Increase In IOP Research Articles

Influence of pterygium excision surgery on corneal biomechanical properties

AbstractPurpose To evaluate biomechanical corneal changes after pterygium excision surgery.Methods Prospective, interventional study in which 22 patients with unilateral pterygium were enrolled. Patients underwent pterigyum excision surgery with conjunctival autograft transplantation. The following corneal biomechanical properties were studied using Ocular Response Analyzer (ORA), preoperatively and postoperatively: Corneal Resistance Factor (CFR), Corneal Hysteresis (CH), Goldman correlated intraolcular pressure (IOPg) and Corneal Compensated IOP (IOPcc).Results CRF increased after pterygium excision surgery. Nevertheless, CRF returned to normal values at day 30. There was a decrease in CH parameters at day 7 and at day 30 compared with preoperative values. There was an increase in IOP, IOPg and IOPcc postoperatively.Conclusion CH decreases after pterygium surgery probably because of the elimination of a biomechanical reinforcement provided by the fibrovascular tissue that invades the anterior stroma. The postoperative decrease in CH could influence the IOP measure, which could be infraestimated using the Golman applanation technique. ORA postoperavtive exploration provides more precise IOP values.

Possible future strategies in Neuroprotection

AbstractRetinal ganglion cell (RGC) degeneration is causing blindness in retinal diseases like glaucoma. However, all therapeutic strategies in glaucoma are targeting the IOP increase but they do not aim at retinal ganglion cell neuroprotection. Using purified retinal ganglion cells, we are screening for neuroprotective molecules. Two natural protective molecules were thus identified. This investigation started when finding retinal ganglion cell degeneration in taurine‐deprived animals, we wanted to define if this taurine was acting directly on retinal ganglion cells. Taurine not only increased RGC survival in a pure culture but also in retinal explants exposed to NMDA. Taurine was also found to increase RGC survival in animal models of glaucoma and retinitis pigmentosa. In addition, we had observed that media used to culture mixed retinal cells can promote RGC survival. Using the luminex technology, we have found the presence of VEGF in such media. In fact, recombinant VEGF was able to stimulate RGC survival. RGCs were found to express VEGF receptors in vivo suggesting that this mechanism could have a role in control and pathological conditions. We therefore demonstrated that both taurine and VEGF can provide direct neuroprotective effects on RGCs. If the administration of VEGF is unlikely to become a treatment for glaucoma, these results raise questions on the generalized use of anti‐VEGF strategies for retinal diseases such as age‐related macular degeneration.

Nitric oxide (NO): an emerging target for the treatment of glaucoma.

The predominant risk factor for the progression of glaucoma is an increase in IOP, mediated via a reduction in aqueous outflow through the conventional (trabecular meshwork and Schlemm's canal) outflow pathway. Current IOP lowering pharmacological strategies target the uveoscleral (nonconventional) outflow pathway or aqueous humor production; however, to date no therapy that primarily targets the conventional pathway exists. Nitric oxide (NO) is an intracellular signaling molecule produced by endogenous NO synthases, well-known for its key role in vasodilation, through its action on smooth muscle cells. Under physiological conditions, NO mediates a multitude of diverse ocular effects, including maintenance of IOP. Nitric oxide donors have been shown to mediate IOP-lowering effects in both preclinical models and clinical studies, primarily through cell volume and contractility changes in the conventional outflow tissues. This review is focused on evaluating the current knowledge of the role and mechanism of action of endogenous NO and NO donors in IOP regulation. Data on key additional functions of NO in glaucoma pathology (i.e., ocular blood flow and effects on optic neuropathy) are also summarized. The potential for future therapeutic application of NO in the treatment of glaucoma is then discussed.

Loss of outer retinal neurons and circuitry alterations in the DBA/2J mouse.

