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Indian Journal of Ophthalmology Feb 2022To determine the proportion of erroneously assumed ocular hypertension (OHT) among referred patients of elevated intraocular pressure (IOP) seen in glaucoma clinic of a...
PURPOSE
To determine the proportion of erroneously assumed ocular hypertension (OHT) among referred patients of elevated intraocular pressure (IOP) seen in glaucoma clinic of a teaching hospital in Northern India.
METHODS
Retrospective review of case records of referred, diagnosed patients of OHT or unspecified glaucoma seen between January 2019 and March 2020. Using an algorithmic clinical approach, including gonioscopy, Goldmann applanation tonometry (GAT), and pachymetry, underlying cause for elevated-IOP was amended and proportion of erroneously assumed OHT was calculated.
RESULTS
Of 276 patients diagnosed either as OHT or unspecified glaucoma before being seen at our glaucoma clinic, 44 (16%) had IOP within normal range (10-21 mmHg) on GAT. In 97 (35%) cases elevated-IOP was associated with angle closure. The central corneal thickness (CCT) was >550 μm in 39 (14%) patients with elevated-IOP. The proportion of erroneously assumed OHT was 70% in this study.
CONCLUSION
The elevated-IOP does not imply with OHT unless evident through comprehensive clinical examination and appropriate investigations.
Topics: Cornea; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Tonometry, Ocular
PubMed: 35086238
DOI: 10.4103/ijo.IJO_938_21 -
[Zhonghua Yan Ke Za Zhi] Chinese... Jun 2012Ocular hypertensions (OHTs) in juvenile are characterized by occurrence in teenage with intraocular pressure (IOP) frequently fluctuated and increased over 30 mm Hg (1...
Ocular hypertensions (OHTs) in juvenile are characterized by occurrence in teenage with intraocular pressure (IOP) frequently fluctuated and increased over 30 mm Hg (1 mm Hg = 0.133 kPa) without any ocular symptoms and disturbance of visual acuity. IOPs are normalized in the majorities of juvenile over adolescence stage with long-term follow up. The medical terminology of 'adolescence IOP fluctuation' or 'adolescence ocular hypertension' is therefore used. The diagnosis and management of juvenile OHT remain difficult clinical challenges. OHTs in juvenile sometimes are incorrectly diagnosed due to inappropriate IOP measurement and thicker central cornea as younger children are non-compliant and resisting the examination. In this paper, we reviewed OHT in juvenile in the light of significant studies in the past and based on our experience of clinical practice in order to provide a better understanding and management of OHTs in juvenile.
Topics: Adolescent; Child; Humans; Ocular Hypertension
PubMed: 22943799
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jul 2005Open angle glaucoma is one of the most common causes of blindness in industrialised nations. Treatments to lower ocular pressure are widely used in glaucoma prevention... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Open angle glaucoma is one of the most common causes of blindness in industrialised nations. Treatments to lower ocular pressure are widely used in glaucoma prevention and treatment, despite conflicting evidence.
DESIGN
We performed meta-analyses to reassess the effectiveness of pressure lowering treatment to delay the development of glaucoma in ocular hypertension, as well as progression of manifest open angle glaucoma.
DATA SOURCES
Medline, Embase, and the Cochrane Library.
SELECTION OF STUDIES
Eligible studies were randomised controlled trials with a concurrent untreated control group and information on time to glaucomatous changes to visual field and optic disc. Trial reports were reviewed independently by two investigators in an unblinded standardised manner.
RESULTS
Meta-analysis of trials in ocular hypertension showed a significant preventive effect of reducing intraocular pressure on progression to glaucoma (hazard ratio 0.56, 95% confidence interval 0.39 to 0.81, P = 0.01; number needed to treat 12). Pooled data of studies in manifest glaucoma showed a significant delay of visual field deterioration (0.65, 0.49 to 0.87, P = 0.003; NNT = 7), with subgroup analysis showing a larger effect in patients with raised pressure and a reduced effect in normal tension glaucoma (subgroup comparison: not significant).
CONCLUSIONS
Lowering intraocular pressure in patients with ocular hypertension or manifest glaucoma is beneficial in reducing the risk of visual field loss in the long term.
Topics: Glaucoma, Open-Angle; Humans; Ocular Hypertension; Proportional Hazards Models; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 15994659
DOI: 10.1136/bmj.38506.594977.E0 -
American Journal of Ophthalmology Sep 2004To critically review the existing literature concerning risk factors for progression of ocular hypertension and glaucoma to assist in assigning levels of risk for... (Review)
Review
PURPOSE
To critically review the existing literature concerning risk factors for progression of ocular hypertension and glaucoma to assist in assigning levels of risk for individual patients.
DESIGN
Evidence-based review.
METHODS
A panel of physicians specializing in treatment of glaucoma patients was convened to critically analyze published population-based studies of ocular hypertension and glaucoma progression. The strength of evidence in support of reported risk factors was weighed.
