Automated and ImageJ thresholding algorithm-based analysis of macular vessel density in diabetic patients.

Purpose: To assess the macular vessel density (VD) on optical coherence tomography angiography (OCT-A) using proprietary software (automated) and image processing software (manual) in diabetic patients. Methods: In a retrospective study, OCT-A images (Triton, TOPCON Inc.) of type 2 diabetics presenting to a tertiary eye care center in North India between January 2018 and December 2019 with or without nonproliferative diabetic retinopathy (NPDR) and with no macular edema were analyzed. Macular images of size 3 × 3 mm were binarized with global thresholding algorithms (ImageJ software). Outcome measures were superficial capillary plexus VD (SCP-VD, automated and manual), deep capillary plexus VD (DCP-VD, manual), and correlation between automated and manual SCP-VD. Results: OCT-A images of 89 eyes (55 patients) were analyzed: no diabetic retinopathy (NoDR): 29 eyes, mild NPDR: 29 eyes, and moderate NPDR: 31 eyes. Automated SCP-VD did not differ between NoDR and mild NPDR (P = 0.69), but differed between NoDR and moderate NPDR (P = 0.014) and between mild and moderate NPDR (P = 0.033). Manual SCP-VD (Huang and Otsu methods) did not differ between the groups. Manual DCP-VD differed between NoDR and mild NPDR and between NoDR and moderate NPDR, but not between mild and moderate NPDR with both Huang (P = 0.024, 0.003, and 0.51, respectively) and Otsu (P = 0.021, 0.006, and 0.43, respectively) methods. Automated SCP-VD correlated moderately with manual SCP-VD using Huang method (r = 0.51, P < 0.001) with a mean difference of -0.01% (agreement limits from -6.60% to +6.57%). Conclusion: DCP-VD differs consistently between NoDR and NPDR with image processing, while SCP-VD shows variable results. Different thresholding algorithms provide different results, and there is a need to establish consensus on the most suited algorithm.

Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma.

PURPOSE: To evaluate long-term perimetric stabilization at set Target (IOPs) in primary angle-closure glaucoma with visual field defects. METHODS: Two hundred forty-eight eyes, of 124 primary angle-closure glaucoma (PACG) patients on medical treatment, and 124 eyes, of 95 patients after trabeculectomy performed at least 5 years prior were evaluated. One hundred eighty-five eyes had a follow-up of ≥10 years. Target IOPs for mild, moderate, and severe glaucomatous optic neuropathy were set at ≤18, ≤15, and ≤12 mmHg, respectively. Progression was evaluated by event-based changes on guided progression analysis. Primary outcome measure was therapy required to achieve individualized Target IOP. Secondary outcome measure was assessment of perimetric change over time. RESULTS: Mean baseline IOP was 23.34 ± 6.16 mmHg in medically treated and 36.08 ± 9.73 mmHg in surgically treated eyes (P = 0.0001). All eyes with a baseline IOP of <25 mmHg were on medications alone, 65.33%, of those with a baseline IOP of 25-30 mmHg were on medications, while 34.67% required trabeculectomy. In total, 91.4% of eyes with a baseline IOP of >30 mmHg underwent a trabeculectomy for achieving Target IOP. Perimetric stabilization was achieved in 98.17% of PACG eyes. "Target" IOP was achieved for mild, moderate, and severe glaucomatous optic neuropathy, medically in 90.2, 73.9, and 29.7%, and surgery was required in 9.8, 26.1, and 70.3%, respectively. Overall analysis found that percentage reduction in IOP was significantly more after trabeculectomy than medical treatment, 64.16 ± 14.91 and 43.61 ± 13.73%, P = 0.0001. Decrease in IOP was significantly greater 5-9 years after trabeculectomy, in comparison to ≥10 years, P = 0.001. CONCLUSION: Medications controlled IOP to "Target" in PACG eyes with mild and moderate glaucoma for over ≥10 years, when the baseline IOP off treatment was <30 mmHg. Trabeculectomy was necessary in PACG eyes having severe glaucomatous optic neuropathy, or with a baseline IOP of >30 mmHg to achieve Target IOP. These appropriate initial therapeutic interventions and Target IOPs are therefore suggested as a clinically validated algorithm of care for different severities of PACG.

Physiological and metabolic changes in two Himalayan medicinal herbs under drought, heat and combined stresses.

