Mean Increase In Intraocular Pressure Research Articles

Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application

To examine the influence of different intravitreous injection techniques on the short-term intraocular pressure (IOP) in patients with exudative age-related macular degeneration (AMD) receiving 0.05 ml ranibizumab (Lucentis) in the supine position. Forty-five eyes (45 patients, 16 male, 29 female, mean age: 78 years) received intravitreal ranibizumab injections for treatment of exudative AMD (0.05 ml = 0.5 mg). A total of 31 patients received a standard straight scleral incision, and 14 were injected using the tunneled sclera technique. IOP was measured by Schiøtz tonometry immediately pre-and postoperatively, and the amount of subconjunctival reflux was documented using a semi-quantitative scale. Twenty-three eyes were phakic, and the remaining 22 were pseudophakic. No history of glaucoma was present. The Wilcoxon matched-pairs test was used for comparisons. The mean preoperative IOP was 22.4 +/- 5.5 mmHg in the supine position. Immediately after the injection, the IOP increased to 47.9 +/- 15.1 (range 23-82). The mean difference between preoperative IOP and immediately after the injection was 25.5 +/- 13.6 mmHg. The mean IOP increase in eyes receiving a standard straight scleral incision was 21.9 +/- 14.2 mmHg (median 22.3) versus 33.5 +/- 7.2 mmHg (median 34.7) in the tunneled scleral incision group (p = 0.001). IOP increased significantly in a considerable number of patients after receiving 0.05-ml intravitreal ranibizumab injections. This increase was dependent on the intravitreal injection technique and was significantly higher if a tunneled scleral injection was performed.

Intraocular pressure and ocular pulse amplitude variations during the Valsalva maneuver

To evaluate the effect of the Valsalva maneuver (VM) on short-term variations of intraocular pressure (IOP) and ocular pulse amplitude (OPA) values in healthy, young, male subjects. IOP and OPA values were measured before and during VM by Pascal dynamic contour tonometer (DCT) in 55 eyes of 55 healthy male volunteers aged 20 through 27 years. Mean IOP before VM was 17.2 +/- 2.9 mmHg and during the VM was 19.8 +/- 4 mmHg. The increase in mean IOP during the VM was found to be statistically significant (p = 0.001). The IOP increased in 46 (83.6%) of 55 eyes. However, in nine eyes (16.4%), IOP decreased during the VM. Mean OPA value before VM was 3.6 +/- 1.4 mmHg and during the VM was 3.6 +/- 1.3 mmHg. The change in mean OPA value was found to be statistically insignificant (p = 0.9). The IOP significantly increases during VM, whereas OPA remains stable. Strong autoregulatory mechanisms may provide consistent ocular perfusion in healthy subjects during VM.

Sustained Ocular Delivery of Fluocinolone Acetonide by an Intravitreal Insert

To compare Iluvien intravitreal inserts that release 0.2 or 0.5 microg/day of fluocinolone acetonide (FA) in patients with diabetic macular edema (DME). Prospective, randomized, interventional, multicenter clinical trial. We included 37 patients with DME. Subjects with persistent DME despite > or = 1 focal/grid laser therapy were randomized 1:1 to receive an intravitreal insertion of a 0.2- or a 0.5-microg/day insert. The primary end point was aqueous levels of FA throughout the study with an important secondary outcome of the change from baseline in best-corrected visual acuity (BCVA) at month 12. The mean aqueous level of FA peaked at 3.8 ng/ml at 1 week and 1 month after administration of a 0.5-microg/day insert and was 3.4 and 2.7 ng/ml 1 week and 1 month after administration of a 0.2-microg/day insert. For both inserts, FA levels decreased slowly thereafter and were approximately 1.5 ng/ml for each at month 12. The mean change from baseline in BCVA was 7.5, 6.9, and 5.7 letters at months 3, 6, and 12, respectively, after administration of a 0.5 microg/day-insert and was 5.1, 2.7, and 1.3 letters at months 3, 6, and 12, respectively, after administration of a 0.2-microg/day insert. There was a mild increase in mean intraocular pressure after administration of 0.5-microg/day inserts, but not after administration of 0.2-microg/day inserts. The FA intravitreal inserts provide excellent sustained intraocular release of FA for > or = 1 year. Although the number of patients in this trial was small, the data suggest that the inserts provide reduction of edema and improvement in BCVA in patients with DME with mild effects on intraocular pressure over the span of 1 year. Proprietary or commercial disclosure may be found after the references.

