Twenty-four hours intraocular pressure in keratoconic eyes assessed by applanation tonometry and Tono-Pen AVIA

AIM: To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS: Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS: Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman's correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, rs=0.879 (P<0.01); cGAT-TPA, -1.02±2.08, rs=0.723 (P<0.01); and nGAT-TPA, -2.35±2.23, rs=0.730 (P<0.01). Bland-Altman analysis for agreement between cGAT-TPA and nGAT-TPA mean IOP DCPo measurements revealed a mean difference of 1.02 (95%CI, 0.35-1.70) and 2.35 (95%CI, 1.62-3.07) mm Hg, respectively. Regression analysis yielded the following equation: TPA IOP=5.49+0.775×cGAT-0.015×ACD-0.299×corneal astig matism, which allowed us to infer TPA IOP values from other parameters. CONCLUSION: In keratoconic eyes, IOP peaks of DCPo measurements are identified at 6 a.m., independent of the tonometer. The mean DCPo values are: TPA>cGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.

Comparison of intraocular pressure obtained by Goldmann applanation tonometer, Corvis ST and an airpuff tonometer in healthy adults

Purpose To assess the agreement among four types of intraocular pressure (IOP) measurements: IOP obtained by Goldmann applanation tonometer (IOP-GAT),IOP obtained by an air-puff tonometer (Nidek NT-510)(IOP-NCT), the non-corrected IOP obtained by the Corneal Visualization Scheimpflug Technology (IOP-Corvis) and the biomechanically corrected IOP obtained by the Corvis ST (bIOP-Corvis) in healthy patients with a broad spectrum of IOP values. Methods: This prospective, observational study recruited 113 healthy individuals. Each patient underwent IOP evaluation via GAT, Nidek NT-510 and Corvis ST. Difference in mean in IOP readings was assessed by one-way repeated-measures analysis of variance (ANOVA).Tonometer intermethod agreement was assessed by the Bland-Altman method. The difference between the four IOP measurements was correlated against corneal (CCT) and age with Pearson’s correlation test. Results: IOP-Corvis showed the highest values (16.59 ± 3.08 mmHg),followed by IOP-NCT (16.05 ± 3.43 mmHg), IOP-GAT (15.62 ± 3.08 mmHg) and bIOP-Corvis (15.10 ± 2.67 mmHg).There were statistically significant differences in IOP measurements among all the ANOVA pairwise comparisons except between IOP-GAT and bIOP-Corvis ( p = 0.07),as well as between IOP-GAT and IOP-NCT ( p = 0.25). Bland Altman analysis revealed a notable bias (all p < 0.05) among IOP-GAT and bIOP-Corvis, IOP-GAT and IOP-Corvis, IOP-GAT and IOP-NCT, bIOP-Corvis and IOP-Corvis, bIOP-Corvis and IOP-NCT,IOP-Corvis and IOP-NCT of 0.51, −0.97, −0.43, −1.49, −0.95, 0.53 mmHg respectively. We observed a strong correlation of the difference between bIOP-Corvis and IOP-Corvis with CCT and patient age. Conclusion: Compared with GAT and Nidek NT-510, the Corvis-derived IOPs were recorded either the highest as IOP-Corvis or the lowest as bIOP-Corvis. Even if the differences among the tonometers were relatively small, the IOP values obtained with the Corvis ST, NCT and GAT were not interchangeable.

Association of rs 10038177 and rs 1971050 Polymorphism of WDR 36 Gene with Clinical Profile in POAG Patients

Aim: To study WDR36 gene polymorphism (rs10038177 , rs1971050) and its association with clinical parameters in patients of primary open angle glaucoma. Methods: A cross sectional study conducted on 105 cases of POAG to study its association with WDR36 gene polymorphisms (rs 10038177, rs 1971050). The study subjects underwent complete ophthalmic examination, slit lamp examination, IOP measurement by Goldmann’s Applanation Tonometer, gonioscopy, fundus evaluation by 90D lens. RNFL thickness was measured using cirrus 500 OCT by Carl Zeiss. Peripheral blood samples were collected in EDTA-anticoagulant tubes, then DNA was extracted using the genomic DNA extraction and genotyped by PCR-RFLP by using (AluI) enzyme.Data analysis by SPSS, version 21.0. Chi-square and Independent sample ‘t’-tests used for comparison. Results: The association of genotypic expression of rs10038177 polymorphism with different clinical variables in POAG patients, and the mean IOP (31.66 + 5.88) and CDR (0.72+ 0.15) for heterozygous genotype TC was significantly higher as compared to homozygous de33eeeee4(p<0.05) while in rs1971050 polymorphism, Diabetic history was significantly higher in genotype TC(60%)(p=0.012) as compared to genotype TT (19.1%). Conclusion: Our study shows that WDR 36 polymorphism (rs10038177) and (rs1971050) have an association with higher IOP and RNFL thinning which could be the underlying factors in pathogenesis and progression of POAG.

