Comparison of intraocular pressure measurements between Easyton transpalpebral tonometry and Perkins, iCare iC100 and Corvis ST, and the influence of corneal and anterior scleral thickness.

PURPOSE: To compare intraocular pressure (IOP) measurements between Easyton transpalpebral tonometry and Perkins, iCare iC100 and Corvis ST. Also, to assess the influence of corneal characteristics and anterior scleral thickness (AST) on the IOP measurements. METHODS: Sixty-nine eyes from 69 healthy subjects were included. IOP was measured by Easyton, Perkins, iC100 and Corvis ST (corrected IOP, bIOP; and non-corrected IOP, IOPnct). Other variables studied were AST, axial length (AL), and Corvis parameters: Length 1, velocity 1, length 2, velocity 2, peak distance, radius, deformation amplitude, and central corneal thickness (CCT). Pearson correlation, limits of agreement (LoA), and multiple regression analysis were calculated. RESULTS: No significant differences in IOP between Easyton and Perkins, iC100, and bIOP were observed (all p > 0.05), being significant only between Perkins and IOPnct ( - 1.49 mmHg, p < 0.001). Bland-Altman graphs showed that the mean difference between Perkins and Easyton was 0.07 mmHg (p < 0.001), and LoA - 7.49 to + 7.39 mmHg. Significant correlations were found between the measurements of Perkins and iC100, IOPnct, bIOP (r = 0.710, 0.628, 0.539; p < 0.001 respectively), iC100 and IOPnct, bIOP (r = 0.627, 0.513; p < 0.001, respectively). The multivariate regression analysis revealed that differences between Perkins and Easyton (adjusted R2 = 0.25) were influenced by AL (B = 1.28, p < 0.008), length 1 (B = 3.13, p < 0.018), and the radius (B = 1.26, p < 0.010). Differences between Perkins and bIOP (adjusted R2 = 0.21) were affected by the CCT (B = 0.029, p < 0.003). CONCLUSIONS: There are no significant differences in the IOP measurements between Perkins and Easyton, iC100 or bIOP. Length 1, radius, and CCT have limited influence on these differences, while AST did not show any effect.

Fourier domain optical coherence tomography to assess the iridocorneal angle and correlation study in a large Caucasian population.

BACKGROUND: Recently, novel anatomic parameters that can be measured by optical coherence tomography (OCT), have been identified as a more objective and accurate method of defining the iridocorneal angle. The aim of the present study is to measure the iridocorneal angle by Fourier domain (FD) OCT and to identify correlations between angle measurements and subject factors in a large healthy Caucasian population. METHODS: A cross sectional study was performed in 989 left eyes of 989 healthy subjects. The iridocorneal angle measurements: trabecular-iris angle (TIA), angle opening distance (AOD500) and trabecular-iris space area (TISA500) 500 µm from the scleral spur, were made using the FD-OCT RTVue®. Iris thickness was also measured. Correlations were examined between angle measurements and demographic and ocular factors. The main determinants of angle width were identified by multivariate linear regression. RESULTS: TIA could be measured in 94% of the eyes, and AOD500 and TISA500 in 92%. The means recorded were TIA 35.8 ± 12.2 degrees (range 1.5 to 76.1), AOD500 542.6 ± 285.4 µm (range 15 to 1755), and TISA500 0.195 ± 0.104 mm(2) (range 0.02 to 0.62). The correlation between the temporal and nasal quadrant was R = 0.902 for TIA. The reproducibility of measurements was excellent (intraclass correlation coefficient >0.947). Mean angle width measurements were smaller in women (p = 0.02). Correlation was detected between angle means and anterior chamber volume (ACV; R = 0.848), anterior chamber depth (ACD; R = 0.818), spherical error (R = -0.619) and age (R = -0.487), while no correlation was observed with Intraocular pressure (R = -0.052). ACV emerged as the main determinant of TIA (R(2) = 0.705; p < 0.001). CONCLUSIONS: In this Caucasian population, strong correlation was detected between FD-OCT anterior angle measurements and ACV, ACD, spherical refractive error and sex, emerging the ACV as the main determinant of TIA.

Visual outcomes after bilateral trifocal diffractive intraocular lens implantation.

