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Background Both long-term glycaemic variability and arterial stiffness have been recognized as cardiovascular risk factors. This study aims to investigate whether an association between these phenomena exists in individuals with type 1 diabetes. Methods This cross-sectional study included 673 adults (305 men, 368 women) with type 1 diabetes and combined available retrospective laboratory data on HbA1c from the preceding 10 years with outcome data on arterial stiffness and clinical variables from a comprehensive study visit. HbA1c variability was calculated as adjusted standard deviation (adj-HbA1c-SD), coefficient of variation (HbA1c-CV) and average real variability (HbA1c-ARV). As measures of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV; n = 335) and augmentation index (AIx; n = 653) were assessed using applanation tonometry. Results The study population had a mean age of 47.1 (± 12.0) years and a median duration of diabetes of 31.2 (21.2–41.3) years. The median number of HbA1c assessments per individual was 17 (12–26). All three indices of HbA1c variability were significantly correlated with both cfPWV and AIx after adjustment for sex and age (p 1c-SD and HbA1c-CV were significantly associated with cfPWV (p = 0.032 and p = 0.046, respectively) and AIx (p = 0.028 and p = 0.049, respectively), even after adjustment for HbA1c-mean. HbA1c-ARV was not associated with cfPWV or AIx in the fully adjusted models. Conclusions An association independent of HbA1c-mean was found between HbA1c variability and arterial stiffness, suggesting a need to consider multiple HbA1c metrics in studies assessing cardiovascular risk in type 1 diabetes. Longitudinal and interventional studies are needed to confirm any causal relationship and to find strategies for reducing long-term glycaemic variability.

Objective: Current minimally-invasive glaucoma surgery (MIGS) devices promise to control elevated levels of intraocular pressure (IOP) while avoiding many of the downsides of traditional glaucoma surgery. However, there remains room for improvement in performance metrics, including drainage efficacy, device longevity, and time to implant, as outlined by benchmarks set forth by the Audacious Goals Initiative. We introduce a better shunt, which achieves similar or improved pre-clinical safety and efficacy outcomes to commercial MIGS devices, while reducing surgical profile and implantation time. Methods: We developed a parylene-based microbore glaucoma drainage device capable of modulating IOP via a minimally-invasive implantation procedure. We surgically implanted microbore tubing in five healthy New Zealand White rabbits and measured IOP levels biweekly using handheld applanation tonometry to assess device efficacy in lowering and maintaining IOP. After 6 weeks, the rabbits were euthanized and eyes were enucleated to evaluate inflammatory and histologic response to a foreign-body implant. Results: This device is the only one that fulfills the 10-minute benchmark for implantation time compared to other commercial MIGS devices. In 4 of 5 animals implanted, post-op IOP in the experimental eye dropped by an average of 16.17%. Histopathologic evaluation revealed localized evidence of minor inflammatory reaction and tissue irritation, as well as minimal fibrosis along the tube-tissue interface. Conclusion and Significance: Based on these findings, this device stands as a promising platform to lowering IOP, particularly in patients with mild to moderate glaucoma requiring no need for cataract intervention, without eliciting a severe biological response.

Background and Aim: Tonometers are an important instrument for measuring intraocular pressure (IOP) in the diagnosis of glaucoma or uveitis. This study aimed to compare the accuracy of the main types of tonometers with different IOP measurement methodologies in dogs: TonoVet and TonoVet Plus (rebound), Tono-Pen Avia Vet (applanation), and Kowa HA-2 (Goldmann applanation). Materials and Methods: IOP was measured in 152 eyes of 76 dogs. A postmortem study was performed by comparing manometry and tonometry values and calculating the correlation coefficient (r2), in vivo real IOP (manometry) among the tonometers was compared, and an outpatient study was conducted with healthy eyes and eyes with signs of glaucoma and uveitis. Results: In the postmortem study, the values of r2 in descending order were Kowa (0.989), TonoVet Plus (0.984), TonoVet (0.981), and Tono-Pen Avia Vet (0.847). The IOP values in mmHg in the in vivo study were as follows: Aneroid manometer (16.8±2.5.7), TonoVet (18.1±2.9), TonoVet Plus (20.6±2.3), Tono-Pen Avia Vet (17.1±2.5), and Kowa (16.1±1.7); in outpatient clinics: TonoVet (16.8±3.8), TonoVet Plus (19.2±2.9), Tono-Pen Avia Vet (16.2±2.4), and Kowa (15.0±1.3); glaucoma: TonoVet (30.2±3.5), TonoVet Plus (35.0±6.1), Tono-Pen Avia Vet (29.5±4.2), and Kowa (23.9±5.0); and uveitis: TonoVet (14.2±1.4), TonoVet Plus (17.6±1.9), Tono-Pen Avia Vet (13.7±2.1), and Kowa (12.6±1.7). Conclusion: There was a strong correlation between IOP values and manometry in all the tonometers. The highest values were obtained with TonoVet Plus and the lowest with Kowa HA-2. All tonometers accurately measured IOP in dogs, including the latest TonoVet Plus, which showed an excellent correlation coefficient.

Objective: To assess the influence of corneal biomechanics on intraocular pressure (IOP) measurements made with the Icare200 (IC200) rebound tonometer and the Perkins hand-held applanation tonometer in patients with primary congenital glaucoma (PCG). Materials and methods: 40 PCG patients and 40 healthy controls, age and gender-matched, were recruited. IOP was measured with the Ocular Response Analyzer (IOPc, IOPg), Icare200 and Perkins. The variables age, IOP, corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), best corrected visual acuity, spherical equivalent, medications and glaucoma surgeries were recorded for each subject. Uni and multivariate analysis were used to detect effects of variables on IOP measurements. Results: Mean CCT was 545.65±71.88 μm in PCG vs. 558.78±27.58 μm in controls (p=0.284). CH and CRF were significantly lower in PCG group than in control group: mean CH 8.11±1.69 mmHg vs. 11.15±1.63 mmHg (p

Background Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfaction with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) flap, using objective and subjective methods. Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP flap between 2012 and 2018. Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation was performed using the BREAST-Q questionnaire. Results Objectively, DIEP flaps were significantly softer than EP breast reconstructions. Non-operated contralateral breasts were significantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question (labelled 1.h) “How satisfied or dissatisfied have you been with the softness of your reconstructed breast (s)?” was higher in the DIEP flap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation tonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs = 0.37). Conclusions In terms of breast softness, breast reconstructions with DIEP flaps result in more satisfied patients. Concerning applanation tonometry as an objective tool for softness assessment, future studies on interobserver agreement are warranted. Level of evidence: Level I, therapeutic study

Objective: to determine the indications for penetrating keratoplasty (PK) in the Kingdom of Jordan and evaluate its clinical and functional outcomes. Materials and methods . 213 patients underwent PK at the ophthalmology department of King Abdullah University Hospital (KAUH) in Jordan from January 1, 2010 to December 31, 2018. While 196 (92.2%) patients were operated on in one eye, 17 (8.8%) underwent PK in both eyes. For all patients, the best corrected visual acuity (BCVA) was checked using the Snellen table and compared with the BCVA before surgery; biomicroscopy of the anterior segment of the eye, as well as applanation tonometry, were carried out. Results . Keratoconus was found to be the most common indication for PK – 154 patients (73.2%). For all patients, the BCVA improved from 0.08 before surgery to 0.25 after surgery. Conclusion . Keratoconus is the most common indication for PK in both men (97, 71.3%, p < 0.05) and women (57, 74%, p < 0.05) in the Kingdom of Jordan. PK is an effective method for treating various corneal disorders.

