Selective Laser Trabeculoplasty as a Substitute for Medications in Patients with Mild-to-moderate Glaucoma in the Brazilian Public Health System.

PRCIS: Selective laser trabeculoplasty can be used as a substitute for medications in patients with mild-to-moderate glaucoma, reducing the cost of eye drop distribution in the Brazilian public health system. PURPOSE: To observe the effectiveness of selective laser trabeculoplasty (SLT) as a substitute for eye drops in patients with open angle glaucoma in the Brazilian Public Health System. MATERIALS AND METHODS: SLT was performed bilaterally after medication washout. This is a prospective interventional study comparing intraocular pressure (IOP) when using eye drops at baseline (post-washout), and at 12-month follow-up after SLT. Medication was added if the target IOP was not achieved, following the Brazilian Public Health System eye drops protocol, based on medication costs. Absolute (without eye drops) and qualified (with eye drops) success were measured with IOP ≤ 21, IOP ≤ 18, IOP ≤ 15 and IOP ≤ 12 mm Hg. Besides IOP evolution, the ability to reduce IOP (in %), and eye drops reduction were evaluated. RESULTS: Ninety-two eyes of 46 patients were included, 70 eyes with mild glaucoma and 22 with moderate glaucoma; the mean number of eye drops was 2.26±1.06 (82.6% were using a prostaglandin analogue), and post-washout IOP of 21.10±5.24 mm Hg. There was relative success at IOP ≤18 mm Hg, where the mild group had greater success than the moderate group (88.1% vs. 71.4%, P =0.824). The average IOP reductions were 23.04% and 25.74% at 6 and 12 months, respectively. The average number of eye drops was 1.02, with 1.1% using a prostaglandin analogue. Furthermore, 68.19% of the patients had a decrease in the quantity of eye drops used. CONCLUSION: SLT is effective in reducing IOP and replacing eye drops in patients in the Brazilian Public Health System. Moreover, there was a significant reduction in the use of prostaglandin analogues.

The influence of topical anesthetic and fluorescein on non-contact tonometry measurements using ultra-high-speed dynamic Scheimpflug.

This study aimed to investigate the effects of topical anesthetic and fluorescein drops on intraocular pressure (IOP), central corneal thickness (CCT) and biomechanical properties as measured by Corvis ST (CST-Oculus; Wezlar, Germany) in healthy eyes. A cross-sectional observational study was conducted on 46 healthy patients. The CST measurements were obtained before and immediately after the instillation of topical anesthetic and fluorescein drops. Pre-post instillation data were statistically analyzed. IOP measurements were compared to Goldmann's Applanation Tonometry (GAT), which was also performed after drops instillation. Biomechanical parameters analyzed included applanation 1 velocity, applanation 2 velocity, applanation 1 time, applanation 2 time, whole eye movement, deflection amplitude, and stiffness parameter at first applanation. A statistically significant difference in IOP, both for non-corrected IOP (IOPnct) and biomechanically corrected IOP (bIOP), was observed before and after the instillation of eyedrops. Despite this statistical significance, the observed difference lacked clinical relevance. The IOPnct demonstrated a significant difference pre and post-anesthetic and fluorescein instillation compared to GAT (14.99 ± 2.27 mmHg pre-instillation and 14.62 ± 2.50 mmHg post-instillation, versus 13.98 ± 2.04 mmHg, with p-values of 0.0014 and 0.0490, respectively). Comparable findings were noted when justaposing bIOP to GAT (14.53 ± 2.10 mmHg pre-instillation and 13.15 ± 2.25 mmHg post-instillation, against 13.98 ± 2.04 mmHg, with p-values of 0.0391 and 0.0022, respectively). Additionally, CCT measurements revealed a statistically significant elevation following the administration of topical anesthetic and fluorescein drops (from 544.64 ± 39.85 µm to 586.74 ± 41.71 µm, p < 0.01. None of the analyzed biomechanical parameters showed statistically significant differences after drops instillation. While the administration of topical anesthetic and fluorescein drops induced a statistically significant alteration in both IOPnct and bIOP readings, these changes were not clinically consequential. Furthermore, a notable statistical rise was observed in CCT measurements post-drops instillation, as determined by CST. Yet, corneal biomechanical parameters remained unaffected.

