Incidence Of Intraocular Pressure Elevation Research Articles

Glaucoma and refractive surgery: A comprehensive review.

The global surge in refractive surgeries, particularly among myopic individuals, has elicited concerns regarding potential inaccuracies in the measurement of intraocular pressure (IOP) post surgery, primarily associated with central corneal thinning. The incidence of elevated IOP after intraocular refractive surgeries is higher than expected and is multifactorial. Myopic eyes have a higher susceptibility to both primary and secondary glaucoma. Consequently, meticulous preoperative screening for glaucoma is imperative, coupled with systematic postoperative follow-up and evaluation. This comprehensive review analyses the etiology, mechanisms, and therapeutic strategies for managing elevated IOP following refractive surgery. We propose an algorithm to summarize the causative factors of elevated IOP and formulate effective interventions in these instances.

The 0.19-mg Fluocinolone Acetonide Intravitreal Implant for Diabetic Macular Edema: Intraocular Pressure-Related Effects over 36 Months

To evaluate effects of the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN) on intraocular pressure (IOP) in patients with diabetic macular edema (DME). Secondary analysis of a 36-month, phase IV, nonrandomized, open-label, observational study. The study included 202 eyes from 159 patients who received the 0.19-mg FAc implant after a successful prior steroid challenge per the United States label indication. Study eyes were assessed for IOP values, incidence of IOP elevations, and best-corrected visual acuity (BCVA) for up to 36 months post-FAc implant. Mean IOP was stable over 36 months post-FAc; IOP change from baseline peaked at 2.12 mmHg at 9 months, then declined to baseline levels. At 36 months, eyes had a 32.5% cumulative probability of an IOP event > 25 mmHg and a 15.6% probability of an IOP event > 30 mmHg (Kaplan-Meier). The probability of requiring IOP-lowering medication at any time by month 36 was 38.3%. A total of 78% of eyes did not have IOP elevations > 25 mmHg if similar values were seen with the previous steroid challenge. Although 7.4% of eyes had an IOP > 30 mmHg during a scheduled study visit, most exceeded this threshold only once (60%). Regardless of IOP status, mean BCVA remained stable. Over 36 months, the 0.19-mg FAc implant was associated with relatively stable IOPs in patients with DME, and there was no significant impact of IOP elevations identified regarding their effects on long-term visual outcomes. The probability that a prior corticosteroid challenge will not predict an IOP elevation > 25 mmHg over 36 months post-FAc is 22%; therefore, routine IOP monitoring should be scheduled. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Antivascular endothelial growth factor for macular oedema secondary to retinal vein occlusion: a systematic review and meta-analysis

PurposeTo evaluate the efficacy and safety of antivascular endothelial growth factor (anti-VEGF) agents in treating macular oedema due to retinal vein occlusion (RVO-ME).MethodsStudies of randomised controlled trials were searched in...

Self-identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy.

Précis:In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis.Purpose:The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS.Materials and Methods:The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension.Results:The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all).Conclusions:The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.

Incidence of elevated intraocular pressure after intravitreal injection in Japanese patients with age-related macular degeneration

The purpose of this study was to report the incidence of elevated intraocular pressure (IOP) after intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in Japanese patients with age-related macular degeneration (AMD). A retrospective study of chart review of patients who underwent ≥ 10 intravitreal anti-VEGF injections between April 2009 and December 2019 was conducted. Elevated IOP was defined as IOP ≥ 25 mmHg at one visit. Cases with elevated IOP resulting from IVI were identified. Furthermore, the association between elevated IOP and some parameters, as the risk factors that influence elevated IOP, was investigated. A total of 402 eyes of 370 patients were included in this study. Twenty-eight eyes of 26 patients (7.0%) were identified as cases with elevated IOP after IVI. The mean time of elevation after baseline was 50.6 ± 26.5 months. History of glaucoma (p = 0.021; odds ratio, 5.85), treatment modality (p = 0.019; odds ratio, 6.32), and total number of injections (p = 0.003; odds ratio, 1.03) were significantly associated with elevated IOP. A late complication of elevated IOP is associated with IVI in patients with AMD. Particularly, history of glaucoma and treat and extend regimen with frequent injections were found to be risk factors of elevated IOP.

Ten-Year Clinical Outcomes of Acute Primary Angle Closure Randomized to Receive Early Phacoemulsification Versus Laser Peripheral Iridotomy.

