Significant Change In Intraocular Pressure Research Articles

Effect of silicone oil versus gas tamponade on macular layer microstructure after pars plana vitrectomy for macula on rhegmatogenous retinal detachment

PurposeTo analyze structural changes in the macular retinal layers and sub-foveal choroidal thickness (SFCT) in eyes after macula-on rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy with either silicone oil (SO) or gas tamponade, and the effect of these changes on visual acuity.Patients and methodsRetrospective study which included 26 eyes in the SO Group and 32 in the Gas Group. Optical coherence tomography (OCT) scans of the affected eyes were obtained before surgery, and 3 months after PPV in the Gas Group, and during silicone oil in situ and 3 months after SO removal, in the SO Group. Qualitative assessment of photoreceptor layer and foveal contour, along with quantitative assessment of macular retinal thickness and SFCT was performed. Postoperative OCT macular microstructural changes were recorded and correlated to corrected distance visual acuity (CDVA). Intraocular pressure (IOP) was measured preoperative and at 3 months post operative.ResultsThere was a 2-line loss (from 20/28 preoperatively to 20/40 at final follow-up) of CDVA in the SO Group (p=0.051), while there was no statistically significant change in CDVA in the Gas Group (p=0.786). There was no significant correlation between CDVA loss and duration of silicon tamponade (r=-0.031, p=0.893). There was a statistically significant increase in IOP from its baseline to final follow-up of 0.7 mmHg in the SO Group (p=0.023) while there was no statistically significant change in IOP in the Gas Group. During silicone oil tamponade, there was approximately 11% and 5% of retinal and sub-foveal choroidal thinning respectively, which was moderately resolved following silicone oil removal. 20% (5/24) of eyes in the SO Group had qualitative flattening of foveal contour during SO tamponade that resolved after SO removal.ConclusionThinning of the macula was noticed after macula-on RRD repair with SO tamponade. Such thinning was only partially reversible after the removal of SO.

The Effect of Esophagogastroduodenoscopy on Intraocular Pressure.

Esophagogastroduodenoscopy (EGD) is an endoscopic examination of the upper gastrointestinal tract that requires insufflation with gas, leading to intra-abdominal hypertension (IAH). There is evidence suggesting that IAH positively correlates with intracranial pressure (ICP) and possibly with intraocular pressure (IOP). The aim of this study was to examine the effect of a routine screening EGD on the IOP. In this observational study, 25 patients were recruited; 15 males with a mean age of 50 ± 18 years and 10 females with a mean age of 45 ± 14 years. EGD was conducted under sedation in 21 subjects. Both eyes' IOP measurements were performed using Tonopen Avia in the sitting and left lateral decubitus positions before sedation and the start of EGD, and subsequently in the left lateral decubitus position when the endoscope reached the duodenum (D2) and at the end of the procedure. The final measurement was performed in the sitting position 10 min after the end of the procedure. The mean IOP in the sitting position was 15.16 ± 2.27 mmHg, and in the left lateral decubitus position, 15.68 ± 2.82 mmHg. When the gastroscope entered the D2, it was 21.84 ± 6.55 mmHg, at the end of the procedure, 15.80 ± 3.25 mmHg, and 10 min later, 13.12 ± 3.63 mmHg. There was a statistically significant IOP increase when the gastroscope entered the duodenum (p < 0.01). At the end of the gastroscopy, the IOP significantly decreased compared to the one registered when the gastroscope entered the D2 (p < 0.001) and it became similar to the values measured before the EGD, in the same left lateral decubitus position (p > 0.05). Significant changes in IOP were observed during the EGD. IOP fluctuations during EGD should be taken into account, especially in patients that need repeated EGDs during their life or in patients with glaucoma. Further studies are needed to better understand the short-effect and long-effect influence of an IOP increase in these patients.

Anterior segment parameters after trabeculectomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma.

