Safety and efficacy of Aurolab aqueous drainage implant in refractory glaucoma: A prospective study

Purpose: This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non?valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods: This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results: Thirty-four eyes were analyzed and the mean follow?up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion: AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long?term follow?up studies are needed to assess long?term IOP control and cost?effectiveness.

Effects of acupuncture, combined with phacoemulsification for cataract with glaucoma / 中国针灸

OBJECTIVE@#To observe the effects of acupuncture combined with phacoemulsification for cataract with glaucoma.@*METHODS@#Sixty-eight patients with cataract and angle-closure glaucoma were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the control group were treated with phacoemulsification. Based on the treatment in the control group, the patients in the observation group were treated with and acupuncture at acupoints around eyes; the treatment was given once every other day, and 15-day treatment constituted a course, and 2 courses (60 days) were given. The intraocular pressure (IOP), visual acuity, pain severity, aqueous outflow (F value) and clinical symptoms were observed in the two groups before treatment and after 1 d, 7 d, 30 d and 60 d of treatment.@*RESULTS@#The IOP after 1 d, 7 d, 30 d and 60 d of treatment in the observation group was lower than that in the control group (all <0.05), while the visual acuity after 7 d, 30 d and 60 d of treatment in the observation group was higher than that in the control group (all <0.05). Compared before treatment, the IOP was significantly decreased after 1 d, 7 d, 30 d and 60 d of treatment in the two groups, and the visual acuity was significantly increased after 7 d, 30 d and 60 d of treatment in the two groups (all <0.05). The pain scores and F value after 7 d, 30 d and 60 d of treatment in the observation group were lower than those in the control group (all <0.05). Compared before treatment, the pain scores and F value after 7 d, 30 d and 60 d of treatment were significantly reduced in the two groups (all <0.05). After 60 d of treatment, the number of patients who presented general clinical symptoms in the observation group was significantly lower than that in the control group (<0.05).@*CONCLUSION@#Based on phacoemulsification, acupuncture and could significantly reduce the IOP and F value, relieve pain and improve visual acuity in patients with cataract and glaucoma.

Exploration and application of polyhydroxyalkanoates and polylactic acid membranes during glaucoma filtering surgery and interlaminar transplantation in rabbits / 中国比较医学杂志

Objective To evaluate the effect of two polymer membranes, polyhydroxyalkanoates(PHA)and polylactic acid(PLA)during glaucoma filtration surgery(GFS),and to evaluate the morphology of membranous PHA after interlamellar implantation. Methods Twenty-eight New Zealand white rabbits were chosen and twenty-four of them were randomly divided into 6 groups(n=4):the PHA-low group,PHA-high group,PLA-low group,PLA-high group,positive control group(MMC group)and blank control group. The rabbits in each group received GFS. The corresponding polymer membranes were implanted under the scleral flap,while the MMC group was treated with 0.2 mg/mL mitomycin C(MMC) for 3 minutes,and the blank control group was treated without extra drugs. The intraocular pressure(IOP)was examined at 0 d,1 d, 3 d, 7 d, 14 d, 28 d and 84 d after GFS. The corneal layers of four rabbits were implanted with PHA membranes and the corneal morphological changes were observed after 84 d. Results The IOP of the PHA-low and PLA-high groups was lower than that of the blank control group at 84 d after GFS(P < 0.05),and was similar with that of the MMC group(P> 0.05). Morphological studies showed that there were no collagenous fibers filling in the duct, and the collagenous fibers around the membranes were generally arranged in parallel. There were no obvious changes in the peripheral collagen structure after implantation of PHA membranes between the corneal layers. Conclusions Application of PHA and PLA membranes during GFS in rabbits may maintain the level of IOP,and the effect is similar with MMC. The mechanism may be achieved through the mechanical blocking of fibrous tissue.

