Intraocular Pressure In Group Research Articles

Selective Laser Trabeculoplasty vs Medical Therapy for the Treatment of Open-angle Glaucoma or Ocular Hypertension: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

Selective laser trabeculoplasty (SLT) and medical therapy groups displayed comparable intraocular pressure (IOP) at most follow-ups. SLT was associated with significantly decreased rates of glaucoma surgeries, antiglaucomatous medications, and ocular adverse effects. To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) compared to medical therapy in the treatment of open-angle glaucoma (OAG) or ocular hypertension (OHT). A systematic search was performed in PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials (RCTs) comparing SLT with medical therapy were included. We computed mean differences (MDs) or standardized mean differences (STDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Software R, version 4.2.1, was used for statistical analyses. Subgroup analyses were performed on treatment-naive patients and on the class of drugs in the medical therapy group. Fourteen RCTs comprising 1,706 patients were included, of whom 936 were submitted to SLT. Medical therapy was associated with a significantly improved IOP at 1 month and a higher proportion of patients achieving ≥20% IOP reduction. There were no significant differences between groups in IOP at 2, 3, 6, and 12 months, IOP fluctuation, rate of eyes at target IOP, visual field, and quality of life. The SLT group exhibited significantly decreased rates of glaucoma surgeries, antiglaucoma medications, and ocular adverse effects. SLT demonstrated comparable efficacy to medical therapy in IOP control at most follow-ups, along with favorable impacts on critical treatment-related factors. Our findings support SLT as a safe and effective treatment for OAG or OHT.

Antioxidant effect of gallic acid on retinal ganglion cells in glaucoma model

To evaluate the protective effect of gallic acid on the optic nerve by studying the inhibitory effect of gallic acid on oxidative stress in retinal ganglion cells. 100 male SD rats were randomly divided into four groups: normal control group, simple high IOP group, 0.5% gallic acid experimental group, and 1% gallic acid experimental group. HE staining, immunofluorescence, DHE staining, Western blot, and q-PCR were used to observe the antioxidant effect of gallic acid on the retina of acute ocular hypertension rats. HE staining of the retina of SD rats confirmed that the nucleus of RGCs was clear, the thickness of the RNFL was regular in the normal control group, and the nucleus of RGCs was ruptured and lysed in the simple high intraocular pressure (IOP) group and the gallic acid group, and the thickness of the RNFL was significantly thickened, but the thickness of the RNFL in the gallic acid group was significantly reduced compared with that in the simple high IOP group (p < 0.05). DHE staining showed that ROS content in the simple high IOP group was significantly increased compared with the normal control group, and ROS content was significantly decreased after the application of gallic acid (p < 0.05). Immunofluorescence staining with Brn-3a antibody confirmed that the number of RGCs was significantly reduced in the simple high IOP group compared with the normal control group, whereas after application of gallic acid, the number of RGCs was significantly more in the gallic acid group than in the simple high IOP group (p < 0.05). Western Blot and q-PCR confirmed that hypoxia-inducing factor 1α (HIF-1α) protein content and transcription level were significantly increased in the retinal tissue of the simple high IOP group, and gallic acid could inhibit HIF-1α protein content (p < 0.05) and reduce transcription factor level (p < 0.05). Gallic acid exerts a protective effect on RGC by inhibiting oxidative stress in rats with acute IOP elevation.

Changes of aqueous humor cytokine profiles of patients with high intraocular pressure after PPV for retinal detachment

