Glaucoma Eye Drops Research Articles

Efficacy of ripasudil in reducing intraocular pressure and medication score for ocular hypertension with inflammation and corticosteroid.

To investigate the efficacy of ripasudil, a Rho kinase inhibitor, in reducing intraocular pressure (IOP) and medication scores of anti-glaucoma drugs in patients with ocular hypertension with inflammation and corticosteroid. The study included 11 patients diagnosed with ocular hypertension with inflammation and corticosteroid, all of whom were prescribed ripasudil eye drops and followed up for at least 2y after the initiation of treatment. IOP was measured using a non-contact tonometer before enrollment and at each follow-up visit. The medication score of glaucoma eye drops was calculated for each patient. The mean IOP (26.4±2.9 mm Hg before treatment) significantly decreased after ripasudil therapy (13.7±3.3 mm Hg at 3mo) and remained stable in the low-teens during the 2-year follow-up period (P<0.0001). A significant decrease in the medication score was observed at 12mo or later after the initiation of ripasudil therapy (P<0.05). Both baseline medication scores and glaucomatous optic disc change rates were significantly higher in the five eyes that required glaucoma surgery during the 2-year observation period than the 10 eyes that did not require surgery. Our results demonstrate the efficacy of ripasudil, in reducing IOP and the medication score over a 2-year treatment period in patients with ocular hypertension with inflammation and corticosteroid. Our findings also suggest that ripasudil could reduce the IOP in uveitic glaucoma patients with both lower baseline medication score and lower glaucomatous optic disc change rate.

Risks of Topical Carbonic Anhydrase Inhibitors in Glaucoma Patients With Chronic Kidney Disease: A Nationwide Population-Based Study

To investigate the risks of metabolic acidosis and renal outcomes after topical carbonic anhydrase inhibitor (CAI) use in patients with both primary open-angle glaucoma (POAG) and advanced chronic kidney disease (CKD). Nationwide, population-based cohort study. This study was conducted with population data from Taiwan's National Health Insurance (NHI) Research Database between January 2000 and June 2009. Patients with advanced CKD who were diagnosed with glaucoma (International Classification of Diseases, Ninth Revision [ICD-9] code 365) and had been receiving eye drops for glaucoma (including carbonic anhydrase inhibitors selected by NHI drug code) were enrolled. Using Kaplan-Meier methods, we compared the cumulative incidence of mortality, long-term dialysis, and cumulative incidence of metabolic acidosis over time between CAI users and CAI non-users. Primary outcomes comprised mortality, renal outcome (progression to hemodialysis), and metabolic acidosis. In this cohort, topical CAI users had a higher incidence of long-term dialysis than non-users (incidence=1,216.85 vs 764.17 events per 100 patient-years; adjusted hazard ratio=1.17, 95% CI=1.01-1.37). Hospital admissions due to metabolic acidosis were higher in CAI users compared with non-users (incidence=21.54 vs 11.87 events per 100 patient-years; adjusted hazard ratio=1.89, 95% CI=1.07-3.36). Topical CAIs may be associated with higher risks of long-term dialysis and metabolic acidosis in patients with POAG and pre-dialysis advanced CKD. Therefore, topical CAIs should be used with caution in advanced CKD patients.

緑内障に対する眼圧下降治療の現状と限界

Currently, the only reliable treatment for glaucoma is intraocular pressure (IOP) -lowering therapy. Guidelines recommend setting a target IOP for each patient prior to starting treatment. Previous randomized controlled study results have shown that the lower the target IOP is set, the greater the suppression of glaucoma progression. In addition to lowering the mean clinical IOP, there also needs to be increased attention to IOP fluctuations, such as 24-hour and long-term IOP fluctuations. Although first-line drugs normally administered include prostanoid FP receptor agonists (FP agonists), EP2 receptor agonists (EP2 agonists), which do not lead to the periorbitopathy (PAP) associated with prostaglandin, are sometimes prescribed in Japan as first-line drugs. From an adherence viewpoint, the second-line drug is often changed to a fixed combination eye drop, with a fixed combination of an FP receptor agonist and a β-blocker. The IOP-lowering effects of glaucoma eye drops involve specific 24-hour variations that are dependent on the type of drug. While β-blockers have less nighttime IOP-lowering effects, FP agonists, the EP2 agonist, carbonic anhydrase inhibitors and ROCK inhibitors exhibit significant 24-h IOP-lowering effects. Unfortunately, even with multidrug therapy, the maximum 24-hour IOP tends to occur in the middle of the night. However, the use of selective laser trabeculoplasty and physiological outflow pathway reconstruction has been shown to not only reduce daytime IOP-lowering, but also nighttime IOP-lowering and 24-hour IOP fluctuations. In addition, trabeculectomy combined with mitomycin C has been shown to exhibit the greatest reduction in the preoperative mean IOP and 24-hour IOP fluctuation. Nevertheless, as the IOP is known to clinically increase postoperatively, multidrug therapy often needs to be restarted, thereby leading to increases in the 24-hour IOP fluctuations that will ultimately reduce the quality of the IOP-lowering effect.

