RomJOphthalmol 59 252

Romanian Journal of Ophthalmology, Volume 59, Issue 4, October-December 2015.
pp:252-254
GENERAL ARTICLE
Corneal hy stere sis and primary ope n

angle glaucoma
Dascalescu Dana*, Constantin Mihaela**, Iancu Raluca***, Cristea Miruna*,
Ionescu Catalina*, Cioboata Miruna*, Speranta Schmitzer*, Corbu Catalina*
*Clinical Ophthalmology Emergency Hospital Bucharest, **Oftaclinic Clinic Bucharest,
***University Emergency Hospital Bucharest
Correspondence to: Catalina Corbu,

Mobile phone: 0722 674 076, E-mail: carol_corbu@yahoo.com, mailing address danadascalescu@yahoo.com
Accepted: October 10, 2015
Abstract
Objects: To investigate the variability of the corneal hysteresis in primary open angle
glaucoma(POAG) patients.
Material and Methods: Out of 123 eyes, 99 carried out the inclusion criteria and were
investigated further using Goldman Aplanotonometer to measure intraocular
pressure(IOP), Ocular Response Analyzer(ORA) in order to determine corneal hysteresis
(CH) and corneal resistance factor(CRF), ultrasonic pachimetry (Ocuscan) to measure
central corneal thickness(CCT) and Humphrey visual field to determine mean
deviation(MD), pattern standard deviation(PSD) and visual field index(VFI). The patients
were divided into two groups: one group of diagnosed POAG patients and one control
group of healthy individuals. Statistical analysis was performed using descriptive
analyses and linear regression.
Results: A considerable statistic correlation was found between CH and VFI both in the
group of primary open angle glaucoma patients(r=0.52, P<0.0001), and the control
group (r=0.22, p<0.04).
Conclusions: The study shows a positive correlation, statistically significant, between
corneal hysteresis and visual field index both in glaucoma patients and control subjects
proving that a lower CH associates with a lower VFI. Ocular response analyzer can be
considered a useful instrument in evaluation of primary open angle glaucoma patients.
Key words: glaucoma, hysteresis, cornea
Introduction CCT represent a risk factor for the progression of

glaucoma progression independent on the IOP
Glaucoma represents the second leading [7].
cause of blindness in the world [1] determining Corneal hysteresis (CH) does not represent
progressive visual field damage associated with an intrinsic corneal property, it measures the
variable optic nerve head changes [2]. ability of the cornea to absorb and dissipate
Cornea is known as a viscoelastic system energy [6]6. In this way, CH can help physicians
that can be defined trough its physical predict how the eyes will react to high
dimensions (central corneal thickness (CCT)) intraocular pressure (IOP) and which eyes are
and behavior (biomechanics) [6]. Studies such as more susceptible to optic nerve head damage
Ocular Hypertension Treatment Study show that
and visual field loss.
252 Romanian Society of Ophthalmology

© 2015
Romanian Journal of Ophthalmology 2015;59(4): 252-254
Key words: glaucoma, hysteresis, risk, one (r=0.38, p<0.0001) for the first group and
progression the second group(r=0.39, p<0.02). Corneal
hysteresis also correlates positively with mean
deviation (p=0.63, p<0.0001) and (p=0.67,
Objectives p<0.0001) respectively. Correlation between
corneal hysteresis and visual field index is also
To investigate the role of corneal hysteresis
positive in both groups: (r=0.52, P<0.0001) for
in primary open angle glaucoma (POAG) patients
POAG group (Fig. 2) and (r=0.22, p<0.04) for the
and to find a way to identify those patients that
control group.
have a higher risk of glaucoma progression over
time.
Materials and Methods

This was an observational study that
included 99 eyes that were divided into two
groups: first group contains 37 eyes diagnosed
primary open angle glaucoma while the second
group contains 21 healthy eyes.
All patients underwent a complete
ophthalmologic examination which included
anamnesis, visual acuity measurement with and Fig. 1. Linerar regression analyzis showing a
without correction, slit lamp examination of the negative correlation between CH and IOP in POAG
anterior pole, intraocular pressure measurement patients
using Goldman aplanotonometer, gonioscopic
examination, computerized perimetry using
Humphrey perimeter strategy 24-2 followed by
Ocular Response Analyzer measurement,
ultrasonic pachimetry, instillation of mydriatics
and fundus examination.
For statistical analysis we used descriptive
analysis and frequency tests, means and linear
regression.
Results
The means of IOP in the first group was Fig. 2. Linerar regression analyzis showing a
19mmHg ± 5.31mmHg, while in the second positive correlation between CH and VFI in POAG
group was 17mmHg ± 2.97mmHg. Means of CH patients
was 9.85 ± 1.96 in POAG group and 11.0 ± 1.51 in
the control group, while means of CRF was 10.3
± 1.77 in the first group and 11.6 ± 1.65 in Discussions
second group. Means of CCT was 547µ ± 39.55 µ
in POAG group and 575µ ± 39.80 µ in the control There are many studies which clarify the
group. implication of the central corneal thickness in
A considerable negative statistic primary open angle glaucoma. Although in the
correlation was found between CH and IOP both past it was considered that the progression and
in the group of primary open angle glaucoma the prognosis of the glaucoma are influenced by
eyes (r=-0.27, p<0.0001) (Fig. 1)., and the CCT, recent studies centered on the involvement
control group (r=-0.53, p<0.0001), The of the biomechanical properties showed that a
correlation between CH and CCT was a positive low corneal hysteresis represents a risk factor in
253
Romanian Society of Ophthalmology
© 2015
Romanian Journal of Ophthalmology 2015;59(4): 252-254
glaucoma progression and in the advancement of Mar;153(3):419-427.e1. doi:

the visual field deficit, no matter the central 10.1016/j.ajo.2011.08.022. Epub 2011 Oct 21.
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are considerably lower in primary open angle Arch Ophthalmol. 2002;120(6):714–20. discussion
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literature our research shows a positive thickness as a risk factor for advanced glaucoma
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6. Madhvi Deol, David Taylor, Nathan Radcliffe, Corneal
the corneal hysteresis and visual field hysteresis and its relevance to glaucoma. Curr Opin
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that those eyes that have lower corneal Identification of Biomechanical Properties of the
Cornea:The Ocular Response Analyzer. Curr Eye Res
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8. Nathan Radcliffe. Hysteresis: a powerful tool for
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represents a risk factor in glaucomatous eyes, prostaglandin analogs on the biomechanical
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1. http://www.who.int/bulletin/volumes/82/11/featur predict the onset of primary open-angle glaucoma.
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254
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Romanian Journal of Ophthalmology, Volume 59, Issue 4, October-December 2015.

Corneal hy stere sis and primary ope n

Correspondence to: Catalina Corbu,

Accepted: October 10, 2015

Introduction CCT represent a risk factor for the progression of

252 Romanian Society of Ophthalmology

Materials and Methods

glaucoma progression and in the advancement of Mar;153(3):419-427.e1. doi:

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