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Singh IP, Berdahl JP, Sarkisian SR, Voskanyan LA, Ang RE, Doan LV, Applegate D, Shen Y, Katz LJ, Kothe AC, Navratil T. Long-Term Safety and Efficacy Evaluation of Travoprost Intracameral Implant Based on Pooled Analyses from Two Phase III Trials. Drugs 2024:10.1007/s40265-024-02074-9. [PMID: 39240530 DOI: 10.1007/s40265-024-02074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 09/07/2024]
Abstract
AIM The purpose of this study was to conduct and interpret a pooled 12-month analysis of two prospective, multi-center, randomized, double-masked, controlled trials designed to assess the efficacy and safety of the travoprost intracameral implant (slow-eluting [SE] implant in development as a new therapeutic and fast-eluting [FE] implant included for masking purposes) in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). METHODS Subjects with OAG or OHT, on 0-3 intraocular pressure (IOP)-lowering medications, baseline unmedicated mean diurnal IOP of ≥ 21 mmHg, and IOP ≤ 36 mmHg at each baseline diurnal timepoint, received either a travoprost implant and twice-daily (BID) placebo eye drops or BID timolol 0.5% eye drops and a sham procedure. Subjects were followed through 12 months and assessed for IOP, reduction in topical IOP-lowering medications, and safety parameters including treatment-emergent adverse events (TEAEs). IOP at 8AM was prospectively collected at all study visits through 12 months and diurnal IOP, measured at 8AM, 10AM, and 4PM, was prospectively collected at baseline, day 10, week 6, and months 3 and 12. RESULTS A total of 1150 subjects were randomized (385 FE implant, 380 SE implant, and 385 sham/timolol) across the two trials. Statistical non-inferiority to timolol and clinically relevant reductions in 8AM IOPs were demonstrated at month 12. In more detail, both implant groups demonstrated statistical non-inferiority to timolol and clinically relevant reductions from baseline in mean diurnal IOP at all visits over the 12-month evaluation period when diurnal IOP was collected. Additionally, both implant groups demonstrated robust treatment effect based on 8AM average IOP from day 10 through the specified visit which ranged from day 10 to month 12 from 6.9 to 8.5 mmHg in the FE implant group; 6.8 to 8.5 mmHg in the SE implant group; and 7.3 to 7.5 mmHg in the sham/timolol group. With regards to reduction in topical pharmacotherapy, at month 12, 77.6% of FE and 81.4% of SE implant eyes were completely free of all topical IOP-lowering medications and a significantly greater proportion of FE and SE implant eyes (89.9% and 93.0%) versus sham/timolol eyes (66.9%) were on the same or fewer topical IOP-lowering medications compared with pre-study (p < 0.0001). Furthermore, of subjects on topical IOP medications at screening, a significantly greater proportion of FE implant (80.2%) and SE implant (85.1%) eyes versus sham/timolol (22.8%) eyes were on fewer topical IOP-lowering medications at month 12 compared with pre-study (p < 0.0001). Lastly, of SE implant eyes on same or fewer topical IOP-lowering medications at month 12, the average through month 12 decreased by 0.9 medications, and of those SE implant eyes on fewer topical IOP-lowering medications compared with pre-study, the average through month 12 decreased by 1.4 medications. The most common TEAEs related to study treatment were hyperemia (conjunctival or ocular), iritis, and IOP increased. CONCLUSION The travoprost intracameral implant demonstrated robust IOP-lowering efficacy that was sustained and statistically non-inferior to timolol over the entire 12 months, resulting in a significant reduction in topical IOP-lowering medication use, with the majority of SE implant eyes remaining completely free of all topical IOP-lowering medications. In addition, the implant demonstrated a favorable safety and tolerability profile based on this pooled 12-month analysis of two pivotal trials. TRIAL REGISTRATION ClinicalTrials.gov identifiers NCT03519386 (registered May 09, 2018) and NCT03868124 (registered March 08, 2019).
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Affiliation(s)
- I Paul Singh
- The Eye Centers of Racine and Kenosha, Racine, WI, USA
| | | | | | | | | | - Long V Doan
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, USA
| | | | - Yannan Shen
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, USA
| | - L Jay Katz
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, USA
| | - Angela C Kothe
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, USA
| | - Tomas Navratil
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, USA.
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Sarkisian SR, Ang RE, Lee AM, Berdahl JP, Heersink SB, Burden JH, Doan LV, Stephens KG, Kothe AC, Usner DW, Katz LJ, Navratil T. Phase 3 Randomized Clinical Trial of the Safety and Efficacy of Travoprost Intraocular Implant in Patients with Open-Angle Glaucoma or Ocular Hypertension. Ophthalmology 2024; 131:1021-1032. [PMID: 38423216 DOI: 10.1016/j.ophtha.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To evaluate the safety and intraocular pressure (IOP)-lowering efficacy of 2 models of the travoprost intraocular implant (fast-eluting [FE] and slow-eluting [SE] types) from 1 of 2 phase 3 trials (the GC-010 trial). DESIGN Multicenter, randomized, double-masked, sham-controlled, noninferiority trial. PARTICIPANTS Patients with open-angle glaucoma or ocular hypertension having an unmedicated baseline mean diurnal IOP (average of 8 am, 10 am, and 4 pm time points) of ≥ 21 mmHg, and IOP of ≤ 36 mmHg at each of the 8 am, 10 am, and 4 pm timepoints at baseline. METHODS Study eyes were randomized to the travoprost intraocular implant (FE implant [n = 200] or SE implant [n = 197] model) or to timolol ophthalmic solution 0.5% twice daily (n = 193). MAIN OUTCOME MEASURES The primary outcome was mean change from baseline IOP in the study eye at 8 am and 10 am, at each of day 10, week 6, and month 3. Safety outcomes included adverse events (AEs) and ophthalmic assessments. RESULTS Mean IOP reduction from baseline over the 6 time points ranged from 6.6 to 8.4 mmHg for the FE implant group, from 6.6 to 8.5 mmHg for the SE implant group, and from 6.5 to 7.7 mmHg for the timolol group. The primary efficacy end point was met; the upper limit of the 95% confidence interval of the difference between the implant groups and the timolol group was < 1 mmHg at all 6 time points. Study eye AEs, most of mild or moderate severity, were reported in 21.5%, 27.2%, and 10.8% of patients in the FE implant, SE implant, and timolol groups, respectively. The most common AEs included iritis (FE implant, 0.5%; SE implant, 5.1%), ocular hyperemia (FE implant, 3.0%; SE implant, 2.6%), reduced visual acuity (FE implant, 1.0%; SE implant, 4.1%; timolol, 0.5%), and IOP increased (FE implant, 3.5%; SE implant, 2.6%; timolol, 2.1%). One serious study eye AE occurred (endophthalmitis). CONCLUSIONS The travoprost intraocular implant demonstrated robust IOP reduction over the 3-month primary efficacy evaluation period after a single administration. The IOP-lowering efficacy in both implant groups was statistically and clinically noninferior to that in the timolol group, with a favorable safety profile. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | - James H Burden
- Skyline Vision Clinic and Laser Center, Colorado Springs, Colorado
| | - Long V Doan
- Glaukos Corporation, Aliso Viejo, California
| | | | | | | | - L Jay Katz
- Glaukos Corporation, Aliso Viejo, California
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Dervos T, Fortuna LL, Gugleta K, Scholl HP, Gatzioufas Z, Hasler PW, Arabin V, Enz TJ. Real-world outcomes of micropulse transscleral laser therapy in glaucoma patients: Efficacy of initial and repeated treatment, transient intraocular pressure spikes. Heliyon 2024; 10:e36019. [PMID: 39224325 PMCID: PMC11367502 DOI: 10.1016/j.heliyon.2024.e36019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose To investigate the clinical outcomes of micropulse transscleral laser therapy (MP-TLT) in a cohort of glaucoma patients, including safety profile, post-operative transient intraocular pressure (IOP) spikes, long-term efficacy and prognostic factors in terms of IOP-lowering. Methods This was a retrospective observational cohort study. Medical records of all patients who consecutively underwent MP-TLT between May 2019 and February 2023 at a tertiary referral centre were scrutinised and relevant data were retrospectively analysed. Results A total of 131 patients (138 eyes) with a mean age of 73.2 ± 14.2 years were included. Mean pre-interventional IOP was 24.1 ± 9.1 mmHg. Within 6-12 h following the intervention on the same day, an IOP spike was regularly observed, reaching on average 31.7 ± 10.3 mmHg (p < 0.001 to baseline). Two years after the intervention, mean IOP was 16.1 ± 5.6 mmHg (p < 0.005 to baseline). In 18 eyes, the treatment was repeated, and the IOP lowering effect was more durable after the second intervention compared to the first one (Cox-Mantel test, p=<0.005). Apart from the transient post-interventional IOP spikes, no severe complications were observed. Conclusions MP-TLT is associated with significant IOP spikes in the first post-operative hours. Thus, close post-interventional IOP monitoring or even preventive (additional) IOP-lowering treatment may be considered. In the long term, the procedure yields favourable outcomes in terms of safety and IOP reduction. Repeated MP-TLT treatment, if necessary, seems to achieve more sustained IOP reduction than the initial treatment.
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Affiliation(s)
- Thomas Dervos
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Laura L. Fortuna
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Konstantin Gugleta
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Hendrik P.N. Scholl
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Pascal W. Hasler
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Valentin Arabin
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Tim J. Enz
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
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Fortuna LL, Dervos T, Gatzioufas Z, Scholl HPN, Gugleta K, Enz TJ. Short-Term Effect of Micropulse Transscleral Laser Therapy on Intraocular Pressure in Untreated Fellow Eyes of Glaucoma Patients: Preliminary Results. J Clin Med 2023; 12:jcm12113680. [PMID: 37297875 DOI: 10.3390/jcm12113680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
It has been observed that an intraocular pressure (IOP) altering intervention in one eye is followed by a consensual response in the untreated fellow eye. The underlying mechanisms remain unclear. Involvement of neuronal, cytokine, and hormonal regulation of aqueous humor dynamics, as well as improved treatment adherence or systemic absorption of topically administered medical compounds, have been suggested. Our aim was to investigate the short-term effects of unilateral micropulse transscleral laser therapy on IOP in the fellow eye. All medical records of glaucoma patients who underwent micropulse transscleral laser therapy in a tertiary referral center between May 2019 and February 2023 were collected and analyzed. We found a significant reduction in IOP in the treated eyes, indicating successful treatment. In the fellow eyes, despite not having changed any of the pharmacological IOP-reducing therapies, a significant reduction in IOP from 17.0 ± 5.1 mmHg to 13.5 ± 4.4 mmHg (p < 0.01) was observed. This reduction was, however, short-term and reached statistical significance on the first postoperative day only. Our findings support the concept of consensual inter-eye responses to unilateral IOP changes. Further research is warranted to elucidate the mechanisms underlying this phenomenon.
