24小时血压参数与原发性开角型青光眼视神经损害的相关性

目的：研究24 h血压参数与原发性开角型青光眼（POAG）视神经损害之间的相关性。方法：病例对照研究。选择2013年6月至2016年12月期间成都市第一人民医院确诊的60例POAG患者作为POAG组,55 例正常人群作为对照组。2 组均进行24 h眼压和血压的同步监测,比较2 组受检者24 h血压参数、眼灌注压及眼压的差异,并分析POAG组患者24 h血压参数、眼灌注压及眼压与相关视功能之间的关系。采用独立样本t检验和多重线性回归等进行统计学分析。结果：①POAG组的24 h平均眼压、眼压差、眼灌注压差及脉压差显著高于对照组,2 组差异均有统计学意义（t =3.22、6.57、2.29、2.39,P ＜0.05）。②POAG组平均收缩压显著高于对照组（t =3.02,P =0.003）,其收缩压最高值、收缩压波动值、夜间平均收缩压、夜间最高收缩压及其波动值均显著高于对照组（t =4.38、5.27、4.13、4.13、 4.14,P ＜0.001）。③POAG组24 h平均舒张压、舒张压最高值、夜间平均舒张压、夜间舒张压最高值也显著高于对照组（t =2.22、2.50、2.29、2.10,P ＜0.05）。④POAG组患者的24 h血压相关参数与视神经损害相关性：平均眼压是POAG视野的平均缺损值（MD）的影响因素,二者呈负相关（b =-0.44,P =0.004）;盘周平均视网膜神经纤维层（RNFL）厚度与平均眼压（b =-0.956,P =0.001）、眼压差（b =-1.125,P =0.003）呈负相关;夜间平均舒张压（b =0.395,P ＜0.001）和夜间平均动脉压（b =0.046,P =0.001）分别与AP100和AP50值呈正相关。结论：①24 h血压相关参数与POAG的视神经损害之间存在相关性;②夜间眼灌注压、夜间舒张压和夜间动脉压可能是POAG视神经损害的影响因素;③在POAG的治疗中,稳定的血压和靶眼压有利于保持有效的稳定的眼灌注压,提示在关注降眼压治疗POAG的同时应该关注血压的变化。     

应用三维光学相干断层扫描仪对原发性开角型青光眼和正常眼脉络膜厚度的对比分析

目的　通过三维光学相干断层扫描仪比较原发性开角型青光眼（primary open-angle glaucoma,POAG）和正常眼的脉络膜厚度,并分析其影响因素,探讨脉络膜厚度与青光眼的关系。方法　选取140例（216眼）POAG患者作为青光眼组,67例（106眼）正常受试者作为正常组。采用日本Topcon公司生产的超景深广角眼底断层扫描仪对各组受试者脉络膜厚度进行检测。通过单变量和多变量回归分析受试者年龄、眼轴长度、角膜厚度、收缩压、舒张压、收缩期灌注压、舒张期灌注压、眼压以及视野缺损值等因素与脉络膜厚度的关系。结果　青光眼组受试者年龄、眼轴长度、收缩压、收缩期灌注压均高于正常组（均为P<0.05）;青光眼组受试者视野损害更严重,视野缺损值差异有统计学意义（P<0.001）;两组受试者角膜厚度、舒张压、眼压、舒张期灌注压差异均无统计学意义（均为P>0.05）;青光眼组受试者脉络膜厚度为（157.70±48.54）μm,正常组为（179.90±36.10）μm,差异有统计学意义（P<0.001）。对所有受试者脉络膜厚度与各因素进行单变量回归分析,结果提示脉络膜厚度与年龄、眼轴长度、是否青光眼均呈显著负相关（均为P<0.05）。在考虑年龄和眼轴长度等因素在内的多变量回归分析结果显示,当年龄和眼轴长度被矫正时,青光眼组与正常组之间的脉络膜厚度差异无统计学意义（P=0.216）,是否青光眼与脉络膜厚度之间无相关性。结论　脉络膜厚度与青光眼无明显相关性,年龄、眼轴长度与脉络膜厚度呈负相关,脉络膜厚度不能作为诊断POAG和病情评估的指标。     

