Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

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Previous Glaucoma Research: 2002-2006   
The Glaucoma File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Glaucoma, click HERE.
    

Latest Research on Glaucoma
     
Br J Ophthalmol. 2008 Aug;92(8):1129-33. Epub 2008 May 29.
The effect of travoprost on daytime intraocular pressure in normal tension glaucoma: a randomised controlled trial.
Ang GS, Kersey JP, Shepstone L, Broadway DC.
Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.

BACKGROUND/AIMS: To determine the medium-term effect of travoprost on the daytime intraocular pressure (IOP) of patients with normal tension glaucoma (NTG) METHODS: Newly diagnosed NTG patients underwent baseline, daytime, hourly IOP phasing. Patients were randomised to either treatment or no treatment (control). Treatment comprised once daily topical travoprost 0.004%. After 6 months, the participants underwent their second IOP phasing. RESULTS: Data from 88 participants were analysed-54 were randomised to treatment and 34 to the control group. The mean duration of treatment was 6 months. The average, maximum and minimum diurnal IOPs for treated patients were statistically significantly lower than for control patients at follow-up (p<0.001). When compared with baseline IOP, the travoprost treated group demonstrated a decrease of 16.1%, 13.5% and 16.7% in the average IOP, maximum IOP, and minimum IOP respectively. Of those treated, about one-third achieved a decrease in average IOP of at least 20%; only about one-tenth achieved a reduction of at least 30%. CONCLUSION: Travoprost monotherapy had a sustained hypotensive effect in NTG and achieved a reasonable or good response (>20% reduction in average IOP) in 32.9% of treated eyes. However, in the majority of eyes with NTG, travoprost monotherapy appeared unable to produce the desirable 30% reduction in average IOP.

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Br J Ophthalmol. 2008 Jul;92(7):901-5.
Reversal of optic disc cupping in glaucoma.
Harju M, Saari J, Kurvinen L, Vesti E.
Helsinki University Eye Hospital, Haartmaninkatu 4 C, PO Box 220, 00029 Hus, Finland. mika.harju@aad.fi

AIM: To study whether reversal of optic disc cupping after intraocular pressure (IOP) reduction is related to risk of glaucoma progression. METHODS: In this prospective follow-up study, where 51 patients with exfoliation glaucoma and five with ocular hypertension combined with exfoliation syndrome were followed for 6 years after IOP reduction, 24 showed progression of glaucoma in visual fields or optic nerve head (ONH) stereophotographs. ONH topography was measured with the Heidelberg Retina Tomograph (HRT). A decrease in HRT parameter cup volume of more than 5% was considered cup reversal. Multiple logistic regression was used to model progression of glaucoma. RESULTS: Cup reversal (OR 0.226; 95% CI 0.055 to 0.918, p = 0.037), final IOP (OR 1.216; 95% CI 1.000 to 1.479, p = 0.050) and visual field mean defect at entry (OR 1.158; 95% CI 1.034 to 1.296, p = 0.011) were associated with progression. IOP change from study entry to 6-year control visit was not associated with progression (OR 0.964, 95% CI 0.850 to 1.092, p = 0.56). CONCLUSION: Cup reversal seemed to be an independent protective factor for progression of glaucoma.

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Curr Med Res Opin. 2008 Jul;24(7):2035-43. Epub 2008 Jun 4.
Brimonidine-purite 0.1% versus brimonidine-purite 0.15% twice daily in glaucoma or ocular hypertension: a 12-month randomized trial.
Cantor LB, Safyan E, Liu CC, Batoosingh AL.
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. lcantor@iupui.edu

OBJECTIVE: To compare the safety and intraocular pressure (IOP)-lowering effects of brimonidine-purite 0.1% with the marketed formulation of brimonidine-purite 0.15% (Alphagan P 0.15%) when used twice daily (BID) by patients with glaucoma or ocular hypertension previously treated with brimonidine-purite 0.15% for at least 6 weeks. METHODS: In a 12-month, randomized, double-masked, multicenter, parallel group, non-inferiority study, patients with glaucoma or ocular hypertension who were treated with brimonidine-purite 0.15% BID were randomly assigned to continue brimonidine-purite 0.15% (n=102) or to administer brimonidine-purite 0.1% (n=105) BID for 12 months. IOP was measured at approximately 8 a.m. (hour 0) and 10 a.m. (hour 2). MAIN OUTCOME MEASURES: Mean change from baseline IOP and adverse events. RESULTS: Demographics and baseline characteristics were similar between treatment groups. Treated-baseline mean IOPs at both timepoints were similar between groups (p > or = 0.606). Brimonidine-purite 0.1% provided IOP-lowering that was non-inferior to brimonidine-purite 0.15% at each of the 12 follow-up timepoints, and there were no statistically significant between-group differences at any timepoint. The most commonly reported adverse event was conjunctival hyperemia (13.5% for brimonidine-purite 0.1%; 10.8% for brimonidine-purite 0.15%). No significant differences in the incidence of adverse events were noted between the two formulations. CONCLUSIONS: Brimonidine-purite 0.1% BID is as effective as brimonidine-purite 0.15% BID in lowering IOP in patients with glaucoma or ocular hypertension who were previously treated with brimonidine-purite 0.15%, and both formulations are well tolerated. Limitations of the study include enrollment of only patients who were already on treatment with brimonidine-purite 0.15%. The 0.1% formulation of brimonidine-purite allows for decreased exposure to brimonidine while providing an IOP-lowering effect comparable to that of the 0.15% formulation. Clinical trial registered at clinicaltrials.gov; identifier: NCT00168363.

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Ophthalmology. 2008 Jul;115(7):1109-1116.e7. Comment in: Ophthalmology. 2008 Jul;115(7):1107-1108.e1.
Longitudinal rates of postoperative adverse outcomes after glaucoma surgery among medicare beneficiaries 1994 to 2005.
Stein JD, Ruiz D Jr, Belsky D, Lee PP, Sloan FA.
Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.

PURPOSE: To determine longitudinal rates of postoperative adverse outcomes after incisional glaucoma surgery in a nationally representative longitudinal sample. DESIGN: Retrospective, longitudinal cohort analysis. PARTICIPANTS: Medicare beneficiaries >or=68 years who underwent a primary trabeculectomy (PT), trabeculectomy with scarring (TS), or glaucoma drainage device (GDD) implantation from 1994 to 2003 with follow-up through 2005. INTERVENTION: Primary trabeculectomy, TS, and GDD were identified from International Classification of Diseases (ICD-9-CM) and Current Procedural Terminology (CPT) procedure codes. Change in rates of postoperative adverse outcomes associated with these 3 surgical interventions was analyzed by cumulative incidence rates and Cox proportional hazards model regression; regression analysis controlled for prior adverse outcome measures (3-year run-up) and demographic variables. MAIN OUTCOME MEASURES: First-, second-, and sixth-year cumulative rates and probability of experiencing serious adverse outcomes (retinal detachment, endophthalmitis, suprachoroidal hemorrhage), less serious adverse outcomes (choroidal detachment, corneal edema, hypotony), and receipt of additional glaucoma surgery were identified through Medicare claims for each treatment group. RESULTS: At the 1-year follow-up, rates of severe adverse outcomes were higher among beneficiaries in the GDD group (2.0%) relative to the PT (0.6%) and TS groups (1.3%). Controlling for prior adverse outcomes to the surgery and demographic factors in Cox proportional analysis, differences were often reduced, but generally remained statistically and clinically significant. Rates of severe outcomes, less severe outcomes, corneal edema, and low vision/blindness were higher for persons undergoing GDD than PT or TS. However, rates of reoperation were higher for TS than GDD. CONCLUSIONS: The risk for adverse outcomes was higher in GDD than in PT surgery or TS, controlling for a number of important case mix and demographic factors.

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BMC Ophthalmol. 2008 Jun 11;8:11.
Comparative study of the stability of bimatoprost 0.03% and latanoprost 0.005%: a patient-use study.
Paolera MD, Kasahara N, Umbelino CC, Walt JG.
Private practice, São Paulo, Brazil. paolera@terra.com.br

BACKGROUND: The stability of ophthalmic preparations in multidose containers is influenced by the preservative as well as the stability of the active ingredient. Unstable drugs may require refrigeration to preserve their active ingredient level and they are more likely to degrade over time, therefore becoming more susceptible to degradation based on patient mishandling. The purpose of this study was to determine the degree of molecular degradation that occurs in bimatoprost and latanoprost in a patient-use setting. METHODS: This was an open-label, laboratory evaluation of the relative stability of bimatoprost and latanoprost. Patients presently using bimatoprost (n = 31) or latanoprost (n = 34) were identified at 2 clinical sites in Brazil. Patients were instructed to use and store their drops as usual and return all used medication bottles between day 28 and day 34 after opening. RESULTS: Bimatoprost demonstrated no degradation, but latanoprost degraded at various levels. The mean age of bimatoprost was 43.0 +/- 3.4 days and the mean age of latanoprost was 43.9 +/- 2.8 days (P = .072). The mean percentage of labeled concentration was 103.7% in the bimatoprost bottles and 88.1% in the latanoprost bottles (P < 001). CONCLUSION: This study showed that bimatoprost maintained > or =100% concentration throughout the study period while latanoprost did not.

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J Glaucoma. 2008 Jun-Jul;17(4):303-7.
Amniotic membrane transplantation in trabeculectomy with mitomycin C for refractory glaucoma.
Sheha H, Kheirkhah A, Taha H.
Department of Ophthalmology, Saudi German Hospitals Group, Jeddah, Saudi Arabia. hoss88@gmail.com

PURPOSE: To compare outcomes of trabeculectomy combined with mitomycin C (MMC) and amniotic membrane transplantation (AMT) with those of trabeculectomy with MMC alone in refractory glaucoma. METHODS: This prospective, randomized study included 37 eyes with refractory glaucoma at such high risks as neovascular, pseudophakic, and prior failure. Trabeculectomy with MMC and single-layer AMT under the scleral flap was performed in 19 eyes and trabeculectomy with MMC alone in 18 eyes. The outcome measures included intraocular pressure (IOP), number of antiglaucoma medications, and complications. All patients were followed for 12 months. RESULTS: Complete success (IOP <22 mm Hg without glaucoma medications) was seen in 15/16 (93.7%) study eyes and 9/15 (60%) control eyes at 6 months postoperatively (P=0.03), and in 12/15 (80%) and 6/15 (40%) at 12 months after surgery, respectively (P=0.03). IOP decreased from 45.6+/-12.7 mm Hg and 44.9+/-10.7 mm Hg preoperatively in study and control groups to 15.3+/-2.3 mm Hg and 21.3+/-3.8 mm Hg, respectively, at 12 months (P<0.0001). Early postoperative hypotony developed in 3 (16.7%) control eyes owing to excessive filtration but none of study eyes (P=0.1). Encapsulated bleb occurred in 7 (38.9%) control eyes but in 1 (5.3%) study eye (P=0.02). CONCLUSIONS: In refractory glaucoma, trabeculectomy combined with MMC and AMT compared to trabeculectomy with MMC alone has higher success rates, lower postoperative mean IOPs, and less complication rates.

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J Glaucoma. 2008 Jun-Jul;17(4):287-92.
The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure.
Rubin B, Taglienti A, Rothman RF, Marcus CH, Serle JB.
Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA.

