Elevated IOP Research Articles

Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review.

BackgroundUveitis is a group of intraocular inflammatory diseases whose primary treatment involves immunosuppression. Although corticosteroids (CSs) remain the mainstay therapy, sirolimus is among the recently studied immunomodulatory drugs for treating noninfectious uveitis (NIU).ObjectiveThe aim of this review was to assess and summarize the updated evidence on the outcomes of treatment with sirolimus for NIU.Materials and methodsTwo reviewers conducted a systematic search on November 5, 2018, of electronic databases (EMBASE, MEDLINE, and The Cochrane Library) and clinical trial registers having no restrictions on language or publication date. The primary outcome was uveitis activity as measured by vitreous haze (VH), while the secondary outcomes included central macular thickness (CMT), best-corrected visual acuity (BCVA), CS-sparing effect, IOP elevation, and other adverse events. A meta-analysis was conducted on selected studies with appropriate clinical and methodological homogeneity.ResultsSeven studies were included and reviewed. Four randomized clinical trials were eligible for meta-analysis: SAVE 2013, One-year outcomes of the SAVE study, SAVE 2 2016, SAKURA 2016. The pooled proportions of inflammation control (VH improvement) were 38% (95% CI 16.19%–62.66%) during a 6-month follow-up and 49.97% (95% CI 16.19%–83.03%) during a 6- to 12-month follow-up with the latter showing a significantly higher response rate (p=0.0472). BCVA improvement was 62.2% (95% CI 33.17%–87.11%) during a 6-month follow-up and 56.86% (95% CI 20.91%–89.05%) during a 6- to 12-month follow-up with no significant difference between the two (p=0.3705). Increased IOP remained at 7.11% (95% CI 3.46%–12.68%) for both a 6-month follow-up and up to a 12-month follow-up duration. The CS-sparing effect of sirolimus was also well demonstrated. A reduction in CMT was observed, and only minor drug-related adverse events were reported in all the studies reviewed.ConclusionThis review provided evidence that sirolimus is a promising treatment option for controlling inflammatory activity, improving visual acuity, and sparing CS use with minor adverse events for NIU.

Effect of Graft Attachment Status and Intraocular Pressure on Descemet Stripping Automated Endothelial Keratoplasty Outcomes in the Cornea Preservation Time Study

To examine the association of donor, recipient, and operative factors on graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS) as well as the effects of graft dislocation and elevated IOP on graft success and endothelial cell density (ECD) 3 years postoperatively. Cohort study within a multi-center, double-masked, randomized clinical trial. 1090 individuals (1330 study eyes), median age 70 years, undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (6% of eyes). Recipient eyes receiving donor corneal tissue randomized by preservation time (PT) of 0-7 days (N = 675) or 8-14 days (N = 655) were monitored for early or late graft failure through 3 years. Donor, recipient, operative, and postoperative parameters were recorded including graft dislocation (GD), partial detachment, and pre- and post-operative IOP. Pre- and postoperative central donor ECD were determined by a central image analysis reading center. Proportional hazards, mixed effects, and logistic regression models estimated risk ratios and (99% confidence intervals). Three independent predictive factors for GD were identified: a history of donor diabetes (odds ratio [OR]: 2.29 [1.30, 4.02]), increased pre-lamellar dissection central corneal thickness (OR: 1.13 [1.01, 1.27] per 25µ increase), and operative complications (OR: 2.97 [1.24, 7.11]). Among 104 (8%) eyes with GD, 30 (28.9%) developed primary donor or early failure and 5 (4.8%) developed late failure vs. 15 (1.2%; P < .001) and 29 (2.4%; P = .04), respectively, of 1226 eyes without GD. 24 (2%) of 1330 study eyes had early acutely elevated postoperative IOP that was associated with a higher risk of graft failure through 3 years (hazard ratio: 3.42 [1.01, 11.53]), but not with a lower mean 3-year ECD (mean difference 61 (-479, 601) cells/mm2, P = .77). History of elevated postoperative IOP beyond 1 month was not significantly associated with 3-year graft success or ECD. Donor diabetes, increased donor corneal thickness, and intraoperative complications were associated with an increased risk of GD. Early acutely elevated postoperative IOP and GD significantly increased the risk for graft failure following DSAEK.

