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Benagiano V, Rizzi A, Sannace C, Alessio G, Ribatti D, Dammacco R. Aqueous humor as eye lymph: A crossroad between venous and lymphatic system. Exp Eye Res 2024; 243:109904. [PMID: 38642600 DOI: 10.1016/j.exer.2024.109904] [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: 12/15/2023] [Revised: 03/18/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
Aqueous humor (AQH) is a transparent fluid with characteristics similar to those of the interstitial fluid, which fills the eyeball posterior and anterior chambers and circulates in them from the sites of production to those of drainage. The AQH volume and pressure homeostasis is essential for the trophism of the ocular avascular tissues and their normal structure and function. Different AQH outflow pathways exist, including a main pathway, quite well defined anatomically and referred to as the conventional pathway, and some accessory pathways, more recently described and still not fully morphofunctionally understood, generically referred to as unconventional pathways. The conventional pathway is based on the existence of a series of conduits starting with the trabecular meshwork and Schlemm's Canal and continuing with a system of intrascleral and episcleral venules, which are tributaries to veins of the anterior segment of the eyeball. The unconventional pathways are mainly represented by the uveoscleral pathway, in which AQH flows through clefts, interstitial conduits located in the ciliary body and sclera, and then merges into the aforementioned intrascleral and episcleral venules. A further unconventional pathway, the lymphatic pathway, has been supported by the demonstration of lymphatic microvessels in the limbal sclera and, possibly, in the uvea (ciliary body, choroid) as well as by the ocular glymphatic channels, present in the neural retina and optic nerve. It follows that AQH may be drained from the eyeball through blood vessels (TM-SC pathway, US pathway) or lymphatic vessels (lymphatic pathway), and the different pathways may integrate or compensate for each other, optimizing the AQH drainage. The present review aims to define the state-of-the-art concerning the structural organization and the functional anatomy of all the AQH outflow pathways. Particular attention is paid to examining the regulatory mechanisms active in each of them. The new data on the anatomy and physiology of AQH outflow pathways is the key to understanding the pathophysiology of AQH outflow disorders and could open the way for novel approaches to their treatment.
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Affiliation(s)
- Vincenzo Benagiano
- Department of Translational Biomedicine and Neuroscience, University of Bari 'Aldo Moro', Bari, Italy.
| | - Anna Rizzi
- Department of Translational Biomedicine and Neuroscience, University of Bari 'Aldo Moro', Bari, Italy
| | - Carmela Sannace
- Azienda Sanitaria Locale Bari, Ophthalmology Day Service Triggiano-Gioia del Colle, Bari, Italy
| | - Giovanni Alessio
- Department of Translational Biomedicine and Neuroscience, University of Bari 'Aldo Moro', Bari, Italy
| | - Domenico Ribatti
- Department of Translational Biomedicine and Neuroscience, University of Bari 'Aldo Moro', Bari, Italy
| | - Rosanna Dammacco
- Department of Translational Biomedicine and Neuroscience, University of Bari 'Aldo Moro', Bari, Italy
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Mohamed Y, Passaglia CL. Simulation of gravity- and pump-driven perfusion techniques for measuring outflow facility of ex vivo and in vivo eyes. PLoS One 2023; 18:e0294607. [PMID: 37988400 PMCID: PMC10662726 DOI: 10.1371/journal.pone.0294607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
Aqueous humor dynamics are commonly assessed by infusing fluid into the eye and measuring intraocular pressure (IOP). From the pressure-flow relationship, conventional outflow facility is estimated to study glaucomatous processes that lower facility or identify therapeutics that enhance facility in hopes of restoring healthy IOP levels. The relative merits and limitations of constant flow (CF), gravity-driven constant pressure (CPg), and pump-driven constant pressure (CPp) infusion techniques were explored via simulations of a lumped parameter viscoelastic model of the eye. Model parameter values were based on published perfusion system properties and outflow facility data from rodents. Step increases in pressure or flow were simulated without and with IOP noise recorded from enucleated eyes, anesthetized animals, and conscious animals. Steady-state response levels were determined using published window and ratio criteria. Model simulations show that all perfusion techniques estimate facility accurately and that ocular fluid dynamics set a hard limit on how fast measurements can be taken. This limit can be approached with CPg and CPp systems by increasing their gain but not with CF systems, which invariably take longest to settle. Facility experiment duration is further lengthened by inclusion of IOP noise, and data filtering is needed for steady-state detection with in vivo noise. The ratio criterion was particularly affected because noise in the flow data is amplified by the higher gain of CPg and CPp systems. A recursive regression method is introduced, which can ignore large transient IOP fluctuations that interfere with steady-state detection by fitting incoming data to the viscoelastic eye model. The fitting method greatly speeds up data collection without loss of accuracy, which could enable outflow facility measurements in conscious animals. The model may be generalized to study response dynamics to fluid infusion in other viscoelastic compartments of the body and model insights extended to optimize experiment design.
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Affiliation(s)
- Youssef Mohamed
- Department of Medical Engineering, University of South Florida, Tampa, FL, United States of America
| | - Christopher L. Passaglia
- Department of Medical Engineering, University of South Florida, Tampa, FL, United States of America
- Department of Ophthalmology, University of South Florida, Tampa, FL, United States of America
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Fang Z, Bi S, Brown JD, Chen J, Pan T. Microfluidics in the eye: a review of glaucoma implants from an engineering perspective. LAB ON A CHIP 2023; 23:4736-4772. [PMID: 37847237 DOI: 10.1039/d3lc00407d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Glaucoma is a progressive optic neuropathy in the eye, which is a leading cause of irreversible blindness worldwide and currently affects over 70 million individuals. Clinically, intraocular pressure (IOP) reduction is the only proven treatment to halt the progression of glaucoma. Microfluidic devices such as glaucoma drainage devices (GDDs) and minimally invasive glaucoma surgery (MIGS) devices are routinely used by ophthalmologists to manage elevated IOP, by creating an artificial pathway for the over-accumulated aqueous humor (AH) in a glaucomatous eye, when the natural pathways are severely blocked. Herein, a detailed modelling and analysis of both the natural microfluidic pathways of the AH in the eye and artificial microfluidic pathways formed additionally by the various glaucoma implants are conducted to provide an insight into the causes of the IOP abnormality and the improvement schemes of current implant designs. The mechanisms of representative glaucoma implants have been critically reviewed from the perspective of microfluidics, and we have categorized the current implants into four groups according to the targeted drainage sites of the AH, namely Schlemm's canal, suprachoroidal space, subconjunctival space, and ocular surface. In addition, we propose to divide the development and evolution of glaucoma implant designs into three technological waves, which include microtube (1st), microvalve (2nd) and microsystem (3rd). With the emerging trends of minimal invasiveness and artificial intelligence in the development of medical implants, we envision that a comprehensive glaucoma treatment microsystem is on the horizon, which is featured with active and wireless control of IOP, real-time continuous monitoring of IOP and aqueous rate, etc. The current review could potentially cast light on the unmatched needs, challenges, and future directions of the microfluidic structural and functional designs of glaucoma implants, which would enable an enhanced safety profile, reduced complications, increased efficacy of lowering IOP and reduced IOP fluctuations, closed-loop and on-demand control of IOP, etc.
