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Purpose: To determine the pathomechanism of increased intraocular pressure after penetrating and lamellar keratoplasty based on clinical observation and literature data. Materials and methods: Morphometric analysis of the anterior segment of the eye using spectroscopic optical coherence tomography, gonioscopy and biomicroscopy. Results: Pre- and postoperative spectroscopic optical coherence tomography scans in patients after keratoplasty reveal deformation of the peripheral cornea, narrowing of the iridocorneal angle, presence of anterior synechiae and various types of pupillary block. Conclusions: The mechanism of elevated intraocular pressure after corneal grafting is complex and depends on pre-, intra- and postoperative factors, such as anatomy changes of the iridocorneal angle, presence of anterior synechiae, as well as anterior and posterior pupillary block. Spectroscopic optical coherence tomography plays an important role in diagnosis and further treatment management.

Purpose To evaluate the safety and efficacy of topical difluprednate ophthalmic emulsion use for prophylaxis of corneal graft rejection in patients undergoing penetrating keratoplasty. Methods This study reviewed the charts of patients undergoing penetrating keratoplasty who were treated with difluprednate (DP) ophthalmic emulsion postoperatively. At each follow-up visit, patients were followed for signs of graft rejection, cataract development, and intraocular pressure rise in addition to routine ocular examination. Results The charts of 36 patients (38 eyes) who underwent penetrating keratoplasty (PKP) (27 eyes) and PKP triple (11 eyes) were reviewed. All eyes were followed up for at least 8 months postoperatively. Five grafts developed rejection and three grafts subsequently failed. Six eyes had an increase of IOP that required use of antiglaucoma drops. Three eyes were switched from difluprednate to prednisolone acetate (PA) after persistent rise of IOP failed to respond to antiglaucoma drops. None of these cases needed glaucoma surgery. Two patients developed cataract during the follow-up period (out of 12 phakic eyes). Conclusion Topical difluprednate is potentially effective and safe in preventing graft rejection after penetrating keratoplasty. Larger prospective clinical trials are warranted.

Intraocular pressure (IOP) is important in glaucoma development and depends on aqueous humor (AH) dynamics, involving inflow from the ciliary body and outflow through the trabecular meshwork (TM). IOP has a circadian rhythm entrained by sympathetic noradrenaline (NE) or adrenal glucocorticoids (GCs). Here, we investigated the involvement of GC and NE in AH outflow. Pharmacological prevention of inflow/outflow in mice indicated an AH outflow increase during day. Although TM phagocytosis can determine AH drainage, only NE showed a non-self-sustained inhibitory effect in phagocytosis of immortalized human TM cells. Pharmacological approach and RNA interference identified β1-adrenergic receptor (AR)-mediated cAMP-EPAC-SHIP1 signal activation by ablation of phosphatidylinositol triphosphate regulating phagocytic cup formation. Furthermore, pharmacological instillation in mice revealed the role of β1-AR-EPAC-SHIP1 pathway in nocturnal IOP rise. These suggest that IOP rhythm is partially regulated by this pathway. This first demonstration of TM phagocytosis suppression by NE could be useful in glaucoma management.

Purpose: To study the incidence and risk factors of raised intraocular pressures (IOPs) in the follow-up of transconjunctival sutureless vitrectomy (TSV). Methods: A retrospective observational study was performed on 635 patients who underwent TSV under a single surgeon. The IOPs were recorded using a calibrated non-contact tonometer at seven postoperative visits, viz., day 1, 7 and 1, 3, 6 months, and 1 day and 1 month following silicone oil removal. Results: IOP rise was seen in 24.25% (154) out of the 635 eyes studied. Among patients under 50 years of age, 37.73% had an IOP rise, compared to 21.55% above 50 years (Odds Ratio 2.206). Among males, 30.32% had an IOP rise, as compared to 15.98% females (OR 2.287). In eyes with retinal detachment, 49.16% had raised IOP (OR 5.435), and 24.05% with proliferative diabetic retinopathy (OR 1.780), as opposed to 15.38% with macular hole and 12.32% with epiretinal membrane. This was statistically significant (P < 0.001). In eyes with silicone oil, 34.9% developed a rise in IOP (OR 2.738) as compared to 11.94% of other surgeries (OR 0.697). This was statistically significant (P < 0.001). Conclusion: We observed an increase in IOP postoperatively, more in those under 50 years, males and patients undergoing surgery for RD and PDR.

Introduction: The authors describe benefits of the recognised adverse effects of prostaglandin analogues on periocular structures in patients with unilateral proptosis and intraocular pressure rise. This case points to intentional consideration of prostaglandin analogue therapy in this selected cohort of patients with secondary ocular hypertension and proptosis. Case description: A 70-year-old gentleman who presented with a 1-week history of a red and painful right eye associated with tortuous and dilated episcleral blood vessels. Visual acuity was unaffected. A diagnosis of idiopathic orbital inflammatory disease was made by extraocular muscle biopsy. Two weeks later, the patient presented with worsening pain, reduced vision and raised intraocular pressure. The secondary ocular hypertension was successfully treated with topical preserved eye drops, including latanoprost, a prostaglandin analogue. Over 6 months, the patient developed drop intolerance and punctate keratopathy leading to therapy non-adherence. Interestingly, the patient reported improvement in periocular appearance related to prostaglandin-associated periorbitopathy. Ocular surface disease and intraocular pressures were subsequently managed with preservative-free eye drops. Conclusion: Secondary ocular hypertension is not an uncommon consequence of orbital disease. Prostaglandin analogue can act as a double-edged sword in the management of raised intraocular pressure by reducing eye pressure at the cost of developing adverse effects of prostaglandin-associated periorbitopathy. These adverse effects however can be beneficial in the aesthetic rehabilitation of proptosis and associated exposure keratopathy in patients with unilateral orbital disease and probably should be sought as first line treatment in those with proptosis and raised intraocular pressure.

