Risk factors for intraocular pressure rise following phacoemulsification

Purpose:

This study was designed to analyze the risk factors resulting in high intraocular pressure (IOP), which was accepted as IOP higher than 22 mmHg, following uncomplicated phacoemulsification.

Materials and Methods:

The records of 812 eyes of 584 patients who underwent uncomplicated phacoemulsification were evaluated. There were 330 men and 254 women ranging between the age of 26 and 89 years (65.4 ± 9.8 years). The preoperative, postoperative first day (day 1), first week (day 7), and first month (day 30) IOP values were analyzed. Data on history of diabetes, glaucoma, pseudoexfoliation (PXF), incision site, capsular staining with trypan blue, and surgeon were recorded. A multinomial regression analysis was performed to analyse the relationship of the factors with postoperative high IOP.

Results:

The mean IOP was 15.6 ± 4.3 mmHg preoperatively. Postoperatively that were changed to 19.7 ± 9.0 mmHg at day 1, 12.7 ± 4.5 mmHg at day 7, and 12.8 ± 3.7 mmHg at day 30. The factors such as surgeon, presence of PXF, diabetes, surgical incision site, and trypan blue were not related to the postoperative high IOP (P > 0.05, in all). The only factor that related to high IOP at all visits was glaucoma (P < 0.005).

Conclusion:

According to our results, preoperative diagnosis of glaucoma seems to be the only factor to affect the postoperative IOP higher than 22 mmHg.     

Increased intraocular pressure during treatment for chronic uveitis

Objectives: (1) To prospectively evaluate the incidence of increased intraocular pressure (IOP) in patients suffering from chronic uveitis. (2) To identify the main factors responsible for an increase in the IOP among these patients. Methods: Two hundred and one patients suffering from chronic uveitis were included. Enrolled patients had an initial IOP of 8–18 mmHg. The patients were treated and clinically monitored during a period of 4 years. The IOP was measured at each visit and its changes followed prospectively. All patients were followed up for at least 12 months after enrollment. Results: Twenty-four (12%) of the 201 patients had IOP higher than 24 mmHg at two or more consecutive visits. Of these 24 patients, 19 suffered from bilateral uveitis and 5 had unilateral disease. Four of the 19 patients with bilateral uveitis developed a constant IOP higher than 24 mmHg in both eyes, while in 15 patients an IOP higher than 24 mmHg persisted only in one eye. A close association between the increased IOP and the use of corticosteroids was found in 18 of the 24 cases (75%). This association was ascertained in 16 of these patients by the decrease in IOP levels on discontinuation of the corticosteroid regimen and the renewed increase in IOP on rechallenge. The increased IOP was due to pupillary block in three cases (12.5%), to iris and angle neovascularization in two (8.3%), and to the inflammatory process per se in one case only (4.2%). Conclusions: This study demonstrates that a persistent elevation of the IOP in patients suffering from chronic uveitis is, in the majority of cases, associated with the use of corticosteroids.     

Etiopathogeny of intraocular pressure modifications in uveitis

Uveitic glaucoma is a secondary form of glaucoma. Treatment is essentially medical, based on antiglaucomatous medications and immunomodulatory therapy. Therefore, some patients may need filtrating surgery to control intraocular pressure. Understanding the cellular and biochemical modifications of aqueous humor that occur during intraocular inflammation and identification of anatomical modifications of the iridocorneal angle, trabecula, pupil, and ciliary body allow physicians to adapt management depending on the different clinical patterns of uveitic glaucoma. We propose a general review of the role of inflammatory mediators and etiopathogenic mechanisms involved in uveitic glaucoma.     

Risk factors for a postoperative intraocular pressure spike after phacoemulsification

Background: The aim of our study was to examine several potential risk factors for intraocular pressure (IOP) spikes 2 to 3 hours after phacoemulsification.Methods: 50 eyes of 50 consecutive patients undergoing uncomplicated phacoemulsification under topical anesthesia were included in this prospective study. The following variables were recorded:preoperative IOP, nuclear colour,cortical lens opacity,posterior subcapsular lens opacity,patient age;and presence or absence of preexisting glaucoma.Results: The mean IOP at each time interval was as follows: preoperatively, 14.5 (SD 3.4) mm Hg; 2-3 hours postoperatively, 23.1 (7.0) mm Hg; and 24 hours postoperatively, 17.0 (6.0) mm Hg. The postoperative IOP was significantly higher than baseline at 2-3 hours (p < 0.001) and at 24 hours (p = 0.002). Overall there were 10 cases (20%) of IOP spikes 2-3 hours postoperatively. Higher mean baseline IOP was significantly associated with postoperative IOP spikes (p = 0.013). Patient age, sex, operating surgeon, absolute phacoemulsification time, lens nuclear colour, cortical opacity, and posterior opacity were not significantly different between groups with or without an IOP spike (p > 0.05).Interpretation: Patients with high IOP at the preoperative assessment are more likely to have IOP spikes after surgery and should be scheduled at the start of the operating list. In a day-case setting with restricted opening hours, postoperative checks in those patients at risk of IOP spikes can then coincide with the time IOP reaches its peak.     