The DBA/2J mouse line develops essential iris atrophy, pigment dispersion, and glaucomatous age-related changes, including an increase of IOP, optic nerve atrophy, and retinal ganglion cell (RGC) death. The aim of this study was to evaluate possible morphological changes in the outer retina of the DBA/2J mouse concomitant with disease progression and aging, based on the reduction of both the a- and b-waves and photopic flicker ERGs in this mouse line. Vertically sectioned DBA/2J mice retinas were evaluated at 3, 8, and 16 months of age using photoreceptor, horizontal, and bipolar cell markers. Sixteen-month-old C57BL/6 mice retinas were used as controls. The DBA/2J mice had outer retinal degeneration at all ages, with the most severe degeneration in the oldest retinas. At 3 months of age, the number of photoreceptor cells and the thickness of the OPL were reduced. In addition, there was a loss of horizontal and ON-bipolar cell processes. At 8 months of age, RGC degeneration occurred in patches, and in the outer retina overlying these patches, cone morphology was impaired with a reduction in size as well as loss of outer segments and growth of horizontal and bipolar cell processes into the outer nuclear layer. At 16 months of age, connectivity between photoreceptors and horizontal and bipolar cell processes overlying these patches was lost. Retinal degeneration in DBA/2J mice includes photoreceptor death, loss of bipolar and horizontal cell processes, and loss of synaptic contacts in an aging-dependent manner.

Noninvasive evaluation of phase retardation in blebs after glaucoma surgery using anterior segment polarization-sensitive optical coherence tomography.

Evaluation of bleb morphology using anterior segment optical coherence tomography (OCT) can offer important information regarding bleb function after glaucoma surgery. However, analysis of tissue properties, such as scar fibrosis of blebs, is difficult with conventional OCT. The birefringence of the blebs as susceptible measure of fibrosis scar was evaluated using polarization-sensitive OCT (PS-OCT) and its relation with bleb function was assessed. One hundred and fifty-three blebs of 122 patients that had undergone trabeculectomy or an Ex-Press tube shunt were examined. Also, in 14 blebs of 12 patients, consecutive measurements were performed for 2 months after surgery. The birefringence of blebs was evaluated by measuring alteration of phase retardation using PS-OCT. Functionality of the bleb was classified according to IOP and medication. The bleb morphology in terms of size and characteristics was evaluated using three-dimensional (3D) cornea and anterior segment OCT. The alteration of phase retardation of blebs had the largest impact on bleb functionality than bleb morphology as shown by multiple regression analysis. In consecutive measurements, no blebs showed abnormal phase retardation until 1 week after surgery. Some blebs showed partial increase of phase retardation at 1 month after surgery. Intrableb fibrosis can be noninvasively evaluated with PS-OCT. Evaluation of birefringence by measuring phase retardation alterations using PS-OCT suggests new approaches for the postoperative management of glaucoma blebs regarding antifibrotic treatment for preventing IOP increases.

Difluprednate 0.05% Versus Prednisolone Acetate 1% for Endogenous Anterior Uveitis: A Phase III, Multicenter, Randomized Study

Endogenous anterior uveitis (AU), when untreated, may lead to vision loss. This study compared the safety and efficacy of difluprednate versus prednisolone acetate for the treatment of this condition. This phase III, double-masked, noninferiority study randomized patients with mild to moderate endogenous AU to receive difluprednate 0.05% (n = 56) four times daily, alternating with vehicle four times daily, or prednisolone acetate 1% (n = 54) eight times daily. The 14-day treatment period was followed by a 14-day dose-tapering period and a 14-day observation period. The primary efficacy end point was change in anterior chamber cell grade (range, 0 for ≤1 cell to 4 for >50 cells) from baseline to day 14. At day 14, the mean change in anterior chamber cell grade with difluprednate was noninferior to that with prednisolone acetate (-2.2 vs. -2.0, P = 0.16). The proportions of difluprednate-treated patients versus prednisolone acetate-treated patients demonstrating complete clearing of anterior chamber cells at day 3 were 13.0% vs. 2.1% (P = 0.046) and at day 21 were 73.9% vs. 63.8% (P = 0.013). A significant between-group difference in the mean IOP increase was seen at day 3 (2.5 mm Hg for difluprednate-treated patients and 0.1 mm Hg for prednisolone acetate-treated patients, P = 0.0013) but not at other time points. The mean IOP values in both groups remained less than 21 mm Hg throughout the study. Difluprednate 0.05% four times daily is well tolerated and is noninferior to prednisolone acetate 1% eight times daily for the treatment of endogenous AU. (ClinicalTrials.gov number, NCT01201798.).