Optical Coherence Tomography Angiography of Optic Disc Perfusion in Primary Open Angle Glaucoma

AbstractBackground: Glaucoma is a major disease that potentially results in irreversible blindness. Optical coherence tomography angiography (OCTA) is a novel technique for evaluation of retinal vascular changes. Using OCTA have provided useful information about the papillary and peripapillary microvas-culature. Optic nerve head perfusion measurements.Aim of Study: To investigate optic disc perfusion differ-ences between normal and primary open angle glaucoma eyes using optical coherence tomography angiography (OCTA).Methods: This prospective comparative cross-sectional selective pilot study was performed on 15 eyes of 15 primary open angle glaucoma (POAG) patients and 20 eyes of 20 healthy age-matched controls. OCT and OCTA were performed using swept source TOPCON 3D OPTICAL COHERENCE TOMOGRAPHY DRI OCT Triton. The optic nerve head (ONH) was imaged with a 4.5x4.5mm scan and assessed in 4 different levels of segmentation; the superficial Papillary, deep papillary, outer retina level and choroidal level. Density map images gave qualitative data and quantitative assessment, these images were processed using Image J program (IJ 1.46 r edition) for determining vascular density index (VDI). The Central corneal thickness, retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), stereometric parameters cup/disc area, rim area, cup volume and visual field parameters [mean deviation (MD), pattern standard deviation (PSD) were tested for correlation with vascular density.Results: The vascular density index in the OCT angi-ograms, as a quantitative assessment, of the optic nerve head (ONH) perfusion was significantly lower in the glaucoma group when compared with the normal age matched control groups. This reduction was significant in POAG with average VDI was reduced by 6.29%. However, in qualitative assessment the dense microvascular network that was visible on OCTA in normal discs, was visibly attenuated with marked capillary drop out in subjects with glaucoma. This reduction in vascular density i.e. ischemia may have a primary element as detected by decreased VDI at choroidal level POAG that reduced by 17.37%. In addition, it may be secondary to elevated IOP that has direct impact with decrease VDI at superficial papillary level that is marked in cases with high IOP. The vascular density index was correlated significantly with all functional and structural parameters and the rate of disease progression and severity.Conclusions: OCTA may offer insights into the patho-physiology of glaucomatous damage and understanding the role of vascular factors in the pathogenesis of the disease. Hence, it may be a promising technology in glaucoma man-agement.

Optic Nerve Head Astrocytes Display Axon-Dependent and -Independent Reactivity in Response to Acutely Elevated Intraocular Pressure.

PurposeOptic nerve head (ONH) astrocytes provide support for axons, but exhibit structural and functional changes (termed reactivity) in a number of glaucoma models. The purpose of this study was to determine if ONH astrocyte structural reactivity is axon-dependent.MethodsUsing rats, we combine retrobulbar optic nerve transection (ONT) with acute controlled elevation of intraocular pressure (CEI), to induce total optic nerve axon loss and ONH astrocyte reactivity, respectively. Animals were euthanized immediately or 1 day post CEI, in the presence or absence of ONT. ONH sections were labeled with fluorescent-tagged phalloidin and antibodies against β3 tubulin, phosphorylated cortactin, phosphorylated paxillin, or complement C3. ONH label intensities were quantified after confocal microscopy. Retrobulbar nerves were assessed for axon injury by light microscopy.ResultsWhile ONT alone had no effect on ONH astrocyte structural orientation, astrocytes demonstrated significant reorganization of cellular extensions within hours after CEI, even when combined with ONT. However, ONH astrocytes displayed differential intensities of actin (phosphorylated cortactin) and focal adhesion (phosphorylated paxillin) mediators in response to CEI alone, ONT alone, or the combination of CEI and ONT. Lastly, label intensities of complement C3 within the ONH were unchanged in eyes subjected to CEI alone, ONT alone, or the combination of CEI and ONT, relative to controls.ConclusionsEarly ONH astrocyte structural reactivity to elevated IOP is multifaceted, displaying both axon dependent and independent responses. These findings have important implications for pursuing astrocytes as diagnostic and therapeutic targets in neurodegenerative disorders with fluctuating levels of axon injury.

Long-term Safety and Ocular Hypotensive Efficacy Evaluation of Netarsudil Ophthalmic Solution: Rho Kinase Elevated IOP Treatment Trial (ROCKET-2)

To evaluate netarsudil 0.02% ophthalmic solution in patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). Double-masked, randomized, multicenter, parallel-group, noninferiority clinical study. After a washout of all prestudy ocular hypotensive medications, 756 eligible patients with elevated IOP were randomized to receive netarsudil 0.02% once a day (q.d.) (251); netarsudil 0.02% twice a day (b.i.d.) (254); or timolol 0.5% b.i.d. (251) for 12months, as well as a noninterventional Corneal Observation Study (COS) for patients manifesting cornea verticillata. On treatment, mean IOP at 8:00 AM decreased from a baseline IOP of 22.5-22.6mm Hg to 17.9-18.8mm Hg, 17.2-18.0mm Hg, and 17.5-17.9mm Hg for netarsudil q.d., netarsudil b.i.d., and timolol, respectively, over 12months. The most frequently reported adverse events (AEs) were ocular, with the most frequent ocular AE being conjunctival hyperemia, with an incidence of 61%, 66%, and 14%, respectively. The next most frequent AEs were corneal deposits (corneal verticillata), with an incidence of 26%, 25%, and 1%, respectively, and conjunctival hemorrhage (typically petechial), with an incidence of 20%, 19%, and 1%, respectively. All 3 AEs were generally scored as mild, with conjunctival hyperemia and/or hemorrhage appearing sporadically during the study. In the observational follow-up component of this study, there was no clinically meaningful impact of corneal verticillata on visual function in affected patients. In this randomized, double-masked trial, once-daily dosing of netarsudil 0.02% was effective, consistently lowering IOP through 12months, and was tolerated by the majority of patients.

