Reproducibility of ocular response analyzer measurements and their correlation with central corneal thickness.

BACKGROUND: To evaluate the inter- and intraobserver variability of ocular response analyzer (ORA) measurements, namely corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF) and corneal hysteresis (CH). METHODS: One randomly chosen eye of 46 healthy volunteers was included in this study. Three clinical observers performed three consecutive measurements using ORA, with an interval of 1-2 minutes between measurements. In all subjects, central corneal thickness (CCT) was measured. The inter- and intraobserver reproducibility for IOPcc, CRF and CH was assessed by ANOVA-based intraclass correlation coefficient (ICC) and coefficient of variation (CV). RESULTS: The mean ICC for interobserver reproducibility was 0.94 for IOPcc, 0.90 for CRF, and 0.86 for CH. The corresponding CV values were 12.8%, 10.3%, and 13.6% respectively. The intraobserver ICC values for IOPcc were 0.86 for the first examiner, 0.84 for the second, and 0.89 for the third. CV was 11.7%, 11.9%, and 11.0% respectively. For CRF, the intraobserver ICC values were 0.69, 0.81, and 0.63, and corresponding CV values were 9.6%, 8.1, and 10.8%. The intraobserver ICC for CH was 0.66 for the first observer, 0.71 for the second, and 0.61 for the third examiner. The respective CV values were 12.7%, 11.8%, and 13.9%. There was a significant correlation between CCT and CRF (Rsq = 0.13, p = 0.02). The correlations of CCT with IOPcc and CH were not significant (p > 0.05). CONCLUSIONS: The interobserver reproducibility of ORA measurements was almost perfect for IOPcc, CRF, and CH. The intraobserver short-term reproducibility was almost perfect for IOPcc and substantial for CRF and CH, for all observers. The significant correlation between CCT and CRF, and no association between IOPcc and CCT, are in agreement with previous studies. There was no significant correlation between CH and CCT in our study. This device might be useful in glaucoma diagnosis and management.

Evaluation of macular abnormalities in Stargardt's disease using optical coherence tomography and scanning laser ophthalmoscope microperimetry.

BACKGROUND: The purpose of this study is to evaluate the diagnostic value of optical coherence tomography (Stratus OCT) and scanning laser ophthalmoscope (SLO) microperimetry in patients with Stargardt's disease (STGD), and the correlation between macular morphology and visual function in these patients. METHODS: Twenty-two patients with STGD (mean age 44 years, range 11 to 71 years) and 20 age-matched healthy control subjects were included in the study. OCT imaging was performed using six radial line scans manually centered on the fovea. SLO microperimetry was used to assess central scotoma and fixation behavior in patients with STGD. RESULTS: Mean best corrected Snellen visual acuity (BCVA) was 20/80, range 20/25 to 20/300 (log MAR 0.6, range 0.1 to 1.2) in the STGD group and 20/20 (log MAR 0.0) in the control group. Foveal thickness was significantly reduced in patients with STGD (119.0 +/- 19.6 microm) compared to controls (210.7 +/- 19.6 microm, P < 0.0001). A significant correlation between foveal thickness and BCVA was observed within the STGD group (R(2) = 0.62, P < 0.0001). Photoreceptor loss in the macular area and a corresponding central scotoma were observed in all STGD patients. CONCLUSIONS: OCT findings, particularly reduced foveomacular thickness and photoreceptor loss in the macular area may be useful in the diagnosis of STGD. Furthermore, a strong correlation between foveal thickness and visual function was observed in our patients. Assessment of central visual function using SLO microperimetry provides additional useful information, important in the management of STGD.

Effect of trypan blue on the elasticity of the human anterior lens capsule.

