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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.
Glaucoma
Research: 2002-2006
J Ocul Pharmacol Ther. 2006 Oct;22(5):353-61.
A comparative analysis of the effects of the fixed combination of
timolol and dorzolamide versus latanoprost plus timolol on ocular hemodynamics
and visual function in patients with primary open-angle glaucoma.
Siesky B, Harris A, Sines D, Rechtman E, Malinovsky VE, McCranor L, Yung CW,
Zalish M.
Department of Ophthalmology, Indiana University School of Medicine,
Indianapolis, IN.
Aims: The aim of this study was to assess the effects of fixed combination of
timolol and dorzolamide and latanoprost plus timolol on retinal, choroidal, and
retrobulbar hemodynamics and visual function in primary open-angle glaucoma (OAG)
subjects. Methods: Sixteen (16) OAG patients (age, 63.5 +/- 10.8 years; 9 male)
were evaluated in a randomized, crossover, double-blind study design after 4
weeks of treatment of latanoprost with timolol and fixed combination of timolol
and dorzolamide. After randomization, 9 right eyes and 7 left eyes were included
in the hemodynamic portion of the study. Measurements included: adverse events
check, visual acuity, contrast sensitivity, blood pressure, heart rate,
intraocular pressure (IOP), and fundus examination. Ocular blood flow was
assessed using confocal scanning laser Doppler flowmetry, color Doppler imaging,
and scanning laser ophthalmoscopy. Results: Both therapies were effective at
lowering IOP, whereas there was no statistically significant difference between
latanoprost plus timolol and the fixed combination of timolol and dorzolamide
(13.9% and 12.2% reduction, respectively; P = 0.5533). Fixed combination of
timolol and dorzolamide significantly increased central retinal artery end
diastolic blood flow velocity (P = 0.0168) and lowered resistance to flow (P =
0.0279). Temporal posterior ciliary artery peak systolic and end diastolic
velocities were significantly increased with the fixed combination of timolol
and dorzolamide (P = 0.0125 and 0.0238, respectively). Latanoprost plus timolol
had no significant effects on ocular blood flow during 4 weeks of treatment.
There were no statistically significant differences in adverse events, blood
pressure, heart rate, visual acuity, contrast sensitivity scanning laser
ophthalmoscopy, or Heidelberg Retinal Flowmeter for any treatment period.
Conclusions: Fixed combination of timolol and dorzolamide therapy might increase
blood flow in OAG patients while attaining a similar IOP reduction compared to
latanoprost plus timolol. Visual function, however, was not different in this
short-term comparison between the two treatments.
-----
Ophthalmology. 2006 Oct 26; [Epub ahead of print]
Intraocular Pressure-Lowering Effect of Adding Dorzolamide or
Latanoprost to Timolol A Meta-analysis of Randomized Clinical Trials.
Webers CA, Valk RV, Schouten JS, Zeegers MP, Prins MH, Hendrikse F.
Department of Ophthalmology, Maastricht University Hospital, Maastricht, The
Netherlands.
OBJECTIVE: To estimate the intraocular pressure (IOP)-lowering effect of 2%
dorzolamide or 0.005% latanoprost when added to 0.5% timolol. DESIGN:
Meta-analysis of randomized clinical trials. PARTICIPANTS: Seventeen articles
reporting on 19 study arms with 5 possible treatment combinations and 4 study
arms serving as controls. METHODS: Articles written in English, German, French,
or Dutch and published up to December 2004 were identified in Medline, Embase,
the Cochrane Controlled Trials Register, and references from relevant articles.
For the article to be considered, over 85% of the patients had to have primary
open-angle glaucoma or ocular hypertension. The pooled 1- to 3-month additional
IOP-lowering effect after a run-in phase on timolol was calculated by performing
meta-analysis using the random effects model. MAIN OUTCOME MEASURES: Absolute
and relative changes in IOP after run-in on timolol for peak moment, trough
moment, or mean diurnal curve. RESULTS: The pooled change from baseline [mean
(95% confidence interval)] for 0.5% timolol varied from -0.7 mmHg (-1.2 to -0.2,
for the mean diurnal curve) to -2.0 mmHg (-1.3 to -2.7, at peak). Pooled changes
for 2% dorzolamide in concomitant use with 0.5% timolol were -4.1 mmHg (-4.4 to
-3.8) at trough and -4.9 mmHg (-5.3 to -4.5) at peak. The fixed 2% dorzolamide
and 0.5% timolol combination resulted in a pooled change of -3.8 mmHg (-4.2 to
-3.4) at trough and -4.9 mmHg (-5.3 to -4.5) at peak. The concomitant use of
0.005% latanoprost and 0.5% timolol gave a pooled change from baseline of -6.0
mmHg (-6.8 to -5.2) at the mean diurnal curve. The fixed combination of 0.005%
latanoprost and 0.5% timolol resulted in a mean change of -3.0 mmHg (-3.8 to
-2.2) at the mean diurnal curve. CONCLUSION: In this meta-analysis of clinical
trials, the addition of dorzolamide or latanoprost further lowers IOP in eyes on
timolol. This result may not be generalizable because these trials may have
included nonresponders to timolol.
-----
J AAPOS. 2006 Oct;10(5):464-8.
The additive effect of topical dorzolamide and systemic
acetazolamide in pediatric glaucoma.
Sabri K, Levin AV.
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children,
University of Toronto, Toronto, Canada.
BACKGROUND: The effect of adding oral to topical carbonic anhydrase inhibitors
in the management of pediatric glaucoma is unknown. METHODS: We undertook a
retrospective analysis of children with a diagnosis of glaucoma before the age
of 16 years who initially were treated with topical dorzolamide or
dorzolamide-timolol combination and then treated with oral acetazolamide.
Children who had uveitic glaucoma or who had ocular surgery within 3 months
before or during oral acetazolamide therapy were excluded. Various methods of
intraocular pressure (IOP) measurement were used in the study. However, in each
case, the IOP was measured using the same technique, once at the last visit
before the addition of oral acetazolamide and once at the first examination
after the addition of oral acetazolamide. RESULTS: Twenty-two patients were
included in the study with an age range of 8 months to 15 years. Seventeen
children were boys. Oral acetazolamide treatment was via a daily dose (13.3 to
30 mg/kg, mean 22.5 mg/kg), and duration (6 to 31 days, mean 18.1 days). The
intraocular pressure (mean +/- SD) before acetazolamide (32.2 +/- 6.5 mm Hg) was
significantly different than after acetazolamide (21.8 +/- 6.3 mm Hg) with a
mean difference of 10.36 mm Hg (p < 0.0001) and a mean decrease in IOP of 29.6%.
CONCLUSIONS: The addition of oral acetazolamide to topical dorzolamide may
provide additional reduction in IOP in some children already being treated with
topical carbonic anhydrase inhibitors. This possible additive effect has not
been observed in adults treated with a combination of topical and systemic
carbonic anhydrase inhibitors.
-----
Ophthalmologe. 2006 Oct 21; [Epub ahead of print]
[Neovascular glaucoma : Aetiology, pathogenesis and treatment.]
[Article in German]
Loffler KU.
Universitats-Augenklinik, Ernst-Abbe-Strasse 2, 53127 , Bonn, karinloeffler@uni-bonn.de.
Neovascular glaucoma, as a typical secondary glaucoma, is due to ocular or
(earlier) systemic diseases. The formation of a fibrovascular membrane on the
anterior surface of the iris (rubeosis iridis) and extending into the chamber
angle leads to irreversible obliteration of the outflow system, with a
corresponding rise in intraocular pressure. The most frequent cause is retinal
ischaemia resulting either from vascular occlusion or from diabetic alterations.
The differential diagnosis must include acute angle-closure glaucoma and
uncontrolled open-angle glaucoma. Treatment is aimed at eliminating the actual
cause or at least reducing the risk factors (e.g. by retinal laser coagulation),
or consists in cyclodestructive procedures. Medicamentous therapy comprises
anti-inflammatory agents (steroids, cycloplegic agents) and substances that
reduce the production of aequeous humour (carbonic anhydrase antagonists, beta
blockers). In the near future, antiangiogenic medication might be another
effective option. For end-stage neovascular glaucoma, the implantation of
drainage devices is also discussed.
-----
Graefes Arch Clin Exp Ophthalmol. 2006 Oct 17; [Epub ahead of print]
Dose, timing and frequency of subconjunctival 5-fluorouracil
injections after glaucoma filtering surgery.
Reinthal EK, Denk PO, Grub M, Besch D, Bartz-Schmidt KU.
Dept I, University Eye Clinic, Schleichstrasse 12, 72076, Tubingen, Germany,
eva.reinthal@med.uni-tuebingen.de.
BACKGROUND: Although adjunctive postoperative 5-fluorouracil (5-FU) injections
are known to improve the success rate of glaucoma surgery, it is still unknown
what dose, timing and frequency of application will give the best results with
respect to the inhibition of postoperative scarring and intraocular pressure
regulation. We therefore designed the following retrospective investigation.
METHODS: We studied 172 eyes from 172 patients who had undergone trabeculectomy
with adjuvant 5-FU-therapy. Variations of dosage, timing and frequency were
analysed retrospectively. Surgery was defined as a complete success when the
patient reached an intraocular pressure under 21 mmHg and a reduction of 20% 12
months after the operation. A relative success was achieved with these criteria
under additional local medication. Not reaching these postoperative criteria for
a complete success was classified as failure. RESULTS: On average, adjunctive
5-FU-treatment was started 4.6+/-5.85 days postoperatively. The injections
contained between 2 mg and 5 mg FU, and the mean total dose was 26.6+/-13.2 mg
(range 5-65 mg). Surgery on 94 patients (54.65%) was classified as "complete
success", that on 25 patients (14.53%) was classified as "relative success" and
that on 53 eyes (30.81%) was classified as "failure" 12 months (+/-3 months)
postoperatively. The best results were obtained when the treatment started on or
before the first postoperative day (68.0-71.4% complete success; P<0.05). In
contrast, an increase in 5-FU dosage did not result in an increased success rate
of trabeculectomy. None of the 172 patients suffered from vision-threatening
complications such as endophthalmitis or hypotony maculopathy. CONCLUSION: Early
treatment with 5-FU significantly increases the success rates of filtering
surgery.
-----
Ophthalmic Surg Lasers Imaging. 2006 Sep-Oct;37(5):394-8.
Efficacy of laser trabeculoplasty in phakic and pseudophakic
patients with primary open-angle glaucoma.
Mahdaviani S, Kitnarong N, Kropf JK, Netland PA.
Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee
Health Science Center, Memphis, Tennessee 38163, USA.
BACKGROUND AND OBJECTIVE: To compare the efficacy of laser trabeculoplasty in
pseudophakic and phakic patients with primary open-angle glaucoma (POAG).
PATIENTS AND METHODS: Retrospective comparative case-control series of 42 eyes
(21 pseudophakic eyes and 21 phakic eyes of patients matched for age and gender)
with POAG not controlled using medical therapy and treated with laser
trabeculoplasty. Success was reduction of intraocular pressure (IOP) of at least
3 mm Hg from baseline and no additional glaucoma surgery or laser treatment.
uloplasty, there was no significant difference between pseudophakic and phakic
eyes in the mean IOP and change from baseline IOP Success at 12 months was 78%
for pseudophakic and 80% for phakic eyes. Kaplan-Meier survival analysis showed
no statistically significant difference in success after laser trabeculoplasty
comparing phakic to pseudophakic eyes (P = .87). CONCLUSION: In eyes with POAG,
laser trabeculoplasty is as effective in pseudophakic eyes as in phakic eyes.
-----
Klin Monatsbl Augenheilkd. 2006 Sep;223(9):743-7.
[Long-term follow-up of selective laser trabeculoplasty in
primary open-angle glaucoma]
[Article in German]
Gracner T, Falez M, Gracner B, Pahor D.
Lehrkrankenhaus Maribor, Augenabteilung, 2000 Maribor, Slowenien. tomaz.gracner@sb-mb.si
BACKGROUND: Our aim was to investigate the outcomes of selective laser
trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in
a prospective clinical study. PATIENTS AND METHODS: In 90 eyes suffering from
POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG
laser (532 nm). The intraocular pressure (IOP) was measured before the treatment
and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66 and 72 months after. A
failure was defined as an IOP reduction of less than 20 % of the pretreatment
IOP, or a progression of visual field or optic disc damage requiring filtering
surgery. The hypotensive medication during the study period remained unchanged.
RESULTS: The mean follow-up time was 41.2 months (SD 20.0). The mean
pretreatment IOP was 22.4 mmHg (SD 2.3). At one month of follow-up, the mean IOP
reduction was 5.0 mmHg (SD 2.3) or 22.3 % and at 6 months 5.2 mmHg (SD 2.4) or
23.2 %. At 12 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.4)
or 24.0 % and at 24 months 5.8 mmHg (SD 2.3) or 25.5 %. At 36 months of
follow-up, the mean IOP reduction was 5.7 mmHg (SD 2.1) or 25.1 % and at 48
months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 1.9) or 23.1 %. At
60 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 2.0) or 22.6 %
and at the end of 72 months of follow-up, the mean IOP reduction was 5.4 mmHg
(SD 2.3) or 22.8 %. The success rate after 12 months determined by Kaplan-Meier
survival analysis was 94 %, after 24 months 85 %, after 36 months 74 %, after 48
months 68 % and after 72 months 59 %. CONCLUSION: SLT is an effective procedure
offering an additional therapy option for the treatment of POAG, but the effect
diminishes over time.
-----
Graefes Arch Clin Exp Ophthalmol. 2006 Sep 16; [Epub ahead of print]
Long-term results of surgery in childhood glaucoma.
Alsheikheh A, Klink J, Klink T, Steffen H, Grehn F.
University Eye Hospital Wuerzburg, Josef-Schneider-Str.11, 97080, Wuerzburg,
Germany, f.grehn@augenklinik.uni-wuerzburg.de.
PURPOSE: The aim of this study is to assess the functional results and
morphological parameters in children surgically treated for glaucoma. METHODS:
Data from 43 patients and 68 eyes who were operated in our department between
1990 and 2002 were collected. This retrospective trial included primary
congenital glaucoma (n=36), and secondary glaucoma (n=7) in Rieger-Axenfeld
syndrome and Sturge Weber syndrome. Intraocular pressure (IOP), axial length of
the eyeball, visual acuity, refractive errors and orthoptic status were analysed.
RESULTS: The age of patients at the first surgery was 6.0+/-5.3 months (range
0.7 to 28.0 months). The mean period of follow-up was 57.3+/-36.8 months
(6.0-161.0).The mean number of surgical procedures performed on one eye was
2.5+/-2.4 procedures (1-11). The mean IOP before the first surgery was
31.0+/-7.9 mmHg (17.5-52.0), and was 15.0+/-3.9 mmHg (7.0-28.0) at the last
visit. 49 eyes (72.1%) did not need any further medical treatment after the last
surgical procedure. The IOP was 18 mmHg or lower without medication in 29 eyes
(42.6%) after just one surgical procedure (21 trabeculotomy, 8 combined
trabeculotomy/trabeculectomy with or without mitomycin-C). At the first
examination, the mean axial length of the eyeball was 22.6+/-1.8 mm (the mean
normal value at this age is 20.3+/-0.7 mm), and was 24.4+/-2.0 mm at the last
visit (the mean normal value at this age is 22.2+/-0.6 mm). The best corrected
visual acuity at the last visit was 0.25+/-4.6 lines; the normal range of visual
acuity at this age is from 0.4+/-4.0 lines to 0.8+/-3.0 lines. Visual acuity was
0.32 or more in 53.0% of the eyes. Visual acuity was lower than 0.1 in only
15.2% of the eyes. Myopia was present in 57.4% of the eyes with a mean spherical
equivalent of -6.1+/-3.9 dioptres. 15 patients (34.9%) developed strabismus. 22
patients (51.2%) were treated with part-time occlusion. Binocular function as
assessed with the Lang-1 test was positive in 17 of 30 patients (56.7%).
CONCLUSIONS: Although a good long-term IOP-control can often be achieved in
childhood glaucoma, the visual acuity remains below the normal range in most
cases despite close orthoptic follow-up.
-----
Curr Med Res Opin. 2006 Sep;22(9):1643-9.
Ocular hypotensive efficacy and safety of brinzolamide ophthalmic
suspension 1% added to travoprost ophthalmic solution 0.004% therapy in patients
with open-angle glaucoma or ocular hypertension.
Franks W; Brinzolamide Study Group.
Moorfields Eye Hospital, London, UK. wendy.franks@moorfields.nhs.uk
OBJECTIVE: The primary objective of this study was to determine if combined
travoprost ophthalmic solution 0.004% and brinzolamide ophthalmic suspension 1%
therapy is superior in lowering intraocular pressure (IOP) compared to
travoprost monotherapy for patients with open angle glaucoma or ocular
hypertension. The secondary objective was to measure the percentage of patients
achieving IOP levels of 18 mmHg or less. STUDY DESIGN AND METHODS: Single arm,
open-label. PARTICIPANTS: eighty-two patients with inadequate IOP control with
travoprost monotherapy. INTERVENTION: the addition of brinzolamide ophthalmic
suspension 1% twice daily. MAIN OUTCOME MEASURES: The primary endpoint was mean
IOP reduction from baseline at 4 and 12 weeks. The percentage of patients who
achieved IOP values <or= 18 mmHg was also measured. RESULTS: The mean age of the
patients was 67 years. Ethnic origin was 92.7% Caucasian, 3.7% Black, 2.4% Asian
and 1.2% other. The mean duration of travoprost treatment before the trial
started was 30 weeks. Compared to the baseline data (IOP = 22.5 mmHg) with
travoprost ophthalmic solution 0.004% monotherapy, IOP was decreased after 4 (n
= 78) and 12 (n = 71) weeks of combined travoprost and brinzolamide therapy by
an average of 3.9 mmHg (17.4%) and 4.2 mmHg (18.4%), respectively. At baseline
6.3% of patients had an IOP of 18 mmHg or less whereas at 4 and 12 weeks, 53.8%
and 60.6% of patients respectively had an IOP of 18 mmHg or less. Common adverse
events were mild and included ocular hyperaemia, dysgeusia and eye irritation.
Study limitations: this study had a small sample size and was open-label.
CONCLUSION: Patients receiving combined travoprost ophthalmic solution 0.004%
and brinzolamide ophthalmic suspension 1% therapy had lower IOP values compared
to those on travoprost monotherapy (p < 0.0001). Combined therapy resulted in a
significantly greater percentage of patients achieving IOPs of 18 mmHg or less
(p < 0.0001).
-----
Br J Ophthalmol. 2006 Jul 6; [Epub ahead of print]
IOP-Lowering Efficacy of Bimatoprost 0.03% and Travoprost 0.004%
in Patients with Glaucoma or Ocular Hypertension.
Cantor LB, Hoop JS, Morgan L.
Indiana University, United States.
BACKGROUND/AIMS: To evaluate the IOP-lowering efficacy of bimatoprost and
travoprost for the treatment of glaucoma and ocular hypertension. METHODS:
Prospective, randomized, investigator- masked, parallel-group clinical trial.
After completing a washout from any glaucoma medications, patients (n=157) were
randomized to bimatoprost or travoprost for 6 months. Visits were at baseline,
week 1, and months 1, 3, and 6. IOP was measured at 9 AM at each visit and also
at 1 and 4 PM at baseline and months 3 and 6. RESULTS: There were no significant
between-group differences in baseline IOP at 9AM, 1PM, or 4PM (P>.741). After 6
months, both medications significantly reduced IOP at every time point (P<.001).
After 6 months, mean IOP reduction at 9AM was 7.1 mm Hg (27.9%) with bimatoprost
(n=76) and 5.7 mm Hg (23.3%) with travoprost (n=81) (P=.014). At 1PM, mean IOP
reduction was 5.9 mm Hg with bimatoprost (25.3%) and 5.2 mm Hg (22.4%) with
travoprost (P=.213). At 4 PM, the mean IOP reduction was 5.3 mm Hg (22.5%) with
bimatoprost and 4.5 mm Hg (18.9%, P=.207) with travoprost. Both study
medications were well tolerated, with ocular redness the most commonly reported
adverse event in both treatment groups. CONCLUSIONS: Bimatoprost provided
greater mean IOP reductions than travoprost.
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Invest Ophthalmol Vis Sci. 2006 Jul;47(7):2917-23.
Effects of Topical Hypotensive Drugs on Circadian IOP, Blood
Pressure, and Calculated Diastolic Ocular Perfusion Pressure in Patients with
Glaucoma.
Quaranta L, Gandolfo F, Turano R, Rovida F, Pizzolante T, Musig A, Gandolfo E.
Clinica Oculistica, Universita degli Studi di Brescia, Brescia, Italy.
PURPOSE: To compare the short-term effects of timolol 0.5%, brimonidine 0.2%,
dorzolamide 2%, and latanoprost 0.005% on intraocular pressure (IOP), blood
pressure (BP), and diastolic ocular perfusion pressure (DOPP), calculated as the
difference between the diastolic blood pressure (DBP) and IOP. METHODS:
According to a 4 x 4 Latin squares design for repeated measures, 27 untreated
patients and patients with newly diagnosed primary open-angle glaucoma (POAG)
were treated with timolol 0.5% at 8 AM and 8 PM; brimonidine 0.2% at 8 AM and 8
PM; dorzolamide 2% at 8 AM, 2 PM, and 8 PM; and latanoprost 0.005% at 8 PM. The
duration of each treatment course was 6-weeks, with a 4-week washout between
each treatment. IOP and BP were measured at baseline and at the end of each
treatment period. IOP was measured every 2 hours throughout a 24-hour period.
Sitting IOP was measured from 8 AM to 10 PM by Goldmann applanation tonometry.
Supine IOP was assessed from 12 to 6 AM by means of a handheld electronic
tonometer (TonoPen XL; Mentor, Norwell, MA). BP monitoring was performed by
means of an automated portable device (TM-2430; A & D Co., Saitama, Japan).
RESULTS: All the drugs tested decreased the IOP significantly at all time points
in comparison with baseline pressure. The mean 24-hour IOP after latanoprost
administration (16.62 +/- 0.98 mm Hg) was significantly lower than that after
timolol, brimonidine, or dorzolamide (P = 0.0001). During the 24-hour period,
brimonidine induced a significant decrease in systolic BP (SBP) and DBP at all
time points when compared with baseline measurements and with those after
administration of the other drugs (P < 0.0001). Timolol caused a significant
decrease in DBP and SBP at all the 24-hour time points when compared with the
baseline and with the dorzolamide- and latanoprost-induced changes (P < 0.0001).
The mean 24-hour DOPPs were 50.7 +/- 5.9 mm Hg at baseline, 53 +/- 5.5 mm Hg
with timolol, 46.2 +/- 5.4 mm Hg with brimonidine, 55.9 +/- 4.6 mm Hg with
dorzolamide, and 56.4 +/- 4.9 mm Hg with latanoprost. Brimonidine induced a
significant decrease in the mean 24-hour DOPP compared with that at baseline (P
< 0.0001), whereas dorzolamide and latanoprost induced a significant increase (P
< 0.0001). CONCLUSIONS: Latanoprost seemed to induce a uniform reduction in IOP
during the 24-hour period, although timolol was as effective as latanoprost
during the daytime, and dorzolamide are as effective as latanoprost at night.
SBP and DBP were significantly decreased by either timolol or brimonidine. In
this study of patients with newly diagnosed POAG, only dorzolamide and
latanoprost significantly increased mean 24-hour DOPP.
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Eye. 2006 Jun 23; [Epub ahead of print]
Prospective, long-term evaluation of steroid-induced glaucoma.
Sihota R, Konkal VL, Dada T, Agarwal HC, Singh R.
Glaucoma Research Facility, Dr Rajendra Prasad Center for Ophthalmic Sciences,
All India Institute of Medical Sciences, New Delhi, India.
PurposeTo evaluate the intraocular pressure (IOP) after cessation of steroid use
in steroid-induced glaucoma and its control with medication or
surgery.MethodsThirty-four eyes of 34 patients having steroid-induced glaucoma
were prospectively evaluated after cessation of steroid for IOP, visual acuity,
and optic disc status at 3 months, and every 3 months for 18
months.ResultsTopical steroid use (73.5%) was the most frequent cause for
glaucoma. The baseline IOP was 35.47+/-12.59 mmHg. The baseline vertical
cup-disc ratio correlated with duration of steroid use (P=0.014) and the
baseline IOP (P<0.0001). In 25 patients (73.5%), IOP could be controlled by
topical medications alone, whereas nine patients (26.5%) required surgery. The
mean baseline IOP in eyes requiring surgery was 49.67+/-13.28 mmHg and in eyes
managed medically, 30.36+/-7.51 mmHg (P=0.002). The vertical cup-disc ratio in
surgically treated patient was 0.87+/-0.13:1 as compared to 0.71+/-0.15:1
(P=0.012) in the medically treated group. At 6, 12, and 18 months follow-up, 22
(64.7%), 33 (97.1%), and all 34 (100%) patients were off treatment,
respectively.ConclusionsPatients with steroid-induced glaucoma, who were </=20
years old, with a higher IOP, and greater glaucomatous optic neuropathy, were
more likely to need surgery. After cessation of steroid therapy, all eyes were
off treatment at 18 months.Eye advance online publication, 23 June 2006;
doi:10.1038/sj.eye.6702474.
-----
J AAPOS. 2006 Jun;10(3):243-8.
Long-term outcome of pediatric aphakic glaucoma.
Bhola R, Keech RV, Olson RJ, Petersen DB.
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa
City, Iowa.
Purpose: To determine the long-term outcome in pediatric patients with aphakic
glaucoma. Methods: A retrospective analysis of 130 patients diagnosed with
aphakic glaucoma between 1969 and 2004 was performed. A total of 36 patients (55
eyes) were included in this study after excluding those who had cataract
extraction after age 10 and those patients with other ocular conditions,
systemic syndromes, traumatic cataracts, congenital glaucoma, or inadequate
follow-up (less than 1 year). Outcome variables studied included visual acuity,
number of medication changes required over the course of the follow-up, maximum
number of medications used at a time for more than 6 months to control
intraocular pressures, and surgical interventions required. Mean follow-up
period was 18.7 years (range, 6.9-35 years). Results: At the time of last
follow-up, 54.5% of the patients had visual acuity 20/40 or better, 34.5% had
20/50 to 20/200, and 11% had acuity worse than 20/200. During the course of
follow-up, 34% required 1 to 2 medication changes for controlling glaucoma, 33%
required 3 to 5 medication changes, and 33% required 6 or more medication
changes. Thirty-six percent of the eyes required a maximum of 1 to 2 medications
for more than 6 months during the course of follow-up, 33% required 3, and 31%
required 4 or more medications for controlling intraocular pressure. Of the 55
eyes, 15 eyes (27%) required surgical intervention. Six of the 15 eyes (40%)
required 1 surgery, 8 eyes (53%) required 2 to 3 surgeries, and 1 eye (7%)
required 4 to 6 surgeries. Conclusion: Patients with glaucoma after pediatric
cataract surgery can have a good visual outcome although multiple medications
and surgical interventions may be required to control the glaucoma.
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J Ocul Pharmacol Ther. 2006 Jun;22(3):188-93.
Effects of bimatoprost 0.03% on ocular hemodynamics in normal
tension glaucoma.
Chen MJ, Cheng CY, Chen YC, Chou CK, Hsu WM.
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Purpose: The aim of this study was to investigate the effects of bimatoprost
0.03% on ocular hemodynamics in patients with normal tension glaucoma (NTG).
Methods: Twenty-two (22) patients with NTG were consecutively recruited. After
basic eye examination and diurnal intraocular pressure (IOP) measurement, color
Doppler imaging was used to measure the peak systolic and end diastolic
velocities and resistive index of the central retinal, lateral posterior ciliary,
and medial posterior ciliary arteries. Patients received bimatoprost 0.03% for 4
weeks, and these measurements were then repeated. The worse eye of each NTG
patient was used in the statistical analysis. Results: Bimatoprost 0.03%
significantly reduced mean IOP from 15.1 +/- 3.8 mmHg at baseline to 12.0 +/-
2.9 mmHg after treatment in our sample of NTG patients (P < 0.001). No
significant changes in blood velocities or resistance indices were observed in
the retrobulbar vessels after the 4-week treatment. Conclusions: Topical
bimatoprost 0.03% significantly reduced IOP in our NTG patients without causing
significant hemodynamic changes in the retrobulbar vessels.
-----
Kaohsiung J Med Sci. 2006 Jun;22(6):266-70.
Rescula as an alternative therapy for Beta-blockers with
long-term drift effect in glaucoma patients.
Chen CL, Tseng HY, Wu KY.
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan.
The purpose of this study was to evaluate both the intraocular pressure (IOP)-decreasing
and neuroprotective effects of Rescula (0.12% unoprostone isopropyl) as an
alternative therapy to betablockers with a long-term drift effect in patients
with glaucoma. Twenty-eight patients with unilateral or bilateral glaucoma were
treated with Rescula instead of the original beta-blocker therapy. IOP was
measured using a Goldmann applanation tonometer, and visual field defects were
evaluated quantitatively by Humphrey automatic perimetry central 30-2 threshold
test. The mean follow-up time was at least 1 year. Rescula achieved a
significant (p = 0.00001) and long-lasting reduction in IOP (from 20.78 +/- 2.71
to 17.14 +/- 2.70 mmHg) in patients with open-angle glaucoma after 12 months of
follow-up. It also demonstrated a significant (p = 0.02) IOP-reducing effect
(from 20.67 +/- 3.60 to 16.36 +/- 3.67 mmHg) in patients with angleclosure
glaucoma 12 months later. The mean deviation of visual field defects changed
from -13.27 dB baseline to -10.64 dB at 12 months as evaluated by Humphrey field
analyzer II central 30-2 threshold test after Rescula; however, there was no
statistical difference (p = 0.098). Our results showed that Rescula has a
significant IOP-reducing effect as an alternative therapy to beta-blockers with
long-term drift effect in patients with open-angle and angle-closure glaucoma.
However, a neuroprotective effect to prevent further progression of the visual
field defect in patients with glaucoma was not demonstrated in this study.
-----
Drugs. 2006;66(8):1033-9.
Treating ocular hypertension to reduce glaucoma risk : when to
treat?
Higginbotham EJ.
Morehouse School of Medicine, Atlanta, Georgia, USA.
When to treat the patient who presents with ocular hypertension has been a
question that has 'stumped' the ophthalmic community for decades.
Population-based studies and intervention trials have provided the basis for
understanding why we consider treating such patients. Although the EGPS
(European Glaucoma Prevention Study) did not demonstrate that reducing
intraocular pressure (IOP) with dorzolamide prevented the onset of glaucoma
compared with individuals receiving a placebo, the investigators of the OHTS
(Ocular Hypertension Treatment Study) found that the treatment of ocular
hypertension can be delayed with topical medication when treated patients were
compared with an observation group. There are differences in inclusion criteria,
study design and retention rates between the EGPS and the OHTS, which may have
led to the discrepancies in outcomes between these two studies. These
differences provide a basis for understanding the relevance of the findings of
both trials to clinical practice. The clinician should consider key risk factors
such as age, thin corneal thickness measurements, large cup-to-disc ratio and
mean IOP when determining who should be treated. However, the ultimate decision
of when to treat will be determined by other issues such as life expectancy, the
general health of the patient and the number of risk factors. Clearly, the
treatment of only high-risk patients with ocular hypertension should be
considered.
-----
Arch Ophthalmol. 2006 Jun;124(6):800-6. Comment in: Arch Ophthalmol. 2006
Jun;124(6):903-4.
Ahmed Glaucoma Valve implantation in African American and white
patients.
Ishida K, Netland PA.
Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis
38163, USA.
OBJECTIVE: To evaluate the results of Ahmed Glaucoma Valve implantation in
African American and white patients. METHODS: In this retrospective, comparative
case-control study, we reviewed 86 eyes of 86 patients, comparing the surgical
outcomes in white patients (n = 43) with matched African American patients (n =
43). Success was defined as an intraocular pressure (IOP) between 6 mm Hg and 21
mm Hg with or without glaucoma medicines, without further glaucoma surgery, and
without loss of light perception (definition 1) and an IOP between 6 mm Hg and
21 mm Hg and achievement of a 20% reduction in IOP from the preoperative level
(definition 2). RESULTS: The mean follow-up was 2.3 years for white patients and
2.5 years for African American patients (P = .50). At the last follow-up, the
mean +/- SD IOP was 15.3 +/- 3.3 mm Hg and 15.3 +/- 3.5 mm Hg (P = .77) in white
and African American patients, respectively. Life table analysis showed a
significantly lower success rate for African American patients compared with
white patients by both definition 1 (P = .03) and definition 2 (P = .006). Cox
proportional hazards regression analysis detected African American race as a
risk factor for surgical failure by both definitions. Visual outcomes and
complications were comparable between the 2 groups. CONCLUSION: African American
patients have a greater risk of surgical failure after Ahmed Glaucoma Valve
implantation compared with white patients.
