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Survey of Ophthalmology 2020Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding,... (Review)
Review
Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.
Topics: Disease Management; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Wounds and Injuries
PubMed: 32057763
DOI: 10.1016/j.survophthal.2020.02.003 -
Ophthalmology Jun 2022This systematic review and meta-analysis summarizes the existing evidence for the association of alcohol use with intraocular pressure (IOP) and open-angle glaucoma... (Meta-Analysis)
Meta-Analysis Review
TOPIC
This systematic review and meta-analysis summarizes the existing evidence for the association of alcohol use with intraocular pressure (IOP) and open-angle glaucoma (OAG).
CLINICAL RELEVANCE
Understanding and quantifying these associations may aid clinical guidelines or treatment strategies and shed light on disease pathogenesis. The role of alcohol, a modifiable factor, in determining IOP and OAG risk also may be of interest from an individual or public health perspective.
METHODS
The study protocol was preregistered in the Open Science Framework Registries (https://osf.io/z7yeg). Eligible articles (as of May 14, 2021) from 3 databases (PubMed, Embase, Scopus) were independently screened and quality assessed by 2 reviewers. All case-control, cross-sectional, and cohort studies reporting a quantitative effect estimate and 95% confidence interval (CI) for the association between alcohol use and either IOP or OAG were included. The evidence for the associations with both IOP and OAG was qualitatively summarized. Effect estimates for the association with OAG were pooled using random effects meta-analysis. Studies not meeting formal inclusion criteria for systematic review, but with pertinent results, were also appraised and discussed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS
Thirty-four studies were included in the systematic review. Evidence from 10 studies reporting an association with IOP suggests that habitual alcohol use is associated with higher IOP and prevalence of ocular hypertension (IOP > 21 mmHg), although absolute effect sizes were small. Eleven of 26 studies, comprising 173 058 participants, that tested for an association with OAG met inclusion criteria for meta-analysis. Pooled effect estimates indicated a positive association between any use of alcohol and OAG (1.18; 95% confidence interval [CI], 1.02-1.36; P = 0.03; I = 40.5%), with similar estimates for both prevalent and incident OAG. The overall GRADE certainty of evidence was very low.
CONCLUSIONS
Although this meta-analysis suggests a harmful association between alcohol use and OAG, our results should be interpreted cautiously given the weakness and heterogeneity of the underlying evidence base, the small absolute effect size, and the borderline statistical significance. Nonetheless, these findings may be clinically relevant, and future research should focus on improving the quality of evidence.
Topics: Cross-Sectional Studies; Ethanol; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Tonometry, Ocular
PubMed: 35101531
DOI: 10.1016/j.ophtha.2022.01.023 -
Ophthalmology. Glaucoma 2021
Topics: Ciliary Body; Glaucoma; Humans; Light Coagulation; Ocular Hypertension
PubMed: 33172769
DOI: 10.1016/j.ogla.2020.10.006 -
Journal Francais D'ophtalmologie Mar 2022To explore the national trend in prescriptions for glaucoma and ocular hypertension (OHT) in France between 2014 and 2019.
PURPOSE
To explore the national trend in prescriptions for glaucoma and ocular hypertension (OHT) in France between 2014 and 2019.
METHODS
This is a retrospective descriptive study based on prescription data from the Primary Health Insurance Fund databases. All patients with a social security number who received one or more glaucoma/OHT prescriptions between 2014 and 2019 were identified. Figures for 2020 are not yet available as of the date of submission of this article. Demographic characteristics from Common Classification of Medical Acts information and from National Institute of Statistics and Economic Studies were analyzed. The data analysis was carried out using the R version 3.6.2.software from the available databases of the Information Systems Medicalization Program.
RESULTS
Our results suggest an increase in the number of patients treated with glaucoma drugs, which cannot be explained simply by demographic growth. There is also a change in drug prescription habits, both in the class of medication used and in the use of fixed combinations. We also note the increasing use of SLT (Selective Laser Trabeculoplasty), a relatively newer tool in the therapeutic arsenal. Over the same time period, demographic characteristics remained stable; age and sex distribution for each year remained constant. In addition, the phenomenon of poor therapeutic compliance, which we attempted to explore, remained stable.
DISCUSSION
This study updates the French epidemiologic data available on prescriptions for glaucoma and ocular hypertension, a true public health concern.
CONCLUSION
On the one hand, prescribing practices have evolved over the study period. On the other hand, the number of patients treated has increased faster than the growth of the French population over the same period. These findings are consistent with trends observed in previous studies.
Topics: Antihypertensive Agents; Glaucoma; Humans; Intraocular Pressure; Laser Therapy; Ocular Hypertension; Prescriptions; Retrospective Studies; Trabeculectomy
PubMed: 35063295
DOI: 10.1016/j.jfo.2021.05.012 -
Journal of Glaucoma Feb 2020Electrophysiological testing of the visual system has been continuously used in studies involving the evaluation of retinal ganglion cells and the diagnosis of glaucoma.... (Review)
Review
OBJECTIVES
Electrophysiological testing of the visual system has been continuously used in studies involving the evaluation of retinal ganglion cells and the diagnosis of glaucoma. This study aims to review the results of recent studies regarding the clinical applicability of electrophysiological tests to glaucoma.
