[Show abstract][Hide abstract] ABSTRACT: Purpose: To verify the morning to evening variations of refraction, visual acuity, intraocular pressure and biomechanical parameters on patients operated by radial keratotomy who presented for refractive re-treatments; and to correlate the biomechanical parameters with refraction, visual acuity and their variations among morning and evening. Methods: 19 patients were examined, respectively thirty-eight eyes in the morning (9 am) and evening (6 pm), recording sphere-cylindrical dynamic refraction, visual acuity (logMAR) without correction (AVsc) and corrected (AVcc) and ORA (Ocular Response Analyzer) parameters: corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure calibrated for Goldmann (lOPg) e corneal compensated (lOPcc). Variables had no normal distribution (Kolmogorov-Smirnov test), so that the Wilcoxon signed rank was used for testing the significance on the differences for each variable between morning and afternoon. The Spearman test was used for assessing the correlations between the ORA parameters and refraction, visual acuity in the morning and afternoon, as well as to verify the correlations between the ORA parameters and the variations on refraction and visual acuity. Results: Sphere (E), spherical equivalent (EE), defocus equivalent (ED), AVsc, lOPcc e lOPg varied significantly (Wilcoxon, p<0.05) between morning and evening. There was more hyperopia, worse visual acuity, higher pressure and lower CH in the morning measurements. In the morning measurements, there was a positive correlation (Spearman, p<0.05) between EE and ED and lOPcc (rs=0.39 and 0.34 respectively), but not with lOPg. In the evening measurement, there were no correlations between the refractive and pressure measurements. Negative correlations were observed (Spearman, p<0.05) between AVsc (logMAR) and CH in the morning and in the evening (rs= -0.48 e rs= -0,51), between E and CH in the morning and in the evening (rs= -0.66 and -0.76), between E and CRF in the morning and in the evening (rs= -0.40 and -0.47), between EE and CH in the morning and in the evening (rs= -0.70 and -0.68), between EE and CRF in the morning and in the evening (rs= -0.41 and -0.46), between ED and CH in the morning and in the evening (rs= - 0.64 and -0.54) and between ED and CRF in the morning and in the evening (rs= -0.35 and -0.34). There was a significant negative correlation between the morning measurement of CRF and the variation of defocus equivalent (p = 0.05; rs = -0.30) and the variation of AVsc (p = 0.04; rs = -0.33). Conclusion: More hyperopia was recorded in the morning which was associated with higher compensated pressure (lOPcc) but not with lOPg ten years after RK. Lower biomechanical parameters (CRF e CH) were associated with higher hyperopia and worse visual acuity. A trend was observed for having higher fluctuation on weaker corneas. New studies involving the variables derived from the waveform signals, beyond CH and CRF (derived from the applanation pressures) along with data from corneal tomography and wavefront aberrometry are necessary.
Revista brasileira de oftalmologia 06/2012; 71(3):164-172. DOI:10.1590/S0034-72802012000300005 · 0.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To verify possible correlations between the biomechanical state of the cornea before surgery and the results of stromal ring segments implant for keratoconus. METHODS: Nineteen eyes of 19 patients with keratoconus were evaluated before and 12 months after stromal ring segment implant surgery. The implant of one or two Ferrara ring segments was performed accordingly to the nomogram, considering corneal thickness, ectasy pattern on topography and astigmatism. The Wilcoxon test was performed to verify the differences between visual acuity (logMAR) with correction before surgery (AVccPre) and without correction (AVscPos) and with correction (AVccPos) after surgery, topography variables measured with Pentacam on pre and post operative and corneal biomechanics variables measure with ORA (ocular response analyzer). The absolute differences before and after the surgery (delta values - Δ) of variables with significant differences were calculated. The Δ values were correlated with the ORA measurements pre-operatively using Pearson or Spearman's tests, according with the distribution of the variables to be or not normal (Kolmogorov-Smirnov test). RESULTS: There were significant improvements on AVcc and AVscPos comparing with AVccPre (Wilcoxon test, p<0,05). Significant reduction was observed on keratometric astigmatism (AST), Keratometric central values (K1 and K2), higher keratometric value (KMax) and topometric indices: CKI (Center Keratoconus Index), IHD (Index of Height Decentration) and ISV (Index of Surface Variance) after surgery (Wilcoxon test, p<0.05). There was a significant increase in corneal thickness of 3.8 and 4 mm from