Easyton® transpalpebral versus Perkins applanation tonometry in different populations.

OBJECTIVE:  To compare intraocular pressure (IOP) measurements obtained using the new transpalpebral Easyton® tonometer and Perkins applanation tonometer (PAT) in three different clinical populations. METHODS: The participants of this prospective study were 84 subjects divided into the groups: 22 healthy children (G1), 42 healthy adults (G2), and 20 adult patients with primary open angle glaucoma (G3). The data recorded in 84 eyes of these subjects were age, sex, gender, central corneal thickness (CCT), and axial length (AL). In all eyes, IOP was determined in the same examination room by the same experienced examiner using Easyton® and PAT in random order. RESULTS:  Mean differences in IOP readings between Easyton® and PAT were 0.45 ± 1.97 (p = 0.295), - 0.15 ± 2.13 (p = 0.654), - 1.65 ± 3.22 (p = 0.033), and - 0.018 ± 2.50 mmHg (p = 0.500) in the groups G1, G2, G3, and whole sample (G4), respectively. Correlations between Easyton® and PAT IOP values were 0.668 (p = 0.001) for G1, 0.463 (p = 0.002) for G2, 0.680 (p < 0.001) for G3, and 0.605 (p < 0.001) for G4. Moderate to good agreement between the two tonometers was found in all groups according to intraclass correlation coefficients, which were 0.794 (p < 0.001) for G1, 0.632 (p < 0.001) for G2, 0.809 (p < 0.001) for G3, and 0.740 (p < 0.001) for G4. The lower and upper limits of agreement between the devices were - 5.1 and 4.7 mmHg, respectively, in the complete group. No correlation was noted between CCT or AL and the Easyton® IOP measurements. CONCLUSION: IOP measurements obtained with Easyton® and PAT show an acceptable level of agreement mainly in healthy individuals, recommending it for IOP screening in children and in patients in which PAT measurement may be impared as patients with hemifacial spasms, corneal irregularities, or reduced mobility. It is not recommended for glaucoma patients follow-up.

One-Year Changes in Optic Nerve Head Parameters in Recovered COVID-19 Patients.

BACKGROUND: The main purpose was to evaluate the changes in peripapillary retinal nerve fiber layer (RNFL) thickness and vessel density (VD) in post-COVID-19 patients during 12-month follow-up. METHODS: In this prospective study, patients with COVID-19 who were attended in the Hospital Clinico San Carlos (Madrid, Spain) were included. All patients underwent a complete ophthalmological examination, optic nerve head optical coherence tomography (OCT), and OCT angiography (OCTA) using the Cirrus HD-OCT 5,000 with AngioPlex OCTA 1, 3, and 12 months after laboratory-confirmed diagnosis. Sociodemographic data, medical history, disease severity, and laboratory workup were registered. RESULTS: A total of 180 eyes of 90 patients with SARS-CoV-2 infection were included; the mean age was 55.5 ± 8.9 years, and 46 patients (51%) were females. The mean visual acuity was 0.76 ± 0.16, and no abnormalities attributable to SARS-CoV-2 were detected in the ocular or fundus examination. No differences in the OCT and OCTA data were found between severity groups in each visit (all P > 0.05). Overall, there was a decrease in RNFL global thickness ( P < 0.001) from the first to the last visit, and an increase in VD and flux index was noted in some sectors at the 12-month examination. A significant correlation was detected at 12 months between vascularization parameters and RNFL thickness. CONCLUSIONS: One year after SARS-CoV-2 infection, changes in peripapillary RNFL thickness and vascularization occur, possibly indicating a recovery in such parameters.

Systemic treatment with 7,8-Dihydroxiflavone activates TtkB and affords protection of two different retinal ganglion cell populations against axotomy in adult rats.

