Mm Hg In Eyes Research Articles

Outcomes of gonioscopy-assisted transluminal trabeculotomy in advanced pigmentary glaucoma

PurposeTo compare outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) over a 12-month period with trabeculectomy in patients with advanced pigmentary glaucoma (PG).MethodsThis was a pilot randomised controlled trial of patients with...

Anterior Chamber Air Bubble Dynamics With Decreases in Atmospheric Pressure.

To evaluate the effect of decreasing barometric pressure on intracameral bubble size and intraocular pressure (IOP) in eyes with varying air fills in the anterior chamber. A total of 36 human donor eyes received 30%, 50%, or 90% anterior chamber air fill. The eyes were subjected to decreases in atmospheric pressure down to 750 hPa, equal to 2400 m in altitude, and were repeatedly imaged using anterior segment OCT while IOP was measured continuously. Eyes with 30% air fill initially showed moderate increases in IOP yet rising to an average of 30.83 mm Hg at 850 hPa (mimicking 1400 m altitude) and 42.08 mm Hg at 750 hPa. Eyes with larger air bubbles showed more acute increases in IOP with increases to an average of 47.25 mm Hg in eyes with 50% air fill at 850 hPa and 63.33 mm Hg at 750 hPa. In eyes with 90% air fill in the anterior chamber, IOP readings with an average of 113.42 mm Hg were observed already at 850 hPa, at which point additional pressure reduction was not performed. While severe increases in IOP were observed with decreased atmospheric pressure in eyes with large air bubbles in the anterior chamber, small and moderately sized bubbles seem to allow for travel over modest changes in altitude.

Consequences of Clot Formation and Hyphema Post-Internal Trabeculotomy for Glaucoma.

Clot formation and hyphema following internal trabeculotomy represent distinct clinical entities. The eyes with clot formation exhibited a more pronounced postsurgical intraocular pressure spike, longer residual intracameral bleeding, and a higher risk of reoperation. The aim of this study was to investigate the consequences of clot formation and hyphema in the anterior chamber after internal trabeculotomy. In this retrospective interventional comparative study, we investigated the surgical outcomes of internal trabeculotomy in 142 eyes of 142 patients at Sensho-kai Eye Institute. Concurrent clot formation and L≥2 hyphema (height of hyphema ≥1mm) was observed in 22 eyes. In these cases, the postsurgical IOP was 29.3mmHg at 1 week, significantly higher than the 16.1mmHg in eyes that had L≥2 hyphema but without clot formation ( P =0.0002). However, the 1-week postsurgical IOP in L≥2 hyphema and clot (-) eyes, which measured 16.1mmHg was not significantly greater than that in L<2 hyphema and clot (-) eyes, which measured 18.7mmHg ( P =0.162). Thus, clot formation was identified as a significant factor contributing to high postsurgical IOP at 1 week. The resolution time for anterior chamber bleeding in eyes with concurrent clot formation and L≥2 hyphema was 12.3 days, longer than the 5.8 days observed in L≥2 hyphema eyes without clot formation ( P =0.016). Among the 22 eyes with concurrent L≥2 hyphema and clot formation, 8 required anterior chamber washout. Three of the 10 eyes that underwent washout necessitated additional trabeculectomy, a rate significantly higher than that in nonwashout eyes ( P <0.001). After internal trabeculotomy, the sequelae of concurrent clot formation and L≥2 hyphema in the anterior chamber were more severe than those of simple hyphema without clots. Clot formation negatively affected postoperative IOP.

Corneal Behavior during Tonometer Measurement during the Water Drinking Test in Eyes with XEN GelStent in Comparison to Non-Implanted Eyes.

