Transient Intraocular Pressure Elevation Research Articles

Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections

To evaluate the efficacy of subconjunctival triamcinolone injection for treating upper eyelid retraction caused by thyroid-associated ophthalmopathy (TAO). Prospective single blind randomized clinical trial. Patients diagnosed with TAO-associated eyelid retraction and/or swelling <6 months before study onset were randomly assigned to triamcinolone-injected (group I; 55 patients, 75 eyes) or observation-only (group II; 40 patients, 59 eyes) populations. Group I received 1-3 injections of 20 mg triamcinolone acetate into the subconjunctival eyelid, between the conjunctiva and Muller's muscle, at 3-week intervals. Group I was followed up at 3, 6, 9, and 24 weeks post-injection, and group II was evaluated at 9 and 24 weeks after initial visit. Eyelid swelling and retraction were each graded on a 0-3 scale. Treatment was stopped after 1-2 injections if both swelling and retraction resolved completely or if retraction and swelling scored 0/1 or 1/0 without functional or cosmetic patient concerns. Treatment success was defined at 9 and 24 weeks post-injection if eyelids were normal or when treatment was terminated because of early clinical resolution. We compared baseline clinical data between success and failure group evaluated at 9 and 24 weeks in group I, and investigated short-term and long-term success prognostic factor using multiple logistic regression analysis in each group I and II. Swelling and retraction decreased significantly more in group I than in group II. Significantly more eyes had severe swelling (≥ grade 2) in group I (67 %) than in group II (34 %) upon initial evaluation (p < 0.01); this difference disappeared at 9 and 24 weeks. Fewer severely retracted eyes were observed in group I than in group II at 9 and 24 weeks (p < 0.01). Significantly more eyes in group I achieved success at both 9 and 24 weeks (59 %, 75 %) than in group II (39 %, 57 %) (p = 0.03, p = 0.04 respectively). Higher initial retraction grades (2-3) predicted a higher chance of post-injection failure versus the reference group (grade 0-1) at 9 and 24 weeks in group I, with adjusted odds ratios (aOR) 45.4 (95 % CI = 5.9-351.1, p < 0.01) and aOR 11.6 (95 % CI = 2.3-58.5, p < 0.01) respectively. Similarly in group II, initial retraction grade was associated with the failure at 9 and 24 weeks, with aOR 10.3 (95 % CI = 1.8-59.6, p < 0.01) and aOR 5.9 (95 % CI = 1.3-25.9, p < 0.05) respectively. Transient intraocular pressure elevation was observed in three eyes of two patients, although all ocular pressures were normalized within 1 month using anti-glaucoma medication. Subconjunctival triamcinolone injections were very effective in resolving eyelid swelling and retraction in recent-onset TAO. However, the symptom-reducing effect of triamcinolone was modest and less effective in patients initially presenting with severe retraction grades. As intraocular pressure may rise after steroid injection at upper eyelid, the treatment should be avoided in patients suspected to have glaucoma.

Therapeutic targets in glaucoma

AbstractGlaucoma leads to irreversible blindness and is characterized by changes in the optic disc and the visual field. The elevated intraocular pressure is considered the most important factor responsible for the glaucomatous optic neuropathy. There are multiple factors involved in the development of retinal ganglion cell death. The goal of glaucoma treatment is to preserve the visual field of patients and prevent the loss of visual function that is associated with the disease (European Guidelines). We should focus at least on three separate targets of glaucoma treatment (Brubaker RF. Survey of Ophthalmology 2003: Three targets for glaucoma management): Intraocular pressure (IOP), outflow facility, and the retinal ganglion cell (RGC). Elevated IOP is still the primary risk factor for the development and progression of glaucoma, and many studies have shown that IOP reduction can limit the progression of glaucoma and slow the loss of visual function. IOP lowering can be beneficial for normal‐tension as well as high‐tension glaucoma patients, and it may also prevent or delay the onset of visual field loss and optic disk damage in individuals with ocular hypertension. The second target of glaucoma treatment is outflow facility. In a healthy eye, aqueous production (flow) equals aqueous outflow through the trabecular and uveoscleral outflow pathways. Any imbalance between flow and outflow results in a change in IOP, yet even a transient elevation of IOP may cause significant glaucomatous damage. The third target of glaucoma treatment is the RGC itself. RGC death in glaucoma might have many causes, including vascular insufficiency, blockage of axonal transport, diffusion of toxic agents into the nerve cell, or initiation of apoptosis. Treatment that aims to directly protect the RGC from every possible insult might be the ultimate treatment for glaucoma because a strategy of neuroprotection could preserve the visual function of patients regardless of the etiology of their glaucoma.

