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Effect of applying the Honan intraocular pressure reducer before cataract surgery.

We studied 48 patients undergoing cataract extraction with local anesthesia. In 41 patients, after administering the retrobulbar injection, we applied the Honan intraocular pressure reducer for seven to ten minutes at a pressure setting of 30 mm Hg. Of these 41 patients, 13 received 3-ml injections, 14 received 4-ml injections, and 14 received 5-ml injections. No differences in intraocular pressure related to the quantity of retrobulbar injection were noted. After retrobulbar injection, the mean intraocular pressure for the study population as a whole increased 4.4 mm Hg; after application of the Honan device, it decreased 6.2 mm Hg. In a control group of seven patients, who received 4-ml retrobulbar injections but no applications of the Honan device, mean intraocular pressure increased 6.1 mm Hg immediately after retrobulbar injection and decreased only 0.7 mm Hg after seven to ten minutes.

Bupivacaine↗

Intraocular pressure elevation caused by massive and prolonged hemorrhage after trabeculotomy ab externo.

A case with postoperative elevated intraocular pressure levels caused by massive and prolonged hemorrhage after trabeculotomy ab externo is presented. In this case, intraocular pressure was controlled by removal of the hemorrhage, but the transient elevation resulted in progression of visual field defect. Thus, resorption of hyphema and intraocular pressure levels should be monitored closely after trabeculotomy, and surgical removal of the hemorrhage appears to be an effective treatment for this rare complication.

Female↗

Measurements of intraocular pressure made with multiple noncontact tonometers.

Intraocular pressure measurements were made on 30 normal eyes using seven noncontact tonometers. The instruments were from 4 to 8 years old. Results show that pressures indicated by most noncontact tonometers are not significantly different. In the most extreme case, differences in mean pressures of 3.48 mm Hg were obtained. A difference of this magnitude may be important when following a patient over a period of time, and could be the result of measurements being made on a different tonometer.

Humans↗

Intraocular pressure measurement in patients with previous LASIK surgery using pressure phosphene tonometer.

PURPOSE: To compare intraocular pressure (IOP) assessment in post-LASIK patients using non-contact tonometry, pressure phosphene tonometry and applanation tonometry. METHODS: Sixty-two consecutive LASIK patients were analysed preoperatively and postoperatively with non-contact, pressure phosphene and applanation tonometry. Comparisons among these values were assessed with paired sample Student t-test, Pearson's correlation test and Bland-Altman plotting. RESULTS: There was no significant difference for preoperative IOP measurement between non-contact, pressure phosphene and applanation tonometry. The mean +/-SD difference between the preoperative non-contact tonometry and postoperative pressure phosphene tonometry IOP measurements was 0.80 +/- 2.77 mmHg (P < 0.01). Postoperative applanation tonometry significantly underestimated IOP measurement by 5.45 +/- 2.96 mmHg (P < 0.001) and postoperative non-contact tonometry significantly underestimated IOP measurement by 9.96 +/- 2.25 mmHg (P < 0.001). CONCLUSION: Pressure phosphene tonometry may provide an alternative method for the assessment of IOP in post-LASIK patients.

Adult↗

Inhibition of the epinephrine-induced reduction of intraocular pressure by systemic indomethacin in humans.

In a prospective, randomized, double-masked study, 2% epinephrine applied topically twice each day for two weeks to the eyes of patients with glaucoma or ocular hypertension caused an 8.1 +/- 1.4-mm Hg (mean +/- S.E.M.) reduction of intraocular pressure in placebo-treated patients, but only a 1.9 +/- 0.6-mm Hg decrease in patients treated with 25 mg of orally administered indomethacin four times each day (P less than .0005). Systemic treatment with indomethacin for one week did not significantly increase intraocular pressure by itself (baseline, 19.7 +/- 0.6 mm Hg, vs 20.1 +/- 1.4 mm Hg after indomethacin treatment). When indomethacin treatment was discontinued in those patients receiving topical epinephrine, there was a further significant (P less than .05) reduction in intraocular pressure compared with the placebo-treated group. Since the ocular hypotensive effect of topically applied epinephrine is inhibited by indomethacin, a cyclo-oxygenase inhibitor, these results suggest that this reduction of intraocular pressure is at least partially mediated by the endogenous production of prostaglandins, or other cyclo-oxygenase products, and that the intraocular pressure of glaucoma patients undergoing epinephrine therapy may increase when systemic cyclo-oxygenase inhibitors such as indomethacin or aspirin are taken.

