Effect of digital ocular massage on intraocular pressure and Schlemm's canal dimensions.

Digital ocular massage has been reported to temporarily lower intraocular pressure (IOP). This could be related to an enhanced aqueous humor outflow; however, the mechanism is not clearly understood. Using anterior segment optical coherence tomography, the Schlemm's canal (SC) and trabecular meshwork (TM) can be imaged and measured. Here, 66 healthy adults underwent digital ocular massage for 10 min in their right eyes. The IOP and dimensions of the SC and TM were measured before and after ocular massage. All subjects demonstrated IOP reduction from 15.7 ± 2.5 mmHg at baseline to 9.6 ± 2.2 mmHg immediately after, and median of 11.6 mmHg 5-min after ocular massage (Friedman's test, p < 0.001). There was significant change in SC area (median 10,063.5 µm2 at baseline to median 10,151.0 µm2 after ocular massage, Wilcoxon test, p = 0.02), and TM thickness (median 149.8 µm at baseline to 144.6 ± 25.3 µm after ocular massage, Wilcoxon test, p = 0.036). One-third of the subjects demonstrated collapse of the SC area (-2 to -52%), while two-thirds showed expansion of the SC area (2 to 168%). There were no significant changes in SC diameter (270.4 ± 84.1 µm vs. 276.5 ± 68.7 µm, paired t-test, p = 0.499), and TM width (733.3 ± 110.1 µm vs. 733.5 ± 111.6 µm, paired t-test, p = 0.988). Eyes with a higher baseline IOP demonstrated a greater IOP reduction (Pearson correlation coefficient r = -0.521, p < 0.001). Eyes with smaller SC area at baseline showed greater SC area expansion (Pearson correlation coefficient = -0.389, p < 0.001). Greater IOP reduction appeared in eyes with greater SC area expansion (Pearson correlation coefficient r = -0.306, p = 0.01). Association between change in IOP and change in TM thickness was not significant (Spearman's ρ = 0.015, p = 0.902). Simple digital ocular massage is an effective method to lower IOP values, and change in the SC area was significantly associated with IOP changes.

Evaluating Retinal and Choroidal Perfusion Changes After Ocular Massage of Healthy Eyes Using Optical Coherence Tomography Angiography.

Background and objectives: Ocular massage (OM) is used as a treatment option for acute retinal artery occlusion, under the assumption that it induces vessel dilatation and enhances perfusion. Since evidence of ocular perfusion alteration due to OM is lacking, we investigate the impact of OM on the hemodynamics of the posterior pole in healthy eyes in a noninvasive fashion by using optical coherence tomography angiography (OCTA). Materials and Methods: A prospective study was conducted on healthy volunteers, each of whom underwent measurements of intraocular pressure (IOP), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), radial peripapillary capillary perfusion (RPCP), superficial capillary plexus perfusion (SCPP), deep capillary plexus perfusion (DCPP), choriocapillaris perfusion (CCP), Sattler's layer perfusion (SLP) and Haller's layer perfusion (HLP) before and after OM. OM was performed for 2 min, consisting of 10-s turns of compression and decompression of the globe. Results: A total of 21 eyes from 21 participants (median age 29) were included. After OM, IOP significantly declined (p < 0.001), while SFCT (p < 0.005), SCPP (p < 0.001), DCPP (p = 0.004) and CCP (p = 0.008) significantly increased. CMT, RPCP, SLP and HLP did not show any significant alteration due to OM. Changes in SCPP correlated positively with changes in CCP and vice versa. Conclusions: OCTA-based analysis in healthy adults following OM demonstrated a significant increase of retinal perfusion values, assumed to be due to failure of autoregulatory mechanisms. These findings may indicate a positive effect of OM as a treatment option for patients with acute retinal artery occlusion.

Effects of Digital Ocular Massage in Patients in a Hypertensive Phase after Ahmed Glaucoma Valve Implantation

PURPOSE: To evaluate the course of the hypertensive phase (HP) after Ahmed glaucoma valve (AGV) implantation and the effects of digital ocular massage. METHODS: A total of 131 eyes of 131 patients, who underwent AGV implantation surgery, were studied retrospectively. HP was defined as an IOP (intraocular pressure) > or = 22 mm Hg within 6 months after surgery. Various clinical factors related to the occurrence of HP were analyzed. The HP group was compared to the non-HP group. Ocular massage was performed in patients showing acute elevation of IOP at a relatively early postoperative period, and the effects were compared with the non-massage group. The patients who received ocular massage were divided, based on its effects, and compared. RESULTS: HP developed in 62.6% of the patients after AGV surgery, and the success rate was significantly lower in the HP group. HP occurred more often in males and in patients with high IOP before surgery. HP developed in 82 eyes at 3.3 weeks after surgery in average. Ocular massage was performed in 30 eyes that showed acute IOP increase. The amount of IOP reduction, compared to 1 month after surgery, was greater in massage group than no massage group from 2 months to 3 years after surgery. Successful IOP control by ocular massage was observed in 14 eyes (46.7%), and the success rate was higher in these patients than the patients who showed no significant IOP reduction by ocular massage. But, the difference was not significant (p = 0.072). CONCLUSIONS: HP is related to the final outcome of surgery. Digital ocular massage can be used as an effective method to control HP and prevent further glaucomatous damage.

Immediate Natural Course of IOP after IVTA and The Effect of Preoperative Ocular Massage

PURPOSE: We determined immediate natural course of intraocular pressure (IOP) at different time points after intravitreal injection of triamcinolone acetonide (IVTA), and evaluated the effect of preoperative ocular massage to lower the immediate IOP spike after IVTA. METHODS: This prospective randomized comparative case-series study comprised sixty three eyes of 60 patients with macular edema. Thirty three eyes of 28 patients underwent IVTA (group A), and thirty eyes of 27 patients underwent IVTA with preoperative ocular massage (group B). Anterior chamber paracentesis was not performed in any of the eyes. The IOPs before and after massage, and the IOPs after IVTA (immediately, 10 minutes, 20 minutes, 30 minutes, and 1 hour, 2 hours after IVTA) were measured, respectively. RESULTS: Mean IOP reached a significant peak immediately after IVTA, and rapidly declined at 10 minutes, and then normalized after 20 minutes. Although Mean IOP was significantly lowered preoperatively by ocular massage, the IOP increment at any time point after IVTA was not significantly different between two groups. CONCLUSIONS: The significant IOP spike immediately after IVTA was rapidly normalized over 20 minutes. Preoperative ocular massage was not significantly effective in diminishing the immediate IOP elevation and its persistence after IVTA.