Intraocular Pressure In Patients Research Articles

Effect of Intravitreal Injection of Dexamethasone 0.7 mg (Ozurdex®) on Intraocular Pressure in Patients with Macular Edema

Background: To evaluate the effect of Ozurdex® on intraocular pressure in patients with macular edema alone (group 1) or associated with glaucoma or ocular hypertension (group 2). Methods: A clinical, retrospective, observational, comparative study included 92 eyes with macular edema treated with a single injection of Ozurdex®; 27 eyes were previously diagnosed with glaucoma or ocular hypertension. Results: The mean intraocular pressure (group 1 vs. group 2) after injection was 12.1 versus 19.9 mm Hg, (p < 0.05; day 1); 17.5 versus 19.7 mm Hg (p < 0.05; month 1); 18.4 versus 20.9 mm Hg (p < 0.05; month 2); 15 versus 17.4 mm Hg (p < 0.05; month 3); 13.9 versus 16.7 mm Hg (p > 0.05; month 6); 13.8 versus 15.1 mm Hg (p > 0.05; month 9) and 13.1 versus 16.4 mm Hg (p > 0.05; month 12). Thirty eyes (32.6%) showed ocular hypertension (intraocular pressure >21 mm Hg) after the injection: 21.5% of group 1 and 59.3% of group 2. In group 2, 27 eyes (100%) needed medical treatment to reduce intraocular pressure in comparison to 8 patients (12.3%) in group 1 (p < 0.001). Conclusions: Intravitreal injection of Ozurdex® was associated with ocular hypertension in 32.6% of the eyes. Previous glaucoma or ocular hypertension are risk factors for this increase.

Influence of different tilt positions for laparoscopic hysterectomy on intraocular pressure and postoperative comfort of patients

Objective To observe the influence of different tilt positions for laparoscopic hysterectomy on intraocular pressure and patients’ postoperative comfort. Methods Totals of 80 patients with laparoscopic surgery with grade-I anesthesia (American Society of Anesthesiologists, ASA) were chosen and divided into group A(15°T) and group B (30°T) by using the random table methods, with 40 cases in each. Intraocular pressure of patients at baseline (T0), 30 minutes (T1) and 60 minutes (T2) of pneumoperitoneum and after changing the position, and 10 minutes after pneumoperitoneum were monitored. The follow-up of the patients was within 24 hours asking the comfort of them. Results The intraocular pressure of patients at T1 and T2 in group A were (18.16±2.16) and (19.60±2.18)mmHg, which were significantly lower than group B [(19.21±2.17) and (20.87±2.17)mmHg] (t=2.168 9, 2.611 3, respectively; P 0.05). Conclusions 15°head-down position laparoscopic surgery has less effect on the patient’s intraocular pressure than 30°head-down position laparoscopic surgery, besides, patients have more comfort. Key words: Head-down tilt; Laparoscopes; Hysteretomy; Intraocular pressure; Inclination; Comfort

The Effect of the Modified Z Trendelenburg Position on Intraocular Pressure during Robotic Assisted Laparoscopic Radical Prostatectomy: A Randomized, Controlled Study

The Trendelenburg position has a dramatic effect on circulation, consequently increasing cerebral and intraocular pressure. We evaluated whether modifying the Trendelenburg position would minimize the increase in intraocular pressure. In this prospective, randomized, controlled study we compared intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy while in the Trendelenburg position or the modified Z Trendelenburg position. In group 1 intraocular pressure, blood pressure and endotracheal CO2 were measured in the patient at anesthesia induction (time 1), before positioning (time 2), and while in the Trendelenburg position (time 3) and in the modified Z Trendelenburg position (time 4). They were also measured after pneumoperitoneum (time 5), every 30 minutes (times 6 to 16), while supine at the end of pneumoperitoneum (time 17) and before awakening (time 18). We modified the Trendelenburg position by placing the head and shoulders horizontally. Group 1 included 29 patients in the modified Z Trendelenburg position. Group 2 included 21 patients in the Trendelenburg position. No difference was found in patient demographics or surgical outcomes. Median intraocular pressure was in the low normal range at times 1 and 2, and increased in time 3 in each group. From time 4 intraocular pressure decreased and at all time points it was significantly lower in group 1 by a mean of 4.61 mm Hg (95% CI -6.90-2.30, p <0.001). At time 17 mean intraocular pressure decreased to normal (19.6 mm Hg) in group 1 but remained in the hypertensive range (24.9 mm Hg) in group 2. At time 18 mean intraocular pressure was 17 mm Hg in each group. Blood pressure was significantly lower in group 1 with a mean reduction in systolic and diastolic pressure of 6.3 and 4.3 mm Hg, respectively. Our results suggest that modifying the Trendelenburg position during robot-assisted laparoscopic radical prostatectomy has a significant positive effect on patient neuro-ocular safety by lowering intraocular pressure and accelerating its recovery to the normal range without affecting the operation.

