Persistent High Intraocular Pressure Research Articles

The Effect of Persistent High Intraocular Pressure Treated by Phacoemulsification Combined with Goniosynechialysis in Eyes with Acute Primary Angle- closure Glaucoma

AIM: To investigate the availability and safety of phacoemulsification combined with goniosynechialysis for patients with persistent high intraocular pressure in acute primary angle-closure glaucoma. METHODS: Retrospective study. The clinical data of 31 patients (31 eyes) with persistent high intraocular pressure of primary angle-closure glaucoma treated in our center from January 2018 to April 2022 were collected. Each patient underwent phacoemulsification combined with goniosynechialysis after removing the cloudy corneal epithelium and recording the best corrected visual acuity(BCVA), intraocular pressure, and the appearance of the anterior chamber All data were analyzed statistically. RESULTS: After surgical treatment, the best corrected visual acuity was 0.70 (0.30, 0.90) 1 week, 0.30 (0.20, 0.50), 1 month, 0.30 (0.10,0.40), 3 months after surgery, and 0.30 (0.20,0.40) at the last follow-up, respectively, and it was significantly higher than preoperative 1.40 (1.10,2.00) (P < 0.01). The intraocular pressure was 16.20 (12.30,19.40) mmHg, 11.90 (10.80,14.20) mmHg, 13.80 (12.10,16.20) mmHg, 0.30 (0.10,0.40) mmHg and 11.70 (10.40, 12.40) mmHg at 1 day, 1week, 1 month, 3 months, and the last follow-up, and were significantly lower than preoperative 38.60(33.90,42.80)mmHg (P <0.01 ). The central anterior chamber depth and anterior chamber angle width were significantly different between pre-operation and each visit time after the operation (P < 0.01). CONCLUSION: Phacoemulsification combined with goniosynechialysis is a safe and feasible method to treat patients of acute primary angle-closure glaucoma eyes with persistent high intraocular pressure, which can reopen the anterior chamber angle, control intraocular pressure, and improve the visual acuity.

Ab-Interno Bleb Needling in A Failed Trabeculectomy: A Case Report

Introduction : Trabeculectomy remains a gold standard of glaucoma surgical management despite a steady rate of bleb failure due to conjunctival scarring. In this case, we report a case of a failed trabeculectomy managed with ab-interno bleb needling followed by antimetabolite injection of mitomycin C.
 Case Illustration : A 18-year-old male patient with a history of blurry vision in his right eye and vision loss in his left eye. The patient had previously undergone cataract surgery due to juvenile cataracts and developed persistent high intraocular pressure (IOP) in both of his eyes. A trabeculectomy was performed on his right eye six months prior to the examination; however, the IOP remained at 22 mmHg. Ocular examination revealed a shallow anterior chamber and flat conjunctival bleb. An ab-interno bleb needling technique was performed followed by antimetabolite injection of mitomycin C under local anesthesia in an operating theatre. Follow-up results showed a significant reduction of IOP on the first day (13.3 mmHg) and a week after surgery (18.5 mmHg), maintained by one anti-glaucoma eye drop.
 Discussion : Trabeculectomy filtration surgery has a high failure rate in younger patients due to a high risk of conjunctival scarring. The ab-interno needling approach with mitomycin C injection is a novel technique that can be performed and offers the advantage of increasing aqueous outflow through a direct opening of the trabecular meshwork from within the anterior chamber.
 Conclusion : This technique provides effective management of failed trabeculectomy to achieve intraocular pressure lowering effect and a corresponding decrease in the risk of progressive glaucomatous optic neuropathy.

Clinical efficacy of sclerotonyxis for acute angle-closure glaucoma with persistent high intraocular pressure.

