Peak Intraocular Pressure Research Articles

Intereye Symmetry of 24-Hour Intraocular Pressure-related Patterns in Untreated Glaucoma Patients Using a Contact Lens Sensor.

Scarce data are available on the symmetry of 24-hour intraocular pressure (IOP) variations between fellow eyes of glaucoma patients, and such evidence could have profound consequences on the interpretation of monocular therapeutic trials. The objective is to evaluate the intereye correlation of continuously measured circadian IOP-related patterns in untreated glaucoma patients. In this single-center prospective study, a total of 29 untreated patients with open-angle glaucoma underwent bilateral ambulatory 24-hour monitoring of IOP-related patterns using a contact lens sensor (CLS; SENSIMED Triggerfish). IOP was measured before and after CLS monitoring using Goldmann applanation tonometry. Intereye agreement of 24-hour patterns was calculated using Spearman correlation (r) of raw data and after cosinor rhythmometry modeling. Complete bilateral CLS data could be obtained in 20 patients (mean age: 55.5±15.7 y; 51.7% women). On average, intereye correlation was r=0.76±0.19 (range: 0.16 to 0.95) and r=0.77±0.15 (range: 0.49 to 0.91), after excluding 8 patients with lower quality recordings. Cosine rhythmometry modeling showed mean acrophases occurring at 4:21±2:20 AM in left eyes and 3:39±1:50 AM in right eyes (r=0.48; P=0.034). Mean acrophase amplitude was 110.9±51.9 for left eyes and 107.8±46.2 for right eyes (r=0.79; P<0.001). No serious adverse events related to CLS monitoring were recorded. Transient conjunctival hyperemia (13 patients) and blurred vision (11 patients) were the most frequent adverse events. In this group of untreated glaucoma patients, there was good intereye agreement for circadian IOP-related patterns using the CLS. These results show a higher degree of intereye symmetry, in terms of IOP peak timings and amplitudes, than previously reported with standard tonometry.

Glaucomatous Progression After Lens Extraction in Primary Angle Closure Disease Spectrum.

Substantial proportion of primary angle closure glaucoma (PACG) eyes showed glaucomatous worsening after successful lens extraction and intraocular pressure (IOP) control, which may suggest that an earlier intervention may be required to prevent PACG. The purpose of this study was to investigate the longitudinal clinical course of the primary angle closure (PAC) disease spectrum, including PAC, primary angle closure suspect (PACS), and PACG patients, who underwent lens extraction. This retrospective observational study included 77 eyes from patients with PACS, PAC, and PACG who underwent lens extraction and were followed up for >2 years after surgery. The mean, peak, and fluctuation of IOP were analyzed before and after lens extraction among groups. Visual field (VF) mean deviation was compared immediately after lens extraction and the final follow-up. Postoperative glaucoma progression determined by 3 criteria (optic disc/retinal nerve fiber layer photographs, optical coherent tomography, and VF) was compared among the 3 groups. Seventeen PACS, 24 PAC, and 36 PACG eyes were included. The mean and peak IOP, and IOP fluctuation IOP were significantly reduced postoperatively in all groups. Postoperative VF mean deviation was significantly aggravated only in the PACG group (from -7.26 to -8.82 dB, P<0.001). The prevalence of postoperative glaucoma progression by at least 1 criterion was significantly higher in PACG, and none of the eyes with PACS and PAC showed VF conversion (PACS, PAC, PACG; 11.8%, 12.5% vs. 61.1% in disc/retinal nerve fiber layer, 11.8%, 8.3% vs. 63.9% in optical coherent tomography, 0%, 0% vs. 33.3% in VF, all P<0.001). In the PAC spectrum, lens extraction achieved significant IOP reduction. However, despite IOP control, a substantial proportion of PACG eyes showed glaucomatous progression. This result may suggest that lens extraction should be performed early to prevent PACG.

Initial experience in self-monitoring of intraocular pressure.