Resultados clínicos de la cirugía combinada de catarata con vitrectomía 23-gauge

PurposeTo report the clinical outcomes of cataract surgery (phacoemulsification and intraocular lens implantation) combined with 23-gauge vitrectomy, and to evaluate the effectiveness and safety of this technique. MethodsA retrospective, consecutive, non-comparative study which included 105 eyes. Phacoemulsification and intraocular lens implantation (in the capsular sac) combined with 23-gauge vitrectomy were performed. Indications for undergoing surgery were varied. Best corrected logMAR visual acuity (VA) and intraocular pressure (IOP) were measured pre- and postoperatively, and postoperative complications were recorded. ResultsPatients were followed-up for a mean of 16.6±9.9 months. The mean preoperative VA was 0.83±0.40 logMAR, and mean postoperative VA one month after surgery was 0.44±0.38 logMAR. The postoperative visual acuity improved in 83.8% of cases. The mean preoperative IOP was 16.6±3.7mmHg, while the mean postoperative IOP was 22.5±12.8mmHg (1 day after surgery), 17.5±6.8mmHg (after 1 week), and 15.3±3.8mmHg (after 1 month). Postoperative complications included posterior capsular opacification (n=5), macular edema (n=4), corneal de-epithelization (n=3), retinal detachment (n=2), proliferative vitreoretinopathy (n=2), choroidal detachment (n=1), macular hole (n=1), vitreous hemorrhage (n=1), epiretinal membrane (n=1), and transient elevated intraocular pressure (n=36). ConclusionsThe surgery reported in this study involving phacoemulsification combined with 23-gauge vitrectomy was found to be safe and effective, and was associated with improved clinical features, including rapid rehabilitation, a low incidence of complications, and avoids repeat surgery.

Surgical Reduction of Ocular Pigmentation in Patients With Oculodermal Melanocytosis

To show the outcomes of surgical reduction of ocular pigmentation in patients with oculodermal melanocytosis. Surgical reduction of ocular pigmentation was performed in 49 patients with oculodermal melanocytosis at the Asan Medical Center, Seoul, Republic of Korea, between January 2005 and January 2009. In all patients, ocular pigmentation was cosmetically reduced, and most patients were satisfied with the results of surgery. Preoperative and postoperative visual acuities, intraocular pressure (IOP), keratometry, and refractive outcomes did not differ significantly. During the follow-ups, 14 patients showed transient IOP elevation and 4 patients showed conjunctival neovascularization. Surgical reduction of oculodermal melanocytosis seemed to be cosmetically satisfactory and did not cause significant changes in visual acuity, refraction, or keratometry, although 28.6% (14 of 49) of patients showed transient IOP elevation.

Effect of the Honan Intraocular Pressure Reducer to Prevent Vitreous Reflux after Intravitreal Bevacizumab Injection

To evaluate the effect of the Honan intraocular pressure reducer (HIPR) on vitreous reflux during intravitreal (IVT) injection. Prospective, comparative, controlled, investigator-blinded, randomized clinical study. Sixty eyes of 60 patients who underwent IVT injection were allocated into 2 groups with or without using the HIPR. Vitreous reflux was estimated by measuring largest diameter of the conjunctival bleb formed after IVT injection. Preoperative intraocular pressure (IOP) before and after application of the HIPR and IOP immediately postoperatively and 3 and 10 minutes postoperatively were evaluated. The mean amount of vitreous reflux was significantly less with the HIPR than without the HIPR (1.46±1.04 mm vs 2.61±1.37 mm; p<0.001). The preoperative IOP was significantly lower with the HIPR than without the HIPR (11.62±4.04 mmHg vs 16.26±3.86 mmHg; p=0.026). The 3-minute postoperative IOP was 31.34±3.16 mmHg with the HIPR and 32.61±5.62 mmHg without the HIPR (no statistical significance; p=0.345). The HIPR prevents vitreous reflux after IVT through a reduction in the preoperative IOP. However, the HIPR appears not to affect the postoperative course of transient IOP elevation.

