Normal Intraocular Pressure Research Articles

Prognostic value of extraocular muscles for intraocular pressure in thyroid-associated ophthalmopathy patients.

Persistent increase in intraocular pressure (IOP) is often observed in eyes with thyroid-associated ophthalmopathy (TAO), which has irreversible effects on the visual function of patients. This retrospective cross-sectional study evaluated the value of magnetic resonance imaging (MRI) measurements of extraocular muscle (EOM) volume in prognosing IOP in patients with TAO. This single-center study was conducted in Beijing Friendship Hospital (Beijing, China), a tertiary hospital. From 35 participants, 70 eyes (normal IOP group: 50 eyes; high IOP group: 20 eyes; random samples) were enrolled in this study. Basic data from patients were collected and compared using 2-sample t-tests and chi-squared tests. The volume of the EOM, orbit fat, and whole orbit were measured by orbital MRI. Moreover, proptosis, optic nerve (ON) sheath diameter, optic nerve angle (ONA), and gaze angle were additionally measured with MRI. These parameters were compared between the two groups using 2-sample t-tests and chi-squared tests. Before and after post-methylprednisolone therapy, the MRI data of 20 eyes were obtained and compared with a paired t-test. Peripapillary retinal nerve fiber layer (RNFL) thickness was obtained using an optical coherence tomography (OCT) scan. Spearman rank correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curves were performed to evaluate the role of these factors in IOP changes. The EOM volume and axial and sagittal ONAs in the high-IOP group were significantly increased compared to the normal-IOP group (P<0.001, P=0.001, P=0.02, respectively). Logistic regression analysis indicate that the cutoff value for EOM volume for the diagnosis of high IOP was significantly larger than that of the other parameters except orbit volume (P=0.03, P=0.004, P=0.08, respectively). Spearman correlation analysis revealed a significant correlation between EOM volume and ON sheath diameter and average RNFL thickness (P=0.01, P=0.02, respectively). A paired t-test indicated a significant decrease of EOM volume and ON sheath diameter as well as a significant enlargement of the axial ONAs after methylprednisolone therapy (P=0.002, P=0.02, P=0.05, respectively). EOM volume was an effective diagnostic factor for tracking IOP changes and ON patterns in patients with TAO. Methylprednisolone therapy is recommended for patients with TAO with secondary glaucoma to quickly reduce the EOM volume.

Differences in Factors Associated With Glaucoma Progression With Lower Normal Intraocular Pressure in Superior and Inferior Halves of the Optic Nerve Head.

The purpose of this study was to investigate risk factors for progression in the superior and inferior hemi-visual fields (hemi-VFs) and the corresponding hemi-disc/retinas in eyes with normal tension glaucoma (NTG). A 5-year prospective follow-up of 90 patients with NTG with untreated intraocular pressure (IOP) consistently ≤ 15 mm Hg was conducted. The IOP and Humphrey Perimeter measurements and disc/retina stereo-photographs were taken every 3 and 6 months, respectively. Risk factors for progression in the superior and inferior hemi-VFs and in the superior and inferior hemi-disc/retinas were investigated. The mean total deviation values decreased at -0.50 ± 0.76 and -0.13 ± 0.34 dB/year in the superior and inferior hemi-VFs, respectively (P < 0.001). In the superior hemi-VF, the risk factor for faster progression was greater long-term IOP fluctuation (P = 0.022). In the inferior hemi-VF, the risk factors were disc hemorrhage (DH), greater myopic refraction, body mass index (BMI), and vertical cup-to-disc ratio (v-C/D; P < 0.05). The progression probability was 47.7 ± 6.0 and 17.7 ± 4.7% at 5 years in the superior and inferior hemi-disc/retinas respectively (P < 0.001), and DH was a risk factor for progression in both (P = 0.001). In NTG eyes, greater BMI, myopia, and v-C/D are characteristic risk factors for faster progression in the superior half of the optic nerve head (ONH), whereas long-term IOP fluctuation is the significant risk factor in the inferior half of the ONH, whereas DH is a risk factor in both. Different risk factors were identified in superior and inferior hemifields in NTG eyes.

