Intraocular pressure changes in bronchial asthma patients on treatment with inhalational steroids at a tertiary hospital in Southern Nigeria

To study the efficacy of a single drug in patients with primary open angle glaucoma and ocular hypertension who were receiving timolol XE 0.5%, latanoprost 0.005% and brinzolamide 1% with its discontinuation. Sixty patients with open-angle glaucoma or ocular hypertension who were administered timolol XE, latanoprost, and brinzolamide were studied. One drug consisting of timolol XE, brinzolamide, and latanoprost was discontinued and 8 weeks later, it was resumed. A change in intraocular pressure (IOP) was studied. Mean IOP at baseline and at 8 weeks after discontinuation of each drug was 15.8 ± 1.3 and 17.3 ± 1.4 mmHg in the timolol XE group, 15.8 ± 1.0 and 20.0 ± 1.4 mmHg in the latanoprost group, and 16.0 ± 1.4 and 18.1 ± 1.4 mmHg, respectively. A significant increase in mean IOP was found after drug discontinuation (timolol XE: P = 0.0012; latanoprost: P<0.0001; brinzolamide: P<0.0001). The mean change in IOP by discontinuation of the drug was +1.6 ± 0.9 mmHg (+9.6% ± 5.6%) in the timolol XE group, +4.3 ± 1.7 mmHg (27.4% ± 12.4%) in the latanoprost group, and +2.2 ± 0.9 mmHg (+13.7% ± 6.1%) in the brinzolamide group. The change in the latanoprost group was significantly greater compared with those in the timolol XE and brinzolamide groups (timolol XE: mmHg and percent: P<0.0001; brinzolamide: mmHg and percent: P<0.0001). The IOP change in the brinzolamide group was significantly greater than that in the timolol XE group (mmHg: P = 0.0417; percent: P = 0.0328). No significant difference was observed in mean IOP between before drug discontinuation and at 8 weeks after drug resumption in any group. There was a significant increase in IOP from discontinuation of timolol XE, latanoprost, and brinzolamide in the multiple drug treatment. The hypotensive effect of latanoprost in the combined drug therapy is significantly greater than the effects of timolol XE and brinzolamide.

To study the effect of single drug discontinuation in combined timolol XE 0.5% and latanoprost 0.005% treatment. Fifty patients with open-angle glaucoma or ocular hypertension who had received both latanoprost and timolol XE for at least 6 months were enrolled in this study. Timolol XE and latanoprost were administered once daily, timolol XE in the morning and latanoprost in the evening. Twenty-five patients discontinued timolol XE and the remaining 25 patients discontinued latanoprost. Either latanoprost or timolol XE was discontinued and 8 weeks later it was resumed. A change in intraocular pressure (IOP) was studied. All patients had complete follow-up visits. A significant increase in mean IOP was found following drug discontinuation in the 2 groups. Mean change in IOP 8 weeks after discontinuation of the drug was +1.6±1.2 mmHg (10.3%±8.0%) in the timolol XE group and +4.3±1.6 mmHg (+27.2%±11.8%) in the latanoprost group. The change in the latanoprost group was significantly greater compared with that in the timolol XE group (P<0.0001). There was no significant difference in mean IOP between before drug discontinuation and at 8 weeks after drug resumption in any group. There was a significant increase in IOP from discontinuation of timolol XE and latanoprost. The hypotensive effect of latanoprost in the combined drug therapy is significantly greater compared with timolol XE.

