Difference in intraocular pressure measurements between non-contact tonometry and Goldmann applanation tonometry and the role of central corneal thickness in affecting glaucoma referrals.

BACKGROUND: Patients at glaucoma risk are commonly identified by optometrists and subsequently referred to glaucoma specialists. Optometrists mainly use non-contact tonometry (NCT) for intraocular pressure (IOP) measurement. AIMS: To investigate the role of differences in IOP measurement between NCT and Goldmann applanation tonometry (GAT) and the effect of central corneal thickness (CCT) on these differences in optometrist referrals METHODS: Details of the initial clinical visit of patients referred with IOP > 21 mmHg in either eye as measured by NCT to a consultant glaucoma specialist were retrospectively reviewed. Demographic and referral data, IOP, CCT, and glaucoma diagnosis were obtained. The main outcome measure was the IOP measurement differences between NCT and GAT. RESULTS: Of the 98 patients referred, only 23% had IOP > 21 mmHg when measured by GAT. NCT (Nidek NT400, Reichert Puff, Pulsair Easy Eye) measured the IOP greater than GAT by a mean of 5.8 mmHg (NCT 24.1 ± 3.5, GAT 18.3 ± 3.0). The effect of CCT on IOP measurement was less for GAT (R2 0.034, p = 0.067) than for NCT (R2 0.088, p = 0.003). The NCT/GAT IOP differences increased with increasing CCT (R2 0.166, p < 0.0001). The NCT/GAT differences decreased with patient age (R2 0.048, p = 0.03). Patients were classified as normal 67% (66/98), ocular hypertension 11% (11/98), glaucoma suspect 14% (14/98), and glaucoma 7% (7/98). CONCLUSIONS: The difference in IOP measurement between NCT and GAT leads to a possible increase in glaucoma referrals, particularly in patients with thicker corneas. Repeat IOP using GAT and CCT measurement would help in triaging referrals.

Visual outcomes after chemotherapy for optic pathway glioma in children with and without neurofibromatosis type 1: results of the International Society of Paediatric Oncology (SIOP) Low-Grade Glioma 2004 trial UK cohort.

AIMS: To report visual acuity (VA) outcomes following chemotherapy for optic pathway glioma (OPG) in children with or without neurofibromatosis type-1 (NF1) and to analyse associated risk factors. METHODS: A prospective, multicentre, cohort study involving 155 children treated between September 2004 and December 2012. Initial and final VA was used for per-eye and per-subject analysis. Correlation tests were performed to determine whether initial VA predicted final VA. Logistic regression was used to determine whether age and tumour location were associated risk factors. RESULTS: 90 children had complete ophthalmological data. At initiation of chemotherapy, 26% and 49% of eyes with NF1-OPG and sporadic OPG, respectively, had VA of ≥0.7 log of the minimum angle of resolution (logMAR). At final visit, per eye, 49% had ≤0.2, 23% had 0.30-0.60 and 28% had VA≥0.70 logMAR in the NF1-OPG group. In the sporadic OPG group, per eye, 32% had ≤0.2, 11% had VA 0.30-0.60 and 57% had ≥0.70 logMAR. Children with sporadic OPG, per eye, were significantly less likely to have VA outcomes ≤0.60 logMAR compared with children with NF1-OPG (OR=0.30; 95% CI 0.16 to 0.56; P<0.0001). Per subject, VA improved in 24%, remained stable in 35% and worsened in 41% of children with NF1-OPG and improved in 18%, remained stable in 43% and worsened in 39% of children with sporadic OPG. CONCLUSIONS: Children with and without NF1 demonstrated the same rate of VA improvement, stabilisation or worsening; however, children with sporadic OPG had a poorer VA outcome. Better initial VA, older age, absence of postchiasm tumour and presence of NF1 were associated with improved or stable VA outcomes.

The ophthalmic natural history of paediatric craniopharyngioma: a long-term review.

