Elevated IOP Research Articles

Intravitreal Ranibizumab and Dexamethasone Implant Injections as Primary Treatment of Diabetic Macular Edema: The Month 24 Results from Simultaneously Double Protocol

Purpose To compare efficacy of simultaneously administered intravitreal dexamethasone implant (DEX implant) and ranibizumab (simultaneous double protocol) injections with ranibizumab monotherapy for diabetic macular edema (DME) at month 24. Methods This is a prospective, consecutive, clinical interventional study. Naïve eyes with DME were randomized into two groups: 34 eyes received simultaneous double-protocol therapy and 34 eyes received ranibizumab monotherapy. The primary efficacy endpoint was change in visual acuity in month 24. The secondary efficacy endpoints were to evaluate gain of ≥15 letters, morphological changes and central foveal thickness. Decreased vision from DME (study eye BCVA, 20/40 or worse Snellen equivalent using ETDRS testing), the presence of DME with ≥300 μm foveal intraretinal cystoid spaces (within 1000 μm of the centre of the fovea), subfoveal neuroretinal detachment (SND), intraretinal hyperreflective foci (HRF, within 500 μm of the centre of the fovea) or foveal lipid exudates and external limiting membrane (ELM) and ellipsoid zone (EZ) disruption (within 500 μm of the centre of the fovea) on SD-OCT were eligible to enrol. Results The mean baseline BCVA was 48 ± 23 letters in double protocol group and 52 ± 14 letters ranibizumab monotherapy group (p = 0.416). The mean number of ETDRS letters changed from baseline at 12 months versus change from baseline at month 24 in double protocol group and ranibizumab monotherapy group were +21.6 versus +20.2 and +9.6 versus +9.1, respectively. At the month 24 time point, 65.4% of patients in double protocol group and 26.2% of patients in ranibizumab monotherapy group had gained ≥15 ETDRS letters in BCVA from baseline (p < 0.001). The external limiting membrane (ELM) and ellipsoid zone (EZ) integrity were better in the double protocol group in comparison to ranibizumab monotherapy group at month 24. In addition, there was no statistically significant increase in the proportion of patients with epiretinal membrane in double protocol group at month 24, by the contrast with ranibizumab monotherapy group (p = 0.06 and p = 0.04 in the double protocol and ranibizumab monotherapy groups, respectively). From baseline to month 24, the mean central foveal thickness (CFT) was 672 ± 293 μm reduced to 278 ± 84 μm in double protocol group and was 631 ± 279 μm reduced to 356 ± 108 μm in ranibizumab monotherapy group (p < 0.001 and p < 0.001). From baseline to month 24, 38% (13/34) of eyes in double protocol group and 18% (6/34) of eyes in ranibizumab monotherapy group had at least 5 mmHg of IOP elevation (p = 0.012). Two grades or more increased cataract density were detected 27% (6/22) of eyes in the double protocol group and in 12.5% (3/24) of eyes in the ranibizumab monotherapy group from baseline to month 24 (p = 0.032). Conclusion According to the improvements in visual acuity and morphological changes achieved at month 24, the simultaneous double protocol therapy can be an effective treatment option for DME with inflammatory biomarkers on OCT or/and decreased visual acuity.

Hemorrhagic Retinal Detachment Treated by Drainage Sclerotomy Combined with Subretinal and Submacular Tissue Plasminogen Activator

Introduction: The aim of this study was to evaluate the therapeutic effect of a new drainage procedure for treating subretinal hemorrhage (SRH) in hemorrhagic retinal detachment (RD) in patients with polypoidal choroidal vasculopathy (PCV). Methods: Forty-three eyes with hemorrhagic RD attributable to PCV underwent vitrectomy. External drainage via sclerotomy was performed in 25 eyes and internal drainage via retinotomy was performed in 18 eyes, respectively. Based on different surgical techniques, the external drainage group was divided into simple external drainage subgroup (10 eyes), external drainage combined with intravitreal injections of recombinant tissue plasminogen activator (tPA) subgroup (7 eyes), and external drainage combined with subretinal and/or submacular injections of tPA subgroup (8 eyes). The internal drainage group was divided into small retinotomy subgroup (7 eyes) and large retinotomy subgroup (11 eyes). The anatomic reattachment of the retina and postoperative complications were compared between different groups and subgroups. Results: The external drainage technique had shorter mean operation time, higher retinal reattachment rate, and fewer postoperative complications rate compared to the internal drainage procedure. The subfoveal hemorrhage subsided significantly sooner in the large retinotomy subgroup and external drainage combined with subretinal and/or submacular injections of tPA subgroup compared to the small retinotomy subgroup and the external drainage without tPA group (p < 0.05). The small retinotomy subgroup had higher rates of hemorrhage and elevated IOP compared to other subgroups during the first week of the postoperative period (p < 0.05). Conclusion: Our results suggest that external drainage of SRH combined with subretinal and/or submacular injections of tPA can make the operation simpler, shorten the operation time, reduce the postoperative complications with rapid regression of subfoveal hemorrhage, resulting in an effective and safe therapeutic strategy for treating hemorrhagic RD.

