Choroidal blood flow after the first intravitreal ranibizumab injection in neovascular age-related macular degeneration patients.

PURPOSE: To analyse choroidal blood flow (ChBF) changes after the first intravitreal ranibizumab injection in naïve, age-related macular degeneration (ARMD) patients. METHODS: Subfoveal ChBF was assessed by laser Doppler flowmetry (LDF) in newly diagnosed ARMD patients. Both treated and untreated eyes were assessed in each subject at each visit before the first intravitreal ranibizumab injection as well as 24 hr (day 1) and 7 days after (day 7). Central macular thickness (CMT), best-corrected visual acuity (BVCA), systemic haemodynamic parameters and LDF parameters were evaluated at each visit. Nonparametric tests were used to compare data between visits and between treated and untreated eyes. RESULTS: Seventeen ARMD patients were included (12 women and five men, 78 ± 8 years old). At day 7 postintravitreal ranibizumab injection, the normalized choroidal blood velocity (ChBVel) change in the treated eye group was significant (-10.2%; p = 0.006). The choroidal blood volume (ChBVol) did not change significantly after intravitreal injection of ranibizumab. There was a trend for a reduction in ChBF at day 7 (-9.1%, p = 0.08). The sensitivity of the experiment was 12% for ChBVel, 16% for ChBVol and 9% for ChBF. CONCLUSION: In conclusion, the laser Doppler technique provides feasible and noninvasive measurements of blood flow parameters before and after intravitreal injection of antivascular endothelial growth factor (anti-VEGF) in patients with exudative ARMD. Choroidal blood velocity decreased as early as 7 days after intravitreal ranibizumab injection, suggesting a vasoconstriction effect of anti-VEGF in large choroidal vessels in front of choriocapillaris (the site of LDF measurement).

24-Hour Intraocular Pressure Rhythm in Patients With Untreated Primary Open Angle Glaucoma and Effects of Selective Laser Trabeculoplasty.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the 24-hour nyctohemeral rhythm of intraocular pressure (IOP) in patients with untreated primary open angle glaucoma using a contact lens sensor. To evaluate the effect of selective laser trabeculoplasty (SLT) on the 24-hour rhythm of IOP. MATERIALS AND METHODS: Prospective study conducted in a chronobiology center. Fourteen patients with primary open angle glaucoma underwent three 24-hour IOP measurement sessions after a complete wash-out of the medical treatment: before SLT and 1 and 6 months after, using the contact lens sensor Triggerfish (SENSIMED, Lausanne, Switzerland). IOP and the main parameters of nyctohemeral rhythm (existence of a rhythm, acrophase, bathyphase, midline estimating statistic of rhythm, amplitude, and range) before SLT were compared with the same parameters measured 1 and 6 months later. RESULTS: IOP increased from 16.3±3.7 to 22.1±8.4 mm Hg (5.8 mm Hg; 95% confidence interval (CI), 2.41-12.71; P=0.009) after the wash-out procedure. After SLT, IOP significantly decreased by 3.4 mm Hg (95% CI, 0.09-7.89; P=0.041) (14.9%) at 1 month and 1.9 mm Hg (95% CI 0.10-3.84; P=0.044) (8.1%) at 6 months. After medication wash-out, 100% of the subjects had a nyctohemeral IOP rhythm with nocturnal acrophase (01:57±3:32 AM, 01:22±3:01 AM, and 03:17±2:12 AM at inclusion, 1 and 6 mo, respectively). SLT did not significantly change the characteristics of the 24-hour IOP pattern, notably the amplitude and the type of rhythm (persistence of nocturnal acrophase). CONCLUSIONS: After medical treatment wash-out, patients with open angle glaucoma consistently had a significant 24-hour IOP rhythm with nocturnal acrophase. SLT reduces the absolute IOP value but does not modify the nyctohemeral IOP rhythm.

Hypoxic, Hypercapnic, and Hyperoxic Responses of the Optic Nerve Head and Subfoveal Choroid Blood Flow in Healthy Humans.

