A two-year follow-up of oral antioxidant supplementation in primary open-angle glaucoma: an open-label, randomized, controlled trial.

PURPOSE: To evaluate the effect of oral antioxidant supplementation (OAS) on primary open-angle glaucoma (POAG) over a 2-year follow-up period. PATIENTS AND METHODS: In this open-label, randomized controlled trial, 117 eyes of 117 patients with mild or moderate POAG and intraocular pressure under control with topical antiglaucoma medications were recruited and randomly divided into three groups according to supplementation: (1) OAS with (ICAPS R(®) - Alcon Laboratories, n = 26); (2) OAS without ω-3 fatty acids (OFTAN MACULA(®) - Laboratorios Esteve, n = 28); and (3) a control group without OAS (n = 63). They all underwent visual field (VF) tests (Humphrey 24-2) and scans using a Fourier-domain optical coherence tomography (FD-OCT) device (RTVue-100) at the beginning of the study and 2 years later. Mean deviation (MD), standard pattern deviation (PSD), peripapillary retinal nerve fibre layer (RNFL) and macular ganglion cell complex (GCC) parameters were considered for the analysis. Patients were also classified according to MD deterioration (fast deterioration vs. slow deterioration). RESULTS: Visual field global indices, peripapillary RNFL thickness and macular GCC thickness showed no differences among the groups at the beginning and end of the follow-up. Besides all the comparisons among groups for differences before and after the follow-up of the MD, PSD, RNFL and GCC parameters were also non-significant. The proportions of patients according to MD deterioration were similar among the groups and subgroups (p > 0.05 for all the comparisons). CONCLUSION: Oral antioxidant supplementation with or without ω-3 fatty acids does not appear useful as an adjuvant treatment of mild/moderate POAG in the short term.

Comparative study of central corneal thickness using Fourier-domain optical coherence tomography versus ultrasound pachymetry in primary open-angle glaucoma.

PURPOSE: To compare central corneal thickness (CCT) results measured by Fourier-domain optical coherence tomography (FD-OCT) and ultrasound pachymetry (USP) in glaucomatous eyes. METHODS: In this prospective, observational cross-sectional study, 80 eyes of 80 patients with primary open-angle glaucoma (POAG) and no other ocular abnormality were selected: 28 were treated with 1 drug (subgroup 1), 32 with 2 drugs (subgroup 2), and 20 with 3 drugs (subgroup 3). CCT was measured by FD-OCT (RTVue OCT) and USP (Pachymeter Reichert IOPac). Bland-Altman plots were used to assess the agreement between both instruments. The differences between CCTs measured by USP and FD-OCT were compared among the 3 subgroups. RESULTS: The mean CCT was 537.76 ± 32.24 µm and 520.53 ± 30.44 µm for USP and FD-OCT, respectively. A significant difference was found between the mean values obtained by FD-OCT and USP (17.22 ± 7.96 µm, P < 0.001, paired Student t test). A high correlation was obtained for CCT measured by both methods (Pearson correlation coefficient = 0.969; P < 0.001), and there was good agreement between the 2 pachymetry methods. Similar differences in CCT using USP and FD-OCT were found among the 3 treatment subgroups (P > 0.05 in all pairwise comparisons, analysis of variance). CONCLUSIONS: FD-OCT underestimates CCT compared with CCT measured by USP in POAG. Although highly correlated, the difference between these 2 devices can be clinically significant in the context of refractive surgeries in POAG patients but not in intraocular pressure estimation. This difference also seems to be independent of the number of antiglaucoma treatments used.

Comparison of global indices and test duration between two visual field analyzers: Octopus 300 and Topcon SBP-3000.

