scholarly journals Additive effect of brimonidine in maximum tolerated medical therapy for primary open-angle glaucoma

2021 ◽  
Vol 21 (3) ◽  
pp. 129-134
Author(s):  
D.A. Dorofeev ◽  
◽  
V.P. Balukhtina ◽  
M.V. Es’kova ◽  
K.A. Efimova ◽  
...  
Keyword(s):  
Carbonic Anhydrase ◽  
Medical Therapy ◽  
Beta Blocker ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Additive Effect ◽  
Final Visit ◽  
Open Angle ◽  
Group 2 ◽  
Group 1

Aim: to evaluate additive IOP-lowering effect of brimonidine 0.2% to achieve target IOP via enhancing maximum tolerated medical therapy for primary open-angle glaucoma (POAG). Patients and Methods: 63 patients (63 eyes) with advanced POAG and poorly controlled IOP who received prostaglandin analogs and a fixeddose carbonic anhydrase inhibitor/beta-blocker combination were enrolled. All patients were additionally prescribed with brimonidine 0.2%. After a month, patients were divided into two groups based on achieved IOP level. In group 1, target IOP was achieved, and these patients were followed up. In group 2, target IOP was not achieved, and these patients underwent trabeculectomy. IOP was measured by elastotonometry and using the iCare tonometer. Results: a month after prescribing α2 agonist, true IOP level reduced to 14.0 (9.5; 17.0) mm Hg in group 1 and to 17.0 (13.0; 20.0) mm Hg in group 2. At the final visit, IOP levels were within target ranges in both groups, i.e., 13.0 (11.0; 18.5) mm Hg and 13.5 (9.7; 17.2) mm Hg, respectively. Meanwhile, changes in IOP measured by various methods were significantly different. IOP reduced by 5.4% (-7.1%; 17.6%) in group 1 and by 20.7% (4.4%; 30.7%) in group 2 (p<0.05) as measured by elastotonometry and by 8.3% (-11.8%; 28.6%) in group 1 and by 33.3% (13.9%; 50.7%) in group 2 as measured by iCare tonometer. Conclusions: brimonidine 0.2% provides additional IOP reduction to enhance maximum tolerated medical therapy for advanced POAG. An estimated effect of brimonidine is a 8% reduction of IOP from the baseline. If target IOP is not achieved, a patient should be scheduled for surgery. IOP should be measured using the iCare tonometer since this device is more sensitive to minor IOP fluctuations. Keywords: brimonidine 0.2%, maximum tolerated medical therapy for glaucoma, tonometry, elastotonometry, glaucoma, trabeculectomy, additive effect, target IOP. For citation: Dorofeev D.A., Balukhtina V.P., Es’kova M.V. et al. Additive effect of brimonidine in maximum tolerated medical therapy for primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2021;21(3):129–134 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-129-134.

scholarly journals A Comparative Analysis of the Efficacy and Safety of fixed Combinations of Latanoprost/Timolol vs Dorzolamide/Timolol in Primary Open Angle Glaucoma or Ocular Hypertension

2012 ◽  
Vol 46 (4) ◽  
pp. 172-176
Author(s):  
Sukhsagar Ratol ◽  
Rani Walia ◽  
Mridu Chaudhry
Keyword(s):  
Ocular Hypertension ◽  
Primary Open Angle Glaucoma ◽  
Fixed Combination ◽  
Open Angle Glaucoma ◽  
Eye Drops ◽  
Open Angle ◽  
Once Daily ◽  
Group 2 ◽  
Diurnal Iop ◽  
Group 1

