Timolol 0.5%/dorzolamide 2% fixed combination versus timolol 0.5%/pilocarpine 2% fixed combination in primary open-angle glaucoma or ocular hypertensive patients

PURPOSE: To establish the efficacy and safety of timolol maleate/dorzolamide fixed combination (TDFC) versus timolol maleate/pilocarpine fixed combination (TPFC), each given twice daily, in primary open-angle glaucoma or ocular hypertensive patients. METHODS: In this prospective, multicentred, double-masked trial, 37 patients were treated twice daily with timolol for 4 weeks. They were then randomized to one of the treatment medications for 6 weeks, after which they were treated with timolol again for 2 weeks before being placed on the opposite treatment medication for 6 weeks. RESULTS: A total of 36 patients completed the trial. Their mean baseline intraocular pressure (IOP) was 22.3 +/- 3.7 mmHg. Following 6 weeks of treatment, the mean trough (08.00 hours) IOP was 18.0 +/- 2.2 mmHg for TDFC and 17.4 +/- 2.0 mmHg for TPFC (p = 0.22). The mean diurnal curve IOP was 18.1 +/- 2.2 mmHg for TDFC and 16.7 +/- 1.9 mmHg for TPFC (p = 0.0007). At the remaining time-points (10.00, 18.00 and 20.00 hours), TPFC IOPs were statistically lower than TDFC IOPs (p < 0.03). There were statistically more unsolicited reports of vision change and ocular pain associated with TPFC (p = 0.04). Six patients were discontinued early from TPFC therapy (17%) versus two from TDFC (6%) (p = 0.13). CONCLUSIONS: This study suggests that TPFC can provide at least a similar efficacious reduction in IOP as TDFC in patients with primary open-angle glaucoma or ocular hypertension.     

Peribulbar anesthesia: comparing 1% ropivacaine and a mixture of 0.5% bupivacaine--2% lidocaine

PURPOSE: To compare the efficacy of 1% ropivacaine with a mixture of 0.5% bupivacaine and 2% lidocaine in peribulbar anesthesia for elective cataract surgery. MATERIAL AND METHODS: Prospective double-blinded study, enrolling 100 patients randomly assigned to two different groups. Group 1 received 9 ml of 1% ropivacaine and group 2 received 4.5 ml of 0.5% bupivacaine and 4.5 ml of 2% lidocaine. Both groups received 1 ml of hyaluronidase to reach a total volume of 10 ml. RESULTS AND CONCLUSION: No difference between the groups was noted during the study regarding not only onset time, but also the duration of anesthesia and perioperative analgesia. A greater incidence of pain on injection was significantly reported in group 2 (p<0.001). Patients in group 1 had less need for top-up injection and showed better ocular akinesia (p<0.01).     

A 3-month comparison of 1% and 2% carteolol and 0.5% timolol in open-angle glaucoma

Carteolol, a nonselective beta-adrenergic antagonist with intrinsic sympathomimetic activity, was compared in 1% and 2% topical solutions with 0.5% timolol in 105 patients with primary open-angle glaucoma. In this double-masked, randomized 3-month trial, all three preparations significantly lowered intraocular pressure throughout the study, with no significant differences being observed. There were also no significant differences among the three preparations with regard to ocular or systemic adverse reactions, including heart rate and blood pressure. Offprint requests to: M.B. Shields     

Safety and efficacy of bimatoprost 0.03% versus timolol maleate 0.5%/dorzolamide 2% fixed combination

PURPOSE: To determine the efficacy and safety of bimatoprost given every evening versus the dorzolamide/timolol fixed combination (DTFC) given twice daily in open-angle glaucoma and ocular hypertensive patients. METHODS: A double-masked, three-center, prospective, randomized, crossover comparison with two 8-week treatment periods following a 4-week medicine free washout period. Diurnal curve intraocular pressures (IOPs) were taken at 08:00 (trough) and 10:00 and 16:00 hours. RESULTS: A total of 35 patients were enrolled and 32 completed all evaluations. The diurnal untreated baseline intraocular pressures was 24.8 +/- 2.4 mmHg. On the last day of treatment the mean diurnal intraocular pressures was 17.4 +/- 2.9 for bimatoprost and 18.1 +/- 2.8 mmHg for DTFC (p = 0.35). The individual time points for intraocular pressures were not statistically different between groups. Both groups statistically reduced the intraocular pressures from baseline for each time point and for the diurnal curve (p < 0.05). Regarding ocular safety and tolerability, there was more conjunctival hyperemia with bimatoprost (n = 15) than with DTFC (n = 7, p = 0.013) and more burning and stinging with DTFC (n = 12) than with bimatoprost (n = 0, p = 0.0005). Few systemic adverse events were recorded and there was no statistical difference between groups for any individual event (p > 0.05). CONCLUSIONS: This study indicates that the intraocular pressures are lowered to a statistically similar amount with DTFC compared to bimatoprost in open-angle glaucoma and ocular hypertensive patients.     