Background/aimsDiurnal variation in intraocular pressure (IOP) is a routine assessment in glaucoma management. Providing patients the opportunity to perform self-tonometry might empower them and free hospital resource. We previously demonstrated that 74% of patients can use the Icare® HOME tonometer. This study further explores Icare® HOME patient self-monitoring.MethodsPatients were trained by standard protocol to use the Icare® HOME rebound tonometer. Patient self-tonometry was compared to Goldmann applanation tonometry (GAT) over one clinical day. Following this, each patient was instructed to undertake further data collection that evening and over the subsequent two days.ResultsEighteen patients (35 eyes) participated. Good agreement was demonstrated between GAT and Icare® HOME for IOPs up to 15 mm Hg. Above this IOP the Icare® tended to over-read, largely explained by 2 patients with corneal thickness >600 um. The mean peak IOP during ‘clinic hours’ phasing was 16.7 mm Hg and 18.5 mm Hg (p = 0.24) over three days. An average range of 5.0, 7.0 and 9.8 mm Hg was shown during single day clinic, single day home and three day home phasing respectively (p =<0.001). The range of IOP was lower in eyes with prior trabeculectomy (6.1 mm Hg vs 12.2 mm Hg). All patients undertook one reading in the early morning at home with an average of 4.8 readings during, and 3.1 readings after office hours.ConclusionsThis small study shows that self-tonometry is feasible. The findings from home phasing demonstrated higher peak and trough IOPs, providing additional clinical information. Home phasing is a viable alternative. The cost-effectiveness of this approach has yet to be addressed.

Analysis of Retinal Vessel Pulsations with Electrocardiographic Gating.

The origin of retinal venous pulsations has been a matter of debate for some time. One classical explanation to the origin of these pulsations has been that the cardiac cycle induces systolic peaks in the intraocular pressure (IOP) which leads to decreases in retinal vein diameters. Recently, theoretical concepts have been published which postulate that IOP changes during the pulse cycle is not the primary driving force for venous pulsation, and hence, predict that the retinal vein diameter is indeed reduced during IOP diastole. The aim of the study was to test this hypothesis in a clinical trial. Continuous IOP and retinal vessel analyser (RVA) measurements were taken from 21 subjects, ages 20 to 30 years, with no known ophthalmologic diseases, while connected to a standard electrocardiograph (ECG). With this methodology, average and synchronised curves for the pulse cycle of IOP and retinal vessel pulsations were calculated for each subject. Each pulse cycle was standardised to 50 timepoints, which enabled direct phase shift comparisons. All subjects showed comparable results. Close to the optic disc (within 0 to 1.5 optic disc diameters away from the disc), retinal arteries led with the first peak at the 16/50 pulse cycle position, followed by IOP peak at the 23/50 cycle position, and then by veins at the 26/50 cycle position. The present method indeed shows that retinal veins do not collapse when the IOP is highest, on the contrary, IOP and retinal vein diameters seem to be in phase, which lends support to the hypothesis that IOP is not the major driving force of the retinal vein pulsations.

Correlation Between Office-Hour and Peak Nocturnal Intraocular Pressure in Patients Treated with Prostaglandin Analogs

To test the hypothesis that the correlation between office-hour intraocular pressure (IOP) and peak nocturnal IOP is weakened after using a prostaglandin analog. Before-and-after study. Twenty-four-hour IOP data obtained in a sleep laboratory of 51 patients (22 patients with open-angle glaucoma and 29 patients with ocular hypertension) were reviewed. Patients had no IOP-lowering medication upon study entry and were then treated with prostaglandin monotherapy for 4weeks. Measurements of IOP were taken every 2 hours in the sitting and supine positions during the diurnal/wake period (7:30 AM-9:30 PM) and in the supine position during the nocturnal/sleep period (11:30 PM-5:30 AM). Individual and average IOP readings during office hours (9:30 AM-3:30 PM) and peak IOP during the nocturnal/sleep hours were analyzed using the Pearson correlation coefficient and linear regression. There were statistically significant correlations for all the paired variables for the analyses. Average office-hour IOP had a higher correlation with peak nocturnal IOP than individual office-hour IOP. After the treatment with prostaglandin analog, the correlation between average office-hour IOP and nocturnal peak IOP in the sitting position (r= 0.373) and the supine position (r= 0.386) were reduced from the sitting baseline (r= 0.517) and the supine baseline (r= 0.573) in right eyes. Similar change patterns appeared in left eyes. There is a correlation between office-hour IOP reading and peak nocturnal IOP under no IOP-lowering treatment as well as under prostaglandin monotherapy. The strength of correlation was weaker under the treatment compared with baseline.