NSAIDS IN COMBINATION THERAPY FOR THE TREATMENT OF CHRONIC PSEUDOPHAKIC CYSTOID MACULAR EDEMA

The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injections for the treatment of chronic cystoid macular edema. Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks. At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thickness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy. Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.

Comparison of Goldmann tonometry, pneumotonometry and the effect of the central corneal thickness

To compare the intraocular pressure (IOP) measurements using the Goldmann applanation tonometer (GAT) and contact pneumotonometer (NTC), and to evaluate the effects of central corneal thickness (CCT) on the readings.This was a prospective, observational clinical study, which included 96 eyes of 49 patients, 40 glaucomatous, 29 ocular hypertensive and 27 normal subjects. The IOP measurements were performed with each tonometer. The CCT was also measured.A strong correlation coefficient between GAT and the NTC was found (Pearson=0.922, p<0.001). The mean of paired differences between GAT and NTC was 0.72 ± 2.82 mmHg. The mean difference between GAT and NTC was low at lower levels of PIO and higher at higher levels of IOP. Readings with the GAT showed a mean increase in IOP of 0.47 mmHg for every 10 μm of CCT, and the NTC 0.34 mmHg for every 10 μm, the diference was not statistically significant.The contact pneumotonometer is a reliable method in diagnosis and follow up of our population. The effect of the central corneal thickness was more important for the Goldmann applanation tonometer.

Understanding the mechanism of the water drinking test: the role of fluid challenge volume in patients with medically controlled primary open angle glaucoma

To determine whether a 500-mL fluid challenge produces a different intraocular pressure (IOP) response profile compared with a 1000-mL water drinking test (WDT). Prospective, observer-masked, cross-over, observational study. Patients with primary open angle glaucoma were recruited from a private specialist glaucoma practice. One eye of each patient was included. Subjects were randomized to receive either a 500-mL or 1000-mL fluid challenge. Baseline IOP was recorded with a Goldmann applanation tonometer and then every 15 min for 1 h. A second WDT with the alternate volume of water was performed after a minimum washout period of 24 h. Primary statistical analysis was performed using a two-way anova repeated measures of variance with a Bonferroni post-hoc test. Fifteen patients were included in this study. The mean patient age was 67.0 +/- 10.2 (SD) years, and 60% of patients were female. There was no statistically significant difference in baseline IOP between the 500-mL and 1000-mL WDTs (P = 0.11). Both fluid challenge volumes produced a statistically significant rise in IOP from baseline at 15, 30 and 45 min after water ingestion. However the mean maximum increase in IOP was less in the 500-mL WDT (3.3 +/- 1.8 mmHg [23.9%]) compared with the 1000-mL WDT (4.9 +/- 2.3 mmHg [32.5%]; P = 0.0095). The 500-mL WDT may provide an alternative for patients who are unable to tolerate drinking 1000 mL of water. However, because the maximum IOP obtained is less, a 500-mL WDT cannot be used to directly estimate peak diurnal pressure.

Effect of Orally Administered Zingiber Officinale on the Intra Ocular Pressure of Experimental Rabbits

PURPOSE: To determine the therapeutic effect of Ginger (Zingiber officinale) on increased intraocular pressure (IOP). METHODS: Twenty male and female New Zealand rabbits divided into 5 groups (A, B, C, D and E) were used. Groups B and D were administered with topical atropine 1% for 2 weeks while groups A and C were not so treated and group E was used as control. After increased IOP was achieved in groups B and D, oral ginger (1.00 ml) obtained by hot (100 oC) extraction was administered to each rabbit in groups A and B while 1.0 ml of cold (37 oC) extracts of ginger was administered to groups C and D all twice daily. RESULTS: There was significant decrease in mean IOP (within the range of 3.0 ± 1.0 mmHg daily which finally stabilized at 7.00 ± 1.0 mmHg) in all groups treated with both hot and cold extracts of ginger. CONCLUSION: Ginger lowers IOP in rabbits’ eyes and may be a useful agent in reducing IOP in humans as it is cheap, commonly available, relatively free from adverse effects and beneficial to all the major tissues of the body. eywords: Intraocular pressure, Ginger, Zingiber officinale, Topical application

