Effects of Topical Phenylephrine on Blood Flow in the Posterior Segments of Monkey and Aged Human Eyes

Purpose The aim of this study was to evaluate the effects of topical 5% phenylephrine on circulation in the optic nerve head (ONH) of cynomolgus monkeys and in the central retinal artery (CRA) of aged patients.Methods In five monkeys, ONH tissue blood velocity (NB_ONH), determined using the laser speckle method, and intraocular pressure (IOP), blood pressure (BP), and pulse rate (PR) were measured 2h after a single unilateral instillation and after a 7-day twice-daily unilateral instillation of phenylephrine. In 20 aged patients (mean age: 70.4 years), the CRA circulation indices were determined by color Doppler imaging (CDI), and IOP, BP, and PR were measured before and after four serial unilateral instillations at 30-min intervals of phenylephrine.Results In the monkeys, there was no significant change in IOP, BR, or PR, while NB_ONH decreased 2h after a single instillation (P = 0.080) and after a 7-day instillation (P = 0.043). In theaged patients, IOP in the phenylephrine-treated eyes significantly increased (P = 0.022), while the CDI indices, BR, and PR did not. In this CDI assessment, the statistical power to detect significant changes (P < 0.05) in the resistive index was estimated as 4.8% of the standard deviation.Conclusions Topical phenylephrine decreased the ONH tissue blood velocity in monkeys, suggesting possible risks regarding circulation in the posterior portion of the eye. However, these effects were not observed in the CRA circulation in the patients. Jpn J Ophthalmol 2004;48:243–248 © Japanese Ophthalmological Society 2004     

Effects of caffeine on microcirculation of the human ocular fundus

PURPOSE: To determine the effect of caffeine on microcirculation in the human ocular fundus. METHODS: The microcirculation in the ocular fundus of 10 healthy volunteers (10 eyes) was studied using a laser speckle tissue circulation analyzer. Caffeine or placebo (100 mg) was administered orally in a double-masked manner. Square blur rate (SBR), a quantitative index of blood flow velocity, was measured in a temporal site of the optic nerve head (ONH) free of surface vessels and in a middle site of the choroid-retina between the ONH and macula. Intraocular pressure (IOP), blood pressure (BP), pulse rate (PR), and central critical fusion frequency (CFF) were also measured. These parameters were measured before and for 2 hours after administration. The area under curve (AUC) of SBR was calculated for each area. Ocular perfusion pressure (OPP) was also calculated from BP and IOP. RESULTS: The time-course of change in SBR value showed much individual difference. Caffeine decreased the AUC of SBR in the ONH (P =.0218) as well as in the choroid-retina (P =.0469) significantly. IOP, mean BP, PR, OPP, and central CFF did not change significantly. CONCLUSIONS: These results suggest that caffeine may increase blood vessel resistance and decrease blood flow in the human ONH and choroid-retina.     

Effects of erytropoietin treatment and hemodialysis on the serum endothelin level and intraocular pressure of hemodialysis patients

Aim The aim of this study is to evaluate the effect of erythropoietin and hemodialysis (HD) on serum Endotheli-1 (ET-1) and intraocular pressure (IOP) levels in HD patients. Methods The study group was composed of 34 chronic HD patients undergoing erythropoietin (EPO) treatment, while the control group was composed of 16 chronic HD patients without EPO treatment. Serum samples for measuring levels of ET-1 were taken 1 h before and after HD. Endothelin-1 levels were determined using a commercially available Elisa kit. IOP was measured with a calibrated Goldmann applanation tonometer in the right eyes of patients 1 h before and after HD just after blood samples were taken. Results In the EPO group, serum ET-1 levels were significantly higher than those of the control group both before and after HD. Despite increased ET-1 levels in the EPO group, there was no statistically significant difference in pre- and post-dialysis IOP measurements between the erythropoietin and control groups (P > 0.05). In both the HD and control groups, the IOP levels significantly decreased following HD (P < 0.05). Conclusion EPO treatment caused an increase in plasma ET-1 concentration compared to the control group, while there was no related increase in IOP with EPO treatment. The role of ET-1 in glaucoma development must involve a mechanism other than increased IOP.     

