Hypotensive Medications Research Articles

Intraocular Pressure and Medication Burden With Cataract Surgery Alone, or Cataract Surgery Combined With Trabecular Bypass or Goniotomy.

When compared with cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of intraocular pressure (IOP) spikes, a modest effect on IOP, and a minimal effect on medication burden. To compare changes in IOP and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy). We included 138 eyes diagnosed with open-angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21 mm Hg and 10 mm Hg higher than preoperative on postoperative day 1. All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared with their own preoperative baselines. When compared with cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of ~70% for IOP spikes (P≤0.001 for both). Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared with cataract surgery alone in glaucoma patients.

Surgical Management of Intraocular Pressure With Ab Interno Canaloplasty in Postkeratoplasty Patients: 12-Month Results.

The purpose of this study was to report clinical outcomes of ab interno canaloplasty (ABiC) with the iTrack microcatheter (Nova Eye Medical, Fremont, CA) for surgical management of intraocular pressure (IOP) in postkeratoplasty patients. This study was a single-center retrospective case series of postkeratoplasty eyes undergoing ABiC. Efficacy was evaluated based on graft survivability and mean reduction in IOP at 12 months postoperatively. Secondary end points consisted of visual acuity outcomes, number of topical hypotensive medications, and rate of complications. ABiC was successfully performed in 17 eyes after keratoplasty (8 penetrating keratoplasty, 6 DSAEK, 2 penetrating keratoplasty + DSAEK, and 1 DMEK) with elevated IOP refractory to topical hypotensive medications. The baseline mean IOP was 26.2 ± 8.4 mm Hg and reduced significantly to 15.0 ± 4.21 mm Hg at 6 months and 13.0 ± 2.99 mm Hg at 12 months ( P < 0.005). The best-corrected visual acuity improved from 0.61 ± 0.55 logMAR at baseline to 0.47 ± 0.59 and 0.49 ± 0.64 at 6 and 12 months, respectively, following ABiC (not statistically significant: P = 0.6769). The baseline mean number of topical hypotensive medications was 3.7 ± 1.8 and reduced to 2.7 ± 1.4 and 2.9 ± 1.3 at 6 and 12 months, respectively ( P = 0.096). One patient developed a hyphema which required anterior chamber washout. One patient required additional glaucoma surgery 19 months after ABiC. No patients experienced graft failure. ABiC is a clinically safe and effective treatment that can be performed in postkeratoplasty patients to reduce IOP for at least 1 year without any significant complications.

Impact of Primary Needling on the XEN Implant Clinical Outcomes: A Real-Life Retrospective Study.

PurposeTo assess the effectiveness and safety of primary-needling in eyes who underwent a XEN45 implant.MethodsRetrospective and single center study. Consecutive patients with early-to-moderate open-angle glaucoma (OAG) or ocular hypertension, who underwent XEN45 surgery, either alone or combined with phacoemulsification, and had at least a valid 12-month post-operative visit, were included in the study. Primary needling was performed by using a 30-gauge needle without viscoelastic. Subjects were divided in two groups: Eyes who underwent XEN+primary-needling (needling) and those who underwent XEN without primary-needling (no-needling). The primary end-point was the mean change in IOP from baseline to the last follow-up visit.ResultsSixty-three eyes, 19 (30.2%) in the needling group and 44 (69.8%) in the no-needling one, were included in the study. There were not significant differences in mean IOP lowering between needling and no-needling groups at month-12 (mean difference −2.5±5.3 mm Hg, p=0.0926). No significant differences in mean reduction of ocular-hypotensive medications were observed between needling and no-needling groups, p=0.8690. At month-12, 50 (80.6%) had blebs considered as functioning, with no difference between groups, p = 0.5631. At month-12, 59 (93.7%) eyes were classified as success, with no significant differences between needling (17/19) and no-needling (42/44) groups, p=0.3754. Secondary needling was performed in 8 (12.7%) eyes, without differences between groups (p=0.6333).ConclusionPrimary needling, at the time of surgery, was a safe procedure in OAG patients who underwent a XEN implant, although it was not associated with a lower postoperative IOP or less ocular hypotensive medications.

Effect of Prior Phacoemulsification Surgery in Trabeculectomy Surgery Outcomes.

