Intraocular Pressure In Glaucoma Patients Research Articles

Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results.

this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications-none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients. The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained.

The Relationship Of Hypertension With Increased Intraocular Pressure In Glaucoma Patients In Polyclinics Ambon Vlissingen Eye

Glaucoma is a progressive optic neuropathy that characterized by optical nerve damage and loss function were of visual field. This is the second leading cause of blindness worldwide. statistic showed 0.5% of Indonesian people suffering from glaucoma and one of the factors that cause glaucoma is hypertension. The purpose of this study was to determine the correlation of hypertension with increased intraocular pressure in glaucoma patients at Ambon Vlissingen Eye Polyclinic, on January of 2018 using analytical descriptive with cross sectional approach. The number of samples were 38 respondents. Data collection was done through observation sheet and interview guide. Data were analyzed by using chi square test. This study shows the value of p = 0.000 &lt;? = 0.05 which means that there was a relationship between hypertension with an increasing in intraocular pressure in Ambon Vlissingen Eye Polyclinic. conclusion there was a relationship between hypertension with increased intraocular pressure on Eye Polyclinic Ambon Vlisingen. It is expected that health officer of Eye Polyclinic Ambon Vlisingen in order to improve the quality of service so that morbidity and mortality due to glaucoma and hypertension can be reduced.

Retracted: Real-Time Monitoring of Intraocular Pressure in Glaucoma Patients Using Wearable Mobile Medicine Devices.

[This retracts the article DOI: 10.1155/2022/2271937.].

Microcyclophotocoagulation in Glaucoma Treatment: A Medium-Term Follow-Up Study.

This study aimed to assess the effectiveness and safety of transscleral microcyclophotocoagulation (µCPC) in patients with glaucoma for eighteen consecutive months. Sixty-one patients (64 eyes) with primary and secondary glaucoma were enrolled to undergo µCPC (diode laser FOX 810, A.R.C. Laser, Nuremberg, Germany). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after µCPC. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and at the first week, and 1, 3, 6, 12, and 18 months postoperatively. The mean ± SD values of IOP preoperatively at 1 day, 1 week, 1, 3, 6, 12, and 18 months postoperatively were 25.1 ± 8.4 mmHg, 17.3 ± 4.5 mmHg (p < 0.001), 16.5 ± 6.1 mmHg (p < 0.001), 20.5 ± 8.3 mmHg (p < 0.001), 17.1 ± 6.2 mmHg (p < 0.001), 18.0 ± 7.1 mmHg (p < 0.001), 15.8 ± 3.2 mmHg (p < 0.001), and 17.0 ± 5.9 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.5%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 38.5%. Two patients at 18-month follow-up did not require the use of antiglaucoma medications-complete success rate-3.1%. During the follow-up period, twenty-five eyes (39.1%) that required retreatment due to nonachievement of the target IOP were considered as failures. Eleven patients (12 eyes-18.8%) were lost to follow-up. A total of 26 patients (27 eyes) were evaluated 18 months after µCPC. Hypotony was observed in one patient (1.6%) and uveitis in two patients (3.1%) after the procedure. There were no other significant intraoperative or postoperative complications observed. The µCPC is well tolerated and safe for reducing IOP in glaucoma patients in medium-term follow-up; however, success is moderate. Randomized, larger studies are needed to confirm the obtained results.

Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety.

Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40-80. The best way to manage primary open-angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. An open-label, real-world, multicentric, observation-based 3-month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first-line therapy. Diurnal IOP measurements, best-corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day-1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Four hundred and sixty-nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once-daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. We found that netarsudil 0.02% w/v solution monotherapy when used as the first-line treatment in primary open-angle glaucoma and ocular hypertension was both safe and effective.

Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis.

