The value of pancuronium in prolonged intraocular operations

We wished to determine the effectiveness of Pancuronium, a non-depolarizing muscle relaxant, in prolonged intraocular operations. We compared the variations in intraocular pressure when using four different methods of induction of general anesthesia. With Pancuronium the intraocular pressure fell initially and then rose to just below pre-induction levels and remained there. Our study suggests that pancuronium stabilizes intraocular pressure at a level which is highly desirable for intraocular surgery.     

Change in optic disk topography after trabeculectomy

PURPOSE: To investigate the relationship between optic disk topography and intraocular pressure before and after trabeculectomy with confocal scanning laser ophthalmoscopy. METHODS: The eyes of 49 consecutive patients undergoing trabeculectomy at a university-based glaucoma practice underwent preoperative and postoperative imaging using a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph). Three images of one eye of each patient were obtained with a 15-degree field of view. Preoperative images were obtained approximately 2 months before surgery (mean +/- SD, 2.4 +/- 1.6 months). Postoperative images were obtained at least 3 months after surgery (mean, 4.5 +/- 2.6 months). RESULTS: Mean preoperative intraocular pressure, postoperative intraocular pressure, and percent change in intraocular pressure respectively were 23.1 +/- 6.8 mm Hg, 12.7 +/- 7.1 mm Hg, and 43.8% +/- 29.9%. A significant association (P < .01) was found between percent decrease in intraocular pressure and decreases in cup area, cup volume, and cup/disk area ratio as well as between percent decrease in intraocular pressure and increases in rim area, rim volume, mean height contour, retinal cross-section area, and height in contour. Between 11.7% and 31.2% of the variability (R2) in these parameters was explained by the percent change in intraocular pressure. Topography changes were more strongly associated with percent change than with mean change in intraocular pressure. We found no association between percent decrease in intraocular pressure and reference plane height or maximum cup depth. CONCLUSIONS: Changes in optic nerve topography were associated with reduction in intraocular pressure after trabeculectomy.     

First trimester isolated fetal nuchal lucency: significance and outcome

BACKGROUND: In this retrospective study the postoperative alteration of intraocular pressure after cataract extraction and posterior chamber lens implantation was analyzed statistically. The influence on intraocular pressure between different positions of the loops (sulcus versus bag) was compared. PATIENTS AND METHOD: The posterior chamber lens implantation was performed on 267 eyes with 129 sulcus implanted and 138 in-the-bag implanted intraocular lenses. The average age of the patients was 74.8 respectively 71.9 years, with an equal ratio of sex. In surgery the viscoelastic experimentation of the nucleus was done via corneoscleral cut. A x-crossed suture sealed the corneoscleral wound followed by subconjunctival injection of corticosteroids. The postoperative medication for 4-6 weeks consisted of a corticosteroid and antibiotic combination. RESULTS: The average intraocular pressure of the sulcus implanted respectively in the bag implanted intraocular lenses increased from 15.4 mm Hg respectively 15.9 mm Hg preoperatively to 16.3 respectively 15.8 mm Hg at the first postoperative day. After two months the intraocular pressure decreased to 14.6 respectively 14.1 mm Hg. That means a pre- to postoperative difference of -0.8 respectively -1.8 mm Hg. CONCLUSIONS: In summary both groups showed a slight decrease in average intraocular pressure after two months. In comparison to the sulcus implanted intraocular lens the decrease of intraocular pressure was more than 1 mm Hg in case of the in the bag implanted lens. This decrease was statistically significant but may be considered of less clinical interest.     