High intraocular pressure (IOP) is one of the early complications after pars plana vitrectomy (PPV), which may cause glaucoma and poor visual prognosis secondary to surgery. Proliferative vitreoretinopathy (PVR) is one of the complications of retinal detachment (RD) and is the main reason for the poor prognosis, which is related to different kinds of cytokines. It’s essential for the basic mechanism to analyze the relative aqueous humor cytokine profiles with IOP after PPV for RD. In this study, we have collected the aqueous humor of 16 patients and qualified 27 cytokines using Luminex and compared biomarkers with the high IOP group and the normal group. As a result, the concentrations of VEGF, IL-6, FGF2, and G-CSF upregulated significantly (P < 0.05), while VEGFR2 downregulated significantly (P < 0.05) in the high IOP group. IL-6 was positively correlated with high IOP (r = 0.561, P = 0.041). Meanwhile, the concentrations of IL-6 (r = 0.543, P = 0.03), IL-5 (r = 0.576, P = 0.019), IL-15 (r = 0.614, P = 0.011), IL-4 (r = 0.517, P = 0.04), ICAM-1 (r = 0.611, P = 0.012), and G-CSF (r = 0.636, P = 0.008) were significantly associated with preoperative PVR classification, and the aqueous humor levels of IL-4 (r = 0.567, P = 0.022), HGF (r = 0.701, P = 0.005), and MCP-1 (r = 0.565, P = 0.035) are significant relative to laser points. Hence, cytokines might potentially be the therapeutic target of high IOP after PPV.

Investigation of subclinical ocular inflammation in the aqueous humor of patients with myopia following bilateral sequential collamer lens implantation

BackgroundThe aqueous humor, a transparent fluid secreted by the ciliary body, supports the lens of the eyeball. In this study, we analyzed the cytokine and chemokine profiles within the aqueous humor of the contralateral eye post-implantation of an implantable collamer lens (ICL) to evaluate potential subclinical inflammation in the second eye subsequent to ICL implantation in the first eye. MethodsAqueous humor samples were procured from both eyes of 40 patients (totaling 80 eyes) prior to bilateral ICL insertion. Subsequently, a comprehensive statistical analysis was conducted using the Luminex assay to quantify 30 different cytokines in these samples. ResultsCompared to the first eye, the aqueous humor of the second eye demonstrated decreased concentrations of IFN-γ (P = 0.038), IL-13 (P = 0.027), IL-17/IL-17 A (P = 0.012), and IL-4 (P = 0.025). No significant differences were observed in other cytokine levels between the two groups. Patients were then categorized based on the postoperative rise in intraocular pressure (IOP) in the first eye. The group with elevated IOP displayed elevated levels of EGF in the aqueous humor of the first eye (P = 0.013) and higher levels of PDGF-AB/BB in the aqueous humor of the second eye (P = 0.032) compared to the group with normal IOP. Within the elevated IOP group, the levels of EGF (P = 0.013) and IL-17/IL-17 A (P = 0.016) in the aqueous humor were lower in the second eye than in the first eye. In the normal IOP group, cytokine levels did not differ notably between eyes. ConclusionFollowing sequential ICL implantation, it appears that a protective response may be activated to mitigate subclinical inflammation in the second eye induced by the initial implantation in the first eye. Additionally, the increase in IOP subsequent to surgery in the first eye may correlate with the presence of inflammatory mediators in the aqueous humor.

Correlation between Structural and Functional Changes in Patients with Raised Intraocular Pressure Due to Graves' Orbitopathy.

This study explores the complication of secondary intraocular pressure (IOP) elevation and consequent glaucoma development in Graves' orbitopathy (GO), an autoimmune disorder associated with hyperthyroidism. Utilizing Octopus 900 visual field testing and optical coherence tomography (OCT), the research established correlations between functional and structural changes in optic nerve regions in patients with GO and patients with GO with elevated IOP (GO IOP) groups. A comparison with primary open-angle glaucoma (POAG) was conducted in a cohort of 182 subjects. The study identifies optic nerve head parameters that effectively differentiate changes in GO and GO IOP groups. In the GO group, the strongest correlation between structural and functional changes was observed in sector 7, while in the GO IOP group, it was in sectors 1 and 7. For POAG, correlation was found in six sectors. Elevated IOP in GO correlates with structural and functional impairments similarly to early glaucoma. Risk factors for GO-related elevated IOP included older age, longer duration of thyroid disease, and higher anti-thyroglobulin values. The study highlights the significance of regular IOP measurements, visual field assessments, and OCT examinations in GO patients. Early antiglaucoma intervention is warranted when characteristic structural and functional changes and/or risk factors are identified.