the apex toward the temporal horizontal meridian observed a significant increase on cornea thickness, and there was significant downward displacement of the position of KMax (Wilcoxon test, p<0.05). No variable biomechanical statistically significant difference after surgery (Wilcoxon test, p>0.05). The ORA parameters derivate form the aplanation pressure: Corneal Hysteresis (CH), Corneal Resistance Factor (CRF) and the measures of the ocular pressure (IOPg and IOPcc) showed no significant correlations with the parameters delta (Δ). Fifteen of the 38 biomechanical variables derived from the sign of ORA corneal reflex presented significant correlation with at least one parameter Δ, highlighting the correlations between ΔKMax with aindex e path1 (Pearson test, p<0.05; r=-0.56 and 0.56 respectively) and between AVccPre-AVscPos and aindex (Pearson test, p<0.05; r=0.48). The variable that had the greatest number of significant correlations was w21, which correlated negatively with, ΔK2, ΔK1, ΔCKI and ΔKMax (Spearman test, p<0.05; r=-0.56; -0.55; -0.51 and -0.47) respectively. CONCLUSION: There is a significant improvement in visual acuity and keratometric parameters after surgery of implant the Ferrara ring segments for keratoconus. The improvement of several of these parameters with the surgery was significantly correlated with biomechanical characteristics derived from the signal of the ORA corneal reflex preoperatively. A biomechanical preoperative state "weaker" or "less resistant" was significantly related to greater clinical benefit of surgery. Analysis with multiple associations (multivariate) is necessary, including topographic parameters of the cornea and wavefront analysis of preoperative total. This information opens up new horizons for patient selection and planning of ring segments implant surgery for keratoconus.
Revista brasileira de oftalmologia 04/2012; 71(2):89-99. DOI:10.1590/S0034-72802012000200004 · 0.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate central corneal thickness (CCT) and ocular biomechanical properties in patients before and after clear corneal phacoemulsification.
Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments) in 36 consecutive patients (47 eyes) who underwent clear corneal phacoemulsification. Central corneal thickness was measured with the Pentacam (Oculus Optikgeräte GmbH). All measurements were performed prior to surgery and at follow-up at 1, 7, and 30 days postoperatively.
Central corneal thickness was higher at 1 and 7 days compared to preoperatively (P<.05) but not at 30 days. Corneal hysteresis was lower at 1 day than preoperatively (P<.05) but not at 7 and 30 days. Corneal resistance factor was lower at 1, 7, and 30 days compared to preoperatively (P<.05). Corneal-compensated IOP was slightly lower at 1, 7, and 30 days compared to preoperatively, but was not statistically significant (P>.05). Goldmann-correlated IOP was statistically significantly lower at 1 and 7 days than preoperatively (P<.05).
Clear corneal phacoemulsification led to a change in ocular biomechanical properties. The increase in CCT after phacoemulsification was followed by a reduction in CRF and CH. Mean IOPcc was similar before and after phacoemulsification, indicating that IOPcc may be a more accurate indicator of true IOP than IOPg.
Journal of refractive surgery (Thorofare, N.J.: 1995) 11/2011; 28(3):215-9. DOI:10.3928/1081597X-20111103-02 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate ocular pulse amplitude (OPA) using the dynamic contour tonometer (DCT) in patients with asymmetric primary open-angle glaucoma (POAG) and asymmetric intra-ocular pressure (IOP).
The participants consisted of 48 patients (96 eyes) with asymmetric POAG. Three measurements of IOP and OPA were taken using DCT. The diagnosis of asymmetry required a difference of glaucomatous visual field loss greater than 6 dB in the global index MD and a difference of 5 mmHg in IOP measured by Goldmann tonometry between the more affected and the contra-lateral eye. All participants underwent full ophthalmologic clinical assessment including ultrasonic pachymetry and biometric measurements. Exclusion criteria were corneal diseases or scars, topical or systemic glaucomatous medications, and previous ocular surgery.
No difference (p = 0.142) was found between the axial length measurements of the better eyes group (22.95 ± 0.91 mm) and worse eyes group (22.85 ± 0.97 mm). There was a statistically significant difference (p = 0.011) between the central corneal thickness values of the better eyes group (537.08 ± 29.54 μm) and worse eyes group (534.40 ± 29.87 μm). The OPA values of the better eyes group (3.32 ± 1.14 mmHg) were significantly lower (p = 0.001) than those obtained in the worse eyes group (3.83 ± 1.27 mmHg). When correcting the OPA readings by the IOP there was no statistical difference between groups (p = 0.996).