Evidence of Hypoxic Glial Cells in a Model of Ocular Hypertension.

PurposeReoxygenation after hypoxia can increase reactive oxygen species and upregulate autophagy. We determined, for the first time, the impact of elevated IOP on hypoxia induction, superoxide accumulation, and autophagy in a bead model of glaucoma.MethodOcular hypertension was achieved with magnetic bead injection into the anterior chamber. Before mice were killed, they were injected with pimonidazole for hypoxia detection and dihydroethidium (DHE) for superoxide detection. Total retinal ganglion cells (RGCs) and optic nerve (ON) axons were quantified, total glutathione (GSH) was measured, and retinal and ON protein and mRNA were analyzed for hypoxia (Hif-1α and Hif-2α), autophagy (LC3 and p62), and SOD2.ResultsWith IOP elevation (P < 0.0001), the retina showed significantly (P < 0.001) decreased GSH compared with control, and a significant decrease (P < 0.01) in RGC density compared with control. Pimonidazole-positive Müller glia, microglia, astrocytes, and RGCs were present in the retinas after 4 weeks of ocular hypertension but absent in both the control and after only 2 weeks of ocular hypertension. The ON showed significant axon degeneration (P < 0.0001). The mean intensity of DHE in the ganglion cell layer and ON significantly increased (P < 0.0001). The ratio of LC3-II to LC3-I revealed a significant increase (P < 0.05) in autophagic activity in hypertensive retinas compared with control.ConclusionsWe report a novel observation of hypoxia and a significant decrease in GSH, likely contributing to superoxide accumulation, in the retinas of ocular hypertensive mice. The significant increase in the ratio of LC3-II to LC3-I suggests autophagy induction.

PRIMARY OPEN ANGLE GLAUCOMA;

… Introduction: Glaucoma constitutes a group of ocular diseases characterized byoptic nerve damage and loss of visual field, usually associated with elevated IOP. Although theelevation of IOP beyond normal values is not necessary for the occurrence of glaucomatousdamage, it is currently thought to be a major risk factor. Glaucoma is one of principal causes ofblindness in the world. The primary aim of POAG treatment is to prevent functional visualimpairment with in patient’s life time by slowing the rate of ganglion cell loss closer to that ofnormal population (approximately 5000/year). Medications for glaucoma have changed notablyover the past 2 decades with increase in efficacy, better dosing regimens, improvement in safety,and reduction in side-effects. Purpose of study: The purpose of this study is to compare the IOPlowering efficacy of the (Travatan) Travoprost 0.004%ophthalmic solution and (Alphagan)brimondine 0.2% ophthalmic solution in primary open angle glaucoma. Duration: The durationof study was six months from June 2009 to November 2009. Material and methods: The studywas conducted on 60 patients with primary open angle glaucoma (POAG) divided into twogroups randomly.. Each patient was examined regarding visual acuty, refraction, slit lampbiomicroscopy, IOP with Goldmann Applanation Tonometer, Gonioscopy, fundoscopy andPerimetry. Results: GROUP A had 30 patients with 60 eyes there were 25 male (83.33%) patientsand five females (16.67 %) patients. The eye drops travoprost 0.004 % one drop at night wasused. The average IOP reduction was 7mmhg from base line, GROUP B also had 30 patients with60 eyes there were 27 male (90%.) and 3 females (10 %) The eye drops brimonidine tartarate 0.2% was instilled twice a day one drop in the morning and one drop in the evening. The average IOPreduction was 5.5mmhg from base line. Conclusions: In conclusion both latanop

Adrenal and Glucocorticoid Effects on the Circadian Rhythm of Murine Intraocular Pressure.

PurposeIntraocular pressure (IOP) fluctuates with a robust circadian rhythm, which is synchronized to organismal rhythmicity through the master circadian clock located in the suprachiasmatic nuclei. The mechanisms maintaining circadian synchrony between the suprachiasmatic nuclei and IOP rhythms are presently unknown. The purpose of this study was to evaluate the necessity and sufficiency of adrenal and glucocorticoid function for the entrainment of iris-ciliary body (iris-CB) and IOP circadian rhythms in mice.MethodsIris-CB complexes were dissected from C57Bl/6J mice that were kept in 12-hour light/dark cycles at 3-hour intervals, and their core clock gene (Per1, Per2, and Bmal1) and glucocorticoid receptor mRNA expression were quantified. Iris-CB complexes from period2::luciferase mice were dissected and cultured to measure in vitro rhythmicity. To determine the phase-shifting effect of glucocorticoids on the iris-CB, dexamethasone or vehicle was added to the cultured tissues at defined circadian phases. The diurnal IOP rhythms of adrenalectomized or sham-operated mice under the 12-hour light/dark cycles were also measured.ResultsIn iris-CB complexes, glucocorticoid receptor mRNA expression remained stable throughout the day, whereas the mRNA of core clock genes showed a robust circadian rhythmicity. Dexamethasone significantly induced phase-delays when administered between circadian time 8 (CT8) to CT12 and phase-advance when given between CT16 to CT20. Adrenalectomy abolished circadian IOP rhythmicity, particularly diminishing nocturnal IOP elevation compared with sham-operated mice.ConclusionsGlucocorticoids are sufficient for phase shifting the circadian clock in iris-CB. Intact adrenal function is required for manifest circadian rhythms of IOP in mice. Taken together, these data are consistent with the hypothesis that glucocorticoids mediate circadian entrainment of IOP to the master circadian oscillator.