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Affiliation(s)
- Zecong Fang
- Bionic Sensing and Intelligence Center (BSIC), Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.
| | - Shuzhen Bi
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, 215123, China
| | | | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Tingrui Pan
- Bionic Sensing and Intelligence Center (BSIC), Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, 215123, China
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, 230026, China
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Agarwal R, Iezhitsa I. Advances in targeting the extracellular matrix for glaucoma therapy: current updates. Expert Opin Ther Targets 2023; 27:1217-1229. [PMID: 38069479 DOI: 10.1080/14728222.2023.2293748] [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: 10/11/2023] [Accepted: 12/07/2023] [Indexed: 12/31/2023]
Abstract
INTRODUCTION Elevated intraocular pressure (IOP) is a well-recognized risk factor for development of primary open angle glaucoma (POAG), a leading cause of irreversible blindness. Ocular hypertension is associated with excessive extracellular matrix (ECM) deposition in trabecular meshwork (TM) resulting in increased aqueous outflow resistance and elevated IOP. Hence, therapeutic options targeting ECM remodeling in TM to lower IOP in glaucomatous eyes are of considerable importance. AREAS COVERED This paper discusses the complex process of ECM regulation in TM and explores promising therapeutic targets. The role of Transforming Growth Factor-β as a central player in ECM deposition in TM is discussed. We elaborate the key regulatory processes involved in its activation, release, signaling, and cross talk with other signaling pathways including Rho GTPase, Wnt, integrin, cytokines, and renin-angiotensin-aldosterone. Further, we summarize the therapeutic agents that have been explored to target ECM dysregulation in TM. EXPERT OPINION Targeting molecular pathways to reduce ECM deposition and/or enhance its degradation are of considerable significance for IOP lowering. Challenges lie in pinpointing specific targets and designing drug delivery systems to precisely interact with pathologically active/inactive signaling. Recent advances in monoclonal antibodies, fusion molecules, and vectored nanotechnology offer potential solutions.
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Affiliation(s)
- Renu Agarwal
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Igor Iezhitsa
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Dada T, Verma S, Bukke AN, Strohmaier CA, Huang AS. Aqueous Angiography-guided Minimally Invasive Glaucoma Surgery. J Curr Glaucoma Pract 2022; 16:1-3. [PMID: 36060039 PMCID: PMC9385386 DOI: 10.5005/jp-journals-10078-1367] [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] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Dada T, Verma S, Bukke AN, et al. Aqueous Angiography-guided Minimally Invasive Glaucoma Surgery. J Curr Glaucoma Pract 2022;16(1):1-3.
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Affiliation(s)
- Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,Tanuj Dada, All India Institute of Medical Sciences, New Delhi, India, e-mail:
| | - Saurabh Verma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anand N Bukke
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Alex S Huang
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States of America
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Liu P, Wang F, Song Y, Wang M, Zhang X. Current situation and progress of drugs for reducing intraocular pressure. Ther Adv Chronic Dis 2022; 13:20406223221140392. [PMID: 36479139 PMCID: PMC9720821 DOI: 10.1177/20406223221140392] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
Glaucoma, the most common cause of irreversible blindness worldwide, usually causes characteristic optic nerve damage. Pathological intraocular pressure (IOP) elevation is a major risk factor. Drug reduction of IOP is the preferred treatment for clinicians because it can delay the progression of disease. However, the traditional IOP-lowering drugs currently used by patients may be poorly tolerated. Therefore, in recent years, some new drugs have been put into clinical application or in clinical phase I–III studies. They have a better IOP-lowering effect and fewer adverse reactions. Because glaucoma is a chronic disease, drugs need to be administered continuously for a long time. For patients, good compliance and high drug bioavailability have a positive effect on the prognosis of the disease. Therefore, clinicians and scientists have developed drug delivery systems to solve this complex problem. In addition, natural compounds and dietary supplements have a good effect of reducing IOP, and they can also protect the optic nerve through antioxidant action. We summarize the current traditional drugs, new drugs, sustained-release drug delivery systems, and complementary drugs and outline the mechanism of action and clinical effects of these drugs on glaucoma and their recent advances.
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Affiliation(s)
- Peiyu Liu
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Feifei Wang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Yuning Song
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Menghui Wang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Xu Zhang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, 463 Bayi Road, Nanchang 330006, China
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Toris CB, Gagrani M, Ghate D. Current methods and new approaches to assess aqueous humor dynamics. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1902308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Carol B. Toris
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
- Dept. Of Ophthalmology and Visual Science, Case Western Reserve University, Cleveland, OH USA
| | - Meghal Gagrani
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
| | - Deepta Ghate
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
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Kasahara M, Shoji N. Effectiveness and limitations of minimally invasive glaucoma surgery targeting Schlemm's canal. Jpn J Ophthalmol 2020; 65:6-22. [PMID: 33150512 DOI: 10.1007/s10384-020-00781-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15-19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure.
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Affiliation(s)
- Masayuki Kasahara
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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Neffendorf JE, Guillemaut JY, Hutter JC, Ho J, Williamson TH. Effect of Aqueous Dynamics on Gas Behavior Following Retinal Reattachment Surgery. Ophthalmic Surg Lasers Imaging Retina 2020; 51:522-528. [PMID: 32955592 DOI: 10.3928/23258160-20200831-07] [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: 02/24/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine how the gas concentration in air required to achieve full postoperative vitreous cavity fill varies in different aqueous outflow states. MATERIALS AND METHODS A mathematical model was used to estimate gas dynamics. The change in gas bubble volume over time was calculated in an eye with normal aqueous outflow, ocular hypertension (OHT), and OHT with apraclonidine treatment. RESULTS The concentration required was higher for all gases to achieve a full postoperative fill in OHT eyes versus normal eyes. Optimal gas concentrations were 22.6% for SF6, 13.9% for C2F6, and 11.6% for C3F8. Despite this, in OHT, the fill achieved was 95%, 95%, and 94% for SF6, C2F6, and C3F8, respectively. With apraclonidine, percentage fill improved for all gases. CONCLUSIONS This is the first study to show aqueous outflow affects bubble size and indicates eyes with reduced outflow are at risk of underfill. This can ultimately affect surgical success. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:522-528.].
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Byszewska A, Konopińska J, Kicińska AK, Mariak Z, Rękas M. Canaloplasty in the Treatment of Primary Open-Angle Glaucoma: Patient Selection and Perspectives. Clin Ophthalmol 2019; 13:2617-2629. [PMID: 32021062 PMCID: PMC6948200 DOI: 10.2147/opth.s155057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023] Open
Abstract
Canaloplasty is a surgical procedure that has undergone a number of developments since its introduction in 2005. Many thousands of canaloplasties have been performed around the world since then and is, by definition, a blebless procedure. It does not necessitate the use of any antifibrotic agents and results in safe and effective IOP reductions in patients with open-angle glaucoma (OAG) with minimal complications and no bleb-related adverse events. When considering the surgical management of patients with early and medium stages of the disease, canaloplasty can be considered as a first line option. This paper will overview the theoretical effectiveness of canal surgery, the fundamental aspects of aqueous outflow resistance with particular emphasis on the role of the trabecular meshwork, Schlemm's canal, and the collector channels, and the methods available for the clinical evaluation of the outflow pathways in relation to the ocular anatomy. Further, the paper will detail the surgical technique itself and how this has developed over time together with the clinical aspects that should be accounted for when selecting patients for this surgery.
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Affiliation(s)
- Anna Byszewska
- Department of Ophthalmology, Military Institute of Medicine, Warsaw 04-141, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Białystok, Białystok 15-276, Poland
| | | | - Zofia Mariak
- Department of Ophthalmology, Medical University of Białystok, Białystok 15-276, Poland
| | - Marek Rękas
- Department of Ophthalmology, Military Institute of Medicine, Warsaw 04-141, Poland
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11
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How many aqueous humor outflow pathways are there? Surv Ophthalmol 2019; 65:144-170. [PMID: 31622628 DOI: 10.1016/j.survophthal.2019.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/29/2019] [Accepted: 10/04/2019] [Indexed: 12/31/2022]
Abstract
The aqueous humor (AH) outflow pathways definition is still matter of intense debate. To date, the differentiation between conventional (trabecular meshwork) and unconventional (uveoscleral) pathways is widely accepted, distinguishing the different impact of the intraocular pressure on the AH outflow rate. Although the conventional route is recognized to host the main sites for intraocular pressure regulation, the unconventional pathway, with its great potential for AH resorption, seems to act as a sort of relief valve, especially when the trabecular resistance rises. Recent evidence demonstrates the presence of lymphatic channels in the eye and proposes that they may participate in the overall AH drainage and intraocular pressure regulation, in a presumably adaptive fashion. For this reason, the uveolymphatic route is increasingly thought to play an important role in the ocular hydrodynamic system physiology. As a result of the unconventional pathway characteristics, hydrodynamic disorders do not develop until the adaptive routes cannot successfully counterbalance the increased AH outflow resistance. When their adaptive mechanisms fail, glaucoma occurs. Our review deals with the standard and newly discovered AH outflow routes, with particular attention to the importance they may have in opening new therapeutic strategies in the treatment of ocular hypertension and glaucoma.