Valeriana jatamansi Jones and Hedychium spicatum Ham-ex-Smith are important medicinal herbs of the Himalayan region, which are highly demanded by pharmaceutical industries. Climatic variability especially increasing temperature and water deficit affects the growth and productivity of these species. In addition, increased temperature and water deficit may trigger the biosynthesis of medicinally important bioactive metabolites, which influence the quality of raw plant material and finished products. Therefore, V. jatamansi and H. spicatum plants were undertaken and subjected to different levels of drought (no irrigation), heat (35 °C), and combined stresses for investigating their physiological and metabolic responses. Both the treatments (individually and in combination) reduced relative water content, photosynthesis, carboxylation efficiency, chlorophyll content, while increased intracellular CO2, malondialdehyde and H2O2 content in both the species. Transpiration and stomatal conductance increased under heat and reduced under drought stress as compared to control. Water use efficiency was found to be increased under drought, while reduced under heat stress. Protein, proline, carotenoid content and antioxidant enzymes activities (superoxide dismutase, peroxidise, catalase) initially increased and thereafter decreased during late stages of stress. Exposure of plants to combined stress was more detrimental than individual stress. In V. jatamansi, exposure to drought stress significantly (p < 0.05) increased valerenic acid content in all plant parts (1.0-6.9 fold) with maximum increase after 20 days of exposure, while under heat stress, valerenic acid content increased (1.0-1.2 fold) in belowground part of V. jatamansi, and decreased (1.1-1.3 fold) in aerial part as compared to control. In H. spicatum, exposure of individual heat stress for 25-30 days and combined stress for 5-15 days significantly (p < 0.05) increased linalool content to 6.2-6.5 fold and 8.3-19.6 fold, respectively, as compared to control. Higher accumulation of bioactive compounds after exposure to mild stress provides encouraging prospects for enhancing pharmaceutical properties of these Himalayan herbs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12298-021-01027-w.

Evaluating target intraocular pressures in primary congenital glaucoma.

Purpose: The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of glaucomatous neuropathy after surgery in primary congenital glaucoma (PCG). Methods: Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes - Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive error. Results: A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was -0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter. Conclusion: Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary congenital glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia.

Seasonal trends in morpho-physiological attributes and bioactive content of Valeriana jatamansi Jones under full sunlight and shade conditions.

Valeriana jatamansi Jones, an important medicinal herb of the Himalayan region, is an essential source of many therapeutic compounds and is traded/consumed in very high volume. The hypothesis of this study was that different seasons and light conditions may affect the content of medicinally valuable components with changes in the morpho-physiological attributes of the plant. Growing plants under suitable light conditions and harvesting of appropriate plant parts in optimum season is crucial for harnessing the full potential of the crop. Thus, the study was carried out to determine the seasonal response of V. jatamansi plants (genetically identical plants of same age) in terms of growth and phytochemical content under two different light conditions (full sunlight and 50% shade). During all seasons, growth parameters (plant height, leaf number, leaf area, relative water content, plant biomass) and the principle bioactive compounds (valerenic acid) were higher under shade conditions, while total flavonoids, tannins, phenolic compounds and antioxidant activities were higher under full sunlight conditions. HPLC analysis revealed that valerenic acid and most of the phenolic content were higher during summer season, especially in leaf part of the plant. The study suggested harvesting of V. jatamansi plants (especially leaf), during summer season to harness high quality raw material and to prevent loss of belowground parts. This strategy can be adopted by farmers for large scale cultivation of species. SUPPLEMENTARY INFORMATION: The online version of this article contains supplementary material available at 10.1007/s12298-021-00944-0.

Achieving low target intraocular pressures in severe glaucoma.

