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Chirapapaisan C, Eiamsamarng A, Chirapapaisan N, Raksong W, Sakiyalak D, Koodkaew S, Subunnasenee A. Effects of intraocular pressure change on intraocular lens power calculation in primary open-angle glaucoma and ocular hypertension. PLoS One 2024; 19:e0304169. [PMID: 38857282 PMCID: PMC11164340 DOI: 10.1371/journal.pone.0304169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
This study aimed to assess the effect of intraocular pressure (IOP) changes on biometry and intraocular lens (IOL) power calculation in patients diagnosed with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). This prospective non-randomized cohort study enrolled patients with diagnosed POAG and OHT, presenting with IOP levels exceeding 25 mmHg. Thai Clinical Trials Registry number was TCTR20180912007. Optical biometry, encompassing measurements such as corneal thickness (CCT), keratometry, anterior chamber depth (ACD), and axial length, was conducted before and after IOP reduction. The IOL power was also determined using the SRK/T formula. The main outcomes measured were alterations in biometry and IOL power. Correlations between IOP, biometric parameters, and IOL power were analyzed. In total, 28 eyes were included in the study, with a mean patient age of 65.71±10.2 years. After IOP reduction, all biometric parameters, except CCT and ACD, exhibited a decrease without reaching statistical significance (all p>0.05). Meanwhile, IOL power showed a slight increase of 0.214±0.42 diopters (P = 0.035). The correlation between IOP and biometric parameters was found to be weak. However, there was a moderate correlation between IOP and IOL power (r2 = 0.267). Notably, IOL power tended to increase by more than 0.5 diopters when IOP decreased by more than 10 mmHg (p < 0.001). In conclusion, changes in IOP among patients with POAG and OHT do not significantly impact biometry and IOL power calculations. Nonetheless, it may be prudent to consider a slight adjustment in IOL power when IOP is lowered by more than 10 mmHg.
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Affiliation(s)
- Chareenun Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akarawit Eiamsamarng
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Niphon Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wara Raksong
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Darin Sakiyalak
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunisa Koodkaew
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Audcharawadee Subunnasenee
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Bastelica P, Renard JP, Aptel F, Labbé A, Schweitzer C, Poli M, Rousseau A, Lamirel C, Baudouin C. The PRAMOS Study: PRostaglandin Analogues Monotherapy-Awareness Survey on Ocular Surface Involvement. Ophthalmol Ther 2024; 13:1537-1551. [PMID: 38587775 PMCID: PMC11109058 DOI: 10.1007/s40123-024-00936-9] [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: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION Even though the local tolerance of prostaglandin (PG) analogues has improved drastically since the introduction of preservative-free (PF) eye drops, prescription patterns still vary widely among practitioners and between countries and could have an impact on the ocular surface of treated patients and, in consequence, their adherence. The aim of this study is to explore the prescribing patterns of PG analogues monotherapy in France and to evaluate their impact on ocular surface status. METHODS This was a national multicenter cross-sectional observational study that was conducted by 18 glaucoma experts in France. Patients over 18 years of age and receiving monotherapy with topical PG analogues for the treatment of ocular hypertension and/or glaucoma, with no history of prior glaucoma surgery, were consecutively selected from the glaucoma outpatient clinics of participating physicians and underwent an ocular surface examination. RESULTS A total of 344 eyes of 344 patients were enrolled between November 2022 and November 2023. Prescribed PG monotherapy was PF in 271 (78.7%) patients. Clinical history and ocular surface evaluation indicated that 79.4% of the study population (n = 273) presented with at least one symptom or clinical sign of dry eye and that three patients out of four had an unstable tear film. Subgroup analysis comparing preserved and PF PG analogues showed a higher prevalence of conjunctival hyperemia and corneal staining in the preserved group. Multivariate analysis identified conjunctival hyperemia as consistently associated with preservative use (odds ratio = 7.654; p = 0.003 for moderate conjunctival hyperemia). CONCLUSIONS This study highlights the growing trend toward PF PG analogue prescriptions by specialists in France. However, ocular surface issues remain prevalent, impacting patient adherence and treatment efficacy. Comprehensive ocular surface examinations are crucial in glaucoma management to enhance long-term tolerance, compliance, and overall treatment success.
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Affiliation(s)
- Paul Bastelica
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 1423, IHU FOReSIGHT, 75012, Paris, France.
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.
| | - Jean Paul Renard
- Department of Ophthalmology, Hôpital d'Instruction des Armées Bégin, 94160, Saint-Mandé, France
- Académie du Service de Santé des Armées du Val de Grâce, 75005, Paris, France
| | - Florent Aptel
- Cabinet d'ophtalmologie-Visis, 66000, Perpignan, France
- Polyclinique Médipôle Saint-Roch-Elsan, 66330, Cabestany, France
| | - Antoine Labbé
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 1423, IHU FOReSIGHT, 75012, Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles St Quentin, Paris Saclay University, 91190, Gif-sur-Yvette, France
| | - Cédric Schweitzer
- Department of Ophthalmology, CHU Bordeaux, Univ. Bordeaux, ISPED, INSERM, U1219-Bordeaux Population Health Research Centre, 33000, Bordeaux, France
| | - Muriel Poli
- Centre Ophtalmologique Pôle Vision, Clinique du Val d'Ouest, 69130, Ecully, France
- Clinique de la Sauvegarde-Ramsay Santé, 69009, Lyon, France
| | - Antoine Rousseau
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Bicêtre Hospital, AP-HP, Paris-Saclay University, 91190, Gif-Sur-Yvette, France
| | - Cédric Lamirel
- Department of Ophthalmology, Hôpital Fondation Adolphe de Rothschild, 75019, Paris, France
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 1423, IHU FOReSIGHT, 75012, Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles St Quentin, Paris Saclay University, 91190, Gif-sur-Yvette, France
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Anderson SG, Meyer D, Decloedt EH. The Ocular Penetration and Intraocular Pressure Lowering Effect of Topical Acetaminophen in the New Zealand White Rabbit. J Ocul Pharmacol Ther 2024. [PMID: 38800944 DOI: 10.1089/jop.2024.0020] [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: 05/29/2024] Open
Abstract
Purpose: Emerging data suggest that acetaminophen lowers intraocular pressure (IOP) and has the potential to be repurposed as pharmacotherapy to treat open-angle glaucoma. However, pharmacokinetic data are lacking. This study aims to describe the pharmacokinetics of topical acetaminophen and its metabolite [N-arachidonoylaminophenol (AM404)] when administered individually and in combination, and to determine its effect on IOP in the ocular normotensive adult New Zealand White Rabbit (NZWR). Methods: A randomized control trial was conducted using topical 1% acetaminophen and 1% AM404. The study was divided into two sub-studies using both paired-eye and two-eye designs. Results: The mean [95% confidence interval of the mean (95% CI)] concentration of acetaminophen detected in the aqueous humor (AH) was 4.09 ppm (3.18-5.00) at 2 h and 0.92 ppm (0.60-1.24) at 4 h after an immediate dose of topical acetaminophen. The integral IOP, defined as the integral of IOP change from baseline over time, was -5.1 mmHg⋅h (95% CI: -10 to 0.41) for control,-7.5 mmHg⋅h (95% CI: -14 to -1.1) for half-hourly acetaminophen, and -4.4 mmHg⋅h (95% CI: -14 to 5.5) for hourly acetaminophen over a 4-h period. When comparing topical acetaminophen with AM404 dosed half-hourly over a 4-h period, the integral IOP was -2.3 mmHg⋅h (95% CI: -5.9 to 1.3) for control,-2.0 mmHg⋅h (95% CI: -5.6 to 1.7) for AM404, -1.7 mmHg⋅h (95% CI: -4.5 to 1.2) for acetaminophen, and -3.2 mmHg⋅h (95% CI: -5.4 to -0.96) for acetaminophen/AM404 combined. Conclusions: Acetaminophen, but not its metabolite AM404, penetrated the multilayered cornea via passive diffusion in a dose-dependent fashion. There was a nonsignificant tendency to cause a lowering of IOP over the 4-h dosing period with higher AH concentrations of acetaminophen. Topical AM404 did not show a significant IOP-lowering effect.
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Affiliation(s)
- Sean G Anderson
- Division of Pharmacology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - David Meyer
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Eric H Decloedt
- Division of Pharmacology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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Ramesh PV, Morya AK, Azad A, Pannerselvam P, Devadas AK, Gopalakrishnan ST, Ramesh SV, Aradhya AK. Navigating the intersection of psychiatry and ophthalmology: A comprehensive review of depression and anxiety management in glaucoma patients. World J Psychiatry 2024; 14:362-369. [PMID: 38617979 PMCID: PMC11008383 DOI: 10.5498/wjp.v14.i3.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Glaucoma, a prevalent and debilitating eye disease, has long been associated with vision impairment and blindness. However, recent research has shed light on the often-underestimated psychological dimensions of this condition. Anxiety and depression, two pervasive psychiatric comorbidities, have been increasingly recognized among glaucoma patients. This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology, in the context of managing depression and anxiety in glaucoma patients. By meticulously examining peer-reviewed literature, we synthesize current knowledge on the prevalence, risk factors, and underlying mechanisms of anxiety and depression in glaucoma. The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders. Factors such as progressive vision loss, complex medication regimens, and the fear of further visual deterioration contribute to their vulnerability. Moreover, we delve into the bidirectional relationship between glaucoma and mood disorders, shedding light on the complex interplay between ocular and emotional health. Our review investigates the implications of anxiety and depression on glaucoma management, including their potential impact on treatment adherence, disease progression, and overall quality of life. We also explore the neurobiological pathways linking glaucoma and mood disorders, providing a foundation for future research and potential therapeutic interventions. In conclusion, recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care. This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma. By addressing anxiety and depression in glaucoma care, healthcare providers can enhance the overall quality of life for these patients, ultimately leading to improved outcomes and a brighter future for those affected by this condition. This review offers valuable insight for healthcare practitioners and researchers, providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.
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Affiliation(s)
- Prasanna Venkatesh Ramesh
- Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Ashik Azad
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Pavithra Pannerselvam
- Junior Resident, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Aji Kunnath Devadas
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | | | - Shruthy Vaishali Ramesh
- Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Ajanya K Aradhya
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
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Bugara K, Pacwa A, Smedowski A. Molecular pathways in experimental glaucoma models. Front Neurosci 2024; 18:1363170. [PMID: 38562304 PMCID: PMC10982327 DOI: 10.3389/fnins.2024.1363170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Glaucoma is a complex and progressive disease that primarily affects the optic nerve axons, leading to irreversible vision loss. Although the exact molecular mechanisms underlying glaucoma pathogenesis are not fully understood, it is believed that except increased intraocular pressure, a combination of genetic and environmental factors play a role in the development of the disease. Animal models have been widely used in the study of glaucoma, allowing researchers to better understand the underlying mechanisms of the disease and test potential treatments. Several molecular pathways have been implicated in the pathogenesis of glaucoma, including oxidative stress, inflammation, and excitotoxic-induced neurodegeneration. This review summarizes the most important knowledge about molecular mechanisms involved in the glaucoma development. Although much research has been done to better understand the molecular mechanisms underlying this disease, there is still much to be learned to develop effective treatments and prevent vision loss in those affected by glaucoma.
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Affiliation(s)
- Klaudia Bugara
- Department of Physiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Pacwa
- Department of Physiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- GlaucoTech Co., Katowice, Poland
| | - Adrian Smedowski
- GlaucoTech Co., Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- Department of Ophthalmology, Professor K. Gibinski University Clinical Center, Medical University of Silesia, Katowice, Poland
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Rojo-Arnao M, Martinez-de-la-Casa JM, Albis-Donado O, Yañez-Castro G, Maroto-Cejudo R, Téllez J, Menoyo-Calatayud R. Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting. Indian J Ophthalmol 2024; 72:417-426. [PMID: 38153975 PMCID: PMC11001232 DOI: 10.4103/ijo.ijo_1502_23] [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] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. METHODS We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. RESULTS Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. CONCLUSION The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.