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12
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Andrew NH, Akkach S, Casson RJ. A review of aqueous outflow resistance and its relevance to microinvasive glaucoma surgery. Surv Ophthalmol 2019; 65:18-31. [PMID: 31425701 DOI: 10.1016/j.survophthal.2019.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
Primary open-angle glaucoma is the leading cause of irreversible blindness worldwide, and intraocular pressure reduction remains the only proven treatment strategy. Elevated intraocular pressure occurs as the result of impaired aqueous humor outflow. Both a passive model and a dynamic model have been used to explain trabecular outflow resistance. The passive model posits that the trabecular meshwork acts as a static filter that exerts stable and passive resistance to outflow. In contrast, the dynamic model involves a "biomechanical pump." In recent years, the range of surgical management options for glaucoma has dramatically expanded, particularly the class of procedures known as microinvasive glaucoma surgery. These procedures typically target and enhance specific outflow routes. Optimal patient outcomes with microinvasive glaucoma surgery require a clear understanding of aqueous outflow and a surgical approach that is targeted to overcome the site of abnormal resistance in the individual. We review the anatomy and physiology of trabecular and suprachoroidal outflow that is of relevance to microinvasive glaucoma surgery-performing surgeons.
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Affiliation(s)
- Nicholas H Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - Sarmad Akkach
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia; Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
| | - Robert J Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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Fuwa M, Toris CB, Fan S, Taniguchi T, Ichikawa M, Odani-Kawabata N, Iwamura R, Yoneda K, Matsugi T, Shams NK, Zhang JZ. Effects of a Novel Selective EP2 Receptor Agonist, Omidenepag Isopropyl, on Aqueous Humor Dynamics in Laser-Induced Ocular Hypertensive Monkeys. J Ocul Pharmacol Ther 2018; 34:531-537. [PMID: 29989843 DOI: 10.1089/jop.2017.0146] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the mechanism of the intraocular pressure (IOP)-lowering effect of a novel selective prostaglandin E2 receptor 2 (EP2) receptor agonist, omidenepag isopropyl (OMDI). METHODS The effect of OMDI on IOP and aqueous humor dynamics was evaluated in cynomolgus monkeys with unilateral laser-induced ocular hypertension. In a crossover manner, the hypertensive eye of each monkey was dosed once daily with 20 μL of either 0.002% OMDI or vehicle. On day 7 of dosing, IOP was measured by pneumatonometry, aqueous humor flow and outflow facility were evaluated by fluorophotometry, and uveoscleral outflow was calculated mathematically. Treatments were compared by paired t-tests. RESULTS OMDI at 0.002% significantly lowered IOP by 27%, 35%, and 44% at 0.5, 1.5, and 4 h after the last dosing, respectively. There was no difference in aqueous humor flow between vehicle and OMDI treatments. When comparing OMDI to the vehicle treatment, outflow facility and uveoscleral outflow were significantly (P < 0.05) increased by 71% and 176%, respectively. CONCLUSIONS OMDI, a novel IOP-lowering compound, reduced IOP by increasing outflow facility and uveoscleral outflow in nonhuman primates.
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Affiliation(s)
- Masahiro Fuwa
- 1 R&D Division, Santen Pharmaceutical Co., Ltd. , Nara, Japan
| | - Carol B Toris
- 2 Department of Ophthalmology, Nebraska Medical Center, University of Nebraska Medical Center , Omaha, Nebraska.,3 Department of Ophthalmology, Case Western Reserve University , Cleveland, Ohio
| | - Shan Fan
- 2 Department of Ophthalmology, Nebraska Medical Center, University of Nebraska Medical Center , Omaha, Nebraska
| | | | - Masaki Ichikawa
- 1 R&D Division, Santen Pharmaceutical Co., Ltd. , Nara, Japan
| | | | - Ryo Iwamura
- 5 Pharmaceuticals Research Laboratory, Pharmaceutical Division, Ube Industries, Ltd. , Yamaguchi, Japan
| | - Kenji Yoneda
- 5 Pharmaceuticals Research Laboratory, Pharmaceutical Division, Ube Industries, Ltd. , Yamaguchi, Japan
| | - Takeshi Matsugi
- 1 R&D Division, Santen Pharmaceutical Co., Ltd. , Nara, Japan
| | - Naveed K Shams
- 4 R&D Division, Santen Pharmaceutical Co., Ltd. , Osaka, Japan .,6 R&D Division, Santen, Inc. , Emeryville, California
| | - Jin-Zhong Zhang
- 1 R&D Division, Santen Pharmaceutical Co., Ltd. , Nara, Japan .,6 R&D Division, Santen, Inc. , Emeryville, California
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15
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Kostanyan T, Shazly T, Kaplowitz KB, Wang SZ, Kola S, Brown EN, Loewen NA. Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching. Graefes Arch Clin Exp Ophthalmol 2017; 255:2423-2428. [PMID: 28944413 DOI: 10.1007/s00417-017-3804-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/08/2017] [Accepted: 09/12/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To apply propensity score matching to compare Baerveldt glaucoma drainage implant (BGI) to Trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to BGI which is traditionally reserved for more severe glaucoma. METHODS BGI and AIT patients with at least 1 year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients with neovascular glaucoma, with prior glaucoma surgery, or without a close match were excluded. RESULTS Of 353 patients, 30 AIT patients were matched to 29 BGI patients. Baseline characteristics including, IOP, the number of glaucoma medications, type of glaucoma, the degree of VF loss and GI were not significantly different between AIT and BGI. BGI had a preoperative IOP of 21.6 ± 6.3 mmHg compared to 21.5 ± 7.4 for AIT on 2.8 ± 1.1 medications and 2.5 ± 2.3 respectively. At 30 months, the mean IOP was 15.0 ± 3.9 mmHg for AIT versus 15.0 ± 5.7 mmHg for BGI (p > 0.05), while the number of drops was 1.5 ± 1.3 for AIT (change: p = 0.001) versus 2.4 ± 1.2 for BGI (change: p = 0.17; AIT vs BGI: 0.007). Success, defined as IOP < 21 mmHg, < 20% reduction and no reoperation, was achieved at 1 year in 56% of AIT versus 55% of BGI (p > 0.05) and 50% versus 52% at 2.5 years. CONCLUSIONS A propensity score matched comparison of AIT and BGI demonstrated a similar IOP reduction through 1 year. AIT required fewer medications.
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Affiliation(s)
- Tigran Kostanyan
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tarek Shazly
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin B Kaplowitz
- Department of Ophthalmology, VA Loma Linda, Loma Linda University, Loma Linda, CA, USA
| | - Steven Z Wang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sushma Kola
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric N Brown
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nils A Loewen
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA.
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16
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Johnson M, McLaren JW, Overby DR. Unconventional aqueous humor outflow: A review. Exp Eye Res 2017; 158:94-111. [PMID: 26850315 PMCID: PMC4970980 DOI: 10.1016/j.exer.2016.01.017] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/04/2016] [Accepted: 01/26/2016] [Indexed: 11/17/2022]
Abstract
Aqueous humor flows out of the eye primarily through the conventional outflow pathway that includes the trabecular meshwork and Schlemm's canal. However, a fraction of aqueous humor passes through an alternative or 'unconventional' route that includes the ciliary muscle, supraciliary and suprachoroidal spaces. From there, unconventional outflow may drain through two pathways: a uveoscleral pathway where aqueous drains across the sclera to be resorbed by orbital vessels, and a uveovortex pathway where aqueous humor enters the choroid to drain through the vortex veins. We review the anatomy, physiology and pharmacology of these pathways. We also discuss methods to determine unconventional outflow rate, including direct techniques that use radioactive or fluorescent tracers recovered from tissues in the unconventional pathway and indirect methods that estimate unconventional outflow based on total outflow over a range of pressures. Indirect methods are subject to a number of assumptions and generally give poor agreement with tracer measurements. We review the variety of animal models that have been used to study conventional and unconventional outflow. The mouse appears to be a promising model because it captures several aspects of conventional and unconventional outflow dynamics common to humans, although questions remain regarding the magnitude of unconventional outflow in mice. Finally, we review future directions. There is a clear need to develop improved methods for measuring unconventional outflow in both animals and humans.
