Selective laser trabeculoplasty for elevated intraocular pressure following subtenon injection of triamcinolone acetonide
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Ocular Response Analyzer versus Goldmann Applanation Tonometry for Intraocular Pressure Measurements
To establish correlations between intraocular pressure (IOP) measurements obtained with the ocular response analyzer (ORA) and the Goldmann applanation tonometer (GAT). The effects of central corneal thickness on the measures obtained were also examined.This was a cross-sectional study. IOP was determined in 48 eyes of 48 patients with glaucoma In all patients, central corneal thickness (CCT) was measured by ultrasound pachymetry.ORA readings were consistently higher than GAT measurements (Goldmann-correlated IOP - IOP GAT mean difference, 7.2 +/- 3.5 mm Hg; corneal-compensated IOP - IOP GAT mean difference, 8.3 +/- 4.0 mm Hg) However, differences were not constant and increased with increasing IOP GAT readings, both with respect to Goldmann-correlated IOP (slope = 0.623, P < 0.0001) and corneal-compensated IOP (slope = 0.538, P < 0.0001). Both pressure measurements provided by the ORA showed significant correlation with CCT (CCT versus Goldmann-correlated IOP: r = 0.460, P = 0.001; CCT versus corneal-compensated IOP: r = 0.442, P = 0.001). No significant effects of corneal curvature or refraction on any of the pressures were observed.The ORA significantly overestimates IOP compared with the GAT. Differences between both sets of measures increase as the GAT-determined IOP increases. ORA readings seem to be affected by central corneal thickness.
Goldmann Applanation Tonometer
Applanation tonometry
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To investigate the effect of Corneal Visualization Scheimpflug Technology tonometry (CST) on intraocular pressure (IOP).Cohort study.Patients with and without primary open-angle glaucoma (POAG) were included.Intraocular pressure was measured using the Icare rebound tonometer (ICRT; Icare Finland Oy) and the biomechanically corrected IOP (bIOP) using the CST. Intraocular pressure was measured at baseline with ICRT, followed by a CST measurement in one eye with the fellow eye acting as a control. Icare measurements were repeated at 10 seconds and 1, 2, 4, 8, 15, 30, and 60 minutes in both eyes. The ratio of test eye IOP to fellow eye IOP was used to control for intrasubject variation.Intraocular pressure change following Corneal Visualization Scheimflug Technology tonometry.Forty participants (mean age, 54.09 ± 20.08 years) were included comprising 20 patients with POAG and 20 patients with no ocular abnormalities other than cataract. Mean central corneal thickness was similar in those without POAG (547.4 ± 55.05 μm) and with POAG (520.22 ± 37.59 μm; P = 0.14). No significant change was found in IOP measured with the ICRT in the fellow eye versus the 1-hour period in either the healthy (P = 0.87) or POAG (P = 0.92) group. Significant changes were found in IOP after CST measurement for both healthy (P < 0.01) and glaucomatous (P < 0.01) eyes. After the CST measurement, the IOP reduced continuously from a mean of 13.75 mmHg to 10.84 mmHg at 4 minutes for healthy eyes and from 13.28 mmHg to 11.11 mmHg at 8 minutes for glaucomatous eyes before approaching (83% for healthy eyes and 92% POAG eyes) the pre-CST measurement at 1 hour.Corneal Visualization Scheimpflug Technology tonometry causes a significant reduction in IOP in both glaucomatous and healthy eyes that lasts for at least 1 hour afterward.
Scheimpflug principle
Corneal pachymetry
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In Brief Purpose: To study the difference in clearance of intravitreal triamcinolone acetonide quantitatively between vitrectomized and nonvitrectomized eyes. Methods: Eighty-four eyes of 42 rabbits were divided in 2 groups: 42 right eyes underwent standard pars plana vitrectomy (vitrectomized group), and 42 left eyes were not operated on (nonvitrectomized group). All eyes received intravitreal injections with 0.1 mL (0.3 mg) of triamcinolone acetonide. Every 12 eyes were obtained by killing 6 rabbits 1, 2, 4, 7, 12, 20, or 30 days after intravitreal injection. Each eye was enucleated and immediately frozen at −70°C. The frozen vitreous was prepared for measuring the concentration of triamcinolone acetonide. Triamcinolone acetonide was quantified by high-performance liquid chromatography and ultraviolet absorbance detection. Results: After 30 days, triamcinolone acetonide was detected only in 1 eye (0.22 μg/mL) in the vitrectomized group compared with 4 of 6 eyes (0.92 ± 1.25 μg/mL) in the nonvitrectomized group. The coefficient of logarithmic regression was −0.12 in the vitrectomized group and −0.08 in the nonvitrectomized group. Triamcinolone acetonide decreased 1.5 times more rapidly in the vitrectomized group than in the nonvitrectomized group. The half-life of triamcinolone acetonide was 1.57 days in the vitrectomized group and 2.89 days in the nonvitrectomized group. Conclusion: Intravitreal triamcinolone acetonide decreases more rapidly in the vitrectomized eye than in the nonvitrectomized eye. Therefore, the faster clearance of intravitreal triamcinolone acetonide must be considered when planning intravitreal injection of triamcinolone acetonide in the vitrectomized eye. Intravitreal triamcinolone acetonide decreases more rapidly (about 1.5 times) in the vitrectomized eye than in the nonvitrectomized eye.