PurposeTo evaluate whether previous clear-cornea phacoemulsification surgery affects the surgical outcomes of trabeculectomy in open-angle glaucoma (OAG).MethodsWe performed a retrospective cohort study, which included 82 patients with OAG that underwent trabeculectomy between January 1, 2010, and December 31, 2017. The primary outcome was the probability of surgical failure. Failure was defined as IOP >21 mmHg or reduced <20% from baseline, IOP ≤5 mmHg in three consecutive visits, need for further glaucoma surgery, phthisis or loss of light perception vision due to glaucoma.ResultsEighty-two eyes (58 phakic and 24 pseudophakic) were included. Phakic group patients were younger than those in the pseudophakic group, 65.8 ± 11.7 vs 76.2 ± 7.9 years (p < 0.001). The most common type of glaucoma was primary OAG [59% (n = 34) phakic vs 63% (n = 15) pseudophakic], followed by exfoliative and pigmentary glaucomas. The mean preoperative IOP was not significantly different between groups nor was the number of preoperative hypotensive medications. The rate of surgical failure was not significantly different between groups at year 1 [17% (n = 10) phakic vs 29% (n = 7) pseudophakic; p = 0.361] nor at year 2 [28% (n = 16) phakic vs 46% (n = 11) pseudophakic; p = 0.110]. No significant differences were observed regarding the postoperative IOP or any secondary outcome measures at year 1 or 2.ConclusionPrevious clear-cornea phacoemulsification surgery does not lead to statistically significant differences in the rate of trabeculectomy failure. Despite not being significant, clinically relevant differences were observed between groups. Future studies with a larger sample and/or randomized are needed to clarify this association.

Cost Utility of Schlemm's Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System.

Hydrus microstent (HMS) implantation at the time of cataract surgery appears to be cost-effective in mild-to-moderate glaucoma. However, long-term follow-up is essential for a full assessment of device performance, safety and cost-effectiveness. The aim was to assess the societal cost-utility to the US Medicare system of implanting HMS with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma. Markov model cohort of patients with mild-to-moderate open-angle glaucoma and visually significant cataract. Patients received HMS during cataract surgery versus cataract surgery alone, in a deterministic model over a 2-year horizon using TreeAge software. Both arms received additional ocular hypotensive agents to control intraocular pressure. Treatment effect of HMS was measured as mean number of ocular hypotensive medications and intraocular pressure, which directly impacted transition probabilities. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. One-way sensitivity and probabilistic sensitivity analyses were conducted on device efficacy and longer time horizons. At 2 years, HMS with cataract surgery in mild glaucoma had an incremental cost-utility ratio of USD 38,346.43 per utility gained, compared with cataract surgery alone. Probabilistic sensitivity analysis was cost-effective in 61.4% of iterations for HMS+cataract surgery. The probability of side-effects with eye drops, utility decrement with side-effects, cost of the HMS and real-world efficacy rate had the greatest impact on model outcomes. HMS must be 85.60% as effective as published data to maintain cost-effectiveness at a willingness-to-pay threshold of USD 50,000. The incremental cost-utility ratio of HMS with cataract surgery in moderate glaucoma was USD 42,895.38. HMS implantation during cataract surgery appears to be cost-effective for patients with mild-to-moderate glaucoma. Nevertheless, more long-term safety and efficacy data are required.

Оцінка функціональних показників передньої поверхні ока та повік у разі первинної відкритокутової глаукоми

To conduct an analysis of the anterior surface of the eye in patients with the newly diagnosed primary open-angle glaucoma in order to choose treatment with or without preservative. We evaluated the front surface of the eye in 46 patients (92 eyes) diagnosed with primary open-angle glaucoma: 20 men and 26 women aged from 58 to 80 years. The anterior surface of the eye was examined using an analyzer of the anterior eye. The signs of previously diagnosed dry eye syndrome (DES) with various manifestations of dysfunction of meibomian glands and complaints about dry eyes, foreign body sensation, lacrymation and blurred vision were reported in 39 patients (85%). Based on the examination results, preservative-free topical hypotensive medications were recommended for these 39 patients. In order to preserve visual functions and quality of life in patients with newly diagnosed POAG, it is advisable to conduct a preliminary assessment of the condition of the anterior surface of the eye when prescribing drug therapy in order to rationalize the choice of first-line drugs with or without preservative in accordance with the European recommendations of Diagnosis and Treatment for glaucoma.