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Affiliation(s)
| | - José María Martinez-de-la-Casa
- Department of Ophthalmology and ORL, Faculty of Medicine, Ophthalmology Unit, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clinico San-Carlos (IdISSC), Madrid, Spain
- Department of Immunology, Ophthalmology and ORL, School of Medicine, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Oscar Albis-Donado
- Glaucoma Specialist, Private Practice, Visual Sense, Mexico City, Mexico
| | | | | | - Jesús Téllez
- Department of Ophthalmology, Hospital de la Santa Creu i de Sant Pau, Autonoma University of Barcelona, Barcelona, Spain
- Departament of Ophthalmology, Grupo Admiravisión, Barcelona, Spain
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7
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Larrosa JM, Martínez-de-la-Casa JM, Giménez Gómez R, Goñi FJ, Milla E, Pazos M, Perucho Martínez S, Urcola Carrera JA. XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:98-108. [PMID: 38216051 DOI: 10.1016/j.oftale.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/29/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND AND OBJECTIVE Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. METHODS A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. RESULTS Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. CONCLUSIONS This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.
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Affiliation(s)
- J M Larrosa
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - J M Martínez-de-la-Casa
- Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
| | | | - F J Goñi
- Departamento de Oftalmología, Hospital de Mollet del Vallès, Mollet del Vallès, Barcelona, Spain
| | - E Milla
- Unidad de Glaucoma, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Pazos
- Unidad de Glaucoma, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - S Perucho Martínez
- Hospital de Fuenlabrada, Madrid, Spain; Facultad de Medicina, Universidad Rey Juan Carlos, Madrid, Spain
| | - J A Urcola Carrera
- Servicio de Oftalmología, Hospital Universitario Araba, Vitoria-Gasteiz, Spain; Departamento de Dermatología, Oftalmología y Otorrinolaringología, Universidad del País Vasco, Leioa, Spain
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Kim TH, Kwon YH, Kim MJ, Jin SW. Longitudinal Change of Cup to Disc Ratio in Premature Infants with Enlarged Cup to Disc Ratio and Normal Intraocular Pressure. Semin Ophthalmol 2024; 39:165-171. [PMID: 37800727 DOI: 10.1080/08820538.2023.2264381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the longitudinal change of cup to disc ratio (CDR) in premature infants with enlarged CDR and normal intraocular pressure (IOP). METHODS This retrospective, observational study included 283 eyes of 283 premature infants at single center. Infants were divided into enlarged CDR and control groups. Data on demographics, gestational age (GA), birth weight (BW), vertical cup to disc ratio (vCDR), IOP, and corneal diameter were analyzed. RESULTS Of the 283 patients, 38 (13.4%) and 245 (86.6%) were in the enlarged CDR and control groups, respectively. In the enlarged CDR group, the vCDR and baseline IOP was 0.63 ± 0.12 and 12.7 ± 2.2 mmHg, respectively. In the control group, the vCDR and baseline IOP was 0.18 ± 0.05 and 10.9 ± 1.7 mmHg, respectively. The IOP at a GA of 40 weeks and at 1 and 2 years of age were significantly lower than that at baseline. The differences in vCDR between baseline and each follow-up visit were not significant. vCDR was negatively correlated with GA and BW; however, these correlations were not significant. CONCLUSIONS The vCDR did not significantly change up to age of 2 years of age in premature infants with enlarged CDR and normal IOP. However, close follow-up is needed until other reliable glaucoma examinations, such as optical coherence tomography and visual fields, can be possible.
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Affiliation(s)
- Tae Hwan Kim
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Yoon Hyung Kwon
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Myo Jing Kim
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sang Wook Jin
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Republic of Korea
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9
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Lai C, Chuang LH, Lai CC, Liu CF, Yang JW, Chen HSL. Longitudinal changes in optical coherence tomography angiography characteristics in normal-tension glaucoma with or without high myopia. Acta Ophthalmol 2024. [PMID: 38279584 DOI: 10.1111/aos.16644] [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: 07/05/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To evaluate the structural, microvascular, and functional progression of normal tension glaucoma (NTG) with or without high myopia by examining longitudinal changes in optical coherence tomography angiography (OCTA) and visual field (VF) parameters. METHODS We evaluated 61 NTG eyes and classified 25 of the eyes with axial lengths (ALs) of ≥26 mm as highly myopic. We assessed the rate of change in OCTA parameters, namely radial peripapillary capillary (RPC) vessel density (VD), parafovea VD, deep parafovea VD, retinal nerve fibre layer (RNFL) thickness, and ganglion cell complex thickness. We evaluated the correlation of the rate of change in OCTA parameters with VF loss and AL. RESULTS Among the 61 NTG eyes, rates of loss of RPC VD, parafovea VD, deep parafovea VD, and RNFL thickness were significantly different from zero despite the nonsignificant rate of change in VF mean deviation (MD). Changes in these OCTA parameters did not differ significantly in highly myopic NTG eyes. The rate of change in VF MD was significantly correlated with the rate of change in parafovea VD in highly myopic and non-highly myopic NTG eyes. In highly myopic NTG eyes, AL was negatively correlated with the rates of loss of RNFL thickness, VF MD, and VF PSD. CONCLUSION NTG eyes with a relatively stable VF exhibited loss of VD and RNFL thickness. VF progression in NTG was correlated with decreasing parafovea VD, indicating a structure-function correlation. Greater AL may indicate faster VF loss and RNFL thinning in highly myopic NTG eyes.
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Affiliation(s)
- Chin Lai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Fu Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ju-Wen Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Henry S L Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
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10
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Ayala M. Former smoking as a risk factor for visual field progression in exfoliation glaucoma patients in Sweden. Eur J Ophthalmol 2024:11206721241226990. [PMID: 38233361 DOI: 10.1177/11206721241226990] [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: 01/19/2024]
Abstract
PURPOSE The present study aimed to identify whether former smoking was a risk factor for visual field progression in exfoliation glaucoma patients. METHODS Prospective nonrandomised cohort study. The study included patients diagnosed with exfoliation glaucoma. All included patients were followed for three years (± three months) with reliable visual fields. At least five reliable visual fields needed to be included in the study. Exfoliation glaucoma was defined using the European Glaucoma Society Guidelines. The visual fields were tested using the 24-2 test strategy of the Humphrey Field Analyzer. Smoking was assessed through questionnaires. Outcomes: Visual field progression. Three different approaches were used: difference in mean deviation (MD), rate of progression (ROP), and guided progression analysis (GPA). RESULTS In total, n = 113 patients were included; among them, n = 57 were smokers. Smoking was a significant predictor for visual field progression in the three models (MD/ROP/GPA) studied (p = 0.01/p = 0.001/p ≤ 0.001), even adjusting for intraocular pressure (IOP). Other predictors were included in the MD model: IOP at diagnosis (p = 0.04) and selective laser trabeculoplasty (SLT) treatment (p = 0.01). Other predictors were in the ROP model: Visual field index (p = 0.005), number of medications (p = 0.001) and SLT treatment (p = 0.001). The number of medications was another predictor in the GPA model (p = 0.002). CONCLUSIONS Former smoking induced visual field deterioration in all models studied. Smoking status should be considered when establishing the glaucoma diagnosis. Increased glaucoma care should be provided to former smokers to slow the progression of the disease.
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Affiliation(s)
- Marcelo Ayala
- Eye Department, Skaraborg Hospital, Sahlgrenska Academy, Gothenburg University & Karolinska Institute, Skövde, Sweden
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11
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Bott D, Subramanian A, Edgar D, Lawrenson JG, Campbell P. Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework. Ophthalmic Physiol Opt 2024; 44:96-114. [PMID: 37985237 DOI: 10.1111/opo.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Nonadherence to medication reduces treatment effectiveness, and in chronic conditions it can significantly reduce health outcomes. In glaucoma, suboptimal adherence can lead to sight loss, which places a greater financial burden on society and reduces patients' quality of life. Interventions to improve adherence have so far had limited success and lack robust theoretical underpinnings. A better understanding of the determinants of medication adherence behaviour is needed in order to develop interventions that can target these factors more effectively. This systematic review aims to identify modifiable barriers and enablers to glaucoma medication adherence and identify factors most likely to influence adherence behaviour. RECENT FINDINGS We searched CINAHL, MEDLINE, PsycINFO, EMBASE, the Cochrane Library and sources of grey literature up to August 2022 for studies reporting determinants of glaucoma medication adherence. Data describing modifiable barriers/enablers to adherence were extracted and analysed using the Theoretical Domains Framework (TDF), a behavioural framework consisting of 14 domains representing theoretical factors that most likely influence behaviour. Data were deductively coded into one of the TDF domains and inductively analysed to generate themes. Key behavioural domains influencing medication adherence were identified by frequency of study coding, level of elaboration and expressed importance. Eighty-three studies were included in the final synthesis. Four key domains influencing glaucoma medication adherence were identified: 'Environmental Context and Resources', 'Knowledge', 'Skills' and 'Memory, Attention and decision processes'. Frequently reported barriers included complex eyedrop regimens, lack of patient understanding of their condition, forgetfulness and difficulties administering eyedrops. Whereas simplified treatments, knowledgeable educated patients and good patient-practitioner relationships were enablers to adherence. SUMMARY We identified multiple barriers and enablers affecting glaucoma medication adherence. Four theoretical domains were found to be key in influencing adherence behaviour. These findings can be used to underpin the development of behaviour change interventions that aim to improve medication adherence.
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Affiliation(s)
- Deborah Bott
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Ahalya Subramanian
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - David Edgar
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - John G Lawrenson
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Peter Campbell
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
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12
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Shamseldin Shalaby W, Reddy R, Razeghinejad R, Jay Katz L. Contemporary Approach to Narrow Angles. J Ophthalmic Vis Res 2024; 19:88-108. [PMID: 38638634 PMCID: PMC11022020 DOI: 10.18502/jovr.v19i1.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/12/2023] [Indexed: 04/20/2024] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Among all glaucoma types, primary angle closure glaucoma (PACG) affects approximately 23 million people worldwide, and is responsible for 50% of glaucoma-related blindness, highlighting the devastating consequences of this disease. The main mechanism of PACG is relative pupillary block. High-risk populations are female gender, Asian ethnicity, high hyperopia, short axial length, and a thick/anteriorly positioned lens. This review discusses the clinical diagnosis, classification, and management of patients with a narrow angle with and without intraocular pressure (IOP) elevation and glaucomatous optic nerve damage, including laser peripheral iridotomy (LPI), endocycloplasty (ECPL), lens extraction, and goniosynechialysis.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Rohit Reddy
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - L. Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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13
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Ribeiro M, Barbosa-Breda J, Gonçalves F, Faria Pereira A, Falcão-Reis F, Alves F, E Silva S, B Melo A. [Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study]. ACTA MEDICA PORT 2023; 36:698-705. [PMID: 36929920 DOI: 10.20344/amp.19170] [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] [Received: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. MATERIAL AND METHODS Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. RESULTS Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). CONCLUSION Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.
