scholarly journals New Opportunities in Non-Preservative Glaucoma Therapy

2021 ◽  
Vol 18 (2) ◽  
pp. 260-265
Author(s):  
A. A. Antonov ◽  
I. V. Kozlova ◽  
A. A. Vitkov
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Topical Therapy ◽  
Hypotensive Effect ◽  
Current Therapy ◽  
Prospective Clinical Study ◽  
Medication Regimen ◽  
Conjunctival Hyperemia ◽  
Glaucoma Therapy ◽  
Preservative Free

Most of the medicines used for the treatment of glaucoma include a preservative in various concentrations. With long-term topical therapy, patients with glaucoma may develop dry eye syndrome (DES). The severity of symptoms depends on the number of drugs used and the presence of a preservative in them. Against the background of DES progression, compliance to glaucoma therapy may decrease, and, consequently, the effectiveness of the treatment may decrease. Currently, new non-preservative hypotensive drugs containing brimonidine, as well as a fixed combination (FC) of dorzolamide and timolol, are available on the market.Purpose: to compare assessment of the hypotensive effect and tolerability of preservative-free drugs FC Dorzolamid 20 mg/ml, Timolol 5 mg/ml (Dortmol Antiglau ECO) and Brimonidine 2 mg/ml (Brim Antiglau ECO) when switching from similar drugs containing a preservative in patients with compensated glaucoma.Patients and methods. In this prospective clinical study, 60 patients (60 eyes) with compensated primary open-angle glaucoma on combined topical therapy were examined. In group 1 (30 patients, 30 eyes), the combinations of dorzolamide / timolol or brinzolamide / timolol were switched with the non-preservative Dortmol Antiglau ECO. In group 2 (30 patients, 30 eyes), the brimonidine as part of the medication regimen were replaced with the non-preservative Brim Antiglau ECO. The level of corneal-compensated IOP was assessed before the switch in therapy and after 1 month. Subjective feelings and objective signs of the treatment’s use were monitored during examination and using a questionnaire, which was compiled to study the tolerance of therapy.Results. Switching to a preservative-free combination of dorzolamide and timolol resulted in a reduction in complaints of irritation, lacrimation, and foreign body sensation. The efficiency control did not reveal a significant change (p > 0.05) in the cornealcompensated intraocular pressure (IOPcc). When transferred to the Brim Antiglau ECO as part of the local hypotensive treatment, intraocular pressure decreased significantly (p < 0.05). The average total score characterizing drug intolerance, when evaluated by the patient, decreased by 2.4 times, by the attending physician-by 1.9 times. The degree of conjunctival hyperemia on the MacMonnies photographic scale decreased in both groups.Conclusion. Preservative-free drugs can be recommended for most patients with glaucoma as a starting treatment and as a replacement for current therapy. 

Timogel® vs Timolol 0.5% Ophthalmic Solution: Efficacy, Safety, and Acceptance

2011 ◽  
Vol 22 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Teresa Rolle ◽  
Daniela Curto ◽  
Camilla Alovisi ◽  
Mauro Franzone ◽  
Beatrice Brogliatti ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Side Effects ◽  
Open Angle Glaucoma ◽  
Ophthalmic Solution ◽  
Previous Treatment ◽  
Hypotensive Effect ◽  
Schirmer Test ◽  
Blurred Vision ◽  
Once Daily ◽  
Preservative Free

Purpose To evaluate the efficacy, safety, and tolerability of Timogel® preservative-free once daily compared to timolol 0.5% ophthalmic solution bid in patients with ocular hypertension (OHT) and patients with primary open-angle glaucoma (POAG). Methods A total of 75 patients with OHT and patients with POAG treated with timolol 0.5% bid with intraocular pressure (IOP) ≤21 mmHg were enrolled. They underwent complete ophthalmologic examination, IOP measurements (at trough and daytime curve), evaluation of side effects, Schirmer test, break-up time [BUT], blood pressure, heart rate, ocular diastolic perfusion pressure measurements, and acceptance (Comparison of Ophthalmic Medications for Tolerability). Patients switched to Timogel® and were re-evaluated 3 months later. The analysis of variance and the Pearson χ2 tests were used to test differences between the treatments. Results Intraocular pressure reduction at trough was 23.6% with timolol 0.5% and 22.3% with Timogel®. No statistical differences were observed in IOP values at trough and in the daytime curve between the 2 treatments. Local and systemic side effects were less frequent with Timogel® (hazard ratio: p<0.05). Patients demonstrated a significant improvement of Schirmer test and BUT (p<0.05) and a reduction of dryness and foreign body sensation (42.6% vs 15.4%; p<0.01) after switching to Timogel®. Mild and short-lasting blurred vision after Timogel® instillation occurred in about 18.5% of patients. A total of 82% of patients were satisfied or very satisfied with Timogel® vs 61% with previous treatment (p<0.01). Conclusions Timogel® preservative-free dosed once every morning has a 24-hour hypotensive effect with a better safety profile than timolol 0.5% bid and it is well-accepted by patients. The once-daily dosing improved acceptance and compliance.