BACKGROUND: In recent years new models of intraocular lenses are appearing on the market to reduce requirements for additional optical correction. The purpose of this study is to assess visual outcomes following bilateral cataract surgery and the implant of a FineVision® trifocal intraocular lens (IOL). METHODS: Prospective, nonrandomized, observational study. Vision was assessed in 44 eyes of 22 patients (mean age 68.4 ± 5.5 years) before and 3 months after surgery. Aberrations were determined using the Topcon KR-1 W wave-front analyzer. LogMAR visual acuity was measured at distance (corrected distance visual acuity, CDVA 4 m), intermediate (distance corrected intermediate visual acuity, DCIVA 60 cm) and near (distance corrected near visual acuity, DCNVA 40 cm). The Pelli-Robson letter chart and the CSV-1000 test were used to estimate contrast sensitivity (CS). Defocus curve testing was performed in photopic and mesopic conditions. Adverse photic phenomena were assessed using the Halo v1.0 program. RESULTS: Mean aberration values for a mesopic pupil diameter were: total HOA RMS: 0.41 ± 0.30 µm, coma: 0.32 ± 0.22 µm and spherical aberration: 0.21 ± 0.20 µm. Binocular logMAR measurements were: CDVA -0.05 ± 0.05, DCIVA 0.15 ± 0.10, and DCNVA 0.06 ± 0.10. Mean Pelli-Robson CS was 1.40 ± 0.14 log units. Mean CSV100 CS for the 4 frequencies examined (A: 3 cycles/degree (cpd), B: 6 cpd, C: 12 cpd, D: 18 cpd) were 1.64 ± 0.14, 1.77 ± 0.18, 1.44 ± 0.24 and 0.98 ± 0.24 log units, respectively. Significant differences were observed in defocus curves for photopic and mesopic conditions (p < 0.0001). A mean disturbance index of 0.28 ± 0.22 was obtained. CONCLUSIONS: Bilateral FineVision IOL implant achieved a full range of adequate vision, satisfactory contrast sensitivity, and a lack of significant adverse photic phenomena. TRIAL REGISTRATION: Eudract Clinical Trials Registry Number: 2014-003266-2.

Visual and refractive outcomes after bilateral implantation of an enhanced monofocal intraocular lens: prospective study.

PURPOSE: To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with emmetropia as a target refraction. SETTING: San Carlos Hospital, Madrid, Spain. DESIGN: Prospective, monocentric, noncomparative study. METHODS: Adults 21 years or older suitable for cataract surgery and with corneal astigmatism <1.50 diopters (D) were bilaterally implanted with the RayOne EMV IOL and followed up for 3 months. Outcomes measures included refraction, monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity, distance-corrected intermediate visual acuity (DCIVA), and defocus curve, aberrometry, and satisfaction. Visual symptoms were assessed using the CatQuest-9SF questionnaire. RESULTS: 50 eyes of 25 patients were included. At month 3, the mean manifest spherical equivalent was -0.39 ± 0.28 D, with all eyes within 1.00 D. Binocularly, uncorrected, at distance, 68% of patients could read ≤0.0 logMAR and 95% ≤0.2 logMAR; at intermediate 59% of patients could read ≤0.1 and 100% ≤0.2 logMAR. Mean monocular CDVA was -0.03 ± 0.06 logMAR and mean monocular DCIVA was 0.28 ± 0.07 logMAR. Binocular defocus curve demonstrated a visual acuity ≤0.2 logMAR over a 2 D range from +1.00 D to -1.25 D. Satisfaction was good in 96% of patients. CONCLUSIONS: Bilateral implantation of an enhanced monofocal IOL with emmetropia as a target provided excellent binocular CDVA and good DCIVA, with a high level of satisfaction.

Improvement of objective ocular redness measured with Keratograph 5M in glaucoma patients after instilling brimonidine drops.

