Difference In Intraocular Pressure Research Articles

[Comparison of surgical outcomes between Kahook Dual Blade goniotomy and Trabectome surgery in patients with open-angle glaucoma].

Objective: To compare the medium-term therapeutic effects of Kahook Dual Blade (KDB) goniotomy and Trabectome surgery in the treatment of patients with primary open-angle glaucoma (POAG). Methods: This study was a non-randomized prospective interventional controlled clinical study. POAG patients who underwent KDB goniotomy or Trabectome surgery at Beijing Tongren Hospital from May 2017 to April 2022 were enrolled. The definition of successful surgery was postoperative average intraocular pressure (IOP)≤21 mmHg (1 mmHg=0.133 kPa) and IOP decrease≥20%. Follow-up visits were conducted on the 1st day, 1st week, 1st, 3rd and 6th month after surgery. The IOP value, the number of IOP-lowering medications, the proportion of surgical success (average IOP≤21 mmHg at 6 months), and complications were evaluated. Statistical methods included independent sample t-test, Mann-Whitney rank sum test, χ2 test, repeated measures two-factor analysis of variance, Bonferroni, Friedman M test, Wilcoxon, and Log-rank. The Kaplan-Meier method was used to calculate the cumulative success rate of each group. Results: Seventeen male patients (17 eyes) and 10 female patients (10 eyes) were included. The mean age was (39.9±17.7) years old. There were 11 patients in the KDB group and 16 patients in the Trabectome group. There was no significant difference in clinical baseline conditions between the two groups (P>0.05). The IOPs in the KDB and Trabectome groups at postoperative 1 week [(16.6±6.3) and (16.4±4.1) mmHg) and 6 months [(17.8±5.3) and (19.9±4.4) mmHg) were lower than those before surgery [(25.1±9.3) and (27.4±9.1) mmHg) (all P<0.05). There was no significant difference in the overall IOP between groups (P>0.05). The IOP reduction rates in the KDB and Trabectome groups were 23.4% and 19.0%, with no significant difference (P=0.674). The numbers of IOP-lowering medications used in the KDB and Trabectome groups at 3 months [2.0 (1.0, 4.0) and 2.0 (1.0, 2.3)] and 6 months [2.0 (0.0, 4.0) and 2.0 (1.0, 3.0)] after surgery were not significantly different from those before surgery [4.0 (2.0, 4.0) and 3.0 (2.0, 4.0)] (both P>0.05). There was no statistical significance in the overall number of IOP-lowering medications used between the two groups (P>0.05). There was also no statistically significant difference in the proportion of patients with an IOP decrease of≥20% and the proportion of patients whose mean postoperative IOP was≤21 mmHg (all P>0.05). The proportions of IOP≤21 mmHg in the KDB group and the Trabectome group at 6 months after surgery were 81.8% and 68.8% (P>0.05). Serious intraoperative or postoperative complications occurred in neither group. Conclusions: Both KDB trabeculotomy and Trabectome surgery can effectively reduce IOP and have a good safety profile in treating POAG, with the same number of IOP-lowering medications.

Couching of cataractous lens in microphthalmic eyes with irido-fundal coloboma: revisiting the historical technique.

Cataract surgery in microphthalmic eyes is challenging due to anatomical restraints, hard bulky nucleus. This series aims to evaluate the safety and efficacy of couching of intraocular lens in irido-fundal coloboma with microphthalmos. Tertiary care centre in South India. Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7mm and brown cataract. Visual acuity less than 6/60 in other eye. Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6months. Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9years. At baseline, mean IOP 14.5 ± 3.8mmHg, mean axial length 19.3 ± 0.5mm, mean corneal diameter was 6.5 ± 0.34mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8mmHg), 3months post-surgery (16 ± 2.8mmHg) and 6months post-surgery (14.9 ± 2.5mmHg). One patient underwent re-couching. No other major complications were noted. Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.

A Comparative Study on Efficacy of Intraocular Pressure Lowering of Two Fixed-Dose Antiglaucoma Drug Combination Brinzolamide-Brimonidine Versus Latanoprost-Timolol in Primary Open-Angle Glaucoma and Ocular Hypertension.

