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Khopade AJ, Halder A, Patel V, Upadhyay S, Burade V, Pateliya B, Panchal S, Mandhane S, Awati C, Zope M. Preclinical Evaluation of a Novel Once-a-Day Brimonidine Ophthalmic Nanosuspension. J Ocul Pharmacol Ther 2023. [PMID: 37646731 DOI: 10.1089/jop.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Purpose: This article aims to describe a preclinical proof of concept for a novel once-a-day (OD) brimonidine ophthalmic nanosuspension. Methods: The preclinical proof of concept was established using New Zealand white rabbits as animal models. Dose-finding, multiple-dose efficacy, ocular pharmacokinetic, and hemodynamic studies were performed in normotensive rabbits. Steroid-induced ocular hypertension model in rabbits was used to study efficacy in glaucomatous pathophysiology. The test (0.35% OD suspension) and reference (0.15% three times a day [TID] solution) were compared. Results: The intraocular pressure (IOP) reduction was sustained for 0.35% and 0.5% strengths but not for other lower strengths tested or reference strengths. A 0.35% OD suspension reduced IOP >2 mmHg after 24 h of dosing, which was not seen with the reference. After multiple dosing, 0.35% OD suspension reduced IOP by 4-6 mmHg after 24 h, which was comparable to the 0.15% TID reference solution. An ocular pharmacokinetic study showed that the brimonidine was rapidly absorbed and distributed throughout the eye after topical administration. Concentration was higher in tissues with high α2 receptors, such as cornea-conjunctiva, iris/ciliary body, and choroid/retina. The steady-state concentrations in these organs were also significant after 24 h of the last dose. There was an indication of increased plasma levels, so a hemodynamic study was performed to assess any adverse effects. All hemodynamic parameters were normal and no new unusual safety findings were observed. Conclusions: The study demonstrated that the novel brimonidine 0.35% ophthalmic nanosuspension is both safe and effective when administered OD and is comparable to the marketed reference formulation administered TID.
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Affiliation(s)
- Ajay J Khopade
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Arindam Halder
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Vivek Patel
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Shivam Upadhyay
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Vinod Burade
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Bharat Pateliya
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Satish Panchal
- Department of Translational Development, Sun Pharma Advanced Research Company Ltd., Vadodara, India
| | - Sanjay Mandhane
- Department of Translational Development, Sun Pharma Advanced Research Company Ltd., Vadodara, India
| | - Chandan Awati
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
| | - Murlidhar Zope
- Department of Formulation R&D Non-Orals, Sun Pharmaceutical Industries Ltd., Vadodara, India
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Sapowadia A, Ghanbariamin D, Zhou L, Zhou Q, Schmidt T, Tamayol A, Chen Y. Biomaterial Drug Delivery Systems for Prominent Ocular Diseases. Pharmaceutics 2023; 15:1959. [PMID: 37514145 PMCID: PMC10383518 DOI: 10.3390/pharmaceutics15071959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular diseases, such as age-related macular degeneration (AMD) and glaucoma, have had a profound impact on millions of patients. In the past couple of decades, these diseases have been treated using conventional techniques but have also presented certain challenges and limitations that affect patient experience and outcomes. To address this, biomaterials have been used for ocular drug delivery, and a wide range of systems have been developed. This review will discuss some of the major classes and examples of biomaterials used for the treatment of prominent ocular diseases, including ocular implants (biodegradable and non-biodegradable), nanocarriers (hydrogels, liposomes, nanomicelles, DNA-inspired nanoparticles, and dendrimers), microneedles, and drug-loaded contact lenses. We will also discuss the advantages of these biomaterials over conventional approaches with support from the results of clinical trials that demonstrate their efficacy.
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Affiliation(s)
- Avin Sapowadia
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Delaram Ghanbariamin
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Libo Zhou
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Qifa Zhou
- Department of Biomedical Engineering and Ophthalmology, University of Southern California, Los Angeles, CA 90089, USA
| | - Tannin Schmidt
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Ali Tamayol
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Yupeng Chen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
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Li S, Ni N, Wu X, Lan T, Yu Y. Protective Effect of Fangchinoline Against Glaucoma and Neuroinflammation in Unilateral Ocular Hypertension in Mice. INT J PHARMACOL 2023. [DOI: 10.3923/ijp.2023.131.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Menon MG, Goodkin ML. Triple Fixed-Combination Bimatoprost/Brimonidine/Timolol in Glaucoma and Ocular Hypertension in India: A Multicenter, Open-Label, Phase 3 Study. Clin Ophthalmol 2022; 16:3559-3569. [PMID: 36274674 PMCID: PMC9582300 DOI: 10.2147/opth.s369626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a triple fixed-combination of bimatoprost, brimonidine, and timolol (TFC) in patients with glaucoma or ocular hypertension (OHT) treated with fixed-combination or unfixed brimonidine and timolol therapy (dual-combination therapy). Methods In this multicenter, open-label, phase 3 study, patients who received 4-8 weeks of dual-combination therapy twice daily and had an IOP >18 and <34 mmHg in at least one eye were switched (at baseline) to treatment with TFC twice daily for 12 weeks. At Weeks 4, 8, and 12 on TFC, IOP was assessed at Hours 0, 2, and 8. Primary efficacy variable: mean diurnal IOP change from baseline in the study eye at Week 12 (modified intent-to-treat [mITT] population). Sensitivity (per-protocol [PP] population) and subgroup (≤65 vs >65 years) analyses were performed. Safety, including adverse events (AEs), was assessed at each visit. Results Of 126 patients enrolled, 121 and 103 formed the mITT/safety and PP populations, including 109 (90.1%) and 94 (91.3%) who completed the study, respectively. In the mITT/safety population, mean age was 58.6 years. Patients had open-angle glaucoma (51.2%), angle-closure glaucoma with patent iridotomy (36.4%), and/or OHT (13.2%). At Week 12, the mean diurnal change in IOP from dual combination-treated baseline was statistically significant (P<0.001) with TFC in the mITT (-3.98 mmHg) and PP (-4.22 mmHg) populations. Results were similar at all visits, regardless of the age subgroup. The most frequent treatment-related AEs were conjunctival hyperemia (14.0%) and dry eye (4.1%); 5.8% of the patients discontinued treatment due to ocular AEs. Conclusion TFC offers a beneficial therapeutic alternative for patients with glaucoma or OHT whose IOP is not sufficiently controlled with dual-combination therapy. Safety and efficacy findings support those of published studies of TFC in primary open-angle glaucoma and OHT, despite differences in study designs.
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Affiliation(s)
- Meena G Menon
- Glaucoma Services, Sankara Eye Hospital, Bangalore, Karnataka, India,Correspondence: Meena G Menon, Glaucoma Services, Sankara Eye Hospital, Bangalore, Karnataka, India, Email
| | - Margot L Goodkin
- Ophthalmology Clinical Development, Allergan (an AbbVie Company), Irvine, CA, USA
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Bostancı NS, Büyüksungur S, Hasirci N, Tezcaner A. Potential of pectin for biomedical applications: a comprehensive review. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2022; 33:1866-1900. [PMID: 35699216 DOI: 10.1080/09205063.2022.2088525] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/18/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
Pectin is a polysaccharide extracted from various plants, such as apples, oranges, lemons, and it possesses some beneficial effects on human health, including being hypoglycemic and hypocholesterolemic. Therefore, pectin is used in various pharmaceutical and biomedical applications. Meanwhile, its low mechanical strength and fast degradation rate limit its usage as drug delivery devices and tissue engineering scaffolds. To enhance these properties, it can be modified or combined with other organic molecules or polymers and/or inorganic compounds. These materials can be prepared as nano sized drug carriers in the form of spheres, capsules, hydrogels, self assamled micelles, etc., for treatment purposes (mostly cancer). Different composites or blends of pectin can also be produced as membranes, sponges, hydrogels, or 3D printed matrices for tissue regeneration applications. This review is concentrated on the properties of pectin based materials and focus especially on the utilization of these materials as drug carriers and tissue engineering scaffolds, including 3D printed and 3D bioprinted systems covering the studies in the last decade and especially in the last 5 years.
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Affiliation(s)
- Nazlı Seray Bostancı
- Department of Biotechnology, Middle East Technical University (METU), Ankara, Turkey
| | - Senem Büyüksungur
- Center of Excellence in Biomaterials and Tissue Engineering, METU BIOMATEN, Ankara, Turkey
| | - Nesrin Hasirci
- Department of Biotechnology, Middle East Technical University (METU), Ankara, Turkey
- Center of Excellence in Biomaterials and Tissue Engineering, METU BIOMATEN, Ankara, Turkey
- Department of Chemistry, METU, Ankara, Turkey
- Tissue Engineering and Biomaterial Research Center, Near East University, (NEU), Lefkosa, Turkey
| | - Ayşen Tezcaner
- Department of Biotechnology, Middle East Technical University (METU), Ankara, Turkey
- Center of Excellence in Biomaterials and Tissue Engineering, METU BIOMATEN, Ankara, Turkey
- Department of Engineering Sciences, METU, Ankara, Turkey
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Watanabe M, Sato T, Tsugeno Y, Higashide M, Furuhashi M, Umetsu A, Suzuki S, Ida Y, Hikage F, Ohguro H. An α2-Adrenergic Agonist, Brimonidine, Beneficially Affects the TGF-β2-Treated Cellular Properties in an In Vitro Culture Model. Bioengineering (Basel) 2022; 9:bioengineering9070310. [PMID: 35877361 PMCID: PMC9312232 DOI: 10.3390/bioengineering9070310] [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] [Received: 06/11/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
We report herein on the effects of brimonidine (BRI), an α2-adrenergic agonist, on two-dimensional (2D) and three-dimensional (3D) cell-cultured TGF-β2-untreated and -treated human trabecular meshwork (HTM) cells. In the presence of TGF-β2 (5 ng/mL), (1) the effects of BRI on (1) the 2D HTM monolayers’ barrier function were investigated as estimated using trans-endothelial electrical resistance (TEER) measurement and FITC dextran permeability; (2) real-time analyses of cellular metabolism using a Seahorse Bioanalyzer; (3) the largeness and hardness of 3D spheroids; and (4) the expression of genes that encode extracellular matrix (ECM) proteins, including collagens (COL) 1, 4, and 6; fibronectin (FN) and α-smooth muscle actin (α-SMA); ECM modulators, including a tissue inhibitor of matrix proteinase (TIMP) 1–4; matrix metalloproteinase (MMP) 2, 9, and 14; and several endoplasmic reticulum (ER) stress-related genes, including the X-box-binding protein 1 (XBP1), the spliced XBP1 (sXBP1), glucose-regulated protein (GRP)78, GRP94, and CCAAT-enhancer-binding protein homologous protein (CHOP). BRI markedly inhibited the TGF-β2-induced increase in the values of TEER of the 2D cell monolayer and the hardness of the 3D spheroids, although it had no effect on their sizes. BRI also cancelled the TGF-β2-induced reduction in mitochondrial maximal respiration but had no effect on the glycolytic capacity. In addition, the gene expression of these molecules was quite different between the 2D and 3D cultures of HTM cells. The present observations found in this study indicate that BRI may beneficially affect TGF-β2-induced changes in both cultures, 2D and 3D, of HTM cells, although their structural and functional properties that were altered varied significantly between both cultures of HTM cells.