IOP Elevation Reduces Schlemm's Canal Cross-Sectional Area

Previously, we demonstrated reduced Schlemm's canal cross-sectional area (SC-CSA) with increased perfusion pressure in a cadaveric flow model. The purpose of the present study was to determine the effect of acute IOP elevation on SC-CSA in living human eyes. The temporal limbus of 27 eyes of 14 healthy subjects (10 male, 4 female, age 36 ± 13 years) was imaged by spectral-domain optical coherence tomography at baseline and with IOP elevation (ophthalmodynamometer set at 30-g force). Intraocular pressure was measured at baseline and with IOP elevation by Goldmann applanation tonometry. Vascular landmarks were used to identify corresponding locations in baseline and IOP elevation scan volumes. Schlemm's canal CSA at five locations within a 1-mm length of SC was measured in ImageJ as described previously. A linear mixed-effects model quantified the effect of IOP elevation on SC-CSA. The mean IOP increase was 189%, and the mean SC-CSA decrease was 32% (P < 0.001). The estimate (95% confidence interval) for SC-CSA response to IOP change was -66.6 (-80.6 to -52.7) μm(2)/mm Hg. Acute IOP elevation significantly reduces SC-CSA in healthy eyes. Acute dynamic response to IOP elevation may be a useful future characterization of ocular health in the management of glaucoma.

Posture-induced changes in intraocular pressure: comparison of pseudoexfoliation glaucoma and primary open-angle glaucoma

The objective of this study was to evaluate and compare the IOP values in the sitting and supine positions in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) patients. We also investigated possible relationships between the level of visual field damage and postural IOP change. Twenty-nine patients with POAG and 32 patients with PXG were recruited to the study. An Icare PRO tonometer was used to measure IOP in the sitting and supine positions. Intraocular pressure in the sitting position was also measured with a Goldmann applanation tonometer (GAT). Humphrey field analyzer 750 data taken within the previous 3 months were obtained and analyzed. The mean difference between the GAT and the Icare PRO tonometer readings was 0.12 ± 0.8 mmHg, and the tonometers were in close agreement (r = 0.964; P < 0.0001). The mean Icare PRO IOP in the sitting position was 16.6 ± 3.3 mmHg in the POAG group and 14.9 ± 2.7 mmHg in the PXG group. The average rise was 1.7 ± 1.2 mmHg in the POAG group and 2.9 ± 1.9 mmHg in the PXG group. The difference in IOP between the sitting and supine positions was significant between the groups (P = 0.001). The ∆IOP was negatively correlated with both the mean deviation and the visual field index (P < 0.0001 for both). The ∆IOP and pattern standard deviation were positively correlated (P < 0.0001). A higher increase in IOP was observed in PXG patients from the sitting to the supine position than in POAG patients. Postural variation in IOP was found to be associated with the severity of visual field damage.

Comparison of Posture-Induced Intraocular Pressure Changes in Medically Treated and Surgically Treated Eyes With Open-Angle Glaucoma

To compare the posture-induced IOP changes in medically treated eyes with those in surgically treated eyes having open-angle glaucoma (OAG) and low IOP. Fifty-one posttrabeculectomized OAG eyes with a cystic filtering bleb and 51 nonoperated, medically treated OAG eyes were studied. The IOP measured with a Goldmann applanation tonometer (GAT) was 12 mm Hg or less in both groups. It was measured in the sitting and lateral decubitus positions with a rebound tonometer. The IOP was measured in the upper eye 5 minutes after assuming the lateral decubitus position. The mean (SD) IOP measured with the GAT was 9.7 (1.5) mm Hg in the trabeculectomized eyes and 9.7 (1.4) mm Hg in the medically treated eyes (P = 0.892, unpaired t-test). In the surgically treated group, the mean (SD) IOP measured with the rebound tonometer was 10.3 (2.3) mm Hg in the sitting position and 11.3 (2.8) mm Hg in the lateral decubitus position (P < 0.001, paired t-test). In the medically treated group, the mean (SD) IOP measured with the rebound tonometer was 10.8 (2.0) mm Hg in the sitting position and 14.1 (2.9) mm Hg in the lateral decubitus position (P < 0.001, paired t-test). The greater IOP increase of 3.3 mm Hg in the medically treated group compared with the 1.0 mm Hg in the surgically treated group was significant (P < 0.001, unpaired t-test). The lower posture-induced IOP change in the successfully trabeculectomized eyes indicates that trabeculectomy will not only lead to a decrease in the IOP but also lower the posture-induced IOP change.