ABSTRACT Background Glaucoma is a leading cause of irreversible blindness. The fundamental problem in medical management of glaucoma is of patient compliance. An ideal drug or a drug combination is needed to slow the progression of this majorly symptomless disease. Aim To compare the efficacy and tolerability of the fixed combination latanoprost and timolol instilled once daily in the evening vs fixed combination of dorzolamide and timolol instilled twice daily in primary open angle glaucoma or ocular hypertension. Materials and methods A 12-week, randomized, open, parallel group study including 50 patients with primary open angle glaucoma or ocular hypertension was conducted at a tertiary care hospital. Patients were randomized to group 1, (fixed combination (FC) latanoprost and timolol eye drops, once daily in evening) and group 2, (FC dorzolamide and timolol eye drops, twice daily). At baseline, 2, 4 and 12 weeks, IOP was recorded at 9 AM and 12 noon. The difference in IOP reduction in two treatment groups from baseline to 12 weeks was the main outcome measure. Results Mean diurnal IOP was similar at baseline for both groups. Mean reduction in IOP from baseline to 12 weeks was 9.92 mm Hg (p = 0.001) in group 1 and 9.22 (p = 0.001) in group 2. The reduction in IOP in both groups 1 and 2 was statistically significant at all time intervals. There was a statistically significant advantage for group 1 at 12 weeks for both time readings (p = 0.013 and 0.002 respectively) as compared to group 2. Conclusion The fixed combination of latanoprost and timolol was more effective than that of dorzolamide and timolol in reducing mean diurnal IOP and both treatments were well tolerated. To confirm further such studies are required. How to cite this article Ratol S, Walia R, Chaudhry M. A Comparative Analysis of the Efficacy and Safety of fixed Combinations of Latanoprost/Timolol vs Dorzolamide/Timolol in Primary Open Angle Glaucoma or Ocular Hypertension. J Postgrad Med Edu Res 2012;46(4):172-176.

scholarly journals Ab Interno vs. Ab Externo Microcatheter-Assisted Circumferential Trabeculotomy in Treating Patients With Primary Open-Angle Glaucoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Weijia Zhang ◽  
Yiwei Wang ◽  
Chen Xin ◽  
Yang Sun ◽  
Kai Cao ◽  
...  
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Success Rates ◽  
Criterion A ◽  
The Mean ◽  
Group 2 ◽  
Ab Interno ◽  
Group 1

Background: Circumferential trabeculotomy have evolved from ab externo to ab interno approach. Both procedures may lower IOP, but it is unclear which maybe a superior approach.Purpose: To compare the outcomes of ab interno and ab externo circumferential trabeculotomy in patients with primary open-angle glaucoma.Design: Retrospective, comparative case series.Participants: Primary open angle glaucoma patients undergoing ab interno (40 patients in Group 1) or ab externo (54 patients in Group 2) circumferential trabeculotomy, with about one half of them having prior incisional glaucoma surgery.Methods: Outcomes including intraocular pressure (IOP), glaucoma medications and surgical complications were analyzed.Main Outcome Measures: IOP, medications and surgical success defined as an IOP of ≤ 21 mmHg and a reduction of IOP ≥20% from baseline (criterion A) or IOP ≤ 18 mmHg and a reduction of IOP 20% from baseline (criterion B) with (qualified success) or without (complete success) medications.Results: At 1 year, IOP decreased by 37.1% (26.0–14.8 mmHg) in Group 1 and 39.5% (28.5–15.1 mmHg) in Group 2. Medications decreased from 3.5 in Group 1 and 3.6 in Group 2 pre-operatively to 0.6 ± 1.0 and 0.3 ± 0.6 post-operatively, respectively. Success rates did not differ significantly between groups based on criterion A (complete and qualified success: 68.7 and 81.9% in Group 1, and 75.3 and 90.4% in Group 2, respectively) or criterion B (complete and qualified success: 58.2 and 79.3%in Group 1, and 69.5 and 88.4% in Group 2, respectively). For eyes with prior filtration surgeries, the mean percent reduction of IOP (41.7 ± 32.7% in Group 1, 39.7 ± 27.8% in Group 2, P = 0.724) and the mean medication reduction (2.9 ± 1.6 in Group 1, 3.4 ± 1.0 in Group 2, P = 0.454) were not significantly different.Conclusions: Ab interno circumferential trabeculotomy achieved comparable outcomes to ab externo trabeculotomy and may be an effective surgical option for patients with primary open-angle glaucoma.

