"Selective Laser Trabeculoplasty as a Substitute for Medications in Patients with Mild-to-moderate Glaucoma in the Brazilian Public Health System"

PRCIS

Selective laser trabeculoplasty can be used as a substitute for medications in patients with mild-to-moderate glaucoma, reducing the cost of eye drop distribution in the Brazilian public health system.

PURPOSE

To observe the effectiveness of selective laser trabeculoplasty (SLT) as a substitute for eye drops in patients with open-angle glaucoma in the Brazilian Public Health System.

MATERIALS AND METHODS

SLT was performed bilaterally after medication washout. This is a prospective interventional study, comparing intraocular pressure (IOP) when using eye drops, at baseline (post-washout), and at 12-month follow-up, after SLT. Medication was added if the target IOP was not achieved, following the Brazilian Public Health System eye drops protocol, based on medication costs. Absolute (without eye drops) and qualified (with eye drops) success were measured with IOP ≤ 21, IOP ≤ 18, IOP ≤ 15 and IOP ≤ 12 mmHg. Besides IOP evolution, ability to reduce IOP (in %), and eye drops reduction were evaluated.

RESULTS

92 eyes of 46 patients were included, 70 eyes with mild glaucoma and 22 with moderate glaucoma, mean number of eye drops 2.26±1.06 (82.6% were using a prostaglandin analogue) and post-washout IOP of 21.10±5.24 mmHg. There was relative success at IOP ≤18 mmHg, where the mild group had greater success than the moderate group (88.1% vs. 71.4%, P=0.824). The average IOP reductions were 23.04% and 25.74% at 6 and 12 months, respectively. The average number of eye drops was 1.02, with 1.1% using a prostaglandin analogue. Furthermore, 68.19% of the patients had a decrease in the quantity of eye drops used.

CONCLUSION

SLT is effective in reducing IOP and replacing eye drops in patients in the Brazilian Public Health System. Moreover, there was a significant reduction in the use of prostaglandin analogues.

The influence of topical anesthetic and fluorescein on non-contact tonometry measurements using ultra-high-speed dynamic Scheimpflug

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.

Comparison of the hypotensor effect between latanoprost versus selective laser trabeculoplasty obtained with the water drinking test

PURPOSE

Glaucoma is the main cause of irreversible blindness worldwide. Peak intraocular pressure is one of the main risk factors for glaucoma progression, and intraocular pressure reduction remains the only therapeutic strategy for all types of glaucoma. The main purpose of our study was to compare the baseline and peak intraocular pressure reduction obtained with the water drinking test between the two eyes of the same patients using 0.005% latanoprost in one eye and selective laser trabeculoplasty application in the contralateral eye.

METHODS

This was a prospective, interventional, longitudinal, and randomized clinical trial, in which 30 consecutive glaucomatous patients, medically controlled using latanoprost monotherapy, were recruited from a single ophthalmological center. The patients' eyes were randomized, and one eye was selected for SLT treatment and topical 0.005% latanoprost was introduced in the contralateral eye. The baseline intraocular pressure and peak intraocular pressure were evaluated 1 month (water drinking test 2) and 6 months (water drinking test 3) after treatment.

RESULTS

There was no significant difference between the mean pre-washout intraocular pressure in the randomized eyes for selective laser trabeculoplasty and latanoprost (13.6 ± 2.1 and 13.3 ± 1.8 mmHg, respectively; p=0.182). Regarding baseline intraocular pressure, there was no significant difference in the water drinking test 2 (p=0.689) and water drinking test 3 (p=0.06) between the groups. There was no significant difference in the intraocular pressure peak between the SLT and latanoprost groups at water drinking test 2 (p=0.771) or water drinking test 3 (p=0.774).

CONCLUSIONS

The intraocular pressure reduction efficacy is similar between latanoprost and selective laser trabeculoplasty. Glaucomatous patients who are medically controlled with latanoprost and switch treatment to selective laser trabeculoplasty maintain control of intraocular pressure.

Catalytic Chemoselective O-Phosphorylation of Alcohols

Phosphorylation of alcohols is a fundamentally important reaction in both life science and physical science. Product phosphate monoesters play key roles in living organisms, natural products, pharmaceuticals, and organic materials. Most of the chemical methods to date for synthesizing phosphate monoesters, however, require multistep sequences or are limited to specific types of substrates possibly due to harsh conditions. An alternative way to enable the simple production of phosphate monoesters from highly functionalized precursor alcohols is, thus, highly desired. We report herein a catalytic phosphorylation of alcohols with high functional group tolerance using tetrabutylammonium hydrogen sulfate (TBAHS) and phosphoenolpyruvic acid monopotassium salt (PEP-K) as the catalyst and phosphoryl donor, respectively. This method enables the direct introduction of a nonprotected phosphate group to the hydroxy group of a diverse menu of alcohol substrates, including functionalized small molecules, carbohydrates, and unprotected peptides. Nuclear magnetic resonance, mass spectrometric, and density functional theory analyses suggest that an unprecedented mixed anhydride species, generated from PEP-K and TBAHS, acts as an active phosphoryl donor in this reaction. This operationally simple and chemoselective catalytic phosphorylation allows for the efficient production of densely functionalized O-phosphorylated compounds, which are useful in diverse fields including biology and medicine.

The effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of optic disk topography in patients with diabetic retinopathy

PURPOSE

To determine the effect of panretinal photocoagulation on optic disk topographic parameters in non-glaucomatous patients with proliferative diabetic retinopathy.

METHODS

This was a prospective, single-center, observational study. Thirty-eight eyes of 26 patients with diabetes underwent panretinal photocoagulation for proliferative diabetic retinopathy. Stereoscopic disk photographs and optic nerve head parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscope (Heidelberg Retinal Tomograph), respectively, at baseline and 12 months after the completion of panretinal photocoagulation.

RESULTS

Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 (range 26-74) years were recruited. No significant difference was found between the stereo photography determined mean horizontal and vertical cup-to-disk ratio before and after panretinal photocoagulation treatment (p=0.461 and 0.839, respectively). The global values of the optic nerve head parameters analyzed with the HRT3 showed no significant change from baseline to 12 months, including the disk area, cup area, rim area, cup volume, rim volume, cup-to-disk area ratio, linear cup-to-disk ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and cross-sectional area.

CONCLUSION

Our results suggest that panretinal photocoagulation does not cause morphological optic disk changes in patients with diabetic proliferative retinopathy after 1 year of follow-up.

Effect of panretinal photocoagulation on the peripapillary retinal nerve fiber layer in diabetic retinopathy patients

OBJECTIVES

To determine the effect of panretinal photocoagulation (PRP) on the peripapillary retinal nerve fiber layer (RNFL) in nonglaucomatous patients with proliferative diabetic retinopathy (PDR).

METHODS

This is a prospective, single center, observational study. Thirty-eight eyes of 26 diabetic patients underwent PRP for proliferative diabetic retinopathy. Peripapillary RNFL thickness was measured using scanning laser polarimetry (SLP) with variable corneal compensation (GDx VCC; by Carl Zeiss Meditec, Dublin, CA) and spectral-domain optical coherence tomography (OCT) (Heidelberg Spectralis, Carlsbad, USA) at baseline and 12 months after PRP was performed.

RESULTS

Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 years (range 26 to 74 years) were recruited. No significant difference was found among all RNFL thickness parameters tested by GDx VCC software (p=0.952, 0.464 and 0.541 for temporal-superior-nasal-inferior-temporal (TSNIT) average, superior average, inferior average, respectively). The nerve fiber indicator (NFI) had a nonsignificant increase (p=0.354). The OCT results showed that the average RNFL thickness (360° measurement) decreased nonsignificantly from 97.2 mm to 96.0 mm at 1 year post-PRP (p=0.469). There was no significant difference when separately analyzing all the peripapillary sectors (nasal superior, temporal superior, temporal, temporal inferior, nasal inferior and nasal thickness).

CONCLUSION

Our results suggest that PRP, as performed in our study, does not cause significant changes in peripapillary RNFL in diabetic PDR patients after one year of follow-up.

Clinical relevance of protruded retinal layers in minimum rim width measurement of the optic nerve head

BACKGROUND/AIMS

Optical coherence tomography (OCT) imaging of the optic nerve head minimum rim width (MRW) has recently been shown to sometimes contain components besides extended retinal nerve fibre layer (RNFL). This study was conducted to determine whether excluding these components, termed protruded retinal layers (PRLs), from MRW increases diagnostic accuracy for detecting glaucoma.

METHODS

In this cross-sectional study, we included 123 patients with glaucoma and 123 normal age-similar controls with OCT imaging of the optic nerve head (24 radial scans) and RNFL (circle scan). When present, PRLs were manually segmented, and adjusted MRW measurements were computed. We compared diagnostic accuracy of adjusted versus unadjusted MRW measurement. We also determined whether adjusted MRW correlates better with RNFL thickness compared with unadjusted MRW.

RESULTS

The median (IQR) visual field mean deviation of patients and controls was -4.4 (-10.3 to -2.1) dB and 0.0 (-0.6 to 0.8) dB, respectively. In the 5904 individual B-scans, PRLs were identified less frequently in patients (448, 7.6%) compared with controls (728, 12.3%; p<0.01) and were present most frequently in the temporal sector of both groups. Areas under the receiver operating characteristic curves and sensitivity values at 95% specificity indicated that PRL adjustment did not improve diagnostic accuracy of MRW, globally or temporally. Furthermore, adjusting MRW for PRL did not improve its correlation with RNFL thickness in either group.

CONCLUSION

While layers besides the RNFL are sometimes included in OCT measurements of MRW, subtracting these layers does not impact clinical utility.

Effect of Bacillus subtilis C-3102 on loose stools in healthy volunteers

Ingestion of Bacillus subtilis C-3102 spores (C-3102) has relieved the symptoms of diarrhoea in piglets and changed the composition of gut microbiota in humans. Recently, it was suggested that the composition of the human gut microbiota affects stool consistency. In this study, a double-blind, randomised, placebo-controlled trial was conducted to assess the preventive effects of chronic diarrhoea in healthy volunteers with loose stools by ingestion of C-3102. The results showed that oral doses of C-3102 tablets significantly decreased the Bristol Stool Scale score and stool frequency, and also significantly improved abdominal sounds. With regard to gut microbiota, the relative abundance of Lachnospira, Actinomyces and SMB53 were significantly changed. This study shows that C-3102 could be effective for treating loose stools (Trial registration: UMIN000022583, http://tinyurl.com/ya4refqn ).