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Affiliation(s)
- Laura L Fortuna
- Department of Ophthalmology, University Hospital Basel, 4056 Basel, Switzerland
| | - Thomas Dervos
- Department of Ophthalmology, University Hospital Basel, 4056 Basel, Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, 4056 Basel, Switzerland
| | - Hendrik P N Scholl
- Department of Ophthalmology, University Hospital Basel, 4056 Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel, 4056 Basel, Switzerland
| | - Konstantin Gugleta
- Department of Ophthalmology, University Hospital Basel, 4056 Basel, Switzerland
| | - Tim J Enz
- Department of Ophthalmology, University Hospital Basel, 4056 Basel, Switzerland
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Senapati S, Youssef AAA, Sweeney C, Cai C, Dudhipala N, Majumdar S. Cannabidiol Loaded Topical Ophthalmic Nanoemulsion Lowers Intraocular Pressure in Normotensive Dutch-Belted Rabbits. Pharmaceutics 2022; 14:2585. [PMID: 36559077 PMCID: PMC9781840 DOI: 10.3390/pharmaceutics14122585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Cannabidiol (CBD) is the major non-psychoactive and most widely studied of the cannabinoid constituents and has great therapeutic potential in a variety of diseases. However, contradictory reports in the literature with respect to CBD's effect on intraocular pressure (IOP) have raised concerns and halted research exploring its use in ocular therapeutics. Therefore, the current investigation aimed to further evaluate CBD's impact on the IOP in the rabbit model. CBD nanoemulsions, containing Carbopol® 940 NF as a mucoadhesive agent (CBD-NEC), were prepared using hot-homogenization followed by probe sonication. The stability of the formulations post-moist-heat sterilization, in terms of physical and chemical characteristics, was studied for three different storage conditions. The effect of the formulation on the intraocular pressure (IOP) profile in normotensive Dutch Belted male rabbits was then examined. The lead CBD-NEC formulation (1% w/v CBD) exhibited a globule size of 259 ± 2.0 nm, 0.27 ± 0.01 PDI, and 23.2 ± 0.4 cP viscosity, and was physically and chemically stable for one month (last time point tested) at 4 °C, 25 °C, and 40 °C. CBD-NEC significantly lowered the IOP in the treated eyes for up to 360 min, with a peak drop in IOP of 4.5 mmHg observed at the 150 min time point, post-topical application. The IOP of the contralateral eye (untreated) was also observed to be lowered significantly, but the effect lasted up to the 180 min time point only. Overall, topically administered CBD, formulated in a mucoadhesive nanoemulsion formulation, reduced the IOP in the animal model studied. The results support further exploration of CBD as a therapeutic option for various inflammation-based ocular diseases.
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Affiliation(s)
- Samir Senapati
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Ahmed Adel Ali Youssef
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Corinne Sweeney
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Chuntian Cai
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Narendar Dudhipala
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
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Hu K, Vemulapalli K, Gandhewar R, Shah A, Virgili G, Bunce C, Gazzard G. Minimally invasive trabecular meshwork surgery for open-angle glaucoma. Hippokratia 2022. [DOI: 10.1002/14651858.cd015186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kuang Hu
- Glaucoma Service; Moorfields Eye Hospital NHS Foundation Trust; London UK
- UCL Institute of Ophthalmology; London UK
| | | | | | - Anupa Shah
- Cochrane Eyes and Vision, Centre for Public Health; Queen's University Belfast; Belfast UK
| | - Gianni Virgili
- Cochrane Eyes and Vision, Centre for Public Health; Queen's University Belfast; Belfast UK
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA); University of Florence; Florence Italy
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust; London UK
| | - Gus Gazzard
- Glaucoma Service; Moorfields Eye Hospital NHS Foundation Trust; London UK
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7
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Nassiri N, Mei F, Tokko H, Zeiter J, Syeda S, Kim C, Swendris R, Goyal A, Veld EI, Mas-Ramirez A, Rana SW, Juzych MS, Hughes BA. Consensual Ophthalmotonic Reaction Following Selective Laser Trabeculoplasty. J Curr Glaucoma Pract 2022; 16:36-40. [PMID: 36060042 PMCID: PMC9385382 DOI: 10.5005/jp-journals-10078-1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nariman Nassiri
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
- Nariman Nassiri, Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States, Phone: +1 313-577-7615, e-mail:
| | - Frank Mei
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Hassan Tokko
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - John Zeiter
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Sarah Syeda
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Chaesik Kim
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Ronald Swendris
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Anju Goyal
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Elise In'T Veld
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Alma Mas-Ramirez
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Sonia W Rana
- Department of Ophthalmology, Lansing Ophthalmology Eye Care, East Lansing, Michigan, United States
| | - Mark S Juzych
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
| | - Bret A Hughes
- Department of Ophthalmology, Kresge Eye Institute, Detroit, Michigan, United States
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Meshksar A, Hajizadeh M, Sharifipour F, Yazdani S, Pakravan M, Kheiri B. Intraocular Pressure Changes in the Contralateral Eye After Glaucoma Surgery. J Glaucoma 2021; 30:1074-1081. [PMID: 34628431 DOI: 10.1097/ijg.0000000000001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
PRCIS Glaucoma surgery in 1 eye can result in significant intraocular pressure (IOP) elevation in the fellow eye in a significant percentage of subjects. This effect is more pronounced following glaucoma drainage device implantation and in subjects developing postoperative hypotony in the first eye. PURPOSE The aim was to investigate the course and magnitude of IOP changes in contralateral eyes following glaucoma surgery. PATIENTS AND METHODS We studied 131 glaucoma patients undergoing surgery. IOP changes in fellow eyes and the number of glaucoma medications were recorded for 6 months. Both normal and glaucomatous fellow eyes were included. Patients on preoperative acetazolamide were analyzed separately. IOP change ≥4 mm Hg or 20% increase from baseline values was considered significant. RESULTS Baseline IOP in fellow eyes was 13.1±3.3 mm Hg which increased significantly at all-time points with a peak at 1 week (mean increase: 3.1±3.2 mm Hg) gradually decreasing up to 6 months (mean increase 0.9±2.1 mm Hg). The number of fellow eyes with clinically significant IOP elevation at 1 day, 1 week, and 1, 3. and 6 months was 47, 76, 47, 31, and 37 showing mean IOP rise of 4.5±2.3 (38.5%), 5.4±1.8 (48.5%), 4.8±1.6 (44.2%), 3.7±1.3 (36.5%), and 3.2±1.3 (32.6%) mm Hg, respectively. Medications were added to 18 fellow eyes (including 10 initially "normal" eyes) while 7 other fellow eyes required surgery.Significant IOP elevation in fellow eyes was associated with tube shunt surgery (P<0.008 at all-time points), a diagnosis of glaucoma following cataract surgery, IOP ≤5 mm Hg on the first postoperative day (P=0.002) and use of preoperative acetazolamide. CONCLUSION Glaucoma surgery was associated with IOP elevation in fellow eyes in a significant number of subjects and suggests that IOP in the unoperated eye should also be checked at postoperative visits.
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Affiliation(s)
- Aidin Meshksar
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences
- Department of Ophthalmology and Poostchi Ophthalmology Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz
| | - Maryam Hajizadeh
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Farideh Sharifipour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences
- Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences
- Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Pakravan
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences
- Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences
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Pandit R, George RJ, Lingam V, Balekudaru S. Incidence of presumed steroid response in contralateral eye of patients who underwent glaucoma filtration surgery. Indian J Ophthalmol 2021; 69:2481-2483. [PMID: 34427248 PMCID: PMC8544061 DOI: 10.4103/ijo.ijo_3069_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to report the incidence of presumed steroid response in contralateral eye of patients who underwent glaucoma filtration surgery. METHODS We reviewed records of 298 glaucoma patients (147 PACG [primary angle-closure glaucoma], 129 POAG [primary open-angle glaucoma], and 22 JOAG [juvenile open-angle glaucoma]) who underwent either trabeculectomy alone or trabeculectomy with cataract extraction. All patients received prednisolone acetate 1% eye drop postoperatively in the operated eye for up to 6 to 8 weeks. The contralateral eye received the same antiglaucoma medications as before. Information collected included age, sex, number of antiglaucoma medications in the fellow eye preoperatively, and VFI (visual field index). The preoperative intraocular pressure (IOP) in the contralateral eye was taken as the baseline. The maximum IOP recorded postoperatively up to a follow-up period of 6 to 8 weeks was noted. A steroid response was defined as rise in the IOP by ≥6 mmHg. RESULTS In this study, 298 eyes of 298 glaucoma patients were included. The mean age of patients was 60.1 ± 13.7 years. The mean number of antiglaucoma medications in the fellow eye pre-operatively was 2.4 ± 1.2. Mean preoperative and postoperative IOP in the fellow eye were 17.46 ± 7 and 19.37 ± 7.1 mmHg, respectively. Sixty-three eyes out of 298 eyes (21.14%) showed a rise in IOP by 6 mmHg. The maximum IOP difference noted was 15 mmHg. The average time interval to the defined steroid response was 16.13 days. The majority showed a steroid response within 19 days. CONCLUSION Steroid response is a significant factor leading to elevated IOP postoperatively in the contralateral eye as well.
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Affiliation(s)
- Rinal Pandit
- Department of Glaucoma, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie J George
- Department of Glaucoma, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vijaya Lingam
- Department of Glaucoma, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Magnesium Hydroxide Nanoparticles Improve the Ocular Hypotensive Effect of Twice Daily Topical Timolol Maleate in Healthy Dogs. Vet Sci 2021; 8:vetsci8080168. [PMID: 34437490 PMCID: PMC8402916 DOI: 10.3390/vetsci8080168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/03/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
Timolol maleate (TM), a beta-adrenergic receptor antagonist, is widely used for canine antiglaucoma eye drops; however, its bioavailability is <5%. Our previous study revealed that magnesium hydroxide nanoparticles (nMH) have potency in improving the bioavailability of fixed-combined TM in rodent models. This study aimed to investigate whether the fixed combination with nMH improves the ocular hypotensive effect of TM and affects pupil size (PS), heart rate (HR), and mean arterial pressure (MAP) in clinically healthy dogs. Five clinically healthy dogs were administered topical saline, commercial 0.5% TM, and a 0.01% or 0.1% nMH–0.5% TM fixed combination (0.01% or 0.1% nMH–TM) twice daily in one eye for 7 days with at least a 28-day interval. The changes from baseline were calculated and were statistically analyzed for each drug. IOP was significantly reduced in both 0.01% and 0.1% nMH–TM-treated-dogs compared with saline- and TM-treated dogs. Meanwhile, 0.01% and 0.1% nMH did not exacerbate the side effects of TM. From these results, nMH improved the ocular hypotensive effect of TM without enhancing side effects. Topical nMH–TM is potentially more effective for canine ocular hypotensive eye drops than TM.
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Liu C, Umapathi RM, Atalay E, Schmetterer L, Husain R, Boey PY, Aung T, Nongpiur ME. The Effect of Medical Lowering of Intraocular Pressure on Peripapillary and Macular Blood Flow as Measured by Optical Coherence Tomography Angiography in Treatment-naive Eyes. J Glaucoma 2021; 30:465-472. [PMID: 33675336 DOI: 10.1097/ijg.0000000000001828] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Reduction of intraocular pressure (IOP) by latanoprost in treatment-naive eyes is significantly correlated to an increase in vessel density (VD) at the optic nerve head (ONH). PURPOSE To evaluate the effect of topical latanoprost on ocular microvasculature using optical coherence tomography angiography (OCTA). PATIENTS AND METHODS In this prospective case-control study, 26 eyes from 18 treatment-naive subjects in whom prostaglandin analogue (PGA) latanoprost 0.005% was initiated were included as cases. In 10 out of the 18 subjects, medication was initiated in only 1 eye; their contralateral untreated eyes were used as controls. OCTA (AngioVue, Optovue Inc., Fremont, CA) was performed at baseline and ≥3 weeks after commencing treatment. Main outcome measures were change in flow area and VD at the ONH, radial peripapillary capillaries (RPC), and macula. Comparison between the 2 visits was performed using a linear mixed model adjusted for intereye correlation and mean ocular perfusion pressure. RESULTS IOP decreased by 26.1%±11.3% (P<0.001) in the cases and 0.18%±12.2% (P=0.63) in controls. Significant correlations between change in IOP and change in ONH VD (correlation coefficient [r]=-0.42, P=0.04), and between change in IOP and change in RPC VD (r=-0.48, P=0.02) were observed in the cases, whereas none were observed in the controls. When multiple testing was considered, no significant changes in flow area and VD were observed in cases and controls. CONCLUSIONS The reduction of IOP by a PGA in treatment-naive eyes was significantly correlated to the increase in ONH VD and RPC VD. This may indicate a mechanism by which IOP reduction modulates the risk of glaucoma progression by improving ocular microperfusion.