近视人群不同注视眼位下的眼压变化

目的：研究近视人群在不同注视眼位下的眼压变化。方法：系列病例研究。选择2019 年12 月至 2020年1月在校的暨南大学单纯性近视大学生为研究对象。根据等效球镜度（SE）分为低度、中度、 高度近视组。对所有研究对象进行眼部检查，获取眼轴长度（AL）、中央前房深度（ACD）、中央角膜 厚度（CCT）及角膜曲率（K1、K2）等参数。采用iCare回弹式眼压计测量双眼原在位放松状态下的基 础眼压（IOPP）及分别注视9个不同眼位（集合、上、下、左、右、左上、左下、右上、右下）5 min后的 眼压，每个注视眼位间隔休息5 min。采用独立样本t检验、单因素方差分析及相关性检验对数据进 行分析。结果：最终纳入研究对象60例（60眼），其中低、中、高度近视组分别为21、28、11眼。左 右眼IOPP差异无统计学意义（t=0.835，P=0.406），以右眼为研究眼。3组间SE、AL差异有统计学意 义（F=139.789，P<0.001；F=21.917，P<0.001），而组间IOPP、ACD、CCT、K1、K2差异均无统计学 意义。近视眼人群向9个不同眼位注视5 min后的眼压值与IOPP[（13.80±3.92）mmHg]差异无统计学 意义。3组的IOPP、下方眼位眼压（IOPD）与SE均无相关性，IOPP与AL均无相关性。低、中度近视组 的集合眼位眼压（IOPC）与SE之间无相关性，高度近视组的IOPC与SE呈正相关（r=0.713，P=0.014）。 结论：不同注视眼位下的眼压与IOPP之间无差异，IOPP与SE之间无明显相关性，但高度近视者更应 科学合理用眼，避免长时间近距离用眼。     

白内障超声乳化吸除术中高灌注压下眼内血流的变化

目的 探讨高灌注压下白内障超声乳化吸除术时搏动性眼血流的变化及相关影响因素。设计  前瞻性非比较性病例系列。研究对象 白内障超声乳化吸除术患者23例。方法 应用搏动性眼血流分析仪分别在手术前、手术中动态测量眼内搏动性眼血流参数,包括搏动性眼血流量（POBF）、脉搏周期内平均眼压等,心电监护仪记录心率及血压。术前基线观察点为手术开始置开睑器后,术中超声乳化阶段及皮质抽吸阶段各测量1次。分析年龄、眼压、心率和血压与POBF的相关性。主要指标 搏动性眼血流量,眼压。结果 患者术前基线、超声乳化阶段、皮质抽吸阶段测得的搏动性眼血流量分别为（16.43±6.52）、（12.36±9.60）、（8.24±6.55）μl/秒。与术前基线相比,术中超声乳化及皮质抽吸时的搏动性眼血流量均有不同程度下降。在皮质抽吸时搏动性眼血流量较超声乳化时进一步下降,与基线值相比差异均有统计学意义（P均<0.001）。患者术前基线、超声乳化阶段、皮质抽吸阶段的平均眼压分别为（21.10±4.10）、 （59.64±13.83）、 （39.72±10.04）mm Hg。与术前基线眼压相比,术中两个观察点的眼压明显升高,且均有统计学意义（P均<0.05）。患者年龄和眼压与POBF呈负相关（b=-0.068,P<0.001和b=-0.012,P<0.001）,心率和收缩压与POBF呈正相关（b=0.005,P=0.046;b=0.007,P<0.001）。结论 白内障超声乳化手术在高灌注压的持续作用下,眼压明显升高,搏动性眼血流持续下降,提示持续高灌注压下的白内障超声乳化手术可造成眼内的血供减少。（眼科, 2013, 22:82-85）     

周期性眼外负压吸引对角膜地形的影响

目的探讨周期性眼外负压吸引对角膜地形的影响及可能原因。方法随机选取“球外反博”治疗患者40例（40眼）,以眼外负压100 mmHg/3 s速度升高至（300±20）mmHg,维持5 s后释放负压至0,间隔1 min重复,共10个循环。试验后1、5、15 min检测患者角膜地形图、视力、眼压、眼表状况、自觉症状等。以受试眼自身前后对照,分析角膜不规则指数（CIM）、形状因子（SF）、角膜散光度（ASTIG）等角膜地形指标。结果周期性眼外负压吸引后随时间的变化,ASTIG、CIM变化差异均有统计学意义（F=7.62,P=0.006;F=0.431,P=0.001）,吸引后15 min恢复至吸引前状态;SF的改变差异无统计学意义（F=0.635,P=0.050 2）。性别、眼别及瞳孔大小差异均无统计学意义（P〉0.05）。吸引结束后,轻度眼部不适4例（10%）,结膜轻度充血15例（37.5%）,有轻度角膜上皮点状脱失1例（2.5%）,轻度视物模糊2例（5%）。吸引结束后15 min,患者视力均无下降,眼压在正常范围内。结论周期性眼外负压吸引对角膜表面形状有一定影响,随着时间的推移该影响力迅速减少,15 min时角膜形状已基本恢复。     

