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Bruno P Figueiredo,1,2 Sebastião Cronemberger,1 Fabio N Kanadani3,4 1Departments of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, 2Departments of Ophthalmology, Glaucoma and Cataract Service, Santa Casa of Belo Horizonte, 3Department of Ophthalmology, São José University Hospital, Belo Horizonte, Minas Gerais, 4Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil Background: The purpose of this study was to investigate the correlation between ocular perfusion pressure and ocular pulse amplitude in glaucoma, ocular hypertension, and normal eyes. Methods: Ninety eyes from 90 patients were included. Thirty patients had been recently diagnosed with glaucoma and had no previous history of treatment for ocular hypotension, 30 had elevated intraocular pressure (IOP) without evidence of glaucoma, and 30 had normal IOP (

Aim: This study reports the bilateral association of Peters' anomaly and congenital aniridia in monozygotic twins subsequently diagnosed with Wilms tumour (WAGR syndrome)., Methods: Two monozygotic female twins were referred at age 2 months with bilateral corneal opacity. A diagnosis of Peters' anomaly associated to aniridia was made in both eyes of both twins. Physical examination and ultrasonography were carried out at 12 months of age to explore the possibility of WAGR-related anomalies, specifically Wilms tumour. DNA were isolated and subjected to whole exome sequencing., Results: Peters' anomaly associated to aniridia in both eyes as well as bilateral Wilms tumour in both children were diagnosed. Exome analyses showed a large heterozygous deletion encompassing 6 648 473 bp in chromosome 11p13, using Integrative Genomics Viewer and AnnotSV software., Conclusion: WAGR syndrome is a rare contiguous gene deletion syndrome with a greater risk of developing Wilms tumour associated with Peters' anomaly and congenital aniridia. However, co-occurrence of both anomalies was rarely reported in twins, and never in both eyes of monozygotic twins. Here, we report the bilateral association of Peters' anomaly and congenital aniridia in monozygotic twins with WAGR syndrome., (© 2024 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Implantation of glaucoma drainage devices is a valuable therapeutic option, particularly in children with glaucoma refractory to primary surgical treatment. Glaucoma drainage devices are typically used when conjunctival scarring hampers filtration surgery or prior angle procedures are not effective in controlling intraocular pressure. Despite known complications, the use of glaucoma drainage devices in children has increased in recent years, even as the primary surgical option. In this review, we evaluate the results of recent studies involving the implantation of glaucoma drainage devices in children, discussing new advances, and comparing the success rates and complications of different devices.

Introduction: Bilateral acute iris transillumination (BAIT) is a relatively new syndrome whose etiopathogenesis is still not fully understood. It is characterized by acute bilateral onset of intense pigment dispersion in the anterior chamber, iris depigmentation with severe transillumination defects, accentuated pigment deposition in the angle, and elevated intraocular pressure (IOP). In literature, the first case was of bilateral acute iris depigmentation (BADI) reported in 2004 in a 77-year-old woman. In 2019, Perone et al. published a review about BAIT syndrome. They reported a total of 79 cases have been published up that date, mainly in Europe and especially in Turkey and Belgium. The majority of reported cases were of bilateral acute iris depigmentation (BADI). BAIT syndrome might be mainly confused with acute iridocyclitis, acute primary angle-closure (APAC) and pigment dispersion syndrome (PDS). In relation to BAIT, controversies still exist regarding the etiology being the differential diagnosis of paramount importance for adequate treatment., Purpose: To report a case of BAIT syndrome associated to refractory glaucoma and to discuss the differential diagnosis based on clinical, OCT and UBM findings., Methods: We present a case of BAIT syndrome in which clinical, OCT and UBM findings have pointed out the similarities and, mainly the diagnosis differences with other ocular diseases., Conclusions: BAIT syndrome with accentuated IOP rise must be differentiated of other ocular diseases. It requires urgent clinical therapy and/or surgical management as occurred in the present case for avoiding structural damage in OCT and visual field loss. OCT and UBM are critical for early recognition, differential diagnosis and management., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Eyelid spasms might be associated with elevated intraocular pressure (IOP) in hemifacial spasm (HFS) patients. IOP assessment using a Goldmann applanation tonometer (GAT) is often compromised by eyelid spasms. This study aimed to assess the effect of HFS on IOP measurements using the transpalpebral tonometer Diaton® before and after treatment with botulinum toxin type A (BTX-A) and compared Diaton® and GAT measurements after treatment with BTX-A., Methods: IOP measurements were obtained with Diaton® in 27 patients with moderate-to-severe HFS before and after treatment with BTX-A. After treatment, the IOP was also measured using GAT and the results were compared with the ones measured with a Diaton®. The patients underwent automated perimetry, OCT, and pachymetry for screening to glaucoma., Results: Mean IOP with Diaton® was 11 ± 3.42 mmHg before treatment in the affected eye and 9 ± 2.98 mmHg in the contralateral eye. This difference was statistically significant (P = 0.012). However, after treatment with BTX-A, no interocular difference was found in IOP obtained with Diaton® (P = 0.204) or GAT (P = 0.971). Comparison between GAT and Diaton® measurements showed no significant differences after BTX-A treatment between the affected (P = 0.212) and contralateral eye (P = 0.971)., Conclusions: A significant reduction in IOP measurements on the affected side of HFS patients was observed after treatment with BTX-A, demonstrating that eyelid spasms may increase the IOP. No significant difference was observed between Diaton® and GAT measurements after the application of BTX-A. No differences were found in automated perimetry, OCT, and CCT when comparing affected eyes with contralateral eyes., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Traboulsi syndrome is a rare disease clinically characterized by facial dysmorphism, abnormal spontaneous filtering blebs, ectopia lentis (EL) and multiple anterior segment abnormalities., Material and Methods: An 18-year-old female was referred to the Emergency Service of Hospital São Geraldo (HSG) claiming decreased right eye (RE) visual acuity associated with ocular pain that was noticed approximately 2 months earlier. She underwent a complete ophthalmic and physical examination including hands, ankle, wrist and chest X-ray, abdominal ultrasound, echocardiogram and genetic analysis (whole-exome sequencing)., Results: The ophthalmic examination revealed a high myopia with spherical equivalent of - 9.50 D and best corrected visual acuity (BCVA) of 20/60 in RE and - 9.25 D with BCVA of 20/30 in the left eye (LE). Slit-lamp examination showed normal conjunctiva in both eyes (BE) and a superior-temporal cystic lesion in RE and nasal in LE; the flat anterior chamber in BE with the transparent crystalline lens touches the central corneal endothelium in the RE. Fundoscopy suggested glaucoma as the cup/disc ratio was 0.7, although the intraocular pressure (IOP) was 10 mmHg in BE without medication. Validation of data from whole exome demonstrated a novel splicing homozygous pathogenic variant (PV) (c.1765-1G>A) of the ASPH gene as well as a heterozygous variant of unknown significance (VUS) of the FBN1 gene (c.6832C>T)., Conclusion: We here report a novel splice-affecting homozygous pathogenic variant in the ASPH gene that was detected in a Brazilian patient with clinical features of Traboulsi syndrome.

Purpose: In patients with primary congenital glaucoma (PCG), elevated intraocular pressure (IOP) causes abnormal eye growth. This study compared the outcomes of children with PCG who underwent ab externo trabeculotomy (TROC) at age ≤ 6 months (early TROC) and of those who underwent TROC at age > 6 months (delayed TROC)., Methods: Intraocular pressure, horizontal corneal diameter (HCD), central corneal thickness (CCT) and axial length (AL) were compared before TROC and at 1-, 3-, 6- and 12-month follow-up visits between the groups of children who underwent TROC until or after 6 months of age. The ALs of these groups were also compared with the ALs of healthy age-matched eyes examined under the same conditions., Results: Trabeculotomy was performed in 43 children: 18 (33 eyes) aged 6 months (group 1) and 25 (37 eyes) aged >6 months (group 2); the mean ages were 86.56 ± 53.64 and 504.48 ± 448.14 days, respectively. The mean pre- and 12-month postoperative IOP values were 15.97 ± 4.78/16.62 ± 4.85 and 9.77 ± 2.88/10.93 ± 4.83 mmHg, respectively. Delayed TROC was associated with abnormal AL in 31 (88.6%) out of 37 eyes, while after early TROC, only 13 (41.9%) out of 33 eyes had abnormal AL (chi-square, 8.00; p = 0.03). In multivariable analysis, each 1-mmHg increase in preoperative IOP was associated with a 0.25-mmHg increase at 12 months (p = 0.04). On average, the mean IOP of the delayed TROC group was higher than that of the early TROC group by 3.72 mmHg at postoperative month 12 (95% CI = 0.44-6.99; p = 0.02)., Conclusion: Compared with delayed TROC, early TROC is associated with reduced IOP and substantially reduced incidence of abnormal AL at postoperative month 12., (© 2022 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

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, r s =0.879 ( P <0.01); cGAT-TPA, -1.02±2.08, r s =0.723 ( P <0.01); and nGAT-TPA, -2.35±2.23, r s =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., (International Journal of Ophthalmology Press.)