Диагностическое значение макулярного кровотока при глаукоме низкого давления

Aim: to evaluate macular microcirculation in patients with early newly diagnosed normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) with elevated IOP using optical coherence tomography angiography (OCTA). Patients and Methods: patients aged 45–65 years with early newly diagnosed NTG (35 patients, 35 eyes) or POAG with elevated IOP (43 patients, 43 eyes) and healthy individuals without ocular disorders (n=50) were examined. All patients underwent OCTA by measuring vascular density (VD, %) using the ETDRS grid (central Fovea and Parafovea) and retinal thick-ness using the Angio Retina 3.0 protocol of the Optovue XR Avanti with the AngioVue function (Optovue, USA). Results: in patients with NTG and POAG, a decrease in vascular density in the superficial choroid plexus was detected. In patients with NTG, retinal thickness in the Fovea, Parafovea, Inferior, and Nasal quadrants was lower than that in the control group and correlated with VD in the Fovea and superior Parafovea of the superficial choroid plexus. The severity of focal losses of the retinal ganglion cell complex was lower than that in the control group and demonstrated a significant weak negative correlation (r=-0.487, p&lt;0.01) with the vascular density index in the Fovea of the superficial choroid plexus. In patients with POAG, retinal thickness in the Fovea and Parafovea was also reduced and correlated with vascular density in the temporal and inferior Parafovea. The severity of global losses of the retinal ganglion cell complex demonstrated a weak negative correlation (r=-0.464, p&lt;0.01) with microcirculation density in the Fovea of the superficial retinal choroid plexus. Conclusion: OCTA revealed a decrease in vascular density in the superficial choroid plexus in early glaucoma. Moreover, a significant difference between NTG and POAG in the Fovea and Parafovea was revealed. Our study established the predominance of vascular changes in patients with NTG. OCTA parameters of the superficial choroid plexus identify microcircula-tion abnormalities at early glaucomatous damage. KEYWORDS: primary open-angle glaucoma, normal tension glaucoma, OCT, optical coher-ence tomography angiography, vascular density index. FOR CITATION: Zagidullina A.Sh., Galimova V.U., Arslanova A.I., Nugmanova A.R. Diagnostic value of macular blood flow in normal tension glaucoma. Russian Journal of Clinical Ophthalmology. 2023;23(4):174–180 (in Russ.). DOI: 10.32364/2311-7729-2023-23-4-1.

Visual Acuity and Visual Field Changes in Patients with End-Stage PACG with Tubular Visual Field after Cataract Surgery