Administration, Oral↗

Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma.

Fifty-five patients with primary open-angle glaucoma and early glaucomatous damage who had medical therapy and laser trabeculoplasty were followed up for four to 11 years or until progressive glaucomatous damage was documented. Factors associated with the stability or progression of glaucoma were evaluated. Eyes with mean intraocular pressure higher than 21 mm Hg during the follow-up period uniformly had progressive glaucomatous changes. Conversely, eyes with mean intraocular pressure less than 17 mm Hg remained stable, and approximately half of the eyes with mean intraocular pressure between 17 and 21 mm Hg had progressive glaucomatous changes. Patients who remained stable were slightly younger than those with progressive glaucomatous changes (P less than .05), but initial optic nerve head appearance, initial visual field findings, number of medicines used, medical history, and patient gender or race were not statistically associated with stability or progression of the glaucoma. These findings reinforce the importance of intraocular pressure control in primary open-angle glaucoma and the need to identify other markers that help determine the proper level of intraocular pressure for individual patients.

Adult↗

[Experimental investigations on the influence of environmental stimuli on the intraocular pressure (author's transl)].

The aim of this study was to demonstrate the effects of the influences of the technological world (optical, acoustical and stress) on intraocular pressure. The experiments were undertaken on rabbits for the following reasons: compliance with the laws governing experimentation, practicability, and the assumption that our premise was correct. Under normal living conditions we found that the rabbit's intraocular pressure followed a pattern of; mornings an average of 23.15 mm Hg, afternoons of 23.05 mm Hg, and evenings of 24.14 mm Hg. After subjection to intense optical and acoustical strain and after situations of stress the intraocular pressure rose on an average of 6 mm Hg (25%). It seems clear that we should make use of these results in our practice and give appropriate consultation and advice to our patients with raised intraocular pressure.

Acoustic Stimulation↗

Comparison of intramuscular and intravenous succinylcholine on intraocular pressure.

The effect of succinylcholine on intraocular pressure was determined in one group of patients who received the drug intravenously, compared with a similar group receiving the drug intramuscularly. The group receiving intravenous succinylcholine showed a significantly earlier rise in pressure and a significantly higher rise in pressure compared to the group receiving the drug intramuscularly. In both groups the pressure returned to normal within five minutes. It is suggested that in cases with a ruptured globe or wound leak in which succinylcholine is used to facilitate tracheal intubation, the drug should be administered intramuscularly.

Adolescent↗

The effect of standardised submaximal work load on intraocular pressure.

A relatively small decrease in intraocular pressure secondary to submaximal work can be demonstrated when factors other than the work load itself are eliminated--diurnal variation, body position, and the effect of repeated examinations. A feedback mechanism that causes a return of IOP towards its normal value after work-induced decreases is postulated.

Adult↗

The use of cyclodialysis to limit exposure to elevated intraocular pressure in rat glaucoma models.