To measure the effect of 1% apraclonidine hydrochloride eyedrops on intraocular pressure (IOP) after cataract surgery. The effects of two different dosage regimens, once before surgery or once before and after surgery, were studied. Patients scheduled for extracapsular cataract extraction and artificial lens implantation were randomly assigned to three groups: group A had a placebo treatment (n = 18), group B had one drop of 1% apraclonidine 1 hour before surgery (n = 16), and group C had one drop of 1% apraclonidine 1 hour before surgery and 1 drop at the end of surgery (n = 17). Two percent hydroxy-propyl-methyl-cellulose was used as the viscoelastic substance. The preoperative IOP and the IOP 6 hours postoperatively in each patient were compared. The paired Student's t test was used to compare IOP before and after surgery. The study design was a randomly assigned, double-masked controlled clinical trial. In group A (placebo) and group B (apraclonidine before surgery), there was a significant increase in IOP (mean IOP increase 11.2 +/- 9.9 mm Hg SD, range -4 to 32, P = .00017, and 9.4 +/- 7.4 mm Hg SD, range -3 to 24, P = .00014, respectively). In group C (apraclonidine 1 hour before and immediately after surgery), the increase in IOP was not significant (mean IOP increase 5.1 +/- 11.5 mm Hg SD, range -10 to 28, P = .084). A postoperative IOP of more than 40 mm Hg applanation tension was reached by two patients in group A, one patient in group B, and two patients in group C. Although 1% apraclonidine eye-drops instilled 1 hour before and immediately after extracapsular cataract extraction with artificial lens implantation may help prevent a statistically significant increase in IOP after the operation, 2 of the 17 patients still had IOPs greater than 40 mm Hg 6 hours postoperatively. Apraclonidine applied only before surgery did not prevent a statistically significant increase in IOP.

Background: Intraocular pressure (IOP) is a critical determinant in the development and progression of glaucoma. Emerging evidence suggests that prolonged smartphone use, particularly involving sustained near-vision tasks, may induce transient elevations in IOP. However, the influence of ambient lighting conditions during smartphone use on IOP changes remains insufficiently explored, especially among healthy young adults who represent a high smartphone-using population. Objective: To assess the effect of smartphone use on intraocular pressure under bright and dark room lighting conditions in healthy young adults. Methods: A comparative cross-sectional study was conducted involving 154 healthy participants aged 15–30 years. Baseline IOP was measured using a non-contact air puff tonometer under standardized bright (300 lux) and dark (100 lux) room conditions. Participants then performed a continuous smartphone reading task for 15 minutes, after which IOP was re-measured in the same lighting environment. Each participant underwent assessments in both lighting conditions with a washout interval. Data were analyzed using SPSS version 27. Paired t-tests were applied to compare pre- and post-reading IOP within each lighting condition, while comparative analysis between bright and dark room post-reading IOP values was performed. Statistical significance was set at p &lt; 0.05. Results: A statistically significant increase in IOP was observed following smartphone use in both lighting conditions (p &lt; 0.001). In the bright room, mean IOP increased from 14.76 ± 2.54 mmHg before reading to 16.78 ± 2.47 mmHg after reading. In the dark room, mean IOP rose from 15.72 ± 2.66 mmHg to 18.92 ± 2.51 mmHg following smartphone use. The post-reading IOP was significantly higher in the dark room compared to the bright room, indicating a greater magnitude of IOP elevation under low-light conditions. Conclusion: Smartphone use resulted in a significant short-term increase in intraocular pressure in healthy young adults, with dark room conditions producing a more pronounced effect than bright environments. These findings highlight ambient lighting as an important modifiable factor during smartphone use and emphasize the need for preventive strategies and further research on long-term ocular health implications, particularly for individuals at risk of glaucoma.

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Intraocular Pressure Changes and Ocular Biometry during Sirsasana (Headstand Posture) in Yoga Practitioners