PURPOSE: To assess effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced elevated IOP. METHODS: Retrospective review of 7 patients (7 eyes) with IOP elevation after intravitreal triamcinolone acetonide (4.0 mg/0.1 mL) injections for macular edema (6 patients) or central retinal vein occlusion (1 patient). Three patients had preexisting open angle glaucoma; 2 patients had preexisting ocular hypertension. Time between intraocular corticosteroid injection and subsequent increased IOP ranged from 5 to 29 weeks. After unsuccessful maximum tolerated medical therapy, patients underwent unilateral SLT between April 2003 and June 2005. IOP was measured 4 weeks prelaser; on the day of laser; within 3 weeks, and at 1, 3, and 6 months postlaser. Two-sample t test was used for analysis. RESULTS: The pre-SLT and post-SLT IOP measurements were the major outcome measures used to define the relative success of the SLT procedure. Seven patients were taking 4.0+/-0.8 ocular hypotensive medications before SLT. Preoperative IOP (mm Hg+/-SD) 38.4+/-7.3 decreased postoperative to 25.6+/-7.1 within 3 weeks (P<0.003), 25.9+/-8.8 at 1 month (P<0.007), 23.9+/-10.6 at 3 months (P<0.006), and 15.7+/-2.2 at 6 months (P<0.001). Four patients underwent a second SLT procedure. Two patients failed after the 3-month visit. IOP in fellow eyes of all patients was unchanged (P>0.080). CONCLUSIONS: SLT lowered (P<0.007) IOP in 5 eyes of 7 patients with steroid-induced increased IOP from 3 weeks to 6 months postoperative. Two patients required additional surgical procedures. Repeat SLT treatments may be necessary. SLT is a temporizing procedure to consider in patients with steroid-induced elevated IOP.

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J Glaucoma. 2008 Jun-Jul;17(4):275-9.
Long-term relationship between intraocular pressure and visual field loss in primary open-angle glaucoma.
Inatani M, Iwao K, Inoue T, Awai M, Muto T, Koga T, Ogata-Iwao M, Hara R, Futa R, Tanihara H.
Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, Japan. inatani@fc.kuh.kumamoto-u.ac.jp

PURPOSE: To investigate the dependence upon intraocular pressure (IOP) of the progression of visual field defects in eyes with primary open-angle glaucoma (POAG), in which the mean IOP was maintained at < or =21 mm Hg. METHODS: This study involved 100 eyes with POAG, which were followed up for > or =5 years. The mean IOP levels were maintained at < or =21 mm Hg during the follow-up period. The relationship between the IOP and the progression of visual field defects, which was scored using the Advanced Glaucoma Intervention Study criteria, was investigated retrospectively. RESULTS: Compared with the baseline scores, the visual field defect scores had significantly worsened by the end of the follow-up period (P<0.0001, Wilcoxon paired signed rank test). The change in the visual field defect score (2.5+/-0.5) in eyes with average IOP levels of > or =16 mm Hg (n=36) was significantly greater (P=0.031, Mann-Whitney U test) than the change (1.3+/-0.3) in eyes with average IOP levels of <16 mm Hg (n=64). Moreover, IOP of > or =18 mm Hg made a major contribution to the aggravation of visual field defects in eyes with POAG. CONCLUSIONS: Eyes with POAG and with mean IOP levels maintained at < or =21 mm Hg underwent IOP-dependent progression of their visual field defects. Our results suggest that further IOP lowering would be beneficial in such cases.

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Ophthalmology. 2008 Jun;115(6):1089-98.
Aqueous shunts in glaucoma: a report by the American Academy of Ophthalmology.
Minckler DS, Francis BA, Hodapp EA, Jampel HD, Lin SC, Samples JR, Smith SD, Singh K.

OBJECTIVE: To provide an evidence-based summary of commercially available aqueous shunts currently used in substantial numbers (Ahmed [New World Medical, Inc., Rancho Cucamonga, CA], Baerveldt [Advanced Medical Optics, Inc., Santa Ana, CA], Krupin [Eagle Vision, Inc, Memphis, TN], Molteno [Molteno Ophthalmic Ltd., Dunedin, New Zealand]) to control intraocular pressure (IOP) in various glaucomas. METHODS: Seventeen previously published randomized trials, 1 prospective nonrandomized comparative trial, 1 retrospective case-control study, 2 comprehensive literature reviews, and published English language, noncomparative case series and case reports were reviewed and graded for methodologic quality. RESULTS: Aqueous shunts are used primarily after failure of medical, laser, and conventional filtering surgery to treat glaucoma and have been successful in controlling IOP in a variety of glaucomas. The principal long-term complication of anterior chamber tubes is corneal endothelial failure. The most shunt-specific delayed complication is erosion of the tube through overlying conjunctiva. There is a low incidence of this occurring with all shunts currently available, and it occurs most frequently within a few millimeters of the corneoscleral junction after anterior chamber insertion. Erosion of the equatorial plate through the conjunctival surface occurs less frequently. Clinical failure of the various devices over time occurs at a rate of approximately 10% per year, which is approximately the same as the failure rate for trabeculectomy. CONCLUSIONS: Based on level I evidence, aqueous shunts seem to have benefits (IOP control, duration of benefit) comparable with those of trabeculectomy in the management of complex glaucomas (phakic or pseudophakic eyes after prior failed trabeculectomies). Level I evidence indicates that there are no advantages to the adjunctive use of antifibrotic agents or systemic corticosteroids with currently available shunts. Too few high-quality direct comparisons of various available shunts have been published to assess the relative efficacy or complication rates of specific devices beyond the implication that larger-surface-area explants provide more enduring and better IOP control. Long-term follow-up and comparative studies are encouraged.

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Optom Vis Sci. 2008 Jun;85(6):417-24.
Molecular and cell-based approaches for neuroprotection in glaucoma.
Lebrun-Julien F, Di Polo A.
Department of Pathology, Université de Montréal, Montreal, Quebec, Canada.

A hallmark of glaucomatous optic nerve damage is retinal ganglion cell (RGC) death. RGCs, like other central nervous system neurons, have a limited capacity to survive or regenerate an axon after injury. Strategies that prevent or slow down RGC degeneration, in combination with intraocular pressure management, may be beneficial to preserve vision in glaucoma. Recent progress in neurobiological research has led to a better understanding of the molecular pathways that regulate the survival of injured RGCs. Here we discuss a variety of experimental strategies including intraocular delivery of neuroprotective molecules, viral-mediated gene transfer, cell implants and stem cell therapies, which share the ultimate goal of promoting RGC survival after optic nerve damage. The challenge now is to assess how this wealth of knowledge can be translated into viable therapies for the treatment of glaucoma and other optic neuropathies.

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Optom Vis Sci. 2008 Jun;85(6):406-16.
Neuroprotection in glaucoma: drug-based approaches.
Cheung W, Guo L, Cordeiro MF.
Glaucoma & Retinal Degeneration Research Group, UCL Institute of Ophthalmology, London, UK.

In recent years the focus of glaucoma research has shifted toward neuroprotection, as the traditional strategies of lowering intraocular pressure have been shown to be unable to prevent progressive vision loss in some glaucoma patients. As a result various neuroprotective drug-based approaches have been shown capable of reducing the death of retinal ganglion cells, which is the hallmark of glaucomatous optic neuropathy. There has been increasing evidence that glaucomatous neurodegeneration is analogous to other neurodegenerative diseases in the central nervous system, with recent work from our group elucidating a strong link between basic cellular processes in glaucoma and Alzheimer's disease. Additionally, there is a growing trend for using existing neuroprotective strategies in central nervous system diseases for the treatment of glaucoma. In fact, a trial treating patients with primary open-angle glaucoma with memantine, a drug approved for the treatment of Alzheimer's disease, has recently been completed. Results of this trial are not yet available. In this review, we will examine currently advocated neuroprotective drug-based strategies in the potential management of glaucoma.

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Curr Eye Res. 2008 May;33(5):477-82.
Topical and oral ketorolac administration increases the intraocular pressure-lowering effect of latanoprost.
Costagliola C, Campa C, Perri P, Parmeggiani F, Romano MR, Incorvaia C.
Department of Health Sciences, University of Molise, Campobasso, Italy.

PURPOSE: To verify the influence of a non-steroidal anti-inflammatory drug (NSAID), ketorolac (topical and oral) on the intraocular pressure reduction induced by 0.005% latanoprost topical administration, both in patients affected by primary open-angle glaucoma and in healthy controls. METHODS: Two groups of subjects were enrolled for this randomized, prospective, masked clinical study: 16 glaucomatous patients well controlled with 0.005% latanoprost eyedrops (group I) and 16 healthy adult volunteers (group II). Group I subjects were treated at one-week intervals with 10 mg of oral ketorolac, oral placebo, topical ketorolac, and topical placebo, respectively; for each administration modality, the switch between drug and placebo was performed in a randomized, crossover, double-blind fashion. Group II subjects followed the same protocol, with the topical once-daily 0.005% latanoprost treatment starting three days prior to the ketorolac/placebo administration. Intraocular pressure (IOP) was investigated in both groups on the day of oral/topical administration of ketorolac or placebo at baseline (8:00 AM) and at the following intervals: 1, 2, 4, 8, 12, and 24 hours. RESULTS: No significant IOP changes after oral and topical placebo administration were observed in either group. In contrast, when the subjects received ketorolac (either oral or topical), a marked decrease in IOP was recorded, with a noticeable fall at the first hour after the NSAID administration (p = 0.01), which remained still significant 8 hours later (p < 0.05). CONCLUSION: Topical and oral ketorolac strengthens the latanoprost-induced IOP-lowering effect both in glaucomatous patients and in healthy subjects.

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Oftalmologia. 2007;51(4):89-94.
[The future started: nitric oxide in glaucoma]
[Article in Romanian]
Stefan C, Dumitrica DM, Ardeleanu C.
Central Military Emergency Hospital Carol Davila, Bucharest.

Nitric oxide (NO) is an important messenger intra and extra molecular implicated in vasodilatation, contractility, neurotransmission, neurotoxicity and inflammation. NO is formed from L-arginine by nitric oxide synthase (NOS). Nitric oxide synthase has three isoforms: NOS- 1 neuronal, NOS-2 inducible and NOS-3 endothelial (role in vasodilatation). Nitric oxide has a demonstrate role in many neurodegenerative diseases like: glaucoma, Alzheimer disease, multiple sclerosis and cerebral-cardio-vascular diseases. PURPOSE: To investigate the activity of the NOS by immunohistochemistry in patients with primary open angle glaucoma (POAG). METHODS: Observational, prospective, clinical study, during 9 months on one group of 9 patients with POAG that have underwent filtering surgery - trabeculectomy. The fragments of trabecular meshwork harvested during surgery were studied by immunohistochemistry for NOS. The exclusion criteria at the beginning of the study were any ocular or general pathology associated. RESULTS AND CONCLUSIONS: After laboratory analyses in patients with primary open angle glaucoma we observed the presence of the activity of NOS in trabecular meshwork. The trabecular distribution of NOS suggests an important role of nitric oxide in the future therapies for the glaucoma. The increase of nitric oxide makes vasodilatation and improves contractility in the trabecular meshwork; the final effect being the decrease of intraocular pressure and on the other hand the contra-apoptotic effect giving neuroprotection.

