IOP Changes Research Articles

A New Ray of Hope in the Treatment of Seasonal Hyperacute Panuveitis: Could Intravitreal Triple Combination Therapy of an Antibiotic with Dual Steroids Play a Pivotal Role?

ABSTRACT Introduction Seasonal Hyperacute Panuveitis (SHAPU) is a blinding disease in Nepal with unknown aetiology. Henceforth, we proposed to study the treatment outcome of a triple intravitreal combination therapy of dual steroids triamcinolone (long-acting steroid) and dexamethasone (short-acting steroid) along with antibiotic moxifloxacin for patients with severe stage of SHAPU. Methods A prospective study was conducted among the SHAPU patients presenting in severe stages during the September to December 2023 outbreak. Intravitreal injection of 4-mg preservative-free triamcinolone acetonide (4 mg/0.1 ml) with intravitreal dexamethasone injection (0.4 mg/0.1 ml) and 0.5 mg/0.1 ml of moxifloxacin was given in the operating theatre. Best corrected visual acuity, intraocular pressure measurements, vitreous haze and fundus evaluation, were assessed to determine the treatment outcome on examination on day 7 and day 30 following intravitreal combination therapy. Result A total of 6 patients (2 female and 4 male) were enrolled. At presentation, the mean BCVA was 2.40 ± 0.30 logMAR, mean intraocular pressure was 12.8 mmHg and vitreous haze was 4+ haze in all cases. The evaluation on the 7th day and 30th after injection showed significant improvement in BCVA (p value = 0.039; p value = 0.040, respectively). The change in the IOP at day 7 (p value = 0.85) was insignificant. However, the IOP change was significant at day 30 (p value = 0.5). Similarly, there was a marked reduction in the vitreous haze with better fundus visibility after treatment. Conclusion This study depicted that steroids prevent the dreaded complication of hypotony due to ciliary shutdown by combating severe inflammation, thus adding new hope to the armamentarium of SHAPU management.

Early Results of PRESERFLO TM MicroShunt for Primary Open-angle Glaucoma in Caucasian Patients.

The PRESERFLO MicroShunt effectively lowered intraocular pressure in primary high and normal pressure open-angle glaucoma. To evaluate the efficacy and safety of the PRESERFLOTM MicroShunt in patients with primary open-angle glaucoma (POAG) and the two variants high (HPG) and normal pressure glaucoma (NPG) after one year. Single-center prospective interventional case series consecutively including eyes of White/European patients with POAG, who received the PRESERFLOTM MicroShunt as a primary and stand-alone glaucoma intervention. Primary outcome measures: change in mean 24-h IOP (mdIOP, mean of 6 measurements), peak IOP, IOP fluctuations, anti-glaucoma medications, and success rates. Secondary outcome measures: visual acuity, visual fields, complications, surgical interventions, and adverse events. Forty-two eyes of 42 POAG patients, 29 in the HPG and 13 in the NPG group, were analyzed after 1-year follow-ups. Median [Q25, Q75] mdIOP (mmHg) dropped by 30% from 16.5 [13.7-27.3] to 12.8 [10.2-14.5] in the HPG and by 40% from 14.3 [13.3-16.0] to 9.5 [8.3-11.1] in the NPG group, with a median postoperative medication use of 0 [0-0] in both groups. At one year, 92.5% of eyes were medication-free versus 0% preoperatively. The reduction of mdIOP (P=1.0), peak IOP (P=0.932), IOP fluctuations (P=0.142) and the rate of interventions (P=0.298) were not statistically significantly different between the HPG and NPG group. None of the patients experienced severe adverse events or loss of vision. Effective and safe intraocular pressure lowering was observed one year following MicroShunt implantation for primary HPG and NPG in white patients of European descent.