We present the case of a 46-year-old woman with sympathetic ophthalmia occurring 27 years after complicated juvenile cataract surgeries. The patient declined systemic immunosuppressive therapy. Dexamethasone implant in the sympathizing eye allowed good visual recovery up to 18 months of follow-up with a total of 6 implants. Intraocular pressure rise was controlled medically. This is a unique report of sympathetic ophthalmia treated solely with slow-release dexamethasone implant without systemic therapies.

BACKGROUND Patients who require endotracheal intubation in the emergency department often require a rapid sequence induction technique to protect against gastric contents aspiration and to facilitate intubation. Rapid Sequence Induction medication practices vary among the anaesthetists throughout the world. The use of succinylcholine causes an undesirable rise in intraocular pressure. Dexmedetomidine is a highly selective centrally acting α2-adrenergic agonist that has intraocular pressure lowering properties. The aim and objective of the present study was undertaken to evaluate the role of dexmedetomidine for attenuation of IOP. MATERIALS AND METHODS It was an observational study on 60 patients aged 20-50 years, and of ASA grade I and II, undergoing elective surgery in a tertiary care referral hospital. IOP was measured preoperatively and then just before intubation, after conclusion of premedication, thirty seconds after induction, thirty seconds after succinylcholine, immediately after intubation, two minutes, four minutes and six minutes after induction. RESULTS The study findings showed that at all time intervals dexmedetomidine had a better control on mean IOP. CONCLUSION Rise of IOP with succinylcholine and rapid sequence intubation can be blunted with I.V. dexmedetomidine premedication.

Purpose: To study the incidence and risk factors of raised intraocular pressures (IOPs) in the follow-up of transconjunctival sutureless vitrectomy (TSV). Methods: A retrospective observational study was performed on 635 patients who underwent TSV under a single surgeon. The IOPs were recorded using a calibrated non-contact tonometer at seven postoperative visits, viz., day 1, 7 and 1, 3, 6 months, and 1 day and 1 month following silicone oil removal. Results: IOP rise was seen in 24.25% (154) out of the 635 eyes studied. Among patients under 50 years of age, 37.73% had an IOP rise, compared to 21.55% above 50 years (Odds Ratio 2.206). Among males, 30.32% had an IOP rise, as compared to 15.98% females (OR 2.287). In eyes with retinal detachment, 49.16% had raised IOP (OR 5.435), and 24.05% with proliferative diabetic retinopathy (OR 1.780), as opposed to 15.38% with macular hole and 12.32% with epiretinal membrane. This was statistically significant (P < 0.001). In eyes with silicone oil, 34.9% developed a rise in IOP (OR 2.738) as compared to 11.94% of other surgeries (OR 0.697). This was statistically significant (P < 0.001). Conclusion: We observed an increase in IOP postoperatively, more in those under 50 years, males and patients undergoing surgery for RD and PDR.

To evaluate the effect of preoperative intraocular pressure (IOP) and the vacuum level on IOP during femtosecond laser-assisted cataract surgery.Intraocular pressure was measured in 40 enucleated porcine eyes by intracameral manometry prior, during and after vacuum application using the VICTUS femtosecond laser platform (BauschLomb, Technolas Perfect Vision GmbH, Germany). Twenty combinations of different preoperative IOP levels (12, 16, 20 and 24 mmHg) and different vacuum levels (350-550 mbar) were investigated.Multivariate regression analysis indicated that both the vacuum level (beta = 0.138; p 0.001) but much stronger the preoperative IOP (beta = 0.861; p 0.001) were predictive factors for IOP rise during vacuum application. Mean IOP was 28.23 ± 3.86, 34.23 ± 3.92, 40.35 ± 4.41 and 46.82 ± 4.11 mmHg in groups with baseline IOP of 12, 16, 20 and 24 mmHg, respectively. In the 350, 450 and 550 mbar group, and mean IOP was 35.85 ± 7.85, 37.33 ± 7.90 and 39.00 ± 8.04 mmHg, respectively. Lowering the preoperative IOP by 2 mmHg and reducing the vacuum from maximum to minimum resulted in a similar reduction in IOP during vacuum application (-3.10 ± 0.79 mmHg versus -3.15 ± 0.88 mmHg; p = 0.015). Furthermore, decreasing the baseline IOP from 20 to 12 mmHg resulted in a 30.0% reduction in intraoperative IOP.Preoperative IOP was a stronger predictive factor for intraoperative IOP rise than the applied vacuum level. Measurements and critical interpretation of preoperative IOP in a preliminary examination could help estimating the individual risk of significant IOP rise during femtosecond laser-assisted cataract surgery and could help taking early countermeasures in selected cases. Due to the porcine ex vivo model, further studies are needed to verify these findings.