Favorable effect of ripasudil use on surgical outcomes of microhook ab interno trabeculotomy.

We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that almost all types of glaucoma eye drop either enhance the drainage through the uveoscleral pathway or reduce aqueous humor production, we hypothesized that prolonged use of these medications might cause disuse atrophy of the conventional pathway. In contrast, ripasudil increases the conventional outflow and eventually shows a favorable outcome of µTLO. This study aimed to evaluate the effect of ripasudil use on µTLO outcomes. The medical charts of 218 patients who underwent µTLO were analyzed retrospectively. We compared the 1-year outcome between ripasudil users versus nonusers by using propensity score matching. We set the covariates as age, sex, glaucoma types, preoperative intraocular pressure (IOP), the mean deviation values of visual field tests, the presence or absence of concomitant cataract surgery, trabecular meshwork incision range, the presence or absence of any glaucoma medication except ripasudil and duration of glaucoma medical therapy. Success was defined as a postoperative IOP between 5 and 21mmHg, a ≥ 20% IOP reduction from baseline, and no additional glaucoma surgery at postoperative 1year. Fifty-seven patients each were allocated to the ripasudil users or nonusers. The 1-year success rates were 74% in ripasudil users and 51% in nonusers (p = 0.01). Kaplan‒Meier survival curves also showed that the ripasudil users had a higher survival distribution (p = 0.01). The patients who took ripasudil showed a favorable 1-year outcome of µTLO.

Preparation and Characterization of Instantly-soluble Solid Eye Drop for Glaucomatous Patients

For the treatment of glaucoma eye drops are chronically used. However, chronic use of preservatives in eye drops cause irritation problem and aff ects ocular tissues. The aim is to formulate an instant soluble solid eye drop to avoid using preservatives since solid dosage forms do not require preservation. Ocular mini-tablets of dorzolamide hydrochloride (DZ) and timolol maleate (TM) were prepared by direct compression using diff erent polymers and were evaluated for their physical properties. The release DZ and TM was compared to COSOPT eye drops. Formulation F2 mini-tablets (which contain DZ, TM, mannitol and microcrystalline cellulose MCC) were chosen as the optimum formula because they had uniform shape and minimum variation in weight 9.69 ± 0.55 mg. Thickness and diameter were 1.38 ± 1.28 and 3.01 ± 0.03 mm, respectively, within the acceptable limits. Hardness and friability were also within the permissable range which were 4.14 ± 0.22 kg/cm2 for hardness and 0.73% ± 0.05 for friability. The drug content for both DZ and TM were within the acceptable limits and the release had no signifi cant diff erence (p &gt; 0.05) compared to commercial eye drop and the mini-tablets dissolved completely with less than one minute. The FTIR and DSC revealed no interaction between the drugs and excipients used. Sterilization using gamma radiation was performed to test the animal’s mini-tablets. The radiation did not signifi cantly (p &gt; 0.05) alter any properties of F2 and no signs of irritation on the animal eye appeared. In conclusion, instant soluble solid eye drop in the form of mini-tablet was successfully prepared by direct compression method and caused no irritation when tested on animals

Ab interno trabeculotomy without/with cataract operation-An alternative treatment before or instead of trabeculectomy in patients with high intraocular pressure?

