Effect of prostaglandins and beta blockers on progression of hypertensive and normotensive glaucomas

Comparison of the Effect on Vessel Density and RNFL between Carteolol and Latanoprost

The aim of the study was to compare the treatment of hypertensive glaucoma (HTG) in the early stages with carteolol and latanoprost by assessing the change in vessel density (VD) and retinal nerve fibre layer (RNFL). Methods: The first group with diagnosed HTG consisted of 46 eyes treated with carteolol; the second group consisted of 52 eyes treated with latanoprost. The following examinations were evaluated in all patients: intraocular pressure (IOP), retinal nerve fibre layer (RNFL), vessel density (VD) and visual field examination (glaucoma fast threshold test). The results were compared before treatment and 3 months after treatment. Results: There was no difference in the overall visual field defect (OD) between groups before treatment. After treatment, there was a decrease in IOP in both groups (carteolol-treated group had a mean decrease of 5.8 mmHg and latanoprost-treated eyes had a mean decrease of 7 mmHg). This difference was not statistically significant (p = 0.133). No similar difference was observed for RNFL (p = 0.161). In contrast, the change in the VD parameter was statistically significant between groups (p < 0.05), with a greater difference observed in the carteolol-treated group of eyes. Carteolol had a better effect on the VD.

HIGHLIGHTS OF HYPERTENSIVE AND NORMOTENSIVE GLAUCOMA

The paper presents the up-to-date overview of pathogenesis, functional and structural changes in normotensive glaucoma (NTG) and its differences from hypertensive glaucoma (HTG). The autors point out new facts that distinguish both diagnostic groups. In the first place are the results of OCT angiography, which verify the pathology of NTG to the anterior part of optic nerve. Our findings confirmed that vascular component (VD) is more involved in changes of visual field than in perfusion parameters, especially in arteria ophtalmica (AO). Perfusion in arteria centralis retinae (ACR) does not play a significant role in NTG changes in the visual field. VD has very little effect on changes in visual field in HTG. Similarly, the retinal nerve fiber layer (RNFL) for changes in the visual field. Howerver, VD is moderately influenced by changes in RNFL. It should be emphasized that we compared the sum of sensitivity in the central part of the visual field (0-22 degrees) with RNFL and VD. In NTG, the anterior part of the optic nerve is altered. Mainly VD contributes to visual filed changes in NTG. It is also important to note that when the intraocular pressure (IOP) increased above 20 mm Hg, the macular and papillary VD was significantly reduced. Antiglaucomatous treatment with prostaglandins and beta-blockers is essential for the reduction of IOP in HTG. This reduction shoud be bellow 20 mm Hg, in eyes with thinner cornea the decrease in IOP should be more pronounced. It does not matter which antiglaucoma treatment was used. However, it should be noted that prostaglandins have a greater effect on disease progression, but the greater protective effect on the visual field have beta-blockers. Neuroprotectives should be recommended systemically in patients with HTG. When treating NTG, it is important to maintain blood flow of the posterior pole of the eye, but mainly of the anterior part of the optic nerve. Prostaglandins are not suitable in NTG patients, although their effect on IOL reduction is high. Beta-blockers (betaxolol and carteol) and brimonidine are most suitable. Corneal thickness has no effect on disease progression.

OCT ANGIOGRAPHY, VISUAL FIELD AND RNFL WITH VARIOUS MEDICATIONS IN HYPERTENSIVE GLAUCOMAS

AIM

The aim of the study was to determine whether hypertensive glaucoma (HTG) with different types of treatment leads to significant damage in any of the evaluated parameters.

SAMPLE AND METHODOLOGY

The sample, consisting of 36 HTG patients (72 eyes), was divided into three subgroups: In the first group, patients were treated with combination therapy (latanoprost + timolol, latanoprost + dorzolamide + timolol, dorzolamide + timolol). The group consisted of seven women and five men, with an average age of 64 years (49-81). In the second group, patients were treated with beta-blockers (carteolol, betaxolol, timolol). The group consisted of five women and five men, with an average age of 62 years (27-77). In the third group, patients were treated with prostaglandins (latanoprost, bimatoprost). The group consisted of eleven women and three men, with an average age of 61 years (61-78). Criteria for inclusion in the study were visual acuity of 1.0 with a possible correction of less than ±3 dioptres, approximately the same changes in the visual fields of all patients, an intraocular pressure (IOP) of less than 18 mmHg, and no other ocular or neurological disease. The retinal nerve fibre layer (RNFL) on the optic nerve target and vessel density (VD) was measured using an Avanti RTVue XR from Optovue. We determined the values of VD in whole image (WI) and VD of peripapillary (PP). In both cases, we then measured all vessels (VDa) and small vessels (VDs). The visual field was examined by means of a fast threshold glaucoma program with a Medmont M 700 instrument. In addition to the sum of sensitivities in apostilbs (asb) in the range of 0-22 degrees, the overall visual field defect (OD) was also evaluated. The statistical analysis was carried out using a multivariate regression model with adjustment for age and gender. The measured values of the third group were taken as baseline.

