PubMed Health⌕ Search

Biomedical subjects

S Pourjavan

Publications and source records attributed to S Pourjavan.

5 recordsLinked to original sources
PubMed2006

[Clinical evaluation of the dynamic rebound tonometer Icare].

PURPOSE: The Icare dynamic tonometer (impact or Rebound tonometry) is a new tonometer based on making a moving object collide with an eye and on monitoring the motion parameters of this object following contact. The purpose of this study was to assess intra- and interobserver variability of IOP measurements with the Icare and their correlations with Goldmann applanation tonometry (GAT) and central corneal thickness (CCT). MATERIAL AND METHODS: A prospective study including three groups of patients: group 1 (50 normal subjects), group 2 (50 patients with OHT or POAG and GAT IOP>22 mmHg), and group 3 (38 glaucomatous patients with GAT IOP< or =22 mmHg). In group 1, three consecutive IOP measurements were taken by three distinct observers with Icare followed by three GAT measurements by the same clinician. In group 2, the same procedure was followed from patients 1 to 25 and the reverse sequence from patients 25 to 50 after a 10-min break. In group 3, only one clinician took three GAT measurements followed by three Icare measurements after a 10-min break to exclude a tonographic effect in eyes with statistically normal-range IOPs. RESULTS: : In group 1, intraobserver variability was about 6% for each observer (NS). There was no learning curve effect. The interobserver variation coefficient was 6.4%. Icare overestimated IOP compared to GAT (mean difference, 1.5-2.2 mmHg) (p<0.001). Icare IOP was 23.4 mmHg for observer 1 when GAT was 22 mmHg (95% individual CI, 18-28.9 mmHg). In group 2, intraobserver variation coefficients of the IOP ranged from 5% to 5.4% (NS). Icare overestimated IOP by mean 0.84 mmHg compared with GAT. In group 3, mean IOP was not different between Icare and GAT. Icare IOP of 20.7 mmHg corresponded to a value of 22 mmHg using GAT. In this group, correlations between CCT and IOP measurements were higher for Icare than for GAT (p=0.062). CONCLUSION: Icare measures IOP in an unanesthetized sitting patient in a very brief time. Patient's minimal cooperation is needed. As long as the device is correctly positioned, the learning curve is short. Icare gives reproducible IOP measurements. Intra- and interobserver variability of IOP measurements are close to those of GAT. Icare overestimates IOP measurements an average 1.5 mmHg compared with GAT. Whatever the IOP level, Icare IOP measurements are well correlated with GAT. To a greater extent than for GAT, the reliability of IOP measurements is influenced by CCT. This tonometer can be used as a screening device for ocular hypertension as long as CCT measurements can be taken.

Equipment Design↗
PubMed2006

Comparative safety profile between "modern" trabeculectomy and non-penetrationg deep sclerectomy.

PURPOSE: To compare the incidence and the severity of short-and medium-term complications following "modern" trabeculectomy (mTRAB) with non-penetrating deep sclerectomy (NPDS). MATERIALS AND METHODS: Comparative retrospective nonrandomized study including 65 eyes (55 patients) (mean age: 68.6 years) with medically uncontrolled glaucoma. mTRAB was performed in 43 eyes, NPDS in 22 eyes. mTRAB was performed according to a slightly modified P.T. Khaw protocol. NPDS procedures were done according to Kozlov's and Mermoud's technique with SKGEL implant in 18/22 eyes. Intraoperative antimetabolites (AMETAB) were given in 25 eyes (58%) in the mTRAB and 17 (77%) in the NPDS (p>0.05). RESULTS: Mean follow-up was longer in NPDS (10.7+/-5.5 months) than in mTRAB (8.5+/-3.4 months) (p<0.05). Preoperatively, the two groups were comparable in respect of age, type of glaucoma, mean IOP, severity of VF defects and bleb failure risk factors (p>0.05). Peroperatively, mTRAB were uneventful in 86% vs 90% of NPDS. 1st month postop complications occurred in 60.4% in mTRAB and 77.2% in NPDS (P>0.05). Most of them were minor and transient in both surgeries. Postop early anterior chamber inflammation was mild to moderate in all cases. The incidence of wound leaks (21% in the mTRAB group and 18% in the NPDS group) and hyperfiltration related complications (14% and 13.6% respectively in the mTRAB and NPDS group) were comparable between the two procedures (p > 0.05). Intraoperative antimetabolite application was not associated with an increased rate of postoperative hyperfiltration related complications. Scarring of filtration blebs had concerned a lower percentage of mTRAB eyes (19%) than the NPDS (36%). The number for 5-FU injections was less - although not significantly - in the mTRAB than in the other group (18.6% in mTRAB versus 41% in NPDS (p=0.05). Late complications were not observed in the mTRAB group. Iris prolapse associated with increased IOP occurred in 3 of the 22 NPDS procedures (13.6%). Final mean visual acuity was unchanged compared with preop value and was similar between the 2 groups (p>0.05). Diffuse, mildly vascularized filtration blebs were observed in 84% in mTRAB and 64% in DS (p>0.05). Mean IOP significantly decreased from 24.8+/-8.3 mm Hg to 13.4+/-4,3 mm Hg in mTRAB and from 25.1+/-6.5 mm Hg to 14.7+/-4.6 mm Hg in DS (p> 0.05). It was not different between the 2 groups with and without AMETAB augmentation. 70% of the mTRAB achieved a final IOP < or = 15 mmHg vs 41% in NPDS (p<0.05). The mean number of postop medications was 0.49 in mTRAB and 0.96 in NPDS (p<0.05). Complete (target IOP reached without meds) and qualified (target IOP reached with and without meds) final success rates were 60% and 88% in mTRAB and 36.4% and 68.2% in NPDS (p>0.05). CONCLUSIONS: Whether surgery was augmented with intraoperative antimetabolite or not, mTRAB revealed as a priority to be associated with comparable and even less complications than deep sclerectomy. Owing to the limitations of our study and until further confirmation, our results have suggested that mTRAB was associated with a slightly more important IOP reduction as well as higher success rates than NPDS.