Efficacy and tolerability of mono-compound topical treatments for reduction of intraocular pressure in patients with primary open angle glaucoma or ocular hypertension: an overview of reviews.

AimTo evaluate the existing evidence on relative efficacy and tolerability of topical mono-compound intraocular pressure (IOP)-lowering drugs in treatment of primary open angle glaucoma (POAG) and ocular hypertension (OHT).MethodsIn this systematic review of systematic reviews/meta-analyses of randomized controlled trials a thorough and sensitive search of PubMed, Embase and Cochrane Databases was performed. Individual study methodological quality and quality of evidence were assessed using the AMSTAR checklist and the GRADE system, respectively. The relationships between individual drugs were evaluated based on the best available evidence.ResultsOf the 133 initial non-duplicate records, 16 studies met the inclusion criteria. Five achieved an overall “moderate” (none achieved “high”) quality of evidence and evaluated prostaglandin analogues (PGAs) – latanoprost, travoprost, and bimatoprost; timolol; “other beta-blockers;” carbonic anhydrase inhibitors (CAI) as a group or dorzolamide separately; and brimonidine. “Moderate quality” refers to efficacy and incidence of conjunctival hyperemia. Quality of evidence regarding other tolerability aspects was low. PGAs should be considered equivalent regarding efficacy, but latanoprost was relevantly better tolerated than the other two. Non-PGA compounds did not relevantly differ between each other in either efficacy or safety. Timolol and brimonidine were relevantly less effective than all PGAs. The same was true for CAI vs bimatoprost. Regarding tolerability, timolol was superior to all PGAs and brimonidine and CAI were superior to bimatoprost.ConclusionNo high quality evidence on relative efficacy and tolerability of the most commonly used mono-compound IOP-lowering drugs for POAG/OHT exists. Moderate quality evidence indicates latanoprost as a treatment with the most favorable trade-off between benefits and harms.

The effect of preservative free tafluprost on intraocular pressure in patients with ocular hypertension or primary open angle glaucoma

AbstractPurpose Since increased intraocular pressure (IOP) is the most important modifiable risk factor for the development and progression of glaucoma, potent and save IOP lowering therapy is of special importance. Preservative free prostaglandins offer a new treatment option using a potent topical drug without the disadvantages of a co‐administered preservatives. The aim of the present study was to investigate the effect of 8 weeks treatment with preservative free tafluprost on IOP in patients with glaucoma or ocular hypertension.Methods 16 patients with either primary open angle glaucoma with an uncontrolled intraocular pressure ≥ 30mmHg or patients with ocular hypertension with an IOP ≥ 30mmHg were included in the present open pilot study. For patients who were already on antiglaucoma therapy, a washout period with a duration of 4 weeks was scheduled. IOP was measured at 8am and 6pm after the washout period as well as 4 and 8 weeks of after start of topical drug treatment.Results A total of 16 patients (age range 31‐76 years) were included in the study. After the 4 week washout period, mean IOP was 35.6±4.5mmHg at the morning and 32.9±5.4mmHg at the evening measurement. 4 weeks after treatment start, a decrease in IOP by ‐31%±12% to 24.4±4.6mmHg (p&lt;0.01) was observed at the morning measurement and by ‐34%±14% to 21.6±4.6mmHg (p&lt;0.01) at the evening measurement. 8 weeks after treatment start IOP remained low, on average 24.4±4.6mmHg (‐31%±13% compared to baseline, p&lt;0.01) in the morning and 21.9±3.9mmHg (‐32%±16% compared to baseline, p&lt;0.01) in the evening.Conclusion The present data indicate that treatment with preservative free saflutan is safe and has the capacity to significantly decrease IOP in patients with primary open angle glaucoma and ocular hypertension. Further studies are needed to investigate the effect of preservative free formulations for long term treatment.