PURPOSE: This study aimed to assess details of therapy required to achieve an intraocular pressure (IOP) of ⩽12 mmHg in patients with severe glaucoma of different etiologies. METHODS: Patients with a follow-up of at least 1 year, who fulfilled inclusion criteria were selected, and data analyzed with respect to baseline IOP, number of medications, and/or surgeries required to achieve an IOP of ⩽12 mmHg and ⩾6 mmHg. Final IOP, visual field status and medications/surgery required were noted. RESULTS: About 127 eyes of 85 patients met all criteria. There were 48 eyes having primary angle closure glaucoma (PACG), 16 eyes with primary open angle glaucoma (POAG), 17 eyes of juvenile open angle glaucoma (JOAG), and 46 eyes of secondary glaucoma. The mean baseline IOP was 33.14 ± 11.07 mmHg and final IOP 10.25 ± 1.81 mmHg. In the age group >40 years, 29.63% of patients were controlled on medication as compared to 9.09% and 5.71% in the age group of <20 years and 20-40 years (p = 0.007). With a baseline IOP of <25 mmHg, 48.65% required a trabeculectomy, whereas for 25-30, and >30 mmHg, 62.5% and 97.29% respectively, required surgery (p < 0.001).66.67% of patients having mean deviation of -12 to -16 dB (decibels) on Humphrey field analyzer (HFA) underwent surgery to achieve target IOP in comparison to 83.52% who had mean deviation greater than -16 dB (p = 0.036). CONCLUSION: Only 21.26% of severe glaucoma eyes could be controlled on medications alone. A baseline IOP of >25 mmHg, age <40 years and mean deviation worse than -16 dB, had a higher frequency of trabeculectomies to achieve an IOP of ⩽12 mmHg.

Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?

PURPOSE: Evaluation of the intraocular pressure (IOP) lowering efficacy of trabeculectomies over > 10 years and their ability to stabilize glaucomatous optic neuropathy. METHODS: In total, 181 eyes (136 patients), which underwent trabeculectomy (10 min surgery) at least 10 years prior and were on regular follow-up, were evaluated. Qualified/complete success was taken as criteria A: IOP ≤ 12 mmHg, B: IOP ≤ 15 mmHg and C: IOP ≤ 18 mmHg, with all > 5 mmHg, with/without medications. Target IOP in advanced glaucoma is about 10 mmHg, therefore trabeculectomy 10-10-10 challenge! RESULTS: The mean age of patients was 46.32 ± 11.50 years. Absolute success was 50.27%, 54.14% and 59.66% according to criteria A, B and C at last follow-up, while qualified success was 70.11%, 81.77% and 96.13%. An IOP of ≤ 12 mmHg was noted in 34, 64.15%, PACG eyes, 14, 73.68%, POAG, 15, 65.22%, JOAG and 64, 74.42%, secondary glaucoma eyes. The reduction in IOP overall was 64.83 ± 16.80% at last review and was 59.47 ± 16.07% in PACG, 62.40 ± 17.72% in POAG, 71.89 ± 8.50% in JOAG and 67.74 ± 18.10% in secondary glaucoma eyes. "Target" IOP was achieved in 97.29% of early glaucoma, 85.71% moderate glaucoma and 70% severe glaucoma eyes. 97.24% of patients were perimetrically stable. 2.21% of eyes post-trabeculectomy had a shallow anterior chamber needing surgical intervention. Visual acuity was maintained or better in 93.92% of patients, with a cataract surgery performed in 6.63% eyes. A repeat trabeculectomy was performed in 3.31% of eyes. CONCLUSION: Trabeculectomy 10-10-10 is achievable in the long term, with few complications or repeat surgical interventions in the majority of POAG, PACG, JOAG and secondary glaucomas. Therefore, trabeculectomy should not be relegated to a last resort, but should be undertaken as soon as possible, if medical therapy is inadequate, unaffordable or compliance is an issue.

Treatment before macular grid in patients of diabetic macular edema.

AIM: The aim of this study is to compare the efficacy of intravitreal bevacizumab and posterior subtenons triamcinolone acetate in the management of diffuse diabetic macular edema (DME) and to evaluate their efficacy as an adjunct to modified grid laser in management of DME. DESIGN: This was a prospective, randomized clinical trial of 30 patients. MATERIALS AND METHODS: A total of 30 patients attending the medical ophthalmology clinic at a tertiary care hospital were included in the study. These 30 patients were divided into two groups. Group I (15 eyes) received intravitreal bevacizumab followed by modified grid photocoagulation 2 weeks after injection. Group II (15 eyes) received posterior subtenons triamcinolone followed by modified grid photocoagulation 2 weeks after injection. Each patient in our study was followed up at 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after the initial injection to record the central macular thickness (CMT) and best-corrected visual acuity (BCVA). RESULTS: Both the combination therapies have efficacy to reduce the CMT (P = 0.001). The percentage fall in CMT was greater in bevacizumab + laser group, and there was a significant difference in the CMT values at the end of the study in the bevacizumab group (P = 0.013). The mean BCVA improved in both the groups and this difference was statistically significant compared to the baseline (P = 0.005). However, there was no statistically significant difference in BCVA between the two groups at the end of the study. CONCLUSION: Both intravitreal bevacizumab and posterior subtenons triamcinolone given as an adjuvant therapy along with modified grid laser are equally efficacious in the reduction of the CMT; however, the percentage fall in the CMT was greater in bevacizumab + laser group, and there was a significant difference in the fall in CMT at all the visits as compared to a plateau in the fall of CMT in posterior subtenons triamcinolone group.

