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PubMed2005

Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification.

PURPOSE: To evaluate the intraocular pressure (IOP) lowering effect of travoprost and brinzolamide within the first 24 h after phacoemulsification cataract surgery. METHODS: This prospective, randomized, double-masked, controlled study comprised 90 eyes of 90 consecutive patients with senile cataract who had uneventful phacoemulsification surgery. Eyes in the first group received travoprost 0.0015%, second group received brinzolamide 1%. Eyes in the third group received balanced salt solution and were used as control. One drop was instilled immediately after surgery. IOP was measured 24 h preoperatively, 6 and 24 h postoperatively. Analysis of variance, Student's-t and chi2-tests were used for statistical analyses. RESULTS: Preoperatively IOP was not significantly different among the three groups (P = 0.653). At 6 and 24 h postoperatively IOP was lower in both travoprost and brinzolamide group when compared to control group (P = 0.018 and 0.015 at 6 h, P = 0.010 and 0.007 at 24 h between travoprost and brinzolamide group was not significant (P = 0.744 at 6 h and P = 0.672 at 24 h). CONCLUSION: Both travoprost and brinzolamide significantly lowered IOP after small incision phacoemulsification cataract surgery within the first 24 h without any side effect.

Adult↗

PubMed2000

Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 1 intraocular pressure control and complications.

BACKGROUND: Reduction of intraocular pressure (IOP) by 20-30% with glaucoma drainage surgery slows disease progression in normal tension glaucoma (NTG). It is not clear whether adjunctive antiproliferative agents are necessary or safe in eyes at low risk for scarring. METHOD: 86 eyes of 73 white NTG patients who had undergone a primary guarded fistulising procedure were reviewed. 25 eyes had no antiproliferatives, 36 had peroperative 5-fluorouracil (5-FU) and 25 had peroperative mitomycin C (MMC). Their postoperative IOPs, complications, and changes in visual acuity were recorded. RESULTS: Eyes that had no adjunctive antiproliferative less commonly maintained a 20-30% reduction in IOP (47.4% at 2 years) compared with either the 5-FU group (69.4%at 2 years, p=0.01) or the MMC group (64.9% at 2 years, p=0.04). Eyes that had adjunctive MMC more often had late hypotony (28%, p=0.02) and late bleb leak (12%, p<0.001). Eyes that had adjunctive MMC also more often had a two lines loss of Snellen visual acuity (39.8% by 2 years) compared with those that had adjunctive 5-FU (14.7% by 2 years), p=0.06. CONCLUSION: For NTG patients at low risk of scarring trabeculectomy with adjunctive peroperative 5-FU should maintain a suitable target IOP without the additional sight threatening complications seen with adjunctive MMC.

Aged↗

PubMed1998

The accuracy of finger tension for estimating intraocular pressure after penetrating keratoplasty.

BACKGROUND AND OBJECTIVE: Intraocular pressure (IOP) estimation by Goldmann tonometry is inaccurate in the immediate postoperative period after penetrating keratoplasty. For this reason, many corneal surgeons use a finger tension (FT) IOP estimation technique in the early post-keratoplasty period. The authors performed a prospective clinical study to evaluate the accuracy of this traditional technique. PATIENTS AND METHODS: FT estimates were performed by three experienced corneal surgeons on 68 patients on the first and second days after penetrating keratoplasty. These estimates were compared with MacKay-Marg (MM) tonometry readings for these patients. RESULTS: The mean confident FT from the pooled data of the three surgeons exceeded the MM reading by 5.0 mm Hg (22.6 vs. 17.6). The mean FT exceeded the MM reading by only 3.9 mm Hg for the most accurate surgeon. Some observers were significantly more accurate than others, however, lid edema and tenderness of the globe markedly diminished the FT accuracy of all of the observers at significance levels of P < .001 and P < .01, respectively. Among all of the FT estimates, in only one patient (2%) did the FT underestimate the MM reading by more than 10 mm Hg. CONCLUSION: The authors' results suggest that for some patients, and for some surgeons, the FT or digital method of IOP estimation remains useful for detecting elevated IOP early after corneal transplantation if the proper technique is used and substantial lid edema and patient discomfort are absent.

Fingers↗

PubMed2006

Dynamic contour tonometry: a new way to assess intraocular pressure in ectatic corneas.