Purpose: To report intraocular pressure (IOP) after use of difluprednate ophthalmic solution 0.05% (Durezol®; Novartis AG, Basilea, Switzerland) post corneal cross-linking (CXL) versus prednisolone (Pred-Forte®; Allergan Inc., Irvine, CA, USA). Methods: A retrospective single-center case series evaluation of 34 keratoconus patients ages 16-“41 (36 eyes) who underwent CXL with Avedro's KXL System® (Avedro Inc; Waltham, MA) between August 2016 and August 2017. Post-CXL, six eyes were given difluprednate and 30 were given prednisolone. IOP was recorded using Reichert model 30 pneumatonometer. Those that exhibited increased IOP at 3 days were given anti-glaucoma medications and changed to fluorometholone or loteprednol. Results: IOP's 3 days' postoperative (24.167 ± 5.23) in the difluprednate group were significantly higher than preprocedure (16.5 ± 2.258). In the prednisolone group, 3 days postprocedure the mean IOP (14.2 ± 3.199) was not significantly higher than preoperatory IOP mean (16.8 ± 4.232). The difference between IOP 3 days' postprocedure and before was 7.667 ± 4.546 for the difluprednate group and 2.567 ± 2.648 for the prednisolone group. These were compared using an unpaired t-test (t value = 3.750 ± 1.297) with P = 0.0007. Discussion: This study shows statistically significant difference in postoperative and preoperative IOP values after the use of difluprednate or prednisolone in young patients postCXL. Measuring the pachymetry on follow-up examinations could help see if changes in corneal thickness affect measured IOP. A controlled prospective double-blind study could confirm a greater increase in IOP following difluprednate versus prednisolone use, but due to the high risk, we do not recommend this study.

Purpose: The objective of this study was to introduce and validate a next-generation dual bore cannula for microincisional vitrectomy surgery. Methods: The SideFlō cannula with a closed tip and four vent ports on the sides was designed and manufactured. The cannula is designed to inject vital dyes for macular staining and perfluorocarbon liquids. Injection and venting properties were assessed subjectively in vivo, and venting was quantified in a plastic eye model system; 23-, 25-, and 27-gauge SideFlō cannulas were assessed and compared with existing axial dual bore cannula designs. Results: The SideFlō cannula created a broad fan-like egress of fluid that was perpendicular to the axial direction of the cannula and eliminated the possibility for retinal fluid jet damage. Enhanced outflow venting was clinically relevant in terms of smoother injection experience and less intraocular pressure rise when compared with previous dual bore designs. Testing in a model eye system confirmed marked improvement in passive outflow compared with the first-generation dual bore cannula single vent port design for all gauges. Conclusion: The SideFlō cannula represents a novel next-generation dual bore cannula design with significantly improved performance over first-generation dual bore cannulas. Axial jet damage from fluid injection is eliminated, and pressure equilibration by passive venting from the eye is significantly enhanced.

Phacoemulsification (phaco) for cataract extraction is 1 of the most commonly performed ophthalmic surgeries. With increasing evidence of significant intraocular pressure (IOP) reduction after phaco, the paradigm for glaucoma treatment has been shifting toward more cataract extraction instead of glaucoma surgery; thus, the population of glaucoma patients undergoing phaco is likely to continue to increase in the coming years. Although the safety of surgery has improved over the years with newer technologies and machines, postoperative IOP spike remains an important condition even after an uneventful operation. Glaucoma patients undergoing phacoemulsification are particularly at risk of further glaucomatous optic nerve damage from the transient yet potentially high pressures after phaco. Common treatments include topical, intracameral, oral, and systemic IOP-lowering medications; postoperative anterior chamber paracentesis (ACP); and so on. No single treatment to date can guarantee effective prevention or control IOP rise in the first 24 hours after phaco. Sometimes, the IOP remains high despite all of the above treatments and the risk for further glaucomatous damage may be unavoidable. In this perspective article, we discuss the incidence, causes, and treatments of IOP rise after phaco and introduce a new technique, a non-self-sealing (leaky) ACP that may be of use in regulating postoperative IOP rise, especially for patients with glaucoma.

Purpose. To assess visual performance at near to far distances in early presbyopic patients with undercorrection by implantation of an ICL with a central hole (hole ICL). Methods. This prospective study evaluated forty-two eyes of 21 early presbyopic patients (age, 40 to 53 years) with spherical equivalents of -7.37 ± 3.18 D [mean ± standard deviation] who underwent hole ICL implantation and whose targeted refraction was set at slight myopia (-0.61 ± 0.28 D) for both eyes. We assessed the safety, efficacy at near to far distances, predictability, and adverse events of the surgery, during the 6-month observation period. Results. Corrected distance visual acuity did not improve significantly, from -0.17 ± 0.07 preoperatively to -0.19 ± 0.08 logMAR postoperatively (p=0.066, Wilcoxon signed-rank test). Uncorrected distance visual acuity was significantly improved from 1.30 ± 0.24 preoperatively to -0.03 ± 0.20 logMAR postoperatively (p Conclusions. Our pilot study showed that intentional undercorrection by hole ICL implantation for early presbyopia was safe with predictable refractive results and provided good binocular vision at near to far distances, without developing cataract, suggesting its viability as a surgical presbyopic treatment for such patients.

Background To report the negative effect of Nd: Yag (Neodymium-doped: Yttrium Aluminium Garnet) laser capsulotomy on the intraocular pressure (IOP) and the trabeculectomy bleb integrity, in a small series of eyes, both trabeculectomised and pseudophakic, following the laser application for the management of posterior capsular opacification (PCO). Methods This is a retrospective, non-comparative interventional case series study, in which 20 trabeculectomised and pseudophakic eyes from 15 patients, with otherwise well functioning blebs, were presented with uncontrolled IOP, in a variable distance of time following the application of YAG laser capsulotomy. Student paired t-test confirmed a statistically significant difference (P

Intraocular pressure (IOP) rise after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) can be either short-term or long-term and may require medical intervention. Short-term IOP spikes are a fairly common and well recognized complication of anti-VEGF injections. Long-term IOP rise is less well-understood and disputed as a complication by some authors. We try to review current literature on the subject and especially studies focused on the prevalence of this complication, speculate on possible mechanisms of IOP rise and discuss correlations of long-term IOP rise with the nature of the injected agent, average number of injections, previous glaucoma history and other factors. How to cite this article: Kampougeris G, Spyropoulos D, Mitropoulou A. Intraocular Pressure rise after Anti-VEGF Treatment: Prevalence, Possible Mechanisms and Correlations. J Current Glau Prac 2013;7(1):19-24.

