Decrease In IOP Research Articles

ANALYSIS OF HYPOTENSIVE EFFECT OF EX-PRESS DRAINAGE DEVICE FOR REFRACTORY GLAUCOMA

Purpose: to analyze the effectiveness of Ex-Press drainage device implantation for refractory glaucoma of different origin for 3 years. Patients and methods : The study consisted of 82 patients (86 eyes) with refractory glaucoma aged 26–86 years (67.37±0.53). Pre-operative IOP level averaged 37.8±1.04 mm Hg. Ex-Press drainage device implantation was rated according to the following criteria: IOP, time course of visual functions, the need for additional drug therapy and reoperation, the presence of intraoperative and postoperative complications. Examination of the patients was carried out from 1 to 8 days after the surgery and within 1, 3, 6, 12, 24 and 36 months. Results: According to our research results relative hypotensive effect equaled 74.4% (64/86) within a year after the surgery; 67.4% (58/86) — within 2 years; 65.1% (56/86) — after 3 years of follow-up period. The maximum decrease in IOP by 61.6% was observed immediately after the surgery. There was no effect of surgical treatment within3 years in 34.9% (30/86). Complications were observed in 23.2% (20/86) of cases: choroidal detachment — 12.8% (11/86), hyphema — 3.5% (3/86), eruption and dislocation — 3.5% (3 / 86), delayed expulsive hemorrhage — 2.3% (2/86), cyst of filtering bleb — 1.2% (1/86). Conclusion . Fistulizing operations with implantation of Ex-Press drainage device for refractory glaucoma provide normalization of IOP in 65.1% of cases (including 15.1% on the background of additional drug therapy) at follow-up period up to 3 years.

Long-term Clinical and Functional Results of Neovascular Glaucoma Surgical Treatment with Glautex Drainage and Ahmed Valve

Purpose — to determine the effect of fistulizing operations with Glautex drainage and Ahmed valve implantation in the cases with neovascular glaucoma within 3 years. Patients and methods. We observed 44 patients (44 eyes) with secondary neovascular glaucoma on the background of post-thrombotic and proliferative diabetic retinopathy. Patient age averaged 60,84±1,29 years. Males — 19, females — 25. The patients were divided into two groups depending on the used drainages and drainage devices. In Group I the standard sinus trabeculectomy with Glautex drainage was performed in 23 patients. The II group included 21 patients who were implanted Ahmed valve. Results. According to the results of our research the relative hypotensive effect was in groups I and II, respectively, 52.2% (12/23) and 79.4% (17/21) 1 year after surgery; 43.5% (10/23) and 71.4% (15/21) — 2 years after surgery; 39.1% (9/23) and 66.7% (14/21) — after 3 years of follow up. The maximum decrease in IOP was observed immediately after surgery in the analyzed groups, 66.8% and 64.5%, respectively. There was no surgical treatment effect for 3 years in Group I in 60.8% (14/23), in group II — 33.3% (7/21) of the cases. Conclusion. The analysis of clinical and functional results of surgical treatment of patients with neovascular glaucoma in terms of 3 years follow up showed that the most lasting preservation of visual function and the hypotensive effect was achieved after implantation of the Ahmed valve — in 66.7% of the cases. In the cases of sinus trabeculectomy with Glautex drainage — in 39.1% of the cases. The incidence of postoperative complications in both groups was comparable: as hyphema, hypotension, and the eruption of implants developed after sinus trabeculectomy with Glautex drainage in 26.1%, 21.7% and 4.3%, respectively, after Ahmed valve implantation in 23 8%, 19.1% and 9.6% of the cases.

