Incidence Of High Intraocular Pressure Research Articles

Prediction model for elevated intraocular pressure risk after silicone oil filling based on clinical features.

To evaluate risk factors and further develop prediction models for intraocular pressure elevation (IOP) after vitreoretinal surgery with silicone oil tamponade to support clinical management. A retrospective study analyzed 1,061 eyes of 1,061 consecutive patients that presented to the Jiangsu Province Hospital between December 2015 and December 2020, the IOP was measured from the preoperative visit and at the 1-week, 1-month, 3-month, and 6-month visits, and the final postoperative visit before silicone oil removal. Four machine learning methods were used to carried out the prediction of IOP elevation: Decision Tree, Logistic Regression, Random Forest, and Gradient-Boosted Decision Trees (GBDT) based on features including demographic and clinical characteristics, preoperative factors and surgical factors. Predictors were selected based on the p-value of the univariate analysis. Elevated intraocular pressure developed in 26.01% of the eyes postoperatively. Elevated intraocular pressure primarily occurred within 1-2 weeks after surgery. Additionally, the majority of IOP values were distributed around 25-40 mmHg. GBDT utilizing features with p-values less than 0.5 from the hypothesis testing demonstrated the best predictive performance for 0.7944 in accuracy. The analysis revealed that age, sex, hypertension, diabetes, myopia, retinal detachment, lens status and biological parameters have predictive value. Age, sex, hypertension, diabetes, myopia, retinal detachment, lens status and biological parameters have influence on postoperative intraocular pressure elevation for patients with silicone oil tamponade after pars plana vitrectomy. The prediction model showed promising accuracy for the occurrence of IOP elevation. This may have some reference significance for reducing the incidence of high intraocular pressure after pars plana vitrectomy combined with silicone oil filling.

A review of ten years of experience using dexamethasone intravitreal implants (Ozurdex) for uveitis.

Uveitis is a type of ocular inflammatory disease caused by various etiologies, for which corticosteroids are the main treatment. Dexamethasone Intravitreal implant (DEX-I) has been widely used in the treatment of uveitis across the world. Then, new indications and complications appeared. This review aims to summarize the use of DEX-I in uveitis in the past 10 years. We summarized the clinical data (baseline characteristics, efficacy and safety) and discussed controversies by retrospectively analyzing the articles and cases published in PubMed and Web of Science using the terms "Ozurdex", OR "intravitreal dexamethasone implant", AND "uveitis" from 2010 to 2022. DEX-I is effective in reducing edema, improving inflammation and improving vision when treating various conditions of uveitis including infectious, no-infectious, pediatric uveitis, and surgery-related applications. The efficacy of DEX-I as a monotherapy is related to the following: etiology and course of disease, treatment of systemic diseases, patients' toleration after multiple injections, economic situation, etc. In addition, intravitreal corticosteroids implantation may replace systemic therapy in some patients. In terms of safety, the incidence of high intraocular pressure is about 20.52%, and the incidence of cataract is about 15.51%. DEX-I can effectively treat non-infectious uveitis and some infectious uveitis such as suspected tuberculosis, and its safety is controllable. Further studies are necessary to evaluate the effect of monotherapy and to expand more indications.

Comparison of intravitreal ranibizumab monotherapy vs. ranibizumab combined with dexamethasone implant for macular edema secondary to retinal vein occlusion.

PurposeTo compare the efficacy and the injection number of intravitreal ranibizumab (IVR) monotherapy vs. intravitreal ranibizumab plus dexamethasone (IVR + DEX) implants for macular edema (ME) secondary to retinal vein occlusion (RVO).MethodsThis prospective, control trial comprised 96 eyes of 96 patients with ME due to non-ischemic RVO divided into two groups. The IVR monotherapy group consisted of 61 patients (29 with CRVO and 32 with BRVO) treated with ranibizumab with three consecutive loading doses at a monthly + pro re nata (three + PRN) regimen. The IVR + DEX implant group consisted of 35 patients (19 with CRVO and 16 with BRVO) treated with intravitreal ranibizumab plus DEX implant. All eyes underwent best-corrected visual acuity (BCVA, log MAR), central foveal thickness (CFT), and intraocular pressure (IOP). In case of recurrence, each group received initial medication.ResultsAt the 12-month visit, the mean log MAR BCVA that was improved from baseline was 0.23 with the IVR group and 0.30 with the IVR + DEX group. CFT decreased on average by 420 ± 292 μm with the IVR group and 393 ± 259 μm with the IVR + DEX implant group. No significant differences were detected in BCVA improvement and CFT reduction between the two groups (p > 0.05). The mean number of injections was 5.4 in the IVR group and 3.9 in the IVR + DEX implant group (p < 0.001). The mean reinjection interval for patients with the IVR + DEX implant was 131.2 ± 8.9 days (range: 98–150). The incidence of high IOP and cataract progression were significantly higher in the IVR + DEX implant group than in the IVR group (both p < 0.001).ConclusionIn RVO-ME, the IVR + DEX implant did not have synergistic efficacy, providing further improvement in BCVA and a reduction in CFT. However, the IVR + DEX implant still had an advantage in reducing the number of injections and prolonging the time between injections.

