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R.N. Khurana, G. Scott, R.E. Smith, S.C. Yiu; Esterified Estrogens combined with Methyltestosterone Raise Intraocular Pressure in Postmenopausal Women. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5588.
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Purpose: Intraocular pressure (IOP) is influenced by both estrogens and androgens. Estrogens have been shown to induce reductions in IOP while higher serum levels of testosterone are associated with increased IOP. The purpose of this study was to investigate the effect of esterified estrogens combined with methyltestosterone (Estratest) on IOP in postmenopausal women. Methods: We reviewed the charts of 13 consecutive cases of postmenopausal women with Dry Eye Syndrome treated with Estratest (1.25 mg of esterified estrogens and 2.5 mg of methyltestosterone). Intraocular pressures were recorded before, during and after Estratest therapy. Paired T Tests were used to analyze IOP changes during therapy. Results: The mean baseline IOP increased from 15.0 mm Hg to mean IOP of 18.2 mm Hg on Estratest therapy (p<0.0001) after a median duration of 11.3 months (0.9–19.3). The increase in IOP was statistically significant at the .05 level of significance within 3 months and continued over 12 months. At baseline, the mean IOP (mm Hg) was 15.0 ± 2.6 (n=26), at 0–3 months: 16.2 ±2.4 (n=20, p=0.009), at 3–6 months: 16.8 ±2.1 (n=12, p=0.64), at 6–9 months: 17.0 ±1.9 (n=16, p=0.03), at 9–12 months: 18.9 ±1.9 (n=14, p=0.002), and >12 months: 18.6 ±1.0 (n=10, p=0.006). The change in IOP from baseline at 0–3 months: +1.7 mm Hg (n=20, p=0.009), at 3–6 months: +0.4 (n=12, p=0.64), at 6–9 months: +1.6 (n=16, p=0.03), at 9–12 months: +2.5 (n=14, p=0.002) and >12 months: +2.7 (n=10, p=0.006). Two patients whose pressures increased (> 4 mm Hg) returned to baseline levels after Estratest was discontinued. Conclusions: Esterified estrogens combined with methyltestosterone produce a clinically significant rise in IOP in postmenopausal women with Dry Eye Syndrome. Further prospective studies are needed to confirm this rise in IOP.
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