Effect of carbachol on intraocular pressure in small-incision cataract surgery

Sixty patients, who underwent phacoemulsification and implantation of a folded polyHema intraocular lens were assigned to two groups. Following wound closure 0.5 ml of 0.01% carbachol or balanced salt solution was instilled into the anterior chamber. Healon was used in all eyes but evacuated from the capsular bag behind the intraocular lens and the anterior chamber. Intraocular pressure was measured the day before as well as 6 and 18 hours postoperatively. At 6 hours the mean change of intraocular pressure from baseline was ±2.8 ± 5.3 mmHg in the carbachol group compared with +4.7 ± 8.0 mmHg in the BSS group (p < 0.0001). At 18 hours the mean change from baseline was ±3.0 ± 4.6 mmHg in the treatment group and +2.3 ± 8.5 in the control group (p < 0.0001). Intraocular pressure exceeding 25 mmHg at 6 hours was observed in 8 (27%) eyes of the control group but none of the treatment group. At 18 hours 4 (13%) eyes of the control group and 1 (3%) of the carbachol group still had an increase of intraocular pressure. Summarizing our results we conclude that the effect of Healon on the postoperative intraocular pressure is successfully counteracted by its aspiration from the capsular bag and the anterior chamber, especially when carbachol is used for intraoperative miosis.     

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.     

Retinal vessel responses to systemic autonomic stimulation in fellow eyes of patients with retinal vein occlusion

The retinal vessel calibre responses to systemic autonomic stimulation were studied in fellow eyes of 11 patients with central retinal vein occlusion (CRVO) and 10 patients with branch retinal vein occlusion (BRVO), using sustained isometric muscle contraction as the stimulus. These vessel responses were compared to those of a control group of 11 subjects of similar ages. The changes in retinal vessel calibre were measured using the Quantimet Image Analyser. There was no significant difference in mean arteriolar constriction during isometric muscle contraction (mean ± SEM) between the CRVO group (6.0 ± 1.34%) and the BRVO group (5.4 ± 0.31%), (p > 0.05), and between either of these groups compared with the control group (7.4 ± 1.20%), (p > 0.50). Similarly there was no significant difference in mean venule responses between the groups (CRVO 4.9 ± 0.48%; BRVO 4.6 ± 0.63%; control subjects 3.8 ± 0.90%;p > 0.05). The diastolic blood pressure responses were similarly not significantly different between the 3 groups (CRVO 22.3 ± 1.27, range +17 to 29mmHg; BRVO 25.8 ± 2.9mmHg, range 18 to 45mmHg; control subjects 21.3 ± 1.7mmHg, range 16 to 35mmHg), (p > 0.10). The implications of the results are discussed.     

Exfoliation syndrome as a risk factor for optic disc changes in nonglaucomatous eyes

Exfoliation syndrome as a possible risk factor for morphologic changes of the optic nerve was examined in 66 patients with unilateral exfoliation and no glaucoma. K-readings (7.74 ± 0.3 mm and 7.75 ±0.3 mm), axial lengths (23.1 ± 1.1 mm and 23.1 ±1.1 mm), and refraction (+0.9 ± 2.3 mm and +1.1 ±2.3 mm) did not differ in exfoliative and contralateral nonexfoliative eyes. The mean intraocular pressure (IOP) difference, 17.2 ± 3.3 mmHg and 15.6 ±3.2 mmHg, respectively, was statistically highly significant (P < 0.001). The mean visual acuity difference, 0.8 ±0.3 and 0.9 ± 0.2, respectively, was significant (P < 0.05). The difference in visual acuity between the pairs of eyes was explained by the more frequent subcapsular cataract in exfoliative eyes. Lens opacity values (opacity lens meter), 27.9 ± 8.3 and 28.0 ± 8.4 opacity units, respectively, were similar. Disc area, neuroretinal rim area, rim/disc ratio, cup area, and cup volume values analyzed with the Imagenet (Topcon) nerve head analyzer did not differ significantly between the eyes. It was concluded that exfoliation as such does not induce optic nerve head changes but indicates a risk factor for elevated IOP and lens opacification. Correspondence to: P. Puska     

Intraocular pressure decrease after local ocular cooling is underestimated by applanation tonometry