Analysis of Ultrasonic Emulsification Surgery and Small Incision Cataract Extracapsular Extraction Surgery for Cataract Clinical Treatment Level Improvement

Objective: To analyze the efficacy of ultrasonic emulsification and small incision cataract extracapsular extraction in cataract patients. Methods: 96 cataract patients admitted from May 2021 to May 2023 were selected and randomly grouped into group A (ultrasonic emulsification) and group B (small-incision extracapsular cataract extraction), with 48 cases each. Results: At 1 week, 1-month, and 3 months post-operation, the visual acuity of group A was higher and the astigmatism value was lower than that of group B (P &lt; 0.05); at 12h, 24h, and 48h post-operation, the intraocular pressure of group A was higher than that of group B (P &lt; 0.05); the thickness of macular area of group A was lower than that of group B at 1 week and 1-month post-operation (P &lt; 0.05). Conclusion: Ultrasonic emulsification in cataract patients was slightly better than small incision cataract extracapsular extraction in correcting astigmatism, improving visual acuity, and regulating macular thickness. However, due to the high energy of ultrasonic emulsification, the risk of complications such as high postoperative intraocular pressure was higher. Small-incision extracapsular cataract extraction has better application value in economically disadvantaged areas.

A Noninvasive Clinical Method to Measure in Vivo Mechanical Strains of the Lamina Cribrosa by OCT

To measure mechanical strain of the lamina cribrosa (LC) after intraocular pressure (IOP) change produced 1 week after a change in glaucoma medication. Cohort study. Adult glaucoma patients (23 eyes, 15 patients) prescribed a change in IOP-lowering medication. Noninvasive OCT imaging of the eye. Deformation calculated by digital volume correlation of OCT scans of the LC before and after IOP lowering by medication. Among 23 eyes, 17 eyes of 12 persons had IOP lowering ≥ 3 mmHg (reduced IOP group) with tensile anterior-posterior Ezz strain= 1.0% ± 1.1% (P= 0.003) and compressive radial strain (Err)=-0.3% ± 0.5% (P= 0.012; random effects models accounting inclusion of both eyes in some persons). Maximum in-plane principal (tensile) strain and maximum shear strain in the reduced-IOP group were as follows: Emax= 1.7% ± 1.0% and Γmax= 1.4% ± 0.7%, respectively (both P < 0.0001 vs. zero). Reduced-IOP group strains Emax and Γmax were significantly larger with greater % IOP decrease (P < 0.0001 and P < 0.0001, respectively). The compliances of the Ezz, Emax, and Γmax strain responses, defined as strain normalized by the IOP decrease, were larger with more abnormal perimetric mean deviation or visual field index values (all P ≤ 0.02). Strains were unrelated to age (all P ≥ 0.088). In reduced-IOP eyes, mean LC anterior border posterior movement was only 2.05 μm posteriorly (P= 0.052) and not related to % IOP change (P= 0.94, random effects models). Only Err was significantly related to anterior lamina depth change, becoming more negative with greater posterior LC border change (P= 0.015). Lamina cribrosa mechanical strains can be effectively measured by changes in eye drop medication using OCT and are related to degree of visual function loss in glaucoma. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Efficacy of drainage implants in combined cataract and glaucoma surgery

This study evaluates the hypotensive effect and visual function outcomes of combined surgery for complicated cataract and glaucoma using the mesh drain made of digeland the xenocollagen drain. Patients in Group 1 (n=43; 48.3%) underwent combined cataract and glaucoma surgery with implantation of the digel drainage implant, while patients in Group 2 (n=46; 51.7%) underwent an identical operation with the xenocollagen implant. Preoperative tonometric pressure was 27.2±1.7 and 27.3±1.9 mm Hg; best corrected visual acuity was 0.35±0.21 and 0.33±0.18, respectively. The following surgical technique was employed. At 3.0-4.0 mm from the limbus, an intrascleral tunnel was created using a 2.2 mm sclerotome through the conjunctiva in the anteroposterior direction, exiting into the anterior chamber. Capsulorhexis and phacoaspiration were performed. The scleral tunnel was widened to 3 mm, and the intraocular lens was implanted. Penetrating basal coloboma of the iris was formed. The deep flap of the scleral tunnel was dissected from the flat part of the ciliary body and removed. The digel implant was shaped into a T-configuration, while the xenocollagen implant was used without modification. Each drainage was implanted into the intrascleral tunnel (one end directed into the anterior chamber, the other exiting the scleral tunnel). The conjunctiva was sutured with 10/0 stitches, and the paracenteses were hydrated. Over a 24-month follow-up period, the tonometric intraocular pressure in Groups 1 and 2 was 18.8 and 18.5 mm Hg, respectively, and the best corrected visual acuity was 0.51 and 0.58. The use of both drainages in the proposed combined surgery for complicated cataract and glaucoma results in similarly stable hypotensive outcomes and high visual function.

