Efficacy and Safety of Brinzolamide as Add-On to Prostaglandin Analogues or β-Blocker for Glaucoma and Ocular Hypertension: A Systematic Review and Meta-Analysis

Future research perspective on the interfacial physics of non-invasive glaucoma testing in pathogen transmission from the eyes

Non-contact tonometry (NCT) is a non-invasive ophthalmologic technique to measure intraocular pressure (IOP) using an air puff for routine glaucoma testing. Although IOP measurement using NCT has been perfected over many years, various phenomenological aspects of interfacial physics, fluid structure interaction, waves on corneal surface, and pathogen transmission routes to name a few are inherently unexplored. Research investigating the interdisciplinary physics of the ocular biointerface and of the NCT procedure is sparse and hence remains to be explored in sufficient depth. In this perspective piece, we introduce NCT and propose future research prospects that can be undertaken for a better understanding of the various hydrodynamic processes that occur during NCT from a pathogen transmission viewpoint. In particular, the research directions include the characterization and measurement of the incoming air puff, understanding the complex fluid-solid interactions occurring between the air puff and the human eye for measuring IOP, investigating the various waves that form and travel; tear film breakup and subsequent droplet formation mechanisms at various spatiotemporal length scales. Further, from an ocular disease transmission perspective, the disintegration of the tear film into droplets and aerosols poses a potential pathogen transmission route during NCT for pathogens residing in nasolacrimal and nasopharynx pathways. Adequate precautions by opthalmologist and medical practioners are therefore necessary to conduct the IOP measurements in a clinically safer way to prevent the risk associated with pathogen transmission from ocular diseases like conjunctivitis, keratitis, and COVID-19 during the NCT procedure.

Efficacy of brinzolamide in the initial management of acute primary angle closure: A randomized controlled trial

WHAT IS KNOWN AND OBJECTIVE?: Since comprehensive medication has an important role in the initial management of patients presenting with acute primary angle closure, it is necessary to analyse the effect of each drug on alleviating the disease. This study aimed to evaluate the intraocular pressure-lowering effect of brinzolamide in the sequential treatment of acute primary angle closure. METHODS: In this randomized double-blind controlled trial, a total of 131 eyes of 125 consecutive patients who presented with their first episode of acute primary angle closure were recruited and received sequential treatment. In this treatment, in the absence of remission, anti-glaucoma drugs, anterior chamber paracentesis and argon laser peripheral iridoplasty are used sequentially. The patients were randomized to receive either brinzolamide or normal saline as a placebo. The primary outcomes were decreased intraocular pressure, success rate and treatment time. RESULTS AND DISCUSSION: There was no statistically significant difference in the decreased level of intraocular pressure between the two groups at 6, 12 or 24 h after the start of treatment (p-values were 0.526, 0.206 and 0.130 respectively). The success rate and treatment time were also not significantly different between the groups. No adverse side effects of brinzolamide were observed in the brinzolamide group. WHAT IS NEW AND CONCLUSION?: In patients with a first episode of acute primary angle closure, brinzolamide did not improve the effectiveness of the sequential treatment for reducing the intraocular pressure levels or shortening the treatment time within the first 24 h of initiating therapy.

Ocular microemulsion of brinzolamide: Formulation, physicochemical characterization, and in vitro irritation studies based on EpiOcular™ eye irritation assay

In recent years, the hydrophobic active substances have led researchers to develop new formulations to enhance bioavailability and dissolution rate; brinzolamide, a lipophilic drug belongs to carbonic anhydrase inhibitors, which cause reduction of intraocular pressure in patients suffering from glaucoma. Currently, the marketed product of brinzolamide is in the form of ocular drops; nonetheless, the conventional drops provide decreased therapeutic efficacy owing to their low bioavailability and pulsed drug release. Thus, the development of novel ocular formulations such as topical microemulsions is of high importance. In this work, the preparation of new microemulsions containing brinzolamide (0.2, 0.5 and 1% w/w) and comprised from isopropyl myristate, tween 80 and span 20 and Cremophor EL was performed. The obtained microemulsions were further characterized for their physicochemical properties. In addition, Fourier Transformed-Infrared spectroscopy was used touate the compatibility of active ingredients and components. In vitro release studies along with kinetic modeling were performed using the dialysis membrane method in simulated tear fluid. Bioadhesion studies were performed using Texture analysis. Finally, in vitro ocular irritation based on EpiOcular™ Eye Irritation Test and cytocompatibility studies was performed to examine any possible harm on ocular cells and predict in vivo safety profile.

Co-delivery of brinzolamide and miRNA-124 by biodegradable nanoparticles as a strategy for glaucoma therapy

Co-delivery nanoparticles with characteristics of intracellular precision release drug have been generally accepted as an effective therapeutic strategy for eye diseases. In this study, we designed a new co-delivery system (miRNA/NP-BRZ) as a lasting therapeutic approach to prevent the neuro-destructive after the long-term treatment of glaucoma. Neuroprotective and intraocular pressure (IOP) response were assessed in in vivo and in vitro models of glaucoma. At the meaning time, we describe the preparation of miRNA/NP-BRZ, drug release characteristics, intraocular tracing, pharmacokinetic and pharmacodynamics study and toxicity test. We found that miRNA/NP-BRZ could remarkably decrease IOP and significantly prevent retinal ganglion cell (RGC) damages. The new formula of miRNA-124 encapsulated in PEG-PSA-BRZ nanoparticles exhibits high encapsulation efficiency (EE), drug-loading capacity (DC), and stable controlled-release efficacy (EC). Moreover, we also verified that the miRNA/NP-BRZ system is significantly neuroprotective and nontoxic as well as lowering IOP. This study shows our co-delivery drug system would have a wide potential on social and economic benefits for glaucoma.