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Nepalese Journal of Ophthalmology : a... Jan 2022This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy...
Causes and Managements of Early-Onset Ocular Hypertension Following Pars Plana Vitrectomy with Silicone Oil for Retinal Detachment and Exploration of Trabeculectomy as a Viable Alternative Management: A Pilot Study.
INTRODUCTION
This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy with silicone oil (PPV with SO) procedure for retinal detachment. Additionally, to explore the outcome of trabeculectomy in managing such patients.
MATERIALS AND METHODS
This is a retrospective exploratory pilot study. We studied 23 patients who underwent the procedure then subsequently developed ocular hypertension within a month of the procedure. The probable causes for their early-onset ocular hypertension were identified and addressed with medicine, peripheral iridotomy (PI), complete or partial silicone removal. Trabeculoplasty was done in irretractable causes. This study aimed to evaluate the causes of early onset ocular hypertension after pars plana vitrectomy with silicone oil and explore the outcome of different managements including trabeculectomy.
RESULTS
Inflammation (n=11, 47.8%) was the most common cause of early-onset ocular hypertension. Other causes were overfilling/spilling of silicone oil in anterior chamber (n=5, 21.7%), pupillary block (n=4, 17.4%) and angle-recession glaucoma (n=2, 8.69%). Majority of the cases responded to intraocular pressure (IOP) lowering medications (n=11). Three eyes with persistently high intraocular pressure underwent trabeculectomy after which the intraocular pressure was controlled.
CONCLUSION
Even though prior studies have reported that trabeculectomy does not address late-onset ocular hypertension, our study shows that the procedure might be helpful in early-onset ocular hypertension. This is probably because at the time of presentation for early-onset ocular hypertension, silicone has not emulsified, which will not be the case in late-onset ocular hypertension. If a large study also shows that trabeculectomy can correct early-onset ocular hypertension, this information can guide the practices of ophthalmologists whose patients cannot afford expensive glaucoma drainage devices.
Topics: Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Pilot Projects; Retinal Detachment; Retrospective Studies; Silicone Oils; Trabeculectomy; Vitrectomy
PubMed: 35996902
DOI: 10.3126/nepjoph.v14i1.35475 -
American Journal of Ophthalmology Jun 2019To provide evidence that corticosteroid-induced ocular hypertension has a genetic component. (Review)
Review
PURPOSE
To provide evidence that corticosteroid-induced ocular hypertension has a genetic component.
DESIGN
Evidence-based perspective.
METHODS
We conducted a comprehensive literature search for studies exploring genetic influences on intraocular pressure responses to corticosteroid treatment.
RESULTS
Studies demonstrating increased risk of corticosteroid-induced ocular hypertension among first-degree relatives of affected individuals support a genetic contribution to the disease. Family and personal history of primary open-angle glaucoma also increases the risk of corticosteroid-induced intraocular pressure elevation, suggesting common genetic etiologies. A number of studies have attempted to identify predisposing genetic factors; however, reproducible findings have not yet been reported. The recent availability of large data sets with clinical and genetic data for patients affected by corticosteroid-induced ocular hypertension and glaucoma provides new opportunities to study the genetic underpinnings of this important condition.
CONCLUSIONS
There is substantial evidence suggesting a genetic component to corticosteroid-related ocular hypertension and glaucoma, but specific genetic risk factors have yet to be identified. The current confluence of large genetic data sets and affordable genetic sequencing technologies has great potential for discovering the genes that increase risk for this blinding complication of corticosteroid therapy.
Topics: Eye Proteins; Genome-Wide Association Study; Glucocorticoids; Humans; Intraocular Pressure; Ocular Hypertension
PubMed: 30763540
DOI: 10.1016/j.ajo.2019.02.001 -
Ophthalmology. Glaucoma 2019To quantify patients' preferences for glaucoma outcomes and use this information to prioritize outcomes that are important to patients.
PURPOSE
To quantify patients' preferences for glaucoma outcomes and use this information to prioritize outcomes that are important to patients.
DESIGN
A cross-sectional study using best-worst scaling object case (BWS).
PARTICIPANTS
Two hundred seventy-four participants newly diagnosed with ocular hypertension or mild to moderate open angle glaucoma from three private practices and one academic medical center in the United States.
METHODS
We designed a preference-elicitation survey based on findings from 25 semi-structured, qualitative interviews with patients with glaucoma (reported elsewhere). The survey asked participants to rate the importance of 13 glaucoma outcomes on a Likert scale as a warm-up exercise followed by completion of 13 BWS tasks. For each task, we presented participants a subset of four outcomes from the possible thirteen, and participants chose the most important and least important outcome. Outcomes included in the survey pertain to maintaining ability to perform vision-dependent activities of daily living (e.g., driving), maintaining visual function and perception (e.g., depth perception), minimizing need to take glaucoma drops, not experiencing ocular surface symptoms (e.g., red eyes, teary eyes), and having adequate control of intraocular pressure (IOP). We administered the survey online and analyzed response patterns using conditional logistic regression to determine the relative importance of different outcomes.