Ab-Externo XEN Gel stent implantation effectively treated refractory glaucoma with prior failed shunt tube

PurposeTo assess the efficacy of a gelatin stent (XEN 45 Gel Stent; Allergan) implant in advanced glaucoma eyes that have failed prior aqueous shunt implantation.MethodsWe retrospectively reviewed 6 patients with refractory glaucoma, defined as persistently high IOP (> 21 mmHg) despite taking at least 3 IOP-lowering medications subsequent to undergoing a glaucoma drainage device (GDD) with or without a second GDD or cilioablative procedure. Eyes with previous failed GDD underwent subconjunctival 0.3 cc (0.4 mg/ml) mitomycin C, tenonectomy, and placement of an ab- externo XEN stent. The outcome measures included change in IOP and the number of glaucoma medications. Success was defined as patients achieving an IOP ≤ 18 mmHg with a percentage reduction of 25% or 15 mmHg and 40% mean IOP reduction from baseline while taking the same number or fewer medications.ResultsAll six eyes with age of 77.6 ± 7.82 years who underwent XEN implantation following previous GDD surgery had primary open-angle glaucoma. The IOP decreased significantly from 32.33 ± 5.99 to 12.67 ± 3.27 mmHg (p < 0.001) with a follow-up of 13.9 ± 2 (11.7–16.7) months. Visual acuity and visual field remained stable after XEN placement. Compared to the baseline number of medications of 4.2 ± 0.8, all medication was discontinued except in one eye on two drops at the end of the follow-up. The overall surgical success rate was 100%. No complications, needling, or additional procedures were required.ConclusionThis study described successful implantation of the XEN stent following failed GDD. XEN Gel stent implantation associated with mitomycin C and tenonectomy can be considered a viable surgical option for patients with a history of previously failed tube shunt requiring further IOP lowering.

A retrospective review of selective laser trabeculoplasty outcomes at Lancashire Teaching Hospitals, UK.

Selective laser trabeculoplasty has been carried out at Lancashire Teaching Hospitals over the past seven years. This work aimed to review the use of SLT in this Trust. The primary objectives were to establish the efficacy of SLT in reducing intraocular pressure, to analyse how prior treatment with different topical medications can influence SLT outcomes and to analyse the outcomes in revisionary patients. We conducted a retrospective review of 288 eyes, with a known history of glaucoma or ocular hypertension and who underwent initial SLT laser treatment between October 2018 and January 2020. SLT was performed on known glaucoma and treatment naïve patients where IOP control was deemed sub-optimal. All patient data was fully anonymised. We found that SLT was effective in lowering IOP. Around two-thirds of the eyes (181/280, 65%) achieved a reduction in IOP of 10% or more. Just under half (127/280, 45%) achieved a reduction of 20% or more. For a pre-SLT IOP of 14.6 mmHg, we found that no mean change in IOP is expected, and for each 1 mmHg by which the pre-SLT IOP exceeds this threshold, the mean reduction in IOP is expected to be 0.61 mmHg. We also found that combination therapies of PGA plus aqueous suppressants gave better outcomes compared with PGA alone. We found that revisionary SLT compared favourably with the first treatment, although first-time outcomes were not a good predictor of success with revisionary SLT. Primary and revisionary SLT has been shown to be effective across the cohort of patients in this study.

Brief Report on 12-Month Outcomes of the ab Interno Gel Stent Using the Intraoperative Posterior Sweep of Tenons (PoST) Technique

87 eyes of 70 patients (mean age 75.03 years) with an average 12-months follow-up underwent ab-interno Xen45 gel stent with PoST technique. Primary outcome: mean IOP change. Secondary outcomes: change in medications and complications. Preoperative mean IOP and medications were 18.66 mmHg and 3.36 respectively. At 12 months, mean IOP and medications were 13.1 mmHg and 1.35. Cumulative proportion of success (IOP less than 22 mmHg, ≥ 20% reduction in baseline IOP and no additional surgical intervention) was 0.72. Needling proportion was 9%. Cumulative proportion of reoperation was 0.22. The PoST technique resulted in significant reduction in IOP and medications.

Intraocular Pressure Before and After Corneal Refractive Surgery: A Prospective Comparison of Corvis ST and Ocular Response Analyzer.

