Ocular hypertensive response to topical dexamethasone in children: a dose-dependent phenomenon

OBJECTIVE: To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children. DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Thirty-one consecutive children undergoing bilateral strabismus surgery. INTERVENTION: Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and another received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for 4 weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more. MAIN OUTCOME MEASURES: Intraocular pressure was measured on the day before the surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP more than 20 mmHg in the two study groups were analyzed. RESULTS: A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 +/- 2.0 years (range, 2-10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 +/- 6.8 mmHg vs. 14.3 +/- 2.4 mmHg, P < 0.001; four times daily, 28.7 +/- 6.9 mmHg vs. 14.3 +/- 2.9 mmHg, P < 0.001). The peak IOP was significantly higher in the four times daily group (P < 0.001), as was the net increase in IOP (twice daily, 10.9 +/- 5.8 mmHg vs. four times daily, 14.5 +/- 6.4 mmHg; P < 0.001). There was no difference in time for both groups to achieve the peak IOP, but the time to exceed its upper normal value (20 mmHg) was shorter in the four times daily group (twice daily, 12.3 +/- 9.1 days vs. four times daily, 10.0 +/- 7.4 days; P < 0.05). CONCLUSIONS: In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children.     

Ocular hypertensive response to topical dexamethasone ointment in children

PURPOSE: To investigate the rate and the degree of the ocular hypertensive response to dexamethasone ointment in children undergoing eyelid surgery. METHODS: Dexamethasone ointment (Dexcosil) was applied three times a day for the first week and twice a day for the second to third week postoperatively to children undergoing epiblepharon surgery. Intraocular pressure (lOP) was measured on the day before surgery, postoperative day 1, 7, 14, 21, 28 and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase and time to reach a peak IOP were analyzed. Dexamethasone ointment was discontinued if the IOP was 25 mmHg or more. Results: A total of 96 children (mean age, 6.5 +/- 2.7 years) were included. Preoperative mean IOP was 13.6 +/- 2.9 mmHg (range 7-19). After dexamethasone ointment treatment, the children showed a significant rise in IOP as compared with the preoperative values. The peak IOP was 20.6 +/- 4.9 mmHg (range 11-39) and the time to reach peak IOP was 8.5 +/- 5.9 days. The low responders (delta IOP < or = 5 mmHg) of our group comprised 35.4% (34/96) of patients, intermediate responders (delta IOP 6-15 mmHg) comprised 56.3% (54/96) of patients and high responders (delta IOP > or =16) comprised 8.3% (8/96) of patients. A net increase in IOP was significantly higher in children 5 years old or less as compared with those older than 5 years (age < or =5, 9.4 +/- 7.5 mmHg vs. age > 5, 6.3 +/- 4.4 mmHg; p = 0.015, unpaired t-test). CONCLUSIONS: Ocular hypertensive response after dexamethasone ointment to the eyelids occurred frequently in children, especially those 5 years old or younger.     

Measurement of intraocular pressure in LASIK and LASEK patients using the Reichert Ocular Response Analyzer and Goldmann applanation tonometry

PURPOSE: To determine the efficacy of the Reichert Ocular Response Analyzer (ORA) to measure intraocular pressure (IOP) following corneal laser refractive surgery. METHODS: Intraocular pressure was measured using Goldmann applanation tonometry preoperatively and 3 months following LASIK and LASEK for all levels of myopia and low levels of hyperopia. In LASIK eyes, 120-microm flaps were cut using the Hansatome XP. The ORA was used to measure Goldmann correlated IOP and corneal compensated IOP 3 months postoperatively. Postoperative central corneal thickness, hysteresis, and corneal curvature were assessed to determine their relationship with postoperative change in Goldmann applanation tonometry IOP. Efficacy of ORA IOP measurement was analyzed by comparing Goldmann applanation tonometry IOP with Goldmann correlated IOP. RESULTS: LASEK was performed on 35 eyes, and LASIK was performed on 90 eyes. In the LASIK group, mean Goldmann applanation tonometry IOP decreased 3.7+/-2.3 mmHg postoperatively (P=.00). Postoperative Goldmann applanation tonometry did not differ significantly (P=.06) from postoperative ORA Goldmann correlated IOP (10.2+/-2.1 mmHg). In the LASEK group, mean Goldmann applanation tonometry IOP decreased 3.9+/-2.3 mmHg (P=.00). Postoperative Goldmann applanation tonometry did not differ significantly (P=.6) from postoperative ORA Goldmann correlated IOP (10.7+/-2.5 mmHg). Postoperative decrease in Goldmann applanation tonometry IOP did not correlate with age, ablation depth, pre- and postoperative central corneal thickness or corneal hysteresis, or postoperative decrease in corneal curvature. CONCLUSIONS: Intraocular pressure measurements were similar using both the ORA Goldmann correlated IOP and Goldmann applanation tonometry following keratorefractive surgery.     

