Evaluation of the effects on choroidal thickness of bimatoprost 0.03% versus a brinzolamide 1.0%/timolol maleate 0.5% fixed combination

From Eye Care to Hair Growth: Bimatoprost

BACKGROUND

Bimatoprost has emerged as a significant medication in the field of medicine over the past several decades, with diverse applications in ophthalmology, dermatology, and beyond. Originally developed as an ocular hypotensive agent, it has proven highly effective in treating glaucoma and ocular hypertension. Its ability to reduce intraocular pressure has established it as a first-line treatment option, improving management and preventing vision loss. In dermatology, bimatoprost has shown promising results in the promotion of hair growth, particularly in the treatment of alopecia and hypotrichosis. Its mechanism of action, stimulating the hair cycle and prolonging the growth phase, has led to the development of bimatoprost-containing solutions for enhancing eyelash growth.

AIM

The aim of our review is to provide a brief description, overview, and studies in the current literature regarding the versatile clinical use of bimatoprost in recent years. This can help clinicians determine the most suitable individualized therapy to meet the needs of each patient.

METHODS

Our methods involve a comprehensive review of the latest advancements reported in the literature in bimatoprost formulations, which range from traditional eye drops to sustained-release implants. These innovations offer extended drug delivery, enhance patient compliance, and minimize side effects.

RESULTS

The vast literature published on PubMed has confirmed the clinical usefulness of bimatoprost in lowering intraocular pressure and in managing patients with glaucoma. Numerous studies have shown promising results in dermatology and esthetics in promoting hair growth, particularly in treating alopecia and hypotrichosis. Its mechanism of action involves stimulating the hair cycle and prolonging the growth phase, leading to the development of solutions that enhance eyelash growth. The global use of bimatoprost has expanded significantly, with applications growing beyond its initial indications. Ongoing research is exploring its potential in glaucoma surgery, neuroprotection, and cosmetic procedures.

CONCLUSIONS

Bimatoprost has shown immense potential for addressing a wide range of therapeutic needs through various formulations and advancements. Promising future perspectives include the exploration of novel delivery systems such as contact lenses and microneedles to further enhance drug efficacy and patient comfort. Ongoing research and future perspectives continue to shape its role in medicine, promising further advancements and improved patient outcomes.

Evaluation of the Effect of Duration on Retinal Nerve Fiber Layer Thickness and Choroidal Thickness in Exfoliation Syndrome and Exfoliative Glaucoma

Aims: To compare retinal nerve fiber layer (RNFL) thickness and choroidal thickness in patients with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) for 1−5 years or 6−10 years compared to healthy volunteers. Methods and Material: Seventy-eight eyes of 78 patients with XFG, 78 eyes of 78 patients with XFS, and 83 eyes of 83 healthy individuals were included in this prospective study. SD-OCT data for choroid thickness and RNFL were recorded. Results: RNFL thickness was statistically significantly lower in eyes with XFG and XFS than in the control group (p < 0.001). Macular choroidal thickness decreased significantly in the XFG group compared to the XFS and control groups (p < 0.001). No significant difference was observed between the XFS and control groups (p > 0.05). In terms of choroidal and RNFL thicknesses by years in XFG and XFS patients, values were lower in the patients diagnosed 6−10 years previously than in those diagnosed 1−5 years previously. However, the difference was not statistically significant (p > 0.05). Conclusions: Thinning of both choroidal and RNLF thickness in XFG and XFS patients may mean that PEX material is an important risk factor for the progression of XFS to XFG. In addition, thinner choroid and RNLF thickness in the 6−10 years groups show the effect of PEX material and the importance of time.

Study of choroidal vasculature in open angle glaucoma patients

PURPOSE

To investigate the vessel density (VD) of the choriocapillary (CC) plexus in patients affected by preperimetric glaucoma (PPG), advanced glaucoma (AG) and in a healthy control group using Optical Coherence Tomography Angiography (OCTA) in order to clarify the pathogenetic mechanisms of this disease.