Resume Objectif Comparer les valeurs de la pression intraoculaire (PIO) obtenues avec chacune des methodes de tonometrie, d’une part, et, d’autre part, etudier l’influence de la pachymetrie corneenne sur les mesures obtenues par chacune des methodes. Materiel et methodes Nous avons realise une etude prospective transversale, descriptive et analytique dans le service d’ophtalmologie d’une polyclinique a Abidjan (Cote d’Ivoire) d’avril 2018 a aout 2018. Les patients âges de 15 ans et plus ont ete concernes par l’etude. Durant cette periode, la PIO a ete mesuree par le Tonometre a aplanation de Goldmann (Haag Streit, AT 900, Suisse) et le tonopachymetre a air (Nidek, NT 530 P Japon), qui a aussi permis la pachymetrie corneenne optique centrale. Les donnees analysees ont porte sur les caracteristiques sociodemographiques, les antecedents ophtalmologiques, la tonometrie et la pachymetrie corneenne centrale. La comparaison des valeurs obtenues par les deux appareils et l’influence de l’ECC sur la tonometrie ont ete analysees a l’aide du logiciel EpiData Analysis V2.2.2.183. Resultats Nous avons examine 318 yeux de 159 patients dont l’âge moyen etait de 40 ± 12,57 ans avec des extremes de 16 a 82 ans. Le sex ratio etait de 1. Des antecedents ophtalmologiques ont ete notes chez 79,2 % des patients. La PIO moyenne au tonometre a aplanation de Goldmann etait de 12,75 ± 3,17 mm Hg et celle du tonometre sans contact a air de 13,83 ± 3,80 mm Hg. L’epaisseur corneenne centrale moyenne etait de 530,50 ± 32,61 μm. La difference entre les PIO mesurees par tonometrie non contact et celles mesurees par tonometrie contact etait statistiquement significative avec p = 0,00. Il n’y avait pas de relation statistiquement significative entre la pachymetrie corneenne centrale et la tonometrie contact (p = 0,80). Par contre, il existait une relation statistiquement significative entre la tonometrie non contact et la pachymetrie centrale (p = 0,00). Les valeurs obtenues au tonometre a air pulse sont plus influencees par l’epaisseur corneenne centrale. Conclusion Le tonometre a aplanation de Goldmann n’est pas superposable au tonopachymetre sans contact a air.

Background: Various factors involved in phaco can influence the tissue structures of the eyeball Ultrasonic energy should be taken into consideration as a risk factor that may affect the structure of the tissue in the eyeball. Objective: To evaluate changes on macular thickness before and after phacoemulsification surgery with variable Phaco Times and constant phaco ‎power by Optical Coherence Tomography (OCT). Patients and methods: A prospective observational clinical study on 40 eyes with Nuclear cataract grade II-III. All patients under went full medical and ophthalmic history, history of ocular surgeries, complete ophthalmic examination include ingvisual acuity: Uncorrected VA (UCVA) and best corrected VA (BCVA),Anterior segment examination using Slit-lamp bio microscopy, Intraocular pressure (IOP) measurement by applanation tonometry, Fundus examination, OCT was done preoperatively and then 4-6 weeks postoperatively. Results: In patients with Nuclear cataract, there was no significant correlation between postoperative 4-6 weeks macular thickness (MT) with phaco time. Conclusion: After phacoemulsification surgery with variable phaco times and constant phaco power, there was no significant correlation between postoperative 4-6 weeks macular thickness (MT) with phaco time.

Purpose: To assess the iridocrystalline complex status in patients with cataract, complicated by zonular weakness, before and after surgical treatment. Patients and Methods. The study enrolled 28 patients (29 eyes) with cataract, complicated by zonular weakness (8 women, 20 men, 74.13 ± 8.48 years old). All patients undergone phacoemulsification with IOL implantation and a capsular tension ring (CTR) if it was necessary. In each case optical biometry, ultrasound biomicroscopy and applanation tonometry were provided. After 1, 3 and 6 months postoperatively refractometry, visual acuity measurement, optical biometry, ultrasound biomicroscopy and OCT of the anterior segment were carried out. Results . Patients were divided into 2 groups. In I group (17 eyes) standard phacoemulsification was provided. In II group (11 eyes) it was necessary to implant CTR. 1 patient was excluded due to the extracapsular cataract extraction. Preoperatively angle of the crystalline lens tilt (3.62 ± 0.34° and 1.78 ± 0.27°, p = 0,00) and IOP were higher in group II. 6 months postoperatively UCVA was significantly higher in group II (0.59 ± 0.09 and 0.39 ± 0.21, p = 0.09), upright angle of IOL tilt (0.28 ± 0.35° and 1.40 ± 1.46°, p = 0.10), total zonnular length (14.28 ± 1.00 and 18.93 ± 0.86 mm, p = 0.00) and the value of IOL decentration (0.80 ± 0.17 and 0.20 ± 0.22 mm, p = 0.04) were significantly less in group II. Conclusion . The angle of crystalline lens tilt according to ultrasound biomicroscopy could be considered as an important diagnostic criterion for the CTR implantation necessity during phacoemulsification. CTR implantation provided decrease of IOL tilt and decentration due to a more regular distribution of zonular tension that increases the UCVA postoperatively in complicated cases. OCT of the anterior segment of the eye and ultrasound biomicroscopy application after phacoemulsification gives a great capacity in IOL-capsular complex visualization and measurement.

Raffaele Nuzzi, Simona Scalabrin, Alice Becco Eye Clinic, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, ItalyCorrespondence: Raffaele NuzziEye Clinic of University of Turin, Turin, ItalyTel +39 0116337225Fax +39 0116335481Email prof.nuzzi_raffaele@hotmail.itPurpose: This study aims to evaluate the effectiveness of different decompressive injection techniques in reducing intraocular pressure (IOP) spikes, if compared to the injection without pressure applied on the eye, following the intravitreal injection of bevacizumab.Patients and Methods: Two hundred patients with indication to intravitreal therapy were randomized into five arms: 40 received intravitreal injection without ocular decompression (arm A), 40 with pre-injection scleral indentation with cotton swab (arm B), 40 with pre-injection digital ocular massage (arm C), 40 with post-injection scleral indentation with cotton swab (arm D) and 40 with post-injection digital ocular massage (arm E). All patients underwent measurement of the IOP with Goldamm applanation tonometer 10 minutes before and 10 minutes after the injection. The primary endpoint of the study was variation of the post- injection IOP with the different techniques.Results: An increase in post-injection IOP was observed in all the arms, if compared to pre-injection values. The greatest increase was observed in arm A with a mean IOP rise of 17.60 mmHg. All other techniques showed lower mean IOP increases: arm B 10.76 mmHg, arm C 9.35 mmHg, arm D 8.8 mmHg, arm E 3.4 mmHg. The post-injection IOP differences of innovative techniques compared to the technique without ocular decompression were all statistically significant (p-value < 0.01). If compared to arm A (35%), a reduction in IOP spike ≥ 40 mmHg frequency was also observed. The status of phakia/pseudophakia, a previous diagnosis of glaucoma and the underlying pathology for which indication was given to inject bevacizumab did not significantly alter the post-injection IOP in any of the protocols.Conclusion: The introduction of new injection protocols, such as injections performed before or after decompressive treatments, could be a safe and effective approach to control post-injection IOP increase.Keywords: bevacizumab injection, injection technique, intraocular pressure spike, digital ocular massage, scleral indentation, applanation tonometry

INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse cardiovascular outcomes and reportedly overused in American-style football (ASF). However, assessment of ASF NSAID use in the context of cardiovascular risk has not been performed. We sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes. METHODS A total of 226 ASF athletes, 60 endurance athletes, and 63 nonathletic controls were studied pre- and postseason with echocardiography, vascular applanation tonometry, and clinical data assessment. Qualitative NSAID use throughout the season was recorded at postseason. RESULTS ASF athletes gained weight (Δ0.86 ± 3.9 kg, P < 0.001), increased systolic blood pressure (SBP, Δ3.1 ± 12 mm Hg, P < 0.001) and pulse wave velocity (Δ0.2 ± 0.6 m·s, P < 0.001), and decreased E' (Δ-1.4 ± 2.8 cm·s, P < 0.001) across one athletic season. Seventy-seven percent (n = 173) of ASF athletes reported that sport-specific NSAID use began in middle school. ASF NSAID use was more frequent with "weekly" (n = 42.19%) and "daily" (n = 32.14%) use compared with endurance athletes (P < 0.001) and controls (P = 0.02). ASF NSAID use increased in parallel with postseason SBP and weights. "Daily" ASF NSAID users demonstrated the highest postseason SBP (137 ± 13 vs 128 ± 13 mm Hg, P = 0.002) and weight (109.0 ± 18.6 vs 95.8 ± 20.5 kg, P = 0.002) compared with "never/rare" users. Adjusting for player position, SBP, pulse wave velocity, and E', increased weight (odds ratio = 1.04, 95% confidence interval = 1.0-1.08, P = 0.037) was associated with more frequent NSAID use. CONCLUSIONS Habitual NSAID use commonly begins during adolescence, before full physical maturation, and is associated with cardiovascular risk, particularly increased weight, in ASF athletes. NSAID use frequency should be considered when risk stratifying high-risk ASF athletes.