Purpose: To use machine learning to predict the risk of intraocular pressure peaks at 6 a.m. in primary open-angle glaucoma patients and suspects., Methods: This cross-sectional observational study included 98 eyes of 98 patients who underwent a 24-hour intraocular pressure curve (including the intraocular pressure measurements at 6 a.m.). The diurnal intraocular pressure curve was defined as a series of three measurements at 8 a.m., 9 a.m., and 11 a.m. from the 24-hour intraocular pressure curve. Two new variables were introduced: slope and concavity. The slope of the curve was calculated as the difference between intraocular pressure measurements at 9 a.m. and 8 a.m. and reflected the intraocular pressure change in the first hour. The concavity of the curve was calculated as the difference between the slopes at 9 a.m. and 8 a.m. and indicated if the curve was bent upward or downward. A classification tree was used to determine a multivariate algorithm from the measurements of the diurnal intraocular pressure curve to predict the risk of elevated intraocular pressure at 6 a.m., Results: Forty-nine (50%) eyes had intraocular pressure measurements at 6 a.m. >21 mmHg, and the median intraocular pressure peak in these eyes at 6 a.m. was 26 mmHg. The best predictors of intraocular pressure measurements >21 mmHg at 6 a.m. were the intraocular pressure measurements at 8 a.m. and concavity. The proposed model achieved a sensitivity of 100% and a specificity of 86%, resulting in an accuracy of 93%., Conclusions: The machine learning approach was able to predict the risk of intraocular pressure peaks at 6 a.m. with good accuracy. This new approach to the diurnal intraocular pressure curve may become a widely used tool in daily practice and the indication of a 24-hour intraocular pressure curve could be rationalized according to risk stratification.

Purpose: To analyze the relationship between retinal nerve fiber layer thickness (RNFLT) and intraocular pressure (IOP) variation in glaucoma suspects (GS) and patients with primary open-angle glaucoma (POAG)., Methods: Thirty-one GS and 34 POAG patients underwent ophthalmologic examination and 24-h IOP measurements. GS had IOPs ranging from 19 to 24 mmHg and/or suspicious appearance of the optic nerve. POAG patients had reproducible abnormal visual fields. We only included patients who presented with short-term IOP fluctuation >6 mm Hg (∆IOP). Only one eye per patient was included through a randomized process. Peripapillary RNFLT was assessed by spectral-domain optical coherence tomography. We correlated RNFLT with IOP parameters., Results: Mean IOP was similar between GS and POAG groups (15.6 ± 3.47 vs 15.6 ± 2.83 mmHg, p  = 0.90) as was IOP peak at 6 AM (21.7 ± 3.85 vs 21.3 ± 3.80 mmHg, p  = 0.68). Statistically significant negative correlations were found in POAG group between IOP at 6 AM and RNFLT in global ( r s  = -0.543; p  < 0.001), inferior ( r s  = -0.540; p  < 0.001), superior ( r s  = -0.405; p  = 0.009), and nasal quadrants ( r s  = -0.561; p  < 0.001). Negative correlations were also found between ∆IOP and RNFLT in global ( r s  = -0.591; p  < 0.001), and all other sectors ( p  < 0.05). In GS IOP at 6 AM correlated only with inferior quadrant ( r s  = -0.307; p  = 0.047)., Conclusion: IOP at 6 AM and ∆IOP had negative correlations with RNFLT quadrants in POAG. In GS this correlation occurred between IOP at 6 AM and inferior quadrant. These findings may indicate potential risk factors for glaucoma progression.

Prcis: Tono-Pen AVIA (TPA) intraocular pressure (IOP) values are different from those taken with handheld Goldmann applanation tonometer (GAT) in primary congenital glaucoma (PCG). These differences indicate both tonometers cannot be used interchangeably for measuring IOP in PCG., Purpose: The aim was to compare IOP measurements obtained using TPA and a handheld version of GAT in children with PCG., Materials and Methods: Forty-two eyes from 23 patients were evaluated for central corneal thickness (CCT), axial length, biomicroscopy and IOP measurement with TPA and a handheld GAT under inhalation anesthesia. After 1 eye from each patient was randomized, paired the Student t-test and the Pearson correlation were used for analysis. Generalized linear mixed model was used to estimate the difference between tonometers., Results: Mean age of children was 28.3±20.5 months. Mean axial length was 24.89±3.33 mm and mean CCT was 605.9±81.0 µm. Mean IOP was 22.1±9.6 for TPA and 14.0±4.5 mm Hg for GAT. There was a significant difference of 8.1±6.9 mm Hg between TPA IOP and GAT IOP (P<0.001). Each 6 months increase in age was associated with 1.32 mm Hg reduction in the difference between tonometers (P=0.002) and each 1 mm Hg higher of mean GAT IOP was associated with -0.73 mm Hg in the difference between TPA and GAT (P=0.002). Also, for every 20 µm increase in CCT an increase of 1.16 mm Hg in the difference between both devices was expected (P=0.003), after adjustment for potentially confounding variables., Conclusion: There is a significant difference between TPA IOP and GAT IOP in PCG. The difference between TPA and GAT in PCG is influenced by CCT, age and GAT IOP value., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

A benzamidine derivative from diminazene was tested for a novel activity: treatment of primary open-angle glaucoma. This drug was incorporated into mucoadhesive polymeric inserts prepared using chitosan (Chs) and chondroitin sulfate (CS). Of current interest is the mucoadhesion, which increases the contact time with the ocular surface, resulting in improved bioavailability; also, the inserts are made to act as a prolonged release system. In the present work the inserts were prepared by the solvent casting method using different polymeric proportions (30:70, 50:50, 75:25% w/w Chs:CS and 100% Chs). Thermal analysis and infrared spectroscopy both demonstrated physical dispersion of the active drug. The most promising was the 50:50% Chs:CS which demonstrated that it was not fragile and has an in vitro release profile of up to 180 minutes. In addition, it presented greater adhesion strength in relation to the other formulations. These physicochemical results corroborate the in vivo tests performed. In this sense, we also demonstrated that the treatment with the 50:50% insert can control the intraocular pressure (IOP) for at least 3 weeks and prevents damage to the retinal ganglion cells (RGCs) compared to the placebo insert. Thus, this indicates thus that the new drug is quite viable and promising in glaucoma treatment., (© 2020 Wiley Periodicals, Inc.)

Introduction: The most common treatment for Primary Open-Angle Glaucoma (POAG) is the daily use of eye drops. Sustained-release drug delivery systems have been developed to improve patient adherence by achieving prolonged therapeutic drug concentrations in ocular target tissues while limiting systemic exposure. The purpose of this study is to compare the efficacy and safety of bimatoprost inserts with bimatoprost eye drops in patients with POAG and Ocular Hypertension (OH)., Methods: We include OH and POAG patients aged between 40 and 75 years-old. Both OH and POAG patients had intraocular pressure (IOP) greater than 21 and ≤30 mmHg at 9:00 am without glaucoma medication and normal biomicroscopy. Five normal patients with IOP≤14 mmHg constitute the control group. A chitosan-based insert of bimatoprost was placed at the upper conjunctival fornix of the right eye. In the left eye, patients used one drop of LumiganTM daily at 10:00 pm. For statistical analysis, a two-way analysis of variance (ANOVA), Student t-test, and paired t-test is used., Results: Sixteen POAG and 13 OH patients with a mean age of 61 years were assessed. In both eyes, IOP reduction was similar during three weeks of follow-up (19.5±2.2 mmHg and 16.9±3.1 mmHg), insert, and eye drop, respectively; P=0.165). The percentage of IOP reduction in the third week was 30% for insert and 35% for eye drops (P=0.165). No intolerance or discomfort with the insert was reported. Among the research participants, 58% preferred the use of the insert while 25% preferred eye drops, and 17% reported no preference., Conclusion: Bimatoprost-loaded inserts showed similar efficacy to daily bimatoprost eye drops during three weeks of follow up, without major side effects. This might suggest a possible change in the daily therapeutic regimen for the treatment of POAG and OH., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The use of chitosan as a pharmaceutical excipient in the ocular field is already established. Nevertheless, some aspects related to its ocular administration, such as sterilization and excipient's pharmacokinetics, remain unclear. So, in this study, we evaluated those two relevant aspects, related to chitosan administration in eye. We used chitosan-based ocular inserts (CI) as formulation model. CI were produced by solvent/casting method and sterilized by saturated steam. Sterilization was confirmed by direct inoculation of inserts in suitable microbiological growth media. Physicochemical characterization of inserts before and after sterilization was performed. Results suggested that, although steam sterilization changed the arrangement of the matrix, the heat and the humidity did not modify the structure of the main polymeric chain. Pharmacokinetics of CI radiolabeled with technetium-99m ( 99m Tc) was assessed by scintigraphic images and ex vivo biodistribution study, after ocular administration in male Wistar rats. Scintigraphic and images analysis and ex vivo biodistribution study showed that the insert remained mainly in the eye until 6 hr after administration and its degradation products began to migrate to the abdominal cavity after 18 hr. Together, these data represent an important step forward the manufacturing and the clinical application of CI in the ophthalmic field., (© 2020 Wiley Periodicals, Inc.)