Ocular comfort of combination glaucoma therapies: brimonidine 0.2%/timolol 0.5% compared with dorzolamide 2%/timolol 0.5%.

PURPOSE: Successful management of glaucoma and ocular hypertension requires patient compliance with the therapeutic regimen. Because ocular discomfort affects compliance, we compared the comfort of brimonidine 0.2%/timolol 0.5% and dorzolamide 2%/timolol 0.5%. METHODS: In this single-centre, randomized, double-masked, internally controlled/paired-eye study, 30 subjects without a significant ocular surface disease received brimonidine 0.2%/timolol 0.5% in 1 eye and dorzolamide 2%/timolol 0.5% in the fellow eye. They evaluated discomfort at 30-40 s and 5 min postinstillation. RESULTS: At 30-40 s, brimonidine 0.2%/timolol 0.5% provided significantly lower mean ocular discomfort scores than dorzolamide 2%/timolol 0.5% (P < 0.0001). This pattern persisted at 5 min but was not statistically significant. Significant differences were seen in the subjects' determination of the more comfortable treatment (P < 0.0001): brimonidine 0.2%/timolol 0.5% was rated as more comfortable than dorzolamide 2%/timolol 0.5% by 80% of subjects at 30-40 s and by 27% at 5 min. Only 10% of subjects at each time point rated dorzolamide 2%/timolol 0.5% as more comfortable. The remaining subjects reported no preference at either time point. No adverse events were reported. CONCLUSIONS: Brimonidine 0.2%/timolol 0.5% was significantly more comfortable than dorzolamide 2%/timolol 0.5% upon instillation. Patients with ocular hypertension or glaucoma may be more compliant with brimonidine 0.2%/timolol 0.5% treatment.     

Corneal-wetting property of lignocaine 2% jelly

PURPOSE: To evaluate the corneal-wetting property of lignocaine 2% jelly. SETTING: A district general hospital. METHODS: Fifty patients having cataract surgery were divided into 3 groups. Group 1 comprised 20 patients who had topical eyedrop anesthesia and corneal irrigation with balanced salt solution (BSS(R)) during surgery as necessary. Group 2 comprised 15 patients who received lignocaine jelly on arrival and just before the corneal incision was made as well as corneal moisturizing by BSS during surgery. Group 3 comprised 15 patients who received lignocaine jelly on arrival and additional lignocaine jelly if necessary just before the corneal incision was made to maintain corneal clarity. The duration of efficacy and the frequency of the applications of the 2 agents were recorded. Corneal clarity and reflections were noted intraoperatively. Corneal status was assessed postoperatively in the ward. RESULTS: Preoperative lignocaine 2% jelly maintained corneal clarity longer than BSS (P <.001). A second application of lignocaine was needed when surgery was prolonged. CONCLUSIONS: The corneal-wetting property of lignocaine 2% jelly can be useful during cataract surgery by avoiding repeated corneal irrigation with BSS.     

Comparison of 2% hydroxypropyl methylcellulose and 1% sodium hyaluronate in implant surgery

We conducted a prospective randomized clinical trial of 2% hydroxypropyl methylcellulose and 1% sodium hyaluronate (Healon) in routine extracapsular cataract surgery with implantation of a posterior chamber intraocular lens. Of the 84 patients 40 received methylcellulose and 44 received sodium hyaluronate. There was no statistically significant difference in endothelial-cell loss or induced cellular polymegathism between the two groups. The intraocular pressure before and after surgery was similar in the two groups, as was the visual acuity 8 weeks after surgery. The results suggest that 2% hydroxypropyl methylcellulose is a safe and effective alternative to 1% sodium hyaluronate in routine implant surgery.     

