Mean Intraocular Pressure Research Articles

Surgery Outcomes of Glaucoma Drainage Device Implantation in Refractory Glaucoma Patients at Sardjito General Hospital

Introduction & ObjectivesGlaucoma drainage device (GDD) implantation was an effective surgical procedure in treatinguncontrolled intraocular pressure (IOP) of glaucoma patients in certain complicated conditions. GDDimplants were classified into valved and non-valved in which its surgical outcomes in different typesof device and various etiologies were not similar. This study aimed to evaluate the surgery outcomesof GDD implantation in patients with refractory glaucoma at Sardjito General Hospital.
 MethodsAll 12 eyes of 11 patient’s medical records who underwent GDD implantation during 2022 at SardjitoGeneral Hospital was reviewed. Baseline data include age, gender, eye laterality, type of glaucoma,IOP and visual acuity. The IOP and visual acuity (LogMAR) were measured at week 1, month 1, 2and 3. Type of GDD implants, postoperative glaucoma medications, complications and need forfurther glaucoma surgery were documented.
 ResultsThe mean IOP at baseline was 44 ± 14.2 mmHg with 3.4 ± 0.6 glaucoma medications. It decreasedafter surgery into 19.1 ± 11.2 mmHg (p=0.003) at 3 months follow up with 0.7 ± 1.7 (p=0.002)glaucoma medications. The mean initial visual acuity was 1.9 ± 0.6 and changed insignificantly to1.7 ± 0.8 (p=0.624) at last follow up. Six eyes (50%) were implanted with valved implant. The mostcommon early postoperative complications were recurrent high IOP (4 eyes, 33.3%) associated toripcord of non-valved implant (p=0.025). Five eyes (41.7%) needed additional surgery related tonon-valved implant type (p=0.003).
 ConclusionGDD implantation especially valved type appears to be safe and effective surgical option in treatingrefractory glaucoma patients.

INTRAOPERATIVE MITOMYCIN-C, 5-FLUOROURACIL, RETROBULBAR TRIAMCINOLON ACETONIDE, IS IT EQUALLY EFFECTIVE TO DECREASE INTRAOCULAR PRESSURE AFTER TRABECULECTOMY?

Objectives: To evaluate the effect of mitomycin-C (MMC), 5-fluorouracil (5-FU), and retrobulbar triamcinolone acetonide (TA) on the surgical result of trabeculectomy Materials and Methods: All consecutive trabeculectomies with releasable sutures performed in Sardjito General Hospital between January 2022 and December 2022 were retrospectively reviewed from medical records. Patients without any intraoperative metabolite (control group, n=5) were compared to those with retrobulbar TA (n=5), MMC group (n=19), and 5-FU group (n=11) in terms of surgical success. Successful surgery results were defined as IOP between 5 - 21 mm Hg without any further medications or surgical intervention and fewer complications. Results: 40 eyes of 35 patients (15 male, 25 female, mean age 52.4 years) were included in the study. The IOP pre operative in TCA group was 47.12 ±12.16 mmHg, in MMC group was 35.53 ± 17.05 mmHg, in 5-FU group was 34.54 ± 17.77 mmHg, and 43.80 ± 15.79 mmHg in group without any metabolite. The patient was observed until the post-operation day (POD) 90. There were no significant differences in intraocular pressure at POD 1, 7, 30, 60, and 90 between the control group compared to TCA, MMC, and 5-FU group. In TCA group, pre operative IOP was 47.12 ±12.16 mmHg then decreases to 15.60 ± 4.61 mmHg at POD 90. In MMC group, pre operative IOP was 35.53 ± 17.05 mmHg, 90 days later became 14.42 ± 5.71 mmHg. In 5-FU group, pre operative IOP was 34.54 ± 17.77 mmHg then decrease to 13.64 ± 4.08 mmHg. In group without metabolite, pre operative IOP was 43.80 ± 15.79 mmHg, then became 21.00 ± 6.81 mmHg at POD 90. The lowest mean intraocular pressure of POD 90 was in the 5-FU group (13.64 ± 4.08 mmHg). Complication after trabeculectomy in the TCA group was 21%, the MMC group was 27%, the 5-FU group was 10%, and the control group was 42%. Conclusion: MMC, 5-FU, and TCA in this study are equally effective to decrease IOP after trabeculectomy.

