (PIO) durante el examen oftalmológico. Objetivo: evaluar la concordancia de la medida de la presión intraocular tomada con los tonómetros de Goldmann, Pascal® y ORA, en pacientes con glaucoma de la consulta externa del servicio de oftalmología del Hospital de San José. Diseño: estudio descriptivo, de corte transversal y concordancia. Métodos: se compararon las medidas de Goldmann corregido, Pascal® y ORA corregido en 90 pacientes (167 ojos) con diagnóstico de glaucoma que asisten a consulta de oftalmología del Hospital de San José. Resultados: el coeficiente de correlación y concordancia de Lin entre Goldmann corregido y Pascal® es de 0.61; entre Goldmann corregido y ORA corregido de 0.64 y entre Pascal® y ORA corregido de 0.81. Conclusiones: se encontró una concordancia moderada para los tres tonómetros en la medición de la PIO en los ojos con glaucoma del servicio de oftalmología del Hospital de San José. Los tres métodos no son reemplazables, por lo tanto el seguimiento de los pacientes siempre debe ser tomado con un mismo método.

Introduction: glaucoma is the leading cause of worldwide irreversible blindness, high intraocular pressure remains the most important risk factor; because of that, it is essential to measure accurately the intraocular pressure (IOP). Objective: to evaluate the intraocular pressure correspondence of Goldmann-correlated IOP, Pascal® dynamic contour tonometer and Reichert Ocular Response Analyzer ORA tonometers in patients with glaucoma diagnosis at Ophthalmology Service, Hospital de San José. Design: a descriptive, cross-sectional and matching. Methods: measurements of Goldmann correlated IOP, Pascal® and ORA corneal compensated IOP were compared, in patients (167 eyes) diagnosed with glaucoma attending at ophthalmology Hospital San José. Results: the correlation coeffi cient and concordance Lin between Goldmann correlated IOP and Pascal® is 0.61; between ORA and Goldmann correlated IOP is 0.64 and between Pascal® and ORA is 0.81. Conclusions: we found a moderate agreement for the three tonometers for measuring IOP in eyes glaucoma attending at ophthalmology Hospital San José. The three methods are not replaceable, therefore monitoring of patients should always be taken with the same method.

Pressão intraocular (PIO) após cirurgia de extração de catarata / Intraocular pressure (IOP) after cataract extraction surgery

Objetivo: Determinar se existe variação da PIO em doentes com glaucoma submetidos à cirurgia de catarata. Métodos: Estudo retrospectivo de 101 olhos, de 75 doentes com média de idade de 78,91 ± 7,9 anos submetidos à cirurgia de catarata por facoemulsificação por dois cirurgiões, sem complicações associadas e com follow-up superior a 6 meses. Os olhos foram subdivididos em dois grupos: olhos com glaucoma (G) e olhos sem glaucoma (SG). A PIO foi avaliada por tonometria de Goldmann. Resultados: Analisaram-se 51 olhos do grupo (SG) e 50 olhos do grupo (G). A PIO média nos dois grupos era no pré-operatório 16,08 ± 3,04, sendo aos 12 meses 14,69 ± 2,7 e aos 24 meses 14,21 ± 3,56. A diminuição média de PIO do pré-operatório para os 12 meses foi de 1,49 ± 2,98. A PIO pré-operatória apresentou uma diferença com significado estatístico da PIO aos 12 e 24 meses (p<0,001 e p=0,001, respectivamente T. t pares) na amostra global. Não se detectou uma diferença com significado estatístico na variação de PIO entre estes 2 grupos de olhos (p>0,05, teste T Student). Determinou-se um modelo de regressão linear stepwise para a variação de PIO do pré-operatório para os 12m. As variáveis com valor preditivo eram a PIO pré-operatória (R2=0,249, p=0,03), e a idade (R2=0,18, p=0,01). Conclusão: O nosso estudo revela que a cirurgia de catarata por facoemulsificação leva a uma diminuição significativa da PIO, que se mantém aos 12 e 24m. .

Objective: To describe the variation of intraocular pressure (IOP) in patients with glaucoma submitted to cataract surgery. Methods: Retrospective study of 101 eyes of 75 patients with medium age of 78.91 ± 7.9 submitted to cataract surgery by facoemulsification by two surgeons, without complications and with at least 6 months of follow-up. The eyes were divided in two groups: eyes with glaucoma (G) and eyes without glaucoma (NG). The IOP was evaluated with Goldmann tonometry. Results: 51 eyes without glaucoma and 50 eyes with glaucoma. The medium IOP was 16.08 ± 3.04 before surgery, 14.69 ± 2.7 at 12 months and 14.21 ± 3.56 at 24 months. The medium value of IOP reduction before surgery to 12 months was 1.49 ± 2.98. IOP measured before surgery differed statistically from IOP at 12 and 24 months (p<0.001 e p=0.001 respectively, T. Student). Between the two groups of eyes there wasn’t a statistically significant difference in the variation of IOP (p>0.05, T Student). A model of linear regression stepwise was calculated for the variation of the IOP from before surgery to 12 months. The variables with more predictive value were IOP before surgery (R2=0.249, p=0.03) and age (R2=0.18, p=0.01). Conclusion: In our study cataract surgery results in IOP reduction, that is maintained at 12 months. .