23-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY FOR RETAINED LENS FRAGMENTS AFTER COMPLICATED CATARACT SURGERY

The purpose of this study was to evaluate the effectiveness and safety of 23-gauge (23-G) transconjunctival sutureless vitrectomy in patients with retained lens fragments after complicated cataract surgery. In this retrospective consecutive case series, 17 eyes of 17 patients with retained lens fragments after complicated cataract surgery and managed by using 23-G transconjunctival sutureless vitrectomy were evaluated between January 2007 and March 2009 at our institution. Mean follow-up time was 8.5 ± 3.00 months. Nine patients (53%) were pseudophakic, and 8 (47%) were aphakic. A foldable acrylic intraocular lens was implanted in eight eyes with aphakia. In 2 eyes (11.8%), one of 23-G sclerotomy port was enlarged and intravitreal phacoemulsification was performed with 20-gauge phacofragmatome to remove hard nucleus. Visual acuity improved in 100% of eyes and was 20/40 or better in 70.6% of eyes. Postoperative complications were transient elevation of intraocular pressure (29.4%), decentralization of the intraocular lens (5.9%), fibrin reaction (5.9%), mild vitreous hemorrhage (5.9%), and macular retinal pigment epithelial changes (5.9%). Twenty-three-gauge transconjunctival sutureless vitrectomy was observed to be effective and safe in patients with retained lens fragments after complicated cataract surgery. In cases with hard nucleus, 23-G vitrectomy probe may not be adequate to remove the lens fragments.

Long-Term Rescue of Rat Retinal Ganglion Cells and Visual Function by AAV-Mediated BDNF Expression after Acute Elevation of Intraocular Pressure

To evaluate the ability of increased expression of brain-derived neurotrophic factor (BDNF) using adenoassociated viral (AAV) vector to prevent the loss of rat retinal ganglion cells (RGCs) and visual function after acute elevation of intraocular pressure (IOP). AAV vectors (expressing BDNF or GFP) were injected into the vitreous 6 hours after a transient IOP elevation to 130 mm Hg for 45 minutes. Protective effects were evaluated by counting RGCs retrogradely labeled with fluorogold (FG) from the superior colliculus, measuring the amplitude and the latency of the P1 component of the visual evoked potential (VEP), and observing the visual acuity and contrast sensitivity in awake and behaving animals. RGC numbers decreased continuously to 9 weeks after the elevation of IOP. FG-positive RGC loss was significantly decreased in the retinas treated with AAV-BDNF at 3, 6, and 9 weeks after the insult, with corresponding improvements in VEP parameters. Supplementing BDNF protein once to compensate for the slow onset of AAV-mediated gene expression rescued a larger number of RGCs and the parameters of the VEP. Visual acuity and contrast sensitivity were significantly improved in all treated groups, with the largest improvement in the combined-therapy group, and were maintained for up to 70 weeks. The authors further demonstrated that BDNF rescued the RGCs by activating TrkB receptors through both autocrine and paracrine mechanisms. AAV-mediated BDNF expression in the rat retina achieved a sustained rescue of RGCs and visual function after an acute elevation of IOP.

Long-Term Effects of Intravitreal Injection of GMP-Grade Bone-Marrow–Derived CD34+Cells in NOD-SCID Mice with Acute Ischemia-Reperfusion Injury

To determine long-term safety of intravitreal administration of good manufacturing practice (GMP)-grade human bone-marrow-derived CD34(+) cells in NOD-SCID (nonobese diabetic-severe combined immunodeficiency) mice with acute retinal ischemia-reperfusion injury, a model for retinal vasculopathy. Acute ischemia-reperfusion injury was induced in the right eye of adult NOD-SCID mice (n = 23) by transient elevation of intraocular pressure. Seven days later, 12 injured eyes and 5 normal contralateral eyes were injected each intravitreally with 5 × 10(4) CD34(+) cells isolated under GMP conditions from a healthy human donor bone marrow using an immunomagnetic cell isolation system. The remaining 11 injured eyes were not treated and served as controls. Mice were euthanized 1 day, 4 months, and 8 months later. Both eyes were enucleated and examined by immunohistochemical analysis and hematoxylin and eosin staining. Among mice followed for 8 months, electroretinography (ERG) was performed on both eyes before euthanization. All major organs were examined grossly and histologically after serial sectioning. Immunohistochemical staining 4 months after injection showed detectable CD34(+) cells in the retinal vasculature. ERG at 8 months after CD34(+) cell injection showed signals that were similar in untreated eyes. Histology of the enucleated eyes injected with CD34(+) cells showed no intraocular tumor or abnormal tissue growth after 8 months. Histologic analysis of all major organs showed no abnormal proliferation of human cells. Intravitreal administration of GMP-grade human bone-marrow-derived CD34(+) cells appears to be well tolerated long-term in eyes with acute retinal ischemic injury. A clinical trial will start to further explore this therapy.