Characterization and monitoring of deltamethrin-resistance in Anopheles culicifacies in the presence of a long-lasting insecticide-treated net intervention.

BACKGROUND: Deltamethrin-impregnated, long-lasting insecticidal nets (LLINs) were distributed in the study area from November 2014 to January 2015 to evaluate their impact on malaria transmission in the presence of insecticide-resistant vectors. Studies were carried out in 16 selected clusters in Keshkal sub-district, Chhattisgarh State, India to monitor and characterize deltamethrin resistance in Anopheles culicifacies sensu lato. RESULTS: Deltamethrin susceptibility of An. culicifacies decreased in a post-LLIN survey compared to a pre-LLIN survey and was not significant (p > 0.05) while, the knockdown values showed significant increase (p < 0.05). Pre-exposure to piperonyl butoxide, triphenyl phosphate showed synergism against deltamethrin (p < 0.001). Biochemical assays showed significantly (p < 0.05) elevated monooxygenases in 3 of 5 clusters in post-LLIN survey-I that increased to 10 of 11 clusters in post-LLIN survey-II, while esterases were found significantly elevated in all clusters and both enzymes were involved in conferring pyrethroid resistance, not discounting the involvement of kdr (L1014L/S) gene that was heterozygous and at low frequency (4-5%). CONCLUSION: This field study, in a tribal district of India, after distribution of deltamethrin-impregnated LLINs showed decrease in deltamethrin susceptibility in An. culicifacies, a major vector of malaria in this study area and in India. Results indicated development of resistance as imminent with the increase in insecticide selection pressure. There is an urgent need to develop new vector control tools, with insecticide classes having novel mechanisms of resistance, to avoid or delay the onset of resistance. Regular insecticide resistance monitoring and mechanistic studies should be the priority for the malaria control programmes to suggest strategies for insecticide resistance management. The global commitment to eliminate malaria by 2030 needs various efforts that include development of combination vector control products and interventions and few are becoming available.

Ocimum sanctum leaf extract induces drought stress tolerance in rice.

Ocimum leaves are highly enriched in antioxidant components. Thus, its leaf extract, if applied in plants, is believed to efficiently scavenge ROS, thereby preventing oxidative damage under drought stress. Thus, the present study was performed in kharif 2013 and rabi 2014 season to evaluate the effect of aqueous leaf extract of Ocimum sanctum against drought stress in 2 rice genotype under glass house conditions. Here we show that various morpho- physiological (chlorophyll fluorescence, leaf rolling score, leaf tip burn, number of senesced leaves and total dry matter) and biochemical parameters (proline, malondialdehyde and superoxide dismutase content) were amended by Ocimum treatment in both the seasons. Application of Ocimum extract increased expression of dehydrin genes, while reducing expression of aquaporin genes in drought stressed rice plant. Thus, application of Ocimum leaf extract under drought stress can be suggested as a promising strategy to mitigate drought stress in economical, accessible and ecofriendly manner.

Dose-dependent response of Trichoderma harzianum in improving drought tolerance in rice genotypes.

MAIN CONCLUSION: This study demonstrates a dose-dependent response of Trichoderma harzianum Th-56 in improving drought tolerance in rice by modulating proline, SOD, lipid peroxidation product and DHN / AQU transcript level, and the growth attributes. In the present study, the effect of colonization of different doses of T. harzianum Th-56 strain in rice genotypes were evaluated under drought stress. The rice genotypes treated with increasing dose of T. harzianum strain Th-56 showed better drought tolerance as compared with untreated control plant. There was significant change in malondialdehyde, proline, higher superoxide dismutase level, plant height, total dry matter, relative chlorophyll content, leaf rolling, leaf tip burn, and the number of scorched/senesced leaves in T. harzianum Th-56 treated rice genotypes under drought stress. This was corroborated with altered expression of aquaporin and dehydrin genes in T. harzianum Th-56 treated rice genotypes. The present findings suggest that a dose of 30 g/L was the most effective in improving drought tolerance in rice, and its potential exploitation will contribute to the advancement of rice genotypes to sustain crop productivity under drought stress. Interaction studies of T. harzianum with three aromatic rice genotypes suggested that PSD-17 was highly benefitted from T. harzianum colonization under drought stress.