PURPOSE: To analyze responses of different RGC populations to left intraorbital optic nerve transection (IONT) and intraperitoneal (i.p.) treatment with 7,8-Dihydroxyflavone (DHF), a potent selective TrkB agonist. METHODS: Adult albino Sprague-Dawley rats received, following IONT, daily i.p. injections of vehicle (1%DMSO in 0.9%NaCl) or DHF. Group-1 (n = 58) assessed at 7days (d) the optimal DHF amount (1-25 mg/kg). Group-2, using freshly dissected naïve or treated retinas (n = 28), investigated if DHF treatment was associated with TrkB activation using Western-blotting at 1, 3 or 7d. Group-3 (n = 98) explored persistence of protection and was analyzed at survival intervals from 7 to 60d after IONT. Groups 2-3 received daily i.p. vehicle or DHF (5 mg/kg). Retinal wholemounts were immunolabelled for Brn3a and melanopsin to identify Brn3a+RGCs and m+RGCs, respectively. RESULTS: Optimal neuroprotection was achieved with 5 mg/kg DHF and resulted in TrkB phosphorylation. The percentage of surviving Brn3a+RGCs in vehicle treated rats was 60, 28, 18, 13, 12 or 8% of the original value at 7, 10, 14, 21, 30 or 60d, respectively, while in DHF treated retinas was 94, 70, 64, 17, 10 or 9% at the same time intervals. The percentages of m+RGCs diminished by 7d-13%, and recovered by 14d-38% in vehicle-treated and to 48% in DHF-treated retinas, without further variations. CONCLUSIONS: DHF neuroprotects Brn3a + RGCs and m + RGCs; its protective effects for Brn3a+RGCs are maximal at 7 days but still significant at 21d, whereas for m+RGCs neuroprotection was significant at 14d and permanent.

A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma.

PURPOSE: To assess the safety and effectiveness of the Hydrus Microstent (Ivantis, Inc, Irvine, CA) with concurrent cataract surgery (CS) for reducing intraocular pressure (IOP) in open-angle glaucoma (OAG). DESIGN: Prospective, multicenter, randomized, single-masked, controlled clinical trial. PARTICIPANTS: One hundred eyes from 100 patients 21 to 80 years of age with OAG and cataract with IOP of 24 mmHg or less with 4 or fewer hypotensive medications and a washed-out diurnal IOP (DIOP) of 21 to 36 mmHg. METHODS: On the day of surgery, patients were randomized 1:1 to undergo CS with the microstent or CS alone. Postoperative follow-up was at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. Washout of hypotensive medications was repeated at 12 and 24 months. MAIN OUTCOME MEASURES: Response to treatment was defined as a 20% or more decrease in washed out DIOP at 12 and 24 months of follow-up compared with baseline. Mean DIOP at 12 and 24 months, the proportion of subjects requiring medications at follow-up, and the mean number of medications were analyzed. Safety measures included change in visual acuity, slit-lamp observations, and adverse events. RESULTS: The proportion of patients with a 20% reduction in washed out DIOP was significantly higher in the Hydrus plus CS group at 24 months compared with the CS group (80% vs. 46%; P = 0.0008). Washed out mean DIOP in the Hydrus plus CS group was significantly lower at 24 months compared with the CS group (16.9±3.3 mmHg vs. 19.2±4.7 mmHg; P = 0.0093), and the proportion of patients using no hypotensive medications was significantly higher at 24 months in the Hydrus plus CS group (73% vs. 38%; P = 0.0008). There were no differences in follow-up visual acuity between groups. The only notable device-related adverse event was focal peripheral anterior synechiae (1-2 mm in length). Otherwise, adverse event frequency was similar in the 2 groups. CONCLUSIONS: Intraocular pressure was clinically and statistically significantly lower at 2 years in the Hydrus plus CS group compared with the CS alone group, with no differences in safety.

Association between SNPs of Metalloproteinases and Prostaglandin F2α Receptor Genes and Latanoprost Response in Open-Angle Glaucoma.

PURPOSE: To determine whether single nucleotide polymorphisms (SNPs) of genes coding for matrix metalloproteinases (MMPs) and the prostaglandin F2α receptor gene (PTGFR) are related to a response to latanoprost in a white Spanish population of glaucomatous patients. DESIGN: Case-control study. PARTICIPANTS: One hundred twenty-four patients with open-angle glaucoma. METHODS: Genotyping was performed in 117 patients with primary open-angle glaucoma with a minimum treatment duration of 4 weeks. Candidate genes and individual polymorphisms were selected according to the effect on the mechanism of action of latanoprost. Multi-SNP haplotype analyses for associations also were tested. MAIN OUTCOME MEASURES: Diurnal intraocular pressure reduction and genotyping of the SNPs in the MMPs and PTGFR. RESULTS: The PTGFR SNPs were associated with positive (rs6686438, rs10786455) and negative (rs3753380, rs6672484, rs11578155) responses to latanoprost. Multiple testing found 2 genes, PTGFR and MMP-1, were related to refractoriness to latanoprost. CONCLUSIONS: The SNPs of the PTGFR and MMP-1 genes may determine the latanoprost response in a white European Spanish population. This study identified 5 SNPs related to the latanoprost response; 1 SNP, rs3753380, already has been associated with a poor response to latanoprost in a healthy Japanese population. Latanoprost is a commonly used antiglaucomatous drug, and increased knowledge of its mechanism of action will lead to advances in pharmacogenetics.