Elevated intraocular pressure (IOP) is the most common risk factor for glaucoma and pressure control is the goal of current clinical glaucoma therapy. Yet, recent clinical studies have documented that, even after therapeutic lowering of IOP, glaucomatous visual field loss can progress in many patients. Experimental elevation of IOP in the rat is commonly used to model human glaucomatous injury. However, there currently is no rodent model for the clinical situation of glaucomatous progression in eyes with apparently controlled IOP. The purpose of this study was to evaluate the ability of surgical cyclodialysis to produce both prolonged, non-injurious reduction of IOP in rat eyes and to stably normalize IOP in eyes with experimental pressure elevation. To perform cyclodialysis, a blunted spatula was fashioned from a hypodermic needle and used to separate a portion of the ciliary body from the sclera, opening a channel into the suprachoroidal space to allow aqueous outflow. Experimental IOP elevation was produced in rats by unilateral injection of hypertonic saline. Cyclodialysis in normal eyes resulted in an average 40 +/- 4% reduction in IOP, without marked hypotony. IOP lowering could be sustained for at least 6 months. The risk of retinal or optic nerve injury following a single cyclodialysis procedure was minimal as evidenced by unaltered levels of four injury-responsive retinal mRNAs and by normal optic nerve morphology. Cyclodialysis in eyes with experimental IOP elevation resulted in IOP normalization that was sustained for durations of 7 and 21 days in 88% and 53% of eyes, respectively. In addition, in eyes with the same cumulative dose of elevated IOP prior to the procedure, successful IOP normalization by cyclodialysis resulted in significantly less optic nerve injury than that seen in eyes in which IOP control was ineffective (p = 0.03). These studies show that cyclodialysis provides a simple, non-injurious method to reduce experimentally elevated IOP in rats that can be used to model the clinical situation of eyes previously damaged by pressure. This tool offers new opportunities for identifying and studying the molecular processes associated with glaucomatous progression and for testing potential neuroprotective therapies in a clinically relevant situation.

Animals↗

The relationship between intraocular pressure and visual field progression in glaucoma.

The purpose of this study was to determine the intraocular pressure characteristics in glaucoma suspects and patients whose visual fields were classified as stable or progressing over a long-term follow-up. We present data from 64 patients who received either medical or laser treatment and who were followed up for a median of 7.4 years. The visual fields of 27 patients were classified as stable and 37 as progressing using predetermined criteria on either the Tübinger or Goldmann perimeter. Patients with initially normal and initially abnormal fields were analysed separately to avoid bias. There were no significant group differences in the mean, highest or interquartile range of intraocular pressure in the follow-up. The largely overlapping distributions over a wide spectrum of the pressure variables in patients with stable and progressing fields show that intraocular pressure alone cannot separate these two groups of patients. Our study does not suggest that pressure reduction in glaucoma has no beneficial effect, but that there may be other factors which determine the fate of the visual field in glaucoma.

Aged↗

The effect of miotics on the intraocular pressure of conscious owl monkeys.

The intraocular pressure of conscious, unsedated owl monkeys (Aotus trivirgatus) was measured with an applanation tonometer. Untreated eyes of the conscious animals were found to have higher values than those reported for owl monkeys anesthetized with pentobarbitone. Locally applied pilocarpine, carbachol, and oxotremorine gave concentration-related reduction in pressure, oxotremorine being the most potent and having longer duration of effect than the other compounds. Slight reductions were also observed with aceclidine and R. S. 86. These results are discussed in relation to the effects of miotics in man.

Anesthesia, Local↗

Botulinum A toxin injection for restrictive myopathy of thyroid-related orbitopathy: effects on intraocular pressure.

