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Shajiei TD, Iadanza S, Bachmann LM, Kniestedt C. Inventory of Ocular Pulse Amplitude Values in Healthy Subjects and Patients With Ophthalmologic Illnesses: Systematic Review and Meta-analysis. Am J Ophthalmol 2024; 259:151-165. [PMID: 37898282 DOI: 10.1016/j.ajo.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Many studies have examined the ocular pulse amplitude (OPA) to better understand its physiology and clinical relevance, but the papers are scattered, not consistently indexed, and sometimes difficult to locate. We aimed to identify and summarize the relevant published evidence on OPA and, in a meta-analysis, outline specific differences of this parameter between healthy individual, primary open-angle glaucoma, normal-tension glaucoma, ocular hypertension, and cataract patients. DESIGN Systematic review and meta-analysis. METHODS A thorough literature search and data extraction were conducted by 2 reviewers independently. Reports on OPA measured by the dynamic contour tonometry in conjunction with different ocular and systemic diseases or potential influencing factors were included. RESULTS Of the 527 initially found reports, 97 met the inclusion criteria assessing 31 clinical conditions. A meta-analysis based on 6850 eyes and 106 study arms (68.8%) revealed differences in mean OPA values in millimeters of mercury between various entities. Among healthy eyes, the OPA was 2.58 mm Hg (95% CI: 2.45-2.71), whereas OPA values were higher in glaucoma (unspecified glaucoma 2.73 mm Hg, 95% CI: 2.38-3.08; normal-tension glaucoma 2.66 mm Hg, 95% CI: 2.36-2.97; and primary open-angle glaucoma 2.92 mm Hg, 95% CI: 2.75-3.08). Although ocular hypertension showed the highest OPA values (3.53 mm Hg, 95% CI: 3.05-4.01), the lowest values were found in cataract eyes (2.26 mm Hg, 95% CI: 1.57-2.94). CONCLUSION We found different OPA values characteristic of different clinical entities, with above-normal values in glaucoma and ocular hypertension and lower values in cataract patients. Our work is intended for clinicians and researchers who want to get a quick overview of the available evidence or who need statistical data on OPA distributions in individual diseases.
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Affiliation(s)
- Tania D Shajiei
- From the Talacker Augen Zentrum Zürich (TAZZ), Department of Ophthalmology, University Hospital Zurich (T.D.S.), Zurich, Switzerland
| | - Sandro Iadanza
- Talacker Augen Zentrum Zürich (S.I., C.K.), Zurich, Switzerland
| | - Lucas M Bachmann
- Medignition Inc, Research Consultants (L.M.B.), Zurich, Switzerland.
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[Intraocular pressure elevation after vitrectomy-Goldmann applanation tonometry measures lower intraocular pressure than dynamic contour tonometry]. Ophthalmologe 2021; 119:71-76. [PMID: 34228205 PMCID: PMC8763771 DOI: 10.1007/s00347-021-01443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/13/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
Hintergrund Das dynamische Konturtonometer PASCAL (DCT) ist ein digitales, der natürlichen Hornhautgeometrie angepasstes Kontakttonometer. Verglichen wurde das DCT mit dem Goldmann-Applanationstonometer (GAT). Methodik In einer prospektiven Querschnittstudie wurden 100 Augen vor und nach Pars-plana-Vitrektomie (ppV) vergleichend mit dem GAT und DCT gemessen. Verwendete Endotamponaden waren verschiedene Gase und Silikonöle. Erfasst wurden der präoperative intraokulare Druck (IOD), postoperative Druckveränderungen und die Intertonometerdifferenz. Ergebnisse Präoperativ lag der mittlere IOD mit dem GAT gemessen bei 15,8 ± 5,2 mm Hg und dem DCT bei 17,5 ± 5,9 mm Hg. Am ersten postoperativen Tag stieg bei Augen, die mit Gas versorgt wurden, der Druck im Mittel um 2,5 mm Hg (p = 0,035) an. Das DCT erfasste 18 Augen (19,1 %) mit einem postoperativen IOD von ≥ 25 mm Hg. Postoperativ maß das GAT den IOD im Schnitt 2,5 mm Hg niedriger und bei expansiver Gasendotamponade im Mittel um 3,0 mm Hg niedriger als das DCT. Bei IOD-Werten von postoperativ über 20 mm Hg lag das GAT im Mittel 4,7 mm Hg unter dem DCT. Zehn von 18 Augen mit IOD ≥ 25 mm Hg wurden mit dem GAT nicht als hypertensiv (≥ 25 mm Hg) erkannt. Bei 13 % maß das DCT am 1. postoperativen Tag einen um mindestens 6 mm Hg höheren IOD als das GAT. In einem Extremfall wurde der IOD mit dem GAT bei Gasendotamponade um 12 mm Hg unterschätzt. Schlussfolgerung Postoperative Druckanstiege nach ppV sind gefürchtete Komplikationen und können zu irreversiblem Visusverlust führen. Abhängig von der verwendeten Endotamponade misst das GAT den IOD niedriger als das DCT – besonders bei Druckspitzen durch expansive Gase. Die postoperative IOD-Messung nach ppV ist bedeutend und die Messwerte von GAT und DCT können abweichen.
