Obstructive sleep apnea syndrome as a risk factor of glaucomatous neuropathy

The consequences of sleep apneas in patients with obstructive sleep apnea (OSA) syndrome may influence the function of visual system. In 21 patients with OSA syndrome (apnea/hypopnea index--AHI 50+/-20) the detailed ophthalmologic studies, including tonometry, biomicroscopic evaluation of the anterior segment of the eye, automatic perimetry and stereoscopic examination of the eye fundus have been performed. In 4 patients (19%) the signs of lesions in the optic tract have been found. These were: defects in visual field caused by glaucoma (primary open-angle glaucoma and normal-tension glaucoma) in 2 patients and defects in visual field (concentric and quadrantic homonymous) caused by diffuse lesions in the cortico-nuclear tract in 2 patients. In patients with the lesions in the optic tract there were severe disorders of breathing during sleep: AHI >60, mean SaO2 at the end of the apneas <86% and minimal SaO2 at the end of the apneas <70%. The authors conclude that in OSA patients there is a high risk of the lesions of the optic tract as a consequence of severe and repetitive hypoxemia during sleep.     

Normal-tension glaucoma is associated with sleep apnea syndrome

INTRODUCTION: In normal-tension glaucoma, optic nerve damage occurs without elevated intraocular pressures, hence vascular and pathogenic mechanisms other than intraocular pressure effects have been postulated. However, the exact cause(s) remain unknown. We have looked for an association between normal-tension glaucoma and sleep apnea syndrome, a disease characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of late cardiovascular and neurological sequelae. METHODS: We performed overnight polysomnography in 16 consecutive Caucasian patients with normal-tension glaucoma. The respiratory disturbance index (RDI) during night sleep was used to diagnose and grade obstructive sleep apnea. Patients with an RDI of 10 or more were diagnosed as having obstructive sleep apnea. RESULTS: We observed the following prevalences of obstructive sleep apnea in normal-tension glaucoma patients: 0% (0 of 2) for the group of patients younger than 45 years, 50% (3 of 6) for the age group 45-64 years, and 63% (5 of 8) for the group older than 64 years. Prevalences in the middle and older age group were significantly higher than in a historic control group (p < 0.025 for both, binomial test). CONCLUSION: Normal-tension glaucoma patients constitute a high-risk population for sleep apnea syndrome. Therefore, they should be screened for sleep apnea syndrome, and, if necessary, be treated to avoid late cardiovascular and neurological sequelae.     

Normal-tension glaucoma and central corneal thickness.

PURPOSE: To determine whether a decreased corneal thickness is a primary factor in the lower intraocular pressure readings found in normal-tension glaucoma patients. METHODS: Fourteen patients with normal-tension glaucoma were compared with 14 age- and sex-matched glaucoma patients. Corneal thickness was measured by ultrasonic pachymetry on each eye. RESULTS: The corneal thickness (mean +/- SD) in patients with normal-tension glaucoma was 0.536 +/- 0.035 mm. The corneal thickness in patients with glaucoma was 0.537 +/- 0.035 mm. The 95% confidence interval for the difference between the two groups was -0.027 to +0.027 mm. CONCLUSION: It has been documented that increased corneal thickness leads to high readings of intraocular pressure. Therefore, decreased corneal thickness may lead to a lower intraocular pressure reading. This study suggests that for most normal-tension glaucoma patients corneal thickness is not a major factor in accounting for the lower intraocular pressure measurements when compared with primary open angle glaucoma patients.     