Objectives This study aims to evaluate the inflammatory status and clinical and vascular alterations using tonometry and B-mode sonography in patients with ankylosing spondylitis (AS). Patients and methods The study included 71 AS patients (57 males, 14 females; mean age 40.1±10.8 years; range, 29 to 51 years) without cardiovascular disease and 30 healthy controls (24 males, 6 females; mean age 41.2±9.3 years; range, 32 to 50 years). We evaluated participants' clinical, biological and functional status along with laboratory data and measured both the arterial stiffness using carotid-femoral pulse wave velocity (PWV) measured by applanation tonometry and carotid intima-media thickness (CIMT) as a preclinical atherosclerosis marker. Results The mean disease duration of AS patients was 10.6±4.2 years. CIMT (p=0.03) and PWV (p=0.04) data showed significant differences between AS patients and healthy controls. Multiregression analysis showed that PWV correlated with age (r2=0.42; p=0.03) and disease duration (r2=0.31; p=0.04), while CIMT correlated with disease duration (r2=0.37; p=0.03) and Bath Ankylosing Spondylitis Disease Activity Index (r2=0.3; p=0.04). Conclusion This study demonstrated an increase in early preclinical atherosclerosis in AS patients without cardiovascular (CV) disease compared to healthy controls. Therefore, screening AS patients with noninvasive methods for atherosclerosis and subclinical vasculopathy would allow us to take primary prevention measures. We found that the major determinant for increased CV risk was the disease duration, while there was no difference between different treatment modalities.

Aim To compare intraocular pressure (IOP) measurements before and after laser in situ keratomileusis (LASIK) with a femtosecond laser for flap creation using ocular response analyzer (ORA) and Goldmann applanation tonometry, and to identify factors that may influence the preoperative and postoperative IOP. Methods A prospective study conducted on myopic patients who underwent LASIK using a femtosecond laser for flap fashioning. Enrolled patients were evaluated preoperatively, 6wk and 3mo postoperatively for manifest refraction (MR), keratometric (K) readings and central corneal thickness (CCT) using a scheimpflug-based topography. Corneal resistance factor (CRF), corneal hysteresis (CH), Goldmann correlated IOP (IOPg) and corneal compensated IOP (IOPcc) were measured using ORA besides IOP assessment by Goldman applanation tonometry (GAT). Results There was a statistically significant decrease in measures of IOPg by 3.35±0.83 mm Hg, followed by GAT which decreased by 2.2±0.44 mm Hg, and the least affected by operation was IOPcc which decreased only by 0.87±0.1 mm Hg after 6wk. After 3mo follow up there was a statistically significant decrease in IOPcc which decreased only by 0.76±0.4 mm Hg, followed by IOP GAT by 1.6±0.5 mm Hg, and the most affected by operation was IOPg which decreased by 2.3±0.3 mm Hg. Correspondingly, there was a statistically significant decrease in CH and CRF after 6wk and 3mo. At 3mo, the preoperative MR and preoperative GAT were prominent significant predictors of the postoperative GAT changes. The prediction equation was subsumed. Conclusion IOP measurements and corneal biomechanical factors reduce significantly after LASIK with a femtosecond laser for flap creation. The IOPcc values are less influenced by changes in corneal properties than IOPg and GAT, indicating that IOPcc may provide the most reliable measurement of IOP after this procedure.

Summary Objectives This study was to investigate sex differences in central and peripheral arterial stiffness after exercise in young adults. Methods Sixty-one young adults (32 males, 29 females; age 18–35 years) performed an acute bout of aerobic exercise at 70% of heart rate reserve. The carotid-femoral, carotid-radial, and femoral-ankle pulse wave velocity, and carotid and femoral artery diameters, were measured before exercise and 30- and 60-min after exercise using applanation tonometry (Millar Instruments, Houston, TX, USA) and SphygmoCor (AtCor Medical, Sydney, Australia). Results The sex-by-time interactions were not significant for the carotid-femoral and carotid-radial pulse wave velocity, but were significant for the femoral-ankle pulse wave velocity (P = 0.03). There were also significant sex-by-time interactions for the relative diameter changes in the femoral artery (P = 0.043), but not in the carotid artery. The change in femoral-ankle pulse wave velocity from pre-exercise to 60-min post-exercise was significantly positively correlated with leg lean soft tissue mass in males (P = 0.01, R = 0.45), but not in females. Conclusion Our study shows that the effect of acute aerobic exercise on lower-limb arterial stiffness varies between the sexes, with greater reductions in arterial stiffness in young males than in females.

Background: Lichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities. Objective: The purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group. Methods: Fifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry. Results: No statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p = 0.006, and p = 0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p < 0.001, and p = 0.005, respectively). Study limitations: Relatively low number of patients. Conclusion: The positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.

SIGNIFICANCE Icare HOME rebound tonometry is increasingly adopted into clinical practice for IOP phasing of glaucoma patients and suspects. Because of measurement differences with applanation tonometry and diurnal fluctuations, interpretation of the IOP measured with Icare HOME phasing can be challenging. PURPOSE The purpose of this study was to use a large patient cohort to develop a practical, analytical tool for interpreting Icare HOME measurements with respect to applanation pressure. METHODS IOP measurements using the Icare HOME and an applanation tonometer were taken prospectively in 498 consecutive patients. Bland-Altman, frequency distribution, and linear regression analysis were applied to determine measurement differences. A novel criterion, Threshold Icare HOME IOP, was developed to assist identification of elevation above target applanation pressure, considering the expected diurnal variation and measurement variability. RESULTS Icare HOME tended to underestimate applanation tonometry (mean bias, -1.7 mmHg; 95% limits of agreement, -7.0 to +3.6). Overall, differences were within ±3 mmHg in 71.5% and ±5 mmHg in 92% of patients. Based on the novel criterion developed, Icare HOME measurements that exceed target applanation pressure by 6 mmHg or greater are generally outside the 95% limit of expected observations. CONCLUSIONS The Threshold Icare HOME IOP is a novel and practical criterion that can assist clinicians in their interpretation of Icare HOME phasing measurements with respect to target applanation pressures. Elevation above the expected thresholds may prompt closer monitoring or even modifications to glaucoma management.

The combination of chronic obstructive pulmonary disease and cardiovascular disease is an urgent public health problem, that determines more severe disease progression, worse prognosis for the patient. The aim of the work was to evaluate the status of the cardiovascular system performing a pulse wave contour analysis in patients with chronic obstructive pulmonary disease depending on the severity of bronchial obstruction. Material and Methods. Applanation tonometry was performed in 60 patients (56 men, age 63.5 [IQR 59; 70] years) with chronic obstructive pulmonary disease to assess central hemodynamic parameters. The severity of obstructive disorders was determined by spirometry after taking bronchodilator. Results. In case of progression of bronchial obstruction, a decrease in parameters characterizing coronary blood flow was detected, mainly determined by an increase in heart rate and by a decrease in the duration of diastole. In addition, higher values of augmentation pressure, corrected by heart rate of 75 bpm, pulse pressure, central pulse height at the point of maximum rise of direct pulse wave were determined in patients with more severe bronchial obstruction. These parameters indicate higher values of arterial stiffness in this group of patients. Conclusion. In patients with chronic obstructive pulmonary disease and high values of bronchial obstruction there is an imbalance in the ratio of myocardial load and actual blood supply, and increased arterial stiffness with impaired aortic damping function, that contributes to the development of cardiovascular disease in this group of patients. These factors may explain high prevalence of cardiovascular disease in this group of patients.