Eye-Specific IOP-Induced Displacements and Deformations of Human Lamina Cribrosa

To measure high-resolution eye-specific displacements and deformations induced within the human LC microstructure by an acute increase in IOP. Six eyes from donors aged 23 to 82 were scanned using second harmonic-generated (SHG) imaging at various levels of IOP from 10 to 50 mm Hg. An image registration technique was developed, tested, and used to find the deformation mapping between maximum intensity projection images acquired at low and elevated IOP. The mappings were analyzed to determine the magnitude and distribution of the IOP-induced displacements and deformations and contralateral similarity. Images of the LC were obtained and the registration technique was successful. IOP increases produced substantial, and potentially biologically significant, levels of in-plane LC stretch and compression (reaching 10%-25% medians and 20%-30% 75th percentiles). Deformations were sometimes highly focal and concentrated in regions as small as a few pores. Regions of largest displacement, stretch, compression, and shear did not colocalize. Displacements and strains were not normally distributed. Contralateral eyes did not always have more similar responses to IOP than unrelated eyes. Under elevated IOP, some LC regions were under bi-axial stretch, others under bi-axial compression. We obtained eye-specific measurements of the complex effects of IOP on the LC with unprecedented resolution in uncut and unfixed human eyes. Our technique was robust to electronic and speckle noise. Elevated IOP produced substantial in-plane LC stretch and compression. Further research will explore the effects of IOP on the LC in a three-dimensional framework.

Incidence of increased intraocular pressure and factors associated with it after optical penetrating keratoplasty at secondary care centre, India

Background: An increase in intraocular pressure (IOP/glaucoma) any time after penetrating keratoplasty (PK) leads to a significant endothelial cell loss with dire consequences. The present study was conducted to know the incidence of increased IOP and factors associated with it following optical PK. Materials and Methods: A prospective study was conducted at Ophthalmology Department of PDU Medical College and Civil Hospital Rajkot, a secondary level center for 2 years from May 2010 to April 2012. A total of 50 patients admitted for optical PK during the study period were enrolled. Detailed history was elicited regarding ocular problem and any treatment taken for the same. Results: Nearly 30% of the patients reported an increase in IOP in the present study. Majority (58.0%) patients were above the age of 55 years. Based on preoperative diagnosis, increase in IOP was reported among patients with aphakic bullous keratopathy (100.0%), adherent leucoma (50.0%), graft failure (44.4%) and pseudophakic bullous keratopathy (25.0%). After 1 month of optical PK, 18.0% patients reported an increase in IOP, 28.0% after 2 months and 26.0% after 3 months. Out of 15 patients who reported an increase in IOP, 14 (93.3%) were given medical treatment and 1 (6.7%) patient required surgical treatment. Conclusion: Age above 55 years, preoperative diagnosis of adherent leucoma, aphakic eyes were major risk factors for the post-operative increase in IOP in the present study. Peak rise in IOP was reported following 2 months post keratoplasty. Post PK glaucoma in the majority of patients responded to medical treatment.