Molteno implants in children

We report our experience with Molteno implants in 27 eyes of 20 children with glaucoma. Associated ocular findings included Sturge Weber syndrome (one patient), aniridia and retinoschisis (one patient), aphakia (seven patients, eight eyes), rubella syndrome (two patients), Peters anomaly (one patient), and Treacher Collins syndrome (one patient). Fifteen eyes received a single-plate implant, and 12 eyes received a double-plate implant in two stages. The patients' ages ranged from 2 months to 13 years (mean 47 +/- 55 months). The average number of previous glaucoma procedures was four per eye (range two to 10). The follow-up period ranged from 6 to 36 months (mean 20 +/- 9 months). The mean intraocular pressure before surgery was 34 +/- 4 mm Hg. The mean postoperative intraocular pressure was 19 +/- 11 mm Hg at 1 month and 19 +/- 6 mm Hg at 1 year (p < 0.001 at both times). After surgery nine eyes (33.3%) required no medication for control of intraocular pressure. Additional surgery was required in 12 eyes (44.4%). We believe the Molteno implant is a useful approach for children with glaucoma who fail to respond to standard medical and surgical treatments.     

Comparison of ocular hypotensive effect and safety of brinzolamide and timolol added to latanoprost

PURPOSE: To compare the ocular hypotensive effect and safety of brinzolamide and timolol added to latanoprost monotherapy. METHODS: In prospective randomized fashion, we evaluated the ocular hypotensive effect and safety of brinzolamide or timolol in 1 eye of 32 patients with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension who had been treated with latanoprost for more than 1 month. Intraocular pressure (IOP), blood pressure, and pulse were measured before and at 4, 8, and 12 weeks. Corneal endothelial cell density was measured at baseline and at 12 weeks. RESULTS: The IOP was 17.8+/-1.7 mm Hg (mean+/-SD) before the addition of brinzolamide (n=15) and 15.7+/-2.1 mm Hg at 12 weeks (P<0.01). In comparison, the IOP was 18.5+/-3.7 mm Hg before the addition of timolol (n=15) and 15.8+/-3.2 mm Hg at 12 weeks (P<0.01). Both brinzolamide and timolol significantly decreased IOP at 12 weeks, by a mean of 2.0 mm Hg and mean 2.7 mm Hg, respectively, and were more effective than latanoprost alone (P<0.01), but there were no significant differences between the drugs and no significant differences in corneal endothelial cell density and blood pressure before and after addition of either drug. At 12 weeks, pulse was decreased in patients receiving timolol (P<0.01). As systemic adverse events, there was one instance of malar flushing after brinzolamide addition and episodes of chest discomfort after timolol addition in 1 patient. Ocular adverse events were slight. CONCLUSIONS: Brinzolamide and timolol added to latanoprost have similar ocular hypotensive effects and safety in primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension.     

Asymmetry in intraocular pressure and retinal nerve fiber layer thickness in normal-tension glaucoma.

The etiology of glaucoma is most probably multifactorial. This study intended to investigate the asymmetry in intraocular pressure (IOP) and that in retinal nerve fiber layer (RNFL) thickness in normal-tension glaucoma patients. Two diurnal tension curves, obtained within 3 months and counting at least five IOP readings each, including an early morning IOP measurement upon awaking, were obtained in 15 normal-tension glaucoma patients. None of the patients received IOP-lowering therapy. IOP asymmetry was present in at least three readings and was always in the same direction. The optic nerve was imaged in both eyes in each patient by means of confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph). The interocular difference in RNFL thickness and the RNFL cross-sectional area were correlated with the interocular difference in IOP by means of Spearman's rank correlation factor. Nine female and 6 male normal-tension glaucoma patients (mean +/- SD age was 62. 4 +/- 16.9 years) were included in this study. Interocular IOP asymmetry varied between 0.30 and 4 mm Hg. Strong negative correlations were found between interocular asymmetry in IOP and interocular asymmetry in RNFL thickness asymmetry (R = -0.652, p = 0. 0083) and interocular asymmetry in RNFL cross-sectional area (R = -0. 702, p = 0.0034). The present results demonstrate for the first time a more marked thinning of the neuroretinal nerve fiber layer in the eye with the higher IOP in normal-tension glaucoma patients.     