Distribution and reference intervals of daytime intraocular pressure in the eye health screening population of Handan

Objective: To describe the distribution and establish reference intervals (RI) of daytime intraocular pressure (IOP) in the eye health screening population of Handan. Methods: This cross-sectional study included subjects who participated in eye health screening at the Physical Examination Center of Handan First Hospital from May 2021 to June 2022. A complete general and ocular examination was performed, including measurements of visual acuity and IOP (using Goldmann tonometry), slit lamp microscopy, fundus photography, and anterior and posterior segment optical coherence tomography. Subjects with factors that could cause significant changes in IOP or affect the accuracy of IOP measurement, or with an inability to measure IOP were excluded. Simple random sampling was used to select participants, who were grouped by gender and age (18 to <30, 30 to <40, 40 to <50, 50 to <60, 60 to <70, and ≥70 years). Central corneal thickness and IOP at 8 to 11 o'clock in one eye of each participant were recorded. The independent sample t test and ANOVA were used for statistical analysis, and the RI of IOP values was calculated by x¯±1.96s. Results: A total of 9 310 subjects had their IOP measured, and 3 491 participants (3 491 eyes) were randomly selected from 7 886 healthy subjects. The age of the participants was (47.74±14.47) years old, ranging from 18 to 90 years old. There were 1 694 males and 1 797 females. The central corneal thickness of all participants was (525.56±49.39) μm. The daytime IOP of all participants was (15.40±2.54) mmHg (1 mmHg=0.133 kPa), and the RI was 10.42 to 20.39 mmHg. The IOP was (15.49±2.58) mmHg for males and (15.29±2.49) mmHg for females, and the gender difference was statistically significant (P<0.05). The RI of daytime IOP values was 10.43 to 20.54 mmHg for males and 10.41 to 20.18 mmHg for females. There were significant differences in daytime IOP [(15.13±2.58), (15.33±2.53), (15.49±2.50), (15.53±2.55), (15.39±2.62), and (15.28±2.52) mmHg] among 6 age groups (P<0.05). Conclusions: The distribution of daytime IOP in different gender and age groups in the eye health screening population of Handan and the RIs derived from the distribution were roughly the same as the international normal IOP RI (10 to 21 mmHg). It is recommended to refer to the RI of daytime IOP values of different genders and ages for clinical decision.

Twenty-Four-Hour Intraocular Pressure in Chronic Primary Angle-Closure Disease.

Primary angle closure and primary angle closure glaucoma may exhibit normal intraocular pressure. Twenty-four-hour intraocular pressure fluctuation is highest in primary angle closure glaucoma. The degree of peripheral anterior synechiae was associated with a 24-hour intraocular pressure pattern in primary angle-closure disease without laser iridotomy. The purpose of this study was to study 24-hour intraocular pressure (IOP) patterns in eyes with chronic primary angle-closure disease and evaluate associations between peripheral anterior synechiae (PAS) and 24-hour IOP pattern. In this prospective cohort study, 59 eyes of 35 Asian patients with chronic primary angle-closure disease underwent complete ocular examinations at Ramathibodi Hospital, Mahidol University. Twenty-four-hour IOP records were obtained using Goldmann applanation tonometry at 2-hour intervals. Peak, mean, and trough 24-hour IOP values and 24-hour IOP fluctuation (difference between peak and trough values) were compared among groups. None of the participants received any treatment before complete data collection. Even univariable analysis demonstrated a significant difference in peak, mean, and trough IOP and 24-hour IOP fluctuation between the 3 groups; the magnitude of trough IOP was not higher than 21mmHg in all groups. In multivariable analysis, PAC and PACG eyes showed significantly higher peak IOP ( P =0.020 and 0.006, respectively) and 24-hour IOP fluctuation ( P =0.048 and 0.001, respectively) compared with PACS eyes. In comparison between combined PACS and PAC eyes versus PACG eyes, PACG eyes revealed significantly higher 24-hour IOP fluctuation. The degree of PAS was associated with peak and mean IOP values and with 24-hour IOP fluctuation in PAC and PACG eyes. Twenty-four-hour IOP fluctuation was highest in PACG eyes. Although PAC and PACG eyes showed higher peak IOP and 24-hour IOP fluctuation values, compared with PACS eyes, trough IOP in PAC and PACG eyes were mostly below 21mmHg. In addition, the degree of PAS was associated with a 24-hour IOP pattern in either PAC or PACG eyes.

