High IOP Research Articles

ASSOCIATION OF INTRAOCULAR PRESSURE CHANGES IN DIFFERENT DEGREES OF MYOPIA

Introduction: Myopia, also known as “short-sightedness” or “near-sightedness,” is an increasingly widespread condition around the world. Myopia is commonly defined as a spherical equivalent (SE) ≤ 0.5 dioptres (D) and develops mainly during childhood and early adulthood when excessive elongation of the eye causes images of distant objects to fall in front of the retina with the eye at rest, resulting in a blurred distance vision. Myopia can be classified according to age of onset, clinical variety, etiology, and degree. According to the degree, myopia can be classified as mild/low myopia (-0.25D to -2.75D);moderate/medium myopia (-3.00D to -6.00D) and high myopia (Above -6.00D).Aim and Objective: To investigate the intraocular pressure changes in the different degrees of myopia. Material and Methods: This study was a clinical study carried out at the department of ophthalmology, rukmani birla hospital,Jaipur. An informed consent was gotten from all the subjects who were part of the study.Clinical tests performed on the subjects include case history, visual acuity, external eye examination, ophthalmoscopy, static retinoscopy and subjective refraction. The subjects with myopia were grouped into three according to the degree of myopia. Their intraocular pressure was measured using the indentation tonometry. Data was collected and uploaded into the Statistical Package for Social Sciences (SPSS) version 21 and the one-way ANOVA was used to test the null hypotheses at 0.05% level of significance and 95% confidence interval. Result: The study included a Sample size of 100 Patients.The table showed that 50 (50.00%) of the subjects had mild myopia;42 (42.00%) had moderate myopia and 8 (8.00%) had high myopia.IOP of 10 - 15 were 20 (20.00%);16 -20,26 (26.00%);21 – 25,4 (4.00%);26 – 30,0 (0.00%).Minimum,maximum and mean IOP values for low myopes were 10.3,30.6 and 17.13 mmHg respectively.For medium myopes,the minimum,maximum and mean IOP values were 11, 22 and 16.63 mmHg respectively. For high myopes, the minimum, maximum and mean IOP values were 18.8, 22 and 20.15 mmHg respectively. SPSS data analysis using the one-way ANOVA at 0.05 level of significance showed that there was a significant difference [P(0.036) < 0.05] in the IOP values between the different degrees of myopia. Conclusion: In conclusion, there was a significant difference in the IOP of different degrees of myopia.Eye care practitioners are advised to closely monitor the IOP of their myopic patients.For young children,as the myopia progresses,the IOP should also be monitored.

Predictors of long-term visual field outcome after an episode of acute primary angle closure.

To investigate the long-term visual field (VF) outcome and baseline factors associated with functional sequelae in patients who experienced an episode of acute primary angle closure (APAC) and underwent subsequent lens extraction. Fifty patients (50 eyes) who experienced an APAC episode and underwent subsequent lens extraction at Chonnam National University Hospital were enrolled in this retrospective study. Patients underwent VF examinations after 1 year of an acute episode. They were classified into two groups based on whether they had significant VF defects or not. Demographic data were recorded, and baseline anterior-segment OCT (AS-OCT) images were analysed. Multivariate logistic regression analysis was performed to assess baseline risk factors for presence of VF defects. Twenty-five (50%) eyes were found to have varied degree of VF defects after 1 year of an acute episode. Longer duration between the symptom onset and IOP lowering (p=0.005), a higher presenting IOP (p=0.014), and flat iris curvature (p=0.037) at baseline AS-OCT measurement were significant predictors of VF loss. The area under the receiver operating characteristic curve (AUC) revealed that combination of these three potential baseline factors could predict the long-term VF outcome (AUC=0.921). Patients exhibiting a long duration between symptom onset and IOP lowering, a high presenting IOP, and flat iris curvature were at a higher risk of visual impairment after an episode of APAC. The eyes with such features may require more careful follow-up after an episode of APAC.