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.

Evaluation of vitrectomycombined preoperative intravitreal ranibizumab and postoperative intravitreal triamcinolone acetonide for proliferative diabetic retinopathy.

To explore the treatment efficacy of the combination of preoperative intravitreal ranibizumab (IVR) and postoperative intravitreal triamcinolone acetonide (IVTA) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). A retrospective comparative study was performed on 128 eyes of 128 patients who had PDR and underwent PPV. Patients who received a single PPV were assigned to Group A. Those who received PPV with preoperative IVR were assigned to Group B. Patients in Group C underwent PPV combined preoperative IVR and postoperative IVTA. Intraoperative findings, changes in mean best-corrected visual acuity (BCVA) and postoperative adverse events, were retrospectively evaluated at 6-month follow-up. The incidences of iatrogenic breaks, severe intraoperative bleeding, using long-term internal tamponade agents, recurrent vitreous hemorrhage (VH), and duration of surgery were statistically significantly less in Group B and Group C than in Group A. The postoperative BCVA was statistically significantly better in Groups B and Group C than in Group A, respectively, at 1month after surgery. The mean 3-month postoperative visual acuity was better in Group C. The incidence of high intraocular pressure (IOP) was significantly higher in Group C at the first postoperative week. There were no statistically significant differences in the incidence of exudative retinal detachment and choroidal detachment among the three groups. In patients undergoing PPV for PDR, preoperative IVR significantly reduced the occurrence of intraoperative and postoperative complications, and the combination of preoperative IVR and postoperative IVTA can better improve the postoperative visual outcome.

Gender-Specific Association Between Serum Uric Acid and Incident High Intraocular Pressure in Chinese Population: A Cross-Sectional Study.

PurposeThe purpose of this study was to investigate the relationship between high intraocular pressure (IOP) and uric acid.MethodsIn a retrospective cross-sectional study, 19,147 participants were included in 2018. Serum uric acid (SUA) was cut to four groups as Q1 to Q4, according to the quartiles. The odds ratio (OR) and 95% confidence interval (CI) of different SUA levels were estimated by a binomial logistic regression model in men and women. A restrictive cubic spline method was used to estimate the dose-response relationship between uric acid and high IOP. Subgroup analysis was performed to find the gender-specific association between uric acid and high IOP.ResultsIn women, after adjusting for confounding factors, the Q3 and Q4 of SUA levels were significantly associated with the risk of high IOP. The OR with 95% CI for Q3 and Q4 were 1.77 (1.22, 2.57) and 1.51 (1.01, 2.26), respectively, Q1 as a reference. For men, SUA levels were not associated with the incidence of high IOP. Moreover, the spline analysis found an inverted U‐shaped relationship between uric acid and high IOP in women (P = 0.0171).ConclusionsElevated levels of SUAwere independently associated with an increased risk of high IOP in women, but not in men. In addition, uric acid had an inverse U-shaped nonlinear dose-response relationship with high IOP in women.