New Surgical Approach for Secondary Intraocular Lens Implantation Using an Artificial Bag with Optic Capture in Patients with Intraocular Lens Dislocation.

We present a newly developed approach to secondary intraocular lens (IOL) implantation, which uses an artificial bag with optic capture (i.e., ABC technique) in patients with IOL dislocation. This is a retrospective, noncomparative, and interventional case series that reveals the results of secondary IOL implantation using an artificial bag with optic capture in four cases of IOL dislocation. All patients underwent the abovementioned surgery and were followed up for at least 6 months. The best-corrected visual acuity of patients ranged from 20/30 to 20/20. The IOL of all patients showed no tilting or decentration with normal intraocular pressure. We believe that this method produces satisfactory results and will be especially beneficial to retinal surgeons for the management of patients with IOL dislocation.

Sigma-1 Receptor Activation Is Protective against TGFβ2-Induced Extracellular Matrix Changes in Human Trabecular Meshwork Cells.

The trabecular meshwork (TM) route is the principal outflow egress of the aqueous humor. Actin cytoskeletal remodeling in the TM and extracellular matrix (ECM) deposition increase TM stiffness, outflow resistance, and elevate intraocular pressure (IOP). These alterations are strongly linked to transforming growth factor-β2 (TGFβ2), a known profibrotic cytokine that is markedly elevated in the aqueous humor of glaucomatous eyes. Sigma-1 receptor (S1R) has been shown to have neuroprotective effects in the retina, but data are lacking about its role in the TM. In this study, we identified the presence of S1R in mouse TM tissue and investigated the effect of an S1R agonist fluvoxamine (FLU) on TGFβ2-induced human TM cells regarding cell proliferation; ECM-related functions, including F-actin reorganization; and the accumulation of ECM elements. TGFβ2 increased the proliferation, cytoskeletal remodeling, and protein levels of fibronectin, collagen type IV, and connective tissue growth factor, and decreased the level of matrix metalloproteinase-2. Most importantly, FLU reversed all these effects of TGFβ2, suggesting that S1R agonists could be potential candidates for preserving TM function and thus maintaining normal IOP.

Phenotypic consequences of a nanophthalmos-associated TMEM98 variant in human and mouse

Nanophthalmos is characterised by shorter posterior and anterior segments of the eye, with a predisposition towards high hyperopia and primary angle-closure glaucoma. Variants in TMEM98 have been associated with autosomal dominant nanophthalmos in multiple kindreds, but definitive evidence for causation has been limited. Here we used CRISPR/Cas9 mutagenesis to recreate the human nanophthalmos-associated TMEM98 p.(Ala193Pro) variant in mice. The p.(Ala193Pro) variant was associated with ocular phenotypes in both mice and humans, with dominant inheritance in humans and recessive inheritance in mice. Unlike their human counterparts, p.(Ala193Pro) homozygous mutant mice had normal axial length, normal intraocular pressure, and structurally normal scleral collagen. However, in both homozygous mice and heterozygous humans, the p.(Ala193Pro) variant was associated with discrete white spots throughout the retinal fundus, with corresponding retinal folds on histology. This direct comparison of a TMEM98 variant in mouse and human suggests that certain nanophthalmos-associated phenotypes are not only a consequence of a smaller eye, but that TMEM98 may itself play a primary role in retinal and scleral structure and integrity.

A "T.E.S.T." hydrogel bioadhesive assisted by corneal cross-linking for in situ sutureless corneal repair.

Corneal transplantation is an effective clinical treatment for corneal diseases, which, however, is limited by donor corneas. It is of great clinical value to develop bioadhesive corneal patches with functions of "Transparency" and "Epithelium & Stroma generation", as well as "Suturelessness" and "Toughness". To simultaneously meet the "T.E.S.T." requirements, a light-curable hydrogel is designed based on methacryloylated gelatin (GelMA), Pluronic F127 diacrylate (F127DA) & Aldehyded Pluronic F127 (AF127) co-assembled bi-functional micelles and collagen type I (COL I), combined with clinically applied corneal cross-linking (CXL) technology for repairing damaged cornea. The patch formed after 5min of ultraviolet irradiation possesses transparent, highly tough, and strongly bio-adhesive performance. Multiple cross-linking makes the patch withstand deformation near 600% and exhibit a burst pressure larger than 400mmHg, significantly higher than normal intraocular pressure (10-21mmHg). Besides, the slower degradation than GelMA-F127DA&AF127 hydrogel without COL I makes hydrogel patch stable on stromal beds in vivo, supporting the regrowth of corneal epithelium and stroma. The hydrogel patch can replace deep corneal stromal defects and well bio-integrate into the corneal tissue in rabbit models within 4 weeks, showing great potential in surgeries for keratoconus and other corneal diseases by combining with CXL.

Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields.

The thicknesses of the circumpapillary retinal nerve fiber layer (cpRNFL) and ganglion cell complex (GCC) did not change during 5 years in physiological large disc cupping. We evaluated longitudinal changes in the thicknesses of the cpRNFL and GCC in large disc cupping with a normal intraocular pressure (IOP) (<21mmHg) and visual field. This retrospective, consecutive case series study included 269 eyes of 269 patients with large disc cupping and normal IOP. We analyzed patient demographics, IOP, central corneal thickness, vertical cup-to-disc ratios using color fundus photography, the thicknesses of the cpRNFL and GCC using RTVue-100, and mean deviation using visual field examinations. The differences in IOP, vertical cup-to-disc ratios, and mean deviation between the baseline and each follow-up visit were not statistically significant. The baseline average and mean average at 60 months follow-up of the cpRNFL thickness were 106.5±8.5 and 105.1±9.3μm, respectively; differences between the baseline and each follow-up visit were not statistically significant. The baseline average and mean average at 60 months follow-up of the GCC thickness were 82.8±9. and 81.5±9.2μm, respectively; differences between baseline and each follow-up visit were not statistically significant. The thicknesses of the cpRNFL and GCC did not change in well-maintained optic nerve head findings with normal IOP and visual field during a 5-year follow-up period. Optical coherence tomography evaluations of the thicknesses of the cpRNFL and GCC help accurately diagnose physiological optic disc cupping.

Association of trabecular meshwork height with steroid-induced ocular hypertension

It is important to identify at-risk patients prior to administering steroid injections to prevent avoidable irreversible blindness inducted by steroid-induced ocular hypertension (SIOH). We aimed to investigate the association of SIOH following intravitreal dexamethasone implantation (OZURDEX) using anterior segment optical coherence tomography (AS-OCT). We conducted a retrospective case control study to assess the association between trabecular meshwork and SIOH. A total of 102 eyes that underwent both AS-OCT and intravitreal dexamethasone implant injection were divided into the post-steroid ocular hypertension and normal intraocular pressure groups. Ocular parameters that can contribute to intraocular pressure were measured using AS-OCT. Univariable logistic regression analysis was used to calculate the odds ratio of the SIOH and significant variables were further analyzed using a multivariable model. Trabecular meshwork (TM) height was significantly shorter in the ocular hypertension group (716.13 ± 80.55 μm) than that in the normal intraocular pressure group (784.27 ± 82.33 μm) (p < 0.001). The receiver operating characteristic curve technique analysis showed that the optimal cut-off of ≥ 802.13 μm for TM height specificity was 96.2%, and TM height with < 646.75 μm had a sensitivity of 94.70%. The odds ratio of the association was 0.990 (p = 0.001). TM height was identified as a newly observed association with SIOH. TM height can be assessed using AS-OCT, with acceptable sensitivity and specificity. Caution must be exercised while injecting steroids in patients with short TM height (especially < 646.75 μm) as it may cause SIOH and irreversible blindness.

Early pigment dispersion and raised intraocular pressure after uneventful central-hole implantable collamer lens surgery

Introduction: With ever-increasing cases of myopia worldwide, there has been a quantum jump in the number of refractive procedures. 3 cases who had an uncomplicated implantable collamer lens (ICL) surgery in both eyes, but had a new complication, are presented here. This is not yet described in the literature to the authors' knowledge. Patient and Clinical Findings: 2 weeks after uneventful bilateral ICL surgery, the patients presented with slight blurring of vision in 1 eye only. On examination, there was excessive pigment dispersion in the anterior chamber both in front of and behind the ICL. They also had raised intraocular pressure (IOP) a few days later, possibly due to blockage of the trabecular meshwork by iris pigments. Diagnosis, Intervention, and Outcomes: All the patients were managed conservatively on anti-inflammatory and IOP-lowering eyedrops. The dispersed pigments decreased with normalization of IOP after 2 to 4 weeks of conservative management with no blurring of vision. However, the pupil remained slightly dilated and irregular in all these cases. Conclusions: The excessive pigment dispersion seen after ICL surgery is not commonly encountered after ICL surgery and can be managed conservatively.