Bleb-Independent Glaucoma Surgery to Activate the Uveolymphatic Route of Non-Trabecular Aqueous Humor Outflow: Short-Term Clinical and OCT Results.

The deep sclerectomy technique was modified to enhance aqueous humor (AH) outflow via the non-trabecular pathway. A pilot study was carried out to assess its safety and effectiveness. Thirty-eight patients were under observation. After superficial scleral flap (4 × 4 mm), deep scleral layers were divided into three parts by three parallel-to-limbus incisions. Deep sclerectomy without creating a window in the Descemetes’ membrane was carried out in the distal part. A collagen implant was placed under the sclera of the remaining two parts with one end in the intrascleral pool. The third proximal part was excised to expose the uvea and implant. A Nd:YAG laser trabeculotomy at the surgery site was made on postoperative days 7–10. Outcome measures were IOP change, use of hypotensive medication(s), complications, and the need for a second surgery. At six months, the mean IOP decreased from 29.1 ± 9.2 mm Hg to 14.0 ± 4.3 mm Hg (p = 1.4 × 10−9); hypotensive medication use reduced from 2.9 ± 0.9 to 0.6 ± 1.0 (p = 1.3 × 10−10); complete success was achieved in 68.4% of cases and partial success was achieved in 31.6% of cases. Intraoperative and postoperative complications were rare and manageable. The OCT of the surgery site revealed the absence of bleb in all cases. Lymphatic vessels with characteristic bicuspid valves in their lumen were detected in conjunctiva near the operation site and over it in 32 patients. IOP decrease in the proposed technique was achieved by activation of the uveolymphatic route of AH outflow.

360° Ab-Interno Schlemm's Canal Viscodilation with OMNI Viscosurgical Systems for Open-Angle Glaucoma-Midterm Results.

Purpose: To evaluate the effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm’s canal (SC) performed with OMNI viscosurgical system in open angle glaucoma (OAG) together or not with phacoemulsification. Setting: Two surgical sites. Design: Retrospective, observational. Methods: Eighty eyes from 73 patients with mild to moderate OAG underwent ab- interno SC viscodilation performed with OMNI system. Fifty eyes (Group 1) underwent only SC viscodilation, while 30 eyes (Group 2) underwent glaucoma surgery + cataract extraction. Primary success endpoint at 12 months was an intraocular pressure (IOP) reduction higher than 25% from baseline with an absolute value of 18 mmHg or lower, either on the same number or fewer ocular hypotensive medications, without further interventions. Secondary effectiveness endpoints included mean IOP, number of medications and comparison of outcomes between groups. Safety endpoints consisted of best-corrected visual acuity (BCVA), adverse events (AEs), and subsequent surgical procedures. Results: Primary success was achieved in 40.0% and 67.9% in Groups 1 and 2, respectively. Mean IOP at 12-month follow-up showed a significant reduction in both groups (from 23.0 to 15.6 mmHg, p < 0.001, and from 21.5 to 14.1, p < 0.001, in Groups 1 and 2, respectively). Mean medication number decreased in both groups (from 3.0 to 2.0, p < 0.001 and from 3.4 to 1.9, p < 0.001, in Groups 1 and 2, respectively). AEs included hyphema (2 eyes), mild hypotony (4 eyes), IOP spikes one month after surgery (1 eye). Twelve eyes (15.0%) required subsequent surgical procedures. No BCVA reduction was observed. Conclusions: Viscodilation of SC using OMNI viscosurgical systems is safe and relatively effective in reducing IOP in adult patients with OAG.