Comparison of the hypotensor effect between latanoprost versus selective laser trabeculoplasty obtained with the water drinking test / Comparação do efeito hipotensor entre latanoprosta versus trabeculoplastia seletiva a laser obtida com teste de sobrecarga hídrica

ABSTRACT Purpose: Glaucoma is the main cause of irreversible blindness worldwide. Peak intraocular pressure is one of the main risk factors for glaucoma progression, and intraocular pressure reduction remains the only therapeutic strategy for all types of glaucoma. The main purpose of our study was to compare the baseline and peak intraocular pressure reduction obtained with the water drinking test between the two eyes of the same patients using 0.005% latanoprost in one eye and selective laser trabeculoplasty application in the contralateral eye. Methods: This was a prospective, interventional, longitudinal, and randomized clinical trial, in which 30 consecutive glaucomatous patients, medically controlled using latanoprost monotherapy, were recruited from a single ophthalmological center. The patients' eyes were randomized, and one eye was selected for SLT treatment and topical 0.005% latanoprost was introduced in the contralateral eye. The baseline intraocular pressure and peak intraocular pressure were evaluated 1 month (water drinking test 2) and 6 months (water drinking test 3) after treatment. Results: There was no significant difference between the mean pre-washout intraocular pressure in the randomized eyes for selective laser trabeculoplasty and latanoprost (13.6 ± 2.1 and 13.3 ± 1.8 mmHg, respectively; p=0.182). Regarding baseline intraocular pressure, there was no significant difference in the water drinking test 2 (p=0.689) and water drinking test 3 (p=0.06) between the groups. There was no significant difference in the intraocular pressure peak between the SLT and latanoprost groups at water drinking test 2 (p=0.771) or water drinking test 3 (p=0.774). Conclusions: The intraocular pressure reduction efficacy is similar between latanoprost and selective laser trabeculoplasty. Glaucomatous patients who are medically controlled with latanoprost and switch treatment to selective laser trabeculoplasty maintain control of intraocular pressure.

RESUMO Objetivo: Glaucoma é a principal causa de cegueira irreversível no mundo. O pico da pressão intraocular é um dos principais fatores de risco para progressão do glaucoma, e o controle pressórico ainda é o único tratamento efetivo para todas as formas de glaucoma. O objetivo principal deste estudo é comparar a redução basal e do pico da pressão intraocular, obtidas através do Teste de Sobrecarga Hídrica, entre os dois olhos dos mesmos pacientes utilizando latanoprosta 0,005% em um olho e submetidos à aplicação de trabeculoplastia a laser seletiva no olho contralateral. Métodos: Este é um estudo prospectivo, intervencionista, longitudinal e randomizado. Trinta pacientes consecutivos, glaucomatosos, com pressão intraocular controlada em uso de monoterapia com latanoprosta, foram recrutados de um único centro oftalmológico. Os olhos dos pacientes foram randomizados e um olho foi selecionado para tratamento com trabeculoplastia a laser seletiva e olho contralateral tratado com colírio de latanoprosta 0,005%. Foram avaliados a pressão intraocular basal e pico de pressão intraocular um mês (Teste de Sobrecarga Hídrica 2) e seis meses (Teste de Sobrecarga Hídrica 3) após tratamento. Resultados: Não houve diferença estatística entre a pressão intraocular pré washout entre os olhos randomizados para trabeculoplastia a laser seletiva e latanoprosta, 13,6 ± 2,1 e 13,3 ± 1,8 mmHg, respectivamente (p=0,182). Em relação à pressão intraocular basal, não houve diferença estatística entre os grupos, tanto no Teste de Sobrecarga Hídrica 2 (p=0,689) e Teste de Sobrecarga Hídrica 3 (p=0,06). Não houve diferença estatística em relação ao pico de pressão intraocular entre os grupos trabeculoplastia a laser seletiva e latanoprosta, no Teste de Sobrecarga Hídrica 2 (p=0,771) e Teste de Sobrecarga Hídrica 3 (p=0,774). Conclusões: Em resumo, nosso estudo demonsrou que a eficácia da redução pressórica é similar entre latanoprosta e trabeculoplastia a laser seletiva, e pacientes glaucomatosos que estão com a pressão intraocular clinicamente controlados com latanoprosta e trocam de tratamento para trabeculoplastia a laser seletiva mantém sua pressão intraocular controlada.

Comparison of the hypotensor effect between latanoprost versus selective laser trabeculoplasty obtained with the water drinking test.