终末期糖尿病肾病患者围血液透析期眼部相关参数变化

目的：观察终末期糖尿病肾病(end-stage diabetic nephropathy,ESDN)患者围血液透析期眼压(intraocular pressure,IOP)、眼灌注压(ocular perfusion pressure,OPP)、中央前房深度(central anterior chamber depth,CACD)和黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)变化的特点,评估血液透析(hemodialysis,HD)对ESDN患者眼部血供的可能影响。

方法：病例前后对照研究。观察我院肾病科HD治疗的ESDN患者42例84眼,在HD开始前30min、开始后2h、结束后30min内,分别测量收缩压和舒张压,手持式回弹式眼压计测量眼压,经换算得出OPP(OPP=4/9舒张压+2/9收缩压-眼压)。HD开始前30min和结束后30min内,分别采用光学相干生物测量仪测量CACD,光学相干断层扫描(optical coherence tomography,OCT)测量SFCT。对HD前后各测量参数采用方差齐性检验、ANOVA分析、LSD-t组间比较和配对样本t检验进行统计学分析。

结果：ESDN患者84眼中,HD开始前30min、开始后2h与结束后30min相比,收缩压差异无统计学意义(F=0.254,P=0.783); 舒张压差异无统计学意义(F=0.114,P=0.896); IOP差异有统计学意义(F=7.527,P=0.001); OPP差异有统计学意义(F=4.692,P=0.027)。HD开始前30min与开始后2h相比,IOP差异有统计学意义(t=-3.646,P=0.001),IOP较HD前升高; OPP差异有统计学意义(t=2.321,P=0.022),OPP较HD前降低。HD开始前30min与结束后30min相比,IOP差异有统计学意义(t=-2.977,P=0.003),IOP较HD前升高; OPP差异无统计学意义(t=0.219,P=0.872); CACD差异有统计学意义(t=6.291,P<0.05),CACD较HD前变浅; SFCT差异有统计学意义(t=5.736,P<0.05),SFCT较HD前变薄。

结论：HD后可致ESDN患者IOP不同程度升高,OPP一过性降低,前房变浅,脉络膜血供减少。HD前应评估ESDN患者的眼部状况,采取有效的监测和预防措施,降低HD引起眼部血供状态变化对视功能的可能影响。     

不同屈光状态儿童应用盐酸环喷托酯滴眼后1 h内等效球镜度与瞳孔直径达到稳定所需时间及变化幅度的相关影响因素

目的　探讨不同屈光状态儿童应用盐酸环喷托酯（cyclopentolate hydrochloride，CH）滴眼后1 h内等效球镜度（spherical equivalent，SE）与瞳孔直径（pupil diameter，PD）达到稳定所需时间及变化幅度的相关影响因素。方法　选取2019年9月首次于天津医科大学眼科医院视光门诊就诊，拟诊断为屈光不正，需要进行睫状肌麻痹验光的患儿56例100眼。根据末次测量的SE将患儿分为3组:（1）近视组（40眼）:SE <-0.50 D；（2）正视组（29眼）:-0.50 D ≤ SE ≤ +0.50 D；（3）远视组（31眼）:SE > +0.50 D。在第一滴CH滴眼前和滴眼后1 h内，由同一名研究人员分别应用自动电脑验光仪（精度0.13 D）和红外瞳孔计（精度0.01 mm）监测SE和PD的动态变化，每5 min监测1次，共计13次。通过重复测量方差分析确定不同屈光状态组SE与PD达到稳定所需时间；通过方差分析比较不同屈光状态组SE和PD变化幅度差异；通过Pearson双变量相关分析寻找SE及PD变化幅度的相关影响因素。结果　近视组在第一滴CH滴眼30 min之后（包括30 min），SE峰值与各观察时间点SE测量值之间的差异均无统计学意义（均为P>0.05），差值均不超过0.04 D；正视组在第一滴CH滴眼30 min之后（包括30 min），SE峰值与各观察时间点SE测量值之间的差异均无统计学意义（均为P>0.05），差值均不超过0.13 D；远视组在第一滴CH滴眼35 min之后（包括35 min），SE峰值与各观察时间点SE测量值之间的差异均无统计学意义（均为P>0.05），差值均不超过0.07 D。总体上，95眼（95%）在第一滴CH滴眼后1 h内SE峰值与SE在第一滴CH滴眼后35 min时的测量值之间差异不超过0.25 D。近视组在第一滴CH滴眼后55 min内（包括55 min），PD峰值与各观察时间点PD测量值之间的差异均有统计学意义（均为P<0.05），但在55 min时差异（0.07 mm）无临床意义；正视组在第一滴CH滴眼后55 min内（包括55 min），PD峰值与各观察时间点PD测量值差异均有统计学意义（均为P<0.05），但在55 min时差异（0.05 mm）无临床意义；远视组在第一滴CH滴眼后55 min内（包括55 min），PD峰值与各观察时间点PD测量值差异均有统计学意义（均为P<0.05），但在55 min时差异（0.06 mm）无临床意义。总体上，86眼（86%）在第一滴CH滴眼后1 h内PD峰值与PD在第一滴CH滴眼后55 min时的测量值之间差异不超过0.10 mm。Pearson双变量线性相关分析显示，SE变化幅度与眼轴长度（r=-0.445，P<0.001）、年龄（r=-0.225,P=0.024）均呈显著负相关，与末次SE（r=0.543，P<0.001）、初始SE（r=0.297，P=0.003）均呈显著正相关，与性别（r=0.113，P=0.262）、眼压（r=-0.142，P=0.158）均无相关性。PD变化幅度与初始PD（r=-0.583，P<0.001）呈显著负相关，与年龄（r=-0.008，P=0.933）、性别（r=0.005，P=0.957）、眼压（r=-0.139，P=0.167）、眼轴长度（r=-0.020，P=0.843）、末次PD（r=-0.003，P=0.979）均无相关性。本研究全程未观察到严重不良反应。结论　CH用于6~15岁儿童时，SE早于PD达到稳定。睫状肌麻痹验光无需等到瞳孔充分散大，可在第一滴CH滴眼35 min后进行。CH对于年龄小和远视的儿童睫状肌麻痹作用更强，对于初始瞳孔越小的儿童瞳孔散大作用越明显。     