INTRAOPERATIVE MITOMYCIN-C, 5-FLUOROURACIL, RETROBULBAR TRIAMCINOLON ACETONIDE, IS IT EQUALLY EFFECTIVE TO DECREASE INTRA OCULAR PRESSURE AFTER TRABECULECTOMY?

Introduction & ObjectivesTo evaluate the effect of mitomycin-C (MMC), 5-fluorouracil (5-FU), and retrobulbar triamcinoloneacetonide (TA) on the surgical result of trabeculectomy.
 MethodsAll consecutive trabeculectomies with releasable sutures performed in Sardjito General Hospitalbetween January 2022 and December 2022 were retrospectively reviewed from medical records.Patients without any intraoperative metabolite (control group, n=5) were compared to those withretrobulbar TA (n=5), MMC group (n=19), and 5-FU group (n=11) in terms of surgical success.Successful surgery results were defined as IOP between 5 - 21 mm Hg without any furthermedications or surgical intervention and fewer complications.
 Results40 eyes of 35 patients (15 male, 25 female, mean age 52.4 years) were included in the study. Patientwas observed until post-operation day (POD) 90. There were no significant differences of intraocularpressure at POD 1, 7, 30, 60, and 90 between control group compared to TCA, MMC, and 5-FUgroup. Intraocular pressure pre- and post-operation in each group was significantly different(p<0.05). The lowest mean intraocular pressure of POD 90 was in 5-FU group (13.64 ± 4.08).Complication after trabeculectomy in TCA group was 21%, MMC group was 27%, 5-FU group was10%, and control group was 42%.
 ConclusionMMC, 5-FU, and TCA in this study are equally effective to decrease IOP after trabeculectomy.

Microinvasive Glaucoma Surgery using Goniotomy as A Potential Surgical Treatment Modality in Indonesia: A Descriptive Study and Literature Review

Introduction & ObjectivesMicro-invasive glaucoma surgery with goniotomy is a recent surgical treatment modality that targetsthe trabecular outflow to maintain intraocular pressure. This study aims to describe the clinicaloutcomes of excisional goniotomy using KDB and to review the published literature regarding amodified goniotomy technique as a potential surgical treatment modality in Indonesia.
 MethodsA cross-sectional descriptive study was conducted in patients that underwent goniotomy stand-aloneor combined with cataract surgery. Main outcome parameters consist of visual acuity, intraocularpressure (IOP), number of glaucoma medications, and complications during post-operative follow-up.
 ResultsA total of 7 patients (8 eyes) were included in the study, consisting of 5 (71,4%) males and 2 (28,6%)females. The mean age of the subjects was 47.7 years. Subjects consisted of primary,pseudoexfoliative, steroid-induced, and angle-recess glaucoma. Mean pre-operative IOPmeasurements showed 20.74 mmHg with visual acuity consisting of 1 (14.3%) mild visualimpairment and 7 (85.7%) severe visual impairment. Postoperatively there was progressiveimprovement in the mean IOP to 13.81 and 11.31 mmHg on first-day and one-week follow-up,respectively. Visual improvement was observed in 2 (28.5%) with mild visual impairment, 3 (42.6%)with severe visual impairment, and 2 (28.5%) with hand movement due to complications of cornealedema following phacoemulsification. A week later, visual acuity improved to 4 (57.1%) with mildvisual impairment and 3 (42.9%) with moderate visual impairment.
 ConclusionGoniotomy is a simple surgical method that may be applied in Indonesia as a novel technique toprovide an effective intraocular pressure-lowering effect.

