Casein kinase-2 inhibition promotes retinal ganglion cell survival after acute intraocular pressure elevation

Intraocular pressure elevation can induce retinal ganglion cell death and is a clinically reversible risk factor for glaucoma,the leading cause of irreversible blindness.We previously demonstrated that casein kinase-2 inhibition can promote retinal ganglion cell survival and axonal regeneration in rats after optic nerve injury.To investigate the underlying mechanism,in the current study we increased the intraocular pressure of adult rats to 75 mmHg for 2 hours and then administered a casein kinase-2 inhibitor(4,5,6,7-tetrabromo-2-azabenzimidazole or 2-dimethylamino-4,5,6,7-tetrabromo-1H-benzimidazole)by intravitreal injection.We found that intravitreal injection of 4,5,6,7-tetrabromo-2-azabenzimidazole or 2-dimethylamino-4,5,6,7-tetrabromo-1H-benzimidazole promoted retinal ganglion cell survival and reduced the number of infiltrating macrophages.Transcriptomic analysis showed that the mitogen activated protein kinase signaling pathway was involved in the response to intraocular pressure elevation but was not modulated by the casein kinase-2 inhibitors.Furthermore,casein kinase-2 inhibition downregulated the expression of genes(Cck,Htrsa,Nef1,Htrlb,Prph,Chat,Slc18a3,Slc5a7,Scn1b,Crybb2,Tsga10ip,and Vstm21)involved in intraocular pressure elevation.Our data indicate that inhibition of casein kinase-2 can enhance retinal ganglion cell survival in rats after acute intraocular pressure elevation via macrophage inactivation.

Background diseases and the number of previous intravitreal aflibercept injections on immediate intraocular pressure increase and vitreous reflux rate in phakic eyes

●AIM:To evaluate the effect of background diseases and number of previous intravitreal aflibercept injections(IVAIs)on immediate intraocular pressure(IOP)increase and vitreous reflux(VR)rate and to evaluate the correlation of both age and axial length with immediate IOP increase and VR rate.●METHODS:This study included 105 patients with cystoid macular edema secondary to retinal vein occlusion,35 patients with diabetic macular edema,69 patients with neovascular age-related macular degeneration(nAMD),and 12 patients with myopic choroidal neovascularization,which underwent first-time IVAI.The correlation of immediate IOP increase and VR rates with the four background diseases was investigated.Moreover,the correlation of age with immediate IOP increase and VR rate as well as correlation of axial length with immediate IOP increase and VR rate were evaluated.Further,54 patients with nAMD were treated with IVAI>10 times(multiple IVAIs).Moreover,the correlation of immediate IOP increase and VR rates with first-time and multiple IVAIs in nAMD was determined.●RESULTS:The immediate IOP increase(P=0.16)and VR rates(P=0.50)were almost similar among the four background diseases.The immediate postinjection IOP and age,VR rate and age,immediate postinjection IOP and axial length,or VR rate and axial length were not correlated in the four background diseases.The immediate IOP increase(P=0.66)and VR rates(P=0.28)did not significantly differ between first-time and multiple IVAIs in nAMD.●CONCLUSION:Background diseases and number of previous IVAIs have no effect on immediate IOP increase and VR rate.Further,age and axial length have no correlation on immediate IOP increase and VR rate.

Intraocular pressure before and after capsulorhexis using two viscoelastic substances and two surgical approaches in enucleated porcine eyes

AIM:To investigate the influence of ophthalmic viscoelastic devices(OVDs)and different surgical approaches on the intraocular pressure(IOP)before and after creation of the curvilinear circular capsulorhexis(CCC)as a measure for anterior chamber stability during this maneuver.METHODS:Prospective experimental WetLab study carried out on enucleated porcine eyes.IOP was measured before and after CCC with the iCare Rebound tonometer(iCare ic200;iCare Finland Oy,Vantaa,Finland).The OVDs used were a cohesive one[Z-Hyalin,Carl Zeiss Meditec AG,Germany;hyaluronic acid(HA)]and a dispersive[Z-Celcoat,Carl Zeiss Meditec AG,Germany;hydroxy propylmethylcellulosis(HPMC)].The CCC was created using Utrata forceps or 23 g microforceps in different combinations with the OVDs.RESULTS:Using the Utrata forceps the IOP dropped from 63.65±6.44 to 11.25±3.63 mm Hg during the CCC.The use of different OVDs made no difference.Using the 23 g microforceps the IOP dropped from 65.35±8.15 to 36.55±6.09 mm Hg.The difference between IOP drop using either Utrata forceps or 23 g microforceps was highly significant regardless of the OVD used.CONCLUSION:Using the sideport for the creation of the capsulorhexis leads to a lesser drop in IOP during this maneuver compared to the main incision in enucleated porcine eyes.The use of different OVD has no significant influence on IOP drop.