Safety of Submacular Suprachoroidal Drug Administration via a Microcatheter: Retrospective Analysis of European Treatment Results

Purpose: To investigate the safety and feasibility of using a microcatheter for drug delivery in the suprachoroidal space in eyes with advanced, exudative, age-related macular degeneration (AMD) unresponsive to conventional therapy. Procedures: A unique microcatheter was used to deliver a drug combination consisting of bevacizumab and triamcinolone to the submacular suprachoroidal space. Twenty-one eyes of 21 patients with choroidal neovascularization (CNV) secondary to advanced, exudative AMD were followed over a 6-month postprocedure period. Results: The microcatheter was successfully and atraumatically inserted into the suprachoroidal space of all eyes. No serious intraoperative or postoperative complications including suprachoroidal hemorrhages were encountered. Postsurgically, complications consisted of 1 eye experiencing a transient elevation in intraocular pressure at 3 months, which was medically controlled, and 2 eyes (10.5%) with an apparent increase in nuclear sclerotic cataracts. Conclusions: Suprachoroidal drug administration was achieved without serious complication using a novel microcatheter. Direct drug delivery to the choroid can potentially increase local tissue drug levels and drug efficacy for the treatment of AMD and other diseases associated with CNV.

Complications Following Inappropriate Intravitreal Triamcinolone Acetonide Injection

Purpose: Intravitreal Triamcinolone Acetonide (IVTA) is a useful treatment option for various intraocular diseases such as Macular Edema (ME). The treatment can cause several complications, including transient elevation of intraocular pressure and cataract formation. Here, we describe an atypical complication of IVTA. Case: A 60-year-old Japanese man presented with ME associated with central retinal vein occlusion. We performed intravitreal injection of 4 mg of TA. However, the drug spread behind the posterior lens capsule and also flowed into the anterior chamber. Although the amount of TA particles behind the lens capsule decreased over time, these particles persisted for more than 2 months. Conclusion: Although IVTA is an easy and effective treatment for ME, TA is harmful when injected into inappropriate regions of the eye. Accurate IVTA injection is important for effective treatment.

Bilateral traumatic expulsive aniridia after phacoemulsification

We report a case of bilateral traumatic expulsive aniridia after uneventful phacoemulsification through small clear corneal incisions. Phacoemulsification was performed 8 and 13 months prior to the trauma in the left and right eyes, respectively. In both eyes, the intraocular lens and capsular bag were undisturbed after trauma. After resolution of hyphema, transient elevated intraocular pressure, and anterior chamber inflammation, best corrected visual acuity returned to 20/25 in each eye 6 months later. Self-sealing clear corneal wounds likely serve as a decompression valve during blunt trauma, thus preventing devastating intraocular damage and globe rupture. The intraocular lens may absorb the external force, therefore preventing damage to the capsular bag and zonules as well as preventing prolapse of posterior structures. A review of previously reported cases of traumatic aniridia is also presented.

INTRAVITREAL DICLOFENAC VERSUS INTRAVITREAL TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF DIABETIC MACULAR EDEMA

To compare the efficacy and safety of intravitreal diclofenac versus intravitreal triamcinolone acetonide in the treatment of diabetic macular edema. Thirty-two eyes with diffuse diabetic macular edema were randomly allocated to intravitreal injection of 4 mg/0.1 mL of triamcinolone (Group 1: N = 16) or 500 μg/0.1 mL of diclofenac (Group 2: N = 16). Preoperative and postoperative visual acuity, intraocular pressure, and central macular thickness were recorded and compared between the 2 groups up to 12 weeks. Both groups showed statistically significant reduction in central macular thickness (triamcinolone: P = 0.02 and diclofenac: P = 0.01), without statistically significant difference between the 2 groups. Visual improvement was significant only in triamcinolone group (P = 0.05). However, the 2 groups showed no statistically significant difference in mean visual acuity or mean line improvement. Transient elevation of intraocular pressure occurred in 12.5% of the triamcinolone group. Diclofenac group showed statistically significant reduced intraocular pressure (P = 0.02). Intravitreal diclofenac is effective in the treatment of diffuse diabetic macular edema up to 12 weeks. Intravitreal triamcinolone and diclofenac appear to have comparable therapeutic effects on retinal thickness. The degree of visual improvement is higher with triamcinolone.