Association of intraocular pressure with the metabolic syndrome and novel cardiometabolic risk factors

This study aimed to investigate the association of intraocular pressure (IOP) with the metabolic syndrome and other emerging cardiometabolic risk factors. A total of 1112 participants undergoing a health check-up in a community hospital were recruited. All participants underwent ophthalmological examination including IOP measurement. Participants with metabolic syndrome had significantly higher IOP than those without metabolic syndrome (mean IOP+/-SD: 15.07+/-2.74 vs 14.29+/-2.72 mm Hg, P=2x10(-4)). Each additional component of the metabolic syndrome was associated with a mean increase in IOP of 0.33 mm Hg (95% confidence interval: 0.18-0.48, trend P<0.0001). Other insulin resistance-related features, including hepatic steatosis, increased left ventricular mass, and proteinuria, were also associated with IOP (P<0.0001, 0.002, and 0.01, respectively). However, we did not find significant association of plasma apolipoprotein A, apolipoprotein B1, homocysteine, or highly sensitive C-reactive protein levels with IOP. IOP was also not associated with measures of subclinical atherosclerosis including brachial-ankle pulse wave velocity, ankle-brachial index, and vertebral artery flow. Metabolic syndrome and other insulin resistance-related features, including hepatic steatosis, increased left ventricular mass, and proteinuria, are strongly associated with IOP.

Retinal changes after acute increase of the intraocular pressure in adult mice

Abstract Purpose To investigate the effects of increased IOP on the outer retina and its circuitry. Methods Adult male swiss mice received a mean of 75 laser impacts (532 nm wavelength, 300 mW power, 0.5 second duration, 100 µm diameter spot size) over the limbar and episcleral veins of the left eye. Intraocular pressure (IOP) was measured with the Tonolab tonometer prior to and at 12 h, and 1, 2, 8 or 20 wks after lasering. Full field ERG responses were recorded from both eyes prior to and 1, 2, 8 or 20 wks after lasering. Mice were processed at 3 (n=5), 8 (n=4) or 12 (n=4) wks after lasering. Cryostat retinal sections were analized by fluorescent confocal microscopy. Results Laser treatment induced an increase in mean IOP of 130% over baseline 12 hours after lasering but reached basal levels by 1 wk. Three wks after lasering, immunostaining with recoverin and transducin could not document any changes in the ONL, but both ON‐rod bipolar and horizontal cells had lost their dendritic processes in the OPL. Sprouting of horizontal and bipolar cell processes were observed into the ONL. Eight weeks and 12 weeks after lasering, mice with severe impairment of their ERG (disappearance of b‐wave) presented loss of photoreceptor cells. PKC showed morphologic changes of rod bipolar cells and Calbindin showed abnormal and diminished horizontal cells. Immunoreactivity for synaptophysin was decreased and no all the rod bipolar dendrites showed relationship with rod spherules. Conclusion Increased IOP by laser photocoagulation of the perilimbar and episcleral veins in swiss mice results in changes of retina cell morphology and impairs retinal circuitries.

