The Efficacy and Safety of Timolol Maleate versus Brinzolamide Each Given Twice Daily Added to Travoprost in Patients with Ocular Hypertension or Primary Open-Angle Glaucoma

PURPOSE

To compare the efficacy and safety of timolol maleate 0.5% versus brinzolamide 1% when added to travoprost 0.004% in patients with ocular hypertension or primary open-angle glaucoma.

DESIGN

A prospective, double-masked, randomized, active-controlled, parallel comparison.

METHODS

Qualified patients at Visit 1 were placed on travoprost dosed every evening for 4 weeks and then were randomized at baseline (Visit 2) to the addition of timolol maleate or brinzolamide each given twice daily. Patients returned to clinic at Week 4 (Visit 3) for a safety visit and Week 12 (Visit 4) for an efficacy visit. At Visits 2 and 4 the intraocular pressure (IOP) was measured at 08:00, 12:00, and 16:00 hours.

RESULTS

Ninety-seven patients on brinzolamide had a baseline diurnal IOP of 21.5+/-2.2 mmHg and 95 on timolol maleate had 21.3+/-2.5 mmHg, each added to travoprost. The diurnal mean IOP at Week 12 was 18.1+/-2.7 mmHg for brinzolamide and 18.1+/-3.0 mmHg for timolol maleate (p=0.96). There was no statistical difference found between treatment groups in the absolute level of pressure, or in the reduction in IOP from baseline, at each time point or for the diurnal curve (p>0.05). There was no significant difference for any adverse event between groups (p>0.05), with the most common side effect being conjunctival hyperemia in 15/97 (16%) brinzolamide and 6/95 (6%) timolol treated patients (p=0.06).

CONCLUSIONS

This study showed that brinzolamide provides similar safety and efficacy compared to timolol maleate when added to travoprost.

Application of hyaluronidase after unsuccessful trabeculectomy

Trabeculectomy fails to control the intraocular pressure (IOP) adequately in some cases. The effect of the enzyme hyaluronidase--300 IU Hylase 'Dessau' (commercially available ampuls)--applied in subconjunctival injection in the region above the filtering bleb in case of postoperative rise in IOP following trabeculectomy was studied. Successful IOP control was defined as an IOP below or equal to 20 mmHg with or without medication. The investigation concerned 62 eyes (46 patients) with primary open angle glaucoma (POAG) divided in three groups: Group I--39 eyes with early postoperative rise in IOP (7-20 days postoperatively), group II--15 eyes with late rise in IOP (6 months-1 year after surgery), group III--8 eyes with one previous unsuccessful trabeculectomy. In all examined cases IOP was over 20 mmHg (mean IOP was 26.23 +/- 3.46 mmHg) postoperatively before application of hyaluronidase. The follow up period ranged from 6 to 34 months. We found statistically significant lowering in IOP in group I (p < 0.01), group II (p < 0.05) and group III (p < 0.05). Complications related to the use of hyaluronidase were not observed up to now. Postoperative subconjunctival injection of hyaluronidase appears to improve the prognosis following unsuccessful trabeculectomy in POAG patients.

Clinical application of acupuncture in ophthalmology

Acupuncture of 50 persons suffering from myopia, glaucoma, retinitis pigmentosa (degeneratio retinae pigmentosa), optic nerve atrophy, aged 5 to 71 was carried out. One to three courses were conducted, each consisting of 10-15 seances. All the patients were treated with acupuncture at these bilateral points: Extra 2, BL 2, GB 14, 4, TH 17, St 1. In cases of optic nerve atrophy, the authors also needled points T 15 and BL 60. By indirect electroacupuncture (by Chinese apparatus WQ 10), points BL 2 and St 1 were also stimulated. In all the patients, a subjective improvement of visual acuity was observed. In children with myopia, relative accommodation was enlarged. In patients with retinitis pigmentosa, an enlargement of the borders of the visual field, investigated by perimetry and isopter perimetry was observed, as well as light difference sensitivity established by static perimetry. Electrooculograms showed a reduction of the basic values and of Arden's ratio. 3 of the patients with glaucoma had a decrease in pressure of the eye, measured by Maklakow's tonometer.