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Oftalmologia. 2007;51(4):30-3.
[Ginkgo biloba in glaucoma]
[Article in Romanian]
Dumitrică DM, Stefan C.
Spitalul Clinic de Urgenţă Militar Central Carol Davila, Clinica de Oftalmologie, Bucureşti. dianamelinte2004@yahoo.com

The two principal directions in the therapy of the primary open angle glaucoma (POAG) are lowering intraocular pressure medication and the surgical way. Neither of these two therapeutic modalities act on independent pressure risk-factors. Thinking in this direction the neuro-protection concept should be in our minds all the time in the treatment of this disorder.

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Klin Monatsbl Augenheilkd. 2008 Jan;225(1):30-8.
[Surgery of primary open angle glaucoma.]
[Article in German]
Grehn F.
Universitäts-Augenklinik Würzburg.

The selection of the surgical approach to glaucoma depends primarily on the type of glaucoma. Filtration surgery (trabeculectomy) is considered the gold standard for the most common form of glaucoma, primary open angle glaucoma. The technique of surgery has been continuously improved during the past years resulting in less immediate postoperative complications such as flat anterior chamber, choroidal detachment and hypotony. The major problem of glaucoma surgery nowadays is wound healing with scarring of the outflow area. By intensified postoperative care using antimetabolites at the time of surgery and during postoperative care, many problems of scar formation can be managed. The absolute success rate may be doubled by using intensified postoperative care. Non-penetrating surgery such as deep sclerectomy or trabeculotomy are effective; however, the amount of IOP lowering achieved is inferior to that of trabeculectomy. To select a special glaucoma surgical procedure, the individual target pressure for the respective patient has to be defined. Recent large randomised prospective studies have shown that a low target pressure is needed to preserve and stabilise the visual field in advanced cases. Glaucoma filtration surgery is an important mainstay of advanced glaucoma treatment.

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Br J Ophthalmol. 2008 Jan 22 [Epub ahead of print]
Quality of Diurnal IOP Control in Primary Open Angle Patients Treated with Latanoprost Compared to Surgically Treated Glaucomatous Patients: a Prospective Trial.
Mansouri K, Orguel S, Mermoud A, Haefliger I, Flammer J, Ravinet E, Shaarawy T.
Switzerland.

PURPOSE: To compare the IOP diurnal fluctuations of glaucoma patients treated with latanoprost 0.005% once a day to patients with controlled IOP after deep sclerectomy or trabeculectomy. METHODS: The trial included 60 prospectively recruited subjects with POAG. The medical group consisted of 20 patients with controlled IOP (<18 mmHg) under latanoprost 0.005% monotherapy and with no history of previous intraocular surgery or argon laser trabeculoplasty; the surgical groups included 20 patients after trabeculectomy (TE), and 20 patients after deep sclerectomy with collagen implant (DSCI). The patients in the surgical groups had a controlled IOP without any ocular hypotensive medications. All patients underwent a diurnal tension curve (8.00 - 17.00/3-hour intervals), followed by a water-drinking test (WDT) with the last IOP measurement taken at 21.00. The between-group differences were tested for significance by means of analysis of variance (ANOVA). RESULTS: Baseline IOP was significantly different between the TE group (10.1 +/- 3.4 mmHg), the DSCI group (13.9 +/- 2.8 mmHg) and the latanoprost group (15.5 +/- 2.0 mmHg) (p = 0.005). The average IOP during the diurnal tension curve (10.1 mmHg, 13.7 mmHg , and 15.7 mmHg respectively for the groups TE, DSCI, and latanoprost) differed significantly between the groups (ANOVA: p <0.0001), but the variation was comparable in the three groups (ANOVA: p = 0.13). Following the WDT, elevation of IOP was significantly larger among patients treated with latanoprost (p = 0.003). CONCLUSION: Trabeculectomy patients had a statistically significant lower average IOP in the diurnal tension curve compared to the other two groups. No wider variation in diurnal IOP with latanoprost compared to the surgical procedures was found. However, IOP increase during WDT was most marked in patients under latanoprost therapy.

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Br J Ophthalmol. 2008 Jan;92(1):7-12.
The efficacy and harm of prostaglandin analogues for IOP reduction in glaucoma patients compared to dorzolamide and brimonidine: a systematic review.
Hodge WG, Lachaine J, Steffensen I, Murray C, Barnes D, Foerster V, Ducruet T, Morrison A.
University of Ottawa Eye Institute, The Ottawa Hospital General Campus, 501 Smyth Road, Tower III, Ottawa Ontario, K1H 8L6, Canada. whodge@ottawahospital.on.ca

AIM: To systematically review the literature on the efficacy and harm of prostaglandin analogues (PGAs) compared to brimonidine and dorzolamide in treating elevated intraocular pressure (IOP). METHODS: Keywords were searched in major literature databases to identify relevant randomised clinical trials (RCTs) of PGAs for ophthalmic use. The study quality of RCTs was assessed using the Jadad scale. Outcomes assessed included reduction in IOP in individual patients, adverse events (AEs) and withdrawals due to AEs. RESULTS: Eight unique RCTs evaluating a total of 1,722 individuals were included in this systematic review. Analysis did not show a significant reduction in the mean IOP from patients receiving latanoprost compared with those receiving brimonidine (WMD = -1.04; p = 0.30). On the other hand, the latanoprost group showed a significant reduction in mean IOP compared to the dorzolamide group (WMD = -2.64; p<0.00001). The number of ocular AEs (excluding hyperaemia) was significantly higher in the brimonidine group compared with the latanoprost group (RR = 0.66; p = 0.0005). CONCLUSION: Latanoprost was found to be significantly superior to dorzolamide but not brimonidine. However, ocular adverse events were significantly fewer in latanoprost users than in brimonide users. Neither travoprost nor bimatoprost was compared to dorzolamide or brimonidine in the present literature.

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Eye. 2008 Jan 18 [Epub ahead of print]
The effects of dorzolamide 2% and dorzolamide/timolol fixed combination on retinal and optic nerve head blood flow in primary open-angle glaucoma patients.
Rolle T, Tofani F, Brogliatti B, Grignolo FM.
1Department of Clinical Physiopathology, Section of Ophthalmology, Eye Clinic, University of Torino, Torino, Italy.

Purpose: To compare the effect of dorzolamide hydrochloride 2%, timolol maleate 0.5%, and their fixed combination on intraocular pressure (IOP) and retinal and optic nerve head haemodynamics in primary open-angle glaucoma patients. Methods: Twenty-eight patients with early-moderate glaucomatous damage treated with beta-blockers (>6 months) with IOP values ranging from 18 to 22 mmHg at trough participated in this trial. After a 4-week washout period, patients were randomized in two groups: group I started with dorzolamide 2% monotherapy and group II with timolol 0.50% monotherapy for 4 weeks. After this period, both groups switched to dorzolamide/timolol fixed combination for 4 weeks. IOP, ocular diastolic perfusion pressure (ODPP), heart rate, and Scanning Laser Doppler Flowmetry measurements at the peripapillary retina and neuroretinal rim were taken at T0 (enrolment), T1 (wash out), T2 (monotherapy), and T3 (dorzolamide/timolol). Data were compared between different study times.
Statistical analysis was conducted using a paired t-test. Results: Between T1 and T3, IOP decreased significantly in group I (-21.40%) (P<0.001) and in group II (-21.25%) (P<0.001). At the same time intervals, blood flow increased significantly at rim level for group I (+30.03%) (P<0.05) and also when all patients were considered (rim +17.99%) (P<0.05). Between T1 and T3, we also observed a significant increase of ODPP in group I (+7.24%) (P<0.01) and in group II (+6.08%) (P<0.05) and when all patients were considered (+8.43%) (P<0.01). Conclusions: Dorzolamide/timolol fixed combination increased blood flow significantly at the neuroretinal rim showing a combination of hypotensive and haemodynamic effects.Eye advance online publication, 18 January 2008; doi:10.1038/sj.eye.6703071.

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Arch Soc Esp Oftalmol. 2008 Jan;83(1):15-22.
[Intermediate-term outcome of glaucoma drainage devices.]
[Article in Spanish]
Merino-de-Palacios C, Gutiérrez-Díaz E, Chacón-Garcés A, Montero-Rodríguez M, Mencía-Gutiérrez E.
Servicio de Oftalmología, Hospital 12 de Octubre, Universidad Complutense, Madrid, España.

OBJECTIVE: To study the intermediate-term results of glaucoma drainage devices (DDG) with respect to control of intraocular pressure (IOP), control of glaucoma, and maintenance of pre-operative visual acuity. METHODS: This was a retrospective cohort study of 86 eyes in 77 patients in whom a DDG was implanted, using descriptive statistics and survival analysis. RESULTS: Success was achieved in 53 eyes (61.6%), complete (without treatment) in 34 eyes (39.5%) and qualified (needing treatment) in 19 eyes (22.1%). In the 33 eyes where the DDG treatment was unsuccessful, poor IOP control occurred in 13 eyes - (15.1%), and complications occurred in 20 eyes (23.2%) resulting in a severe reduction or loss of visual acuity (plate exposure, suprachoroidal hemorrhage, retinal detachment). IOP control was obtained in 66 eyes (76.7%), 47 of them without treatment (54.6%), although on 13 occasions the overall treatment failed due to complications occurring. Despite IOP control, glaucoma pro
gression occurred in 7 eyes (8.1%). Preoperative vision was maintained in 46 eyes (53.5%), but decreased by 3 or more lines in 20 eyes (46.5%); bullous kerathopathy was the most frequent cause of the worsening. Loss of light perception occurred in 21 eyes (24.4%) and 4 eyes (4.6%) were eviscerated. CONCLUSIONS: DDG are an effective surgical option for control of IOP when conventional surgery has a poor prognosis, but they are associated with an increased risk of serious complications and loss of visual acuity in a significant proportion of cases (Arch Soc Esp Oftalmol 2008; 83: 15-22).

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Ophthalmology. 2008 Jan;115(1):99-103.
Comparison of the 24-hour intraocular pressure-lowering effects of latanoprost and dorzolamide/timolol fixed combination after 2 and 6 months of treatment.
Konstas AG, Kozobolis VP, Tsironi S, Makridaki I, Efremova R, Stewart WC.
Glaucoma Unit, First University Department of Ophthalmology, AHEPA Hospital, Thessaloniki, Greece.

PURPOSE: To evaluate the 24-hour intraocular pressure (IOP)-lowering effect of latanoprost and the dorzolamide/timolol fixed combination (DTFC) after 2 and 6 months of treatment. DESIGN: Randomized, prospective, crossover comparison. PARTICIPANTS: Thirty-nine patients had primary open-angle glaucoma, and 14 patients had ocular hypertension. METHODS: After a 6-week washout period, patients were randomized to either 6 months of treatment with the DTFC twice daily or latanoprost every evening and then crossed over to the opposite treatment for an additional 6 months. MAIN OUTCOME MEASURE: Mean 24-hour IOP after 2 and 6 months of treatment. RESULTS: Fifty-three patients had an average 24-hour baseline IOP of 25.2+/-2.3 mmHg. After 6 months of treatment, 24-hour IOPs were 18.1+/-1.9 mmHg for the DTFC and 18.3+/-1.9 mmHg for latanoprost. Compared with 2 months of therapy, at 6 months the DTFC showed no significant change in mean 24-hour IOP, whereas latanoprost demonstrated a reduction of 0.3 mmHg (P = 0.01). The DTFC had more burning (P<0.001) and bitter taste (P = 0.01), whereas the latanoprost had more hypertrichosis (P = 0.02). CONCLUSIONS: After 6 months of therapy, the DTFC and latanoprost have clinically similar 24-hour IOP-lowering efficacies.