Ocular hypertensive and anti-inflammatory responses to different dosages of topical dexamethasone in children: a randomized trial

BACKGROUND: The purpose of the present study was to investigate the ocular hypertensive and anti-inflammatory responses to two different dosage schedules of 0.1% topical dexamethasone in a population of Chinese children undergoing strabismus surgery. METHODS: Children undergoing bilateral strabismus surgeries were randomly assigned to receive topical 0.1% dexamethasone eye drops four times daily (group A) or twice daily (group B) for 4 weeks. Intraocular pressure (IOP) and anti-inflammatory responses were monitored for 8 weeks. RESULTS: A total of 137 children with mean age 6.5 years (SD, 1.9 years; range, 3-10 years) participated in the study. The IOP increased significantly after 4 weeks in both groups compared to the preoperative values (P < 0.001). Peak IOP ranged from 14.0 to 50.3 mmHg in group A and 11.0-41.3 mmHg in group B. Cases in group A (mean, 13.8 mmHg; SD, 8.4 mmHg) had a greater net increase in IOP than cases in group B (mean, 10.2 mmHg; SD, 6.2 mmHg; P = 0.004). Younger-aged children had higher peak IOP (r = -0.244, P = 0.048), and attained the peak IOP earlier (r = 0.252, P = 0.041) in group A. There was no significant difference in ocular inflammatory response between the two groups. CONCLUSION: Ocular hypertensive effect to topical 0.1% dexamethasone is dose and age dependent in children. Twice-daily 0.1% topical dexamethasone eye drops control inflammation after strabismus surgery as effectively as four-times-daily dosage, but induces less increase in IOP, and may be a better treatment schedule.     

改良的黏弹剂Schlemm管切开术治疗原发性开角型青光眼的临床研究

目的观察改良的黏弹剂Schlemm管切开术（VCO）和小梁切除术（TE）治疗原发性开角型青光眼的疗效和安全性。方法采用前瞻性随机对照方法,对100例（100只眼）药物控制眼压不理想的原发性开角型青光眼患者,随机分为改良VCO组50例（50只眼）,TE组50例（50只眼）,术后平均随访28个月。结果手术后1个月,改良VCO组和TE组患者的平均眼压分别为（11．22±4．34）和（12．35±3．79）mmHg（1mmHg=0．133kPa）,手术成功率（术后未用任何降眼压药物眼压〈21mmHg）均为98．0％;手术后12个月,两组的平均眼压分别为（14．50±3．22）和（16．58±4．73）mmHg,手术成功率分别为87．5％和70．0％,两组差异有统计学意义（P〈0．05）;手术后24个月,两组的平均眼压分别为16．0和15．4mmHg,手术成功率分别为76．1％和67．3％,两组差异无统计学意义（P〉0．05）;早期并发症如浅前房、脉络膜脱离、囊样滤过泡等以TE组明显多于改良VCO组,两组差异有统计学意义（P〈0．01）。结论在治疗原发性开角型青光眼方面,改良VCO组的成功率较TE组高．术后早期并发症相对较少.     

