[Clinical evaluation of the Pascal dynamic contour tonometer]. / Evaluation clinique du tonomètre dynamique de contour Pascal.

PURPOSE: The Pascal dynamic contour tonometer (DCT) was designed to measure IOP independently of corneal properties. This study aimed at 1) assessing the intra- and interindividual variability of DCT IOP measurements, the differences between DCT and applanation tonometry IOP measurements (APL), and their correlations with central corneal thickness (CCT); 2) analyzing the variability of the ocular pulse amplitude (OPA) and its correlations with age, blood pressure (BP), cardiac beat pulse (CP), diagnosis of glaucoma, IOP, and severity of glaucomatous visual field (VF) defects. METHODS: Twenty-five normal subjects (25 eyes), 14 patients with ocular hypertension (27 eyes), and 54 glaucomatous patients (104 eyes) were included in this prospective study. In the first 12 normal subjects, three consecutive IOP measurements were taken by three different observers using DCT, directly followed by three measurements with APL by the same observer. In the following 13 subjects, the reverse sequence was followed. In the other group, the IOP measurements (three DCT and three APLs) were taken by the same observer. Only DCT measurements with quality levels 1-3 were considered for analysis. RESULTS: In the normal group, DCT IOP measurement variability varied between 4.4%-7.3% (intraobserver variation coefficient) and 8% (interobserver variation coefficient). DCT IOP measurement was not influenced by the sequence of measurements or the observer. DCT overestimated IOP by a mean of 2.2 mmHg compared with APL (p<0.001). The 95% limits of agreement for each subject tested with both tonometers ranged from -0.5 mmHg to +6.3 mmHg. IOP APL and DCT measurements were strongly correlated. Both DCT and APL were not correlated with CCT. OPA ranged from 1.2 mmHg to 6.6 mmHg (mean, 3.1+/-1.2 mmHg) and was comparable between the three observers. Intraobserver OPA variability ranged from 7.6% to 9.5%. The interobserver OPA variability coefficient was 8.8%. OPA was only correlated with systolic BP (p<0.05). In glaucomatous patients, the correlation between DCT and APL IOP measurements was highly significant (r=0.860, p<0.001). DCT overestimated IOP by a mean 2 mmHg compared with APL (p<0.001). IOP differences between both tonometers were not influenced by the sequence of measurements. Unlike APL, DCT was not or only slightly influenced by CCT (p=0.07 for DCT; p=0.001 for APL). The mean difference between IOP DCT and APL was larger in thin corneas (<520 microm): 2.8+/-3.1 mmHg versus 0.8+/-2.3 mmHg in thick corneas (580 microm) (p=0.001). OPA was not correlated with age. It was positively correlated with IOP (p<0.001), systolic BP (p=0.047), and MD (mean deviation) (p=0.018). It was negatively correlated with diastolic BP (p=0.003), cardiac frequency (p<0.001), severity of glaucomatous VF defects (p=0.002), and PSD (pattern standard deviation) (p=0.008). It was significantly higher in the OHT subgroup and significantly lower in the NTG subgroup (p<0.05). In both groups, the IOP difference between DCT and APL was not correlated with age (p>0.05). CONCLUSIONS: IOP measurements with the Pascal(R) DCT and APL correlated well and were reproducible. DCT IOP measurement variability was slightly higher than APL with relatively wide 95% limits of agreement. Considering the entire study population, DCT overestimated IOP by a mean 2.0 mmHg compared with APL. DCT was independent of CCT, especially in thin corneas. The DCT does not appear to be clinically advantageous over the Goldmann tonometer in the IOP measurement in thick corneas. Therefore an IOP follow-up by APL tonometry and pachymetry appeared to be mandatory for the interpretation of the true IOP. Interindividual OPA variations were high, as was measurement variability. OPA was correlated with BP, cardiac frequency, IOP, diagnosis of glaucoma, and severity of glaucomatous VF defects. These must be considered in the clinical interpretation of this parameter.

Comparative safety profile between "modern" trabeculectomy and non-penetrationg deep sclerectomy.

