Investigational and experimental drugs for intraocular pressure reduction in ocular hypertension and glaucoma

In vivo Modulation of Intraocular and Intracranial Pressures Causes Nonlinear and Non-monotonic Deformations of the Lamina Cribrosa and Scleral Canal

Purpose

To evaluate changes in monkey optic nerve head (ONH) morphology under acutely controlled intraocular pressure (IOP) and intracranial pressure (ICP).

Methods

Seven ONHs from six monkeys were imaged via optical coherence tomography while IOP and ICP were maintained at one of 16 conditions. These conditions were defined by 4 levels for each pressure: low, baseline, high and very high. Images were processed to determine scleral canal area, aspect ratio, and planarity and anterior lamina cribrosa (ALC) shape index and curvature. Linear mixed effect models were utilized to investigate the effects of IOP, ICP and their interactions on ONH morphological features. The IOP-ICP interaction model was compared with one based on translaminar pressure difference (TLPD).

Results

We observed complex, eye-specific, non-linear patterns of ONH morphological changes with changes in IOP and ICP. For all ONH morphological features, linear mixed effects models demonstrated significant interactions between IOP and ICP that were unaccounted for by TLPD. Interactions indicate that the effects of IOP and ICP depend on the other pressure. The IOP-ICP interaction model was a higher quality predictor of ONH features than a TLPD model.

Conclusions

In vivo modulation of IOP and ICP causes nonlinear and non-monotonic changes in monkey ONH morphology that depend on both pressures and is not accounted for by a simplistic TLPD. These results support and extend prior findings.

Translational Relevance

A better understanding of ICP's influence on the effects of IOP can help inform the highly variable presentations of glaucoma and effective treatment strategies.

Ultrasound cyclo plasty for the management of refractory glaucoma in chinese patients: a before-after study

BACKGROUND

Cyclocryotherapy and transscleral cyclophotocoagulation are commonly used procedures for the treatment of refractory glaucoma, but still with many complications. Ultrasound cyclo plasty (UCP) is a novel technique that determines a selective and more precise coagulation necrosis of the ciliary body to reduce intraocular pressure (IOP), but its efficacy and safety have been less investigated in Chinese population. This study aimed to evaluate the clinical efficacy and safety of UCP in Chinese patients with refractory glaucoma.

METHODS

We designed a prospective, before-after study involving 36 eyes of 36 patients with refractory glaucoma that underwent uneventful UCP. Mean IOP, mean IOP reduction and subjective pain scale scores before and after UCP were compared to evaluate the efficacy of UCP in these patients. Procedural success defined as no abnormality of the treatment sites, and complications were recorded, along with confirmation of the safety of UCP.

RESULTS

The 36 UCP patients had a mean IOP of 53.61 ± 12.4 mmHg and a mean VAS score of 5.69 ± 3.02 preoperatively. Successful operation was achieved in 28 patients, with a success rate of 77.8%. In the follow-up observation at day 1, day 7, and month 1, 2, 3 and 6 postoperatively, both mean IOP and mean VAS score were significantly lower than those before operation (both P < 0.0001). The median baseline IOP reduction ranged from 22 to 36%. The mean reduction was 42.5% in 36 patients when taking IOP at the last follow-up visit as the last. No significant changes in visual acuity were achieved in 4 patients after UCP, and no adverse outcomes were present in other patients after timely treatment of complications such as conjunctival hyperemia, subconjunctival hemorrhage, or hyphema.

CONCLUSIONS

UCP is a novel yet reliable option for Chinese patients with refractory glaucoma since its high efficacy and safety.