PURPOSE: To compare the global indices and test duration as measured by Octopus 300 and Topcon SBP-3000 perimeters. To our knowledge, this is the first study performed in this way. METHODS: Eighty eyes of 40 glaucomatous and ocular hypertensive patients with previous perimetric experience had visual field tests with Octopus 300 (TOP strategy) and TOPCON SBP-3000. All pairs of tests were performed randomly on separate days, but within 1 month of each other. Taking into account reliability factors of both perimetric examinations, 54 eyes of thirty patients were eligible. Only one eye from each patient was considered. Mean sensitivity (MS), mean defect (MD), loss of variance (sLV-Octopus- and LV -Topcon-) and test duration times were considered. RESULTS: A significant difference was found between the global indices and duration times of the Octopus and the Topcon perimeters (p < 0.05; Wilcoxon test). Moderate degrees of correlation were obtained for MS (Spearman's rho = 0.635; p < 0.001) and MD (Spearman's rho = 0.592; p = 0.001) measurements. There was no correlation between sLV and LV (Spearman's rho = 0.181; p = 0.337). Agreements between pairs of global indices were low as measured by concordance correlation coefficient. CONCLUSION: Global indices measured by the Octopus and Topcon perimeters are significantly different, so direct comparison of the measured values is not reliable. Because of the poor association and agreement between values obtained by these two perimeters, indirect comparison is also inadvisable.

Central corneal thickness, intraocular pressure, and degree of myopia in an adult myopic population aged 20 to 40 years in southeast Spain: determination and relationships.

OBJECTIVE: To determine the values of, and study the relationships among, central corneal thickness (CCT), intraocular pressure (IOP), and degree of myopia (DM) in an adult myopic population aged 20 to 40 years in Almeria (southeast Spain). To our knowledge this is first study of this kind in this region. METHODS: An observational, descriptive, cross-sectional study was done in which a sample of 310 myopic patients (620 eyes) aged 20 to 40 years was selected by gender- and age-stratified sampling, which was proportionally fixed to the size of the population strata for which a 20% prevalence of myopia, 5% epsilon, and a 95% confidence interval were hypothesized. We studied IOP, CCT, and DM and their relationships by calculating the mean, standard deviation, 95% confidence interval for the mean, median, Fisher's asymmetry coefficient, range (maximum, minimum), and the Brown-Forsythe's robust test for each variable (IOP, CCT, and DM). RESULTS: In the adult myopic population of Almeria aged 20 to 40 years (mean of 29.8), the mean overall CCT was 550.12 µm. The corneas of men were thicker than those of women (P = 0.014). CCT was stable as no significant differences were seen in the 20- to 40-year-old subjects' CCT values. The mean overall IOP was 13.60 mmHg. Men had a higher IOP than women (P = 0.002). Subjects over 30 years (13.83) had a higher IOP than those under 30 (13.38) (P = 0.04). The mean overall DM was -4.18 diopters. Men had less myopia than women (P < 0.001). Myopia was stable in the 20- to 40-year-old study population (P = 0.089). A linear relationship was found between CCT and IOP (R(2) = 0.152, P ≤ 0.001). CCT influenced the IOP value by 15.2%. However no linear relationship between DM and IOP, or between CCT and DM, was found. CONCLUSIONS: CCT was found to be similar to that reported in other studies in different populations. IOP tends to increase after the age of 30 and is not accounted for by alterations in CCT values.

A 5-year follow-up of antioxidant supplementation in type 2 diabetic retinopathy.

PURPOSE: This study was designed to evaluate the effect of antioxidant supplementation on diabetic retinopathy (DR) over a 5-year follow-up period. To our knowledge, this is the first such clinical trial performed. METHODS: We recruited 105 type 2 diabetic patients with nonproliferative DR. A complete ophthalmic checkup and a plasma determination of oxidative (malonyldialdehyde [MDA]) and antioxidant parameters (total antioxidant status [TAS]) were obtained as the baseline. One part of the cohort was randomly assigned to oral antioxidant supplementation at nutritional doses. The same examinations were performed with 97 diabetic patients who completed the 5-year follow-up period. The best-corrected visual acuity, DR score, MDA, and TAS values were compared at the beginning and the end of the follow-up. RESULTS: Best-corrected visual acuity did not change during the follow-up, irrespective of supplementation. However, the retinopathy stage showed a retardation of progression in the subgroup with supplementation, but worsened in the subgroup with no antioxidant supplementation. Furthermore, the antioxidant supplementation group maintained its antioxidant plasma status levels, which was related to decreased oxidative plasma activity. CONCLUSIONS: Oral antioxidant supplementation could be a useful adjunctive long-term therapy in the treatment of nonproliferative DR.

