A comparison of subjective and objective conjunctival hyperaemia grading with AOS® Anterior software

Purpose: Preservatives in glaucoma medications have been associated with ocular toxicity. We compared ocular signs and symptoms in patients with open-angle glaucoma or ocular hypertension treated in monotherapy with preserved or preservative-free prostaglandin analogues. Methods: Observational cross-sectional clinical study in real life. 82 patients treated for at least 6 months with prostaglandin analogue were assessed for intraocular pressure, ocular symptoms and ocular signs including conjunctival hyperaemia, tear break-up time and tear meniscus height measured using objective and non-invasive methods (OCULUS Keratograph 5M). Patients presenting with symptoms of ocular toxicity with preserved prostaglandin analogues were switched to preservative-free latanoprost, and a second assessment was processed 6 months after. Results: At inclusion, 30 (36.6%) patients were treated with preservative-free latanoprost, 25 (30.5%) with preserved latanoprost, 16 (19.5%) with preserved travoprost and 11 (13.4%) with preserved bimatoprost. Patients treated with preservative-free latanoprost reported significantly less ocular symptoms upon instillation (mainly burning) and between instillations than patients treated with preserved prostaglandin analogues. The mean conjunctival hyperaemia (limbal + bulbar) was significantly lower with preservative-free latanoprost (2.08 ± 0.55) compared to preserved latanoprost (2.50 ± 0.7, p = 0.0085), preserved travoprost (2.67 ± 0.82, p = 0.0083) and preserved bimatoprost (2.68 ± 0.67, p = 0.0041). There were no relevant between-group differences in mean tear meniscus height and break-up time. Ocular symptoms and conjunctival hyperaemia improved when preserved prostaglandin analogues were switched to preservative-free latanoprost for 6 months while intraocular pressure reduction was maintained. Conclusion: Overall, this study suggests a better subjective and objective ocular tolerance when patients were treated with preservative-free latanoprost than with other preserved prostaglandin analogues monotherapy. Switching to preservative-free latanoprost maintained intraocular pressure at the same level as preservative prostaglandin analogue, but improved ocular surface tolerance.

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Effect of Desonide 0.25% Ophthalmic Solution on Central Corneal Thickness and Intraocular Pressure of Patients with Allergic Conjunctivitis

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v12i3.305 ◽

1970 ◽

Vol 12 (3) ◽

pp. 156-158

Author(s):

Ozlem Gurses Sahin

Keyword(s):

Intraocular Pressure ◽

Allergic Conjunctivitis ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Ophthalmic Solution ◽

Applanation Tonometry ◽

Goldmann Applanation Tonometry ◽

Mean Values ◽

Conjunctival Hyperaemia ◽

Significant Difference

Aim: To evaluate whether a significant difference exists between the initial and final mean central corneal thickness that might affect Goldmann applanation tonometer recordings of patients with allergic conjunctivitis treated with desonide 0.25% ophthalmic solution, and to determine the effect of desonide on intraocular pressure by using adjusted intraocular pressure values.Methods: This double-blind randomised placebo-controlled trial enrolled 30 patients (60 eyes) with allergic conjunctivitis. Patients were randomly assigned to receive desonide to 1 eye (study eye) and preservative-free tear supplement (Tears Naturale Free®) to the other eye (control eye) 3 times daily for 3 weeks. Goldmann applanation tonometry and central corneal thickness of both eyes were recorded on the day of presentation and 3 weeks later.Results: Regression of itching, tearing, conjunctival hyperaemia, and tarsal conjunctival papillary reaction were noted in the study eyes after 3 weeks of treatment. The control eyes showed mild regression of pruritis, tearing, conjunctival hyperaemia, and tarsal conjunctival papillary reaction after 3 weeks. There was a significant difference between the initial and final mean central corneal thickness values for the study eyes (p = 0.003). There were no statistically significant differences between the initial and final mean values of Goldmann applanation tonometry and adjusted intraocular pressure for the study eyes. No statistically significant differences were found between the initial and final mean values of any of the parameters for the control eyes.Conclusion: Inflammation-induced increase in central corneal thickness of patients with allergic conjunctivitis treated with desonide showed statistically significant regression. However, this regression did not significantly affect Goldmann applanation tonometry and adjusted intraocular pressure values of the treated eyes.