The effects of trabeculectomy on anterior segment parameters have been widely investigated. However, the stabilization time for various glaucoma types after trabeculectomy remains debatable. We investigated the effect of mitomycin C-augmented trabeculectomy on ocular anterior segment parameters in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) during short-term follow-up using the Pentacam HR. In this retrospective observational study, consecutive patients diagnosed with medically uncontrolled POAG or PXG who underwent MMC-augmented trabeculectomy were recruited. All individuals underwent detailed ocular examinations. All trabeculectomies were performed by a single surgeon using the same technique. Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and central corneal thickness (CCT) were measured using the Pentacam HR, along with intraocular pressure (IOP) using a Goldmann applanation tonometer, pre-operatively and at 1-week, 1-month, and 3-month post-operative visits. We included 80 patients with a median (range) age of 58.0 (41.0-86.0) years having a nearly similar sex ratio. The study groups were matched according to sex and age (both P > 0.05). The group-by-time interaction was significant for CCT and ACV (both P < 0.05) but not for IOP, ACD, and ACA (all P > 0.05). The mean (standard deviation [SD]) IOP, ACD, and ACA were comparable between groups (all P > 0.05) during the 3-month period; however, they changed significantly over time in both groups (all P < 0.001). The mean CCT and ACV were comparable between groups at each time point (all P > 0.05), except at the 1-month post-operative visit, at which the mean (SD) ACV was significantly lower in the PXG group (P < 0.05). We found a comparable mean (SD) CCT between paired visits in each group (all P > 0.05), except for the mean (SD) CCT at 3 months, which was significantly lower than that at the 1-month post-operative visit in the PXG group (P < 0.05). We found a comparable mean (SD) ACV between paired visits in each group (all P > 0.05); however, it was significantly lower at the 1-month post-operative versus the baseline visit in both groups and resumed a significantly higher value at the 1-month versus the 1-week visit and at the 3-month versus the 1-month visit in the PXG group (all P < 0.05). We observed significant changes in IOP, ACD, and ACA over 3 months after post-augmented trabeculectomy in eyes with POAG and PXG; however, the majority of anterior segment parameters were comparable between the two groups. Further large-scale studies with longer follow-up periods should be conducted to verify the post-operative fluctuations in these parameters in POAG and PXG.

Influence of ketamine, propofol or isoflurane on intraocular pressure, heart rate and blood pressure in healthy dogs premedicated with medetomidine and midazolam.

According to the findings of several studies, sedatives and anaesthetics have different effects on the functioning of the cardiovascular system and intraocular pressure (IOP). For accurate diagnosis, treatment and surgery with minimal complications, it is necessary to be aware of the effects of sedatives and anaesthetics on the cardiovascular system and IOP. The aim of this study was to evaluate the effects of sedatives (medetomidine and midazolam) and anaesthetics (ketamine, propofol and isoflurane) on IOP, heart rate (HR) and blood pressure in dogs. In this study, 10 dogs participated in three treatments using a randomised cross-over design, with a 1-week washout period between each treatment. Dogs in all treatments were premedicated with medetomidine and midazolam. Anaesthesia was induced using ketamine, propofol, or isoflurane and maintained for 60 min with the appropriate doses of each drug. The cardiovascular variables (heart rate, and systolic, diastolic and mean arterial pressures) and IOP were measured at different timepoints: before premedication (baseline values, T-Bas), 15 min after medetomidine administration (T-Med), 20 min after midazolam administration (T-Mid) and at 15 (T-15), 30 (T-30), 45 (T-45) and 60 (T-60) min after anaesthesia induction. Medetomidine significantly reduced the IOP and HR and did not significantly change the mean arterial pressure (MAP). Midazolam significantly reduced the IOP while did not significantly change the HR and MAP. Ketamine and isoflurane significantly increased the IOP and HR while did not significantly change the MAP. Propofol significantly increased the HR, but did not cause significant changes in IOP and MAP. Considering that anaesthetics are typically administered in conjunction with pre-anaesthetic drugs, the increases in IOP induced by ketamine and isoflurane are not important, as the IOP did not exceed the baseline values. However, further studies are required to investigate these effects in patients with elevated IOP.