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Clin Experiment Ophthalmol. 2007 Dec;35(9):812-7.
Phaco-microtrabeculectomy: technique and intraocular pressure control in comparison with microtrabeculectomy.
Rotchford AP, Vernon SA.
Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK. rotchford@doctors.org.uk

PURPOSE: To describe a modified technique for combined cataract and glaucoma drainage surgery involving a small flap (micro) trabeculectomy combined with phaco-emulsification (PMT). To assess the level of intraocular pressure (IOP) control achieved by this procedure in comparison with microtrabeculectomy (MT) alone. METHODS: In this retrospective controlled case series records were reviewed for 37 consecutive low-risk patients undergoing PMT augmented with 5-fluorouracil (5-FU) and 37 low-risk subjects undergoing MT with 5-FU. IOP control was compared by survival analysis using IOP targets < or = 21 mmHg and < or = 16 mmHg at final follow up and with at least a 25% reduction from the preoperative pressure. RESULTS: Mean follow up was 41.7 months (range 19.0-72.0) in the PMT group and 43.5 months (range 18.0-66.0) in the MT group. A final IOP < or = 21 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 91.9% patients undergoing PMT (70.3% on no glaucoma drops). IOP < or = 16 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 67.6% (56.8% without drops). There were no significant differences in survival rates between PMT and MT for either IOP target. The mean final IOPs were 13.4 and 13.5 mmHg on a mean of 0.6 and 0.8 glaucoma drops in the PMT and MT groups, respectively. In the PMT final visual acuity improved by at least one Snellen line in 81.1% and was worse in a single eye. CONCLUSIONS: IOP control following combined surgery by PMT is as good as following MT alone.

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Ophthalmology. 2007 Dec 31 [Epub ahead of print]
Prospective Randomized Comparison of One- versus Two-Site Phacotrabeculectomy Two-Year Results.
Buys YM, Chipman ML, Zack B, Rootman DS, Slomovic AR, Trope GE.
Department of Ophthalmology and Visual Sciences, Toronto Western Hospital, Toronto, Canada.

PURPOSE: Previous studies have failed to find a significant difference in intraocular pressure (IOP) between one- and two-site phacotrabeculectomy. A possible explanation has been relatively small samples and short follow-up. We prospectively observed 80 patients for 2 years randomized to one- versus two-site phacotrabeculectomy with the primary outcome measure being IOP. DESIGN: Prospective randomized controlled study. PARTICIPANTS: Eighty eyes were randomized and 79 underwent phacotrabeculectomy; 76 completed 24 months' follow-up. METHODS: Eligible patients scheduled for phacotrabeculectomy were randomized to one- or two-site phacotrabeculectomy after giving informed consent. A sample size of 54 was calculated to detect a difference of 2 mmHg between the groups with a power of 80%. Data recorded included demographics, visual acuity, IOP, endothelial cell counts, glaucoma medications, phacoemulsification settings, iris manipulation, suture lysis, needling, and complications. Follow-up data were obtained at 3, 6, 12, and 24 months. MAIN OUTCOME MEASURE: Mean IOP at 24 months. RESULTS: There were no significant differences between the groups preoperatively. Mean IOPs were 17.6 versus 17.6, 12.6 versus 12.5, 13.1 versus 11.7, 13.1 versus 12.7, and 12.5 versus 12.9 mmHg for one- versus two-site at baseline and 3, 6, 12, and 24 months. There was a significant lowering of IOP compared with baseline at all time points (P<0.05). There was no significant difference in mean IOP between the groups at any time. The mean number of glaucoma medications decreased from 3.0 in each group to 0.2 and 0.4 for one- and two-site, respectively, at 24 months (P = 0.20). At 3 and 12 months, the endothelial counts (cells/mm(2)) were significantly lower in the two-site group: 2333 versus 2207 (P = 0.17), 2239 versus 1938 (P = 0.01), 2180 versus 1934 (P = 0.04), and 2147 versus 1947 (P = 0.08) at baseline and 3, 12, and 24 months, respectively. The surgical time was significantly longer for two-site (48.1+/-7.8 minutes) compared with one-site (39.2+/-6.4 minutes; P<0.001). CONCLUSION: At 2 years after phacotrabeculectomy, there was no statistically significant difference in IOP between groups. Corneal endothelial cell counts were significantly lower in the two-site group at 3 and 12 months. Two-site surgery took significantly more time.

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Ophthalmology. 2007 Dec 26 [Epub ahead of print]
Efficacy of the Ahmed S2 Glaucoma Valve Compared with the Baerveldt 250-mm(2) Glaucoma Implant.
Goulet RJ 3rd, Phan AD, Cantor LB, Wudunn D.
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana.

OBJECTIVE: To compare the efficacy of the Ahmed S2 Glaucoma Valve with the Baerveldt 250-mm(2) Glaucoma Implant in the treatment of adult glaucoma. DESIGN: Comparative case series. PARTICIPANTS: Fifty-nine eyes of 59 patients who received the Ahmed S2 Glaucoma Valve and 133 eyes of 133 patients who received the Baerveldt 250-mm(2) Glaucoma Implant by the Indiana University Glaucoma Service from 1996 to 2003. METHODS: Eyes that had previous drainage implant procedures were excluded from both groups. If both eyes of a single patient received an implant, the second eye to undergo implantation was excluded from the study. MAIN OUTCOME MEASURES: Kaplan-Meier survival with success defined as intraocular pressure (IOP) > 5 mmHg and < 22 mmHg and at least 20% reduction from preoperative IOP (with or without antiglaucoma medications) and without loss of light perception. Secondary outcome measures included intraocular pressure, visual acuity, number of glaucoma medications, and surgical complications. RESULTS: The 2 groups were similar with regards to age, gender, race, neovascular glaucoma diagnosis, number of prior ocular surgeries, preoperative IOP, and number of preoperative glaucoma medications. Mean durations of follow-up were 20.0 months for Ahmed eyes and 22.9 months for Baerveldt eyes. Cumulative successes in the Ahmed group were 0.73 at 1 year and 0.62 at 2 years, whereas cumulative successes in the Baerveldt group were 0.92 at 1 year and 0.85 at 2 years (Kaplan-Meier survival functions: P = 0.03, log rank test). Male gender, African descent, neovascular glaucoma, and Ahmed implantation were found to be significant predictors of failure. At last follow-up visit, eyes in the Ahmed group had a significantly higher mean IOP (19.8+/-9.5 vs. 15.8+/-7.9 mmHg, P = 0.003, t test) and more antiglaucoma medications (1.4+/-1.2 vs. 0.9+/-1.1 medications, P = 0.008, Mann-Whitney test) than eyes in the Baerveldt group. Two methods for avoiding hypotony after Baerveldt 250-mm(2) implantation had similar outcomes. CONCLUSIONS: Our study suggests that the Ahmed S2 Glaucoma Valve may be less effective at lowering IOP than the Baerveldt 250-mm(2) Glaucoma Implant.

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Acta Ophthalmol Scand. 2007 Nov 17; [Epub ahead of print]
Predicting intraocular pressure change before initiating therapy: timolol versus latanoprost.
van der Valk R, Webers CA, Hendrikse F, de Vogel SC, Prins MH, Schouten JS.
Department of Epidemiology, Maastricht University, The Netherlands.

Purpose: To study intraocular pressure (IOP) reductions with timolol and latanoprost reached in clinical practice, taking into account data that are routinely collected by the ophthalmologist; to predict IOP reduction from these variables. Methods: A cohort of patients with primary open-angle glaucoma (suspect) or ocular hypertension was recruited from nine Dutch centres. Mean absolute and relative IOP reduction was calculated in order to compare timolol to latanoprost. IOP reduction was calculated by comparing patients with certain characteristics to those who had none. Results: One hundred and fifty-six persons started on timolol and 76 started on latanoprost monotherapy. Mean [95% confidence interval (CI)] absolute reduction was 7.2 mmHg (7.9; 6.5) for timolol and 6.9 mmHg (8.0; 5.8) for latanoprost. Mean relative reduction (95% CI) was 27.2% (29.3; 25.1) for timolol and 26.6% (30.2; 22.9) for latanoprost. No significant difference in IOP reduction between timolol and latanoprost was found when adjusting for data that are routinely collected by the ophthalmologist. At the time of starting treatment, none of these items normally used for the management of glaucoma, except IOP at baseline, could predict change in IOP. Conclusion: In clinical practice, timolol and latanoprost achieve similar IOP reductions that are comparable to those achieved in randomized trials. No clinically relevant information for glaucoma management can be used to predict IOP reduction accurately.

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Can J Ophthalmol. 2007 Nov 16;42(6) [Epub ahead of print]
Short-term intraocular pressure changes after intravitreal injection of bevacizumab.
Hollands H, Wong J, Bruen R, Campbell RJ, Sharma S, Gale J.

Background: This study examines the changes in short-term intraocular pressure (IOP) in patients receiving intravitreally administered bevacizumab. A prospective series of consecutive patients undergoing injection of intravitreal bevacizumab was investigated. Methods: All patients received bevacizumab (0.05 cc) injected intravitreally in a standard fashion. IOP was measured at baseline, 2, 5, and 30 minutes after injection by 1 of 2 observers using Goldman applanation tonometry. An intraobserver study was done to assess agreement in IOP measurements. Results: We accrued 104 patients with a mean age of 76 years: 58% were female, and 42% were male. Most patients (85%) were being treated for neovascular age-related macular degeneration. The mean IOP values at baseline, 2, 5, and 30 minutes after injection were 14.0 (95% confidence interval [CI] 13.4-14.7) mm Hg, 36.1 (95% CI 33.5-38.6) mm Hg, 25.7 (95% CI 23.8-27.5) mm Hg, and 15.5 (95% CI 12.4-16.51) mm Hg, respectively. Three patients (2.9%) had an IOP of 25 mm Hg or higher at 30 minutes. IOP normalized within 2 hours without medical therapy in 2 of these patients, and 1 patient required a 1-week course of glaucoma medication. Regression analysis showed a trend towards phakic patients having higher IOP at 30 minutes (odds ratio = 3.2; p = 0.089). Interpretation: Intravitreal injection of bevacizumab is safe with respect to short-term IOP changes, as almost all patients' IOP returned to a safe range (<25 mm Hg) within 30 minutes. Elevated IOP at 30 minutes after injection does occur, rarely, thus clinicians should consider checking IOP after injection as a precaution. Transient extreme IOP elevations occur in a significant percentage of patients, but the consequences of these events are unknown.

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Can J Ophthalmol. 2007 Nov 16;42(6) [Epub ahead of print]
Bevacizumab in glaucoma: a review.
Ichhpujani P, Ramasubramanian A, Kaushik S, Pandav SS.