Comparison of clinical outcomes between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in advanced-stage pseudoexfoliation glaucoma.

To compare clinical outcomes between gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) in patients with advanced-stage pseudoexfoliation glaucoma (PEXG). This comparative study comprised 62 patients who underwent GATT (N = 31) or TRAB (N = 31) for advanced-stage PEXG. Primary outcome was cumulative probability of surgical success at the end of 12-month follow-up. Success was determined as intraocular pressure (IOP) reduction ≥ 30% from baseline, IOP between 6 and 18mmHg and IOP upper limits for IOP < 15mmHg and < 12mmHg, separately. Secondary outcomes were IOP reduction, antiglaucoma medication (AGM) use, and complications in the study. Age, sex, cup/disc ratio, mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness did not significantly differ between the groups (p > 0.05 for all). The probability of cumulative surgical success at the end of 12months was similar between the two groups for IOP < 15mmHg and < 18mmHg but significantly higher after TRAB (92.0%) than GATT (82.5%) for IOP < 12mmHg (log-rank test p = 0.035). Percentage of IOP reduction from baseline was similar between the groups (53.1 ± 18.6% in GATT group and 53.0 ± 16.6% in TRAB group, p = 0.98) at the end of 12months. No significant difference in the mean number of AGM was present at the 12-month visit (1.3 ± 1.4 in GATT and 1.1 ± 1.4 in TRAB, p = 0.65). At the end of 12months, IOP reduction rate was similar between GATT and TRAB. Cumulative surgical success was higher after TRAB than GATT for IOP < 12mmHg.

Twenty-Four-Hour Intraocular Pressure Pattern In Glaucoma Suspects in an African Population.

Twenty-four-hour intraocular pressure measurement (Phasing) among glaucoma suspects showed higher intraocular pressure (IOP), greater fluctuation, and more varying peak times occurring mostly outside clinic hours, between 12 midnight and 8 am in 68.9% of them. To characterise 24-hour variation in IOP, in glaucoma suspects and normal individuals in an African population. A cross-sectional analytical study was carried out between March and October 2019 at the University of Ilorin Teaching Hospital. A total of 204 study participants, comprising 102 primary open angle glaucoma (POAG) suspects and 102 age and sex-matched controls with healthy eyes were recruited. Participants had a comprehensive ophthalmic examination. Measurements of IOP were taken every 2 hours during a 24-hour period using an iCare tonometer. The mean age was 43.64±14.02 SD and 43.02±13.55 SD ( P =1.000) for POAG suspects and controls, respectively. The mean peak IOP was significantly higher in POAG suspects (21.87± 4.65mmHg) compared with controls (17.17± 2.32mmHg) ( P <0.001). Whereas, the mean trough IOP reading was not significantly different between the 2 groups. In both groups of participants, the peak and trough IOP in the majority were recorded outside of clinic hours. The majority (68.9%) of POAG suspects had a peak IOP between midnight and 8 am, whereas the control group peaked mostly at 4 pm (16.7%) and 4 am (41.7%). Twenty-four-hour IOP variation was 6mmHg or less in 73.6% of control eyes, while in the POAG suspects, 83.3% of eyes had variation greater than 6mmHg. Compared with age and sex-matched healthy controls, glaucoma suspects of African descent showed significantly higher mean IOP and IOP variation, with most peak IOP detected outside of clinic hours.