Background: bronchodilators are the major class of drugs prescribed for chronic obstructive pulmonary disease (COPD). Meanwhile, treatment strategies for obstructive lung disease using bronchodilators are continually discussed and reviewed, in particular, with regard to their potential effect on cardiovascular system. Aim: to evaluate the effect of the combination of a short-acting β2-agonist plus an anticholinergic medication (fenoterol 50 μg/dose + ipratropium bromide 20 μg/dose, 2 doses) on the efficacy of coronary blood flow in COPD patients. Patients and Methods: spirometry with bronchodilator testing (at least 12 hours after using the medication) was performed in 30 COPD patients. The efficacy of coronary blood flow was assessed by central subendocardial viability ratio (C_SEVR) measured by applanation tonometry which was performed before and 15, 30, and 60 min after using the bronchodilator. Oxygen saturation was measured at all stages of the study. Results: the combination of fenoterol and ipratropium bromide resulted in the increase of C_SEVR by 9.5 [3.3; 10.8]% in patients with low oxygen saturation at baseline due to heart rate reduction, diastolic lengthening, and oxygen level improvement. The timing of the effect was determined by the reversibility of bronchial obstruction. No effects of the combination of fenoterol and ipratropium bromide on central and peripheral blood pressure were reported. Conclusion: low oxygen saturation at baseline and reversible bronchial obstruction in COPD patients allow for a favorable predicted systemic effect of the combination of fenoterol and ipratropium bromide. When using in therapeutic dosages and according to recommended dosage regimen, this combination improves bronchopulmonary function, oxygen saturation, and the efficacy of coronary blood flow measured by applanation tonometry. KEYWORDS: chronic obstructive pulmonary disease, applanation tonometry, central subendocardial viability ratio, SEVR, bronchial obstruction, oxygen saturation. FOR CITATION: Punin D.A. Effect of the combination of a short-acting β2-agonist plus an anticholinergic drug on the efficacy of coronary blood flow measured by applanation tonometry in chronic obstructive pulmonary disease. Russian Medical Inquiry. 2020;4(4):199–206. DOI: 10.32364/2587-6821-2020-4-4-199-206.

The cold pressor test examines the cardio-vascular reactivity during certain physiological states - rest, stress and recovery. Currently it is a widespread tool for laboratory induced stress in an experimental setting amongst various fields of science. PURPOSE: To systemize the fields of application of the cold pressor test in an attempt to outline the possibilities to analyze cardio-vascular reactivity in connection to symptoms of depression, anxiety and stress. RESULTS: Unlike similar experiments (e.g. mental arithmetic test), which actively involve the behavior and motivation of the participants, the cold pressor test is a physical stressor that passively involves the participant. Cardiovascular response (BP, heart rate, aortic pulse wave velocity) to cold pressor test is measured with applanation tonometry - a novel, simple, easy-to-use method. In CONCLUSION, the combination of the cold pressor test with speech task and mental arithmetic test would contribute to the adequate tracking and comparison of vascular and myocardial reactivity during the assessment of psychological symptoms (depression, anxiety, and stress). All of this would facilitate the involvement of the individuals with clinical or sub-clinical symptoms of depression and anxiety in experimental studies and would further help in a more precise assessment of the cardiovascular risk amongst them.

Background Carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system and exhibits typical symptoms of red eye, diplopia, blurred vision, headache, and murmur. However, the symptoms for CCF may vary and can lead to misdiagnosis. IOP pulsations provide a hint leading to suspicion of CCF. We report three cases related to CCF differential diagnosis: two cases of CCF patients and one case of conjunctivitis with corkscrew conjunctival vessels. Case presentation The case 1 patient, with a typical unilateral CCF, exhibited significant IOP pulsation in Goldmann tonometry measurements in the affected eye. The case 2 patient did not show typical symptoms of CCF except asymmetric upper eyelid swelling (right > left). In clinical evaluation, IOP elevation in the right eye and IOP pulsation in both eyes were noted. Based on radiology, the patient was diagnosed with bilateral CCF. The case 3 patient was referred to our institution for differential diagnosis of CCF. The patient had corkscrew conjunctival vessels in both eyes, which had appeared after he had been revived through CPR (cardiopulmonary resuscitation) 25 years prior. IOP pulsation was not observed in Goldmann tonometry. Radiology test result for arterio-venous fistula was negative in the case 3 patient. Conclusion For diagnosis of CCF, IOP pulsation by Goldmann applanation tonometry exhibits a good correlation with the disease in our cases and provides useful diagnostic clues.

The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.

Summary Vascular-ventricular coupling is a major determinant of left ventricular load. The aim of our study was to assess non- invasively left ventricular load and its dependency on central hemodynamics. Sixty-five healthy and gender-matched individuals were divided in two groups according to their age: 20y/o and 50y/o. Applanation tonometry was performed using the Sphygmocor device. Central pressures and pulse wave analysis indices were computed. Central systolic (120±3 vs. 98±2 mm Hg) and pulse pressures (43±3 vs. 29±1 mm Hg) as well as the augmentation index (AIx75) (23±3 vs. 6±2%) were significantly higher in the 50y/o group (p

OBJECTIVE To compare intraocular pressures (IOPs) estimated by rebound and applanation tonometry for dogs with lens instability. ANIMALS 66 dogs. PROCEDURES Medical records of dogs examined between September 2012 and July 2018 were reviewed for diagnoses of anterior (ALL) or posterior (PLL) lens luxation or lens subluxation. RESULTS Estimates of IOP obtained with rebound and applanation tonometry significantly differed from each other for all types of lens instability considered collectively (mean ± SE difference between tonometric readings, 8.1 ± 1.3 mm Hg) and specific types of lens instability considered individually (mean ± SE difference between tonometric readings: ALL, 12.8 ± 2.5 mm Hg; PLL, 5.9 ± 1.7 mm Hg; subluxation, 2.8 ± 0.8 mm Hg). Median (range) differences between rebound and applanation tonometer readings for dogs with ALL was 5 mm Hg (–9 to 76 mm Hg), with PLL was 3 mm Hg (–1 to 19 mm Hg), and with lens subluxation was 3 mm Hg (–9 to 18 mm Hg). In eyes with ALL, rebound tonometer readings exceeded applanation tonometer readings on 44 of 60 (73%) occasions. CONCLUSIONS AND CLINICAL RELEVANCE Rebound tonometry yielded higher estimates of IOP than did applanation tonometry in eyes with ALL and with all types of lens luxation considered collectively. Estimates of IOP in eyes with lens instability should ideally be obtained with both rebound and applanation tonometers. Veterinarians with only one type of tonometer should interpret results for dogs with lens instability concurrent with physical examination findings.

Background Measurement of intraocular pressure (IOP) plays a central role throughout ophthalmology. It is part of routine ophthalmologic examinations and important in the management and follow-up of patients with glaucoma. While elevated IOP remains the most important risk factor for development and progression of open angle glaucoma, at least half of the population diagnosed with open angle glaucoma is asymptomatic. Objectives The aim of our study is to compare the accuracy of intraocular pressure measurement before and after Laser in situ keratomeulsis (LASIK) surgery using three different types of Tonometers: Goldmann Applanation tonometry (GAT), Non contact tonometry (NCT) and Rebound tonometry (I care), considering the change in the central corneal thickness (CCT). Patients and Methods In this study Eighty eyes of 40 patients with mean age of 27.00±6.00 years were scheduled for LASIK..Central corneal thickness before and after surgery was obtained by Ultrasound (US) pachymetry.IOP values were measured before and after surgery using three different types of Tonometers: Goldmann Applanation tonometry, Non contact tonometry and Rebound tonometry. Results The results revealed that lower post-operative IOP measurements using all techniques. The least affected technique was Non –contact with IOP change 16%, followed by GAT with IOP change 18%, and finally Rebound with IOP change 19 %, respectively. The percentage of change in CCT between pre- and post- LASIK surgery measured with the Ultrasound pachymetry was statistically highly significant. There was a clinical significant correlation between Percentage of tissue ablation (PTA) and IOP change for GAT, NCT and rebound tonometry. Also, there was a significant correlation between Residual stromal bed (RSB) and IOP change for GAT and NCT. There was no clinical significant correlation between Ablation depth (AD) and percentage of change of IOP measurements pre and post LASIK, except for IOP measured with GAT when AD Conclusion Refractive surgery causes significant lowering of IOP as measured using Goldmann applanation tonometry, non contact tonometry and rebound tonometry. The least affected tonometry post LASIK is non contact tonometry. The reduction was correlated to the percentage of tissue ablated. The ideal method to measure IOP in post-LASIK patients would be a device that is free of corneal factors.

Background and objectives The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia. Methods 27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35, and 30 mmHg EtCO2 for 5 minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. Results Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia. Conclusions Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation. Trial registration The study was registered at http://www.clinicaltrials.gov , identifier: NCT02203097, registration date: July 29, 2014.

