Early Intraocular Pressure Elevation Research Articles

Impact of postoperative intraocular pressure elevation on graft endothelial cells in non-preexisting glaucoma eyes undergoing descemet membrane endothelial keratoplasty: a cohort study

BackgroundDescemet membrane endothelial keratoplasty (DMEK) has become the dominant keratoplasty procedure. However, the impact of high intraocular pressure (IOP) on the DMEK prognosis in patients without preexisting glaucoma remains unknown.MethodsNon-glaucoma patients who underwent DMEK in Peking University Third Hospital between July 2017 and March 2023 with a follow-up duration longer than six months were included in this cohort study. Eyes were divided into three groups: Group A) normal IOP; Group B) early IOP elevation (IOP ≥ 30 mmHg or increase of more than 10 mmHg from baseline within 3 days); Group C) intermediate-term IOP elevation (IOP > 21 mmHg or increase of more than 10 mmHg from baseline after 14 days postoperatively). The postoperative IOP, endothelial cell density (ECD), central corneal thickness (CCT), best-corrected visual acuity (BCVA) and rate of graft failure were analysed.ResultsForty-seven eyes from forty-seven patients were included. Thirty-seven eyes were bullous keratopathy, and ten were Fuchs endothelial corneal dystrophy. Twenty-five eyes were classified as Group A, six as Group B and sixteen as Group C. The mean peak IOP was 49.00 ± 4.99 mmHg in Group B eyes and 31.89 ± 11.75 mmHg in Group C eyes. The postoperative BCVA significantly differed from that before surgery (P < 0.001). The ECD at 3 months after surgery in eyes with intermediate-term IOP elevation was lower (P = 0.032). Four eyes with intermediate-term IOP elevation developed graft failure (P = 0.001).ConclusionsIntermediate-term IOP elevation after DMEK may reduce the graft ECD and lead to graft failure within six months after surgery. However, early IOP elevation had no effect on the prognosis. Careful IOP monitoring and intermediate-term IOP management should be conducted for graft protection.

Impact of Early Intraocular Pressure Elevation on Postoperative Outcomes After Descemet Membrane Endothelial Keratoplasty in Non-glaucoma Patients.

The purpose of this study was to investigate the impact of transient elevations in postoperative intraocular pressure (IOP) on the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) surgery in non-glaucoma patients. Retrospective analysis from a prospective database of eyes without preexisting glaucoma that underwent DMEK with 90% anterior chamber and 20% sulfur hexafluoride endotamponade. Group A included eyes without postoperative IOP increase (IOP <30 mm Hg and a relative increase from preoperative value <10 mm Hg). Group B included eyes with IOP elevation (postoperative IOP ≥30 mm Hg or a relative increase from preoperative value ≥10 mm Hg) handled according to a standardized protocol. The impact of elevated IOP within 3 days after DMEK surgery was evaluated regarding best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) at 1, 3, and 6 months. One hundred seventy-six eyes from 164 patients were included. An IOP increase after DMEK occurred in 20 eyes (11.3%; 19 patients, group B), and the mean peak IOP was 48 ± 12 mm Hg (range 32-69 mm Hg). There were no significant postoperative differences in BCVA, CCT, and ECC on comparing both groups. The BCVA increased significantly (P < 0.001, respectively), whereas CCT (P < 0.001, respectively) and ECC (P < 0.001, respectively) decreased significantly from preoperative values. The rebubbling rate tended to be higher in group B without statistical significance (6.4% vs. 10%, P = 0.648). Temporary IOP elevation after DMEK may not affect functional and morphological outcomes in non-glaucoma patients. However, careful postoperative IOP monitoring and appropriate management are crucial to avoid irreversible ocular damage.

Schlemm Canal and Trabecular Meshwork Features in Highly Myopic Eyes With Early Intraocular Pressure Elevation After Cataract Surgery

To investigate the morphologic features of the Schlemm canal and trabecular meshwork in highly myopic eyes with early intraocular pressure (IOP) elevation after cataract surgery. Retrospective case-control study. Eighty-eight highly myopic eyes of 88 patients after uneventful cataract surgery were included, 31 of which had early postoperative IOP elevation and 57 of which did not. The morphologic features of the Schlemm canal and trabecular meshwork, collected with swept-source optical coherence tomography before surgery, were reviewed. Backwards stepwise multiple linear regression was used to investigate the anatomic risk factors for early IOP elevation in highly myopic eyes. Highly myopic eyes with early postoperative IOP elevation had smaller Schlemm canal vertical diameter and area, as well as smaller trabecular meshwork thickness and width, in each quadrant than the non-elevation group. There was no significant difference in Schlemm canal horizontal diameter between the IOP elevation and non-elevation groups. In the highly myopic eyes, average Schlemm canal vertical diameter, Schlemm canal area, trabecular meshwork thickness, and width were all correlated negatively with the IOP elevation. A multivariate analysis showed that average Schlemm canal vertical diameter (β=-0.262, P= .004) and trabecular meshwork thickness (β=-0.173, P < .001) were significantly associated with early transient IOP elevation in highly myopic cataract eyes. A smaller vertical diameter of Schlemm canal and a thinner trabecular meshwork are 2 anatomic risk factors for early IOP elevation after cataract surgery in highly myopic eyes.