Vascular endothelial growth factor has been identified as playing a key role in ocular angiogenesis. Bevacizumab, a humanized monoclonal antibody that binds to all isoforms of vascular endothelial growth factor, has shown promising results in regression of neovascularization. The use of bevacizumab has been reported extensively in various retinal pathologies, including proliferative diabetic retinopathy, cystoid macular edema, neovascular age-related macular degeneration, and neovascular glaucoma, but the clinical use in glaucoma is not yet clear. Glaucoma filtering surgery entails fashioning an external filter for aqueous drainage, and a prerequisite to its optimum functioning is a patent filtering bleb. Since fibroblast function and growth of new vessels is a component of healing of the bleb, there have been attempts to retard this healing by the use of bevacizumab. This article reviews current clinical studies documenting the use of bevacizumab in glaucoma.

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Drugs Aging. 2007;24(12):1007-16.
Use of fixed-dose combination drugs for the treatment of glaucoma.
Khouri AS, Realini T, Fechtner RD.
Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.

Glaucoma is a leading cause of irreversible visual loss. This potentially blinding disease is a progressive optic neuropathy associated with elevated intraocular pressure (IOP). Initial therapy for glaucoma typically consists of topical medications or laser treatment to lower IOP. Frequently, more than one medication is required to achieve adequate control of IOP. However, more medications means more bottles and greater complexity for the patient. There are several potential benefits of fixed combination medications compared with using the individual components separately. These include a reduction in the total number of drops and preservative instilled per day, cost savings, improved tolerability and compliance and avoiding the washout effect resulting from rapid-sequence instillation of multiple drops. Attempts to develop effective fixed combinations of glaucoma medications date back several decades. In recent years, fixed combinations of commonly paired drugs have been approved by various regulatory bodies in different countries and have gained wide acceptance. Current commercially available, fixed combination drugs include the topical beta-adrenoceptor antagonist timolol 0.5% combined with a prostaglandin, a topical carbonic anhydrase inhibitor or an alpha-adrenoceptor agonist. Although there is no uniformity among registration trial designs, most published literature compares the efficacy of the fixed combination to the individual components and to concomitant use of both components. Various factors inherent to study design such as medication run-in, washout periods and peak and trough effects have to be taken into consideration when analysing the demonstrated efficacy of fixed combinations. Fixed combination treatments offer effective IOP control while reducing the washout effect and exposure to preservatives. They are also convenient. However, fixed combinations also remove the possibility of titrating the individual components both in terms of concentration and timing of administration. In addition, fixed combinations might not always provide the same efficacy as proper use of the individual components. The clinician must make individualised assessments when weighing the convenience of these medications against their limitations for specific patients.

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Graefes Arch Clin Exp Ophthalmol. 2007 Oct 27; [Epub ahead of print]
Long-term results after transscleral diode laser cyclophotocoagulation in refractory posttraumatic glaucoma and glaucoma in aphakia.
Schlote T, Grüb M, Kynigopoulos M.
Department of Ophthalmology, Clinic Pallas, Louis-Giroud-Strasse 20, CH-4600, Olten, Switzerland.

PURPOSE: To evaluate the long-term effect and safety of transscleral diode laser cyclophotocoagulation (TDLC) in eyes with advanced glaucoma in aphakia and posttraumatic glaucoma. PATIENTS AND METHODS: Twenty-one eyes of 21 patients with glaucoma in aphakia and 25 eyes of 25 patients with posttraumatic glaucoma were treated with TDLC between 1996 and 2004. If the intraocular pressure (IOP) remained above 21 mmHg despite medication for more than 4 weeks after TDLC, the procedure was repeated. The IOP, number of medications, visual acuity, complications and need of further surgical intervention were all recorded during the follow-up period. RESULTS: Follow-up ranged from 12 to 93 months (mean 42.0 +/- 29.2) in glaucoma in aphakia and from 12 to 73 months (mean 33.3 +/- 17.4) in posttraumatic glaucoma. TDLC was successful in 48% of aphakic eyes with glaucoma and 40% of eyes with posttraumatic glaucoma. More than one TDLC was performed in 85% of cases of glaucoma in aphakia and 76% of cases of posttraumatic glaucoma). In both groups, TDLC was more effective in older patients than younger patients. Further glaucoma surgeries other than TDLC were performed in 43% of glaucoma in aphakic cases, and 44% of posttraumatic glaucoma cases, within the follow-up period. Loss of any light perception was recorded in two aphakic eyes with glaucoma (9.5%) and three eyes with posttraumatic glaucoma (12%). No hypotonia and no phthisis occurred. CONCLUSIONS: TDLC is moderately effective in advanced posttraumatic glaucoma and glaucoma in aphakia, more effective in older than younger patients, not influenced by prior other glaucoma surgery, and despite a high re-treatment rate very safe in both groups of glaucoma. For younger patients with severe secondary glaucoma in particular, new treatment strategies are needed.

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Curr Med Res Opin. 2007 Oct 23; [Epub ahead of print]
Costs and effectiveness of travoprost versus a dorzolamide + timolol fixed combination in first-line treatment of glaucoma: analysis conducted on the United Kingdom General Practitioner Research Database.
[No authors listed]

OBJECTIVE: To compare the effectiveness and associated costs of travoprost versus a fixed combination of dorzolamide + timolol as first-line therapy for glaucoma according to data collected by the United Kingdom General Practitioner Research Database (UK-GPRD). METHODS: Patients with a diagnosis of ocular hypertension, glaucoma, or who had been treated topically by surgery or laser therapy were selected. Patients starting first-line treatment with travoprost or a fixed dorzolamide + timolol combination were included. Times to treatment failure were compared with an adjusted Cox model. MAIN OUTCOME MEASURES: Cost and treatment failure defined as a prescription change (adding or removing a topical treatment, or initiating laser therapy or surgery). RESULTS: 56 612 patients were extracted from the database and 39 808 patients received at least one topical prescription for IOP-lowering (intraocular pressure) therapy. Of these, 639 were treated with travoprost and 387 with dorzolamide + timolol, as first-line therapies. No significant difference was found between patient characteristics. Patients were aged 70.0 years and 48.5% were male. At 1 year, treatment failure was experienced by 30.4% of patients receiving travoprost and 49.4% receiving dorzolamide + timolol (p < 0.001). The hazard ratio for failure was 0.79 (p < 0.03) less with travoprost, after adjusting on age, gender, comorbidities and duration of follow-up. Adjusted annual costs of glaucoma management were significantly (p < 0.001) lower with travoprost ( pound198.31) than with dorzolamide + timolol ( pound312.21). CONCLUSION: This retrospective costs and consequences analysis study showed that travoprost is more efficient than dorzolamide + timolol as first-line therapy for glaucoma patients. Patients continued longer with first-line treatment when prescribed travoprost at a lower cost.

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Curr Med Res Opin. 2007 Oct 18; [Epub ahead of print]
Efficacy and safety of brimonidine and dorzolamide for intraocular pressure lowering in glaucoma and ocular hypertension.
Katz LJ, Simmons ST, Craven ER.

BACKGROUND: Brimonidine and dorzolamide are intraocular pressure (IOP)-lowering medications most commonly used in second-line treatment of glaucoma and ocular hypertension. Scope: An evidence-based review of comparative clinical trials of brimonidine and dorzolamide was under taken to determine the relative efficacy and safety of these drugs in reducing IOP. Using the keywords brimonidine and dorzolamide, all articles describing such trials from September 1966 to July 2007 were found in MEDLINE and EMBASE. FINDINGS: In all identified studies, brimonidine and dorzolamide were both found to provide significant IOP reduction from treated or untreated baseline levels. Results of eight trials reported to date indicate that brimonidine produced either a lower treated IOP or greater pressure reduction from baseline than dorzolamide at one or more measured timepoints, and provided comparable IOP lowering over all other measurements. Differences between the IOP reductions provided by brimonidine and dorzolamide were more pronounced when the medica tions were used adjunctively with other classes of drugs. Six other trials showed similar efficacy, and one additional monotherapy study showed lower IOP with dorzolamide treatment. Ocular burning was noted with dorzolamide more than any other adverse event with either drug. Trials ranged widely in duration of therapy and the time of day IOP measurements were taken, and many were too small for sufficient statistical power. CONCLUSION: Brimonidine and dorzolamide are both efficacious and reasonably well tolerated. Possible overall distinctions in efficacy were obscured by differences in study designs and treatment regimens, but adjunctive therapy with brimonidine may reduce IOP as effectively or more effectively than adjunctive or fixed combination dorzolamide therapy. In certain patients with glaucoma and ocular hypertension brimonidine may be a better choice than dorzolamide for second-line treatment.

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J AAPOS. 2007 Oct 16; [Epub ahead of print]
Aqueous drainage device surgery in refractory pediatric glaucoma: II. Ocular motility consequence.
O'Malley Schotthoefer E, Yanovitch TL, Freedman SF.
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.

PURPOSE: To determine the prevalence of complications relating to ocular motility and alignment in children with refractory congenital and aphakic glaucoma treated with aqueous drainage device surgery. METHODS: Chart review of consecutive children treated with aqueous drainage devices at Duke University Eye Center from 1995 to 2006 for ocular motility abnormalities and strabismus as well as sensorimotor testing results before and after aqueous drainage device placement. RESULTS: Thirty-eight eyes of 30 children with congenital glaucoma and 41 eyes of 32 children with aphakic glaucoma were included. Optotype visual acuity testing could be performed in a minority of children preoperatively. After aqueous drainage device surgery, 14 and 20 eyes, respectively, were >20/100 in the congenital glaucoma and aphakic glaucoma groups. Only a few children had stereopsis or demonstrated binocular function on Worth 4-Dot testing in both groups before and after aqueous drainage device surgery. Horizontal and vertical strabismus was common, especially after aqueous drainage device surgery and occurred in 57% of congenital glaucoma patients and 47% of aphakic glaucoma patients. Motility limitation (both vertical and horizontal) was also common and occurred in 37% overall. DISCUSSION: Ocular motility abnormalities and strabismus were common in children after aqueous drainage device surgery. These potential problems should be considered when aqueous drainage device surgery is planned, especially in children with binocularity.

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Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006030.
Acupuncture for glaucoma.
Law S, Li T.

BACKGROUND: Glaucoma is a multifactorial optic neuropathy in which there is an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although there are many existing treatments, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating the relevant points on the body surface. OBJECTIVES: The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, ZETOC, CINAHL, AMED (Allied and Complementary Medicine Database), TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System), CBM (Chinese Biological Database), the Chinese Acupuncture Trials Register and the National Center for Complementary and Alternative Medicine web site (http://nccam.nih.gov/) in February 2006. We ran update searches of CENTRAL, MEDLINE, EMBASE, LILACS and ZETOC in July 2007. We also handsearched Chinese medical journals at Peking Union Medical College Library in April 2007. SELECTION CRITERIA: We planned to include randomized and quasi-randomized clinical trials in which one arm of the study involved acupuncture treatment. DATA COLLECTION AND ANALYSIS: Two authors independently evaluated the search results against the inclusion and exclusion criteria. Discrepancies were resolved by discussion. MAIN RESULTS: We found no randomized clinical trials and subsequently no meta-analysis was conducted. Evidence was limited to a few case series of small sample size. AUTHORS' CONCLUSIONS: At this time, it is impossible to draw reliable conclusions from the available data to support the use of acupuncture for the treatment of glaucoma. Since most glaucoma patients currently cared for by ophthalmologists do not use non-traditional therapy, the clinical practice decisions will have to be based on physician judgement and patients' value given this lack of data in the literature.

