Central corneal thickness and intraocular pressure in children undergoing congenital cataract surgery: a prospective, longitudinal study.

AIM: To investigate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after congenital cataract surgery, as well as risk factors associated with these changes. METHODS: 37 eyes of 26 children with congenital cataract undergoing surgery were prospectively recruited. IOP and CCT measurements were performed before the surgery and 6, 12, 18, 24 and 36 months after the procedure. RESULTS: Among the 37 eyes, 15 became aphakic and 22 pseudophakic. Mean CCT significantly increased from 556.24 ± 44.19 to 585.07 ± 56.45 µm (p=0.003) after 3 years, whereas mean IOP significantly increased from 12.05 ± 2.3 to 13.89 ± 2.96 mm Hg (p=0.037). Aphakic eyes underwent surgery at an early age (15.16 ± 32.02 months) compared with pseudophakic eyes (71.48 ± 53.14 months) (p<0.001). After 3 years, mean CCT change in aphakic eyes (56.10 ± 46.97 µm) was significantly higher than in pseudophakic eyes (12.71 ± 38.41 µm) (p=0.015). Age at the time of surgery was inversely correlated to CCT change (r=-0.34, p=0.04), but not to IOP change (r=-0.18, p=0.27). When surgery was performed between 0 and 1 year of age, mean CCT change at 3 years was 70.11 ± 42.3 µm, compared with 6.27 ± 28.09, -17.0 ± 8.04 and 48.33 ± 34.99 µm when surgeries were performed at 1-5, 5-10 and >10 years old, respectively (p<0.001). IOP change was not correlated to CCT change (r=0.31, p=0.06). CONCLUSIONS: CCT increases in eyes undergoing congenital cataract surgery, especially when the surgery is performed at an early age.

Influence of pupil size and other test variables on visual function assessment using visual evoked potentials in normal subjects.

The purpose of this study was to assess the influence of pupil size and optical blur on measurements obtained with isolated-check visual evoked potential (icVEP). Two stimulus conditions of icVEP, +15 and -15% contrasts, were studied in normal subjects with normal (N), miotic (M), and dilated (D) pupils. The effects of optical blur were studied in subjects with normal pupil. Response to visual stimuli was quantified by a signal-to-noise (SNR) ratio. In 30 normal subjects, the mean age was 26.0 +/- 3.4 years. Mean pupil diameters were N = 4.2 +/- 0.6 mm, M = 2.7 +/- 0.6 mm, and D = 7.3 +/- 0.9 mm. For both +15 and -15% contrast levels, mean SNR values were reduced for dilated and constricted pupils when compared with normal pupils. Mean SNR values for optical blur with a +2 or +3 diopter lens placed over the distance correction were reduced when compared with SNR measurements obtained with best-corrected visual acuity under both +15 and -15% contrast levels. Statistical significance was found in comparisons of N versus M (P < 0.001) and N versus D (P = 0.002) for +15 and -15% contrast conditions, respectively. No statistical difference was seen for M versus D (P = -0.435). The effect of optical blur was statistically significant when compared to the normal pupils with best-corrected vision (P < 0.001). No statistically significant difference was found comparing +2 and +3 diopters lenses for optical blur testing. Visual evoked potential values are influenced by pupillary constriction and dilation, as well as optical blur. When obtaining icVEP measurements, the influence of pupil size and optical blur should be kept in mind for accurate interpretations.

Clinical outcomes of patients with anterior segment neovascularization treated with or without intraocular bevacizumab.

INTRODUCTION: The purpose of this study was to evaluate the clinical outcomes of patients with anterior segment neovascularization treated with or without intravitreal bevacizumab. METHODS: This was a retrospective, comparative case series of 60 patients with anterior segment neovascularization: 30 consecutive patients treated with intravitreal bevacizumab and 30 age-, gender-, and race-matched controls treated without bevacizumab. RESULTS: The mean follow-up time was 9.1+/-6.3 months in the bevacizumab group and 8.6+/-6.2 months in the control group (P=0.769). At baseline, no significant difference was observed in initial visual acuity, intraocular pressure, gonioscopy, and iris or angle neovascularization (P=0.179, 0.432, 0.065, and 0.966, respectively). At the final examination, no significant difference was observed in mean intraocular pressure (P=0.464), mean number of glaucoma medications (P=1.00), or presence of anterior segment neovascularization (P=0.699). Final visual acuity better than 20/60 was achieved in six patients in the bevacizumab group and none in the control group (P=0.013). Comparison of linear regressions of baseline and final visual acuity (LogMAR) showed a significant difference between the two groups (P=0.040). In the bevacizumab group, 18 patients required glaucoma surgery, whereas 30 patients in the control group required surgery (P<0.001), usually with a glaucoma drainage implant. Both bevacizumab and control patients who presented with closed angles required glaucoma surgery (P=1.000). CONCLUSIONS: Treatment of anterior segment neovascularization with intravitreal bevacizumab significantly improves visual outcomes and significantly decreases the need for glaucoma surgery. In patients with closed anterior chamber angle, addition of bevacizumab treatment does not reduce the need for glaucoma surgery.

Comparison of twice-daily and three-times-daily dosing of dorzolamide in ocular hypertension and primary open-angle glaucoma patients treated with latanoprost.

INTRODUCTION: Clinically, dorzolamide (Trusopt(R); Merck & Co Inc, West Point, PA, USA) is often used twice daily (b.i.d.) or three times daily (t.i.d.) as adjunctive therapy with prostaglandins. Our purpose was to determine the effect of dorzolamide on intraocular pressure (IOP) when added to latanoprost (Xalatan(R); Pfizer Inc, New York, NY, USA) baseline treatment, and to evaluate potential efficacy differences between b.i.d. and t.i.d. dosing of dorzolamide. METHODS: This was a prospective, randomised, two-period crossover trial in ocular hypertensive or primary open-angle glaucoma patients (29 eyes in 15 patients) with an IOP of > 20 mmHg on latanoprost baseline treatment. Patients were randomly assigned to b.i.d. (08.00 and 20.00) or t.i.d. (08.00, 16.00 and 20.00) dosing of dorzolamide, treated in both eyes for 4 weeks, washed out for 3 weeks, then switched to the opposite dosing frequency for 4 weeks. Diurnal IOP measurements (every 2 hours from 08.00 to 20.00) were performed at baseline and at the end of treatment periods. RESULTS: The mean baseline IOP was 20.9+/-0.6 mmHg. After b.i.d. and t.i.d. dosing, the mean IOP was 17.7+/-0.6 mmHg (13.5% reduction) and 17.8+/-0.8 mmHg (16.5% reduction), respectively (both P<0.001 compared with baseline IOP). Diurnal IOP control was similar in the two groups, although mean IOP reduction was significantly lower at 18.00 on the t.i.d. regimen (4.7+/-3.3 mmHg) than with the b.i.d. regimen (2.3+/-2.7 mmHg, P=0.038). At other time points, no significant differences between the groups were observed. CONCLUSION: Dorzolamide 2% added to latanoprost 0.005% baseline treatment caused a significant decrease in IOP. The b.i.d. versus t.i.d. dosing of dorzolamide did not significantly affect a change in IOP except at one afternoon time point.