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Affiliation(s)
- Megumi Watanabe
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Tatsuya Sato
- Departments of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (T.S.); (M.F.)
- Departments of Cellular Physiology and Signal Transduction, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Yuri Tsugeno
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Megumi Higashide
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Masato Furuhashi
- Departments of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (T.S.); (M.F.)
| | - Araya Umetsu
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Soma Suzuki
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Yosuke Ida
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Fumihito Hikage
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
| | - Hiroshi Ohguro
- Departments of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan; (M.W.); (Y.T.); (M.H.); (A.U.); (S.S.); (Y.I.); (F.H.)
- Correspondence: ; Tel.: +81-611-2111
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Khopade AJ, Halder A, Burade V, Pateliya B, Jani K, Patel V, Upadhyay S. Ophthalmic suspension of Brimonidine for sustained delivery using nano-resin/drug complex technique. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lehrer S, Rheinstein PH. Cannabis, Intraocular Pressure, and the Growth Arrest-Specific 7 (GAS7) Gene: A Retrospective Analysis. Cureus 2022; 14:e23919. [PMID: 35411287 PMCID: PMC8989065 DOI: 10.7759/cureus.23919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intraocular pressure (IOP) is a highly heritable risk factor for primary open-angle glaucoma (POAG), with at least 27 related genes; however, we are still not aware as to which receptors or genes that the main components of cannabis use to lower IOP. Methods In the current study, we used data from the UK Biobank (UKBB) to assess the relationship of growth arrest-specific 7 (GAS7) with IOP and cannabis in 37,046 subjects. GAS7, at chromosome 17p31.1, is quite close to a cannabis receptor at chromosome 17p31.3. For comparison, we chose a second IOP/glaucoma gene, CDKN2B-AS1 on chromosome 9p21.3, with no known relationship to cannabis. In addition, we examined the effect of CB1, GPR18, and cannabis on IOP; these two genes are associated with cannabis IOP reduction in mice. Results Total cannabis use versus IOP and genotypes of GAS7 SNP rs9913911 in the 37,046 subjects showed significant variation [p<0.001, univariate analysis of variance (ANOVA)]. Carriers of the GAS7 rs9913911 minor allele G had lower IOP with increased cannabis use. Total cannabis use versus IOP of genotypes of CDKN2B-AS1 SNP rs944801 in 37,046 subjects had IOP variability with cannabis use that was insignificant (p=0.138). We analyzed the relationship of CB1 SNP rs806365 and GPR18 SNP rs3742130 with cannabis use and IOP, which was insignificant. CB1 and GPR18 are probably not involved in cannabis-associated human IOP reduction, unlike what has been reported in mice. Conclusion Cannabis-based treatments, which apparently act on the GAS7 gene, can be utilized to reduce IOP. However, their disadvantages outweigh their advantages, which was not the case when the initial reports of marijuana's effects on IOP were published in the 1970s. Hence, cannabis-based glaucoma treatments are now of questionable value.
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Affiliation(s)
- Steven Lehrer
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
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Fakhoury H, Abdelmassih Y, El-Khoury S, Amro M, Zaarour K, Cherfan C, Tomey K, Khoueir Z. Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial. J Curr Glaucoma Pract 2021; 15:58-63. [PMID: 34720494 PMCID: PMC8543749 DOI: 10.5005/jp-journals-10078-1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective Evaluate the short-term safety and efficacy of dexmedetomidine (0.0055%) drops on intraocular pressure (IOP) in healthy eyes. Materials and methods In this randomized controlled trial, patients with normal eye exams were randomly assigned to receive, in a randomly selected eye, one drop of either balanced salt solution (BSS) or dexmedetomidine (0.0055%). Goldmann applanation tonometry was performed at baseline and then 30 minutes, 4 hours, and 24 hours after drop instillation. Results Forty-nine eyes of 49 normal volunteers were enrolled in the study, with 21 eyes (group I) receiving BSS and 28 (group II) dexmedetomidine. Both groups were comparable at baseline as far as age and IOP (p = 0.55 for both parameters). Intraocular pressure significantly decreased from baseline in group II at 30 minutes and 4 hours (p = 0.001 and 0.05, respectively). Maximum IOP decrease was obtained at 30 minutes after dexmedetomidine instillation, with a 9% decrease from baseline (mean decrease: 1.15 mm Hg). The percentage of IOP decrease was significantly higher in group II at 30 minutes compared with group I (9 vs 1.1%; p = 0.05). No side effects were recorded. Conclusion In this pilot study, dexmedetomidine 0.0055% drops have shown good safety and efficacy in lowering IOP in normal healthy volunteers with no history of glaucoma. This medication has a short onset of action, with a 10% reduction of IOP occurring 30 minutes post-instillation. Trial registration number NCT03690622. How to cite this article Fakhoury H, Abdelmassih Y, El-Khoury S, et al. The Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial. J Curr Glaucoma Pract 2021;15(2):58-63.
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Affiliation(s)
- Henry Fakhoury
- Anesthesia Department, Lebanese University, Faculty of Medicine, Beirut, Lebanon; Anesthesia Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon
| | - Youssef Abdelmassih
- Ophthalmology Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; Ophthalmology Department, Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon; Retina Department, Fondation Ophtalmologique Adolphe de Rothschild, Service du Dr Caputo, Paris, France
| | - Sylvain El-Khoury
- Ophthalmology Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; Retina Department, Fondation Ophtalmologique Adolphe de Rothschild, Service du Dr Caputo, Paris, France
| | - Mazen Amro
- Ophthalmology Department, Lebanese University, Faculty of Medicine, Beirut, Lebanon; Ophthamology Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon
| | - Karen Zaarour
- Ophthalmology Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; Ophthalmology Department, Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Carole Cherfan
- Ophthalmology Department, Lebanese University, Faculty of Medicine, Beirut, Lebanon; Ophthamology Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon
| | - Karim Tomey
- Glaucoma Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; Ophthalmology Department, Lebanese American University, Gilbert and Rose-Mary Chagoury School of Medicine, Byblos, Lebanon
| | - Ziad Khoueir
- Ophthalmology Department, Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon; Glaucoma Department, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
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Abstract
Acetazolamide is the drug of choice for glaucoma treatment in an emergency. However, it is not available in any topical formulation and it is available only as systemic tablets. Despite its efficiency as a drug in decreasing intraocular pressure, it has negative systemic effects as renal toxicity and metabolic acidosis. Moreover, it suffers from poor aqueous solubility and low corneal permeability limiting its ocular bioavailability and its use topically. Cubosomes have enormous advantages as a drug delivery system, most importantly, high surface area, thermal stability, and ability to encapsulate hydrophobic, amhiphilic, and hydrophilic molecules. Herein, we have exploited the unique properties of cubosomes as a novel nano-delivery system for acetazolamide as eye drops dosage form for glaucoma treatment. Different acetazolamide-loaded cubosomes have been developed and evaluated. The best-optimized formulation (F5), was cubic shaped structure, with an average particle size of 359.5 ± 2.8 nm, surface charge −10.8 ± 3.2 mV, and 59.8% entrapment efficiency. Ex-vivo corneal permeation studies have revealed a 4-fold increase in acetazolamide permeability coefficient compared to that stated in the literature. F5 showed superior therapeutic efficacy represented by a 38.22% maximum decrease in intraocular pressure vs. 31.14 and 21.99% decrease for the commercial Azopt® eye drops and Cidamex® tablets, respectively. It also exhibited higher (AUC0–10) compared to Azopt® eye drops and Cidamex® tablets by 2.3 and 3 times, respectively. F5 showed mean residence time 4.22 h vs. 2.36 and 2.62 h for Azopt® and Cidamex® with no eye irritation observed according to the modified Draize test. To the best of our knowledge, this is the first study for developing acetazolamide-loaded cubosomes as the topical delivery system for glaucoma treatment.
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Affiliation(s)
- Hoda E Teba
- Department of Pharmaceutics, Faculty of Pharmacy and Drug Manufacturing, Misr University for Science and Technology, 6th of October, Egypt
| | - Islam A Khalil
- Department of Pharmaceutics, Faculty of Pharmacy and Drug Manufacturing, Misr University for Science and Technology, 6th of October, Egypt
| | - Heba M El Sorogy
- Department of Pharmaceutics, Faculty of Pharmacy and Drug Manufacturing, Misr University for Science and Technology, 6th of October, Egypt
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Sharif NA. Therapeutic Drugs and Devices for Tackling Ocular Hypertension and Glaucoma, and Need for Neuroprotection and Cytoprotective Therapies. Front Pharmacol 2021; 12:729249. [PMID: 34603044 PMCID: PMC8484316 DOI: 10.3389/fphar.2021.729249] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/18/2021] [Indexed: 12/11/2022] Open
Abstract
Damage to the optic nerve and the death of associated retinal ganglion cells (RGCs) by elevated intraocular pressure (IOP), also known as glaucoma, is responsible for visual impairment and blindness in millions of people worldwide. The ocular hypertension (OHT) and the deleterious mechanical forces it exerts at the back of the eye, at the level of the optic nerve head/optic disc and lamina cribosa, is the only modifiable risk factor associated with glaucoma that can be treated. The elevated IOP occurs due to the inability of accumulated aqueous humor (AQH) to egress from the anterior chamber of the eye due to occlusion of the major outflow pathway, the trabecular meshwork (TM) and Schlemm’s canal (SC). Several different classes of pharmaceutical agents, surgical techniques and implantable devices have been developed to lower and control IOP. First-line drugs to promote AQH outflow via the uveoscleral outflow pathway include FP-receptor prostaglandin (PG) agonists (e.g., latanoprost, travoprost and tafluprost) and a novel non-PG EP2-receptor agonist (omidenepag isopropyl, Eybelis®). TM/SC outflow enhancing drugs are also effective ocular hypotensive agents (e.g., rho kinase inhibitors like ripasudil and netarsudil; and latanoprostene bunod, a conjugate of a nitric oxide donor and latanoprost). One of the most effective anterior chamber AQH microshunt devices is the Preserflo® microshunt which can lower IOP down to 10–13 mmHg. Other IOP-lowering drugs and devices on the horizon will be also discussed. Additionally, since elevated IOP is only one of many risk factors for development of glaucomatous optic neuropathy, a treatise of the role of inflammatory neurodegeneration of the optic nerve and retinal ganglion cells and appropriate neuroprotective strategies to mitigate this disease will also be reviewed and discussed.
