Significant Increase In Intraocular Pressure Research Articles

Change in intraocular pressure in patients on hemodialysis at Ahmed Gassim dialysis center

Background: Hemodialysis (HD) is common for Severe Renal dysfunction patients. Hemodialysis (HD) that may lead to change in intraocular pressure (IOP). Objectives: The objective is to evaluate the effects of hemodialysis on IOP in patients with chronic kidney disease. Materials and Methods: In a cross-sectional prospective hospital-based study, 100 adult Sudanese patients who were undergoing HD at Ahmed Gassim dialysis Center; August–November 2016. Portable Perkins Applanation Tonometry was done for all at two time points; pre- and post-HD. Data analysis with SPSS. Results: Two percent of age group ≤18 years, 21% - 19–35 years, 38% - 36–50 years, 39% - >50 years. Duration of HD: 50 years of age group. The commencement of HD was significantly related to the change of IOP. Hypertension, diabetes mellitus, and polycystic kidney disease had no significant differences. Conclusion: Although there is no previous real agreement about the effect of HD on the increase of IOP; so, this study demonstrates a statistically significant increase in IOP during HD.

Effectiveness of 0.1% topical salicylic acid on blepharoconjunctivitis affecting glaucoma patients treated with topical prostaglandin analogues: a prospective randomized trial.

To evaluate the efficacy of 0.1% topical salicylic acid (TSA) to treat iatrogenic chronic blepharoconjunctivitis in patients with primary open angle glaucoma (POAG), treated with topical prostaglandin analogues (TPAs). Totally 60 patients were randomly distributed into 3 equal size groups, two of which treated with 0.1% TSA (OMKASA®) and 0.1% topical clobetasone butyrate (TCB; VISUCLOBEN®) respectively, and one consisting of untreated controls. The parameters taken into account at baseline (T0) and after 30d (T1) of therapy were: conjunctival hyperemia, lacrimal function tests [Schirmer I test and break up time (BUT)] and intraocular pressure (IOP). Conjunctival hyperemia showed a substantial improvement in both treated groups (P<0.001) but not among controls. Similarly, lacrimal function tests displayed an improvement of Schirmer I test in both treated groups (P<0.05) and an extension of BUT only in the group treated with 0.1% TSA (P<0.05). The IOP increase was statistically significant only in those patients treated with 0.1% TCB (P<0.001). The 0.1% TSA has proved to be an effective anti-inflammatory treatment of blepharoconjunctivitis affecting glaucoma patients on therapy with TPAs, leading to a sizeable decrease of inflammation as well as both quantitative and qualitative improvement of tear film. Furthermore, differently from 0.1% TCB, it does not induce any significant IOP increase.

RKI-1447, a Rho kinase inhibitor, causes ocular hypotension, actin stress fiber disruption, and increased phagocytosis.

This study investigated the hypotensive effect of RKI-1447, a Rho kinase inhibitor, in a porcine ex vivo pigmentary glaucoma model. Twenty-eight porcine anterior chambers were perfused with medium supplemented with 1.67 × 107 pigment particles/ml for 48h before treatment with RKI-1447 (n = 16) or vehicle control (n = 12). Intraocular pressure (IOP) was recorded and outflow facility was calculated. Primary trabecular meshwork cells were exposed to RKI-1447 or vehicle control; effects on the cytoskeleton, motility, and phagocytosis were evaluated. Compared to baseline, the perfusion of pigment caused a significant increase in IOP in the RKI-1447 group (P = 0.003) at 48h. Subsequent treatment with RKI-1447 significantly reduced IOP from 20.14 ± 2.59 to 13.38 ± 0.91mmHg (P = 0.02). Pigment perfusion reduced the outflow facility from 0.27 ± 0.03 at baseline to 0.18 ± 0.02 at 48h (P < 0.001). This was partially reversed with RKI-1447. RKI-1447 caused no apparent histological changes in the micro- or macroscopic TM appearance. RKI-1447-treated primary TM cells showed significant disruption of the actin cytoskeleton both in the presence and absence of pigment (P < 0.001) but no effect on TM migration was observed. Pigment-treated TM cells exhibited a reduction in TM phagocytosis, which RKI-1447 reversed. RKI-1447 significantly reduces IOP by disrupting TM stress fibers and increasing TM phagocytosis. These features may make it useful for the treatment of secondary glaucomas with an increased phagocytic load.

Is a pillow a risk factor for glaucoma?