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Affiliation(s)
- Mark Johnson
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA; Department of Ophthalmology, Northwestern University, Chicago, IL, USA.
| | - Jay W McLaren
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Darryl R Overby
- Department of Bioengineering, Imperial College London, London, England, UK
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17
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Abstract
Uveitic glaucoma consists one of the most serious complications of intraocular inflammation and, despite its rarity, is considered as one of the leading causes of preventable loss of vision worldwide. It has been associated with a wide spectrum of inflammatory diseases, but its pathogenesis is still not fully comprehended. It appears that the type of inflammation, the steroid-response and the anatomical alterations of the anterior chamber play a pivotal role. To our knowledge, the mechanisms may be both acute and chronic. The main targets of the treatment are to control the inflammation and reduce the intraocular pressure (IOP). The management of glaucoma associated with uveitis remains an extremely challenging condition for ophthalmologists. The successful treatment of uveitic glaucoma is inextricably correlated with prompt and immediate therapeutic decisions. Very often a solid collaboration between clinicians from different specialties may be required for treating the underlying disease. Further understanding of its pathogenesis can indicate therapeutic targets and may lead to the development of new and more efficient therapeutic approaches. New glaucoma surgical modalities may ameliorate the prognosis after surgical intervention, but this calls for further evaluation. This study aims to highlight the complexity of uveitic glaucoma analyzing the main pathogenetic mechanisms and the correlations with the inflammatory response.
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Affiliation(s)
| | - Velota Ct Sung
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospital, NHS Trust, UK
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18
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Boussommier-Calleja A, Li G, Wilson A, Ziskind T, Scinteie OE, Ashpole NE, Sherwood JM, Farsiu S, Challa P, Gonzalez P, Downs JC, Ethier CR, Stamer WD, Overby DR. Physical Factors Affecting Outflow Facility Measurements in Mice. Invest Ophthalmol Vis Sci 2016; 56:8331-9. [PMID: 26720486 DOI: 10.1167/iovs.15-17106] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Mice are commonly used to study conventional outflow physiology. This study examined how physical factors (hydration, temperature, and anterior chamber [AC] deepening) influence ocular perfusion measurements in mice. METHODS Outflow facility (C) and pressure-independent outflow (Fu) were assessed by multilevel constant pressure perfusion of enucleated eyes from C57BL/6 mice. To examine the effect of hydration, seven eyes were perfused at room temperature, either immersed to the limbus in saline and covered with wet tissue paper or exposed to room air. Temperature effects were examined in 12 eyes immersed in saline at 20 °C or 35 °C. Anterior chamber deepening was examined in 10 eyes with the cannula tip placed in the anterior versus posterior chamber (PC). Posterior bowing of the iris (AC deepening) was visualized by three-dimensional histology in perfusion-fixed C57BL/6 eyes and by spectral-domain optical coherence tomography in living CD1 mice. RESULTS Exposure to room air did not significantly affect C, but led to a nonzero Fu that was significantly reduced upon immersion in saline. Increasing temperature from 20 °C to 35 °C increased C by 2.5-fold, more than could be explained by viscosity changes alone (1.4-fold). Perfusion via the AC, but not the PC, led to posterior iris bowing and increased outflow. CONCLUSIONS Insufficient hydration contributes to the appearance of pressure-independent outflow in enucleated mouse eyes. Despite the large lens, AC deepening may artifactually increase outflow in mice. Temperature-dependent metabolic processes appear to influence conventional outflow regulation. Physical factors should be carefully controlled in any outflow studies involving mice.
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Affiliation(s)
| | - Guorong Li
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Amanda Wilson
- Department of Bioengineering Imperial College London, London, United Kingdom
| | - Tal Ziskind
- Department of Bioengineering Imperial College London, London, United Kingdom
| | - Oana Elena Scinteie
- Department of Bioengineering Imperial College London, London, United Kingdom
| | - Nicole E Ashpole
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Joseph M Sherwood
- Department of Bioengineering Imperial College London, London, United Kingdom
| | - Sina Farsiu
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Pratap Challa
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Pedro Gonzalez
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - J Crawford Downs
- Department of Ophthalmology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - C Ross Ethier
- Department of Bioengineering Imperial College London, London, United Kingdom 4Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - W Daniel Stamer
- Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Darryl R Overby
- Department of Bioengineering Imperial College London, London, United Kingdom
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19
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Gigon A, Shaarawy T. The Suprachoroidal Route in Glaucoma Surgery. J Curr Glaucoma Pract 2016; 10:13-20. [PMID: 27231415 PMCID: PMC4875730 DOI: 10.5005/jp-journals-10008-1197] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022] Open
Abstract
Glaucoma surgeries targeting the uveoscleral drainage pathways have been drawing more attention lately. Among all the available techniques, procedures focusing on the supra-choroidal space seem particularly promising, by making use of a presumably efficient and secure outflow route and avoiding subconjunctival filtration blebs. The purpose of this review is to assess the efficacy and the security of the different suprachoroidal drainage implants, namely the CyPass Micro-Stent, the iStent Supra, the SOLX Gold Shunt, the Aquashunt, and the STARflo Glaucoma Implant. Most clinical studies seem to currently point toward the direction that there are actual benefits in suprachoroidal surgeries by avoiding bleb-related complications. Nevertheless, even suprachoroidal implants may be subject to scarring and failure. More data are still needed, especially concerning long-term effects, although the approach does seem appealing. How to cite this article: Gigon A, Shaarawy T. The Suprachoroidal Route in Glaucoma Surgery. J Curr Glaucoma Pract 2016;10(1): 13-20.
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Affiliation(s)
- Anthony Gigon
- Medical Student (Final Year), Department of Ophthalmology, Geneva University Hospital Geneva, Switzerland
| | - Tarek Shaarawy
- LecturerDepartment of Ophthalmology, Geneva University Hospital Geneva, Switzerland
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20
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Yucel Y, Gupta N. Lymphatic drainage from the eye: A new target for therapy. PROGRESS IN BRAIN RESEARCH 2015; 220:185-98. [PMID: 26497791 DOI: 10.1016/bs.pbr.2015.07.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lowering intraocular pressure (IOP) has been central to glaucoma care for over a century. In order to prevent sight loss from disease, there has been considerable focus on medical and surgical methods to improve fluid drainage from the eye. In spite of this, our understanding of exactly how aqueous humor leaves the eye is not complete. Recently, lymphatic vessels have been discovered in the human uvea, with studies showing lymphatic fluid outflow in several models, in addition to evidence for their pharmacological enhancement. The presence of a lymphatic outflow system points to an exciting, expanded understanding of how fluid and particulate materials such as proteins move out of the eye, and how IOP may be regulated. We coin the term "uveolymphatic pathway"-to reflect a comprehensive and compelling new target for glaucoma and an exciting opportunity for future investigations to better understand the eye in health and disease.