Effects of different types of music on intraocular pressure and the underlying mechanism

Objective: To explore the effect of listening to different types of music on intraocular pressure (IOP) and the underlying mechanism. Methods: Cross-sectional study. Participants were students from Sun Yat-sen University from October 2017 to May 2018. The study consisted of two parts. In part 1, three types of music, including relaxing, positive and negative music, were used to find out which kind of music could reduce IOP. IOP was measured before and after listening to music. A self-report questionnaire was used to evaluate emotional responses to each type of music. In part 2, the diurnal curve of IOP at 6 time points of 7:30, 9:30, 11:30, 13:30, 15:30 and 17:30 was measured to determine when the individual's IOP peaked. On the second day, the subject listened to the music that could reduce IOP for 15 minutes at his/her IOP peak time. IOP, blood pressure (BP) and heart rate (HR) were measured, and morphology of the chamber angle was captured by swept-source optical coherence tomography before and after listening to music. Image J software was used to measure the diameter and cross-sectional area of Schlemm's canal (SC). Paired t-test was used to compare BP, HR and SC measurements prior to and post-music intervention. Results: In part 1, fifteen subjects, including 7 males and 8 females, were enrolled, with an average age of (23±1) years. Relaxation music could significantly lower IOP [(11.62±2.51) vs. (12.65±2.49) mmHg (1 mmHg=0.133 kPa) , t=-2.39, P=0.032]. Positive music had no effect on IOP [(12.45±2.77) vs. (12.65±2.46) mmHg, P=0.566] and negative music increased IOP [(12.13±1.60) vs. (10.86±2.78) mmHg, t=2.45, P=0.029]. Relaxation music could also arouse relaxation emotions in 14 out of 15 subjects. In part 2, 55 subjects, including 20 males and 35 females, were enrolled, with an average age of (26±10) years. The diurnal curve of IOP at 6 time points of every participant was measured. At each individual's peak time point, listening to relaxation music could decrease IOP [(12.66±4.32) vs. (13.99±4.47) mmHg, t=-5.72, P<0.01]. HR before and after listening to relaxation music was (79.57±10.43) and (75.57±9.62) beats/min, respectively (t=-3.68, P=0.001). Systolic BP was (118.11±13.92) and (110.82±12.67) mmHg, respectively (t=-5.10, P<0.01). Diastolic BP significantly declined from (70.07±9.96) to (66.14±8.48) mmHg (t=-3.65, P=0.001). Average SC area significantly increased after listening to relaxation music [(255.96±93.36) vs. (230.07±92.20) pixels, t=2.88, P=0.006]. Average SC diameter was (8.62±1.89) and (9.41±2.37) pixels, respectively before and after listening to relaxation music (t=3.39, P=0.001). Conclusion: Relaxation music reduces IOP in healthy subjects probably by dilating the SC.(Chin J Ophthalmol, 2020, 56: 25-31).

OCULAR HYPERTENSION AFTER INTRAVITREAL INJECTION OF 2-MG TRIAMCINOLONE.

To report the incidence and course of ocular hypertension after intravitreal injection of 2-mg triamcinolone acetonide (IVT). In a retrospective, consecutive series, all patients receiving 2-mg IVT at a single institution between March 1, 2012, and March 1, 2017, with a minimum of 3-month follow-up were reviewed. Ocular hypertension was defined as an intraocular pressure (IOP) measurement over 24 mmHg at any follow-up visit after IVT. Patients receiving topical, periocular, or intravitreal corticosteroid other than 2-mg IVT were excluded. A total of 106 eyes in 100 patients receiving at least one injection of 2-mg IVT were included. Eyes received an average of 2.9 injections (range 1-17), and average patient follow-up was 15.1 months (range 3.0-52.5 months). A total of 14 eyes (13.2%) in 14 patients developed ocular hypertension after a median of 1.5 injections (range 1-9) with an average peak IOP of 29 mmHg (range 25-38 mmHg). Overall, a total of 11 eyes (10.4%) had an IOP elevation ≥10 mmHg above baseline at any point after first IVT. In all cases of ocular hypertension, IOP was successfully managed with observation or topical IOP-lowering medication alone; no patients required surgical intervention. Ocular hypertension developed in 13.2% of eyes receiving intravitreal injection of 2-mg triamcinolone acetonide. Incidence of ocular hypertension after 2-mg IVT compares favorably with other intravitreally administered corticosteroids.