Effect of caffeine on microcirculation of human ocular fundus]

PURPOSE: To determine the effect of caffeine on the microcirculation in the human ocular fundus. SUBJECTS AND METHODS: The microcirculation of the ocular fundus in 10 eyes of 10 healthy volunteers was studied using a laser speckle tissue circulation analyser. 100 mg of caffeine or placebo was given orally in a double-blind test. Square blur rate(SBR), a quantitative index of blood flow velocity, was measured in the temporal site of the optic nerve head(ONH) free of surface vessels and in the middle site of the choroid-retina between the ONH and the macula. Intraocular pressure(IOP), blood pressure(BP), pulse rate(PR), and central critical fusion frequency(CFF) were also measured. These parameters were measured before and for 2 hours after administration. The area under curve(AUC), of the SBR was calculated for each area. Ocular perfusion pressure(OPP) was also obtained from blood pressure and intraocular pressure. RESULTS: The time-course change of SBR value showed much individual difference. Caffeine decreased the AUC of the SBR in the ONH as well as in the choroid-retina significantly. IOP, mean BP, PR, OPP and central CFF did not change significantly. CONCLUSIONS: These results suggest that caffeine may increase blood vessel resistance and decrease blood flow in the ONH and choroid-retina in humans.     

The mechanism and change in the optic nerve head (ONH) circulation in rabbits after glucose loading

PURPOSE: To assess the influence of the blood glucose level on ocular capillary circulation, we induced clinically significant hyperglycemia (200--300 mg/dl) in rabbits and investigated the changes in the optic nerve head (ONH) circulation. METHODS: Hyperglycemia was induced by injection of glucose (5.6 mmol/kg) into an auricular vein of healthy albino rabbits and changes in the ONH circulation were measured by the laser speckle method. In order to examine the role of nitric oxide (NO), glucose was administered after intravenous injection of an NO synthetase inhibitor (N(G)-nitro-L-arginine methyl ester, L-NAME, 1 mg/kg), then changes in the ONH circulation were measured. RESULTS: The blood glucose level reached a peak at 30 min after glucose loading and returned to its initial level by 2 hours. ONH circulation showed a 60% increase compared with its initial level at 15 min after glucose loading and subsequently remained almost unchanged throughout the 2-hour observation period. There were no significant changes of the blood pressure, heart rate, or intraocular pressure. The glucose-induced increase of ONH circulation was completely inhibited by pretreatment with L-NAME. CONCLUSIONS: ONH circulation was increased by administration of glucose to healthy rabbits. A high blood glucose level seems to promote ocular capillary circulation and NO as well as insulin appear to have a role in this process.     

Circadian changes of intraocular pressure and ocular perfusion pressure after timolol or latanoprost in Caucasians with normal-tension glaucoma

Purpose To evaluate the circadian effects on intraocular pressure (IOP) and ocular perfusion pressure (OPP) of 0.5% timolol or 0.005% latanoprost in Caucasian patients affected by normal-tension glaucoma (NTG). Patients and methods In this crossover trial, 30 consecutive NTG subjects underwent three 24-hour assessments of IOP, blood pressure (BP), heart rate (HR), and OPP [calculated according to the formula OPP = (1/3 systolic BP + 2/3 diastolic BP) x 2/3 – IOP]: at baseline, and after 1-month treatment with timolol or latanoprost. These parameters were recorded at 4 a.m., 8 a.m., noon, 4 p.m., 8 p.m., and midnight. Results Both timolol and latanoprost reduced IOP (p < 0.001), with a difference in favour of latanoprost of 1.3 mmHg (95% CI 0.9, 1.6; p < 0.001). After timolol, BP and HR decreased with respect to baseline (p < 0.001). Latanoprost increased mean OPP (3.6 mmHg, 95% CI 2.9, 4.3; p < 0.001), whereas timolol did not improve it. Conclusions Latanoprost induces an IOP reduction greater than timolol, also achieving a better circadian flattening of the IOP curve. Only latanoprost significantly increased mean 24-hour OPP. The management of Caucasian NTG patients should be critically realized, considering the 24-hour influence of each IOP-lowering drug on the ocular blood perfusion.     