Glaucoma is the second leading cause of blindness in the world, with an estimated 57.5 million people suffering from glaucoma globally. Treatment of glaucoma focuses on lowering intra-ocular pressure to prevent progression of visual field defects, which is the only proven method for treating this disease. Yoga practices are believed to lower intra-ocular pressure in the eyes and prevent further damage in patients with glaucoma. Therefore, this systematic review was planned to explore the available scientific studies on yoga and intra-ocular pressure in glaucoma patients. PubMed, Cochrane Library, and Google Scholar were the basis for the investigation of the literature. The Jadad Scale was used to assess the quality of included clinical trials, and the JBI Critical Appraisal Checklist was used to assess the quality of included case studies. Based on the quality assessment and eligibility, six studies on yoga and intra-ocular pressure in glaucoma patients carried out between 2007 and 2021 were included in the final review. The results showed a reduction in intra-ocular pressure in patients with glaucoma through Jyoti-trataka (gazing steadily on a point or candle flame) and some other slow yogic breathing techniques, whereas studies on inversion Asanas (yoga postures) showed a rapid increase in intra-ocular pressure soon after starting. The three high-quality RCTs included in the meta-analysis showed a greater improvement in intra-ocular pressure in the yoga groups in both eyes than in the control groups; however, there were some limitations related to a small sample size, study quality, a long-term follow-up period, and variations in the yoga practices. Therefore, further studies with larger sample sizes and long-term follow-up are needed to overcome the limitations for a better understanding.

Effect of phacoemulsification on intraocular pressure in glaucoma patients

Introduction: Cataracts and Glaucoma are the leading causes of irreversible blindness worldwide. Lens extraction using the Phacoemulsification technique can be an effective IOP-lowering treatment for all types of glaucoma.&#x0D; Objective: To study was to measure the Intra-Ocular Pressure before and after phacoemulsification and to determine the mean change in Intra-Ocular Pressure.&#x0D; Methodology: This study included 53 glaucoma patients with Primary Open Angle Glaucoma (POAG), Angle Closure Glaucoma (ACG), and Pseudoexfoliation (PXF) % (n=4) Glaucoma who visited the Glaucoma Department of Al-Shifa Trust Eye Hospital Rawalpindi. Pre and post-interventional study designs were used. Based on a slit lamp examination, patients were labeled as having cataracts in glaucomatous eyes. Pre-operative Intraocular pressure (IOP) was noted using Goldmann Applanation Tonometer (GAT). Patients were referred for Phacoemulsification and their IOP was noted after 2 weeks of surgery. The non-Probability convenient sampling Technique was used. Paired t-test was used to find the mean change in IOP. &#x0D; Results: The mean age of respondents was (62.5±10.25) and had a maximum value of 81 years and a minimum value of 40 years among a sample of 53 respondents. The mean IOP before phacoemulsification was (16.25±7.251) the mean IOP after phacoemulsification was (13.28±5.940) and the mean difference was (2.962 ±8.364) in glaucomatous patients having cataracts. This difference was found to be statistically significant (p-value&lt;0.05).&#x0D; Conclusion: In Glaucomatous patients having cataracts after phacoemulsification there is a significant reduction in IOP and medications after surgery. This IOP reduction was more marked in POAG patients as compared to other types of Glaucoma.

Ultrasound Cyclo Plasty in Patients with Open Angle Glaucoma and High Myopia.

Ultrasound cyclo plasty (UCP) using high-intensity focused ultrasound is an effective and safe procedure in lowering intraocular pressure (IOP) in patients with glaucoma, even in those with high myopia. This study aimed to evaluate the efficacy and safety of UCP in glaucoma patients with high myopia. In this retrospective, single-center study, we enrolled 36 eyes divided into 2 groups based on axial length: group A (≥26.00mm) and group B (<26.00mm). We collected data about visual acuity, Goldmann applanation tonometry, biomicroscopy, and visual field before the procedure and at 1, 7, 30, 60, 90, 180, and 365 days after the procedure. Mean IOP significantly decreased in both groups after treatment ( P <0.001). Mean IOP reduction from baseline to the last visit was 9.8±6.6mmHg (38.7%) in group A and 9.6±6.3mmHg (34.8%) in group B ( P <0.001). Mean IOP at the last visit was 15.8±4.1mmHg in the myopic group and 18.1±5.6mmHg in the non-myopic one. Regarding the number of IOP-lowering eyedrops being taken by our patients, statistically significant differences were found between groups A and B neither at baseline (2.8±0.9 and 2.6±1.0; P =0.568) nor 1 year after the procedure (2.5±1.1 and 2.6±1.1; P =0.762). No major complications occurred. All minor adverse events resolved within a few days. UCP seems to be an effective and well-tolerated strategy to lower IOP in glaucoma patients with high myopia.