MAIN OUTCOME
Ordinal ranking of glaucoma outcomes based on preference weights.
RESULTS
Between September 1, 2017 and February 28, 2018, we invited 1035 patients to complete our survey, among whom 274 (26%) responded. Most participants were older than 65 years of age (146/274, 53%) and currently on IOP-lowering drops (179/274, 65%). Participants identified that outcomes with the largest relative importance weight were having "adequate IOP control" and ability to "drive a car during the day," and the outcomes with the smallest relative importance weights were "maintaining appearance of the eye" and "reducing the number of IOP-lowering drops".
CONCLUSIONS
Determining the relative importance of glaucoma outcomes to patients can help researchers design studies that may better inform clinical and regulatory decision-making. Although IOP is an outcome that researchers often measure in glaucoma clinical trials, patients also prioritized outcomes related to the ability to perform vision-dependent activities such as driving.
Topics: Activities of Daily Living; Aged; Antihypertensive Agents; Cross-Sectional Studies; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension
PubMed: 32355909
DOI: 10.1016/j.ogla.2019.08.007 -
Ophthalmology. Glaucoma 2023To perform a phase Ⅰ/Ⅱ evaluation of an H-1337 ophthalmic solution in subjects with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To perform a phase Ⅰ/Ⅱ evaluation of an H-1337 ophthalmic solution in subjects with primary open-angle glaucoma (POAG) or ocular hypertension (OHT).
DESIGN
This was a phase I/II, randomized, double-masked, vehicle-controlled, dose-response study conducted at 6 private practice sites in the United States. The study was registered with clinicaltrials.gov as NCT03452033.
PARTICIPANTS
Eighty-seven subjects with bilateral POAG or OHT were enrolled.
METHODS
After washout of ocular hypotensive medications as required, the subjects were randomized to receive either the H-1337 ophthalmic solution at 0.06%, 0.2%, and 0.6% or its vehicle twice daily unilaterally in the study eye for the first 3 days and then twice daily in both eyes from day 4 to 28.
MAIN OUTCOME MEASURES
The primary efficacy end point was the mean change in intraocular pressure from baseline (day 0) for each group on day 28 at hour 4 compared with the vehicle.
RESULTS
In the primary efficacy end point, i.e., mean change from the baseline on day 28 at hour 4, the mean change from the baseline was - 4.45 ± 3.801, - 5.16 ± 3.114, - 4.93 ± 3.110, and - 0.39 ± 2.355 in the 0.06%, 0.2%, and 0.6% H-1337 and vehicle groups, respectively. The difference between each active group and the vehicle group was statistically significant (P < 0.0001). Treatment-emergent adverse events (TEAEs) occurred in 49% of subjects who received H-1337 (range, 41% [0.2% arm]-64% [0.6% arm] across the H-1337 arms) and 18% of subjects who received the vehicle. The majority of TEAEs were mild in severity; 3 subjects who received H-1337 had a TEAE of moderate intensity (instillation site erythema, blurred vision, and muscle strain).
CONCLUSIONS
The H-1337 ophthalmic solution showed clinically and statistically significant ocular hypotensive activity and was well tolerated, with a relatively low incidence of hyperemia.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found after the references.
Topics: Humans; Glaucoma, Open-Angle; Ophthalmic Solutions; Ocular Hypertension; Glaucoma; Intraocular Pressure
PubMed: 36055467
DOI: 10.1016/j.ogla.2022.08.015 -
Ophthalmology. Glaucoma 2020To evaluate the effectiveness and safety of primary and adjunctive micropulse cyclophotocoagulation (MPCPC) in the treatment of ocular hypertension (OHT) and glaucoma.
PURPOSE
To evaluate the effectiveness and safety of primary and adjunctive micropulse cyclophotocoagulation (MPCPC) in the treatment of ocular hypertension (OHT) and glaucoma.
DESIGN
Retrospective cohort study.
PARTICIPANTS
Ocular hypertension and all severities of glaucoma (including treatment-naïve and well-sighted eyes) and all types of glaucoma (including normal-tension glaucoma [NTG]).
METHODS
Consecutive eyes with glaucoma or OHT that underwent MPCPC (Iridex Cyclo G6 Glaucoma Laser System, Mountain View, CA) between 2016 and 2018 were identified.
MAIN OUTCOME MEASURES
Intraocular pressure (IOP), visual acuity, glaucoma medications, and ocular adverse events.