Purpose: To investigate the presence of the variants of lysyl oxygenase ( LOX ) and superoxide dismutase 1 ( SOD1 ) genes in Brazilian patients with advanced keratoconus., Methods: Donor genomic DNA extracted from blood samples was screened for 5'UTR, exonic LOX, and SOD1 variants in a subset of 26 patients presenting with advanced keratoconus (KISA > 1000% and I-S > 2.0) by Sanger sequencing. The impact of non-synonymous amino acid changes was evaluated by SIFT, PMUT, and PolyPhen algorithms. The Mutation Taster tool was used to evaluate the potential impact of formation of new donor and acceptor splice sites in the promoter region of affected volunteers carrying sequence variants. A 7-base SOD1 deletion (IVS2 + 50del7bp) previously associated with keratoconus was screened in 140 patients presenting classical keratoconus by gel fragment analysis, and positive samples were sequenced for confirmation., Results: We found an unreported missense variant in LOX exon 6 in one heterozygous patient, leading to substitution of proline with threonine at residue 392 (p. Thr392Pro) of LOX protein sequence. This mutation was predicted to be potentially damaging to LOX protein. Another LOX variant, Arg158Gln, was also detected in another patient but predicted to be non-pathogenic. Two additional new polymorphisms in LOX 5'UTR region (-116C > T and -58C > T) were found in two patients presenting with advanced keratoconus and were predicted to modulate or create donor/acceptor splice sites in LOX transcripts. Additionally, SOD1 deletion was detected in one patient presenting with severe keratoconus, not in control samples., Conclusion: We described three novel LOX polymorphisms identified for the first time in Brazilian patients with advanced keratoconus, as well as a previously described SOD1 deletion strongly associated with keratoconus. A possible role of these variants in modulating transcript levels in the cornea of affected individual requires further investigation., Competing Interests: There are no conflicts of interest., (Copyright © 2020 Gadelha et al.)

Eye drops containing hydrophilic drugs are commonly used to reduce intraocular pressure (IOP) in glaucoma patients, but compliance to the treatement is commonly reduced by frequent dosing and eventual systemic side effects. Sustained-release drug delivery systems, such as ocular inserts, can reduce dosing, limit systemic exposure, reduce side effects, and, then, improve patient adherence to therapy. Here, we developed and evaluated chitosan/hydroxyethyl cellulose-based ocular inserts for sustained release of dorzolamide, a hydrophilic drug. Dorzolamide inserts (DI) were produced by solvent/casting method and characterized by various physicochemical techniques. Pharmacokinetics studies were performed using scintigraphic images and ex vivo biodistribution. The effectiveness of inserts was tested in glaucomatous rats. Characterization studies showed that the drug strongly interacted with the polymeric matrix, but in vitro results showed that DI took only 3 h to release 75% of dorzolamide entraped. However, scintigraphic images and ex vivo biodistribution studies revealed that more than 50% of 99m Tc-dorzolamide remained in the eye after 18 h of DI administration, while only about 30% of the drug remained in the eye after drops instilation. DI exerted significant hypotensive effect for two weeks, after single administration, while IOP values remained high in placebo and untreated groups. Eye drops were effective only during the treatment period. Only DI treatment prevented retinal ganglion cells death. Altogether, these findings evidenced the potential application of polymeric-based inserts for sustained release of dorzolamide in glaucoma management., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: To assess the feasibility of a novel surgical technique in painful blind eyes., Design: A prospective safety study conducted at the Federal University of Minas Gerais, Brazil., Participants/samples: A total of 15 end-stage glaucomatous eyes without light perception vision., Methods: After implantation, conjunctival hyperemia, discharge, erosion, aqueous humor leakage, corneal edema, hyphema, anterior chamber cells and depth, dislocation of the implant, and filtering bleb height were assessed by slit-lamp biomicroscopy. Intraocular pressure was measured preoperatively and 24 months following surgery. A numerical rating scale was used to evaluate pain. Anterior segment optical coherence tomography was also assessed., Results: Laminar drainage implant surgery was performed in all patients without major complications. Mean intraocular pressure was significantly reduced after surgery without hypotensive medication (preoperatively 54.5 ± 5.1 mmHg vs 24 months after surgery 37.0 ± 15.4 mmHg, p = 0.003). Subjective ocular pain intensity also reduced (preoperatively 10 vs at 24-month follow-up visits 0). Corneal edema incidence reduced from 85.7% (95% confidence interval: 57.2%-98.2%) to 16.7% (95% confidence interval: 2.1%-48.4%) at the 24-month follow-up. No patients experienced a prolonged flat anterior chamber or erosion of overlying tissues., Conclusion: The surgery was feasible and safe in painful blind eyes.

This paper proposes a customized and versatile optical setup to evaluate the optical performance of different commercially available intraocular lenses (IOLs). The setup was used to measure the wavefront error induced by different IOL models, verifying and analyzing the magnitude of low- and high-order aberrations induced by currently available IOLs. Independent analyses included non-toric spherical and aspheric IOLs from three different manufacturers. Three different dioptric powers were tested: 15, 20, and 25 D from each model. Dioptric power, induced cylinder, and spherical aberration were measured in each tested lens. All lenses had dioptric power within the tolerated margin of error. Induced cylinder was also within the current standards and clinically irrelevant. Spherical aberration varied according to the analyzed dioptric power and to the IOL model. We reported on the importance of the plane where the spherical aberration is reported, IOL or cornea. All analyzed IOLs were within current standards for the dioptric power and induced cylinder. Spherical IOLs had higher spherical aberration measured at the IOL plane.

Objective: This study investigated the influence of early to moderate primary open angle glaucoma on gait, functional mobility and fall risk., Methods: Thirty-three participants in the early and moderate stages of primary open angle glaucoma and 34 asymptomatic controls participated in the study. Spatiotemporal gait data were obtained with the GAITRite system and included: velocity, cadence, step length, base of support, swing, stance and double support times. Functional measures included the Timed Up and Go test, the Five-Repetition Sit-To-Stand test and the Dynamic Gait Index. Fall risk was measured using the Physiological Profile Assessment., Results: The variables contrast sensitivity, proprioception and the Timed Up and Go and Dynamic Gait Index tests were significantly different between groups. In addition, the glaucoma group presented significantly higher risk of falling compared to the control group. Individuals in the early and moderate stages of primary open glaucoma presented mobility and sensory deficits that increase the risk of falling., Conclusions: The results of this study suggest that adding the Timed Up and Go and Dynamic Gait Index tests to routine physical therapy assessment of individuals with early glaucoma could be useful. Rehabilitation programs should focus on maintaining and/or improving mobility and balance, and prevention of falls in this population., (Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objective: to study the efficacy and safety of the use of subconjunctival triamcinolone acetate alone or in combination with mitomycin C as a modulator of trabeculectomy healing in rabbits., Methods: we submitted thirty male, albino, New Zealand rabbits to bilateral trabeculectomy. We divided the animals into four experimental groups with 15 eyes per group: control, mitomycin C, triamcinolone acetate and triamcinolone acetate + mitomycin C. We performed aplanation tonometry and clinical analysis of the bleb through the Moorfields Graduation System in the postoperative period. For the evaluation of healing, we carried out the quantitative analysis of the inflammatory infiltrate (polymorphonuclear) through Hematoxylin & Eosin staining, and vascular proliferation, through immunohistochemistry., Results: we observed a significant decrease in postoperative intraocular pressure in all groups compared with the preoperative pressure (p<0.001). However, there was no difference between groups (p=0.186). The triamcinolone + mitomycin C acetate group presented better indices as for the maximum bleb height and vascularization of the bleb central area (p=0.001); in addition, there was a lower inflammatory response (p=0.001) and lower vascular proliferation (p=0.001) in the intermediate phase of the study compared with the monotherapies., Conclusion: the combination of mitomycin C and triamcinolone acetate resulted in a synergistic action between these agents, with broader and more diffuse blebs, less inflammatory infiltrate and less vascular proliferation in the intermediate stages of follow-up in this animal model.

