The Effect of Breath-Hold Diving on Intraocular Pressure, Optic Nerve, Visual Field in Korean Haenyeo (Female Divers)

PURPOSE: To examine how breath-hold diving activities of Korean haenyeo female divers affect intraocular pressure (IOP), optic nerve and visual field (VF). METHODS: Basic ophthalmologic tests were performed for a group of breath-hold female divers (26 eyes) and a control group of non-divers (26 eyes) and the results compared between the 2 groups. For the breath-hold female diver group, a questionnaire survey was conducted on the patterns of breath-hold diving and the correlation with abnormalities in IOP, optic nerve and VF analyzed. RESULTS: IOP was significantly higher in the diver group (diver group: 15.00 +/- 3.76 mm Hg, control group: 13.93 +/- 2.36 mm Hg, p < 0.05). Between the 2 groups, the cup area (diver group: 1.21 +/- 0.60 mm2, control group: 0.83 +/- 0.46 mm2, p < 0.05), the cup-to-disc (C/D) ratio (diver group: 0.44 +/- 0.21, control group: 0.31 +/- 0.14, p < 0.05), and the vertical C/D ratio (diver group: 0.70 +/- 0.17, control group: 0.51 +/- 0.12, p < 0.05) were also significantly different. A significant correlation between working hours per day and IOP (r = 0.44, p < 0.05), between diving depth and RNFL defect, and cup area, and vertical C/D ratio (r = 0.43, r = 0.41, r = 0.39, p < 0.05) was observed. CONCLUSIONS: Subjects who breath-hold dive for a long period, such as Korean Haenyeo, need to have a glaucoma test regularly.

Change in Intraocular Pressure According to Sleeping Posture in Normal People

PURPOSE: The present study examined how intraocular pressure is affected by changes in sleeping posture (22-2400 hours) from the sitting position to the supine, prone, and lateral positions in normal subjects. METHODS: Ophthalmological examination was performed on 140 eyes of 70 healthy adult men, and changes in the intraocular pressure were measured according to posture during sleep. The subject was initially relaxed and the base intraocular pressure was measured in the sitting position. In order to reduce the influence of intraocular pressure among the positions, namely, the supine, the prone, and the lateral recumbent positions, the subject was seated for ten minutes before assuming each position. Intraocular pressure was measured twice at 0 and 10 minutes in each position, and the mean of the two values was used for comparison. RESULTS: Compared to the intraocular pressure in the sitting position, intraocular pressure increased significantly in the supine, prone, and lateral positions (p< 0.05). Compared to the base intraocular pressure, the intraocular pressure measured in the prone position showed the largest difference, increasing 6.34 mm Hg in the right eye and 6.43 mm Hg in the left eye. The intraocular pressure measured in the lateral position was 3.62 mm Hg higher in the right eye and 3.63 mm Hg higher in the left eye, and that in the supine position was 2.42 mm Hg and 2.28 mm Hg higher in the right and left eyes, respectively. CONCLUSIONS: The change in posture during sleeping from the sitting position to the supine, prone, and lateral positions caused increases in intraocular pressure in normal subjects. The results show that the change in sleeping posture induced by sleeping habits may raise intraocular pressure.

A Case of Ahmed Glaucoma Valve Implantation without Removal of the Anterior Chamber Lens

PURPOSE: To report the results of performing an Ahmed glaucoma valve implantation without removing the anterior chamber lens to treat secondary glaucoma. CASE SUMMARY: A 72-year-old male visited the hospital for imminent visual field loss in the left eye. At the time of the visit, he had a mild headache, and the intraocular pressure of the left eye was 38 mm Hg. The left eye had received anterior chamber lens insertion with iridectomy and the posterior capsule was ruptured. The vitreous protruded at the two o'clock site and adhered to the backside of the anterior chamber lens tilting it toward the temporal cornea. At the time of the visit, the maximum corrected vision of the left eye was 0.32. The patient was diagnosed with secondary glaucoma caused by the anterior chamber lens. Because the patient did not want to have the anterior chamber lens removed and the supporting area of the anterior chamber lens blocked the trabeculectomy and peripheral iridectomy sites, the authors performed an Ahmed glaucoma valve implantation instead. The outcome of Ahmed glaucoma valve implantation was evaluated through a preoperative and postoperative vision test and periodical corneal endothelial cell analysis. During the six months of postoperative follow-up, the vision was improved, intraocular pressure was stabilized, and corneal endothelial cells were maintained. CONCLUSIONS: When a patient requires glaucoma surgery for secondary glaucoma caused by an anterior chamber lens, an Ahmed implantation without lens removal may be an option which may carefully be considered. However, because of the possibility of subsequent complications, a longer follow-up period is necessary.