-----
Arch Ophthalmol. 2006 Mar;124(3):355-60.
Long-term results of Molteno implant insertion in cases of
neovascular glaucoma.
Every SG, Molteno AC, Bevin TH, Herbison P.
Section of Ophthalmology, Department of Medical and Surgical Sciences, Dunedin
School of Medicine, University of Otago, Dunedin, New Zealand.
OBJECTIVE: To describe the long-term outcomes of cases of neovascular glaucoma
drained by Molteno implants. METHODS: A prospective study of 145 eyes (130
patients) followed up for a mean of 3.3 years (range, 0.02 year [5 days] to 18.1
years) in the province of Otago, New Zealand, from 1979 to 2002. RESULTS:
Insertion of a Molteno implant controlled the intraocular pressure at 21 mm Hg
or less with a probability (95% confidence interval) of 0.72 (0.64-0.80), 0.60
(0.51-0.69), and 0.40 (0.29-0.50) at 1, 2, and 5 years, respectively. Failure to
control intraocular pressure at 1, 2, and 5 years was significantly correlated
with persistent iris neovascularization (P<.001, P<.001, and P = .01,
respectively). Visual acuity at final follow-up in nonenucleated eyes was
maintained or improved in 56 eyes (39%) and deteriorated to light perception or
better in 25 (17%) or no light perception in 47 (32%). Seventeen eyes (12%) were
enucleated. CONCLUSIONS: The insertion of Molteno implants for neovascular
glaucoma maintained or improved vision in 39% of eyes, whereas 12% were
eventually enucleated (all of which initially had visual acuity <20/1200). The
outcome depended mainly on progression of the underlying vascular disease.
-----
Eye. 2006 Mar 3; [Epub ahead of print]
The effect of aspirin and warfarin therapy in trabeculectomy.
Cobb CJ, Chakrabarti S, Chadha V, Sanders R.
1Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK.
AimThe management of patients on antiplatelet and anticoagulation therapy (APACT)
in glaucoma surgery currently has no specific recommendations. We aimed to
establish the risk of haemorrhagic complications and surgical outcome in
patients on APACT in glaucoma surgery.MethodsWe retrospectively examined 367
consecutive trabeculectomies performed between 1994 and 1998. Preoperatively 60
(16.4%) patients were on APACT (55 on aspirin and five on warfarin). The
incidence of hyphaema and haemorrhagic complications between patients with and
without APACT was documented. Surgical success was defined in two categories as
an intraocular pressure (IOP) <21 mmHg and an IOP <16 mmHg 2 years following
trabeculectomy with and without antiglaucoma medication.ResultsNone of the
patients on aspirin suffered significant intra or postoperative haemorrhage.
Aspirin was associated with a significantly higher risk of hyphaema (P=0.0015)
but this was not found to significantly affect IOP control at 2 years. Patients
on warfarin suffered haemorrhagic complications and trabeculectomy
failure.ConclusionsAspirin appears to be safe to continue with during
trabeculectomy. Patients on aspirin have an increased risk of hyphaema following
trabeculectomy. This however does not appear to affect surgical outcome.
Warfarinised patients are at risk of serious bleeding complications. They
require careful monitoring pre- and postoperatively and are at risk of
trabeculectomy failure.Eye advance online publication, 3 March 2006;
doi:10.1038/sj.eye.6702277.
-----
Ophthalmology. 2006 Mar;113(3):446-50.
24-hour intraocular pressure control obtained with evening-
versus morning-dosed travoprost in primary open-angle glaucoma.
Konstas AG, Mikropoulos D, Kaltsos K, Jenkins JN, Stewart WC.
Glaucoma Unit, Department of Ophthalmology, A University, AHEPA Hospital,
Thessaloniki, Greece.
PURPOSE: To evaluate the quality of 24-hour intraocular pressure (IOP) control
between morning- and evening-dosed travoprost in primary open-angle glaucoma
patients. DESIGN: Prospective, crossover, double-masked comparison. METHODS:
After a 6-week medicine-free period, 33 patients were randomized to receive
travoprost dosed in the morning or evening. After 8 weeks of treatment, a
24-hour IOP curve was performed at 6 am, 10 am, 2 pm, 6 pm, 10 pm, and 2 am.
Patients were then treated with the opposite dosing regimen for another 8 weeks,
after which the 24-hour IOP curve was repeated. MAIN OUTCOME MEASURES:
Twenty-four-hour IOP. RESULTS: The untreated mean 24-hour IOP was 23.6+/-2.0
mmHg. There were no differences for mean 24-hour IOP between the morning
(17.5+/-1.9 mmHg) and evening (17.3+/-1.9 mmHg) dosings (P = 0.7). At 10 am, the
evening dosing provided a statistically lower IOP (17.2+/-2.1 mmHg) than the
morning dosing (19.1+/-2.5 mmHg) (P = 0.02). Evening dosing demonstrated a
statistically lower 24-hour fluctuation of IOP (3.2+/-1.0 mmHg) than morning
dosing (4.0+/-1.5 mmHg) (P = 0.01). Safety was similar, with conjunctival
hyperemia being the most common adverse event (n = 9 [27% for morning dosing]
and n = 11 [33% for evening dosing], P = 0.6). CONCLUSIONS: This study suggests
that both morning and evening dosings of travoprost provide effective 24-hour
IOP reduction. However, the evening dosing of travoprost demonstrates slightly
greater daytime efficacy, with a narrower range of 24-hour pressure.
-----
Br J Ophthalmol. 2006 Mar;90(3):328-32.
Baerveldt glaucoma implant in paediatric patients.
van Overdam KA, de Faber JT, Lemij HG, de Waard PW.
The Rotterdam Eye Hospital, Schiedamse Vest 180, 3011 BH Rotterdam, Netherlands.
AIM: To evaluate the Baerveldt glaucoma implant (BGI) in paediatric glaucoma
treatment. METHODS: In a retrospective non-comparative case series 55 eyes of 40
consecutive paediatric patients (< or =16 years) with primary or secondary
glaucoma underwent Baerveldt (350 mm2) implantation. Surgical outcome was
evaluated by Kaplan-Meier table analysis. RESULTS: The overall success rate was
80% at last follow up, with a mean follow up of 32 (range 2-78) months.
Cumulative success was 94% at 12 months and 24 months, 85% at 36 months, 78% at
48 months, and 44% at 60 months. 11 eyes (20%) failed postoperatively because of
an IOP >21 mm Hg (eight eyes), persistent hypotony (two eyes), and choroidal
haemorrhage following cataract surgery (one eye). The most frequent complication
needing surgery was tube related (20%). A new observation was mild to moderate
dyscoria in 22% of the eyes, all buphthalmic, caused by entrapment of a tuft of
peripheral iris in the tube track. CONCLUSIONS: The BGI is effective and safe in
the management of primary and secondary glaucoma. When angle surgery has proved
to be unsuccessful or inappropriate in paediatric patients, a BGI is a good
treatment option. One must be prepared to deal with the tube related problems.
-----
J AAPOS. 2006 Feb;10(1):7-21.
Glaucoma in children: are we making progress?
Biglan AW.
University of Pittsburgh School of Medicine, Department of Ophthalmology,
Cranberry Township, PA, USA.
Background: Glaucoma in children presents difficult clinical challenges. Even
when appropriately treated, blindness can occur. Design: Retrospective
interventional case series and literature review. Methods: All clinical records
of children seen by the author with a diagnosis of glaucoma established before
16 years of age were reviewed from 1977 to 2003. Glaucoma was classified as
primary infantile, aphakic, syndrome-related, and secondary. The best-corrected
visual acuity, refractive error, configuration of the optic nerve cup, and
perimetry were recorded. The intraocular pressure (IOP) for each visit was
recorded. IOP measurements of 19 mm Hg or less were considered "good." The
percentage of "good" readings was calculated for each eye. Representative visual
acuities, refractive errors, IOP, disk configuration, and perimetry were
recorded at 6, 12, 18, and 24 years of age for each patient. The admitting
ophthalmologic diagnosis for each child at the Western Pennsylvania School for
Blind Children was recorded from 1887 to 2003. Results: One hundred twenty-six
children (204 eyes) were studied: infantile glaucoma, 52 eyes; aphakic glaucoma,
40 eyes; syndrome associated, 69 eyes; and secondary glaucoma, 43 eyes. The mean
follow-up was 11.6 years (1 to 30 years). Overall, 60 (29.4%) of 204 eyes had a
6/12 (20/40) or better corrected visual acuity at the most recent visit. The
percentage with this acuity remained stable throughout the follow-up period.
Eyes with infantile glaucoma had the best acuity, and 40% had 6/12 (20/40) or
better. Amblyopia was common and responded to treatment. Eyes with aphakic
glaucoma had the worst acuity with only 10% achieving 6/12 or better. These eyes
had a bimodal onset of glaucoma; eyes with an early onset had an angle closure
configuration and eyes with a delayed onset had an open angle. Early cataract
removal and microcornea were risk factors for glaucoma. If the IOP was
maintained at 19 mm Hg or less (good) on 80% of the determinations over time,
the optic nerve cup compared with the diameter of the optic nerve (C/D ratios)
were stable. Eight patients had multiple, good quality, visual fields performed
over 3 to 15 years. If the patients had "good" IOP on 70% of the measurements,
the visual fields remained stable. A historical perspective of glaucoma control
was gained by looking at the admitting diagnosis at the Western Pennsylvania
School for Blind Children. From 1910 to 1970, an average of 9.2 children blind
due to glaucoma were admitted each decade. From 1971 to 2003, there were only
three children with glaucoma admitted over 30 years. Conclusion: Removal of
congenital cataracts should be delayed until 3 to 4 weeks of age. Consideration
should be given for using 19 mm Hg or less to measure the success of glaucoma
treatment in children. Treatment of amblyopia is as important as IOP control in
children. Imaging technology such as optical coherence tomography and
measurement of central corneal thickness may play an important future role in
the assessment of children with suspected or known glaucoma.
-----
J Fr Ophtalmol. 2006 Feb;29(2):164-8.
[Observational survey on the use of dual therapy in ocular
hypertension or glaucoma treatment.]
[Article in French]
Bron A, Nordmann JP, Rouland JF, Baudouin C, Sartral M.
Service d'Ophtalmologie, CHU, Dijon.
Aim: To ascertain why ophthalmologists shift therapy to a fixed-combination or
non-fixed-combination drug therapy. PATIENTS AND METHODS: A prospective
multicenter observational study was conducted among French ophthalmologists
working in private or mixed practice. The study included adult patients with
open-angle glaucoma or ocular hypertension, treated with monotherapy or dual
therapy and needing to modify their initial treatment. The patients had to fill
out a self-questionnaire 15 days after the change in therapy, evaluating the
compliance and assessment of the new treatment. RESULTS: The analysis was made
on 775 questionnaires filled out by ophthalmologists between March 1st and July
31st 2003 on 5734 patients. The mean age was 66.4+/-12.4 years and women
represented 53.6% of the patients. The diagnosis had been made, on average,
7.5+/-7.3 years before. The mean initial intraocular pressure under treatment
was 19.8+/-4.1 mmHg in both eyes. Initially, 58.2% of the patients had
monotherapy, 40.4% dual therapy and 1.4% triple therapy. The main reasons for
shifting therapy were "high intraocular pressure under treatment" for 63.5% of
the patients and "simplification of the treatment" for 39.1% of the patients
(several reasons per patient were accepted). Most of the patients were satisfied
with their new therapy (71%), which in most cases was a fixed-combination
therapy (95.2%). DISCUSSION: This study has shown that the use of at least two
active principles is a common practice in the treatment of glaucoma and ocular
hypertension. An additive therapy is given in order to better control the
intraocular pressure, mainly with a fixed combination.
-----
J Fr Ophtalmol. 2006 Feb;29(2):153-6.
[Trabeculectomy for the management of uveitic glaucoma.]
[Article in French]
Souissi K, El Afrit MA, Trojet S, Kraiem A.
Service d'Ophtalmologie, Centre Hospitalo-Universitaire Habib Thameur, Tunis,
Tunisie.
PURPOSE: To report middle-term results of trabeculectomy in patients with
uveitic glaucoma resistant to medical therapy. PATIENTS AND METHODS: Seventeen
eyes of 14 patients with uveitic glaucoma resistant to medical therapy were
treated by trabeculectomy without antimetabolites from 1994 to 2001. The
patients'mean age was 48.1 years (range, 23-63 years). All had their uveitis
controlled for at least 3 months before surgery by an anti-inflammatory therapy.
RESULTS: Mean follow-up was 52.1 months. Success was obtained in 11 eyes
(64.7%). It was complete in five eyes (45.5%) and relative in six eyes (54.5%).
Failure was noted in six eyes (35.3%), which were treated with a second
filtering surgery. Intraocular pressure was reduced from a mean preoperative
value of 34.2mmHg to a mean postoperative value of 18.6 (45.6% reduction).
Antiglaucomatous medication was reduced from a mean of 2.8 medications
preoperatively to 1.1 medications (60.7% reduction). Postoperative complications
included three cases of lens opacity, two cases of hyphema, two cases of
transitory hypotony, one case of flat anterior chamber, and one case of
inflammation relapse. CONCLUSION: In the absence of failure risk factors except
inflammation, trabeculectomy without antimetabolites can be successful in
uveitic glaucoma not controlled by medical therapy, with good results even at
the middle term.
-----
Pharmacoeconomics. 2006;24(3):297-314.
Bimatoprost: a pharmacoeconomic review of its use in open-angle
glaucoma and ocular hypertension.
Plosker GL, Keam SJ.
Adis International Limited, Auckland, New Zealand.
Bimatoprost (Lumigan((R))) is a prostamide analogue used for the reduction of
elevated intraocular pressure (IOP) in patients with open-angle glaucoma or
ocular hypertension. In comparative clinical trials of up to 1 year in duration,
administration of 0.03% bimatoprost ophthalmic solution once daily was more
effective than 0.5% timolol twice daily and at least as effective as the
prostaglandin analogues 0.005% latanoprost and 0.004% travoprost once daily in
terms of reducing IOP and/or achieving target IOP levels. Bimatoprost was also
more effective than twice-daily administration of 0.5%/2% timolol/dorzolamide in
patients refractory to topical timolol therapy. Although generally well
tolerated, bimatoprost is associated with a higher incidence of conjunctival
hyperaemia than latanoprost, timolol or the combination of timolol and
dorzolamide.Three fully published modelled cost-effectiveness analyses of
bimatoprost evaluating cost per treatment success in patients with glaucoma or
ocular hypertension have been conducted in the US. The analyses incorporated
results of randomised, multicentre clinical trials and used a 1-year time
horizon. In the treatment algorithm used in the models, patients not achieving
target IOP levels with bimatoprost or comparator required additional medical
visits and adjunctive therapy. Bimatoprost was associated with lower costs per
treatment success than latanoprost, timolol or timolol/dorzolamide across a
range of clinically relevant target IOPs. Results were sensitive to changes in
treatment success rates and/or drug acquisition costs. Along with the inherent
limitations of economic models, other possible criticisms of the analyses are
the use of selected IOP data, and the lack of inclusion of costs associated with
conjunctival hyperaemia or other adverse effects of therapy.Various other
cost-effectiveness analyses of bimatoprost are available, primarily as abstracts
and/or posters. In general, most of these studies have also been favourable for
bimatoprost, despite having been conducted in different countries and/or from
different perspectives.In conclusion, in patients with open-angle glaucoma or
ocular hypertension, bimatoprost is an effective and generally well tolerated
therapeutic option, albeit with a relatively high incidence of conjunctival
hyperaemia. Although results of modelled cost-effectiveness analyses should be
interpreted with due consideration of the limitations of the studies, available
pharmacoeconomic data generally support the use of bimatoprost as a
cost-effective treatment in this patient population.
-----
Arch Soc Esp Oftalmol. 2006 Feb;81(2):93-100.
[Short- and medium-term intraocular pressure lowering effects of
combined phacoemulsification and non-penetrating deep sclerectomy without
scleral implant or antifibrotics.]
[Article in Spanish]
Moreno-Lopez M, Perez-Alvarez MJ.
Servicio de Oftalmologia, Hospital Universitario de Guadalajara, Espana.
PURPOSE: To examine the short- and medium-term intraocular pressure (IOP)
lowering effects of combined phacoemulsification and non-penetrating deep
sclerectomy without the use of scleral implant or antifibrotics in open-angle
glaucoma (primary and pseudoexfoliative) and coexisting cataract in eyes with no
known risk factors for bleb failure. METHODS: Retrospective study of 15 eyes of
12 patients with medically uncontrolled open-angle glaucoma or open-angle
glaucoma treated with two or more drugs and coexisting cataract with no known
risk factors for glaucoma surgery failure. All patients received combined
phacoemulsification and non-penetrating deep sclerectomy without scleral implant
or antifibrotics performed by the same surgeon. Nd-YAG perforation of the
trabeculodescemetic membrane and/or needling with mitomycin-C was performed
postoperatively for IOP control. Main outcome measures were postoperative IOP,
percentage of eyes with IOP <17mmHg, complications and final visual acuity (VA).
Median follow-up was 12.0 months (SD: 0.6) and ranged from 1 to 30 months.
RESULTS: Mean preoperative IOP with medical treatment was 21.80 mmHg (SD: 5.14)
and decreased to 14.42 mmHg (SD: 2.15) at 12-month visit. Mean antiglaucoma
medication preoperative was 1.93 (SD: 0.70) and was reduced to 0.13 (DE: 0.35)
postoperative. At 12-month visit, 80% had an IOP lower than 17 mmHg with a mean
VA gain of 2.50 Snellen lines. Conjuntival wound leakage was the most frequent
complication (20%; 3/15). CONCLUSIONS: Primary combined phacoemulsification and
non-penetrating deep sclerectomy without collagen implant or antifibrotics in
primary open-angle glaucoma with coexisting cataract, significantly lowers IOP
in the short- and medium term in low-risk cases for glaucoma surgery failure,
allowing for rapid visual improvement with a low complication rate (Arch Soc Esp
Oftalmol 2006; 81: 93-100).
-----
Eur J Ophthalmol. 2006 Jan-Feb;16(1):100-4.
Long-term clinical results of selective laser trabeculoplasty in
the treatment of primary open angle glaucoma.
Weinand FS, Althen F.
Department of Ophthalmology, University Eye Clinic, Giessen - Germany.
PURPOSE. To investigate the long-term efficacy of selective laser
trabeculoplasty (SLT) in primary open-angle glaucoma, the authors performed a
non-randomized, prospective, non-comparative clinical case series. METHODS.
Fifty-two eyes of 52 patients (19 male, 33 female) with primary open angle
glaucoma were treated with SLT. Patients were treated with the Coherent Selecta
7000 (Coherent, Palo Alto, CA, USA) frequency-doubled q-switched Nd:YAG laser
(532 nm). A total of approximately 50 non-overlapping spots were placed over 180
degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ
per pulse. After surgery, patients were maintained with the drug regimen
identical to that before treatment. RESULTS. After 1 year the average reduction
in intraocular pressure (IOP) from the baseline was 24.3% (6.0 mmHg), after 2
years 27.8% (6.12 mmHg), after 3 years 24.5% (5.53 mmHg), and after 4 years
29.3% (6.33 mmHg). A Kaplan-Meier survival analysis revealed a 1-year success
rate of 60%, a 2-year success rate of 53%, a 3-year success rate of 44%, and a
4-year success rate of 44%. CONCLUSIONS. Despite a declining success rate, SLT
is an effective method to lower IOP over an extended period of time. (Eur J
Ophthalmol 2006; 16: 100-4).
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Graefes Arch Clin Exp Ophthalmol. 2005 Dec 8;:1-6 [Epub ahead of print]
Effect of additive preoperative latanoprost treatment on the
outcome of filtration surgery.
Berthold S, Pfeiffer N.
Department of Ophthalmology, University Hospital of Johannes Gutenberg
University, Langenbeckstrasse 1, 55131, Mainz, Germany, Silke.Berthold@web.de.
BACKGROUND: Long-term glaucoma medication has been suspected to be a risk factor
for bleb failure following trabeculectomy. It was the goal of our study to
investigate whether additive preoperative treatment with latanoprost has an
effect on the outcome of subsequent trabeculectomy. METHODS: We retrospectively
analysed the outcome of trabeculectomy in 32 eyes of 16 patients who had
received bilateral trabeculectomy within the Mainz-II study. This study had been
designed to examine the effect of 6 months' use of topical latanoprost therapy
on iris darkening. The first eye of each patient was operated upon without
preoperative latanoprost therapy; the other eye was operated on after 6 months'
treatment with latanoprost in addition to existing medical glaucoma treatment.
We analysed the outcome of these patients and compared success rates and average
intra-ocular pressures (IOPs) between the latanoprost-treated and the untreated
partner eyes. Success was defined as an average postoperative IOP of 18 mmHg or
less. RESULTS: We obtained IOP values from 13 of 16 patients, with a mean
follow-up period of 6.8 years. Three patients were lost to follow-up. In both
groups eight eyes (61.5%) had an average postoperative IOP (average of all IOPs
measured in the follow-up period) of 18 mmHg or less. The mean average
postoperative IOPs in the control group and in the latanoprost group were 15.2
mmHg and 15.8 mmHg, respectively. Intra-individual comparison revealed that one
pair of eyes had equal IOPs, while six eyes in each group showed better
postoperative IOP control than the respective partner eye. However, mean delta
IOPs (maximum preoperative IOP minus average postoperative IOP) were 17.8 mmHg
and 14.2 mmHg for the control group and latanoprost group, respectively.
CONCLUSION: In this small group 6 months of additive preoperative treatment with
latanoprost did not have a statistically significant effect on the success rate
of trabeculectomy or on the postoperative IOP level following trabeculectomy.
However, trabeculectomy in eyes preoperatively receiving latanoprost for 6
months might lead to a slightly smaller delta IOP than in eyes naive to
prostaglandins.
-----
Adv Drug Deliv Rev. 2005 Dec 13;57(14):2063-2079. Epub 2005 Nov 28.
Recent progress in ocular drug delivery for posterior segment
disease: Emphasis on transscleral iontophoresis.
Myles ME, Neumann DM, Hill JM.
Department of Ophthalmology, LSU Health Sciences Center, New Orleans, LA, USA.
Age-related macular degeneration, diabetic retinopathy, posterior uveitis, and
retinitis due to glaucoma are leading causes of vision loss in the United States
and other developed countries. Because these diseases are located in the
posterior segment of the eye, topical application of ophthalmic medicines is of
limited benefit, since topically applied drugs rarely reach therapeutic levels
in the affected posterior tissues such as the choroid and retina. Intravitreal
injections can deliver drugs to the posterior segment without the side effects
associated with systemic administration. However, the repeated and long-term
injections often needed may cause complications, such as vitreous hemorrhage,
retinal detachment, or endophthalmitis. Recent advances in ocular drug delivery
methods and the development of novel biopharmaceutical agents could lead to new
regimens for the treatment of disease of the posterior retina, choroids, and
macula. This review will summarize recent literature concerning ocular drug
delivery of bioactive compounds to the posterior segment of the eye with
emphasis on transscleral iontophoresis.
-----
Ophthalmology. 2005 Dec;112(12):2137-42.
Otago Glaucoma Surgery Outcome Study: follow-up of young patients
who underwent Molteno implant surgery.
Ah-Chan JJ, Molteno AC, Bevin TH, Herbison P.
Eye Department, Dunedin Hospital, Dunedin, New Zealand.
OBJECTIVE: To provide data on the results of patients with nonneovascular
juvenile glaucoma who had Molteno implant surgery in the province of Otago, New
Zealand. DESIGN: Prospective noncomparative case series. PARTICIPANTS:
Fifty-five operations in 52 eyes of 45 patients with nonneovascular juvenile
glaucoma who had Molteno implant surgery between the ages of 9 and 49 years from
1976 to 2003 at Dunedin Hospital and were observed for a mean of 12.2 years
(range, 0.1-25). INTERVENTION: Insertion of a Molteno implant. MAIN OUTCOME
MEASURES: Intraocular pressure (IOP) and visual acuity (VA). RESULTS: Insertion
of a Molteno implant controlled IOP at < or =21 mmHg with probabilities of 0.89
(95% confidence interval [CI], 0.81-0.97) at both 1 and 2 years and 0.85 (95%
CI, 0.75-0.95), 0.78 (95% CI, 0.66-0.90), and 0.71 (95% CI, 0.58-0.85) at 5, 10,
and 15 years, respectively. Mean VA was 20/100 preoperatively; improved to 20/60
at 1 year; and stabilized at 20/120 at 5, 10, and 15 years postoperatively.
Twenty-nine eyes had their preoperative VA maintained or improved at final
follow-up, and the VAs of 17 eyes deteriorated but were at least light
perception at final follow-up. CONCLUSION: The use of Molteno implants in cases
of nonneovascular juvenile glaucoma controlled IOP with a probability of 0.71 15
years postoperatively, whereas 53% maintained or improved their vision from
their preoperative VA at final follow-up.
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Ophthalmologe. 2005 Dec;102(12):1207-14.
[Primary lensectomy following acute primary angle closure
glaucoma.]
[Article in German]
Jacobi PC.
Arzte fur Augenheilkunde, VENI VIDI, Koln.
Recent developments and clinical studies indicate that primary
phacoemulsification and intraocular lens implantation are safe and effective for
the surgical treatment of primary angle closure glaucoma (ACG) compared to
conventional iridectomy or laser-iridotomy. When compared to control eyes
treated using standard peripheral iridectomy, the outcome in terms of
intraocular pressure control, adjunct anti-glaucoma medication, visual acuity,
and the necessity for successive surgical interventions favored primary
phacoemulsification and intraocular lens implantation. Earlier biometric data
underline the importance of the "lens factor" in the pathogenesis of relative
pupillary block in ACG obtained by Scheimflug image processing and ultrasound
biomicroscopy. Thevast improvements in modern cataract surgery combined with our
current understanding of the pathogenesis of relative pupillary block in ACG
indicate that lens extraction is a better procedure in uncontrolled angle
closure glaucoma than conventional iridectomy.
-----
Ophthalmologica. 2005 Nov-Dec;219(6):317-23.
Therapeutic strategies for normal-tension glaucoma.
Orgul S, Zawinka C, Gugleta K, Flammer J.
University Eye Clinic, Basel, Switzerland. sorguel@uhbs.ch
Treatment of normal-tension glaucoma has been a subject of debate for several
years. Glaucomatous damage cannot be influenced directly, and current treatment
modalities in normal-tension glaucoma are aimed at the control of risk factors.
Intraocular pressure is a widely accepted risk factor and its reduction can
improve the prognosis in normal-tension glaucoma patients. The repeated
demonstration of the importance of hemodynamic factors in normal-tension
glaucoma has, however, not been paralleled by a comparable progress in the
development of therapeutic modalities capable of influencing favorably ocular
blood flow. Today, calcium channel blockers seem to be the most promising
adjunctive treatment to be considered in patients with glaucomatous optic
neuropathy without increased intraocular pressure. Copyright 2005 S. Karger AG,
Basel.
-----
J Glaucoma. 2005 Dec;14(6):504-7.
Effects of caffeine on intraocular pressure: the Blue Mountains
Eye Study.
Chandrasekaran S, Rochtchina E, Mitchell P.
Centre for Vision Research, Department of Ophthalmology and the Westmead
Millennium Institute, the University of Sydney, Australia.
PURPOSE: To examine the relationship between coffee and caffeine intakes and
intraocular pressure (IOP). MATERIALS AND METHODS: The Blue Mountains Eye Study
examined 3654 participants aged 49+ years in an area west of Sydney, Australia.
A detailed medical history questionnaire included average daily intakes of
coffee and tea. The eye examination included Goldmann applanation tonometry and
automated perimetry. Participants using glaucoma medications or who had previous
cataract or glaucoma surgery or signs of pigmentary glaucoma/pigment dispersion,
were excluded. Mean and maximum IOP calculations were used. RESULTS:
Participants with open-angle glaucoma (OAG) who reported regular coffee drinking
had significantly higher mean IOP (19.63 mm Hg) than participants who said that
they did not drink coffee (16.84 mm Hg), after multivariate adjustment, P =
0.03. Participants consuming > or = 200 mg caffeine per day had higher mean IOP
(19.47 mm Hg) than those consuming < 200 mg caffeine per day (17.11 mm Hg),
after adjusting for age, sex, and systolic blood pressure (SBP), P = 0.06. This
association did not reach statistical significance after multivariate
adjustment. No association between coffee or caffeine consumption and higher IOP
was found in participants with ocular hypertension (OH) and those without
open-angle glaucoma. CONCLUSIONS: In participants with open-angle glaucoma, this
study identified a positive cross-sectional association between coffee
consumption/higher caffeine intakes and elevated intraocular pressure.
-----
Graefes Arch Clin Exp Ophthalmol. 2005 Nov 29;:1-6 [Epub ahead of print]
Microincisional cataract surgery and Thinoptx rollable
intraocular lens implantation.
Cinhuseyinoglu N, Celik L, Yaman A, Arikan G, Kaynak T, Kaynak S.
Ophthalmology Clinic, SSK Okmeydani Hospital, Istanbul, Turkey.
BACKGROUND: Microincisional cataract surgery is a safe procedure with a very
short learning period for an experienced cataract surgeon and rollable ultrathin
intraocular lenses eliminate the need for enlargement of corneal incision. The
purpose of the study was to evaluate the safety and efficacy of cataract surgery
through a corneal microincision and implantation of rollable ultrathin
intraocular lenses. The setting was Dokuz Eylul University Medical Faculty,
Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital,
Ophthalmology Clinic, Istanbul, Turkey. PATIENTS AND METHODS: Ninety eyes in 85
patients were operated on through clear corneal microincisions with sleeveless
phacoemulsification and rollable intraocular lenses were implanted. Forty-six of
the patients were men and 39 were women between the ages of 27 and 83, with a
mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had
nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4
patients had diabetes mellitus without retinopathy. Three eyes had posterior
capsular opacifications of unknown etiology. Two eyes had primary open angle
glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense
nuclear sclerosis of grade 4 with very low visibility of retinal structures.
Other patients had no ocular or systemic pathology other than nuclear/corticonuclear
cataract of grade 2-3. Uncorrected and best spectacle-corrected distance and
near visual acuities, keratometric values, and refractive status were noted
preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical
analysis of keratometric changes between preoperative and postoperative findings
was performed using the paired samples t test. RESULTS: At 6 months
postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA)
of 0.2, the patient with atrophic senile macular degeneration. The rest of the
eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55
(61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8
and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the
Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month,
and 6 months were 0.69+/-0.43 D, 0.66+/-0.46 D and 0.65+/-0.48 D respectively.
Statistical analysis revealed a significant change in corneal astigmatisms at
the 1st week visit (p<0.05), but not at the 1st and 6th month visits (p>0.05)
compared with preoperative findings. CONCLUSION: Based on the limited data in
the literature and in this study, it is not possible to make concrete decisions
about the benefits and disadvantages of the ThinOptx IOL for longer durations.
Intraoperatively, this IOL apparently eliminates the need for enlargement of the
corneal incision during implantation. However, the statistical insignificance of
induced astigmatisms after microincisions and classical phacoincisions should
also be taken into consideration. We conclude that ThinOptx IOL is a pioneering
intraocular lens implant that will contribute to the exciting future of cataract
refractive surgical procedures. However, both clinical and laboratory
investigations are needed to clearly describe the long-term effectiveness of
this new rollable IOL.
-----
Eye. 2005 Nov 25; [Epub ahead of print]
Glaucoma management in pregnancy: a questionnaire survey.
Vaideanu D, Fraser S.
1Sunderland Eye Infirmary, Sunderland, Tyne and Wear, UK.