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Affiliation(s)
- Yeni Yucel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada; Ophthalmic Pathology Laboratory, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Engineering & Architectural Science, Ryerson University, Toronto, ON, Canada.
| | - Neeru Gupta
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada; Glaucoma and Nerve Protection Unit, St. Michael's Hospital, Toronto, ON, Canada
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21
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Abstract
AIM To analyze current understanding of the factors that contribute to raised intraocular pressure (IOP) in patients with uveitis. METHODS A pubmed literature review was carried out using words including "uveitic glaucoma", "IOP AND uveitis", "ocular hypertension AND uveitis", "inflammation AND glaucoma", "aqueous dynamics" AND "glaucoma/uveitis". RESULTS Of the two studies looking at the aqueous dynamics in experimentally induced uveitis, both found aqueous flow decreased acutely, and one found that uveoscleral outflow increased. This is likely to reflect the types of uveitis that present acutely with hypotony. A study examining patients with Fuch's heterochromic cyclitis found no difference in aqueous flow or uveoscleral outflow. No studies have examined aqueous dynamics in types of uveitis that present with acutely raised IOP. Levels of prostaglandins rise in acute uveitis, which has been shown to increase uveoscleral and trabecular outflow, without affecting aqueous flow. Studies have demonstrated that raised levels of trabecular protein reduce trabecular outflow. Steroid treatment, inflammatory cells, free radicals and enzymes are also likely to contribute to the development of raised pressure. When considering the impact of the pathogenesis of raised pressure in uveitis on its treatment, prostaglandins may provide good intraocular pressure control, but there are concerns regarding their theoretical ability to worsen the inflammatory response in uveitis. Studies have not conclusively proven this to be the case. Surgical success rates vary, but trabeculectomy plus an antimetabolite, deep sclerectomy plus an antimetabolite, and Ahmed valve surgery have been used. CONCLUSIONS Uveitic glaucoma is caused by a number of different diseases, some of which present with acute hypotony, others with acutely raised IOP, and others which demonstrate an increase in IOP over time. Further studies should be carried out to examine the differing pathogenesis in these types of diseases, and to establish the best treatment options.
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Affiliation(s)
- Alexander Jan Baneke
- a Department of Ophthalmology , St Thomas' Hospital, Guy's and St Thomas' NHS Trust , London , UK
| | - K Sheng Lim
- a Department of Ophthalmology , St Thomas' Hospital, Guy's and St Thomas' NHS Trust , London , UK
| | - Miles Stanford
- a Department of Ophthalmology , St Thomas' Hospital, Guy's and St Thomas' NHS Trust , London , UK
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22
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Harrison BA, Almstead ZY, Burgoon H, Gardyan M, Goodwin NC, Healy J, Liu Y, Mabon R, Marinelli B, Samala L, Zhang Y, Stouch TR, Whitlock NA, Gopinathan S, McKnight B, Wang S, Patel N, Wilson AGE, Hamman BD, Rice DS, Rawlins DB. Discovery and Development of LX7101, a Dual LIM-Kinase and ROCK Inhibitor for the Treatment of Glaucoma. ACS Med Chem Lett 2015; 6:84-8. [PMID: 25589936 DOI: 10.1021/ml500367g] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/24/2014] [Indexed: 12/14/2022] Open
Abstract
The structure of LX7101, a dual LIM-kinase and ROCK inhibitor for the treatment of ocular hypertension and associated glaucoma, is disclosed. Previously reported LIM kinase inhibitors suffered from poor aqueous stability due to solvolysis of the central urea. Replacement of the urea with a hindered amide resulted in aqueous stable compounds, and addition of solubilizing groups resulted in a set of compounds with good properties for topical dosing in the eye and good efficacy in a mouse model of ocular hypertension. LX7101 was selected as a clinical candidate from this group based on superior efficacy in lowering intraocular pressure and a good safety profile. LX7101 completed IND enabling studies and was tested in a Phase 1 clinical trial in glaucoma patients, where it showed efficacy in lowering intraocular pressure.
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Affiliation(s)
- Bryce A. Harrison
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Zheng Y. Almstead
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Hugh Burgoon
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Michael Gardyan
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Nicole C. Goodwin
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Jason Healy
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Ying Liu
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Ross Mabon
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Brett Marinelli
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Lakshman Samala
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Yulian Zhang
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | - Terry R. Stouch
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
| | | | | | | | | | | | | | | | | | - David B. Rawlins
- Department
of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540, United States
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23
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Saccà SC, Pulliero A, Izzotti A. The Dysfunction of the Trabecular Meshwork During Glaucoma Course. J Cell Physiol 2014; 230:510-25. [DOI: 10.1002/jcp.24826] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/05/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Sergio Claudio Saccà
- Department of Head/Neck Pathologies; St Martino Hospital; Ophthalmology Unit; Genoa Italy
| | - Alessandra Pulliero
- Department of Health Sciences; Section of Hygiene and Preventive Medicine; University of Genoa; Genoa Italy
| | - Alberto Izzotti
- Department of Health Sciences; Section of Hygiene and Preventive Medicine; University of Genoa; Genoa Italy
- Mutagenesis Unit; IST National Institute for Cancer Research; IRCCS Hospital-University San Martino Company; Genoa Italy
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24
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Mastropasqua L, Agnifili L, Mastropasqua R, Fasanella V, Nubile M, Toto L, Carpineto P, Ciancaglini M. In vivo laser scanning confocal microscopy of the ocular surface in glaucoma. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2014; 20:879-894. [PMID: 24576766 DOI: 10.1017/s1431927614000324] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Over the past decade, knowledge about the ocular surface in glaucoma has significantly increased through the use of in vivo laser scanning confocal microscopy (LSCM). This in vivo imaging method can show modifications at the cellular level induced by anti-glaucoma drugs on ocular surface structures and adnexa in the eye. High-quality images of the conjunctiva, cornea, limbus, meibomian glands, and lymphoid structures during therapy can be obtained. In addition, LSCM opened new fields of research on the patho-physiology of aqueous humor (AH) hydrodynamics in untreated, and in medically or surgically treated glaucomatous patients. In these conditions, an enhancement of the trans-scleral AH outflow contributed to clarification of the mechanism of action of different anti-glaucoma medications and surgical approaches. Finally, the use of LSCM represented a huge advance in evaluation of bleb functionality after filtration surgery, defining the hallmarks of AH filtration through the bleb-wall and distinguishing functional from nonfunctional blebs. Thus, signs seen with LSCM may anticipate clinical failure, guiding the clinician in planning the appropriate timing of the various steps in bleb management. In this review we summarize the current knowledge about in vivo LSCM of the ocular surface in glaucoma.
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Affiliation(s)
- Leonardo Mastropasqua
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Luca Agnifili
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Rodolfo Mastropasqua
- 2Ophthalmology Unit,Department of Neurological,Neuropsychological,Morphological and Movement Sciences,University of Verona,Verona,53593,Italy
| | - Vincenzo Fasanella
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Mario Nubile
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Lisa Toto
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Paolo Carpineto
- 1Ophthalmic Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti,66100,Italy
| | - Marco Ciancaglini
- 3Ophthalmic Clinic,Department of Surgical Science,University of L'Aquila,L'Aquila,67100,Italy
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25
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Saccà SC, Izzotti A. Focus on molecular events in the anterior chamber leading to glaucoma. Cell Mol Life Sci 2014; 71:2197-218. [PMID: 24142347 PMCID: PMC11113507 DOI: 10.1007/s00018-013-1493-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/03/2013] [Accepted: 10/07/2013] [Indexed: 12/11/2022]
Abstract
Primary open-angle glaucoma is a multifactorial disease that affects the retinal ganglion cells, but currently its therapy is to lower the eye pressure. This indicates a definite involvement of the trabecular meshwork, key region in the pathogenesis of glaucoma. This is the first target of glaucoma, and its functional complexity is a real challenge to search. Its functions are those to allow the outflow of aqueous humor and not the reflux. This article describes the morphological and functional changes that happen in anterior chamber. The "primus movens" is oxidative stress that affects trabecular meshwork, particularly its endothelial cells. In these develops a real mitochondriopaty. This leads to functional impotence, the trabecular meshwork altering both motility and cytoarchitecture. Its cells die by apoptosis, losing barrier functions and altering the aqueous humor outflow. All the morphological alterations occur that can be observed under a microscope. Intraocular pressure rises and the malfunctioning trabecular meshwork endotelial cells express proteins that completely alter the aqueous humor. This is a liquid whose functional proteomics complies with the conditions of the trabecular meshwork. Indeed, in glaucoma, it is possible detect the presence of proteins which testify to what occurs in the anterior chamber. There are six classes of proteins which confirm the vascular endothelium nature of the anterior chamber and are the result of the morphofunctional trabecular meshwork decay. It is possible that, all or in part, these proteins can be used as a signal to the posterior pole.