Safety of YAG laser vitreolysis for intraocular tissues: analysis of postoperative complications

PurposeTo evaluate the safety of yttrium–aluminum-garnet (YAG) laser vitreolysis for intraocular tissues.MethodsThirty-six New Zealand rabbits were divided as follows: Group 1000 (n = 12) treated with YAG laser of 1000 mJ (5 mJ × 200 shots), Group 2000 (n = 12) treated with YAG laser of 2000 mJ (5 mJ × 400 shots), Group 3000 (n = 12) treated with YAG laser of 3000 mJ (5 mJ × 600 shots). Either a single eye was chosen as the study eye in study groups while the other was untreated as the control group. Intraocular pressure (IOP), slit-lamp, optical coherence tomography (OCT), transmission electron microscopy (TEM), and inflammatory cytokines of aqueous humor (interleukin-1α (IL-1α), interleukin-1β (IL-1β), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α)) were performed to examine the rabbits.ResultsThere were no abnormalities in the study groups of IOP, slit-lamp, and OCT examinations. Group 3000 of TEM showed: neutrophils and mitochondrial swelling on day 1, and fibroblasts and neocollagen on day 14. No abnormalities were observed in Group 1000 and 2000 of TEM. Levels of IL-1α and TNF-α increased at 12 h and decreased to baseline on day 3. Levels of IL-1β increased at 12 h and decreased to baseline on day 7. Levels of IL-8 increased on day 1 and decreased to baseline on day 3.ConclusionYAG laser vitreolysis is safe when the distance is more than 2 mm from ablation point to the lens and the retina, and the total energy is less than 2000 mJ for one treatment procedure.

Prognostic value of extraocular muscles for intraocular pressure in thyroid-associated ophthalmopathy patients.

Persistent increase in intraocular pressure (IOP) is often observed in eyes with thyroid-associated ophthalmopathy (TAO), which has irreversible effects on the visual function of patients. This retrospective cross-sectional study evaluated the value of magnetic resonance imaging (MRI) measurements of extraocular muscle (EOM) volume in prognosing IOP in patients with TAO. This single-center study was conducted in Beijing Friendship Hospital (Beijing, China), a tertiary hospital. From 35 participants, 70 eyes (normal IOP group: 50 eyes; high IOP group: 20 eyes; random samples) were enrolled in this study. Basic data from patients were collected and compared using 2-sample t-tests and chi-squared tests. The volume of the EOM, orbit fat, and whole orbit were measured by orbital MRI. Moreover, proptosis, optic nerve (ON) sheath diameter, optic nerve angle (ONA), and gaze angle were additionally measured with MRI. These parameters were compared between the two groups using 2-sample t-tests and chi-squared tests. Before and after post-methylprednisolone therapy, the MRI data of 20 eyes were obtained and compared with a paired t-test. Peripapillary retinal nerve fiber layer (RNFL) thickness was obtained using an optical coherence tomography (OCT) scan. Spearman rank correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curves were performed to evaluate the role of these factors in IOP changes. The EOM volume and axial and sagittal ONAs in the high-IOP group were significantly increased compared to the normal-IOP group (P<0.001, P=0.001, P=0.02, respectively). Logistic regression analysis indicate that the cutoff value for EOM volume for the diagnosis of high IOP was significantly larger than that of the other parameters except orbit volume (P=0.03, P=0.004, P=0.08, respectively). Spearman correlation analysis revealed a significant correlation between EOM volume and ON sheath diameter and average RNFL thickness (P=0.01, P=0.02, respectively). A paired t-test indicated a significant decrease of EOM volume and ON sheath diameter as well as a significant enlargement of the axial ONAs after methylprednisolone therapy (P=0.002, P=0.02, P=0.05, respectively). EOM volume was an effective diagnostic factor for tracking IOP changes and ON patterns in patients with TAO. Methylprednisolone therapy is recommended for patients with TAO with secondary glaucoma to quickly reduce the EOM volume.

One-year outcomes of combined phacoemulsification and viscogoniosynechialysis with and without endoscopic cyclophotocoagulation in primary angle-closure glaucoma.