Formulation of Biocompatible Targeted ECO/siRNA Nanoparticles with Long-Term Stability for Clinical Translation of RNAi

Nanoparticle based siRNA formulations often suffer from aggregation and loss of function during storage. We in this study report a frozen targeted RGD-polyethylene glycol (PEG)-ECO/siβ3 nanoparticle formulation with a prolonged shelf life and preserved nanoparticle functionality. The targeted RGD-PEG-ECO/siβ3 nanoparticles are formed by step-wised self-assembly of RGD-PEG-maleimide, ECO, and siRNA. The nanoparticles have a diameter of 224.5 ± 9.41 nm and a zeta potential to 45.96 ± 3.67 mV in water and a size of 234.34 ± 3.01 nm and a near neutral zeta potential in saline solution. The addition of sucrose does not affect their size and zeta potential and substantially preserves the integrity and biological activities of frozen and lyophilized formulations of the targeted nanoparticles. The frozen formulation with as low as 5% sucrose retains nanoparticle integrity (90% siRNA encapsulation), size distribution (polydispersity index [PDI] ≤20%), and functionality (at least 75% silencing efficiency) at -80°C for at least 1 year. The frozen RGD-PEG-ECO/siβ3 nanoparticle formulation exhibits excellent biocompatibility, with no adverse effects on hemocompatibility and minimal immunogenicity. As RNAi holds the promise in treating the previously untreatable diseases, the frozen nanoparticle formulation with the low sucrose concentration has the potential to be a delivery platform for clinical translation of RNAi therapeutics.

Efficacy and safety of prostaglandin analogues in primary open-angle glaucoma or ocular hypertension patients: A meta-analysis

BACKGROUND

To evaluated and compared the efficacy and safety of 3 prostaglandin analogues (0.005% latanoprost, 0.004% travoprost, and 0.03% bimatoprost) in treatment of primary open-angle glaucoma (POAG) or ocular hypertension (OHT).

METHODS

PubMed, Embase, Cochrane library, Web of science, CNKI, Wanfang, and Vip database, published between January 1, 2000 and June 1, 2018, were systematically examined for randomized controlled trials (RCT) based on prostaglandin analogues for POAG or OHT treatment. Statistical analyses including weighted mean difference (WMD) calculation and odds ratio (OR) were performed using Review Manager Software version 5.3.

RESULT

The 17 studies were included in this analysis (N = 2433 participants) with 1∼12 months' follow-ups. The difference of intraocular pressure (IOP) reduction between latanoprost and travoprost group had not significant; there was significant difference of IOP reduction between latanoprost and bimatoprost group in the third month and sixth month; Travoprost was significantly different from bimatoprost in reducing IOP in the third month. Travoprost revealed an elevated risk of conjunctival hyperemia compared with latanoprost. An elevated risk of conjunctival hyperemia and growth of lashes compared with latanoprost. Bimatoprost shows lower ocular tolerability with higher incidence of side effects such as conjunctival hyperemia.

CONCLUSIONS

0.03% bimatoprost appears more effective following long time use (3 and 6 month post-treatment) for IOP control compared to 0.005% latanoprost, and is more effective compared to 0.004% travoprost after being used for a certain period of time (3 months post-treatment); nevertheless, 0.005% latanoprost is better tolerated in patients with POAG or OHT.

[Efficacy and safety of neuroprotection in patients with primary open-angle glaucoma]

Elevated intraocular pressure (IOP) is considered one of the main factors in the development and progression of primary open-angle glaucoma (POAG). The main schemes of drug treatment and cell protection from glaucomatous damage are aimed particularly at reducing IOP. However, it is possible for the disease to progress with normalized IOP. This determines the need to search for drugs that would affect other pathogenetic links of the progression of POAG.

PURPOSE

To study the effect of 'Cytoflavin' drug on the stabilization of glaucomatous optic neuropathy in patients with POAG.

MATERIAL AND METHODS

The study included 103 patients with initial or developed POAG. Patients were randomized into two groups using random numbers: the control group patients (n=50) receiving standard conservative treatment, and the main group (n=53), where patients received the combined drug with metabolic action 'Cytoflavin'. In addition to standard ophthalmological studies, all patients underwent biological, electrophysiological, perimetric, structural topographic, laboratory and sociological examinations before and after the treatment.