METHODS

In this prospective observational study, 19 eyes from 19 patients affected by preperimetric glaucoma (PPG) and 18 eyes from 18 patients affected by advanced glaucoma were studied from January 2022 to May 2022 at the University of Naples "Federico II". These patients had been compared with 20 eyes of 20 healthy subjects that represented the control group. All subjects underwent EDI-OCT to assess the subfoveal choroidal thickness (SFCT). OCTA was used to evaluate the vessel density (VD) of the CC in whole image in the studies groups.

RESULTS

The PPG and AG groups showed a statistically significant reduction in CC vessel density parameters with respect to controls (p < 0.001). Regarding EDI OCT results AG patients exhibited a statistically significant increase in the SFCT compared to healthy controls (p < 0.001). Whereas,no statistically significant difference was between the PPG groups and to healthy controls (p 0.851).

CONCLUSIONS

CC vessel density could represent a helpful and sensible biomarker to identify early choroidal microvascular changes in PPG and MCI in order to better understand the vascular pathophysiological mechanisms involved in glaucoma diseases.

Effect of topical latanoprost on choroidal thickness and vessel area in Guinea pigs

The aim of this study was to investigate the effect of latanoprost, an ocular hypotensive agent and prostaglandin analog, on choroidal thickness and structure in young adult guinea pigs. Young (three-month-old) guinea pigs (n = 10) underwent daily monocular treatment with topical 0.005% latanoprost for 2 weeks, followed by a washout period of 2 weeks. Tonometry (iCare) and retinoscopy were undertaken to monitor intraocular pressure (IOP) and refractive error (recorded as spherical equivalent refractive error; SER), respectively. Axial length (AL) and choroidal thickness (ChT) were measured using high frequency A-scan ultrasonography, with additional ChT data, as well as choroidal vessel (ChV) areas obtained from posterior segment imaging using Spectral Domain-Optical Coherence Tomography (SD-OCT). Image J was used to analyze SD-OCT images. As expected, latanoprost significantly reduced IOP in treated eyes. Mean interocular IOP difference (±SE) changed from -0.40 ± 0.31 mmHg at baseline to -2.23 ± 0.43 mmHg after 2 weeks of treatment (p = 0.05). However, SER and AL were unaffected; interocular difference changed from 0.41 ± 0.58 to 0.38 ± 0.43 D and from -0.002 ± 0.02 mm to -0.007 ± 0.01 mm (p > 0.05), respectively. Latanoprost had minimal effect on ChT. Interocular ChT differences were 0.01 ± 0.06 μm at baseline and 0.04 ± 0.06 μm after 2 weeks of treatment (SD-OCT; p > 0.05). However, treated eyes had significant increased ChV areas; interocular differences changed from -0.76 ± 69.2 to 100.78 ± 66.9 μm² after treatment (p = 0.04). While this study was limited to otherwise untreated young adult guinea pigs, the possibility that choroidal vessel enlargement contributes to the previously reported inhibitory effect of topical latanoprost on myopia progression in young guinea pigs warrants investigation.

Choroidal thickness assessment in keratoconus patients treated with cross-linking compared to healthy population

PURPOSE

To analyze the choroidal thickness between patients with keratoconus undergoing cross-linking treatment and a healthy population, as well as to determine the factors that influence choroidal thickness.

METHODS

This was an observational, analytical, case-control study that was conducted from February 2021 to June 2021. Choroidal thickness was measured at different locations, including the subfoveal, nasal (1000 μm), temporal (1000 μm), superior (1000 μm) and inferior (1000 μm) locations using a Spectral-domain optical coherence tomography with enhanced depth imaging, which allowed us to obtain horizontal and vertical B-scans centered on the fovea.

RESULTS

This study included 21 patients with keratoconus (mean age, 21.86 ± 5.28 years) and 28 healthy patients (mean age, 24.21 ± 4.71 years). Choroidal thickness was significantly greater in patients with keratoconus than in healthy patients in each of the following measured locations: subfoveal (P < 0.001); nasal (1000 μm) (P < 0.001), temporal (1000 μm) (P < 0.001), superior (1000 μm) (P < 0.001) and inferior (1000 μm) (P < 0.001) locations. Variables such as age (ρ = - 0.09; P = 0.50) and refraction (ρ = 0.14; P = 0.34) were not found to be associated with choroidal thickness. In a stepwise multiple linear regression, the group was the single variable correlated with choroidal thickness (β = 0.88; P < 0.001).