Applanation tonometry: a comparison of the Perkins handheld and Goldmann slit lamp-mounted methods.

PURPOSE: To compare intraocular pressure (IOP) measurements, taken using Perkins applanation tonometry (PAT) and Goldmann applanation tonometry (GAT). METHODS: 100 eyes of 100 patients underwent Perkins and Goldmann applanation tonometry, with a randomized order of modality, performed by a masked observer. The right eye was measured, for all subjects, and the data used in statistical analysis. The comparability of results given by the two instruments was evaluated using the Bland-Altman method. RESULTS: IOP measurements for 100 eyes were obtained (range: 10-44 mmHg). The mean GAT reading was 21.63 mmHg, with standard deviation (SD) 5.69 mmHg. The mean PAT reading was 21.40 mmHg, with SD 5.67 mmHg. The mean difference between readings from Goldmann versus Perkins tonometry was 0.22 mmHg (SD: 0.44 mmHg). The limits of agreement were calculated to be -0.64-+1.08 mmHg (1.96 SD either side of the bias). CONCLUSION: The Perkins applanation tonometer yields IOP measurements that are closely comparable with GAT. Therefore, PAT may be used in routine clinical practice, as part of the implementation of national guidelines, or preferred practice patterns, for glaucoma and ocular hypertension.

Poor correlation between intracranial pressure and intraocular pressure by hand-held tonometry.

PURPOSE: The aim of this study is to provide data on the controversial issue of whether handheld measurements of intraocular pressure (IOP) are capable of accurately predicting elevated intracranial pressure (ICP) in patients undergoing lumbar puncture (LP). METHODS: All patients over the age of 18 years who underwent an LP in the emergency or neurological departments at the Tel Aviv Medical Center for any reason between October 2007 and July 2010 were eligible to participate in this prospective observational pilot study. IOP was measured with the Tono-Pen XL while patients were in the supine position before undergoing LP. ICP was measured in the lateral recumbent position. ICP and bilateral IOP were measured, and the mean and maximum values of IOP were calculated. The association between ICP and each one of the four IOP measures was evaluated by the Pearson correlation coefficient. RESULTS: Twenty-four patients (mean age 37.8 ± 15.8 years, ten males and 14 females) were enrolled. The reasons for their requiring an LP were headache (19/24 patients), evaluation for hemiparesis (2/24), cognitive deterioration (1/24), and seizures (2/24). Nine had elevated mean opening pressure (>20 cm H2O), six had an elevated mean IOP (>20 mmHg), and four of these six also had an elevated opening pressure. There was no significant correlation between the ICP measurements and any of the IOP measurements. CONCLUSION: Handheld ocular tonometry has poor sensitivity and specificity for the prediction of increased ICP and is not an effective tool for screening for ICP in the ED or in the neurology department.

Comparison of central corneal thickness of primary open angle glaucoma patients with normal controls in South India.

BACKGROUND: Studies mainly in the western population have compared central corneal thickness in primary open angle glaucoma and normal individuals have found variable results. We did this study to compare the central corneal thickness of primary open angle glaucoma patients with normal controls in a south Indian population. MATERIALS AND METHODS: This was a masked, cross-sectional study undertaken in a tertiary care center in South India. A total of 50 controls and 50 primary open angle glaucoma patients were studied. Central corneal thickness between the two groups was compared using Wilcoxon two sample test and the signed rank test. RESULTS: The mean central corneal thickness in the control group was 536 µm (462-608 µm) and in the primary open angle glaucoma group was 531 µm (476-609 µm). CONCLUSION: There was no significant difference in the central corneal thickness between primary open angle glaucoma patients and the normal controls.