RESULTS
Many putative risk factors for progression of ocular hypertension or glaucoma have been reported in the literature. The risk factors most strongly supported by evidence are higher intraocular pressure (IOP), greater cup-to-disk ratio, thinner central corneal measurement, and older age. Black race does not appear to be an independent risk factor, although black individuals tend to have thinner corneas, greater cup-to-disk ratios, and higher IOP, which increase their risk. The limited number of studies in which other suspected risk factors are reported prevents drawing firm conclusions about their importance at this time.
CONCLUSIONS
Only a subset of patients with ocular hypertension will eventually develop glaucoma. Decisions regarding the implementation and extent of therapy for ocular hypertension can be difficult and require an understanding of the relative importance of risk factors for progression. This review discusses the strength of evidence supporting reported risk factors and may be useful in assessing the risk for progression of individual patients.
Topics: Disease Progression; Evidence-Based Medicine; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Risk Assessment; Risk Factors
PubMed: 15364049
DOI: 10.1016/j.ajo.2004.04.058 -
Current Eye Research Oct 2022To examine the safety and efficacy of selective laser trabeculoplasty (SLT) in patients responding to topical steroids with elevated intraocular pressure following...
To examine the safety and efficacy of selective laser trabeculoplasty (SLT) in patients responding to topical steroids with elevated intraocular pressure following endothelial keratoplasty. Patients that underwent Descemet Membrane Endothelial Keratoplasty (DMEK) or Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) were offered SLT as first-line therapy if they presented with steroid response and met inclusion criteria. Patient demographics, best-corrected visual acuity (BCVA), steroid and glaucoma regimens were recorded before and after SLT. Twelve eyes of eight patients were recruited to the study. All patients demonstrated a reduction in IOP and only one patient remained on anti-glaucoma drops after SLT. The mean (±SD) reduction in IOP following SLT was 8.8 (±4.9) mmHg ( < 0.0001). BCVA remained stable and no adverse events following treatment were observed. SLT may be a safe and effective treatment option that reduces topical antihypertensive burden while allowing continuance of corticosteroids in steroid-responsive eyes at high risk of rejection following endothelial keratoplasty. Larger randomized studies are needed to compare SLT efficacy with topical medication in this patient group and to review any impact on graft survival and glaucoma progression.
Topics: Antihypertensive Agents; Corneal Transplantation; Descemet Stripping Endothelial Keratoplasty; Glaucoma; Humans; Intraocular Pressure; Laser Therapy; Lasers; Ocular Hypertension; Retrospective Studies; Steroids; Trabeculectomy; Treatment Outcome; Visual Acuity
PubMed: 35686724
DOI: 10.1080/02713683.2022.2088800 -
Der Ophthalmologe : Zeitschrift Der... Nov 2011
Topics: Humans; Intraocular Pressure; Ocular Hypertension; Terminology as Topic
PubMed: 22090087
DOI: 10.1007/s00347-011-2379-9 -
Graefe's Archive For Clinical and... May 2016To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with chronic ocular graft-versus-host disease (GVHD).
PURPOSE
To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with chronic ocular graft-versus-host disease (GVHD).
METHODS
We performed a retrospective chart review of 218 patients diagnosed with chronic ocular GVHD. Ocular hypertension was defined as intraocular pressure (IOP) ≥ 24 mmHg in either eye without any glaucomatous optic disc changes. Glaucoma suspect was defined as optic disc changes with a cup-to-disc ratio ≥ 0.7 in either eye or asymmetry of ≥ 0.3 between the two eyes. Glaucoma was defined by glaucomatous optic disc changes plus glaucomatous visual field defects in two consecutive reliable visual field tests. The number of cases of ocular hypertension, glaucoma, and glaucoma suspects was evaluated.
RESULTS
Thirty-three patients (15 %) were diagnosed with OHT, eight patients (3.6 %) with suspicion of glaucoma, and one patient (0.4 %) with glaucoma. OHT occurred within 6 months of developing ocular GVHD in 60 % of the cases and within the first year in 76 %. High IOP normalized in 67 % of patients when the dosage of topical or systemic corticosteroids was lowered, and 27 % of patients required anti-glaucoma therapy.
CONCLUSIONS
Ocular hypertension is a common complication in patients with ocular GVHD, with a prevalence of 15 %. The rise in intraocular pressure is often transient and resolves with management of corticosteroids in most cases. However, clinicians should be aware that nearly one-third of the patients with OHT might require anti-glaucoma treatment. The prevalences of glaucoma and suspicion of glaucoma were not higher than in the general population.
Topics: Adult; Aged; Antihypertensive Agents; Chronic Disease; Female; Glaucoma; Graft vs Host Disease; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Prevalence; Retrospective Studies; Tonometry, Ocular; Young Adult
PubMed: 26968719
DOI: 10.1007/s00417-016-3312-3 -
Methods in Molecular Biology (Clifton,... 2018Two methods to induce elevation of the intraocular pressure (experimental glaucoma) are described in the present chapter. The first method is based on increasing the...
