Mean Increase In Intraocular Pressure Research Articles

Intraocular Pressure Changes After Rhinoplasty: A Before-and-After Cross-Sectional Study.

Rhinoplasty, a prevalent cosmetic surgery, often involves lateral osteotomy, which can lead to ocular complications such as edema and ecchymosis. A potential complication is increased intraocular pressure (IOP) postoperatively. This study aims to investigate the impact of lateral osteotomy during rhinoplasty on IOP in patients. This prospective before-and-after cross-sectional study evaluated the effect of lateral osteotomy during rhinoplasty on IOP in 96 patients. Preoperative ophthalmologic examinations included best-corrected visual acuity, slit lamp biomicroscopy, Goldmann tonometry, and dilated fundoscopy. IOP measurements were taken three times per eye at baseline, during surgery, on the first postoperative day, after nasal pin removal on the seventh postoperative day, and on the thirtieth postoperative day using a Goldmann tonometer. The mean IOP was recorded at each time point. The study found no significant changes in IOP at 1, 7, or 30 days postsurgery (p = 0.194). Additionally, the type of surgery did not significantly affect ocular internal pressure (p = 0.622). Rhinoplasty with lateral osteotomy appears to be safe concerning IOP. However, monitoring IOP during rhinoplasty is advisable.

The Strain Response to Intraocular Pressure Increase in the Lamina Cribrosa of Control Subjects and Glaucoma Patients.

The purpose of this study was to measure biomechanical strains in the lamina cribrosa (LC) of living human eyes undergoing intraocular pressure (IOP) increase. Healthy control subjects and patients with glaucoma underwent optical coherence tomographic (OCT) imaging of the LC before and after wearing of swim goggles that increased IOP (57 image pairs, 39 persons). Digital volume correlation was used to measure biomechanical strains in optic nerve head tissue and change in depth of the anterior border of the LC. The mean IOP increase in both glaucoma and control eyes was 7.1 millimeters of mercury (mm Hg) after application of the goggles. Among glaucoma eyes, strains that were significant were: contractile Ezz (average = -0.33%, P = 0.0005), contractile Eθθ (average = -0.23%, P = 0.03), Emax (average = 0.83%, P < 0.0001), and Γmax (average = 0.95%, P < 0.0001), whereas the average anterior LC depth (ALD) decreased by 2.39µm (anterior; P = 0.0002). In glaucoma eyes, shear strain Ezθ was greater with worse mean deviation (MD) and visual function index (P = 0.044 and P = 0.006, respectively, multivariate models). Strain compliance for Erθ, Ezθ, and Eθθ all increased with greater MD worsening prior to imaging (P = 0.04, P = 0.007, and P = 0.03). LC strains were measurable 20 minutes after IOP increase, producing axial compression and greater peripheral strain than centrally. Some strain compliances were greater with worse existing visual field loss or with more progressive past field loss. Biomechanical strains are related to measures of glaucoma damage, supporting the hypothesis that optic nerve head biomechanical responses represent a noninvasive biomarker for glaucoma.

Home iCare – What we already know

Abstract The only known modifiable risk factor for the development and progression of glaucoma is an increased intraocular pressure (IOP). Current follow-up with Goldmann applanation tonometry (GAT) constitutes a suboptimal approach, given out-of-office IOP peaks and fluctuations will not be exposed. Self-tonometry in the home environment could address this unmet need, detecting uncontrolled disease and potentially impacting further therapeutic management. Since recently, iCare HOME was developed as a handheld rebound tonometer for this purpose. The aim of this literature review is twofold. First, the accuracy of iCare HOME compared to GAT will be assessed, including evaluation of the influence of corneal characteristics and the mean IOP. Second, an overview of the reported feasibility and acceptance on the use of iCare HOME will be presented. The literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature was searched on Medline (via Pubmed), Embase, Cochrane Library, and Web of Science (Core Collection) on April 10, 2023. A total of 187 records were identified after deduplication, of which 20 articles were included after full evaluation of their suitability. This study reported that iCare HOME has a moderate to good accuracy compared to GAT and a tendency to underestimate GAT, with a median underestimation of 1 mmHg, ranging from 2.66 mmHg underestimation to 2.08 mmHg overestimation. Success rates ranged between 67.5% and 100% with a median rate of 82.5%. Sufficient acceptance was demonstrated. In conclusion, self-tonometry with iCare HOME constitutes an accurate, feasible, and accepted method for home monitoring of glaucoma, providing additional out-of-office IOP-data, and increasing patient empowerment.