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Firat PG, Orman G, Doganay S, Demirel S. Influence of corneal parameters in keratoconus on IOP readings obtained with different tonometers. Clin Exp Optom 2021; 96:233-7. [DOI: 10.1111/cxo.12016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 08/23/2012] [Accepted: 09/15/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Penpe Gul Firat
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey,
| | - Gozde Orman
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey,
| | - Selim Doganay
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey,
| | - Soner Demirel
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey,
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Tonometers-which one should I use? Eye (Lond) 2018; 32:931-937. [PMID: 29456251 DOI: 10.1038/s41433-018-0040-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/08/2022] Open
Abstract
Although several factors are known to play a role in the development and progression of glaucoma, intraocular pressure (IOP) remains the only modifiable risk factor. Medical and surgical treatments for glaucoma both aim to reduce IOP to minimize disease progression. Tonometry is therefore an essential element of the ophthalmological exam. There are several types of tonometers available currently. These range from well-established instruments that have been in clinical use for decades to new devices, which are the result of recent technological advances. The various instruments have advantages and disadvantages that affect their suitability for a given setting, purpose, and patient population. In this review, we aim to describe the most commonly available tonometers today along with their advantages, disadvantages, and applicability.
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Özcura F, Yıldırım N, Tambova E, Şahin A. Evaluation of Goldmann applanation tonometry, rebound tonometry and dynamic contour tonometry in keratoconus. JOURNAL OF OPTOMETRY 2017; 10:117-122. [PMID: 27402573 PMCID: PMC5383454 DOI: 10.1016/j.optom.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/28/2016] [Accepted: 04/13/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare the intraocular pressure (IOP) measurements obtained with the rebound tonometry (RT), dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in keratoconic corneas and to investigate the effects of central corneal thickness (CCT) and corneal radius of curvature (CR) on IOP measurements. METHODS Sixty-three eyes of 63 keratoconus patients were enrolled in this cross-sectional study. IOP was measured on each subject always in the same order, ICare RT-Pascal DCT-GAT, after a minimum interval of 10min between measurements. CCT and CR were measured using a rotating Scheimpflug camera before the IOP measurements in all subjects. One way repeated measures ANOVA and Pearson correlation coefficient analysis was used for the statistical assessment. RESULTS Mean IOP for all enrolled eyes was 11.72±2.59mmHg for GAT, 9.34±3.29mmHg for RT, and 15.42±3.31mmHg for DCT. There were statistically significant differences among the three tonometers; GAT and RT (P<0.001), GAT and DCT (P<0.001), and RT and DCT (P<0.001). GAT and RT were significantly positively correlated with CCT (r=0.288, P=0.025 and r=0.483, P<0.001, respectively). RT was also significantly positively correlated with CR (r=0.550, P<0.001). DCT was not significantly correlated with CCT (r=0.115, P=0.377) nor CR (r=-0.179, P=0.168). CONCLUSIONS DCT has overestimated but RT has underestimated IOP readings according to GAT measurements in keratoconic corneas. DCT may be the most appropriate tonometer to use in keratoconus for the measurements of IOP, because DCT do not appear to be dependent upon CCT and CR.