Efficacy of anterior chamber paracentesis after intravitreal triamcinolone injection

PURPOSE: To investigate the efficacy of anterior chamber paracentesis for intravitreal triamcinolone acetonide injection (IVTA). METHODS: A prospective, randomized clinical trial was conducted on 30 eyes from 30 patients scheduled for IVTA (4 mg/0.1 mL). Eyes were randomly divided into two groups: eyes that had undergone anterior chamber paracentesis (Group 1, 15 eyes) and eyes that did not have anterior chamber paracentesis (Group 2, 15 eyes). Intraocular pressure (IOP) was measured by Goldmann applanation tonometry at a baseline of 2, 15, 30, and 60 minutes at 1 day and 1 week after the injection. The authors analyzed the short-term postoperative changes of the IOP in each group. RESULTS: For Group 1, the mean preoperative IOP was 15.33+/-1.72 mmHg, and the postoperative IOP at 2 and 15 minutes were 7.80+/-1.47 and 11.73+/-1.67 mmHg, respectively. For Group 2, there was a significant elevation of IOP (46.73+/-8.26 mmHg) 2 minutes after the injection, which decreased to the normal range (16.13+/-2.61 mmHg) by 15 minutes after the injection. There were no significant differences between the two groups in IOP at 15 minutes postsurgery compared with the distinct difference in IOP at 2 minutes post surgery (Student t-test, p=0.01). CONCLUSIONS: The findings suggest that routine anterior chamber paracentesis is inappropriate due to the brief immediate postoperative IOP elevation with IVTA.     

Intraocular pressure measurement after hyperopic and myopic LASIK

PURPOSE: To assess the effects of hyperopic and myopic laser in situ keratomileusis (LASIK) on the intraocular pressure (IOP) measurement by Goldmann applanation tonometry. METHODS: Intraocular pressure was measured by Goldmann applanation tonometry pre- and postoperatively in 48 hyperopic eyes (26 patients) and 56 myopic eyes (28 patients). RESULTS: The mean preoperative spherical equivalent refraction was +3.97 +/- 2.48 diopters (D) in the hyperopic group and -6.73 +/- 4.79 D in the myopic group. Attempted correction was equivalent to preoperative refraction in each group. Mean preoperative IOP was 14.22 +/- 2.56 mmHg and 13.70 +/- 2.09 mmHg in the hyperopic and myopic groups, respectively. Following LASIK, the mean IOP was 11.85 +/- 2.52 mmHg and 11.38 +/- 3.08 mmHg in the hyperopic and myopic groups, respectively. CONCLUSIONS: The IOP measurement was significantly reduced (P < .001) by 2.37-2.25 mmHg and 2.32 +/- 2.89 mmHg following hyperopic and myopic LASIK, respectively.     

Control of intraocular pressure elevations after argon laser trabeculoplasty: comparison of brimonidine 0.2% to apraclonidine 1.0%.

OBJECTIVE: To determine whether brimonidine 0.2% can control intraocular pressure (IOP) spikes as well as apraclonidine 1.0% can in those patients undergoing argon laser trabeculoplasty (ALT). DESIGN: Prospective, randomized, double-masked, clinical trial. PARTICIPANTS: A total of 56 eyes of 41 patients with open-angle glaucoma or ocular hypertension were entered in the study; 46 eyes of 41 patients were eventually used for the final analysis. INTERVENTION: Patients were randomized to receive either brimonidine 0.2% or apraclonidine 1.0% before and after 360 degrees ALT. Both patient and physician were masked as to which agent each patient received. MAIN OUTCOME MEASURES: Intraocular pressure measurements were recorded before surgery and at 1, 2, and 4 hours after surgery. The difference between the preoperative IOP (baseline) and the highest recorded postoperative IOP was recorded as the maximum IOP change. The mean of the maximum IOP change for each group was analyzed using a two-sample, one-tailed t test. RESULTS: The mean of the maximum IOP change in the brimonidine 0.2% group was -2.6+/-3.6 mmHg, and the mean for the apraclonidine 1.0% group was -2.3+/-3.7 mmHg (P = 0.8). No patient had a pressure spike greater than 10 mmHg. CONCLUSIONS: Brimonidine 0.2% appears to be as effective as apraclonidine 1.0% in preventing IOP spikes after argon laser trabeculoplasty.     