Refractory open angle glaucoma treated by high intensity focused ultrasound (HIFU). Results at one year of a prospective series

AbstractPurpose To assess the safety and efficacy of Ultrasound Circular Cyclo‐Coagulation (UC3 procedure) using HIFU (high intensity focused ultrasound) in patients with refractory open angle glaucoma.Methods Prospective clinical series performed in two centers, on twenty‐eight eyes of twenty‐eight patients with primary open‐angle glaucoma, treated with the EyeOP1 medical device equipped with six miniaturized cylindrical piezoelectric transducers. All eyes were treated with a 6‐second exposure time from each transducer. The main assessment criteria were safety and efficacy as indicated by the incidence of complications and by the IOP reduction. Ophthalmic, ultrasound biomicroscopy and flare examinations were performed before treatment and during clinical follow‐up at D1, D7, M1, M2, M3 M6 and M12Results The mean intraocular pressure was significantly reduced from 29.0 ± 7.2 mmHg before treatment to 21.6 ± 9.4 mmHg at last follow‐up. Eight patients needed to be re‐treated. Complete success rate, as defined by an IOP reduction &gt;20% and IOP&gt; 5 mmHg after one UC3 procedure was 50%, and 68% after re‐treatments. The mean IOP reduction achieved in responding patients was 45%. No major intra‐ or post‐operative complications occurred. Clinical examination showed no lesions of the ocular structures other than the ciliary body and no or few signs of intraocular inflammation after treatment. Ocular inflammation evidenced by flare was very limited and non‐significant.Conclusion Coagulation of the ciliary body using high intensity focused ultrasound delivered by miniaturized transducers is a simple, well‐tolerated procedure which enables to significantly reduce the intraocular pressure in patients with refractory Open Angle Glaucoma. Commercial interest

Short- and Long-Term Effects on the Ciliary Body and the Aqueous Outflow Pathways of High-Intensity Focused Ultrasound Cyclocoagulation

Several physical methods can be used to coagulate the ciliary body and decrease intra-ocular pressure in patients with glaucoma. The study described here investigated the short- and long-term effects of high-intensity focused ultrasound (HIFU) cyclocoagulation on the aqueous humor production structures and outflow pathways. Thirty-four rabbit eyes were sonicated with a ring-shaped probe containing six miniaturized HIFU transducers. Light, scanning electron and transmission electron microscopy and corrosion casts were performed. In the affected regions, the epithelium of the ciliary processes was degenerated or necrotic and sloughed off. Examinations performed several months afterward revealed involution of the ciliary processes. Vascular corrosion cast revealed focal interruption of the ciliary body microvasculature. In most animals, a sustained fluid space was seen between the sclera, the ciliary body and the choroid, likely indicating an increase in the aqueous outflow by the uveoscleral pathway. These results suggest that HIFU cyclocoagulation has a dual effect on aqueous humor dynamics.

Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma.

To investigate the prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. Case series. School of Medicine, Düzce University, Turkey. Twenty-one consecutive primary open-angle glaucoma patients (12 females and 9 males) who attended the out-patient clinic of the Department of Ophthalmology between July 2007 and February 2008 were included in this study. All patients underwent polysomnographic examination. The prevalence of obstructive sleep apnoea syndrome was 33.3% in patients with primary open-angle glaucoma; the severity of the condition was mild in 14.3% and moderate in 19.0% of the subjects. The age (P=0.047) and neck circumference (P=0.024) in patients with obstructive sleep apnoea syndrome were significantly greater than those without the syndrome. Triceps skinfold thickness in glaucomatous obstructive sleep apnoea syndrome patients reached near significance versus those without the syndrome (P=0.078). Snoring was observed in all glaucoma cases with obstructive sleep apnoea syndrome. The intra-ocular pressure of patients with primary open-angle glaucoma with obstructive sleep apnoea syndrome was significantly lower than those without obstructive sleep apnoea syndrome (P=0.006 and P=0.035 for the right and left eyes, respectively). There was no significant difference in the cup/disc ratio and visual acuity, except visual field defect, between primary open-angle glaucoma patients with and without obstructive sleep apnoea syndrome. Although it does not provide evidence for a cause-effect relationship, high prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma in this study suggests the need to explore the long-term results of coincidence, relationship, and cross-interaction of these two common disorders.

Preservative-free latanoprost eye drops in patients with primary open-angle glaucoma/ocular hypertension.