Proportion of Pseudoexfoliative Glaucoma Among Glaucomatous Patients Attending Makah Hospital in Aden, Yemen

Background: Pseudoexfoliative glaucoma is the most common type of secondary open-angle glaucoma. Objective: To describe the proportion and clinical features of pseudoexfoliative glaucoma among glaucomatous patients Materials and method: A retrospective chart review. The collected data were sex, age, family history, clinical features, clinical eyes examination, type of treatment and intraocular pressure outcome. SPSS version 17 was used. Data were presented as frequencies and means. The statistical significance of differences between data was evaluated using Fisher test. P < 0.05 was considered to indicate statistical significance. Results: The proportion of PEXG patients among glaucoma patients was (9.1%). (Females 51.2% and males 48.8%). The mean age of the patients is 67.6 ± 9.8 years. The patients of the age group 60 – 69 years old were predominant. 65.1% had bilateral PEXG. Severe visual impairment (27.9%) found in the right eyes and (34.9%) were in the left eyes. Round regular react pupils were (60.5%) in the right eyes and (74.4%) in the left eyes, followed by relative afferent pupillary defect with (27.9%) in the right eyes and (11.6%) in the left eyes. High IOP > 21 mmHg found in (60.5%) the right eyes and (53.5%) in the left eyes. The cup/disc ratio with > 0.5 in the right eyes of the PEXG patients found in (60.1%). The means of cup/disc ratio in the right and the left eyes were 0.65 ± 0.26 and 0.67 ± 0.28 respectively (p < 0.05). The medication treatment was given for (76.7%) patients and medication + surgical treatment was given for (23.3%). Conclusion: PEXG was more frequently observed in females. The proportion of PEXG patients was (9.1%). Severe visual impairment was predominant in both eyes. A population-based study suggests to further define the prevalence and characteristics of PEXG in Aden and the surrounding governorates. Keywords: proportion, pseudoexfoliative glaucoma, Makkah hospital, Aden.

Critical Evaluation of Multifunctional Betaxolol Hydrochloride Nanoformulations for Effective Sustained Intraocular Pressure Reduction.

Glaucoma is a chronic disease that requires long-term adherence to treatment. Topical application of conventional eye drops results in substantial drug loss due to rapid tear turnover, with poor drug bioavailability being a major challenge for efficient glaucoma treatment. We aimed to prepare the anti-glaucoma drug betaxolol hydrochloride (BH) as a novel nano-delivery system that prolonged the retention time at the ocular surface and improved bioavailability. We constructed multifunctional nanoparticles (MMt-BH-HA/CS-ED NPs) by ion cross-linking-solvent evaporation method. The particle size, zeta potential, encapsulation efficiency and drug loading of MMt-BH-HA/CS-ED NPs were physicochemically characterized. The structure of the preparations was characterized by microscopic techniques of SEM, TEM, XPS, XRD, FTIR and TGA, and evaluated for their in vitro release performance as well as adhesion properties. Its safety was investigated using irritation assays of hemolysis experiment, Draize test and histopathology examination. Precorneal retention was examined by in vivo fluorescence tracer method and pharmacokinetics in tear fluid was studied. A model of high IOP successfully induced by injection of compound carbomer solution was used to assess the IOP-lowering efficacy of the formulation, and it was proposed that micro-interactions between the formulation and the tear film would be used to analyze the behavior at the ocular surface. The positively charged MMt-BH-HA/CS-ED NPs were successfully prepared with good two-step release properties, higher viscosity, and slower pre-corneal diffusion rate along with longer precorneal retention time compared to BH solution. The micro-interactions between nanoparticles and tear film converted the drug clearance from being controlled by fast aqueous layer turnover to slow mucin layer turnover, resulting in higher drug concentration on the ocular surface, providing more durable and stable IOP-lowering efficacy. The novel multifunctional MMt-BH-HA/CS-ED NPs can effectively reduce IOP and are suitable for the treatment of chronic disease glaucoma.

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.

Impact of self-tonometry on glaucoma treatment decision.

