The effect of caffeine on choroidal thickness in young healthy subjects

Background: To investigate the effect of oral caffeine intake on choroidal thickness using optical coherence tomography (OCT).

Methods: Eighteen otherwise healthy caffeine users and 18 controls were enrolled. All participants underwent OCT scanning with high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1 and 3?h following 200-mg oral caffeine intake in the study and after oral placebo in the control group. The measurements were taken in the morning (10–12 am) to avoid diurnal fluctuation.

Results: The median choroidal thickness at the fovea prior to oral caffeine intake was 337.00 (IQR 83.75) μm, which decreased to 311.00 (IQR 79.25) μm at 1?h and 311.00 (IQR 75.00) μm at 3?h following oral caffeine intake (p?=?0.001, 0.002, respectively). The median choroidal thickness was also significantly decreased following oral caffeine intake at other five extrafoveal points (p?p?=?0.552, 0.704, respectively).

Conclusions: Caffeine causes a significant decrease in choroidal thickness following oral intake. This decrease might be a result of reduced ocular blood flow due to its vasoconstrictive effect.     

An evaluation of peripapillar choroidal thickness in patients receiving systemic isotretinoin treatment

Purpose: Oral isotretinoin (13-cis retinoic acid, 13-cis RA) was approved for severe acne treatment by the FDA in 1982. The ocular side effects associated with oral isotretinoin use are mostly dose-dependent. Numerous ocular pathologies affect peripapillary choroidal layer primarily or indirectly.

Objective: Evaluation of the peripapillary choroidal layer in the patients receiving oral isotretinoin therapy may aid in explaining the pathophysiology of ocular side effects.

Methods: In this study, peripapillary choroidal thickness was assessed in the patients receiving oral isotretinoin treatment via optical coherent tomography technique.

Results: Significant difference was found in the superotemporal and temporal areas.

Conclusion: Oral isotretinoin treatment may affect the thickness of the peripapillary choroidal layer.     

Assessment of macular choroidal thickness,central macular thickness and retinal nerve fiber layer in patients receiving oral isotretinoin treatment

Abstract

Purpose

To investigate the impact of oral isotretinoin therapy in choroidal thickness, central macular thickness (CMT), and retinal nerve fibre layer (RNFL) thickness using optical coherence tomography (OCT).     

New drugs for the prevention and treatment of migraine: topiramate and BIBN 4096 BS

Migraine is one of the leading causes of disability. Topiramate has multiple mechanisms and may reduce neurotransmission through the trigeminocervical complex to prevent migraine. In clinical trials for the prevention of migraine, the mean monthly migraine frequency decreased from 5.6 to 4.5 in the placebo group and larger decreases were observed with topiramate (100 mg/day, 5.8 to 3.5; 200 mg/day, 5.1 to 3.0). However, topiramate use is associated with a high incidence of adverse events (paraesthesia, fatigue, anorexia, diarrhoea), which may limit the willingness of patients to use topiramate for the prevention of migraine. BIBN 4096 BS is a non-peptide calcitonin gene-related peptide-receptor antagonist that has recently been trialled in migraine attacks. The primary efficacy end point was the reduction of severe or moderate headache prior to treatment to mild or no headache at 2 h. This endpoint was achieved in 21 of 32 (66%) patients with BIBN 4096 BS 2.5 mg, compared to 27% of patients given placebo. Although BIBN 4096 BS is a non-peptide, it is still administered intravenously, which will probably limit its use to medical centres.     

Peripapillary choroidal thickness in patients with chronic obstructive pulmonary disease

Objective: To evaluate the peripapillary choroidal thickness of patients with chronic obstructive pulmonary disease (COPD) via enhanced depth imaging optical coherence tomography (EDI-OCT).

Materials and methods: A total of 80 patients with COPD (80 eyes) and 50 control subjects (50 eyes) were enrolled. Choroidal scans and the retinal nerve fiber layer (RNFL) thickness were obtained for all eyes using OCT.