Intraocular pressure and gonioscopic findings in primary angle-closure disease in India—a big data study

AIM:To describe the gonioscopic profile and intraocular pressure(IOP)in primary angle-closure(PAC)disease in patients presenting to a tertiary eye care network in India.METHODS:A cross-sectional hospital-based study that included 31484 new patients presenting between 2011 and 2021.Patients with a clinical diagnosis of PAC/suspect/glaucoma were included.The data was collected from an electronic medical record system.RESULTS:PAC glaucoma(PACG)(47.55%)was the most common diagnosis followed by PAC(39.49%)and PAC suspect(PACS;12.96%).Female preponderance(54.6%)was noted with higher mean age at presentation among males(P<0.0001).PACS and PAC showed the highest prevalence in 6th decade but PACG was higher at 7th decade.The probability of angle opening was 95.93%,90.32%and 63.36%in PACS,PAC and PACG eyes respectively post peripheral iridotomy(PI).Plateau iris syndrome(PIS)was noted in 252 eyes and all showed post dilated rise of IOP.A post dilated IOP rise was also noted with 8.86%,33.95%and 57.19%eyes with PACS,PAC and PACG respectively with IOP rise between 6-8 mm Hg across the disease spectrum.CONCLUSION:The superior quadrant is the narrowest angle and difficult to open with indentation and post PI.The probability of angle opening is less in PIS especially the complete variety along with post dilated IOP rise.The post dilated IOP rise in angle closure eyes warrants a careful dilatation,especially with PIS.

Single-cell RNA sequencing analysis of the retina under acute high intraocular pressure

High intraocular pressure causes retinal ganglion cell injury in primary and secondary glaucoma diseases,yet the molecular landscape characteristics of retinal cells under high intraocular pressure remain unknown.Rat models of acute hypertension ocular pressure were established by injection of cross-linked hyaluronic acid hydrogel(Healaflow■).Single-cell RNA sequencing was then used to describe the cellular composition and molecular profile of the retina following high intraocular pressure.Our results identified a total of 12 cell types,namely retinal pigment epithelial cells,rod-photoreceptor cells,bipolar cells,Müller cells,microglia,cone-photoreceptor cells,retinal ganglion cells,endothelial cells,retinal progenitor cells,oligodendrocytes,pericytes,and fibroblasts.The single-cell RNA sequencing analysis of the retina under acute high intraocular pressure revealed obvious changes in the proportions of various retinal cells,with ganglion cells decreased by 23%.Hematoxylin and eosin staining and TUNEL staining confirmed the damage to retinal ganglion cells under high intraocular pressure.We extracted data from retinal ganglion cells and analyzed the retinal ganglion cell cluster with the most distinct expression.We found upregulation of the B3gat2 gene,which is associated with neuronal migration and adhesion,and downregulation of the Tsc22d gene,which participates in inhibition of inflammation.This study is the first to reveal molecular changes and intercellular interactions in the retina under high intraocular pressure.These data contribute to understanding of the molecular mechanism of retinal injury induced by high intraocular pressure and will benefit the development of novel therapies.