Valve cyclodialysis with implantation of a non‐absorbable collagen implant in the cyclodialysis tunnel in surgical management of open‐angle glaucoma: long‐term results

AbstractPurposeTo assess long‐term efficacy and safety of valve cyclodialysis (VC) with implantation of a non‐absorbable collagen implant (NCI) in cyclodialysis tunnel (CT) in decreasing intraocular pressure (IOP) in open‐angle glaucoma patients.MethodsSixty‐one patients (25 male, 36 females; average age ‐ 73.4±8.8 years; 61 eyes) were included in this study. Surgical technique included dissection of a superficial scleral flap, creation of a scleral valve (2*1mm) out of deep scleral layers 4 mm away from limbus, creation of a CT (2*4mm) and implantation of a NCI in the CT. The scleral valve helped to minimize trauma to ciliary body while inserting NCI. Among other patients, 20 patients (32.8%) with failed filtering surgeries and 45 patients (73.8%) with cataract were included. Thirty‐three patients (54.1%) had advanced stage of glaucoma. Post‐operative follow‐up was up to 24 months. Outcome measures were: IOP change, reduction in hypotensive medication use, need for repeat surgery and intra‐ and postoperative complications. The data were processed by the method of variation statistics.ResultsBaseline mean IOP was 28.0±5.5 mmHg [95% confidence interval (CI) 24.8‐29.2]. At 18 and 24 months, mean IOP decreased to 19.2±1.8 mmHg (n=61, 95% CI 18.1‐19.0) and 18.9±1.8 mmHg (n=30, 95% CI 18.2‐19.5), making a decrease by 29.5±11.4% and 28.0±12.4% respectively. The hypotensive drugs use was reduced from 2.6±0.9 to 0.5±1.0 and 0.5±1.0 respectively. Repeat surgery was required in 2 cases at 18 months. Intraoperative hemorrhage while creating the CT was observed in 6 patients (9.8%). In the early postoperative period hyphema was prevalent in 1 patient, shallow AC – in 2 patients, hypotony – in 1 patient, and some exudative reaction in 3 patients. No complication was noticed in any of the cases in the late postoperative period.ConclusionsLong‐term results showed that VC with implantation of a NCI in the CT is an effective and safe surgical glaucoma procedure.

Long‐term result of combined ab externo Schlemm’s canal surgery and phacoemulsification in management of open angle glaucoma in cataract patients

AbstractPurposeTo evaluate the effectiveness of segmental Schlemm’s canal (SC) distension using Kumar’s Schlemm’s canal expander (SCE) in decreasing intraocular pressure (IOP) in cataract patients suffering from open angle glaucoma (OAG).MethodsBetween October, 2012 and March, 2020 in a prospective interventional case series study. SCE device, made from 0.04 mm thick medical grade stainless steel wire, having inner lumen diameter of 0.12 mm and outer – 0.2 mm, 4–5 mm long was implanted into SC ab externo after completion of cataract surgery of 59 patients (38 male and 21 female; average age – 75.47 ± 6.2 years) suffering from OAG. Outcome measures were IOP change, number of glaucoma medications pre‐ and postoperatively and complications. Success rates were evaluated using World Glaucoma Association guidelines. A paired t‐test was used for analysis. Results were significant when p less than 0.05.ResultsMean preoperative IOP was 28+/–4.7mmHg and mean number of medications – 2.4 ± 0.8. At 4 years mean IOP reduced by 27%+/–15.5% and was 20,4+/–4,9 (n=59; p=.0000006) use of medications reduced to 1 ± 1.2 (p = 0.0000001). Complete success was achieved in 24% (14/59) cases and partial – in 49% (29/59) respectively. Intraoperatively, microperforation occurred in 5 cases (8.5%). Postoperatively, 6 cases (10%) required YAG laser trabeculopuncture to control IOP. In these cases, one end of SCE was lying in anterior chamber angle without contact with intraocular structures. Postoperatively, specific complications related to SCE were rare. In one case the body of SCE ruptured TM because of extra pressure put on eye ball while inserting goniolens. Both ends of the expander were embedded in SC. Patient’s IOP was under control with one medication.ConclusionsCombined surgery phacoemulsification with intraocular lens implantation and SCE implantation in surgical management of OAG in cataract patients show significant reduction in IOP from the baseline and in hypotensive medication(s) use in long‐term period.

Effect of tobacco smoking on outcomes of trabeculectomy.

To evaluate the effect of tobacco smoking on trabeculectomy outcomes. Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.