Purpose: To compare the efficacy of Brinzolamide-Brimonidine (BB) (1%+0.2%) with the gold standard Latanoprost-Timolol (LT) (0.005%+0.5%) in treating primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Methods: A 1-year prospective study, spanning from May 2022 to May 2023, conducted at a tertiary eye-care hospital. Participants, aged 40-60, with a baseline intraocular pressure (IOP) >21 mm Hg, requiring a >30% reduction, were enrolled. Group A (n = 100) received BB, and Group B (n = 100) received LT. Outcomes were assessed at 1 month (IOP difference from baseline), 3 and 6 months (mean diurnal variations). Results: The mean age at presentation was 55.5 ± 4.5 years in Group A and 54.7 ± 4.2 years in Group B. At 1 month, Group A exhibited a mean IOP of 18.7 mm Hg, while Group B had 17.6 mm Hg, with no statistically significant difference (P = 0.53). No significant diurnal variation was observed in either group (P = 0.07). Target pressure was achieved in 88% of patients in Group A and slightly higher at 92% in Group B. Moreover, no serious side effects were reported, and compliance was higher in Group B (98%) compared to Group A (96%). Conclusion: Although LT showed slightly better and sustained IOP reduction, the difference was not statistically significant. Both BB and LT demonstrated comparable outcomes for managing POAG and OHT.

Exploring ethnic and racial differences in intraocular pressure and glaucoma: The Canadian Longitudinal Study on aging

PurposeTo determine whether self-reported race/ethnicity is associated with intraocular pressure (IOP) and glaucoma and to explore whether any associations are due to social, behavioral, genetic, or health differences. DesignCross-sectional analysis of population-based data. MethodsWe used the Canadian Longitudinal Study on Aging Comprehensive Cohort, which consists of 30,097 adults aged 45–85 years. Race/ethnicity was self-reported. Corneal-compensated intraocular pressure (IOP) was measured in mmHg using the Reichert Ocular Response Analyzer. Participants were asked to report if they have ever had a diagnosis of glaucoma and whether they used eye care in the past year. A glaucoma polygenic risk score (PRS) was calculated. Logistic and linear regression models were used. ResultsBlack individuals had higher mean IOP levels (beta coefficient (β) = 1.46; 95% confidence interval [CI], 0.62, 2.30) while Chinese, Japanese and Korean (β = −1.00; 95% CI, −1.63, −0.38) and Southeast Asian and Filipino individuals (β = −1.56; 95% CI, −2.68, −0.43) had lower mean IOP levels as compared to White individuals after adjustment for sociodemographic, behavioral, genetic, and health-related variables. Black people were more likely to report glaucoma as compared to White people after adjustment (odds ratio [OR] = 2.43; 95% CI, 1.27, 4.64). ConclusionRacial and ethnic differences in IOP and glaucoma were identified. Adjusting for sociodemographic, behavioral, genetic, and health-related variables did not fully explain these differences. Longitudinal research is needed to further explore the reasons for these differences and to understand their relevance to disease pathogenesis and progression.

Outcomes of phaco-trabeculectomy versus phaco-viscocanalostomy for primary open angle glaucoma

PurposeThis study aimed to compare the intraocular pressure (IOP)-lowering effect and postoperative adverse effects of combined phacoemulsification and trabeculectomy (PT) and combined phacoemulsification and viscocanalostomy (PVC) in eyes with primary open-angle glaucoma (POAG). MethodsIn this prospective study, eighty-one consecutive patients (81 eyes) with POAG and cataract were enrolled. The eyes were randomly assigned to either the PT group (40 eyes) or the PVC group (41 eyes). The main outcomes included the success rate based on IOP and the evaluation of adverse effects during the 6-month follow-up period. The surgery was considered a complete success if the IOP was between 6 and 20 mmHg and reduced by ≥30% without glaucoma medications or additional surgery compared to the preoperative level. A qualified success was characterized by an IOP within the range of 6−20 mmHg and a 20−30% reduction in IOP achieved through the use of glaucoma medications. ResultsThe mean baseline IOP was 23.20 ± 7.94 mmHg in the PT group and 21.29 ± 6.81 mmHg in the PVC group (P = 0.249). At 6 months, the mean postoperative IOP in the PT and PVC groups were 13.50 ± 2.49, and 13.73 ± 1.70, respectively. There was no significant difference in mean IOP between the groups at any time (P > 0.05). At 6 months, 22 patients (55%) in the PT group and 22 patients (53.66%) in the PVC group achieved complete success. Nine eyes (22.50%) in the PT group and 10 eyes (24.39%) in the PVC group achieved qualified success. The other patients (9 eyes in each group) did not meet the criteria for at least a qualified success and were considered failures (P = 0.980). Intraoperative microperforation of Descemet's membrane occurred in 2 cases (15%) in the PVC group. Postoperative complications included 4 cases (10%) of shallow/flat anterior chamber, 1 case (2.5%) of choroidal effusion, and 1 case (2.5%) of aqueous misdirection in the PT group. The rate of these postoperative adverse effects was not significant between the two groups (P > 0.05). ConclusionsThere was no significant difference in IOP reduction between PT and PVC in patients with POAG. Furthermore, PVC is safe enough in these patients, compared to PT.