Abstracts: European Society of Veterinary Ophthalmologists, Toulouse, France, October 6‐9, 2016

Purpose: To evaluate the effects of 2% Dorzolamide, 0.5% Timolol and 0.005% Latano- prost on the biometrics of the anterior segment in normotensive cats. Material/Methods: Three groups of 15 clinically healthy randomly selected cats received one single molecule on the right eye during 7 days (Group 1: 2% Dorzolamide BID, Group 2: 0.5% Timolol BID, Group 3: 0.005% Latanoprost SID). Left eyes received no treatment and were used as con- trols. Complete ophthalmic examination, IOP measurement and anterior segment assessment by Ultrasound Biomicroscopy (UBM) were performed in the same conditions at day 1 and day 7, on both eyes. Eight anatomical parameters of the anterior segment were evaluated: the geometric iridocorneal angle (ICA) – formed by the plane of the iris root and the inter- nal corneoscleral limbus – the width of the opening of the ciliary cleft (CC), the width of the mid-CC, the length of the CC, the anterior chamber (AC) depth (distance between the corneal endothelium and the anterior lens capsule), the central and peripheral corneal thick- nesses, then the distance between the anterior lens capsule and the internal corneoscleral limbus. Results: The use of the controlateral eye as control was statistically validated, as well as the representativeness of fifteen-cat cohorts. A significant decrease of IOP was observed only for dorzolamide (5.3%). None of the eight anatomical parameters were statistically modified by the topical instillation of the three drugs. Discussion: The use of the three first-line antiglaucomatous agents does not significantly alter the anterior segment architecture in normotensive cats.

Antiglaucoma pharmacotherapy: analysis of treatment regimens and efficacy indicators

The purpose of this paper is to assess regimens administered for treatment of primary open-angle glaucoma in terms of their compliance with the Protocol of medical care to appropriate group of patients, as well as assessment of the therapy efficacy by the criterion of a degree of intraocular pressure reduction.Research methods. The study was conducted on the basis of data received from outpatients diagnosed "primary open-angle glaucoma". 49 different variants of medicine combinations, consisting of one to three antiglaucoma medicines in the pharmaceutical form of eye drops were prescribed to patients from the subject group.Results of the study. The eight most commonly prescribed regimens consisted primarily of first-line medicines for glaucoma pharmacotherapy. Five of eight subject regimens consisted in monotherapy and only three regimens consisted of two medicines. Also, we calculated a degree of IOP decrease in patients received the above treatment regimens compared with baseline IOP indicators, established at diagnosis stage. It was found that the most effective regimens were the ones containing Arutimol 0.5 %, or Azopt in combination with Taflotan. The study of distribution of regimens containing antiglaucoma medicines, depending on the POAG stage, demonstrated that patients with a stage I disease were administered monotherapy, whilst combined regimens were used mainly for treatment of patients with stage III POAG.Conclusion. The results of the analysis allowed us to determine the most commonly prescribed regimens of antiglaucoma therapy, effective in reaching the target IOP, which consequently would be used for pharmacoeconomic analysis

Passive removal of silicone oil through 23 gauge transconjunctival sutureless vitrectomy system

Objective:To study the outcomes of passive removal of silicone oil by 23 Gauge Transconjunctival Sutureless Vitrectomy System.Methods:This prospective, consecutive case series study was conducted at Ophthalmology Department Unit I, Dow University of Health Sciences, Civil Hospital Karachi from January 2011 to December 2014. Only psuedophakic eyes with silicone oil temponade were selected. Main outcome measures were intra ocular pressure, time taken for removal of silicone oil, per operative and post operative complications. Pre and post operative IOP was compared by using two-tailed paired t-test and mean values with standard deviation were computed using difference of 95% confidence interval. Chi square test was applied for correlation of different variables. P-value of less than 0.05 was considered statistically significant.Results:Out of 79 patients who underwent passive ROSO, 38 (48.1%) were males. Mean age of patients was 47.5±7.1 (sd) years. Mean time taken for passive ROSO was 7.31±2.41 (sd) minutes. Pre and post operative intra ocular pressure shows statistically significant (p=0.000) decrease in IOP. Retinal redetachment found in 13 (16.5%) cases during follow up period.Conclusion:Passive removal of silicone oil with 23 G suture less vitrectomy system is safe and effective in terms of less per operative and post operative complications. In this simple technique, there is less tissue trauma and little time consumed so it provides more comfort to patients and surgeons as well.