We investigated changes of intraocular pressure (IOP) according to eye gaze. IOP was significantly elevated in adduction, abduction, and supraduction. However, there was no significant difference between glaucoma and control groups. We assessed changes in IOP according to eye gaze and identified their correlations with various risk factors of glaucoma. In this prospective observational study that included 56 glaucoma patients and 34 healthy participants, we measured IOP in the primary position with a Goldmann applanation tonometry and rebound tonometer. Then, this IOP was measured in abduction, adduction, supraduction using a rebound tonometer. IOP changes according to eye gaze were measured based on the baseline IOP, and IOP changes between glaucoma and the control groups were compared. Correlations between IOP changes and risk factors of glaucoma were evaluated. The baseline IOP was not significantly different between glaucoma and the control groups. Compared with the IOP in the primary position, a significant increase in IOP was 2.3±2.7 mm Hg during abduction (P<0.0001), 0.7±2.7 mm Hg during adduction (P<0.0001), and 1.2±2.8 mm Hg during supraduction (P<0.0001). However, there was no significant difference in the amount of IOP elevation or the ratio of IOP change between glaucoma and the control groups in all gazes. The baseline IOP measured by Goldmann applanation tonometry and IOP changes according to eye gaze showed a significant negative correlation in all gazes. IOP was significantly elevated in adduction, abduction, and supraduction than in the primary position in both the normal and glaucoma groups. However, there was no significant difference of IOP changes between glaucoma and normal groups.

Glaucoma and Intravitreal Steroids

Objective Intraocular pressure (IOP) is essential in maintaining normal function of the eye. High IOP is associated with glaucoma. Many physiological factors, including age and hormones, can cause variation in IOP. This study was designed to investigate IOP changes in postmenopausal women and the associated factors, which included sex hormones and body mass index (BMI). Methods This was a cross-sectional study. Ninety-eight women were recruited: 49 premenopausal women and 49 postmenopausal women. IOPs between the two groups were compared. The influence of estradiol, progesterone, testosterone, and BMI on IOP was analyzed by a multivariate method. P Results The age of the premenopausal group was 47.14±3.93 years and that of the postmenopausal group was 52.10±3.04 years. The other factors in both groups, which included BMI, blood pressure, and central cornea thickness, were not significantly different. The mean IOP in the postmenopausal group was significantly higher than the mean IOP in the premenopausal group (15.26±2.96 mm Hg vs. 14.07±2.65 mm Hg, P=0.04). BMI had a weak positive correlation with IOP in premenopausal women (r=0.31, P=0.03). Estradiol was less likely to influence IOP changes in the postmenopausal group as compared with the premenopausal group (B=−0.021, P=0.002). IOP was not significantly related to progesterone and testosterone levels. Conclusion Menopausal status has a significant effect on IOP, with a significant increase in IOP seen in postmenopausal women as shown by our study. Estradiol was shown to be a protective factor in reducing IOP among postmenopausal women. Through understanding of the influence of postmenopausal status and sex hormones on IOP, glaucoma management may be improved and the target group for disease screening may be more specific. Significance statement Intraocular pressure (IOP) is essential in maintaining normal function of the eye. High IOP is associated with glaucoma. Many physiological factors, including age and hormones, can cause variation in IOP. Menopausal status has a significant effect on IOP, with a significant increase in IOP seen in postmenopausal women as shown by our study. However, changes in IOP with menopausal status do not appear to have any correlation with sex hormone changes, but body mass index had a weak positive correlation with IOP in premenopausal women. Through understanding of the influence of postmenopausal status and body mass index on IOP, glaucoma management may be improved and the target group for disease screening may be more specific.

To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.