OBJECTIVE: To compare objective ocular redness measured using OCULUS Keratograph 5 M before and after 0.2% brimonidine instillation in glaucoma patients under topical hypotensive treatment. METHODS: 60 eyes from 60 subjects diagnosed with glaucoma or ocular hypertension under hypotensive ocular topical treatment were analyzed. Basal Ophthalmological examination was performed.Outcome variables were OCULUS Keratograph 5 M redness scores (RS) before and after 0.2% brimonidine instillation; overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN); non-invasive average tear film breakup time (Nia-BUT), non-invasive first tear film breakup time (Nif-BUT) and meibography. In addition, the following clinical data were collected: intraocular pressure, type, duration, amount, and preservatives/or not of hypotensive treatment, fluorescein corneal staining score and lower tear meniscus height. RESULTS: All eyes were under topical medication. All redness scores were reduced after brimonidine instillation, mean RS differences were BT 0.82 ± 0.62, BN hyperemia 1.03 ± 0.55, LN hyperemia 0.84 ± 0.49, LT hyperemia 0.71 ± 0.50 and total hyperemia 0.91 ± 0.52 (all p < 0.001). 30 min after brimonidine instillation mean overall RS reduction was 47.97 ± 12.39% (p < 0.001) and after 1 h there was a persistent reduction of overall RS of 45.92 ± 14.27% (p < 0.001). Hyperemia reduction was significant and comparable between preservative and preservative-free group 0.12 ± 0.14 (p > 0.392) and between patient with combination therapy and monotherapy 0.16 ± 0.14 (p > 0.258). CONCLUSION: A significant reduction of conjunctival hyperemia was objectively found in glaucoma patients under topical hypotensive treatment before and after brimonidine instillation. Its fast and long-lasting effect may be useful preoperatively in glaucoma patients to reduce intraoperative bleeding and associated complications.

Intense pulsed light-based treatment for the improvement of symptoms in glaucoma patients treated with hypotensive eye drops.

BACKGROUND: Ocular surface disease in glaucoma patients is a significant ocular co-morbidity that can affect 40% to 59% of these patients worldwide. The current study was aimed at evaluating the potential clinical benefit of an intense pulsed light (IPL)-based treatment in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop treatments. To our knowledge, this is the first series analyzing the therapeutic effect of this treatment option in this type of patients. METHODS: This non-comparative prospective case series study enrolled a total of 30 glaucoma patients ranging in age from 57 to 94 years old and treated with hypotensive eyedrops for years with dry eye symptomatology. All patients received four sessions of IPL treatment using the Optima IPL system (Lumenis, Yokneam, Israel) adjusted to the official optimized Lumenis setting. Changes in symptomatology, corneal staining, conjunctival hyperemia, non-invasive break-up time (NIBUT), tear osmolarity, tear meniscus height (TMH), meiboscore and meibomian gland expressibility was analyzed after treatment. RESULTS: Statistically significant reductions were observed after IPL treatment in the symptomatology scores measured with different questionnaires [ocular surface disease index (OSDI), standard patient evaluation of eye dryness (SPEED) and symptom assessment questionnaire in dry eye (SANDE)] as well as with the visual analogue scale (P < 0.001). Mean change in OSDI was - 15.0 ± 11.3. A significant reduction was found after treatment in the corneal staining score (P < 0.001). A significant reduction was found in tear film meniscus height (P = 0.012), as well as in tear film osmolarity (P = 0.001). A significant reduction was also found in meibomian gland expressibility (P = 0.003), changing the percentage of grade 3 eyes from 44.4% before IPL to 17.2% after treatment. CONCLUSIONS: IPL therapy combined with meibomian gland expression (MGX) seems to be an effective option to improve symptomatology in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop treatments, with an additional improvement in clinical signs, such as tear osmolarity and corneal staining.

Corneal Properties in Primary Open-angle Glaucoma Assessed Through Scheimpflug Corneal Topography and Densitometry.