Comparison of Anterior Segment Features between Groups with or without Glaucoma in Pseudoexfoliation Syndrome

PURPOSE: To investigate the factors associated with glaucoma in patients with pseudoexfoliation syndrome by comparing features of the anterior segments and ocular biometry according to the presence or absence of open-angle glaucoma in pseudoexfoliation syndrome. METHODS: We analyzed 96 patients (115 eyes) diagnosed as having pseudoexfoliation syndrome in this study. The patients were divided into two groups of simple pseudoexfoliation syndrome (64 patients, 76 eyes) and pseudoexfoliation glaucoma (32 patients, 39 eyes). We compared the age, sex, underlying disease, location of pseudoexfoliative material, iris change, degree of nuclear cataract, pupil dilatation, corneal endothelial cell counts, central corneal thickness, anterior chamber depth, axial length, corneal curvature, and intraocular pressure (IOP). RESULTS: There were no significant differences between the two groups in terms of age (p = 0.694), sex (p = 0.161), diabetes (p = 0.440), hypertension (p = 0.238), pseudoexfoliative material observed in anterior capsule (p = 0.700), pupillary margin (p = 0.210), iris depigmentation (p = 0.526), pupillary ruff loss (p = 0.708), degree of nuclear cataract (p = 0.617), pupil dilatation (p = 0.526), central corneal thickness (p = 0.097), anterior chamber depth (p = 0.283), axial length (p = 0.095), or horizontal and vertical corneal curvature (p = 0.066 and 0.306, respectively). In pseudoexfoliation glaucoma, significantly higher IOP (p = 0.026), a high frequency of membrane formation (p = 0.047), and decreased corneal endothelial cell counts (p = 0.048) were observed. CONCLUSIONS: Pseudoexfoliation syndrome with open-angle glaucoma was shown to be associated with high IOP, decreased corneal endothelial cell counts, and a high frequency of membrane formation. Therefore, when such changes are observed in pseudoexfoliation syndrome patients, a higher risk of open-angle glaucoma should be recognized, and careful attentionis required accordingly.

The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma

PURPOSE: To determine the effect of intraocular pressure (IOP) reduction of selective laser trabeculoplasty (SLT) on medically uncontrolled open-angle glaucoma (OAG) and the factors associated with the treatment result. METHODS: Forty-seven eyes of 47 OAG patients were enrolled for 180° SLT or 360° SLT, all under maximal tolerated medical therapy and with IOP above their target pressure. All patients were followed-up for at least 1 year after the procedure. Treatment success was defined as IOP reduction ≥20% from baseline at 12 months after SLT treatment without additional anti-glaucomatous intervention. RESULTS: The treatment success rate was 65.96%. Baseline IOP was 23.84 ± 4.52 mmHg in the success group and 21.44 ± 2.97 mmHg in the failure group (p = 0.035). Significant mean IOP reduction was observed at 6, 9, and 12 month follow-ups (p = 0.001 at 6 months; 0.041 at 9 months, and <0.001 at 12 months). The success rate did not vary significantly by sex (p = 0.362), age (p = 0.081), history of cataract surgery (p = 0.470), number of medications (p = 0.857), duration of medication (p = 0.613), or angular degree of SLT treatment (180° vs. 360°) (p = 0.137). There was a positive correlation between mean baseline IOP and mean reduction of IOP from baseline in the success group (p < 0.001, r = 0.861), while there was no such correlation in the failure group (p = 0.272, r = −2.921). CONCLUSIONS: SLT was an effective treatment for IOP reduction until 12 months in medically uncontrolled OAG patients. A greater amount of IOP reduction is expected in patients with higher baseline IOP in the success group.

Ocular Tonometry and Sporadic Creutzfeldt - Jakob Disease (sCJD): A Confirmatory Case-Control Study.