The Effect of Positional Change During Laparoscopic Surgery on Intraocular Pressure

PURPOSE: The present study proposes to examine the change of IOP in response to the rise of abdominal pressure and in response to position change during laparoscopic surgery. METHODS: The subjects of the present study included 28 patients who had laparoscopic appendectomy and 20 patients who had laparoscopic cholecystectomy. In both groups, the IOP was measured before surgery, after general anesthesia, after the occurrence of pneumoperitoneum, after position change according to operative method, after the removal of pneumoperitoneum and under general anesthesia. RESULTS: When comparing the IOP before and after the occurrence of pneumoperitoneum, the IOP after the occurrence increased by 3.70 +/- 0.96 mm Hg in the appendectomy group and by 3.15 +/- 0.5 mm Hg in the cholecystectomy group. After the occurrence of pneumoperitoneum, the IOP measured in the head-low position was 3.25 +/- 0.16 mm Hg higher than measured in the level position in the appendectomy group, and the IOP measured in the head-high position was 2 +/- 0.12 mm Hg lower than measured in the level position in the cholecystectomy group. Between the 2 groups, there was a significant difference of 6.5 mm Hg in IOP according to the change of head position. CONCLUSIONS: In the present study, the occurrence of pneumoperitoneum in laparoscopic surgery increased IOP, and position change according to operative method also changed IOP. In addition, IOP was significantly different between the 2 groups. In order to prevent the patient from being exposed to high IOP for a long period during laparoscopic surgery, keeping the duration of pneumoperitoneum and a head-low position to a minimum may be helpful.

A Case of Recurrent Posterior Scleritis With Hyperthyroidism in Both Eyes

PURPOSE: Posterior scleritis is known to be a rare disease. The authors of the present study herein report a case of posterior scleritis, which occurred in a patient's eye, accompanied by hyperthyroidism and recurring in the other eye one year later. CASE SUMMARY: A 39-year-old female patient visited the hospital for ocular pain in the left eye and a headache. The patient was diagnosed with posterior scleritis through fundus examination, ultrasonography, CT and MRI, and an effective outcome of treatment was obtained by oral administration of methylprednisolone. Four months after discharge, the patient received left subtotal thyroidectomy for thyroid papillary cancer. Seven months after surgery she visited again, due to ocular pain that started 1 week earlier in the left eye, as well as a headache, and was diagnosed with posterior scleritis upon fundus examination, ultrasonography and MRI. Methylprednisolone was administered orally and an effective treatment result was obtained. After discharge, the patient was followed up for 5 months and did not show any signs of recurrence. CONCLUSIONS: When a hyperthyroidism patient has ocular pain or a headache, the possibility of posterior scleritis accompaniment should be considered, as well as the possibility that posterior scleritis, which already occurred in one eye, may recur in the other eye.

The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving

PURPOSE: To examine how SCUBA diving activities in high-pressure underwater environment affect their intraocular pressure (IOP), visual field (VF), retinal nerve fiber layer (RNFL), and the shape of optic disc. METHODS: We performed visual acuity and refractory test, IOP test, VF test, RNFL photography, optical coherent tomography, and 3D optic disc photography for a group of 32 people and a control group of 32 non-divers, and analyzed the differences between the two groups. For the diver group, we conducted a questionnaire survey on the patterns of diving and diving experience, and analyzed their correlation with results of test. RESULTS: Compared to the Control, the diver group showed significant difference in the mean IOP (diver group: 15.71 +/- 2.54 mmHg, control group: 14.23 +/-2.15 mmHg, p = 0.019), and abnormal visual field (diver group: 7 eyes (11.3%), control group: 0 eye (0%), p = 0.006). 85.7% of abnormal visual field belonged to early defect. The diver group did not showed significant difference in the shape of optic disc (p = 0.546), but the optic nerve atrophy in shape of optic disc test field (diver group: 8 eyes (12.9%), control group: 2 eyes (3.1%), p = 0.042) was significantly different. CONCLUSIONS: Divers who did SCUBA diving activities need to have a glaucoma test regularly. Additional research and large cross or longitudinal study are needed to evaluate causes that scuba diving activities affect.

