小梁切除联合羊膜植入和巩膜瓣松解缝线术治疗难治性青光眼

目的　探讨小梁切除联合羊膜植入和巩膜瓣松解缝线术治疗难治性青光眼的疗效。方法　对完成追踪观察的 5 8例 (6 7只眼 )难治性青光眼患者施行小梁切除术 ,术中巩膜瓣下及结膜瓣下植入新鲜或贮存羊膜 ,联合应用巩膜瓣松解缝线术控制房水渗漏量。结果　术后随访 5～ 38个月 ,平均 19 5个月 ,其中≥ 12个月者占 79 1%。术后 12个月时 ,新生血管性青光眼的眼压由术前 (43 86± 7 12 )mmHg(1mmHg=0 133kPa)降至 (19 6 3± 2 5 7)mmHg(t=4 96 ,P <0 0 0 1) ,人工晶状体植入术后青光眼的眼压由术前 (40 31± 4 79)mmHg降至 (18 0 9± 2 2 1)mmHg(t=3 5 4 ,P <0 0 5 ) ,无晶状体性青光眼的眼压由术前 (37 94± 5 6 3)mmHg降至 (2 0 14± 3 15 )mmHg (t=5 12 ,P <0 0 5 ) ,青少年型青光眼的眼压由术前 (32 4 8± 3 98)mmHg降至 (16 5 4± 1 84 )mmHg(t=4 2 3,P <0 0 1) ,葡萄膜炎性青光眼的眼压由术前 (36 0 1± 4 13)mmHg降至 (18 11± 3 4 0 )mmHg(t=4 4 7,P <0 0 1) ,滤过性手术失败的青光眼眼压由术前 (34 4 3± 5 2 8)mmHg降至 (18 31± 1 5 2 )mmHg(t=2 0 5 ,P <0 0 5 ) ;患者手术前、后眼压比较 ,差异均有显著意义。功能性滤过泡形成率为 80 6 %。无排斥反应和严重并发症。结论     

实验性兔青光眼前房水肝细胞生长因子的含量

目的 :探讨实验性兔青光眼不同时期前房水肝细胞生长因子 (HGF)含量的变化。方法 :用 1%的甲基纤维素每周一次注入 2 0只白兔的前房内 ,使眼压稳定升高达 30～ 4 0mmHg ,在 0、1、2、4、8周时抽出前房水 0 2ml,用酶联免疫吸附试验(ELISA)方法测量前房水HGF的含量。结果 :实验眼和对照眼术前前房水HGF浓度分别是 (32 1 3± 75 7) pg/ml和 (319 2±85 2 ) pg/ml,在眼压升高 1、2、4、8周后前房水HGF的浓度分别是 (5 4 0 3± 83 2 )pg/ml、(5 4 9 8± 10 2 4 ) pg/ml、(5 6 2 0±98 6 ) pg/ml和 (6 0 4 0± 92 6 )pg/ml ,比对照眼明显升高 (P <0 0 1)。在青光眼第 8周时房水HGF浓度最高 ,但与 1、2、4周时无统计学上的差异 (P >0 0 5 )。结论 :青光眼眼压升高后前房水HGF浓度升高并且维持一较高浓度 ,是一反应性升高而不是发病原因 ,HGF含量增高可能增加房水的外引流和修复损伤的小梁细胞。     