Abstract #1401671: Hashimoto’s Disease with Thyroid Eye Disease, Negative TRAB and Positive TPO Antibodies Treated with Teprotumumab

Thyroid Eye Disease (TED) is most commonly associated with hyperthyroidism secondary to Graves’ disease (GD). The disease activity of TED is positively correlated with the presence of thyrotropin receptor antibodies (TRAB). Some with TED are euthyroid at presentation but have positive TRAB. Less frequently, patients with Hashimoto’s disease have TED, the majority of which are TRAB positive. We present a unique case of euthyroid TED with negative TRAB but positive thyroid peroxidase antibodies (TPO Ab) treated with teprotumumab. A 65-year-old African-American male presented with a 9-day history of gradually worsening vision, ocular pain, and bilateral eye bulging. His best-corrected visual acuity at near was 20/200 right eye and 20/400 left eye with full peripheral vision by confrontation. Pupils were equal and reactive to light with normal intraocular pressure. There was bilateral upper eyelid retraction, diffuse conjunctival injection, proptosis, and diffuse external ophthalmoplegia. His clinical activity score was 7. The thyroid exam was normal. Computed Tomography (CT) scan of the orbits showed significant, tendon-sparing enlargement of all extraocular muscles along with bilateral orbital apex crowding. Bilateral compressive optic neuropathy from severe TED was suspected. TSH, free T4, and T3 were normal. TPO Ab was positive but TRAB was negative by both binding inhibitory and Thyroid Stimulating Immunoglobulin (TSI) assays. He was treated with high-dose intravenous methylprednisolone for 5 days followed by 2 weeks of oral prednisone. One month after presentation treatment was initiated with 8 infusions of teprotumumab with complete resolution of all ocular symptoms and restoration of normal vision. Six months after the last dose of teprotumumab he remains euthyroid with negative TRAB and positive TPO Ab. TED is uncommon in euthyroid individuals. Most have positive TRAB and many ultimately develop hyperthyroidism. Even less common are those with Hashimoto’s thyroiditis (HT) presenting with TED. Teprotumumab is the only Food and Drug Administration-approved medication to treat TED. Our patient with vision-threatening TED had a remarkable response to teprotumumab with the restoration of normal vision and resolution of TED. We could not identify any other reports of a patient with euthyroid HT with positive TPO Ab but negative TRAB treated with teprotumumab. Physicians should be mindful of this unusual presentation to detect cases early and institute appropriate treatment to prevent visual complications.

Contribution of Ultrabiomicroscopy in Phacomorphic Glaucoma: A Prospective Study of 25 Eyes

Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens intumescence, leading to pupillary block and closure of the irido corneal angle (ICA). This condition presents as an acute glaucoma crisis due to angle closure, which can lead to serious complications. The aim of our study is to determine the usefulness of ultra biomicroscopic ultrasound (UBM) in the evaluation of the iridocorneal angle before and after cataract surgery in phacomorphic glaucoma. The prospective analytical study included 25 eyes diagnosed with phacomorphic glaucoma. The intraocular pressure, the visual acuity, the UBM parameters including; the Anterior Chamber Depth (ACD), the Trabecular-Iris Angle (AIT), the Angel Opening Distance (AOD500), were assessed preoperatively and postoperatively. The mean age of our patients was 74.7 years, there was no significant gender preference. The mean intraocular pressure (IOP) under maximal treatment was reduced from 45.36 5.4 to 25.8 mmHg in our study. With IOP at 17+/-2.5 to 15+/-1.3 after surgery within 1-3 days. The gonioscopic results were in agreement with the UBM results, which provided more specific angle measurements; all angle parameters are improved after cataract surgery. All eyes had a mean angle of more than 20° in all four quadrants with a mean angle of (37.1+/-4.5), very similar to the angle status of the uninvolved eye. In conclusion, after an acute attack of angle closure of phacomorphic origin, all parameters of the ICA measured by UBM increased significantly as well as normalization of IOP after cataract surgery

Atypical Lens Subluxation in Marfan Syndrome

A 16-years-old male, presented with complaints of both eyes decreased in vision since childhood. Ophthalmological examination revealed a limited visual acuity to counting finger in right eye and 1/10 in left eye, with clear corneas and normal intraocular pressure in both eyes.