Applications of the water drinking test in glaucoma management

Intraocular pressure (IOP) peaks and means have been considered important factors for glaucoma onset and progression. However, peak IOP detection depends only on appropriated IOP checks at office visits, whereas the mean IOP requires longitudinal IOP data collection and may be affected by the interval between visits. Also, IOP peak assessment is necessary to verify if the peak pressure of a given patient is in target range, to evaluate glaucoma suspect risk, the efficacy of hypotensive drugs and to detect early loss of IOP control. The water-drinking test has gained significant attention in recent years as an important tool to evaluate IOP peaks and instability. The main objective of this review was to present new findings and to discuss the applicability of the water-drinking test in glaucoma management.

Studies of Pig Complement: Measurement of Pig CH50, ACH50, and Components

BACKGROUND

On the basis of a comparison of the hemolytic complement titer in pigs with that in humans, the complement system of pigs was investigated. The response of innate immunity, such as the natural antibodies, against humans was also examined.

METHODS

Hemolytic complement activity of pig serum was measured with the use of a microtitration technique. CH50 was determined according to the method of Mayer. ACH50 was assayed according to the methods of Platts-Milles and Ishizaka. Hemolytic activities of C1, C4, C2, C3, C5, C8, and C9 were estimated through the use of intermediate cells and reagents, as described previously. In addition, the pig natural anti-human antibody was studied with the use of human peripheral blood mononuclear cells (PBMCs). Human PBMCs were stained with 5% pig serum, followed by staining with fluorescein isothiocyanate-labeled goat anti-pig IgG and IgM. The resulting stained cells were quantified by use of a FACScalibur system. The alternative pathway of pig complement was also measured with the use of human erythrocytes and normal pooled pig serum with or without Mg(++)EGTA.

RESULTS

Both the CH50 and ACH50 titers were lower than those of humans. Concerning the components, except for C3, each component, that is, C1, C4, C2, C5, C8, and C9, was also lower than that of humans, based on measured values for human complement components. Pig serum clearly contains natural antibodies, IgG and IgM, to human PBMCs. The alternative pathway of pig complement reacted with human erythrocytes.

CONCLUSIONS

As a whole, pig innate immunity, the complement system and natural antibody, recognizes the surfaces of human cells.

Choroidal thickness variation in highly myopic eyes during the water drinking test

PURPOSE

To evaluate variations in choroidal thickness (CT) during the water drinking test (WDT) in emmetropic eyes (EE) and highly myopic eyes (ME) using spectral-domain optical coherence tomography (SD-OCT).

METHODS

Clinical trial performed at a tertiary care hospital comprising 30 randomly selected eyes. The WDT and SD-OCT macular scans were performed 10 and 45 min after water ingestion in 15 myopic and 15 EE of 15 healthy patients in each group. Primary study outcomes were average macular CT measured by SD-OCT and intraocular pressure (IOP) during the WDT.

RESULTS

The mean spherical equivalent refraction was 0.15 ± 0.24 D in emmetropic and -7.1 ± 1.75 D in ME (p<0.001). No statistical differences between EE and ME were observed during the WDT response. EE had higher CT compared with ME at the fovea (361.4 ± 55.4 vs 257.9 ± 95.3; p<0.001), 3 mm nasal to the fovea (158.0 ± 71.8 vs 122.5 ± 54.5; p =0.047), and 3 mm temporally to the fovea (310.6 ± 52.4 vs 247.6 ± 90.1; p=0.05). Regarding CT variation, significant differences in foveal CT at 10 min after water ingestion were observed in both EE and ME, with no statistically significant difference observed between groups. A moderate correlation between IOP peak during the WDT and CT was demonstrated in ME (r=0.52; p=0.04).

CONCLUSIONS

No statistically significant differences in CT variation during the WDT were observed between EE and ME, indicating similar behavior of the choroidal bed during the WDT in both groups. Further, CT was thinner in highly ME, with CT variation unable to explain elevations in IOP observed during the WDT.

The role of pattern-reversal electroretinography in the diagnosis of glaucoma

Pattern electroretinography is used to assess the function of the inner retinal layers, particularly the retinal ganglion cell layer, using a reversing checkerboard or grating pattern that maintains a constant overall mean luminance over time. A normal transient response comprises a positive component of the wave (P50) followed by a longer negative component of the wave (N95). Glaucomatous optic neuropathy causes progressive loss of retinal ganglion cells, potentially detectable as abnormalities on examination, particularly in the N95 component. Therefore, pattern electroretinography may be useful in the diagnosis and evaluation of glaucoma. The present article is an updated review of published data regarding the use of pattern electroretinography for the detection of glaucoma-induced retinal changes.

Reproducibility of the water drinking test in treated glaucomatous patients

BACKGROUND

To evaluate the reproducibility of intraocular pressure peaks and fluctuation elicited during the water drinking test in treated glaucomatous patients with a long follow-up interval.