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Affiliation(s)
- Chang Liu
- Singapore Eye Research Institute, Singapore National Eye Centre
| | | | - Eray Atalay
- Department of Ophthalmology, Eskişehir Osmangazi University, Medical School, Eskişehir, Turkey
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre
- Duke-NUS Graduate Medical School
- School of Chemical and Biomedical Engineering, Nanyang Technological University
- SERI-NTU Advanced Ocular Engineering (STANCE)
- Department of Clinical Pharmacology
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Wien, Austria
- Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre
| | - Pui Yi Boey
- Singapore Eye Research Institute, Singapore National Eye Centre
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre
- Duke-NUS Graduate Medical School
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre
- Duke-NUS Graduate Medical School
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12
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Sandhu A, Jayaram H, Hu K, Bunce C, Gazzard G. Ab interno supraciliary microstent surgery for open-angle glaucoma. Cochrane Database Syst Rev 2021; 5:CD012802. [PMID: 34049422 PMCID: PMC8163518 DOI: 10.1002/14651858.cd012802.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Glaucoma is the leading cause of global irreversible blindness, often associated with raised intraocular pressure (IOP). Where medical or laser treatment has failed or is not tolerated, surgery is often required. Minimally-invasive surgical approaches have been developed in recent years to reduce IOP with lower surgical risks. Supraciliary microstent surgery for the treatment of open-angle glaucoma (OAG) is one such approach. OBJECTIVES To evaluate the efficacy and safety of supraciliary microstent surgery for the treatment of OAG, and to compare with standard medical, laser or surgical treatments. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2020, Issue 8); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 27 August 2020. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of supraciliary microstent surgery, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts from the database search to identify studies that met the selection criteria. Data extraction, analysis, and evaluation of risk of bias from selected studies was performed independently and according to standard Cochrane methodology. MAIN RESULTS One study met the inclusion criteria of this review, evaluating the efficacy and safety of the Cypass supraciliary microstent surgery for the treatment of OAG, comparing phacoemulsification + supraciliary microstent surgery with phacoemulsification alone over 24 months. This study comprised 505 eyes of 505 participants with both OAG and cataract, 374 randomised to the phacoemulsification + microstent group. In this study, the perceived risk of bias from random sequence generation, allocation concealment and selective reporting was low. However, we considered the study to be at high risk of performance bias as surgeons/investigators were unmasked. Attrition bias was unclear, with 448/505 participants contributing to per protocol analysis. Insertion of a Cypass supraciliary microstent combined with phacoemulsification probably increases the proportion of participants who are medication-free (not using eye-drops) at 24 months compared with phacoemulsification alone (85% versus 59%, risk ratio (RR) 1.27, 95% confidence interval (CI) 1.09 to 1.49, moderate-certainty evidence). There is high-certainty evidence that a greater improvement in mean IOP occurs in the phacoemulsification + microstent group - mean (SD) change in IOP from baseline of -5.4 (3.9) mmHg in the phacoemulsification group, compared to -7.4 (4.4) mmHg in the phacoemulsification + microstent group at 24 months (mean difference -2.0 mmHg, 95% CI -2.85 to -1.15). There is moderate-certainty evidence that insertion of a microstent is probably associated with a greater reduction in use of IOP-lowering drops (mean reduction of 0.7 medications in the phacoemulsification group, compared to a mean reduction of 1.2 medications in the phacoemulsification + microstent group). Insertion of a microstent during phacoemulsification may reduce the requirement for further glaucoma intervention to control IOP at a later stage compared to phacoemulsification alone (RR 0.26, 95% CI 0.07 to 1.04, low-certainty evidence). There is no evidence relating to the rate of visual field progression, or proportion of participants whose visual field loss progressed in this study. There is moderate-certainty evidence showing little or no difference in the proportion of participants experiencing postoperative complications over 24 months between participants in the microstent group compared to those who received phacoemulsification alone (RR 1.1, 95% CI 0.8 to 1.4). Five year post-approval data regarding the safety of the Cypass supraciliary microstent showed increased endothelial cell loss, associated with the position of the microstent in the anterior chamber. There were no reported health-related quality of life (HRQoL) outcomes in the included study. AUTHORS' CONCLUSIONS Data from this single RCT show superiority of supraciliary microstent surgery when combined with phacoemulsification compared to phacoemulsification alone in achieving medication-free control of OAG. However, there are long-term safety concerns with the device used in this trial, relating to the observed significant loss of corneal endothelial cells at five years following device implantation. At the time of this review, this device has been withdrawn from the market. This review has found that few high-quality studies exist comparing supraciliary microstent surgery to standard medical, laser or surgical glaucoma treatments. This should be addressed by further appropriately designed RCTs with sufficient long-term follow-up to ensure robust safety data are obtained. Consideration of health-related quality of life outcomes should also feature in trial design.
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Affiliation(s)
- Amanjeet Sandhu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, UK
| | - Kuang Hu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, UK
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13
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Aghayeva FA, Chronopoulos P, Schuster AK, Pfeiffer N, Hoffmann EM. Inter-eye relationship of intraocular pressure change after unilateral trabeculectomy, filtering canaloplasty, or PreserFlo™ microshunt implantation. Graefes Arch Clin Exp Ophthalmol 2021; 259:3045-3053. [PMID: 33963917 PMCID: PMC8478758 DOI: 10.1007/s00417-021-05188-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study assesses short-term intraocular pressure (IOP) change in the fellow eye of glaucoma patients after mitomycin C-augmented trabeculectomy, filtering canaloplasty, or PreserFlo™ microshunt implantation in the treated eye. MATERIALS AND METHODS Retrospective chart review of 235 glaucoma patients (235 eyes) was performed. Patients underwent initial trabeculectomy (187 patients), filtering canaloplasty (25 patients), or PreserFlo™ microshunt implantation (23 patients) in one eye, while the fellow eye was naïve to any previous glaucoma surgery. IOP was evaluated before and on the 1st and 2nd days and at 1 week after surgery. Main outcome measure was IOP change in the fellow eye. Secondary outcomes were proportion of clinically significant IOP elevation in the fellow eye and evaluation of potential risk factors associated with postoperative IOP fluctuation. RESULTS IOP in the fellow eye at 1 week after trabeculectomy was statistically significantly lower than preoperatively (p < 0.0001), while the IOP did not change significantly in the fellow eyes in filtering canaloplasty or PreserFlo groups. The higher the preoperative IOP was in the fellow eye, the larger was the intraocular pressure-lowering effect at 1 week after trabeculectomy (p < 0.0001). A clinically significant IOP elevation was noted in 14.2%, 9.5%, and 5% of fellow eyes after trabeculectomy, filtering canaloplasty, or PreserFlo™ microshunt implantation, respectively. CONCLUSIONS This study shows an IOP-lowering effect in the fellow eye of glaucoma patients after trabeculectomy. Significant IOP rise might occur in the fellow eye of some glaucoma patients after different types of glaucoma surgery.
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Affiliation(s)
- Fidan A Aghayeva
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan
| | - Panagiotis Chronopoulos
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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14
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Alward WL. The Invisible Paper that Shook Ophthalmology. Am J Ophthalmol 2021; 225:185-186. [PMID: 32919616 DOI: 10.1016/j.ajo.2020.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
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15
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Hu K, Shah A, Virgili G, Bunce C, Gazzard G. Ab interno trabecular bypass surgery with Trabectome for open-angle glaucoma. Cochrane Database Syst Rev 2021; 2:CD011693. [PMID: 33580495 PMCID: PMC8094917 DOI: 10.1002/14651858.cd011693.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Glaucoma is the leading cause of irreversible blindness. Minimally invasive surgical techniques, such as ab interno trabecular bypass surgery, have been introduced to prevent glaucoma from progressing. OBJECTIVES: In light of the potential benefits for people with open-angle glaucoma and the widespread uptake of the technique, it is important to critically evaluate the evidence for whether treatment with ab interno trabecular bypass surgery with Trabectome is both efficacious and safe. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2020, Issue 7); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 17 July 2020. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of ab interno trabecular bypass surgery with Trabectome compared to other surgical treatments (other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment, or medical treatment. We also included trials in which these devices were combined with phacoemulsification compared to phacoemulsification in combination with other glaucoma surgery or alone. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcome was proportion of participants who were medication-free (not using eye drops). Secondary outcomes included mean change in intraocular pressure (IOP), proportion of participants who required further glaucoma surgery, mean change in quality of life, proportion of participants who achieved an IOP of 21 mmHg or less, 17 mmHg or less, or 14 mmHg or less and rate of visual field progression. Adverse effects were the proportion of participants experiencing intra- and postoperative complications. All outcomes were measured in the short term (6 to 18 months), medium term (18 to 36 months), and long term (36 months or longer). MAIN RESULTS In this update, we included one RCT which had previously been identified as an ongoing study in our 2016 publication. This trial was a single-centre, single-surgeon RCT set in Canada with 19 participants. Participants were adults who had open-angle glaucoma, open angles, and had inadequately controlled IOP that required surgical intervention. The study was terminated before the intended sample size was reached 'due to slow recruitment and increasing lack of clinical equipoise over time'. This reduced the power of the study to detect clinically important effects. We assessed the trial as being at high risk of attrition, reporting, and other potential sources of biases. The risks of performance and detection bias are unclear. The intervention group of 10 people had Trabectome ab interno trabeculotomy combined with cataract extraction (phaco-AIT) and the comparator group of 9 people had trabeculectomy with mitomycin C combined with cataract extraction (phaco-Trab), one of whom was lost to follow-up. Seven of 10 participants in the phaco-AIT group and 4 of 8 in the phaco-Trab group were medication-free (not using drops) at 12 months (odds ratio (OR) 2.33, 95% confidence interval (CI) 0.34 to 16.2; very low-certainty evidence). At 12 months, the mean change in IOP was worse for phaco-AIT than for phaco-Trab, but this evidence was very uncertain (mean difference (MD) 3.70 mmHg, 95% CI -1.44 to 8.84; very low-certainty evidence) in the phaco-AIT group, as was the difference in the mean number of IOP-lowering drops taken per day (MD -0.41, 95% CI -1.22 to 0.40; very low-certainty evidence). Only one participant in the phaco-AIT group required further glaucoma surgery. The study protocol declared that quality of life and visual field progression were measured, but they were not reported All 8 participants with complete data in the phaco-Trab group and 8 of 10 in the phaco-AIT had at least one early or late postoperative complication (e.g. day 1 IOP spike, hypotony, choroidal effusion, bleb leak or encapsulation, uveitis, or peripheral anterior synechiae). The evidence was very low-certainty due to high risk of bias for several domains for this study and for large imprecision of all estimates. We also identified one ongoing study, identified from the International Clinical Trials Registry Platform (ICTRP): a multicentre, open, RCT comparing Trabectome to ab interno trabeculectomy using microhook. The study investigators plan to recruit 120 adults between 20 and 90 years of age. The primary outcome is duration of treatment success. Secondary outcomes include postoperative IOP, number of anti-glaucoma medications, and adverse events. AUTHORS' CONCLUSIONS There is currently no high-quality evidence for the outcomes of ab interno trabecular bypass surgery with Trabectome for open-angle glaucoma. Properly designed RCTs are needed to assess the long-term efficacy and safety of this technique.