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Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313396 ◽

2019 ◽

Vol 104 (6) ◽

pp. 813-821 ◽

Cited By ~ 4

Author(s):

Ghee Soon Ang ◽

Eva K Fenwick ◽

Marios Constantinou ◽

Alfred Tau Liang Gan ◽

Ryan Eyn Kidd Man ◽

...

Keyword(s):

Assessment Tool ◽

Controlled Trial ◽

Well Being ◽

Randomised Clinical Trial ◽

Absolute Difference ◽

Selective Laser Trabeculoplasty ◽

Topical Medication ◽

Intention To Treat ◽

Conjunctival Hyperaemia ◽

Laser Trabeculoplasty

Background/AimsTo determine if selective laser trabeculoplasty (SLT) is superior to topical medication as a first-line treatment for glaucoma on quality of life (QoL) and clinical outcomes.MethodsIn this international, longitudinal, multisite randomised controlled trial, treatment naïve mild-to-moderate primary open angle or exfoliation glaucoma patients were randomised 1:1 to SLT or topical medication. Glaucoma-specific QoL (primary outcome) was measured using the Glaucoma Outcomes Assessment Tool (GOAT; 342 items, 12 domains). Secondary outcomes included rate of successful intraocular pressure (IOP) reduction (>25% reduction from baseline) and presence of ocular surface disease including conjunctival hyperaemia and eyelid erythema. Our intention-to-treat analysis was performed at months 12 and 24.ResultsOf 167 enrolled patients, 83 and 84 were randomised to SLT and topical medication, respectively; and 145 (n=75 SLT, n=70 medication) completed 24-month follow-up. While both treatment arms achieved significant within-group gains in GOAT outcomes at both endpoints, SLT patients reported a greater between-group improvement in ‘social well-being’ compared with medication patients (mean±SE=0.28±0.13; p=0.034) at 24 months. At month 24, the rate of successful IOP reduction was 18.6% (95% CI 3.0% to 34.3%, p=0.022) higher (absolute difference) in the medication compared with SLT group. More individuals in the medication group had conjunctival hyperaemia and eyelid erythema compared with SLT at 24 months.ConclusionOverall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL. While we found superior IOP reduction in the medication arm, eyelid erythema and conjunctival hyperaemia were more prevalent in these patients compared with the SLT group.Trial registrationACTRN12611000720910.

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Objective Assessment of Autonomic Signs During Triggered First Division Trigeminal Neuralgia

Cephalalgia ◽

10.1046/j.1468-2982.2002.00330.x ◽

2002 ◽

Vol 22 (4) ◽

pp. 251-255 ◽

Cited By ~ 40

Author(s):

JA Pareja ◽

M Barón ◽

P Gili ◽

J Yangüela ◽

AB Caminero ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Objective Assessment ◽

Conjunctival Injection ◽

Female Patients ◽

Conjunctival Hyperaemia ◽

Symptomatic Side

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 ± 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.

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Corticosteroids in Moderate-To-Severe Graves’ Ophthalmopathy: Oral or Intravenous Therapy?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010155 ◽

2019 ◽

Vol 16 (1) ◽

pp. 155 ◽

Cited By ~ 1

Author(s):

Laura Penta ◽

Giulia Muzi ◽

Marta Cofini ◽

Alberto Leonardi ◽

Lucia Lanciotti ◽

...

