Significant Intraocular Pressure Elevation Research Articles

Intraocular Pressure After Intravitreal Injection of Triamcinolone Acetonide Following Vitrectomy for Macular Edema

To evaluate long-term intraocular pressure (IOP) response after intravitreal injections of different doses of triamcinolone acetonide (TA) upon completion of pars plana vitrectomy (PPV) for macular edema secondary to diabetic retinopathy or retinal vein occlusion. Retrospective, consecutive, comparative, interventional case series. Twenty-seven eyes of 25 consecutive patients with macular edema associated with diabetic retinopathy (n=18) or retinal vein occlusion (n=9), who underwent PPV for the treatment of macular edema between January 2003 and December 2003, were included. Upon completion of vitrectomy, different doses of TA were injected into the vitreous cavity: 14 eyes with 5 mg of TA (group 1) and 13 eyes with 10 mg of TA (group 2). The main outcome measure was IOP. All patients were followed up for at least 12 months. Preoperative IOP was 12.6+/-2.6 mm Hg (mean+/-standard deviation) in group 1 and 13.2+/-2.1 mm Hg in group 2. Postoperatively, IOP increased to a mean maximum of 20.6+/-5.5 mm Hg in group 1 and 31.5+/-3.5 mm Hg in group 2 (P<0.01 for both groups). The difference between groups was also significant (P<0.05). Five of 14 eyes (36%) in group 1 and 10 of 13 eyes (77%) in group 2 had an elevation of IOP exceeding 21 mm Hg (P=0.03). The median interval from surgery to reach maximal IOP was 7 days in both groups. The significant IOP elevation lasted for 3 months in group 1 and 6 months in group 2. After injecting of TA into the vitreous cavity upon completion of PPV for macular edema, a dose-dependent IOP elevation was observed, starting from early postoperative days and returning to normal values after several months. These results show that intravitreal TA injection in the vitrectomized eyes might have different IOP changes from in the nonvitrectomized eyes.

The Effect of Swimming Goggles on Intraocular Pressure and Blood Flow within the Optic Nerve Head

PurposeGoggles are frequently worn in the sport of swimming and are designed to form a seal around the periorbital tissue orbit. The resultant pressure on the eye may have the potential to affect intraocular pressure and blood flow of the optic nerve head. This study evaluates the influence of wearing swimming goggles on intraocular pressure (IOP) and blood flow of the ocular nerve head (ONH) in normal subjects.Materials and MethodsThirty healthy participants took part in this study. The IOP of each participant was measured using a Goldmann tonometer. Measurements were taken immediately before putting on swimming goggles, at 5, 10, 30, and 60 minutes after putting on swimming goggles, and then immediately after taking off the goggles. Blood flow of the ONH was measured using the Heidelberg retinal flowmeter.ResultsThe average IOP before, during and after wearing the swimming goggles were 11.88 ± 2.82 mmHg, 14.20 ± 2.81mmHg and 11.78 ± 2.89 mmHg, respectively. The IOP increased immediately after putting on the goggles (p < 0.05) and then returned to normal values immediately after removal (p > 0.05). Blood flow of the ONH was 336.60 ± 89.07 Arbitrary Units (AU) before and 319.18 ± 96.02 AU after the goggles were worn (p < 0.05).ConclusionA small but significant IOP elevation was observed immediately after the swimming goggles were put on. This elevated IOP was maintained while the goggles were kept on, and then returned to normal levels as soon as they were taken off. Blood flow of the ONH did not change significantly throughout the experiment. These facts should be considered for safety concerns, especially in advanced glaucoma patients.