Aortic blood pressure (aoBP) waveform-derived indexes could provide valuable (prognostic) information over and above cardiovascular risk factors (CRFs). To obtain aoBP waveform-characteristics, several (i) techniques, (ii) recording sites, (iii) pressure-only waveform analysis mathematical approaches [e.g., pulse wave analysis (PWA), wave separation analysis (WSA)], and (iv) indexes [augmentation pressure and index (AP and AIx), forward (Pf) and backward (Pb) components of aoBP, reflection magnitude (RM), and reflection index (Rix)], were proposed. An accurate clinical use of these indexes requires knowing their physiological age-related profiles and the expected values for a specific subject. There are no works that have characterized waveform-derived indexes profiles in large populations considering: (i) as a continuous, data from different age stages (childhood, adolescence, and adulthood), (ii) complementary indexes, (iii) data obtained from different techniques and approaches, and (iv) analyzing potential sex- and body height (BH)-related differences. In addition, (v) there is a lack of normative data (reference intervals, RIs) for waveform-derived indexes.Aims(1) to evaluate the association and agreement between PWA- and/or WSA-derived indexes obtained with different techniques and approaches; (2) to determine the need for sex-, BH-, and/or age-specific RIs; (3) to define RIs for PWA- and WSA-derived indexes in a large cohort of healthy children, adolescents, and adults.Methods3619 subjects (3–90 y) were included; 1688 healthy (2–84 y). AP, AIx, AIx@75, Pf, Pb, RM, and RIx were obtained (carotid and radial tonometry, brachial oscillometry/plethysmography). The association and agreement between indexes were analyzed (Concordance correlation coefficients, Bland–Altman analysis). Mean and SD equations and sex-specific BH- and age-related profiles were obtained (regression methods; fractional polynomials).ResultsWaveform-derived indexes were not equivalent; for a specific index, there were systematic and proportional differences associated with the recording site (e.g., carotid vs. radial) and technique (e.g., tonometry vs. oscillometry). The need for sex-, BH-, or age-specific RIs was dependent on the index and/or age considered. RIs were defined for each index considering differences between recording sites and techniques. Equations for waveform-derived indexes age-related profiles were included, enabling to determine for a specific subject, the expected values and potential data deviations.

Acupuncture is an ancient Chinese form of therapy that involves needle stimulation of specific points on the body for therapeutic and homeostatic effects. In ophthalmology, acupuncture helps as a conventional or adjuvant therapy for numerous eye disorders, including myopia, strabismus, dry eye, and cataracts. This study aimed to evaluate the effect of acupuncture on tear production (TP) and intraocular pressure (IOP) in horses. Ten healthy horses, females and males with ages varying between eight months and nine years, were used. Schirmer’s I test and applanation tonometry were used to evaluate the basal TP and IOP of both eyes. The measurements were taken immediately before (T10) the insertion of the needles and 5 (T5), 15 (T15), 30 (T30) and 60 (T60) minutes and 24 (T24) hours after a 20-minute acupuncture session. Mean values of both eyes were analyzed over time. TP increased in 50% of the animals at T5, T15 and T24, in 30% at T30, and in 40% at T60, with an increase of up to 8.5 mm/min at T15 and T60. In addition, there was a significant difference between T24 and T30, with a 14.1% increase in TP at T24. Meanwhile, IOP decreased in 50% of the animals at T5 and T30, in 20% at T15, in 60% at T60, and in 70% at T24. Thus, we suggest that acupuncture is a technique that can benefit horses with diseases that alter these parameters, either alone or as an adjunct in conventional therapeutic protocols. RESUMO: A acupuntura é uma terapia milenar de origem chinesa que funciona através da estimulação de pontos específicos do corpo com agulhas, visando efeitos terapêuticos e homeostáticos. Na área de oftalmologia a acupuntura tem auxiliado como terapia convencional ou adjuvante de inúmeras afecções oculares, incluindo miopia, estrabismo, olho seco, catarata, entre outras. Esse estudo teve como propósito avaliar o efeito da acupuntura no comportamento da produção lacrimal e da pressão intraocular em equinos. Utilizou-se 10 equinos hígidos, fêmeas e machos, com idades variando entre oito meses e nove anos. O teste lacrimal de Schirmer tipo I e da tonometria de aplanação foram utilizados para avaliar a produção basal de lágrima (PL) e a pressão intraocular (PIO) de ambos os olhos. As aferições foram realizadas imediatamente antes da inserção das agulhas (T0) e cinco (T5), 15 (T15), 30 (T30) e 60 (T60) minutos e 24 (T24) horas após sessão de acupuntura de 20 minutos. Os valores obtidos foram analisados quanto ao seu comportamento ao longo do tempo, utilizando-se a média dos dois olhos de cada animal. A PL aumentou em 50% dos animais em T5, T15 e T24, 30% dos animais em T30 e 40% dos animais em T60, com aumento de até 8,5 mm/min em T15 e T60. Além disso, observou-se diferença significativa entre o T24 e o T30 (p = 0,0128), com aumento de 14,1% na PL no T24. Com relação à PIO, notou-se que 50% dos animais sofreram redução na pressão em T5 e T30, 20% dos animais redução em T15, 60% dos animais em T60 e 70% dos animais apresentaram redução em T24. A estimulação dos acupontos relacionados ao sistema visual foi capaz de aumentar a produção lacrimal e diminuir a pressão intraocular em equinos sadios. Dessa maneira, sugere-se que a acupuntura é uma técnica que poderá trazer benefícios a cavalos portadores de doenças que cursam com a alteração desses parâmetros, tanto quando empregada isoladamente, como quando adjuvante a protocolos terapêuticos convencionais.

This study investigated the agreement of intraocular pressure measurements using rebound tonometry and applanation tonometry in response to atmospheric changes in a hyperbaric chamber. Twelve eyes of 12 healthy subjects were included in this prospective, comparative, single-masked study. Intraocular pressure measurements were performed by rebound tonometry followed by applanation tonometry in a multiplace hyperbaric chamber at 1 Bar, followed by 2, 3 and 4 Bar during compression and again at 3 and 2 Bar during decompression. Mean differences between rebound and applanation intraocular pressure measurements were 1.6, 1.7, and 2.1 mmHg at 2, 3, and 4 Bar respectively during compression and 2.6 and 2.2 mmHg at 3 and 2 Bar during decompression. Lower limits of agreement ranged from -3.7 to -5.9 mmHg and upper limits ranged from -0.3 to 1.9 mmHg. Multivariate analysis showed that the differences between rebound and applanation intraocular pressure measurements were independent of atmospheric pressure changes (p = 0.79). Intraocular pressure measured by rebound tonometry shows a systematic difference compared to intraocular measured by applanation tonometry, but this difference is not influenced by changes of atmospheric pressure up to 4 Bar in a hyperbaric chamber. Agreement in magnitude of change between devices suggests rebound tonometry is viable for assessing intraocular pressure during atmospheric changes. Future studies should be designed in consideration of expected differences in IOP values provided by the two devices.

Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 21 days of head-down bed rest (HDBR) and (2) to determine the effects of resistance vibration exercise (RVE) alone or combined with nutritional supplementation (NeX). In this case, 12 healthy male subjects completed three interventions of a 21-day HDBR: a control condition without countermeasure (CON), a condition with resistance vibration exercise (RVE) comprising of squats, single leg heel and bilateral heel raises and a condition using also RVE associated with nutritional supplementation (NeX). Intraocular pressure (IOP) was assessed by applanation tonometry. Retinal nerve fiber layer thickness (RNFLT) was assessed with spectral-domain optical coherence tomography, before HDBR and between Day 2 and Day 4 after each session of HDBR. In CON condition, IOP was preserved; while in RVE and NeX conditions, IOP was increased. In CON condition, RNFLT was preserved after HDBR. RVE and NeX conditions did not have significant effects on RNFLT. This study showed that a 3-week HDBR did not induce significant ophthalmological changes. However, RVE induced an elevation in IOP after HDBR. Nutritional supplementation did not reduce or exacerbate the side effects of RVE.