PurposeTo study whether a clinically significant increase in intraocular pressure (IOP) occurs during simulated sleep conditions with the subject's head turned comfortably into a pillow (the simulated sleep position) and the effect of protective glasses on any such IOP rise.MethodsA specially developed electronic epipalpebral pressure (EPP) sensor was attached to an eyelid of the right eye of all participants: 11 patients with primary open‐angle glaucoma and 11 healthy volunteers. During calibration, mechanical pressure was applied to the EPP sensor taped to the lower eyelid and the IOP was measured simultaneously at the slit lamp by Goldmann applanation tonometry. The EPP was increased in a stepwise fashion to assess the relationship between EPP and IOP for each individual eye. Thereafter, EPP (with the sensor now taped to the upper eyelid) measurements were performed in the simulated sleep position, both with and without protective glasses. The EPP was determined in each individual eye, and the estimated IOP was then inferred from the established EPP/IOP relationship.ResultsIn the simulated sleep position, the mean IOP increased by an estimated 19.6 mmHg (SD: 7.5; range 11.6–32.8; p < 0.0001) in the patient group and 28.0 mmHg (SD: 9.6; range 12.3–41.1); p < 0.0001) in the control group. When the subjects wore protective glasses, the mean estimated IOP decreased again by 16.3 mmHg (SD: 5.6; range 9.8–28.1; p < 0.0001) in the patient group and 25.1 mmHg (SD: 8.2; range 11.7–38.3; p = <0.0001) in the control group.ConclusionTurning the head into a pillow gave a large and clinically significant increase in the estimated IOP in the simulated sleep position. With protective glasses, however, the increase in estimated IOP was almost absent. Therefore, protective shielding of the eyes during sleep may be a treatment option in glaucoma.

Factors influencing IOP changes in postmenopausal women

Objective Intraocular pressure (IOP) is essential in maintaining normal function of the eye. High IOP is associated with glaucoma. Many physiological factors, including age and hormones, can cause variation in IOP. This study was designed to investigate IOP changes in postmenopausal women and the associated factors, which included sex hormones and body mass index (BMI). Methods This was a cross-sectional study. Ninety-eight women were recruited: 49 premenopausal women and 49 postmenopausal women. IOPs between the two groups were compared. The influence of estradiol, progesterone, testosterone, and BMI on IOP was analyzed by a multivariate method. P Results The age of the premenopausal group was 47.14±3.93 years and that of the postmenopausal group was 52.10±3.04 years. The other factors in both groups, which included BMI, blood pressure, and central cornea thickness, were not significantly different. The mean IOP in the postmenopausal group was significantly higher than the mean IOP in the premenopausal group (15.26±2.96 mm Hg vs. 14.07±2.65 mm Hg, P=0.04). BMI had a weak positive correlation with IOP in premenopausal women (r=0.31, P=0.03). Estradiol was less likely to influence IOP changes in the postmenopausal group as compared with the premenopausal group (B=−0.021, P=0.002). IOP was not significantly related to progesterone and testosterone levels. Conclusion Menopausal status has a significant effect on IOP, with a significant increase in IOP seen in postmenopausal women as shown by our study. Estradiol was shown to be a protective factor in reducing IOP among postmenopausal women. Through understanding of the influence of postmenopausal status and sex hormones on IOP, glaucoma management may be improved and the target group for disease screening may be more specific. Significance statement Intraocular pressure (IOP) is essential in maintaining normal function of the eye. High IOP is associated with glaucoma. Many physiological factors, including age and hormones, can cause variation in IOP. Menopausal status has a significant effect on IOP, with a significant increase in IOP seen in postmenopausal women as shown by our study. However, changes in IOP with menopausal status do not appear to have any correlation with sex hormone changes, but body mass index had a weak positive correlation with IOP in premenopausal women. Through understanding of the influence of postmenopausal status and body mass index on IOP, glaucoma management may be improved and the target group for disease screening may be more specific.

The Effect of Steep Trendelenburg Positioning on Retinal Structure and Function during Robotic-Assisted Laparoscopic Procedures.