The aim of the study was to investigate the clinical effectiveness and safety of sclerotonyxis in acute angle-closure glaucoma (ACG) with persistent high intraocular pressure (IOP). The clinical data of 50 eyes from 50 patients (mean age: 68.9±7.19 years) with acute ACG and persistently high IOP who were admitted to our department between January 2012 and January 2022 were retrospectively analyzed. Patients who were administered the maximum dose of systemic and topical anti-glaucoma drugs and still had an IOP of >40 mmHg 24 hours after admission underwent sclerotonyxis. After the IOP control, an individualized phase II treatment plan was designed according to the patient's ocular condition. Forty-eight patients showed improvement in their visual acuity 6 months postoperatively compared to their preoperative values. The mean IOPs were 54.84±7.82 mmHg and 21.34±7.81 mmHg 24 hours pre and postoperatively, respectively. The mean anterior chamber depth showed statistically significant differences pre and postoperatively (1.75±0.16 mm and 1.84±0.17 mm, respectively) (p<0.05). After IOP stabilized, four patients underwent YAG laser peripheral iridectomy, 18 underwent simple cataract phacoemulsification combined with intraocular lens (IOL) implantation, 21 underwent cataract phacoemulsification combined with IOL implantation and goniosynechialysis under a gonioscope, and 7 patients underwent combined surgery of glaucoma and cataract. The mean IOPs were 15.94±3.3 mmHg and 15.64±2.99 mmHg 1 week and 6 months after stage II surgery, respectively. Moreover, 42 eyes (84%) attained complete success and 8 eyes (16%) attained conditional success 6 months postoperatively. No serious complications, such as corneal endothelial decompensation, malignant glaucoma, vitreous or eruptive choroidal hemorrhage, and retinal detachment, were observed intraoperatively or postoperatively in both procedures. Sclerotonyxis can rapidly lower IOP, release the pupillary blockage, reconstruct the anterior chamber, and reduce systemic complications caused by long-term high-dose antiglaucoma drugs. Thus, it normalizes the IOP and provides a safe operating space for stage II surgery, effectively reducing complications in patients in a persistent high IOP state.

Encapsulated Bleb and Fibrous Ingrowth in the Ahmed Glaucoma Valve System and Bleb Revision with Mitomycin-C

Purpose: To report a case of fibrous tissue ingrowth after Ahmed valve implantation and bleb revision using mitomycin-C.Case summary: A 50-year-old man, who had received an Ahmed implantation 6 months prior, underwent bleb revision due to persistent high intraocular pressure, despite massage and multiple needling attempts. Bleb encapsulation over the entire valve plate was observed, and the bleb was gently dissected. Fibrous ingrowth over the entire valve system was confirmed. The broad stalk-like fibrous tissue was firmly adhered to the valve system. It was removed by pulling the connected bleb, taking care not to cut the stalk. Then, the long stalk-like fibrous ingrowth along the cleft between valve leaflets and main plate was removed, in the same manner. A sponge soaked with mitomycin-C (0.3 mg/mL) was instilled for 2 minutes, and the conjunctiva was sutured. Two weeks after the surgery, conjunctival suture was performed due to Ahmed valve exposure. Three weeks later, the Ahmed valve was removed due to re-exposure. Trabeculectomy surgery was performed due to uncontrolled intraocular pressure.Conclusions: There is a possibility of extensive fibrous tissue ingrowth after Ahmed valve implantation; thus, care should be taken when using mitomycin-C for bleb revision.

Clinical Observation of Laser Peripheral Iridoplasty with Number of Laser Shots in the Treatment of Acute Angle-Closure Glaucoma.