Study question Is the cardiometabolic health of adolescents conceived through ART worse than that of their spontaneously-conceived counterparts? Summary answer The majority of cardiometabolic and vascular health parameters of ART-conceived adolescents are more favourable than those of their spontaneously-conceived counterparts of similar age. What is known already It has been proposed that ART induces epigenetic alterations during embryonic development which could lead to cardiometabolic disease later in life. However, individuals requiring ART may themselves be metabolically less healthy than the general population, which could lead to a genetically increased risk of cardiometabolic disorders in the offspring, rather than the ART procedure. The literature pertaining to cardiometabolic health of ART-conceived offspring is contradictory, but generally suggests unfavourable cardiometabolic health parameters. With over 8 million children and adults born through ART worldwide, it is imperative to investigate whether early signs of adverse cardiometabolic differences persist into adolescence and beyond. Study design, size, duration The Growing Up Healthy Study (GUHS) is a prospective study that recruited 303 ART-conceived adolescents, born 1991-2001 in Western Australia. Their health parameters, including cardiometabolic factors, were assessed and compared with spontaneously conceived counterparts of similar socioeconomic background and age from the Raine Study Generation 2 (Gen2). The 2868 Gen2 participants were born 1989-1992 and are representative of the Western Australian adolescent population. At age 16-17 (2013-2017), GUHS participants replicated assessments previously completed by Gen2. Participants/materials, setting, methods Cardiometabolic parameters were compared between 165 GUHS (male = 50.9%) and 1690 Gen2 (male = 49.8%) adolescents. Assessments consisted of a detailed questionnaire; health and demographic parameters, anthropometric assessments; height, weight, body-mass index (BMI), waist circumference and skinfold thickness, fasting serum biochemistry, arterial stiffness and blood pressure assessment using applanation tonometry, assessment of non-alcoholic fatty liver (NAFLD) and thickness of abdominal fat compartments using ultrasonography. Chi2, Fisher’s Exact and Mann-Whitney U tests, performed in SPSS V25, examined cohort differences. Main results and the role of chance GUHS adolescents appeared to be healthier from a cardiometabolic perspective than their Gen2 counterparts. They were leaner, with lower BMI (median: 21.23 vs. 22.06, P = 0.004), lower waist circumference (median: 74.10 vs. 76.75 cm, P = 0.031), and thinner skinfolds (triceps median: 12.1 vs. 14.0 mm, P = 0.019, subscapular median: 10.6 vs. 11.9 mm, P < .001, mid-abdominal median: 16.0 vs. 19.9 mm, P Limitations, reasons for caution Despite the substantial study size and the unique study design, we were unable to differentiate between different types of ART (e.g. IVF vs. ICSI), draw definite conclusions or relate outcomes to cause of infertility. Given the observational character of this study, causation cannot be proven. Wider implications of the findings In this study we did not detect any adverse effect of ART on cardiometabolic health at adolescence, in contrast to some studies. Given the lack of consensus, future well-designed and appropriately-powered studies are necessary to investigate cardiometabolic health in ART adults. Trial registration number not applicable

We test a new wireless soft capacitance sensor (CAP) based on applanation tonometry at the radial and dorsalis pedis arteries against the gold standard, invasive arterial line (A-Line), for continuous beat to beat blood pressure (BP) measurements in the Operating Room during surgical procedures under anesthesia in 17 subjects with the mean age and body mass index (BMI) of 57. 35 ± 18.72 years and 27.36 ± 4.20 kg/m2, respectively. We have identified several parameters to monitor in order to compare how well the CAP sensor tracks the entire hemodynamic waveform as compared to the A-Line. This includes waveform similarity, heart rate (HR), absolute systolic BP (SBP), diastolic BP (DBP), and temporal response to a vasopressor. Overall, the CAP sensor shows good correlations with A-Line with respect to hemodynamic shape (r > 0.89), HR (mean bias = 0.0006; SD = 0.17), absolute SBP, and DBP in a line of best fit (slope = 0.98 in SBP; 1.08 in DBP) and the mean bias derived from Bland-Altman method to be 1.92 (SD = 12.55) in SBP and 2.38 (SD = 12.19) in DBP across body habitus and age in OR patients under general anesthesia. While we do observe drifts in the system, we still obtain decent correlations with respect to the A-Line as evidenced by excellent linear fit and low mean bias across patients. When we post-process using a different calibration method to account for the drift, the mean bias and SD improve dramatically to −1.85 and 7.19 DBP as well as 1.43 and 7.43 SBP, respectively, indicating a promising potential for improvement when we integrate strategies to account for movement identified by our integrated accelerometer data.

Background: The present study was conducted to assess clinical profile of patients with uveitis. Materials & Methods: 62 cases of uveitis underwent Visual acuity by Snellen’s chart, refraction, intraocular pressure by applanation tonometry, slit lamp biomicroscopic examination and a detailed fundus examination. Results: Clinical types were acute in 36, chronic in 18 and recurrent in 8 cases. The difference was significant (P

Aim: To describe the value and results of family screening of glaucoma patients in the glaucoma clinic of a tertiary center in the Garhwal Himalayan region over a period of one year. Material and Method: 300 patients underwent comprehensive ophthalmic examination and glaucoma examination including IOP measurement by Goldman applanation tonometry, binocular dilated fundoscopy with +90D Volk lens, gonioscopy using the 4 mirror Volk goniolens. Results: 300 persons detected with primary glaucoma whose families were invited to participate in the family screening initiative, there were 114 first degree relatives who attended the screening with a response rate of 32%. The relatives of probands ranged in age from 18 to 89 years with 56.8% being males. 198 were diagnosed as primary angle-closure suspects, 8 as angle-closure,238 as glaucoma suspects and 132 subjects (11.6%) had definite glaucoma. Most affected subjects were in 40-70 years. The angle-closure disease was found more in females. Conclusion: Study also found a higher prevalence of glaucoma in siblings; especially the angle-closure entity. Targeting first degree relatives of persons with primary glaucoma may offer a relatively inexpensive way of detecting glaucoma and in the identification of suspects at risk of glaucoma who may be advocated closer monitoring.

OBJECTIVE The aim of the present study was to provide ophthalmic reference values under normal physiological conditions for Aegypius monachus (cinereous vulture). PROCEDURES Thirty-two eyes of sixteen adult captive cinereous vultures were used for this study. Tear tests and tonometry in conscious and anesthetized states, neuro-ophthalmic tests, measurement of corneal diameter, slit-lamp biomicroscopy, ophthalmoscopy, and funduscopy were performed. RESULTS Schirmer tear test (STT) value was 11.4 ± 2.6 and 11.5 ± 2.8 mm/min in the right (OD) and left eye (OS), respectively. Phenol red thread test (PRT) values were 22.3 ± 2.1 mm/15 s OD and 22.8 ± 3.0 mm/15 s OS. The results showed a strong correlation between STT and PRT in both eyes. Intraocular pressure (IOP) values were 32.8 ± 6.9 mm Hg OD and 31.9 ± 7.1 mm Hg OS with TonoVet and 20.7 ± 4.5 mm Hg OD and 19.5 ± 4.1 mm Hg OS with Tono-Pen. There were significant differences in IOPs between rebound and applanation tonometry in both OD and OS. Tear production and IOP values showed significant reductions with general anesthesia in both tear tests and both tonometry (P

BACKGROUND Distinguishing cardiac from noncardiac causes of dyspnea is clinically important, and a reliable noninvasive measure of left atrial pressure (LAP) is needed. Subtracting the peak systolic gradient between left ventricle (LV) and left atrium (LA) from the central systolic blood pressure (BP) should provide this measure. Using a commercially available blood pressure system incorporating applanation tonometry and bedside echocardiography, we tested this hypothesis in a broad spectrum of patients. METHODS A total of 75 stable patients, scheduled for right heart catheterization for any reason, were included. Central systolic pressure was measured by a Sphygmocor® tonometry system; peak LV-LA gradient was calculated as 4*(peak mitral regurgitation (MR) velocity)2 . Microbubble contrast was used as needed to augment the MR signal. LAP estimates using central BP were compared with wedge pressure as were LAP estimates using brachial BP. RESULTS Left atrial pressure estimates using central BP showed a good correlation with wedge pressure (r2 = 0.774, P