Effect of wind instrument playing on intraocular pressure

PURPOSE: To evaluate the effect of wind instrument playing on intraocular pressure. METHODS: In a prospective, nonrandomized clinical trial, 24 eyes of 24 wind instrument players with no history of any ocular or systemic disease were evaluated. The musicians were members of Bilkent Academic Symphony Orchestra of Bilkent University in Ankara. A complete eye examination, including best-corrected visual acuity, slit-lamp examination, and fundus examination, was performed. The intraocular pressure was measured before and after a 90-minute rehearsal of a piece by Wagner. All intraocular pressure measurements were carried out by the same researcher using Goldmann applanation tonometry. The difference in intraocular pressure measurements before and after the 90-minute wind instrument-playing performance was analyzed. RESULTS: The mean intraocular pressure was 13.79 +/- 1.93 mm Hg before and 15.12 +/- 2.44 mm Hg after the performance. Wind instrument playing significantly increased the mean intraocular pressure by 9.6% (P = 0.0149). CONCLUSION: These results indicate that wind instrument playing may significantly increase intraocular pressure in healthy patients. The significance of this finding for patients with suspected normal-tension or high-tension glaucoma needs further evaluation.     

Suprachoroidal seton implantation in refractory glaucoma: a novel surgical technique

PURPOSE: To describe a new surgical technique in which aqueous humor is diverted from the anterior chamber to the suprachoroidal space for the augmentation of uveoscleral outflow in the management of refractory glaucoma. METHODS: Four painful-blind eyes of four consecutive patients were included in the study. Mean age of patients was 54.7+/- 9.2 years. Preoperative diagnosis was neovascular glaucoma complicating diabetic retinopathy in three cases and chronic angle-closure glaucoma in one case. Mean preoperative intraocular pressure of the patients receiving two medications was 58.5 +/- 9.2 mm Hg. A modified Krupin eye valve with disk was implanted into the suprachoroidal space. The anterior tube part of the Seton device was placed into the anterior chamber through the long scleral tunnel for draining the aqueous humor from the anterior chamber to the suprachoroidal space. RESULTS: The placement of modified Krupin eye valve with disk to the suprachoroidal space was achieved in all cases. While mean preoperative intraocular pressure was 58.5 +/- 9.2 mm Hg, it was 14.2 +/- 4.7 mm Hg at postoperative one week. It was 13.5 +/- 4.6 mm Hg and 15 +/- 4.9 mm Hg at one and three months respectively. At the last follow-up visit, mean intraocular pressure was 17.25 +/- 5.37 mm Hg ranging from 12 to 24 mm Hg. Choroidal detachment was developed in one case and regressed in six weeks. Rubeosis irides regressed at third month in three cases. None of the eyes developed suprachoroidal hemorrhage, retinal detachment, or phthisis bulbi. CONCLUSION: The drainage of aqueous humor from the anterior chamber to the suprachoroidal space with the implantation of the glaucoma Seton device is effective in lowering intraocular pressure in refractory glaucoma.     

Tube fenestrations in Baerveldt Glaucoma Implant surgery: 1-year results compared with standard implant surgery

PURPOSE: To evaluate the efficacy and safety of tube fenestrations in eyes undergoing polyglactin suture-ligated Baerveldt Glaucoma Implant surgery. PATIENTS AND METHODS: The authors performed a retrospective nonrandomized comparative interventional study of consecutive cases of 111 eyes of 111 patients with refractory glaucoma who received polyglactin (Vicryl) suture-ligated Baerveldt 350 implants as a single procedure. In 69 of these cases (group 1), fenestrations were placed anterior to the ligature using a suture needle. In 42 cases (group 2), no fenestrations were performed. Main outcome measures included intraocular pressure, visual acuity, and complications. RESULTS: Mean (+/- SD) preoperative intraocular pressure was 36.7 +/- 10.2 mm Hg in group 1 and 28.3 +/- 10.3 mm Hg in group 2 (P <0.001). Postoperative mean intraocular pressure was lower in group 1 than in group 2 at day 1 (20.2 +/- 12.8 vs. 29.3 +/- 1.9 mm Hg, P <0.001) and week 1 (18.3 +/- 10.4 vs. 23.7 +/- 8.6 mm Hg, P = 0.006), but was virtually identical at 1 year (12.7 +/- 4.9 vs. 12.6 +/- 4.4 mm Hg, P = 0.95). Number of glaucoma medications used by group 1 patients was significantly lower up to 3 months (P 相似文献   

