Journal of Clinical Medicine

Editorial

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5 pages, 215 KiB

Open AccessEditorial

It Is All about Pressure

by Paolo Brusini, Maria Letizia Salvetat and Marco Zeppieri

J. Clin. Med. 2022, 11(13), 3640; https://doi.org/10.3390/jcm11133640 - 23 Jun 2022

Cited by 1 | Viewed by 1384

Abstract

Glaucoma is an ocular disease caused by elevated intraocular pressure that leads to progressive optic neuropathy [...] Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

Research

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9 pages, 1359 KiB

Open AccessArticle

Correlation Analysis between Intraocular Pressure and Extraocular Muscles Based on Orbital Magnetic Resonance T2 Mapping in Thyroid-Associated Ophthalmopathy Patients

by Ban Luo, Wei Wang, Xinyu Li, Hong Zhang, Yaoli Zhang and Weikun Hu

J. Clin. Med. 2022, 11(14), 3981; https://doi.org/10.3390/jcm11143981 - 8 Jul 2022

Cited by 2 | Viewed by 1653

Abstract

Background: The correlation between intraocular pressure (IOP) and the magnetic resonance imaging (MRI) parameters in thyroid-associated ophthalmopathy (TAO) patients was explored. Methods: This study included 82 eyes in 41 TAO patients who had a large difference in the IOP between each eye. We [...] Read more.

Background: The correlation between intraocular pressure (IOP) and the magnetic resonance imaging (MRI) parameters in thyroid-associated ophthalmopathy (TAO) patients was explored. Methods: This study included 82 eyes in 41 TAO patients who had a large difference in the IOP between each eye. We measured the T2 relaxation time (T2RT) of the extraocular muscles (EOMs), the orbital fat, and the area of the EOMs. Results: There was a positive correlation between IOP and exophthalmos, the clinical activity score (CAS), the T2RT (of the medial rectus (MR)), the area of the MR, inferior rectus (IR) and lateral rectus, and the mean area. We established a regression model with IOP as the dependent variable, and the area of the IR was statistically significant. Conclusions: High IOP in TAO patients was positively correlated with the degree of exophthalmos and EOM inflammation (especially the inferior rectus). The state of the EOMs in an orbital MRI may partially explain high IOP and provide the necessary clinical information for subsequent high IOP treatment. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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12 pages, 744 KiB

Open AccessArticle

Corneal Behavior during Tonometer Measurement during the Water Drinking Test in Eyes with XEN GelStent in Comparison to Non-Implanted Eyes

by Agnieszka Jóźwik, Joanna Przeździecka-Dołyk, Ewa Wałek, Magdalena Czerniak and Magdalena Asejczyk

J. Clin. Med. 2022, 11(11), 2962; https://doi.org/10.3390/jcm11112962 - 24 May 2022

Cited by 2 | Viewed by 1459

Abstract

Biomechanics of the cornea have significant influences on the non-contact measurement of the intraocular pressure. The corneal behaviour during tonometry is a fundamental factor in estimating its value. The aim of the study was to analyse the behaviour of the cornea during tonometric [...] Read more.

Biomechanics of the cornea have significant influences on the non-contact measurement of the intraocular pressure. The corneal behaviour during tonometry is a fundamental factor in estimating its value. The aim of the study was to analyse the behaviour of the cornea during tonometric measurement with the forced change in intraocular pressure during the water drinking test. Ocular Response Analyser (Reichert) was used to the measurement. Besides four basic parameters connected with intraocular pressure (IOPg, IOPcc) and biomechanics (corneal hysteresis CH and corneal resistance factor (CRF), other parameters representing the behaviour of the cornea during a puff of air were analysed. There were 47 eyes included in the study, including 27 eyes with a XEN GelStent implanted and 20 without it. The eyes of people with monocular implementation were the reference group. The values of analysed parameters were compared before and after 10, 25, 40, and 55 min after drinking the water. The intraocular pressure increased by 2.4 mmHg (p < 0.05) for eyes with a XEN stent and 2.2 mmHg for eyes without a stent (p < 0.05) in the tenth minute after drinking of water. This change caused a decreasing of corneal hysteresis (p < 0.05) without significant changes in the corneal resistance factor (p > 0.05). Corneal hysteresis changed similarly in the reference group and the group with a XEN GelStent. The analysis of additional parameters showed a difference in the behaviour of the cornea in eyes with a XEN GelStent in comparison to the corneas of eyes without a stent. This was particularly visible in the analysis of the cornea’s behaviour during the second applanation, when the cornea returns to its baseline state after deformation caused by air puff tonometry. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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10 pages, 1559 KiB

Open AccessArticle

Intraocular Pressure Measurement in Childhood Glaucoma under Standardized General Anaesthesia: The Prospective EyeBIS Study

by Alicja Strzalkowska, Nina Pirlich, Julia V. Stingl, Alexander K. Schuster, Jasmin Rezapour, Felix M. Wagner, Justus Buse and Esther M. Hoffmann

J. Clin. Med. 2022, 11(10), 2846; https://doi.org/10.3390/jcm11102846 - 18 May 2022

Cited by 6 | Viewed by 2132

Abstract

Objective: We aimed to compare intraocular pressure (IOP) measurements using iCare^® PRO rebound tonometry (iCare) and Perkins applanation tonometry (Perkins) in childhood glaucoma subjects and healthy children and the influence of anaesthesia depth, age and corneal thickness. Material: Prospective clinical, case-control study [...] Read more.