The study showed that Corvis ST's biomechanical intraocular pressure (bIOP) and ocular response analyzer's (ORA) cornea-compensated intraocular pressure (IOPcc) do not agree well, before or after photorefractive keratectomy (PRK), and may not be used interchangeably. bIOP remained unchanged after PRK. To evaluate the agreement between the biomechanically corrected intraocular pressure (bIOP) measured by the Corvis ST and the IOPcc measured by the ORA before and after PRK. In this prospective interventional study, a total of 53 patients (53 eyes) were included. Measurements were acquired using both the Corvis ST and ORA devices before and 3 months post-PRK. The agreement between the 2 devices was evaluated using limits of agreement (LoA) and Bland-Altman plots. The participants had a mean age of 29.6 ± 5.21 years (range: 21 to 40), with 41 (77.4%) of them being females. After the surgery, the average change in intraocular pressure (IOP) was 0.3 ± 1.7mm Hg for bIOP and -1.6 ± 4.0mm Hg for IOPcc. The corresponding 95% LoA were -3.5 to 4.2mm Hg and -9.5 to 6.3mm Hg, respectively. The 95% LoA between bIOP and IOPcc after PRK was -2.3 to 8.5mm Hg. Notably, the bIOP values were higher for IOPs <20mm Hg and lower for IOPs >20mm Hg compared with IOPcc. The findings indicate a weak agreement between the Corvis ST-bIOP and the ORA-IOPcc both before and after PRK. These devices may not be used interchangeably for IOP measurement. bIOP exhibited less variation compared with the IOPcc, suggesting that the bIOP may be a better option for IOP reading after PRK.

Characteristics and Treatment Outcomes of Hypotony Maculopathy Post-Glaucoma Filtering Surgery: An Optical Coherence Tomography-Based Study.

This study assesses morphological characteristics using SD-OCT in patients with hypotony maculopathy (HM) following glaucoma filtering surgery and evaluates the results of its treatment. Retrospective analysis of all HM patients between January 2019 and March 2023. Inclusion criteria consisted of both pre-operative and post-revision SD-OCT images of the macula and the presence of HM as observed on OCT images preoperatively. HM was graded according to its appearance in OCT both pre- and post-revision surgery. Change in visual acuity and IOP were assessed. 45 eyes of 45 patients were included. 21 eyes had HM limited to retinal pigment epithelium (RPE), 18 eyes had involvement of RPE and photoreceptor layers and 6 eyes had additional intra- or subretinal edema. After revision surgery with IOP elevation, 64% of eyes had complete HM regression with no HM signs in OCT imaging. 80% of patients achieved at least one grade improvement in HM. Preoperative visual acuity increased from 0.7±0.4 (logMAR) to 0.4±0.4 at 2 weeks postoperatively, over the course of an increase of IOP from 3.5±1.8mmHg to 17.1±10.6mmHg at day one. Eyes with complete HM regression had higher IOP at day 1 compared to those without improvement (P=0.04). The median time between HM onset and revision was 10.0 days for those with complete regression and 27 days for those without improvement (P=0.04). Bleb revision procedures for HM following glaucoma filtering surgery show promising outcomes, including notable improvements in visual acuity and IOP. The timing of revision surgery appears to influence outcome. In our study earlier intervention was associated with better results. Even delayed surgeries can lead to an improvement, although complete morphological restoration may not be achieved in advanced grades of HM.

PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature.