METHODS
A systematic review of the literature was carried out by 2 independent reviewers using the PubMed and EMBASE electronic databases, searching for articles published in English from January 1, 2014 to July 1, 2019 using a combination of the following keywords: ("glaucoma" OR "ocular hypertension") AND ("electrophysiolog" OR "electroretinogra" OR "ERG" OR "mfERG" OR "Pattern-reversal electroretinography" OR "PERG" OR "mfPERG" OR "photopic negative response" OR "pattern electroretinogram" OR "visual evoked potential" OR "multifocal electroretinography" OR "multifocal electroretinogram" OR "electro-oculography" OR "multifocal VEP" OR "mf-ERG"). A total of 38 studies were selected and the data of 30 of them were tabulated in this review.
RESULTS
Among the 30 studies selected, the photopic negative response and the reversal pattern electroretinogram were found to be the major methods used to record the electroretinographic responses generated by the retinal ganglion cell. Their multifocal versions and the multifocal visual evoked potential were also proposed during this period. In general, the results underscored a consistent but general correlation between the amplitude and latency measures and routine tests for glaucoma, such as perimetry and optical coherence tomography.
DISCUSSION
In agreement with previous reviews, clinical electrophysiological testing of the visual system reasonably matched with both the structural and functional analyses for glaucoma. No definitive indications of these tests have been established either at early detection or during follow-up of the disease, and easier protocols and better topographical correspondence with current glaucoma tests are warranted for their routine use.
Topics: Electrooculography; Electrophysiology; Electroretinography; Evoked Potentials, Visual; Glaucoma, Open-Angle; Humans; Ocular Hypertension; Retinal Ganglion Cells; Tomography, Optical Coherence; Visual Field Tests; Visual Fields
PubMed: 31809397
DOI: 10.1097/IJG.0000000000001422 -
Drugs & Aging Jun 2020Bimatoprost implant (Durysta™), developed by Allergan, is a sustained-release drug delivery system containing bimatoprost, a prostaglandin analogue with ocular... (Review)
Review
Bimatoprost implant (Durysta™), developed by Allergan, is a sustained-release drug delivery system containing bimatoprost, a prostaglandin analogue with ocular hypotensive activity. The implant, administered intracamerally, involves the use of a biodegradable, solid polymer drug delivery system for slow, sustained drug release, designed to lower intraocular pressure (IOP) over a 4- to 6-months period. In March 2020, bimatoprost implant received its first approval, in the USA, for use to reduce IOP in patients with open angle glaucoma (OAG) or ocular hypertension (OHT). Allergan's clinical development programme for bimatoprost implant is ongoing. This article summarizes the milestones in the development of bimatoprost implant leading to this first approval for use in the reduction of IOP in patients with OAG or OHT.
Topics: Bimatoprost; Drug Approval; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Prostheses and Implants
PubMed: 32447639
DOI: 10.1007/s40266-020-00769-8 -
International Ophthalmology May 2022Ocular hypertension (OHT) is a clinical entity characterized by elevated intraocular pressure (IOP) without optic nerve damage. In the presence of other risk factors,...
PURPOSE
Ocular hypertension (OHT) is a clinical entity characterized by elevated intraocular pressure (IOP) without optic nerve damage. In the presence of other risk factors, OHT may progress to glaucoma. This study aimed to evaluate ocular blood flow (OBF) and choroidal thickness (CT), which may be markers and/or risk factors that could assess the progression of OHT to glaucoma.
MATERIAL AND METHODS
Age and gender matched 60 eyes of 32 patients with OHT and 61 eyes of 31 control patients were included for this study. All participants underwent a detailed ophthalmological examination including best-corrected visual acuity, IOP measurement with Goldmann applanation tonometry, gonioscopy, optic nerve evaluation with 78 D lens, and visual field test with Humphrey visual field analyzer. Retinal nerve fiber layer, ganglion cell complex, and central corneal thickness measurements were performed by optical coherence tomography (OCT). CT was measured with OCT in the fovea, 1.5 mm, 2 mm, 2.5 mm nasal and temporal to the fovea and from nasal and temporal to the optic disk. OBF data including peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI) were measured with color Doppler imaging (CDI) from the ophthalmic artery (OA), central retinal artery (CRA), medial and lateral branches of short posterior ciliary arteries (MPCA, LPCA). Systolic (SBP) and diastolic arterial blood pressure were also noted.