Aims: To evaluate the hypothesis that sporadic Creutzfeldt-Jakob disease (sCJD) may be transmitted through ocular tonometry. Background: The infectious agent of sCJD may be present in the cornea prior to clinical symptoms. Cornea infectiousness has been documented by cornea transplants in guinea pigs and humans. sCJD is resistant to complete inactivity by conventional sterilization techniques. Thus contact tonometry equipment is not disinfected sufficiently to kill sCJD. We previously hypothesized that contact tonometry is a sCJD risk factor. Study Design: Population-based case-control study. Place and Duration of Study: Department of Neurology, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 4 years. Methodology: An 11-state case-control study of pathologically confirmed definite sCJD cases, individually matched controls, and a sample of control surrogates was conducted. Ocular tonometry histories were obtained from case-surrogates, controls, and a sample of controlsurrogates. Results: The odds ratio (OR) for ever vs never having had an ocular tonometry test was statistically significant for matched and unmatched analyses for 15 through 3 years prior to disease onset, using both control self-responses and control surrogates: ORs were ∞ and 19.4 with 1-sided P-values <0.0001 and 0.003 and ORs=∞ and 11.1 with 1-sided P-values <0.003 and 0.02, respectively. ORs increased as the number of tonometry tests increased during this age period: trend test, 2-sided P-value < 0.0001. For ≥5 vs <5 tonometry tests, the OR was 5.8 (unmatched) and 3.7 (matched), 2-sided P-value<0.00005. Respondents generally could not specify the type of tonometry. There was no indication of increased tonometry testing among cases within 2 years of disease onset. Conclusions: The a priori hypothesis was supported. Contact tonometry, preferred by ophthalmologists, may be capable of transmitting sCJD. Consideration should be given to using disposable instrument covers after each use. The use the disposable covers or non-contact tonometry is preferable in the absence of effective disinfectant processes at this time.

Effects of intraocular pressure drop for two kinds of aqueous humor drainage implant devices / 医用生物力学

Objective To observe and compare the effects of intraocular pressure (IOP) drop on using two kinds of aqueous drainage device implantation. Methods Forty healthy New Zealand white rabbits were chosen for the experiments. According to different implant devices, they were divided into NADI (new aqueous drainage implant) group and Ahmed group respectively, with 20 rabbits in each. Results Neither group appeared shallow anterior chamber after operation. At 8th week after operation, the postoperative IOP of NADI group and Ahmed group was decreased by 19.4% and 15.7%, respectively, as compared to the preoperative IOP. Statistical comparison showed that there were significant differences in IOP between two groups within 8 weeks (P＜0.05), and the IOP of NADI group was decreased more significantly than that of Ahmed group. Conclusions The IOP in NADI group was reduced more than that in Ahmed group, and such IOP drop was maintained for a longer period in NADI group, which means that NADI has an obvious IOP drop effect and good prospect in clinical application.

Effects of aqueous humor drainage to different parts of rabbit eye on intraocular pressure drop / 医用生物力学

Objective To observe and compare the effects of intraocular pressure (IOP) drop when the aqueous humor was drained to limbus, ambitus and posterior segment of rabbit eye by implanting medical silicone tube. Methods Forty-five healthy New Zealand white rabbits were chosen for the experimental group, each with the medical silicone tube implanted in one eye. According to different implanting ways, the rabbits were divided into the limbus group, ambitus group and posterior segment group respectively, with 15 rabbits in each group. Results According to statistical comparison of preoperative and postoperative IOP values among the 3 groups within 4 weeks, the IOP of the posterior segment group was decreased most by 26.6%, and that of the ambitus group and limbal group was decreased by 16.2% and 1.2%, respectively. The differences between the preoperative and postoperative IOP in first, second and fourth week were statistically significant (P<0.01) for all three groups. The IOP of the posterior segment group after 4 weeks was decreased most, and there were significant differences in IOP values among three groups (P<0.01). Conclusions The greatest IOP drop occurred when the aqueous humor was drained to the posterior segment of the rabbit eye, and this result could provide some reference for the clinical surgery.

Paracentesis as an initial intervention in Malay Indonesian eyes with acute primary angle closure.

