Mean Change In Intraocular Pressure Research Articles

Long-term effect of Nd:YAG laser posterior capsulotomy on intraocular pressure.

To study the long-term effect of Nd:YAG capsulotomy on intraocular pressure (IOP). We reviewed the records of patients with bilateral pseudophakia who received Nd:YAG capsulotomy in only 1 eye. Using the Wilcoxon rank sum test, we compared the mean change in IOP in eyes before and after capsulotomy with that of the noncapsulotomy eyes at corresponding time intervals. Using multiple regression tests, we analyzed the factors significantly associated with postcapsulotomy long-term IOP increases. The study included 100 patients who were followed up for a median of 1.5 years after capsulotomy. The mean +/- SD age of the study group was 76+/-7 years, and 37 patients had glaucoma. The changes in IOP in the eyes treated with capsulotomy were significantly higher than those in noncapsulotomy eyes at each time interval following capsulotomy. The long-term IOP increase was significantly associated with the IOP increase measured 1 hour after the capsulotomy (P =. 001). Patients with glaucoma were more likely to require long-term additional glaucoma medication than were nonglaucoma patients to require initial glaucoma therapy after the capsulotomy (P =.002). After Nd:YAG capsulotomy, long-term IOP is often elevated above precapsulotomy baselines, especially in glaucoma patients or patients who experience a significant IOP increase within hours after the capsulotomy.

Comparison of brimonidine with latanoprost in the adjunctive treatment of glaucoma

Objective This study compared brimonidine with latanoprost as adjunctive therapy for the treatment of open-angle glaucoma and ocular hypertension. Background Patients with open-angle glaucoma or ocular hypertension often require > 1 medication to achieve control of intraocular pressure (IOP). Both brimonidine and latanoprost effectively lower IOP, but no previously reported clinical trials have directly compared these agents as adjunctive therapy. Methods This was a prospective, randomized, investigator-masked, multicenter, paralleldesign clinical trial. Forty patients (69 study eyes) with uncontrolled IOP of ≤34 mm Hg while using a topical beta-blocker plus dorzolamide or pilocarpine were randomly assigned to receive either brimonidine 0.2% BID or latanoprost 0.005% QD over 6 months as adjunctive therapy. Tolerability was assessed by reports of adverse events, and efficacy was determined by reduction in IOP from baseline. Clinical success was defined as the achievement of a ≥15% reduction in IOP from baseline. Results There were no significant between-group differences in any demographic variable. Most patients in each group were white, had open-angle glaucoma, and were being treated with a nonselective beta-blocker and dorzolamide. When brimonidine or latanoprost was used as an adjunctive agent with a beta-blocker and dorzolamide or pilocarpine, the rates of clinical success at month 1 were 85% (17/20 patients) with brimonidine versus 65% (13/20 patients) with latanoprost ( P = 0.144). Overall mean IOP reduction at month 1 was 4.60 ± 0.62 mm Hg (22.8%; P < 0.001) with brimonidine and 3.43 ± 0.62 mm Hg (17.2%; P < 0.001) with latanoprost, with no significant differences between groups ( P = 0.219). Among the patients with an inadequate IOP-lowering response (< 15% reduction from baseline), the mean IOP reduction was 0.36 ± 0.66 mm Hg with latanoprost (n = 7) and 0.50 ±2.18 mm Hg with brimonidine (n = 3). Brimonidine and latanoprost had comparable IOP-lowering efficacy in patients receiving concomitant pilocarpine therapy (mean change in IOP of −4.23 mm Hg vs −3.75 mm Hg, P = 0.173). In patients concurrently treated with dorzolamide, brimonidine produced a mean change in IOP of −5.29 mm Hg, compared with a mean change of −3.21 mm Hg in the latanoprost group ( P = 0.159). Both brimonidine and latanoprost were well tolerated. Few adverse events leading to discontinuation were observed with either drug regimen (n = 2 with brimonidine; n = 0 with latanoprost). Conclusions Both brimonidine 0.2% BID and latanoprost 0.005% QD were well-tolerated and reduced IOP in most patients when used as third-line adjunctive therapy. However, clinical success was achieved by 17 of 20 patients (85%) who received brimonidine, compared with 13 of 20 patients (65%) who received latanoprost ( P = 0.144). These results suggest that brimonidine 0.2% BID may be more reliable than latanoprost 0.005% QD as adjunctive therapy for glaucoma and ocular hypertension.