Biomechanics of the cornea have significant influences on the non-contact measurement of the intraocular pressure. The corneal behaviour during tonometry is a fundamental factor in estimating its value. The aim of the study was to analyse the behaviour of the cornea during tonometric measurement with the forced change in intraocular pressure during the water drinking test. Ocular Response Analyser (Reichert) was used to the measurement. Besides four basic parameters connected with intraocular pressure (IOPg, IOPcc) and biomechanics (corneal hysteresis CH and corneal resistance factor (CRF), other parameters representing the behaviour of the cornea during a puff of air were analysed. There were 47 eyes included in the study, including 27 eyes with a XEN GelStent implanted and 20 without it. The eyes of people with monocular implementation were the reference group. The values of analysed parameters were compared before and after 10, 25, 40, and 55 min after drinking the water. The intraocular pressure increased by 2.4 mmHg (p < 0.05) for eyes with a XEN stent and 2.2 mmHg for eyes without a stent (p < 0.05) in the tenth minute after drinking of water. This change caused a decreasing of corneal hysteresis (p < 0.05) without significant changes in the corneal resistance factor (p > 0.05). Corneal hysteresis changed similarly in the reference group and the group with a XEN GelStent. The analysis of additional parameters showed a difference in the behaviour of the cornea in eyes with a XEN GelStent in comparison to the corneas of eyes without a stent. This was particularly visible in the analysis of the cornea’s behaviour during the second applanation, when the cornea returns to its baseline state after deformation caused by air puff tonometry.

Comparative effects of latanoprost and latanoprostene bunod on intraocular pressure and pupil size in ophthalmologically normal Beagle dogs.

To compare effects of latanoprost, a topical prostaglandin analogue (PGA) commonly used to treat glaucoma and lens instability in dogs, and latanoprostene bunod, a novel PGA with a nitric oxide-donating moiety, on intraocular pressure (IOP) and pupil diameter (PD). Ten ophthalmologically normal Beagle dogs. Dogs were treated twice a day for 5days in a randomly selected eye with either latanoprost or latanoprostene bunod. After a 6-week washout period, dogs were treated with the opposite drug. IOP and PD were measured at treatment times, at midday on days 1 and 5, and for 6days post-treatment. Both drugs significantly decreased IOP and PD. At midday on day 5 of treatment, mean IOP in eyes treated with latanoprost was 4.5mmHg lower than the fellow eye and 3.0mmHg lower than the same eye at baseline, while mean IOP in eyes treated with latanoprostene bunod was 5.5mmHg lower than the fellow eye and 3.6mmHg lower than baseline. Mean PD was 0.94mm in eyes treated with latanoprost and 0.76mmHg in eyes treated with latanoprostene bunod. There was no significant difference between the two drugs for either parameter at that time point (p=.372 and .619, respectively, for IOP relative to control and to baseline; p=.076 for PD) or when analyzed longitudinally. Significant diurnal variation in PD was noted and may have implications for treatment of lens' instability. Latanoprost and latanoprostene bunod produce similar IOP reduction and miosis in normal canine eyes.

Twenty-Years of Experience in Childhood Glaucoma Surgery.

To quantify the results of childhood glaucoma treatment over time in a cohort of children with different types of childhood glaucoma. A retrospective cohort study of consecutive cases involving children with primary congenital glaucoma, primary juvenile, and secondary juvenile glaucoma at the Childhood Glaucoma Center, University Medical Center Mainz, Germany from 1995 to 2015 was conducted. The main outcome measure was the long-term development of intraocular pressure. Further parameters such as surgical success, refraction, corneal diameter, axial length, and surgical procedure in children with different types of childhood glaucoma were evaluated. Surgical success was defined as IOP < 21 mmHg in eyes without a need for further intervention for pressure reduction. A total of 93 glaucomatous eyes of 61 childhood glaucoma patients with a mean age of 3.7 ± 5.1 years were included. The overall mean intraocular pressure at first visit was 32.8 ± 10.2 mmHg and decreased to 15.5 ± 7.3 mmHg at the last visit. In the median follow-up time of 78.2 months, 271 surgical interventions were performed (130 of these were cyclophotocoagulations). Many (61.9%) of the eyes that underwent surgery achieved complete surgical success without additional medication. Qualified surgical success (with or without additional medication) was reached by 84.5% of the eyes.

Efficacy and safety of selective laser trabeculoplasty and pattern scanning laser trabeculoplasty: a randomised clinical trial

AimsTo compare the intraocular pressure (IOP) lowering effect and safety profile between pattern scanning laser trabeculoplasty (PSLT) and selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG) or...