Background: The effects of intense systemic or local cooling on aqueous humor dynamics in animals are an increased total outflow facility and a decreased aqueous flow. Few studies suggest that only vasoconstriction of arteriolar segments of the episcleral vasculature may be the cause for a decrease in intraocular pressure after local cooling in humans. Because corneal changes may have influenced such studies, the effect of local cooling was assessed in normal subjects. Methods: Intraocular pressure and corneal thickness were measured in 18 healthy human subjects before and after exposure of the right eye to both, an air stream at 20° C, and an air stream at 0° C. Results: No significant changes in IOP or corneal thickness occurred under 20° C conditions. After local cooling, the mean corneal thickness increased from 0.52 ± 0.01 mm to 0.57 ± 0.02 mm (p < 0.001). Mean intraocular pressure decreased from 13.8 ± 2.9 mmHg to 12.9 ± 3.1 mmHg (p < 0.026). The observed decrease in IOP correlated significantly but negatively (R = – 0.53; p = 0.024) with the increase in corneal thickness, indicating that the cooling effect on IOP may be rather underestimated. Conclusion: The eye is very sensitive to local cooling effects, which may, however, partially be masked by changes in corneal thickness.     

Age dependence of perimacular white blood cell flux during isometric exercise

PURPOSE: To investigate the age dependence of perimacular white blood cell flux (WBCF) during isometric exercise. METHODS: Fourteen healthy young (age range: 21-29 years; 24 +/- 3 years, mean +/- SD, 12 male and 2 female) and 15 healthy middle-aged (age range: 45-57 years; 53 +/- 4 years, mean +/- SD; 5 male and 10 female) volunteers were studied. Subjects performed isometric handgrip for 10 minutes and squatting for 6 minutes. WBCF was assessed with the blue field entoptic technique, mean arterial pressure (MAP) was measured with an automated oscillometric device, intraocular pressure (IOP) was measured by Goldmann applanation tonometry and ocular perfusion pressure (OPP) was calculated as 2/3 MAP - IOP. RESULTS: Baseline WBCF was significantly higher in young subjects than in middle-aged subjects (191 +/- 28 vs 142 +/- 23; p = 0.001). Isometric handgrip induced a significant increase in WBCF in the middle-aged subjects (23 +/- 24%; p = 0.005), but not in the young subjects. Squatting significantly increased WBCF in both groups (young: 42 +/- 23%; p = 0.004 and middle aged: 51 +/- 27%; p < 0.001). A significant deviation from baseline WBCF was observed when OPP increased by 42 +/- 4% (p = 0.003) and 35 +/- 4% (p < 0.001) for the young and middle-aged subjects, respectively. The OPP-WBCF relationship was not different between the two study groups. CONCLUSION: Altered retinal autoregulation as observed in vascular ocular disease appears to be unrelated to the normal physiological aging process.     

Surgical management of closed angle glaucoma: our experience

In this paper we present our experience of the last three years in the surgical treatment of eyes with closed angle glaucoma. We have performed an extracapsular lens extraction and posterior chamber intraocular lens implantation on 34 eyes of 34 patients. All of them were affected by closed angle glaucoma with variable control after a Yag laser iridotomy: 6 eyes had high I.O.P. notwithstanding maximal therapy, 11 eyes had I.O.P. under control (less than 21 mmHg) without therapy, 9 with I.O.P. controlled with topical therapy, 8 with I.O.P. controlled with maximal therapy (C.A.I, included).The cases with well controlled glaucoma were operated on because of the presence of a more or less significant lens opacities. After a follow-up of up to 40 months (mean=20.3, range=1–40), all eyes show satisfactory intraocular pressure and no eye needed a filtering procedure. The results of our studies are as follows (values are mean±SD). In the group of 6 eyes with high I.O.P., the mean pre-operative intraocular pressure was 29.7±5.6 mmHg and the mean post-operative I.O.P. was 15.1±1.4mmHg. The mean reduction was 14.5±6.6mmHg (p<0.005). In the 28 eyes with pre-operative I.O.P. under control (17.5±1.6), the mean post-operative I.O.P. was 14.4±2.3 mmHg, with a mean reduction of 3.1±3.1 mmHg (p< 0.005). Before the E.C.C.E., 11 eyes had I.O.P. less than 21 mmHg without anti-glaucoma medication, whereas after the E.C.C.E. 28 eyes did not need such a medication. No significant correlation was found between pre-operative and post-operative extension of peripheral anterior synechiae (when assessable) and post-operative intraocular pressure control. The difference between pre- and post-operative anterior chamber depth measured by ultrasonic biometry was remarkable, i.e. M=1.93+0.36mm and 3.42±0.2mm (pre-operative and post-operative, respectively; p<0.005).     

