Purpose: Clinically evaluate a modified applanating surface Goldmann tonometer prism designed to substantially negate errors due to patient variability in biomechanics. Methods: A modified Goldmann prism with a correcting applanation tonometry surface (CATS) was mathematically optimized to minimize the intraocular pressure (IOP) measurement error due to patient variability in corneal thickness, stiffness, curvature, and tear film adhesion force. A comparative clinical study of 109 eyes measured IOP with CATS and Goldmann prisms. The IOP measurement differences between the CATS and Goldmann prisms were correlated to corneal thickness, hysteresis, and curvature. Results: The CATS tonometer prism in correcting for Goldmann central corneal thickness (CCT) error demonstrated a reduction to <+/- 2 mmHg in 97% of a standard CCT population. This compares to only 54% with CCT error <+/- 2 mmHg using the Goldmann prism. Equal reductions of similar to 50% in errors due to corneal rigidity and curvature were also demonstrated. Conclusion: The results validate the CATS prism's improved accuracy and expected reduced sensitivity to Goldmann errors without IOP bias as predicted by mathematical modeling. The CATS replacement for the Goldmann prism does not change Goldmann measurement technique or interpretation.

No description available.

No description available.

Deutschsprachige Zusammenfassung Dissertation zur Erlangung des akademischen Grades Dr. med. Titel: Mögliche Korrelation zwischen dem Stadium der altersabhängigen Makuladegeneration und der zentralen Hornhautdicke eingereicht von: Christian Koch angefertigt an der: Klinik und Poliklinik für Augenheilkunde Universität Leipzig betreut von: Professor Dr. med. Peter Wiedemann Klinik und Poliklinik für Augenheilkunde Universität Leipzig Monat und Jahr: Juni 2015 Annahme: Es soll ein statistischer Zusammenhang zwischen der zentralen Hornhautdicke in der Pupillenmitte mit dem nicht exsudativen frühen Stadium der AMD, dem exsudativen späten Stadium der AMD und einer Kontrollgruppe überprüft werden. Methodik: Die erste Studiengruppe stellten 48 Augen von 48 Patienten mit einer Form der frühen AMD dar (Durchschnittsalter 75,4 Jahre, 70,8% der Probanden waren Frauen). Die zweite Studiengruppe bildeten 49 Augen von 49 Patienten mit einer Form der späten AMD (Durchschnittsalter 79,8 Jahre, 59,2% der Probanden waren Frauen). Als Kontrollgruppe wurden 49 Augen von 49 Individuen ohne retinale oder korneale Erkrankungen genutzt (Durchschnittsalter 68,9 Jahre, 59,2% der Probanden waren Frauen). Die Vermessung der Hornhautdicke in Pupillenmitte im Sinne der Hornhautmittendicke erfolgte als Pachymetrie mit der Oculus Pentacam. Ergebnisse: Die durchschnittliche zentrale Hornhautdicke betrug bei der Kontrollgruppe 552,76 μm (SD 36,27 μm), bei der nicht exsudativen Gruppe 552,19 μm (SD 31,27 μm) und bei der exsudativen Gruppe 553,73 μm (SD 33,11 μm). Die Extrempunkte der Kontrollgruppe lagen bei 483 und 640 μm, der Gruppe der nicht exsudativen AMD bei 480 und 617 μm und Minimum und Maximum der exsudativen Gruppe bei 473 und 617 μm. Es gab keine statistisch signifikanten Unterschiede im arithmetischen Mittel der zentralen Hornhautdicke in Pupillenmitte bei der Studiengruppe mit früher AMD im Vergleich mit der Studiengruppe mit später AMD und jeweils im Vergleich zur Kontrollgruppe (P > 0,05). Schlussfolgerung: Die Messwerte der zentralen Hornhautdicke bei Patienten mit früher AMD, später AMD und Kontrollindividuen unterscheiden sich nicht. Die Erhebung der Hornhautmittendicke bietet somit keine Screeningmöglichkeit zur Erkennung einer AMD. / English Abstract Central corneal thickness in patients with AMD Koch, C.; Jochmann, C.; Wiedemann, P. University of Leipzig, Department of Ophthalmology and Eye Hospital, Leipzig, Germany Purpose: To evaluate central corneal thickness in patients with AMD in the early and late phase and a control group. Method: The first study group was made up of 48 eyes of 48 patients with early AMD (mean age 75.4 years, 70.8 % women), the second study group was made up of 49 eyes of 49 patients with late AMD (mean age 79.8 years, 59.2 % women). 49 eyes of 49 individuals without any retinal or corneal damage (mean age 68.9 years, 59.2 % women) were used as control group. The central corneal thickness was measured with the Oculus Pentacam pachymetry. Results: The mean central corneal thickness in early non-exudative AMD group was found to be 552.19 μm (SD 31.27 μm), while the mean central corneal thickness in the late exudative AMD group was measured as 553.73 μm (SD 33.11 μm). The control group had a mean central corneal thickness of 552.76 μm (SD 36.27 μm). There were no statistically significant differences in the mean central corneal thickness in the early non-exudative AMD group in comparison with the late exudative AMD group and each of them compared to the control group (P > 0,05). Conclusion: The central corneal thickness measurements do not differ in patients with early non-exudative AMD, late exudative AMD and control subjects.