Effects of nilvadipine, a calcium antagonist, on rabbit ocular circulation and optic nerve head circulation in NTG subjects

PURPOSE: To study the effects of nilvadipine, a Ca2+ antagonist, on tissue circulation in the optic nerve head (ONH), choroid, and retina in rabbits and on the ONH circulation in normal tension glaucoma (NTG) patients. METHODS: Nilvadipine (3.2 microg/kg) or vehicle solution was injected intravenously into urethane-anesthetized rabbits, and the normalized blur value (NB), a quantitative index of in vivo tissue blood velocity, was measured in the choroid and in an area of the ONH and retina free of visible surface vessels before and for 90 minutes after injection, using the laser speckle method. The effects of nilvadipine on the ONH circulation was also studied using the H2 gas clearance method in separate groups of rabbits. Oral nilvadipine (4 mg/d) or placebo was administered to NTG patients in a double-masked manner, and NB in an area of the ONH rim free of visible surface vessels was measured by the same method before and 2, 4, 8, and 12 weeks after administration. RESULTS: The NB obtained from the ONH, choroid, or retina during the experimental period was increased by approximately 10% to 25% in the nilvadipine group compared with the NB in the control group (P < 0.0001, ANOVA), although systemic condition parameters and intraocular pressure (IOP) showed no significant intergroup difference except for a transient decrease in blood pressure in the nilvadipine groups. Blood flow rate in the ONH determined by the H2 gas clearance method also showed an approximately 25% increase in the nilvadipine group. The NB in the ONH of the oral nilvadipine-treated patients was significantly increased, by approximately 20% compared with the placebo-treated patients throughout the follow-up period. No significant intergroup difference was seen in blood pressure, pulse rate, or IOP. CONCLUSIONS: Nilvadipine increased blood velocity and, probably, blood flow in the ONH, choroid, and retina of rabbits. It also increased blood velocity in the ONH of NTG patients.     

In vivo measurement of ocular circulation with the laser speckle method--development of apparatus and application in ophthalmological research

We have developed an apparatus utilizing laser speckle phenomenon which can measure the peripheral circulation in the iris, choroid, retina and optic nerve head (ONH) and blood velocity through retinal vessels in the living eye non-invasively and quantitatively. A blue-component argon laser (wavelength 488 nm) was used for measurement of peripheral circulation in the retina and a diode laser (wavelength 808 nm) for measurements of peripheral circulation in the iris, posterior choroid and ONH, and measurement of centerline blood velocity through retinal vessels. A fundus camera (TRC-WT 3, Topcon) was equipped with a laser source and an image sensor where the speckle pattern from the fundus appears, and the data were analyzed with a personal computer to give a normalized blur (NB) value or a square blur rate (SBR) value, both quantitative indices of blood velocity. The NB value, whose computation requires much less time, was adopted to evaluate peripheral circulation because of non-linear correlation between the NB and actual blood velocity in the range above 20 mm/sec. The SBR value, whose computation requires a longer time, was adopted for measurement of blood velocity through retinal vessels. Measurement field in the living eye was 1.06 x 1.06 mm at its maximum and reproducibility index of the in vivo measurement in the rabbit iris, choroid, retina, and ONH was approximately 10%. When blood flow was changed by intraocular pressure (IOP) change in rabbit eyes, NB values obtained from the iris, choroid, and retina showed a significant correlation with the blood flow simultaneously determined with the colored microsphere technique in the same eye, and the NB obtained from the ONH also correlated with the blood flow determined with the H2 gas clearance method. Stepwise reduction in the ocular perfusion pressure (OPP) by stepwise increment of IOP resulted in proportional reduction in the iris- and choroid-NB. On the other hand, the retina- or ONH-NB remained almost unaltered at OPP levels above 50 mmHg, and decreased along with OPP at levels less than 50 mmHg. By monitoring NB values for 2 hours, presence or absence of autoregulatory mechanism against OPP change in the choroidal and ONH circulation was studied in rabbits. Throughout the experimental period of 2 hours, the choroidal NB was changed along with the OPP change, suggesting absence of blood flow autoregulation in this tissue. In the ONH, however, the NB returned to the baseline after its transient increase or decrease when the OPP was continuously increased or decreased, showing the presence of an autoregulatory mechanism in the ONH circulation. However, the time course of the NB resumption depended on the extent of OPP change. These results indicated that the laser speckle method can be useful in investigating the autoregulatory mechanism and processes of peripheral circulation in ocular tissues. Unilateral instillation of drugs with vasodilative activity (ifenprodil, betaxolol or nipradilol) in rabbit eyes significantly increased ONH and/or choroidal circulation. The extent in change in the ONH and/or choroidal circulation correlated with the number of doses, but not with the extent of IOP reduction, which suggested that the observed effects were attributable to the drug which penetrated locally. Intravenous administration of a Ca(2+)-antagonist (nicardipine, nilvadipine or pranidipine) significantly increased choroidal or retinal circulation in rabbits. The ONH circulation, however, was not affected by nicardipine, but affected by nilvadipine or pranidipine. Given the same effect on the ONH circulation, systemic hypotensive effect was stronger in pranidipine than in nilvadipine, which suggested that nilvadipine can be used in patients with ocular circulatory insufficiency. A modification of the laser speckle apparatus used for animal experiments was devised so that the NB or SBR values could be measured in human eyes every 0.12 sec on a real-time basis. (ABSTRACT TRUN     