玻璃体内注射康柏西普治疗急进性后极部早产儿视网膜病变早期眼压的改变

目的　探讨玻璃体内注射康柏西普治疗急进性后极部早产儿视网膜病变(AP-ROP)患儿早期眼压的改变。方法　选取2017年6月至2019年5月于厦门市儿童医院确诊的AP-ROP行玻璃体内注射康柏西普（0.25 mg/0.025 mL）治疗的22例（32眼）患儿纳入研究。分别记录注射前5 min及注射后1 min、5 min、10 min、2 h、24 h眼压,同时记录注射后疗效并分析并发症情况。结果　22例（32眼）患儿注射前5 min眼压为（10.44±2.68）mmHg（1 kPa=7.5 mmHg),注射后1 min、5 min、10 min、2 h及24 h的眼压分别为（18.66±3.09）mmHg、（21.81±3.09）mmHg、（18.34±3.26）mmHg、（14.53±3.29）mmHg、（12.03±3.36）mmHg。方差分析结果显示,不同时间点间的眼压差异具有统计学意义（F=61.91,P＜0.01）;两两时间点比较结果显示,注射后10 min与注射后1 min、注射后24 h与注射前5 min眼压相比差异均无统计学意义（均为P>0.05),其余各观察时间点间眼压两两相比差异均有统计学意义(均为P＜0.05)。注射后各时间点眼压的变化趋势为先升后降,眼压峰值出现在注射后5 min。患儿注射后5 min眼压较注射前升高幅度≥15 mmHg的患眼,其合并虹膜新生血管的比例更高,出生体质量更低（均为P＜0.05）。结论　玻璃体内注射康柏西普治疗AP-ROP患儿出现的眼压升高是一过性的,眼科临床医生需多关注注射后5 min的眼压,以避免因为眼压升高影响术后效果。     

睫状体光凝术与小梁切除术治疗原发性急性闭角型青光眼持续性高眼压疗效比较

背景 经巩膜二极管激光睫状体光凝术（TDCP）既往仅用于视功能差的晚期青光眼患者的治疗,但随着技术的发展和设备的进步,目前其适应证逐步扩大,已有报道将其用于不同时期的多种类型青光眼,但相关临床疗效评价研究较少. 目的 比较TDCP和小梁切除术治疗原发性急性闭角型青光眼（PAACG）持续性高眼压的疗效.方法 采用回顾性病例对照设计.收集2009年1月至2010年12月在解放军第180医院眼科确诊为PAACG持续性高眼压的患者,根据治疗方式不同分为TDCP组56例62眼和小梁切除术组39例44眼.对两组患者治疗前,治疗后1周、3个月和末次随访时的视力、眼压、术后需用降眼压药物的数量以及后续治疗情况进行分析比较.结果 两组患者的人口基线特征差异无统计学意义（均P＞0.05）.TDCP组治疗前后不同时间点间视力改善眼数的总体比较差异有统计学意义（x2=30.927,P=0.002）,治疗后1周视力改善的眼数明显多于治疗前,差异有统计学意义（x2=16.778,P=0.002）,但治疗后各时间点间视力改善的眼数差异均无统计学意义（均P＞0.008）.小梁切除术组治疗前后不同时间点间视力改善眼数的总体比较差异有统计学意义（x2 =44.345,P＜0.001）,小、梁切除术后1周与术前相比视力提高的眼数明显增加,差异有统计学意义（x2=23.725,P＜0.001）,但术后各时间点间视力改善的眼数差异均无统计学意义（均P＞0.008）.治疗前后各时间点2个组间的眼压比较差异无统计学意义（F组别=3.836,P=0.053）,但手术前后不同时间点间的眼压变化差异有统计学意义（F时间=757.078,P＜0.001）,两组术眼术后各时间点的眼压均明显低于术前,差异均有统计学意义（均P＜0.001）.末次随访时TDCP组需用降眼压药物者占48.4％,小梁切除术组为27.3％,两组间差异有统计学意义（x2=4.796,P=0.029）.TDCP组中术后20眼再行睫状体光凝术或小梁切除术,占32.3％,小梁切除术组为2眼,占4.5％.结论 TDCP治疗PAACG持续性高眼压与小梁切除术的短期降眼压效果无明显差别,且其操作更为简便,手术持续时间短.TDCP治疗后的远期降眼压效果较小梁切除术差,需用降眼压药物和重复手术治疗的患者比例高于小梁切除术.     