Two methods to induce elevation of the intraocular pressure (experimental glaucoma) are described in the present chapter. The first method is based on increasing the post-trabecular resistance to aqueous outflow by cauterizing the episcleral veins (EVC). This method allows the observation of ultrastructural changes in the trabecular meshwork (TM) without interfering with any structure within the eye such as TM, ciliary body, and/or the Retina. The second method is the multiple injection of microbeads into the anterior chamber, as a pre and intra-trabecular method that induce secondary effects on the TM cells. Both methods lead to an increase in IOP.
Topics: Animals; Cautery; Disease Models, Animal; Glaucoma; Microspheres; Ocular Hypertension; Retinal Vein; Sclera; Swine; Swine, Miniature; Trabecular Meshwork
PubMed: 29190016
DOI: 10.1007/978-1-4939-7407-8_4 -
International Journal of Molecular... Jun 2022To explore the role of atorvastatin in regulating intraocular pressure (IOP) in glaucoma , and to investigate its related molecular pathway , an ocular hypertension...
To explore the role of atorvastatin in regulating intraocular pressure (IOP) in glaucoma , and to investigate its related molecular pathway , an ocular hypertension model was generated by intravitreal injection of an adenoviral vector encoding transforming growth factor (TGF)‑β2 in the right eye of BALB/cJ mice, while the left was treated with an empty control adenovirus. To determine its anti‑intraocular hypertension role, these induced hyper‑IOP mice were gavaged with atorvastatin (20 mg/kg/day). Furthermore, extracellular matrix (ECM) factors were examined in the primary human trabecular meshwork (HTM) cells followed atorvastatin (0~200 µM) treatment . Whole genome microarray was employed to identify potential therapeutic target molecules associated with ECM regulation. Unilateral murine ocular hypertension was induced, via intravitreal injection of the adenoviral vector carrying the human TGF‑β2 gene (Ad.hTGF‑β2), raising IOP from 12±1.6 to 32.3±0.7 mmHg (n=6, P<0.05) at day 15, which plateaued from day 15 to 30. Atorvastatin administration from day 15 to 30 decreased IOP from 32.3±0.7 to 15.4±1.1 mmHg (n=6, P<0.05) at day 30. Additionally, atorvastatin administration changed the morphology of cultured HTM cells from an elongated and adherent morphology into rounded, less elongated and less adherent cells, accompanied with suppressed expression of ECM. Gene Ontology and Genome analysis revealed that FGD4 (FYVE, RhoGEF and PH domain containing 4) might be a key factor contributing to these changes. Our data demonstrated that atorvastatin reduced TGF‑β2‑induced ocular hypertension , perhaps via modifying cellular structure and decreasing ECM, using the FGD4 signaling pathway, as demonstrated in HTM cells. Our findings provide some useful information for the management of glaucoma, with statin therapy revealing a potential novel therapeutic pathway for glaucoma treatment.
Topics: Animals; Atorvastatin; Cells, Cultured; Extracellular Matrix; Glaucoma; Intraocular Pressure; Mice; Microfilament Proteins; Ocular Hypertension; Trabecular Meshwork; Transforming Growth Factor beta2
PubMed: 35417030
DOI: 10.3892/ijmm.2022.5132 -
Current Opinion in Ophthalmology Mar 2008To describe the epidemiology of disc hemorrhages and underscore the importance of detecting these markers of potential glaucomatous damage and progression. (Review)
Review
PURPOSE OF REVIEW
To describe the epidemiology of disc hemorrhages and underscore the importance of detecting these markers of potential glaucomatous damage and progression.
RECENT FINDINGS
The Ocular Hypertension Treatment Study has confirmed that disc hemorrhages are an independent risk factor in the development of glaucoma. The risk of developing glaucoma was six times more likely in ocular hypertensive patients with disc hemorrhages compared with ocular hypertensive patients without disc hemorrhages. This study also highlighted the difficulty in detecting disc hemorrhages on clinical examination, noting that only 16% of disc hemorrhages detected on stereophotographs were identified on funduscopic examination. One study has demonstrated that surgical lowering of intraocular pressure decreased the occurrence of disc hemorrhages.
SUMMARY
Although the mechanism for the development of disc hemorrhages remains vague, the recent literature describes the difficulty in detecting disc hemorrhages, the importance of identifying this negative prognostic indicator and the effectiveness of intraocular pressure lowering with trabeculectomy in decreasing the risk of future disc hemorrhages.
Topics: Disease Progression; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Optic Disk; Optic Nerve Diseases; Retinal Hemorrhage; Risk Factors
PubMed: 18301280
DOI: 10.1097/ICU.0b013e3282f3e6bc