Repeatability, reproducibility, and agreement of three tonometers for measuring intraocular pressure in rabbits

Safety and tolerability of pooled human immune globulins after topical ophthalmic administration in New Zealand White rabbits

PURPOSE

To evaluate the safety and tolerability of pooled human immune globulins, Flebogamma® 5% DIF and Flebogamma® 10% DIF, administered by topical ophthalmic instillation to New Zealand White (NZW) rabbits.

METHODS

Male NZW rabbits were used in this study. In the acute single dose tolerability study, rabbits (n = 12) received a single topical dose of Flebogamma® 5% DIF. In the two-week repeated-dose tolerability study, rabbits (n = 5 for each group) were administered either Flebogamma® 5% DIF or Flebogamma® 10% DIF by topical bilateral administration four times daily (q.i.d.) between 8 am and 6 pm for a period of two weeks. Full ophthalmic examinations were conducted to evaluate ocular tolerability at baseline, Day 7, and Day 14.

RESULTS

In the acute single dose study, mild hyperaemia was observed in 1 out of 4 eyes at each 4 h and 24 h post-instillation of Flebogamma® 5% DIF. In the repeated dose study, no ocular signs were detected after q.i.d. topical instillation of Flebogamma® 5% DIF, while Flebogamma® 10% DIF resulted in mild hyperaemia in 8 out of 10 eyes on Day 7, and 5 out of 10 eyes on Day 14. No positive corneal fluorescein staining was detected. Schirmer tear test results were unremarkable. No other ocular signs were observed. Administration of immune globulins had no effect on intraocular pressure.

CONCLUSIONS

Flebogamma® 5% DIF and Flebogamma® 10% DIF were well-tolerated by NZW rabbits following single and repeat dose topical ophthalmic administration, supporting the future development of topical pooled human immune globulins for the treatment of ocular surface disease.

Agreement of tonometer for measuring intraocular pressure in Wistar rats: a systematic review

Glaucoma is the most common cause of irreversible blindness in the world. It is associated with elevated intraocular pressure (IOP). Fluctuations in tonometer readings have implications for glaucoma research, where accurate IOP measurements are vital for evaluating disease progression and treatment efficacy. Researchers should carefully select the appropriate tonometer and consider biases associated with different tonometers. Validation against standard measurements can improve IOP measurement accuracy in rat models. In conclusion, this systematic review will emphasize on the importance of selecting the appropriate tonometer for IOP measurement in rat models, considering potential biases and their implications for glaucoma research. Accurate and consistent IOP measurement in rat models is crucial for understanding glaucoma pathophysiology and developing effective treatments. This systematic review aims to assess agreement among tonometers used for measuring IOP in Wistar rat models primarily focusing on TonoLab, TonoVet, and Tono-pen. The review was conducted using PRISMA guidelines. Two articles were included for qualitative synthesis. The studies compared manometric IOP with TonoLab, rebound tonometer, and Tono-pen XL readings. It was observed that TonoLab consistently underestimated IOP, while Tono-pen XL tended to overestimate IOP compared to manometric measurements. The study's findings will help researchers in making decisions about tonometer selection, leading to more reliable outcomes in glaucoma research using rat models. Further research, specifically RCT's (randomized controlled trial) is needed to confirm the results and enhance IOP measurement precision in rat models.

Determination of intraocular pressure and Schirmer tear test and the comparison between the applanation tonometer (Tono-Pen AVIA®) and the rebound tonometer (TonoVet Plus®) in mini lionhead rabbits

OBJECTIVE

To determine intraocular pressure (IOP) and tear production, as well as to compare the IOP obtained with the TonoVet Plus® (rebound) with the Tono-Pen Avia® (applanation) tonometers.

ANIMALS

Twenty-five Mini Lionhead rabbits (n = 50 eyes).

PROCEDURE

Tear production was measured at 6:00 a.m. and 6:00 p.m. by using the STT. The IOP reading was performed with the rebound tonometer, followed by the applanation tonometer, at 6:00 a.m., 9:00 a.m., 12:00 p.m., 3:00 p.m., and 6:00 p.m. Regression analysis, analysis of variance (anova) and Bland-Altman statistics were used.