Background: Acute primary angle closure (APAC) is one of the causes of blindness in Department of Ophthalmology Cipto Mangunkusumo General Hospital. Management of APAC is still controversial. Laser peripheral iridotomy is difficult to be done due to corneal edema as a result of persistent high intraocular pressure (IOP). It is believe that paracentesis will lower IOP immediately. The objective of the study was to assess outcome of paracentesis as the initial management in Malay Indonesian eyes with APAC. Methods: This intervention study was conducted at the Eye Clinic of Cipto Mangunkusumo Hospital and Jakarta Eye Center commencing in January 2005 until December 2007. Malay Indonesian eyes with APAC were included in this study in accordance with the new Asia Pacific consensus. All APAC eyes underwent paracentesis to lower IOP. The presenting and post-paracentesis IOP and peripheral anterior synechiae were noted. The outcome was termed as good when IOP was ≤ 21 mmHg and poor when IOP was > 21 mmHg. Results: A total of 45 APAC eyes were recruited. Thirty-eight of these belonged to women; mean age was 54.6 ± 1.56 years. Meanwhile, average duration of symptoms was 13.15 ± 7.4 days and mean of extent of peripheral anterior synechiae (PAS) was 7.7 ± 3.1 hours. There was a strong correlation regarding duration of symptoms to the formation of PAS (r = 0.672; p < 0.001). The mean presenting IOP was 55 ± 13.37 mmHg and mean post-paracentesis IOP was 27 ± 12.78 mmHg. A decrease of 49% in IOP ( p < 0.001) was observed after paracentesis with good outcome in 19 eyes and poor outcome in 26 eyes. Conclusion: Paracentesis as an initial intervention in APAC eyes reduces the IOP immediately, but only as a temporary response.

Regularity on change of retinal nerve fiber layer thickness with acute high intraocular pressure / 医用生物力学

Objective To measure the rabbit retinal nerve fiber layer(RNFL) thickness in vivo under different intraocular pressures (IOP) and at different time intervals after acute high IOP, and to obtain the regularity on change of RNFL thickness with acute high IOP. Methods Four groups of acute high IOP model were formed by perfusing the saline water into the anterior chamber of rabbit eyes, then RNFL thickness under different IOPs was measured by optical coherence tomography with radial scanning mode whose center was optical papilla and diameter was 6 mm. Results The absolute change values of RNFL thickness were(-27.16±14.24), (-33.33±6.74), (-48.75±5.24), (-67.29±3.89) μm under different IOPs of (4.50±0.35), (6.07±0.31), (7.74±0.26), (10.71±0.07) kPa, respectively. The linear relationship was found between the relative change of RNFL thickness and IOP. IOP could return to the normal level within two days after acute high IOP, while the RNFL thickness could be restored at the second week, and it was easier to restore if the IOP was lower than 6.65 kPa. Conclusions The acute high IOP could cause RNFL thickness to decrease significantly with the increased acute high IOP, but it will be restored after some time.

Risk Factors of Intraocular Pressure (IOP) Changes in Pseudoexfoliation (PEX) Syndrome

PURPOSE: We evaluated the short and long-term changes of intraocular pressure (IOP) and studied its risk factors in pseudoexfoliation (PEX). METHODS: A total of 40 eyes that had been newly diagnosed with PEX from January 1, 1995 to December 31, 2007 were included in this study. Age, gender and accompanying systemic disease were recorded. In addition, the age, gender, number of antiglaucoma eye drops, history of cataract operation, and history of systemic disease were evaluated as risk factors for IOP elevation during the follow-up periods. Pre and post cataract operation IOP was checked to evaluate the effect of the cataract operation on IOP. RESULTS: The risk factors for IOP elevation in patients newly diagnosed with PEX were old age and female gender. After treatment, a long follow-up period and number of eyedrops were risk factors for IOP elevation. The cataract operation had a one year IOP control effect, especially in cases where the pre operative IOP was greater than 21 mmHg. Over the long term, however, the IOP control effect of cataract surgery could not be determined. CONCLUSIONS: IOP increased as result of increased patient age. Phacoemulsification was a protective factor for IOP elevation and may be a good method for short-term IOP control.