PURPOSE: Glaucoma is the main cause of irreversible blindness worldwide. Peak intraocular pressure is one of the main risk factors for glaucoma progression, and intraocular pressure reduction remains the only therapeutic strategy for all types of glaucoma. The main purpose of our study was to compare the baseline and peak intraocular pressure reduction obtained with the water drinking test between the two eyes of the same patients using 0.005% latanoprost in one eye and selective laser trabeculoplasty application in the contralateral eye. METHODS: This was a prospective, interventional, longitudinal, and randomized clinical trial, in which 30 consecutive glaucomatous patients, medically controlled using latanoprost monotherapy, were recruited from a single ophthalmological center. The patients' eyes were randomized, and one eye was selected for SLT treatment and topical 0.005% latanoprost was introduced in the contralateral eye. The baseline intraocular pressure and peak intraocular pressure were evaluated 1 month (water drinking test 2) and 6 months (water drinking test 3) after treatment. RESULTS: There was no significant difference between the mean pre-washout intraocular pressure in the randomized eyes for selective laser trabeculoplasty and latanoprost (13.6 ± 2.1 and 13.3 ± 1.8 mmHg, respectively; p=0.182). Regarding baseline intraocular pressure, there was no significant difference in the water drinking test 2 (p=0.689) and water drinking test 3 (p=0.06) between the groups. There was no significant difference in the intraocular pressure peak between the SLT and latanoprost groups at water drinking test 2 (p=0.771) or water drinking test 3 (p=0.774). CONCLUSIONS: The intraocular pressure reduction efficacy is similar between latanoprost and selective laser trabeculoplasty. Glaucomatous patients who are medically controlled with latanoprost and switch treatment to selective laser trabeculoplasty maintain control of intraocular pressure.

Effect of panretinal photocoagulation on the peripapillary retinal nerve fiber layer in diabetic retinopathy patients.

OBJECTIVES: To determine the effect of panretinal photocoagulation (PRP) on the peripapillary retinal nerve fiber layer (RNFL) in nonglaucomatous patients with proliferative diabetic retinopathy (PDR). METHODS: This is a prospective, single center, observational study. Thirty-eight eyes of 26 diabetic patients underwent PRP for proliferative diabetic retinopathy. Peripapillary RNFL thickness was measured using scanning laser polarimetry (SLP) with variable corneal compensation (GDx VCC; by Carl Zeiss Meditec, Dublin, CA) and spectral-domain optical coherence tomography (OCT) (Heidelberg Spectralis, Carlsbad, USA) at baseline and 12 months after PRP was performed. RESULTS: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 years (range 26 to 74 years) were recruited. No significant difference was found among all RNFL thickness parameters tested by GDx VCC software (p=0.952, 0.464 and 0.541 for temporal-superior-nasal-inferior-temporal (TSNIT) average, superior average, inferior average, respectively). The nerve fiber indicator (NFI) had a nonsignificant increase (p=0.354). The OCT results showed that the average RNFL thickness (360° measurement) decreased nonsignificantly from 97.2 mm to 96.0 mm at 1 year post-PRP (p=0.469). There was no significant difference when separately analyzing all the peripapillary sectors (nasal superior, temporal superior, temporal, temporal inferior, nasal inferior and nasal thickness). CONCLUSION: Our results suggest that PRP, as performed in our study, does not cause significant changes in peripapillary RNFL in diabetic PDR patients after one year of follow-up.

Correlating Structural and Functional Damage in Glaucoma.

Structural and functional tests are essential for detecting and monitoring glaucomatous damage. However, the correlations between structural and functional tests in glaucoma are complex and faulty, with the combination of both modalities being recommended for better assessment of glaucoma. The objective of this review is to explore investigations from the last 5 years in the field of structure-function correlation in glaucoma that contributed to increment in the understanding of this correlation and have the potential to improve the diagnosis and detection of glaucoma progression.

The effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of optic disk topography in patients with diabetic retinopathy / Efeito da panfotocoagulação retiniana na oftalmoscopia confocal de varredura a laser e parâmetros da estereofotografia do disco óptico em pacientes com retinopatia diabética

ABSTRACT Purpose: To determine the effect of panretinal photocoagulation on optic disk topographic parameters in non-glaucomatous patients with proliferative diabetic retinopathy. Methods: This was a prospective, single-center, observational study. Thirty-eight eyes of 26 patients with diabetes underwent panretinal photocoagulation for proliferative diabetic retinopathy. Stereoscopic disk photographs and optic nerve head parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscope (Heidelberg Retinal Tomograph), respectively, at baseline and 12 months after the completion of panretinal photocoagulation. Results: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 (range 26-74) years were recruited. No significant difference was found between the stereo photography determined mean horizontal and vertical cup-to-disk ratio before and after panretinal photocoagulation treatment (p=0.461 and 0.839, respectively). The global values of the optic nerve head parameters analyzed with the HRT3 showed no significant change from baseline to 12 months, including the disk area, cup area, rim area, cup volume, rim volume, cup-to-disk area ratio, linear cup-to-disk ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and cross-sectional area. Conclusion: Our results suggest that panretinal photocoagulation does not cause morphological optic disk changes in patients with diabetic proliferative retinopathy after 1 year of follow-up.

