ABSTRACT.Purpose: We aimed to determine corneal hysteresis values (CH) using the ocular response analyser (ORA) in non-glaucomatous and glaucomatous eyes and their relationship with central corneal thickness (CCT). Methods: Corneal hysteresis, intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) and CCT were prospectively evaluated in 74 non-glaucoma subjects with IOP < 21 mmHg and in 108 patients with treated primary open-angle glaucoma (POAG). One eye in each subject was randomly selected for inclusion in the analysis. Results: Mean (± standard deviation [SD]) age was 59.2 ± 14.2 years in the non-glaucoma group and 62.4 ± 9.8 years in the glaucoma group. Mean (± SD) GAT IOP was 15.7 ± 2.65 mmHg and 16.38 ± 2.73 mmHg in the non-glaucoma and glaucoma groups, respectively. There was no statistically significant difference between the two groups in mean age (p = 0.396) or mean GAT IOP (p = 0.098). Mean (± SD) CH was 10.97 ± 1.59 mmHg in the non-glaucoma and 8.95 ± 1.27 mmHg in the glaucoma groups, respectively. The difference in mean CH between the two groups was statistically significant (p < 0.0001). There was a strong positive correlation between CH and CCT in the non-glaucoma group (r = 0.743) and a significantly (p = 0.001) weaker correlation (r = 0.426) in the glaucoma group. Conclusions: Corneal hysteresis was significantly lower in eyes with treated POAG than in non-glaucomatous eyes. The corneal biomechanical response was strongly associated with CCT in non-glaucoma subjects, but only moderately so in glaucoma patients. It can be assumed that diverse structural factors, in addition to thickness, determine the differences in the corneal biomechanical profile between non-glaucomatous and glaucomatous eyes. Corneal hysteresis could be a useful tool in the diagnosis of glaucoma.
Long-term silicone oil can be a last-resort option in selected patients with severe vitreoretinal disease. Anterior and posterior segment complications did occur at significant rates. Forty percent of our patients maintained ambulatory vision. The actual number of patients that achieved satisfactory stereopsis and benefited functionally from long-term SO was much less [7/50 (14%)].
The overall numbers of patients with endophthalmitis following intravitreal injections has risen dramatically over the past years. In contrast to earlier reports of multicentre studies, outcome of patients is relatively poor in the current treatment settings. We did not find clinical features useful in identifying cases with negative culture.
Silicone oil blends containing small percentages of a high molecular weight additive are easier to inject than single grade oils of the equivalent shear viscosity.
Despite modern and sophisticated vitreoretinal techniques, the authors are convinced that an underreported patient group exists, for whom long-term silicone oil tamponade is unavoidable. We conducted a literature review of the current evidence base in order to provide guidance on the ocular tolerance and side effects of long-term silicone oil, weighing up benefits against complications as well as providing an outlook on future silicone oils with improved physical properties. We advocate the removal of silicone oil in all cases; however, one has to recognise that long-term silicone oil tamponade may have to be considered as a measure of last resort for selected patients. There is a clinical need to develop novel, emulsification-resistant tamponades.
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