Introduction: To investigate the impact of cataract surgery on visual acuity and visual field (VF) in patients with end-stage glaucoma with tubular VF, and assess the risk of severe visual impairment. Methods: Retrospective analysis of the case data of patients with end-stage glaucoma with tubular VF who underwent cataract surgery in our hospital in the past 7 years. Results: A total of 59 patients with 63 eyes were enrolled, 62 eyes were primary angle-closure glaucoma (PACG) and 1 eye was primary open-angle glaucoma. The last follow-up time was an average of 9 months, and no cases of severe vision loss occurred. Best corrected visual acuity (BCVA) improved significantly after surgery (0.57 ± 0.46 vs. 0.45 ± 0.43 logarithm of the minimum angle of resolution, p < 0.01), and there was a significant drop in intraocular pressure (IOP; 22.85 ± 9.7 vs. 16.07 ± 3.38, p < 0.01), a reduced number of glaucoma medications (2 ± 1.32 vs. 0.5 ± 1, p < 0.01), statistical improvement in VF index (VFI) and mean defect (MD) (12.3% ± 7.65% vs. 16.1% ± 9.84%, p < 0.01; −29.09 ± 2.16 vs. −28.31 ± 3.01, p < 0.01) after surgery. The higher the preoperative VFI and MD were, the better the postoperative BCVA (r = −0.387, r = −0.347, respectively). The degree of postoperative VFI improvement was significantly correlated with preoperative MD (r = 0.372, p < 0.01). During the follow-up period, 5 eyes (8%) underwent anti-glaucoma surgery due to elevated IOP. Conclusion: Cataract surgery can significantly improve visual acuity and VF in patients with end-stage PACG with tubular VF, and no patients have severe visual impairment. The less preoperative VF damage there is, the greater the postoperative visual acuity and VF improvement. Poor IOP control is the main cause of further damage to postoperative visual acuity and VF.

Benign Intracranial Hypertension Secondary to Intranasal Corticosteroid Administration

Steroids have been used for a wide spectrum of indications in clinical practice. The potential benefits of steroids outweigh the complications in most settings. Steroids have been used over the counter in our country for allergy and arthritis. Here we present a case of a young girl who presented with headache, tinnitus, vomiting, and papilledema, visual field defect in perimetry with elevated IOP, presumed secondary to intranasal steroid use for allergic rhinitis. There are case reports suggesting a causal relationship between steroids and benign intracranial hypertension. Here patient on follow-up had significant improvement on stopping steroid spray. This case report is to highlight the need for awareness of the possibility of benign intracranial hypertension in patients who are on inhalational steroids.

Comparison of Intraocular Pressure After Phacoemulsification Compared to Laser Peripheral Iridotomy (LPI) in Acute Primary Angle Closure (APAC) Patients: A Systematic Review

Aim: To compare IOP in APAC patients after phacoemulsification compared to LPI. Background: Acute primary angle closure (APAC) is a type of PACG and an important cause of blindness in East Asia. In APAC patients, both LPI and phacoemulsification have been shown to be effective in controlling elevated IOP. Knowledge and information about changes in IOP after phacoemulsification and LPI&nbsp;in APAC patients, which is one of the criteria for successful APAC management, can be a reference as well as a consideration for choosing an effective treatment for APAC patients. Results: Of the 15 articles reviewed, 84% of patients who received phacoemulsification intervention experienced &gt;50% reduction and 24.3% of patients experienced &lt;50% decrease in post-op IOP compared with the mean pre-op IOP. While patients who received LPI intervention, 80.5% of patients experienced &gt;50% reduction in IOP and 19.4% of patients experienced &lt;50% reduction in IOP post-op compared with the mean pre-op IOP. Conclusion: There were decreases in IOP of APAC patients after phacoemulsification or LPI. In addition, there are differences in the decrease in IOP of APAC patients after phacoemulsification compared to LPI. Clinical Significance: Phacoemulsification and LPI are effective&nbsp;for&nbsp;lowering IOP in the early stages of an acute attack. LPI&nbsp;is the preferred procedure according to most guidelines&nbsp;because it is relatively non-invasive, easy to administer on an outpatient basis, and has a lower risk of complications.&nbsp;Phacoemulsificatin&nbsp;has been shown to be a more effective treatment than LPI for IOP reduction in early and medium-term IOP controls.

Intracameral injection of cross‐linking hydrogel polymer as an animal model of IOP increase