Single versus Double PreserFlo MicroShunt Implantation in Glaucoma Patients: A Retrospective Cohort Study

Introduction: The aim of this study was to describe and evaluate double PreserFlo MicroShunt implantation as a modified micro-invasive glaucoma surgery technique and to retrospectively compare the outcomes in a cohort of glaucoma patients with single or double implantation. Materials and Methods: A retrospective data analysis of 57 glaucoma patients who consecutively underwent PreserFlo implantation was performed. Medical records were examined for patients’ demographics, glaucoma type, intraocular pressure (IOP), medication, complications, and re-interventions. Two groups with single (n = 29) or double (n = 28) implantation were formed, and the outcomes were compared. In cases of two-stage double implantation (n = 17), the courses of the initial and the second implantations were compared. Results: Mean preoperative IOP was significantly higher in the double compared to the single implantation group (29.4 ± 10.0 mm Hg; 21.7 ± 8.2 mm Hg; p = 0.003). Postoperatively, IOP was significantly lower in the double implantation group at various time-points (day 1, week 1, months 3 and 6; all p < 0.021). In the subgroup with two-stage procedures, mean preoperative IOP was 24.5 ± 8.5 mm Hg and 29.8 ± 10.1 mm Hg, respectively (p = 0.128). While immediately postoperatively, mean IOP lowering was clinically significant and similar following both procedures, the longer sustainable effect was observed after the second procedure (month 12: 25.5 ± 7.5 mm Hg; 12.4 ± 4.8 mm Hg; p = 0.001). No serious complications were observed. Discussion/Conclusion: Double PreserFlo implantation appears safe and efficient for lowering IOP in glaucoma patients. Our preliminary findings suggest that double is superior to single implantation in terms of IOP lowering and the need for additional topical medication. Patients with insufficient IOP lowering following single implantation may benefit from a second implantation. Further research is warranted to evaluate double implantation as a first-line, one-stage procedure.

Hubungan Status Refraksi dengan Tekanan Intraokular Pada Pasien Glaukoma

Refractive status is the ability of the eye to refract light on an objective or subjective refraction examination. Refractive status is divided into two category, emetropia and ametropia. Emetropia is normal refractive status and ametropia is refractive error include myopia, hypermteropia and astigmatism. Refractive error in Indonesia has become the most common disease in the eye. The factors that influence the changes in intraocular pressure (IOP) are refraction status, gender, diabetes mellitus (DM), hypertension and diurnal variation. Intraocular pressure is the main risk factor that causes glaucoma. Purpose of this study to investigate the correlation between refractive status and intraocular pressure in glaucoma patients at SMEC (Sabang Merauke Eye Center) Eye Clinic Samarinda. This research used analytical observational method with cross-sectional approach. 79 Samples were selected, consisting of 38 POAG patients, 18 PACG patients, and 23 NTG patients from the medical records at SMEC Samarinda. The data were gathered from the medical records using purposive sampling method. Glaucoma occurred mostly in female patients aged 40 years old and above. Astigmatism is the refractive status with the highest average of IOP observed in this research. The Chi-Square test showed that there was no correlation between refractive status and intraocular pressure, indicated by p-value of 0.374. There is no correlation between refractive status and intraocular pressure in glaucoma patients.