TRABECULECTOMY VERSUS TUBE OUTCOME IN NEOVASCULAR GLAUCOMA

Introduction: Neovascular glaucoma (NVG) is known to be a refractory form of glaucoma, which frequently requires the integrated use of medical, laser and incisional surgery. Tube-shunt implantation and trabeculectomy with anti-fibrotic agent are the two most-popular incisional procedures for managing refractory glaucoma. This study aims to compare surgical outcome between patients who underwent trabeculectomy versus tube-shunt implantation for the treatment of NVG. Methods: A retrospective study was held of NVG patients that underwent trabeculectomy and tube-shunt implantation between January 2020 - December 2022 at Dr. Kariadi Hospital, Semarang. IOP outcome and success rate was measured at 3 months post operatively. Statistical analysis was used to compare the outcome between groups, p<0.05 was considered significant. Result: There were no significant differences in characteristics between groups at baseline. Mean IOP measured at 3 months postoperatively was 18.58 ± 5.53 and 15.94 ± 10.79 in trabeculectomy and tube group respectively (p=0.04), complete success rate was 18.8% in trabeculectomy and 25% in tube group, qualified success rate was 37.5% in trabeculectomy and 56.3% in tube group. Greater failure rate was observed in trabeculectomy group (43.8%). Conclusion: Compared to trabeculectomy, tube-shunt implantation has lower IOP at 3 months postoperatively in NVG. Similar number of anti-glaucoma medications was needed postoperatively in both procedure. Greater qualified success rate was achieved in tube-shunt implantation. Greater failure rate was observed in trabeculectomy.

Optic Nerve Head and Retinal Nerve Fiber Layer Analysis in Emmetropic Malay Children.

The study aims to investigate the normal reference values for optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters in emmetropic Malay children, utilizing measurements obtained through Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA). A cross-sectional study was conducted on 95 Malay children, aged between seven and 17 years, with no ocular abnormalities. It was held at Hospital Universiti Sains Malaysia, Malaysia, from January 2014 to December 2015. All children underwent a full ocular examination, including refraction and calculation of axial length. ONH and retinal nerve fiber layer thickness (RNFLT) parameters were measured using the Cirrus SD-OCT machine. One eye of each subject was selected randomly for study. The associations between the parameters and the effect of age, gender,axial length, and spherical equivalent (SE) on the measurements were statistically validated. Ninety-five children were involved in the study, with 65 females (68.4%) and 30 males (31.6%). The mean age was 10.6 (2.82) years, the mean intraocular pressure (IOP) was 14.8 (2.81) mmHg, the mean SE-refraction was 0.12 (0.28) diopters, and the mean axial length was 23.03 (0.76) mm. The mean disc area, rim area, and cup volume were 2.32 (0.40) mm2, 1.53 (0.33) mm2, and 0.204 (0.16) mm3, respectively. The average cup-to-disc ratio (SD) (CDR) and the vertical CDR were 0.55 (0.13) and 0.50(0.14). Mean (SD) RNFLT was 102.08 (11.08) μm for all patients. There was a strong positive correlation between the average, superior, and inferior RNFLT with the optical disc area. The rim area and the average, superior, inferior, and nasal RNFLT alsoshowed a significant correlation. The inferiorRNFLT was negatively correlated with the average CDR. There was also a major influence of gender on the disc area. There were no major age, axial length, and SE influences on the measurements. This study provided normative information for ONH and RNFLT parameters in emmetropic Malay children. It was observed that emmetropic Malay males exhibited a significantly larger optical disc area. The increase in RNFLT is correlated with a significant increase in disc and rim areas.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18mmHg, and (3) IOP ≤ 15mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4mmHg and 32.3 ± 8.4mmHg, respectively, which significantly reduced to 14.5 ± 0.7mmHg and 11.6 ± 0.6mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Changes in intraocular pressure during the first 24 h after transscleral cyclophotocoagulation.

