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Konstas AG, Schmetterer L, Katsanos A, Hutnik CML, Holló G, Quaranta L, Teus MA, Uusitalo H, Pfeiffer N, Katz LJ. Dorzolamide/Timolol Fixed Combination: Learning from the Past and Looking Toward the Future. Adv Ther 2021; 38:24-51. [PMID: 33108623 PMCID: PMC7854404 DOI: 10.1007/s12325-020-01525-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
The key clinical attributes of preserved dorzolamide/timolol fixed combination (DTFC) and the emerging potential of preservative-free (PF) DTFC are reviewed with published evidence and clinical experience. The indications and role of DTFC in current glaucoma management are critically discussed. Preserved DTFC became the first intraocular pressure (IOP)-lowering fixed combination (FC) approved by the US Food and Drug Administration (FDA) and remains one of most commonly used medications worldwide. The pharmacological properties of DTFC reflect those of its two time-tested constituents, i.e., the carbonic anhydrase inhibitor dorzolamide and the non-selective beta-blocker timolol. In regulatory studies DTFC lowers IOP on average by 9 mmHg (32.7%) at peak and by 7.7 mmHg (27%) at trough. In trials DTFC shows equivalence to unfixed concomitant therapy, but in real-life practice it may prove superior owing to enhanced convenience, elimination of the washout effect from the second drop, improved tolerability, and better adherence. PF DTFC became the first PF FC approved, first in unit-dose pipettes, and more recently in a multidose format. Cumulative evidence has confirmed that PF DTFC is at least equivalent in efficacy to preserved DTFC and provides a tangible clinical benefit to patients with glaucoma suffering from ocular surface disease by improving tolerability and adherence. Finally, we identify areas that warrant further investigation with preserved and PF DTFC
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Use of Topical Intraocular Pressure-lowering Medications in the US Population: Results From the NHANES Study 1999 to 2014. J Glaucoma 2020; 28:772-776. [PMID: 31465304 DOI: 10.1097/ijg.0000000000001315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS We found no evidence of an increase in the number of Americans using topical intraocular pressure (IOP) medication or a number of drops used per patient from 1999 to 2014, although there were significant changes in the class of medications used. PURPOSE The purpose of this study was to determine changes in topical IOP-lowering medication use in the United States from 1999 to 2014. MATERIALS AND METHODS A series of 8 nationally representative, weighted cross-sectional surveys of United States residents were performed every 2 years from 1999 to 2014. On 2-year cycles, professional interviewers performed in-home interviews of a representative sample of the nation as part of the National Health and Nutrition Examination Survey study. Participants were asked, "In the past month, have you used or taken medication for which a prescription is needed?" Adults over age 40 who responded to this question were included in the analysis. The primary outcome was number of US adults using topical IOP-lowering medication. Secondary outcomes included the number and types of medications used. RESULTS There was no change in the number of adults using topical IOP-lowering medications over the time period studied (P=0.74) with 1.4% (95% confidence interval: 0.9%-1.8%) of US residents on IOP-lowering medications in 1999 to 2000 and 1.4% of US residents (95% confidence interval: 1.1%-1.8%) on topical medications in 2013 to 2014. There was no change in the number of medications per patient over the period of the study (P=0.14). There was a significant increase in the use of prostaglandin analogs and combination medications and a decrease in the use of β-blockers (all P<0.01). CONCLUSIONS In contrast to the increase in glaucoma medication use seen in several other developed nations, use in the United States remained stable from 1999 to 2014. This may be due to differential use of other procedures. Future studies of IOP-lowering medications incorporating the effect of new agents and minimally invasive surgeries are warranted.