Purpose Robotic-assisted laparoscopic radical prostatectomy (RALP) has become a standard treatment choice for localized prostate cancer. RALP requires a steep Trendelenburg position, which leads to a significant increase in intraocular pressure (IOP). This study evaluated the effect on the retinal structure and function in patients undergoing RALP. Methods Standard automated perimetry (SAP) and optical coherence tomography (OCT) were performed in 20 males scheduled for RALP at 1 month and 1 day before the operation and at 1 and 3 months after the operation. IOP measurements were made in the supine position at 5 min after intubation under general anesthesia (T1), at 6 discrete time points (5, 30, 60, 120, 180, and 240 min; T2-7), and at 5 min after returning to a horizontal supine position (T8). Serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression were assessed using the guided progression analysis software program. RNFL thickness progression and visual field progression were evaluated by event analysis. Results Average IOP (mmHg) for each time point was as follows: T1 = 12.3 ± 2.6, T2 = 20.4 ± 4.2, T3 = 23.3 ± 3.8, T4 = 24.0 ± 3.2, T5 = 24.3 ± 3.4, T6 = 27.1 ± 7.2, T7 = 29.8 ± 8.7, and T8 = 20.1 ± 4.4. During RALP, IOP significantly increased. There was no progression of the visual field and RNFL thickness after surgery or any other ocular complications found. Conclusions Although IOP significantly increased during RALP, there were no significant changes in the retinal structure and function between the pre- and postoperation observations.

Effect of 0.05% Difluprednate Ophthalmic Emulsion on Proinflammatory Cytokine Levels After Retinal Laser Photocoagulation in Rabbits.

We aimed to evaluate the effect of the topical application of a strong corticosteroid, difluprednate, on the levels of inflammatory and angiogenic cytokine in the vitreous and aqueous humor after laser photocoagulation. Pigmented rabbits were treated with retinal laser photocoagulation and divided into 4 groups, namely control (no additional treatment), topical application of difluprednate 0.05%, betamethasone sodium phosphate 0.1%, and sub-Tenon injection of triamcinolone acetonide (STTA). Samples of vitreous and aqueous humor were collected on posttreatment days 0, 1, 7, and 14. The levels of intraocular vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), and monocyte chemotactic protein-1 (MCP-1) were measured using an immunoassay. Intraocular pressure (IOP) was monitored in each group. VEGF, IL-6, ICAM-1, and MCP-1 were significantly elevated on day 1 and were reduced in both the vitreous and aqueous humor following topical application of difluprednate and STTA. Topical betamethasone reduced their levels in the aqueous humor but not in the vitreous. A significant increase of IOP induced by difluprednate returned to control levels after withdrawal of administration. Although the elevation of IOP was an expected, manageable side effect, topical application of difluprednate was more effective than STTA and betamethasone for reducing inflammatory cytokine levels after laser treatment.

The Real-World Effect of Intravitreous Anti–Vascular Endothelial Growth Factor Drugs on Intraocular Pressure: An Analysis Using the IRIS Registry

To identify sustained differences in intraocular pressure (IOP) after intravitreous injections of anti-vascular endothelial growth factor (VEGF) drugs. Database study. Patients seeing an ophthalmic provider who contributes to the database. We identified a total of 23 776 unique patients who received only a single type of anti-VEGF medication (bevacizumab, aflibercept, or ranibizumab) by injection in the right eye in the American Academy of Ophthalmology Intelligent Research in Sight Registry. Subgroups included patients with age-related macular degeneration only and patients who had not received an anti-VEGF injection for at least 1 year before the study. We examined those with at least 12, 18, and 25 injections for each of these 3 medications. For all groups, we used fellow, untreated eyes for comparison. The mean change in IOP from baseline at a minimum of 1 year of follow-up and the proportion of eyes with a clinically significant IOP increase (defined as sustained rise of at least 6 mmHg to an IOP of more than 21 mmHg). All patients in all groups receiving all drugs showed a decrease in IOP from baseline, with a mean of 0.9 mmHg in treated eyes compared with an average decrease of 0.2 mmHg in fellow untreated eyes, a statistically significant difference. A generalized linear model accounting for confounders associated bevacizumab with slightly less lowering of IOP than aflibercept and ranibizumab in most subgroups. A clinically significant IOP increase was seen in 2.6% of eyes receiving injections compared with 1.5% in the associated untreated fellow eyes. Clinically significant IOP increases occurred at a rate of 1.9%, 2.8%, and 2.8% for aflibercept, ranibizumab, and bevacizumab, respectively, which was significantly higher than untreated fellow eyes for bevacizumab and ranibizumab, but not for aflibercept. These analyses from real-world data indicate that anti-VEGF intravitreous injections are associated with a small but statistically significant decrease in IOP over time. A proportion of patients, on average 2.6%, experienced a sustained clinically significant IOP rise with these drugs overall compared with 1.5% in the fellow untreated eyes. However, such an increase was not seen with aflibercept.