RESUMO Objetivo: Determinar o efeito da panfotocoagulação retiniana nos parâmetros topográficos do disco óptico em pacientes não glaucomatosos com retinopatia diabética proliferativa. Métodos: Este é um estudo observacional pros­pectivo e unicêntrico. Trinta e oito olhos de 26 pacientes dia­béticos foram submetidos à panfotocoagulação retiniana para retinopatia diabética proliferativa. As estereofotografias e os parâmetros do disco óptico foram avaliados usando o retinógrafo Visucam da Zeiss e o oftalmoscópio confocal de varredura a laser (Heidelberg Retinal Tomograph), respectivamente, no início e 12 meses após a conclusão da panfotocoagulação. Resultados: Trinta e oito olhos de 26 pacientes (15 mulheres) com média de idade de 53,7 anos (intervalo de 26-74) foram recrutados. Nenhuma diferença significativa foi encontrada entre a média horizontal e vertical para relação escavação/disco óptico determinadas pelas estereo­fotografias antes e após o tratamento com panfotocoagulação retiniana (p=0,461 e 0,839, respectivamente). Os valores globais dos parâmetros do disco óptico analisados com a tomografia de varredura a laser não mostraram nenhuma mudança significativa entre o início até os 12 meses, incluindo disk area, cup area, rim area, cup volume, rim volume, C/D area ratio, linear C/D ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness e cross-sectional area. Conclusão: Nossos resultados sugerem que a panfotocoagulação retiniana não causa alterações morfológicas no disco óptico em pacientes com retinopatia diabética proliferativa após um ano de seguimento.

The effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of optic disk topography in patients with diabetic retinopathy.

PURPOSE: To determine the effect of panretinal photocoagulation on optic disk topographic parameters in non-glaucomatous patients with proliferative diabetic retinopathy. METHODS: This was a prospective, single-center, observational study. Thirty-eight eyes of 26 patients with diabetes underwent panretinal photocoagulation for proliferative diabetic retinopathy. Stereoscopic disk photographs and optic nerve head parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscope (Heidelberg Retinal Tomograph), respectively, at baseline and 12 months after the completion of panretinal photocoagulation. RESULTS: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 (range 26-74) years were recruited. No significant difference was found between the stereo photography determined mean horizontal and vertical cup-to-disk ratio before and after panretinal photocoagulation treatment (p=0.461 and 0.839, respectively). The global values of the optic nerve head parameters analyzed with the HRT3 showed no significant change from baseline to 12 months, including the disk area, cup area, rim area, cup volume, rim volume, cup-to-disk area ratio, linear cup-to-disk ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and cross-sectional area. CONCLUSION: Our results suggest that panretinal photocoagulation does not cause morphological optic disk changes in patients with diabetic proliferative retinopathy after 1 year of follow-up.

Macular and Multifocal PERG and FD-OCT in Preperimetric and Hemifield Loss Glaucoma.

PURPOSE: To evaluate the ability of macular and multifocal (mf) pattern electroretinogram (PERG) to differentiate preperimetric glaucoma (PG) and glaucoma with hemifield loss (GHL) from controls, to compare the discrimination ability of PERG and fourier-domain optical coherence tomography (FD-OCT), and to assess the relationship between measurements. PATIENTS AND METHODS: Standard automated perimetry, steady-state and transient PERG and mfPERG measurements were obtained from PG (n=14, 24 eyes), GHL (n=5, 7 eyes), and controls (n=19, 22 eyes). Circumpapillary retinal nerve fiber layer (cpRNFL), full-thickness macula, and segmented macular layer thicknesses on FD-OCT were investigated. Measurements were compared using mixed effects linear models. The relationships between measurements and the diagnostic performance of each technology were assessed. RESULTS: Compared with controls, average P50 peak time transient PERG responses were reduced in PG and GHL, whereas average latency and amplitude steady-state and mfPERG responses were abnormal only in GHL. cpRNFL and macular thickness measurements in PG and GHL differed significantly from controls. A significant relationship was found between PERG and most FD-OCT or SAP parameters. Partial least squares discriminant analysis revealed that OCT parameters, along with mfPERG and transient PERG parameters had similar ability to discriminate PG and GHL from healthy controls. CONCLUSIONS: PERG and OCT parameters may be abnormal, with significant correlations between measurements, in PG eyes. Both technologies may be useful for detection of early glaucoma.