To estimate the changes in intraocular pressure (IOP) during the first 24 h after transscleral cyclophotocoagulation (TCP). A prospective single-centre study, where patients with glaucoma destined for treatment with TCP were asked for participation. The IOP was measured prior to TCP and at 1, 2, 4, 6 and 24 h post-TCP. An IOP spike was defined as an elevation of IOP of ≥5 mmHg compared with baseline. The visual acuity (VA) was examined at baseline and after 24 h. The mean IOP prior to TCP in 58 eyes of 58 patients was 26.2 (±8.9 SD) mmHg. Twenty-three eyes (40%) experienced an IOP spike at some examination timepoint during the first 24 h. The mean value of the IOP spike was 12.1 (±6.9) mmHg. Fifty-six per cent of the eyes with pseudoexfoliation glaucoma (PEXG) experienced an IOP spike, and 16% had an IOP spike ≥20 mmHg. The IOP was significantly reduced at the 24 h examination by 8.1 (±7.8) mmHg (n = 58). The VA 24 h after TCP was unchanged compared with baseline. Clinically significant IOP spikes were common in the first 24 h post-TCP. Almost one in five eyes had an increase of 10 mmHg and in almost one in 10 eyes, the IOP increase was 20 mmHg or higher. Eyes with PEXG had a higher occurrence of IOP spikes and displayed a greater magnitude of IOP elevation. Prophylactic post-operative IOP-lowering medication should be considered to prevent further glaucoma damage.

Effects of intranasal and intramuscular administration of butorphanol and zolazepam-tiletamine combination on intraocular pressure and tear secretion in New Zealand White rabbits.

This study aimed to compare the effect of intranasal (IN) and intramuscular (IM) administration of butorphanol and zolazepam-tiletamine (ZT) combination on intraocular pressure (IOP) and tear secretion (TS) in rabbits. Fourteen healthy male New Zealand White rabbits weighing 3.05 ± 0.72 kg, aged between 1 and 2 years old, were included in the study. Animals randomly received 0.5 mg/kg butorphanol and 15 mg/kg ZT combination either with IN or IM administration. IOP and TS were measured at baseline (T0), and followed by 5, 15, 30, 45, and 60 min after drug administration. The sedation variables, the time to onset of sedation, duration of sedation, and sedation scores were also recorded. The route of administration for the butorphanol and ZT combination had no significant effect on the mean IOP (p = .301) and TS (p = .445). Furthermore, there were no significant changes observed in the IOP (p = .472) and TS (p = .348) over time. The time to onset of sedation was earlier in the IN group (4.57 ± 0.79 min) than in the IM group (5.86 ± 0.9 min; p = .0004). The duration of sedation was significantly longer for IM (57.43 ± 3.41 min) compared with IN (45.0 ± 1.91 min; p < .0001). No significant difference in the sedation score was observed between groups at all time points. In conclusion, both IN and IM administration of the butorphanol and ZT combination in rabbits had similar effects on IOP and TS.

Evaluation of early period changes in intraocular pressure, ocular biometry and anterior segment after upper eyelid blepharoplasty.

To investigate the acute effects of upper eyelid blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters. This prospective cross sectional study examined the eyes of 49 patients with dermatochalasis. Following a detailed ophthalmological examination, corneal topography was used to evaluate the eyes mesopic and photopic pupil diameter, anterior chamber depth, and corneal astigmatism on the day of surgery and on days first and seventh postoperatively. Ocular biometry was used to assess axial length and intraocular lens power. Goldmann applanation tonometry was used to measure intraocular pressure. Forty-nine eyes (26 males and 23 females) of 49 patients aged between 44 and 76years (mean 61 ± 7.9) were included in our study. The mean anterior chamber depth (ACD) was 2.90 ± 0.37mm preoperatively, 3.00 ± 0.29mm at postoperative day first, and 3.04 ± 0.29mm at postoperative day seventh, and the increase in anterior chamber depth was statistically significant (p < 0.001). The mean astigmatism values were measured as preoperative 0.73 ± 0.69 D, postoperative first day 0.93 ± 0.81 D, and postoperative seventh day 1.26 ± 0.90 D. The increase in astigmatism values was statistically significant (p < 0.001).The mean pupil diameter measurements in the mesopic environment were 4.20 ± 0.61mm preoperatively, 4.40 ± 0.59mm on the first postoperative day, and 4.39 ± 0.57mm on the seventh postoperative day, and there was a statistically significant difference between the three measurements (p = 0.03). The mean IOP measurements of the patients were 15.91 ± 3.51mmHg preoperatively, 16.81 ± 3.36mmHg on the first postoperative day, and 16.97 ± 3.13mmHg on the seventh postoperative day. The increase between these three measurements was statistically significant (p = 0.013). This study includes important insights into the potential acute phase impact of blepharoplasty surgery on ocular findings. Patients undergoing upper eyelid surgery should be informed about the possible change in ocular biometric parameters, intraocular pressure, and pupil diameter.

Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

Background/aimWhile intraocular pressure (IOP) remains the only modifiable risk factor for glaucoma progression, the ultimate goal of glaucoma management is to preserve patients’ functional vision and quality of life. To...

Comparison of Tonovet® and Tonovet plus® tonometers for measuring intraocular pressure in dogs, cats, horses, cattle, and sheep.

Reference ranges for intraocular pressure (IOP) in healthy animals are device-specific; therefore, it is strongly recommended to use appropriate reference values according to the device. Therefore, our aim was to compare IOP readings made by TonoVet® and TonoVet Plus® in healthy dogs, cats, sheep, cattle, and horses. We compared IOP values measured by TonoVet® and TonoVet Plus® tonometers in clinically normal eyes of dogs, cats, horses, cattle, and sheep. Five groups comprising 20 animals each of dogs (various breeds, 9 months-10 years old, 14 females, 6 males), cats (various breeds, 6 months-12 years old, 8 females, 12 males), horses (various breeds, 5-12 years old, 12 females, 8 males), cattle (Holstein, 1-7 lactation, female), and sheep (Latvian Darkhead ewes, 1-8 years old) were included in the study. Both eyes of all animals were subjected to ophthalmic examination, including evaluation of IOP by rebound tonometry using TonoVet® and TonoVet Plus® devices. Normality was determined using the Shapiro-Wilk test. The independent t-test was used to determine differences between IOP values in the right and left eyes and between both tonometers. This study was approved by the Ethical Commission of the Latvia University of Life Sciences and Technologies (Nr. LLU_Dzaep_2022-2-4). No differences in IOP between the right and left eyes were found in all cases (p > 0.05). The mean IOP ± standard deviation values in both eyes for TonoVet® and TonoVet Plus® tonometers were as follows: for dogs, 15.25 ± 2.73 mmHg and 19.65 ± 3.46 mmHg; and in cats, 18.88 ± 3.98 mmHg and 18.78 ± 4.26 mmHg, respectively. In horses, mean IOP was 22.15 ± 3.74 mmHg and 24.28 ± 3.00 mmHg; in cattle, 24.73 ± 2.89 mmHg and 23.28 ± 2.97 mmHg; and in sheep, 18.05 ± 3.54 mmHg and 22.49 ± 4.66 mmHg, respectively. Significant differences in IOP values were observed between the tonometers in sheep, dog, and horse groups (mean difference -4.40, -4.48, and 2.13, respectively). This study showed significantly higher IOP values measured by the TonoVet Plus® tonometer in dogs and sheep.

Expanded Polytetrafluoroethylene Spacer for Nonpenetrating Deep Sclerectomy Combined with Cataract Surgery.