The aim of this study was to examine the impact of self-tonometry on clinicians' decision in glaucoma treatment. Medical records of 133 patients who had performed self-tonometry using iCare® Home between January and December 2019 were retrospectively reviewed. Inclusion criteria were as follows: age over 18 years, all types of glaucoma, as well as ocular hypertension and glaucoma suspect, compliance with tonometer manufacturer's recommendations and monitoring over at least 2 days. The data consisted of age, gender, diagnosis, visual field index, rate of progression and type of treatment pre- and post-intraocular pressure (IOP) phasing. The following IOP measurements were used to calculate the mean and maximum IOP, and range over each day and consecutive days: Goldmann applanation tonometry (GAT) measurements from referral and training visits and iCare® Home measurements made by the trainers and the patients themselves. A total of 90 patients were included. Clinicians were satisfied with the actual treatment in 54.4% of the cases. There was a statistically significant difference between the clinicians' decision to maintain same treatment or to escalate therapy for all the mean and maximum IOPs measured on each single day and over a 2- or 3-day period (p< 0.002). Our results suggest that the presence of high IOP values obtained with self-tonometry supports an intensification of glaucoma treatment. Self-tonometry provides clinicians with an important complement for clinical decision-making, and under- or over-treatment may be avoided for the benefit of patients.

Gynostemma Glycosides Protect Retinal Ganglion Cells in Rats with Chronic High Intraocular Pressure by Regulating the STAT3/JAK2 Signaling Pathway and Inhibiting Astrocyte and Microglia Activation.

Objective To observe the protective effect of gynostemma glycosides on retinal ganglion cells in rats with chronically high intraocular pressure. Materials and Methods A total of 60 rats were randomly divided into group A (the blank group, 10 rats) and chronic high IOP model group (50 rats). The IOP model group (IOP above 22 mmHg) was then randomly divided into an additional 5 groups (10 rats per group): group B (negative control group) treated with normal saline; group C treated with gynostemma glycosides 25 mg/(kg-d); group D treated with gynostemma glycosides 50 mg/(kg-d); group E treated with gynostemma glycosides 100 mg/(kg-d); and group F (positive control group) treated with VitB1 and VitB12. The eyes of each rat were monitored from day 1 to 14 (D1–D14). On day 14, rats were euthanized, after which retinal tissue and optic nerve were examined using real-time PCR, western blot, HE staining, LFB staining, and TUNEL assay. Results Groups A, C, D, E, and F had significantly lower expression of CD11b, GFAP, Brn3α, and more TUNEL cells than in group B (all P < 0.05). Moreover, the relative expression of STAT3 mRNA and JAK2 (mRNA and protein) in groups A, C, D, E, and F was significantly lower than in group B (P < 0.05), while in group E, the expression was lower than in group D (P < 0.05). Conclusion Gynostemma glycosides protect retinal ganglion cells in rats with chronically high intraocular pressure possibly associated with the STAT3/JAK2 signaling pathway.

The Efficacy and Safety of Dexamethasone Intravitreal Implant for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis of Randomized Controlled Trials.

Purpose The purpose of this meta-analysis was to evaluate the efficacy and safety of dexamethasone intravitreal implant (DEX) for the treatment of diabetic macular edema (DME) with retinal vein occlusion secondary to macular edema (RVO-ME). Materials and Methods Relevant databases were searched to include randomized controlled trials (RCTs) evaluating DEX for DME and RVO-ME. The search was conducted until March 2022. Meta-analysis was performed using Rev Man 5.4.1 software after screening the literature by inclusion and exclusion criteria, extracting information, and evaluating the methodological quality of the included studies. Results The study showed that DEX treatment of RVO-ME was associated with an improvement in best corrected visual acuity (BCVA) (MD = −9.08, 95% CI: −10.89–7.27, P < 0.00001) and central retinal thickness (CRT) (MD = 93.47, 95% CI: 28.55–159.39, P=0.005). DEX treatment of DME was significantly better than anti-VEGF treatment in terms of CRT reduction (MD = −72.35, 95% CI: −115.0–29.69, P=0.0009). The safety study showed that the risk of cataract from RVO-ME (OR = 5.06, 95% CI: 1.96 to 13.06, P=0.0008) and the incidence of high intraocular pressure (OR = 6.67, 95% CI: 3.46 to 12.86, P < 0.00001) were significantly higher with DEX than with anti-VEGF therapy. The risk of cataract from DME (OR = 4.70, 95% CI: 2.10 to 10.54, P=0.00022) was significantly higher with DEX than with anti-VEGF therapy (OR = 4.70, 95% CI: 2.10 to 10.54, P=0.0002). The incidence of high IOP (OR = 13.77, 95% CI: 4.96 to 38.18, P < 0.00001) was significantly higher with DEX than with anti-VEGF therapy. Conclusions In patients with DME and RVO-ME, DEX was more efficacious but slightly less safe than anti-VEGF therapy.