Chronomorphological and pressure changes in a sign of aging - pseudoexfoliation of the eye

Background: Pseudoexfoliation (PXE) is an age-related disorder, a risk factor for glaucoma. The aim of this research was to study the chronomorphological and pressure changes in PXE of the eye. Aims and Objectives: To determine and to compare the anterior chamber depth (ACD), lens thickness (LT), axial length (AL), corneal curvature (CC), and intraocular pressure (IOP) in cases with PXE and in controls. Thence, predict the future onset of pseudoexfoliative glaucoma. Material and Methods: This was a case–control study, patients diagnosed to have PXE with the help of slit lamp, above 50 years were taken as cases and age-matched subjects as controls. Measurement of ACD, LT, and AL by A-scan; CC by Keratometer; and IOP by Schiotz tonometer of both cases and controls were performed. Results: Fourteen cases and seventeen controls were studied. A significant difference in mean IOP (P = 0.029) and AL (P = 0.001) between cases and controls was found. Conclusion: IOP and AL were significantly more in PXE as compared to controls. A significant increase in IOP and AL together may predict the future onset of PXE and hence, may help in early diagnosis of glaucoma and which may be missed in cases of PXE.

Effect of Hemifacial Spasm on Intraocular Pressure Measurement.

Purpose To evaluate the effect of hemifacial spasm (HFS) on intraocular pressure (IOP) measurement. Methods Twenty-four consecutive patients with HFS and 25 age- and gender-matched randomly selected eyes of healthy volunteers underwent corneal pachymetry and IOP measurements using Goldmann applanation tonometer (GAT) and noncontact tonometer (NCT). IOP measurements were performed before (during HFS) and 2 weeks after Botox injections in HFS patients and in healthy volunteers without Botox injections. Results There was no statistical difference between involved eye side and uninvolved eye side of HFS patients in measured central corneal thickness. Similarly, no difference was found between involved eye side of HFS patients and controls. There were no statistically significant differences comparing IOP values before treatment and levels measured at 2 weeks of Botox injections, either with GAT (p = 0.33, 0.11) or NCT (p = 0.80, 0.43) devices in the involved eyes and uninvolved eyes of patients with HFS, respectively. There were also no significant differences in these parameters (GAT (p = 0.63) and NCT (p = 0.54)) in controls. Conclusions Contractions in facial muscles may not lead to significant increase in IOP in HFS patients. This result may help clinical decision making in the treatment of glaucoma patients with HFS. This trial is registered with NCT03390803.

Effects of sub-Tenon's triamcinolone injections in patients with uveitis.

To evaluate the response to sub-Tenon's triamcinolone injection in patients with uveitis. We studied 28 eyes with macular edema associated with controlled uveitis. We administered sub-Tenon's injection of triamcinolone and followed the patients for 180 days to analyze the positive effects (improvement of macular edema and visual acuity) and monitor the possible adverse effects. This prospective study was conducted at the Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Brazil. We observed improvement in macular edema in 86% of patients. The mean central macular thickness at each time point of assessment was 432.22, 298.80, 286.37, 267.49, 253.87, and 253.49 mm at baseline (before sub-Tenon's injection of triamcinolone), 15 days after the procedure, at 30 days, at 60 days, at 90 days, and at 180 days, respectively. The mean reduction in retinal thickness was 30.8%, 33.7%, 38.11%, 41.2%, and 41.35% at 15, 30, 60, 90, and 180 days of follow-up, respectively. Visual acuity also improved in 85.7% of patients, with a mean improvement of 1.36, 1.93, 2.23, 2.26, and 2.30 lines gained on the Early Treatment Diabetic Retinopathy Study chart at 15, 30, 60, 90, and 180 days of follow-up, respectively. No statistically significant increases in intraocular pressure and conjunctival abnormalities were caused by the procedure, and no other adverse effects were observed. Overall, the results of this study were similar to those described in the literature. Sub-Tenon's injection of triamcinolone provides reduced macular thickness and improvement in visual acuity with no significant adverse effects and is therefore an effective and safe procedure for the treatment of sequelae of uveitis.

