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Red-Free Light for Measurement of Intraocular Pressure Using Goldmann Applanation Tonometer without Fluorescein
摘要： Purpose: To evaluate the use of red-free light for the measurement of intraocular pressure (IOP) using a Goldmann applanation tonometer without fluorescein. Methods: This cross-sectional study was carried out on 500 eyes in 250 patients attending the Ophthalmology Outpatient Clinic at Suez Canal University Hospital. The IOP was measured using a Goldmann applanation tonometer mounted on a Haag-Streit slit-lamp. The measurements were performed first using red-free light without fluorescein. Then the measurements were repeated with cobalt blue light and topical fluorescein on the same eyes. Results: The mean IOP was 15.23 ± 3.3 (SD) mm Hg using the red-free light without fluorescein, whereas it was 15.78 ± 3.7 (SD) mm Hg when measured using cobalt blue light after the application of fluorescein to the conjunctival sac. This difference was not statistically significant. Conclusions: Measurement of IOP with a Goldmann applanation tonometer with red-free light and without the use of fluorescein is simple, saves time, and gives an accurate IOP measurement relative to the traditional measurement technique with cobalt blue light and topical fluorescein.
关键词： Red-free light,Intraocular pressure,Goldmann applanation tonometer
更新于2025-09-23 15:22:29
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Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver
摘要： Purpose: To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. Methods: This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. Results: VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p>0.05). IOP and PD significantly increased during VM (for both; p<0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p<0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p<0.05). Conclusions: VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.
关键词： Anterior chamber,Optic disc/anatomy & histology,Valsalva maneuver,Intraocular pressure,Choroid/anatomy & histology
更新于2025-09-23 15:22:29
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Yellow filter effect on melatonin secretion in the eye: Role in IOP regulation
摘要： Purpose: Melatonin is a neurohormone mainly synthesized in the pineal gland; however, it is also present in the aqueous humor. One of melatonins’ functions in the eye is the regulation of intraocular pressure. Melatonin is known to be sensitive to light. Recently, the photopigment which controls melatonin synthesis, melanopsin, was found in the crystalline lens. Therefore, light conditions is an interesting possible way of regulating melatonin levels in the aqueous humor. The current study used yellow-filters, since melanopsin is activated by short-wavelength (blue light). methods: New Zealand white rabbits were used, divided in two groups, one under controlled 12h-light/dark cycles, while the rest had their cages encased with a yellow filter (λ 465-480). IOP measurements were taken every week at the same time before they were anesthetized for aqueous humour extraction. Results: Keeping the rabbits under the yellow filter resulted in a decrease in IOP up to 43.8 ± 7.8% after 3 weeks. This effect was reversed after the topical application of selective and non-selective melatonin receptors antgonists, 4PPDOT and luzindole. Also, blocking melanopsin by its antagonist AA92593 under white light condition decreased IOP. Finally, melatonin levels were found significantly higher in the aqueous humor of rabbits developed under yellow filter compared to controls (37.4 ± 4.2 ng/ml and 15.3 ± 3.1 ng/ml, respectively). Conclusion: Yellow filters modulate melatonin levels in the aqueous humour due to deactivating melanopsin activity. This effect leaded to a decrease in IOP mediated by melatonin receptors.
关键词： Melatonin,Intraocular pressure,Melanopsin.,Yellow filter
更新于2025-09-23 15:22:29
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Continuous 24-hour ocular dimensional profile recording in medically treated normal-tension glaucoma
摘要： Purpose: To analyze the 24-hour ocular dimensional profile in normal-tension glaucoma (NTG) patients on medical treatment. Methods: Consecutive, medically treated NTG subjects were recruited from a university eye center. Subjects were on a mean of 1.7±0.7 types of antiglaucoma medications and 56.6% were on a prostaglandin analog. A contact lens-based sensor device was worn in one eye of NTG patients to record the intraocular pressure (IOP)-related profile for 24 hours, recording the following: variability from mean over 24 hours, nocturnally and diurnally, as well as the number of peaks and troughs diurnally and nocturnally. Results: In 18 NTG subjects, the nocturnal variability around the mean contact lens-based sensor device signal was 48.9% less than the diurnal variability around the mean. The number of peaks was 54.7% less during the nocturnal period than during the diurnal period. The rate of increase in the ocular dimensional profile when going to sleep was significantly greater than the rate of decrease upon waking (P<0.001). Conclusion: In medically treated NTG subjects, there was more variability in the IOP-related pattern during the daytime and there were fewer peaks during sleep.