Trabeculotomy with the Kahook knife is anew ab interno minimally invasive glaucoma surgery (MIGS) procedure. The MIGS are usually performed in early to intermediate glaucoma eyes. In this retrospective study we analyzed the intraocular pressure (IOP) and topical glaucoma eye drop therapy (Meds) reduction achieved by the Kahook trabeculotomy (TO) without (n = 19) or with (n = 18) combined cataract operation (Cat-TO) as initial treatment before or to avoid filtering surgery. A total of 37eyes of 37patients were examined when IOP was > 21 mm Hg in at least 2examinations despite the maximum tolerable Meds applied. Cat-TO was performed in 18phakic eyes (primary open-angle glaucoma, POAG = 11, pseudoexfoliation glaucoma, PEX = 5, ocular hypertension, OHT = 2). In 19pseudophakic eyes (POAG = 12, PEX = 6, OHT = 1) an isolated TO was executed. Complete success (no Meds) and relative success (irrespective of Meds) for IOP ≤ 21 mm Hg, ≤ 18 mm Hg, ≤ 16 mm Hg were evaluated2, 6 and 12months postoperatively. The IOP was significantly reduced from preoperatively to 2months after Cat-TO as well as after TO (Cat-TO: 26.8 ± 5.9 mm Hg to 16.0 ± 2.9 mm Hg, p < 0.001; TO: IOD 28.2 ± 5.6 mm Hg to 16.3 ± 3.5 mm Hg, p < 0.001). Meds reduction after Cat-TO as well as after TO was not significant (Cat-TO: 2.1 ± 1.3 to 1.3 ± 1.3, p = 0.11; TO: Meds 2.7 ± 1.1 to 2.2 ± 1.3, p = 0.23); however, Meds reduction after6 and 12months was significantly greater in the Cat-TO group compared to the TO group (p = 0.02). The IOP and Meds did not change significantly from2 to 6months. After Cat-TO, qualified success after 12months for IOP ≤ 18 mm Hg was 61% (11/18) and for IOP ≤ 16 mm Hg 28% (5/18). After TO, qualified success after 12months for TO was 47% (9/19) for IOP ≤ 18 mm Hg and 26% (5/19) for IOP ≤ 16 mm Hg. The intervention was not sufficient for 7patients after TO and 2patients after Cat-TO (IOP two times > 21 mm Hg). The first year results show that TO as well as Cat-TO are effective minimally invasive interventions to delay or even avoid afiltrating operation. In case of Meds intolerance and target IOP ≤ 16 mm Hg Cat-TO is not sufficient.

One Year Results of the Preserflo MicroShunt Implantation for Refractory Glaucoma.

The Preserflo MicroShunt is an effective method to achieve a satisfying intraocular pressure (IOP) reduction in patients with complicated forms of glaucoma. To evaluate the efficacy and safety of the Preserflo MicroShunt with mitomycin C in patients with complicated glaucoma. This prospective interventional study included all patients that underwent Preserflo MicroShunt Implantation between April 2019 and January 2021 to treat severe and therapy refractory glaucoma. The patients either suffered from primary open angle glaucoma with already failed incisional glaucoma surgery or presented severe forms of secondary glaucoma (eg, after penetrating keratoplasty or globe penetrating injury). Primary endpoint was the IOP-lowering effect and the success rate after 12 months. Secondary endpoint was the occurrence of intraoperative or postoperative complications. Complete success was defined as reaching the target IOP (>6 mm Hg and <14 mm Hg) without additional IOP-lowering medication whereas qualified success was attained with the same IOP target regardless of the medication. A total of 40 eyes of 38 patients were enrolled. After 12 months 85.7% of the eyes achieved complete success with an average IOP of 10.5 ± 2.0 mm Hg, without the use of glaucoma eye drops. The average IOP reduction was 58.4% from baseline. In 5 cases (12.5%) failure occurred as revisional surgery was required. The Preserflo MicroShunt for refractory glaucoma cases achieved a high complete success rate without additional medication at 1 year. Revisional surgery was needed in some cases and long-term studies are needed.