Higher OPA values were found in eyes with higher IOP levels and advanced glaucoma's lesions in asymmetric hypertensive POAG patients. However, after the OPA correction by the IOP levels there was no more statistical difference between eyes.
Current eye research 08/2011; 36(8):727-32. DOI:10.3109/02713683.2011.584652 · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare corneal hysteresis (CH) and corneal resistance factor (CRF) in eyes with keratoconus with a central corneal thickness (CCT) ≥ 520 μm with CH and CRF in matched controls, and to estimate the sensitivity and specificity of these parameters for discriminating between the two groups.
This prospective, comparative case series comprised 19 eyes of 19 patients with keratoconus with CCT ≥ 520 μm and 19 eyes of 19 healthy sex-, age-, and CCT-matched patients who underwent a complete clinical eye examination, corneal topography, tomography, and biomechanical evaluation. The receiver operating characteristic (ROC) curve was used to identify cutoff points that maximized the sensitivity and specificity for discriminating between groups.
Central corneal thickness was 543.1 ± 13.9 μm (range: 520 to 568 μm) in the keratoconus group and 545 ± 12.5 μm (range: 527 to 575 μm) in the control group (P=.6017). Corneal hysteresis was 9.22 ± 1.44 mmHg (range: 6.2 to 11.35 mmHg) in the keratoconus group and 10.58 ± 1.91 mmHg (range: 7.34 to 13.53 mmHg) in the control group (P=.0075). Corneal resistance factor was 8.62 ± 1.52 mmHg (range: 5.60 to 11.20 mmHg) in the keratoconus group and 10.30 ± 1.92 mmHg (range: 6.95 to 14.12 mmHg) in the control group (P=.0049). The ROC curve analyses showed a poor overall predictive accuracy of CH (cutoff, 9.90 mmHg; sensitivity, 78.9%; specificity, 63.2%; test accuracy, 71.05%) and CRF (cutoff, 8.90 mmHg; sensitivity, 68.4%; specificity, 78.9%; test accuracy, 73.65%) for detecting keratoconus in the eyes studied.
Corneal hysteresis and CRF were statistically lower in the keratoconus group compared with the control group. Given the large overlap, both CH and CRF had low sensitivity and specificity for discriminating between groups.
Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2011; 27(3):209-15. DOI:10.3928/1081597X-20100415-02 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in healthy eyes with a central corneal thickness (CCT) < 505 µm with CH and CRF in gender-, age-, and CCT-matched keratoconus cases, and to estimate the sensitivity and specificity of these parameters for discriminating between the two groups.
Prospective, comparative case series. In total 46 eyes from 30 healthy patients with CCT < 505 µm, and 42 eyes from 30 CCT-, gender- and age-matched keratoconus cases were enrolled. Biomechanical metrics (CH and CRF) were measured using the Ocular Response Analyzer (ORA) and then compared. A receiver operating characteristic (ROC) curve was used to identify cut-off points to maximize the sensitivity and specificity for discriminating between the groups.
The CCT was 485.96 ± 17.61 µm (range, 438 - 505) in healthy thin corneas and 483.64 ± 16.19 µm (range, 452 - 505) in keratoconus; p=0.5225. CH was 8.63 ± 1.23 mmHg (range, 5.95 - 12.2) and 8.07 ± 1.17 mmHg (range, 4.9 - 9.85), respectively; p=0.0312. CRF was 8.43 ± 1.29 mmHg (range, 5.45 - 11.10) and 7.22 ± 1.34 mmHg (range, 4.7 - 9.45), respectively; p<0.001. ROC curve analysis showed a poor overall predictive accuracy of CH (cut-off, 8.95 mmHg; sensitivity, 63%; specificity, 23.8%; test accuracy, 44.30%) and CRF (cut-off, 7.4 mmHg; sensitivity, 28.3%; specificity, 40.5%; test accuracy, 34.12%) for detecting keratoconus in the eyes studied.
CH and CRF were statistically lower in keratoconus than in healthy thin corneas. However, CH and CRF offered very low sensitivity and specificity for discriminating the groups.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the sensitivity, specificity, and test accuracy of corneal biomechanical metrics and anterior segment data in differentiating keratoconus from healthy corneas.