The PRESERFLO™ MicroShunt (MP; Santen Inc., Osaka, Japan) is a minimally invasive bleb surgery (MIBS) manufactured to treat primary open-angle glaucoma (POAG), with lower postoperative adverse effects than with conventional filtering surgeries. We describe here the case study of a 58-year-old woman who presented with bilateral severe myopia with bilateral advanced POAG and unreached target pressure under quadritherapy, who was successfully managed by PM surgery. A review of the literature completes our observation. At presentation, the patient had a spherical equivalent of - 7.50 RE and - 7.75 LE with an IOP of 22 mmHg right and left eye (RLE) under quadritherapy, and with severe bilateral visual field loss, including scotomas within the central 5°. The patient presented with systemic hypertension treated with an antihypertensive drug. Two selective laser trabeculoplasties (SLT), performed 3 months apart, were first tried on the LE, without any change in IOP at 2 months. After considering the high risk of postoperative complications, a PM operation was proposed, with a targeted IOP in the mid-fifteens RLE. The patient's eyes underwent PM surgery with mitomycin C (MMC) MMC0.2 mg/mL for 3 minutes without any complications. The LE required 2 consecutive needlings with 1 mL MMC0.2 mg/mL. At 24 months after surgery, the two eyes gave successful results without the need for any additional medical therapy, and with well-functioning conjunctival blebs. The PM was an effective alternative to the gold standard trabeculectomy in our severely myopic patient. A comparative study between conventional filtering operations and this MIBS in highly myopic patients would confirm our observation.

The Effect of Childhood Obesity on Intraocular Pressure, Corneal Biomechanics, Retinal Nerve Fiber Layer, and Central Macular Thickness.

Elevated corneal hysteresis (CH) and resistance factor (CRF) in obese and overweight children imply weight's effect on corneal biomechanics. Increased Goldmann-correlated intraocular pressure (IOPg) in obese children indicates glaucoma risk, emphasizing screening for IOP and retinal changes. To evaluate the effect of obesity on corneal biomechanics, retinal nerve fiber layer (RNFL), and central macular thickness (CMT) in children. In this prospective, cross-sectional, comparative study, 146 eyes of normal-weight, over-weight, and obese children aged between 6 to 17 years were evaluated. The IOPg, corneal compensated IOP (IOPcc), CH, CRF, and the average retinal nerve fiber layer (RNFL), average cup-to-disk ratio (c/d), and central macular thickness (CMT) were measured by Ocular Response Analyser and Spectral-Domain Optical Coherence Tomography (SD-OCT), respectively. There was no statistically significant difference regarding age, gender, IOPcc, average RNFL thickness, c/d ratio, and CMT among the groups ( P ≥0.05). The IOPg was significantly higher in obese children compared with normal-weight children, while CH and CRF values were significantly higher in both obese and over-weight children compared with healthy ones ( P <0.05). There was a positive correlation between BMI percentile and IOPg, CH, and CRF values. In our study, higher IOPg, corneal hysteresis, and corneal resistance factor values suggest that obese children could be potential candidates for glaucoma. Therefore, it would be appropriate to screen them for IOP and retinal alterations. Further investigations with larger sample size and longer follow-up are needed to understand the risk of glaucoma in obese children.

CORRELATION BETWEEN CHANGES IN INTRA OCULAR PRESSURE AND MEAN ARTERIAL PRESSURE BEFORE AND AFTER DIALYSIS IN REGULAR DIALYSIS PATIENTS

Introduction &amp; ObjectivesGlaucoma is an eye disorder characterized by glaucomatous optic neuropathy with a typical visualfield defect and increased intraocular pressure (IOP).The incidence of glaucoma in dialysis patient is8.18/10,000 person. The dialysis process may change the IOP and Mean Arterial Pressure (MAP)which may lead to glaucoma. The aims of this study are to determine whether there was a change inIOP and MAP and to determine the correlation between changes in IOP and MAP due to dialysis.&#x0D; MethodsThis is an observational study with cross sectional approach using stratified sampling method. Thesubjects were all regular dialysis patient at the Dialysis Unit in Sanglah Hospital period April-May2021 with total 63 people. The data taken are age,gender ,duration of dialysis, fasting blood sugar,urea and serum creatinine level before dialysis. Subjects were measured IOP and calculated MAPbefore and after dialysis.&#x0D; ResultsMean of age of this study was 47,03±12,06 years old and dominated by male. Paired T-Test showedno significant changes IOP after dialysis but there were significant decreased on systolic, diastolicand MAP. Pearson correlation showed no correlation between changes of IOP and MAP afterdialysis. Multivariate analysis shows significant correlation between changes of IOP with urea levelbefore dialysis.&#x0D; ConclusionIOP after dialysis was not increased in this study. Systolic, diastolic and MAP were decreased afterdialysis compared to before dialysis. There is no correlation between changes in IOP and MAP afterdialysis compared to before dialysis. Urea level before dialysis may be associated with increased IOPafter dialysis.