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Affiliation(s)
- Najam A Sharif
- Global Alliances and External Research, Ophthalmology Innovation Center, Santen Inc., Emeryville, CA, United States
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Gautam N, Kesavan K. Phase Transition Microemulsion of Brimonidine Tartrate for Glaucoma Therapy: Preparation, Characterization and Pharmacodynamic Study. Curr Eye Res 2021; 46:1844-1852. [PMID: 34176380 DOI: 10.1080/02713683.2021.1942071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: The aim of this study was to formulate brimonidine tartrate loaded phase transition microemulsions (PMEs), which undergo phase transition from water in oil (W/O) microemulsions to liquid crystalline (LC) and then oil in water (O/W) microemulsions after instilled into the eye and prolong the precorneal residence time and ocular bioavailability for the effective treatment of glaucoma.Methods: The pseudo-ternary phase diagram was developed and various PMEs were prepared using Tween 80 and Span 80 with isopropyl myristate and water. Globule size and shape, physicochemical parameters, in vitro and ex vivo drug release of PMEs were studied. The in vivo anti-glaucoma efficacy of optimized PMEs was studied in an experimental rabbit eyes model and compared with marketed formulation (MF).Results: Globule size of PMEs was found less than 200 nm, which was confirmed by both dynamic light scattering technique and Transmission Electron Microscopy. Physicochemical properties such as pH, refractive index, percentage transparency, viscosity and conductivity were also found in the acceptable ranges. In vitro release studies of PMEs exhibited sustained release property. Ex vivo permeation study also supported the enhanced drug flux through cornea from PMEs as compared with MF. In pharmacodynamic study, a greater reduction in intraocular pressure was seen in PMEs as compared to MF.Conclusion: PMEs as ocular drug delivery system offer a promising approach to enhance the corneal contact, higher permeation and prolonged precorneal retention time in the eye leading to sustained drug release, enhanced bioavailability and patient compliance.
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Affiliation(s)
- Nivedita Gautam
- Department of Pharmaceutics, SLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur, India
| | - Karthikeyan Kesavan
- Department of Pharmaceutics, SLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur, India
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Napolitano M, Potestio L, Castagliola C, Fabbrocini G, Patruno C. Allergic contact dermatitis probably due to brimonidine tartrate in eyedrops. Contact Dermatitis 2021; 85:382-384. [PMID: 33861874 DOI: 10.1111/cod.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ciro Castagliola
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Sharma PK, Chauhan MK. Optimization and Characterization of Brimonidine Tartrate Nanoparticles-loaded In Situ Gel for the Treatment of Glaucoma. Curr Eye Res 2021; 46:1703-1716. [PMID: 33844617 DOI: 10.1080/02713683.2021.1916037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purposes: The present study aimed to develop brimonidine tartrate loaded poly(lactic-co-glycolic acid) acid vitamin E-tocopheryl polyethylene glycol 1000 succinate (BRT-PLGA-TPGS) nanoparticles in thermosensitivein situ gel to improve mucoadhensive properties and drug holding capacity for the better management of glaucoma.Methods: Nanoparticles was optimized by means of Box-Behnken Design (BBD). The formulations were prepared using various concentration of PLGA (0.1-0.4% w/v) and TPGS (0.3-0.5% w/v). The analytical data of fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and transmission electron microscopy (TEM) depicted the drug excipients compatibility and confirmed the nanoparticles. Nanoparticles incorporated gel was evaluated for transcorneal permeability, gelation time, gelling temperature, and rheological studies. In addition, in vitro, transcorneal permeation drug release studies and intraocular pressure (IOP) for optimized gel was also performed. Biocompatibility of formulations was investigated in rabbit model.Results: The drug loaded nanoparticles exhibited 115.72 ± 4.18 nm, 0.190 ± 0.02, -11.80 ± 2.24 mV and 74.85 ± 6.54% of mean size, polydispersity index (PDI), zeta potential and entrapment efficiency (% EE), respectively. As compared to marketed eye drop, the sustained and continuous release BRT release from Poloxamer-based in situ gel was 85.31 ± 3.51% till 24 h. The transcorneal steady-state flux (136.32 μg cm-2 h-1) of optimized in situ gel was approximately 3.5 times higher than marketed formulation (38.60 μg cm-2 h-1) flux at 4 h. The optimized formulation produces 3 fold greater influences on percentage reduction of IOP (34.46 ± 4.21%) than the marketed formulation (12.24 ± 2.90%) till 8 h.Conclusion: The incorporation of optimized BRT-PLGA-TPGS nanoparticles into a thermosensitivein situ gel matrix to improve precorneal residence time without causing eye irritation and also serve the sustained release of BRT through cornea for effective management of glaucoma.
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Affiliation(s)
- Pankaj Kumar Sharma
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, DPSR-University, New Delhi, India
| | - Meenakshi Kanwar Chauhan
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, DPSR-University, New Delhi, India
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Yu HJ, Wykoff CC. Investigational Agents in Development for the Treatment of Geographic Atrophy Secondary to Age-Related Macular Degeneration. BioDrugs 2021; 35:303-323. [PMID: 33893984 DOI: 10.1007/s40259-021-00481-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/13/2022]
Abstract
Geographic atrophy (GA) is an advanced form of age-related macular degeneration, a late-onset, complex, genetic degenerative disease of the retina. Multiple environmental and genetic factors have been implicated in the development of GA, a pathology ultimately defined by loss of photoreceptors and the underlying retinal pigment epithelium and choriocapillaris. The personal burden of GA has been documented to have a substantial negative impact on quality of life, with progressive and cumulative loss of visual function each year. Currently, there are no treatments to prevent or slow the development or progression of GA. Multiple genetic and histopathologic studies have implicated dysregulation of the complement cascade in GA pathogenesis, leading to the development of several investigational pharmaceuticals targeting key factors in this inflammatory pathway. Several other biochemical pathways have also been implicated in GA development and progression, such as mitochondrial components, mediators of apoptosis and molecules involved in extracellular matrix remodeling, many of which are also being investigated for their potential value as therapeutic targets for GA treatment. Recent advancements in our understanding of GA pathogenesis and the progression of multiple potential therapeutics into later-stage human clinical trials hold great promise for a clinically effective therapeutic for patients with GA to emerge within the near future.
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Affiliation(s)
- Hannah J Yu
- Retina Consultants of Texas, Retina Consultants of America, 4460 Bissonnet St., Suite 200, Bellaire, Texas, 77401, United States
| | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, 4460 Bissonnet St., Suite 200, Bellaire, Texas, 77401, United States.
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
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Takahashi N, Matsunaga N, Natsume T, Kitazawa C, Itani Y, Hama A, Hayashi I, Shimazawa M, Hara H, Takamatsu H. A longitudinal comparison in cynomolgus macaques of the effect of brimonidine on optic nerve neuropathy using diffusion tensor imaging magnetic resonance imaging and spectral domain optical coherence tomography. Heliyon 2021; 7:e06701. [PMID: 33898826 PMCID: PMC8056221 DOI: 10.1016/j.heliyon.2021.e06701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/04/2021] [Accepted: 03/31/2021] [Indexed: 10/26/2022] Open
Abstract
Early detection of optic neuropathy is crucial for initiating treatment that could delay or prevent visual field loss. Preclinical studies have advanced a number of potential neuroprotective strategies to prevent retinal ganglion cell (RGC) degeneration, but none have successfully completed clinical trials. One issue related to the lack of preclinical to clinical translation is the lack of preclinical morphometric assessments that could be used to track neuroprotection, as well as neurodegeneration, over time within the same animal. Thus, to assess whether clinically used morphometric assessments can identify neuroprotection of RGC, the current study compared optic nerve fractional anisotropy (FA) obtained with diffusion tensor imaging (DTI) and retinal nerve fiber layer (RNFL) thickness measured with spectral domain optical coherence tomography (SD-OCT) to observe not only the early progression of RGC axonal degeneration but to also discern which imaging modality identifies signs of neuroprotection during treatment with the alpha-adrenoceptor agonist brimonidine. Elevated and sustained intraocular pressure (IOP) was observed following laser photocoagulation of the trabecular meshwork in one eye of nonhuman primates (NHP). Either brimonidine (0.1%) or control treatment was instilled twice daily for two months. In control-treated eyes, increased IOP, increased vertical cup-to-disc (C/D), reduced rim-to-disc (R/D) ratio, decreased RNFL thickness and decreased FA were observed. While IOP remained elevated during the course of the study, brimonidine tended to delay the progression of RNFL thinning. However, in the same animal, optic nerve FA did not appear to decline. Brimonidine treatment did not affect other measures of RGC axonal degeneration. The current findings demonstrate that early progression of optic neuropathy can be tracked over time in a nonhuman primate model of ocular hypertension using either DTI or SD-OCT. Furthermore, the delayed changes to RNFL thickness and FA appear to be a neuroprotective effect of brimonidine independent of its effect on IOP.