To compare the outcomes of combined phacoemulsification and viscogoniosynechialysis (VGSL) with and without endoscopic cyclophtocoagulation (ECP) in primary angle-closure glaucoma (PACG). In this prospective interventional case series 52 eyes of 50 patients were enrolled. Twenty-seven eyes underwent combined phacoemulsification and VGSL (PV group) and 25 eyes underwent the same procedure plus circumferential ECP (PVE group). All eyes were followed 1day, 1week, 3months, 6months, and 1year after the procedure. Intraocular pressure and antiglaucoma medications were compared between and within groups using generalized estimating equations. Kaplan-Meier survival analysis was carried out to compare intensity to failure between groups. The mean ± SD age was 63.23 ± 6.87years and 50% of the cases were male in the entire group. Intraocular pressure (IOP) and antiglaucoma medications were significantly reduced at all time points in comparison with the baseline in both groups (p < 0.05). There was no significant difference between groups in either IOP or medications at specific time points (p > 0.05). One eye in each group developed a fibrinous reaction in the postoperative period. There was no statistically significant difference between groups regarding the intensity to failure (P = 0.169). There were no significant differences in IOP and medication reduction between groups. Also, the complications were comparable between groups.

Comparison of the results of Ex-PRESS® surgery for primary open-angle glaucoma between high and low preoperative intraocular pressure.

To compare surgical outcomes of Ex-PRESS® (EXP) surgery for primary open-angle glaucoma (POAG) between low preoperative intraocular pressure (IOP) and high preoperative IOP. This was a retrospective non-randomized study. Seventy-nine POAG patients who underwent EXP surgery and were followed for > 3years were included. Patients with a preoperative IOP of ≦ 16mmHg and > 16mmHg with tolerant glaucoma medications were defined as the low IOP group and the high IOP group, respectively. We compared the surgical outcomes, postoperative IOP and number of glaucoma medications. Success was defined as a postoperative IOP of ≦15mmHg and a reduction of > 20% from the preoperative IOP to the postoperative IOP. EXP surgeries significantly decreased IOPs from 13.2 ± 2.0 to 9.1 ± 2.9mmHg in the low IOP group (p < 0.001), and from 22.5 ± 4.8 to 12.5 ± 4.0mmHg in the high IOP group (p < 0.001). The mean postoperative IOP was significantly low in the low IOP group at 3years (p = 0.0008). Success rates compared using the Kaplan-Meier survival curve were not significantly different (p = 0.449). EXP surgery was useful for POAG patients with a low preoperative IOP.

Vault-Correlated Efficacy and Safety of Implantable Collamer Lens V4c Implantation for Myopia in Patients with Shallow Anterior Chamber Depth

Introduction: The aim of the study was to evaluate efficacy and safety outcomes after implantation of the Visian Implantable Collamer Lens (ICL V4c) in myopia patients with shallow anterior chamber depth (ACD). Methods: This retrospective study followed 163 eyes of 94 patients for at least 24 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intraocular pressure (IOP), manifest refraction, vault, endothelial cell density (ECD), anterior chamber angle (ACA), anterior chamber volume, and the distance from the corneal endothelium to the central ICL (C-ICL) were measured during follow-ups. Spearman’s correlation and logistic regression were used to identify variables correlated with changes in ECD and potential risk factors for ineffective outcomes, respectively. Results: All surgeries were performed safely. High IOP of 9 eyes and anterior capsular opacity of 5 eyes were observed. The last follow-up ACA had a significant difference between the high and normal IOP groups (p = 0.0003). The mean ECD and vault were 2,855.76 ± 270.82 cells/mm2 and 388.01 ± 135.28 μm at the last follow-up, respectively. The vault and C-ICL were significantly associated with ΔECD (all p < 0.05). Furthermore, the vault was most responsible for the ECD loss. Twenty-two eyes had unsatisfactory postoperative UDVA, and the low vault at the last follow-up was a significant risk factor for this ineffective outcome (p < 0.001, OR = 14.739). Conclusions: ICL V4c implantation in patients with shallow ACD achieved stable visual outcomes. The vault is related to postoperative visual acuity and ECD loss, which needs to be paid attention during follow-up.

