Purpose: To introduce a new method, derived from the Glaucoma Staging System (GSS), for classifying glaucomatous visual field defects. Patients and Methods: Four sample groups composed respectively of 471 (sample #1), 128 (sample #2), 185 (sample #3), and 131 (sample #4) patients with either ocular hypertension or chronic glaucoma were considered. The GSS 2 uses both the MD and CPSD/CLV or PSD/LV perimetric indices to classify visual field defect in 6 stages and in 3 types (generalized, localized, and mixed). The formulas were determined using sample #1. A new borderline stage was created, on the basis of sample #2. The relationship between the PSD/LV and CPSD/CLV values was studied on sample #3 to verify the possibility of using the uncorrected indices instead of the CPSD/CLV. The relationship with other classification methods was studied on sample #4. Results: The GSS 2 showed a strong level of association with the AGIS and the Hodapp-Parrish-Anderson methods in staging defect severity. A good correlation was also found with a classification based on the Bebie curve. Conclusions: The GSS 2 was able to correctly classify both damage severity and perimetric defect type in the sample studied, using either the corrected or uncorrected visual field indices. It is a quick and easy method, and its formulas can be introduced in any software.

Purpose To compare the intraocular pressure (IOP) readings taken with the new ICare tonometer and with the Goldmann applanation tonometer (GAT) and to evaluate the influence of central corneal thickness (CCT) on the IOP measurements. Patients and Methods One eye of 178 consecutive patients with primary open-angle glaucoma underwent ultrasonic CCT measurement, followed by IOP evaluation with the GAT and with the ICare tonometer. The deviation of ICare readings from GAT values, corrected according to the Doughty and Zaman formula, was calculated and correlated to CCT by a linear regression model. The agreement between the 2 devices was assessed by use of the Bland-Altman method. Results The average CCT was 552±39 μm. The mean IOP and the mean corrected IOP with GAT were 19.4±5.4 mm Hg, and 18.5±5.7 mm Hg, respectively. The mean ICare IOP reading was 18.4±5.2 mm Hg. The deviations of ICare readings from corrected GAT values were highly correlated with CCT values (r=0.63, P<0.01). Linear regression analysis showed that a CCT change of 10 μm resulted in an ICare reading deviation of 0.7 mm Hg. The Bland-Altman scatter-plot showed a reasonable agreement between the 2 tonometers. Conclusions The ICare tonometer can be useful in a routine clinical setting. The IOP readings are quite in accordance with those obtained by GAT. The measurements seemed to be influenced by CCT variations, and thus pachymetry should always be taken into consideration.

Purpose To investigate short-term effect on intraocular pressure (IOP) after intravitreal injection of ranibizumab (Lucentis) (IVIL). Materials and Methods This prospective study included 1 eye of 54 patients (64±12 y) with wet age-related macular degeneration treated with IVIL. IOP measurements with TonoPen were taken: immediately before and 5 seconds, 5, 10, 15, 30, 60 minutes, and 1 day after IVIL. Axial length (with ultrasound biometry) was assessed in 24 eyes. The analysis included IOP difference at various time points and between phakic and pseudophakic eyes and the relationship between axial length and IOP increases after 5 seconds. Results Mean IOP were 16.3±3.0 mm Hg (range: 12.0 to 21.3), 44.1±10.6 (22.0 to 59.3), 29.0±9.6 (15.0 to 49.0), 25.8±7.9 (16.0 to 45.0), 23.7±6.6 (15.7 to 39.0), 21.9±5.6 (14.7 to 37.0), 18.8±6.1 (10.0 to 35.0), and 16.1±3.0 (11.0 to 21.0), respectively, for time points immediately before, 5 seconds, 5, 10, 15, 30, 60 minutes, and 1 day after IVIL. Differences between before IVIL and after IVIL IOP were statistically significant after 5 seconds, 5, 10, 15, and 30 minutes (P=0.0001); however, were not significant after 1 hour (P=0.064) and 1 day (P=0.449). Differences between phakic and pseudophakic eyes were not significant (P>0.05). The relationship between shorter axial length and IOP increase after 5 seconds was significant (linear regression analysis; R²=0.28, P=0.007). Conclusions IVIL causes a considerable short-term transient rise in IOP. The IOP increase after IVIL can be statistically significant at 0 to 30 minutes after injection in both phakic and pseudophakic eyes, and tends to be greater in shorter eyes.

Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry (GAT); however, this procedure requires local anesthetics, can be difficult in patients with scarce compliance, surgical patients and children, and is influenced by several corneal parameters. Numerous tonometers have been proposed in the past to address the problems related to GAT. The authors review the various devices currently in use for the measurement of intraocular pressure (IOP), highlighting the main advantages and limits of the various tools. The continuous monitoring of IOP, which is still under evaluation, will be an important step for a more complete and reliable management of patients affected by glaucoma.

Purpose: To evaluate precision and accuracy of Corvis-ST, a new noncontact tonometer equipped with a high-speed Scheimpflug technology, which measures intraocular pressure (IOP), central corneal thickness (CCT), and corneal deformation parameters (CDPs). Relationships among IOP, CCT, and CDPs were also assessed. Materials and Methods: This prospective, randomized study included 1 eye of 164 subjects (79 controls and 85 glaucoma patients), which underwent IOP measurements taken 3 times with Goldmann applanation tonometry (GAT) and Corvis-ST in random order. Precision was evaluated using intraclass correlation coefficients. Intermethod agreement was assessed using Bland-Altman method. Relationships amongst IOP, CCT and CDPs were evaluated using linear regression analysis. Results: Corvis-ST intraclass correlation coefficients ranged between 0.95 and 0.99 for IOP and CCT; between 0.17 and 0.97 for CDPs. Mean (GAT−Corvis-ST) IOP was 1.4±2.7 mm Hg, which appeared related to IOP and CDPs (P<0.05). CDPs significantly differed between glaucoma patients and controls (P<0.05). GAT and Corvis-ST IOP was related to CCT (P<0.05) and CDPs (P<0.001). Conclusions: Corvis-ST precision was excellent for IOP and CCT; moderate for CDPs. Corvis-ST underestimated GAT IOP, especially at higher IOP and at lower corneal deformability levels. GAT and Corvis-ST IOP increased in thicker and less deformable corneas. Glaucoma patients showed significantly less deformable corneas than controls.

Canaloplasty is a new nonperforating surgical technique for open-angle glaucoma, in which a microcatheter is inserted within Schlemm’s canal for the entire 360 degrees. A 10-0 prolene suture, which is tied to the distal tip of the microcatheter, is then positioned and left tensioned in Schlemm’s canal, thus facilitating aqueous outflow through natural pathways. A small amount of viscoelastic agent is delivered in Schlemm’s canal while the catheter is withdrawn. The mid-term results are very promising. Based on our cohort of 214 patients, the percentages of eyes that obtained postoperative IOP≤21 mmHg,≤18 mmHg, and≤16 mmHg with or without medical therapy after 2 and 3 years were 88.7%, 73.7%, and 46.2% (2 years); 86.2%, 58.6%, and 37.9% (3 years), respectively. The most frequent complications observed included hyphema; descemet membrane detachment; IOP spikes; and hypotony. The advantages of canaloplasty over trabeculectomy include (1) no subconjunctival bleb; (2) no need for antimetabolites; (3) fewer postoperative complications; and (4) a simplified follow-up. The disadvantages include the following: (1) a long and rather steep surgical learning curve; (2) the need of specific instruments; (3) average postoperative IOP levels tend not to be very low; and (4) impossibility to perform the entire procedure in some cases.