The Effect of Positional Changes during Heavy Weight Lifting on Intraocular Pressure

PURPOSE: To measure intraocular pressure (IOP) as a function of positional changes of the head during heavy weight lifting. METHODS: The subjects of this study were 30 healthy adult males in their twenties to forties. This study investigated their ophthalmic examinations, BMI (body mass index), and 1RM (one repetition maximum) according to the three bench press positions. RESULTS: Before exercising, the IOP was higher in the lowered head position in the decline bench press (18.20+/-2.89 mmHg) than in the incline bench press (14.38+/-2.32 mmHg) (p<0.001). The IOP increased significantly during the bench press exercise, relative to during the pre-exercise (p<0.001). Upon lift down, IOP increased by 3.72+/-1.85 mmHg greater than upon lift up, and mean IOP increased by 2.61+/-1.63 mmHg (p<0.001). In our experiments, IOP increased to a maximum of 22.10+/-2.79 mmHg, measured during lift down in the decline bench press configuration. The BMI and the IOP before exercise showed significant correlation (p<0.05). CONCLUSIONS: IOP increased more during exercise involving a lower head position. Further study is needed to know the extent to which this result is relevant for glaucoma patients and which activities and head positions during exercise may worsen glaucoma. In the meantime, patients with severe glaucoma may need to avoid lifting heavy objects with a lowered head position.

A Case of a Traumatic Eyeball Rupture in Terrien's Marginal Degeneration and It's Surgical Repair

PURPOSE: To report a primary surgical repair of a severe corneal laceration, a lens prolapse and a traumatic aniridia by blunt trauma in Terrien's marginal degeneration. METHODS: A 46-year-old female visited our hospital for corneal laceration due to a blunt trauma of the right eye. A primary corneal suture was done and 8 days later, amniotic membrane transplantation was performed. RESULTS: The perforated eyeball regained its integrity with a stabilized cornea. Also, the anterior chamber was reformed and visual acuity improved. CONCLUSIONS: In the first case of Terrien's marginal degeneration in the right eye, which had a 360-degree iridodialysis(aniridia) with aphakia due to blunt traumatic separation of the iris root from the ciliary body. We achived a good operative result with primary corneal suture and amniotic membrane transplantation.

Clinical Investigation of Therapeutic Effect and Extrusion Rate of Punctal Plug for Dry Eye Syndrome

PURPOSE: To investigte the extrusion rate of punctal plugs and to evaluate their long-term effectiveness related to punctal occlusion. METHODS: The subjects were 120 eyes of 60 patients with tear-deficient dry eye who underwent punctal occlusion using a silicone punctal plug from May 2003 to Jun 2004. They were followed up for 382.3+/-164.3 days. We studied the extrusion rate and the period of extrusion for each plug and examined the differences between the objective and subjective indicators of dry eye syndrome before and after plug insertion and between extruded and non-extruded punctal plugs. RESULTS: In this study, 25.8% of all plugs were extruded during the follow-up period. The majority of plugs (41.9%) were extruded within 100 days after plug insertion. As objective indicators, results of Schirmer test and BUT were significantly increased after plug insertion. As subjective indicators, the patients' clinical symptoms significantly improved. Patient use of artificial tear drops significantly decreased and was discontinued by 70.8% after plug insertion. There were however no significant differences between the extrusion group and the non-extrusion group in each case. CONCLUSIONS: Punctal plug occlusion therapy for tear-deficient dry eye is effective, but the extrusion rate is relatively high. Regardless of punctal plug extrusion, patients experienced a symptomatic improvement. Serious consideration of this fact may greatly aid in making therapeutic adaptations and maintaining a good relationship.