To compare the 10-year clinical outcomes of eyes with acute primary angle closure (APAC) randomized to receive either early phacoemulsification or laser peripheral iridotomy (LPI). Sixty-two APAC patients, who underwent either early phacoemulsification (phaco group) or laser peripheral iridotomy (LPI group) in a previous randomized controlled trial, were invited for assessment 10 years after the interventions. The results of the 2 groups were compared. Forty of 62 patients (64.5%; 19 in phaco group and 21 from LPI group) were examined. None of them underwent additional glaucoma procedure but 15 (71.4%) patients in the LPI group received lens extraction before this assessment. The mean follow-up duration was 10.7±0.7 years. The phaco group used less medication (0.16±0.37 vs. 0.76±1.09 bottle per eye, P=0.028), had less extensive anterior synechiae (120.0±116.12 vs. 244.3±139.8 degree, P=0.010), and greater mean Shaffer gonioscopy grading (1.79±0.84 vs. 1.40±0.87; P=0.021) than the LPI group. Five eyes had persistent intraocular pressure elevation of >21 mm Hg in 2 consecutive visits and 4 eyes had blindness (best-corrected visual acuity worse than 6/60 and/or central visual field of <20 degree) in the LPI group, compared with none in the phaco group (P=0.022 and 0.045, respectively). There was no significant difference in the mean intraocular pressure, best-corrected visual acuity, and the number of eyes with visual field progression. At 10 years, APAC eyes that underwent early phacoemulsification required less medication, less peripheral anterior synechiae, lower incidence of intraocular pressure elevation and a lower incidence of blindness compared with APAC eyes that underwent initial LPI.

Challenges in the complex management of post-keratoplasty glaucoma.

Glaucoma is a serious complication after corneal transplantation and itself a common cause for graft failure and leading cause of vision loss post-keratoplasty due to corneal endothelial decompensation. Endothelial keratoplasty procedures like Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) may be superior to penetrating keratoplasty (PK) regarding the incidence of elevated intraocular pressure (IOP) and development of glaucoma. There are indications that regardless of the method of keratoplasty, some corneal diseases like pseudophakic bullous keratopathy, corneal perforation, and graft rejection have a higher risk for developing post-keratoplasty glaucoma than keratoconus and corneal dystrophies and likewise respond less to IOP lowering therapy. In this review, the pathophysiology of post-keratoplasty glaucoma, the diagnostic tools with focus on different devices, and their limitations with regard to measuring IOP and the treatment modalities are presented.

Age as a risk factor for steroid-induced ocular hypertension in the non-paediatric population

Background/aimsTo evaluate the age-related risk of steroid-induced ocular hypertension by analysing intraocular pressure (IOP) changes after intravitreal dexamethasone (DEX, Ozurdex) implant injection.MethodsA retrospective observational study was conducted among patients (n=455;...

Intraocular pressure elevation after subtenon triamcinolone acetonide injection; Multicentre retrospective cohort study in Japan.

To evaluate real-world evidence for intraocular pressure (IOP) elevation after subtenon triamcinolone acetonide injection (STTA) in 1252 Japanese patients (1406 eyes) in the Japan Clinical REtina STudy group (J-CREST). This was a multicentre retrospective study of the medical records of 1252 patients (676 men (758 eyes); mean age: 63.8 ± 12.9 years) who received STTA in participating centres between April 2013 and July 2017. IOP elevation was observed in 206 eyes (14.7%) and IOP increase ≥ 6 mmHg was found in 328 eyes (23.3%). In total, 106 eyes (7.5%) needed medication and two eyes (0.14%) needed surgical procedures. Younger age, higher baseline IOP, and steroid dose were risk factors associated with IOP elevation. Risk factors associated with IOP increase ≥ 6 mmHg were younger age, lower baseline IOP, steroid dose, and higher incidences of diabetic macular oedema (DME) and uveitis. In contrast, with steroid dose fixed at 20 mg, a lower incidence of DME was a risk factor for increased IOP, suggesting that STTA had dose-dependent effects on IOP increase, especially in patients with DME. Our real-world evidence from a large sample of Japanese patients who received STTA showed that the incidence of IOP elevation after STTA was 14.7%, and was associated with younger age, higher baseline IOP, and steroid dose. Thus, IOP should be monitored, especially in patients with younger age, higher baseline IOP, and higher incidences of DME and uveitis.

Risk of intraocular pressure elevation after topical steroids in children and adults: A systematic review.