Objective: We aimed to compare intraocular pressure (IOP) measurements using iCare^® PRO rebound tonometry (iCare) and Perkins applanation tonometry (Perkins) in childhood glaucoma subjects and healthy children and the influence of anaesthesia depth, age and corneal thickness. Material: Prospective clinical, case-control study of children who underwent an ophthalmologic examination under general anaesthesia according to our protocol. Children were 45.45 ± 29.76 months old (mean ± SD (standard deviation)). Of all children, 54.05% were female. IOP was taken three times (T1–T3), according to duration and the depth of anaesthesia. The order of measurement alternated, starting with iCare. Agreement between the device measurements was evaluated using Bland–Altman analysis. Results: 53 glaucoma subjects and 22 healthy controls. Glaucoma subjects: IOP measured with iCare was at T1: 27.2 (18.1–33.8), T2: 21.6 (14.8–30.6), T3: 20.4 mmHg (14.5–27.0) and Perkins 17.5 (12.0–23.0), 15.5 (10.5–20.5), 15.0 mmHg (10.5–21.0) (median ± IQR (interquartile range)). Healthy controls: IOP with iCare: T1: 13.3 (11.1–17.0), T2: 10.6 (8.1–12.4), T3: 9.6 mmHg (7.7–11.7) and Perkins 10.3 (8.0–12.0), 7.0 (5.5–10.5), 7.0 mmHg (5.5–8.5) (median ± IQR). The median IOP was statistically significantly higher with iCare than with Perkins (p < 0.001) in both groups. The mean difference (iCare and Perkins) was 6.0 ± 6.1 mmHg for T1–T3, 7.3 at T1, 6.0 at T2, 4.9 mmHg at T3. Conclusion: The IOP was the highest in glaucoma subjects and healthy children at T1 (under sedation), independently of the measurement method. iCare always leads to higher IOP compared to Perkins in glaucoma and healthy subjects, regardless of the duration of anesthesia. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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9 pages, 1219 KiB

Open AccessArticle

Pulsatile Trabecular Meshwork Motion: An Indicator of Intraocular Pressure Control in Primary Open-Angle Glaucoma

by Rong Du, Chen Xin, Jingjiang Xu, Jianping Hu, Huaizhou Wang, Ningli Wang and Murray Johnstone

J. Clin. Med. 2022, 11(10), 2696; https://doi.org/10.3390/jcm11102696 - 10 May 2022

Cited by 13 | Viewed by 1783

Abstract

(1) Background: To investigate the value of pulsatile trabecular meshwork (TM) motion in predicting the diurnal intraocular pressure (IOP) fluctuation of primary open-angle glaucoma (POAG). (2) Methods: This cross-sectional study recruited 20 normal patients and 30 patients with POAG. Of the POAG group, [...] Read more.

(1) Background: To investigate the value of pulsatile trabecular meshwork (TM) motion in predicting the diurnal intraocular pressure (IOP) fluctuation of primary open-angle glaucoma (POAG). (2) Methods: This cross-sectional study recruited 20 normal patients and 30 patients with POAG. Of the POAG group, 20 had stable diurnal IOP and 10 had high IOP fluctuation. A clinical prototype phase-sensitive optical coherence tomography (PhS-OCT) model was used to measure TM pulsatile motion with maximum velocity (MV) and cumulative displacement (CDisp). (3) Results: MV and CDisp were higher in the external region in both normal and POAG patients. All MV and CDisp reduced significantly in the POAG group (p < 0.001). In the POAG group, except MV in the external region (p = 0.085), MV and CDisp in the nasal area were significantly higher than those in the temporal area (p < 0.05). The MV and CDisp in the external region in the nasal area of POAG patients with high IOP fluctuation were much lower than those with stable IOP (p_EMV3 = 0.031, p_ECDisp3 < 0.001); (4) Conclusions: Pulsatile TM motion reduced in POAG patients relevant to the level of diurnal IOP fluctuation. This study presents the segmental variance of TM stiffness in human living eyes and suggests the clinical potential of the measurement of pulsatile TM motion with PhS-OCT for the evaluation of diurnal IOP fluctuation. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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9 pages, 1966 KiB

Open AccessArticle

Canaloplasty in Pseudoexfoliation Glaucoma. Can It Still Be Considered a Good Choice?

by Paolo Brusini, Veronica Papa and Marco Zeppieri

J. Clin. Med. 2022, 11(9), 2532; https://doi.org/10.3390/jcm11092532 - 30 Apr 2022

Cited by 4 | Viewed by 1575

Abstract

Purpose: The aim of this study was to assess the long-term outcomes of canaloplasty surgery in pseudoexfoliation glaucoma (PEXG) patients. Material and Methods: A total of 116 PEXG patients with an intraocular pressure (IOP) > 21 mm/Hg and maximum tolerated local medical therapy [...] Read more.