PURPOSE: To compare intraocular pressure (IOP) measurements in patients with keratoconus (KC), pellucid marginal degeneration (PMD), and unilateral penetrating keratoplasty (PK) for KC by Goldmann applanation tonometry (GAT), Tono-Pen tonometry (TP), and Pascal dynamic contour tonometry (DCT). METHODS: Patients with KC, PMD, or PK were included in a prospective study. IOPs were measured by GAT, TP, and DCT. Severity of ectasia was determined by the steep curvature by corneal topography and central thinning by contact ultrasound pachymetry. IOP measurements were compared and correlated with disease severity. RESULTS: Fifty-three eyes of 36 patients were enrolled. Mean age was 45.3 +/- 12.5 years (range: 28-72 years). Twenty-nine eyes had KC, 21 eyes had a PK for KC, and 3 eyes had PMD. Mean DCT, GAT, and TP readings were 16.1 +/- 2.9, 14.3 +/- 4.1, and 13.8 +/- 4.1 mm Hg, respectively. The differences of mean IOP between GAT and DCT and TP and DCT were statistically significant, whereas the difference between GAT and TP was not. Both GAT and TP readings were significantly higher in the PK eyes than the KC and PMD eyes, whereas DCT readings were not. DCT measurements were not significantly different in PK versus non-PK eyes. CONCLUSION: DCT is a newly Food and Drug Administration (FDA)-approved device that is designed to measure IOP, independent of corneal thickness, corneal curvature, and ocular rigidity. DCT gave significantly higher IOP readings than GAT and TP in this study. DCT readings were not affected by corneal thickness. DCT may be more accurate in IOP measurement in eyes with KC and PMD.

Adult↗

PubMed1989

[A pilot study on the effect of atrial natriuretic peptide on intraocular pressure in the human].

The presence of receptors for atrial natriuretic factor (HANaP) on the ciliary body leads to the conclusion that HANaP may play a role in the regulation of intraocular pressure. In two groups of patients (each group consisted of ten patients) the injection of 100 mg HANaP was followed by a significant lowering of the intraocular pressure. This effect could be seen over a period of 4 h. The intraocular pressure was reduced by about 25% of the baseline pressure.

Atrial Natriuretic Factor↗

PubMed1989

Comparison of postoperative intraocular pressures after use of Miochol and Miostat.

Over 100 cases of standard extracapsular cataract extraction with intraocular lens implantation were reviewed and the effects of two commercially available pharmacological agents were compared. The treatment groups received either acetylcholine chloride (Miochol) or carbachol (Miostat). Intraocular pressures were measured preoperatively and 20 to 24 hours postoperatively. The difference in mean pressures between the treatment groups was statistically significant. The results of the study showed Miostat to be the better pharmacological agent for controlling intraocular pressure 20 to 24 hours later. Since the majority of surgeons use Miochol rather than Miostat, the conclusions of this study appear to be significant.

Acetazolamide↗

PubMed2003

Inhibition of 11beta-hydroxysteroid dehydrogenase type 1 lowers intraocular pressure in patients with ocular hypertension.

BACKGROUND: Intraocular pressure (IOP) is maintained by a balance between aqueous humour (AH) production (dependent on sodium transport across a ciliary epithelial bi-layer) and drainage (predominantly through the trabecular meshwork). In peripheral epithelial tissues, sodium and water transport is regulated by corticosteroids and the 11beta-hydroxysteroid dehydrogenase (11beta-HSD) isozymes (11beta-HSD1 activating cortisol from cortisone, 11beta-HSD2 inactivating cortisol to cortisone). AIM: To analyse expression of 11beta-HSD in the human eye and investigate its putative role in AH formation. DESIGN: Multipart prospective study, including a randomized controlled clinical trial. METHODS: The expression of 11beta-HSD1 in normal human anterior segments was evaluated by in situ hybridization (ISH). RT-PCR for 11beta-HSDs, glucocorticoid and mineralocorticoid receptors (GR, MR) was performed on human ciliary body tissue. AH cortisol and cortisone concentrations were measured by radioimmunoassay on specimens taken from patients with primary open-angle glaucoma (POAG) and age-matched controls. Randomized, placebo-controlled studies of healthy volunteers and patients with ocular hypertension (OHT, raised IOP but no optic neuropathy) assessed the effect of oral carbenoxolone (CBX, an inhibitor of 11beta-HSD) on IOP. RESULTS: ISH defined expression of 11beta-HSD1 in the ciliary epithelium, while RT-PCR analysis of ciliary body tissue confirmed expression of 11beta-HSD1, with additional GR and MR, but not 11beta-HSD2 expression. In both POAG patients and controls, AH concentrations of cortisol exceeded those of cortisone. The CBX-treated healthy volunteers who demonstrated the largest change in urinary cortisol metabolites, indicative of 11beta-HSD1 inhibition, had the greatest fall in IOP. Patients with OHT showed an overall reduction of IOP by 10% following CBX administration, compared to baseline (p<0.0001). DISCUSSION: CBX lowers IOP in patients with ocular hypertension. Our data suggest that this is mediated through inhibition of 11beta-HSD1 in the ciliary epithelium. Selective and topical inhibitors of 11beta-HSD1 could provide a novel treatment for patients with glaucoma.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗

PubMed2001

Intraocular pressure and medication control after clear corneal phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs.