Relationship Between Sleep Position and Glaucoma Progression

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Glaucoma, a leading cause of irreversible blindness worldwide, is strongly influenced by intraocular pressure (IOP), with recent studies suggesting that nocturnal IOP fluctuations and body position during sleep may play a critical role in disease progression. The purpose of the study was to explore the relationship between sleep position and glaucoma progression. &amp;lt;i&amp;gt;Aim of the study&amp;lt;/i&amp;gt;: The aim of the study was to evaluate the relationship between sleep position and glaucoma progression. Methods: This cross-sectional observational study was conducted at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, over a 1-year period from mid-2023 to mid-2024. A total of 40 patients were included. Data were collected retrospectively from medical records, focusing on demographic characteristics, sleep position preferences, and intraocular pressure (IOP) measurements. Descriptive statistics, chi-square tests used for data analysis, with statistical significance set at p &amp;lt; 0.05. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: Among the patients, 35.00% were aged 60-70 years, with a significant male predominance (87.50%). The most preferred sleep position was the right lateral decubitus position (LDP), chosen by 45.00% of patients, and it was associated with a mean intraocular pressure (IOP) increase of 1.8 mmHg and a 50.00% progression rate of glaucoma. Notably, patients with higher baseline IOP, representing 30.00% of the sample, experienced a mean IOP increase of 2.0 mmHg. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The study highlights that the right lateral decubitus position is strongly associated with increased intraocular pressure and higher glaucoma progression, emphasizing the need to consider sleep position and individual risk factors in glaucoma management.

Short-term intraocular pressure changes after intravitreal aflibercept 2 mg, aflibercept 8 mg and faricimab: a prospective, comparative study

Background/aimsIntravitreal injection (IVT) of anti-vascular endothelial growth factor agents is the standard of care for several retinal diseases but can cause intraocular pressure (IOP) elevations. This study investigates short-term postinjection...

The Impact of Femtosecond Laser on Intraocular Pressure With Cataract Surgery in Healthy Eyes.

Femtosecond laser-assisted cataract surgery (FLACS) leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP. To evaluate the effect of FLACS using the LDVZ8 laser on IOP during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a 6-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed. The mean IOP increase after docking was 2.3±4.1mmHg ( P <0.0001); the maximum increase was 17.6mmHg, peak of 38mmHg. Sixty-one eyes (25.1%) demonstrated an increase of ≥5mmHg and 10 (3.7%) showed an increase of ≥10mmHg; predocking IOP was associated with an IOP increase of ≥5mmHg ( P =0.029). IOP reduction over 6 months postsurgery was similar for FLACS and CPCS ( P >0.05), -1.33±3.12mmHg for FLACS ( P <0.001) and -1.4±2.87mmHg for CPCS ( P <0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P <0.001) and CPCS (β -0.743, P <0.001). Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.

Psychological Stress and Intraocular Pressure in Glaucoma: A Randomized Controlled Trial

To evaluate the intraocular pressure (IOP) behavior after applying a standardized protocol to induce psychological stress in patients with primary open-angle glaucoma (POAG). Randomized controlled trial. A total of 39 patients with POAG were included: 18 in the stress group and 21 in the control group. Patients were randomized to undergo the Trier Social Stress Test (TSST) or to be included in the control group. All participants were submitted to a modified diurnal tension curve (DTC) 1-4 weeks before randomization, with 3 IOP measurements performed between 8:00 am and 2:00 pm. We evaluated the response to the TSST by measuring the levels of salivary cortisol, salivary amylase, IOP, mean arterial pressure, and heart rate before, immediately after, and 40 minutes after the TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals. Changes in IOP (mmHg), salivary cortisol and amylase, heart rate, mean arterial pressure, and STAI scores. At baseline, there were no significant differences between the groups regarding age (P=0.661), sex (P=0.669), salivary cortisol (P=0.104), and mean DTC IOP for the right (P=0.439) and left (P=0.576) eyes. We observed a significant mean IOP increase of 3.8 mmHg (right eye; P<0.001) and 4.1 mmHg (left eye; P<0.001) when we compared IOP measurements obtained during the DTC and immediately after TSST. Salivary cortisol (5.9 nmol/L; P=0.004), salivary amylase (323388 UL; P=0.004), mean arterial pressure (10.1 mmHg; P<0.001), and heart rate (12.9 bpm; P<0.001) also increased significantly after the TSST. In addition, 61.1% (11of 18) of the patients in the TSST group showed an IOP increase > 4 mmHg following the test. The STAI-state score significantly increased after the TSST compared to baseline (P<0.001) and decreased from poststress to the recovery period (P<0.001). Patients with POAG present significant elevations of IOP, salivary cortisol and amylase, mean arterial pressure, heart rate, and STAI scores after psychological stress induced by the TSST. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Investigation of the effect of subacromial corticosteroid injections on intraocular pressure