Risk Factors for Early Intraocular Pressure Elevation After Cataract Surgery in a Cohort of United States Veterans.

Cataract surgery is the most frequently performed surgery in the Veterans Health Administration (VHA). A well-known complication is a transient but potentially harmful elevation in intraocular pressure (IOP) within the 24-h postoperative period. The purpose of this study is to investigate the risk factors for IOP elevation 1 d after cataract surgery in a cohort of United States (US) veterans. The study included 784 patients who underwent cataract surgery between April 2013 and April 2016 at a single Veterans Affairs medical center in Providence, RI. One thousand one hundred thirty-seven cataract surgeries were considered in total. Institutional Review Board (IRB) approval was obtained through the Providence Veterans Affairs Medical Center (PVAMC). Logistic regression, adjusted for patients with bilateral surgeries, was used to evaluate risk factors for first postoperative day IOP elevation (≥28 mmHg). The main outcome measure was elevated IOP on postoperative day 1 (POD1) after cataract surgery. The average patient age was 74 yr. Ninety-eight percent (1,110/1,137) of cases involved male patients; 75.3% (856/1,137) of the cataract surgeries were performed by resident surgeons. Type II diabetes mellitus (DM) was present in 41% (461/1,137), alpha-1 blocker use in 31% (358/1,137), ocular hypertension (ocular HTN) in 4% (44/1,137), and glaucoma in 11% (126/1,137) of cases. Twenty-two percent (232/1,137) of eyes had elevated IOP. Independent risk factors were a history of ocular HTN (OR: 8.74 [4.03-18.9]), glaucoma (OR: 3.54 [2.17-5.75]), a preoperative IOP ≥22 mmHg (OR: 2.51 [1.12-5.62]), and complicated cataract surgery (OR: 2.45 [1.18-5.08]), defined as vitreous loss, anterior capsular tear (ACT), posterior capsular tear (PCT), or presence of zonular lysis. These findings suggest that cataract surgery patients with ocular HTN, glaucoma, a preoperative IOP ≥22 mmHg, or significant intraocular complications may benefit from prophylactic ocular anti-hypertensive medication.

白内障超声乳化人工晶体植入术后早期眼压升高的原因分析

白内障超声乳化人工晶体植入术后早期眼压升高的原因分析

Early Postoperative Intraocular Pressure Elevation after Vitreoretinal Surgery

Objective: The evaluation of intraocular pressure (IOP) after vitreoretinal surgery is critical to ensure the normal function of the eye. The purpose of this study was to determine the incidences and risk factors of early postoperative IOP elevation after vitreoretinal surgery. Method: Data were collected and retrospectively analyzed from 150 patients (150 eyes) who received vitreoretinal surgery from March 2012 to December 2012 in Tongji Hospital. IOP was measured before surgery and on day 1, 2, 3, 4-7 after surgery by Goldmann applanation tonometer. Ocular hypertension was defined as IOP ≥ 24 mmHg. The incidences and risk factors were analyzed. Results: 87 of the 150 patients were male and 63 were female. The IOP was elevated significantly in 54 eyes (36.00%) within 1 week after vitreoretinal surgery. Among them, 31 eyes (57.40%) occurred on day 1; 14 eyes (25.93%) occurred on day 2. The incidences of elevated IOP between different primary diseases had no statistical difference (p>0.05). However, patients with proliferative diabetic retinopathy (PDR), and rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade ≥ C2, had higher rates of IOP elevation. Vitrectomy combined with cataract surgery or scleral buckling had no significant difference in IOP elevation compared with vitrectomy only (p>0.05). The rate of IOP elevation between 20G pars-plana vitrectomy (41.76%) and 23G pars-plana vitrectomy (27.40%) had statistical difference (p=0.033). The incidence of IOP elevation with intraocular tamponade of C3F8 was significantly higher than simple vitrectomy (chi2=7.723, p=0.005), while with silicone oil, the difference was not significant (chi2=3.627, p>0.05). Conclusion: IOP measurement after vitreoretinal surgery is important to monitor and prevent unintentional high IOP as it is a common complication after vitreoretinal surgery. The risk factors of early IOP elevation include the 20G pars-plana vitrectomy and C3F8 injection. Early treatment of IOP may prevent IOP spike to protect the vison.