Comparison of real intraocular pressure (IOP) during LASIK versus Epi‐LASIK

Abstract Purpose To compare real‐time intraocular pressure (IOP) in LASIK versus Epi‐LASIK in porcine eyes during flap creation using the Moria 2 microkeratome and the Moria Epi‐KTM epikeratome. Methods Interventional, prospective study of two keratomes: Moria Group (M2) and epipolis laser in situ keratomileusis Group (MEpi‐K). These devices were used to create a lamellar corneal or epithelial flap respectively in freshly enucleated porcine eyes. The IOP changes induced by the procedures were recorded using manometry by direct cannulation with a reusable blood pressure transducer connected to the anterior chamber. Results 7 eyes were included for M2 Group and 10 for the MEpi‐K Group. In the M2 Group the IOP increased during suction phase to a mean value of 122.53±30.40 mm Hg and to 160.52±22.73 mm Hg during cutting phase (mean time: 21.42±7.48 and 15.71±1.88 secs respectively). In the MEpi‐K Group, mean IOP increase was 100.66±18.60 mm Hg during suction phase, 91.38±17.79 mm Hg during cutting phase and 74,37±12.70 during low‐back phase (mean time: 25.79±3.44, 33.68±2.81 and 29.74± 3.11 secs respectively). IOP values in both groups showed statistical significant difference in all comparison (p&lt;0.01). Conclusion Real‐time IOP can be measured during flap creation process using direct manometry in the anterior chamber. Our results show a significant increase in IOP during the surgical procedure in both groups although the IOP increase reached with MEpi‐K epikeratome seems to be lower than M2 microkeratome.

Effect of a new cohesive ophthalmic viscosurgical device on corneal protection and intraocular pressure in small-incision cataract surgery

To compare the corneal protective and intraocular pressure (IOP) effects of a new cohesive ophthalmic viscosurgical (OVD), Neocrom Cohesive (sodium hyaluronate 1.4%), with those of Healon (sodium hyaluronate 1.0%) in cataract surgery. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. This randomized patient-masked examiner-masked study with fellow-eye comparison comprised 29 cataract surgery patients. Surgery was performed with Neocrom Cohesive in 1 eye and Healon in the other eye. Central corneal thickness (CCT) was measured preoperatively and 1 day and 3 months postoperatively; endothelial cell density (ECD), preoperatively and 3 months postoperatively; and IOP, preoperatively and 6 hours and 1 day postoperatively. The mean CCT change from preoperatively to postoperatively in the Neocrom Cohesive, respectively, group and Healon group was +16.0 microm +/- 25.7 (SD) (P<.01) and +7.0 +/- 17.1 microm (P<.05), respectively, at 1 day and -5.7 +/- 10.8 microm (P<.01) and -4.7 microm +/- 9.5 microm) (P<.01), respectively, at 3 months. The mean ECD change at 3 months was 8 +/- 155 cells/mm(2) in the Neocrom Cohesive group (P = .8) and -46 +/- 139 cells/mm(2) in the Healon group (P = .08). The mean IOP increase was +2.2 +/- 3.5 mm Hg (P<.01) and +1.4 +/- 4.2 mm Hg (P = .14), respectively, 6 hours postoperatively and +0.9 +/- 4.3 mm Hg (P = .37) and 0.0 +/- 3.5 mm Hg (P = .77), respectively, at 1 day. There was no significant difference between Neocrom Cohesive and Healon in the changes in CCT, ECD, and IOP after cataract surgery.

Intracameral triamcinolone acetonide to control postoperative inflammation following cataract surgery with phacoemulsification

To explore the efficacy, safety and tolerability of 1 mg intracameral triamcinolone acetonide (TA) in controlling ocular inflammation in patients undergoing cataract surgery. Sixty eyes of 60 patients undergoing cataract extraction with phacoemulsification at the Department of Ophthalmology, Baskent University School of Medicine were randomized into two groups. After surgery, eyes in group A were injected with 1 mg/0.1 ml TA into the anterior chamber, but eyes in group B were not. Postoperatively; in group B, topical prednisolone acetate 1% eyedrops were administered six times per day for 7 days, then four times per day for 15 days, to control postoperative inflammation. In group A, topical corticosteroids were not used. To evaluate the efficacy of intracameral TA, anterior chamber cells, anterior chamber flare and conjunctival hyperaemia were measured on postoperative days 1, 7 and 30 by slit-lamp biomicroscopy. The safety of intracameral TA was evaluated by visual acuity measurements, intraocular pressure values and fundus examination. Tolerance variables were assessed by the degree of burning, stinging and blurred vision. Both treatments were equally effective in controlling postoperative inflammation following phacoemulsification. No statistically significant differences between groups were observed for the efficacy, safety and tolerance variables, and no serious adverse events were observed. Intracameral TA of 1 mg can effectively be used to control postoperative inflammation after uncomplicated cataract surgery with phacoemulsification. This makes it possible to decrease the dosage and duration of topical prednisolone acetate.