Application and design of a new prone position headrest to reduce complications caused by improper body position after vitrectomy

Objective To improve patient postoperative comfort of vitrectomy with tamponnade in the prone position, design a new prone position headrest to reduce complications caused by improper body position and observe its clinical effect. Methods According to the postoperative position of the patients, 360 cases were collected. The patients were divided into the control group and the observation group with 180 cases of each group. Observation group was treated with the new prone position headrest nursing, control group were treated with routine prone position. The comfort of patients, postoperative adverse reactions, success rate of retina reattachment were observed. Results According to simplified comfortable situation scale, physiological, psychological, social culture and environment of each individual score respectively was (2.74±0.21), (3.54±0.29) , (3.25±0.23), (3.36±0.27) points in observation group and (2.30± 0.19), (2.92±0.31), (2.93±0.26), (2.79±0.30) points in control group, and there were significant differences (t=12.368-20.845, all P <0.05). The daily posture duration in postoperative first time and 5 days was respectively (220.00±25.08), (1008.00 ± 20.32) min in observation group and (85.00±28.07), (650.00±30.12) min in control group, and there were significant differences(t=48.117, 133.194, all P<0.01). The incidence of corneal edema, conjunctival congestion, water turbidity in observation group were lower than those in control group at 4 weeks after surgery, and there were statistically significant difference (U=6.308, 8.130, 6.875, P < 0.01). The incidence of high intraocular pressure, recurrent retinal detachment rate and reduction rate in observation group were lower than those in control group at 4 weeks after surgery, and there were statistically significant difference (χ2=9.000, 10.540, 11.770, P < 0.01). Conclusions The new prone headrest can effectively improve the resection of vitreous body with tamponade patients in comfort, ensure the operation effect. Key words: Nursing care; Prone headrest; Vitrctomy with tamponade

Clinical compartion of Suture fixation of posterior chamber intraocular lens and anterior chamber intraocular lens implantation

Objective To investigate the posterior capsule can not be supported by better artificial lens implantation surgery. Methods In our hospital posterior chamber intraocular lens suture fixation(65 cases) and anterior chamber intraocular lens implantation(54 patients) compared the clinical follow-up. Results off residual rate( corrected visual acuity ＞ 0. 3 ) difference was not statistically significant, suture fixation of intraocular lens group a higher incidence of displacement, there were significant differences between the two groups, early high intraocular pressure group the incidence of anterior chamber high significant difference between the two groups, but a month after the incidence of high intraocular pressure was no significant difference between the two groups, corneal edema ,uveitis ,hyphema, the incidence of deformed pupil was no significant difference between two groups. Conclusion Anterior chamber intraocular lens implantation, surgery is relatively simple, with few complications. Key words: Intraocular lens; Suture fixation; Anterior chamber

Clinical analysis of intraocular pressure elevation following vitreoretinal surgery

To study the incidence and risk factors of intraocular pressure (IOP) elevation in patients who underwent vitreoretinal surgery. Data for 422 patients (446 eyes) who underwent vitreoretinal surgery from June 2005 to June 2007 were retrospectively analyzed. IOP was measured before surgery and on day 1, 2, 3, 7-14 after surgery with Goldmann applanation tonometer. Ocular hypertension was defined as IOP 25 mmHg or more. All factors were analyzed for association with Ocular hypertension. 232 of the 422 patients were female. 190 were male. The IOP was elevated significantly in 185 eyes (41%) after surgery within 2 weeks. Among them the IOP occurred mostly in day 1 (152 eyes, 82%). The rate of IOP elevation with intraocular tamponade of C3F8 or silicone oil was 53% or 55%, the difference being not statistically significant (P>0.05). The incidence of high IOP in C3F8 injection group and silicone oil injection group were statistically higher than simple pars plana vitrectomy group (P<0.01). The risk factors of ocular hypertension include C3F8 injection (chi2=37.82, P<0.01), silicone oil injection (chi2=27.84, P<0.01), lentectomy (chi2=8.98, P<0.01), scatter endolaser (chi2=7.41, P<0.01), diabetes (chi2=12.12, P<0.01) and increasing patient age (chi2=7.07, P<0.01). IOP elevation was a common complication of vitreoretinal surgery. The risk factors of ocular hypertension include C3F8 injection, silicone oil injection, lentectomy, scatter endolaser, diabetes and increasing patient age.

Correlation between quantity of silicone oil emulsified in the anterior chamber and high pressure in vitrectomized eyes.