The effect of increased intra-abdominal pressure on orbital subarachnoid space width and intraocular pressure

In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years （12 females and 3 males）, at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg （1 mmHg = 0.133 kPa）, then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ＋ 0.1 mm （range： 0.77-1.05 mm）, 0.77 ＋ 0.11 mm （range： 0.60-0.94 mm）, 0.70 ＋ 0.08 mm （range： 0.62-0.80 ram）, and 0.68 _＋ 0.08 mm （range： 0.57-0.77 mm） at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the intra-abdominal pressure elevation. These results verified that the increased intra-abdominal pressure widens the orbital subarachnoid space in this acute trial, but does not alter the intraocular pressure, indicating that intraocular pressure is not affected by rapid increased in- tra-abdominal pressure. This study was registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-ONRC-14004947）.

Combined ab-interno trabeculectomy and cataract surgery induces comparable intraocular pressure reduction in supine and sitting positions

AIM:To analyze the therapeutic effect of combined abinterno trabeculectomy and cataract surgery on intraocular pressure(IOP)levels in supine and sitting postures during a 24-hour IOP profile.METHODS:Twenty-six eyes of twenty-six patients receiving ab-interno trabeculectomy using electroablation of the trabecular meshwork combined with cataract surgery or stand-alone were included in this retrospective analysis.IOP change during 24-hour IOP profiles within two years postoperatively were analyzed for eyes receiving surgery(“study eyes”)and compared to fellow eyes,which had not received surgery.Clinical data including mean sitting IOP(siIOP),mean supine IOP(su IOP)and the number of topical antiglaucomatous medications(TAM)were extracted from patients’files.RESULTS:Preoperatively,si IOP was 17.6±5.3 mm Hg in study and 17.1±4.7 mm Hg in fellow eyes(P=0.347).Patients were treated with an average of 2.8±1.0 TAM.Best corrected visual acuity(BCVA)was significantly worse in study eyes(P<0.001),visual field function was marginally not significantly dif ferent(P=0.057).Af ter surger y 9.6±6.8 mo,study eyes had a mean si IOP of 14.5±3.6 mm Hg(IOP reduction:-3.2 mm Hg,P=0.009),a mean su IOP of 18.0±3.5 mm Hg,and an average of 1.3±1.34 TAM(P<0.001),while in fellow eyes,mean si IOP was 16.2±3.4 mm Hg and mean su IOP was 20.5±5.1 mm Hg.Postoperatively,the relative IOP increase between sitting and supine postures was approximately 30%in both study and fellow eyes(P=0.99).CONCLUSION:IOP after ab-interno trabeculectomy shows a comparable relative reduction in both supine and sitting position.Classical trabeculectomy is known to lower su IOP overproportionally.

Distribution and associated factors of intraocular pressure in the older population:Tehran Geriatric Eye Study

AIM:To determine the distribution and associated factors of intraocular pressure(IOP) in an Iranian elderly population 60 years of age and above.METHODS:The present report is part of the Tehran Geriatric Eye study(TGES),a population-based cross-sectional study that was conducted on the residents of Tehran 60 years of age and above.The sampling was performed using multistage stratified random cluster sampling methods from 22 districts of Tehran,Iran.Demographic and history information,blood samples,and blood pressure were collected from all participants.Ocular examinations included measurement of uncorrected and best-corrected visual acuity,objective and subjective refraction,and slit-lamp biomicroscopy.The IOP was measured using Goldmann applanation tonometry(GAT).Corneal imaging and ocular biometry were performed using Pentacam AXL.RESULTS:The data of 3892 eyes of 2124 individuals were analyzed for this report.The mean age of the study participants was 66.49±5.31y(range:60 to 95y).The mean IOP was 15.2 mm Hg(95%CI:15.1 to 15.4),15.3 mm Hg(95%CI:15.1 to 15.5) and 15.1 mm Hg(95%CI:15.0 to 15.3) in all participants,males,and females,respectively.Of the study participants,1.3% had an IOP of ≥20 mm Hg.The mean IOP increased from 15.1 mm Hg in the age group 60-64y to 16.3 mm Hg in the age group ≥80y.According to the final multiple GEE model,the IOP was statistically significantly higher in men than in women.All the studied age groups,except for the 75-79-year-old age group,had significantly higher IOP compared to the 60-64-year-old age group.The IOP was significantly higher in underweight compared to other body mass index groups.Moreover,the IOP had a statistically significant direct relationship with the mean corneal power(mean CP),central corneal thickness(CCT),and systolic blood pressure.CONCLUSION:The present study presents the distribution of IOP in an Iranian elderly population.A higher IOP(within the range 14 to 17 mm Hg) is significantly associated with older age,male sex,high systolic blood pressure,increased mean CP,and CCT.These factors should be considered in the clinical interpretation of IOP.