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Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003919.
Laser trabeculoplasty for open angle glaucoma.
Rolim de Moura C, Paranhos A Jr, Wormald R.

BACKGROUND: Open angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence. OBJECTIVES: The objective of this review was to study the effects of laser trabeculoplasty for OAG. SEARCH STRATEGY: We identified trials from CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and manual searching. We also contacted researchers in the field. SELECTION CRITERIA: We included randomised controlled trials comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery. We also included trials comparing different technical modalities of laser trabeculoplasty. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted the data. We contacted trial investigators for missing information. MAIN RESULTS: This review included 19 trials involving 2137 participants. Only five trials fulfilled the criteria of good methodological quality. One trial compared laser trabeculoplasty with topical beta-blocker to no intervention in early glaucoma. The risk of glaucoma progression was higher in the control group at six years of follow up (risk ratio (RR) 0.71 95% confidence interval (CI) 0.53 to 0.95). No difference in health-related quality of life was observed between the two groups. Three trials compared laser trabeculoplasty to medication (regimens used before the 1990s) in people with newly diagnosed OAG. The risk of uncontrolled intraocular pressure (IOP) was higher in the medication group compared to the trabeculoplasty group at six months and two years of follow up. Three trials compared laser trabeculoplasty with trabeculectomy. The risk of uncontrolled IOP was significantly higher in the trabeculoplasty group at six months but significant heterogeneity was observed at two years. Diode and selective laser are compared to argon laser trabeculoplasty in three trials and there is some evidence showing a comparable effect in controlling IOP at six months and one year of follow up. AUTHORS' CONCLUSIONS: Evidence suggests that, in people with newly diagnosed OAG, the risk of uncontrolled IOP is higher in people treated with medication used before the 1990s when compared to laser trabeculoplasty at two years follow up. Trabeculoplasty is less effective than trabeculectomy in controlling IOP at six months and two years follow up. Different laser technology and protocol modalities were compared to the traditional laser trabeculoplasty and more evidence is necessary to determine if they are equivalent or not. There is no evidence to determine the effectiveness of laser trabeculoplasty compared to contemporary medication (prostaglandin analogues, topical anhydrase inhibitors and alpha2-agonists) and also with contemporary surgical techniques. Also there should be further investigation in to the effectiveness of laser trabeculoplasty in specific racial groups, specific diagnostic groups, such as pseudoexfoliation and pigmentary glaucoma and different stages of OAG. More research is also required determining cost-effectiveness of laser trabeculoplasty in the management of glaucoma.

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Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003167.
Medical interventions for primary open angle glaucoma and ocular hypertension.
Vass C, Hirn C, Sycha T, Findl O, Bauer P, Schmetterer L.

BACKGROUND: Primary open angle glaucoma (POAG) is a progressive optic neuropathy with an elevated intraocular pressure (IOP), where the optic nerve head becomes pathologically excavated and the visual field (VF) is characteristically altered. Ocular hypertension (OHT) is a condition with elevated IOP but without discernible pathology of the optic nerve head or the VF. It is a major risk factor for development of POAG. OBJECTIVES: To assess and compare the effectiveness of topical pharmacological treatment for POAG or OHT to prevent progression or onset of glaucomatous optic neuropathy. SEARCH STRATEGY: We searched CENTRAL, MEDLINE and EMBASE in May 2007. We searched the bibliographies of identified articles and contacted experts, investigators and pharmaceutical companies for additional published and unpublished studies. SELECTION CRITERIA: Randomised controlled trials comparing topical pharmacological treatment to placebo, no treatment or other treatment for specified endpoints which included people with POAG or OHT, and with duration of treatment of at least one year. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed trial quality. Where appropriate, we summarised data using Peto odds ratio and mean difference after testing for heterogeneity between studies. MAIN RESULTS: We included 26 trials, which randomised 4979 participants, in this review. Meta-analysis of 10 trials clearly demonstrated reduction of onset of VF defects in treated OHT (OR 0.62, 95% CI 0.47 to 0.81). No single drug showed a significant VF protection compared to placebo or untreated controls. We did identify some border line evidence for a positive influence of treatment on VF prognosis (OR 0.67, 95% CI 0.45 to 1.00) for the beta-blockers . AUTHORS' CONCLUSIONS: The results of this review support the current practice of IOP lowering treatment of OHT. A visual field protective effect has been clearly demonstrated for medical IOP lowering treatment. Positive but weak evidence for a beneficial effect of the class of beta-blockers has been shown.Direct comparisons of prostaglandins or brimonidine to placebo are not available and the comparison of dorzolamide to placebo failed to demonstrate a protective effect. However, absence of data or failure to prove effectiveness should not be interpreted as proof of absence of any effect. The decision to treat a patient or not, as well as the decision regarding the drug with which to start treatment, should remain individualised, taking in to account the amount of damage, the level of IOP, age and other patient characteristics.

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Arch Ophthalmol. 2007 Jul;125(7):883-8.
Silicone oil pupillary block: an exception to combined argon-Nd:YAG laser iridotomy success in angle-closure glaucoma.
Zalta AH, Boyle NS, Zalta AK.
Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA. zaltaah@uc.edu

OBJECTIVES: To examine the rate of laser iridotomy failure at the University of Cincinnati Glaucoma Service, Cincinnati, Ohio, during the last 10 years and to evaluate the importance of silicone oil pupillary block glaucoma (SOPBG) as a causal factor. METHODS: We retrospectively reviewed the operative records of all 1711 eyes that underwent laser iridotomy for the treatment of pupillary block angle-closure glaucoma between January 1, 1996, and December 31, 2005. The occurrence, etiology, timing, and rate of laser iridotomy failure were assessed with SOPBG cases analyzed separately. RESULTS: Analyses using the chi(2) test demonstrated significantly higher laser iridotomy failure rates for 13 eyes with SOPBG compared with 1698 eyes with non-SOPBG for all 3 timing outcomes (immediate, 15.4% vs 0%; short term, 92.3% vs 2.5%; and long term, 38.5% vs 0.1%; all P < .0001). To achieve long-term patency, SOPBG iridotomy failures required, on average, 2.7 laser iridotomy procedures, 4.1 periocular steroid injections, and 0.7 intracameral tissue plasminogen activator injections. CONCLUSIONS: Eyes with SOPBG require extensive resources to prevent laser iridotomy failure. In managing SOPBG, ophthalmologists should anticipate the need for additional laser treatment and use adjunctive steroids and intracameral tissue plasminogen activator to enhance long-term patency and avert invasive surgical procedures.

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Klin Monatsbl Augenheilkd. 2007 Jun;224(6):511-5.
[Glaucoma in childhood uveitis.]
[Article in German]
Heinz C, Schlote T, Dietlein T, Pillunat L.
Augenabteilung am St. Franziskus Hospital Münster.

Secondary glaucoma is a common complication in childhood uveitis. The incidence of glaucoma depends on the anatomic localisation of inflammation and the associated underlying disease. The pathophysiology can be divided in secondary angle closure and open angle glaucoma. Data on conservative and operative therapy often rely on small patient groups or can only be transferred from children with non-uveitic glaucoma. The selection of topical medication must reflect the special quality of the juvenile organism. Topical therapy of first choice seems to be antagonists of carboanhydrase due to their good clinical effect without elevated risk profile. As second choice beta-receptor antagonists are suitable. Gel formulations of 0.1 % timolol seem to exhibit fewer of the known side effects. Children aged 2 years and under have a special risk of apnoea. Alpha agonists should not be used in children of 6 years and younger because of their central nervous side effects. Prostaglandins might induce more recurrences of uveitis and might aggravate cystoid macular oedema, therefore this group should only be used with restrictions. Active uveitis is a contraindication for the use of prostaglandins. Parasympathomimetics are generally not recommended in uveitis due to the known side effects. Surgical therapy follows ineffective conservative therapy. The choice of the adequate surgical approach depends on individual factors and general recommendations cannot be made. Techniques include filtering procedures, cyclodestructive procedures, trabecular meshwork surgery, and glaucoma drainage devices. Before surgery the duration of quiescence of inflammation should be 8 weeks or longer.

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J Ocul Pharmacol Ther. 2007 Jun;23(3):311-3.
Clinical experience in the treatment of normal tension glaucoma with latanoprost in Germany.
Thelen U, Weiler W, Kirchhoff E, Fuchs HB, Stewart WC.

AIMS: The aim of this analysis was to evaluate the general ophthalmologist's experience in using latanoprost to treat normal tension glaucoma (NTG) patients. METHODS: NTG patients included in this study were part of an observational cohort of patients that were changed from previous therapy to latanoprost in Germany. RESULTS: This study included 200 NTG glaucoma patients who were being treated with latanoprost monotherapy (average duration, 1.2 +/- 1.4 years) and had 6 months of follow-up. At the beginning of the observation period, patients had an average intraocular pressure (IOP) of 15.2 +/- 2.5 mmHg and after 6 months, 15.0 +/- 2.4 mmHg (P = 0.769). Eight (8) patients (4.0%) were discontinued from latanoprost during the observation period, with the most common reason noted as the need for further IOP reduction (n = 7; 3.5%). Twenty-four (24) patients (12.0%) noted at least one ocular adverse event during the observation period, with the most common reason noted as burning/stinging (n = 9; 4.5%) or conjunctival hyperemia (n = 9; 4.5%). CONCLUSIONS: This study suggests that patients with NTG who are already treated with latanoprost monotherapy should continue to have, over a short-term follow-up, generally stable IOPs, low side-effect incidence, and discontinuations, as well as "very good" to "excellent" physician ratings of patient efficacy, tolerability, and satisfaction.

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Expert Opin Emerg Drugs. 2007 May;12(2):313-27.
Fixed-combination and emerging glaucoma therapies.
Woodward DF, Chen J.
Allergan, Inc., 2525 DuPont Drive, Mail Code RD3-2B, Irvine, CA 92612, USA.

Ocular hypotensive agents are the only approved pharmacotherapy for glaucoma. Despite significant advances during the past two decades, a large proportion of glaucoma patients require more than one drug. The most recent additions to the armamentarium of antiglaucoma drugs are fixed-combination products for the glaucoma patient who is insufficiently responsive to monotherapy. Fixed-combination products have the combined efficacy of two ocular hypotensive drugs, and the convenience of a two-drug treatment regimen in a single container, which may aid patient adherence to treatment. Available fixed-combination products consist of timolol 0.5% as an invariant with brimonidine 0.2%, dorzolamide 2%, travoprost 0.004%, latanoprost 0.005% or bimatoprost 0.03%. Research on more advanced antiglaucoma medications continues. Promising new directions appear to be the Rho-kinase inhibitors, microtubule-disrupting agents, serotonergics and cannabimimetics. Efforts continue to improve existing antiglaucoma drugs in an attempt to design second-generation cholinomimetics, adrenergics, prostaglandins and prostamides.