Objective To quantitatively study the intraocular pressure (IOP) control and chamber angle opening degree of patients with acute angle-closure glaucoma (stage of attack) treated by laser peripheral iridoplasty (LPIP) with different numbers of laser shots, and to evaluate the efficacy and safety of different numbers of laser shots. Methods Fifty-five patients (60 eyes) with acute angle-closure glaucoma treated in our hospital from May 2019 to December 2020 were selected as the research subjects. All patients had poor intraocular pressure control (≥40 mmHg) after IOP-lowering drug therapy. The patients were randomly divided into three groups, 20 eyes in each group, and underwent laser peripheral iridoplasty (LPIP) with different numbers of laser shots (group I: 35 laser shots, group II: 45 laser shots, and group III: 60 laser shots). The best-corrected visual acuity, IOP, corneal condition, and opening degree of anterior chamber angle (ACA), namely, the trabecular-iris angle (TIA), angle opening distance at 500 μm (AOD500), and complications of patients before LPIP, 2 hours after LPIP, and 24 hours after LPIP were observed, and the opening degree of ACA were quantitatively measured. Results The corrected visual acuity of the three groups after LPIP was improved to varying degrees, and the IOP decreased, TIA and AOD500 were increased compared with those before operation, and the differences were statistically significant (P < 0.05). There were statistically significant differences between group II and group I (P < 0.05). Four eyes in group I underwent LPIP again due to increased IOP. In group III, iris hemorrhage occurred in one eye and iris depigmentation occurred in one eye, and there was no statistical difference compared with group II (P > 0.05). Conclusions LPIP can effectively reduce preoperative IOP and increase ACA width in patients with persistent high IOP that failed to respond to drug therapy, and moderate numbers of laser shots can achieve satisfactory results and highest safety.

Observation on the efficacy of intravitreal conbercept injection for macular edema secondary to retinal vein occlusion

Objective To observe the efficacy of intravitreal injection of conbercept for macular edema secondary to retinal vein occlusion (RVO). Methods A case-control retrospective study. The data of 52 patients with macular edema secondary to RVO from Jan. 2016 to Dec. 2018 in Shanxi Province Eye Hospital were analyzed. All patients were treated with intravitreal conbercept injection, dose of 0.5 mg or 0.05 mL, in the 3+ pro renata(PRN) project. The followed up time was 6 months. Results The best corrected visual acuity (BCVA) at 1, 2, 3 and 6 months after treatment were better than that before treatment (t=13.010, 15.980, 7.530, 4.051, P<0.05). The thickness of central macula after treatment was lower than that before treatment (t=17.92, 12.32, 5.58, 0.41, P<0.05). During the treatment and follow-up, there was no serious complication such as vitreous hemorrhage, retinal detachment, persistent high intraocular pressure or endophthalmitis. Conclusion Intravitreal injection of conbercept is effective in the treatment of macular edema secondary to RVO, which can improve vision and reduce macular edema. Key words: Macular edema, secondary; Conbercept, injection, intravitreal; Retinal vein occlusion

The effect of persistent high intraocular pressure on cataract surgery in eyes with acute primary closed angle glaucoma

The effect of persistent high intraocular pressure on cataract surgery in eyes with acute primary closed angle glaucoma

Intravitreal injection of bevacizumab or ranibizumab for the treatment of pathological myopia choroidal neovascularization

Objective To compare the efficacy of intravitreal injection of ranibizumab and bevacizumab in the treatment of pathological myopia choroidal neovascularization (PM-CNV). Methods It is a retrospective case study. Seventy-nine patients (79 eyes) with PM-CNV were enrolled in this study. There were 26 males (26 eyes) and 53 females (53 eyes), with the mean age of (30.77±5.53) years. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, fundus color photography, fundus fluorescein angiography, and optical coherence tomography (OCT) were performed. BCVA was recorded as logarithm of the minimum angle of resolution (logMAR). The central retinal thickness (CMT) was measured by OCT (Cirrus HD-OCT). The eyes were divided into bevacizumab treatment group (38 eyes) and ranibizumab treatment group (41 eyes). There was no difference of the mean logMAR BCVA, intraocular pressure and CMT between two groups (t=−0.467, −1.983, 1.293;P=0.642, 0.051, 0.200). The eyes in bevacizumab treatment group were treated with bevacizumab 0.05 ml (1.25 mg), and the eyes in ranibizumab treatment group were treated with ranibizumab 0.05 ml (0.5 mg). Times of injection between two groups were compared. The changes of intraocular pressure were observed at 1, 7 days and 1 month after treatment. The changes of logMAR BCVA and CMT at 1, 3, 6, 12 and 24 months after treatment and systemic adverse reactions occur were compared. Results At the 1, 3, 6, 12 and 24 months after treatment, the mean logMAR BCVA of the bevacizumab treatment group and the ranibizumab treatment group was significantly improved than that before treatment (F=132.374,P<0.01). There was no significant difference in the mean logMAR BCVA at different time points between the two groups (F=0.095,P=0.759). The mean CMT of the two groups was lower than that before treatment (F=151.653,P<0.01). There was no significant difference in the mean CMT between the two groups (F=0.332,P=0.566). No retinal detachment, endophthalmitis, cataract and persistent high intraocular pressure were associated with drug, injection-related eye and systemic adverse events during follow-up. Seven eyes had conjunctiva bleeding after treatment, 11 patients (11 eyes) complained of shadow floaters after treatment. Conclusion Intravitreal injection of bevacizumab or ranibizumab can equally effectively improve the visual acuity and reduce the CMT of PM-CNV patients. Key words: Choroidal neovascularization/therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Myopia, degenerative/complications

Effect of persistent high intraocular pressure on microstructure and hydraulic permeability of trabecular meshwork**Project supported by the National Natural Science Foundation of China (Grant Nos. 31070840, 10802053, and 81201123), the Natural Science Foundation of Beijing, China (Grant No. 3122010), the Natural Science Foundation of Guangdong Province, China (Grant No. S2012040006576), the Shenzhen Science and Technology Innovation Committee, China (Grant No.

As the aqueous humor leaves the eye, it first passes through the trabecular meshwork (TM). Increased flow resistance in this region causes elevation of intraocular pressure (IOP), which leads to the occurrence of glaucoma. To quantitatively evaluate the effect of high IOP on the configuration and hydraulic permeability of the TM, second harmonic generation (SHG) microscopy was used to image the microstructures of the TM and adjacent tissues in control (normal) and high IOP conditions. Enucleated rabbit eyes were perfused at a pressure of 60 mmHg to achieve the high IOP. Through the anterior chamber of the eye, in situ images were obtained from different depths beneath the surface of the TM. Porosity and specific surface area of the TM in control and high IOP conditions were then calculated to estimate the effect of the high pressure on the permeability of tissue in different depths. We further photographed the histological sections of the TM and compared the in situ images. The following results were obtained in the control condition, where the region of depth was less than 55 μm with crossed branching beams and large pores in the superficial TM. The deeper meshwork is a silk-like tissue with abundant fluorescence separating the small size of pores. The total thickness of pathway tissues composed of TM and juxtacanalicular (JCT) is more than 100 μm. After putting a high pressure on the inner wall of the eye, the TM region progressively collapses and decreases to be less than 40 μm. Fibers of the TM became dense, and the porosity at 34 μm in the high IOP condition is comparable to that at 105 μm in the control condition. As a consequent result, the permeability of the superficial TM decreases rapidly from 120 μm2 to 49.6 μm2 and that of deeper TM decreases from 1.66 μm2 to 0.57 μm2. Heterogeneity reflected by descent in permeability reduces from 12.4 μm of the control condition to 3.74 μm of the high IOP condition. The persistently high IOP makes the TM region collapse from its normal state, in which the collagen fibers of the TM are arranged in regular to maintain the physiological permeability of the outflow pathway. In the scope of pathologically high IOP, the microstructure of the TM is sensitive to pressure and hydraulic permeability can be significantly affected by IOP.

Operation for primary angle closure glaucoma under the condition of persistent high intraocular pressure

Objective To investigate the safety and therapeutic effect of operation for primary angle closure glaucoma under the condition of persistent high intraocular pressure. Methods Thirty-six eyes of 34 cases with primary angle closure glaucoma whose intraocular pressure was not controlled by drugs underwent anti-glaucoma surgery in our hospital and their data were reviewed. Results Three months after surgery, the intraocular pressure was below 20 mmHg (1 mmHg=0.133 kPa), and most of the eyes retained good vision. No serious complication occurred. Conclusion The trabeculectomy can protect the visual function of patients with primary angle closure glaucoma under the condition of persistent high intraocular pressure. Adequate preoperative preparation, good operative techniques and effective treatments for postoperative complications are necessary to make the operation safe and effective. Key words: Intraocular pressure, high; Glaucoma, angle-closure, acute, primary; Operation

Use of hypertonic glucose in the surgery of uncontrolled acute angle-closure combined with cataract

We describe the use of hypertonic glucose to lessen the corneal edema resulting from persistent high intraocular pressure (IOP) in acute primary angle-closure (APAC) patients’ cataract surgery. Some patients are unresponsive to the antiglaucoma drugs, and the persistent high IOP make the corneal edema severe, which make it impossible to perform laser iridotomy or phacoemulsification directly. We perform a temporal incision on the transparent cornea and use the gossypium asepticum with 50 % hypertonic glucose over the cornea for 5 min in the surgery; the corneal edema alleviates as a result, and the cornea is clear enough to perform the surgery. The technique has been used in five cases and made the surgeries implement easier.

The clinical study of early post-cataract surgery capsular block syndrome

Objective To discuss the causes,prevention and treatment of persistent high intraocular pressure caused by early capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation.Methods 54 patients who developed early postoperative CBS were included in this study.22 cases received anterior vitrectomy and anterior chamber gas injection,19 cases received YAG laser anterior or posterior capsulotomy,13 cases only received medication to drop intraocular pressure.Statistical data was analysed by SPSS 13.0 software package to compare the efficacy of treatment.Results The corrected visual acuity improved after one week of treatment,there was no significant difference between the three groups (P =0.594).The high intraocular pressure relieved,there was significant difference (P =0.048).After three months of follow-up,there was no significant difference between the three groups of corrected visual acuity (P =0.240),but there was significant difference of IOP (P =0.030).Furthermore,there was no significant difference of IOP between the vitrectomy group and laser group (P =0.725),but the IOP of the vitrectomy group and laser group was significantly better than that of medication group (P =0.004,P =0.033).Conclusion The early postoperative CBS can be prevented by expansion of capsulorhexis diameter,selecting appropriate intraocular lens,and improving surgical skills to complete removal of the viscoelastic material.When the medication fails,early operation of anterior vitrectomy and anterior chamber gas injection can effectively reduce intraocular pressure and improve corrected visual acuity,which may achieve the same effect of laser treatment. Key words: Post-cataract surgery; Capsular block syndrome; High intraocular pressure ; Anterior vitrectomy ; YAG laser

Paracentesis as an initial intervention in Malay Indonesian eyes with acute primary angle closure

Background: Acute primary angle closure (APAC) is one of the causes of blindness in Department of Ophthalmology Cipto Mangunkusumo General Hospital. Management of APAC is still controversial. Laser peripheral iridotomy is difficult to be done due to corneal edema as a result of persistent high intraocular pressure (IOP). It is believe that paracentesis will lower IOP immediately. The objective of the study was to assess outcome of paracentesis as the initial management in Malay Indonesian eyes with APAC. Methods: This intervention study was conducted at the Eye Clinic of Cipto Mangunkusumo Hospital and Jakarta Eye Center commencing in January 2005 until December 2007. Malay Indonesian eyes with APAC were included in this study in accordance with the new Asia Pacific consensus. All APAC eyes underwent paracentesis to lower IOP. The presenting and post-paracentesis IOP and peripheral anterior synechiae were noted. The outcome was termed as good when IOP was ≤ 21 mmHg and poor when IOP was > 21 mmHg. Results: A total of 45 APAC eyes were recruited. Thirty-eight of these belonged to women; mean age was 54.6 ± 1.56 years. Meanwhile, average duration of symptoms was 13.15 ± 7.4 days and mean of extent of peripheral anterior synechiae (PAS) was 7.7 ± 3.1 hours. There was a strong correlation regarding duration of symptoms to the formation of PAS (r = 0.672; p < 0.001). The mean presenting IOP was 55 ± 13.37 mmHg and mean post-paracentesis IOP was 27 ± 12.78 mmHg. A decrease of 49% in IOP ( p < 0.001) was observed after paracentesis with good outcome in 19 eyes and poor outcome in 26 eyes. Conclusion: Paracentesis as an initial intervention in APAC eyes reduces the IOP immediately, but only as a temporary response. (Med J Indones. 2012;21:113-7) Keywords: Acute primary angle closure (APAC), intraocular pressure (IOP), paracentesis, peripheral anterior synechiae (PAS)

The surgical method and effect of angle-closure glaucoma during high intraocular pressure

Objective To study the efficacy and surgical method of angle-closure glaucoma ( ACG)in persistent high intraocular pressure (IOP). Method 42 cases (45 eyes) with ACG accepted trabeculectomy in high IOP.Puncture and release of aqueous were done twice preoperative and intraoperative.Visual acuity,filtering bleb,anterior chamber,IOP and complications were observed after operation.Results All of the 42 cases (45 eyes) underwent surgery successfully. There were no complications of perichoroidal space bleeding or prolapse of vitreous occurred.Conclusion Trabeculectomy is safe and effective for the treatment of primary angle-closure glaucoma in high intraocular pressure with proper treament perioperatively. Key words: Glaucoma,angle-closure,acute; Intraocular pressure,high; Trabeculectomy; Method; Efficiency

The resuit analyzing of Surgical treatment for advanced primary glaucoma with high intraocular preasure

Objective To evaluate the effect of the trabeculectomy in advanced primary glaucoma with persistent high intraocular pressure. Methods 34cases (36eyes) of advanced primary glaucoma were performed trabeculectomy under surface aneathesia with the use of mitomycin , after slowly releasing aqueous.Results Postoperative following up 6 ～ 12 months, postoperative visual acuity increased in 27 eyes, no changed in 7eyes,and decreased in 2 eyes. The intraocular pressure were controled below 20.55mmHg. Postoperative conjunctival filtration functions were good ,no limitation or functional filtering bleb was found. Visual field in 20 eyes was expanded postoperative. Conclusions For patients with advanced primary glaucoma, trabeculectomy with using mitomycin can effectively reduce intraocular pressure. Key words: Glaucoma, advanced, primary; Intraocular pressure; Trabeculectomy; Mitomycin

Drainageimplantat nach Molteno/von Denffer bei therapierefraktären Glaukomen

In glaucoma eyes in which the pressure regulation was not possible with drugs and surgery or which were blind already, we treated the patients with a Molteno implant by von Denffer. In 10 years (1995 to 2004) we treated 19 eyes with a glaucoma drainage device -- the Molteno implant developed by von Denffer. The average age of the patients was 64 (range: 15 to 77) years. On average 3,1 operations were realised before the implant. The average eye pressure was 44 mm Hg preoperatively. Our patients suffered from different glaucomatous diseases: 7 primary glaucomas (congenital, open and narrow angle glaucoma) and secondary: neovascular glaucoma (4), PEX glaucoma (2), traumatic glaucoma (3) and postoperative glaucoma (3). The intraocular pressure had a successful outcome of under 20 mm Hg in 13 eyes, 5 patients out of these were treated with 1 to 3 drugs. Early complications (flat anterior chamber, hyphaema, hypotonia) were reversible. Late complications were phthisis bulbi (3), explantation of the implant (2) and one evisceration bulbi. We found an improvement of the visual acuity in 4 cases in traumatic and postoperative glaucoma. The stabilisation of visual acuity was possible in primary glaucoma. The implantation of the Molteno implant by von Denffer is an ultimate ratio in eyes with persistent high intraocular pressure. A durable reduction of the pressure is possible in two-thirds and the conservation of the bulbus was achieved in three-fourths of the patients.