Cerebrospinal fluid pressure in ocular hypertension

Background: To assess the lumbar cerebrospinal fluid pressure (CSF‐P) in ocular hypertensive subjects with elevated intraocular pressure (IOP) but without development of glaucomatous optic nerve damage. Methods: The prospective interventional study included 17 patients with ocular hypertension and 71 subjects of a nonglaucomatous control group. All patients underwent a standardized ophthalmologic and neurological examination including measurement of lumbar CSF‐P. In the ocular hypertensive group, the IOP was corrected for its dependence on central corneal thickness (IOP_corrected). The trans‐lamina cribrosa pressure difference (Trans‐LCPD) was calculated as IOP_corrected ? CSF‐P. Results: CSF‐P was significantly (p < 0.001) higher in the ocular hypertensive group (16.0 ± 2.5 mmHg) than in the control group (12.9 ± 1.9 mmHg). CSF‐P was significantly associated with IOP_corrected (p < 0.001; r = 0.82). In multivariate analysis, CSF‐P was significantly correlated with IOP_corrected (p < 0.001) and marginally significantly with mean blood pressure (p = 0.05). Trans‐LCPD was not associated significantly with blood pressure (p = 0.69). Conclusion: Some ocular hypertensive subjects with increased intraocular pressure measurements (after correction for their dependence on central corneal thickness) had an abnormally high lumbar cerebrospinal fluid pressure. Assuming that lumbar cerebrospinal fluid pressure correlated with orbital cerebrospinal fluid pressure, one may postulate that the elevated retro‐lamina cribrosa pressure compensated for an increased intraocular pressure. The elevated retro‐lamina cribrosa pressure may have led to a normal trans‐laminar pressure difference in the eyes with elevated intraocular pressure, so that glaucomatous optic nerve damage did not develop. Intraocular pressure, cerebrospinal fluid pressure and arterial blood pressure were correlated with each other.     

Control of blood pressure by a calcium antagonist during cataract surgery]

The authors evaluated the systemic and ocular hypotensive effects of nicardipine hydrochloride (Perdipine:NH) in 31 cases with acute hypertension (over 160/95 mmHg) during cataract surgery. All cases received an intravenous bolus injection of NH 30 micrograms/kg. Blood pressure and intraocular pressure were compared with level at rest, a preoperatively and 5 minutes after the administration of NH. Blood pressure significantly elevated from 136.9 +/- 10.6/73.4 +/- 10.2 mmHg at rest to 187 +/- 11.5/98 +/- 13.1 mmHg preoperatively (p less than 0.001), but it significantly reduced to 125.6 +/- 13.1/67.1 +/- 8.3 mmHg 5 minutes after the administration of NH (p less than 0.001). On the other hand, in the same way an blood pressure changed, intraocular pressure significantly elevated from 13.3 +/- 2.8 mmHg at rest to 19.8 +/- 2.9 mmHg preoperatively (p less than 0.001), but significantly reduced 17.1 +/- 3.0 mmHg 5 minutes after administration of NH (p less than 0.001). The hypotensive effect of NH continued for over 90 minutes. There were no side effects apart from mild tachycardia in all cases. NH is safe, easy to administer and useful for control of acute hypertension during limited-period surgery such as cataract surgery.     