Normal tension glaucoma, sleep apnea syndrome and nasal continuous positive airway pressure therapy--case report with a review of literature

BACKGROUND: In the pathogenesis of glaucoma, besides an elevated intraocular pressure (IOP), cardiovascular risk factors, such as arterial hypotension and hypertension, vasospasms, autoregulatory defects, atherosclerosis, and diabetes mellitus are of increasing importance, especially in normal tension glaucoma. Recently, there have been several reports of an additional risk factor: obstructive sleep apnea syndrome. METHODS: Literature review (Medline) and case report. RESULTS: The authors report on a 8 1/2 years follow-up of a 60-year-old patient with normal tension glaucoma. Despite successful pharmacological and surgical lowering of intraocular pressure a progressive glaucomatous damage with optic nerve atrophy and increasing visual field defects occurred. As a result of intensive investigations of possible cardiovascular risk factors, an obstructive sleep apnea syndrome was diagnosed. Since the beginning of therapy with nCPAP (nasal continuous positive airway pressure) more than 3 1/2 years ago, no further progression of glaucomatous optic nerve damage or visual field defects have been observed. CONCLUSIONS: In clinical practice, obstructive sleep apnea syndrome often is underdiagnosed. In patients suffering from glaucoma and obstructive sleep apnea syndrome, intraocular pressure lowering therapy may not be enough, whereas an additional nCPAP-therapy potentially could prevent the beginning/progression of glaucomatous optic nerve damage.     

Trabeculectomy with 5-fluorouracil for adult inflammatory glaucoma

We reviewed the records of 12 eyes of ten adult patients with inflammatory glaucoma who underwent trabeculectomy with the adjuvant use of 5-fluorouracil between January 1986 and January 1989. Intraocular pressure decreased from 36 +/- 10 mm Hg (range, 17 to 50 mm Hg) preoperatively to 11 +/- 4 mm Hg (range, 3 to 17 mm Hg) postoperatively after a median follow-up of 7.75 months (range, six to 38 months). All eyes achieved an intraocular pressure of less than 20 mm Hg, and ten of 12 required no intraocular pressure lowering medications. The mean (+/- S.D.) amount of 5-fluorouracil used was 33 +/- 10 mg (range, 20 to 55 mg). During the period of observation, five of 12 eyes had an episode of uveitis, but in no patient did this result in loss of intraocular pressure control. Preoperative and postoperative systemic and topical corticosteroid use was the same. Trabeculectomy with 5-fluorouracil is an effective treatment for selected cases of adult inflammatory glaucoma refractory to medical management.     

Effect of inverted body position on intraocular pressure

We evaluated changes in intraocular pressure in eyes with primary open-angle glaucoma after inversion into a totally dependent position with the head down and compared them with the changes intraocular pressure in healthy nonglaucomatous eyes. Five minutes after inversion, intraocular pressure increased from 16.8 mm Hg +/- 2.8 (sitting) to 32.9 mm Hg +/- 7.9 in normal eyes and from 21.3 mm Hg +/- 2.3 (sitting) to 37.6 mm Hg +/- 5.0 in glaucomatous eyes. Although visual fields were unchanged after inversion, glaucomatous eyes may be particularly susceptible to such changes and unable to withstand the transient but significant increase in intraocular pressure that occurs after assuming an inverted position. We recommend that patients with ocular hypertension or glaucoma refrain from this activity.     