PURPOSE To investigate real-time intraocular pressure (IOP) during a new surgical technique-the "twisting maneuver"-when inserting a sutureless vitrectomy system trocar in porcine eyes. METHODS An interventional prospective study of 2 trocar insertion methods-direct insertion and gently twisting insertion-in a 25-gauge vitrectomy system (Alcon, Fort Worth, TX). These methods were used to create a scleral wound using a trocar blade and trocar cannula in freshly enucleated porcine eyes. The IOP changes induced by the procedures were recorded with a pressure transducer connected to the posterior chamber by direct cannulation. RESULTS Fourteen porcine eyes were studied in each group. During insertion, the mean of highest IOP rise (peak IOP rise) was 63.9 ± 25.5 mmHg in the direct insertion group compared with 30.3 ± 16.9 mmHg in the twisting insertion group (P = 0.001). During insertion, the mean of average IOP rise in the direct insertion group was 39.9 ± 16.5 mmHg compared with 21.5 ± 8.9 mmHg in the twisting insertion group (P = 0.002). The total time needed to complete the procedure in the twisting insertion group was significantly longer than that in the direct insertion group (43.3 ± 21.8 vs. 14.9 ± 8.1 seconds, P = 0.0003). CONCLUSION A simple modification of surgical technique, namely, using a gently twisting insertion maneuver during trocar insertion, could significantly reduce the IOP elevation to allow a safer sutureless vitrectomy.

PURPOSE:To measure changes in intraocular pressure (IOP) in association with yoga exercises with a head-down position. METHODS:The single Center, prospective, observational study included 10 subjects with primary open-angle glaucoma and 10 normal individuals, who performed the yoga exercises of Adho Mukha Svanasana, Uttanasana, Halasana and Viparita Karani for two minutes each. IOP was measured by pneumatonometry at baseline and during and after the exercises. RESULTS:All yoga poses were associated with a significant (P < 0.01) rise in IOP within one minute after assuming the yoga position. The highest IOP increase (P < 0.01) was measured in the Adho Mukha Svanasana position (IOP increase from 17 ± 3.2 mmHg to 28 ± 3.8 mmHg in glaucoma patients; from 17 ± 2.8 mmHg to 29 ± 3.9 mmHg in normal individuals), followed by the Uttanasana position (17 ± 3.9 mmHg to 27 ± 3.4 mmHg (glaucoma patients) and from 18 ± 2.5 mmHg to 26 ± 3.6 mmHg normal individuals)), the Halasana position (18 ± 2.8 mmHg to 24 ± 3.5 mmHg (glaucoma patients); 18 ± 2.7 mmHg to 22 ± 3.4 mmHg (normal individuals)), and finally the Viparita Kirani position (17 ± 4 mmHg to 21 ± 3.6 mmHg (glaucoma patients); 17 ± 2.8 to 21 ± 2.4 mmHg (normal individuals)). IOP dropped back to baseline values within two minutes after returning to a sitting position. Overall, IOP rise was not significantly different between glaucoma and normal subjects (P = 0.813), all though glaucoma eyes tended to have measurements 2 mm Hg higher on average. CONCLUSIONS:Yoga exercises with head-down positions were associated with a rapid rise in IOP in glaucoma and healthy eyes. IOP returned to baseline values within 2 minutes. Future studies are warranted addressing whether yoga exercise associated IOP changes are associated with similar changes in cerebrospinal fluid pressure and whether they increase the risk of glaucoma progression. TRIAL REGISTRATION:ClinicalTrials.gov #NCT01915680.

In this case report, we present occurrence of bilateral angle closure glaucoma in a 9-year-old girl with geleophysic dysplasia. Bilateral YAG laser iridotomy was applied, but intraocular pressure (IOP) remained at high levels, necessitating bilateral trabeculectomy with mitomycin C. On her follow-up examinations for 3 years, IOP remained in the mid-20s with no need for further intervention or antiglaucoma medication. There are few reports describing the ocular findings of geleophysic dysplasia in literature. To our knowledge, this is the first case report describing an application of glaucoma surgery and its results at geleophysic dysplasia.

The study was conducted to evaluate the intra-session repeatability of Tonopen AVIA (TPA). 180 eyes of 180 patients (50 eyes with glaucoma, 130 eyes of controls) were recruited for this observational study. The mean age of patients enrolled in the study was 43.9 ± 16.7 yrs (84 males, 96 females). Mean IOP recorded with Tonopen AVIA was 19.5 ± 9.5 mmHg, 19.4 ± 9.6 mmHg and 19.3 ± 9.2 mmHg, respectively in the first, second and third instances (P = 0.656). The intraclass correlation coefficient (ICC) ranged from 0.996 (95% CI: 0.956 - 0.998) for glaucoma subjects to 0.958 (95% CI: 0.934 - 0.975) for controls. The coefficient of variation in the study population ranged from 3.47% (glaucoma patients) to 8.10% (healthy controls), being 6.07% overall. The coefficient of repeatability varied between 2.96 (glaucoma patients), 3.35 (healthy controls) to 3.24 (overall). Thus, the Tonopen Avia shows good intrasessional repeatability of IOP in both glaucomatous patients and healthy subjects.