Orientador: Cláudia Valéria Seullner Brandão / Resumo: O estudo objetivou descrever valores de referência para importantes testes diagnósticos oftalmológicos, como sensibilidade corneal, produção lacrimal, pressão intraocular, espessura corneal e microbiota conjuntival em saguis de tufo preto (Callithrix penicillata) saudáveis e sem alterações oculares. Foram utilizados 13 saguis de tufo preto, totalizando 26 olhos, provenientes do CEMPAS da Faculdade de Medicina Veterinária e Zootecnia - UNESP, Botucatu, São Paulo, Brasil. Os saguis foram submetidos a contenção química com anestesia dissociativa à base de cetamina e midazolam, para realização dos exames. Os resultados obtidos para sensibilidade corneal com estesiômetro Cochet-Bonnet foi de 5,8 ± 0,6cm; produção lacrimal com ponta de papel absorvente endodôntica estéril de 13 ± 3mm/min; pressão intraocular com tonômetro de rebote Tonovet Plus Icare® de 22,2 ± 2,9mmHg; espessura corneal 340,7 ± 25,5µm; e predomínio de bactérias Gram-positivas nas amostras de microbiota conjuntival. Não houve diferença significativa considerando lateralidade e sexo dos animais (P>0,05). Os resultados obtidos nos testes diagnósticos oftalmológicos poderão auxiliar médicos veterinários oftalmologistas a diagnosticar e tratar doenças oculares em saguis de tufo preto, além de contribuir para pesquisas na área de visão. / Abstract: The study aimed to describe reference values for important ophthalmic diagnostic tests, such as corneal sensitivity, tear production, intraocular pressure, corneal thickness and conjunctival microbiota in black tufted marmosets (Callithrix penicillata). Thirteen black tuft marmosets were used, totaling 26 eyes, followed by CEMPAS by the Faculty of Veterinary Medicine and Zootechnics - UNESP, Botucatu, São Paulo, Brazil. The procedures were used for chemical containment with dissociative anesthesia based on ketamine and midazolam, to perform the exams. The results obtained for corneal sensitivity with a Cochet-Bonnet esthesiometer were 5.8 ± 0.6 cm; tear production with sterile endodontic absorbent paper tip of 13 ± 3mm / min; intraocular pressure with Tonovet Plus Icare® rebound tonometer of 22.2 ± 2.9mmHg; corneal thickness 340.7 ± 25.5 µm; and predominance of Gram-positive bacteria in conjunctival microbiota. There was no significant difference considering the laterality and sex of the animals (P> 0.05). The results obtained in ophthalmological diagnostic tests can help veterinary ophthalmologists to diagnose and treat eye diseases in the black tufted marmosets, in addition to contributing to research in the field of vision. / Mestre

Deutschsprachige Zusammenfassung Dissertation zur Erlangung des akademischen Grades Dr. med. Titel: Mögliche Korrelation zwischen dem Stadium der altersabhängigen Makuladegeneration und der zentralen Hornhautdicke eingereicht von: Christian Koch angefertigt an der: Klinik und Poliklinik für Augenheilkunde Universität Leipzig betreut von: Professor Dr. med. Peter Wiedemann Klinik und Poliklinik für Augenheilkunde Universität Leipzig Monat und Jahr: Juni 2015 Annahme: Es soll ein statistischer Zusammenhang zwischen der zentralen Hornhautdicke in der Pupillenmitte mit dem nicht exsudativen frühen Stadium der AMD, dem exsudativen späten Stadium der AMD und einer Kontrollgruppe überprüft werden. Methodik: Die erste Studiengruppe stellten 48 Augen von 48 Patienten mit einer Form der frühen AMD dar (Durchschnittsalter 75,4 Jahre, 70,8% der Probanden waren Frauen). Die zweite Studiengruppe bildeten 49 Augen von 49 Patienten mit einer Form der späten AMD (Durchschnittsalter 79,8 Jahre, 59,2% der Probanden waren Frauen). Als Kontrollgruppe wurden 49 Augen von 49 Individuen ohne retinale oder korneale Erkrankungen genutzt (Durchschnittsalter 68,9 Jahre, 59,2% der Probanden waren Frauen). Die Vermessung der Hornhautdicke in Pupillenmitte im Sinne der Hornhautmittendicke erfolgte als Pachymetrie mit der Oculus Pentacam. Ergebnisse: Die durchschnittliche zentrale Hornhautdicke betrug bei der Kontrollgruppe 552,76 μm (SD 36,27 μm), bei der nicht exsudativen Gruppe 552,19 μm (SD 31,27 μm) und bei der exsudativen Gruppe 553,73 μm (SD 33,11 μm). Die Extrempunkte der Kontrollgruppe lagen bei 483 und 640 μm, der Gruppe der nicht exsudativen AMD bei 480 und 617 μm und Minimum und Maximum der exsudativen Gruppe bei 473 und 617 μm. Es gab keine statistisch signifikanten Unterschiede im arithmetischen Mittel der zentralen Hornhautdicke in Pupillenmitte bei der Studiengruppe mit früher AMD im Vergleich mit