Purpose: The aim of this study was to assess the long-term outcomes of canaloplasty surgery in pseudoexfoliation glaucoma (PEXG) patients. Material and Methods: A total of 116 PEXG patients with an intraocular pressure (IOP) > 21 mm/Hg and maximum tolerated local medical therapy who underwent canaloplasty from February 2008 to January 2022 were considered. Every six months, all subjects underwent a complete ophthalmic examination. The period of follow-up ranged from 2 to 167 months. Inclusion criteria included only patients for whom the entire procedure could be completed with a follow-up of at least 2 years. Results: Amongst the 116 PEXG patients, the entire procedure could not be performed in 10 eyes (8.6%), and thus they were not considered in the analysis. Twenty-three patients did not reach the two-year follow-up and another 16 patients during this time period were lost. A total of 67 patients with a mean follow-up of 49 ± 32.3 months were considered in the analysis. The pre-operative mean IOP was 31.2 ± 8.7 mm/Hg (range 20–60). The mean IOP at the two-year follow-up was 17.2 ± 6.7 mmHg, with a mean reduction from baseline of 44.9%. After two years, the qualified success rates according to three different criteria (IOP ≤ 21, ≤18 and ≤16 mmHg) were 80.6%, 73.1% and 61.0%, respectively. The total number of medications used pre- and at the follow-up at 2 years was 3.5 ± 0.8 and 1.2 ± 1.4, respectively. Early complications included: hyphema, in about 30% of cases; Descemet membrane detachment (4.9%); and IOP spikes > 10 mmHg (9.7%). A late failure with an acute IOP rise of up to 50 mmHg was observed in 41 cases (61.2%) after 3 to 72 months. Conclusions: Long-term post-operative outcomes of canaloplasty in PEXG patients appear to be quite good on average; however, an acute rise in IOP can be observed in more than 60% of the cases after a long period of satisfactory IOP control. For this reason, canaloplasty may not be suitable in eyes with PEXG, especially in patients with severe functional damage. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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10 pages, 521 KiB

Open AccessArticle

Modification of Corneal Biomechanics and Intraocular Pressure Following Non-Penetrating Deep Sclerectomy

by María Dolores Díaz-Barreda, Ignacio Sánchez-Marín, Ana Boned-Murillo, Itziar Pérez-Navarro, Juana Martínez, Elena Pardina-Claver, Diana Pérez, Francisco Javier Ascaso and Juan Ibáñez

J. Clin. Med. 2022, 11(5), 1216; https://doi.org/10.3390/jcm11051216 - 24 Feb 2022

Cited by 1 | Viewed by 1752

Abstract

Changes in the cornea can influence outcomes in patients with primary open-angle glaucoma (POAG). We aimed to evaluate the relevance of changes in corneal biomechanics and intraocular pressure (IOP) in patients undergoing non-penetrating deep sclerectomy (NPDS) with the Esnoper V2000 implant^® (AJL [...] Read more.

Changes in the cornea can influence outcomes in patients with primary open-angle glaucoma (POAG). We aimed to evaluate the relevance of changes in corneal biomechanics and intraocular pressure (IOP) in patients undergoing non-penetrating deep sclerectomy (NPDS) with the Esnoper V2000 implant^® (AJL Ophthalmic S.A., Gasteiz, Spain). We included 42 eyes of 42 patients with POAG scheduled for NPDS with the Esnoper V2000 implant. Biomechanical properties were measured by Ocular Response Analyzer^® G3 (ORA; Reichert Inc., Depew, NY, USA). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) were measured the day before surgery and on day 1, 7, and 30 and 2 and 3 months after surgery. CH initially increased, fell below the presurgical value at 30 days after the surgery, and increased again at 2 and 3 months. CRF, IOPcc, and IOPg decreased on the first day after surgery, then followed a trend of increasing but stayed below pre-surgery levels. All values reached statistical significance. While observed changes in corneal biomechanics after NPDS and Esnoper V2000 implant were significant, more studies are needed if we are to understand their influence on corneal biomechanics and their clinical relevance in POAG. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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14 pages, 2522 KiB

Open AccessArticle

The Dual Effect of Rho-Kinase Inhibition on Trabecular Meshwork Cells Cytoskeleton and Extracellular Matrix in an In Vitro Model of Glaucoma

by Juliette Buffault, Françoise Brignole-Baudouin, Élodie Reboussin, Karima Kessal, Antoine Labbé, Stéphane Mélik Parsadaniantz and Christophe Baudouin

J. Clin. Med. 2022, 11(4), 1001; https://doi.org/10.3390/jcm11041001 - 15 Feb 2022

Cited by 23 | Viewed by 3441

Abstract

The trabecular meshwork (TM) is the main site of drainage of the aqueous humor, and its dysfunction leads to intraocular pressure elevation, which is one of the main risk factors of glaucoma. We aimed to compare the effects on cytoskeleton organization and extracellular [...] Read more.