Latanoprost is an ester prodrug prostaglandin F2α analogue that is a selective agonist of endogenous prostanoid FP receptors and that reduces intraocular pressure (IOP) by increasing the uveoscleral outflow of aqueous humour. Preservative-free (PF) latanoprost [Monoprost(®)] is a new formulation of latanoprost that is approved for use in the EU in patients with primary open-angle glaucoma (POAG)/ocular hypertension. This article reviews the clinical pharmacology of this new formulation, focussing on its efficacy and tolerability in this indication. PF latanoprost was efficacious in reducing IOP in a randomized, investigator-masked, multinational trial in patients with POAG/ocular hypertension (n = 404). At days 15, 42 and 84 of follow-up, PF latanoprost was noninferior to benzalkonium chloride-preserved (BAK) latanoprost in terms of reductions in IOP. In this trial, at days 42 and 84 the proportions of patients with conjunctival hyperaemia were significantly lower with PF latanoprost than with BAK latanoprost. Patient subjective ratings of ocular symptoms were also significantly lower with PF latanoprost than with BAK latanoprost. In the absence of head-to-head comparisons with other anti-glaucoma drugs, an adjusted, indirect comparison meta-analysis was performed using data from 21 randomized clinical trials in patients with POAG/ocular hypertension. Based on this analysis, PF latanoprost had similar efficacy to different formulations of three comparator prostaglandin analogues in reducing the patient's IOP and was associated with a significantly lower risk of developing hyperaemia/ocular redness than these comparators. PF latanoprost offers a useful alternative to the available preserved prostaglandin analogues for the treatment of POAG/ocular hypertension.

Elevated intraocular pressure in patients with acromegaly.

To evaluate central corneal thickness (CCT) and intraocular pressure (IOP) in a cohort of acromegalic patients, and to correlate CCT with serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Consecutive patients affected by acromegaly underwent a comprehensive endocrinological and ophthalmological evaluation, including serum GH and IGF-1 levels, CCT measured with ultrasonic pachymetry and IOP assessed with Goldmann applanation tonometry. Fourteen patients with acromegaly and 28 healthy controls were included in the study. Acromegalic patients had a statistically higher median CCT (570μm [range 551.5-638] vs 542.7μm [range 461.5-610]; p < 0.01) and higher median IOP (17.2mm Hg [range 14-21] vs 13.7mm Hg [range 10.5-19]; p < 0.01) than healthy controls. No statistically significant correlation was found among CCT and GH, CCT and IGF-1, IOP and GH, IOP and IGF-1 in the acromegalic group, whereas a statistically significant correlation was documented between CCT and IOP in the entire cohort (Spearman's correlation coefficient: 0.56, p < 0.01). However, when IOP was corrected for CCT no significant difference was found between the two study groups (p = 0.07). Our results suggest that acromegaly is associated with an increased CCT, which could lead to an overestimation of IOP readings as determined with Goldmann applanation tonometry.

Treatment of refractory open-angle glaucoma using ultrasonic circular cyclocoagulation: a prospective case series

Objective:To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation (UC3) procedure in patients with refractory primary open-angle glaucoma.Research design and methods:Prospective non-comparative interventional case series performed in two French glaucoma centers. Twenty-eight eyes of 28 patients with primary open-angle glaucoma, intraocular pressure (IOP) >21 mmHg, an average of 1.4 failed previous surgeries and an average of 3.8 hypotensive medications were insonified with a therapy probe comprising six piezoelectric transducers. The six transducers were activated and all patients were treated with a 6 second exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after.Main outcome measures:Primary outcomes were surgical success (defined as IOP reduction from baseline ≥20% and IOP >5 mmHg) at the last follow-up visit, and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared to baseline, medication use, complications, and re-interventions.Results:IOP was significantly reduced (P < 0.05), from a mean preoperative value of 29.0 ± 7.2 mmHg (n = 3.8 hypotensive medications) to a mean value of 21.6 ± 9.4 mmHg at last follow-up (n = 3.8 hypotensive medications and n = 1.29 procedures) (mean IOP reduction of 26%). Complete success (IOP reduction >20% without re-intervention and without hypotensive medications adjunction) was achieved in 50% of eyes at last follow-up (mean IOP reduction of 45% in these same eyes) and qualified success (IOP reduction >20% with possible re-interventions) was achieved in 68% of eyes at last follow-up. No major intra- or post-operative complications occurred.Conclusions:UC3 procedure seems to be an effective and well tolerated method to reduce intraocular pressure in patients with primary open-angle glaucoma. Studies directly comparing the efficacy and safety of the UC3 procedure with that of trabeculectomy or diode laser are needed.