PURPOSE: To evaluate the effect of trypan blue (VisionBlue) staining on the elastic properties of the human anterior lens capsule. SETTING: Center for Vision Science, Ruhr University Eye Hospital, Bochum, Germany. METHODS: Nineteen anterior capsules were obtained from 19 human eyes at the time of cataract operation. Two same-size strips were prepared from each capsule; 1 was exposed to trypan blue staining for 10 seconds, and the other was a control. The elasticity measurements were performed on both specimens using a modified rheometer. RESULTS: The mean age of the patients was 75.3 years +/- 13.3 (SD) (range 35 to 89 years). Sixty-three measurements of 19 suitable specimen pairs were performed. In 13 pairs, the elasticity measurements were eligible for statistical analysis. The stress value at the tearing point was statistically significantly lower in the treated group (mean 169 +/- 55 Pa) than in the control group without staining (mean 252 +/- 67 Pa) (P = .023). The difference in stress between the stained and control samples at 3 seconds and 5 seconds was not statistically significant (P = .093 versus P = .316). Dynamic frequency sweep measurements showed a statistically significant elevation of the viscosity modulus in the samples stained with trypan blue. CONCLUSIONS: Trypan blue staining affected the biomechanical properties of the human lens capsule and led to a significant reduction in elasticity and an increase in stiffness. These results confirm clinical reports of changes in the capsule by dye and should be taken into consideration in dye-enhanced cataract surgery.

Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens.

PURPOSE: To evaluate the changes in pupil size after implantation of an iris-supported toric phakic intraocular lens (TPIOL) for correction of myopia and hyperopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: Twenty-two myopic eyes and 9 hyperopic eyes were included in the study. The mean age of the 2 groups was 34 years and 40 years, respectively. The scotopic pupil size was measured with a handheld infrared pupillometer (Colvard, Oasis Medical) before and 6 months after implantation of the TPIOL. All examinations were performed under scotopic conditions after 2 minutes of dark adaptation with the fellow eye covered. Intraindividual comparisons were made between preoperative and postoperative pupil sizes. The relationship between implanted IOL power and postoperative pupil width in each group was studied to determine whether lens magnification could lead to misinterpretation of the results. The difference between horizontal and vertical postoperative pupil diameters was assessed in eyes with horizontally aligned IOLs to determine the potential mechanical effect of the TPIOL on pupil size. RESULTS: The mean scotopic pupil diameter decreased significantly from 4.7 mm (range 3.0 to 6.0 mm) preoperatively to 3.6 mm (range 2.0 to 5.0 mm) postoperatively in myopic eyes and from 5.0 mm (range 4.0 to 6.0 mm) to 4.0 mm (range 2.0 to 5.0 mm) in hyperopic eyes. No significant correlation between the power of the TPIOL and the postoperative pupil size diameter was found, confirming that the IOL did not distort measurements of pupil size. Comparing horizontal and vertical pupil diameters under medical mydriasis revealed reduced pupil size in the axis of enclavation. CONCLUSIONS: The scotopic pupil diameter decreased by a mean of 1.1 mm in myopic eyes and 1.0 mm in hyperopic eyes after implantation of the iris-supported TPIOL. Postoperative pupil size was not related to IOL power, patients' emotional states, or other factors. The slightly smaller pupil diameter in the axis of enclavation suggests that this fixation method restricts pupil size under scotopic conditions, which could reduce the incidence of postoperative photic phenomena.

The size of subconjunctival preparation does not influence the outcome of trabeculectomy with mitomycin C.

PURPOSE: To compare the outcome of fornix-based trabeculectomy with mitomycin C (MMC) using 2 different sizes of subconjunctival preparation (36 mm² compared with 72 mm²). METHODS: Prospective, randomized interventional case series. STUDY POPULATION: Patients 18 to 85 years of age with open-angle glaucoma and progressive visual field defects under maximum tolerated medical therapy were randomized to undergo initial fornix-based trabeculectomy with MMC (0.2 mg/mL for 5 min) with subconjunctival preparation of 6×6 mm (group A) or 8×9 mm (group B). Main outcome parameters were: intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of 5-fluorouracil (5-FU) injections, and laser suturolyses (SL). RESULTS: Twenty-eight eyes of 26 patients were enrolled, including 14 eyes in group A and 14 in group B. At 12 months, IOP (mean±SD) was 9.69±2.5 mm Hg in group A and 9.93±3.2 mm Hg in group B (P=0.17) without glaucoma medication. Mean BCVA (logMAR) at month 12 was 0.29±0.26 in group A and 0.26±0.2 in group B (P=0.71). Patients required 3.0 5-FU in group A and 4.1±2.9 5-FU in group B (P=0.16); 1.3±1.1 SL and 1.8±1.1 SL, respectively (P=0.23). We noted 2 cases of intraocular hypotony in the 6×6 mm group (14.3%) and 1 in the 8×9 mm group (7.1%). CONCLUSIONS: There were no significant differences between study groups in mean IOP reduction, change in BCVA, or number of applied 5-FU and SL at 1-year follow-up. The area of subconjunctival preparation is only one of several factors playing a role in the outcome of trabeculectomy with MMC.

