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

Purpose:

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

Methods:

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

Results:

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

Conclusion:

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

The effects and safety of intravitreal triamcinolone injections in the treatment of diabetic macular edema

BACKGROUND

Diabetic macular edema (DME) is responsible for three-quarters of vision-loss cases in diabetic eye disease. In most cases, early treatment by laser photocoagulation can only stabilize vision. Glucocorticoids have been used as a local pharmacological treatment in DME when the inflammation seems to have a pathological background.

OBJECTIVES

The aim of the study was to establish the effectiveness and safety of intravitreal triamcinolone injections in the treatment of DME.

MATERIAL AND METHODS

Twenty mg intravitreal injections of triamcinole acetonide (IVTA) were applied to 110 DME patients after ineffective laserphotocoagulation or as an initial treatment. Best corrected visual acuity (BCVA) for distant and near vision, central retinal thickness and intraocular pressure (IOP) were analyzed before and after the treatment at intervals of 1 week, 1 month, 3 months and 6 months. The measurements were continued in cases of repeated IVTA.

RESULTS

Statistically significant improvements were observed in BCVA in near and distant vision, as well as a decrease in central retinal thickness after all time-intervals following IVTA. BCVA in distant vision was not significantly improved after repeated IVTA. IOP increases were observed 1 week, 1 and 3 months after IVTA, but not at 6 months after IVTA. No sight-threatening side effects of IVTA were observed.

CONCLUSIONS

IVTA is useful in stabilizing DME progression, although its therapeutic effect may be timelimited.

Acute retinal necrosis--a case report

Acute retinal necrosis (ARN) is a rare but very severe form of retinitis. In contrast to progressive outer retinal necrosis acute retinal necrosis typically affects immunocompetent individuals. Herpes Simplex and Varicella-zoster viruses play the main role in the development of the disease. We report a case study of a healthy, young male who presented to the ophthalmologist with unilateral visual acuity decrease and eye irritation. The acute retinal necrosis was diagnosed and a therapy was started including both systemic and local anti-viral agents, as well as an oral anticoagulant. Additional systemic steroid therapy was introduced a week later. The regression of retinal inflammatory changes and the improvement of visual acuity were observed. The polymerase chain reaction assay for the presence of viral DNA in serum was negative. The IgM antibody assay for potential causal pathogens was negative, but the level of Varicella-zoster virus IgG antibodies was markedly elevated. During the follow-up, the patient developed retinal detachment and pars plana vitrectomy with silicone oil endotamponade was performed. Although the surgery resulted in the successful retinal reattachment, the final visual acuity remained decreased. Six months after the surgery, the eye was free of the intraocular inflammation and the visual acuity slightly improved.

Quantitative assessment of placental vasculature and placental volume in normal pregnancies with the use of 3D Power Doppler

PURPOSE

The aim of the study was to determine reference values for placental vascular indices and placental volume according to gestational age.

MATERIAL/METHODS

The assessment of placental vascular indices and placental volume using 3D Power Doppler and the Virtual Organ Computer-aided Analysis (VOCAL) technique was performed on 100 normal fetuses between 22 and 41 weeks of gestation. In this study the method of the individual setting of the power Doppler gain value was used. Only patients with entirely visualized placenta were included in the study.

RESULTS

No statistically relevant difference in the values of placental vascular indices and placental volume between different localizations of the placenta was detected. No statistically significant changes to placental vascular indices depending on gestational age were found. It enabled to determine the 10th, 50th and 90th percentile values for the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), which are independent of gestational age. No correlation was found between placental volume and placental vascular indices.

CONCLUSIONS

The values of placental vascular indices are constant between the 22nd and 41st week of a normal pregnancy. Placental volume measured with the use of the VOCAL program increases between 22nd and 41st week of a normal pregnancy. In a normal pregnancy the placental vasculature increases adequately to the increase of its volume. The method of the individual setting of the power Doppler gain value makes it possible to achieve comparable values of placental vascular indices regardless of the distance between the probe and the placenta.

Application of optical coherence tomography in glaucoma suspect eyes

PURPOSE

  The aim of the study was to compare the optical coherence tomography (OCT) parameters of the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) and to identify which measurements are best able to differentiate between normal and glaucoma suspect eyes.