Netarsudil as an Adjunctive Therapy: Efficacy and Factors Contributing to a Favorable IOP-Lowering Effect.

The aim of the study is to assess netarsudil's intraocular pressure (IOP)-lowering potential when prescribed as an adjunctive agent, to examine the effect of baseline IOP on patients' response to netarsudil, and to explore patients' characteristics predictive of pronounced responses to netarsudil. This is a single-center, multiprovider retrospective cohort study set at Massachusetts Eye and Ear. Patients with a diagnosis of glaucoma or ocular hypertension on netarsudil and at least one other hypotensive agent for glaucoma who had at least one month of follow-up were included. Patients with additional procedures or glaucoma medication changes were excluded. The main outcome measures were IOP reduction, Kaplan-Meier survival analyses, netarsudil responder type, and complication rates. 236 eyes of 236 patients were included. The mean baseline IOP was 19.06 ± 4.6 mmHg on an average of 4 ocular hypotensive medications. 196 (83.1%) patients experienced IOP reduction at the first follow-up visit of 2.84 ± 0.30 mmHg at 55.66 ± 51.89 days. IOP reduction at the second visit among these patients was 3.01 ± 0.44 mmHg at 133.24 ± 77.63 days. After starting netarsudil, 59% had a sustained response (median duration of 315 days), 25% had a robust response (>20% IOP reduction for at least 80% of visits), and 10% had a super response (>20% and >10 mmHg IOP reduction). Netarsudil was effective as an adjunctive therapy across all baseline IOP categories with greater relative IOP reduction in higher baseline IOP groups. Netarsudil is an effective adjunctive glaucoma therapy. IOP reductions between 2 and 3 mmHg are typical, but a minority had more pronounced and sustained effects (>10 mmHg). Further analysis is needed to assess specific demographic and clinical factors predictive of these robust responses.

Changes in Intraocular Pressure following Narcosis With Medetomidine, Midazolam, and Fentanyl in Association With Initial Intraocular Pressure in Mice

Purpose This article describes the development of decreased intraocular pressure (IOP) under general anesthesia with medetomidine, midazolam, and fentanyl in mice with normal and elevated IOP. Methods IOP was measured using the iCare Tonolab rebound tonometer. Twelve 3–4 months-old male and female C57BL/6J mice were randomized to a control group with physiological IOP and a high IOP group with experimentally induced ocular hypertension using tarsal injections of dexamethasone-21-acetate. For anesthesia, medetomidine and midazolam were used, subgroups additionally received fentanyl. IOP was measured every 2.5 min for 30 min. Results Control group differed with 14.89 mmHg (SEM: 0.58) significantly (p = 0.0002) from the high IOP group with initial 20.44 mmHg (SEM: 0.75). All groups showed a significant (p < 0.05) decrease in IOP under general anesthesia. There was no significant difference in IOP development and decrease between the group additionally receiving fentanyl and the group without fentanyl. The decrease in IOP was highly dependent on the initial value, with the high IOP group showing a greater decrease. After 10 min, no significant difference in IOP could be detected between the high IOP and control group. Conclusions In mice, general anesthesia with medetomidine and midazolam leads to a declining IOP over time. Adding fentanyl to the anesthesia did not alter these effects. The decline is time-dependent and IOP-dependent

23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous Hemorrhage.