Results: The average peripapillary choroidal thickness measurements of the COPD group (147.58?±?53.53?μm) were lower than the control group (160.84?±?44.73?μm) (p?=?0.068). Inferior segment thicknesses were significantly thinner than the other segments (p?<?0.05). Subfoveal choroidal thickness and RNFL thickness measurements of the COPD group were also lower than those of the control group (p?=?0.111).

Conclusion: Hypoxia in COPD seems to affect the choroidal thickness. Thinning of the choroid may be attributed to increased vascular resistance and reduced blood flow in patients with COPD. The possible effects of the disease to the eye may be clarified through the role of the choroidal vasculature in the blood supply of the anterior optic nerve head.     

Effects of cigarette smoking on choroidal and retinal thickness and ocular pulse amplitude

Background: In our study, we aimed to show the effects of smoking on choroidal thickness and ocular pulse amplitude. It is known that the anatomy and physiologic functions of the choroid is important in ocular diseases like glaucoma and age-related macular degeneration. Choroidal thickness is measured by the spectral domain optical coherence tomography (SD-OCT). The ocular pulse amplitude (OPA) is the difference between the systolic and diastolic intraocular pressure (IOP) and it is an index of choroidal perfusion.

Design: This was a cross-sectional prospective observational study at the Turgut Ozal University Hospital setting.

Participants: The test subjects were divided into two groups: the smokers group which consisted in 24 participants (20 male, 4 female) and the control group with 22 participants (16 male, 6 female).

Methods: The participants underwent full ophthalmological examination including best-corrected visual acuity (BCVA), spherical equivalent (SE) values of refractive errors, intraocular pressure (IOP), ocular pulse amplitude (OPA), central corneal thickness (CCT), axial length (AL) and choroidal thickness. The IOP and the OPA were measured with the dynamic contour tonometer. The CCT and the AL were measured with the Nidek AL-Scan (Nidek Co., Ltd., Gamagori, Japan). The choroidal thickness was measured by the Cirrus high-definition optical coherence tomography (Cirrus Version 6.0; Carl Zeiss Meditec, Dublin, CA).

Results: Gender did not differ significantly between the groups (p?=?0.12). The age, SE, IOP, OPA, CCT and AL did not differ significantly in smokers and control groups (p?=?0.12, p?=?0.37, p?=?0.54, p?=?0.80, p?=?0.56 and p?=?0.82, respectively). The nasal, temporal, central retinal (p?=?021, p?=?021, p?=?0.11) and nasal, temporal, central choroidal thicknesses (p?=?0.80, p?=?0.39, p?=?0.75) did not differ significantly between smokers and control groups.

Conclusions: We could not find a significant difference in OPA, retinal and choroidal thicknesses between smokers and non smokers. Further studies including histopathological changes in larger groups are needed to show the effect of smoking on choroidal thickness especially in patients with ocular diseases like age-related macular degeneration.     

Optical coherence tomography findings in patients with alcohol use disorder and their relationship with clinical parameters

Abstract

Purpose: In our study, we aimed to investigate the ganglion cell-inner plexiform layer thickness (GCIPL), retinal nerve fibre layer thickness (RNFL), mean macular volume (MMV), central macular thickness (CMT), mean macular thickness (MMT), and choroidal thickness (CT) values with optical coherence tomography (OCT) in patients who are diagnosed with alcohol use disorder (AUD).

Materials and methods: The study included 43 patients who were diagnosed with AUD, and 43 healthy controls. Detailed biomicroscopic examinations of all the participants, visual acuity, intraocular pressure, anterior and posterior segment examinations, and then, OCT measurements were carried out.

Results: Although the measured values for RNFL in the superior and temporal quadrant are within normal limits, they were slightly higher compared to those in the control group (p values 0.127 and 0.191 for superior quadrant and temporal quadrant, respectively). The CT measurements in all quadrants were higher than the control group; however, these measurements were not statistically significant (p?>?0.05). When the relation between clinical features and OCT findings of the patients were examined, it was determined that the ages of the patients were statistically significantly and inversely correlated with the temporal CT and also the nasal and temporal quadrants of RNFL.