Effectiveness of two trabecular micro bypass stents in open angle glaucoma

Micro-invasive glaucoma surgical implantation of trabecular micro- bypass stents, previously shown to be safe and effective for open-angle glaucoma (OAG) subjects during cataract surgery, was considered for evaluation as a sole procedure. Objectives:The aim of this study was to evaluate the safety and intraocular pressure (IOP)-lowering efficacy after ab interno implantation of two Glaukos Trabecular Micro-Bypass iStent inject second generation devices in subjects with OAG. Methods: 99 patients with OAG on at least two topical ocular hypotensive medications who required additional IOP lowering to control glaucoma disease underwent implantation of two GTS400 stents in a standalone procedure. Patients were qualified if they presented with preoperative mean IOP between 22 and 38 mmHg after medication washout. Postoperatively, subjects were assessed at Day 1, Months 1, 3, 6, 7, 9, and 12. IOP, medication use and safety were assessed at each visit. Results: Sixty-six percent of subjects achieved IOP B18 mmHg at 12 months without medication, and 81% of subjects achieved Month 12 IOP B 18 mmHg with either a single medication or no medication. Mean baseline washout IOP values decreased by 10.2 mmHg or 39.7% from 26.3 (SD 3.5) mmHg to 15.7 (SD 3.7) mmHg at Month 12. Mean IOP at 12 months was 14.7 (SD 3.1) mmHg in subjects not using ocular hypotensive medications. Reduction from preoperative medication burden was achieved in 86.9% of patients, including 15.2% with reduction of one medication and 71.7% with reduction of two or more medications. Postoperative complications occurred at a low rate and resolved without persistent effects. Conclusion: In this series, implantation of two trabecular micro-bypass second generation stents in subjects with OAG resulted in IOP and medication reduction and favorable safety outcome

Uticaj lokalnih antiglaukomatoznih lekova na redukciju pada senzitivnosti vidnog polja usled druza glave vidnog živca - prikaz slučaja

Optic nerve head drusen are congenital anomalies of the optic nerve, a form of calcium degeneration of axons of the optic nerve head. Initially asymptomatic, drusen may be one of the causes of progressive optic neuropathy. They are clinically presented as acellular, hyaline deposits of globular appearance in prelaminar segment of the optic nerve head. They occure due to: altered axonal transport, small diameter of scleral channel, compression and ischemia. Frequent complications include progressive visual field defects, ischemic optic neuropathy, central retinal artery or vein occlusion, or peripapillar neovascularization. Diagnostic tools: ophthalmoscopy, angiography, computerized perimetry, B-scan ultrasonography, CT, OCT, HRT, GDx, electrophysiological testing. The treatment is medicamentous, laser, or surgery. Most of the pilot studies confirms the benefit of topical hypotensive drugs even when the drusen are not associated with glaucoma. The decrease of intraocular pressure reduces compression of the optic nerve axons and improves reperfusion. This paper presents a young patient with bilateral optic nerve head drusen, progressive scotoma and topical hypotensive medication administered. After six months, scotoma and the loss of sensitivity were reduced. The effect of neuroprotective drugs is researched to reduce potential morbidity.

Особливості передньої поверхні ока у пацієнтів з уперше виявленою первинною відкритокутовою глаукомою

The aim. To conduct an analysis of the anterior surface of the eye in patients with the newly diagnosed primary open-angle glaucoma in order to choose treatment with or without preservative. Materials and methods. We evaluated the front surface of the eye in 46 patients (92 eyes) diagnosed with primary open-angle glaucoma: 20 men and 26 women aged from 58 to 80 years. The anterior surface of the eye was examined using an analyzer of the anterior eye. Results. The signs of previously diagnosed dry eye syndrome (DES) with various manifestations of dysfunction of meibomian glands and complaints about dry eyes, foreign body sensation, lacrimation and blurred vision were reported in 39 patients (85%). Based on the examination results, preservative-free topical hypotensive medications were recommended for these 39 patients. Conclusion. In order to preserve visual functions and quality of life in patients with newly diagnosed POAG, it is advisable to conduct a preliminary assessment of the condition of the anterior surface of the eye when prescribing drug therapy in order to rationalize the choice of first-line drugs with or without preservative in accordance with the European recommendations of Diagnosis and Treatment for glaucoma. Keywords: preservative-free medications, dry eye syndrome, primary open-angle glaucoma.