非穿透小梁手术术中和术后早、中期并发症及疗效分析

目的　评价非穿透小梁手术术中和术后早、中期并发症及临床疗效和安全性。方法16 8例 (2 5 8只眼 )原发性开角型青光眼患者 ,按年龄、性别、病情严重程度进行匹配后 ,随机分为两组 ,一组行非穿透小梁手术联合透明质酸钠凝胶植入术 (14 2只眼 ) ,另一组行小梁切除术 (116只眼 )。非穿透小梁手术组和小梁切除术组患者术前平均眼压分别为 (31 85± 4 83)mmHg(1mmHg =0 133kPa)和 (32 5 9± 4 6 2 )mmHg。对两组患者的术后眼压及术中、术后 3个月内的并发症进行对照研究。结果　 (1)眼压 :非穿透小梁手术组患者术后 7、14d ,1、3、6个月时 ,平均眼压分别为 (6 6 7± 2 4 3)mmHg、(11 4 2± 2 89)mmHg、(12 5 9± 2 2 4 )mmHg、(15 4 5± 1 82 )mmHg、(17 99± 1 80 )mmHg ;小梁切除术组患者眼压分别为 (4 87± 1 6 5 )mmHg、(10 4 8± 2 38)mmHg、(12 0 1± 2 83)mmHg、(15 0 1± 2 6 6 )mmHg、(17 4 8± 2 97)mmHg。术前、后 1～ 6个月 ,两组患者眼压差异无显著意义(t=1 2 8、1 78、1 5 5、1 6 0 ,P =0 2 0 2、0 0 77、0 12 4、0 112 )。术后 7d及 14d ,小梁切除术组平均眼压低于非穿透小梁手术组 ,差异有显著意义 (t=7 0 3、2 89,P <0 0 0 0 1、P =0 0 0 4 )。 (2 )视力 :两组患     

青光眼黏弹剂小管扩张术的临床疗效观察及Schlemm管直径测量

目的 评价青光眼黏弹剂小管扩张术的安全性和有效性,探讨Schlemm管直径的测量方法.方法 收集21例31眼青光眼(开角和慢闭)行黏弹剂小管扩张术及Schlemm管直径测量(NPTS组)的临床资料,总结和分析患者的眼压、视力、眼内反应、滤过泡及手术并发症的发生情况,以及Schlemm管直径测量情况,并与青光眼经典小梁切除手术(PTS组)20例33眼青光眼(开角和慢闭)进行比较.术后随访时间至少6月.结果 术后6月,NPTS组平均眼压为(10.44±3.88)mmHg(1mmHg=0.133 kpa),较术前降低(24±15.78)mmHg,差异有显著意义(P=0.000);术后1周、1月、6月两组降眼压效果比较,差异无显著意义(P=0.959,0.986,0.884).Schlemm管直径测量结果为0.39～0.63 mm,平均(0.50±0.07)mm.NPTS组术后视力均无下降;PTS组术后视力8眼下降.NPTS组术中并发症包括小梁网Descement膜小穿孔5眼,术后滤过泡漏1眼,3只眼有轻微房水闪辉2～3d消失外无任何眼内反应.PTS组术后并发症包括浅前房、前房出血各4只眼,前房出血3-7d消失;术后15眼有轻微房水闪辉,2-6d消失;脉脱2眼,滤过泡漏1眼,并发性白内障2眼.结论 青光眼黏弹剂小管扩张术效果好、并发症少,可安全、有效治疗开角性和部分慢性闭角型青光眼.Schlemm管直径测量方法可行.     

巩膜层间隧道房水引流术治疗难治性青光眼

目的探讨巩膜层间隧道房水引流术治疗难治性青光眼的临床效果。设计前瞻性随机对照临床研究。研究对象 87例(98眼)难治性青光眼患者。方法将不同类型难治性青光眼患者随机分为2组,隧道组(50眼)行巩膜层间隧道房水引流术,在浅层巩膜下纵形切除5．0mm×1.5mm条状饭层巩膜和常规的小梁切除,条状巩膜远端超过巩膜床1．5-2．0mm,对照组(48 眼)行常规的小梁切除术。术后随访6-12个月。主要指标视力、眼压、滤过泡、术巾及术后并发症。结果 (1)术后视力隧道组和对照组比较差异无统计学意义(x2=1．15,P=0．76)。(2)术后1周两组眼压与术前相比差异有统计学意义,而组间比较差异无统计学意义(t=1.85,P=0．08);术后6个月隧道组平均眼压(14．34±3．95)mmHg.对照组(19．57±7．76)mmHg;手术成功率:隧道组 88．00％,对照组64．58％,差异均有统计学意义(P<0．05)。(3)隧道组功能性滤过泡82,0％,对照组60．4％,两组比较差异有统计学意义(x2=5．59,P=0．02)。(4)术后隧道组出现浅前房较对照组多,治疗后1周内恢复正常,没有其他并发症。结论对于难治性青光眼,与常规小梁切除术比较,巩膜层间隧道房水引流术在防止滤过道瘢痕形成,术后眼压控制等方面均有明显优势。     

