Intravenous Hypertonic Saline to Lower Intraocular Pressure in Ocular Hypertension and Primary Open-angle and Exfoliation Glaucoma.

Abstract

The purpose of this article was to quantitate the effect of intravenous hypertonic saline (IVHTS) on elevated intraocular pressure (IOP) among 3 groups of glaucoma patients or suspects. Among the forty-four patients with IOP 24 to 30 mm Hg included in this study, 13 had ocular hypertension (OHT), 14 primary open-angle glaucoma (POAG), and 17 exfoliation glaucoma (ExG). Participants received a bolus of 23.4% IVHTS (1.0 mmol/kg) through an antecubital vein. We measured IOP, heart rate, and blood pressure before the bolus, thereafter every minute for 10 minutes, and less frequently for 2 hours. The median baseline IOP was 24 mm Hg (range, 24 to 30 mm Hg), 26.5 mm Hg (range, 24 to 30 mm Hg), and 26 mm Hg (range, 24 to 30 mm Hg) in OHT, POAG, and ExG patients, respectively. Sixteen minutes after the bolus, IOP was a median of 9 mm Hg (range, 4 to 12 mm Hg), 10 mm Hg (range, 6 to 12 mm Hg), and 10 mm Hg (range, 4 to 14 mm Hg) lower in OHT, POAG, and ExG groups (P=0.70), respectively. After 1 hour, the median IOP reduction was similar between ExG (9 mm Hg; range, 4 to 14 mm Hg) and POAG patients (9.5 mm Hg; range, 6 to 12 mm Hg) but lower in OHT patients (6 mm Hg; range, 2 to 9 mm Hg; P=0.006). Heart rate decreased by a median of 7 beats/min. Blood pressure increased within 3 minutes (median, mm Hg; 15 systolic; 5 diastolic), but returned to baseline at 10 minutes. Within 1 to 3 minutes of treatment, 36 (82%) patients felt pain in the infusion arm, and 29 (66%) reported a feeling of warmth in their head. IVHTS reduced IOP effectively in all groups.