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Affiliation(s)
- Margarida Ribeiro
- Ophthalmology. Centro Hospitalar e Universitário de São João. Porto; Biomedicine Department. Unit of Farmacology and Therapeutics. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - João Barbosa-Breda
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; UnIC@RISE. Departmento of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal; KU Leuven. Research Group Ophthalmology. Department of Neurosciences. Leuven. Belgium
| | | | - Ana Faria Pereira
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - Flávio Alves
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Sérgio E Silva
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - António B Melo
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
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14
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Macedo M, Hatanaka M, Barboza WL, Mingione GM, Ambrósio R, Susanna R. The influence of topical anesthetic and fluorescein on non-contact tonometry measurements using ultra-high-speed dynamic Scheimpflug. Sci Rep 2023; 13:17864. [PMID: 37857798 PMCID: PMC10587345 DOI: 10.1038/s41598-023-45165-5] [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] [Received: 07/12/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023] Open
Abstract
This study aimed to investigate the effects of topical anesthetic and fluorescein drops on intraocular pressure (IOP), central corneal thickness (CCT) and biomechanical properties as measured by Corvis ST (CST-Oculus; Wezlar, Germany) in healthy eyes. A cross-sectional observational study was conducted on 46 healthy patients. The CST measurements were obtained before and immediately after the instillation of topical anesthetic and fluorescein drops. Pre-post instillation data were statistically analyzed. IOP measurements were compared to Goldmann's Applanation Tonometry (GAT), which was also performed after drops instillation. Biomechanical parameters analyzed included applanation 1 velocity, applanation 2 velocity, applanation 1 time, applanation 2 time, whole eye movement, deflection amplitude, and stiffness parameter at first applanation. A statistically significant difference in IOP, both for non-corrected IOP (IOPnct) and biomechanically corrected IOP (bIOP), was observed before and after the instillation of eyedrops. Despite this statistical significance, the observed difference lacked clinical relevance. The IOPnct demonstrated a significant difference pre and post-anesthetic and fluorescein instillation compared to GAT (14.99 ± 2.27 mmHg pre-instillation and 14.62 ± 2.50 mmHg post-instillation, versus 13.98 ± 2.04 mmHg, with p-values of 0.0014 and 0.0490, respectively). Comparable findings were noted when justaposing bIOP to GAT (14.53 ± 2.10 mmHg pre-instillation and 13.15 ± 2.25 mmHg post-instillation, against 13.98 ± 2.04 mmHg, with p-values of 0.0391 and 0.0022, respectively). Additionally, CCT measurements revealed a statistically significant elevation following the administration of topical anesthetic and fluorescein drops (from 544.64 ± 39.85 µm to 586.74 ± 41.71 µm, p < 0.01. None of the analyzed biomechanical parameters showed statistically significant differences after drops instillation. While the administration of topical anesthetic and fluorescein drops induced a statistically significant alteration in both IOPnct and bIOP readings, these changes were not clinically consequential. Furthermore, a notable statistical rise was observed in CCT measurements post-drops instillation, as determined by CST. Yet, corneal biomechanical parameters remained unaffected.
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Affiliation(s)
- Marcelo Macedo
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil.
| | - Marcelo Hatanaka
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | | | | | - Renato Ambrósio
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Remo Susanna
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
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15
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Riedlová K, Saija MC, Olżyńska A, Vazdar K, Daull P, Garrigue JS, Cwiklik L. Latanoprost incorporates in the tear film lipid layer: An experimental and computational model study. Int J Pharm 2023; 645:123367. [PMID: 37666309 DOI: 10.1016/j.ijpharm.2023.123367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
Glaucoma is a leading cause of blindness worldwide, with elevated intraocular pressure being a major risk factor for its development and progression. First-line treatment for glaucoma relies on the administration of prostaglandin analogs, with latanoprost being the most widely used. However, before latanoprost reaches the cornea, it must pass through the tear film and tear film lipid layer (TFLL) on the ocular surface. Given the significant lipophilicity of latanoprost, we hypothesize that TFLL could, to a certain extent, act as a reservoir for latanoprost, releasing it on longer time scales, apart from the fraction being directly delivered to the cornea in a post-instillation mechanism. We investigated this possibility by studying latanoprost behavior in acellular in vitro TFLL models. Furthermore, we employed in silico molecular dynamics simulations to rationalize the experimental results and obtain molecular-level insight into the latanoprost-TFLL interactions. Our experiments demonstrated that latanoprost indeed accumulates in the TFLL models, and our simulations explain the basis of the accumulation mechanism. These results support the hypothesis that TFLL can serve as a reservoir for latanoprost, facilitating its prolonged release. This finding could have significant implications for optimizing glaucoma treatment, especially in the development of new drug delivery systems targeting the TFLL.
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Affiliation(s)
- Kamila Riedlová
- J. Heyrovský Institute of Physical Chemistry, Czech Academy of Sciences, Dolejškova 3, 18223 Prague, Czech Republic; Department of Physical and Macromolecular Chemistry, Faculty of Science, Charles University, Hlavova 8, 12800 Prague, Czech Republic
| | - Maria Chiara Saija
- J. Heyrovský Institute of Physical Chemistry, Czech Academy of Sciences, Dolejškova 3, 18223 Prague, Czech Republic; Department of Physical and Macromolecular Chemistry, Faculty of Science, Charles University, Hlavova 8, 12800 Prague, Czech Republic
| | - Agnieszka Olżyńska
- J. Heyrovský Institute of Physical Chemistry, Czech Academy of Sciences, Dolejškova 3, 18223 Prague, Czech Republic.
| | - Katarina Vazdar
- J. Heyrovský Institute of Physical Chemistry, Czech Academy of Sciences, Dolejškova 3, 18223 Prague, Czech Republic
| | - Philippe Daull
- SANTEN SAS, Novagali Innovation Center, 1 rue Pierre Fontaine, Bâtiment Genavenir IV, CEDEX F-91458 Evry, France
| | - Jean-Sebastien Garrigue
- SANTEN SAS, Novagali Innovation Center, 1 rue Pierre Fontaine, Bâtiment Genavenir IV, CEDEX F-91458 Evry, France
| | - Lukasz Cwiklik
- J. Heyrovský Institute of Physical Chemistry, Czech Academy of Sciences, Dolejškova 3, 18223 Prague, Czech Republic.
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16
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Bowden EC, Panarelli JF. Randomized Clinical Trials Comparing Initial Therapies for Glaucoma. Int Ophthalmol Clin 2023; 63:3-12. [PMID: 37755440 DOI: 10.1097/iio.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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17
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Scheres LMJ, Hiligsmann M, van Gorcom L, Essers BAB, Beckers HJM. Eliciting preferences in glaucoma management-a systematic review of stated-preference studies. Eye (Lond) 2023; 37:3137-3144. [PMID: 36944711 PMCID: PMC10564796 DOI: 10.1038/s41433-023-02482-3] [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] [Received: 08/24/2022] [Revised: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In most cases, glaucoma patients require long-term medical and/or surgical treatment. Preference studies investigate how different aspects of glaucoma management, such as health or process outcomes, are valued and herewith help stakeholders make care more responsive to patients' needs. As, to our knowledge, no overview of these studies is currently available, this study aims to systematically review and critically appraise these studies. METHODS A systematic literature review was conducted using keywords for stated-preference studies and glaucoma up to October 2021. Studies were included if they were original research and used a stated-preference methodology to investigate preferences in patients or healthcare professionals for different aspects of glaucoma management. Data were extracted and summarized. Furthermore, a quality appraisal of the included studies was performed using two validated checklists. RESULTS The search yielded 1214 articles after removal of duplicates. Of those, 11 studies fulfilled the inclusion criteria. Studies aimed to elicit preferences for glaucoma treatment (27%), glaucoma related health state valuation (36%), and services (36%) from the patient (91%) or ophthalmologists' perspective (9%). Altogether studies included 69 attributes. The majority of attributes were outcome related (62%), followed by process (32%) and cost attributes (6%). Outcome attributes (e.g., effectiveness) were most often of highest importance to the population. CONCLUSIONS This systematic review provides an up-to-date and critical review of stated-preference studies in the field of glaucoma, suggesting that patients have preferences and are willing to trade-off between characteristics, and revealed that outcome attributes are the most influential characteristics of glaucoma management.
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Affiliation(s)
- L M J Scheres
- University Eye Clinic Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - M Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - L van Gorcom
- University Eye Clinic Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - B A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - H J M Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands
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18
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Hoyos CER, Ferreira MC, Libreros-Peña L, Shah MA, Aristizabal JC, Muñoz E, Seth A. Plateau iris syndrome: Epidemiology, diagnosis, and treatment: A narrative review. Oman J Ophthalmol 2023; 16:415-420. [PMID: 38059089 PMCID: PMC10697250 DOI: 10.4103/ojo.ojo_238_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/22/2023] [Accepted: 03/04/2023] [Indexed: 12/08/2023] Open
Abstract
Plateau iris syndrome (PIS) was first coined in 1958 to describe the iris configuration of a patient, 2 years later; the concept of plateau iris was published. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy (UBM) determining it as a form of primary angle-closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of the trabecular meshwork, this condition is most often found in young patients. We aim to review the current literature and knowledge on the diagnosis and treatment options of PIS; the search was conducted in PubMed, LILACS, and BIREME internet search sites using keywords and snowball search strategy of articles published until 2022, focusing on PIS history, epidemiology, clinical diagnosis, UBM feature, and treatment.
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Affiliation(s)
- Carlos Eduardo Rivera Hoyos
- Collective Innovations, Cali, Colombia
- Departament of Ophthalmology Research, Pontificia Universidad Javeriana
- Mc Williams Collective, Research Department, University of Tennessee Health Science Center, Memphis, USA
- GSR Medical Center, Cali, Colombia
| | - Maria Catalina Ferreira
- Collective Innovations, Cali, Colombia
- Departament of Ophthalmology Research, Pontificia Universidad Javeriana
- Department of Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Laura Libreros-Peña
- Collective Innovations, Cali, Colombia
- Departament of Ophthalmology Research, Pontificia Universidad Javeriana
| | | | - Juan Carlos Aristizabal
- Collective Innovations, Cali, Colombia
- Departament of Ophthalmology Research, Pontificia Universidad Javeriana
| | - Edgar Muñoz
- Collective Innovations, Cali, Colombia
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, Texas, USA
| | - Ankur Seth
- Collective Innovations, Cali, Colombia
- Mc Williams Collective, Research Department, University of Tennessee Health Science Center, Memphis, USA
- GSR Medical Center, Cali, Colombia
- Department of Medicine, University of Tennessee Health Science Center, Memphis, USA
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19
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Eraslan N, Celikay O. Assessment of corneal sublayer thickness changes in glaucoma patients using optical coherence tomography and correlation of epithelial layer thinning with dry eye monitoring. Photodiagnosis Photodyn Ther 2023; 43:103728. [PMID: 37517427 DOI: 10.1016/j.pdpdt.2023.103728] [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] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND In this study, we aimed to assess the central corneal epithelial thickness (CET), central corneal stromal thickness (CST), and total central corneal thickness (CCT) thinning relationships with dry eye development monitoring and underestimated measurement of intraocular pressure (IOP) in primary open-angle glaucoma (POAG) patients treated with timolol, dorzolamide, and brimonidine. METHODS This longitudinal cohort study included 106 patients with POAG. All patients underwent a detailed ophthalmic examination. In addition, CET, CST, and CCT were measured using anterior segment optical coherence tomography (AS-OCT). Subsequently, the cohort was divided into three groups based on the therapy administered. The Tomec group received monotherapy with benzalkonium chloride (BAK)-preserved timolol + dorzolamide fixed combination. The Alphagan group received monotherapy with purite-preserved brimonidine, and the Combigan group received monotherapy with BAK-preserved timolol + brimonidine fixed combination. RESULTS CET, CST, and CCT did not show a statistically significant decrease in the Alphagan group (p>0.05). However, the Tomec and Combigan groups showed significantly reduced measurements, except for stromal thickness (p<0.05). Finally, a significant positive correlation was found between changes in tear break-up time (TBUT) and CET during the follow-up period (r = 0.637, p = 0.001). CONCLUSIONS CET and CCT thinning were higher in the Tomec and Combigan groups than in the Alphagan group. Furthermore, although CCT reduction was significant in the Tomec and Combigan groups, its effect on IOP underestimation was approximately 1%. Furthermore, the positive correlation between CET and TBUT suggests that CET measurement with AS-OCT may also be useful in dry eye monitoring.