Daytime diurnal curve comparison between the fixed combinations of latanoprost 0.005%/timolol maleate 0.5% and dorzolamide 2%/timolol maleate 0.5%

PURPOSE: The diurnal efficacy and safety of the fixed combinations of latanoprost/timolol given once daily vs dorzolamide/timolol given twice daily in primary open-angle glaucoma or ocular hypertensive patients. DESIGN: A double-masked, two-centre, crossover comparison. RESULTS: In 33 patients, the mean diurnal IOP (0800-2000, measured every 2 h) for latanoprost/timolol fixed combination was 17.3+/-2.2 mmHg and for dorzolamide/timolol, the fixed combination was 17.0+/-2.0 mmHg (P = 0.36). Additionally, there was no statistical difference for individual time points following a Bonferroni correction. A bitter taste was found more frequently with the dorzolamide/timolol fixed combination (n = 6) than the latanoprost/timolol fixed combination (n = 0) (P = 0.040), while the latanoprost/timolol fixed combination demonstrated more conjunctival hyperaemia (n = 9) than the dorzolamide/timolol fixed combination (n = 2) (P = 0.045). One patient was discontinued early from the dorzolamide/timolol fixed combination due to elevated IOP. CONCLUSION: This study suggests that the daytime diurnal IOP is not statistically different between the dorzolamide/timolol fixed combination and latanoprost/timolol fixed combination in primary open-angle glaucoma and ocular hypertensive patients.     

A controlled clinical interventional trial comparing 2% chloroprocaine-bupivicaine versus 2% lidocaine-bupivicaine for retrobulbar anesthesia in scleral buckling surgery

Objective: We undertook this prospective study to compare the relative effectiveness of a bupivicaine mixture with either lidocaine or chloroprocaine for retrobulbar anesthesia in scleral buckling surgery, since chloroprocaine, in some types of nonocular nerve block anesthesia, has been demonstrated to be a more effective nerve block anesthetic.Design: This prospective, randomized, double-blind, controlled, clinical, unicentre, interventional trial compared mixtures of lidocaine-bupivacaine with chloroprocaine-bupivacaine in scleral buckling surgery performed by 1 surgeon during a 12-month period.Participants: A total of 136 patients who underwent scleral buckling surgery constituted the cases studied.Methods: A total of 31 variables comprising surgical, anesthetic, and patient-centered data were analyzed to determine which drug combination was more efficacious.Results: No statistically significant differences were found between chloroprocaine and lidocaine mixtures for retrobulbar anesthesia in scleral buckling surgery from the point of view of the surgeon, anesthetist, or patient.Conclusions: We found no difference in effectiveness for bupivicaine mixed with either lidocaine or chloroprocaine for retrobulbar anesthesia in scleral buckling surgery. Surgeon, anesthetist, and patient-centered data showed no differences in any of the measures studied.     

Comparative study of the effects of 2% ibopamine, 10% phenylephrine,and 1% tropicamide on the anterior segment

PURPOSE: To assess in normal and glaucomatous eyes the effect of the dopaminergic drug 2% ibopamine on visual acuity, IOP, pupil size and anterior segment geometry, compared with 10% phenylephrine and 1% tropicamide. METHODS: Fifteen healthy subjects and 15 patients with primary open-angle glaucoma, aged from 40 to 70 years (mean age: 54.8 +/- 9.6), were recruited into this open prospective study. After instillation of 2% ibopamine, refraction, visual acuity, pupil diameter, IOP, five A-scan ultrasonographic parameters, and 15 ultrasound biomicroscopy parameters were evaluated. The study was repeated with assessment of the same parameters 20 to 30 days later in 10 subjects (5 normal and 5 with glaucoma), using first 10% phenylephrine and then 1% tropicamide. A second group of 15 healthy subjects, aged from 45 to 70 years (mean age: 53.5 +/- 8.6) was examined to evaluate the dose-response effect and time course on pupil diameter, of ibopamine, phenylephrine, and tropicamide. RESULTS: After 40 minutes 2% ibopamine induced a marked mydriatic effect (from 5 to 9.1 mm; P < 0.0001) greater than that produced by 10% phenylephrine (from 4.7 to 7.9 mm; P < 0.0001) or 1% tropicamide (from 4.6 to 6.9 mm; P < 0.0001), with no changes in refraction or visual acuity. IOP was significantly increased only in patients with glaucoma after instillation of either 2% ibopamine (from 22.2 to 24.8 mm Hg; P < 0.0001) or 1% tropicamide (from 21.2 to 23.6 mm Hg; P = 0.004), whereas 10% phenylephrine induced no statistically significant changes. Ibopamine (2%) caused a significant increase in iris thickness with a reduction of the sulcus ciliaris and posterior chamber depth. The anterior chamber angle (ACA) showed a mean 5 degrees widening with an increase in scleral-iris angle (SIA) and sclera-ciliary process angle. In 11 (37%) of 30 cases, separation of the pupil border and lens surface occurred, whereas contact was maintained only with the zonule in the other 19 (63%) of 30. The changes after 10% phenylephrine instillation were similar, although only the increase in iris thickness and SIA was statistically significant. Tropicamide (1%) induced a slight but significant increase in SIA. CONCLUSIONS: The results confirm the potent mydriatic effect of 2% ibopamine, which is greater than that of either 10% phenylephrine or 1% tropicamide, as well as its ability to induce an increase in intraocular pressure when used in patients with glaucoma alone. These data support the hypothesis that the widening of the ACA induced by 2% ibopamine is due to posterior rotation of the iris plane and ciliary processes. These changes are quantitatively greater than those induced by 10% phenylephrine and 1% tropicamide and are related to the greater mydriatic effect of the drug.     