Apraclonidine and clonidine: a comparison of efficacy and side effects in normal and ocular hypertensive volunteers

We performed a prospective, randomized double blind study comparing the cardiovascular and intraocular pressure (IOP) effects of unilateral therapy with clonidine 0.125% and apraclonidine hydrochloride 1.0% in 15 normal and 15 ocular hypertensive volunteers. Baseline values were obtained prior to instillation. One drop of test medication (clonidine, apraclonidine or placebo) was instilled unilaterally, and the postinstillation measurements were taken at 1, 2, 4, 6 and 8 hours. Apraclonidine 1% produced a maximum 31.4%±6.9% (4.83±1.17mmHg) decrease in mean IOP in ocular normotensive volunteers and 33.9%±6.9% (10.10±2.45 mmHg) in ocular hypertensive patients (p<0.001).These values were 22.1%±6.9% (2.90±1.94 mmHg) and 22.7%±6.9 (6.80±2.31 mmHg), respectively in clonidine group (p<0.001).In apraclonidine group, there were no changes in contralateral IOP, blood pressure or pulse rate. Clonidine produced a significant decrease in contralateral IOP, but this reduction was not statistically significantly different than that of placebo. In clonidine group, there was no change in pulse rate, but a significant decrease in blood pressure.Eyelid retraction, conjunctival blanching and mydriasis were noted in eyes treated with apraclonidine. However there were no statistically and clinically significant changes in pupil size or interpalpebral fissure width with clonidine.This study suggests that apraclonidine appears to be safer and more effective ocular hypotensive agent than clonidine in treatment of glaucoma.     

Efficacy of apraclonidine ophthalmic solution (lopidine) in presumed silicon oil-induced glaucoma and primary open-angle glaucoma

Background: This pilot study evaluated the acute effects of topical ocular apraclonidine 1% (Iopidine) in 10 patients with presumed silicone oil-induced secondary glaucoma (SOIG) and in 10 patients with high-pressure primary open-angle glaucoma (POAG) despite maximum tolerated medical therapy. Methods: Intraocular pressure (TOP) measurements were carried out before and 1, 2 and 3 h after a single drop of apraclonidine. Results: Patients with SIOG presented with a mean IOP of 30.0 ± 2.8 mmHg, which was reduced to 21.7 ± 2.9 mmHg (P<0.001) after 1 h, to 20.4 ± 2.3 mmHg (P<0.001) after 2 h and to 20.0±2.5 mmHg (P<0.001) after 3 h. In the POAG group, TOP was reduced from 25.9±1.9 mmHg before treatment to 18.9±1.4 mmHg after 1 h (P<0.001), 17.7±1.2 mmHg after 2 h (P<0.001) and 16.9±0.9 mmHg after 3 h (P<0.001). There were no significant changes in blood pressure or pulse rate. Conclusion: This study confirmed the activity of apraclonidine as an TOP suppressant.This study was presented in abstract at the 1993 ARVO meeting, Sarasota, Florida (poster 2422)     

Narrowing of the anterior chamber angle during Valsalva maneuver: a possible mechanism for angle closure

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva maneuver in eyes suspected to have a primary adult glaucoma. METHODS: Seventy-six consecutive patients underwent recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, angle recess area, scleral spur-iris root distance, iris thickness, iridociliary angle, ciliary body thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva maneuver was standardized to a pressure of 40 mmHg for 15 seconds, using a manometer. RESULTS: The mean baseline intraocular pressure changed from 19.5+/-4.1 mmHg to 29.5+/-4.8 mmHg during Valsalva (p<0.0001). The anterior chamber angle recess narrowed from 17.9+/-9.5 to 7.8+/-9.2 degrees (p=0.0001). The angle recess area diminished from 0.15+/-0.14 mm2 to 0.14+/-0.12 mm2 (p=0.03) and the scleral spur to iris distance decreased from 0.19+/-0.2 mm to 0.16+/-0.18 mm (p=0.0001). The iridociliary angle narrowed from 72.6+/-33.5 degrees to 62.5+/-32.8 degrees (p=0.04). There was a significant increase in the thickness of the ciliary body, from 0.99+/-0.19 mm to 1.12+/-0.16 mm (p=0.001) and in iris thickness from 0.47+/-0.07 mm to 0.55+/-0.09 mm (p=0.0001). There was no significant change in the angle opening distance, anterior chamber depth, or pupillary diameter. A significant narrowing of the angle to less than 5 degrees was seen in 37 eyes, with iridocorneal apposition present in 28 eyes. After multivariate regression analysis it was found that the baseline ciliary body thickness and angle recess were significant predictors of narrowing of the angle (R2=96.1%). CONCLUSIONS: Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess, thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver. The Valsalva maneuver may lead to angle closure in eyes anatomically predisposed to primary angle closure glaucoma.     