Intraoperative acetazolamide in the prevention of intraocular pressure rise after pars plana vitrectomy with fluid-gas exchange.

PURPOSE: To assess the effect of intraoperative acetazolamide (Diamox) on postoperative intraocular pressure (IOP) in gas-filled, vitrectomized eyes. METHODS: We conducted a prospective randomized clinical trial of 63 consecutive patients undergoing pars plana vitrectomy with total fluid-gas exchange and long-acting intraocular gas tamponade. Patients were randomized by a blind draw to receive either intravenous 500 mg acetazolamide (Diamox) (Group 1) or no treatment (Group 2) at the conclusion of the operative procedure. Intraocular pressures at the conclusion of surgery (IOP-1), 4-8 hours following surgery (IOP-2), and on the first postoperative day (IOP-3) were measured using an Oculab Tono-Pen. RESULTS: Patients in Groups 1 and 2 showed similar mean IOP on postoperative day 1 (20.48+/-7.84 mmHg versus 19.89+/-7.89 mmHg). A similar incidence of IOP-2 greater than 30 mmHg (1 versus 3 patients with high IOP) and IOP-3 greater than 30 mmHg (4 versus 3 patients with high IOP) was seen. Patients in Group 1 had a lower mean IOP at 4-8 hours postoperatively (16.25+/-6.47 mmHg) than those in Group 2 (20.13+/-6.33 mmHg). No correlation could be demonstrated between IOP-1 and subsequent IOP. However, IOP on the first postoperative day (IOP-3) was strongly correlated with IOP 4-8 hours after surgery (IOP-2) (P = 0.0001). No protective effect of Diamox could be demonstrated on either IOP-2 or IOP-3. CONCLUSIONS: No protective effect against pressure rise could be demonstrated for intraoperative acetazolamide (Diamox) in the prophylaxis of IOP rise following pars plana vitrectomy and total fluid-gas exchange with long-acting intraocular gas.     

Brimonidine 0.2% versus apraclonidine 0.5% for prevention of intraocular pressure elevations after anterior segment laser surgery

OBJECTIVE: To compare the efficacy of brimonidine 0.2% with apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after anterior segment laser surgery. DESIGN: Double-masked, randomized clinical trial. PARTICIPANTS: Sixty-six patients underwent either laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:yttrium-aluminum-garnet laser capsulotomy. INTERVENTION: Eyes received either one drop of brimonidine 0.2% or apraclonidine 0.5% before laser surgery. MAIN OUTCOME MEASURES: Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. RESULTS: Before the laser treatment, 33 patients (50.0%) received brimonidine 0.2% and 33 patients (50.0%) received apraclonidine 0.5%. Eight of 33 patients (24.2%) in the brimonidine-treated group and 9 of 33 patients (27.3%) in the apraclonidine group had postoperative IOP increases of 5 mmHg or more. This was not statistically different (P = 0.80). By the time of last follow-up examination, 3 of 33 patients (9.1%) in the brimonidine-treated group and 3 of 33 patients (9.1%) in the apraclonidine group had IOP increases of 10 mmHg or more. This was also not statistically different (P > or = 0.95). The mean IOP reduction from baseline in the brimonidine group (-2.8 +/- 2.8 mmHg) was not statistically different (P = 0.55) compared with the mean IOP reduction in the apraclonidine group (-3.6 +/- 3.3 mmHg). There were no statistically significant changes in mean heart rate or blood pressure in either group except for a slight reduction in diastolic blood pressure at 1 hour (P = 0.005) in the brimonidine group (-5.2 +/- 7.4 mmHg) compared with the apraclonidine group (-0.2 +/- 6.4 mmHg). There were no clinically significant side effects noted in either group. CONCLUSIONS: A single preoperative drop of brimonidine 0.2% is as effective as apraclonidine 0.5% in preventing IOP elevation immediately after anterior segment laser surgery.     

The efficacy and ocular discomfort of substituting brinzolamide for dorzolamide in combination therapy with latanoprost, timolol, and dorzolamide.