Predictors of glaucoma in patients with uveitis and scleritis.

To examine risk factors for development of glaucoma in a large cohort of subjects with uveitis and scleritis. Retrospective review of subjects diagnosed with uveitis or scleritis between 2006 and 2019 at Auckland District Health Board. Subjects were excluded if they had glaucoma due to another cause. Main outcome measure was development of glaucoma. Data for local steroid use was not available. 3462 eyes of 2414 subjects were included in the study. Mean follow-up was 5.7 years (total follow-up time 19,897 eye years). Median age was 44.3 years and 1189 (49.3%) were female. Glaucoma developed in 222 eyes (6.3%) during the follow-up. Five-year cumulative risk of glaucoma was 6.2% (CI 5.0-7.5%) for anterior uveitis, 5.4% (CI 3.2-9.0%) for intermediate uveitis, 1.6% (CI 0.4-6.7%) for posterior uveitis, 8.7% (CI 6.5-11.7%) for panuveitis, and 3.2% (CI 1.0-9.5%) for scleritis. Five-year cumulative risk of glaucoma was lowest in HLA-B27 uveitis at 0.9% (CI 0.4-2.1%) and highest in viral uveitis 15.1% (CI 10.1-22.3%), sarcoidosis 9.9% (CI 6.1-15.9%) and tuberculosis 9.7% (CI 5.4-17.0%). On multivariate analysis, risk factors for development of glaucoma were older age at presentation, higher presenting intraocular pressure, chronic inflammation, and cystoid macular oedema. Glaucoma is a common complication of uveitis and scleritis and was more frequent in older subjects, high presenting IOP, chronic inflammation and those with cystoid macular oedema. Local steroid therapy contributes to this, but is not quantifiable in this study. Targeted screening is required to avoid irreversible progression of glaucomatous optic neuropathy.

The clinical outcomes of keratoplasty in irreversible corneal decompensation secondary to Axenfeld-Rieger syndrome.

To evaluate the clinical outcomes of penetrating keratoplasty (PK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) in eyes with irreversible corneal decompensation secondary to Axenfeld-Rieger syndrome (ARS). In this retrospective case series, a total of four eyes undergoing PK and seven eyes undergoing DSAEK, including one eye requiring one repeat DSAEK, between 2014 and 2021 were enrolled. Postoperative complications, graft survival, glaucoma treatment before and after keratoplasty, visual outcomes, and endothelial cell density were recorded. The mean follow-up duration was 34.4 ± 16.8months. Before keratoplasty, the mean BCVA was 2.0 ± 0.4 LogMAR, and the mean IOP was 21.7 ± 8.1mmHg. A total of 63.6% of eyes (7/11) received glaucoma treatment, including five eyes with glaucoma surgeries. After keratoplasty, 27.3% of eyes (3/11) exhibited secondary graft failure. The mean BCVA reached a maximum of 0.7 ± 0.5 LogMAR at 8.9 ± 7.5months, with no significant difference between the PK and DSAEK groups (P1 = 1.00, P2 = 0.12). Four eyes with previous glaucoma surgeries exhibited markedly high IOP. A total of 72.7% of eyes (8/11) required additional glaucoma treatments. The mean endothelial cell loss (ECL) rates at 1, 6, 12 and 24months were 43%, 49%, 63% and 54%, respectively, with no significant difference between the PK and DSAEK groups (P1 = 0.64, P2 = 1.00, P3 = 0.57, and P4 = 0.44). Both PK and DSAEK can successfully treat corneal decompensation secondary to ARS, resulting in similar outcomes with regard to IOP control, BCVA and ECL. IOP control is essential for postoperative management, especially for eyes with previous glaucoma surgeries.