Concurrent use of 5% natamycin and 2% econazole for the management of fungal keratitis

PURPOSE: To determine if concurrent use of 5% natamycin and 2% econazole offers greater benefits than monotherapy with 5% natamycin for the management of fungal keratitis. METHODS: Subjects presenting to the cornea service were treated with 5% natamycin and 2% econazole used concurrently. We compared the results with a historical control of patients treated with 5% natamycin in the same calendar year. The same clinical and examination protocol including inclusion and exclusion criteria was used for both groups. RESULTS: We compared results of 47 subjects on concurrent use of 5% natamycin and 2% econazole with all 53 subjects who had received 5% natamycin in a previous study (historical controls). Baseline characteristics were similar between the 2 groups. There were no significant differences (P=0.9) between the 2 arms for success (defined as a healed or healing ulcer). CONCLUSIONS: Concurrent use of 5% natamycin and 2% econazole does not appear to offer additional benefits over monotherapy with 5% natamycin for the management of fungal keratitis.     

利多卡因布比卡因对兔视神经毒性的电镜观察

目的 观察2%利多卡因及0.75%布比卡因二者单独应用及联合应用,对兔视神经的毒性作用.方法 10只正常新西兰兔随机等分为正常对照组、生理盐水组、利多卡因组、布比卡因组和利多卡因＋布比卡因组5个组,每组2只兔（4眼）.正常对照组不作任何处理;生理盐水组、利多卡因组、布比卡因组分别球后注射生理盐水、2%利多卡因或0.75%布比卡因各1 mL,利多卡因＋布比卡因组球后注射2%利多卡因和0.75%布比卡因各1 mL.注射后观察眼部表现并于注射后48 h取出视神经作透射电镜检查.结果 所有兔均未出现注射并发症;2%利多卡因、0.75%布比卡因均能导致兔视神经发生脱髓鞘现象以及轴突水肿,两药联合组最为显著.结论 2%利多卡因及0.75%布比卡因球后注射对兔视神经均具有轻度的毒性作用,且可能具有相加或协同作用.     

Comparative acute effects of brimonidine 0.2% versus dorzolamide 2% combined with beta-blockers in glaucoma

Purpose: To assess the acute intraocular hypotensive efficacy of brimonidine tartrate 0.2% (a highly selective α₂-adrenergic agonist) compared with dorzolamide 2% (a topical carbonic anhydrase inhibitor) as adjunct therapy to topical β-blockers in patients with primary open-angle glaucoma. Methods: A randomized cross-over masked study was performed. We enrolled one eye of each of 28 patients who were on different β-blocker therapy. We measured the intraocular pressure (IOP) 2 h after the β-blocker instillation; we then randomly administered one of the two drugs and we compiled an IOP diurnal curve. One month later we repeated the same procedures with the second drug. Unpaired Mann-Whitney U-test was used to compare decreases in IOP between the two drugs (P<0.05). Results: Both brimonidine 0.2% and dorzolamide 2% have good ocular hypotensive efficacy, significantly lowering IOP when compared to β-blocker therapy alone, for the whole diurnal curve. Maximum mean percent IOP decrease from baseline was 22.0±15.7% (4.0± 2.9 mmHg) for dorzolamide 2% 6 h after instillation and 35.5±16.4% (7.0±4.1 mmHg) for brimonidine 0.2% 8 h after administration of the drug. When we compared the two treatments, brimonidine 0.2% showed a higher hypotensive effect than 2% dorzolamide after 4 h (28.4±16.8% vs 17.6 ±9.3%; P=0.04) and 8 h (35.5±16.4% vs 21.6 ±10.8%; P=0.04). Conclusion: This study indicates that 0.2% brimonidine acutely associated with β-blockers is an interesting new combination treatment useful in the management of glaucoma. Received: 29 July 1999 Revised: 14 September 1999 Accepted: 29 September 1999