Purpose: To examine the changes in intraocular pressure (IOP) and the incidence of substantial rises in IOP in the early period after cataract surgery in eyes with open-angle glaucoma (OAG). Setting: Hayashi Eye Hospital, Fukuoka, Japan. Methods: The study included 32 eyes of 32 patients with OAG and 31 control eyes of 31 age-matched patients scheduled for phacoemulsification surgery. The IOP was measured preoperatively and 1, 2, 3, 5, 7, 14, and 28 days postoperatively. The incidence of a substantial rise in IOP postoperatively was evaluated, with the criterion being an IOP higher than 30 mm Hg. Results: In the OAG group, the mean IOP increased 1, 2, and 3 days postsurgery and then decreased, whereas in the control group, it decreased from day 1 postsurgery. Although no significant differences were found between groups preoperatively, the mean IOP in the OAG group was significantly higher than in the control group postoperatively. Furthermore, the mean IOP decrease was also less in the OAG group than in the control group. A substantial increase in IOP occurred at day 1 postsurgery in 4 eyes (12.5%) in the OAG group, whereas no eyes in the control group showed such an increase; this difference was significant ( P = .0419). Conclusions: A substantial increase in IOP occurred in an approximately 13% of eyes with OAG 1 day after phacoemulsification surgery. The IOP shortly after surgery was significantly greater in the eyes with OAG than in nonglaucomatous eyes.

To evaluate the rise in intraocular pressure (IOP) after phacoemulsification using a straight microtip or a Kelman microtip and its relationship to phaco energy delivered to the eye.Iladevi CataractIOL Research Center, Ahmedabad, India.This prospective randomized study comprised 48 consecutive age- and sex-matched patients with senile cataract. Inclusion criteria included older than 45 years and presence of any type of cataract from grade I to III. The patients were divided into 2 groups: straight microtip and Kelman microtip. Each group comprised 13 men and 11 women. The mean age was 58.29 years +/- 6.46 (SD) in the straight microtip group and 60.05 +/- 8.45 years in the Kelman microtip group. The IOP was measured preoperatively and postoperatively with a pneumotonometer and applanation tonometer. One surgeon performed all operations using a standardized surgical technique and topical anesthesia. The intraoperative mean phaco power and ultrasound (US) time were noted. The effective phaco time (EPT), percentage of IOP rise, and wound-site thermal injury (mild, moderate, or severe) were calculated. The correlation between the EPT and percentage of rise in IOP was evaluated using correlation coefficients and the paired t test.The mean preoperative IOP was 13.73 +/- 2.89 mm Hg in the straight microtip group and 15.14 +/- 2.60 mm Hg in the Kelman microtip group. The mean US time was 239.4 +/- 1.61 seconds and 238.2 +/- 1.48 seconds, respectively. The mean phaco power was 17.37% +/- 3.28% in the straight microtip group and 17.10% +/- 5.26% in the Kelman microtip group and the mean EPT, 39.06 +/- 2.28 seconds and 40.08 +/- 0.24 seconds, respectively (P =.412). The mean rise in IOP was 111.60% +/- 37.83% in the straight microtip group and 91.29% +/- 31.85% in the Kelman microtip group. The difference between groups was significant (P.05). The correlation coefficient between the EPT and percentage of IOP rise was significant in both groups: 0.3823, straight microtip group (P.05); 0.514, Kelman microtip group (P.01). Wound-site thermal injury was noted in 3 patients in the straight microtip group and 1 patient in the Kelman microtip group.Although the amount of phaco energy dissipated in the eye was the same between the 2 groups, the percentage of IOP rise was greater with the straight microtip. The rise in IOP was correlated with the dissipated phaco energy.

Purpose: To evaluate the efficacy of latanoprost in reducing acute intraocular pressure (IOP) elevation after neodymium:Yag laser iridotomy (LI). Methods: Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine or with pilocarpine only before LI. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes of 47 patients who had one eye in each group. Results: Postoperative pressure spikes were significantly lower (p = 0.010) in the latanoprost group (4.1 ± 5.0 mmHg) than in the control group (6.7 ± 7.0 mmHg). Mean elevation of IOP was less in the latanoprost group than in the control group at 1 hour (2.5 ± 4.8 versus 4.1 ± 4.7 mmHg, p = 0.013) and 2 hours (0.8 ± 5.6 versus 4.4 ± 8.1 mmHg, p = 0.003) postoperatively. Eleven eyes in the latanoprost group (23.4%) and 20 eyes in the control group (42.6%) developed a rise in IOP ≥ 6 mmHg (p = 0.048). Conclusion: Latanoprost may reduce the pressure rise following LI in PACG eyes, but its application is limited by a late onset of effect.

Intravitreal triamcinolone acetonide (IVTA) is an effective treatment for recalcitrant diabetic macular oedema (DMO). It has been shown to improve vision with benefits persisting up to five years. The most common initial side effect of IVTA treatment is rise in intraocular pressure, occurring in approximately 50% of patients within the first 6 months of treatment. We evaluated whether there is a correlation between the development of intraocular pressure rise and improvement in vision. Analysis of individual data from 33 eyes of 33 participants treated with IVTA for DMO from a prospective, randomised, double-masked, placebo controlled trial. The degree of intraocular pressure (IOP) rise was correlated with improvement in best-corrected visual acuity (BCVA) at 1 and 6 months. The proportion of eyes gaining 5 or more logMAR letters was higher in eyes with greater IOP rise (p = 0.044). Better absolute improvement in BCVA at 6 months (p = 0.045) was also found in eyes with greater IOP rise. Regression analyses revealed a correlation between IOP rise of 10 or more mmHg and absolute BCVA improvement at 6 months (odds ratio 1.22, 95% confidence interval 1.01-1.48, p = 0.039), but not at 1 month. IOP rise and vision improvement appear to be correlated following IVTA for DMO, suggesting that the mechanisms that cause both may be linked. Clinical trials.gov NCT00167518 , September 5, 2005.