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Affiliation(s)
- Numan Eraslan
- Department of Ophthalmology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Osman Celikay
- Department of Ophthalmology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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20
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Baumgarten S, Lohmann T, Prinz J, Walter P, Plange N, Fuest M. [Ab interno trabeculotomy without/with cataract operation-An alternative treatment before or instead of trabeculectomy in patients with high intraocular pressure?]. DIE OPHTHALMOLOGIE 2023; 120:825-831. [PMID: 36934332 DOI: 10.1007/s00347-023-01835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Trabeculotomy with the Kahook knife is a new ab interno minimally invasive glaucoma surgery (MIGS) procedure. The MIGS are usually performed in early to intermediate glaucoma eyes. In this retrospective study we analyzed the intraocular pressure (IOP) and topical glaucoma eye drop therapy (Meds) reduction achieved by the Kahook trabeculotomy (TO) without (n = 19) or with (n = 18) combined cataract operation (Cat-TO) as initial treatment before or to avoid filtering surgery. MATERIAL AND METHODS A total of 37 eyes of 37 patients were examined when IOP was > 21 mm Hg in at least 2 examinations despite the maximum tolerable Meds applied. Cat-TO was performed in 18 phakic eyes (primary open-angle glaucoma, POAG = 11, pseudoexfoliation glaucoma, PEX = 5, ocular hypertension, OHT = 2). In 19 pseudophakic eyes (POAG = 12, PEX = 6, OHT = 1) an isolated TO was executed. Complete success (no Meds) and relative success (irrespective of Meds) for IOP ≤ 21 mm Hg, ≤ 18 mm Hg, ≤ 16 mm Hg were evaluated 2, 6 and 12 months postoperatively. RESULTS The IOP was significantly reduced from preoperatively to 2 months after Cat-TO as well as after TO (Cat-TO: 26.8 ± 5.9 mm Hg to 16.0 ± 2.9 mm Hg, p < 0.001; TO: IOD 28.2 ± 5.6 mm Hg to 16.3 ± 3.5 mm Hg, p < 0.001). Meds reduction after Cat-TO as well as after TO was not significant (Cat-TO: 2.1 ± 1.3 to 1.3 ± 1.3, p = 0.11; TO: Meds 2.7 ± 1.1 to 2.2 ± 1.3, p = 0.23); however, Meds reduction after 6 and 12 months was significantly greater in the Cat-TO group compared to the TO group (p = 0.02). The IOP and Meds did not change significantly from 2 to 6 months. After Cat-TO, qualified success after 12 months for IOP ≤ 18 mm Hg was 61% (11/18) and for IOP ≤ 16 mm Hg 28% (5/18). After TO, qualified success after 12 months for TO was 47% (9/19) for IOP ≤ 18 mm Hg and 26% (5/19) for IOP ≤ 16 mm Hg. The intervention was not sufficient for 7 patients after TO and 2 patients after Cat-TO (IOP two times > 21 mm Hg). CONCLUSION The first year results show that TO as well as Cat-TO are effective minimally invasive interventions to delay or even avoid a filtrating operation. In case of Meds intolerance and target IOP ≤ 16 mm Hg Cat-TO is not sufficient.
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Affiliation(s)
- Sabine Baumgarten
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Tibor Lohmann
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Julia Prinz
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Peter Walter
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Niklas Plange
- Augenzentrum am Annapark, Steigerweg 3, 52477, Alsdorf, Deutschland
| | - Matthias Fuest
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Tanihara H, Yamamoto T, Aihara M, Koizumi N, Minami H, Kojima S, Isobe T, Kanazawa M, Suganami H. Crossover Randomized Study of Pharmacologic Effects of Ripasudil-Brimonidine Fixed-Dose Combination Versus Ripasudil or Brimonidine. Adv Ther 2023; 40:3559-3573. [PMID: 37330927 PMCID: PMC10329961 DOI: 10.1007/s12325-023-02534-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Multidrug regimens for glaucoma treatment often result in adherence issues due to inconvenience; these issues may be improved with fixed-dose combination drugs. The ophthalmic solution of ripasudil-brimonidine fixed-dose combination (RBFC; K-232) is the first treatment combining a Rho kinase inhibitor and an α2-adrenoceptor agonist, and has demonstrated ability to lower intraocular pressure (IOP) and have various effects on conjunctival hyperemia and corneal endothelial cell morphology. This study evaluates the pharmacologic effects of RBFC treatment versus its separate components-ripasudil or brimonidine. METHODS This single-center, prospective, randomized, open-label, blinded endpoint study with 3 × 3 crossover design randomly assigned healthy adult men to three groups (1:1:1) to undergo consecutive 8-day administration phases (with drug-free intervals of at least 5 days). Subjects received twice-daily instillation of RBFC → ripasudil → brimonidine (group A), ripasudil → brimonidine → RBFC (group B), or brimonidine → RBFC → ripasudil (group C). Endpoints included change in IOP, severity of conjunctival hyperemia, corneal endothelial cell morphology, pupil diameter, and pharmacokinetics. RESULTS Eighteen subjects were assigned in total (six to each group). RBFC significantly reduced IOP from baseline at 1 h post-instillation on days 1 and 8 (12.7 vs. 9.1 and 9.0 mmHg, respectively; both P < 0.001), and provided significantly greater IOP reductions than ripasudil or brimonidine at several time points. The most common adverse drug reaction with all three treatments was mild conjunctival hyperemia, which transiently increased in severity with RBFC or ripasudil, peaking at 15 min post-instillation. In post hoc analyses, conjunctival hyperemia scores were lower with RBFC than with ripasudil at several time points. Transient morphologic changes in corneal endothelial cells occurred for up to several hours with RBFC or ripasudil, but not with brimonidine. Pupil diameter did not change with RBFC. CONCLUSION RBFC significantly reduced IOP compared with each agent alone. A combination of each agent's pharmacologic profile was observed in that of RBFC. TRIAL REGISTRATION Japan Registry of Clinical Trials; Registration No. jRCT2080225220.
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Affiliation(s)
- Hidenobu Tanihara
- Department of Ophthalmology, Biei Municipal Hospital, 3-8-35 Naka-machi, Biei Town, Kamikawa-gun, Hokkaido, 071-0207, Japan.
| | - Tetsuya Yamamoto
- Prof. Kazuo Iwata Memorial Kaijin Glaucoma Center, Kaiya Eye Clinic, Shizuoka, Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyoto, Japan
| | - Hiroomi Minami
- Pharmaceutical Clinical Development Management Department, Kowa Company, Ltd., Tokyo, Japan
| | - Satoshi Kojima
- Pharmaceutical Clinical Development Management Department, Kowa Company, Ltd., Tokyo, Japan
| | - Tomoyuki Isobe
- Tokyo New Drug Research Laboratories, Kowa Company, Ltd., Tokyo, Japan
| | - Mizuho Kanazawa
- Medical Affairs Department, Kowa Company, Ltd., Tokyo, Japan
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22
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Tsugeno Y, Sato T, Watanabe M, Furuhashi M, Ohguro H. Prostanoid FP and EP2 Receptor Agonists Induce Epithelial and Subepithelial Fibrogenetic Changes in Human Conjunctival Fibroblasts in Different Manners. J Ocul Pharmacol Ther 2023; 39:404-414. [PMID: 37459581 DOI: 10.1089/jop.2023.0011] [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: 07/20/2023] Open
Abstract
Purpose: To examine the effects of prostanoid FP and EP2 receptor agonists, PGF2α and Omidenepag (OMD), respectively, on the transforming growth factor beta (TGF-β2) induced conjunctival fibrogenesis. Methods: Two-dimension (2D) and three-dimension (3D) cultures of these fibroblasts were subjected to following analyses: (1) planar proliferation evaluated by transendothelial electron resistance (TEER) measurements, (2) real-time metabolic analyses, (3) subepithelial proliferation evaluated by 3D spheroid' size and stiffness measurements, and (4) the mRNA expression of extracellular matrix (ECM) molecules and their modulators. Results: TGF-β2 induced increase in the planar proliferation was significantly decreased or enhanced by PGF2α or OMD, respectively. The proportion of oxygen consumption required to drive ATP synthesis compared with that driving proton leakage was increased by PGF2α and OMD independently with TGF-β2. In contrast, maximal mitochondrial respiration was decreased by PGF2α and OMD, and the OMD-induced effect was further enhanced by the presence of TGF-β2. In addition, the TGF-β2 dependent increase in the glycolytic capacity was cancelled by PGF2α and/or OMD. Alternatively, subepithelial proliferation, as evidenced by the stiffness of the 3D spheroids, was substantially increased by both PGF2α and OMD, and these were differently modulated by TGF-β2. The expression of several related factors as above fluctuated among the conditions for both 2D and 3D and TGF-β2 untreated or treated cultures. Conclusion: The present findings indicate that the prostanoid FP or the EP2 receptor agonist may solely and differently induce the planar and subepithelial proliferation of HconF cells and these were also modulated by TGF-β2.
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Affiliation(s)
- Yuri Tsugeno
- Department of Ophthalmology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tatsuya Sato
- Department of Cardiovascular, Renal and Metabolic Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Cellular Physiology and Signal Transduction, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Megumi Watanabe
- Department of Ophthalmology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Ohguro
- Department of Ophthalmology, Sapporo Medical University School of Medicine, Sapporo, Japan
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23
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Valladales-Restrepo LF, Oyuela-Gutiérrez MC, Delgado-Araujo AC, Machado-Alba JE. Use Pattern of Ophthalmic Antiglaucoma Agents with and without Preservatives: A Cross-Sectional Study. Pharmaceuticals (Basel) 2023; 16:ph16050743. [PMID: 37242526 DOI: 10.3390/ph16050743] [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: 02/17/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Different drugs have been approved to reduce the intraocular pressure. However, most of them contain preservatives to maintain sterility and these can be toxic to the ocular surface. The aim was to determine the patterns of use of antiglaucoma agents and ophthalmic preservatives in a group of patients from Colombia. METHODS A cross-sectional study that identified ophthalmic antiglaucoma agents from a population database of 9.2 million. Sociodemographic and pharmacological variables were considered. Descriptive and bivariate analyses were performed. RESULTS A total of 38,262 patients were identified, with a mean age of 69.2 ± 13.3 years, and 58.6% were women. A total of 98.8% were prescribed antiglaucoma drugs in multidose containers. The most widely used were prostaglandin analogs (59.9%), especially latanoprost (51.6%) and β-blockers (59.2%). A total of 54.7% of patients received combined management, especially with fixed-dose combination (FDC) drugs (41.3%). A total of 94.1% used antiglaucoma drugs with preservatives (benzalkonium chloride, 68.4%). CONCLUSIONS The pharmacological treatment of glaucoma was very heterogeneous, but the most commonly used therapeutic groups were in accordance with the recommendations of clinical practice guidelines but with differences by sex and age. Most of the patients were exposed to preservatives, especially benzalkonium chloride, but the wide use of FDC drugs can minimize toxicity on the ocular surface.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira 660003, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia
| | - María Camila Oyuela-Gutiérrez
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia
| | - Ana Camila Delgado-Araujo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira 660003, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira 660003, Colombia
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Romano GL, Gozzo L, Maurel OM, Di Martino S, Riolo V, Micale V, Drago F, Bucolo C. Fluoxetine Protects Retinal Ischemic Damage in Mice. Pharmaceutics 2023; 15:pharmaceutics15051370. [PMID: 37242611 DOI: 10.3390/pharmaceutics15051370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To evaluate the neuroprotective effect of the topical ocular administration of fluoxetine (FLX) in a mouse model of acute retinal damage. METHODS Ocular ischemia/reperfusion (I/R) injury in C57BL/6J mice was used to elicit retinal damage. Mice were divided into three groups: control group, I/R group, and I/R group treated with topical FLX. A pattern electroretinogram (PERG) was used as a sensitive measure of retinal ganglion cell (RGC) function. Finally, we analyzed the retinal mRNA expression of inflammatory markers (IL-6, TNF-α, Iba-1, IL-1β, and S100β) through Digital Droplet PCR. RESULTS PERG amplitude values were significantly (p < 0.05) higher in the I/R-FLX group compared to the I/R group, whereas PERG latency values were significantly (p < 0.05) reduced in I/R-FLX-treated mice compared to the I/R group. Retinal inflammatory markers increased significantly (p < 0.05) after I/R injury. FLX treatment was able to significantly (p < 0.05) attenuate the expression of inflammatory markers after I/R damage. CONCLUSIONS Topical treatment with FLX was effective in counteracting the damage of RGCs and preserving retinal function. Moreover, FLX treatment attenuates the production of pro-inflammatory molecules elicited by retinal I/R damage. Further studies need to be performed to support the use of FLX as neuroprotective agent in retinal degenerative diseases.