BackgroundThe management of glaucoma in a pregnant woman can pose a challenge
for the ophthalmologist. The risks and benefits to the mother and foetus must be
weighed. When it is decided that treatment is necessary, there is no consensus
as to the safest treatment. This study was designed to garner the experiences
and views of UK ophthalmologists with regard to this scenario.MethodsAll
consultant ophthalmologists in the UK were sent a questionnaire. They were asked
if they had previous experience treating pregnant women with glaucoma, what
management they had used, what management they would currently employ, and, if
they were to use medical treatment, what would their first choice agent
be.ResultsA total of 282 out of 605 questionnaires were returned. Of the
respondents, 26% had previously treated pregnant women with glaucoma. Most (71%)
had continued with the therapy that the women were already on. In all, 34% had
observed the situation and had not needed to treat. When asked what they would
currently do in this scenario, 31% were unsure. A total of 40% would simply
continue the prepregnancy treatment. A total of 45% of respondents, if they were
to use medical treatment, would use beta-blockers, compared to 33% who would use
prostaglandins.ConclusionAlthough it is thought to be a relatively rare clinical
situation, over a quarter of our respondents had first hand experience of the
management of glaucoma in pregnancy. Our results indicate some uncertainty about
the optimal strategy. It is unlikely that trials will be performed and we
suggest guidelines be produced using current knowledge and modified as evidence
appears.Eye advance online publication, 25 November 2005;
doi:10.1038/sj.eye.6702193.
-----
Eye. 2005 Nov 25; [Epub ahead of print]
Deep sclerectomy with mitomycin C in failed trabeculectomy.
Rebolleda G, Munoz-Negrete FJ.
1Glaucoma Unit, Ophthalmology Department, Hospital Ramon y Cajal, University of
Alcala, Madrid, Spain.
AimTo evaluate the success rate and complications associated with deep
sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in
previously failed trabeculectomy.MethodsThis prospective study included 20 eyes
with a previously failed trabeculectomy, which were treated with deep
sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial
scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity,
and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6,
and 12 months postoperatively.ResultsThe mean preoperative IOP was 25.8+/-7.3
mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative.
At each interval, the mean IOP was significantly lower than preoperatively
(P=0.000). At 1 year, the complete success rate (IOP</=21 mmHg untreated) was
65% and the qualified success rate (IOP</=21 mmHg with and without medication)
was 100%. 12 patients (60%) achieved an IOP</=15 mmHg with and without
medication. No shallow or flat anterior chamber, endophthalmitis, or leakage
developed.ConclusionsThese data suggest that deep sclerectomy augmented with MMC
is a safe surgical procedure that decreases IOP in eyes with a previously failed
trabeculectomy.Eye advance online publication, 25 November 2005;
doi:10.1038/sj.eye.6702183.
-----
Curr Med Res Opin. 2005 Nov;21(11):1875-83.
Analytic review of bimatoprost, latanoprost and travoprost in
primary open angle glaucoma.
Holmstrom S, Buchholz P, Walt J, Wickstrom J, Aagren M.
Allergan Europe, Pforzheimer Str. 160, D-76275 Ettlingen, Germany.
OBJECTIVE: The objective of this review was to evaluate different measures of
efficacy of the intraocular pressure (IOP) lowering lipid class agents
bimatoprost, latanoprost and travoprost in the treatment of primary open angle
glaucoma. Study arms of timolol in trials including the above mentioned lipid
class drugs were also included. METHODS: MEDLINE and EMBASE were searched for
randomized clinical trials including one or more of the lipid class drugs
bimatoprost, latanoprost and travoprost. The study results were pooled, and the
simple, weighted IOP-lowering efficacy was compared among the lipid class drugs
and timolol, where data were available. Efficacy parameters were reviewed,
including mean reduction of IOP and percentage of patients achieving different
levels of IOP. RESULTS: 161 articles were identified of which 42 were included
in the analysis. A total of 9295 patients participated in the included trials.
Based on all studies, timolol on average had a weighted mean IOP reduction of
22.2%, while latanoprost, travoprost and bimatoprost had a weighted mean IOP
reduction of 26.7%, 28.7% and 30.3%, respectively. Analysis of target
achievement to various IOP levels shows that bimatoprost seems more efficacious
than latanoprost. The direct comparisons (head-to-head studies) also show that
bimatoprost is the most efficacious treatment, however it is not conclusive
whether latanoprost or travoprost is better in reducing IOP. CONCLUSIONS: This
review shows that bimatoprost seems to be the most efficacious treatment in
lowering IOP. Head-to-head studies confirm this.
-----
Br J Ophthalmol. 2005 Nov;89(11):1413-7.
A randomised, prospective study comparing selective laser
trabeculoplasty with latanoprost for the control of intraocular pressure in
ocular hypertension and open angle glaucoma.
Nagar M, Ogunyomade A, O'Brart DP, Howes F, Marshall J.
Department of Ophthalmology, St Thomas's Hospital, Lambeth Palace Road, London
SE1 7EH, UK.
AIM: To compare 90 degrees , 180 degrees , and 360 degrees selective laser
trabeculoplasty (SLT, 532 nm Nd:YAG laser) with latanoprost 0.005% for the
control of intraocular pressure (IOP) in ocular hypertension (OHT) and open
angle glaucoma (OAG). METHODS: A prospective, randomised clinical trial in the
Department of Ophthalmology, St Thomas's Hospital, London, and Clayton Eye
Centre, Wakefield, West Yorkshire. 167 patients (167 eyes) with either OHT or
OAG were randomised to receive 90 degrees , 180 degrees , and 360 degrees SLT or
latanoprost 0.005% at night and were evaluated at 1 hour, 1 day, 1 week and 1,
3, 6, and 12 months. RESULTS: The mean follow up was 10.3 months (range 1--12
months). Early, transient, complications such as postoperative ocular pain,
uveitis, and 1 hour IOP spike occurred in a number of eyes after SLT, with pain
being reported more frequently after 360 degrees than 90 degrees treatments
(p>0.001). Success rates defined in terms of both a 20% or more and a 30% or
more IOP reduction from baseline measurements with no additional
antiglaucomatous interventions were better with latanoprost than 90 degrees
(p<0.001) and 180 degrees SLT (p<0.02) treatments. Differences in success rates
between latanoprost and 360 degrees SLT did not reach statistical significance
(p<0.5). Success rates were greater with 180 degrees and 360 degrees compared to
90 degrees SLT (p<0.05). With 360 degrees SLT, 82% of eyes achieved a >20% IOP
reduction and 59% a >30% reduction from baseline. Although success rates were
better with 360 degrees than 180 degrees SLT treatments, differences did not
reach statistical significance. There were no differences with regard to age,
sex, race, pretreatment IOP, OHT versus OAG, laser power settings, and total
laser energy delivered between eyes which responded, in terms of a >20% and a
>30% IOP reduction, and those that did not respond with 180 degrees and 360
degrees SLT treatments. CONCLUSIONS: Success rates were higher with latanoprost
0.005% at night than with 90 degrees and 180 degrees SLT treatments. 90 degrees
SLT is generally not effective. 360 degrees SLT appears to be an effective
treatment with approximately 60% of eyes achieving an IOP reduction of 30% or
more. Transient anterior uveitis with associated ocular discomfort is not
unusual in the first few days after SLT. Late complications causing ocular
morbidity after SLT were not encountered.
-----
J Glaucoma. 2005 Oct;14(5):392-399.
A Three-Month, Multicenter, Double-Masked Study of the Safety and
Efficacy of Travoprost 0.004%/Timolol 0.5% Ophthalmic Solution Compared to
Travoprost 0.004% Ophthalmic Solution and Timolol 0.5% Dosed Concomitantly in
Subjects With Open Angle Glaucoma or Ocular Hypertension.
Hughes BA, Bacharach J, Craven ER, Kaback MB, Mallick S, Landry TA, Bergamini
MV.
>From the *Kresge Eye Institute, Department of Opthalmology, Wayne State
University School of Medicine, Detroit, Michingan; daggerNorth Bay Eye
Associates, Inc., Petaluma, California; double daggerGlaucoma Consultants of
Colorado, Littleton, Colorado; section signGlaucoma Consultants, Slingerlands,
New York; and paragraph signAlcon Research Ltd., Forth Worth, Texas.
PURPOSE:: The primary objective of this study was to compare the intraocular
pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% fixed
combination to the concomitant administration of travoprost 0.004% (TRAVATAN(R))
and timolol 0.5% in subjects with open angle glaucoma or ocular hypertension.
METHODS:: This was a randomized, multicenter, double-masked, active-controlled,
parallel group study. Three hundred sixteen patients with open angle glaucoma or
ocular hypertension were randomly assigned to travoprost 0.004%/timolol 0.5%
ophthalmic solution fixed combination once daily in the morning or concomitant
administration of timolol 0.5% once daily in the morning and travoprost 0.004%
ophthalmic solution once daily in the evening. The efficacy and safety of the
fixed combination were compared with concomitant therapy over three months. The
primary efficacy outcome measure was mean intraocular pressure. RESULTS:: Both
travoprost 0.004%/timolol 0.5% fixed combination and the concomitant
administration of travoprost 0.004% and timolol 0.5% produced statistically
significant reductions from baseline in IOP, with mean IOP ranging from 15.2 to
16.5 mm Hg in the patients using travoprost 0.004%/timolol 0.5% fixed
combination compared with 14.7 to 16.1 mm Hg in the concomitant group. The upper
95.1% confidence limit for the differences in mean IOP (fixed combination minus
concomitant) was </=1.5 mm Hg at 7 of 9 visits, including all three 8 AM time
points, 24-hours post-dose. Mean IOP reductions from baseline ranged from 7.4 to
9.4 mm Hg in the fixed combination group compared with 8.4 to 9.4 mm Hg with
concomitant therapy. Safety analysis demonstrated equivalent safety between the
two treatment groups. CONCLUSIONS:: A fixed combination of travoprost 0.004% and
timolol 0.5% produced clinically relevant IOP reductions in patients with open
angle glaucoma or ocular hypertension that were comparable to concomitant
therapy with its components. Safety and tolerability of the fixed combination
were also equivalent to concomitant therapy. Travoprost 0.004%/timolol 0.5%
fixed combination offers IOP reduction equivalent to concomitant therapy, with
potential benefits that include convenience (fewer bottles and drops per day),
improved compliance, cost savings (based on fewer co-payments), and elimination
of potential washout effects.
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Ophthalmologica. 2005 Sep-Oct;219(5):281-6.
Deep sclerectomy versus punch trabeculectomy: effect of
low-dosage mitomycin C.
Cillino S, Di Pace F, Casuccio A, Lodato G.
Istituto di Clinica Oculistica, Universita di Palermo, Palermo, Italy. cillino@iol.it
PURPOSE: To compare IOP behavior after deep sclerectomy (DS) and trabeculectomy
with the Crozafon-De Laage Punch (TP), using low-dosage intraoperative mitomycin
C (MMC) in both techniques. METHODS: The study was a prospective randomized
clinical trial. All patients met inclusion and exclusion criteria, and were
scheduled for glaucoma surgery. Forty patients were randomized to undergo either
a nonpenetrating DS with MMC (DSMMC) (19 eyes) or a TP with MMC (TPMMC) (21
eyes). Postoperative examinations were performed at the 1st day, the 1st, 2nd
and 3rd weeks and the 1st, 3rd, 6th, 9th and 12th months. Postoperative
complications, number of antiglaucoma medications and the IOP level were checked
at each control. Complete success (without antiglaucoma medications) and
qualified success (with or without medications) were assessed at two target IOP
levels, namely < or = 21 and < or = 17 mm Hg in both groups. Moreover, the
success rates at < or = 21 mm Hg target IOP level were compared with those from
previous series of patients who had undergone DS without MMC (historical control
group). RESULTS: Data from all eyes were available until the 12th month. The
mean preoperative IOP +/- SD was 29.6 +/- 5.8 mm Hg in DSMMC eyes, 28.0 +/- 6.0
in TPMMC eyes; the mean IOP at the 1st postoperative day was 12.5 +/- 4.2 and
13.9 +/- 6.5 mm Hg, while at the endpoint the mean IOP was 14.5 +/- 4.0 and 16.1
+/- 3.8, respectively, with significant reduction (p < 0.0005) of the
preoperative IOP in both groups. Complete success (< or = 21 mm Hg target IOP)
in 15 eyes (78.9%) of the DSMMC group and in 15 eyes (71.4%) of the TPMMC group
was respectively found, while qualified success was achieved in all the eyes.
When a < or = 17 mm Hg target IOP was considered, complete success in 12 eyes
(63.1%) and 13 eyes (61.9%), and qualified success in 13 eyes (68.4%) and 15
eyes (71.4%) were found in the DSMMC and TPMMC groups, respectively. No
significant intergroup differences were found in terms of success rate. There is
no statistical significance in the Kaplan-Meier cumulative survival curves as
for complete and qualified success rate in both surgical groups for a < or = 17
mm Hg target IOP (log rank, p = 0.918 and p = 0.429, respectively). As for the
frequency of postoperative complications, hypotony and shallow anterior chamber
were significantly more frequent in TPMMC when compared with the DSMMC group.
The historical comparison between the DSMMC group and simple DS cases shows no
significant difference between the groups, with a mild positive trend in DSMMC
when compared with DS eyes. CONCLUSIONS: Both techniques, DSMMC and TPMMC,
control IOP efficaciously at our endpoint. Our results indicate that low-dosage
MMC can be considered a mild enhancement of DS IOP lowering effect without any
negative effect on the well-known intra- and postoperative safety of the
technique. Copyright 2005 S. Karger AG, Basel.
-----
Am J Ophthalmol. 2005 Sep;140(3):524-5.
Selective laser trabeculoplasty as a replacement for medical
therapy in open-angle glaucoma.
Francis BA, Ianchulev T, Schofield JK, Minckler DS.
Doheny Eye Institute, Keck School of Medicine, University of Southern
California, Los Angeles, California.
PURPOSE: To evaluate selective laser trabeculoplasty (SLT) as a replacement for
medical therapy in controlled open-angle glaucoma. DESIGN: Prospective,
non-randomized, interventional clinical trial. METHODS: SLT was performed
inferiorly in 66 eyes of 66 patients with medically controlled primary
open-angle glaucoma (OAG) or exfoliation glaucoma, and no history of glaucoma
surgery. The primary outcome was number of medications at 6 and 12 months while
maintaining a pre-determined target intraocular pressure (IOP). RESULTS: The
mean of the differences in medications from baseline was 2.0 (95% confidence
interval = 1.8-2.3) at 6 months, and 1.5 (1.27-1.73) at 12 months (P < .0001).
The group mean of medications was 2.8 +/- 1.1 at baseline, 0.7 +/- 0.9 at 6
months, and 1.5 +/- 0.9 at 12 months (P < .0001). Reduction in medications was
attained in 64 of 66 eyes (97%) at 6 months, and 52 of 60 (87%) at 12 months.
CONCLUSION: SLT enabled a reduction in medicine in controlled OAG over 12
months.
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Ophthalmol Clin North Am. 2005 Sep;18(3):461-8.
Medical therapy of pediatric glaucoma and glaucoma in pregnancy.
Maris PJ Jr, Mandal AK, Netland PA.
Hamilton Eye Institute, University of Tennessee Health Science Center, 930
Madison Avenue, Suite 100, Memphis, TN 38163, USA.
Although surgery remains the definitive treatment for congenital and other
childhood glaucomas, medical therapy can be effective in lowering intraocular
pressure as a temporizing measure before surgery or as long-term adjunctive
treatment in disease refractory to surgical measures. Carbonic anhydrase
inhibitors, beta-blockers, cholinergic drugs, and the prostaglandin-related
drugs all play an effective role in pediatric glaucoma management. The
usefulness and safety profile of the adrenergic agonists and the osmotic agents
are less well established. In medically treating the pediatric patient or the
pregnant woman for glaucoma, the clinician must be mindful of the possibility of
adverse effects and be prepared to alter or terminate treatment if needed.
-----
Ophthalmol Clin North Am. 2005 Sep;18(3):431-442.
Glaucoma Drainage Implants in Pediatric Patients.
Ishida K, Mandal AK, Netland PA.
Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee
Health Science Center, 903 Madison Avenue, Suite 100, Memphis, TN 38163, USA;
Department of Ophthalmology, Gifu University Graduate School of Medicine,
Yanagido 1-1, Gifu 501-1194, Japan.
Approximately, one fifth of primary congenital glaucoma patients fail primary
surgery. Also, some pediatric glaucomas respond poorly to goniotomy or
trabeculectomy. In these situations, clinicians often choose trabeculectomy with
mitomycin-C or a drainage implant as a surgical treatment. Glaucoma drainage
device implantation is a useful option in refractory patients. When other
surgical treatments have a poor prognosis for success, prior conventional
surgery fails, or significant conjunctival scarring precludes filtration
surgery, glaucoma drainage implant may effectively control intraocular pressure.
Patients often require adjunctive glaucoma medications after surgery and may
develop complications. Most of these complications, however, are reversible or
resolve spontaneously, and most are not associated with vision loss.
-----
Am J Ophthalmol. 2005 Sep;140(3):490-6.
Primary Viscocanalostomy for Juvenile Open-angle Glaucoma.
Stangos AN, Whatham AR, Sunaric-Megevand G.
Department of Clinical Neurosciences, Division of Ophthalmology, University
Hospitals of Geneva, Switzerland.
PURPOSE: To evaluate the efficacy and safety of primary viscocanalostomy for
medically uncontrolled juvenile open-angle glaucoma (JOAG). DESIGN: Prospective,
noncomparative, interventional case-series study. METHODS: The study included 20
eyes of 20 consecutive patients with medically uncontrolled JOAG who were
treated by viscocanalostomy at one institution. No surgical or laser procedure
preceded viscocanalostomy. Surgical outcome was defined as an overall success by
the following criteria: no visual field deterioration, no optic-neuropathy
progression, postoperative intraocular pressure IOP </=20 mm Hg, and IOP
reduction >/=30% compared with baseline values with or without medication. When
medications were not required, success was defined as complete. Cases that did
not fulfill the aforementioned criteria and cases in which a surgical revision
or further goniopuncture was performed were defined as a failure. RESULTS:
Gender distribution was similar. Fourteen eyes belonged to the white race; five
eyes belonged to the black race, and one eye belonged to Arab ethnicity. Mean
age (+/-SD) at operation was 33.77 +/- 6.16 years, with the mean preoperative
IOP (+/-SD) at 22.9 +/- 4.77 mm Hg. Thirty-six months after operation, 16 cases
(80%) were considered an overall success. In 11 cases (55%), success was
complete. Four cases (20%) were considered failures. No serious complications
were documented either during or after operation. In two cases (10%), we
documented a spontaneously reabsorbed microhyphema. Trabeculo-Descemet-membrane
microperforation occurred in two cases (10%). In two other cases (10%),
Trabeculo-Descemet-membrane perforation occurred and was accompanied by iris
prolapse that needed peripheral iridectomy. CONCLUSION: Primary viscocanalostomy
can efficiently and safely reduce intraocular pressure in cases of medically
uncontrolled JOAG and provide a rational alternative to conventional surgical
modalities.
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Ophthalmologe. 2005 Aug 24; [Epub ahead of print]
[Cataract extraction including posterior chamber lens
implantation into eyes with angle-closure glaucoma.]
[Article in German]
Bleckmann H, Keuch R.
Augenzentrum des DRK-Klinikums Westend, Akademisches Lehrkrankenhaus der
Humbold-Universitat, Berlin.
OBJECTIVE: The aim of this study was to compare phacoemulsification in eyes with
angle-closure glaucoma to the partner eyes with or without iridectomy or laser
iridotomy, respectively.METHODS: Twelve eyes with an elevated intraocular
pressure due to an angle closure that were treated by phacoemulsification and
IOL implantation were compared with 12 partner eyes with narrow angle and
iridectomy or iridotomy without intraocular pressure elevation and cataract
extraction. The average follow-up period was 15.7+/-2.1 months.RESULTS: The
average intraocular pressure in eyes with angle-closure glaucoma was 54.1+/-14.7
mmHg and in the partner eyes 22.4+/-8.6 mmHg preoperatively. Follow-up pressure
was 19.3+/-2.0 mmHg in eyes with angle-closure glaucoma and 18.8+/-1.5 mmHg in
the partner eyes.CONCLUSION: Primary cataract extraction including posterior
chamber lens implantation into eyes with angle-closure glaucoma reduced
intraocular pressure to normal levels, increased visual acuity, and decreased
the number of antiglaucomatous drugs. Eyes with angle-closure glaucoma do not
respond differently to phacoemulsification and lens implantation compared to
eyes with narrow angle without pressure elevation during and after
phacoemulsification.
-----
J Ocul Pharmacol Ther. 2005 Aug;21(4):337-48.
Brimonidine and timolol fixed-combination therapy versus
monotherapy: a 3-month randomized trial in patients with glaucoma or ocular
hypertension.
Craven ER, Walters TR, Williams R, Chou C, Cheetham JK, Schiffman R; Combigan
Study Group.
Glaucoma Consultants of Colorado, Littleton, CO, USA. ercraven@yahoo.com
PURPOSE: The aim of this study was to compare the safety and intraocular
pressure (IOP)- lowering efficacy of a fixed combination of brimonidine 0.2% and
timolol 0.5% (fixed brimonidine/ timolol) versus each drug used as monotherapy.
METHODS: Patients with glaucoma or ocular hypertension were randomized to
receive fixed brimonidine/timolol BID (n = 385), brimonidine 0.2% TID (n = 382),
or timolol 0.5% BID (n = 392) in a multicenter, double-masked study. The primary
outcome measure was decrease from baseline IOP. RESULTS: Over all follow-up
measurements, the mean decrease from baseline IOP ranged from 4.9 to 7.6 mmHg
with brimonidine/timolol, from 3.1 to 5.5 mmHg with brimonidine, and from 4.3 to
6.2 mmHg with timolol. Mean IOP reductions from baseline were significantly
larger with fixed brimonidine/timolol than with timolol at all follow-up
measurements (P < or = 0.026); the difference was greater than 1.5 mmHg at 10 AM
(peak effect for each treatment). Mean IOP reductions from baseline were
significantly larger with fixed brimonidine/ timolol than with brimonidine at 8
AM, 10 AM, and 3 PM (P < 0.001); the difference was greater than 1.5 mmHg. The
rate of discontinuations owing to adverse events was 3.6% in the fixed timolol/brimonidine
group. CONCLUSIONS: The fixed combination of brimonidine and timolol was
well-tolerated and provided significantly better IOP control compared with
either brimonidine or timolol used alone.
-----
J AAPOS. 2005 Aug;9(4):336-40.
Ahmed valve implantation for uncontrolled pediatric uveitic
glaucoma.
Kafkala C, Hynes A, Choi J, Topalkara A, Foster CS.
Massachusetts Eye Research and Surgery Institute and Ocular Immunology and
Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School,
Boston, Massachusetts.
Purpose: We sought to evaluate the safety and efficacy of Ahmed valve
implantation for the management of glaucoma associated with chronic uveitis in
pediatric patients. Methods: A retrospective chart review was conducted of 6
pediatric patients (7 eyes) who underwent Ahmed valve implantation because of
refractory uveitic glaucoma. Intraocular pressure (IOP) reduction, preoperative
and postoperative visual acuities, the number of hypotensive medications
required, and complications associated with the operation were evaluated.
Results: Mean follow-up was 36.8 months (range, 6-60). At the last visit, all 7
eyes had IOPs between 9 and 18 mm Hg (average, 12.1). IOP reduction averaged
69.6% (P = 0.0005, paired t-test). The number of hypotensive agents was reduced
from an average of 3 to an average of 0.71 medicines per eye (P = 0.001). The
only complication was hemorrhagic choroidal detachment postoperatively in two
eyes; both resolved within one month. Conclusions: For children with good
immunomodulatory control of their inflammation and appropriate follow-up, Ahmed
valve implantation can be an effective and safe procedure for treating pediatric
uveitic glaucoma.
-----
J AAPOS. 2005 Aug;9(4):330-5.
Combined intraocular lens implantation and glaucoma implant (tube
shunt) surgery in pediatric patients: a case series.
Tesser R, Hess DB, Freedman SF.
Duke University Eye Center, Durham, North Carolina.
Purpose: We sought to investigate the outcomes of children who underwent
simultaneous intraocular lens (IOL) implant and glaucoma implant surgery.
Methods: Medical records of all patients who underwent simultaneous IOL implant
and glaucoma implant surgery from January 1995 through August 2003 by a single
surgeon were reviewed. Criteria for success included intraocular pressure </=22
mm Hg, or judged adequate for glaucoma severity, without vision loss or
devastating complication. Results: The study included 9 eyes of 8 children who
had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months
(range, 8.5-35 months) after simultaneous IOL (either cataract removal with
primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma
implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery
fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical
features (such as shallow anterior chamber and/or vitreous in the pupillary
plane) making an IOL helpful in positioning the tube away from corneal
endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean
intraocular pressure for operated eyes was 29 mm Hg (range, 21-44)
preoperatively and fell to 17 mm Hg (range, 11-22) at last follow up, P = 0.01.
The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5)
versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were
varied, only 2 of which required additional surgery. Eighty-nine percent (8/9)
of patients met criteria for success at last follow-up. Conclusions: Selected
children can do well after combined glaucoma implant and IOL surgery, achieving
both satisfactory glaucoma control and stable visual acuity.
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Am J Ophthalmol. 2005 Aug;140(2):242-50.
Efficacy and safety of a fixed combination of travoprost 0.004%/timolol
0.5% ophthalmic solution once daily for open-angle glaucoma or ocular
hypertension.
Schuman JS, Katz GJ, Lewis RA, Henry JC, Mallick S, Wells DT, Sullivan EK,
Landry TA, Bergamini MV, Robertson SM.
UPMC Eye Center, Eye and Ear Institute, Pittsburgh, Pennsylvania 15213, USA.
schumanjs@upmc.edu
PURPOSE: To compare the efficacy of a fixed combination of travoprost 0.004%/timolol
0.5% every day in the morning with a concomitant regimen of timolol 0.5% every
day in the morning, plus travoprost 0.004% every day in the evening; and timolol
0.5% twice daily on the intraocular pressure (IOP) of subjects with open-angle
glaucoma or ocular hypertension over 3 months. DESIGN: Prospective, randomized,
double-masked, parallel-group, active-controlled, multicenter trial. METHODS:
Patients comprised adult subjects (n = 403) of either gender with open-angle
glaucoma or ocular hypertension in at least one eye. To qualify, the IOP had to
be between 22 to 36 mm Hg in the same eye at two consecutive eligibility visits.
The primary outcome variable was IOP measured with a Goldmann applanation
tonometer. RESULTS: Mean IOP ranged from 16.2 to 17.4 mm Hg with the combination
travoprost/timolol compared with 15.4 to 16.8 mm Hg in the concomitant
travoprost + timolol group, from baselines of 23.1 to 25.6 mm Hg and 22.9 to
25.0 mm Hg, respectively. The fixed combination of travoprost/timolol
significantly lowered IOP by 7 to 9 mm, similar to the IOP reductions observed
with concomitant therapy. The most frequent ocular adverse event was hyperemia
that occurred in 14.3% and 23.4% of subjects treated with travoprost/timolol
combination and concomitant travoprost + timolol, respectively. CONCLUSIONS:
Travoprost/timolol combination produces greater IOP reductions than the positive
control, timolol 0.5%, and reductions that were similar to concomitant
travoprost + timolol. This study demonstrates that the fixed combination of
travoprost/timolol produces significant and clinically relevant reductions of
IOP in a once-daily dosing regimen.
-----
Jpn J Ophthalmol. 2005 Jul-Aug;49(4):287-93.
Effect of topical unoprostone isopropyl on optic nerve head
circulation in controls and in normal-tension glaucoma patients.
Kimura I, Shinoda K, Tanino T, Ohtake Y, Mashima Y.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
kimura@sc.itc.keio.ac.ip
PURPOSE: To evaluate the effect of unoprostone isopropyl on microcirculation in
the optic nerve head (ONH) of controls and patients with normal-tension glaucoma
(NTG). METHODS: Thirty healthy volunteers were randomly placed in a placebo
group or a control group. For ten NTG patients, one eye was selected to receive
the placebo drops and the contralateral eye received the unoprostone in a masked
fashion. In both studies, the intraocular pressure (IOP) and the parameters of
the blood hemodynamics of the ONH were obtained before and at 1 and 2 h after
the instillation. Blood flow measurements were made with a scanning laser
Doppler flowmeter. RESULTS: In both control subjects and NTG patients, the
changes in the IOPs after the instillation of either unoprostone or the placebo
were not significant because almost all of the NTG patients had IOPs lower than
15 mmHg. Although the hemodynamic parameters were not significantly changed in
the placebo-treated eyes of the controls, the eyes of the controls treated with
unoprostone had mean blood velocity and flow values that were significantly
higher than the baseline values 1 and 2 h after instillation (P < 0.01). The
velocity values of the controls treated with unoprostone were significantly
higher than in those controls receiving the placebo at 2 h postinstillation (P =
0.027). The values for the three circulation parameters (volume, velocity, flow)
were significantly higher than the baseline values after instillation in the
eyes of the NTG patients treated with unoprostone (P < 0.05). In contrast, none
of these parameters was significantly different from the baseline in the eyes of
NTG patients treated with placebo. CONCLUSIONS: These results showed that
unoprostone significantly increased microcirculation in the ONH in control
subjects and in NTG patients without reducing the IOP significantly. (c)
Japanese Ophthalmological Society 2005.
-----
Br J Ophthalmol. 2005 Jun;89(6):694-8.
Combined cataract and glaucoma surgery with mitomycin C:
phacoemulsification-trabeculectomy compared to phacoemulsification-deep
sclerectomy.
Funnell CL, Clowes M, Anand N.
West Yorkshire Rotation, Clarendon Wing, Leeds General Infirmary, Leeds, UK.
AIMS: To compare outcomes of phacoemulsification combined with trabeculectomy
(PT) or deep sclerectomy (PDS) with intraoperative mitomycin C (MMC)
application. METHODS: Non-randomised, consecutive, retrospective comparative
study. 97 eyes of 97 patients (59 PDS, 38 PT) undergoing combined surgery with
intraoperative MMC (0.1-0.4 mg/ml for 1-3 minutes) were identified for inclusion
in the study. RESULTS: The probability of maintaining intraocular pressure (IOP)
below 19 mm Hg and 15 mm Hg, with a 30% drop from preoperative IOP and without
additional medication, 1 year after surgery were 77.6% (95% CI: 67 to 90) and
71.5% (60 to 85) for the PDS group and 89.5% (80 to 99) and 89.5 (80 to 99) for
the PT group, respectively, and these differences were not statistically
significant (p>0.05, log rank test). After excluding ocular co-morbidity no
differences were observed in the improvement of visual acuity between the two
groups. There were no major differences in the complication rates except that
delayed bleb leaks were seen in seven eyes (18.4%) of the PT group (p = 0.004).
CONCLUSION: In this study, no statistically significant difference was found in
the IOP and visual outcomes between PDS and PT. A significantly higher frequency
of late bleb leaks after PT was observed.
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Ophthalmology. 2005 Jun;112(6):962-7.
Clinical results with the Trabectome for treatment of open-angle
glaucoma.
Minckler DS, Baerveldt G, Alfaro MR, Francis BA.
Doheny Eye Institute, Keck School of Medicine, University of Southern
California, Los Angeles, California 90033-4666, USA.
OBJECTIVE: To describe clinical results from a pilot study of a novel glaucoma
surgical device. DESIGN: Prospective interventional case series. PARTICIPANTS:
Thirty-seven adult Hispanic and Caucasian patients (17 male, 20 female) with
uncontrolled open-angle glaucoma (OAG) in one or both eyes with or without
previous surgery or laser treatment were recruited from a clinical practice in
Tijuana, Mexico. INTERVENTION: Surgery was performed with the Trabectome (NeoMedix
Corp., San Juan Capistrano, CA) in one eye of each patient. MAIN OUTCOME
MEASURES: Goldmann applanation intraocular pressures and Snellen visual acuities
were measured before and after surgery. Intraoperative and postoperative adverse
events were tabulated, and numbers of preoperative and postoperative adjunctive
medications were compared before and after surgery. RESULTS: Preoperative
pressures after 1 week of medication washout averaged 28.2+/-4.4 mmHg (n = 37).