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The objective of this study was to examine the correlation between the presence of primary iris-ciliary cysts and the intraocular pressure.Sixty patients with short-sightedness undergoing routine examination for laser vision correction in our hospital in 2003 were enrolled. Patients with known high intraocular pressure and risk of glaucoma were excluded from the study. A total of 119 eyes were examined by the Ultrasound Biomicroscope (UBM), and the presence of the primary iris-ciliary cysts was confirmed. Intraocular pressure was measured by using a blowing tonometer for each eye in triplicate. Through Pentacam correction of intraocular pressure using the Ehlers formula, the influence of the thickness of central cornea on intraocular pressure was excluded.Among all participants, 62 eyes (52.1%) were with high myopia, 57 eyes (47.9%) with low and moderate myopia, 27 eyes (22.7%) with single cyst, 20 eyes (16.8%) with multiple cysts, and 72 eyes (60.5%) were free from cysts. Moreover, the intraocular pressure was found within the normal range in 72 eyes (60.5%), and abnormally high in 47 eyes (39.5%).Our results showed that the presence of primary iris-ciliary cysts and the intraocular pressure were positively correlated, with a correlation coefficient of 0.235 (p = 0.01). These findings may prove useful for prediction and screening of high intraocular pressure.
IRIS (biosensor)
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To compare intraocular pressure measured using the Goldmann applanation tonometer with that measured using the ocular response analyzer after congenital cataract surgery.This study included 113 eyes of 64 patients who underwent lensectomy and vitrectomy. In all, 36 eyes remained aphakic after surgery. Intraocular lens implantation was performed at the time of surgery in 47 eyes and secondarily in 30 eyes. Corneal hysteresis, corneal resistance factor, and cornea-compensated intraocular pressure were measured. The influences of independent factors on the difference between the cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer were investigated using linear regression analyses. Agreement between the two tonometers was investigated using the Bland and Altman and 95% limits of agreement analysis.Central corneal thickness, corneal hysteresis, and corneal resistance factor were 591.2 ± 53.3 µm, 10.83 ± 2.27 mmHg, and 11.36 ± 2.14 mmHg, respectively. Cornea-compensated intraocular pressure (16.75 ± 4.82 mmHg) was significantly higher than intraocular pressure measured with Goldmann applanation tonometer (14.41 ± 2.27 mmHg, p < 0.001). Central corneal thickness (p = 0.02) and corneal hysteresis (p < 0.001) were identified as the main predictors of difference between cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer readings. A 95% limits of agreement for cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer was between -4.86 and 9.53 mmHg in the entire group. Cornea-compensated intraocular pressure showed the best agreement with intraocular pressure measured with Goldmann applanation tonometer in the primary pseudophakic subgroup as compared to the other subgroups.The Goldmann applanation tonometer and ocular response analyzer cannot be used interchangeably for measuring intraocular pressure after congenital cataract surgery. The difference between the cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer was primarily affected by central corneal thickness and corneal hysteresis. Among the subgroups, the primary pseudophakic subgroup had the thinnest cornea and the highest corneal hysteresis values and demonstrated the best agreement between the two tonometers.
Applanation tonometry
Goldmann Applanation Tonometer
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Elevated intraocular pressure
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Refractory (planetary science)
Diabetic macular edema
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Objective To observe the curative effect of Triamcinolone acetonide combined with ratinoic acid treating keloid. Methods 55 cases of keloid patient were devided into two group randomly, treatment group and control group.The treatment group composed by 29 keloid patients was treated with Triamcinolone acetonide and ratinoic acid; The control group by 25 keloid patients was treated with Triamcinolone acetonide only. Results The curative rate and total efficacy rate of treatment group was 58.62% and 93.11% respectively, while which of control group was 26.92% and 73.07%. The curative rate and total efficacy rate between two groups were significantly different. Conclusion The method of local blockage with Triamcinolone acetonide conbined with ratinoic acid was effective in treating keloid.
Keloid
Acetonide
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To evaluate the changes in intraocular pressure (IOP) after intravitreal injection of triamcinolone acetonide for the management of diabetic macular edema (DME). The study design is a prospective, interventional, two-arm, dose–response study. Nineteen patients with bilateral DME were included, one eye for every patient underwent intravitreal injection of 4 mg triamcinolone acetonide (group A, 19 eyes), and the other eye of the same patient underwent intravitreal injection of 8 mg triamcinolone acetonide (group B, 19 eyes); the selection as to which eye was to receive either dose was random. The patients were followed up for 6 months after injection; complete ophthalmological examination and optical coherent topography were done. Intravitreal triamcinolone acetonide was effective in reduction of DME in group A in the first 3 months only, while in group B with high dose (8 mg) the improvement continued for 6 months after injection. Significant IOP rise was observed in both groups with an incidence of 68.1% and 73.7% in groups A and B, respectively. IOP-lowering drugs were used to control IOP; however, one patient in each group needed glaucoma filtration surgery in both eyes after intractable glaucoma with failure of medical treatment. Although intravitreal injection of triamcinolone acetonide is very effective in managing DME and with lower cost than other modalities, the rise in IOP and the burden of glaucoma are major concerns. High corticosteroid responder is an individualized reaction irrespective of the intravitreal triamcinolone acetonide dose used.
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