RCI001, a novel therapeutic candidate for the treatment of ocular inflammatory diseases, have demonstrated remarkable anti-inflammatory and antioxidant effects in various ocular experimental models. This study was to evaluate the effects of RCI001 on intraocular pressure (IOP) and compare them with those of corticosteroids in experimental mouse models. Experimental mice were randomly divided into naïve, phosphate-buffered saline (PBS), 0.1% dexamethasone (DEX-1), and 1% RCI001 (RCI) groups, and each reagent was pipetted into the right eye of the mouse at 10 μL thrice daily for 5 weeks. In addition, 20 μL of 0.1% dexamethasone was injected subconjunctivally into the right eye once weekly for 5 weeks in the DEX-2 group. The IOP was measured under anesthesia at baseline and twice weekly for 5 weeks. The △IOP (%) was defined as the change in IOP from baseline [△IOP (%) = (IOPweek5-IOPbaseline)/IOPbaseline × 100%]. The anterior segments were clinically and histologically examined. There was no significant increase in IOP and △IOP (%) [values by week 3 (day 21) in any of the groups]. However, IOP and △IOP (%) in the DEX-2 group tended to increase slightly after day 10 compared with baseline. Compared with baseline IOP values, the DEX-1 group showed a statistically significant increase in IOP at weeks 4 and 5, and the DEX-2 group at week 5. The △IOP (%) of the DEX-1 and DEX-2 groups (%) at week 5 were 38.2% ± 5.8% and 38.4 ± 4.6%, respectively. However, the IOP in the RCI group did not increase significantly until week 5. The RCI group did not show notable corneal changes, such as epithelial defects or stromal opacities, at week 5. In addition, hematoxylin and eosin (H&E) staining of corneas in the RCI group revealed healthy corneal epithelial, stromal, and endothelial integrity. Long-term use of RCI001 did not induce significant IOP elevation or ocular surface changes, whereas topical corticosteroids significantly increased the IOP. Therefore, RCI001 may be an effective anti-inflammatory agent with a low risk of drug-induced IOP elevation.

Purpose This study aimed to assess the effectiveness of monocular and bilateral injections of Dexamethasone-21-acetate (Dex-21-Ac) into the murine fornix twice a week as a glucocorticoid-induced ocular hypertension model and investigated potential systemic side effects. Methods Dex-21-Ac was administered twice weekly in three groups: bilateral injections, monocular injections, and a control group receiving the vehicle solution bilateral. After 21 days, enucleated eyes were examined using immunocytochemistry (ICC), and organ histology was performed. Results All groups receiving Dex-21-Ac injections had a significant increase in intraocular pressure (IOP). Monocular injections also resulted in a significant increase in IOP in the fellow eye. The Dex-21-Ac-treated groups showed a bilateral increase in IOP of approximately 8 mmHg, accompanied by elevated expression of alpha smooth muscle actin and fibronectin in the anterior chamber angle. There were no significant changes in weight progression. Hepatic steatosis was observed in all Dex-21-Ac-treated animals, and some suffered from residual neuromuscular blockade under fentanyl anesthesia. Conclusion Bilateral injections of Dex-21-Ac twice a week lead to a significant increase in daytime IOP and fibrotic changes in the trabecular meshwork. Unilateral application has a significant impact on the fellow eye. Local dexamethasone leads to notable systemic effects independent of changes in animal weight. Considering liver damage and associated influence on metabolization, hepatically eliminated injection anesthetics may lead to overdosing and are not recommended. They should be replaced by inhalation anesthesia.

Purpose To compare real‐time intraocular pressure (IOP) in LASIK versus Epi‐LASIK in porcine eyes during flap creation using the Moria 2 microkeratome and the Moria Epi‐KTM epikeratome. Methods Interventional, prospective study of two keratomes: Moria Group (M2) and epipolis laser in situ keratomileusis Group (MEpi‐K). These devices were used to create a lamellar corneal or epithelial flap respectively in freshly enucleated porcine eyes. The IOP changes induced by the procedures were recorded using manometry by direct cannulation with a reusable blood pressure transducer connected to the anterior chamber. Results 7 eyes were included for M2 Group and 10 for the MEpi‐K Group. In the M2 Group the IOP increased during suction phase to a mean value of 122.53±30.40 mm Hg and to 160.52±22.73 mm Hg during cutting phase (mean time: 21.42±7.48 and 15.71±1.88 secs respectively). In the MEpi‐K Group, mean IOP increase was 100.66±18.60 mm Hg during suction phase, 91.38±17.79 mm Hg during cutting phase and 74,37±12.70 during low‐back phase (mean time: 25.79±3.44, 33.68±2.81 and 29.74± 3.11 secs respectively). IOP values in both groups showed statistical significant difference in all comparison (p&lt;0.01). Conclusion Real‐time IOP can be measured during flap creation process using direct manometry in the anterior chamber. Our results show a significant increase in IOP during the surgical procedure in both groups although the IOP increase reached with MEpi‐K epikeratome seems to be lower than M2 microkeratome.