Importance: Visual field variability may impair detection of glaucoma progression over time. Despite the possible overlap between neurocognitive disorders and glaucoma in older individuals, no study has investigated the association between cognitive changes and visual field variability., Objective: To evaluate the association between global neurocognitive impairment and visual field variability in patients diagnosed as having glaucoma or glaucoma suspects., Design, Setting, and Participants: This prospective observational cohort study was conducted at the Visual Performance Laboratory, University of California, San Diego. The study involved 211 eyes of 115 patients followed up for a mean (SD) period of 2.5 (0.8) years, ranging from 1.2 to 4.7 years. Data were obtained during the period extending from March 2011 to April 2015, with data analysis conducted from November 2015 to May 2016., Main Outcomes and Measures: Association between cognitive decline and visual field variability. Patients were monitored with standard automated perimetry (SAP) and had longitudinal assessment of cognitive ability using the Montreal Cognitive Assessment (MoCA). Visual field variability was estimated by the SD of the residuals of ordinary least squares linear regressions of SAP mean deviation (MD) values over time. Linear regression models were used to investigate the association between cognitive decline and visual field variability, adjusting for potentially confounding factors., Results: Among the 115 patients, the mean (SD) age at baseline was 67.4 (10.1) years, 63 were men (54.8%), and 86 were white (74.8%). There was a statistically significant association between change in MoCA scores and visual field variability over time. In a univariable model, a 5-point decline in MoCA score was associated with an increase of 0.18 dB in the SD of residuals of SAP MD (R2 = 4.3%; 95% CI, 0.06-0.30; P = .003). In a multivariable model adjusting for baseline MoCA score, mean SAP MD, age, sex, race/ethnicity, educational level, income, and number of SAP tests, each 5-point decline in MoCA score was associated with an increase of 0.23 dB in the SD of residuals of SAP MD (95% CI, 0.11-0.35; P < .001)., Conclusions and Relevance: Cognitive decline was associated with increased visual field variability during follow-up. These findings suggest that screening and monitoring of cognitive dysfunction may be important in the assessment of visual field progression in the context of glaucoma.

Purpose: The relationship between clinical data and genetic ancestry in Brazilian patients with primary congenital glaucoma (PCG) was studied., Patients and Methods: Thirty patients with PCG and 60 unrelated controls underwent a complete ophthalmological examination. The PCG inclusion criterion was prior surgery with a minimum follow-up of 6 months after the last surgical procedure. Clinical data were recorded and DNA from each individual was extracted and genotyped for a panel of 40 validated ancestry-informative insertion-deletion DNA polymorphisms (indels)., Results: Eighteen (60%) children had bilateral disease and 16 (53.3%) were male. The mean age at diagnosis was 6.3 months and surgical follow-up time varied from 8 to 85 months. For the PCG group, the proportion of Europeans, Africans, and Amerindians was 0.784±0.044 (mean±SEM), 0.149±0.035, and 0.067±0.023, respectively, whereas for the control group was 0.730±0.048, 0.132±0.034, and 0.138±0.032, respectively. An increased proportion of African indels was associated with worse surgical prognosis (P=0.036). There was also a statistically significant (P<0.05) positive correlation between axial length and African component (initial: R=0.625; final: R=0.567)., Conclusions: An increased proportion of African indels was associated with worse prognosis for PCG in a mixed population. Genetic ancestry markers may be helpful in assessing risk factors for surgical outcomes in PCG. Further studies are needed to unveil the role of ancestry in heterogeneous populations such as Brazilians with PCG.

The aim of this study was to develop and evaluate the effects of chitosan inserts for sustained release of the angiotensin-converting enzyme 2 (ACE2) activator, diminazene aceturate (DIZE), in experimental glaucoma. Monolayer DIZE loaded inserts (D+I) were prepared and characterized through swelling, attenuated total reflectance Fourier transformed infrared spectroscopy (ATR-FTIR), differential scanning calorimetry (DSC) and in vitro drug release. Functionally, the effects of D+I were tested in glaucomatous rats. Glaucoma was induced by weekly injections of hyaluronic acid (HA) into the anterior chamber and intraocular pressure (IOP) measurements were performed. Retinal ganglion cells (RGC) and optic nerve head cupping were evaluated in histological sections. Biodistribution of the drug was accessed by scintigraphic images and ex vivo radiation counting. We found that DIZE increased the swelling index of the inserts. Also, it was molecularly dispersed and interspersed in the polymeric matrix as a freebase. DIZE did not lose its chemical integrity and activity when loaded in the inserts. The functional evaluation demonstrated that D+I decreased the IOP and maintained the IOP lowered for up to one month (last week: 11.0 ± 0.7 mmHg). This effect of D+I prevented the loss of RGC and degeneration of the optic nerve. No toxic effects in the eyes related to application of the inserts were observed. Moreover, biodistribution studies showed that D+I prolonged the retention of DIZE in the corneal site. We concluded that D+I provided sustained DIZE delivery in vivo, thereby evidencing the potential application of polymeric-based DIZE inserts for glaucoma management.

Purpose: To assess the effect of intraocular pressure (IOP) control on central corneal thickness (CCT), horizontal corneal diameter (HCD), and axial length (AL) in primary congenital glaucoma (PCG)., Methods: The medical records of children under 10 years of age surgically treated for PCG from 2003 to 2012 were retrospectively reviewed to identify patients with IOP of ≤12 mm Hg with a minimum of 6 months' follow-up. Pre- and post-treatment IOP, CCT, HCD, and AL values were correlated and compared with those of healthy age-matched controls., Results: A total of 131 controls and 20 patients (12 bilateral; 8 unilateral) were included. Mean follow-up was 32.4 months. In 24 eyes IOP was controlled by 1 trabeculotomy, with 6 eyes requiring antiglaucoma medication; in 5 eyes, by 2 trabeculotomies, without medication; and in 3 eyes, by 2 trabeculotomies plus 1 with mitomycin-C and 2 eyes requiring antiglaucomatous medication. The mean IOP was 15.69 ± 5.31 mm Hg preoperatively and 6.16 ± 2.42 mm Hg at final follow-up. Mean pre- and postoperative CCT values were, respectively, 614.38 ± 89.41 μm and 548.56 ± 63.12 μm; HCD, 13.45 ± 1.00 mm and 13.98 ± 1.01 mm, respectively; AL, 24.57 ± 2.71 mm and 25.37 ± 2.66 mm, respectively. All differences were statistically significant (P ≤ 0.002). In 40% of patients, post-treatment CCT values were comparable to those of controls; in 6.2%, HCD measurements; and in 26%, AL measurements. Pre- and post-treatment measurements were positively correlated (P ≤ 0.009)., Conclusions: Controlling IOP had a positive effect on the CCT, HCD, and AL in patients with congenital glaucoma., (Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the optic disc and retinal nerve fiber layer (RNFL) thickness in megalopapilla cases by confocal scanning laser ophthalmoscopy and Stratus optical coherence tomography (OCT). To assess the importance of these measurements in diagnosing megalopapilla., Methods: This study included 59 eyes (30 patients) diagnosed as megalopapilla. All subjects underwent a complete ophthalmic examination that included intraocular pressure and central corneal thickness measurements and standard automated perimetry using the Swedish Interactive Threshold Algorithm and the 24-2 program (Humphrey Field Analyzer; Carl Zeiss Meditec Inc., Dublin, CA). Confocal scanning laser ophthalmoscopy examinations were performed with the Heidelberg retina tomograph (HRTII; Heidelberg Engineering, Germany). Thickness of the RNFL around the optic disc was measured with Stratus OCT, version 4.0.1 (Stratus OCT; Carl Zeiss Meditec). A descriptive analysis was made using SPSS (version 12.0; SPSS Inc., Chicago, IL) statistical software., Results: The mean global optic disc area for all eyes with megalopapilla was 3.28±0.53 mm and was not statistically different among races (P≥0.159) or sex (P≥0.108). The average RNFL thickness was 102.5±12.68 μm. Pattern standard deviation was 3.8±2.4 and mean deviation was -1.22±2.65. Central corneal thickness mean value was 543±35.9 μm. Intraocular pressure (average from 3 measurements) ranged from 10.0 to 20.6 mm Hg (14.4±2.7)., Conclusions: In megalopapilla, the optic disc is abnormally large. The RNFL thickness is normal. These findings are essential for distinguishing megalopapilla from the optic glaucomatous neuropathy.