非增生型糖尿病视网膜病变患者黄斑中心凹下脉络膜厚度变化

目的 观察非增生型糖尿病视网膜病变（NPDR）患者黄斑中心凹下脉络膜厚度（SFCT）变化及其与视网膜病变严重程度的关系。方法 内分泌科检查确诊的2型糖尿病（DM）患者93例164只眼（DM组）纳入研究。其中,男性34例,女性59例;平均年龄（59.3±5.6）岁。平均糖尿病病程（5.11±4.64）年。所有患者均行视力、眼压、裂隙灯显微镜、间接检眼镜、A/B型超声、光相干断层扫描（OCT）检查,以及空腹血糖、平均动脉压检查。患者平均眼轴长度（23.04±0.78） mm;平均空腹血糖（8.88±2.59） mmol/L;平均动脉压（100.44±9.63） mmHg。按糖尿病视网膜病变（DR）国际分期标准将DM组分为无DR（NDR）组、轻度NPDR组、中度NPDR组、重度NPDR组,分别为64、33、37、30只眼。选取同期正常受试者25例42只眼作为对照组。应用Topcom 3D-OCT仪测量受检者黄斑SFCT。采用完全随机设计资料的方差分析法分析SFCT变化及其与DR严重程度的关系以及糖尿病病程、空腹血糖、平均动脉压、眼轴长度与SFCT的相关性。结果 DM组SFCT为130.5～340.0 μm,平均SFCT为（224.24±42.10） μm。正常对照组SFCT为141.5～415.0 μm,平均SFCT为（276.77±48.07） μm 。DM组SFCT与正常对照组SFCT比较,差异有统计学意义（F=23.86,P＜0.05）。NDR组、轻度NPDR组、中度NPDR组、重度NPDR组间SFCT比较,差异有统计学意义（P＜0.05）。NDR组SFCT较轻度NPDR组SFCT厚,但差异无统计学意义（P＜0.05）;中度NPDR组SFCT与重度NPDR组SFCT比较,中度NPDR组SFCT较厚,但差异也无统计学意义（P＞0.05）。SFCT与DR严重程度呈负直线相关关系（r=-0.555,P=0.000）;糖尿病病程与SFCT呈负相关（r=-0.332,P=0.001）;而空腹血糖（r=－0.123）、平均动脉压（r=－0.116）、眼轴长度（r=－0.018）与SFCT无相关性（P＞0.05）。结论 DM患者较正常对照者SFCT变薄;不同分期DR患者间SFCT也存在差异,随DR严重程度增加SFCT逐渐变薄。     

Autoregulative behavior of retinal arteries and veins during changes of perfusion pressure: a clinical study

Purpose To investigate the autoregulative response of large retinal vessels to artificial reduction of perfusion pressure.Methods The diameters of a venous and an arterial segment (each approx.1.5 mm in length) in one eye of each of 13 healthy volunteers (age 54.5±18 years) were measured continuously using the Retinal Vessel Analyzer (Imedos, Weimar, Germany). The intraocular pressure (IOP; mean before examination 13.7±2.9 mmHg) was increased by 21.2±3.5 mmHg by means of a suction cup in order to produce a temporary reduction of the retinal perfusion pressure. The RVA measurements were taken for 2 min without artificial intervention (baseline), for 100 s during IOP elevation, and for up to 10 min after removal of the suction cup.Results A significant response of arterial and venous diameters to the provocation was found (P<0.02, ANOVA). The arterial and venous responses were opposite: Whereas the artificially elevated IOP increased the arterial diameter by +1.9±4.5%, the venous vessel diameter decreased by –2.6±3.5% (P<0.02, Mann–Whitney U-test). After normalization of the IOP the arterial diameter fell slightly below the baseline value, while the veins underwent temporary dilation by +5.9±3.3% (P<0.001). The mean systemic blood pressure did not change significantly during the investigation.Conclusion Retinal arteries and veins of healthy volunteers exhibited opposite autoregulative behavior in response to perfusion pressure changes. This is believed to be due to the different regulative functions of arteries and veins.     