Bevacizumab vs Ranibizumab in Macular Edema due to Retinal Vein Occlusion: Short-term Outcomes

Introduction &amp; ObjectivesBevacizumab or Ranibizumab was widely used as therapy for macular edema (ME) in retinal veinocclusion (RVO) and diabetic retinopathy. The purpose of this study was to comparing short-termoutcomes for patients who received intravitreal Bevacizumab (IVB) injection or Ranibizumab (IVR)for ME due to RVO&#x0D; MethodsThis was observational, cross sectional study comparing patients received IVB or IVR. Primaryoutcomes data (visual acuity and central macular thickness/CMT) and secondary outcomes data(number injection and intra ocular pressure/IOP) were collected at baseline and 3 months afterinjection&#x0D; ResultsThere were 4 eyes in each group. There were no significant difference in mean change of visualacuity (-0.275±0.25 vs -0.15±0.5 logMAR; p=0.676) and CMT (-171.50±129.08 vs -98.25±37.67 um;p=0.345) in IVB vs IVR groups. There were also no significant difference in mean change of IOP(2±2.16 vs 2±4.69 mmHg; p=1) and number of injection (2.25±0.50 vs 1.75±0.9; p=0.401 ) in bothgroups.&#x0D; ConclusionIn short-term both IVB and IVB have relative similar outcomes on increasing visual acuity anddecreasing CMT in ME due to RVO

Safety and Efficacy of CLS-TA by Anatomic Location of Inflammation: Results from the Phase 3 PEACHTREE Clinical Trial

ABSTRACT Purpose To explore the efficacy of CLS-TA, a proprietary suprachoroidal injectable suspension of triamcinolone acetonide, in noninfectious uveitis (NIU) with macular edema (ME), categorized by anatomic subtype. Methods Patients diagnosed with ME associated with NIU of any etiology and anatomic subtype were eligible for the phase 3 PEACHTREE trial of CLS-TA. Post-hoc analyses were performed, stratified by discrete anatomic subtype of uveitis (anterior, intermediate, posterior, and panuveitis.) Results Across all anatomic subtypes at 24 weeks, patients receiving CLS-TA at baseline and week 12 demonstrated mean increases in BCVA ranging from +12.1 to +15.9 letters, mean central subfield thickness (CST) improvement ranging from −120.1 µm to −189.0 µm, and IOP changes ranging from +0.5 to +3.1 mmHg. Overall, reports of adverse events were similar among subtypes. Conclusions Irrespective of the uveitic anatomic subtype among patients treated for ME associated with NIU, a clinical benefit in participants treated with CLS-TA was demonstrated, with a comparable safety profile.