Effect of postural changes on intraocular pressure in patients with acute angle-closure glaucoma in Indian population

Objective: The objective of the study was to compare the posture-induced intraocular pressure (IOP) changes in primary angle-closure glaucoma (PACG) with or without glaucoma medications, and healthy control eyes with normal IOPs in Indian subjects. Materials and Methods: The IOP was measured in the sitting position and the supine position after 10, 20, and 30 min with a rebound tonometer. Results: Twenty-five patients with PACG and 30 controls with normal IOPs were studied. The IOP in the sitting position measured with the rebound tonometer was 13.8 + 3.2 mm Hg in eyes with PAC, and 12.9 + 2.9 mm Hg in eyes with normal IOPs. The IOP increased to 14.4 mm Hg, 16.8 mm Hg, and 18.9 mm Hg at 10 min, 20 min, and 30 min in PACG subjects. In normal age-matched controls, the IOP increased to 13.4 mm Hg, 14.9 mm Hg, and 17.8 mm Hg at 10 min, 20 min, and 30 min, respectively, but none of these differences were significant (P = 0.09; P = 0.08, P = 0.08). The mean postural IOP change from baseline was also not significant between the two groups. Only three patients were on single antiglaucoma medication with well-controlled IOP in the PACG group. Conclusions: Postural IOP changes are comparable among eyes with PACG with and without glaucoma medications, and control eyes.

Intermediate Results of iStent or iStent inject Implantation Combined with Cataract Surgery in a Real-World Setting: A Longitudinal Retrospective Study.

IntroductionIn this real-world, retrospective, comparative study we evaluated 6-month performance and safety in consecutive eyes following implantation of the iStent® or iStent inject® trabecular micro-bypass device with concomitant cataract surgery.MethodsPerformance outcomes included intraocular pressure (IOP) reduction; glaucoma medication reduction; proportions of eyes achieving an IOP of < 18, < 16, < 14, or < 12 mmHg; and proportions of eyes on 0, 1, 2, or ≥ 3 medications. Safety outcomes included adverse events, secondary surgeries, and best-corrected visual acuity (BCVA).ResultsA total of 73 eyes with open-angle glaucoma and cataract were included in the study; of these, 38 eyes were implanted with the iStent device and 35 were implanted with the iStent inject device. The two groups of patients had similar baseline characteristics, with the exception of mean age and medication burden (both higher in patients receiving the iStent inject device); over 90% of eyes in both groups had early glaucoma. At 6 months after surgery, mean IOP had fallen from 16.5 ± 3.9 to 13.9 ± 2.3 mmHg in eyes with the iStent implant (p < 0.001), and from 17.3 ± 3.0 to 12.7 ± 1.8 mmHg in those with the iStent inject implant (p < 0.001). This reduction was significantly greater in the iStent inject eyes than in the iStent eyes (26.6 vs. 15.8%) (p = 0.005). Significantly more eyes receiving the iStent inject device compared to the iStent device achieved an IOP of < 18 mmHg at 6 months post surgery (100 vs. 86.8%) (p = 0.033). Average medication usage was reduced from 1.8 to 0.4 medications in iStent eyes (p < 0.001) and from 2.3 to 0.4 medications in iStent inject eyes (p < 0.001). Over 70% of eyes in both groups became medication-free by 6 months post implantation. Adverse events in iStent eyes were mild and resulted in no sequelae; two iStent eyes underwent non-penetrating deep sclerectomy during follow-up. No complications or secondary surgeries were noted in iStent inject eyes. All eyes in both groups maintained or showed improved BCVA versus baseline.ConclusionSignificant and safe IOP and medication reductions were observed after iStent or iStent inject implantation with concomitant cataract surgery. Trends toward greater effectiveness and fewer adverse events were observed with the iStent inject device compared with the iStent device.FundingArticle processing charges were provided by Glaukos Corporation.

The effect of intravitreal ranibizumab on optic nerve by pattern VEP test evaluation

Aim: To evaluate the effect of intravitreal injection of ranibizumab, an anti-VEGF agent commonly used for the treatment of choroidal neovascularization, on optic nerve by pattern VEP test. Material and Method: Pattern VEP test was applied to 20 eyes of 20 patients who received 0.5 mg of ranibizumab injection because of age related choroidal neovascularization maculopathy and also to other non-injected eyes of the same patients in 1st and 6th weeks. Results are compared with 10 control patients of same age distribution. Results: Mean age was 73.45 in 20 age related maculopathy patients ranging between 64 and 82. Mean best corrected visual acuity of eyes receiving injection was 9/100 before injection and 14/100 finally on 6th week. Mean intraocular pressure was 13.85mmHg in eyes receiving before the injection, 16.75mmHg at 1st week and finally 14mmHg at 6th week. There was no statistically significant difference between the VEP wavelengths and latencies of the patient group and the control group (p> 0.05). There was no statistically significant difference between VEP wavelengths and latencies in 1st and 6th weeks between injection receiving eyes and the other eyes (p> 0.05). Conclusion: As a result of VEP evaluation it is concluded that 0.5 mg intravitreal ranibizumab injection does not have an indirect toxic effect to the optic nerve.