Effects of mydriatics on intraocular pressure and pupil size in the normal feline eye

To determine the effect of various mydriatics (1% atropine, 1% cyclopentolate, 0.5% tropicamide, 10% phenylephrine) on intraocular pressure (IOP) and pupil size (PS) in normal cats. The mydriatics were tested in 10 adult ophthalmoscopically normal European Domestic Short-haired cats. Procedure Single-dose drug studies were divided into placebo (vehicle of phenylephrine), 10% phenylephrine, 0.5% tropicamide, 1% cyclopentolate and 1% atropine. After measurement of IOP and pupil size (PS) at 8 a.m. on the first day, one drop of the tested drug was applied to one randomly selected eye. The IOP and PS were measured for a minimum of 36 h until the pupil returned to pretest size. Ten per cent phenylephrine had no significant effect on IOP, and the effect on the pupil size was minimal (<or= 1 mm difference). One per cent atropine showed a maximal mean difference of 4.3 mmHg +/- 4.1 mmHg in IOP compared to the untreated eye. These differences were statistically significant at 1, 3, 6, 12 and 16 h post-treatment. At 1, 1.5 and 2 h after unilateral application of 1% cyclopentolate, the IOP in the treated eye was significantly higher than the IOP in the untreated eye with a maximal mean difference of 4.1 mmHg +/- 4.5 mmHg. With 0.5% tropicamide, IOP of the treated eye was significantly higher than IOP of the untreated eye at 1 and 1.5 h after treatment with a maximal mean difference of 3.5 mmHg +/- 3.3 mmHg. One per cent atropine caused the greatest increase in IOP, followed by 1% cyclopentolate and 0.5% tropicamide. The dilating effect of atropine, cyclopentolate and tropicamide lasted longer than the effect on intraocular pressure. The parasympatholytics 1% atropine, 1% cyclopentolate and 0.5% tropicamide caused a statistically significant elevation of IOP and produced mydriasis in the treated eye in normal cats, while the sympathomimetic 10% phenylephrine had no significant effect on IOP or pupil size.

Lidocaine vs. mepivacaine for peribulbar anaesthesia in cataract surgery

Lidocaine vs. mepivacaine for peribulbar anaesthesia in cataract surgery

Short-term Course of Intraocular Pressure after Intravitreal Injection of Triamcinolone Acetonide

To describe the natural history of intraocular pressure (IOP) within the first 30 minutes after intravitreal injection of triamcinolone acetonide (TA). Prospective, interventional, consecutive case series. Thirty-eight consecutive patients who met inclusion and exclusion criteria and underwent intravitreal injection of 0.1 ml (4 mg) of TA were studied. Intraocular pressure was measured by Goldmann applanation tonometry at baseline; immediately after injection; and at 2, 5, 10, 20, and 30 minutes after injection. Intraocular pressure measurements at baseline; immediately after intravitreal injection; and 2, 5, 10, 20, and 30 minutes after injection, and percentage of patients with IOP < or = 24 mmHg at 30 minutes. Patients who did not experience vitreous reflux (30/38 [78.9%]) at the site of injection had a significant initial elevation of IOP that rapidly normalized. Patients who experienced vitreous reflux (8/38 [21.1%]) at the site of injection had either no change in IOP or a small drop in IOP that rapidly normalized. The IOP measured in millimeters of mercury immediately after injection (45.9 [no reflux], 12.6 [reflux]), 2 minutes after injection (39.9 [no reflux], 13.5 [reflux]), 5 minutes after injection (33.3 [no reflux], 13.8 [reflux]), 10 minutes after injection (26.4 [no reflux], 15.1 [reflux]), and 20 minutes after injection (21.8 [no reflux], 15.0 [reflux]) showed a statistically significant difference between the 2 groups. The difference in IOP between the 2 groups was not significant at baseline or 30 minutes after injection. At 30 minutes, 90% (95% confidence interval, 85.8%-95.2%) of patients without vitreous reflux had an IOP < 24 mmHg. Patients undergoing intravitreal injection of TA with no vitreous reflux have a risk of short-term elevation of IOP that rapidly normalizes over 30 minutes. In patients with vitreous reflux after the injection, the IOP declines immediately after injection and rapidly normalizes over 10 minutes.