Innovative approaches to measuring intraocular pressure

AbstractAlthough different factors have been implicated in the development and progression of glaucoma, intraocular pressure (IOP) remains the main modifiable risk factor. Goldmann applanation tonometer (GAT) considers the “gold standard” for measuring IOP. The main deficiency of GAT, however, is the static nature of its measurements and that it is dependent on corneal biomechanics, central corneal thickness as well as scleral stiffness. The single measurement of IOP for the management of glaucoma provides limited information since it does not take into account the natural fluctuation of IOP, individual ranges, IOP peaks or variations throughout the day. Although the role of IOP fluctuations in glaucoma progression is not clearly defined, there is consensus on the importance of understanding the circadian profiles of IOP in glaucoma patients. Given the limitations of GAT for the actual measurement of IOP, different tonometers have been designed with the aim of advancing in self‐tonometry as Icare HOME, or obtaining independent measurements of corneal biomechanics, as Ocular Response Analyser (ORA), Pascal dynamic contour tonometer or the Corvis ST tonometer. Research to monitor IOP is based on three different strategies: (1) self‐tonometry; (2) permanent monitoring of the IOP; and (3) the temporary monitoring of the IOP. Currently, the sensors in contact lenses allow the IOP profiles to be recorded semi‐continuously for 24 hours with a minimally invasive technique, independent of the patient's position and the activity performed, opening new perspectives in the knowledge and management of glaucoma.

Periosteal graft and conjunctival pedicle flap for re‐exposed glaucoma drainage device tube

AbstractPurpose: To report the management of exposed glaucoma drainage device (GDD) tube using periosteal graft.Methods: A case report of patient from ophthalmology outpatient clinic in Dr. Saiful Anwar general Hospital.Results: A 26‐year‐old male with history of steroid induced glaucoma came to ophthalmology clinic. Patient already underwent several procedures to control his intraocular pressure (IOP), including trabeculectomy and implantation of GDD. Implantation of GDD is widely used to control IOP in glaucoma patients. One month after implantation, patient experienced exposed GDD tube. Exposed GDD tube is one of the most common complications. The incidence is about 12% and tend to happen in eyes that already underwent many surgeries previously. This condition needs a further operative procedure such as adding patch graft on exposed area, in this case patient underwent conjunctival and pericardial graft. One month after additional patch graft procedure, patient felt uncomfortable sensation and redness on his right eye, even though IOP was 12 mmHg. During anterior segment examination, tube expose was found again. Patient underwent periosteal graft from his right tibial bone and conjunctival pedicle flap. After 2 months of evaluation, the graft is attached and IOP controlled at 14 mmHg.Conclusions: Periosteal graft and conjunctival pedicle flap could be one of the appropriate choices to cover re‐exposed GDD tube.

Predicting a reduction in intraocular pressure in glaucoma patients in the early period after a trabeculectomy: Development and assessment of a new predictive nomogram

PurposeTo identify the factors associated with a reduction in intraocular pressure (IOP) in the early postoperative period after a trabeculectomy and to develop a predictive nomogram to guide clinical care.MethodsThis study included clinical data on 588 glaucoma patients (N = 588 eyes) who underwent a trabeculectomy in our hospital between January 2016 and December 2021. There were 412 eyes in a training cohort and 176 eyes in a validation cohort. We used logistic regression analysis to evaluate whether these factors were related to a decrease in IOP in the early period postsurgery and established a predictive model by combining features selected in a univariate analysis. We used external validation for evaluation. The standard for IOP reduction was that the IOP decreased to the normal range (10−21 mmHg) 1 month after the trabeculectomy.ResultsAmong the patients in the training cohort, 82.8% met the standard for IOP lowering. There were 11 meaningful differences among the enrolled predictors, but the logistic regression analysis only showed significant differences with anterior chamber angle closed, age, preoperative IOP, axial length, and visual field mean sensitivity (MS). The C-index of the model was 0.910 (95% confidence interval [CI]: 0.869-0.951). The C-index was 0.956 for external validation of the model.ConclusionThis new nomogram can be used to predict whether the IOP will reach the standard in the early stages after a trabeculectomy. The anterior chamber angle closed, age, preoperative IOP, axial length, and visual field MS are independent risk factors.