PURPOSE: To determine whether clear corneal phacoemulsification and the implantation of a copolymer acrylic (AcrySof, Alcon, Fort Worth, TX) intraocular lens will maintain the intraocular pressure (IOP) and number of medications in patients with a previous filtering bleb. PATIENTS AND METHODS: This retrospective analysis included 69 consecutive patients with previous trabeculectomy who had a copolymer acrylic intraocular lens implanted during cataract surgery between 1995 and 1999 by a single surgeon (A.C.S.C.). RESULTS: Mean IOP significantly decreased from 26.03 mm Hg (range, 14.5-70 mm Hg; n = 69) before trabeculectomy to 13.58 +/- 3.98 mm Hg (range, 5-24 mm Hg; n = 69) before the cataract extraction. After cataract extraction, the mean IOP increased significantly by 1.49 mm Hg (n = 67; P = 0.0013), by 1.85 mm Hg (n = 57; P = 0.0005), and by 1.01 mm Hg (n = 67; P = 0.042) after 6 months, after 1 year, and at the patient's last appointment, respectively. When patients whose pressures were purposely increased during cataract surgery were not included (n = 5), the mean increase at the last appointment was not significantly increased (0.54 mm Hg; n = 62; P = 0.25). The average number of antiglaucoma medications decreased from 2.93 (range, 1-5; n = 69) before trabeculectomy to 0.36 (range, 0-2; n = 69) before cataract surgery. This mean decreased to 0.34 (range, 0-2; n = 67; P = 0.8366) 6 months after cataract surgery and increased to 0.49 (range, 0-3; n = 57; P = 0.1029) and 0.62 (range, 0-3; n = 67; P = 0.0006) after 1 year and at the last appointment, respectively. Of the total study population, two (2.9%) patients required additional glaucoma surgery and 14 (20.3%) patients required additional antiglaucoma medications as compared with their precataract levels. CONCLUSIONS: Clear corneal phacoemulsification and the implantation of a copolymer acrylic (AcrySof, Alcon) posterior chamber intraocular lens statistically increased the number of medications and IOP of patients in our study. These increases, although statistically significant, did not cause a clinically significant deterioration in IOP control.

Acrylates↗

PubMed1975

Bell's palsy and intraocular pressure.

A prospective study was established to test the effect of orbicularis tone on intraocular pressure. Local nerve block of the 7th cranial nerve by either the methods of Van Lint or O'Brien and Atkinson revealed no effect on the measured intraocular pressure.

Facial Paralysis↗

PubMed2004

Intraocular pressure fluctuations in response to the water-drinking provocative test in patients using latanoprost versus unoprostone.

Impairment of outflow facility in glaucoma causes large intraocular pressure (IOP) fluctuations that have been shown to be a risk factor for disease progression. The water-drinking provocative test (WDT) has been proposed as an indirect measurement of outflow facility to compare intraocular pressure responses of glaucoma eyes to different drugs. This study was a double-masked, randomized, parallel-group clinical trial comparing the IOP fluctuations in response to the WDT in patients using latanoprost versus unoprostone. After completing a wash-out of ocular hypotensive medications, patients with primary openangle glaucoma or ocular hypertension were randomized to receive either latanoprost (N=40) or unoprostone (N=42). IOP was measured before treatment and at 8 weeks after treatment (baseline IOP for WDT), followed by the WDT. IOP fluctuations and maximum IOP after water ingestion were compared between the two groups. Analysis of covariance was used to adjust for the effects of baseline IOP and treatment efficacy. The mean percentage reduction of IOP was 27% in patients using latanoprost, as compared to 13% in patients using unoprostone (p<0.001). Patients on treatment with latanoprost had significantly less IOP fluctuations in response to the WDT, compared to patients using unoprostone. From an overall baseline IOP of 20.0 mmHg and an overall treatment efficacy of 20%, the mean+/-standard error of the mean (SEM) of the IOP fluctuation during the WDT was 5.3+/-0.4 mmHg in the unoprostone group, and 3.6+/-0.4 mmHg in the latanoprost group (p=0.005, ANCOVA). This could represent an additional benefit of latanoprost over unoprostone in controlling the intraocular pressure of glaucomatous patients.