Natural Course of Intraocular Pressure after Cataract Surgery with Sodium Hyaluronate 1% versus Hydroxypropylmethylcellulose 2%

To investigate the natural course of intraocular pressure (IOP) after small-incision cataract surgery with sodium hyaluronate 1% versus hydroxypropylmethylcellulose 2%. Randomized clinical trial. Eighty eyes of 40 consecutive patients with bilateral age-related cataract. The patients were assigned randomly to receive sodium hyaluronate 1% or hydroxypropylmethylcellulose 2% during cataract surgery in the first eye. The second eye received the other ophthalmic viscosurgical device. The IOP was measured preoperatively and 30 minutes; 1, 2, 3, 4, 6, 8, and 20 to 24 hours; and 1 week postoperatively. Postoperative IOP increase. The highest mean IOP increase occurred at 8 hours postoperatively (5.3+/-6.4 mmHg) in the sodium hyaluronate 1% group and at 2 hours postoperatively (7.8+/-6.1 mmHg) in the hydroxypropylmethylcellulose 2% group. Overall, the IOP increase was higher with hydroxypropylmethylcellulose 2% (P = 0.005). Intraocular pressure spikes to > or =30 mmHg occurred in 5 eyes (13%) in the sodium hyaluronate 1% group and 13 eyes (33%) in the hydroxypropylmethylcellulose 2% group. Sodium hyaluronate 1% and hydroxypropylmethylcellulose 2% caused significant IOP increases during the first 8 hours after cataract surgery. A single measurement at 6 hours postoperatively could detect all IOP spikes in the sodium hyaluronate 1% group. In the hydroxypropylmethylcellulose 2% group, a single measurement at 2 hours postoperatively could detect two thirds of IOP spikes.

Intraocular Pressure Changes and Ocular Biometry during Sirsasana (Headstand Posture) in Yoga Practitioners

To study the intraocular pressure (IOP) changes in Sirsasana (headstand posture) done by experienced yoga practitioners and correlate the ocular biometric parameters with the IOP changes, and to screen for the prevalence of ocular hypertension in this group of subjects. Prospective case observational series. Seventy-five subjects (50 Asian Indians and 25 Caucasians) from a yoga training institute volunteered for the study. All participants underwent a detailed ophthalmic examination along with ocular biometry and corneal pachymetry. Intraocular pressure was recorded using a Tonopen before, during, and after the Sirsasana. Changes were compared using the paired t test. Age, axial length, anterior chamber depth, lens thickness, corneal curvature, corneal thickness, race, and the length of time for which the practitioner was performing yoga were correlated with the induced IOP difference in a randomly selected eye using Pearson's correlation coefficient with Bonferroni correction for multiple comparisons. Ocular biometry and induced IOP difference. The mean increase in IOP at baseline and immediately after assuming Sirsasana was 15.1+/-4.1 mmHg (R = 0.07; P = 0.999) and after 5 minutes was 15.8+/-4.6 mmHg (R = -0.25; P = 0.357). The induced increase in IOP during the posture was twice the baseline IOP. There was no correlation between age, ocular biometry, and ultrasound pachymetry when compared with the induced IOP difference. One subject (1.33%) was found to have baseline IOP of more than 21 mmHg. There was a uniform 2-fold increase in the IOP during Sirsasana, which was maintained during the posture in all age groups irrespective of the ocular biometry and ultrasound pachymetry. We did not demonstrate a higher prevalence of ocular hypertensives in this cohort of yoga practitioners nor did the risk factors contributing to glaucoma show any correlation with magnitude of IOP raise during the posture.