深层巩膜切除联合激光小梁灼滤术治疗开角型青光眼

目的　观察深层巩膜切除联合激光小梁灼滤术治疗开角型青光眼的临床疗效。方法对 32例 (32只眼 )中、晚期开角型青光眼患者施行深层巩膜切除术 ,暴露Schlemm管外壁及残存的小梁网菲薄角膜缘组织 ,采取半导体激光器眼内用导光纤维 ,紧靠巩膜突前方小梁网角膜缘区域 ,直视下激光热灼击开 2或 3个圆形滤孔 ,滤孔直径 5 0 0 μm ,房水缓缓溢出。巩膜瓣缝合 1或 2针。术后观察患者眼压、眼内反应、滤过泡形态、前房角镜及超声生物显微镜 (UBM)检查结果。随访时间 4～ 2 4个月 ,平均 (7 94± 6 2 0 )个月。结果　 32只眼术后早期前房形成良好 ,视力稳定。最终随访患者平均眼压 (14 86± 4 15 )mmHg(1mmHg =0 133kPa) ,明显低于术前 (2 9 6 8± 5 76 )mmHg ,差异有非常显著意义 (t=7 4 15 ,P <0 0 0 1)。术后 32只眼均形成明显弥散性滤过泡 ;随访期间 ,2 7只眼有功能性滤过泡 ,5只眼于术后 2～ 3个月功能性滤过泡消失。 2只眼术中虹膜轻微灼伤 ,出现前房一过性色素脱失和房水混浊 ;角膜与晶状体无激光性损伤。 2只眼术后眼压偏高 ,局部应用抗青光眼药物后眼压控制正常。结论　深层巩膜切除联合激光小梁灼滤术能有效降低眼压 ,无穿透性小梁切除术常见的严重并发症 ,是治疗开角型青光眼的有效术式之一。     

非穿透性小梁手术联合透明质酸钠生物胶植入术的临床观察

目的 :观察非穿透性小梁手术 (nonperforatingtrabecularsurgery ,NPTS)联合透明质酸钠生物胶植入术的临床疗效。方法 :对 7例 11眼开角型青光眼行NPTS联合透明质酸钠生物胶植入术。术后对视力、眼压、滤过泡、前房、房角、并发症等进行观察 ,并作超声生物显微镜 (UBM )检查。结果 :经 2～ 15个月 ,平均 (10 3 6± 9 2 0 )个月的随访 ,9眼视力无变化 ,2眼有波动 (原有视网膜出血复发 ,经治疗后恢复 )术前平均眼压 (2 8 5 5± 12 0 9)mmHg (1mmHg =0 13 3kPa) ,术后 (13± 5 68)mmHg ,平均降低 15 5 5mmHg ,降低率为5 4 47% ,手术前后有高度显著性差异 (P <0 0 1) ,11眼眼压均 <2 1mmHg ,其中 2眼局部点用一种抗青光眼药物 ,占 18 18% ,未用药 9眼 ,占 81 82 %。术中小梁网 -狄氏膜窗微穿孔 3眼 (未作处理 ) ,前房少量出血 1眼 ,2天后吸收 ,前房轻度变浅 3眼 ,分别于术后 2～ 5天恢复。术后房水轻度闪辉 3眼 ,均 2～ 5天内消失。滤过泡 :Ⅰ型 (微囊型 ) 2眼 ,Ⅱ型 (弥漫型 ) 7眼 ,Ⅳ型 (包囊型 ) 2眼。房角可见相应手术区房角 -长方形变薄半透明区域 ,并隐约可见巩膜瓣下的液腔 ,微穿孔的 3眼 ,微穿孔区不明显 ,无虹膜前粘连。术后 2周后行UBM检查 ,可见手术区域房角开放 ,所剩小梁厚 0 0 75mm～     