scholarly journals Preservative-free versus preserved latanoprost eye drops for reducing intraocular pressure: a non-inferiority phase III randomized, multi-center, single-blind, parallel-group controlled trial

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Panos Theodosiadis ◽  
Anastasios Konstas ◽  
Ioannis Halkiadakis ◽  
Vasiliki Dimera ◽  
Dimitrios Koufakis ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ocular Hypertension ◽  
Open Angle Glaucoma ◽  
Ophthalmic Solution ◽  
Phase Iii ◽  
Point Estimate ◽  
Eye Drops ◽  
Open Angle ◽  
Parallel Group ◽  
Preservative Free

Background: The aim of this study was to test the non-inferiority of preservative-free (PF) latanoprost 50 μg/mL multi-dose ophthalmic solution versus the marketed benzalkonium chloride (BAK)-preserved latanoprost 50 μg/mL ophthalmic solution in patients with open-angle glaucoma and patients with ocular hypertension. Methods: This was a prospective, national, randomized, multi-center, observer-blind, parallel-group controlled clinical trial. Patients were randomized to receive either PF or BAK-preserved latanoprost once daily for 12 weeks. The primary endpoint was the change in intraocular pressure (IOP) at 8:00 AM in the affected eye between the end of the treatment (week 12) and the baseline (week 0). Secondary measurements were taken at weeks 2 and 6, with IOP being recorded at 8:00 AM, 12:00 PM, and 4:00 PM. Results: A total of 158 patients were included in the per protocol (PP) population (77 in the PF latanoprost treatment arm and 81 patients in the BAK-preserved latanoprost treatment arm). PF latanoprost was non-inferior to BAK-preserved latanoprost in reducing IOP at 8:00 AM in the study eye from the baseline (week 0) to the end of the treatment (week 12). The point estimate of the between-treatment difference was 0.1 mmHg (95% confidence interval: -0.646, 0.847). Mean between-group differences in IOP reduction from the baseline to each of the secondary measurements were also similar between the two treatment arms. The two treatments were well tolerated and had comparable adverse event profiles. Conclusions: PF latanoprost was non-inferior to BAK-preserved latanoprost in reducing IOP in patients with open-angle glaucoma or ocular hypertension. Both treatments were well tolerated.

The effectiveness of descemethogoniopuncture depending on the timing of its implementation after microinvasive non-penetrating deep sclerectomy in patients with glaucoma

2021 ◽  
pp. 79-82
Author(s):  
E.L. Sorokin ◽  
◽  
N.V. Postupaeva ◽  
◽  
Keyword(s):  
Intraocular Pressure ◽  
Antihypertensive Effect ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Hypotensive Effect ◽  
Ultrasound Biomicroscopy ◽  
Deep Sclerectomy ◽  
Group 2 ◽  
Group 1

Purpose. Evaluation of the efficacy of descemethogoniopuncture (DGP) at various times after microinvasive non-penetrating deep sclerectomy (MNPDS) in patients with glaucoma. Material and methods. The analysis of the results of DGP in 64 eyes of patients with primary open-angle glaucoma after previously performed MNPDS. According to the timing of DGP after MNPDS, the patients were divided into 3 groups. In the 1st group BPH was performed after 1–2 months (22 eyes), the 2nd group – after 3–4 months (21 eyes), the 3rd group after 5–6 months (21 eyes). The follow-up period was 1 year. Results. The level of intraocular pressure before DGP averaged 15.1±0.6 mm Hg in group 1, 17.5±0.9 mm Hg in group 2, and group – 18.6±0.7 mm Hg. After DGP, 13.1±0.4 mm Hg, 14.6±0.7 mm Hg, 16.1±0.5 mm Hg respectively. According to ultrasound biomicroscopy, the highest and extended intrascleral cavities and tunnels, as well as a thin loose trabeculodescemet membrane (TDM), were observed in the eyes of the 1st group. With an increase in the time after MNPDS, there was a compaction of TDM, a decrease in the height and length of the intrascleral cavity and tunnels. 12 months after DGP, the most pronounced antihypertensive effect without antihypertensive therapy occurred in group 1 – 55% of cases compared with groups 2 and 3 (33% and 14% respectively). Conclusion. The greatest efficiency was shown by performing DGP within 1–2 months after MNPDS, which is associated with the minimum development of proliferative processes in the intrascleral outflow tract in the early stages after this operation. Key words: descemethogoniopuncture, microinvasive non-penetrating deep sclerectomy, intraocular pressure, hypotensive effect, glaucoma.