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Affiliation(s)
- Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95100 Catania, Italy
| | - Lucia Gozzo
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
| | - Oriana Maria Maurel
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
| | - Serena Di Martino
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
| | - Valentina Riolo
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
| | - Vincenzo Micale
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95100 Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95100 Catania, Italy
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95100 Catania, Italy
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25
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Cassottana P, Toma C, Maltese C, Villa V, Ricciarelli R, Traverso CE, Iester M. A Case of Bilateral Choroidal Effusion after XEN Gel Stent Implantation. Gels 2023; 9:gels9040276. [PMID: 37102888 PMCID: PMC10138104 DOI: 10.3390/gels9040276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose: This study aimed to describe a rare case of bilateral choroidal effusion following a XEN45 implantation. Case Report: An 84-year-old man with primary open-angle glaucoma underwent uneventful ab interno XEN45 device implantation in the right eye. The immediate postoperative period was complicated by hypotony and serous choroidal detachment, which were treated and resolved using steroids and cycloplegic drops. Eight months later, the fellow eye underwent the same surgery, which was followed by choroidal detachment that required transscleral surgical drainage. Conclusions: This case highlights the importance of a careful postoperative follow-up and a timely intervention in the context of XEN45 implantation, and suggests that choroidal effusion in one eye may be a risk factor for choroidal effusion in the other eye when undergoing the same type of surgery.
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Affiliation(s)
- Paola Cassottana
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Clinica Oculistica, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, 16132 Genoa, Italy
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy
| | - Chiara Toma
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Clinica Oculistica, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, 16132 Genoa, Italy
| | - Cristina Maltese
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Clinica Oculistica, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, 16132 Genoa, Italy
| | - Viviana Villa
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy
| | - Roberta Ricciarelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Clinica Oculistica, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, 16132 Genoa, Italy
| | - Michele Iester
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Clinica Oculistica, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, 16132 Genoa, Italy
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26
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Naithani R, Jammal AA, Estrela T, Onyekaba NAE, Medeiros FA. Association of an Objective Structural and Functional Reference Standard for Glaucoma with Quality of Life Outcomes. Ophthalmol Glaucoma 2023; 6:160-168. [PMID: 36038106 PMCID: PMC10697472 DOI: 10.1016/j.ogla.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 04/26/2023]
Abstract
PURPOSE To compare self-reported quality-of-life (QoL) outcomes of patients diagnosed as normal, glaucoma suspect, and glaucoma based on an objective reference standard for glaucomatous optic neuropathy (GON). DESIGN Cross-sectional study. PARTICIPANTS 1884 eyes of 1019 patients were included in the study. METHODS The data was sourced from the Duke Glaucoma Registry. Eyes were classified according to the presence and topographic correspondence of functional and structural damage, as assessed by parameters from standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). The objective diagnosis of the worse eye was used to define patient-level diagnosis. To assess QoL in the diagnostic groups, 14 unidimensional vision-related items of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) were used to assess QoL in the diagnostic groups. Association between NEI VFQ-25 Rasch-calibrated scores and diagnostic groups was assessed through multivariable regression that controlled for confounding demographic and socioeconomic variables such as age, sex, race, income, marriage status, insurance status, and highest education level. MAIN OUTCOME MEASURES NEI VFQ-25 Rasch scores compared with objective criteria diagnosis based on SAP mean deviation (MD) and SD-OCT retinal nerve fiber layer (RNFL) thickness. RESULTS Overall, eyes classified as normal, glaucoma suspect, and glaucoma had decreasing mean scores in SAP MD (0.2 ± 1.0 dB, -0.9 ± 2.4 dB, -6.2 ± 7.0 dB, respectively; P < 0.001) and SD-OCT RNFL thickness (97.8 ± 9.5 μm, 89.0 ± 13.1 μm, 64.5 ± 12.8 μm, respectively; P < 0.001). The mean Rasch-calibrated NEI VFQ-25 score was significantly different among normal, suspect, and glaucoma groups (82.9 ± 13.0, 78.2 ± 14.8, and 72.6 ± 16.2, respectively; P < 0.001). When adjusted for confounding socioeconomic variables, glaucoma patients had significantly worse QoL than those classified as normal (β = -6.8 Rasch score units; P < 0.001). CONCLUSION A glaucoma diagnosis, based on an objective reference standard for GON, was significantly associated with worse Rasch-adjusted scores of QoL. Utilization of such objective criteria may provide clinically relevant metrics with potential to improve comparability of research findings and validation of newly proposed diagnostic tools. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Rizul Naithani
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin; Campbell University School of Medicine, Lillington, North Carolina
| | - Alessandro A Jammal
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin
| | - Tais Estrela
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin
| | - Ndidi-Amaka E Onyekaba
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory (VIP), Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolin; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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27
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Salowe RJ, Chen Y, Zenebe-Gete S, Lee R, Gudiseva HV, Di Rosa I, Ross AG, Cui QN, Miller-Ellis E, Addis V, Sankar PS, Daniel E, Ying GS, O'Brien JM. Risk factors for structural and functional progression of primary open-angle glaucoma in an African ancestry cohort. BMJ Open Ophthalmol 2023; 8:e001120. [PMID: 37278425 PMCID: PMC9990679 DOI: 10.1136/bmjophth-2022-001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND/AIMS To investigate the rates of structural and functional progression of primary open-angle glaucoma in an African ancestry cohort and identify risk factors for progression. METHODS This retrospective study included 1424 eyes from glaucoma cases in the Primary Open-Angle African American Glaucoma Genetics cohort, with ≥2 visits for retinal nerve fibre layer (RNFL) thickness and mean deviation (MD) measurements over ≥6-month follow-up. The rates of structural progression (change in RNFL thickness/year) and functional progression (change in MD/year) were calculated from linear mixed effects models, accounting for intereye correlation and longitudinal correlation. Eyes were categorised as slow, moderate or fast progressors. Risk factors for progression rates were assessed using univariable and multivariable regression models. RESULTS The median (interquartile) rates of progression were -1.60 (-2.05 to -1.15) µm/year for RNFL thickness and -0.40 (-0.44 to -0.34) decibels/year for MD. Eyes were categorised as slow (structural: 19%, functional: 88%), moderate (structural: 54%, functional: 11%) and fast (structural: 27%, functional: 1%) progressors. In multivariable analysis, faster RNFL progression was independently associated with thicker baseline RNFL (p<0.0001), lower baseline MD (p=0.003) and beta peripapillary atrophy (p=0.03). Faster MD progression was independently associated with higher baseline MD (p<0.0001), larger cup-to-disc ratios (p=0.02) and lower body mass index (p=0.0004). CONCLUSION The median rates of structural and functional progression in this African ancestry cohort were faster than the rates reported from previously published studies in other ethnic groups. Higher baseline RNFL thickness and MD values were associated with faster progression rates. Results highlight the importance of monitoring structural and functional glaucoma progression to provide timely treatment in early disease.
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Affiliation(s)
- Rebecca J Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yineng Chen
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Selam Zenebe-Gete
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harini V Gudiseva
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isabel Di Rosa
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahmara G Ross
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qi N Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eydie Miller-Ellis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gui-Shuang Ying
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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28
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Real-World Analysis on the Characteristics, Therapeutic Paths and Economic Burden for Patients Treated for Glaucoma in Italy. Healthcare (Basel) 2023; 11:healthcare11050635. [PMID: 36900638 PMCID: PMC10001280 DOI: 10.3390/healthcare11050635] [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: 11/23/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
This real-world analysis was performed on administrative databases to evaluate characteristics, therapies, and related economic burden of glaucoma in Italy. Adults with at least 1 prescription for ophthalmic drops (ATC class S01E: antiglaucoma preparations, miotics) during data availability period (January 2010-June 2021) were screened, then patients with glaucoma were included. First date of ophthalmic drops prescription was the index date. Included patients had at least 12 months of data availability before index-date and afterwards. Overall, 18,161 glaucoma-treated patients were identified. The most frequent comorbidities were hypertension (60.2%), dyslipidemia (29.7%) and diabetes (17%). During available period, 70% (N = 12,754) had a second-line therapy and 57% (N = 10,394) a third-line therapy, predominantly ophthalmic drugs. As first-line, besides 96.3% patients with ophthalmic drops, a small proportion reported trabeculectomy (3.5%) or trabeculoplasty (0.4%). Adherence to ophthalmic drops was found in 58.3% patients and therapy persistence reached 78.1%. Mean total annual cost per patient was €1,725, mostly due to all-cause drug expenditure (€800), all-cause hospitalizations (€567) and outpatient services (€359). In conclusion, glaucoma-treated patients were mostly in monotherapy ophthalmic medications, with an unsatisfying adherence and persistence (<80%). Drug expenditures were the weightiest item among healthcare costs. These real-life data suggest that further efforts are needed to optimize glaucoma management.
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29
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Cao Y, Lin HS, Mao HY, Zhao Y, Xie YQ, Zhang SD, Zhang Q, Wang PJ, Li GX, Fang AW, Liang YB. Trend of glaucoma internal filtration surgeries in a tertiary hospital in China. Int J Ophthalmol 2023; 16:251-259. [PMID: 36816210 PMCID: PMC9922641 DOI: 10.18240/ijo.2023.02.12] [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: 08/29/2022] [Accepted: 12/07/2022] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University. METHODS A review of the medical records of inpatients who had been diagnosed with glaucoma and received anti-glaucoma surgery between January 1, 2015 and December 31, 2021 was conducted. The glaucoma diagnosis in this study included primary open angle glaucoma, primary angle-closure glaucoma, secondary glaucoma, and paediatric glaucoma. The types of surgeries were categorised as internal filtration, external filtration, and cyclodestruction surgery based on the pathway of aqueous humor outflow. The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed. RESULTS The number of patients hospitalised for glaucoma surgery increased yearly, from 752 in 2015 to 1373 in 2021, at the Eye Hospital of Wenzhou Medical University. Regarding the patients diagnosed with primary open angle glaucoma, internal filtration surgery increased from 27.40% of the sample to 54.40% of the sample, while external filtration surgery decreased from 71.50% to 44.20% between 2015 and 2021. For paediatric glaucoma, internal filtration surgery increased from 37.50% in 2015 to 88.20% in 2021. Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma, the proportion of internal filtration surgery also showed an increase from 18.20% in 2015 to 40.90% in 2021. Meanwhile, internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00% in 2015, and showed a small increase by 2021. CONCLUSION As surgical technology and surgical experience continue to elevate and improve, the range of glaucoma surgeries are correspondingly evolving. This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.
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Affiliation(s)
- Yang Cao
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Hai-Shuang Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Hui-Yan Mao
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yin Zhao
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yan-Qian Xie
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Shao-Dan Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Qi Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Pei-Juan Wang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Guo-Xing Li
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Ai-Wu Fang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yuan-Bo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Glaucoma Research Institute, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
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30
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Montesano G, Ometto G, King A, Garway-Heath DF, Crabb DP. Two-Year Visual Field Outcomes of the Treatment of Advanced Glaucoma Study (TAGS). Am J Ophthalmol 2023; 246:42-50. [PMID: 36228777 DOI: 10.1016/j.ajo.2022.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE to compare visual field (VF) progression between the 2 arms of the Treatment of Advanced Glaucoma Study (TAGS). DESIGN Post hoc analysis of VF data from a 2-arm, multicenter, randomized controlled clinical trial. METHODS A total of 453 patients with newly diagnosed advanced open-angle glaucoma in at least 1 eye from 27 centers in the United Kingdom were randomized to either trabeculectomy (n = 227) or medication in their index eye (n = 226) and followed-up for 2 years with 2 24-2 VF tests at baseline, 4, 12, and 24 months. Data were analyzed for participants with a reliable VF (false positive rate < 15%) at baseline and at least 2 other time points. Average difference in rate of progression (RoP) was analyzed using a hierarchical Bayesian model. Time for each eye to progress from baseline beyond specific cut-offs (0.5, 1, 1.5, and 2 dB) was compared using survival analysis. RESULTS This study analyzed 211 eyes in the trabeculectomy first arm and 203 eyes in the medication first arm. The average RoP (estimate [95% credible intervals]) was -0.59 [-0.88, -0.31] dB/year in the medication first arm and -0.40 [-0.67, -0.13] dB/year in the trabeculectomy first arm. The difference was not significant (Bayesian P-value = .353). More eyes progressed in the medication first arm, but this difference was not significant. CONCLUSIONS There was no significant difference in the average RoP at 2 years.
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Affiliation(s)
- Giovanni Montesano
- From City, University of London, Optometry and Visual Sciences, London, UK (G.M., G.O., D.P.C.); NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK (G.M., D.F.G-H.)
| | - Giovanni Ometto
- From City, University of London, Optometry and Visual Sciences, London, UK (G.M., G.O., D.P.C.)
| | - Anthony King
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, UK (A.K.)
| | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK (G.M., D.F.G-H.)
| | - David P Crabb
- From City, University of London, Optometry and Visual Sciences, London, UK (G.M., G.O., D.P.C.).