Posner schlossman syndrome - A case report

A 23 year old female patient presented to Ophthalmology OPD with complaints of left sided headache since one month, it was sudden in onset and was associated with redness, watering, photophobia and blurring of vision. There were about 8-10 episodes, each lasted for 1-2 days with asymptomatic period between the attacks. Left eye showed fine keratic precipitates with grade 2 flare and cells in anterior chamber. Pupils were mid-dilated and sluggishly reacting. IOP in left eye was 38 mmHg. Patient was started on topical steroids, oral Acetazolamide and topical anti glaucoma medication. Patient was followed after 3 days, showed decrease in inflammation and IOP of 22.00mm Hg in left eye, Gonioscopy revealed open angles and Humphreys visual field test showed no obvious visual field defects. Dilated fundus examination showed normal optic discs. Patients were followed regularly for IOP and any obvious optic disc and visual field defects.

COMPARATIVE EVALUATION OF ANTIHYPERTENSIVE DRUG’S EFFICACY IN PATIENTS WITH PRIMARY GLAUCOMA AT EARLY AND ADVANCED STAGES

Purpose. To comparatively evaluate the antihypertensive efficacy and tolerability of preservative-free Tafluprost 0,0015% and Latanoprost 0,005% with preservative (0.02% BACH) in patients with initial and advanced stages of POAG. patients and methods. 63 patients (83 eyes) with primary open-angle glaucoma, aged from 56 to 75 years. 21 Men, 42 women. Patients were randomized intwo groups. The first group consisted of 32 patients (38 eyes), they received Latanoprost 0,005% (Prolatan®, “Sentiss Pharma”,) 1 drop once daily in the evening. The second group consisted of 31 (45 eyes) of patients treated with Tafluprost 0,0015% (Taflotan® JSC, “Santen”, Finland) 1 drop once daily in the evening. The follow-up period was 3 months. results. All patients had received reliable decrease in the true IOP: on monotherapy with Prolatan® on average by 27.8% (from 22.5±0,14 to 17.6±0,14 mm Hg.St.) in the first month, 26.4% (22,5±0,14 to 17.8±0,14 mm Hg.St) in third. In patients treated with Taflotan, reduction of IOP was approximately on the same level: 29.7 % in a month, 26.8 % in three months. The study of perimetry showed significant improvement of the MD index by 17.4% in the first group and 20% in the second, index, PSD, respectively, 10.7% and 11.9%. Improved parameters as a result of reduction IOP of optic nerve head were in both groups. But a significant decrease in the volume and area of excavation, respectively, 8.4% and 24.4% as well asincreasing the area of the disc rim band by 20.8% were observed only in the first group (instillation Prolatan®). Side effects were registered in 6 patients from the first group and 7 patients from the second group. One patient had several side effects. A mild hyperemia was identified in 3 patients of the first group and 2 from the second group at 4 week, in 5 out of first and 4 from second 8 week. Flushing medium degree was observed in 2 patients of the first group and 3 of the second group at 4 week. Conclusion. Thus, a comparative study has shown that the antihypertensive efficacy of the drug Prolatan comparable with the value of the drug Taflotan. According to optical coherence tomography as a result of treatment significantly decreased the volume, the area of excavation and the increased area of the disc rim of the shoulder in patients of the first group and was not observed in patients of the second group, which may indirectly indicate possible neuroprotective properties of the drug Prolatan. Side effects were registered in both groups, mostly of local character in the form of hyperemia of mild and moderate, increased pigmentation and growth of eyelashes. Patients in both groups noted the complete absence of burning, discomfort, foreign body in the administration of the drugs for a long period of time, with no cases of general disorder.