RESULTS

Daily tear production was 10.25 ± 3.75 mm/min, with no differences among the moments evaluated. Average daily IOP was 17.7 ± 3.08 mmHg with the TonoVet Plus® and 11.5 ± 4.56 mmHg with the Tono-Pen Avia®. IOP values were higher at the beginning and end of the day with both tonometers.

CONCLUSION

The IOP values are higher with the TonoVet Plus® tonometer. The reference values of IOP and tear production obtained in this work may support the diagnosis, treatment, and monitoring of ocular disorders in pet Mini Lionhead rabbits.

Comparison of intraocular pressure in New Zealand White rabbits measured using rebound and applanation tonometers and four different methods of physical restraint

AIMS

To compare intraocular pressure (IOP) measurements obtained in rabbits using rebound (TV) and applanation (TPV) tonometers with four different methods of physical restraint.

METHODS

A total of 20 New Zealand White rabbits (40 eyes) were included in this study. IOP readings were obtained from both eyes using the two different tonometers. The rabbits were placed on a table and restrained by wrapping in a cloth (Method I), by scruffing with rear support (Method II), by wrapping in a cloth and cupped in the hands (Method III), or by a box restrainer (Method IV).

RESULTS

The mean IOP measurement obtained by TPV was higher than that obtained with the TV for all handling methods. Mean differences (TV-TPV, in mmHg) in IOP were -5.3 (95% Cl = -6.5 to -4.1) for Method 1, -4.7 (95% Cl = -6.2 to -3.29) for Method II, -4.9 (95% Cl = -6.2 to -3.7) for Method III and -7.6 (95% Cl = -9.2 to -5.9) for Method IV. Using the TV tonometer, mean IOP for Method IV was higher than for Method I (mean difference 2.1 (95% Cl = 1.1-3.1)), whereas using the TPV tonometer, mean IOP for Method IV was significantly higher than Method I, II, and III (mean differences: 4.4 (95% Cl = 2.6-5.9), 3.7 (95% Cl = 2-5.3) and 3.8 (95% Cl = 2-5.4), respectively). According to Bland-Altman plots, IOP readings for TPV tended to be higher than those for TV with all handling methods, but with a lack of agreement. The mean difference and 95% limits of agreement for the differences between TV and TPV were -5.4 mmHg (-12.5-1.9 mmHg), -4.7 mmHg (-12.9-3.5 mmHg), -4.9 mmHg (-12-2.2 mmHg), and -7.5 mmHg (-17.4-2.3 mmHg), with Methods I, II, III, and IV, respectively. Comparing TV and TPV, only 7.5%, 12.5%, 27.5%, and 15% of IOP measurements from 20 rabbits were within the range considered clinically acceptable for IOP (± 2 mmHg) for Method I, II, III, and IV, respectively.

CONCLUSION AND CLINICAL RELEVANCE

In conclusion, the physical restraint method should be recorded when IOP is measured in rabbits, and TV and TPV tonometers cannot be used interchangeably (high bias and low proportion of measurements within ± 2 mmHg).

Identifying new drugs and targets to treat rapidly elevated intraocular pressure for angle closure and secondary glaucomas to curb visual impairment and prevent blindness

A multitude of pharmacological compounds have been shown to lower and control intraocular pressure (IOP) in numerous species of animals and human subjects after topical ocular dosing or via other routes of administration. Most researchers have been interested in finding drug candidates that exhibit a relatively long duration of action from a chronic therapeutic use perspective, for example to treat ocular hypertension (OHT), primary open-angle glaucoma and even normotensive glaucoma. However, it is equally important to seek and characterize treatment modalities which offer a rapid onset of action to help provide fast relief from quickly rising IOP that occurs in certain eye diseases. These include acute angle-closure glaucoma, primary angle-closure glaucoma, uveitic and inflammatory glaucoma, medication-induced OHT, and other secondary glaucomas induced by eye injury or infection which can cause partial or complete loss of eyesight. Such fast-acting agents can delay or prevent the need for ocular surgery which is often used to lower the dangerously raised IOP. This research survey was therefore directed at identifying agents from the literature that demonstrated ocular hypotensive activity, normalizing and unifying the data, determining their onset of action and rank ordering them on the basis of rapidity of action starting within 30-60 min and lasting up to at least 3-4 h post topical ocular dosing in different animal species. This research revealed a few health authority-approved drugs and some investigational compounds that appear to meet the necessary criteria of fast onset of action coupled with significant efficacy to reduce elevated IOP (by ≥ 20%, preferably by >30%). However, translation of the novel animal-based findings to the human conditions remains to be demonstrated but represent viable targets, especially EP2-receptor agonists (e.g. omidenepag isopropyl; AL-6598; butaprost), mixed activity serotonin/dopamine receptor agonists (e.g. cabergoline), rho kinase inhibitors (e.g. AMA0076, Y39983), CACNA2D1-gene product inhibitors (e.g. pregabalin), melatonin receptor agonists, and certain K+-channel openers (e.g. nicorandil, pinacidil). Other drug candidates and targets were also identified and will be discussed.