RESULTS
CT measurement at each point in the OHT group compared to the control group were found to be significantly thinner (p = 0.001). There was a decrement in CT from the fovea to the nasal and temporal retina in both groups. In the OHT group, there was a significant decrease in PSV and EDV of OA, CRA, MPCA, and LPCA, and a significant increase in PI and RI of measured arteries. (EDV p = 0.036, PI p = 0.006, RI p = 0.006 for OA and p = 0.001 for other arteries and all OBF measurements). There was a negative correlation between CT and age, IOP and axial length (AL) in OHT group (r = - 0.529, p = 0.001; r = - 0.258, p = 0.047; r = - 0.345, p = 0.007, respectively, for fovea). But there was no statistically significant correlation between CT and other measurements in the control group, except age (r = - 0.860 p = 0.001 for fovea).
CONCLUSION
We found that OBF decrement and choroidal thinning in OHT group compared with controls. Interpretation both of CT measurements with OCT and OBF parameters with CDI and new imaging technologies may help to prevent and reduce the possible optic nerve damage.
Topics: Blood Flow Velocity; Ciliary Arteries; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Ophthalmic Artery; Retinal Artery; Ultrasonography, Doppler, Color
PubMed: 34822054
DOI: 10.1007/s10792-021-02123-2 -
Survey of Ophthalmology 2020Glaucoma secondary to ocular inflammation is potentially blinding and requires aggressive multifaceted management. The pathogenesis is related to the intraocular... (Review)
Review
Glaucoma secondary to ocular inflammation is potentially blinding and requires aggressive multifaceted management. The pathogenesis is related to the intraocular pressure elevation secondary to compromised aqueous humor outflow by inflammatory cells, chemical mediators released into the aqueous, and to the uveitic therapy itself (corticosteroid induced). The management of uveitic glaucoma needs a careful combination between anti-inflammatory therapy and appropriate intraocular pressure-lowering drugs to prevent worsening of condition and long-term visual loss. Although there have been novel medications that have emerged in the management of glaucoma and uveitis, around 30% of uveitic glaucoma eyes do not respond to maximal medical therapy and require surgical intervention. Studied procedures include laser therapy, filtration surgery, and glaucoma drainage devices, as well as recent surgical techniques for intraocular pressure control such as minimally invasive glaucoma surgery and angle-based procedures. We review and update the medical and surgical management of uveitic glaucoma.
Topics: Disease Management; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Uveitis
PubMed: 31816329
DOI: 10.1016/j.survophthal.2019.12.003 -
Vestnik Oftalmologii 2022Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) for the treatment of age-related macular degeneration with choroidal... (Review)
Review
Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) for the treatment of age-related macular degeneration with choroidal neovascularization have become much more popular nowadays. Anti-VEGF therapy is generally well-tolerated; however, one of its possible side effects is ocular hypertension - elevation of intraocular pressure (IOP) above the accepted norm, but without structural and functional changes in the retina and optic nerve common for glaucoma. The average duration of IOP elevation is 30 to 60 minutes, but it can increase when the patient has primary open-angle glaucoma (POAG). There is currently no uniform understanding of the pathogenesis of elevated IOP after IVI, as well as the effect of IOP fluctuations on the functional prognosis and the condition of the ocular tunics. This review considers the main causes and mechanisms of IOP elevation after IVI, analyzes recent publications on the consequences of ocular hypertension for the neurosensory part of the retina and the optic nerve, and examines the conditions for transition of IOP fluctuations into clinically significant ocular hypertension or POAG.
Topics: Humans; Intravitreal Injections; Endothelial Growth Factors; Glaucoma, Open-Angle; Bevacizumab; Vascular Endothelial Growth Factor A; Ocular Hypertension; Glaucoma; Intraocular Pressure; Angiogenesis Inhibitors; Ranibizumab
PubMed: 36287161
DOI: 10.17116/oftalma2022138052234 -
Survey of Ophthalmology 2023Glaucoma is a chronic, progressive disease leading to irreversible blindness if left untreated; however, since reducing intraocular pressure has proven to be successful... (Review)
Review
Glaucoma is a chronic, progressive disease leading to irreversible blindness if left untreated; however, since reducing intraocular pressure has proven to be successful in slowing disease progression, little is known about the natural history of untreated glaucoma. This knowledge can be valuable in guiding management decisions in the era of personalized medicine. A systematic search was performed in Medline (PubMed), Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRIMSA) guidelines. The rate of structural and/or functional progression and conversion to glaucoma or to a more advanced stage of glaucoma are discussed for ocular hypertension and different types of open-angle glaucoma. Forty-three studies were included. Different rates of progression were found both among and within the different diagnostic groups that belong to the open-angle glaucoma spectrum. The highest rate was found in pseudoexfoliation glaucoma, followed by high tension glaucoma, normal tension glaucoma, and ocular hypertension, in decreasing order. The lowest rate was observed in glaucoma suspects. The known rates of progression provide valuable prognostic information for ophthalmologists and patients. Nonetheless, due to high variability among patients, individual progression cannot be accurately predicted and repeated follow-up examinations are required to estimate individual progression.
Topics: Humans; Glaucoma, Open-Angle; Glaucoma; Ocular Hypertension; Intraocular Pressure; Eye
PubMed: 36563707
DOI: 10.1016/j.survophthal.2022.12.001