Results of a new modification of anti-glaucoma surgery in the treatment of primary open-angle glaucoma in combination with cataract

2021 ◽  
pp. 67-70
Author(s):  
M.M. Bikbov ◽  
◽  
O.I. Orenburgkina ◽  
A.E. Babushkin ◽  
G.Z. Israfilova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Visual Functions ◽  
Group 2 ◽  
Group 1

Purpose. To study the effectiveness of the developed partially fistulizing glaucoma surgery in the treatment of primary open-angle glaucoma (POAG) in combination with complicated cataract. Material and methods. 28 patients (28 eyes) were examined, including 13 patients (13 eyes) with I–III stages of POAG, operated according to the method of glaucoma surgery developed by us (group 1), and 15 patients (15 eyes) with a combination of previously unoperated glaucoma with incomplete complicated cataracts, who underwent a combined intervention – simultaneous phacoemulsification of cataracts with the specified variant of partially fistulizing glaucoma intervention (group 2). The analysis of the frequency of complications, the dynamics of visual functions, visual acuity and ophthalmotonus before surgery, at the time of discharge from the hospital, and in the longterm (6–9 months) after surgery was carried out. Results. In group 1, in the long term, the absolute hypotensive effect was recorded in 81.8% of cases, visual functions remained the same – in 90.9%. In group 2, by the end of follow – up, the level of normalized intraocular pressure was recorded in all patients, while in 78.6% of cases without drug correction and in 21.4% – with the help of antihypertensive drugs. Visual acuity in group 2, after a single-stage combined operation by the day of discharge from the hospital, averaged 0.53±0.05, in the long-term – 0.77±0.06, while the stabilization of glaucoma optic neuropathy after surgery occurred in 92.9%. Conclusion. Glaucoma surgery according to the proposed method in the studied long-term periods in patients with POAG provided a sufficiently high hypotensive effect and the preservation of visual functions. Combined single-stage intervention was an effective way to increase visual acuity, normalize ophthalmotonus and stabilize glaucoma optic neuropathy, as well as reduce drug load. Key words: primary open-angle glaucoma, cataract, partially fistulizing glaucoma surgery, cataract phacoemulsification.

scholarly journals A spectrofluorimetric study of the limbal area in patients with primary open-angle glaucoma

2021 ◽  
Vol 14 (4) ◽  
pp. 60-64
Author(s):  
V. V. Neroev ◽  
V. V. Gar’kavenko ◽  
V. V. Salmin
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Beta Blockers ◽  
Early Postoperative Period ◽  
Open Angle ◽  
Limbal Area ◽  
Advanced Stages ◽  
Group 2 ◽  
Hypoxic State ◽  
Group 1

Purpose: to evaluate hypoxic changes in the limbus area conjunctiva of patients with primary open-angle glaucoma (POAG) treated with prolonged instillations of prostaglandin (PG) analogs. Material and methods. A spectrofluorimetric study of the limbus zone was carried out in 202 patients aged 56–87 years with POAG in the developed and advanced stages, divided into 2 groups. Group 1 consisted of patients aged 69.4 ± 10.3 years who received beta-blockers (BB) and carbonic anhydrase inhibitors (ICA) for 5–10 months; of these, 39 (30.2 %) had a developed stage of POAG and 90 (69.7 %) had advanced POAG. Group 2, aged 72.3 ± 9.4, received PG analogs, in addition to BB and ICA, for 5–10 months. In this group, 21 (28.7 %) patients had developed POAG and 52 (71.23 %) had advanced POAG. Results. The patients who received PG instillations showed a significantly higher ratio of fluorescence intensity in the wavelength range of 410/520 nm NADH/FAD (0.352 ± 0.043) than those receiving no such therapy (0.319 ± 0.047), which can be interpreted as a hypoxic state of the limbus area. Conclusion. Spectrofluorimetric testing of POAG patients taking PG analogs can be useful for detecting ischemia in the limbus area, because this category of patients are very likely to form cicatricial changes in the area of the filtration cushion in the early postoperative period after antiglaucomatous interventions.