Relationship between optic disc hemorrhage and corneal hysteresis

ObjectiveTo determine the relationship between optic disc hemorrhage (DH) and corneal hysteresis (CH). MethodsConsecutive patients with prior or current photographic evidence of unilateral DH who had undergone CH measurement with the Ocular Response Analyzer (ORA; Reichert, Buffalo, NY) were enrolled. Eyes with a history of corneal disease, refractive surgery, or bilateral DH were excluded. Central corneal thickness (CCT), visual field data, 5 consecutive previous intraocular pressures (IOPs), and maximum documented peak IOP were obtained by chart review. Vertical cup-to-disc ratio (VCDR), the presence of neuroretinal rim notching, number of clock hours of beta zone parapapillary atrophy (ßPPA), and eye with greater ßPPA width were determined from photographs by 2 masked expert examiners. ResultsWe identified and analyzed 49 patients with photographically documented unilateral DH. Compared to fellow non-DH eyes, eyes with DH had lower CH (8.7 ± 1.9 vs 9.2 ± 1.7; p = 0.002), higher IOP (15.6 ± 3.6 vs 14.3 ± 4.1; p = 0.017), and greater VCDR (0.79 ± 0.13 vs 0.68 ± 0.23; p < 0.001), but were similar with respect to CCT, ßPPA extent, rim notching, peak IOP, and visual field damage (all p > 0.05). Using multivariate conditional logistic regression analysis, only CH (p = 0.012) and VCDR (p = 0.004) predicted the laterality of the DH. ConclusionsLower CH and greater VCDR are independently associated with DH. This suggests that CH may be a structural biomarker for an abnormality of the optic nerve complex that may be associated with progressive glaucoma. Eyes in which DH were detected had lower CH.

The impact of oral escitalopram treatment on the function of retinal interneurons in the rat model of retinal ischemia – a pilot study

AbstractPurposeTo evaluate the impact of oral treatment with SSRI – escitalopram (EC) on the function of interneurons (IN) assessed in electroretinography.MethodsSix Long Evans rats were treated orally with SSRI‐escitalopram (n=3) or phosphate buffered saline‐PBS (n=3) for 6 weeks daily. After 4 weeks transient elevation of intraocular pressure (IOP) was inducted in the right eye of every rat in order to induce retinal ischemia (IC). Electroretinography (ERG) was performed using Celeris device and oscillatory potentials were analysed (OPs) in 4 time points ‐ before drug administration, before IC induction and 7 &amp; 14 days after it. After 6 weeks rats were sacrificed, retinas were isolated in order to conduct the histological assessment and cell counts. Western Blot analysis was performed in order to assess BDNF and connexin 36 content in retinas and brains.ResultsThe mean peak IOP was 24 mmHg in the right eye and 12 mmHg in the left eye and was similar in treated and control groups. In both groups no loss of RGC density was noted between the eye with induced IC and the healthy one (80 ± 31 vs 76 ± 20 cells/visual field for EC and 55 ± 10 vs 55 ± 11 for PBS; p &gt; 0.05). In the functional measurements in the EC group amplitudes of all scotopic OPs (OP1‐5) were significantly higher 14 days after IC induction when compared to control group (p &lt; 0.05), where deep disturbance of IN function was observed, specifically for OP2‐4, expressed in significant reduction of OP amplitudes (p &lt; 0.05). Similar changes were not observed in photopic conditions.ConclusionsOral treatment with EC prevents desynchronization of retinal IN function during ischemic conditions in a rat. Observations presented above may become crucial for new therapeutic methods for vascular pathologies of the retina.

Relationship between preoperative high intraocular pressure and retinal nerve fibre layer thinning after glaucoma surgery

Recent reports show varying results regarding peripapillary retinal nerve fibre layer (RNFL) thickness after intraocular pressure (IOP)-lowering glaucoma surgery. We hypothesised that different levels of the preoperative IOP influence RNFL thickness. A total of 60 patients (60 eyes) with glaucoma, who underwent glaucoma surgery and had a stable postoperative mean IOP < 22 mmHg, were enrolled. The RNFL thickness was measured using spectral domain optical coherence tomography, before and at 3–6 months after surgery. The preoperative peak IOP, 37.4 ± 10.8 mmHg, decreased to a postoperative mean IOP of 14.8 ± 3.5 mmHg (p < 0.001). The average RNFL thickness was significantly reduced from 75.6 ± 17.7 μm to 70.2 ± 15.8 μm (p < 0.001). In subgroup analyses, only patients with a preoperative peak IOP ≥ median value (37 mmHg) exhibited significant RNFL thinning (9.7 ± 6.6 μm, p < 0.001) associated with a higher preoperative peak IOP (r = 0.475, p = 0.008). The RNFL thinning was evident for a few months after glaucoma surgery in patients with a higher preoperative peak IOP, although the postoperative IOP was stable.

