The Authors of a recent study have found that Goldmann applanation tonometry, Pascal dynamic contour tonometry and ocular response analyzer tonometry each demonstrate clinically acceptable measurement repeatability and reproducibility, despite some intermethod variability differences. Subjects for the two-phase, prospective, observational study were recruited from consecutive Albuquerque VA Medical Center eye clinic patients that were previously diagnosed as glaucoma suspects or as having ocular hypertension, primary open-angle or normal-pressure glaucoma. Two sets of intraocular pressure measurements (three to four ORA, two DCT and two GAT) were obtained approximately 15 minutes apart. Each set was obtained by one of two examiners using random examiner sequences. ORA was measured first in both eyes, followed by either DCT or GAT, which were obtained in random order. Repeatability was assessed by examining variability of consecutive measurements by the same examiner, and reproducibility was examined by assessing variability between the first and second measurement sets.
One hundred and twenty eyes of 60 subjects were reviewed for the study. The mean age was 64.1 ±9.6 years and 58 out of 60 participants (97 percent) were male. Intraobserver repeatability was highest for GAT, followed closely by DCT and then ORA. Intersession reproducibility proved similar for all methods, although a tonographic effect may have corrupted the GAT and DCT reproducibility results. No repeatability or reproducibility differences were found between the eyes, between the examiners or between the measurement sets.
J Glaucoma 2009;18:666-73
Sullivan-Mee M, Gerhardt G, Halverson KD, et al.
Flap-Lift Retreatment Threatens Epithelial Ingrowth
Flap-lift retreatment perfor-med three or more years after primary LASIK has led to a higher risk of clinically significant epithelial ingrowth than primary LASIK or earlier flap-lift retreatment, according to a recent study. In order to analyze the risk of clinically significant epithelial ingrowth following the procedures, the authors retrospectively reviewed data from all cases of the procedure performed by the same surgeon in a
Clinically significant epithelial ingrowth occurred in none of the 3,866 primary LASIK cases and in 15 (2.3 percent) of the 646 flap-lift retreatment cases (p<0.0001). Clinically significant ingrowth was more frequent when flap-lift retreatment was performed three or more years after primary LASIK (7.7 percent versus 1.0 percent) (p=0.0001). Patient age and sex did not have a statistically significant effect on the epithelial ingrowth rate. There was an insignificant trend toward increased epithelial ingrowth after flap-lift retreatment of Automated Corneal Shaper mic-rokeratome flaps.
J Cataract Refract Surg 2010;36:97-101
Caster A, Friess D, Schwendeman F.
SynergEyes Proves a Viable Alternative to RPG Lenses
SynergEyes hybrid contact lenses (SynergEyes Inc.) was recently shown to be useful as a viable alternative for visual rehabilitation in patients with keratoconus and pellucid marginal degeneration who are otherwise unable to use rigid gas-permeable lenses.
The authors of the study retrospectively reviewed the charts of patients who were fitted with SynergEyes lenses during the first seven months the lens was available at the Cornea Service at Wills Eye Institute in Philadelphia (August 2006 to March 2007). Their review revealed that 61 eyes (44 patients) with keratoconus (58 eyes) or PMD (three eyes) were fitted with SynergEyes lenses.
The mean age was 40 ±12.6 years; the mean follow-up period was 7.8 ±4.6 months. The most common indication found for SynergEyes was RGP lens intolerance, 31 of 61 eyes (50.8 percent); inability to be fitted with RGP lenses was the indication in eight eyes (13.1 percent), and 22 eyes (36 percent) were refitted from SoftPerm lenses (CIBA Vision). Twenty-two patients required refitting, including 17 base curve changes and five skirt changes. The success rate was 86.9 percent (53 of 61 eyes). Most failures (eight eyes of six patients) discontinued the lens within the first two months because of either discomfort (five eyes) or unsatisfactory vision (three eyes).
Abdalla YF, Elsahn AF, Hammersmith KM, et al.
Additional Implants May Reduce IOP in Refractory Glaucoma
The addition of a second glaucoma implant has shown the potential to effectively lower in-traocular pressure in eyes afflicted with refractory glaucoma, according to the authors of a recent retrospective, observational cohort study. The authors evaluated patients that underwent a second glaucoma implant surgery from 1996 to 2008 to check the efficacy of the additional implant in eyes with prior glaucoma implant
surgery and inadequate IOP control.
Outcome measures included visual acuity, IOP, glaucoma medication use and complications. Success was defined as IOP <21 mmHg (criterion 1) and IOP <17 mmHg (criterion 2), with at least a 25-percent reduction in IOP and no prolonged hypotony. Forty-three eyes from 43 patients had a mean follow-up of 32.6 ±21.6 months. Life-table analysis demonstrated success rates of 93 percent, 89 percent and 83 percent using criterion 1 and 83 percent, 75 percent and 75 percent using criterion 2 at one, two and three years, respectively. At last follow-up, the mean IOP (13.6 ±4.6 vs. 24.7 ±7.5 mmHg; p<0.001) and the mean number of medications (1.4 ±1.2 vs. 3.9 ±1.2; p<0.001) was lower following the second implant. There was no difference in preoperative and the most recent logarithm of the minimal angle of resolution visual acuities (0.86 ±0.13 vs. 1.1 ±0.13; p=0.07). The most frequently used second implants were similar in percentage IOP reduction (Baerveldt implant, 45 ±19 percent; Ahmed valve, 40 ±18 percent; p=0.4).
Am J Ophthalmol 2009;149:95-101
Anand A, Tello C, Sidoti PA, et al.
New Treatments Show Potential for
Both the anterior juxtascleral depot of a drug and anecortave acetate demonstrate potential as promising candidates for intraocular pressure reduction in eyes with open-angle glaucoma, says a recent study. The authors of the prospective, interventional case series evaluated seven eyes of six subjects presenting with OAG with uncontrolled IOP while being administered one or more topical medications. Subjects then received 24 mg of anecortave acetate delivered by anterior juxtascleral depot. IOP was then assessed at baseline and regularly after treatment for up to 24 months.
Mean IOP before the anecortave acetate treatment was 31.3 ±11.3 mmHg, which then dropped by 9.5 ±4.5 mmHg (32.7 ±16.8 percent) within one week after treatment. This IOP reduction was sustained through the six months (8.4 ±5.4 mmHg [29.6 ±12.4 percent]) and 12 months (9.5 ±5.7 mmHg [34 ±15.9 percent]) following the single anecortave acetate treatment. The injection process was well-tolerated, and no eyes experienced any injection-related or drug-related serious adverse events.
Despite the positive results, additional studies are required to better establish the efficacy and safety, optimal dosing frequency, mechanism of action, and potential additivity to other IOP-lowering therapies.
Am J Ophthalmol 2009;147:45-50