Nachbehandlung nach nicht penetrierender Glaukomchirurgie: die Goniopunktion

Non-penetrating glaucoma surgery was primarily developed as an alternative to the widely applied trabeculectomy. Since the anterior chamber in non-penetrating surgery is not directly opened, common postoperative complications such as hypotony are rare. The most frequently applied technique in this group is the deep sclerectomy. After having prepared a superficial scleral flap a deeper scleral flap is performed and excised unroofing Schlemm's canal. The trabecular meshwork is then peeled leaving a residual trabeculodescemet membrane. As a consequence aqueous humour diffuses via the trabeculodescemet membrane under the scleral flap and subsequently under the conjunctiva. One of the reasons for a postoperatively high IOP is seen in the resistance of the residual trabculodescemet membrane. A solution to this problem lies in its puncture, the so-called goniopuncture. Goniopunctures are done in approximately 50 % of cases after deep sclerectomy and are also applied in cases of canaloplasty and viscocanaloplasty. Usually a 1064 nm Nd : YAG laser is used. A potential risk of iris incarceration is described. Two studies have shown that an equally IOP lowering effect can be achieved by treating the trabeculodescemet membrane with a frequency-doubled 532 nm Nd : YAG laser (SLT). No complications were detected in those cases. In conclusion, goniopuncture should be considered as the first line treatment for postoperative IOP increase in cases of non-penetrating glaucoma surgery. It should therefore be preferred to a (re)start of topical treatment.

A comparison of alfaxalone and propofol on intraocular pressure in healthy dogs

To compare the effects of alfaxalone and propofol on intraocular (IOP) pressure in the canine eye. Twenty-three healthy adult dogs. Dogs were randomized to receive intravenous propofol (n = 11) or alfaxalone (n = 12) until loss of jaw tone, 20 min after intravenous premedication (acepromazine 0.02-0.03 mg/kg and hydromorphone 0.05-0.1 mg/kg). IOP was measured at baseline (BL), 20 min postpremedication (postpremed), loss of jaw tone (postinduct), and immediately following orotracheal intubation (postintub). Between- and within-treatment effects were analyzed with two-way and one-way repeated measures ANOVA with Bonferroni's post hoc test, respectively. P < 0.05 was considered significant. No significant IOP differences were detected between alfaxalone or propofol groups at any time point (P > 0.05). Propofol: IOP did not change between BL (15.5 ± 2.7 mmHg) and postpremed (16.2 ± 3.6 mmHg, P > 0.05), or postinduct (19.1 ± 5.2 mmHg) and postintub (21.0 ± 4.6 mmHg, P > 0.05), but differed significantly between BL and postinduct (P < 0.0001), and postintub (P < 0.0001). Alfaxalone: IOP did not change between BL (15.7 ± 2.8 mmHg) and postpremed (15.3 ± 4.1 mmHg, P > 0.05), or postinduct (19.2 ± 4.9 mmHg) and postintub (20.5 ± 4.5 mmHg, P > 0.05), but differed significantly between BL and postinduct (P < 0.01), and postintub (P < 0.0001). These data show a potentially clinically significant increase in IOP following induction with propofol or alfaxalone, but no difference between agents.

The Dynamic Response of Intraocular Pressure and Ocular Pulse Amplitude to Acute Hemodynamic Changes in Normal and Glaucomatous Eyes

To evaluate the effects of acute arterial blood pressure (ABP) and venous pressure changes on IOP in rats with experimental glaucoma. Unilateral experimental ocular hypertension was established in Sprague-Dawley rats by weekly intracameral injection of microbeads. Ocular pulse amplitude (OPA) and IOP were recorded from the anterior chamber using 1.2-Fr microsensors under urethane anesthesia. The effects on IOP during hemodynamic challenges using phenylephrine (PE) (50 μg/kg/min intravenous [IV]) and rapid saline loading (20 mL/kg/min IV) were studied. Over an 8-week period, IOP was significantly elevated by 60% in the unilateral ocular hypertensive eyes. Both ABP and IOP were significantly increased by PE infusion. A significantly greater IOP increase was found in the experimental eyes compared with control eyes (1.32 ± 0.18 mm Hg vs. 0.90 ± 0.09 mm Hg). Correspondingly, higher OPAs and an amplification of the OPA during arterial hypertension were found in the experimental eyes. A sustained rise in IOP secondary to IV saline loading was observed, with a greater rise observed among experimental eyes (0.74 ± 0.13 mm Hg vs. 0.37 ± 0.005 mm Hg). Sympathetic acceleration of ABP using PE resulted in surges in IOP and OPA. In contrast, increased venous pressure resulted in a more sustained rise in IOP but to a lesser extent. These responses were more pronounced in eyes with experimental glaucoma compared with control eyes, which may reflect the higher starting IOP contributing to a reduced ocular compliance. Our results suggest that eyes with ocular hypertension are more susceptible to IOP variability induced by hemodynamic fluctuations.