Retinitis Pigmentosa Sine Pigmento in a Carrier of Usher Syndrome

We report a carrier of Usher syndrome type I with retinitis pigmentosa sine pigmento. A 71-year-old male was referred for further evaluation of severe, progressive, painless vision loss in both eyes over the course of four years. He had bilateral sensorineural hearing loss. Upon a comprehensive examination, his best-corrected visual acuity was 20/100 in the right eye and 20/40 in the left eye. He had an unremarkable anterior segment examination and normal intraocular pressures in both eyes. Upon fundus examination, the patient had pale discs, optic disc cupping, and multiple scattered drusen in the macula and at the midperiphery of both eyes. Optical coherence tomography showed retinal nerve fiber layer thinning in all quadrants. The visual field was severely constricted in both eyes. A comprehensive workup for infectious and inflammatory causes, as well as a brain MRI, was unremarkable. Sequencing analysis showed that he carried a heterozygous pathogenic mutation, USH1C c.672C&gt;A (p.Cys224*) variant. Usher syndrome is a rare genetic disease characterized by hearing loss and retinitis pigmentosa. Our case suggests that patients and carriers of Usher syndrome may have a phenotype compatible with retinitis pigmentosa sine pigmento.

Effect of Ayurveda Protocol (Nasya, Pindi, Bidalaka &amp; Anjana) in Intra Ocular Hydrops – A Pilot Study

Normal Intra Ocular Pressure (IOP) ranges from 14 – 21 mm of Hg. Intra-Ocular Hydrops is an asymptomatic condition with raised Intra Ocular Pressure without any visual impairment or comorbidities. Altered Intra Ocular Pressure above / below normal level with associated visual symptoms &amp; optic neuropathy are referred to as glaucoma. Intra Ocular Hydrops population is at greater risk of developing glaucoma. They remain unnoticed and undiagnosed most of the time for a longer duration or advancement of the condition. Early diagnosis and timely management prevent the progression of the disease to Primary Open Angle Glaucoma and other conditions. Proven Ayurvedic treatment modalities are not available for Intra Ocular Hydrops. In such a scenario, considering the multifactorial involvement, an Ayurvedic protocol containing different treatment modalities was developed and its effect was studied. Materials &amp; Methods: 100 patients were screened from the eye Out Patient Department of institute. 10 Patients who fulfilled the inclusion criteria were enrolled and analysed for results. Ayureda Protocol was administered (Table 1) which included an in Patient Department basis for Nasya, Pindi and Bidalaka for a period of 11 days and Anjana for a period of 30 days. The assessment of Intra Ocular Pressure was done with the help of Goldman’s Applanation Tonometry. The assessment was done on 0th day (BEFORE TREATMENT), 11th day (AT), 26th day (FU1) and 41st day (FU2). Results: For statistical analysis T test was used was used. Within the group, there was a significant reduction of Intra Ocular Pressure with a p-value &lt;0.0001. Conclusion: There was significant reduction in the values of Intra Ocular Pressure and a nearly normal value was achieved as target Intra Ocular Pressure.

Case Report: Acute Retinal Necrosis following Unexpanded Gas Tamponade Acute Retinal Necrosis following Unexpanded Gas Tamponade

Purpose: To present 2 cases of acute non-hemorrhagic retinal necrosis occurring following pars plana vitrectomy for epiretinal membrane peeling following the use of unexpanded gas tamponade. Case Report: Two eyes (both right eyes) of 2 healthy females presented with decreased visual acuity due to Epiretinal membrane, and they underwent 25G vitrectomy and membrane peeling. The vitrectomy operation was uneventful and was concluded with the insertion of 20% sulfur hexafluoride (SF6) tamponade. Both eyes were pseudophakic and had no other ocular or systemic pathology. Patients were controlled 24 hours following the surgery and both presented with normal anterior segment examination and normal intraocular pressure. Both patients complained of central scotoma and both had very difficult light perception. Fundus examination showed devitalized macula structures in the presence of gas bubbles occupying almost 100% of the vitreous cavity. OCT examination done a few days after surgery revealed necrotic retinal tissue. Four weeks later, both eyes had light perception vision, and devitalization of the central macula and spicule-like pigment changes in the midperiphery of the retinal in both eyes. Conclusion: We present 2 cases of blindness after vitrectomy with ILM peeling combined with 20% SF6 Intraocular tamponade. This severe complication was not related to elevated intraocular pressure due to gas expansion.

Technical difficulties of adequate assessment of intraocular pressure in a patient with glaucoma in the long term after corneal refractive surgery (clinical case)

PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.

Bleach-Associated Uveitis: A Case Report

Introduction: Chemical ocular injuries represent ophthalmologic emergencies with potentially blinding complications. Burns with alkalis tend to be more serious due to deeper tissue penetration as a result of colliquative necrosis. Uveitis is usually observed in higher grades of burns with significant alterations in the anterior segment of the eye. This study aimed to report a case of late-onset unilateral uveitis following a mild alkali burns with sodium hypochlorite (bleach).&#x0D; Case presentation: A 64-year-old Caucasian woman reported that 3 weeks ago, she had an accident with bleach coming in contact with both eyes. At that time, she had emergency ocular irrigation with saline to both eyes, and she had also used artificial tears for about a week. Besides bilateral conjunctival hyperaemia and punctate corneal epithelial erosions, no other complications had been noted. Her symptoms had subsided in several days. Upon presentation to the clinic, reduced best-corrected visual acuity was observed in both eyes to 20/30, which was attributed to age-related cataracts, normal intraocular pressure, normal conjunctiva in both eyes, the clear cornea in the right eye (OD) and several white, round, middle-sized granulomatous keratic precipitates in the left eye (OS), without epithelial and stromal alterations. The anterior chamber of OS demonstrated a 0.5+ cellular reaction. The remaining ocular status was normal.&#x0D; Conclusion: Based on the history of chemical ocular injury, the lack of systemic diseases and the mild form of ocular inflammation, no additional diagnostic tests were offered. The patient was started on topical dexamethasone phosphate for 1 month with an initial dose of one drop four times daily, which led to remission.

Visual prognosis and surgical timing of Ahmed glaucoma valve implantation for neovascular glaucoma secondary to diabetic vitrectomy

BackgroundEvaluate the visual outcomes of Ahmed glaucoma valve implantation (AGVI) in patients with neovascular glaucoma (NVG) who underwent diabetic vitrectomy and suggest appropriate AGVI timing.MethodsMedical records of patients who underwent AGVI due to NVG after diabetic vitrectomy were reviewed. Successful intraocular pressure (IOP) control was defined as an IOP between 6 and 21 mmHg. Visual outcome was compared before NVG diagnosis and after AGVI, and the “favorable” visual outcome was defined as a postoperative deterioration in BCVA of less than 0.3 logMAR units compared to those before the development of NVG. Various factors including surgical timing were evaluated to identify the risk factors associated with unfavorable visual outcome.ResultsA total of 35 eyes were enrolled and divided into group 1(medically uncontrolled NVG group, IOP more than 30mmHg, 16 eyes) and group 2(NVG group responded well to the initial non-surgical treatment but eventually required AGVI, 19 eyes). Despite the favorable rate of normalization of post-AGVI IOP (85.7%), 43.8% in Group 1 and 26.3% in Group 2 showed unfavorable visual outcomes. In group 1, delayed surgical timing more than 1 week from the NVG diagnosis showed a significant association with unfavorable visual outcomes (P = 0.041). In group 2, poor patient compliance (follow up loss, refuse surgery) was the main factor of unfavorable visual outcomes.ConclusionWhen NVG occurs in patients with proliferative diabetic retinopathy after vitrectomy, physicians should be cautious not to delay the surgical intervention, especially in patients with IOP of 30 or more despite non-surgical treatment. Early AGVI within six days might be necessary to preserve useful vision in these patients.