Phacoemulsification with and without iStent: A Systematic Review and Meta-Analysis of Comparative Studies

Background: The iStent (Glaukos Corporation; Laguna Hills, CA, USA) is one of the minimally invasive glaucoma devices. It can be inserted at the time of phacoemulsification or as a stand-alone procedure to lower the intraocular pressure (IOP). Objective: Our aim was to conduct a systematic review and meta-analysis comparing the effect of iStent insertion at the time of phacoemulsification with phacoemulsification alone in patients with ocular hypertension or open-angle glaucoma. Methods: We searched EMBASE, MEDLINE (OVID and PubMed), CINAHL, and Cochrane Library for articles published between 2008 and June 2022 (PRISMA 2020 for the checklist). Studies comparing the IOP-lowering effect of iStent with phacoemulsification versus phacoemulsification alone were included. The endpoints were IOP reduction (IOPR) and the mean reduction in the number of glaucoma drops. A quality-effects model was used to compare both surgical groups. Results: Ten studies were included, reporting on 1,453 eyes. Eight hundred fifty three eyes had the combined iStent and phacoemulsification, and 600 eyes underwent phacoemulsification alone. IOPR was higher in the combined surgery at of 4.7 ± 2 mm Hg compared to 2.8 ± 1.9 mm Hg in phacoemulsification alone. A greater decrease in postoperative eye drops was noted in the combined group having a decrease of 1.2 ± 0.3 eye drops versus of 0.6 ± 0.6 drops in isolated phacoemulsification. The quality effect model showed an IOPR weighted mean difference (WMD) of 1.22 mm Hg (confidence interval [CI]: [–0.43, 2.87]; Q = 315.64; p < 0.01; I2 = 97%) and decreased eye drops WMD 0.42 drops (CI: [0.22, 0.62]; Q = 42.6; p < 0.01; I2 = 84%) between both surgical groups. Subgroup analysis shows that the new generation iStent may be more effective in reducing IOP. Conclusion: iStent has a synergetic effect with phacoemulsification. The reduction of IOP and glaucoma eye drops was higher when iStent is combined with phacoemulsification compared with isolated phacoemulsification.

The effect of preserved glaucoma eye drops exposure on glaucoma surgery prevalence and surgical failure in a French nationwide study between 2009 and 2017

AbstractPurpose: Preservatives induce trabecula toxicity and conjunctival fibrosis. This may negatively affect the management of glaucoma by inducing uncontrolled intraocular pressure or excessive healing after surgery.Methods: To evaluate the association between preserved glaucoma eye drops exposure and the occurrence of glaucoma surgery as well as surgical failure. A retrospective analysis of French National database was conducted between January 1st 2009 and December 31st 2017 and followed until December 31st 2018. Patients were categorized as 0% preservative exposure, 100% preservative exposure and mixed exposure. The occurrence of glaucoma surgery was the main outcome and surgical failure the secondary outcome.Results: A total of 664 494 patients (57% women; median age, 66 years [interquartile range, IQR, 18.0 years]) with first glaucoma eye drops claim were included. Among them, 8467 (1.3%) individuals had glaucoma surgery with a median delay of 2 years (IQR, 3.3 years). The occurrence of glaucoma surgery was respectively 1.8 times higher (hazard ratio [HR], 1.8 [95% CI, 1.73–1.97], p = &lt;0.001) for 100% preserved group, 2.7 times higher (HR, 2.7; [95% CI, 2.46–2.89]; p = &lt;0.001) for mixed exposure compared to 0% preservatives group. Among patients with glaucoma surgery, 2671 (31.5%) individuals had surgical failure with a median delay of 6 months (IQR, 14.0 months). The risk of surgical failure increased by 1.5‐fold for 100% preserved group and low mixed group (HR = 1.5; [95% CI, 1.1–2.1]; HR = 1.5; [95% CI, 1.0–2.1], respectively) and by 1.7‐fold for high mixed group (HR = 1.7; [95% CI, 1.2–2.5]), compared to 0% preservatives group.Conclusions: An increased risk of glaucoma surgery and its failure was observed in patients treated with preserved glaucoma eye drops. This suggests the interest to initiate glaucoma treatment with preservative‐free eye drops to decrease trabecular toxicity and conjunctival fibrosis.

Two-year clinical outcomes of triple therapy with photodynamic therapy, anti-vascular endothelial growth factor agent, and triamcinolone acetonide for neovascular age-related macular degeneration.