der Studiengruppe mit später AMD und jeweils im Vergleich zur Kontrollgruppe (P > 0,05). Schlussfolgerung: Die Messwerte der zentralen Hornhautdicke bei Patienten mit früher AMD, später AMD und Kontrollindividuen unterscheiden sich nicht. Die Erhebung der Hornhautmittendicke bietet somit keine Screeningmöglichkeit zur Erkennung einer AMD. / English Abstract Central corneal thickness in patients with AMD Koch, C.; Jochmann, C.; Wiedemann, P. University of Leipzig, Department of Ophthalmology and Eye Hospital, Leipzig, Germany Purpose: To evaluate central corneal thickness in patients with AMD in the early and late phase and a control group. Method: The first study group was made up of 48 eyes of 48 patients with early AMD (mean age 75.4 years, 70.8 % women), the second study group was made up of 49 eyes of 49 patients with late AMD (mean age 79.8 years, 59.2 % women). 49 eyes of 49 individuals without any retinal or corneal damage (mean age 68.9 years, 59.2 % women) were used as control group. The central corneal thickness was measured with the Oculus Pentacam pachymetry. Results: The mean central corneal thickness in early non-exudative AMD group was found to be 552.19 μm (SD 31.27 μm), while the mean central corneal thickness in the late exudative AMD group was measured as 553.73 μm (SD 33.11 μm). The control group had a mean central corneal thickness of 552.76 μm (SD 36.27 μm). There were no statistically significant differences in the mean central corneal thickness in the early non-exudative AMD group in comparison with the late exudative AMD group and each of them compared to the control group (P > 0,05). Conclusion: The central corneal thickness measurements do not differ in patients with early non-exudative AMD, late exudative AMD and control subjects.

Justification: Le glaucome entraîne une perte progressive de la vision causée par la détérioration du nerf optique. Le glaucome est répandu dans le monde et cause la cécité dans environ sept millions de personnes. Le glaucome touche plus de 400 000 Canadiens et sa prévalence augmente avec le vieillissement de la population.1,2 Il s'agit d'une maladie chronique surnoise dont les symptômes se manifestent uniquement lors des stades avancés et qui peuvent mener à la cécité. Présentement, le seul moyen possible d’arrêter la progression du glaucome au stade initial est de diminuer la pression intra-oculaire (PIO). Les analogues de prostaglandines (APG) topiques sont fréquemment utilisées comme traitement de première ligne. Cependant, la recherche démontre que cette classe de médicaments peut changer certaines propriétés de la cornée, et possiblement influencer la mesure de la PIO.3 Objectif: À déterminer si l'utilisation d'APG affecte les propriétés biomécaniques de la cornée. La conclusion sera basée sur l'analyse intégrée des résultats obtenus de l'analyseur Reichert oculaire Réponse (ORA), la tonométrie par applanation de Goldmann (TAG) et la pachymétrie ultrasonographique. Le deuxième objectif potentiel de cette étude est de déterminer la corrélation, le cas échéant, entre les propriétés biomécaniques de la cornée, l'épaisseur de la cornée centrale (ECC) et la PIO chez les patients subissant un traitement d’APG topique. L'hypothèse principale de cette étude est que l’APG influence les propriétés de la cornée telles que l'épaisseur centrale, l'élasticité et la résistance. Patients et méthodes : Soixante-dix yeux de 35 patients, âgés de 50-85 ans, atteints de glaucome à angle ouvert (GAO) et traités avec APG topique ont été examinés. Seulement les sujets avec une réfraction manifeste entre -6,00 D et +4,25 D ont été inclus. Les critères d'exclusion sont: patients avec n'importe quelle autre maladie de la cornée de l’œil, telles que la dystrophie endothéliale de Fuch’s et kératocône, ou tout antécédent de traumatisme ou d'une chirurgie de la cornée, ainsi que le port de lentilles de contact. Nous avons demandé aux patients atteints du glaucome qui ont des paramètres stables et qui utilisent l’APG dans les deux yeux de cesser l’APG dans l'œil moins affecté par la PIO, et de continuer l’utilisation d’APG dans l'œil contralatéral. Le meilleur œil est défini comme celui avec moins de dommage sur le champ visuel (CV) (déviation moyenne (DM), le moins négatif) ou une PIO maximale historique plus basse si la DM est égale ou encore celui avec plus de dommage sur la tomographie par cohérence optique (TCO, Cirrus, CA) ou la tomographie confocale par balayage laser (HRT, Heidelberg, Allemagne). Toutes les mesures ont été prises avant