Clear lens extraction for primary angle closure: how clear are we?

Azuara-Blanco et al . (1) in their multicentric “EAGLE” study have done a remarkable work in comparing efficacy of clear lens extraction (CLE) vs . laser peripheral iridotomy (LPI) in 155 eyes having newly diagnosed primary angle closure (PAC) with ocular hypertension (IOP ≥30 mmHg) and 263 eyes with early to moderate primary angle closure glaucoma (PACG). The authors reported better quality of life scores and a mean intraocular pressure lower by 1 mmHg in eyes which underwent CLE as compared to LPI at 36 months follow-up. The conclusion of the study was that CLE has a greater efficacy and is more cost effective as compared to the current standard of care (LPI followed by topical therapy) and should therefore be considered as the first line therapy in management of PAC disease (PAC and PACG).

Effect of Pilocarpine Hydrochloride on the Schlemm Canal in Healthy Eyes and Eyes With Open-Angle Glaucoma.

The in vivo effect of pilocarpine hydrochloride on the Schlemm canal may help explain its pharmacologic mechanism of action and better indicate its clinical use. To investigate the effect of pilocarpine on the structure of the Schlemm canal in vivo in healthy eyes and eyes with glaucoma. In this case-control study, healthy individuals and patients with open-angle glaucoma were prospectively enrolled between September 1, 2013, and June 30, 2014, after a complete ophthalmologic examination at a tertiary glaucoma referral practice. Eighty-one serial, horizontal, enhanced depth imaging optical coherence tomographic B-scans (interval between B-scans, approximately 35 µm) of the nasal corneoscleral limbus were performed before and 1 hour after topical administration of pilocarpine, 1%, in 1 eye of healthy volunteers and pilocarpine, 2%, in 1 eye of patients with glaucoma. Fifty B-scans in the overlapping area (circumferential length, approximately 1.7 mm) between the 2 sets of serial scans (before and after pilocarpine administration) were selected for analysis based on the structures of aqueous and blood vessels as landmarks. The cross-sectional area of the Schlemm canal was measured in each selected B-scan. Volume of the Schlemm canal was calculated using commercially available 3-dimensional reconstruction software. Mean cross-sectional area of the Schlemm canal. Enhanced depth imaging optical coherence tomographic scans of the Schlemm canal were performed successfully before and after administration of pilocarpine, 1%, in 9 healthy eyes (9 individuals) and pilocarpine, 2%, in 10 eyes with glaucoma (10 patients) (mean [SD] age, 31.9 [7.8] and 68.7 [13.2] years, respectively). Following pilocarpine administration, mean (SD) intraocular pressure decreased from 14.3 (1.3) to 13.7 (1.1) mm Hg in healthy eyes (P = .004) and from 17.5 (6.0) to 16.6 (6.1) mm Hg in eyes with glaucoma (P = .01). The mean (SD) cross-sectional area of the Schlemm canal increased by 21% (4667 [1704] to 5647 [1911] µm2) in healthy eyes (P < .001) and by 24% (3737 [679] to 4619 [692] µm2) in eyes with glaucoma (P < .001) (mean difference in percent increase, 2.2%; 95% CI, -8.5% to 12.9%). The mean (SD) volume of the Schlemm canal in the overlapping area increased from 8 004 000 (2 923 000) to 9 685 000 (3 277 000) µm3 in healthy eyes (P < .001) and from 6 468 000 (1 170 000) to 7 970 000 (1 199 000) µm3 in eyes with glaucoma (P < .001). These data suggest that pilocarpine expands the Schlemm canal in eyes with and without glaucoma. No differences in the effect were identified between the 2 groups. Enhanced depth imaging optical coherence tomography may be useful in investigating the effect of pharmacologic agents on the Schlemm canal.