0.01%阿托品对青少年近视调节参数的影响

观察0.01%阿托品对青少年近视调节参数的影响。方法：前瞻性非随机对照研究。选取2015年 4月至2018年6月于聊城市第二人民医院眼科就诊的轻中度近视患者61例（122眼），年龄13～16 （14.4±0.9）岁，根据监护人意愿分为2组：阿托品组30例（60眼），滴用0.01%阿托品滴眼液1次；对照组31例（62眼），滴用玻璃酸钠滴眼液1次。阿托品组在用药前及用药后2、4、6 h行近视力、调节幅度和调节灵敏度检查。对照组在用药前及用药后2、6 h行近视力、调节幅度和调节灵敏度检查。采用重复测量方差分析、t检验对数据进行统计学分析。结果：点眼药前后，2组间近视力差异无统计学意义（F=0.209，P=0.650），各时间点近视力比较差异无统计学意义（F=0.292，P=0.594），组别与时间无交互作用（F=0.097，P=0.756）。阿托品组用药后2 h调节幅度低于对照组（t=-13.09， P<0.001），2 组间用药后6 h调节幅度差异无统计学意义（t=-0.26，P=0.797）；阿托品组用药后 2 h调节幅度[（10.09±0.69）D]较用药前[（12.58±0.88）D]下降（P<0.001），用药后4 h调节幅度（10.98±0.77）D较用药后2 h升高（P<0.001），用药后6 h调节幅度（12.45±0.77）D和用药前相比，差异无统计学意义（P=0.911）。阿托品组用药后2、6 h的调节灵敏度与对照组比较，差异均无统计学意义；阿托品组各时间点调节灵敏度比较差异无统计学意义（F=0.09，P=0.965）。结论：0.01%阿托品滴眼液滴眼部1次后，调节幅度下降，但剩余的调节力足够，不影响近视力和调节灵敏度。     

Effects of isometric exercise on subfoveal choroidal blood flow in smokers and nonsmokers

PURPOSE: Little is known about potential effects of smoking on ocular blood flow regulation. In the present study, the hypothesis was that choroidal blood flow (CBF) changes during an increase in ocular perfusion pressure induced by isometric exercise are altered in chronic smokers. METHODS: The study was performed in 24 (12 smokers and 12 nonsmokers) healthy male volunteers in an observer-masked, two-cohort study design. The difference in CBF regulation between smokers and nonsmokers was tested during isometric exercise over a period of 6 minutes. CBF was assessed with laser Doppler flowery (LDF), and ocular perfusion pressure (OPP) was calculated from mean arterial pressure (MAP) and intraocular pressure (IOP). RESULTS: Six minutes of isometric exercise induced a significant increase in MAP, pulse rate (PR), OPP, and CBF in smokers and nonsmokers (each P<0.001). The increase in CBF was significantly higher in the smoking group (P<0.001) than in the healthy control group, whereas a comparable increase in MAP (P=0.18), PR (P=0.18), and OPP (P=0.43) occurred in smokers and nonsmokers. IOP remained unchanged during isometric exercise in both groups. Moreover, in smokers, CBF started to increase at OPPs more than 49% above baseline, whereas CBF in nonsmokers remained stable until an increase in OPP of 74% over baseline. This difference between the two groups was significant (P<0.001). CONCLUSIONS: These data indicate abnormal CBF regulation in chronic smokers compared with age-matched nonsmoking subjects during isometric exercise. The pathways responsible for this abnormal blood flow response remain to be elucidated.     

