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W. Shihadeh, R. Ritch, B. Scharf, J.M. Liebmann; Delayed Intraocular Pressure Elevation After Pupillary Dilation in Exfoliation Syndrome . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4835.
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Purpose: To determine the effect of pupillary dilation on intraocular pressure (IOP) in normotensive patients with exfoliation syndrome (XFS). Methods: In this prospective study, 25 eyes of 19 Caucasian patients (9 male, 10 female) with XFS were enrolled. All eyes were untreated, unoperated, and normotensive with full fields. Pre–dilation IOPs were measured. IOPs and pupil sizes were checked after dilation with tropicamide 1% and phenylephrine 2.5% eye drops hourly for four consecutive hours. Pigment cell release in the anterior chamber was recorded and labeled as: 1) None, 2) trace: < 5 pigment particles/ HPF, 3) +1 : 5–10 pigment particles/ HPF, 4) +2: 10–20 pigment particles/ HPF, 5) +3: 20–50 pigment particles/ HPF, and 6) +4: >50 pigment particles/ HPF. Results: Twelve eyes (48%) exhibited a rise in IOP ≥ 4 mmHg above the pre–dilation baseline IOP. Four eyes (16%) exhibited a rise ≥ 9 mmHg (range 9–28 mmHg). Post–dilation gonioscopy confirmed the presence of an open anterior chamber angle in all eyes. The maximum IOP was reached in three hours post–dilation in three eyes and in two hours in the remaining eyes. The four eyes with marked IOP rise exhibited an elevation between 1–7 mmHg at one hour. The extent of dilation as well as the extent of anterior chamber pigment release did not seem to affect the magnitude of IOP rise. Conclusions: Patients with XFS are at increased risk for developing significant delayed post–dilation IOP rises. This is particularly important in patients with advanced cupping and / or severe visual field loss who may not be able to tolerate a marked elevation of IOP for even a short period of time. An early, mild rise in IOP at one hour may serve as a warning sign for a more severe, delayed response. Eyes with XFS should have their IOPs monitored after dilation.
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