Role of 24-Hour Intraocular Pressure Monitoring in Glaucoma Management.

Glaucoma is the leading cause of irreversible blindness worldwide and the prevalence is on the rising trend. Intraocular pressure (IOP) reduction is the mainstay of treatment. The current practice of IOP monitoring is based on spot measurements during clinic visits during office hours. However, there are up to 50% of glaucoma patients who had normal initial IOP, while some treated patients continued to have progressive glaucomatous optic nerve damage even with a low IOP. Recent studies have shown that the IOP of glaucoma patients fluctuated during the day with different patterns, and some of them had peak IOP outside office hours. These findings provided us with new insights on the role of 24-hour IOP monitoring in managing normal tension glaucoma and patients with progressive deterioration despite apparently well-controlled IOP. Nevertheless, results to date are rather inconsistent, and there is no consensus yet. In this review, we briefly highlighted the current modalities of 24-hour IOP monitoring and summarized the characteristic 24-hour IOP pattern and the clinical relevance of IOP parameters in predicting glaucomatous progression in different glaucoma subtypes. We also discussed the therapeutic efficacy of current glaucoma treatment modalities with respect to the mentioned 24-hour IOP profiles, so as to strengthen the role of 24-hour IOP monitoring in identifying and stratifying the risks of progression in glaucoma patients, as well as optimizing treatments according to their IOP profiles.

Δ9-Tetrahydrocannabinol Derivative-Loaded Nanoformulation Lowers Intraocular Pressure in Normotensive Rabbits.

PurposeΔ9-Tetrahydrocannabinol-valine-hemisuccinate, a hydrophilic prodrug of Δ9-tetrahydrocannabinol, synthesized with the aim of improving the ocular bioavailability of the parent molecule, was investigated in a lipid-based nanoparticle dosage form for ocular delivery.MethodsSolid lipid nanoparticles (SLNs) of Δ9-tetrahydrocannabinol-valine-hemisuccinate and Δ9-tetrahydrocannabinol, along with a nanoemulsion of Δ9-tetrahydrocannabinol-valine-hemisuccinate, were tested for glaucoma management in a normotensive rabbit model by using a multiple-dosing protocol. Marketed formulations of timolol maleate and pilocarpine HCl were also tested for their pharmacodynamic profile, post-single dose administration.ResultsA peak intraocular pressure (IOP) drop of 30% from baseline was observed in rabbits treated with SLNs loaded with Δ9-tetrahydrocannabinol-valine-hemisuccinate at 90 minutes. Treated eyes of rabbits receiving Δ9-tetrahydrocannabinol-valine-hemisuccinate SLNs had significantly lower IOP than untreated eyes until 360 minutes, whereas the group receiving the emulsion formulation showed a drop in IOP until 90 minutes only. In comparison to marketed pilocarpine and timolol maleate ophthalmic solutions, Δ9-tetrahydrocannabinol-valine-hemisuccinate SLNs produced a greater effect on IOP in terms of both intensity and duration. In terms of tissue concentrations, significantly higher concentrations of Δ9-tetrahydrocannabinol-valine-hemisuccinate were observed in iris-ciliary bodies and retina-choroid with SLNs.ConclusionΔ9-Tetrahydrocannabinol-valine-hemisuccinate formulated in a lipid-based nanoparticulate carrier shows promise in glaucoma pharmacotherapy.Translational RelevanceGlaucoma therapies usually focus on decreased aqueous humor production and increased outflow. However, such therapy is not curative, and there lies a need in preclinical research to focus efforts on agents that not only affect the aqueous humor dynamics but also provide neuroprotection. Historically, there have been bench-scale studies looking at retinal ganglion cell death post-axonal injury. However, for a smooth translation of this in vitro activity to the clinic, animal models examining IOP reduction, i.e., connecting the neuroprotective activity to a measurable outcome in glaucoma management (IOP), need to be investigated. This study investigated the IOP reduction efficacy of cannabinoids for glaucoma pharmacotherapy in a normotensive rabbit model, bringing forth a new class of agents with the potential of IOP reduction and improved permeation to the back of the eye, possibly providing neuroprotective benefits in glaucoma management.