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Affiliation(s)
- Kuang Hu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Anupa Shah
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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16
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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17
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Gedde SJ, Lind JT, Wright MM, Chen PP, Muir KW, Vinod K, Li T, Mansberger SL. Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern®. Ophthalmology 2021; 128:P151-P192. [DOI: 10.1016/j.ophtha.2020.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
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18
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Intraocular pressure change with face-down positioning after macular hole surgery. PLoS One 2020; 15:e0242567. [PMID: 33201931 PMCID: PMC7671540 DOI: 10.1371/journal.pone.0242567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
This study evaluated changes in intraocular pressure (IOP) with face-down positioning (FDP) following surgical treatment of idiopathic macular hole. We retrospectively reviewed the records of 130 patients diagnosed with idiopathic macular hole who underwent pars plana vitrectomy (PPV) with intravitreal gas injection after fluid-gas exchange. We analyzed IOP changes in both eyes following FDP over the course of 7 days. The mean IOP of the operated eyes was 14.98±2.95 mmHg preoperatively and 16.82±3.12 and 15.57±6.10 mmHg on postoperative days 2 and 7, respectively. In contralateral eyes, the mean IOP changed from 14.78±3.15 mmHg preoperatively to 16.27±1.87 and 14.40±4.14 mmHg on postoperative days 2 and 7, respectively. On postoperative day 2, the IOP increased in both eyes compared to the preoperative values, but the increase was significant only in operated eyes (p = 0.039). In contralateral eyes, the IOP on postoperative day 7 was significantly decreased compared with that on postoperative day 2 (p = 0.021) and in eyes with an axial length ≥ 23.0 mm, compared with the preoperative values (p = 0.042). The IOP of the operated eyes on postoperative day 7 was higher than that of the contralateral eyes (p = 0.039). Based on a short-term follow-up, FDP after PPV with intravitreal gas tamponade for the treatment of idiopathic macular hole may cause IOP elevation not only in the operated, but also in the contralateral eyes; the IOP increase in contralateral eyes was not as significant as that in operated eyes and was not maintained over 7 days after surgery; the IOP change seems to be affected by axial length and lens status.
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19
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Chan ASY, Tun TA, Allen JC, Lynn MN, Tun SBB, Barathi VA, Girard MJA, Aung T, Aihara M. Longitudinal assessment of optic nerve head changes using optical coherence tomography in a primate microbead model of ocular hypertension. Sci Rep 2020; 10:14709. [PMID: 32895414 PMCID: PMC7477239 DOI: 10.1038/s41598-020-71555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022] Open
Abstract
In humans, the longitudinal characterisation of early optic nerve head (ONH) damage in ocular hypertension (OHT) is difficult as patients with glaucoma usually have structural ONH damage at the time of diagnosis. Previous studies assessed glaucomatous ONH cupping by measuring the anterior lamina cribrosa depth (LCD) and minimal rim width (MRW) using optical coherence tomography (OCT). In this study, we induced OHT by repeated intracameral microbead injections in 16 cynomolgus primates (10 unilateral; 6 bilateral) and assessed the structural changes of the ONH longitudinally to observe early changes. Elevated intraocular pressure (IOP) in OHT eyes was maintained for 7 months and serial OCT measurements were performed during this period. The mean IOP was significantly elevated in OHT eyes when compared to baseline and compared to the control eyes. Thinner MRW and deeper LCD values from baseline were observed in OHT eyes with the greatest changes seen between month 1 and month 2 of OHT. Both the mean and maximum IOP values were significant predictors of MRW and LCD changes, although the maximum IOP was a slightly better predictor. We believe that this model could be useful to study IOP-induced early ONH structural damage which is important for understanding glaucoma pathogenesis.
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Affiliation(s)
- Anita S Y Chan
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,Department of Ophthalmology, University of Tokyo, Tokyo, Japan.
| | - Tin Aung Tun
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore, Singapore
| | | | - Myoe Naing Lynn
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Sai Bo Bo Tun
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michaël J A Girard
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
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20
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Kim JS, Choi HJ, Park KH. Glaucoma conversion of the contralateral eye in unilateral normal-tension glaucoma patients: a 5-year follow-up study. Br J Ophthalmol 2020; 105:1383-1389. [PMID: 32892166 DOI: 10.1136/bjophthalmol-2020-316371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/23/2020] [Accepted: 08/16/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To investigate clinical characteristics and risk factors for glaucoma conversion of the contralateral eye in unilateral normal-tension glaucoma (NTG) patients. METHODS A retrospective observational cohort study was conducted on a total of 76 subjects who had been diagnosed with unilateral NTG at the baseline and followed up for more than 5 years. Glaucoma conversion in the contralateral eye was defined as increased thinning of neuro-retinal rim, development of retinal nerve fibre layer defect and/or development of glaucomatous visual field defect. RESULTS During the mean follow-up period of 7.3±2.4 years, 21 of 76 (27.6%) subjects were confirmed to have developed glaucoma in the non-glaucomatous contralateral eye. The 5-year rate of glaucoma conversion in contralateral eyes was 19.7%. The maximum width of β-zone parapapillary atrophy (MWβPPA)-disc diameter (DD) ratio at the baseline and the presence rate of disc haemorrhage during follow-up period were significantly greater in the contralateral eyes of the conversion group than in those of the non-conversion group (p=0.011, <0.001, respectively). A multivariate Cox-proportional hazard model revealed intraocular pressure (IOP) over 17 mm Hg (HR 5.05, p=0.031), central corneal thickness (CCT) under 491 μm (HR 4.25, p=0.025) and MWβPPA-DD ratio over 0.32 (HR 6.25, p=0.003) in contralateral eye at the baseline as the independent risk factors for glaucoma conversion. CONCLUSIONS Among unilateral NTG patients, those with low CCT and high MWβPPA-DD ratio as well as high IOP in the contralateral eye are more likely to develop glaucoma in that eye during long-term follow-up.
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Affiliation(s)
- Jin-Soo Kim
- Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea (the Republic of)
| | - Hyuk Jin Choi
- Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of) .,Ophthalmolgy, Seoul National University Hospital, Seoul, Korea (the Republic of).,Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea (the Republic of)
| | - Ki Ho Park
- Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Ophthalmolgy, Seoul National University Hospital, Seoul, Korea (the Republic of)
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21
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Intereye Symmetry of 24-Hour Intraocular Pressure-related Patterns in Untreated Glaucoma Patients Using a Contact Lens Sensor. J Glaucoma 2020; 29:666-670. [PMID: 32487950 DOI: 10.1097/ijg.0000000000001563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Scarce data are available on the symmetry of 24-hour intraocular pressure (IOP) variations between fellow eyes of glaucoma patients, and such evidence could have profound consequences on the interpretation of monocular therapeutic trials. The objective is to evaluate the intereye correlation of continuously measured circadian IOP-related patterns in untreated glaucoma patients. METHODS In this single-center prospective study, a total of 29 untreated patients with open-angle glaucoma underwent bilateral ambulatory 24-hour monitoring of IOP-related patterns using a contact lens sensor (CLS; SENSIMED Triggerfish). IOP was measured before and after CLS monitoring using Goldmann applanation tonometry. Intereye agreement of 24-hour patterns was calculated using Spearman correlation (r) of raw data and after cosinor rhythmometry modeling. RESULTS Complete bilateral CLS data could be obtained in 20 patients (mean age: 55.5±15.7 y; 51.7% women). On average, intereye correlation was r=0.76±0.19 (range: 0.16 to 0.95) and r=0.77±0.15 (range: 0.49 to 0.91), after excluding 8 patients with lower quality recordings. Cosine rhythmometry modeling showed mean acrophases occurring at 4:21±2:20 AM in left eyes and 3:39±1:50 AM in right eyes (r=0.48; P=0.034). Mean acrophase amplitude was 110.9±51.9 for left eyes and 107.8±46.2 for right eyes (r=0.79; P<0.001). No serious adverse events related to CLS monitoring were recorded. Transient conjunctival hyperemia (13 patients) and blurred vision (11 patients) were the most frequent adverse events. CONCLUSIONS In this group of untreated glaucoma patients, there was good intereye agreement for circadian IOP-related patterns using the CLS. These results show a higher degree of intereye symmetry, in terms of IOP peak timings and amplitudes, than previously reported with standard tonometry.
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22
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Otarola F, Virgili G, Shah A, Hu K, Bunce C, Gazzard G. Ab interno trabecular bypass surgery with Schlemm´s canal microstent (Hydrus) for open angle glaucoma. Cochrane Database Syst Rev 2020; 3:CD012740. [PMID: 32147807 PMCID: PMC7061024 DOI: 10.1002/14651858.cd012740.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Glaucoma is a leading cause of irreversible blindness. A number of minimally-invasive surgical techniques have been introduced as a treatment to prevent glaucoma from progressing; ab interno trabecular bypass surgery with the Schlemm's canal Hydrus microstent is one of them. OBJECTIVES To evaluate the efficacy and safety of ab interno trabecular bypass surgery with the Hydrus microstent in treating people with open angle glaucoma (OAG). SEARCH METHODS On 7 May 2019, we searched CENTRAL (2019, Issue 5), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov; and the WHO ICTRP. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of the Hydrus microstent, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimally-invasive glaucoma device techniques, trabeculectomy), laser treatment, or medical treatment. DATA COLLECTION AND ANALYSIS A minimum of three authors independently extracted data from reports of included studies, using a data collection form and analysed data, based on standard Cochrane methods. MAIN RESULTS We included three published studies, with 808 people randomised. Two studies had multiple international recruitment centres in the USA and other countries. The third study had several sites based in Europe. All three studies were sponsored by the Hydrus manufacturer Ivantis Inc. All studies included participants with mainly mild or moderate OAG (mean deviation between -3.6 dB (decibel) and -8.4 dB in all study arms), which was controlled with medication in many participants (mean medicated intraocular pressure (IOP) 17.9 mmHg to 19.1 mmHg). There were no concerns regarding allocation concealment bias, but masking of outcome assessors was high or unclear risk in all studies; masking of participants was achieved, and losses to follow-up were not a concern. Two studies compared the Hydrus microstent combined with cataract surgery to cataract surgery alone, in participants with visually significant cataracts and OAG. We found moderate-certainty evidence that adding the Hydrus microstent to cataract surgery increased the proportion of participants who were medication-free from about half to more than three quarters at 12-month, short-term follow-up (risk ratio (RR) 1.59, 95% confidence interval (CI) 1.39 to 1.83; 2 studies, 639 participants; I² = 0%; and 24-month, medium-term follow-up (RR 1.63, 95% CI 1.40 to 1.88; 2 studies, 619 participants; I² = 0%). The Hydrus microstent combined with cataract surgery reduced the medium-term mean change in unmedicated IOP (after washout) by 2 mmHg more compared to cataract surgery alone (mean difference (MD) -2.00, 95% CI -2.69 to -1.31; 2 studies, 619 participants; I² = 0%; moderate-certainty evidence), and the mean change in IOP-lowering drops (MD -0.41, 95% CI -0.56 to -0.27; 2 studies, 619 participants; I² = 0%; low-certainty evidence). We also found low-certainty evidence that adding a Hydrus microstent to cataract surgery reduced the need for secondary glaucoma surgery from about 2.5% to less than 1% (RR 0.17, 95% CI 0.03 to 0.86; 2 studies, 653 participants; I² = 27%; low-certainty evidence). Intraocular bleeding, loss of 2 or more visual acuity (VA) lines, and IOP spikes of 10 mmHg or more were rare in both groups; estimates were imprecise, and included both beneficial and harmful effects. There were no cases of endophthalmitis in either group. No data were available on the proportion of participants achieving IOP less than 21 mmHg, 17 mmHg, or 14 mmHg; health-related quality of life (HRQOL), or visual field progression. One study provided short-term data for the Hydrus microstent compared with the iStent trabecular micro-bypass stent (iStent: implantation of two devices in a single procedure) in 152 participants with OAG (148 in analyses). Use of the Hydrus increased the proportion of medication-free participants from about a quarter to about half compared to those who received iStent, but this estimate was imprecise (RR 1.94, 95% CI 1.21 to 3.11; low-certainty evidence). Use of the Hydrus microstent reduced unmedicated IOP (after washout) by about 3 mmHg more than the iStent (MD -3.10, 95% CI -4.17 to -2.03; moderate-certainty evidence), and the use of IOP-lowering medication (MD -0.60, 95% CI -0.99 to -0.21; low-certainty evidence). Both devices achieved a final IOP < 21 mmHg in most participants (Hydrus microstent: 91.8%; iStent: 84%; RR 1.09, 95% CI 0.97 to 1.23; low-certainty evidence). None of the participants who received the Hydrus microstent (N = 74) required additional glaucoma surgery; two participants who received the iStent (N = 76) did. Few adverse events were found in either group. No data were available on the proportion of participants achieving IOP less than 17 mmHg or 14 mmHg, or on HRQOL. AUTHORS' CONCLUSIONS In people with cataracts and generally mild to moderate OAG, there is moderate-certainty evidence that the Hydrus microstent with cataract surgery compared to cataract surgery alone, likely increases the proportion of participants who do not require IOP lowering medication, and may further reduce IOP at short- and medium-term follow-up. There is moderate-certainty evidence that the Hydrus microstent is probably more effective than the iStent in lowering IOP of people with OAG in the short-term. Few studies were available on the effects of the Hydrus microstent, therefore the results of this review may not be applicable to all people with OAG, particularly in selected people with medically uncontrolled glaucoma, since IOP was controlled with medication in many participants in the included studies. Complications may be rare using the Hydrus microstent, as well as the comparator iStent, but larger studies are needed to investigate its safety.