Purpose: To investigate the impact of different gas mixtures (hyperoxia, hypoxia, and hypercapnia) on the optic nerve head (ONH) and choroidal (Ch) hemodynamics. Methods: Twenty-three healthy subjects (28 ± 6 years) took part in the study. Variations in inspired oxygen and carbon dioxide fraction were produced by a gas mixing device. Arterial oxygen saturation (SpO2) was measured continuously using a transcutaneous sensor and end-tidal carbon dioxide partial pressure by capnography. The experiment comprised three successive periods: 3-minute baseline (room air breathing), 15-minute gas mixture inhalation (normocapnic hypoxia, hypercapnia, or hyperoxia), and 15-minute recovery (room air breathing). Laser Doppler flowmeter parameters-velocity (VEL), volume (VOL), and flow (BF) of red blood cells-were measured. Two-way ANOVAs were performed for statistical analysis. Results: In response to hyperoxia, ONHBF significantly decreased by -18% ± 6% (P = 0.04) from baseline, due to significant changes in VEL (-12% ± 3% P = 0.0002). During hypoxia at 85% SpO2, ONH VEL increased by +12% ± 3% (P = 0.0009), whereas VOL and BF did not change significantly. ChBF significantly increased by +7% ± 2% (P = 0.004) in response to hypoxia, due to significant changes in VEL +5% ± 2% (P = 0.03). Both Ch and ONHBFs did not vary significantly in response to hypercapnia. Conclusions: The magnitude of the blood flow response is the most significant during hyperoxia for ONH and hypoxia for ChBF. For ONHBF, a 37% difference between hyperoxia and hypoxia can be useful when vasoreactivity to O2 will be tested in patients.

Longitudinal study of retinal status using optical coherence tomography after acute onset endophthalmitis following cataract surgery.

PURPOSE: To analyse the macula imaged with optical coherence tomography (OCT) in patients treated for acute postcataract endophthalmitis. METHODS: Patients presenting with acute postcataract endophthalmitis were included in this observational and multicentre study from January 2008 to December 2011. We recorded the following OCT data at the 3, 6 and 12-month visits: the central macular thickness, the perifoveal macular thickness, the central foveal point thickness and abnormalities of the outer retina, the macula and vitreoretinal interface. RESULTS: 46 patients were included in the OCT analysis. From month 3 to 12, epiretinal membrane (ERM) prevalence increased from 26% to 39%, vitreomacular traction prevalence decreased from 12% to 6%, non-tractional macular oedema (ME) prevalence varied between 7% and 13%. Only macular thinning remained stable at 10%. At month 12, a significant correlation was found between non-tractional ME and capsular rupture (at the time of cataract extraction, p=0.03). Eyes with an ERM exhibited increased central macular thickness (p=0.001) and lower visual acuity (VA) (p=0.02) at M12 in comparison to the group with normal macula. OCT analysis showed a significant association between ERM and the alteration of the ellipsoid band (p=0.02), as well as the external limiting membrane (ELM, p=0.07) at M12. CONCLUSIONS: ERM and ME were the main macular abnormalities diagnosed after 1 year of follow-up, associated with VA less than or equal to 20/40 in 50% of the cases. Ultrastructural abnormalities of the ELM and the ellipsoid band were frequently observed in those patients.

Comparison of intraocular pressure measurements with the Reichert Pt100, the Keeler Pulsair Intellipuff portable noncontact tonometers, and Goldmann applanation tonometry.

PURPOSE: The aim of this study was to compare intraocular pressure (IOP) measurements using 2 portable tonometers, the Keeler Pulsair Intellipuff and the Reichert PT100, with Goldmann applanation tonometry (GAT). MATERIALS AND METHODS: Prospective cross-sectional study was conducted on normotensive and hypertensive patients recruited from the outpatient clinic of the University Hospital of Grenoble. IOP was measured using 2 portable noncontact tonometers (NCTs) and GAT in one eye of each patient in a random order. Central corneal thickness was measured with the Accutome PachPen Pachymeter. The Wilcoxon and t tests were used to compare the differences between tonometers, the Pearson and the Spearman correlation tests to evaluate the correlation among the methods, and the Bland-Altman plots to evaluate the agreement among the methods. Intraclass correlation coefficient (ICC) was used to evaluate the agreement among the methods in normotensive and hypertensive patients separately. RESULTS: A total of 137 eyes of 137 patients were included, 104 normotensive and 33 hypertensive eyes. We found an excellent agreement between PT100 and GAT (ICC=0.77) and between Intellipuff and GAT (ICC=0.75) in normotensive patients. We found a fair to good agreement (ICC=0.67) between PT100 and GAT in hypertensive patients. The agreement we found between Intellipuff and GAT was also excellent in hypertensive patients (ICC=0.86). Both NCTs significantly overestimated IOP measurements compared with GAT in normotensive and hypertensive eyes (mean of the differences between PT100 and GAT: 1.3±2.1 and 8.1±4.6 mm Hg in normotensive and in hypertensive patients, respectively (P<0.05), and between Pulsair Intellipuff and GAT: 1.5±1.8 and 2.3±4.8 mm Hg in normotensive and in hypertensive patients, respectively (P<0.05). CONCLUSIONS: The 2 NCTs agree well with GAT in normotensive patients. The Pulsair Intellipuff also agrees well with GAT in hypertensive patients.