Effect of hospitalization on intraocular pressure in patients with normal-tension glaucoma

OBJECTIVE: To investigate the effect of hospitalization on intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG). METHODS: The study was conducted in 52 patients with a definite diagnosis of NTG. The correlation between IOP measured from 9.00 a.m. to 12.00 p.m. on an outpatient basis within 3 months each prior to and after hospitalization (ambulatory IOP) and IOP measured during the same time period after admission (inpatient IOP) was investigated in NTG patients. RESULTS: Inpatient IOP (13.9 +/- 2.4 mm Hg) was significantly lower than ambulatory IOP (15.2 +/- 2.1 mm Hg), with a difference of 1.3 +/- 2.0 mm Hg (p < 0.01). The difference between inpatient IOP and ambulatory IOP was negatively correlated with inpatient IOP (r = 0.58, p < 0.01). CONCLUSIONS: These results revealed that hospitalization decreased IOP in NTG patients, with the decrease being particularly pronounced in cases of low ambulatory IOP. Interpretation of inpatient IOP should be carefully included in glaucoma treatment.     

Episcleral venous pressure in untreated primary open-angle and normal-tension glaucoma

The aim of this prospective study was to investigate episcleral venous pressure (EVP) in different forms of glaucoma in comparison with age-matched controls. EVP was measured by means of a venomanometer in 32 eyes with untreated primary open-angle glaucoma (POAG), 36 eyes with untreated normal-tension glaucoma (NTG) as well as 56 control eyes without ophthalmological disease other than cataract. In addition to ophthalmological standard examination, cardiovascular parameters such as systolic and diastolic blood pressure and heart rate were recorded. In the POAG group, EVP was 12.1 +/-0.5 mm Hg and in the NTG group 11.6 +/- 0.4 mm Hg. This was significantly different from EVP of the controls (9.5 +/- 0.2 mm Hg). The EVP/intraocular pressure (IOP) ratio was significantly different in NTG patients (80.0% +/- 3.2) in comparison with both POAG patients (67.1% +/- 2.8) and controls (69.2% +/- 2.4). The difference between IOP and EVP (IOP - EVP) was 6.2 +/- 0.6 in the POAG, 3.1 +/- 0.45 in the NTG and 4.5 +/- 0.4 in the control group. All these values were significantly different from each other. Regression analysis revealed a significant linear correlation between EVP and IOP in both the NTG and the POAG group. In the control group, however, the correlation was weak. This study is the first to demonstrate differences in EVP between untreated NTG and POAG and an age-matched healthy control group.     

Diode laser transscleral cyclophotocoagulation as primary surgical treatment for medically uncontrolled chronic angle closure glaucoma: long-term clinical outcomes

PURPOSE: To evaluate the long-term efficacy and safety of diode laser transscleral cyclophotocoagulation as primary surgical treatment of medically uncontrolled chronic angle closure glaucoma. PATIENTS AND METHODS: Thirteen eyes of 13 Chinese patients with medically uncontrolled chronic angle closure glaucoma were treated with diode laser transscleral cyclophotocoagulation between February 2000 and May 2001, and followed up for over 18 months. Post-treatment anti-glaucoma medications were adjusted according to intraocular pressure. If intraocular pressure remained above 21 mm Hg despite medications for more than 4 weeks after cyclophotocoagulation, the procedure was repeated. RESULTS: Mean follow-up +/- SD was 26.5 +/- 4.2 months. Two eyes required repeat cyclophotocoagulation at 6 weeks. Rate of relative success, defined as maintaining an intraocular pressure of 21 mm Hg or below with or without medications, was 92.3% (12 of 13 eyes). Rate of absolute success, defined as maintaining an intraocular pressure of 21 mm Hg or below without medications, was 0% (0 of 13 eyes). Mean +/- SD intraocular pressure was reduced from 36.4 +/- 12.6 mm Hg pre-operatively, to 18.7 +/- 12.2 mm Hg at final follow-up (P = 0.003, paired t test). The mean +/- SD number of intraocular pressure-lowering eye drops was reduced from 2.0 +/- 0.8 pre-operatively, to the lowest point of 0.5 +/- 0.8 at 12 months, and then gradually increased to 2.1 +/- 0.9 at final follow-up. The visual acuity improved after treatment in 2 of 13 eyes (15.4%), remained unchanged in 6 of 13 eyes (46.2%) and deteriorated in 5 of 13 eyes (38.5%). No major complications were encountered. CONCLUSION: Diode laser cyclophotocoagulation appeared to be an effective and safe primary surgical treatment of medically uncontrolled chronic angle closure glaucoma, with intraocular pressure-lowering effect persisting for up to two years.     

