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Waisberg E, Ong J, Masalkhi M, Lee AG, Berdahl J. Wearable, dropless reduction in intraocular pressure as an emerging therapy for glaucoma. Eye (Lond) 2023; 37:3047-3048. [PMID: 36890262 PMCID: PMC10516853 DOI: 10.1038/s41433-023-02448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 03/10/2023] Open
Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Pang R, Lin D, Di X, Liu X, Gao L, Chen J, Jia Y, Cao K, Ren T, Cheng Y, Wang Y, Wang J, Wang N. Reference values for trans-laminar cribrosa pressure difference and its association with systemic biometric factors. Eye (Lond) 2023; 37:2240-2245. [PMID: 36481959 PMCID: PMC10366086 DOI: 10.1038/s41433-022-02323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To provide reference values of trans-laminar cribrosa pressure difference (TLCPD) and reveal the association of TLCPD with systemic biometric factors. METHODS In this cross-sectional study, 526 quasi-healthy subjects (including 776 eyes) who required lumbar puncture for medical reasons were selected from 4915 neurology inpatients from 2019 to 2022. Patients with any diseases affecting intraocular pressure (IOP) or intracranial pressure (ICP) were excluded. The ICPs of all subjects were obtained by lumbar puncture in the left lateral decubitus position. IOP was measured in the seated position by a handheld iCare tonometer prior to lumbar puncture. TLCPD was calculated by subtracting ICP from IOP. Systemic biometric factors were assessed within 1 h prior to TLCPD measurement. RESULTS The TLCPD (mean ± standard deviation) was 4.4 ± 3.6 mmHg, and the 95% reference interval (defined as the 2.5th-97.5th percentiles) of TLCPD was -2.27 to 11.94 mmHg. The 95% reference intervals for IOP and ICP were 10-21 and 6.25-15.44 mmHg, respectively. IOP was correlated with ICP (r = 0.126, p < 0.001). TLCPD was significantly negatively correlated with body mass index (r = -0.086, p = 0.049), whereas it was not associated with age, gender, height, weight, blood pressure, pulse, or waist and hip circumference. CONCLUSIONS This study provides reference values of TLCPD and establishes clinically applicable reference intervals for normal TLCPD. Based on association analysis, TLCPD is higher in people with lower BMI.
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Affiliation(s)
- Ruiqi Pang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Danting Lin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Di
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinyu Liu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lehong Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tianmin Ren
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Cheng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Samuelson TW, Ferguson TJ, Brubaker JW, Bacharach J, Gallardo MJ, Chaglasian M, Comer G, Yoo P. Negative Pressure Application via a Multi-Pressure Dial to Lower IOP in Patients with Suspected Glaucoma or Open Angle Glaucoma. J Glaucoma 2023; 32:708-720. [PMID: 37171994 DOI: 10.1097/ijg.0000000000002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/16/2023] [Indexed: 05/14/2023]
Abstract
PRCIS The multi-pressure dial applies localized periocular negative pressure to safely and effectively lower IOP and represents the first non-invasive, non-pharmacologic device for IOP reduction. OBJECTIVE To evaluate the safety and effectiveness of the Multi-Pressure Dial (MPD) system, a device that applies periocular negative pressure to lower intraocular pressure (IOP). SETTING 6 investigational sites, United States. DESIGN Prospective, assessor-masked, randomized controlled trial. METHODS Subjects with suspected glaucoma, ocular hypertension (OHTN), and open angle glaucoma (OAG) with baseline IOP ≥13 mmHg and ≤32 mmHg were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. The primary effectiveness endpoint was the proportion of study eyes versus control eyes achieving an IOP reduction ≥20% at Day 90. Secondary endpoints included the proportion of eyes achieving an IOP reduction ≥25% at Day 90 as well as the proportion of eyes achieving an IOP reduction ≥20% at Days 30 and 60. RESULTS 116 eyes of 58 subjects completed the study. At the Day 90 visit, 89.7% ( n =52) of study eyes versus 3.4% ( n =2) of control eyes achieved an IOP reduction ≥20% ( P <0.001). At Day 90, 77.6% ( n =45) of study eyes achieved a ≥25% IOP reduction compared to 1.7% ( n =1) of control eyes ( P <0.001). The most commonly reported adverse events were lid (17.2% study eye, 7.8% control eye) and periorbital edema (14.1% study eye, 10.9% control eye). CONCLUSIONS This trial demonstrates that the MPD safely and effectively lowers IOP in a group of patients that included glaucoma suspects, OHTN, and patients with OAG.
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Affiliation(s)
| | | | | | | | - Mark J Gallardo
- El Paso Eye Surgeons, El Paso, TX, USA
- University of Texas Health Sciences Center, San Antonio, TX, USA
| | | | - George Comer
- Southern California College of Optometry, Fullerton, CA, USA
| | - Paul Yoo
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
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Treatment of Glaucoma with Natural Products and Their Mechanism of Action: An Update. Nutrients 2022; 14:nu14030534. [PMID: 35276895 PMCID: PMC8840399 DOI: 10.3390/nu14030534] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023] Open
Abstract
Glaucoma is one of the leading causes of irreversible blindness. It is generally caused by increased intraocular pressure, which results in damage of the optic nerve and retinal ganglion cells, ultimately leading to visual field dysfunction. However, even with the use of intraocular pressure-lowering eye drops, the disease still progresses in some patients. In addition to mechanical and vascular dysfunctions of the eye, oxidative stress, neuroinflammation and excitotoxicity have also been implicated in the pathogenesis of glaucoma. Hence, the use of natural products with antioxidant and anti-inflammatory properties may represent an alternative approach for glaucoma treatment. The present review highlights recent preclinical and clinical studies on various natural products shown to possess neuroprotective properties for retinal ganglion cells, which thereby may be effective in the treatment of glaucoma. Intraocular pressure can be reduced by baicalein, forskolin, marijuana, ginsenoside, resveratrol and hesperidin. Alternatively, Ginkgo biloba, Lycium barbarum, Diospyros kaki, Tripterygium wilfordii, saffron, curcumin, caffeine, anthocyanin, coenzyme Q10 and vitamins B3 and D have shown neuroprotective effects on retinal ganglion cells via various mechanisms, especially antioxidant, anti-inflammatory and anti-apoptosis mechanisms. Extensive studies are still required in the future to ensure natural products' efficacy and safety to serve as an alternative therapy for glaucoma.
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Shafer B, Ferguson TJ, Chu N, Brambilla E, Yoo P. The Effect of Periocular Negative Pressure Application on Intraocular and Retrobulbar Pressure in Human Cadaver Eyes. Ophthalmol Ther 2021; 11:365-376. [PMID: 34910290 PMCID: PMC8770790 DOI: 10.1007/s40123-021-00442-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction To investigate the effect of applying negative pressure (vacuum) to the periocular space on intraocular pressure (IOP) and retrobulbar pressure (RBP) by use of the Multi-Pressure Dial (MPD) system (Equinox Ophthalmic, Inc.). Methods Two eyes of two full body cadavers were studied. In each subject, the retrobulbar space, posterior segment and intra-goggle space were cannulated to provide direct IOP, RBP and intra-goggle pressure measurements via a pressure transducer data acquisition system. The goggles of the MPD system were placed over the eyes of each subject, and multiple test runs were performed, with negative pressure settings programmed to 5, 10 and 20 mmHg. IOP and RBP measurements were continuously obtained during each run and plotted against time for analysis. Results For both subjects, the mean reduction (± standard deviation) in IOP was 1.6 ± 0.9 (10%), 3.5 ± 1.8 (23%) and 5.6 ± 2.0 (37%) mmHg at programmed negative pressure levels of − 5, − 10 and − 20 mmHg, respectively. The overall mean change in RBP (mmHg) during negative pressure application was 0.02 ± 0.14 at − 5 mmHg, 0.03 ± 0.19 at − 10 mmHg and − 0.01 ± 0.18 at − 20 mmHg. In both subjects, the magnitude of RBP change during application of negative pressure fell below the uncertainty of the measurement system. Conclusions The application of negative pressure to the periocular space with the MPD decreases IOP but does not affect RBP. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00442-2.
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Affiliation(s)
| | | | - Nathan Chu
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
| | | | - Paul Yoo
- Equinox Ophthalmic, Inc., Newport Beach, CA, USA
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Dong L, Li J, Zhao M, Ren J. Application of B-ultrasound information image in Renal Puncture Biopsy treatment and Nursing. Pak J Med Sci 2021; 37:1564-1568. [PMID: 34712283 PMCID: PMC8520377 DOI: 10.12669/pjms.37.6-wit.4831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives This study was to explore the application value of B-ultrasound in guiding puncture biopsy of chronic kidney disease (CKD) and the clinical nursing effects under the guidance of B-ultrasound. Methods Pathological examination of kidney biopsy was performed on 94 patients with CKD under the guidance of ultrasound from August 2020 to December 2020.; patients were observed for symptoms such as low back pain, backache, hematuria, and subcapsular hematoma. Color Doppler ultrasonography was performed on the punctured patients on day 1, 2, and 3 to observe whether there was subrental hematoma. The pathological results were analyzed and the success rate of percutaneous renal biopsy under ultrasound guidance was analyzed. Before the patient was discharged, investigate the satisfaction with the nursing work. Results (1) After the puncture, 45 patients developed low back pain and low back pain symptoms, 12 cases developed subcapsular hematoma; 8 cases showed gross hematuria, 62 cases showed microscopic hematuria, and the rest had no obvious symptoms; (2) the nursing satisfaction rate of 94 cases was as high as 95.7%. Conclusion US-PRB is a safe and effective auxiliary examination method, which can improve the success rate of puncture and reduce postoperative complications. Effective nursing can reduce the incidence of postoperative complications and improve patient satisfaction.
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Affiliation(s)
- Linyan Dong
- Linyan Dong, Nurse-in-Charge. Department of Nephrology, Xingtai People's Hospital, Xingtai 054000, Hebei, China
| | - Junhong Li
- Junhong Li, Nurse-in-Charge. Department of Nephrology, Xingtai People's Hospital, Xingtai 054000, Hebei, China
| | - Mixia Zhao
- Mixia Zhao, Nurse-in-Charge. Department of Nephrology, Xingtai People's Hospital, Xingtai 054000, Hebei, China
| | - Jing Ren
- Jing Ren, Nurse-in-Charge. Department of Nephrology, Xingtai People's Hospital, Xingtai 054000, Hebei, China
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