Potential risk factors and treatment of high IOP elevation after operation in retinal detachment eyes of diabetic patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the intraocular pressure(IOP)fluctuation at the early stage of pars plana vitrectomy(PPV)and silicon oil tamponade in high myopia with rhegmatogenous retinal detachment(RRD)eyes in diabetic patients and analyze the potential risk factors and effective treatment.<p>METHODS: One hundred consecutive diabetic patients of rhegmatogenous retinal detachment in highly myopic eyes were retrospectively reviewed. Patients were divided into two groups: the experimental group, those who used Tobramycin Dexamethasone Eye Drops(TDED), and control group. Pre- and postoperative IOPs, retinal nerve fiber layer thickness(RNFL)and optic nerve head parameters were recorded before and after IOP elevation, and in the contralateral eye before the operation. Graphpad 7.01 was used for data analysis.<p>RESULTS: IOP elevation occurred in 42 eyes within 1wk after vitrectomy in all diabetic participants. Ocular hypertension(OHTN)was observed in 31 of 53 eyes in experimental group and 11 eyes of 47 eyes in control group at the early stage after operation. Significant differences were found between groups in 5d-1wk and 1mo after vitrectomy. In addition, IOP of 39 eyes had decreased by proper treatment and 3 eyes received glaucoma filtration surgery. Compared to the optic disc parameters before IOP elevation, the average and inferior RNFL thickness were thinner and rim area decreased as well as cup volume and vertical C/D radio increased after IOP elevation. The RNFL thickness of the opposite eyes in patients with IOP elevation was found thinner than the ones who never suffered ocular hypertension.<p>CONCLUSION: Continual use of glucocorticoid after vitrectomy is a potential risk factor of IOP elevation in high myopia with diabetes, and doubtful open angle glaucoma should be focused on its sensibility to glucocorticoid and IOP elevation.

Expression of caspase-9 affected by AG on retina of rats with chronic IOP elevation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study caspase-9 expression on rat retina in the process of chronic elevation of IOP and the changes with the application of amino guanidine (AG), thus to investigate potential protective function of AG to rat retina with chronic elevation of IOP.METHODS: Immunohistochemistry, RT-PCR and Western blot were used to observe retinal morphology and expression of caspase-9 at different time points of rat with chronic IOP elevation, both affected or not affected by the application of AG.RESULTS: Compared with control group, as time passed retina of experimental group gradually had detectable morphological changes. On 21st day of chronic IOP elevation, retinas became thinner and the quantity of retinal ganglion cells (RGCs) decreased; caspase-9 expression increased, consistent with the morphological changes. The group using AG presented relatively smaller morphology changes and less expression of caspase-9.CONCLUSION: Apoptosis-related gene caspase-9 played a part in the process of chronic IOP elevation; AG protects retina by down-regulating expression of caspase-9.

The Complications after Intravitreal Injection of Triamcinolone Acetonide

PURPOSE: This study was performed to ascertain the complications including intraocular pressure (IOP) elevation and cataract progression, can possibly arise after 4.0 mg triamcinolone (TA) is injected into the vitreous cavity in the treatment of macular diseases, and to analyze the influential factors. METHODS: This retrospective study comprises 325 eyes of 289 patients followed for over 6 months. All patients had undergone an intravitreal TA injection between March 2004 and September 2005. Visual acuities and intraocular pressures had been measured preoperatively, and at 1 day, 7 days, 1, 3, 6, 12, and 18 months postoperatively. Likewise, changes in crystalline lenses were observed at the same periods. RESULTS: The maximum IOP was significantly increased compared with preoperative IOP (P<0.0001). The average pressure measured at 1, 3, 6, and 18 months postoperatvely, was significantly increased (P<0.05). IOP elevation was observed in 52 eyes (16%). This complication was improved after treatment in most cases, but 2 eyes (0.62%) required surgical repair. Cataract progression was observed at 56 eyes (21.50%); posterior subcapsular opacity accounted for the highest proportion (42 eyes, 16.1%) and 6 eyes (2.3%) required surgery. Younger age (P=0.005) and the presence of diabetes mellitus (P=0.035) were significantly associated with TA-induced IOP elevation and cataract progression, respectively. CONCLUSIONS: Although intravitreal TA injection is effective in treating macular diseases, careful consideration of complications such as IOP elevation and cataract progression and their related risk factors must be taken when choosing the proper treatment.

Brimonidine 0.2% versus Apraclonidine 0.5% for Controlling Intraocular Pressure Elevation after Q-switched Nd:YAG Laser Posterior Capsulotomy

PURPOSE: To compare the effectiveness of 0.2% brimonidine tartrate and that of 0.5% apraclonidine hydrochloride for controlling IOP elevation after Nd:YAG laser capsulotomy. METHODS: Thirty eyes were given with 0.2% brimonidine (group 1) and fourteen eyes with 0.5% apraclonidine (group 2) before and after the procedure. Fifteen eyes served as untreated controls (group 3). Intraocular pressure and visual acuity were measured preoperatively and 1 hour, 3 hours, 24 hours, and 1 week postoperatively in all cases. RESULTS: The postoperative mean intraocular pressures of group 3 (14.97+/-3.58, 16.47+/-3.93 mmHg) at 1 hour and 3 hours were statistically significant higher than those of group 1 (11.23+/-3.43, 11.50+/-3.01mmHg), and those of group 2 (10.79+/-3.51, 11.57+/-3.03 mmHg)(p< 0.05), but, there were no statistically significant differences in mean IOP at 1 hour and 3 hours between group 1 and group 2 (P=0.569, P=0.610). At 1 hour and 3 hours, there was no case of IOP elevation of 5 mmHg above baseline in group1 and group 2. but, there were 5 cases (33.3%) at 1 hour and 6 cases (40%) at 3 hours in group 3. CONCLUSIONS: This result suggests that 0.2% brimonidine and 0.5% apraclonidine are equally effective for preventing acute IOP elevation after Nd:YAG laser capsulotomy, that is, 0.2% brimonidine is an effective and well-tolerated agent for preventing acute IOP rises after Nd:YAG laser posterior capsulotomy.

The Effect of Apraclonidine Hydrochloride 0.5%Ve rsus 1%for Controlling Intraocular Pressure Elevation after Nd :YAG Laser Posterior Capsulotomy

Previous reports have shown that Nd:YAG laser capsulotomy is associated with elevated intraocular pressure(IOP). Topical apraclonidine hydrochloride has been shown to be effective in preventing postlaser pressure spikes. This study was designed to compare the effect of apraclonidine hydrochloride 0.5%versus 1% in controlling IOP elevation after Nd:YAG laser posterior capsulotomy. Fourteen eyes were treated with 0.5%apraclonidine(Group 1), twenty eyes with 1%apraclonidine(Group 2)and fifteen eyes without apra-clonidine(Group 3)in Nd:YAG laser posterior capsulotomy. The mean post-operative IOP at 1 to 3 hours of Group 3(15.0+/-3.6 mmHg, 16.0+/-4.3 mmHg) was higher than Group 1(10.8+/-3.5 mmHg, 11.6+/-3.0 mmHg)and Group 2 (11.2+/-3.0 mmHg, 12.7+/-2.3 mmHg)(P0.05). This result suggests that 0.5%and 1%apraclonidine are equally effective in preventing IOP rise and 0.5%apraclonidine can be a useful adjunct in preventing IOP elevation following Nd:YAG laser posterior capsulotomy.