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Affiliation(s)
- Fatih Özcura
- Department of Ophthalmology, Dumlupinar University School of Medicine, Kutahya 43270, Turkey.
| | - Nilgün Yıldırım
- Department of Ophthalmology, Eskisehir Osmangazi University School of Medicine, Eskisehir 26480, Turkey
| | - Emre Tambova
- Department of Ophthalmology, Eskisehir Osmangazi University School of Medicine, Eskisehir 26480, Turkey
| | - Afsun Şahin
- Department of Ophthalmology, Eskisehir Osmangazi University School of Medicine, Eskisehir 26480, Turkey
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Andreanos K, Koutsandrea C, Papaconstantinou D, Diagourtas A, Kotoulas A, Dimitrakas P, Moschos MM. Comparison of Goldmann applanation tonometry and Pascal dynamic contour tonometry in relation to central corneal thickness and corneal curvature. Clin Ophthalmol 2016; 10:2477-2484. [PMID: 28003737 PMCID: PMC5158174 DOI: 10.2147/opth.s115203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study was to assess the influence of central corneal thickness (CCT) and corneal curvature in tonometry measurements taken by Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT). Methods This was a prospective study of 185 eyes from 97 subjects, attending outpatient ophthalmology appointments, who underwent intraocular pressure measurements by GAT and Pascal DCT. CCT and corneal curvature were obtained using ultrasound pachymetry and Orbscan topography, respectively. All measurements were carried out among males and females during the period 2009–2012. Apart from the usual descriptive and exploratory data analysis, one-way analysis of variance and agreement analysis were performed, linear as well as intraclass correlation coefficients were estimated, and multiple scatter and Bland–Altman plots were produced. Results Mean IOP measurements obtained were 17.21±4.10 mmHg by DCT and 13.23±4.07 mmHg by GAT. Mean difference between the GAT and DCT measurements was 3.88±2.8 mmHg. Mean CCT and corneal curvature were 522.78±52 μm and 43.83±2.9823 D, respectively. Conclusion Intraocular pressure measured by GAT was consistently lower when compared with DCT, and this difference was greatest with thinner CCT. Flat corneas seem to influence GAT measurements compared to DCT.
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Affiliation(s)
- Konstantinos Andreanos
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Chryssanthi Koutsandrea
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Dimitris Papaconstantinou
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Andreas Diagourtas
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Andreas Kotoulas
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Panagiotis Dimitrakas
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, Athens, Greece
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Willekens K, Rocha R, Van Keer K, Vandewalle E, Abegão Pinto L, Stalmans I, Marques-Neves C. Review on Dynamic Contour Tonometry and Ocular Pulse Amplitude. Ophthalmic Res 2015; 55:91-8. [PMID: 26650248 DOI: 10.1159/000441796] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 11/19/2022]
Abstract
Intraocular pressure (IOP) measurement is the cornerstone of the management of glaucoma patients. The gold standard for assessing IOP is Goldmann applanation tonometry (GAT). Recently, the dynamic contour tonometer (DCT) has become available. While both devices provide reliable IOP measurements, the results are not interchangeable. DCT has the advantage of measuring an additional parameter: ocular pulse amplitude (OPA). OPA is defined as the difference between systolic and diastolic IOP and represents the pulsatile wave front produced by the varying amount of blood in the eye during the cardiac cycle. It has been shown to vary with ocular structural parameters, such as axial length, corneal thickness, and ocular rigidity, as well as with systemic variables like heart rate, blood pressure, and left ventricular ejection fraction. Although the existence of some of these associations is still controversial, the clinical relevance of OPA has been consistently suggested, especially in glaucoma. Further research on this intriguing parameter could not only provide insight into glaucoma pathophysiology but also help integrate this variable into clinical practice.