Effect of latanoprost on the diurnal variations in the intraocular and ocular perfusion pressure in normal tension glaucoma

PURPOSE: To evaluate the effects of latanoprost on the diurnal variations in the intraocular pressure (IOP) combined with the ocular perfusion pressure (OPP) in patients with normal tension glaucoma (NTG). PATIENTS AND METHODS: Twenty-two eyes from 22 patients with NTG were used for the study. The diurnal variations in the IOP and blood pressure (BP) were measured every 3 hours without therapy, and then the patients were treated with latanoprost (0.005%) once daily for more than 12 weeks. The diurnal variations in the IOP and BP under medication were again measured every 6 hours. The diurnal variation of IOP for 24 hours, mean diurnal IOP, maximum IOP, minimum IOP, range of variation in IOP, OPP, and BP were compared between the baseline and after treatment by means of a paired t test. RESULTS: At 3 months after the start of the latanoprost treatment regimen, the IOP showed a statistically significant decrease at every assessed time point over 24 hours (P<0.001). Latanoprost significantly reduced the mean diurnal IOP, maximum IOP, minimum IOP, and mean range of variation in the IOP values from baseline (P<0.001, <0.001, <0.001, and 0.009, respectively). OPP after treatment showed no significant difference at any assessed time points from the baseline (P>0.1). Latanoprost did not significantly alter the mean diurnal OPP (P>0.1), and BP (P>0.5) from the baseline. CONCLUSIONS: Latanoprost was thus found to significantly reduce IOP over 24 hours, whereas it does not affect OPP and BP in NTG patients. Therefore, it may be a useful medication for NTG.     

Effect of Topical Phenylephrine 2.5% on Episcleral Venous Pressure in Normal Human Eyes

PurposePhenylephrine has been shown to affect intraocular pressure (IOP) but the mechanism of action is poorly understood. However, its action as a vasoconstrictor suggests possible effects on episcleral venous pressure (EVP). In this study, we evaluated the effect of phenylephrine on EVP and IOP in healthy subjects.MethodsForty eyes of 20 subjects were included. Each subject received 3 drops of phenylephrine 2.5% in one eye at 1-minute intervals. The fellow eye served as control. Blood pressure, heart rate, and IOP and EVP of both eyes were measured at baseline, 15 minutes, and 60 minutes after instillation of phenylephrine. IOP was measured by pneumatonometry. EVP was assessed by using a computer-controlled episcleral venomanometer. Changes in IOP, EVP, blood pressure, and heart rate at 15 and 60 minutes were analyzed by paired t-tests.ResultsIOP increased 15 minutes after instillation of phenylephrine in both treated (P = 0.001) and control eyes (P = 0.01) and returned to baseline at 60 minutes. The change in IOP at 15 minutes was not significantly different between the 2 groups. EVP in treated eyes was unchanged at 15 minutes (P = 0.8) but decreased significantly at 60 minutes (P < 0.001). In control eyes, there was no change in EVP at any time (P > 0.6). There were no significant changes from baseline in systolic and diastolic blood pressure and heart rate after instillation of phenylephrine.ConclusionsIOP elevation associated with topical phenylephrine is not caused by an increase in EVP in healthy subjects. Instead, EVP decreases with phenylephrine, but the mechanism remains to be determined.     

Changes in choroidal thickness,axial length,and ocular perfusion pressure accompanying successful glaucoma filtration surgery

Purpose

To investigate the changes in choroidal thickness (CT), axial length (AL), and ocular perfusion pressure (OPP) accompanying intraocular pressure (IOP) reduction after trabeculectomy.

Methods

Thirty-nine eyes of 39 patients with primary open-angle glaucoma uncontrolled by medical therapy were included in this prospective and interventional study. All patients underwent a fornix-based trabeculectomy. The CT was measured by enhanced depth imaging-optical coherence tomography. IOP, AL, and systolic/diastolic blood pressure were also measured, and OPP was calculated. All measurements were performed at baseline and 1 month after surgery.

Results

The mean IOP was 25.0±5.8 mm Hg at baseline and 11.7±2.6 mm Hg after trabeculectomy (P<0.001), and the mean subfoveal CT was 295±84 mm Hg at baseline and 331±82 mm Hg after trabeculectomy (P<0.001). The mean AL was 23.64±0.98 mm at baseline and 23.54±0.96 mm after trabeculectomy (P<0.001), whereas the mean OPP was 38.8±6.2 mm Hg preoperatively, and 51.1±7.3 mm Hg postoperatively (P<0.001). The change in CT negatively correlated with the change in IOP (r=−0.785, P<0.001) and AL (r=−0.693, P<0.001), whereas it positively correlated with the change in OPP (r=0.418, P=0.008).

Conclusion

These results suggest that the large IOP decrease following trabeculectomy causes choroidal thickening. In addition, CT changes are associated with IOP and AL reduction as well as OPP increase.     