The trabecular meshwork (TM) is the main site of drainage of the aqueous humor, and its dysfunction leads to intraocular pressure elevation, which is one of the main risk factors of glaucoma. We aimed to compare the effects on cytoskeleton organization and extracellular matrix (ECM) of latanoprost (LT) and a Rho-kinase inhibitor (ROCKi) on a transforming growth factor beta2 (TGF-β2)-induced glaucoma-like model developed from primary culture of human TM cells (pHTMC). The TGF-β2 stimulated pHTMC were grown and incubated with LT or a ROCKi (Y-27632) for 24 h. The expression of alpha-smooth muscle actin (αSMA) and fibronectin (FN), and phosphorylation of the myosin light chain (MLC-P) and Cofilin (Cofilin-P) were evaluated using immunofluorescence and Western blot. The architectural modifications were studied in a Matrigel^TM 3D culture. TGF-β2 increased the expression of αSMA and FN in pHTMC and modified the cytoskeleton with cross-linked actin network formation. LT did not alter the expression of αSMA but decreased FN deposition. The ROCKi decreased TGF-β2-induced αSMA and FN expression, as well as MLC-P and Cofilin-P, and stimulated the cells to recover a basal cytoskeletal arrangement. In the preliminary 3D study, pHTMC organized in a mesh conformation showed the widening of the TM under the effect of Y-27632. By simultaneously modifying the organization of the cytoskeleton and the ECM, with fibronectin deposition and overexpression, TGF-β2 reproduced the trabecular degeneration described in glaucoma. The ROCKi was able to reverse the TGF-β2-induced cytoskeletal and ECM rearrangements. LT loosened the extracellular matrix but had no action on the stress fibers. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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10 pages, 845 KiB

Open AccessArticle

Mid-Term Impact of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure

by Marc-Antoine Hannappe, Florian Baudin, Anne-Sophie Mariet, Pierre-Henri Gabrielle, Louis Arnould, Alain M. Bron and Catherine Creuzot-Garcher

J. Clin. Med. 2022, 11(4), 946; https://doi.org/10.3390/jcm11040946 - 11 Feb 2022

Cited by 1 | Viewed by 1570

Abstract

The effect of intraocular injections of anti-vascular endothelial growth factor (VEGF) on intraocular pressure (IOP) has not been clearly stated. We extracted data from the electronic health records at Dijon University Hospital of 750 patients who were unilaterally injected with anti-VEGF agents between [...] Read more.

The effect of intraocular injections of anti-vascular endothelial growth factor (VEGF) on intraocular pressure (IOP) has not been clearly stated. We extracted data from the electronic health records at Dijon University Hospital of 750 patients who were unilaterally injected with anti-VEGF agents between March 2012 and March 2020. These were treatment-naïve patients who had received at least three injections of the same treatment (aflibercept, bevacizumab, or ranibizumab) in one eye only, and had IOP measurements before and after the injections. Fellow untreated eyes were used as comparators. A clinically significant IOP rise was determined as an IOP above 21 mmHg and an increase of at least 6 mmHg compared to baseline, or the need for IOP-lowering agents. We found an overall slight increase in IOP between treated and untreated eyes at 6 months (+0.67 ± 3.33 mmHg, 95% confidence interval 0.33–1.02, p < 0.001). Ranibizumab had a higher final IOP at 1 and 3 months. Age, sex, and the number of injections were not associated with IOP variation. Ranibizumab was associated with a higher rate of increase in clinically significant IOP at 6 months (p = 0.03). Our study confirms that anti-VEGF injections constitute a relatively safe treatment regarding their impact on IOP. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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12 pages, 2442 KiB

Open AccessArticle

Elevated Levels of Growth/Differentiation Factor-15 in the Aqueous Humor and Serum of Glaucoma Patients

by Rupalatha Maddala, Leona T. Y. Ho, Shruthi Karnam, Iris Navarro, Anja Osterwald, Sandra S. Stinnett, Christoph Ullmer, Robin R. Vann, Pratap Challa and Ponugoti V. Rao

J. Clin. Med. 2022, 11(3), 744; https://doi.org/10.3390/jcm11030744 - 29 Jan 2022

Cited by 5 | Viewed by 2087

Abstract

Dysregulated levels of growth/differentiation factor-15 (GDF15), a divergent member of the transforming growth factor-beta super family, have been found to be associated with the pathology of various diseases. In this study, we evaluated the levels of GDF15 in aqueous humor (AH) and serum [...] Read more.

Dysregulated levels of growth/differentiation factor-15 (GDF15), a divergent member of the transforming growth factor-beta super family, have been found to be associated with the pathology of various diseases. In this study, we evaluated the levels of GDF15 in aqueous humor (AH) and serum samples derived from primary open-angle glaucoma (POAG) and age- and gender-matched non-glaucoma (cataract) patients to assess the plausible association between GDF15 and POAG. GDF15 levels were determined using an enzyme-linked immunosorbent assay, and data analysis was performed using the Wilcoxon rank sum test, or the Kruskal–Wallis test and linear regression. GDF15 levels in the AH (n = 105) of POAG patients were significantly elevated (by 7.4-fold) compared to cataract patients (n = 117). Serum samples obtained from a subgroup of POAG patients (n = 41) also showed a significant increase in GDF15 levels (by 50%) compared to cataract patients. GDF15 levels were elevated in male, female, African American, and Caucasian POAG patients. This study reveals a significant and marked elevation of GDF15 levels in the AH of POAG patients compared to non-glaucoma cataract control patients. Although serum GDF15 levels were also elevated in POAG patients, the magnitude of difference was much smaller relative to that found in the AH. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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15 pages, 1698 KiB