PURPOSE: The aim of this study was evaluate the efficacy and ocular discomfort of substituting brinzolamide for dorzolamide in patients with glaucoma treated by latanoprost, timolol, and dorzolamide. METHODS: An 8-week, prospective, randomized, open-label, comparative study was performed in 58 patients with primary open-angle glaucoma treated by latanoprost, timolol, and dorzolamide. These patients were randomly enrolled into two groups: (1) dorzolamide three times daily was substituted with brinzolamide twice-daily (substituting group); and (2) dorzolamide three times daily was continued (control group). Intraocular pressure (IOP) was measured at baseline, 4, and 8 weeks after the enrollment. Subjective ocular discomfort (irritation and blurred vision) at the time of the instillation of the patient was noted with interview. RESULTS: The IOPs at baseline, 4 and 8 weeks after the enrollment were 17.7 +/- 2.7 mmHg, 17.5 +/- 2.6 mmHg, and 17.4 +/- 2.9 mmHg in the substituting group, and 18.0 +/- 2.5 mmHg, 17.8 +/- 2.5 mmHg, and 17.9 +/- 2.6 mmHg in the control group, respectively. There were no significant differences in IOP changes between the two groups (P = 0.74). In the substituting group, ocular irritation was decreased significantly (P = 0.0014) from 63% to 20%. The slight increase of blurred vision from 27% to 37% that occurred in the substituting group was not significant (P = 0.58). In the control group, neither ocular irritation (P = 0.58, from 68% to 57%) nor blurred vision (P = 0.99, from 25% to 21%) was changed. CONCLUSIONS: Substituting brinzolamide for dorzolamide maintained stable IOP with improvement in ocular comfort in patients with glaucoma.     

260例青光眼白内障联合手术临床分析

目的：分析评价青光眼白内障联合手术的疗效。方法：对２６０例（２７９眼）行青光眼白内障联合手术的病例作回顾性分析,并将病人分为３组。Ⅰ组：白内障囊外摘除联合小梁切除术;Ⅱ组：白内障囊外摘除、人工晶体植入联合小梁切除术;Ⅲ组：超声乳化白内障吸出、人工晶体植入联合小梁切除术;并分析比较３组的术后视力、眼压和并发症。结果：３组病例术后视力≥０．３者分别为１６．３％、３２．４％和４３．５％,术后视力改善率分     

Two-staged Baerveldt glaucoma implant for childhood glaucoma associated with Sturge-Weber syndrome

PURPOSE: To report the outcome and complications of 10 eyes of 9 children with Sturge-Weber syndrome (SWS) who underwent two-stage insertion of a Baerveldt glaucoma implant (BGI) for glaucoma. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: The authors reviewed the medical records of children under the age of 14 years with SWS who underwent two-stage BGI for glaucoma at two tertiary care referral centers. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications, intraocular pressure (IOP), number of glaucoma medications, visual acuity, and further surgical intervention. RESULTS: Ten eyes of nine patients were included in the study. Ages of the nine patients at time of first stage BGI ranged between 6 weeks and 13 years. With average follow-up of 35 months (range, 10-50), all eyes had adequate IOP control (< or = 21 mmHg) without the need for additional glaucoma surgery. Intraocular pressure was reduced from a mean (+/- standard deviation) of 24.8 +/- 6.2 mmHg preoperatively to 16.9 +/- 2.3 mmHg at last follow-up visit (P = 0.001). The number of medications used for control of glaucoma was reduced from a mean (+/- standard deviation) of 1.8 +/- 1.0 preoperatively to 1.1 +/- 1.4 at last follow-up visit (P = 0.2). One eye had serous choroidal effusions with overlying serous retinal detachment that resolved spontaneously after 7 days with no permanent visual loss, and one eye had low choroidal effusion that lasted 4 days. There were no intraoperative or postoperative suprachoroidal hemorrhages. At last follow-up, visual acuity had improved by one or more lines in all patients in whom vision was measurable. CONCLUSIONS: Two-stage BGI surgery appears to be a safe and effective treatment for refractory glaucoma in children with SWS.     