DESIGN

Retrospective cohort study in a tertiary care practice.

PARTICIPANTS

Thirty-four treated primary open-angle glaucoma patients.

METHODS

All patients underwent the water drinking test performed in two consecutive visits without any change in the therapeutic regimen. The mean interval between tests was 4.85 (range: 3-6) months. Reproducibility of peak and fluctuation during the water drinking test was assessed using intraclass correlation coefficients. Bland-Altman analysis was used to assess the agreement of intraocular pressure peaks and fluctuation measured between two consecutive tests.

MAIN OUTCOME MEASURES

Intraclass correlation and agreement of intraocular pressure peaks and fluctuation between visits.

RESULTS

There were no significant differences in baseline intraocular pressure values (mean ± standard deviation, 11.73 ± 2.36 and 11.61 ± 2.71 mmHg; P = 0.72) and peaks (14.55 ± 3.41 and 15.02 ± 3.66 mmHg, respectively; P = 0.163) detected during the water drinking test between the first and second visits. There was also no significant difference between the average intraocular pressure fluctuation values (2.82 ± 1.99 and 3.41 ± 2.54 mmHg, respectively; P = 0.135). Intraocular pressure peaks and fluctuation presented intraclass correlation coefficients of 0.85 (P < 0.001) and 0.50 (P < 0.001), respectively.

CONCLUSIONS

Our results demonstrate excellent reproducibility of intraocular pressure peaks during the water drinking test. Intraocular pressure fluctuation did not reveal good reproducibility, though. These results emphasize the applicability of this test to assess treatment efficacy in daily practice and interventional studies.

Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy

Objective

To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM–FC) in patients not achieving the target IOP of ≤18 mmHg while on timolol 0.5% (TIM) monotherapy.

Methods

A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19–35 mmHg in ≥1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM–FC was initiated and administered once daily at 8 pm for 4–6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance).

Results

A total of 49 patients were enrolled (mean age, 63 [range, 42–82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM–FC was 31 days. Mean ± standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM–FC) was −5.0±3.6 mmHg. IOP decreased significantly (P<0.0001) from baseline (22.1±2.6 mmHg) to study end (17.1±3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP ≤18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs.

Conclusions

TRAV/TIM–FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP ≤18 mmHg with TRAV/TIM–FC. TRAV/TIM–FC was well tolerated in this population.

Influence of Bacillus subtilis C-3102 on microbiota in a dynamic in vitro model of the gastrointestinal tract simulating human conditions

Survival and germination rate of Bacillus subtilis C-3102 spores were investigated in a stomach and small intestine model (TIM-1), while the impact of C-3102 cells that had passed through TIM-1 on human colon microbiota was evaluated in a model of the large intestine (TIM-2). The survival of C-3102 spores in TIM-1 was 99%; 8% of the spores had germinated. Effluent of TIM-1 was subsequently introduced into TIM-2 and a micro-array platform was employed to assess changes in the microbiota composition. The effluent, which contained germinated C-3102 cells, increased some Bifidobacterium species and decreased some Clostridium groups. These changes were greater compared to those obtained by adding C-3102 spores directly to TIM-2. The present study suggests that oral doses of B. subtilis C-3102 spores have the potential to modulate the human colon microbiota. This effect may be caused by germination of the spores in the gastrointestinal tract.

Reproducibility of intraocular pressure peak and fluctuation of the water-drinking test

BACKGROUND

The water-drinking test has been used as a stress test to evaluate the drainage system of the eye. However, in order to be clinically applicable,a test must provide reproducible results with consistent measurements. This study was performed to verify the reproducibility of intraocular pressure peaks and fluctuation detected during the water-drinking test in patients with ocular hypertension and open-angle glaucoma.

DESIGN

A prospective analysis of patients in a tertiary care unit for glaucoma treatment.

PARTICIPANTS

Twenty-four ocular hypertension and 64 open-angle glaucoma patients not under treatment.

METHODS

The water-drinking test was performed in 2 consecutive days by the same examiners in patients not under treatment. Reproducibility was assessed using the intraclass correlation coefficient.

MAIN OUTCOME MEASURES

Peak and fluctuation of intraocular pressure obtained with the water-drinking test were analysed for reproducibility.

RESULTS

Eighty-eight eyes from 24 ocular hypertension and 64 open-angle glaucoma patients not under treatment were evaluated. Test and retest intraocular pressure peak values were 28.38 ± 4.64 and 28.38 ± 4.56 mmHg, respectively (P = 1.00). Test and retest intraocular pressure fluctuation values were 5.75 ± 3.9 and 4.99 ± 2.7 mmHg, respectively (P = 0.06). Based on intraclass coefficient, reproducibility was excellent for peak intraocular pressure (intraclass correlation coefficient = 0.79) and fair for intraocular pressure fluctuation (intraclass correlation coefficient = 0.37).

CONCLUSION

Intraocular pressure peaks detected during the water-drinking test presented excellent reproducibility, whereas the reproducibility of fluctuation was considered fair.

Twenty-four-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals

OBJECTIVE

To verify the 24-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals.