Open AccessArticle

360° Ab-Interno Schlemm’s Canal Viscodilation with OMNI Viscosurgical Systems for Open-Angle Glaucoma—Midterm Results

by Giacomo Toneatto, Marco Zeppieri, Veronica Papa, Laura Rizzi, Carlo Salati, Andrea Gabai and Paolo Brusini

J. Clin. Med. 2022, 11(1), 259; https://doi.org/10.3390/jcm11010259 - 4 Jan 2022

Cited by 14 | Viewed by 2411

Abstract

Purpose: To evaluate the effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm’s canal (SC) performed with OMNI viscosurgical system in open angle glaucoma (OAG) together or not with phacoemulsification. Setting: Two surgical sites. Design: Retrospective, observational. Methods: Eighty eyes from 73 patients [...] Read more.

Purpose: To evaluate the effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm’s canal (SC) performed with OMNI viscosurgical system in open angle glaucoma (OAG) together or not with phacoemulsification. Setting: Two surgical sites. Design: Retrospective, observational. Methods: Eighty eyes from 73 patients with mild to moderate OAG underwent ab- interno SC viscodilation performed with OMNI system. Fifty eyes (Group 1) underwent only SC viscodilation, while 30 eyes (Group 2) underwent glaucoma surgery + cataract extraction. Primary success endpoint at 12 months was an intraocular pressure (IOP) reduction higher than 25% from baseline with an absolute value of 18 mmHg or lower, either on the same number or fewer ocular hypotensive medications, without further interventions. Secondary effectiveness endpoints included mean IOP, number of medications and comparison of outcomes between groups. Safety endpoints consisted of best-corrected visual acuity (BCVA), adverse events (AEs), and subsequent surgical procedures. Results: Primary success was achieved in 40.0% and 67.9% in Groups 1 and 2, respectively. Mean IOP at 12-month follow-up showed a significant reduction in both groups (from 23.0 to 15.6 mmHg, p < 0.001, and from 21.5 to 14.1, p < 0.001, in Groups 1 and 2, respectively). Mean medication number decreased in both groups (from 3.0 to 2.0, p < 0.001 and from 3.4 to 1.9, p < 0.001, in Groups 1 and 2, respectively). AEs included hyphema (2 eyes), mild hypotony (4 eyes), IOP spikes one month after surgery (1 eye). Twelve eyes (15.0%) required subsequent surgical procedures. No BCVA reduction was observed. Conclusions: Viscodilation of SC using OMNI viscosurgical systems is safe and relatively effective in reducing IOP in adult patients with OAG. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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7 pages, 1001 KiB

Open AccessArticle

Different Effects of Aging on Intraocular Pressures Measured by Three Different Tonometers

by Kazunobu Sugihara and Masaki Tanito

J. Clin. Med. 2021, 10(18), 4202; https://doi.org/10.3390/jcm10184202 - 17 Sep 2021

Cited by 4 | Viewed by 1991

Abstract

This study aimed to compare intraocular pressures (IOP) using different tonometers, Goldmann applanation (IOP_GAT), non-contact (IOP_NCT), and rebound (IOP_RBT), and to assess the effects of aging and central corneal thickness (CCT) on the measurements. The IOP_GAT [...] Read more.

This study aimed to compare intraocular pressures (IOP) using different tonometers, Goldmann applanation (IOP_GAT), non-contact (IOP_NCT), and rebound (IOP_RBT), and to assess the effects of aging and central corneal thickness (CCT) on the measurements. The IOP_GAT, IOP_NCT, IOP_RBT, mean patient age (65.1 ± 16.2 years), and CCT (521.7 ± 39.2 µm) were collected retrospectively from 1054 eyes. The differences among IOPs were compared by the paired t-test. Possible correlations between devices, age, and CCT were assessed by linear regression analyses. The effects of age and CCT on the IOP reading were assessed by mixed-effects regression models. The IOP_GAT values were 2.4 and 1.4 mmHg higher than IOP_NCT and IOP_RBT, respectively; the IOP_NCT was 1.0 mmHg lower than IOP_RBT (p < 0.0001 for all comparisons). The IOPs measured by each tonometer were highly correlated with each other (r = 0.81–0.90, t = 45.2–65.5). The linear regression analyses showed that age was negatively correlated with IOP_NCT (r = −0.12, t = −4.0) and IOP_RBT (r = −0.14, t = −4.5) but not IOP_GAT (r = 0.00, t = −0.2); the CCT was positively correlated with IOP_GAT (r = 0.13, t = 4.3), IOP_NCT (r = 0.29, t = 9.8), and IOP_RBT (r = 0.22, t = 7.2). The mixed-effect regression models showed significant negative correlations between age and IOP_NCT (t = −2.6) and IOP_RBT (t = −3.4), no correlation between age and IOP_GAT (t = 0.2), and a significant positive correlation between CCT and the tonometers (t = 3.4–7.3). No differences between IOP_GAT and IOP_RBT were seen at the age of 38.8 years. CCT affects IOPs from all tonometers; age affects IOP_NCT and IOP_RBT in different degrees. IOP_RBT tended to be higher than IOP_GAT in young subjects, but this stabilized in middle age and became higher in older subjects. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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7 pages, 532 KiB