Impact of antibiotic resistance on chemotherapy for pneumococcal infections

PURPOSE: To detect the mechanism of intraocular pressure elevation during hemodialysis. METHODS: We measured intraocular pressure, as well as serum osmolality and plasma CO2 pressure, every 30 min during hemodialysis, in 5 eyes with severely compromised aqueous outflow facility (Group A) from 4 renal failure patients. The same measurements were repeated on the same eyes using intravenous hyperosmotic Glyceol to prevent a rapid change in serum osmolality. We also measured the same parameters on 8 eyes with normal aqueous outflow facility (Group B) from 5 patients. The mean +/- SE of percent changes in each parameter was used for the statistical analysis. RESULTS: In Group A, the mean percent change of intraocular pressure increased significantly after 90 min, with the exception of the change at 180 min. The mean percent change of serum osmolality decreased significantly after starting dialysis. A negative correlation in the mean percent change of intraocular pressure with serum osmolality was detected (r = -0.759, r < 0.0001). The administration of intravenous hyperosmotic agent prevented significant changes in not only serum osmolality but also intraocular pressure. In Group B, the mean percent change in intraocular pressure showed no significant difference at any time, although the change in serum osmolality decreased significantly. CONCLUSION: A remarkable rise in intraocular pressure occurs during hemodialysis in eyes with an impaired aqueous outflow, when serum osmolality decreases rapidly.     

Mitoxantrone immunotherapy in multiple sclerosis

We compared the effects of postural changes on intraocular pressure, systemic blood pressure, and pupil size with and without induced mydriasis in 15 chronic chagasic patients and 20 healthy age-matched controls. The chagasic patients showed a marked fall in intraocular pressure on rising. However, systemic systolic blood pressure changes and pupil size in patients did not differ from those measured in controls. Our findings may be explained by an alteration in the autonomic ocular system that regulates homeostasis of ocular pressure and the probable existence of a baroreceptor arc-reflex that restores the equilibrium of sudden changes in the intraocular pressure.     

Primary osteosarcoma of the urinary bladder

PURPOSE: To review the effects on intraocular pressure control of the use of standard and heparin-coated intraocular lenses (IOLs) following combined cataract and glaucoma surgery after a minimum period of 2 years. METHODS: Case note review of all patients with glaucoma who required cataract extraction combined with trabeculectomy and who were randomized to either of the two IOL types. The number of ocular hypotensive medications and the intraocular pressures were recorded pre-operatively and at 3, 6, 18 and 24 months following surgery. RESULTS: The two groups (9 receiving standard IOLs and 10 heparin-coated IOLs) were comparable for age, sex and follow-up, as were the pre-operative intraocular pressures and number of treatments. Post-operatively, all patients achieved an intraocular pressure < 21 mmHg at the final visit, with only one patient in each group requiring topical medication, but the standard lens group had a higher intraocular pressure at 2 years (p<0.05). The magnitude of the fall from the pre-operative values was greater in the heparin-coated lens group at 2 years after surgery (p<0.02). The presence of a visible drainage bleb occurred equally frequently in the two groups. CONCLUSIONS: Use of a heparin-coated IOL does not adversely affect the intraocular pressure control following combined cataract and drainage surgery. The greater fall in intraocular pressure at 2 years in those receiving a heparin-coated IOL may have occurred by chance.     

Effect of local administration of mitomycin C on intraocular pressure

BACKGROUND: Animal studies suggest that the decrease of intraocular pressure after application of mitomycin C is particularly mediated by toxic effects on the substance of ciliary body. Moreover it has been shown that the concentration of mitomycin C after topical application in the aqueous humour is as high when performing fistulating surgery. In this prospective study we wanted to investigate whether the topical application of mitomycin C would result in a significant decrease of intraocular pressure. PATIENTS AND METHODS: Forty-one eyes of 41 patients underwent pterygium surgery using a bare sclera technique. Afterwards phototherapeutic keratectomy with the excimer laser (193 nm) was performed in the area of the excision. In hospital mitomycin C eye drops (0.02%) were given twice daily for four days. The intraocular pressure of treated and untreated eyes was measured with applanation tonometry at least three times per day preoperatively, postoperatively at the fourteenth day and after 6 month. RESULTS: Mean intraocular pressure of the treated eyes was preoperatively 15.73 +/- 2.35 mm Hg, 14 days postoperatively 15.92 +/- 2.79 mm Hg and at the last examination 15.86 +/- 2.39 mm Hg. For untreated eyes the mean intraocular pressure was preoperatively 15.70 +/- 2.04 mm Hg, after 14 days 15.76 +/- 2.96 mm Hg and at the last examination 15.89 +/- 2.67 mm Hg. Consequently there was no statistically significant change of intraocular pressure in the eyes treated with mitomycin C. Furthermore there were no significant differences of intraocular pressure between treated and untreated eyes at any time of postoperative check-up. CONCLUSION: The short-term local application of mitomycin C did not result in a detectable change of intraocular pressure and is therefore probably an alternative to intraoperative application during filtration surgery.     