Effect of a fixed dorzolamide\\Ntimolol combination on intraocular pressure after small-incision cataract surgery with Viscoat

The effect of a fixed dorzolamide-timolol combination (Cosopt) on intraocular pressure (IOP) after small-incision cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) was evaluated in a prospective, randomized study. Seventy-six eyes of 38 patients scheduled for small-incision cataract surgery in both eyes were randomized to receive 1 drop of dorzolamide-timolol in one eye or no treatment immediately after surgery. The fellow eye received the other assigned treatment following surgery at a later date. Small-incision cataract surgery was performed with sodium chondroitin sulfate 4%-sodium hyaluronate 3% in an identical fashion in both eyes. The baseline IOP was measured by Goldmann applanation tonometry 1 day before surgery and 6 hours and 20 to24 hours after surgery by a masked observer. The intraocular pressure was measured by Schiotz tonometry at the conclusion of the case and was adjusted to 20 mm Hg. Six hours after surgery, the mean increase in IOP was significantly lower in the dorzolamide-timolol group than in the control group (4.3 + 5.6 mm Hg vs 8.4 + 6.1 mmHg, respectively; p= 0.003). Two eyes in the dorzolamide-timolol group had IOP spikes of 30 mm of higher vs 9 eyes in the control group (p = 0.022). Twenty to 24 hours after surgery, the mean IOP change was -2.6 + 3.3 mm Hg in the dorzolamide-timolol group vs 1.5 + 3.2 mm Hg in the control group (ph 0.001). A single topical drop of dorzolamide-timolol was effective in reducing IOP 6 hours and 20 to 24 hours after cataract surgery, and it reduces, but does not eliminate, the risk of sodium chondroitin sulfate 4%-sodium hyaluronate 3%-induced IOP spikes of 30 mm Hg or higher. Michael D. Wagoner.

Effect of a fixed dorzolamide–timolol combination on intraocular pressure after small-incision cataract surgery with Viscoat

To evaluate the effect of a fixed dorzolamide-timolol combination (Cosopt) on intraocular pressure (IOP) after small-incision cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat). Department of Ophthalmology, University of Vienna, Vienna, Austria. This prospective randomized study comprised 76 eyes of 38 patients scheduled for small-incision cataract surgery in both eyes. Patients were randomized to receive 1 drop of the fixed dorzolamide-timolol combination in 1 eye or no treatment (control) immediately after cataract surgery. The fellow eye received the other assigned treatment. Cataract surgery was performed with Viscoat in an identical fashion in both eyes. The IOP was measured preoperatively and 6 hours, 20 to 24 hours, and 1 week postoperatively. Six hours after surgery, the mean increase in IOP was significantly lower in the dorzolamide-timolol group than in the control group (4.3 mm Hg +/- 5.6 [SD] versus 8.4 +/- 6.1 mm Hg; P =.003). Two eyes in the dorzolamide-timolol group and 9 in the control group had IOP spikes of 30 mm Hg or higher (P =.022). Twenty to 24 hours after surgery, the mean IOP change was -2.6 +/- 3.3 mm Hg in the dorzolamide-timolol group and 1.5 +/- 3.2 mm Hg in the control group (P<.001). The fixed dorzolamide-timolol combination was effective in reducing IOP 6 hours and 20 to 24 hours after cataract surgery. However, it did not prevent Viscoat-induced IOP spikes of 30 mm Hg or higher.

Determinants of intraocular pressure and its association with glaucomatous optic neuropathy in Chinese Singaporeans: the Tanjong Pagar Study.

To examine the relationship between intraocular pressure (IOP), anthropomorphic, demographic, socioeconomic, systemic, and ocular factors and glaucomatous optic neuropathy (GON) in Chinese people. Chinese people (n = 2000), aged 40 to 79 years, were selected from the Singapore electoral register. Of the 1717 considered eligible for examination, 1232 participated, representing a response rate of 71.8%. IOP was estimated with Goldmann applanation tonometry. The drainage angle was assessed with static and dynamic gonioscopy. The optic nerve was examined at high magnification through a dilated pupil with a fundus contact lens or a +78-D lens. Static automated visual field testing was performed on subjects with suspected glaucoma. GON was diagnosed on the basis of structural and functional abnormalities of the optic nerve. The main independent determinants of higher IOP were higher systolic blood pressure (P < 0.001), quadrants of any peripheral anterior synechiae (PAS, P = 0.02) and width of the drainage angle (P = 0.049). A 100- micro m increase in corneal thickness was associated with an increase in mean IOP of 1.5 to 1.8 mm Hg (P < 0.001). Odds of GON increased 1.2 times per 1-mm Hg increase in screening IOP. A clear association between corneal thickness and GON was not identified. Clinical IOP estimates are related to systolic blood pressure and corneal thickness. Variation in IOP with angle width may suggest that trabecular compaction significantly contributes to causes of the increase in IOP, independent of angle-closure. GON is an IOP-related phenomenon among Chinese Singaporeans.