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Affiliation(s)
- Nobuyuki Takahashi
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
| | - Naoko Matsunaga
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
| | - Takahiro Natsume
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
| | - Chinatsu Kitazawa
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
| | - Yoshitaka Itani
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
| | - Aldric Hama
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
| | - Ikuo Hayashi
- Hamamatsu Pharma Research USA, Inc., 4660 La Jolla Village Drive, San Diego, CA, 92122 USA
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu 501-1196, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu 501-1196, Japan
| | - Hiroyuki Takamatsu
- Pharmacology, Hamamatsu Pharma Research, Inc., 1-3-7, Shinmiyakoda, Kita-ku, Hamamatsu, Shizuoka, 431-2103, Japan
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Çalışkan B, Öztürk Kesebir A, Demir Y, Akyol Salman İ. The effect of brimonidine and proparacaine on metabolic enzymes: Glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, and glutathione reductase. Biotechnol Appl Biochem 2021; 69:281-288. [PMID: 33438819 DOI: 10.1002/bab.2107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Abstract
Oxidative stress is to upregulate the pentose phosphate pathway (PPP). The PPP consists of two functional branches, glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconaste dehydrogenase (6PGD). Glutathione reductase (GR) has a significant role in catalyzing an oxidized glutathione form into a reduced form. The purpose of this study is to investigate the effects of brimonidine and proparacaine on the activity of 6PGD, G6PD, and GR enzymes purified from human erythrocytes. Brimonidine displayed considerable inhibition profile against G6PD with IC50 value and KI constant of 29.93 ± 3.56 and 48.46 ± 0.66 μM, respectively. On the other hand, proparacaine had no inhibitory effect against G6PD. KI values were found to be 66.06 ± 0.78 and 811.50 ± 11.13 μM for brimonidine and proparacaine, respectively, for 6PGD. KI values were found to be 144.10 ± 2.01 and 1,654.00 ± 26.29 μM for brimonidine and proparacaine, respectively, for GR. Herein, also in silico molecular docking studies were performed between drugs and enzymes.
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Affiliation(s)
- Büşra Çalışkan
- Department of Ophthalmology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Arzu Öztürk Kesebir
- Department of Chemistry, Faculty of Science, Atatürk University, Erzurum, Turkey
| | - Yeliz Demir
- Department of Pharmacy Services, Nihat Delibalta Göle Vocational High School, Ardahan University, Ardahan, Turkey
| | - İlknur Akyol Salman
- Department of Ophthalmology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Jayanetti V, Sandhu S, Lusthaus JA. The Latest Drugs in Development That Reduce Intraocular Pressure in Ocular Hypertension and Glaucoma. J Exp Pharmacol 2020; 12:539-548. [PMID: 33244278 PMCID: PMC7685378 DOI: 10.2147/jep.s281187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Glaucoma causes irreversible vision loss, with elevated intraocular pressure (IOP) being the only known modifiable risk factor. There are a variety of medical and interventional options for lowering IOP; however, despite these treatments, glaucoma continues to be a leading cause of visual impairment. Further research continues to strive for treatment options with improved side effect profiles, additional IOP-lowering effects, and ease of use. This review provides a brief summary of current IOP-lowering therapies and then outlines pipeline ocular hypotensive agents, their mechanisms of action, benefits, and side effect profiles. Advancements are seen within currently used eye drop classes such as prostaglandin analogues, Rho kinase inhibitors and nitric oxide donors, whilst there are also new drug classes, such as tyrosine protein kinase activators. Most developing drugs are topical drop formulations, with a number already having entered Phase III trials. Alternative drug delivery methods are also in development and will be briefly discussed. Pharmacological and drug delivery developments continue to provide glaucoma patients and clinicians with new options and the promise of better outcomes, particularly in terms of improved tolerance and reduced frequency of dosing.
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Affiliation(s)
- Viran Jayanetti
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sartaj Sandhu
- Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Jed A Lusthaus
- Glaucoma Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
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Xu R, Gil D, Dibas M, Rickert M, Meyer D, Perron L, Kollbaum P, Bradley A. Time-course of the visual Impact on presbyopes of a low dose miotic. Ophthalmic Physiol Opt 2020; 41:73-83. [PMID: 33150654 DOI: 10.1111/opo.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the pupil and visual impact of a single early morning drop of a low concentration miotic. METHODS Pupil size, refraction, visual acuity (VA), near reading performance and intraocular pressure were monitored for 8 h at a wide range of light levels following bilateral instillation of single drops of 0.1% brimonidine tartate in 19 early presbyopes (40-50 years) and 11 mature presbyopes (>50 years). RESULTS Pupil miosis did not alter distance VA or refraction. Significant pupil miosis peaked at 1-2 h after dosing, which expanded the depth of focus of mature presbyopes with the mean improvement in near logMAR VA of -0.15, -0.07 and -0.03, at 20, 200 and 2000 lux, respectively. One hour after instillation, near reading speed improved by 21, 24 and 5 words per min for text size commonly seen in US newspaper and cellphone text messages, 18, 21 and 19 words per min for text size of grocery labels and 12, 13 and 30 words per min for text size of over-the-counter medications at light levels of 20, 200 and 2000 lux, respectively. No such improvements in near VA and near reading speed were observed in the young presbyopes having some residual accommodation. Most of the pupil miosis remained 8 h after instillation, whereas near VA improvements disappeared after 4 h. CONCLUSION Low dose miotics can enhance near vision in presbyopic subjects while retaining high quality distance vision over a wide range of light levels. Significant improvements in near vision were observed only during the 1-2 h period after dosing when miosis peaked.
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Affiliation(s)
- Renfeng Xu
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, USA
| | | | | | - Martin Rickert
- School of Optometry, Indiana University, Bloomington, USA
| | - Dawn Meyer
- School of Optometry, Indiana University, Bloomington, USA
| | - Laura Perron
- School of Optometry, Indiana University, Bloomington, USA
| | - Pete Kollbaum
- School of Optometry, Indiana University, Bloomington, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, USA
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20
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Chin JY, Toh ZH, Lo YT, Wang HT, Poh EY, Chua CH, Hee OK, Lim BA, Yong VK, Laude A, Wong HT, Yip LW. Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude. Int J Ophthalmol 2020; 13:1451-1458. [PMID: 32953586 DOI: 10.18240/ijo.2020.09.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 06/12/2020] [Indexed: 01/20/2023] Open
Abstract
AIM To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients. METHODS Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed. Validated questionnaires: the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered prospectively. Subjects with non-glaucomatous optic neuropathy or concomitant retinal pathology were excluded. Glaucoma severity was based on HVF 24-2 perimetry. Binocular single vision was represented based on the better eye. Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared. RESULTS A total of 79 primary open angle glaucoma (POAG), 27 primary angle-closure glaucoma (PACG) patients, and 89 controls were recruited. PACG patients had higher median PSQI scores (P=0.004) and poorer sleep quality (P<0.001). Compared to controls, PACG patients were 3.34 times more likely to have poor sleep quality (P=0.008), which remained significant after adjustment for demographics (P=0.016) and predictive variables (P=0.013). PACG patients have poorer sleep quality when visual acuity (VA) was 6/15 or worse (P=0.009). Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance. CONCLUSION PACG patients have poorer sleep quality but not daytime sleepiness. This is important in South-East Asian population with heavy disease burden. Evaluations on sleep disturbances can be considered to provide more holistic care.
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Affiliation(s)
- Jacob Yh Chin
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Zhi Hong Toh
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Ying Tai Lo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Hannah Ty Wang
- Monash School of Medicine, Monash University, Victoria 3800, Australia
| | - Elizabeth Yw Poh
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Chun Hau Chua
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Owen Kim Hee
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Boon Ang Lim
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Vernon Ky Yong
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Augustinus Laude
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Hon Tym Wong
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
| | - Leonard Wl Yip
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 308433, Singapore
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Gelling hypotonic polymer solution for extended topical drug delivery to the eye. Nat Biomed Eng 2020; 4:1053-1062. [PMID: 32895514 PMCID: PMC7655548 DOI: 10.1038/s41551-020-00606-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/28/2020] [Indexed: 01/19/2023]
Abstract
Eye-drop formulations should hold as high a concentration of soluble drug in contact with ocular epithelium for as long as possible. However, eye tears and frequent blinking limit drug retention on the ocular surface, and gelling drops typically form clumps that blur vision. Here, we describe a gelling hypotonic solution containing a low concentration of a thermosensitive triblock copolymer, for extended ocular drug delivery. On topical application, the hypotonic formulation forms a highly uniform and clear thin layer that conforms to the ocular surface and resists clearance from blinking, significantly increasing the intraocular absorption of hydrophilic and hydrophobic drugs and extending the drug–ocular-epithelium contact time with respect to conventional thermosensitive gelling formulations and commercial eye drops. We also show that the conformal gel layer allows for therapeutically relevant drug delivery to the eyeball’s posterior segment in pigs. Our findings highlight the importance of formulations that conform to the ocular surface prior to viscosity enhancement, for increased and prolonged ocular-surface contact and drug absorption.
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22
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Scuteri D, Bagetta G, Nucci C, Aiello F, Cesareo M, Tonin P, Corasaniti MT. Evidence on the neuroprotective properties of brimonidine in glaucoma. PROGRESS IN BRAIN RESEARCH 2020; 257:155-166. [PMID: 32988470 DOI: 10.1016/bs.pbr.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND glaucoma is the leading cause of irreversible blindness all over the world. The degree of visual field loss accounts for the severity of the disease and represents the main clinical outcome of treatment for patients affected by glaucoma. The α2 agonists, like brimonidine, emerged in the 1960s as topical ophthalmologic treatment. Their neuroprotective mechanism in glaucoma is still debated, ranging from effect on extracellular glutamate, to ocular hypotension and blood flow. OBJECTIVES this systematic review and meta-analysis aims at assessing the efficacy of brimonidine on visual field deterioration during glaucoma through the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) approach. Databases consulted: the literature search has been performed on PubMed, MEDLINE, ClinicalTrials.gov and Scopus up to June 10th, 2020. Study eligibility criteria, participants, and interventions: clinical trials assessing the effects of brimonidine on visual field in patients with glaucoma. Study appraisal: the eligibility of the studies has been assessed by two independent authors and the selection has followed the PRISMA flow diagram. The retrieved results have been subjected to risk of bias evaluation. RESULTS the search of literature has retrieved 418 papers, among which 5 are eligible for inclusion in the qualitative analysis. All the studies present high heterogeneity, therefore meta-analysis has not been possible. The results obtained suggest that brimonidine improves visual field, but the design of the clinical trials rises some concerns in terms of risk of bias. CONCLUSIONS the evidence of neuroprotective effect of brimonidine is inconclusive and needs stronger support. Large double-blind randomized clinical trials are necessary to strengthen this evidence.
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Affiliation(s)
- Damiana Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy.