The Effect of +Gz Acceleration on Intraocular Pressure / 항공우주의학회지

BACKGROUND: The physiological change of positive acceleration is primarily focused on the hydrostatic column effects that are associated with acceleration exposures. IOP values during positive acceleration is reduced according to this theory. However, the first trial of IOP measurement during positive acceleration showed that there were no significant changes in IOP values during the +2G phase of parabolic flight. In addition, IOP study during centrifuge exposures showed that there were significant increases in IOP during +2Gz and +3Gz. Therefore, the purpose of this study is to investigate the effect of positive acceleration on IOP. METHODS: The data from 4 normal subjects (2 men and 2 women) were included in this study. The baseline IOPs of subjects were within normal range. The subjects did not wear anti-G suits and use anti-G maneuver during the acceleration exposure. Pressure phosphene tonometer was used to measure IOP. To minimize the difference between the Goldmann tonometer and the pressure phosphene tonometer, IOPs were measured in subjects for 1 week prior to this study. IOP measurements of protocol 1 were obtained with pressure phosphene tonometer at +1Gz (baseline), +2Gz, +3Gz, +4Gz, and again at +1Gz (post). IOP measurements of protocol 2 were obtained at + 1Gz (baseline), +3Gz, and again at +1Gz (post). IOP measurements of protocol 3 were obtained at + 1Gz (baseline), +4Gz, and again at +1Gz (post). A total of 55 IOP measurements for each subject were made. RESULTS: The result showed that there was a significant difference in the means of IOP in protocol 1, 2, and 3 (P<0.05). But, they did not show an increasing or decreasing trend according to increase in acceleration. In particular, subject 1 showed that there was significant decrease of IOP in protocol 1, 2, and 3 compared to the baseline IOP measurements during positive acceleration(P<0.05). Based on symptom questionnaire and VTR review, variable body contractions may affect the IOP measurements during acceleration. There were significant differences in the means of IOP among variable body contractions in subject 1 when compared to the baseline IOP measurements. CONCLUSIONS:Persistent decreases of IOP in subject 1 suggest that the mechanism of IOP changes under positive acceleration could be explained by the hydrostatic column effect. In addition, interpretation for IOP measurements under positive acceleration should be cautious due to variable muscle contraction.

Sequential versus combined glaucoma and cataract procedures in Siriraj Hospital.

Objective: To compare the efficacy of intraocular pressure (IOP) control after combined cataract and trabeculectomy with sequential cataract surgery after trabeculectomy, both with and without antimetabolites. Methods: The retrospective study recruited 96 eyes of 73 patients who underwent cataract and glaucoma surgery, and were classified into two groups. Group I sequential procedures: 72 eyes of 56 patients who had undergone a previous trabeculectomy (with or without antimetabolites) for at least 6 months before planned phacoemulsification or ECCE. Groups II combined procedures: 24 eyes of 17 patients who underwent combined trabeculectomy(with or without antimetabolites) with phacoemulsification or ECCE between January 1998 and May 2003. The effects on IOP, best corrected visual acuity, and number of glaucoma medications taken were compared. Results: Mean postoperative IOP without oral medications was 14.17 mmHg in group I and 17.15 mmHg in group II (p=0.05) at 12 month follow up. The mean IOP remained significantly lower in group I (13.67) than in group II (16.36) (p=0.023) at the last follow up. There was a significant difference in surgical success between the groups (p=0.005). The reduction in the mean number of glaucoma medications was significantly higher in group I (p=0.04). In group I the mean IOP before and after cataract surgery were similar (p=0.787) but the numbers of glaucoma medications used were significantly increased (p=0.000) after cataract surgery. Conclusion: Sequential glaucoma and cataract procedure was associated with better IOP control than combined procedure. Cataract surgery in eyes with functioning bleb might have the adverse effect on IOP control.