Pressão intraocular antes e após a facoemulsificação em olhos normais / Intraocular pressure before and after phacoemulsification in normal eyes

OBJETIVO: Avaliar comparativamente a pressão intraocular (PIO) antes e após 1 dia, 3 dias, 1 semana, 1 mês, 3 meses, 6 meses e 1 ano, em olhos normais submetidos à facoemulsificação. MÉTODOS: Análise retrospectiva da pressão intraocular (medida pelo tonômetro de aplanação de Goldmann) de 221 olhos normais de 133 pacientes submetidos à facoemulsificação sem intercorrências. A PIO foi avaliada antes e após a facoemulsificação (1dia, 3 dias, 1 semana, 1 mês, 3 meses, 6 meses e 1 ano), e os valores encontrados nestes períodos foram submetidos a uma análise comparativa. RESULTADOS: A PIO média foi de 16,06±2,69 mmHg no pré-operatório; 18,76±5,96 mmHg após 1 dia; 14,82±4,08 mmHg após 3 dias; 14,03±3,06 mmHg após 1 semana; 13,88±3,26 mmHg após 1 mês; 12,74±2,45 mmHg após 3 meses; 12,74±2,01 mmHg após 6 meses; e 13,24±2,77 mmHg após 1 ano. A PIO aumentou 18,9 por cento após 1 dia; diminuiu 6,9 por cento após 3 dias; 12,3 por cento após 1 semana; 12,5 por cento após 1 mês; 19,3 por cento após 3 meses; 20,1 por cento após 6 meses; e 19,9 por cento após 1 ano. CONCLUSÃO: A cirurgia de facoemulsificação sem intercorrências leva a uma redução significativa da PIO em olhos normais. A diminuição da PIO é mais acentuada naqueles pacientes que apresentam PIO mais alta no pré-operatório.

PURPOSE: To assess intraocular pressure (IOP) before and after 1 day, 3 days, 1 week, 1 month, 3 months, 6 months and 1 year in normal eyes submitted to a phacoemulsification. METHODS: Intraocular pressure retrospective analyses (measured by Goldmann applanation tonometer) of 221 normal eyes of 133 patients submitted to an uneventful phacoemulsification. The IOP was evaluated before and after phacoemulsification ( 1day, 3 days, 1 week, 1 month, 3 months, 6 months and 1 year), and these values were submitted to a comparative analyses. RESULTS: The mean preoperative IOP of 16,06±2,69 mmHg rose postoperatively to 18,76±5,96 mmHg at 1 day; dropped to 14,82±4,08 mmHg at 3 days; 14,03±3,06 mmHg at 1 week; 13,88±3,26 mmHg at 1 month; 12,74±2,45 mmHg at 3 months; 12,74±2,01 mmHg at 6 months; and 13,24±2,77 mmHg at 1 year. The IOP rise was 18,9 percent at 1 day; fall of 6,9 percent at 3 days; 12,3 percent at 1 week; 12,5 percent at 1 month; 19,3 percent at 3 months; 20,1 percent at 6 months; and 19,9 percent at 1 year. CONCLUSION: In normal eyes, uneventful phacoemulsification reduced IOP. The greatest IOP decreases were in patients with a higher preoperative IOP.

Influência do peso corporal e do índice de massa corporal no teste de sobrecarga hídrica / The influence of body weight and body mass index on the water-drinking test

OBJETIVO: Avaliar a influência do peso corporal e do índice de massa corporal (IMC) nos picos e na flutuação da pressão intra-ocular (PIO) no teste de sobrecarga hídrica (TSH) em pacientes com glaucoma primário de ângulo aberto (GPAA), glaucoma de pressão normal (GPN) e olhos normais (ON). MÉTODOS: Estudo transversal em que foram avaliados 32 olhos de 32 pacientes com GPAA, 30 olhos de 30 pacientes com GPN e 20 olhos de 20 ON. Nenhum dos pacientes glaucomatosos havia iniciado o tratamento da doença. O TSH foi realizado às 17h, sendo avaliada a correlação entre o peso corporal e o IMC e os picos e a flutuação da PIO durante o TSH. Os resultados foram analisados através dos testes de Anova-fator único com teste de Bonferroni e correlação linear de Pearson. Foi considerado significativo valor de p menor que 0,05. RESULTADOS: Não houve diferença significativa na idade (p=0,13), no peso corporal (p=0,13) e no IMC (p=0,83) entre os três grupos. Foi encontrada correlação estatisticamente significativa no grupo GPAA entre o peso corporal e a flutuação da PIO no TSH (p=0,02; r=-0,42) e entre o IMC e a flutuação da PIO no TSH (p=0,02; r=-0,41). Não houve correlação significativa entre o peso corporal e o IMC e os picos de PIO nos três grupos e entre o peso corporal e o IMC e a flutuação da PIO nos grupos GPN e ON.. CONCLUSÃO: Os resultados do presente estudo sugerem que o peso corporal e o IMC devem ser considerados ao se avaliar os resultados do TSH em portadores de GPAA e que pacientes portadores de GPAA com maior IMC e maior peso corporal podem apresentar menor flutuação da PIO no TSH.

