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Monthly measurements of intraocular pressure in normal, ocular hypertensive, and glaucoma male subjects of same age group.

BACKGROUND: Recently it has been shown that environmental conditions have a significant influence on intraocular pressure (IOP). Due to differences in inherent constitution, diet and environmental conditions, there is a clear need for well collected IOP data in different countries and ethnic groups. The seasonal variation of IOP has never been described in Pakistani subjects. METHODS: IOP was measured each month over the course of 12 months with the Goldmann applanation tonometer in normal, ocular hypertensive, and glaucoma male subjects. RESULTS: In all groups, the average intraocular pressures in the winter months were highest, while lowest in summer months. The intraocular pressures of spring and autumn months were nearly the same. The intraocular pressure levels in these seasons were between the IOP levels in summer and winter seasons. The difference between highest and lowest IOP was 1.4 +/- 0.2, 3.1 +/- 1.4, and 2.3 +/- 1.1 mmHg, in normal, ocular hypertensive, and glaucoma subjects, respectively. The ups and downs of intraocular pressure were greater in the ocular hypertensive subjects than in the glaucoma patients. CONCLUSIONS: This study confirms that season influences IOP, and concludes that seasonal influence is highest in ocular hypertensive than in normal and glaucoma subjects. As compared to other nations, effect of seasons on IOP seems to be somewhat less pronounced in Pakistan.

Glaucoma↗

Association of intraocular pressure and myopia in children.

PURPOSE: While elevated intraocular pressure (IOP) is associated with myopia in adults, its potential influence on the growth of eyes in juveniles without glaucoma is controversial. To address this issue, a possible relation between IOP and refraction in children was sought. METHODS: A cross-sectional survey of IOP was conducted in children presenting to the Division of Pediatric Ophthalmology at The Children's Hospital of Philadelphia for a complete eye examination. Measurement of IOP was attempted in all children, including those with amblyopia, prematurity, and strabismus. Exclusion criteria were abnormalities of the posterior pole and/or conditions such as cataract that precluded assessment of refractive error. For analysis, myopia was defined as a spherical equivalent of more than 1 diopter (D) of myopia. Logistic regression was used to assess the association between other patient characteristics and presence of myopia. RESULTS: Intraocular pressure testing was attempted in all age groups, but was more successful in older children. Reliable readings were obtained on 321 subjects. The mean age was 9.8 years, with a mean IOP of 17.3 mmHg in the right eye and 17.2 mmHg in the left and a mean spherical equivalent of +0.2 D in the right eye and +0.1 D in the left. Increasing age, a family history of myopia, and amblyopia were associated myopia. Increasing IOP also was related to myopia. Even when patients with amblyopia, strabismus, and prematurity were exclude, age, family history of myopia, and IOP again were associated with myopia. CONCLUSIONS: These results indicate that IOP in children may be higher in myopic than nonmyopic eyes. Whether IOP could contribute to the mechanisms causing the abnormal eye growth of childhood myopia requires further study.

Adolescent↗

Hydrocortisone replacement dosage influences intraocular pressure in patients with primary and secondary hypocortisolism.

BACKGROUND: It has been suggested that the variation of intraocular pressure (IOP) during the day follows the diurnal variation of serum cortisol. There is also a higher risk of ocular hypertension and glaucoma in patients taking excessive oral steroid treatment. We assessed whether different replacement doses of hydrocortisone (HC) influenced IOP. METHODS: Seventeen patients (six Addison's disease, 11 hypopituitarism; seven males) aged 24-58 years mean 42.7 years and 20 control subjects (nine males) aged 20--59 years mean 38.7 years were studied. On the first visit, the 17 patients had been taking HC replacement doses, 20 mg morning and 10 mg afternoon. Serum cortisol and IOP in both eyes (Goldmann applanation tonometer) were measured at 0900, 1100, 1300, 1500, 1700 hours with HC 20 mg taken after the 0900 h assessment. The dose of HC was then reduced to 10 mg morning and 10 mg afternoon for 1 week and the measurements were repeated in 16 patients, with HC 10 mg taken at 0900 h. RESULTS: In the patients the peak serum cortisol occurred at 1100 h after the 0900 h HC dose. Cortisol levels were significantly higher at 1100, 1300, 1500 and 1700 h after taking 20 mg compared to 10 mg HC. The mean (SEM) IOP (mmHg) was significantly higher after 20 mg HC compared with 10 mg HC at 1300 h: 14.7(0.6) v 13.1(0.6) (P = 0.004) and at 1500 h: 14.4(0.6) v 13.1(0.5) (P = 0.04). The total mean (SEM) daily IOP score was significantly higher after 20 mg HC compared with 10 mg HC: 14.5(0.3) v 13.5(0.3) (P = 0.0002). The total mean (SEM) daily IOP score after the 20 mg HC dose compared with the control subjects was: 14.5(0.3) v 13.7(0.3) (P = 0.08). CONCLUSION: Intraocular pressures during the day are influenced by the morning hydrocortisone replacement dosage with significantly higher intraocular pressure levels in the early afternoon following 20 mg compared with 10 mg. A morning hydrocortisone dose of 10 mg leads to a more physiological intraocular pressure profile during the day. These data support the view that a daily replacement dose of 30 mg hydrocortisone may be excessive.