Purpose. The aim of this study is to examine the influence of capsulotomy size on, spherical equivalent (SE), intraocular pressure (IOP), and macular thickness.Materials and Methods. Sixty-eight patients were examined preoperatively and 1, 4, and 12 weeks after Nd:YAG capsulotomy. Patients were divided into two groups based on the postoperative capsulotomy size. Changes in SE, IOP, and macular thickness were compared between two groups.Results. We found a higher hyperopic shift in large capsulotomy group. In both groups 1 and 2, IOP increased 1 week postoperatively. Intraocular pressure rise in group 2 was higher than in group 1. Both groups had increased macular thickness at 1 week postoperatively. The degree of macular thickening was similar in group 1 and group 2.Comment. Patients who underwent a larger capsulotomy have a higher hyperopic shift and IOP elevation. Rise in macular thickness was similar in large and small capsulotomy groups.

Small-gauge vitrectomy has been used to treat various vitreous and macular pathologies. Trocar/cannula insertion may raise intraocular pressure (IOP) to the point it might become detrimental to the eye, especially in the setting of open-globe trauma and eyes with severe vascular compromise. We propose to determine the magnitude of this IOP rise and its possible implications. Three different settings were designed to measure IOP rise during trocar placement for 25 ga vitrectomy (TSV); water-column manometry was performed during trocar placement in pig eyes. Electronic applanation tonometry was recorded in human eyes undergoing 25-ga vitrectomy for macular pathology during trocar placement, and wound behavior was recorded during trocar placement in harvested dog eyes with a previously sutured corneal wound. The pressure recorded during trocar placement was 57.5 mmHg in pig eyes and 63.7 mmHg in human eyes. Sutured corneal wounds in dog eyes showed wound leakage and tissue incarceration during trocar insertion. The 25-ga vitrectomy system may have limited usefulness in the setting of open-eye trauma and compromised bloodflow, due to the elevated pressures reached during trocar placement.

Background None of the keratoprostheses available today is absolutely successful in the long term, neither the problems of extrusion, retroprosthetic membrane formation and intraocular pressure rise are yet solved. A new type of keratoprosthesis is required which can show improved ingrowth characteristics and allow intraocular pressure measurements. In order to possibly meet the above mentioned requirements we developed a flexible silicone keratoprosthesis with scleral fixation and chemical surface modification. Methods The one-piece keratoprosthesis is made of silicone rubber. Its optical zone has a diameter of 11 mm and is 0.3 mm thick. The surface-modified haptic consists of a scleral rim and eight branches for scleral fixation. A ridge at the back of the keratoprosthesis fitting into the trephination hole shall avoid leakage and retroprosthetic membrane formation. Optical and mechanical qualities are characterised by tensile tests, spectrophotometry and topography. Results A method for keratoprosthesis-production was established. The optical quality of the device was improved by submicron lathing of the mould. Spectrophotometry showed high visible and ultraviolet light transmission of the silicone. Mechanical tests with silicone samples revealed high tensile strength and elongation at break. The mechanical properties were not impaired by surface modification. Conclusions The production of a flexible silicone keratoprosthesis with high optical and mechanical properties was established. Its use both for the treatment of permanently opacified corneas and as temporary keratoprosthesis seems to be possible.

The objective of this study is to estimate the incidence of steroid-induced severe intraocular pressure (IOP) rise following intravitreal triamcinolone acetonide (IVTA) injection and to describe case profiles of the patients affected within the United Kingdom.A national survey was carried out to identify cases that had developed severe IOP rise requiring laser or surgery following IVTA through the British Ophthalmic Surveillance Unit. Respondents were mailed a questionnaire and with a follow-up questionnaire 1 year later, to ascertain characteristics of the patients identified. We also carried out a midpoint survey to ascertain national practice of IVTA at the time.There were 29 confirmed reports of severe IOP rise after IVTA in the 13-month period of surveillance. All the cases were unilateral and the mean time between the IVTA and the maximum recorded IOP was 16 weeks. Six of these patients had pre-existing glaucoma or ocular hypertension, and a further two were known to be 'steroid responders'. Using the adjusted denominators, obtained from our national survey, the estimated annual incidence would be between 3.6 and 9.5 per 1000 injections.These results confirm that severe IOP rise after IVTA is an uncommon but serious complication. Data obtained from this national study should aid clinicians in choosing the treatment best suited to their patients.

Retinal detachment after ocular perforation related to local anesthesia is a common complication, which is usually associated with a poor prognosis despite complex vitreoretinal surgical procedures. We report a case of 62-year-old male with cataract surgery done 4 weeks back with nasal retinal detachment with a posterior break. Pneumatic retinopexy was performed and laser barrage of the breaks was done the next day when the retina got attached. A vision of 20/30 was achieved at the end of 2 months. To the best of our knowledge, this is a first case report in literature where pneumatic retinopexy was used to manage a retinal detachment caused by block-related perforation.