Antihypertensive Agents↗

PubMed1978

Intraocular pressure tonometry.

The family physician should include measurement of the intraocular pressure in his examination. Chronic open-angle glaucoma can be discovered early. Tactile tension is not adequate. Many methods are available, but the Schiøtz tonometer is the best for general use. Careful attention to technique is required. When the tonometer reveals an intraocular pressure exceeding 21 mm. Hg, further studies are necessary for a diagnosis of glaucoma.

Glaucoma↗

PubMed2002

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. RESULTS: Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). CONCLUSIONS: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Aged↗

PubMed1994

Mechanism of intraocular pressure decrease after contact transscleral continuous-wave Nd:YAG laser cyclophotocoagulation.

Twenty-two eyes of 11 cynomolgus monkeys were subjected to contact transscleral cyclophotocoagulation with a continuous-wave Nd:YAG laser. The right eye of each monkey was coagulated at the pars plicata region by the contact probe placed 1.0 mm from the limbus, while the left eye of each monkey was coagulated at the pars plana region by the contact probe placed 3.0 mm from the limbus. Physiological and morphological studies were carried out up to 6 months after the treatment. The postoperative intraocular pressure showed a significant decrease within 1 week, corresponding to the inflammation of the anterior chamber. A gradual increase of the intraocular pressure occurred from the 2nd week on and returned to the preoperative value 8 weeks after pars plicata coagulation. The pars plana coagulation group maintained the intraocular pressure lower than the preoperative value until the end of the observation period. Histopathological examinations were carried out by the use of tracer particle perfusion into the anterior chamber. The pathologic features of pars plicata coagulation were necrosis, followed by atrophy of the ciliary process. The tracer particles accumulated at the anterior portion of the space between the bundles of ciliary muscle. The pathologic features of pars plana coagulation were necrosis followed by extension of proliferative tissue into the vitreous. The surrounding extracellular space of the stroma was enlarged, and the ciliary muscles were separated from the sclera. The tracer particles accumulated at the enlarged extracellular space of the stroma and the opened suprachoroidal space. These results suggest that the decrease of the intraocular pressure after pars plicata cyclocoagulation resulted from the reduction of aqueous secretion, whereas that after pars plana cyclocoagulation resulted from enhancement of the uveoscleral outflow through the enlarged extracellular space from the anterior chamber into the suprachoroidal space.

Animals↗

PubMed1999

Effects of ethacrynic acid on intraocular pressure of anesthetized rats.

Ethacrynic acid (ECA) lowers intraocular pressure (i.o.p.) by an effect usually ascribed to increased drainage of aqueous humor by the trabecular meshwork. Here, we describe the effects of a continuous 2-hr intracameral infusion of balanced salt solution (BSS), with or without 2 mM ECA (sodium salt), on IOP of pentobarbital anesthetized rats. The infusion was divided into a constant (0.05 microliter/min) and a periodic (0.25 microliter/min) component that cycled 4 min on then 4 min off. This permitted the calculation of dynamic changes in resistive (trabecular and uveoslceral drainage) and nonresistive (aqueous synthesis, episcleral venous pressure) components of IOP by fitting a second-order transfer function to the responses. ECA markedly blunted the BSS-induced rise in IOP (P < 0.01). The rise in resistive mechanisms (ocular impedance) was transiently blunted by ECA (P < 0.05) during the third and fourth 8-min cycles, and nonresistive mechanisms were reduced by ECA from cycles 3-10 (P < 0.05). Then, at the end of the infusion, the control and ECA dynamic values were similar (P < 0.05), although IOP of ECA-treated rats was still slightly reduced (P < 0.05). The most likely explanation is a summation of small changes in both resistive and nonresistive components of IOP dynamics. Systemic blood pressure was unchanged within either group. The well-known effects of ECA on the trabecular meshwork, alone, are insufficient to explain the dynamic changes in IOP observed in this model.

Anesthesia↗

PubMed2004

Evaluation of intraocular pressure change after laser in situ keratomileusis using the pressure phosphene tonometer.