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Expert Opin Emerg Drugs. 2007 May;12(2):195-8.
A novel perspective on natural therapeutic approaches in glaucoma therapy.
Mozaffarieh M, Flammer J.
University Eye Clinic Basel, Mittlere Strasse 91, PO Box, CH-4031 Basel, Switzerland.

Glaucoma is becoming recognised as a condition for which not only elevated intraocular pressure (IOP), but also non-pressure-dependent risk factors, are responsible. Better knowledge of the pathogenesis has opened up new therapeutic approaches that are often referred to as non-IOP-lowering treatment. These new avenues of treatment, some of which are still under investigation, include agents that can improve vascular regulation and blood flow to the eye and reduce oxidative stress. Vascular regulation can be improved systemically with magnesium. Dark chocolate and omega-3-fatty acids can also improve blood flow regulation. Oxidative stress at mitochondrial level can be reduced by gingko. Polyphenolic flavonoids (tea, coffee and red wine), anthocyanosides, ubiquinone and melatonin have antioxidant properties, and heat-shock proteins can be induced naturally by the use of sauna baths. Future intensive studies on the effect of these compounds may open up a new therapeutic era in glaucoma.

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Drugs Aging. 2007;24(6):509-28.
Ocular carteolol: a review of its use in the management of glaucoma and ocular hypertension.
Henness S, Swainston Harrison T, Keating GM.
Wolters Kluwer Health | Adis, Auckland, New Zealand, an editorial office of Wolters Kluwer Health, Conshohocken, Pennsylvania, USA.

Ocular carteolol (Mikelan((R)), Teoptic((R)), Ocupress((R))) is a nonselective beta-adrenoceptor antagonist with intrinsic sympathomimetic activity (ISA). Ocular carteolol effectively reduces intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH). Twice-daily administration of standard carteolol has generally similar IOP-lowering efficacy to other ocular beta-adrenoceptor antagonists such as timolol, betaxolol and metipranolol in patients with OAG or OH. In addition, long-term treatment with carteolol has similar efficacy to timolol and betaxolol in terms of reducing IOP and maintaining visual fields in patients with newly diagnosed primary OAG (POAG). The new long-acting formulation of once-daily carteolol has equivalent efficacy to the standard formulation of carteolol administered twice daily in patients with OAG or OH. Both the standard and long-acting formulations of ocular carteolol are generally well tolerated in terms of topical adverse effects involving the eyes or systemic adverse effects involving the cardiovascular system. Thus, twice-daily carteolol is a well established option in the treatment of glaucoma and OH, and the new once-daily formulation of long-acting carteolol offers similar efficacy and tolerability with a potential for improved patient adherence.

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Adv Ther. 2007 Mar-Apr;24(2):376-86.
Tolerability, quality of life, and persistency of use in patients with glaucoma who are switched to the fixed combination of latanoprost and timolol.
Dunker S, Schmucker A, Maier H; Latanoprost/Timolol Fixed Combination Study Group.
Troisdorf, Germany. stephandun@aol.com

This study was undertaken to assess tolerability, quality of life, and persistency of use and to monitor changes in intraocular pressure (IOP) during the first 6 mo after a switch to fixed combination latanoprost/timolol. In Germany, 271 general ophthalmology practices enrolled patients who were switched from previous ocular hypotensive therapies to latanoprost/timolol for medical reasons. Usual care routines were followed, and IOP was measured at baseline and approximately 6 mo later. Adverse events were recorded throughout. Immediately before switching and at follow-up, patients completed a 29-item quality-of-life questionnaire. Of 1052 patients who met analysis criteria, 748 (71%) switched from combination therapy and 304 (29%) from monotherapy. An insufficient IOP reduction with the previous therapy was a reason for switching in 71% of patients; the desire to simplify to once-daily administration was cited in 66%. Ocular adverse events were reported in 19 patients after the switch, and 97% remained on therapy throughout the follow%up period. After switching, patients were less likely to forget to instill their eyedrops or to feel that their drops had adverse effects; they found it easier to include eyedrop administration in their routine; they were more satisfied with the frequency of instillation; and they were more likely to want to continue with the drops. Across all previous therapies, mean IOP decreased from 20.6+/-3.7 mm Hg to 17.2+/-2.8 mm Hg after the switch (P<.001)-a 14.8% difference. Fixed combination latanoprost/timolol is well tolerated and effective in patients who are switched from other monotherapies or combination therapies for medical reasons. Such a switch may be associated with improved quality of life.

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Adv Ther. 2007 Mar-Apr;24(2):302-9.
Ocular hypotensive efficacy of brimonidine 0.15% as adjunctive therapy with latanoprost 0.005% in patients with open-angle glaucoma or ocular hypertension.
Mundorf T, Noecker RJ, Earl M.
Private Practice, Charlotte, NC, USA.

This study was undertaken to evaluate the ocular hypotensive efficacy of brimonidine Purite 0.15% (Alphagan P 0.15%; Allergan, Inc., Irvine, Calif) given as adjunctive therapy with latanoprost 0.005% (Xalatan; Pfizer Inc., New York, NY( to patients with open-angle glaucoma or ocular hypertension. In this multicenter, open-label, prospective evaluation, the intraocular pressure (IOP) of the 43 enrolled patients was > or =18 mm Hg after at least 6 wk of latanoprost monotherapy. The primary outcome measure was IOP at peak drug effect )10 AM, or approximately 2 h after the morning dose of brimonidine 0.15%(. IOP at trough drug effect (8 AM, or approximately 12 h after the evening dose of brimonidine) was also measured. Baseline IOP was 21.9 (+/-2.3) mm Hg. After 1 mo of treatment, additional mean IOP reductions from latanoprost-treated baseline values were 5.8 mm Hg (26%) at peak drug effect (P<.001) and 3.3 mm Hg (15%) at trough (P<.001). At the month 2 visit, additional mean IOP reductions from latanoprost-treated baseline values were 5.1 mm Hg (23%) at peak drug effect (P<.001) and 2.0 mm Hg (9%) at trough (P=.002). Brimonidine Purite 0.15% provided statistically significant additional reductions in IOP from latanoprost-treated baseline values. These findings suggest that brimonidine Purite 0.15% is an efficacious adjunctive therapy in patients given latanoprost who require additional lowering of IOP.

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Curr Opin Ophthalmol. 2007 Mar;18(2):152-158.
Nonpenetrating glaucoma surgery: a critical evaluation.
Sarodia U, Shaarawy T, Barton K.
aGlaucoma Service, Moorfields Eye Hospital, London, UK bClinique d'ophtalmologie, Hopitaux Universitaires de Geneve, Switzerland.

PURPOSE OF REVIEW: Nonpenetrating glaucoma surgery is popular in a number of countries because of its perceived superior safety profile to mitomycin-C trabeculectomy. This article critically evaluates recently published literature relating to nonpenetrating glaucoma surgery. RECENT FINDINGS: Recent modifications in nonpenetrating glaucoma surgery, including the use of implants, augmentation with antiproliferatives, and use of laser goniopuncture, appear to result in improved intraocular pressure control. Comparative studies suggest a better safety profile with nonpenetrating glaucoma surgery but higher long-term intraocular pressure than after trabeculectomy. Despite this perception, a difference in intraocular pressure control between mitomycin-C trabeculectomy and nonpenetrating glaucoma surgery, when the most recent modification has been incorporated, has not been demonstrated conclusively in randomized trials conducted over sufficiently long periods to be clinically important. SUMMARY: Nonpenetrating glaucoma surgery continues to evolve. Intraocular pressure-lowering efficacy seems to have improved with recent modifications in technique but the degree and longevity of intraocular pressure-lowering in comparison with trabeculectomy are still uncertain.

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J Fr Ophtalmol. 2007 Feb;30(2):200-8.
[Glaucoma surgery and retinal pathology]
[Article in French]
Creuzot-Garcher C.
Service d'Ophtalmologie, CHU Dijon, Hopital General, Dijon, France.

The occurrence of hypertonia during a surgically treated retinal disease is frequent because these disorders often involve the same population of patients. The main cause of postoperative hypertonia remains a preoperative unknown glaucoma. Hypertonia occurring before the treatment of a retinal detachment can result from angle recession glaucoma, ghost cell glaucoma, or Schwartz-Matzuo syndrome; all of which are frequently associated with trauma. Hypertonia occurring after the surgery of a retinal detachment can be caused by scleral buckling, a topical postoperative steroid treatment, or an internal tamponade with gas or silicone. The latter is responsible for severe hypertonia that is frequently resistant to treatment. Hypertonia occurring after the use of triamcinolone is usually controlled with medical treatment. Prior filtrating surgery can lead to technical problems during retinal surgery. The knowledge of pre-existing glaucoma may be reason for cautious management of retinal surgery.

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J AAPOS. 2007 Feb;11(1):34-40. Epub 2006 Nov 2.
Endoscopic diode laser cyclophotocoagulation in the management of aphakic and pseudophakic glaucoma in children.
Carter BC, Plager DA, Neely DE, Sprunger DT, Sondhi N, Roberts GJ.
Indiana University Medical Center, Indianapolis, Indiana.

INTRODUCTION: Endoscopic cyclophotocoagulation (ECP) has been shown to be a useful adjunct in the management of a variety of difficult pediatric and adult glaucomas. This study reports the efficacy and safety of this procedure for pediatric aphakic and pseudophakic glaucoma. METHODS: ECP was performed on 34 eyes of 25 patients under 16 years of age with aphakic or pseudophakic glaucoma between April 1994 and November 2004. Patients were followed for a minimum of 12 months or until a treatment failure had been declared. Treatment failure was defined as postoperative intraocular pressure (IOP) of >24 mm Hg and IOP lowering of less than 15% despite the addition of glaucoma medications or the occurrence of any visually significant complications. Aphakic eyes of patients with congenital glaucoma or an anterior segment dysgenesis were not included in the study group. RESULTS: Pretreatment IOP averaged 32.6 mm Hg in the 34 eyes, compared with a final postoperative average of 22.9 mm Hg. Mean follow-up period for study eyes was 44.4 months, and the average number of procedures per eye was 1.5. Overall success rate was 53% (18/34). Thirteen of the 34 eyes (38%) received one treatment only and were deemed a success. Retinal detachments developed in two eyes within the first postoperative month. CONCLUSIONS: ECP is a useful tool in the treatment of aphakic and pseudophakic glaucoma, with a low rate of visually significant complications. Retreatment of eyes improved the overall success rate, although experience with cases beyond two treatment sessions is limited. Hypotony was not encountered despite 8 of the 34 eyes receiving 360 degrees of total endocyclophotoablation to the ciliary processes.

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J AAPOS. 2007 Feb;11(1):23-8.
Endoscopic laser cyclophotocoagulation in pediatric glaucoma with corneal opacities.
Al-Haddad CE, Freedman SF.
Duke University Eye Center, Durham, NC.