PURPOSE: To compare the incidence and the severity of short-and medium-term complications following "modern" trabeculectomy (mTRAB) with non-penetrating deep sclerectomy (NPDS). MATERIALS AND METHODS: Comparative retrospective nonrandomized study including 65 eyes (55 patients) (mean age: 68.6 years) with medically uncontrolled glaucoma. mTRAB was performed in 43 eyes, NPDS in 22 eyes. mTRAB was performed according to a slightly modified P.T. Khaw protocol. NPDS procedures were done according to Kozlov's and Mermoud's technique with SKGEL implant in 18/22 eyes. Intraoperative antimetabolites (AMETAB) were given in 25 eyes (58%) in the mTRAB and 17 (77%) in the NPDS (p>0.05). RESULTS: Mean follow-up was longer in NPDS (10.7+/-5.5 months) than in mTRAB (8.5+/-3.4 months) (p<0.05). Preoperatively, the two groups were comparable in respect of age, type of glaucoma, mean IOP, severity of VF defects and bleb failure risk factors (p>0.05). Peroperatively, mTRAB were uneventful in 86% vs 90% of NPDS. 1st month postop complications occurred in 60.4% in mTRAB and 77.2% in NPDS (P>0.05). Most of them were minor and transient in both surgeries. Postop early anterior chamber inflammation was mild to moderate in all cases. The incidence of wound leaks (21% in the mTRAB group and 18% in the NPDS group) and hyperfiltration related complications (14% and 13.6% respectively in the mTRAB and NPDS group) were comparable between the two procedures (p > 0.05). Intraoperative antimetabolite application was not associated with an increased rate of postoperative hyperfiltration related complications. Scarring of filtration blebs had concerned a lower percentage of mTRAB eyes (19%) than the NPDS (36%). The number for 5-FU injections was less - although not significantly - in the mTRAB than in the other group (18.6% in mTRAB versus 41% in NPDS (p=0.05). Late complications were not observed in the mTRAB group. Iris prolapse associated with increased IOP occurred in 3 of the 22 NPDS procedures (13.6%). Final mean visual acuity was unchanged compared with preop value and was similar between the 2 groups (p>0.05). Diffuse, mildly vascularized filtration blebs were observed in 84% in mTRAB and 64% in DS (p>0.05). Mean IOP significantly decreased from 24.8+/-8.3 mm Hg to 13.4+/-4,3 mm Hg in mTRAB and from 25.1+/-6.5 mm Hg to 14.7+/-4.6 mm Hg in DS (p> 0.05). It was not different between the 2 groups with and without AMETAB augmentation. 70% of the mTRAB achieved a final IOP < or = 15 mmHg vs 41% in NPDS (p<0.05). The mean number of postop medications was 0.49 in mTRAB and 0.96 in NPDS (p<0.05). Complete (target IOP reached without meds) and qualified (target IOP reached with and without meds) final success rates were 60% and 88% in mTRAB and 36.4% and 68.2% in NPDS (p>0.05). CONCLUSIONS: Whether surgery was augmented with intraoperative antimetabolite or not, mTRAB revealed as a priority to be associated with comparable and even less complications than deep sclerectomy. Owing to the limitations of our study and until further confirmation, our results have suggested that mTRAB was associated with a slightly more important IOP reduction as well as higher success rates than NPDS.

Five-year experience with non penetrating deep sclerectomy.

PURPOSE: To assess the long-term safety and effectiveness of non penetrating deep sclerectomy (DS) and to compare the incidence and the severity of postoperative complications and the IOP results according to surgical adjuvants (implant device, antimetabolite or both) were used or not. MATERIAL-METHODS: Retrospective non randomised study including 171 eyes (136 patients), mean age: 63.9 years) with medically uncontrolled open-angle glaucoma and without previous filtering surgery. 81 eyes (48.2%) had severe glaucomatous damage. All procedures were performed according to the Kozlov's and Memoud's technique. Except for 8 eyes, they were associated with the placement of an implant device (SKGEL or T-FUX) and/or intra-operative application of low dose antimetabolite (5-FU in 58 eyes and mitomycine C in 53 eyes). RESULTS: Mean follow-up was 39.6 +/- 18.3 months. According to surgery, DS were categorized in 4 groups: Group 1: DS with Healon GV (n=8)(4.7%); Group 2: DS with antimetabolite application (n=26) (15.2%); Group 3: DS with placement of an implant (n=53) (31%). Group 4: intraoperative antimetabolite +implant device (n=84 eyes) (49.1%). Peroperative microperforations without iris hernia occurred in 35 eyes (21%). 1st month postoperative complications were observed in 90 eyes (52.6%) with mild to moderate hyperfiltration in 27 eyes, excessive scarring of filtration bleb in 38 eyes, and iris incarceration in 10 eyes. 5-FU injections were given in 58 eyes (34%). YAG gonioperforation was needed in 107/171 eyes (63%) and was complicated by iris incarceration in 9 eyes. Early and late spontaneous iris incarceration was observed in 10 eyes. A second filtering procedure was needed in 10 eyes.