Open AccessArticle

Corneal Higher-Order Aberrations after Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade: Preliminary Early 3-Month Results

by Hiromitsu Onoe, Kazuyuki Hirooka, Hideaki Okumichi, Yumiko Murakami and Yoshiaki Kiuchi

J. Clin. Med. 2021, 10(18), 4115; https://doi.org/10.3390/jcm10184115 - 12 Sep 2021

Cited by 7 | Viewed by 1564

Abstract

We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent μLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that [...] Read more.

We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent μLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that underwent cataract surgery alone used as controls. Visual acuity and corneal HOAs, coma-like aberrations, and spherical-like aberrations were analyzed before and at 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence HOAs were evaluated. No significant postoperative changes were noted for corneal HOAs, coma-like aberrations, and spherical-like aberrations after cataract surgery alone. The mean corneal HOAs, coma-like aberrations, and spherical-like aberrations were 0.222 ± 0.115 μm, 0.203 ± 0.113 μm, and 0.084 ± 0.043 μm at baseline and 0.326 ± 0.195 μm (p < 0.001), 0.302 ± 0.289 μm (p = 0.03), and 0.150 ± 0.115 μm (p < 0.001) at 3 months after LOT-Phaco, respectively. Results of the analysis for risk factors suggested that a longer incision in Schlemm’s canal could influence corneal HOAs, coma-like aberrations, and spherical-like aberrations after LOT-Phaco. Although no significant postoperative changes were observed in corneal HOAs and coma-like or spherical-like aberrations after cataract surgery alone, a significant increase in corneal HOAs and coma-like or spherical-like aberrations remained after the LOT-Phaco procedure. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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19 pages, 3108 KiB

Open AccessArticle

Influence of Chronic Ocular Hypertension on Emmetropia: Refractive, Structural and Functional Study in Two Rat Models

by Silvia Mendez-Martinez, Teresa Martínez-Rincón, Manuel Subias, Luis E. Pablo, David García-Herranz, Julian García Feijoo, Irene Bravo-Osuna, Rocío Herrero-Vanrell, Elena Garcia-Martin and María J. Rodrigo

J. Clin. Med. 2021, 10(16), 3697; https://doi.org/10.3390/jcm10163697 - 20 Aug 2021

Cited by 2 | Viewed by 2611

Abstract

Chronic ocular hypertension (OHT) influences on refraction in youth and causes glaucoma in adulthood. However, the origin of the responsible mechanism is unclear. This study analyzes the effect of mild-moderate chronic OHT on refraction and neuroretina (structure and function) in young-adult Long-Evans rats [...] Read more.

Chronic ocular hypertension (OHT) influences on refraction in youth and causes glaucoma in adulthood. However, the origin of the responsible mechanism is unclear. This study analyzes the effect of mild-moderate chronic OHT on refraction and neuroretina (structure and function) in young-adult Long-Evans rats using optical coherence tomography and electroretinography over 24 weeks. Data from 260 eyes were retrospectively analyzed in two cohorts: an ocular normotension (ONT) cohort (<20 mmHg) and an OHT cohort (>20 mmHg), in which OHT was induced either by sclerosing the episcleral veins (ES group) or by injecting microspheres into the anterior chamber. A trend toward emmetropia was found in both cohorts over time, though it was more pronounced in the OHT cohort (p < 0.001), especially in the ES group (p = 0.001) and males. IOP and refraction were negatively correlated at week 24 (p = 0.010). The OHT cohort showed early thickening in outer retinal sectors (p < 0.050) and the retinal nerve fiber layer, which later thinned. Electroretinography demonstrated early supranormal amplitudes and faster latencies that later declined. Chronic OHT accelerates emmetropia in Long–Evans rat eyes towards slowly progressive myopia, with an initial increase in structure and function that reversed over time. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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8 pages, 561 KiB

Open AccessArticle

Factors Associated with Increased Neuroretinal Rim Thickness Measured Based on Bruch’s Membrane Opening-Minimum Rim Width after Trabeculectomy

by Do-Young Park and Soon-Cheol Cha

J. Clin. Med. 2021, 10(16), 3646; https://doi.org/10.3390/jcm10163646 - 18 Aug 2021

Cited by 4 | Viewed by 2017

Abstract

Purpose: To investigate the factors associated with an increase in the neuroretinal rim (NRR) thickness measured based on Bruch’s membrane opening-minimum rim width (BMO-MRW) after trabeculectomy in patients with primary open-angle glaucoma (POAG). Methods: We analyzed the BMO-MRW using spectral-domain optical coherence tomography [...] Read more.

