The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension

Purpose:

To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension.

Methods:

A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability.

Results:

Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001).

Conclusion:

Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

Reactive oxygen species promote localized DNA damage in glaucoma-iris tissues of elderly patients vulnerable to diabetic injury

Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM). Glaucoma is more often present in the elderly. Important prognostic factors of glaucoma may be oxidative stress resulting from the toxic effects of glucose, and diabetes-associated vascular complications. Fifty-five patients and control subjects aged 71.0+/-10.1 yrs were enrolled in this study. Iris-tissue samples from DM type-2 patients, primary open-angle glaucoma-positive and -negative DM patients, and from healthy subjects were examined by use of the alkaline comet assay. We measured the DNA damage as numbers of strand breaks (SBs), oxidized purines as glycosyl-formamido-glycosylase (Fpg)-susceptible sites, and oxidized pyrimidines as endonuclease III (Nth)-susceptible sites. It was found that the level of oxidative damage in iris tissue was statistically higher in DM and glaucoma patients than that in healthy controls (oxidized purines: 38.0% and 34.7% vs 15.4%; oxidized pyrimidines: 43.3% and 39.0% vs 23.3%; P<0.001). Interestingly, we found strongly elevated levels of oxidized purines and pyrimidines in glaucomatous patients who also had DM, in comparison with healthy controls (oxidized purines: 55.7% vs 15.4%; oxidized pyrimidines: 61.8% vs 23.3%; P<0.001). Our observations suggest that the generation of reactive oxygen species may promote localized DNA damage in glaucoma-iris tissues of elderly patients vulnerable to diabetic injury.

[Current trends in glaucoma surgery]

The aim of this paper is presentation of new methods of laser and surgery treatment for glaucomatous patients, mainly no perforating operations: deep sclerectomy and viscocanalostomy and new modifications of known very well trabeculectomy.

[Intraoperative use of mitomycin C in glaucoma filtering surgery--indications, results and complications]

PURPOSE

The influence of MMC on the cornea, especially on the corneal endothelium and thickness, were checked.

MATERIAL AND METHODS

In one-year-follow up patients after trabeculectomies with or without topical use of mitomycin C were controlled for early and late complications, and levels of intraocular pressure. The progression of glaucomatous neuropathy was obtained by comparing the cup to disc ratio and some parameters of static visual field testing (MD, PSD) progressions, after one year observations.

RESULTS

Intraocular pressures were stable and at lower levels in the group of patients after primary trabeculectomies (group C) than in the control group (group A). We obtained good, statistically significant decrease in IOP in all groups during one year follow-up.

CONCLUSIONS

We didn't find any toxic effects of MMC, given on a sponge during trabeculectomy, on the morphology and physiology of the corneal endothelium and the central corneal thickness. We also didn't note any differences between groups in the progression of glaucomatous optic nerve damaged and cataract after 1 year follow up.

[The reasons for the false positive diagnosis of glaucoma]

Glaucoma, if left untreated, leads to blindness, but if detected early, disease progression can be stopped or slowed with drugs or surgical treatment. The development of existing and new diagnostic methods has allowed substantial improvement in the clinical detection of possible glaucoma. But in some cases false positive diagnoses can be undertaken. In this paper we discussed reasons for the wrong evaluation of factors suggesting the diagnosis of glaucoma, with special interest for mistakes in applanation tonometry results caused by thick cornea.

[Pharmacological methods improving the effectiveness of filtering procedures]

Different antiproliferative agents: 5-fluorouracil, mitomycin C, growth factors antibodies, cyclosporine A, used as an adjunct to improve the success rate in filtering surgery and most common complications associated with them, are described.

[The analysis of refractive error in children and adolescents from 6-15 years of age based on 1000 examinations in two major Polish regions]

PURPOSE

The aim of this study is to present the results of screening examinations of refractive errors, taken on 1002 of school children ranging from 6 to 15 years of age.

MATERIAL AND METHODS

As the result of Internet screening visual acuity and color perception tests named "I can see..." in 10,021 children from randomly chosen schools in Poland in the year 2002, the group of 1002 children was chosen. In this group, the subjective and objective refractive error examination was taken as well as the visual acuity test, color perception with the use of Ishihara tables and full ophthalmologic examination.

RESULTS

Average visual acuity was RE: 0.72 (SD +/- 0.31) and LE: 0.72 (SD +/- 0.31). The prevalence of emmetropia was 34%. In the examined group myopia in 17%, hyperopia in 20%, astigmatism in 5.5% of children was found, and in 24.5% of patients complex errors occur such as myopic and hyperopic astigmatism.

[Diode laser cyclophotocoagulation--effect on intraocular pressure in comparison with cyclodiathermy under the scleral flap]

The aim of this study was to retrospectively analyze intraocular pressure and state of the eyeball in patients treated with diode laser, and to compare the outcomes with a group of patients after cyclodiahtermy under the scleral flap. We analyzed: visual acuity, IOP, percentage of lowering the IOP from the beginning, subjective patients' feelings of pain and complications.

CONCLUSIONS

TSCPC is safe for patients and may be repeated, if needed. Laser cyclodestruction gives new possibilities in noninvasive IOP lowering with less complications than cyclodiahtermy, without changes in patient's visual functions.

[Timolol 0.5%/dorzolamide 2% fixed combination versus timolol 0.5%/pilocarpine 2% fixed combination in primary open-angle glaucoma or ocular hypertensive patients]

PURPOSE

To establish the efficacy and safety of timolol 0.5%/dorzolamide 2% fixed combination versus timolol 0.5%/pilocarpine 2% fixed combination, each given twice daily, in primary open-angle glaucoma and ocular hypertensive patients.

MATERIAL AND METHODS

In this prospective, multicenter, double-masked trial, 37 patients were treated twice daily with timolol for 4 weeks. Then, they were randomized to one of the treatment medications for 6 weeks, after which they were treated with timolol again for 2 weeks before placed on the opposite treatment medication for 6 weeks.

RESULTS

A total of 36 patients completed the trial. The mean baseline intraocular pressure (IOP) was 22.3 +/- 3.7 mmHg. Following 6 weeks of treatment, the mean decrease of IOP was 18.0 +/- 2.2 mmHg for timolol/dorzolamide combination and 17.4 +/- 2.0 for timolol/pilocarpine combination. The mean diurnal curve IOP was 18.1 +/- 2.2 mmHg for timolol/dorzolamide group and 16.7 +/- 1.9 mmHg for timolol/pilocarpine group. These differences were statistically significant. Statistically more patients reported ocular pain and diminished vision during use of the timolol/pilocarpine combination.

CONCLUSIONS

This study suggest that timolol 0.5%/pilocarpine 2% fixed combination can provide at least similar efficacious reduction in IOP as timolol 0.5 %/dorzolamide 2% fixed combination in patients with primary open-angle glaucoma and ocular hypertension.