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Marques RE, Ferreira NP, Sousa DC, Barata AD, Sens P, Marques-Neves C, Abegão Pinto L. High intensity focused ultrasound for glaucoma: 1-year results from a prospective pragmatic study. Eye (Lond) 2020; 35:484-489. [PMID: 32317796 DOI: 10.1038/s41433-020-0878-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Ciclo plasty using high-intensity focused ultrasound (HIFU) technology acts through the selective coagulation of the ciliary body. Our aim was to evaluate the safety and efficacy profiles of 8-s probe HIFU cyclocoagulation using the EyeOP1 device. METHODS Prospective pragmatic trial. INCLUSION CRITERIA adult glaucoma patients with uncontrolled IOP despite optimised medical therapy, and/or intolerant to medical therapy required to achieve target IOP. PRIMARY OUTCOME surgical success defined as IOP reduction from baseline >20% with final IOP ≤21 mmHg, without adding any IOP-lowering drugs, and without loss of light perception; or decreased use of IOP-lowering drugs with stable/decreased IOP, without loss of light perception. SECONDARY OUTCOMES mean IOP, intra and postoperative complications, best-corrected visual acuity (BCVA) and number of IOP-lowering drugs at each visit. Outcome data were collected preoperatively and at postoperative day 1, and months 1, 3, 6 and 12. RESULTS Forty-nine eyes of forty-nine patients (28 male) with a mean age of 70 ± 14 years were enroled. Pre-operative IOP was 26.9 ± 7.4 mmHg under 2.8 ± 0.9 topical medications, decreasing to 17.8 ± 6.4 mmHg under 2.3 ± 1 drugs at 12 months (p < 0.01). One-year surgical success was achieved in 71.4% of patients (IOP-reduction criteria: 59.2%; decreased use of IOP-lowering drugs: 38.8%). Eight patients were ultimately submitted to other glaucoma surgical interventions. Five patients experienced serious adverse events (loss of light perception n = 5; hypotony n = 1). CONCLUSIONS This innovative non-invasive technology seems to be effective in decreasing IOP and/or the number of administered drops in patients with refractory glaucoma. It seems a valuable tool to delay or preclude the need for filtering procedures in the majority of the patients.
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Affiliation(s)
- Raquel E Marques
- Department of Ophthalmology, Hospital Santa Maria, Lisboa, Portugal.,Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Nuno P Ferreira
- Department of Ophthalmology, Hospital Santa Maria, Lisboa, Portugal.,Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - David C Sousa
- Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Visual Sciences Study Centre, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - André Diogo Barata
- Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Visual Sciences Study Centre, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Paula Sens
- Department of Ophthalmology, Hospital Santa Maria, Lisboa, Portugal.,Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Carlos Marques-Neves
- Department of Ophthalmology, Hospital Santa Maria, Lisboa, Portugal.,Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Visual Sciences Study Centre, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Luis Abegão Pinto
- Department of Ophthalmology, Hospital Santa Maria, Lisboa, Portugal. .,Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. .,Visual Sciences Study Centre, CECV, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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Abstract
PURPOSE The XEN gel stent is a minimally invasive surgical device aimed at creating a subconjunctival drainage of aqueous humor, thereby reducing intraocular pressure (IOP). Being a novel device, doubts remain with regard to the efficacy and safety of its implantation in the early stage of new users. This paper illustrates the XEN implantation learning curve, assessed through several surgeons of different expertise. METHODS This was a retrospective study on the first 6 XEN implants performed by each of the 10 certified ophthalmic surgeons. Simultaneous cataract surgery was allowed (phaco-XEN). Primary outcomes were as follows: surgical time; intraoperative and postoperative surgical complications. Secondary outcomes were as follows: IOP; the number of topical drugs in use; the need for needling procedures. Outcome data were collected preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Statistical analysis was performed with STATA 14.1 and SPSS. RESULTS Sixty patients were included (56.7% female patients). Mean age was 73 years (45 to 89). Mean preoperative IOP was 23.8±8.95 mm Hg. From the included patients, 29 (48.3%) were submitted to simple XEN implant and 31 (51.7%) to phaco-XEN. In both groups, mean surgical time decreased by 9 minutes throughout the 6-implant learning curve. Final IOP was 15±7.27 mm Hg in the stent group (-43% than baseline), and 14.92±3.32 mm Hg in the phaco-XEN group (-16% than baseline). On average, patients decreased 2 topical IOP-lowering drugs. Needling procedures were performed in 17 patients (28.3%). CONCLUSIONS XEN gel stent was associated with a fast learning curve, by both experienced surgeons and novice residents. By the sixth implant, both groups had considerably decreased mean surgical time and complication rates.
