Intraocular pressure curves of untreated glaucoma suspects and glaucoma patients in sitting and lateral decubitus positions using the goldmann applanation tonometer.

PURPOSE: Evaluation of data obtained during diurnal intraocular pressure (IOP) measurements by means of the Goldmann Applanation tonometer in sitting and lateral decubitus positions. PATIENTS AND METHODS: Retrospective cohort study of 41 consecutive untreated subjects (82 eyes) with ocular hypertension or suspicious discs. The IOP was measured by Goldmann Applanation tonometer in sitting position at 9 AM, 12 AM, 3 PM, and 6 PM; and in right lateral decubitus position around 12:15 PM. RESULTS: In the right eye (RE) mean peak IOP was 22.19±4.68 mm Hg. In the left eye (LE) peak mean IOP was 22.19±3.8 mm Hg. In 91.5% of the eyes, the IOP increased in the lateral decubitus position. The average change in the RE was an increment of 4.22±2.67 mm Hg (P<0.001) and in the LE an increment of 3.51±3.11 (P<0.001). This increment was significantly higher in the dependent eye (i.e., lower eye) (P=0.049). Sixty-seven percent of eyes had a positional elevation of IOP between 2 and 5 mm Hg and 23.2% of eyes had IOP elevation between 6 and 12 mm Hg. In the great majority of the eyes (80.5% RE and 78% LE) the lateral decubitus IOP was greater than maximal diurnal sitting IOP. CONCLUSIONS: The IOP in the lateral decubitus position was significantly higher than the mean maximal diurnal sitting IOP. Over 20% of the patients had an IOP increase of ≥6 mm Hg when lying down. Timely identification of patients with excessive postural elevation of IOP could affect their management and prevent visual fields loss.

Minocycline upregulates pro-survival genes and downregulates pro-apoptotic genes in experimental glaucoma.

PURPOSE: Minocycline, a second-generation tetracycline with anti-inflammatory and anti-apoptotic properties, was reported to be neuroprotective in experimental glaucoma and optic nerve transection as well as in other neurodegenerative diseases. The purpose of this study was to investigate the mechanism underlying that neuroprotective effect in murine glaucoma. METHODS: Elevated intraocular pressure was induced in 159 rats by the translimbal photocoagulation laser model. Minocycline 22 mg/kg or saline was injected intraperitoneally starting 3 days before the induction of glaucoma, and continued daily until the animals were sacrificed. The effect of minocycline on gene expression was evaluated using a quantitative polymerase chain reaction (PCR) array for apoptosis. The involvement of selected pro-apoptotic, pro-survival, and inflammatory genes was further analyzed by quantitative real-time PCR at multiple time points. Immunohistochemistry was used to study the effect of minocycline on microglial activation and to localize Bcl-2 changes. RESULTS: Minocycline significantly increased the anti-apoptotic gene Bcl-2 expression at day 8 and day 14 after the induction of glaucoma (p = 0.04 and p = 0.03 respectively), and decreased IL-18 expression in the retina at day 14 and day 30 (p = 0.04 and p < 0.001 respectively). PCR arrays suggested that additional genes were affected by minocycline, including Tp53bp2, TRAF4, osteoprotegerin, caspase 1 and 4, and members of the tumor necrosis factor superfamily. Additionally, minocycline decreased the amount of activated microglia in glaucomatous eyes. CONCLUSIONS: These results suggest that minocycline upregulates pro-survival genes and downregulates apoptotic genes, thus shifting the balance toward the anti-apoptotic side in experimental glaucoma.

Conjunctival pyogenic granuloma associated with intravitreal bevacizumab injection.

PURPOSE: To report a case of conjunctival pyogenic granuloma after intravitreal injection of anti-vascular endothelial growth factor, bevacizumab. METHODS: A 52-year-old patient after 3 intravitreal bevacizumab injections was found to have a vascular conjunctival nodule at the injection site. A pathologic analysis of the vascular conjunctival nodule was performed after surgical excision. RESULTS: The pathologic analysis revealed a conjunctival pyogenic granuloma. CONCLUSION: Conjunctival pyogenic granuloma can complicate an otherwise uneventful intravitreal anti-vascular endothelial growth factor injection.

The inner limiting membrane does not regrow after indocyanine green-guided peeling: photo-report of two cases.

PURPOSE: The purpose of this study is to report two photo-cases of inner limiting membrane (ILM) defect staining during repeated vitrectomy. METHODS: This study is an interventional case report. Two cases are reported in which the ILM defect was indocyanine green (ICG) stained and photographed during repeated vitrectomy for a persistent macular hole. RESULTS: The ICG dye demonstrated a large circular area of nonstaining centered on the macular hole, corresponding to the area denuded of the ILM in the first operation. These areas were documented by video photography. CONCLUSION: The ILM most probably does not regrow after peeling in a way that it could be stained by ICG. A successful ILM peeling does not guarantee closure of macular hole, but repeated ILM peeling may have additional beneficial effect.