Response to topical epinephrine. A practical prognostic test in patients with ocular hypertension

Discovery of the ROCK inhibitor netarsudil for the treatment of open-angle glaucoma

Inhibition of Rho kinase (ROCK) to improve fluid outflow through the trabecular meshwork and lower intraocular pressure is a strategy for the development of new anti-glaucoma agents. Alpha-aryl-beta-amino isoquinoline analogs were identified as potent ROCK inhibitors. Compounds that provided a longer duration of intraocular pressure reduction in Dutch Belted rabbits also inhibited norepinephrine transporter. Ester 60 improved bioavailability of its parent ROCK inhibitor, 29 (Ki=0.2nM) and demonstrated an effective and sustained IOP reduction for 24h after dosing. From these studies, netarsudil (a.k.a. AR-13324) was discovered and is currently in clinical trials for the treatment of glaucoma and ocular hypertension.

Latanoprost Nonresponders with Open-Angle Glaucoma in the Japanese Population

PURPOSE

As some patients show little response to latanoprost, one of the most powerful topical glaucoma medications, we investigated the incidence and clinical profiles of latanoprost nonresponders (LNR) in the Japanese population.

METHODS

We examined 62 glaucoma patients (62 eyes) who had received only latanoprost for more than 3 months. Their mean age was 63.8 +/- 1.8 years; the mean observation period was 9.7 +/- 0.4 months. At 1, 3, 6, and 12 months, their intraocular pressure (IOP) was measured, and the IOP reduction rate (RR) and the rate of LNR, defined as RR of 10% or less, were calculated. We statistically analyzed clinical factors involved in the LNR status of our study population.

RESULTS

At 1, 3, 6, and 12 months, RR was 20.1 +/- 2.0%, 18.8 +/- 2.3%, 21.1 +/- 2.8%, and 23.0 +/- 2.6%, respectively. At the same time points, the LNR incidence was 23.1%, 28.1%, 23.5%, and 31.8%, respectively, and significantly higher in patients whose baseline IOP was less than 15 mmHg. Patient sex and age and the glaucoma type played no significant role in the LNR status.

CONCLUSIONS

The incidence of LNR in the Japanese population, including normal-tension glaucoma (NTG) patients, is higher than among European or American patients. Only low baseline IOP was a significant clinical factor among LNR.

Early diagnosis of glaucoma. II. The value of the initial examination in ocular hypertension

In a group of 46 patients with moderately elevated intraocular pressure (22-30 mmHg), signs of early glaucoma were found in half of them after a follow-up of 5-7.5 years. Most of the patients showed only a small increase in optic disc cupping revealed by stereophotography. Initial IOP higher than 25 mmHg, large pressure differences between the two eyes, large diurnal pressure variation, occurrence of pseudoexfoliation, pressure drop of more than 8 mmHg after topical epinephrine, and a pressure rise of more than 4 mmHg after water loading were more frequent in the group of patients who developed signs of glaucoma. Age, a positive family history, occurrence of cardiovascular disease, and the cup/disc ratio did not differ in the two groups of patients. The pilocarpine test and steroid provocation had no predictive value. Surprisingly, there was a small drop of pressure after topical steroids in 6 of the 8 patients with pseudoexfoliation.

Guanethidine--adrenaline eye drops in glaucoma simplex production and outflow of the aqueous humour during a long-term treatment

A comparative tonographic study was performed in 10 primary open angle glaucoma patients (15 eyes) and 7 patients with suspected glaucoma (14 eyes) during a 7-months' period. The patients were treated twice daily with guanethidine 3% and adrenaline 0.5% (GA). The fall in intraocular pressure (IOP) of 44% in primary open angle glucoma patients was mainly due to an inhibition of aqueous humour production (54%; p < 0.005) and to a lesser extent an increase in outflow facility. In the suspected glaucoma patients, the fall in IOP of 43% was due to an inhibition of the aqueous rate (46%; p < 0.005) and to an increase in outflow facility (64%; p < 0.005). The increase in outflow facility during treatment was significantly different between both groups of patients. It suggests degeneration of the receptors mediating outflow mechanism in the patients with open angle glaucoma. For both groups of patients it is shown that during treatment with GA there is not only a supersensitivity for adrenaline 0.5% of the mechanisms that mediate the inhibition of the aqueous rate, but also of the mechanisms that mediate outflow facility.