[Clinical evaluation of the dynamic rebound tonometer Icare]. / Evaluation clinique du tonomètre dynamique Icare.

PURPOSE: The Icare dynamic tonometer (impact or Rebound tonometry) is a new tonometer based on making a moving object collide with an eye and on monitoring the motion parameters of this object following contact. The purpose of this study was to assess intra- and interobserver variability of IOP measurements with the Icare and their correlations with Goldmann applanation tonometry (GAT) and central corneal thickness (CCT). MATERIAL AND METHODS: A prospective study including three groups of patients: group 1 (50 normal subjects), group 2 (50 patients with OHT or POAG and GAT IOP>22 mmHg), and group 3 (38 glaucomatous patients with GAT IOP< or =22 mmHg). In group 1, three consecutive IOP measurements were taken by three distinct observers with Icare followed by three GAT measurements by the same clinician. In group 2, the same procedure was followed from patients 1 to 25 and the reverse sequence from patients 25 to 50 after a 10-min break. In group 3, only one clinician took three GAT measurements followed by three Icare measurements after a 10-min break to exclude a tonographic effect in eyes with statistically normal-range IOPs. RESULTS: : In group 1, intraobserver variability was about 6% for each observer (NS). There was no learning curve effect. The interobserver variation coefficient was 6.4%. Icare overestimated IOP compared to GAT (mean difference, 1.5-2.2 mmHg) (p<0.001). Icare IOP was 23.4 mmHg for observer 1 when GAT was 22 mmHg (95% individual CI, 18-28.9 mmHg). In group 2, intraobserver variation coefficients of the IOP ranged from 5% to 5.4% (NS). Icare overestimated IOP by mean 0.84 mmHg compared with GAT. In group 3, mean IOP was not different between Icare and GAT. Icare IOP of 20.7 mmHg corresponded to a value of 22 mmHg using GAT. In this group, correlations between CCT and IOP measurements were higher for Icare than for GAT (p=0.062). CONCLUSION: Icare measures IOP in an unanesthetized sitting patient in a very brief time. Patient's minimal cooperation is needed. As long as the device is correctly positioned, the learning curve is short. Icare gives reproducible IOP measurements. Intra- and interobserver variability of IOP measurements are close to those of GAT. Icare overestimates IOP measurements an average 1.5 mmHg compared with GAT. Whatever the IOP level, Icare IOP measurements are well correlated with GAT. To a greater extent than for GAT, the reliability of IOP measurements is influenced by CCT. This tonometer can be used as a screening device for ocular hypertension as long as CCT measurements can be taken.

Evaluation of a supplemental assay for the diagnosis of hepatitis C virus infections.

OBJECTIVES: A supplemental test was evaluated for hepatitis C virus (HCV). METHODS: One hundred forty-six sera that were inconclusive or discrepant in two screening tests for HCV infection were evaluated using a supplemental test, MATRIX-HCV2 (Abbott Laboratories, Chicago, IL, USA). Results of the supplemental test were compared to the detection of HCV RNA by a nested polymerase chain reaction after a step of reverse transcription (RT-PCR). RESULTS: Thirty-nine RNA-containing sera (positive with RT-PCR) of 40 (97%) reacted with at least one antigen in the supplemental test. Reactivity with one to three antigens also was observed with 77 PCR-negative sera (66%). Twenty-nine sera were found negative with both techniques. CONCLUSIONS: Despite clear results and good sensitivity, the MATRIX-HCV2 assay was poorly predictive of viremia in patients with indeterminate results in initial screening assays.