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Affiliation(s)
- Sergio Claudio Saccà
- Ophthalmology Unit, Department of Head and Neck Pathologies, St Martino Hospital, Viale Benedetto XV, 16132, Genoa, Italy,
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26
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Zhang Z, Dhaliwal AS, Tseng H, Kim JD, Schuman JS, Weinreb RN, Loewen NA. Outflow tract ablation using a conditionally cytotoxic feline immunodeficiency viral vector. Invest Ophthalmol Vis Sci 2014; 55:935-40. [PMID: 24448264 DOI: 10.1167/iovs.13-12890] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To create an in vivo model of vector-mediated trabecular meshwork (TM) ablation and replacement. METHODS We generated a conditionally cytotoxic, trackable vector, HSVtkiG, that expressed herpes simplex virus 1 thymidine kinase (HSVtk) and enhanced green fluorescent protein (eGFP). We optimized HSVtkiG ablation in vitro with ganciclovir (GCV) in comparison to eGFP control vector GINSIN and investigated the mechanism. Right eyes of 24 rats were then injected intracamerally with either HSVtkiG or GINSIN, before intraperitoneal GCV was administered 1 week later. Intraocular pressure, central corneal thickness (CCT), and slit-lamp exams were assessed for 8 weeks. Transduction and ablation were followed by gonioscopic visualization of eGFP. Histology was obtained with TM cell counts and immunohistochemistry markers of inflammation. RESULTS Transduction and ablation parameters were established in vitro. Apoptosis was the cause of cell death. In vivo, transduction was seen gonioscopically to be targeted to the TM, followed by disappearance of eGFP marker fluorescence in HSVtkiG-transduced cells after injection of GCV. Ablation resulted in an IOP decrease of 25% in HSVtkiG-injected eyes 2 days after GCV but not in GINSIN or noninjected control eyes (P < 0.05). Trabecular meshwork cellularity was decreased at the time of lowest IOP and recovered thereafter, while CCT remained unchanged. Inflammation was absent. CONCLUSIONS A vector-based system for inducible ablation of cells of the outflow tract was developed. Trabecular meshwork ablation lowered IOP, and recovery of cellularity and IOP followed. This model may be useful to study pressure regulation by the TM, its stem cells, and migration patterns.
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Affiliation(s)
- Ze Zhang
- Yale University School of Medicine, New Haven, Connecticut
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27
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Moroi SE, Raoof DA, Reed DM, Zöllner S, Qin Z, Richards JE. Progress toward personalized medicine for glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 4:145-161. [PMID: 23914252 DOI: 10.1586/eop.09.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
How will you respond when a patient asks, "Doctor, what can I do to prevent myself from going blind from glaucoma like mom?". There is optimism that genetic profiling will help target patients to individualized treatments based on validated disease risk alleles, validated pharmacogenetic markers and behavioral modification. Personalized medicine will become a reality through identification of disease and pharmacogenetic markers, followed by careful study of how to employ this information in order to improve treatment outcomes. With advances in genomic technologies, research has shifted from the simple monogenic disease model to a complex multigenic and environmental disease model to answer these questions. Our challenges lie in developing risk models that incorporate gene-gene interactions, gene copy-number variations, environmental interactions, treatment effects and clinical covariates.
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Affiliation(s)
- Sayoko E Moroi
- Associate Professor, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA
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28
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Quaranta L, Katsanos A, Russo A, Riva I. 24-hour intraocular pressure and ocular perfusion pressure in glaucoma. Surv Ophthalmol 2013; 58:26-41. [PMID: 23217586 DOI: 10.1016/j.survophthal.2012.05.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 04/26/2012] [Accepted: 05/01/2012] [Indexed: 11/16/2022]
Abstract
This review analyzes the currently available literature on circadian rhythms of intraocular pressure (IOP), blood pressure, and calculated ocular perfusion pressure (OPP) in patients with open-angle glaucoma. Although adequately powered, prospective trials are not available. The existing evidence suggests that high 24-hour IOP and OPP fluctuations can have detrimental effects in eyes with glaucoma. The currently emerging continuous IOP monitoring technologies may soon offer important contributions to the study of IOP rhythms. Once telemetric technologies become validated and widely available for clinical use, they may provide an important tool towards a better understanding of long- and short-term IOP fluctuations during a patient's daily routine. Important issues that need to be investigated further include the identification of appropriate surrogate measures of IOP and OPP fluctuation for patients unable to undergo 24-hour measurements, the determination of formulae that best describe the relationship between systemic blood pressure and IOP with OPP, and the exact clinical relevance of IOP and OPP fluctuation in individual patients. Despite the unanswered questions, a significant body of literature suggests that OPP assessment may be clinically relevant in a significant number of glaucoma patients.
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Affiliation(s)
- Luciano Quaranta
- Department of Ophthalmology, University of Brescia, Brescia, Italy.
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Comparative In Vitro Flow Study of 3 Different Ex-PRESS Miniature Glaucoma Device Models. J Glaucoma 2013; 22:209-14. [DOI: 10.1097/ijg.0b013e31824479ce] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clement CI, Kampougeris G, Ahmed F, Cordeiro MF, Bloom PA. Combining phacoemulsification with endoscopic cyclophotocoagulation to manage cataract and glaucoma. Clin Exp Ophthalmol 2013; 41:546-51. [PMID: 23231754 DOI: 10.1111/ceo.12051] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND To examine the outcome and complications of combined phacoemulsification and endoscopic cyclophotocoagulation as surgical management of cataract and glaucoma. DESIGN Retrospective uncontrolled case series from the glaucoma unit, Western Eye Hospital, London, UK. PARTICIPANTS Sixty-three eyes from 59 patients with coexisting cataract and glaucoma. METHODS Patients underwent routine phacoemulsification followed by 270-360 degree endoscopic cyclophotocoagulation as a single procedure. MAIN OUTCOME MEASURES Intraocular pressure, number of intraocular pressure-lowering medications, logMAR visual acuity, recorded complications. RESULTS Baseline characteristics included mean age (77.3 ± 11.1 years), mean logMAR visual acuity (1.01 ± 0.98), mean intraocular pressure (21.13 ± 6.21 mmHg) and mean number of intraocular pressure-lowering medications, (2.71 ± 1.06). Twelve months after phacoemulsification and endoscopic cyclophotocoagulation, mean intraocular pressure had reduced to 16.09 ± 5.27 mmHg (P < 0.01), number of intraocular pressure-lowering medications reduced to 1.47 ± 1.30 (P < 0.01) and mean logMAR acuity improved to 0.33 ± 0.22 (P < 0.01). Success, defined as an intraocular pressure reduction > 20% with intraocular pressure 6-21 mmHg, was achieved in 55.5% of eyes at 12 months. Complications included fibrinous uveitis, elevated intraocular pressure, posterior vitreous detachment and induced astigmatism. CONCLUSION Phacoemulsification and endoscopic cyclophotocoagulation is both safe and effective as surgical management for cataract and glaucoma. Larger intraocular pressure reductions can be achieved in older patients and those with higher baseline intraocular pressure.
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Grippo TM, Liu JHK, Zebardast N, Arnold TB, Moore GH, Weinreb RN. Twenty-four-hour pattern of intraocular pressure in untreated patients with ocular hypertension. Invest Ophthalmol Vis Sci 2013; 54:512-7. [PMID: 23211815 DOI: 10.1167/iovs.12-10709] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated ocular hypertensive (OHTN) patients. METHODS IOP measurements were taken every 2 hours during a 24-hour period from 15 untreated OHTN patients (ages 41-77 years). Measurements were both sitting and supine (diurnal) and supine only (nocturnal). Mean diurnal and nocturnal IOPs in the OHTN group were compared to previously reported values in age-matched healthy and glaucomatous eyes. Post hoc analysis compared the 24-hour IOP pattern of the OHTN patients who converted to glaucoma and those who did not with that in the same healthy and glaucomatous eyes. RESULTS Mean sitting and supine IOPs were significantly higher in the OHTN group than in the healthy control but not the glaucoma group. Similar to the glaucoma group, the OHTN group demonstrated significant differences from healthy controls in diurnal IOP variation and IOP changes upon awakening in habitual and supine positions. The 24-hour IOP curve acrophases and amplitudes for OHTNs were closer to those of the glaucoma than the healthy control group in the habitual position. Thirty-three percent of OHTNs developed glaucoma during a mean follow-up period of 4.3 ± 3.8 years. Similar to findings in the glaucoma group, habitual IOP curve phase delay, habitual IOP variation, diurnal-to-nocturnal IOP changes, and IOP changes upon awakening of the converters were significantly different from those in healthy controls. There were no differences between nonconverters and other groups. CONCLUSIONS Baseline 24-hour IOP pattern in OHTN patients is similar to that in glaucomatous patients. In contrast to nonconverters, OHTN patients who converted to glaucoma are significantly different from healthy controls.