The Outcomes of Trabeculectomy following Anti-VEGF Treatments in Neovascular Glaucoma : A Systematic Review and Meta-Analysis

Introduction&#x0D; Neovascular glaucoma (NVG) is a secondary glaucoma that potentially causes blindness due to proliferation of fibrovascular tissue in the anterior chamber angle. Ischemia in retinal triggers a cascade of various angiogenic factors including vascular endothelial growth factor (VEGF) and interleukin-6 which lead to neovascularization. It was known that anti-VEGF inhibits the primary mediators of neovascularization and control intraocular pressure (IOP) in NVG.&#x0D; Objective&#x0D; To summarize outcome of anti-VEGF with trabeculectomy and applied in clinical practice.&#x0D; Methods &#x0D; PRISMA guideline was followed and analyzed the comparison with Revman (version 5.4). We used databases and professional websites published on eye conditions between 2013-2023 in English. All interventional and observational studies with 95% confidence interval (CI) were used. Risk of bias was measured using funnel plot. Outcomes measured were IOP, Best Corrected Visual Acquity (BCVA), neovascularization iris (NVI) recurrence before and after trabeculectomy.&#x0D; Result &#x0D; Six studies (199 eyes) showed a significant difference in IOP (MD=25.84, 95%CI 24.08-27.60, p&lt; 0.00001) and NVI recurrence (RD=0.94, 95%CI 0.86-1.01, p&lt;0.00001). While four studies (143 eyes) found there was a significant difference in BCVA (MD=0.21, 95%CI 0.06-0.37, p=0.008). The result of NVI should be interpreted with caution and not considered as definitive statement since the data was moderately heterogenic (I2=68% p=0.009).&#x0D; Conclusion &#x0D; It could be concluded there was a significant difference in IOP, BCVA, and NVI recurrence after given anti-VEGF with trabeculectomy. We could not conclude which anti-VEGF gave better result since there were lack of studies, low of studies quality, and heterogen data for NVI recurrence.

The Effects of Bevacizumab in Augmenting Trabeculectomy for Glaucoma : Systematic Review and Meta-Analysis

Introduction &amp; Objectives : Anti-vascular endothelial growth factor (VEGF) agents have been used to slow the healing response and postoperative scar tissue formation. To determine the effectiveness of adding Anti VEGF bevacizumab to the results of trabeculectomy in glaucoma.&#x0D; Methods : Searches were conducted in a structured way using keywords across several data sources, including Pubmed, Proquest and Cochrane library. The keywords used for searching were “Bevacizumab”, “Trabeculectomy” and “Glaucoma”. The reviewed articles are Randomized Control Trial in english, conducted on humans in the last 15 years. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.&#x0D; Results : From a total of 353 articles, there were 6 studies with 362 eyes of 352 patients been evaluated for the effectiveness of bevacizumab addition to trabeculectomy. The primary outcome of all articles was the assessment of Intra Ocular Pressure (IOP). No significant difference in IOP was found between the subconjunctival bevacizumab + Mytomycin-c group and mytomycin-c alone group (MD 0.11 ; 95% CI -0.10 to 0.33), as well as subconjunctival comparison with mytomycin-c (MD 0.11 ; 95% CI -0.29 to 0.50). Similar results were also found in the intracameral and placebo groups (MD 0.08 ; -0.22 to 0.38). However, 3 articles reported significant differences in peripheral vascularity of the bleb both by the Moorfields Bleb Grading System and by the Indiana Bleb Appearance System.&#x0D; Conclusion : The addition of bevacizumab to trabeculectomy did not show any benefit in reducing IOP when compared with MMC. But it gives better peripheral vascularity of the bleb.

Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis.

