Agreement between anterior segment swept source-OCT and Scheimpflug imaging corneal aberration measurements in healthy eyes.

PURPOSE: To assess agreement between corneal aberration measurements made through swept-source optical coherence tomography using a new anterior segment imaging device (Anterion) and a Scheimpflug imaging device (Pentacam HR) in healthy subjects. METHODS: Cross-sectional study. In 50 eyes of 50 healthy subjects, 14 aberration parameters (7 across the anterior corneal surface and 7 across the total surface) were measured in 4 mm and 6 mm optic zones using each device: oblique trefoil (Z3_-3), vertical coma (Z3_-1), horizontal coma (Z3_1), horizontal trefoil (Z3_3), spherical aberration (Z4_0), root mean square (RMS) lower order aberrations (LOA) and RMS higher order aberrations (HOA). Data for the two devices were compared through intraclass correlation coefficients (ICC), paired t tests, limits of agreement (LoA) and Bland Altman plots. RESULTS: Vertical coma was the only corneal aberration parameter that consistently showed excellent agreement (ICC > 0.8, mean difference -0.019, LoA -0.165 to 0.126). Good agreement (ICC = 0.75) between the devices was observed for RMS HOA, but this was slightly worse in the 6 mm optical zone (ICC = 0.667 for anterior RMS HOA). No over- or underestimation trend by one or other device was noted. Agreement was poor to moderate for the rest of the corneal parameters (ICC 0.2 to 0.7). CONCLUSION: Despite good agreement overall for vertical coma and RMS HOA values, agreement for the remaining corneal aberration measurements was poor to moderate. As mean differences in our sample were overall small, in normal eyes these devices could be clinically judged as interchangeable.

Anterior-Segment Swept-Source Ocular Coherence Tomography and Scheimpflug Imaging Agreement for Keratometry and Pupil Measurements in Healthy Eyes.

This study examines agreement between the devices Anterion® and Pentacam HR® used for corneal and pupil measurements in healthy eyes. The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), anterior astigmatism (D), anterior K max (D), posterior Km (D), posterior K2 (D), posterior K1 (D), posterior K1 axis (°), posterior astigmatism (D), CCT (µm), thinnest point thickness (µm), thinnest point X-coordinate (mm), thinnest point Y-coordinate (mm), pupil diameter (mm), pupil center-corneal vertex distance (mm) (angle kappa), pupil centroid angle (°), pupil centroid X-coordinate (mm), and pupil centroid Y-coordinate (mm). The Student's t test for independent samples identified significant differences (p < 0.005) between devices for the measurements anterior and posterior flat K axis, posterior flat K, steep K, and mean K. For these last three measurements, although significant, none of the differences were clinically relevant. Corneal power and thickness measurements except Kf axis showed excellent agreement between Anterion and Pentacam. In a clinical setting we would not recommend the interchangeable use of Pentacam and Anterion for measurement of pupil parameters.

Comparing in-vivo confocal microscopy and ex-vivo light and scanning electron microscopy images of the hairs of the pine processionary caterpillar embedded in the cornea: Report of three cases.

This report describes three cases of pine processionary caterpillar hairs (setae) embedded in the cornea: one in a 69-year-old man with acute keratouveitis, a second case in a 65-year-old man with an epithelial defect and a stromal infiltrate, and the third case affecting a 54-year-old woman with mild keratitis. The two first patients had one hair embedded in the anterior corneal layers while the last one had several hairs deeply embedded in the stroma. By comparing in-vivo confocal microscopy (IVCM) with ex-vivo light microscopy (LM) and scanning electron microscopy (SEM) images, the morphology of the setae was identified and confirmed.

Efficacy of Ologen matrix implant in Ahmed Glaucoma Valve Implantation.

To determine the efficacy and safety of the Ologen collagen matrix adjunctive to Ahmed valve surgery. A randomized prospective multicentre clinical trial involving 58 patients that were followed for one year. Conventional surgery with Ahmed valve was performed in 31 eyes (Control group/CG) and in 27 Ologen (Ologen group/OG) was placed over the valve's plate. Baseline data: age, corneal thickness, intraocular pressure(IOP) and antiglaucoma medications.Postoperative data (days 1, 7 and months 1, 3, 6 and 12): IOP, antiglaucoma medications, visual acuity and complications were recorded. Frequency of hypertensive phase, complete and qualified success and survival rate were studied. No differences were found between CG and OG in the baseline data. The only difference between groups was a significantly lower IOP at day 1. No other differences were found in the follow-up between groups. Hypertensive phase (56%CG and 55%OG, p = 0,947), complete success 28,6%CG and 30,4%OG (p = 0,88) and qualified success 96,4% and 95,9%(p = 0,794). Survival rates at 1 year were 76,7%(CG) and 69,2%(OG)(p = 0,531). 38,7% of patients in the CG suffered some complication during follow-up and 61,5% in OG(p = 0,086). Ologen does not increase safety or efficacy in Ahmed valve surgery at one-year follow-up. This is the first study that shows no benefit of Ologen adjunctive to this surgery.