七氟烷吸入麻醉对大鼠青光眼造模眼眼压的影响

目的研究吸入麻醉药七氟烷对磁性微球前房注射诱导实验性大鼠青光眼造模眼和正常眼眼压(IOP)的影响。方法雄性8～10周挪威褐鼠6只,进行2周清醒状态下IOP测量训练后,采用磁性微球前房注射方法诱导实验性青光眼,右眼为青光眼造模眼,左眼为自身对照眼,研究吸入麻醉药七氟烷麻醉对造模眼和对照眼IOP的影响。结果七氟烷可明显降低造模眼和对照眼的IOP,麻醉平稳后造模眼IOP最大降低幅度为52.6%(t=20.61),对照眼最大降低幅度为37.5%(t=4.98),造模眼降低的程度明显大于对照眼。造模眼IOP在大鼠苏醒后仍低于基础值,差异有统计学意义,而对照眼IOP在苏醒后即恢复至接近基础值。结论七氟烷吸入麻醉可以显著降低大鼠IOP,其中青光眼造模眼的下降幅度更为显著,持续时间更长。该结果提示在对先天性青光眼患儿使用七氟烷全身麻醉下检查时,应充分考虑到该药物降低IOP的作用。     

Risk factors of glaucoma progression: intraocular pressure fluctuations

Intraocular pressure is not a fixed value and varies both over short-term periods and periods of several months or years. In healthy subjects, the circadian fluctuations in intraocular pressure are moderate, generally not exceeding 5 mmHg. In patients with glaucoma or ocular hypertension, intraocular pressure fluctuations are greater and circadian rhythms may be inverted. These fluctuations are probably involved in the conversion of ocular hypertension to glaucoma or glaucoma progression. Large observational clinical studies, however, are not unanimous on the role played by intraocular pressure fluctuations on the risk of conversion from ocular hypertension to glaucoma or glaucoma worsening. Nevertheless, it is important for each patient to estimate the short-term and long-term fluctuations and to prioritize a treatment that minimizes these fluctuations.     

Intravitreal triamcinolone and elevated intraocular pressure

PURPOSE: To ascertain whether intravitreal triamcinolone given for subretinal neovascularization is associated with an ocular pressure rise. METHODS: A total of 113 patients with angiographically proven subretinal neovascularization were enrolled into a prospective study of the effects of intravitrea triamcinolone. Intraocular pressure was one of the parameters studied. RESULTS: Approximately 30% of the study group developed a significant rise (> or =5 mm Hg) in intraocular pressure above baseline during the first 3 months. CONCLUSIONS: Patients considering this form of treatment should be fully informed of the known risks of intraocular injections of steroids.     

硅油注入后高眼压的治疗策略

目的 回顾性分析轻重硅油注入术后1个月高眼压的发生及其治疗策略.方法 玻切+轻/重硅油注入术后1个月发生高眼压共46例(46眼).对两种硅油注入术后1个月高眼压的发生率进行分析对比,且对高眼压的处理方式进行对比.结果用x2检验进行分析.结果 轻硅油注入术后取油的时机一般在3个月(68.8％)左右,取出后高眼压可以降至正常范围;重硅油在2个月左右取油(64.3％),取出后高眼压可以降至正常范围.二者没有统计学差异.但重硅油注入术后因高眼压行抗青光眼手术的比例较轻硅油者高,差异有统计学意义.结论 轻重硅油注入术后1个月高眼压的发生率没有统计学差异,但重硅油引起的高眼压最终行抗青光眼手术的比例较轻硅油者高.     

Risk factors for intraocular pressure elevations after pupillary dilation in patients with open angles

Purpose To determine risk factors for postdilation pressure elevations in patients with open angles. Methods Patients included in the study had angles open to at least scleral spur before and after dilation with 0.8% tropicamide and 2.5% phenylephrine. Results Included were 411 eyes. Risk factors for postdilation pressure elevations of 6 mmHg or more included miotic use and glaucoma (primary open angle, normal tension, and pseudoexfoliation). Conclusions Patients at risk should be closely monitored. This author has stated that she does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The author also does not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

Risk factors for intraocular pressure elevation during the early period post cataract surgery

Japanese Journal of Ophthalmology - To assess the risk factors for intraocular pressure (IOP) elevation during the early period post cataract surgery. Retrospective study. This study involved 1587...     

Premature elevated intraocular pressure after cataract surgery

We evaluated the frequency of elevated intraocular pressure (IOP) the first 1-3 postoperative days for a group of patients undergoing standard or phacoemulsification extracapsular cataract extraction (ECCE). IOP was measured in the pre and postoperative period using non-contact tonometer. From the 356 operated patients, 21 patients (6%) had early elevated IOP. The frequency of elevated IOP was greater among the patients that received anterior chamber (AC) IOL (25%) as compared to that of patients that received posterior chamber (PC) IOL (5.5%). The viscoelastic substance was responsible for a great percentage of cases (51%). The results show that the majority of elevated IOP is transient, recovered spontaneously or by treatment with carbonic anhydrase inhibitors or beta-adrenergic blockers. Elevated postoperative IOP occurs more frequently in the presence of glaucoma, cataract associated with systemic diseases, in complicated and traumatic cataract.     