Efficacy of ripasudil in reducing intraocular pressure and medication score for ocular hypertension with inflammation and corticosteroid

·AIM:To investigate the efficacy of ripasudil,a Rho kinase inhibitor,in reducing intraocular pressure(IOP)and medication scores of anti-glaucoma drugs in patients with ocular hypertension with inflammation and corticosteroid.·METHODS:The study included 11 patients diagnosed with ocular hypertension with inflammation and corticosteroid,all of whom were prescribed ripasudil eye drops and followed up for at least 2y after the initiation of treatment.IOP was measured using a non-contact tonometer before enrollment and at each follow-up visit.The medication score of glaucoma eye drops was calculated for each patient.·RESULTS:The mean IOP(26.4±2.9 mm Hg before treatment)significantly decreased after ripasudil therapy(13.7±3.3 mm Hg at 3mo)and remained stable in the low-teens during the 2-year follow-up period(P<0.0001).A significant decrease in the medication score was observed at 12mo or later after the initiation of ripasudil therapy(P<0.05).Both baseline medication scores and glaucomatous optic disc change rates were significantly higher in the five eyes that required glaucoma surgery during the 2-year observation period than the 10 eyes that did not require surgery.·CONCLUSION:Our results demonstrate the efficacy of ripasudil,in reducing IOP and the medication score over a 2-year treatment period in patients with ocular hypertension with inflammation and corticosteroid.Our findings also suggest that ripasudil could reduce the IOP in uveitic glaucoma patients with both lower baseline medication score and lower glaucomatous optic disc change rate.

Transpalpebral intraocular pressure measurement by Diaton compared to Goldman applanation tonometer in myopic eyes before and after transepithelial photorefractive keratectomy in Saudi Arabia

AIM:To compare intraocular pressure(IOP)measured via the trans palpebral IOP(tp IOP)method using a Diaton or with a Goldman applanation tonometer(GAT)and study the determinants of IOP difference in eyes undergoing transepithelial photorefractive keratectomy(TPRK)for myopia.METHODS:This cross-sectional validation study was held in 2020 in an eye hospital in Saudi Arabia.IOP was measured by Diaton and GAT before treatment,after one week,and one month of TPRK.It is considered if IOP difference by Diaton and GAT was less than±2 mm Hg acceptable.The IOP difference was tested if correlated to spherical equivalent(SE),central corneal thickness(CCT),age,gender,or tp IOP.RESULTS:Totolly 200 myopic eyes of 100 patients were included in the study.The mean difference of IOP measured by two methods before TPRK,1wk,and 1mo after TPRK were 0.790,-0.790,and-0.920 mm Hg,respectively(P<0.001).Diaton could measure IOP effectively 89.5%eyes before TPRK and 82%and 84%at 1wk and 1mo after TPTK,respectively.At week 1,IOP differences were significantly correlated to baseline CCT(P=0.02)and tp IOP at week 1(P<0.001).One month after TPRK,only tp IOP was significantly correlated to the difference in IOP(P<0.001).CONCLUSION:Diaton is a good screening tool for IOP before TPRK.It helps in monitoring IOP after surgery.Although more practical,it is less efficient than GAT.In eyes with high myopia and low tp IOP before surgery,IOP post-TPRK by Diaton and GAT could differ.

Inflammatory myofibroblastic tumor diagnosed due to high intraocular pressure

Dear Editor,I am writing this letter to present an unusual case of orbital inflammatory myofibroblastic tumor(IMT)diagnosed due to high intraocular pressure(IOP).IMT is a rare mesenchymal,low-grade malignant or borderline tumor,composed of differentiated myofibroblastic spindle cells,often accompanied by plasma cells and lymphocyte infiltration[1].The onset in most patients is insidious.