To compare the outcomes of nonpenetrating deep sclerectomy (NPDS) with and without an expanded polytetrafluoroethylene (e-PTFE) implant combined with phacoemulsification (PE). Interventional case series with concurrent control group. Patients with medically uncontrolled glaucoma underwent PE nonpenetrating deep sclerectomy (NPDS) and were consecutively divided into a study group receiving an e-PTFE implant and a control group undergoing PE-NPDS. Intraocular pressure (IOP), corrected distance visual acuity (CDVA), and the number of glaucoma medications at 1 day, 1 week, 1 month, 3 months, and 6 months were recorded. A total of 22 eyes of 16 patients underwent PE-NPDS, including 11 eyes receiving an e-PTFE implant and another 11 eyes with no implant. NPDS with spacer achieved successful results in all patients, including eight (72.7%) complete and three (27.3%) qualified success, 6 months, postoperatively. The corresponding values in the control group were 10 (90.9%) and 1 (9.1%), respectively. In the spacer group, mean IOP was decreased from 19.3 ± 2.8 at baseline to 12.1 ± 2.0 mm Hg at month 6 (p < 0.001). Corresponding values for the control group were 18.6 ± 3.4 and 10.6 ± 1.5 mm Hg, respectively (p < 0.001). Mean IOPs were comparable between the study groups at all time points. Implant exposure occurred in one of the patients in the study group. While the implant was extruded, the IOP was medically controlled. Outcomes of PE-NPDS using an e-PTFE implant were comparable to the same surgery without a spacer in the short term. Larger studies with longer follow-ups are needed to determine the efficacy and safety of this new implant. Hajizadeh M, Meshksar A, Hassanpour K, et al. Expanded Polytetrafluoroethylene Spacer for Nonpenetrating Deep Sclerectomy Combined with Cataract Surgery. J Curr Glaucoma Pract 2024;18(2):51-56.

Corneal parameters in diabetics versus non-diabetics and correlation with various blood sugar parameters.

Aim: To compare corneal parameters in diabetics versus age-group-matched non-diabetics; also, to correlate these parameters with the duration of diabetes, glycated haemoglobin (HbA1c) levels, and severity levels of diabetic retinopathy (DR). Materials and methods: A comparative study was conducted at a tertiary eye-care center from January 2020 to December 2020. Two-hundred patients (400 eyes) with type-2 diabetes (100) and age-sex-matched non-diabetics (100) were included. Corneal morphological parameters like central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CoV), hexagonality (6A), and average cell area were recorded by specular microscopy. These parameters were correlated with the duration of diabetes, severity of disease based upon fasting blood glucose levels, HbA1c, and grade of DR. Mean and standard deviation were calculated, and regular distribution of continuous data was tested using independent sample t-test and ANOVA. Results: Mean ECD (2447.32 ± 269.89/mm2), 6A (45.03 ± 6.71%), and IOP (15.47 ± 2.02 mmHg) changed in diabetic cases and were significantly low in diabetics, whereas, mean average cell area (413 ± 50.19 mm2), standard deviation (167.05 ± 77.91), CCT (525.81 ± 36.69) and CoV (39.84 ± 15.59%), were significantly high in diabetics. Mean CCT had insignificant variation. Subgroup analysis within diabetics showed a statistically significant reduction of ECD, cell count, and 6A with increased duration of diabetes, poor glycaemic control, and raised HbA1c. Discussion: The corneal endothelial analysis is vital in daily clinical practice and provides valuable evidence concerning the viability of corneal endothelium in various intraocular surgeries. Uncontrolled DM harms the cornea with 70% of diabetics resulting in complications like keratopathy. The study highlighted that the increased duration of diabetes raised HbA1c, and poor glycemic control negatively affected corneal morphology. Our study showed a definite reduction in ECD and 6A in diabetics compared to non-diabetics. Conclusion: A definite reduction in the corneal endothelial counts, cell density, and hexagonality was found in type-2 diabetics compared to non-diabetics. Abbreviations: DM = Diabetes Mellitus, CCT = central corneal thickness, ECC = endothelial cell counts, ECD = endothelial cell density, CoV = coefficient of variance, 6A = hexagonality, DR = Diabetic retinopathy, SD = Standard of deviation, IOP = Intraocular pressure.

The effect of 1% tropicamide on central corneal thickness and intraocular pressure