Purpose: To investigate the factors associated with an increase in the neuroretinal rim (NRR) thickness measured based on Bruch’s membrane opening-minimum rim width (BMO-MRW) after trabeculectomy in patients with primary open-angle glaucoma (POAG). Methods: We analyzed the BMO-MRW using spectral-domain optical coherence tomography (SD-OCT) of patients with POAG who underwent a trabeculectomy for uncontrolled intraocular pressure (IOP) despite maximal IOP reduction treatment. The BMO-MRW was measured before and after trabeculectomy in patients with POAG. Demographic and systemic factors, ocular factors, pre- and post-operative IOP, and visual field parameters were collected, together with SD-OCT measurements. A regression analysis was performed to investigate the factors that affected the change in the BMO-MRW after the trabeculectomy. Results: Forty-four eyes of 44 patients were included in the analysis. The IOP significantly decreased from a preoperative 27.0 mmHg to a postoperative 10.5 mmHg. The mean interval between the trabeculectomy and the date of post-operative SD-OCT measurement was 3.3 months. The global and sectoral BMO-MRW significantly increased after trabeculectomy, whereas the peripapillary retinal nerve fiber layer thickness did not show a difference between before and after the trabeculectomy. Younger age and a greater reduction in the IOP after the trabeculectomy were significantly associated with the increase in the BMO-MRW after trabeculectomy. Conclusions: The NRR thickness measured based on the BMO-MRW increased with decreasing IOP after trabeculectomy, and the increase in the BMO-MRW was associated with the young age of the patients and greater reduction in the IOP after trabeculectomy. Biomechanically, these suggest that the NRR comprises cells and substances that sensitively respond to changes in the IOP and age. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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7 pages, 1134 KiB

Open AccessFeature PaperArticle

Comparison of Efficacy between 120° and 180° Schlemm’s Canal Incision Microhook Ab Interno Trabeculotomy

by Naoki Okada, Kazuyuki Hirooka, Hiromitsu Onoe, Yumiko Murakami, Hideaki Okumichi and Yoshiaki Kiuchi

J. Clin. Med. 2021, 10(14), 3181; https://doi.org/10.3390/jcm10143181 - 19 Jul 2021

Cited by 18 | Viewed by 2128

Abstract

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes [...] Read more.

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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9 pages, 614 KiB

Open AccessArticle

Serum Calcium Level as a Useful Surrogate for Risk of Elevated Intraocular Pressure

by Yu-Min Chang, Jiann-Torng Chen, Ming-Cheng Tai, Wei-Liang Chen and Ying-Jen Chen

J. Clin. Med. 2021, 10(9), 1839; https://doi.org/10.3390/jcm10091839 - 23 Apr 2021

Cited by 2 | Viewed by 1994

Abstract

Background: Uncontrolled intraocular pressure (IOP) plays a principal role in the deterioration of glaucoma, and the intraocular pressure is also accepted as the most important modifiable factor. Calcium ion has been found to play a vital role in regulating the resistance of the [...] Read more.

Background: Uncontrolled intraocular pressure (IOP) plays a principal role in the deterioration of glaucoma, and the intraocular pressure is also accepted as the most important modifiable factor. Calcium ion has been found to play a vital role in regulating the resistance of the trabecular meshwork in humans. However, the relationship between serum total calcium and IOP has not been well-established. Methods: We investigated the association between serum total calcium and the IOP in a large population (14,037 eligible participants, consisting of 7712 men and 6325 women, were included) at the Tri-Service General Hospital from 2010 to 2016. Several models of covariate adjustments associated with IOP were designed. Univariate and multivariate regression analysis was performed for gender differences in the association between the serum total calcium level and IOP. Results: There was a significant relationship between serum total calcium levels and IOP in women and men with a β coefficient of 0.050 (95% confidence interval (CI), 0.030–0.069) and 0.025 (95%CI, 0.007–0.043). Notably, participants in the highest tertiles of serum total calcium levels had significantly higher IOP, in both the male and female participants. Conclusions: Our study shows that IOP is significantly associated with serum total calcium levels in a large Asian population. This study supports the notion that serum total calcium may play an important role in groups at high risk for elevated IOP. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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Review

Jump to: Editorial, Research

16 pages, 339 KiB

Open AccessReview

A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”

by Tomislav Sarenac, Anela Bečić Turkanović, Peter Ferme and Tomaž Gračner

J. Clin. Med. 2022, 11(13), 3879; https://doi.org/10.3390/jcm11133879 - 4 Jul 2022

Cited by 8 | Viewed by 4479

Abstract

Presently, there is no efficacious treatment for glaucomatous optic neuropathy; the current treatment is focused on lowering intraocular pressure (IOP). Studies have demonstrated the safety and efficacy of selective laser trabeculoplasty (SLT) in reducing the IOP in eyes with open-angle (OAG) glaucoma or [...] Read more.