Recurrent Intraocular Pressure Elevation during Hemodialysis in a Patient with Neovascular Glaucoma

PURPOSE: To report a patient with symptomatic intraocular pressure (IOP) elevation in an eye with neovascular glaucoma (NVG) during hemodialysis. METHODS: Case report. RESULTS: Recurrent episodes of severe ocular pain and elevated IOP in the NVG eye were noted during hemodialysis in a 29-year-old man. The patient was recently diagnosed at our ophthalmology clinic with NVG due to central retinal vein occlusion. IOP was temporarily controlled after the Ahmed valve implantation. However, after the fibrous membrane developed and occluded the tip of the Ahmed valve, IOP elevation during hemodialysis recurred. Further treatments with intravenous mannitol, oral carbonic anhydrase inhibitor, topical antiglaumatic agents and subconjunctival 5-fluorouracil (5-FU) injections all failed to control relapsing pain and IOP elevation. Eventually, evisceration and hydroxyappatite implantation were performed. CONCLUSIONS: Physicians must be alert to the possibility of IOP elevation in glaucomatous eyes during hemodialysis.

Medical Treatment of Glaucoma

No abstract available.

Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

PURPOSE: This study investigated firstly the change of intraocular pressure (IOP) after injection of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema and secondly the factors that influence these changes. METHODS: A prospective, non-comparative study was performed in 60 patients at Kangnam Sacred Heart Hospital from October 2003 to September 2004. All the patients received 4-mg IVTA injection. RESULTS: Mean IOP was elevated from the day after injection and peaked at 20.5 mmHg after 2 months (p=0.000). Twenty-six eyes (43.3%) showed significant IOP elevation. IOP was not controlled despite full glaucoma medication in 7 (11.7%) eyes. Two eyes underwent filtering surgery. Younger age was a statistically significant predictive factor for IOP elevation (p=0.009). CONCLUSIONS: In this study, patients who needed filtering surgery developed an IOP spike within one week after the injection. Therefore, clinicians should consider checking IOP at the end of the first week. Furthermore, greater cautions is mandatory with relatively younger patients.

The Relationship between Intraocular Pressure and Cardiovascular Risk Factors

PURPOSE: To evaluate the relationship between intraocular pressure (IOP) and cardiovascular risk variables in healthy Koreans adjusted for age and mean blood pressure. METHODS: A total of 1477 healthy participants underwent automated multi-phasic test, including tonometry, automated perimetry, fundus photography, blood pressure, and cardiovascular risk variables such as total cholesterol, high density lipoprotein, triglyceride, and blood glucose. The subjects were divided into six age groups by decades ranging from 20~29 years to over 70 years. The relationship between IOP and cardiovascular risk variables was examined using multiple regression analysis. RESULTS: The mean age of participants was 49.0 years, and 778 (52.7%) of participants were men. The mean IOP was 15.8+/-3.2 mmHg, and was significantly higher in men than in women (p0.05). CONCLUSIONS: As increased IOP was associated with cardiovascular risk variables, it is necessary to control increased total cholesterol, triglyceride, and blood glucose levels in the normal population to prevent or control the IOP elevation.

Phacoemulsification using Iris Hook in Patients with Secondary Angle-Closure Glaucoma Associated with Lens Subluxation