AbstractGlaucoma is a multifactorial neurodegenerative disease that leads to the progressive loss of retinal ganglion cells (RGCs) and their axons resulting in visual field damage and retinal and optic nerve head changes. Progression is generally slow but, in some patients, can lead to a ‘catastrophic’ reduction of visual function and in advanced cases may lead to blindness. Glaucoma is, in fact, the leading cause of irreversible blindness worldwide.Finding a model of retinal ganglion cell (RGC) loss or experimental glaucoma which accurately mimics human disease has been a challenge for researchers. There have been many attempts to produce a model of studying RGC pathophysiology or death longitudinally to study pharmacological treatments or neuroprotective interventions. There are many methods, both acute and chronic, that have been used to induce retinal ganglion cell death. Some methods made a direct injury to the optic nerve which causes rapid RGC death, while others are models try to increase the IOP with mechanical damage or injection of different agents into the anterior chamber to block aqueous humour outflow.Several models of chronic glaucoma, primarily in non‐human primates and rodents, in which IOP is elevated has been described. However, most of these animal models due to the opacification of the ocular medias as a result of the inflammation or intraocular pression increase only allow to perform a single time point for many different time ex vivo analysis of the RGCs. So, longitudinal changes in the number of RGCs in the same animal can only be performed in vivo. This is an important way to remove the between‐subject variability, but any aging effects will be compounded to those due to disease progression.A novel glaucoma model using a cross‐linking polymer result in a consistent and sustained elevation of IOP with preservation of optical media clarity for long term.This model is based on in situ temperature sensitive cross‐linking of a mixture of two components (hyaluronic acid functionalized with vinyl sulfone (HA‐VS) and thiol groups (HA‐SH)). When the mixture is injected into the anterior chamber, the higher temperature of aqueous humour compared to air causes the gel to solidify within the anterior chamber angle thereby blocking aqueous outflow through the trabecular meshwork and increasing the IOP. Furthermore, the hydrogel is localized to the anterior chamber angle with no noticeable media opacities, thereby allowing repeated in vivo imaging.It has been shown that the increased IOP and the optical media clarity produced in this animal model of glaucoma allows for in vivo study with the Confocal Scanning Laser Ophthalmoscope of the density and structural loss of RGCs, as well as functional loss of RGCs with electroretinography for more than 4 weeks after the hydrogel injection.

TO STUDY THE VISUAL OUTCOME AND IOP CHANGES AFTER ND: YAG LASER CAPSULOTOMY

Aims and objectives : To study the Visual outcome and IOP changes after Nd YAG Laser Capsulotomy in patients with posterior capsular opacity. To study the age and sex distribution. To study intra and post laser complications of Nd YAG Laser Capsulotomy. Materials and Methods: This was a Prospective interventional study done on 100 eyes of 100 Post Cataract surgery patients who are having PCO attending to OPD of Ophthalmology department, Dr. R.S.P.R Government Regional eye hospital, Andhra Medical College, Visakhapatnam from August 2021 to August 2022. Relevant detailed History and Ocular examination was done. Results: Majority of the patients are in the age group of 51-60yrs(36%). Females (54%) are more than Males(46%). Fibrous type is seen in majority of cases(45%). The mean IOP is more at 2hrs post Laser treatment. 1- 5 mmHg rise is seen in majority of cases(70%). 85% of patients showed best corrected visual acuity better than 6/18. 15% patients showed visual acuity less than 6/24. Elevation of IOP (&gt;4 mm of hg) is the most common complication (46%) and Pitting of IOL (5%) after Nd: YAG Laser Capsulotomy. Conclusion: Visual improvement is excellent after Nd: YAG Laser Capsulotomy. Transient rise of IOP is the most common complication. Even though transient, it may be detrimental to the health of of the optic nerve head. So a careful monitoring of IOP before and after Nd:YAG Laser Capsulotomy is very much needed.

Neuroprotective Effects of Transferrin in Experimental Glaucoma Models.

Iron is essential for retinal metabolism, but an excess of ferrous iron causes oxidative stress. In glaucomatous eyes, retinal ganglion cell (RGC) death has been associated with dysregulation of iron homeostasis. Transferrin (TF) is an endogenous iron transporter that controls ocular iron levels. Intraocular administration of TF is neuroprotective in various models of retinal degeneration, preventing iron overload and reducing iron-induced oxidative stress. Herein, we assessed the protective effects of TF on RGC survival, using ex vivo rat retinal explants exposed to iron, NMDA-induced excitotoxicity, or CoCl2-induced hypoxia, and an in vivo rat model of ocular hypertension (OHT). TF significantly preserved RGCs against FeSO4-induced toxicity, NMDA-induced excitotoxicity, and CoCl2-induced hypoxia. TF protected RGCs from apoptosis, ferroptosis, and necrosis. In OHT rats, TF reduced RGC loss by about 70% compared to vehicle-treated animals and preserved about 47% of the axons. Finally, increased iron staining was shown in the retina of a glaucoma patient's eye as compared to non-glaucomatous eyes. These results indicate that TF can interfere with different cell-death mechanisms involved in glaucoma pathogenesis and demonstrate the ability of TF to protect RGCs exposed to elevated IOP. Altogether, these results suggest that TF is a promising treatment against glaucoma neuropathy.