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
| | - Maria Tiziana Corasaniti
- School of Hospital Pharmacy, University "Magna Graecia" of Catanzaro and Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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23
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Sedlak L, Wojnar W, Zych M, Wyględowska-Promieńska D. Influence of timolol, benzalkonium-preserved timolol, and benzalkonium-preserved brimonidine on oxidative stress biomarkers in the tear film. Cutan Ocul Toxicol 2020; 39:260-268. [DOI: 10.1080/15569527.2020.1787435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Lech Sedlak
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, Katowice, Poland
| | - Weronika Wojnar
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
| | - Maria Zych
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
| | - Dorota Wyględowska-Promieńska
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, Katowice, Poland
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24
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Azarcon CP, Santiago DE. Prolonged central nervous system and respiratory depression in preterm neonates after exposure to brimonidine tartrate and timolol maleate ophthalmic drops. GMS OPHTHALMOLOGY CASES 2020; 10:Doc25. [PMID: 32676270 PMCID: PMC7332996 DOI: 10.3205/oc000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: We report three cases of preterm neonates who presented with central nervous system (CNS) and respiratory depression after inadvertent exposure to brimonidine tartrate 0.2% and timolol maleate 0.5% fixed-combination ophthalmic drops. Case descriptions: CNS and respiratory depression were observed in the three neonates within two hours of administration of brimonidine tartrate 0.2% and timolol maleate 0.5% eye drops. Respiratory support was initiated upon admission to the neonatal intensive care unit (NICU). The effects of the drug combination lasted for 24 to 48 hours. Conclusion: This case series suggests that the drug combination of brimonidine tartrate and timolol maleate causes a prolonged depression of the central nervous and respiratory systems in preterm neonates.
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Affiliation(s)
- Corrina P. Azarcon
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Manila, Philippines,*To whom correspondence should be addressed: Corrina P. Azarcon, Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Taft Avenue, Ermita, Barangay 670 Zone 72, Manila, 1000 Metro Manila, Philippines, Phone: +63 998 552 4095, E-mail:
| | - Darby E. Santiago
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, Manila, Philippines,University of the Philippines College of Medicine, Manila, Philippines
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Tanigawa Y, Wainberg M, Karjalainen J, Kiiskinen T, Venkataraman G, Lemmelä S, Turunen JA, Graham RR, Havulinna AS, Perola M, Palotie A, Daly MJ, Rivas MA. Rare protein-altering variants in ANGPTL7 lower intraocular pressure and protect against glaucoma. PLoS Genet 2020; 16:e1008682. [PMID: 32369491 PMCID: PMC7199928 DOI: 10.1371/journal.pgen.1008682] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/18/2020] [Indexed: 12/17/2022] Open
Abstract
Protein-altering variants that are protective against human disease provide in vivo validation of therapeutic targets. Here we use genotyping data from UK Biobank (n = 337,151 unrelated White British individuals) and FinnGen (n = 176,899) to conduct a search for protein-altering variants conferring lower intraocular pressure (IOP) and protection against glaucoma. Through rare protein-altering variant association analysis, we find a missense variant in ANGPTL7 in UK Biobank (rs28991009, p.Gln175His, MAF = 0.8%, genotyped in 82,253 individuals with measured IOP and an independent set of 4,238 glaucoma patients and 250,660 controls) that significantly lowers IOP (β = -0.53 and -0.67 mmHg for heterozygotes, -3.40 and -2.37 mmHg for homozygotes, P = 5.96 x 10-9 and 1.07 x 10-13 for corneal compensated and Goldman-correlated IOP, respectively) and is associated with 34% reduced risk of glaucoma (P = 0.0062). In FinnGen, we identify an ANGPTL7 missense variant at a greater than 50-fold increased frequency in Finland compared with other populations (rs147660927, p.Arg220Cys, MAF Finland = 4.3%), which was genotyped in 6,537 glaucoma patients and 170,362 controls and is associated with a 29% lower glaucoma risk (P = 1.9 x 10-12 for all glaucoma types and also protection against its subtypes including exfoliation, primary open-angle, and primary angle-closure). We further find three rarer variants in UK Biobank, including a protein-truncating variant, which confer a strong composite lowering of IOP (P = 0.0012 and 0.24 for Goldman-correlated and corneal compensated IOP, respectively), suggesting the protective mechanism likely resides in the loss of interaction or function. Our results support inhibition or down-regulation of ANGPTL7 as a therapeutic strategy for glaucoma.
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Affiliation(s)
- Yosuke Tanigawa
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Michael Wainberg
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Juha Karjalainen
- Program in Medical and Population Genetics and Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Guhan Venkataraman
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Susanna Lemmelä
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joni A. Turunen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
| | - Robert R. Graham
- Maze Therapeutics, South San Francisco, California, United States of America
| | - Aki S. Havulinna
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markus Perola
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Aarno Palotie
- Program in Medical and Population Genetics and Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | | | - Mark J. Daly
- Program in Medical and Population Genetics and Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Manuel A. Rivas
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, United States of America
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Cimolai N. A review of neuropsychiatric adverse events from topical ophthalmic brimonidine. Hum Exp Toxicol 2020; 39:1279-1290. [DOI: 10.1177/0960327120918307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Brimonidine is a first-line topical medication for increased intraocular pressure and glaucoma which may be used alone or in conjunction with other topical therapies. Its structural and pharmacological comparabilities to clonidine give way to the hypothesis that it may cause neuropsychiatric side effects. The majority of case reports citing brimonidine toxicity, either for topical or peripheral exposure, include pediatric age groups but especially infants. Among the latter, a dose-response phenomenon is evident. Dose-response correlates have also been shown among adults. Case series and prospective double-blind treatment studies also give evidence for the occurrence of several central nervous system adverse reactions. Topical ophthalmic brimonidine use should be followed for the occurrence of neuropsychiatric disturbances generally, and enhanced vigilance should be maintained for at-risk populations.
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Affiliation(s)
- N Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Children’s and Women’s Health Centre of British Columbia, Vancouver, BC, Canada
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27
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Machen L, Razeghinejad R, Myers JS. Fixed-combination topical anti-hypertensive ophthalmic agents. Expert Opin Pharmacother 2020; 21:1269-1282. [PMID: 32228188 DOI: 10.1080/14656566.2020.1743264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of fixed-combination medications will help educate and inform providers for optimal patient care. AREAS COVERED In this review, the authors describe the composition, mechanism of action, efficacy, side effects, and safety profile of fixed-combination agents for the treatment of ocular hypertension and glaucoma as well as comparisons between the most frequently prescribed medications. EXPERT OPINION Fixed-combination therapeutics provide an effective and efficient means of lowering intraocular pressure with comparable side effects and outcomes to constituent parts with lower patient exposure to preservatives and improvement in compliance.
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Affiliation(s)
- Lindsay Machen
- Glaucoma Service, Wills Eye Hospital , Philadelphia, PA, USA
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28
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Neuroprotective Strategies for Retinal Ganglion Cell Degeneration: Current Status and Challenges Ahead. Int J Mol Sci 2020; 21:ijms21072262. [PMID: 32218163 PMCID: PMC7177277 DOI: 10.3390/ijms21072262] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/12/2022] Open
Abstract
The retinal ganglion cells (RGCs) are the output cells of the retina into the brain. In mammals, these cells are not able to regenerate their axons after optic nerve injury, leaving the patients with optic neuropathies with permanent visual loss. An effective RGCs-directed therapy could provide a beneficial effect to prevent the progression of the disease. Axonal injury leads to the functional loss of RGCs and subsequently induces neuronal death, and axonal regeneration would be essential to restore the neuronal connectivity, and to reestablish the function of the visual system. The manipulation of several intrinsic and extrinsic factors has been proposed in order to stimulate axonal regeneration and functional repairing of axonal connections in the visual pathway. However, there is a missing point in the process since, until now, there is no therapeutic strategy directed to promote axonal regeneration of RGCs as a therapeutic approach for optic neuropathies.
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Barwal I, Kumar R, Dada T, Yadav SC. Effect of Ultra-Small Chitosan Nanoparticles Doped with Brimonidine on the Ultra-Structure of the Trabecular Meshwork of Glaucoma Patients. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2019; 25:1352-1366. [PMID: 31018876 DOI: 10.1017/s1431927619000448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Brimonidine, an anti-glaucoma medicine, acts as an adrenergic agonist which decreases the synthesis of aqueous humour and increases the amount of drainage through Schlemm's canal and trabecular meshwork, but shows dose-dependent (0.2% solution thrice daily) toxicity. To reduce the side effects and improve the efficacy, brimonidine was nanoencapsulated on ultra-small-sized chitosan nanoparticles (nanobrimonidine) (28 ± 4 nm) with 39% encapsulation efficiency, monodispersity, freeze-thawing capability, storage stability, and 2% drug loading capacity. This nanocomplex showed burst, half, and complete release at 0.5, 45, and 100 h, respectively. Nanobrimonidine did not show any in vitro toxicity and was taken up by caveolae-mediated endocytosis. The nanobrimonidine-treated trabeculectomy tissue of glaucoma patients showed better dilation of the trabecular meshwork under the electron microscope. This is direct evidence for better bioavailability of nanobrimonidine after topical administration. Thus, the developed nanobrimonidine has the potential to improve the efficacy, reduce dosage and frequency, and improve delivery to the anterior chamber of the eye.
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Affiliation(s)
- Indu Barwal
- Department of Anatomy, Nanotechnology Lab, Electron Microscope Facility, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rahul Kumar
- Department of Anatomy, Nanotechnology Lab, Electron Microscope Facility, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Subhash Chandra Yadav
- Department of Anatomy, Nanotechnology Lab, Electron Microscope Facility, All India Institute of Medical Sciences, New Delhi 110029, India
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30
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Wu M, Liu M, Schuman JS, Wang Y, Lucy KA, Ishikawa H, Wollstein G. Evaluating Glaucoma Treatment Effect on Intraocular Pressure Reduction Using Propensity Score Weighted Regression. Sci Rep 2019; 9:15496. [PMID: 31664148 PMCID: PMC6820863 DOI: 10.1038/s41598-019-52052-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/12/2019] [Indexed: 11/09/2022] Open
Abstract
Observational studies in glaucoma patients can provide important evidence on treatment effects, especially for combination therapies which are often used in reality. But the success relies on the reduction of selection bias through methods such as propensity score (PS) weighting. The objective of this study was to assess the effects of five glaucoma treatments (medication, laser, non-laser surgery (NLS), laser + medication, and NLS + medication) on 1-year intraocular pressure (IOP) change. Data were collected from 90 glaucoma subjects who underwent a single laser, or NLS intervention, and/or took the same medication for at least 6 months, and had IOP measures before the treatment and 12-months after. Baseline IOP was significantly different across groups (p = 0.007) and this unbalance was successfully corrected by the PS weighting (p = 0.81). All groups showed statistically significant PS-weighted IOP reductions, with the largest reduction in NLS group (-6.78 mmHg). Baseline IOP significantly interacted with treatments (p = 0.03), and at high baseline IOP medication was less effective than other treatments. Our findings showed that the 1-year IOP reduction differed across treatment groups and was dependent on baseline IOP. The use of PS-weighted methods reduced treatment selection bias at baseline and allowed valid assessment of the treatment effect in an observational study.