Low-dose 5-fluorouracil trabeculectomy as initial surgery in uncomplicated glaucoma: long-term followup

OBJECTIVE: To compare the effectiveness of trabeculectomy with adjunctive, low-dose, subconjunctival 5-fluorouracil (5-FU) to trabeculectomy alone in patients with uncomplicated glaucoma undergoing their first incisional surgical procedure. DESIGN: Retrospective, nonrandomized comparative trial. PARTICIPANTS: Consecutive series of 52 patients and 74 control subjects. INTERVENTION: Trabeculectomy was performed in all patients. Study patients received adjunctive, subconjunctival injections of 5-FU up to 14 days from the date of surgery. MAIN OUTCOME MEASURES: Intraocular pressure, number of postoperative antiglaucoma medications, interventions, and complications were evaluated. RESULTS: Mean followup for all patients was 58.1 +/- 44.1 months (range, 1.1-159.9 months). Mean followup for successful eyes was 55.9 +/- 47.1 months (range, 7.6-159.9 months). The cumulative 5-year success (intraocular pressure [IOP] < or = 21 mmHg) was 77.8% in the 5-FU group and 62.2% in the control group (P = 0.02, Wilcoxon test. Complete success (IOP < or = 21 mmHg without medications) at 5 years was lower in both the 5-FU group (72.3%) and the control group (51.3%). Postoperative mean IOP at 5 years for all successful patients was lower in eyes receiving 5-FU (10.7 +/- 3.6 mmHg vs. 16.0 +/- 6.1 mmHg [P = 0.02, t-test]). For those patients considered to be complete successes, there was no difference in IOP between the two groups of patients at any evaluated time interval. Patients in the 5-FU group were using 0.7 +/- 1.1 medications at final followup compared with 1.8 +/- 1.4 medications in the control group (P = < 0.0001, t test). Bleb-related ocular infection occurred in 6.3% of patients and was more common in patients receiving 5-FU than controls (6 of 52 vs 2 of 74, respectively; P = 0.05, Fischer's exact test). CONCLUSIONS: Adjunctive, low-dose 5-FU at the time of initial surgery in uncomplicated glaucoma improves long-term IOP control and reduces the need for postoperative, antiglaucoma therapy. Eyes receiving 5-FU are at greater risk of developing late bleb-related ocular infection.     

The efficacy of timolol in gel-forming solution after morning or evening dosing in Asian glaucomatous patients.

AIMS: The aim of this study was to determine the effectiveness of timolol gel-forming solution as a monotherapy and to compare the efficacy of timolol gel-forming solution morning instillation versus at night application in Asians with newly diagnosed open-angle glaucoma. METHODS: A retrospective, comparative, parallel group study was conducted on 78 eligible patients diagnosed with open-angle glaucoma who received topical timolol gel-forming solution either on morning (AM dosing group; 39 patients) or evening (PM dosing group; 39 patients) as monotherapy treatment. Intraocular pressure was taken at baseline, 1, 3, 6, and 12 months post-treatment. RESULTS: Mean baseline intraocular pressure (IOP) for timolol gel-forming solution in general was 22.7 +/- 6.6 mmHg with the mean IOP reduction of 5.7 +/- 5.3 mmHg (23.1% reduction). The mean IOP reduction of the AM dosing group was 7.5 +/- 5.2 mmHg (31.0% reduction) and 3.9 +/- 4.9 mmHg (15.1% reduction) in the PM dosing group (P = 0.0002). There was a statistically significant difference of IOP reductions between AM and PM dosing group at 1 month (P = 0.041), 3 months (P = 0.037) and 12 months (P = 0.015) post-treatment. Seventy-five percent (24) of good responders was in the AM group and 67.4% (31) of poor responders were patients in the PM group. CONCLUSION: Timolol gel-forming solution is effective in reducing IOP in Asian eyes. Morning dosing was more effective in lowering the IOP compared to evening dosing.     