Choroidal Morphology and Systemic Circulation Changes During the Menstrual Cycle in Healthy Japanese Women.

Changes in systemic circulatory dynamics and choroidal thickness are poorly understood. This study aimed to investigate the time course of changes in choroidal morphology during normal menstrual cycles in healthy women using enhanced depth imaging optical coherence tomography (EDI-OCT). This prospective study included 15 left eyes of 15 healthy Japanese women (mean age, 20.2 ± 0.8 years) with a normal menstrual cycle. Using EDI-OCT, the subfoveal choroidal thickness (SCT) was manually measured during the late follicular and mid-luteal phases. Intraocular pressure (IOP), systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP), and heart rate (HR) were also evaluated during these phases. SBP, DBP, and MBP were significantly elevated in the mid-luteal phase. The average SCT was significantly decreased in the mid-luteal phase. In contrast, there were no significant changes in IOP or HR. These findings indicate that choroidal thickness decreases during the mid-luteal phase in healthy Japanese women with normal menstrual cycles depending on systemic circulatory dynamics. However, since the difference in the SCT values between the late follicular and the mid-luteal phase is not large (7 μm), the menstrual cycle may have little influence on the interpretation of choroidal thickness data in clinical practice.

Intravitreal allogeneic mesenchymal stem cells: a non-randomized phase II clinical trial for acute non-arteritic optic neuropathy

BackgroundAn effective treatment for acute non-arteritic ischemic optic neuropathy (NA-AION) has not been known or proven yet. Previous studies have suggested a neuroprotective effect of allogeneic bone marrow-derived mesenchymal stem cells. This study aims to report the results of a clinical trial on patients with acute non-arteritic optic neuropathy (NA-AION) treated with an intravitreal injection of allogeneic bone marrow-derived mesenchymal stem cells (BM-MSCs) (MSV®).MethodsWe conducted a prospective, non-randomized, clinical phase-II study (Eudra CT number 2016-003029-40; ClinicalTrials.gov Registry NCT03173638) that included 5 patients with acute unilateral NA-AION diagnosed within 2 weeks after symptom onset and who received an intravitreal injection of allogeneic BM-MSCs (0.05 ml; cell concentration: 1.5 × 106cells/mL). The patients underwent regular ophthalmological examinations and were followed for one year.ResultsIn this trial, allogeneic BM-MSCs appeared to be safe as no patients developed signs of acute nor chronic intraocular inflammation or a significant change in intraocular pressure, although an epiretinal membrane was developed in one patient. A retrolental aggregate formed shortly after the injection spontaneously disappeared within a few weeks in another phakic patient, leaving a subcapsular cataract. Visual improvement was noted in 4 patients, and amplitudes of P100 on the visually evoked potentials recordings increased in three patients. The retinal nerve fiber layer and macular ganglion cell layer thicknesses significantly decreased during the follow-up.ConclusionsBesides the development of an epiretinal membrane in one patient, the intravitreal application of allogeneic BM-MSCs appeared to be intraocularly well tolerated. Consequently, not only NA-AION but also BM-MSCs deserve more clinical investigational resources and a larger randomized multicenter trial that would provide stronger evidence both about safety and the potential therapeutic efficacy of intravitreally injected allogeneic BM-MSCs in acute NA-AION.Trial registration: Safety Assessment of Intravitreal Mesenchymal Stem Cells for Acute Non-Arteritic Anterior Ischemic Optic Neuropathy (NEUROSTEM). NCT03173638. Registered June 02, 2017 https://clinicaltrials.gov/ct2/show/NCT03173638.

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.

Effect of Scleral Contact Lens Size and Duration of Wear on Intraocular Pressure.