Effect of the consumption of ethanol on the microcirculation of the human optic nerve head in the acute phase

PURPOSE: The effect of the consumption of ethanol on the circulation of the optic nerve head (ONH) in the human eye in the acute phase and its mechanism were studied. METHODS: Eleven volunteers drank a bottle of beer (633 ml) with or without ethanol (29.5 g). Normalized blur (NB), a quantitative index of blood flow velocity, was measured in the temporal site of the ONH. NB, blood pressure (BP) and pulse rate (PR) were measured before, immediately after, and every 15 minutes for 90 minutes after consumption. Intraocular pressure (IOP) and plasma ethanol concentration were measured before, and 30 and 90 minutes after consumption. Genotyping of the aldehyde dehydrogenase (ALDH) 2 gene was also performed. RESULTS: NB in the ONH increased significantly from 15 to 45 minutes after consumption of ethanol and the maximum increase was 14% at 15 minutes. IOP was lowered at 90 minutes after consumption, but it was not significant. Mean BP was lowered significantly after 60 minutes. PR and ocular perfusion pressure did not change. A significant correlation was found between plasma ethanol concentration at 30 minutes and maximum NB. NB in the ALDH 2-deficient group was significantly larger from 15 to 45 minutes after consumption than in the proficient group. CONCLUSION: It appeared that the consumption of ethanol can increase the blood flow in the human ONH in the acute phase through decreased resistance in blood vessels induced by acetaldehyde, a metabolite of ethanol.     

Effect of the consumption of ethanol on the microcirculation of the human optic nerve head in the acute phase

Purpose: The effect of the consumption of ethanol on the circulation of the optic nerve head (ONH) in the human eye in the acute phase and its mechanism were studied.Methods: Eleven volunteers drank a bottle of beer (633 mL) with or without ethanol (29.5 g). Normalized blur (NB), a quantitative index of blood flow velocity, was measured in the temporal site of the ONH. NB, blood pressure (BP) and pulse rate (PR) were measured before, immediately after, and every 15 minutes for 90 minutes after consumption. Intraocular pressure (IOP) and plasma ethanol concentration were measured before, and 30 and 90 minutes after consumption. Genotyping of the aldehyde dehydrogenase (ALDH) 2 gene was also performed.Results: NB in the ONH increased significantly from 15 to 45 minutes after consumption of ethanol and the maximum increase was 14% at 15 minutes. IOP was lowered at 90 minutes after consumption, but it was not significant. Mean BP was lowered significantly after 60 minutes. PR and ocular perfusion pressure did not change. A significant correlation was found between plasma ethanol concentration at 30 minutes and maximum NB. NB in the ALDH 2-deficient group was significantly larger from 15 to 45 minutes after consumption than in the proficient group.Conclusions: It appeared that the consumption of ethanol can increase the blood flow in the human ONH in the acute phase through decreased resistance in blood vessels induced by acetaldehyde, a metabolite of ethanol.     