Patterns of pseudophakic retinal detachment in a referral tertiary care center and the need for improving cataract surgical training.

PURPOSE: To determine the risk factors associated with development of rhegmatogenous retinal detachment (RRD) in patients undergoing different types of cataract surgery. METHODS: Records of 200 patients presenting with pseudophakic retinal detachment (PRD) between January 2012 and July 2013 at a tertiary care center were reviewed. Duration and type of cataract surgery (phacoemulsification, extracapsular cataract extraction [ECCE], and small-incision cataract surgery [SICS]) and history of YAG capsulotomy with risk factors were recorded. Presence or absence of these risk factors was analyzed and their association with type of cataract surgery was evaluated. RESULTS: Of these 200 patients, 137 were male and 63 were female. The mean age of the patients was 55.19 ± 12.60 years and mean duration of cataract surgery to diagnosis of RRD was 8.64 ± 5.15 months. Most patients underwent phacoemulsification (45%), followed by ECCE (31.5%) and SICS (23.5%). Most of the patients with PRD had complicated cataract surgery with intraocular lens (IOL) in sulcus in 63%, anterior chamber IOL in 3%, and aphakia in 0.5%. There was no difference among the 3 types of surgery performed in mean presenting visual acuity, duration between cataract surgery and YAG capsulotomy, or number of posterior chamber IOLs. Incidence of posterior capsular rent (p = 0.02) and presence of vitreous in anterior chamber (p = 0.01) were significantly higher for patients with retinal detachment (RD) who underwent SICS. CONCLUSIONS: Many risk factors are associated with RD development after cataract surgery. More stringent efforts at improving the quality of cataract surgical training are likely to help in reducing the risk of PRD.

Sensitivity of multifocal electroretinography (mfERG) in detecting siderosis.

OBJECTIVE: To evaluate use of multifocal electroretinography (mfERG) in diagnosing retinal toxicity from siderosis with normal ERG. DESIGN: Prospective case series. PARTICIPANTS: Six patients with retained intraocular foreign body were recruited. METHODS: The affected eye of the patients had no clinical evidence of siderosis, had similar full-field photopic 3.0 ERG compared with the fellow eye, and had subnormal visual acuity. Group averages in each MfERG ring for implicit time and amplitude at P1 wave were compared between affected and fellow eye to look for latent siderosis. RESULTS: On mfERG, no statistical difference in group averaged amplitude was observed; however, a significant difference (p < 0.05) was found in group averaged latency between fellow and affected eye at most tested rings (<2 degree, 2-5 degree, and >15 degree rings). Average latency for overall retinal area mapped also showed significant difference (p = 0.010). CONCLUSIONS: Increased mfERG latency may serve as an early predictor of retinal damage from siderosis when full-field ERG is normal.

Changing pattern of utilization of human donor cornea in India.

PURPOSE: To review the changing pattern of donor, corneal utilization in an eye bank at a Tertiary Care Center in Northern India by analyzing the trend in the years 2003, 2008, and 2011. METHODS: A retrospective review of eye bank records for 3 years (2003, 2008, and 2011) was performed at the National Eye Bank. Details including a clinical grade of donor cornea, indication of corneal transplantation (therapeutic or optical), type of procedure (penetrating or lamellar keratoplasty [LK]), and clinical diagnosis of the graft recipients were recorded. Primary outcome measure was to observe any preference toward LK, judicious usage of donor corneal tissue, and impact of lamellar corneal transplant in the usage of donor corneas. Secondary outcomes included overall utilization rate and change in trend of indication for keratoplasty. RESULTS: A total of 673, 745, and 864 corneas were retrieved in the years 2003, 2008, and 2011, respectively. The percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011 (P = 0.014); however, this change was reflected only in the usage of nonoptical grade corneas and not for the optical grade corneas. There was an overall increase in lamellar corneal procedures for any clinical grade of cornea (P = 0.0019); number of Descemet's stripping automated endothelial keratoplasty (DSAEK) procedures increased significantly (P < 0.001), particularly for pseudophakic corneal edema (PCE) (P = 0.0085) and failed graft (P = 0.002). Significant increase in the utilization of nonoptical grade corneas was observed over the years (P = 0.005), though the utilization did not increase significantly for optical purposes viz., LK (P = 0.08). CONCLUSIONS: Utilization rate of donor corneas increased over the years, primarily due to increase in usage of nonoptical grade corneas for therapeutic purposes. There was a procedural shift toward DSAEK for PCE and failed graft. However, an increase in usage of nonoptical grade corneas for LK, a single donor corneal tissue for two recipients, and retrieval or utilization of optical grade cornea was not observed.