Эффективность и безопасность различных методик хирургического лечения эпимакулярного фиброза

Purpose . To evaluate the efficiency and safety of three different techniques in the surgical treatment of epimacular fibrosis. Material and methods. A comparative evaluation of surgical treatment results was carried out in three groups of patients with epimacular fibrosis. In the first group – 20 patients (20 eyes), epiretinal membrane (ERM) was removed without vitrectomy. In the second group 30 patients (30 eyes), epiretinal membrane was removed after subtotal vitrectomy. In the third group – 30 patients (30 eyes), epiretinal membrane was removed after local vitrectomy. Local vitrectomy was performed by the following procedure: installing three 25G ports, induction of posterior hyaloids detachment in the macular area, local vitrectomy within the zone of vascular arcades (approximately 20% of the total vitreous volume), except for the area over the optic nerve head, layer-by-layer staining with MembraneBlueDual, removal of ERM, and then ILM. In all the groups a control of visual acuity was monitored, as well as intraocular pressure, the retinal thickness in the central zone, and the thickness of the retinal nerve fiber layer (RNFL) in different sectors. The OCT was used for a control the optic nerve head. The control of fusion of flickering frequency was made. The control of the optic nerve head was made using OCT and the control of fusion of flickering frequency (CFFF). Sensitivity of the macular zone of the retina was determined using the Maia microperimeter, and peripheral zones (Peripheral 60-4) were detected by means of the Humpfrey computer perimeter. The patients were examined before the surgery and 1, 3, 6 and 12 months after the sur gery. Results . The average duration of surgery was 8 minutes in the group without vitrectomy, 32 minutes in the group of subtotal vitrectomy and 18 minutes in the group of local vitrectomy. In the group of ERM removal without vitrectomy 6 patients out of 20 had a relapse of fibrosis found in follow-up period of 3 to 6 months. The groups showed a comparable improvement in visual acuity and photosensitivity of the central retina, as well as a decrease in the thickness of the r etina. In the group of subtotal vitrectomy, a significant IOP increase 1.6mmHg was recorded, as well as an increase in optic disc excavation, a more significant effect on the thickness of RNFL, indicators of the CFFF (drop from 38.4Hz to 34.3Hz), and a decrease in the light sensitivity of the retina periphery. In the local vitrectomy group, the IOP decreased significantly (from 16.5mmHg initially to 14.6mmHg). In addition, there was no decrease in the light sensitivity of the peripheral regions of the retina, and the changes in excavation of optic disc and RNFL were significantly smaller compared to the group of subtotal vitrectomy. Surgical cataract treatment was required in 47% of cases (14 patients) in the group of subtotal vitrectomy, and only 15% (5 patients) in the group of local vitrectomy. Patients of the first group did not require any cataract treatment. Conclusion . Subtotal vitrectomy with epiretinal membrane peeling is effective (30% increase in visual acuity), however, this intervention increases a risk of cataract development (47% of patients were operated on for cataract), negatively affects the optic nerve (CFFF decreased by 4Hz, increase of excavation of optic disk) and intraocular pressure (a 2mmHg persistent IOP increase 12 months later), and also, probably, reduces the sensitivity of the peripheral zone of the retina (-17dB in the upper-temporal quadrant). An alternative method of treatment is a removal of the membrane without vitrectomy. It allows to avoids the above-mentioned complications, but this method is associated with a high relapse rate (6 out of 20 patients had a relapse with a preservation complaints), due to the complexity of implementation and it significantly lim its the use of this method. Local vitrectomy demonstrated the most optimal balance between efficacy, safety, risk of recurrence and difficulty of implementation (no elevation of IOP, less pronounced negative impact on the optic disc and RNFL, no relapse, a low percentage of cataract development – 15%).

Risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy.