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Affiliation(s)
- Koen Willekens
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Which tonometry in eyes with keratoconus? Eye (Lond) 2015; 30:431-7. [PMID: 26634712 DOI: 10.1038/eye.2015.248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 10/20/2015] [Indexed: 11/09/2022] Open
Abstract
AIMS To compare intraocular pressure (IOP) measurements obtained with Goldmann applanation tonometery (GAT), dynamic contour tonometry (DCT), tonopen (TP), and ocular response analyzer (ORA), and to determine the influence of Amsler grade and central corneal thickness (CCT) on the IOP readings in eyes with keratoconus that are classified into four groups according to the Amsler-Krumeich classification. METHODS All eyes with keratoconus were separated into four groups using Amsler-Krumeich classification for keratoconus. IOP was measured in 202 eyes of 202 patients with keratoconus using GAT, DCT, TP, and ORA. RESULTS The IOP differences revealed no significant difference among the Amsler degree in the DCT and corneal-compensated IOP (IOPcc) measurements (P>0.05 for all). There was no statistically significant difference in terms of IOP differences between GAT and IOPcc (P>0.05), TP and Goldmann-correlated measure of IOP (IOPg; P>0.05) in the Amsler I, while the IOP measurements revealed significant difference among the measurements of the four different tonometers in the Amsler II, Amsler III, and Amsler IV (P<0.05 for all). CONCLUSIONS There was no significant association between DCT IOP or IOPcc and CCT in eyes with keratoconus; no statistically significant difference was found between keratoconus stages and the control group in terms of the IOP analyzed with these two techniques. These two techniques may be the most stable in the measurement of IOP in different keratoconus stages. However, no IOP technique can be used interchangeably with other techniques in the follow-up of keratoconus patients.
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Czepita M, Karczewicz D, Safranow K, Czepita D. Macular Pigment Optical Density and Ocular Pulse Amplitude in Subjects with Different Axial Lengths and Refractive Errors. Med Sci Monit 2015; 21:1716-20. [PMID: 26071973 PMCID: PMC4471852 DOI: 10.12659/msm.893225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of our study was to: (1) investigate the macular pigment optical density (MPOD) and ocular pulse amplitude (OPA) in subjects with different axial lengths (AL) and refractive errors (RE); (2) determine if there is a correlation between MPOD and OPA; and (3) evaluate whether MPOD and OPA depend on intraocular pressure (IOP). MATERIAL AND METHODS This study included 140 eyes of 70 subjects - 17 men and 53 women, aged 18 to 29 years (mean: 22.5 years; SD=2.8). Every examined person underwent a thorough eye examination including: visual acuity, anterior segment and fundus examination, keratometry, auto-refractometry, and MPOD, OPA, AL, and IOP measurements. The obtained results were analyzed statistically using Statistica 10 software. P values of <0.05 were considered statistically significant. RESULTS The following refractive errors were selected: emmetropia (34 eyes), hyperopia (18 eyes), low myopia (60 eyes), medium myopia (19 eyes), and high myopia (9 eyes). It has been established that the OPA increases with the rise in the spherical equivalents (SE) (Rs=+0.38, P<0.001), while the increase in AL correlates with the decrease of OPA (Rs=-0.40, P<0.001). The increase in IOP correlates with the rise in the OPA (Rs=+0.20, P<0.05). There were no significant correlations between IOP and SE or AL. CONCLUSIONS (1) MPOD is not correlated with the OPA in subjects with different AL and RE; (2) OPA decreases with the rise of AL; (3) OPA decreases with the fall of the SE; and (4) OPA increases with the rise in IOP.