To analyze the 2-year treatment outcomes of triple therapy with standard-fluence photodynamic therapy (PDT), intravitreal injection of ranibizumab (IVR)/aflibercept (IVA), and sub-tenon injection of triamcinolone acetonide (STTA) for neovascular age-related macular degeneration (nAMD) in Japanese patients. A retrospective, clinical case-series study. Forty-four eyes of 44 patients with treatment-naïve nAMD followed for more than 24 months were evaluated. Initial treatment was given with triple therapy and retreatment with IVR/IVA as a pro re nata regimen. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), the number of treatments, and intraocular pressure elevation were analyzed. The mean age was 73.3 ± 10.0 years. The mean BCVA significantly improved from 0.61 ± 0.30 at baseline to 0.50 ± 0.46 at 24 months (p = 0.034). CRT significantly improved from 373 ± 162μm at baseline to 200 ± 107μm at 24 months (p < 0.001). The number of treatments given during the 2-year treatment period was 2.7 ± 1.8. No retreatments were necessary in 18 of 44 eyes (40.9%), with no significant difference between IVR (46.4%) or IVA (31.3%) used during the 2-year follow-up of triple therapy (p = 0.51). Four eyes (9.1%) temporarily required glaucoma eye drop treatments. In nAMD patients, induction treatment with triple therapy resulted in approximately 40% of the patients requiring no retreatment for 2 years. The type of anti-VEGF agents used made no difference in the results.

Clinical and diagnostic color-coding in ophthalmology - An indispensable educational tool for ophthalmologists.

Schematic diagrams have been important tools in Ophthalmology for ages. These are vital tools to document ocular pathologies, assist in the comparison of clinical records on follow-up visits, serve as standardized means of communication between ophthalmologists, educating trainees and postgraduates, and helping in the easy follow-up of disease course over a period. There are standardized color codes for depicting different pathologies in the anterior and posterior segments. The understanding of these guidelines allows proper documentation of findings and helps in standardizing ophthalmic care. This method of documentation is beneficial as this is a less expensive tool, provides immediate records at a glance, allows distinctive marking of clinical findings not possible to document with clinical photographs, and can help in medico-legal cases as well. This article focuses on highlighting the standard guidelines that will be useful for training ophthalmologists. This article primarily focuses on various color-codings for anterior and posterior segment schematic representations, along with a brief touch on the importance of color-coding in glaucoma and standardized eye drop (vials) color codes as per the American Academy of Ophthalmology guidelines. We believe this can be taken as a template for future reference by all trainees, postgraduates, fellows, and clinician ophthalmologists in their day-to-day clinical practice.

PreserFlo™ MicroShunt Versus Trabeculectomy in Patients With Moderate to Advanced Open-Angle Glaucoma: 12-Month Follow-Up of a Single-Center Prospective Study.

Purpose: The study compares the efficacy and safety of PreserFlo™ MicroShunt (Santen, Osaka, Japan) and trabeculectomy in eyes with moderate to advanced open-angle glaucoma.Methods: In this prospective study, 300 patients (300 eyes) with moderate to advanced open-angle glaucoma were treated with either PreserFlo MicroShunt or trabeculectomy. The implantation of the PreserFlo MicroShunt was performed in 150 eyes (group A) and trabeculectomy was performed in 150 eyes (group B). The efficacy was evaluated by estimating the absolute and qualified success rates using the Kaplan-Meier survival analysis. Results: During the 12-month follow-up period, 81.33% of eyes in group A and 94% in group B reduced intraocular pressure (IOP) >20% without glaucoma eye drops. The average IOP 12 months after surgery was 12.89±3.4 mmHg in group A and 11.39±4.5 mmHg in group B, which was significantly lower than the baseline intraocular pressure (group A: 23.47±8.36 mmHg, p=0.00053; group B: 22.03±5.2 mmHg, p= 0.0006). The number of topical medications administered 12 months after ocular surgery was 0.4±0.8 in group A and 0 in group B, compared to 2.5±1.2 in group A and 2.7±0.9 in group B at baseline (group A: p= 0.00091; group B: p= 0.00072). Ten eyes (6.67%) in group A and four eyes (2.67%) in group B were referred for bleb revision due to bleb fibrosis and consequent acute postoperative rise in IOP. Four eyes of group A and two eyes of group B were treated with transscleral cyclophotocoagulation. Five eyes in group B received re-trabeculectomy because of dysfunction of the primary bleb.Conclusion: PreserFlo MicroShunt reduced the number of antiglaucoma agents compared to baseline, but was inferior to trabeculectomy at reducing IOP after 12 months. Additionally, trabeculectomy produced better absolute success rates after 12 months than PreserFlo MicroShunt in the treatment of moderate to advanced open-angle glaucoma.