Distribution of Central Corneal Thickness and its Association with Ocular Parameters in a Large Central European Cohort: The Gutenberg Health Study

Main objectiveTo evaluate the distribution of central corneal thickness (CCT) in a large German cohort and to analyse its relationship with intraocular pressure and further ocular factors.DesignPopulation-based, prospective, cohort study.MethodsThe Gutenberg Health Study (GHS) cohort included 4,698 eligible enrollees of 5,000 subjects (age range 35–74 years) who participated in the survey from 2007 to 2008. All participants underwent an ophthalmological examination including slitlamp biomicroscopy, intraocular pressure measurement, central corneal thickness measurement, fundus examination, and were given a questionnaire regarding glaucoma history. Furthermore, all subjects underwent fundus photography and visual field testing using frequency doubling perimetry.ResultsMean CCT was 557.3±34.3 µm (male) and 551.6±35.2 µm in female subjects (Mean CCT from right and left eyes). Younger male participants (35–44 years) presented slightly thicker CCT than those older. We noted a significant CCT difference of 4 µm between right and left eyes, but a high correlation between eyes (Wilcoxon test for related samples: p<0.0001). Univariable linear regression stratified by gender showed that IOP was correlated with CCT (p<0.0001). A 10 µm increase in CCT led to an increase in IOP between 0.35–0.38 mm Hg, depending on the eye and gender. Multivariable linear regression analysis revealed correlations between gender, spherical equivalent (right eyes), and CCT (p<.0001 and p = 0.03, respectively).ConclusionsWe observed positive correlations between CCT and IOP and gender. CCT was not correlated with age, contact lens wear, positive family history for glaucoma, lens status, or iris colour.

Dependence of the origin of pain in the eyes with terminal stage of glaucoma from chemical composition of vitreous

AbstractPurpose To identify a possible link between the origin of hypertonic pain syndrome (HPS) in the eyes with terminal stage of glaucoma and the difference of the urea concentrations between vitreous contents and blood serum.Methods 31 patients (31 eyes) with refractory terminal glaucomas of different origins with IOP more 35 mm Hg were studied and operated on. The principle of surgery was drainage of the vitreous space for HPS elimination. Some vitreous contents and venous blood were taken during the surgery and researched for measuring urea concentrations. The samples were centrifuged then the blood serum and the supernatant of the vitreous contents were analyzed (SPOTCHEM‐EZ SP 4430). The patients were divided into 3 groups depending on the intensity of pain syndrome: 1st with strong pain; 2nd ‐ pain was present earlier; but it was absent before the surgery; 3d ‐ pain was never registered.Results A high concentration of urea in vitreous contents was found. Only in 6.45% the urea concentration in blood serum was higher then in vitreous. In 12.9% concentrations were near equal and in 80.64% the urea concentration in vitreous contents was higher than in blood serum. Pain existed in the cases when the difference (the negative gradient) of urea concentrations exceeded 6.1 mmol/L only.Conclusion High concentration of the osmoticaly active urea in the vitreous cavity can be the reason for increase of IOP in some cases of refractory glaucomas. If the negative gradient of the urea concentrations were higher than the critical level, it would be the reason for the development of HPS.

Genome-wide association study of intraocular pressure identifies the GLCCI1/ICA1 region as a glaucoma susceptibility locus

To discover quantitative trait loci for intraocular pressure, a major risk factor for glaucoma and the only modifiable one, we performed a genome-wide association study on a discovery cohort of 2175 individuals from Sydney, Australia. We found a novel association between intraocular pressure and a common variant at 7p21 near to GLCCI1 and ICA1. The findings in this region were confirmed through two UK replication cohorts totalling 4866 individuals (rs59072263, Pcombined = 1.10 × 10−8). A copy of the G allele at this SNP is associated with an increase in mean IOP of 0.45 mmHg (95%CI = 0.30–0.61 mmHg). These results lend support to the implication of vesicle trafficking and glucocorticoid inducibility pathways in the determination of intraocular pressure and in the pathogenesis of primary open-angle glaucoma.