Intraluminal deposits: A rare cause of glaucoma drainage implant total obstruction.

To report the unforeseen complication of total obstruction of a glaucoma drainage implant (GDI) tube lumen by white deposit material and to present a preliminary report identifying the composition of this material. Two subjects with a high IOP due to total obstruction of a GDI tube were reviewed. Both patients had a long history with brinzolamide and timolol maleate eye drops. The GDI tube was swept with a 5-0 polypropylene suture stent in order to open the tube. The intraluminal solid sample was successfully collected from the implant tube in one patient. High-performance liquid chromatography-mass spectrometry (HPLC-MS) was used to determine the origin of the intraluminal sample. Intraluminal deposits containing components of antiglaucoma drugs e.g., timolol and brinzolamide are a rare cause of total obstruction of GDI tubes. Our study describes a new cause of total obstruction GDI tubes. The long-term use of timolol maleate and brinzolamide and their presence in the intraluminal solid sample collected from the blocked GDI tube suggest that the glaucoma medication may have a role in the pathogenesis. However, the exact mechanism is unknown and requires further studies.

Determinants for late presentation of glaucoma among adult glaucomatous patients in University of Gondar Comprehensive Specialized Hospital. Case-control study.

Glaucoma is a disease which causes optic nerve damage and remains a major public health concern worldwide. Late presentation is a major risk factor for glaucoma induced blindness. The aim of this study was to assess determinants for late presentation of glaucoma among adult glaucomatous patients. A hospital-based case-control study was conducted among 452 adult glaucomatous patients. Late presenters were glaucoma patients diagnosed with cup to disc ratio (CDR) > 0.8 and mean deviation of greater than -14 decibel in either of the eyes at their first presentation. Study participants were selected among glaucomatous follow-up patients by using systematic random sampling. Data were entered into EPI Info version 7 and exported to SPSS version 22 for analysis. Bivariable and multivariable logistic regression analysis was done to identify determinants. Variables with P-value < 0.05 were considered as statistically significant. The mean age of participants were 55.1 ± 13.2 years. Being > 60 years of age, 4.51 times (AOR: 4.51; 95% CI: 1.74, 11.67), resided > 53 km away from the hospital 6.02 times (AOR: 6.02; 2.76, 13.14), Presenting IOP > 30 mmHg, 4.49 times (AOR: 4.49, 95% CI: 2.10, 9.12), poor knowledge of glaucoma, 4.46 times (AOR: 4.46, CI: 2.62, 7.58) and absence of regular eye checkup, 2.35 times (AOR: 2.35, 95% CI: 1.09, 5.47) higher odds of being late presenter. Increasing age, high IOP, poor knowledge of glaucoma, residing far away from the hospital and absence of regular eye checkups were significantly associated with late presentation.

Protective limb remote ischemic post-conditioning against high-intraocular-pressure-induced retinal injury in mice.