Only 3 patients were not using topical medications preoperatively. Follow-up
ranged between 3 months (n = 37) and 13 months (n = 11). Mean postoperative IOPs
were 18.4+/-10.9 mmHg (n = 37) at 1 day, 17.5+/-5.9 mmHg (n = 37) at 1 week,
17.4+/-3.5 mmHg (n = 25) at 6 months, and 16.3+/-2.0 mmHg (n = 15) at 12 months.
Visions returned to within 2 lines of preoperative levels and remained stable in
all patients beyond 3 weeks postoperatively except one, not sutured at surgery,
who had a late hyphema probably associated with corneal wound gaping after
accidental blunt trauma. The number of adjunctive medications decreased from
1.2+/-0.6 among preoperative patients on medications (n = 34) to 0.4+/-0.6 among
all patients at 6 months (n = 25). Blood reflux occurred in all eyes on
instrument withdrawal after angle surgery and was present at day 1 in 22 eyes
(59%) with clearing by slit-lamp examination at a mean of 6.4+/-4.1 days
postoperatively. CONCLUSIONS: The Trabectome seems to offer a safe and effective
method of lowering IOP in OAG.
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Eur J Ophthalmol. 2005 May-Jun;15(3):347-52.
Pilot study to evaluate the efficacy and safety of pneumatic
trabeculoplasty in glaucoma and ocular hypertension.
Bucci MG, Centofanti M, Oddone F, Parravano M, Balacco Gabrieli C,
Pecori-Giraldi J, Librando A, Paone E, Bores LD.
Department of Ophthalmology, "Tor Vergata" University of Roma; G.B. Bietti
Foundation for Ophthalmology, ONLUS, Roma - Italy.
PURPOSE. Following laser-assisted in situ keratomileusis (LASIK), intraocular
pressure (IOP) is measurably lower in a significant number of cases. It has been
proposed that the decrease in IOP may be a real event. Prior trials have
evaluated pneumatic trabeculoplasty (PNT) in combination with concomitant
glaucoma medications. The aim of this study was to determine the efficacy and
the safety of PNT alone to lower IOP in patients with primary open angle
glaucoma (POAG) or ocular hypertension (OH). METHODS AND RESULTS. A total of 37
subjects with POAG or OH were enrolled in a prospective, open-label, fellow-eye,
multicenter trial to determine the IOP lowering effects of PNT. All subjects
underwent ophthalmologic examinations and IOP measurements and were washed out
from all glaucoma medications prior to the start of the study. The trial was
intrapatient controlled for the first 30 days, with one eye receiving PNT at
days 0 and 7 and the fellow eye serving as the control. The second eye was
treated with PNT at day 30. The patients were followed for 120 days, with the
first eye receiving an additional PNT treatment at days 90 and 97. Two
analyses-an intent to treat analysis in which the last IOP measurement for
patients dropped from the study was carried forward and an analysis including
only those patients who completed the trial-were performed. Of the 37 patients
enrolled, 27 (73%) completed the study. For the intent to treat analysis the
baseline mean IOP was 24.7+/-1.9 mmHg for eye 1 and 23.6+/-2.3 mmHg for eye 2
and the difference was statistically significant (p<0.05). Using this analysis
the differences between eye 1 mean IOP at days 1, 7, 14, and 60 and the baseline
mean IOP were statistically significant (p<0.05). The differences between eye 2
mean IOP and the baseline mean IOP were statistically significant (p<0.05) at
all time points except day 14 and day 30. The greater mean IOP reductions from
the baseline mean IOP for eye 1 were at study day 1 (-16,1%), day 14 (-9%), and
day 60 (-8.9%). For eye 2 they were at day 60 (-8.7%) and at day 120 (-9.1%).
For the analysis that included only those subjects who completed the trial the
decrease in eye 1 mean IOP from baseline was statistically significant (p<0.05)
at all time points. The decrease in eye 2 mean IOP from baseline was
statistically significant at all time points except day 30. Using this analysis
the greater mean IOP reductions from the baseline mean IOP for eye 1 were at
study day 1 (-19%), day 14 (-15.7%), day 37 (-16.3%), day 60 (-20.0%), day 90
(-18.1%), day 97 (-16.8%), and day 120 (-15.8%). For eye 2 greater mean IOP
reductions from baseline mean IOP were seen on day 37 (-13.0%), day 60 (-16.7%),
day 90 (-15.5%), day 97 (-14.5%), and day 120 (-7.2%). No statistically
significant differences were found in mean IOP reduction between the two eyes
treated. A total of 34 patients (92%) showed adverse effects: conjunctival
hyperemia in 26 (70.3%) and conjunctival hemorrhage in 14 (37.8%). CONCLUSIONS.
This pilot study of PNT showed a potentially good IOP lowering effect on
glaucoma and hypertensive patients. Additional studies would help to better
define the types of patients who respond to PNT and to identify risk factors
that may lead to treatment failure.
-----
Eur J Ophthalmol. 2005 May-Jun;15(3):336-42.
Safety and efficacy of bimatoprost 0.03% versus timolol maleate
0.5%/dorzolamide 2% fixed combination.
Day DG, Sharpe ED, Beischel CJ, Jenkins JN, Stewart JA, Stewart WC.
Omni Eye Services, Atlanta, GA - USA.
PURPOSE. To determine the efficacy and safety of bimatoprost given every evening
versus the dorzolamide/timolol fixed combination (DTFC) given twice daily in
open-angle glaucoma and ocular hypertensive patients. METHODS. A double-masked,
three-center, prospective, randomized, crossover comparison with two 8-week
treatment periods following a 4-week medicine free washout period. Diurnal curve
intraocular pressures (IOPs) were taken at 08:00 (trough) and 10:00 and 16:00
hours. RESULTS. A total of 35 patients were enrolled and 32 completed all
evaluations. The diurnal untreated baseline intraocular pressures was 24.8 +/-
2.4 mmHg. On the last day of treatment the mean diurnal intraocular pre s s u
res was 17.4 +/- 2.9 for bimatoprost and 18.1 +/- 2.8 mmHg for DTFC (p = 0.35).
The individual time points for intraocular pressures were not statistically
different between groups. Both groups statistically reduced the intraocular
pressures from baseline for each time point and for the diurnal curve (p <
0.05). Regarding ocular safety and tolerability, there was more conjunctival
hyperemia with bimatoprost (n = 15) than with DTFC (n = 7, p = 0.013) and more
burning and stinging with DTFC (n = 12) than with bimatoprost (n = 0, p =
0.0005). Few systemic adverse events were recorded and there was no statistical
difference between groups for any individual event (p > 0.05). CONCLUSIONS. This
study indicates that the intraocular pressures are lowered to a statistically
similar amount with DTFC compared to bimatoprost in open-angle glaucoma and
ocular hypertensive patients.
-----
Jpn J Ophthalmol. 2005 May-Jun;49(3):223-7.
Efficacy and complications after trabeculectomy with mitomycin C
in normal-tension glaucoma.
Jongsareejit B, Tomidokoro A, Mimura T, Tomita G, Shirato S, Araie M.
Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo,
Japan, tomidokoro-tky@umin.ac.jp.
PURPOSE: To evaluate the efficacy of and complications after trabeculectomy
using mitomycin C (MMC) in Japanese normal-tension glaucoma (NTG) patients by a
retrospective analysis based on the Kaplan-Meier life table method. METHODS:
Clinical records of 39 NTG patients who underwent trabeculectomy with 0.04% MMC
and had postoperative follow-up periods of 3 years or more (50.5 +/- 8.4 months,
mean +/- SD) were reviewed. Postoperative intraocular pressure (IOP) at every 1
or 2 months, complications, visual acuity, and visual field at every 6 months
were recorded. RESULTS: IOP significantly decreased from 15.9 +/- 1.9
preoperatively to 8-11 mmHg throughout the postoperative follow-up period (P <
0.0001). The life table analysis, in which failure of IOP control was defined as
an IOP above a level either 30% or 20% lower than the preoperative IOP at three
consecutive visits, showed a cumulative survival rate of 39.4 +/- 7.8% (mean +/-
SEM) or 41.3 +/- 8.9%, respectively, at 4 years after surgery. Mean deviation of
the visual field results did not significantly change (P > 0.5). The cumulative
survival rate from postoperative late-onset hypotony was 74.7 +/- 6.3% at 4
years after surgery. Postoperative complications observed were shallow anterior
chamber (six eyes), choroidal detachment (nine eyes), hypotonous maculopathy
(seven eyes), bleb leak (one eye), cataract development (three eyes), and
blebitis (two eyes). No eyes developed endophthalmitis. CONCLUSIONS: In NTG
patients, trabeculectomy with MMC showed significant efficacy in reducing IOP up
to 4 years after surgery. Since risks of postoperative complications are
unavoidable, indications for surgery should be carefully considered, and careful
follow-up is necessary to avoid severe postoperative complications. Jpn J
Ophthalmol 2005;49:223-227 (c) Japanese Ophthalmological Society 2005.
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Am J Ophthalmol. 2005 May;139(5):847-54.
Experience with the baerveldt glaucoma implant in the management
of pediatric glaucoma.
Rolim de Moura C, Fraser-Bell S, Stout A, Labree L, Nilfors M, Varma R.
Department of Ophthalmology, Federal University of Sao Paulo/Paulista School of
Medicine, Sao Paulo, Brazil.
PURPOSE: To report the clinical outcome in 48 eyes of 48 children who received a
Baerveldt glaucoma implant (BGI) for the management of pediatric glaucoma.
DESIGN: Retrospective, noncomparative case series. METHODS: The medical records
of all patients with pediatric glaucoma who underwent a BGI at two tertiary care
referral centers in Los Angeles between 1990 and 1999 were reviewed. Intraocular
pressure (IOP), intraoperative and postoperative complications, number of
glaucoma medications, visual acuity, and pre- and postoperative corneal diameter
and axial length were collected from patient records. Criteria for success were
IOP between 6 and 21 mm Hg with or without glaucoma medications, no need for
further glaucoma surgery, the absence of visually threatening complications, and
some residual vision (minimum visual acuity of light perception). RESULTS: The
study included 48 eyes from 48 patients aged 16 years and younger (mean age 4.1
years). Mean preoperative IOP was 31.2 +/- 25.7 mm Hg, and mean postoperative
IOP was 16.4 +/- 4.9 mm Hg. Cumulative probability of success (based on the
Kaplan-Meier survival curve) was 95% at 6 months, 90% at 1 year, 84% at 2 years,
74% at 36 months, and 58% at 48 months. On average, the BGIs were successful for
a mean period of 5.6 years (67.7 months). Overall, 11 eyes failed, with the
causes being uncontrolled IOP (eight eyes), retinal detachment (two eyes), and
no light perception (one eye). CONCLUSIONS: Baerveldt glaucoma implants can be a
safe and effective treatment modality for the management of pediatric glaucoma
refractive to medical therapy.
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J Ocul Pharmacol Ther. 2005 Apr;21(2):170-3.
The efficacy and safety of topical brinzolamide and dorzolamide
when added to the combination therapy of latanoprost and a beta-blocker in
patients with glaucoma.
Tsukamoto H, Noma H, Matsuyama S, Ikeda H, Mishima HK.
Department of Ophthalmology and Visual Sciences, Hiroshima University Graduate
School of Biomedical Sciences, Hiroshima, Japan. htsuka@hiroshima-u.ac.jp
PURPOSE: Brinzolamide and dorzolamide are often used as adjunctive therapy to
other antiglaucoma agents. The purpose of this study was to compare the efficacy
and safety of brinzolamide 1% versus dorzolamide 1% when added to the
combination therapy of latanoprost and a beta-blocker in patients with glaucoma.
METHODS: An 8-week, randomized, open-label comparative study was performed in 52
patients with glaucoma. Brinzolamide 1% (twice a day) or dorzolamide 1% (3 times
a day) was randomly administered to the patients who had been treated with both
latanoprost and a betablocker. RESULTS: Intraocular pressure (IOP) were both
decreased significantly (P < 0.0001) from 18.6 +/- 2.3 mmHg to 16.7 +/- 2.3 mmHg
and from 18.4 +/- 2.6 mmHg to 16.6 +/- 2.5 mmHg, respectively, 8 weeks after the
addition of brinzolamide or dorzolamide. However, the difference between the
groups was not significant (P = 0.86). The incidence of ocular irritation was
significantly higher (P < 0.0001) in the dorzolamide group (74%) than the
brinzolamide group (16%), but there was no significant difference in blurred
vision between the groups (dorzolamide 37% versus brinzolamide 52%, P = 0.40).
CONCLUSIONS: We concluded that the efficacy of brinzolamide 1% was equivalent to
dorzolamide 1%; however, the safety of brinzolamide 1% was superior to
dorzolamide 1% as adjunctive therapy to the combination with latanoprost and a
beta-blocker.
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Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004399.
Medical versus surgical interventions for open angle glaucoma.
Burr J, Azuara-Blanco A, Avenell A.
Health Services Research Unit, University of Aberdeen, Foresterhill Lea,
Aberdeen, UK, AB 2ZD25.
BACKGROUND: Open angle glaucoma (OAG) is the commonest cause of irreversible
blindness worldwide. OBJECTIVES: To study the relative effects of medical and
surgical treatment of OAG. SEARCH STRATEGY: We searched the Cochrane Central
Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE
(1966 to February 2005), EMBASE (1988 to February 2005), and reference lists of
articles. We also contacted researchers in the field. SELECTION CRITERIA:
Randomised controlled trials comparing medications to surgery in adults. DATA
COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and
extracted data. We contacted trial investigators for missing information. MAIN
RESULTS: Four trials involving 888 participants with previously untreated OAG
were included. Surgery was Scheie's procedure in one trial and trabeculectomy in
three trials. In three trials, primary medication was usually pilocarpine, in
one trial a beta-blocker.In the most recent trial, participants with mild OAG,
progressive visual field (VF) loss, after adjustment for cataract surgery, was
not significantly different for medications compared to trabeculectomy (Odds
ratio (OR) 0.74; 95% CI 0.54 to 1.01). Reduction of vision, with a higher risk
of developing cataract (OR 2.69, 95%% CI 1.64 to 4.42), and more patient
discomfort was more likely with trabeculectomy than medication.There is some
evidence, from three trials, for people with moderately advanced glaucoma that
medication is associated with more progressive VF loss and 6 to 8 mmHg less
intraocular pressure (IOP) lowering than surgery, either by a Scheie's procedure
or trabeculectomy. There was a trend towards an increased risk of failed IOP
control over time for initial pilocarpine treatment compared to trabeculectomy.
In the longer-term (two trials) the risk of failure was significantly greater
with medication than trabeculectomy (OR 3.90, 95% CI 1.60 to 9.53; HR 7.27, 95%
CI 2.23 to 25.71). Medicine and surgery have evolved since these trials were
undertaken, and additionally the evidence is potentially subject to detection
and attrition bias. AUTHORS' CONCLUSIONS: Evidence from one trial suggests, for
mild OAG, that VF deterioration up to five-years is not significantly different
whether treatment is initiated with medication or trabeculectomy. Reduced
vision, cataract and eye discomfort are more likely with trabeculectomy. There
is some evidence, for more severe OAG, that initial medication (pilocarpine, now
rarely used as first line medication) is associated with greater VF
deterioration than surgery. In general, surgery lowers IOP more than
medication.There was no evidence to determine the effectiveness of contemporary
medication (prostaglandin analogues, alpha2-agonists and topical carbonic
anhydrase inhibitors) compared to surgery in severe OAG, and in people of black
African ethnic origin who have a greater risk of more severe open angle
glaucoma. More research is required.
-----
Klin Monatsbl Augenheilkd. 2005 Apr;222(4):326-31.
[Long-term results after selective laser trabeculoplasty -- a
clinical study on 269 eyes]
[Article in German]
Best UP, Domack H, Schmidt V.
UPBest@t-online.de
BACKGROUND: Selective laser trabeculoplasty SLT is a new method to reduce
intraocular pressure in eyes with primary open angle glaucoma. With a
Q-switched, frequency-doubled Nd:YAG laser it targets the pigmented trabecular
meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT
acts non-thermally, the intracellular microdisruptions triggered by the laser
are confined to the targeted cells, the laser pulses are so short that heat
created within the targeted cells does not have time to spread to the
surrounding tissue. A clinical prospective study was conducted to evaluate the
long-term results, safety and efficacy of SLT in the treatment of open angle
glaucoma. PATIENTS AND METHODS: Since 2002, we have performed a selective laser
trabeculoplasty in 269 eyes: in 17 eyes with ocular hypertension, in 239 eyes
with primary open angle glaucoma, in 11 eyes with low tension glaucoma, while 2
eyes had a secondary glaucoma due to uveitis. In 22 eyes the primary initial
treatment was SLT. RESULTS: Three months after treatment, the mean IOP reduction
from baseline was 3.4 mm Hg, respectively 15 %, after 12 months the mean IOP
reduction was 3.0 mm Hg (12.9 %), and after 24 months 2.7 mm Hg or 12.1 %. The
response curve of the eyes with ocular hypertension greatly resembled the eyes
with primary open angle glaucoma and with low tension glaucoma. CONCLUSIONS: SLT
has shown reasonable efficacy in lowering IOP in eyes with primary open angle
glaucoma and ocular hypertension, both as a first-line treatment and as a
treatment in medication-refractory eyes. SLT is effective for patients who have
had prior treatment with ALT. Long-term follow-up studies are needed to
determine whether the IOP lowering effect is sustained over time, and to assess
the efficacy of repeated SLT. The exact biological effect induced with the SLT
is still not understood.
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Curr Opin Ophthalmol. 2005 Apr;16(2):89-93.
Glaucoma lasers: a review of the newer techniques.
Holz HA, Lim MC.
Department of Ophthalmology, University of California, Davis, Sacramento,
California, USA.
PURPOSE OF REVIEW: This paper serves to review the safety and efficacy of new
laser techniques for the treatment of glaucoma with emphasis on those studies
published within the past year. RECENT FINDINGS: Recently published studies have
reinforced the strong safety profile, and efficacy of selective laser
trabeculoplasty (SLT). Endoscopic photocoagulation, while more technically
challenging and more invasive, offers several advantages over transcleral
cyclophotocoagulation including direct observation of treatment and therefore,
fewer complications. Laser goniopuncture is a fledgling technology with, thus
far, a good safety profile, and benefits that include conjunctival sparing and
good treatment response. Many unanswered questions remain including long-term
success rates and ideal treatment parameters. SUMMARY: The benefits of laser in
the treatment of glaucoma have been well established, and while some techniques
will add to the ophthalmologists' armamentarium, others will fall into disuse as
the efficacy and safety profiles of these procedures become recognized. Novel
laser modalities, as well as the more traditional ones, require continued
evaluation to further refine treatment parameters and to determine their
long-term benefits.
-----
J Glaucoma. 2005 Apr;14(2):161-167.
Latanoprost or Brimonidine as Treatment for Elevated Intraocular
Pressure: Multicenter Trial in the United States.
Camras CB, Sheu WP; for the United States Latanoprost-Brimonidine Study Group.
>From the *Department of Ophthalmology, University of Nebraska Medical Center,
Omaha, Nebraska; daggerPharmacia Corporation, a Pfizer Company, New York, New
York. Members of the United States Latanoprost-Brimonidine Study Group are
listed in the appendix at the end of this article.
PURPOSE:: To compare the efficacy and tolerability of latanoprost or brimonidine
in patients with elevated intraocular pressure (IOP). MATERIALS AND METHODS::
This prospective, randomized, masked-evaluator, parallel-group, multicenter
study in the United States included patients with primary open angle glaucoma or
ocular hypertension. Patients received latanoprost 0.005% once daily (8:00 AM; n
= 152) or brimonidine tartrate 0.2% twice daily (8:00 AM and 8:00 PM; n = 151).
Patients underwent evaluation at screening, baseline (randomization), and after
0.5, 3, and 6 months of treatment. IOP was measured at 8:00 AM, 10:00 AM, noon,
and 4:00 PM at baseline and the months 3 and 6 visits, and at 8:00 AM only at
week 2. The main outcome measure was the difference in diurnal IOP change from
baseline to month 6 between treatment groups. Adverse events were recorded at
each visit. RESULTS:: Baseline mean diurnal IOP levels were similar between
groups. At month 6, the adjusted mean (+/- SEM) diurnal IOP reduction was 5.7
+/- 0.3 mm Hg in the latanoprost group and 3.1 +/- 0.3 mm Hg in patients
receiving brimonidine (P < 0.001). The mean difference in diurnal IOP reduction
was 2.5 +/- 0.3 mm Hg (95% CI: 1.9, 3.2; P < 0.001). Five times more patients
receiving brimonidine than latanoprost were withdrawn from the study due to
adverse events. CONCLUSION:: Latanoprost instilled once daily is more effective
and better tolerated than brimonidine administered twice daily for the treatment
of patients with glaucoma or ocular hypertension. During therapy, the range of
daily fluctuation of IOP is less for latanoprost compared with brimonidine.
-----
Eye. 2005 Mar 11; [Epub ahead of print]
Ahmed valve implantation in glaucoma secondary to chronic uveitis.
Ozdal PC, Vianna RN, Deschenes J.
1Department of Ophthalmology, Uveitis Service, McGill University, Montreal,
Canada.
PURPOSE: To evaluate the efficacy of Ahmed valve (AV) implantation in patients
with uveitic glaucoma. METHODS: In total, 18 patients (19 eyes) with glaucoma
secondary to chronic uveitis, who underwent AV implantation were retrospectively
reviewed. Visual acuity, intraocular pressure (IOP), and glaucoma medications at
the most recent examination prior to surgery, were compared with those of last
postoperative examination. The surgical success was defined as IOP less than 21
mmHg and greater than 4 mmHg without loss of light perception and visually
devastating complications at the last postoperative examination. Decrease in the
number of glaucoma medications was also a criterion for surgical success.
RESULTS: The mean follow-up period was 26+/-9.7 months. The mean preoperative
and postoperative IOPs were 33.3+/-9.7 (range, 20-57) mmHg and 17.3+/-10.8
(range, 6-40) mmHg respectively (P<0.0001). The mean number of antiglaucoma
medications was 3.5+/-0.8 (range, 2-5) preoperatively and 1.4+/-1.3 (range, 0-4)
postoperatively (P<0.0001). Valve occlusion (five eyes, 26.3%) was the most
commonly observed complication. Surgical success was achieved in 13 eyes
(68.4%). The cumulative probability of success was 94.4% at 1 year and 60% at 2
years. Five eyes (26.3%) with IOP greater than 21 mmHg and one (5.3%) with
corneal decompensation requiring penetrating keratoplasty were considered as
failures. CONCLUSIONS: The implantation of AV is an effective surgical procedure
for the management of uveitic glaucoma. The inflammatory background might
contribute to the occurrence of valve occlusion, which is the most common
complication. Prevention of this complication is an essential factor for
improving the surgical outcome.Eye advance online publication, 11 March 2005;
doi:10.1038/sj.eye.6701841.
-----
Eye. 2005 Mar 4; [Epub ahead of print]
Deep sclerectomy augmented with mitomycin C.
Anand N, Atherley C.
Department of Ophthalmology, Calderdale & Huddersfield NHS Trust, Huddersfield,
Royal Infirmary, Huddersfield, UK.
AIMS: To investigate the comparative efficacy and safety of deep sclerectomy
with and without intraoperative mitomycin C (MMC) application for lowering the
intraocular pressure (IOP). METHODS: A total of 71 eyes of 71 consecutive
patients who had routine deep sclerectomy (DS), nonaugmented (DS-noMMC) or with
mitomycin C (DS-MMC) augmentation (0.2 mg/ml for 2 min) and follow-up of 4
months or more were identified from an ongoing prospective database on glaucoma
surgery. Indications for MMC use were the presence of risk factors for
subconjunctival scarring and low target IOPs. MMC 0.2 mg/ml was applied in the
sub-Tenons space for 2 min. RESULTS: There were 19 eyes in the DS-noMMC group
and 52 eyes in the DS-MMC group. In 11 eyes (15.5%), the procedure was
complicated by intraoperative perforation of the trabeculo-Descemet's window.
Eyes in the DS-MMC group had significantly lower IOPs (MANOVA, P=0.04).
Kaplan-Meier survival curve analysis showed that the probability of maintaining
IOP below target IOP level, below 18 mmHg and below 14 mmHg at 1 year was 51,
67, and 35% for the DS-noMMC group and 80, 86, and 74% for the DS-MMC group. The
survival rates of the DS-MMC group were not statistically significant (P=0.06)
when the success criterion was maintaining an IOP less than 18 mmHg but were
significant for the other criteria, namely IOP less than target levels (P=0.03)
and less than 14 mmHg (P=0.03). Nd:YAG goniopuncture to lower IOP to target
levels was done more frequently in the DS-noMMC group (13 eyes, 81%) than the
DS-MMC group (20 eyes, 45%) and this difference was significant (P=0.03). The
prevalence of avascular areas within filtration blebs and transconjunctival
oozing of aqueous was significantly higher in the DS-MMC group (P<0.01).
CONCLUSIONS: The use of intraoperative MMC during deep sclerectomy has a
significant effect on the postoperative IOP and increases the probability of
achieving target IOPs. However, our current technique of MMC application is
associated with a higher incidence of avascular blebs and transconjunctival
oozing.Eye advance online publication, 4 March 2005; doi:10.1038/sj.eye.6701403.
-----
Ophthalmology. 2005 Mar;112(3):366-75.
Results of the European Glaucoma Prevention Study.
Miglior S, Zeyen T, Pfeiffer N, Cunha-Vaz J, Torri V, Adamsons I; European
Glaucoma Prevention Study (EGPS) Group.
OBJECTIVE: The European Glaucoma Prevention Study (EGPS) seeks to evaluate the
efficacy of reduction of intraocular pressure (IOP) by dorzolamide in preventing
or delaying primary open-angle glaucoma (POAG) in patients affected by ocular
hypertension (OHT). DESIGN: Randomized, double-masked, controlled clinical
trial. PARTICIPANTS: One thousand eighty-one patients (age, > or =30 years) were
enrolled by 18 European centers. The patients fulfilled a series of inclusion
criteria, including: IOP 22 to 29 mmHg; 2 normal and reliable visual fields (on
the basis of mean deviation and corrected pattern standard deviation or
corrected loss variance of standard 30/II Humphrey or Octopus perimetry); normal
optic disc as determined by the Optic Disc Reading Center. INTERVENTION:
Patients were randomized to treatment with dorzolamide or placebo (the vehicle
of dorzolamide). MAIN OUTCOME MEASURES: Efficacy end points were visual field,
optic disc changes, or both. A visual field change during follow-up had to be
confirmed by 2 further positive tests. Optic disc change was defined on the
basis of the agreement of 2 of 3 independent observers evaluating optic disc
stereo slides. The safety end point was an IOP of more than 35 mmHg on 2
consecutive examinations. RESULTS: During the course of the study, the mean
percent reduction in IOP in the dorzolamide group was 15% after 6 months and 22%
after 5 years. Mean IOP declined by 9% after 6 months and by 19% after 5 years
in the placebo group. At 60 months, the cumulative probability of converting to
an efficacy end point was 13.4% in the dorzolamide group and 14.1% in the
placebo group (hazard ratio, 0.86; 95% confidence interval [CI], 0.58-1.26; P =
0.45). The cumulative probability of developing an efficacy or a safety end
point was 13.7% in the dorzolamide group and 16.4% in the placebo group (hazard
ratio, 0.73; 95% CI, 0.51-1.06; P = 0.1). CONCLUSIONS: Dorzolamide reduced IOP
by 15% to 22% throughout the 5 years of the trial. However, the EGPS failed to
detect a statistically significant difference between medical therapy and
placebo in reducing the incidence of POAG among a large population of OHT
patients at moderate risk for developing POAG, because placebo also
significantly and consistently lowered IOP.
-----
Expert Opin Emerg Drugs. 2005 Feb;10(1):109-18.
Current and emerging medical therapies for glaucoma.
Tsai JC, Kanner EM.
Columbia University, Edward S. Harkness Eye Institute, Department of
Ophthalmology, 635 West 165th Street, New York, NY 10032, USA.
Glaucoma is a multifactorial optic neuropathy in which there is a characteristic
acquired loss of retinal ganglion cells, at levels beyond normal age-related
baseline loss, and corresponding atrophy of the optic nerve. Although
asymptomatic in its earlier stages, the disease is nevertheless one of the
leading global causes of irreversible blindness. Although elevated intraocular
pressure (IOP) is one of the most important risk factors and lowering of IOP is
the only proven treatment so far, the definition of glaucoma has evolved from a
disease caused by increased IOP to one characterised by an IOP-sensitive,
progressive optic neuropathy. In recent years, safer and better tolerated
topical medications have been developed to control IOP more effectively, thereby
limiting the need for surgery. New research has also noted the importance of
diurnal IOP variation as a critical risk factor for progression of glaucomatous
optic neuropathy (GON) and subsequent visual field loss. Moreover, new
discoveries have further elucidated the basic pathophysiological and genetic
mechanisms underlying the elevated levels of IOP, as well as the cellular
mechanisms of GON. As our understanding of these complex pathways continues to
improve, development opportunities for new therapeutic modalities will be
enhanced.
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Eur J Ophthalmol. 2005 Jan-Feb;15(1):27-31.
The effect of adjunctive Mitomycin C in Ahmed glaucoma valve
implantation.
Kurnaz E, Kubaloglu A, Yilmaz Y, Koytak A, Ozerturk Y.
Department of Ophthalmology, Education and Research Hospital, Istanbul - Turkey.
ekremkurnaz@hotmail.com
PURPOSE: To evaluate the effectiveness and safety of adjunctive mitomycin C (MMC)
in Ahmed glaucoma valve (AGV) implantation for refractory glaucoma. METHODS:
Twenty-two eyes of 22 patients who underwent AGV implantation with adjunctive
MMC (0.5 mg/ml) for 3 minutes (Group A) were compared to a control group of 26
eyes of 26 patients (Group B) who received AGV implantation without MMC. Nine
patients were female and 13 patients were male in Group A and 11 patients were
female and 15 patients were male in Group B. The mean age was 56 years ranging
from 13 to 77 in Group A and 58 ranging from 14 to 71 years in Group B. Success
was defined as an intraocular pressure (IOP) between 4 and 21 mmHg with or
without glaucoma medication and with no additional glaucoma surgery, phthisis,
or loss of light perception. RESULTS: The probability of success at 1 year was
86.36% and 80.76% in Group A and Group B, respectively. The number of glaucoma
medications decreased from 2.82 to 0.56 in Group A and from 2.65 to 0.73 in
Group B. Postoperative hypotony as an early complication was higher in Group A
(31.81% in Group A and 15.38% in Group B). As a late postoperative complication,
tube exposure developed in 3 patients (13.63%) in Group A and no such
complication was seen in Group B. There was no statistically significant
difference in success and complication rates between the two groups (p>0.05).
CONCLUSIONS: Although adjunctive MMC in AGV implantation is safe and effective,
it may not offer a better chance of surgical success compared with AGV
implantation without MMC.
-----
Trans Am Ophthalmol Soc. 2004;102:219-23; discussion 223-4.
Does medical treatment influence the success of trabeculectomy?
Flach AJ.
Department of Ophthalmology, University of California, San Francisco, Medical
Center, San Francisco, California, USA.
PURPOSE: Many ophthalmologists believe that long-term use of topically applied
glaucoma medications can adversely affect results of fistulizing surgery. This
presentation critically analyzes the published studies most often cited in
support of this view to determine whether this conclusion is justified. METHODS:
Morphologic effects of long-term treatment with antiglaucoma drugs on the
conjunctiva and Tenon's capsule in glaucomatous patients have been studied. The
results of these studies encouraged investigators to examine the influence of
prior therapy on the success of trabeculectomy performed in patients with
open-angle glaucoma. From this work, many have concluded that long-term use of
topically applied glaucoma medications can adversely affect the results of
fistulizing surgery. These results and conclusions are summarized and critically
analyzed to determine whether this conclusion is justified. RESULTS: Morphologic
studies describe increased numbers of macrophages, fibroblasts, lymphocytes, and
mast cells in conjunctival and Tenon's capsule specimens taken from patients
receiving long-term antiglaucoma drugs. These findings suggest a potential for
more inflammation and subsequent scarring following trabeculectomies in these
patients. Efforts to confirm the clinical relevance of these histologic findings
in open-angle glaucoma patients with a history of long-term antiglaucoma
medication prior to surgery have been published. These retrospective,
nonrandomized, unmasked studies of open-angle glaucoma patients include
treatment groups and surgeries that are not comparable. In addition, the medical
treatments within these studies do not reflect our current approaches to the
medical management of open-angle glaucoma. CONCLUSIONS: At present, there is no
convincing clinical evidence that long-term medical treatments influence the
success of contemporary trabeculectomy surgery performed on open-angle glaucoma
patients.