The immunotherapy role in ocular hypertension management

Objective. To study the immunotherapy role in preventing edematous exophthalmos (EE). Matherials and methods. 19 patients with EE were examined: 8 people (16 eyes) with diffuse toxic goiter (DTG) on the stage of preparation for surgery or for radioactive iodine therapy, 4 people (8 eyes) with autoimmune thyroiditis (AIT), and 7 people (14 eyes) with both AIT and DTG. In all patients, a dry eye syndrome and highly active form of systemic disease were found. In the first group, to prevent edematous exophthalmos decompensation, a standard glucocorticosteroid (GC) pulse therapy during 3 days was performed; in the second group, intravenous (i/v) GC therapy during 2 days and i/v pentoxyfilline therapy; and in the third group, intravenous (i/v) GC therapy during 2 days, i/v pentoxyfilline therapy, and Restasis instillations. In all groups, a background treatment of thyroid disease was carried out. Results. Restasis therapy in edematous exophthalmos (EE) promoted not only dry eye signs leveling, but, in combination with cytokine blocker pentoxyfilline, lead to IOP and exophthalmos decrease, thus contributing to an amelioration of the optic nerve condition. Individualized approach to EE treatment consists in prevention of keratoconjunctivitis sicca and of other complications by 6 months Restasis therapy. Dry eye in endocrine ophthalmopathy (EO) will probably attract attention of endocrinologists and ophthalmologists as an early syndrome of individual predisposition to the development of complication cascade related to endocrine ophthalmopathy (EO)/ Conclusion. The proposed combined treatment appeared to be effective in influencing IOP decrease, dry eye syndrome signs and exophthalmos leveling, and acting on the optic neuropathy course.

Comparison of Surgical Outcomes Between Phacocanaloplasty and Phacotrabeculectomy at 12 Months’ Follow-up

To compare operative outcomes of patients after phacocanaloplasty and phacotrabeculectomy through 12 months' follow-up. Retrospective, nonrandomized, comparative case series. We included 36 eyes of 36 patients with open-angle glaucoma who underwent combined phacoemulsification and canaloplasty (phacocanaloplasty) and 41 eyes of 41 patients with open-angle glaucoma who underwent combined phacoemulsification and trabeculectomy with mitomycin C (phacotrabeculectomy) with 12 months' of postoperative follow-up. All surgeries were performed by a single surgeon (R.S.A.) between January 2007 and May 2011. Failure was based on intraocular pressure (IOP; >18 or <4 mm Hg at 1 y), second operative procedure (any eye requiring reoperation), or decrease in visual acuity by 0.20 logMAR. Change in IOP, visual acuity (VA), glaucoma medications, and complication rates at 12 months were analyzed. There were no differences in demographics other than the sex between the groups. There were also no significant differences in previous surgery or in preoperative VA, IOP, or use of glaucoma medications between the groups, though the phacotrabeculectomy group had a higher preoperative IOP at baseline and a larger SD. Both groups showed significant reduction in IOP from baseline at every time point (P<0.001). No significant difference in mean IOP at 12 months was found, with a mean of 14.1±4.4 mm Hg in the phacocanaloplasty group and 11.8±5.4 mm Hg in the phacotrabeculectomy group (P=0.07). The phacotrabeculectomy group showed a significantly greater median absolute (8 vs. 5 mm Hg) and percent (40% vs. 28%) reduction in IOP at 12 months (P=0.02). Postoperative glaucoma medication use was similar between the 2 groups.Overall failure rates at 1 year were comparable between the 2 groups: 22% for phacocanaloplasty versus 20% for phacotrabeculectomy (P=0.79). Phacotrabeculectomy eyes experienced more visual failures (5% vs. 0%, P=0.50), whereas phacocanaloplasty experienced more IOP failures (17% vs. 12%, P=0.75). No difference in operative failure rate was found between the phacocanaloplasty and phacotrabeculectomy groups (6% vs. 5%, P=1.00) and this held after controlling for covariates. Final VA was not statistically different between the 2 groups. Phacocanaloplasty and phacotrabeculectomy both achieved significant reduction in IOP and improvement in VA at 12 months with comparable success rates. Phacotrabeculectomy achieved a statistically greater median percentage decrease in IOP, but the 2 procedures resulted in comparable mean IOP at 12 months.

Pressure-Lowering Effect of Fistula Occlusion in a Patient with Secondary Glaucoma Due to an Intracranial Arteriovenous Fistula.