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Sá-Sousa A, Almeida R, Vicente R, Nascimento N, Martins H, Freitas A, Fonseca JA. High oral corticosteroid exposure and overuse of short-acting beta-2-agonists were associated with insufficient prescribing of controller medication: a nationwide electronic prescribing and dispensing database analysis. Clin Transl Allergy 2019; 9:47. [PMID: 31559008 PMCID: PMC6755705 DOI: 10.1186/s13601-019-0286-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recurrent use of oral corticosteroids (OCS) and over-use of short-acting beta-2-agonists (SABA) are factors associated with adverse side effects and asthma-related death. We aim to quantify high OCS exposure, SABA over-use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP). METHODS This was a 1-year (2016) retrospective population-based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone-equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT-prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA-to-maintenance treatment > 1 or having SABA over-use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol-equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression. RESULTS The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high-dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over-use in 24/100,000. About 1/6 of SABA over-users were not prescribed any controller medication and 7% of them had a ratio maintenance-to-total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over-users. High OCS exposure or SABA over-use were not associated with primary adherence. High OCS exposure was associated with a maintenance-to-total medication ratio < 70% (insufficient prescription of maintenance treatment), age > 45 years old and male sex. CONCLUSIONS Exposure to high-dose of OCS (101 per 100,000 patients) and SABA over-use (24 per 100,000) were frequent, and were associated with a low maintenance-to-total prescription ratio but not with primary non-adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing.
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Affiliation(s)
- Ana Sá-Sousa
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ricardo Vicente
- SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | | | - Henrique Martins
- SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | - Alberto Freitas
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
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Holló G, Katsanos A, Boboridis KG, Irkec M, Konstas AGP. Preservative-Free Prostaglandin Analogs and Prostaglandin/Timolol Fixed Combinations in the Treatment of Glaucoma: Efficacy, Safety and Potential Advantages. Drugs 2018; 78:39-64. [PMID: 29196953 DOI: 10.1007/s40265-017-0843-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Glaucoma therapy-related ocular surface disease (OSD) is a serious pathology with a broad spectrum of insidious clinical presentations and complex pathogenesis that undermines long-term glaucoma care. Preservatives, especially benzalkonium chloride (BAK), contained in topical intraocular pressure-lowering medications frequently cause or aggravate OSD in glaucoma. Management of these patients is challenging, and to date often empirical due to the scarcity of controlled long-term clinical trials. Most of the available data are extracted from case series and retrospective analysis. Preservative-free prostaglandins and prostaglandin/timolol fixed combinations are novel options developed to remove the harmful impact of preservatives, especially BAK, upon ocular tissues. Based on what is currently known on the value of preservative-free antiglaucoma therapies it is tempting to speculate how these new therapies may affect the future medical management of all glaucoma patients. This article provides a comprehensive and critical review of the current literature on preservative-free prostaglandins and preservative-free prostaglandin/timolol fixed combinations.