Safety and Efficacy of Intravitreal Bevacizumab Followed by Pegaptanib Maintenance as a Treatment Regimen for Age-Related Macular Degeneration

Vascular endothelial growth factor (VEGF)-A, both necessary and sufficient in promoting ocular neovascularization, is an attractive therapeutic target. Combining nonselective and selective VEGF blockade may provide clinical benefit with minimal risks in the treatment of neovascular age-related macular degeneration (AMD). Twenty patients with all subtypes of neovascular AMD and a broad range of baseline vision were treated with intravitreal bevacizumab followed by pegaptanib sodium for 54 weeks. Visual acuity measurements, biomicroscopy, funduscopy, fluorescein angiography, optical coherence tomography, and adverse event assessments were performed. Mean visual acuity improved from approximately 20/200 at baseline to 20/80. All patients experienced an improvement in retinal thickness, ranging from -47 to -297 microns. Adverse events were limited to transient irritation or redness. No significant elevation in intraocular pressure occurred following either bevacizumab or pegaptanib injections. Nonselective VEGF blockade with bevacizumab induction and selective VEGF165 blockade with pegaptanib as maintenance therapies may offer clinically meaningful outcomes with acceptable safety profiles in patients with AMD.

Triamcinolone-Induced Intraocular Pressure Elevation: Intravitreal Injection for Macular Edema and Posterior Subtenon Injection for Uveitis

PurposeTo assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP).Methodswe reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed.ResultsThe IOP increased significantly (p<0.001) from 16.3±2.5 mmHg preoperatively to a mean maximum of 21.7±5.3 mmHg in the IVTA group, and from 15.3±4.5 mmHg to 20.6±3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline IOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks.ConclusionsBoth developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.

Mouse model of sustained elevation in intraocular pressure produced by episcleral vein occlusion

We have developed an inducible mouse model of glaucoma based on episcleral vein cauterization (EVC). Intraocular pressure (IOP) elevation in adult mice was produced by cauterizing three episcleral veins. Serial IOP measurements were done by induction-impact tonometry. IOP was significantly elevated by 104±20% in 20 out of 23 mice (87%) within the first day after EVC, and remained elevated for 4 weeks, with mean IOP 94% higher in EVC-treated vs. contralateral control eyes. Aqueous outflow blockade was verified from the IOP response to pulsed fluid infusions into the anterior chamber. Retinal ganglion cell (RGC) loss, determined by retrograde labelling using Fluoro-Gold applied to the superior colliculous, was ∼20% at 2 weeks after EVC. We conclude that episcleral vein occlusion in mice produces significant and sustained elevation in IOP associated with increased outflow resistance and RGC loss, and thus may be useful to model glaucoma in genetically modified and drug-treated mice.

Effects of diazepam, ketamine, and their combination on intraocular pressure in normal dogs

Ketamine has been implicated as causing increases in intraocular pressure. The purpose of this study is to document the effects of ketamine, diazepam, and their combination on intraocular pressure (IOP) in normal, unpremedicated dogs. Random-source dogs were assigned to one of five groups of 10 dogs each: ketamine 5 mg kg–1 (KET5), ketamine 10 mg kg–1 (KET10), diazepam 0.5 mg kg–1 (VAL), ketamine 10 mg kg–1 with diazepam 0.5 mg kg–1 (KETVAL), saline 0.1 mL kg–1 (SAL), all given intravenously. A baseline IOP was measured before injection, immediately after injection, and at 5, 10, 15, and 20 minutes following injection. IOP was increased over baseline immediately after injection in the KET5, KET10, and KETVAL groups; at 5, 10, and 15 minutes in the KET5 group; and at 20 minutes in the KETVAL group. The mean IOP change compared to SAL increased immediately after injection and at 5 minutes in the KET5, KET10, and KETVAL groups; at 10 and 15 minutes in the KET5 group, and at 20 minutes in the KETVAL group. The mean IOP increased up to 5.7, 3.2, and 3.1 mm Hg over mean baseline in the KET5, KET10, and KETVAL groups, respectively. All dogs in the KET5 group and the majority in the KETVAL and KET10 groups had an increase in their IOP over baseline. Ketamine caused a clinically and statistically significant elevation in IOP over baseline and compared to SAL. The concurrent addition of diazepam did not blunt this increase. Ketamine should be avoided in dogs with corneal trauma, glaucoma, or in those undergoing intraocular surgery.

Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

This study investigated firstly the change of intraocular pressure (IOP) after injection of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema and secondly the factors that influence these changes. A prospective, non-comparative study was performed in 60 patients at Kangnam Sacred Heart Hospital from October 2003 to September 2004. All the patients received 4-mg IVTA injection. Mean IOP was elevated from the day after injection and peaked at 20.5 mmHg after 2 months (p=0.000). Twenty-six eyes (43.3%) showed significant IOP elevation. IOP was not controlled despite full glaucoma medication in 7 (11.7%) eyes. Two eyes underwent filtering surgery. Younger age was a statistically significant predictive factor for IOP elevation (p=0.009). In this study, patients who needed filtering surgery developed an IOP spike within one week after the injection. Therefore, clinicians should consider checking IOP at the end of the first week. Furthermore, greater cautions is mandatory with relatively younger patients.

Ibopamine provocative test and glaucoma: Consideration of factors that may influence the examination

Purpose. To evaluate factors that may influence the ibopamine provocative test for the diagnosis of glaucoma. Methods. Two Ibopamine (3,4 di-isobutyrylester of N-methyldopamine) 2% eyedrops were instilled 5 minutes apart in one eye selected at random in both glaucoma and normal subjects. The intraocular pressure (IOP) was assessed prior to the drops and 30, 60 and 180 minutes after instillation. The test was considered positive when there was an IOP increase of greater than 4 mmHg at any one of the timepoints. The amount of IOP change was compared to the severity of glaucomatous visual field loss and to the types of medical treatment. Results. The sensitivity (glaucoma patients with a positive result) and specificity (normal individuals with a negative result) of the Ibopamine test was 87 and 95%, respectively. Glaucoma patients using prostaglandin analogues did not have a significant IOP elevation. Conclusion. The Ibopamine provocative test may be an auxiliary test in glaucoma diagnosis. Concurrent use of prostaglandin analogues reduces the test’s sensitivity.

Total Retinal Nitric Oxide Production is Increased in Intraocular Pressure-elevated Rats

Nitric oxide (NO) is a well-known vaso-dilator but its regulation in the retina is unclear. This study was conducted to quantify total NO production and retinal ganglion cell (RGC) loss in an experimental glaucoma model. Three quarters of the peri-limbal/episcleral drainage vessels and anterior angle (right eyes) of Sprague-Dawley rats were thermally blocked using laser irradiation, while the left eyes served as controls. We measured the intraocular pressure (IOP) of both eyes using a digital tonometer (Tonopen) 21, 28 and 35 days after the laser treatment. After 35 days, we determined the total NO level in retinas and remaining ocular tissues for the laser-treated and control eyes using a spectro-photometric assay. The viable RGC numbers were also determined by counting the cell bodies stained retrogradely by fluoro-gold. The laser treatment significantly increased the IOP 2.0-2.6x throughout the whole periodof measurements (P<0.0001). The mean total RGC number decreased significantly from 98725+/-5383 (+/-S.E. (M.)) to 69276+/-5592, or 29.8% reduction, in the laser-treated eyes after 35 days (P=0.008). The mean total NO level in the laser-treated retina was significantly increased by 2.4x compared with controls (P=0.016), but no significant difference was found in the eyecups (P>0.05). Laser treatment resulted in significant IOP elevation and RGC loss, suggesting that thermal coagulation of the perilimbal region may provide an alternate protocol for glaucoma study. NO level was increased by two-fold in the retina but not in other ocular tissues. Since NO is capable of producing powerful peroxynitrite anions and hydroxyl radicals, elevated level of NO has a potential role in glaucoma.