Central corneal thickness and its relationship to Parkinson’s disease severity

ObjectiveTo investigate the effect of Parkinson’s disease (PD) on blink rate (BR), tear breakup time test (TBUT), Schirmer’s test, and corneal thickness, and the relationship of these effects with disease severity. DesignProspective controlled study. ParticipantsFifty-five eyes from 55 patients with PD and 40 eyes from 40 healthy subjects were analyzed in the study. MethodsThe patients were divided into 2 groups according to their Hoehn–Yahr (H-Y) scores; patients classified as H-Y 1–2 were designated as the mild group, and those classified as H-Y 3–5 were designated as the moderate group. Subjects were screened for BR, TBUT, and Schirmer’s test, and the central corneal thickness (CCT) was measured. ResultsThe BR, Schirmer’s test, TBUT, and CCT values of the patient group were significantly lower than those of the control group. The BR and TBUT of the mild group were significantly lower than those of the control group, but the decreases in the Schirmer’s test values and CCT were not statistically significant. In addition, significant decreases in the BR, TBUT, Schirmer’s test scores, and CCT were observed in the patient group as the H-Y score increased. ConclusionsA reduced BR and poor tear quality in the early stages of PD, as well as decreased tear production as the disease progresses, can result in reduced CCT. The possibility of a thin cornea should be taken into consideration while measuring the intraocular pressure in patients with severe PD.

Total antioxidant level is correlated with intra-ocular pressure in patients with primary angle closure glaucoma

BackgroundTo evaluate total antioxidant status (TAS) in the plasma of primary angle closure glaucoma (PACG) patients and to compare it to that of the control group. Additionally, we aim to investigate the association of various PACG clinical indices with TAS level.MethodsPlasma samples were obtained from 139 PACG patients and 149 glaucoma-free controls of matching age, sex, and ethnicity. TAS in all samples was determined by spectrophotometric and enzyme-linked immunosorbent assay methods. We studied the possible association of the TAS level with various clinical indices relevant to PACG.ResultsThe mean (±SD) total antioxidant (TAS) value was almost similar in patients 1 (±0.22) compared to controls 0.97 (±0.43); p = 0.345. Among cases, mean TAS concentration showed a statistically significant lower pattern among subjects with glaucoma onset at the age of ≤ 50 years (p = 0.037) and female subjects (p = 0.014) as well as having a family history of glaucoma (p = 0.010). Interestingly, a statistically significant inverse correlation was detected between TAS concentration and intra ocular pressure (IOP), (R = -0.14, p = 0.037).ConclusionsThe inverse correlation of TAS level with IOP, highlights TAS potential role as a predictive-marker for PACG-severity.

Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep Trendelenburg position

Intraocular pressure is increased during laparoscopic surgeries performed in a steep Trendelenburg position. This study compared the effects of propofol with those of sevoflurane on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy in a 30° Trendelenburg position. Sixty-six patients were randomly allocated to a maintenance anesthetic consisting of remifentanil and sevoflurane (Sevoflurane Group) or remifentanil and propofol (Propofol Group). Intraocular pressure (IOP) was measured at nine predefined time points, including baseline (T0), five minutes after establishing pneumoperitoneum (T2), 30min after establishing the Trendelenburg position with pneumoperitoneum (T3), five minutes after returning to the horizontal position (T4), and immediately after tracheal extubation (T6). The primary outcome was the change in intraocular pressure from T0 to T3. The results of linear mixed model analysis showed that intraocular pressure differed between the two groups (P=0.0039). At T3, the mean (SD) IOP was greater in the Sevoflurane Group [23.5 (4.3) mmHg] than in the Propofol Group [19.9 (3.8) mmHg] (P=0.0019). At T2 and T6, IOP was also greater in the Sevoflurane Group than in the Propofol Group (P=0.038 and P=0.009, respectively). There was a statistically significant increase in intraocular pressure from baseline to T3 (pneumoperitoneum and steep Trendelenberg) in the Sevoflurane Group [6.0 (5.0) mmHg; P<0.001] but not in the Propofol Group [2.1 (5.1) mmHg; P=0.136]. None of the patients experienced ocular complications. Intraocular pressure increases after pneumoperitoneum and the steep Trendelenburg position are established. This increase is less with propofol than with sevoflurane anesthesia. This trial was registered at ClinicalTrials.gov: NCT01744262.

