Trabeculectomy and optic nerve head topography.

The objective of the present study was to evaluate changes in optic nerve head parameters, measured by confocal laser tomography, before and after trabeculectomy in order to identify outcome measures for the management of glaucoma. The optic nerve head of 22 eyes (22 patients) was analyzed by confocal laser tomography with the Heidelberg retinal tomogram (HRT) before and after trabeculectomy. The median time between the first HRT and surgery was 4.6 months (mean: 7.7 +/- 8.3) and the median time between surgery and the second HRT was 10.8 months (mean: 12.0 +/- 6.8). The patients were divided into two groups, i.e., those with the highest (group A) and lowest (group B) intraocular pressure (IOP) change after surgery. Differences in the 12 standard topographic parameters before and after surgery for each group were evaluated by the Wilcoxon signed rank test and the differences in these parameters between the two groups were compared by the Mann-Whitney rank sum test. Multiple regression analysis was used to evaluate the influence of the change in IOP (DeltaIOP and DeltaIOP%) and the changes in the other parameters. There were significant differences in the HRT measures before and after surgery in group A only for cup volume. In group B, no parameter was statistically different. The changes in group A were not significantly different than those in group B for any parameter (P > 0.004, Bonferroni correction for multiple comparisons). DeltaIOP and DeltaIOP% had a statistically significant effect on Delta cup disk area, Delta cup volume and Delta mean cup depth. Changes in cup shape size were influenced significantly only by DeltaIOP. Some optic disc parameters measured by HRT presented a significant improvement after filtering surgery, depending on the amount of IOP reduction. Long-term studies are needed to determine the usefulness of these findings as outcome measures in the management of glaucoma.

Trabeculectomy and optic nerve head topography

The objective of the present study was to evaluate changes in optic nerve head parameters, measured by confocal laser tomography, before and after trabeculectomy in order to identify outcome measures for the management of glaucoma. The optic nerve head of 22 eyes (22 patients) was analyzed by confocal laser tomography with the Heidelberg retinal tomogram (HRT) before and after trabeculectomy. The median time between the first HRT and surgery was 4.6 months (mean: 7.7 ± 8.3) and the median time between surgery and the second HRT was 10.8 months (mean: 12.0 ± 6.8). The patients were divided into two groups, i.e., those with the highest (group A) and lowest (group B) intraocular pressure (IOP) change after surgery. Differences in the 12 standard topographic parameters before and after surgery for each group were evaluated by the Wilcoxon signed rank test and the differences in these parameters between the two groups were compared by the Mann-Whitney rank sum test. Multiple regression analysis was used to evaluate the influence of the change in IOP (deltaIOP and deltaIOP percent) and the changes in the other parameters. There were significant differences in the HRT measures before and after surgery in group A only for cup volume. In group B, no parameter was statistically different. The changes in group A were not significantly different than those in group B for any parameter (P > 0.004, Bonferroni correction for multiple comparisons). deltaIOP and deltaIOP percent had a statistically significant effect on delta cup disk area, delta cup volume and delta mean cup depth. Changes in cup shape size were influenced significantly only by deltaIOP. Some optic disc parameters measured by HRT presented a significant improvement after filtering surgery, depending on the amount of IOP reduction. Long-term studies are needed to determine the usefulness of these findings as outcome measures in the management of glaucoma.

Influence of keratometric readings on comparative intraocular pressure measurements with Goldmann, Tono-Pen, and noncontact tonometers.

PURPOSE: To evaluate the influence of keratometric measurements on the concordance of intraocular pressure (IOP) readings with three applanation tonometers. PATIENTS AND METHODS: The IOPs of 404 eyes of 202 patients from a general eye clinic were measured by Goldmann, Tono-Pen XL, and noncontact Nidek NT 2000 tonometers. Differences in the IOP measurements between Goldmann and the other two tonometers (deltaIOPG-TP and deltaIOPG-NCT) were analyzed in the overall group and within three subgroups based on keratometry measures: flatter, intermediate, and steeper corneas (quartiles as cut-off points). Regression analysis of deltaIOP and keratometry measures was also performed. Right and left eyes were analyzed separately. RESULTS: The IOP readings taken with the Goldmann tonometer were significantly higher than those taken with either of the other two tonometers within the overall study population. The deltaIOP within the three keratometric subgroups was not statistically significant except for deltaIOPG-TP in the right eyes. Regression analysis showed that keratometry and deltaIOPG-TP and deltaIOPG-NCT had a significant but very weak coefficient of correlation in the right eye, but not in the left. CONCLUSION: Corneal curvature within the normal range does not have a clinically significant influence on the concordance of IOP readings obtained with Goldmann and Tono-Pen or noncontact tonometers.