Outcome of combined trabeculectomy with cataract operation and intraocular lens implantation

BACKGROUND: When trabeculectomy and cataract extraction with intraocular lens insertion are combined, do the success and complication rates add. MATERIAL AND METHODS: Follow-up of 47 eyes of 34 patients with combined trabeculectomy and cataract extraction with intraocular lens implantation after 12 to 42 months. RESULTS: With a low perioperative complication rate the intraocular pressure after one year was below 22 mm Hg in 90% without any medication and in 98% additional glaucoma therapy. After 2 and 3 years the intraocular pressure was normal without any additional therapy in 83% of the eyes. The visual acuity was better or equal to the preoperative value in 89% of the cases. CONCLUSIONS: The combination of trabeculectomy and of cataract extraction with intraocular lens implantation has a low complication rate and gives good results regarding intraocular pressure and visual rehabilitation. When a trabeculectomy is indicated, the indication for a simultaneous cataract extraction with intraocular lens implantation should not be to restricted.     

Effect of plasma colloid osmotic pressure on intraocular pressure during haemodialysis

BACKGROUND: In a previous case report, it was shown that an increase in plasma colloid osmotic pressure induced by the removal of fluid during haemodialysis was instrumental in decreasing intraocular pressure. The relation between changes in intraocular pressure, plasma osmolarity, plasma colloid osmotic pressure, and body weight before and after haemodialysis is evaluated. METHODS: Intraocular pressure, plasma osmolarity, plasma colloid osmotic pressure, and body weight were evaluated before and after haemodialysis in 36 patients. RESULTS: Intraocular pressure and plasma osmolarity both decreased significantly after haemodialysis (p < 0.0001). Plasma colloid osmotic pressure increased significantly after haemodialysis (p < 0.0001). Body weight decreased significantly because of the removal of fluid during haemodialysis (p < 0.0001). No significant correlation was found between the change in intraocular pressure and that in plasma osmolarity (r = -0.206, p = 0.2297), whereas the change in intraocular pressure was correlated with the change in plasma colloid osmotic pressure (r = -0.510, p = 0.0012) and the change in body weight (r = 0.534, p = 0.0006). A significant correlation was found between the change in plasma colloid osmotic pressure and that in body weight (r = -0.756, p < 0.0001). CONCLUSION: The change in intraocular pressure was inversely correlated with the increase in plasma colloid osmotic pressure caused by the removal of fluid during haemodialysis.     

Normalization of low vitamin B12 serum levels in older people by oral treatment

PURPOSE: To report the potential for retinal ischemia caused by high intraocular pressure and to suggest a simple test for this condition. METHODS: We measured the intraocular pressure and directly examined the optic nerve head in four eyes of four patients at the conclusion of cataract surgery. RESULTS: With intraocular pressure above 40 mm Hg, elderly patients may abruptly lose the ability to perceive microscope illumination. The central retinal artery pulsated at these pressures. Light perception returned immediately upon reduction of intraocular pressure. CONCLUSION: Testing for light perception at the conclusion of surgery can indicate retinal ischemia with loss of light perception, which may occur during sealing of the cataract surgical wound.     