PURPOSE: To evaluate the applicability of pressure phosphene tonometry in measuring intraocular pressure (IOP) after laser in situ keratomileusis (LASIK). SETTING: Baptist Eye Clinic, Kyoto, Japan. METHODS: Thirty-six eyes of 22 consecutive patients who had had LASIK for myopia were enrolled in this prospective comparative study. The mean age of the patients was 32.6 years +/- 9.0 (SD). The IOP was measured using the pressure phosphene tonometer (FPT), Goldmann applanation tonometry (GAT), and noncontact tonometry (NCT). The patients themselves took measurements with the FPT before and 1 week after surgery. One-way analysis of variance followed by a Bonferroni/Dunn multiple comparison post hoc test was administered to compare the preoperative and postoperative measurements with each tonometer. These data were represented graphically using a method described by Bland and Altman. The relationship between each tonometric change and the central corneal thickness (CCT) or keratometry (K) changes after LASIK were evaluated with by Pearson correlation coefficient. RESULTS: Statistically significant differences were found between preoperative and postoperative measurements with GAT and NCT but not with FPT. Preoperative and postoperative FPT readings conformed to the British Standard for reproducibility of a standard test method for IOP estimation. No significant correlation between FPT changes and CCT or K changes was found. CONCLUSIONS: Pressure phosphene tonometry measures IOP through the upper eyelid, and changes in corneal shape do not appear to have an effect on the IOP. The IOP measurements with FPT were constant before and after LASIK.

Adult↗

PubMed1975

The effect of intraocular pressure on conventional outflow resistance in the enucleated human eye.

A technique for measuring resistance to outflow in enucleated eyes is described. The technique minimizes the artifactual effects of ocular stretching and anterior chamber deepening. Using this perfusion technique, it was found that the resistance to outflow in normal, enucleated human eyes increases directly and linearly with intraocular pressure. This phenomenon, termed the outflow obstruction effect, was defined as the fractional increase in baseline outflow resistance (outflow resistance at an outflow pressure of zero) per millimeter of Hg intraocular pressure rise above baseline and was designated by the letter Q. The value of Q was found to be 0.012 mm. Hg-1 plus or minus 0.0014 indicating that the outflow resistance rise above its baseline value approximately 1 per cent per millimeter of Hg rise in intraocular pressure. Estimates of Q, calculated from data published by other investigators over the past two decades, are also included.

Anterior Chamber↗

PubMed1977

The association of HLA-B7 and HLA-B12 antigens with cup/disk ratio, family history of glaucoma, and intraocular pressure.

The presence of either HLA-B7 or HLA-B12 antigens was associated with a higher prevalence of cup/disk ratios greater than 0.3 in the GG responders (intraocular pressure greater than 31 mm Hg after six weeks of topical dexamethasone 0.1%, four times daily) and in the combined NN-NG (intraocular pressure less than or equal to 31 mm Hg) groups. The presence of either antigen was associated with a higher prevalence of a family history of glaucoma in the GG group. N association was noted between the antigens and age, sex, race, or mean intraocular pressure in either of the groups studied.

Dexamethasone↗

PubMed1989

The effect of various levels of intraocular pressure on the rat aqueous outflow system.

The eyes of 20 normal mature Swiss albino rats were fixed by intracameral perfusion with glutaraldehyde at various levels of intraocular pressure (10, 20, 30 and 40 mmHg). The anterior chamber was connected by a fine cannula to a reservoir of fixative for 10 minutes while the animal was maintained under anaesthesia for a further 20 minutes after death. Five animals were studied at each pressure. Fixation at 0 mmHg was achieved by rapid immersion of enucleated eyes from 5 animals whose eyes had been cannulated and open to atmospheric pressure for the first 10 minutes. The anterior segment tissues were studied by light microscopy and by scanning and transmission electron microscopy. The eyes from rats fixed by cardiac perfusion provided control tissue. Progressive increase in intraocular pressure produced varying degrees of structural alterations in the iridocorneal angle. These included widening of the ciliary cleft and enlargement of the spaces of Fontana; however, the pectinate ligaments remained intact even at the highest pressure. The trabecular tissues became more distended and there was a statistically significant relationship between the fixation pressure and the mean number of giant vacuoles in the inner wall of Schlemm's canal. The response between animals fixed at the same pressure was variable. This was most pronounced at 10 and 40 mmHg. The results indicate that the rat outflow system responds morphologically to various levels of experimentally induced intraocular pressure in a similar fashion to primates. These findings, together with the morphological similarities between the rat and primate aqueous humour outflow pathways, particularly the presence of a single canal of Schlemm, suggest that the rat may be a valuable model for future studies of the normal and abnormal mechanisms of aqueous drainage. The technical difficulties of experimental studies of the aqueous drainage mechanism in such a small eye are discussed.

Animals↗