Predictive Value of the Water Drinking Test and the Risk of Glaucomatous Visual Field Progression.

PURPOSE: The purpose of this is to test the hypothesis the intraocular pressure (IOP) peaks during a stress test [the water drinking test (WDT)] can estimate the risk of future visual field progression in treated primary open-angle glaucoma (POAG) patients. PATIENTS AND METHODS: Design: Prospective, longitudinal study. SETTING: Clinical practice. STUDY POPULATION: Treated POAG patients whose IOP was ≤18 mm Hg and who had no IOP-lowering interventions between the date of the WDT and the last eligible visual field. INTERVENTION: At baseline examination, patients underwent the WDT and were then followed at regular intervals with office-based IOP measurements and visual field testing. MAIN OUTCOME MEASURE: Cox-proportional hazards survival analysis testing the predictive value of IOP peaks during the WDT versus IOP measurements during office hours on visual field progression. RESULTS: A total of 144 eyes of 96 patients with baseline visual field damage ranging from mild to severe followed for a mean of 28 months were analyzed. In the multivariable analysis adjusting for potential confounders, higher IOP peaks during the WDT were predictive of future visual field progression (hazard ratio=1.11; 95% confidence interval, 1.02 to 1.21; P=0.013). The average and peak IOP during office hours over the same follow-up period were not significantly associated with progression (P=0.651 and 0.569, respectively). CONCLUSIONS: IOP peaks detected with the WDT were predictive of future visual field progression in a treated POAG population. This stress test could be a useful tool for risk assessment in daily practice.

Applications of the water drinking test in glaucoma management.

Intraocular pressure (IOP) peaks and means have been considered important factors for glaucoma onset and progression. However, peak IOP detection depends only on appropriated IOP checks at office visits, whereas the mean IOP requires longitudinal IOP data collection and may be affected by the interval between visits. Also, IOP peak assessment is necessary to verify if the peak pressure of a given patient is in target range, to evaluate glaucoma suspect risk, the efficacy of hypotensive drugs and to detect early loss of IOP control. The water-drinking test has gained significant attention in recent years as an important tool to evaluate IOP peaks and instability. The main objective of this review was to present new findings and to discuss the applicability of the water-drinking test in glaucoma management.

Evaluation of the Efficacy and Safety of the New Susanna Glaucoma Drainage Device in Refractory Glaucomas: Short-term Results.

PURPOSE: To assess the efficacy and safety of the new Susanna glaucoma drainage device (SGDD) in patients with neovascular and refractory glaucomas. MATERIALS AND METHODS: In this prospective study, patients with neovascular glaucoma or refractory glaucomas (defined as eyes with previous trabeculectomy failure) were enrolled. All eyes had to have intraocular pressure (IOP) above 21 mm Hg despite maximum tolerated topical medication, or recent documentation of anatomic and/or functional progression. Patients underwent glaucoma surgery with the new SGDD in a standardized manner. Postoperative visits were performed at days 1 and 7; months 1, 3, and 6; and every 6 months thereafter. Preoperative and postoperative IOP, number of antiglaucoma medications, surgical complications, and any subsequent related events were recorded. Success criteria were: (I) IOP≥6 and ≤21 mm Hg; (II) IOP≥6 and ≤18 mm Hg. Each criterion was classified as complete (without medication) or qualified (with medication). RESULTS: A total of 58 patients with a mean age of 64.3±11.5 years were included [19 with neovascular glaucoma (group 1) and 39 with failure of first trabeculectomy (group 2)]. Overall, mean follow-up was 7.1±3.8 months, and mean IOP was reduced from 31.5±1.6 (range, 18 to 68) mm Hg to 12.6±0.7 (range, 2 to 28) mm Hg at the last follow-up visit (P<0.01). The mean number of antiglaucoma medications used was reduced from 3.4±0.9 to 1.4±1.5 (P<0.01). At 6 months postoperatively, qualified success rates for groups 1 and 2 were 73% and 86%, respectively (considering the stricter criterion). Main complications were 2 cases of conjunctival erosion and 2 cases of late hypotony. CONCLUSIONS: Our initial findings suggest that the new SGDD is an effective alternative for managing neovascular and refractory glaucomas, with minor postoperative complications in the short-term.

