J. Fontanarosa

Intraocular pressure alterations following intravitreal triamcinolone acetonide.

Aims: To determine the prevalence of intraocular pressure (IOP) alterations following intravitreal injection of triamcinolone acetonide (IVTA) and to assess possible risk factors of IOP elevation in eyes receiving single and/or repeat injections. Methods: Retrospective, consecutive case series. 570 consecutive eyes of 536 patients who received a single IVTA injection (4 mg/0.1 ml) and a second set of 43 eyes of 40 patients who received a second injection. Retrospective review of all IVTA cases performed by three vitreoretinal surgeons over a 42 month period beginning in 2000. The main outcome measure was change in IOP defined as absolute value of IOP elevation (5 mmu200aHg or higher, 10 mmu200aHg or higher), and percentage of baseline (30% or higher increase from baseline IOP). Results: Of the 528 eyes receiving single injections, 281 (53.2%) had an IOP elevation; 267 eyes (50.6%) experienced an elevation of IOP of at least 30%, and 245 (45.8%) and 75 (14.2%) eyes had an increase of 5 mmu200aHg or 10 mmu200aHg or more, respectively. Baseline IOP greater than 16 mmu200aHg is a risk factor for post-injection IOP elevation. Of the 43 eyes which received a second injection, 28 (65.1%) experienced an increase in IOP of at least 30% of baseline. Filtering surgery was required in five (0.094%) of the single and one (2.3%) of repeat injection eyes. Conclusions: Elevated IOP after IVTA is common and patients should be monitored beyond 6 months post-injection. Patients with a baseline IOP more than 16 mmu200aHg or receiving a second injection should be carefully monitored for an elevated IOP.

Level of disagreement between Proview phosphene tonometer and Goldmann applanation tonometer intraocular pressure readings.

Purpose:To evaluate the agreement of intraocular pressure (IOP) readings obtained with the Proview™ phosphene tonometer and those obtained by Goldmann applanation tonometry as well as the effect of regular use of the Proview™ on patients anxiety about their glaucoma. Methods:One hundred thirty-five consecutive patients with glaucoma, 35 designated as controls, were enrolled in a 10-month randomized prospective clinical trial. The study patients but not the controls used the Proview™ outside the office. At office visits IOP was measured by an ophthalmologist with the Goldmann applanation tonometer (GAT) as well as by examiners and patients using the Proview™. Patients in the treatment group (n = 100) were asked to measure and record their IOP at home as well. Using ANOVA, we examined the relationship between demographic variables and the level of agreement between the Proview™ readings and those measured by GAT at the final office visit. All participants also were asked to complete a questionnaire regarding their anxiety about their IOP at the baseline and final office visits. The primary outcome measure was the level of agreement of the Proview™ measurements with those obtained by GAT. Secondary outcome measures included patients anxiety about their glaucoma. Results:The absolute mean difference between GAT and Proview™ readings at the final visit was 3.5 ± 2.9 mm Hg (median, 2.8 mm Hg). The treatment group reported significantly less anxiety about their glaucoma after 4 to 6 weeks of using the Proview™ (P = .024). Conclusions:There was considerable discrepancy between Proview™ and GAT readings. However, regular use of the Proview™ tonometer significantly reduced patients anxiety about their glaucoma.

Timolol/dorzolamide combination therapy as initial treatment for intraocular pressure over 30 mm Hg.

Purpose:To determine the intraocular pressure (IOP)-lowering effect of a fixed timolol/dorzolamide combination (Cosopt®) for patients with IOP over 30 mm Hg. Study Design:Prospective interventional case series. Methods:Eighteen patients being seen on the Wills Eye Hospital Glaucoma Service with at least one eye with an IOP >30 mm Hg were recruited. None had used any glaucoma medications for at least 1 month. IOP was confirmed by diurnal testing. Cosopt was administered at 9 am and 9 pm. Trough IOP measurements were made at 9 am and peak IOP measurements at 11 am at baseline, 1 month, and 2 months. Pretreatment and posttreatment IOPs were compared using a paired-samples independent t test. Results:Mean pretreatment IOP was 37.5 ± 1.0 mm Hg. Baseline posttreatment IOP was 18.4 ± 0.5 mm Hg (P < 0.01). At 2 months, the mean trough IOP was 21.1 ± 0.9 mm Hg and the peak, 17.6 ± 0.6 mm Hg (each, P < 0.01, as compared with pretreatment baseline IOP). One patient did not respond to Cosopt; two had a clinically insufficient response and did not complete the study. Data from these patients were included in the analysis. Conclusions:Over 80% of the eyes responded to Cosopt, with an average trough IOP reduction of 40% at 2 months.