RESULTS
Three hundred ninety-nine MPCPC surgeries, on 342 eyes of 214 patients, were analyzed. Laser power ranged from 900 to 2800 mW. Main diagnoses in descending prevalence were primary open-angle glaucoma (55.9%), chronic angle-closure glaucoma (10.8%), neovascular glaucoma (9.0%), NTG (6.5%), and OHT (5.5%). Mean baseline IOP was 19.8±7.4 mmHg and IOP reduction was 22.7%, 20.2%, 20.7%, and 23.7% at postoperative months (POMs) 1, 3, 6, and 12 (P < 0.0001 for all time points). The end point of 20% or more mean IOP reduction from baseline was achieved by 67.8% of the study cohort at POM 12. Additional mean IOP reduction of 16.4% (P < 0.0001) was achieved with each re-treatment. Analysis based on IOP stratification demonstrated 30.5% mean IOP reduction at POM 12 when baseline IOP was more than 21 mmHg and 20.1% when it was 21 mmHg or less (71% of overall cohort; P < 0.0001). Analysis based on laser power stratification demonstrated mean IOP reduction of 31.5% at POM 12 with laser power of 2500 mW or more and 17.8% with laser power of less than 2500 mW (P < 0.02). Overall, the mean number of topical glaucoma medications was unchanged from baseline to POM 12. Greater baseline IOP and number of baseline topical glaucoma medications were significant predictors of effectiveness in the regression analysis. No patients demonstrated persistent inflammation or hypotony, phthisis bulbi, or sympathetic ophthalmia.
CONCLUSIONS
In patients with OHT or glaucoma, MPCPC demonstrated effectiveness and safety in IOP reduction sustained to 1 year. Baseline IOP of 21 mmHg or less subgroup demonstrated a more limited response. A dose-response relationship is suggested with respect to laser power and repeat treatments.
Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Ciliary Body; Female; Filtering Surgery; Follow-Up Studies; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Laser Coagulation; Male; Middle Aged; Ocular Hypertension; Retrospective Studies; Tonometry, Ocular; Treatment Outcome; Visual Acuity
PubMed: 32672613
DOI: 10.1016/j.ogla.2020.02.005 -
Journal of Ocular Pharmacology and... 2018Discovery ophthalmic research is centered around delineating the molecular and cellular basis of ocular diseases and finding and exploiting molecular and genetic... (Review)
Review
Discovery ophthalmic research is centered around delineating the molecular and cellular basis of ocular diseases and finding and exploiting molecular and genetic pathways associated with them. From such studies it is possible to determine suitable intervention points to address the disease process and hopefully to discover therapeutics to treat them. An investigational new drug (IND) filing for a new small-molecule drug, peptide, antibody, genetic treatment, or a device with global health authorities requires a number of preclinical studies to provide necessary safety and efficacy data. Specific regulatory elements needed for such IND-enabling studies are beyond the scope of this article. However, to enhance the overall data packages for such entities and permit high-quality foundation-building publications for medical affairs, additional research and development studies are always desirable. This review aims to provide examples of some target localization/verification, ocular drug discovery processes, and mechanistic and portfolio-enhancing exploratory investigations for candidate drugs and devices for the treatment of ocular hypertension and glaucomatous optic neuropathy (neurodegeneration of retinal ganglion cells and their axons). Examples of compound screening assays, use of various technologies and techniques, deployment of animal models, and data obtained from such studies are also presented.
Topics: Animals; Disease Models, Animal; Drug Discovery; Humans; Neuroprotective Agents; Ocular Hypertension; Optic Nerve Diseases; Pharmaceutical Research
PubMed: 29323613
DOI: 10.1089/jop.2017.0125 -
Asia-Pacific Journal of Ophthalmology... 2016Glaucoma suspect is a diagnosis reserved for individuals who do not definitively have glaucoma at the present time but have characteristics suggesting that they are at... (Review)
Review
Glaucoma suspect is a diagnosis reserved for individuals who do not definitively have glaucoma at the present time but have characteristics suggesting that they are at high risk of developing the disease in the future based on a variety of factors. This review provides a practical approach to individuals classified as glaucoma suspects caused by one or more of the following risk factors or indicators of disease: ocular hypertension, optic nerve features suggestive of glaucoma, visual field abnormalities, and other characteristics placing them at greater risk than the average population. In addition to diagnostic considerations, this overview provides information on therapeutic approaches to the glaucoma suspect.
Topics: Disease Management; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Optic Nerve; Risk Factors; Vision Disorders; Visual Fields
PubMed: 26886117
DOI: 10.1097/APO.0000000000000173 -
European Journal of Ophthalmology Sep 2020To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract. (Review)
Review
PURPOSE
To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract.
METHODS
Case report and literature review.