PURPOSE: To study the effect of extraocular muscle injections of botulinum A toxin on intraocular pressure in patients with thyroid-related orbitopathy. DESIGN: Retrospective observational case series. METHODS: The medical records of eight consecutive patients with restrictive myopathy secondary to thyroid related orbitopathy (TRO) who underwent botulinum A toxin injection from December 1997 to December 1998 were reviewed and analyzed retrospectively. All patients were seen at the University of California, San Diego (UCSD) Thyroid Eye Center, a university-based tertiary referral center. The main outcome measure was intraocular pressure (IOP) readings taken before and after injection in both primary gaze and upgaze (involving one eye in seven of the patients and both eyes in one patient). Intraocular pressure readings were measured by an unmasked physician using a Goldmann applanation tonometer. RESULTS: A statistically significant decrease in IOP in upgaze was noted 2 to 6 weeks following botulinum A toxin injection and in both fields of gaze (primary and upgaze) after 2 to 4 months. The mean IOP before injection was 21.4 +/- 3.0 mm Hg in primary gaze and 29.9 +/- 9.7 mm Hg in upgaze. The mean IOP, following injection at 2 to 6 weeks, was 19.2 +/- 4.2 mm Hg (P <.095) in primary gaze and 25.1 +/- 5.9 mm Hg (P <.023) in upgaze. At 2 to 4 months following injection, the mean IOP was 19.3 +/- 3.9 mm Hg (P <.044) in primary gaze and 27.7 +/- 8.5 mm Hg (P <.024) in upgaze. Six patients indicated improved ocular deviation, which was associated with a lowering of IOP. Two patients indicated no change in IOP or strabismic deviation following botulinum A toxin injection. CONCLUSIONS: Botulinum A toxin injections cause a secondary effect to lower IOP in patients with restrictive strabismus associated with thyroid-related orbitopathy.

Adult↗

[Metipranolol in the prevention of intraocular pressure elevation after cataract extraction].

Elevated intraocular pressure during the first few days after routine intracapsular cataract extraction with and without alpha-chymotrypsin is a well-known symptom. A prospective, double-blind study was conducted to determine whether Metipranolol would prevent this increase in pressure. In 40 eyes which underwent routine, uncomplicated cataract extraction a drop of either Metipranolol 0,6% or placebo was administered before and during the first days after surgery. Prophylactic Metipranolol 0,6% can substantially reduce the incidence of severe early postoperative ocular hypertension.

Adrenergic beta-Antagonists↗

Effect of chymase on intraocular pressure in rabbits.

Chymase is a chymotrypsin-like serine protease that is stored exclusively in the secretory granules of mast cells and converts big endothelins to endothelin-1 (1-31). The aim of this study was to evaluate the effect of chymase on intraocular pressure in rabbits. Chymase injection (3 and 10 mU) resulted in a trend toward increased intraocular pressure and a significant increase in intraocular pressure at a dose of 10 mU compared with the control. A specific chymase inhibitor, Suc-Val-Pro-Phe(P)(OPh)(2), attenuated the ocular hypertension induced by chymase. Endothelin-1 (1-31) also caused ocular hypertension, which was inhibited by a selective endothelin ET(A) receptor antagonist, cyclo(D-Asp-Pro-D-Val-Leu-D-Trp) (BQ-123). Moreover, chymase-induced ocular hypertension was inhibited by BQ-123. These results suggest that chymase influences the regulation of intraocular pressure, and it is likely that the formation of endothelin-1 (1-31) and subsequent activation of endothelin ET(A) receptors are involved in the development of ocular hypertension induced by chymase.

Animals↗

Intraocular pressure measured at ground level and 10,000 feet.

BACKGROUND: Intraocular pressure (IOP) may be subject to change during altitude exposure. This may be an important consideration for long-haul flights. In this study, intraocular pressure change was investigated following exposure to an altitude of 10,000 ft during flight in an unpressurized aircraft. METHODS: We measured the IOP of the right eye of 20 healthy volunteers (18 men, 2 women; mean age 34.6 +/- 9.5 yr) at a ground level of 1,760 ft (536 m) above the sea level (ASL) using a Tono-Pen XL tonometer. We then repeated the measurements during a flight in the unpressurized cabin of a CASA (CN235-100 M) aircraft after gaining an altitude of 10,000 ft (3,048 m) ASL. Changes in the IOP were evaluated. RESULTS: Mean IOP was 16.2 +/- 2.46 mmHg at ground level and 15.0 +/- 2.61 mmHg at 10,000 ft (3,048 m) ASL. IOP was reduced in 13 eyes, increased in 6 eyes, and remained unchanged in 1 eye. The mean change in IOP was 1.2 +/- 2.69 mmHg. However, this was not statistically significant (p = 0.06). CONCLUSION: Acute change in altitude resulted in a statistically non-significant reduction in IOP in healthy subjects.

Adult↗