Results of secondary retropupillary-fixated intraocular lens implantation

To evaluate specific morphofunctional changes in the eye after dislocated IOL exchange with retropupillary-fixated iris-claw IOL. Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus-fixated IOL dislocation (28 eyes) were analyzed. The follow-up period was 1-3 years. Increase in visual acuity and stable retropupillary fixation of the IOL was observed in all cases after reimplantation. Mean endothelial cell loss after 3 months was 6.9±1.3% in the group with preoperative density of >1200 cells/mm2 and 12.3±2.7% in the group with preoperative density of <1200 cells/mm2. There was no significant increase in intraocular pressure after IOL reimplantation. The incidence of clinical cystoid macular edema with decreased visual acuity was 4.7%, which is significantly more frequent than in patients after uncomplicated phacoemulsification with in-the-bag IOL implantation. Retropupillary implantation of iris-claw IOL provides stable fixation, good functional outcomes with low complication rates and is suitable for reimplantation in eyes without adequate capsular support.

Evaluation of the clinical effectiveness in routine practice of fluocinolone acetonide 190 µg intravitreal implant in people with diabetic macular edema

Objective: The aim of the Iluvien Clinical Evidence study in the UK (ICE-UK) was to assess the real-world effectiveness of fluocinolone acetonide (FAc) 190 µg intravitreal implant for the treatment of clinically significant chronic diabetic macular edema (DME) in routine clinical practice.Methods: This retrospective study collected data from patient medical records in 13 ophthalmology centers for people with DME prescribed FAc intravitreal implant between April 1, 2013 and April 15, 2015. Visual acuity (VA) and intraocular pressure (IOP) measurements were collected for 12 months prior to and after implant.Results: Two hundred and eight people, contributing 233 eyes, treated with FAc implant were included. Mean age was 68.1 years and 62% were male. In the 12 months prior to FAc implant, VA declined. Median (interquartile range, IQR) VA was 0.66 (0.48–1.00) LogMAR units (equivalent to 52.0 ETDRS letters) at implant, improving to 0.60 (0.38–0.90) LogMAR units (55.0 letters) at 12 months post-implant (p < 0.001). In total, 44%, 30%, and 18% of people achieved an improvement in ETDRS score of ≥5, ≥10, and ≥15 letters, respectively, over the same period. A small but significant (p < .001) increase in median IOP was observed (median = 15.0, IQR = 13.0–18.0 mmHg at implant to 18.0, 15.0–21.0 mmHg at 12 months). In the 12 months following implant, additional IOP-lowering therapy was prescribed in 15% of subjects previously not requiring such therapy.Conclusion: Following FAc implant, an overall significant improvement in VA was observed over a period of 12 months, accompanied by a significant but small increase in IOP.

The acute effect of strength exercises at different intensities on intraocular pressure.

This study aimed to determine the effect of two basic strength exercises with progressive loads on intraocular pressure (IOP). Seventeen (out of 20 recruited) physically active male military officers (46±4.77years) performed the jump squat and the ballistic bench press exercises, in counterbalanced order, with four and five progressive loads, respectively. IOP was measured with a rebound tonometer before and after each of the corresponding loads. IOP linearly increases with heavier loads for the jump squat (r=0.976) and the ballistic bench press (r=0.991) exercises. A significant IOP elevation was observed during the jump squat test (p<0.001), and Bonferroni-Holm correction revealed that ~75% of one repetition maximum (RM) was able to promote significant changes in IOP with respect to the other three loads (all corrected p values <0.05), whereas the load corresponding to ~65%RM and ~60%RM induced a significant IOP rise when compared with the load of ~50%RM (corrected p-values of 0.43 in both cases). For its part, IOP significantly increases with the bench press test (p<0.001), and performing the ~50%RM load was enough to induce significant IOP changes (corrected p-value <0.01). Acute performance of jump squat and ballistic bench press lead to a significant increase of IOP, and 5min of rest are enough to recover baseline IOP values. There is a strong linear association between the increase in load and the IOP rise for both exercises, and bench press execution produces a significantly higher IOP increase when compared with the jump squat for the same relative loads.

Single Dexamethasone Intravitreal Implant in the Treatment of Noninfectious Uveitis.