Dose-Response Evaluation of the Ocular Hypotensive Effect of Brinzolamide Ophthalmic Suspension (Azopt ®)

Brinzolamide is a novel carbonic anhydrase inhibitor that elicits an ocular hypotensive effect when instilled topically. A multicenter, double-masked, placebo-controlled, parallel trial was conducted to evaluate the optimal intraocular pressure (IOP)–lowering concentration and ocular tolerability of topically administered brinzolamide (0.3%, 1%, 2%, and 3%) in patients with primary open-angle glaucoma or ocular hypertension. After a washout phase, patients were administered brinzolamide or placebo twice daily for 2 weeks. The IOP was measured on days 8 and 15 at 8:00 a.m., and then 2, 4, 8, and 12 hours after dosing, and these measurements were compared with IOP values obtained at the corresponding times during an off-therapy diurnal baseline. All concentrations of brinzolamide produced significantly greater (P < 0.005) mean percent IOP reductions and mean IOP reductions compared with placebo. Mean percent IOP changes (mean IOP changes) from baseline for brinzolamide 0.3%, 1%, 2%, and 3% were −11.3% (−3.0 mm Hg), −16.1% (−4.3 mm Hg), −16.1% (−4.4 mm Hg), and −15.4% (−4.2 mm Hg), respectively, when pooled over visit and visit time. Comparisons between concentrations demonstrated that the mean percent IOP reduction for brinzolamide 1.0% was significantly greater than that for the 0.3% concentration (P < 0.03), with no difference in efficacy between the 1%, 2%, and 3% concentrations. The incidence of adverse events was dose-dependent, and those related to therapy were usually mild and resolved without treatment. Blurred vision, ocular discomfort, and abnormal taste were the most frequently reported adverse events. Based on these findings, the optimal IOP-lowering concentration of brinzolamide was 1%. When administered twice daily, brinzolamide 1% was well tolerated by patients with primary open-angle glaucoma or ocular hypertension.

The Efficacy and Safety of Brinzolamide 1% Ophthalmic Suspension (Azopt ®) as a Primary Therapy in Patients With Open-Angle Glaucoma or Ocular Hypertension

A randomized, multicenter, double-masked, prospective, parallel study was designed to establish the intraocular pressure (IOP)–lowering efficacy, safety, and tolerability of brinzolamide 1.0% (Azopt ®) as a primary therapy compared with dorzolamide 2.0% (Trusopt ®) and placebo in patients diagnosed with open-angle glaucoma (with or without a pseudoexfoliative or a pigmentary dispersion component) or ocular hypertension. Brinzolamide 1.0%, dosed two times (b.i.d.) and three times (t.i.d.) a day, dorzolamide 2.0% (t.i.d.), and placebo (t.i.d) were administered to patients during a 3-month treatment period. Diurnally corrected IOP reduction from baseline, including peak and trough times, was the primary end point. Sample sizes were chosen to establish statistical equivalence between treatments. Mean IOP changes observed on treatment were as follows: −3.4 mm Hg (−13.2%) to −4.1 mm Hg (−16.7%) with brinzolamide 1.0% b.i.d.; −4.1 mm Hg (−16.6%) to −4.8 mm Hg (−19.1%) with brinzolamide 1% t.i.d.; and −4.3 mm Hg (−16.9%) to −4.9 mm Hg (−20.1%) with dorzolamide 2.0%. IOP reductions after administration of brinzolamide 1.0% b.i.d. and t.i.d. were equivalent to each other and also clinically and statistically equivalent to those with dorzolamide 2.0% t.i.d. The incidence of ocular discomfort (burning and stinging) upon instillation was significantly higher for dorzolamide (10.7%) than brinzolamide (b.i.d. or t.i.d., 3.0% each). The most frequent nonocular event reported was taste perversion, which was less (3.7%) with brinzolamide 1.0% b.i.d., but brinzolamide t.i.d. was similar to dorzolamide t.i.d. (6.8% vs. 5.3%). Brinzolamide 1.0% b.i.d., brinzolamide 1.0% t.i.d., and dorzolamide 2.0% t.i.d. equaled each other in IOP-lowering efficacy, and brinzolamide was significantly more comfortable than dorzolamide upon instillation.