Review of Evidence for the Usage of Antioxidants for Eye Aging.

Oxidative stress is one of the common factors leading to age-related eye diseases in older adults. Factors such as high oxygen consumption, high concentration of polyunsaturated fatty acids, and cumulative exposure to high-energy visible light in the eyes, lead to excessive generation of reactive oxygen species, hence triggering apoptosis of ocular cells and giving rise to ophthalmic diseases. Dietary supplements such as carotenoids, anthocyanins, and vitamins have antioxidant properties which may be of benefit in retaining better vision or reversing vision impairment; thus, studies have been conducted to understand the role of dietary supplements in the treatment or prevention of ophthalmic diseases. While high concentration of carotenoids such as lutein and zeaxanthin decrease the risk of developing age-related macular disease, anthocyanins and vitamins play a role in the treatment and prevention of other ophthalmic diseases: saffron extract reduced intraocular pressure in glaucoma patients; bilberry extract prevented impairments in lenses and retina, as well as alleviate symptoms of dry eye disease; high concentration of beta-carotene may reduce the risk of developing cataract. Further studies with clinical measurements are required to investigate the effectiveness of antioxidants on visual function and ophthalmic diseases.

Transconjunctival XEN45 Implantation for Glaucoma Performed at the Slit Lamp: A Pilot Study.

Précis:This pilot study of ab externo implantation of a gel microstent is a novel, minimally invasive glaucoma surgery performed at the slit lamp that is effective for lowering intraocular pressure in patients with uncontrolled glaucoma.Purpose:To evaluate the intraocular pressure (IOP)–lowering effect of gel microstent (XEN Gel Stent, Allergan, Irvine, CA) implantation using an ab externo approach in an office setting.Patients and Methods:This retrospective, multicenter chart review examined outcomes in patients with uncontrolled glaucoma receiving maximally tolerated medical therapy, who underwent slit lamp ab externo gel stent implantation. At postoperative visit, the IOP, the number of glaucoma medications, the final position of the stent, and the needling rate were analyzed. Assessments were conducted 1 day, 1 week and 1, 3, 6, and 12 months after the implantation. Treatment success was defined as IOP ≥6 mm Hg and ≤18 mm Hg with ≥20% reduction from presurgical IOP, with or without medications.Results:Thirty-four eyes from 28 patients were included. Mean preoperative IOP was 24.1±8.0 mm Hg on 3.2±0.9 glaucoma medications. At 12 months postoperative, IOP was reduced to 15.4±4.7 mm Hg on 0.6±1.0 medications; 46.9% and 81.3% of eyes achieved complete and partial success, respectively. The gel stent was properly positioned in 94.1% of eyes after 1 attempt at implantation and in 100% of eyes after a second attempt. In addition to malpositioning, observed complications included occlusion, erosion, and endophthalmitis following anterior chamber reformation. Adjunctive needling was required in 21% of implanted eyes.Conclusion:Slit-lamp-based transconjunctival XEN45 implantation reduced intraocular pressure in glaucoma patients in the first year of this pilot study and was most commonly associated with wound leak and hypotony among other adverse events.

Micropulse laser trabeculoplasty on Chinese patients with glaucoma or ocular hypertension: average 35 months follow-up results

