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Intraocular pressure changes following topical ocular hypotensive medications washout
  1. Henrietta Ho1,
  2. Arij Daas1,2,
  3. Jason Ho1,
  4. Pouya Alaghband2,3,
  5. Elizabeth Angela Galvis2,
  6. Alba de Antonio Ramirez2,
  7. Piergiacomo Grassi1,
  8. Rongxuan Lim1,
  9. Kin Sheng Lim1,2
  1. 1 Department of Ophthalmology, St. Thomas' Hospital, London, UK
  2. 2 KCL Frost Eye Research Department, King's College London, London, UK
  3. 3 Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, North Yorkshire, UK
  1. Correspondence to Mr Kin Sheng Lim, Department of Ophthalmology, St Thomas' Hospital, London, UK; sheng.lim{at}


Background To review the changes in intraocular pressure (IOP) following topical hypotensive medications washout in patients with primary open angle glaucoma (POAG), ocular hypertension (OHT) and uveitic glaucoma (UG)/OHT.

Methods The study included 120 patients with POAG, OHT and UG recruited from prospective clinical trials between February 2013 and July 2017. We excluded 20 eyes with IOP of ≤21 mm Hg, 11 eyes with previous incisional surgery and 17 eyes with incomplete data. UG eyes with active inflammation and on steroid treatment were excluded. Participants underwent a 1-month washout period from topical ocular hypotensive medications before IOP phasing. Comparisons were made between pre/post-washout IOP, and highest-recorded (peak) and post-washout IOP.

Results A total of 110 eyes with POAG, 33 eyes with OHT and 43 eyes with UG were included for analysis. The mean pre-washout IOP was 18.1±3.3 mm Hg in POAG, 18.8±3.3 mm Hg in OHT and 17.9±8.8 mm Hg in UG; the mean post-washout IOP was 26.6±4.8 mm Hg, 26.4±3.9 mm Hg, 23.1±10.1 mm Hg in POAG, OHT and UG, respectively. The mean increase in IOP after washout was significantly lower in UG compared with POAG and OHT eyes (p=0.01). The percentage of eyes with post-washout IOP <22 mm Hg was 12.7% in POAG, 6.1% in OHT and 51.2% in UG.

Conclusion Active inflammation and steroid treatment contributes to elevated IOP in uveitis. Therefore, IOP may revert to normal once inflammation subsides. We recommend ocular hypotensive treatment washout to be considered in UG eyes that have IOP under control in the absence of recurrence of uveitis.

  • prospective clinical trials
  • IOP phasing
  • uveitic glaucoma

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  • Contributors HH and KSL made primary contributions to data analysis, interpretation of results and writing of the manuscript. HH, JH and KSL contributed to the study conception and design. All authors contributed to interpretation of results, all revised the manuscript critically for important intellectual content and all approved the final manuscript.

  • Funding Mr Lim is supported by research grants from Ivantis, Eye Tech Care, IRIDEX and the International Glaucoma Association. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

  • Disclaimer The manuscript represents valid work and neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere.

  • Competing interests All authors declare no conflicts of interest for the submitted work, no relevant financial activities outside the submitted work and no other relationships or activities that readers could perceive to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was deemed unnecessary by the ethics committee. However, all previous study protocols were approved by the Institutional Review Board and conformed to the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data used in the study are not included in a repository. The study includes secondary analysis from clinical trials conducted at St Thomas' Hospital, London (identifier NCT NCT02765308 and NCT02839590), whereby use was in accordance with the terms agreed upon their receipt.

  • Author note HH and KSL had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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