la cessation d’APG et répétées 6 semaines après l’arrêt. Les patients ont ensuite recommencé l’utilisation d’APG et toutes les mesures ont été répétées encore une fois après une période supplémentaire de 6 semaines. Après commencer ou de changer le traitement du glaucome, le patient doit être vu environ 4-6 semaines plus tard pour évaluer l'efficacité de la goutte.4 Pour cette raison, on été décidé d'utiliser 6 semaines d'intervalle. Toutes les mesures ont été effectuées à l’institut du glaucome de Montréal par le même technicien, avec le même équipement et à la même heure de la journée. L'œil contralatéral a servi comme œil contrôle pour les analyses statistiques. La tonométrie par applanation de Goldmann a été utilisée pour mesurer la PIO, la pachymétrie ultrasonographique pour mesurer l'ECC, et l’ORA pour mesurer les propriétés biomécaniques de la cornée, incluant l'hystérèse cornéenne (HC). L’hypothèse de l'absence d'effet de l'arrêt de l’APG sur les propriétés biomécaniques a été examiné par un modèle linéaire à effets mixtes en utilisant le logiciel statistique R. Les effets aléatoires ont été définies à deux niveaux: le patient (niveau 1) et l'œil de chaque patient (niveau 2). Les effets aléatoires ont été ajoutés au modèle pour tenir compte de la variance intra-individuelle. L’âge a également été inclus dans le modèle comme variable. Les contrastes entre les yeux et les temps ont été estimés en utilisant les valeurs p ajustées pour contrôler les taux d'erreur internes de la famille en utilisant multcomp paquet dans R. Résultats: Une augmentation statistiquement significative due l 'HC a été trouvée entre les visites 1 (sur APG) et 2 (aucun APG) dans les yeux de l'étude, avec une moyenne (±erreur standard) des valeurs de 8,98 ± 0,29 mmHg et 10,35 ± 0,29 mmHg, respectivement, correspondant à une augmentation moyenne de 1,37 ± 0,18 mmHg (p <0,001). Une réduction significative de 1,25 ± 0,18 mmHg (p <0,001) a été observée entre les visites 2 et 3, avec une valeur moyenne HC finale de 9,09 ± 0,29 mmHg. En outre, une différence statistiquement significative entre l’oeil d’étude et le contrôle n'a été observée que lors de la visite 2 (1,01 ± 0,23 mmHg, p <0,001) et non lors des visites 1 et 3. Une augmentation statistiquement significative du facteur de résistance conréen (FRC) a été trouvée entre les visites 1 et 2 dans les yeux de l'étude, avec des valeurs moyennes de 10,23 ± 0,34 mmHg et 11,71 ± 0,34 mmHg, respectivement. Le FRC a ensuite été réduit de 1,90 ± 0,21 mmHg (p <0,001) entre les visites 2 et 3, avec une valeur moyenne FRC finale de 9,81 ± 0,34 mmHg. Une différence statistiquement significative entre l’oeil d’étude et le contrôle n'a été observée que lors de la visite 2 (1,46 ± 0,23 mmHg, p <0,001). Une augmentation statistiquement significative de l'ECC a été trouvée entre les visites 1 et 2 dans les yeux de l'étude, avec des valeurs moyennes de 541,83 ± 7,27 µm et 551,91 ± 7,27 µm, respectivement, ce qui correspond à une augmentation moyenne de 10,09 ± 0,94 µm (p <0,001). L'ECC a ensuite diminué de 9,40 ± 0,94 µm (p <0,001) entre les visites 2 et 3, avec une valeur moyenne finale de 542,51 ± 7,27 µm. Une différence entre l’étude et le contrôle des yeux n'a été enregistré que lors de la visite 2 (11,26 ± 1,79 µm, p <0,001). De même, on a observé une augmentation significative de la PIO entre les visites 1 et 2 dans les yeux de l'étude, avec des valeurs moyennes de 15,37 ± 0,54 mmHg et 18,37 ± 0,54 mmHg, respectivement, ce qui correspond à une augmentation moyenne de 3,0 ± 0,49 mmHg (p <0,001). Une réduction significative de 2,83 ± 0,49 mmHg (p <0,001) a été observée entre les visites 2 et 3, avec une valeur moyenne de la PIO finale de 15,54 ± 0,54 mmHg. L’oeil de contrôle et d’étude ne différaient que lors de la visite 2 (1,91 ± 0,49 mmHg, p <0,001), ce qui confirme l'efficacité du traitement de l’APG. Lors de la visite 1, le biais de la PIO (PIOcc - PIO Goldmann) était similaire dans les deux groupes avec des valeurs moyennes de 4,1 ± 0,54 mmHg dans les yeux de contrôles et de 4,8 ± 0,54 mmHg dans les yeux d’études. Lors de la visite 2, après un lavage de 6 semaines d’APG, le biais de la PIO dans l'œil testé a été réduit à 1,6 ± 0,54 mmHg (p <0,001), ce qui signifie que la sous-estimation de la PIO par TAG était significativement moins dans la visite 2 que de la visite 1. La différence en biais PIO moyenne entre l'étude et le contrôle des yeux lors de la visite 2, en revanche, n'a pas atteint la signification statistique (p = 0,124). On a observé une