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 Influence of BAK-Preserved Prostaglandin Analog Treatment on the Ocular Surface Health in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Martina Tomić ◽  
Snježana Kaštelan ◽  
Kata Metež Soldo ◽  
Jasminka Salopek-Rabatić
Keyword(s):  
Intraocular Pressure ◽  
Ocular Surface ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Final Visit ◽  
Open Angle ◽  
Newly Diagnosed ◽  
Prostaglandin Analog ◽  
Ocular Surface Health

Purpose. Primary open-angle glaucoma (POAG), a chronic, degenerative optic neuropathy, requires persistent decrease of intraocular pressure so as to prevent visual impairment and blindness. However, long-term use of topical ocular medications may affect ocular surface health. Purpose of this study was to evaluate the influence of BAK-preserved prostaglandin analog treatment on the ocular surface health in patients with newly diagnosed POAG.Methods. 40 newly diagnosed POAG patients were included in this prospective study. Intraocular pressure (IOP), tear break-up time (TBUT), and ocular surface disease index (OSDI) were assessed at baseline and 3-month after starting treatment with BAK-preserved travoprost 0.004%.Results. IOP decreased in all patients from baseline to 3-month final visit (23.80 ± 1.73 mmHg versus 16.78 ± 1.27 mmHg;P<0.001). Mean TBUT decreased from11.70±1.86seconds at baseline to 8.30 ± 1.29 seconds at 3-month final visit (<0.001). Mean OSDI score increased from 31.63 ± 18.48 to 44.41 ± 16.48 (P<0.001).Conclusions. This study showed that BAK-preserved travoprost 0.004% is an effective medication in newly diagnosed POAG patients, but its long-term use may negatively influence ocular surface health by disrupting the tear film stability. Further studies are needed to better understand the clinical effects of different preservative types and concentrations on the ocular surface.

scholarly journals Evaluation of Corneal Endothelium in Adolescents with Juvenile Glaucoma

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Beata Urban ◽  
Alina Bakunowicz-Łazarczyk ◽  
Marta Michalczuk ◽  
Małgorzata Krętowska
Keyword(s):  
Endothelial Cell ◽  
Carbonic Anhydrase ◽  
Beta Blocker ◽  
Corneal Endothelium ◽  
Central Corneal Thickness ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Control Group ◽  
Open Angle ◽  
Juvenile Glaucoma

Purpose. To evaluate the endothelial cell density (ECD) and central corneal thickness (CCT) in adolescents with juvenile open-angle glaucoma (JOAG) and ocular hypertension (OH) and to investigate the influence of topical antiglaucoma medications on ECD and CCT in adolescents with JOAG.Methods. ECD and CCT were investigated in 66 eyes of 33 adolescents with JOAG. Depending on the topical treatment the eyes were classified into 4 groups: (1) topical carbonic anhydrase inhibitor, (2) prostaglandin analogs, (3) beta-blocker, and (4) CAI-beta-blocker combination. ECD and CCT were also checked in 24 adolescents with OH and in control group (33 persons).Results. ECD was significantly lower in eyes with JOAG (2639.5 cells/mm2) compared with ECD in eyes with OH (2924.5 cells/mm2) and in control group (2955.5 cells/mm2). CCT was 0.554 mm in eyes with JOAG, 0.55 mm in eyes with OH, and 0.544 mm in control group. ECD in patients with JOAG was 2730 cells/mm2(1 group), 2773.5 cells/mm2(2 group), 2539.5 cells/mm2(3 group), and 2551 cells/mm2(4 group). CCT was 0.556 mm in 1 group, 0.558 mm in 2 group, 0.532 mm in 3 group, and 0.544 mm in 4 group.Conclusions. Our findings indicate that JOAG and OH did not affect CCT, but JOAG has influence on ECD in adolescents. There were no significant differences between ECD and CCT of eyes treated with different kinds of antiglaucoma medications.

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