Predictive value of heidelberg retina tomograph parameters for the development of glaucoma in the European glaucoma prevention study.

PURPOSE: To determine whether baseline Heidelberg Retina Tomograph (HRT) measurements of the optic disc are associated with the development of open-angle glaucoma (OAG) in individuals with ocular hypertension in the European Glaucoma Prevention Study (EGPS). DESIGN: Retrospective analysis of a prospective, randomized, multicenter, double-masked, controlled clinical trial. METHODS: There were 489 participants in the HRT Ancillary Study to the EGPS. Each baseline HRT parameter was assessed in univariate and multivariate proportional hazards models to determine its association with the development of OAG. Proportional hazards models were used to identify HRT variables that predicted which participants in the EGPS had developed OAG. Development of OAG was based on visual field and/or optic disc changes. RESULTS: At a median follow-up time of about 5 years, 61 participants developed OAG. In multivariate analyses, adjusting for randomization arm, age, baseline IOP, central corneal thickness, pattern standard deviation, and HRT disc area, the following HRT parameters were associated with the development of OAG: the "outside normal limits" classification of the Frederick Mikelberg (FSM) discriminant function (hazard ratio [HR] 2.51, 95% confidence interval [CI]: 1.45-4.35), larger mean cup depth (HR 1.64, 95% CI: 1.21-2.23), cup-to-disc area ratio (HR 1.43, 95% CI: 1.14-1.80), linear cup-to-disc ratio (HR 1.43, 95% CI: 1.13-1.80), cup area (HR 1.33, 95% CI: 1.08-1.64), smaller rim area (HR 1.33, 95% CI: 1.07-1.64), larger cup volume (HR 1.30, 95% CI: 1.05-1.61), smaller rim volume (HR 1.25, 95% CI: 1.01-1.54), larger maximum cup depth (HR 1.18, 95% CI: 1.01-1.36), and cup shape measure (HR 1.18, 95% CI: 1.01-1.36). CONCLUSIONS: Several baseline HRT parameters, alone or in combination with baseline clinical and demographic factors, were significantly associated with the development of OAG among the EGPS participants.

Contrast sensitivity after implantation of toric iris-claw lenses in phakic eyes.

PURPOSE: To evaluate the change in contrast sensitivity after implantation of the Verisyse toric phakic intraocular lens (IOL) (AMO) for the correction of myopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: Eighteen eyes had implantation of an iris-supported toric phakic IOL to correct myopia with astigmatism. The mean preoperative spherical equivalent was -12.65 diopters +/- 3.6 (SD). The contrast sensitivity with best spectacle correction was determined before surgery and 3 months after surgery using the CSV-1000 HGT instrument (Vector Vision Inc.). RESULTS: Three months after IOL implantation, the mean contrast sensitivity had significantly increased from preoperatively at midrange spatial frequencies from 3.2 to 4.4 (6 cycles per degree [cpd]; P = .033) and from 2.4 to 3.7 (12 cpd; P = .032). The differences at spatial frequencies of 3 cpd and 18 cpd were not statistically significant (P = .59 and P = .086, respectively). CONCLUSIONS: Implantation of the Verisyse toric iris-claw lens in phakic eyes to correct high or moderate myopia with astigmatism has the potential to improve contrast vision. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels.

Standard automated perimetry versus matrix frequency doubling technology perimetry in subjects with ocular hypertension and healthy control subjects.