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. Department of Ophthalmology, University of Vienna, Vienna, Austria. This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Impact of Increased Intraocular Pressure on Long-Term Corneal Endothelial Cell Density after Penetrating Keratoplasty

Purpose: Besides immunological graft rejection, persistently increased intraocular pressure (IOP) is among the most important causes for graft failure after penetrating keratoplasty (PK). The purpose of this study was to assess the longitudinal development of IOP after PK and to investigate possible correlations with corneal endothelial cell density. Methods: This longitudinal prospective study included 209 eyes after PK with a complete follow-up at 3 months, 6 months, before first suture removal (16 ± 5 months) and after complete suture removal (21 ± 5 months). At each examination, IOP was measured by Goldmann applanation tonometry. Endothelial cell density was assessed by specular microscopy (EM 1100, Tomey). The indications for PK were 48% keratoconus, 34% Fuchs’ dystrophy, 5.4% stromal dystrophies, 8.6% secondary bullous keratopathy and 4% corneal scars. An iridotomy was performed routinely during PK. The postoperative treatment with topical steroids was standardized. Results: Preoperatively, the mean IOP was 13.6 ± 2.9 mm Hg with increased IOP (>21 mm Hg) in 2.0% of eyes. After 3 months, the incidence of increased IOP (24.5 ± 4.6 mm Hg) was highest (6.7%) and decreased thereafter to 3.0% after complete suture removal. No patients showed IOP higher than 30 mm Hg. A persistently increased IOP for more than 3 months was seen in 2% of patients. At 3 months postoperatively, the mean endothelial cell density was 1,977 ± 496/mm² and did not decrease significantly (p > 0.05) until 6 months (1,771 ± 507 cells/mm²). At the end of the follow-up period, the mean endothelial cell density was significantly reduced (1,347 ± 501 cells/mm²). There was no significant correlation between IOP and mean endothelial cell density at any postoperative examination stage (p > 0.24). Patients with persistently increased IOP for more than 3 months did not have significantly different endothelial cell densities in comparison with those without increased IOP. Conclusion: From 6 months after PK, the incidence of increased IOP was not higher than the preoperative level. Mild to moderate temporary IOP elevations after PK do not seem to affect the endothelial cell density of the graft until complete suture removal. Further long-term studies are necessary to assess the clinical relevance of these observations.

Effect of topical brimonidine on intraocular pressure after small incision cataract surgery

To evaluate the effect of brimonidine 0.2% on intraocular pressure (IOP) after small incision cataract surgery. Department of Ophthalmology, University of Vienna, Vienna, Austria. This prospective randomized study comprised 80 eyes of 40 patients scheduled for small incision cataract surgery in both eyes. In each patient, 1 eye was randomly assigned to receive 1 drop of brimonidine 0.2% or no treatment (control) immediately after surgery. The fellow eye received the other assigned treatment. All patients had standardized surgery by the same surgeon with sodium hyaluronate 1%, a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. Six hours after surgery, the mean increase in IOP was 4.7 mm Hg +/- 6.1 (SD) in the brimonidine group and 4.6 +/- 5.3 mm Hg in the control group. In each group, 17 eyes (43%) had an IOP increase of 5 mm Hg or more. Twenty to 24 hours after surgery, the mean increase in IOP was 1.5 +/- 4.2 mm Hg in the brimonidine group and 1.6 +/- 4.4 mm Hg in the control group. There were no statistically significant between-group differences at any measurement. In both groups, IOP significantly increased 6 hours and 20 to 24 hours after small incision cataract surgery. Brimonidine 0.2% failed to reduce the IOP increase observed after small incision cataract surgery.