Latanoprostene Bunod 0.024% in the Treatment of Open-Angle Glaucoma and Ocular Hypertension: A Meta-Analysis.

Latanoprostene bunod (LBN) 0.024%, a newly approved glaucoma eye drop, is metabolized into latanoprost acid and a nitric oxide (NO)-donating moiety, thus increasing the outflow of aqueous humor through the uveoscleral and trabecular routes, respectively. This study aimed to evaluate the intraocular pressure (IOP)-lowering effect of LBN among patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). The effectiveness of LBN was also compared with timolol maleate 0.5% and latanoprost 0.005%. We searched PubMed and Embase between 1 January 2010, and 31 March 2022 and adopted only peer-reviewed clinical studies in our meta-analysis. A total of nine studies (2389 patients with OAG or OHT) assessing the IOP-reduction effect of LBN were included. Standardized mean differences (SMDs) of IOP between post-treatment time points (2 weeks, 6 weeks, 3 months, 6 months, 9 months, and 12 months) and baseline were calculated. The pooled analysis according to each time point revealed a significant IOP drop after LBN treatment (all p values for SMD < 0.05). In addition, LBN revealed a significantly stronger efficacy in decreasing IOP than timolol maleate 0.5% and latanoprost 0.005% during the follow-up period of three months. No serious side effects of LBN 0.024% were reported. Our study concluded that LBN could achieve good performance for IOP reduction in patients with OAG and OHT. The safety was favorable with no severe side effects.

One-year outcomes and predictable factors for microhook ab interno trabeculotomy.

To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy (µLOT). The medical records of consecutive patients with open angle glaucoma who underwent µLOT (including combination of µLOT and cataract surgery) between February 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure (IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using Kaplan-Meier survival analysis. A multivariate Cox proportional-hazards regression model was used to investigate the factors associated with surgical failure. The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma (POAG) and 31 with secondary open angle glaucoma (SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg (P<0.01) and 2.1±1.8 (P<0.01), respectively, 12mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes (80.0% vs 48.0%; P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio (aHR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike (IOP>25 mm Hg within 2wk post-surgery; P<0.001, aHR: 5.382, 95%CI: 2.113-13.707) as independent factors associated with surgical failure. The µLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.

Topical ophthalmic beta‐blockers are associated with ocular pseudopemphigoid: A pharmacovigilance study of antiglaucoma medications utilising the FDA adverse event reporting system

ABSTRACTBackground/objectiveThe association between antiglaucoma medications and the development of ocular pseudopemphigoid (OPP) has been described; however, the independent risk of each medication has not been quantified.MethodsCase/non‐case analyses were performed in the FDA Adverse Events Reporting System (FAERS) using data from 2010–2020 to examine the reporting odds ratio (ROR) signal for OPP for all classes of antiglaucoma medications under multiple conditions: (i) comparison to all other drugs in FAERs, (ii) comparison to other antiglaucoma medications, (iii) comparison to vehicle/hydrating eye drops with cases of OPP and (iv) comparison to vehicle/hydrating eyedrops with and without cases of OPP to control for topical irritant and preservative effects.ResultsA statistically significant ROR for OPP was found for aggregate antiglaucoma medications under the first condition but not the third or fourth (i.96.97 (95% CI 52.54–178.98). The largest signal for OPP when compared to other glaucoma drugs and eye drops was seen with unoprostone (ii.68.96 (95% CI 8.35–569.50, iii.39.85 (95% CI 4.14–383.33), iv.581.67 (95% CI 49.38–6851.57) followed by carteolol (ii.32.51(95% CI 9.02–117.67), iii.10.67 (95% CI 1.77–64.13), iv.77.84 (95% CI 12.95–467.78) and betaxolol (ii.23.38 (95% CI 7.28–74.46), iii.6.94 (95% CI 1.27–38.01), iv.50.67 (95% CI 9.26–277.25). A statistically significant ROR was noted only for the beta‐blockers class aggregate under conditions ii and iv.ConclusionsOur findings support an association between OPP and antiglaucoma medications; under the most stringent control for topical irritant/preservative effect by of comparison to topical eye drops, unoprostone, carteolol, betaxolol and timolol all had a significant ROR for OPP.