Addison Disease↗

Effect of latanoprost on intraocular pressure in steroid-induced glaucoma.

PURPOSE: To study the effect of monotherapy with latanoprost 0.005% on intraocular pressure (IOP) in a prospective nonrandomized clinical trial of patients newly diagnosed with steroid-induced secondary open-angle glaucoma. PATIENTS AND METHODS: Eight patients (16 eyes) with newly diagnosed steroid-associated secondary open-angle glaucoma were prescribed latanoprost 0.005% once a day in each eye. The initial IOP before treatment served as an internal control for each eye. Intraocular pressure was remeasured after 1 month of monotherapy with latanoprost. Investigators (WJS) were blinded to initial IOP at the time of remeasurement. After discontinuation of steroids, IOP was rechecked. If IOP was stable, latanoprost was discontinued. Intraocular pressure was rechecked 2 to 4 weeks later to confirm an association with steroid use. RESULTS: Intraocular pressure was significantly decreased after treatment with latanoprost (18.3 +/- 2.8 mm Hg) compared with initial IOP (25.3 +/- 9.1 mm Hg). This change represented a 28% decrease in IOP compared with baseline levels. Average IOP after discontinuation of steroids and latanoprost (17.3 +/- 1.4 mm Hg) did not differ from IOP measured during treatment with latanoprost, but it was significantly less than the initial IOP before treatment. No adverse effects were noted. CONCLUSIONS: Monotherapy with latanoprost is safe and effective in patients with steroid-induced glaucoma. Advantages include lack of systemic side effects and convenient once-daily dosing.

Aged↗

[Intraocular pressure after phacoemulsification and implantation of silicone plate haptic intraocular lenses without viscoelastics].

BACKGROUND: A rise in intraocular pressure (IOP) after cataract operation is a well known problem. Avoidance of the use of viscoelastics seems to solve the problem. PATIENTS AND METHODS: The IOP was measured in a group of 33 eyes of 33 patients one day before, as well as 6 hours, 24 hours, and 7 days after phacoemulsification and implantation of a foldable silicone plate haptic intraocular lens without viscoelastics and by means of an injector and of the anterior chamber maintainer. RESULTS: Mean preoperative IOP was 16.1 +/- 3.9 mm Hg (range 10 to 28 mm Hg). Postoperatively mean IOP was 12.3 +/- 3.3 mm Hg (range 5 to 18 mm Hg) after 6 hours (p < 0.0001), 13.8 +/- 2.8 mm Hg (range 7 to 19 mm Hg) after 24 hours (p = 0.032), and 15.5 +/- 3.4 (range 10 to 24) after one week (p = 0.39). In none of the eyes was the pressure in the first 24 hours higher than 18 mm Hg. When excluding the 4 patients with glaucoma and PEX or when taking them as a separate group, the results were similar. CONCLUSIONS: Pressure elevation after cataract operation without the use of viscoelastic substances can be avoided, thus contributing not only to lower costs but also to a higher safety.

Adjuvants, Immunologic↗

Intraocular pressure responses to systemic autonomic stimulation.