Peripapillary and macular vessel density changes after trabeculectomy

Aims/Purpose: to evaluate peripapillary, optic disc and macular microvascular changes in glocomatous eyes after trabeculectomy using optical coherence tomography angiography (OCTA).Methods: 90 eyes of 52 patients with primary open angle (20%), pseudoexfoliative (71%) and angle closure glaucoma (9%), and were included. 24 eyes (Group 1) underwent trabeculectomy during the study, 34 eyes (Group 2) had previous trabeculectomy three years more ago and 37 eyes (Group 3) had no trabeculectomy trabeculectomy. The AngioVue OCTA (Optovue Inc., Fremont, CA, USA) was performed at baseline (within one week before trabeculectomy for Group 1), one week and one month following baseline examination. The main outcomes of interest were changes in the superficial and deep macular vessel density (VD) as well as whole image and inside optic disc.Results: The mean IOP at baseline was 25.3 ± 5.0 mmHg, 14.4 ± 3.7 mmHg and 14.7 ± 3.6 mmHg for the Group 1, Group 2 and Group 3 respectively. No significant differences in baseline characteristics were found between three groups, except for Group 3 group had milder glaucoma (it would be good to put the VF MD values of the groups). A reduction of IOP was observed in Group 1 one week and one month after trabeculectomy (14 ± 6.0 mmHg and 10 ± 6.2 mmHg respectively, p &lt; 0.001). There were no significant IOP changes in Group 2 and 3. In all groups the changes in macular vessel density were nonsignificant. In Group 1 the mean inside disc small vessel density increased one week postoperatively (p = 0.04) and peripapillary vessel density increased one month postoperatively(p = 0.03) when compared with the baseline values. There was no significant difference in mean peripapillary or macular vessel densities between groups.Conclusions: IOP reduction causes mild microvascular changes of optic disc and peripapillary regions in early postoperative period, however, does not affect macula.

An Investigation Comparing the Efficiency of Timolol 0.5% with Brimonidine 0.2% in Managing the Increase in Intraocular Pressure Subsequent to Nd-Yag Laser Capsulotomy

Objective: Conducting a comparison between the efficacy of Timolol 0.5% eye drops and Brimonidine 0.2% eye drops in managing the elevation of intraocular pressure post Nd-YAG laser capsulotomy. Study Design: Employed a randomized controlled trial. Methodology: The research involved 80 patients (one eye per patient) aged between 45 and 70, diagnosed with posterior capsular opacification scheduled for Nd-YAG laser capsulotomy at the Department of Ophthalmology, Mathuradas Mathur Hospital (Dr. S. N. M. C.) in Jodhpur. The patients were divided into two groups, X and Y, each consisting of 40 individuals. Baseline intraocular pressure was measured using an applanation tonometer before administering eye drops. Group X received a single drop of Timolol 0.5%, while group Y received a single drop of Brimonidine 0.2% one hour prior to capsulotomy. Intraocular pressure was recorded at 1 hour and 4 hours post the laser procedure. Results: Both groups comprised 40 patients each. The baseline IOP was 16±2.16 for group X and 15±2.56 for group Y. There was no statistically significant variance between the two groups in mean IOP changes at 1 hour following Nd-YAG laser capsulotomy. However, after 4 hours, the mean reduction in IOP was -1.54 mmHg for group X and -1.85 mmHg for group Y (p&lt;0.5). Conclusion: Our study indicates that both Timolol 0.5% eye drops and Brimonidine 0.2% eye drops are similarly effective in controlling elevated intraocular pressure after Nd-YAG laser capsulotomy

Influence of Phacoemulsification on Intraocular Pressure in Patients with Glaucoma

Phacoemulsification (PE) is a current ‘gold standard’ of the surgical treatment of the cataract. Apart from lens extraction and intraocular lens implantation, PE is accompanied by IOP changes in most cases. In cases of ophthalmic hypertension or primary open-angle glaucoma, IOP is most often decreased; however, the mechanism of this phenomenon is currently completely unknown. In closed-angle glaucoma, PE provides opening of the anterior chamber angle, which restores physiological outflow of intraocular fluid and leads to IOP stabilization. In some cases, however, PE may be accompanied by a short-term increase in IOP. The exact mechanism of this reaction is unknown, however, in most cases it is associated with the inflammatory response of the eye to surgical trauma.

Safety and Efficacy of the Rho-Kinase Inhibitor (Ripasudil) in Bleb Needling after Trabeculectomy: A Prospective Multicenter Study.