Comparison of dorzolamide and pilocarpine as adjunctive therapy in patients with open-angle glaucoma and ocular hypertension

Many patients with glaucoma or ocular hypertension initially receive beta-blocker monotherapy to control intraocular pressure (IOP), but some of these patients will require an additional IOP-lowering agent within 1 year. This active-controlled, double-masked, randomized, multicenter, 12-week study compared the effectiveness and tolerability of dorzolamide hydrochloride ophthalmic solution 2% TID with those of pilocarpine hydrochloride 2% QID as adjunctive therapy to timolol maleate ophthalmic gel-forming solution (TG) 0.5% QD as measured by changes in IOP and occurrence of adverse events. One hundred ninety-four patients with open-angle glaucoma or ocular hypertension participated in this study. Their mean age was ~63 years. Slightly more than one half were white, and approximately one third were black. After a 3-week run-in period during which all patients received TG 0.5% QD, patients with an IOP of ≥22 mm Hg at the morning trough measure- ment were randomly assigned to receive additional double-masked therapy with either dorzolamide or pilocarpine. The primary outcome measure was the mean change in IOP at the morning trough measurement from baseline to week 12. The secondary outcome measure was the mean change in IOP at the morning peak measurement from baseline to week 12. There was no significant difference in IOP-lowering effect between the 2 drugs at either morning trough or morning peak. The mean change in IOP at morning trough was −3.17 mm Hg (−12%) in patients receiving dorzolamide; it was −3.45 mm Hg (−13%) in patients receiving pilocarpine. The mean change in IOP at morning peak was −2.25 mm Hg (−10%) for patients who received dorzolamide and −2.51 mm Hg (−11%) for those who received pilocarpine. In the pilocarpine group, 62 (63%) patients experienced ≥1 adverse event compared with 35 (36%) patients in the dorzolamide group ( P < 0.001). Twenty-one (21%) patients in the pilocarpine group discontinued treatment because of an adverse event compared with 2 (2%) patients in the dorzolamide group ( P < 0.001). These results demonstrate that dorzolamide and pilocarpine were equally effective as adjunctive therapy in lowering IOP but that dorzolamide was better tolerated.

Apraclonidine 0.5% Versus Brimonidine 0.2% for the Control of Intraocular Pressure Elevation Following Anterior Segment Laser Procedures

Both apraclonidine hydrochloride 0.5% and brimonidine tartrate 0.5% are potent alpha-2 agonists, effective in controlling the intraocular pressure (IOP) rise following argon laser trabeculoplasty (ALT). Brimonidine has recently become available commercially as a 0.2% solution. Our goal in this study was to compare the efficacy and side effect profile of 0.2% brimonidine to that of 0.5% apraclonidine in the prevention of IOP spikes following anterior segment laser procedures. Patients undergoing argon laser trabeculoplasty, Nd:Yag peripheral iridectomy or posterior capsulotomy were prospectively randomized to receive either apraclonidine 0.5% or brimonidine 0.2%, approximately 10 minutes prior to laser surgery. Intraocular pressure was measured by a masked observer, using Goldmann applanation tonometry, before and 1 hour after the treatment. 51 ALTs, 21 peripheral iridectomies, and 13 posterior capsulotomies were performed. The incidence of an IOP rise greater than 5 mmHg was 3/43 (7.0%) in the brimonidine group and 0/42 (0%) in the apraclonidine group (P = 0.08, chi-squared). There were no IOP elevations greater than 8 mmHg. All IOP rises of greater than 5 mmHg occurred in the ALT sub-group, and within this sub-group, the mean change in IOP from pre- to post-op was -4.00 +/- 5.87 in the brimonidine group versus -4.29 +/- 3.86 in the apraclonidine group (P = 0.84). There was a statistically significant decrease in IOP from baseline in both drug groups (P < .0001). Both drugs are highly effective in controlling IOP spikes following anterior segment laser procedures. There is a tendency toward higher risk of IOP rise following argon laser trabeculoplasty with 0.2% brimonidine as compared to 0.5% apraclonidine, however, this was not statistically significant.

