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AIM: To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS: Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS: Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman's correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, r s=0.879 (P<0.01); cGAT-TPA, -1.02±2.08, r s=0.723 (P<0.01); and nGAT-TPA, -2.35±2.23, r s=0.730 (P<0.01). Bland-Altman analysis for agreement between cGAT-TPA and nGAT-TPA mean IOP DCPo measurements revealed a mean difference of 1.02 (95%CI, 0.35-1.70) and 2.35 (95%CI, 1.62-3.07) mm Hg, respectively. Regression analysis yielded the following equation: TPA IOP=5.49+0.775×cGAT-0.015×ACD-0.299×corneal astig matism, which allowed us to infer TPA IOP values from other parameters. CONCLUSION: In keratoconic eyes, IOP peaks of DCPo measurements are identified at 6 a.m., independent of the tonometer. The mean DCPo values are: TPA>cGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.
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ABSTRACT Objective: To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP). Methods: Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3. Results: 54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0-23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness. Conclusion: A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.
RESUMO Objetivo: Avaliar alterações estruturais e do campo visual 1 ano ou mais após uma crise única de fechamento angular primário agudo utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada. Métodos: Pacientes que apresentaram crise unilateral única de fechamento angular primário agudo há pelo menos 1 ano foram consecutivamente incluídos entre 2013 e 2016. Os olhos contralaterais foram utilizados como controles. Todos os pacientes foram submetidos a exame oftalmológico, avaliação das camadas de fibras nervosas da retina utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada com o Octopus 1-2-3. Resultados: Foram incluídos 54 olhos (27 pacientes) com razão homem:mulher de 1:2. O tempo médio após a crise foi de 5,0±5,1 anos (1,0 a 23,5) e a pressão intraocular na crise foi 52,5±9,8mmHg. Nos olhos com fechamento angular primário agudo, todas as espessuras das camadas de fibras nervosas da retina peripapilares (36,3%; p<0,001) e de algumas seções maculares (de 2,1 a 4,7%; p<0,01) estavam reduzidas em comparação aos olhos contralaterais. Além do mais, nos olhos submetidos a fechamento angular primário agudo, o mean defect do campo visual foi estatisticamente e negativamente correlacionado com a redução da espessura de todos os quadrantes peripapilares da camada de fibras nervosas da retina. Conclusão: Um único episódio de fechamento angular primário agudo foi associado com redução na espessura da camada de fibras nervosas da retina peripapilar e da espessura macular e com defeitos de campo visual 1 ano ou mais após a crise no olho afetado. Correlações estatisticamente significativas foram identificadas entre danos estruturais e funcionais.