Comparison of intraocular pressure peak and fluctuations among Filipino patients with non-glaucomatous eyes and glaucoma suspects using water drinking test and diurnal intraocular pressure

AIM:To compare the intraocular pressure(IOP)peaks and fluctuations using water drinking tests(WDTs)and mean diurnal IOP among Filipino patients with normal eyes and glaucoma suspectsMETHODS:This prospective study included normal and glaucoma suspect patients.Each patient underwent both WDT and mean diurnal examination on separate visits.For mean diurnal examination,IOP was recorded every 2 h for 8 h while in WDT,IOP was recorded prior to WDT,and postWDT at 5,15,30,45,and 60 min.IOP peak was recorded as the highest IOP for both methods,and IOP fluctuation was recorded as highest IOP minus lowest IOP.RESULTS:With the comparison of diagnostic tests,both normal eyes and glaucoma suspect groups,the peak IOP was caught at 15 min.Comparative analysis of both groups also showed that the peak IOP measurements were statistically higher for the WDT compared to mean diurnal IOP(P=0.039,P=0.048 under normal group and P=0.032 and P=0.031 under glaucoma suspect group).Similarly,the WDT had a statistically higher mean IOP fluctuation score than the mean diurnal IOP method in both groups(P=0.003,P=0.011 under normal group;P=0.002 and P=0.005 under glaucoma suspect group).CONCLUSION:This study shows that WDT is a comparable diagnostic exam in predicting IOP fluctuations than mean diurnal measurement.WDT is a promising diagnostic procedure for risk assessment in glaucoma.

Impact of intraocular pressure fluctuations on progression of normal tension glaucoma

AIM:To investigate short-and long-term intraocular pressure(IOP)fluctuations and fur ther ocular and demographic parameters as predictors for normal tension glaucoma(NTG)progression.METHODS:This retrospective,longitudinal cohort study included 137 eyes of 75 patients with NTG,defined by glaucomatous optic disc or visual field defect with normal IOP(<21 mm Hg),independently from therapy regimen.IOP fluctuation,mean,and maximum were inspected with a mean follow-up of 38 mo[standard deviation(SD)18 mo].Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry,Heidelberg retina tomograph(HRT)imaging,and optic disc photographs.The impact of IOP parameters,myopia,sex,cup-to-disc-ratio,and visual field results on progression of NTG were analyzed using Cox regression models.A sub-group analysis with results from optical coherence tomography(OCT)was performed.RESULTS:IOP fluctuations,average,and maximum were not risk factors for progression in NTG patients,although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression(P=0.054).The 46/137(33.5%)eyes progressed over the followup period.Overall progression(at least three progression confirmations)occurred in 28/137 eyes(20.4%).Most progressions were detected by perimetry(36/46).Longterm IOP mean over all pressure profiles was 12.8 mm Hg(SD 1.3 mm Hg);IOP fluctuation was 1.4 mm Hg(SD 0.8 mm Hg).The progression-free five-year rate was 58.2%(SD 6.5%).CONCLUSION:Short-and long-term IOP fluctuations do not result in progression of NTG.As functional changes are most likely to happen,NTG should be monitored with visual field testing more often than with other devices.

A pilot study of the precision of digital intraocular pressure measurement during vitrectomy

AIM:To evaluate the precision of digital intraocular pressure(IOP)measurement in silicone oil(SO)filled eyes during vitrectomy.METHODS:This is a retrospective,single-blind study.Patients who were diagnosed with retinal detachment and scheduled for vitrectomy with SO injection were consecutively enrolled.During the vitrectomy,IOP was digitally measured and then by a rebound tonometer(Icare PRO).The rebound tonometer readings were masked to the surgeons.The digitally measured IOP and that of rebound tonometer were compared,and the inter-methods agreement was assessed.The absolute deviation in IOP values between these two methods(△IOP)was also calculated,and correlations between△IOP and refractive status,lens status and levels of surgeons’experience were analyzed.RESULTS:A total of 131 patients(131 eyes)were recruited,with a mean age of 51.0±16.1 y.There was no significant difference in IOPs between digital measurement and the rebound tonometer(15.6±4.3 vs 15.7±5.1 mm Hg;t=0.406,P=0.686).Intraclass correlation coefficients(ICC)analysis indicated a strong correlation between these two measurements(ICC=0.830,P<0.001).The mean△IOP was 2.0±1.9 mm Hg(range:0-12.8 mm Hg),with 98 eyes(74.8%)had the△IOP within 3 mm Hg.△IOP was found to be negatively correlated with levels of surgeons’experience(r=-0.183;P=0.037),but not with the refractive status or lens status of the patients(both P>0.05).CONCLUSION:For experienced surgeons,the digital IOP measurement may be an acceptable technique for IOP measurement in SO filled eyes during vitrectomy.However,its use by inexperienced surgeons should be taken with caution.