CONCLUSION

Choroidal thickness is thicker in keratoconus patients treated with cross-linking than in the healthy population. This finding could be associated with inflammatory choroidal mechanisms in keratoconus patients, but more studies are needed. Age and refractive error do not seem to influence choroidal thickness.

Topical Medication Therapy for Glaucoma and Ocular Hypertension

Glaucoma is one of the most common causes of blindness, thus seriously affecting people’s health and quality of life. The topical medical therapy is as the first line treatment in the management of glaucoma since it is inexpensive, convenient, effective, and safe. This review summarizes and compares extensive clinical trials on the topical medications for the treatment of glaucoma, including topical monotherapy agents, topical fixed-combination agents, topical non-fixed combination agents, and their composition, mechanism of action, efficacy, and adverse effects, which will provide reference for optimal choice of clinical medication. Fixed-combination therapeutics offer greater efficacy, reliable security, clinical compliance, and tolerance than non-fixed combination agents and monotherapy agents, which will become a prefer option for the treatment of glaucoma. Meanwhile, we also discuss new trends in the field of new fixed combinations of medications, which may better control IOP and treat glaucoma.

Lowering Intraocular Pressure: A Potential Approach for Controlling High Myopia Progression

High myopia is among the most common causes of vision impairment, and it is mainly characterized by abnormal elongation of the axial length, leading to pathologic changes in the ocular structures. Owing to the close relationship between high myopia and glaucoma, the association between intraocular pressure (IOP) and high myopia progression has garnered attention. However, whether lowering IOP can retard the progression of high myopia is unclear. On reviewing previous studies, we suggest that lowering IOP plays a role in progressive axial length elongation in high myopia, particularly in pathologic myopia, wherein the sclera is more remodeled. Based on the responses of the ocular layers, we further proposed the potential mechanisms. For the sclera, lowering the IOP could inhibit the activation of scleral fibroblasts and then reduce scleral remodeling, and a decrease in the scleral distending force would retard the ocular expansion like a balloon. For the choroid, lowering IOP results in an increase in choroidal blood perfusion, thereby reducing scleral hypoxia and slowing down scleral remodeling. The final effect of these pathways is slowing axial elongation and the development of scleral staphyloma. Further animal and clinical studies regarding high myopia with varied degree of IOP and the changes of choroid and sclera during IOP fluctuation in high myopia are needed to verify the role of IOP in the pathogenesis and progression of high myopia. It is hoped that this may lead to the development of a prospective treatment option to prevent and control high myopia progression.

EDI-OCT choroidal thickness in Posner-Schlossman syndrome

PURPOSE

To compare the choroidal thickness (CT) of the affected eyes with the contralateral eyes in the active period and in the remission period in Posner-Schlossman syndrome (PSS) using EDI-OCT.

PATIENTS AND METHODS

This prospective longitudinal study included 15 patients with PSS and 15 age- and sex-matched healthy subjects. All subjects underwent complete ophthalmologic examinations, and EDI-OCT was conducted to measure macular CT (mCT) at the subfoveal locations and at 0.5, 1.0 and 2.0 mm superior, inferior, nasal and temporal to the fovea. The mean measurements at each location were used for analysis. Linear regression analysis was performed to analyse the correlation between the choroidal thickness and IOP, and the correlation between the choroidal thickness and episode time.