The intraocular pressure (IOP) responses to two standard tests of autonomic nerve function were studied in 15 healthy subjects, mean age 33 years (range: 20-64). Both tests are based on cardiovascular reflexes: (1) The rise in diastolic blood pressure provoked by sustained isometric muscle contraction, a response mediated by the sympathetic nervous system and (2) The heart-rate responses to the Valsalva manoeuvre, a response mediated by the parasympathetic nervous system. During sustained isometric exercise, the mean IOP decreased significantly from baseline values of 12.60 mmHg (SEM 0.55) to 11.26 mmHg (SEM 0.32, p less than 0.05) while mean diastolic blood pressure increased by 20.80 mmHg (range: +12 to +53 mmHg). However there was no direct correlation between them (r = -0.05). Post exercise the mean IOP remained significantly lower than baseline values for five minutes (p less than 0.01). During the Valsalva manoeuvre, there was a significant increase in IOP of 7.20 mmHg from a baseline of 12.80 mmHg (SEM 0.45) to 20.00 mmHg (SEM 0.78, p less than 0.001); during the recovery period, mean IOP was significantly lower than baseline values at 12.13 mmHg (SEM 0.39, p less than 0.05). The mean Valsalva ratio was normal at 1.68 (range: 1.2-2.6). The possible mechanisms involved in these responses are discussed.

Adult↗

[Model and the experimental therapy of acute increase of intraocular pressure (author's transl)].

Comparative experiments were carried out on 63 rabbits to study the acute increase in intraocular pressure which develops in the eye after introduction of prostaglandin F2 (instillations, subconjunctival injections) and other substances (hypertonic solution of sodium chloride, and reopirin). Tonometry, tonography, and radioisotope studies of aqueous humor (24Na, albumin-labeled 131I) were done. Differences in the display and mechanisms of acute increase of intraocular pressure were marked following administration of prostaglandin and a hypertonic solution of sodium chloride. It is stated that prostaglandin increases the permeability of the blood-aqueous humor barrier for the 24Na ions in comparison with hypertonic solution of sodium chloride, and that the eye, under the influence of prostaglandin, heightens intraocular pressure. Pretreatment with dizinon (etamsilat) reduces the increase in intraocular pressure caused by prostaglandin.

Aminopyrine↗

Intraocular pressure asymmetry and undiagnosed open-angle glaucoma in an older population.

PURPOSE: To quantify prevalence of asymmetric intraocular pressure (IOP) and assess associations with undiagnosed open-angle glaucoma. DESIGN: Population-based cross-sectional study. METHODS: Participants underwent applanation tonometry. Intraocular pressure asymmetry was defined for differences > or = 3 mm Hg; open-angle glaucoma was diagnosed if glaucomatous optic disk and field changes were congruous. Analyses excluded subjects using glaucoma medication, known glaucoma, pseudoexfoliation, and cataract surgery. RESULTS: Intraocular pressure asymmetry was present in 5.1% of subjects and was greater for patients older than 70 years (6.2%). Of subjects with maximum IOP > 21 mm Hg, IOP asymmetry was present in 41.1%. Undiagnosed open-angle glaucoma was more frequent among subjects with (4.8%) than without (1.2%) IOP asymmetry. This relationship remained significant for maximum IOP < or = 21 mm Hg. CONCLUSIONS: Intraocular pressure asymmetry may be a useful sign of undiagnosed glaucoma in subjects without elevated IOP.

Aged↗

Intraocular pressure: association with menstrual cycle, pregnancy and menopause in apparently healthy women.

The relationship between days of the menstrual cycle and variations in intraocular pressure (IOP) findings are not consistent. Although, previous studies have demonstrated that IOP decreases during pregnancy and as compared to menstruating women, it is higher in postmenopausal women but the degree of the reported change in IOP values, differs from study to study. In recent years it has been noted that intraocular pressure is a dynamic function and is subject to many acute and long term influences. The large differences in the results of previous studies may be due to several neglected factors. Accordingly after placing controls on these factors this study investigated the effect of pregnancy, menopause, and menstruation on IOP. Pregnant women in each trimester and non-pregnant control, along with menstruating and menopausal subjects of the same age groups were studied. To study the effect of menstruation, in three female volunteers, IOPs were measured after every sixth day, starting from first day of the cycle, and continuing through three consecutive menstrual cycles. IOPs were measured with a Goldmann applanation tonometer. All subjects were examined according to standard protocols. In all trimesters of pregnancy, intraocular pressure was found to be lower than in non-pregnant control subjects. The difference between control and first, control and second, and control and third trimester groups were found to be 0.07 +/- 0.23 mmHg, (p > 0.05), 0.47 +/- 0.18 mmHg (p < 0.05), and 2.30 +/- 0.38 mmHg (p < 0.001), respectively. The difference between second and third trimester groups was 1.83 +/- 0.34 mmHg (p < 0.001). The mean intraocular pressures in postmenopausal women was 16.07 +/- 0.36 mmHg and in the control group, who were of same age group and still menstruating, was found to be and 15.40 +/- 0.38 mmHg. The difference between these two groups was statistically significant (p < 0.05). Although the IOP values differed in each subject at various days of the cycle, they did not correlate with it over the course of three cycles. This study confirms the ocular hypotensive effect of pregnancy and higher IOP in postmenopausal women than in those who were still menstruating. This study concludes that physiological hormonal changes associated with the menstrual cycle have no influence on intraocular pressure. Knowledge of the normal level of IOP, during various stages of female life, may help glaucoma screeners.