The efficacy and safety of latanoprost 0.005% once daily versus brimonidine 0.2% twice daily in open-angle glaucoma or ocular hypertension

PURPOSE: To evaluate the efficacy and safety of latanoprost 0.005% given topically every evening versus brimonidine 0.2% given topically twice daily in primary open-angle glaucoma or ocular hypertensive patients. METHODS: This was a multicenter, crossover, double-masked comparison. After a 28-day treatment-free period, patients with primary open-angle glaucoma or ocular hypertension were randomized for 6 weeks to brimonidine or latanoprost and then crossed over to the opposite treatment. At baseline and after each treatment period, patients underwent intraocular pressure measurements every 2 hours from 08:00 to 20:00. RESULTS: In 33 patients the mean baseline trough (08:00) was 23.2 +/- 2.1 mm Hg and the diurnal curve pressure was 19.8 +/- 2.7 mm Hg. The trough and diurnal intraocular pressures for brimonidine were 19.6 +/- 3.4 mm Hg and 17.6 +/- 2.2 mm Hg, respectively. Brimonidine statistically reduced the pressure from baseline at each time point except hours 10 and 12 (P =.14 and P =.21, respectively). For latanoprost, the trough and diurnal pressures were 16.2 +/- 2.9 mm Hg and 15.4 +/- 2.5 mm Hg, respectively, and the pressure was statistically reduced at each time point (P <.001) and for the diurnal curve (P <.001). When compared directly, the intraocular pressure level for latanoprost was lower than brimonidine for the diurnal pressure and at each time point (P <.05). One patient was discontinued early from latanoprost treatment because of eyelid swelling; also, latanoprost caused more hyperemia than brimonidine (P =.04). CONCLUSION: This study suggests latanoprost dosed daily in the evening statistically reduces intraocular pressure more during daytime and evening hours than brimonidine dosed twice daily. Brimonidine may not consistently decrease the pressure 10 and 12 hours past dosing from nontreated levels.     

Relationship between postural change of the intraocular pressure and visual field loss in primary open-angle glaucoma

PURPOSE: To determine the relationship between the postural changes of the intraocular pressure and the visual field loss in patients with primary open-angle glaucoma. METHODS: Eleven normal subjects and 11 patients with primary open-angle glaucoma were studied. Intraocular pressure was measured in both the sitting and the supine positions. Visual fields were measured with automated perimetry. RESULTS: When patients moved from a sitting to supine position, the intraocular pressure increased by an average of 3.1 +/- 0.4 mm Hg (mean +/- SEM) in normal subjects and 4.0 +/- 0.2 mm Hg in patients with primary open-angle glaucoma. There was a significant difference between the normal subjects and patients with primary open-angle glaucoma (P = 0.049). Intraocular pressure increased by 4.4 +/- 0.3 mm Hg (P = 0.02) in the worse eye for mean deviation and 3.6 +/- 0.3 mm Hg (P = 0.38) in the better eye for mean deviation. There was no significant difference in intraocular pressure in the sitting position between both groups. CONCLUSIONS: The greatest difference in intraocular pressure between the sitting and supine positions was observed in the worse eye of patients with primary open-angle glaucoma. This result suggests that damage to the optic nerve in primary open-angle glaucoma might occur when patients are asleep in the supine position.     

Open-angle glaucoma associated with Graves disease

PURPOSE: To estimate the prevalence of open-angle glaucoma, including normal-tension glaucoma, in association with Graves disease. METHODS: In a prospective study, a complete ophthalmic examination including applanation tonometry, exophthalmometry, automated static threshold perimetry, and computed tomography of the orbit was performed in 104 consecutive Japanese patients with Graves disease (age range, 11 to 86 years; mean, 42 years; 80 women, 24 men). Ocular hypertension was defined as an intraocular pressure greater than 21 mm Hg on at least two occasions during the period of follow-up. RESULTS: Of the 104 patients, 14 (13%) exhibited typical glaucomatous visual field defects in automatic static threshold perimetry in the absence of compressive optic neuropathy. The intraocular pressure in seven of the 14 patients was consistently less than 21 mm Hg during the follow-up period. Thus, these patients were diagnosed as having normal-tension glaucoma. Of the 104 patients, 23 (22%) were diagnosed as having ocular hypertension. CONCLUSIONS: The prevalence of normal-tension glaucoma as well as open-angle glaucoma and ocular hypertension was significantly higher among patients with Graves disease than in the general population.     