-----
J Glaucoma. 2004 Dec;13(6):500-6.
Deep sclerectomy versus punch trabeculectomy with or without
phacoemulsification: a randomized clinical trial.
Cillino S, Pace FD, Casuccio A, Calvaruso L, Morreale D, Vadala M, Lodato G.
From the Department of Ophthalmology, University of Palermo, Italy. cillino@iol.it
PURPOSE: To compare the efficacy of non-penetrating deep sclerectomy without
implant with Crozafon-De Laage punch trabeculectomy, and to evaluate the effect
of simultaneous temporal approach phacoemulsification on both techniques.
PATIENTS AND METHODS: Setting: Department of Ophthalmology of the University of
Palermo. DESIGN: Prospective randomized clinical trial. Patients and
intervention procedures: Sixty-five patients (65 eyes) with primary open angle
glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG): 32 eyes underwent
non-penetrating deep sclerectomy (NPDS), 17 as single procedure and 15 combined
with phacoemulsification (phaco-NPDS), and 33 eyes underwent punch
trabeculectomy (PT), 18 single and 15 with phaco (phaco-PT). The patients were
randomly assigned to each procedure. No adjuvants, such as Nd: YAG laser
goniopuncture, laser suturelysis, and antimetabolites were used. Main Outcome
Measures: Postoperative complications, number of antiglaucoma medications, and
IOP level were checked at each control. Complete success indicated the
achievement of the target IOP without antiglaucoma medications, while qualified
success indicated the same goal with or without medications. These categories
were assessed at two target IOP levels, namely < or =21 mm Hg and < or =17 mm Hg
in all four groups. RESULTS: The mean follow-up period was 22.5 +/- 2.5 months.
The mean preoperative IOP was 30.2 mm Hg in NPDS eyes, 26.8 in phaco-NPDS eyes,
32.1 in PT eyes, and 27.0 in phaco-PT ones, without significant intergroup
difference. At the end point the mean IOP was 17.7 +/- 0.8, 15.7 +/- 0.9, 14.2
+/- 1.1, and 13.8 +/- 1.1 mm Hg respectively with postoperative IOP
significantly lower (P = 0.005) than preoperative IOP in all groups. No
difference was observed among groups at any observation time when simple and
combined surgery were compared. Significant difference at the end point was
found between NPDS and PT (P = 0.030). As for complete and qualified success
with a < or =21 and < or =17 mm Hg target IOP no significant differences were
noticed in all groups. Among postoperative complications, hypotony was
significantly more frequent in both PT groups when compared with the NPDS
groups. The same was true, but relating only to the single procedures, for
shallow anterior chamber and choroidal detachment. The Kaplan-Meier cumulative
survival curves relating to the qualified success rate in the four surgical
groups for a < or =21 mm Hg target IOP (log rank, P = 0.564) and for a < or =17
mm Hg target IOP (log rank, P = 0.591) showed no significant intergroup
differences. When the < or =21 mm Hg target IOP was considered, a mild positive
trend in combined procedures (both phaco-NPDS and phaco-PT) was found in
comparison with simple procedures. At lower IOP target (ie, < or =17 mm Hg) a
better trend was found in favor of simple or combined PT procedure. CONCLUSIONS:
Both techniques, NPDS and PT, without enhancements (ie, implants or
antimetabolites) control IOP efficaciously at our end point. Phacoemulsification
combined with penetrating and non-penetrating procedures does not seem to
interfere with final results. When a lower target IOP and probability of success
over time are considered, PT, single or combined, exhibits a better trend. PT,
therefore, could be more suitable for higher IOP levels or longer life
expectancies.
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J Glaucoma. 2004 Dec;13(6):450-3.
Trabeculectomy with mitomycin-C in uveitic glaucoma associated
with Behcet disease.
Yalvac IS, Sungur G, Turhan E, Eksioglu U, Duman S.
Glaucoma Department, Ankara Education and Research Hospital, Ankara, Turkey.
iyalvac@hotmail.com
PURPOSE: To determine the effect of intraoperative application of Mitomycin-C (MMC)
with trabeculectomy in uveitic glaucoma associated with Behcet disease.
MATERIALS AND METHODS: Twenty-six eyes of 26 patients with uveitic glaucoma
associated with Behcet disease who underwent trabeculectomy with MMC between
1996 and 2001 were reviewed in this retrospective, noncomparative study.
Trabeculectomy + MMC in concentration of 0.4 mg/mL for 3 minutes was performed
to all patients. Main outcome measures were control of IOP, the number of
antiglaucoma medications required to achieve the desired IOP, visual acuity and
complications. The surgical success was defined as IOP less than 22 mm Hg and
greater than 5 mm Hg without additional further glaucoma surgery or loss of
light perception. RESULTS: The cumulative probability of success was 83.3% at 1
year, 76.2% at 2 years, 70% at 3 years, 66.7% at 4 years and 62.5% at 5 years
after surgery. The mean follow-up was 40.0+/-18.0 months. At last follow-up 23%
of the patients required no antiglaucoma medications. Best-corrected visual
acuity improved or remained within two lines of preoperative visual acuity in 19
eyes (73.1%). Glaucomatous (1 eye 3.8%) and nonglaucomatous optic atrophy (3
eyes 11.5%) was the most frequent reason for visual decrease (total 4 eyes
15.2%). The most common complications were cataract formation in 6 eyes (23.1%),
bleb leakage in 4 eyes (15.3%) and choroidal effusion in 3 eyes (11.5%).
Phthisis bulbi was found in one (3.8%) patient. CONCLUSION: Trabeculectomy and
intraoperative application of MMC appears to provide long term safety and
effectiveness in uveitic glaucoma associated with Behcet disease.
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Ophthalmologica. 2004 Nov-Dec;218(6):390-6.
Retinal Peripapillary Blood Flow before and after Topical
Brinzolamide.
Iester M, Altieri M, Michelson G, Vittone P, Traverso CE, Calabria G.
Department of Neurological Sciences, Ophthalmology and Genetics, Clinica
Oculistica, University of Genoa, Genoa, Italy.
Purpose: To study the effect of topical brinzolamide on retinal capillary blood
flow by the Heidelberg Retina Flowmeter (HRF) in patients with glaucoma.
Methods: Twenty patients with glaucoma were consecutively recruited. One eye for
each patient was randomly selected. Patients were classified as glaucomatous if
they had an abnormal visual field and/or an abnormal optic nerve head with an
intraocular pressure (IOP) greater than 21 mm Hg without any treatment. After an
eye examination, baseline retinal blood flow measurements were made with
confocal scanning laser Doppler flowmetry. Blood flow and IOP measurements were
then repeated after 1 month of treatment. Blood flow measurements were analyzed
by using an automatic full-field perfusion image analysis (AFFPIA) program. The
blood flow was calculated in the superior and inferior part of the optic disk.
In each area, the blood flow was calculated as temporal area, the nasal area and
the rim area as for software AFFPIA. Results: The mean age of the patients was
56 +/- 7 (mean +/- standard deviation) years. The mean IOP before treatment was
23.7 +/- 1.5 mm Hg while the mean IOP after 4 weeks of treatment was 19.1 +/-
2.2 mm Hg. This difference was statistically significant (p < 0.01). Significant
(p < 0.05) increases in retinal blood flow were found for the temporal and nasal
areas between baseline and 1 month after the treatment. No difference was found
between superior and inferior sectors. Conclusion: Topical brinzolamide reduced
the IOP significantly and apparently improved retinal blood flow as measured by
the HRF. Copyright (c) 2004 S. Karger AG, Basel.
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J Fr Ophtalmol. 2004 Nov;27(9 Pt 1):971-7.
[Comparison of once-daily nonpreserved timolol and timolol
maleate gel-forming solution associated with latanoprost.]
[Article in French]
Bron A, Velasque L, Rebica H, Pouliquen P, Elena PP, Rouland JF.
Service d'Ophtalmologie, CHU de Dijon, Hopital General, Dijon.
Aim: To compare the efficacy and safety of a single daily instillation of
nonpreserved timolol to a timolol maleate gel-forming solution in patients with
chronic glaucoma or ocular hypertension already treated with latanoprost.
PATIENTS: and methods: A randomized, prospective, multicenter, open,
parallel-group clinical trial was undertaken with 73 patients with chronic
glaucoma treated with latanoprost and a timolol maleate gel-forming solution. In
36 patients, the previous regimen was substituted by nonpreserved timolol given
instead of timolol maleate gel for 3 months. The changes in intraocular pressure
(IOP) were recorded as well as local and systemic tolerance and patient
compliance. RESULTS: At 3 months, both regimens were found equivalent in
maintaining IOP control between D0 and D84. The difference with baseline was
-0.08+/-2.22mmHg and -0.38+/-2.41mmHg in the nonpreserved timolol group and in
the timolol maleate gel-forming solution group, respectively (CI 95% [-0.79;
1.38]). After 84 days of treatement, blurred vision (5.9%) and eyelid deposits
(5.9%) were reduced in the preservative-free timolol group compared to the other
group (respectively, 33.3% and 24.2%). These differences were statistically
significant for both signs (blurred vision: p<0.0001 and for eyelid deposits:
p=0.03). CONCLUSION: This short-term study has demonstrated the equivalence of
nonpreserved timolol to timolol maleate gel-forming solution in terms of IOP
control. Moreover, the local tolerance of nonpreserved timolol was better.
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Ophthalmology. 2004 Nov;111(11):2137-43.
Contact transscleral neodymium:yttrium-aluminum-garnet laser
cyclophotocoagulation Long-term outcome.
Lin P, Wollstein G, Schuman JS.
New England Eye Center, Tufts-New England Medical Center, Tufts School of
Medicine, Boston, Massachusetts, USA.
PURPOSE: Contact transscleral neodymium:yttrium-aluminum-garnet (Nd:YAG) laser
cyclophotocoagulation (CYC) is a treatment option for advanced glaucoma
refractory to alternative treatments. This study determined the long-term
efficacy and risks of contact transscleral Nd:YAG laser CYC. DESIGN: A
prospective study was performed with patients with advanced, uncontrolled
glaucoma who received CYC from 1988 through 1989. PARTICIPANTS: Records for 68
eyes of 64 patients were obtained and reviewed for the 10-year follow-up.
METHODS: A transscleral continuous-wave Nd:YAG laser was used for
photocoagulation of the ciliary body. MAIN OUTCOME MEASURES: Intraocular
pressure (IOP), visual acuity, and second intervention. Failure was defined as
the need for second intervention, IOP of more than 25 mmHg, or IOP of less than
3 mmHg. RESULTS: The mean follow-up period was 5.85+/-4.0 years (range, 0.1-10
years). The mean preoperative IOP of 36.3+/-10.1 mmHg decreased to 22.6+/-11.3
mmHg at 1 year of follow-up (P<0.001). The mean postoperative IOP at 5 years was
21.8+/-13.3 mmHg (P<0.001) and was 18.9+/-12.2 mmHg at 10 years of follow-up
(P<0.001). A second intervention after CYC was required in 30 eyes (44.1%). Six
eyes (8.8%) with initial visual acuity of counting fingers or worse progressed
to no light perception, and 5 of 8 eyes (62.5%) with visual acuity better than
20/200 lost 2 or more Snellen lines. Hypotony developed in 3 eyes (4.4%).
Overall, the failure rate by 10 years of follow-up was 51.5% (35/68 eyes).
CONCLUSIONS: Cyclophotocoagulation resulted in a significant reduction of IOP
after surgery at 1, 5, and 10 years of follow-up; however, 51.5% of eyes failed
by the end of 10 years, with most failures occurring within the first year
(40%). Although CYC provides a useful method to lower IOP significantly, this
study suggests that its success in controlling IOP is tempered by its failure
rate and risk of complications, including visual loss, phthisis, and loss of
light perception.
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J Cataract Refract Surg. 2004 Nov;30(11):2391-6
Refractive changes after phacoemulsification combined with deep
sclerectomy assisted by corneal topography.
Corcostegui J, Rebolleda G, Munoz-Negrete FJ.
Glaucoma Unit, Ophthalmology Department, Hospital Ramon y Cajal, University of
Alcala, Madrid, Spain.
Purpose: To evaluate the corneal surgically induced refractive change (SIRC)
after phacoemulsification and deep sclerectomy. Setting: Glaucoma Unit,
Department of Ophthalmology, Hospital Ramon y Cajal, Madrid, Spain. Methods:
This prospective study comprised 38 eyes of 35 patients with a mean age of 77
years having phacoemulsification using a right clear corneal approach (temporal
approach and nasal approach in the right eye and the left eye, respectively)
combined with a deep sclerectomy and placement of a reticulated hyaluronic acid
implant in the superior quadrant. Computerized keratography was performed
preoperatively and 1 month and 3 months postoperatively. The SIRC was calculated
at each follow-up by the Holladay-Cravy-Koch method and was expressed
vectorially in 3 Cartesian coordinates to facilitate statistical analysis.
Results: The magnitude of the resulting mean SIRC components was very small. No
significant change was observed in any vectorial component 1 month and 3 months
postoperatively. Overall, 47.4% of patients had an induced with-the-rule
astigmatism change at 3 months (range 0.03 to 1.67 diopters [D]); however, the
mean change was less than 0.50 D and not statistically significant. The mean
spherical postoperative change was greater in left eyes than in right eyes (P =
.05). No statistically significant changes between the right eye and left eye
were observed in the astigmatism vectorial components. Conclusions: Overall, the
refractive change after phacoemulsification combined with deep sclerectomy was
mild and not clinically significant. The greater mean spherical change in left
eyes than in right eyes might be related to the phacoemulsification approach.
-----
J Fr Ophtalmol. 2004 Oct;27(8):907-11.
[Nonpenetrating deep trabeculectomy treated with mitomycin C,
without implant. A prospective evaluation of 55 cases]
[Article in French]
Gonzalez Bouchon J, Gonzalez Mathiesen I, Gonzalez Galvez M, Marin R, Varas A,
Montesinos TM.
Departement de Glaucome, Universite de Concepcion, HCRC, Chile. jdgb@surnet.cl
PURPOSE: Since 1998 we have been conducting a prospective study of
nonpenetrating deep trabeculectomy with chronic open-angle glaucoma to evaluate
the efficiency of the technique. MATERIAL AND METHODS: The study was carried out
in 55 eyes of 41 patients who suffered from open-angle glaucoma. After
performing a superior scleral flap, mitomycin diluted to 0.01% was applied for 3
minutes, then the 4 x 4-mm superficial scleral flap was dissected at two-thirds
deepness until reaching the cornea. The Schlemm canal and the external trabecula
were surgically removed and the two points of the Schlemm canal were
catheterized with a trabeculotome to ensure that the ablation was well done. If
it was not, it was completed by using a trabeculotome as a guide.
Postoperatively, if the filtering bleb tended to decrease or ocular pressure
began to increase, the operated trabecular region was reopened with Yag laser.
The filtering bleb characteristics were correlated with the normalization of
intraocular pressure in the first 30 cases. RESULTS: Preoperative pressure
without treatment was 32 mmHg. Postoperative intraocular pressure without
treatment was 20 mmHg or less in 79% of the eyes after 4 months, 77.5% after 6
months, 75% after 8 months and 61% after 12 months. By adding a local
hypotension treatment in monotherapy, a pressure of 20 mmHg or less was obtained
in 79% of the cases after 12 months. No severe complications were observed. The
presence of a filtering bleb is an important factor in the normalization of
postoperative pressure (p=0.0048). CONCLUSIONS: This surgical technique provides
a substantial decrease in intraocular pressure and very few complications after
12 months of follow-up.
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Arch Ophthalmol. 2004 Aug;122(8):1122-8.
Long-term outcome of trabeculotomy for the treatment of
developmental glaucoma.
Ikeda H, Ishigooka H, Muto T, Tanihara H, Nagata M.
Department of Ophthalmology, Tenri Hospital, Nara, Japan. hanakoi@mbox.kyoto-inet.or.jp
OBJECTIVE: To elucidate long-term outcome of trabeculotomy in primary and
secondary developmental glaucoma. METHODS: One hundred forty-nine eyes of 89
patients with developmental glaucoma who underwent trabeculotomy were
retrospectively studied. Intraocular pressure (IOP), success probabilities,
visual acuities, and visual field were determined during follow-up and at the
final visit. RESULTS: The mean +/- SD IOP of 112 eyes with primary developmental
glaucoma at the final visit with an mean +/- SD follow-up period of 9.5 +/- 7.1
years was 15.6 +/- 5.0 mm Hg. The average IOP for 37 eyes with secondary
developmental glaucoma was 16.7 +/- 4.2 mm Hg. One hundred eyes (89.3%) with
primary developmental glaucoma were defined as achieving success at the final
visit. Complete and qualified successes were achieved in 71 eyes (63.4%) and 29
eyes (25.9%), respectively. Visual acuities were 20/40 or better in 78 (59.5%)
of 131 eyes examined and were poorer than 20/200 in 32 eyes (24.4%). The causes
of poor visual acuities were mainly progression of glaucoma, including delay of
detection of onset or surgery and amblyopia. Eyes with glaucoma that existed
before 2 months of age or eyes that needed several trabeculotomies were
considered to have poor visual acuity. Visual fields were classified as normal
or almost normal in 21 (44.7%) of 47 eyes. CONCLUSIONS: Trabeculotomy for
developmental glaucoma is effective over a long time. There is a fairly good
prognosis for visual function of eyes with developmental glaucoma with early
detection of the onset, proper treatment, and proper management after
trabeculotomy.
-----
Klin Monatsbl Augenheilkd. 2004 Aug;221(8):646-51.
[Surgical management of posttraumatic secondary angle closure
glaucoma]
[Article in German]
Schlote T.
Universitats-Augenklinik, Abteilung I (Erkrankungen der vorderen und hinteren
Augenabschnitte), Tubingen.
Medical and surgical treatment of secondary angle closure glaucoma has often
been disappointing. Therefore the visual prognosis of these eyes is mostly
restricted. Transscleral cyclophotocoagulation is a relatively safe method for
the treatment of advanced refractory glaucoma and represents the method of
choice in secondary angle closure glaucoma due to anterior peripheral synechiae.
In younger glaucoma patients and patients with traumatic glaucoma, long-term
reduction of the intraocular pressure is only partially achieved. New surgical
techniques will increase the possibilities of an effective reduction of the
intraocular pressure in secondary angle closure glaucoma. On the other hand,
data concerning the clinical efficacy and safety are still limited. These new
procedures are endoscopic cyclophotocoagulation, retinectomy and the
implantation of drainage devices via the pars plana. Further evaluation and
modifications of these surgical techniques should markedly improve the visual
prognosis of eyes with secondary angle closure glaucoma.
-----
Br J Ophthalmol. 2004 Aug;88(8):1012-7.
A randomised, prospective study comparing trabeculectomy with
viscocanalostomy with adjunctive antimetabolite usage for the management of open
angle glaucoma uncontrolled by medical therapy.
O'Brart DP, Shiew M, Edmunds B.
Department of Ophthalmology, St Thomas's Hospital, London SE1 7EH, UK.
davidobrart@aol.com
AIMS: To compare trabeculectomy with viscocanalostomy augmented with adjunctive
antimetabolite use for the control of intraocular pressure (IOP) in open angle
glaucoma (OAG). METHODS: 45 patients (50 eyes) with uncontrolled OAG were
randomised to either trabeculectomy (25 eyes) or a viscocanalostomy technique
(25 eyes). Preoperatively, all eyes were graded in terms of risk factors for
drainage failure and were given intraoperative antimetabolites (5-fluorouracil
25 mg/ml (5-FU), mitomycin C (MMC) 0.2 mg/ml and 0.4 mg/ml) according to a
standard protocol. RESULTS: There were no significant differences between the
groups in age, sex, type of OAG, preoperative medications, risk factors for
drainage failure, and preoperative IOP. Mean follow up was 20 months (range 3-24
months). It was 12 months or longer in all eyes, except two lost to follow up at
3 months. At 12 months, complete success (IOP<21 mm Hg without antiglaucoma
medications) was seen in 91% of eyes undergoing trabeculectomy, but in only 60%
of eyes undergoing viscocanalostomy (p<0.02). Similarly, at the last follow up
visit (mean 20 months) complete success was seen in 68% of eyes undergoing
trabeculectomy and 34% with viscocanalostomy (p<0.05). In terms of qualified
success (IOP<21 mm Hg with or without glaucoma medications) and mean IOP
measurements postoperatively there were no difference between the groups,
although the mean number of antiglaucomatous medications required
postoperatively was less with trabeculectomy (0.39) than viscocanalostomy (1.04)
(p<0.05). Needling procedures were more commonly required after trabeculectomy
(p<0.02). YAG goniotomy was required in three eyes (13%) after viscocanalostomy.
Early transient complications such as anterior chamber shallowing and encysted
blebs were more common in the trabeculectomy group (p<0.05). Late postoperative
cataract formation was similar between the two groups. CONCLUSION: In terms of
complete success and number of antiglaucomatous medications required
postoperatively, IOP control appears to be better with trabeculectomy.
Viscocanalostomy is associated with fewer early transient postoperative
complications.
-----
Optom Vis Sci. 2004 Aug;81(8):574-7.
Deepening of lid sulcus from topical bimatoprost therapy.
Peplinski LS, Albiani Smith K.
Bennett & Bloom Eye Centers, 4010 Dupont Circle, Suite 380, Louisville, KY
40207, USA. DrP@eyecenters.com
PURPOSE: To report a new adverse effect related to treatment with bimatoprost.
CASE REPORTS: Serial clinical examination of three patients was performed. In
each of the three reported patients, alteration of eyelid appearance with
deepening of the lid sulcus was evident as the result of topical bimatoprost
therapy. DISCUSSION: A comprehensive literature search of Medline using WebMd
and MDConsult, was conducted to cross reference known side effects of topical
prostaglandin analog treatment. The keywords utilized were prostaglandin
analogs, prostaglandins, prostamide, glaucoma, ocular hypertension, intraocular
pressure, side effects, adverse effects, bimatoprost, latanoprost, lumigan, and
xalatan. This appears to be the first such report in the literature. Clinicians
and patients should be made aware of this possible complication of topical
bimatoprost therapy.
-----
Oftalmologia. 2004;48(1):5-14.
[Timolol topical ophthalmic combination]
[Article in Romanian]
Calugaru M, Calugaru D.
The primary standard therapy in patients with open-angle glaucoma and ocular
hypertension is carried out by means of monotherapy with synthetic prostaglandin
analogues. Most of the glaucoma patients need more than one medication for
adequate intraocular pressure control. Timolol represents the basic component of
these combinations. Timolol topical ophthalmic combinations with dorzolamide (Cosopt),
pilocarpine, latanoprost (Xalacom), travoprost and unoprostone are thoroughly
described. Most antiglaucoma medications achieve on one side directly
baroprotection by decreasing intraocular pressure and on the other side they
produce indirectly vasoprotection, that is secondary to intraocular pressure
lowering. The Cosopt, due to its Dorzolamide component, makes an exception since
it produces directly both baroprotection by aqueous humor flow suppression and
vasoprotection by increasing the blood flow within the retina, choroid, optic
nerve head and retrobulbar area. Given these considerations as well as the fact
that the ocular hypotensive effect of both the Cosopt and the latanoprost are
equally potent, a question seems reasonable according to accepted standard i.e.
Cosopt or latanoprost as primary glaucoma therapy?
-----
J Clin Pharm Ther. 2004 Aug;29(4):375-80.
Comparing the fixed combination dorzolamide-timolol (Cosopt) to
concomitant administration of 2% dorzolamide (Trusopt) and 0.5% timolol -- a
randomized controlled trial and a replacement study.
Francis BA, Du LT, Berke S, Ehrenhaus M, Minckler DS; Cosopt Study Group.
Doheny Eye Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA. bfrancis@usc.edu
PURPOSE: To compare the intraocular pressure (IOP) lowering effect of
concomitant administration of 0.5% timolol and 2% dorzolamide and a fixed
combination dorzolamide-timolol (Cosopt) To critically evaluate discrepancies
between phase 3 clinical trials and prior replacement studies. DESIGN: A
prospective, randomized, controlled clinical trial and a prospective,
non-randomized comparative replacement trial. PARTICIPANTS/INTERVENTIONS: In a
national multicentre trial, 131 patients were randomized to dorzolamide-timolol
or a topical carbonic anhydrase inhibitor (CAI) and non-selective beta-blocker
following a 1-month run-in using the separate components. Peak (maximal drug
effect) and trough (minimal drug effect) IOPs were measured at baseline and 1
month after treatment. The replacement therapy study enrolled 404 consecutive
glaucoma patients using a non-selective beta-blocker and dorzolamide and changed
treatment to the fixed combination. Mean IOPs at the same time of day were
compared before and 1 month after changeover. MAIN OUTCOME MEASURE: The main
outcome measure was IOP, comparing baseline and on-therapy measurements at study
conclusion between the two arms of the randomized trial and before and after
switching therapy in the replacement trial. RESULTS: In the randomized trial,
the mean baseline peak and trough IOPs were 18.4 and 21.0 mmHg in the group
randomized to combination therapy and 17.6 and 19.8 mmHg in the dual drug group.
After randomization and treatment for four weeks, the peak and trough IOPs were
17.6 and 19.5 mmHg in the combination group and 17.3 and 19.0 mmHg in the
concomitant group. The percentage change in IOP was -3.2% at peak and -6.5% at
trough for the combination and -0.3 and -3.2% for the concomitant group. These
differences did not show statistical significance. In the replacement study,
mean baseline IOP was 19.4 mmHg. Four weeks after initiation of treatment on the
fixed combination, a significant additional IOP reduction of 1.7 mmHg (-8.8%)
was observed (P < 0.0001). Overall, 81% of eyes exhibited equal or lower IOP on
the fixed combination compared with concomitant therapy. CONCLUSION: The results
of the randomized trial indicate that the fixed combination dorzolamide-timolol
(Cosopt) was as effective as its components in controlling IOP, confirming
results seen in phase 3 clinical trials. However, in the replacement study,
utilization of the combination drug offered a statistically significant
additional IOP reduction (P < 0.0001), which duplicates results from previous
replacement studies.
-----
Jpn J Ophthalmol. 2004 Jul-Aug;48(4):408-11.
Phacotrabeculectomy in treatment of primary angle-closure
glaucoma and primary open-angle glaucoma.
Lai JS, Tham CC, Chan JC, Lam DS.
Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong.
laism@ha.org.hk
PURPOSE: To evaluate the surgical outcome of combined phacoemulsification,
posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy)
in patients with primary angle-closure glaucoma (PACG) or primary open-angle
glaucoma (POAG). METHODS: The records of 57 consecutive patients (65 eyes) with
PACG or POAG that were treated with phacotrabeculectomy were reviewed
retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean
follow-up period was 21.0 +/- 8.3 months. The visual acuity, intraocular
pressure (IOP), number of medications, and complications were evaluated.
RESULTS: The mean IOP and the number of glaucoma medications decreased
significantly after phacotrabeculectomy in both groups. The mean IOP reduction
was significantly greater in eyes with PACG (P < 0.05). The absolute success
rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the
success rates was not significant (P = 0.297). The early postoperative
complication rates were similar in both groups. CONCLUSIONS: Phacotrabeculectomy
results in greater IOP reduction in eyes with PACG than in those with POAG, but
the overall success rates were not significantly different. Copyright Japanese
Ophthalmological Society 2004
-----
Chin Med J (Engl). 2004 Jul;117(7):1006-10.
Efficacy of non-penetrating trabecular surgery for open angle
glaucoma: a meta-analysis.
Cheng JW, Ma XY, Wei RL.
Department of Ophthalmology, Changzheng Hospital, Second Military Medical
University, Shanghai 200003, China.
BACKGROUND: Non-penetrating trabecular surgery is a new filtrating surgery
without opening in ternal trabecular structures. This study was to estimate the
overall efficacy of non-penetrating trabecular surgery for open angle glaucoma.
METHODS: The published articles selected for this study were obtained by a
computerised Medline and China Biological Medicine Disk search of the literature
and a manual search of the bibliographies of relevant articles. Articles meeting
the inclusion criteria were reviewed systematically, and the reported data were
aggregated using the statistical techniques of meta-analysis. RESULTS: A total
of 37 articles were included in the meta-analysis. The pooled complete success
rates of non-penetrating trabecular surgery with different techniques were: deep
sclerectomy single, 69.7% (95% CI: 58.5% - 81.0%); deep sclerectomy with
collagen implant, 59.4% (95% CI: 47.0% - 71.8%); deep sclerectomy with
reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8% - 85.3%); and
viscocanalostomy, 72.0% (95% CI: 57.6% - 86.4%). The overall weighted complete
success rate of non-penetrating trabecular surgery was 67.8% (95% CI: 61.4% -
74.3%). CONCLUSIONS: Non-penetrating trabecular surgery is the best available
therapy method for medically uncontrolled open angle glaucoma with a complete
success rate of over 60%. But the different techniques cannot belie the complete
success rate of non-penetrating trabecular surgery.
-----
J Fr Ophtalmol. 2004 Jun;27(6 Pt 2):718-9.
[Initial medical treatment: beta-blockers or prostaglandins.
Prostaglandins: a modern glaucoma treatment]
[Article in French]
Baudouin C.
Service d'Ophtalmologie 3, CHNO des XV-XX, 28 rue de Charenton, 75012 Paris.
In the initial treatment of glaucoma, prostaglandin analogs have indisputable
advantages: better efficacy than timolol--particularly for inducing low or even
very low IOP--but also their possible use in normotensive glaucoma, posology of
a single instillation per day, and no systemic effects. The only disadvantages
are minor local effects and a higher cost than beta-blockers.
-----
J Fr Ophtalmol. 2004 Jun;27(6 Pt 2):701-5.
[Treatment of acute angle-closure glaucoma]
[Article in French]
Renard JP, Giraud JM, Oubaaz A.
Service d'Ophtalmologie, HIA du Val de Grace, 74 boulevard de Port Royal, 75005
Paris.
Treatment of acute angle-closure glaucoma is now better adapted for each stage
of the disease. The urgent necessity to lower intraocular pressure is normally
achieved using medical therapy followed by laser peripheral iridotomy and
sometimes by filtration surgery. Early argon laser peripheral iridoplasty is
effective and safe in some cases, allowing a very early peripheral iridotomy to
be performed and avoiding systemic treatment. When surgery is required, lens
extraction must be considered. In all cases, IOP control and regular gonioscopic
examination the 1st Year are essential to detect peripheral anterior synechiae.
-----
J Fr Ophtalmol. 2004 Jun;27(6 Pt 2):697-700.
[Chronic closed-angle glaucoma]
[Article in French]
Valtot F.
Institut du Glaucome, Fondation Hopital Saint-Joseph, 185 rue Raymond Losserand,
75674 Paris Cedex 14.
Five times more frequent than the acute form, chronic closed-angle glaucoma
often goes unrecognized for a long time, resulting in considerable visual field
deficiencies, even in loss of the eye. It is sometimes confused with chronic
glaucoma and treated as such, which is inadequate to halt the progression of the
disease. Only gonioscopy can diagnose it. If doubt persists, UBM (ultrasound
biomicroscopy) can detect goniosynechiae, a malposition of the ciliary body or
of the lens, or the existence of iridociliary cysts. Nine times out of ten,
pupillary block initiates the process and an iridotomy should always be done to
remediate it, even if this procedure alone does not always suffice to solve the
problem.
-----
Zhonghua Yan Ke Za Zhi. 2004 May;40(5):291-4.
[Clinical observation of combined surgery for cataract and
glaucoma: phacoemulsification and viscocanalostomy]
[Article in Chinese]
Yao K, Shentu XC, Xu W, Chen PQ, Zhang Z.
Eye Center, Affiliated Second Hospital, College of Medicine, Zhejiang
University, Hangzhou 310009, China. xlren@zju.edu.cn
OBJECTIVE: To evaluate the therapeutic effects and safety of phacoemulsification-intraocular
lens (IOL) implantation combined with viscocanalostomy (V-P) and compared the
outcomes of phacoemulsification-IOL implantation combined with trabeculectomy
(T-P). METHODS: Combined phacoemulsification with corneal incision, foldable
intraocular lens implantation and viscocanalostomy was performed in 30 eyes of
28 cataract patients with primary open-angle glaucoma. RESULTS: Follow-up was
performed up to 6 months after surgery. The mean intraocular pressure (IOP) of
V-P group was (14.65 +/- 2.70) mm Hg (1 mm Hg = 0.133 kPa) with a mean pressure
reduction of 10.33 mm Hg compared with IOP before the operation (P = 0.000).