Corneal Biomechanics and Visual Field Progression in Eyes with Seemingly Well-Controlled Intraocular Pressure

To investigate the incidence and risk factors for glaucomatous visual field progression in eyes with well-controlled intraocular pressure (IOP). Prospective cohort. A total of 460 eyes of 334 patients with glaucoma under treatment. Study subjects had a mean follow-up of 4.3±0.8 years. Patients were classified as well controlled if all IOP measurements were less than 18 mmHg. Rates of visual field progression were calculated using ordinary least-squares linear regression of standard automated perimetry (SAP) mean deviation (MD) values over time. Progression was defined as a significantly negative MD slope (alpha= 0.05). Rates of SAP MD change; mean and peak IOP, and IOP fluctuation; and corneal biomechanics: corneal hysteresis (CH), central corneal thickness (CCT), and corneal index. Of the 179 eyes with well-controlled IOP, 42 (23.5%) demonstrated visual field progression. There was no significant difference between progressing and stable patients in baseline MD (-6.4±7.1 decibels [dB] vs.-6.0±6.2 dB; P= 0.346), mean IOP (11.7±2.0 mmHg vs. 12.1±2.3 mmHg; P= 0.405), IOP fluctuation (1.6±0.6 mmHg vs. 1.6±0.5 mmHg; P= 0.402), or peak IOP (14.3±1.9 mmHg vs. 14.6±2.1 mmHg; P= 0.926). Progressing eyes had significantly lower CH (8.6±1.3 mmHg vs. 9.4±1.6 mmHg; P= 0.014) and thinner CCT (515.1±33.1 μm vs. 531.1±42.4 μm; P= 0.018, respectively) compared with stable eyes. In the multivariate analysis, a 1 standard deviation lower corneal index, a summation of normalized versions of CH and CCT, resulted in a 68% higher risk of progression (odds ratio, 1.68; 95% confidence interval, 1.08-2.62; P= 0.021). Approximately one-quarter of eyes with well-controlled IOP may show visual field progression over time. Thin cornea and low CH are main risk factors.

IOP Lowering Effects of Ocimum basilicum Seed Extract in Two Rabbit Models of Ocular Hypertension

Introduction: Ocimum basilicum (OB), a herb known for its antihypertensive, anticholinesterase and antioxidant properties was investigated for possible intraocular pressure (IOP) lowering effects in rabbits with ocular hypertension (OHT). Methods: The IOP lowering effect of a single drop of OB extract (OBE) was evaluated in oculonormotensive rabbits using three concentrations (0.25, 0.5 and 1% w/v). The concentration showing maximum IOP reduction was further evaluated in rabbits with water-loading and steroid-induced OHT. Results: IOP lowering effect of OBE 0.5% in oculonormotensive rabbit eyes was significantly greater compared to OBE 0.25% (p&lt;0.05) but was comparable (p&gt;0.05) to OBE 1%. Therefore, 0.5% concentration was selected for further evaluation. Pretreatment with OBE (0.5%) caused significantly lower increase in IOP after water loading amounting to 23.39% above baseline as compared to 54.00% in control eye, 15 minutes post water loading. At 60 minutes, post water loading, mean IOP rise was 95.12% and 63.58% in control and test eyes, respectively. Significant difference between the mean IOP of two eyes persisted during the 2nd hr. In rabbits with steroid induced OHT, OBE 0.5% produced a mean IOP reduction of 24.73% at the end of first hr and the mean peak IOP reduction of 31.63% was observed at the end of 2 hr. A significant difference between the IOP of test and control eyes persisted from 1 to 6 hr. Conclusions: Ocimum basilicum seed extract showed significant IOP lowering effect in rabbits with water loading and steroid induced OHT, however, its utility as an effective antiglaucoma medication needs further investigations.