Conclusions: Our study is the first study that examines the retinal GCIPL and CT with OCT in patients who are diagnosed with AUD. In our results, it was determined that there were no statistically significant differences between the participants in terms of OCT parameters. Further studies with larger sampling groups evaluating neurotransmission findings may provide wider results.     

川芎清脑颗粒联合托吡酯治疗偏头痛的疗效观察

目的探讨川芎清脑颗粒联合托吡酯片治疗偏头痛的临床疗效。方法选取2016年5月—2018年5月重庆市梁平区人民医院收治的182例偏头痛患者作为研究对象,随机将患者分为对照组和治疗组,每组各91例。对照组口服托吡酯片,25 mg/d,维持1周;第2周25 mg/次,2次/d;第3周早上25 mg,晚上50 mg;第4周50 mg/次,2次/d。治疗组在对照组治疗的基础上冲服川芎清脑颗粒,10 g/次,3次/d。两组患者均连续治疗8周。观察两组患者的临床疗效,比较两组治疗前后的临床症状改善情况、神经元放电情况和血液流变学指标。结果治疗后,对照组和治疗组的总有效率分别为76.9%、95.6%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者偏头痛发作频率和持续时间均明显下降(P0.05);治疗后,治疗组发作频率、持续时间均显著短于对照组(P0.05)。治疗后,治疗组α波频率变慢、δ波增多和θ波增多比例均显著高于对照组(P0.05)。治疗后,两组患者血浆黏度(PV)、全血高切黏度(WBHSV)、全血低切黏度(WBLSV)、红细胞压积(HCT)和纤维蛋白原(FIB)水平均明显下降(P0.05);治疗后,治疗组血液流变学指标均显著低于对照组(P0.05)。结论川芎清脑颗粒联合托吡酯片治疗偏头痛具有较好的临床疗效,可有效改善患者的神经元放电和血液流变学指标,具有一定的临床推广应用价值。     

加巴喷丁联合西酞普兰滴定治疗慢性偏头痛伴广泛性焦虑障碍临床疗效分析

目的:探讨加巴喷丁联合西酞普兰对慢性偏头痛(CM)伴广泛性焦虑障碍患者的临床疗效、安全性及两药的有效剂量.方法:按照随机数字表法将210例慢性偏头痛患者纳入加巴喷丁联合西酞普兰组(治疗组)105例和托吡酯联合西酞普兰组(对照组)105例,均治疗6个月.分别记录2组患者治疗前及治疗3,6个月后每月发作天数、偏头痛严重程度...     

托吡酯治疗320例癫痫病人的不良反应

目的：了解托吡酯治疗癫痫病人的不良反应。方法：对托吡酯单用或作为添加治疗的320例癫痫病人进行不良反应的前瞻性研究。结果：320例病人的用药时间为(30±s 7)wk,16 wk～36 mo。有98例出现不同程度的不良反应,占全部病人的30．6%,其中13例(13．2%)因不良反应停药。单用托吡酯的142例病人中有68例(48．0%)出现不同程度的不良反应,添加治疗的178例病人有30例(17．0%)出现不良反应,两者间差异有非常显著意义(P＜0．01)。最常见的是体重减轻、手足麻木、头痛头晕,12例病人用药后述有记忆力或学习成绩下降,简易韦氏智能测定9例异常。结论：托吡酯是较为安全的新抗癫痫药,虽然不良反应发生率高,但多数很轻微。     