PURPOSE: To evaluate the influence of the body weight and body mass index (BMI) on the intraocular pressure (IOP) peaks and fluctuation in the water-drinking test (WDT) in primary open angle (POAG) and normal tension glaucoma (NTG) patients, as well as normal eyes (NE). METHODS: Thirty-two eyes of 32 POAG patients, 30 eyes of 30 NTG patients and 20 eyes of 20 normal patients were evaluated in this transversal study. None of the patients were using antiglaucomatous drugs at the beginning of the study. The WDT was performed at 5:00 pm for further correlation between body weight, BMI and intraocular pressure peaks and fluctuation. Analysis of variance, Bonferroni test and Pearson correlation coefficient were used for statistical analysis. Inherent to the methods used, p-values below 0,05 were considered to ensure statistical relevance. RESULTS: There was no statically significant difference between age (p=0,13), body weight (p=0,13) and BMI (0,83) in the three groups studied. There was significant correlation between body weight and IOP fluctuations (p=0,02; r=-0,42) and between BMI and IOP fluctuations (p=0,02; r=-0,41) in POAG patients. Body weight and BMI were not significantly associated with IOP peaks in the three groups. There was no statistically significant correlation between body weight, BMI and IOP fluctuations in NTG patients and in NE. CONCLUSION: The results suggest that knowledge of body weight and BMI is advisable before interpreting the WDT outcomes in POAG patients. POAG patients with higher body weight and BMI may present lower fluctuation in the WDT.

Influência da postura na pressão intra-ocular e nos defeitos de campo visual no glaucoma primário de ângulo aberto e glaucoma de pressão normal / Postural influence on intraocular pressure and visual field defects in open angle glaucoma and normal tension glaucoma

OBJETIVO:Avaliar a variação da pressão intra-ocular (PIO) na mudança de posição em pacientes com glaucoma primário de ângulo aberto (GPAA), glaucoma de pressão normal (GPN) e olhos normais (ON), e correlacionar esta variação à gravidade do defeito de campo visual. MÉTODOS: Foram avaliados 32 olhos de 32 pacientes com GPAA, 30 olhos de 30 pacientes com GPN e 20 olhos de 20 ON. A PIO foi aferida às 6h da manhã na posição supina e 5min após com o paciente sentado. Foi avaliada a correlação entre variação da pressão decorrente da mudança de posição e os defeitos de campo visual. Foram utilizados os testes estatísticos não paramétricos de Kruskal-Wallis, Wilcoxon, Mann-Whitney e o teste de correlação linear de Spearman. Foi considerado significativo valor de p < 0,05. RESULTADOS: Foi encontrada diferença significativa entre as pressões intra-oculares na posição supina e assentada nos três grupos (p<0,001). Não houve diferença significativa na variação da PIO com a mudança de posição entre os três grupos (p=0,17). Não houve correlação significativa entre a variação da PIO nas duas posições e o índice MD do campo visual nos grupos GPAA (p=0,81) e GPN (p=0,89). CONCLUSÃO:Os resultados sugerem que existe aumento significativo da PIO com a mudança da posição assentada para supina em pacientes com GPAA, GPN e ON, não havendo, porém, diferença significativa desta variação entre os três grupos. Não foi encontrada correlação significativa entre a variação da PIO e a severidade do campo visual.

PURPOSE: To evaluate intraocular pressure variation due to postural changing of supine to sitting position and, to correlate this variation with visual field defects in primary open angle and normal tension glaucoma patients, as well as normal eyes. METHODS: Thirty-two eyes of 32 POAG patients, 30 eyes of 30 NTG patients and 20 eyes of 20 normal patients were evaluated in the study. Intraocular pressure was measured at 6 o'clock in supine position and 5 minutes after in sitting position for further correlation between intraocular pressure behavior after postural changing and visual field defects Kruskal-Wallis, Wilcoxon, Mann-Whitney and Spearman linear correlation non-parametric tests were used for statistical analysis. Inherent to the methods used, p<0,05 were considered to ensure statistical relevance. RESULTS: Relevant results were observed between intraocular pressure measured in supine and sitting position in all groups, disclosing statistical significance (p<0,001). However, this statistical relevance was not seen when compared among the 3 groups studied (p=0,17). Moreover, visual field defects, expressed by MD index, did not point to have statistical correlation to intraocular pressure variation after postural changing in POAG (P=0,81) and NTG (p=0,89). CONCLUSION: The results suggest there is a significant increase in intraocular pressure due to postural changing in primary open angle and normal tension glaucoma patients, as well as in normal eyes. However, the raise in intraocular pressure neither was significant when compared among the 3 groups nor was consistent with visual field defects.