To determine whether limb remote ischemic post-conditioning (LRIC) protects against high-intraocular-pressure (IOP)-induced retinal injury, and to identify underlying molecular mechanisms. In mice, IOP was increased to 110 mm Hg for 50min and LRIC applied to the unilateral leg for three occlusion cycles (5min/release). Three animal groups (control, high IOP, and high IOP+LRIC) were arranged in this study. Plasma was collected from LRIC treated mice. Retinal histology, oxidative stress were determined by histological section staining and chemical kit. C/EBP homologous protein (CHOP), and Iba-1 parameters were evaluated by immunofluorescent staining and Western blot. The data showed that LRIC treatment alleviated the retinal histological disorganization and ganglion cell loss induced by high IOP. The CHOP, Iba-1 expression and oxidative stress marker also were inhibited by LRIC treatment. To further explore underlying mechanisms, plasma from LRIC treated animals was intravenously transfused into high-IOP animals. The results showed plasma injection decreased caspase 9 expression and DHE staining signals compared with that in high IOP retinas. These data suggest that LRIC treatments exert retinal protective effects against high-IOP injury. Endogenous humoral factors release into the circulation by LRIC may contribute to homeostatic protection by reducing monocyte infiltration and/or microglia activation.

Postoperative Complications of Trabeculectomy in Primary Open Angle Glaucoma Versus Primary Angle Closure Glaucoma

Purpose: To compare the frequency of postoperative complications of trabeculectomy in primary open angle glaucoma (POAG) with primary angle closure glaucoma (PACG). Study Design: Comparative experimental study. Place and Duration of Study: Department of Ophthalmology, Abbasi Shaheed Hospital, Karachi, from January 2017 to November 2019. Methods: Seventy-one patients who underwent primary trabeculectomy without antimetabolites for primary open-angle glaucoma and primary angle-closure glaucoma during the given period were included in the study. Patients who had significant cataract, repeated trabeculectomy, failed argon laser trabeculoplasty and trabeculectomy done for congenital glaucoma, traumatic glaucoma, secondary glaucoma were excluded from the study. Patients were followed up for 12 months and complications were compared. Secondary outcome was reduction in IOP. Results: Out of 71 patients, 52 had POAG and 19 had PACG. The mean age was 56.7 ± 10.9 for POAG and 52.2 ± 9.5 for PACG. The frequency of complications in POAG group was 28.2% and in PACG group was 21.1% (p &gt;0.005).Complications were: cataract, uveitis, hyphema, choroidal folds, shallow anterior chamber, high IOP and positive Seidel test. Mean IOP reduction was from 31 ± 6.7mm of Hg and 40 ± 14.8 to 15.6 ± 4.2 and 13.8 ± 4.7 in POAG and PACG respectively (p-value &gt; 0.005).Trabeculectomy was successful in 80.7% POAG and 73.6% PACG patients (p value &gt; 0.005). Conclusion: No significant difference was observed in the frequency of complications in POAG and PACG patientsfollowing Trabeculectomy, over a period of 12 months. Trabeculectomy was equally effective in lowering IOP in both the groups. Key Words: Glaucoma, Primary Open Angle Glaucoma, Primary Angle Closure Glaucoma, Trabeculectomy,

Ultrasound-Guided Peribulbar Block with Blunt Canula for Cataract Surgery: A Review of Historical Case-Series

Introduction: Cataract surgery is one of the procedures most performed worldwide. Those are several options for anesthetic management, with many factors that affect the choice of any given technique, depending on patients’ needs, surgeons’ preferences and institutional facilities and processes. Although being more invasive than topic anesthesia, and with possible hazardous side effects, peribulbar block is still an effective and successful technique. The utilization of blunt canula and ultrasound guidance might enhance the safety pattern for this technique. Methods: This article presents a revision of 1089 consecutive cases from February 2016 to January 2022, of patients submitted to cataract surgery under peribulbar anesthesia with blunt canula and ultrasound guidance. Results: 1318 surgical records were selected, with 1089 filling the inclusion criteria. There was a higher prevalence of the feminine gender (54%), with a median age of 64.3 (28 - 102) years. Mean IAV was 2.9 mL (sd 0.16 mL, 2.5 - 3.0 mL), with total HOS 91.1%; OR to reach G2 or above for each (ISB/IMB) was 11.0; CA was 47.9%, with mean FAV of 4.29 mL (sd 2.17mL, 2.5 - 15 mL). In 8.9% patients, HOS could not be fully observed. ISB, IMB, CA and FAV were calculated for both groups (non-HOS and HOS-only). OR for CA (non-HOS/HOS-only) was 126.21. The main adverse effects were chemosis (2.9%), hyposphagma (5.7%) and high IOP (7.5%). No procedure was postponed due to anesthesia-associated adverse events. Discussion: This study points towards the feasibility of the described technique in an outpatient fashion, with low, mild and tolerable side effects associated.