Topical steroids may induce a rise in intraocular pressure. The risk may increase with prolonged use, high frequency of administration, young age, higher ocular penetrance and higher anti-inflammatory potency. We aimed to study this relationship by comparing published rates of intraocular pressure elevation following administration of topical steroids and compared the risk of higher versus lower dosage regimes, high- versus low-potency/penetration steroids and adults versus children. Data sources used were Ovid Embase, Ovid Medline, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, CINHAL Plus and LILACS. Eligible studies were randomised controlled trials of topical steroids versus any other topical steroid, nonsteroidal anti-inflammatory drugs, placebo or vehicle, or a different mode of administration administered for 7 days or longer that reported intraocular pressure elevation from baseline as >10, 6-15 or >15 mm Hg in adults or children. Risks of bias were reviewed using the GRADE quality approach. Data were extracted into the software package, RevMan, Version 5 (Cochrane Collaboration). In total, 43 studies were included. Meta-analysis was not possible. Topical steroids of lower anti-inflammatory potency, and with reduced intraocular penetration, are associated with reduced incidence of intraocular pressure elevation. A comparison of data in children and adults is limited by the use of different reporting systems. The principal obstacle to meta-analysis is the different reporting systems used to categorise intraocular pressure elevation. We recommend future studies should report intraocular pressure elevation >10 mm Hg from baseline to allow meta-analysis of data.

Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes.

Purpose:To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP).Methods:This was a 5-year hospital-based retrospective study of children ≤16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done.Results:Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome.Conclusion:Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Incidence and Risk Factors of Ocular Hypertension following Pars Plana Vitrectomy and Silicone Oil Injection

Purpose: To evaluate the risk factors for elevated intraocular pressure (IOP) after pars plana vitrectomy (PPV) with silicone oil injection (SOI). Procedures: This prospective interventional study included 254 consecutive eyes receiving PPV with SOI. Results: Elevated IOP developed in 48% of the eyes postoperatively. The onset of IOP elevation was early (≤1 week) in 61.5% of the eyes, intermediate (1–6 weeks) in 28.7%, and late (> 6 weeks) in 9.8%. The incidence of IOP elevation was higher with primary uncomplicated rhegmatogenous retinal detachment than with tractional detachment (p = 0.01). Pseudophakia, high myopia, and high preoperative IOP were found to have higher incidences of ocular hypertension, whereas diabetic patients had a lower incidence. Conclusion: IOP elevation is a common complication following silicone oil (SO) tamponade. Risk factors for ocular hypertension development are pseudophakia, high myopia, high preoperative IOP, and low-viscosity SO.

Intraocular pressure 1 year after vitrectomy in eyes without a history of glaucoma or ocular hypertension.

ObjectiveThe aim of this study was to investigate the incidence, risk factors, and treatment of elevated intraocular pressure (IOP) 1 year after vitrectomy in eyes without a history of glaucoma or ocular hypertension.Patients and methodsThis retrospective study comprised 256 eyes from 256 consecutive patients without a history of glaucoma or ocular hypertension who underwent vitrectomy and were followed up for 1 year. The incidence of elevated IOP at 1 year after vitrectomy was calculated. We compared the characteristics of patients with or without elevated IOP to identify possible risk factors for elevated IOP. The treatments used to control IOP were recorded and analyzed.ResultsA total of 50 patients (19.5%) had elevated IOP after vitrectomy at the 1-year follow-up. Tamponade was a significant risk factor for elevated IOP (P<0.05). The cumulative rates of elevated IOP in eyes with air, balanced salt solution, sulfur hexafluoride, perfluoropropane (C3F8), and silicone oil as the tamponade were 0, 10.8%, 5.9%, 19.8%, and 28.4%, respectively (P<0.05). About 68% of cases of elevated IOP occurred within 1 month after vitrectomy. At 1 year after vitrectomy, 29 patients (58.0%) had stopped their IOP-lowering drugs and 21 (42.0%) patients were continuing these drugs. About 65% of ocular hypertension patients who received silicone oil tamponade had not stopped IOP-lowering drugs; this rate was significantly greater than that of ocular hypertension patients who received C3F8 tamponade (18.2%, P<0.05).ConclusionElevated IOP is a common complication after vitrectomy. Silicone oil tamponade was associated with greater risk of elevated IOP and had long-term effects on IOP. Drugs and surgery were used to control IOP, and some patients required long-term IOP-lowering therapy.