Changes in intraocular pressure and ocular perfusion pressure after latanoprost 0.005% or brimonidine tartrate 0.2% in normal-tension glaucoma patients

OBJECTIVE: To evaluate and compare the effects of latanoprost 0.005% once daily and brimonidine tartrate 0.2% twice daily in patients with normal-tension glaucoma (NTG). DESIGN: A randomized, open-label, crossover study. PARTICIPANTS: Twenty-eight NTG patients with progressive visual field defects/optic disc excavation, new disc hemorrhage, or field defects that threatened fixation. INTERVENTION: Patients were randomly allocated to one of two groups. Patients in group 1 were treated with latanoprost, lubricant, and brimonidine for 4 weeks each, whereas patients in group 2 were treated with brimonidine, lubricant, and latanoprost for 4 weeks each. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), pulse rate, and blood pressure were measured at 8 am, 12 noon, and 4 pm after each 4-week treatment. Ocular perfusion pressure (OPP) was calculated. RESULTS: Latanoprost and brimonidine reduced the average IOP by 3.6 +/- 1.9 mmHg (P < 0.001) and 2.5 +/- 1.3 mmHg (P < 0.001), respectively, with a significant difference between the two regimens (P = 0.009). Both drugs significantly reduced IOP at each time point. Latanoprost decreased IOP significantly more than did brimonidine at 8 am (11.7 +/- 2.2 mmHg vs. 13.7 +/- 2.1 mmHg, P = 0.004) and 4 pm (11.4 +/- 2.1 mmHg vs. 13.2 +/- 2.9 mmHg, P = 0.004), but IOP was equal between the two agents at 12 noon (11.5 +/- 2.6 mmHg vs. 11.5 +/- 2.3 mmHg, P = 0.967). IOP was maintained at 12 mmHg or lower in 18 (66.7%) of 27 patients after treatment with latanoprost and in 9 (33.3%) of 27 patients after treatment with brimonidine. Latanoprost monotherapy reduced IOP by 30% in 8 patients (29.6%), but brimonidine monotherapy did not reduce IOP by that much in any of the patients. OPP increased after latanoprost treatment (P < 0.001) but did not increase after brimonidine treatment (P = 0.355). There was no significant change in pulse rate or blood pressure. CONCLUSIONS: Both latanoprost and brimonidine reduce IOP in NTG patients. Brimonidine has a peak IOP-lowering effect equal to that of latanoprost but produces a higher mean diurnal IOP than does latanoprost because of its shorter effect. Latanoprost might favorably alter optic disc blood perfusion by increasing OPP.     

Refractory glaucoma – tube or diode?

BACKGROUND: The aim of the present study was to assess the relative effectiveness of tube surgery and cyclodiode laser in terms of achieving intraocular pressure control. METHODS: A retrospective study was undertaken to compare patients undergoing double plate Molteno tube implantation with patients undergoing diode cyclophotocoagulation. Intraocular pressure (IOP) was documented at 7 days prior to surgery and postoperatively at various time points. Surgical success was defined as a final IOP between 6 (inclusive) and 21 mmHg (inclusive), without the use of topical medication, while 'qualified' success was defined as IOP within the same range with the use of topical medication. RESULTS: Twenty-eight diode patients and 26 tube patients were included for the study. An average follow up of 150 weeks (range = 21-322 weeks) was available. Mean preoperative IOP was 37 +/- 12 mmHg for the tube group and 39 +/- 16 mmHg for the diode group (t = 0.51, P = 0.61). The final IOP was 17 +/- 12 mmHg for the tube group and 21 +/- 13 mmHg for the diode group (t = 0.35, P = 0.73). Surgical success was achieved in 46% of tube eyes and 11% of diode eyes, while qualified success was achieved in 81% of tube eyes compared with 64% of eyes in the diode group. Two eyes which underwent diode became phthisical. CONCLUSIONS: IOP control may be achieved in a greater number of patients with tube surgery. The possible benefits of IOP control in diode patients need to be weighed against the risks of long-term visual loss and the need for multiple re-treatments in this group.     