To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using theGrading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

Steroids and/or Non-Steroidal Anti-Inflammatory Drugs as Postoperative Treatment after Trabeculectomy—12-Month Results of a Randomized Controlled Trial

This prospective randomized controlled trial aimed to compare the efficacy and safety of topical preservative-free diclofenac (DICLO) to dexamethasone (DEX) eyedrops, and their combination (DEX+DICLO) after trabeculectomy. Sixty-nine patients with medically uncontrolled glaucoma were randomized to receive topical postoperative treatment with DICLO (n = 23), DEX (n = 23), or a combination of DEX and DICLO (n = 23). The primary outcome was the intraocular pressure (IOP) 12 months postoperatively. Secondary outcomes included surgical success, failure, visual field, and visual acuity from baseline to 12 months postoperatively. IOP reached the lowest point one day after trabeculectomy. At 12 months, IOP was 10.0 mmHg (95% CI, 8.4–11.6 mmHg) for DICLO, 10.9 mmHg (95% CI, 9.4–12.3 mmHg) for DEX, and 11.2 mmHg (95% CI, 9.1–13.3 mmHg) for DEX+DICLO. There were no significant differences in IOP, surgical success, failure, visual field, or visual acuity between the DICLO, DEX, or DEX+DICLO groups. We found that topical diclofenac was not statistically different from topical dexamethasone in controlling IOP 12 months after trabeculectomy. Combining diclofenac and dexamethasone offered no added IOP control compared to dexamethasone alone.

Comparison of Tonovet® and Tonovet plus® tonometers for measuring intraocular pressure in dogs, cats, horses, cattle, and sheep.

Reference ranges for intraocular pressure (IOP) in healthy animals are device-specific; therefore, it is strongly recommended to use appropriate reference values according to the device. Therefore, our aim was to compare IOP readings made by TonoVet® and TonoVet Plus® in healthy dogs, cats, sheep, cattle, and horses. We compared IOP values measured by TonoVet® and TonoVet Plus® tonometers in clinically normal eyes of dogs, cats, horses, cattle, and sheep. Five groups comprising 20 animals each of dogs (various breeds, 9 months-10 years old, 14 females, 6 males), cats (various breeds, 6 months-12 years old, 8 females, 12 males), horses (various breeds, 5-12 years old, 12 females, 8 males), cattle (Holstein, 1-7 lactation, female), and sheep (Latvian Darkhead ewes, 1-8 years old) were included in the study. Both eyes of all animals were subjected to ophthalmic examination, including evaluation of IOP by rebound tonometry using TonoVet® and TonoVet Plus® devices. Normality was determined using the Shapiro-Wilk test. The independent t-test was used to determine differences between IOP values in the right and left eyes and between both tonometers. This study was approved by the Ethical Commission of the Latvia University of Life Sciences and Technologies (Nr. LLU_Dzaep_2022-2-4). No differences in IOP between the right and left eyes were found in all cases (p > 0.05). The mean IOP ± standard deviation values in both eyes for TonoVet® and TonoVet Plus® tonometers were as follows: for dogs, 15.25 ± 2.73 mmHg and 19.65 ± 3.46 mmHg; and in cats, 18.88 ± 3.98 mmHg and 18.78 ± 4.26 mmHg, respectively. In horses, mean IOP was 22.15 ± 3.74 mmHg and 24.28 ± 3.00 mmHg; in cattle, 24.73 ± 2.89 mmHg and 23.28 ± 2.97 mmHg; and in sheep, 18.05 ± 3.54 mmHg and 22.49 ± 4.66 mmHg, respectively. Significant differences in IOP values were observed between the tonometers in sheep, dog, and horse groups (mean difference -4.40, -4.48, and 2.13, respectively). This study showed significantly higher IOP values measured by the TonoVet Plus® tonometer in dogs and sheep.

Prospective, Randomized Controlled Trial of Cataract Surgery vs Combined Cataract Surgery With Insertion of iStent Inject