PurposeTo investigate the potential risk factors for neovascular glaucoma (NVG) after vitrectomy in eyes with proliferative diabetic retinopathy.Subjects and methodsIn this retrospective, observational, comparative study, patients with proliferative diabetic retinopathy who underwent vitrectomy at Toho University Sakura Medical Center between December 2011 and November 2016 and who were followed for ≥12 months after surgery were included. Subject parameters examined included age, glycated hemoglobin (HbA1c), fasting blood glucose, administration of insulin, and estimated glomerular filtration rate. Ocular parameters examined included preoperative best-corrected visual acuity, preoperative IOP, operative history (specifically panretinal photocoagulation), lens status, ocular pathology (eg, iris/angle neovascularization, tractional retinal detachment, diabetic macular edema, vitreous hemorrhage, combined tractional retinal detachment), intraoperative retinal tamponade use, vitrectomy gauge, combined lens extraction/vitrectomy procedure, subsequent surgical procedures, and pre- and postoperative intravitreal bevacizumab. Correlations between variables and postoperative NVG development were examined using logistic regression analyses (backward elimination method).ResultsA total of 254 eyes of 196 consecutive subjects (146 men [74.5%], 54.0±10.8 years old) were included. Sixty of 254 eyes (23.6%) developed NVG. Several preoperative factors increased the risk of developing NVG, including iris/angle neovascularization (P=0.042), preoperative high IOP (P=0.005), low HbA1c (P=0.004), and administration of insulin (P=0.045). Intraoperative retinal tamponade also increased NVG risk (P=0.021, backward elimination method).ConclusionPreoperative parameters such as elevated IOP, iris/angle neovascularization, fasting blood sugar and HbA1c discrepancies, administration of insulin, as well as use of retinal tamponade during retinal surgery were identified as the risk factors for developing NVG.

Herpetic Anterior Uveitis – Analysis of Presumed and PCR Proven Cases

ABSTRACTPurpose: To describe the demographics and clinical characteristics of patients with herpetic anterior uveitis (HAU), and compare characteristics by pathogen, recurrence, and association to iris atrophy.Methods: Multicenter, retrospective study of AU patients diagnosed clinically and by polymerase chain reaction (PCR).Results: The study included 112 eyes in 109 patients: 54 (48.2%) HSV, 34 (30.4%) VZV, 2 (1.8%) CMV, and 22 (19.6%) unspecified diagnosis. HSV eyes, compared to VZV, had a higher recurrence rate, corneal involvement, KPs, iris atrophy, elevated IOP and posterior synechia (p < 0.05). VZV patients had more frequent immunomodulatory treatments and history of systemic herpetic disease (p < 0.05). Fifty-nine (52.7%) eyes had recurrent disease. Iris atrophy was associated with a higher prevalence of posterior synechia, dilated distorted pupil, and high IOP (p < 0.05).Conclusion: Different HAU-causing Herpesviridae produce common clinical findings; therefore, PCR should be used more often to confirm specific diagnosis. Iris atrophy was associated with more severe disease.

Effects of Intravitreal Injection of Ranibizumab on Intraocular Pressure

Background: the administration of anti-vascular endothelial growth factor (anti-VEGF) agents has become an application of IVIs to treat a variety of retinal and choroidal neovascular diseases including neovascular age-related macular degeneration, vein occlusion with macular edema, and diabetic maculopathy. ranibizumab is the most commonly used anti-VEGF treatments for retinal disease. While Intravitreal ranibizumab appears to be safe and effective but it can cause adverse effects as intraocular inflammation, cataract, vitreous haemorrhage, and increased intraocular pressure. Aim of the work: this study aimed to Evaluation of Iop changes after intravitreal injection of Ranibizumab retinal and choroidal neovascular diseases as neovascular age-related macular degeneration (AMD), central vein or branch vein occlusion with macular edema, and diabetic maculopathy Patients and Methods: this prospective study was carried out from March 2018 to September 2018 on 35 eyes of patients attending outpatient clinic of Al-Azhar University Hospitals and Ophthalmology Department of Research Institute of Ophthalmology in Giza. All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. IOP was measured Using Applanation tonometer and Perkins tonometer before IVI of ranibizumab immediately after injection, 30 minutes, 1ST day, 1st week, and 1st month after injection. Results: IOP was highly increased immediately after injection of ranibizumab, preoperative mean IOP 15.31±3.70, immediate after injection mean IOP 24.62±11.38, then it started to decrease till reaching normal values in the first 24h after injection, 1st 24hours mean IOP 16.31±3.60.The mean IOP for patients who were previously injected was 16.47±3.74 pre injection, and it was 30.88±12.55 immediately after injection, it still decreasing till reaching 20.24±2.77 after 30 minutes, we follow the patients after 1 day it was 18.41±3.12, then it became 18.29±3.62 after 1 week, and 17.88±3.33 after 1 month. The mean IOP for patients who were the first time to be injected was 14.22±3.41 pre injection, Immediate after injection the mean IOP was 18.72±5.92, after 30 minutes of injection the mean IOP was 15.44±3.99 mm Hg, after 1 day of injection the mean IOP was 14.33±2.87 mm Hg, We followed up the patients to one week after injection and we checked the IOP. The mean IOP after one week was 13.72±2.93mm Hg, We continue following the patients for one month and checked IOP, The mean IOP was 14.06±3.21 mm Hg. Conclusion: IOP tends to increase after intravitreal injection of Ranibizumab 0.05ml (0.5 mg). It causes mainly a transient immediate increase in intraocular pressure especially in patients who exposed to repeated intravitreal injection. This elevation of IOP tends to normalize after one day. Recommendations: this study recommend monitoring of IOP after intravitreal injection of ranibizumab and Care should be taken for cases with multiple injections and predisposing risk factors like glaucoma and glaucomatous patients