Intraocular light scatter in patients on topical intraocular pressure-lowering medication.

PURPOSE:: To quantify ocular light scattering in patients under treatment with intraocular pressure-lowering eye-drops. METHODS:: In this prospective, observational, cross-sectional case series study, 160 eyes of 160 patients with primary open angle glaucoma or primary ocular hypertension were consecutively recruited from our Glaucoma Department over 7 months. In total, 46 eyes of 46 healthy volunteers matched for age and sex served as the control group. The variables recorded in a single visit were as follows: drug and number of drops per day, treatment duration, OXFORD corneal staining grade, lower tear meniscus height as measured by spectral domain optical coherence tomography, ocular redness and non-invasive tear breakup time measured with the Oculus Keratograph 5M, ocular surface disease index questionnaire score and objective scatter index through a double-pass technique (Optical Analysis System II). RESULTS:: Objective scatter index was higher in the patient group (3.1, interquartile range = 1.8-5.47) than in the control group (1.95; interquartile range = 0.7-5; p = 0.017). In a multiple linear regression model, non-invasive tear breakup time was identified as the most influential variable on light scatter (mean ratio = -1.015; p = 0.003; 95% confidence interval = -1.025 to -1.005). No correlation with objective scatter index was observed for number of daily eye-drops, preservative concentration or treatment duration. CONCLUSION:: Participants on anti-glaucoma medication showed a significantly higher objective scatter index than control group individuals. In the treated patient group, a lower non-invasive tear breakup time was associated with a higher objective scatter index. This suggests that lubricating eye-drops to improve tear breakup time could also improve vision quality in these patients by diminishing light scattering.

Phacoemulsification plus endoscopic cyclophotocoagulation versus phacoemulsification alone in primary open-angle glaucoma.

PURPOSE: To examine the efficacy and safety of combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) compared to phacoemulsification alone in patients with primary open-angle glaucoma (POAG). METHODS: We performed a retrospective notes review of 99 consecutive clinical records of patients with POAG from 2 London eye departments. A total of 69 patients who underwent phaco-ECP and 30 sex- and age-matched control patients who underwent cataract surgery alone were included. Data on intraocular pressure (IOP), visual acuity (VA), number of ocular hypotensive medications, and postoperative complications were collected over 12 months. The primary outcome measure was defined as an IOP within normal limits (<21 mm Hg) and at least a 20% reduction in IOP from baseline. RESULTS: Mean IOP was significantly decreased in both groups after 1 year (p<0.001 from baseline). The success rate was significantly higher in the phaco-ECP group (69.6%) than in the phaco group (40%) after 1 year (p = 0.004). Reduction in mean IOP and number of medications was also greater in the phaco-ECP group after 1 year (IOP reduction: 4.5 ± 5.13 mm Hg vs 1.83 ± 3.61 mm Hg; p = 0.007; number of medications reduction: 0.73 ± 0.71 vs 0.23 ± 0.56; p = 0.001). Both groups achieved a similar improvement in VA. There was a higher incidence of minor and self-limiting complications in the phaco-ECP group (p<0.047). CONCLUSIONS: Phaco-ECP resulted in a greater reduction in IOP and number of medications than phacoemulsification alone in POAG.

Ocular Redness Measured with the Keratograph 5M in Patients Using Anti-Glaucoma Eye Drops.

PURPOSE: To examine correlations between ocular redness measured with the new topographer Keratograph 5M and the use of topical anti-glaucoma medication. METHODS: A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication and 51 eyes of 51 healthy volunteers were recruited over 10 months. Outcome variables were keratograph redness scores (RS): overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN). In each subject, we also recorded the intraocular pressure-lowering eye drops used, daily doses and daily and cumulative preservative concentrations, fluorescein corneal staining score (OXFORD), lower tear meniscus height (Fourier-domain OCT), non-invasive tear film breakup time (Keratograph 5M), and ocular surface disease questionnaire index (OSDI). RESULTS: Higher RS were recorded in the medication than control group (P < 0.01 all scores). Within the medication group, older patients returned greater RS (P < 0.05 all scores). Prostaglandin was a strong predictor of higher scores, except LN RS. A higher OSDI was associated with a higher LN RS (ß = 0.007; P < 0.05), while the use of ß-blockers was linked to a lower LN RS (ß = -0.225; P < 0.05). The use of ≥3 daily eye drops with preservative gave rise to a higher BN RS and ≥3 daily eye drops to a higher LN RS (ß = 0.366, P < 0.01; ß = 0.296, P < 0.05, respectively). CONCLUSION: Keratograph 5M can objectively detect the hyperaemia induced by glaucoma medication. The factors contributing to ocular redness were advanced age, more daily eye drops (nasal sectors), a higher OSDI, and prostaglandin as the medication used.

Correlating Corneal Biomechanics and Ocular Biometric Properties with Lamina Cribrosa Measurements in Healthy Subjects.