The efficacy and safety of the Dorzolamide—timolol combination versus the concomitant administration of its components

Objective To evaluate whether a fixed combination of 2% dorzolamide and 0.5% timolol given twice daily showed equivalent efficacy to the concomitant administration of 2% dorzolamide given three times daily and 0.5% timolol given twice daily in patients whose intraocular pressure (IOP) remained elevated during monotherapy with 0.5% timolol twice daily. Design Multicenter, parallel, randomized, double-masked clinical trial with an open-label extension. Participants and intervention In the masked phase, 242 patients received either the dorzolamide-timolol combination twice daily and placebo three times daily or dorzolamide three times daily and timolol twice daily for up to 3 months. In the open-label extension, 220 patients received the dorzolamide-timolol combination twice daily for up to 9 months. Main outcome measures The criterion for establishing treatment equivalency was a 95% or greater confidence that the absolute difference in the mean change in IOP from baseline was less than 1.5 mmHg between treatments. Results During 3 months of treatment, the dorzolamide-timolol combination reduced IOP relative to the 0.5% timolol baseline by approximately 14% at hour 0 (just before the morning dose), 20% at hour 2, and 15% at hour 8. The IOP-lowering effect of concomitant therapy with dorzolamide and timolol was approximately 16% at hour 0, 20% at hour 2, and 17% at hour 8. At hours 0, 2, and 8, there was greater than 97% confidence that the treatments were equivalent. During the open-label extension, the mean IOP reduction ranged from 14% to 15% at hour 0 and from 20% to 21% at hour 2. The treatment groups were generally comparable in terms of adverse events, symptoms, ocular signs, visual acuity, visual fields, physical examination, and laboratory measures. Conclusions The IOP-lowering effect of the dorzolamide-timolol combination is comparable to that of dorzolamide three times daily plus timolol twice daily and is maintained for up to 1 year. The dorzolamide-timolol combination provides clinically important reduction in IOP relative to baseline treatment with timolol alone and is generally well-tolerated for up to 1 year.

Clinical efficacy and safety of brinzolamide (Azopt™), a new topical carbonic anhydrase inhibitor for primary open-angle glaucoma and ocular hypertension

PURPOSE: To determine the intraocular pressure-lowering efficacy and safety of brinzolamide 1.0%, compared with dorzolamide 2.0% and timolol 0.5%.METHODS: A multicenter, double-masked, prospective, parallel-group study was conducted to compare brinzolamide 1.0%, administered two and three times a day, dorzolamide 2.0% three times a day, and timolol 0.5% twice a day in 572 patients with primary open-angle glaucoma or ocular hypertension. The primary end point was diurnally corrected intraocular pressure reduction from baseline, evaluated at both peak and trough times during a 3-month period.RESULTS: Mean intraocular pressure changes after twice daily (−3.8 to −5.7 mm Hg) and three times daily (−4.2 to −5.6 mm Hg) dosing with brinzolamide 1.0% were statistically equivalent (confidence limit ≤ 1.5 mm Hg) to each other and also to dorzolamide 2.0% three times a day (−4.3 to −5.9 mm Hg). The range of intraocular pressure change with timolol 0.5% twice daily was −5.2 to −6.3 mm Hg. Clinically relevant intraocular pressure changes (reduction ≥ 5 mm Hg or intraocular pressure ≤ 21 mm Hg) were observed in up to 75.7% of patients taking brinzolamide twice daily and in up to 80.1% taking brinzolamide three times daily. Treatment with brinzolamide 1.0% was safe, comfortable, and well tolerated. The incidence of ocular discomfort (burning and stinging) on instillation of brinzolamide (twice daily, 1.8%; three times daily, 3.0%) was significantly less (P = .000) compared with treatment with dorzolamide (16.4%).CONCLUSIONS: Brinzolamide 1.0% produced clinically relevant intraocular pressure reductions in substantial numbers of patients. Brinzolamide’s effectiveness equaled that of dorzolamide 2.0% and it produced less ocular discomfort (burning and stinging) on instillation.