PURPOSE: To evaluate the effect on the intraocular pressure after the phacoemulsification on the secondary angle-closure glaucoma associated with lens subluxation. METHODS: We reviewed the clinical records of 8 patients (9 eyes) prospectively who's intraocular pressure (IOP) didn't controlled with medication, so received the lens removal by the phacoemulsification. We reviewed their intraocular pressure, visual acuity, and complications before and after the surgery. RESULTS: The patients' mean age was 60.4 +/- 11.9. Initial mean IOP was 41.2 +/- 15.0 mmHg with mean of 1.1 +/- 1.8 medication and mean preoperative IOP was 30.4 +/- 11.2 mmHg with mean of 1.2 +/- 1.1 medication. Postoperative IOP was 16.2 +/- 2.8 mmHg with usage of 0.6 +/- 0.9 medication during the follow-up of 4.6 +/- 1.4 months, and the IOP of 6 eyes (66.7%) were controlled under 21 mmHg without any medication. With anti-glaumatic medication, the IOP of all patients were controlled under 21 mmHg. The best corrected visions were also improved after the surgery in all patients. The complications occurred in 5 eyes (55.6%), temporarily increased IOP in 4 eyes (44.4%), and hyphema in 1 eye (11.1%). CONCLUSIONS: The phacoemulsification in the secondary angle-closure glaucoma with the lens subluxation showed relatively satisfactory results, but thorough follow-up would be needed due to the recurrence of elevated IOP afterward.

A Relationship between Intraocular Pressure and Age and Body Mass Index in a Korean Population

PURPOSE: This study was carried out to evaluate the relationship between intraocular pressure (IOP) and age or obesity adjusted for systemic health parameters such as gender, mean blood pressure in a Korean population. METHODS: A total of 13212 healthy participants underwent automated multi-phasic test, including tonometry, automated perimetry, fundus photography, blood pressure, and body mass index (BMI). We used six age groups divided by decades ranging from 20 to 29 years to 70 to over 70 years old. The association between IOP and systemic health parameters was examined by means of cross-sectional analysis. RESULTS: The median age of participants was 47.6 years (range, 20 to 84 years), and 6684 (50.6%) of participants was males. The mean IOP of participants was 15.5 mmHg. The mean IOP, blood pressure, and BMI value was significantly higher in male than in female (P 22 mmHg without signs of glaucoma field or optic disc damages, was 6.1% in males and 2.5% in females. IOP was associated with mean blood pressure, gender, age, and BMI by multiple regression analysis (P<0.05). The relationship between IOP and age adjusted for gender, mean blood pressure, and BMI showed a significantly negative tendency in both genders (P<0.05). BMI had a significantly positive relation with IOP after controlling for age, gender, and mean blood pressure in male (P<0.05), but not in female. CONCLUSIONS: In this Korea population, after multiple adjustment, IOP was found to decrease with age in both gender and to increase with BMI in male.

A Study of Intraocular Pressure During Hemodialysis in CRF Patients

PURPOSE: Hemodialysis, a treatment for patients with severely compromised renal failure, is the elimination of osmotic active substances by diffusion. Some authors have reported that change in osmorality between the serum and the aquous humor during hemodialysis increased in intraocular pressure (IOP). We investigated the change of IOP and serum osmolarity during hemodialysis and the effect of oral carbonic anhydrase inhibitor (Diamox(R)), topical carbonic anhydrase inhibitor (Trusopt(R)) and oral hypertonic solution(glycerol). METHODS: In 45 CRF patients (90 eyes) without glaucoma, IOP, serum osmorality, pH, and HCO3- were measured during hemodialysis, and oral carbonic anhydrase inhibitor (Diamox(R)), topical carbonic anhydrase inhibitor (Trusopt(R)) and oral hypertonic solution (glycerol) werw administered if IOP rose by over 6mmHg during hemodialysis. After adminitration of the agents, we checked effect of preventing IOP elevation and metabolic change during hemodialysis. RESULTS: The intraocular pressure rose above 6 mmhg in 24 eyes (24.6%) during hemodialysis. Oral carbonic anhydrase inhibitor induced more severe metabolic acidosis than topical carbonic anhydrase inhibitor but topical carbonic anhydrase inhibitor was less effective in lowering IOP. CONCLUSIONS: Because of more effective lowering of IOP and rare complications of metabolic acidosis, hypertonic solution (glycerol) was effective and safe in neovascular glaucoma and in glaucoma patients with severely damaged optic nerve.