To evaluate the effects of scleral lens size and the duration of wear on intraocular pressure (IOP) during lens wear. Healthy adults were recruited for this prospective and randomized study. Intraocular pressure measurements were performed using a pneumotonometer. A block randomization was used to assign the order of scleral lens diameter of either 15.6 mm or 18.0 mm for 5-hr bilateral wear over a course of two visits. Scleral IOP (sIOP) was measured during the predetermined intervals, 1.25 hr apart, during the 5-hr scleral lens wear. Corneal IOP (cIOP) was measured before and after the scleral lens wear. The primary outcome measure was the mean change in sIOP from prelens insertion baseline. Corneal IOP unchanged after scleral lens removal compared with the baseline measurements ( P =0.878). Smaller and larger lenses introduced significantly higher sIOP at 2.5 hr after lens insertion with the mean (95% CI) increase of 1.16 (0.54, 1.78) mm Hg and 1.37 (0.76, 1.99) mm Hg, respectively. There was no difference in IOP change between the smaller and larger diameter lenses ( P =0.590). Well-fitted scleral lenses do not result in clinically significant changes in intraocular pressure during 5-hr lens wear in young and healthy individuals.

Intraocular Pressure Changes after Neodymium Doped: Yttrium-Aluminum-Garnet (Nd: Yag) Laser Capsulotomy

Purpose: To assess the difference in intraocular pressure before and after Nd-YAG laser posterior capsulotomy. Study Design: Quasi-experimental study. Place and Duration of Study: Layton Rahmatulla Benevolent Trust Eye Hospital, Karachi, from July 2021 to October 2021. Methods: Patients of both gender with posterior capsular opacification (PCO) after cataract surgery, were included. Age ranged between 40 and 60 years. Patients with less than 6 months of surgery were excluded. Patients with posterior segment pathology like glaucoma, uveitis, high myopia, diabetic retinopathy, macular pathology, and hereditary fundus dystrophies were excluded from the study. After detailed history, complete ocular examination was performed. After pupil dilatation, YAG laser capsulotomy was done.IOP was measured with Goldmann Applanation Tonometer after instilling a topical anesthetic agent. Post-YAG, IOP was again measured at 1 hour and on day 1. Data was analyzed using SPSS version 25. Paired T-tests were used to assess the significance of any change in IOP. Results: Ninety eyes of 90 patients were inducted into the study in which 51 (57%) were male and 39 (43%) were female. The age varied from 40 to 60 years (mean 52.3 ± 10.25 years). There was no statistically significant difference between pre-YAG and post-YAG IOP. Similarly, no difference in IOP was found depending upon the age of the patients. No significant change was observed after 1 hour and 1 day in both groups with P &gt; 0.05. Conclusion: This showed no significant change in intraocular pressure at one hour and one day, after Nd-YAG laser posterior capsulotomy.

Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia.

The COVID-19 pandemic brought the world to a standstill in 2020. Many countries have imposed lockdowns, known as the movement-control order (MCO) in Malaysia, to prevent transmission of the disease. The objective of this study is to evaluate the impact of the MCO on the management of glaucoma patients in a suburban tertiary hospital. We conducted a cross-sectional study of 194 glaucoma patients between June 2020 and August 2020 in the glaucoma clinic at Hospital Universiti Sains Malaysia. We evaluated the patients' treatment, visual acuity, intraocular pressure (IOP) measurements, and potential signs of progression. We compared the results with those of their last clinic visits prior to the MCO. We studied 94 (48.5%) male and 100 (51.5%) female glaucoma patients with a mean age of 65 ± 13.7. The mean duration between pre-MCO and post-MCO follow-up was 26.4 ± 6.7 weeks. There was a significant increase in the number of patients with deterioration of visual acuity, and one patient lost his vision after the MCO. There was also a significant elevation of the mean IOP of the right eye: pre-MCO, 16.7 ± 7.8 mmHg, compared to post-MCO, 17.7 ± 8.8 mmHg (p = 0.027). The cup-to-disc ratio (CDR) for the right eye increased significantly from pre-MCO, 0.72 ± 0.18, to 0.74 ± 0.19 post-MCO (p < 0.001). However, there were no significant changes in IOP or CDR in the left eye. Twenty-four patients (12.4%) missed medications during the MCO period, and 35 patients (18%) required additional topical medications due to the progression of the disease. Only one patient (0.5%) required admission due to uncontrolled IOP. Lockdown, as a preventive step in the COVID-19 pandemic, indirectly caused the progression of glaucoma and uncontrolled IOP.