Effects of prostaglandin F2α analogues on endothelin-1-induced impairment of rabbit ocular blood flow: Comparison among tafluprost,travoprost, and latanoprost

We investigated the effects of prostaglandin F_2α (PGF_2α) analogues on the endothelin-1 (ET-1)-induced impairment of optic nerve head (ONH) blood flow and on ET-1-induced contraction in isolated ciliary artery segments. In male rabbits, one of four PGF_2α analogues [0.0015% tafluprost, 0.0015% 15-hydroxyl tafluprost (15-OH tafluprost), 0.005% latanoprost, or 0.004% travoprost] was topically administered at various pretreatment times before intravitreal ET-1 injection. ONH blood flow was estimated by the laser speckle method, which expresses blood velocity as a quantitative index, the squared blur rate (SBR). SBR was measured just before (baseline value) and at 30, 60, and 120 min after ET-1 injection. SBR was significantly decreased from 4.47 ± 0.20 to 3.50 ± 0.10 (78.6 ± 2.4% of baseline) at 120 min after intravitreal ET-1 injection (5 pmol/eye). The ET-1-induced decrease was almost completely prevented by tafluprost and significantly inhibited by the other three analogues. The inhibitory effect lasted longest with tafluprost, as indicated by the effective pretreatment times (tafluprost: 90, 120, or 240 min; 15-OH tafluprost: 90, but not 120 or 240 min; latanoprost and travoprost: 120, but not 240 min). In vitro, the effects of PGF_2α analogues on ET-1-induced contractions in male rabbit ciliary arteries were evaluated using an isometric tension recording system. Tafluprost, latanoprost, travoprost, and 15-OH tafluprost concentration-dependently relaxed the 10 nM ET-1-induced ciliary artery contraction. Improvement of the ocular circulation may be superior with tafluprost than with the other PGF_2α analogues. The underlying mechanism may involve relaxation of ocular resistance vessels.     

Effects of prostaglandin F2α analogues on endothelin-1-induced impairment of rabbit ocular blood flow: Comparison among tafluprost,travoprost, and latanoprost

We investigated the effects of prostaglandin F_2α (PGF_2α) analogues on the endothelin-1 (ET-1)-induced impairment of optic nerve head (ONH) blood flow and on ET-1-induced contraction in isolated ciliary artery segments. In male rabbits, one of four PGF_2α analogues [0.0015% tafluprost, 0.0015% 15-hydroxyl tafluprost (15-OH tafluprost), 0.005% latanoprost, or 0.004% travoprost] was topically administered at various pretreatment times before intravitreal ET-1 injection. ONH blood flow was estimated by the laser speckle method, which expresses blood velocity as a quantitative index, the squared blur rate (SBR). SBR was measured just before (baseline value) and at 30, 60, and 120 min after ET-1 injection. SBR was significantly decreased from 4.47 ± 0.20 to 3.50 ± 0.10 (78.6 ± 2.4% of baseline) at 120 min after intravitreal ET-1 injection (5 pmol/eye). The ET-1-induced decrease was almost completely prevented by tafluprost and significantly inhibited by the other three analogues. The inhibitory effect lasted longest with tafluprost, as indicated by the effective pretreatment times (tafluprost: 90, 120, or 240 min; 15-OH tafluprost: 90, but not 120 or 240 min; latanoprost and travoprost: 120, but not 240 min). In vitro, the effects of PGF_2α analogues on ET-1-induced contractions in male rabbit ciliary arteries were evaluated using an isometric tension recording system. Tafluprost, latanoprost, travoprost, and 15-OH tafluprost concentration-dependently relaxed the 10 nM ET-1-induced ciliary artery contraction. Improvement of the ocular circulation may be superior with tafluprost than with the other PGF_2α analogues. The underlying mechanism may involve relaxation of ocular resistance vessels.     

Effect of topical carteolol on tissue circulation in the optic nerve head

The effect of topical 2% carteolol on tissue circulation in the albino rabbit optic nerve head (ONH) was investigated using a laser speckle tissue circulation analyzer. In the first experiment, the normalized blur (NB) value, a quantitative index of tissue blood flow velocity in the ONH, intraocular pressure (IOP), blood pressure (BP), and pulse rate were measured under general anesthesia before as well as 30, 60, 90, and 120 minutes after a 20-μL instillation of carteolol in one eye and the vehicle in the other eye in a masked, randomized manner. In the second experiment, one eye of a rabbit received carteolol twice daily for 20 days and the fellow eye received the vehicle in a masked, randomized manner. The IOP was measured every 5 days, and the NB in the ONH and IOP were measured before treatment and 2 hours after the last instillation on the 20th day. After a single instillation of carteolol, pulse rate showed a maximum reduction of 15%, and IOP in the carteolol-treated eyes showed a maximum decrease of 22%. The NB in the ONH and BP did not show any significant change during the experiment. After 20-day treatment with carteolol, IOP showed a maximum decrease of 25% in the carteolol-treated eyes and 21% in the vehicle-treated eyes. The NB showed a significant increase of 15% (P < 0.01) in the carteolol-treated eyes and 11% (P < 0.01) in the vehicle-treated eyes. It was indicated that long-term topical carteolol increased the blood velocity in the ONH tissue both in the carteolol- and vehicle-treated contralateral eyes in albino rabbits.     