Choroidal thickness variation in highly myopic eyes during the water drinking test.

PURPOSE: To evaluate variations in choroidal thickness (CT) during the water drinking test (WDT) in emmetropic eyes (EE) and highly myopic eyes (ME) using spectral-domain optical coherence tomography (SD-OCT). METHODS: Clinical trial performed at a tertiary care hospital comprising 30 randomly selected eyes. The WDT and SD-OCT macular scans were performed 10 and 45 min after water ingestion in 15 myopic and 15 EE of 15 healthy patients in each group. Primary study outcomes were average macular CT measured by SD-OCT and intraocular pressure (IOP) during the WDT. RESULTS: The mean spherical equivalent refraction was 0.15 ± 0.24 D in emmetropic and -7.1 ± 1.75 D in ME (p<0.001). No statistical differences between EE and ME were observed during the WDT response. EE had higher CT compared with ME at the fovea (361.4 ± 55.4 vs 257.9 ± 95.3; p<0.001), 3 mm nasal to the fovea (158.0 ± 71.8 vs 122.5 ± 54.5; p =0.047), and 3 mm temporally to the fovea (310.6 ± 52.4 vs 247.6 ± 90.1; p=0.05). Regarding CT variation, significant differences in foveal CT at 10 min after water ingestion were observed in both EE and ME, with no statistically significant difference observed between groups. A moderate correlation between IOP peak during the WDT and CT was demonstrated in ME (r=0.52; p=0.04). CONCLUSIONS: No statistically significant differences in CT variation during the WDT were observed between EE and ME, indicating similar behavior of the choroidal bed during the WDT in both groups. Further, CT was thinner in highly ME, with CT variation unable to explain elevations in IOP observed during the WDT.

Comparison of the Intraocular Pressure Variation Provoked by Postural Change and by the Water Drinking Test in Primary Open-angle Glaucoma and Normal Patients.

PURPOSE: To evaluate the intraocular pressure (IOP) peak and variability detected by moving the body from sitting to supine position (postural test) and by the water drinking test (WDT) in normal and primary open-angle glaucoma (POAG) subjects. PATIENTS AND METHODS: Prospective, cross-sectional observational analysis of 14 eyes of 14 normal subjects and 31 eyes of 31 patients with POAG. All POAG subjects were under clinical therapy. IOP measurements were all performed on the same day. RESULTS: When the subjects moved to the supine position, there was an IOP increase of 1.36±1.34 and 2.84±2.21 mm Hg in the normal and POAG groups, respectively (P=0.011). During the WDT, mean IOP peak and fluctuation in the POAG group was 19.29±4.10 and 4.13±2.33 mm Hg, respectively. These levels were significantly higher in comparison with the normal group (16.50±3.76 and 2.71±0.99 mm Hg; P=0.018 and 0.022, respectively). The mean peak IOP observed in the WDT was significantly higher than the IOP in the supine position (19.29±4.10 vs. 17.32±4.66 mm Hg, P=0.013). The mean IOP increase during the WDT was also significantly higher when compared with the postural test (4.13±2.33 vs. 2.84±2.21 mm Hg, P=0.019). CONCLUSIONS: POAG eyes demonstrated a significant IOP increase when assuming the supine position and during the WDT. The IOP increase during the WDT was significantly higher than the IOP increase after postural test. Hence, the results of both tests are not interchangeable.

Choroidal thickness variation in highly myopic eyes during the water drinking test / Variação da espessura de coroide em olhos alto míopes durante o teste de sobrecarga hídrica

ABSTRACT Purpose: To evaluate variations in choroidal thickness (CT) during the water drinking test (WDT) in emmetropic eyes (EE) and highly myopic eyes (ME) using spectral-domain optical coherence tomography (SD-OCT). Methods: Clinical trial performed at a tertiary care hospital comprising 30 randomly selected eyes. The WDT and SD-OCT macular scans were performed 10 and 45 min after water ingestion in 15 myopic and 15 EE of 15 healthy patients in each group. Primary study outcomes were average macular CT measured by SD-OCT and intraocular pressure (IOP) during the WDT. Results: The mean spherical equivalent refraction was 0.15 ± 0.24 D in emmetropic and -7.1 ± 1.75 D in ME (p<0.001). No statistical differences between EE and ME were observed during the WDT response. EE had higher CT compared with ME at the fovea (361.4 ± 55.4 vs 257.9 ± 95.3; p<0.001), 3 mm nasal to the fovea (158.0 ± 71.8 vs 122.5 ± 54.5; p =0.047), and 3 mm temporally to the fovea (310.6 ± 52.4 vs 247.6 ± 90.1; p=0.05). Regarding CT variation, significant differences in foveal CT at 10 min after water ingestion were observed in both EE and ME, with no statistically significant difference observed between groups. A moderate correlation between IOP peak during the WDT and CT was demonstrated in ME (r=0.52; p=0.04). Conclusions: No statistically significant differences in CT variation during the WDT were observed between EE and ME, indicating similar behavior of the choroidal bed during the WDT in both groups. Further, CT was thinner in highly ME, with CT variation unable to explain elevations in IOP observed during the WDT.