Endocyclophotodestruction in glaucoma patients undergoing combined surgery of pars plana vitrectomy and phacoemulsification.

BackgroundThe purpose of this trail was to assess the effect of a novel intraoperative endocyclophotodestruction method on intraocular pressure in patients undergoing combined procedure of phacovitrectomy to determine the efficacy of this combined surgical approach.Material/MethodsThe study sample included 87 subjects divided into 2 groups: Group I consisted of 52 patients who underwent intraoperative endocyclophotodestruction performed during phacovitrectomy. Group II consisted of 35 controls. The follow-up duration was 12 months. The preoperative (baseline) intraocular pressure (IOP) was determined and later assessed postoperatively at the following time points: on 1 day and at 1, 2, 3, 6, and 12 months. Other evaluated parameters were the number of topical antiglaucoma medications, and the cyclophotodestruction circumference-to-outflow resistance ratio (R).ResultsThe mean postoperative reduction of intraocular pressure was by 4.26 mmHg at 6 months and by 4.91 mmHg at 12 months. The number of topical antiglaucoma medications was reduced postoperatively from the mean preoperative value of 1.66 to 0.69 at 6 months and 1.04 at 12 months.ConclusionsThe results show a significant reduction of intraocular pressure in patients undergoing the combined triple-procedure surgery and postoperative decrease in the number of topical medications. The best outcomes in terms of IOP decrease and reduced number of medications were achieved in patients with low outflow coefficient. Endocyclophotodestruction is an alternative IOP-reducing technique to be used in patients with glaucoma who require phacovitrectomy. It is recommended for patients with low outflow coefficient in whom posterior pole abnormalities constitute the main indications for surgery.

Electrochemical Reduction and Stripping Voltammetric Determination of the Anti-Glaucoma Drug Levobunolol HCl in Formulation and Human Serum at the Mercury Electrode

Levobunolol HCl is a potent non-selective s-adrenoceptor blocking agent used for the topical treatment of increased intraocular pressure in patients with chronic open angle glaucoma or ocular hypertension. Precise, rapid and extraction-free square-wave adsorptive cathodic stripping voltammetry (SW-AdCSV) method has been described for trace quantitation of levobunolol HCl in bulk form, commercial formulation (ophthalmologic drops) and human serum. Limits of quantification (LOQ) of 1.0 × 10-10 mol L-1 (in bulk form) and 2.5 × 10-10 mol L-1 levobunolol HCl (in spiked human serum) were achieved by the described method. Insignificant interferences from excipients associated with formulation of levobunolol HCl and from some common metal ions, co-administrated drugs, some other s-blocker agents and its metabolite dihydrolevobunolol that are likely to be present in the biological fluids were obtained. The described SW-AdCSV method is sensitive enough to assay the drug in human serum compared to most of the reported methods.

Postoperative Trendelenburg Position for Graft Adherence After Descemet Stripping Automated Endothelial Keratoplasty

To present a case of repeated graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) in a post-trabeculectomy eye and to suggest a simple postoperative maneuver to minimize this occurrence. A 61-year-old woman presented to our cornea clinic with pseudophakic bullous keratopathy in her left eye 13 years after a trabeculectomy had been performed. After the DSAEK was performed, repeated graft dislocations were observed. When air was seen in the filtering bleb in the immediate postoperative period, it was assumed that it had escaped from the air bubble remaining in the anterior chamber at the end of the surgery. The patient was thus placed in the Trendelenburg position immediately after performing a rebubbling procedure to retain the air bubble in the anterior chamber and away from the filtering bleb. The corneal graft remained centered and clear at postoperative day 1 and remained so at the last follow-up visit 8 months after the surgery had taken place. The patient's intraocular pressure was well controlled with a functional filtering bleb. Postoperative Trendelenburg positioning is an easily applied maneuver that may promote graft adherence after performing a DSAEK in eyes that have undergone glaucoma surgery.