To assess the existence of any correlation between the quantity of silicone oil emulsified in the anterior chamber and the incidence of high intraocular pressure in vitrectomized eyes. Forty-nine eyes of 49 patients underwent vitrectomy with silicone oil injection as an adjuvant procedure. At the time of observation, between September 1999 and September 2000, 13 eyes (26.5%) were phakic; 23 eyes (47%) were pseudophakic; and 13 eyes (26.5%) were aphakic. Ultrasound biomicroscopy, slit-lamp biomicroscopy, and gonioscopy were performed to quantify the presence of silicone oil emulsified in the anterior chamber. The 13 phakic eyes did not have a high intraocular pressure. In 8 of the 13 eyes, ultrasound biomicroscopy detected only scarce oil emulsification in the anterior chamber (0.304 mm); in 5 of the 13 eyes, gonioscopy and ultrasound biomicroscopy did not detect anterior chamber oil emulsification. Fourteen of 23 pseudophakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.922 mm). Nine of 23 pseudophakic eyes did not have a high intraocular pressure; of these, ultrasound biomicroscopy detected little anterior chamber oil emulsification (0.209 mm). The 13 aphakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.795 mm). The coefficient of correlation for the measurements obtained was 0.98 (F = 62.3, P = 0.05; t = 11.1, P = 0.001). This study showed a high correlation between the incidence of high intraocular pressure and the quantity of emulsified silicone oil in the anterior chamber.

Signs of Glaucoma in Rhesus Monkeys from a Restricted Gene Pool

To investigate the distribution of intraocular pressure (IOP) and cup properties in a colony of rhesus monkeys that has had no outside genetic input since 1938 (approximately 12 generations). This sample of sequestered monkeys is significantly larger than any previously reported. Comparisons are made with a sample of random-source monkeys to develop population estimates defining the limits of normalcy. The IOP and cup/disc ratio estimates were collected from 701 eyes of 354 adult rhesus monkeys from the closed colony on Cayo Santiago, Puerto Rico. Results for IOP were compared with the normal rhesus IOP population distribution function calculated from an earlier sample of genetically heterogeneous rhesus. The mean +/- standard deviation IOP in the Cayo Santiago monkeys (15.8+/-3 mmHg) related well to the calculated "normal" rhesus distribution (14.5+/-2 mmHg) below and around the mean IOP only. Above the mean rhesus IOP, the samples from the Cayo monkeys were strongly skewed: 129 eyes had IOP more than two standard deviations above the normal mean IOP, and 54 eyes had IOP more than three standard deviations above the normal mean IOP. Cup/disc ratio estimations tended to cluster as higher values in the higher IOP quartiles. Some eyes with IOP below the mean had cup/disc ratios > 0.5. Values for IOP that were more than two standard deviations above the mean and cup/disc ratios > 0.4 were not uniformly distributed across social groupings, although incidence of high IOP was more than 25% in one group. After 12 generations with the same genetic pool, expression of ocular hypertension and large optic disc cups is high but not uniform.

Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation

Purpose: To evaluate transient increases in intraocular pressure (IOP) after use of high-viscosity viscoelastic agents in cataract surgery.Setting: Military Hospital, Ulm, Germany.Methods: In a prospective, randomized study, we evaluated IOP following cataract surgery using two different viscoelastic substances (Healon®, Healon® GV). The viscosity of Healon GV is 10 times higher than that of Healon because of higher concentration and molecular weight. Patients having identical phacoemulsification procedures (sutureless clear corneal tunnel incision with foldable silicone lens implantation) (N = 60) and identical viscoelastic removal were assigned to groups of 15 based on viscoelastic used and removal time (20 or 40 seconds). Intraocular pressure was measured preoperatively and at 6, 24, 36, and 48 hours and 1 month postoperatively.Results: The highest mean IOP elevations in both viscoelastic groups were obtained at 24 hours postoperatively (2.9 mm Hg ± 4.3 [SD] with Healon and 3.3 ± 6.3 mm Hg with Healon GV). There were no statistically significant differences between the two viscoelastics and the two removal times during the entire follow-up period (unpaired t-test), but standard deviations were higher in the Healon GV groups at 6 and 24 hours. Two patients in the Healon groups and three in the Healon GV groups required medical treatment for IOP within the first 24 postoperative hours; however, all five patients had an IOP lower than 22 mm Hg on the second postoperative day.Conclusions: Based on postoperative IOP, both viscoelastics can be equally well removed from the anterior chamber. Incidence of high IOP using high-viscosity hyaluronic acid is minimized by the described removal technique.