The purpose of the present study was to develop and assess a novel sustained-release drug delivery system of Bimatoprost (BIM). Chitosan polymeric inserts were prepared using the solvent casting method and characterized by swelling studies, infrared spectroscopy, differential scanning calorimetry, drug content, scanning electron microscopy and in vitro drug release. Biodistribution of 99mTc-BIM eye drops and 99mTc-BIM-loaded inserts, after ocular administration in Wistar rats, was accessed by ex vivo radiation counting. The inserts were evaluated for their therapeutic efficacy in glaucomatous Wistar rats. Glaucoma was induced by weekly intracameral injection of hyaluronic acid. BIM-loaded inserts (equivalent to 9.0 µg BIM) were administered once into conjunctival sac, after ocular hypertension confirmation. BIM eye drop was topically instilled in a second group of glaucomatous rats for 15 days days, while placebo inserts were administered once in a third group. An untreated glaucomatous group was used as control. Intraocular pressure (IOP) was monitored for four consecutive weeks after treatment began. At the end of the experiment, retinal ganglion cells and optic nerve head cupping were evaluated in the histological eye sections. Characterization results revealed that the drug physically interacted, but did not chemically react with the polymeric matrix. Inserts sustainedly released BIM in vitro during 8 hours. Biodistribution studies showed that the amount of 99mTc-BIM that remained in the eye was significantly lower after eye drop instillation than after chitosan insert implantation. BIM-loaded inserts lowered IOP for 4 weeks, after one application, while IOP values remained significantly high for the placebo and untreated groups. Eye drops were only effective during the daily treatment period. IOP results were reflected in RGC counting and optic nerve head cupping damage. BIM-loaded inserts provided sustained release of BIM and seem to be a promising system for glaucoma management.

Purpose: To evaluate the eye-tracking-based follow-up (EBF) function in the reproducibility of the peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained with Fourier-domain optical coherence tomography (Fd-OCT)., Methods: Thirty healthy subjects were imaged on an Fd-OCT device at the same visit by two examiners. Peripapillary circular scans in "high-speed" (HS) mode with the "automatic real time" (ART) set at 16 and in "high-resolution" (HR) mode with the ART off were obtained without and with the EBF function activated., Results: Mean (± SD) global RNFL thickness was 105.1 (± 9.5) μm on HS mode and 105.4 (± 9.6) μm on HR mode. Interobserver analysis for global RNFL thickness revealed an intraclass correlation coefficient (ICC) greater than or equal to 0.96 for all but the HR mode without the use of EBF function (ICC = 0.73). Intraobserver analysis for global RNFL thickness revealed an ICC greater than 0.98 for all but the HR mode without the use of EBF function (ICC = 0.86). The interobserver and intraobserver analyses revealed the lowest ICC values for the temporal region on both HS and HR modes. Higher ICC values were obtained with the HS mode and when the EBF function was activated, particularly when using the HR mode., Conclusions: The EBF function had no influence in the reproducibility of the global peripapillary RNFL thickness measurements in healthy subjects on HS mode with ART on. However, reproducibility of the global RNFL thickness measurements on HR mode as well as of the temporal and temporal superior regions in both HS and HR modes was greater with the EBF function.

Purpose: To assess the efficacy of needle revision using mitomycin C (MMC) for reviving failed filtering blebs during the late postoperative period and its safety for the corneal endothelium., Design: Prospective interventional case series., Participants: We recruited 125 eyes from 98 patients with uncontrolled glaucoma. All had at least 1 failed trabeculectomy, a flat filtering bleb, and a patent internal ostium on gonioscopy. The average time between the last trabeculectomy and needle revision was 5.3±5.3 years (range, 6 months to 30 years)., Intervention: Needling revision with a subconjunctival injection of 8 μg of MMC., Main Outcome Measures: Intraocular pressure (IOP) and number of hypotensive medications at latest visit, central corneal thickness (CCT), corneal endothelial cell density (ECD), coefficient of variation of cell size (CV), and hexagonality before and after needling., Results: We performed 186 needling procedures on 125 eyes (mean, 1.5±0.6 procedures/eye). Seventy-three eyes (58.4%) were needled once, 44 eyes (35.2%) were needled twice, 7 eyes (5.6%) were needled 3 times, and 1 eye (0.8%) was needled 4 times. We reestablished aqueous flow and obtained a raised bleb in 115 eyes (92%). After an average follow-up of 20.8±12.0 months, the mean IOP decreased from 20.1±5.2 mmHg preoperatively to 13.2±6.8 mmHg (P<0.001), and the mean number of hypotensive medications per eye decreased from 2.4±1.1 to 0.8±1.3 (P<0.001) at the latest visit. The overall success rate (IOP ≤16 mmHg) was 76% (58.4% without medication and 17.6% with hypotensive medications). Kaplan-Meier survival rates were 91.2% at the 1-month follow-up, 84.5% at 6 months, 81.0% at 1 year, 74.6% at 2 years, and 66.3% at 3 years. We studied the corneal endothelium in 42 eyes of 36 patients. There was no statistically significant difference between preoperative CCT, ECD, CV, or hexagonality and postoperative measurements at 1 week and 1, 3, 6, and 12 months., Conclusions: Needling revision with adjunctive MMC is effective for reviving flat filtering blebs and controlling IOP, even several years after the original trabeculectomy, and seems to be safe for the corneal endothelium., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare, clinically and biometrically, affected and fellow acute primary angle-closure (APAC) eyes and glaucomatous eyes with narrow angle (NA)., Methods: Comparative case series; 30 patients with APAC and 27 glaucomatous patients with NA were evaluated. Keratometry (K), central corneal thickness (CCT), lens thickness (LT), axial length (AL) and anterior chamber depth (ACD) were measured. Parameters defined as lens posisiton (LP) and relative lens position (RLP) were calculated., Results: Biometric difference between APAC-affected and fellow eyes was found only in LP (P=0.046). When fellow eyes were compared to glaucomatous eyes with NA, differences were found in ACD (P=0.009), AL (P=0.010), and LT/AL (P=0.005). The comparison between APAC-affected and glaucomatous eyes with NA showed significant differences in almost all biometric parameters, except for LT (P=0.148) and RLP (P=0.374). We found that the logistic regression model (LRM), built with three parameters (K, CCT and LT/AL), higher than 0.334 could be a reasonable instrument to differentiate APAC eyes from glaucomatous eyes with NA., Conclusions: This study showed that APAC-affected and fellow eyes have similar biometric features, and glaucomatous eyes with NA have a less crowded anterior segment. The LRM built showed promising results in distinguishing APAC from glaucomatous eyes with NA.

Purpose: To assess the importance of intraocular pressure measurement obtained at 6:00 a.m. in bed and darkness for the diagnosis and intraocular pressure control of primary open-angle glaucoma., Methods: Retrospective analysis of the daily curve of intraocular pressure of suspects and glaucomatous patients under treatment. Suspects were classified as intraocular pressure values ranging from 19 to 24 mmHg in isolated measurements and/or cup/disc ratio > 0.7 in one or both eyes and/or asymmetry of cup/disc ratio > 0.3 and a normal visual field. Each daily curve of intraocular pressure comprised five to seven IOP measurements with Goldmann applanation tonometer at 9:00 a.m., 12:00 p.m., 3:00 and/or 6:00 and 10:00 p.m. and/or 12:00 a.m. and in the following day morning at 6:00 a.m. in supine position in bed and in darkness with Perkins tonometer before the patient had stood up. Only the daily curves of intraocular pressure that presented an intraocular pressure peak (difference between the higher and the lesser intraocular pressure value) >6 mmHg were analyzed. In these daily curves, the average intraocular pressure and the standard deviation were calculated. The average intraocular pressure and standard deviation values were compared with the normal superior limits: average + two standard deviation of average intraocular pressure and standard deviation of intraocular pressure daily curve from normal patients of the same age group. Daily curves were considered abnormal when their average intraocular pressure and standard deviation values were above the normal superior limits. Secondary and congenital glaucoma were excluded., Results: Daily curves of intraocular pressure of 565 eyes were analyzed; 361 suspected eyes and 204 eyes with primary open-angle glaucoma. In suspects, 64.3% presented an intraocular pressure peak at 6:00 a.m. in bed. In primary open-angle glaucoma, 68.6% presented an intraocular pressure peak at 6:00 a.m. in bed. In 5.3% of the suspects and in 5.9% of primary open-angle glaucoma patients, the daily curve of intraocular pressure profile was inverted (lesser intraocular pressure at 6:00 a.m.)., Conclusion: Intraocular pressure peaks at 6:00 a.m. were responsible for the diagnosis of preperimetric glaucoma in 64.3% of suspects and revealed inadequate intraocular pressure control in 68.6% of eyes with primary open-angle glaucoma. The daily curve of intraocular pressure including the intraocular pressure measurement at 6:00 a.m. in bed and in darkness is of vital importance in doubtful cases in order to confirm the diagnosis of preperimetric glaucoma in suspects as well as for the adequate intraocular pressure evaluation of antiglaucomatous treatment.