Internal Limiting Membrane Peeling for Diffuse Tractional Diabetic Macular Oedema

Aim: To determine the efficacy of internal limiting membrane (ILM) peeling vitrectomy for diffuse tractional diabetic macular oedema. Patients and methods: A prospective non –randomized interventional study was carried out at Nour- EL–Hayaha Eye Center (Cairo) between March, 2015 and March, 2017. 40 eyes of 31 patients with symptomatic marked diminution of vision and tractional diabetic macular oedema were enrolled in this study. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. 23-gauge vitrectomy with internal limiting membrane peeling assisted by staining by brilliant blue G stain(BBG) were performed for all patients with a follow –up period at least 6 months. Spectral domain optical coherent tomography (SD OCT) images were obtained at the follow –up visits to determine the presence of an epiretinal membrane (ERM). Results: At 6 months there was a median 200µ decrease from baseline in the central subfield thickness (P<0.005).Mean change in the central subfield macular thickness was -150µ (SD± 130.56).There was 7 (17.5%) cases developed iatrogenic retinal break during removal of posterior vitreous and treated by endodiathermy, of greatest importance, 3(7.5%) eyes developed a vitreous hemorrhage treated by conservative treatment after B scan evaluation, and 1(2.5%) eye developed a retinal detachment. All complications were successfully managed. 23 out of 40 eyes (57.5%) underwent cataract surgery with IOL implantation within 6 months of pars plana vitrectomy. Transient elevation of IOP was developed in 7(17.5%) eyes and managed carefully with antiglucomatous drugs. One eye developed persistent elevation of IOP that required maintenance anti glaucomatous drug. Also macular hole developed in one eye and epiretinal membrane developed in one eye. Conclusion: ILM peeling achieved higher anatomic success with a reduced need for additional surgical interventions and or event postoperative ERM formation that might result in subsequent visual loss.

Effects of Intravitreal Injection of Ranibizumab on Intraocular Pressure

Background: the administration of anti-vascular endothelial growth factor (anti-VEGF) agents has become an application of IVIs to treat a variety of retinal and choroidal neovascular diseases including neovascular age-related macular degeneration, vein occlusion with macular edema, and diabetic maculopathy. ranibizumab is the most commonly used anti-VEGF treatments for retinal disease. While Intravitreal ranibizumab appears to be safe and effective but it can cause adverse effects as intraocular inflammation, cataract, vitreous haemorrhage, and increased intraocular pressure. Aim of the work: this study aimed to Evaluation of Iop changes after intravitreal injection of Ranibizumab retinal and choroidal neovascular diseases as neovascular age-related macular degeneration (AMD), central vein or branch vein occlusion with macular edema, and diabetic maculopathy Patients and Methods: this prospective study was carried out from March 2018 to September 2018 on 35 eyes of patients attending outpatient clinic of Al-Azhar University Hospitals and Ophthalmology Department of Research Institute of Ophthalmology in Giza. All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. IOP was measured Using Applanation tonometer and Perkins tonometer before IVI of ranibizumab immediately after injection, 30 minutes, 1ST day, 1st week, and 1st month after injection. Results: IOP was highly increased immediately after injection of ranibizumab, preoperative mean IOP 15.31±3.70, immediate after injection mean IOP 24.62±11.38, then it started to decrease till reaching normal values in the first 24h after injection, 1st 24hours mean IOP 16.31±3.60.The mean IOP for patients who were previously injected was 16.47±3.74 pre injection, and it was 30.88±12.55 immediately after injection, it still decreasing till reaching 20.24±2.77 after 30 minutes, we follow the patients after 1 day it was 18.41±3.12, then it became 18.29±3.62 after 1 week, and 17.88±3.33 after 1 month. The mean IOP for patients who were the first time to be injected was 14.22±3.41 pre injection, Immediate after injection the mean IOP was 18.72±5.92, after 30 minutes of injection the mean IOP was 15.44±3.99 mm Hg, after 1 day of injection the mean IOP was 14.33±2.87 mm Hg, We followed up the patients to one week after injection and we checked the IOP. The mean IOP after one week was 13.72±2.93mm Hg, We continue following the patients for one month and checked IOP, The mean IOP was 14.06±3.21 mm Hg. Conclusion: IOP tends to increase after intravitreal injection of Ranibizumab 0.05ml (0.5 mg). It causes mainly a transient immediate increase in intraocular pressure especially in patients who exposed to repeated intravitreal injection. This elevation of IOP tends to normalize after one day. Recommendations: this study recommend monitoring of IOP after intravitreal injection of ranibizumab and Care should be taken for cases with multiple injections and predisposing risk factors like glaucoma and glaucomatous patients