Surgical Outcomes of the Ahmed Valve Implantation Following Trans-scleral Cyclophotocoagulation

Purpose: To determine the intraocular pressure (IOP) lowering effect and complications of Ahmed valve implantation (AGV) in patients who underwent cyclophotocoagulation (CPC).Methods: Patients who underwent AGV after CPC in group 1, those who underwent CPC after AGV in group 2, and patients who underwent repeated CPC in group 3 were included in this retrospective observational study. Changes in IOP, number of glaucoma eye drops, and best corrected visual acuity (BCVA) were analyzed before and 1 week, 1 month, 3 months, 6 months, and 12 months after surgery, and postoperative complications were analyzed.Results: Eight patients in group 1, 10 patients in group 2, and seven patients in group 3 were included in the analysis. Preoperative IOP was 45.6 ± 15.5, 29.3 ± 5.6, and 43.4 ± 14.4 mmHg in the three groups, respectively, and the number of glaucoma eye drops was 3.8 ± 0.7, 3.9 ± 0.3, and 3.7 ± 1.0 in the three groups, respectively. At 12 months postoperatively, IOP decreased significantly in all three groups compared to preoperatively (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05), and the number of glaucoma eye drops was also significantly reduced (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Among patients with preoperative BCVA of 0.02 decimal or higher, postoperative BCVA decreased in two patients in group 2 and one in group 3 (&lt;i&gt;p&lt;/i&gt; = 0.380). Hypotony occurred in one patient in group 1 and two patients in group 3 (&lt;i&gt;p&lt;/i&gt; = 0.383), and among them, one patient in group 1 and one patient in group 3 progressed to the phthisis (&lt;i&gt;p&lt;/i&gt; = 0.940).Conclusions: In patients whose IOP cannot be controlled after CPC, AGV is expected to be used as a relatively safe and effective treatment method for lowering IOP.

Dry Eyes and Glaucoma: A Report of Sixty Eyes

Introduction: Glaucoma is an optic neuropathy defined by optic disc cupping, characteristic visual field defects, and often an increase in intraocular pressure. It remains a leading cause of irreversible blindness, with an estimated 60.5 million people affected worldwide. It is a chronic disease that frequently requires long-term treatment with topical ocular hypotensive eyedrops. The use of antiglaucoma medications has been associated with dry eye. Another reason for the correlation between glaucoma and dry eyes, is that prevalence for both increases with age. Patients and methods: Sixty eyes of 30 patients with medically treated primary open-angle glaucoma (POAG) were included in this study. Dry eye syndrome was searched with Schirmer test (less than 10 mm in 5 minutes) and tear break-up time (BUT: less than 10 seconds). Results: Forty-eight eyes medically treated primary open-angle glaucoma (80%) present dry eye syndrome, this is consistent with previously published literature. All the POAG patients with dry eyes, were medically treated with preserved glaucoma eye drop. They were compliant to their treatment, thinking their vision is blurry because their glaucoma is getting worse and they’re dealing with what they think is irreversible. After solving the dry eye syndrome, we effect a control of the Visual Field test, we can say that dry eye’s treatment can significantly improve reliability and visual field index of glaucoma patients undergoing visual field examination. Conclusion: this study shows that dry eye syndrome associated with glaucoma might lead to ocular discomfort and low-quality retinal images which can decreased compliance of treatment, and deteriorate the Visual field test results. Protecting the integrity of the ocular surface while treating ocular conditions like glaucoma is necessary.

Short Tear Breakup Time Could Exacerbate the Progression of Presbyopia in Women.