Purpose: to study a correlation between morphometric parameters of the eye and tonometry data, taking into account viscoelastic properties of the cornea in patients with primary open-angle glaucoma (POAG), as well as in practically healthy individuals using different methods of tonometry. Patients and Methods. Correlations between morphometric parameters of the eye and tonometry data were studied in view of viscoelastic properties of the cornea in 51 patients with POAG who were observed at the “Optimed” Laser Vision Recovery Center in Ufa (99 eyes) and in 31 practically healthy individuals (62 eyes). Various methods of tonometry were used: tonometry according to Maklakov, contactless tonometry, tonometry with the Ocular Response Analyzer (ORA, Reichert Inc., USA), as well as ultrasound echobiometry, pachymetry. Results. The CH and CRF parameters reflecting the biomechanical properties of the corneoscleral membrane of the eye were close in value to each other with a high degree of positive correlation in the control group (ρ = 0.783, p < 0.001), with an average correlation in the group with POAG (ρ = 0.545, p < 0.001). In eyes with POAG, a negative CH correlation of average degree with corneal-compensated IOP (ρ = -0.572, p < 0.001), a negative CRF correlation of moderate degree with IOP by the Maklakov method (ρ = -0.346, p < 0.001) and corneal-compensated IOP with dynamic bi-directional applanation tonometry (ρ = -0.327, p = 0.001), low correlation with IOP using contactless tonometry (ρ = 0.243, p < 0.015) were observed. In the group of patients with POAG, a positive average correlation was found between the central thickness of the cornea and CRF (ρ = 0.398, p < 0.001), and CH (ρ = 0.368, p < 0.001), low correlation with IOP using contactless tonometry (ρ = 0.266, p = 0.008). Conclusion. Correlations of biomechanical properties of the corneoscleral membrane and morphometric parameters of the eye in patients with POAG were revealed using different methods of tonometry. In the group of patients with POAG and in the control group, positive correlations of the central thickness of the cornea with the IOP level in tonometry were determined by the contactless method, as well as with the main ORA parameters reflecting the visco-elastic properties of the fibrous membrane of the eye — the corneal resistance factor, corneal hysteresis.

Objectives: To analyze the reproducibility of the new iC100 rebound tonometer, to compare its results with the applanation tonometry and iCare PRO and to evaluate the preference between them. Materials and methods: For the study of reproducibility, 15 eyes of 15 healthy Caucasian subjects were included. Three measurements were taken each day in three separate sessions. For the comparative study, 150 eyes of 150 Caucasian subjects were included (75 normal subjects and 75 patients with glaucoma). Three consecutive measurements were collected with each tonometer, randomizing the order of use. The discomfort caused by each tonometer was evaluated using the visual analogue scale. Results: No statistically significant differences were detected between sessions. In the comparison between tonometers, the measurements with iC100 were statistically lower than those of Perkins (−1.35 ± 0.417, p = 0.004) and that iCare PRO (−1.41 ± 0.417, p = 0.002). The difference between PRO and Perkins was not statistically significant ( p = 0.990). The mean time of measurement (in seconds) with iC100 was significantly lower than with Perkins (6.74 ± 1.46 vs 15.53 ± 2.01, p Conclusion: The reproducibility of this instrument has been proven good. iC100 underestimates intraocular pressure compared to applanation tonometry at normal values and tends to overestimate it in high intraocular pressure values. Most of the subjects preferred iC100 tonometer.

BACKGROUND Patients with type 1 diabetes mellitus (T1DM) often develop atherosclerosis at an early age. In the subclinical stage of the process, minimal/non-morphological changes can be noticed, but the arterial wall function can be impaired. Applanation tonometry allows to assess the arterial tree stiffness; however, the Two-Dimensional Speckle Tracking (2DST) is an increasingly accepted alternative. This study evaluated arterial wall stiffness using these 2 techniques in children with T1DM. MATERIAL AND METHODS We performed applanation tonometry and carotid arteries sonography with evaluation of the carotid intima-media thickness (cIMT) and use of the 2DST in 50 children with T1DM and in 50 healthy sex- and age-matched controls. We also assessed the reliability of 2DST in 10 random subjects. RESULTS Children with T1DM had increased arterial wall stiffness, which was confirmed by tonometry (PWV: p=0.0386) and 2DST (Strain: p=0.0004; Strain rate: p=0.0081). There was no significant difference in cIMT between groups (0.45±0.06 vs. 0.43±0.05, p=0.073 in children with T1DM and controls, respectively). 2DST presented good intraclass correlation coefficient between researchers and within a single researcher. CONCLUSIONS Children with T1DM presenting with subclinical stage of atherosclerosis were found to have arterial wall stiffening. The 2DST, the same as applanation tonometry, allows to recognize this condition but in a more accessible and reproducible manner.

The effect of constant light and constant darkness on intraocular pressure (IOP) in goats has not been investigated. We hypothesized that IOP variations would differ between goats kept under a cycle of 12 hours of light and 12 hours of darkness (LD), constant darkness (DD), and constant light (LL). To test this hypothesis, goats were exposed to these conditions for five days (LD, 30 goats; DD, 10 goats; LL, 10 goats). IOP was measured by applanation tonometry at 9 a.m. (beginning of photophase in LD) and 9 p.m. (beginning of scotophase in LD) on the fourth and fifth days of exposure. We found that changes in mean IOP from 9 a.m. to 9 p.m. differed significantly between groups (χ

Wave reflection at central arteries consists of a major component of left ventricular afterload. Central augmentation index (AIx) is the most widely used surrogate of wave reflection. Recent technological developments now provide the ability to obtain, non‐invasively, aortic, or carotid pressure waves and measure AIx based on various algorithms of pulse wave analysis. The aim of this study was to compare AIx measurements performed by the Arteriograph, Complior, and Mobil‐O‐Graph apparatuses. Recordings by each device in randomized order were performed with 5‐minute interval at 211 individuals (age 55.1 ± 14.1 years, 67.8% males) who underwent diagnostic cardiovascular assessment. All measurements were obtained at the supine position, and AIx was calculated using the formula AIx = 100 × (Augmentation pressure)/(Pulse Pressure). Bland‐Altman analysis was performed. Mean difference (bias) ± one standard deviation of difference (with limits of agreement) of AIx between different devices was as follows: (a) Mobil‐O‐Graph vs Complior: −2.1 ± 14.8% (−31.1% to 26.9%), (b) Arteriograph vs Complior: 12.9 ± 14.6% (−15.7% to 41.5%), and (c) Mobil‐O‐Graph vs Arteriograph: −10.8 ± 16.9% (−43.9% to 22.3%). The three examined devices exerted significant differences in central AIx estimation which makes the three devices non‐interchangeable for wave reflection assessment. However, the Mobil‐O‐Graph device showed the highest agreement (lowest bias) with the Complior system as regards to the AIx measurement.

Purpose. To study tonometry parameters features, measured by different methods, taking into account individual morphometric eye parameters and biomechanical properties of the corneoscleral shell in patients with the initial and the advanced stages of primary open angle glaucoma (POAG).Material and methods. 51 patients (99 eyes) aged 48–82, with the initial (45 eyes) and advanced stages (54 eyes) of POAG were examined. The control group consisted of 31 patients (62 eyes) aged 47–83 without ophthalmic pathology. In addition to standard ophthalmologic examination, tonometry was performed using the Ocular Response Analyzer (ORA, Reichert Inc., the USA).Results. The main tonometry parameters of ORA revealed significant differences between POAG patients and the control group. No significant difference in the central corneal thickness (CCT) was found between the POAG and the control group. Patients with I and II stages of glaucoma taken separately showed differences in CCT and tonometry parameters.Conclusion. Dynamic bi-directional applanation tonometry enables to take into account the changes in viscoelastic properties of the corneoscleral eye shell, and definitely has diagnostic advantages in examining patients with various stages of POAG.

Aim. To study muscular (brachial and radial arteries) and elastic (aorta) regional arterial stiffness in IBD patients in comparison with those without IBD, as well as to establish the relationship between arterial stiffness and the characteristics of the IBD course (the duration of illness, severity of attack, activity of systemic inflammation). Materials and methods. The study included 21 IBD patients and 30 patients in the comparison group. The values of regional aortic and muscular arterial stiffness were measured by applanation tonometry. The carotid–femoral pulse wave velocity (cfPWV) and the carotid-radial pulse wave velocity (crPWV) were determined. The laboratory research plan included the analysis of complete blood count, biochemical parameters, fibrinogen and a high sensitivity C-reactive protein (hsCRP).Results. crPWV, similar to cfPWV, was not significantly different between the groups. At the same time, the proportion of individuals with an increase in the cfPWV of more than 10 m/s was higher in the group of IBD patients. However, these differences did not reach the level of statistical significance. According to the results of the correlation analysis, the increase in cfPWV was associated with an increase in patient age (r = 0.564; p = 0.01), the duration of IBD history (r = 0.628; p = 0.003), fasting plasma glucose (r = 0.367; p = 0.034) and GFR decrease (r = -0.482; p = 0.031). The crPWV also directly correlated with the IBD duration (r = 0.630; p = 0.003). According to the results of the regression analysis, an increase in the IBD duration by 1 year is associated with an increase in cfPWV by 0.205 m/s, i.e. the increase in the IBD duration by 5 years is associated with an increase in the cfPWV of approximately 1 m/s.Conclusion. In IBD patients, the duration of the disease directly correlated with an increase in cfPWV and crPWV. The increase in the IBD duration by 1 year was associated with an increase in cfPWV by 0.205 m/s. The muscular and elastic regional arterial stiffness was not statistically significantly different between IBD patients and the comparison group.