A Cross-sectional Observational Study to Assess the Influence of 1% Cyclopentolate and 1% Tropicamide on Intraocular Pressure in Children Undergoing Cycloplegic Refraction at a Tertiary Care Hospital in Southern India

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value ≤0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p≤0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve.

Changes to Outflow Structures After Pilocarpine in Primary Open Angle Glaucoma Compared With Healthy Individuals Using Optical Coherence Tomography.

Lower response of aqueous outflow pathway structures after pilocarpine could be observed in primary open angle glaucoma (POAG) patients, which is likely to be helpful for understanding intraocular pressure (IOP) evaluation in glaucoma. To evaluate the morphologic changes in the trabecular meshwork (TM), Schlemm canal (SC), scleral spur (SS), and ciliary muscle after miosis in patients with POAG and healthy individuals. A total of 30 patients with POAG and 26 healthy controls were recruited. All participants underwent complete ophthalmologic examinations, including IOP and swept-source optical coherence tomography (OCT), before and 1 hour after the local administration of pilocarpine (2%). OCT measurements included TM thickness and width, SC diameter and area, SS length, ciliary muscle thickness, and ciliary muscle angle (CMA). Pilocarpine administration induced a decline in IOP (15.6±2.3-14.6±2.2mmHg), decrease in nasal SS length (196.31±47.75-171.52±33.93μm), decrease in TM thickness (90.18±16.43-83.02±13.74μm), and increase in SC diameter (134.84±32.28-162.08±48.67μm) and SC area (3851.37±1455.07-4801.39±1762.37μm 2 ) among healthy controls. In contrast, no significant changes in IOP and OCT measurements were found in patients with POAG. At baseline, CMA was independently correlated with IOP in normal eyes. After miosis, the change in TM thickness was independently correlated with changes in IOP in normal eyes; in eyes with POAG, changes in SS length and CMA were independently associated with changes in IOP. Topical pilocarpine-induced morphologic changes to outflow pathway structures in healthy individuals without significant changes in POAG. The lower response observed in patients with glaucoma may be relevant to understanding IOP changes.

Discomfort During Instillation Of Antihypertensives And Ocular Surface Condition In Glaucoma Patients

Background — An increase in the frequency of manifestations of dry eye syndrome (DES), against the background of hypotensive therapy, leads to a decrease in treatment adherence. After reformulation in the composition of a preservative-free preparation of a carbonic anhydrase inhibitor (CAI) (sodium benzoate was added), patient complaints of burning sensation during instillation became more frequent, which was the reason for our study. Objective — To evaluate the effect of sodium benzoate on the course of DES during local hypotensive therapy of glaucoma. Methods and Results — Group 1 consisted of 21 eyes with glaucoma receiving hypotensive therapy, Group 2 (20 eyes) included patients with suspected glaucoma not receiving therapy. Patients underwent standard diagnostic methods and examination of the ocular surface condition: tear break-up time test sensu Norn, Schirmer test, vital staining with lissamine green, and a survey based on the Ocular Surface Disease Index (OSDI) questionnaire. When a preservative-free CAI in combination therapy was replaced with the CAI containing sodium benzoate, no statistically significant change in IOP occurred after four weeks of treatment (p&gt; 0.05). In both groups, the indicators characterizing the ocular surface condition did not change statistically significantly over the observation period. Conclusion — Replacement of preservative-free CAI in combination therapy of glaucoma with CAI with sodium benzoate does not lead to statistically significant changes in intraocular pressure. The ocular surface condition does not change statistically significantly over a month of observation. Instillation discomfort is not related to the pH of the preparation.

The Effect of Specific Techniques of Nasal Breathing [Pranayama] on Intra-Ocular Pressure in Normal Individuals, a Randomized Trial.

