Delayed intraocular pressure elevation after pupillary dilation in exfoliation syndrome

Abstract

. Purpose: To determine the effect of pupillary dilation on intraocular pressure (IOP) in normotensive patients with exfoliation syndrome (XFS). Methods: Patients with XFS were enrolled in this prospective trial. All eyes were untreated, had no previous laser or operative surgery and were normotensive with full visual fields and open angles. IOP was measured before dilation and hourly for four consecutive hours after dilation with tropicamide 1% and phenylephrine 2.5% eyedrops. Results: Twenty‐five eyes of 19 White patients (nine male, 10 female) with XFS were enrolled. Twelve eyes (48%) had a rise in IOP of ≥ 4 mmHg above the pre‐dilation baseline IOP and four (16%) had a rise of ≥ 9 mmHg (9–28 mmHg). Post‐dilation gonioscopy confirmed the presence of an open anterior chamber angle in all eyes. The maximum IOP was reached 3 hr post‐dilation in three eyes and after 2 hr in the remaining eyes. The four eyes with marked IOP rise exhibited an elevation of between 1 and 7 mmHg at 1 hr. Extensive pigment release was noticed in all eyes that had a rise in IOP. Conclusion: Patients with XFS are at risk of developing delayed post‐dilation IOP rises. Awareness of this phenomenon is particularly important in patients with advanced cupping and/or severe visual field loss who may not be able to tolerate a marked elevation of IOP. An early, mild rise in IOP at 1 hr may serve as a warning sign for a more severe, delayed response. Eyes with XFS should be monitored carefully after dilation, especially those with marked pigment release.

Effects of Diagnostic Mydriasis with Tropicamide and Phenylephrine on Intraocular Pressure

“…Shaw & Lewis and Siam et al, also reported higher post dilatation IOPs but their studies included patients with glaucoma [16,33]. Other studies with similar results were those of Hung et al, and Shihadeh et al, but these studies were on children and patients with pseudoexfoliation respectively [17,19]. On the other hand, Pukrushpan et al, reported no significant difference in mean IOP pre and post dilatation even though their study population was similar to that of this study [24].…”

“…Pupillary dilatation for dilated fundus examination (diagnostic mydriasis) is a very important aspect of ophthalmic practice. Diagnostic mydriasis has the ability to cause both ocular and systemic effects [14][15][16][17][18][19][20][21][22][27][28][29][30].…”

“…Diagnostic mydriasis using these pharmacological agents is not without consequences. Many studies have shown that pupillary dilatation can cause a change in IOP, most supporting an increase in IOP in normal eyes and also abnormal eyes notably those that are glaucomatous [14][15][16][17][18][19][20][21][22] and others showing no significant change [23,24].…”

Der Einfluss von Medikamenten auf das Glaukom und den Augeninnendruck

“…Bei bis zu 30 % dieser Patienten ist ein signifikanter Druckanstieg feststellbar, wobei Patienten mit PEX-Glaukom und PEX-Syndrom (PEX: Pseudoexfoliation) häufiger betroffen sind als Patienten mit primär chronischem Offenwinkelglaukom [22]. Bei Patienten mit PEX-Syndrom kann ein früher leichter Druckanstieg nach Mydriase (1 h nach Applikation) Vorbote eines zeitlich verzögerten stärkeren Druckanstiegs (2-3 h nach Applikation) sein, der durch eine Pigmentausschüttung nach Mydriase ausgelöst wird [23]. Gerade bei Patienten mit bereits stärkerer Optikusschädigung sollte auf dieses Phänomen geachtet werden.…”

Estudio genético del síndrome pseudoexfoliativo

“…Los pacientes con GPEX presentan un mayor riesgo de sufrir picos de incremento de la PIO transitorios tras la dilatación pupilar debido a la dispersión de partículas de pigmento y de material pseudoexfoliativo en la cámara anterior que se produce tras la instilación tópica de midriáticos. La máxima elevación de la PIO, que puede alcanzar hasta los 30 mmHg sobre la PIO basal del paciente, se alcanza de 2 a 3 horas tras la dilatación pupilar y tarda de 10 a 15 horas en volver a normalizarse [163].…”