augmentation peu significative de 1,53 ± 0,60 mmHg (p = 0,055) entre les visites 2 et 3 dans les yeux de l'étude, avec une valeur de polarisation finale de la PIO moyenne de 3,10 ± 0,54 mmHg dans les yeux d'études et de 2,8 ± 0,54 mmHg dans les yeux de contrôles. Nous avons ensuite cherché à déterminer si une faible HC a été associée à un stade de glaucome plus avancé chez nos patients atteints du glaucome à angle ouvert traités avec l’APG. Lorsque l'on considère tous les yeux sur l’APG au moment de la première visite, aucune association n'a été trouvée entre les dommages sur le CV et l'HC. Cependant, si l'on considère seulement les yeux avec un glaucome plus avancé, une corrélation positive significative a été observée entre la DM et l'HC (B = 0,65, p = 0,003). Une HC inférieure a été associé à une valeur de DM de champ visuelle plus négative et donc plus de dommages liés au glaucome. Conclusions : Les prostaglandines topiques affectent les propriétés biomécaniques de la cornée. Ils réduisent l'hystérèse cornéenne, le facteur de résistance cornéen et l'épaisseur centrale de la cornée. On doit tenir compte de ces changements lors de l'évaluation des effets d’APG sur la PIO. Plus de recherche devrait être menées pour confirmer nos résultats. De plus, d’autres études pourraient être réalisées en utilisant des médicaments qui diminuent la PIO sans influencer les propriétés biomécaniques de la cornée ou à l'aide de tonomètre dynamique de Pascal ou similaire qui ne dépend pas des propriétés biomécaniques de la cornée. En ce qui concerne l'interaction entre les dommages de glaucome et l'hystérésis de la cornée, nous pouvons conclure qu' une HC inférieure a été associé à une valeur de DM de CV plus négative. Mots Clés glaucome - analogues de prostaglandines - hystérèse cornéenne – l’épaisseur de la cornée centrale - la pression intraoculaire - propriétés biomécaniques de la cornée. / Rationale: Glaucoma is a chronic disease that causes a gradual loss of vision due to progressive damage to the optic nerve. It is widespread in the world and causes blindness in about seven million people. In addition, it affects more than 400,000 Canadians and its prevalence is increasing with the aging of the population.1, 2 Glaucoma becomes symptomatic only in the more advanced stages of the disease, and currently, the goal of treatment is to halt the progression of the disease by lowering the intra-ocular pressure (IOP). Topical prostaglandin analogs (PGA) are currently the first line treatment, however research has shown that this class of medications may change certain properties of the cornea, and hence the measurement of IOP.3 Aim: To determine whether the use of topical prostaglandin analogs (PGA) affects the biomechanical properties of the cornea. The conclusion will be based on the integrated analysis of the data collected from the Reichert Ocular Response Analyzer (ORA), Goldmann tonometry and ultrasound pachymetry. The second potential aim of this study is to determine the correlations, if any, between the biomechanical properties of cornea, the Central Corneal Thickness (CCT) and IOP in patients undergoing topical PGA treatment. The main hypothesis of this study is that the PGA drops influence the properties of the cornea such as central thickness, elasticity and resistance. Patients and Methods: In this study, seventy eyes of 35 patients, aged 50 - 85 years, with open angle glaucoma (OAG) and treated with topical PGA were examined. Only subjects with a manifest refraction between -6.00 D and +4.25 D were included. Exclusion criteria included patients with any other corneal eye disease, such as Fuch’s endothelial dystrophy or keratoconus, or any past history of corneal trauma or surgery. Contact lens wearers were also excluded. Patients with stable glaucoma parameters who were using topical PGA in both eyes prior to the start of the study were asked to discontinue the PGA in the best eye and to continue the application of PGA to the contralateral eye. The "best" eye, representing the eye with the least amount of glaucoma-related damage, was selected based on the results of the Humphrey Visual Field (HFA, Carl Zeiss Meditec, Inc., Dublin, CA), Heidelberg Retinal Tomography (HRT II, Heidelberg Engineering GmbH, Heidelberg, Germany), Optical Coherence Tomography (CIRRUS HD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA) and maximum IOP. The contralateral eye served as a control for statistical analyses. Corneal measurements were taken before PGA cessation and repeated 6 weeks after