PURPOSE: To examine interrelations between corneal biomechanics, ocular biometric variables and optic disc size (ODS), lamina cribosa depth (LCD) or thickness (LCT) in a healthy population. MATERIAL AND METHODS: In a cross-sectional case-control study, the following measurements were made in 81 eyes of 81 participants: axial length, anterior chamber depth, lens thickness, and central corneal thickness using the optical biometer Lenstar LS900; and corneal hysteresis (CH), corneal resistance factor (CRF), Goldman-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) using the Ocular Response Analyzer. Serial horizontal enhanced depth imaging optical coherence tomography (EDI OCT) B-scans of the optic nerve head were obtained in each participant. Mean ODS, mean LCD, and mean LCT were measured in 11 equally spaced horizontal B-scans, excluding the LC insertion area under Bruch's membrane and scleral rim. RESULTS: LCD was measured in 74 of 81 eyes (91.36%); LCT in 60/81 (75.3%); ODS in 81/81 (100%). CRF was poorly, but significantly, correlated with LCT (Pearson's R = 0.264; P = 0.045). IOPcc, IOPg, CH, and ocular biometrics variables were poorly (non-significantly) correlated with LCD, LCT, and ODS. CONCLUSIONS: CRF was poorly but directly correlated with LCT. No association was detected between CH or ocular biometric variables and ODS, LCD, or LCT.

Ocular Surface Disease in Patients under Topical Treatment for Glaucoma.

PURPOSE: To examine the relationship between ocular surface disease (OSD) and topical antiglaucoma therapy. METHODS: A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication were recruited over 10 months. Controls were 51 eyes of 51 healthy age- and sex-matched volunteers. In each patient, we recorded the intraocular pressure-lowering eyedrops used, the number of medications used, and daily and cumulative preservative concentrations (PC). Main outcome measures were fluorescein corneal staining score (Oxford scale), lower tear meniscus height (LTMH) (spectral-domain optical coherence tomography), noninvasive tear film breakup time (NI-TBUT) (Oculus Keratograph 5M), and OSD symptom questionnaire index (OSDI). RESULTS: Compared to controls, significantly higher OSDI (median [interquartile range] 10.24 [4.54-18.94] vs 2.5 [0-12.5]; p<0.001) and corneal staining (≥1: 64.93% vs 32.61%; p<0.001) scores were recorded in the medication group. The NI-TBUT and LTMH failed to vary between the groups (p>0.05). A higher daily PC was associated with a lower LTMH (R -0.142; p = 0.043). In the medication group, multivariate analysis identified correlations between benzalkonium chloride (BAK) (odds ratio [OR] 1.56) and BAK plus polyquaternium-containing drops (OR 5.09) or higher OSDI (OR 1.06) and abnormal corneal staining test results and between older age (mean ratio [MR] 1.05), longer treatment duration (MR 1.02), or corneal staining presence (MR 1.22) and a higher OSDI score. CONCLUSIONS: Ocular surface disease was more prevalent in the medication group. The main factors impacting OSD were drops with preservatives, longer treatment duration, and older age.

Tear cytokine profile of glaucoma patients treated with preservative-free or preserved latanoprost.

PURPOSE: To determine variations in cytokine levels of glaucoma patients treated either with preservative-free latanoprost or preserved latanoprost, relative to healthy individuals. METHODS: Tear samples were collected from 39 healthy subjects, 20 glaucoma patients treated with preserved latanoprost, and 20 patients treated with preservative-free latanoprost. A set of 27 inflammatory cytokines was analyzed in each group, including interleukin (IL)-1ß, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL9, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor (FGF) basic, granulocyte colony stimulating factor (G-CSF), granulocyte monocyte colony stimulating factor (GM-CSF), interferon (IFN)-γ, interferon gamma-induced protein (IP)-10, monocyte chemo attractant protein (MCP)-1MCAF, macrophage inflammatory protein (MIP)-1α, MIP-1ß, platelet-derived growth factor (PDGF)-BB, regulated on activation, normal T cell expressed and secreted (RANTES), tumor necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF). Cytokine concentrations were obtained by the Bio-Plex Human Cytokine Immunoassay. Non-invasive tear breakup time (NI-TBUT), tear meniscus height, corneal fluorescein staining, conjunctival hyperemia and ocular surface disease index (OSDI) were assessed in patients treated with preservative-free and preserved latanoprost. RESULTS: The levels of IL-2, IL-5, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, FGF basic, PDGF-BB, and TNF-α were significantly higher in patients receiving preserved latanoprost, compared to normal controls (p < 0.05). The expression of all the cytokines studied remained statistically invariable in patients receiving preservative-free latanoprost, compared to healthy subjects (p > 0.05). Ocular surface parameters were not significantly different in both glaucoma groups, and no correlation between these clinical parameters and cytokine levels was observed. CONCLUSIONS: Treatment with preserved latanoprost has a direct impact on tear cytokine levels, whereas this effect is not observed upon preservative-free latanoprost instillation.