Comparison of the efficacy and safety of 2% dorzolamide and 0.5% betaxolol in the treatment of elevated intraocular pressure

A multicenter, parallel-design, randomized, double-masked study was conducted to compare the efficacy and safety of 2% dorzolamide with those of 0.5% betaxolol in the treatment of elevated intraocular pressure (IOP). A total of 311 adults with ocular hypertension or open-angle glaucoma were randomly allocated to receive either 2% dorzolamide administered topically TID or 0.5% betaxolol administered topically BID plus placebo administered topically QD for 12 weeks. After the washout of previous ocular hypotensive drugs, patients with IOP ≥23 mm Hg in at least one eye at 10 am or 4 pm on study day 1 were randomly allocated to receive one of the study treatments. Throughout the study, IOP was measured 2 and 8 hours after instillation of study medication for the morning peak effect (hour 2) and afternoon trough effect (hour 8). After 12 weeks of therapy, the mean change in IOP was not significantly different between the dorzolamide and betaxolol treatment groups at hour 8 (−3.6 mm Hg in both groups) or hour 2 (−5.4 vs −5.3 mm Hg, respectively). The differences between treatments (and 95% CIs associated with these differences) in mean IOP changes from baseline were 0.02 mm Hg (−0.870 to 0.901) for hour 8 and −0.14 mm Hg (−0.959 to 0.685) for hour 2. The ocular adverse experience (AE) most frequently reported by patients was ocular burning and/or stinging, and the most frequently reported nonocular AEs were taste perversion, upper respiratory infection, and headache. Only the incidence of taste perversion was significantly different between treatment groups (14.6% for the dorzolamide group and 0.0% for the betaxolol group). Two percent of patients in each treatment group discontinued the study due to AEs. This study confirmed the similar IOP-lowering effect of 2% dorzolamide and 0.5% betaxolol. Both treatments were generally well tolerated, and their safety profiles were similar.

Change in Optic Disk Topography After Trabeculectomy

To investigate the relationship between optic disk topography and intraocular pressure before and after trabeculectomy with confocal scanning laser ophthalmoscopy. The eyes of 49 consecutive patients undergoing trabeculectomy at a university-based glaucoma practice underwent preoperative and postoperative imaging using a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph). Three images of one eye of each patient were obtained with a 15-degree field of view. Preoperative images were obtained approximately 2 months before surgery (mean +/- SD, 2.4 +/- 1.6 months). Postoperative images were obtained at least 3 months after surgery (mean, 4.5 +/- 2.6 months). Mean preoperative intraocular pressure, postoperative intraocular pressure, and percent change in intraocular pressure respectively were 23.1 +/- 6.8 mm Hg, 12.7 +/- 7.1 mm Hg, and 43.8% +/- 29.9%. A significant association (P < .01) was found between percent decrease in intraocular pressure and decreases in cup area, cup volume, and cup/disk area ratio as well as between percent decrease in intraocular pressure and increases in rim area, rim volume, mean height contour, retinal cross-section area, and height in contour. Between 11.7% and 31.2% of the variability (R2) in these parameters was explained by the percent change in intraocular pressure. Topography changes were more strongly associated with percent change than with mean change in intraocular pressure. We found no association between percent decrease in intraocular pressure and reference plane height or maximum cup depth. Changes in optic nerve topography were associated with reduction in intraocular pressure after trabeculectomy.

Comparison of the effect of four viscoelastic agents on early postoperative intraocular pressure

Purpose: To compare the effect of four commercially available viscoelastic agents on postoperative intraocular pressure (IOP).Setting: Four outpatient sites.Methods: Sixty-nine patients having routine extracapsular cataract extraction were enrolled in the study; 54 were available for a 3 month follow-up examination. The four viscoelastic agents were Amvisc®, Amvisc® Plus, Healon®, and Viscoat®. Intraccular pressure was measured preoperatively and at 2, 3, 4, 5, 6, 8, 10, 12, and 24 hours and 3 months postoperatively. Pachymetry and endothelial cell counts were performed preoperatively and 3 months postoperatively.Results: Mean postoperative IOP and IOP changes from baseline did not differ among the four treatment groups at any time. However, when mean maximal IOP was compared, the Healon group demonstrated the highest IOP increases (P = .0033). There was also a significant difference (P = .0015) among treatment groups in the mean maximum postoperative change from baseline; the Healon group exhibited the largest mean change in IOP. At 3 months postoperatively, IOP values and pachymetry were normal for all treatment groups and were not statistically different among groups, indicating the four agents provided a similar degree of endothelial protection and IOP stability.Conclusion: These results suggest that IOP increases occur in varying degrees and at varying times in the early postoperative period after cataract surgery using a viscoelastic agent.