Total Retinal Nitric Oxide Production is Increased in Intraocular Pressure-elevated Rats

Nitric oxide (NO) is a well-known vaso-dilator but its regulation in the retina is unclear. This study was conducted to quantify total NO production and retinal ganglion cell (RGC) loss in an experimental glaucoma model. Three quarters of the peri-limbal/episcleral drainage vessels and anterior angle (right eyes) of Sprague-Dawley rats were thermally blocked using laser irradiation, while the left eyes served as controls. We measured the intraocular pressure (IOP) of both eyes using a digital tonometer (Tonopen) 21, 28 and 35 days after the laser treatment. After 35 days, we determined the total NO level in retinas and remaining ocular tissues for the laser-treated and control eyes using a spectro-photometric assay. The viable RGC numbers were also determined by counting the cell bodies stained retrogradely by fluoro-gold. The laser treatment significantly increased the IOP 2.0–2.6× throughout the whole periodof measurements (P<0.0001). The mean total RGC number decreased significantly from 98725±5383 (±S.E. (M.)) to 69276±5592, or 29.8% reduction, in the laser-treated eyes after 35 days (P=0.008). The mean total NO level in the laser-treated retina was significantly increased by 2.4× compared with controls (P=0.016), but no significant difference was found in the eyecups (P>0.05). Laser treatment resulted in significant IOP elevation and RGC loss, suggesting that thermal coagulation of the perilimbal region may provide an alternate protocol for glaucoma study. NO level was increased by two-fold in the retina but not in other ocular tissues. Since NO is capable of producing powerful peroxynitrite anions and hydroxyl radicals, elevated level of NO has a potential role in glaucoma.

Elevated intraocular pressure-induced interlamellar stromal keratitis

Purpose To describe a series of cases (Elevated Intraocular Pressure Induced Interlamellar Stromal Keratitis (PISK)) that appears to be identical to post-laser in situ keratomileusis (LASIK) diffuse lamellar keratitis (DLK), but was present at a later time frame and was associated with a significant elevation of intraocular pressure (IOP). Unlike DLK, this syndrome is not steroid responsive, but resolves with a lowering of the IOP. Design Retrospective, noncomparative, small case series. Participants The medical records of four LASIK patients with IOP-induced interface changes for the 1-year period March 2000 to March 2001 were reviewed retrospectively. Main outcome measure Slit-lamp appearance. Results In the four cases presented, the slit-lamp findings and visual degradation appeared identical to DLK. All cases, however, presented outside of the first postoperative week and were not associated with any antecedent trauma. All four cases failed to respond to high-dose topical steroids. Significant IOP elevations were noted in all cases, and the interface changes responded dramatically to both a lowering of the IOP and a discontinuation or lowering of the topical steroids. Conclusions Elevated IOP-induced post-LASIK interface keratitis (PISK) is a poorly documented phenomena. Because the condition may be caused by or worsened by frequent topical steroids, early recognition is important. Treatment consists primarily of normalizing the IOP.

Efficacy and safety of the soft-shell technique in cases with a hard lens nucleus

Purpose To evaluate the efficacy and safety of the soft-shell technique in reducing corneal endothelial cell damage during cataract surgery in patients with a hard lens nucleus. Setting Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. Methods Sixty eyes of 57 cataract patients with a hard lens nucleus (Emery-Little classification grade 3 or higher) had phacoemulsification using the soft-shell technique with Healon ® (sodium hyaluronate 1%) and Viscoat ® (sodium hyaluronate 3.0%–chondroitin sulfate 4.0%) (soft-shell group) or with Healon alone (control group). The visual acuity, intraocular pressure (IOP), flare intensity in the anterior chamber, central corneal thickness, and corneal endothelial cell density were evaluated postoperatively. Results There were no significant IOP elevations in either group. The mean central corneal thickness in the control group was 539 μm ± 26.0 (SD) preoperatively and 578 ± 52.0 μm 1 day after surgery; the increase was significant ( P = .0154). There was no significant change in the central corneal thickness in the soft-shell group. There were no statistically significant differences between the 2 groups in uncorrected visual acuity, best corrected visual acuity, IOP, flare intensity in the anterior chamber, and central corneal thickness throughout the follow-up. The rate of endothelial cell loss 3 months after surgery was 6.4% ± 9.6% in the soft-shell group and 16.3% ± 9.8% in the control group ( P = .0003). Conclusion The results suggest that the soft-shell technique is safe and effective in protecting corneal endothelial cells during cataract surgery in patients with a hard lens nucleus.