Comparison of the influence of aerobic and resistance exercise of the upper and lower limb on intraocular pressure

Purpose: To compare the influence of aerobic and resistance exercise on intraocular pressure (IOP). Methods: Twenty‐one healthy subjects participated. Aerobic exercise was performed using a cycle ergometer, and resistance exercise was performed with a leg curl and a butterfly machine. Intraocular pressure was measured at baseline, during exercise and 10 min after. During resistance exercise, a Valsalva manoeuvre was prevented. Results: Before aerobic exercise, the mean IOP was 18.8 ± 2.7 mmHg. It was 16.5 ± 2.8 after 10, 17.1 ± 2.6 after 20 and 16.7 ± 3.3 mmHg after 30 min of exercise. After 10 min, the IOP returned to baseline (18.8 ± 2.7 mmHg). The mean IOP before resistance exercise with the leg curl machine was 17.0 (15.6–18.4; 65%W_max) and 16.8 (15.3–18.3) mmHg; 75%W_max) and did not change significantly during the experiment. The mean IOP before resistance exercise with the butterfly machine (65%W_max) was 16.4 (15.2–17.6) and increased to 17.2 (16.0–18.4) mmHg (p < 0.05). After 10 min of recreation, it recovered to 16.3 (15.0–17.5) mmHg. At 75%W_max, the mean baseline IOP was 16.3 (15.2–17.4) mmHg, and there were no significant changes. Conclusions: Aerobic exercise leads to a significant decrease of IOP. There was no influence of resistance exercise on IOP as long as a Valsalva manoeuvre was prevented.     

The effects of sevoflurane and ketamine on intraocular pressure in children during examination under anesthesia

PURPOSE: We studied the effects on intraocular pressure (IOP) of anesthesia administered during examination under anesthesia (EUA) in children. DESIGN: Randomized clinical trial. METHODS: This randomized trial compared IOP after inhaled sevoflurane gas to that after intramuscular ketamine hydrochloride in children undergoing EUA. IOP was measured in 30 eyes with TonoPen XL (Mentor, Inc, Norwell, Massachusetts, USA) as soon as possible after anesthesia induction (T1) and two, four, six, and eight minutes thereafter. At the same times, we recorded systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR). RESULTS: Compared with the mean IOP at T1, IOP in the sevoflurane group was significantly lower for all measurements from two to eight minutes thereafter (mean decrease in IOP: two minutes = 12%, four minutes = 19%; six minutes = 19%; eight minutes = 17%, all P < or = .01). In the ketamine group, mean IOP was not significantly changed from T1 through six minutes, whereas at eight minutes, it was 7% lower (P = .03). SBP and DBP were significantly lower for sevoflurane than for ketamine at all measurements from two minutes onward, and HR was lower for sevoflurane than for ketamine at two, four, and six minutes. CONCLUSIONS: IOP measured after ketamine sedation is more likely to represent the awake IOP than that after sevoflurane anesthesia. Changes in SBP, DBP, and HR caused by sevoflurane suggest that hemodynamic alterations may underlie its effects on IOP.     

Effects of topical hypotensive drugs on circadian IOP, blood pressure, and calculated diastolic ocular perfusion pressure in patients with glaucoma

PURPOSE: To compare the short-term effects of timolol 0.5%, brimonidine 0.2%, dorzolamide 2%, and latanoprost 0.005% on intraocular pressure (IOP), blood pressure (BP), and diastolic ocular perfusion pressure (DOPP), calculated as the difference between the diastolic blood pressure (DBP) and IOP. METHODS: According to a 4 x 4 Latin squares design for repeated measures, 27 untreated patients and patients with newly diagnosed primary open-angle glaucoma (POAG) were treated with timolol 0.5% at 8 AM and 8 PM; brimonidine 0.2% at 8 AM and 8 PM; dorzolamide 2% at 8 AM, 2 PM, and 8 PM; and latanoprost 0.005% at 8 PM. The duration of each treatment course was 6-weeks, with a 4-week washout between each treatment. IOP and BP were measured at baseline and at the end of each treatment period. IOP was measured every 2 hours throughout a 24-hour period. Sitting IOP was measured from 8 AM to 10 PM by Goldmann applanation tonometry. Supine IOP was assessed from 12 to 6 AM by means of a handheld electronic tonometer (TonoPen XL; Mentor, Norwell, MA). BP monitoring was performed by means of an automated portable device (TM-2430; A & D Co., Saitama, Japan). RESULTS: All the drugs tested decreased the IOP significantly at all time points in comparison with baseline pressure. The mean 24-hour IOP after latanoprost administration (16.62+/-0.98 mm Hg) was significantly lower than that after timolol, brimonidine, or dorzolamide (P=0.0001). During the 24-hour period, brimonidine induced a significant decrease in systolic BP (SBP) and DBP at all time points when compared with baseline measurements and with those after administration of the other drugs (P<0.0001). Timolol caused a significant decrease in DBP and SBP at all the 24-hour time points when compared with the baseline and with the dorzolamide- and latanoprost-induced changes (P<0.0001). The mean 24-hour DOPPs were 50.7+/-5.9 mm Hg at baseline, 53+/-5.5 mm Hg with timolol, 46.2+/-5.4 mm Hg with brimonidine, 55.9+/-4.6 mm Hg with dorzolamide, and 56.4+/-4.9 mm Hg with latanoprost. Brimonidine induced a significant decrease in the mean 24-hour DOPP compared with that at baseline (P<0.0001), whereas dorzolamide and latanoprost induced a significant increase (P<0.0001). CONCLUSIONS: Latanoprost seemed to induce a uniform reduction in IOP during the 24-hour period, although timolol was as effective as latanoprost during the daytime, and dorzolamide are as effective as latanoprost at night. SBP and DBP were significantly decreased by either timolol or brimonidine. In this study of patients with newly diagnosed POAG, only dorzolamide and latanoprost significantly increased mean 24-hour DOPP.     