To investigate the effect of a single intravitreal dexamethasone implant (IVT-DI; Ozurdex; Allergan, Inc.) on visual acuity, macular thickness, and intraocular pressure (IOP) in active noninfectious uveitis. Medical records of patients with noninfectious active uveitis treated by IVT-DIs were retrospectively reviewed. Uveitis etiologies, treatment indications, best corrected visual acuity (BCVA), central retinal thickness measured by ocular coherence tomography, IOP, and systemic, local, and topical treatments were collected. Parameters were analyzed before the injection of the implant, after 1.5 ± 0.8 months and 4.4 ± 0.9 months for the BCVA, after 2 ± 1.3 months and 4.6 ± 1.3 months for the ocular coherence tomography, and after 1.3 ± 0.7 months and 4.4 ± 1 months for the IOP. We included 14 patients (20 eyes, 20 implant injections) with cystoid macular edema (78%), vasculitis (7%), choroiditis (7%), and vasculitis associated with choroiditis (7%). Before the injection, mean visual acuity was 0.4 ± 0.5 logMAR (logarithm of the minimum angle of resolution) that improved to 0.3 ± 0.5 logMAR (P = 0.0002) after 1.5 ± 0.8 months and to 0.3 ± 0.5 logMAR (P = 0.005) after 4.4 ± 0.9 months. A statistically significant decrease of macular thickness was observed both at 2 ± 1.3 months and at 4.6 ± 1.3 months after IVT-DI. Mean IOP was 16 ± 5 mmHg before injections, 18 ± 6 mmHg (P = 0.13) at 1.3 ± 0.7 months, and 15 ± 4 mmHg (P = 0.65) at 4.4 ± 1 months. By Kaplan-Meier analysis, we found that after 3.3 months, 17% of the eyes still present a BCVA amelioration ≥0.3 logMAR. In our patients with active noninfectious uveitis, injection of a first single dexamethasone implant was found to improve visual acuity and decrease macular thickness without significant increase of IOP, although the effect seems limited in time.

Fluocinolone Acetonide Intravitreal Implant 0.19mg (ILUVIEN®): A Review in Diabetic Macular Edema.

Fluocinolone acetonide intravitreal implant 0.19mg (ILUVIEN®) is a nonbiodegradable, injectable, corticosteroid implant that is approved in several countries, including the USA, for the treatment of diabetic macular edema (DME). ILUVIEN® releases fluocinolone acetonide at an initial rate of 0.25µg/day (average rate 0.2µg/day) and lasts 36months. In the two pooled pivotal FAME trials in patients with DME previously treated with macular laser photocoagulation, fluocinolone acetonide intravitreal implant 0.2µg/day was significantly more effective than sham injection with respect to the proportion of patients with an improvement from baseline in best-corrected visual acuity of ≥15 letters at 24months (primary endpoint). This therapeutic effect was maintained at 36months. The implant also significantly decreased foveal thickness at 24months. FAME study results are broadly supported by real-world studies in patients with chronic DME considered insufficiently responsive to available therapies. Consistent with corticosteroid class-specific adverse events, cataract and elevated intraocular pressure (IOP) were the most common adverse events with the fluocinolone acetonide intravitreal implant. Raised IOP was treated with medications in most patients, with <5% requiring incisional IOP-lowering surgery. In the USA, fluocinolone acetonide intravitreal implant should be used only in patients who have been previously treated with a course of corticosteroids and did not have a clinically significant increase in IOP. Available data indicate that fluocinolone acetonide intravitreal implant 0.19mg is a useful option for the treatment of DME in these patients.

A Randomized Controlled Trial to Determine the Effect of Inhaled Corticosteroid on Intraocular Pressure in Open-Angle Glaucoma and Ocular Hypertension: The ICOUGH Study.

The purpose of this study was to determine the risk of a steroid pressure response from inhaled corticosteroids. This randomized, double-masked, placebo-controlled trial included 22 adults with well-controlled open-angle glaucoma or ocular hypertension. Consenting participants were randomized to a 6-week course of twice-daily fluticasone propionate 250-μg metered-dose inhaler or saline placebo metered-dose inhaler. Biweekly clinic visits included masked Goldmann applanation tonometry and assessment to identify adverse effects. Primary outcome was mean intraocular pressure (IOP) at week 6. Secondary outcomes included IOP elevation of >20% at 2 consecutive visits, adherence, side effects, and logMAR visual acuity. A total of 10 patients in each arm completed the study. There were no statistically significant differences in IOP between groups at baseline (14.3±3.0 and 15.6±3.6 mm Hg in steroid and placebo groups, respectively, P=0.39) or at week 6 (14.7±2.4 and 14.8±3.8 mm Hg in steroid and placebo groups, respectively, P=0.92). Adherence was >80% for all participants. There were no statistically significant differences between groups in any secondary measures. One patient in the steroid group met the secondary end point of >20% elevation in IOP (IOP increased from baseline of 9 to 11 mm Hg at weeks 2 and 4). We found no clinically significant increase in mean IOP in patients with well-controlled open-angle glaucoma and ocular hypertension after 6 weeks of twice-daily inhaled fluticasone propionate compared with inhaled placebo. No participants exceeded their individualized target IOP. There were no differences in secondary outcomes.