There were no statistical differences of the IOP within two groups during
postoperative 1 week, 1 and 6 month (P = 0.661, 0.381, 0.526). Postoperatively,
the best corrected visual acuities of V-P group were > or = 0.5 in 18 eyes
(follow-up 29 eyes, 62.1%), 20 eyes (28 eyes, 71.4%), 24 eyes (30 eyes, 80.0%)
at 1 week, 1 month and 6 months, but no statistical difference with T-P group,
(P = 0.621, 0.702, 0.893). Complications of V-P group included: Descemet's
membrane puncture 2 eyes (6.7%), Schlemm's tube puncture 2 eyes (6.7%) and IOP
spikes 4 eyes (13.3% at 24 hours postoperatively). The V-P group showed a
significantly less inflammation, hyphema and choroidal detachment than that in
the T-P group. CONCLUSIONS: Phacoemulsification-IOL implantation combined with
viscocanalostomy is a safe and efficacious surgery with lower complications.
-----
J Glaucoma. 2004 Jun;13(3):228-32.
Comparison between Results of Trabeculectomy in
Primary Congenital Glaucoma with and without the Use of Mitomycin
C.
Rodrigues AM, Junior AP, Montezano FT, De Arruda Melo PA,
Junior JP.
Department of Ophthalmology, Division of Glaucoma, Universidade
Federal de Sao Paulo, Escola Paulista de Medicina, Sao Paulo SP,
Brazil.
PURPOSE:: To evaluate the results of trabeculectomy with and
without the use of mitomycin C in children with primary congenital
glaucoma. METHODS:: The authors retrospectively studied the data
of 91 patients who underwent the first trabeculectomy for primary
congenital glaucoma, with 19 years of follow-up. Success criteria
were set with two distinct values of intraocular pressure: lower
or equal to 15 mm Hg or lower than 21 mm Hg and separately analyzed.
RESULTS:: Among the studied patients, 61 had undergone trabeculectomy
without mitomycin C and 30 with mitomycin C. The comparison between
the groups of patients showed age homogeneity (P = 0.152) and
did not demonstrate any difference in preoperative (P = 0.234)
and postoperative (P = 0.907) intraocular pressure. Success rates
through time, for both pressure limits was not different between
the groups. Both age and the presence of previous trabeculotomy
did not influence the success of trabeculectomy through time,
for the two pressure limits considered. The complication rate
was higher among the patients who received mitomycin C (P = 0.010).
CONCLUSIONS:: The success of trabeculectomy for primary congenital
glaucoma with mitomycin C was not different than that of trabeculectomy
with mitomycin C in the studied patients. Mitomycin C was associated
with a higher incidence of complications.
-----
Arch Soc Esp Oftalmol. 2004 Apr;79(4):163-8.
[Efficiency of brimonidine 0.2% and dorzolamide
2% as adjunctive therapy to beta-blockers]
[Article in Spanish]
Carrasco Font C, Arias Puente A, Garcia Saenz MC, Villarejo Diaz-Maroto
I.
Hospital Fundacion Alcorcon Madrid.
PURPOSE: To evaluate the clinical efficiency and tolerability
of brimonidine and dorzolamide twice daily as an adjunctive therapy
for glaucoma patients with an inadequate response to beta-blockers
therapy. METHODS: This multicenter prospective analysis included
92 patients (180 eyes) with primary open-angle glaucoma or ocular
hypertension on therapy beta-blockers and with intraocular pressure
(IOP) greater than or equal to 18mmHg. The patients were randomly
treated either with brimonidine 0.2% or dorzolamide 2% added for
three months. Efficiency was determined by the reduction in 15%
IOP from baseline at the first and the third month. RESULTS: Mean
pre-treatment IOP was 22.37 DE 2.8 mmHg in the brimonidine group
and 22.38 DE 2.6 mmHg in the dorzolamide group; mean post-treatment
IOP decrease was 4.39 mmHg in the brimonidine group and 3.29 mmHg
in the dorzolamide group. Clinical control at the first month
was achieved in 78.3% and 71% of cases respectively (p=0.05).
No statistical differences existed between groups for systemic
adverse events. Four patients on brimonidine discontinued treatment
due to local side effects. In the dorzolamide group, two patients
left the treatment referring itching and three others left due
to ocular allergy. CONCLUSIONS: This study found similar efficiency
and safety when treating with brimonidine or dorzolamide as an
adjunctive therapy for patients with hypertension or primary open-angle
glaucoma (Arch Soc Esp Oftalmol 2004; 79: 163-168).
-----
J Ocul Pharmacol Ther. 2004 Apr;20(2):115-22.
Efficacy of bimatoprost 0.03 percent in untreated
glaucoma and ocular hypertension patients: results from a large
community-based clinical trial.
Quinones R, Severin T, Mundorf T.
Arbor Center For Eye Care, Homewood, IL 60430, USA.
PURPOSE: To evaluate the intraocular pressure- (IOP-) lowering
efficacy of bimatoprost 0.03% (Lumigan, Allergan, Inc.) monotherapy
in the treatment of patients with glaucoma or ocular hypertension
not currently using ocular hypotensives. METHODS: Open-label,
community-based, multicenter evaluation. Patients (n = 6767) who,
according to their physicians, required IOP lowering were prescribed
bimatoprost for 2 months. Subgroup analyses of the results, stratified
by treatment history and use of concomitant medications, were
performed. This report focuses on the subgroup of patients that
was not being treated with antiglaucoma medications at baseline
(n = 1946, 29%). All of these patients were placed on bimatoprost
monotherapy. RESULTS: The mean IOP at the untreated baseline was
23.8 mmHg. Bimatoprost provided a mean IOP reduction of 7.5 mmHg
(30%, p < 0.001) from baseline after 2 months of monotherapy.
Further, bimatoprost allowed patients to achieve low target pressures.
For example, 41.5% of patients achieved target IOPs of < or
=15 mmHg after 2 months of bimatoprost monotherapy, and 75.8%
of patients reached IOPs of < or =18 mmHg. The most commonly
reported adverse event was conjunctival hyperemia (7.9%). CONCLUSION:
Bimatoprost monotherapy was well tolerated and reduced IOP by
an average of 30% in a large population of untreated patients.
-----
Ophthalmologica. 2004 Mar-Apr;218(2):77-95.
Cyclodestructive procedures. I. Clinical and morphological
aspects: a review.
Fankhauser F, Kwasniewska S, Van Der Zypen E.
Lindenhofspital, University of Berne, Berne, Switzerland.
Laser cyclophotocoagulation is an accepted method of cyclodestruction,
such as cyclocryothermy and the application of cyclodiathermy,
microwaves and ultrasound. These procedures may be considered
as ultima ratios or 'last-resort interventions'. Also, in cases
where surgery is not possible, cyclodestruction may be the initial
intervention. Among other lasers, the Nd:YAG and diode lasers
are the energy sources of choice. Contact and noncontact methods
have about the same clinical efficiency and risk. While immediate
complications are transitory, other, late complications, mentioned
in the world literature, such as sympathetic ophthalmia, malignant
glaucoma and retinal detachment, are more serious but are rare,
and their causal relationship with the cyclodestructive procedure
is doubtful. However, they still merit our attention. The ultrastructural
mechanisms related to cyclocoagulation have been studied. The
study of aqueous flow may improve our understanding of cyclophotocoagulation
techniques. Cyclophotocoagulation is considered an important cornerstone
in glaucoma therapy. The uncertainty of its effect is no greater
than that of any other therapeutic measure in the treatment of
glaucoma. Copyright 2004 S. Karger AG, Basel
-----
Eye. 2004 Feb 27 [Epub ahead of print]
Short-term ocular tolerability of dorzolamide
2% and brinzolamide 1% vs placebo in primary open-angle glaucoma
and ocular hypertension subjects.
Stewart WC, Day DG, Stewart JA, Holmes KT, Jenkins JN.
[1] 1Pharmaceutical Research Network, LLC, Charleston, SC, USA
[2] 2Carolina Eye Institute at the University of South Carolina,
School of Medicine Columbia, SC, USA.
Purpose To compare ocular tolerability of dorzolamide 2%, brinzolamide
1%, and placebo given three times daily.Methods A prospective,
double-masked, three-centre, crossover comparison in which 25
ocular hypertensive or primary-open angle glaucoma subjects were
randomized to receive dorzolamide, brinzolamide, or placebo three
times daily for 3 days. Intraocular pressure, visual acuity, a
visual analogue scale, and ocular and systemic symptom queries
were completed at the end of each period.Results After chronic
dosing, there was a significant difference in ocular pain on the
visual analogue scale among the groups at the 10-s postinstillation
time point with dorzolamide having the highest level (22.5+/-28.9)
compared to brinzolamide (5.0+/-8.7) or placebo (3.2+/-10.4) (P=0.0006).
No differences between groups were observed preinstillation nor
following dosing at 3 or 10-min postinstillation. On the initial
instillation, the 10-s postinstillation pain was rated as 43.3+/-77.1,
which was significantly higher than after chronic dosing (P=0.017).
On the ocular symptom query, dorzolamide had the highest incidence
of burning/stinging and redness compared to the other groups,
but was generally characterized as mild. There were no significant
differences in the visual acuity at any time point.Conclusions
This study suggests that subjects treated with dorzolamide suffer
more ocular pain upon instillation compared to brinzolamide or
placebo. However, pain symptoms are fewer following chronic dosing
and are generally characterized as mild.Eye advance online publication,
27 February 2004; doi:10.1038/sj.eye.6701353
-----
Br J Ophthalmol. 2003 Dec;87(12):1492-6.
Intraocular pressure after replacement of current
dual therapy with latanoprost monotherapy in patients with open
angle glaucoma.
Pillunat LE, Larsson LI.
Department of Ophthalmology, Augenklinik der Techn, Universitat
Dresden, Germany. Department of Ophthalmology, Uppsala University
Hospital, Uppsala, Sweden.
AIMS: To evaluate the efficacy and safety of replacing current
dual ocular hypotensive therapy with latanoprost 0.005% monotherapy
in patients with open angle glaucoma. METHODS: This randomised,
open label, parallel group, multinational study included 466 patients
with open angle glaucoma currently on dual ocular hypotensive
therapy, including a beta adrenergic receptor antagonist. Patients
were assigned (1:3) to ongoing dual therapy or a switch to monotherapy
with latanoprost 0.005% once daily for 6 months. Intraocular pressure
(IOP) was measured at 10 am and 5 pm at baseline, month 3, and
month 6. Groups were compared for differences in diurnal IOP change,
IOP success rates (IOP </=22 mm Hg with </=15% increase
from baseline), and clinical success rates (not requiring change
in therapy). RESULTS: Baseline mean diurnal IOP was 17.8 (SD 2.0)
mm Hg in the latanoprost group and 17.6 (2.1) mm Hg in the dual
therapy group. After 6 months, mean diurnal IOP was reduced by
0.26 (0.18) (SEM 1.4%) mm Hg (p = 0.153) in the group switched
to latanoprost and by 0.37 (0.25) (2.1%) mm Hg (p = 0.138) in
those continuing dual therapy (difference: 0.11 mm Hg; p = 0.641).
Success rates defined by IOP criteria were 83% for latanoprost
and 89% for continued dual therapy (difference: 6%; p = 0.122).
Clinical success rates were 97% for latanoprost and 99% for dual
therapy (difference: 2%; p = 0.161). Ocular adverse events were
reported by 23% of patients in both treatment groups. CONCLUSION:
Latanoprost monotherapy is a safe and effective alternative for
many patients with open angle glaucoma requiring dual topical
ocular hypotensive therapy for IOP control.
-----
Ophthalmology. 2003 Dec;110(12):2362-8.
A 3-month randomized controlled trial of bimatoprost
(LUMIGAN) versus combined timolol and dorzolamide (Cosopt) in
patients with glaucoma or ocular hypertension.
Coleman AL, Lerner F, Bernstein P, Whitcup SM.
Jules Stein Eye Institute, UCLA, Los Angeles, California 90095,
USA.
PURPOSE: To compare the efficacy and safety of topical bimatoprost
(LUMIGAN; Allergan, Inc., Irvine, CA) once daily with that of
topical combined timolol and dorzolamide (Cosopt; Merck and Co,
Inc., Whitehouse Station, NJ) twice daily. DESIGN: Prospective,
randomized, double-masked, multicenter clinical trial. PARTICIPANTS:
One hundred seventy-seven patients with a diagnosis of glaucoma
or ocular hypertension and inadequate control of intraocular pressure
(IOP) after at least 2 weeks of topical timolol maleate 0.5% monotherapy.
METHODS: Patients were randomized to receive bimatoprost 0.03%
once daily (n = 90) or combined timolol 0.5% and dorzolamide 2%
twice daily (n = 87) over a 3-month period. MAIN OUTCOME MEASURES:
Intraocular pressure, the primary end point, was measured at 8
AM and 10 AM at baseline, week 1, and months 1, 2, and 3, and
also at 4 PM and 8 PM at baseline and month 3. RESULTS: Bimatoprost
provided significantly greater IOP lowering compared with combined
timolol and dorzolamide. At the 8 AM measurements, bimatoprost
lowered mean IOP 6.8 mmHg to 7.6 mmHg from baseline, whereas combined
timolol and dorzolamide lowered mean IOP 4.4 to 5.0 mmHg from
baseline (P<0.001). At the last follow-up, patients had better
diurnal IOP control with bimatoprost than combined timolol and
dorzolamide. At 8 AM at the 3-month visit, the percentages of
patients achieving IOPs of <or =13 mmHg, < or =14 mmHg,
< or =15 mmHg, or < or =16 mmHg were more than twice as
high for bimatoprost than for combined timolol and dorzolamide
(all P< or =0.008). Taste perversion, ocular burning, and stinging
with instillation were more common with combined timolol and dorzolamide,
whereas conjunctival hyperemia was more common with bimatoprost.
CONCLUSIONS: In individuals with glaucoma or ocular hypertension,
uncontrolled on a topical beta-blocker alone, bimatoprost lowered
IOP more consistently than did combined timolol and dorzolamide.
-----
Am J Ophthalmol. 2003 Dec;136(6):1001-8.
Evaluation of the hypertensive phase after insertion
of the Ahmed Glaucoma Valve.
Nouri-Mahdavi K, Caprioli J.
Glaucoma Division, Jules Stein Eye Institute, University of California
Los Angeles, Los Angeles, California 90095, USA.
PURPOSE: To investigate the postoperative hypertensive phase
(HP) in patients undergoing glaucoma drainage implant surgery.
DESIGN: Interventional case series. METHODS: A retrospective chart
review of 156 consecutive eyes (139 patients) who underwent placement
of an Ahmed Glaucoma Valve (AGV) with a follow-up of >or=3
months was performed. Main outcome measures were occurrence and
resolution of the HP and intraocular pressure (IOP) control. The
HP was defined as IOP > 21 mm Hg during the first 3 months
after surgery. Resolution of the HP was defined as an IOP <
22 mm Hg and an IOP reduction of 3 mm Hg with the same or fewer
number of glaucoma medications. RESULTS: An HP was observed in
88 eyes (56%). It occurred after a mean of 5.0 weeks (median,
4 weeks; range, 1-13 weeks) with an average (+/- standard deviation)
peak IOP of 30.1 (+/- 7.5) mm Hg. Resolution of the HP occurred
in 19 of 68 eyes (28%) with available data. Eyes with an HP had
a higher mean IOP and needed more medications 6 to 12 months after
surgery than eyes without an HP (17.2 +/- 5.6 vs 14.3 +/- 5.8
mm Hg; P =.012 and 1.7 +/- 1.2 vs 0.3 +/- 0.6 medications; P <.001,
respectively). CONCLUSION: A hypertensive phase occurs frequently
after implantation of the AGV. However, it resolves in only a
minority of eyes. The majority of eyes with an HP have no significant
improvement of IOP control and continue to require the same number
of glaucoma medications as they did during the HP.
-----
J Glaucoma. 2003 Dec;12(6):466-9.
Rate of response to latanoprost or timolol in
patients with ocular hypertension or glaucoma.
Camras CB, Hedman K; US Latanoprost Study Group.
Department of Ophthalmology, University of Nebraska medical Center,
Omaha, Nebraska 68198-5540, USA. cbcamras@unmc.edu
PURPOSE: This study determined the rate of response to latanoprost
compared with timolol in patients with glaucoma or ocular hypertension,
whether some patients convert from non-responders to responders
after more prolonged therapy, and whether this conversion represents
a delayed response or random fluctuation. METHODS: In a previously
described, multicenter, randomized, double-masked, parallel group
study, patients received either 0.005% latanoprost once daily
(n = 128) or 0.5% timolol twice daily (n = 140) for 6 months.
Intraocular pressure (IOP) was assessed at baseline and at 0.5,
1.5, 3, 4.5, and 6 months of treatment at 8 am on all visits,
and also at noon and 4 pm at baseline and 6 months. Rate of response
based on diurnal measurement at 6 months compared with baseline
was assessed using several criteria for response. Eyes with an
IOP reduction of less than 15% compared with baseline at 8 am
arbitrarily were classified as non-responders at each of the 5
visits during treatment. Consistency of non-responder classifications
for individual eyes was assessed. RESULTS: Mean IOP reduction
was greater (P < 0.001) in latanoprost-versus timolol-treated
patients throughout the course of therapy. A greater rate of response
occurred in patients treated with latanoprost, and differences
in response rates between the 2 drugs increased as the definitions
of response became more stringent. A greater percentage of non-responders
at any single visit were classified as responders at all other
visits with latanoprost in comparison with timolol. CONCLUSIONS:
Latanoprost produces a greater rate of response compared with
timolol. A higher percentage of non-responders to latanoprost
compared with timolol on any individual visit are responders on
all other visits. Likewise, a higher proportion of patients who
do not initially respond will become responders with continued
treatment with latanoprost compared with timolol.
-----
Prescrire Int. 2003 Oct;12(67):173-4.
Timolol + latanoprost: new preparation. Last-resort
eye drops.
[No authors listed]
(1) First-line drug treatment of chronic open-angle glaucoma
or intraocular hypertonia is based on monotherapy with timolol
eye drops. Patients in whom several single-agent treatments have
failed can use combinations of timolol + dorzolamide (a carbonic
anhydrase inhibitor) or a betablocker + pilocarpine (a parasympathomimetic
agent). (2) An eye-drop preparation is now available in which
0.5% timolol is combined with 0.005% latanoprost, a prostaglandin
F2alpha analogue. (3) A clinical trial indicated that the timolol
+ latanoprost combination was more effective than the timolol
+ dorzolamide combination on intraocular pressure, but the report
of this study is too scanty to accept these results at face value.
Once-a-day dosing with timolol + latanoprost has not been compared
with a betablocker + pilocarpine combination. (4) Patients using
the timolol + latanoprost combination are exposed to the adverse
effects of both latanoprost (especially ocular irritation and
brown iris discoloration) and the betablocker. (5) It is not known
whether the once-a-day dosing of the timolol + latanoprost combination
is a significant advantage, especially in terms of adherence to
treatment. (6) In practice, the arrival of the timolol + latanoprost
combination changes virtually nothing for patients with chronic
open-angle glaucoma, except for those with no other alternative.
-----
Bull Soc Belge Ophtalmol. 2003;(289):81-6.
The long-term effect of diode laser cyclodestruction
on intraocular pressure.
Callens C, D'Hondt K, Zeyen T.
Dpt. of Ophthalmology, A.Z. Middelheim, Antwerp.
We retrospectively reviewed the first 24 patients (26 eyes)
who underwent ab externo diode laser cyclodestruction for refractory
glaucoma and who had a follow-up of at least 10 months. We compared
the intraocular pressure (IOP) and the number of antiglaucomatous
medications used pre- and postoperatively. The mean follow-up
period was 28 months (range 10 to 50 months). The mean IOP before
and after treatment was respectively 30 +/- 12 mmHg and 22 +/-
12 mmHg (p < 0.05), a mean reduction of 29%. The average number
of treatment sessions was 1.5 (range 1 to 5). An IOP < or =
21 mmHg was obtained in 65% of the cases; an IOP < or = 17
mmHg was achieved in 46% of the cases. The mean number of anti-glaucomatous
medications used pre- and postoperatively was respectively 2.3
and 1.7 (p < 0.05). Only mild postoperative uveitis was observed;
no eye developed phthisis bulbi. The study suggests that diode
laser cyclodestruction is a safe procedure that can reduce the
IOP in the long term in patients with refractory glaucoma.
-----
J Fr Ophtalmol. 2003 Oct;26 Spec No 2:S56-61.
[The refractory glaucomas]
[Article in French]
Valtot F.
Institut du Glaucome, Fondation Hopital Saint-Joseph, 185, rue
Raymond-Losserand, 75674 Paris Cedex 14, France.
Refractory types of glaucoma continue to present a therapeutic
challenge to ophthalmologists. Approaches toward the management
of these difficult glaucomas are addressed in this paper. The
first part devotes special attention to understand the cause(s)
of the failure of previous filtering surgery(ies). The next part
emphasizes filtration surgery with intraoperative application
of antimetabolites: 5-fluorouracil or mitomycin C and the surgical
and pharmacological management of failing filtration. In case
of failure of multiple filtering surgery with application of antimetabolites,
surgeons have to consider cyclodestructive procedures (transscleral
diode laser or endoscopic cyclophotocoagulation) to reduce aqueous
production, or fistulizing procedures with tube implants or other
drainage devices (valves).
-----
J Fr Ophtalmol. 2003 Oct;26 Spec No 2:S53-5.
[How to conduct glaucoma therapy when pressure
stays high despite topical treatment?]
[Article in French]
Nordmann JP.
Centre du glaucome, Hopital des Quinze-Vingts, 28, rue de Charenton,
75012 Paris, France.
When glaucoma worsens with elevated ocular pressure despite
an initial treatment, an additional reduction of pressure is needed.
It is necessary to evaluate the cause of the therapeutic failure
which could be the consequence of a low compliance from the patient,
a poor efficacy of the topical drug or a short or long term drift
of this efficacy. Depending on the aetiology, another monotherapy
or a combination of treatments should be initiated. The evaluation
of the target pressure and the comparison between this pressure
and the current pressure of the eye allows to evaluate the likeliness
of reaching the target through medical treatment alone or through
surgical approach. When medical treatment is possible, it is usual
to combine two drugs, one acting on the aqueous humor inflow and
the other one on the uveoscleral outflow pathway. If target pressure
is lower than what can be expected to be reached with topical
treatment, surgery should be proposed to the patient. Laser Argon
trabeculoplasty keeps still some indications, like pigmentary
or exfoliative glaucoma. Long term stability of the visual field
in glaucoma depends more on the reduction of pressure and on its
stability than on the choice of medical or surgical approach.
-----
Ophthalmology. 2003 Oct;110(10):1909-15.
Outcome of surgery on infants younger than 1 month
with congenital glaucoma.
Mandal AK, Gothwal VK, Bagga H, Nutheti R, Mansoori T.
Jasti V. Ramanamma Children's Eye Care Centre, L. V. Prasad Eye
Institute, L.V Prasad Marg, Banjara Hills, Hyderabad 500-034,
India. mandal@lvpeye.stph.net
PURPOSE: To determine the visual outcomes and surgical and
anesthetic complication rates of patients with newborn glaucoma
operated within 1 month of age. DESIGN: Retrospective, consecutive,
noncomparative case series. PARTICIPANTS: All children with newborn
glaucoma who underwent surgery between January 1990 and December
2000 were included. METHODS: The medical records of 25 consecutive
patients (47 eyes) who underwent primary combined trabeculotomy
and trabeculectomy either bilaterally in a single session or unilaterally
were reviewed retrospectively. Outcomes were evaluated using Kaplan-Meier
survival analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment
included corneal clarity, intraocular pressure (IOP), bleb characteristics,
visual acuity, refractive errors, and identification of surgical
and anesthetic complications. RESULTS: The mean follow-up was
3.1+/-1.8 years (range, 9.5 months-7.4 years). The mean preoperative
IOP was 26.9+/-5.2 mmHg (range, 14-42 mmHg). At the final follow-up
visit, the mean IOP was 14.5+/-3.8 mmHg (range, 8-28 mmHg). The
percentage reduction in IOP was 43.3+/-21.5 (P<0.0001). Twelve-,
24-, and 36-month survival rates for complete success for IOP
control were 89.4%, 83.6%, and 71.7%, respectively, which were
maintained for 7 years of follow-up. After surgery, complete clearance
of corneal edema was achieved in 66% of the eyes. Data on visual
acuity was available for 19 patients. Final best spectacle-corrected
visual acuity was 20/40 or better in the better eye in 5 patients
(26.3%), 7 patients (36.8%) obtained 20/60 or better in the better
eye, 8 patients (42.1%) achieved final visual acuity of less than
20/60 to 20/200 in the better eye (low vision), and four patients
obtained less than 20/400 visual acuity in the better eye (blind)
according to World Health Organization criteria. However, there
was no eye with absent perception of light in the better eye.
Myopia (mean spherical equivalent, 4.6+/-3.2 diopters) was the
most common refractive error, present in approximately half of
the eyes (n = 23; 53.8%). There were no significant intraoperative
or postoperative complications in any patient. Anesthesia-related
complications developed in 2 patients; however, they were resuscitated
successfully. CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy
offers a viable surgical option in infants that have cloudy corneas
at birth as a result of congenital glaucoma. It is associated
with a favorable visual outcome and a low rate of anesthetic complications
in an Indian population.
-----
Ophthalmology. 2003 Oct;110(10):1869-78; quiz 1878-9, 1930.
Interventions for angle-closure glaucoma: an evidence-based
update.
Saw SM, Gazzard G, Friedman DS.
Department of Community, Occupational and Family Medicine, National
University of Singapore, 16 Medical Drive, Singapore 117597, Republic
of Singapore. cofsawsm@nus.edu.sg
PURPOSE: To assess the interventions to treat acute angle closure
(AAC) and primary angle closure (PAC) with or without glaucomatous
optic neuropathy. CLINICAL RELEVANCE: Primary angle closure is
one of the leading causes of blindness in East Asia. At present,
there are few clinical guidelines on the optimal treatment of
AAC or PAC in the affected or contralateral eye. METHODS: All
randomized clinical trials, prospective controlled clinical trials,
nonprospective controlled clinical trials, and retrospective case
series with >50 cases that evaluated treatments for AAC or
PAC were included. Studies published in the English language were
identified from MEDLINE, PubMed, EMBASE, and the Cochrane Collaborations,
as well as by a hand search of the reference lists of important
articles. RESULTS: Nine randomized clinical trials and 24 nonrandomized
clinical trials and large case series were evaluated. Laser peripheral
iridotomy (LPI) has been found to be as effective as surgical
peripheral iridectomy in randomized clinical trials of the affected
and contralateral eyes of AAC or PAC patients with or without
evidence of glaucoma. In another randomized clinical trial, latanoprost
was found to decrease intraocular pressure (IOP) more than timolol
for PAC in patients for whom LPI alone failed. CONCLUSIONS: This
review suggests that LPI should be recommended for the treatment
of affected and contralateral eyes of AAC patients. In patients
with PAC and insufficient treatment with LPI, latanoprost eye
drops may decrease IOP more than timolol. There is still insufficient
evidence about other interventions for the treatment of AAC and
PAC.
-----
Acta Ophthalmol Scand. 2003 Oct;81(5):474-9.
Evaluation of retinal haemodynamics and retinal
function after application of dorzolamide, timolol and latanoprost
in newly diagnosed open-angle glaucoma patients.
Arend O, Harris A, Wolter P, Remky A.
Department of Ophthalmology, Medical School, Technical University
Aachen, Pauwelsstrasse 30, Aachen 52057, Germany. oliver.arend@web.de
PURPOSE: The purpose of this prospective, randomized, cross-over
study was to investigate and compare the microcirculatory effects
of timolol, dorzolamide and latanoprost in newly diagnosed primary
open-angle glaucoma (POAG) patients. Haemodynamics were assessed
using fluorescein angiography by means of a scanning laser ophthalmoscope
(SLO). Visual function and visual field indices were evaluated
during all drug treatment phases. METHODS: Fourteen patients with
newly diagnosed POAG (age 55 +/- 7 years; 10 male, four female)
were recruited for the study. At baseline examination, blood pressure,
heart rate, intraocular pressure (IOP), SLO angiograms, and contrast
sensitivity (CS) were analysed. Patients then randomly received
timolol, dorzolamide or latanoprost treatment for 4 weeks. Patients
then returned and all procedures were repeated and assessed. Arteriovenous
passage times (AVPs), peripapillary arterial and venous diameters
were assessed from SLO angiograms, using digital image processing.
Calculated ocular perfusion pressure was determined for each treatment
phase. RESULTS: Intraocular pressure was significantly lowered
by each drug compared to baseline (p < 0.0001). Arteriovenous
passage times were significantly shortened after dorzolamide application
compared to baseline (p = 0.009), whereas neither timolol nor
latanoprost treatment resulted in significant AVP changes. Peripapillary
arterial and venous diameters, systolic and diastolic blood pressure,
heart rate and ocular perfusion pressures were not significantly
altered during any treatment phase. Contrast sensitivity testing
at 6 cycles/degree (c.p.d.) revealed a significant rise after
dorzolamide compared to timolol (p = 0.007). CONCLUSION: Our results
suggest that dorzolamide treatment significantly shortened AVP
times in newly diagnosed open-angle glaucoma patients, whereas
timolol and latanoprost had no significant effect. Given that
prolonged AVP times have been associated with disease progression
in glaucoma; dorzolamide treatment may benefit optic nervehead
preservation by increasing ocular perfusion.
-----
Br J Ophthalmol. 2003 Oct;87(10):1252-7.
A two centre study of the dose-response relation
for transscleral diode laser cyclophotocoagulation in refractory
glaucoma.
Murphy CC, Burnett CA, Spry PG, Broadway DC, Diamond JP.
Division of Ophthalmology, University of Bristol, Bristol, UK.
BACKGROUND/AIMS: Transscleral diode laser cyclophotocoagulation
("cyclodiode") is widely used to treat refractory glaucoma.
The main aims of this study were to investigate the dose-response
relation of cyclodiode and to evaluate possible predictive factors
that would help establish optimum treatment parameters. METHODS:
A retrospective analysis of the case notes of 263 eyes of 238
consecutive patients who underwent transscleral diode laser cyclophotocoagulation
at two centres was undertaken. RESULTS: Mean intraocular pressure
(IOP) decreased significantly from 40.7 mm Hg (SD 13.7) before
cyclodiode therapy to 17.7 mm Hg (SD 10.9) post-treatment, a reduction
of 52.6% (p = 0.0001). Following cyclodiode, 89% of patients achieved
an IOP of less than 22 mm Hg or a greater than 30% drop in IOP.
Hypotony occurred in 9.5% of patients, 76% of whom had neovascular
glaucoma. A linear dose relation response was found for the 122
eyes with neovascular glaucoma (p = 0.001) but not for the group
as a whole. Treatment failure was associated with male sex (multivariate
regression analysis, p = 0.008) and low mean energy per treatment
session (univariate analysis alone, p = 0.016). High pretreatment
IOP (p = 0.031) and high mean energy per treatment episode (p
= 0.001) appeared to be associated with the occurrence of hypotony,
although multivariate analysis did not support this finding. CONCLUSION:
Cyclodiode therapy is highly effective but there is a significant
risk of hypotony, which may be reduced by applying lower energy
in cases of very high pretreatment IOP and in neovascular glaucoma.
The dose-response association remains unpredictable, although
a linear relation was found for neovascular glaucoma.
-----
J Fr Ophtalmol. 2003 Sep;26(7):668-74.
[Efficacy and safety of substituting a twice-daily
regimen of timolol with a single daily instillation of nonpreserved
beta-blocker in patients with chronic glaucoma or ocular hypertension]
[Article in French]
Bron A, Chiambaretta F, Pouliquen P, Rigal D, Rouland JF.