RESULTS

In the statistical analysis, we have found differences in visual field in the combination treatment group (p = 0.0006) and differences were recorded for RNFL in the beta-blocker group (p = 0.04).

Optical coherence tomography angiography and the visual field in hypertensive and normotensive glaucoma

BACKGROUND

Hypertensive glaucoma (HTG) causes damage to the retinal ganglion cells and eventually to the entire visual pathway due to high intraocular pressure (IOP). However, increased IOP will also affect the vessel density (VD) of the posterior pole of the eye and the related retinal ganglion nerve fibres (RNFL). In normotensive glaucoma (NTG), the retinal ganglion cells are relatively intact. The pathology is at the level of ganglion fibres. The unanswered question is what has altered ganglion cell fibres at the level of the retina and optic nerve head in NTG?

AIM

The aim of this study was to determine whether there is a correlation between the retinal nerve fibre layer (RNFL) and vessel density (VD) at the same altitudinal half of the retina and the sum of sensitivities of the contralateral half of the visual field of the same eye in hypertensive and normotensive glaucoma (NTG).

METHODS

Our group included 20 patients with HTG and 20 patients with NTG. The Pearson's correlation coefficient r was used for evaluation of the relationship of the peripapillary RNFL and VD, visual field (using the fast threshold glaucoma program) as the sum of sensitivities in apostilbs (asb) to the extent of 0-22 degrees. The results of sensitivity were compared with the RNFL and VD of the contralateral altitudinal half of the retina in the same eye.

RESULTS

In the HTG group there was a moderate relationship between RNFL and VD (both hemifields), but no relationship between RNFL and VF. VD SH and VF IH showed weak correlation and VD IH and VF SH showed no correlation. In patients with NTG, we found a strong correlation between RNFL and VD (both hemifields), between VD SH and VF IH a moderate correlation, between VD IH and VF SH also a moderate correlation and a weak correlation between RNFL and VF.

CONCLUSION

By comparing the RNFL and VD at the same altitudinal halves of the retina, we found a moderate correlation in HTG and a strong correlation in NTG. We found no or a weak correlation between VD and VF in HTG. In NTG the relationship between VD and VF showed a strong correlation. These findings reveal the differences in the diagnostic groups.

Betaxolol, Brimonidin and Carteolol in the Therapy of Normal-Tension Glaucoma

PURPOSE

The purpose of the study was to evaluate influence of betaxolol, brimonidine and carteolol in the progression of the visual field defects during time at patients with normotensive glaucoma (NTG).

MATERIALS AND METHODS

This study included (60 eyes of) 30 patients with NTG. First group consisted of 20 eyes of 10 patients of the average age of 58.5 years, who were treated by betaxolol. Second group also consisted of 20 eyes of 10 patients of the average age of 62.6 years and they were treated by brimonidine. Third group had the same count of the eyes and patients, the average age was 61.1 years and these patients were treated by carteolol. Diagnose of NTG was based on the comprehensive ophthalmological examination including electroretinography and visual evoked potentials. Visual fields were examined by fast threshold glaucoma test using Medmont M700 device. We compared pattern defect (PD) in the visual field for 3 years. The including criteria were: similar visual field findings at the beginning of the study, stable eye therapy (treatment was not changed during the study), uncorrected or best corrected (up to +-3 D) visual acuity of 1,0 of ETDRS, intraocular pressure between 10-15 mm Hg, if present, then compensated cardiovascular disease, no other internal or neurological disorders.

RESULTS

We didnt notice any statistically important difference of PD. The study revealed that brimonidin (p=0,99) and betaxolol (p = 0,81) had the best effect.

CONCLUSION

Local therapy of betaxolol, brimonidine and carteolol has an essential clinical value in normotensive glaucoma. All the mentioned treatments had a protective effect on the visual field. However, local side-effects of brimonidinu are a question.