小梁切开术联合小范围小梁切除术治疗先天性青光眼

目的 :探讨小梁切开术联合小范围小梁切除术治疗先天性青光眼的有效性和安全性。方法 :对 14例 ( 2 0只眼 )先天性青光眼行小梁切开术联合小范围小梁切除术。术后观察眼压、角膜横径、杯盘比值、滤过泡及并发症。随访 2 4～ 3 6个月平均 2 6 2 0± 6 0 2个月。结果 :术前平均眼压 3 2 5 0± 7 3 2mmHg ,最后一次随访时的平均眼压 14 60± 4 3 2mmHg ,两者差异有显著性 (t =6 2 4,P <0 0 1) ,手术成功率为 95 % (IOP <2 1mmHg)。术后 15只眼有功能性滤过泡。所有病例角膜横径和杯盘比值稳定。无玻璃体脱出 ,浅前房 ,虹膜粘连及眼内感染等并发症。结论 :小梁切开术联合小范围小梁切除术是一种安全、有效的治疗先天性青光眼的方法。     

小梁切除联合羊膜移植用于青光眼再手术

目的　观察小梁切除联合羊膜移植术的效果和安全性。方法　对 3 4例 (3 6眼 )青光眼再手术病例施行小梁切除联合羊膜移植术 ,术后随访 1年 ,检查记录术后视力、滤过泡、前房深度、眼压及术后并发症。结果　随访期间眼压由术前的(3 5 2 3± 8 3 )mmHg降至术后的 (15 12± 3 5 )mmHg(1mmHg =0 13 3kPa) ,比术前降低 5 7% ,P <0 0 0 1。术后 1年眼压控制率为91 7% (3 3 / 3 6) ,术后视力提高 2行以上者 5 0 % (18/ 3 6) ,不变者 3 3 3 % (12 / 3 6) ,减退者 16 7% (6/ 3 6) ,保持功能性滤过泡 3 2眼(88 9% ) ,并发症主要为低眼压 (8眼 )和浅前房 (4眼 )。结论　羊膜移植联合小梁切除术可减少滤过道瘢痕形成 ,显著提高手术成功率。用于青光眼再手术安全有效。     

抗青光眼术后白内障行超声乳化术的前房炎症反应临床研究

目的观察抗青光眼术后白内障超声乳化吸出及人工晶体植入术后的前房炎症反应及其对眼压和视功能的影响。方法对40例(62眼)老年性白内障及40例(50眼)抗青光眼术后白内障患者(15眼无瞳孔粘连35眼有瞳孔粘连,开角型青光眼2例4眼,慢性闭角型青光眼17例29眼,急性闭角型青光眼11例17眼),应用激光闪光细胞检测仪(Laserflarecellmeter,LFCM)测量并比较超声乳化白内障吸除并人工晶体植入术前及术后1天、7天、30天及90天房水的平均闪辉值并观察术前后的眼压、视力及滤过泡情况。结果术前,老年性白内障及抗青光眼术后白内障患者房水的平均闪辉值无明显差别。各组术后1天、7天及30天的房水蛋白浓度均较术前为主,并有显著性差异(P<0.05)。术后90天时,老年性白内障患者与术前无显著性差别,而抗青光眼术后白内障患者仍高于术前水平,并有显著性差异(P<0.05)。术后1天,无瞳孔粘连眼与有瞳孔粘连组差异有显著性。两组术后视力均明显提高,眼压控制稳定,青光眼组术后眼压下降,与术前有显著性差别。结论抗青光眼术后白内障手术后眼血-房水屏障功能破坏,炎症反应重,恢复需要更长的时间,但手术具有安全性,术后视功能及眼压恢复理想,且能进一步降低青光眼的眼压。     

