The Fluctuation of Intraocular Pressure Measured by a Contact Lens Sensor in Normal-Tension Glaucoma Patients and Nonglaucoma Subjects.

PURPOSE: We compared the fluctuation of intraocular pressure (IOP) in normal-tension glaucoma (NTG) patients and individuals with nonglaucoma eyes. We obtained continuous IOP values using a SENSIMED Triggerfish contact lens sensor. MATERIALS AND METHODS: The eyes of 12 nonglaucoma subjects and 14 NTG patients were examined. In all 26 subjects, the IOP fluctuation was measured continuously for 24 hours with a contact lens sensor. We evaluated the range of IOP fluctuations over the 24-hour period separately for diurnal IOP and nocturnal IOP and identified each subject's maximum value. The range of IOP fluctuation were analyzed, cutoff level of IOP fluctuation was calculated using receiver operating characteristic curve analyses. RESULTS: The mean IOP in the NTG eyes was 11.5±2.4 mm Hg and that in the nonglaucoma eyes was 12.7±2.0 mm Hg, a nonsignificantly difference (P=0.175). The 24-hour range of IOP fluctuations in the NTG group was significantly larger than that of the nonglaucoma group (P=0.007). The percentage of NTG patients who had the peak time of IOP fluctuation during nocturnal sleep was 57.1%, whereas the corresponding rate for the nonglaucoma eyes was 91.7%. The cutoff level of IOP fluctuation for glaucoma was 442 mVeq (sensitivity=1.00; specificity=0.571). CONCLUSIONS: The range of IOP fluctuation was larger in the eyes with NTG than in the nonglaucoma eyes. This larger fluctuation might be one of the reasons underlying the aggravation of the visual field by NTG. Measurements of 24-hour continuous IOP might be one of the useful methods to distinguish NTG from nonglaucoma eyes.

The relationship between vascular endothelial dysfunction and treatment frequency in neovascular age-related macular degeneration.

PURPOSE: To assess the correlation between endothelial dysfunction and frequency of antivascular endothelial growth factor (anti-VEGF) treatment for neovascular age-related macular degeneration (nAMD). METHODS: We examined 64 consecutive patients with nAMD who were evaluated for endothelial function by use of peripheral arterial tonometry (EndoPAT 2000; Itamar Medical, Caesarea, Israel) at Toyama University Hospital from January 2015. We tallied the number of anti-VEGF treatments between January 2014 and December 2015 and determined the correlation between the number of anti-VEGF injections and endothelial function expressed as the reactive hyperemia index (RHI). Multiple regression analysis was also performed to identify the independent predictors of a larger number of injections. RESULTS: The mean number of anti-VEGF injections was 8.2 ± 3.3. The mean lnRHI was 0.47 ± 0.17. The lnRHI correlated with the number of anti-VEGF injections (r = -0.56; P = 0.030). The multiple regression analysis revealed that endothelial function, neovascular subtypes, and treatment regimens were associated with the number of injections. CONCLUSIONS: Endothelial dysfunction may affect the efficacy of anti-VEGF therapy. Neovascular subtypes may also predict a larger number of injections.

Intraoperative changes in idiopathic macular holes by spectral-domain optical coherence tomography.

PURPOSE: To examine anatomical changes in idiopathic macular holes during surgery using handheld spectral-domain optical coherence tomography (SD-OCT). METHODS: Five eyes of 5 patients who underwent surgery for the repair of idiopathic macular holes were examined. The surgery included standard 25-gauge, 3-port pars plana vitrectomy, removal of the internal limiting membrane (ILM), fluid-air exchange, and 20% sulfur hexafluoride tamponade. Intraoperative SD-OCT images of the macular holes were obtained after ILM removal and under fluid-air exchange using a handheld SD-OCT. From SD-OCT images, the macular hole base diameter (MHBD) was measured and compared. RESULTS: All macular holes were successfully closed after the primary surgery. The mean MHBD under fluid-air exchange was significantly smaller than the mean MHBD after ILM removal and the preoperative mean MHBD. In 1 eye with a stage 3 macular hole, SD-OCT images revealed that the inner edges of the macular hole touched each other under fluid-air exchange. CONCLUSION: Fluid-air exchange significantly reduced MHBD during surgery to repair macular holes. Fluid-air exchange may be an important step for macular hole closure as it reduces the base diameter of the macular hole.