scholarly journals Effect of a Topical Combination of Latanoprost and Pranoprofen on Intraocular Pressure and the Ocular Surface in Open-Angle Glaucoma Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Simin Zhu ◽  
Dabo Wang ◽  
Jing Han
Keyword(s):  
Intraocular Pressure ◽  
Ocular Surface ◽  
Open Angle Glaucoma ◽  
Study Groups ◽  
Control Group ◽  
Open Angle ◽  
Conjunctival Hyperemia ◽  
Ocular Symptoms ◽  
Nsaid Group ◽  
Symptom Scores

Objective. A prospective study was performed to observe the effects of nonsteroidal anti-inflammatory drug (NSAID) eyedrops on intraocular pressure (IOP) and the ocular surface in primary open-angle glaucoma (POAG) patients treated with 0.005% latanoprost eyedrops. Methods. Forty-eight subjects were randomized into two study groups (NSAID and control). Latanoprost was continued for 10 weeks in all subjects. At the end of week 4, pranoprofen was added in the NSAID group, and treatment lasted for 4 weeks, whereas patients in the control group were treated with latanoprost alone. IOP was measured in both groups every 2 weeks, and the changes in the ocular surface in the NSAID group were evaluated once a month. Results. Pranoprofen addition resulted in a decrease in IOP in the NSAID group compared to the control group (p<0.01). After pranoprofen was discontinued, IOP significantly increased in the NSAID group (p<0.01), remaining approximately at the same IOP as when they were being treated with latanoprost alone. During the same examination, no significant variations in IOP were found in the control group. Patients who were treated with latanoprost alone showed gradual improvements in ocular surface symptom scores and conjunctival hyperemia scores during the first four weeks of treatment (p<0.01). When pranoprofen eyedrops were added, ocular surface symptom scores decreased (p<0.01), but conjunctival hyperemia scores did not change significantly. Conclusions. For POAG patients treated with latanoprost, the combination of pranoprofen can not only significantly enhance the latanoprost-induced IOP-lowering effect but also relieve the uncomfortable ocular symptoms caused by latanoprost.

scholarly journals Complex use of energetic surgery in treatment of patients with primary open-angle glaucoma and cataract on the background of pseudoexfoliative syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. 25-34
Author(s):  
Benta G. Dzhashi ◽  
Sergei V. Balalin
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Visual Functions ◽  
Incipient Stage ◽  
Laser Trabeculoplasty

BACKGROUND: Glaucoma remains one of the current problems of modern ophthalmology. The combination of glaucoma and cataract is observed in 1738.6% of cases, and glaucoma with pseudoexfoliative syndrome in 2050% of primary open-angle glaucoma cases. AIM: The aim of this work is to develop an effective and safe technology of complex energetic surgical treatment of the incipient primary open-angle glaucoma stage and cataract on the background of pseudoexfoliation syndrome on the basis of modified laser, hydrodynamic and ultrasound methods use. MATERIALS AND METHODS: 187 patients (187 eyes) with the incipient stage of primary open-angle glaucoma, cataract and pseudoexfoliation syndrome were examined. In the main group (111 eyes), selective laser trabeculoplasty followed by femtosecond laser-assisted cataract surgery with hydrodynamic trabeculocleaning was performed. Patients in the control group (76 eyes), after selective laser trabeculoplasty, underwent phacoemulsification according to the standard technique. RESULTS: The developed technology allowed to reach the hypotensive effect in 35.2% (t=23.0; р 0.001) of baseline intraocular pressure values, of individual intraocular pressure level without adding IOP-lowering medications in 27% of cases, stabilization of visual functions and morphometric indices of the optic disc during 2 years of follow-up in 97.3% of cases unlike the selective laser trabeculoplasty with subsequent phacoemulsification (21.2, 5.3 and 81.6% respectively). The patients of the main group had significantly lower energy expenditure during the stage of phacoemulsification, a lower percentage of postoperative inflammatory reaction was noted, and a persistent hypotensive effect with stabilization of visual functions was achieved based on the results of a two-year follow-up. CONCLUSIONS: Femtosecond laser-assisted phacoemulsification, performed as part of complex treatment in patients with cataract and incipient stage of primary open-angle glaucoma, is a sparing method that minimizes surgical trauma and achieves a persistent hypotensive effect, reduces intraocular pressure to an individual level and stabilizes visual functions in 97.3% of cases.

scholarly journals Non-inferiority evaluation of preservative-free latanoprost/timolol eye drops solution versus preserved latanoprost/timolol eye drops in patients with high intraocular pressure and open-angle glaucoma