Risk Factors for Fast Visual Field Progression in Glaucoma

To identify baseline and longitudinal risk factors for fast visual field (VF) decay in patients with open-angle glaucoma. Retrospective cohort study. Patients with open-angle glaucoma with ≥6 VFs and ≥4 years of follow-up were included. VF decay rates were measured with the following methods: mean deviation (MD) rate, VF index (VFI) rate, and the Glaucoma Rate Index (GRI). The relationship between VF rates and clinical variables were investigated with linear mixed models. Logistic regression analysis was performed to determine which factors were associated with fast progression. A total of 1317 eyes of 745 patients with a mean (± SD) age of 63.3 (±10.9) years and a median (interquartile range) MD-2.4 (-0.7 to-5.6) dB at baseline were analyzed. The median (interquartile range) number of VFs was 12 (9 to 16), and mean follow-up duration was 11.5 (±3.7) years. Older age (P < .001), higher peak intraocular pressure (IOP) (P < .001), and glaucoma surgery during the study period (P < .001) were associated with faster rates of progression regardless of the method used. Worse baseline MD was associated with MD rate (P= .02), but neither with VFI rate (P=.37) nor GRI (P= .31); whereas pseudoexfoliative glaucoma was associated with faster rates of progression with MD (P = .008) and VFI (P = .01) rates, but not with GRI. Higher peak IOPs (P= .005) was a significant predictor for fast progression. In this cohort, older age, peak IOP, pseudoexfoliative glaucoma, and baseline MD were associated with the rate of glaucomatous VF worsening. Fast progressors had a higher peak IOP than non-fast progressors. The identification and appropriately aggressive treatment of fast progressors would reduce visual disability from glaucoma.

Significance of dynamic contour tonometry in evaluation of progression of glaucoma in patients with a history of laser refractive surgery

AimsIn this study, we tested the hypothesis that intraocular pressure (IOP) parameters measured by dynamic contour tonometry (DCT) would be more relevant in progression of glaucoma when there is a...

Self-monitoring of intraocular pressure using Icare HOME tonometry in clinical practice.

Purpose: To determine the value of self-monitoring of diurnal intraocular pressure (IOP) by Icare Home rebound tonometer in patients with glaucoma and ocular hypertension.Methods: Patients with open-angle glaucoma or ocular hypertension, controlled IOP at office visits, and at least 3 years of follow-up in the glaucoma clinic were included. Progression of glaucoma was based on medical records and defined by documented structural and/or visual field change. Patients were trained to correctly perform self-tonometry and instructed to measure diurnal IOP in a home setting for 3 days. IOP characteristics (mean, peak IOP, fluctuation of IOP as range, and SD of IOP) were documented and compared between the progressive and stable eyes.Results: Ninety-four patients (50 females) with a mean (SD) age of 57.1 (14.7) years were included. Among the 94 eyes from 94 subjects, 72 (76.6%) eyes had primary open-angle glaucoma, ten (10.6%) had pigmentary glaucoma, four (4.3%) had exfoliative glaucoma, and eight (8.5%) eyes had ocular hypertension. Thirty-six eyes showed progression and 58 eyes were stable. Patients with progression were older than those with stable disease (mean (SD) 65.8 (8.4) years vs 51.7 (15.3) years, P<0.001). The progression group had higher average IOP (mean (SD) 15.8 (4.0) mmHg vs 13.3 (3.7) mmHg, P=0.002), peak IOP (mean (SD) 21.8 (5.8) mmHg vs 18.6 (4.8) mmHg, P=0.01), and greater IOP fluctuation range (mean (SD) 11.6 (4.8) vs 9.1 (3.5) mmHg, P=0.011) compared to non-progression group.Conclusion: Self-monitoring of IOP using Icare Home tonometry provides more complete data on variability of IOP to assist in the management of glaucoma.

216 Risk Stratification of Orbital Compartment Syndrome: A Comparison of Intra-Ocular Pressure and the Baux Score

Early fluid resuscitation is a mainstay in acute burn care. Aggressive fluid therapy in significant thermal burns can lead to third spacing of fluid into the orbit thus increasing the risk of orbital compartment syndrome. The Baux score is a simple tool often used in burn care to help predict mortality and thus indicate severity of the burn. This study aims to quantify the intra-ocular pressures (IOP) as it relates to the patient’s Baux score, in an effort to stratify the risk for orbital compartment syndrome. This study is a retrospective analysis of 70 patients with thermal burns at a level one burn center. The initial Baux score was noted for each patient as well as the highest measured IOP within the first 72 hour period. Linear regression was used to test for an association between peak intraocular pressure and the Baux score. Patients requiring orbital decompression were compared with those who did not, using the Fisher exact test. Eleven of 70 patients required emergent orbital decompression with a lateral canthotomy and cantholysis and had a higher Baux score than patients who did not receive the procedure (p = 0.03). The average IOP was 18.7 +/- 5mmHg but patients who underwent an orbital decompression all had IOP greater than 40. There was a positive relationship between the Baux score and IOP for Baux scores greater than 70; however, this was no longer statistically significant when adjusted for periocular burns. The risk of orbital compartment syndrome linearly increases with beaux scores greater than 70 and additionally in patients with periocular burns. As such, a high index of suspicion and early evaluation by an ophthalmologist is warranted in these patients to preserve vision. An elevated Beaux score can predict the necessity for ophthalmic intervention in patients at a high risk for vision loss secondary orbital compartment syndrome