Reduced intraocular pressure after cataract surgery in patients with narrow angles and chronic angle-closure glaucoma

To evaluate the effect of cataract surgery on intraocular pressure (IOP) in patients with narrow angles and chronic angle-closure glaucoma (ACG) and to determine whether the change in IOP was correlated with the preoperative pressure, axial length (AL), and anterior chamber depth (ACD). Private practice, Atlanta, Georgia, USA. Retrospective case series. Charts of patients with narrow angles or chronic ACG who had cataract surgery were reviewed. All eyes had previous laser iridotomies. Data recorded included preoperative and postoperative IOP, AL, and ACD. The preoperative IOP was used to stratify eyes into 4 groups. The charts of 56 patients (83 eyes) were reviewed. The mean reduction IOP in all eyes was 3.28 mm Hg (18%), with 88% having a decrease in IOP. There was a significant correlation between preoperative IOP and the magnitude of IOP reduction (r = 0.68, P < .001). The mean decrease in IOP was 5.3 mm Hg in eyes with a preoperative IOP above 20 mm Hg, 4.6 mm Hg in the over 18 to 20 mm Hg group, 2.5 mm Hg in the over 15 to 18 mm Hg group, and 1.4 mm Hg in the 15 mm Hg or less group. The mean follow-up was 3.0 years ± 2.3 (SD). Cataract surgery reduced IOP in patients with narrow angles and chronic ACG. The magnitude of reduction was highly correlated with preoperative IOP and weakly correlated with ACD. No author has a financial or proprietary interest in any material or method mentioned.

Effect on intraocular pressure of switching from latanoprost and travoprost monotherapy to timolol fixed combinations in patients with normal-tension glaucoma.

Purpose. To evaluate the effect on intraocular pressure (IOP) of switching from latanoprost and travoprost monotherapy to timolol fixed combinations in Japanese patients with normal-tension glaucoma (NTG). Methods. 27 NTG patients (54 eyes) were compared IOP, superficial punctuate keratitis (SPK) scores, and conjunctival injection scores in eyes treated with prostaglandin (PG) or PG analog/beta-blocker (PG/b) fixed-combination 6 months after the change in therapy. Results. The mean baseline intraocular pressure was 17.4 ± 1.59 mmHg in eyes receiving PG therapy only and 17.4 ± 1.69 mmHg in eyes switched to PG/b. Switching to fixed combination therapy from PG monotherapy, the mean IOP was 13.1 ± 1.79 mmHg (P < 0.001) (−24.71% reduction from baseline) at 6 months. The mean conjunctival injection score was 0.69 for eyes on PG monotherapy and 0.56 for eyes on fixed combination therapy (P = 0.028). The mean SPK scores were 0.46 and 0.53. This difference was not statistically significant (P = 0.463). Conclusions. Switching from PG monotherapy to PG/b fixed combination therapy for NTG resulted in a greater intraocular pressure reduction than PG alone without increasing the number of instillations.

Distribution of Intraocular Pressure and Its Association with Ocular Features and Cardiovascular Risk Factors: The Gutenberg Health Study

To describe the distribution of intraocular pressure (IOP) and its association with ocular features and cardiovascular risk factors in an adult European cohort. Population-based, cross-sectional study. This analysis was based on a Gutenberg Health Study (GHS) cohort that included 4335 eligible enrollees from among 5000 subjects who participated in the survey from 2007 through 2008. The age range was 35 to 74 years at enrollment. Participants underwent a standardized protocol with a comprehensive questionnaire; ophthalmic examination including slit-lamp biomicroscopy, noncontact tonometry, fundus photography, central corneal thickness measurement, and visual field testing; and a thorough general examination focused on cardiovascular parameters, psychological evaluation, and laboratory tests, including genetic analysis. Mean and reference interval of IOP stratified by age, gender, and eye. Mean ± standard deviation (SD) IOP was 14.0 ± 2.6 mmHg in both eyes, 13.9 ± 2.7 mmHg in right eyes, and 14.0 ± 2.7 mmHg in left eyes. Mean ± SD IOP in men (n = 2216) and in women (n = 2119) was 14.1 ± 2.7 mmHg and 13.9 ± 2.5 mmHg with an intersex difference (P = 0.009). Positive univariate associations with higher IOP were detected for brown iris color, central corneal thickness, hypertension, diabetes, smoking, obesity, dyslipidemia, body mass index, weight, hip size (women only), waist circumference, and waist-to-hip ratio. Multivariate testing revealed male gender, central corneal thickness, brown iris color, hypertension, smoking, and waist-to-hip ratio to be correlated with higher IOP. In women, age correlated negatively with IOP in the multivariate analysis. Intraocular pressure distribution in this cohort yielded a lower mean IOP than in similar white study populations. Increasing age in women correlated with lower IOP. Association analyses with several systemic characteristics revealed that cardiovascular risk factors correlated with higher IOP. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Posture-Induced Intraocular Pressure Changes in Eyes with Open-Angle Glaucoma, Primary Angle Closure with or without Glaucoma Medications, and Control Eyes