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Affiliation(s)
- Mengfei Wu
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA.,Department of Population Health, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, NYU School of Medicine, NYU Langone Health, New York, NY, USA. .,Department of Environmental Medicine, NYU School of Medicine, NYU Langone Health, New York, NY, USA.
| | - Joel S Schuman
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA.,Center of Neural Science, NYU, New York, NY, USA
| | - Yuyan Wang
- Department of Population Health, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Katie A Lucy
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Hiroshi Ishikawa
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA
| | - Gadi Wollstein
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, USA.,Center of Neural Science, NYU, New York, NY, USA
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31
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Dry Eye Symptoms and Ocular Pain in Veterans with Glaucoma. J Clin Med 2019; 8:jcm8071076. [PMID: 31336584 PMCID: PMC6678384 DOI: 10.3390/jcm8071076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022] Open
Abstract
Dry eye and glaucoma are two frequently encountered ocular conditions, which can lead to substantial morbidity and decreased quality of life. Patients on topical glaucoma medications are known to be at greater risk for ocular surface symptoms. Veterans seen in the eye clinics at the Miami Veterans Affairs Hospital from January to July 2016 completed surveys assessing dry eye and ocular pain symptoms, including the five item Dry Eye Questionnaire (DEQ5). A total of 62 patients with glaucoma completed the survey. Of those, 52 were on glaucoma medications at the time of the survey, with the majority requiring more than one medication to control intraocular pressure. The frequency of mild or greater dry eye symptoms (defined as DEQ5 >6) tended to increase with increasing medication burden, and patients on brimonidine were more likely to report a DEQ5 >6. Patients on three or more glaucoma medications were more likely to report symptoms of shooting pain, dryness, and itchiness. Patients using timolol were more likely to report throbbing and pain by light, while those on latanoprost reported stinging. Our data support an association between increasing number of glaucoma medications and worsening of dry eye symptoms. Patient and medication-associated symptoms can be used to tailor individual medication regimens.
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Konieczka K, Koch S, Hauenstein D, Chackathayil TN, Binggeli T, Schoetzau A, Flammer J. Effects of the Glaucoma Drugs Latanoprost and Brimonidine on Corneal Temperature. Transl Vis Sci Technol 2019; 8:47. [PMID: 31259092 PMCID: PMC6590090 DOI: 10.1167/tvst.8.3.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/07/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to investigate the effects of the glaucoma drugs latanoprost, brimonidine, and the combination of both on the central corneal temperature (CT) of healthy subjects by means of infrared thermography. Changes of the central CT may reflect changes of ocular blood flow. Methods Before application and during 2 hours after the application of latanoprost, brimonidine, or the combination of both in one eye, the CT in both eyes of 40 healthy subjects was measured repeatedly. Results Brimonidine reduced CT by approximately 0.5°C. This effect was statistically significant (P < 0.0001). Latanoprost, however, had a very small and insignificant influence (P = 0.47). Accordingly, the combination of brimonidine and latanoprost also reduced CT up to 0.5°C, and this effect was statistically significant (P < 0.0001). Conclusions Brimonidine, but not latanoprost, had a significant effect on central CT. This cooling effect of brimonidine is most probably due to a drug-induced reduction of blood circulation in the ciliary body and iris and to a certain extent also to a reduction of blood flow in the fundus of the eye. Translational Relevance This study shows evidence that thermography of the cornea provides indirect information on the influence of drugs on the blood flow to the anterior segment of the patient's eye.
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Affiliation(s)
- Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Augen Zentrum Prof Fankhauser, Bern, Switzerland
| | - Simone Koch
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | | | | | - Tatjana Binggeli
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Andreas Schoetzau
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Josef Flammer
- Department of Ophthalmology, University of Basel, Basel, Switzerland
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Effects of Brimonidine and Timolol on the Progression of Visual Field Defects in Open-angle Glaucoma: A Single-center Randomized Trial. J Glaucoma 2019; 28:575-583. [PMID: 31188229 DOI: 10.1097/ijg.0000000000001285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PRéCIS:: Instillation of brimonidine or timolol slowed visual field deterioration in patients with open-angle glaucoma; both brimonidine and timolol might improve the mean deviation (MD) slopes. PURPOSE The purpose of this study was to investigate and compare the effects of 0.1% brimonidine and 0.5% timolol on the progressing visual field defects in open-angle glaucoma. PATIENTS AND METHODS We evaluated 1 eye each of 68 glaucoma patients who were treated with at least 1 prostaglandin analog. Their baseline MD slopes were < -0.5 dB/y based on at least 5 Humphrey field analyzer measurements within 3 years. Eligible eyes were randomly assigned to brimonidine or timolol treatment groups and treatments were administered without the wash-out period. Clinical examinations were performed every 4 months for 2 years. We designated the MD slope as the primary endpoint. RESULTS Ultimately, 56 eyes (brimonidine:timolol=26:30) were included in the present study (mean age=65.2 y). Dropout rates of brimonidine and timolol treatment groups were 27.8% and 6.3%, respectively. There were no significant differences in baseline intraocular pressure or MD slopes between brimonidine and timolol groups (12.7 and 12.9 mm Hg, P=0.77, and -1.22 and -1.08 dB/y, P=0.43, respectively). Intraocular pressure decreased significantly in the brimonidine group at 4, 8, 12, and 16 months, and in the timolol group at 4 months, without significant differences between the drugs (P=0.20). MD slopes significantly improved in both groups (brimonidine: -0.38 dB/y, P<0.001; timolol: -0.52 dB/y, P=0.04). Furthermore, there was no significant difference between groups in the primary endpoint (P=0.59). CONCLUSION Brimonidine and timolol treatments improved MD slopes in open-angle glaucoma.
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34
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Kurysheva NI. [Selective α2-agonists in the treatment of glaucoma: pharmacology, efficacy and safety]. Vestn Oftalmol 2019; 135:144-150. [PMID: 31215546 DOI: 10.17116/oftalma2019135021144] [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] [Indexed: 06/09/2023]
Abstract
Glaucoma is the main cause of irreversible blindness in the world. Among the hypotensive eye drops, an important place belongs to the selective α2-adrenergic receptor antagonist brimonidine. This part of the review focuses on key pharmacological and therapeutic characteristics of brimonidine and its mode of action. The article also discusses the side effects of brimonidine and the methods of their prevention.
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Affiliation(s)
- N I Kurysheva
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation State Research Center ,Burnasyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency, Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Department of Opthalmology, 15 Gamalei St., Moscow, Russian Federation, 123098
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35
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Das P, Delost MD, Qureshi MH, Smith DT, Njardarson JT. A Survey of the Structures of US FDA Approved Combination Drugs. J Med Chem 2018; 62:4265-4311. [DOI: 10.1021/acs.jmedchem.8b01610] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Pradipta Das
- Department of Chemistry & Biochemistry, University of Arizona, 1306 East University Boulevard, Tucson, Arizona 85721, United States
| | - Michael D. Delost
- Department of Chemistry & Biochemistry, University of Arizona, 1306 East University Boulevard, Tucson, Arizona 85721, United States
| | - Munaum H. Qureshi
- Department of Chemistry & Biochemistry, University of Arizona, 1306 East University Boulevard, Tucson, Arizona 85721, United States
| | - David T. Smith
- Department of Chemistry & Biochemistry, University of Arizona, 1306 East University Boulevard, Tucson, Arizona 85721, United States
| | - Jon T. Njardarson
- Department of Chemistry & Biochemistry, University of Arizona, 1306 East University Boulevard, Tucson, Arizona 85721, United States
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36
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Kim SN, Ko SA, Park CG, Lee SH, Huh BK, Park YH, Kim YK, Ha A, Park KH, Choy YB. Amino-Functionalized Mesoporous Silica Particles for Ocular Delivery of Brimonidine. Mol Pharm 2018; 15:3143-3152. [DOI: 10.1021/acs.molpharmaceut.8b00215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Se-Na Kim
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Song Ah Ko
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Chun Gwon Park
- Department of Biomedical Engineering, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Seung Ho Lee
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
| | - Beom Kang Huh
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Yoh Han Park
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Young Bin Choy
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
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37
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Bhatti A, Singh G. Efficacy of three different formulations of brimonidine for control of intraocular pressure in primary open-angle glaucoma: A 6-week randomized trial. Oman J Ophthalmol 2018; 11:140-143. [PMID: 29930448 PMCID: PMC5991052 DOI: 10.4103/ojo.ojo_98_2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: To compare the intraocular pressure (IOP)-lowering efficacy and safety of brimonidine (0.2%), brimonidine purite (0.15%), and brimonidine purite (0.1%) in patients of primary open-angle glaucoma (POAG). MATERIALS AND METHODS: Sixty patients of POAG with IOP >21 mmHg were enrolled into this study for 6-week duration. The patients were randomly divided into three groups with 20 patients in each group. Group A instilled brimonidine 0.2%, Group B instilled brimonidine purite 0.15%, and Group C instilled brimonidine purite 0.1% twice daily. IOP was recorded by applanation tonometry at baseline and subsequently at 2, 4, and 6 weeks at 9:00–10:00 am during each visit around 30 min after instillation of eye drops. RESULTS: Mean IOP reduction in Group A was from 25.55 ± 2.01 to 19.85 ± 2.05 mmHg at the end of study, thus resulting in fall of 5.70 mmHg (22.30%), in Group B, it decreased from 25.65 ± 2.41 to 19.55 ± 2.43 mmHg, thus resulting in fall of 6.10 mmHg (23.78%), and in Group C, it decreased from 25.80 ± 2.26 mmHg to 19.85 ± 2.16 mmHg, thus resulting in fall of 6.35 mmHg (24.61%). There was no statistically significant difference in IOP-lowering efficacy of study drugs. Conjunctival hyperemia, foreign body sensation, dry eye, and papillary reaction were the important side effects seen with study drugs. Brimonidine 0.2% caused more side effects than brimonidine purite 0.15% and brimonidine purite 0.1%. CONCLUSION: All the three formulations of brimonidine produced statistically equal lowering of IOP in patients of POAG with reduced systemic and ocular adverse reactions with brimonidine purite 0.15% and 0.1%.