Optic cup enlargement followed by reduced optic nerve head circulation after optic nerve stimulation.

PURPOSE: To investigate changes in optic nerve head (ONH) circulation, visual evoked potentials (VEPs), and ONH cupping after stimulation of the optic nerve. METHODS: Electrodes were fixed above the optic chiasma in rabbits under general anesthesia. Screw-type electrodes for VEP recording were fixed on the dura. ONH circulation, intraocular pressure (IOP), and blood pressure (BP) were measured after the passage of a current of 0.1 mA for 0.1 second (weak stimulation), 1 mA for 1 second (moderate), 5 mA for 10 seconds (strong), or 25 mA for 10 seconds (severe). Normalized blur (NB), indicative of tissue blood flow and velocity, was measured in the ONH after each stimulation, by using a laser speckle circulation analyzer. Changes in VEP and ocular fundus were also recorded. The ratio of cup area (CA) to disc area (DA) was measured before and 4 weeks after stimulation. After all experiments, the ONH was histologically examined. RESULTS: Weak stimulation increased NB in ONH for 10 minutes, whereas strong or severe stimulation significantly decreased NB for a longer time, in a dose-dependent manner. BP showed no significant change, except with severe stimulation. IOP was not significantly changed. VEP amplitude was reduced 30 minutes after strong stimulation. The CA-to-DA ratio was significantly increased 4 weeks after strong stimulation. In some rabbits, disc hemorrhage occurred, followed by enlargement of disc cupping, with slight gliosis. CONCLUSIONS: Electrical stimulation of the optic nerve changed ONH circulation and VEPs and increased disc cupping. This technique warrants further investigation as an experimental model for normal-tension glaucoma.     

Effects of lomerizine, a calcium channel antagonist, on retinal and optic nerve head circulation in rabbits and humans

PURPOSE: To investigate the effects of lomerizine, a Ca2+ antagonist, on the ocular tissue circulation in rabbits and on the circulation in the optic nerve head (ONH) and choroid in healthy volunteers. METHODS: Lomerizine (0.1 [n=10] or 0.3 [n=11] mg/kg) or vehicle solution (n=11) was injected intravenously in urethane-anesthetized rabbits, and blood flow in the retina, choroid, and iris-ciliary body was measured by the microsphere method and that in the ONH by the H2 gas-clearance method (0.1 [n=6] or 0.3 [n=9] mg/kg or vehicle, n=6). Oral 5 mg lomerizine or placebo was administered to volunteers (n=8) in a crossover study, and in areas of the fovea and ONH, the normalized blur (NB), a quantitative index of blood velocity, was measured, together with blood pressure, heart rate, and intraocular pressure (IOP), before and 1.5, 3, 6, and 9 hours after administration. RESULTS: Blood flow in the rabbit retina increased significantly in the lomerizine-treated group, but blood flow changed little in the choroid or iris-ciliary body. Blood flow in the rabbit ONH also showed a significant increase in the lomerizine-treated group. In human studies, the NB obtained from the ONH during the experimental period showed a small but significant increase in the lomerizine-treated group compared with the placebo-treated group, but no significant intergroup difference was detected in the NB obtained from the fovea or in blood pressure, heart rate, or IOP. CONCLUSIONS: Lomerizine increases blood velocity, and probably blood flow, in the ONH and retina in rabbits, and it also increases blood velocity in the ONH in healthy humans, without significantly altering blood pressure or heart rate.     