A Comparison of the Ocular Hypotensive Efficacy of Twice-Daily 0.25% Levobunolol to 0.5% Timolol in Patients Previously Treated with 0.5% Timolol

Treatment with noncardioselective beta-adrenoceptor antagonists (e.g., 0.5% timolol or 0.5% levobunolol) is standard practice for lowering elevated intraocular pressure (IOP). However, because there are risks and side effects associated with the use of these agents, a lower, yet still effective, dose may be preferred. We gave 0.5% timolol twice daily for 30 days to 143 patients. In a double-masked, randomized fashion, we then assigned patients to continue to receive 0.5% timolol twice daily or 0.25% levobunolol twice daily for 8 weeks. The mean unmedicated baseline IOP for both groups was approximately 25 mm Hg. After 30 days of timolol pretreatment, the mean IOP in both groups decreased to approximately 19 mm Hg (p = 0.210). After the 30-day timolol pretreatment period, and subsequent randomization to either 0.5% timolol or 0.25% levobunolol treatment, there was little change in overall mean IOP (0.03 mm Hg decrease for levobunolol, 0.06 mm Hg increase for timolol; p = 0.811) from the timolol pretreatment baseline. One patient assigned to the timolol treatment group was terminated from the study due to inadequate control of IOP. We conclude that the mean IOP lowering effect of 0.25% levobunolol is equivalent to 0.5% timolol, and switching patients from twice-daily 0.5% timolol to twice-daily 0.25% levobunolol poses no significant risk of decreased ocular hypotensive efficacy.

The Effect of Caffeine on Intraocuular Pressure in Glaucoma Patents

The authors investigated the effect of drinking regular coffee on intraocular pressure (IOP) using a single-masked randomized crossover study comparing coffee and herbal tea in 13 glaucoma patients. Intraocular pressure and blood pressure were monitored before ingestion of coffee or tea and at 30, 60, and 90 minutes after ingestion. The mean (± standard error of measurement) change in IOP 30, 60, and 90 minutes after ingestion for the coffee drinkers was 0.96 ± 0.4, 1.38 ± 0.53, and 1.04 ± 0.37 mmHg, respectively. The mean change in IOP for the tea drinkers 30, 60, and 90 minutes after ingestion was 0.85 ± 0.41, 0.23 ± 0.36, and −0.42 ± 0.44 mmHg, respectively. There was a statistically significant difference in the change in IOP at 90 minutes when comparing coffee to tea (P = 0.003) and no significant difference for 30 and 60 minutes. Although there was a statistically significant difference in IOP at 90 minutes between coffee and tea drinkers, the change was not clinically significant.

Anterior Chamber Tube Shunt to an Encircling Band in the Treatment of Neovascular Glaucoma

A new procedure for neovascular glaucoma that has reduced intraocular pressure (IOP) significantly and has caused relatively few postoperative complications is introduced. Aqueous is shunted to the reservoir of an encircling no. 20 silicone band from which fluid is postulated to diffuse into the orbit. The anterior chamber tube shunt to an encircling band (ACTSEB) procedure was conducted in 19 eyes with neovascular glaucoma. After surgery 18 of the 19 eyes (95%) followed for periods ranging between five and 26 months (mean: 59 weeks) had controlled IOP using ≤20 mm Hg as normal, and one eye had partial control (eye 9) at 26 mm Hg. Despite the preoperative use of atropine sulfate, timolol maleate, acetazolamide, and 20% mannitol, the patients’ average preoperative IOP was 54.1 mm Hg. After surgery the average IOP fell, dramatically, to 16.2 mm Hg. The mean change in IOP was 37.9 ± 9.8 (SD). This change is statistically significant by the paired t-test, P < 0.01. Minimal postoperative medications were required for pressure control. Postoperative complications included hyphema (21%), prolonged flat chamber (74%), localized peripheral lens opacity (5%), localized corneal opacity (5%), and possible acceleration of progressive cataract formation (25%). Results of current surgical procedures used to manage neovascular glaucoma are compared to the ACTSEB results.