Comment to ‘First postoperative day intraocular pressure rise in resident-performed cataract surgery’

To determine the efficacy and safety of oral clonidine in decreasing the prevalence and intensity of postoperative intraocular pressure (IOP) rise in those undergoing phacoemulsification.This was a prospective randomized, double-blind, placebo-controlled, clinical trial including 62 patients (each with 1 affected aye) with senile cataract scheduled for phacoemulsification who were randomly assigned to receive preoperative oral clonidine (5 μg/kg, 31 patients) or placebo (1 tablet, 31 patients). The IOP was measured preoperatively and at 6, 12, and 24 h postoperatively. The prevalence and intensity of the acute postoperative IOP rise was compared between and within the groups.There was no significant difference between the 2 study groups regarding the baseline characteristics and the baseline IOP (P=0.628). Patients who received placebo as premedication had significantly higher IOP at 6 (17.96±5.49 vs. 13.61±4.09; P0.001) and 12 (16.90±4.11 vs. 13.96±3.25; P=0.003) h postoperatively compared with those who received oral clonidine. However, there was no significant difference between the 2 groups regarding the IOP at 24 h after operation (15.41±3.96 vs. 16.01±3.41; P=0.0539). The prevalence of acute IOP rise (21 mmHg) was significantly higher in placebo group compared with clonidine group (25.8% vs. 9.6%; P=0.091).Administering preoperative oral clonidine in a dosage of 5 μg/kg, 2 h before phacoemulsification, significantly decreases the prevalence and intensity of acute postoperative IOP rise in those undergoing general anesthesia. Oral clonidine is safe, cheap, and easily accessible and, thus, it is recommended for controlling the IOP after phacoemulsification, especially in high-risk patients.

The one significant complication of viscoelastic materials is that they may cause postoperative intraocular pressure rise. We investigated the rate and ease of removal of various viscoelastics using the Miyake video technique. Five viscoelastics were investigated: sodium hyaluronate (Healon), Healon GV, chondroitin sulfatesodium hyaluronate (Viscoat), hydroxypropylmethylcellulose (Occucoat), and polyacrylamide (Orcolon). The viscoelastics were dyed with fluorescein and, after filling the capsular bag with a viscoelastic material, a posterior chamber intraocular lens (IOL) was implanted. The viscoelastic was then aspirated using an automated irrigation/aspiration device. Healon and Healon GV were completely removed within 20 to 25 seconds. Viscoat adhered to the lens capsule and to the posterior surface of the IOL and cooplete removal required approximately 3.5 minutes. Most Occucoat and Orcolon was aspirated within one minute; however, removal was completed only after three minutes. Removal of Healon and Healon GV was faster and more complete than removal of the other viscoelastics. Whether a small amount of viscoelastic left in the eye or trapped behind the IOL optic has any clinical significance has to be studied.

SummaryTopical treatment with 1% apraclonidine significantly reduced, but did not eliminate, the occurrence of postoperative increases in intraocular pressure (IOP) I h after either argon laser trabeculoplasty or laser iridotomy. IOP before laser trabeculoplasty in the 121 nontreated patients (24.2

Primary angle closure typically causes acute intraocular pressure rise in the phakic elderly. Alternative diagnoses, however, for which iridotomy is usually ineffective, occur commonly in younger, nonhyperopic, and pseudophakic patients.High-resolution ultrasonography has advanced our understanding of these entities. Management of platueau iris, present in over half of angle closures with patent iridotomy, may depend on disease stage. Early postoperative pseudophakic patients with myopic shift and narrow angle should be treated with laser capsulotomy for capsular block. Bilateral angle closure is usually due to an offending systemic pharmacologic agent, which must be stopped to resolve the closure. Ciliary body swelling often produces angle closure by blocking the access of aqueous to the anterior chamber, sometimes paradoxically after hypotony. Annular choroidal effusions, difficult to detect without ultrasound, may mimic angle closure. Although cycloplegic and corticosteroid therapy may resolve some entities, pars plana vitrectomy and lensectomy may be necessary to resolve severe ciliary block. We also discuss unique variants of angle closure in patients with retinal disease.Atypical angle closures should always be considered. Careful examination techniques and new technology can detect the mechanisms involved and direct treatment.

Purpose: To determine if there is a relationship between the amount of increase in IOP following dilatation with a cycloplegic agent and the future course of glaucoma. Method: A retrospective chart review of 100 eyes from 55 subjects with open-angle glaucoma who had had IOP measured before and after pharmacological pupillary dilatation was performed to establish the rate of progression of glaucoma, based on serial evaluation of the visual fields using the Glaucoma Staging System 2 (GSS 2), and optic discs using the Disc Damage Likelihood Scale (DDLS). Progressive visual field loss was defined as an increase of two or more stages with the GSS 2 and progressive deterioration of the disc was defined as an increase of two or more stages with the DDLS. Mean follow-up time was 7.2 years. Results: 26 eyes showed glaucomatous progression. The likelihood of progression of glaucoma was related to the amount of IOP increase after pharmacological pupillary dilatation. For every one mmHg increase in IOP, the odds of progression increased 24% (p=0.008). The likelihood of progression of glaucoma, however, was not related to the baseline IOP, which was 20.63 mmHg (SD=4.59 mmHg) in those showing deterioration of disc or field and 19.72 mmHg (SD=5.32 mmHg) in those not worsening according to our definition. Conclusion: In patients with open-angle glaucoma, the amount of increase in IOP caused by pharmacological pupillary dilatation is related to the likelihood of future progression of glaucoma.