Background: Subacromial corticosteroid injection is one of the most commonly used procedures to treat subacromial impingement syndrome. Despite their significant efficacy, corticosteroids have several serious adverse effects, including increased intraocular pressure (IOP) and visual loss. The purpose of this study is to determine the effect of subacromial corticosteroid injections on IOP. Materials and Methods: 42 patients with impingement syndrome, who received subacromial corticosteroid injection, were included in the study. Patients received a single dose of betamethasone. IOP was monitored using a tonometer prior to injection, 24 hours after injection, and one week following injection. Results: The average age of the patients was 52.1±9.0, and 31 (74%) of them were female. Patients’ mean IOP values were 16.0±2.6 mmHg, 16.4±2.4 mmHg, and 16.1±2.31 mmHg before injection, one day after injection, and one week after injection, respectively. Repeated ANOVA tests revealed no statistically significant difference between the three measurements (P=0.386). Age, gender, history of diabetes, and history of hypertension didn’t have a significant effect on IOP change after corticosteroid injection. Those with a family history of glaucoma had a significantly greater increase in IOP on day 1 post-injection than those without (P=0.05). Conclusions: This is the first study to examine the effect of subacromial corticosteroid injections on IOP change. While a single subacromial steroid injection has no statistically significant effect on IOP change, care should be taken, particularly in susceptible individuals and those who need repeated injections.

Clinical Features Associated with Acute Elevated Intraocular Pressure After Intravitreal Anti-VEGF Injections.

To study the effects of intravitreal injection (IVI) of anti-VEGF (vascular endothelial growth factor) agents on intraocular pressure (IOP) and find associations with acute pressure spikes. This was a three-month, prospective study of patients receiving outpatient IVI of anti-VEGF agents for diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) at the Acuity Eye Group Medical Centers. IOP was measured pre- and post-injection at 10-minute intervals up to 50 minutes after injection with a handheld tonometer. Patients with an IOP greater than 35 mmHg at 30 minutes received an anterior chamber paracentesis (ACP), while patients below 35 mmHg were monitored without intervention. A total of 617 patients (51% female, 49% male) received IVI for DR (n = 199), AMD (n = 355), and RVO (n = 63). ACP was performed in 17 patients. Average pre-injection IOP was 16 ± 4 compared to 24 ± 7 mmHg for the non-ACP vs ACP group, respectively (mean ± standard deviation), p < 0.0001. IOP returned to baseline in 98% of patients at 50 minutes. A diagnosis of glaucoma and glaucoma suspect was more prevalent in the ACP group compared to the non-ACP group, 82.3% vs 14.2% and 17.6% vs 9.0%, respectively, p < 0.0001 and p > 0.05. Patients with a pre-injection IOP >25 mmHg and a history of glaucoma had a 58.3% rate of ACP. A 31-gauge needle had a higher mean increase in IOP from baseline compared to 30-gauge needle, p < 0.0001. IOP spikes are most significant in the first 10 minutes after IVI but typically resolve within the first hour. However, utilizing a smaller 31-gauge IVI in patients with a glaucoma history and pre-injection IOP >25 mmHg may be associated with significant IOP spikes lasting longer than 30 minutes.

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics.