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Affiliation(s)
- Anubha Bhatti
- Department of Ophthalmology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Gursatinder Singh
- Department of Ophthalmology, Government Medical College, Patiala, Punjab, India
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38
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Barse RK, Tagalpallewar AA, Kokare CR, Sharma JP, Sharma PK. Formulation and ex vivo-in vivo evaluation of pH-triggered brimonidine tartrate in situ gel for the glaucoma treatment using application of 3 2 factorial design. Drug Dev Ind Pharm 2017; 44:800-807. [PMID: 29228819 DOI: 10.1080/03639045.2017.1414229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CONTEXT Short residence time, poor bioavailability and poor permeability are the major problems for conventional eye drops treatment. OBJECTIVE The aim of this article is to develop, optimize and ex vivo-in vivo investigation of brimonidine tartrate in situ gel as compared to marketed eye drops for the treatment of glaucoma. MATERIALS AND METHODS The effect of independent variables, namely concentrations of polymers, on various dependent variables like viscosity at physiological pH and in vitro drug release were studied by using 32 factorial design. Further the optimized formulation was characterized for ex vivo and in vivo study. RESULTS AND DISCUSSION Experimental data demonstrated that optimized in situ gel formulation (F8) showed in vitro-ex vivo sustained release profile with polymer composites carbopol 974P and HPMC K4M. After 5 h of ex vivo transcorneal permeation study, the amount recovered from the corneal surface on the donor chamber 12.40% (124 ug) and the amount collected from the receptor chamber 76.8% (760 ug) of the initial dose 1 mg. The total amount recovered from the permeation experiment was 89.2%. Bioadhesive carbopol 974P and viscosity HPMC K4M composites optimized formulation (F 8) produce greater influence on the duration of drug action and improved intraocular pressure reduction activity as compared to marketed eye drop solution in in vivo study. CONCLUSION The developed in situ gelling system as a promising ophthalmic formulation to prolong the drug lowering effect on the intraocular pressure.
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Affiliation(s)
- Rohan K Barse
- a School of Pharmaceutical Sciences , Jaipur National University , Jaipur , India.,b Department of Pharmaceutics , STES's Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University) , Pune , India
| | - Amol A Tagalpallewar
- b Department of Pharmaceutics , STES's Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University) , Pune , India
| | - Chandrakant R Kokare
- b Department of Pharmaceutics , STES's Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University) , Pune , India
| | - Jaya P Sharma
- a School of Pharmaceutical Sciences , Jaipur National University , Jaipur , India
| | - Pankaj K Sharma
- a School of Pharmaceutical Sciences , Jaipur National University , Jaipur , India
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Grove KJ, Kansara V, Prentiss M, Long D, Mogi M, Kim S, Rudewicz PJ. Application of Imaging Mass Spectrometry to Assess Ocular Drug Transit. SLAS DISCOVERY 2017; 22:1239-1245. [PMID: 28787579 DOI: 10.1177/2472555217724780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI IMS) is becoming an important technology to determine the distribution of drugs and their metabolites in the tissue of preclinical species after dosing. Interest in IMS is growing in the ophthalmology field, but little work to this point has been done to investigate ocular drug transit using this technology. Information on where and how a drug is distributing through the eye is important in understanding efficacy and whether it is reaching the desired target tissue. For this study, ocular distribution of brimonidine was investigated in rabbits following topical administration. Brimonidine has been shown to lower intraocular pressure and is approved to treat glaucoma, the second leading cause of blindness in the world. We have developed IMS methods to assess transit of topically administered brimonidine from the anterior to the posterior segment of rabbit eyes. Using IMS, brimonidine was detected in the cornea, aqueous humor, iris, and posterior segments of the eye. The distribution of brimonidine suggests that the route of transit following topical administration is mainly through the uvea-scleral route. This study demonstrates that IMS can be applied to assess ocular transit and distribution of topically administered drugs.
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Affiliation(s)
- Kerri J Grove
- 1 Novartis Institutes for BioMedical Research, Emeryville, CA, USA
| | - Viral Kansara
- 2 Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Melissa Prentiss
- 2 Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Debby Long
- 2 Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Muneto Mogi
- 2 Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Sean Kim
- 2 Novartis Institutes for BioMedical Research, Cambridge, MA, USA
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40
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Sun J, Zhang X, Huang T. A validated stability-indicating HPLC method for determination of brimonidine tartrate in BRI/PHEMA drug delivery systems. Chem Cent J 2017; 11:62. [PMID: 29086854 PMCID: PMC5505891 DOI: 10.1186/s13065-017-0292-2] [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] [Received: 05/10/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A simple, rapid and accurate stability-indicating reverse phase high performance liquid chromatography (RP-HPLC) was developed and validated for the determination of brimonidine tartrate in brimonidine tartrate/poly(2-hydroxyethyl methacrylate) (BRI/PHEMA) drug delivery contact lenses and pharmaceutical formulations. RESULTS Optimum chromatographic conditions for separating brimonidine tartrate from other impurities in the leaching liquor of BRI/PHEMA drug delivery contact lenses or pharmaceutical formulations have been achieved by using a Diamonsil C18 column (150 mm × 4.6 mm, 5 μm) as a stationary phase and a mixture solution of phosphate buffer (10 mM, pH3.5) containing 0.5% triethlamine and methanol (85:15, v/v) as a mobile phase at a flow rate of 1 mL/min. The theoretical plates for the brimonidine tartrate measurement were calculated to be 8360 when detection was performed at 246 nm using a diode array detector. The proposed method was validated in accordance with ICH guidelines with respect to linearity, accuracy, precision, robustness, specificity, limit of detection and quantitation. Regression analysis showed a good correlation (R2 > 0.999) for brimonidine tartrate in the concentration range of 0.01-50 μg/mL. The peak purity factor is ≥980 for the analyte after all types of stress tests, indicating an excellent separation of brimonidine tartrate peak from other impurities. The measurement course could be completed within 10 min, which was very quick, effective and convenient. CONCLUSIONS Overall, the proposed stability-indicating method was suitable for routine quality control and drug analysis of brimonidine tartrate in BRI/PHEMA drug delivery contact lenses and other pharmaceutical formulations.
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Affiliation(s)
- Jianguo Sun
- Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,Key Laboratory of Myopia, NHFPC, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China
| | - Xiuwen Zhang
- Department of Pharmacy, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
| | - Taomin Huang
- Department of Pharmacy, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
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41
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Lusthaus JA, Goldberg I. Brimonidine and brinzolamide for treating glaucoma and ocular hypertension; a safety evaluation. Expert Opin Drug Saf 2017; 16:1071-1078. [DOI: 10.1080/14740338.2017.1346083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jed Asher Lusthaus
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
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Abdelkader A, Kaufman HE. Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia. EYE AND VISION 2016; 3:31. [PMID: 27981057 PMCID: PMC5139101 DOI: 10.1186/s40662-016-0065-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022]
Abstract
Background To test and compare in a masked fashion the efficacy of using a parasympathomimetic drug (3% carbachol) and an alpha-2 agonist (0.2% brimonidine) in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia. Methods A prospective, double-masked, randomized, controlled clinical trial was conducted. Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. All subjects received 3% carbachol and 0.2% brimonidine in both combined and separate forms, 3% carbachol alone and 0.2% brimonidine (control) alone in their non-dominant eye in a crossover manner with one week washout between tests. The subjects’ pupil sizes and both near and distance visual acuities will be evaluated pre- and post-treatment at 1, 2, 4, and 8 h, by a masked examiner at the same room illumination. Results Statistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received combined 3% carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone (P < 0.0001). Conclusion Based on the data, the combined solution demonstrated greater efficacy than the other solutions that were tested. Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity, with no change in binocular distance vision. Trial registration ACTRN12616001565437. Registered 11 November 2016.
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Affiliation(s)
- Almamoun Abdelkader
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Herbert E Kaufman
- Department of Ophthalmology, Louisiana State University Eye Center, LSU Medical School, New Orleans, LA USA
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43
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Sethi HS, Naik M, Gupta VS. Management of glaucoma in pregnancy: risks or choices, a dilemma? Int J Ophthalmol 2016; 9:1684-1690. [PMID: 27990376 PMCID: PMC5145101 DOI: 10.18240/ijo.2016.11.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022] Open
Abstract
The treatment of glaucoma in and around pregnancy offers the unique challenge of balancing the risk of vision loss to the mother as against the potential harm to the fetus or newborn. Most anti-glaucoma drugs (i.e. beta-blockers, prostaglandin analogues, carbonic anhydrase inhibitors topical and systemic, cholinergics, anticholinesterases, and apraclonidine) are considered category C agents and ophthalmologists are usually limited to treating patients with the category B drugs of brimonidine and dipivefrin. Brimonidine is generally the preferred first-line drug in the first, second and early third trimester. Late in the third trimester, brimonidine should be discontinued because it can induce central nervous system depression in newborns wherein topical carbonic anhydrase inhibitors may be the optimal choice. Glaucoma surgery can be performed with caution in second and third trimester if the patients have a strong indication for the procedure. However, anesthetics, sedative agents, and antimetabolites still have potential risk for the fetus. Argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT) is an alternative treatment that can be performed in all trimesters. Carbonic anhydrase inhibitors and β-blockers are certified by the American Academy of Pediatrics for use during nursing. However, low doses of these medications should be considered when used in the breast feeding period. Optimum treatment for glaucoma in pregnancy must not be withheld so as to prevent any further deterioration in progressive vision loss and quality of life.