丹七软胶囊联合舒马普坦治疗偏头痛的临床研究

目的探讨丹七软胶囊联合舒马普坦治疗偏头痛的临床疗效。方法选取2017年1月—2019年4月于天津医科大学第二医院进行治疗的偏头痛患者126例,随机分为对照组和治疗组,每组各63例。对照组口服琥珀酸舒马普坦片,100 mg/次,1次/d。治疗组在对照组的基础上口服丹七软胶囊,5粒/次,3次/d,两组均连续治疗4周。观察两组的临床疗效,比较两组治疗前后头疼发作情况、血清基质金属蛋白酶-9(MMP-9)的变化情况。结果治疗组治疗总有效率(95.24%)优于对照组(82.54%)(P0.05)。治疗后两组患者头疼发作频次、发作程度评分均显著降低,头疼发作持续时间均显著缩短(P0.05);治疗后,治疗组头疼发作情况显著优于对照组(P0.05)。治疗后,两组患者MMP-9均显著降低(P0.05);且治疗后治疗组MMP-9显著低于对照组(P0.05)。结论丹七软胶囊联合舒马普坦治疗偏头痛具有较好的临床疗效,能够有效改善患者血液流变学指标,减少头痛发作,具有一定的临床推广应用价值。     

Topiramate: the evidence for its therapeutic value in the prevention of migraine

INTRODUCTION: Preventive therapy is recommended in patients with migraines frequent and/or severe enough to interfere with daily life, and/or with an inadequate response to acute therapy (26-43% of patients with migraine in a recent US survey). Preventive treatments include beta blockers, amitriptyline, and antiepileptics (sodium valproate, gabapentin), but these may have significant adverse effects and are contraindicated in some patients. Topiramate is an antiepileptic recently approved for prevention of migraine. AIMS: To assess the evidence on the therapeutic value of topiramate as preventive treatment for migraine in adults. EVIDENCE REVIEW: All identified outcomes were patient-oriented. Strong evidence shows that topiramate 100 or 200 mg/day is more effective than placebo in reducing mean monthly migraine frequency, and further evidence shows better effectiveness than placebo on responder rate, rescue medication use, migraine severity, and migraine duration. The 100 mg/day dose appears generally better tolerated than 200 mg/day. Evidence shows that topiramate is associated with weight loss rather than weight gain. Limited evidence suggests that topiramate can improve health-related quality of life and reduce days with disability. Uncontrolled studies indicate effectiveness in refractory migraine. Limited evidence indicates broadly similar efficacy and tolerability for topiramate 100 mg/day and propranolol 160 mg/day, though more comparative trials are required. There is insufficient economic evidence to assess the cost effectiveness of topiramate. PLACE IN THERAPY: Topiramate 100 mg/day is the dose with the best balance between efficacy and tolerability, and offers therapeutic value in patients in whom propranolol or other preventive migraine therapies are contraindicated, poorly tolerated, or ineffective.     

Follow up of retinal nerve fiber layer thickness with optic coherence tomography in patients receiving anti-tubercular treatment may reveal early optic neuropathy

Purpose: To evaluate the effect of anti-tubercular treatment on retinal nerve fiber layer (RNFL) thickness and the efficiency of optic coherence tomography (OCT) on early diagnosis of optic neuropathy.

Methods: Twenty patients diagnosed with either pulmonary or extra-pulmonary tuberculosis which were treated with anti-tubercular treatment (isoniazid (INH), rifampicin, ethambutol (ETM), and pyrazinamide) were enrolled in the study. RNFL thicknesses of the patients were measured via OCT, at baseline (before starting anti-tubercular treatment) and after the two-month treatment period. Standard ophthalmologic examinations were also performed.

Results: Compared to baseline values, after the two-month treatment period, thinning was detected in the right eye’s average and superior quadrant RNFLs (p?=?0.024 and p?=?0.006 respectively) and in the left eye’s average, superior quadrant, and inferior quadrant RNFLs (p?=?0.001, p?=?0.008, p?Conclusion: We displayed that patients receiving INH and ETM, which were the basic medicines of anti-tubercular treatment, experienced thinning in RNFL after the two-month treatment period. Patients receiving these drugs can be followed via OCT in terms of reduction in RNFL thicknesses for early diagnose of INH and ETM toxicity.     