Test-retest variability of retinal nerve fiber layer thickness and macular ganglion cell-inner plexiform layer thickness measurements using spectral-domain optical coherence tomography.

PURPOSE: To evaluate the test-retest variability of spectral-domain optical coherence tomography (OCT) in measurement of retinal nerve fiber layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. METHODS: A total of 65 eyes of healthy subjects were enrolled in this observational cross-sectional study. RNFL thickness and GCIPL thickness were measured using the repeat scan optic cube and macular cube protocol using Cirrus HD-OCT (software version 6.0). A single operator obtained 3 measurements during 1 session to determine test-retest variability. Intrasession repeatability was defined by intraclass correlation, limits of agreement, and coefficient of variation. RESULTS: The mean age of patients was 37.89±15.11 years (range, 10 to 70 y). The mean RNFL thickness readings as measured during 3 sessions were 93.89±9.73, 93.63±10.00, and 93.55±9.64 µm and average GCIPL thickness measurements were 82.90±4.61, 82.98±4.24, and 83.06±4.36 µm, respectively. Coefficient of variation was 1.2 for average RNFL thickness and 0.82 for average GCIPL thickness. The intraclass correlation coefficient showed a good correlation between repeat measurements for both average RNFL and GCC thicknesses (0.994 and 0.990, respectively). The limits of agreement (95% confidence interval) for the 3 sessions ranged from -3.61 to 4.13 µm for the average RNFL thickness and -2.55 to 2.40 µm for GCIPL thickness measurements. CONCLUSIONS: In healthy eyes, Cirrus HD-OCT shows excellent intrasession repeatability for RNFL and GCIPL thickness measurements.

IOP agreement between I-Care TA01 rebound tonometer and the Goldmann applanation tonometer in eyes with and without glaucoma.

To analyze correlation of intraocular pressure (IOP) measurement between new rebound tonometer (RBT) I-Care TA01 and Goldmann applanation tonometer (GAT). One hundred eighty-five eyes of 185 subjects presenting with glaucoma or cataract were enrolled in the study. In all patients, IOP was obtained by an ophthalmologist using I-Care TA01 and GAT. IOP between the two were compared at range of 8-15, 16-21, and >22 mmHg and difference was considered as significant at p < 0.05 (t test). Bland-Altman analysis tested agreement between instruments overall and for each subgroup of patients with glaucoma or no glaucoma (cataract only). Of 185 patients, 86 had glaucoma; 99 did not. Mean age of patients was 55.77 ± 14.46 years; with no difference between the two subgroups (p = 0.12). There was no significant difference in mean IOP between the two tonometers at IOP between 8-15 mmHg (p = 0.097) and 16-21 mmHg (p = 0.51). However, a significant difference was observed between the two at IOP > 22 mmHg (p = 0.023) with mean GAT (24.8 mmHg) being higher than mean RBT (23.16 mmHg). Overall, there was no difference between the two (p = 0.59) and they had a high correlation (Pearson correlation r = 0.815; p = 0.01). The mean difference between the two was 0.1 (95 % agreement limits: UL +6 (1.96SD), LL -5.8 (-1.96SD)), in patients with no glaucoma was 0.091 (95 % AL: UL +4.8 (1.96SD), LL -4.6 (-1.96SD)), and in patients with glaucoma was 0.151 (95 % AL: UL +7.25 (1.96SD), LL -6.9 (-1.96SD)). RBT I-Care TA01 and Goldmann tonometer cannot be used interchangeably due to large limits of agreement.