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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Related Experiment Video

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Trabecular Meshwork Response to Pressure Elevation in the Living Human Eye
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Impact of Small Incision Lenticule Extraction for High Myopia on Intraocular Pressure Measurements With

Kjeld M Mohr, Anders N Gyldenkerne, Jesper Ø Hjortdal

    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
    |September 7, 2023
    PubMed
    Summary

    Small incision lenticule extraction (SMILE) surgery significantly lowers intraocular pressure (IOP) readings from air-puff tonometry (APT), causing underestimation. Adding 6.4 mm Hg to APT measurements may suffice for screening post-SMILE patients.

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    Area of Science:

    • Ophthalmology
    • Refractive Surgery
    • Ocular Biomechanics

    Background:

    • Small Incision Lenticule Extraction (SMILE) is a popular refractive surgery for myopia.
    • Air-puff tonometry (APT) is a common method for measuring intraocular pressure (IOP).
    • Previous studies suggest refractive surgery can affect IOP measurements.

    Purpose of the Study:

    • To assess the medium-term effect of SMILE on APT readings.
    • To determine if a correction method can improve IOP accuracy after SMILE.
    • To evaluate the impact of SMILE on IOP measurements.

    Main Methods:

    • Prospective study of 69 eyes from patients with high myopia undergoing SMILE.
    • Measurements included central corneal thickness (CCT), spherical equivalent refraction (SEQ), corneal power, and IOP via APT.
    • Data collected pre-operatively and 3 months post-operatively.

    Main Results:

    • A significant decrease in measured IOP (mean -6.43 mm Hg) was observed post-SMILE.
    • APT readings significantly underestimated true IOP after SMILE.
    • Correlation found between changes in SEQ, CCT, and apparent IOP.
    • Multiple regression correction did not significantly improve IOP estimation compared to adding 6.4 mm Hg.

    Conclusions:

    • SMILE surgery leads to underestimation of true IOP by APT.
    • Previous SMILE surgery must be considered when interpreting APT results.
    • Adding 6.4 mm Hg to apparent IOP may be adequate for screening purposes in post-SMILE patients.