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Affiliation(s)
- Tomas M Grippo
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California at San Diego, La Jolla, California, USA.
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Eveleth D, Starita C, Tressler C. A 4-week, dose-ranging study comparing the efficacy, safety and tolerability of latanoprost 75, 100 and 125 μg/mL to latanoprost 50 μg/mL (xalatan) in the treatment of primary open-angle glaucoma and ocular hypertension. BMC Ophthalmol 2012; 12:9. [PMID: 22607109 PMCID: PMC3475103 DOI: 10.1186/1471-2415-12-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 05/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Several studies have investigated the effect of latanoprost on intraocular pressure (IOP). We compared the IOP-lowering effects of three higher concentrations of latanoprost with the commercially available concentration of 0.005% (50 μg/mL) in patients with primary open-angle glaucoma or ocular hypertension. Methods Treatment-naive subjects or those receiving IOP-lowering medication with baseline IOP levels of ≥24 mmHg and ≤36 mmHg in at least one eye after washout were randomized to receive an evening dose of latanoprost 50, 75, 100, or 125 μg/mL for 4 weeks. At weeks 1, 2, 3, and 4, ocular examinations were performed and IOP was measured. Ocular symptoms and adverse events were monitored. The primary efficacy endpoint was the change in IOP from baseline to week 4 at 8 a.m. and 4 p.m. for the per protocol (PP) population using a "worse eye" analysis. Secondary efficacy endpoints were change in IOP at each time point from baseline across all visits, and percentage change in IOP from baseline to week 4 at 8 a.m. Results In all, 282 patients were randomized and treated; 274 were included in the PP population. Treatment groups were similar at baseline; 68% were diagnosed with primary open-angle glaucoma. Mean baseline IOP levels were comparable across treatments. There were no statistically significant differences in IOP reductions from baseline to week 4 at either time point between those treated with higher concentrations of latanoprost versus those receiving 50 μg/mL. Least squares mean IOP changes at 8 a.m. were −10.13, -9.59, -10.02, and −9.06 mmHg for latanoprost 50, 75, 100, and 125 μg/mL, respectively, and at 4 p.m. were −8.90, -8.29, -8.81, and −8.34 mmHg, respectively. Results of secondary efficacy analyses supported those of the primary analysis. Conjunctival hyperemia, the most commonly reported adverse event, occurred in 16.9%, 18.6%, 20.8% and 15.9% of subjects receiving latanoprost 50, 75, 100, and 125 μg/mL, respectively. Conclusions IOP reductions were observed in all treatment groups postbaseline, with no clinically relevant or statistically significant differences detected favoring any of the higher concentrations of latanoprost compared with latanoprost 50 μg/mL. All doses of latanoprost were well tolerated. Trial registration Clinical Trials.gov Identifier NCT01379144.
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Bhandari M, Raman R, Sharma T. Clinical application of the ocular fluorophotometer. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Camras LJ, Sufficool KE, Camras CB, Fan S, Liu H, Toris CB. Duration of anesthesia affects intraocular pressure, but not outflow facility in mice. Curr Eye Res 2010; 35:819-27. [PMID: 20795864 DOI: 10.3109/02713683.2010.494241] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The study of aqueous humor dynamics (AHD) in mice is becoming more prevalent as more strains with elevated intraocular pressure (IOP) are developed. High IOP is usually associated with reduced outflow facility making this one of the more important AHD parameters to evaluate. Ocular measurements in mice require anesthesia that has profound effects on IOP but unknown effects on outflow facility. This study evaluates the effects of anesthesia duration and latanoprost treatment on outflow facility and IOP in BALB/c mice. METHODS IOPs were measured in conscious and anesthetized mice by tonometry. Outflow facility was evaluated in 15-min intervals at three pressure levels over two 45-min periods. Comparisons were made between latanoprost-treated eyes and untreated contralateral eyes. To determine the effect of anesthesia duration on IOP, a microneedle method was used to follow IOP for 120 min in separate mice. RESULTS IOP was 9.7 +/- 0.3 mmHg (mean +/- SEM) in conscious mice and 7.1 +/- 0.02 within 10 min of anesthesia initiation (p < 0.01). IOP changed significantly between but not within assessment periods. IOP at 75 min was significantly (p = 0.004) reduced compared to IOP at 15 min after initial anesthesia. In control eyes, outflow facility did not change between the two 45-min assessment periods during the 120 min test (p = 0.80). In latanoprost-treated eyes, outflow facility increased compared with control eyes during both assessment periods (p = 0.03). A test of filters in series with known resistance found that the method was sensitive enough to detect a change in outflow facility of 0.001 microl/min/mmHg. CONCLUSIONS Administration of ketamine/xylazine anesthesia for 120 min did not alter outflow facility or lessen the effect of latanoprost on outflow facility in mice as determined by a new analysis system. Accurate IOP measurements must be made within minutes of anesthesia administration but outflow facility measurements can be made with less haste.
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Affiliation(s)
- Lucinda J Camras
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198-5840, USA
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Aqueous humor dynamics in inbred rhesus monkeys with naturally occurring ocular hypertension. Exp Eye Res 2010; 91:860-5. [DOI: 10.1016/j.exer.2010.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 08/31/2010] [Accepted: 09/14/2010] [Indexed: 11/24/2022]
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Efficacy and Mechanisms of Intraocular Pressure Reduction With Latanoprost and Timolol in Participants With Ocular Hypertension: A Comparison of 1 and 6 Weeks of Treatment. J Glaucoma 2010; 19:356-64. [PMID: 20179619 DOI: 10.1097/ijg.0b013e3181d12dd8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harrison BA, Whitlock NA, Voronkov MV, Almstead ZY, Gu KJ, Mabon R, Gardyan M, Hamman BD, Allen J, Gopinathan S, McKnight B, Crist M, Zhang Y, Liu Y, Courtney LF, Key B, Zhou J, Patel N, Yates PW, Liu Q, Wilson AGE, Kimball SD, Crosson CE, Rice DS, Rawlins DB. Novel Class of LIM-Kinase 2 Inhibitors for the Treatment of Ocular Hypertension and Associated Glaucoma. J Med Chem 2009; 52:6515-8. [DOI: 10.1021/jm901226j] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bryce A. Harrison
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | | | - Michael V. Voronkov
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Zheng Y. Almstead
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Kun-jian Gu
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Ross Mabon
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Michael Gardyan
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | | | | | - Suma Gopinathan
- Department of Drug Metabolism, Pharmacokinetics, and Toxicology
| | | | | | - Yulian Zhang
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Ying Liu
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Lawrence F. Courtney
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | | | | | | | - Phil W. Yates
- Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, South Carolina 29425
| | | | | | - S. David Kimball
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
| | - Craig E. Crosson
- Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, South Carolina 29425
| | | | - David B. Rawlins
- Department of Medicinal Chemistry, Lexicon Pharmaceuticals, 350 Carter Road, Princeton, New Jersey 08540
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Lindsey JD, Hofer A, Wright KN, Weinreb RN. Partitioning of the aqueous outflow in rat eyes. Invest Ophthalmol Vis Sci 2009; 50:5754-8. [PMID: 19797235 DOI: 10.1167/iovs.09-3398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To determine the effect of molecular size on the drainage route of dextrans injected into the rat anterior chamber (AC). METHODS Anesthetized adult rats received monocular AC injections of a mixture of 3-kDa dextran-cascade blue, 40-kDa dextran-Texas red, and 500-kDa dextran-FITC. After exsanguination of the rats 2, 4, 6, 12, 24, or 72 hours later, the eyes, facial lymph nodes, and cervical lymph nodes were isolated, and the total content of each dextran type was determined by spectrofluorometry. Also, lymph nodes were evaluated histologically 4 and 24 hours after AC injection of 40-kDa dextran-FITC. RESULTS The speed of tracer exit from the eye varied with 3-kDa dextran > 40-kDa dextran > 500-kDa dextran. No 3-kDa dextran was detected in either facial lymph nodes or cervical lymph nodes at any time point. The average recovery of 40-kDa dextran in the facial and cervical lymph nodes peaked at 52.6% of the amount injected. In contrast, average recovery of 500-kDa dextran in the facial and cervical lymph nodes peaked at 1.8% of amount the injected. Histology showed 40-kDa dextran was mostly contained within lymph node cells at both 4 and 24 hours after injection. CONCLUSIONS Transport of 40-kDa dextran from the AC to the facial lymph nodes and cervical lymph nodes is markedly more efficient than that of 500-kDa dextran. In contrast, there is negligible transport of 3-kDa dextran. These results demonstrate that different sized aqueous macromolecules can exit the eye by different routes.