PurposeTo evaluate the efficacy and safety of combined cataract surgery with insertion of an ab interno trabecular microbypass device (iStent Inject, Glaukos Corporation) compared to cataract surgery alone in patients with mild-to-moderate glaucoma. DesignProspective, randomized, assessor-masked controlled trial at a single centre. ParticipantsEyes with visually-significant cataract and mild-to-moderate glaucoma with preoperative intraocular pressure (IOP) of 12 – 30 mmHg on 0 to 3 ocular hypotensive medications. MethodsParticipants eyes were randomised (2017-2020) 1:1 to combined cataract surgery with iStent Inject (treatment group, n= 56) or cataract surgery alone (control group, n=48), and followed up for two years. Main Outcome MeasuresThe co-primary effectiveness endpoints were the number of ocular hypotensive medications and IOP at 24-months post-surgery. The secondary effectiveness endpoints were ocular comfort as measured by the Ocular Surface Disease Index (OSDI) and vision-related quality of life as measured by the Glaucoma Activity Limitation Questionnaire (GAL-9) at 24-months. Safety measures included postoperative visual acuity, any unplanned return to the operating theatre, adverse events, and complications. ResultsParticipants (67.3% male) were aged 53-85 years and treatment groups were similar in terms of mean medicated IOP (treatment group 17.7 mmHg ± 4.0; control group 17.1 mmHg ± 3.1), and number of ocular hypotensive medications (treatment group 1.69 ± 1.05; control group 1.80 ± 1.22) at baseline. At 24 months, the number of ocular hypotensive medications were 0.7 ± 0.9 in the treatment groups compared to 1.5 ± 1.9 in the control group, with an adjusted difference of 0.6 fewer medications per eye in the treatment group (95% CI 0.2 to 1.1, p=0.008). 57% of eyes in the treatment group were on no glaucoma medications compared to 36% in the control group. There was no significant difference in IOP between the two groups beyond the 4-weeks. There were no differences in patient-reported outcomes between the two groups. The visual outcomes and safety profiles were similar between the two groups. ConclusionsCombined cataract surgery with iStent Inject achieved a clinically- and statistically-significantly greater reduction in ocular hypotensive medication usage at 24-months compared to cataract surgery alone, with no significant difference in IOP.

Pars plana vitrectomy for retinal detachment using perfluoro-n-octane as intraoperative tamponade: a multicenter, randomized, non-inferiority trial.

To evaluate the efficacy and safety of perfluoro-n-octane (PFO) for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy (PPV) in management of retinal detachment. This multicenter, prospective, randomized, double-masked, parallel-controlled, non-inferiority trial was conducted in three ophthalmology clinical centers in China. Patients with retinal detachment, who were eligible for PPV were consecutively enrolled. Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, and dilated fundus examination were performed preoperatively and at 1, 7±1, 28±3d postoperatively. The primary outcome was complete retinal reattachment rate at postoperative day one. The non-inferiority margin was set at 9.8%. The secondary outcomes included intraoperative retinal reattachment rate, and mean changes in IOP and BCVA from baseline to 1, 7±1, 28±3d postoperatively, respectively. Safety analyses were presented for all randomly assigned participates in this study. Totally 124 eligible patients completed the study between Mar. 14, 2016 and Jun. 7, 2017. Sixty of them were randomly assigned to the PFO for ophthalmic surgery group, and 64 were assigned to the F-Octane group. Baseline characteristics were comparable between the two groups. Both groups achieved 100% retinal reattachment at postoperative day one (difference 0, 95%CI: -6.21% to 5.75%, P=1). The pre-defined noninferiority criterion was met. No significant difference was observed in intraoperative retinal reattachment rate (difference 1.77%, P=0.61), mean changes in IOP (difference 0.36, -0.09, 2.22 mm Hg at 1, 7±1, 28±3d postoperatively, with all P>0.05) and BCVA (difference 0.04, -0.02, 0.06 logMAR at 1, 7±1, 28±3d postoperatively, all P>0.05) between the two groups. No apparent adverse events related to the utilization of PFO were reported. In patients with retinal detachment undergoing PPV, PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade, and both are safe and well-tolerated.

INTRAOCULAR PRESSURES OF AQUARIUM-HOUSED COWNOSE RAYS (RHINOPTERA BONASUS) WITH NORMAL AND ABNORMAL OPHTHALMIC EXAMS.