METHODS

A prospective analysis of 88 eyes from 88 ocular hypertensive or open-angle glaucoma patients was conducted on diurnal tension curves obtained by the same examiner on two consecutive days. The intraclass correlation coefficient test was used for statistical analysis.

RESULTS

Eighty-eight eyes from 88 patients were analyzed. Fifty-seven patients (64.8%) were female. The mean age of all participants was 68.7 (SD 10.8, range 51-79) years. The intraclass correlation coefficient values for measurements at 8 AM, 11 AM, 2 PM, and 4 PM were 0.80, 0.82, 0.83, and 0.86, respectively (all intraclass correlation coefficient values, p<0.001).

CONCLUSION

Diurnal intraocular pressure data collected on a single day characterize the diurnal intraocular pressure variability over 24 hours in primary open-angle glaucoma and ocular hypertensive patients.

Additive intraocular pressure reduction effect of fixed combination of maleate timolol 0.5%/dorzolamide 2% (Cosopt) on monotherapy with latanoprost (Xalatan) in patients with elevated intraocular pressure: a prospective, 4-week, open-label, randomized, controlled clinical trial

PURPOSE

To evaluate the additive effect of dorzolamide/timolol fixed combination in patients under monotherapy with latanoprost.

PATIENTS AND METHODS

In this prospective, 4-week, randomized, open-label controlled clinical trial, patients with open-angle glaucoma or ocular hypertension, which presented at least 15% intraocular pressure (IOP) reduction after a minimum period of 15 days of monotherapy with latanoprost and whose IOP level was considered above the established target-IOP level were randomized to receive fixed combination of timolol/dorzolamide twice daily in one of eyes. The fellow eye was kept under monotherapy and was included in the control group. A modified diurnal tension curve (mDTC) followed by the water drinking test were performed in the baseline and week 4 visits to evaluate IOP profile between groups.

RESULTS

Forty-nine per-protocol patients were analyzed. After latanoprost monotherapy run-in period, IOP levels were significantly reduced (P<0.001) in both control and study groups to 15.34+/-2.96 mm Hg and 15.24+/-2.84 mm Hg (30.8% and 32.2% IOP reduction, respectively; P=0.552). At week 4, mean baseline diurnal IOP levels were 15.60+/-3.09 and 14.44+/-3.03 (7.4% difference; P=0.01). Mean baseline IOP modified diurnal tension curve peak after latanoprost run-in period were 17.47+/-3.68 mm Hg and 17.02+/-3.35 mm Hg (control and study eyes, respectively; P=0.530). At week 4 visit, mean water-drinking test peaks were significantly reduced in the study eye group in comparison with the control group: 19.02+/-3.81 mm Hg and 20.39+/-4.19 mm Hg, respectively (6.7% reduction; P=0.039).

CONCLUSIONS

In our sample, dorzolamide 2%/timolol 0.5% fixed combination as add-on therapy in patients with open-angle glaucoma or ocular hypertension under monotherapy with latanoprost with IOP already in mid-teens levels may further enhance pressure reduction.

Hyper IgM syndrome and complement Clq deficiency in an individual with systemic lupus erythematosus-like disease

Many immunedeficiency syndromes are associated with autoimmune disorders. We here report on a girl with a systemic lupus erythematosus-like disease who suffered from both hyperimmunoglobulin M syndrome (HIGMS) and C1q deficiency. Despite severe central nervous system-lupus like disease, probably due to C1q deficiency, kidney function was relatively spared. IgM autoantibody might play a protective role against lupus-glomerulonephritis.

A comparison of bimatoprost 0.03% versus the fixed-combination of latanoprost 0.005% and timolol 0.5% in adult patients with elevated intraocular pressure: an eight-week, randomized, open-label trial

INTRODUCTION AND PURPOSE

Bimatoprost and the fixed combination of latanoprost with timolol maleate are 2 medications widely used to treat glaucoma and ocular hypertension (OHT). The aim of the study is to compare the efficacy of these 2 drugs in reducing intraocular pressure (IOP) after 8 weeks of treatment in patients with primary open angle glaucoma (POAG) or OHT.

METHODS

In this randomized, open-label trial, 44 patients with POAG or OHT were allocated to receive either bimatoprost (1 drop QD) or latanoprost/timolol (1 drop QD). Primary outcome was the mean diurnal IOP measurement at the 8th week, calculated as the mean IOP measurements taken at 8:00 am, 10:00 am, and 12:00 pm Secondary outcomes included the baseline change in IOP measured 3 times a day, after the water-drinking test (performed after the last IOP measurement), and the assessment of side effects of each therapy.

RESULTS

The mean IOP levels of latanoprost/timolol (13.83, SD = 2.54) was significantly lower than of bimatoprost (16.16, SD = 3.28; P < 0.0001) at week 8. Also, the change in mean IOP values was significantly higher in the latanoprost/timolol group at 10:00 am (P = 0.013) and 12:00 pm (P = 0.01), but not at 8:00 am (P = ns). During the water-drinking test, there was no significant difference in IOP increase (absolute and percentage) between groups; however, there was a significant decrease in mean heart rate in the latanoprost/timolol group. Finally, no significant changes in blood pressure and lung spirometry were observed in either groups.