Evaluation of accuracy of measuring intraocular pressure by handheld non-contact applanation tonometer

PURPOSE: To evaluate the accuracy of measuring intraocular pressure by handheld non-contact applanation tonometer. METHOD: 58 patients' (113 eyes) intraocular pressure were measured by Keeler, non-contact tonometer and R 900 Goldmann applanation tonometer and the results of measurement of intraocular pressure by the two kinds of tonometers were compared. RESULT: The mean intraocular pressure measured by non-contact is 16.31 +/- 5.59 mmHg and 17.49 +/- 6.13 mmHg (1 mmHg = 0.1333 kPa) by Goldmann applanation tonometer, respectively. There was no statistical significance to be found (P > 0.05) between the two methods. By linear correlation and regression analysis, a positive correlation was found between the two methods (r = 0.8942, b = 0.8154). CONCLUSION: The handheld non-contact tonometer has the same accuracy and reliability of measurement of intraocular pressure comparing with Goldmann applanation tonometer, and it can be used in glaucoma clinic and screening.     

Effect of intravenous fenoldopam on intraocular pressure in ocular hypertension

Intravenous fenoldopam, a selective dopamine-1 receptor agonist, was compared with placebo in this randomized, double-blind, two-period crossover study to evaluate its effects on intraocular pressure, aqueous dynamics, and macular blood flow in patients with elevated intraocular pressure or primary open-angle glaucoma. Doses of fenoldopam were titrated up to a maximum of 0.5 microgram/kg/min. Intraocular pressure, measured by pneumotonometry, was the primary outcome variable. Other outcomes included macular blood flow assessed by blue field examination, visual field examined by automated perimetry, aqueous outflow facility measured by tonography, and aqueous humor production determined by fluorophotometry. During infusions of fenoldopam, intraocular pressure increased from a mean baseline level of 29.2 mmHg to a mean maximum level of 35.7 mmHg. During the placebo infusions, pressure increased from a mean baseline of 28.4 mmHg to a mean of 29.0 mmHg at the time point that corresponded to the mean maximum intraocular pressure on the day intravenous fenoldopam was administered, to yield a mean difference in pressure between study days of 6.7 mmHg (P < 0.05). There were no apparent changes in macular blood flow, visual fields, or production or outflow of aqueous humor associated with fenoldopam infusion. The increase in intraocular pressure seen in this population of patients with ocular hypertension during infusions of fenoldopam is consistent with fenoldopam-associated increases in intraocular pressure reported in previous studies of healthy volunteers and of patients with accelerated systemic hypertension. These results further suggest that dopamine-1 receptors play a role in the regulation of intraocular pressure.     

Increased intraocular pressure induced by corticosteroids

Twelve patients who were highly responsive to topically administered betamethasone were subjected to various corticosteroid preparations (four times daily for four weeks). Each patient was tested in the same eye with fluorometholone, tetrahydrotriamcinolone, medrysone, and betamethasone and the potential to elvate intraocular pressure was determined. The response of intraocular pressure to all the corticosteroids was dose-related and a highly significant correlation was demonstrated between the concentration of betamethasone and the magnitude of intraocular pressure response. The order of potential of corticosteroids to elevate IOP was betamethasone 0.1%, betamethasone 0.05%, tetrahydrotriamcinolone 1.25%, betamethasone 0.02%, fluorometholone 0.1%, medrysone 1.0%, and betamethasone 0.01%. Tetrahydrotriamcinolone 0.25% and fluorometholone 0.05 and 0.01% failed to elevate intraocular pressure significantly.     

Lack of diurnal variation in vision, refraction, or keratometry after excimer laser photorefractive keratectomy

PURPOSE: To examine whether diurnal variation in visual acuity, spherical equivalent, keratometry, or intraocular pressure occurs in patients who have undergone photorefractive keratectomy. METHODS: Twenty-nine post-photorefractive keratectomy patients underwent morning and evening measurements of visual acuity, spherical equivalent, keratometry, and intraocular pressure at intervals between 5 and 13 months after photorefractive keratectomy. RESULTS: There was no statistically significant post-photorefractive keratectomy diurnal variation in visual acuity, spherical equivalent, or keratometry in the group studied. Diurnal variation in post-photorefractive keratectomy intraocular pressure was not significantly different between patients' treated and untreated eyes. CONCLUSION: Photorefractive keratectomy does not appear to result in diurnal variation in visual acuity, spherical equivalent, or keratometry post-operatively, nor does it seem to effect normal diurnal variation in intraocular pressure.     