Central corneal thickness and degree of myopia in the adult myopicpopulation of Almería, Spain

The aim of this work is to determine the values and study the relationship of central corneal thickness (CCT) and the degree of myopia (DM) in the adult myopic population aged 20-40 years in Almería, Southeast Spain. To our knowledge this first study addressing these issues in this region. A cross-sectional, descriptive, observational study in which 310 myopic patients aged 2040 years were selected by sex- and age-stratified sampling which was proportionally fixed to the population strata size, for which 20% prevalence of myopia, 5% epsilon and 95% confidence interval were hypothesised. CCT and DM and their relationships were studied by calculating means, the standard deviation, the 95% confidence interval for means, the median, Fisher’s (asymmetry) coefficient, range, maximum and minimum and BrownForsythe’s robust test for each variable. CCT measurements were taken with a DGH 4000 B ultrasound pachymeter, and subjective and objective ocular refractions were performed with a Nidek AR-6000 auto-refractor. In the adult myopic population of Almería aged 20-40 years (mean age, 29.8), the mean overall CCT was 550.12 micrometers. In general, no statistical differences were found between the right (548.98) and left (551.19) eyes (p=0.426). The CCT was thicker for men (553.62) than for women (546.61) (p=0.014), and there were no significant differences (p=0.553) in CCT for the 20-40 age group; therefore CCT is stable with age. The overall DM was -4.18 dioptres, with no statistically significant differences between the right (4.17) and left (4.19) eyes (p=0.901) in general. Men had less myopia (media -3.82) than women (mean -4.54) (p<0.001). Myopia was stable in the 20-40 age group (p=0.089). We found no linear relationship between CCT and DM (AU)

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The influence of posterior capsular opacification removal on anterior segment birefringence parameters as measured by scanning laser polarimetry.

PURPOSE: To determine the effect of posterior capsular opacification (PCO) removal on anterior segment birefringence (ASB) and its influence on peripapillary retinal nerve fibre layer (RNFL) retardation measurements obtained by means of scanning laser polarimetry. METHODS: In this prospective interventional study, scanning laser polarimetry was performed using GDx variable corneal compensation on 26 eyes of 26 patients who developed clinically significant PCO (after uncomplicated cataract surgery and with no other ocular pathology) both before and between 1 and 4 weeks after Nd:YAG capsulotomy. Best-corrected visual acuity (BCVA), intraocular pressure, corneal polarization axis (CPA), corneal polarization magnitude (CPM) were compared using the Student t-test and Wilcoxon signed ranks test. Spearman correlations between changes (differences between values after and before capsulotomy) in the CPA, CPM, BCVA and RNFL data were also performed. RESULTS: PCO removal is associated with a shift in CPA (from 10.86 to 15.03 degrees, P = 0.004) and CPM (from 28.54 to 37.92 nm, P = 0.004). Significant correlations were found between changes in the parameters of ASB and BCVA. Furthermore, RNFL measurements (nerve fibre indicator, temporal-superior-nasal-inferior-temporal average and superior average) were also well related to the CPA and CPM shifts. CONCLUSIONS: PCO induces an inaccurate compensation of ASB which affects RNFL assessment. Thus, it is necessary to recompensate ASB after posterior capsulotomy.

Conjunctival provocation test for the diagnosis of ocular hypersensitivity to chlorobutanol.