Glaucoma is an optic neuropathy where intraocular pressure is the only modifiable risk factor. Yoga is thought to adversely affect intra-ocular pressure (IOP) but we do not know if yogic breathing exercises can influence IOP. With this study, we aimed to determine the effect of specific nasal breathing techniques on intra-ocular pressure in normal individuals. One hundred and sixty-four normal subjects were randomly assigned to one of four specific breathing groups - right nostril breathing (RNB), left nostril breathing (LNB), alternate nostril breathing (ANB), normal breathing (NB). The IOP was measured in both eyes at baseline and following the breathing exercise; and the change was analyzed. Eighty-five women and 79 men participated and there was no significant difference in baseline age or IOP between the groups. In RNB, IOP reduced significantly in both right and left eyes, from 14.3 ± 3.0mmHg to 13.9 ± 2.6mmHg, (p=0.022) and from 14.7 ± 3.2mmHg to 14.2 ± 3mmHg (p=0.016) respectively. In LNB, there was no significant IOP change in the right eye, whereas in the left eye, there was a significant reduction from 14.2 ± 2.7mmHg to 13.3 ± 2.5mmHg (p< 0.0001). There was no significant IOP change in ANB and NB. Specific breathing techniques like right and left nostril breathing, alternate nostril breathing are safe and do not raise IOP in normal subjects. Additionally, right and left nostril breathing techniques have a beneficial effect of lowering IOP.

Selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma

AbstractPurpose: To describe the results of selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma.Methods: a retrospective case series of 8 eyes of 8 patients with history of non‐penetrating injury to the eye resulted in angle recession glaucoma. All eyes underwent SLT. Post‐treatment, the best‐corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications, additional need for intervention, and complications were recorded. Success of treatment was defined as an IOP reduction of 20% or reduction in medications and maintaining target IOP without further intervention during follow up period of more than 3 months.Results: Mean patient age was 44 years, 6 males and 2 females. Mean pre‐ and post‐SLT IOP were 20.31 ± 3.59 and 15.04 ± 3.13 mmHg, respectively. IOP decreased significantly in all follow‐up visits. SLT treatment resulted in decreased IOP by 21% in 2 patients and by 25% with reduced medication burden in 4 patients and reduced medication burden in 2 patients who stopped glaucoma medication with no significant change in IOP (from 10 to 14 mmHg) at last follow up visit at 45 months.Conclusions: SLT is a safe procedure that cloud be a reasonable alternative management in angle recession glaucoma when patients are unwilling to try medical or surgical intervention.

Comparison of the Effect of Bromfenac versus Betamethasone Ophthalmic Solutions in Patients with Diabetic Macular Edema

Purpose To examine the effect of 0.1% bromfenac (BF) ophthalmic solution and 0.1% betamethasone (BM) ophthalmic solution on diabetic macular edema (DME). Methods This was a prospective trial. Nineteen patients (mean age of 66.6 ± 10.1 years) with DME and mean retinal thickness within a diameter of 1 mm from the fovea (central subfield thickness: CST) of 250–500 µm were randomized and instilled with BF or BM. CST, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were measured at 4, 8, and 12 weeks after administration. Results CST at baseline (p = .128) and that at 4, 8, and 12 weeks of administration was not significantly different between the BF (10 patients) and BM groups (9 patients). In patients with glycated hemoglobin (HbA1c) <8.0%, CST, compared with baseline, was significantly decreased in the BF group (seven patients) at 8 (p = .025) and 12 weeks (p = .043) of administration. When compared with the baseline, no significant changes in BCVA were observed at any point in time in either group. Baseline IOP was comparable between the groups. In the BM group, the values of change in IOP from baseline significantly increased at 8 (p = .025) and 12 weeks (p = .044) of administration, with no significant changes in IOP over the 12 weeks of administration in the BF group. Conclusions BF did not affect IOP even after 12 weeks of administration, suggesting its effect in reducing CST in DME with good glycemic control. Trial registration University Hospital Medical Information Network (UMIN-CTR); UMIN000026201, February 18, 2017; Japan Registry of Clinical Trials; jRCTs031180308, March 15, 2019

Real-World Efficacy and Safety of Tafluprost in Primary Open-Angle Glaucoma Patients with Corneal Disorders: A Taiwan Experience.