Comparative study for central corneal thickness with ORB-SCAN, lenstar and USG for corneal treatment

This study is led to decide the relationship between&#39;s U.S.G Pachymetry, ORBSCAN Pachymetry and LENSTAR Pachymetry. Cornea is the straightforward piece of the eye that covers the front piece of the eye. it covers the understudy (the opening at the focal point of the eye) Iris (the hued piece of the eye), and foremost chamber (the liquid - filled within the eye) The cornea fundamental capacity is to refract or twist, light. The straightforward cornea contains one 6th of the foremost eyeball. Corneal thickness is vital if there should be an occurrence of Refractive Surgery. If patient having extremely less corneal thickness He/She can’t go through refractive surgery. Deciding treatment methodology as P.R.K and S.B.K The corneal thickness assumes a significant part in the event of Glaucoma. We all realize that a thick cornea gives misleading high perusing of IOP, and strangely slim cornea gives bogus low perusing of IOP. In that condition we want to apply amendment factor in the wake of estimating the IOP. Hence it is exceptionally essential that the patient is having high IOP on account of thick cornea or it is huge. Alongside these circumstances corneal thickness is significant if there should arise an occurrence of any corneal transfer. Penetrating keratoplasty Descemets endothelial stripling keratoplasty Deep front lamellar keratoplasty Collagen cross connecting As made sense of over that we have intrusive and harmless technique to quantify corneal thickness. Non-obtrusive strategies are demonstrated in pre lasik assessment orbscan gives total corneal planning including corneal thickness too. To keep away from corneal scraped area we want to do painless examination like orbscan / lenstar. For this concentrate on 160 people groups of the age bunch 19-35 is haphazardly chosen in facilities and Eye camp where this study is directed.

Correlation between choroidal thickness and intraocular pressure control in primary angle-closure glaucoma

Purpose:To study the correlation between choroidal thickness (CT) and IOP control in primary angle-closure glaucoma (PACG).Methods:In total, 61 patients (102 eyes) with PACG underwent subfoveal CT (SFCT) scanning using enhanced depth imaging–optical coherence tomography. The subjects with PACG were further grouped as controlled IOP (≤21 mm Hg on maximal medical therapy) and uncontrolled IOP (>21 mm Hg on maximal medical therapy). The average CT of the PACG eyes was calculated and compared between both groups. A correlation analysis was done between CT and intereye difference in CT with the disease parameters.Results:The mean CT was 274.38 ± 42.10 μm in 102 PACG eyes. SFCT was significantly increased in the uncontrolled IOP group as compared with the controlled IOP group. The mean SFCT was 245.57 ± 62.10 μm in the controlled group and 294.46 ± 51.05 μm in the uncontrolled group (P < 0.01). Factors associated with a thicker choroid were younger age, high IOP, and higher optic nerve head cupping (P < 0.001). Neither the visual field-mean deviation (VF-MD) nor pattern standard deviation (PSD) was found to be associated with overall CT. The intereye asymmetry between CT was significantly associated with poor VF-MD and PSD.Conclusion:PACG eyes with thicker choroid may be a risk factor for poor IOP control on medical anti-glaucoma therapy. Thicker choroid as compared to the fellow eye is a poor prognostic sign and these eyes should be monitored closely.

A STUDY ON VISUAL PROGNOSIS IN LENS INDUCED GLAUCOMAAFTER MEDICAL & SURGICAL MANAGEMENT.