Purpose: To investigate, through ultrasound biomicroscopy images, the presence of plateau iris configuration in eyes with narrow-angle from patients with open-angle glaucoma and in eyes with previous acute primary angle-closure and compare the biometric features of eyes with plateau iris configuration with those of normal eyes., Methods: Ultrasound biomicroscopic images from 196 patients with open-angle glaucoma and narrow-angle and 32 patients with acute primary angle-closure were retrospectively analyzed. The inclusion and specific criteria for the diagnosis of plateau iris configuration was the presence of an anterior positioning of the ciliary processes, supporting the peripheral iris so that it was parallel to the trabecular meshwork; the iris root had a steep rise from its insertion point, followed by a downward angulation from the corneoscleral wall; presence of a central flat iris plane; an absent (complete plateau iris configuration) or partially absent (incomplete plateau iris configuration) ciliary sulcus. The ultrasound biomicroscopic parameters were compared between complete and incomplete plateau iris configuration. The same parameters of both groups were compared with those of normal eyes. The following measurements were performed: anterior chamber depth; angle opening distance at 500 microm from the scleral spur; peripheral iris thickness at 500 microm from the scleral spur; iris-ciliary process distance; trabecular-ciliary process distance and angle recess area., Results: Plateau iris configuration was found in 33 eyes of 20 (10.2%) out of 196 patients with open-angle glaucoma and narrow-angle and in 4 eyes of 2 (6.3%) out of 32 patients with acute primary angleclosure. Seventeen (77.3%) patients with plateau iris configuration were female and 5 (22.7%) male. Twenty-three (62.2%) out of 37 eyes had complete plateau iris configuration, and 14 (37.8%) had incomplete plateau iris configuration. Complete and incomplete plateau iris configuration presented similar biometric features with the exception of the iris-ciliary process distance. All plateau iris configuration eyes showed biometric parameters completely different from those of normal eyes except for peripheral iris thickness at 500 microm from the scleral spur., Conclusions: Plateau iris configuration was present in 10.2% of patients with open-angle glaucoma and narrow-angle and in 6.3% of patients with acute primary angle-closure. Biometric features were similar in eyes with complete and incomplete plateau iris configuration with the exception of iris-ciliary process distance. Compared to normal eyes, all plateau iris configuration eyes showed biometric parameters completely different except for peripheral iris thickness at 500 microm from the scleral spur.

Purpose: To study the mechanisms of pupillary block in eyes with occludable angle by ultrasound biomicroscopy., Methods: Initially, a pilot study of 13 eyes with acute primary angle-closure without medication was executed. Ultrasound biomicroscopy measurements of the angle, posterior chamber depth and iris thickness were performed in the temporal quadrant under light and dark conditions. Afterwards, ultrasound biomicroscopy measurements of iris-lens contact distance and iris-lens angle in the temporal quadrant and central anterior chamber depth were made in 32 eyes with acute primary angle-closure or intermittent primary angle-closure without medication, under light and dark conditions before and after laser peripheral iridectomy., Results: In the pilot study, a significant decrease in the angle as well as a significant increase in the iris thickness occurred when comparing light to dark conditions. Before and after laser peripheral iridectomy (second study), significant differences were found in iris-lens contact distance (P<0.001) and iris-lens angle (P<0.001) under light and dark conditions. Also, significant differences were found in light and dark conditions, before laser peripheral iridectomy, in iris-lens angle (P=0.005), and after laser peripheral iridectomy, in iris-lens contact distance (P<0.001). No significant change occurred with anterior chamber depth., Conclusions: A decreased angle was correlated to an increase in iris thickness. After laser peripheral iridectomy, acute primary angle-closure or primary angle-closure eyes had an increased iris-lens contact distance and a decreased iris-lens angle. The anterior chamber depth did not change. These findings contradict the theory that pupillary block is the mechanism of acute primary angle-closure.

Purpose: To assess the intraocular pressure (IOP) and ocular rigidity (E) at 1, 3, 6 and 24 postoperative months in eyes that underwent LASIK., Methods: The IOP measured by Goldmann applanation tonometer (GAT) and by the 5.5 and 10 gm. weights of a standardized Schioetz tonometer (ST) and the E measured by differential tonometry (the 5.5 and 10 gm. of ST) were assessed before and after LASIK (at 1, 3, 6 and 24 month) in 23 eyes. The volume of the corneal indentation (Vc) and IOP with ST resting on the eye (tonometric pressure - Pt) were also evaluated., Results: The average IOP (GAT) at 6 and 24 months after LASIK was lower than at 1 and 3 months and before LASIK. A statistically significant difference of E was found at 1, 3, 6 and 24 months. The reduction of the central corneal thickness (CCT) by LASIK was the cause of increasing values of Vc and decreased values of Pt. In turn, the changes in Vc and Pt were responsible for the lower IOP measurements by GAT and E changes., Conclusions: LASIK reduces IOP readings by GAT but not the ones by ST (differential tonometry). LASIK also diminishes E. IOP (GAT) values are lower at 6 and 24 months. IOP evaluation by ST is more accurate than that by GAT. At 6 months, Vc, Pt and E parameters are stabilized (no changes relatively to 24 months measurements.

Purpose: To investigate biometrically the differences between plateau iris configuration (PIC) eyes and primary open angle glaucoma with narrow angle eyes., Methods: A comparative study involving a case series with 20 eyes of 11 plateau iris configuration patients and 45 eyes of 27 primary open angle glaucoma with narrow angle eyes patients was done. The following measurements were taken: corneal curvature, central corneal thickness, anterior chamber depth, lens thickness (LT), axial length (AL), lens thickness and axial length ratio, lens position (LP) and relative lens position (RLP)., Results: The plateau iris configuration eyes presented a higher corneal cuvature value than primary open angle glaucoma with narrow angle eyes eyes but not with clinical and statistical difference (P=0.090). The plateau iris configuration eyes demonstrated a higher central corneal thickness, with statistical significance, when compared to primary open angle glaucoma with narrow angle eyes (P=0.010). Statistical significant difference between plateau iris configuration and primary open angle glaucoma with narrow angle eyes was found in axial length (21.69 +/- 0.98 vs. 22.42 +/- 0.89; P=0.003). No significant difference was found when anterior chamber depth (2.62 +/- 0.23 vs. 2.71 +/- 0.31; P=0.078), LT (4.67 +/- 0.36 vs. 4.69 +/- 0.45; P=0.975), LT/AL (2.16 +/- 0.17 vs. 2.10 +/- 0.21; P=0.569), LP (4.95 +/- 0.25 vs. 5.06 +/- 0.34; P=0.164) and RLP (0.23 +/- 0.01 vs. 0.22 +/- 0.14; P=0.348) were evaluated., Conclusion: The eyes with plateau iris configuration presented statistical significantly shorter axial length and higher central corneal thickness than primary open angle glaucoma with narrow angle eyes.

Purpose: To assess the prognosis of different types of glaucoma in relation to unilateral and bilateral blindness at a University Hospital., Methods: Charts of glaucomatous patients which presented complete data of clinical history, visual acuity, visual field, fundus examination and diagnosis were retrospectively analyzed. The patients were classified as: not blind, legally blind (best corrected visual acuity <20/200 and/or visual field <20 masculine), or totally blind (no light perception) in one or both eyes. Patients with blindness due to congenital glaucoma and other no glaucomatous causes, and incomplete charts were excluded., Results: 3,786 (76.3%) of 4,963 charts fulfilled the criteria. In 3,786 glaucomatous patients, 1,939 (51.2%) were not blind and 1,847 (48.8%) were blind. 1,359 patients (73.6%) were legally blind and 488 (26.4%) totally blind, 1,333 (72.2%) had unilateral blindness and 514 (27.8%), bilateral blindness. 1,564 patients (84.7%) were already blind (74.9% with legal blindness and 25.1% with total blindness) when they arrived at the Service and 283 (15.3%) became blind after their inclusion in the Service. Neovascular glaucoma presented the highest proportion (95.6%) of blindness. Postsurgical glaucoma was second causing blindness in 72.7% and thirdly, primary angle-closure glaucoma with 67.4%. Primary open-angle glaucoma presented the lowest proportion (40.5%) of blindness., Conclusions: Neovascular glaucoma had the worst prognosis with the highest proportion of blindness. Primary angle-closure glaucoma caused blindness roughly 1.7 times more than primary open-angle glaucoma. Primary open-angle glaucoma presented the best prognosis. The proportion of patients that became blind after their inclusion in the Service was relatively low in relation to the proportion of patients who were blind when they arrived at the Service.