IntroductionThis case report presents the pressure-lowering effect of transluminal fistula occlusion in a patient suffering from secondary glaucoma due to carotid cavernous fistula (CCF).Case ReportA 76-year-old Caucasian woman presented with dilated epibulbar vessels with elevated intraocular pressure (IOP, >30 mmHg) as well as glaucomatous excavations of the optic disc in both eyes. Cerebral digital subtraction angiography revealed a CCF with bilateral orbital communication. Preoperative diurnal pressure profiling showed an average IOP of 25.8 mmHg (right eye) and 26.6 mmHg (left eye). Transluminal intervention and fistula occlusion led to a decrease in IOP of about 9 mmHg. A post-operative oculomotor nerve palsy regressed spontaneously.ConclusionSecondary glaucoma due to CCF might be affected by fistula occlusion. Therefore, it should be considered before any surgical glaucoma interventions are performed. Diurnal pressure profiling is an effective tool for monitoring therapeutic success.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0036-0) contains supplementary material, which is available to authorized users.

Comprehensive evaluation of dehydration impact on ocular tissue during Ramadan fasting

Purpose The present study aimed to review the effect of dehydration during Ramadan on the health and ocular parameters leading to changes in eye function. Methods Articles included in the study were taken from PubMed, Ovid, Web of Science and Google Scholar up to 2014. Related articles were also obtained from scientific journals on and vision system. Results Dehydration and nutrition changes in Ramadan cause an increase in tear osmolarity, ocular aberration, anterior chamber depth, IOL measurement, central corneal thickness, retinal and choroidal thicknesses, and also a decrease in IOP, tear secretion, and vitreous thickness. Conclusion Much research related to the effect of dehydration on ocular parameters during Ramadan exists. The findings reveal association with significant changes on ocular parameters. Thus, it seems requisite to have a comprehensive study on fasting and ocular parameters”, which will be helpful in making decisions and giving plan to the patients.

Variation of intraocular pressure in resistance exercise performed in two different positions

Objetivo Verificar a variacao da PIO no exercicio resistido na posicao sentada e em decubito dorsal. Metodos Foram avaliados 14 voluntarios do Centro de Atividades Fisicas do Banco de Olhos de Sorocaba (BOS Fit). Os criterios de exclusao adotados foram: I) opacidade de meios; II) alteracao de volume do bulbo ocular ou ausencia de bulbo ocular; III) PIO maior do que 21mmHg; IV) idade inferior 20 e superior a 40 anos; V) tempo de pratica de treinamento resistido inferior a 30 dias. Inicialmente foi realizado o teste de predicao no exercicio leg press para determinar o percentual de carga para o respectivo exercicio durante o experimento. Os voluntarios foram submetidos a duas intervencoes separadas em um intervalo de 72 horas, ambas com o mesmo volume e intensidade no exercicio leg press, ou seja, 3 series de 15 repeticoes com 60% 1RM, tempo de intervalo entre as series de 60 segundos e velocidade moderada, de acordo com as seguintes posicoes: P1) leg-press executado na posicao sentada e P2) leg press na posicao em decubito dorsal. A PIO foi obtida utilizando o tonometro de Perkins em tres momentos: M1) imediatamente antes do exercicio; M2) imediatamente apos a terceira serie; M3) tres minutos apos a finalizacao da terceira serie. Resultados Em ambas as posicoes houve queda significativa da PIO apos o exercicio (M2), permanecendo significativamente reduzida apos tres minutos de recuperacao (M3). Contudo, nao houve diferenca da PIO segundo a posicao (P1 e P2), independentemente do momento de afericao (M1, M2 e M3). Conclusao Houve queda da PIO decorrente ao exercicio resistido e nao foi verificada resposta diferencial da PIO de acordo com a posicao do exercicio.

Contribution of hemodynamic disturbances in magistral vessels to optic neuropathy progression and ocular tension changes in endocrine ophthalmopathy