To compare the posture-induced intraocular pressure (IOP) changes in eyes with open-angle glaucoma (OAG), primary angle closure (PAC) with or without glaucoma medications, and healthy control eyes with normal IOPs. The IOP was measured in the sitting position (SP) and the lateral decubitus position (LDP) with a rebound tonometer. The IOP in the LDP was measured in the upper eyes 5 minutes after assuming this posture. Fifty-two patients with OAG, 52 with PAC, and 52 controls with normal IOPs were studied. The IOP in the SP measured with the rebound tonometer was 14.3 ± 4.0 mm Hg in eyes with OAG, 15.8 ± 4.5 mm Hg in eyes with PAC, and 13.9 ± 3.7 mm Hg in eyes with normal IOPs. None of these differences was significant (P = 0.060; ANOVA). The IOP in the LDP was significantly increased to 18.3 ± 4.6 mm Hg in eyes with OAG, 19.3 ± 4.4 mm Hg in eyes with PAC, and 17.3 ± 3.5 mm Hg in eyes with normal IOPs (P = 0.000 for all; paired t-tests). The postural IOP difference was +4.0 ± 2.2 mm Hg in OAG eyes, +3.5 ± 2.2 mm Hg in PAC eyes, and +3.4 ± 1.8 mm Hg in normal eyes, and these increases were not significantly different among the three groups (P = 0.309; ANOVA). The correlation between the posture-induced IOP changes and the axial length was not significant in each group. Postural IOP changes are comparable among eyes with OAG, PAC with and without glaucoma medications, and control eyes.

Evaluation of intraocular pressure measurements obtained by use of a rebound tonometer and applanation tonometer in dogs before and after elective phacoemulsification

To determine whether an applanation tonometer and rebound tonometer can be used to detect similar intraocular pressure (IOP) measurements in eyes of dogs undergoing phacoemulsification. 24 dogs (40 eyes) undergoing elective phacoemulsification. IOP measurements were obtained from each eye by use of both the rebound tonometer and applanation tonometer. Central corneal thickness was measured by use of an ultrasonic pachymeter 3 hours before surgery and 2 and 24 hours after surgery. Statistical analysis was performed by use of paired t tests. Mean ± SD IOP 3 hours before surgery, 2 hours after surgery, and 24 hours after surgery was 11.9 ± 4.7 mm Hg, 15.5 ± 11.7 mm Hg, and 10.9 ± 6.7 mm Hg, respectively, as measured with the rebound tonometer and 12.2 ± 5.3 mm Hg, 15.7 ± 12.5 mm Hg, and 12.4 ± 5.4 mm Hg, respectively, as measured with the applanation tonometer. Measured IOP did not differ significantly between the 2 tonometers 3 hours before surgery and 2 hours after surgery, but measured IOP differed significantly between the tonometers 24 hours after surgery. Use of a rebound tonometer underestimated IOP, relative to results for use of an applanation tonometer, by 1.65 mm Hg in eyes 24 hours after phacoemulsification. Caution should be used when IOP measurements obtained with a rebound tonometer are in the high part of the reference range, and verification of these values with an applanation tonometer would be advised.