Objective To evaluate the clinical efficacy of the combined application of 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction in the treatment of neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) combined with vitreous hemorrhage (VH). Methods Eighty-three patients (91 eyes) with PDR diagnosed as NVG phase III complicated with VH from June 2018 to May 2020 were selected as the study subjects. The subjects were randomly divided into 3 groups: group A was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation; group B was given 23G minimally invasive vitrectomy combined with phacoemulsification cataract extraction; and group C was treated with 23G minimally invasive vitrectomy combined with glaucoma drainage valve implantation and phacoemulsification cataract extraction. The uncorrected visual acuity (UCVA), intraocular pressure (IOP), and iris neovascularization (INV) scores were recorded and compared among the 3 groups before and after operation, and then the postoperative pain relief and complications were observed. Results Through observation, there was no significant difference in the UCVA, IOP, and INV scores in the 3 groups before operation. After the operation, the UCVA, IOP, and INV scores of the 3 groups were significantly lower than those before operation. After operation, the UCVA of the 3 groups increased first and then decreased, and it improved most significantly in the 3rd month after operation and decreased in the 4th month after operation. There were significant differences in UCVA among the 3 groups at each time point after operation. From the 1st day to the 6th month after operation, the IOP of the 3 groups showed an upward trend, and there was no significant difference among the 3 groups in IOP at each time point after operation. At the 1st, 3rd, and 6th months after operation, the INV score of group A and group B was higher than that of group C. There was no significant difference in the INV score between group A and group B. The incidence of complications was not significantly different among the 3 groups. Conclusion 23G minimally invasive vitrectomy, glaucoma drainage valve implantation, and phacoemulsification cataract extraction can effectively improve the UCVA, IOP, and INV scores of NVG secondary to PDR with VH, and the combined application of the 3 methods has better security.

Distribution of Pigment Particles in Aqueous Drainage Structures in a DBA/2J Mouse Model of Pigmentary Glaucoma.

PurposeTo characterize the distribution of pigment particles in aqueous drainage structures of DBA/2J mice with different intraocular pressure (IOP) levels.MethodsDBA/2J mice were monitored from 9 to 44 weeks of age. IOP measurements were performed periodically. At 12, 20, 28, and 36 weeks, three mice were randomly selected for each time point and divided into three IOP groups. The morphology, size, and quantity of pigment particles in aqueous drainage structures were determined via transmission electron microscopy combined with ImageJ-based analysis. Between-group differences were evaluated with a one-way analysis of variance and Fisher's least significant difference test.ResultsIn the anterior chamber, 74.2% (187/252) of pigment particles were round (diameter range, 0.20–0.73 µm), and 25.8% (65/252) were oval (length range, 0.35–1.20 µm ). In the high-IOP group (IOP≥15 mmHg), pigment particles in the trabecular meshwork (TM) were more abundant and larger in size than those in the normal-IOP group (P<0.001). All separate pigment particles in the TM of the high-IOP group were >0.4 µm in size. The diameters of round (IOP≤10 mmHg, 0.44±0.13 µm; IOP between 10 and 15 mmHg, 0.57±0.13 µm; IOP≥15 mmHg, 0.61±0.12 µm) and the lengths of oval (0.65±0.14 µm vs. 0.77±0.12 µm vs. 0.88±0.15 µm, respectively) pigment particles in the TM differed among groups (F=27.258 and F=27.295, respectively; both P<0.001). No such differences were discovered in the iris and around Schlemm's canal (P>0.05).ConclusionsIn DBA/2J mice, large and medium pigment particles (>0.4 µm) seem to play an important role in causing aqueous outflow obstruction and IOP elevation.

Comparison between the values of intra-ocular pressure measured by Goldmann applanation tonometer and Air-Puff non-contact tonometer and their relationship with central corneal thickness.

Glaucoma is a sight threatening disorder in which measuring intra-ocular pressure (IOP) with accuracy plays a fundamental role. This study aimed to compare the IOP values air-puff of non-contact tonometer(APT) and Goldmann applanation tonometer (GAT) along with their relationship to central corneal thickness (CCT), in various IOP groups. Three hundred and eleven patients were enrolled using convenience sampling in this cross-sectional, prospective study. IOP was measured with Keeler 3000 APT and GAT along with CCT using TOMEY EM-4000. Data was analysed using Bland-Altman, Spearman's and intra-class correlation analysis of APT, GAT and CCT on SPSS 24.0. The median IOP by APT and GAT was 14 mmHg (range:37) and 12 mmHg (range:16) whereas the median CCT was 534µ (range: 44), respectively. At low (<10 mmHg) and normal IOP (10-20 mmHg) both the instruments showed similar results but GAT was found to be more accurate (p£0.001) at higher IOP (21-30 mmHg). However, at moderate and higher groups of IOP, APT revealed overestimation of IOP compared to GAT. CCT also plays a significant role.