To investigate the efficacy and safety of switching to 0.0015% tafluprost ophthalmic solution with reduced benzalkonium chloride (BAK) on primary open-angle glaucoma (POAG) patients with corneal disorders under 0.005% latanoprost treatment. Material and Methods. This was a single-arm, open-label, switching study on adult POAG patients treated with latanoprost 0.005% for more than 3 months, with corneal disorders but no dry eye therapy. All patients were switched to tafluprost 0.0015% and followed up for 3 months. The primary outcome was the change in fluorescein staining score (National Eye Institute/Industry [NEI] score) at the end of the study. Secondary outcomes included changes in intraocular pressure (IOP), tear break-up time (TBUT), hyperemia score, and other ocular and nonocular adverse events. Of the 20 patients initially enrolled, 17 patients, all with POAG, completed the study. At the end of the study, the mean NEI score significantly decreased by 1.8 ± 2.2 (p < 0.01). No significant changes in IOP were observed (12.8 ± 4.6 mmHg at baseline vs. 12.3 ± 4.0 mmHg on visit 2; p=0.470). TBUT increased by 1.2 ± 1.7 seconds (p < 0.05). The proportions of patients with no sign of hyperemia on the bulbar and palpebral conjunctiva increased from 58.5% to 64.7% at baseline (before switching to tafluprost treatment) to 94.1% and 94.1%, respectively, after switching to tafluprost treatment. Dry eye sensation scores were significantly reduced (p < 0.05), while other ocular symptom scores did not change significantly. Switching to tafluprost 0.0015% significantly improved fluorescein staining score, TBUT, and conjunctival hyperemia while maintaining IOP control among POAG patients with corneal disorders.

Effect of corneal cross linkage (CXL) on intraocular pressure (IOP) measurements in keratoconus patients

This study aims to determine the effect of corneal cross-linkage (CXL) on intraocular pressure (IOP) in keratoconus patients. Methods: A quasi-experimental study was carried out at the Cornea Clinic of Al Ibrahim Eye Hospital Malir, Karachi. A total of 60 eyes of 36 subjects with progressive keratoconus with the age range of 15 to 31 years were fulfilling the criteria of the study. Subjects were selected with convenient sampling and subjects with a previous history of CXL were excluded from the study. A complete history of the patient, clinical examination with slit-lamp biomicroscopy, and visual acuity (VA) with Snellen chart were recorded. Intraocular pressure (IOP) measurements of each subject were recorded with Goldman Applanation Tonometer (GAT) before and immediately after 15 minutes of CXL and on the 2nd day of CXL, 1month, and 3 months after CXL. SPSS version 22 was used to analyze the data. Results: The average preoperative measured intraocular pressure (IOP) was 20.22 +/- 3.97 mmHg. There was a statistically significant decrease in IOP measurements 18.96 +/- 3.73 mmHg on the same day after the corneal cross linkage procedure with (P 0.001) while there was no statistically significant change in intraocular pressure (IOP) measurements was observed on the 2nd day, 1 month and 3 months after CXL. The postoperative mean of IOP measurements was 19.61 +/- 3.47 mmHg on the 2nd day, 19.67 +/- 3.14 mmHg on 1 month, and 19.33 +/- 3.64 mmHg at 3 months respectively. Conclusion: This study shows that reductions in intraocular pressure (IOP) measurements were observed on the immediate response of corneal cross-linkage (CXL) on the same day. This change might be due to immediate alteration in the biomechanics of the cornea during corneal cross-linkage. These changes return to the normal position later because no change was seen on different follow-ups of patients after CXL in eyes with keratoconus.