Longterm follow‐up of diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma

This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TDLCP) in advanced refractory glaucoma. A total of 124 eyes in 121 patients with advanced glaucoma refractory to medical treatment were treated consecutively with TDLCP. Success was defined as final intraocular pressure (IOP) of 5-21 mmHg in eyes with visual acuity (VA) of more than hand movements (HM) and relief of pain in eyes with VA of HM or less, including blind eyes. Mean patient age was 65.6 +/- 17.1 years (range 14-91 years). Mean follow-up was 17 +/- 14.6 months (range 3-42 months). Mean pretreatment IOP was 29.9 +/- 8.4 mmHg (range 17-58 mmHg) and IOP at last follow-up was 20.8 +/- 8 mmHg (range 6-45 mmHg) (p < 0.001). The number of laser applications (mean 9.2 +/- 2.8, range 4-15) and maximal laser power (mean 2.01 +/- 0.22 mW, range 1.3-3.0 mW) were not associated with lower postoperative IOP. Intraocular pressure of < or = 21 mmHg was recorded in 63.0% of eyes at the last follow-up visit. Overall, 28 (21.7%) eyes required at least one retreatment. No phthisis bulbi or persistent hypotonia developed. TDLCP is an effective and safe method for the treatment of advanced refractory glaucoma, although repeated treatments are often necessary.

Evaluation of Corneal Biomechanical Properties Following Penetrating Keratoplasty Using the Ocular Response Analyzer

PurposeTo evaluate corneal biomechanical properties in eyes that had previously undergone penetrating keratoplasty (PK) using the ocular response analyzer (ORA).MethodsWe recruited 26 patients who had received unilateral PK. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc) were measured with the ORA and were compared to the measurements from the contralateral eyes that did not undergo PK.ResultsThe CH was 8.95±2.59 mmHg in eyes that underwent PK and 9.78±1.45 mmHg in the contralateral eyes that did not undergo PK (p=0.077). The CRF was 10.26±2.64 mmHg in post-PK eyes and 9.75±1.45 mmHg in the contralateral eyes (p=0.509), and the CH-CRF was significantly smaller in post-PK eyes (-1.31±2.32 mmHg in post-PK eyes vs. 0.03±0.88 mmHg in fellow eyes, p=0.016). The IOPg and IOPcc were significantly higher in the PK group than they were in the control group. The IOPcc's were 20.81±7.81 mmHg and 16.27±2.49 mmHg in post-PK and control eyes, respectively (p=0.011); and the IOPg's were 19.22±7.34 mmHg and 15.07±3.03 mmHg in post-PK and control eyes, respectively (p=0.019). The IOPcc-g's were 1.59±2.81 mmHg and 1.21±1.30 mmHg in post-PK and control eyes, respectively (p=0.412), and the central corneal thickness (CCT)'s were 489.11±90.60 µm and 556.24±42.84 µm in post-PK and control eyes, respectively (p=0.068).ConclusionsFollowing PK, CH tended to decrease while CRF tended to increase, significantly decreasing CH-CRF. A significantly higher intraocular pressure and a thinner CCT following PK may have contributed to the observed changes in these corneal biomechanical parameters.

Prolonged Multifocal Electroretinographic Implicit Times in the Ocular Ischemic Syndrome

Purpose. To examine retinal function in chronic ocular ischemia using multifocal electroretinography (mfERG). Methods. Thirteen patients with unilateral ocular ischemic syndrome (OIS) underwent assessment of ophthalmic systolic blood pressure by ocular pneumoplethysmography, carotid artery patency by ultrasonography, intraocular pressure (IOP) by applanation tonometry, retinal perfusion by fluorescein angiography, and retinal function by mfERG. Results. Ophthalmic systolic blood pressure was 67.0 +/- 11.6 mm Hg in eyes with OIS and 106.1 +/- 18.0 mm Hg in fellow eyes, whereas IOP was 13.8 +/- 3.2 and 14.4 +/- 1.7 mm Hg, respectively. Summed mfERG implicit times (N1, P1, N2) were prolonged in eyes with OIS, by 7.6%, 6.2%, and 7.5%, respectively, compared with fellow eyes (P < or = 0.0048). The retardation of retinal function was significant outside the macula, whereas the assessment of responses from the central retina was limited by high variance. Second-order kernel (first slice) summed implicit times (N1, P1, N2) were also prolonged in OIS, by 6.6%, 7.3%, and 6.8%, respectively (P < or = 0.0058). Of the amplitudes, only the second-order N2 amplitude was significantly abnormal, being reduced by 23.2% in OIS (P = 0.011). Conclusions. The function of the outer and middle layers of the retina was found to be suppressed in chronic ocular hypoperfusion. The moderate delay in retinal function does not appear to explain the prominent photopic symptom of diffuse glare in bright light, and the delay could be evidence of a functional adaptation that serves to maintain and optimize signaling under conditions of compromised perfusion. (ClinicalTrials.gov number, NCT00403195.).