CONCLUSIONS

The fixed combination of latanoprost/timolol was significantly superior to bimatoprost alone in reducing IOP in patients with POAG or OHT. Further studies with large sample sizes should be taken to support the superior efficacy of latanoprost/timolol, as well as to better assess its profile of side effects.

Correlation between central corneal thickness and intraocular pressure peak and fluctuation during the water drinking test in glaucoma patients

OBJECTIVE

To investigate the correlation between central corneal thickness and outflow facility assessed by intraocular pressure peak and fluctuation during the water drinking test.

METHODS

Fifty-five newly diagnosed primary open-angle glaucoma patients submitted to central corneal thickness measurements and water drinking test were enrolled in this retrospective study.;. Patients were divided into three groups according to their central corneal thickness. Pearson's Correlation test was performed in the groups with lower and higher pachymetric values.

RESULTS

The mean age was 65,65 ± 28,28 years; 63,63% were female and 52,72% were caucasian. The mean central corneal thickness was 544,32 ± 36,86 µm, and the mean baseline intraocular pressure was 23,36 ± 6,26 mmHg. During the water drinking test, the mean intraocular pressure peak and mean intraocular pressure fluctuation were 30,43 ± 8,13 mmHg and 31,46 ± 18,46%, respectively. No relevant correlation was detected between the central corneal thickness and the intraocular pressure peak (r² = 0,021) or between the central corneal thickness and the intraocular pressure fluctuation (r² = 0,011). Group 1 presented a mean central corneal thickness of 505,81 ± 13,86 µm, and Group 3 was 583,55 ± 27,87 µm (p = 0,001). The mean intraocular pressure peak was 31,05 ± 9,05 mmHg and 27,83 ± 4,92 mmHg in Group 1 and in Group 3, respectively (p = 0,193). The difference of intraocular pressure fluctuation was not statistically significant between Group 1 (mean 28,47 ± 16,25%) and Group 3 (mean 33,27 ± 21,27%) (p = 0,43).

CONCLUSION

In our case series, no correlation was found between central corneal thickness and water drinking test results.

The effect of prostaglandin analogs and prostamide on central corneal thickness

OBJECTIVE

The aim of this study was to verify the influence of prostaglandin analogs and prostamide on central corneal thickness (CCT).

METHODS

A prospective analysis was done of CCT in glautomatous patients submitted to monotherapy with prostaglandin analogs (latanoprost 0.005% or travoprost 0.004%) or prostamide (bimatoprost 0.03%) during an 8-week period. A control group of patients without any ocular medication was also evaluated. CCT measurements were performed with a commercially available ultrasound pachymeter. A total of 73 patients were included in this study. Mean age was 68.5 +/- 9.2 (range, 48-85) years old.

RESULTS

A statistically significant reduction in CCT was observed in all groups, except the control group (n = 21): Bimatoprost 0.03% group (n = 21): 544.41 +/- 35.4 vs. 540.35 +/- 35.9 microm (P = 0.039); travoprost 0.004% group (n = 17): 538.47 +/- 32.0 vs. 532.25 +/- 30.4 microm (P = 0.009); latanoprost 0.005% group (n = 14): 548.57 +/- 32.4 vs. 543.88 +/- 35.6 microm (P = 0.036).

CONCLUSION

Topical therapy with prostaglandin analogs and bimatoprost is associated with CCT reduction over a period of at least 8 weeks.

Increased insulin demand promotes while pioglitazone prevents pancreatic beta cell apoptosis in Wfs1 knockout mice

AIMS/HYPOTHESIS

The WFS1 gene encodes an endoplasmic reticulum (ER) membrane-embedded protein called Wolfram syndrome 1 protein, homozygous mutations of which cause selective beta cell loss in humans. The function(s) of this protein and the mechanism by which the mutations of this gene cause beta cell death are still not fully understood. We hypothesised that increased insulin demand as a result of obesity/insulin resistance causes ER stress in pancreatic beta cells, thereby promoting beta cell death.

METHODS

We studied the effect of breeding Wfs1 ( -/- ) mice on a C57BL/6J background with mild obesity and insulin resistance, by introducing the agouti lethal yellow mutation (A ( y ) /a). We also treated the mice with pioglitazone.

RESULTS

Wfs1 ( -/- ) mice bred on a C57BL/6J background rarely develop overt diabetes by 24 weeks of age, showing only mild beta cell loss. However, Wfs1 ( -/- ) A ( y ) /a mice developed selective beta cell loss and severe insulin-deficient diabetes as early as 8 weeks. This beta cell loss was due to apoptosis. In Wfs1 ( +/+ ) A ( y ) /a islets, levels of ER chaperone immunoglobulin-binding protein (BiP)/78 kDa glucose-regulated protein (GRP78) and phosphorylation of eukaryotic translation initiation factor 2, subunit alpha (eIF2alpha) apparently increased. Levels of both were further increased in Wfs1 ( -/- ) A ( y ) /a murine islets. Electron micrography revealed markedly dilated ERs in Wfs1 (-/-) A ( y ) /a murine beta cells. Interestingly, pioglitazone treatment protected beta cells from apoptosis and almost completely prevented diabetes development.