Service d'Ophtalmologie, CHU de Dijon, Hopital General, 3, rue
du Faubourg Raines, BP 1519, 21033 Dijon Cedex. Alain.bron@CHU-Dijon.fr
AIM: To evaluate the efficacy and safety of a single daily
instillation of nonpreserved timolol in patients with chronic
glaucoma or ocular hypertension previously treated with a twice-daily
regimen of timolol 0.25% or 0.50%. PATIENTS AND METHODS: A prospective
open clinical trial was undertaken by 220 ophthalmologists in
435 patients with chronic glaucoma or ocular hypertension controlled
with twice-daily instillations of timolol 0.25% or 0.50%. In this
population, the previous regimen was substituted with a single
daily instillation of preservative-free timolol 0.25% or 0.50%
for 3 months. The changes in intraocular pressure (IOP) were recorded
as well as local and systemic tolerance and patient compliance.
RESULTS: It was found that 398 patients (93.6%) maintained stable
IOP: in 92%, IOP increased no more than 2 mmHg. The mean IOP was
17.0 +/- 2.2 mmHg at D0, 16.5 +/- 2.4 mmHg at D28/42 and 16.6
+/- 2.4 mmHg at D84. The proportion of patients with at least
one ocular symptom upon instillation or at another time decreased
(p<0.0001 and p=0.03, respectively). The proportion of conjunctival
hyperemia reduced from 24.4% to 14.6% (p=0.0002). The rate of
folliculopapillar reactions and superficial punctate keratitis
was halved (p=0.005 and p=0.02, respectively). CONCLUSION: During
this study in daily practice, the switch from a twice-daily regimen
of timolol to a once-daily application maintained stable intraocular
pressure with a notable improvement in tolerance.
-----
Ophthalmology. 2003 Sep;110(9):1822-6.
Trabeculectomy with beta radiation: long-term
follow-up.
Lai JS, Poon AS, Tham CC, Lam DS.
Department of Ophthalmology, United Christian Hospital, Kowloon,
Hong Kong.
PURPOSE: To evaluate the long-term outcome and complications
of trabeculectomy with beta radiation. DESIGN: Retrospective noncomparative
case series. PARTICIPANTS: Forty-three patients with confirmed
primary open-angle glaucoma (POAG), who received trabeculectomy
with adjunctive beta radiation at the Prince of Wales Hospital
between June 1991 and November 1994. METHODS: Patients fulfilling
the preceding criteria were followed up longitudinally. The visual
acuity, intraocular pressure (IOP), bleb morphology, and complications
were evaluated. MAIN OUTCOME MEASURES: Visual acuity, IOP, bleb
morphology, complications. RESULTS: Forty-three eyes of 43 consecutive
Chinese patients were recruited and successfully followed up for
a minimum of 7 years. The mean age +/- 1 standard deviation (SD)
was 60.9 +/- 13.0 years. There were 29 males and 14 females. The
mean baseline IOP +/- 1 SD was 28.3 +/- 5.8 mmHg. The mean postoperative
IOP +/- 1 SD after the initial trabeculectomy was 11.9 +/- 4.3
mmHg, and the mean number of preoperative IOP-lowering eyedrops
+/- 1 SD was reduced from 2.8 +/- 0.5 to 0.7 +/- 1.0 at 7 years
follow-up. The qualified success rate at 7 years follow-up, defined
as IOP <or=21 mmHg with and without medication(s), was 88.4%.
The complete success rate at 7 years defined as IOP <or=21
mmHg without medication was 60.7%. Two eyes developed blebitis,
and one of them progressed to corneal decompensation after the
infection. One eye had hypotony, and one eye had a traumatic ruptured
bleb. Twelve eyes (27.9%) developed significant cataract. No corneal
ulceration or scleral necrosis was encountered. CONCLUSIONS: From
this noncomparative study, trabeculectomy with a single dose of
1000 rad beta radiation used as an adjunctive measure for POAG
in Chinese eyes had achieved a qualified success rate of 88.4%
at 7 years.
-----
Ophthalmology. 2003 Sep;110(9):1814-21.
The Ahmed shunt versus the Baerveldt shunt for
refractory glaucoma: a single-surgeon comparison of outcome.
Tsai JC, Johnson CC, Dietrich MS.
Department of Ophthalmology, Columbia University College of Physicians
and Surgeons, New York, New York 10032, USA. jct2002@columbia.edu
PURPOSE: To compare the surgical outcome of Baerveldt and Ahmed
shunt implants in the treatment of refractory glaucoma. DESIGN:
Retrospective, nonrandomized, comparative trial. METHODS AND PARTICIPANTS:
Medical records of 118 consecutive patients who underwent glaucoma
shunt implantation (70 Baerveldt, 48 Ahmed) by a single surgeon
were reviewed. MAIN OUTCOME MEASURES: The primary outcome measure
was surgical success (6 mmHg <or= intraocular pressure [IOP]
<or= 21 mmHg without additional glaucoma surgery or devastating
complication) at 12 months after surgery. Secondary outcome measures
included mean IOP and number of medications used at the following
postoperative visits: day 1, 1 week, 1 month, 3 months, 6 months,
and every 6 months thereafter. Additional outcome measures evaluated
include visual acuities, prevalence and timing of postoperative
choroidal detachment, and clinical bleb encapsulation. RESULTS:
Survival curve analysis showed success rates of 82.9% of the Ahmed
group and 72.9% of the Baerveldt group at 12 months after surgery
(P = 0.257). Patients in the Ahmed group exhibited lower IOPs
at 1 day (P < 0.001) and 1 week (P < 0.001) after surgery
and were taking fewer glaucoma medications at 1 week (P < 0.001)
and 1 month (P < 0.001) after surgery. A higher proportion
of Ahmed patients experienced clinical bleb encapsulation than
did the Baerveldt patients (60.4% vs. 27.1%; P < 0.001). Moreover,
the first observation of postoperative bleb encapsulation was
sooner after surgery for the Ahmed patients (50.0 +/- 43.8 days)
than for the Baerveldt patients (69.8 +/- 22.6 days; P = 0.001).
CONCLUSIONS: The Ahmed shunt implant exhibited better control
of IOP in the early postoperative period (1 day and 1 week) with
patients requiring fewer glaucoma medications at 1 week and 1
month after surgery. There was both a higher prevalence and earlier
onset of bleb encapsulation observed with the Ahmed shunt implant.
-----
Am J Ophthalmol. 2003 Sep;136(3):464-70.
Long-term follow-up of primary glaucoma surgery
with Ahmed glaucoma valve implant versus trabeculectomy.
Wilson MR, Mendis U, Paliwal A, Haynatzka V.
Creighton University School of Medicine, Omaha, Nebraska, Omaha
68178, USA. mrw@creighton.edu
PURPOSE: To compare the long-term results of trabeculectomy
and Ahmed glaucoma valve implant in the initial surgical management
of primary open- and closed-angle glaucoma. DESIGN: Randomized
controlled clinical trial. METHODS: One eye each of consecutive
patients with primary glaucoma and without prior intraocular surgery
was randomized to receive either trabeculectomy or the Ahmed implant.Large
university-affiliated eye hospital in Columbo, Sri Lanka. RESULTS:
Of 123 patients, 64 were randomized to trabeculectomy and 59 to
the Ahmed implant. With a mean follow-up of 31 months, the trabeculectomy
group had statistically lower intraocular pressures (IOP) during
the first postoperative year. After the first year, the IOPs were
comparable. No statistically significant differences between groups
were noted for postoperative visual acuity, visual field, anterior
chamber depth, and short-term or long-term complications. Adjunctive
medication requirement was comparable for both groups. The cumulative
probabilities of success (IOP <21 mm Hg and at least 15% reduction
in IOP from preoperative levels) at the final follow-up period
(months, 41-52) were 68.1% for trabeculectomy and 69.8% for Ahmed
implant (P =.86). CONCLUSIONS: Lower IOPs were noted for the trabeculectomy
group during the first year. With longer follow-up, the IOPs and
the cumulative probabilities of success were comparable between
the two groups.
-----
Br J Ophthalmol. 2003 Sep;87(9):1094-102.
Retinectomy for treatment of intractable glaucoma:
long term results.
Joussen AM, Walter P, Jonescu-Cuypers CP, Koizumi K, Poulaki
V, Bartz-Schmidt KU, Krieglstein GK, Kirchhof B.
Department of Vitreoretinal Surgery, Center of Ophthalmology,
University of Cologne, Germany.
AIM: To report long term efficacy and complications of retinectomy
as an intraocular pressure lowering procedure for intractable
glaucoma. METHODS: This was a consecutive interventional case
series. In 44 consecutive eyes (39 patients, 22 men and 17 women)
retinectomy was performed to lower the intraocular pressure (IOP)
in patients with uncontrolled IOP (>35 mm Hg for more than
4 months) despite conventional filtering surgery and drug treatment.
Pars plana vitrectomy was performed and the peripheral retina
was surgically excised to various degrees. The procedure was concluded
by an intraocular gas tamponade of 20% C(3)F(8). Included were
patients with neovascular glaucoma (12 eyes), infantile and juvenile
glaucoma (three eyes), secondary glaucoma due to aphakia (13 eyes),
severe ocular trauma (seven eyes), uveitis (seven eyes), and glaucoma
in Ehlers-Danlos syndrome (two). RESULTS: All patients underwent
successful surgical retinectomy. All patients were followed for
5 years. Mean postoperative IOP after 4 years was 15.7 (SD 9.4)
mm Hg, representing a decrease of IOP by 61% compared to the preoperative
level (41.2 (9.4) mm Hg). In 52.3% of eyes long term regulation
of IOP could be achieved without complications. Retinectomy was
least effective in neovascular glaucoma because of central retinal
vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis
showed a tendency towards low IOP levels with subsequent phthisis
bulbi. The initial visual acuity of all patients was lower than
20/50 (mean 1.8 (0.8) logMAR) in the treated eye. Final visual
acuity was 2.3 (0.6) logMAR. 21 out of 44 cases developed retinal
complications (retinal detachment or proliferative vitreoretinopathy
(PVR)) after surgery, requiring silicone tamponade in 11 eyes
(52%) either for persistent low IOP or for PVR. Nine eyes developed
phthisis, seven of which were enucleated during the follow up.
CONCLUSIONS: Long term results after retinectomy demonstrate its
efficacy in otherwise intractable glaucoma. Efficacy and safety
of retinectomy are dependent on the underlying disease.
-----
Acta Ophthalmol Scand. 2003 Aug;81(4):349-54.
Timolol 0.5%/dorzolamide 2% fixed combination
versus timolol 0.5%/pilocarpine 2% fixed combination in primary
open-angle glaucoma or ocular hypertensive patients.
Kaluzny JJ, Szaflik J, Czechowicz-Janicka K, Kaluzny J,
Orzalkiewicz A, Zaleska A, Krajewska M, Stewart JA, Leech JN,
Stewart WC.
Klinika Okulistyki, Bydgoszcz, Poland.
PURPOSE: To establish the efficacy and safety of timolol maleate/dorzolamide
fixed combination (TDFC) versus timolol maleate/pilocarpine fixed
combination (TPFC), each given twice daily, in primary open-angle
glaucoma or ocular hypertensive patients. METHODS: In this prospective,
multicentred, double-masked trial, 37 patients were treated twice
daily with timolol for 4 weeks. They were then randomized to one
of the treatment medications for 6 weeks, after which they were
treated with timolol again for 2 weeks before being placed on
the opposite treatment medication for 6 weeks. RESULTS: A total
of 36 patients completed the trial. Their mean baseline intraocular
pressure (IOP) was 22.3 +/- 3.7 mmHg. Following 6 weeks of treatment,
the mean trough (08.00 hours) IOP was 18.0 +/- 2.2 mmHg for TDFC
and 17.4 +/- 2.0 mmHg for TPFC (p = 0.22). The mean diurnal curve
IOP was 18.1 +/- 2.2 mmHg for TDFC and 16.7 +/- 1.9 mmHg for TPFC
(p = 0.0007). At the remaining time-points (10.00, 18.00 and 20.00
hours), TPFC IOPs were statistically lower than TDFC IOPs (p <
0.03). There were statistically more unsolicited reports of vision
change and ocular pain associated with TPFC (p = 0.04). Six patients
were discontinued early from TPFC therapy (17%) versus two from
TDFC (6%) (p = 0.13). CONCLUSIONS: This study suggests that TPFC
can provide at least a similar efficacious reduction in IOP as
TDFC in patients with primary open-angle glaucoma or ocular hypertension.
-----
Acta Ophthalmol Scand. 2003 Aug;81(4):343-8.
Viscocanalostomy and deep sclerectomy for the
surgical treatment of glaucoma: a longterm follow-up.
Wishart PK, Wishart MS, Porooshani H.
Royal Liverpool University Hospital, Prescot Street, Liverpool
L7 8XP, UK. Vicki.Griffiths@rlbuh-tr.mwest.nhs.uk
PURPOSE: To study the outcome of viscocanalostomy (VC) and
deep sclerectomy (DS) for the surgical management of medically
uncontrolled glaucoma. PATIENTS AND METHODS: A non-randomized,
prospective study of all consecutive non-penetrating glaucoma
filtering procedures was carried out in two centres. In the first
centre, one surgeon (MSW) performed VC in 105 eyes (27 VC and
78 phaco VC). In the second centre, one surgeon (PKW) performed
DS in 87 eyes (52 DS and 35 phaco DS). RESULTS: The mean follow-up
was 36 months (range 9-60 months). At final follow-up the complete
success rate (intraocular pressure < or = 21 Hg without medication)
was 92.6% for VC eyes, 96% for phaco VC eyes, 77% for DS eyes
and 94% for phaco DS eyes. Kaplan-Meier survival analysis for
complete success showed no significant difference between DS and
VC nor between phaco VC and phaco DS (p > 0.05). By 36 months
postoperatively, mean IOP was 16.8 mmHg (SD 3) in VC eyes, 16.6
mmHg (SD 3.1) in phaco VC eyes, 16.7 mmHg (SD 5.7) in DS eyes
and 15 mmHg (SD 3.2) in phaco DS eyes. Postoperative Nd:YAG laser
goniopuncture was necessary in 10 eyes in the DS group. Large
or cystic drainage blebs occurred only in the DS eyes. CONCLUSIONS:
Viscocanalostomy and DS are effective and safe methods of achieving
sustained IOP reduction in glaucomatous eyes and both techniques
can be successfully combined with cataract extraction.
-----
J Glaucoma. 2003 Aug;12(4):360-4.
Diode laser transscleral cyclophotocoagulation
in the treatment of chronic angle-closure glaucoma: a preliminary
study.
Lai JS, Tham CC, Chan JC, Lam DS.
Department of Ophthalmology, United Christian Hospital, Kowloon,
Hong Kong. laism@ha.org.hk
PURPOSE: To evaluate the efficacy and safety of diode laser
transscleral cyclophotocoagulation in the treatment of chronic
angle-closure glaucoma. PATIENTS AND METHODS: A prospective, non-comparative
interventional pilot study was conducted. Fourteen eyes of 14
Chinese patients with chronic angle-closure glaucoma whose intraocular
pressures were greater than 21 mm Hg on medications were treated
with diode laser transscleral cyclophotocoagulation using the
G-probe at the United Christian Hospital between February 2000
and May 2001. The inferior 270 degrees quadrant (from 2 to 11
o'clock for right eye and from 1 to 10 o'clock for left eye) was
treated and the patients were followed up regularly. The initial
laser energy was set at 2,000 mWatt with a duration of 2 seconds.
The post-treatment anti-glaucoma medications were adjusted according
to the intraocular pressure. If medications failed to lower the
intraocular pressure to below 21 mm Hg, cyclophotocoagulation
to the same inferior 270 degrees quadrant was repeated. RESULTS:
All patients completed a 12-month follow-up period. The total
success rate defined as IOP < 21 mm Hg with or without medication(s)
was 85.7% at 1 year of follow-up review. The mean +/- SD intraocular
pressure decreased from pre-treatment level of 36.9 +/- 11.7 mm
Hg to 18.9 +/- 6.5 mm Hg at 1 year after treatment. The difference
was statistically significant (P < 0.001) (Paired t test).
The mean +/- SD number of IOP-lowering eyedrops was significantly
reduced from 1.9 +/- 0.7 before cyclophotocoagulation to 0.4 +/-
0.8 at 1 year after treatment (P = 0.0002) (Paired t test). Two
eyes required repeat treatment. Seven eyes (50%) had atonic pupil
following the laser treatment. CONCLUSION: Diode laser transscleral
cyclophotocoagulation is effective in lowering the intraocular
pressure in chronic angle-closure glaucoma and its effect lasts
for at least 1 year.
-----
Zhonghua Yan Ke Za Zhi. 2003 Aug;39(8):466-70.
[Treatment of open angle glaucoma with deep sclerectomy
combined with laser trabecular puncture]
[Article in Chinese]
Yin JF, Tong FF, Wu LL, Wu RY.
Department of Ophthalmology, Affiliated Second Hospital, Medical
College of Zhejiang University, Hangzhou 310009, China. xlren@zju.edu.cn
OBJECTIVE: To study the effect of deep sclerectomy combined
with laser trabecular puncture for the treatment of open angle
glaucoma (OAG). METHODS: Deep sclerectomy was performed in 32
eyes of 32 patients with moderate to advanced stages of OAG. After
the exposure of external wall of Schlemm's canal and the remaining
trabecula, the intraocular optic fiber of diode laser photocoagulator
was directed to the trabecula-limbus near the anterior edge of
the scleral spur. Two or three punctures, approximately 0.5 mm
in diameter, were performed with laser beam under direct visualization
until aqueous humor was extravasated slowly. The scleral flap
was closed with one or two sutures. Postoperative observation
included intraocular pressure (IOP), intraocular tissue reaction,
the appearance of filtering bleb, gonioscopy and ultrasound biomicroscopy.
The follow-up period was 4 to 24 months (7.94 +/- 6.20) months.
RESULTS: The anterior chamber was recovered shortly after the
operation and the visual acuity remained the same in all eyes.
At the end of follow-up period, the postoperative IOP (14.86 +/-
4.15) mm Hg was lower than the preoperative IOP (29.68 +/- 5.76)
mm Hg, the difference was statistically significant (t = 7.415,
P < 0.001). Diffuse and obvious filtering blebs were found
in all eyes after the operation, including 27 functional blebs
and 5 blebs that disappeared 2 to 3 months later. Iris was burned
slightly in 2 cases, pigment was released and appeared in the
anterior chamber temporarily. No laser injury occurred in the
cornea and the lens. High IOP was found in 2 cases after long-term
follow-up and could be controlled by antiglaucoma medication.
CONCLUSIONS: Deep sclerectomy with laser trabecular puncture can
effectively reduce the IOP, without the occurrence of serious
complications that commonly seen after the trabeculectomy. It
is an effective surgical method for the treatment of OAG.
-----
Ned Tijdschr Tandheelkd. 2003 Jul;110(7):298-9.
[Glaucoma]
[Article in Dutch]
Bol P.
Faculteit Civiele Techniek en Geowetenschappen Sectie Gezondheidstechniek
TU Delft Postbus 5048, 2600 GA Delft. pbol@xs4all.nl
Glaucoma is a group of afflictions that have loss of eyesight
in common. This impairment of vision is caused by damage to the
optic nerve as a result of high intraocular pressure. The patient's
optical fields narrow and at last only a tiny rest is left. The
mechanisms of the disease are well known but it is in most cases
unexplained why a person develops glaucoma. This review discusses
the several forms of glaucoma, the diagnosis and therapy, and
the epidemiology and prevention.
-----
Arch Ophthalmol. 2003 Jul;121(7):957-60.
Selective laser trabeculoplasty as primary treatment
for open-angle glaucoma: a prospective, nonrandomized pilot study.
Melamed S, Ben Simon GJ, Levkovitch-Verbin H.
The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute,
Sheba Medical Center, Tel Hashomer, Israel. melamed_shlomo@hotmail.com
OBJECTIVE: To examine the safety and efficacy of selective
laser trabeculoplasty as primary treatment for patients with open-angle
glaucoma. METHODS: Forty-five eyes of 31 patients with open-angle
glaucoma or ocular hypertension (intraocular pressure [IOP] >or=23
mm Hg on 2 consecutive measurements) underwent selective laser
trabeculoplasty as primary treatment. All patients underwent complete
ophthalmic evaluation before and at intervals after treatment.
This evaluation included visual acuity, slitlamp examination,
ophthalmoscopy, gonioscopy, and visual field analysis. The IOP
was measured 1 hour, 1 day, 1 week, and 1, 3, 6, 12, 15, and 18
months postoperatively. During the follow-up period, patients
were treated with topical antiglaucoma medications as required.
RESULTS: Mean +/- SD decreased by 7.7 +/- 3.5 mm Hg (30%), from
25.5 +/- 2.5 mm Hg to 17.9 +/- 2.8 mm Hg (P<.001). Only 2 eyes
(4%) did not respond to selective laser trabeculoplasty, and 3
eyes (7%) required topical medications to control their IOP at
the end of the follow-up period. Forty eyes (89%) had a decrease
of 5 mm Hg or more. Visual acuity, visual fields, and gonioscopic
findings remained unchanged. Complications included conjunctival
redness and injection within 1 day postoperatively in 30 eyes
(67%). One hour after selective laser trabeculoplasty, an increase
in IOP of more than 5 mm Hg was detected in 5 eyes (11%), while
an increase in IOP between 2 and 5 mm Hg was measured in 3 eyes
(7%). CONCLUSION: Selective laser trabeculoplasty is effective
and safe as a primary treatment for patients with ocular hypertension
and open-angle glaucoma.
-----
Eur J Ophthalmol. 2003 Jul;13(6):546-52.
Peak pressures: crossover study of timolol and
latanoprost.
Sihota R, Saxena R, Agarwal HC, Pandey RM, Gulati V.
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India
Institute of Medical Sciences, New Delhi, India. rjsihota@hotmail.com
PURPOSE: To compare the diurnal efficacy and action on peak
intraocular pressures (IOP) of 0.005% latanoprost and 0.5% timolol
as primary therapy in 60 eyes having dark brown irides with primary
open angle glaucoma (POAG). METHODS: A prospective, comparative,
observer-masked, crossover, interventional trial including the
mean of both eyes of 30 patients with POAG who were randomly started
on either latanoprost once daily or timolol twice daily. Three
months after treatment with one drug, the second drug was substituted.
A masked observer carried out diurnal assessments of IOP before
the start of therapy and at 3 and 7 months. The fourth month was
the washout period for the first drug. RESULTS: The average baseline
IOP was 23.36 +/- 2.14 mm Hg, which was reduced by 8.8 +/- 2.2
mmHg with latanoprost (p < 0.01) and by 6.75 +/- 1.9 mm Hg
with timolol (p = 0.01). The reduction was greater for latanoprost
(p < 0.005). The average peak IOP at baseline was 27.6 +/-
2.22 mmHg. The effective fall in IOP at the time of new peaks
in subsequent diurnal recordings of IOP compared to the baseline
diurnal curve was 8.9 mm Hg with latanoprost (p < 0.005) and
5.77 mm Hg with timolol (p < 0.01). This difference in IOP
reduction between the two drugs was statistically significant
(p < 0.01). Latanoprost had a lower efficacy in peak IOP reduction
in eyes with evening peak of IOP than in those with morning peak
(p < 0.005). The efficacy of timolol was lower overall compared
to latanoprost, but was similar in all circadian rhythms. The
shift in timing of IOP peak was greater with latanoprost compared
to timolol (4.34 hours vs -0.72 hours, p < .01). A total of
90% of patients on latanoprost and 33.3% on timolol achieved a
reduction of > 30% in baseline mean IOP. The average of the
trough IOP recorded in each of the individual baseline IOP curves
was 19.05 +/- 2.05 mm Hg. CONCLUSIONS: Greater mean and peak IOP
reduction was achieved with latanoprost compared to timolol. Dampening
of the circadian rhythm was better with latanoprost. Latanoprost
appears to be more effective than timolol at all points in time
with greater efficacy in eyes with morning peaks compared to evening
peaks.
-----
Eur J Ophthalmol. 2003 Jul;13 Suppl 4:S44-52.
Patient persistency with pharmacotherapy in the
management of glaucoma.
Reardon G, Schwartz GF, Mozaffari E.
Informagenics, LLC, Worthington, OH 43085, USA. greardon@informagenics.com
PURPOSE: To evaluate persistency with monotherapy in the treatment
of glaucoma in patients new to pharmacological management. METHODS:
This population-based, retrospective cohort study, using managed
care administrative claims data, included patients who were 20
years of age and older and who initiated monotherapy with betaxolol,
brimonidine, dorzolamide, latanoprost, or timolol between May
1999 and January 2001. Follow-up continued through January 31,
2001, and prescription refill records for all ocular hypotensive
medications were extracted for the full 21-month study period.
The primary outcome measures were discontinuation and change (switching/adding
on) of the index ocular hypotensive medication. Rates of discontinuation
and discontinuation/change were compared using Cox regression
methods; survival curves were generated. RESULTS: In all, 14,539
patients were prescribed any ocular hypotensive drug during the
study period, and 2850 patients met all inclusion criteria. Patients
treated with betaxolol, brimonidine, dorzolamide, or timolol were
significantly (p < 0.05) more likely to discontinue and to
discontinue/change the index therapy than were those treated with
latanoprost. Results were confirmed in analyses adjusted for age
and sex. CONCLUSIONS: Patients initially treated with latanoprost
monotherapy are more persistent than those who begin treatment
with beta-blockers, brimonidine, or the carbonic anhydrase inhibitor
dorzolamide. Greater persistency with an initial ocular hypotensive
therapy may improve health outcomes and reduce long-term costs
to patients and health plans by limiting the increased resource
use associated with discontinuations or changes in therapy.
-----
Eur J Ophthalmol. 2003 Jul;13 Suppl 4:S21-9.
Persistency and clinical outcomes associated with
latanoprost and beta-blocker monotherapy: evidence from a European
retrospective cohort study.
Diestelhorst M, Schaefer CP, Beusterien KM, Plante KM,
Fain JM, Mozaffari E, Dhawan R.
Department of Ophthalmology, University of Cologne, Cologne, Germany.
PURPOSE: To evaluate persistency (time on initial therapy)
and the clinical impact of latanoprost versus beta-blocker monotherapy
in treating glaucoma. METHODS: This observational, multicenter,
retrospective medical chart review study conducted in four European
countries included patients with primary open-angle glaucoma or
ocular hypertension who began their first glaucoma treatment with
latanoprost or a beta-blocker between November 1996 and November
1998. Persistency and glaucoma-related clinical outcomes data
were abstracted for the 2 years following treatment initiation.
RESULTS: In all, 260 patient charts were analyzed (94 latanoprost,
166 beta-blocker). Patients in the latanoprost group stayed on
therapy twice as long as those who received a beta-blocker (p
< 0.0001). After adjusting for baseline characteristics, patients
receiving a beta-blocker as initial therapy were 3.8 times more
likely to change therapy than those initially treated with latanoprost
(p < 0.0001). Patients in the latanoprost group also experienced
greater mean decreases in intraocular pressure (IOP) than those
receiving a beta-blocker (7.4 mmHg versus 4.6 mmHg, respectively;
p < 0.0001), and fewer had worsened optic nerve head excavation
(1.7% versus 14.2%, respectively; p < 0.05) by the time of
their first therapy change or last study visit, whichever came
first. CONCLUSIONS: Over a 2-year period, latanoprost was associated
with significantly greater persistency and better clinical IOP
outcomes compared with beta-blocker therapy.
-----
Eur J Ophthalmol. 2003 May;13(4):370-6.
Effects of ibopamine eye drops on intraocular
pressure and aqueous humor flow in healthy volunteers and patients
with open-angle glaucoma.
Azevedo H, Ciarniello MG, Rosignoli MT, Dionisio P, Cunha-Vaz
J.
AIBILI, Clinical Trial Centre, Azinhaga St. Comba, Celas, Coimbra,
Portugal.
PURPOSE: On the basis of intraocular pressure measurements
and fluorophotometry we assessed the effects of 2% ibopamine eye
drops on aqueous humor production in normal and glaucomatous eyes.
METHODS: Thirty subjects (15 healthy volunteers and 15 open-angle
glaucoma patients with ocular hypertension) were included in a
placebo-controlled study with random assignment of treatment from
masked containers. All subjects underwent ophthalmologic examinations
and intraocular pressure (IOP) measurements. Fluorophotometry
was done in both eyes at baseline (without treatment) and during
treatment. Each subject was treated with 1 drop of 2% ibopamine
in one eye and 1 drop of placebo in the fellow eye 30 minutes
before fluorophotometric scans and every hour after the first
instillation (for a total of 4 times). Safety was evaluated by
recording adverse events and ocular symptoms and signs. Aqueous
humor flow data were analyzed using the paired t-test, comparing
ibopamine and placebo-treated eyes. RESULTS: No changes in IOP
were detected in normal eyes, whereas glaucomatous eyes showed
a mean increase of 4 mmHg (95% CI 3.46-4.51) from baseline. The
difference in IOP between healthy eyes and those with glaucoma
was significant (p < 0.0001). In normal eyes and patients with
glaucoma ibopamine led to a significant increase in aqueous humor
flow compared with placebo-treated eyes (p < 0.01). The safety
profile of ibopamine was very good. CONCLUSIONS: The results seem
to confirm that ibopamine increases aqueous humor production in
normal and glaucomatous eyes, raising IOP only in eyes with glaucoma.
-----
Adv Ther. 2003 Mar-Apr;20(2):92-100.
Comparison of brimonidine/latanoprost and timolol/dorzolamide:
two randomized, double-masked, parallel clinical trials.
Zabriskie N, Netland PA; Brimonidine with Latanoprost Study
Groups 1 and 2.
John A. Moran Eye Center, University of Utah, Salt Lake City,
Utah, USA.
Two double-masked, randomized, parallel, multicenter trials
of similar design were conducted to compare the IOP-lowering efficacy
of dual therapy with brimonidine 0.2% and latanoprost 0.005% with
the fixed combination of timolol 0.5%/dorzolamide 2% in patients
with glaucoma or ocular hypertension. The combination of brimonidine
and latanoprost produced significantly greater mean IOP reductions
at each visit in both trials. In study 1, the mean reduction at
peak drug effect after 6 weeks was 9.2 mm Hg (34.7%) with brimonidine
and latanoprost and 6.7 mm Hg (26.1%) with timolol/dorzolamide
(P=.024); respective reductions at week 12 were 9.0 mm Hg (33.9%)
and 6.5 mm Hg (25.3%) (P=.044). At the month 1 visit in study
2, the mean peak IOP reduction was 10.6 mm Hg (39.0%) with dual
therapy and 6.3 mm Hg (25.1%) with the fixed combination (P=.001).
After 3 months, reductions were 9.1 mm Hg (33.4%) and 6.6 mm Hg
(26.3%) (P=.047). In these studies, the combination of brimonidine
and latanoprost provided IOP control superior to that of the fixed
combination of timolol/dorzolamide.
-----
J Ocul Pharmacol Ther. 2003 Apr;19(2):93-6.
Comparison of the efficacy of the fixed-combination
timolol/dorzolamide versus concomitant administration of timolol
and dorzolamide.
Bacharach J, Delgado MF, Iwach AG.
North Bay Eye Associates, Inc. Petaluma, CA 94954, USA. jbiop@cds1.net
The purpose of this study was to compare the efficacy of the
fixed-combination solution of timolol 0.5%/dorzolamide 2% with
the concomitant administration of its components, timolol 0.5%
twice a day and dorzolamide 2% twice a day. Ninety-eight patients
adequately controlled with a concomitant regimen of timolol and
dorzolamide were switched to the fixed-combination regimen of
the same components. Intraocular pressures at baseline and 4 weeks
after the change in regimen were recorded. The mean baseline intraocular
pressure (IOP) was 16.0 +/- 5.6 mmHg. Four weeks after the change
in medication to the fixed-combination regimen, the mean IOP was
14.5 +/- 5.6 mmHg. The mean IOP change from baseline was -1.5
+/- 3.9 mmHg. The difference between the two treatment modalities
was found to be statistically significant (p-value < 0.001).
Eighty-one (83%) patients were considered successfully switched
after 4 weeks of fixed-combination therapy, and seventeen eyes
(17%) were deemed unsuccessful because a rise in IOP was detected.
In conclusion, the fixed combination of timolol 0.5%/dorzolamide
2% twice a day provided equivalent or better intraocular pressure
reduction in most patients who were successfully controlled on
concomitant administration of its components, timolol and dorzolamide.