Effectiveness of Topical Ganciclovir 2% Monotherapy Versus Combined Steroid Therapy in Cytomegalovirus Endotheliitis.

We aimed to report the clinical manifestations of cytomegalovirus (CMV) corneal endotheliitis and the results of long-term treatment with topical ganciclovir 2% with and without steroids. This retrospective, interventional study included 15 eyes of 13 patients diagnosed with CMV corneal endotheliitis by positive CMV DNA and treated with long-term topical ganciclovir 2% eye drops at a tertiary referral center and the median follow-up period was 17 months. Ocular manifestations included keratic precipitates (KPs) (100%), elevated IOP (93.3%), iritis (60%), corneal edema (60%), and moth-eaten iris atrophy (60%). After long-term treatment, corneal edema, iritis, and KPs significantly decreased (effect size: 72%, 76% and 70%, respectively; p = 0.024, p = 0.006 and p < 0.001, respectively). Both the logMAR acuity and IOP significantly improved (median logMAR was 0.52 before treatment and 0.22 after treatment; median IOP was 42 mmHg before treatment and 12 mmHg after treatment; p = 0.001 and p < 0.001, respectively). The ECD was maintained (effect size: 80%), and the percentage of hexagonal cell ratio of endothelial cells significantly improved after treatment (effect size: 82%; p = 0.035). Fewer anti-glaucoma medications were used in the non-steroid group (effect size: 79%; p = 0.034). Long-term maintenance treatment with topical ganciclovir 2% monotherapy not only provides effective therapy and reduces recurrence, but also decreases the high IOP related to the combination of steroids used.

A Multicenter 12-Month Retrospective Evaluation of Canaloplasty and Trabeculotomy in Patients with Open-Angle Glaucoma: The ROMEO 2 Study.

PurposeTwelve-month safety and effectiveness results for canaloplasty combined with trabeculotomy using the OMNI surgical system in pseudophakic eyes or combined with cataract surgery in mild-to-moderate open-angle glaucoma (OAG).SettingSixteen centers in 11 US states (AL, AR, CA, CT, KS, LA, MO, NY, SD, TN, TX).DesignRetrospective, case series, open-label.MethodsA total of 136 eligible patients from 20 surgeons: mild-to-moderate OAG (visual field mean deviation (MD) not worse than −12 dB), 12-month follow-up, preoperative medicated IOP >18 mmHg and ≤36 mmHg on ≤5 medications. One eye per patient enrolled. Endpoints included proportion with ≥20% reduction in IOP or IOP between 6 and 18 mmHg (inclusive) and on the same or fewer medications without secondary surgical intervention (SSI) (primary success), mean IOP, change in IOP, ocular hypotensive medication use, and proportion of patients with a 20% or greater reduction in IOP at 12 months. Safety: adverse events (AE) and best corrected visual acuity (BCVA).ResultsPrimary success was met by 71%. Mean IOP was reduced (22.3–15.9 mmHg, p < 0.0001). Medications went from 1.9 ± 1.3 to 1.3 ± 1.2 (p < 0.001). AE were mild and as expected for angle surgery. The most frequent AE were BCVA loss (6%), mild inflammation (4%), IOP elevation (3%), and clinically significant hyphema (3%). There were 4 (3%) SSI.ConclusionThe OMNI system provides effective IOP reduction, sustained IOP control, and meaningful medication reduction for up to 12 months postoperative. The present study confirms and extends the results from ROMEO.

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

PurposeTo evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma.DesignIn this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors.ResultsThe 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” (n = 16) compared to Fuchs’ dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456–27.031]).ConclusionThe risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure.