To compare the clinical characteristics of patients with direct and dural carotid cavernous sinus fistulas (CCFs). The medical records of 60 patients diagnosed with CCFs were retrospectively reviewed. The collected data included demographic characteristics, clinical findings, and ocular manifestation. The clinical characteristics of the direct and the dural CCFs were compared on head-to-head basis. Logistic regression analysis was used to demonstrate the direction and magnitude of the difference and reported as odds ratio with its 95% confidence interval. There were 28 patients (46.67%) with direct CCFs, and 32 patients (53.33%) with dural CCFs. Patients with direct CCF were mostly male (p=0.023), younger age (p<0.001), had history of trauma (p<0.001), and more visual impairment at presentation (p=0.025), when compared to those with dural CCFs. In addition, patients with direct CCF had significantly more chemosis (p=0.005), proptosis (p=0.042), bruit (p<0.001) and dilated retinal vessels (p=0.008) than those with dural CCF. Thirty patients (50%) had increased intraocular pressure (IOP). Mean IOP of the affected eyes was significantly higher than the unaffected eyes (p<0.0001). In patients with normal IOP, mean IOP of the affected eyes was also higher than the unaffected eyes (p=0.0027). Patients with direct CCF were younger age, associated with trauma, and more visual impairment at presentation. Chemosis, proptosis, bruit and dilated retinal vessels were detected more in the direct CCF than the dural CCF. Despite normal IOP, affected eyes had significantly higher IOP than the unaffected eyes. Information on these clinical characteristics may be helpful in discrimination of the direct type, which is more urgent for further investigation and treatment.

The efficacy and complication of intravitreal dexamethasone implant in diabetic macular edema – Novel use as a primary treatment modality

Purpose: This study investigates an intravitreal dexamethasone implant and its efficacy and complications in patients with diabetic macular edema (DME). Materials and Methods: This was a prospective, interventional study involving 30 eyes of 20 patients with DME. Patients' eyes with DME which were pseudophakic with a visual acuity of 6/12 or less and a central macular thickness (CMT) of 300 microns or more on optical coherence tomography were included. Primary efficacy variables were best-corrected visual acuity (BCVA), CMT, and intraocular pressure (IOP), noted at baseline. The patients were followed up and parameters noted at 1 week, 1 month, and 3 months following the implant into the vitreous cavity. Results: Eyes receiving the implant had a significant improvement (P &lt; 0.001) in BCVA and gained a mean of 6.10 letters on the Snellen chart over the 3-month period. Furthermore, there was a significant reduction in CMT in the eyes receiving the implant. The mean increase in IOP over the 3-month follow-up, although statistically significant, was well within the normal physiological range. Conclusion: The study concluded that intravitreal dexamethasone implant is an effective treatment for DME, and it has a statistically significant and clinically meaningful effect on BCVA and CMT.

THE MOMENTARY EFFECT OF XYLOPIA AETHIOPICA ON INTRAOCULAR PRESSURE

Xylopia aethiopica is an important item of local trade throughout Africa as a spice, flavouring for food and for medicine. The aim of this study was to determine the effect of aqueous extract of its fruit on intraocular pressure (IOP) of normotensive subjects. A total of eighty (n=80) ocular normotensives between 18 and 50 years, with mean age of 27.28±7.84years and mean body weight of 64.45±12.70kg consisting of forty (40) (50%) males and forty (40) (50%) females, were recruited for this study. Their baseline intraocular pressure was measured and intraocular pressure was taken for 30, 60 and 90 minutes after ingestion of either distilled water or aqueous extract of Xylopia aethiopica fruit. The mean baseline intraocular pressure was 13.52±1.70mmHg; 30minutes after ingestion of the aqueous extract of Xylopia aethiopica, there was a significant increase in mean intraocular pressure to 15.55±2.00mmHg (p&lt; 0.05); after 60minutes the mean IOP decreased to 14.43±1.62mmHg and then returned close to mean baseline IOP of 13.45±1.80mmHg.There was no significant change in mean IOP (p&gt; 0.05) when males were compared withfemales. Xylopia aethiopica causes a transient fluctuation in IOP which may affect thefindings and analyses of IOP. Eye care providers should be cautious of raised IOP inducedby spices like X. aethiopica; and ask patients about their meals or medications before IOPmeasurements are taken.