-----
J Ocul Pharmacol Ther. 2003 Apr;19(2):105-12.
Effect of changing from concomitant timolol pilocarpine
to bimatoprost monotherapy on ocular blood flow and IOP in primary
chronic angle closure glaucoma.
Agarwal HC, Gupta V, Sihota R.
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute
of Medical Sciences, New Delhi, India. gupta_v@mailcity.com
The aim of the present prospective masked study was to assess
the effect of bimatoprost monotherapy on ocular blood flow and
intraocular pressure (IOP) in eyes of primary chronic angle closure
glaucoma patients already on concomitant timolol and pilocarpine.
Thirty two patients of bilateral primary chronic angle closure
glaucoma (PCACG) on topical timolol 0.5% twice a day and pilocarpine
2% three times daily were switched over to bimatoprost 0.03% once
daily in both eyes. Intraocular pressure (IOP) and pulsatile ocular
blood flow (POBF) were recorded before and after starting bimatoprost
and were followed up every four weeks for three months. Bimatoprost
had statistically significant (p < 0.05) mean IOP reduction
from 19.3 +/- 6.6 to 13.5 +/- 4.5 mmHg (30.5%) and there was improvement
from 858 +/- 260 to 1261 +/- 321 microL/min (46.8%) in mean pulsatile
ocular blood flow (p < 0.05). Conjunctival hyperemia (32%)
was the most common adverse effect of bimatoprost. Bimatoprost
0.03% monotherapy improved ocular blood flow and provided a better
diurnal IOP control than concomitant timolol-pilocarpine in eyes
with primary chronic angle closure glaucoma and was found to be
well tolerated.
-----
Arch Ophthalmol 2002 Oct;120(10):1286-93
One-year, randomized study comparing bimatoprost
and timolol in glaucoma and ocular hypertension.
Higginbotham EJ, Schuman JS, Goldberg I, Gross RL, VanDenburgh
AM, Chen K, Whitcup SM; Bimatoprost Study Groups 1 and 2.
Department of Ophthalmology, University of Maryland at Baltimore,
419 W Redwood St, Suite 580, Baltimore, MD 21201-1595, USA. fcwejh6786@aol.com
OBJECTIVE: To compare bimatoprost with timolol maleate in patients
with glaucoma or ocular hypertension. METHODS: In 2 identical,
multicenter, randomized, double-masked, 1-year clinical trials,
patients were treated with 0.03% bimatoprost once daily (QD) (n
= 474), 0.03% bimatoprost twice daily (BID) (n = 483), or 0.5%
timolol maleate BID (n = 241). MAIN OUTCOME MEASURES: Diurnal
intraocular pressure (IOP) at 8 AM, 10 AM, and 4 PM and safety
variables (IOP was also measured at 8 PM at selected sites). RESULTS:
Bimatoprost QD provided significantly lower mean IOP than timolol
at every time of the day at each study visit (P<.001). This
was also true for bimatoprost BID at most time points, but the
efficacy was not as good as that of the QD regimen. At 10 AM (peak
timolol effect) at month 12, the mean reduction in IOP from baseline
was 7.6 mm Hg (30%) with bimatoprost and 5.3 mm Hg (21%) with
timolol (P<.001). A significantly higher percentage of patients
receiving bimatoprost QD (58%) than timolol (37%) achieved IOPs
at or below 17 mm Hg (10 AM, month 12; P<.001). The most common
adverse effect with bimatoprost was hyperemia (significantly higher
with bimatoprost QD than timolol; P<.001). CONCLUSIONS: Bimatoprost
QD provides sustained IOP lowering superior to timolol or bimatoprost
BID and achieves low target IOPs in significantly more patients.
--
Arch Ophthalmol 2002 Oct;120(10):1268-79
Reduction of intraocular pressure and glaucoma
progression: results from the
Early Manifest Glaucoma Trial.
Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein
M; Early Manifest Glaucoma Trial Group.
Department of Ophthalmology, Malmo University Hospital, SE-20502
Malmo, Sweden. anders.heijl@oftal.mas.lu.se
OBJECTIVE: To provide the results of the Early Manifest Glaucoma
Trial, which compared the effect of immediately lowering the intraocular
pressure (IOP), vs no treatment or later treatment, on the progression
of newly detected open-angle glaucoma. DESIGN: Randomized clinical
trial. PARTICIPANTS: Two hundred fifty-five patients aged 50 to
80 years (median, 68 years) with early glaucoma, visual field
defects (median mean deviation, -4 dB), and a median IOP of 20
mm Hg, mainly identified through a population screening. Patients
with an IOP greater than 30 mm Hg or advanced visual field loss
were ineligible. INTERVENTIONS: Patients were randomized to either
laser trabeculoplasty plus topical betaxolol hydrochloride (n
= 129) or no initial treatment (n = 126). Study visits included
Humphrey Full Threshold 30-2 visual field tests and tonometry
every 3 months, and optic disc photography every 6 months. Decisions
regarding treatment were made jointly with the patient when progression
occurred and thereafter. MAIN OUTCOME MEASURES: Glaucoma progression
was defined by specific visual field and optic disc outcomes.
Criteria for perimetric progression were computer based and defined
as the same 3 or more test point locations showing significant
deterioration from baseline in glaucoma change probability maps
from 3 consecutive tests. Optic disc progression was determined
by masked graders using flicker chronoscopy plus side-by-side
photogradings. RESULTS: After a median follow-up period of 6 years
(range, 51-102 months), retention was excellent, with only 6 patients
lost to follow-up for reasons other than death. On average, treatment
reduced the IOP by 5.1 mm Hg or 25%, a reduction maintained throughout
follow-up. Progression was less frequent in the treatment group
(58/129; 45%) than in controls (78/126; 62%) (P =.007) and occurred
significantly later in treated patients. Treatment effects were
also evident when stratifying patients by median IOP, mean deviation,
and age as well as exfoliation status. Although patients reported
few systemic or ocular conditions, increases in clinical nuclear
lens opacity gradings were associated with treatment (P =.002).
CONCLUSIONS: The Early Manifest Glaucoma Trial is the first adequately
powered randomized trial with an untreated control arm to evaluate
the effects of IOP reduction in patients with open-angle glaucoma
who have elevated and normal IOP. Its intent-to-treat analysis
showed considerable beneficial effects of treatment that significantly
delayed progression. Whereas progression varied across patient
categories, treatment effects were present in both older and younger
patients, high- and normal-tension glaucoma, and eyes with less
and greater visual field loss.
--
J Fr Ophtalmol 2002 Jun;25(6):641-54
[Ocular hypertension and glaucoma: the contribution
of large studies to daily practice]
[Article in French]
Bron A.
Service d'Ophtalmologie, CHU, Hopital General, 21000, Dijon.
Official guidelines to manage and treat various clinical presentations
of glaucoma and ocular hypertension are not currently in wide
use. Several well-designed clinical trials have been published
recently which can provide ophthalmologists with therapeutic recommendations.
In the field of ocular hypertension, three major and historic
studies are reported and discussed in this review. A more recent
study undertaken in Sweden and the design of the Ocular Hypertension
Treatment Study (OHTS) are reviewed as well, although the final
results of this important trial have not yet been published. The
conclusions of the Collaborative Normal Tension Study Group (CNTSG)
have been expected for a long time since this disease is difficult
to manage; a 30% reduction in baseline intraocular pressure avoids
further deterioration of the visual field in most patients. Other
studies have dealt with different strategies in open angle glaucoma.
The Advanced Glaucoma Intervention Study (AGIS) has investigated
different therapeutic sequences in advanced glaucoma while the
Collaborative Initial Glaucoma Treatment Study (CIGTS) and the
Early Manifest Glaucoma Trial (EMGT), still in progress, have
evaluated the efficacy and safety of surgery versus medical treatment
and treatment versus no treatment, respectively, in new and low-grade
glaucoma. These long-term studies have led to a better approach
to ocular hypertension, normal tension glaucoma, initial glaucoma,
and advanced glaucoma. This review presents the characteristics
of these clinical studies, points out the problems linked to giving
a fair and practical interpretation, and attempts to draw useful
guidelines for daily clinical practice.
--
J Fr Ophtalmol 2002 Jun;25(6):604-8
[Comparison of latanoprost monotherapy with
timolol-dorzolamide combination in patients with open-angle glaucoma
or ocular hypertension]
[Article in French]
Bron A; , Et le groupe Europeen d'etudes du latanoprost (European
latanoprost study group).
CHU, Hopital General 21000 Dijon.
PURPOSE: To compare the efficacy and safety of latanoprost
monotherapy to dorzolamide combined with timolol from pooled data
of five multicenter, randomized, 3-month, observer-masked trials
with identical study design. METHODS: Patients who were on a beta-blocker
or dual therapy where one agent was a beta-blocker were eligible
after a 2- to 4-week run-in period on timolol 0.5%, twice daily.
Patients then either discontinued timolol treatment and received
latanoprost monotherapy n=345) or continued on timolol and received
dorzolamide add-on therapy (n=352). Data from these 697 patients
were included in the meta-analysis. RESULTS: From an overall baseline
of 22.8mmHg, the mean IOP reduction was 4.8mmHg (21%) in latanoprost-treated
patients and 4.1mmHg (18%) in timolol + dorzolamide-treated patients
p<0.001). A reduction in diurnal IOP of >=20% was achieved
in 54% of the latanoprost-treated patients compared with 44% of
the timolol + dorzolamide-treated patients. There was no marked
difference between the two groups in the incidence of ocular and
systemic events. CONCLUSION: This meta-analysis provides further
support that a switch to latanoprost monotherapy can be an alternative
to combined treatment with timolol + dorzolamide.
--
J Fr Ophtalmol 2002 Jun;25(6):568-75
[Use of brimonidine 0.2% in treatment of glaucoma
or ocular hypertony after poorly tolerated beta-blocker treatment]
[Article in French]
Titouamane S, Baudouin C.
CHNO des XV-XX, 28, rue de Charenton, 75012 Paris, France.
This study intended to evaluate the advantages of brimonidine
tartrate 0.2% (Alphagan((R))), a selective alpha-2 receptor agonist,
relaying a poorly tolerated beta-blocker treatment. Effectiveness,
as assessed by intraocular pressure, local and general tolerance
of the treatment, and the quality of life of the patients included
in the study, was compared for these two eye drops. This multicenter
and prospective study, performed by 450 ophthalmologists, included
807 adults presenting with glaucoma or ocular hypertony over 8
months. After a poorly tolerated beta-blocker treatment, which
had started at least 6 months before, these patients received
brimonidine over 8 weeks. At 3 successive visits, intraocular
pressure, biomicroscopic examination results, and visual acuity
were recorded. A quality-of-life questionnaire evaluating breathlessness,
fatigue, depressive mood, loss of appetite, and satisfaction with
the treatment was also given to patients. In the 731 patients
observed in the study, the analysis concluded a statistically
significant decrease in intraocular pressure (-2.5mmHg) and in
the cardiovascular parameters during brimonidine treatment: blood
pressure was reduced by 3mmHg and 1.1mmHg for systolic and diastolic
pressure, respectively. The heart rate rose by 1.7 beats/min.
The quality-of-life questionnaire revealed less breathlessness
(-26%), fatigue (-24.9%), depressive mood (-19.3%), and better
appetite (+8.2%). The feeling of satisfaction with the brimonidine
treatment was significantly improved for 95 patients. However,
12% of all patients stopped their treatment because of adverse
effects. Brimonidine improved the glaucomatous patients' quality
of life, at least in some areas. Improved intraocular pressure
could at least in part result from better compliance with the
treatment. Brimonidine is an encouraging alternative after an
unsatisfactory beta-blocker treatment.
--
Ophthalmology 2002 Sep;109(9):1612-21
The European glaucoma prevention study design
and baseline description of the participants.
European Glaucoma Prevention Study Group.
OBJECTIVES: The European Glaucoma Prevention Study seeks to
evaluate the efficacy of reducing intraocular pressure (IOP),
with dorzolamide to prevent or delay patients affected by ocular
hypertension from developing primary open-angle glaucoma. DESIGN:
Randomized, double-blinded, controlled clinical trial. PARTICIPANTS:
Patients (age > or =30 years) were enrolled from 18 European
centers. The patients fulfilled a series of inclusion criteria
including the measurements of IOP (22-29 mmHg), two normal and
reliable visual fields (VFs) (on the basis of mean defect and
corrected pattern standard deviation/corrected loss of variance
of standard 30/II Humphrey or Octopus perimetry), and normal optic
disc as determined by the Optic Disc Reading Center (vertical
and horizontal cup-to-disc ratios; asymmetry between the two eyes
< or =0.4). INTERVENTION: Patients were randomized to the treatment
with dorzolamide or a placebo. MAIN OUTCOME MEASURES: End points
are VF and/or optic disc changes. A VF change during the follow-up
must be confirmed by two further positive tests. Optic disc change
is defined by the agreement of two out of three independent observers
evaluating optic disc stereo-slides. RESULTS: One thousand seventy-seven
subjects were randomized between January 1, 1997 and May 31, 1999.
The mean age was 57.03 +/- 10.3 years; 54.41% were women and 99.9%
were Caucasian. Mean IOP was 23.6 +/- 1.6 mmHg in both eyes. Mean
visual acuity was 0.97 +/- 0.11 in both eyes; mean refraction
was 0.23 +/- 1.76 diopters in the right eye and 0.18 +/- 1.79
diopters in the left eye. Previous use of medication for ocular
hypertension was reported by 38.4% of the patients, systemic hypertension
by 28.1%, cardiovascular diseases by 12.9%, and diabetes mellitus
by 4.7%. The qualifying VFs were normal and reliable according
to protocol criteria. CONCLUSIONS: The mean IOP of the patients
enrolled in the European Glaucoma Prevention Study is consistent
with the estimated mean IOP (within the range of 22-29 mmHg) found
in a large sample of the European population. The European Glaucoma
Prevention Study should be able to better address the clinical
question of whether pharmacological reduction of IOP (by means
of dorzolamide) in ocular hypertension patients at moderate risk
for developing primary open-angle glaucoma effectively lowers
the incidence of primary open-angle glaucoma.
--
Ophthalmology 2002 Sep;109(9):1607-11
Long-term filtration and visual field outcomes
after primary glaucoma triple procedure with and without mitomycin-C.
Shin DH, Iskander NG, Ahee JA, Singal IP, Kim C, Hughes BA,
Eliassi-Rad B, Kim YY.
Kresge Eye Institute, Wayne State University School of Medicine,
Detroit, Michigan 48201-1423, USA.
OBJECTIVE: To evaluate the long-term effectiveness of glaucoma
management in patients undergoing primary glaucoma triple procedure
(PGTP) with and without adjunctive subconjunctival mitomycin-C
(MMC). DESIGN: Case-controlled study. PARTICIPANTS: Of the 203
eyes of 203 primary open-angle glaucoma (POAG) patients who had
undergone PGTP and in whom reliable Humphrey visual fields had
been obtained both before and after surgery at 13.5 +/- 8.9 and
27.9 +/- 8.9 months, 124 of the 144 eyes that received MMC during
surgery were matched to the other 59 eyes that did not with respect
to cup-to-disc ratio and risk factors for filtration failure in
addition to other variables. MAIN OUTCOME MEASURES: Both preoperative
and postoperative intraocular pressure (IOP), Humphrey visual
fields and their global indices, number of glaucoma medications,
and best-corrected visual acuity (BCVA). RESULTS: There were no
significant differences in demographics between the two groups
(P > 0.05 for each). Whereas both the control and the MMC groups
attained significant decreases of mean IOP (18.5 +/- 5.7 mmHg-;15.6
+/- 4.6 mmHg, P = 0.0014; 19.3 +/- 7.0 mmHg-13.7 +/- 4.9 mmHg,
P = 0.0001) and mean number of medications (2.1 +/- 1.3-1.3 +/-
1.3, P = 0.0001; 2.3 +/- 1.2-1.0 +/- 1.3, P = 0.0001) at 36 months
after surgery, the MMC group had significantly lower mean IOP
than the control group at all postoperative visits (P < 0.05
for each). The MMC group also tended to have less medical dependency
after surgery than the control group. There was no significant
difference in postoperative BCVA between the two groups. Patients
in both groups had mean visual acuity of 20/30 or better. There
was a significant worsening of corrected pattern standard deviation
(CPSD) in the control group (3.97 +/- 3.18-5.17 +/- 3.36, P =
0.001) compared with no significant change in the MMC group (5.07
+/- 4.11-5.23 +/- 3.36, P = 0.93). The mean deviation did not
change significantly in either group. CONCLUSIONS: The long-term
glaucoma management in POAG patients with cataract undergoing
PGTP indicates a successful outcome in final IOP, medical dependency,
and BCVA. Furthermore, the MMC group had better IOP control and
stable visual fields (CPSD), whereas the control group had a significant
worsening of CPSD.
--
Ophthalmology 2002 Sep;109(9):1597-603
Primary phacoemulsification and intraocular
lens implantation for acute angle-closure glaucoma.
Jacobi PC, Dietlein TS, Luke C, Engels B, Krieglstein GK.
University of Cologne, Department of Ophthalmology, Cologne,
Germany.
OBJECTIVE: To evaluate the safety and efficacy of primary phacoemulsification
and intraocular lens implantation (PPI) for acute angle-closure
glaucoma (ACG). STUDY DESIGN: Prospective, nonrandomized comparative
trial. PARTICIPANTS AND INTERVENTION: Forty-three eyes of 43 patients
with acute ACG and uncontrolled intraocular pressure (IOP) were
treated by PPI. Thirty-two eyes of 32 patients treated by conventional
surgical iridectomy (CSI) constituted the control group. MAIN
OUTCOME MEASURES: Postoperative visual acuity, IOP, number of
antiglaucoma medications, complications, and secondary surgical
interventions, if any, required for IOP control. RESULTS: Glaucoma
control was achieved in 31 eyes (72%) in the PPI group and in
11 (35%) in the CSI group (P = 0.01). Mean preoperative IOP was
40.5 +/- 7.6 mmHg (standard deviation) and 39.7 +/- 7.8 mmHg,
respectively (P = 0.46). Mean postoperative IOP was 17.8 +/- 3.4
mmHg (PPI group) and 20.1 +/- 4.2 mmHg (CSI group) after a mean
follow-up of 10.2 +/- 3.4 months (P = 0.03). Postoperatively,
the mean number of ocular hypotensive medications was 0.18 +/-
0.45 (PPI group) and 0.45 +/- 0.62 (CSI group) (P = 0.0001). Relative
increase in postoperative best-corrected visual acuity (logarithm
of the minimum angle of resolution) was 0.52 +/- 0.29 (PPI group)
and 0.19 +/- 0.21 (CSI group), respectively (P = 0.0001). Additional
surgery was necessary in 5 eyes (11.5%) in the PPI group and in
20 eyes (63%) in the CSI group (P = 0.01). Intraoperative and
postoperative complications were few and manageable. CONCLUSIONS:
CSI in patients with acute ACG was effective in reducing IOP initially
but was associated with multiple surgical reinterventions. Conversely,
primary PPI turned out to be safe and effective in reducing IOP
and improving visual acuity. These results affirm that lens extraction
may be considered the better procedure in uncontrolled ACG when
faced with options of CSI or PPI.
--
Ophthalmology 2002 Sep;109(9):1591-
Argon laser peripheral iridoplasty versus conventional
systemic medical therapy in treatment of acute primary angle-closure
glaucoma : a prospective, randomized, controlled trial.
Lam DS, Lai JS, Tham CC, Chua JK, Poon AS.
Department of Ophthalmology and Visual Sciences, The Chinese
University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong
Kong, People's Republic of China. dennislam@cuhk.edu.hk
OBJECTIVE: To study whether argon laser peripheral iridoplasty
(ALPI) is as effective and safe as conventional systemic medications
in treatment of acute primary angle-closure glaucoma (PACG) when
immediate laser peripheral iridotomy is neither possible nor safe.
DESIGN: Prospective, randomized, controlled trial. PARTICIPANTS:
Seventy-three eyes of 64 consecutive patients with their first
presentation of acute PACG, with intraocular pressure (IOP) levels
of 40 mmHg or more, were recruited into the study. INTERVENTION:
The acute PACG eye of each consenting patient received topical
pilocarpine (4%) and topical timolol (0.5%). The patients were
then randomized into one of two treatment groups. The ALPI group
received immediate ALPI under topical anesthesia. The medical
treatment group was given 500 mg of intravenous acetazolamide,
followed by oral acetazolamide 250 mg four times daily, and an
oral potassium supplement until IOP levels normalized. Intravenous
mannitol also was administered to the latter group if the presenting
IOP was higher than 60 mmHg. The acute PACG eye of both groups
continued to receive topical pilocarpine (1%) until peripheral
iridotomy could be performed. MAIN OUTCOME MEASURES: Intraocular
pressure profile, corneal clarity, symptoms, visual acuity, angle
status by indentation gonioscopy, and complications of treatment.
RESULTS: Thirty-three acute PACG eyes of 32 patients were randomized
to receive immediate ALPI, whereas 40 acute PACG eyes of 32 patients
had conventional systemic medical therapy. Both treatment groups
were matched for age, duration of attack, and IOP at presentation.
The ALPI-treated group had lower IOP levels than the medically
treated group at 15 minutes, 30 minutes, and 1 hour after the
start of treatment. The differences were statistically significant.
The difference in IOP levels became statistically insignificant
from 2 hours onward. The duration of attack did not affect the
efficacy of ALPI in reducing IOP in acute PACG. No serious laser
complications occurred, at least in the early postlaser period.
CONCLUSIONS: Argon laser peripheral iridoplasty significantly
is more effective than conventional systemic medications in reducing
IOP levels in acute PACG in eyes not suitable for immediate laser
peripheral iridotomy within the first 2 hours from the initiation
of treatment. Argon laser peripheral iridoplasty is a safe and
more effective alternative to conventional systemic medications
in the management of acute PACG not amenable to immediate laser
peripheral iridotomy.
--
Am J Manag Care 2002 Aug;8(10 Suppl):S278-80
Measuring persistency and intraocular pressure-controlled
days in patients receiving
topical glaucoma medications.
Schwartz GF, Platt R.
Investigators have developed methods to estimate the number
of healthy days or symptom-free days in randomized trials or population-based
settings. Such measures can be used in cost-effectiveness studies
or disease management surveillance. This paper suggests that the
concept can be extended to measure intraocular pressure (IOP)-controlled
days in glaucoma by combining data from randomized trials on IOP
control (ie, whether a target IOP or percent reduction in IOP
was achieved) with data from pharmacy database studies on drug
persistency. Patients with lower rates of persistency would be
expected to experience fewer IOP-controlled days as they switch
therapies or discontinue topical therapy altogether. Evaluating
IOP-controlled days according to patients' topical glaucoma therapies
could improve population-based disease management compared with
the use of simpler measures that consider IOP measurements at
a single point in time.
--
Am J Manag Care 2002 Aug;8(10 Suppl):S262-70
Rates of discontinuation and change of glaucoma
therapy in a managed care setting.
Spooner JJ, Bullano MF, Ikeda LI, Cockerham TR, Waugh WJ, Johnson
T, Mozaffari E.
BACKGROUND: Comparing discontinuation and change rates of glaucoma
pharmacotherapies provides insight as to which agents perform
more effectively. OBJECTIVE: To quantify the rates of discontinuation
and change of different glaucoma therapies. METHODS: This retrospective,
observational study using managed care administrative claims data
included patients who were between 20 and 64 years of age and
received at least 1 prescription for 1 of the following glaucoma
agents as monotherapy: betaxolol, brimonidine, latanoprost, or
timolol. Patients receiving any glaucoma medication during the
180 days prior to their index prescription were excluded, as were
those who did not have continuous plan enrollment during this
period. The primary outcome measures were the discontinuation
and change (switching/adding on) of the index glaucoma medication.
Rates of discontinuation and change were compared using a proportional
hazard model. RESULTS: A total of 1006 patients comprised the
final study population. Approximately 62% of patients discontinued
their index glaucoma medication, and 18% of patients changed to
a different therapy within 18 months of starting therapy. Among
those discontinuing therapy, latanoprost patients remained on
therapy the longest (mean: 217 days) compared to other study cohorts
(range: 182 to 184 days). Compared with latanoprost, patients
initiated on any of the other agents were more likely to discontinue
or change therapy. CONCLUSIONS: This study indicates that latanoprost
therapy results in a lower rate of discontinuation or change compared
to patients started on betaxolol, brimonidine, or timolol.
--
Am J Manag Care 2002 Aug;8(10 Suppl):S240-8
An economic analysis of switching to latanoprost
from a beta-blocker or adding brimonidine or latanoprost to a
beta-blocker in open-angle glaucoma or ocular hypertension.
Stewart WC, Leech J, Sharpe ED, Kulze J, Ellyn J, Day DG.
BACKGROUND: In treating patients with ocular hypertension or
primary open-angle glaucoma, if a single agent cannot successfully
control the pressure, additional medications may be prescribed.
The cost of treatment may become expensive, especially with multiple
drug therapy. Thus, prescribing techniques that help minimize
costs may be beneficial to patients when medically appropriate.
OBJECTIVE: To evaluate differences in drug and visit costs after
switching to latanoprost 0.005% monotherapy (LM) versus adding
latanoprost 0.005% once daily (Lbeta) or brimonidine 0.2% twice
daily (Bbeta) in patients uncontrolled on beta-blocker therapy
alone. METHODS: This study included 148 consecutive qualified
charts of open-angle glaucoma or ocular hypertension patients
within the first year of follow-up after switching from beta-blocker
monotherapy to latanoprost or adding latanoprost or brimonidine.
RESULTS: The Bbeta group demonstrated the highest costs per month,
followed by the Lbeta group, then the LM group. A trend existed
in the Lbeta group to a lower pressure than the Bbeta or the LM
groups. A greater mean change in medication per patient per month
was seen in the Bbeta group compared to the latanoprost treatment
groups. Additionally, a greater number of visits per month occurred
in the Bbeta than in the LM and Lbeta groups. The Bbeta group
also reported significantly more tearing and fatigue. CONCLUSIONS:
This study suggests that in patients uncontrolled on beta-blocker
therapy, switching to latanoprost, when medically appropriate,
may provide a further mean reduction in intraocular pressure and
save costs compared to adding latanoprost or brimonidine.
--
Cesk Slov Oftalmol 2002 Jul;58(4):233-7
[Long-term experience with glaucoma silicone
implants in a multicenter study]
[Article in Czech]
Kraus H, Novak J, Rozsival P, Hornova J, Fucik M, Maresova
K, Splichal L.
Ocni klinika 1. lekarske fakulty UK a VFN, Praha. hanus.kraus@vfn.cz
PURPOSE: To evaluate the experience with a glaucoma implant
in complicated glaucoma, designed in collaboration with the Institute
of Polymers in Prague. METHODS: In a multicentric retrospective
study 91 eyes of 86 patients with otherwise uncontrollable glaucoma
underwent GSI implantation in four departments. The implant of
medical silicone consists of a tube with an internal diameter
of 0.4 mm, connected to a round lens-shaped episcleral plate 169
mm2, covering the tube orifice from above. The indications were
infantile glaucoma (14 eyes), traumatic glaucoma (14 eyes), various
secondary glaucomas in 12, primary open-angle glaucoma in 11,
neovascular and after PPV in 10 eyes each, usually after unsuccessful
previous surgery. RESULTS: The average follow-up time was 20.5
months (SD +/- 19.5). Postoperative intraocular pressure at the
last control was 6-22 mmHg in 56 eyes (50.95%). Life table analysis
showed a cumulative probability of 494% (at least qualified success).
Long-term hypotony was seen in 6 eyes. CONCLUSIONS: The GSI is
comparable with similar tube shunts but is much less expensive.
In vitro experiments are planned to improve the construction of
the implant and its results.
--
Drugs Aging 2002;19(6):465-71; discussion 472-3
Travoprost.
Waugh J, Jarvis B.
Adis International Limited, Mairangi Bay, Auckland, New Zealand.
demail@adis.co.nz
Travoprost is a synthetic ester prodrug of a prostaglandin
F(2alpha) analogue used in the treatment of open-angle glaucoma
and ocular hypertension. Intraocular travoprost 0.004% once daily
was significantly more effective at reducing intraocular pressure
(IOP) in patients with open-angle glaucoma or ocular hypertension
than placebo or timolol 0.5% twice daily and was at least as effective
as latanoprost 0.005% once daily in randomised, double-blind studies.
When used as adjunctive therapy with timolol 0.5% twice daily
in patients with elevated IOP not adequately controlled by timolol
alone, travoprost 0.004% showed significant additional IOP reduction
in a randomised double-blind trial. Travoprost 0.004% was well
tolerated in clinical trials. The majority of adverse events such
as ocular hyperaemia and eyelash changes were mild and resolved
without treatment.
--
Drug Saf 2002;25(8):583-97
Safety of unoprostone isopropyl as mono- or
adjunctive therapy in patients with primary open-angle glaucoma
or ocular hypertension.
de Arruda Mello PA, Yannoulis NC, Haque RM.
Department of Ophthalmology, Federal University of Sao Paulo-Paulista
School of Medicine and Director Residency Training, Sao Paulo,
Brazil.
This review summarises the safety of unoprostone isopropyl
(both at the 0.12 and 0.15% concentrations) instilled twice daily
in patients with primary open-angle glaucoma (POAG) or ocular
hypertension (OH). For unoprostone 0.15%, combined data from two
12-month comparative monotherapy studies are reported, as well
as data from three adjunctive therapy studies and two special
population studies. With unoprostone monotherapy, most adverse
events were mild or moderate and transient in nature. Less than
7% of unoprostone-treated patients discontinued therapy due to
an adverse event. The most common adverse events associated with
unoprostone were burning/stinging, burning/stinging directly upon
drug instillation, ocular itching, and conjunctival hyperaemia.
Unoprostone had no clinically notable effects on vital signs,
laboratory profiles, or comprehensive ophthalmic examinations.
One of 659 unoprostone 0.15%-treated patients had a change in
iris colour after 12 months of monotherapy. Except for a higher
incidence of burning/stinging and burning/stinging upon instillation,
unoprostone was comparable to timolol 0.5% twice daily and betaxolol
0.5% twice daily. No safety concerns were raised with use of unoprostone
as adjunctive therapy. Unoprostone had no significant effect on
exercise-induced heart rate in healthy subjects or on pulmonary
function in patients with mild-to-moderate asthma. The safety
profile of unoprostone 0.15% was consistent with published information
on the 0.12% formulation. In conclusion, unoprostone has an excellent
safety profile in patients with POAG or OH.
--
Arch Ophthalmol 2002 Jul;120(7):915-22
Latanoprost and timolol combination therapy
vs monotherapy: one-year randomized trial.
Higginbotham EJ, Feldman R, Stiles M, Dubiner H; Fixed Combination
Investigative Group.
Department of Ophthalmology, University of Maryland School
of Medicine, 419 W Redwood St, Suite 580, Baltimore, MD 21201,
USA. FCWEJH6786@aol.com
OBJECTIVE: To compare the efficacy and safety of a fixed combination
of 0.005% latanoprost and 0.5% timolol maleate administered once
daily vs monotherapy with either 0.005% latanoprost once daily
or 0.5% timolol twice daily. METHODS: Patients with either primary
or secondary open-angle glaucoma or ocular hypertension participated
in a 6-month, randomized, double-masked, multicenter study with
3 parallel treatment groups. The double-masked period was preceded
by a 2- to 4-week "run-in" treatment with timolol. Subjects
could receive fixed combination therapy during a 6-month open-label
extension. MAIN OUTCOME MEASURE: The difference between groups
in mean diurnal intraocular pressure reduction in study eye(s)
from baseline through 6 months of treatment. RESULTS: Overall,
418 patients were enrolled in the study; 332 completed the open-label
phase. Diurnal intraocular pressure levels were similar at baseline,
but at week 26, they were 19.9 +/- 3.4 mm Hg in the fixed combination
therapy group, 20.8 +/- 4.6 mm Hg in latanoprost-treated patients,
and 23.4 +/- 5.4 mm Hg in timolol-treated patients (data are given
as mean +/- SD). The mean change from baseline was greater among
patients receiving fixed combination therapy compared with each
monotherapy group (P<.01). Fixed combination therapy effectively
lowered intraocular pressure levels for up to 1 year. All treatments
were well tolerated. CONCLUSION: The combination of 0.005% latanoprost
and 0.5% timolol administered once daily is effective and well
tolerated for up to 12 months.
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