PURPOSE: The purpose of this study was to compare corneal topography and densitometry measurements in patients with primary open-angle glaucoma (POAG) and healthy subjects. PATIENTS AND METHODS: A total of 200 eyes of 75 patients with POAG and 125 healthy controls underwent corneal topography and densitometry (Oculus Pentacam HR). The data compared in the 2 groups were: anterior chamber angle, anterior chamber depth, and anterior chamber volume, keratometry (Kminimum, Kmaximum, and Kmean), central corneal thickness, central anterior elevation, anterior elevation apex, maximum anterior elevation, and posterior elevation apex. Densitometry measurements were made at 3 depths on a 12-mm-diameter circle divided into 4 concentric rings (0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm). The diagnostic capacity of the corneal variables was assessed through the areas under the receiver operating characteristics curve. RESULTS: The corneal density of practically all depth layers and total corneal density were significantly higher in the POAG than the control group (P<0.05). Total corneal density was positively correlated with age (r=0.623; P<0.001) and also showed a good diagnostic capacity for glaucoma [area under the curve=0.617; 95% confidence interval (CI): 0.541-0.697; P<0.001]. In a multiple linear regression designed to assess its relationship with age, sex, central corneal thickness, and Kmean, age emerged as a significant confounder both in controls (coefficient=0.315; P<0.001; 95% CI: 0.246-0.384) and patients (coefficient=0.370; P<0.001; 95% CI: 0.255-0.486). CONCLUSION: Corneal densitometry measurements showed a good diagnostic capacity for POAG suggesting this type of examination could have clinical applications in the diagnosis and management of glaucoma.

Corneal densitometry and biomechanical properties in patients with primary congenital glaucoma.

OBJECTIVE: To describe corneal densitometry, topographic measurements, and biomechanical properties in patients with primary congenital glaucoma (PCG) and healthy patients. To examine correlations between variables and determine their glaucoma diagnostic capacity. METHODS: This was a cross-sectional, case-control study conducted in 50 eyes of 50 patients with PCG (G1) and 40 eyes of 40 healthy patients (G2). The variables determined in each participant were: intraocular pressure, best corrected visual acuity (BCVA), corneal densitometry, topographic data using the Pentacam HR-Scheimpflug imaging system (Oculus Optikgerate GmbH, Wetzlar, Germany), and corneal hysteresis (CH) and corneal resistance factor (CRF) using the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Depew, NY). RESULTS: Overall densitometry was significatively higher in the PCG group (G1: 17.94 ± 4.99 vs G2: 13.25 ± 1.96, p < 0.001). CH (G1: 8.02 ± 11.35 vs G2: 11.35 ± 1.42, p < 0.001) and CRF (G1: 9.48 ± 2.83 vs G2: 10.77 ± 1.34, p < 0.001) were lower in the glaucoma group. Mean posterior, central, and anterior elevation and mean keratometry were higher in G1 (p < 0.05). In the PCG group, overall densitometry showed significant correlation with CH (r = -0.321, p = 0.028) and with BCVA (r = -0.498, p = 0.002). AUCs (areas under the curve) for CH and overall densitometry were high (0.839 and 0.899 respectively) and the best overall densitometry; CH and CRF cutoffs were 14.0, 9.3 and 9.2 respectively. CONCLUSION: Densitometry is increased, and biomechanical corneal properties are decreased in patients with PCG. Densitometry and visual acuity showed a negative and significant correlation, so this measurement could be used as an indirect parameter of BCVA in the clinical practice.

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens.

PURPOSE: To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT). METHODS: This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and -5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD). RESULTS: The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 µm before surgery and 99.55 µm after. With Cirrus OCT, the global thickness was 85.29 µm before surgery and 89.77 µm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants. CONCLUSIONS: The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

Visual outcomes after progressive apodized diffractive intraocular lens implantation.

PURPOSE: To assess photopic and mesopic vision in patients implanted with the Bi-Flex® M 677 MY bifocal intraocular lens (IOL). METHODS: In this prospective clinical study, 25 patients with cataract in both eyes were subjected to cataract surgery and bilateral implantation of the Bi-Flex® M 677MY (Medicontur, Hungary) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were determined. Intermediate at 65 cm (DCIVA) and near at 40 cm (DCNVA) visual acuity were also measured, both with best distance correction. The CSV-1000 test chart was used to assess contrast sensitivity (CS). Defocus curves were constructed under photopic and mesopic conditions, determining binocular best-corrected visual acuity over the range +1.50 D to -4.00 D in 0.50-D steps. A KR-1W Wavefront Analyzer was used to measure pupil size and aberrometric outcomes. Presence and type of dysphotopsia were evaluated with the Likert scale. RESULTS: Mesopic mean pupil diameter was 4.58 ± 0.73 mm. The mean values at 3 months were UDVA 0.03 ± 0.09, CDVA -0.05 ± 0.06, DCIVA 0.20 ± 0.07, and DCNVA 0.11 ± 0.08. Mean CS for the 4 frequencies examined were 1.66 ± 0.16, 1.75 ± 0.14, 1.39 ± 0.22, and 0.96 ± 0.19. Significant differences were observed in defocus curves for photopic and mesopic conditions. A significant correlation between pupil diameter and the dysphotopic photopic was found (r = 0.62; p = 0.02). CONCLUSIONS: The evaluated progressive apodized diffractive design IOL provides effective restoration of visual function in far and near vision distance with an adequate intermediate visual quality between -1.00 and -1.50 focus.

