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Significance This study is the first to show that the manual upper eyelid elevation (manual UEE) that is commonly used to prevent disruption of the IOP measurement due to blinking or upper eyelid contact with the tip of the tonometer does not affect the IOP values. Purpose We investigated whether manual UEE affects the IOP readings using three rebound tonometers (Icare TA01i, Icare PRO, and Icare ic100) and Goldmann applanation tonometry (GAT). Methods One eye was measured for 101 patients (56 eyes of primary open-angle glaucoma patients and 45 healthy subjects). The IOPs were measured without and with manual UEE. Each IOP was measured twice; the measurement order using the tonometers was randomly selected. In addition, palpebral fissure height (distance between the upper and lower eyelids) was measured. Results The IOPs without manual UEE were 12.1 ± 2.9, 13.3 ± 2.7, 11.7 ± 2.9, and 16.0 ± 3.2 mmHg (Icare TA01i, Icare PRO, Icare ic100, and GAT), and those with manual UEE were 12.3 ± 3.0, 13.3 ± 2.8, 11.7 ± 2.9, and 16.0 ± 3.3, respectively. No significant difference was found between the IOP without and with manual UEE (IOP difference; all, P > .50; paired t test). Multiple linear regression analyses revealed that palpebral fissure height did not affect IOP difference for any of the tonometers. Conclusions Simple manual UEE when measuring the IOP has little effect on the IOP obtained using all current rebound tonometers and GAT.

Purpose: To investigate iris morphological features in 360° angle-closure neovascular glaucoma (NVG) by swept-source anterior segment optical coherence tomography (ASOCT). Patients and Methods: In this retrospective, clinic-based, comparative study, 14 patients with 360° angle-closure NVG and 14 healthy age-matched control subjects were enrolled. All patients enrolled had no prior glaucoma surgery but underwent cataract surgery with intraocular lens implantation. Horizontal scanning images of swept-source ASOCT were analyzed using software calipers in temporal and nasal angle areas. The iris thickness at 1 and 2 mm from the pupil edge, iris length, trabecular meshwork length, peripheral anterior synechia (PAS) length, PAS height ratio (PAS length/trabecular meshwork length), and pupil diameter were measured. Results: Between the groups, there were no statistically significant differences in iris length, trabecular meshwork length, and pupil diameter (p > 0.05). However, the iris thickness was significantly reduced in the NVG group compared with the control group in the temporal and nasal areas (0.306 vs. 0.563 mm/0.326 vs. 0.645 mm at 1 mm, 0.278 vs. 0.523 mm/0.282 vs. 0.546 mm at 2 mm, respectively) (mean, all p < 0.001). In the NVG group, PAS height ratios were 1.55 ± 0.45 (mean ± standard deviation) (range, 0.58–2.30) and 1.55 ± 0.78 (range, 0.68–3.68) at the temporal and nasal angles, respectively. Conclusions: In patients with 360° angle-closure NVG, the iris thickness decreased to about 50% of that in healthy subjects, and the PAS length exceeded the trabecular meshwork length by about 1.5 times.

PURPOSE To investigate the iris thickness (IT) in neovascular glaucoma (NVG) using swept-source anterior-segment optical coherence tomography (ASOCT). PATIENTS AND METHODS In this retrospective, clinic-based, comparative study, we enrolled 20 NVG patients [11 with 360-degree angle-closure (AC)-NVG and 9 with NVG without AC] and 14 healthy age-matched controls. Horizontal scanning images of swept-source ASOCT were analyzed using software calipers in temporal and nasal angle areas. ITs at 1 and 2 mm from the pupil edge were measured using ASOCT. The relation between IT and the severity of NVG, the effects of intraocular pressure (IOP), intravitreal antivascular endothelial growth factor (anti-VEGF) injection, and panretinal photocoagulation (PRP) were assessed using linear regression analysis based on the corrected Akaike information criteria index. RESULTS The IT was thinner in 360-degree AC-NVG patients, followed by NVG patients without AC and controls (0.33 vs. 0.48 vs. 0.57 mm at 1 mm and 0.31 vs. 0.43 vs. 0.49 mm at 2 mm; P

We evaluated the agreement between the intraocular pressure (IOP) values of new rebound tonometer, Icare ic100, and Icare TA01i or Goldmann applanation tonometer (GAT).We studied one eye each of 106 subjects (57 with primary open-angle glaucoma, 49 healthy subjects). IOP was randomly measured twice with the patient in sitting position using the Icare ic100, Icare TA01i, and GAT. Tonometer measurements were evaluated using Bland-Altman analysis. The relationship between IOP difference (Icare ic100-GAT) and age, sex, disease, axial length, central corneal thickness (CCT), and corneal curvature was investigated using multivariate regression analysis.IOPs measured using Icare ic100, Icare TA01i, and GAT were 11.7±3.0 (mean±standard deviation), 12.2±2.9, and 16.0±3.2 mm Hg, respectively (P0.001, one-way analysis of variance). Icare ic100 showed significantly lower IOPs than GAT (P0.05), but not than Icare TA01 (P0.05; Tukey-Kramer test). Bland-Altman analysis revealed that the mean differences between Icare ic100 and Icare TA01i and those between Icare ic100 and GAT were -0.46 and -4.2 mm Hg, respectively (95% limits of agreement, -3.35 to 2.42 and -10.10 to 1.61 mm Hg, respectively). For IOP differences between Icare ic100 and GAT, parameters selected in the optimal model were CCT (coefficient, 20.3, P=0.029), corneal curvature (3.0, P=0.020), and glaucoma-normal (-1.0, P=0.004).The new rebound tonometer Icare ic100 almost constantly showed IOPs lower than GAT. The difference was affected by CCT, corneal curvature, and disease.

We investigated the detailed time course of conjunctival hyperemia induced by ripasudil 0.4%, a novel Rho-kinase inhibitor anti-glaucoma eye drop, in healthy subjects.We recruited 51 healthy subjects and administered ripasudil 0.4% in their right eye. We evaluated conjunctival hyperemia using slit lamp photography and measured the intraocular pressure (IOP) using the Icare PRO Rebound Tonometer at baseline and after 5, 15, 30, 60, 90, and 120 min. The conjunctival hyperemia score was graded by three independent observers on a scale of 0 (none) to 3 (severe). Additionally, we analyzed the "percent coverage" of conjunctival hyperemia by using an automated hyperemia analysis software program; this program provides the pixel coverage of the conjunctival vessels in the region of interest. Dunnett and Steel multiple comparison tests were used, as appropriate, for the subsequent analyses.The conjunctival hyperemia score and percent coverage increased rapidly after the instillation of ripasudil 0.4%, peaking at 15 min (score: 1.83 ± 0.29 [mean ± SD]) and 5 min (11.6% ± 4.7%), respectively, and then gradually decreasing until 120 min (0.45 ± 0.22 and 4.7% ± 1.8%, respectively), when they reached a level that was not significantly different from the baseline values. The IOP decreased significantly compared to the baseline at 30, 60, and 90 min, based on the Dunnett test.Conjunctival hyperemia induced by ripasudil 0.4% peaks rapidly to moderate severity, but subsides relatively quickly.