Intermediate-term results of Baerveldt tube shunt surgery with mitomycin C use.

BACKGROUND AND OBJECTIVEnTo study the intermediate-term results of the Baerveldt glaucoma drainage device with adjunctive use of intraoperative mitomycin C.nnnPATIENTS AND METHODSnCharts of 243 consecutive patients with advanced glaucoma who had undergone tube shunt surgery between 1992 and 1999 were retrospectively analyzed. A total of 64 patients were eligible for the study. Patients were observed for a mean of 34.3 +/- 21 months. Kaplan-Meier survival analysis was used to determine intermediate-term success.nnnRESULTSnThe mean preoperative intraocular pressure (IOP) was 34.4 mm Hg and the 1-year postoperative IOP was 16.6 mm Hg. The mean percent IOP reduction after surgery was 51.7%, 53.2%, and 51.4% at 1, 2, and 5 years, respectively. Kaplan-Meier analysis showed a 77% success rate at 1 year, 66% at 2 years, and 59% at 5 years. The most common complication was choroidal detachment (18.8%).nnnCONCLUSIONnThe use of mitomycin C with Baerveldt implantation showed IOP control equivalent to that without mitomycin C at intermediate follow-up.

Clinical predictors of latanoprost treatment effect.

Purpose:To determine the relationship between latanoprost efficacy and clinical features of glaucoma. Patients and Methods:Study design was retrospective, observational case series. The charts of all patients who underwent a one-eyed therapeutic trial of latanoprost during the course of their clinical care between 1997 and 2001 were reviewed. Intraocular pressures of both eyes prior to and one month after initiation of latanoprost were recorded. Latanoprost treatment effect was calculated by subtracting the change in intraocular pressure (IOP) in the fellow eye from the change in the treated eye. The effect of optic disc stage, age, race, sex, diagnosis, involved eye, type and number of other glaucoma medications, pattern of cupping (concentric, focal, or indeterminate), and pre-treatment IOP was correlated with the treatment effect. The stage of glaucoma was determined by determining the disc damage likelihood scale (DDLS) stage. Results:One hundred eighty-six cases were included. Latanoprost treatment effect was 4.5 ± 5.7 mm Hg, was moderately correlated with pre-treatment IOP (Pearsons r = 0.527, P < 0.01), and was weakly inversely correlated with advancing disc stage (Pearsons r = −0.194, P < 0.01) and age (Pearsons r = −0.175, P < 0.05). It was independent of the other variables studied (P > 0.05). Conclusion:Most clinical parameters examined in this study were not correlated with latanoprost treatment response. A moderate direct correlation was noted with pre-treatment IOP and a weak inverse correlation was noted with optic disc stage and age.

Intracameral 2.3% Sodium Hyaluronate to Treat Postoperative Hypotony in Patients With Glaucoma

BACKGROUND AND OBJECTIVEnTo evaluate the intracameral use of Healon5 (2.3% sodium hyaluronate) (Advanced Medical Optics, Santa Ana, CA) in patients with hypotony.nnnPATIENTS AND METHODSnFifteen consecutive patients with glaucoma who had hypotony for at least 7 days were prospectively recruited. Indications for the intracameral injection of Healon5 were an intraocular pressure (IOP) of less than 6 mm Hg with negative results on Seidel test.nnnRESULTSnThe mean IOP readings at baseline, 1 to 2 weeks post-injection, and 4 to 6 weeks post-injection were 3.8 +/- 1.58, 6.58 +/- 2.62, and 6.50 +/- 2.24 mm Hg, respectively. The increase in IOP at both follow-up points was significant (P < .01). The visual acuity improvement was small but significant at the 4 to 6 week point (P = .05). In the early-onset cases, IOP increased significantly from baseline at both follow-up points (P< .05), but visual acuity did not. No significant change from baseline IOP or visual acuity occurred among the late-onset cases. The existing hypotony-related conditions consistently improved by the 4 to 6 week point.nnnCONCLUSIONSnIntracameral injection of Healon5 raised IOP more in early-onset hypotony cases than in late-onset cases. Although the improvements in IOP and visual acuity were statistically significant, the overall clinical picture did not change because the endpoint IOP was still hypotonus. Twenty percent of the patients had IOP spikes that required medical treatment.