房水闪辉和细胞的定量测量

激光蛋白细胞检测仪可快速、精确、定量测定房水蛋白浓度和细胞数量,评价各种眼内疾病、手术和治疗对血-房水屏障功能的影响,对疾病的诊断和疗效观察提供有利帮助,本文就其在临床上的应用作一综述。     

Iris delay,a neglected factor in aqueous humour dynamics. A study in the cynomolgus monkey (Macaca fascicularis)

A method is described, intended for measuring the rate — over a short period of time — of aqueous humour outflow in non-anaesthetized primates. [¹²⁵I] and [¹³¹I]-o-iodohippurates were infused s.c. at an interval into the conscious Cynomolgus monkey so as to give two time-displaced plasma curves. The isotope concentrations were measured in plasma by frequent sampling over the first 1–2 hr and in aqueous humour at the end of the experiment under brief anaesthesia. The coefficient of diffusion (k_diff) between plasma and aqueous, and the coefficient of loss (k_out) out of the anterior chamber were calculated by making the usual assumptions about aqueous dynamics.Topical treatment of one eye with timolol consistently reduced k_out, as expected, but many control values for k_out were lower than expected or (impossibly) negative. Examination of the data reveals a likely source of error emanating from the commonly made assumption that diffusion of marker substance (in our case iodohippurate) from plasma to aqueous humour is proportional to the instantaneous concentration difference between plasma and aqueous. In fact, there may be a delay of several minutes during which the substance negotiates the stroma and anterior boundary layer of the iris. Evidence is presented that variation between and within individual monkeys may stem from the highly variable anatomy of the iris and from changes in sympathetic tone operating on the blood vessels and perhaps the anterior boundary layer.     

Brain natriuretic peptide: identification of a second natriuretic peptide in human aqueous humour

AIMS/BACKGROUND—To measure aqueous humour levels of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) in humans. To compare peptide levels in glaucomatous and control eyes to test the hypothesis that these peptides are increased in glaucoma. BNP and ANP are cyclic endopeptides whose principal biological effects are natriuresis and vasodilatation. Experimental glaucoma in animal models results in elevated aqueous ANP. Intravenous ANP administration in both animals and humans causes lowering of intraocular pressure (IOP). There are equivocal data to support a role for ANP in IOP regulation in human eyes. There are as yet no published data on BNP in human aqueous humour.
METHOD—This was a case-control study. Cases were primary open angle, pseudoexfoliation, and mixed mechanism glaucoma eyes undergoing trabeculectomy. Controls were cataract extraction eyes. There were 47 trabeculectomy eyes (44 patients) and 47 cataract extraction eyes (46 patients) matched for age, sex, race, systemic medications, and type of anaesthetic. 100-200 µl of aqueous humour were aspirated by paracentesis as the first step in the surgical procedure. Peptide levels were later measured by radioimmunoassay.
RESULTS—The presence of BNP and ANP in human aqueous humour was confirmed. BNP was present in higher concentrations than ANP. BNP levels tended to be greater in control eyes—glaucoma median 56.5 (range 0-3526.5) pg/ml versus control median 65.16 (range 0-1788) pg/ml (Wilcoxon signed rank test p = 0.78). ANP levels tended to be greater in glaucoma eyes than in controls: glaucoma median 3 (range 0-68.5) pg/ml versus control median 0 (range 0-60) pg/ml (Wilcoxon signed rank test p = 0.82). ANP and BNP were log linearly related in both groups (r glaucoma group = 0.961, r control group = 0.894).
CONCLUSION—This is the first report of BNP and ANP in human aqueous humour. Peptide levels did not differ significantly between glaucoma and cataract extraction eyes. A linear relation between log BNP and ANP was found. Further studies are required to clarify the role of these peptides in aqueous humour production and IOP regulation.