We present our experience over the long-term of monitoring of visual function in children with craniopharyngioma. Our study involves an analysis of all paediatric patients with craniopharyngioma younger than 16 at the time of diagnosis and represents a series of predominantly sub-totally resected tumours. Visual data, of multiple modality, of the paediatric patients was collected. Twenty patients were surveyed. Poor prognostic indicators of the visual outcome and rate of recurrence were assessed. Severe visual loss and papilledema at the time of diagnosis were more common in children under the age of 6. In our study visual signs, tumour calcification and optic disc atrophy at presentation are predictors of poor visual outcome with the first two applying only in children younger than 6. In contrast with previous reports, preoperative visual field (VF) defects and type of surgery were not documented as prognostic indicators of poor postoperative visual acuity (VA) and VF. Contrary to previous reports calcification at diagnosis, type of surgery and preoperative VF defects were not found to be associated with tumour recurrence. Local recurrence is common. Younger age at presentation is associated with a tendency to recur. Magnetic resonance imaging (MRI) remains the recommended means of follow-up in patients with craniopharyngioma.

Correction of undesirable pseudophakic refractive error with the Sulcoflex intraocular lens.

PURPOSE: To evaluate the visual outcomes, efficacy, predictability, and short-term safety of implanting the Sulcoflex (Rayner Intraocular Lenses Ltd) intraocular lens (IOL) to correct residual pseudophakic errors. METHODS: Retrospective study of patients undergoing implantation of the Sulcoflex IOL. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and refractive outcomes were evaluated. Postoperative follow-up was at 1 week and 1, 3, 6, and 12 months. RESULTS: Fifteen eyes (13 patients) were evaluated. Mean follow-up was 20 months (range: 14 to 30 months). The Sulcoflex aspheric (653L) and toric (653T) IOLs were implanted in 3 and 12 eyes, respectively. Preoperatively, mean logMAR (Snellen) UDVA and CDVA were 0.44 (20/55) and 0.05 (20/22), respectively. At 3 months, all eyes achieved logMAR UDVA of 0.20 (20/32) or better, with 10 (67%) eyes achieving UDVA of 0 (20/20) or better. Preoperative mean spherical and astigmatic errors were 1.07±0.83 diopters (D) and -1.45±0.98 D, respectively. Preoperative mean spherical equivalent refraction was -0.54±1.11 (D). Postoperative mean sphere and astigmatism at 3 months were -0.25±0.38 D and -0.50±0.57 D, respectively. Postoperative mean spherical equivalent refraction at 3 months was -0.15±0.28 D. All patients were within 1.00 D of attempted correction, with 93% within 0.50 D. Linear regression analysis showed good correlation (R²=0.72) between attempted versus achieved spherical equivalent refractions. No significant intra- or postoperative complications occurred. CONCLUSIONS: Implantation of the Sulcoflex IOL was found to be an effective and predictable option for enhancing postoperative refractive results and reducing spectacle dependence for distance after surgery. The IOL was well tolerated in all eyes.

Presumed occult globe rupture resulting in sympathetic ophthalmia.

INTRODUCTION: Sympathetic ophthalmia (SO) is an uncommon bilateral granulomatous panuveitis following uveal trauma to one eye. We present an unusual case of SO which resulted from presumed occult globe rupture following blunt trauma; and highlight the association of trauma and acquired external ocular pigmentation as a possible predictor for SO. CASE REPORT: Five weeks following blunt trauma to the left eye (OS), a 30-year-old patient presented complaining of spontaneous blurred vision (4/60) in the right eye (OD). In the OD, there was anterior chamber and vitreous inflammation (3+), multiple areas of serous retinal detachments, Dalen Fuchs spots, and optic disk swelling. In the OS, there was iridodialysis, post-traumatic acquired external ocular pigmentation suggestive of occult globe rupture. This was diagnosed as SO and treated with systemic steroids and a steroid sparing agent; which resulted in resolution of the inflammation with improvement in the visual acuity. CONCLUSION: Sympathetic ophthalmia has been reported to occur following penetrating eye injury secondary to trauma and surgery, and also secondary to non-penetrating eye trauma. This case reports SO occurring after presumed occult globe rupture; and reinforces the association between acquired external ocular pigmentation and SO in the context of trauma.