Ocular Response Analyzer versus Goldmann Applanation Tonometer for Measurement of Intra-Ocular Pressure

Background Goldmann applanation tonometry (GAT) has been the gold standard for intraocular pressure(IOP) measurement ,since its appearance in clinical practice around 50 years ago.(1) In spite of being almost unchallenged, the last few years have become a sustained search for a new standard method for IOP measurement,. One such recently marketed instrument is the Ocular Response Analyzer (ORA), which able to detect the corneal biomechanics. Aim of the Work is to compare the IOP measurement estimated by Goldmann applanation tonometer to that of ORA and detect the effect of state of refraction, corneal topography and central corneal thickness (CCT) on these measurements. Patients and Methods This cross-sectional study was done from March 2018 to October 2018 on 65 eyes of patients visiting the outpatient clinic. Results The mean GAT IOP was 15.938 ± 6.041 while the mean ORA (IOPcc) and (IOPg) were 19.711 ± 7.59 and 17.242 ± 7.35 mm Hg respectively. There is a strong positive relationship between GAT IOP & ORA IOPg measurement (r = 0.880 – p = &lt;0.001*). Also finding a weak yet significant correlation between IOPg and CCT (r = 0.385, p = 0.001). None of the pressure measurements was affected by refraction or corneal curvature significantly. Conclusion In conclusion, our results suggest that mean IOPs obtained by ORA were significantly higher than that of GAT with different influencing factors that are not completely understood. caution has to be sought when using the ORA, the values obtained ought not to be used interchangeably with the values obtained by 1 GAT, despite the presence of a positive correlation between these values. This underlines the importance of using one and only method of evaluation of the IOP for every patient in successive follow-up visits.

ASSESSMENT OF INTRAOCULAR PRESSURE FOLLOWING THE INTRAVITREAL INJECTION OF ANTI-VEGF

Objective: The objective of the study is to assess the frequency of raised IOP after intravitreal injection of Anti VEGF by using an applanation tonometer. Methods: Each patients who fulfil the presence criteria were nominated by the researcher through ‘the outpatient department (OPD) of ophthalmology, Jinnah Post Graduate Medical Center. Performa was filled. Aim and process of study was explained to all patients. Conversant consent was reserved. Model ocular inspection, including IOP was done. By using either a 30-or 32-gauge needle, 1.25 ml bevacizumab (Avastin) were administered by the researcher under the direct supervision of consultant. Patients were consistently sterilely prepped, that was comprised incerted of topical antibiotic and anesthetic drops, supplement of a lid speculum. Later pointing the injection place on the sclera with a caliper calculating 3.0 to 3.5 mm after limbus, conjunctiva was expatriate somewhat through a sterile cotton-tipped applicator immediately earlier ingoing the eye by a needle. Later injection, place was occluded provisionally it was amended through a sterile cotton-tipped applicator while the needle remained inhibited from the eye. Since the needle was inhibited, a drop of anesthetic was employed on the cornea and IOP was measured. Then next IOP interpretation was measured later 1day of intravitreal Avastin. All pressures were measured using the applantation tonometry. IOPs were measured earlier intravitreal Avastin "baseline IOP" and instantly following injection "T0" and 1day next injection. Results: 235 Patients exactly nominated for the research study. Intravitreal Injection, Bevacizumab was applied in 235 Eyes of overstated 235 patients. Elsewhere of the 235 patients, 133 males and 102 females, Their ages ranged from 30-70 y (mean 52.02 y. The most shared sign intravitreal with bevacizumab, diabetic retinopathy observed in 114 (48.5%) patients, indicated by exudative ARMD in 70 (29.7%) patients, BRVO in 12 (5%) patients, Myopic CNV23(9.7) with CRVO observed in 11 (4.6%) patients, Eale’s sickness in 2(0.85%) patients even as Idiopathic CNV was observed in only 3 (1%) patient. Of the 235 patients, 118 (50.2%) patients with right eye suffered, 117(49.7%) patients with left eye suffered. After 24 h of intravitreal Bevacizumab Raised IOP was observed in only 3 (1.28) patient and 232(98.2) patient IOP was in the normal range. According to our study, the result of stratification with respect to age, side of the eye and gender is not significant as p-value for age (0.838), gender (0.723) and side of the eye (0.556), respectively. Conclusion: In our study, frequency of raised IOP after anti VEGF were found 3(1.28) patient out of 232 (98.2). Anti-VEGF treatment is the foundation for the management of numerous retinal illnesses. Notwithstanding its capable effectiveness in uncertain the sickness and refining, vision for the patients, intravitreal injection of anti-VEGF products may be related with overwhelming problems. To diminish the risk cautious care to the injection method and suitable post-injection observing are essential.