CONCLUSIONS/INTERPRETATION

Wfs1-deficient beta cells are susceptible to ER stress. Increased insulin demand prompts apoptosis in such cells in vivo. Pioglitazone, remarkably, suppresses this process and prevents diabetes. As common WFS1 gene variants have recently been shown to confer a risk of type 2 diabetes, our findings may be relevant to the gradual but progressive loss of beta cells in type 2 diabetes.

Long Ciliary Processes With no Ciliary Sulcus and Appositional Angle Closure Assessed by Ultrasound Biomicroscopy

PURPOSE

Nonpupil block mechanisms and appositional angle closure after laser iridotomy (LI) have been reported as common findings in Asians. We evaluated the presence of these findings in a cohort of Brazilian patients using ultrasound biomicroscopy (UBM).

METHODS

This observational case-control study included 22 open angle eyes and 31 eyes with occludable angles on gonioscopy (defined by 2 examiners). UBM radial scans through a typical ciliary process were obtained in both light and dark conditions, at 6 and 12-o'clock positions. Long ciliary processes with no ciliary sulcus were determined on the basis of a reference line drawn perpendicular to the iris plane passing through a point located 750 mum from scleral spur. Trabecular ciliary processes distance was measured on 6-o'clock UBM images.

RESULTS

After LI, 52% of occludable angle eyes had appositional angle closure in both 6 and 12-o'clock UBM images. We also observed this finding in 14% and 23% of the control eyes (in 6 and 12-o'clock UBM images, respectively). A long ciliary process with no ciliary sulcus was observed in 61% of occludable angle eyes, and also in 32% of control eyes (6-o'clock UBM images). Control eyes had longer trabecular ciliary processes distance than occludable angle eyes (P<0.001).

CONCLUSIONS

The UBM finding of long ciliary processes associated with the absence of ciliary sulcus is not necessarily related to an anterior positioning of the ciliary processes. Whether UBM appositional angle closure after LI is associated with further angle closure process and/or poor intra-ocular pressure control remains to be evaluated.

Changes in the Burgers vector of perfect dislocation loops without contact with the external dislocations

We report the observations of a new type of changing process in the Burgers vector of dislocations by in situ transmission electron microscopy. Small interstitial-type perfect dislocation loops in bcc iron with diameters less than approximately 50 nm are transformed from a 1/2<111> loop to another 1/2<111> one or an energetically unfavorable <100> one; furthermore, a <100> loop is transformed to a 1/2<111> one. These transformations occurred on high-energy electron irradiation or simple heating without contact with external dislocations. The origin of these phenomena is discussed.

cDNA cloning and functional characterization of Xenopus laevis DNase γ

We report here the cDNA cloning and functional analysis of Xenopus DNase gamma (xDNase gamma). Two forms of cDNAs are isolated from adult spleen: one composing a 933 bp open reading frame for the enzymatically active xDNase gamma protein, and the other encoding an inactive short alternative form. Northern blot analysis revealed that the xDNase gamma mRNA is expressed in spleen, liver, testis, and ovary. xDNase gamma expression is scarcely detected in the tail muscle of tadpoles; however, it increases during metamorphosis and reaches a maximum during the late metamorphic climax. The ectopic expression of xDNase gamma results in the appearance of extensive DNA fragmentation in C2C12 myoblasts after the induction of apoptosis. In contrast, Xenopus DNase I fails to induce apoptotic DNA ladder formation under the same conditions. Our results suggest a possible involvement of xDNase gamma in apoptosis during amphibian metamorphosis.

Correlation of Asymmetric Glaucomatous Visual Field Damage and Water-Drinking Test Response

PURPOSE

To determine whether there is a correlation between asymmetric glaucomatous visual field (VF) damage and water-drinking test (WDT) response.

METHODS

A retrospective analysis was conducted of VF and WDT data from 101 patients with glaucoma in clinical therapy, who were receiving treatment with the same topical medication in both eyes, and asymmetric VF defect. Eyes were classified according to mean deviation (MD) into "better" and contralateral "worse" eyes. Maximum mean difference in basal IOP was 2 mm Hg between both eyes. The peak IOP and fluctuation obtained with the WDT were compared between both groups. For the statistical analysis, the Tukey post hoc multiple comparison test and paired t-test were used.

RESULTS

Better and contralateral worse eyes presented mean MDs of -4.6 +/- 5.3 and -9.0 +/- 7.4 dB, respectively (P < 0.001). Mean basal IOPs were 13.9 +/- 3.3 and 13.9 +/- 3.1 mm Hg, respectively (P = 0.67). Mean maximum IOPs after water ingestion were 16.5 +/- 3.8 mm Hg in the group with less severe VF defect and 17.2 +/- 4.1 mm Hg in the contralateral group with worse visual fields (P < 0.001). Mean fluctuation (maximum IOP - minimum IOP after water ingestion) was 3.6 +/- 1.8 and 4.4 +/- 2.2 mm Hg (P < 0.001), respectively.

CONCLUSION

Eyes with worse MDs presented higher IOP peaks and fluctuation after water ingestion. This study demonstrates a lower capacity of eyes with worse glaucomatous lesion to respond to a stimulus that leads to a transitory elevation of IOP.

The relation between intraocular pressure peak in the water drinking test and visual field progression in glaucoma

AIM

To compare the results of the water drinking test between glaucomatous eyes with and without visual field progression.