Keyword(s):

Thyroid Function ◽

Anterior Segment ◽

Thyroid Stimulating Hormone ◽

Graves Disease ◽

Free Triiodothyronine ◽

Upper Eyelid ◽

Conjunctival Hyperaemia ◽

Graves Ophthalmopathy ◽

Antibody Positivity ◽

The Right

Background: Ophthalmopathy is a rare extra-thyroid manifestation of Graves’ disease, in paediatrics. Intravenous corticosteroids are the main treatment of moderate-to-severe Graves’ orbitopathy. In this paper, we describe a moderate-to-severe active Graves’ ophthalmopathy in a child and the response to oral therapy with prednisone. Case presentation: A nine-year-old male child suffering for a few months, from palpitations, tremors, and paresthesia was hospitalized in our Pediatric Clinic. At admission, the thyroid function laboratory tests showed hyperthyroidism with elevated free thyroxine (FT4) and free triiodothyronine (FT3) levels and suppressed thyroid-stimulating hormone (TSH) levels. These findings, combined with the clinical conditions—an ophthalmologic evaluation (that showed the presence of exophthalmos without lagophthalmos and visual acuity deficiency), thyroid ultrasound, and TSH receptor antibody positivity—led to a diagnosis of Graves’ disease. Therefore, methimazole was administered at a dose of 0.4 mg/kg/day. After 4 months, thyroid function was clearly improved, with normal FT3 and FT4 values and increasing TSH values, without adverse effects. Nevertheless, an eye examination showed ophthalmopathy with signs of activity, an increase in the exophthalmos of the right eye with palpebral retraction, soft tissue involvement (succulent and oedematous eyelids, caruncle and conjunctival hyperaemia and oedema) and keratopathy, resulting from exposure. We began steroid therapy with oral administration of prednisone (1 mg/kg/day) for four weeks, followed by gradual tapering. After one week of therapy with prednisone, an eye assessment showed reduced retraction of the upper eyelid of the right eye, improvement of right eye exophthalmometry and reduction of conjunctival hyperaemia. After four weeks of therapy with prednisone, an eye assessment showed reduction of the right palpebral retraction without conjunctival hyperaemia and no other signs of inflammation of the anterior segment; after twelve weeks, an eye assessment showed a notable decrease in the right palpebral retraction and the absence of keratitis, despite persisting moderate conjunctival hyperaemia. No adverse event associated with steroid use was observed during the treatment period and no problem in compliance was reported. Conclusion: Prednisone seems a better choice than intravenous corticosteroids, for treating moderate-to-severe and active Graves’ ophthalmopathy, keeping in mind the importance of quality of life in pediatric patients.

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Evaluating a new objective grading software for conjunctival hyperaemia

Contact Lens and Anterior Eye ◽

10.1016/j.clae.2019.07.003 ◽

2020 ◽

Vol 43 (2) ◽

pp. 137-143 ◽

Cited By ~ 2

Author(s):

Byki Huntjens ◽

Mandeep Basi ◽

Manbir Nagra

Keyword(s):

Conjunctival Hyperaemia

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PSS6 CONJUNCTIVAL HYPERAEMIA ASSOCIATED WITH THE FIXED COMBINATIONS OF LATANOPROST/TIMOLOL AND BIMATOPROST/ TIMOLOL IN THE TREATMENT OF OCULAR HYPERTENSION OR GLAUCOMA

Value in Health ◽

10.1016/s1098-3015(10)75243-8 ◽

2009 ◽

Vol 12 (7) ◽

pp. A453

Author(s):

MJ Vinuesa ◽

I Vinuesa ◽

S Díaz ◽

I Martin ◽

J Soto ◽

...

Keyword(s):

Ocular Hypertension ◽

Conjunctival Hyperaemia

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Severity Classification of Conjunctival Hyperaemia by Deep Neural Network Ensembles

Journal of Ophthalmology ◽

10.1155/2019/7820971 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Hiroki Masumoto ◽

Hitoshi Tabuchi ◽

Tsuyoshi Yoneda ◽

Shunsuke Nakakura ◽

Hideharu Ohsugi ◽

...