cessation. Patients then restarted the use of PGA and all measurements were repeated once more after an additional 6 weeks. After starting or changing glaucoma treatment the patient should be seen approximately 4-6 weeks later to assess efficacy of the drop.4 For this reason it was decided to use 6 weeks interval. All measurements were performed at The Montreal Glaucoma Institute by the same trained technician, with the same equipment and at the same time of day. Goldmann applanation tonometry was used to measure the patient’s intraocular pressure (IOP), ultrasound pachymetry was used to measure central corneal thickness (CCT) and the ORA provided the measurements of the corneal biomechanical properties, including corneal hysteresis (CH). The hypothesis of no effect regarding the discontinuation of PGA on the biomechanical properties was examined by a linear mixed-effect model using the nlme package in R. Random-effects was defined on two levels: the patient (level-1) and the eye within each patient (level-2). Those random-effects were added to the model to account for the intra-individual variance due to the repeated-measure design. Age was also included in the model as a covariate. Contrasts between the eyes and times were estimated using adjusted p-values to control for familywise error rate using multcomp package in R. Results: A statistically significant increase in CH was found between Visit 1 (on PGA) and Visit 2 (no PGA) in the study eyes, with mean (±Standard Error) values of 8.98 ± 0.29 mmHg and 10.35 ± 0.29 mmHg, respectively, corresponding to a mean increase of 1.37 ± 0.18 mmHg (p < 0.001). A significant reduction of 1.25 ± 0.18 mmHg (p < 0.001) was also observed between Visits 2 and 3, with a final mean CH value of 9.09 ± 0.29 mmHg. In addition, a statistically significant difference between the study and control eyes was only observed at Visit 2 (1.01 ± 0.23 mmHg; p < 0.001) and not at Visits 1 and 3. A statistically significant increase in Corneal Resistance Factor (CRF) was found between Visits 1 and 2 in the study eyes, with mean values of 10.23 ± 0.34 mmHg and 11.71 ± 0.34 mmHg, respectively. CRF was then reduced by 1.90 ± 0.21 mmHg (p < 0.001) between Visits 2 and 3, with a final mean CRF value of 9.81 ± 0.34 mmHg. A statistically significant difference between the study and control eyes was only observed at Visit 2 (1.46 ± 0.23 mmHg; p < 0.001). A statistically significant increase in CCT was found between Visits 1 and 2 in the study eyes, with mean values of 541.83 ± 7.27 µm and 551.91 ± 7.27 µm respectively, corresponding to a mean increase of 10.09 ± 0.94 µm (p < 0.001). CCT then decreased by 9.40 ± 0.94 µm (p < 0.001) between Visits 2 and 3, with a final mean value of 542.51 ± 7.27 µm. A difference between the study and control eyes was only recorded at Visit 2 (11.26 ± 1.79 µm; p < 0.001). Similarly, a significant increase in IOP was observed between Visits 1 and 2 in the study eyes, with mean values of 15.37 ± 0.54 mmHg and 18.37 ± 0.54 mmHg respectively, corresponding to a mean increase of 3.0 ± 0.49 mmHg (p < 0.001). A significant reduction of 2.83 ± 0.49 mmHg (p < 0.001) was observed between Visits 2 and 3, with a final mean IOP value of 15.54 ± 0.54 mmHg. The control and study eyes only differed at Visit 2 (1.91 ± 0.49 mmHg; p < 0.001), confirming the effectiveness of PGA treatment. At Visit 1, the IOP bias (IOPcc – Goldmann IOP) was similar in both groups, all eyes at that time being on long term PGA medication, with mean values of 4.1 ± 0.54 mmHg in the control eyes and 4.8 ± 0.54 mmHg in the study eyes. At Visit 2, after a 6 week washout of PGAs, the IOP bias in the tested eye was reduced to 1.6 ± 0.54 mmHg (p<0.001), meaning that underestimation of IOP by Goldmann tonometry was significantly less than at Visit 1. The difference in mean IOP bias between the study and control eyes at Visit 2, however, did not reach statistical significance (p= 0.124). A marginally significant increase of 1.53 ± 0.60 mmHg (p = 0.055) was observed between Visits 2 and 3 in the study eyes, with a final mean IOP bias value of 3.10 ± 0.54 mmHg in the study eyes and 2.8 ± 0.54 mmHg in the control eyes. We then tried to determine if a low CH was associated with signs of more severe glaucoma progression among our open-angle glaucoma patients treated with PGA. When considering all eyes on PGA at the time of the first Visit, no association was found between VF damage and CH. However, when considering only eyes with more advanced glaucoma, a significant positive correlation