RESULTS

The mean mCT was significantly thinner in affected eyes than in contralateral eyes in the acute phase (p = 0.010) but were not different in the remission phase (p = 0.404). The mean mCT was significantly increased in the remission phase compared to that in the acute phase in the affected eyes (p = 0.000). The mCT of healthy subjects was significantly thicker than in the affected eyes (p = 0.020) and similar to the fellow eyes of PSS patients (p = 0.357) in the acute phase. Linear regression analyses show negative correlations between the mCT changes and IOP changes in the affected eyes compared to those in the fellow eyes in the acute period (R² = 0.396, p = 0.033) and between the mCT changes and IOP changes from the acute period to the remission period in the affected eyes (R² = 0.372, p = 0.027). Linear regression analyses show positive correlations (age- and sex-matched) between the CT changes and episode time from the affected eyes to the fellow eyes in the acute period (R² = 0.492, p = 0.012).

CONCLUSIONS

The mCT values of the PSS-affected eyes were significantly thinner than those of the fellow eyes in the acute phase and in the remission phase, and this change was correlated with IOP reduction and episode time.

Comparison of peripapillary and subfoveal choroidal thickness in normal versus primary open-angle glaucoma (POAG) subjects using spectral domain optical coherence tomography (SD-OCT) and swept source optical coherence tomography (SS-OCT)

Objective

To elucidate the difference between choroidal thickness (CT) in primary open-angle glaucoma (POAG) and normal subjects and to compare the CT measured using spectral domain optical coherence tomography (SD-OCT) and swept source optical coherence tomography (SS-OCT).

Methods and analysis

This cross-sectional observational study included 25 eyes of 17 POAG subjects (cases) and 31 eyes of 20 normal subjects (controls). All the patients underwent complete ophthalmologic examination, enhanced depth imaging, SD-OCT and SS-OCT. In both controls and cases, the CT was measured in seven predetermined points in macular and peripapillary area and were compared.

Results

Choroid was significantly thicker on SS-OCT compared with SD-OCT in peripapillary and macular area in both cases and controls, except for inferior peripapillary in controls. The CT was not different from glaucoma and controls in peripapillary or macular area on SD-OCT (p>0.05), however, the CT was significantly thicker in glaucoma compared with controls in peripapillary area on SS-OCT (p<0.05) except inferior peripapillary (p=0.13). There was good intraobserver (±20 µm) and interobserver (±55 µm and ±45 µm) agreement on both SD-OCT and SS-OCT respectively.

On SD-OCT, choroid was thinnest at the temporal peripapillary and thickest at subfoveal location in controls. In POAG, choroid was thinnest at inferior peripapillary region and thickest (500 µm) nasal to the fovea. On SS-OCT, choroid was thinnest at inferior peripapillary and thickest at the temporal peripapillary area in both cases and controls.

Conclusion

CT measurements on SS-OCT were higher than the SD-OCT measurements possibly due to better delineation of the sclerochoroidal junction on SS-OCT. CT was significantly thicker in glaucoma subjects compared with controls in peripapillary area on SS-OCT but not in macular area.

Direct and crossover effects of brinzolamide, betaxolol, and latanoprost on choroidal thickness

PURPOSE

To investigate the acute effects of brinzolamide, betaxolol, and latanoprost (drugs commonly used in the medical management of glaucoma) on choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT).

METHODS

Ninety healthy volunteers were evaluated in this prospective study. Participants were randomly divided into 3 groups. Brinzolamide, betaxolol, and latanoprost were administered into the left eyes of the first group (n = 30), second group (n = 30), and third group (n = 30), respectively, and artificial tear (Sodium hyaluronate) was instilled into the right eyes of all participants. Subfoveal choroidal thickness (SFCT) was measured using EDI-OCT before and 45 minutes after administration of the antiglaucomatous drops.

RESULTS

SFCT revealed a significant increase in the left eye (administered antiglaucomatous drop) in the brinzolamide (p = 0.001) and betaxolol groups (p = 0.049) and a significant increase also in the right eye (administered artificial drop) in the brinzolamide (p = 0.001) and betaxolol groups (p = 0.001). However, SFCT did not reveal a significant increase in the left eye (p = 0.213) or in the right eye (p = 0.062) in the latanoprost group.

CONCLUSION

Brinzolamide and betaxolol caused an increase in SFCT, while latanoprost had no significant effect on SFCT.