Changes in intraocular pressure after intraocular eye surgery——the influence of measuring technique

AIM: To investigate the changes in intraocular pressure(IOP) before and after intraocular surgery measured with Goldmann applanation tonometry(GAT) and pascal dynamic contour tonometry(PDCT), and assessed their agreement.METHODS: Patients who underwent trans pars plana vitrectomy(TPPV) with or without cataract extraction(CE) were included. The IOP was measured in both eyes with GAT and PDCT pre-and postoperatively, where the nonoperated eyes functioned as control.RESULTS: Preoperatively, mean IOP measurements were 16.3±6.0 mm Hg for GAT and 12.0±2.8 mm Hg for PDCT for the operated eyes. Postoperatively, the mean IOP dropped to 14.3±5.6 mm Hg for GAT(P=0.011) and rose up to 12.7±2.6 mm Hg for PDCT(P=0.257). Bland-Altman analysis showed a poor agreement between GAT and PDCT with a mean difference of 2.9 mm Hg preoperatively and 95% limits of agreement ranging from -3.2 to 9.0 mm Hg. Postoperatively, the mean difference was 1.2 mm Hg with 95% limits of agreement ranging from-8.3 to 10.7 mm Hg. There were no significant differences between the TPPV and TPPV+CE group, except when measured with PDCT postoperatively(P=0.012).CONCLUSION: The IOP is reduced after surgery when measured with GAT and remained stable when measured with PDCT. However, the agreement between GAT and PDCT is poor. Although PDCT may be a more accurate predictor of the true IOP, it seems less suitable for daily use in the clinical practice.

Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients

AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.

Complications of intravitreal triamcinolone acetonide for macular edema and predictive factors for intraocular pressure elevation

AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of patients with macular edema secondary to branch retinal vein occlusion (BRVO), diabetic retinopathy and uveitis who had received IVTA injections were reviewed to document its complications. IOP elevation was defined as a pressure of ≥24mmHg at some point during follow-up. Multivariate logistic regression analysis was performed to characterize baseline risk factors for this elevation. RESULTS: The study included 111 eyes of 65 female and 46 male patients with a mean follow-up of (11.6±5.1) months. Of the 111 eyes, 52 (46.8%) had macular edema secondary to BRVO, 44 (39.6%) had clinically significant diabetic macular edema (CSDME) and 15 (13.5%) had non-infectious uveitis with macular edema. IOP was recorded ≥24mmHg in 38 eyes (34.2%) during the follow-up. Higher baseline IOP (P =0.022), younger age (P =0.003), and male gender (P = 0.014) were significant risk factors for IOP elevation after IVTA injection. Eyes with prior vitrectomy were less likely to have IOP elevation (P =0.054). Two eyes (5.2% of eyes with increased IOP) underwent trabeculectomy, and 9 eyes (16.3% of the phakic eyes) necessitated cataract surgery. Other complications included branch vein occlusion (1.8%), sterile endophthalmitis (0.9%) and pseudohypopyon (0.9%). CONCLUSION: IVTA has side effects with IOP elevation and cataract formation being the two most common. A subset of patients is more prone to developing increased IOP following IVTA, namely, younger male patients with higher baseline IOP.