Changes in optic nerve head blood flow induced by the combined therapy of latanoprost and beta blockers

Purpose To assess the effects of combined therapy with latanoprost and beta blockers on optic nerve head (ONH) blood flow in normal‐tension glaucoma (NTG) patients. Methods Intraocular pressure (IOP), ONH blood flow (laser speckle flowgraphy) and blood pressure were measured in 15 eyes of 15 NTG patients (41–76 years old) before treatment or after a 1‐month washout period. Similar measurements were performed at 2 months after the commencement of treatment with latanoprost and at 3 months after the start of combined therapy of latanoprost with 0.5% timolol or 2% carteolol in a crossover study using the envelope method. Measurement was carried out 2–3 hr after the morning application of eyedrops. Results Latanoprost decreased IOP with no significant change in ONH blood flow. Concomitant use of timolol or carteolol further decreased IOP with no significant difference between these two drugs. Only the combined therapy of latanoprost with carteolol significantly (p < 0.01) increased ONH blood flow by approximately 10%, compared to initial levels. There was no significant change in mean blood pressure, ocular perfusion pressure or pulse rate as a result of these therapies. Conclusion: Topical latanoprost–carteolol combined therapy increased ONH blood flow in NTG patients, unlike latanoprost–timolol therapy. Because ocular perfusion pressure was unchanged, direct vasodilative effects were suspected as the mechanism.     

Effect of nitric oxide synthase inhibitor on optic nerve head circulation in conscious rabbits

PURPOSE: To study the effect of a nitric oxide synthase inhibitor on tissue circulation in the optic nerve head (ONH) of conscious rabbits. METHODS: N(G)-nitro-L-arginine methyl ester (L-NAME) (1, 10, or 100 mg/kg), D-NAME (10 mg/kg), or physiological saline was administered intravenously to albino rabbits. A quantitative index of blood velocity, the normalized blur (NB), was measured in the ONH by laser speckle tissue circulation analyzer. The intraocular pressure (IOP) and blood pressure (BP) were also measured. L-arginine (10 mg/kg) was intravenously administered 20 minutes after L-NAME (10 mg/kg) injection. Acetylcholine (ACh; 10 microg/kg per minute) was infused for 15 minutes, with or without pretreatment of L-NAME (1 mg/kg). RESULTS: L-NAME induced a continuous decrease of the NB in a dose-dependent manner, but D-NAME caused no significant change. At 100 mg/kg, L-NAME significantly increased the IOP, mean BP, and ocular perfusion pressure, but the other doses caused no significant changes. When L-arginine was administered after L-NAME injection, the NB returned to its initial level and remained there. Pretreatment with L-NAME inhibited the increase of NB induced by ACh. CONCLUSIONS: These results indicate that nitric oxide regulates basal tissue circulation in the ONH of conscious rabbits and suggest that ACh increases the circulation by promoting nitric oxide synthesis.     

First-line therapy with latanoprost 0.005% results in improved ocular circulation in newly diagnosed primary open-angle glaucoma patients: a prospective, 6-month, open-label study

PURPOSE: To evaluate the effect of latanoprost 0.005% on the optic nerve head (ONH) and retinal circulation of newly diagnosed and previously untreated primary open-angle glaucoma (POAG) patients.METHODS: Twenty-two newly diagnosed and previously untreated POAG patients (mean age+/-SD: 68.38+/-11.92 years) were included in this longitudinal open-label study. Patients were treated with latanoprost 0.005% once a day. Intraocular pressure (IOP), systemic blood pressure (BP), mean ocular perfusion pressure (MOPP), and ocular perfusion parameters 'volume', 'velocity', and 'flow' measured at the optic nerve head (ONH) and retina by means of Heidelberg Retina Flowmeter system were evaluated during a 6-month follow-up period.RESULTS: Treatment with latanoprost 0.005% resulted in a significant decrease in IOP (P<0.0001) and increase in MOPP (P<0.0001). After correcting for changes in MOPP, the blood velocity measured at the ONH level was significantly higher after 6 months of treatment than at baseline (P=0.0310). In addition, blood volume and flow measured at the peripapillary retina level improved after 3 and 6 months of treatment (P=0.0170; P=0.0260, and P=0.0170; P=0.0240 respectively).CONCLUSION: Previously untreated POAG patients exhibit reduced IOP, increased MOPP and improved ocular perfusion at the ONH and retina levels when treated with Latanoprost 0.005%. These effects could be beneficial for glaucoma patients suffering from ocular vascular dysregulation.     

Effect of topical betaxolol on tissue circulation in the human optic nerve head.

