Use of corneal hysteresis and corneal resistance factor in target intraocular pressure estimation in patients with early primary open-angle glaucoma.

PURPOSE: To introduce a new method for estimation of the target intraocular pressure (TIOP) in naïve eyes with early primary open-angle glaucoma (POAG) using corneal hysteresis (CH) and corneal resistance factor (CRF). METHODS: A prospective quasi-experimental study was conducted on naïve 90 eyes of 45 patients who were newly diagnosed with early primary open-angle glaucoma (POAG). They were compared to 72 eyes of 36 normal subjects. The TIOP was determined for each eye. The IOP Goldmann (IOPg), IOP corneal-compensated (IOPcc), CH and CRF were estimated by ocular response analyzer (ORA, Reichert) device. Measurements were taken for each patient prior to treatment and after 1, 3, 6, 9 and 12 months of receiving medications; either monotherapy or combination therapy. RESULTS: For all patients, there was a significant negative correlation (p < 0.05) between IOP, either IOPg or IOPcc, and CH, while a significant positive relationship (p < 0.05) existed between IOP and CRF. For patients with early POAG, the CH was significantly increased (p ≤ 0.001), while CRF was significantly decreased (p ≤ 0.001) when TIOP was achieved. At IOP levels higher than TIOP, CH value was lower than CRF with a significant negative correlation between them in contrast to controls. This correlation was reversed on reaching TIOP and CH values became higher than CRF similar to controls. CONCLUSION: CH, CRF and IOP measured by ORA can be used for TIOP estimation. This provides us with a guide for assessing the effectiveness of medications introduced to patients with POAG.

Visual Impact of Early Hydroxychloroquine-Related Retinal Structural Changes in Patients with Systemic Lupus Erythematosus.

PURPOSE: The aim of the study was to assess the early retinal structural changes due to hydroxychloroquine (HCQ) use and its impact on visual acuity (VA) of patients with systemic lupus erythematosus (SLE). PATIENTS AND METHODS: The study was conducted as a case-control study that included 60 eyes of 30 SLE patients treated with HCQ compared with 50 eyes of 25 healthy individuals. Patients were kept on 200 or 400 mg as daily maintenance dose. SLE patients were subgrouped into patients with normal VA and patients with decreased VA. All participants were assessed by the optical coherence tomography (OCT), and early structural abnormalities were recorded. The main outcomes and measures were best-corrected VA, drug exposure time, central macular thickness (CMT), inner segment-outer segment (IS-OS) junction disruption, ganglion cell complex † (GCC†, ganglion cell layer + inner plexiform layer), ganglion cell complex †† (GCC††, nerve fiber layer + GCC†), and peripapillary retinal nerve fiber layer. The characteristics of HCQ retinal toxicity were correlated to VA. RESULTS: All OCT parameters were found to be significantly lower (p < 0.001) in HCQ patients with decreased VA than in controls. Patients receiving a daily dose of 400 mg had lower (p < 0.05) parameters than those receiving 200 mg. Patients with IS-OS disruption had lower CMT, GCC †, and GCC †† than those without (p < 0.05). VA was significantly correlated (p < 0.05) with CMT and drug exposure time. CONCLUSIONS: The HCQ use caused OCT changes that precede clinically visible retinopathy and might be associated with slight VA reduction. Screening with OCT of patients receiving HCQ is essential to detect early vision loss.

Optical Coherence Tomography-Assisted Evaluation of Fractional Er:YAG Laser Versus Fractional Microneedling Radiofrequency in Treating Striae Alba.

BACKGROUND AND OBJECTIVES: Striae distensae (SD) is a challenging skin condition. Striae alba (SA) represents the chronic late atrophic stage of SD. Fractional laser technology is among the modalities used for treating SD. Lately, fractional microneedling radiofrequency (FMR) is gaining increased popularity in treating SD. The aim of our study was to assess and compare the efficacy of FMR and fractional Er:YAG laser in the treatment of SA. STUDY DESIGN/MATERIALS AND METHODS: Twenty female patients were enrolled in the study fulfilling all inclusion and exclusion criteria. On a randomly selected half side of the body, the patients were treated with 2940 nm fractional Er:YAG laser while the other half side was treated with the FMR. RESULTS: Both modalities showed a significant reduction in the width of the widest striae (P < 0.005); however, there was no significant difference between them. Using optical coherence tomography, all patients demonstrated a mean significant increase in epidermal thickness; however, the FMR-treated sites showed significantly better results when compared with the ER:YAG-treated sides (P = 0.029). Scar improvements in both modalities did not correlate to skin type, duration, or site of the striae. CONCLUSION: Er:YAG and FMR represent two safe, effective, tolerable modalities for treating SA and are associated with minimal side effects. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Assessment of Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Changes following Cataract Surgery in Patients with Pseudoexfoliation Glaucoma.

PURPOSE: To assess eye pressure, ganglion cell complex, and retinal nerve fiber layer changes following cataract surgery in patients with pseudoexfoliation glaucoma. METHODS: Eighty-five patients with pseudoexfoliation glaucoma (PEXG) were included in the study. They were divided into two groups; the first group included patients with PEXG and cataract who underwent phacoemulsification (pseudophakic group; n = 40 eyes). The second group included patients with PEXG without cataract (control group; n = 45 eyes). Both groups were on antiglaucoma treatment. IOP changes after surgery and the ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were evaluated in patients underwent cataract extraction surgery compared to controls that did not have cataract, nor underwent surgery. Both groups were followed up postoperatively for 18 months. RESULTS: There was no difference in the mean age and glaucoma stage in both groups (P=0.242 and 0.70, respectively). In the pseudophakic group, the mean IOP significantly dropped from 20.43 ± 0.90 to 17.00 ± 2.75 mmHg at the end of the follow-up period (P ≤ 0.001). Slight decrease (≈3 µm) was recorded in the mean GCC thickness of the pseudophakic patients from the baseline at the end of the follow-up period. This decrease was lower than that of the controls (≈5 µm). No significant pRNFL changes were recorded all over the postoperative visits (88.78 ± 22.55 µm at 3 months, 88.67 ± 23.14 µm at 6 months, 87.62 ± 23.04 µm at 12 months, and 87.32 ± 22.61 µm at 18 months) as compared to preoperative value (90.28 ± 22.31 µm) with P=0.335, 0.387, 0.158, and 0.110, respectively, or controls (89.69 ± 21.76 µm, 88.73 ± 21.08 µm, 87.33 ± 20.67 µm, and 87.23 ± 20.54 µm with P=0.850, 0.990, 0.951, and 0.984). CONCLUSION: Phacoemulsification and IOL implantation may aid in managing pseudoexfoliation glaucoma by lowering IOP and slowing the rate of GCC and pRNFL losses over a short-term period.