Fluocinolone acetonide 0.19-mg implant for the treatment of noninfectious uveitis with involvement of the posterior segment: a real-world study

PurposeTo evaluate the effectiveness of 0.19-mg fluocinolone acetonide implant (FAi) for preventing inflammatory relapses in noninfectious uveitis with posterior segment involvement in standard clinical practice. Further, to assess the value of remission induction therapy with intraocular and periorbital administered high-dose corticosteroids before FAi.MethodsA retrospective cohort study in a tertiary referral center specialized in uveitis management. The primary study outcomes were the best-corrected visual acuity (BVCA) and central retinal thickness (CRT) within a 12-month observation period. The secondary outcomes were intraocular pressure (IOP) and intraocular inflammation. The main safety measures were IOP increase and cataract formation.ResultsIn total, 76 eyes of 57 patients received FAi. Locally administered high-dose corticosteroids were applied in 68.4% of all eyes before FAi. BCVA remained stable within the 12-month observation period (63.21 vs. 62.95, difference 0.26 letters; 95% CI: − 6.31 to 6.84; p > 0.9). Significant CRT reduction upon FAi was sustained after 12 months (362.7 vs. 309.1 μm, difference 53.57 μm; 95% CI: 1.55 to 105.6; p = 0.04). Intraocular inflammation was reduced until 9 months of follow-up (0.82 vs. 0.3, difference 0.53; 95% CI: 0.11 to 0.95; p = 0.007). A mean IOP increase (13.68 vs. 15.6; difference − 1.92; 95% CI: − 3.85 to 0.004; p = 0.0507) and cataract development (20% of all phakic eyes) were noted.ConclusionWe observed similar levels of FAi effectiveness for the treatment of noninfectious uveitis in standard clinical practice compared to previous randomized clinical trials. Moreover, remission induction therapy before FAi can benefit patients with increased baseline uveitis activity.

Impact of systemic steroids combined with immunosuppressive treatment on glaucomatous features in patients with systemic lupus erythematosus.

To evaluate the incidence of increased intraocular pressure (IOP) and glaucomatous changes in systemic lupus erythematosus (SLE) patients in comparison with systemic steroids and immunosuppressive treatment. Sixty-two women with SLE were divided into two groups: treated (n=47, 94 eyes) and not treated (n=15, 30 eyes) with systemic glucocorticosteroids (GC; GC-free). Twenty-one individuals in GC group were treated with immunosuppressive agents (immunomodulating and biologic). The visual acuity and IOP with ocular pulsatile amplitude (OPA) measurements, as well as scanning laser polarimetry (GDx) with nerve fiber index (NFI) measurement, spectral domain optical coherence tomography (SD-OCT) of the optic disk with retinal nerve fiber layer (RNFL) analysis and the macular region with ganglion cell analysis (GCA) were performed. Mean IOP values in group with combined GC and immunosuppressive therapy was 15.8±2.56 mm Hg and was significantly lower than in individuals with exclusive GC treatment (17.63±4.38 mm Hg, P=0.043). Contrary, no differences in mean IOP values between GC-free group and individuals treated with combined GC and immunosuppressive therapy were detected (P=0.563). Similarly, mean IOP in GC was 17.14±3.94 mm Hg and in GC-free patients was equal to 16.67±3.45 mm Hg (P=0.671). According to treatment regimen no statistical differences in optic disk SD-OCT for RNFL thickness, RNFL symmetry, cupping volume and the C/D ratio were observed. Similarly, no statistical differences for the mean and minimal ganglion cell layer (GCL) thickness measured in macular SD-OCT or NFI in GDx were detected. Combined immunosuppressive and systemic GC therapy in SLE patients may lower the risk of iatrogenic ocular hypertension. No relationship between treatment regimen and glaucomatous damage of optic nerve fibers in analyzed groups with SLE is detected.