Ripasudil, a rho-associated protein kinase inhibitor ophthalmic solution, shows a protective effect in preventing excessive scarring in vitro. This study aims to evaluate the safety and efficacy of ripasudil for glaucoma patients submitted to the needling procedure. In this prospective, multicenter, single-arm study, we included 20 eyes of 20 patients with glaucoma who underwent the needling procedure without antimetabolites. All patients administered ripasudil after needling for three months. The primary endpoint of this study was the safety of ripasudil in patients, and the secondary endpoint was the change in IOP at 12 weeks after the needling procedure. No serious complications were found in the patients. One eye experienced pruritus and conjunctival follicle, while another eye had conjunctival follicle. These complications were transient and resolved quickly after discontinuation of ripasudil. The mean preoperative IOP was 14.6 ± 4.6 mmHg, which decreased to 11.0 ± 4.7 mmHg (p = 0.0062) at 1 week postoperatively. The IOP reduction effect continued to 12 weeks (11.8 ± 3.1 mmHg; p = 0.0448). The administration of the ROCK inhibitor, ripasudil, after the needling procedure is safe and effective in maintaining IOP for 12 weeks.

Сравнительный анализ динамики внутриглазного давления и центральной толщины роговицы после факоэмульсификации катаракты с имплантацией интраокулярной линзы в зависимости от наличия первичной открытоугольной глаукомы

A prospective open study of 64 eyes (64 patients) was conducted, the parameters of IOP and central corneal thickness (CCT) in the early postoperative period were studied in patients with primary-open-angle glaucoma (POAG) and without glaucoma. The terms of normalization of these parameters are determined, as well as possible influencing factors on changes in IOP and CCT indicators. In patients with POAG after phaco an increase in hypotensive drops was required in 50 % of cases, in 19 % of patients with an average IOP after surgery up to 28.8 ± 5.2 mm Hg (p&lt;0.01), there was a need for antiglaucoma operation (AGO) in the early postoperative period due to persistent IOP decompensation. Basically, these were patients who received 2 or 3 hypotensive drugs before phaco, had 3rd degree lens density, stage 3 glaucoma and a longer operation time. In patients without POAG an increase of IOP level is possible at day 1 after phaco to an average of 22.4±5.6 mm Hg (p=0.03), but to a lesser extent than in patients with POAG (p&lt;0.05). This group consisted exclusively of patients with 2nd and 3rd degree of lens density and longer operation time. In patients with POAG at the day after phaco CCT index significantly increases to an average of 617.9 ±88.6 microns (p&lt;0.001), approaching the norm at day 14. In patients without glaucoma the level of CCT at the day after surgery also equally significantly increases to an average of 624±106.3 microns, approaching the baseline level by day 14. Key words: early postoperative period; open-angle glaucoma; cataract; intraocular pressure; central corneal thickness.

Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma.

To evaluate the long-term safety and efficacy of sequential canaloplasty and trabeculotomy combined with cataract surgery in patients with mild, moderate, and advanced open-angle glaucoma. Case records of 171 consecutive patients (171 eyes) who had undergone cataract surgery followed by canaloplasty (≥180°) and trabeculotomy (≥90°) for mild, moderate, or advanced open-angle glaucoma (Shaffer grade ≥3) using the OMNI Surgical System (Sight Sciences, Inc., Menlo Park, CA) were analyzed retrospectively. Efficacy endpoints included change in mean IOP and number of medications from baseline to postoperative 12- and 24-months for the overall dataset and stratified by each stage of glaucoma. Kaplan-Meier survival analysis of success (eyes that did not require secondary surgical interventions (SSI)) by postoperative 24 months was also performed. Postoperatively, there was a statistically significant reduction in IOP (baseline of 17.2 mmHg on 1.3 medicines reduced to 14.3 on 0.8 medicines (12 months) and 14.0 on 0.9 medicines (24 months), p<0.001 for both time points). Eyes with advanced glaucoma (N=63) maintained significant IOP reduction (17.8 mmHg on 1.6 medicines at baseline reduced to 13.6 mmHg on 1.3 medicines (12 months) and 13.0 on 1.5 medicines (24 months), p<0.001). Kaplan-Meier analysis showed a 93.0% survival probability for the avoidance of SSI at 2 years after surgery. Canaloplasty and trabeculotomy combined with cataract surgery provided effective IOP reduction for eyes with all stages of glaucoma at postoperative 12 and 24 months, and the procedure yielded a 93% survival rate for SSI avoidance at 2 years.