Characteristics of histamine-induced leukocyte rolling in the undisturbed microcirculation of the rat mesentery

PURPOSE: To determine the efficacy and safety of latanoprost treatment for 1 year in glaucoma patients, and to evaluate the effects of switching from timolol to latanoprost therapy. METHODS: Latanoprost 0.005% was topically applied once daily without masking for 6 months in 223 patients with elevated intraocular pressure after previous treatment with latanoprost once daily or 0.5% timolol twice daily for 6 months in a multicenter, randomized, double-masked, parallel group study. RESULTS: Compared with baseline values before treatment, a significant (P < .0001) diurnal reduction in intraocular pressure of 6 to 8 mm Hg was maintained with minimal fluctuation for the duration of treatment. When treatment was switched from timolol to latanoprost, intraocular pressure was reduced by 1.5 +/- 0.3 mm Hg (mean +/- SEM; 8% change in intraocular pressure; 31% of the intraocular pressure reduction produced by timolol; P < .001) compared with the change in intraocular pressure in patients remaining on latanoprost therapy. Of the patients initially enrolled, 95% successfully completed treatment. There was a slight overall increase in conjunctival hyperemia in patients who switched from timolol to latanoprost, but no change in those who continued latanoprost. The timolol-induced reduction of resting heart rate returned to baseline levels after switching to latanoprost. Of the 247 patients treated with latanoprost during the masked and/or open-label studies, 12 (5%) demonstrated a definite (n = 4) or possible (n = 8) increase in iris pigmentation. CONCLUSIONS: Latanoprost is a well-tolerated ocular hypotensive agent that appears to be more effective than timolol in reducing intraocular pressure. The increase in iris pigmentation appears to be harmless but requires further investigation.     

A clinical comparison of transscleral cyclophotocoagulation with neodymium: YAG and semiconductor diode lasers

PURPOSE: To compare the efficacy of transscleral cyclophotocoagulation using a neodymium: YAG (Nd:YAG) or semiconductor diode laser in controlling intraocular pressure in patients with refractory glaucoma. METHODS: In a prospective study, 95 eyes of 91 patients with refractory glaucoma randomly received Nd:YAG or diode cyclophotocoagulation. Patients were followed for a mean of 10.4 months (10.42 +/- 3.16, mean +/- SD). We compared available data preoperatively and at 1 week, 1 month, 6 months, and 12 months postoperatively. Data analyzed were corrected visual acuity, intraocular pressure, and the type of glaucoma. RESULTS: There was a statistically significant decrease in intraocular pressure after both Nd:YAG and diode cyclophotocoagulation at each time period. However, there were no significant differences in postoperative intraocular pressure or visual acuity change between Nd:YAG and diode procedures. CONCLUSIONS: Compared with the Nd:YAG laser for transscleral cyclophotocoagulation, the diode laser has technological advantages including portability, durability, and smaller size, while providing equivalent postoperative intraocular pressure and visual acuity change.     

The Chiropractic Outcome Study: pain, functional ability and satisfaction with care