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.

Peripapillary and macular vascular parameters by optical coherence tomography angiography in primary congenital glaucoma.

OBJECTIVE: To evaluate the differences in peripapillary and macular vascular parameters by optical coherence tomography angiography (OCTA) between patients with primary congenital glaucoma (PCG) and healthy controls; and to determine their diagnostic accuracy. MATERIAL AND METHODS: Observational, cross-sectional study including 39 eyes with PCG and 78 healthy eyes. Only one eye per patient was included. All included patients underwent a comprehensive ophthalmic examination and peripapillary and macular analysis were performed by AngioplexTM OCTA (Cirrus HD-OCT 5000) with a 4.5 × 4.5 mm optic nerve head scan and 6 × 6 mm macular scan. Global data and quadrant data from peripapillary vascular parameters and global data and circular sectors data from macular superficial plexus parameters were compared between groups. The glaucoma discrimination capability of these parameters was calculated as areas under the receiver operating characteristics curve (AUC ROC). RESULTS: Mean age was 14.1 ± 8.7 years for the PCG patients and 11.7 ± 6.2 years for controls (p = 0.093). All vascular peripapillary measurements (global and quadrants; all p < 0.001) and all macular measurements (p < 0.042) excepting perfusion density in the inner circle (p = 0.087), were reduced in the PCG group compared to controls. According to AUC ROC, peripapillary (all ≥ 0.706) and macular parameters (all ≥ 0.699) showed good diagnostic capacity. AUC ROC for the most discriminatory measurements corresponding to blood flux index (0.887) and whole macula vascular density (0.855) were similar (p = 0.085). CONCLUSION: Peripapillary and macular vascular parameters by OCTA are decreased in patients with PCG, showing a good capacity to discriminate between normal and glaucomatous eyes.

Effects of Corneal Biomechanical Properties on Rebound Tonometry (Icare200) and Applanation Tonometry (Perkins) Readings in Patients With Primary Congenital Glaucoma.

OBJECTIVE: The aim was to assess the influence of corneal biomechanics on intraocular pressure (IOP) measurements made with the Icare200 (IC200) rebound tonometer and the Perkins handheld applanation tonometer in patients with primary congenital glaucoma (PCG). MATERIALS AND METHODS: A total of 40 PCG patients and 40 healthy controls, age, and sex-matched, were recruited. IOP was measured with the Ocular Response Analyzer (IOPc, IOPg), IC200 and Perkins. The variables age, IOP, corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), best-corrected visual acuity, spherical equivalent, medications, and glaucoma surgeries were recorded for each subject. Univariate and multivariate analysis were used to detect effects of variables on IOP measurements. RESULTS: Mean CCT was 545.65±71.88 µm in PCG versus 558.78±27.58 µm in controls (P=0.284). CH and CRF were significantly lower in PCG group than in control group: mean CH 8.11±1.69 versus 11.15±1.63 mm Hg (P<0.001), and mean CRF 9.27±2.35 versus 10.71±1.75 mm Hg (P=0.002). Mean differences between IOP IC200-Perkins were 0.79±0.53 mm Hg in PCG versus 0.80±0.23 mm Hg in controls (P<0.001) and mean differences IC200-IOPc were -0.89±5.15 mm Hg in PCG (P<0.001) versus 1.60±3.03 mm Hg in controls (all P<0.009). Through multivariate analysis, CRF showed positive association and CH negative association with IOP measured with Perkins or IC200 in both subject groups. No association was detected for CCT, age, or sex. CONCLUSION: CH and CRF were identified as the main factors interfering with IOP measurements made with both tonometers in patients with PCG and healthy controls.