Purpose: To assess the efficacy of latanoprost (L) and travoprost (T) as monotherapy as well as both drugs associated with 0.5% timolol maleate twice a day regarding the daily curve of intraocular pressure (DCPo) with the measurement of intraocular pressure (IOP) at 6 am in bed., Methods: Retrospective study analyzing the daily curve of intraocular pressure of patients treated with L or T with or without 0.5% Tim. Patients who did not correctly follow the treatment were excluded. We also excluded the patients who used the prostaglandin analog associated with any other antiglaucomatous drug different from 0.5% Tim and those who were treated with more than two antiglaucomatous drugs. Statistical analysis was made through the SPSS 11.0 program calculating mean intraocular pressure (Pm), variability (V), p value and standard deviation. Ethnic aspects or type of glaucoma were no criteria of inclusion or exclusion in this study., Results: Seventy-five patients (142 eyes) were included. The average age was 61.7 years. Thirty-three (44.0%) patients were male and 42 (56.0%) were female. Thirteen patients (26 eyes 18.3%) used L, 18 patients (33 eyes - 23.2%) were treated with T, 18 patients (32 eyes - 22.5%) used latanoprost and 0.5% timolol (L 0.5%Tim) and 26 patients (51 eyes - 35.9%) used travoprost and 0.5% timolol (T 0.5%Tim). Chronic simple glaucoma was the most common type (92.0%), followed by congenital glaucoma (6.7%) and glaucoma secondary to cataract surgery (1.3%). Pm was 15.2 (+/- 4.2) mmHg among those treated with L and 14.8 (+/- 3.2) mmHg among the T users. Those patients showed a V of 2.0 (+/- 1.2) and 3.2 (+/- 1.9). In the group of L 0.5%Tim and T 0.5%Tim the Pm and V were 14.9 (+/- 2.2) mmHg, 15.0 (+/- 3.2) mmHg, 2.4 (+/- 1.2) and 2.8 (+/- 1.6) respectively. No statistical significant difference was found in the Pm neither with the drugs used as monotherapy nor with them associated with 0.5% timolol maleate as well as in the V with both drugs associated with 0.5% timolol maleate. However, V showed a significant statistically difference when we considered the drugs in monotherapy, the IOP fluctuation being lower with L (t= -2.9; p=0.005)., Conclusion: In the daily curve of intraocular pressure performed with the measurement of intraocular pressure at 6 am in bed, L and T associated with 0.5% timolol maleate had a similar efficacy; however, in monotherapy, Pm was similar in both drugs but the V obtained with L was lower the difference being statistically significant.

Purpose: To compare morphometric features between fellow acute primary angle-closure (APAC) eyes and glaucomatous or suspect eyes with narrow angle (NA)., Methods: Fellow eyes of 30 patients with unilateral APAC and 30 with NA were evaluated by ultrasound biomicroscopy (UBM) under light and dark conditions. UBM parameters such as anterior chamber depth (ACD), angle opening distance at 250 microm/500 microm from the scleral spur (AOD250/AOD500), trabecular ciliary process distance (TCPD) and iris-lens contact distance (ILCD) were measured in the superior (SQ) and inferior (IQ) quadrants., Results: Significant differences between APAC fellow and NA eyes were found in ACD, P<0.001; AOD250 at SQ and IQ, P<0.001; AOD500 at SQ and IQ, P<0.001; TCPD light, P=0.010 and TCPD dark at SQ, P=0.031; and TCPD light at IQ, P=0.010. Significant differences between light and dark examinations of APAC fellow eyes were found in ILCD (P=0.009) at SQ and ILCD at IQ (P=0.006), and of NA eyes in ILCD at SQ (P=0.047) and ILCD at IQ (P<0.001)., Conclusions: APAC fellow eyes have a more crowded anterior segment and shallower ACD than NA eyes. ILCD decreases in both groups when the illumination conditions change from light to dark.

The term plateau iris was first coined in 1958 to describe the iris configuration of a patient. Two years later the concept of plateau iris was published. In 1977, the plateau iris configuration was classically defined as presurgical changes of an eye with a relative normal central anterior chamber depth, flat iris by conventional biomicroscopy, but displaying an extremely narrow or closed angle on gonioscopic examination. On the other hand, the plateau iris syndrome was defined as an acute glaucoma crisis in one eye with a relative normal central anterior chamber depth and patent iridotomy on direct examination, presenting angle closure confirmed by gonioscopic examination after mydriasis. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy. Finally, plateau iris has been considered an anatomic variant of iris structure in which the iris periphery angulates sharply forward from its insertion point and then again angulates sharply and centrally backward, along with an anterior positioning of the ciliary processes seen on ultrasound biomicroscopy. The clinical treatment of plateau iris syndrome is carried out with topical use of pilocarpine. However, the definitive treatment should be fulfilled by performing an argon laser peripheral iridoplasty.

Purpose: To determine the incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital, to establish the profile of these patients and to identify the possible risk factors., Methods: Transversal study. Period of assessment: from September/2005 to August/2006., Inclusion Criteria: diagnosis of primary angle-closure glaucoma., Exclusion Criteria: presence of cataracts that cause low visual acuity or index-myopia, secondary glaucoma, plateau iris. Number of visits, incidence of primary angle-closure glaucoma, age, gender, race, family history of glaucoma, keratometric, and biometric data were assessed., Results: Of 879 attended patients, 20 (2.3%) had the diagnosis of primary angle-closure glaucoma, therefore, the incidence of the primary angle-closure glaucoma was 22.7 cases per 1000 attended. Of those patients with primary angle-closure glaucoma: 6 (30.0%) were men and 14 (70.0%) women; the age varied from 40 to 73 years (average: 60.4 +/- 8.1 years); 12 (60.0%) were leukodermics and 8 (40.0%) pheodermics; 5 (25.0%) with positive familiar history of glaucoma. The relative risk for women was 1.44 (95% IC). Eleven (55.0%) patients had primary angle-closure glaucoma of the right eye and 9 (45.0%) of the left. When biometric data and keratometry were compared between the affected and contralateral eye, no statistical significant difference was observed., Conclusions: The incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital was 22.7 cases per 1000 attended. It was more frequent in leukodermic women, without family history of glaucoma and with an average age of 60.4 years. The affected and contralateral eyes were biometrically similar.

Purpose: To establish the profile of patients with acute primary angle-closure glaucoma (APACG) and to assess comparatively clinical and morphometric parameters between eyes with APACG and contralateral eyes (CLEs)., Methods: Prospective study including patients attended from September 2005 to March 2007., Inclusion Criteria: diagnosis of APACG., Exclusion Criteria: presence of cataract (except for "glaukomflecken") that may cause low visual acuity or myopization, secondary glaucoma, previous APAGC or surgical procedure in the (CLE), no possibility to control the acute crisis of glaucoma clinically, plateau iris. The following were evaluated: incidence of APACG, age, gender, race, family history of glaucoma, corrected visual acuity (CVA) and uncorrected visual acuity (UVA), spherical equivalent (SE), cup/disc ratio (C/D), gonioscopy, keratometry (K), central corneal thickness (CCT), and echobiometric data [anterior central chamber depth (ACCD), axial length (AL), lens thickness (LT)] and relation between lens thickness and axial length (LT/AL)., Results: One thousand and three hundred and forty-three patients were examined from September 2005 to March 2006; 28 (2.1%) had the diagnosis of APACG. The incidence of the APACG was 20.8 cases per 1000 patients. The patients with APACG were manly white women with a negative familial history of glaucoma and with an average age of 59.6 years. When clinical aspects were compared between eyes with APACG and CLEs, statistical significance was observed: UVA (APACG: 0.27 +/- 0.32; CLE: 0.57 +/- 0.33, p=0.000); CVA (APACG: 0.53 +/- 0.44; CLE: 0.88 +/- 0.23, p=0.000); SE (APACG: +0.49 +/- 1.98; CLE: +1.21 +/- 2.03, p=0.007); C/D (APACG: 0.51 +/- 0.28; CLE: 0.42 +/- 0.20; p=0.031). Also, by gonioscopy, eyes with APACG demonstrated more frequently angle closure than CLEs. The eye of the crisis showed the following characteristics: average K of 45.21 +/- 1.96 D, average CCT of 534.46 +/- 34.15 mm, average ACCD of 2.43 +/- 0.28 mm, average AL of 21.68 +/- 0.96 mm, average LT 4.85 +/- 0.32 mm and average LT/AL of 2.24 +/- 0.16. The CLE presented average K of 44.92 +/- 1.86 D, average CCT of 533.18 +/- 31.41 microm, average ACCD of 2.51 +/- 0.29 mm, average AL of 21.82 +/- 0.92 mm, average LT 4.85 +/- 0.36 mm and average LT/AL of 2.23 +/- 0.18. There were statistically significant differences only in two parameters (K and ACCD) when affected and the CLE were compared., Conclusions: The incidence of the APACG was 20.8/1000. It was more frequent in white women, leu kodermics, without family history of glaucoma and with an age average of 59.6 years. The eyes with APACG showed, with statistical significance, worse visual acuity, higher C/D, lower hypermetropic SE, higher average K, and lower ACCD than CLEs.