Causes of elevated intraocular pressure following implantation of phakic intraocular lenses for myopia

The purpose of this study is to present the causes and visual acuity outcomes in patients with elevated intraocular pressure (IOP) following implantable collamer lens (ICL) implantation. A chart review identified patients who developed high IOP at any postoperative examination and a minimum follow-up period of 3 months after ICL implantation. Data are reported out to 6 months postoperatively. Outcome measures included causes of elevated IOP, best-corrected visual acuity (BCVA) at last visit, number of glaucoma medications, other interventions, and glaucomatous damage. Elevated IOP occurred in 58 (10.8 %) of 534 eyes that received ICL. The mean age was 28 ± 7.2 years. The preoperative IOP was 16.3 ± 1.2 mmHg. Elevated IOP most commonly occurred on the first postoperative day (23/58 (39.7 %) eyes) due to retained viscoelastic. This was followed by steroid response in 22/58 (37.9 %) eyes at 2–4 weeks postoperatively. IOP elevation in 6 (10.3 %) eyes was related to high ICL vault and pupillary block, and in 4 (6.9 %) eyes due to synechial angle closure. At last visit, BCVA was 20/40 or better in 56/58 (96.6 %) eyes, and 5/58 (8.6 %) eyes remained on glaucoma medications due to persistent steroid response (2 eyes), synechial angle closure glaucoma (1 eye), and other causes (2 eyes). One eye showed glaucomatous damage. Two eyes with high vault and elevated IOP underwent ICL explantation. There is a moderate risk of transiently developing elevated IOP after ICL implantation. Thorough removal of viscoelastic and use of anti-glaucoma medications during steroid use will reduce the majority of cases with postoperative IOP elevation.     

Risk factors for cystoid macular oedema in patients with uveitis

PURPOSE: To determine ophthalmologic and systemic factors associated with the presence of cystoid macular oedema (CMO) in patients with uveitis. METHODS: Retrospective cross-sectional study in which 97 consecutive patients with uveitis filled in an extensive questionnaire for the presence of cardiovascular diseases and its risk factors. An analysis of the ophthalmologic and questionnaire data was conducted. RESULTS: CMO was present in 44% (43/97) of patients. Its presence was strongly associated with increasing age (P=0.001) and age at onset of uveitis (P<0.001). For patients older than 50 years, the risk of having CMO was 3.8-fold (95% confidence intervals 1.6-9.0) larger than for younger patients. The most frequent anatomic location of uveitis associated with CMO was panuveitis (49%). Papillary leakage on fluorescein angiography was associated with CMO (P<0.001), independently of other risk factors. After adjustment for age, multivariate logistic regression showed no association between cardiovascular disease and its risk factors and the presence of CMO. CONCLUSIONS: Age, independent of duration of uveitis, was a major risk factor for the presence of CMO in uveitis. A positive correlation between CMO and papillary leakage on angiography was noted.     

The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure

PURPOSE: To assess effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced elevated IOP. METHODS: Retrospective review of 7 patients (7 eyes) with IOP elevation after intravitreal triamcinolone acetonide (4.0 mg/0.1 mL) injections for macular edema (6 patients) or central retinal vein occlusion (1 patient). Three patients had preexisting open angle glaucoma; 2 patients had preexisting ocular hypertension. Time between intraocular corticosteroid injection and subsequent increased IOP ranged from 5 to 29 weeks. After unsuccessful maximum tolerated medical therapy, patients underwent unilateral SLT between April 2003 and June 2005. IOP was measured 4 weeks prelaser; on the day of laser; within 3 weeks, and at 1, 3, and 6 months postlaser. Two-sample t test was used for analysis. RESULTS: The pre-SLT and post-SLT IOP measurements were the major outcome measures used to define the relative success of the SLT procedure. Seven patients were taking 4.0+/-0.8 ocular hypotensive medications before SLT. Preoperative IOP (mm Hg+/-SD) 38.4+/-7.3 decreased postoperative to 25.6+/-7.1 within 3 weeks (P<0.003), 25.9+/-8.8 at 1 month (P<0.007), 23.9+/-10.6 at 3 months (P<0.006), and 15.7+/-2.2 at 6 months (P<0.001). Four patients underwent a second SLT procedure. Two patients failed after the 3-month visit. IOP in fellow eyes of all patients was unchanged (P>0.080). CONCLUSIONS: SLT lowered (P<0.007) IOP in 5 eyes of 7 patients with steroid-induced increased IOP from 3 weeks to 6 months postoperative. Two patients required additional surgical procedures. Repeat SLT treatments may be necessary. SLT is a temporizing procedure to consider in patients with steroid-induced elevated IOP.