Trabeculectomy with brief exposure to mitomycin C

BACKGROUND: To evaluate the safety and efficacy of primary trabeculectomy with brief exposure (15 s) to mitomycin C (MMC) (0.4 mg/mL). METHODS: Medical record review of all patients who underwent primary trabeculectomy with brief exposure to MMC at the Goldschleger Eye Institute in a 4-year period was performed. RESULTS: Sixty-three patients (35 men, mean age of 55 years) underwent trabeculectomy with brief exposure to MMC. Intraocular pressure (IOP) decreased a mean +/- standard deviation of 17.9 +/- 9.6 mmHg from 30.4 +/- 9.5 mmHg preoperatively to 12.5 +/- 6.2 mmHg postoperatively after a mean follow up of 18.3 months (P < 0.001). Number of antiglaucoma medications decreased from 2.9 +/- 1.1 preoperatively to 0.2 +/- 0.4 postoperatively (P < 0.001, paired samples t-test). Complete success, defined as IOP < 18 mmHg without antiglaucoma medication, was achieved in 46 patients (73%) and qualified success, defined as IOP 相似文献   

小瓣小梁切除术治疗青光眼

目的探讨小瓣小梁切除术治疗青光眼的方法及效果.方法治疗组各型青光眼40例40眼,行小瓣小梁切除术,巩膜瓣2 mm×2 mm,小梁切除1 mm×1 mm.对照组各型青光眼40例40眼,行复合式小梁切除术,巩膜瓣4 mm×3 mm,小梁切除1.0mm×3.0 mm.观察术后眼压及浅前房等并发症,并进行比较.结果治疗组术前眼压44.11±14.86 mmHg(1 mmHg=0.133 kPa),对照组术前眼压为46.45±11.27.随访12～18月,术后最后随访眼压治疗组为12.94±4.13 mmHg,对照组为13.51±3.56mmHg,两组差异无显著意义(t=0.66,P＞0.05).浅前房发生率治疗组为16%(6/40),对照组2.6%(1/40),两组差异无显著意义(X2=1.59＜3.84,P＞0.05).结论小瓣小梁切除术是一种安全、有效的抗青光眼滤过手术.眼科学报2001;17239～240.     

Effect of bimatoprost on intraocular pressure after phacoemulsification in eyes with exfoliation syndrome

PURPOSE: To evaluate the effect of bimatoprost 0.03% on intraocular pressure (IOP) after phacoemulsification in eyes with exfoliation syndrome. METHODS: This prospective, randomized, masked study comprised 90 eyes of 90 patients scheduled for phacoemulsification. The patients were divided into three groups (group 1 = without exfoliation, group 2 = with exfoliation syndrome, group 3 = exfoliation syndrome + bimatoprost). Immediately after phacoemulsification, one drop of bimatoprost was instilled in eyes in group 3. Baseline IOP was measured 1 day before surgery and routine follow-ups were performed at 6 hours, 20-24 hours and 1 week postoperatively. RESULTS: Preoperative IOP was 15.0 +/- 2.7 mmHg in group 1, 15.6 +/- 3.2 mmHg in group 2 and 16.1 +/- 3.2 mmHg in group 3 (p = 0.372). Six hours postoperatively, there was a significant difference between the groups (p = 0.013): IOP in group 2 (22.4 +/- 7.3 mmHg) was higher than in group 1 (18.4 +/- 4.4 mmHg) (p = 0.018) and group 3 (18.9 +/- 4.9 mmHg) (p = 0.044). In all groups, IOP values at 6 hours postoperatively were higher than preoperative values (p < 0.001), but IOP values at 20-24 hours and 1 week after surgery were not significantly different from baseline values (p > 0.05). The change in IOP in group 2, from baseline to 6 hours postoperatively, was greater than the equivalent changes in group 1 (p = 0.048) and group 3 (p = 0.016). CONCLUSIONS: Transient IOP increase and spikes were more common in eyes with exfoliation syndrome. Postoperative application of bimatoprost was effective in reducing IOP and preventing IOP spikes >/= 30 mmHg in eyes with exfoliation syndrome in the early postoperative period.