BackgroundGlaucoma is a group of eye diseases that can damage the optic nerve and cause vision loss. A novel technology micropulse laser trabeculoplasty (MLT) can use duty-circle subvisible laser pulses to treat glaucoma. The aim of this study is to evaluate the efficacy of 360° MLT to alleviate intraocular pressure (IOP) in patients with glaucoma.MethodsThis was a single-center prospective study on patients treated with 360° MLT using a Diode True-Yellow 577-nm Laser with MicroPulse technology. All the patients were recruited from the Department of Ophthalmology. Follow-up visits were carried out at 1 day, 1 week, 1 month, 3 months, 6 months, 18 months, and 36 months after the procedure. Best-corrected visual acuity (BCVA), Intraocular pressure (IOP), and vertical cup-to-disc ratio (C/D ratio) were measured during the follow-up. Repeated-measures analysis of variance (ANOVA) and Kaplan–Meier analysis were performed to evaluate the outcomes.ResultsA total of 39 eyes from 25 patients were included in this study (10 men/15 women). The average age of patients was 41.47 ± 14.39 years old, and the baseline IOP was 21.13 ± 7.75 mmHg. MLT significantly reduced the IOP at 1 day (range 15.61–19.01, P = 0.0218), 3 months (range 16.47–19.22, P = 0.0390), and 6 months (range 15.38–18.56, P = 0.0332) compared with the baseline. However, by the end of the study, only 21.88% of patients demonstrated a ≥ 20% IOP reduction, while seven eyes needed further laser or surgical treatment. The IOP of glaucoma patients was significantly lower than the ocular hypertension patients at 1 month (P = 0.0124), 3 months (P = 0.0004), 18 months (P = 0.0061) and 36 months (P = 0.0119).ConclusionsMicropulse laser trabeculoplasty reduce IOP in patients with glaucoma or ocular hypertension for a short period, but its lowering efficiency is limited up to 6 months of the follow-up period.

Brinzolamide- and latanoprost-loaded nano lipid carrier prevents synergistic retinal damage in glaucoma

Glaucoma is a common eye disease and a major cause of blindness. We designed brinzolamide (Brla)-and latanoprost (Ltp)-loaded nano-lipoidal carriers (NLCs) for glaucoma treatment. Brla and Ltp-loaded NLCs were designed and characterized by assessing the zeta potential, polydispersity index, X-ray diffraction and scanning electron microscopy images, and particle size. Drug release was assessed by in vitro and ex vivo methods to determine transcorneal permeation, ocular irritation, and cell viability. Moreover, Brla- and Ltp-loaded NLCs were assessed in terms of the management of raised intraocular pressure (IOP). The size of Brla- and Ltp-loaded NLCs was <200 nm, the drug entrapment efficiency was 97.5%, and the zeta potential was 35.33 mv. The transcorneal permeation levels of Blra and Ltp after 8 h were 50.5% and 49.4%, respectively; after 24 h, they were 81.4% and 84.2%, respectively. However, NLCs are not cytotoxic. Moreover, Brla+Ltp-treated NLCs effectively reduced IOP in glaucoma patients. Therefore, Brla+Ltp-loaded NLCs showed promising effects against glaucoma.

Real-Time Monitoring of Intraocular Pressure in Glaucoma Patients Using Wearable Mobile Medicine Devices.

Glaucoma is caused by excessive aqueous humor in the eye, resulting in a continuous or intermittent increase of intraocular pressure, which exceeds the tolerance of the eyeball and damages the optic nerve. Existing treatments for glaucoma do not work well or have significant side effects. Intraocular pressure signal is a very important physiological signal that needs real-time and accurate monitoring in glaucoma patients, especially in severe glaucoma patients. Therefore, long-term, real-time, and accurate monitoring of intraocular pressure is of great significance for the diagnosis and treatment of glaucoma patients. The use of wearable devices for real-time ocular diagnosis and treatment of glaucoma patients is an effective approach. However, the current commonly used intraocular pressure measurement and monitoring technology is difficult to meet the diagnosis and monitoring needs of glaucoma patients in terms of size, measurement accuracy, power consumption, and intelligence. Therefore, facing the needs of glaucoma disease treatment, this topic studies an implantable flexible intraocular pressure sensor for long-term continuous monitoring of intraocular pressure in glaucoma patients and mainly focuses on the working principle, structural design, process fabrication, measurement and control system, characterization, and performance test of the intraocular pressure sensor. It is of great significance for personalized and accurate treatment of glaucoma patients.