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31
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Tang Y, Fan X, Wang M, Wu L. Visual field progression in open-angle glaucoma after refractive corneal ablation surgery. Lasers Med Sci 2023; 38:57. [PMID: 36715786 DOI: 10.1007/s10103-023-03709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
This study aimed to investigate visual field (VF) progression in open-angle glaucoma (OAG) subjects who had a history of refractive corneal ablation surgery (RCAS). Retrospective study. The medical records of 21 subjects who had a history of refractive corneal ablation surgery (RCAS group) and 36 patients who had myopia without a history of RCAS (non-RCAS group) were reviewed. VF progression was determined by the non-parametric progression analysis (NPA) method. VF progression and clinical characteristics were compared between the two groups. For the RCAS group, refractive regressions were analysed. The mean follow-up periods were 4.5 years and 5.5 years for the RCAS and non-RCAS groups, respectively. More glaucoma subjects in the RCAS group (57.1%) had likely VF progression than in the non-RCAS group (25.0%) (p = 0.01). The RCAS group had a significantly lower percentage of IOP reduction with anti-glaucoma medication than the non-RCAS group (p = 0.037). Eyes with likely VF progression had a higher incidence of refractive regression (91.7%, 11/12) than eyes without it (33.3%, 3/9). Among subjects whose eyes had refractive regression, 78.6% (11/14) had likely VF progression, and 21.4% (3/14) did not (p = 0.016). The VF progression in OAG after RCAS was faster than that of myopic OAG without RCAS. Anti-glaucoma treatment should be actively enhanced in clinical practice.
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Affiliation(s)
- Yu Tang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Department of Ophthalmology, Dalian Municipal Central Hospital, Dalian, China
| | - Xiang Fan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Minshu Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Lingling Wu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
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32
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Opazo-Toro V, Fortuna V, Jiménez W, Pazos López M, Royo MJM, Ventura-Abreu N, Brunet M, Milla E. Genotype and Phenotype Influence the Personal Response to Prostaglandin Analogues and Beta-Blockers in Spanish Glaucoma and Ocular Hypertension Patients. Int J Mol Sci 2023; 24:ijms24032093. [PMID: 36768422 PMCID: PMC9916755 DOI: 10.3390/ijms24032093] [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] [Received: 12/12/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
Analysis of the genotype that predicts the phenotypic characteristics of a cohort of glaucoma and ocular hypertension patients, and the correlation with their personal pharmacological response to beta-blockers (BB) and prostaglandin analogues (PGA). Prospective study that included 139 eyes from 72 patients under BB and/or PGA treatment, and in some cases other types of ocular hypotensive treatments. Five single-nucleotide polymorphisms were genotyped by real-time PCR assays: prostaglandin-F2α receptor (rs3766355, rs3753380); cytochrome-P450 2D6 (rs16947, rs769258); and beta-2-adrenergic receptor (rs1042714). Other studied variables were mean deviation (MD) of visual field, previous ocular interventions, medical treatment, baseline (bIOP), and treated intraocular pressure (tIOP). From a total of 139 eyes, 71 (51.1%) were left eyes. The main diagnosis was primary open angle glaucoma (66.2%). A total of 57 (41%) eyes were under three or more medications (PGA + BB + other) and, additionally, 57 eyes (41%) had had some kind of glaucoma surgery. The mean bIOP and tIOP were 26.55 ± 8.19 and 21.01 ± 5.54 mmHg, respectively. Significant differences in tIOP were found between heterozygous (HT) (21.07 ± 0.607 mmHg) and homozygous (HM) (20.98 ± 0.639 mmHg) rs3766355 with respect to wildtype individuals (16 ± 1.08 mmHg) (p = 0.031). The MD values presented significant differences between wildtype rs3766355 (-2 ± 2.2 dB), HT (-3.87 ± 4 dB), and HM carriers (-9.37 ± 9.51 dB) (p = 0.009). Significant differences were also observed between the MD in wildtype rs3753380 (-6.1 ± 8.67 dB), HT (-9.02 ± 8.63 dB), and HM carriers (-9.51 ± 7.44 dB) (p = 0.017). Patients carrying the variant rs3766355 in HM or HT presented clinically-significantly higher tIOP than wildtype patients. Additionally, some differences in MD were found in rs3766355 and rs3753380 carriers, and the more alleles that were affected, the worse the MD value, meaning greater severity of the glaucoma. Poor response to treatment and more visual field damage may be associated with being a carrier of these mutated alleles.
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Affiliation(s)
- Valeria Opazo-Toro
- Glaucoma Unit, Instituto Oftalmologico Integral, C/María Auxiliadora 25, 08017 Barcelona, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center, Hospital Clinic Barcelona, University of Barcelona, 08007 Barcelona, Spain
| | - Wladimiro Jiménez
- Biochemistry and Molecular Genetics Service, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, 08036 Barcelona, Spain
- August Pí i Sunyer Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Correspondence:
| | - Marta Pazos López
- Glaucoma Unit, Institut Clínic d’Oftalmologia, Hospital Clínic, 08036 Barcelona, Spain
| | | | | | - Mercè Brunet
- Biochemistry and Molecular Genetics Service, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, 08036 Barcelona, Spain
- August Pí i Sunyer Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Elena Milla
- August Pí i Sunyer Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Glaucoma Unit, Institut Clínic d’Oftalmologia, Hospital Clínic, 08036 Barcelona, Spain
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33
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Kumon M, Fuwa M, Shimazaki A, Odani-Kawabata N, Iwamura R, Yoneda K, Kato M. Downregulation of COL12A1 and COL13A1 by a selective EP2 receptor agonist, omidenepag, in human trabecular meshwork cells. PLoS One 2023; 18:e0280331. [PMID: 36630412 PMCID: PMC9833537 DOI: 10.1371/journal.pone.0280331] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Omidenepag isopropyl (OMDI) is an intraocular pressure (IOP)-lowering drug used to treat glaucoma. The active form of OMDI, omidenepag (OMD), lowers elevated IOP, the main risk factor for glaucoma, by increasing the aqueous humor outflow; however, a detailed understanding of this mechanism is lacking. To clarify the IOP-lowering mechanism of OMDI, the effects of OMD on the mRNA expression of the extracellular matrix, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) were evaluated in human trabecular meshwork cells. Under 2D culture conditions, the mRNA expression of FN1, COL1A1, COL1A2, COL12A1, and COL13A1 decreased in a concentration-dependent manner after 6 or 24 h treatment with 10 nM, 100 nM, and 1 μM OMD, while that of COL18A1 decreased after 6 h treatment with 1 μM OMD. Significant changes in expression were observed for many MMP and TIMP genes. Under 3D culture conditions, the extracellular matrix-related genes COL12A1 and COL13A1 were downregulated by OMD treatment at all three concentrations. Under both 2D and 3D culture conditions, COL12A1 and COL13A1 were downregulated following OMD treatment. Reduction in the extracellular matrix contributes to the decrease in outflow resistance, suggesting that the downregulation of the two related genes may be one of the factors influencing the IOP-lowering effect of OMDI. Our findings provide insights for the use of OMDI in clinical practice.
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Affiliation(s)
- Masashi Kumon
- Product Development Division, Santen Pharmaceutical Co., Ltd., Nara, Japan
| | - Masahiro Fuwa
- Product Development Division, Santen Pharmaceutical Co., Ltd., Nara, Japan
- * E-mail:
| | - Atsushi Shimazaki
- Product Development Division, Santen Pharmaceutical Co., Ltd., Nara, Japan
| | | | - Ryo Iwamura
- Pharmaceutical Division, Pharmaceuticals Research Laboratory, UBE Corporation, Yamaguchi, Japan
| | - Kenji Yoneda
- Pharmaceutical Division, Pharmaceuticals Research Laboratory, UBE Corporation, Yamaguchi, Japan
| | - Masatomo Kato
- Product Development Division, Santen Pharmaceutical Co., Ltd., Nara, Japan
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Jones L, Maes N, Qidwai U, Ratnarajan G. Impact of minimally invasive glaucoma surgery on the ocular surface and quality of life in patients with glaucoma. Ther Adv Ophthalmol 2023; 15:25158414231152765. [PMID: 37077654 PMCID: PMC10107052 DOI: 10.1177/25158414231152765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Background: Minimally invasive glaucoma procedures are emerging as clinically effective and safe glaucoma management approaches; however, evidence regarding quality-of-life outcomes is limited. Objectives: To explore the impact of minimally invasive glaucoma surgery (MIGS) combined with phacoemulsification on patient-reported outcomes and clinical parameters related to ocular surface disease in people with glaucoma. Design: Retrospective observational study. Methods: Fifty-seven consecutive patients were examined prior to undergoing iStent combined with phacoemulsification with or without adjunctive endocyclophotocoagulation and at 4-month follow-up. Results: At follow-up, on average patients returned statistically significantly improved scores on glaucoma-specific (GQL-15, p < 0.001; GSS, p < 0.001), general health (EQ-5D, p = 0.02) and ocular surface PROMs (OSDI, p = 0.001). Patients were using fewer eye drops on average after MIGS compared with before surgery (1.1 ± 0.9 versus 1.8 ± 0.8; p < 0.001). Undergoing MIGS was associated with improved tear film break-up time ( p < 0.001) and reduced corneal fluorescein staining ( p < 0.001). Conclusion: This retrospective audit shows quality of life and clinical parameters related to the ocular surface are improved following MIGS combined with phacoemulsification in patients previously treated with anti-glaucoma therapy.
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Affiliation(s)
- Lee Jones
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Natalia Maes
- Brighton and Sussex University Hospitals NHS Trust, West Sussex, UK
| | - Umair Qidwai
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Gokulan Ratnarajan
- Corneo-Plastic Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead RH19 3DZ, UK
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35
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Neoh FP, Y A, Siti AAH, Liza-Sharmini AT. Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese. J Curr Glaucoma Pract 2023; 17:3-8. [PMID: 37228307 PMCID: PMC10203328 DOI: 10.5005/jp-journals-10078-1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/02/2021] [Indexed: 05/27/2023] Open
Abstract
Objective To compare anterior segment biometry parameters in progress and non-progress primary angle closure glaucoma (PACG) among Malay and Chinese patients. Materials and methods A cross-sectional study was conducted between November 2015 and December 2016 involving 75 patients with PACG (43 Malays and 32 Chinese) who were recruited from a single glaucoma center in Malaysia. Ocular examination included anterior segment biometry measurements on the selected eye. Axial length (AL) and anterior chamber depth (ACD) measurement was done using a noncontact partial coherence interferometer (IOL Master, Carl Zeiss, Germany). Anterior chamber angle (ACA) was measured by Anterior Segment-OCT (Spectralis Heidelberg, Germany). Humphrey visual field (HVF) 24-2 analysis of the same eye was conducted and compared with the HVF when diagnosis was made. Progression of PACG patients was assessed according to the Hodapp, Parrish and Anderson's (HPA) classification, they were then divided into progress and non-progress groups. Comparison of anterior segment biometry parameters between Malay and Chinese PACG patients with and without progression was analyzed using independent T test. Multivariate ANOVA analysis was used to compare the anterior segment parameters between progress and non-progress PACG patients, with adjustment for age, gender, lens status, family history and presence of diabetes mellitus. Results Chinese PACG patients have significant shorter AL (22.18 mm ± 0.76) and narrower ACA (11.96° ± 6.00) compared to Malay PACG patients. Among the progress group, Chinese PACG patients have significant shorter AL, shallower ACD and narrower ACA compared to Malays. However, after controlling for confounding factors, there was significant difference in ACA between Malay and Chinese PACG. There was also no significant difference of ocular biometry measurement between Chinese and Malay patients in progress and non-progress group. Conclusion There was racial influence in ocular biometry measurement in PACG patients. Chinese have significant narrower ACA compared to Malays. Serial AS-OCT monitoring is important in management of PACG. How to cite this article Neoh FP, Azhany Y, Siti-Azrin AH, et al. Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese. J Curr Glaucoma Pract 2023;17(1):3-8.