RESUMO Objetivo: Avaliar a espessura de coroide (EC) e sua variação durante o teste de sobrecarga hídrica (TSH) em olhos emétropes (EE) e míopes (ME) utilizando a tomografia de coerência óptica Spectral-Domain (SD-OCT). Métodos: Ensaio clinico realizado em um hospital terciário. 30 olhos selecionados randomizadamente, 15 míopes e 15 emétropes de 15 pacientes em cada grupo foram submetidos ao TSH e scans maculares com SD-OCT realizados 10 e 45 minutos após a ingestão de água. Os principais resultados avaliados foram média da EC na região macular pelo SD-OCT e pressão intraocular (PIO) durante o TSH. Resultados: O equivalente esférico médio foi de 0.15 ± 0.24 dioptrias em emétropes e -7,1 ± 1,75 dioptrias nos olhos míopes (p<0,001). Não foram encontradas diferenças estatísticas durante a resposta ao TSH entre EE e ME. EE apresentaram maior EC em comparação com ME, tanto na região foveal (361,4 ± 55,4 vs 257,9 ± 95,3; p<0,001), 3 milímetros nasal à fóvea (158,0 ± 71,8 vs 122,5 ± 54,5; p=0,047) e 3 mm temporal à fóvea (310,6± 52.4 vs 247,6 ± 90,1; p=0,05). Em relação à variação da EC, diferenças estatisticamente significativas foram demonstrados na região foveal, 10 minutos após a ingestão de água em ambos EE e ME, sem diferenças entre os grupos. Moderada correlação entre pico de PIO durante o TSH e EC foi demonstrada em ME ( r=0,52; p=0,04). Conclusão: A diferença na variação da EC provocada pelo TSH não foi estatisticamente diferente entre olhos emétropes e míopes, o que sugere um comportamento semelhante da coroide nestes dois grupos quando submetidos ao TSH. Além disso, a EC é mais fina nos olhos alto míopes, e a variação na EC não explica o aumento da PIO durante o TSH.

Reproducibility of the water drinking test in treated glaucomatous patients.

BACKGROUND: To evaluate the reproducibility of intraocular pressure peaks and fluctuation elicited during the water drinking test in treated glaucomatous patients with a long follow-up interval. DESIGN: Retrospective cohort study in a tertiary care practice. PARTICIPANTS: Thirty-four treated primary open-angle glaucoma patients. METHODS: All patients underwent the water drinking test performed in two consecutive visits without any change in the therapeutic regimen. The mean interval between tests was 4.85 (range: 3-6) months. Reproducibility of peak and fluctuation during the water drinking test was assessed using intraclass correlation coefficients. Bland-Altman analysis was used to assess the agreement of intraocular pressure peaks and fluctuation measured between two consecutive tests. MAIN OUTCOME MEASURES: Intraclass correlation and agreement of intraocular pressure peaks and fluctuation between visits. RESULTS: There were no significant differences in baseline intraocular pressure values (mean ± standard deviation, 11.73 ± 2.36 and 11.61 ± 2.71 mmHg; P = 0.72) and peaks (14.55 ± 3.41 and 15.02 ± 3.66 mmHg, respectively; P = 0.163) detected during the water drinking test between the first and second visits. There was also no significant difference between the average intraocular pressure fluctuation values (2.82 ± 1.99 and 3.41 ± 2.54 mmHg, respectively; P = 0.135). Intraocular pressure peaks and fluctuation presented intraclass correlation coefficients of 0.85 (P < 0.001) and 0.50 (P < 0.001), respectively. CONCLUSIONS: Our results demonstrate excellent reproducibility of intraocular pressure peaks during the water drinking test. Intraocular pressure fluctuation did not reveal good reproducibility, though. These results emphasize the applicability of this test to assess treatment efficacy in daily practice and interventional studies.