Clinical features and management of iris melanoma - a systematic review

Introduction and purpose Uveal melanoma is the most common primary intraocular malignancy in adults. Most of them arise in the choroid and ciliary body, whereas 2-5 % of the cases are located to the iris. Nevertheless, during the last few decades the incidence of this neoplasm has been increasing. The aim of the study is to discuss the risk factors, clinical features and methods of diagnosis and treatment of iris melanoma. Description of the state of knowledge Iris melanomas vary in their shape, size, degree of pigmentation and clinical behavior and most commonly present as a nodular tumor located in the lower temporal iris quadrant. This localisation is linked to exposure to solar radiation, which among light-colored iris, skin color and pre- existing iris naevus, is a risk factor for this malignancy. Gender predilection for the development of iris melanoma is unclear, however, some studies indicate a predominance of female patients. The most common clinical symptoms are growth of a pre-existing naevus, detection of new, dark lesion, pain secondary to elevated IOP and blurred vision. Due to anterior location of this site of uvea, early diagnosis and treatment is possible. Slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (UBM) allow staging of the tumor to guide the most appropriate treatment. As many primary iris lesions have a benign prognosis, surgical resection or radiotherapy is efficient way of treatment and allows good local tumor control. Summary Iris melanoma is least frequent of all uveal melanomas and usually presents as variably pigmented, elevated, solitary lesion. When there is a clinical suspicion of malignancy slit- lamp examination and UBM should be performed. When early diagnosed it can be successfully treated.

Ocular hypertension in patients with active thyroid-associated orbitopathy: a predictor of disease severity, particularly of extraocular muscle enlargement.

A total of 96 eyes and orbits of 48 adult patients with active TAO were investigated. All patients underwent magnetic resonance imaging of the orbit and measurement of all extraocular recti muscles (EOM). The obtained data was divided into two groups according to the IOP value: normal IOP ≤ 21mmHg; n = 47 and elevated IOP with IOP > 21mmHg; n = 49, and analyszed. A significant difference was found in the short diameter of medial rectus and inferior rectus muscles and in the sum of short parameters of all EOM. All these parameters were significantly higher in the elevated IOP group. Motility restriction in at least one gaze direction was also significantly more frequent (p < 0.0001) in the elevated IOP group. A positive moderate correlation was found between IOP and the sum of short parameters of EOM (r = 0.496). No correlation was found between the IOP and exophthalmos values (r = 0.267). During the follow-up, the frequency of strabismus surgery and orbital decompression was significantly higher in the elevated IOP group (p = 0.003; p = 0.002). Elevated IOP in the active TAO stage particularly correlates with extraocular muscle involvement. These patients are also more likely to require orbital decompression and strabismus surgery.

Clinical and morphological aspects of the development of secondary ophthalmic hypertension in uveal melanoma

Ophthalmic hypertension is mostly associated with medium- or large-sized melanomas. The pathogenesis of persistent IOP elevation in uveal melanoma is not fully understood at present. Purpose. To analyze the clinical and morphological mechanisms of the development of secondary ophthalmic hypertension in patients with uveal melanoma. Material and methods. The case histories of 26 patients with T3N0M0-T4N0M0 uveal melanoma were analyzed retrospectively from 2015 to 2019. The main group included 18 patients with secondary monolateral IOP elevation while the control group was composed of 8 patients with normal IOP. Tumors in both groups were comparable in size. All patients underwent eradication treatment (enucleation/exenteration). Enucleated eys were histologically examined. Results. Pronounced pathological changes of the iridocorneal angle, iris and ciliary body were found morphologically in all specimens with elevated IOP. The following dominating mechanisms ofophthalmic hypertension were detected: iris and anterior chamber angle neovascularization; tumor-associated chronic uveitis; obstruction of trabecular meshwork by cellular elements (pigment-rich macrophages, blood cells, inflammatory cells); fibrosis and deformation of trabecular meshwork and Schlemm's canal; closed angle glaucoma with lens-iris diaphragm shift; tumor invasion into the angle. Conclusions. Investigation of morphological changes in patients with UM and found resemblances with already studied non-tumor forms of glaucoma may help find previously undetectable receptors for the development of targeted anti-tumor drugs.

A Novel Technique Identifies Valve-Like Pathways Entering and Exiting Schlemm's Canal in Macaca nemestrina Primates With Similarities to Human Pathways.