to investigate the contribution of various hemodynamic disturbances in magistral vessels to optic neuropathy (ON) progression and ocular tension changes in endocrine ophthalmopathy (EOP). A total of 39 patients (78 eyes) with subclinical EOP (clinical activity score, CAS ≤ 2) associated with Graves' disease (n = 32, 64 eyes) or autoimmune thyroiditis (n = 7, 14 eyes) were examined. Orbit echography was performed in all patients. Blood flow was assessed with a Voluson 730 PRO ultrasound diagnostic system ("Kretz", Austria) in triplex mode (B-scan, color Doppler flow mapping in combination with pulse-wave Doppler). Thus obtained hemodynamic parameters in ophthalmic artery, central retinal artery (CRA), central retinal vein (CRV), short posterior ciliary arteries (SPCA), and long posterior ciliary arteries (LPCA) were analyzed. To reveal the role of hemodynamic disturbances in the above mentioned vessels in ON progression and eye pressure maintenance, the patients were divided into 7 groups. Only those eyes, whose peripheral indices were increased by more than 25% of normal values and diastolic blood flow decreased by not less than 25%, were selected for further study. Intraocular pressure changes were evaluated by group mean (Mmean = M ± m mmHg), optic neuropathy progression--by the difference in group mean depth (dB) and number of scotomas between the first and the last visit (6 months of observation). In almost all types of perfusion disturbances, the resultant chronic ocular ischemia causes a decrease in IOP. The only exception, as shown, is simultaneous involvement of CRA, SPCA, and LPCA. The level of blood flow disturbance determines the severity of qualitative and quantitative changes in eyes with EOP-associated ON. The rate of ON progression directly correlates with baseline IOP values on day zero. Long-lasting chronic impairment of blood supply of the eyeball leads to reduction in ocular tension and progression of optic neuropathy. Combined perfusion disturbances in CRA and LPCA as well as in CRA, LPCA, and SPCA can be considered a high-risk factor, while SPCA and/or LPCA involvement--a moderate-risk factor.

Effect of diode laser cyclophotocoagulation in treatment of patients with refractory glaucoma

Refractory glaucoma is glaucoma resistant to conventional management (maximally tolerated medical therapy, one or more glaucoma surgeries) and glaucoma in cases of neovascularisation after panretinal photocoagulation or cryoablation. The aim of the study was to determine the intraocular pressure (IOP) lowering efficacy of transscleral diode laser cyclophotocoagulation (DCPC) treatment in the management of pain and IOP in patients with refractory glaucoma. This nonrandomized, retrospective study, included 95 patients (95 eyes) with refractory glaucoma treated at the University Eye Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia, between November 2007 and November 2012 in accordance with the established protocols (16-18 spots, 270°, up to 5J of energy). All the eyes were treated with transscleral DCPC (Iris Medical OcuLight SLx, Iridex Co, Mountain View, USA). Patient's symptoms, bests corrected visual acuity and IOP were recorded 7 days, and 1, 3 and 6 months after the DCPC treatment. Out of 95 patients (95 eyes) enrolled in this study 24 (25.2%) were with primary (the group I), and 71 (74.5%) with secondary (the group II) glaucoma. The mean baseline IOP in these two groups was similar: 36.08 ± 8.39 mmHg for the first group and 37.36 ± 8.19 mmHg in the second group. Measurement of the mean IOP in the group I showed the following results: on the day 7 it was 13.96 ± 8.30 mmHg (62.1% decrease of the baseline value), on the day 30 it was 18.44 ± 8.85 mmHg (48.9% decrease regarding the baseline value), after 3 months it was 22.44 ± 7.36 mmHg (37.8% decrease regarding the baseline value), and after 6 months it was 25.92 ± 7.65 mmHg (28.2% decrease regarding the baseline value). Measurement of IOP in the group II showed the following results: on the day 7 it was 15.77 ± 9.73 mmHg (57.8% decrease of the baseline value), on the day 30 it was 20.14 ± 10.20 mmHg (46.1% decrease regarding the baseline value), after 3 months it was 23.46 ± 9.83 mmHg (37.2% decrease regarding the baseline value) and after 6 months it was 27.23 ± 9.87 mmHg (27.2% decrease regarding the baseline value). Pain was the main symptom in 70 (73.6%) patients before the treatment and it persisted in only 4 (4.2%) of our patients. Other complaints (burning, stinging, foreign body sensation) were experienced by 39 (41%) of the patients, postoperatively. A total of 52 (54.7%) patients had no com- plaints after the treatment. Our study confirmed that transscleral DCPC is a useful, effective and safe procedure with predictable amount of IOP decrease, which makes it the treatment of choice for refractory glaucoma.