Ultrasonic circular cyclo coagulation in patients with primary open‐angle glaucoma: A multicenter clinical trial

AbstractPurpose To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure in patients with primary open‐angle glaucoma (POAG).Methods Prospective multicenter clinical trial. 42 eyes of 42 patients with POAG, intraocular pressure (IOP) &gt; 21 mmHg, an average of 1.65 failed previous surgeries and an average of 3.2 hypotensive medications were insonified with a probe comprising 6 piezoelectric transducers. 18 patients (group 1) were treated with a 4 seconds exposure time for each shot and 24 patients (group 2) with a 6 seconds exposure time. Follow‐up visits were performed at 1 day, 1 week, 1, 2, 3, 6 and 12 months after.Results IOP was significantly reduced in both groups (p&lt;0.05), from a mean preoperative value of 28.6 ± 4.7 mmHg in group 1 and 28.1 ± 8.6 mmHg in group 2 to a mean value of 16.1 ± 2.8 mmHg in group 1 and 16.7 ± 4.4 mmHg in group 2 at last follow‐up. Success (IOP reduction &gt;20%) was achieved in 12 of 18 (67%) eyes of the group 1 and in 17 of 24 (71%) eyes of the group 2. Four patients were re‐treated. No major intra‐ or post‐operative complications occurred.Conclusion UC3 seems to be an effective and well‐tolerated method to reduce intraocular pressure in patients with POAG. Commercial interest

Differential diagnostic of eye morphometric parameters in patients with refractive and axial myopia

AbstractPurpose Many authors have shown that myopia is associated with changes in the anatomical parameters of the eye. The aim: To study morphometric parameters in patients with refractive and axial myopiaMethods The observation involved 264 patients (502 eyes) with varying degrees of myopia (myopic refraction of ‐2.75 diopters), age ‐ 18.41 year. Patients were divided by type of myopia: refractive (RM) ‐ 133 eyes, axial ‐ 217 eyes, mixed (SM) ‐ 91 eyes, and combined ‐ 61 eyes. Methods: visometry for distance, keratometry and refractometry after cycloplegia with cyclomed 1% with Accuref‐K 9001, Shin Nippon, the definition of the horizontal pupil diameter by keratotopograf PCT‐110, Optopol and horizontal corneal diameter by KR‐8900 Topcon and HRK‐7000 Huvitz.Results Results Analysis of the data showed that the axial myopia has significantly larger average diameter , the radius and refraction of cornea, pupil diameter , length of the vitreous humor, axis length of the eye and the degree of myopia, compared with refractive myopia. Significantly higher mean values of intraocular pressure and the width of the anterior chamber angle were established in refractive myopia in comparison with axial myopia (p &lt;0,01). Values of anterior chamber depth and lens thickness between patients with axial and refractive myopia showed no significant differences (p&gt; 0,1).Conclusion Obtained results showed that morphometric parameters of the eye, intraocular pressure in patients with axial and refractive myopia have practical value for early detection and prediction of the development and progression of myopia in patients with myopia

Treatment of refractory glaucoma using UC3 procedure with HIFU (High Intensity Focused Ultrasound). Prospective series

AbstractPurpose To assess the safety and efficacy of Ultrasound Circular Cyclo‐Coagulation (UC3 procedure) using HIFU (high intensity focused ultrasound) in patients with refractory glaucoma.Methods Prospective clinical series performed in two centers, on twenty‐seven eyes of twenty‐seven patients with refractory glaucoma, treated with the EyeOP1 medical device equipped with six miniaturized cylindrical piezoelectric transducers. All eyes were treated with a 6‐second exposure time from each transducer. The main assessment criteria were safety and efficacy as indicated by the incidence of complications and by the IOP reduction. Ophthalmic, ultrasound biomicroscopy and flare examinations were performed before treatment and during clinical follow‐up at D1, D7, M1, M2, M3 and M6Results No major intra‐ or post‐operative complications occurred. Clinical examination showed no lesions of the ocular structures other than the ciliary body and no or few signs of intraocular inflammation after treatment. Visual acuity was not modified after the procedure. The mean intraocular pressure was reduced from 27.5 ± 7.0 mmHg before treatment to 18.3 ± 4.4 mmHg at last follow‐up. Four patients needed to be re‐treated. The success rate, as defined by an IOP reduction &gt;20%, was 67%.The mean IOP reduction achieved was 33%. Ocular inflammation evidenced by flare was very limited and non‐significant.Conclusion Coagulation of the ciliary body using high intensity focused ultrasound delivered by miniaturized transducers is a simple, well‐tolerated procedure which enables to significantly reduce the intraocular pressure in patients with refractory glaucoma. Commercial interest