INTRODUCTION: Endoscopic diode cycloablation (ECP) has shown modest efficacy for the management of pediatric glaucomas. Eyes with pediatric glaucoma and corneal opacities pose obstacles to intraocular surgery. We examined the role of ECP in lowering intraocular pressure (IOP) as well as that of endoscopy in facilitating tube shunt placement in these eyes. METHODS: Retrospective chart review of 12 eyes (11 patients) with glaucoma and corneal opacities from 12/99 to 9/05. ECP was performed for IOP control with success defined as postoperative IOP </=21 mm Hg, with or without medications and without procedure-related complications. Success of ECP, repeat ECP, and endoscopically guided tube shunt placement was studied. RESULTS: Diagnoses included the following: Peters/anterior segment dysgenesis in nine eyes and corneal scar/failed corneal graft in three. Patients included eight females and three males with median age 3 years (0.5 to 10.3) at treatment. Median number of prior surgeries was three; median time to failure was 7.8 months (0.3 to 38). Ten eyes had prior external cycloablation(s). Success of first ECP (mean 6.1 clock hours) was 2/12 (17%), with Kaplan-Meier median survival 12 months. Two treatment failures had repeat ECP, and both failed. Four treatment failures had subsequent tube shunt surgery (three with endoscopic assistance), and all were successful at median follow-up of 33 months (11 to 63). Baseline IOP was 36.8 +/- 11 mm Hg before ECP versus 28.2 +/- 16 mm Hg after first treatment (p = 0.07). Procedure-related complications included chorioretinal detachment in one eye. CONCLUSIONS: ECP had limited success in children with refractory glaucoma. However, with anatomic limitations, endoscopy itself was valuable in facilitating subsequent successful tube shunt surgery.

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Ophthalmology. 2007 Feb;114(2):367-73.
Experience with the polymer-coated hydroxyapatite implant after enucleation in 126 patients.
Shields CL, Uysal Y, Marr BP, Lally SE, Rodriques E, Kharod B, Shields JA.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

OBJECTIVE: To evaluate the new polymer-coated hydroxyapatite implant. DESIGN: Retrospective nonrandomized single-center case series. PARTICIPANTS: One hundred twenty-six patients managed with enucleation and placement of the polymer-coated hydroxyapatite implant at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University. METHODS: A retrospective analysis was performed on 126 patients managed with enucleation and placement of the polymer-coated hydroxyapatite implant. MAIN OUTCOME MEASURES: Ease of placement, functional ocular motility, tissue complications, and patient satisfaction. RESULTS: The preenucleation diagnoses included uveal melanoma (n = 76; 61%), retinoblastoma (n = 34; 27%), blind painful eye (n = 8; 6%), neovascular glaucoma from intraocular tumors or retinal detachment (n = 5; 4%), and others (n = 3; 2%). Previous ocular therapies for posterior segment conditions such as plaque radiotherapy, retinal detachment repair, and chemoreduction, thermotherapy, and cryotherapy had been performed in 22% of patients (n = 27). The implant size was 20 mm (n = 103; 82%), 18 mm (n = 22; 17%), and 16 mm (n = 1; 1%). Implant preparation and placement was uncomplicated in all patients, without adhesion to surrounding tissue. Four rectus muscles were attached to the implant in all patients. Socket motility was judged to be good (n = 118; 94%), fair (n = 6; 5%), and poor (n = 2; 2%). Complications included conjunctival thinning (n = 1; <1%), pyogenic granuloma (n = 1; <1%), conjunctival cyst (n = 3; 2%), implant infection (n = 1; <1%), and implant exposure (n = 3; 2%). There were no cases of implant extrusion or allergic reaction to the polymer. Patient satisfaction was reported as good (n = 123; 98%), fair (n = 2; 2%), and poor (n = 1; <1%). CONCLUSIONS: The polymer-coated hydroxyapatite implant is smoothly placed into the orbit after enucleation without the need for additional tissue wrap. With proper placement, this implant provides satisfactory functional motility and shows favorable tissue tolerance with no clinical evidence of allergic reaction or extrusion.

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Eur J Ophthalmol. 2007 Jan-Feb;17(1):53-62.
A double-masked, randomized, parallel comparison of a fixed combination of bimatoprost 0.03%/timolol 0.5% with non-fixed combination use in patients with glaucoma or ocular hypertension.
Hommer A.
Department of Ophthalmology, Hera Hospital, Vienna - Austria.

PURPOSE. To compare the safety and efficacy of the fixed combination product with non-fixed combination use of the same active ingredients in separate bottles (bimatoprost once-daily [qd], and timolol twice-daily [bid]). A bimatoprost 0.03% qd treatment arm was used for validation of the study. METHOD. This was a double-masked, randomized, parallel study in 445 patients with open-angle glaucoma or ocular hypertension. They were randomized in a ratio of 2:2:1 to receive bilateral treatment with the fixed combination, non-fixed combination treatment, or bimatoprost alone. RESULTS. Comparing the fixed combination and non-fixed combination, the non-inferiority margin of 1.5 mm Hg was met at all three timepoints for mean intraocular pressure (IOP), and a margin of 1.0 mm Hg for mean diurnal IOP. The incidence of conjunctival hyperemia was statistically significantly lower (p=0.014) in the fixed combination group (8.5%, 15/176) compared with the bimatoprost group (18.9%, 17/90) and the non-fixed combination group (12.5%, 22/176). CONCLUSIONS. The fixed combination of bimatoprost 0.03%/timolol 0.5% administered once daily was comparable in ocular hypotensive efficacy to the non-fixed combination. The lower propensity of the fixed combination to elicit conjunctival hyperemia suggests a superior comparative benefit/risk assessment of the fixed combination in the treatment of elevated IOP. Members of the Ganfort(R) Investigators Group I were as follows: Investigators-W. Benton Boone, MD, Inglewood, CA; James D. Branch, MD, Winston-Salem, NC; Luca Brigatti, MD, Rochester, NY; William C. Christie, MD, Pittsburgh, PA; William S. Clifford, MD, Garden City, KS; David L. Cooke, MD, St. Joseph, MI; Joel Corwin, MD, Ventura, CA; William F. Davitt III, MD, El Paso, TX; Jason Burns, MD, Jorge De La Chapa, DO, San Antonio, TX; Donald Digby, MD, Greensboro, NC; Mark DiSclafani, MD, Bradenton, FL; Martin Dorner, MD, Bocholt, Germany; Anton Hommer, MD, Vienna, Austria; Barry Katzman, MD, San Diego, CA; Hartwig Koch-Schweitzer, MD, Mettingen, Germany; Theodore Krupin, MD, Chicago, IL; Mark A. Latina, MD, Reading, MA; Charles Lederer, MD, Kansas City, MO; Martin R. Leopold, MD, Fishkill, NY; Mark Lesk, MD, Montreal, Quebec, Canada; Arash Mansouri, MD, Fredericksburg, VA; David Manusow, MD, Winnipeg, Manitoba, Canada; Paul Murphy, MD, Saskatoon, Saskatchewan, Canada; Katherine Ochsner, MD, Wilmington, NC; Peter Otto, MD, Berlin, Germany, Norbert Pfeiffer, MD, Mainz, Germany; Roberto Piemontesi, MD, Saskatoon, Saskatchewan, Canada; Eugene Protzko, MD, Bel Air, MD; Jay Rubin, MD, San Antonio, TX; Roman Rybiczka, MD, Wien, Austria; Sonja Scholzel, MD, Berlin, Germany; Sriram Sonty, MD, Calumet City, IL; Robert H. Stewart, MD, Houston, TX; Joseph Tauber, MD, Kansas City, MO; and Thomas R. Walters, MD, Austin, TX. Organizational Center-Amy L. Batoosingh, Izabella Bossowska, MD, Connie Chou, PhD, Alison Ingram, and Gary D. Novack, PhD.

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J Fr Ophtalmol. 2007 Jan;30(1):49-52.
[Cortisone glaucoma: epidemiological, clinical, and therapeutic study]
[Article in French]
El Afrit MA, Mazlout H, Trojet S, Larguech L, Megaieth K, Belhaj S, Khemiri N, Kraiem A.
Service d'Ophtalmologie, Hopital Habib Thameur, Tunis, Tunisia. ali.elafrit@rns.tn

INTRODUCTION: Cortisone glaucoma is a secondary glaucoma induced by local or oral steroids used to treat chronic inflammatory diseases. PATIENTS AND METHODS: Retrospective study including 43 eyes of 23 patients (three patients were monophthalmos). We present epidemiological and clinical features with evaluation of functional damage (visual acuity, visual field), and therapeutic results with a follow-up period ranging from 2 to 10 years. RESULTS: Topical steroids were incriminated in 15 of 23 cases (self-medication), whereas general steroids (for chronic diseases) were used by eight patients. Visual function was seriously affected (visual acuity<1/10 in 23/43 eyes at the first visit with pronounced visual field abnormalities). Surgery was necessary in 16 of 43 eyes (deep sclerectomy with or without implant, trabeculectomy). DISCUSSION: Cortisone glaucoma is rather frequent in Tunisia where conjunctival allergy and self-medication are common. Young adults are concerned, making it a high surgical risk usually requiring surgical devices such as a T Flux implant. CONCLUSION: Cortisone glaucoma is a serious complication of steroid therapy that usually affects young adults. The disease is usually detected late, explaining the severe functional damage.

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Drugs. 2007;67(2):237-55.
The clinical applications of Fluorouracil in ophthalmic practice.
Abraham LM, Selva D, Casson R, Leibovitch I.
Glaucoma Services, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.

Fluorouracil (5-fluorouracil, 5-FU) is a pyrimidine analogue that was originally known for its widespread use as an anticancer drug. The ability of 5-FU to reduce fibroblastic proliferation and subsequent scarring has made it an important adjunct in ocular and periorbital surgeries. It is used in primary glaucoma filtering surgeries and in reviving failing filtering blebs, in dacryocystorhinostomy, pterygium surgery, and in vitreoretinal surgery to prevent proliferative vitreoretinopathy. In addition, 5-FU is also gaining recognition in the treatment and surgical management of ocular surface malignancies like ocular surface squamous neoplasia; however, the specific action of the drug on highly proliferating cells limits its use in primary acquired melanosis of the conjunctiva. When applied topically, this drug has a low rate of sight-threatening adverse effects, is inexpensive, and is easy to administer, making it an important tool in enhancing the success rate in ophthalmic surgery and in reducing the recurrence of ocular surface neoplasia.

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Chem Immunol Allergy. 2007;92:221-7.
Glaucoma.
Tezel G, Wax MB.
Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Ky., USA.

Glaucoma is a chronic neurodegenerative disease of the optic nerve, in which apoptosis of retinal ganglion cells (RGCs) and progressive loss of optic nerve axons result in structural and functional deficits in glaucoma patients. This neurodegenerative disease is indeed a leading cause of blindness in the world. The glaucomatous neurodegenerative environment has been associated with the activation of multiple pathogenic mechanisms for RGC death and axon degeneration. Growing evidence obtained from clinical and experimental studies over the last decade also strongly suggests the involvement of the immune system in this neurodegenerative process. Paradoxically, the roles of the immune system in glaucoma have been described as either neuroprotective or neurodestructive. A balance between beneficial immunity and harmful autoimmune neurodegeneration may ultimately determine the fate of RGCs in response to various stressors in glaucomatous eyes. Based on clinical data in humans, it has been proposed that one form of glaucoma may be an autoimmune neuropathy, in which an individual's immune response facilitates a somatic and/or axonal degeneration of RGCs by the very system which normally serves to protect it against tissue stress.
  
Previous Glaucoma Research: 2002-2006   
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