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Affiliation(s)
- James D Lindsey
- Sophie and Arthur Brodie Laboratory, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California 92093-0946, USA
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Abstract
In a chronic disease such as glaucoma, a therapy that provides a long lasting local effect with minimal systemic side effects, while circumventing the issue of patient compliance, is very attractive. The field of gene therapy is growing rapidly and ocular applications are expanding. Our understanding of the molecular pathogenesis of glaucoma is leading to greater specificity in ocular tissue targeting. Improvements in gene delivery techniques, refinement of vector construction methods, and development of better animal models combine to bring this potential therapy closer to reality.
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Alm A, Nilsson SF. Uveoscleral outflow – A review. Exp Eye Res 2009; 88:760-8. [PMID: 19150349 DOI: 10.1016/j.exer.2008.12.012] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 12/03/2008] [Accepted: 12/04/2008] [Indexed: 10/21/2022]
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McLaren JW. Measurement of aqueous humor flow. Exp Eye Res 2009; 88:641-7. [DOI: 10.1016/j.exer.2008.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 10/21/2008] [Accepted: 10/28/2008] [Indexed: 11/26/2022]
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Lim KS, Nau CB, O'Byrne MM, Hodge DO, Toris CB, McLaren JW, Johnson DH. Mechanism of action of bimatoprost, latanoprost, and travoprost in healthy subjects. A crossover study. Ophthalmology 2008; 115:790-795.e4. [PMID: 18452763 DOI: 10.1016/j.ophtha.2007.07.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 06/29/2007] [Accepted: 07/02/2007] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To study the effects of 3 prostaglandin analogs, bimatoprost, latanoprost, and travoprost, on aqueous dynamics in the same subjects and to compare techniques of assessing outflow facility. DESIGN Experimental study (double-masked, placebo-controlled, randomized paired comparison, 4-period crossover). PARTICIPANTS Thirty healthy adult subjects. METHODS Bimatoprost, latanoprost, travoprost, or a placebo was administered to the left eye once a day in the evening for 7 days, after a minimum 4-week washout period between each session. Tonographic outflow facility was measured by Schiøtz tonography and pneumatonography on day 7. On day 8, the aqueous humor flow rate and fluorophotometric outflow facility were measured by fluorophotometry. Uveoscleral outflow was calculated from the aqueous humor flow rate and outflow facility using the Goldmann equation. MAIN OUTCOME MEASURES Facility of outflow, aqueous humor flow rate, intraocular pressure (IOP), and calculation of uveoscleral outflow. RESULTS All medications lowered IOP relative to a placebo. None of the drugs affected aqueous humor production. All medications increased outflow facility compared with placebo when measured by Schiøtz and 2-minute pneumatonography (P< or =0.02); the apparent increase of outflow facility measured with fluorophotometry and 4-minute pneumatonography did not reach statistical significance. In contrast, uveoscleral outflow was significantly increased by all medications when calculated from 4-minute pneumatonography data, and fluorophotometry and Schiøtz data at higher episcleral venous pressures. The apparent increase found with 2-minute pneumatonography did not reach statistical significance. These differing results in the same patients indicate that differences in measurement techniques, and not differences in mechanism of action, explain previous conflicting published reports on the mechanism of action of the prostaglandins. CONCLUSIONS Bimatoprost, latanoprost, and travoprost have similar mechanisms of action. All 3 drugs reduce IOP without significantly affecting the aqueous production rate. All drugs increase aqueous humor outflow, either by enhancing the pressure-sensitive (presumed trabecular) outflow pathway or by increasing the pressure-insensitive (uveoscleral) outflow, but the assessment of the amount of flow through each pathway depends upon the measurement technique.
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Affiliation(s)
- K Sheng Lim
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Chapter 9 Effects of Circulatory Events on Aqueous Humor Inflow and Intraocular Pressure. CURRENT TOPICS IN MEMBRANES 2008. [DOI: 10.1016/s1063-5823(08)00409-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Chapter 13 Outflow Signaling Mechanisms and New Therapeutic Strategies for the Control of Intraocular Pressure. CURRENT TOPICS IN MEMBRANES 2008. [DOI: 10.1016/s1063-5823(08)00413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Toris CB, Camras CB. Chapter 8 Aqueous Humor Dynamics II. CURRENT TOPICS IN MEMBRANES 2008. [DOI: 10.1016/s1063-5823(08)00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Toris CB, Zhan G, Fan S, Dickerson JE, Landry TA, Bergamini MVW, Camras CB. Effects of Travoprost on Aqueous Humor Dynamics in Patients With Elevated Intraocular Pressure. J Glaucoma 2007; 16:189-95. [PMID: 17473728 DOI: 10.1097/ijg.0b013e31802fc6d3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the mechanism by which travoprost 0.004% reduces intraocular pressure (IOP) in patients with ocular hypertension or primary open angle glaucoma. DESIGN This is a randomized, double-masked, placebo-controlled, single center study of 26 patients scheduled for 3 visits (baseline, day 15, and days 17 to 18) following screening. METHODS After appropriate washout of all ocular medications, baseline IOPs were taken and travoprost 0.004% was administered once-daily in the evening for 17 consecutive doses to 1 eye and its vehicle to the fellow eye in a randomized, masked fashion. On day 15, beginning 12 hours after the 14th consecutive dose, IOP was measured by pneumatonometry, aqueous flow and outflow facility by fluorophotometry, and episcleral venous pressure by venomanometry. Uveoscleral outflow was determined by mathematical calculation. Two days later, the last drop of drug/vehicle was given at 2000 hours. Fluorophotometry and tonometry measurements were repeated between 2200 and 0600 hours. Treated eyes were compared with contralateral control eyes or baseline measurements, and daytime measurements were compared with nighttime measurements using paired t tests. RESULTS Travoprost-treated eyes showed a significant (P<0.001) decrease in daytime IOP compared with baseline (26%) or to vehicle-treated eyes (22%), and an increase in daytime outflow facility (P=0.001; 64%). The increase in uveoscleral outflow was not statistically significant. At night, the IOPs of travoprost-treated eyes remained 21% to 24% below baseline daytime values. Seated and supine IOPs in control eyes were significantly (P<0.04) lower at 2200 hours than 1700 hours (P<0.04). Supine IOPs were higher than seated IOPs in both control and treated eyes (P<0.001). Aqueous flow was significantly (P<0.001) reduced at night in both travoprost (30%) and vehicle-treated (25%) eyes when compared with daytime values. No other comparisons were statistically significant. CONCLUSIONS Travoprost seems to lower IOP by increasing trabecular outflow facility. An effect on uveoscleral outflow cannot be ruled out.
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Affiliation(s)
- Carol B Toris
- Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE 68198-5840, USA.
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Fautsch MP, Johnson DH. Aqueous humor outflow: what do we know? Where will it lead us? Invest Ophthalmol Vis Sci 2006; 47:4181-7. [PMID: 17003404 PMCID: PMC2092444 DOI: 10.1167/iovs.06-0830] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Michael P Fautsch
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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