Порівняння гіпотензивного ефекту ендотрабекулоектомії та селективної лазерної трабекулопластики

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p &lt; 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p &lt; 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

Effectiveness of Netarsudil as an Additional Therapy for Glaucoma in Patients Already on Maximally Tolerated Medical Therapy.

PurposeThis study seeks to evaluate the effectiveness of netarsudil (Rhopressa) in patients with inadequately controlled IOP on otherwise maximally tolerated medical therapy.MethodsThis is a retrospective study of patients started on netarsudil at Stanford University. Exclusion criteria included glaucoma surgery or laser within 6 months of starting netarsudil and other modifications to the baseline medication regimen within 4 weeks of starting netarsudil. The primary outcome was treatment success, defined as IOP reduction meeting a predetermined target, and no further medication, laser, or surgery recommended subsequent to starting netarsudil.ResultsSixty-two eyes were included, and 36 (58%) achieved treatment success at first follow-up. Mean baseline IOP was 19.5 ± 5.6 mmHg on a mean of 3.5 ± 0.7 ocular hypotensive medications. The mean change in IOP from baseline to first follow-up was −3.53 mmHg (−17%). In patients who achieved treatment success, mean IOP change was −5.22 mmHg (−28.0%). Of the eyes with baseline IOP ≤ 20 mmHg, 69% achieved treatment success, compared to only 17% of eyes with baseline IOP ≥ 21 mmHg (P < 0.05).ConclusionNetarsudil is effective in lowering IOP for patients on otherwise maximally tolerated medical therapy, for which glaucoma laser or surgery would have been the only remaining therapeutic options. Treatment success was more likely in eyes with baseline IOP under 20 mmHg.

Ultrasound Cyclo Plasty for Treatment of Surgery-Naïve Open-Angle Glaucoma Patients: A Prospective, Multicenter, 2-Year Follow-Up Trial.

Background: The purpose of this prospective study was to evaluate the efficacy and safety of the Ultrasound Cyclo Plasty (UCP) procedure using high-intensity focused ultrasound in surgery-naïve open-angle glaucoma patients. Methods: prospective, non-randomized, single-arm, multicenter clinical trial. Sixty-six eyes with primary open-angle glaucoma, intraocular pressure (IOP) ≥21 mmHg and with no history of filtering surgery were enrolled. Patients were treated by UCP with a therapy probe comprising six piezoelectric transducers, consecutively activated for 8 s each. Complete ophthalmic examination was performed before the procedure, 1 day after the procedure, and 1, 3, 6, 12, 18 and 24 months after the procedure. Primary outcomes were complete success (defined as IOP lowering from baseline ≥20% without additional glaucoma medications) and vision-threatening complications. Secondary outcomes were the presence of complications and the reduction of the number of medications used. Results: IOP was significantly reduced after one procedure (p < 0.05), from a mean pre-operative value of 24.3 ± 2.9 mmHg (n = 2.3 hypotensive medications) to a mean value of 15.9 ± 3.6 mmHg (n = 2.2 hypotensive medications) at 2 years (mean IOP lowering of 33%). Surgical success was achieved in 74% of eyes. Notwithstanding side effects such as transient anterior chamber inflammation, refractive error changes, transient hypotony and macular edema, no major intra or post-operative complications such as phthisis, induced cataract, neovascularization or significant vision loss were observed. Conclusions: Ultrasound Cyclo Plasty is a valuable, effective and well-tolerated procedure to lower IOP in patients with open-angle glaucoma without previous filtering surgery.