Delayed axonal degeneration in slow Wallerian degeneration mutant mice detected using diffusion tensor imaging

Previous studies have shown the feasibility of using diffusion tensor imaging (DTI) as a noninvasive imaging modality to evaluate neurodegeneration in humans and animals. The axial and radial diffusivities derived from DTI were demonstrated to be sensitive markers for axonal and myelin damage, respectively. This study used DTI to evaluate optic nerve degeneration in wild-type and slow Wallerian degeneration (Wld(S)) mutant mice. Longitudinal DTI was performed on optic nerves following high intraocular pressure-induced transient retinal ischemia. The axial diffusivity of wild-type nerves decreased 30% (P<0.05) at 3 days and 40% (P<0.05) at 5-30 days after transient elevation of intraocular pressure. In contrast, the axial diffusivity of Wld(S) nerves did not change at 3 days; decreased by 20% (P<0.05) at 5 days, and continued to decrease by 30% (P<0.05) at 15 days and 40% (P<0.05) at 30 days after transient intraocular pressure elevation, suggesting delayed axonal damage in Wld(S) mice. Radial diffusivity increased 200% (P<0.05) at 15-30 days in the wild-type mice and 100% (P<0.05) at 30 days in the Wld(S) mice after transient intraocular pressure elevation, suggesting delayed myelin damage in Wld(S) mice. DTI detected damage was confirmed with immunohistochemistry using phosphorylated neurofilament and myelin basic protein for assessing axonal and myelin integrity, respectively. These findings support the use of DTI not only to evaluate the progression of neurodegeneration but also to noninvasively demonstrate Wld(S) mutation to delay the Wallerian degeneration.

Glaucoma and retinal detachment surgery

AbstractPurpose Secondary transient or permanent elevation of intraocular pressure (IOP) is a quite common complication following vitreoretinal procedures.Methods This presentation will focus on different mechanisms, clinical diagnosis and management of the secondary glaucoma after scleral buckling, vitrectomy with or without gas or silicone oil tamponade, and application of steroids.Results In pre‐existing operated glaucoma with filtering surgery, maintenance of the bleb requires an approach for conjunctiva preservation with techniques such as small gauge vitrectomy. Secondary hypertension can occur after scleral buckling because of congestion and anterior rotation of the ciliary body. Medical therapy is usually successful in controlling IOP, however surgical intervention could also be needed. Intravitreal injection of gases (SF6, C3F8) may produce secondary angle‐closure glaucoma with or without pupillary block. Intraocular gas removal may be indicated. Secondary glaucoma can also develop after intravitreal injection of silicone oil due to pupillary block, inflammation, synechial angle closure, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. Patients with medically uncontrolled glaucoma after silicone oil tamponade, with an open inferior iridectomy, may require oil removal with or without concurrent glaucoma surgery.Conclusion Diode laser transcleral cyclophotocoagulation and drainage implants constitute approved methods for long‐term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial. Cooperation between vitreoretinal and glaucoma specialists may be helpful in successful treatment.

Glaucoma after vitreoretinal surgery

AbstractWith the important advances in the microsurgical techniques during the past three decades, various and complex eye diseases involving retina and vitreous are currently accessible to vitreoretinal surgery. Most current vitreoretinal surgical procedures have major relationships with glaucoma and potential devastating consequences on the optic nerve head. In a pre‐existing glaucoma patient having history of filtering surgery, maintenance of the patency of the filtering bleb requires a vitreoretinal approach for conjunctival preservation with techniques (pneumatic retinopexy or small gauge vitrectomy). Whether coming after intravitreal triamcinolone acetonide injection or associated with panretinal photocoagulation, scleral buckling, pars plana vitrectomy, intraocular gases or silicone oil tamponade, transient or sustained elevation of intraocular pressure and open‐ or closed‐angle secondary glaucomas of a multifactorial nature are a common occurrence following vitreoretinal surgery. Adequate and successful therapeutic intervention should be tailored to the individual patient based on the early identification of the underlying mechanism of the pressure elevation. Patients with or suspect for glaucoma or those who may at risk to develop postoperative ocular hypertension and secondary glaucoma should be carefully screened before any vitreoretinal procedure. This presentation will focus on the different mechanisms, frequency, risk factors, clinical diagnosis and prognosis of ocular hypertension and glaucoma resulting from the different vitreoretinal procedures with their respective available therapeutical options.