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Affiliation(s)
- Francisco Otarola
- Moorfields Eye Hospital NHS Foundation TrustGlaucoma Service162 City RoadLondonUKEC1V 2PD
- Clínica las CondesCentro de la VisiónSantiagoChile
| | - Gianni Virgili
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Palagi, 1FlorenceItaly50134
| | - Anupa Shah
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Kuang Hu
- Moorfields Eye Hospital NHS Foundation TrustGlaucoma Service162 City RoadLondonUKEC1V 2PD
| | - Catey Bunce
- King's College LondonSchool of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine4th Floor, Addison HouseGuy's CampusLondonUKSE1 1UL
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation TrustGlaucoma Service162 City RoadLondonUKEC1V 2PD
- Institute of Ophthalmology UCL & NIHR Biomedical Research CentreLondonUKEC1V 2PD
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Wang LZ, Syn N, Li S, Barathi VA, Tong L, Neo J, Beuerman RW, Zhou L. The penetration and distribution of topical atropine in animal ocular tissues. Acta Ophthalmol 2019; 97:e238-e247. [PMID: 30259687 DOI: 10.1111/aos.13889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To conduct a multi-tissue investigation on the penetration and distribution of topical atropine in myopia treatment, and determine if atropine is detectable in the untreated contralateral eye after uniocular instillation. METHODS Nine mature New Zealand white rabbits were evenly divided into three groups. Each group was killed at 5, 24 and 72 hr, respectively, following uniocular instillation of 0.05 ml of 1% atropine. Tissues were sampled after enucleation: conjunctiva, sclera, cornea, iris, ciliary body, lens, retina, aqueous, and vitreous humors. The assay for atropine was performed using liquid chromatography-mass spectrometry (LC-MS), and molecular tissue distribution was illustrated using matrix-assisted laser desorption ionization-imaging mass spectrometry (MALDI-IMS) via an independent experiment on murine eyes. RESULTS At 5 hr, the highest (mean ± SEM) concentration of atropine was detected in the conjunctiva (19.05 ± 5.57 ng/mg, p < 0.05) with a concentration gradient established anteriorly to posteriorly, as supported by MALDI-IMS. At 24 hr, preferential binding of atropine to posterior ocular tissues occurred, demonstrating a reversal of the initial concentration gradient. Atropine has good ocular bioavailability with concentrations of two magnitudes higher than its binding affinity in most tissues at 3 days. Crossing-over of atropine to the untreated eye occurred within 5 hr post-administration. CONCLUSION Both transcorneal and transconjunctival-scleral routes are key in atropine absorption. Posterior ocular tissues could be important sites of action by atropine in myopic reduction. In uniocular atropine trials, cross-over effects on the placebo eye should be adjusted to enhance results reliability. Combining the use of LC-MS and MALDI-IMS can be a viable approach in the study of the ocular pharmacokinetics of atropine.
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Affiliation(s)
- Louis Zizhao Wang
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
| | - Shiya Li
- Dyson School of Design Engineering Imperial College London London UK
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
| | - Louis Tong
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
- Singapore National Eye Centre Singapore city Singapore
| | | | - Roger W. Beuerman
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
| | - Lei Zhou
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
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Tóth M, Shah A, Hu K, Bunce C, Gazzard G. Endoscopic cyclophotocoagulation (ECP) for open angle glaucoma and primary angle closure. Cochrane Database Syst Rev 2019; 2:CD012741. [PMID: 30801132 PMCID: PMC6388466 DOI: 10.1002/14651858.cd012741.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Glaucoma is a leading cause of irreversible blindness. A number of minimally invasive surgical techniques have been introduced as a treatment to prevent glaucoma progressing. Among them, endoscopic cyclophotocoagulation (ECP) is a cyclodestructive procedure developed by Martin Uram in 1992. OBJECTIVES To evaluate the efficacy and safety of ECP in people with open angle glaucoma (OAG) and primary angle closure whose condition is inadequately controlled with drops. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 12 July 2018. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of ECP compared to other surgical treatments (other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. We also planned to include trials where these devices were combined with phacoemulsification compared to phacoemulsification alone. DATA COLLECTION AND ANALYSIS Two review authors planned to independently extract data from reports of included studies using a data collection form and analyse data based on methods expected by Cochrane. Our primary outcome was proportion of participants who were drop-free (not using eye drops). Secondary outcomes included mean change in IOP; proportion of participants who achieved an IOP of 21 mmHg or less, 17 mmHg or less or 14 mmHg or less; and proportion of participants experiencing intra- and postoperative complications, We planned to measure all outcomes in the short-term (six to 18 months), medium-term (18 to 36 months), and long-term (36 months onwards). MAIN RESULTS We found one ongoing study that met our inclusion criteria (ChiCTR-TRC-14004233). The study compares combined phacoemulsification with ECP to phacoemulsification alone in people with primary angle closure glaucoma. The primary outcome is intraocular pressure (IOP) and number of IOP-lowering drugs. A total of 50 people have been enrolled. The study started in February 2014 and the trialists have completed recruitment and are in the process of collecting data. AUTHORS' CONCLUSIONS There is currently no high-quality evidence for the effects of ECP for OAG and primary angle closure. Properly designed RCTs are needed to assess the medium and long-term efficacy and safety of this technique.
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Affiliation(s)
- Márta Tóth
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Anupa Shah
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Kuang Hu
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Catey Bunce
- King's College LondonDepartment of Primary Care & Public Health Sciences4th Floor, Addison HouseGuy's CampusLondonUKSE1 1UL
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation TrustNIHR Biomedical Research Centre162 City RoadLondonUK
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Lazreg S, Merad Z, Nouri MT, Garout R, Derdour A, Ghroud N, Kherroubi R, Meziane M, Belkacem S, Ouhadj O, Baudouin C, Tiar M. Efficacy and safety of preservative-free timolol 0.1% gel in open-angle glaucoma and ocular hypertension in treatment-naïve patients and patients intolerant to other hypotensive medications. J Fr Ophtalmol 2018; 41:945-954. [PMID: 30477719 DOI: 10.1016/j.jfo.2018.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
GOALS To assess the efficacy and safety of preservative-free timolol 0.1% gel in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). METHODS In this multicenter, open-label, non-controlled clinical trial in Algeria, treatment-naïve patients with intraocular pressure (IOP)>20mmHg and<31mmHg (treatment-naïve patients, group 1) and patients with IOP controlled by current ocular monotherapy but presenting with local intolerance in at least one eye (intolerant patients; group 2) were eligible. Timolol gel was administered once daily in the morning for 84 days. The primary efficacy criteria were reduction in IOP (group 1) and maintenance of baseline IOP (group 2). RESULTS Overall, 93 patients were included (53 in group 1, 40 in group 2). All patients in group 2 had been previously treated with preserved eye drops. In group 1, patients showed a significant reduction in IOP with mean changes in the worse eye of -10.3±3.0mmHg at D28 and -10.8±2.5mmHg at D84 (P<0.0001). In group 2, the maintenance of efficacy on IOP at D84 was satisfactory in 91.7% of patients (worse eye). Preservative-free timolol gel was well tolerated in both groups. In group 2, the overall symptom score was significantly reduced from 8.6±5.1 to 0.9±1.6 at D28 and 0.7±1.2 at D84 (P<0.0001), and the overall ocular sign score from 3.7±2.1 to 0.8±1.0 at D28 and 0.6±0.8 at D84 (P<0.0001). CONCLUSIONS This preservative-free timolol 0.1% gel was effective in decreasing IOP in treatment-naïve patients and in controlling IOP and reducing ocular signs and symptoms in patients intolerant to their previous preserved medications.
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Affiliation(s)
- S Lazreg
- Private practice, Ophthalmology, Blida, Algeria
| | - Z Merad
- CHU, Ophthalmology, Blida, Algeria
| | - M T Nouri
- CHU Benimessous, Ophthalmology, Algiers, Algeria
| | - R Garout
- HCA, Ophthalmology, Algiers, Algeria
| | | | - N Ghroud
- Military Hospital, Ophthalmology, Oran, Algeria
| | - R Kherroubi
- CHU Mustapha, Ophthalmology, Algiers, Algeria
| | - M Meziane
- Private practice, Ophthalmology, Oran, Algeria
| | | | - O Ouhadj
- CHU Mustapha, Ophthalmology, Algiers, Algeria
| | - C Baudouin
- Ophthalmology, XV-XX Hospital, 16008 Paris, France
| | - M Tiar
- CHU Lamine Debbaghine, Bab El Oued, Ophtalmologie, Alger, Algeria.