Fluorometholone 0.1% as Ancillary Therapy for Trachomatous Trichiasis Surgery: Randomized Clinical Trial

To assess the hypothesis that fluorometholone 0.1% eye drops are safe and effective as adjunctive therapy for trachomatous trichiasis (TT) surgery; determining the most promising dose. Randomized, placebo-controlled, double-masked parallel dose-ranging clinical trial. Patients undergoing upper lid TT surgery at a rural Ethiopian hospital were randomized to fluorometholone 0.1% twice daily for 4weeks, 4 times daily for 4weeks, 4 times daily for 8weeks, or matching frequency placebo in a 3:1:3:1:3:1 ratio for 1 eye. Randomization was stratified by TT severity (1-4 vs ≥5 lashes touching the globe). Safety outcomes (intraocular pressure [IOP] elevation, cataract, and other dose-limiting toxicities) and postoperative TT incidence were assessed over 1 year. Subjects randomized were 39:13:39:13:38:13 in the respective groups, and 1 subject in the 8-weeks fluorometholone group was withdrawn. Of 154 subjects, 148 (96.1%) completed 1 year's follow-up. Among 76 eyes receiving fluorometholone 4 times daily, 1 developed IOP elevation ≥ 30mm Hg (to 37mm Hg) and 1 had an allergic reaction attributed to the study drug; each resolved upon drug cessation without sequelae. No cataract or other dose-limiting toxicity events occurred. Postoperative TT within 1 year occurred in 29.3% of placebo eyes vs 17.7%, 19.6%, and 23.2% among the respective fluorometholone groups (P= .29 comparing placebo vs all active treatments combined). The results suggest fluorometholone 0.1% is likely to be safe and efficacious to reduce postoperative TT following TT surgery, and 1 drop twice daily for 4weeks is the most promising dose. Confirmation in a full-scale clinical trial is needed before programmatic implementation.

Diagnostic efficacy of real-time PCR for ocular cytomegalovirus infections

PurposeThe aim of this study is to determine the efficacy of quantitative real-time PCR (qPCR) and clinical characteristics to diagnose ocular cytomegalovirus (CMV) infections.MethodsThe technical factors were assessed by the outcomes of the qPCR assay at five institutions in Japan using the WHO International Standard of cytomegalovirus. The clinical factors were assessed by examining the aqueous humor samples of 197 eyes of 197 consecutive patients suspected of CMV using the receiver operating characteristics (ROCs).ResultsAll of the institutions had excellent detection efficacy, although the copy number ranged from 0.82 to 4.66 copies/IU. In the clinical samples, CMV was detected in 51 eyes, and the amount of CMV DNA was significantly higher for CMV retinitis. In corneal diseases, the amount of CMV DNA was significantly associated with frequency of recurrences and IOP elevations. The sensitivity and specificity of qPCR for the diagnosis was 90.0 and 98.7%, respectively. For the corneal and anterior uveitis types of CMV diseases, the area under the curve (AUC) of qPCR was 0.95 and 0.96, followed by frequency of recurrences with AUC of 0.89 and 0.82, and IOP elevations with AUC of 0.78 and 0.76. Unclassified cytomegalovirus detection, which did not meet diagnostic criteria of CMV corneal endotheliitis, anterior uveitis, or retinitis, was 4.6%, and it was significantly associated with corneal diseases and history of corneal transplantation.ConclusionsqPCR with standardization is specific and accurate; however, the inclusion and knowledge of the clinical characteristics improve the diagnostic efficacy.

The Magnitude of Intraocular Pressure Elevation Associated with Eye Rubbing

ABSTRACT Purpose To determine the magnitude of IOP elevation associated with eye rubbing Study Design Experimental Study Subjects Three nonhuman primates (NHPs) Methods Three young adult male rhesus macaques were briefly anesthetized with ketamine and dexmedetomidine, and antibiotic ointment was placed in both eyes. The anesthetic was immediately reversed with atipamezole, and the animals quickly recovered. IOP was continuously recorded at 500 measurements per second during the experiment using a validated implantable wireless telemetry system; high-definition video was recorded while the NHP rubbed its eyes to remove the ointment, and rubbing events were marked in the IOP data. The experiment was repeated four times in each NHP, with numerous eye rubs recorded for each session, and these data were marked and the IOP elevation magnitudes were analyzed using NOTOCORD-hem software. Main Outcome Measures IOP elevation above baseline IOP due to eye rubbing Results IOP increased as much as 310 mmHg due to eye rubbing. The largest IOP elevations were associated with rubbing the eye and orbit with the back of the hand or wrist, rather than the fingers or knuckle. Eye rubs elicited mean IOP elevations of ∼80-150 mmHg above baseline for 3-4 seconds, with peak IOP elevations reaching 205-310 mmHg depending on the individual NHP and eye. Conclusions Rubbing the eyes causes momentary IOP elevations that average 109 mmHg above baseline IOP and can exceed 300 mmHg above baseline IOP in NHP eyes.