Keywords: brain natriuretic peptide; aqueous natriuretic peptide; aqueous humour; glaucoma     

Measurement of aqueous humor flow

Aqueous humor flow, one of the primary determinants of intraocular pressure, has been measured non-invasively in the human eye since the early 1950s. Other than sleep, which decreases flow rate to approximately half of what it is during alert wakefulness, few conditions affect flow rate. Three classes of medication can suppress flow and have been used therapeutically, β-adrenergic antagonists, α₂-adrenergic agonists, and carbonic anhydrase inhibitors. Studies of the production and circulation of aqueous humor have provided a basis for understanding the fundamental dynamics of the eye as well as understanding treatments for glaucoma.     

Isolation of the human T-cell leukemia/lymphotropic virus type III from aqueous humor in two patients with perivasculitis of the retinal vessels

Summary The human T-cell leukemia/lymphotropic virus type III (HTLV-III) has been isolated from aqueous humor in two patients with perivasculitis of the peripheral retinal vessels, an AIDS-related ocular manifestation. Both patients had antibodies to HTLV-III and although they presented with herpes zoster ophthalmicus, they did not present other symptoms known to be associated with HTLV-III infection. The isolation of HTLV-III from aqueous humor in these two patients with retinal perivasculitis suggests that the virus itself may play a role in the etiology of this ocular sign. The presence of infectious HTLV-III in the anterior chamber further emphasises the necessity to discard corneas from HTLV-III infected donors. Address for offprints: Mrs Suzy Sprecher-Goldberger, Institut Pasteur du Brabant, rue Engeland 642, Bruxelles/Uccle Belgium     

Total protein concentration and T-cell suppression activity of aqueous humour before and after penetrating keratoplasty

Purpose

We wished to determine whether immune privilege parameters assayed in aqueous humour (AqH) are relevant to the fate of penetrating keratoplasty (PK) in humans.

Methods

AqH was collected in 28 patients before PK (prospective cohort), in 6 patients with no history of graft rejection undergoing cataract surgery after PK (acceptors), in another 6 patients undergoing treatment of an acute endothelial immune reaction (rejectors), and in 65 controls undergoing uncomplicated cataract extraction. AqH was tested for total protein concentration and the ability to suppress T-cell activation.

Results

AqH protein concentrations of acceptors and rejectors post-PK were elevated (2.7±0.8 and 2.7±0.7 mg/ml, respectively) compared with pre-PK AqH level and cataract controls (1.0±0.1 mg/ml, P=0.01). All AqH samples suppressed T-cell activation, irrespective of source and timing of AqH removal.

Conclusion

Assays of immune privilege markers in AqH suggest that PK surgery may result in a sustained loss of integrity of the blood–aqueous barrier. Although trends were evident, values of immune privilege markers determined pre- and post-PK were not statistically significantly different between the study groups. However, further prospective studies determining additional immune privilege markers have to be conducted in order to find out whether these markers might serve as predictive parameters for immune reactions following PK.     