Comparative case series. Patients with and without keratoconus (gender and age-matched) were submitted for complete eye examinations including corneal hysteresis (CH) and corneal resistance factor (CRF) as measured by the Ocular Response Analyzer and anterior segment data as gathered through Pentacam assessments. The anterior segment data measurement included average central keratometric readings (K-Ave), corneal astigmatism (CA), central corneal thickness (CCT), anterior chamber depth (AC depth) and corneal volume (CV). All parameters were assessed, compared and analyzed. A receiver operating characteristic (ROC) curve was used to identify the best cutoff point by which to maximize the sensitivity and specificity of discriminating keratoconus from normal corneas for each data category.
Seventy seven eyes from forty three patients (24 male, 19 female) with keratoconus and eighty six eyes from forty three (24 male, 19 female) healthy controls were enrolled. ROC curve analysis showed poor overall predictive accuracy for all studied parameters in differentiating keratoconus from normal corneas. The highest sensitivity (79.2%) was obtained for both AC depth and CH (cutoff points 3.22 mm and 9.39 mmHg respectively). The best specificity (89.5%) and test accuracy (80.34%) were obtained for CA (cutoff point of 2.2 D).
When considered together, studied parameters showed statistical differences between groups. However, when considered independently they presented low sensitivity, specificity and test accuracy in differentiating keratoconus from healthy corneas.
[Show abstract][Hide abstract] ABSTRACT: To assess the effect of electroacupuncture (EA), akin to percutaneous electroneurostimulation, on pain and biochemical measures during and after inguinal hernia repair.
Thirty-three patients were randomised to EA (n=16) or sham transcutaneous electrical nerve stimulation (TENS) control (n=17). EA was applied at different frequencies, through needles inserted around the incision, over selected peripheral nerve branches and in the ear, from 30 min before surgery until the end of surgery, when needles were removed. All patients also received routine sedation and local anaesthesia.
There was no difference between the pain scores in the groups receiving EA and sham TENS in the immediate postoperative period, which may be owing to adequate levels of analgesia from conventional techniques. On the fourth and seventh postoperative days, less pain and lower consumption of analgesic drugs were reported in the treatment group. Seroma occurred more frequently in the control group, which also had higher glucose blood levels in the immediate postoperative surgery period. The single case of chronic postoperative pain occurred in the control group.
The sample size was too small to draw any conclusions about the effect of EA on pain and other parameters following inguinal hernia surgery, but our observations suggest that future studies in this area are justified.
Acupuncture in Medicine 06/2010; 28(2):65-70. DOI:10.1136/aim.2009.000570 · 1.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare corneal hysteresis (CH), corneal resistance factor (CRF), spherical equivalent (SE), average central keratometry (K-Avg), corneal astigmatism (CA), corneal volume (CV), anterior chamber (AC) depth, and central corneal thickness (CCT) between patients with mild keratoconus and healthy controls and to estimate the sensitivity and specificity of CH and CRF in discriminating mild keratoconus from healthy corneas.
Comparative case series.
Sixty-three eyes (40 patients) with mild keratoconus (group 1) and 80 eyes from 40 gender- and age-matched controls (group 2).
Patients underwent a complete clinical eye examination, corneal topography (Humphrey ATLAS; Carl Zeiss Meditec, Dublin, CA), tomography (Pentacam; Oculus, Wetzlar, Germany), and biomechanical evaluations (ocular response analyzer; Reichert Ophthalmic Instruments, Depew, NY). The receiver operating characteristic (ROC) curve was used to identify cutoff points that maximized sensitivity and specificity in discriminating mild keratoconus from normal corneas.
Corneal hysteresis, CRF, SE, K-Avg, CA, CV, AC depth, and CCT. The diagnostic performance of CH and CRF for detecting mild keratoconus was assessed using the ROC curve.
In group 1 versus group 2, the SE values (mean+/-standard deviation) were -3.55+/-2.87 diopters (D) versus -1.46+/-3.09 D (P = 0); K-Avg, 45.09+/-2.24 versus 43.24+/-1.54 D (P = 0); CA, 3.15+/-1.87 versus 1.07+/-0.83 D (P = 0); CV, 57.3+/-2.12 versus 60.86+/-3.39 mm3 (P = 0); AC depth, 3.19+/-0.35 versus 3.05+/-0.43 mm (P = 0.0416); CCT, 503+/-34.15 versus 544.71+/-35.89 microm (P = 0); CH, 8.50+/-1.36 versus 10.17+/-1.79 mmHg (P = 0); CRF, 7.85+/-1.49 versus 10.13+/-2.0 mmHg (P = 0). The ROC curve analyses showed a poor overall predictive accuracy of CH (cutoff, 9.64 mmHg; sensitivity, 87%; specificity, 65%; test accuracy, 74.83%) and CRF (cutoff, 9.60 mmHg; sensitivity, 90.5%; specificity, 66%; test accuracy, 76.97%) for detecting mild keratoconus.