Purpose: The aim of the study was 1) to describe a novel combination of techniques that permit immunohistochemistry imaging of Schlemm’s canal inlet (SIV) and outlet (SOV) valve-like structures, 2) to identify tissue-level SIV adhesive relationships linking the trabecular meshwork (TM) to hinged collagen leaflets at the Schlemm’s canal (SC) external wall, and 3) to determine whether the SIV lumen wall’s adhesive vascular markers are similar to those of the SC inner wall endothelium. Materials and Methods: Anterior segments of 16 M. nemestrina primates underwent immunohistochemistry (IHC) labeling. We perfused fluorescent microspheres into 12 of the eyes. Limbal tissues were divided into quadrants, viscoelastic introduced into SC, tissues fixed, immunohistochemistry performed, radial segments cut, tissues clarified, and confocal microscopy performed. Finally, we generated ImageJ 3D projections encompassing the TM, SC, and distal pathways. Results: IHC imaging identified 3D relationships between SIV, collector channel ostia, collector channels (CC), SOV, and intrascleral channels. Imaging depth increased 176.9%, following clarification (p < 0.0001). Imaging demonstrated CD31, collagen type 1 and 4 in the walls of the SIV lumen and more distal pathways. In eight eyes, 384 segments were examined, 447 SIV identified, and 15.4% contained microspheres. Conclusion: Our technique’s imaging depth permitted the identification of SIV linkage between the TM and SOV. We found comparable cell–cell adhesion molecules (CD31) and basement membrane components in the SC inner wall and SIV lumen walls. Recent OCT studies have suggested that SIV tensional relationships may control CC entrance dimensions that regulate distal resistance. Cellular adhesive properties sustain SIV tensional relationships. These SIV cell–cell and cell-basement membrane properties warrant further study because abnormalities could be a factor in the IOP elevation of glaucoma.

ANALYSIS OF POST MSICS IOP RISE WITH 2%HPMC AND 1% SODIUM HYALURONATE OVDs - a comparative study

Background. Elevated IOP is the most frequent postoperative complication after cataract surgery and consequences of raised IOP lead to sight threatening problem. Intraocular pressure spikes of 30 mm HG or higher in the early period after cataract surgery causes pain, corneal epithelial edema, and damage to optic disc. The main cause of postoperative IOP increase is that the viscoelastic agent remains in the eye, which causes a mechanical obstruction of trabecular meshwork . To compare theAims and objectives. effect of two OVDs (2% HPMC and 1% Sodium Hyaluronate) on Intraocular pressure after MSICS. This is a prospectiveStudy design. observational study of 8 months duration in a tertiary hospital of Eastern India. 100 consecutive patients above the age 50 years havingMethods. age related cataract planned for elective cataract surgery will be included in this study. 50 consecutive patients were assigned to receive Hydroxypropyl methylcellulose(2%) and remaining 50 patients were assigned to receive Sodium hyaluronate (1%) during surgery. The IOP was measured 6 hours,24 hours and 1 week after surgery and the ndings were noted. After the study period the collected data was analyzed by standard statistical tools. .Mean IOP increased by 4.08 mm of Hg in the group receiving 2% HPMC and by 8.2 mm of Hg in patientsResults receiving 1% Sodium Hyaluronate. In both HPMC and Sodium Hyaluronate group the rise of the IOP in 6 hour post operative period was found to be signicantly higher (p&lt;0.05) than the pre operative IOP value. But the post operative 6 hour mean IOP rise was 4.32 mmHg more in the Sodium Hyaluronate group(8.2mm Hg) than the HPMC group (4.08 mmHg) . 24 hours and 1 week post-operatively the rise in mean IOP was found to be not signicantly different from each other. These ndings indicate that 1% Sodium Hyaluronate causes a signicantlyConclusion : higher IOP rise than 2% HPMC in the early post operative period.But 24 hours and 1 week post-operatively the rise in mean IOP was insignicant in both the group.

Intraocular Pressure and its Variation with Total Amount of Energy used Following Nd: YAG Capsulotomy in Pseudophakic