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Faralli JA, Dimeo KD, Trane RM, Peters D. Absence of a secondary glucocorticoid response in C57BL/6J mice treated with topical dexamethasone. PLoS One 2018; 13:e0192665. [PMID: 29499052 PMCID: PMC5834162 DOI: 10.1371/journal.pone.0192665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/26/2018] [Indexed: 01/13/2023] Open
Abstract
Glucocorticoids such as dexamethasone can cause an increase in intraocular pressure (IOP) in some of the population, but not all. In this paper we used a mouse model of glucocorticoid induced ocular hypertension to examine the changes in the anterior segment of the eye in mice that failed to respond to glucocorticoid treatment with a sustained increase in IOP. C57BL/6J mice were treated with either 0.1% dexamethasone sodium phosphate ophthalmic solution or sterile PBS 3 times daily for up to 5 weeks. IOP was measured weekly at approximately the same time of the day. After 3–5 weeks of treatment, eyes were enucleated and evaluated for changes associated with steroid induced glaucoma. These studies showed that IOP was significantly elevated in dexamethasone (DEX) treated mice compared to PBS treated mice after 3 weeks of treatment, but IOP in DEX treated mice returned to baseline levels after 5 weeks of treatment. All the mice demonstrated a response to the glucocorticoid treatments and showed an elevation in FKBP5 expression after both 3 and 5 weeks of DEX treatment (primary glucocorticoid response protein) and a weight loss. Western blot analysis of anterior segments from treated mice, however, did not show an increase in secondary glucocorticoid response proteins such as β3 integrin or myocilin. Fibronectin levels were also not statistically different. The data suggest that in mice, which do not exhibit a prolonged increase in IOP in response to the DEX treatment, there is a compensatory mechanism that can prevent or turn off the secondary glucocorticoid response.
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Affiliation(s)
- Jennifer A. Faralli
- Department of Pathology & Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Kaylee D. Dimeo
- Department of Pathology & Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Ralph M. Trane
- Department of Ophthalmology & Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Donna Peters
- Department of Pathology & Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Department of Ophthalmology & Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
- * E-mail:
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Shin DH, Bae JH, Kim JM. The Effect of a Fixed Combination of 0.0015% Tafluprost-0.5% Timolol in Normal Tension Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.8.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dae Hwan Shin
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hun Bae
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sandhu A, Jayaram H, Hu K, Bunce C, Gazzard G. Ab interno supraciliary microstent surgery for open angle glaucoma. Hippokratia 2017. [DOI: 10.1002/14651858.cd012802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Amanjeet Sandhu
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Hari Jayaram
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Kuang Hu
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Catey Bunce
- Kings College London; Department of Primary Care & Public Health Sciences; 4th Floor, Addison House Guy's Campus London UK SE1 1UL
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
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Randomized Prospective Study of the Use of Anti-Inflammatory Drops After Selective Laser Trabeculoplasty. J Glaucoma 2017; 26:e22-e29. [PMID: 27552500 DOI: 10.1097/ijg.0000000000000522] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Evaluating the use of Indomethacin, Dexamethasone, and no anti-inflammatory treatment immediately after selective laser trabeculoplasty (SLT). MATERIALS AND METHODS Prospective randomized clinical trial of 132 eyes. Both eyes of the patient underwent SLT. One of the eyes was treated with Indomethacin 0.1% or Dexamethasone 0.1% 3 times daily for 1 week; the other eye did not receive any anti-inflammatory treatment. Intraocular pressure (IOP) and inflammatory parameters were recorded at 1 hour, 1 week, 1, 3, and 6 months. RESULTS Cells in the anterior chamber were present in 57% to 71% of the patients after 1 hour. About 16% to 37% of the patients reported pain/discomfort after 1 hour. Redness was present before SLT in 29% to 34% of the patients, probably due to antiglaucoma medication. After 1 hour, the amount of redness recorded raised to 32% to 42%, but the amount of patients with redness returned to pretreatment levels after 1 week. An IOP peak of >5 mm Hg above baseline IOP 1 hour after laser was present in 3% to 9% of the patients. IOP lowered 11% to 21% compared with IOP at baseline. The number of medications needed changed from 1.45 to 1.49 before, to 0.23 to 0.45 six months after SLT.No differential effects based on the kind of anti-inflammatory treatment or no treatment were found for any of the parameters. CONCLUSIONS SLT induces little inflammation: anti-inflammatory drops do not make a significant difference in pain, redness, cells in anterior chamber, or peak IOP following SLT.The IOP-lowering effect of the SLT is not influenced by the use of Indomethacin or Dexamethasone.
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Tufan AK, Onur İU, Yiğit FU, Ağaçhan A, Aşık Nacaroğlu Ş. Selective Laser Trabeculoplasty vs. Fixed Combinations with Timolol in Practice: A Replacement Study in Primary Open Angle Glaucoma. Turk J Ophthalmol 2017; 47:198-204. [PMID: 28845323 PMCID: PMC5563547 DOI: 10.4274/tjo.87300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/18/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate the potential of selective laser trabeculoplasty (SLT) in two arms (360˚ vs. 180˚) as a replacement for fixed combinations (FCs) with timolol in primary open angle glaucoma over 6 months. MATERIALS AND METHODS Of 40 patients in a prospective, comparative, interventional case series, 18 eyes and 22 eyes were randomized to SLT 180º and SLT 360º groups, respectively, along with 40 fellow-control eyes. FC with timolol was discontinued on the day of treatment for the eye to be operated on, while ongoing therapy was not interrupted for the contralateral eye. Eyes were examined for intraocular pressure (IOP) elevation 1 hour and 1 day after SLT. The follow-up visits were then scheduled for 1 week, 1 month, 3 months, and 6 months after, during the which the IOP of both eyes and any possible complications were evaluated. RESULTS There were no statistically significant differences in mean IOPs through 6 months among the groups with exception of postlaser 1 hour and postlaser 1 day (p<0.001 and p=0.010, respectively). Multiple comparison analysis showed significantly higher IOP in both SLT 180º and SLT 360º subgroups compared to their controls at postlaser 1 hour (p=0.007, p<0.001) but significantly lower IOP only in SLT 360º subgroup compared to the controls at postlaser day 1 (p=0.013). CONCLUSION SLT offers promising potential as a substitute equivalent to efficacy of FCs with timolol. However, SLT 360˚ may not achieve additional IOP reduction.
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Affiliation(s)
- Ali Kutlay Tufan
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İsmail Umut Onur
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Fadime Ulviye Yiğit
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Ahmet Ağaçhan
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Şenay Aşık Nacaroğlu
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Otarola F, Hu K, Gazzard G, Bunce C. Ab interno trabecular bypass surgery with Schlemm´s Canal Microstent (Hydrus) for open angle glaucoma. Hippokratia 2017. [DOI: 10.1002/14651858.cd012740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francisco Otarola
- Moorfields Eye Hospital NHS Foundation Trust; Glaucoma; 162 City Road London UK EC1V 2PD
| | - Kuang Hu
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK
| | - Catey Bunce
- Kings College London; Department of Primary Care & Public Health Sciences; 4th Floor, Addison House Guy's Campus London UK SE1 1UL
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Tóth M, Hu K, Bunce C, Gazzard G. Endoscopic cyclophotocoagulation (ECP) for open angle glaucoma and primary angle closure. Hippokratia 2017. [DOI: 10.1002/14651858.cd012741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Márta Tóth
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Kuang Hu
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Catey Bunce
- Kings College London; Department of Primary Care & Public Health Sciences; 4th Floor, Addison House Guy's Campus London UK SE1 1UL
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
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Pandis N, Chung B, Scherer RW, Elbourne D, Altman DG. CONSORT 2010 statement: extension checklist for reporting within person randomised trials. BMJ 2017; 357:j2835. [PMID: 28667088 PMCID: PMC5492474 DOI: 10.1136/bmj.j2835] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Nikolaos Pandis
- University of Bern, Medical Faculty, School of Dental Medicine, Department of Orthodontics and Dentofacial Orthopedics, Bern, Switzerland
| | - Bryan Chung
- Division of Plastic Surgery, University of British Columbia, Victoria, BC, Canada
| | - Roberta W Scherer
- Johns Hopkins Bloomberg School of Public Health, Epidemiology Mailroom E6138 Baltimore, MD, USA
| | - Diana Elbourne
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK OX3 7LD
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Abstract
BACKGROUND Glaucoma is the leading cause of irreversible blindness. Minimally invasive surgical techniques, such as ab interno trabecular bypass surgery, have been introduced to prevent glaucoma progressing. OBJECTIVES The main objective was to assess the results at two years of ab interno trabecular bypass surgery with Trabectome for open angle glaucoma in comparison to conventional medical, laser, or surgical treatment in terms of efficacy and safety. A secondary objective was to examine the effects of Trabectome surgery in people who have concomitant phacoemulsification in comparison to those who do not have concomitant phacoemulsification. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 12 May 2016. SELECTION CRITERIA We included only randomised controlled trials (RCTs) of ab interno trabecular bypass surgery with Trabectome. DATA COLLECTION AND ANALYSIS We planned to have two review authors independently extract data from reports of included studies using a data collection form. MAIN RESULTS One randomised controlled trial identified from ClinicalTrials.gov, NCT00901108, met the criteria for inclusion. This study has subsequently been terminated. The ClinicalTrials.gov record indicates that the investigators plan to complete 12 months of follow-up and analysis on 19 participants already recruited into the trial. AUTHORS' CONCLUSIONS There is currently no high-quality evidence for the outcomes of ab interno trabecular bypass surgery with Trabectome for open angle glaucoma. Properly designed RCTs are needed to assess the long-term efficacy and safety of this technique.
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Affiliation(s)
- Jimmy T Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amanda K Bicket
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tianjing Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
PURPOSE To measure the change in intraocular pressure (IOP) of the fellow eye after glaucoma surgery in 1 eye. PATIENTS AND METHODS In this prospective interventional study, 71 patients with primary and secondary glaucoma, undergoing glaucoma surgery in 1 eye were included. The IOP in the fellow eye following glaucoma surgery in 1 eye from the first postoperative week till 6 months following surgery was studied. Both normal and glaucomatous fellow eyes were included. IOP change from preoperative IOP levels in the fellow eye was analyzed. Patients treated with acetazolamide preoperatively were analyzed separately. RESULTS The mean baseline IOP of the operated and fellow eyes was 28.14±9.4 and 16.5±6.1 mm Hg, respectively. IOP of fellow eyes significantly increased compared with baseline at all timepoints (P<0.001), with a maximum rise 6 weeks postoperatively (4.8±3.3 mm Hg). There was no significant difference in the consensual rise between glaucomatous and nonglaucomatous fellow eyes, or between patients treated with or without acetazolamide before surgery. Regression analysis showed no baseline factor associated with the rise in IOP. By the sixth postoperative month, 24 patients required surgery or needed an increase in medications in the fellow eye for IOP control. CONCLUSIONS Glaucoma surgery in eye is associated with a rise in IOP of the fellow eye, regardless of whether the fellow eye is normal or glaucomatous, or had been previously treated with acetazolamide. Fellow eyes of all patients scheduled for glaucoma surgery require careful monitoring of the IOP.
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Shum JW, Choy BN, Ho WL, Chan JC, Lai JS. Consensual ophthalmotonic reaction in Chinese patients following augmented trabeculectomy or ExPRESS shunt implantation. Medicine (Baltimore) 2016; 95:e4190. [PMID: 27442642 PMCID: PMC5265759 DOI: 10.1097/md.0000000000004190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Consensual ophthalmotonic reaction (COR) was first described in 1924. Studies following monocular application of glaucoma drops and laser trabeculoplasty showed a drop in fellow eye intraocular pressure (IOP). However, studies following monocular surgery showed heterogeneous results. The purpose of this study was to investigate the COR in Chinese patients who have received monocular filtration surgery. METHODS A noncomparative retrospective study of 65 eyes undergoing filtration surgery in Queen Mary Hospital was conducted. The IOP was obtained at baseline and postoperative days 1, 3, 7 and 14. Patient's age, sex, type of glaucoma and surgery, preoperative medications, postoperative bleb status, and number of interventions were tabulated. The postoperative IOP measurements over both eyes were obtained, and the readings were averaged to decrease the chances of extreme readings being a one-off event and allow for regression to the mean bias. RESULTS COR was observed in the unoperated fellow eye. The mean preoperative IOP and averaged postoperative IOP were 17.2 ± 5.2 mm Hg and 20.1 ± 8.9 mm Hg, respectively (P < 0.04). All medications were continued in the fellow eye or even stepped up. Twenty-three percent of patients demonstrated fellow eye IOP rise >30% from baseline, while none showed IOP drop >30% from baseline. DISCUSSION Following monocular penetrating filtration surgery, our Chinese population demonstrated a significant fellow eye IOP increase in the early postoperative period. We should bear in mind the influence of COR and take care to measure the fellow eye IOP following monocular surgery.