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Affiliation(s)
- FP Neoh
- Department of Ophthalmology & Visual Science, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Azhany Y
- Department of Ophthalmology & Visual Science, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Azrin AH Siti
- Unit of Biostatistics and Research Methodology, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - AT Liza-Sharmini
- Department of Ophthalmology & Visual Science, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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36
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Cvenkel B, Kolko M. Devices and Treatments to Address Low Adherence in Glaucoma Patients: A Narrative Review. J Clin Med 2022; 12:jcm12010151. [PMID: 36614952 PMCID: PMC9821329 DOI: 10.3390/jcm12010151] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Poor adherence to topical glaucoma medications has been linked to worse visual field outcomes in glaucoma patients. Therefore, identifying and overcoming the adherence barriers are expected to slow down the progression of disease. The most common barriers to adherence, in addition to the lack of knowledge, include forgetfulness, side effects of medications, difficulties with drop instillation and low self-efficacy. Symptoms and signs of ocular surface disease, which importantly reduce patients' quality of life, are decreased by using preservative-free topical medications. Sustained drug delivery systems using different vehicles seem promising for relieving the burden of drop administration. Currently, only the bimatoprost sustained-release intracameral implant is available for clinical use and single administration. In the era of digitalization, smart drug delivery-connected devices may aid adherence and, by sharing data with care providers, improve monitoring and adjusting treatment. Selective laser trabeculoplasty as first-line treatment delays the need for drops, whereas minimally invasive glaucoma procedures with and without devices combined with cataract surgery increase the likelihood of patients with early-to-moderate glaucoma to remain drop free or reduce the number of drops needed to control intraocular pressure. The aim of this narrative review is to present and discuss devices and treatments that may improve adherence by reducing the need for drops and side effects of medications and aiding in glaucoma monitoring. For the future, there is a need for studies focusing on clinically important outcomes, quality of life and the cost of intervention with longer post-interventional follow up.
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Affiliation(s)
- Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark
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Pol S, Upasani SD. Glaucoma in Pregnancy: Know What Next!! J Obstet Gynaecol India 2022; 72:366-368. [PMID: 36457432 PMCID: PMC9701255 DOI: 10.1007/s13224-021-01581-z] [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: 07/25/2021] [Accepted: 10/07/2021] [Indexed: 10/18/2022] Open
Abstract
Glaucoma is a complex disease which when encountered in pregnancy poses a challenge to the woman's obstetrician and her ophthalmologist. The dilemma arises while opting the line of management, either medical or surgical which requires balancing the clinical disease of the mother with the potential threat of therapy to the growing child. Such was our case an elderly primigravida 10 weeks of gestation who had an acute episode of angle closure glaucoma with diminishing vision, who was managed both medically (anti-glaucoma drugs) and surgically (trabeculectomy). She recovered with a normal IOP, improved vision and anomaly scan of the fetus showing a structurally normal fetus. Thus, the fear of uncertain drug teratogenicity should not discourage doctors from prescribing treatments when their expected benefits to the mother are thought to outweigh the risk to the fetus.
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Affiliation(s)
- Shraddha Pol
- Department of Obstetrics and Gynecology at Lokmanya, Tilak Municipal Medical College and General Hospital, Mumbai, India
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38
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Kotb MS, El Gharbawy SA, Abdelrahman AM, Makled HS. Sutureless versus conventional deep sclerectomy for management of open angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2022; 261:1083-1090. [PMID: 36435917 PMCID: PMC10049952 DOI: 10.1007/s00417-022-05910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/10/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Introduction
To compare sutureless deep sclerectomy to conventional deep sclerectomy regarding their lowering effect on intraocular pressure (IOP) in cases with open-angle glaucoma.
Methods
This is a prospective interventional randomized comparative study that included 60 eyes of 50 patients with open-angle glaucoma (OAG) who were indicated for surgical intervention. Patients were recruited from the glaucoma subspecialty clinic of the Cairo University teaching hospital and were divided into two groups: group A (underwent sutureless deep sclerectomy) and group B (underwent conventional deep sclerectomy).
Results
Both surgeries showed significant reduction of IOP all through the study period: in group A, mean reduction was 71.37%, 53.35%, 50.3%, and 44.33% at 1st day, 1 month, 3 months, and 6 months respectively, and in group B, mean reduction was 57.62%, 40.63%, 37.41%, and 31.68% at 1st day, 1 month, 3 months, and 6 months, respectively. Comparison between percentage of reduction in both groups showed no statistically significant difference. Also, use of anti-glaucoma medications dropped significantly at 6 months postoperatively in both groups with no significant difference between the 2 groups. Regarding reported complications, 12.9% in group A and 10.3% in group B presented with non-serious complications. One month postoperatively, UBM detected non-functioning blebs in 6.4% of group A and 3.4% in group B. Other cases with non-functioning blebs were detected at 3 and 6 months postoperatively, and all cases were managed.
Conclusion
Sutureless deep sclerectomy seems to be a safe and effective modification, with significant IOP reduction in POAG.
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Affiliation(s)
- Mohamed Sabry Kotb
- Ophthalmology Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, 11562, Egypt
| | - Shahenda Ahmed El Gharbawy
- Ophthalmology Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, 11562, Egypt
| | - Ahmed Mostafa Abdelrahman
- Ophthalmology Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, 11562, Egypt
| | - Hebatalla Samir Makled
- Ophthalmology Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, 11562, Egypt.
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Melchior B, De Moraes CG, Paula JS, Cioffi GA, Girkin CA, Fazio MA, Weinreb RN, Zangwill LM, Liebmann JM. Frequency of Optical Coherence Tomography Testing to Detect Progression in Glaucoma. J Glaucoma 2022; 31:854-859. [PMID: 35980865 PMCID: PMC9633358 DOI: 10.1097/ijg.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
PRCIS With high specificity and less variability than perimetry, more frequent testing resulted in shorter time to detect progression, though a 6-month testing interval provides a reasonable trade-off for following glaucoma patients using optical coherence tomography (OCT). PURPOSE To investigate the time to detect progression in glaucomatous eyes using different OCT test intervals. MATERIALS AND METHODS Participants with manifest glaucoma from the African Descent and Glaucoma Evaluation Study (ADAGES), a multicenter, prospective, observational cohort study, were included. A total of 2699 OCT tests from 171 glaucomatous and 149 normal eyes of 182 participants, with at least 5 tests and 2 years of follow-up, were analyzed. Computer simulations (n=10,000 eyes) were performed to estimate time to detect progression of global circumpapillary retinal nerve fiber layer thickness (cpRNFL) measured with OCT tests. Simulations were based on different testing paradigms (every 4, 6, 12, and 24 mo) and different rates of change (µm/year). Time to detect significant progression ( P <0.05) at 80% and 90% power were calculated for each paradigm and rate of cpRNFL change. RESULTS As expected, more frequent testing resulted in shorter time to detect progression. Although there was clear disadvantage for testing at intervals of 24 versus 12 months (~22.4% time [25 mo] increase in time to progression detection) and when testing 12 versus 6 months (~22.1% time [20 mo] increase), the improved time to detect progression was less pronounced when comparing 6 versus 4 months (~11.5% time [10 mo] reduction). CONCLUSION With high specificity and less variability than perimetry, a 6-month testing interval provides a reasonable trade-off for following glaucoma patients using OCT.
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Affiliation(s)
- Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carlos G De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Jayter S Paula
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | | | - Massimo A Fazio
- Department of Ophthalmology, University of Alabama-Birmingham, Birmingham, AL
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute University of California-San Diego, La Jolla, CA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute University of California-San Diego, La Jolla, CA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
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40
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Real-World Efficacy and Safety of Tafluprost in Primary Open-Angle Glaucoma Patients with Corneal Disorders: A Taiwan Experience. J Ophthalmol 2022; 2022:4885485. [DOI: 10.1155/2022/4885485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the efficacy and safety of switching to 0.0015% tafluprost ophthalmic solution with reduced benzalkonium chloride (BAK) on primary open-angle glaucoma (POAG) patients with corneal disorders under 0.005% latanoprost treatment. Material and Methods. This was a single-arm, open-label, switching study on adult POAG patients treated with latanoprost 0.005% for more than 3 months, with corneal disorders but no dry eye therapy. All patients were switched to tafluprost 0.0015% and followed up for 3 months. The primary outcome was the change in fluorescein staining score (National Eye Institute/Industry [NEI] score) at the end of the study. Secondary outcomes included changes in intraocular pressure (IOP), tear break-up time (TBUT), hyperemia score, and other ocular and nonocular adverse events. Results. Of the 20 patients initially enrolled, 17 patients, all with POAG, completed the study. At the end of the study, the mean NEI score significantly decreased by 1.8 ± 2.2 (
). No significant changes in IOP were observed (12.8 ± 4.6 mmHg at baseline vs. 12.3 ± 4.0 mmHg on visit 2;
). TBUT increased by 1.2 ± 1.7 seconds (
). The proportions of patients with no sign of hyperemia on the bulbar and palpebral conjunctiva increased from 58.5% to 64.7% at baseline (before switching to tafluprost treatment) to 94.1% and 94.1%, respectively, after switching to tafluprost treatment. Dry eye sensation scores were significantly reduced (
), while other ocular symptom scores did not change significantly. Conclusion. Switching to tafluprost 0.0015% significantly improved fluorescein staining score, TBUT, and conjunctival hyperemia while maintaining IOP control among POAG patients with corneal disorders.
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Yıldırım N, Bozkurt B, Yüksel N, Ateş H, Altan-Yaycıoğlu R, Ocakoğlu Ö, Burcu A, Yalvaç I, Kemer ÖE, Orhan M. Prevalence of Ocular Surface Disease and Associated Risk Factors in Glaucoma Patients: A Survey Study of Ophthalmologists. Turk J Ophthalmol 2022; 52:302-308. [PMID: 36317767 PMCID: PMC9631508 DOI: 10.4274/tjo.galenos.2021.20726] [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: 12/05/2022] Open
Abstract
OBJECTIVES This survey study of ophthalmologists investigated the prevalence and clinical manifestations of ocular surface disease (OSD) in glaucoma patients, assessment methods used, risk factors, glaucoma drugs considered responsible, and treatment approaches. MATERIALS AND METHODS A questionnaire prepared jointly by the Turkish Ophthalmological Association Cornea and Ocular Surface Society and Glaucoma Society using SurveyMonkey was sent to ophthalmologists via e-mail. The distribution of parameters was compared with chi-square test and p<0.05 was considered statistically significant. RESULTS Forty-five percent of the ophthalmologists reported that OSD was evident in least 25% of their patients. The most common symptom was redness (91.9%), while the most common ocular surface finding was conjunctival hyperemia (75.6%). The tests considered to be the most important in ocular surface assessment were ocular staining (38.7%) and tear film break-up time (TBUT) (21.9%). Ninety percent of the physicians stated that the main cause of OSD was benzalkonium chloride (BAC) in medications. Prostaglandin analogs and alpha-2 agonists were reported to be the most common medications causing OSD. In case of OSD, the ophthalmologists often switch to a glaucoma drug from a different group (38%), a non-preservative glaucoma drug (33.7%) or a drug with a preservative other than BAC (20.4%). Most physicians prescribed artificial tears (84.6%). CONCLUSION In this cross-sectional survey study, ophthalmologists detected varying rates of OSD in glaucoma patients depending on chronic drug use and BAC exposure. Although ocular surface examination was performed by physicians, tests such as TBUT and ocular surface staining were rarely used. Detecting OSD in glaucoma patients and planning personalized treatment increase patient comfort, drug compliance, and treatment effectiveness. For this reason, it is important to prepare an algorithm for the management of comorbid OSD in glaucoma patients.