IOP change after phacoemulsification with PCIOL implantation and its association with ocular biometric parameters

: To assess the impact on intraocular pressure (IOP) after Phacoemulsification (PE) with Posterior Chamber Intraocular Lens (PCIOL) implantation and its relation with ocular biometric parameters. The study was a prospective observational study included 524 eyes with normal IOP (11-21 mmHg) who underwent uneventful Phacoemulsification with PCIOL Implantation surgery for age-related cataract. IOP, Central Corneal Thickness (CCT), Anterior Chamber Depth (ACD), Axial Length (AL) were measured pre-operatively and one month post-operatively by Goldman Applanation Tonometer, Corneal Pachymeter and Optical Coherence Biometer, respectively. The post-operative IOP change and its relation with preoperative biometric parameters were determined.: The mean pre-operative and post-operative IOP was 13.44±1.98 & 11.54±1.66mmHg, respectively, with an average IOP reduction after one month of 1.90±0.61mmHg. The mean pre-operative and post-operative ACD was 3.27±0.24 and 3.66±0.27 mm, respectively, with an average increase of 0.39 ±0.3 mm. Paired t-test showed post-operative IOP reduction was significantly associated with preoperative IOP (p&#60;0.001) and ACD (p&#60;0.001). But CCT and AL were not significantly associated. The linear regression analysis confirmed the proportional reduction of post-operative IOP, r 0.921. So 92.1% of the preoperative IOP is proportional to post-operative IOP reduction. The graphical representation shows more the pre-operative IOP, more the post-operative IOP reduction.: IOP is significantly reduced, and ACD increased after PE with PCIOL implantation surgery and is associated with post-operative IOP reduction. The post-operative IOP reduction is proportional to pre-operative IOP, and more the preoperative IOP, more the post-operative IOP reduction.

A study to compare intraocular pressure using Perkins and Schiotz tonometer with respect to Goldmann applanation tonometer as a gold standard in a tertiary health care centre, Navi Mumbai

To compare IOP measurement of Perkin’s tonometer and Schiotz tonometer with respect to Goldmann applanation tonometer (GAT).100 eyes of 50 patients aged 18 to 65 years presenting to Ophthalmology OPD were selected by randomization and detailed general and ophthalmic examination was done. IOP was measured using applanation tonometers (Perkin’s and GAT) and indentation tonometer (Schiotz tonometer) in that order. The study population included 38 male eyes and 62 female eyes; 50 right eyes and 50 left eyes. There was a statistically highly significant difference seen for the values between the groups (p&#60;0.01) with higher values in IOP measured by GAT followed by IOP measured by Perkin’s tonometer and least in IOP measured by Schiotz tonometer.There was a statistically non significant difference seen for the values between Perkin’s tonometer and GAT (p&#62;0.05). While there was a statistically highly significant difference seen for the values between GAT and Schiotz tonometer (p&#60;0.01).There was a statistically non significant difference seen for the IOP values between right eye and left eye. There was a statistically non significant difference seen for the IOP values between males and females. Measurement of IOP with Perkin’s was closer to the values obtained by GAT. Perkin’s being portable, easy to use and precise tonometer than Schiotz tonometer, can be considered as an excellent substitute to GAT, for large scale examination, if cost is not a concern.

Edward S Perkins, MD, PhD (1919–2015): In the vanguard of ophthalmic physician–scientists

British-American ophthalmologist Edward Perkins, MD, PhD (1919–2015) held wide-ranging research interests during his career at the Institute of Ophthalmology in London, the University of Iowa, and as a military doctor stationed in Kenya. With his PhD and a medical degree, Perkins was in the vanguard of clinician–scientists who possessed such dual credentials, enabling him to perform noteworthy experimental and clinical research. Perkins’ glaucoma research included early work on acetazolamide and prostaglandins, laser iridotomy, and large-scale glaucoma surveys such as the Bedford Glaucoma Survey. In 1957, Perkins earned a PhD with a thesis on cranial nerve influences on rabbit intraocular pressure. Perkins also invented a handheld applanation tonometer; wrote an entire volume on uveitis for Duke-Elder's system of Ophthalmology; co-founded the Association for Eye Research (the European Association for Vision and Eye Research forerunner); and was a charter member of the Glaucoma Research Society. In 1961, Perkins became the first Professor of Experimental Ophthalmology at the Institute of Ophthalmology in London. In 1979, Perkins and his family emigrated to the United States, where he became a Professor of Ophthalmology at the University of Iowa. Perkins’ understated personality masked a legacy of extensive contributions to the field of ophthalmology.