BACKGROUND: To evaluate the relationship and agreement between standard automated perimetry (SAP) and Matrix frequency doubling technology (Matrix-FDT) in subjects with ocular hypertension and healthy control subjects. METHODS: Forty-four eyes of 44 ocular hypertensive subjects and 29 eyes of 29 healthy age-matched control subjects were included in this prospective study. All participants underwent complete ophthalmic examination, including slit-lamp biomicroscopy, intraocular pressure measurement, pachymetry, and dilated fundus examination, and showed reliable visual field tests. One randomly selected eye of each participant was examined with SAP (Swedish Interactive Threshold Algorithm [SITA] Standard 24-2 test) and Matrix-FDT (24-2 threshold test), in random order. Correlations between global indices (MD, PSD), regions (2 hemifields, 4 quadrants, 6 sectors) and 52 single field positions were analyzed using Spearman's rank correlation coefficient. RESULTS: In both groups, mean deviation values of SAP and Matrix-FDT correlated significantly (OHT subjects: r = 0.47, p<0.005; healthy subjects: r = 0.68; p<0.001, respectively). Pattern standard deviation of SAP and Matrix-FDT showed no significant correlation in healthy subjects but correlated significantly in ocular hypertensive subjects (r = 0.45, p<0.005). In healthy subjects, a significant correlation between SAP and Matrix-FDT was shown in the supero-temporal and infero-temporal sectors of the disc (r = 0.40 and r = 0.38, p<0.05, respectively). In OHT subjects, supero-temporal, supero-nasal and nasal sectors correlated significantly (r = 0.49, 0.62 and 0.38, p≤0.01, respectively). The correlation pattern of individual visual field test locations appeared heterogeneous in both groups. CONCLUSIONS: In both, ocular hypertensive and healthy subjects SAP and Matrix-FDT correlate well. In ocular hypertensive subjects, both techniques showed good correlation in the supero-temporal, supero-nasal, and nasal sectors of the disc. Poor agreement was found in the temporal, infero-temporal and infero-nasal disc sectors. This missing correlation might be related to early retinal nerve fiber layer damage in these regions of the disc, recognized by one of the visual field instruments.

The Heidelberg retina tomograph ancillary study to the European glaucoma prevention study: study design and baseline factors.

PURPOSE: To describe the study design and baseline factors of the Heidelberg Retina Tomograph ancillary study within the EGPS. Furthermore, to examine the relationship between HRT optic disc topographic measurements and baseline demographic and ocular factors. METHODS: Four hundred and eighty-nine ocular hypertensive participants were included. Each participant completed HRT imaging at least annually. The associations between HRT measurements and IOP, central corneal thickness (CCT), baseline photographic estimates of vertical CDR ratio (CDR), asymmetry between the two eyes in CDR ratio and baseline visual field indices were assessed using regression analysis. RESULTS: Associations between HRT measurements and vertical CDR by photographs were found for almost all stereometric optic disc parameters in both univariate and multivariate analysis. The strongest association was found between vertical CDR measurements and disc, cup and rim area; cup and rim volume, CDR area, linear CDR, mean and maximum cup depth and cup shape measure (all p < 0.0001). In multivariate analysis, pattern standard deviation (PSD) and HRT disc area had significant associations with several HRT optic disc measurements. Furthermore, CCT was significantly associated with reference height and the glaucoma probability score (GPS, outside normal limits). CONCLUSIONS: The EGPS is the first multicentre, placebo-controlled randomized clinical trial to use HRT for monitoring optic disc changes in participants with ocular hypertension. We found strong associations between stereophotographic vertical CDR estimates, HRT disc area, PSD and several HRT parameters. We found, furthermore, that the parameters reference height and GPS were significantly related to central corneal thickness.

Histological examination of an eye with endogenous Aspergillus endophthalmitis treated with oral voriconazole: a case report.

PURPOSE: To report the histological findings of an eye with severe Aspergillus endophthalmitis after oral treatment with voriconazole. METHODS. Case report. RESULTS: Histopathological examination revealed no fungal elements in choroidal or retinal vessels. The hyphae were mainly restricted to the vitreal side of the preretinal inflammatory infiltrate. Since the treatment with voriconazole had not been completed at the time of enucleation, the clinical course with potential further limitation or regression of the lesion remains unsettled. CONCLUSIONS: Endogenous Aspergillus endophthalmitis is a devastating condition often associated with immunodeficiency. The pathogenesis of this entity implies the primary invasion of choroidal and retinal vessels. The lack of antifungal drugs with high blood-ocular permeability results in an extremely poor visual prognosis. Our histological examination indicates promising activity and ocular penetration of the new antifungal agent voriconazole.