ZusammenfassungDie Messung des Augeninnendruckes ist vor allem bei Erkrankungen und iatrogenen Veränderungen der Hornhaut eine fehler- und abweichungsanfällige Untersuchung. Es existiert eine Vielzahl an unterschiedlichen Messmethoden, die auf unterschiedliche Art und Weise die Hornhaut und ihre Biomechanik einbeziehen. Die Abweichungen von der bisher als Goldstandard akzeptierten Goldmann-Applanationstonometrie sind in unterschiedlichem Maße von der Beschaffenheit der Hornhaut abhängig. Für unterschiedliche Erkrankungen/Veränderungen variieren diese für die einzelnen Methoden. Eine bei veränderten Hornhäuten klar zu bevorzugende Messmethode existiert nicht, die Kenntnis über die einzelnen Abweichungsverhältnisse ist daher wichtig, um Augeninnendruckwerte individuell einschätzen und einordnen zu können.

Background Reflected arterial waves contribute to left ventricular (LV) afterload. Heart failure patients with reduced ejection fraction (HFrEF) are afterload sensitive and sympathetically activated. We tested the hypothesis that HFrEF patients exhibit a positive relationship between sympathetic vasoconstrictor discharge and aortic wave reflection. Methods Sixteen treated patients with HFrEF (61 ± 9 years of age, left ventricular ejection fraction 30 ± 7%, 3 women) and 16 similar-aged healthy control subjects (57 ± 7 years of age, 4 women) underwent noninvasive measurements of radial pulse waveforms (applanation tonometry) to calculate central blood pressures and aortic wave reflection characteristics: augmentation pressure (AP), augmentation index (AIx), and AIx corrected to a heart rate of 75 beats/min (AIx@75). Muscle sympathetic nerve activity (MSNA) burst frequency was recorded from the fibular nerve (microneurography). Results HFrEF patients had higher AIx (26 ± 9 vs 17 ± 15%; P .05), AP (11 ± 5 vs 7 ± 8 mm Hg; P = 0.11), or AIx@75 (19 ± 9 vs 13 ± 11%,-P = 0.14). MSNA correlated positively with AP (r = 0.50; P 0.49). Conclusions In patients with HFrEF, but not similarly aged healthy subjects, indices of aortic wave reflection correlate positively with MSNA. By increasing LV afterload, such neurovascular coupling could impair LV performance and worsen heart failure symptoms. Therapies that attenuate neurogenic vasoconstriction may benefit HFrEF patients by diminishing arterial wave reflection.

Intraocular pressure (IOP) measurement can be performed with different methods. Newer methods have to be compared to the standard method, the Goldmann applanation tonometry (GAT). We herein compare two air-puff tonometers, the non-contact tonometer (Tomey NCT) and the Corvis ST (CST) with GAT in eyes with a broad spectrum of IOP. Two hundred and forty-nine eyes of 249 patients (with diagnosis of either glaucoma or ocular hypertension) were included in this monocenter prospective cohort study. Each eye underwent IOP measurements via GAT, NCT and CST. Bland–Altman plots were calculated to compare the different methods in the three groups. Paired t tests were used for statistical comparison between the three measurement methods. The difference between the different methods was tested on correlation against central corneal thickness (CCT). Mean IOP in GAT was 17.6 mmHg (standard deviation (SD) 5.9), 16.3 mmHg (SD 5.6) in NCT and 18.0 mmHg (SD 5.5) in CST. Comparisons between GAT and CST vs. NCT showed significant differences (p

Although applanation tonometry is the most widely used method for evaluating arterial stiffness, oscillometric ambulatory blood pressure monitoring devices using specific algorithms for pulse wave analyses have been validated more recently. Currently, it is not clear how to interpret 24-h mean values of arterial stiffness parameters. The objective of this study was to compare 24-h mean values of arterial stiffness parameters obtained using 24-h ambulatory blood pressure monitoring device (Mobil-O-Graph) against a validated single-measure tonometric system (SphygmoCor).We measured brachial and central arterial pressure, augmentation index (AIx), and carotid-to-femoral pulse wave velocity (cfPWV) using SphygmoCor device in 82 high and very high cardiovascular risk patients. The Mobil-O-Graph device for the 24-h blood pressure and arterial stiffness parameter monitoring was used on the same day and started within 2 h after measurements using SphygmoCor were done.Mean AIx values were 26.38±9.95 for SphygmoCor office measurement and 26.69±8.45 for Mobil-O-Graph 24-h mean values. The mean difference was -0.31±9.78 (P=0.775). CfPWV values were 10.56±2.59 m/s for SphygmoCor office measurement and 8.72±1.29 m/s for Mobil-O-Graph 24-h mean values. The difference of 1.84±2.15 m/s was statistically significant (P0.001). Correlation coefficients for AIx and cfPWV between two methods were 0.444 and 0.468, respectively (P0.001).The agreement between SphygmoCor single measurement and Mobil-O-Graph 24-h mean values of arterial stiffness parameters is moderate. The 24-h mean values of cfPWV obtained by Mobil-O-Graph are significantly lower than SphygmoCor values obtained in the office, whereas 24-h AIx mean values do not have a significant bias.

PURPOSE To assess the outcomes of micropulse transscleral cyclophotocoagulation for intraocular pressure (IOP) control in keratoplasty eyes. METHODS Outcomes of micropulse laser treatments of postkeratoplasty eyes were retrospectively reviewed. IOP was assessed with applanation tonometry. Keratoplasty survival was calculated with Kaplan-Meier survival analysis. RESULTS Sixty-one eyes in 57 patients received laser treatment; 31 eyes received 1, 21 received 2, 8 received 3, and 1 received 4 treatments. The median follow-up was 21 months (range, 2-35 months). At baseline, the mean IOP was 28 ± 11 mm Hg. At 1, 3, 6, and 12 months after the last treatment, respectively, the numbers of eyes with IOP data were 58, 50, 46, and 38; the mean IOP was 17 ± 7, 17 ± 8, 18 ± 9, and 15 ± 5 mm Hg; the proportions of eyes with IOP ≤ 15 mm Hg were 40%, 51%, 48%, and 55%; and the proportions with IOP ≤ 12 mm Hg were 21%, 29%, 20% and 29%. Six eyes (10%) received subsequent glaucoma filtration surgery. The mean number of antiglaucoma medications used before the initial treatment was 2.7 (range, 0-4) versus 2.2 (range, 0-4) at last follow-up. At baseline, 7 grafts were decompensated and 5 of 54 clear grafts (9%) had endothelial cell density < 700 cells/mm. Graft survival was 94% at 1 year and 81% at 2 years after the initial laser treatment. CONCLUSIONS Micropulse transscleral cyclophotocoagulation is a noninvasive alternative to glaucoma filtration surgery for IOP reduction in keratoplasty eyes.

Purpose: Evaluate potential corneal biomechanical changes following corneal crosslinking (CXL) by paired differential tonometry intraocular pressure (IOP) measurements with a Goldmann tonometer (GAT) prism and corneal compensating, correcting applanation tonometry surface (CATS) prism.Methods: IOP was measured prospectively on 23 unique eyes undergoing CXL for keratoconus with a GAT using a standard flat GAT prism and a curved corneal error correcting CATS prism before treatment and at 2 weeks, 2 months and 6 months after treatment. Concurrent measurements of central corneal thickness (CCT) and corneal hysteresis (CH) were completed.Results: Paired IOP measurements with standard GAT and corneal correcting CATS prisms indicated a significant sustained relative increase in the differential IOP between the two prisms after CXL (p = .002,0.051,0.062). CH initially decreased at two weeks post-CXL then returned to sustained pre-op levels (p = .033,0.20,0.20). CCT progressively decreased following CXL (p = .005).Discussion: Differential tonometry between standard GAT and corneal biomechanical compensating CATS prisms indicates findings consistent with increased corneal rigidity following CXL and may demonstrate a simple and sensitive method for measurement of relative corneal biomechanical changes due to pharmacologic agents and procedures.