OBJECTIVE:To assess the visual prognosis in lens induced glaucoma after medical &amp; surgical management. MATERIALS AND METHODS: This is a prospective study on patients with LIG attending OPD in department of Ophthalmology at Navodaya medical college hospital and Research centre &amp; willing to participate this study. RESULTS:In all the 100 cases of LIG included in the study, the lens was removed &amp; depending upon the condition IOLwas implanted. Majority of the patients were having IOPin the range 31-50mmHg (64%), post-operative IOPreduced to normal in most of the cases. As the duration of attack increases the best corrected V/Adecreases. In present study when duration of attack &lt;10 days, 90% showed best corrected V/Abetter than 6/60 but in cases with longer than &gt;10 days, 40% showed V/Abetter than 6/60. CONCLUSION: Despite high IOP at the initial presentation in cases of LIG, IOP came down to normal limits after lens extraction. The results of LIG in response to visual recovery &amp; IOPcontrol are quite satisfactory &amp; encouraging.

Short-Term Intraocular Pressure Response to the Combined Effect of Transcutaneous Electrical Nerve Stimulation over Acupoint (Acu-TENS) and Yoga Ocular Exercise in Type 2 Diabetic Patients with Primary Open-Angle Glaucoma: A Randomized Controlled trial.

Despite the adherence to medications, the control of the modifiable key risk factor-intraocular pressure (IOP)-for the progression of primary open-angle glaucoma (POAG) in diabetics is usually difficult; hence, many glaucoma patients try other alternative therapeutic options. Objectives: This randomized controlled study investigated the short-term IOP response to the combined effects of transcutaneous electrical nerve stimulation over acupoint (Acu-TENS) and yoga ocular exercise in type 2 diabetics with POAG. Eighty diabetics with bilateral POAG, ages ≥ 50 years, IOP > 21 mmHg in both eyes, and a body mass index below 30 kg/m2 were included in this trial. The patients were randomly assigned to group A (n = 40; this group received 20 minutes of yoga ocular exercise followed by 20 minutes of active Acu-TENS over bilateral BL 61 and BL 62 acupoints) and group B (n = 40; this group received the same protocol as group A but with a placebo Acu-TENS). The repeated measurement of IOP were recorded before, immediately after, 30 minutes, and 60 minutes after the sessions. The repeated measures analysis of variance revealed a greater significant decline of IOP in group A than group B in both eyes at the consecutive intervals of time measurements. According to this short-term observation, the addition of Acu-TENS to yoga ocular exercise could reduce the high IOP in diabetic patients with POAG, but further longterm trials are needed.

Altered peripapillary vessel density and nerve fiber layer thickness in thyroid-associated ophthalmopathy using optical coherence tomography angiography

ObjectiveTo measure the peripapillary vessel density (VD) and retinal nerve fiber layer thickness (RNFLT) in thyroid-associated ophthalmopathy (TAO) and dysthyroid optic neuropathy (DON) patients using optical coherence tomography angiography (OCTA), and determine their prognostic relevance.MethodsForty-three TAO patients with or without DON (82 eyes in total) and 26 healthy subjects (52 eyes) were enrolled. All participants underwent ophthalmology and endocrinology tests. The peripapillary VD in retinal peripapillary capillary layer and RNFLT were analyzed using OCTA images. Multiple linear regression analysis was used to assess the relationship between peripapillary VD /RNFLT and the relevant factors.ResultsThe total peripapillary VD and RNFLT were significantly lower in the DON patients compared to the other groups (P < 0.001, 95% confidence intervals), and each quadrant of VD and RNFLT showed similar results except temporal RNFLT. No significant difference was seen between the RNFLT and VD of active non-DON (ANDON), inactive non-DON (NDON) patients and normal control (NC) group. Multivariable linear regression model showed that high IOP is an independent risk factor for lower peripapillary VD and RNFLT (β = −0.465, P < 0.001 and β = −0.343, P = 0.002 respectively).ConclusionOCTA parameters are suitable indicators for diagnosing DON. TAO patients with high IOP should be considered at high risk of retinal vessel and nerve fiber layer deterioration. In addition, patients with TAO should be advised to quit smoking since it could affect peripapillary VD and RNFLT.