针刺治疗偏头痛36例临床观察

目的观察针刺治疗偏头痛的临床疗效。方法将偏头痛患者72例随机分为治疗组和对照组各36例,治疗组给予针刺百会、四神聪、合谷穴治疗,对照组给予口服布洛芬（芬必得）治疗,比较2组临床疗效。结果治疗组在治疗后1个月、3个月和6个月的视觉模拟评分（VAS）均显著低于对照组,差异均有统计学意义（P〈0.01）。结论针刺治疗偏头痛安全、有效。     

光学相干断层扫描技术前房角检查对糖尿病视网膜病变的价值

目的 探讨糖尿病视网膜病变(DR)不同分期病人运用光学相干断层扫描(OCT)前房角形态学检查的意义与价值,为病人提供更准确的检测方法提供依据.方法 糖尿病视网膜病变病人613例,按照不同分期分为背景期DR组258例与增殖期DR组355例,同时选取糖耐量异常病人120例作为对照组.所有纳入研究受试者均采取OCT检查并记录前房角相关参数,包括房角角度(ACA)和前房深度(ACD)、房角开放距离(AOD)、房角隐窝面积(ARA)、小梁网虹膜空间面积(TISA),比较各组病人不同参数的差异.结果 三组纳入研究病人的ARA500、ARA750、AOD750,AOD500,TISA750,TISA500参数差异有统计学意义(P<0.05),增殖期DR组房角开放程度各项指标、各组前房相关指标均小于背景期DR组与对照组,参数差异有统计学意义(P<0.05),背景期DR组各项指标亦小于对照组(P<0.05).结论 OCT检测可很好的反映视网膜病变的参数变化,前房角形态指标对DR诊断具有一定的应用价值.     

Advances in pharmacological treatment of migraine

Migraine is a paroxysmal disorder with attacks of headache, nausea, vomiting, photo- and phonophobia and malaise. This review summarises new treatment options both for the therapy of the acute attack as well as for migraine prophylaxis. Analgesics like aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) are effective in treating migraine attacks. Few controlled trials were performed for the use of ergotamine or dihydroergotamine. These trials indicate inferior efficacy compared with serotonin (5-HT_1B/D) agonists (triptans). The triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan), are highly effective. They improve headache as well as nausea, photo- and phonophobia. The different triptans show only minor differences in efficacy, headache recurrence and adverse effects. The knowledge of their different pharmacological profile allows a more specific treatment of the individual migraine characteristics. Migraine prophylaxis is recommended, when more than three attacks occur per month, if attacks do not respond to acute treatment or if side effects of acute treatment are severe. Substances with proven efficacy include the beta-blockers metoprolol and propranolol, the calcium channel blocker flunarizine, several 5-HT antagonists and amitriptyline. Recently anti-epileptic drugs (valproic acid, gabapentin, topiramate) were evaluated for the prophylaxis of migraine. The use of botulinum toxin is under investigation.     

Evaluation of the effects on choroidal thickness of bimatoprost 0.03% versus a brinzolamide 1.0%/timolol maleate 0.5% fixed combination

Objective: To investigate the effects of two different medical treatment options on choroidal thickness (CT) in cases of open-angle glaucoma (OAG).

Methods: Sixty-seven eyes newly diagnosed with OAG and 52 healthy eyes constituting the control group were included in the study. Glaucomatous eyes were randomly divided into two subgroups; Group I was started on bimatoprost 0.03% and Group II on a brinzolamide 1.0%/timolol maleate 0.5% fixed combination (BTFC). Intraocular pressure (IOP), ocular pulse amplitude (OPA) and subfoveal CT measurements were performed in all eyes in the study before treatment and on weeks 2, 4 and 8 after treatment.