Changes in corneal biomechanical properties after 24 hours of continuous intraocular pressure monitoring using a contact lens sensor.

OBJECTIVE: This study was designed to assess changes in corneal topography and biomechanics after intraocular pressure (IOP) monitoring using the Triggerfish contact lens sensor (CLS). METHODS: For this prospective study, 30 eyes of 30 subjects: 14 healthy subjects (G1) and 6 glaucoma patients (G2), were recruited for 24 hours of continuous IOP monitoring using the CLS. The following measurements were taken before CLS fitting and after lens removal: maximum keratometry (Kmax), mean keratometry (MK), and corneal astigmatism (Cyl) measured through Pentacam corneal topography, and the corneal biomechanical variables corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA). RESULTS: Pentacam data revealed significant changes after CLS removal in Kmax (+3.14 ± 2.46 D, p = 0.002), MK (+0.52 ± 0.63 D, p = 0.02), and Cyl (+0.48 ± 0.53 D, p = 0.019) in G1; and Kmax (+1.38 ± 1.43 D, p = 0.002) in G2. The changes observed were more pronounced in G1 than in G2 but differences were not significant. The ORA results indicated higher CH (11.35 ± 2.42 vs 8.17 ± 2.09) and CRF (10.3 ± 2.03 vs 9.1 ± 1.81) before lens fitting in G1 than G2, while no significant changes were produced after CLS removal in either group. CONCLUSIONS: The use of CLS for IOP monitoring over 24 hours caused topographic changes in both healthy subjects and glaucoma patients. No changes were produced in corneal biomechanics.

Changes in retinal nerve fiber layer thickness measurements in response to a trifocal intraocular lens implantation.

AIMS: To determine the changes produced on the peripapillary retinal nerve fiber layer (RNFL) thickness, measured by an spectral-domain optical coherence tomography (OCT), after the implantation of a trifocal diffractive intraocular lens (IOL) and compare them with the variations produced by a monofocal IOL implantation. METHODS: A prospective, double masked study in which 50 eyes belonging to 50 patients with bilateral cataract were enrolled. Sequentially, the first 25 patients were bilaterally implanted with the trifocal diffractive IOL AT LISA® Tri 839 MP and the following 25 patients with the monofocal IOL CT ASPHINA® 409 M/MP. RNFL thickness measurements were performed by Cirrus HD®-OCT before and six months after the second eye surgery. RESULTS: Mean patient age was 69.5 ± 6.1 years. In response to surgery, the average RNFL thickness increased 7.29 ± 10.51 µm at the AT LISA® Tri group and 1.96 ± 2.90 µm at the monofocal IOL group from the baseline (p = 0.017). Statistically significant differences in thickness variations were also detected in the superior sector (7.86 ± 7.70 µm at the AT LISA® Tri group vs 1.73 ± 5.74 µm at the monofocal group). Statistically significant differences between the pre and the postsurgery measurements were found in all sectors except the inferior one with the trifocal IOL and in two of the studied sectors (average and temporal) with the monofocal IOL. CONCLUSIONS: The IOL implantation produce changes in the RNFL thickness, which are larger in case of a trifocal diffractive IOL.

Photopic and Mesopic Performance of 2 Different Trifocal Diffractive Intraocular Lenses.