Cytokine profile in tear and aqueous humor of primary open-angle patients as a prognostic factor for trabeculectomy outcome.

OBJECTIVE: To evaluate the cytokine profile in tear and aqueous humor in primary open-angle glaucoma before trabeculectomy and correlate preoperative cytokine levels with the surgical outcome. METHODS: Prospective study. Twenty-nine patients with primary open-angle glaucoma undergoing primary trabeculectomy were included. Levels of 27 cytokines were measured in tear an aqueous humor using the Bio-Plex Pro Human Cytokine 27-Plex Immunoassay kit (Bio-Rad Laboratories, Hercules, CA, USA). RESULTS: 29 patients who underwent trabeculectomy were included and their first-year follow-up visits were recorded. Mean age was 76.0 ± 7.0 years (range 56-84), mean intraocular pressure was 18.2 ± 3.6 mmHg and mean number of topical medications was 2.3 ± 0.9. At the one-year visit, 5 patients were classified as surgical failure. In aqueous humor, preoperative cytokine levels of regulated on activation normal T cell expressed and secreted (RANTES) were significantly higher in those patients with surgical failure at one year. IL-8 in tear and interferon gamma-induced protein (IP-10) in aqueous humor correlated positively with one-year IOP reduction. No statistically significant correlations were found with changes in visual field mean defect or global peripapillary retinal nerve fiber layer thickness (all, p >0.05). CONCLUSIONS: Preoperative RANTES levels in aqueous humor as well as other cytokines could serve as useful biomarkers for trabeculectomy outcome.

Safety and Effectiveness of the PRESERFLO® MicroShunt in Primary Open-Angle Glaucoma: Results from a 2-Year Multicenter Study.

PURPOSE: To assess the safety and effectiveness of the PRESERFLO® MicroShunt (formerly InnFocus MicroShunt) in patients with primary open-angle glaucoma (POAG). DESIGN: The MicroShunt, a controlled ab externo glaucoma filtration surgery device, was investigated in a 2-year, multicenter, single-arm study. PARTICIPANTS: Eligible patients were aged 18-85 years with POAG inadequately controlled on maximal tolerated medical therapy with intraocular pressure (IOP) ≥18 and ≤35 mmHg or when glaucoma progression warranted surgery. METHODS: The MicroShunt was implanted as a stand-alone procedure with adjunctive use of topical mitomycin C (MMC; 0.2-0.4 mg/ml) for 2-3 minutes. MAIN OUTCOME MEASURES: The primary effectiveness outcome was IOP reduction and success (not requiring reoperation or pressure failures [IOP > 21 mmHg and < 20% reduction in IOP]) at year 1. Additional end points at year 2 included IOP reduction, success, glaucoma medications, adverse events (AEs), and reoperations. Results are reported in the overall population and subgroups of patients receiving 0.2 or 0.4 mg/ml MMC. RESULTS: In 81 patients, mean (± standard deviation [SD]) IOP decreased from 21.7 ± 3.4 mmHg at baseline to 14.5 ± 4.6 mmHg at year 1 and 14.1 ± 3.2 mmHg at year 2 (P < 0.0001). Overall success (with and without supplemental glaucoma medication use) at year 1 was 74.1%. Mean (± SD) number of medications decreased from 2.1 ± 1.3 at baseline to 0.5 ± 0.9 at year 2 (P < 0.0001), and 73.8% of patients were medication free. Most common nonserious AEs were increased IOP requiring medication or selective laser trabeculoplasty (25.9%) and mild-to-moderate keratitis (11.1%). There were 6 (7.4%) reoperations and 5 (6.2%) needlings by year 2. In an analysis (post hoc) according to MMC concentration, overall success was 78.1% (0.2 mg/ml) and 74.4% (0.4 mg/ml; P = 0.710). In the 0.2 and 0.4 mg/ml MMC groups, 51.9% and 90.3% of patients were medication free, respectively (P = 0.001). There was a trend toward lower IOP and higher medication reduction in the 0.4 mg/ml MMC subgroup. CONCLUSIONS: In this study, mean IOP and glaucoma medication reductions were significant and sustained over 2 years postsurgery. No long-term, sight-threatening AEs were reported. Further studies may confirm potential risk/benefits of higher MMC concentration.

Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma.

The surgical management of glaucoma has been revolutionized by the introduction of minimally invasive glaucoma surgery (MIGS). The various MIGS options aim to meaningfully lower intraocular pressure with a better safety profile than traditional glaucoma surgery. The key clinical attributes and the emerging potential of an ab externo MicroShunt (PreserFlo™) are reviewed in the context of published evidence and clinical experience. This novel MicroShunt consists of an 8.5-mm-long tube that is implanted in the eye via an ab externo approach enabling aqueous humor drainage into the sub-Tenon's space through the formation of a bleb, similar in appearance to that created by trabeculectomy. The efficacy and safety of this procedure, the concomitant use of antimetabolites, the impact of tube positioning, and its future value in clinical practice are critically reviewed. Recent evidence has demonstrated the MicroShunt to be less effective than traditional filtration surgery, but with a significant improvement in safety. Cumulative data suggest that the new implant provides tangible clinical benefits to selected patients with glaucoma in need of further intraocular pressure (IOP) lowering. Future research should delineate the precise role of this and other MIGS options in the rapidly evolving glaucoma treatment algorithm.

Agreement between rebound (Icare ic200) and applanation tonometry (Perkins) in patients with primary congenital glaucoma.

PURPOSE: To examine agreement between intraocular pressure (IOP) measurements made using the rebound tonometer Icare ic200 (RT200) and the Perkins handheld applanation tonometer (PAT) in patients with primary congenital glaucoma (PCG). The impacts of several covariables on measurements using the two devices were also assessed. MATERIALS AND METHODS: Intraocular pressure measurements were made in a single session in 86 eyes of 86 patients with PCG (46 under anaesthesia, 40 in the office). The order was RT200 then PAT. The variables age, central corneal thickness (CCT), corneal state and anaesthesia were recorded in each patient. Data were compared by determining interclass correlation coefficients (ICC) for each tonometer and representing the differences detected as Bland-Altman plots. Effects of covariables were assessed through univariate and multivariate regression. RESULTS: Mean IOP difference between tonometers (RT200 minus PAT) was 1.26 mmHg (95%: 0.22-2.31). Absolute agreement (ICC) was 0.73 (95% CI: 0.62-0.82). Lower and upper limits of agreement (95%) were -8.06 mmHg (95% CI: -9.87 to -6.25) and 10.59 mmHg (95% CI: 8.77-12.40), respectively. The tonometers showed systematic differences (a = -4.63 mmHg; 95% CI: -9.11 to -1.44) and proportional differences; for each mmHg increase in PAT-IOP, the RT200 reading increased by 1.28 mmHg (b = 1.28; 95% CI: 1.12-1.53). None of the variables tested as predictors were able to explain differences between the tonometers. CONCLUSIONS: Despite the good overall agreement between both tonometers, caution should be taken in high values of IOP, considering the interchangeability of its readings as systematic and proportional differences appear to exist between both methods.

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.

Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients.

To assess the effectiveness and safety of the Preserflo Microshunt (PMS) implantation combined with cataract surgery in open-angle glaucoma (OAG) patients. Retrospective, open-label study conducted on insufficiently controlled OAG patients, who underwent a PMS implant procedure with mitomycin-C 0.2%, either alone or in combination with cataract surgery, and were followed for at least 12 months. Success was defined as an intraocular pressure (IOP) ≤ 18 mmHg and a reduction of at least 20% without (complete) or with (qualified) hypotensive medication. Fifty-eight eyes were included in the study, 35 eyes underwent PMS alone and 23 underwent PMS + Phaco. In the overall study sample, mean IOP was significantly lowered from 21.5 ± 3.3 mmHg at baseline to 14.6 ± 3.5 mmHg at month 12 (p < 0.0001). The IOP was significantly reduced in both groups; p < 0.0001 each, respectively. Ocular hypotensive medication was significantly reduced (p < 0.0001) in both groups. No significant differences were observed in IOP lowering or medication reduction between groups. At month 12, 62.1% eyes were considered as complete success and 82.8% eyes as qualified success. The most common adverse events were device close-to-endothelium, conjunctival fibrosis, and wound leakage. PMS, either alone or in combination with phacoemulsification, may be considered as a valuable option for treating OAG patients.