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Panos Theodosiadis ◽  
Anastasios Konstas ◽  
Ioannis Halkiadakis ◽  
Vasiliki Dimera ◽  
Dimitrios Koufakis ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Ophthalmic Solution ◽  
Phase Iii ◽  
Point Estimate ◽  
Eye Drops ◽  
Open Angle ◽  
Local Tolerance ◽  
Safety Parameters ◽  
Preservative Free

Background: This study aimed to evaluate the non-inferiority and safety of a newly developed preservative-free (PF) multi-dose latanoprost/timolol ophthalmic solution, compared with the benzalkonium chloride (BAK)-preserved fixed combination, in patients with open-angle glaucoma and ocular hypertension.Methods: A Phase III randomized multi-center observer-blind parallel-group clinical trial was conducted. A total of 210 adult patients (aged over 18 years) were randomly treated with the PF- or the BAK-preserved latanoprost/timolol solution once daily in the affected eye(s) for 12 weeks. Follow-up visits were scheduled at weeks 2, 6, and 12; intraocular pressure (IOP) was recorded at 8:00 AM, 12:00 PM, and 4:00 PM. The primary efficacy endpoint to prove non-inferiority was the IOP change at 8:00 AM (± 1 hour) from the baseline to the end of treatment (week 12) in the studied eye. Safety parameters were also assessed.Results: In total, 196 patients completed the study. The pressure-lowering effect of the PF eye drops was comparable to that of the preserved formulation at all time points. Latanoprost/timolol PF formulation was non-inferior to the BAK-preserved solution as shown by the change in IOP from day 0 to week 12. The point estimate of the inter-treatment difference was 0.624 mmHg (95% CI: -0.094, 1.341). Both treatments were well-tolerated during the study, and they had similar adverse event profiles.Conclusions: PF-latanoprost/timolol combination was found to be non-inferior to the BAK-preserved formulation based on the efficacy at all times, with similar local tolerance.

Comparison of Hypotensive Effect of Endotrabeculoectomy and Selective Laser Trabeculoplasty

2021 ◽  
pp. 19-25
Author(s):  
Olha V. Levytska ◽  
Igor Ya. Novytskyy
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty ◽  
Significant Difference ◽  
The Difference

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p < 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p < 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

scholarly journals Comparative treatment results of non-penetrating surgeries for treating primary open-angle glaucoma

2012 ◽  
Vol 93 (6) ◽  
pp. 996-999
Author(s):  
S N Bulgar ◽  
R F Akhmetshin ◽  
D E Malinin
Keyword(s):  
Intraocular Pressure ◽  
Aqueous Humor ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Hypotensive Effect ◽  
Deep Sclerectomy ◽  
Open Angle ◽  
Flow Reduction ◽  
Aqueous Humor Flow ◽  
Hypotensive Drugs

Aim. To assess the effectiveness of combined non-penetrating surgery: non-penetrating deep sclerectomy and ab externo trabeculectomy in patients with primary open-angle glaucoma depending on type of aqueous humor retention. Methods. Results of surgeries on 72 patients (83 eyes) with primary open-angle glaucoma were analyzed. Patients were divided into 2 groups. Standard ophthalmic examination was added by fluorescein lymphography of the anterior eye to determine the surgery type as well as for hypotensive effect long-term prognosis. Non-penetrating deep sclerectomy and ab externo trabeculectomy were conducted in the first group (67 eyes). In the control group (16 eyes) standard non-penetrating deep sclerectomy was performed. A cytostatic was used as a subconjunctival injections in the post-surgical period. Results. Intraocular pressure was fully compensated in 52 eyes out of 67 (77.6%) in the long-term period after non-penetrating deep sclerectomy and ab externo trabeculectomy in the first group. In 15 eyes (22.4%) topical hypotensive drugs were required for complete compensation of intraocular pressure. Complete compensation of intraocular pressure was registered in patients with moderate aqueous humor flow reduction (trabecular and mixed with prevalence of trabecular forms). Topical hypotensive drugs were required in severe aqueous humor flow reduction (mixed form with prevalence of intrascleral). In the second group, compensation of intraocular pressure was achieved only in early post-surgical period in 12 eyes (75%) with further decrease of hypotensive effect after 4-6 months. There was no complete compensation of intraocular pressure at late post-surgical period. To normalize the intraocular pressure, topical hypotensive drugs were required in 15 eyes (93.8%), surgery was repeated in 1 (6.2%) case. Conclusion. Combined surgery (non-penetrating deep sclerectomy and ab externo trabeculectomy) is more effective compared to non-penetrating deep sclerectomy and is indicated in patients with open-angle glaucoma and moderate aqueous humor flow reduction.

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