Purpose To assess photopic and mesopic vision in patients implanted with 2 different trifocal intraocular lenses (IOLs). Methods Fifty patients with cataract in both eyes had surgery with bilateral implantation of a trifocal FineVision (FV, n = 25) or AT LISA tri 839MP (LisaTri, n = 25) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were determined using the Early Treatment Diabetic Retinopathy Study test. Intermediate (65 cm) and near (40 cm) visual acuity were also measured, both with best distance correction (DCIVA and DCNVA, respectively). The CSV1000 test chart was used for binocular and monocular contrast sensitivity. Defocus curves were constructed under photopic and mesopic conditions. Results Mean patient age was 68.4 ± 5.5 years (FV) and 67.3 ± 5.6 years (LisaTri) (p = 0.540). No differences were found in terms of visual acuity between the groups. The CDVA, DCIVA, and DCNVA were 0.05 ± 0.06, 0.25 ± 0.10, and 0.13 ± 0.10 logMAR for FV and -0.04 ± 0.11, 0.32 ± 0.09, and 0.12 ± 0.11 logMAR for LisaTri, respectively (p = 0.09, p = 0.08, and p = 0.12). Photopic and mesopic defocus curves were comparable between the 2 IOL groups (p>0.05). Mesopic values were significantly worse than photopic in both groups for all the measured values (p<0.001). No differences in contrast sensitivity were observed between the 2 IOL groups (p>0.05). Conclusions Both trifocal diffractive IOLs provided good visual quality with a statistically significant decrease in mesopic conditions.

Morphometry of the trabecular meshwork in vivo in a healthy population using fourier-domain optical coherence tomography.

PURPOSE: We measured the length, thickness, and area of the trabecular meshwork (TM) in vivo using Fourier domain optical coherence tomography (FD-OCT) in a Caucasian population of healthy subjects. METHODS: A cross-sectional study was done of 1006 healthy subjects. Left eyes were randomly selected. Age, sex, IOP, and spherical refractive error were noted. The depth and volume of the anterior chamber and the central corneal thickness were measured with Pentacam, while IOL Master was used to measure the axial length. The length, thickness, and area of the TM were measured through FD-OCT RTVue. A study was done to determine the correlation between TM size, and other demographic and ocular parameters. Finally, the reproducibility of the measurements was assessed for a subgroup of 50 eyes from 50 patients. RESULTS: We were able to measure the TM in 91.1% of the total eyes studied. The mean TM length was 496.99 ± 92.77 µm (range, 275-800), TM thickness was 174.16 ± 28.14 µm (range, 100-276), and TM area was 0.069 ± 0.031 mm(2) (range, 0.023-0.133). No differences were found in terms of length and area for sex, although the TM was slightly thicker in men (P = 0.046). No correlation was observed between the TM measurements and any of the studied demographic or ocular parameters (R < 0.09, P < 0.001). Intra- and interobserver reproducibility of the measurements were good (intraclass correlation coefficient > 0.750, P < 0.001). CONCLUSIONS: The FD-OCT is an effective and reproducible examination technique to measure the length, thickness, and area of the TM in vivo.

Clinical Variability of Primary Congenital Glaucoma in a Spanish Family With Cyp1b1 Gene Mutations.

BACKGROUND: Primary congenital glaucoma (PCG) is a rare disease. In around a third of Spanish patients, the disease is attributed to mutations in the CYP1B1 gene inherited in an autosomal recessive manner. Such mutations are the main known genetic cause of PCG. CASE REPORT: We describe the case of a family with 3 of 7 siblings diagnosed with PCG. In a genetic study of the CYP1B1 gene, 2 null mutations were identified in the affected siblings (R355fsX69/T404fsX38). Two of the 4 healthy siblings were heterozygous for mutation R355fsX69 and the remaining 2 had no mutations. The healthy parents were found to be heterozygous for mutations T404fsX38 (mother) and R355fsX69 (father). High variation in the expression of PCG was observed, especially in terms of disease onset and severity: Patient 1 in the eldest affected sibling, PCG was diagnosed at 8 years of age and is presently stable after 60 months of medical treatment; patient 2 the second affected child underwent surgery at 7 days of age. Today, at 104 months, she has undergone 2 operations on the right eye and 3 on the left eye; patient 3 the youngest sibling, the disease also manifested at birth and the boy underwent surgery at 4 days. Currently he is 84 months old, he has required 7 operations for glaucoma, 3 in the right eye and 4 in the left. CONCLUSIONS: This clinical case reveals the etiological relationship between CYP1B1 mutations and PCG. In addition, it indicates a highly variable clinical picture associated with a single disease genotype mainly affecting disease onset and progression.