Baerveldt implant in refractory glaucoma: long-term results and factors influencing outcome

Purpose: To evaluate the clinical outcome of patients who received aBaerveldt implant for refractory glaucoma and to identify factors which mayinfluence the outcome. Methods: Retrospective study including 51 eyesof 51 patients with medically uncontrolled glaucoma who underwent Baerveldtimplant surgery between June 1994 and December 1998. Criteria for successwere intraocular pressure (IOP) 21 mmHg and >6 mmHg, necessityof further antiglaucoma medications, absence of additional glaucoma surgeryand no loss of light perception. Results: Over a mean follow-up of 37.6(SD: ± 18.8) months, the mean intraocular pressure decreased from 34.8(±12.5) mmHg to 14.0 (±4.3) mmHg at month 60. Qualified successrate, achieved when IOP was below 21 mmHg and higher than 6 mmHg withmedications was 25/48 (52%), complete success rate (same IOP limits withoutmedication) was 14/48 (29%). Seven eyes had major complications or lostlight perception. Postoperative visual acuity improved or remained within oneSnellen line of the preoperative visual acuity in 35 patients (73%). Factorsassociated with a better prognosis were a preoperative visual acuity better than 20/400 and etiology of glaucoma. Conclusion: The Baerveldt implant iseffective in lowering intraocular pressure in most patients with refractoryglaucoma. Long-term results are promising with satisfactory IOP control.     

Five-year follow up of selective laser trabeculoplasty in Chinese eyes

PURPOSE: To study the effectiveness and safety of selective laser trabeculoplasty (SLT) on primary open-angle glaucoma and ocular hypertension in Chinese eyes. METHODS: This was a prospective randomized controlled clinical study in which 58 eyes of 29 patients with primary open-angle glaucoma or ocular hypertension were included. One eye of each patient was randomized to receive SLT (Group 1) and the fellow eyes received medical treatment (Group 2). Patients were evaluated after laser treatment at 2 h, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, and then yearly. RESULTS: All patients (13 male, 16 female) were Chinese. The mean age was 51.9 +/- 14.7 years. The mean baseline intraocular pressure was 26.8 +/- 5.6 mmHg in group 1 and 26.2 +/- 4.2 mmHg in group 2 (P = 0.62). The failure rate, defined as intraocular pressure >21 mmHg with maximal medications, was 17.2% in group 1 and 27.6% in group 2 at 5-year follow-up (P = 0.53). Eight eyes (27.6%) in group 1 required medications to control the intraocular pressure to below 21 mmHg. There was no statistically significant difference in the intraocular pressure reductions between the two groups at all time intervals (P > 0.05). The mean number of antiglaucoma medications was significantly lower in the SLT than the medical treatment group up to 5 years of follow up (P < 0.001). Transient post-SLT intraocular pressure spike >5 mmHg was observed in three eyes (10.3%). CONCLUSION: With fewer medications, SLT gives similar intraocular pressure reduction to medical therapy alone in Chinese patients with primary open-angle glaucoma or ocular hypertension.     

Sildenafil increases ocular perfusion

Purpose: Our goal was to determine whether visual system responses to sildenafil accompany shifts in ocular perfusion.The human choroid, which supports the metabolic functionof the outer retina, is an erectile tissue, analogous in many respects to the corpus cavenosum. Methods: Right eyes of 12 normal adults were evaluated before and 2 hafter 50 mg oral dose of sildenafil. Pulsatile ocular blood flow (POBF), intraocular pressure (IOP), Heidelberg retinal flowmetry (HRT), 4.26 cpd, 7.5 Hz temporally-modulated contrast sensitivity (CS), full-threshold C-20 frequency doubling technology (FDT) perimetry, and blood pressure (BP) were measured.Results: POBF (+29.4%; p > 0.016) and CS (+33.6%; p > 0.014%)increased within 110 (±7.7) minutes after sildenafil administration. No subject demonstrated decreases in either variable. HRF flow values increase among 7 of the 9 eyes producing stable scans (+8.2%; p > 0.1). FDT values did not change significantly, nor did systemic pulse amplitude or mean IOP.Conclusions: Since IOP and systemic pulse amplitude bothremained stable after sildenafil administration, while POBF values increased to a level nearly one third greater than baseline. It appears sildenafil can induce intrinsic change in the choroidal vasculature, with an apparently positive impact on pericentral contrast sensitivity. This effect may be of clinical utility.     