was observed between VF MD and CH (B = 0.65; p = 0.003). A lower CH was associated with a more negative visual field MD value and thus greater glaucoma-related damage. Conclusions: Topical prostaglandin analogs reduce CH, CRF, CCT and IOP in glaucomatous eyes. The changes in CH and CCT influence the measurement of IOP, and therefore, these changes should be taken into account when evaluating IOP lowering response to PGA medications. To discern an interaction between IOP and corneal hysteresis, further research should be conducted with intraocular pressure control. It can be achieved by using systemic medications that decrease IOP and do not influence biomechanical properties. It can also be achieved by using Pascal dynamic contour tonometry or a similar tonometer that does not depend on the biomechanical properties of the cornea. Regarding the interaction between severity of glaucoma damage and corneal hysteresis, it was demonstrated that a lower CH was associated with a more negative visual field MD value. Key Words glaucoma – prostaglandin analogs – corneal hysteresis – central corneal thickness – intraocular pressure – biomechanical properties of the cornea.

Background: Compare Goldmann applanation tonometer (GAT) prism and correcting applanation tonometry surface (CATS) prism to intracameral intraocular pressure (IOP), in vivo and in vitro. Methods: Pressure transducer intracameral IOP was measured on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically to 10, 20, and 40 mmHg. Simultaneously, IOP was measured using a Perkins tonometer with a standard GAT prism and a CATS prism at each of the intracameral pressures. Statistical comparison was made between true intracameral pressures and the two prism measurements. Differences between the two prism measurements were correlated to central corneal thickness (CCT) and corneal resistance factor (CRF). Human cadaver eyes were used to assess measurement repeatability. Results: The CATS tonometer prism measured closer to true intracameral IOP than the GAT prism by 1.7+/-2.7 mmHg across all pressures and corneal properties. The difference in CATS and GAT measurements was greater in thin CCT corneas (2.7+/-1.9 mmHg) and low resistance (CRF) corneas (2.8+/-2.1 mmHg). The difference in prisms was negligible at high CCT and CRF values. No difference was seen in measurement repeatability between the two prisms. Conclusion: A CATS prism in Goldmann tonometer armatures significantly improve the accuracy of IOP measurement compared to true intracameral pressure across a physiologic range of IOP values. The CATS prism is significantly more accurate compared to the GAT prism in thin and less rigid corneas. The in vivo intracameral study validates mathematical models and clinical findings in IOP measurement between the GAT and CATS prisms.

Background: Goldmann applanation tonometry (GAT) error relative to intracameral intraocular pressure (IOP) has not been examined comparatively in both human cadaver eyes and in live human eyes. Futhermore, correlations to biomechanical corneal properties and positional changes have not been examined directly to intracameral IOP and GAT IOP. Methods: Intracameral IOP was measured via pressure transducer on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically on each patient alternately to 10, 20, and 40 mmHg. IOP was measured using a Perkins tonometer in the supine position on 58 eyes and upright on a subset of 8 eyes. Twenty one (21) fresh human cadaver globes were Intracamerally IOP adjusted and measured via pressure transducer. Intracameral IOP ranged between 5 and 60 mmHg. IOP was measured in the upright position with a Goldmann Applanation Tonometer (GAT) and supine position with a Perkins tonometer. Central corneal thickness (CCT) was also measured. Results: The Goldmann-type tonometer error measured on live human eyes was 5.2 +/- 1.6 mmHg lower than intracameral IOP in the upright position and 7.9 +/- 2.3 mmHg lower in the supine position (p <.05). CCT also indicated a sloped correlation to error (correlation coeff. = 0.18). Cadaver eye IOP measurements were 3.1+/-2. 5 mmHg lower than intracameral IOP in the upright position and 5.4+/- 3.1 mmHg in the supine position (p <.05). Conclusion: Goldmann IOP measures significantly lower than true intracameral IOP by approximately 3 mmHg in vitro and 5 mmHg in vivo. The Goldmann IOP error is increased an additional 2.8 mmHg lower in the supine position. CCT appears to significantly affect the error by up to 4 mmHg over the sample size.