Circadian changes of intraocular pressure and ocular perfusion pressure after timolol or latanoprost in Caucasians with normal-tension glaucoma

Purpose To evaluate the circadian effects on intraocular pressure (IOP) and ocular perfusion pressure (OPP) of 0.5% timolol or 0.005% latanoprost in Caucasian patients affected by normal-tension glaucoma (NTG). Patients and methods In this crossover trial, 30 consecutive NTG subjects underwent three 24-hour assessments of IOP, blood pressure (BP), heart rate (HR), and OPP [calculated according to the formula OPP = (1/3 systolic BP + 2/3 diastolic BP) x 2/3 – IOP]: at baseline, and after 1-month treatment with timolol or latanoprost. These parameters were recorded at 4 a.m., 8 a.m., noon, 4 p.m., 8 p.m., and midnight. Results Both timolol and latanoprost reduced IOP (p < 0.001), with a difference in favour of latanoprost of 1.3 mmHg (95% CI 0.9, 1.6; p < 0.001). After timolol, BP and HR decreased with respect to baseline (p < 0.001). Latanoprost increased mean OPP (3.6 mmHg, 95% CI 2.9, 4.3; p < 0.001), whereas timolol did not improve it. Conclusions Latanoprost induces an IOP reduction greater than timolol, also achieving a better circadian flattening of the IOP curve. Only latanoprost significantly increased mean 24-hour OPP. The management of Caucasian NTG patients should be critically realized, considering the 24-hour influence of each IOP-lowering drug on the ocular blood perfusion.     

Relative change in diurnal mean ocular perfusion pressure: a risk factor for the diagnosis of primary open-angle glaucoma

PURPOSE: To investigate diurnal change and pattern of variation in intraocular pressure (IOP) and systolic (SBP) and diastolic (DSP) blood pressures in a group with untreated primary open-angle glaucoma (uPOAG) and compare it with an age-matched, normal group. METHODS: IOP, SBP, and DBP were measured in 14 patients with uPOAG and in 14 normal subjects, every hour between 7 AM and 10 PM and the mean ocular perfusion pressure (MOPP) was calculated. Mixed-effect linear models were used to analyze the repeated-measures data in which both fixed and random effects were included. The relative diurnal change was calculated as the percentage decrease from maximum. RESULTS: The uPOAG group had the higher IOP (P < 0.001) and lower MOPP (P = 0.025). There was a significant diurnal change in IOP, SBP, DBP, and MOPP in both groups (P < 0.001). The pattern of diurnal variation in IOP (P = 0.137), SBP (P = 0.569), and DBP (P = 0.937) was not significantly different between groups but was significantly different for MOPP (P = 0.040). MOPP and IOP were most similar at 7 AM and 1 PM. Postprandial hypotension was significant for SBP, DBP, and MOPP (P < 0.001), but not IOP (P = 0.388) in both groups. The relative change in MOPP was larger in the uPOAG group (38% vs. 26%, P < 0.001), but the change in IOP was similar (42% vs. 41%, P = 0.786). There was a significant effect of DBP on IOP over the course of the day in the uPOAG group (P = 0.011) but not in the normal group (P = 0.733). CONCLUSIONS: The relative diurnal change in IOP was similar in both uPOAG and normal subjects but MOPP showed a significant difference. MOPP significantly decreased after lunch, and was at its lowest in uPOAG at 7 AM, when IOP was at its highest. A significant association was found between diurnal DBP and IOP in uPOAG.