Intraocular Pressure And Corneal Thickness Measurement Biology Essay

Systemic medicine is a drugs which in consumption orally or injection, which have some reaction with different receptors of our organic structure to merchandise the expected consequences. For illustration, to kill painful, diminish the secernment and kill virus in our organic structure etc. In this thesis, we are concentrating on the relationship between the medicine and the intraocular force per unit area ( IOP ) , and how is the medicine affect to the intraocular force per unit area. So we are concentrating on cardiovascular medicine, it is because cardiovascular force per unit area has a really close relationship with the IOP ( Leske, 1983 ) and it shown in some of the surveies if person have a high blood force per unit area or the blood force per unit area jobs who will hold higher prevalence to acquire intraocular force per unit area job. And it is because the systemic medicine which would impact the blood force per unit area, either addition or diminish it.

The intraocular force per unit area measuring which is an of import portion of the everyday oculus trial in UK, most of the patients who are aged over approximately 40 or the patient who has closed household glaucoma history, the IOP measuring should be involved in the everyday oculus trial. The IOP measuring which is really of import due to the consequence is one of the biggest hazard to name the patient have glaucoma potentially or non, although the consequence is non the lone information which is considered by the practician. And the diagnosing besides consider with the household history, age, race, cup and phonograph record alteration, ocular field defect etc. So if the patient who has high intraocular force per unit area, he/she may non be involve the glaucoma. But the patient should hold a high prevalence to acquire a high blood force per unit area ( Leske, 1983 ) .

The first tonometry measuring technique which used by GP is digital tactual exploration, and it is used the finger to gauge the force per unit area or the hardness between two closed eyes. The first one tonometer in the universe is “ Schiotz Tonometer ” which introduced by Hjalmar August Schiotz in 1905 ( Loffler ) . And this tonometer is utilizing on the patient who are lying. It is because the rigidness of the oculus may impact the consequence of the IOP measuring, Friedenwald introduced a revised tabular array, called Friedenwald ‘s nomograph, which to minimise the job which affect the measuring. After the first tonometer introduce and used clinically, there are many other tonometer with different theory to be presented. The one of the marketed tonometer being a gilded criterion and used since it introduced in 1954 until now which is Goldmann tonometer and which is along the same thought and theory, Perkins tonometer introduced in 1965 ( Loffler, 2006 ) . They are based on the Imbert-Fick jurisprudence which stated by three grounds: ( 1 ) it is accurate applied on the all right thin membrane ; ( 2 ) it is accurate on applied on the elastic sphere surface ; ( 3 ) it is accurate on applied on homogenous elastic domain ( Jun, 2005 ) .

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With the ground of the IOP measuring is a of import portion of the everyday oculus trial, and it will impact by the blood force per unit area, so there is why this thesis started for the research of the “ What impact do systemic medicines have on intraocular force per unit area ”

Keywords: Cardiovascular medicine ; intraocular force per unit area ( IOP ) ; tonometry ;

Chapter 1 – Introducation

The subject of the thesis is “ What impact do systemic medicines have on intraocular force per unit area ”

“ Systemic ” stated impacting the whole organic structure, non merely the particularly portion of the organic structure. ( Mikel, 2005 )

“ Medicine ” stated that handling the disease or illness of the organic structure by drugs or some chemical substances. ( Mikel, 2005 )

“ Intraocular force per unit area ( IOP ) ” stated that it is force per unit area which is used to keep the formation of the orb and besides the value of the force per unit area is happening by the sum of the drainage of the aqueous temper. ( Millodot, 2004 )

Presents, the people who populating in developed states or developing states paid more attending of wellness of the eyes, it is the why some of the developed states which will supply regular oculus trial to their state, for illustration, U.K. Checking the oculus force per unit area is one of the of import portion within the oculus scrutiny in UK, it is because the unnatural force per unit area of the oculus is one of of import factor of hazard of glaucoma. And glaucoma is one of the popular oculus diseases in the universe. So the oculist is really concern on the intraocular force per unit area ( IOP ) .

Glaucoma may damage the ocular map by mechanical theory and vascular ischemic theory. Mechanical theory stated that the addition of the intraocular force per unit area which elongate the laminar beams and do the harm ganglion cells on the retina ( Josef, 2002 ) . And the other theory, vascular ischemic theory stated that the deficient supply of the blood for the ganglion cell on the retina which cause by the addition of the intraocular or the other hazard factors accordingly ( Josef, 2002 ) .

Nowadays, there are many types of the diseases are discovered. And there are many drugs utilizing to handle the unwellness in the universe. Some of it may used for short term, e.g. the medicine used to handle the grippe or cold. And some of these medicine will utilize for long term, it may used to command the abnormalcy or abnormality in our organic structure, e.g. command the blood force per unit area or the degree of the cholesterin etc. Most of these drugs are systemic drugs which are used by unwritten or injection, some of the survey showed that there are some effects on the intraocular force per unit area ( Leopold, 2001 ) ( Volkan, 2005 ) . And it is the chief point why this thesis started and it is because there is non many surveies review the impact of intraocular force per unit area by the systemic medicine.

In this thesis, I will by and large reexamine different types of the systemic medicine which may do the consequence on the IOP. It is because the blood force per unit area has really closed relationship with the intraocular force per unit area. Some of the systemic medicines are reviewed that are chiefly used to handle the cardiovascular disease and some other abnormalcy of the organic structure. The chief determination of this thesis is traveling to happen how much does the medicine impact on the intraocular force per unit area ( IOP ) . Some of the surveies which traveling to reexamine is mensurating how are the optic blood flow and some about the aqueous dynamic affect by the systemic medicine.

I am looking the medicine which may impact the IOP, the list is shown below:

Acetazolamide

Dexamethasone

Esmolol

Hormone replacing therapy ( HRT )

Nitric Oxide

Sildenafil Citrate

Triamcinolone

Chapter 2 – Drugs

2.1 Acetazolamide

It is a carbonaceous anhydrase inhibitor which is used to diminish production of aqueous wit in the oculus and the intraocular force per unit area. And it can diminish the elimination of nephritic tubule cells. It is because it can raise the H2O elimination by the kidney, so it may utilize a diuretic agent for the patient ( Amy, 1996 ) . It can be use as ague mountain illness intervention agent as demand while at high height ( Amy, 1996 )

2.2 Dexamethasone

It is a corticoid. As we know corticosteroid is used to handle the inflammatory status. It can be formed as tablet, injection solution, oculus beads and oculus unction for prescription ( Hawthorn, 2003 ) . For this medical specialty, it can be used to handle the arthritic disease and daze & A ; intellectual hydrops by endovenous injection ( Hawthorn, 2003 ) . It besides can used as diagnosis drug for Cushing disease why caused by exogenic glucocorticoids therapy normally ( Burch, 1994 ) .

2.3 Esmolol

It is a beta-blocker which is used for cardio job. They are commanding the musculus of the bosom which block stimulates the beta receptors of the sympathetic nervous system by noradrenaline. The beta-blocker is normally used to handle the high blood pressure in younger and older patients presents ( Che, 2009 ) . This can be used by orally or endovenous extract. It is used to handle the bosom arrhythmias which is the status that the patient with irregular pulse beat ( Mikel, 2005 ) . Besides it can be used to handle the high blood pressure that occurs after the surgery.

2.4 Hormone replacing therapy ( HRT )

It is a uninterrupted combined therapy with oestrogen and progestin ( both are the endocrines ) which are taken every twenty-four hours. It can be taken by tablet orally or taken by skin spot or implant. It is aim to bring forth a similar degree of endocrines which should be before the climacteric ( Westcott, 1993 ) . Although there are many methods to make this therapy, and the common method which used by general practician is pill signifier. It is really common utilizing in UK, US and Australia ( Westcott, 1993 ) . It is because it is easy to take and easy to set the dosage of the therapy. This therapy is used to handle the vaginal waterlessness, cystitis-like symptoms and besides it may assisting some physical symptoms, for illustration, increasing energy and assurance during the climacteric period.

2.5 Sildenafil Citrate

It besides named a Viagra. This drug is traveling to suppress the enzyme that metabolizes guanosine monophosphate ( Nazzareno, 2005 ) . It can be relax and suppress the growing of the smooth musculus cell, including of lung. It can used to handle erectile disfunction, which can better the penile hard-on due to distend the blood vass in the principal cavernosum ( Boolell, 1996 ) . And Sildenafil is developed to handle cardiac ischaemic conditions ( Jackson, 1999 ) .

2.6 Triamcinolone

It is a systemic corticoid. This drug injection is used to handle the neovascular, inflammatory and some retinal upsets ( Jonas, 2005 ) , e.g. pull off the hypercalcaemia associated with malignant neoplastic disease systemically ( Amy ) . After the injection, the drugs compound will adhere to the cytoplasmatic receptors and bring forth the reaction to make the anti-inflammatory and immunosuppressive effects.

Chapter 3 – Intraocular Pressure & A ; Measurement

3.1 Intraocular Pressure ( IOP )

Intraocular Pressure ( IOP ) may impact by the corneal rigidness or the corneal thickness. Some study stated that the thicker the cornea, the higher the intraocular force per unit area and the dilutant the cornea, the lower the IOP measuring consequence ( Herndon, 1997 ) . The clinical probe of the everyday oculus test the normal IOP measuring value should be under 21mmHg. The average IOP should be about 16mmHg ( Asrani, 2000 ) . Besides the IOP should hold a fluctuation due to the clip of the twenty-four hours, e.g. forenoon and eventide, pulse, degree of blood force per unit area, respiration and medicine. And the normal diurnal fluctuation is 4mmHg and the glaucoma oculus may be 10mmHg or above ( Loffler, 2006 ) . The value of IOP is controlled by the rate of aqueous wit production by ciliary organic structure and the drainage system of aqueous wit in the anterior oculus through the canal of Schlemm ( Duo, 2002 ) . Besides some of the fluid may go through from posterior chamber to anterior chamber through the student, but it is bulk go throughing through by the trabeculate web.

There are some factors may impact the IOP ( Loffler, 2006 ) :

The degree of aqueous wit production

The obstructor encountered in the drainage system

The episcleral venous force per unit area

Other chief vessel force per unit area of the eyes and non-pathological factors, such as age or the sum of of H2O or java consumption.

3.2 Measurement of IOP

The measuring of intraocular force per unit area is called “ Tonometry ” . It is mensurating the force per unit area or tenseness of the oculus. The instrument which is used to step is called “ Tonometer ” . Nowadays, tonometry is one of the of import process to measure the patient have glaucoma or non in the normal oculus trial. There are different types of the tonometry, chiefly divided into contact and non-contact. The theory of the former requires local anaesthetic and the latter is non due to utilize the air whiff and the detector.

3.2.1 Contact tonometry

The first rule of contact tonometry is indentation theory. The instrument which developed by this theory is mensurating the grade of feeling or indenture produced by the known weight. The patient is required to lie horizontally and the instrument is placed on their cornea. But there is some job of this theory of the measuring, such as surface tenseness force due the sum of thickness of tear movie and the snap of optic wall due to the thickness of cornea ( Henson, 1996 ) . The original design of this type of tonometer is a known weight of speculator rod which passed through a concave footplate, and the terminal of rod has the same curvature with the footplate which contacts to the oculus.

Tonography is an electronic tonometer developed by the indenture theory. This instrument is required to go forth on the oculus surface for several proceedingss. It is besides assume that the IOP will lift ab initio and fall down bit by bit.

The 2nd theory of tonometry is called “ applanation tonometry ” . It stated that is mensurating the force which can flatten a standard country of the corneal surface due to the Imbert-Fick jurisprudence. The jurisprudence stated that is accurate merely for the spherical surface with thin membrane, absolutely dry, flexible and elastic. The value is measured by the external force which the fixed country is flattened.

Figure 1 Schiotz Tonometer

The first tonometer which is developed by this theory is Schiotz Tonometer which is utilizing with the Friedenwald ‘s nomograph ( Elliott, 1997 ) .

Figure 2 Goldmann Tonometer

The 2nd tonometer which is developed by the applanation theory is Goldmann Tonometer. It is besides a gilded criterion instrument of IOP measuring due to the truth. It is still a good guideline, standard and desirable instrument utilizing by the oculus attention professional. And there are few grounds why the Goldmann tonometer is truth.

Due to dry surface of the Imbert-Fick jurisprudence, the country of instrument caput which contact to the corneal surface is about 3.06mm in diameter, covert to the sum of country is 7.35mm2. so the sum of fluid in applanated country is really little, so it can accommodate to the dry surface demand ( Moseley, 1983 ) .

Due to the really little applanated country, it can be presume that the force which produces by the tear movie is equal to coerce which applanate on the corneal surface

It is simple transition due to the force in gm is equal to 1/10th of the IOP in mmHg ( Henson, 1996 ) .

The Goldmann tonometer is including applanated caput and spring loaded lever. It is used mounting on a slit-lamp. When utilizing Goldmann tonometer, the local anaesthesia and fluorescent dye is required. During the scrutiny, the applanated caput is reaching to the corneal surface, and the practician would see the applanated country through the slit lamp microscope. The value of force per unit area is measured by seting the spring- loaded lever until the standard round fluorescent dye pattern shown in the microscope. There are many advantages why the Goldmann tonometer being a criterion in the professional field, ( 1 ) sensible monetary value ; ( 2 ) eliminated corneal rigidness consequence ; ( 3 ) patients are non required to be lie ( 4 ) it is really of import demand either in pattern or research – quotable consequence.

After the Goldmann tonometer developed, the other harmonizing to applanation theory tonometer is “ Perkin tonometer ” which is normally seen and utilize in the pattern.

3.2.2 Non-contact Tonometry ( NCT )

There are few common non-contact tonometers, such as Reicher Non-Contact Tonometer, Keeler PulsAir Tonometer and Topcon CT-60 or CT-80. Both of them is used a same technique which is used a rapid air pulsation to applanate the cornea and detected by the electro-optical system. The detected force of the air whiff of the applanation which is the intraocular force per unit area measured ( Schlote, 2005 ) . The differenve between the non-contact tonometer and the Goldmann tonometer is about 3mmHg ( Moseley, 1983 ) . So the non-contact tonometer can non be the criterion to diagnosing, it play the function in the everyday oculus cheque as a fast and simple showing. But now, the consequence of modern non-contact tonometers is shown that the consequence is really correlative with Goldmann criterion, such as a new non-contact tonometer, Reichert AT550 ( Jorge, 2002 ) . It is because the non-contact tonometry is mensurating without any contact between the cornea and the instrument, so it can diminish the opportunity of disease transmittal potentially. Therefore, if the public presentation of the non-contact tonometer is similar to the contact tonometry, the non-contact tonometer should be one of the criterion for diagnosing and used more often in the pattern.

Chapter 4 – Aqueous Humor and Anatomy of Eye

4.1 The aqueous wit system

The aqueous wit which is the fluid found in the oculus in the front tooth and posterior chamber. And it is clear and colorless liquid. It plays a really of import function in the oculus metamorphosis because the fluid brings the foods and O for the avascular tissues in the oculus, such as, cornea and the intraocular lens. There is some alteration of the sentiment on the production of aqueous wit. The first theory of production is that the aqueous wit is produced by ciliary procedures ( Saude, ) . Then it changes the construct that the fluid is produced by ultrafiltration and dialysis. Nowadays, the modern and general theory showed that the aqueous wit is produced or secreted by the cililary epithelial tissue. For the constituents of aqueous wit, it contains electrolytes, glucose, ascorbic acid, protein etc. and besides Na and chloride ( Saude ) .

There is an outflow system with different degree to assist the aqueous wit circulation. The obvious one is trabeculate net, and so to the Schlemm ‘s canal which located in the sclerotic coat tissues. After that, it will run out into the anterior ciliary venas. The other system is is uveoscleral drainage system, it is working when the force per unit area in suprachoroid is 2-4mmHg lower than the force per unit area in the anterior chamber ( Forrester, 2002 ) , some of the glaucoma intervention is utilizing this drainage system by lifting the escape of this system to diminish the intraocular force per unit area ( Forrester, 2002 ) , such as prostaglandin. The last system is episcleral circulation, which is working the intraocular force per unit area is over 15 mmHg as shown many old ages ago survey ( Forrester, 2002 ) . The aqueous will run out into the the Schlemm ‘s canal by trabeculate net and so into the episcleral vena.

Function of aqueous wit

Bringing the O and nutritions to the avascular optic tissue, e.g. cornea

Bing a metamorphosis agent for for the avascular tissues

Retain the intraocular force per unit area and maintain the form of the orb

Defend the pathogens due to the immunogloblulins in the aqueous by immune reaction

4.2 Episcleral Vein

The episcleral vena located in the outer bed of sclerotic coat which is called “ episclera ” , and it is place near the border of the cornea and the system of trabeculate net. The episcleral vena got a really close relationship with the escape of the aqueous wit, and aqueous wit escape system is correlated with the intraocular force per unit area. And episcleral vena is one of the drainage systems of the aqueous wit. Some of the survey showed that there is a force per unit area alteration of the episcleral vena. Some of the survey show that when the episcleral vena force per unit area alterations, the intraocular force per unit area will alter besides. And the value show that they are really similar, if the episcleral vena alteration about 1mmHg, the IOP will besides alter 1mmHg ( Friberg, 1987 ) .

And the blood force per unit area is correlated with the optic force per unit area if there is the alteration of the blood force per unit area and showed in some old survey ( Bulpitt, 1975 ) . So it means that episcleral vena force per unit area, blood force per unit area and intraocular force per unit area has really closed relationship between them. And some of the system interventions or therapies show that there are some alterations with those force per unit areas of three of them. It is besides the chief point why this thesis is created

Chapter 5 – Determination

Acetazolamide

Range ( mmHg )

Duration of intervention

Control Group

Pre-treatment

Intraocular force per unit area

10.0 – 21.0

Post-treatment

Intraocular force per unit area

6hrs after intervention

14.0 – 31.5

Post-treatment

Intraocular force per unit area

24 hours after intervention

12.0 – 27.0

Table 1. The intraocular force per unit area of the scope between the pre-treatment and the post-treatment of the drug acetazolamide

The difference between the pre-treatment and post-treatment is increasing from 12.0 – 21.0 to 14.0 – 31.5 in the continuance of intervention is about 6 hours after the first intervention has been taken in the control group. The scope between before the intervention and after the intervention is about 10mmHg in 6 hours after the intervention. The per centum of the scope is different with the pre-treatment is about 45 % addition. The different between the pre-treatment and post-treatment in the control group is increasing about 5mmHg after 24 hours intervention. The per centum of the scope between it alteration is about 28 % addition.

For the intervention group which is taking acetazolamide. The difference between the pre-treatment and post-treatment is increasing about 4.5mmHg after 6hours intervention. The per centum of this group alteration is about 21.4 % addition. And after 24 hours intervention, the intraocular force per unit area is important lessening about 3mmHg. The lessening per centum is about 25 % in the intervention group which took 24 hours intervention.

Acetazolamide

Mean A± SD ( mmHg ) ( 95 % assurance intervals )

Duration of intervention

Control Group

Pre-treatment

Intraocular force per unit area

15.69 A±2.76

Post-treatment

Intraocular force per unit area

6hrs after intervention

20.1 A±5.57

Post-treatment

Intraocular force per unit area

24hours after intervention

16.15 A±2.99

Table 2. The chart of mean and standard divergence between intraocular force per unit area of the the pre-treatment and the post-treatment of the drug acetazolamide in 6 hours and over 1 hebdomad intervention

Table 2 shows the average alteration of the intraocular force per unit area. For the control group, the value of the intervention which taken after 6 hours, the mean of IOP will traveling higher than before intervention about 4mmHg, and the standard divergence is besides addition from 2.76 to 5.57. After one hebdomad intervention, the difference between the pre-treatment and post-treatment, the mean of IOP is somewhat increasing approximately less than 1 mmHg every bit good as the standard divergence. In the intervention group, the tabular array shows the intraocular force per unit area is diminishing bit by bit from the pre-treatment to the post-treatment after one hebdomad. And the standard divergence is somewhat increasing after 6 hours intervention. But eventually after 24 hours intervention, the intraocular force per unit area is significantly diminishing from 17 to 14 mmHg.

Dexamethasone

Mean A± SD ( mmHg ) ( 95 % assurance intervals )

Pre-treatment

Intraocular force per unit area

16.4 A± 3.7

Post-treatment

Intraocular force per unit area

After 1stweek with upper limit dosage

19.7 A±3.7

P value & lt ; 0.0001

Post-treatment

Intraocular force per unit area

Between after 1stweek and before 3rdweek with lower limit dosage

15.8 A±4.3

P value & lt ; 0.0001

Stop intervention after 3rdweek

16.0 A±4.0

P value = 0.07

After 9thweek and intraocular force per unit area

14.5 A± 3.3

P value = 0.062

Table 3. The chart of mean and standard divergence of intraocular force per unit area between the pre-treatment and the post-treatment of the drug Decadron after 1st hebdomad in upper limit dosage, 3rd hebdomad with lower limit dosage and halt the intervention and mensurating the IOP after 3rd hebdomad & A ; 9th hebdomad so halt the research

From table 3, before the intervention of the Decadron, the mean of the intraocular force per unit area ( IOP ) is 16.4, but after the intervention with upper limit dosage, the intraocular force per unit area had important addition from 16.4 to 19.7. And after 1st hebdomad, the intervention has alteration to minimum dosage, so the IOP lessening about 4mmHg, to 15.8 mmHg. After the 3rd hebdomad, the intraocular force per unit area has somewhat increased 0.2 mmHg when the intervention is stopped. In the concluding hebdomad ( 9th hebdomad ) , the mean of intraocular force per unit area is 14.5mmHg.

Esmolol

Mean A± SD ( mmHg ) ( 95 % assurance intervals )

Duration of intervention

Placebo Group

Intraocular force per unit area before intervention

16 A±5

Mean arterial force per unit area ( mmHg )

93 A± 11

Intraocular force per unit area ( mmHg )

15 A±3

Table 4. The chart of mean and standard divergence of arterial force per unit area and intraocular force per unit area between the placebo group and intervention group of the drug Esmolol, all the p-value is & gt ; 0.05

Table 4 shows that the Brevibloc working in placebo group the, intraocular force per unit area is little lessening about 1 mmHg. And in the intervention group, the intraocular force per unit area is besides lessening from 16 to 15 by 1 mmHg. But for the arterial force per unit area, there is difference between placebo group and the intervention group, there is 4 mmHg between them, so it is non a important difference between placebo and intervention group in the arterial force per unit area

Hormone Replacement Therapy ( HRT )

Scope of intraocular force per unit area ( mmHg )

Pre-treatment

16 – 20

Post-treatment

After 4thweek

12 – 15

Post-treatment

After 12thweek

13 -15

Table 5 The scope of the Hormone Replacement Therapy between the Pre-treatment and Post intervention and mensurating the IOP in 4th hebdomad and 12th hebdomad

Table 5 shows that before the endocrine replacing therapy is about 16 – 20 mmHg in intraocular force per unit area. After acquiring intervention for 4th hebdomad, the intervention is acquiring decrease significantly to 4 – 5 mmHg in the scope. And after hebdomad 12, the IOP has somewhat increase the scope from 12 -15 mmHg to 13-15 mmHg, but it is non really big difference between hebdomad 4 and hebdomad 12. And compare the hebdomad 12 consequence and the pre-treatment intraocular force per unit area. The value of the IOP shows that there is a significantly lessening after taking the intervention.

Nitric Oxide

Mean A± SD ( mmHg )

Duration of intervention

Placebo Group

Intraocular force per unit area before intervention

14 A±1

Intraocular force per unit area

After intervention 5 proceedingss

Intraocular force per unit area

After intervention 10 proceedingss

15 A±1

Table 6 The mean and standard divergence of the Nitric Oxide between the Pre-treatment and Post intervention and mensurating the IOP after intervention 5 proceedingss and 10 proceedingss.

