The amount of intraocular pressure rise during pharmacological pupillary dilatation is an indicator of the likelihood of future progression of glaucoma

Siam, Ghada A; Barros, Daniela Souto; Gheith, Moataz E; Silva, Renata S Da; Lankaranian, Dara; Tittler, E. H.; Myers, Jonathan S.; Spaeth, George L.

doi:10.1136/bjo.2007.116855

Cited by 22 publications

(18 citation statements)

References 20 publications

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“…This result differs from that reported by Leske et al in the recent EMGT report, 15 wherein thinner CCT was associated with an increased risk of VF progression among those with higher baseline IOP. We could not assess unmeasured factors like lower ocular systolic perfusion pressure and lower systolic blood pressure, 15 migraine 16 and IOP rise during pupillary dilatation, 29 which have been reported to be associated with an increased risk of VF progression. Several measures of IOP control during treatment have been related to the risk of glaucomatous progression.…”

Section: Discussionmentioning

confidence: 99%

Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study

et al. 2009

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Purpose To evaluate factors associated with visual field (VF) progression, using all available follow-up through nine years after treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Longitudinal follow-up of participants enrolled in a randomized clinical trial. Participants 607 newly diagnosed glaucoma patients. Methods In a randomized clinical trial, 607 subjects with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy. After treatment initiation and early follow-up, subjects were evaluated clinically at 6-month intervals. Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined, eye-specific target pressure. VF progression was analyzed using repeated measures models. Main outcome measures VF progression, measured by Humphrey 24-2 full threshold testing and assessed by the change in the mean deviation (MD), and an indicator of substantial worsening of the VF (MD decrease of ≥3 dB from baseline), assessed at each follow-up visit. Results Follow-up indicates minimal change from baseline in each initial treatment group’s average MD. However, at the eight year follow-up examination, substantial worsening (≥3 dB) of MD from baseline was found in 21.3% and 25.5% of the initial surgery and initial medicine groups, respectively. The effect of initial treatment on subsequent VF loss was modified by time (P<0.0001), baseline MD (P=0.03), and diabetes (P=0.01). Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline, whereas subjects with diabetes had more VF loss over time if treated initially with surgery. Conclusions The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both treatment groups. Progression in VF loss was seen in a subset increasing to over 20% of the subjects. Our findings regarding initial surgery being beneficial for subjects who present at diagnosis with more advanced VF loss, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation.

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Section: Discussionmentioning

confidence: 99%

Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study

et al. 2009

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“…Taner et al (2004) reported increased IOP in patients with XFS and exfoliative glaucoma (XFG) 45 min after the instillation of cyclopentolate, with an associated decrease in retrobulbar blood flow. Also, in patients with open-angle glaucoma, the amount of increase in IOP caused by pharmacological pupillary dilation is related to the likelihood of future progression of glaucoma (Siam et al 2007). Pigment liberation into the anterior chamber and subsequent obstruction of the trabecular meshwork has been suggested to be responsible for the acute pressure elevation observed after pupil dilation.…”

Section: Discussionmentioning

confidence: 99%

Delayed intraocular pressure elevation after pupillary dilation in exfoliation syndrome

Shihadeh

Ritch

Scharf

et al. 2009

Acta Ophthalmologica

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. 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.

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“…Elevation of IOP after pharmacological dilation in patients with POAG may also be related to increased likelihood of future progression of the disease. For every 1 mmHg increase in IOP after dilation the odds of progression increase up to 24% [27]. The clinical applicability of this finding is unknown.…”

Section: Intraocular Pressurementioning

confidence: 92%