There have been no reports to date on long-term betaxolol instillation effects on the human optic nerve head (ONH) tissue circulation. The purpose of this study was to study the effect of topical 0.5% betaxolol on tissue blood velocity in the human ONH. Using a laser-speckle tissue blood flow analyzer, normalized blur (NB; a quantitative index of tissue blood velocity) was measured every 0.125 seconds at a temporal ONH site free of visible surface vessels. Measurements were averaged for 3 cardiac cycles (NB(ONH)). For baseline comparison (day 0), recordings of bilateral NB(ONH) and intraocular pressure (IOP), blood pressure (BP) and pulse rate (PR) were recorded in healthy volunteers before, and 2, 4.5, and 7 hr after, instillation of 30 microL of betaxolol vehicle, and again on day 21; IOP was also recorded on days 7 and 14. On day 1 (the day after baseline measurements), and twice daily for 3 weeks, 30 microL of 0.5% betaxolol into one eye and 30 microL vehicle was instilled into the other in a double-blind study. Measurements as on day 0 were again recorded on day 21; IOP was also recorded on days 7 and 14. During baseline recordings, no significant changes were noted in any parameters. After administration of topical betaxolol, IOP was significantly reduced, bilaterally, with greater reduction in the betaxolol-treated eyes on day 21. Also on day 21, the NB(ONH) of the betaxolol-treated eyes was significantly higher 4.5 hr after instillation than that of the comparable baseline recording (p = 0.035 with Bonferroni's correction); BP, PR, and NB(ONH) in the eye which received only the vehicle showed little change. Tissue blood velocity in the human ONH was increased at least temporarily by instillation of topical betaxolol twice daily for 3 weeks. Although the obtained increase is small and may be clinically insignificant, the potential of betaxolol that can affect the ONH tissue circulation in humans after 21 days of instillation is thought to deserve further investigation.     

Pneumatic trabeculoplasty vs latanoprost as adjunctive therapy to timolol in primary open-angle glaucoma or ocular hypertension

Purpose  To evaluate the efficacy and safety of pneumatic trabeculoplasty (PNT) compared with latanoprost 0.005%, in primary open-angle glaucoma (POAG) and ocular hypertension (OH) not controlled by timolol 0.5%. Procedures  In a randomized clinical study, 18 patients affected with primary open-angle glaucoma (POAG) or ocular hypertension (OH) with intraocular pressure (IOP) >20 mmHg after timolol 0.5% in one eye were treated with PNT; 18 control eyes received adjunctive therapy with latanoprost 0.005%. Visual acuity, IOP, visual field, biomicroscopy findings and fundus appearance were evaluated at each month. Patients with IOP >20 mmHg were excluded from the study. The study was continued until in one group no patients were left. Results  At 1 month, IOP had decreased significantly in both groups. In PNT-treated eyes the mean IOP decrease was 4.5 ± 1.8 mmHg (19.1 ± 7.8%) and in latanoprost-treated eyes was 6.6 ± 1.3 mmHg (28.2 ± 5.7%) (between two groups, P < 0.001). Eleven PNT-treated eyes (61%) and 17 latanoprost-treated eyes (94%) had an IOP reduction of more than 20% of baseline value (P = 0.049); two PNT-treated patients received additional therapy. At the following months, in the latanoprost group, IOP was stable: an IOP reduction of 20% or more was seen in 89% of the eyes. In some PNT-treated eyes IOP increased: at 2 months, an IOP reduction≥20% was seen in 50%, at 3 months in 33%, and at 4 months in 17% of the eyes. (between the two groups, respectively, P = 0.03, P = 0.002, P < 0.001). The number of eyes that required therapy increased progressively in the PNT group, and at 8 months all eyes had required therapy, whereas one latanoprost-treated eye had had additional therapy. After PNT, no patients had visual acuity reduction or intraocular inflammation; three eyes had subconjunctival hemorrhage and five eyes a hyperemia that regressed within 1 week. No posterior segment changes or visual field progression were detected in either groups. Conclusions  In eyes with glaucomatous damage that is not advanced, PNT can reduce the IOP in 60% of the eyes at 1 month, and in 33% of the eyes at 3 months, without significant side-effects. The indications, efficacy and safety of PNT retreatments remain to be investigated. IOP reduction is less and of shorter duration than that obtained by latanoprost adjunctive therapy. No financial relationship