Purpose: The objective of the study was how Nd: YAG laser capsulotomy affected IOP and how it changed with the amount of energy utilised. Methods: A prospective, multi ccentered study was conducted between September 2021 to February 2022 in Ophthalmology Department departments. Total of sixty pseudophakic eyes of both genders, age ranging between 40 to 60 years with significant posterior capsular opacity following uncomplicated cataract surgery were included through non-probability purposive sampling technique. Inflammation, ocular malignancies, posterior segment disease, and systemic disease participants were all ruled excluded. After detailed history and ocular examination, Nd: YAG laser posterior capsulotomy was done. Patients were divided into two groups on the basis of total amount of laser energy used was noted as high energy (&gt;50mJ) and low energy (&lt;50mJ) and then post-laser IOP after one hour and 24 hours measured. Data was analyzed by using SPSS through repeated measure ANOVA for comparison of quantitative variables. Results: Best corrected visual acuity after Nd: YAG capsulotomy improved significantly (P=0.001). Pre-laser IOP was 14.01± 2.95 mmHg. Mean high energy was 76mJ and low energy 40mJ. Elevated IOP was seen in 55 patients, significantly increase in IOP after 1 hour in both groups (P=0.000). After 24hours IOP change was significantly higher in high energy group (p=0.033) than in low energy. Post-laser IOP after 1 hour in high energy group was 21.89±4.59 mmHg and in low energy group 16.79±2.89 mmHg. IOP after 24hour in high energy group was 19.89± 3.05 mmHg and in low energy group 14.98±1.79 mmHg. Conclusions: After Nd: YAG laser capsulotomy, there is a considerable increase in IOP, which varies depending on the overall amount of energy used. Greater the amount of Nd-YAG energy has significantly higher chances of raising IOP. Hence, it was suggested that each patient after Nd: YAG capsulotomy must monitored for IOP variation. Keywords: Intraocular pressure, Nd: YAG capsulotomy, Energy level, Posterior capsular opacity, Visual acuity

To study the clinical efficacy of Nd Yag peripheral iridotomy in narrow angle glaucoma

: To examine the clinical efficacy of laser peripheral iridotomy (LPI) in subjects with primary angle closure (PAC).134 patients with angle closure glaucoma were included in this retrospective study which was carried out at the glaucoma clinic, department of ophthalmology at DR B.R Ambedkar medical college and hospital over a period of 2 years. A total of 134 patients, 268 eyes were participated in this study. All were treated with LPI. The 268 eyes with Successful opening of angle more than 2 for at least 24 weeks. Follow-up ranged from 4 to 24 weeks. Gonioscopy was performed in each visit to confirm the angle status and patency of iridotomy. Success is defined as opening of more than 2 angles ITC for at least 24 weeks, with no need for further medication or laser treatment.The percentage of open angle at 4 weeks was more 2 angles in 72 eyes(26.9%), ITC&amp;#62;3 angles in 56eyes, (20.9%) and ITC&amp;#62;4 angles in 140 eyes are (52.2%), at 12weeks more 2 angles 48 eyes (17.9%), ITC&amp;#62; 3angles in ,60 eyes (20.9%) ITC&amp;#62;4 angles in 160 eyes (59.7%) and 24 weeks was more 2 angles eyes 28 (10.4%), ITC&amp;#62; 3,60 eyes (22.4%) ITC&amp;#62;4 angle in180 (67.2%). The success rate at 24 weeks ITC more than2 angle was 10.4%, ITC&amp;#62;3angles 22.4% and ITC&amp;#62; 4angles in 67.2% respectively.In all cases, IOP was measured within 1 hour and IOP elevation of greater than 8 mm Hg was observed in eyes (15.7%). Mild-to-moderate anterior chamber reaction is seen in 128 eyes, hyphema in 12 eyes, ghost images seen in 4 eyes, 4cases of macular edema, cataract progression seen in 32 eyes, and iridotomy in 52 eyes were noted.Post laser procedure combination of steroid and antibiotic medication was prescribed for 5 days and IOP pressure more 8 mmHg seen in 42 eyes(15.7%), antiglaucoma medications started and oral T. Diamox 250mg 2 tablets were prescribed followed up after 5 days to reassurance. LPI is an effective treatment option for all patients with in Primary Angle Closure suspect to prevent the acute angle closure glaucoma. LPI is a effective, compliance free, repeatable, most PACS eyes don’t receive further treatment and safe therapeutic modality having only minor, transient, self-limiting or easily controlled side effects with no sequelae. Progression to PACG is uncommon in PACS and PAC. Despite our methodology, the inherent limitations of studies should be considered, and conclusion drawn from our pooled results should be interpreted with caution. Future large-volume, well-designed with extensive follow-up are awaited to confirm and update the findings of this analysis.

Surgical Treatment in Silicone Oil-Associated Glaucoma.

Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods.