Significant Change In Intraocular Pressure Research Articles

Bimatoprost ophthalmic solution 0.03% lowered intraocular pressure of normal-tension glaucoma with minimal adverse events

PurposeThe aim of this study was to evaluate the efficacy and safety of bimatoprost ophthalmic solution 0.03% (bimatoprost) in Japanese normal-tension glaucoma (NTG) patients with an intraocular pressure (IOP) of 18 mmHg or less.MethodsBimatoprost was instilled into the unilateral conjunctival sac of Japanese NTG patients with a baseline IOP of 18 mmHg or less. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 2, 4, 8, and 12 weeks post bimatoprost instillation.ResultsThirty-two of the 38 enrolled NTG patients (mean age, 64.1 ± 12.6 years; 19 males and 19 females) completed the study, with six patients unable to complete the study (two patients discontinued because of side effects and four patients withdrew). The levels of IOP in the treated eyes were significantly reduced (P < 0.0001) from the baseline IOP levels. No significant change in IOP was observed in the fellow eyes. There were significant increases in conjunctival hyperemia. No significant superficial punctate keratitis scores were noted between the baseline and each point examined. Eyelash disorder, eyelid pigmentation, and deepening of the upper eyelid sulcus were observed in 28, six, and three eyes, respectively.ConclusionBimatoprost effectively lowered the IOP. It was well tolerated in Japanese NTG patients, with few patients having to discontinue because of adverse events.

Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty?

Objective Selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) are used to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). We report long-term follow-up data comparing SLT to ALT. Design Follow-up of prospective randomized clinical trial. Participants Patients with glaucoma from the practices of three ophthalmologists at the University of Ottawa. Methods We randomized 176 eyes of 152 patients with uncontrolled IOP on maximal tolerated medical therapy (MTMT, with or without previous ALT) to undergo either SLT or ALT. Data were available for 142 eyes at 3 years, 134 eyes at 4 years, and 120 eyes at 5 years. The primary outcome was change in IOP from pretreatment baseline. Results Comparison of baseline parameters was similar in the two groups. Lowering of IOP were similar at 3 years (SLT –6.7 ± 7.1 vs ALT –6.1 ± 5.1); at 4 years (SLT 7.0 ± 7.7 vs ALT –6.3 ± 5.0); and at 5 years (SLT –7.4 ± 7.3 vs ALT –6.7 ± 6.6). There was no statistically significant change in IOP in either of the two groups. Medication changes were equivalent in each group. A number of interventions were required in both groups, cumulatively, over the 5-year follow-up period (49 SLT and 33 ALT). Survival analysis indicated that the time to 50% failure in each group was approximately 2 years. Conclusions The IOP-lowering effect of SLT and ALT was similar over 5 years in this group of patients with open-angle glaucoma on MTMT.

Randomised trial of sequential pretreatment for Nd:YAG laser iridotomy in dark irides

AimsTo compare iridotomy outcomes in dark irides by 1064 nm pulsed Nd:YAG laser with and without 532 nm continuous-wave Nd:YAG (frequency-doubled) green laser pretreatment.Methods30 patients with occludable anterior chamber angles...

Efecto de Combigan ® versus placebo en el flujo sanguíneo ocular en pacientes hipertensos oculares

Purpose This study was undertaken to compare the ocular haemodynamic effects of Combigan ® versus placebo in patients with ocular hypertension (OHT). Methods Thirty patients with OHT were included in a controlled, randomised, double blind study in two parallel groups; 15 were randomised to receive Combigan ® and 15 to receive placebo for a period of 3 months. At baseline and at 3 months retrobulbar blood flowmeasurements of the ophthalmic artery (OA) and central retinal artery (CRA) were taken using colour Doppler imaging(CDI) ultrasound, concurrently with intraocular pressure (IOP). Results Combigan ® significantly reduced IOP after 3 months of treatment (P = 0.001), whereas placebo showed no significant change in IOP. The baseline haemodynamic parameters were similar between treatment and placebo groups. Patients treated with Combigan® showed a statistically significant decrease in CRA resistive index (P = 0.007). Conclusions Patients treated for 3 months with Combigan ® showed a significant decrease of CRA resistive index that could be explained by the decrease in IOP.

Effect on ocular blood flow of Combigan® versus placebo in patients with ocular hypertension

PurposeThis study was undertaken to compare the ocular haemodynamic effects of Combigan® versus placebo in patients with ocular hypertension (OHT). MethodsThirty patients with OHT were included in a controlled, randomised, double blind study in two parallel groups; 15 were randomised to receive Combigan® and 15 to receive placebo for a period of 3 months. At baseline and at 3 months retrobulbar blood flowmeasurements of the ophthalmic artery (OA) and central retinal artery (CRA) were taken using colour Doppler imaging(CDI) ultrasound, concurrently with intraocular pressure (IOP). ResultsCombigan® significantly reduced IOP after 3 months of treatment (P=0.001), whereas placebo showed no significant change in IOP. The baseline haemodynamic parameters were similar between treatment and placebo groups. Patients treated with Combigan® showed a statistically significant decrease in CRA resistive index (P=0.007). ConclusionsPatients treated for 3 months with Combigan® showed a significant decrease of CRA resistive index that could be explained by the decrease in IOP

Perfluorocarbon-perfused 23 gauge three-dimensional vitrectomy for complicated diabetic tractional retinal detachment

BackgroundPerfluorocarbon liquid (PCL)-perfused vitrectomy has been shown in previous studies to be feasible, safe, and to have advantages in managing complicated cases of tractional retinal detachment. The present study had the objectives of describing the anatomical results and measuring surgical time and PCL consumption when combining PCL-perfused techniques with modern vitrectomy equipment.MethodsA prospective, interventional consecutive case series was investigated. We enrolled patients with diabetic tractional retinal detachment, complicated by proliferative vitreoretinopathy and poor vision. A 23 gauge PCL-perfused vitrectomy was done with three-dimensional settings. During the procedure, we assessed the degree of surgical bleeding, visualization quality, and difficulty of membrane dissections. Visual acuity, intraocular pressure, and anatomical success were assessed at one and 3 months of follow-up.ResultsTwelve patients were enrolled in this study. There were no statistical significant changes in intraocular pressure and visual acuity throughout the follow-up period. Surgery was performed in a hemorrhage-free environment in almost all cases, with good visualization and low technical difficulty. The mean complete surgical time was 94.92 ± 25.03 minutes. The mean effective vitrectomy time was 22.50 ± 19.04 minutes and the mean PCL consumption was 25.08 ± 9.76 mL, with a speed of 1.11 mL/minute. Anatomical success was 67% at 3 months.ConclusionAlthough the technique proved to have some advantages in managing complicated cases of diabetic tractional retinal detachment, there was a high consumption of PCL. A redesign of the entire system is needed in order to decrease the amount of PCL needed for the technique.

Injections sous-conjonctivales de bévacizumab dans le traitement de la néovascularisation cornéenne

To assess efficacy and safety of subconjunctival bevacizumab in corneal neovascularization treatment. The study was a prospective case series that included patients treated with subconjunctival bevacizumab injections for corneal neovascularization over a period of four months. A dose of 2.5 mg (0.1 mL) of bevacizumab (25 mg/mL) was injected into the subconjunctival area 1-2mm behind the limbus near the corneal neovascularization. The main outcome measures were visual acuity, corneal neovascularization, as well as local and general side effects. Thirteen eyes of 12 patients were included. The mean patient age was 44.2 years (range, 18-87 years). Patients received from two to four bevacizumab injections. The mean corneal neovascularization area decreased from 41.1 to 33.7 % at day 45 (p=0.0003) and to 33.9 % at day 120 (p=0.0013). Median visual acuity changed from 1.32 to 1.28 LogMAR on day 45 and to 1.25 LogMAR on day 120. Subconjunctival bevacizumab was well tolerated without general side effects. There was no significant change in intraocular pressure. An epithelial defect was described in three patients after initiation of bevacizumab therapy. Subconjunctival bevacizumab injections were effective and safe in reducing corneal neovascularization within the first four months. Meanwhile, improving vision may provide additional strategies.

Diurnal and Nocturnal Effects of Brimonidine Monotherapy on Intraocular Pressure

To investigate the effect of brimonidine monotherapy on intraocular pressure (IOP) during the nocturnal/sleep period. Prospective, open-label experimental study. Fifteen patients with newly diagnosed open-angle glaucoma or ocular hypertension (ages, 46-72 years). Baseline data of 24-hour IOP in untreated patients were collected in a sleep laboratory. Measurements of IOP were taken using a pneumatonometer every 2 hours in the sitting and supine body positions during the 16-hour diurnal/wake period and in the supine position during the 8-hour nocturnal/sleep period. Patients were treated afterward with 0.1% brimonidine 3 times per day for 4 weeks, and 24-hour IOP data were collected under the same laboratory conditions. Diurnal and nocturnal IOP means under the brimonidine treatment were compared with the baseline. The diurnal IOP mean was significantly lower under the brimonidine treatment than the baseline IOP in both the sitting and supine positions. There was no statistically significant change in IOP under the brimonidine treatment from the baseline during the nocturnal period. Although 0.1% brimonidine monotherapy significantly lowered IOP during the diurnal/wake period, it did not significantly lower IOP during the nocturnal/sleep period. Proprietary or commercial disclosure may be found after the references.

Effect of Repeated Applanation Tonometry on the Accuracy of Intraocular Pressure Measurements

Purpose: To evaluate the stability of successive applanation tonometry measurements in glaucomatous eyes.Methods: A prospective, comparative, randomized, and evaluator-masked study was conducted in a tertiary medical center. Sixty-seven patients with glaucoma attending our glaucoma clinic underwent four successive intraocular pressure (IOP) measurements with Goldmann-type applanation tonometry. Findings were compared with 70 patients scheduled for cataract surgery, similar in age and sex. The results were statistically analyzed with repeated measures analysis.Results: In the glaucoma group, the difference between the first and second IOP measurements was statistically significant (15.94 mmHg vs 14.9 mmHg, p < 0.0001), as was the decrease in IOP from the first measurement to each of the other successive measurements. No significant change in IOP was noted in the control group (mean, 13.7 mmHg).Conclusions: Patients with glaucoma show a decrease in IOP on repeated applanation tonometry measurements. By contrast, in individuals without glaucoma, no significant decrease in IOP on repeated applanation tonometry measurements was found.

Effects of Topical Phenylephrine and Tafluprost on Optic Nerve Head Circulation in Monkeys with Unilateral Experimental Glaucoma

To compare the effects of a topical alpha agonist (vasoconstrictor) and a prostaglandin receptor (FP) agonist (vasodilator) on circulation in the optic nerve head (ONH) in experimental glaucomatous and normal eyes of monkeys. Tissue blood velocity in the ONH (NB(ONH)) was determined using the laser speckle method in both eyes of eight normal cynomolgus monkeys under systemic anesthesia for 180 minutes after bilateral instillation of 5% phenylephrine. The effect of 0.0015% tafluprost, a potent FP agonist, was also studied after single and once-daily 7-day instillations. Measurements were repeated in both eyes of the eight monkeys after establishment of unilateral laser-induced glaucoma. NB(ONH) decreased significantly in both eyes of normal monkeys 30 to 120 minutes after phenylephrine instillation by a maximum of 9% to 11% (P < 0.05) without significant change in intraocular pressure (IOP). A similar decrease in NB(ONH) was found in non-laser-treated eyes in glaucomatous monkeys despite the absence of significant changes in contralateral experimental glaucomatous eyes. NB(ONH) increased by 16% (P < 0.05) 60 minutes after a single instillation and also after 7-day repeated instillations of tafluprost in both eyes of normal monkeys. A similar increase in NB(ONH) occurred in both eyes after the establishment of unilateral glaucoma but was completely abolished by 5 mg/kg indomethacin injected intravenously 15 minutes after tafluprost instillation. Tafluprost significantly reduced IOP only in experimental glaucomatous eyes by 34%. The ONH vasculature in glaucomatous and normal eyes reacts differently to an exogenous alpha agonist, whereas it reacts similarly to an FP agonist.

The Effect of Aerobic Exercise on Intraocular Pressure in Horse

The present study was planned to investigate the effect of the intensity of exercise on intraocular pressure (IOP), systolic and diastolic blood pressure, glycaemia and blood lactate concentration in regularly trained Italian saddle jumper horses. On the first day five female horses performed 1 h of walking on an electronically controlled horse-walker at 100 m/min; on the second day 1 h session consisted of 5 min of walk, 30 min of trot, 20 min of gallop and one exercise of a 300 m long trail with eight jumps 90 cm high to be run in 1 min. The studied indicators were collected at rest, immediately after the exercise and 30 min after the exercise. Analysis of variance (ANOVA) showed a significant effect of different workloads on blood lactate concentration, systolic and diastolic blood pressure. No significant difference was found in IOP reduction when comparing aerobic and moderate anaerobic exercise. Our results confirm that the lack of a significant change in IOP in the athletic horse after mild exercise is in accordance with the human athlete. The cardiovascular and haematological changes induced by aerobic and moderate anaerobic exercise had no significant effect on IOP, either.

Intraocular pressure changes following Descemet’s stripping with endothelial keratoplasty

To evaluate the postoperative changes in intraocular pressure (IOP) following Descemet's stripping with endothelial keratoplasty (DSEK). A retrospective chart review of 45 eyes that underwent DSEK for the treatment of corneal edema induced by aphakic or pseudophakic bullous keratopathy (ABK/PBK) and Fuchs' endothelial dystrophy. A mean baseline IOP was obtained at three different preoperative visits using Tono-Pen XL tonometer. This baseline pressure was compared to IOPs obtained at postoperative months 1, 3, 6 and 12. Intraocular pressure increased from a mean preoperative value of 15.6 +/- 4.2 mmHg to 15.9 +/- 5.8 mmHg in the first postoperative month; 17.0 +/- 5.7 mmHg at 3 months; 18.1 +/- 6.2 mmHg at 6 months and 16.8 +/- 4.7 mmHg at 1 year. These pressure differences were considered statistically significant, p = 0.0074 (repeated measures ANOVA). Eyes diagnosed with ABK/PBK (n = 20) showed a significant rise in IOP only noted after the 3(rd) month that peaked at 6 months, p = 0.0001 (repeated measures ANOVA). A subgroup of patients with a diagnosis of Fuchs' endothelial dystrophy (n = 25), showed no statistically significant changes in IOP at 1 year follow-up; p = 0.9103 (repeated measures ANOVA). In a subgroup of eyes with a diagnosis of glaucoma or ocular hypertension (n = 13), a statistically significant increase in IOP was noted after 1 year of follow-up. Mean IOP raised from a preoperative mean value of 16.0 +/- 3.7 mHg to 19.0 +/- 5.3 mmHg at 1 year; p = 0.0074 (repeated measures ANOVA). DSEK induced statistically significant IOP increases in the early postoperative period with a tendency to higher pressures after the 3(rd) month of follow-up. Patients with a preoperative diagnosis of Fuchs' endothelial dystrophy did not show a statistically significant increase in IOP compared to a baseline mean preoperative value. The difference between statistically significant and clinically significant IOP increase is yet to be established.

Effect of phacoemulsification on the primary open angle glaucoma control after trabeculectomy: a case‐control study

Abstract Purpose In this retrospective and comparative study, we analyzed the influence of phacoemulsification (PE) on the glaucoma control in case patients (trabeculectomy‐phacoemulsification [CE]) compared with the control that underwent trabeculectomy (T) alone in eyes with primary open angle glaucoma (POAG). Methods Twenty one patients who underwent PE subsequent to T were identified, and 41 who underwent T alone were matched. Visual acuity (VA), intraocular pressure (IOP), bleb appearance, vertical cup disc ratio (VCDR), visual field (VF), glaucoma medications, iris manipulation and complications were documented. Mean follow up was 12 months. Success was defined when IOP ≤ 21 mmHg with the abscense of glaucoma medication and/or further surgical intervention. Results Patients in CE group had no significant change in IOP from pre‐operative measures to 12 months post‐operative (p=0.001). The mean IOP reduced from 15.3 mm Hg to 14.7 mmHg postoperatively. The control group showed an average IOP reduction of 6 mm Hg in the last visit. In CE group, 19% required 1 or 2 glaucoma medications at one year fellow‐up vs 19.5% in the control group. In CE group 9.5% showed flattening of previously formed bleb in the last visit (P&lt;0.001), 9.7 % ended with flat bleb in the T group. The increase in VCDR for the CE group was statistically significant when compared to the control group (p&lt;0.001). Patients in CE group were more likely to exhibit a change in VF (47.6% versus 7.3% respectively). The study is limited by the small number of cases available. Conclusion Corneal PE in eyes with filtering blebs does not adversely affect long‐term glaucoma control in patients with POAG.

Sympathetic influence on intraocular pressure

Abstract Purpose To apply wavelet analysis to investigate the sympathetic modulation upon intraocular pressure(IOP)of the cold pressure test Methods In an autonomic dedicated lab continuous and simultaneous recording of(IOP) with Pascal(DCT) and arterial blood pressure(BP) were made in 11 healthy individuals,of both sexes,in basal conditions and during 1minute of cold‐pressure test(CPT).The tests were in the morning period and in the 24h previous individuals were told not to smoke and to avoid xanthines or other stimulants ingestion. Individuals under medication or with other pathology that could affect the autonomic nervous system were excluded. Data analysis of IOP and systolicBP (SBP) in the time‐scale domain with wavelets(DB12)was performed, for both variables, during the last minute prior to test and during one minute upon test. In this last case,periods of 10s where individually analysed and the period with the largest value was the chosen for statist analysis using t‐Student test, Welch corrected(Ducla‐Soares et al, 2007).LFIOP and LFSBP were calculated and differences between basal and CPT values were considered significant where p&lt;0.05. Data were expressed as mean±SEM., and for LF mmHg2 Results Data refer to 6 male and 5 female with a mean age of 49[40‐70] On CPT, a sympathetic challenging manoeuvre, an increase of SBP was observed. Wavelet analysis of both signals showed a significant increase of LFIOP and LFSBP from 0.13±0.15 and 8.66±1.51 to 0.37±0.26 mmHg2 and 18.7±4.5mmHg2, respectively, and a not significant change in IOP 17.0±2.6 to18.0±1.5 Conclusion Our data show a sympathetic signature on IOP correlated with that observed in BP. We show that wavelets are a suitable tool for the evaluation of sympathetic signature on short periods of IOP recorded by DCT

Complex Antibody Profile Changes in an Experimental Autoimmune Glaucoma Animal Model

Increased serum antibodies against heat shock protein 27 (HSP27) have been identified in patients with glaucoma. Immunization with HSP27 caused retinal ganglion cell (RGC) loss in animals. The authors analyzed whether HSP27 immunization not only causes RGC loss but also affects systemic antibody patterns. Rats were immunized with HSP27 and were surveyed for 4, 5, and 6 weeks (groups 1-3). Control animals were humanely killed after 6 weeks (group 4). Intraocular pressure was measured before and 2 and 4 weeks after immunization. Fundus images were taken at the same time. Retinal flatmounts were prepared, and Brn-3a labeled RGCs were counted. Serum was collected during the study to detect antibody patterns against retinal antigens through Western blot analysis and mass spectrometry techniques. Patterns were analyzed by multivariate statistical techniques, and biomarkers were identified with the use of mass spectrometry. No significant changes in intraocular pressure were observed, and no fundus abnormalities were noted. The animals immunized with HSP27 showed lower RGC density than controls (P < 0.05). Two and 4 weeks after immunization, we detected a significant difference in antibody profiles between groups 1 and 4 (P < 0.05) and groups 3 and 4 (P < 0.05). Proteins with different antibody level expression after immunization included heat shock protein 90, alpha-enolase, and glyceraldehyde-3-phosphate dehydrogenase. After immunization with HSP27, animals showed IOP-independent RGC loss and changes in serum antibody patterns. Thus, this model might be a beneficial approach to study the development and effects of anti-retinal antibodies and their involvement in RGC loss.

Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis

Objective Perennial allergic rhinitis (PAR) affects children at a young age. Current guidelines recommend intranasal corticosteroids as the first-line treatment in patients with moderate-to-severe or persistent disease or in those who have congestion. In this study, the long-term safety and efficacy of mometasone furoate nasal spray (MFNS) were assessed in children with PAR. Methods In this multicenter, active-controlled, evaluator-blind, 12-month study, 255 children aged 6–11 years with a ≥1-year history of PAR were randomized to receive once-daily MFNS 100 μg ( n = 166) or the active comparator beclomethasone dipropionate (BDP) 168 μg ( n = 85). Changes from baseline in overall PAR symptoms and response to treatment were rated at each visit. Cosyntropin stimulation testing, as well as tonometry and slit lamp procedures, were performed. Safety variables were assessed. Results A total of 137 subjects in the MFNS group and 68 in the BDP group completed treatment. The mean reductions in physician- and subject-rated overall condition of PAR at week 52 were −42.1% and −39.7%, respectively, for MFNS, compared with −44.0% and −39.0%, respectively, for BDP. A total of 94% and 100% of MFNS and BDP subjects, respectively, reported adverse events (AEs), which were mostly mild or moderate. The most frequently reported treatment-related AEs in both groups were epistaxis, headache, and pharyngitis. Response to cosyntropin was normal and no posterior subcapsular cataracts were observed in either group. Although no significant changes in intraocular pressure were observed with MFNS, one subject receiving BDP demonstrated this effect. Conclusions Treatment with MFNS 100 μg once daily for 1 year was well tolerated in children 6–11 years old, with negligible systemic exposure and no evidence of suppression of the hypothalamic–pituitary–adrenal axis or ocular changes.

Effect of haemodialysis on intraocular pressure

To study the effect of haemodialysis on intraocular pressure (IOP) of patients at the University Malaya Medical Centre, Kuala Lumpur, and the influence of anterior chamber angles, surgery, and diabetes on the change in IOP after haemodialysis. Prospective, single centre study on patients undergoing haemodialysis with a sample size of 98 eyes (49 patients). Ocular examination was performed before haemodialysis. Pre- and post-haemodialysis IOP measurements were taken. Plasma osmolarity changes and volume of fluid removed were noted. Patients on antiglaucoma treatment or who have had earlier laser or surgical procedures for it were excluded. Student's t-test and Pearson's coefficient test were used to determine the statistical significance. Plasma osmolarity decreased significantly (-11.6+/-10.0 m Osm/l, P<0.001). In eyes with occludable angles (8% of cases), IOP decreased significantly (-3.63+/-1.92 mmHg, P<0.001). In non-occludable angle eyes (92% of cases), no significant changes (P>0.05) in all subgroups of non-operated/operated and diabetic/non-diabetic eyes were seen. Haemodialysis does not cause significant changes in IOP in non-glaucomatous and non-occludable angle eyes.

Phakic Iris-Claw IOL Implantation, with Bursa Technique, through a Self-Sealing Scleral Tunnel and without Iridotomy or Iridectomy

To present a novel technique for the implantation of phakic iris-claw intraocular lenses (IOL) in highly myopic cases. Twelve cases, under the age of 40, with high myopia were included in this retrospective study. The mean follow-up span was 14.4+/-5.8 months. Phakic iris-claw IOL implantation was performed, through a 5.5 or 6.5 mm self sealing scleral tunnel with Bursa technique. No suturing and opening a peripheral iridectomy or iridotomy was required in our study. Pre- and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best-corrected visual acuity (BCVA), induced astigmatism, and intraocular pressure (IOP) assessments. All eyes gained one to nine lines of BCVA of the Snellen chart. The vector analysis revealed an induced astigmatism of 0.63 D. No significant IOP change was detected throughout the follow-up. The data suggest that nonfoldable iris fixated phakic IOL implantation, through a self-sealing incision with Bursa technique, is safe and requires no iridectomy or iridotomy in cases with deep anterior chambers.

Changes in visual function after intraocular pressure reduction using antiglaucoma medications

To evaluate the change in visual function after starting glaucoma treatment and correlate this to a decrease in intraocular pressure (IOP) in primary open-angle glaucoma patients. A prospective, randomized clinical trial was carried out involving 54 glaucoma patients (54 eyes). After inclusion, patients randomly received timolol maleate 0.5%, brimonidine tartrate 0.2%, or travoprost 0.004% in one randomly selected eye. Patients underwent Goldmann applanation tonometry, visual acuity test, standard automated perimetry (SAP), visual quality perception test (visual analogue scale), and contrast sensitivity (CS) test, in a random order before and after the 4-week glaucoma treatment. There were statistically significant changes in IOP (mean change [standard deviation], 7.8 [3.6] mmHg, P<0.001), SAP mean deviation index (0.84 [2.45] dB, P=0.02), visual quality perception (0.56 [1.93], P=0.045), and CS at frequencies of 12 cycles/degree (0.10 [0.37], P=0.03) and 18 cycles/degree (0.18 [0.42], P=0.02) after the 4-week treatment when compared with baseline. No statistically significant differences were found between the treatment groups in visual function changes after treatment (P>0.40). No significant correlations between IOP reduction and changes in visual function were found (P>0.30). Visual quality perception, visual field mean deviation index, and CS at higher frequencies improve after starting glaucoma therapy. However, no correlation was found between IOP reduction and changes in visual function, and no differences were found in visual function when the three medications studied were compared.

Intraocular Pressure Changes Associated with Intubation with the Intubating Laryngeal Mask Airway Compared with Conventional Laryngoscopy

This open, prospective, randomised study was designed to evaluate the changes in intra-ocular pressure and haemodynamics after tracheal intubation using either the intubating laryngeal mask airway (ILMA) or direct laryngoscopy. Sixty adult patients, ASA physical status 1 or 2 with normal intra-ocular pressure were randomly allocated to one of the two techniques. Anaesthesia was induced with propofol followed by rocuronium. Tracheal intubation was performed using either the ILMA or Macintosh laryngoscope. Intra-ocular pressure, heart rate and blood pressure were measured immediately before and after tracheal intubation and then minutely for five minutes. In the laryngoscopy group there was a significant increase in intra-ocular pressure (from 7.2+/-1.4 to 16.8+/-5.3 mmHg, P<0.01), which did not return to pre-intubation levels within five minutes, and also in mean arterial pressure after tracheal intubation, which returned to baseline levels after five minutes. In the ILMA group there were no significant changes in intra-ocular pressure (from 7.6+/-1.8 to 10.4+/-2.8 mmHg, P >0.05) or mean arterial pressure after tracheal intubation. Time to successful intubation was longer with the ILMA, 56.8+/-7.8 seconds, compared with the laryngoscopy group, 33+/-3.6 seconds (P<0.01). Mucosal trauma was more frequent with the ILMA (eight of 30) compared with the laryngoscopy group (three of 30) (P<0.01). The postoperative complications were comparable. In terms of minimising increases in intra-ocular pressure and blood pressure, we conclude that the ILMA has an advantage over direct laryngoscopy for tracheal intubation.