RESULTS

By the end of the 3rd month of the treatment, the patients of the main group showed positive dynamics of the amplitude and phase characteristics of bioelectric activity of the retina, improvement in the total sensitivity of the retina for central field of view. Cytoflavin contributed to reducing the rate of progression of glaucoma according to optical coherence tomography: stabilization of the thickness of the nerve fiber layer, reduction of the rate of global and focal loss of retinal ganglion cells. In patients of the main group, by the end of the 3^rd month, the severity of oxidative stress has significantly reduced and the antioxidant defense improved. On the background of stabilized glaucomatous process, a subjective improvement in general and psycho-emotional health, increased confidence in the success of the therapy and thus the improved the quality of life was observed in comorbid patients of the main group.

CONCLUSION

Cytoflavin acts on the mechanisms that enhance the protection of the retina against the effects of reperfusion injury and oxidative stress, contributes to the metabolic adaptation of neurons and leads to a more favorable variant of POAG.

Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma: a retrospective multicenter study

AIM

To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma (POAG) patients.

METHODS

This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as: 1) IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2) no additional glaucoma surgery required.

RESULTS

A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y (P=0.05). The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery (P=0.04). The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone (100% vs 76%). In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen.

CONCLUSION

Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

Safety and Efficiency of Trabectome-mediated Trabecular Meshwork Ablation for Chinese Glaucoma Patients: A Two-year, Retrospective, Multicentre Study

BACKGROUND

The aim of the study was to evaluate the long-term safety and efficacy of the Trabectome for Chinese glaucoma patients.

METHODS

This was a multicenter, retrospective, observational study. Glaucoma patients, except those with neovascular glaucoma, with/without a visually significant cataract were enrolled. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome evaluation was a reduction in intraocular pressure (IOP), and the secondary outcomes were a reduction in glaucoma medication, the 2-year success percentages, and complications. Success was defined as an IOP <21 mmHg and at least a 20% IOP reduction from baseline after 3 months for any two consecutive visits, without additional glaucoma surgery. The data were processed using the R Stats Package version 3.0.0. The Wilcoxon test was used to compare the postoperative IOP and the number of glaucoma medications with baselines. The Kaplan-Meier test was used to calculate the 2-year success percentage. The risk factors related to Trabectome failure were determined by logistic regression.

RESULTS

A total of 120 glaucoma patients were enrolled. The Trabectome efficiently reduced the IOP from a baseline of 22.8 ± 1.34 mmHg to 17.6 ± 0.96 mmHg, and the use of glaucoma medications from 2.2 ± 0.17 mmHg to 1.4 ± 0.21 in a 2-year follow-up (both, P < 0.01). The overall success percentage was 80%. No risk factor related to Trabectome failure was identified. No vision-threatening complication was observed. Ten patients, who required secondary glaucoma surgery, all reached the target IOP.

CONCLUSIONS

In a 2-year follow-up, Trabectome was an efficient and safe procedure for Chinese glaucoma patients.

Phenotypic Description of the Spanish Multicentre Genetic Glaucoma Group Cohort

INTRODUCTION

The aim of the study was to make a phenotypic description of the Spanish multicentre glaucoma group cohort of patients.

DESIGN

Retrospective, observational, multicentre, cohort study.

MATERIAL AND METHODS

The clinical charts of 152 patients with hereditary glaucoma from18 Spanish eye centres were reviewed in order to make an epidemiologic description of the type of glaucoma and associated factors. True hereditary cases were compared with familiar cases according to the Gong et al. criteria.

RESULTS

61% were true hereditary cases and 39% familiar cases. Ocular comorbidity, optic disc damage, and visual field mean defect were significantly more severe in hereditary patients, who required significantly more first-line hypotensive drugs and surgical interventions to control intraocular pressure than familiar patients.

CONCLUSIONS

The strength of the hereditary component of glaucoma seems to worsen the clinical course, causing more structural and functional damage and requiring more intense glaucoma treatment. The family history of glaucoma should be carefully investigated and taken into consideration when making treatment decisions or intensifying previous treatment.