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Affiliation(s)
- Maciej Czepita
- Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Danuta Karczewicz
- Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Damian Czepita
- Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
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Colás-Tomás T, Prieto-Del Cura M, Villafruela-Güemes I, Clariana-Martín A, Valdivia-Pérez A. [Comparison of dynamic contour tonometry, Goldmann and pneumotonometer in ocular hypertension patients and their relationship to pachymetry and ocular pulse amplitude]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2012; 87:401-6. [PMID: 23121701 DOI: 10.1016/j.oftal.2012.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 03/20/2012] [Accepted: 05/23/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the relationship between dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT) and pneumotonometry (PNT) in ocular hypertension patients (OHT) and their relationship to central corneal thickness (CCT) and ocular pulse amplitude (OPA). METHODS Sixty patients (101 eyes) with intraocular pressure (IOP) ≥21 mmHg using GAT and normal appearing optic nerve heads and normal visual fields were included. The following tests were performed simultaneously during a single visit: IOP using DCT, GAT and PNT, OPA using DCT and CCT using ultrasound pachymetry. We studied the difference IOP between these 3 tonometers using Wilcoxon non-parametric test and the effect of CCT on IOP and OPA, as well as the relationship between OPA and IOP using Spearman correlation coefficient. RESULTS The median PNT IOP was 24 mmHg (Inter-quartile range [IQR]: 22-26), median GAT IOP was 22 mmHg (IQR: 22-24), and median DCT IOP was 28.2 mmHg (IQR: 24.1-30.7). PNT and DCT had higher IOP values than GAT (median 2 mmHg and 6.2 mmHg, respectively). Mean CCT was 594.5 μm (SD 30.0). GAT IOP and DCT IOP showed an increase with increased corneal thickness (r:0.209; P=.036 and r:0.195; P=.051, respectively). PNT IOP did not change with CCT (r:0.15; P=.12). The median OPA was 4.8 mmHg (IQR: 3.6-6.1), and significantly increased with GAT IOP (r:0,38; P<.001) and with CCT (r:0.287; P=.004). This association was unclear with IOP PNT and IOP DCT (r:0.067; P=.50 and r:0,17, P=.08, respectively). CONCLUSIONS DCT and PNT IOP values were higher than GAT IOP measurements in ocular hypertension patients. GAT IOP showed a significant increase with increased corneal thickness. Increased OPA seems to correlate with increased CCT and IOP, particularly if GAT is used.
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Affiliation(s)
- T Colás-Tomás
- Servicio de Oftalmología, Hospital del Tajo, Aranjuez, Madrid, España.
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A comparison between Goldmann applanation tonometry and dynamic contour tonometry after photorefractive keratectomy. Graefes Arch Clin Exp Ophthalmol 2012; 251:603-8. [DOI: 10.1007/s00417-012-2142-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022] Open
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Plange N, Rennings C, Herr A, Weber A, Roessler GF, Mazinani BE, Kaup M, Remky A. Ocular pulse amplitude before and after cataract surgery. Curr Eye Res 2011; 37:115-9. [PMID: 22007729 DOI: 10.3109/02713683.2011.626910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the impact of cataract surgery on the association of the ocular pulse amplitude (OPA) and intraocular pressure (IOP) with respect to the interpretation of OPA as an estimate of ocular blood flow. METHODS Twenty-four patients with cataract were included in a clinical study. OPA was measured using dynamic contour tonometry (DCT, Pascal(®), SMT Swiss Microtechnology AG, Switzerland). IOP was measured by means of Goldmann applanation tonometry (IOP GAT) and DCT (IOP DCT). All measurements were performed before and one day after cataract surgery. RESULTS At baseline, OPA was correlated to IOP GAT (r = 0.67, P = 0.0002) and IOP DCT (r = 0.82, P < 0.0001), but not to age or axial length. Postoperative OPA was correlated to IOP GAT (r = 0.67, P = 0.0002) and IOP DCT (r = 0.65, P = 0.0004). In 17 patients, IOP GAT decreased after surgery (IOP DCT n = 14), whereas an increase was apparent in seven patients (IOP DCT n = 10). The mean absolute deviation of IOP GAT pre- to post-surgery was 4.54 mmHg ± 2.47 (range 1-10 mmHg) and 5.4 mmHg ± 3.2 (range 1.1-13.1 mmHg) for IOP DCT. The changes of OPA were significantly correlated to changes in IOP GAT (r = 0.48, P = 0.017) and IOP DCT (r = 0.60, P = 0.001). IOP GAT and IOP DCT changes were not correlated to changes in corneal thickness. CONCLUSIONS The OPA measured with the Pascal(®) device seems to be dependent on IOP changes. Particular caution should be taken in the interpretation of OPA in estimating pulsatile ocular blood flow.