Tear and aqueous humour cytokine profile in primary open-angle glaucoma.

PURPOSE: To evaluate the concentrations of pro-inflammatory cytokines in tear and aqueous humour of patients with primary open-angle glaucoma (POAG), relative to healthy controls. METHOD: Tear and aqueous humour samples were collected from 29 healthy controls and 27 POAG patients. Twenty-seven inflammatory cytokines were analysed: interleukin (IL)-1ß, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL9, IL-10, IL-12, IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor (FGF) basic, granulocyte colony-stimulating factor, granulocyte-monocyte colony-stimulating factor, interferon (IFN)-γ, interferon gamma-induced protein, monocyte chemo-attractant protein-1, macrophage inflammatory protein (MIP)-1α, MIP-1ß, platelet-derived growth factor, regulated on activation normal T cell expressed and secreted, tumour necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF). RESULTS: In tear samples of glaucoma patients, an increase in IL-4, IL-12, IL-15, FGF-basic and VEGF was observed, as well as a decrease in MIP-1a relative to the control group (p < 0.05). IL-5, IL-12, IL-15, IFN-γ and MIP-1a were significantly higher in aqueous humour of glaucoma eyes (p < 0.05). A poor correlation between cytokine levels in tear and aqueous humour was observed. CONCLUSION: The different profiles of inflammatory marker expression of patients with POAG and healthy controls confirm the inflammatory activity of the pathology, indicating that some of them could be used as potential biomarkers of this disease.

Utility of optical coherence tomography angiography in detecting vascular retinal damage caused by arterial hypertension.

OBJECTIVE: To evaluate the potential utility of perfusion density measurements to discriminate patients with arterial hypertension by cardiovascular risk category. METHODS: In this cross-sectional study, one eye per subject was evaluated (N = 73). The study cohort was divided into three groups according to the clinical criteria established by the European Guidelines for Arterial Hypertension: 26 controls, 24 patients with low cardiovascular risk, and 23 patients with very high cardiovascular risk. All patients were examined using RS-3000 Advance optical coherence tomography angiography to analyze macular and peripapillary perfusion density. RESULTS: There were no differences among the three risk groups by sex or age. Decreased macular perfusion density was found at the level of the superficial and deep plexuses (p ⩽ 0.047). No differences were observed in peripapillary perfusion density (p = 0.18). CONCLUSION: Optical coherence tomography angiography can detect changes in macular perfusion density in patients with hypertension and high cardiovascular risk and might represent a supportive imaging method in the evaluation of the cardiovascular risk in hypertensive patients.

Clinicians agreement in establishing glaucomatous progression using the Heidelberg retina tomograph.

PURPOSE: To assess the degree of concordance among clinicians reviewing 3 Heidelberg retina tomograph (HRT) printouts used to detect progression, the Moorfields regression analysis (MRA), the topographic change analysis (TCA), and trend analysis (TA), and to compare with progression identified by stereophotographs. DESIGN: Observational cohort study. PARTICIPANTS: We longitudinally followed 237 eyes of 168 patients (50 glaucomatous eyes, 187 glaucoma suspects) from the Diagnostic Innovation in Glaucoma Study (mean follow-up, 46.8+/-14.2 months), with a minimum of 4 HRT images (range, 4-8). METHODS: Three experienced observers judged the presence of progression using the HRT follow-up printouts available for each HRT method of analysis (MRA, TCA, TA). The overall assessment was based on majority rule, with >or=2 graders agreeing on the classification. MAIN OUTCOME MEASURES: Observers agreement in assessing HRT progression and agreement for progression or no progression between the HRT methods of analysis and the reference standard represented by masked stereophotograph assessment. The kappa test was used to assess the interobserver agreement. RESULTS: In general, agreement among clinicians for subjective assessment of progression based on HRT printouts was moderate to good; agreement (kappa) ranged from 0.52 to 0.71 for MRA, 0.61 to 0.63 for TCA, and 0.45 to 0.74 for TA. Of the 237 eyes, 16 (6.8%) were found to progress during follow-up based on masked stereophotograph assessment. Agreement for progression/no progression between the HRT methods and stereophotography was similar among MRA (84.8%, agreement on 5 progressing eyes and 196 nonprogressing eyes; kappa = 0.14), TCA, (82.3%, agreement on 8 progressing eyes and 187 nonprogressing eyes; kappa = 0.2), and TA (84%, agreement on 2 progressing eyes and 197 nonprogressing eyes; kappa = 0.01). CONCLUSIONS: Clinicians' agreement in identifying suspected glaucomatous progression using different HRT methods of analysis was moderate to good and was similar among all methods, including MRA, which is not designed to detect progression. Agreement between progression identified by HRT and masked stereophotograph assessment was poor. These results suggest that assessment of the HRT and stereophotography may be identifying different aspects of structural change. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosures may be found after the references.