Telemetric Intraocular Pressure Monitoring after Boston Keratoprosthesis Surgery Using the Eyemate-IO Sensor: Dynamics in the First Year

To analyze the dynamics of telemetrically measured intraocular pressure (IOP) during the first year after implantation of a Boston keratoprosthesis type I (BI-KPro) cornea and to compare agreement of telemetric IOP measurements with finger palpations. Prospective, open-label, multicenter, single-arm clinical trial. In the ARGOS (NCT02945176) study, 12 individuals underwent implantation of an Eyemate-IO intraocular system. Follow-up after surgery took place 12months later with 13 visits planned per patient. During BI-KPro surgery, an electromagnetic induction sensor ring enabling telemetric IOP data transfer to a hand-held reading device outside the eye was implanted into the ciliary sulcus with or without trans-scleral suture fixation. Comprehensive ophthalmic examinations and IOP assessments through the telemetric system were compared to IOP assessed by finger palpation by 2 experts. Preoperative IOP measured by Goldmann tonometry was 13.4 ± 6.2mm Hg. Telemetric IOP peaked at 23.1 ± 16.5mm Hg at the first postoperative day. On day 5, mean IOP was 16.0 ± 5.2mm Hg and 20.95 ± 6.5mm Hg after 6-12months. IOP estimation by finger palpation was grouped in 4 categories: normal, A; soft/hypotonic, B; borderline, C; and hypertonic, D. Mean telemetric IOP was 18.2 ± 6.1mm Hg in category A, 8.9 ± 2.8mm Hg in B, 22.4 ± 4.9mm Hg in C, and 34.3 ± 11.0mm Hg in D. Differences in mean telemetric IOPs per category were statistically significant (P < .001). Daily IOP fluctuations and peaks could be identified. Telemetric IOP assessment seems to be able to identify postoperative IOP peaks and a longitudinal increase of IOP after BI-KPro surgery. IOP measurements using the telemetric Eyemate-IO sensor showed a satisfactory agreement with those of finger palpations by 2 experts.

Cataract Surgery and Rate of Visual Field Progression in Primary Open-Angle Glaucoma

To test the hypothesis that cataract surgery slows the apparent rate of visual field (VF) decay in primary open-angle glaucoma patients compared with rates measured during cataract progression. Retrospective cohort study. Consecutive open-angle glaucoma patients who underwent cataract surgery and who had ≥4 VFs and ≥3 years of follow-up before and after surgery were retrospectively reviewed. Mean deviation (MD) rate, visual field index (VFI) rate, pointwise linear regression (PLR), pointwise rate of change (PRC), and the Glaucoma Rate Index (GRI) were compared before and after cataract surgery. A total of 134 eyes of 99 patients were included. Median (interquartile range) follow-up was 6.5 (4.7-8.1) and 5.3 (4.0-7.3) years before and after cataract surgery, respectively. All intraocular pressure (IOP) parameters (mean IOP, standard deviation of IOP, and peak IOP) significantly improved (P < .001) after cataract surgery. All VF indices indicated an accelerated VF decay rate after cataract surgery: MD rate (-0.18 ± 0.40 dB/year vs -0.40 ± 0.62 dB/year, P < .001), VFI rate (-0.44% ± 1.09%/year vs -1.19% ± 1.85%/year, P < .001), GRI (-5.5 ± 10.8 vs -13.5 ± 21.5; P < .001), and PRC (-0.62% ± 2.47%/year before and -1.35% ± 3.71%/year after surgery; P < .001) and PLR (-0.20 ± 0.82 dB/year before and -0.42 ± 1.16 dB/year after surgery; P < .001) for all VF locations. Worse baseline MD and postoperative peak IOP were significantly associated with the postoperative VF decay rate and the change in the decay rate after cataract surgery. Although all IOP parameters improved after cataract surgery, VFs continued to progress. Cataract surgery does not slow the apparent rate of glaucomatous VF decay as compared to rates measured during the progression of the cataract.