Change in intraocular pressure in the early period after cataract phacoemulsification

AbstractPurpose Described decrease of IOP after phaco is 2‐5 mm Hg . At the same time, in the early period after cataract extraction frequent increase in IOP is described. The purpose of our study was to analyse the dynamics of IOP after uncomplicated phacoemulcificationMethods The study included 67 eyes of 66 patients who underwent uncomplicated phaco with foldable IOL implantation . All patients underwent tonography resulting tonographic IOP (Po) and ease outflow coeffitient (C) , a study of corneal ‐ compensated IOP (IOPcc) and Goldmann IOP (IOPg) with Ocular Response Analyzer. Which were repeated before surgery, the first two days , 2 weeks , 1 and 3 months after operation.Results Average Po before surgery was 15,67± 0,85 mm Hg, IOPcc 15,91 ±0,69 mm Hg and IOPg 14,51 ±0,78 mm Hg. On the first day after surgery IOPcc increased by 2,84 mm Hg, and IOPg by 1.53 mm Hg . Two weeks after surgery Po decreased from baseline by 3.45 mm Hg , IOPcc still increasing by 0.62 mm Hg , IOPg also further increased by 1.44 mm Hg .1 month after surgery Po virtually unchanged compared with data from 2 weeks , IOPcc returned to preoperative values , IOPg reduced compared with the preoperative figures by 1.0 mm Hg . Finally, after 3 months Po became lower then preoperative by 3.23 mm Hg , IOPcc reduced compared with preoperative by 1.51 mm Hg, and IOPg by 1.92 mm HgConclusion IOP rise after phaco begins on the first postoperative day , reaching a maximum in 2 weeks. Then towards the end of the first month after surgery IOP returns to preoperative values. IOP reduction 1,5‐ 2 mm Hg starts after decrease of postoperative reactive syndrome 1 month after surgery

Schlemm's canal expands after trabeculectomy in patients with primary angle-closure glaucoma.

To evaluate the in vivo changes in the Schlemm's canal (SC) in patients with primary angle-closure glaucoma (PACG) after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT). Forty eyes of 40 patients with PACG who underwent trabeculectomy were included. All participants underwent SD-OCT. The diameter and area of SC were examined and measured before and within 1 month after trabeculectomy. All SD-OCT images were processed using adaptive compensation algorithm to improve contrast and image quality. Multivariate linear regression analysis was performed for predictors of percentage change in the mean SC diameter and area. The mean age of participants was 60.5 ± 14.6 years. Adaptive compensation significantly increased the percentage of sections in which SC was observable in the subjects studied from 52.5% (21/40) to 75.0% (30/40), which has acceptable intraobserver and interobserver repeatability. There was a significant increase in the SC diameter and area at the follow-up examination compared with the baseline value (SC diameter: 34.2 ± 6.2 μm vs. 28.4 ± 6.1 μm; SC area: 8117 ± 1942 μm(2) vs. 5200 ± 996 μm(2); all P < 0.001). After multivariate analysis, the only variable related to changes in SC was percentage change in IOP (SC diameter, P = 0.002; SC area, P < 0.001). In addition, the magnitude of the change in the SC area also correlated with angle opening distance at 750 μm from the scleral spur at baseline. Expansion of SC was observed after trabeculectomy in PACG patients. The degree of SC expansion was related to the extent of the IOP decrease.

Methazolamide-loaded solid lipid nanoparticles modified with low-molecular weight chitosan for the treatment of glaucoma: vitro and vivo study