Results: Mean initial IOP values in groups I and II and the control group were 25.5?±?4.7, 25.1?±?5.2 and 16.1?±?2.9?mmHg, mean OPA values were 3.7?±?1, 3.6?±?1.4 and 2.4?±?0.6?mmHg and mean CT values were 269.4?±?83, 264.5?±?84.4 and 320.1?±?56.6?μm, respectively. Eight weeks after treatment, mean IOP values in Groups I and II and the control group were 18.3?±?2.6, 18.1?±?3.4 and 15.7?±?2.9?mmHg, mean OPA values were 2.9?±?1.2, 2.8?±?1.5 and 2.3?±?0.8?mmHg and mean CT values were 290.2?±?87.3, 271.8?±?82.5 and 319.3?±?56.8?μm, respectively. No significant difference was determined in terms of the decrease in IOP and OPA obtained after treatment in Group I and Group II. However, a significant difference was observed between the two groups in terms of choroidal thickening after treatment.

Conclusion: The use of topical ocular hypotensive medication in eyes with OAG results in an increase in CT. This increase is relatively greater with bimatoprost 0.03% therapy compared to BTFC.     

托吡酯对癫痫病人磁刺激电位的影响及其临床应用的探讨

目的:采用单脉冲经颅磁刺激(TMS)探讨托吡酯对癫痫病人运动皮质兴奋性的影响,寻找早期评价托吡酯疗效的客观指标。方法:对诊断明确的101例癫痫病人随机分为托吡酯组(包括31例新诊断癫痫病人)和非托吡酯组,检查药物治疗前后不同时段TMS参数的变化。结果:发现癫痫病人运动阈值低,皮质静息期(CSP)缩短,托吡酯单药治疗3wk后运动阈值提高,CSP延长(P<0.01),且与剂量有关;但运动诱发电位波幅、周围潜伏期、皮质潜伏期、中枢传导时间没有改变(P>0.05)。结论:托吡酯降低了癫痫病人运动皮质兴奋性,利用这种药物治疗前后TMS参数的改变,可早期评价其疗效。     

托吡酯对癫痫病人胰岛素及瘦素水平的影响

目的:研究托吡酯对癫痫病人的胰岛素和瘦素水平的影响。方法:选取35例未服用托吡酯(对照组)及55例服用托吡酯(托吡酯组)的癫痫病人,应用放射免疫技术检测其空腹胰岛素和瘦素水平并进行比较。结果:托吡酯组空腹胰岛素水平低于对照组(P<0．05);托吡酯组女性病人的空腹胰岛素水平低于对照组女性(P<0．05);2组内男性病人的瘦素水平均低于女性(托吡酯组P<0．05,对照组,P<0．01)。结论:托吡酯可显著降低非肥胖女性癫痫病人的空腹胰岛素水平,对瘦素水平无显著影响。     

Effect of pregnancy on topiramate pharmacokinetics in rabbits

1. Pregnancy is associated with various physiological changes that may lead to significant alterations in the pharmacokinetic profiles of many drugs. The present study was designed to investigate the potential effects of pregnancy on the pharmacokinetics of topiramate (TPM) in the rabbit model.

2. Nineteen female New Zealand white rabbits (nine pregnant and 10 non-pregnant) were used in this study. Blood samples were collected from the animals just before receiving TPM orally at a dose of 20?mg/kg and then serially for up to 24?h. TPM plasma samples were analysed using a validated tandem mass spectrometric (LC-MS/MS) method.

3. The mean values of TPM pharmacokinetic parameters (t_1/2, T_max, AUC_0–∞, and CL/F) were significantly modified in pregnant rabbits as compared with non-pregnant group. Pregnancy significantly (P?<?0.05) increased TPM half-life (t_1/2), time to attain the maximum plasma concentration (T_max), and the area under TPM plasma concentration–time curve (AUC_0-∞) and decreased the drug’s oral clearance (CL/F) compared with non-pregnancy state in rabbits.

4. The present study demonstrates that pregnancy alters the pharmacokinetics of TPM in rabbits in late gestational period and considerable inter-animal variability was observed. The findings of the present study indicate that TPM CL/F is decreased during late pregnancy in the rabbit model.