Longitudinal analysis of intraocular pressure and its associated risk factors of glaucoma patients using Bayesian linear mixed model: A data from Felege Hiwot Hospital, Ethiopia

BackgroundGlaucoma is a neurodegenerative condition that affects the eye and is associated with increased intraocular pressure. Intraocular pressure is the fluid pressure inside the eye and its disturbance often is implicated in the development of pathologies such as glaucoma, uveitis and retinal detachment. The aim of the present study was to identify factors that affect the longitudinal intraocular pressure of glaucoma patients attending the ophthalmology clinic at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, using a Bayesian linear mixed model analysis. MethodsIn a longitudinal study with data obtained from glaucoma patients admitted to Felege Hiwot Hospital, the measurement of intraocular pressure change was applied. The study subjects were enrolled in the period between 1st January 2016 and 1st January 2020 and a total of 328 patients were selected for the study. Data were explored using descriptive statistics and individual and mean profile plots throughout study time. A Bayesian linear mixed model for the longitudinal data was used along with their model comparison, model estimation, model diagnosis and missing data analysis. ResultsThe analysis included 328 individuals with 9 for maximum and 2 for minimum repeated measurements of intraocular pressure change, including the baseline. From the Bayesian linear mixed model variables, observation time, age, place of residence, gender, the cup-disk ratio of patients, type of medication (like Pilocarpin, Timolol with Pilocarpin, Timolol with Diamox with Pilocarpin), and blood pressure of the glaucoma patients significantly affected the intraocular pressure changes over time. However, the type of medication (Diamox and Timolol with Diamox) did not affect the intraocular pressure changes over time. ConclusionBased on the Bayesian linear mixed model analysis, we found that the predictor variables of age, blood pressure, family history, residence, gender, diabetic disease, treatment duration, stages of glaucoma, type of medication and cup-disk ratio significantly affected the average intraocular pressure and had a positive association with the responses of intraocular pressure of glaucoma patients. Furthermore, the type of medication was statistically significant and negatively associated with the responses to intraocular pressure. RecommendationWe recommend the health professionals to give more attention to the type of medication especially Timolol with Pilocarpin, Timolol with Diamox and Timolol with Diamox with Pilocarpine. And taking the combination with the other type of medication minimizes the risk of blindness and intraocular pressure.

The relationship between 24‐hour mean, peak, trough and clinic intraocular pressure in glaucoma patients

AbstractPurposeFor years, ophthalmologists have been relying on clinic intraocular pressure (IOP) to manage glaucoma patients. There are studies which have shown that IOP can vary substantially throughout the day. This prospective observational study is to evaluate the relationship between the 24‐hr mean IOP, peak IOP, trough IOP and clinic IOP and the timing of peak and trough IOP in glaucoma patients.Methods23 patients diagnosed with glaucoma were recruited and all of them were fitted with a contact lens sensor for 24 hours. The 24‐hr mean IOP of each patient was recorded. The peak, trough and clinic IOP of each patient were recorded as well. The Pearson correlation coefficient between 24‐hr mean IOP and peak IOP, trough IOP and clinic IOP were calculated and analysed. The circadian IOP pattern of glaucoma patients was constructed and analysed to determine the peak and trough.ResultsThe Pearson correlation coefficient of 24‐hr mean IOP and peak IOP among our subjects are r(23) = 0.8419 (p &lt; 0.00001). The correlation coefficient between 24‐hr mean IOP and trough IOP is r(23) = 0.8258 (p &lt; 0.00001). However, the correlation coefficient between 24‐hr mean IOP and clinic IOP is r(23) = 0.3608 (p = 0.091). The overall circadian IOP pattern showed peak IOP at 0730 and 1730 and showed trough IOP at 2130.ConclusionsThe 24‐hr mean IOP showed significantly strong positive correlation with peak and trough IOP among glaucoma patients. However, the 24‐hour mean IOP only showed weak positive correlation with the clinic IOP. We can possibly predict the 24‐hour mean IOP in patients based on single peak or single trough IOP reading but measuring a single IOP in clinic might not tell us the 24‐hour mean IOP of glaucoma patients. The best time to pick up peak or trough IOP to correlate with the 24‐hour mean IOP is at 0730/1730 and 2130 respectively.