Local Safety Concerns of Repited Dexamethasone Intravitreal Implant (Ozurdex®) For Macular Diseases

Introduction: The objective of the present study was to analyze the expanding indications for the dexamethasone intravitreal implant (Ozurdex®) in macular edema of varied diseases, and determine its safety concerns. Materials and Methods: We retrospectively reviewed the ophthalmic charts of patients treated with at least one intravitreal injection of Ozurdex® since April 2010 to October 2011. Data regarding complications of the procedure as well as the need for cataract surgery were collected. No patient with the diagnosis of glaucoma was included in the present study. Early recurrences where treated with laser photocoagulation or intravitreal ranibizumab at the discretion of the physician; late recurrences where treated with a new Ozurdex® injection. Results: The causative diseases of ME in the 214 eyes of our sample were: diabetic macular edema (101 eyes of 84 patients); branch retinal vein occlusion (27 eyes of 27 patients with superior temporal branch occlusion; 6 eyes of 6 patients with inferior temporal branch occlusion); central retinal vein occlusion (23 eyes of 23 patients); uveitic macular edema (13 eyes of 11 patients). Patients with other indications such as exudative age-related macular degeneration (27 eyes of 27 patients), and pseudophakic cystoid macular edema (7 eyes of 7 patients). Regarding complications, we found a rate of posterior cataract progression in 69.6% of phakic eyes after receiving a second intravitreal Ozurdex® for the treatment of ME. A significant IOP increase was evidenced in 21.18% of cases following the first Ozurdex® implant. Patients with uveitic macular edema (UME) showed the greatest rate of IOP increase (53.86%) following Ozurdex® implant. In addition, anterior chamber migration of the Ozurdex® implant was seen in 2 cases with lens posterior capsule rupture. Discussion: This is a descriptive study of 214 eyes of 189 patients treated with intravitreal Ozurdex® in real-life conditions, which adds an important value for the retinal physicians. Further long-term studies are warranted in order to establish a more accurate safety profile of Ozurdex® for retinal diseases.

Macintosh laryngoscope versus Bonfils Intubation Endoscopes in endotracheal intubation: Hemodynamic, intra-ocular pressure and serum catecholamine responses

ObjectiveOne of the alternative methods in managing patients for endo-tracheal intubation is the Bonfils fiberscope. We studied the efficacy of Bonfils fiberscope in comparison to the classical laryngoscope with Macintosh blade inhemodynamic, serum catecholamine and intra-ocular pressure responses.MethodsIn a prospective, randomized trial 40 patients ASA I or II aged ⩾18 years scheduled for gynecological, urinary and lower abdominal procedures in supine position were randomly allocated to one of two groups; 20 patients each; according to intubating device by using either Macintosh laryngoscope (L) group or Bonfils Intubation Endoscopes (B) group. Pre-induction (baseline) and pre-insertion values of HR, MAP, IOP and blood samples for catecholamine level were recorded and repeated at 1, 3, and 5 min after intubation.ResultsThere was significant increase in HR, MAP, IOP and catecholamine level in L group at 1, 3, and 5 min after intubation.ConclusionBonfils laryngoscope had superiority over Macintosh as a method of intubation in situations where minimal changes in hemodynamic, catecholamine level and intraocular pressure are desirable.

Phacoemulsification with perfluorocarbon liquid using a 23-gauge transconjunctival sutureless vitrectomy for the management of dislocated crystalline lenses

We describe the modified technique of phacoemulsification in dislocated crystalline lenses. After the vitreous and posterior hyaloid membrane were removed using a 23-gauge three-port vitrectomy, perfluorocarbon liquid (PFCL) was injected at the posterior pole in order to fill the vitreous cavity. The dislocated lens floated on the PFCL, and the injection was ceased once the lens had risen to the iris plane. The lens was then removed from the anterior chamber using standard phacoemulsification procedures. During the phacoemulsification, the PFCL provides a support underneath the nucleus, like a trampoline, and even small fragments can be completely removed. The final best-corrected visual outcome was more than 20/40 in 11 eyes. Although two eyes showed LP(-) due to optic neuropathy, those eyes showed a remission in inflammation and an increase in IOP. This modified use of PFCL in the removal of dislocated lenses fragments may overcome the limitation of earlier management of dislocated lenses.