BACKGROUND: Elevation of intraocular pressure in the supine position has been previously described in literature. Aim of this study is to investigate the elevation of intraocular pressure in normal tension glaucoma and its effect on the morphology of the optic disc, visual field function and capillary blood flow of the retina and optic disc. PATIENTS AND METHODS: 56 eyes of 28 preperimetric and advanced normal tension glaucoma patients were prospectively evaluated. Ten eyes of ten normal patients served as a control group for the measurements of the intraocular pressure. In the course of a 24-h pressure profile applanation tonometry was performed in the morning in a supine and three and ten minutes later in a sitting position with Draeger's and Goldmann's tonometers. Arterial blood pressure was measured at the same time. The optic disc's morphology was evaluated by stereo photographs and Laser Scanning Tomography. As a sensory test computer perimetry was used. Capillary blood flow was measured at defined areas of the retina and optic disc. An intraocular pressure above 21 mm Hg in the supine position was used as a criterium to define two groups of normal tension glaucoma patients. RESULTS: In the supine position a statistically significant elevation of intraocular pressure was observed in 24 normal tension glaucoma patients by 6.2 +/- 2.8 mm Hg up to 21.8 +/- 3 mm Hg. Diastolic blood pressure in the supine position (80 +/- 10.5 mm Hg) was significantly lower than in the sitting position (94 +/- 11 mm Hg, p = 0.021). 12 of 28 normal tension glaucoma patients showed an intraocular pressure lower than 22 mm Hg in the supine position. In these patients a tendency towards a higher incidence for the occurrence of optic disc haemorrhages and significantly higher values for blood flow (p < 0.0005) and volume (p < 0.005) in the retina and optic nerve head could be shown. In this group of normal pressure glaucoma patients a higher incidence of migraine and vasospastic complaints was reported in the patients' history. CONCLUSION: In this study some normal tension glaucoma patients showed intraocular pressures in the supine position higher than 21 mm Hg and a lower diastolic arterial pressure. The higher incidence of haemorrhages and higher values for flow and volume parameters of the optic disc in normal tension glaucoma patients with an intraocular pressure lower than 22 mm Hg implicate the existence of two entities: real and pseudo normal tension glaucomas.     

NaCl-preferring NZB/B1NJ mice and NaCl-avoiding CBA/J mice have similar amiloride inhibition of chorda tympani responses to NaCl

After intracameral injection calcitonin gene-related peptide has been demonstrated to break the blood aqueous barrier and increase intraocular pressure in rabbits. However in cats, calcitonin gene-related peptide decreases intraocular pressure by increasing the outflow facility of aqueous humor. In the present study, the effect of intracameral injection of calcitonin gene-related peptide on the outflow facility in rabbits has been investigated and the intraocular pressure and outflow facility were measured following intravitreal administration of calcitonin gene-related peptide. The results demonstrate that in spite of the apparent pseudofacility component caused by a breakdown of the blood aqueous barrier also the true trabecular outflow is probably increased in the rabbit eye after intracameral injection of calcitonin gene-related peptide. The intravitreal administration of calcitonin gene-related peptide leaves the blood aqueous barrier intact and causes an increase in the outflow facility of aqueous humor with a concomitant long-lasting decrease in intraocular pressure.     

Treatment of persistent glaucoma secondary to periocular corticosteroids

PURPOSE: To describe two patients with uveitis who developed increased intraocular pressure that was unresponsive to maximum medical therapy eight and 13 months after periocular injection of triamcinolone acetonide. METHODS: Excised periocular tissue was analyzed for corticosteroid activity by gas chromatography and mass spectrometry. RESULTS: Excision of the periocular tissue, which contained visible triamcinolone acetonide, resulted in a normal intraocular pressure within 14 days in both patients. Analysis of the excised tissue disclosed residual corticosteroid in one of the two patients. CONCLUSION: Removal of periocular tissue containing injected corticosteroids may facilitate the management of patients developing increased intraocular pressure unresponsive to maximum medical therapy.     

Treatment results with isoglaucon eye drops in sympatheticotone patients with early appearing primary glaucoma (author's transl)

The sympatholytic substance Clonidin (Isoglaucon) that lowers the intraocular pressure as well as the general blood pressure was tested on a small but homogenous group of patients. This group consisted of 11 middle aged male patients with wide angle glaucoma, elevated blood pressure and sympathicotonia. The intraocular pressure was well controlled in 9 of these, and sufficiently lowered in the remaining two. At the same time the general blood pressure was consistently lowered to some extent and the sympathicotonia improved.