The aims of this study were to design and characterize methazolamide (MTZ)-loaded solid lipid nanoparticles (SLN) with and without modification of low molecular weight chitosan (CS) and compare their potentials for ocular drug delivery. Low molecular weight CS was obtained via a modified chemical oxidative degradation method. SLN with CS (CS-SLN-MTZ) and without CS (SLN-MTZ) were prepared according to a modified emulsion-solvent evaporation method. SLN-MTZ and CS-SLN-MTZ were 199.4 ± 2.8 nm and 252.8 ± 4.0 nm in particle size, −21.3 ± 1.9 mV and +31.3 ± 1.7 mV in zeta potential, respectively. Physical stability studies demonstrated that CS-SLN-MTZ remained stable for at least 4 months at 4 °C, while SLN-MTZ no more than 2 months. A prolonged in vitro release profile of MTZ from CS-SLN-MTZ was obtained compared with SLN-MTZ. Furthermore, CS-SLN-MTZ presented a better permeation property in excised rabbit cornea. In vivo studies indicated that the intraocular pressure lowering effect of CS-SLN-MTZ (245.75 ± 18.31 mmHg × h) was significantly better than both SLN-MTZ (126.74 ± 17.73 mmHg × h) and commercial product Brinzolamide Eye Drops AZOPT® (171.17 ± 16.45 mmHg × h). The maximum percentage decrease in IOP of CS-SLN-MTZ (42.78 ± 7.71%) was higher than SLN-MTZ (27.82 ± 4.15%) and was comparable to AZOPT (38.06 ± 1.25%). CS-SLN-MTZ showed no sign of ocular irritancy according to the Draize method and the histological examination.

Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing Ahmed glaucoma valve implantation: 2-year follow-up.

To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) in eyes with neovascular glaucoma (NVG) undergoing Ahmed glaucoma valve (AGV) implantation. This was a multicentre, prospective, randomized clinical trial that enrolled 40 patients with uncontrolled neovascular glaucoma that had undergone panretinal photocoagulation and required glaucoma drainage device implantation. Patients were randomized to receive IVB (1.25 mg) or not during Ahmed valve implant surgery. Injections were administered intra-operatively, and 4 and 8 weeks after surgery. After a mean follow-up of 2.25 ± 0.67 years (range 1.5-3 years), both groups showed a significant decrease in IOP (p < 0.05). There was no difference in IOP between groups except at the 18-month interval, when IOP in IVB group was significantly lower (14.57 ± 1.72 mmHg vs. 18.37 ± 1.06 mmHg - p = 0.0002). There was no difference in survival success rates between groups. At 24 months, there was a trend to patients treated with IVB using less antiglaucoma medications than the control group (p = 0.0648). Complete regression of rubeosis iridis was significantly more frequent in the IVB group (80%) than in the control group (25%) (p = 0.0015). Intravitreal bevacizumab may lead to regression of new vessels both in the iris and in the anterior chamber angle in patients with neovascular glaucoma undergoing Ahmed glaucoma valve implantation. There is a trend to slightly lower IOPs and number of medications with IVB use during AGV implantation for neovascular glaucoma.

The influence of new beta-adrenolytics nebivolol and carvedilol on intraocular pressure and iris blood flow in rabbits

BackgroundThe aim of this study was to assess the influence of propranolol, nebivolol, and carvedilol on intraocular pressure and blood flow in vessels of rabbit’s (New Zealand White) eyeball.MethodsThe study was carried out on New Zealand white rabbits. Intraocular pressure was measured with the applanation tonometer Möller–Wedel and Icare; blood flow was measured with Doppler Laser Blood Flow Monitor MBD3.ResultsFollowing a single administration into a conjunctival sac, all drugs decreased intraocular pressure. Iris blood flow was decreased following administration of propranol, but increased by nebivolol and carvedilol. After single and repeated oral administration of nebivolol and carvedilol an IOP decrease was demonstrated, but with no effect of all applied doses on iris or retina/choroid blood flow.ConclusionStudies performed on an animal model indicate that it is possible to reduce the intraocular pressure and increase ocular blood flow in humans, following topical administration of carvedilol and nebivolol. Confirmation of those results in clinical trials may lead to development of a new anti-glaucoma treatment. Further clinical studies of long-term nebivolol and carvedilol are recommended. They are necessary for evaluation of usefulness of those drugs for selected groups of patients, for example those with glaucoma and arterial hypertension.

Change in choroidal thickness and axial length with change in intraocular pressure after trabeculectomy

Background/aimsWe studied the change in choroidal thickness (CT) and axial length (AL) after intraocular (IOP) changes produced by trabeculectomy.MethodsTwenty-one eyes of 20 patients were studied preoperatively, and then postoperatively at...