Purpose: To compare the cardiovascular and mydriatic effects of 2.5% and 10.0% phenylephrine., Methods: A case-control, randomized, crossover clinical trial study. We monitored heart rate (HR), blood pressure (BP) and mydriasis in healthy volunteers aged 18-45 years after the instillation of 2.5% and 10.0% phenylephrine in two different occasions., Results: The sample comprised 28 healthy volunteers, 17 male and 11 female, with a mean age of 26.5 years. No changes in heart rate and systolic blood pressure were observed. No significant variation of the mean diastolic blood pressure was found after 1, 5, 10 and 30- minute instillation of 2.5% phenylephrine. However, with 10.0% phenylephrine, there was an increase in mean diastolic blood pressure after five and ten minutes, followed by a drop after 30 minutes, which was not statistically significant. Mydriasis was more marked in both eyes with a statistically significant difference after instillation of 10.0% phenylephrine., Conclusions: The mydriatic effect was greater with 10.0% phenylephrine than with 2.5% phenylephrine and the difference was statistically significant. No statistically significant difference was found in relation to cardiovascular effects in both phenylephrine concentrations.

Purpose: To determine the presence of symmetry of anterior segment morphometric measurements between normal adelphic eyes., Methods: One hundred and seventy-eight eyes of 89 subjects with normal ophthalmic examination were examined by ultrasound biomicroscopy (UBM). In each eye, the anterior chamber depth (ACD) as well as 11 other measurements that characterize anterior segment morphometry were measured in 4 different quadrants (superior, nasal, inferior and temporal). The presence of symmetry between right and left eye for each of these variables was then compared for each meridian., Results: No significant statistical differences were observed concerning anterior segment morphometry between right and left eyes for most measured parameters. Only two variables, in two different meridians, presented statistical significant differences between right and left eyes. The difference, however, was inferior to 0.025 mm, which is beyond the precision of UBM and therefore was not considered to be clinically significant. Pearson correlation analysis demonstrated the presence of a statistical significant correlation, with a moderate intensity for the majority of the variables except ACD, whose correlation was excellent., Conclusion: This study demonstrated that symmetry of morphometric measurements between right and left eyes is expected to occur, provided these eyes have similar refractive errors and biometric measurements.

Purpose: To determine the values in decibels of retinal sensitivity within the central 26 degrees of the visual field of normal subjects divided into homogenous age groups using the Octopus 1-2-3; to compare the values of retinal sensitivity we have found with those considered normal in the statistical package obtained by a multicenter study performed in 1994 with Octopus 201., Methods: 181 subjects divided into 6 homogeneous age groups (10 to 19 yr; 20 to 29 yr; 30 to 39 yr; 40 to 49 yr; 50 to 59 yr and 60 year-old or older) were evaluated. Data on visual sensitivity and age, average sensitivity of central and paracentral regions and eccentricity were calculated., Results: The average visual sensitivity of all groups was 26.77 +/- 1.74 dB. Correlation between visual sensitivity and age evaluated by linear regression was 28.4 - 0.040 x (age) for the whole sample and 28.7 - 0.050 x (age) for subjects aged 20 or more. Sensitivity reduction by eccentricity was -0.30 dB/degree for the whole sample and for subjects aged 20 or more., Conclusions: Correlation between retinal sensitivity values and age based on the autoperimeter Octopus 201 (average sensitivity of 31.2 - 0.064 x age) is different from that found in this study: average sensitivity of 28.4 - 0.040 x (age) for the whole sample; 28.7 - 0.050 x (age) for subjects aged 20 or more. Values obtained with the Octopus 1-2-3 autoperimeter cannot be compared with those by other Octopus models (101, 201 and 500) due to their distinct features.

Purpose: To present the prevalence of iridociliary cysts in eyes of patients submitted to UBM examination., Methods: We analyzed retrospectively the UBM images of 1157 patients in the period from September 1995 to June 2004. The inclusion criterion was the UBM examination had been made on the four quadrants (superior, inferior, nasal and temporal) of the eyes. The cysts were assessed and classified in relation to their number in each quadrant; localization and morphology. Using the UBM Pro 2000 software we took the measurements of the largest diameter, wall thickness and area of the cysts besides the angle recession area (ARA)., Results: The prevalence of the cysts was 4.9%. No statistical difference was found between the prevalence of cysts regarding gender or between the right and left eyes. They were more prevalent in the inferior (39.8%) and temporal (29.1%) quadrants. The cysts with the largest diameter and area were located in the temporal and superior quadrants. No difference was found in relation to cysts' wall thickness in all quadrants., Conclusions: No statistical difference was found between the prevalence of cysts as concerns gender or between the right and left eyes. However, the cysts were more prevalent in the inferior and temporal quadrants. The locations of the largest cysts are preferentially the temporal and superior quadrants. The angle recession area was smaller in the temporal and superior quadrants. The cysts' wall thickness is practically the same in all quadrants. The diagnosis of iridociliary cysts was an occasional finding in 64.3% of the patients.

Purpose: To assess the influence of central and peripheral corneal thickness on the IOP measurement by Tonopen., Methods: The IOP of 58 eyes from suspected and glaucomatous patients was evaluated by Goldmann's tonometry (GT) and, by Tonopen XL on the central (TC) and peripheral (TP) regions of the cornea. Using the DGH 5100e pachymeter, we also measured the corneal thickness in its central (CCT) and peripheral (at 6:00 h) regions (PCT). Patients with any corneal changes were excluded. The mean values of all measurements was comparatively analyzed (GT x TC; GT x TP; TC x TP; CCT x PCT) by the paired t test and by regression and correlation analysis., Results: The means (+/- standard deviation) of IOP obtained with GT, TC and TP were respectively 14.6 (+/-) mmHg; 18.9 (+/-2.9) mmHg and 20.7 (+/-3.7) mmHg with a statistical highly significant difference (p<0.001). The means (+/- standard deviation) of central and peripheral corneal thickness were respectively 526 (+/-42.3) and 639 (+/-52.9) microm, also with a statistical highly significant difference (p<0.001). The correlation coefficients (r) between the measurements were 0.71 (p<0.001) for GT and TC; 0.65 (p<0.001) for GT and TP and 0.64 (p<0.001) for TC and TP., Conclusions: There was a positive correlation between the measurements performed with Tonopen XL and Goldmann's tonometer at the central region of the cornea and the mean IOP was higher with Tonopen XL. The mean IOP obtained by TP was higher than that obtained by TC. These data showed that Tonopen XL, besides providing higher IOP readings than those with Goldmann's tonometer, is influenced by the corneal thickness presenting higher IOP readings in the periphery than in the central region of the cornea.

Purpose: To systematically study the anterior segment morphometric measurements by ultrasound biomicroscopy (UBM) in a large population of normal eyes, to evaluate their intra-observer reproducibility. Two new measurements are proposed and also tested concerning their intra-observer reproducibility., Methods: One hundred ninety eyes of 101 patients with normal ophthalmic examination were studied by UBM. Anterior chamber depth (ACD) along with 11 different morphometric parameters that characterize the anterior segment morphometry were measured in the superior, nasal, inferior and temporal meridians. All measurements were performed twice with a minimum interval of four weeks between them., Results: There were no statistical significant differences between the first (M1) and second (M2) measurements and regarding each studied parameter except for 2 variables in 2 meridians in the right eyes (OD) and 2 variables of one meridian in the left eyes (OS). Even in these cases, the largest difference between M1 and M2 was less than 0.006 mm, which was not clinically significant. The new tested parameters also presented a good intra-observer reproducibility., Conclusion: This study confirmed the good intra-observer reproducibility of the variables that characterize anterior segment morphometry by UBM.