METHODS

Retrospective analysis of 76 eyes of 76 open angle glaucoma patients followed for a mean period of 26.0 (SD 13.8) months. Patients were submitted to the water drinking test at the beginning of the follow up period. Reliable achromatic automated perimetry tests performed during the studied period were used to characterise visual field progression. All subjects were under clinical therapy and had an intraocular pressure (IOP) lower than 17 mm Hg monitored by isolated measurements during the follow up period. The results of the water drinking test were compared between glaucomatous eyes with and without visual field progression.

RESULTS

Twenty eight eyes reached definite visual field progression. There were no significant differences in the mean age, sex, race, basal IOP, number of antiglaucomatous drugs, initial mean deviation (MD), and corrected pattern standard deviation (CPSD) between eyes that showed visual field progression and the ones who did not progress. A significant difference of 1.9 (SD 0.6) mm Hg (p = 0.001, analysis of covariance; 95% CI 0.8 to 3.0) was observed between glaucomatous eyes that showed visual field deterioration and glaucomatous eyes that did not progress. A significant difference of 16.8% (SD 4.6%) in the mean percentage of IOP variation was also observed between the two groups (p<0.001, analysis of covariance; 95% CI 7.7 to 26.0).

CONCLUSIONS

Mean IOP peak and percentage of IOP variation during water drinking test were significantly higher in patients with visual field progression compared with patients who did not progress.

Intraocular pressure variability in patients who reached target intraocular pressure

AIM

To assess the intraocular pressure (IOP) variability in patients with primary open angle glaucoma (POAG) under clinical treatment who reached an established target pressure based on isolated office readings.

METHODS

Retrospective analysis of 65 eyes from 65 POAG patients under clinical therapy who submitted to modified diurnal tension curve (mDTC) (measurements at every 3 hours between 8 am and 5 pm) followed by a water drinking test (WDT). All subjects had established target IOP < or =15 mm Hg at 11 am or 2 pm. IOP variability during mDTC or WDT was evaluated.

RESULTS

mDTC revealed IOP measurements > or =17 mm Hg in 16 of 65 eyes (24.6%). Nine eyes (13.8%) presented values > or =18 mm Hg. The highest IOP detected by mDTC was 20 mm Hg in one patient (1.5%). WDT demonstrated IOP values > or =17 mm Hg in 32 of 65 eyes (49.2%). 22 eyes (33.8%) presented values > or =18 mm Hg after water ingestion. Moreover, IOP levels > or =20 mm Hg were observed in 14 eyes (21.5%).

CONCLUSION

A great percentage of POAG patients undergoing clinical treatment and with IOP control based on single office measurement present significantly higher IOP measurements when performing mDTC and, especially, the WDT.

Listeria monocytogenes isolated from cold-smoked fish products in Osaka City, Japan

Listeria monocytogenes contamination of ready-to-eat seafood products commercially available in Osaka was examined between 1999 and 2000. L. monocytogenes was isolated from 12 (13%) of the 95 products tested. All positive samples were from cold-smoked fish with 9 being obtained during the summer. Thirteen isolates of L. monocytogenes were typed by pulsed-field gel electrophoresis (PFGE) and polymerase chain reaction (PCR)-based typing methods. Isolates of the same serotype originating from the same manufacturer gave similar DNA profiles, irrespective of the type of sample or date of isolation. The finding suggest that persistent strains in each manufacturing facility proliferate during the summer and contaminate products during manufacturing processes.

Functional cross-talk of HIV-1 Tat with p53 through its C-terminal domain

Human immunodeficiency virus type 1 (HIV-1) Tat repressed the p53-dependent gene expression through its C-terminal domain of Tat (amino acid residues 73-86) independent of the involvement of NF-kappaB and coactivator CBP/p300. Although Tat did not directly bind to p53, this repression required the N-terminal domain of p53. In contrast, Tat and p53 cooperated in the activation of HIV-1 gene expression. Thus, the cross-talk between Tat and p53 may be linked with cellular transformation by HIV-1 infection or activation of HIV-1 replication.

Calcium phosphate crystal-associated proteins: alpha-2-HS-glycoprotein, prothrombin fragment 1 and osteopontin

To study the inhibitory effects of calcium phosphate-associated proteins on calcium oxalate crystallization and urinary concentrations of proteins in people who form stones and healthy controls. From 60 L of urine from healthy men, calcium phosphate-associated proteins (alpha-2-HS-glycoprotein, prothrombin fragment 1 and osteopontin) were obtained. The effects of the proteins on calcium oxalate (CaOx) crystallization were studied with a mixed suspension mixed product removal system. To examine urinary concentrations of the proteins, urine samples were collected from 17 healthy subjects and 15 stone formers and analyzed using anion-exchange chromatography and an enzyme immunoassay. Prothrombin fragment 1 (PTF1) and osteopontin (OPN) had strong inhibitory effects on CaOx crystallization, while alpha-2-HS-glycoprotein had a mild inhibitory effect. Urinary concentrations of PTF1 and OPN were lower in stone formers than in healthy controls. Low urinary concentrations of PTF1 and OPN might be one of the reasons for stone formation.