Cownose rays (Rhinoptera bonasus) are common elasmobranchs in zoos and aquaria; however, there is a lack of published information regarding ocular findings in this species. Intraocular pressure (IOP) was measured in a total of 52 cownose rays (Rhinoptera bonasus) from two unrelated aquaria (n = 22 from A1, n = 30 from A2) using a TonoVet rebound tonometer on two settings (dog = D, and unidentified species = P) as part of a full ophthalmologic examination. Adult (n = 38) and juvenile (n = 14) rays were sampled out of water briefly in sternal recumbency. Intraocular pressure (mean ± SD [range]) in the D setting (9.10 ± 2.57 [4-18] mmHg) was higher than the P setting (5.21 ± 2.32 [0-12] mmHg) (P<0.001). Statistical analysis revealed no difference in IOP between right and left eyes, and no correlation between body weight and IOP. No differences in IOP between sex, age group, and location were identified in either setting. However, a significant difference was observed between levels of severity of corneal disease in IOP D setting (P=0.006) and P setting (P=0.024), and levels of severity of intraocular disease in IOP D setting (P=0.034) only. This study provides baseline IOP values using rebound tonometry in aquarium-housed cownose rays with apparent corneal and intraocular lesions and reveals that the D setting may be more sensitive in identifying IOP changes in eyes with intraocular disease.

Biomechanical and Vascular Metrics Between Eyes of Patients With Asymmetric Glaucoma and Symmetric Glaucoma.

Corneal hysteresis (CH) and pulsatile ocular blood volume (POBV) were significantly lower in the eye with greater damage in asymmetric glaucoma, without a difference in intraocular pressure (IOP) or central corneal thickness (CCT), and no difference in elastic parameters. To compare biomechanical and vascular metrics between the eyes of patients with asymmetric glaucoma (ASYMM) and those with symmetric glaucoma (SYMM). Forty-five patients were prospectively recruited and divided into ASYMM, defined as cup-to-disc (C/D) ratio difference >0.1 between eyes and SYMM, with C/D difference ≤0.1. For ASYMM, the smaller C/D was defined as the best eye ("best") and the fellow eye was defined as the worst eye ("worse"). All metrics were subtracted as "worse" minus "best," including the viscoelastic parameter CH, and elastic parameters from the Corvis ST, including stiffness parameter at first applanation, stiffness parameter at highest concavity, integrated inverse radius, deformation amplitude ratio, IOP, CCT, mean deviation (MD), ganglion cell complex (GCC), and POBV were included. Paired t tests were performed between eyes in both groups. Statistical analyses were performed with SAS using a significance threshold of P <0.05. For ASYMM (16 patients), "worse" showed significantly lower CH (-0.76 ± 1.22), POBV (-0.38 ± 0.305), MD (-3.66 ± 6.55), and GCC (-7.9 ± 12.2) compared with "best." No other parameters were significantly different. For SYMM (29 patients), there were no significantly different metrics between eyes. Lower CH, POBV, GCC, and worse MD were associated with greater glaucomatous damage in asymmetric glaucoma without a difference in IOP or CCT. Lower CH and GCC are consistent with previous studies. POBV, a new clinical parameter that may indicate reduced blood flow, is also associated with greater damage.

Combined non‐penetrating deep sclerectomy with phacoemulsification versus non‐penetrating deep sclerectomy alone

Aims/Purpose: To compare the intraocular pressure after two surgical techniques: combined non‐penetrating deep sclerectomy with phacoemulsification (Phaco‐NPDS) and non‐penetrating deep sclerectomy (NPDS) alone.Methods: It is a retrospective study including thirty‐two patients with primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG) who were not controlled with medication. They were assigned to Phaco‐NPDS (twenty‐two eyes) or NPDS (twenty eyes). Complications in surgery were noted and also, they were followed up after the surgery and intraocular pressure (IOP) was measured at one day, a month, six months and a year after the surgery. Moreover, best corrected visual acuity (BCVA) and the number of the anti‐glaucoma medications at the end of the postoperative medication was measured.Results: Mean IOP in the Phaco‐NPDS group decreased from 24.55 ± 5.8 mmHg to 17.31 ± 2.1 mmHg and in the NPDS group from 26.05 ± 4.1 to 15.6 ± 2.3 mmHg one day after surgery. The decreases of IOP in the postoperative period were statistically significant in both groups (p &lt; 0.05). There was no significant IOP difference between Phaco‐NPDS and NPDS patients postoperatively (p &gt; 0.05). The mean number of glaucoma medications decreased from 3.31 ± 1.4 to 0.68 ± 0.2 and from 3.2 ± 1.3 to 0.3 ± 0.5 in the Phaco‐NPDS and NPDS groups, respectively. The decreases in the mean number of the anti‐glaucoma medications at the end of the postoperative, 24‐month follow‐up period were found to be statistically significant for both Phaco‐NPDS and NPDS groups (p &lt; 0.05). Mean BCVA increased significantly in both groups. However, the visual outcome was significantly better for the Phaco‐NPDS group (p &lt; 0.05).Conclusions: Phaco‐NPDS surgery achieved excellent IOP control, while also providing immediate visual recovery. The success rate was similar to that of the NPDS procedure alone. It is advisable to consider Phaco‐NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma, including PXG.