Presently, there is no efficacious treatment for glaucomatous optic neuropathy; the current treatment is focused on lowering intraocular pressure (IOP). Studies have demonstrated the safety and efficacy of selective laser trabeculoplasty (SLT) in reducing the IOP in eyes with open-angle (OAG) glaucoma or ocular hypertension (OH). Moreover, the European Glaucoma Society has instated SLT as the first-line or adjunctive treatment in OAG or OH, reiterating its clinical significance. In this review, we outline the old and the new roles of SLT, with an emphasis on clinical practice, and look further into its renewed appeal and future developments. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

13 pages, 637 KiB

Open AccessReview

Corneal Hysteresis, Intraocular Pressure, and Progression of Glaucoma: Time for a “Hyst-Oric” Change in Clinical Practice?

by Patrick Murtagh and Colm O’Brien

J. Clin. Med. 2022, 11(10), 2895; https://doi.org/10.3390/jcm11102895 - 20 May 2022

Cited by 8 | Viewed by 3283

Abstract

It is known that as people age their tissues become less compliant and the ocular structures are no different. Corneal Hysteresis (CH) is a surrogate marker for ocular compliance. Low hysteresis values are associated with optic nerve damage and visual field loss, the [...] Read more.

It is known that as people age their tissues become less compliant and the ocular structures are no different. Corneal Hysteresis (CH) is a surrogate marker for ocular compliance. Low hysteresis values are associated with optic nerve damage and visual field loss, the structural and functional components of glaucomatous optic neuropathy. Presently, a range of parameters are measured to monitor and stratify glaucoma, including intraocular pressure (IOP), central corneal thickness (CCT), optical coherence tomography (OCT) scans of the retinal nerve fibre layer (RNFL) and the ganglion cell layer (GCL), and subjective measurement such as visual fields. The purpose of this review is to summarise the current evidence that CH values area risk factor for the development of glaucoma and are a marker for its progression. The authors will explain what precisely CH is, how it can be measured, and the influence that medication and surgery can have on its value. CH is likely to play an integral role in glaucoma care and could potentially be incorporated synergistically with IOP, CCT, and visual field testing to establish risk stratification modelling and progression algorithms in glaucoma management in the future. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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14 pages, 1256 KiB

Open AccessReview

The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review

by Dries Wijnants, Ingeborg Stalmans and Evelien Vandewalle

J. Clin. Med. 2022, 11(7), 2007; https://doi.org/10.3390/jcm11072007 - 3 Apr 2022

Cited by 6 | Viewed by 3219

Abstract

Topical glucocorticoids are a well-known risk factor of intraocular pressure (IOP) elevation in one third of the general population and in up to 90% of glaucomatous patients. Whether this steroid response is caused by intranasal, inhaled or systemic glucocorticoids, is less known. This [...] Read more.

Topical glucocorticoids are a well-known risk factor of intraocular pressure (IOP) elevation in one third of the general population and in up to 90% of glaucomatous patients. Whether this steroid response is caused by intranasal, inhaled or systemic glucocorticoids, is less known. This study presents an overview of the current literature on the topic, thereby providing guidance on when ophthalmological follow-up is indicated. A literature study was performed in Medline, and 31 studies were included for analysis. Twelve out of fourteen studies discussing intranasal glucocorticoids show no significant association with an elevated IOP. Regarding inhaled glucocorticoids, only three out of twelve studies show a significant association. The observed increase was either small or was only observed in patients treated with high inhaled doses or in patients with a family history of glaucoma. An elevated IOP caused by systemic glucocorticoids is reported by four out of the five included studies, with one study reporting a clear dose–response relationship. This review concludes that a steroid response can be triggered in patients treated with systemic glucocorticoids. Inhaled glucocorticoids may cause a significant IOP elevation when administered in high doses or in patients with a family history of glaucoma. At present, there is no evidence for a clinically significant steroid response caused by intranasally administered glucocorticoids. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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25 pages, 1449 KiB

Open AccessReview

Management of Childhood Glaucoma Following Cataract Surgery

by Anne-Sophie Simons, Ingele Casteels, John Grigg, Ingeborg Stalmans, Evelien Vandewalle and Sophie Lemmens

J. Clin. Med. 2022, 11(4), 1041; https://doi.org/10.3390/jcm11041041 - 17 Feb 2022

Cited by 13 | Viewed by 2750

Abstract

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for ‘glaucoma following cataract surgery’ (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to [...] Read more.

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for ‘glaucoma following cataract surgery’ (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies—presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months—were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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24 pages, 4350 KiB

Open AccessReview

How to Measure Intraocular Pressure: An Updated Review of Various Tonometers

by Paolo Brusini, Maria Letizia Salvetat and Marco Zeppieri

J. Clin. Med. 2021, 10(17), 3860; https://doi.org/10.3390/jcm10173860 - 27 Aug 2021

Cited by 44 | Viewed by 11563

Abstract

Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry [...] Read more.

Intraocular pressure (IOP) is an important measurement that needs to be taken during ophthalmic examinations, especially in ocular hypertension subjects, glaucoma patients and in patients with risk factors for developing glaucoma. The gold standard technique in measuring IOP is still Goldmann applanation tonometry (GAT); however, this procedure requires local anesthetics, can be difficult in patients with scarce compliance, surgical patients and children, and is influenced by several corneal parameters. Numerous tonometers have been proposed in the past to address the problems related to GAT. The authors review the various devices currently in use for the measurement of intraocular pressure (IOP), highlighting the main advantages and limits of the various tools. The continuous monitoring of IOP, which is still under evaluation, will be an important step for a more complete and reliable management of patients affected by glaucoma. Full article

(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)

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