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Affiliation(s)
| | - Bonnie N.K. Choy
- Department of Ophthalmology, the University of Hong Kong, Hong Kong
| | - Wing Lau Ho
- Department of Ophthalmology, Queen Mary Hospital, Hong Kong
| | - Jonathan C.H. Chan
- Department of Ophthalmology, the University of Hong Kong, Hong Kong
- Correspondence: Jonathan C.H. Chan, Department of Ophthalmology, The University of Hong Kong, Room 301, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong. (e-mail: )
| | - Jimmy S.M. Lai
- Department of Ophthalmology, the University of Hong Kong, Hong Kong
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Voykov B, Blumenstock G, Ziemssen F, Bartz-Schmidt KU, Schultheiss M. Fluctuations of the Intraocular Pressure in One Eye Influence the Intraocular Pressure in the Fellow Eye. Curr Eye Res 2016; 42:211-216. [PMID: 27314985 DOI: 10.3109/02713683.2016.1167918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the ophthalmotonic consensual reaction (OCR) in healthy individuals. METHODS This was a cohort study of 59 pairs of eyes of patients who underwent cataract surgery in one eye and had no other ocular pathology than cataract. Main outcome measure was change of intraocular pressure (IOP) in the untreated fellow eye. The IOP was measured 1 hour before, 1 hour after, and 1 day after surgery. RESULTS One hour after surgery, IOP decreased in 24 (41%) operated eyes (group A). In the corresponding untreated fellow eyes (group Af), the mean IOP (±standard deviation [SD]) did not change (14.1 ± 3.0 mmHg preoperatively to 14.2 ± 3.1 mmHg postoperatively, p = 0.8). Only two operated eyes showed unchanged IOP (group B). In 33 (56%) operated eyes, the IOP increased (group C). In the untreated fellow eyes (group Cf), the mean IOP decreased significantly from 15.1 ± 2.9 to 13.7 ± 2.6 mmHg (p = 0.0012). One day after surgery, the mean IOP of group Af decreased significantly from 14.2 ± 3.1 (postoperative IOP) to 12.7 ± 3.2 mmHg (p = 0.007). In group Cf, the mean IOP revealed no changes from 13.7 ± 2.6 to 13.5 ± 2.4 mmHg (p = 0.69). CONCLUSIONS Our results showed some evidence for the existence of the OCR in healthy individuals. Significant IOP elevation in one eye resulted in IOP reduction in the fellow eye. Interestingly, this phenomenon did not exist vice versa.
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Affiliation(s)
- Bogomil Voykov
- a Centre for Ophthalmology , University Hospital Tuebingen , Tuebingen , Germany
| | - Gunnar Blumenstock
- b Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University of Tuebingen , Tuebingen , Germany
| | - Focke Ziemssen
- a Centre for Ophthalmology , University Hospital Tuebingen , Tuebingen , Germany
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Rao HL, Senthil S, Garudadri CS. Contralateral intraocular pressure lowering effect of prostaglandin analogues. Indian J Ophthalmol 2015; 62:575-9. [PMID: 24881604 PMCID: PMC4065508 DOI: 10.4103/0301-4738.129783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral effects of PGA are limited. Aims: To evaluate if PGA treatment in one eye has an effect on the IOP of the untreated fellow eye. Design: Retrospective study. Materials and Methods: Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had office diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and office diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals. Statistical Analysis: IOPs of the fellow eye during the office diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests. Results: Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically significant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was significantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008). Conclusion: Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.
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Affiliation(s)
- Harsha L Rao
- VST Glaucoma Center; Center for Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Andhra Pradesh, India
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Radcliffe NM. The impact of timolol maleate on the ocular tolerability of fixed-combination glaucoma therapies. Clin Ophthalmol 2014; 8:2541-9. [PMID: 25540579 PMCID: PMC4270356 DOI: 10.2147/opth.s76053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Glaucomatous optic atrophy is the second most common cause of blindness worldwide, and lowering intraocular pressure (IOP) is the only proven method to slow or stop the progression of the disease. Approximately 40% of patients with elevated IOP will require more than one medication to obtain a modest 20% reduction in IOP, and as a result, some patients may require two medications, provided in either two separate bottles or in one bottle with the use of fixed-combination therapies. Each therapy has its own unique safety and efficacy profile. Topical beta-blockers have a particularly favorable ocular-tolerability profile, and several studies of fixed-combination medications containing the beta-blocker timolol maleate have shown a lower prevalence of some ocular adverse events for the fixed-combination therapy compared to the non-beta-blocker individual component. In this review, we examined clinical data pertaining to the ocular surface tolerability of fixed-combination medications containing timolol maleate in comparison to the individual components. In particular, preference was given to prospective, randomized, multicenter trials of 3 months in duration or longer that compared a fixed-combination therapy to monotherapy with the individual components. A review of the literature revealed that some fixed-combination therapies can provide a reduced risk of common side effects compared to their individual components, with conjunctival hyperemia and ocular allergy being less frequent in some timolol-containing fixed-combination therapies. This effect appears to be most significant for latanoprost 0.005%, bimatoprost 0.03%, and brimonidine 0.2%.
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Shim SH, Kim JM, Choi CY, Kim CY. Diurnal intraocular pressure with bimatoprost/timolol fixed combination versus latanoprost/timolol fixed combination in healthy subjects. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:39-48. [PMID: 24505200 PMCID: PMC3913981 DOI: 10.3341/kjo.2014.28.1.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/08/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the effects of a bimatoprost/timolol fixed combination (BTFC) and a latanoprost/timolol fixed combination (LTFC) on diurnal intraocular pressure (IOP) and anterior ocular parameters in healthy subjects. METHODS We enrolled 58 healthy subjects in this prospective clinical study. Thirty subjects were treated with BTFC and 28 subjects were treated with LTFC. IOP was measured every 2 hours except from 01:00 and 05:00. Axial length, corneal curvature, and anterior chamber depth were obtained using the IOL master at baseline and 24 hours later. Adverse events were assessed by patient interview and by slit lamp examination. RESULTS The largest difference in IOP between treated and untreated eyes 8 hours after instillation was 1.67 mmHg in the BTFC group (p < 0.001). The largest difference in IOP between treated and untreated eyes 10 hours after instillation was 1.93 mmHg in the LTFC group (p < 0.001). For anterior ocular parameters such as axial length, corneal curvature, anterior chamber depth at baseline and 24 hours after instillation, there were no significant differences between the baseline and 24-hour values in either the BTFC or LTFC group. The most frequently occurring adverse event was conjunctival hyperemia, which was found in 33.3% (n = 10) of the BTFC group and 25.0% (n = 7) of the LTFC group (p = 0.486). CONCLUSIONS BTFC and LTFC provided a significant reduction in IOP from baseline without changing any anterior ocular parameters. Our results provide a reference for monocular trials to assess the effect of eye drops in a clinical condition.
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Affiliation(s)
- Seong Hee Shim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
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Park HS, Choi CY, Bae JH, Kim JM. The Effect of Fixed Combination of Brinzolamide 1% and Timolol 0.5% in Normal-Tension Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.7.1056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Han Seok Park
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hun Bae
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Çömez AT, Tufan HA, Kocabıyık Ö, Gencer B. Effects of Lubricating Agents with Different Osmolalities on Tear Osmolarity and Other Tear Function Tests in Patients with Dry Eye. Curr Eye Res 2013; 38:1095-103. [DOI: 10.3109/02713683.2013.806670] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ong FS, Kuo JZ, Wu WC, Cheng CY, Blackwell WLB, Taylor BL, Grody WW, Rotter JI, Lai CC, Wong TY. Personalized Medicine in Ophthalmology: From Pharmacogenetic Biomarkers to Therapeutic and Dosage Optimization. J Pers Med 2013; 3:40-69. [PMID: 24624293 PMCID: PMC3947950 DOI: 10.3390/jpm3010040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rapid progress in genomics and nanotechnology continue to advance our approach to patient care, from diagnosis and prognosis, to targeting and personalization of therapeutics. However, the clinical application of molecular diagnostics in ophthalmology has been limited even though there have been demonstrations of disease risk and pharmacogenetic associations. There is a high clinical need for therapeutic personalization and dosage optimization in ophthalmology and may be the focus of individualized medicine in this specialty. In several retinal conditions, such as age-related macular degeneration, diabetic macular edema, retinal vein occlusion and pre-threshold retinopathy of prematurity, anti-vascular endothelial growth factor therapeutics have resulted in enhanced outcomes. In glaucoma, recent advances in cytoskeletal agents and prostaglandin molecules that affect outflow and remodel the trabecular meshwork have demonstrated improved intraocular pressure control. Application of recent developments in nanoemulsion and polymeric micelle for targeted delivery and drug release are models of dosage optimization, increasing efficacy and improving outcomes in these major eye diseases.
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Affiliation(s)
- Frank S. Ong
- Illumina Inc., San Diego, CA 92122, USA
- Author to whom correspondence should be addressed; E-Mail:
| | - Jane Z. Kuo
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 119074, Singapore
| | | | - Brian L. Taylor
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wayne W. Grody
- Departments of Pathology and Laboratory Medicine, Pediatrics and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jerome I. Rotter
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Pediatrics and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 119074, Singapore
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Lee JY, Hwang YH, Kim YY. The efficacy of a monocular drug trial in normal-tension glaucoma. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:26-31. [PMID: 22323882 PMCID: PMC3268165 DOI: 10.3341/kjo.2012.26.1.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 12/17/2010] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the efficacy of a monocular drug trial in eyes with normal-tension glaucoma (NTG). Methods This prospective study enrolled 74 patients with NTG. The monocular drug trial was started using latanoprost 0.005% for one week. If the intraocular pressure (IOP) reduction was greater than 15%, the same medication was administered to both eyes for one month. The unadjusted change and adjusted change (the change in the treated eye minus the change in the contralateral eye) in IOP were evaluated, and the predictors of IOP response were analyzed by multivariate linear regression. Results Among the initial 74 patients, 31 (41.9%) were included; others were excluded because they did not meet the requisite conditions. The most significant predictors of IOP response in the initial eye and subsequent eye were the baseline IOPs in both eyes (β = 0.907, 0.771, respectively). The adjusted change in IOP of the initial eye had greater association (β = 0.589) with the IOP after monocular trial in the initial eye than that of unadjusted IOP change (β = 0.279). The adjusted change in IOP also had greater predictability (β = 0.348) for IOP after monocular trial in the subsequent eye than that of the unadjusted IOP change (β = 0.090). Conclusions Although the monocular trial in NTG patients had limited efficacy due to its stringent conditions, it was useful for evaluating the IOP response in the initial eye and for predicting the IOP response in the subsequent eye.