Intraarticular steroid injections are a common first-line therapy for severe osteoarthritis, which affects an estimated 27 million people in the United States. Although topical, oral, intranasal, and inhalational steroids are known to increase intraocular pressure in some patients, the effect of intraarticular steroid injections on intraocular pressure has not been investigated, to the best of our knowledge. If elevated intraocular pressure is sustained for long periods of time or is of sufficient magnitude acutely, permanent loss of the visual field can occur. How does intraocular pressure change 1 week after an intraarticular knee injection either with triamcinolone acetonide or hyaluronic acid? A nonrandomized, nonblinded prospective cohort study was conducted at an outpatient, ambulatory orthopaedic clinic. This study compared intraocular pressure elevation before and 1 week after intraarticular knee injection of triamcinolone acetonide versus hyaluronic acid for management of primary osteoarthritis of the knee. Patients self-selected to be injected in their knee with either triamcinolone acetonide or hyaluronic acid before being informed of the study. The primary endpoint was intraocular pressure elevation of ≥ 7 mm Hg 1 week after injection. This cutoff is determined as the minimum significant pressure change in the ophthalmology literature recognized as an intermediate responder to steroids. Intraocular pressure was measured using a handheld Tono-Pen® applanation device. This device is frequently used in intraocular pressure measurement in clinical and research settings; 10 sequential measurements are obtained and averaged with a confidence interval. Only measurements with a 95% confidence interval were used. Over a 6-month period, a total of 96 patients were approached to enroll in the study. Sixty-two patients out of 96 approached (65%) agreed. Thirty-one (50%) were injected with triamcinolone and 31 (50%) were injected with hyaluronic acid. Patients with osteoarthritis of the knee who were suitable candidates for either a steroid injection or hyaluronic acid injection were included in the study. Exclusion criteria included previous glaucoma surgery, previous corneal injury precluding use of a Tono-Pen, current acute or chronic steroid use, and diagnosis of glaucoma other than primary open-angle. Patients with elevated intraocular pressure at the 1-week timepoint were invited to return at 1 month for repeat measurement; however, only five of nine (55.6%) were able to do so. The mean age of the total population was 64.1 ± 11.65 years. There were 46 (74%) women and 16 men. Patient in the hyaluronic acid injection group were younger than the triamcinolone group, 59.5 ± 11.7 versus 68.7 ± 9.7 years of age (p < 0.003). The mean intraocular pressure increased by 2.79 mm Hg 1 week after treatment with triamcinolone, but it did not change among those patients treated with hyaluronic acid (2.79 ± 9.9 mm Hg versus -0.14 ± 2.96 mm Hg; mean difference 2.93 mm Hg; 95% confidence interval, -0.71 to 6.57 mm Hg; p = 0.12). More patients who received triamcinolone injections developed an increase in intraocular pressure > 7 mm than did those who received hyaluronic acid (29% [nine of 29] versus 0% [zero of 31]; p = 0.002). Of the nine patients who developed elevated intraocular pressure after a triamcinolone injection, five returned for reevaluation 1 month later, and four of them had pressures that remained elevated > 7 mm Hg from baseline. There appears to be an associated intraocular pressure elevation found in patients who have undergone a triamcinolone injection of the knee. Further larger scale randomized investigations are warranted to determine the longevity of this pressure elevation as well as long-term clinical implications, including optic nerve damage and visual field loss. Level II, therapeutic study.

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value ≤0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p≤0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve.