Intravenous Hypertonic Saline to Lower Intraocular Pressure in Ocular Hypertension and Primary Open-angle and Exfoliation Glaucoma.
Inborr Pia Katriina, Harju Mika, Kivelä Tero T
AI Summary
Intravenous hypertonic saline effectively lowered elevated intraocular pressure in patients with ocular hypertension, POAG, and exfoliation glaucoma, offering a potential rapid IOP-reducing option.
Abstract
Purpose
The purpose of this article was to quantitate the effect of intravenous hypertonic saline (IVHTS) on elevated intraocular pressure (IOP) among 3 groups of glaucoma patients or suspects.
Materials and methods
Among the forty-four patients with IOP 24 to 30 mm Hg included in this study, 13 had ocular hypertension (OHT), 14 primary open-angle glaucoma (POAG), and 17 exfoliation glaucoma (ExG). Participants received a bolus of 23.4% IVHTS (1.0 mmol/kg) through an antecubital vein. We measured IOP, heart rate, and blood pressure before the bolus, thereafter every minute for 10 minutes, and less frequently for 2 hours.
Results
The median baseline IOP was 24 mm Hg (range, 24 to 30 mm Hg), 26.5 mm Hg (range, 24 to 30 mm Hg), and 26 mm Hg (range, 24 to 30 mm Hg) in OHT, POAG, and ExG patients, respectively. Sixteen minutes after the bolus, IOP was a median of 9 mm Hg (range, 4 to 12 mm Hg), 10 mm Hg (range, 6 to 12 mm Hg), and 10 mm Hg (range, 4 to 14 mm Hg) lower in OHT, POAG, and ExG groups (P=0.70), respectively. After 1 hour, the median IOP reduction was similar between ExG (9 mm Hg; range, 4 to 14 mm Hg) and POAG patients (9.5 mm Hg; range, 6 to 12 mm Hg) but lower in OHT patients (6 mm Hg; range, 2 to 9 mm Hg; P=0.006). Heart rate decreased by a median of 7 beats/min. Blood pressure increased within 3 minutes (median, mm Hg; 15 systolic; 5 diastolic), but returned to baseline at 10 minutes. Within 1 to 3 minutes of treatment, 36 (82%) patients felt pain in the infusion arm, and 29 (66%) reported a feeling of warmth in their head.
Conclusions
IVHTS reduced IOP effectively in all groups.
MeSH Terms
Shields Classification
Key Concepts5
Intravenous hypertonic saline (IVHTS) reduced intraocular pressure (IOP) effectively in patients with ocular hypertension (OHT), primary open-angle glaucoma (POAG), and exfoliation glaucoma (ExG).
Sixteen minutes after a bolus of 23.4% intravenous hypertonic saline (1.0 mmol/kg), the median intraocular pressure (IOP) reduction was 9 mm Hg (range, 4 to 12 mm Hg) in ocular hypertension patients, 10 mm Hg (range, 6 to 12 mm Hg) in primary open-angle glaucoma patients, and 10 mm Hg (range, 4 to 14 mm Hg) in exfoliation glaucoma patients (P=0.70).
One hour after intravenous hypertonic saline administration, the median intraocular pressure reduction was similar between exfoliation glaucoma patients (9 mm Hg; range, 4 to 14 mm Hg) and primary open-angle glaucoma patients (9.5 mm Hg; range, 6 to 12 mm Hg), but lower in ocular hypertension patients (6 mm Hg; range, 2 to 9 mm Hg; P=0.006).
Intravenous hypertonic saline caused a decrease in heart rate by a median of 7 beats/min, and an increase in blood pressure within 3 minutes (median 15 mm Hg systolic; 5 mm Hg diastolic) which returned to baseline at 10 minutes.
Within 1 to 3 minutes of intravenous hypertonic saline treatment, 36 (82%) of 44 patients felt pain in the infusion arm, and 29 (66%) reported a feeling of warmth in their head.
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