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Determinants of post-mydriatic intraocular pressure in phakic eyes with prevalent angle closure diseases

  • Glaucoma
  • Published:
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Abstract

Purpose

This study aimed to identify acute angle closure (AAC) risk following pharmacologic mydriasis and the factors affecting post-mydriatic intraocular pressure (IOP) in a population with a high prevalence of angle closure disease.

Methods

In total, 460 individuals aged ≥ 72 years were enrolled in this cross-sectional community-based screening program. IOP was measured at baseline and 1 hour after mydriasis. Individuals with post-mydriatic IOP spike > 6 mmHg received indentation gonioscopy and IOP-lowering medication. Linear regression analysis was used to identify ocular parameters associated with post-mydriatic IOP elevation.

Results

The mean age of participants was 77.8 ± 4.1 years, and 65.4% of them were men. In total, 21 eyes of 16 participants (3.48%) had post-mydriatic IOP spikes (range: 6–13.7 mmHg); among them, 15 eyes had an IOP of > 21 mmHg. None of the participants developed AAC. All eyes with IOP spikes were phakic, except for one with pseudophakic angle closure. Analysis of 381 participants with at least one phakic eye revealed that higher post-mydriatic IOP and IOP changes were associated with narrower angle grading, more extensive peripheral anterior synechiae, shallower central anterior chamber, and thicker lens. According to multiple linear regression analysis, post-mydriatic IOP was independently associated with baseline IOP and factors suggestive of crowded anterior chamber based on gonioscopic findings and central or peripheral anterior chamber depth evaluation in conjunction with lens thickness.

Conclusion

Post-mydriatic IOP should be measured in phakic eyes with a crowded anterior chamber. Post-mydriatic IOP spikes can be effectively blunted with intervention to prevent AAC.

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Funding

This research was funded by the Taipei Veterans General Hospital (grant number V95A-096, V95A-102, V95S3-001), and the Ministry of Science and Technology, TAIWAN (MOST 107-2314-B-075-034).

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Authors and Affiliations

  1. Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan

    Yu-Chieh Ko, Che-Yuan Kuo, Tung-Mei Kuang & Catherine Jui-ling Liu

  2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Yu-Chieh Ko, Tung-Mei Kuang & Catherine Jui-ling Liu

  3. Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Wei-Ta Chen

  4. Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

    Pesus Chou

Authors
  1. Yu-Chieh Ko
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  2. Che-Yuan Kuo
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  3. Tung-Mei Kuang
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  4. Wei-Ta Chen
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  5. Pesus Chou
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  6. Catherine Jui-ling Liu
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Correspondence to Che-Yuan Kuo.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of Taipei Veterans General Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ko, YC., Kuo, CY., Kuang, TM. et al. Determinants of post-mydriatic intraocular pressure in phakic eyes with prevalent angle closure diseases. Graefes Arch Clin Exp Ophthalmol 259, 137–143 (2021). https://doi.org/10.1007/s00417-020-04941-z

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  • DOI: https://doi.org/10.1007/s00417-020-04941-z

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