Background: Dilating the eye with tropicamide may alter the intraocular pressure (IOP) because of an obstruction of the iridocorneal angle, resulting in decreased aqueous outflow drainage. Also, the repeated application of eyedrops and instrumentation could lead to increased central corneal thickness (CCT), consequently affecting IOP.Aim: This study aimed to determine the effect of 1% tropicamide on CCT and IOP post-mydriasis among the University of Limpopo optometry students.Setting: The data were collected at the optometry clinic of the University of Limpopo.Methods: A within-subject experimental study was conducted on 59 healthy subjects aged 18 years – 28 years. A computer assisted simple random probability sampling was used to identify a sample of participants from the study population (N = 200). Baseline and post-mydriasis IOP (20 min, 30 min, and 45 min intervals) were measured with a Goldmann applanation tonometer. Central corneal thickness and IOP were analysed using means, correlations and paired t-tests.Results: The mean CCT pre-mydriasis was 504.68 μm, and post-dilation was 507.90 μm, 510.08 μm and 509.25 μm at 20 min, 30 min, and 45 min, P = 026, p = 0.033, P = 0.004, respectively. Moreover, the mean IOP pre-mydriasis was 15.97 mmHg, and post-dilation was 16.85 mmHg, 16.46 mmHg and 16.85 mmHg over 20 min, 30 min, and 45 min of followed-up time, p = 0.140, p = 0.432, and p = 0.183, respectively.Conclusion: Measuring IOP post-dilation is still valid; however, CCT should be measured before the instillation of tropicamide.Contribution: This study analysed the effect of 1% tropicamide on CCT and IOP post-mydriasis in a clinical South African context.

Cyclodiode vs micropulse transscleral laser treatment

BackgroundContinuous-wave transscleral cyclophotocoagulation (CW-TSCP) is usually reserved for advanced/refractory glaucoma. Micropulse transscleral laser therapy (MPTLT) utilises short energy pulses separated by ‘off’-periods. MPTLT is postulated to have fewer complications, but its relative efficacy is not known. The National Institute for Health and Care Excellence (NICE) has deemed the evidence supporting MPTLT use of inadequate quality, limiting its use to research. This study aims to evaluate MPTLT efficacy and safety compared to CW-TSCP.MethodsThis 24-month follow-up retrospective audit included 85 CW-TSCP and 173 MPTLT eyes at a London tertiary referral centre. Primary outcome was success rate at the last follow-up; defined as at least 20% intraocular pressure (IOP) reduction with the same/fewer medications, and IOP between 6 and 18 mmHg. Secondary outcomes were acetazolamide use and success rates per glaucoma type. Safety outcomes were reported as complication rates.ResultsBy 24-months, mean IOP reduced from 34.6[±1.4]mmHg to 19.0[ ± 3.0]mmHg post-CW-TSCP (p < 0.0001); and from 26.1[±0.8]mmHg to 19.1[±2.2]mmHg post-MPTLT (p < 0.0001). Average IOP decreased by 45.1% post-CW-TSCP, and 26.8% post-MPTLT. Both interventions reduced medication requirements (p ≤ 0.05). More CW-TSCP patients discontinued acetazolamide (p = 0.047). Overall success rate was 26.6% for CW-TSCP and 30.6% for MPTLT (p = 0.83). Only primary closed-angle glaucoma saw a significantly higher success rate following CW-TSCP (p = 0.014). CW-TSCP complication rate was significantly higher than MPTLT (p = 0.0048).ConclusionBoth treatments significantly reduced IOP and medication load. CW-TSCP had a greater absolute/proportionate IOP-lowering effect, but it carried a significantly greater risk of sight-threatening complications. Further prospective studies are required to evaluate MPTLT compared to CW-TSCP.

Continuous Wave Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Childhood Glaucoma: A Meta-Analysis.