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Affiliation(s)
- Jong Yeon Lee
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea
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Kutuzova GD, Gabelt BT, Kiland JA, Hennes-Beann EA, Kaufman PL, DeLuca HF. 1α,25-Dihydroxyvitamin D(3) and its analog, 2-methylene-19-nor-(20S)-1α,25-dihydroxyvitamin D(3) (2MD), suppress intraocular pressure in non-human primates. Arch Biochem Biophys 2011; 518:53-60. [PMID: 22198282 DOI: 10.1016/j.abb.2011.10.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/19/2011] [Accepted: 10/29/2011] [Indexed: 01/16/2023]
Abstract
Ocular hypertension is the greatest known risk factor for glaucoma that affects an estimated 70 million people worldwide. Lowering intraocular pressure (IOP) remains the mainstay of therapy in the management of glaucoma. By means of microarray analysis, we have discovered that 1α,25-dihydroxyvitamin D(3) (1α,25-(OH)(2)D(3)) regulates genes that are known to be involved in the determination of intraocular pressure (IOP). Topical administration of 1α,25-(OH)(2)D(3) or its analog, 2-methylene-19-nor-(20S)-1α,25-dihydroxyvitamin D(3) (2MD), markedly reduces IOP in non-human primates. The reduction in IOP is not the result of reduced aqueous humor formation, while a 35% increase in aqueous humor drainage by 1α,25-(OH)(2)D(3) was found but this increase did not achieve significance. Nevertheless, our results suggest that 1α,25-(OH)(2)D(3), or an analog thereof, may present a new approach to the treatment of glaucoma.
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Affiliation(s)
- Galina D Kutuzova
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI 53706-1544, United States
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Yeh J, Kravitz D, Francis B. Rational use of the fixed combination of dorzolamide - timolol in the management of raised intraocular pressure and glaucoma. Clin Ophthalmol 2011; 2:389-99. [PMID: 19668730 PMCID: PMC2693974 DOI: 10.2147/opth.s1813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Glaucoma is a multifactorial optic neuropathy in which the main therapeutic target is lowering of intraocular pressure (IOP) in order to retard the progression of existing structural and functional damage. The three mainstays of treatment are pharmacologic, laser, and surgical. The primary standard therapy in patients with open-angle glaucoma or ocular hypertension is topical medication. When monotherapy does not adequately lower the intraocular pressure, one or more agents are added or substituted. Combination pharmacotherapy such as Cosopt® is available to improve efficacy and simplify medication regimen. A fixed combination of two ocular hypotensive drugs (the carbonic anhydrase inhibitor dorzolamide and the beta-adrenoceptor antagonist timolol), Cosopt® is indicated for the treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension insufficiently responsive to topical beta-adrenoceptor antagonist monotherapy. Compared with concomitant therapy with the individual components, the primary advantage of fixed combination dorzolamide – timolol is convenience, which may also improve compliance. Clinical trials have demonstrated that the fixed combination dorzolamide – timolol is safe, effective and generally well tolerated in lowering IOP in patients with open angle glaucoma or ocular hypertension, including individuals uncontrolled on beta-adrenoceptor antagonist or other monotherapy.
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Affiliation(s)
- Jason Yeh
- Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Liu JHK, Realini T, Weinreb RN. Asymmetry of 24-hour intraocular pressure reduction by topical ocular hypotensive medications in fellow eyes. Ophthalmology 2011; 118:1995-2000. [PMID: 21676464 DOI: 10.1016/j.ophtha.2011.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/02/2011] [Accepted: 03/07/2011] [Indexed: 11/19/2022] Open
Abstract
PURPOSE A core assumption for the 1-eye therapeutic trial of ocular hypotensive medications is the symmetrical reduction of intraocular pressure (IOP) in paired eyes. This assumption was evaluated for 24-hour IOP reduction in patients who underwent monotherapy or adjunctive therapy. DESIGN Database study. PARTICIPANTS Patients 41 to 79 years of age with primary open-angle glaucoma or ocular hypertension. METHODS Twenty-four-hour IOP data from the paired eyes of patients undergoing bilateral monotherapy (n = 66) of latanoprost, travoprost, timolol, or brimonidine or bilateral adjunctive therapy (n = 52) with brinzolamide or timolol added to latanoprost monotherapy were analyzed retrospectively. Measurements of IOP were obtained every 2 hours in a sleep laboratory before and after at least 4-week drug treatments. Strengths of association for single-pair IOP reductions and average IOP reductions in the paired eyes during the office-hour, diurnal, nocturnal, and 24-hour periods and in different body positions were analyzed. MAIN OUTCOME MEASURES Variance for the difference, percentage distribution of large absolute difference, and coefficient of determination (r(2)) in the paired IOP reductions. RESULTS The standard deviations for the differences in single-pair IOP reductions from the means were larger than 2.5 mmHg for all periods and body positions under monotherapy and adjunctive therapy. Absolute differences in single-pair IOP reductions of the cutoff thresholds of 3 and 2 mmHg or more occurred in more than 20% and 36% cases, respectively. Corresponding coefficients of determination were 0.240 to 0.374 with monotherapy and 0.215 to 0.381 with adjunctive therapy. When the average differences in the paired IOP reductions were analyzed for a specific period and posture, the standard deviations for the differences in the paired IOP reductions and the percentage distributions of large absolute differences were reduced, and most coefficients of determination were improved. CONCLUSIONS There is only a weak association between the right- and left-eye responses to IOP-lowering monotherapy or adjunctive therapy during a 24-hour period when single-pair IOP data are considered. Considering the averages of multiple paired IOP responses can improve the strength of the association. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- John H K Liu
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA.
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Cho SW, Kim JM, Park KH, Choi CY. Effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy for glaucoma. Jpn J Ophthalmol 2010; 54:407-13. [PMID: 21052902 DOI: 10.1007/s10384-010-0855-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy in the treatment of patients with glaucoma. METHODS To measure the main treatment effects of a fixed combination of brimonidine 0.2%-timolol 0.5%, we conducted three small studies: (1) a comparison of diurnal intraocular pressure (IOP) at baseline and at 6 months after brimonidine/timolol fixed-combination therapy (n = 81); (2) an assessment of the effects of one drop of the brimonidine/timolol fixed combination on diurnal IOP (n = 25); and (3) the effects of brimonidine/timolol fixed-combination therapy on the anterior ocular segment over time (n = 64). RESULTS (1) After 6 months of treatment with the brimonidine/timolol fixed combination, the mean diurnal IOP in primary open-angle glaucoma (POAG) decreased from 21.4 ± 2.0 to 14.5 ± 3.1 mmHg (32.2%, P < 0.001), and the mean diurnal IOP in normal-tension glaucoma (NTG) decreased from 13.5 ± 2.8 to 10.9 ± 2.0 mmHg (19.3%, P < 0.001). (2) After instillation with one drop of the brimonidine/timolol fixed combination, the IOP in the instilled eye was lowest at 9:00 p.m. and had decreased by 1.7 mmHg compared with the baseline IOP in the instilled eye. The difference in IOP between the instilled eye and untreated fellow eye was largest at 3:00 p.m., measuring 1.7 mmHg (P = 0.011). (3) Brimonidine/timolol fixed-combination therapy caused significant miosis over time (P = 0.003). CONCLUSIONS The results of this study suggest that brimonidine/timolol fixed-combination therapy has beneficial IOP-lowering effects and significant effects on pupil size.
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Affiliation(s)
- Sung Woo Cho
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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The utility of the monocular trial: data from the ocular hypertension treatment study. Ophthalmology 2010; 117:2047-54. [PMID: 20619460 DOI: 10.1016/j.ophtha.2010.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 02/17/2010] [Accepted: 02/17/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine whether adjusting the intraocular pressure (IOP) change of the trial eye for the IOP change of the fellow eye (i.e., monocular trial) is a better assessment of medication response than testing each eye independently. DESIGN Analysis of data from a prospective, randomized, clinical trial. PARTICIPANTS Two hundred six participants with ocular hypertension randomized to the observation group and later started on a topical prostaglandin analog (PGA). METHODS Participants were started on a topical PGA in 1 eye and returned in approximately 1 month to determine medication response. The IOP response of the trial eye was determined by the IOP change between baseline and 1 month in the trial eye alone (unadjusted method) and by adjusting for the IOP change in the fellow eye between the same visits (adjusted method). Our "gold standard" for medication response was the IOP change in the trial eye between up to 3 pre- and 3 posttreatment visits on the same medication. Pearson correlation was used to compare the gold standard with the unadjusted and adjusted methods. In addition, symmetry of IOP response between trial and fellow eyes to the same medication was determined by correlating the trial eye IOP change between up to 3 pre- and 3 posttreatment visits to the fellow eye IOP change between the same visits. MAIN OUTCOME MEASURES Correlations of IOP change of the trial eye using the gold standard to the IOP change of the trial eye using the unadjusted and adjusted methods. RESULTS The correlations of IOP change using the gold standard to the IOP change using the unadjusted and adjusted methods were r = 0.40 and r = 0.41, respectively. The correlation of IOP change of both eyes between the same pre- and posttreatment visits was r = 0.81. CONCLUSIONS The monocular trial (i.e., adjusted method) appears equivalent to testing each eye independently (i.e., unadjusted method); however, neither method is adequate to determine medication response to topical PGAs. Both eyes have a similar IOP response to the same PGA. Further studies to understand IOP fluctuation are necessary to improve current methods of assessing medication response. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Radcliffe NM, Musch DC, Niziol LM, Liebmann JM, Ritch R. The effect of trabeculectomy on intraocular pressure of the untreated fellow eye in the collaborative initial glaucoma treatment study. Ophthalmology 2010; 117:2055-60. [PMID: 20570363 DOI: 10.1016/j.ophtha.2010.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/11/2010] [Accepted: 02/11/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To describe the intraocular pressure (IOP) of the untreated fellow eye after unilateral trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN Data collected from a prospective, multicenter, randomized clinical trial. PARTICIPANTS Three hundred patients with newly diagnosed open-angle glaucoma enrolled at 14 centers in the United States who were randomized to initial trabeculectomy. METHODS After baseline evaluation and randomization to initial trabeculectomy in the study eye, patients were evaluated at 3 and 6 months and at 6-month intervals thereafter. The IOP was measured by Goldmann applanation tonometry. All eyes included in the analysis were untreated fellow eyes, and the data were censored for potential IOP-lowering events in the fellow eye, including trabeculectomy, argon laser trabeculoplasty, or cataract extraction. Predictive factors for IOP response in the fellow eye to initial trabeculectomy in the study eye were analyzed using a linear mixed model. MAIN OUTCOME MEASURES Intraocular pressure in the untreated fellow eye during follow-up. RESULTS Although the IOP in the fellow eye was lower than baseline at 3, 6, 12, 18, and 24 months after trabeculectomy in the study eye, this decrease was statistically significant only at month 12 (mean decrease from baseline, 0.73 ± 3.37 mmHg; P = 0.0134). Predictive associations with higher IOP in the fellow eye during follow-up included higher baseline IOP (P < 0.0001), lower level of education (P = 0.0129), time (P = 0.0005), and the presence of other vascular disease (P = 0.0069). Patients who ultimately required fellow eye trabeculectomy (P < 0.0001) or argon laser trabeculoplasty (P<0.0001), but not cataract extraction (P = 0.4597) in the fellow eye, had lower IOPs during follow-up after these procedures. CONCLUSIONS There was no evidence of a substantial effect of trabeculectomy on the IOP of the untreated fellow eye during follow-up. Trabeculectomy does not seem to decrease the mean IOP of the fellow eye, as suggested by some previous studies. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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