Aim: To determine the long term intraocular pressure (IOP) response to phacoemulsification in patients with and without exfoliation syndrome (XFS). Methods: Prospective, multicentre, cohort study with the following inclusion criteria: age over 50 years, open iridocorneal angle, and cataract. Two groups were enrolled: those with XFS and those without. The main outcome was mean IOP reduction 2 years after phacoemulsification cataract extraction (PCE). Univariate and multivariate analyses were performed. Results: 183 patients were enrolled, 71 with and 112 without XFS. There were 29 patients with glaucoma in both groups. Mean baseline IOP was higher in XFS compared to control eyes (17.60 (SD 3.23) mm Hg v 16.08 (3.18) mm Hg, p = 0.002). Overall IOP reduction was significantly greater in the XFS group at the 2 year time point (21.85 mm Hg v 20.62 mm Hg in the controls (p = 0.0037)). Multivariate analysis demonstrated that the IOP lowering effect in the XFS group may be related to irrigation volume at the time of surgery. In the subgroup analyses IOP lowering was significantly greater in the XFS and XFG patients than in controls without glaucoma, and POAG controls, respectively. The percentage of patients with a postoperative IOP spike was similar and relatively high in both XFS and control groups (34% v 25%; p = 0.54). Conclusion: IOP decreases more in patients with XFS following PCE compared to control eyes without XFS. This effect is more pronounced in glaucoma patients and persists for at least 2 years. E xfoliation syndrome (XFS) is an age related systemic disorder marked by the synthesis and progressive deposition of extracellular fibrillar material within the anterior segment.1 It is, overall, the most common identifiable cause of glaucoma worldwide, and in some countries accounts for the majority of glaucoma.2 The diagnosis of XFS is unusual before 50 years of age, and its prevalence tends to increase with age. 3XFS is associated with a number of ocular findings including increased intraocular pressure (IOP), open angle glaucoma (exfoliative glaucoma), increased prevalence of cataract, lens subluxation, blood-aqueous barrier breakdown, retinal vein occlusion, as well as others ophthalmic sequelae. 4 XFS has also been associated with increased intraoperative risks during extracapsular and phacoemulsification cataract extraction (PCE), including a higher incidence of vitreous loss and zonular/capsular tears. Elevated IOP with or without glaucomatous damage occurs in approximately 25% of people with XFS, or about 6-10 times the rate in eyes without XFS. [7][8][9][10] At the time of diagnosis, IOP is higher than in primary open angle glaucoma (POAG) and there is a higher frequency and severity of optic nerve damage, worse visual field damage, poorer response to medications, more rapid progression, more severe clinical course, and more frequent necessity for surgical intervention. [11][12][13][14][15][16][17][18][19][20][21] In light of this, careful monitoring and control of IOP is of great importance in this pat...
Aim: To evaluate the effect of a tight necktie on intraocular pressure (IOP) measurement using Goldmann applanation tonometry. Methods: 40 eyes of 20 normal subjects and 20 open angle glaucoma patients (all male) were enrolled. IOP was measured with an open shirt collar, 3 minutes after placing a tight necktie, and 3 minutes after loosening it. All measurements were made by the same examiner. Results: Mean IOP in normal subjects increased by 2.6 (SD 3.9) mm Hg (p=0.008, paired t test; range −3 to +14 mm Hg) and in glaucoma patients by 1.0 (1.8) mm Hg (p=0.02, paired t test; range −2 to +4.5 mm Hg). In normal subjects, IOP in 12 eyes was increased by >2 mm Hg and in seven eyes by >4 mm Hg. In glaucoma patients, IOP in six eyes was increased by >2 mm Hg and in two eyes by >4 mm Hg. Conclusion: A tight necktie increases IOP in both normal subjects and glaucoma patients and could affect the diagnosis and management of glaucoma. E levated intraocular pressure (IOP) remains the most important known risk factor for the development and progression of glaucomatous damage. 1 Accurate measurement of IOP remains crucial in decisions regarding management. Many patients wear tight neckties throughout the day and continue wearing them during IOP measurements. We hypothesised that this may elevate IOP by increasing episcleral venous pressure. During routine examination, if a patient were to be wearing a tight necktie, the increased IOP could lead to an erroneous diagnosis of ocular hypertension or even glaucoma.Moreover, if the patient consistently were to wear a tight necktie as a normal preference in daily life, this could lead to a sustained increase in IOP and could predispose to the development of glaucomatous optic neuropathy, thereby rendering a tight necktie a risk factor as well as a confounder of accurate IOP measurement. We evaluated the effect of tight neckties on IOP measurement by Goldmann applanation tonometry. METHODSNormal subjects and open angle glaucoma patients were enrolled in this prospective study. Informed consent was obtained from each subject using a consent form approved by the institutional review board for human research of the New York Eye and Ear Infirmary. All subjects were male, had best corrected visual acuity of 20/60 or better, and wore collared shirts. Subjects were excluded if they had current infection or inflammation in either eye, any abnormality preventing reliable applanation tonometry in either eye, strabismus, previous incisional glaucoma filtration surgery, or other nonglaucomatous disease affecting the visual field.All normal subjects had IOP <21 mm Hg by Goldmann applanation tonometry, normal optic disc appearance based upon clinical examination, and normal achromatic automated perimetry. Normal optic disc appearance was defined as vertical cup to disc asymmetry <0.2, cup/disc ratio <0.6, and an intact neuroretinal rim without peripapillary haemorrhages, notches, localised pallor, or nerve fibre layer defect. Achromatic automated perimetry indices showed a mean defect (MD) and cor...
The movement of the human lens equator during accommodation was examined in vivo. High-resolution ultrasound images of the lens equator were obtained from young human subjects whose amplitude of accommodation was controlled with 1% tropicamide and 2% pilocarpine. To avoid errors that otherwise arise from eye rotation or other movement, the cornea and sclera were used as positional references in comparative studies of the video images obtained from the unaccommodated and accommodated states. During accommodation, the movement at the lens equator involved small displacement; i.e., < 100 microns, and the equator did not move anteriorly or posteriorly but peripherally toward the sclera. These results indicate that the lens equator is under increased zonular tension during accommodation, in contradiction to Helmholtz's widely accepted theory of accommodation.
* BACKGROUND AND OBJECTIVE: To evaluate the ability of high-frequency ultrasound biomicroscopy to diagnose traumatic cyclodialyses not evident on clinical examination. * PATIENTS AND METHODS: Six eyes of six patients with posttraumatic hypotony and/or shallow anterior chamber and suspected cyclodialysis clefts were examined with slit-lamp biomicroscopy, gonioscopy, B-scan ultrasonography, and ultrasound biomicroscopy. Ultrasound biomicroscopy provided high resolution of cross-sectional images of the anterior chamber angle, posterior chamber, and anterior uveal tissue. * RESULTS: Ultrasound biomicroscopy confirmed the disinsertion of the ciliary body from the scleral spur and associated ciliary body detachment in all eyes. Gonioscopy failed to demonstrate a cyclodialysis cleft in five eyes because of hyphema (two eyes) and abnormal iris architecture (related to trauma) precluding visualization of the angle recess (three eyes). Using information from ultrasound biomicroscopy imaging, one patient underwent a ciliary body reattachment procedure and repair of the cyclodialysis cleft. * CONCLUSION: Ultrasound biomicroscopy is a noninvasive method that can accurately diagnose the presence of traumatic cyclodialyses and can aid in surgical management. It is particularly useful in the presence of hazy media, hypotony, and/or abnormal anterior segment anatomy. [Ophthalmic Surg Lasers 1996;27:97-105.]
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