Adolescent↗
PubMed2005

Short term experience with "modern" trabeculectomy augmented with intraoperative antimetabolites.

PURPOSE: Owing to its technical refinements, "modern" trabeculectomy aims to reduce the incidence and severity of early postoperative complications while increasing postop IOP success. The purpose of our study was to evaluate namely the safety of "modern" trabeculectomy, the quality of the filtration blebs, the influence on the quality of life and secondarily IOP reduction according to the surgical procedure whether augmented with peroperative application of antimetabolites or not. MATERIAL-METHODS: Retrospective study including our 45 first consecutive procedures in 38 patients (mean age: 61.1 years) with medically uncontrolled various glaucomas. All procedures were performed according to a modified P. Khaw's protocol. Antimetabolites were applied peroperatively in 28/45 eyes (62.2%) with a history of previous filtering surgery (12/28 eyes) and/or advanced glaucomatous damage (22/28 eyes). Antimetabolites were not used in the 17/45 other eyes with lower surgical risk factors and higher target IOP, surgical procedure was not augmented with antimetabolites. Postoperative management included laser suture lysis, withdrawal of adjustable sutures and 5-FU injections when needed. Complete ocular examination was carried out preoperatively and postoperatively at day 1, 7, at 1, 2 and 3 months and every 3 months thereafter. All patients were questioned for symptoms associated with filtration bleb dysesthesia at the last visit. RESULTS: The mean follow-up was 7.9 +/- 3.3 in the group without antimetbolites and 5.3 +/- 2.2 months in the group with antimetabolites (p < 0.05). Final mean IOP (+/-SD) was significantly lower in the group augmented with antimetabolites (11.2 +/- 4.5 mmHg) compared with the group without antimetabolites (14.9 +/- 3.7 mm Hg) (p < 0.05). Complete and qualified success were respectively 64.3% and 89.3% in the group with antimetabolites and 70.6% and 82.4% in the subgroup without antimetabolites (p > 0.05). 1st month postoperative complications were transient and minor. They occurred in 59% in the group without antimetabolites and in 68% in the subgroup augmented with antimetabolites. Complications had comparable frequency of distribution between the 2 subgroups (p > 0.05). 84% of the filtration blebs (30/45) were diffuse and mildly vascularized. Avascular blebs were noticed in 7 eyes (15.5%) and were not related with the intraoperative application of mitomycin C (p > 0.05). Subjective comfort was good to excellent in 42/45 eyes (93.3%). Mean final visual acuity was not altered compared with preop level (p > 0.05). CONCLUSIONS: Our short term results suggest that the safety of "modern" trabeculectomy augmented with antimetabolites is comparable to those without intraoperative antimetabolites. Filtration blebs were very well tolerated in most patients. The peroperative use of antimetabolites precludes to appreciate if the success rates are due to the use of antimetabolites and/or the technique per se.

Adolescent↗
PubMed2005

Pachymetry before or after applanation tonometry: does it matter?

We examined prospectively 60 healthy volunteers to evaluate if the accuracy of central corneal thickness (CCT) measurement is influenced by Goldmann applanation tonometry (GAT) and vice versa. The sequence of the examinations in the right eye was CCT--GAT--CCT, in the left eye GAT--CCT--GAT and the measurements were done consecutively. Two tonometry and five pachymetry measurements were averaged each time. Pearson correlation coefficients and Bland-Altman plots were used to assess the correlation between the measurements. In the right eye the mean CCT measurement before and after GAT was 565.22 +/- 32.99 micro and 566.04 +/- 33.50 micro (p = 0.34, r = 0.98) respectively. In the left eye the mean GAT before and after pachymetry was 19.38 +/- 4.71 mmHg and 19.16 +/- 4.32 mmHg (p = 0.43, r = 0.86) respectively. The study suggests that the sequence of the two examinations doesn't matter.

Adult↗