EFFECT OF TOPICAL SODIUM DICLOFENAC AS ADJUVANT TO INTRAVITREAL BEVACIZUMAB INJECTION THERAPY ON VISUAL ACUITY INTRAOCULAR PRESSURE CHANGES IN PATIENTS WITH DIABETIC MACULAR EDEMA

Introduction dan Aim: Diabetic Macular Edema (DME) in Diabetic Retinopathy (DR) patients might threaten the patient's visual acuity. Therefore, a robust DME treatment is needed to prevent sight threatening condition in DR patients. In this study, we intended to compare the effects of intravitreal administration of bevacizumab versus bevacizumab and topical natrium diclofenac in DR patients who developed DME. Methods: This was a randomized controlled trial study with double blinds. Data were taken from April 2020 to June 2021 from the Dr. Sardjito Central General Hospital and the Dr. Suhardi Hardjolukito Indonesian Air Force Central Hospital, Yogyakarta. Our patients were assigned to a control group (intravitreal bevacizumab therapy only) and an intervention group (intravitreal bevacizumab and topical natrium diclofenac). Then, we evaluated best corrected visual acuity (LogMar) and intraocular pressure (IOP, mmHg) were recorded in both groups before and after therapy. Results: A total of 38 eyes from 36 patients with naive DME were included in this study. Both treatment groups showed a statistically significant improvement in visual acuity after treatment bevacizumab (pre = 0.8±0.5; post = 0.6±0.5; p-value = 0.033) and bevacizumab and natrium diclofenac (pre = 0.9±0.5; post = 0.5±0.3; p-value = 0.004). In contrast to the above findings, the IOP in both groups did not show a significant change in IOP after therapy, bevacizumab (pre = 15.7±4.1; post = 15.6±4.2; p-value = 0.810) and bevacizumab and natrium diclofenac (pre = 16.0±4.5; post = 16.0±3.9; p-value = 0.868). Conclusion: Our study showed that visual acuity was improved significantly in DME patients treated with either bevacizumab or bevacizumab and natrium diclofenac. This might be a valuable information on the improvement of DME therapy, given that no increased post-therapy IOP in patients treated topical natrium diclofenac.

Effect of Moringa Olifera Leaves on Intraocular Pressure and Blood Pressure

Moringa exhibits many antioxidant, antihypertensive, and anticancer effects. A significant source of therapeutic medicines for reducing ocular and systemic hypertension is herbal remedies. Objectives: To assess the impact of moringa on blood pressure and intraocular pressure and to evaluate various moringa doses that affect IOP and BP. Methods: Quasi Experimental study was conducted at MTH, Faisalabad from September 2022 to April 2023. Sampling technique was non-probability purposive sampling. Emmetropes, age 20-35 years, IOP range 11-22 mmHg, BP 120/80 mmHg was included. After comprehensive eye exam, 60 subjects were divided into two groups. IOP and BP were evaluated before and after intake at 30, 60, 90, and 120 minutes. Data were analyzed with SPSS software. Repeated Measure ANOVA was used for statistical analysis. Results: Out of 60 subjects, mean age was 22.5 ± 1.31. Baseline IOP in group 1 was 19.40 ± 3.19 and BP 113.67 ± 9.27/81.00 ± 8.03 while in group 2 IOP 19.42 ± 4.11 and BP 116.33 ± 10.08/83.17 ± 8.75. There was significant Change in IOP at 90minutes and BP at 60minutes. IOP was 18.54 ± 3.19 and 17.56 ± 4.25 in group 1, 2 respectively. BP was 101.33 ± 7.76/72.67 ± 8.97 and 101.50 ± 9.92/72.50 ± 8.68 in both groups respectively. There were significant Changes as compared to 30, 60, 120minutes. IOP and BP return to its baseline at 120 minutes. Conclusions: Moringa Oleifera has significant effect on lowering IOP and BP. Effect of dose on the reduction rate was directly proportional to the amount of dose administered.