关键词： intraocular pressure,24-hour,normal tension glaucoma
更新于2025-09-23 15:22:29
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Case Series of Inappropriate Concentration of Intraocular Sulfur Hexafluoride
摘要： Due to high complexity, vitreoretinal surgery presents a higher number of patient safety incidents compared with other ophthalmic procedures. Intraocular gases are one of the most useful adjuncts to vitrectomy and surprisingly, surgeons commonly admit to having occasional problems with incorrect gas concentration. The aim of this study is to present a consecutive case series of patients with improper concentration of sulfur hexafluoride (SF6) applied during vitrectomy. Three patients underwent 27-gauge vitrectomy and at the end of surgery inappropriate dilution of 100% SF6 was administered. It was attributed to a calculation error, change in the gas supplier, or increased partial pressure of SF6 before dilution. Postoperatively, due to IOP increase, two eyes required intravitreal gas-air exchange. Subsequently, cataract surgery was performed in one eye with concomitant vitrectomy and silicone oil tamponade due to retinal detachment. To prevent such complications, we suggest using intraocular gases with great care, training of ophthalmic personnel, and prompting manufacturers to provide SF6 in a prepared concentration of 20%.
关键词： Intraocular pressure,Vitrectomy,Expandable gas,Intraocular tamponade,Sulfur hexafluoride
更新于2025-09-23 15:21:01
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Effect of Apraclonidine and Diclofenac on Early Changes in Intraocular Pressure After Selective Laser Trabeculoplasty
摘要： Précis: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. Purpose: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. Materials and Methods: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. Results: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean = +4.05 ± 0.58 mm Hg and +4.47 ± 0.73, respectively, P < 0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean = ?2.41 ± 0.88 mm Hg, P < 0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P = 0.51, 6 mo: P = 0.42). Conclusions: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.
关键词： open-angle glaucoma,non–steroidal anti-inflammatory,selective laser trabeculoplasty,intraocular pressure,ocular hypertension
更新于2025-09-23 15:21:01
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Current review of Excimer laser Trabeculostomy
摘要： Background: Excimer laser trabeculostomy (ELT) is a microinvasive glaucoma surgery (MIGS) that creates multiple laser channels through the trabecular meshwork using a cold laser system, which minimizes tissue fibrosis and aids in bypassing the main area of resistance to aqueous outflow. The purpose of this review is to evaluate the current body of evidence surrounding ELT in terms of efficacy and review the safety profile of the procedure. Main text: Studies screened had to show clear inclusion and exclusion criteria as well as well-defined outcome measures. PubMed, MEDLINE, EMBASE and the Cochrane Controlled Trial Database were searched. Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines were used to assess for study quality and for any bias. Sixty-four articles were initially identified with 18 meeting preliminary screening criteria. Ultimately, 8 studies met inclusion criteria and 2 additional non-referenced publications were also included: 1 randomized control trial, 4 prospective case series and 5 retrospective studies. Overall studies showed moderate intraocular pressure (IOP) lowering of between 20% and 40% from baseline without medication washout and mostly a decrease in glaucoma medications with few complications. Conclusion: Current literature shows a significant IOP-lowering effect of ELT with a favorable safety-profile in standalone cases or combined with cataract surgery. Limitations to these studies are the lack of controls and washout IOP. Overall, ELT is an attractive MIGS option that does not require any residual device remaining in the angle.