Delayed follow‐up of glaucoma patients due to COVID‐19 pandemic – impact on disease progression

AbstractPurposeTo determine the impact of delayed follow‐up on the disease course in patients with glaucoma.MethodsA retrospective case series of 224 glaucoma patients. Data analysis from the hospital electronic medical record was performed on patients attending the glaucoma clinic between April and May 2021 at Charing Cross Hospital, London, United Kingdom, after easing of the national lockdown due to COVID‐19 pandemic. The main outcome measures included increased intraocular pressure (IOP), worsening of visual field (VF) defect, thinning of retinal nerve fibre layer (RNFL) and the posterior pole using spectral domain Optical Coherence Tomography (OCT).ResultsNotes from 224 patients were analysed. Among them, 24 patients were identified to develop a progression of glaucoma. Majority of patients (10, 42%) had open angle glaucoma, 6 (25%) had normal tension glaucoma, 5 (21%) were glaucoma suspects, 2 (8%) had narrow angle glaucoma and 1 (4%) had angle closure glaucoma. The mean IOP (±SD) pre‐lockdown was 15.4 ± 3.8 mmHg and post‐lockdown was 16.7 ± 5.4 mmHg (p &lt; 0.05). The average RNFL thickness pre‐lockdown was 79.7 ± 15.7 µm and post‐lockdown was 78.8 ± 15.6 µm (p &gt; 0.05). Of the 24 patients who developed progression, 16 had an increase in IOP (mean ∆ IOP was 3.8 ± 1.8 mmHg; p &lt; 0.05), 19 patients had a clinically significant RNFL thinning (mean ∆ was 3.3 ± 1.4 µm; p &lt; 0.05) and 9 patients had worsening of VF. The average timing between pre‐ and post‐lockdown visit was 15.1 months (SD ± 7.6).ConclusionsThese results confirm that a proportion of patients developed glaucoma progression during the COVID Lockdown which could be attributed to delayed follow‐up. Further analyses of these data will be needed to confirm how the results of this study could help to guide future decisions making and guidance on prioritising and managing glaucoma patients if disruption to standard of care occurs.

Safety and efficacy of selective laser trabeculoplasty in secondary ocular hypertension following deep anterior lamellar keratoplasty

Purpose: To evaluate the safety and efficacy of selective laser trabeculoplasty (SLT) in eyes with secondary ocular hypertension (OHT) following deep anterior lamellar keratoplasty (DALK). Methods: Retrospective review of patients who underwent SLT for increased intraocular pressure (IOP) following DALK between January 2014 and December 2016. Patients with a minimum follow-up of one year were included. Results: A total of seven eyes (seven patients) were analysed. The mean IOP reduced from 24.6 ± 11.1 to 15.3 ± 3.2 (p = 0.04), 14.2 ± 1.3 (P = 0.15) and 14 ± 1.4 (P = 0.09) mm Hg at one, two, and three years post-SLT respectively. The mean number of antiglaucoma medications (AGMs) reduced from 2.3 ± 1.1 to 0.2 ± 0 at one year, and 0 ± 0 at two and three years (P < 0.05). All eyes had clear graft during the entire follow-up, and there was no inflammation or signs of rejection post-SLT. Conclusions: SLT reduces IOP as well as the number of AGMs in eyes with OHT following DALK.

Evaluation of the Effect of Intravitreal Dexamethasone (Ozurdex®) Implant on Intraocular Pressure in Vitrectomized and Non-Vitrectomized Eyes with Macular Edema.

Objectives:This study aimed to retrospectively evaluate the intraocular pressure (IOP) change in vitrectomized and non-vitrectomized patients receiving 0.7 mg intravitreal dexamethasone implant to treat macular edema due to different indications.Materials and Methods:The patients’ diagnoses, IOP values before receiving the intravitreal dexamethasone implant and in follow-up examinations at 1-3 days, 1 month, 2 months, 3 months, 6 months, 9 months, and 12 months after implantation, pachymetry values, medications used, and history of vitrectomy surgery were recorded.Results:A total of 134 eyes of 112 patients between 46 and 85 years of age who received intravitreal dexamethasone implants were evaluated. Seventeen eyes (12.7%) were vitrectomized and 117 (87.3%) were not vitrectomized. In non-vitrectomized eyes, the mean IOP was 14.01±2.36 mmHg before and 14.8±2.96 at 1-3 days, 16.71±3.97 at 1 month, 17.88±5.27 at 2 months, 15.54±3.35 at 3 months, 15.1±3.24 at 6 months, and 14.61±3.71 mmHg at 12 months after receiving the first dose. In this group, the increases in mean IOP at 1-3 days, 1 month, 2 months, and 3 months were significant compared to the mean IOP before the first dose (p<0.05). In vitrectomized eyes, only the increase in mean IOP at 6 months was significant compared to the mean IOP before the first dose (p<0.05). Twenty-three of the 134 eyes (17.2%) were prescribed 1-3 medications due to IOP elevation (one drug for 73.9%, two drugs for 17.4%, and three drugs for 8.7% of these eyes).Conclusion:The IOP increase that occurs as a side effect of intravitreal dexamethasone administration is generally mild and temporary in both vitrectomized and non-vitrectomized eyes, regardless of indication. There was no cumulative effect in patients who received two or three doses.

Dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes.

To investigate the safety and efficacy of intravitreal dexamethasone implants (Ozurdex®/DEX) in patients with diabetic macular edema (DME) either naïve or non-naïve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors (anti-VEGFs). This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients naïve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) was collected over 6mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients (57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment naïve before receiving DEX implant, was collected. Improvement in mean BCVA was observed from 1-4mo after injection with a decreased effect at month 6 as expected, with better outcomes in naïve compared to non-naïve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2mo after DEX therapy. The mean number of injections of the overall population during the 6mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported. This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in naïve patients.

Corneal Biomechanical Changes Caused by Acute Elevation of IOP in Eyes with and without Glaucoma.

Although corneal biomechanical parameters are well linked with glaucoma, their clinical utility has not yet been fully elucidated. This study was designed to provide unique evidence about the dynamic nature of corneal biomechanical parameters and their potential prognostic ability for glaucoma. This study aimed to evaluate the effect of acute intraocular pressure (IOP) elevation on corneal hysteresis (CH) and corneal resistance factor (CRF) and the associations of these biomechanical parameters with glaucomatous disease. Subjects participating in a prospective, longitudinal glaucoma research study had CH and CRF measured before and during ophthalmodynamometry during visits in the years 2011 to 2012. All participants were diagnosed with primary open-angle glaucoma, ocular hypertension, glaucoma suspect, or normal eyes and had a minimum of 3 years of study participation with at least five reliable visual field (VF) tests. Changes in CH, CRF, and IOP induced by ophthalmodynamometry were compared between diagnostic groups and evaluated for relationships with existing and future glaucomatous VF loss. In 248 eyes of 248 subjects followed up for 7.7 ± 2.3 years, ophthalmodynamometry induced a mean IOP increase from 15.1 to 29.9 mmHg, causing a mean 34 ± 28% increase in CRF and 21 ± 25% decrease in CH. Magnitude of CH change did not differ between diagnostic groups or between eyes that did (n = 20) and did not (n = 95) develop new VF loss during the study period, nor was it related to rate of future VF progression. Ophthalmodynamometry-induced IOP elevation resulted in significant acute changes in CH and CRF in this study; this suggests accounting for IOP may be important in clinical interpretation of these parameters. However, because the degree of CH change was not related to glaucoma or its progression, acute changes in CH and CRF do not seem to have a prognostic value for glaucoma.

Measurement of the Intraocular Pressure Elevation During Laser-Assisted In Situ Keratomileusis Flap Creation Using a Femtosecond Laser Platform.

PurposeThe purpose of this study was to measure the intraocular pressure (IOP) elevation during laser assisted in situ keratomileusis (LASIK) flap creation using the WaveLight FS200 femtosecond (FS) laser platform.MethodsWe conducted an ex vivo experimental study in an animal model. The WaveLight FS200 FS laser platform was used to perform the corneal LASIK flap in freshly enucleated porcine eyes. We measured the changes in IOP from the application of the suction ring (suctioning phase) through the creation of the lamellar corneal flap (cutting phase). The IOP was recorded using a manometric technique with direct cannulation to the anterior chamber.ResultsNine freshly enucleated porcine eyes were included in the study. The mean baseline IOP before the procedure was 20.33 ± 5.9 mm Hg. The mean IOP increase over baseline IOP was 32.33 ± 11.3 mm Hg at the suctioning phase, and 38.22 ± 11.3 mm Hg at the cutting phase. The total surgical time needed to complete the procedure was 29.5 ± 4.4 seconds.ConclusionsThe WaveLight FS200 FS laser platform produces a low to moderate increase in IOP during LASIK flap creation.Translational RelevanceThe WaveLight FS200 is a safe FS laser platform because it induces a low to moderate IOP increase during LASIK flap creation.