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Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, 1085, Hungary.
| | - Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Kostas G Boboridis
- Third Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Murat Irkec
- Department of Ophthalmology, Faculty of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Anastasios G P Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Trends in Glaucoma Surgical Procedures in Portugal: A 16-Year Nationwide Study (2000-2015). J Glaucoma 2018; 27:682-686. [DOI: 10.1097/ijg.0000000000001011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sousa DC, Ferreira NP, Marques-Neves C, Somers A, Vandewalle E, Stalmans I, Pinto LA. High-intensity Focused Ultrasound Cycloplasty: Analysis of Pupil Dynamics. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10078-1232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Use of Ocular Hypotensive Medications in Portugal: PEM Study: A Cross-sectional Nationwide Analysis: Erratum. J Glaucoma 2017; 26:961. [DOI: 10.1097/ijg.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sousa DC, Ferreira NP, Marques-Neves C, Somers A, Vandewalle E, Stalmans I, Pinto LA. High-intensity Focused Ultrasound Cycloplasty: Analysis of Pupil Dynamics. J Curr Glaucoma Pract 2017; 12:102-106. [PMID: 31354201 PMCID: PMC6647825 DOI: 10.5005/jp-journals-10028-1253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim High-intensity focused ultrasound cystoplasty (UCP) aims to noninvasively and selectively target the ciliary body, thus lowering intraocular pressure (IOP). To be used on a large scale, the safety of the UCP procedure should be studied. Therefore, its effect on pupil behavior is important to better inform patients and to help physicians predict possible treatment side effects. This study aimed to evaluate to what extent UCP procedure (EyeOP-1®) affects pupil dynamics. Materials and methods Consecutive glaucoma patients with uncontrolled IOP despite optimal medication scheduled for UCP treatment were recruited and followed for 6 months. Pupillometry (PlusoptiX® S04) was performed at baseline, and 1, 3 and 6 months after UCP procedure at scotopic and mesopic conditions. The difference between pupil diameter (PD) in both lighting conditions was calculated at the three follow-up visits. Demographic, clinical characteristics and specific ocular parameters (anterior chamber depth and volume, white-to-white measurement, axial length, phakic status) were registered. Statistical analysis was performed using STATA 14.1. Results Sixteen eyes of 16 patients with a mean age of 69 ± 11 years were included. Mean preoperative IOP and number of medications were 23.6 ± 3.0 mm Hg and 2.4 ± 1.3, respectively. Mean baseline scotopic and mesopic PD were 4.8 ± 0.8 mm and 4.4 ± 0.9 mm, respectively (difference = 0.38 ± 0.30 mm; range 0.1 to 1.2 mm). At month-1, the pupil diameter (PD) change between scotopic (4.6 ± 0.7 mm) and mesopic (4.5 ± 0.8 mm) conditions decreased to 0.03 ± 0.34 mm, p = 0.01. On the longer follow-up periods, however, the amplitude difference in PD compared to baseline was no longer significant (month-3: 0.28 ± 0.49 mm; month 6: 0.23 ± 0.41 mm; p >0.05). At the end of follow-up, mean scotopic and mesopic PD were 4.7 ± 1.0 mm and 4.4 ± 0.9 mm, respectively. Conclusion and clinical significance In the early postoperative period after UCP treatment, most patients present with a less light-reactive pupil, which seems to normalize with time. How to cite this article Sousa DC, Ferreira NP, Marques-Neves C, Somers A, Vandewalle E, Stalmans I, Pinto LA. High-intensity Focused Ultrasound Cycloplasty: Analysis of Pupil Dynamics. J Curr Glaucoma Pract 2018;12(3):102-106.
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Affiliation(s)
- David C Sousa
- Department of Ophthalmology, Hospital de Santa Maria, Lisboa, PT, Portugal.,Vision Sciences Study Center, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Nuno P Ferreira
- Department of Ophthalmology, Hospital de Santa Maria, Lisboa, PT, Portugal.,Vision Sciences Study Center, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Carlos Marques-Neves
- Department of Ophthalmology, Hospital de Santa Maria, Lisboa, PT, Portugal.,Vision Sciences Study Center, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alix Somers
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium.,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Evelien Vandewalle
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium.,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium.,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Luís Abegão Pinto
- Department of Ophthalmology, Hospital de Santa Maria, Lisboa, PT, Portugal.,Vision Sciences Study Center, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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