Anterior Segment Anatomy and Conventional Outflow Physiology of the Tree Shrew (Tupaia belangeri)

PurposeRodent and primate models are commonly used in glaucoma research; however, both have their limitations. The tree shrew (Tupaia belangeri) is an emerging animal model for glaucoma research owing in part to having a human-like optic nerve head anatomy, specifically a collagenous load-bearing lamina. However, the anterior segment anatomy and function have not been extensively studied in the tree shrew. Thus, the purpose of this study was to provide the first detailed examination of the anterior segment anatomy and aqueous outflow facility in the tree shrew.MethodsAqueous outflow dynamics were measured in five ostensibly normal eyes from three tree shrews using the iPerfusion system over a range of pressures. Gross histological assessment and immunohistochemistry were performed to characterize anterior segment anatomy and to localize several key molecules related to aqueous outflow.ResultsAnterior segment anatomy in tree shrews is similar to humans, demonstrating a scleral spur, a multilayered trabecular meshwork and a circular Schlemm''s canal with a single lumen. Average outflow facility was 0.193 µL/min/mm Hg (95% confidence interval, 0.153–0.244), and was stable over time. Outflow facility was more similar between contralateral eyes (approximately 5% average difference) than between eyes of different animals. No significant dependence of outflow facility on time or pressure was detected (pressure–flow nonlinearity parameter of 0.01 (95% % confidence interval, −0.29 to 0.31 CI µL/min/mm Hg).ConclusionsThese studies lend support to the usefulness of the tree shrew as a novel animal model in anterior segment glaucoma and pharmacology research. The tree shrew''s cost, load-bearing collagenous lamina cribrosa, and lack of washout or anterior chamber deepening provides a distinct experimental and anatomic advantage over the current rodent and nonhuman primate models used for translational research.     

国产房水引流物植入术治疗难治性青光眼疗效观察

目的 评价同产房水引流物(HAD)植入术治疗难治性青光眼的临床疗效。 方法 对21例(21眼)难治性青光眼患者施行HAD植入术。新生血管性青光眼7例、虹膜-角膜内皮综合征继发青光眼3例、无晶状体青光眼7例、青少年性青光眼1例及多次行滤过性青光眼手术失败者3例。术前平均眼压(38.71±11.38)mmHg。术后随访平均(13.90±8.99)月。 结果 术后平均眼压(12.71±5.82)mmHg,眼压平均下降26 mmHg。17例获得成功,手术成功率为80.95％。并发症有暂时性前房出血3例(14.29％)、前葡萄膜炎3例(14.29％)、脉络膜脱离8例(38.10％)、引流盘脱出1例(4.76％)、浅前房8例(38.10％)、并发性白内障2例(9.52％)、角膜内皮失代偿1例(4.76％)。 结论 HAD植入术可有效治疗难治性青光眼,其临床疗效及并发症与使用同外同类产品相当,且HAD柔软性好,易于手术操作,价格低于同类进口产品。     

Efficacy and safety of 1% rimexolone versus 1% prednisolone acetate in the treatment of anterior uveitis – a randomized triple masked study

Purpose: To evaluate the efficacy and safety of 1% rimexolone versus 1% prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis. Methods: A randomised triple masked, parallel comparison of rimexolone and prednisolone acetate ophthalmic suspensions was carried out on 78 patients with acute, chronic and recurrent anterior uveitis. Treatment regimen included instillation of one or two drops of drug one hourly through the waking hours during the first week, two hourly in the second week, four times a day in the third week, two times a day for the first 4 days and once a day for the 3days in the last week. The patient was clinically evaluated on the 3–4th, 7–10th, 14th, 21st and 28th days. The patient was also reviewed on the 30th day. Anterior chamber cells and flare reactions were compared for evaluating the efficacy of the drugs. Result: Rimexolone is as effective as prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis. The largest difference found was 0.1 in the flare reaction (statistically insignificant; p=0.3) and 0.2 score units (statistically significant; p=0.01) in the cells. Overall, comparison of the drugs shows no clinical significance in the treatment of anterior uveitis by either drug. Difference in intraocular pressure (IOP) was also statistically insignificant (p>0.05). However, three patients in the prednisolone acetate group and 1 patient from the rimexolone group showed a rise in IOP. Conclusion: Rimexolone 1% ophthalmic suspension is as effective as and safer than prednisolone acetate 1% ophthalmic suspension in the treatment of anterior uveitis.