RESULTS
An 80-year-old woman presented with cloudiness and pain in the left eye for 1 day. The patient had visual acuity limited to perception of light with raised intraocular pressure of 70 mm Hg. Careful slit-lamp evaluation revealed corneal epithelial edema in superior quadrant and a deep and turbid anterior chamber. Ultrasound biomicroscopy confirmed the presence of a deep anterior chamber, a hypermature cataractous nucleus with lax capsular bag, and ruptured anterior lens capsule. The patient underwent extracapsular cataract extraction. Cytological examination of the lenticular fluid revealed the presence of lens protein-laden macrophages. Post-operatively, the patient had best-corrected visual acuity of 6/60 with advanced glaucomatous optic neuropathy.
CONCLUSION
Phacolytic glaucoma can present with a cloudy cornea and a turbid anterior chamber mimicking endophthalmitis. Careful examination and ancillary investigations including ultrasound biomicroscopy was helpful in making an accurate diagnosis.
Topics: Aged, 80 and over; Anterior Capsule of the Lens; Anterior Chamber; Antihypertensive Agents; Cataract; Cataract Extraction; Corneal Diseases; Female; Glaucoma; Humans; Intraocular Pressure; Lens Nucleus, Crystalline; Microscopy, Acoustic; Ocular Hypertension; Tonometry, Ocular; Visual Acuity
PubMed: 30950286
DOI: 10.1177/1120672119841972 -
Current Opinion in Ophthalmology Mar 2021For decades, laser trabeculoplasty has been a well-proven therapeutic option in glaucoma management, and more recently, it has only gained in popularity. One reason for... (Review)
Review
PURPOSE OF REVIEW
For decades, laser trabeculoplasty has been a well-proven therapeutic option in glaucoma management, and more recently, it has only gained in popularity. One reason for such popularity is that selective laser trabeculoplasty (SLT) is a therapy independent of patient adherence, which is typically low among glaucoma patients. Consequently, the number of studies on SLT has multiplied throughout the past years. This review provides an overview of studies on SLT from the last 12 months.
RECENT FINDINGS
The studies on treatment outcome show a wide range of success rates of SLT reaching between 18 and 88%; however, study designs differ and many studies are not directly comparable. The prospective laser trabeculoplasty for open-angle glaucoma and ocular hypertension (LiGHT) trial has demonstrated good efficacy of SLT - 75% of the eyes achieved their target pressure without drops and 58% after a single SLT.
SUMMARY
SLT has proven to be effective in lowering IOP with satisfactory success rates even after single SLT. SLT is repeatable independent of patient's adherence.
Topics: Glaucoma, Open-Angle; Humans; Intraocular Pressure; Laser Therapy; Lasers, Solid-State; Ocular Hypertension; Trabecular Meshwork; Trabeculectomy
PubMed: 33470670
DOI: 10.1097/ICU.0000000000000732 -
Ophthalmic Research 2020The rate of unknown glaucoma is around 50% in industrialized countries. The purpose of our study was to estimate the prevalence of unknown cases of ocular hypertension,...
INTRODUCTION
The rate of unknown glaucoma is around 50% in industrialized countries. The purpose of our study was to estimate the prevalence of unknown cases of ocular hypertension, glaucoma suspects, and glaucoma in patients consulting for refractive disorders in France.
METHODS
A retrospective study in the Point Vision ophthalmology center was led in Toulouse, France. All participants consulting for refractive disorders between June 2015 and June 2017 in the ophthalmology center were included. The cases were identified by the assessment of intraocular pressure, optic nerve head structure, and visual field. Ocular hypertension was defined as an intraocular pressure >21 mm Hg. Glaucoma was defined as the association of a glaucomatous papilla and two successive pathological visual fields. Glaucoma suspect was defined as the association of a glaucomatous papilla without visual field defect. The primary endpoint was the prevalence of unknown ocular hypertension, glaucoma suspects, and glaucoma in patients seen in an ophthalmology center.
RESULTS
A total of 66,068 patients (mean age = 37 years) consulted for a refraction visual assessment during the study period. Among them, 234 had a visual field and a retinal nerve fiber layer assessment for ocular hypertension and/or suspicious papilla. The prevalence of unknown cases of ocular hypertension, glaucoma suspect, and glaucoma was 2.6, 0.8, and 0.5 per 1,000 consultants, respectively. Median age at diagnosis of ocular hypertension, glaucoma suspect, and glaucoma was 52, 53, and 65 years, respectively.
CONCLUSION
The present study highlights the importance of glaucoma screening in people over 40 years old with the measurement of intraocular pressure and an optic nerve head assessment.
Topics: Female; France; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Prevalence; Retinal Ganglion Cells; Retrospective Studies; Tomography, Optical Coherence; Visual Fields
PubMed: 32097919
DOI: 10.1159/000504717