The role of pattern-reversal electroretinography in the diagnosis of glaucoma / Importância do eletroretinograma de padrão reverso no diagnóstico do glaucoma

Pattern electroretinography is used to assess the function of the inner retinal layers, particularly the retinal ganglion cell layer, using a reversing checkerboard or grating pattern that maintains a constant overall mean luminance over time. A normal transient response comprises a positive component of the wave (P50) followed by a longer negative component of the wave (N95). Glaucomatous optic neuropathy causes progressive loss of retinal ganglion cells, potentially detectable as abnormalities on examination, particularly in the N95 component. Therefore, pattern electroretinography may be useful in the diagnosis and evaluation of glaucoma. The present article is an updated review of published data regarding the use of pattern electroretinography for the detection of glaucoma-induced retinal changes.

O eletroretinograma de padrão reverso é utilizado para avaliar a função das camadas internas da retina, particularmente a camada de células ganglionares retinianas, utilizando um estímulo em xadrez ou barras alternantes, mantendo constante o nível de contraste total. A resposta transiente normal é constituída por uma onda positiva (P50) seguida de uma onda maior negativa (N95). A neuropatia óptica glaucomatosa causa perda progressiva das células ganglionares da retina, detectável como anormalidades no exame, especialmente na onda N95. Por isso, o eletroretinograma de padrão reverso pode ser útil no diagnóstico e seguimento de pacientes glaucomatosos. Este artigo é uma revisão atualizada dos dados publicados a respeito da capacidade do eletroretinograma de padrão reverso em detectar alterações retinianas induzidas pelo glaucoma.

Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy.

OBJECTIVE: To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM-FC) in patients not achieving the target IOP of ≤18 mmHg while on timolol 0.5% (TIM) monotherapy. METHODS: A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19-35 mmHg in ≥1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM-FC was initiated and administered once daily at 8 pm for 4-6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance). RESULTS: A total of 49 patients were enrolled (mean age, 63 [range, 42-82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM-FC was 31 days. Mean ± standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM-FC) was -5.0±3.6 mmHg. IOP decreased significantly (P<0.0001) from baseline (22.1±2.6 mmHg) to study end (17.1±3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP ≤18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs. CONCLUSIONS: TRAV/TIM-FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP ≤18 mmHg with TRAV/TIM-FC. TRAV/TIM-FC was well tolerated in this population.

The role of pattern-reversal electroretinography in the diagnosis of glaucoma.

Pattern electroretinography is used to assess the function of the inner retinal layers, particularly the retinal ganglion cell layer, using a reversing checkerboard or grating pattern that maintains a constant overall mean luminance over time. A normal transient response comprises a positive component of the wave (P50) followed by a longer negative component of the wave (N95). Glaucomatous optic neuropathy causes progressive loss of retinal ganglion cells, potentially detectable as abnormalities on examination, particularly in the N95 component. Therefore, pattern electroretinography may be useful in the diagnosis and evaluation of glaucoma. The present article is an updated review of published data regarding the use of pattern electroretinography for the detection of glaucoma-induced retinal changes.

Reproducibility of the mean, fluctuation, and IOP peak in the diurnal tension curve.

PURPOSE: To verify the reproducibility of the mean, peak, and fluctuation of intraocular pressure (IOP) observed during modified diurnal tension curves (mDTC) performed on ocular hypertensive and primary open-angle glaucoma patients. METHODS: Prospective analysis of 88 eyes from 88 ocular hypertensive and primary open-angle glaucoma patients subjected to 2 consecutive mDTCs (IOP measurements obtained at 8:00 AM, 11:00 AM, 2:00 PM, and 4:00 PM) on 2 consecutive days. Mean IOP was calculated as the average of all IOP measurements obtained during each mDTC. Peak and minimum IOP levels were considered as the highest and lowest IOP level during each mDTC, respectively. IOP fluctuation was calculated using 2 different approaches: the difference between IOP peak and minimum IOP detected during each mDTC and as the SD of all mDTC measurements. Reproducibility was assessed using the intraclass correlation coefficient (ICC). RESULTS: IOP fluctuation between 2 days in the modified diurnal curve, calculated as the difference between peak IOP and minimum IOP and as the SD of all mDTC measurements, was less reproducible than the mean IOP and peak IOP (ICC values 0.60, 0.62, 0.91, and 0.85, respectively; all ICC values, P<0.001). CONCLUSIONS: Mean IOP and peak IOP observed during the mDTC had good reproducibility, whereas the reproducibility of IOP fluctuation was only fair.