Combined cataract-glaucoma surgery using the intracanalicular Eyepass glaucoma implant: first clinical results of a prospective pilot study

PURPOSE: To study prospectively the safety and pressure-reducing efficacy of the Y-shaped Eyepass glaucoma implant (GMP Vision Solutions, Inc.). SETTING: Departments of Ophthalmology, University of Cologne, Cologne, and University of Erlangen, Erlangen, Germany. METHODS: This study comprised 12 patients with primary open-angle or exfoliative glaucoma and cataract who had phacoemulsification with endocapsular implantation of a foldable intraocular lens and intracanalicular implantation of an Eyepass glaucoma implant. The implant is a silicone microtube shunt that bypasses the trabecular meshwork and connects the lumina of Schlemm canal with the anterior chamber in combined cataract-glaucoma surgery. Perioperative complications, intraocular pressure (IOP), and pressure-reducing topical medications were monitored over a preliminary follow-up. RESULTS: Perforation of the trabecular meshwork during Eyepass implantation occurred in 2 eyes; the antiglaucoma procedure was converted to trabeculotomy after the shunt was explanted, and both eyes were excluded from further follow-up. In the remaining 10 eyes, the mean maximum IOP was 30.4 mm Hg +/- 7.5 (SD) (range 21 to 46 mm Hg) preoperatively, 12.0 +/- 6.1 mm Hg (range 2 to 20 mm Hg) 1 day postoperatively, 17.2 +/- 4.1 mm Hg (range 12 to 27 mm Hg) at 4 weeks, and 18.3 +/- 4.5 mm Hg (range 12 to 25 mm Hg) at the end of the preliminary follow-up. The mean number of topical medications was 3.2 +/- 0.8 preoperatively and 0.9 +/- 0.7 at the end of follow-up (mean 7.1 months). Although there were no major complications requiring surgical revision, 4 eyes had an IOP of 18 or higher at the end of follow-up. CONCLUSION: Combined cataract surgery with Eyepass shunt implantation was safe and appeared to be beneficial in glaucomatous eyes with cataract not requiring a low target IOP.     

The use of latanoprost 0.005% once daily and its effect on intraocular pressure as primary or adjunctive therapy.

The purpose of this study was to evaluate differences in efficacy and safety of latanoprost as monotherapy compared to adjunctive therapy in primary open-angle glaucoma. We reviewed records of 527 patients who were treated with latanoprost as mono- or adjunctive therapy to reduce the intraocular pressure. Each patient was treated at least three months unless they were discontinued due to an adverse event or lack of efficacy. In the monotherapy group (n=49) baseline intraocular pressure of 23.6+/-5.2 mm Hg fell to 18.4+/-4.3 mm Hg after 4.4+/-2.0 months of follow-up; in the adjunctive therapy group (n=39) baseline intraocular pressure of 21.8+/-5.7 mm Hg fell to 16.7+/-4.6 mm Hg following 4.3+/-1.8 months of therapy which was a similar change from baseline for both groups (P > 0.9). No differences were noted in the class or number of medicines to which latanoprost could be added including: beta-blockers, alpha-agonists and topical carbonic anhydrase inhibitors. The reasons for failure with monotherapy were mostly adverse events (10/15 patients) and with adjunctive therapy lack of efficacy (14/16 patients). Latanoprost is similarly effective as monotherapy and as an adjunctive agent in reducing the intraocular pressure. Latanoprost can be added successfully to a variety of classes of glaucoma medicines used commonly as adjunctive therapy.