METHODS

  The study included 27 eyes with ocular hypertension (OHT), 33 eyes with pre-perimetric glaucoma (PG), 30 perimetrically unaffected eyes of patients with glaucoma in the fellow eye (FE) and 58 eyes of age-matched normal volunteers. All subjects underwent a complete eye examination with standard automated perimetry, optic disc photography and OCT imaging. Peripapillary 'fast RNFL thickness scans' and 'fast optic disc scans' were performed with time-domain OCT. The ONH and RNFL parameters were compared among the four study groups. The ONH and RNFL parameters were examined alone and then combined via four linear discriminant functions (LDF): LDF 1, the optimal combination of ONH parameters; LDF 2, the optimal combination of RNFL parameters; LDF 3, the optimal combination of both ONH and RNFL parameters; and LDF 4, the optimal combination of the best 11 parameters. The areas under the receiver operating curves (AUC) and the sensitivity at fixed specificity of at least 80 and 95 per cent were calculated for single parameters and LDF combinations and then compared. The best 11 parameters were selected based on their AUC values.

RESULTS

  Comparative analysis of OCT parameters revealed statistically significant differences in all seven ONH parameters in both PG and FE groups (and only in one ONH measurement in the ocular hypertensive group) when compared with normal eyes. Most of the RNFL parameters demonstrated statistically significant differences in all of the study groups when compared with the control group. The max-min parameter (0.835), inferior quadrant (0.833) and average RNFL thickness (0.829) obtained the highest AUC values in the whole glaucoma suspect group. The rim area had the best diagnostic accuracy among the ONH parameters (AUC = 0.817). The AUC values of the four LDF were: 0.825 (LDF 1), 0.882 (LDF 2), 0.902 (LDF 3) and 0.888 (LDF 4). Statistically significant differences were found between the AUC values of the single best ONH and RNFL parameters and LDF 3 and LDF 4.

CONCLUSIONS

  In the present study, RNFL parameters presented with better discriminatory abilities than ONH parameters in the OHT and FE groups. The ONH parameters demonstrated better diagnostic precision in differentiating between PG and normal eyes. The average RNFL thickness, max-min parameter and inferior quadrant RNFL thickness had the best abilities among single OCT measurements for discriminating between glaucoma suspect (including all ocular hypertensive, PG and FE eyes) and normal eyes. The combination of RNFL parameters only or both ONH and RNFL parameters, using linear discriminant analysis, provided the best classification results, improving the diagnostic accuracy of the instrument.

TEM investigation of reaction zone products formed between molten Al and CoO monocrystalline substrate

The research was aimed at microstructure characterization of the reaction products formed between molten aluminium and CoO single crystal during a sessile drop wettability test performed in vacuum at 700 and 1000 degrees C for 120 min using contact heating procedure. The solidified Al/CoO couples were sectioned and used for cutting thin foils with focused ion beam. The transmission electron microscopy and energy dispersive X-ray spectroscopy were used for microstructure and local chemical analysis. The interaction of molten aluminium with CoO substrate at 700 degrees C caused the formation of a corrugated 10-40 microm thick reaction zone (RZ). It consisted of aluminium matrix and Al(2)O(3) crystallites varying in size, i.e. of approximately 0.2 microm near the Al drop/RZ interface, growing up to 1-2 microm at the RZ centre and very fine nano-crystallites near the RZ/CoO interface. The reaction of aluminium with CoO at 1000 degrees C produced much thicker RZ of approximately 280 microm characterized by layered microstructure of alternating fine crystalline Al(2)O(3) and coarser Al(13)Co(4) layers. Moreover, at the RZ/CoO interface the presence of a cobalt layer was also identified.

Liposarcoma of the uterine corpus coexisting with preinvasive cervical cancer--a case report

Case report of isolated liposarcoma of the uterine corpus coexisting with preinvasive cervix cancer in 71-year-old woman, who 41 years ago underwent the enucleation of the uterine corpus myomas. In tumor histogenesis the malignant transformation of fat cells, which might have been previously transferred to myometrium, was taken into consideration. The 8 year long follow-up revealed neither recurrence nor metastases.