A comparative study of ultrasound cycloplasty and endoscopic cyclophotocoagulation in the treatment of secondary glaucoma

To compare the clinical efficacy of ultrasound cycloplasty (UCP) and endoscopic cyclophotocoagulation (ECP) in the treatment of secondary glaucoma. In a 12-month prospective single-center study, 22 patients with secondary glaucoma were treated by high-intensity focused ultrasound (HIFU), and 23 patients with secondary glaucoma were treated by a semiconductor laser. At the final follow-up, the two groups’ surgical outcomes were compared. A complete success was defined as an intraocular pressure (IOP) reduction of at least 20% from baseline and an IOP of > 5 mmHg and ≦ 21 mmHg, while a qualified success was defined as an IOP reduction of at least 20% from baseline and an IOP of > 5 mmHg. The secondary outcome was the average IOP, number of drugs, and complications at each follow-up compared with the baseline. The average preoperative IOPs in the UCP and ECP groups were 36.4 ± 9.5 mmHg (n = 2.3 drops, n = 0.2 tablets) and 34.5 ± 11.7 mmHg (n = 2.0 drops, n = 0.3 tablets), respectively. In the last follow-up, the success rate of UCP was 54% (with a decrease of 32%) and that of ECP was 65% (with a decrease of 35%), and the P-value between the two groups was > 0.05. However, there was a difference in the average IOP between these two groups 1 day and 1 week after the operation, and the IOP reduction efficiency in the ECP group was better. However, the amount of drug used after these two surgeries was significantly reduced. There were fewer postoperative complications in the UCP group (18 cases) than in the ECP group (35 cases). Both UCP and ECP can effectively reduce IOP in secondary glaucoma, and ECP has a better effect at the early stages. However, UCP has higher safety and tolerance for patients.

Evaluation of degeneration retinal ganglion cell loss in acute glaucoma model rats using syringe pump technique

Link of Video Abstract: https://youtu.be/vaGQXY-i4KE Introduction: Glaucoma is a neurodegenerative disorder marked by the gradual decline in function and degeneration of the retinal ganglion cells (RGCs) and their axons. The elevated intraocular pressure (IOP) is a predominant contributing factor to its onset. Employing laboratory animals to model glaucoma is a well-established strategy that serves the dual purpose of identifying disease mechanisms and developing novel neuroprotective approaches. The aim of this study was to develop a preclinical acute model of glaucoma based on controllable intraocular pressure with a syringe pump in rat Rattus norvegicus. Methods: This research was an animal-experimental study in animal model adult male Wistar rat (Rattus norvegicus), taken in May - October 2023 in an integrated laboratory Faculty of Veterinary Medicine Universitas Syiah Kuala. Total samples used in this research were 10 rats, divided into two categories which are control group (A) and treatment group (B) were given a pressure of 250 mmHg pressure in the right eye for 60 minutes. Apoptosis and degeneration of retinal ganglion cells after 8 weeks of elevated intraocular a pressure of 250 mmHg in the right eye for 60 minutes were observed by the HE staining. Result: A significant difference in IOP was noted between control group rat and treatment group rat. All rats that received treatment experienced an increase in IOP (100%). The RGC density decreased significantly in the treatment group rat (mean: 11.72 cell/field of view or lower 46.88%) compared with the control group (p =0.005). Conclusion: A pressure of 250 mmHg for 60 minutes has been proven to cause degeneration of the RGCs up to nearly 50% within a week. We tried a technique to induce increased IOP in rats as a model of acute glaucoma. Syringe pump technique can effectively induce acute ocular hypertension in rats, which causes progressive loss of retinal ganglion cells.