Effect of Dorzolamide/Timolol or Brinzolamide/Timolol Prophylaxis on Intravitreal Anti-VEGF Injection-Induced Intraocular Hypertension

ABSTRACTPurpose: To evaluate prospectively whether anti-glaucomatic drugs administered prior to intravitreal anti-vascular endothelial growth factor (VEGF) injection bevacizumab (Avastin,® Roche) or ranibizumab (Lucentis,® Novartis) prevents intraocular hypertension after the injection. Subjects and methods: In total, 166 patients (175 eyes) scheduled for intravitreal anti-VEGF injection treatment were prophylactically treated 1 hour before the procedure with Dorzolamide/Timolol (Cosopt,® MSD) (Group 1, 53 eyes) or Brinzolamide/Timolol (Elazop,® Alcon) (Group 2, 84 eyes) or left untreated (Group 3, 29 eyes). Intraocular pressure was analyzed 5 minutes prior to the injection, every 5 minutes for 30 minutes after the procedure, and 1 hour, 1 day, 7 days, and 1 month after the procedure. Results: The intraocular pressures 5 minutes before the procedure (baseline) for Groups 1, 2, and 3 were 12.06 ± 1.85, 13.98 ± 2.68, and 13.81 ± 2.24 mmHg, respectively. Five and 30 minutes after the procedure, the intraocular pressures of the three groups were 14.12 ± 4.18, 14.87 ± 3.35, and 28.21 ± 3.16 mmHg, respectively, and 10.87 ± 1.58, 14.25 ± 2.43, and 17.48 ± 2.34 mmHg, respectively. For all three groups, the changes relative to baseline 5 and 30 minutes after injection were significant. When the three groups were divided according to whether they received bevacizumab or ranibizumab and the changes in intraocular pressure relative to baseline were analyzed, all six subgroups exhibited significant changes in intraocular pressure 5 and 30 minutes after the procedure. Conclusion: The prophylactic administration of anti-glaucomatic drugs prior to intravitreal anti-VEGF injection effectively reduced the early intraocular pressure elevation. This approach was also safe and could be performed accurately.

Surgical Outcome After Early Intraocular Pressure Elevation Following Combined Cataract Extraction and Trabeculectomy

We report on the incidence and course of early postoperative intraocular pressure (IOP) elevation and related surgical outcome following combined manual extracapsular cataract extraction (ECCE), using a sclerocorneal tunnel incision and trabeculectomy. The combined procedure was the initial surgery in each eye. Intraocular pressure was measured during the first 4 days, at 1 week, and thereafter following surgery. Of 38 eyes (38 consecutive adults), postoperative IOP elevation to > 25 mm Hg was found in 7 eyes (18.4%) during the first 3 postoperative days. The IOP was reduced to < or = 20 mm Hg without hypotensive medication in 3 of them within the first 3-7 postoperative days, and remained so after 7-16 months (mean, 10.3 +/- 4.9 months). Each of the other 4 eyes underwent argon-laser suture lysis 8-10 days after surgery due to unstable IOP which rose to > 30 mm Hg. Two weeks after the operation and thereafter, ie, after 8-22 months (mean, 12.8 +/- 6.4 months), each of these 4 eyes necessitated 1-4 (mean, 2.5 +/- 1.3) hypotensive medications. This study raises the possibility that in eyes with early IOP elevation, a delay in promoting aqueous outflow beyond a critical period during the first postoperative week might become a risk factor for full surgical success.

Glaucoma in Keratoplasty

This paper reports intraocular pressure findings in 676 eyes that received penetrating keratoplasties. There were four groups: 1. keratoconus without preoperative glaucoma (75 cases); 2. Fuchs' dystrophy and cataract (triple procedure) without glaucoma (260 cases); 3. aphakic eyes with or without intraocular lenses (204 cases); and 4. pseudophakic eyes with or without intraocular lens removal (137 cases). The last two groups had a significant number of glaucoma cases. All were controlled before surgery. There were no early or late glaucoma cases in the first group. A few cases with triple procedures had mild early intraocular pressure elevation. Thirty percent of aphakic eyes and 52% of pseudophakic eyes had early glaucoma. Twenty percent and 25% of these two groups had persistent glaucoma. Preoperative glaucoma eyes were included in these long-standing glaucoma cases.

Timolol in the management of secondary glaucomas

The mechanisms of the secondary glaucomas and the actions and side effects of antiglaucoma drugs are reviewed. Based on these observations, the advantages of timolol, as compared to other medications, in the management of secondary glaucomas are discussed. To illustrate some of these advantages, a study is reported in which timolol is evaluated for control of the early intraocular pressure elevation after routine cataract surgery.