[Cultural adaptation and validation into Spanish of the Glaucoma Symptom Scale (GSS)]. / Adaptación cultural y validación al español del cuestionario de síntomas de glaucoma (Glaucoma Symptom Scale, GSS).

BACKGROUND AND OBJECTIVE: To describe the process of the cultural and psychometric adaptation (validation) into Spanish of the Glaucoma Symptom Scale (GSS) in order to measure the impact of glaucoma symptoms, and inform about the psychometric properties. MATERIAL AND METHOD: The study was supervised by a 6-member expert panel. After forward and backward translations in duplicate, a Spanish version was obtained which was administered to three samples: a 16-patient sample to check comprehenssion and face validity, a 100-patient sample to check structural validity (factor analysis and reliability) and, finally, a 387-patient sample for assessing construct and discrimination validity. RESULTS: The questionnaire yielded 2 dimensions, which are not exactly the same as the ones in the original study. Reliability was high (alpha=0.82), and correlation between even-odd items was high too (r=0.92). The scale discriminated between lower and upper quartile groups (p<0.001). The average on non visual symptoms was higher than on visual ones (p=0.001), showing more inconvenience of the former. There were differences between compliant and non-compliant patients (p=0.004), but a lack of agreement between self-reported measures was also found. We found differences between patients with one or 2 drops treatments (p=0.0014). CONCLUSIONS: The results showed acceptable psychometric properties and they make available to health professionals a new instrument to assess glaucoma symptoms, taking into account the patient perspective.

Apoptosis in the trabecular meshwork of glaucomatous patients.

We established and validated an in toto method to perform TdT-mediated dUTP nick end labeling to study apoptosis in human trabecular meshwork tissue obtained during trabeculectomy in glaucoma patients. In specimens from patients with primary open-angle glaucoma and primary angle-closure glaucoma, we detected a tendency for more apoptotic cells to accumulate in patients with primary open-angle glaucoma. The utility of this method to study apoptosis in the trabecular meshwork is discussed, as well as its application as a tool in biologic samples.

Identification of the optic nerve head with genetic algorithms.

OBJECTIVE: This work proposes creating an automatic system to locate and segment the optic nerve head (ONH) in eye fundus photographic images using genetic algorithms. METHODS AND MATERIAL: Domain knowledge is used to create a set of heuristics that guide the various steps involved in the process. Initially, using an eye fundus colour image as input, a set of hypothesis points was obtained that exhibited geometric properties and intensity levels similar to the ONH contour pixels. Next, a genetic algorithm was used to find an ellipse containing the maximum number of hypothesis points in an offset of its perimeter, considering some constraints. The ellipse thus obtained is the approximation to the ONH. The segmentation method is tested in a sample of 110 eye fundus images, belonging to 55 patients with glaucoma (23.1%) and eye hypertension (76.9%) and random selected from an eye fundus image base belonging to the Ophthalmology Service at Miguel Servet Hospital, Saragossa (Spain). RESULTS AND CONCLUSIONS: The results obtained are competitive with those in the literature. The method's generalization capability is reinforced when it is applied to a different image base from the one used in our study and a discrepancy curve is obtained very similar to the one obtained in our image base. In addition, the robustness of the method proposed can be seen in the high percentage of images obtained with a discrepancy delta<5 (96% and 99% in our and a different image base, respectively). The results also confirm the hypothesis that the ONH contour can be properly approached with a non-deformable ellipse. Another important aspect of the method is that it directly provides the parameters characterising the shape of the papilla: lengths of its major and minor axes, its centre of location and its orientation with regard to the horizontal position.