Effect of topical nasal steroids on intra-ocular pressure in a Nepalese population: a tertiary hospital based prospective observational study

BACKGROUND: Impact of intranasal corticosteroid (INC) on intraocular pressure (IOP) has been a topic of longstanding debate with various studies showing variable results. This study aims to assess the effect of INC on IOP in the Nepalese population in a tertiary hospital of Nepal. METHODOLOGY: This was prospective observational study conducted in a tertiary hospital from May 2021 to November 2022. IOP of patients who met our inclusion criteria were measured before and after 6 weeks of the initiation of INC. Data were collected and compiled in Microsoft Excel. The statistical test was done using SPSS version 25. RESULTS: A total of 48 cases were evaluated. We observed that the mean IOP difference before and after nasal steroid usage exhibited no statistically significant variance: 0.5 mean IOP in the right eye and 0.12 mean IOP in the left eye. CONCLUSIONS: This study proposes that intranasal steroids pose a minimal risk of inducing ocular hypertension in the Nepalese population. Nonetheless, larger cohort studies with extended follow-up durations are warranted to substantiate these findings.

The influence of topical anesthetic and fluorescein on non-contact tonometry measurements using ultra-high-speed dynamic Scheimpflug

This study aimed to investigate the effects of topical anesthetic and fluorescein drops on intraocular pressure (IOP), central corneal thickness (CCT) and biomechanical properties as measured by Corvis ST (CST-Oculus; Wezlar, Germany) in healthy eyes. A cross-sectional observational study was conducted on 46 healthy patients. The CST measurements were obtained before and immediately after the instillation of topical anesthetic and fluorescein drops. Pre-post instillation data were statistically analyzed. IOP measurements were compared to Goldmann's Applanation Tonometry (GAT), which was also performed after drops instillation. Biomechanical parameters analyzed included applanation 1 velocity, applanation 2 velocity, applanation 1 time, applanation 2 time, whole eye movement, deflection amplitude, and stiffness parameter at first applanation. A statistically significant difference in IOP, both for non-corrected IOP (IOPnct) and biomechanically corrected IOP (bIOP), was observed before and after the instillation of eyedrops. Despite this statistical significance, the observed difference lacked clinical relevance. The IOPnct demonstrated a significant difference pre and post-anesthetic and fluorescein instillation compared to GAT (14.99 ± 2.27 mmHg pre-instillation and 14.62 ± 2.50 mmHg post-instillation, versus 13.98 ± 2.04 mmHg, with p-values of 0.0014 and 0.0490, respectively). Comparable findings were noted when justaposing bIOP to GAT (14.53 ± 2.10 mmHg pre-instillation and 13.15 ± 2.25 mmHg post-instillation, against 13.98 ± 2.04 mmHg, with p-values of 0.0391 and 0.0022, respectively). Additionally, CCT measurements revealed a statistically significant elevation following the administration of topical anesthetic and fluorescein drops (from 544.64 ± 39.85 µm to 586.74 ± 41.71 µm, p < 0.01. None of the analyzed biomechanical parameters showed statistically significant differences after drops instillation. While the administration of topical anesthetic and fluorescein drops induced a statistically significant alteration in both IOPnct and bIOP readings, these changes were not clinically consequential. Furthermore, a notable statistical rise was observed in CCT measurements post-drops instillation, as determined by CST. Yet, corneal biomechanical parameters remained unaffected.

INTRAOCULAR PRESSURE REDUCTION FOLLOWING COMBINED PHACOEMULSIFICATION AND TRABECULECTOMY SURGERY: A STUDY OF 300 CASES

Objectives: The aim of the study was to evaluate intraocular pressure (IOP) reduction following combined phacoemulsification and trabeculectomy surgery in primary glaucomapatients with cataract. Methods: A prospective, comparative study of 300 patients with primary glaucoma and cataract who underwent combined surgery phacoemulsification and trabeculectomy at our center between July 2016 and June 2019 were included in this study. Out of these, 124 patients had primary open-angle glaucoma (POAG) and 176 patients had primary angle closure glaucoma (PACG). Phacoemulsification, intraocular lens implantation, and trabeculectomy were performed in all cases. Follow-up visits were carried out at 1, 3, and 6 months after surgery. Complete ophthalmic examination was done at each follow-up visit. Results: The pre-operative mean IOP of all patients was 34.60±6.33 mmHg and mean IOP at last 6 month follow-up was 13.0±2.18 mmHg. There was a statistically significant difference between IOP at presentation and IOP at 6-month follow-up (p&lt;0.001). No significant difference in post-operative IOP in POAG and PACG patients (p&gt;0.001). Out of 300, 58 patients required anti-glaucoma medication at 1 month and this number decreased to 41 patients at 6 month follow-up. No significant intraoperative complications were noted. Conclusion: Combined phacoemulsification and trabeculectomy surgery is safe and effective in controlling IOP with minimal complications in the management of primary glaucoma patients with cataract in expert hands.