To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema.The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 +/- 6.2 months.Visual acuity improved significantly (p0.001) from 0.89 +/- 0.33 logMAR to a best minimum of 0.65 +/- 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, respectively. Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p0.001), 2 months (p0.001), 3 months (p0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected.The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.

espanolCasos clinicos: El uso de triamcinolona intravitrea esta extendiendose como tratamiento de enfermedades maculares. Los efectos secundarios pueden variar en jovenes. Presentamos dos casos de incremento de la presion intraocular (PIO) y desarrollo de cataratas. Dos pacientes jovenes con uveitis cronicas refractarias a glucocorticoides perioculares y orales, recibieron inyecciones intravitreas de triamcinolona. El edema macular cronico mejoro en ambos pacientes. Se produjo un incremento de PIO, seguido de la aparicion acelerada de cataratas. Discusion: La juventud y la inflamacion cronica podrian estar asociadas a incrementos de PIO y el consecuente desarrollo de cataratas tras inyeccion intravitrea de triamcinolona. EnglishCase reports: Intravitreal triamcinolone is being increasingly employed for the treatment of macular diseases. We report two cases of intraocular pressure elevation and cataract formation after intravitreal triamcinolone therapy, and wonder if these complications are more likely when this agent is used in young patients. Intravitreal triamcinolone was injected into both eyes of the two young patients with chronic posterior and intermediate uveitis refractory to peribulbar and oral corticosteroid therapy. Chronic cystoid macular edema improved in both patients, however the intraocular pressure increased, requiring topical antihypertensive therapy, and this was followed by accelerated cataract formation. Discussion: Young age and chronic inflammation could be associated with an intraocular pressure rise and subsequent cataract development after intravitreal triamcinolone.

Most ophthalmologists are aware of the risk of elevated intraocular pressure developing 1 or 2 months after an intravitreal injection of triamcinolone. However, the two cases reported here demonstrate that such a rise can occur significantly later than this. All patients who have had intravitreal steroid injection should therefore have prolonged intraocular pressure monitoring.

Purpose: To evaluate the efficacy of a new trabecular aspiration technique on intraocular pressure (IOP) immediately after cataract surgery. Setting: University Eye Hospital of Cologne, Germany. Methods: This prospective, double-masked study comprised 48 of 100 patients having extracapsular cataract extraction (ECCE) who were randomly assigned to a study group. In these patients, 180 degrees of the inferior circumference of the chamber angle was treated with negative suction pressure ranging between 100 and 200 mm Hg. The other 52 patients served as a control group. Intraocular pressure was measured preoperatively and early (5 to 7 hours) and late (12 to 48 hours) postoperatively. Results: There was a significant mean increase in IOP from the preoperative to early postoperative period in both the control group (20.8 mm Hg) and the treatment group (7.4 mm Hg). There was no significant difference between preoperative and late postoperative pressures in either group. A one-way analysis of covariance of the changes in pressure from the preoperative to early postoperative period showed significantly less increase ( P = .0041) in the aspiration than in the control group. Conclusion: Trabecular aspiration was effective in reducing the amount of IOP increase in the immediate period after ECCE.

We report the first case of vertical fixation by fibrin glue-assisted secondary posterior chamber intraocular lens implantation in a case of surgical aphakia. Advantages of vertical fixation are discussed.

Objective: To analyse the efficacy of (0.5%) apraclonidine in preventing the acute rise of intraocular pressure following Nd-YAG Laser posterior capsulotomy. Material and method: A prospective case controlled randomised study was performed in the department of ophthalmology of SIMS in collaboration of department of pharmacology. Result: A total 52 patients were divided in two groups. Half of the patients were given 0.5% topical apraclonidine 15 minutes before the procedure and immediately after the procedure and after 1 hr, 2hr, and 4hrs respectively. The other half were not given any IOP lowering drug.IOP was measured by tonometry. There was significant fall in IOP in test group patients. IOP in two groups 1hr after procedure was 13.08% rise in control and 6.40% fall in test group. Conclusion: Apraclonidine, a highly selective alpha2 adrenoceptor agonist effectively and safely lowers IOP spikes after laser treatment without causing significant side effects like bradycardia or hypotension.

Objective: Use Bayes′ theorem to estimate the intraocular pressure (IOP) lowering effect of medical treatment initiated for glaucoma and determine if IOP comparisons to the baseline IOP of the same eye is clinically useful. Materials and Methods: The probability that treatment with prostaglandin is responsible for an observed 20% decrease in IOP with prostaglandin treatment was calculated using Bayes′ theorem using the following available information: the probability of a 20% decrease in IOP given treatment with prostaglandin, the probability of a treatment effect using prostaglandin and the overall probability of a 20% decrease in IOP. The calculations were repeated to account for a possible 2 mmHg overestimation of effect caused by measurement error in performing applanation tonometry. Results: The probability that treatment is responsible for an observed 20% decrease in IOP following initiation of treatment with a prostaglandin was 99%. After adjusting for measurement error this probability was 98%. Obtaining two IOP measurements marginally increased the probability. Conclusion: Following initiation of treatment with prostaglandin, Bayes′ theorem allows us to infer that treatment effect is the most likely explanation for an observed 20% decrease in IOP from the baseline; this inference remains even after adjusting for known measurement error. The high probability of a treatment effect is due to the high prior odds of treatment effect and the high likelihood ratio for prostaglandin producing such an effect. If data is available, similar calculations can be used for other percentage decreases, other medications and for the monocular trial.

Primary iridociliary cysts can induce plateau iris configuration and angle closure glaucoma. We report a patient with bilateral, primary, ring-shaped, solitary iridociliary cysts. The right eye displayed normal intraocular pressure, oppositional iridocorneal angle closure, and healthy optic nerve head. The left eye had advanced chronic angle closure glaucoma. The management strategy varied between eyes and is discussed. This, to the best of our knowledge, is the first report of transscleral Diode laser application in an eye with a large iridociliary cyst.