Purpose The contributory factors and symptoms for presbyopia progression have not been fully determined. The purpose of the study was to compare presbyopia progression in subjects with short and normal tear breakup time and to explore the severity of common ocular symptoms associated with presbyopia progression. Method We conducted a clinic-based, retrospective, cross-sectional study. Inclusion criteria were bilateral phakic patients aged 40–69 years with best-corrected distance visual acuity better than 20/30, and exclusion criteria were the use of glaucoma eye drops, any disease affecting vision, or history of ocular surgery. We measured the binocular near add power and compared the results using Kaplan-Meier analysis. Association between near add power and ocular symptoms was explored. Results There were 1411 participants (mean age of 50.1 years). There were no significant differences in age, intraocular pressure, spherical equivalent, astigmatism, or anisometropia between the sexes. Kaplan-Meier analysis indicated that women with short tear breakup time reached the endpoint (near add power of +3.00 D) significantly earlier than those with normal tear breakup time (P = 0.043; Cox-Mantel test). Eye fatigue was most severe in the group with an add power of 1.25-2.00 D. Near add power was correlated with hyperopia, astigmatic errors, and anisometropia. Conclusions This study suggests an exacerbation of presbyopia progression in women with short tear breakup time. Eye fatigue was most severe in those with an add power of 1.25-2.00 D.

Reducing omission of eye drops during hospital admission.

Chronic ophthalmic conditions, such as glaucoma and dry eye disease, are frequently encountered debilitating eye conditions that can lead to substantial reduction in vision and quality of life. However, there is ongoing evidence to suggest that topical ophthalmic therapy is inappropriately omitted on admission to hospital. The primary aim of this audit was to investigate the trust adherence to the National Institute for Health and Care Excellence guideline on the prescribing standard of eye drops during hospital admission. The secondary aim was to raise awareness and ensure successful compliance with national standards to reduce unintentional omission of eye drops on admission and subsequent complications. Electronic medical records of all medical and surgical adult inpatients were studied prospectively on two different occasions. The quality of documentation of eye drops in clerking notes, the length of time taken between the admission and prescription of eye drops, and the accuracy of the prescription were examined. Following the initial audit, interventions focusing on clinician education were implemented. This includes highlighting the importance of eye drops in all departmental mandatory introductory sessions and putting up posters on all the wards as prompts. The same data collection method was used in the reaudit. In the initial audit, 64 (mean age 81.8±8.9 years) patients with regular prescriptions for eye drops were identified; 38 (59.4%) patients had eye drops for dry eye disease only, 20 (31.3%) patients had eye drops for glaucoma only, and six (9.4%) patients had eye drops for both. In the reaudit, 57 (mean age 76.7±15.3 years) patients were identified; 42 (73.7%) patients had eye drops for dry eye disease only, 10 (17.5%) patients had eye drops for glaucoma only, and five (8.8%) patients had eye drops for both. Following the intervention, there was a significant improvement in documentation of ocular diagnosis and eye drops on clerking notes from 41% to 65% (P=0.008), and eye drop reconciliation within 24 hours of admission improved from 45% to 75% (P=0.0008). All patients (100%) received the correct eye drop prescription before and after the intervention. Education is effective in promoting adherence to national guidelines and reducing the incidence of inappropriate omission of eye drops on admission to hospital.

Severe Intraocular Pressure Fluctuation following Hemodialysis after Cataract Surgery in a Patient with Chronic Renal Failure

Purpose: To report a case of severe intraocular pressure fluctuation following hemodialysis after cataract surgery in a patient with chronic renal failure.Case summary: A 51-year-old female patient on hemodialysis for chronic renal failure, who was seen regularly by our retina clinic for proliferative diabetic retinopathy and right eye cataract, presented with decreased visual acuity in her right eye. During phacoemulsification under the diagnosis of right eye cataract, zonular dialysis and posterior capsule rupture occurred and intraocular lens ciliary sulcus insertion was performed. Following hemodialysis 3 days after the surgery, the patient complained of headache and right eye pain. The intraocular pressure of the right eye had increased to 44 mmHg. Mild inflammation in the anterior chamber was found with remnant lens material present at the inferior anterior angle. The use of glaucoma eye drops, anterior chamber paracentesis, and anterior chamber irrigation reduced the intraocular pressure and improved the patient’s symptoms. However, a severe increase in intraocular pressure recurred with the above symptoms, again following hemodialysis. Intraocular pressure fluctuation was repetitively present after serial hemodialysis treatments for 1 month, at which point cataract and glaucoma surgeries were considered. However, the intraocular pressure stabilized afterwards; thus, the patient remained under observation and was treated with glaucoma eye drops.Conclusions: Inflammation and a decrease in the aqueous outflow facility due to remnant lens material and the use of an ophthalmic viscoelastic device in cataract surgery may cause severe intraocular pressure fluctuations in patients undergoing hemodialysis for chronic renal failure.