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Affiliation(s)
- Niklas Plange
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
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Govêia CS, Magalhães E. Ropivacaine in peribulbar anesthesia - vasoconstrictive properties. Rev Bras Anestesiol 2011; 60:495-512. [PMID: 20863930 DOI: 10.1016/s0034-7094(10)70061-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 05/03/2010] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Peribulbar anesthesia can reduce ocular blood flow (OBF) by increasing intraocular pressure (IOP) or due to the action of drugs. Ropivacaine has low toxicity and intrinsic vasoconstrictive properties, yet to be proven on the ocular vasculature. Measurements of ocular pulse amplitude (OPA) allow the indirect evaluation of the OBF. The objective of the present study was to evaluate through the OBF the vasoconstrictive properties of ropivacaine in peribulbar anesthesia. METHODS Forty eyes undergoing peribulbar anesthesia with 7 mL of anesthetic solution without vasoconstrictor were randomly divided into two groups: ropivacaine (n = 20) and bupivacaine (n = 20). The IOP, ocular perfusion pressure (OPP), OPA, hemodynamic parameters, and the degree of akinesia before and 5 and 10 minutes after the blockade were evaluated. A dynamic contour tonometer was used to evaluate ocular parameters. Sedation was similar in both groups. RESULTS A significant variation in hemodynamic parameters and intensity of the motor blockade was not observed between groups. Differences in IOP, OPP, and OPA (p < 0.05) were observed between both groups at 5 and 10 minutes. The variation of IOP at 5 and 10 minutes was -0.88% and -4.54%, respectively with ropivacaine, and 17.61% and 16.56% with bupivacaine. The change in OPP after 5 and 10 minutes was 1.5% and 4.2% with ropivacaine, and -7% and -6% with bupivacaine. Ocular pulse amplitude varied -55.59% and -59.67% with ropivacaine at 5 and 10 minutes, and -34.71% and -28.82% with bupivacaine. CONCLUSIONS Ropivacaine reduced more intensely the ocular pulse amplitude despite little changes in IOP and OPP. The reduction in ocular blood flow caused by ropivacaine can be attributed to its vasoconstrictive effect.
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Garcia-Medina M, Garcia-Medina JJ, Garrido-Fernandez P, Galvan-Espinosa J, Martin-Molina J, Garcia-Maturana C, Perez-Pardo S, Pinazo-Duran MD. Central corneal thickness, intraocular pressure, and degree of myopia in an adult myopic population aged 20 to 40 years in southeast Spain: determination and relationships. Clin Ophthalmol 2011; 5:249-58. [PMID: 21468330 PMCID: PMC3065564 DOI: 10.2147/opth.s16594] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the values of, and study the relationships among, central corneal thickness (CCT), intraocular pressure (IOP), and degree of myopia (DM) in an adult myopic population aged 20 to 40 years in Almeria (southeast Spain). To our knowledge this is first study of this kind in this region. METHODS An observational, descriptive, cross-sectional study was done in which a sample of 310 myopic patients (620 eyes) aged 20 to 40 years was selected by gender- and age-stratified sampling, which was proportionally fixed to the size of the population strata for which a 20% prevalence of myopia, 5% epsilon, and a 95% confidence interval were hypothesized. We studied IOP, CCT, and DM and their relationships by calculating the mean, standard deviation, 95% confidence interval for the mean, median, Fisher's asymmetry coefficient, range (maximum, minimum), and the Brown-Forsythe's robust test for each variable (IOP, CCT, and DM). RESULTS In the adult myopic population of Almeria aged 20 to 40 years (mean of 29.8), the mean overall CCT was 550.12 μm. The corneas of men were thicker than those of women (P = 0.014). CCT was stable as no significant differences were seen in the 20- to 40-year-old subjects' CCT values. The mean overall IOP was 13.60 mmHg. Men had a higher IOP than women (P = 0.002). Subjects over 30 years (13.83) had a higher IOP than those under 30 (13.38) (P = 0.04). The mean overall DM was -4.18 diopters. Men had less myopia than women (P < 0.001). Myopia was stable in the 20- to 40-year-old study population (P = 0.089). A linear relationship was found between CCT and IOP (R(2) = 0.152, P ≤ 0.001). CCT influenced the IOP value by 15.2%. However no linear relationship between DM and IOP, or between CCT and DM, was found. CONCLUSIONS CCT was found to be similar to that reported in other studies in different populations. IOP tends to increase after the age of 30 and is not accounted for by alterations in CCT values.