Keyword(s):

Neural Network ◽

Network Models ◽

Training Data ◽

Neural Network Models ◽

Conjunctival Hyperaemia ◽

Severity Classification ◽

Ocular Disorders ◽

Neural Network Ensembles ◽

Network Ensembles

Conjunctival hyperaemia is a common clinical ophthalmological finding and can be a symptom of various ocular disorders. Although several severity classification criteria have been proposed, none include objective severity criteria. Neural networks and deep learning have been utilised in ophthalmology, but not for the purpose of classifying the severity of conjunctival hyperaemia objectively. To develop a conjunctival hyperaemia grading software, we used 3700 images as the training data and 923 images as the validation test data. We trained the nine neural network models and validated the performance of these networks. We finally chose the best combination of these networks. The DenseNet201 model was the best individual model. The combination of the DenseNet201, DenseNet121, VGG19, and ResNet50 were the best model. The correlation between the multimodel responses, and the vessel-area occupied was 0.737 (p<0.01). This system could be as accurate and comprehensive as specialists but would be significantly faster and consistent with objective values.

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Changes in ocular signs and symptoms in patients switching from bimatoprost–timolol to tafluprost–timolol eye drops: an open-label phase IV study

BMJ Open ◽

10.1136/bmjopen-2018-024129 ◽

2019 ◽

Vol 9 (4) ◽

pp. e024129 ◽

Cited By ~ 3

Author(s):

Rupert Richard Alexander Bourne ◽

Kai Kaarniranta ◽

Katrin Lorenz ◽

Carlo Enrico Traverso ◽

Jouni Vuorinen ◽

...

Keyword(s):

Outcome Measures ◽

Signs And Symptoms ◽

Ocular Symptom ◽

Secondary Outcome ◽

Eye Drops ◽

Open Label ◽

Conjunctival Hyperaemia ◽

Open Label Phase ◽

Ocular Signs ◽

Phase Iv

ObjectivesBimatoprost–timolol (bimatoprost 0.03%–timolol 0.5% fixed-dose combination [FDC]) and tafluprost–timolol (tafluprost 0.0015%–timolol 0.5% FDC) eye drops are currently the only topical intraocular pressure (IOP)-reducing therapies available as preservative-free (PF) prostaglandin and timolol FDC. The aim of this study was to investigate changes to ocular signs and symptoms when patients with ocular hypertension (OH) or open-angle glaucoma (OAG) switched from PF or benzalkonium chloride (BAK)-preserved bimatoprost–timolol to PF tafluprost–timolol eye drops.DesignThis was a 12-week, open-label, phase IV study.SettingSixteen centres in Finland, Germany, Italy and the UK.ParticipantsPatients with OH or OAG (IOP on medication ≤21 mm Hg), treated with PF or BAK-preserved bimatoprost–timolol for ≥4 weeks before screening, and presenting with conjunctival hyperaemia and ≥1 ocular symptom.InterventionsPatients were switched to PF tafluprost–timolol once daily in the treated eye(s).Primary and secondary outcome measuresThe primary endpoints were change from screening to week 12 in conjunctival hyperaemia and worst ocular symptom. The secondary outcome measures were changes from screening in ocular signs (other than conjunctival hyperaemia) and symptoms at week 12.ResultsOf 123 enrolled patients, 121 were included in the intention-to-treat dataset, of which all were Caucasian and 54.5% were female; 76 patients used BAK-preserved bimatoprost–timolol and 45 used PF drops. Conjunctival hyperaemia and severity of worst ocular symptom following switch to PF tafluprost–timolol significantly reduced from screening to week 12 in all patients (p<0.001). The percentage of patients with ocular signs and symptoms was significantly reduced at week 12 compared with screening (p<0.001). IOP was not affected by the change of treatment.ConclusionsSwitching from BAK-preserved or PF bimatoprost–timolol to tafluprost–timolol reduced both signs and symptoms of ocular surface disease with no clinically relevant effect on IOP.Trial registration numberEudraCT2014-005273-37; Results.

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