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Affiliation(s)
- Nilgün Yıldırım
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey,* Address for Correspondence: Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey E-mail:
| | - Banu Bozkurt
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Nurşen Yüksel
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Turkey
| | | | | | - Özcan Ocakoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Ayşe Burcu
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Ilgaz Yalvaç
- Yeditepe University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Özlem Evren Kemer
- University of Health Sciences Turkey, Ankara City Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Mehmet Orhan
- Güven Hospital, Clinic of Ophthalmology, Ankara, Turkey
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42
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Lee D, Ha SJ. Long-term Effects of Latanoprost with Different Excipient Compositions on Intraocular Pressure, Hyperemia and Discomfort. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.9.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare the long-term effects of two preservative-free 0.005% latanoprost ophthalmic solutions with different excipient compositions on intraocular pressure (IOP), conjunctival hyperemia, and subjective ocular discomfort.Methods: The medical records of patients newly diagnosed with normal tension glaucoma or primary open angle glaucoma who started treatment using Xalost S® or Monoprost® were reviewed. IOP was measured with Goldmann applanation tonometry. Conjunctival hyperemia was measured with a Keratograph® 5M and subjective ocular discomfort was surveyed using a visual analog scale. Routine examinations were scheduled 1 week and 1, 3, 6, and 12 months after treatment. A generalized estimating equation was used to evaluate the changes of these parameters with time.Results: Xalost S® was used in 31 patients (60 eyes) and Monoprost® in 27 patients (50 eyes). The baseline characteristics were generally similar in the two groups with no significant differences. In the Xalost S® group, the IOP difference from baseline was significant at all time points (p < 0.001). However, in the Monoprost® group, after 1 month of treatment, the IOP difference decreased significantly (p = 0.054 at 1 week; p = 0.005 at 1 month; p < 0.001 after 1 month). Conjunctival hyperemia and subjective ocular discomfort did not differ significantly from baseline in either group.Conclusions: There was no significant difference in the frequency of side effects between the two drugs. The effect on the IOP drop was similar over time, but the initial IOP drop was greater in the Xalost S® group. This difference is presumed to be due to the different excipient compositions of the two drugs.
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43
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Sverstad A, Torheim EA, Jørstad ØK. A Multi-Lumen Glaucoma Stent With Titratable Pressure-Lowering Effect: A Proof of Concept Study. Transl Vis Sci Technol 2022; 11:20. [PMID: 36149647 PMCID: PMC9520513 DOI: 10.1167/tvst.11.9.20] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the feasibility of a glaucoma stent with a titratable pressure-lowering effect. Methods This was an in vitro study. We created a resin stent with a micro-precision three-dimensional printer. It represented a cylinder with one primary and two secondary lumina. The inner opening of each secondary lumen was sealed with a membrane. We used a surgical eye model to simulate implantation of the stent and a laser procedure analogous to argon laser trabeculoplasty (ALT) to ablate each membrane. To study the fluid dynamics, we used a high-precision syringe pump and measured the steady-state pressure for one, two, and three lumina in parallel at flow rates of 2.5, 5.0, and 10.0 µL/min. Results The stent could be implanted into the eye model and visualized in the anterior chamber angle. Coloring the membrane facilitated laser membranotomy, and a 0.1-second laser pulse with 250-mW power was enough to ablate one membrane. The steady-state pressure for one lumen increased linearly with increasing flow rate, in accordance with the Hagen–Poiseuille equation. Two and three lumina in parallel decreased the pressure by factors of 2.1 and 3.2, respectively, in accordance with the electronic–hydraulic analogy and Ohm's law applied to parallel resistors. Conclusions The study presents proof of concept for a glaucoma stent with multiple lumina, which can be separately opened with an ALT-like procedure to induce a predictable, stepwise increase in pressure-lowering effect. Translational Relevance The glaucoma stent in this experimental study can be reproduced in a biocompatible material and further studied in vivo.
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Affiliation(s)
- Alexander Sverstad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | - Øystein Kalsnes Jørstad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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44
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Biller ML, Müller M, Kohnen T. [How to … Nd:YAG iridotomy]. DIE OPHTHALMOLOGIE 2022; 119:970-972. [PMID: 36053315 DOI: 10.1007/s00347-022-01711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Marvin Lucas Biller
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Michael Müller
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Thomas Kohnen
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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45
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Glaucoma Treatment and Hydrogel: Current Insights and State of the Art. Gels 2022; 8:gels8080510. [PMID: 36005112 PMCID: PMC9407420 DOI: 10.3390/gels8080510] [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: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aqueous gels formulated using hydrophilic polymers (hydrogels) and those based on stimuli-responsive polymers (in situ gelling or gel-forming systems) attract increasing interest in the treatment of several eye diseases. Their chemical structure enables them to incorporate various ophthalmic medications, achieving their optimal therapeutic doses and providing more clinically relevant time courses (weeks or months as opposed to hours and days), which will inevitably reduce dose frequency, thereby improving patient compliance and clinical outcomes. Due to its chronic course, the treatment of glaucoma may benefit from applying gel technologies as drug-delivering systems and as antifibrotic treatment during and after surgery. Therefore, our purpose is to review current applications of ophthalmic gelling systems with particular emphasis on glaucoma.
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46
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Tumbocon JA, Wong TT, Sangapillai T, Yen YC, Park SW, Lim HH, Ruangvaravate N. A Pooled Assessment of Ocular Surface Disease After Switching from Preserved Prostaglandins to Tafluprost Across Six Countries in Asia. Clin Ophthalmol 2022; 16:2669-2676. [PMID: 35999967 PMCID: PMC9393018 DOI: 10.2147/opth.s372312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Preserved prostaglandin analogs (PGAs) have been linked to ocular surface disease (OSD). While the benefits of preservative-low (PL) or -free (PF) Tafluprost (Santen Inc., Japan) were reported in real-world studies in Western countries, this is the first study in Asia to assess the effectiveness and safety of switching from preserved PGA to PL or PF-Tafluprost. Methods We conducted a meta-analysis on studies that included adults (>18 years of age) with a Corneal Fluorescein Staining Score (CFS) >1. These individuals had switched to PL or PF-tafluprost after using a preserved PGA therapy for at least 3 months for glaucoma and were identified from Santen’s tafluprost study database. A total of six studies from South Korea, Philippines, Malaysia, Singapore, Thailand, Taiwan were pooled for analysis. Results An intraocular pressure (IOP) reduction of 5.9% (0.91 mmHg) was seen in 265 patients. However, this result was not statistically significant (95% CI: −3.64, 1.81; Figure 1). Among 132 patients, a 47.9% reduction in the CFS (95% CI: −3.65, −1.91) was seen. Tear film break-up (n=183) significantly increased by 1.06 seconds (95% CI: 0.65, 1.47). In 88 patients, the bulbar conjunctiva score decreased by −0.46 (95% CI: −0.81, −0.10) and palpebral conjunctiva score decreased by −0.42 (95% CI: −0.67–0.17). One or more new adverse reactions were reported in 3% of the individuals after switching. Conclusion Tafluprost IOP reduction is comparable to other PGAs, with significant improvements in the ocular surface and minimal adverse reactions which were already previously reported.
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Affiliation(s)
- Joseph Anthony Tumbocon
- Eye Institute, St. Luke’s Medical Center, Quezon City, Philippines
- Department of Ophthalmology, St. Luke’s Medical Center College of Medicine, Quezon City, Philippines
- Correspondence: Joseph Anthony Tumbocon, Eye Institute, St. Luke’s Medical Center, 279 E Rodriguez Sr. Ave, Quezon City, Metro Manila, 1112, Philippines, Email
| | - Tina T Wong
- Glaucoma Department, Singapore National Eye Centre, Singapore, Singapore
- Cataract & Comprehensive Ophthalmology Department, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | | | - Yung-Chang Yen
- Department of Ophthalmology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Sang-Woo Park
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hsien Han Lim
- Eye Centre, Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia
| | - Ngamkae Ruangvaravate
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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47
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Tekeli O, Köse HC. Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy. Turk J Ophthalmol 2022; 52:262-269. [PMID: 36017234 PMCID: PMC9421937 DOI: 10.4274/tjo.galenos.2021.25488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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48
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van Mechelen RJS, Wolters JEJ, Herfs M, Bertens CJF, Gijbels M, Pinchuk L, Gorgels TGMF, Beckers HJM. Wound Healing Response After Bleb-Forming Glaucoma Surgery With a SIBS Microshunt in Rabbits. Transl Vis Sci Technol 2022; 11:29. [PMID: 36018582 PMCID: PMC9428362 DOI: 10.1167/tvst.11.8.29] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose The PreserFlo MicroShunt is an innovative implant for the surgical treatment of glaucoma. Although usually effective, surgeries can still fail due to fibrosis. This study was conducted to gain insight into the histological aspects of the fibrotic response and find potential targets to reduce postoperative fibrosis. Methods Fifteen New Zealand White rabbits were implanted with a microshunt and followed up for 40 days. Animals were euthanized at postoperative days (PODs) 1, 5, and 40 to collect eyes for histological evaluation. Bleb formation and ocular health were assessed by slit-lamp (SL) biomicroscopy and optical coherence tomography (OCT). Intraocular pressure (IOP) was measured using rebound tonometry. Results Blebs failed after approximately 2 weeks based on bleb survival and IOP measurements. No severe complications were observed with OCT and SL. Histology revealed a wide variety of cells, in the bleb and around the microshunt, including polymorphonuclear leucocytes (PMNs), myofibroblasts, and foreign body giant cells, at different PODs. Conclusions Implantation of a poly(styrene-b-isobutylene-b-styrene) microshunt in rabbits resulted in the occurrence of a wide variety of cells during the wound-healing response. Future research should further elucidate the potential of these (earlier often overlooked) cells to target the fibrotic response in vivo—for example, by developing novel antifibrotic drugs, methods for sustained delivery of medications, or augmenting material properties. Translational Relevance Current antifibrotic therapies aim to inhibit myofibroblasts; however, a wide variety of cells are involved in the fibrotic response. Future research focusing on these cells could offer novel methods for reducing the fibrotic response after glaucoma surgery.
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Affiliation(s)
- Ralph J S van Mechelen
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Jarno E J Wolters
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Marjolein Herfs
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Christian J F Bertens
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Marion Gijbels
- Department of Pathology, Cardiovascular Research Institute Maastricht, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Theo G M F Gorgels
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Henny J M Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
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Yen CY, Chen CC, Tseng PC. Role of pilocarpine use following laser peripheral iridotomy in eyes with refractory acute angle closure glaucoma: A case report and literature review. Medicine (Baltimore) 2022; 101:e29245. [PMID: 35801778 PMCID: PMC9259105 DOI: 10.1097/md.0000000000029245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Angle closure glaucoma (ACG) is one of the most emergent types of glaucoma in clinical practice. Laser peripheral iridotomy (LPI) could minimize pupillary block and prevent ACG from an acute attack. However, recurrent increase in intraocular pressure (IOP) may still occur despite successful LPI. The aim of this study is to highlight the importance of postLPI pilocarpine use and larger LPI size as well as to share some experiences of cataract surgery in patients with ACG. PATIENT CONCERNS A 63-year-old female was referred to our hospital for headache, and poor control of IOP in the right eye for 3 hours. DIAGNOSES The patient was diagnosed ACG in the right eye. Recurrence of ACG in the right eye and new-onset and recurrent ACG in the left eye were noted during follow-up, despite successful LPI. The diagnosis was confirmed through slit lamp and gonioscope examination. INTERVENTIONS The LPI size was enlarged and pilocarpine use was maintained at 2% (1 drop 4 times a day) in both the eyes. Finally, cataract surgery was performed in both the eyes. OUTCOMES No recurrence of ACG was noted during postLPI pilocarpine use in both the eyes. The postoperative IOP was stable for >6 months after cataract surgery without any surgical intervention or antiglaucoma medication use. No discomfort or major complication was observed. CONCLUSION This report highlights the importance of postLPI pilocarpine use and larger LPI size in patients with refractory ACG.
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Affiliation(s)
- Chu-Yu Yen
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Chen Tseng
- Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- *Correspondence: Po-Cheng Tseng, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City 106, Taiwan, R.O.C. (e-mail: )
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50
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Faria BM, Costa VP, Melillo GHL, Daga FB, Scoralick ALB, Paranhos A, Kanadani FN, Prata TS. Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors. J Glaucoma 2022; 31:443-448. [PMID: 35353767 DOI: 10.1097/ijg.0000000000002025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. PURPOSE To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. PATIENTS AND METHODS A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. RESULTS A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. CONCLUSIONS GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.
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Affiliation(s)
- Bruno M Faria
- Department of Ophthalmology, Federal University of Rio Grande do Norte, Natal
| | | | - Gustavo H L Melillo
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland
| | - Fabio B Daga
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
| | - Ana L B Scoralick
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
| | - Fábio N Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Tiago S Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| |
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