Stage II and III idiopathic macular holes treated by triamcinolone-assisted posterior vitreous detachment and internal limiting membrane peeling without any dye

Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole. Key words: Retinal perforations/surgery; Triamcinolone acetonide/ therapeutic uses Vitrectomy

The clinical observation of intraocular lens implantation in the patients of small-incision non-phacoemulsification cataract extraction with posterior capsule intraoperative rupture

Objective To study the efficacy and safety of non-phacoemulsification cataract extraction and intraocular lens implantation in the patients with intraoperative posterior capsule rupture. Methods 346 cases (381 eyes) were accepted small-incision non-phacoemulsification cataract surgery and were implanted intraocular lens. 21 cases underwent intraoperative posterior capsule rupture,of which 18 cases were accepted one-stage implantation of posterior chamber intraocular lens, 3 cases didn' t select it. The complications and postoperative visual acuity after follow-up for three months were investigated. Results Transient elevation of intraocular pressure occurred in 3 eyes ( 16. 67% ) , corneal edema in 16 eyes (88. 89% ) ,mild deviation of intraocular lens in 2 eyes ( 11. 11% ) , pupil less round and mild displacement in 5 eyes (27. 78% ). The best corrected visual acuity was more than 0. 5 in 13 eyes (72. 22% ) three months after operation. No serious complications occurred. Conclusion According to specific conditions, this technique of one-stage implantation of non-phacoemulsification intraocular lens is safe and can achieve better vision in the patients with intraoperative posterior capsule rupture during the surgery of non-phacoemulsification. Key words: non-phacoemulsification; small-incision; posterior capsular rupture; lens,intraocular

Head trauma can cause transient elevation of intraocular pressure in patients with open angle glaucoma.

To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). Retrospective case series. Chart review. All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. The relationship between head trauma and elevation of IOP appears real.

A Phase 1 Study of KH902, a Vascular Endothelial Growth Factor Receptor Decoy, for Exudative Age-Related Macular Degeneration

To determine the safety, tolerability, and bioactivity of KH902, a fully human fusion protein containing key domains from vascular endothelial growth factor receptors 1 and 2 with human immunoglobulin Fc. Prospective, single-center, open-label, dose-escalating, interventional case series. Twenty-eight patients with choroidal neovascularization (CNV) resulting from exudative age-related macular degeneration (AMD) with lesion size of 12 disc areas or less and best-corrected visual acuity (VA) of 55 letters or worse. A single intravitreal injection of KH902 at 1 of 6 escalating doses if no dose-limiting toxicity (DLT) occurred through postinjection day 14 of the previous dose level. Follow-up examinations were performed on postinjection days 1, 3, 5, 7, 14, 28, and 42. The primary end point was at 42 days, and patients were monitored for an additional 6 weeks (12 weeks total). The primary safety measures were changes from baseline in VA, intraocular pressure (IOP), intraocular inflammation, and production of anti-KH902 antibody. Dose-limiting toxicity was defined as intraocular inflammation, elevated IOP, significantly reduced vision, or retinal hemorrhage within 42 days after injection. Bioactivity measures included mean change from baseline in VA, central retinal thickness, and total macular volume on optical coherence tomography and CNV changes on fluorescein angiography. All patients completed the study with no DLT and no serious or drug-related adverse events. Ocular adverse events were mild to moderate in severity, including transient IOP elevation and injection-site subconjunctival hemorrhage after KH902 injections. No serum anti-KH902 antibodies were detected. On day 42 after injection, the mean change in VA from baseline was +19.6 letters with no subjects losing 1 letter or more and 57% of patients gaining 15 letters or more from baseline. The mean change in center point thickness from baseline was -77.2 μm and the mean decrease in CNV area was 12.6%. No safety concerns were detected after a single, intravitreal injection of KH902 up to 3.0 mg in this phase 1 study. Bioactivity of KH902 was suggested with improvements in VA, reduction in central retinal thickness, and a decrease in CVN area in patients with CNV resulting from exudative AMD, indicating that further study is warranted.

Ocular blood-flow hemodynamics before and after application of a laser in situ keratomileusis ring

To evaluate blood-flow responses before and after microkeratome application. School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. Hemodynamic responses were measured in eyes of healthy volunteers before and after transient elevation in intraocular pressure (IOP) resulting from microkeratome application. The IOP was elevated above 85 mm Hg for 90 seconds. Blood-flow responses were measured using color Doppler imaging, Heidelberg retinal flowmetry, and an ocular blood-flow analyzer. The study included 10 eyes. There was no difference in ocular-perfusion measurements before or after IOP elevation using any measurement system. In normal healthy eyes, once suction was released, blood-flow responses returned immediately to normal levels.