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Intraocular pressure values obtained by ocular response analyzer, dynamic contour tonometry, and goldmann tonometry in keratokonic corneas. J Glaucoma 2011; 19:540-5. [PMID: 20164793 DOI: 10.1097/ijg.0b013e3181ca7aeb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the agreement between dynamic contour tonometer (DCT), Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA) in keratoconic corneas and to find out the effect of corneal biomechanics on intraocular pressure (IOP) measurements obtained by these devices. SUBJECTS AND METHODS IOP was measured with the ORA, DCT, and GAT in random order in 120 eyes of 61 keratoconus patients. Central corneal thickness (CCT) and keratometry were measured after all IOP determinations had been made. The mean IOP measurement by the ORA and DCT was compared with the measurement by the GAT, using Student t test. Bland-Altman analysis was performed to assess the clinical agreement between these methods. The effect of corneal hysteresis (CH), corneal resistance factor (CRF), and CCT on measured IOP was explored by multiple backward stepwise linear regression analysis. RESULTS The mean±SD patient age was 30.6±11.2 years. The mean±SD IOP measurement obtained with GAT, ORA Goldmann-correlated IOP (IOPg), ORA corneal-compensated IOP (IOPcc), and DCT was 10.96±2.8, 10.23±3.5, 14.65±2.8, and 15.42±2.7 mm Hg, respectively. The mean±SD CCT was 464.08±58.4 microns. The mean difference between IOPcc and GAT (P<0.0001), IOPcc and DCT (P<0.001), GAT and DCT (P<0.0001), IOPg and GAT (P<0.002), and IOPg and DCT (P<0.0001), was highly statistically significant. In multivariable regression analysis, DCT IOP and GAT IOP measurements were significantly associated with CH and CRF (P<0.0001 for both). CONCLUSIONS DCT seemed to be affected by CH and CRF, and the IOP values tended to be higher when compared with GAT. ORA-measured IOPcc was found to be independent of CCT and suitable in comparison to the DCT in keratoconic eyes.
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Ocular pulse amplitude and associated glaucomatous risk factors in a healthy Hispanic population. OPTOMETRY (ST. LOUIS, MO.) 2010; 81:408-13. [PMID: 20655499 DOI: 10.1016/j.optm.2010.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 02/05/2010] [Accepted: 02/12/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND With increasing evidence that vascular risk factors play a role in the development of glaucoma, it is critical to be familiar with factors related to intraocular blood flow, such as the ocular pulse amplitude (OPA). This study evaluates OPA and factors related to it in a healthy, Hispanic population. METHODS Refractive error, corneal curvature, Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), OPA, axial length, and central corneal thickness (CCT) measurements were obtained on 104 Hispanic subjects recruited from the community. RESULTS OPA ranged from 0.7 to 4.7 mmHg (mean, 2.1 +/- 0.8 mmHg) and showed a significant correlation with refractive error, axial length, GAT, and DCT (r=0.250, -0.358, 0.460, 0.378; P=0.011, <0.001, <0.001, and <0.001, respectively). Mean intraocular pressure with GAT was 15.6 mmHg. Mean CCT was 541.2 microm. The average refractive error was 0.75 diopters (D) of myopia, with 25% having >1.00 D myopia. CONCLUSION Normal OPA values have not been studied in Hispanic populations. OPA is thought to provide information regarding ocular blood flow; however, more studies are needed to determine its significance in glaucoma treatment.
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