Effects of morphine-alfaxalone-midazolam premedication, alfaxalone induction and sevoflurane maintenance on intraocular pressure and tear production in dogs

Intraocular pressure (IOP) and tear production are commonly affected by general anaesthesia. It is necessary to have a good control of both to guarantee successful ophthalmic surgery. The purpose of...

Efficacy and safety of triamcinolone acetonide posterior subtenon injection in patients with diabetic maculopathy

Introduction: Diabetic maculopathy (DM) is the main cause of visual impairment of the working population. Optical coherence tomography and fluorescein angiography give us a precise insight into retinal changes. In recent years, pharmacological treatment of DM is increasing. Posterior subtenon application is accompanied by a smaller percentage of complications compared to intravitreal application. Aim: The aim is to assess the efficacy and safety of triamcinolone acetonide (TA) posterior subtenon injection in the treatment of DM, by measuring intraocular pressure (IOP), central macular thickness (CMT) and visual acuity, before and two months after. Material and methods: The retrospective study included 49 patients admitted during 2016, for posterior subtenon injection of TA in the DM treatment, at Daily Hospital, for the treatment of vascular diseases of the eye and the macula Department of Ophthalmology, Clinical Center of Serbia. Data were collected from medical records on gender, age, type of retinopathy and visual acuity, IOP and CMT, before and two months after intervention. Results: The average age of patients was 63 ± 9.5 years. Out of 49 patients tested, 30.61% were female and 69.39 % were male. The frequency of non-proliferative diabetic retinopathy (NPDR) in the study was 53.6%. There was a statistically significant difference in visual acuity and CMT, before and two months after the intervention, but there was no correlation between the improvement of visual acuity and CMT reduction. There was no statistically significant difference in IOP, before and two months after intervention. Conclusion: The most common type of diabetic retinopathy in this study was NPDR. After posterior subtenon application of TA, there was a significant increase in visual acuity and CMT reduction, but reduction of CMT is not connected with the increase of visual acuity. Posterior subtenon TA application is not accompanied by a significant increase in IOP, and it is an effective and relatively safe way of treating DM.

Changes in intraocular pressure and horizontal pupil diameter during use of topical mydriatics in the canine eye.

The objective of this study was to determine the effects of topical 0.5% tropicamide, 1% atropine sulphate and 10% phenylephrine hydrochloride ophthalmic solutions on intraocular pressure (IOP) and horizontal pupil diameter (HPD) in the dog during the first hour after treatment. Forty clinically and ophthalmologically normal canine patients (between the ages of 2 and 6 years) of varying breed and sex were used in this study. Animals were randomly divided into four groups of ten and given one drop of tropicamide, atropine, phenylephrine or saline into one eye. IOP and HPD were measured in both eyes every 5 minutes for 60 minutes. Tropicamide increased IOP by 8.8±4.0 mmHg 35 minutes post-treatment compared to pre-treatment (P<0.01) only in treated eye. IOP in the contralateral eye did not increase. With atropine the maximum increase in IOP was 2.6±2.8 mmHg at 20 minutes post treatment in the treated eye (P<0.01). IOP in the contralateral eye did not increase. Phenylephrine increased IOP by 2.3±2.1 mmHg (P<0.05) 10 minutes after treatment. Also in the untreated eye IOP increased by 2.3±2.1 mmHg, 20 minutes post-treatment. Maximum HPD in eyes treated with tropicamide occurred at 55 minutes and with atropine at 60 minutes. There were no HPD changes in the contralateral, untreated eye. Topical 10% phenylephrine showed maximal pupil dilation 60 minutes after treatment, but the HPD of the – untreated eye slightly decreased at 15 minutes, but this change only reached statistical significance at 40 min post- treatment (P<0.05). Normal saline showed no influence on IOP or HPD. The drugs investigated here show a significant increase in IOP after mydriatics.