关键词： Excimer laser trabeculostomy,ELT,Trabeculotomy,MIGS,Cataract,Intraocular pressure,Glaucoma
更新于2025-09-23 15:21:01
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Focusing on surgical and laser advances in glaucoma management
摘要： Introduction: Lowering the IOP remains the mainstay treatment to stop the progression of glaucoma. Different modalities can be used to achieve this including IOP lowering medications, laser, and surgeries. Nowadays, minimally invasive glaucoma surgeries and newer lasers are becoming more popular due to their safety profile, and their efficacy, allowing the patients to be less dependent on life long medications and substituting more invasive procedures as trabeculectomy, and shunt operations. Areas covered: This review will go through how lasers and surgery are used to lower the IOP, and the newest techniques, and modalities used to achieve this. Expert opinion: the authors of this review believe that in five years’ time lasers and minimally invasive glaucoma procedures will replace eye drops and surgeries like trabeculectomy and shunt procedures.
关键词： cyclophotocoagulation,trabeculectomy,shunt procedures,minimally invasive glaucoma procedures,non-penetrating glaucoma procedures,laser Trabeculoplasty,Intraocular pressure
更新于2025-09-23 15:19:57
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Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials
摘要： background The only widely accepted, effective treatment for open- angle glaucoma (OAG) is to reduce the intraocular pressure (IOP), with medical therapy being the typical first- line therapy. Notably, an alternative therapy is selective laser trabeculoplasty (SLT), which is safe and effective in lowering the IOP. Nonetheless, whether SLT could replace medication as the first- line therapy for OAG is still under debate. Methods Studies involving randomised controlled trials conducted before August 2019 that compared the efficacy of SLT- related and medication- only treatments for OAG were selected from PubMed, Embase, Cochrane Library and Web of Science. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology was employed to rate the quality of the body of evidence. results 1229 patients in eight trials were included. The overall results revealed no significant differences between SLT- related and medication- only treatments regarding the IOP reduction (mean difference (MD): 0.18, 95% CI ?0.72 to 1.07, p=0.70, I2=73%) and the success rate of IOP control (risk ratio: 1.02, 95% CI 0.99 to 1.04, p=0.74, I2=0%). The SLT- related therapy group required significantly fewer medications compared with the medication- only group (MD: ?1.06, 95% CI ?1.16 to ?0.96, p<0.0000, I2=5%). A quantitative analysis was not performed concerning adverse events and quality of life because of the limited data available. Conclusion SLT is safe and has a lower incidence of ocular side effects. SLT can be the choice of first- line therapy for OAG. However, clinicians should consider the cost- effectiveness, as well as the patient’s characteristics, before deciding on the therapeutic option.
关键词： selective laser trabeculoplasty,intraocular pressure,meta-analysis,medication,open-angle glaucoma
更新于2025-09-23 15:19:57
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Predictors of Success in Selective Laser Trabeculoplasty
摘要： Selective laser trabeculoplasty (SLT) is a common procedure to lower intraocular pressure (IOP) in patients with glaucoma. However, reports are conflicting regarding what factors contribute to SLT success. The purpose of this study was to determine predictors of SLT success. A total of 997 eyes from 677 patients were included in the study. Mean age was 70.2±11.5 years. Selective laser trabeculoplasty success was achieved in 227 eyes (22.8%), whereas 770 eyes (77.2%) did not meet success criteria. Intraocular pressure before SLT was 21.9±5.2 mmHg while taking 2.0±1.2 medications in eyes with successful SLT, compared with 19.0±5.0 mmHg (P < 0.0001) while taking 2.1±1.3 medications (P = 0.52) in eyes with SLT failure. At the 1-year follow-up, mean IOP in eyes with SLT success was 14.7±3.2 mmHg with 2.0±1.2 medications, compared with 16.3±4.7 mmHg (P = 0.008) with a mean of 1.9±1.3 medications (P = 0.37) in eyes with SLT failure. Eyes with SLT success more often showed greater angle pigment (P = 0.03). Age, glaucoma severity, total SLT power, type of glaucoma, severity of glaucoma, visual field mean defect, and retinal nerve fiber layer thickness were not found to correlate with success. No difference was found between the rate of success based on treatments before SLT, whether surgical or medical. In this large cohort of eyes undergoing SLT, greater IOP and angle pigment before SLT correlated positively with SLT success. Age, total SLT power, severity of glaucoma, and prior treatments were not associated with SLT success or failure.
关键词： intraocular pressure,predictors of success,glaucoma,Selective laser trabeculoplasty
更新于2025-09-23 15:19:57