Episcleral venous pressure in younger and older subjects in the sitting and supine positions

PURPOSE: Intraocular pressure is higher in older than younger subjects during the day and night. We attempted to determine whether episcleral venous pressure could explain the difference in the sitting and supine positions. PARTICIPANTS AND METHODS: We compared episcleral venous pressure, intraocular pressure, and blood pressure in a group of younger subjects aged 18 to 30 years and in a group of older subjects aged 65 years or older. The above measurements were performed in the sitting position and after 15 minutes in the supine position. RESULTS: The main difference between the groups was their systemic conditions. Comparing both groups, episcleral venous pressure and intraocular pressure were not different in the sitting position. However, in the supine position, episcleral venous pressure (9.6 vs. 8.3 mm Hg) (P < 0.01) and intraocular pressure (17.1 vs. 15.6 mm Hg) (P < 0.05) were higher in the older group. Statistically, a within-group analysis showed a significant increase in intraocular pressure in the supine position for both the younger (+ 0.8 mm Hg) (P < 0.001) and older subjects (+ 1.8 mm Hg) (P < 0.02). This was associated with an increased episcleral venous pressure in younger (+ 0.4 mm Hg) (P < 0.001) and older subjects (+1 mm Hg) (P < 0.02). There was no gender difference in intraocular pressure and episcleral venous pressure. No differences were found for intraocular pressure and episcleral venous pressure in subjects having certain systemic conditions. Blood pressure was higher for older subjects (P < 0.001). It decreased in the supine position for both groups (P < 0.001). CONCLUSION: Intraocular pressure and episcleral venous pressure were not different in the younger and older group in the sitting position. They were higher in the supine position for older subjects. There was no gender difference.     

糖尿病患者白内障超声乳化吸出联合人工晶状体植入

目的　观察糖尿病患者行白内障超声乳化吸出联合人工晶状体植入术的临床效果。方法　对884 例1 079 眼患有糖尿病的白内障术后患者的视力及并发症进行分析,并选取同时期、同一手术医师施行的非糖尿病白内障患者做对照。手术采用巩膜隧道切口超声乳化及囊袋内人工晶状体植入法。术前空腹血糖控制在8.5 mmol·L-1以下。结果　糖尿病患者术后3 d矫正视力与非糖尿病患者相比无明显差异(P>0 05),<0.5者454眼,均为眼底出血、渗出累及黄斑及黄斑囊样水肿、增殖性视网膜病变所致。糖尿病患者术前瞳孔不能充分散大或术中瞳孔缩小、瞳孔缘损伤和术后角膜水肿、黄斑水肿的病例明显多于非糖尿病患者。结论　糖尿病患者行白内障超声乳化吸出联合人工晶状体植入术,可明显改善视力,超声乳化吸出术治疗糖尿病患者白内障是安全有效的,并为糖尿病视网膜病变的荧光血管造影和激光治疗提供了条件。眼底出血、渗出累及黄斑、黄斑囊样水肿、增殖性糖尿病视网膜病变是影响术后视力的主要因素。     

No changes in anatomical and functional glaucoma evaluation after trabeculectomy

Purpose To assess the influence of glaucoma filtration surgery on anatomical and functional tests for glaucoma evaluation.Methods Twenty-five eyes (25 patients) with primary open-angle glaucoma were evaluated, prospectively. Data were collected on vision acuity, intraocular pressure, standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry (GDx) and confocal scanning laser ophthalmoscopy (HRT II) before and 3–6 months after surgery.Results Mean (±SD) pre- and postoperative visual acuities (logMAR) were 0.28 (±0.18) and 0.30 (±0.17), respectively (P=0.346). In a mean time of 4.5 (±1.1) months after surgery, the mean preoperative intraocular pressure of 20.7 (±5.4) mmHg decreased to 11.04 (±2.52) mmHg (P<0.001). The results of the standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy diagnostic methods revealed no significant difference (P>0.162) between pre and postoperative values and no significant correlation (P>0.296) between intraocular pressure reduction and value changes.Conclusion No significant change on any test variable was detected after glaucoma filtration surgery. Trabeculectomy does not appear to influence standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy (HRT II) results after a 4.5-month period of surgery in early to moderate glaucoma.CAPES (Ministry of Education, Brazil), FAPESP (Secretary of Education, Sao Paulo), Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, USA, October 2004.