Wound Healing Response After Bleb-Forming Glaucoma Surgery With a SIBS Microshunt in Rabbits

Purpose

The PreserFlo MicroShunt is an innovative implant for the surgical treatment of glaucoma. Although usually effective, surgeries can still fail due to fibrosis. This study was conducted to gain insight into the histological aspects of the fibrotic response and find potential targets to reduce postoperative fibrosis.

Methods

Fifteen New Zealand White rabbits were implanted with a microshunt and followed up for 40 days. Animals were euthanized at postoperative days (PODs) 1, 5, and 40 to collect eyes for histological evaluation. Bleb formation and ocular health were assessed by slit-lamp (SL) biomicroscopy and optical coherence tomography (OCT). Intraocular pressure (IOP) was measured using rebound tonometry.

Results

Blebs failed after approximately 2 weeks based on bleb survival and IOP measurements. No severe complications were observed with OCT and SL. Histology revealed a wide variety of cells, in the bleb and around the microshunt, including polymorphonuclear leucocytes (PMNs), myofibroblasts, and foreign body giant cells, at different PODs.

Conclusions

Implantation of a poly(styrene-b-isobutylene-b-styrene) microshunt in rabbits resulted in the occurrence of a wide variety of cells during the wound-healing response. Future research should further elucidate the potential of these (earlier often overlooked) cells to target the fibrotic response in vivo—for example, by developing novel antifibrotic drugs, methods for sustained delivery of medications, or augmenting material properties.

Translational Relevance

Current antifibrotic therapies aim to inhibit myofibroblasts; however, a wide variety of cells are involved in the fibrotic response. Future research focusing on these cells could offer novel methods for reducing the fibrotic response after glaucoma surgery.

Animal models and drug candidates for use in glaucoma filtration surgery: A systematic review

Glaucoma, a degenerative disease of the optic nerve, is the leading cause of irreversible blindness worldwide. Currently, there is no curative treatment. The only proven treatment is lowering intraocular pressure (IOP), the most important risk factor. Glaucoma filtration surgery (GFS) can effectively lower IOP. However, approximately 10% of all surgeries fail yearly due to excessive wound healing, leading to fibrosis. GFS animal models are commonly used for the development of novel treatment modalities. The aim of the present review was to provide an overview of available animal models and anti-fibrotic drug candidates. MEDLINE and Embase were systematically searched. Manuscripts until September 1st^, 2021 were included. Studies that used animal models of GFS were included in this review. Additionally, the snowball method was used to identify other publications which had not been identified through the systematic search. Two hundred articles were included in this manuscript. Small rodents (e.g. mice and rats) are often used to study the fibrotic response after GFS and to test drug candidates. Due to their larger eyes, rabbits are better suited to develop medical devices. Novel drugs aim to inhibit specific pathways, e.g. through the use of modulators, monoclonal antibodies, aqueous suppressants or gene therapy. Although most newly studied drugs offer a higher safety profile compared to antimetabolites, their efficacy is in most cases lower when compared to MMC. Current literature on animal models and potential drug candidates for GFS were summarized in this review. Future research should focus on refining current animal models (for example through the induction of glaucoma prior to undertaking GFS) and standardizing animal research to ensure a higher reproducibility and reliability across different research groups. Lastly, novel therapies need to be further optimized, e.g. by conducting more research on the dosage, administration route, application frequency, the option of creating combination therapies, or the development of drug delivery systems for sustained release of anti-fibrotic medication.