Retinal ultrastructural, electrophysiological, and microvascular morphological outcomes in diabetic macular edema treated with intravitreal bevacizumab.

Investigation of retinal ultrastructural, electrophysiological, and microvascular morphological changes, as well as correlations between these changes and visual outcome in naïve diabetic macular edema (DME) patients after intravitreal bevacizumab therapy (IVBT). This prospective interventional study enrolled 31 DME patients' eyes treated with monthly IVBT for three months. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and fundus fluorescein angiography, optical coherence tomography (OCT), microperimetry, as well as optical coherence tomography angiography (OCTA) were performed before and after IVBT. Patients were grouped based on BCVA improvement after three consecutive IVBT: group 1: > 10 letters, group 2: ≤ 5 letters, and group 3: between 6 and 10 letters. Mean BCVA increased significantly from 34.2 to 39.9 letters (p < 0.001). Central macular thickness decreased significantly from 335.1 to 276.4μm (p < 0.001). Fixation stability, retinal sensitivity, and local deficit all improved significantly (p < 0.001 for all). There was no statistically significant change in IOP (p = 0.665). Although OCTA parameters did not change significantly, lower foveal avascular zone (FAZ) area, higher foveal vessel density 300μm area around FAZ and deep plexus vascular density were associated with highly improved BCVA, retinal sensitivity, and local deficit. Also, there were no significant intergroup differences in gender, age, baseline BCVA, HbA1c, IOP, phakic/pseudophakic lens ratio, concomitant hypertension, and superficial capillary plexus vascular density. IVBT was associated with significantly improved BCVA, retinal ultrastructural integrity, and electrophysiological patterns in naive DME patients. Improvements in retinal electrophysiology correlated with ultrastructural improvements, which could be predicted using OCTA.

Long-Term Intraocular Pressure-Lowering Effects and Adverse Events of Ripasudil in Patients with Glaucoma or Ocular Hypertension over 24Months.

IntroductionGlaucoma is a leading cause of irreversible blindness and ripasudil was the first Rho kinase inhibitor approved as antiglaucoma medication. Here we present the final analysis of the ROCK-J study, a large-scale post-marketing surveillance study to evaluate the long-term safety and effectiveness of ripasudil in Japanese patients with glaucoma or ocular hypertension in a real-word clinical setting.MethodsROCK-J was a 24-month, prospective, open-label, observational study that included ripasudil-naïve patients with glaucoma or ocular hypertension who were initiating treatment with ripasudil according to the Japanese approved indication between June 1, 2015 and April 30, 2017. The primary safety endpoint was the incidence of adverse drug reactions (ADRs) (including blepharitis, plus assessment of its background factors); the primary efficacy endpoint was change in intraocular pressure (IOP) from baseline to 24 months.ResultsA total of 3374 Japanese patients with glaucoma or ocular hypertension were evaluated for safety and 3178 for effectiveness of ripasudil over a mean 524.5-day observational period. Overall, 853 (25.3%) patients experienced adverse drug reactions; the most common were blepharitis (8.6%), conjunctival hyperemia (8.5%), and conjunctivitis (6.3%). Multivariate analyses demonstrated that patients were more likely to experience the ADR blepharitis with ripasudil treatment if they were female (hazard ratio [HR] 1.307; p = 0.040), had comorbid or a previous history of blepharitis (HR 2.178; p = 0.001), or had a history of allergy to pollen (HR 1.645; p = 0.003) or medication (HR 2.276; p < 0.001). IOP decreased significantly from baseline with ripasudil; the least-squares mean ± standard error change in IOP from baseline to 24 months was − 2.6 ± 0.1 mmHg (p < 0.001). Significant IOP changes were seen in four types of glaucoma, namely primary open-angle glaucoma, normal-tension glaucoma, primary angle-closure glaucoma, and secondary glaucoma, and ocular hypertension.ConclusionRipasudil was safe and effective as an antiglaucoma medication with no new safety signals identified and significant reductions in IOP maintained over 24 months of treatment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-02023-y.