Nitric Oxide

Scope of papillose diameter alteration ( millimeter )

Before-treatment

4.1 A±0.2

After-treatment

4.1 A±0.2

Table 7 The scope of pupil diameter alteration before and after the intervention.

In table 6 shows that in the placebo group, the Intraocular alteration of before the intervention and after the intervention 10 proceedingss, the IOP is somewhat increase about 1 mmHg. And in the intervention group, the value of IOP before the intervention is same as the placebo group. And the IOP is measured in 5 and 10 proceedingss after the intervention. In the 5 proceedingss measuring, it IOP is diminishing by 2 mmHg. And so mensurate the IOP after intervention 10 proceedingss. The intraocular force per unit area is increasing somewhat by 1 mmHg.

In table 7, it is mensurating the diameter of the student alteration, and there is no alteration in before and after intervention. The difference between the scopes is besides the same as 0.2 millimeter in diameter.

Sildenafil Citrate ( Viagra )

Mean A± SD ( mmHg )

Dose of drug

Pre-treat

6 hours

Placebo

12.3 A± 2.2

10.6 A± 2.9

10 milligram

14.5 A± 3.0

13.8 A± 3.4

50 milligram

12.8 A± 3.5

9.3 A± 3.1

100 milligram

12.3 A± 2.7

10.3 A± 1.8

150 milligram

13.0 A± 2.4

10.5 A± 3.2

Table 8 the mean and standard divergence alteration of the Viagra citrate intake 10 milligram, 50mg, 100mg and 150mg. And mensurating the intraocular force per unit area before intervention, after intervention 6 hours and 24 hours

In table 8, there is a research with 10 milligrams, 50 milligram, 100 milligram and 150 milligram between 24 hours. For the placebo group, the alteration lessening about 1.6 mmHg after 6 hours intervention. And after 24 hours, the IOP addition to the same degree as the pre-treatment. For the 10 mmHg, there is non a large alteration after 6 hours intervention and 24 hours intervention, the alteration of IOP is merely about diminishing 0.7 mmHg in 6 hours and increase to 14.7 mmHg. But compare with the pre-treatment consequence and the 24 hours consequence, this is non much difference between them. For the 50 milligram, from the pre-treatment to 6 hours intervention, the alteration is lessening to 12.8 to 9.3 by over 3 mmHg. In the 24 hours of this dosage of drug, the IOP is increasing 1 mmHg after the 6 hours measuring. Compare the 24 hours and the pre-treatment, the IOP is still diminishing although the IOP is increasing after 6 hours. In 100 milligram group, the IOP is change by about 2 mmHg from the pre-treatment to after 6 hours. And after 24 hours, the IOP is increasing to 13.7. And comparing with the pre-treatment and after 24 hours, the IOP is increasing by over 1 mmHg. In 150 milligram group, after the intervention 6 hours, the intraocular force per unit area is diminishing form 13 to 10.5 and increasing back to 12.5 after 24 hours. The difference between pre-treatment and after 24 hours, the IOP is somewhat decrease 0.5 mmHg. Although there is a somewhat alterations in the IOP after the intervention after 6 hours, but in the long term there is no important alteration in the IOP

Sildenafil Citrate ( Viagra )

Mean A± SD ( mmHg )

Dose of drug

Day 1

Day 4

Placebo

14.0 A±1.4

14.3 A±2.1

50 milligram

16.3 A±2.7

15.2 A±2.3

100 milligram

13.8 A±3.5

12.7 A±1.6

Table 9. the mean and standard divergence alteration of the Viagra citrate consumption 50mg and 100mg

In table 9, it shows that there is non much alteration in the placebo group either in twenty-four hours 1, twenty-four hours 4 and twenty-four hours 7 measurings. And in twenty-four hours 7, it merely hold little diminishing 0.5 mmHg, it is non really important alteration. And in the 50mg intervention grourp, the IOP is bit by bit diminishing from 16.3 to 15.2 in Day 4 and 15.0 in Day 7. And in 100 milligram group, the decreasing alteration is high in twenty-four hours 4 by 1.1 mmHg, but increase in Day 7 from 13.8 to 14.3 mmHg with about 0.5 mmHg

Triamcinolone

Duration of intervention

Range ( mmHg )

Before intervention

10.2 – 18.3

1-day after

8.7 – 22.7

2-day after

10.2 – 21.2

1-week after

10.9 – 21.2

2-week after

12.2 – 20.3

6-week after

14.2 – 19.8

Table 10 The scope of the Aristocort between before intervention and after 6 hebdomads follow up

The biggest of the lower limit and maximal intraocular force per unit area is after one twenty-four hours, the difference in this scope is about 14 mmHg with minimal and maximal. The smallest scope of this drug is after 6 hebdomads measuring, it is merely have 5.6 differences between lower limit and upper limit.

Triamcinolone

Duration of intervention

Intraocular Pressure ( Mean A± SD ( mmHg ) )

Before intervention

14.99 A± 2.43

1-day after

15.21 A± 1.85

2-day after

14.67 A± 2.6

1-week after

15.24 A± 2.27

2-week after

15.90 A± 1.83

6-week after

16.76 A± 1.16 p-value & lt ; 0.05

Table 11 the mean and standard divergence of the Aristocort between before intervention and after 6 hebdomads intervention

In table 11, it shows that there is little addition in IOP in the intervention after one twenty-four hours. Then the intraocular force per unit area lessening about 0.5 mmHg after 2 yearss. Then is bit by bit increase from the 2nd twenty-four hours after the intervention to 6 hebdomads, the scope of the alteration is about 2 mmHg. After 6 hebdomads, the IOP difference between 6 hebdomads and before the intervention is increasing approximately 1.7 mmHg. It besides shows that there is important alteration in 6 hebdomad after.

Chapter 6 – Discussion

Acetazolamide is one of the unwritten medical specialties which is the systemic carbonaceous anhydrase inhibitors. The anhydrase inhibitors are commanding the fluid secreation, including corneal endothelium, ciliary procedure and retina due to the reaction of different carbonaceous anhydrase receptors, such as obstruction. It is traveling selectively suppress the carbonaceous anhydrase in ruddy blood cell and capillary endothelium ( Vital, 2003 ) . Due to reaction of acetazolamide, it has been developed for lower the intraocular force per unit area for glaucoma patient in 1954 ( Becker, 1954 ) . So the acetazolamide show it have ability to diminish the intraocular force per unit area. Some of the surveies for this drugs for the glaucoma, they will compare the consequence on the flow of aqueous wit with the other topical drug, such as dorzolamide combined with Blocadren or acetazolmide ( Toris, 2004 ) and Rosenberg researched the combination of unwritten acetazolamide and topical drug for diminishing the intraocular force per unit area and the formation of the aqueous wit ( Rosenberg, 1998 ) . In 1993, Chiou who do the experiment about the consequence of the drugs affect on the optic blood flow for the optic high blood pressure, it shows that the acetazolamide will impact the blood flow and choroid ( Chiou, 1993 ) . So it can reason that when the blood flow addition in this two bed of the eyes, the intraocular force per unit area of the oculus will be lessening. Besides, this drug will be usage for the diuresis, and the dose if similar to the research in determination, both are about 250mg. In the determination of this study, the consequence shows that there is large difference between the control group and the intervention group after 6 hours intervention. The highest 1 in the control group, it is increasing over 10 mmHg after 6 hours in the placebo group. After 6 hours intervention in the intervention group, the addition of scope is evidently lower than the placebo group. And in the mean of the determination, it shows that there is a important lessening in the intervention group after 24 hours intervention. So mention to our subject, it means that acetazolamide hold a consequence which can impact to the intraocular force per unit area. It is because it can be impact the creative activity of the aqueous wit and besides got the ability to diminish the intraocular force per unit area.

Dexamethasone is an anti-inflammatory drugs, which will uses in hypercalcaemia related with malignant neoplastic disease ( Amy ) . Or handle the rheumatoid arthritis and autoimmune upset for short term intervention. Some of the surveies ( Pak, 2008 ) stated that there are many neonatologists are utilizing this type of the drugs, Decadron, for the chronic lung disease instance in high dose intervention. The determination shows that there is important consequence during the intervention even though the dosage of the drug is in high dosage or in the low dosage. But in the high dosage intervention, the intraocular force per unit area is important increasing over 3 mmHg. So it is a large affect of the intraocular force per unit area. For the low dosage intervention, it is somewhat decrease in the intraocular force per unit area. So if utilizing this drugs to make the intervention for the long term, it should be hold a effectual on the intraocular force per unit area. Some of the surveies stated that the ground why the corticoid drugs will impact the intraocular force per unit area is non be clarified. But in some surveies shows that there would be the ground that this drugs is impacting the trabecular net which is the of import system commanding the escape of the aqueous wit ( Hernandez 1983, Clark 1995 ) . It is because the steroid cell is extremely situated in the trabeculate net ( Clark ) . So it will impact the cistron of the trabeculate net and the endothelial bed of the canal of Schlemm, so will be increasing the size of the web in the trabecular net which is diminishing the infinite of the web and increasing the intraocular force per unit area due to blockade the escape of the aqueous wit. And the other ground that why the intraocular force per unit area will increase is one of the enzymes call ‘lysosomal ‘ halt to respond with the glycosaminoglycans ( Pak, 2008 ) which the component can establish in many cells. And it is because the glycosaminoglycans is massing up in the trabeculate net. And it is because of this reaction, the escape of the aqueous wit utilizing the trabeculate net is restricted ( Skuta 1996, Bartlett 1999 ) . In the determination, we would see that when the patient acquiring the extremely dosage of the intervention, the IOP will increase significantly after the intervention in 1st hebdomad. And so if the dosage is decreased, the IOP will be diminishing significantly. And when the intervention is stopped, the alteration of the IOP is merely somewhat and besides there is non important alteration for the few hebdomads after the intervention is stopped.

Esmolol is a beta-adrenergic blocking agent which is used to respond with the beta-1 sympathomimetic receptors of the bosom. So it is utilizing for take downing the blood force per unit area with really rapid oncoming and in really short clip. In the determination, the value of the research between the placebo group and the intervention group, there is non important between them, either in the arterial force per unit area and the intraocular force per unit area. But in some of the survey shows that there is a important difference in the bosom rate after 1-2 proceedingss after the intervention, the value of the bosom rate is difference between the control and the intervention group with about 8 beats per minute which is lower in the intervention group ( Anthony, 1992 ) . The continuance of this reaction is merely demoing in 2 proceedingss after the drugs is taken. Although the high systemic blood force per unit area can do the IOP higher than 40 mmHg ( Cunningham 1981, Donlon 1991 ) , but Macri experiment study shows that there is non really near relationship between the general blood force per unit area and the intraocular force per unit area. In the determination and some of the consequence with different study, if the drugs affected the general blood force per unit area, it would non hold a large consequence to the IOP due to they are non close relationship between of them, such as the emsolol have and important alteration in the bosom rate at the short period of reaction clip, but they do non hold a important value altering in the intraocular force per unit area.

Hormone Replacement Therapy ( HRT ) , Sator experiment shows that there is important alteration in the intraocular force per unit area with the HRT ( Sator 1997 ) . HRT is the intervention which is utilizing in the climacteric adult females. Some of the survey shows that the replacing of the Lipo-Lutin can be take downing the IOP ( Alatak 1977 ) . Some of the drugs utilizing for the replacing for female sex endocrine will be impact the base of the azotic oxide synthetase. And the azotic oxide is one of the of import characters in the smooth musculus, and due to the ciliary organic structure is one of the smooth musculus. Because of the azotic oxide synthetase affect to the smooth musculus, the IOP will hold important alteration after HRT due to the ciliary organic structure has many smooth musculus which is create the aqueous wit. And one of the ground that affect the IOP, is the sum of the production of aqueous wit, so that is the why the HRT can impact the IOP.

In the determination, the azotic oxide shows that there is important lessening with the IOP. It is utilizing the L-argininie which is a non-toxic amino acid. It will change over to azotic oxide by azotic oxide synthase. In the research, the research worker besides measured the student diameter which is no difference between the control group and the intervention group. So the important of take downing the intraocular is non the alteration of the size of student. It could be suggest that due to the production of aqueous wit or the more the azotic oxide production increasing by the L-argininie consumption. The study of Urabe shows that the L-argininie will do the addition in urinary elimination of azotic oxide metabolites. Some of the study shows that L-argininie can diminish the intraocular force per unit area ( Wiederholt 1994, Nathanson 1995, Francine 1996 ) . The outflow system of the aqueous wit is one the site have many azotic oxide synthesis, it can be conclude that the higher the IOP is holding less and less azotic oxide. And in the Nathanson determination in 1995, this states that the azotic oxide is play a of import commanding map of the IOP.

For the Viagra, there is no important alteration in the IOP for usage the Viagra for long term. And in the other survey, which is seeking the Viagra affect to the retinal blood vas diameter. The consequence of the research is demoing that there is no important alteration after utilizing the drug, Viagra. Although the drug is used to handle the cardiac ischaemic disease ( Parker, 1998 ) , and there is no alteration of the retinal vas diameter and the IOP.

Triamcinolone, it is the other corticoids in this thesis. This drug may assist the diabetic retinopathy, macular hydrops and other oculus disease ( Jonas, 2003 ) . The side consequence of the steroid is the increasing of intraocular force per unit area. So the steroid can non be usage for long term to handle for the oculus disease because it will do the lift of intraocular force per unit area, it is really harmful to the ocular nervus. And the higher the intraocular force per unit area, the higher the hazard of acquiring the glaucoma.

In the decision, it can reason that the some of the systemic medicine consequence can be increase the IOP, some can take down the IOP. So if the drugs can alter the IOP higher, it can non be usage for a long term, such as steroid group of the drug, Dexamethasone etc. And some of the therapy can do the IOP significantly lower, such as HRT. This therapy can be develop for a new therapy for the IOP. And the other is the azotic oxide which is the harmless component to the homo, it play a of import functions in commanding of the IOP, so it may besides be develop to a new therapy or drugs for the intervention of the glaucoma or used to take down the intraocular. Some of the drug do non do any important different after consumption with them, so they are good for long term usage. Finally, drugs can be a important alteration of the IOP value, so during all the oculus scrutiny, all the oculist is necessitating to inquire what medicine did the patient is taking and it will assist to do the consequence and advice more accurately.

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