Immediate intraocular pressure rise after intravitreal injection of ranibizumab and two doses of triamcinolone acetonide

AIM: To evaluate prospectively immediate intraocular pressure (IOP) changes after the intravitreal injection of ranibizumab, 2 and 4mg triamcinolone acetonide. METHODS: Patients who underwent intravitreal injection of 0.1mL (4mg) triamcinolone acetonide (TA, Group T4), 0.05mL (2mg) TA (Group T2) and 0.05mL (0.5mg) ranibizumab (Group R) comprised the study population. Overall, 229 eyes of 205 patients were injected. Fifty-four eyes (23.6%) were in Group T4, 69 eyes (30.1%) in Group T2 and 106 eyes (46.3%) in Group R. If IOP was less than 26mmHg immediately after the injection no further measurement was performed. If IOP was ≥26mmHg, IOP was remeasured till the reading was below 26mmHg at 5, 15 and 30 minutes. RESULTS: Immediately after the injection, the IOP of 28 eyes (51.9%) in Group T4, 22 eyes (31.9%) in Group T2 and 51 eyes (48.1%) in Group R were over 25mmHg. At 30 minutes, IOP of one eye (1.9%) in group T4, two eyes (2.9%) in group T2 and two eyes (1.9 %) in Group R were over 25mmHg. Immediate post-injection IOP was significantly higher in Group T4 and Group R when compared to Group T2 (P <0.001 and P <0.001, respectively). IOP was significantly higher in eyes without vitreous reflux when compared to those with vitreous reflux in all groups (P <0.001). CONCLUSION: IOP may remarkably increase immediately after the intravitreal injection of 2 or 4mg triamcinolone acetonide, and 0.5mg ranibizumab. Absence of vitreous reflux is the most important predicting factor for immediate IOP rise after the injection.

Intraocular pressure fluctuation and the risk of glaucomatous damage deterioration: a Meta-analysis

AIM: To systematically review whether the increased fluctuation of intraocular pressure(IOP) is a risk factor for open angle glaucoma(OAG) progression. METHODS: Scientific studies relevant to IOP fluctuation and glaucoma progression were retrieved from MEDLINE,EMBASE and CENTRAL databases, and were listed as references in this paper. The hazard ratio(HR) was calculated by using fixed or random-effects models according to the heterogeneity of included studies. RESULTS: Individual data for 2211 eyes of 2637 OAG patients in fourteen prospective studies were included in this Meta-analysis. All studies were longitudinal clinical studies with follow-up period ranging from 3 to 8.5 y. The combined HR was 1.23(95%CI 1.04-1.46, P=0.02) for the association between IOP fluctuation and glaucoma onset or progression with the evidence of heterogeneity(P<0.1).Subgroup analyses with different types of IOP fluctuation were also evaluated. Results indicated that the summary HR was 0.98(95%CI 0.78-1.24) in short-term IOP fluctuation group, which showed no statistical significance with heterogeneity, whereas, the combined HR was 1.43(95%CI1.13-1.82, P=0.003) in long-term IOP fluctuation group without homogeneity. Sensitivity analysis further showed that the pooled HR was 1.10(95%CI 1.03-1.18, P=0.004) for long-term IOP fluctuation and visual function progression with homogeneity among studies(P=0.3). CONCLUSION: Long-term IOP fluctuation can be a risk factor for glaucoma progression based on the presentedevidence. Thus, controlling the swing of IOP is crucial for glaucoma or glaucoma suspecting patients.

Intraocular pressure elevation after intravitreal triamcinolone acetonide injection: a Meta-analysis

AIM：To report on intraocular pressure（IOP）after intravitreal injections of triamcinolone acetonide.·M ETHODS：Systematic literature review of studies that investigated the effects of an injection of triamcinolone Intravitreal triamcinolone acetonide on IOP was conducted according to the Cochrane Collaboration methodology and the reported effects have been analyzed with Meta-analysis.·RESULTS：We found that the IOP follows an inverted-U shape pattern over time starting with an average value of14.81±1.22 mm Hg before the injection,rising to a maximum of 19.48±2.15 mm Hg after one month of injection and falling down to 16.16±1.92 mm Hg after6mo.Moreover,country of study,age,previous history of glaucoma and gender compositions matter for crossstudy were different in reported IOP changes.·CONCLUSION：Our findings may be helpful in determining pressure elevation risk of intravitreal triamcinolone acetonide therapy as well as comparing it with those of more recent therapies such as the antivascular endothelial growth factor agents.