Comparison on the efficacy of two methods of surgery for cataract accompanied with subluxation of lens

Objective To compare the efficacy of two methods of surgery for cataract accompanied with subluxation of lens. Methods The data of 53 eyes of 44 cases with cataract accompanied with subluxation of lens from Jul. 2013 to Jul. 2017 were retrospectively analyzed. All cases were randomly divided into two groups. Group A, phacoemulsification combined with the single loop of capsular IOL suture fixation (Phaco+ IOLSF) were performed in 25 eyes of 20 cases. Group B, pars plana lensectomy and vitrectomy combined with ciliary sulcus-sutured IOL implantation(PPL+ PPV+ IOL)were performed in 28 eyes of 24 cases. The follow-up time was 1-24 months. Results The postoperative BCVA(Log MAR) was 0.71±0.14 in group A and 0.60±0.13 in group B. The low IOP after surgery occurred in 8 eyes(32.0%) in group A and 17 eyes (60.7%) in group B. The IOP elevation occurred in 1 eye(4.1%) in group A and 1 eye(3.6%) in group B. The posterior capsular opacification (PCO) occurred in 18 eyes(72.0%) in group A. The reaction at 3 days postoperatively occurred in 8 eyes(32.0%) in group A and 20 eyes(71.4%) in group B. BCVA of group B was better than that of group A and the difference was statistically significant (t=3.006, P=0.004). The incidence of the low IOP after surgery in group B was higher than that of group A (χ2=4.370, P=0.037). The incidence of the IOP elevation in group B was lower than that of group A (χ2=0.007, P=0.935). The incidence of the reaction postoperatively in group B was higher than that of group A (χ2=8.239, P=0.004). Conclusion Visual acuity can be improved with two surgical methods for subluxation of lens. Postoperative early stage, BCVA of group B is better. The incidence of low IOP of group A is lower and the IOL location is stable. Key words: Subluxation, lens; Lens, intraocular; Ciliary groove-sutured; Single loop suture fixation

Varieties of Constantly Redundant Tension of Accommodation, the Weakness of Accommodation and Intraocular Pressure in Myopia

Purpose: to evaluate the relationship between the functional state of the accommodative eye apparatus according to the data of accomodography and the increase of the ophthalmotonus in patients with myopia.Patients and methods. There were 74 patients with myopia (148 eyes) from 6 to 17 years old. The mean age of the examined subjects was 12.7 ± 0.32 years. Low myopia was detected in 37 persons (73 eyes), medium myopia — in 23 persons (46 eyes) and high myopia — in 15 persons (29 eyes). Progressive myopia was detected in 110 eyes (74.3%), stationary — 38 eyes (25.7%). Constantly redundant tension of accommodation (CRTA) was found in patients on 134 eyes (90.5%).Results. In 53% patients with progressive myopia (58 eyes) the cornea-compensated intraocular pressure (P0CC) was within the limits of the upper individual norm — from 18 to 21 mm Hg or higher. In progressive myopia with combination of accommodation weakness, CRTA and an increase of IOP up to the range of upper norm limits occurs in 4.8 times more often than with stationary myopia (t = 4.7, p &lt; 0.05).Сonclusions. It is necessary to measure intraocular pressure in patients with myopia taking into account the biomechanical properties of the sclera in case of accomodation arrors in the form of a combination of accommodation weakness and CRTA. The combination of accommodation weakness, CRTA and elevated IOP (upper-range) indicates the progression of myopia.

Contribution of prostanoid FP receptor and prostaglandins in transient inflammatory ocular hypertension

We explored the involvement of FP receptor and endogenous prostaglandins (PGs) in transient ocular hypertension (OH) induced by PGE2 or PGF2α in mouse eyes. PGE2 and PGF2α were topically applied to induce transient OH in Wild-type (WT) and FP-, EP1-, EP2-, and EP3-deficient (knockout [KO]) mice. To suppress endogenous PG production, the non-steroidal anti-inflammatory drug nepafenac was applied topically before treatment. PGE2 and PGF2α induced significant OH in the WT, FPKO, and EP1–3KO mice compared to the control 30 min after instillation, and the increase in IOP at 30 or 60 min after instillation in FPKO mice was significantly higher than that in the WT mice. The effects of PGF2α on the increase in IOP were significantly weaker than those of PGE2, especially in EP1KO and EP3KO mice. Transient OH induced by PGE2 and PGF2α was significantly attenuated by nepafenac treatment in FPKO mice. Transient OH was induced by PGE2 and PGF2α in WT, FPKO, and EP1–3KO mice, which was enhanced in FPKO mice. This OH was significantly diminished by nepafenac treatment in FPKO mice, suggesting that FP receptor may have an important naïve physiological role in the eye, and could regulate IOP elevation during PG-associated ocular inflammation.