Revisiting early postoperative follow-up after phacoemulsification

Purpose: To determine whether postoperative evaluation of routine phacoemulsification can be safely and effectively performed on the day of surgery and 4 days postoperatively and evaluate the incidence and management of early intraocular pressure (IOP) elevations 3 to 7 hours postoperatively in patients with or without glaucoma. Setting: Community-based hospital. Methods: This retrospective series comprised 465 consecutive patients who had phacoemulsification and intraocular lens implantation. All patients had postoperative follow-up on the day of surgery (3 to 7 hours postoperatively) and at 4 days. Patients were classified into 2 groups: nonglaucoma (NG), 396 patients; and glaucoma (GL), 69 patients. The main outcome measures were the incidence and management of postoperative complications including IOP spikes, wound leaks, uveitis, and endophthalmitis. Results: Three to 7 hours postoperatively, 73 NG (18.4%) and 32 GL (46.4%) patients had IOP elevations greater than 28 mm Hg, a significant change from baseline ( P < .0001). Fourteen NG (3.6%) and 13 GL (18.8%) patients had IOP elevations greater than 40 mm Hg ( P < .0001). Significant IOP elevations were effectively managed with a paracentesis with or without short-term antiglaucoma medications on the day of surgery, with 75 NG (18.9%) and 39 GL (56.5%) patients requiring IOP intervention. There were no IOP elevations greater than 21 mm Hg on the next day or at 4 days. There were no complications that were missed at the same-day evaluation that may have been identified at the 1-day postoperative visit. Conclusions: The results indicate that after routine phacoemulsification, patients can be safely and effectively reviewed on the day of surgery and 4 days postoperatively to identify and manage early postoperative IOP spikes. A significant number of patients, particularly those with preexisting glaucoma, had potentially harmful IOP spikes 3 to 7 hours postoperatively.

Evaluation of intraocular pressure in the immediate period after phacoemulsification

Purpose To determine the incidence of hypotony or intraocular pressure (IOP) spikes in the early period after clear corneal phacoemulsification in normal and glaucomatous eyes. Setting Ambulatory surgical center. Methods This retrospective analysis comprised 112 eyes that had clear corneal phacoemulsification. Postoperative IOP measurements were collected 30 minutes, 1 day, and 1 month after surgery. Results Twenty-three eyes had an IOP of 5 mm Hg or below 30 minutes postoperatively. The IOP at 30 minutes was lower than at 1 day in both the normal and the glaucoma group. The mean IOP in the normal group was 10.0 mm Hg ± 4.3 (SD) at 30 minutes and 16.9 ± 4.4 mm Hg at 1 day ( P ≤ .005). The means in the glaucoma group were 9.6 ± 3.9 mm Hg and 16.9 ± 5.7 mm Hg, respectively ( P ≤ .0002). The IOPs at 30 minutes and 1 day were not significantly different between the 2 groups. Conclusion A significant percentage of eyes having clear corneal phacoemulsification had an IOP of 5 mm Hg or less 30 minutes after surgery. Even though there were no postoperative complications from hypotony and there was a relative absence of significant IOP elevation 1 day postoperatively, the frequency of low IOP at 30 minutes suggests that consideration be given to leaving postoperative eyes with a higher IOP at the completion of phacoemulsification rather than with the estimated 10 mm Hg tactile IOP strived for in this study.

The use of topical aqueous suppressants in the prevention of postoperative intraocular pressure elevation after pars plana vitrectomy with long-acting gas tamponade

ObjectiveTo determine whether topical aqueous suppressant therapy applied after pars plana vitrectomy with gas tamponade prevents postoperative intraocular pressure (IOP) elevation. DesignProspective, nonrandomized comparative study. ParticipantsForty-one patients who met inclusion criteria and underwent pars plana vitrectomy with gas tamponade (SF6 18%–20% or C3F8 12%–16%) over a 1-year period. InterventionTreatment eyes received topical aqueous suppressants at the end of surgery. Main outcome measuresPostoperative IOP at 4 to 6 hours, 1 day, and 1 week. ResultsTwenty-one control and 20 treatment eyes met the inclusion criteria. The IOP (in mmHg) measured at 4 to 6 hours (23.05 [control], 14.73 [treatment]) and 1 day (23.24 [control], 17.28 [treatment]) postoperatively showed a statistically significant difference between the groups (P = 0.0038) at 4 to 6 hours and a trend toward significance (P = 0.057) at 1 day. Eleven control and three treatment eyes had an IOP spike above 25 mmHg at 4 to 6 hours or 1 day postoperatively (P = 0.02), and six control eyes and one treatment eye had postoperative IOP greater than 30 mmHg. A pressure rise greater than 40 mmHg was seen in two control eyes and no treatment eyes. ConclusionsUse of topical aqueous suppressants after pars plana vitrectomy with long-acting gas tamponade is effective in preventing significant postoperative IOP elevation in most cases.