Female↗

A comparison of the effects of oral nadolol and topical timolol on intraocular pressure, blood pressure, and heart rate.

We compared the effects of oral nadolol 20 mg once daily and topical timolol 0.25% twice daily on the intraocular pressures of 22 glaucoma suspects, in a 12 week double-masked crossover study. Both nadolol and timolol reduced intraocular pressure (p less than 0.001). The reductions in intraocular pressure did not differ significantly after two weeks and four weeks of treatment. Nine of these subjects underwent treadmill exercise tests in order to compare the effects of nadolol and timolol on the cardiovascular system. The effects of the two treatments on blood pressure were comparable, but nadolol caused a significantly greater reduction in heart rate than timolol at rest (p less than 0.05). Nadolol reduces intraocular pressure effectively and may prove a useful alternative treatment for chronic simple glaucoma.

Administration, Oral↗

Apraclonidine prophylaxis for postcycloplegic intraocular pressure spikes.

A randomized, prospective, double-masked study was undertaken to determine the risk of postcycloplegic intraocular pressure spikes in patients with open-angle glaucoma and to evaluate apraclonidine prophylaxis in minimizing these spikes. Patients were stratified as miotic treated or untreated and each group was randomized to receive either placebo (artificial tears) or apraclonidine in both eyes before instillation of tropicamide. In both the miotic treated and untreated groups that received placebo, there was a high incidence, (37% and 38%, respectively) of clinically significant (greater than or equal to 6 mmHg) intraocular pressure spikes after instillation of tropicamide. In both the miotic treated and untreated groups, there was a statistically significant difference in postcycloplegic intraocular pressure between the subgroup that received placebo and the group that received apraclonidine prophylaxis (P = 0.003 and P = 0.006, respectively). Additionally, four eyes that received placebo had a spike of over 10 mmHg (range, 12 to 27 mmHg), while only one eye had an increase of greater than 10 mmHg (12 mmHg) in the apraclonidine group. Thus, apraclonidine appears to be a useful agent for minimizing precipitous increases in intraocular pressure after cycloplegia in eyes of open-angle glaucoma patients prone to this complication of cycloplegia.

Adrenergic alpha-Agonists↗

Mechanisms leading to an acute rise in intraocular pressure in retinal vein occlusion.

Forty patients with retinal vein occlusion were studied to investigate possible mechanisms leading to an acute rise in intraocular pressure. A rise in intraocular pressure on recumbency was found in 64% of eyes with a central retinal vein occlusion and 65% of eyes with a branch retinal vein occlusion. This finding correlated with glucose tolerance test score, and may be the result of abnormal glucose tolerance in these patients. Following provocative testing using pilocarpine and phenylephrine, no eye showed irido-corneal contact or angle closure, however over 50% of eyes release pigment into the anterior chamber. Fifty-two per cent of central retinal vein occlusion and 71% of branch retinal vein occlusion eyes that released pigment showed a rise in intraocular pressure.

Adult↗

The effect of physical activity on the intraocular pressure of glaucomatous patients.

Chronic simple glaucoma patients who performed physical activity had headache and nausea, symptoms that simulated a sudden rise in intraocular pressure. Twelve patients, who were diagnosed as suffering from simple open angle glaucoma, performed multiple bicycle ergometry. The intraocular pressure was measured during the ergometry and was compared to intraocular pressure measurements at rest. A statistically significant decrease was found in intraocular pressure during the ergometry performance. It was concluded that there is no ocular restriction for simple open angle glaucoma patients in performing physical activity.

Adult↗

Postoperative intraocular pressure spikes: the need to treat.