The values for CH, CRF, CV, and CCT were statistically lower and those for SE, K-Avg, CA, and AC depth were statistically higher in patients with mild keratoconus compared with controls. Corneal hysteresis and CRF were poor parameters for discriminating between mild keratoconus and normal corneas.
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[Show abstract][Hide abstract] ABSTRACT: To evaluate and compare tomographic, clinical, and biomechanical data of patients with unilateral keratoconus and healthy controls.
Observational, case-control study. Complete clinical eye examination was followed by topographic (ATLAS), tomographic (Pentacam), and biomechanical (Ocular Response Analyzer) evaluation. Cases were sex- and age-matched with healthy individuals for controls.
Four patients had unilateral keratoconus, and eight healthy patients served as controls. Central corneal thickness was 508±16 μm in the keratoconus group, 531±12.7 μm in the fellow eye group, and 528.6±40.7 μm in the control group (P>.125, all comparisons). Central keratometry was 43.70±2.70 diopters (D) in the keratoconus group, 42.84±1.43 D in the fellow eye group, and 43.81±1.94 D in the control group (P>.45, all comparisons). Corneal astigmatism was 3.30±2.24 D in the keratoconus group, 1.38±1.49 D in the fellow eye group, and 1.34±1.13 D in the control group (P=.037 between the keratoconus and control groups; P=.25 between the keratoconus and fellow eye groups). Corneal hysteresis was 8.13±2 mmHg in the keratoconus group, 8.96±0.86 mmHg in the fellow eye group, and 9.89±1.33 mmHg in the control group (P>.064, all comparisons). Corneal resistance factor was 7.96±2.43 mmHg in the keratoconus group, 8.92±1.39 mmHg in the fellow eye group, and 9.90±2.24 mmHg in the control group (P>.33, all comparisons).
Corneal hysteresis and corneal resistance factor values were not statistically different among the groups; however, a trend for lower values was found for keratoconus and fellow eyes compared to controls. Data should be interpreted with caution because of the small sample.
Journal of refractive surgery (Thorofare, N.J.: 1995) 11/2009; 26(9):677-81. DOI:10.3928/1081597X-20091105-04 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate corneal biomechanical metrics with tomographic parameters (given by the Oculus Pentacam) and refractive data in a population of healthy Brazilian patients.
Observational, cross-sectional study of 150 consecutive patients (53 men and 97 women; 260 eyes). Age, gender, central keratometric readings (central K), central corneal thickness (CCT), anterior chamber depth (ACD), spherical equivalent refraction, corneal hysteresis, and corneal resistance factor (CRF) were assessed and analyzed.
Mean patient age was 46.5+/-21.04 years, average central K was 43.59+/-1.54 diopters (D), CCT was 545.05+/-35.41 microm, ACD was 2.96+/-0.52 mm, spherical equivalent refraction was -1.16+/-3.48 D, corneal hysteresis was 10.17+/-1.82, and CRF was 10.14+/-1.8 (range: 5.45 to 15.1). Mean CRF and corneal hysteresis were distinct among gender: CRF 10.326 in women and 9.810 in men (P=.0266); corneal hysteresis 10.421 in women and 9.727 in men (P=.0031). A negative correlation was found between both CRF and corneal hysteresis with age (r=-0.1255, P=.0434; and r=-0.2445, P=.0001, respectively). No association was found between CRF and average central K (r=0.0633, P=.3086), ACD (r=-0.0474, P=.4498), or spherical equivalent refraction (r=0.1028, P=.1061). Corneal hysteresis was not associated with age and average central K (r=0.0572, P=.3573), ACD (r=0.0060, P=.9236), or spherical equivalent refraction (r=0.0975, P=.1253). Corneal resistance factor and corneal hysteresis were positively associated with CCT (r=0.5760, P=0; and r=0.4655, P=0, respectively).
Corneal biomechanical metrics of healthy Brazilian patients were associated with CCT, gender, and age. Corneal steepness, ACD, and spherical equivalent refraction did not affect comeal hysteresis and CRF values in the studied population.
Journal of refractive surgery (Thorofare, N.J.: 1995) 12/2008; 24(9):941-5. · 3.47 Impact Factor