Change in Intraocular Pressure During Long-Term Use of Loteprednol Etabonate

Loteprednol etabonate is a novel site-active corticosteroid synthesized through structural modifications of prednisolone-related compounds so that it will undergo a predictable transformation to an inactive metabolite. In double-masked studies, loteprednol etabonate was effective in the treatment of giant papillary conjunctivitis, seasonal allergic conjunctivitis, postoperative inflammation, and uveitis. The objective of this analysis was to determine the incidence of clinically significant elevations in intraocular pressure (IOP) with long-term use of loteprednol etabonate. All subjects (healthy volunteers or patients with inflammation or allergy) in all sponsored loteprednol etabonate studies in the United States were evaluated. A clinically significant elevation in IOP was defined as > or = 10 mmHg at any visit, and long-term use was defined as > or = 28 days. Of the 2,210 subjects, 1,648 were treated for 28 days or longer with loteprednol etabonate (0.2% or 0.5%), prednisolone acetate 1%, or vehicle. IOP elevation > or = 10 mmHg occurred in 1.7% (15/901) of patients taking long-term loteprednol etabonate, 0.5% (3/583) of those taking vehicle, and 6.7% (11/164) of those taking prednisolone acetate. Excluding patients who wore contact lenses, the incidence was 0.6% (4/624), 1.0% (3/304), and 6.7% (11/164) for loteprednol etabonate, vehicle, and prednisolone acetate, respectively. The incidence of IOP elevations with 0.2% loteprednol etabonate was 0.8% (1/133), similar to that for vehicle (0.7%, 1/135). The results of this analysis in a large population of subjects undergoing long-term therapy and of a previously published controlled, double-masked study in corticosteroid responders suggest that loteprednol etabonate has less propensity to cause clinically significant elevations in IOP than prednisolone acetate.

Incidence of Elevation of Intraocular Pressure Over Time and Associated Factors in Normal-Tension Glaucoma

The authors determine whether intraocular pressure (IOP) increases to levels that challenge the diagnosis of normal-tension glaucoma (NTG) and determine clinical factors associated with the IOP elevation. Forty patients with NTG who met the following enrollment criteria were selected: IOPs less than 21 mm Hg during initial 24-hour pressure curve and throughout the subsequent 12 months; examined every 1 to 4 months for at least 4 years; and no ocular hypotensive treatment. The eye with the higher mean IOP during the initial 24-hour pressure curve was selected from each patient. The observation period ranged from 4.0 years to 7.8 years (mean, 5.2 years). Significant IOP elevation was defined as a significant increase (p < 0.05) of IOP over time, determined by Spearman rank correlation coefficient method. The IOP elevation was correlated to clinical factors by means of a logistic multiple regression analysis (LOGIST procedure using PC-SAS, SAS Institute, Inc. Cary, NC, U.S.A.). Eleven eyes were rated positive for IOP elevation. The regression model demonstrated that maximum IOP during the initial 24-hour pressure curve and the development of disc hemorrhage (DH) were significantly correlated with IOP elevation (p = 0.006 and p = 0.049, respectively). The odds ratios calculated were 1.98 per 1 mm Hg rise of maximum IOP during the initial 24-hour pressure curve and 6.54 for positive DH. Intraocular pressure might increase in NTG eyes following the initial diagnosis. A higher maximum IOP during initial 24-hour pressure curve and the development of DH during follow-up was significantly associated with subsequent IOP elevation in NTG patients.