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

PurposeEmerging evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic is disrupting health behaviors such as medication adherence. The objective of this study was to determine whether adherence to ocular hypotensive medication was affected by the pandemic and to identify factors associated with this change.DesignIn this cohort study, we used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day monitoring period, which evenly bracketed this declaration, started on October 16, 2019, and ended on August 10, 2020.ParticipantsPatients with primary open-angle glaucoma enrolled in an ongoing longitudinal National Institutes of Health-funded study initiated before the onset of the pandemic were selected if they were prescribed ocular hypotensive medication and had adherence data spanning the 300-day period.MethodsWe applied segmented regression analysis using a “slope change following a lag” impact model to obtain the adherence slopes in the periods before and after the segmentation. We compared the 2 slopes using the Davies test.Main Outcome MeasuresThe main outcome measure was daily adherence to ocular hypotensive medication, defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Adherence was measured objectively using Medication Event Monitoring System caps. We assessed the associations between change in adherence and demographic, clinical, and psychosocial factors.ResultsThe sample included 79 patients (mean age, 71 years [standard deviation, 8 years]). Segmented regression identified a breakpoint at day 28 after the declaration of the pandemic. The slope in the period after the breakpoint (–0.04%/day) was significantly different from zero (P < 0.001) and from the slope in the period before the breakpoint (0.006%/day; P < 0.001). Mean adherence in the period before the segmentation breakpoint was significantly worse in Black patients (median, IQR: 80.6%, 36.2%) compared with White patients (median, IQR: 97.2%, 8.7%; chi-square, 15.4; P = 0.0004). A significant positive association was observed between the Connor-Davidson resilience score and the change in slope between the periods before and after the breakpoint (P = 0.002).ConclusionsAdherence to ocular hypotensive medication worsened during the COVID-19 pandemic and seems to be related to patient resilience. This collateral consequence of the pandemic may translate into vision loss that may manifest beyond its containment.

Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Health Care System.

Précis:Modeling of visual field and pharmacy data (Kaiser Permanente, 2001 to 2014) from open-angle/pseudoexfoliation glaucoma patients in clinical practice indicated a significant inverse association between the level of medication adherence and rate of visual field progression.Purpose:The aim was to quantify the effect of nonadherence to topical hypotensive medication on glaucomatous visual field progression in clinical practice.Methods:Retrospective analysis of combined visual field and pharmacy data from Kaiser Permanente Southern California’s HealthConnect electronic health record database. Patients with a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma (2001 to 2011) and ≥3 subsequent visual field tests of the same Swedish Interactive Threshold Algorithm type were followed up from first medication fill to final visual field test. Medication adherence (proportion of days covered) was estimated from pharmacy refill data. A conditional growth model was used to estimate the effect of adherence level in modifying the progression of mean deviation over time after adjusting for potential confounders, including age, sex, race/ethnicity, baseline glaucoma severity, and comorbidity.Results:In total, 6343 eligible patients were included in the study and followed for (mean) 5.8 years; average treatment adherence during follow-up was 73%. After controlling for confounders and the interaction between time and baseline disease severity, the model indicated that mean deviation progression was significantly (P=0.006) reduced by 0.006 dB per year for each 10% (absolute) increase in adherence. Model estimates of time to glaucoma progression (mean deviation change −3 dB from baseline) were 8.3 and 9.3 years for patients with adherence levels of 20% and 80%, respectively.Conclusions:Improving patient adherence to topical glaucoma medication may result in slower deterioration in visual function over time.

Assessment of eye drop instillation techniques among patients with primary open angle glaucoma in a Nigerian tertiary hospital.

To assess the technique of eye drop instillation and its determinants among patients with primary open angle glaucoma (POAG) attending a Nigerian tertiary hospital. This study was a cross-sectional observational study conducted among 130 participants. Systematic sampling technique was used. Inclusion criteria were the presence of POAG, in individuals ≥ 18years, and self-instilling their ocular hypotensive medications for at least 6months. Demographic data and clinical characteristics were obtained using an interviewer-administered questionnaire and clinical examination. All participants underwent eye drop instillation of sterile water. Administration techniques were observed and graded using a comprehensive grading scheme. Patients with poor techniques were educated. Determinants of poor eye drop administration technique were also explored. One hundred and thirty patients with POAG were studied. The mean age was 57.13 ± 13.20years, and 63% percent of the participants had poor eye drop administration technique. On multivariate analysis, previous eye drop instillation education significantly influenced eye drop instillation technique (p = 0.02; OR = 3.230; 95% CI = 1.173-8.896). Among the participants, 47 (36%) touched the globe, 128 (98.5%) did not wash their hands, and 126 (97%) did not occlude the punctum. Sequel to the training, mean score of subjects improved from 2.8 ± 1.1 to 4.1 ± 1.3 (p value < 0.001). This study demonstrated that a high proportion of POAG patients had poor eye drop instillation technique despite long-term self-use of topical medication. Thus, this aspect of therapy deserves periodic scrutiny by the clinician.