Pediatric intraocular pressure measurements: Tonometers, central corneal thickness, and anesthesia

Fayed, Mahmoud A.; Chen, Teresa C.

doi:10.1016/j.survophthal.2019.05.003

Cited by 26 publications

(12 citation statements)

References 187 publications

(184 reference statements)

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“…Ideally, applanation tonometry should be used for IOP measurement 22 , but it was invasive and not routinely performed in our practice. We were not able to measure corneal thickness, which was associated with IOP 23 . Typically, IOP varies within 24 hours; thus, these patients should be investigated throughout this time cycle 24 .…”

Section: Discussionmentioning

confidence: 98%

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

Chen

et al. 2020

Preprint

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BackgroundThe association between ocular hypertension and endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to a surgical resection were still unknown. MethodsIntraocular pressure (IOP), visual field and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing’s disease (CD) admitted to a tertiary pituitary center for surgery from Jan to Jul 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period were served as controls. We calculated the odds ratio and identified risk factors of developing ocular hypertension, and presented postoperative trends of IOP.Results52 patients (38.4±12.4 years old) with CD were included. IOP was higher in patients with CD (left 19.4 ± 5.4 mmHg and right 20.0 ± 7.1 mmHg) than patients with acromegaly (left 17.5 ± 2.3 mmHg and right 18.6 ± 7.0 mmHg, p = 0.033) and patients with NFPA (left 17.8 ± 2.6 mmHg and right 17.4 ± 2.4 mmHg, p = 0.005). 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension comparing to 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The odds ratio of developing ocular hypertension in patients with CD was 5.1 (95% CI, 1.3 – 25.1, p = 0.029) and 6.6 (95% CI, 1.8 – 30.3, p = 0.007), comparing with the two control groups, respectively. Among patients with CD, those with higher urine free cortisol were more likely to develop ocular hypertension (OR 19.4, 95% CI 1.7 – 72.6). IOP decreased at one-month follow-up in patients with CD and the change sustained at three-month follow-up. ConclusionsIn conclusion, patients with CD had increased risk of developing ocular hypertension comparing to other types of pituitary adenomas, which warrant the discretion of both ophthalmologists and neuroendocrinologists.

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Section: Discussionmentioning

confidence: 98%

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

Chen

et al. 2020

Preprint

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“…Nevertheless, we argued that diabetes mellitus and hypertension were not associated with ocular hypertension. We used a noncontact tonometer, which is not the gold standard for IOP measurements 23. IOP measurement with applanation tonometry would have been better, in addition to considering the diurnal variation and central corneal thickness,24 but tonometry is invasive and not routinely performed in our practice.…”

Section: Discussionmentioning

confidence: 99%

“…We used a noncontact tonometer, which is not the gold standard for IOP measurements. 23 IOP measurement with applanation tonometry would have been better, in addition to considering the diurnal variation and central corneal thickness, 24 but tonometry is invasive and not routinely performed in our practice. In future studies, we will use tonometry and consider the influence of the corneal thickness.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Ocular Hypertension in Patients With Cushing’s Disease

Chen

et al. 2022

Journal of Glaucoma

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Précis: An increased risk of ocular hypertension was seen in Cushing's disease. Introduction: Systemic steroid use is a significant risk factor for increased intraocular pressure (IOP). The incidence of ocular hypertension may rise to 30%–40% of the general population due to topical or systemic glucocorticoid usage. However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to surgical resection, remain unknown. Materials and Methods: The IOP, visual field, and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing’s disease (CD) admitted to a tertiary pituitary center for surgery from January to July 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period served as controls. We calculated the odds ratio (OR), identified the risk factors of developing ocular hypertension, and presented postoperative trends of the IOP. Results: A total of 52 patients (38.4±12.4 y old) with CD were included. The IOP was higher in patients with CD (left 19.4±5.4 mm Hg and right 20.0±7.1 mm Hg) than in patients with acromegaly (left 17.5±2.3 mm Hg and right 18.6±7.0 mm Hg, P=0.033) and patients with NFPA (left 17.8±2.6 mm Hg and right 17.4±2.4 mm Hg, P=0.005). A total of 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension compared with 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The OR of developing ocular hypertension in patients with CD was 5.1 [95% confidence interval (CI), 1.3–25.1, P=0.029] and 6.6 (95% CI, 1.8–30.3, P=0.007) when compared with the 2 control groups. Among patients with CD, those with a higher urine-free cortisol were more likely to develop ocular hypertension (OR=19.4, 95% CI, 1.7–72.6). The IOP decreased at 1 month after surgery in patients with CD, and the change was sustained for 3 months after surgery. Conclusions: An increased risk of ocular hypertension was seen in CD and suggests that endogenous hypercortisolemia should be considered as part of the glaucoma assessment. This result warrants the discretion of both ophthalmologists and neuroendocrinologists.

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“…Previous reports of childhood glaucoma have taken ≤21 mm Hg as success criteria. However, since the normal IOP in an infant is less than that of adults[ 17 ] we used a more stringent criteria of ≤18 mm Hg to define success rates. Outcomes were defined as complete success, qualified success, and failure, as follows: Complete success: when IOP was ≤18 mm Hg without drugs; Qualified success: when IOP was ≤18 mm Hg with up to two topical drugs; Failure: when IOP was >18 mm Hg on two topical drugs, there was a need for systemic drugs for IOP control or requirement of re-surgery.…”

Section: Methodsmentioning

confidence: 99%

Goniotomy for initial and re-surgery for childhood glaucoma in Northern India

Kaushik

Gupta

Thattaruthody

et al. 2021

Indian J Ophthalmol

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Purpose: The aim of this study was to describe the effectiveness of goniotomy for childhood glaucoma in Indian eyes. Methods: Consecutive patients with pediatric glaucoma who underwent goniotomy between July 2017 and June 2020, in a single center in Northwest India were prospectively analyzed. Goniotomy was done as a primary procedure or a re-do surgery of the untreated angle in failed filtering surgery. Success was defined as intraocular pressure (IOP) ≦18 mm Hg with or without 2 topical medications. Results: A total of 172 eyes of 126 children underwent goniotomy during this period (37.9% of all pediatric glaucoma surgeries). Goniotomy comprised 132 of 211 (62.5%) primary pediatric glaucoma surgeries and 40 of 243 (16.5%) re-do surgeries. 145, 112, and 54 eyes had a six months, 1-year and 2-year follow-up, respectively. At 1 year, success rates in Primary Congenital Glaucoma (PCG) were 79.7% for primary surgery and 68.4% for re-do surgery. For non-PCG eyes, the success rate was 62% at 1 year. Among PCG subgroups, infantile and newborn glaucoma had 87.5% and 57.1% success rates, respectively. On logistic regression analysis, lower baseline IOP and lesser axial length at presentation were significantly predictive of successful outcomes ( P = 0.03 and P = 0.02, respectively). At 1 year, in the primary surgery group, 50% had good vision (better than logMAR 0.5), 28.9% had moderate (better than LOGMAR 1.0) and 20% had severe visual impairment. There were no significant intraoperative or post-operative complications. Conclusion: Goniotomy appears to be an effective surgery for childhood glaucoma in Indian eyes. Being minimally invasive, it obviates the need for conjunctival and scleral dissection and antifibrotic agents.

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Pediatric intraocular pressure measurements: Tonometers, central corneal thickness, and anesthesia

Cited by 26 publications

References 187 publications

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

Increased Risk of Ocular Hypertension in Patients With Cushing’s Disease

Goniotomy for initial and re-surgery for childhood glaucoma in Northern India

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