PURPOSE: Conjunctival provocation test (CPT) is a useful tool for the determination of the reagent in patients with allergic conjunctivitis. Our aim is to present an unusual reaction of ocular hypersensitivity to chlorobutanol by using this technique. METHODS: This case describes a 56-year-old woman who presented intense ocular pruritus and conjunctival hyperemia with each instillation of Colircusi Fluotest (Alcon, El Masnou, Spain). Skin tests and CPTs were considered. RESULTS: Skin tests were all negative. CPTs were performed with commercially available ophthalmic products that were selected for their compositions. Chlorobutanol was presumed as the reagent through elimination. Positive CPT with purified chlorobutanol confirmed this hypothesis. CONCLUSION: CPT performed with commercially available products can be a useful, accessible, and inexpensive technique to orient the diagnosis of suspected ocular hypersensitivity to a pharmacologic component. To our knowledge, this is the first report of ocular hypersensitivity to chlorobutanol.

Effect of posterior capsular opacification removal on scanning laser polarimetry measurements.

PURPOSE: To evaluate the effect of posterior capsular opacification (PCO) on retinal nerve fiber layer (RNFL) retardation measurements obtained during scanning laser polarimetry (SLP). We are unaware of previous studies undertaken in this sense. METHODS: SLP was performed using GDx variable corneal compensation (VCC) on 28 eyes of 28 non-glaucomatous patients with clinically significant PCO, previous uneventful cataract surgery and no other ocular pathology, both before and after Nd:YAG capsulotomy. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and SLP examination parameters prior and following PCO removal were compared using the Student t-test and Wilcoxon's test. Spearman correlations between BCVA and SLP measurements before and after capsulotomy were also performed. RESULTS: PCO removal was associated with an increase of BCVA (P<0.0001), nerve fiber indicator (NFI) (P<0.0001) and typical scan score (TSS) (P<0.0001). In parallel, significant decreases of all absolute parameters were observed after capsulotomy. IOP, symmetry, superior ratio, inferior ratio and temporal-superior-nasal-inferior-temporal (TSNIT) standard deviation (SD) revealed no changes. Before capsulotomy, marked correlation existed between the BCVA and some SLP measurements such as nasal average (r= -0.703; P<0.0001) or NFI (r= 0.564; P=0.0017). After PCO removal these correlations were no longer found. CONCLUSIONS: PCO removal changes SLP measurements. Therefore, new measurements to serve as a baseline for future comparisons should be obtained after Nd:YAG capsulotomy. Furthermore, some SLP measurements were significantly associated with BCVA before capsulotomy, suggesting that this technology may be useful to quantify PCO degree in non-glaucomatous patients.

Posterior capsular opacification affects scanning laser polarimetry examination.

PURPOSE: To illustrate the effect of posterior capsular opacification (PCO) on retinal nerve fiber layer (RNFL) retardation measurements obtained during scanning laser polarimetry (SLP). METHODS: SLP was performed using GDx VCC on three eyes of three non-glaucomatous patients with clinically significant PCO, before and after Nd:YAG capsulotomy. RESULTS: PCO removal by Nd:YAG capsulotomy was associated with marked variations in retardation map morphology and with apparent RNFL thinning. Retardation map atypia decreased and typical scan score (TSS) increased remarkably after capsulotomy in all three cases. CONCLUSION: An artifact introduced by PCO presence can affect SLP measurements reliability.

Monocular diplopia after neodymium: YAG laser capsulotomy.

PURPOSE: To present an unusual complication of posterior capsulotomy such as monocular diplopia and to discuss the importance of capsulotomy size. CASE REPORT: A 57-year old man came to our clinic complaining of horizontal monocular diplopia in his right eye for the past 3 days. The patient had undergone a Nd:YAG capsulotomy in this eye 3 weeks before. Slit-lamp biomicroscopy under pupil dilation revealed a small capsulotomy and a considerable Elschnig pearl as the presumable cause of the diplopia. The rest of the examination was completely normal. RESULTS: After repeat Nd:YAG capsulotomy treatment, the diplopia disappeared. CONCLUSION: Capsulotomy size is a significant factor to consider when treating a posterior capsular opacification. A capsulotomy that is larger than the pupil diameter under scotopic conditions may avoid disturbances of vision such as monocular diplopia.