Raised intraocular pressure (IOP) still holds pride of place as the principal risk factor for developing glaucoma. The detrimental effects of chronically elevated IOP on the optic disc are well known. However, the clinical significance of acutely raised IOP is less certain. Transient acute elevations of intraocular pressure (IOP spikes) occur following many surgical and laser procedures. Cataract extraction, glaucoma surgery, pars plana vitrectomy with fluid air exchange, Nd-YAG capsulotomy, or peripheral iridotomy, and laser trabeculoplasty all have been reported to be associated with variable IOP spikes in the early postoperative period. There is considerable diversity of opinion concerning how these IOP spikes should best be managed. We have reviewed the nature and quality of the available experimental and clinical data relating to IOP spikes and we offer some broad, general guidelines for their clinical management.

Animals↗

Minimum concentration of levobunolol required to control intraocular pressure in patients with primary open-angle glaucoma or ocular hypertension.

In a double-masked, randomized, comparison titration study to determine the effective dose of topically applied levobunolol, three concentrations of levobunolol (0.25%, 0.5%, and 1%) and of timolol (0.125%, 0.25%, and 0.5%) were evaluated in patients with mild open-angle glaucoma or ocular hypertension. Following a washout of ocular hypotensive medication, twice-daily treatment in both eyes was initiated with the lowest of the three doses of either drug. The concentration was increased if intraocular pressure remained uncontrolled. Intraocular pressure was controlled in 63% (15 of 24) of the patients tested with the lowest concentration of levobunolol and 69% (18 of 26) with the lowest concentration of timolol. Overall, 75% (18 of 24) of the patients in the levobunolol group and 73% (19 of 26) of the patients in the timolol group had adequately controlled intraocular pressure. At the lowest concentrations tested, mean decreases from baseline in intraocular pressure ranged from 6 to 8 mm Hg in both treatment groups.

Clinical Trials as Topic↗

Control of intraocular pressure with apraclonidine hydrochloride after cataract extraction.

We conducted a randomly assigned, double-masked, controlled clinical trial to assess the efficacy of 1% apraclonidine hydrochloride in controlling postoperative intraocular pressure increases in patients undergoing extracapsular cataract extraction. Apraclonidine hydrochloride was given either one hour preoperatively or immediately after uncomplicated, extracapsular cataract extraction with posterior chamber intraocular lens implantation and compared with artificial tears given immediately postoperatively. Those who received apraclonidine hydrochloride preoperatively had significantly lower mean intraocular pressure at the first postoperative reading (P = .0005). After preoperative and postoperative apraclonidine hydrochloride, the mean early postoperative intraocular pressure was 19.8 mm Hg and 32.0 mm Hg, respectively, and 27.6 mm Hg after artificial tears. No patient who received preoperative apraclonidine hydrochloride had an intraocular pressure increase to 30 mm Hg or higher postoperatively. Nine of 20 patients (45%) who received postoperative apraclonidine hydrochloride and eight of 18 patients (44%) who received postoperative artificial tears had an increase of intraocular pressure to 30 mm Hg or higher in the early postoperative period. These differences were also highly significant (P = .0005).

Adult↗

Effects of three nasal topical steroids in the intraocular pressure compartment.

OBJECTIVE: The purpose of this study was to evaluate whether the use of fluticasone propionate, mometasone furoate, or beclomethasone dipropionate for the treatment of rhinitis produced, as a side effect, an increase in the intraocular pressure; only one printed article proclaims that the increase of secondary intraocular pressure is due to the use of local nasal steroids. PATIENTS AND STUDY DESIGN: We conducted a comparative, double-blind, experimental, prospective, longitudinal study in which 360 patients were divided at random into 4 groups; 90 of them were given a placebo (control group) and the other 270 were divided into 3 other groups of 90 patients each and given a different local nasal steroid for each group. Measurement parameters All patients had their intraocular pressure measured by Goldman's tonometry at 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after using the placebo or local nasal steroid. RESULTS: Variations were found in the intraocular pressure of patients who used local steroid, with discreet elevations in the beclomethasone dipropionate and mometasone furoate groups; however, variations were always within normal limits. CONCLUSION: Fluticasone propionate, mometasone furoate, and beclomethasone dipropionate cause variations in the intraocular pressure, but the variations are within normal limits.

Adolescent↗

Bullous keratopathy accompanying essential iris atrophy: response to lowered intraocular pressure.

We present a patient with essential iris atrophy who was normotensive and yet had corneal edema and bullous keratopathy which cleared upon lowering the intraocular pressure. It is proposed that in this patient the endothelial functional status was so compromised that it could not handle the amount of fluid driven into the cornea by a normal intraocular pressure. A more favorable balance between intraocular pressure and endothelial functional status was obtained by lowering the intraocular pressure with acetazolamide and timolol.

Acetazolamide↗