High-Dose Decanted Triamcinolone for Treatment-Resistant Persistent Macular Edema.

To report the outcomes of decanted high-dose intravitreal triamcinolone acetonide (HD-IVTA) injection for treatment-resistant persistent macular edema (ME). Seventy-seven eyes of 70 consecutive patients who failed prior treatments for persistent ME received as-needed HD-IVTA injections. Best-corrected visual acuity and central macular thickness (CMT) were assessed at all follow-up visits. Thirty-three eyes (42.8%) had ME following pars plana vitrectomy. The mean ETDRS letter score from baseline improved by 6.3 letters ± 11.5 letters at 3 months (P < .001) and 4.8 letters ± 11.4 letters at 12 months (P = .016). The mean change in CMT from baseline was significant at all follow-up visits (P < .001). During 1-year follow-up, 49 eyes (63.6%) required only one HD-IVTA injection. The mean time for reinjection was 6 months ± 2.4 months (range: 1.6 months to 10.5 months) after the first injection of HD-IVTA. The incidence of elevated intraocular pressure was 40.2% (31 of 77 eyes). Of these, one eye required glaucoma surgery. Among 14 phakic eyes, 21.4% (three eyes) developed cataract formation requiring surgery. A single HD-IVTA injection can provide a long duration of effect on ME of up to 6 months. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:717-726.].

Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis

To determine the incidence of elevated intraocular pressure (IOP) and secondary glaucoma in herpetic anterior uveitis (AU), owing to either herpes simplex or varicella zoster virus, by using the Standardization of Uveitis Nomenclature (SUN) criteria, and to identify risk factors for the development of glaucoma. Retrospective observational cohort study. Patients with herpetic AU presenting themselves between 2001 and 2013 at the ophthalmology department of the University Medical Center Groningen were included. Main outcome measures were the incidence of elevated IOP and glaucoma and risk factors for the development of glaucoma. Seventy-three herpetic AU patients were included. Ocular complications most commonly seen during follow-up for uveitis were elevated IOP (75%), keratitis (59%), dry eyes (34%), posterior synechiae (34%), cataract (32%), and glaucoma (15%). Glaucoma patients, in comparison to non-glaucoma patients, had a higher number of IOP peaks during their follow-up for uveitis (P < .001). The majority of patients with elevated IOP (91%) had this already at the start of the uveitis. Nineteen percent of the patients needed glaucoma surgery. Using the SUN criteria, our study confirmed that elevated IOP and secondary glaucoma are major complications in herpetic AU. If an elevated IOP occurred, it was usually already present at the start of a uveitis episode. A risk factor for the development of glaucoma was the number of endured IOP peaks. Future studies are needed to evaluate whether early and prolonged use of antiviral and IOP-lowering medication may prevent glaucoma.

Efficacy and safety of a 3-month loteprednol etabonate 0.5% gel taper for routine prophylaxis after photorefractive keratectomy compared to a 3-month prednisolone acetate 1% and fluorometholone 0.1% taper

PurposeTo compare the outcome of photorefractive keratectomy (PRK) and complications in patients treated with either loteprednol etabonate 0.5% gel or prednisolone acetate 1% suspension and fluorometholone (fml) 0.1% suspension.SettingJohn A Moran Eye Center, University of Utah, Salt Lake City, UT, USA.DesignProspective, randomized, partially masked trial.MethodsPRK was performed on 261 eyes of 132 participants. Patients were randomized to a postoperative corticosteroid regimen of either loteprednol etabonate 0.5% gel (loteprednol) or prednisolone 1% acetate suspension followed by fluorometholone 0.1% suspension (prednisolone/fml). Primary outcome measures included incidence and grade of postoperative corneal haze and incidence of increased intraocular pressure of 10 mmHg above baseline, or any intraocular pressure over 21 mmHg. Secondary outcome measures included uncorrected distance visual acuity, best corrected distance visual acuity, and manifest refraction spherical equivalent.ResultsThe incidence of haze in the first 3 months was 2.6% (3/114 eyes) in the loteprednol group and 4.8% (7/147 eyes) in the prednisolone/fml group and was not statistically significant between groups (P=0.37). The incidence of elevated intraocular pressure was 1.8% (2/114 eyes) in the loteprednol group and 4.1% (6/147 eyes) in the prednisolone/fml group, and was not statistically significant between the groups (P=0.12). The mean 3-month postoperative logMAR uncorrected visual acuity was −0.078±0.10 and −0.075±0.09 in the loteprednol and prednisolone/fml groups, respectively (P=0.83).ConclusionPostoperative corneal haze and elevated intraocular pressure were uncommon in both treatment arms. There was no statistically significant difference between each postoperative regimen. Refractive results were similar and excellent in both treatment arms. A tapered prophylactic regimen of loteprednol 0.5% gel is equally effective to prednisolone 1%/fml 0.1% after PRK.

Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration.

ABSTRACTAimThe aim of this article is to evaluate the rate of patients developing sustained elevated intraocular pressure (IOP) after ranibizumab (Lucentis) intravitreal (IVT) injections.DesignThis is a retrospective study.ParticipantsCharts of 192 consecutive patients receiving Lucentis for age-related macular degeneration (AMD) were retrospectively reviewed.Materials and methodsWe enrolled patients with at least two IOP measurements between injections. Elevated IOP was defined as >21 mm Hg with an increase of at least 20% from baseline. Noninjected contralateral eyes of the same patient cohort were used as control.Main outcome measuresPrimary outcome was defined as elevated IOP. Secondary outcomes were presence and type of glaucoma, number of injections, and time to IOP elevation.ResultsElevated IOP occurred at a significantly higher rate in eyes receiving IVT ranibizumab (7.47%; n = 9) compared with control (0.93%; n = 1). Patients with preexisting glaucoma or ocular hypertension (OHT) were more likely to develop elevated IOP after IVT ranibizumab injection.ConclusionIntravitreal ranibizumab injections are associated with sustained IOP elevation in some eyes.How to cite this articleReis GMSM, Grigg J, Chua B, Lee A, Lim R, Higgins R, Martins A, Goldberg I, Clement CI. The Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration. J Curr Glaucoma Pract 2017;11(1):3-7.

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.

Intraocular Pressure after Intravitreal Triesence Injection

ABSTRACTPurpose: Elevated intraocular pressure (IOP) is a frequent adverse event associated with intravitreal triamcinolone acetate injection. The incidence of elevated IOP with preserved forms of triamcinolone has been studied but the effect of preservative-free formulations has not been clinically evaluated. Design: A retrospective, observational clinical study. Methods: For patients undergoing intravitreal injections over the study period, age, sex, history of glaucoma or ocular hypertension were recorded. For each injection, preinjection IOP, maximum IOP (IOPmax), dose, and indication for injection were noted for both eyes. Results: Fourteen patients received 72 injections in 18 eyes. The mean baseline IOP was 15.4 mm Hg; the mean IOPmax was 19.8 mm Hg (P<0.001), occurring 63 days after injection. Outcomes were not significantly different between patients receiving 2 or 4 mg doses. History of glaucoma did not significantly affect IOPmax. Conclusions: Eyes should be monitored for IOP rises after preservative-free triamcinolone acetonide injections.

Air Bubble-Induced High Intraocular Pressure After Descemet Membrane Endothelial Keratoplasty.

To investigate the incidence and risk factors of pupillary block caused by an air bubble in the anterior chamber in the early postoperative period after Descemet membrane endothelial keratoplasty (DMEK). A retrospective review was conducted in 306 eyes that underwent DMEK from September 2009 through October 2014 at the Tübingen Eye Hospital. Intraocular pressure (IOP) elevation was defined as a spike above 30 mm Hg. In the first 190 eyes, an intraoperative peripheral iridectomy was performed at the 12-o'clock position and in the other 116 eyes at the 6-o'clock position. If possible, reasons for IOP elevation were identified. For all eyes, preoperative and postoperative slit-lamp examinations and IOP measurements were performed. Overall, 30 eyes (9.8%) showed a postoperative IOP elevation within the first postoperative day. The incidence of IOP elevation was 13.9% (5/36) in the triple DMEK group, and 2 of 5 phakic eyes (40%) developed an air bubble-induced IOP elevation. All eyes presented with a de novo IOP elevation, associated in 25 patients with pupillary block from air anterior to iris and in 5 patients with angle closure from air migration posterior to the iris. All of them had an iridectomy at the 12-o'clock position. A postoperative pupillary block with IOP elevation caused by the residual intraoperative air bubble may be an important complication that could be avoided by close and frequent observations, especially in the first postoperative hours and by an inferior peripheral iridectomy and an air bubble with a volume of ≤80% of the anterior chamber.