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Affiliation(s)
- Harinder Singh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Newdelhi 110029, India
| | - Mayuresh Naik
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Newdelhi 110029, India
| | - Vishnu Swarup Gupta
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Newdelhi 110029, India
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44
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Lopez Sanchez M, Crowston J, Mackey D, Trounce I. Emerging Mitochondrial Therapeutic Targets in Optic Neuropathies. Pharmacol Ther 2016; 165:132-52. [DOI: 10.1016/j.pharmthera.2016.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Indexed: 12/14/2022]
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45
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Sharma S, Trikha S, Perera SA, Aung T. Clinical effectiveness of brinzolamide 1%-brimonidine 0.2% fixed combination for primary open-angle glaucoma and ocular hypertension. Clin Ophthalmol 2015; 9:2201-7. [PMID: 26648686 PMCID: PMC4664487 DOI: 10.2147/opth.s72380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main first-line treatment strategy for glaucoma is to reduce intraocular pressure (IOP) by topical ocular hypotensive medications, but many patients require multiple medications for adequate IOP control. Fixed-combination therapies provide several benefits, including simplified treatment regimens, theoretical improved treatment adherence, elimination of the potential for washout of the first drug by the second, and the reduction in ocular exposure to preservatives. β-Adrenoceptor antagonists (particularly 0.5% timolol) are the most commonly used agents in combination with other classes of drugs as fixed-combination eyedrops, but they are contraindicated in many patients, owing to local allergy or systemic side effects. A fixed-combination preparation without a β-blocker is therefore warranted. This paper reviews the clinical effectiveness of brinzolamide 1% and brimonidine 0.2% fixed combination (BBFC) for use in patients with primary open-angle glaucoma and ocular hypertension. We searched PubMed and the ClinicalTrials.gov registry, and identified three randomized controlled trials comparing BBFC vs its constituents (brimonidine vs brinzolamide), and one comparing BBFC with unfixed brimonidine and brinzolamide. All of the studies demonstrated mean diurnal IOP to be statistically significantly lower in the BBFC group compared with constituent groups and noninferior to that with the concomitant group using two separate bottles. The safety profile of BBFC was consistent with that of its individual components, the most common ocular adverse events being ocular hyperemia, visual disturbances, and ocular allergic reactions. Common systemic adverse effects included altered taste sensation, oral dryness, fatigue, somnolence, and decreased alertness. BBFC seems to be a promising new fixed combination for use in glaucoma patients. However, long-term effects of BBFC on IOP, treatment adherence, and safety need to be determined.
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Affiliation(s)
- Sourabh Sharma
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Sameer Trikha
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Shamira A Perera
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore ; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ibrahim MM, Abd-Elgawad AEH, Soliman OAE, Jablonski MM. Natural Bioadhesive Biodegradable Nanoparticle-Based Topical Ophthalmic Formulations for Management of Glaucoma. Transl Vis Sci Technol 2015; 4:12. [PMID: 26175958 PMCID: PMC4497485 DOI: 10.1167/tvst.4.3.12] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/07/2015] [Indexed: 01/20/2023] Open
Abstract
PURPOSE We prepared and characterized topical ophthalmic formulations containing brimonidine-loaded bioadhesive cationic chitosan or anionic alginate nanoparticles (NPs) for sustained release of brimonidine as once daily regimen for management of glaucoma. METHODS Nanoparticles were prepared using a spontaneous emulsification solvent diffusion method. Different concentrations of polymers, emulsifiers, and NPs stabilizers were used for formulation optimization. Nanoparticles were characterized regarding particle size, zeta potential, morphology, and drug content. Brimonidine-loaded NPs were incorporated into eye drops, a temperature-triggered in situ gelling system, and a preformed gel. They then were characterized regarding their pH, viscosity, uniformity of drug content, in vitro release characteristics, in vitro cytotoxicity, and in vivo intraocular pressure (IOP) lowering effects. RESULTS Characteristics of optimized brimonidine-loaded chitosan and alginate NPs, respectively, are: particle size, 115.67 ± 3.58 and 157.67 ± 5.53 nm; zeta potential, +35.27 ± 3.39 and -37.8 ± 3.77 mV; encapsulation efficiency, 74.34% ± 2.05% and 70.40% ± 2.77%; drug loading, 11.81% ± 0.67% and 13.14% ± 0.90%; and yield, 87.91% ± 5.92% and 76.53% ± 3.32%. Transmission electron microscope (TEM) analyses revealed that NPs have spherical shapes with a dense core and distinct coat. Formulations possessed uniform drug content. Furthermore, pH and viscosity were compatible with the eye. Formulations showed a sustained release without any burst effect with a Higuchi non-Fickian diffusion mechanism. Cytotoxicity studies revealed that all formulations are biocompatible. Importantly, all formulations possessed a sustained IOP lowering effect compared to the marketed brimonidine tartrate eye drops. CONCLUSIONS These formulations provide a great improvement in topical ocular brimonidine delivery. The application of a single drop is sufficient to provide extended IOP reduction, which should improve patient compliance. TRANSLATIONAL RELEVANCE We have developed a novel biocompatible topical delivery system for brimonidine, a first line glaucoma medication. Once daily application should have positive effects on patient compliance and, therefore, preservation of vision.
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Affiliation(s)
- Mohammed Mostafa Ibrahim
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | | | | | - Monica M. Jablonski
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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47
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Greig SL, Deeks ED. Brinzolamide/Brimonidine: A Review of Its Use in Patients with Open-Angle Glaucoma or Ocular Hypertension. Drugs Aging 2015; 32:251-60. [DOI: 10.1007/s40266-015-0250-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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48
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Ciotu IM, Stoian I, Gaman L, Popescu MV, Atanasiu V. Biochemical changes and treatment in glaucoma. J Med Life 2015; 8:28-31. [PMID: 25914734 PMCID: PMC4397515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/17/2014] [Indexed: 11/09/2022] Open
Abstract
Glaucoma is the second cause of blindness worldwide. This disease is a neurodegenerative disorder characterized by high intraocular pressure, loss of retinal ganglion cells (apoptosis). Even though there is much research done in this field, the results have not yet managed to stop the progression of glaucoma or to heal this pathology. Free oxygen radicals play a major role; they are formed in the aqueous humor and in the vitreous and they produce apoptosis of the neurons in the optic nerve head, degradation of the trabecular meshwork cells. The purpose of the article is to help in trying to understand the physiopathology of glaucoma and the efficacy of its treatments.
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Affiliation(s)
- I M Ciotu
- Biochemistry Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - I Stoian
- Biochemistry Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - L Gaman
- Biochemistry Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - M V Popescu
- Department of Ophthalmology, Emergency Hospital Bucharest, Romania
| | - V Atanasiu
- Biochemistry Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Wu JH, Zhang SH, Nickerson JM, Gao FJ, Sun Z, Chen XY, Zhang SJ, Gao F, Chen JY, Luo Y, Wang Y, Sun XH. Cumulative mtDNA damage and mutations contribute to the progressive loss of RGCs in a rat model of glaucoma. Neurobiol Dis 2014; 74:167-179. [PMID: 25478814 DOI: 10.1016/j.nbd.2014.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 10/13/2014] [Accepted: 11/17/2014] [Indexed: 11/25/2022] Open
Abstract
Glaucoma is a chronic neurodegenerative disease characterized by the progressive loss of retinal ganglion cells (RGCs). Mitochondrial DNA (mtDNA) alterations have been documented as a key component of many neurodegenerative disorders. However, whether mtDNA alterations contribute to the progressive loss of RGCs and the mechanism whereby this phenomenon could occur are poorly understood. We investigated mtDNA alterations in RGCs using a rat model of chronic intraocular hypertension and explored the mechanisms underlying progressive RGC loss. We demonstrate that the mtDNA damage and mutations triggered by intraocular pressure (IOP) elevation are initiating, crucial events in a cascade leading to progressive RGC loss. Damage to and mutation of mtDNA, mitochondrial dysfunction, reduced levels of mtDNA repair/replication enzymes, and elevated reactive oxygen species form a positive feedback loop that produces irreversible mtDNA damage and mutation and contributes to progressive RGC loss, which occurs even after a return to normal IOP. Furthermore, we demonstrate that mtDNA damage and mutations increase the vulnerability of RGCs to elevated IOP and glutamate levels, which are among the most common glaucoma insults. This study suggests that therapeutic approaches that target mtDNA maintenance and repair and that promote energy production may prevent the progressive death of RGCs.
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Affiliation(s)
- Ji-Hong Wu
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200032, China
| | - Sheng-Hai Zhang
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200032, China
| | - John M Nickerson
- Ophthalmology Department, Emory University, Atlanta, GA, 30322, USA
| | - Feng-Juan Gao
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | | | - Xin-Ya Chen
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | - Shu-Jie Zhang
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | - Feng Gao
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | - Jun-Yi Chen
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | - Yi Luo
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | - Yan Wang
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
| | - Xing-Huai Sun
- Eye & ENT Hospital, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200032, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Shanghai Medical college, Fudan University, Shanghai 200032, China
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50
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Tsumura T, Yoshikawa K, Kimura T, Suzumura H, Kawashima M, Nanno M, Ishijima K, Takeda R. The efficacy and safety of add-on 0.1% brimonidine tartrate preserved with sodium chlorite in on-treatment Japanese normal-tension glaucoma patients. Clin Ophthalmol 2014; 8:1681-7. [PMID: 25214761 PMCID: PMC4159391 DOI: 10.2147/opth.s67366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the efficacy and safety of newly formulated brimonidine (0.1% brimonidine tartrate preserved with sodium chlorite: brimonidine) as add-on therapy in on-treatment Japanese normal-tension glaucoma (NTG) patients. Methods Brimonidine was added to on-treatment NTG patients with intraocular pressures (IOP) of between 13 mmHg and 16 mmHg after three consecutive IOP measurements. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 4, 8, and 12 weeks after brimonidine instillation. Results Though 75 of 83 patients (31 males and 52 females; mean age: 63.4±11.6 years) completed the study, six patients discontinued because of side effects and two patients withdrew. The mean IOP after brimonidine addition at week 4 (12.6±1.8 mmHg, P<0.001), week 8 (12.4±1.7 mmHg, P<0.001), and week 12 (12.6±1.8 mmHg, P<0.001) was significantly decreased compared with that before the addition of brimonidine (13.9±1.2 mmHg). No significant changes in superficial punctate keratitis or conjunctival hyperemia scores were observed throughout the study. Dizziness, sleepiness, eye pain, and itching (mild to moderate) were noted in five, four, three, and three patients, respectively. Conclusions The addition of newly formulated brimonidine to on-treatment Japanese NTG patients with IOP of 13–16 mmHg further reduced the levels of IOP with minimal side effects and adverse events.
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Affiliation(s)
| | | | | | | | | | - Mami Nanno
- Kagurazaka Minamino Eye Clinic, Tokyo, Japan
| | | | - Ryuji Takeda
- Department of Biological Chemistry, Faculty of Agriculture, Kinki University, Nara, Japan
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