OBJECTIVE: Ocular function is fundamental for environmental adaptation and survival capacity. Growth factors are necessary for a mature eyeball, needed for adequate vision. However, the consequences of the deficiency of circulating growth hormone (GH) and its effector insulin-like growth factor I (IGF-I) on the physical aspects of the human eye are still debated. A model of untreated isolated GH deficiency (IGHD), with low but measurable serum GH, may clarify this issue. The aim of this study was to assess the ocular aspects of adult IGHD individuals who have never received GH therapy. DESIGN: Cross sectional study. METHODS: Setting University Hospital, Federal University of Sergipe, Brazil. Patients: Twenty-five adult (13 males, mean age 50.1 years, range 26 to 70 years old) IGHD subjects homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene, and 28 (15 males, mean age 51.1 years, range 26 to 67 years old) controls were submitted to an endocrine and ophthalmological assessment. Forty-six IGHD and 50 control eyes were studied. Main outcome measures: Visual acuity, intraocular pressure (IOP), refraction (spherical equivalent), ocular axial length (AL), anterior chamber depth (ACD),lens thickness (LT), vitreous depth (VD), mean corneal curvature (CC) and central corneal thickness (CCT). RESULTS: IGHD subjects exhibited unmeasurable serum IGF-I levels, similar visual acuity, intraocular pressure and LT, higher values of spherical equivalent and CC, and lower measures of AL, ACD, VD and CCT in comparison to controls, but within their respective normal ranges. While mean stature in IGHD group was 78 % of the control group, mean head circumference was 92 % and axial AL was 96 %. CONCLUSIONS: These observations suggest mild ocular effects in adult subjects with severe IGF-I deficiency due to non-treated IGHD. / OBJETIVO: A função ocular é fundamental para a adaptação ambiental e a capacidade de sobrevivência. Fatores de crescimento são julgados necessáriospara alcançar um globo ocular maduro, e conseqüente visão adequada. No entanto, as consequências da deficiência isoladadohormônio de crescimento circulante (GH) edo seu efetor, o fator de crescimento semelhante à insulina I (IGF-I) nos aspectos físicos do olho humano ainda são debatidas. Um modelo de deficiência isolada de GH não tratada (DIGH) pode esclarecer esta questão. O objetivo deste estudo foi avaliar os aspectos físicos do globo ocular de indivíduos adultos com DIGH que nunca receberam terapia com GH. DESENHO: Estudo transversal. MÉTODOS: Ambiente: Hospital Universitário, Universidade Federal de Sergipe, Brasil. Pacientes: 25 indivíduosadultos (13 homens,com média de idade de 50,1 anos, entre 26 e 70 anos), com DIGH homozigotos para uma mutação nula (c.57 + 1G> A) no gene do receptorGHRH do grupo DIGH e 28 controles (15 homens, com média de idade de 51,1 anos, entre 26 e 67 anos), pareados, foram submetidos à avaliação endócrina e oftalmológica. Principais medidas: acuidade visual(AV), pressão intraocular(PIO),refração (equivalente esférico, EE), comprimento axial ocular (CA), profundidade da câmara anterior(PCA), medida da espessura do cristalino(EC), profundidade do vítreo(PV), curvatura corneana média(CCM) e espessura central corneana(ECC). RESULTADOS:Indivíduos com DIGH apresentaram IGF-I sérico não mensurável, similarAV, PIO e EC, valores mais altos doEEe CCM, e menores valores do CA, PCA, PV e ECC em comparação com os controles, mas dentro das respectivas faixas normais. Enquanto a estaturamédia no grupo DIGH foi de 78% do grupo de controle, a média da circunferência da cabeça foi de 92% e a média docomprimento axial foi de 96%. CONCLUSÃO: Essas observações sugerem efeitos oculares discretosem indivíduos adultos com grave deficiência de IGF-I devido à DIGH não tratada.