Transscleral cyclophotocoagulation (TS-CPC) and endoscopic cyclophotocoagulation (ECP) were effective in reducing intraocular pressure (IOP) and glaucoma medications in childhood glaucoma. To report the outcomes of continuous wave TS-CPC and ECP in childhood glaucoma. We performed a systematic search of relevant databases. We collected data on age, follow-up duration, type of glaucoma, previous surgical interventions, preoperative and postoperative IOP, preoperative and postoperative number of glaucoma medications, adverse events, number of sessions, and success rates at different time points. The main outcome measures are the amount of IOP and glaucoma medication reduction. We included 17 studies studying 526 patients (658 eyes); 11 evaluated the effectiveness of TS-CPC (268 patients, 337 eyes), 5 evaluated ECP (159 patients, 197 eyes), and one study compared both techniques (56 patients, 72 eyes for TS-CPC vs 43 patients, 52 eyes for ECP). The median duration of follow-up was 28 months in the TS-CPC group and 34.4 months in the ECP group. The mean number of treatment sessions was 1.7 in the TS-CPC and 1.3 in the ECP. In the TS-CPC group, the mean IOP was significantly reduced from 31.2 ± 8 to 20.8 ± 8 mm Hg at the last follow-up ( P < 0.001). The mean number of glaucoma medications was reduced from 2.3 ± 1.3 to 2.2 ± 1.3 ( P = 0.37). In the ECP group, there was also a significant reduction in the mean IOP from 32.9 ± 8 mm Hg with a mean of 1.7 ± 0.7 glaucoma medications to 22.6 ± 9.8 mm Hg ( P < 0.0001) on 1.2 ± 1.1 medications ( P = 0.009) at the last follow-up. Both TS-CPC and ECP were effective in reducing the IOP and glaucoma medications in childhood glaucoma. Multiple treatment sessions were required.

Factors Associated with Increased Intraocular Pressure in Type 2 Diabetes Patients

Background: Over one-third of patients living with diabetes will develop ocular disease during their lifetime. The present study analyzes the association between metabolic and anthropometric markers, associated comorbidities, and intraocular pressure (IOP) in patients with type 2 diabetes mellitus (DM). Methods: The retrospective study included 87 adult patients with type 2 DM who underwent routine eye examinations and blood/urine tests. Results: 67.9% of the patients had an IOP &gt; 14.5 mmHg and only 41.3% had an HbA1c &lt; 7%. In a multivariate regression analysis, the mean IOP was associated with diabetes duration in subjects with a disease duration &lt; 15 years and an HbA1c &lt; 7% (adjusted R2 = 0.29, p = 0.008). Also, patients with shorter diabetes duration and optimal glucose control had a lower mean IOP than patients with a higher HbA1c (mean IOP 15.1 mmHG vs. 18.9 mmHg, p = 0.04). The patient’s age, anthropometric or metabolic markers, associated comorbidities like hypertension (HTN) or retinal angiosclerosis, and diabetes therapies were not associated with IOP in this study. Conclusion: Diabetes progression is directly associated with increased IOP. Avoiding clinical inertia and optimizing glycemic control could prevent or delay the increase of IOP. Routine eye examination should include measuring IOP, not only diabetic retinopathy screening.

Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer.

To evaluate the Falck Medical Applanation Tonometer 1 (FMAT-1) as a device for measuring intraocular pressure (IOP) and outflow facility (OF) in patients with uveitis after periocular triamcinolone injection in one eye. Retrospective observational comparison. IOP and OF measurements were recorded and analyzed, comparing Goldmann tonometry and FMAT-1 readings. Records were reviewed for adult patients with uveitis who had undergone recent periocular triamcinolone injection in one eye. A total of 19 patients' records were evaluated. In treated eyes, median IOPs (in mm Hg) by Goldmann and FMAT-1 were 21 and 21.0, respectively, and mean IOPs were 22.21 and 21.15, respectively. In untreated eyes, median IOPs by Goldmann and FMAT-1 were 15 and 15.7, respectively, and mean IOPs were 15.52 and 15.31, respectively. Median OF (in µL/mm Hg) in treated and untreated eyes was 0.17 and 0.22, respectively, and mean values were 0.17 and 0.23, respectively. Pearson correlation showed an inverse relationship between IOP and OF in treated eyes, and linear regression analysis showed that IOP strongly predicted outflow in this group. The FMAT-1 generates IOP results substantially similar to Goldmann and OF readings with greater ease than prior tonography devices. The mechanism of corticosteroid-induced IOP elevation appears to be a reduction in aqueous OF, and its measurement is tonography. This technique has traditionally been cumbersome. FMAT-1 is a newly launched instrument that measures IOP and OF at the slit lamp simultaneously in a few seconds. Staso FD, Gaudio PA. Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer. J Curr Glaucoma Pract 2023;17(4):197-204.

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction.

To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens-treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169-174.